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Background: Repeated crises in children with sickle cell anaemia (SCA), which is a manifestation of disease severity, results in depletion of their minimal tissue folate stores, with higher likelihood of folate deficiency. The study aimed to determine the relationship between disease severity and the folate status of children with SCA attending University of Nigeria Teaching Hospital (UNTH), Enugu. Methods: This was a hospital based, cross-sectional study conducted between September 2018 and March 2019. One hundred participants were recruited, consisting of 50 children having sickle cell crisis and 50 age and gender matched hae- moglobin AA genotype controls. Relevant information was documented using a pretested questionnaire. Sickle cell severity score was determined using frequency of crisis, admissions and transfusions in the preceding one year, degree of liver and splenic enlargement, life-time cummulative frequency of specific complications of SCA, leucocyte count and haematocrit. Results: Folate deficiency was observed in eight percent of the subjects and none of the controls. The difference was not significant (Fisher’s exact = 4.167, p=0.117). The odds of being folate deficient was 8.5 times more likely during anaemic crisis than in vaso-occlusive crisis, though not significant (95% C.I 0.05 – 89.750, p = 0.075). The mean SCA severity score was 8.06 ± 3.64, signifying a moderate SCA severity in the study population. There was a no relationship between folate status and severity of SCA (Fisher’s exact = 0.054, p = 0.949) Conclusion: Folate status in children with SCA is not affected by their disease severity. Therefore, there may be no need for additional folate supplementation with increasing severity of sickle cell anaemia. Keywords: Sickle cell anaemia; disease severity; folate status; children; Enugu.

Folic 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.To 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.This 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.The 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, p0.001). 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, p0.001).Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state.

Children with sickle cell anemia (SCA) usually face psychological complications especially depression. Assessment of depression in resource-limited settings may help identify the extent to which the children with SCA in such settings may need its introduction as part of routine care. This study aimed to assess depression in children and adolescents with SCA in a low-resource setting. This cross-sectional observational study involved 84 children and adolescents with SCA aged 7-17 years who were selected using a systematic random sampling technique. Their controls were 84 age- and sex-matched individuals with AA hemoglobin genotype. A structured questionnaire was used to collect socio-demographic data while depression was assessed with the Children's Depression Inventory. The prevalence of depression was non-significantly higher in subjects compared to the controls (8.3% vs. 2.4%) (Fisher's χ

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

Background: Asthma prevalence is rising worldwide. Amongst the various factors influencing asthma control, the magnesium level of the affected individuals seems to make a major contribution to achieving asthma control through i ts anti - inflammatory and bronchodilation effects.This study therefore was aimed at determining the magnesium level of stable asthmatic children and its relationship, if any, with their levels of asthma control.Methods: A cross-sectional study where the serum magnesium levels of 30 stable asthmatic children attending Asthma clinic and those of 30 children without asthma attending Children Out-patient clinic (CHOP) both at the University of Nigeria Teaching Hospital (UNTH), Enugu, were assessed using atomic absorption spectrophotometer. The levels of asthma control of children with asthma were assessed using asthma therapyassessment questionnaire (ATAQ). Mean serum magnesium levels of the different asthma control levels were compared using the analysis of variance (ANOVA).Results: The mean ages of children with asthma and those without asthma were 10.4 ± 2.98 years and 10.5 ±3.00 years respectively. The mean serum magnesium level of stable children with asthma (1.13 ±1.04 mmol/L) was found to be significantly lower than those of the non-asthmatic controls (1.46 ±1.01 mmol/L), p= 0.004.A significant association was also found between the serum magnesium levels and the levels of asthma control (p = 0.015).Conclusion: This study shows that the serum magnesium level of stable asthmatic children is significantly lower than that of children without asthma and there is a significant association between the mean serum magnesium levels and their levels of asthma control. Keywords: Serum magnesium, asthma control, stable asthma

Objective Our study sought to assesses the knowledge and awareness of individual sickle cell genotype among adolescents. Methods Participants were recruited from a large school in Southeast Nigeria where adult prevalence of sickle cell trait is 25%. Data was collected through a 50-item survey with previously pretested questions that assessed awareness of individual genotype, general knowledge of sickle cell disease, perception of sickle cell trait and sickle cell anaemia (SCA). Additionally, self-reported genotype was compared to the school’s admission records to determine accuracy of self-reported genotype. The knowledge scores were summed on a binary basis with one point assigned for a correct answer while zero was given for an incorrect response. Results Four hundred and nine (409) students were approached and enrolled in the study. A vast majority (94%) of the respondents reported being aware of their genotype and two-thirds had the awareness during school admission. However, in specific knowledge of sickle cell, majority (89.7%) of the participants miscalculated the probability of having a child with SCA in married carrier couple and 71.9% misidentified the proportion of Nigerians with sickle cell trait. Assessing level of knowledge of sickle cell, only very few of the adolescents (7.3%) were found with the expected high knowledge scores of 7–8. Conclusion Although a significant proportion of respondents were aware of their genotype, most were unaware of the implications of sickle cell trait and thought that people with sickle cell trait also have symptoms of sickle cell disease. Also, only a few of the respondents have the expected level of sickle cell knowledge. A focused educational intervention among this age group is crucial as they embark on making reproductive health decisions.

