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IntroductionFolic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis. AimTo determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype. MethodThis study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment. ResultsThe median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p

Introduction: Glanzmann’s Thrombasthenia (GT) is a rare autosomal recessive bleeding disorder due to defective platelet membrane glycoprotein GP IIb/IIIa (integrin αIIbβ3). The prevalence is estimated at 1:1,000,000 and it is commonly seen in areas where consanguinity is high. Case Presentation: The authors report a 12 year old Nigerian girl of Igbo ethnic group, born of non-consanguineous parents, who presented with prolonged heavy menstrual bleeding which started at menarche 3 months earlier, weakness and dizziness. She had a past history of recurrent episodes of prolonged epistaxis, gastrointestinal bleeding and gum bleeding during early childhood. On examination, she was severely pale with a haemic murmur and vaginal bleeding. The initial diag- nosis was menorrhagia secondary to bleeding diathesis possibly von Willebrand’s Disease. She was on supportive treatment with fresh whole blood, fresh frozen plasma and platelets until diagnosis of GT was made in the USA. Currently, she is on 3 monthly intramuscular Depo-provera with remarkable improvement. Conclusion: To the best of our knowledge, this is the first documented report of GT in our environment where consan- guinity is rarely practised. Our health facilities require adequate diagnostic and treatment facilities for rare diseases like GT. Keywords: Glanzmann’s thrombasthenia; Menorrhagia; Nigerian girl.

Background: HIV infection significantly increases depression risk in the caregivers of HIV-infected children. Our study is aimed at determining the depression prevalence and severity in caregivers of children who are infected with HIV. Materials and Methods: This was a hospital-based, cross-sectional, and comparative study. Study participants who met the inclusion criteria were enrolled consecutively to achieve the calculated sample size. Their sociodemographic variables were obtained, and the Zung Self-rating Depression Scale was used to assess the prevalence and severity of depression in the caregivers. Results: There were 352 study participants which comprised 176 caregivers of children infected with HIV, who served as cases and 176 caregivers of HIV-negative children, who served as controls. One hundred and fifty-five (88.1%) of the cases were the biologic caregivers, whereas the biologic caregivers comprised of 133 (75.6%) for the controls. Furthermore, 43 (24.4%) and 133 (75.6%) of the cases were males and females, respectively, whereas 47 (26.7%) and 129 (73.3%) of the controls were, respectively, males and females. The prevalence of depression among the cases and controls was 43.2% and 6.8%, respectively (P < 0.001; odds ratio [OR]: 10.39). Among the cases with depression, 73 (47.1%) were the biological caregivers, whereas 3 (14.3%) were the nonbiological caregivers. This was statistically significant (P = 0.009; OR = 5.341). The severity of depression among the cases was mild depression (52.6%), moderate depression (30.3%), and severe depression (17.1%). Conclusions: There is a high prevalence of depression among the caregivers of children infected with HIV and the biologic caregivers of these children tend to have a higher depression burden than their nonbiologic counterparts.

Introduction: Several factors including the parental literacy, illness, socioeconomic status, poor sanitation and hygienic practices affect the physical growth of children. The aim of this study was to determine the socio-demographic determinants of malnutrition among primary school aged children in Enugu, Nigeria. Methods: A cross-sectional descriptive study involving primary school children in Enugu was carried out over a 3 month period. Subjects were selected using multistage sampling technique. Weight and height were measured using a digital scale and a wooden stadiometer, respectively. Body Mass Index (BMI), weight-for-age (WAZ), Height-for-age (HAZ) and BMI-for-age z scores were then derived using the new WHO reference standards. Results: 348 children (40.4%) were recruited from 5 public schools while 512 (59.6%) were recruited from 9 private schools. The mean age of the study participants was 9.2 ± 1.8 years. 7 (0.8%) children were stunted, 26 (3.3%) wasted and 28 (3.3%) underweight. Of all the study participants, overweight and obesity were observed in 73 (8.5%) and 35 (4.1%) children, respectively. Children of lower socioeconomic class were more stunted, underweight and wasted, while overweight and obesity were more prevalent among children from the upper socioeconomic class. Conclusion: Factors such as age and sex, parental education and socioeconomic class had a significant impact on nutritional status. Overweight and obesity were more prevalent among the children from the upper socioeconomic class, attending private schools, while stunting and wasting were more in children of the lower class attending public schools. Keywords: Socio-demographic, malnutrition, school-age, children, Enugu

