Olisamedua Fidelis Njokanma

Use of complementary and alternative medicines for children with chronic health conditions in Lagos, Nigeria

BackgroundThe use of complementary and alternative medicine (CAM) is on the increase globally with a high prevalence in children and adults with chronic illnesses. Many studies have evaluated the epidemiology of medicine use for children in developing countries but none has evaluated the use of CAM for children with chronic illnesses. The aim of this study was therefore to determine the prevalence, pattern of use, parental sources of information, perceived benefits, cost, and adverse effects of CAM in children with epilepsy, sickle cell anaemia and asthma in Lagos, Nigeria.MethodsParents of children with epilepsy (122), asthma (78) or sickle cell anaemia (118) who presented consecutively to the paediatric neurology, respiratory and haematology clinics of the Lagos State University Teaching Hospital (LASUTH), Ikeja were interviewed with a structured open- and close-ended questionnaire. The information obtained comprised the demography of both the patients and their parents; past and present treatments received by the patients; the type of CAM, if any, used by the patients; and the sources, cost, benefits and adverse effects of the CAM used.ResultsA total of 303 CAMs were used by the patients, either alone or in combination witother CAM. CAM was reportedly used by 99 (31%) patients (epilepsy -38%, sickle cell anaemia – 36% and asthma – 25%). The majority (84%) of these patients were currently using CAM. The use of CAM was stopped six months prior to the study by 16 patients (16%). Biological products were the most frequently used CAMs (58%), followed by alternative medical systems (27%) and mind-body interventions (14%). Relations, friends and neighbours had a marked influence on 76% of the parents who used CAM for their children. Eighty-five (86%) parents were willing to discuss the use of CAM with their doctors but were not asked. CAM use was associated with adverse reactions in 7.1% of the patients.ConclusionParental use of CAMs to treat their children with epilepsy, asthma and sickle cell anaemia is common in Nigeria. Efforts should be made by doctors taking care of these patients to identify those CAM therapies that are beneficial, harmless and cheap for possible integration with conventional therapy.

Possible Risk Factors for Congenital Malaria at a Tertiary Care Hospital in Sagamu, Ogun State, South-West Nigeria

Congenital malaria, defined as the presence of malaria parasites in the erythrocytes of newborns aged <7 days, was considered rare in endemic areas until recent studies started reporting high prevalence rates. Various theories have been postulated to explain this phenomenon, but they are not proven conclusively from research. Against this background, a prospective study was designed with the following objectives. To determine the prevalence of congenital malaria parasitaemia and identify possible risk factors amongst newborns delivered in O.O.U.T.H Sagamu, Ogun State. Over a 6-month period, 192 live newborns and their mothers were consecutively recruited into the study. Within 3 days of life, neonatal peripheral blood samples were collected for malaria screening by blood film microscopy and detection of plasmodium lactate dehydrogenase (pLDH) with the OptiMAL Rapid Malaria Test kit. Maternal peripheral blood samples were taken simultaneously, to check for malaria infestation by blood film microscopy, and questionnaires were administered on the mothers to identify possible factors associated with the development of neonatal parasitaemia. Neonatal clinical and laboratory data were recorded in a pro forma designed for the study. Data analysis was done with Epi-info version 6 software and level of significance set at <5%. Twenty-one of 192 newborns delivered in O.O.U.T.H within the study period were diagnosed as having congenital malaria by blood film microscopy, giving a prevalence rate of 10.9%. The main identified innate neonatal risk factor for congenital malaria parasitaemia was prematurity. First-order pregnancy, history of fever within 3 months of delivery and peripheral parasitaemia at delivery (p < 0.001) were the variables that were significantly higher in the mothers of the parasitemic newborns. We conclude that congenital malaria parasitaemia in tropical endemic areas is not rare. Pre-term neonates, infants of primigravidae, women with history of fever within 3 months of delivery and women with post-partum peripheral parasitaemia may benefit from routine screening for malaria.