The Clinical Summary and Reasoning Format (CSRF) was designed by the Faculties of Paediatrics of the National Postgraduate Medical College of Nigeria and the West African College of Physicians. The form is recommended for routine use in clinical practice as well as for training and examination purposes. The form has sections for documenting information derived from interacting with an index patient and sections for documenting sequential deductions on the way to various levels of diagnosis. The levels of cognition required to complete different sections of the Clinical Summary and Reasoning Format (CSRF) vary in complexity. The CSRF is potentially useful for assessing the quality of a clinician's clinical reasoning process. Such assessment will be enhanced by having a grading system for completed CSRF forms. In turn, grading contents of the form should reflect complexity of the levels of cognition required for the various sections. The present paper evaluated the sections of the CSRF with reference to the modified Bloom's Taxonomy of cognition and also proposed a grading scheme for assessing CSRF forms completed by trainees.Le format de résumé clinique et de raisonnement (CSRF) était conçu par les Facultés de Pédiatrie du National Collège médical de troisième cycle du Nigeria et de l’Afrique de l’Ouest Collège des médecins. Le formulaire est recommandé pour la routine utilisation dans la pratique clinique ainsi que pour la formationet l’examen Fins. Le formulaire comporte des sections pour documenter les informations dérivé de l’interaction avec un patient index et des sections pour documenter les déductionsséquentiel les sur le chemin de diverses niveaux de diagnostic. Les niveaux de cognition requis pour compléter différentes sections du résumé clinique et du raisonnement Le format (CSRF) varie en complexité. Le CSRF est potentiellement utile pour évaluer la qualité d’un processus de raisonnement clinique du clinicien. Cette évaluation sera amélioré par la mise en placed’un système de classement pour le CSRF complété Formes. À son tour, le contenu de classement du formulaire doit refléter complexité des niveaux de cognition requis pour les différents sections.Le présent document a évalué les sections du CSRF avec référence à la taxonomie modifiée de bloom de la cognition et a également proposé un système de notation pour l’évaluation des formulaires CSRF complété par des stagiaires. Mots-clés: Cognition, Raisonnement clinique, Évaluation, Notation.

Patients' records are often bulky and unwieldy, necessitating the creation of summaries. A structured summary format adds the advantage of improved organization and easier retrieval of information. However, typical clinical summary formats do not document intermediate deductions linking symptomatology to diagnosis and to that extent fall short of tracking the cognition process of the clinician. The Clinical Summary and Reasoning Format of the Faculties of Paediatrics of the National Postgraduate Medical College of Nigeria and the West African College of Physicians was designed to track the clinical thought and reasoning processes of clinicians. It consists of two major sections. The first section is for documenting data from history, physical examination and early laboratory reports while the second section is for recording hierarchical deductions on the way to reaching various levels of diagnosis. Definitions and descriptions of the various components of the format are herein presented. The usefulness of the format for clinical practice, clinical training and assessment of trainees is discussed.Les dossiers des patients sont souvent volumineux et peu maniables, ce qui nécessite la création de résumés. Un format de résumé structuré offre l’avantage d’une meilleure organisation et d’une récupération plus facile de l’information. Cependant, les formats de résumé clinique typiques ne documentent pas les déductions intermédiaires reliant la symptomatologie au diagnostic et, dans cette mesure, ne permettent pas de suivre le processus cognitif du clinicien. Le format de résumé clinique et de raisonnement des facultés de pédiatrie du National Postgraduate Medical College of Nigeria et du West African College of Physicians a été conçu pour suivre la pensée clinique et les processus de raisonnement des cliniciens. Il se compose de deux sections principales. La première section sert à documenter les données provenant de l’histoire, de l’examen physique et des premiers rapports de laboratoire, tandis que la seconde section sert à enregistrer les déductions hiérarchiques permettant d’atteindre les différents niveaux de diagnostic. Les définitions et les descriptions des différents composants du format sont présentées ici. L’utilité du format pour la pratique clinique, la formation clinique et l’évaluation des stagiaires est discutée. Mots clés: Cognition, Résumé clinique, Raisonnement clinique, Format, Diagnostic. Mots clés: Cognition, Résumé clinique, Raisonnement clinique, Format, Diagnostic.

