Search

Objective: To determine the neonatal morbidity and mortality pattern in a cohort of infants bom outside hospital but admitted in Abha Maternity Hospital, Saudi Arabia. Patients and Methods: The charts of 151 women and their infants born at home or en route to the hospital were reviewed and the findings were compared with those of 300 in-hospital (in-bom) deliveries from January 1990 to December 1996. Results: Of the 151 unattended deliveries, 36 percent occurred at home and 64 percent in i motor vehicles. Eighty-three percent of the out-born and 63 percent of the controls had no antenatal care. The incidence of respiratory distress syndrome (RDS) was significantly higher :p=0.002) among the out-born cases. Perinatal mortality among the out-born deliveries was 1.7 percent, in contrast to the 1.0 percent in the in-born group. Conclusion: Despite adequate health facilities and governmental financial support, lack of health education and initiative on the part of the patients might be a major contributing factor to the high level of unattended deliveries with the associated adverse outcome. Inten sive health education with emphasis on the need for antenatal care and on the dangers of dclivering infants outside health facilities is advocated.

Background: Malaria, earlier considered rare in neonates, has been reported with increasing frequency in the last decade. Neonatal malaria diagnosis is challenging because the clinical features are non-specific, variable and also overlap with bacterial infection. Aim: To determine the prevalence of neonatal malaria and the associated clinical features in newborn babies with fever. Patients and methods: One hundred and fifty neonates with fever admitted into the Newborn unit of the University of Calabar Teaching Hospital, over a six month period, were recruited consecutively. Symptoms and signs for each neonate were documented. Blood film for malaria parasites and investigation for sepsis workup were done before commencement of drugs. Results: One hundred and fifty babies were recruited. Most (85.3%) of the babies were aged ≤7 days. One hundred and thirty six (90.7%) of the mothers were booked for antenatal care (ANC). Most of the babies were from primiparous women (54.7%). Six babies (4%) had malaria parasitaemia with four (2.7%) being congenital malaria and two (1.3%) acquired malaria. Plasmodium falciparum was the only species identified. All six with malaria were from the 136 booked mothers. Four of the affected six neonates also had septicaemia. The clinical features in babies with malaria only were, fever, fast breathing and jaundice while those with malaria and bacterial co-infection had, in addition, poor suck. Conclusion: Malaria infection and septicemia can coexist in some Nigerian newborns and since the clinical presentation of each of these condition are closely similar, it is recommend that malaria parasite investigation be included as part of the investigation in the newborns with fever. This approach can help to avoid a delay in applying the appropriate therapeutic intervention

Iron deficiency is the most prevalent micronutrient malnutrition globally. It is known to affect both children and adults especially pregnant women largely in the developing countries. Iron is not only important for haemoglobin synthesis but also for normal brain development. In the body, the ferrous form is converted into ferritin which is the active molecule. The brain is especially sensitive to variation in iron availability, in part due to the high metabolic demands of the brain that are supported by iron. Iron is necessary for basic neuronal processes such as myelination, neurotransmitter production, and energy metabolism. With neuroimaging support, Globus pallidus, caudate nucleus, putamen, substantia nigra and the hippocampus have been of primary interest in studies of iron because they show robust and quantifiable levels of iron content. Furthermore, these regions are central to cognitive abilities that develop across childhood and adolescence, such as processing speed, cognitive-motor control, reward-processing, and working memory function. The hippocampus per se plays important roles in the consolidation of information from short-term memory to longterm memory, and in spatial memory that enables navigation. Low iron levels in pregnant women correlates with low ferritin levels in their foetus and newborns whereby several studies have clearly demonstrated the effect of iron on developmental milestone regarding cognition and behaviour. Iron deficiency early in life, therefore, confers irreversible brain dysfunction even after complete brain iron repletion. Iron therapy and replenishment of brain ferritin may revert to normal cognitive functions in adults and adolescents but not in children. Rich sources of iron are meat, liver, dark leafy green vegetables, fish, poultry, peas and beans. Pregnant women require routine daily iron supplement; lactating woman and all children should be fed balanced diet. Special iron supplement should be provided for preterm and small-for-gestational-age infants from the age of two months.

