Bankole Peter Kuti

Epidemiological, clinical and prognostic profile of childhood acute bacterial meningitis in a resource poor setting

Background: Childhood bacterial meningitis is a neurologic emergency that continues to kill and maims children particularly in developing countries with poor immunization coverage. Objective: This study set out to assess the hospital incidence, pattern of presentation, etiologic agents, outcome and determinants of mortality among the children admitted with bacterial meningitis at the Wesley Guild Hospital (WGH), Ilesa. Patients and Methods: We carried out a retrospective review of admitted cases of bacterial meningitis in children aged one month to 15 years at the WGH, Ilesa over a three year period by looking at the hospital records. Factors in the history and examinations were compared among survivors and those that died to determine factors significantly associated with mortality in these children. Results: Eighty-one (5.5%) of the 1470 childhood admissions during the study period had bacterial meningitis. Male preponderance was observed and two-thirds of the children were infants. More cases were admitted during the wet rainy season than during the dry harmattan season. Haemophilus influenzae type B and Streptococcus pneumoniae were the leading etiologic agents and ciprofloxacin and ceftriaxone adequately cover for these organisms. Twenty-two (27.2%) of the 81 children died, while 34 (42.0%) survived with neurologic deficits. Children with multiple seizures, coma, neck retraction, hyponatremia, hypoglycorrhachia, turbid CSF as well as Gram positive meningitis at presentation were found to more likely to die (P < 0.05). None of these factors however independently predict mortality. Conclusion: Childhood bacterial meningitis often results in death and neurologic deficit among infants and young children admitted at the WGH, Ilesa. Children diagnosed with meningitis who in addition had multiple seizures, neck retraction and coma at presentation are at increased risk of dying.

Pattern, etiological factors and determinants of mortality among sick newborns with seizures in Ilesa, Nigeria.

Background: Neonatal seizures contribute significantly to newborn morbidity and mortality particularly in developing countries including Nigeria. Unfortunately the countries with high incidence of neonatal seizures often lack the facilities to adequately diagnose, monitor and prognosticate the condition. Objective: We set out to determine the factors at presentation that predict death among babies admitted with clinically identifiable seizures. Methods: We prospectively observed consecutive neonatal admissions over a nine month period at the Wesley Guild Hospital, Ilesa, Nigeria. Babies with seizures were identified based on clinical observation. Perinatal history, examination and laboratory findings were compared between babies with seizures who survived and those that died. Multivariate regression analysis was used to determine the predictors of mortality. Results: Over a nine month study period, a total of 340 babies were recruited out of which 55 (16.7 percent) had clinically identifiable seizures. Fifteen (27.3 percent) of the 55 babies with clinically identifiable seizures died; while 20 (7.0 percent) of the 285 babies without seizures died. Clinically identifiable neonatal seizures contributed to 42.9 percent of the overall mortality in the neonatal unit during the study period. The risk factors for mortality among the babies with seizures were clinical seizures in the first 24 hours of life, birth asphyxia co-existing with hyponatraemia and presence of cerebral oedema (P < 0.05). The independent determinant of mortality among babies with clinical seizures was cerebral oedema (OR = 4.025; 95% CI 1.342-26.956; P = 0.019). Conclusion: We conclude that clinically identifiable neonatal seizures contribute significantly to neonatal mortality and presentation within 24 hours of delivery, birth asphyxia and cerebral oedema increased the risk of death in babies with seizures.

Serum vitamin D profile of Nigerian children with asthma: Association with asthma severity and control

Childhood asthma is a chronic inflammatory airway disorder with increasing prevalence even in Africa. Vitamin D, with anti‐inflammatory and immune‐modulatory properties, may have effects on the severity and level of symptoms control in childhood asthma. We aimed to assess the serum vitamin D levels in children with asthma as related to disease severity and control in a tropical region.