Skin disorders frequently seen among primary school children are common causes of morbidity. Determining the risk factors of skin diseases, will enhance a better understanding of skin health and prevent skin diseases in school children.To determine the common risk factors of skin diseases among primary school children in Umuahia South Local Government Area of Abia State.A descriptive cross-sectional study carried out over a 4-month period among pupils of public and private primary schools. Diagnosis of skin diseases was based on clinical findings as well as laboratory investigations where indicated. A pre-tested, self-administered, close ended questionnaire was used to ascertain the risk factors of skin diseases.Eight hundred and forty-seven (847) and seven hundred and thirteen (713) subjects were recruited from public and private schools respectively. Fifty-six percent of the subjects were males. The mean age of the study participants was 8.74 ± 2.08 years. The overall prevalence of skin diseases was 40.2%. Using a multivariate logistic regression, gender, number of people per room, frequency of bathing per week and source of water were found to be significant risk factors for skin diseases.Socio-demographic factors and living conditions are significant risk factors of skin diseases. Standard hygienic practices by school children and their parents/ caregivers will help to reduce the high prevalence of skin diseases in our environment.Les troubles cutanés fréquemment observés chez les enfants des écoles primaires sont des causes courantes de morbidité. Déterminer les facteurs de risque des maladies de la peau, permettra de mieux meilleure compréhension de la santé de la peau et de prévenir les maladies les enfants scolarisés.Déterminer les facteurs de risque communs des maladies cutanées chez les élèves de l’école primaire de la zone de Umuahia South Local Government Area of Abia State.Étude descriptive transversale menée pendant une période de 4 mois auprès d’élèves d’écoles primaires publiques et privées. Le diagnostic des maladies de la peau était fondé sur les cliniques ainsi que sur des examens de laboratoire, le cas échéant. Un questionnaire pré-testé, auto-administré et fermé a été utilisé pour déterminer les facteurs de risque des maladies de la peau a été utilisé pour déterminer les facteurs de risque des maladies de la peau.Huit cent quarante-sept (847) et sept cent treize (713) personnes ont été recrutés respectivement dans des écoles publiques et privées respectivement. Cinquante-six pour cent des sujets étaient de sexe masculin. L’âge moyen des participants à l’étude était de 8,74 ± 2,08 ans. La prévalence globale des maladies de la peau était de 40,2 %. En utilisant une régression logistique multivariée, le sexe, le nombre de personnes par pièce, la fréquence des bains par semaine et la source d’eau se sont avérés être des facteurs de risque significatifs de maladies de la peau.Les facteurs sociodémographiques et les conditions de vie sont des facteurs de risque significatifs de maladies de la peau. Les pratiques hygiéniques normalisées des écoliers et de leurs parents ou parents/soignants contribueront à réduire la prévalence élevée des maladies de la peau dans notre environnement.Facteurs de risque, maladies de la peau, écoles, enfant.

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.

Background Superficial fungal infections (SFIs) are prevalent among schoolchildren and result in significant morbidities that may lead to school absenteeism or school drop-out and hence setback in the education of the child. Differences exist in the epidemiology and pattern of SFIs among children in various geographical locations. Community-based studies on diseases are a true reflection of their pattern in that locality. There are no recent studies on this regard in south-east Nigeria despite the high prevalence reported in the country. Aim This study aimed to determine the epidemiology and pattern of SFIs among children in rural and urban communities in Enugu, south-east Nigeria, for evidence-based effective interventions in this region. Methods A comparative and descriptive cross-sectional study of primary school children from three randomly selected urban communities and three randomly selected rural communities was conducted. The sample size was determined with use of the formula for comparison of two proportions. A total of 1662 pupils were recruited through a multistage sampling method, with 831 from urban primary school populations and 831 from rural primary school populations. Data were analysed with IBM SPSS Statistics version 24. Results Of the 1662 children recruited, 748 had SFIs, with 502 (60.4%) seen in urban communities and 246 (29.6%) seen in rural communities. Tinea capitis was the most prevalent SFI (73.7%), and there was a statistically significant difference between urban (40.3%) and rural (26.1%) communities (P

Background Sickle cell anaemia (SCA) is the commonest monogenic haematologic disorder resulting from the inheritance of homozygous mutant haemoglobin genes from both parents. Some factors have been identified as important in explaining the variability in depression in sickle cell anaemia (SCA). Information on this is limited in a resource-limited setting like Nigeria. This study aims to determine factors which influence depression in children and adolescents with sickle cell anaemia in a resource-limited setting. Methods Systematic random sampling technique was used in this cross-sectional study to select children and adolescents aged 7–17 years at the weekly sickle cell clinic of the University of Nigeria Teaching hospital (UNTH) Enugu, Nigeria. Pretested, structured questionnaire was used to collect sociodemographic and disease severity data while depression was assessed using the Children’s Depression Inventory. Results Age and educational level had significant positive linear relationships with depression (r = 0.253, p = 0.02; r = 0.225, p = 0.04 respectively) while gender (χ2 = 0.531, p = 0.466), socioeconomic status (χ2 = 0.451, p = 0.798) and disease severity (χ2 = 0.422, p = 0.810) had no relationship with depression in children and adolescents with SCA. Conclusion Depression in children and adolescents with SCA increased with increasing age and educational level. Psychological evaluation should be integrated into routine assessment of children with SCA during their follow up visits as they get older and progress in class.