School health services (SHS) have widespread impact on the health of a large number of children with implications on access to primary health care especially in developing countries. The aim of this study was to assess health services in primary schools in Enugu East Nigeria. Thirty-three head teachers of primary schools in Enugu east Nigeria and officials of Ministry of Education were interviewed using a questionnaire adapted from school health evaluation scale. Four private schools had health personnel. Only six private schools had a health room. Two public schools had a functional first aid box. There were no health records available in any of the schools. School lunch was given by only one private school. Of a maximum of 45, public and private schools had a mean score of 10.3 and 12.7 respectively on the school health evaluation scale (P=0.01). Three schools only attained the minimum acceptable score of 19. Health services are at a minimal level in primary schools in Enugu East Nigeria. A state school health policy should be developed through inter-sectoral collaboration of the relevant stakeholders to use the platform provided by schools to ensure access to primary health care and also act as bridge for more formal medical care for school children.

Background: Obesity and overweight are emerging major health problems in developing countries in the background of undernutrition. These have been linked to a substantial increase in mortality and morbidity.Objectives: This cross-sectional survey was aimed at determining the prevalence of underweight, overweight, and obesity using body mass index (BMI) in primary school pupils in Abakaliki metropolis of Ebonyi State, south-east Nigeria.Method: Eight hundred and four participants aged 6–12 years, from four public and four private primary schools had their weights and heights measured using standard methods. BMI value was calculated for each subject and compared with BMI for age and sex from World Health Organisation (WHO 2007) reference standard. Socioeconomic status was determined using method proposed by Oyedeji.Results: Out of 804 subjects, 426 (53.0%) were from public schools, whereas 378 (47%) were from private schools (P ≤ 0.01). Four hundred and fifteen (51.6%) were males and 389 (48.4%) were female (P = 0.88). The prevalence of underweight, overweight, and obesity using BMI were 4.5% and 1.2%, 0% in public schools and 1.1%, 5.0%, and 3.0% in private schools, (P < 0.001). The socioeconomic class significantly affected the prevalence of underweight, overweight, and obesity as more subjects with overweight and obesity belonged to upper social class, whereas more underweight subjects belonged to lower social class.Conclusion: Overweight and obesity are emerging in a background of undernutrition, showing ‘‘double burden’’ of nutritional disorder.Keywords: Body mass index, obesity, overweight, primary school children, socioeconomic class, underweight

Intra‑thecal chemotherapy is a recognized therapy for hematological malignancies such as acute lymphoblastic leukemia (ALL). Despite the advantage of these drugs in treating or preventing central nervous system disease, they are not without complications. The authors describe a 12‑year‑old girl with ALL, who developed progressive myelopathy following intra‑thecal administration of cytosine arabinoside. Initial presentation was urine and fecal retention that progressed to paraplegia, and finally encephalopathy. magnetic resonance imaging of the neuroaxis showed T2‑weighted foci of increased signal intensity within the substance of the cervical cord indicative of myelopathy. Physicians should be wary of this rare complication of intra‑thecal chemotherapy.Key words: Cytosine arabinoside, intra‑thecal, myelopathy