Acute chest syndrome in sickle cell anaemia: higher serum levels of interleukin-8 and highly sensitive C-reactive proteins are associated with impaired lung function

ABSTRACT Background: Sickle cell anaemia (SCA) is a chronic inflammatory disorder with multiple organ manifestations including acute and long-term pulmonary dysfunction. Aims/objectives: To assess lung function of children with SCA and determine the possible role of acute chest syndrome (ACS), serum inflammatory cytokines, highly sensitive C-reactive protein (hs-CRP), leucocytes and 25-hydroxyvitamin D on the development of impaired lung function. Subjects and methods: Lung function of 76 children with SCA was determined by spirometer and classified into normal or impaired. Sociodemographic, clinical, haematological, biochemical and immunological data of the two groups were compared by univariate and multivariate analyses. Results: Fifty (65.8%) patients had impaired lung function, comprising of 30.3%, 3.9% and 31.6% with restrictive, obstructive and mixed disease patterns, respectively. Children with previous ACS were 3.6 times more likely to have impaired lung function than those without ACS (82.1% vs 56.3%, p = 0.02, OR 3.6, 95% CI 1.2–10.8). Interleukin (IL)-8 and hs-CRP were significantly higher in patients with impaired lung function (p = 0.02 and <0.001, respectively). Using logistic regression, previous ACS (OR 5.8, 95% CI 1.1–5.8, p = 0.03) and higher serum IL-8 levels (OR 3.0, 95% CI 1.0–8.0, p = 0.02) independently predicted the presence of abnormal lung function. Conclusions: Lung dysfunction, predominantly restrictive pattern, is common in SCA and is associated with previous ACS and alterations in immunological markers, especially serum IL-8 and hs-CRP. Abbreviations: ACS: acute chest syndrome; CBT: chronic blood transfusion; ELISA: enzyme-linked immunosorbent assay; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; HPLC: high-density liquid chromatography; hs-CRP: highly sensitive C-reactive proteins; HU: hydroxyurea; IL: Interleukin; PEFR: peak expiratory flow rate; SEM: standard error of the mean; TLC: total lung capacity; 25-OHD: 25-hydroxyvitamin D; VOC: vaso-occlusive crisis; WGH: Wesley Guild Hospital

Factors Influencing the Academic Performance of Children with Sickle Cell Anaemia in Ekiti, South West Nigeria

Background There is a paucity of information on factors that influence the school performance of children with sickle cell anaemia (SCA) in Nigeria, despite her huge burden of the disease. Methods In total, 101 children with SCA were recruited at a paediatric clinic in Nigeria. Their socio-demographic-matched classmates were the controls. Academic performance and cognitive functioning were obtained from school reports and Zilers Draw-a-Person Test, respectively. Factors influencing the academic performance were determined. Results Children with SCA had higher rates of school absence and lower haemoglobin concentration (p < 0.05). There was no difference in overall school performance between children with SCA and controls (59.0 vs. 60.6%; p = 0.256). School absenteeism > 1 week independently predicts poor school performance among the study participants (odds ratio = 15.71; 95% confidence interval = 5.93-41.66; p =0.000). Most SCA children with poor performance were absent from school for > 1 week. Conclusion There is need to address causes of school absenteeism among children with SCA.

Rural-urban disparity in lung function parameters of Nigerian children: effects of socio-economic, nutritional and housing factors

Introduction The effect of socio-demographic and nutritional factors on lung functions of African children is poorly studied. This study set out to determine the effects of these factors on lung functions of Nigerian school children. Methods Rural and urban secondary schools students in Ilesa, Nigeria were selected by multistage sampling. The socio-demographic, nutritional status as well as lung function parameters measured using incentive Spirometry (MIR Spirolab III srl, Italy) of the children were obtained and compared among the rural and urban children. Results A total of 250 children (128 rural and 122 urban) aged 9 to 17 years participated in the study over a 12 month period. Mean (SD) age was 12.6 (1.9) years and Male: Female 1:1.1. The urban children were heavier, taller and have larger lung volumes than their age and sex matched rural counterpart. Stunted rural males [Mean (SD) FVC 1.8 (0.3) L vs. 2.2 (0.6) L t-test = 2.360; p = 0.022], underweight females [Mean (SD) FVC 1.8 (0.4) L vs. 2.2 (0.6) L; t-test = 2.855; p = 0.006] and those exposed to unclean fuel [Mean (SD) FVC 2.1 (0.6) L vs. 2.4 (0.5) L; t-test = 2.079; p = 0.041] had significantly lower lung volumes compared to their counterparts without these conditions. Conclusion Undernutrition, low socio-economic class and use of unclean fuels adversely affect the lung functions of Nigerian children. Improved standard of living, use of clean fuel and adequate nutrition may ensure better lung health among these children.