Summary Background Nutrition plays a pivotal role in brain development throughout life. Sub-optimal intellectual ability and poor school performance are said to be among the long term effects of malnutrition. The aim of this study was to determine the association between nutritional status of the participants, their intelligence quotient (IQ) and academic performance. Methods Children aged 6–12 years who met the inclusion criteria were recruited from the public and private primary schools in the local government area using a proportionate multistage sampling technique. Weight and height were measured using standard protocols and interpreted as normal or abnormal using the World Health Organization AnthroPlus®. IQ was assessed using the Raven's Standard Progressive Matrices and was grouped into optimal and suboptimal. Academic performance was assessed using the past records of class assessment, and was classified into high, average and low academic performance. A semi-structured questionnaire was used to obtain data such as–age, gender, socioeconomic indices and family size of the study participants. Results The prevalence of underweight, thinness (wasting), stunting, overweight and obesity were 2.0%, 3.6%, 2.1%, 6.7%, and 4.2%, respectively. Indices of over-nutrition were significantly associated with optimal IQ and good academic performance. There was a trend in the association between wasting and suboptimal intelligence [AOR (95%CI) = 1.5 (1.0–3.0), p = 0.06]. Conclusion Acute and chronic under-nutrition did not adversely affect the IQ and academic performance of the study population. The relationship between over-nutrition, IQ and academic performance disappeared when socio-economic status was controlled for.

Introduction:intellectual capacity measured as intelligence quotient (IQ) is one of the determinants of school performance of children. It influences academic achievement, future personal health, social well-being and therefore, is of public health significance. The objectives of the study was to determine the intelligence quotient (IQ) and academic performance of primary school children in Enugu-East LGA. Methods:children who met the inclusion criteria were recruited from both public and private primary schools in the Local Government Area (LGA) using a proportionate multistage sampling technique. Academic performance was classified into high, average and low academic using past records of class assessment. Intelligence Quotient was assessed using the Raven´s Standard Progressive Matrices (RSPM) and was grouped into optimal and suboptimal. A semi-structured questionnaire was used to obtain data such as-age, gender, socio-economic indices and family size of the study participants. Analysis was done with Statistical Package for Social Sciences (IBM-SPSS). Results:a total of 1,122 pupils aged 6 to 12 years were recruited. Optimal IQ and high academic performance was found in 54.0% and 58.8% of the study participants. Being from upper social class, in private school, and family size less than 4 were the significant determinants of high IQ and good academic performance (p4 children) and improve the socio-economic status of families are needed environmental measures to improve intelligence and academic performance.

Intoduction: Burkitt Lymphoma is the fastest growing tumor in human and the commonest of the childhood malignancies. Generalized lymphadenopathy is a common feature of immunodeficiency associated Burkitt lymphoma but an uncommon presentation of the endemic type in Human Immunodeficiency Virus (HIV) negative children.Case presentation: The authors report a 6 year old HIV negative boy who presented with generalized lymphadenopathy, cough, weight loss, fever and drenching night sweat and had received native medication as well as treatment in private hospitals. His examination revealed hepatosplenomegaly, bull neck with generalized significant massive lymphadenopathy. Diagnosis was missed initially until a lymphnode biopsy for histology confirmed Burkitt lymphoma. He was managed on combination chemotherapy with complete resolution and now on follow up.Conclusion: To the best of our knowledge, this is the first documented report of its kind of endemic Burkitt lymphoma involving lymphnodes generally as the primary site. High index of suspicion and early biopsy are the key in this uncommon presentation.Keywords: Burkitt lymphoma, generalized lymphadenopathy, Nigerian child.

Globally, a dramatic increase in the use of television and digital media has been observed among children and adolescents in recent times. The possible health-related effects of frequent and prolonged screen media viewing on these children and adolescents have triggered many concerns among researchers.The study is aimed to determine the screen media viewing practices and caregivers' level of knowledge about the health-related effects of prolonged screen viewing time on their children. This was a descriptive cross-sectional study among caregiver/child and adolescent dyads on outpatient clinic visits.Respondents (caregivers/children's pairs) were consecutively recruited, and data was obtained using an unambiguous pre-tested semi-structured questionnaire comprising four domains: socio demographic characteristics; screen media viewing characteristics, perception of the health related effects of prolonged viewing time, and measures to limit prolonged screen viewing time in children. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 22.0 at a level of statistical significance P0.05.Of the 205 respondents studied, the majority (67.8%, fathers and 76.1%, mothers) had tertiary education. The daily mean time spent by children watching television/screen media was 2 (± 1.58) hours. Up to 89.3% of the caregivers established good standards for healthy screen-viewing in their homes. However, 52.7% of them had poor knowledge of the health-related problems of increased viewing time. Socio-economic class (P = 0.002) and knowledge level of the parents (P = 0.000) were significant predictors limiting children's screen-viewing time.Increasing screen media viewing is common among the children studied. The majority of the caregivers had poor knowledge of health-related effects of prolonged viewing time despite high educational attainment. There is a need to enlighten caregivers on the possible health effects of excess screen media viewing so as to enable them to institute stringent measures to limit the attendant health consequences on the children.

