A. Asindi

Malariometric Indices among Nigerian Children in a Rural Setting

Malaria contributes to high childhood morbidity and mortality in Nigeria. To determine its endemicity in a rural farming community in the south-south of Nigeria, the following malariometric indices, namely, malaria parasitaemia, spleen rates, and anaemia were evaluated in children aged 2–10 years. This was a descriptive cross-sectional survey among school-age children residing in a rubber plantation settlement. The children were selected from six primary schools using a multistaged stratified cluster sampling technique. They were all examined for pallor, enlarged spleen, or liver among other clinical parameters and had blood films for malaria parasites. Of the 461 children recruited, 329 (71.4%) had malaria parasites. The prevalence of malaria parasitaemia was slightly higher in the under fives than that of those ≥5 years, 76.2% and 70.3%, respectively. Splenic enlargement was present in 133 children (28.9%). The overall prevalence of anaemia was 35.7%. Anaemia was more common in the under-fives (48.8%) than in those ≥5 years (32.8%). The odds of anaemia in the under fives were significantly higher than the odds of those ≥5 years (OR = 1.95 [1.19–3.18]). Malaria is highly endemic in this farming community and calls for intensification of control interventions in the area with special attention to school-age children.

Stigma on Nigerian children living with epilepsy

The stigma on Nigerian children (aged 6–18 year) living with epilepsy attending the Pediatric Neurology Clinic in Calabar was studied. The survey was conducted between September 2010 and February 2011 on children having established epilepsy and was attending the Neurology Clinic of the University of Calabar Teaching Hospital, Calabar. A questionnaire with open-ended responses was drawn up and administered on the epileptic children. Information was collected from the children privately in the absence of the parents. The children were interviewed by the authors and the data recorded into the form by the latter. Forty percent of the children reported being regarded as demon-possessed, some were said to be mad and suffering under a family curse. Sixty percent of the children claimed being made objects of ridicule. Fifty percent of the children would wish to withdraw from school while 46% would change school because of embarrassment. Fifty-six percent knew that friends and schoolmates usually run away from them during attacks, 29.4% claim their teachers will not help but only watch them while fitting at school. Twenty-four percent of the victims, all in the age bracket 12–18 yrs, expressed suicide wish. Stigma associated with epilepsy is a problem of children in Calabar. Education of parents and the entire populace is advocated as this could change the societys misconception of epilepsy.

Nigerian secondary school teachers' knowledge and attitudes towards schoolchildren with epilepsy

A cross sectional study was undertaken to assess the knowledge and attitudes of secondary education teachers towards schoolchildren with epilepsy. Questionnaires were administered to three randomly selected schools and systematic random sampling method applied to select teachers in these schools. Their demographic characteristics and responses to the questions were analyzed. Out of the 105 teachers that returned completed forms, majority (97) were university graduates. Sixty-nine (65.7%) are aware that epilepsy may be caused by brain infection, 14 (13.3%) thought it is due to head trauma, while eight (7.6%) associates epilepsy with evil spirits; three (2.9%) thought that epilepsy follows a family curse and 11 (10.5%) were not sure of the cause. Concerning treatment, 89 (84.8%) believed the disease is curable but only 52.4% recommended orthodox treatment. Eighty-seven (82.9%) of the respondents will assist a convulsing child while 18 (17.1%) would either run away or not touch a convulsing child. Forty-nine (46.7%) of the teachers believed that epilepsy is contagious. There is a statistically significant relationship between the teachers who believed epilepsy is contagious and the action taken when a child is convulsing (χ 2 = 21.06, P = 0.00). Sixty (57.1%) of teachers thought that children with epilepsy are intellectually deficient, nevertheless, only 37.1% recommended special schools for children with epilepsy and another 11.4% suggested total exclusion of the children from school. There is relative lack of knowledge on epilepsy leading to misconceptions and stigmatization. These teachers can hand on same misconceptions to their pupils and by extension the entire community. We therefore, recommend an elaborate educational campaign on epilepsy by health professionals.

Hematological indices in febrile neonates with malaria parasitaemia in Calabar

Background: Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis. Aim: To determine the hematological indices in febrile newborn with malaria parasitemia. Materials and Methods: One-hundred fifty neonates (0-28 days) with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14. Results: One-hundred fifty babies were recruited into the study. Most (85.3%) of the babies were aged ≤7 days. Six babies (4%) had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl) even when parasite count was low (average of 30.6/µl) though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization. Conclusion: Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.

Cranial nerve palsies in Nigerian children

Background : Cranial nerve palsies are common clinical problem routinely encountered in neurological practice; the dysfunction can occur at any point in the course of the nerve and may point to serious pathology. The aim of this study was to determine the pattern and underlying aetiology of cranial nerve palsies in Nigerian children. Method: Children in the Children’s Emergency Unit and the Children’s Ward of the University of Calabar Teaching Hospital, Calabar, Nigeria, with neurological problems over a 12-month period (January through December 2012), were recruited into the study. Each child was admitted and evaluated by the Paediatric Neurology Unit. Those with cranial nerve palsies were selected for detailed analysis. The biodata, clinical features and relevant laboratory results were documented. Results: Of the 285 with neurological problems 23 (8.1%) had cranial nerve palsies. Fifteen (65.2%) of the children had single cranial nerve palsies while eight (34.8%) had multiple cranial nerves involvement. Of the 43 nerves involved, the facial nerve was the commonest (38.3%) followed by the oculomotor (23.5%) and abducens (20.6%). Intracranial infections such as meningitis, viral encephalitis and brain abscess were incriminated in 60.8% of the patients and 70.6% of the nerves involved. Conclusion : Cranial nerve palsies cause handicap and cosmetic problems. It is recommended that every child with cranial neuropathy should be evaluated for intracranial infections among other differentials. Prompt diagnosis, treatment and immunisation against related infections is paramount.