six months and 12 years (mean age 4.3 years) in Calabar, has revealed foreign body impaction in the throat to be the commonest cause, occurring in 40.0 percent of the cases. Children, aged between five and 10 years, were commonly involved in foreign body impaction which was caused by coins and food (meat and fish bones) in 31.8 and 27.3 percent respec tively, of the 22 cases. Oesophageal stricture due to accidental ingestion of caustic soda was found in 14.5 percent of the cases and involved children in the age group, six to eight years. The cause of dysphagia was however, unknown in 25.5 percent of the patients. Malnutrition (56.4 percent) and aspiration pneumonia (27.3 percent) were the major complications in the series. It is concluded that most of the causes of dysphagia in the series are preventabl

Summary: The case of a three-and-half-year old male child with the severe form of erythema multiforme (EM) major (Stevens-Johnson syn drome) is described. From the past medical history, the child had seven previous attacks of a similar disease in the immediate past 24 months. The first four attacks of the disease were considered, by their description, to be mild EM minor, as the lesions were limited to the skin, while the next four recurrences, including the present one, were regarded as severe, with extensive involvement of the skin, mucosae of the mouth, nose, eyes and urethral orifice, that required hospitalization. Each recurrent episode of the disease was causally related to self-medication with pyrimethamine-sulfadoxine (Fansidar). With the current frequent and indiscrimi nate use of Fansidar and other sulphonamide-containing substances as alternatives for chloroquine-resistant malaria, physicians should be alerted to the possibility of an upsurge in the prevalence and recurrent attacks of EM, minor or major, in malaria-endemic areas of the developing world.

Summary: Six children with AIDS, aged between eight and 27 months, are reported. As these patients and their mothers were HIV-positive, the mode of transmisssion was considered to be vertical. In the seventh, well and asymptomatic, but HIV-positive infant, transmission of the infection was through transfusion of contaminated blood that was donated by an HIV-positive father. Of the three fathers screened, two tested positive for HIV. Four of the seven HIV positive infants originated from the Cameroon, while three were resident in Nigeria. The disease manifested within the first four months of life in five patients and at the age of 14 months in one patient. Marasmic features, chronic diarrhoea, pneumonia, generalized lymphadenopathy, oropharyngeal candidiasis and dermatoses were the main clinical features. Management of the patients and the families included symp tomatic treatment and counselling. Four of the patients died, three of these in the hospital and one at home.

Summary: The problems of the African child with HIV infection potentials are quite unique because of the global increase in the incidence of HIV infection and the increased birth rate in the poverty-strickens parts of Africa with high inother-to-infant transmission rate of HIV infection. AIDS is still an incurable disease and very costly in controlling; therefore, health work- en ers should direct their efforts towards prevention and health education. It is possi ble to adopt very basic and routine procedures to protect the African newborn from mother-to-child HIV contamination; these include the disinfection of the birth be passage during labour, mandatory elective caesarean section on all infected moth- boala ers, the avoidance of episiotomy and invasive traumatic procedures across the placental barrier or on the foetus and heat sterilization of breast milk. It appears that the hope for chemoprophylaxis against AIDS in Africa in the nearest future is very slim in view of the current astronomical pricing mechanism. This pessimism regarding drugs should, hopefully, not apply to vaccines. Ethical principles of justice require that those who bear the risks of the trials, should have a commen surate share in the benefits of any effective vaccine. Africa has constituted a fertile ground for most HIV vaccine trials and therefore the people should be given first access to the vaccine. Manufacturers of the vaccines should indefinitely make the A vaccine available free, or at least, at substantially reduced prices to the citizens of the host countries. Perhaps, there is wisdom in suggesting a pricing system in which the rich industrialised countries effectively subsidize the distribution of the vaccines in the developing nations.