Skin disorders among primary school children are common in many countries, with a variable spectrum. They can constitute major health problems, resulting in considerable discomfort, parental anxiety, and embarrassment to the child.To determine the prevalence and pattern of skin diseases among primary school children in the Umuahia South local government area.This was a descriptive cross-sectional study carried out over a 4-month period from December 2016 to March 2017 among school children consecutively recruited from their various primary schools.A total of 1560 children aged 5 to 15 years with a mean age of 8.74 ± 2.079 years were studied. The overall prevalence of skin diseases was 40.2%. The prevalence in public schools was 46.0%, whereas the prevalence in private schools was 33.2% (P0.001). Skin eruptions and itchy skin were the most common presentations, whereas tinea capitis, pityriasis versicolor, and scabies were the most common skin diseases noted among the school children.The prevalence of skin diseases in the population studied is high, especially in public schools. The most common manifestation of skin disease is rash, and the most common type of skin disease is tinea capitis. It is recommended that standard hygienic practices should be maintained by primary school children and their parents/caregivers to prevent skin diseases.

Zinc is particularly involved in cellular growth, neurodevelopment, and immune function, which is critical for child survival. To reduce neonatal mortality in developing countries, cost-effective and evidence-based interventions that can enhance growth, development, and immunity, need to be considered. Determining the zinc levels of neonates and how it relates to both gestational age is therefore imperative.A descriptive cross-sectional study was carried out at the University of Nigeria Teaching Hospital, aimed at determining the umbilical cord serum zinc levels among neonates and their relationship with their gestational age. Two hundred and seventy-five neonates of gestational ages 28 to 42 weeks were enrolled in the study. Serum zinc levels were determined using the flame atomic absorption spectrophotometer (AAS model no. FS 240 AA.USA, Agilent Technology Ltd.).Among the 275 neonates, there were 27 (9.82%), 28 (10.18%), and 220 (80%) preterms, moderate-to-late preterms, and term neonates, respectively. The mean serum zinc level of all neonates was 87 ± 16.07 μg/dL and within the normal limit of serum zinc. Their mean serum zinc level increased with increasing gestational age (F = 90.424, P0.001). Very preterm and moderate-to-late preterm neonates had mean serum zinc levels of 65.13 μg/dL ± 6.15 and 69.85 μg/dL ± 9.63 μg/dL, respectively.This study revealed that though the overall mean serum zinc of neonates was normal, preterms (especially those of lower gestational ages) were zinc deficient. Routine zinc supplementation at birth should be considered in preterm neonates to reduce the untoward effects of zinc deficiency.

Adolescence is an important developmental period of childhood. Good health and adequate nutrition consisting major food constituents and trace elements like zinc are fundamental for optimal sexual maturation. To determine the relationship between zinc levels and pattern of breast and pubic hair development, as well as menarcheal age of female SCA children aged 6-18 years and their matched controls with hemoglobin genotype AA. Cross sectional, case-control study. Information on biodata, age at menarche, medical and drug history as well as 24-hour dietary recall was documented using interviewer administered questionnaire. Sexual maturation was assessed using Tanner staging and zinc levels determined using Atomic absorption spectrophotometer. Eighty-one subjects were compared with 81 controls. There was significant delay in the mean age of attainment of various Tanner stages of breast and pubic hair in the subjects. Mean age of 14.81 ± 1.07 years at menarche in subjects was significantly higher than 12.62 ± 1.18 years in controls (p = 0.001). Serum zinc of 58.01 ± 10.58 µg/dl in subjects was significantly lower than 68.37 ± 8.67 µg/dl in controls (p = 0.001). Serum zinc levels were found to have a significant positive relationship with stages of sexual maturation and mean age at menarche. Reduced serum zinc in children with SCA was associated with delayed sexual maturation.

Background: Thrombocytopaenia is known to complicate many neonatal illnesses and contributes significantly to morbidity and mortality. Early diagnosis and treatment are necessary to avoid complications. There are a few studies on the prevalence of neonatal thrombocytopaenia in South Eastern Nigeria. This study aimed to determine the prevalence and clinical correlates of neonatal thrombocytopaenia in South Eastern Nigeria.Methods: The prospective study was carried out over a period of eight months (December 2015 to July 2016). One hundred and fifty nine neonates admitted consecutively into the Special Care Baby Unit of the Federal Medical Centre, Owerri were recruited and evaluated for thrombocytopaenia on admission and after forty-eight hours in the study. Blood platelet was analysed using Sysmex KX-21N automatic platelet analyser and manual counting. Thrombocytopenia was defined as blood platelet less than 100×109/L.Results: The subjects included 89 (56%) males and 70 (44%) females. The prevalence of neonatal thrombocytopaenia was 6.3% on admission and 8.3% after forty-eight hours. Bleeding from orifices (p=0.012), prolonged pregnancy (p=0.047) and petechiae (p=0.020) were clinical correlates significantly associated with thrombocytopaenia. No specific clinical diagnosis was significantly associated with thrombocytopaenia, though the odds of a newborn having thrombocytopaenia was higher in certain conditions indicating increased risk.Conclusions: The prevalence of thrombocytopaenia in this study suggests that platelet count should be done for neonates admitted into special care baby units in resource-poor settings. This should be more in neonates with bleeding from orifices, prolonged pregnancy and petechiae.