The influence of socioeconomic status on the hemoglobin level and anthropometry of sickle cell anemia patients in steady state at the Lagos University Teaching Hospital

BACKGROUND Sickle cell anemia (SCA) has multisystemic manifestations and is associated with severe morbidity and high mortality. It commonly affects growth leading to wasting and stunting. AIMS AND OBJECTIVES This study aimed to determine the influence of socioeconomic status on the nutritional status using anthropometric measurements and steady-state hemoglobin, of children with homozygous SCA, aged 1 year to 10 years in steady state at the Lagos University Teaching Hospital. MATERIALS AND METHODS This is a cross-sectional study involving 100 children with SCA and 100 age-, sex-, and social class-matched controls that fulfilled the inclusion criteria. Social class was assessed using educational attainment and occupation of parents. Hemoglobin concentration was determined using the oxy-hemoglobin method. RESULTS This study demonstrated a significantly lower mean weight and weight-for-height in the SCA patients than those of controls (P < 0.001). By contrast, this study did not demonstrate any statistical significant difference in the mean height and mean body mass index of SCA patients and controls (P = 0.06) and (P = 0.12), respectively. The mean weight, height, and body mass indices of the subjects and controls were consistently below those of the NCHS standards. The magnitude of the difference from the NCHS standard was also more pronounced in the subjects, increased with advancing age and affected male subjects more than females. Progressive declines in the anthropometric attainment and hemoglobin concentration were observed from social class 1 to 4; this was statistically significant in controls (P = 0.00) but not in subjects (P > 0.1). However, SCA patients had significantly lower values than controls in each of the social classes. CONCLUSION Poor socioeconomic status has an adverse effect on the nutritional status and hemoglobin of SCA patients.

Incidence and cost estimate of treating pediatric adverse drug reactions in Lagos, Nigeria

CONTEXT AND OBJECTIVES Adverse drug reactions (ADRs) may cause prolonged hospital admissions with high treatment costs. The burden of ADRs in children has never been evaluated in Nigeria. The incidence of pediatric ADRs and the estimated cost of treatment over an 18-month period were determined in this study. DESIGN AND SETTING Prospective observational study on children admitted to the pediatric wards of the Lagos State University Teaching Hospital (LASUTH) in Nigeria, between July 2006 and December 2007. METHODS Each patient was assessed for ADRs throughout admission. Medical and non-medical costs to the hospital and patient were estimated for each ADR by reviewing the medical and pharmacy bills, medical charts and diagnostic request forms and by interviewing the parents. Cost estimates were performed in 2007 naira (Nigeria currency) from the perspectives of the hospital (government), service users (patients) and society (bearers of the total costs attributable to treating ADRs). The total estimated cost was expressed in 2007 United States dollars (USD). RESULTS Two thousand and four children were admitted during the study; 12 (0.6%) were admitted because of ADRs and 23 (1.2%) developed ADR(s) during admission. Forty ADRs were suspected in these 35 patients and involved 53 medicines. Antibiotics (50%) were the most suspected medicines. Approximately 1.83 million naira (USD 15,466.60) was expended to manage all the patients admitted due to ADRs. CONCLUSIONS Treating pediatric ADRs was very expensive. Pediatric drug use policies in Nigeria need to be reviewed so as to discourage self-medication, polypharmacy prescription and sales of prescription medicines without prescription.

Parental reporting of suspected adverse drug reactions in children in Lagos, Nigeria

Objectives: To determine the feasibility of parental reporting of suspected adverse drug reactions (ADRs) to community pharmacies in Nigeria. Methods: Fifteen registered pharmacies were randomly selected in Lagos, Nigeria. Caregivers who procured antibiotics, antimalarials, paracetamol or ibuprofen for a child up to 12 years of age in these pharmacies between July and September 2007, were asked to report suspected ADRs in their child by filling in a questionnaire given to them by the pharmacist. If the caregivers suspected an ADR within 5 days of administering the medicine, they were asked to return the questionnaire within the following 7 days. Results: 9023 drugs were procured for 2868 children (1807 (63%) of whom were male) and 689 (8%) of these drugs were administered by injection. Antibiotics (1975, 24%) were the most frequently procured type of drug of the four groups surveyed (antibiotics, antimalarials, paracetamol and ibuprofen) and chloroquine (445, 46%) was the most frequently procured antimalarial. 509 (18%) caregivers reported 575 suspected, mostly mild, ADRs (509 to antibiotics, 42 to antimalarials and 24 to analgesics). The two most frequently reported suspected ADRs were diarrhoea in 292/575 (51%) children and skin rashes in 103/575 (18%). The overall prevalence of ADRs in these children was 509/2868 (18%). Conclusion: Parental reporting of suspected ADRs to antibiotics, antimalarial and analgesics in their children is feasible in Nigeria. This method of pharmacovigilance should be used more extensively.