Background: Sickle cell anemia (SCA) is a genetic hematological disorder characterized by red blood cells that assume abnormal, rigid, and sickle shape. The musculoskeletal complications of SCA result from vessel occlusion, leading to tissue ischemia and infarction and progressive end organ damage. Aim: The aim of this study was to determine the pattern of musculoskeletal complications among children with SCA admitted at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla. Subjects and Methods: This is a retrospective study of cases of musculoskeletal complications among SCA patients admitted in UNTH over a 58 month period. Data were analyzed using the SPSS version 20 and GraphPad Prism 5 softwares. Variables analyzed include musculoskeletal complications, age and gender distribution of subjects. Fisherfs exact was used to test for significant association of categorical variables while Mann Whitney U.test was used to compare the means. A P value of less than 0.05 was accepted as significant.Results: There were 300 registered patients in our sickle cell clinic. A total of 78 patients (52 males and 26 females) were admitted between January2007 and October 2012. The median age of the patients was 10 years (range: 9 months to 17 years). 25 of the 78 patients had musculoskeletal complications, giving a prevalence rate of 32.1%. The most common musculoskeletal complication was acute osteomyelitis, diagnosed in 10/78 (12.8%) of the patients. Conclusion: Acute osteomyelitis is the most common musculoskeletal complications in children with SCA attending UNTH Ituku Ozalla.Keywords: Children, Musculoskeletal complications, Sickle cell anemia

Background : Identifying impaired quality of life is a recognized component of asthma management with no published data in Nigerian children with asthma. The aim of this study was to describe the health-related quality of life of school-aged children with and without asthma seen at the Asthma Clinic of the University of Nigeria Teaching Hospital, Enugu. Methods : Cross-sectional hospital -based study of children aged 7- 17 years (with and without asthma) attending the Paediatric Asthma and General Children Outpatient Clinic of the University of Nigeria Teaching Hospital (UNTH) from parts of the south – east region of Nigeria were consecutively enrolled. Quality of life (QOL) scores were obtained using the Paediatric Quality of Life inventory (PedsQLTM) questionnaire which measures the core dimensions of health: physical functioning, emotional functioning, social functioning and school functioning. Results : There were a total of 180 study participants: (90 with asthma and 90 without asthma). Overall quality of life scores for children with asthma was worse than in those without asthma; 75.5, SD19.3 and 82.7, SD14.5 respectively (MD 7.1, CI = 2.3 to 12.3, p=0.01). Physical function domain was significantly more affected in asthmatics than nonasthmatics; 73.4, SD 23.2 vs. 84.4, SD17.3 respectively (MD 11.1, CI = 5.0 to 17.1, p=0.002). The psychosocial health summary scores in children with and without asthma were 77.6 SD 18.1 vs.81.1 SD15.1 (MD 3.5, CI= -1.4 to 8.4, p= 0.24), with the highest scores obtained in the social functioning domain for both asthma and nonasthma patients; 82.7, SD 20.3 and 87.6, SD 15.7(MD 4.9, p = 0.08) respectively. In both the overall and specific QOL domains, boys had higher scores than girls, irrespective of age or socioeconomic status with an inverse relationship between increasing age and QOL scores (r=-0.2, p=0.07). Conclusions : Children with asthma showed worse QOL and significant impairment in their physical functioning, more noticeable among the female study population. Information obtained from our QOL study forms a basis for a more informed management plan with regards to which age groups are more affected and the specific domains of health in children with asthma that need to be given closer attention to reduce asthma morbidity. The study emphasizes the need for QOL integration in asthma management for a more holistic approach to outcome evaluation of treatment rather than the physical outcomes.

Background : Patients with sickle cell anemia (SCA) are prone to recurrent pain crises related to red blood cell sickling and vaso.occlusion with subsequent tissue hypoxia. Alveolar hypoxia has been shown to be associated with entrapment of sickle cells in the pulmonary microcirculation which may propagate a cycle of further hypoxemia and sickling. Pulmonary complications are common in sickle cell disease (SCD) and may exacerbate microvascular occlusive phenomena. Thus, detecting hypoxemia is of particular importance in SCD. Objectives : This study was designed to determine the prevalence of hypoxemia among children with SCA and compare the oxygen saturation of those in crises with those in steady state. Materials and Methods : This is a prospective observational study involving 46 children with SCA in steady state, 42 with crises, and 42 with HbAA genotype carried out between August and December 2010. The study compared the oxygen saturation of sickle cell anaemic children in steady state and in crises with normal hemoglobin genotype using Nellcon pulse oximeter while the hemoglobin concentration was analyzed using automated Sysmex KX.21N model. Results : A total of 130 participants aged 6 months to 18 years were recruited. The overall prevalence of hypoxemia in this study was 13.8%. Hypoxemia was highest among SCA patients in the crisis state (23.8%) compared to 13% and 0% for those in the steady state and in those with normal hemoglobin genotype, respectively (ƒO2 = 6.425, P = 0.04). Hypoxemia was higher among those with hemoglobin less than 5 g/dl (30%) and least among those whose hemoglobin levels were 10 g/dl and above. Conclusions : Hypoxemia was significantly higher among children with SCA during Vaso-occlusion crises. We recommend that one should have a high index of suspicion and take prompt action in managing these individuals especially those with acute chest syndrome. Key words : Enugu, hypoxemia, oxygen saturation, sickle cell anemia

