Edwin E. Eseigbe

Patent medicine sellers: how can they help control childhood malaria?

Roll Back Malaria Initiative encourages participation of private health providers in malaria control because mothers seek care for sick children from them. This study investigated Patent Medicine Sellers (PMS) management of presumptive malaria in children in order to identify how they can assist malaria control. A cross-sectional survey of 491 PMS in Kaduna, Nigeria, was done using interviews and observation of shop activities. Most (80%) customers bought drugs without prescriptions. Only 29.5% were given instructions about doses. Between 40–100% doses of recommended antimalarials were incorrect. Some (22%) PMS did not ask questions about illness for which they were consulted. Most children treated in shops received injections. PMS facilitate homecare but have deficiencies in knowledge and practice. Interventions must focus on training them to accurately determine doses, give advice about drug administration, use oral medication, and ask about illness. Training should be made a prerequisite for registering and reregistering shops.

Febrile seizures in Kaduna, north western Nigeria.

Background: Febrile seizure is the most common seizure of childhood and has a good prognosis. However its presentation is fraught with poor management, with grave consequences, in our environment. Thus a review of its current status is important. Objective: To review the status of febrile seizures in Kaduna metropolis. Materials and Methods: A review of cases seen in the Department of Paediatrics, 44 Nigeria Army Reference Hospital, Kaduna between June 2008 and June 2010. Results: Out of the 635 cases admitted in the department 17 (2.7%) fulfilled the criteria for febrile seizures. There were 11 Males and 6 Females (M: F, 1.8:1). Age range was from 9 months to 5 years with a mean of 2.2 years ± 1.1 and peak age of 3 years. Twelve (70.6%) were in the upper social classes (I-III). Fever, convulsion, catarrh and cough were major presenting symptoms. Incidence of convulsion was least on the 1st day of complaint. Fourteen (82.4%) of the cases were simple febrile seizures while 3 were complex. There was a positive family history in 5 (29.4%) of the cases. Eleven (64.7%) had orthodox medication at home, before presentation, 5 (29.4%) consulted patient medicine sellers and 7 (41.7%) received traditional medication as part of home management. Malaria and acute respiratory infections were the identifiable causes. Standard anti-malaria and anti-biotic therapy were instituted, where indicated. All recovered and were discharged. Conclusion: There was a low prevalence of febrile seizures among the hospitalized children and a poor pre-hospitalization management of cases. It highlighted the need for improved community awareness on the prevention and management of febrile seizures.

Health Care Seeking Behavior among Caregivers of Sick Children Who Had Cerebral Malaria in Northwestern Nigeria

Cerebral malaria is a significant cause of childhood morbidity in our region. The challenges of effective management include time and quality of treatment. The study appraised the health care seeking behavior of caregivers of sick children who developed cerebral malaria, in Zaria, northwestern Nigeria. Caregivers indentified were parents 29 (87.9%) and grandparents 4 (12.1%). Most of them were in the upper social classes. Health care options utilized before presentation at our facility were formal health facility 24 (72.7%), patent medicine seller 12 (36.4%), home treatment 10 (30.3%), and herbal concoction 6 (18.2%) with majority 24 (72.7%) using more than one option. Antimalarial therapy was instituted in 25 (75.6%) of the cases. Mortality was significantly associated with the use of herbal concoction, treatment at a formal health facility and patent medicine seller, multiple convulsions, age less than 5 years, and noninstitution of antimalarial therapy before presentation. The study showed use of inappropriate health care options by caregivers and highlighted the need to pursue an awareness drive among caregivers on the use of health care options.

Challenges in care of the child with special health care needs in a resource limited environment.

To identify challenges encountered in the care of children with special health care needs in a resource limited environment a 10 year-old child with a diagnosis of Tuberous Sclerosis was studied. Challenges identified were in: making a definitive diagnosis, provision of adequate care, cost of care, meeting parental expectations and accessing community support for the child and family. Available specialist health care and related services, including community rehabilitation, were provided for the child and family. The study highlights the need for improved community awareness, development in the provision of specialist health care services and institution of governmental policies that identify, support and protect children with special health care needs.