Factors associated with childhood asthma control in a resource-poor center

Introduction: Optimal asthma control is a major aim of childhood asthma management. This study aimed to determine factors associated with suboptimal asthma control at the pediatric chest clinic of a resource-poor center. Methods: Over a 12-month study period, children aged 2–14 years with physician-diagnosed asthma attending the pediatric chest clinic of the Wesley Guild Hospital (WGH), Ilesa, Nigeria were consecutively recruited. Asthma control was assessed using childhood asthma control questionnaire. Partly and uncontrolled asthma was recorded as a suboptimal control. Relevant history and examinations findings were compared between children with good and suboptimal asthma control. Binary logistic regression analysis was used to determine the predictors of suboptimal asthma control. Results: A total of 106 children participated in the study with male:female ratio of 1.5:1, and majority (83.0%) had mild intermittent asthma. Suboptimal asthma control was observed in 19 (17.9%) of the children. Household smoke exposure, low socioeconomic class, unknown triggers, concomitant allergic rhinoconjunctivitis, and poor parental asthma knowledge, were significantly associated with suboptimal control (P < 0.05). Low socioeconomic class (odds ratio [OR] =6.231; 95% confidence interval [CI] =1.022–8.496; P = 0.005) and poor parental asthma knowledge (OR = 7.607; 95% CI = 1.011–10.481; P = 0.007) independently predict suboptimal control. Conclusion: Approximately, one in five asthmatic children attending the WGH pediatric chest clinic who participated in the study had suboptimal asthma control during the study. More comprehensive parental/child asthma education and provision of affordable asthma care services may help improve asthma control among the children.

Predictors of prolonged hospitalisation in childhood pneumonia in a rural health centre

Background. Pneumonia is a major cause of morbidity and mortality in under-5 children. Caring for children with pneumonia, especially in the case of prolonged hospitalisation, is a daunting task in resource-poor countries where caregivers are required to pay for treatment ‘out of pocket’ at the point of care. These children are often discharged against medical advice with incomplete treatment, with a consequent high rate of re-admission and complications. Objective. To determine factors that predict prolonged hospitalisation among under-5 children with severe pneumonia admitted to a compre h ensive health centre in rural Gambia. Methods. We prospectively assessed 420 consecutive under-5 admissions with severe pneumonia, diagnosed using World Health Organization criteria, for factors in patient history, examination or investigations that could predict a hospital stay longer than 5 full days. Results. Over the 6-month study period, pneumonia accounted for 27.6% of the total number of under-5 admissions. The mean age of children with pneumonia was 18.0 months (standard deviation (SD) ±13.7), there was a male to female ratio of 1.2:1, and 40.0% of the children were infants. Their mean hospital stay was 4.5 (SD ±3.0) days and 105 (25.0%) of the children had a prolonged hospital stay. Head nodding (odds ratio (OR) 1.929; 95% confidence interval (CI) 1.124 - 3.414; p=0.018), the presence of oedematous protein-energy malnutrition (OR 5.813; CI 1.060 - 3.616; p=0.006), severe wasting (OR 2.071; CI 1.047 - 3.241; p=0.034) and hypoxaemia at presentation (OR 2.220; CI 1.097 - 3.405; p=0.023) were independent predictors of prolonged hospital stay. Conclusion. Caregivers of children hospitalised with pneumonia and severe wasting, head nodding, oedema or hypoxaemia should be counselled at admission about the possibility of prolonged hospitalisation.