Background : Human immunodeficiency virus (HIV) affects the kidney. Urine screening for abnormalities can detect early renal parenchymal diseases. Objectives : To determine the prevalence of abnormal urinary findings in HIV positive children in University of Nigeria Teaching Hospital, (UNTH), Enugu. Method : Urinary screening was carried out in 159 HIV positive children in UNTH over a period of 4-months, to detect presence of abnormalities such as glycosuria, proteinuria, haematuria, as well as the presence of nitrite and leucocyte esterase, abnormal urine pH and specific gravity (SG). Results : Eighty males and 79 females were screened. Five (5), 4, and a child had proteinuria, SG of > 1.015 and alkaline urine, giving a prevalence rate of 3.1%, 2.5% and 0.6% respectively. Neither of the subjects had glycosuria, haematuria nor tested positive to nitrite and leucocyte esterase. Subjects with proteinuria were older (5-14 years), had longer duration of HIV diagnosis, longer duration of treatment with HAART, and a lower CD4 cell count (p=0.01). Sixty percent of those with proteinuria had severe immunosuppression, with 4 out of the 5 of them with urine SG more than 1.015. The children with urine SG more than 1.015 were among the older age group (5-14 years), on HAART, had non-advanced HIV disease as well as low CD4 cell count (p=

A review of home management of childhood diarrhea in under-five children among 203 Nigerian mothers was carried out over a period of 3 months in order to ascertain how effectively they manage their children with diarrhea outside a hospital setup (infrastructural health facility). Mothers whose children had diarrhea, with or without other symptoms, and presented at the Children’s Out Patient unit (CHOP), of the UNTH over the study period were consecutively interviewed through a questionnaire designed for the study. The questionnaires were designed and administered by the authors. There were 30 mothers in social class 1; 59 in social class 2; 52 in social class 3; 13 in social class 4, and 7 mothers in social class 5. Information was obtained on the method of detection, causes of diarrhea, and treatment including their knowledge and use of oral rehydration salts with or without anti diarrheal and antibacterial agents. Out of the 203 mothers interviewed, 140 (71%) correctly defined diarrhea. 112 (55.2%) could identify correct causes of childhood diarrhea. Only 80 (39.4%) could correctly manage diarrhea at home. About 76% (154 mothers) knew that they should use an oral rehydration salt; of this number, 56 (27.6%) could correctly prepare SSS, while 29 (14.3%) could do the same for the UNICEF ORS. In addition, anti bacterial, anti-diarrheal, and/or herbal preparations were used by 38 (18.7%) of the mothers. The level of knowledge of oral rehydration therapy has dropped in our locality since its inception in the early 1990s. There is need to intensify maternal education in this area since we now have a new generation of mothers who were not there during the inception of the program.