Summary: Records of 9,200 infants born with meconium staining of the amniotic fluid in Abha Maternity Hospital, Saudi Arabia, during the period January 1985 to December 1997, were reviewed in order to compare the morbidity and mortality patterns in those receiving oropharyngeal as against those receiving intratracheal suctioning. Of this number, 6,050 (65.8 percent) were intubated for intratracheal suctioning while the remaining 3,150 (34.2 percent) were suctioned down to the oropharynx only. Regardless of the method of suctioning, the incidence of meconium aspiration syndrome (MAS) was the same (7 percent) in both groups. The consistency of the meconium, physical condition of the infant at birth, and whether the pharynx and vocal cords were meconium stained or not, did not appear to influence the frequency of MAS. However, morbidity as determined by the need for prolonged administration of oxygen (48,0 percent vs 79.4 percent) or mechanical ventilation (13.0 percent vs 39.9 percent) was comparatively less among the infants intubated for suctioning in the delivery room. Similarly, the frequency of pneumotho rax (7.8 percent vs 32.6 percent), persistent foetal circulation (5.0 percent vs 18.5 percent) and fatality rate (1.9 percent vs 10.3 percent) were less in those who were intubated. These find ings support the need for routine intubation for intratracheal suctioning in every meconium stained infant regardless of his condition at birth.

Background: Cranial nerve palsies are common clinical problem routinely encountered in neurological practice; the dysfunction can occur at any point in the course of the nerve and may point to serious pathology. The aim of this study was to determine the pattern and underlying aetiology of cranial nerve palsies in Nigerian children. Method: Children in the Children’s Emergency Unit and the Children’s Ward of the University of Calabar Teaching Hospital, Calabar, Nigeria, with neurological problems over a 12-month period (January through December 2012), were recruited into the study. Each child was admitted and evaluated by the Paediatric Neurology Unit. Those with cranial nerve palsies were selected for detailed analysis. The biodata, clinical features and relevant laboratory results were documented. Results: Of the 285 with neurological problems 23 (8.1%) had cranial nerve palsies. Fifteen (65.2%) of the children had single cranial nerve palsies while eight (34.8%) had multiple cranial nerves involvement. Of the 43 nerves involved, the facial nerve was the commonest (38.3%) followed by the oculomotor (23.5%) and abducens (20.6%). Intracranial infections such as meningitis, viral encephalitis and brain abscess were incriminated in 60.8% of the patients and 70.6% of the nerves involved. Conclusion: Cranial nerve palsies cause handicap and cosmetic problems. It is recommended that every child with cranial neuropathy should be evaluated for intracranial infections among other differentials. Prompt diagnosis, treatment and immunisation against related infections is paramount.

An epileptic fit does not only manifest as bizarre motor activity but can destabilize autonomic functions. Abnormal electrical discharge originating from the cerebral cortex can spreads to involve the autonomic system thus creating a dysfunction of the sympathetic and the parasympathetic which modulate the cardiorespiratory, digestive, genitourinary systems. The autonomic phenomenon can be encountered in simple partial, complex partial, generalised tonic-clonic, absence and generalized tonic seizures. Both the motor and the autonomic components may manifest simultaneously; at times the autonomic symptoms may precede or outlastthe motor components. Autonomic features affecting the cardiopulmonary function may be life-threatening and contributes to 8-17% of deaths in individuals with epilepsy. Hypoventilation, apnoea, atrial fibrillation, sinus arrhythmias, atrial and ventricular premature depolarisations, bundle branch block and asystole are known to manifest in the peri-ictal and also in interictal phases of epilepsy. Poor control, and polytherapy in the management of patients, render some epileptics more vulnerable toexcessive excitability of the autonomic nervous system. The aim of this communication, therefore, is to alert and remind healthcare givers on the autonomic phenomena of epileptic fits some of which may result in sudden unexpected death. Clinician should always take a holistic approach in the evaluation of epilepsy patients and watch out especially for cardiorespiratory variability during and in-between attacks.

Summary: An outbreak cf measles that occurred among 11 of 16 inmates of an overcrowded motherless babies home in Calabar is presented. The last child, aged eight months, to be admitted into the home, was also the first to develop symptoms of measles, 11 days after admission; thus, it is suggested that this child was incubating the disease before his admission. The patients were aged, between four months and nine years, four patients were below the age of nine months, while six were aged between nine and 18 months; four of these six patients had been immunized against measles. Fifty percent of the 16 inmates were malnourished and of these, 87.5 percent developed measles. Complications of measles consisted mainly of diarrhoea, dehydration and bronchopneumonia. The case fatality was 27.3 percent. It is suggested from the present findings, that immunization of children at the age of six months and perhaps, below, in an environment of poverty and overcrowdiness should be a policy in our immunization schedule.