BACKGROUND Evidence has shown neurocognitive problems often exist among human immunodeficiency virus (HIV)-infected children. There are limited data for children in Nigeria. METHODS This was a cross-sectional study of 100 school-aged perinatally HIV-infected children seen in the paediatric HIV clinic and age/sex-matched controls from the general paediatric clinic. Neuro-cognitive functioning was assessed using the Raven's progressive matrices (RPM) that has been adapted for the Nigerian population. RESULTS The mean RPM score of subjects was 22.97 ± 11.35 compared with 32.93 ± 15.71 among controls (p < 0.001). Twenty-two percent of subjects in the HIV-infected group vs. 56% of controls were in the above-average intelligence group on the RPM. Thirty-four percent had average scores, while 22% were in the below-average scoring range. Neuro-cognitive functioning of the subjects was significantly affected by immunologic staging and socio-economic status. CONCLUSIONS Neurocognitive functioning of the HIV-infected children was significantly lower than those of their un-infected counterparts. Neurodevelopmental evaluation should be part of standard care in HIV-infected children in Nigerian setting.

Background Cardiac complications contribute significantly to morbidity and mortality in children with HIV/AIDS. These rates have been under-reported in sub-Saharan African children. Methods This was an observational, cross-sectional Doppler echocardiographic study of ventricular systolic function, performed at a tertiary clinic on children with HIV/AIDS. Results Left ventricular systolic dysfunction was present in 27.0% of the children with HIV infection and 81.2% of those with AIDS. The mean fractional shortening in the AIDS group (31.6 ± 9.5%) was significantly lower than in the HIV-infected group (35.3 ± 10.5%, p = 0.001). A significant correlation was found with CD4(+) cell count and age, and these were the best predictors of left ventricular systolic dysfunction in the stepwise multiple regression analysis (r = 0.396, p = 0.038; r = -0.212, p = 0.025, respectively). Conclusion Left ventricular systolic dysfunction is common in Nigerian children with HIV/AIDS.

BACKGROUND Nigeria has the highest burden of paediatric HIV in the world. HIV infection may result in significant life stressors, on both the infected children and their caregivers. METHODS This included a hospital-based cross-sectional and comparative study. Subjects and controls who met the inclusion criteria were enrolled consecutively. Their socio-demographic variables were obtained and GHQ-28 was used to assess their psychosocial status. RESULTS A total of 154 caregivers of HIV-infected children (subjects) and 154 caregivers of HIV-negative children (controls) were enrolled into this study. In total, 42 (27.3%) and 112 (72.7%) of the subjects were males and females, respectively, compared with 37 (24.0%) and 117 (76.0%) of the controls, respectively. The prevalence of psychosocial disorders among the subjects and controls was 39 and 2.6%, respectively (p

BACKGROUND: The mother-to-child transmission of HIV which accounts for 90% of infections in children has been reduced markedly through the use of antiretroviral drugs by pregnant women and their newborns. Changes to the World Health Organization guidelines support further extension of the prevention of mother-to-child transmission programs with increased risk of toxicity on the fetuses. AIM: To determine the hematological indices at birth of infants exposed in utero to maternal antiretroviral drugs. METHOD: A comparative analytical study of 126 neonates whose blood samples were analyzed to determine their hematological indices. RESULT: The hemoglobin hematocrit the total white blood cell (WBC) count and absolute neutrophil count (ANC) were significantly lower in infants of HIV-positive mothers. The total WBC and ANC were also significantly lower in the highly active antiretroviral therapy. HAART group and those exposed to maternal drugs for

Poor maintenance of school environment can cause or worsen illnesses among schoolchildren. The objective of this study was to assess the healthfulness of school environments of primary schools in Enugu East, Nigeria, and to compare the difference if any between public and private schools.This was a cross-sectional noninterventional study of the school environments in Enugu East, Nigeria.Multistage sampling method was used to select the sample population. The participating schools were inspected and their head teachers were interviewed using a questionnaire. Scores were awarded using the School Health Program Evaluation scale. Results: Thirty-three schools were studied. The most common source of water for most schools was well. Eleven schools dump refuse openly. Three public schools only had functional toilets. All public schools were adequately ventilated and lit. One private school had a foodservice area. Ten schools did not have a play field, while three public schools had soaps for handwashing. The mean scores for public and private schools were 33.00 and 37.86, respectively. Three schools only attained the minimum score of 57 of a maximum of 66.The environment of primary schools in Enugu east, Nigeria, is unhealthy and unfriendly and currently cannot promote and protect the health of the schoolchildren.