Childhood epilepsy in a tropical child psychiatric unit: Challenges of providing care in a resource-constrained environment

BACKGROUND Epilepsy is an important cause of childhood morbidity and its care is fraught with challenges. Itinerant search for remedy and manifestation as or with psychiatric disorders could result in presentation in a psychiatric unit. Identification of these challenges is essential to providing optimal care. The objective was to identify caregiver challenges in the provision of care to children with epilepsy presenting in a psychiatric unit. MATERIALS AND METHOD Administration of a structured questionnaire to caregivers of children with epilepsy presenting, between September and December 2011, in the newly constituted Child and Adolescent Mental Health(CAMH) Unit of the Federal NeuroPsychiatric Hospital, Kaduna Nigeria. RESULTS A total of 84 caregivers were interviewed. The age range of the caregivers was 23 to 62 years (mean 38 ± 9.2 years) and a female preponderance (50, 59.5%). Most of the caregivers were in the upper social classes (I-III, 79.8%). A high number of challenges were indicated by majority 65, 77.4%) of the caregivers. The recurrence of seizures (84,100%) was the commonest challenge while the experience of discrimination (17, 20.2%) was the least. All caregivers had sought remedy from multiple health care options. Challenges were significantly (P < 0.05) associated with the female caregiver, age < 40 years, generalized type of epilepsy and residing outside Kaduna. CONCLUSION The study identified multi dimensional caregiver challenges and highlighted the need for provision of comprehensive health and social services to children with epilepsy and their families.

Poor academic performance among adolescents with epilepsy in Kaduna, Northern Nigeria: A case-control study

Adolescents with epilepsy experience significant academic difficulties. However, little is known about the effects of epilepsy on the academic performance of adolescents with the disorder in Northern Nigeria. Objective. To assess the academic performance of adolescents with epilepsy and factors associated with poor performance in this population in a Northern Nigerian setting. Methods. The socio-demographic/clinical characteristics of 77 consecutive adolescents (aged 12 - 17 years) with epilepsy attending the Child and Adolescent Clinic of Federal Neuropsychiatric Hospital, Kaduna, North-West, between March 2008 and September 2010 and the socio-demographic characteristics of 76 controls (matched for age and sex) were recorded. Information concerning school attendance and academic performance of the subjects and the controls were obtained from the adolescents and their parents or caregivers. Results. The mean ages of the subjects and the controls were 15.1 (standard deviation (SD) 2.1) and 14.7 (SD 1.7) years, respectively (p>0.05), the mean duration of illness was 6.1 (SD 4.6) years, the mean seizure-free period was 16.8 (SD15.6) weeks, and 64.9% of the subjects and 57.9% of the controls were males. Forty-six subjects (59.7%) and 12 controls (15.8%) had poor academic performance (p<0.001). Long duration of illness, short seizure-free periods and irregular school attendance were significantly associated with poor academic performance (p<0.05). Conclusions. Poor academic performance is common among adolescents with epilepsy and is associated with early onset, poor seizure control and missing school. Efforts should be made to control seizures and educate society about the illness.

Bacterial isolates from the stools of children aged less than 5 years with acute diarrhea in Kaduna, Northwestern Nigeria

Background: Diarrhea is a significant cause of morbidity and mortality among children aged less than 5 years in sub-Saharan Africa. Bacterial organisms are important etiological agents and their identification is vital to effective management. Objective: To identify characteristics of bacterial isolates in the stools of children aged less than 5 years with acute diarrhea. Materials and Methods: The stools of children aged less than 5 years presenting with acute diarrhea were cultured using deoxycholate citrate agar and Salmonella-Shigella agar. Data were analyzed using Epi Info version 3.5.3 and P values <0.05 were regarded as significant. Results: Stool samples were obtained from 270 children aged 0.2 to 4.9 years (mean: 1.6 ΁ 1.4 years). Majority of the children were males (156, 57.8%) and aged <2 years (64.1%). Diarrhea was bloody in 28 (11.8%) children. Antibiotic therapy was instituted in 185 (68.7%) children before presentation and mostly prescribed by caregiver (87, 47%). Metronidazole (154, 83.2%) was the commonest antibiotic prescribed. Bacteria were isolated in 175 (64.8%) samples. The commonest isolate was Escherichia coli (105, 60%). Bacteria were isolated from 7 (25%) of bloody diarrhea stools and the isolates were E. coli (2, 28.6%) and Shigella spp. (5, 71.4%). Isolates were most sensitive to ciprofloxacin (167, 95.4%). Bacterial isolation was significantly (P < 0.05) associated with age <2 years, nonuse of antibiotics, and bloody diarrhea. Conclusion: Enterobacteria are still important etiological agents of acute diarrhea among children. The study highlights the need for appropriate treatment of children with diarrhea and promotion of its prevention.