Children with epilepsy have a significantly higher rate of death than the general population. The cause of premature death among epileptics is contributed by the underlying cause, coexisting neurologic compromise and the epilepsy itself. Mortality directly related to seizures in paediatric epilepsy is the subject of this review. Seizure-related deaths in epileptics arise from status epilepticus, aspiration pneumonia, as well as sudden and unexpected death in epilepsy (SUDEP). Epilepsy per se enhances the risks of accidents and suicide. Children with epilepsy who are otherwise neurologically intact and with normal neuroimaging findings have an exceedingly low risk of seizure-related death. Poor compliance to antiepileptic drugs (AED), poorly controlled (intractable and refractory) seizures, impaired cognition, structural/metabolic aetiology and antiepileptic drug polypharmacy tend to carry poor prognosis. Therefore, parents need to be appropriately advised about the risk of seizurerelated premature death. Early identification, compliance with AED prescription, and treatment of comorbid conditions can reduce mortality risk and improve health outcomes in children with epilepsy. Children with intractable types of epilepsy may benefit from medical marijuana and neurosurgery.

Background: Demyelinating disorders of the central nervous system (CNS) are rare disorders characterized by inflammation and the selective destruction of CNS myelin. The incidence of this disorder is increasing in developed countries. Nigerian studies on the pediatric population on the subject are very scarce., Aims: The aim of the study was to document the epidemiology, clinical profile, and impact of late presentation on the treatment outcome of demyelinating diseases of the CNS in pediatric patients., Methods: The retrospective review of patients aged 1-15 years admitted in a tertiary hospital from January 2018 to December 2022 with various symptoms suggestive of demyelinating CNS disorders. The diagnosis was clinically and radiologically confirmed. Information retrieved from the case notes included patients' demographics, clinical symptoms and signs, number of days with symptoms to presentation in the hospital, results of the magnetic resonance imaging (MRI), treatment, and treatment outcomes. Data were entered in Excel sheet and results were presented in tables and percentages., Results: The incidence of demyelinating disorders over the period was 0.013% (10 out of 769 patients admitted over the period). Acute demyelinating encephalomyelitis (ADEM) was the most common disorder seen in the study population (60%, n = 6), followed by transverse myelitis and two (20%) had optic neuritis (ON). Most of the patients with ADEM were in the 1-5-year age group. The female-to-male ratio was 2.3:1. Paraplegia, visual impairment, and ataxia were the most common clinical presentations in the study population. One of the patients met the criteria for the diagnosis of multiple sclerosis during follow-up. Human immunodeficiency virus (HIV) was identified as the cause of demyelination in one case. Most of the patients improved with steroids., Conclusion: ADEM was the most common clinical phenotype seen in this study. Patients with ADEM and ON had a better prognosis than transverse myelitis. Late presentation was also identified as a poor prognostic factor. Follow-up of cases is very important to monitor disease progression to multiple sclerosis., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Background: Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis., Aim: To determine the hematological indices in febrile newborn with malaria parasitemia., Materials and Methods: One-hundred fifty neonates (0-28 days) with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14., Results: One-hundred fifty babies were recruited into the study. Most (85.3%) of the babies were aged ≤7 days. Six babies (4%) had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl) even when parasite count was low (average of 30.6/µl) though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization., Conclusion: Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.

Malaria contributes to high childhood morbidity and mortality in Nigeria. To determine its endemicity in a rural farming community in the south-south of Nigeria, the following malariometric indices, namely, malaria parasitaemia, spleen rates, and anaemia were evaluated in children aged 2-10 years. This was a descriptive cross-sectional survey among school-age children residing in a rubber plantation settlement. The children were selected from six primary schools using a multistaged stratified cluster sampling technique. They were all examined for pallor, enlarged spleen, or liver among other clinical parameters and had blood films for malaria parasites. Of the 461 children recruited, 329 (71.4%) had malaria parasites. The prevalence of malaria parasitaemia was slightly higher in the under fives than that of those ≥5 years, 76.2% and 70.3%, respectively. Splenic enlargement was present in 133 children (28.9%). The overall prevalence of anaemia was 35.7%. Anaemia was more common in the under-fives (48.8%) than in those ≥5 years (32.8%). The odds of anaemia in the under fives were significantly higher than the odds of those ≥5 years (OR = 1.95 [1.19-3.18]). Malaria is highly endemic in this farming community and calls for intensification of control interventions in the area with special attention to school-age children.