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

Background: Sickle cell anaemia is one of the most common inherited disorders globally. Some affected children have retardation of physical growth which is also seen in those with zinc deficiency. Objective: To assess the relationship between zinc levels and anthropometric indices of SCA children.Methods: A crosssectional, case-control study on young females aged 6-18 years at the UNTH, Enugu. Relevant clinical data as well as 24 hour dietary recall were collected. Weights and heights were measured using standard protocols and BMI calculated. Serum zinc was determined using Atomic Absorption Spectrophotometer. Data was analyzed using SPSS version 15.0 while the level of statistical significance was set at P < 0.05.Results: Eighty-one subjects with HbSS and 81 matched controls with HbAA were studied. Mean weights of 34.58 ± 12.76kg found in patients were significantly lower than 40.19 ± 13.37kg in controls. Also mean BMI of 16.27 ± 2.76kg/m2 in patients were significantly lower than 18.40 ± 2.96kg/m2 in controls (P = 0.01). Mean heights of patients were lower than that of the controls though not significantly so (P > 0.05). Mean serum zinc levels of 58.01 ± 10.58μg/d1 in patients were significantly lower than 68.37 ± 8.6μg/ dl in controls (P = 0.01). Positive correlation was found between serum zinc and BMI of the studied children. Serum zinc has a significant relationship with weight, height and BMI.Conclusion: Reduced serum zinc in SCA children was associated with low anthropometric indices. Estimation of serum zinc is also recommended in SCA children with low anthropometric indices.Keywords: Anthropometric indices, female children, serum zinc, sickle cell anemia

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

Background: Poor growth and nutritional status are common features of sickle cell anemia (SCA) in children. The rising trend of obesity in children in developing countries has been reported despite a huge burden of undernutrition in these settings. In SCA, overweight/obesity is being increasingly reported. Aims: To evaluate the nutritional status and its determinants in children with SCA and to compare the same with hemoglobin AA (HbAA) controls of similar age, gender, and socioeconomic status. Methods: The study was a cross-sectional analytical study involving 175 subjects and controls aged 1–18 years who met the inclusion criteria. Weight and height were measured and body mass index (BMI) was calculated. Z scores were computed for the anthropometric measurements using the World Health Organization (WHO) standard reference. Hemoglobin concentration was determined using HemoCue Hb201+ Analyzer. Results: Subjects had significantly lower Z- scores for weight, height, and BMI compared with controls. Stunting, wasting, and overweight/obesity were observed in 10.9%, 24.6%, and 5.1% of subjects compared with 2.3%, 5.7%, and 9.7% respectively in controls. Wasting, stunting and overweight/obesity in SCA were significantly associated with age while overweight/obesity was significantly associated with upper social class (P = 0.001). Conclusions: Poor growth and nutritional status are still prevalent while overweight and obesity are emerging comorbidities among children with SCA in our environment. Regular nutritional assessment of children with SCA should be encouraged while those at risk of under/over-nutrition should receive adequate nutritional rehabilitation to prevent possible complications.

Aim To determine the normative values of stretched penile length in apparently healthy term Igbo newborn males in South eastern Nigeria and its relationship with gestational age, birth weight and birth length. Methods Eight hundred and eleven apparently healthy term male neonates within the first 72 h of life were studied. Enrolled subjects were consecutively delivered babies of Igbo extraction from three hospitals. The stretched penile length was measured using Schonfeld method, and the smoothed centiles (3 rd to 97th percentile values) for stretched penile length by gestational age were determined. Results The mean stretched penile length of term newborns was 3.46 ± 0.44 cm. The lower and upper limits (±2.5 SD) were 2.36-4.56 cm. Stretched penile length correlated positively with birth length and birth weight (r = 0.343, p = 0.001; r = 0.229, p = 0.001). Conclusion This study has created the first smoothed percentile values for stretched penile length by gestational age for Igbo babies.