Helicobacter pylori associated with breastfeeding, nutritional status and recurrent abdominal pain in healthy Nigerian children

INTRODUCTION There is limited knowledge about the associations of Helicobacter pylori (H. pylori) infections in developing countries. This study aimed to determine the current prevalence and associations of H. pylori infection with breastfeeding practices, nutritional status, and recurrent abdominal pain (RAP) in a group of apparently healthy children and adolescents in Lagos, Nigeria. METHODOLOGY This was a prospective hospital-based study conducted at the Lagos State University Teaching Hospital that involved 118 children who came to the hospital for routine pediatric care. Seroprevalence status of the children was determined by measuring immunoglobulin G antibodies against H. pylori using enzyme-linked immunosorbent assay (ELISA). RESULTS Seventy-five (63.6%) children were seropositive for H. pylori. The prevalence of H. pylori infection increased significantly from 40.4% in children less than five years of age to 85.1% at six to ten years of age (χ(2) = 20.9, p < 0.001). H. pylori infection was associated with low social class (OR = 3.24; 95% CI = 1.20-8.23, p = 0.016) and with RAP (OR = 3.47; 95% CI = 1.55-7.79, p = 0.002), but no association was observed with exclusive breastfeeding, duration of breastfeeding, and under-nutrition. CONCLUSIONS The prevalence of H. pylori infection is high, particularly among children from low socioeconomic backgrounds in Lagos, Nigeria. It is associated with RAP. The effect of this infection on childrens health requires further studies.

Waist Circumference Values of Nigerian Children and Adolescents

Aims: This study aimed to determine the waist circumference (WC) of apparently healthy Nigerian children and adolescents and to compare the obtained values with available data for children from other parts of the world. Methods: A representative sample of children from 7 schools in Abeokuta, a state capital in South West Nigeria, was selected using the multi-staged random sampling technique. The sample population consisted of 570 children with ages ranging from 5 to 19 years. Results: WC increased with age in both sexes. The mean value of WC of children aged 5–9 years was about the same in both sexes (p = 0.113). However, in children older than 9 years, females had higher WCs than males (p = 0.000). Comparison of the 50th percentile WC of Nigerian children with that of American and Spanish children showed that both Nigerian male and female children had the lowest WC values. However, the values were similar to British male children up to 9 years and female children up to 14 years. Conclusion: The WC value varied with age, sex and race. These data are expected to serve as a baseline against which future data can be compared.

Ulcerative colitis in a Nigerian girl: A case report

BackgroundUlcerative colitis (UC) is uncommon in the tropics and sub-tropics. We report a case of UC in a 7 year old girl whose parents were both Nigerians. This report is to alert healthcare professionals in sub-Saharan Africa that UC is not a rare health problem, especially in children.Case presentationThe patient presented with frequent passage of blood stained stool, abdominal pain and significant weight loss. The diagnosis was entertained after she was investigated for common causes of chronic diarrhea in our setting and the findings were negative. The patient symptoms abated after she was commenced on steroid therapy.ConclusionUnder-diagnosis and misdiagnosis may account for a dearth of information on UC in African children.

Performance of a rapid antigen test for the diagnosis of congenital malaria.

Abstract Objective: To assess the performance of OptiMAL®, a rapid malaria antigen capture dipstick, in diagnosing congenital malaria. Methods: Live newborns aged 0–3 days, delivered at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between August 2004 and January 2005, were screened for malaria parasitaemia with an immunochromatographic test (OptiMAL®) and blood film microscopy. OptiMAL® detects plasmodium lactate dehydrogenase (pLDH). Results: Twenty-one of 192 newborns (10.9%) were diagnosed with congenital malaria by blood film microscopy. The OptiMAL® test was negative in all infants. Conclusion: OptiMAL® rapid malaria antigen capture dipstick might not be useful for diagnosing malaria parasitaemia in newborns. Blood film microscopy remains the gold standard for the diagnosis of congenital malaria.

National neonatal resuscitation training program in Nigeria (2008-2012): A preliminary report

BACKGROUND Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth. MATERIALS AND METHODS Between 2008 and 2012, doctors and nurses drawn from all the geo-political zones were trained using the Neonatal Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire-based, cross-sectional surveys of doctor and nurse trainees from the six geo-political zones in Nigeria were conducted eight months after the primary training, to evaluate the post-training neonatal resuscitation activities. RESULTS Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post-training period. The nurses used bag and mask for infant resuscitation more frequently, compared to doctors, with the rate fluctuating between two-to-one and four-to-one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants. CONCLUSION The NRT in Nigeria is well-subscribed and the frequency of secondary training is good.