Background: The complex of Down Syndrome-hypothyroidism-pericardial effusion is largely unreported in sub-Sahara., Objective: To present and highlight an unusual manifestation of hypothyroidism., Methods: A 16-year-old girl with confirmed Down Syndrome presented with complaints of generalised body swelling of eight months' duration. Her work-up consisted of full clinical and laboratory evaluation including ECG and echocardiography., Results: The patient was diagnosed of Down's Syndrome at birth but was lost to follow-up after at eight years of age. Body swelling was associated with clinical features of heart failure. Echocardiography showed massive pericardial effusion. Serum l-thyroxine was less than 0.5mg/dl and TSH >40iu/l. The heart failure and menstrual irregularities responded to l-thyroxine therapy., Conclusion: This appears to be the first report of the complex of Down syndrome, hypothyroidism and pericardial effusion in a Nigerian child. Thyroid function test is therefore recommended as a part of baseline investigation for Nigerian children with Down syndrome as is the practice.

Background: Locked-in syndrome is an extremely difficult neurologic condition to recognize, especially by the non-specialists. A case of locked-in syndrome in a 41-year old Niger Deltan Nigerian with relapsing remitting form of multiple sclerosis (MS) is presented, including a detailed literature review., Patient and Case Report: The patient was in a state of spastic quadriplegia, motionless and aphasic (mute), with the preservation of consciousness and the ability to open and blink the eyes and move them vertically. Two episodes of the disease, varying in duration, have been described. The diagnosis of MS was made from the history and the typical clinical presentation: history of relapsing and remitting signs and clinical evidence of multi-focal involvement of the central nervous system., Conclusion: Patient died at the age of 45 years, from pulmonary complications. This article may enhance easy recognition and management of the syndrome by all clinicians.

This study was conducted to determine the frequency of antenatal intrauterine fetal death (IUFD) and the associated maternal and fetal risk factors in women who presented at a regional tertiary hospital in Saudi Arabia. Over a 5-year period, 191 consecutive cases of IUFD presented and were studied prospectively. Relevant maternal and fetal data were obtained. The stillbirth rate during the period was 10 per 1000 deliveries. In 41% of the cases, the associated causal factors could not be determined. There was a significant (P = 0.00122) linear trend showing an increased risk of IUFD above the age of 20 years and, similarly, a significant (P = 0.00047) linear trend after the first pregnancy. Lack of antenatal care (88.5%), hypertensive diseases in pregnancy (12%) and diabetes mellitus (8%) were associated risk factors while 'major congenital malformation' (14%) was an outstanding fetal factor. The risk factors of antenatal stillbirth in our community seem to be avoidable. Health education to encourage the utilisation of the available antenatal care services, family planning and genetic counselling are being advocated strongly as possible preventive measures.

Objective: This study aims to determine the incidence of prelabor rupture of membranes (PROM) in a tertiary care institution, the bacterial pathogens involved in maternal and neonatal colonization, and the major bacterial pathogens of neonatal sepsis in PROM., Methods: This prospective study was conducted over 2 years from March 1999 to February 2001 in Abha Maternity Hospital, Abha, Kingdom of Saudi Arabia. Consecutive admissions of infant-and-mother pairs with PROM constitute the subjects of this survey. Every mother had endocervical swab taken before delivery, and their infants had surface swabs and sepsis screening before starting antibiotic therapy., Results: The incidence of PROM was 12.6 per 1000 live births. Premature delivery rate was 54.6% while, the overall prematurity rate was 7.2%. The major microorganisms involved in genital colonization of the mothers were coagulase negative Staphylococcus (CONS) (24%), Klebsiella pneumoniae (13%), Pseudomonas aeruginosa (11.3%) and Enterococcus species (11.3%). The infants were colonized largely with CONS (31%), Klebsiella pneumoniae (18%) and Escherichia coli (E.coli) (17%). Fourteen percent of the infants were infected but in only 6% was septicemia documented (Staphylococcus aureus, 3 cases and 1 case each with CONS, group B Streptococci (GBS) and E.coli). In contrast to Western experience, the incidence of GBS was uncommon in both mothers and infants. The bacterial pattern suggests vancomycin and cefotaxime or aminoglycoside combination as empirical antibiotic therapy for both infected infants and selected contaminated mothers with PROM., Conclusion: Generally, it appears wasteful to routinely admit, screen and empirically treat all infants born after PROM; only ill infants, febrile mothers, or either, with associated chorioamnionitis deserve antibiotic treatment.