Background: Reports show that children with sickle‑cell anemia (SCA) have a tendency for nocturnal enuresis when compared with their counterparts with normal hemoglobin. Although nocturnal enuresis in SCA has been attributed to several factors including tubular and even bladder dysfunction, its relationship with hyposthenuria has been questioned in some studies.Aim: The study aims to determine the relationship of hyposthenuria with nocturnal enuresis seen in school‑aged children with SCA.Subjects and Methods: A cross‑sectional study of seventy school‑aged children with SCA, who met the study criteria and seventy age‑ and gender‑matched controls was conducted at the Sickle‑cell Clinic, University of Nigeria Teaching Hospital in Enugu, Southeast Nigeria. The diagnosis of enuresis among the subjects and controls was based on the Diagnostic and Statistical Manual of Mental Disorders‑IV criteria while urine specific gravity (USG) was determined on dipstick urinalysis. The frequencies of categorical variables were compared using Chi‑square test or Fisher exact test as appropriate and the means of continuous variables with Student’s t‑test. The level of statistical significance was taken as P < 0.05.Results: The prevalence of hyposthenuria was 4.5% and 8.3% among enuretic and nonenuretic subjects respectively, 6.7% and 10.9% among enuretic and nonenuretic controls and 4.5% and 6.7% among enuretic subjects and controls, respectively. The differences were not statistically significant. The mean ± standard deviation USG was significantly higher in the subjects than in the controls (1.02 ± 0.01 vs. 1.01 ± 0.01, P = 0.013) and enuretic subjects than enuretic controls (1.02 ± 0.01 vs. 1.01 ± 0.01, P = 0.007). The prevalence of nocturnal enuresis was significantly higher in male subjects compared to female subjects (odds ratio [OR] [95% confidence interval (95% CI)] =8.14 (2.12, 31.24), χ2 = 12.21, P < 0.001) and male controls (χ2 = 5.57, P = 0.018). Enuretic subjects had a significantly higher prevalence of parental history of childhood enuresis (OR [95% CI] =10.39 [2.45, 44.05], P < 0.002) than the enuretic controls. The relationship between the enuretic subjects and controls with respect to age of attainment of urinary control, family size, socioeconomic class, and sibling history of enuresis were not statistically significant.Conclusions: Nocturnal enuresis in children with SCA may not be related to hyposthenuria. However, male gender and parental history of childhood enuresis are significant risk factors.Key words: Hyposthenuria, nocturnal enuresis, sickle‑cell anemia

Background:A number of factors influence sexual maturation in adolescents, including chronic illnesses like HIV. Marshall and Tanner devised a method of classifying the adolescent based on the level of sexual maturation into five stages. This study compared the Tanner staging of HIV-infected and uninfected girls.Methods:This was a cross-sectional study of 100 HIV-infected girls aged 8–18 years and 100 uninfected counterparts matched for age and social class. Using standard photographs as a guide, stages of sexual maturation were determined according to the method proposed by Marshall and Tanner. Data analysis was done with SPSS version 20. p-values Results:The study participants were aged 8–17 years. Fifty-five subjects compared to 39 controls were still in pre-pubertal breast developmental stages while 45 subjects (45%) compared to 61 controls (61%) have commenced breast development (p=0.024). Similarly, 52 subjects compared to 31 controls were in the pre-pubertal pubic hair developmental stages, while 48 subjects (48%) compared to 69 controls (69%) had commenced pubic hair development (p=0.003).Conclusions:Perinatal HIV infection affected the onset of pubic hair and breast development but did not significantly affect the attainment of sexual maturation.

Background: Childhood cancer is a leading cause of child mortality in developed countries as well as a recognized contributor to malnutrition and death in developing countries, in particular those of low socioeconomic status. It is estimated that about 50% of children with cancer in developing countries are malnourished while in developed countries, malnutrition among cancer patients is related to the type and the extent of tumor. Anthropometry is the most common and easy way for assessing the nutritional status of children. Objectives: This study aimed at assessing the nutritional status of children with cancer at the University of Nigeria Teaching Hospital, Enugu, compared with non cancer controls, by using anthropometric parameters. It also attempted to determine the best anthropometric parameter to detect malnutrition in cancer patients. Methods: Over a 36 month period, a case controlled study of children aged 3 months to 18 years with or without cancer was conducted to determine their nutritional status. The children comprised 104 patients with cancer (cases) and 104 controls seen at children’s outpatient clinic with minor illnesses. Their anthropometric measurements were taken within 24 hours of admission and at point of contact for the controls. Result: The prevalence of malnutrition was higher in cancer patients as the anthropometric parameters were significantly lower among them than the controls (WFA: t=0.019, HFA: t=0.019). Prevalence of malnutrition was higher in the low socioeconomic group. Skin fold thickness was observed to be a more sensitive indicator than weight related anthropometry in assessing the nutritional status of children with cancer. Conclusion: Children with cancer on admission were significantly more malnourished than those without cancer and will require nutritional support to reduce the morbidity and mortality arising from such illness.

In a previous retrospective study, it was observed that the greater the amounts of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the blood, the lesser the number of complications of sickle cell disease (SCD) and the higher the steady state haemoglobin level. SCD causes ischaemia-reperfusion injury and inflammation; which can be ameliorated by a metabolite of DHA that down-regulates expression of pro-inflammatory genes. The objectives of this prospective pilot study were to evaluate the effects of DHA and EPA supplements in SCD, and test the hypothesis that these effects are mediated partly by reducing inflammation. Oral DHA and EPA supplements were given to 16 SCD patients for 6 months. We then compared pre- and post-supplementation values of number of crisis, steady state Hb, plasma unconjugated bilirubin and three indices of inflammation: plasma interleukin-6, blood neutrophil and platelet counts. There was a significant reduction in the plasma level of unconjugated bilirubin, and the number of sickle cell crisis; but not in the markers of inflammation. The pilot data suggest that DHA and EPA supplements reduce the number of crisis and steady state haemolysis in SCD; but provide no evidence that these effects are mediated by reducing inflammation.