Strong family history and early onset of schizophrenia: about 2 families in Northern Nigeria

Schizophrenia is a highly heritable psychotic disorder and high genetic loading is associated with early onset of the disease. The outcome of schizophrenia has also been linked with the age of onset as well as the presence of family history of the disease. Therefore families with patients with early onset Schizophrenia are subpopulations for genetic studies. We present 2 families with heavy genetic loading who have adolescents with schizophrenia.

Descriptive Characterization of Psycho-Trauma, Psychological Distress, and Post-traumatic Stress Disorder among Children and Adolescent Internally Displaced Persons in Kaduna, Nigeria

Background A postelection violent conflict in Kaduna resulted in 800 deaths and 65,000 displaced people leading to setting up of camp for internally displaced persons (IDPs). We set out to determine the prevalence and pattern of psycho-traumatic stressful life events, psychological distress, and post-traumatic stress disorder (PTSD) among child/adolescents IDPs. Methods A descriptive cross-sectional study of 73 child/adolescent IDPs were selected by total sampling. Stressful life event checklist measured conflict-related trauma and reaction of adolescents to traumatic stress (RATS) measured post-trauma reaction of children/adolescents. Hopkins Symptoms Checklist 37 for Adolescents measured psychological distress associated with trauma. Diagnostic Interview Schedule for Children was used for diagnosis of PTSD. Results Of 73 respondents, 3 (4.1%) had probable PTSD, 2 (2.7%) had definitive PTSD, and mean score of the child/adolescent IDPs on HSCL-37A and RATS was 44.7 (SD = 6.3) and 31.9 (SD = 5.7), respectively. Most frequently occurring psychological distress among female participants was suddenly scared for no reason 7 (19.5%) and becoming angry easily and feeling fearful 5 (13.9%). The average score for female participants were higher than that for males on depressive and anxiety subscale of HSCL-37A. Conclusion We concluded that children/adolescent IDPs were exposed to psycho-trauma following postelection violent conflict and developed psychological distress. However, the low prevalence of psychological distress and PTSD suggested that living with parents and psychosocial intervention provided could have led to much lower morbidity.

Electroencephalographic findings in patients referred for electroencephalogram in a University Teaching Hospital in Northern Nigeria

Background: Electroencephalogram (EEG) is a valuable investigation for the assessment of patients with seizures and some other neuropsychiatric disorders. The literature is scanty of reports describing its application and usefulness in Nigerian patients. In this study we analyzed the EEG records of a series of patients who were referred with various provisional diagnoses. Materials and Methods: EEG records of the entire 200 consecutive cases referred from various clinics within and outside a tertiary hospital in Northern Nigeria during a 1 year period were analyzed. Information on biodemographic data, clinical description of symptoms and provisional diagnosis made by referring physicians and the EEG diagnosis were obtained from the records. Results: Most of the attendees were aged between 10 years and 29 years (59.5%) and mostly males (63.5%). About 80% of the attendees had received a provisional diagnosis of seizure disorder (generalized and partial). The EEG diagnosis of seizure disorder accounted for 75%, normal EEG record accounted for 21% and organic brain disorder accounted for 4% of all EEG diagnosis. Generalized seizure disorder was the commonest seizure type by EEG diagnosis (50%). There was a significant association between the provisional diagnosis and EEG diagnosis (P < 0.05). Conclusion: Most of the patients referred for the EEG had their reports consistent with clinical suspicion. EEG was found to be a useful tool in the evaluation of seizures and organic brain disorder in our study.