Objective: The aim of this prospective study was to evaluate the prevalence and pattern of congenital malformations of the gastrointestinal tract among the Saudi newborn population in Aseer region, Kingdom of Saudi Arabia., Methods: Every consecutive newborn admitted to the neonatal intensive care unit of Aseer Central Hospital, Kingdom of Saudi Arabia with features of gastrointestinal tract anomaly during the period January 1995 to December 2000 had relevant data obtained and entered into a program form., Results: During the 6 year period, a total of 1386 Saudi infants were admitted into the neonatal intensive care unit of Aseer Central Hospital. Of these, 12.4% were confirmed to have congenital malformation of the gastrointestinal tract; male/female ratio of 1.7:1. The total number of live births by Saudi mothers in Aseer region during the period was 128,093, giving an incidence rate of 1.3 per 1000 live births. The 172 newborns presented with 174 anomalies of the gastrointestinal tract. The leading malformations were imperforate anus (78 cases or 44.8%), tracheosophageal fistula/atresia (42 cases or 24.1%) and intestinal atresia (37 cases or 21.3%). Other lesions included Hirschsprung's disease (14 cases or 8%) and stenosis (2 pyloric and one duodenal) (1.7%). Some patients had more than one defect within the tract (1%) and multisystemic defects (23%). The overall fatality rate was (12%), due largely to post-operative infection (75% of cases) and multiple anomalies (25% of cases)., Conclusion: The prevalence of congenital defect of the gastrointestinal tract in Aseer region appears to be high. The incidence of associated multisystemic anomalies is also high. Fatality incidence is influenced by post-operative sepsis and associated multiple defects. A high incidence of consanguineous marriage in the region may be the underlying etiological factor hence genetic counseling may be helpful.

Objective: The objective of the present study was to measure the prevalence of asthma and asthma-related symptoms among male school children in Abha City and to determine some of the possible risk factors influencing its occurrence., Methods: A randomly selected sample of 4300 male school children aged 7 to 15 years in Abha were subjected to a previously validated questionnaire for asthma to be completed by parents. Asthma was identified based on the Rush Medical College and International Study of Asthma and Allergies in Children questionnaire. Information of asthma family history, asthma related symptoms, and other atopic conditions, smokers in the family, pets ownership and monthly family income were collected., Results: The overall prevalence of asthma was 9% (95% Confidence Interval: 7.73%-9.67%). Doctor-diagnosed asthma was reported by 4%, exercise-induced asthma by 4% and wheeze in the past year by 8%. Multiple logistic regression analysis showed that positive family history of atopic condition (Odds Ratio=437.11, P<0.001), pets ownership (Odds Ratio=2.91, p<0.001), and lower monthly family income (Odds Ratio=2.00, P<0.02) were significant factors influencing the development of asthma., Conclusion: In conclusion, the screening methodology adopted in this study could be applied for all children at the beginning of the school year, being simple and non-invasive measure. The prevalence of asthma in school children in Abha is greater than that reported from most developing countries and closer to the rates reported in developed countries. Avoidance of pets ownership at home, improving social class and premarital counselling for atopic persons are all recommended.

