Gabriel E Ofovwe

Phototherapy Device Effectiveness in Nigeria: Irradiance Assessment and Potential for Improvement

This study investigated the effectiveness of simple-to-implement adjustments of phototherapy devices on irradiance levels in a cross-section of Nigerian hospitals. A total of 76 phototherapy devices were evaluated in 16 hospitals while adjustments were implemented for a subset of 25 devices for which consent was obtained. The mean irradiance level was 7.6 ± 5.9 µW/cm(2)/nm for all devices prior to adjustments. The average irradiance level improved from 9.0 µW/cm(2)/nm to 27.3 µW/cm(2)/nm for the adjusted group (n = 25) compared with 6.8 ± 5.4 µW/cm(2)/nm for the unadjusted group (n = 51). Simple, inexpensive adjustments to phototherapy devices with sub-optimal irradiance levels can significantly improve their effectiveness to acceptable international standards and should be widely promoted in resource-constrained settings.

The prevalence of attention-deficit/hyperactivity disorder among school-aged children in Benin City, Nigeria

Objective: To establish the prevalence of ADHD among school-aged children in Benin City, Nigeria. Method: A total of one thousand, three hundred and eighty four (1384) primary school pupils, aged between six and 13 years, were recruited from six primary schools. Teachers ratings of the 18 DSM-IV symptoms of ADHD were collected and analysed as a function of gender and subtype. Results: The results support a documented trend in ADHD reports: males had a higher prevalence rate. The prevalence rate of 8.0% found is also consistent with documented evidence. Conclusion The results strengthen earlier observations that there is no significant geographical variation on the prevalence of ADHD if common definitions and diagnostic tools are employed. This study being the first from Nigeria provides data for crosscultural comparison as a prerequisite for establishing a common knowledge of ADHD.

A modified Bilirubin-induced neurologic dysfunction (BIND-M) algorithm is useful in evaluating severity of jaundice in a resource-limited setting

BackgroundSevere neonatal jaundice with associated acute bilirubin encephalopathy occurs frequently in low- and middle-income countries, where advanced diagnostic technology is in short supply. In an effort to facilitate the physical diagnosis of acute bilirubin encephalopathy, we pilot-tested a modified bilirubin induced neurologic dysfunction scoring algorithm in a group of pediatric trainees (residents) and their mentors (consultants) in a resource-constrained setting.MethodsJaundiced Nigerian infants were examined by consultant and resident pediatricians. The modified bilirubin induced neurologic dysfunction score assigned by residents was compared with the clinical diagnosis of acute bilirubin encephalopathy by expert consultants. Demographic information was obtained. Known risk factors were also evaluated among infants with and without acute bilirubin encephalopathy in addition to exploratory analyses. Data were analyzed by Statistical Analysis System; statistical significance was set at p < 0.05.ResultsThree hundred and thirty three paired modified bilirubin induced neurologic dysfunction scores (333) were analyzed and showed excellent agreement (weighted Kappa coefficient 0.7969) between residents and consultants. A modified bilirubin induced neurologic dysfunction score greater than or equal to 3 was highly predictive of a clinical diagnosis of acute bilirubin encephalopathy, with sensitivity of 90.7%, specificity of 97.7%, positive predictive value of 88.9%, and negative predictive value of 98.2%. Exposure to mentholated products was strongly associated with increased risk of acute bilirubin encephalopathy among those with known glucose-6-phosphate dehydrogenase deficiency (odds ratio = 73.94; 95% confidence interval = 5.425-infinity) as well as among those whose G6PD phenotype was unknown (odds ratio = 25.88; 95% confidence interval = 2.845-235.4).ConclusionsThe modified bilirubin induced neurologic dysfunction score for neonatal jaundice can be assigned reliably by both residents and experienced pediatricians in resource-limited settings as reflected in the algorithm’s sensitivity and specificity. It may be useful for predicting the development and severity of acute bilirubin encephalopathy in neonates.

Cluster survey on neonatal tetanus mortality in Nigeria: observation on some clinical aspects.

A total of 2623 live births were recorded over a 12-month period during a cluster survey on neonatal tetanus (NNT) mortality in Kano Metropolis, Northern Nigeria. The survey involved a two-stage cluster sampling technique. Some aspects of the clinical features of NNT were evaluated. There were 79 neonatal deaths and 54 NNT deaths with NNT mortality rate of 20.6/1000 live births. The mean incubation period for NNT was 7.3 days, while the mean age at death was 12.7 days. The peak age at death was 8 days. Interval between mean age at onset and mean age at death was 5.4 days. Mean delay in presentation at health facilities for treatment was 4.8 days. The possible significance of these features in prognosis is highlighted.

Intestinal helminthiasis in children with chronic neurological disorders in Benin City, Nigeria: intensity and behavioral risk factors

BackgroundBehavioral aberrations such as nail biting, finger sucking, and pica have been postulated as risk factors that enhance helminths ova transmission. These aberrations may present commonly in children with chronic neurological disorders and predispose them to heavy intensity of intestinal helminthiasis. This comparative cross-sectional study was to determine the prevalence, intensity, and behavioral risk factors for intestinal helminthiasis in children with chronic neurological disorders and apparently healthy controls.MethodsFresh stool samples from 155 children (2–17 years) with chronic neurological disorders seen at the child neurology clinic and 155 age and sex matched controls from nursery and primary schools in Benin City were analyzed using the Kato-Katz technique for detection of ova of helminths from November 2008 to April 2009.ResultsThe prevalence of intestinal helminthiasis (31.0%) was significantly higher in children with chronic neurological disorders compared with the controls (19.4%) (P=0.03). The intensity of infections in both groups was light ranging 24–144 eggs per gram. Ascaris lumbricoides, Trichuris trichiura and hookworm were the intestinal helminths isolated in both groups. Behavioral aberrations were significantly more represented in the subjects than in the controls (P<0.0001, OR=2.8). Nail biting and encopresis were the most significant independent predictors of intestinal helminthiasis (P=0.025 and 0.001, respectively) in the subjects only. Hand washing with water and soap after defecation and frequent de-worming exercise were practices significantly associated with decreased prevalence of intestinal helminthiasis in the subjects and controls.ConclusionsBehavioral modification in children with chronic neurological disorders should be an integral part of the control program for intestinal helminthiasis.

Erratum to: Predictors of Preterm Births and Low Birthweight in an Inner-City Hospital in Sub-Saharan Africa

Replace penultimate sentence with ‘‘Premature rupture of membranes (PAR = 33.91%) and antepartum hemorrhage (PAR = 33.54%) were the leading contributors to preterm birth in contrast to IUGR (PAR = 82.28%) and premature rupture of membranes (PAR = 32.31%) for low birthweight.’’ Results Risk factors for preterm birth Replace fifth sentence with ‘‘Premature rupture of membranes (PAR = 33.91%) and antepartum hemorrhage (PAR = 33.54%) had the highest attributable risk for preterm delivery.’’ Risk factors for low birthweight Replace third sentence with ‘‘IUGR was not only associated with the largest odds but also with the highest attributable risk for low birthweight (PAR = 82.28%) followed by premature rupture of membranes (PAR = 32.31%).’’