Background: Hepatitis C virus (HCV) has become an important cause of chronic liver disease and liver cancer worldwide. A study of the sociodemographic differences in the distribution of HCV antibodies (Anti-HCV) among those at risk will broaden knowledge of the problem among patients in this part of the country. Objective: To determine the sociodemographic differences in the distribution of HCV antibodies among transfused children with sickle cell anaemia (SCA) in Enugu and compare it with their non- transfused counterparts. Methodology: The study was conducted among two hundred and sixty-nine children with SCA attending the paediatrics sickle cell clinic at University of Nigeria Teaching Hospital (UNTH) Enugu, 136 transfused SCA patients as subjects and 133 age and sex matched non-transfused SCA as controls were studied. Results: There was no statistically significant difference in the age and sex distribution of the anti-HCV positive subjects and controls P > 0.05. Majority of the subjects (66.7%) and control (71.4%) who tested positive were in lower socio-economic class. Conclusion: HCV infection is not uncommon in children with SCA. There is no significant difference in the sociodemographic characteristics of the HCV positive subjects and controls. Keywords: Sociodemographic, Hepatitis C, Sickle cell anaemia

Background Some factors are known to influence the academic performance of children with Sickle Cell Anaemia (SCA). Information on their effects in these children is limited in Nigeria. The factors which influence academic performance of children with SCA in Enugu, Nigeria are determined in this study. Methods Consecutive children with SCA aged 5–11 years were recruited at the weekly sickle cell clinic of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Their age- and sex- matched normal classmates were recruited as controls. The total number of days of school absence for 2009/2010 academic session was obtained for each pair of pupils from the class attendance register. Academic performance was assessed using the average of the overall scores in the three term examinations of same session. Intelligence ability was determined with Draw-A-Person Quotient (DAPQ) using the Draw-A-Person Test while socio-economic status was determined using the occupational status and educational attainment of each parent. Results Academic performance of children with SCA showed statistically significant association with their socio-economic status (χ2 = 9.626, p = 0.047), and significant correlation with DAPQ (r = 0.394, p = 0.000) and age (r = -0.412, p = 0.000). However, no significant relationship existed between academic performance and school absence in children with SCA (r = -0.080, p = 0.453). Conclusions Academic performance of children with SCA is influenced by their intelligence ability, age and socio-economic status but not negatively affected by their increased school absenteeism.

Background Majority of the oral diseases in children are preventable. The paediatricians owing to the unique position they occupy in child care are invaluable in achieving standard oral and dental healthcare in children. This study was aimed at assessing the paediatricians’ views on basic oral healthcare in children in Nigeria. Methods This was a cross sectional descriptive study. Respondents were paediatricians attending the 2015 Annual General Meeting and Scientific Conference of the Paediatric Association of Nigeria. Relevant information sought from the respondents included: socio- demographic characteristics, duration and location of practice; specific questions on knowledge of basic oral health care in children and recommendations for improvement in knowledge of oral and dental health among paediatricians based on standard clinical guidelines. Data was analyzed using the SPSS version 20.0 and presented in simple frequencies and percentages. Test of associations was done using chi- square while logistic regression analysis was used to determine significantly associated variables (p

Background Urinary tract infection (UTI) is a common cause of childhood morbidity and mortality in the tropics. Children with sickle cell anemia (SCA) may have compromised kidney function arising from repeated vaso-occlusive episodes and recurrent symptomatic or asymptomatic UTI. Objectives This study aims at determining the prevalence of asymptomatic bacteriuria and sensitivity pattern in children with homozygous sickle haemoglobin compared to children with normal haemoglobin. Methods One hundred children with SCA in stable state and 100 children with normal haemoglobin aged 2-12 years were screened for asymptomatic bacteriuria using midstream urine samples. The samples were incubated aerobically at 37°C for 24 hours within one hour of collection. Children whose urine samples yielded significant bacteriuria (≥105cfu/ml) on two consecutive cultures were regarded as having asymptomatic bacteriuria. Results Asymptomatic bacteriuria was noted in 6% of children with SCA and occurred more in females than males (F: M = 5:1) when compared to 2% in children with normal haemoglobin. Escherichia coli was the commonest organism isolated (33.3%). All the organisms were resistant to co-trimoxazole and ampicillin while most were sensitive to gentamicin, ceftriaxone and the quinolones. Conclusion The risk of asymptomatic bacteriuria is three times more common in children with sickle cell anemia than in children with normal haemoglobin. It is therefore important to screen SCA patients, especially the females for UTI and should be treated according to the sensitivity result of the cultured organisms.