Objective: To determine the prevalent bacterial agents of neonatal meningitis and their antibiotic susceptibility in a referral intensive care unit in Assir Central Hospital, Saudi Arabia, during the years 1993-1998., Methods: Records of newborn infants with positive cerebrospinal fluid culture during the period were retrospectively studied., Results: There were 1473 nursery admissions, of which 32 episodes of meningitis occurred amongst 31 neonates. Klebsiella pneumoniae (31%) and Serratia marcescens (21%) were the main pathogens. The incidence of concurrent septicemia among these infants was 58%. Klebsiella pneumoniae appears to dominate in both early and late onset infections. The sex incidence was equal and the mortality rate was 48%., Conclusion: The survey identifies Klebsiella pneumoniae and Serratia sp. as the leading bacterial agents of neonatal meningitis in our environment. The relatively high frequency of Serratia infection in the present survey appears unique as this organism is comparatively rare in other reports across the globe. No Group B Streptococcus was isolated, which is in contrast to reports obtained in Europe, America and Australia where it is the predominant organism of neonatal sepsis or meningitis. Antibiogram identified imipenem and cefotaxime as the empirical antibiotics in infants with a clinical diagnosis of neonatal sepsis in our hospital; no more conventional use of ampicillin. In view of the changing bacterial pattern of infant infection with time even in the same environment, a periodic review of this subject is advocated.

Full text is available as a scanned copy of the original print version.

Full text is available as a scanned copy of the original print version.

Full text is available as a scanned copy of the original print version.

The pattern of faecal excretion of Vibrio cholerae was studied over a duration of eight months among 13 cholera convalescents by two-weekly surveillance cultures. Stools and rectal swabs were cultured on Thiosulphate citrate bile salts sucrose (TCBS) agar for the recovery of vibrio pathogens. Clinical phase and convalescent phase V. cholerae strains were compared for antibiogram profiles. The population of vibrios recovered from faecal inocula was usually scanty (<10(3) vibrios/g). All clinical isolates except three were concordant with convalescent phase strains. Sensitivity to tetracycline was uniform for concordant V. cholerae strains, with minimum inhibitory concentration (MIC) ranging from 0.54-4.0 microg/ml. Nine (69.2%) of the convalescents had positive faecal cultures for periods ranging from two weeks to more than seven months. Two adults whose excretions lasted several months also tested positive for human immuno-deficiency virus (HIV) infections. The significance of stool surveillance cultures for identifying asymptomatic infections among convalescents who may need chemotherapy to abolish excretion is emphasised. However, it could not be established with certainty if vibrios excreted during convalescence were from enteric colonization by the causative strains, or re-infections with the common strains in circulation.

Objective: To determine the pattern and long term outcome of neurological complications following cerebral malaria (CM) in a group of Nigerian children treated in Calabar., Design: Prospective, follow up study., Setting: Children's emergency room (CHER) of the University of Calabar Teaching Hospital (UCTH) located in a malaria-holoendemic rainforest belt of south eastern Nigeria., Subjects: Survivors among 45 children with CM treated between February and December, 1991. All received intravenous quinine infusion and supportive care. Survivors (39) were followed up until detected neurological sequelae had resolved., Results: Case fatality rate was 13.3%, 95% CI. Eleven (28.2%) of the survivors developed neurological sequelae. Prolonged coma, focal seizures and abnormal posturing (decorticate/decerebrate) were associated with increased risk of sequelae. Commonest neurological sequelae were cortical blindness (3/11), speech disorders (3/11: aphasia or echolalia) and motor abnormalities (5/11: dyskinesia/hemiplegia). Eight cases recovered completely from the neurological deficits within a mean period of three (1.3) weeks. One persisted with hyperactivity and attention deficit, had a remarkable improvement at the sixth month of follow up but developed secondary dyslexia and other learning disabilities by the third year of follow up., Conclusion: Although short lived, neurological sequelae of CM appear common among these Nigerian children. This problem could significantly add to the burden of childhood disability in Nigeria. Early diagnosis, use of appropriate drugs and large scale malaria control programmes can prevent malady.

A case-control study of children attending a diarrhoea treatment unit (DTU) in Calabar, Nigeria was undertaken to evaluate the association between failure to breastfeed on one hand, and dysentery, persistent diarrhoea and malnutrition on the other. The prevalence of dysentery, persistent diarrhoea and underweight were 6.3%, 1.2% and 36.4% respectively among a total of 1133 children with diarrhoea. The proportion of the children with persistent diarrhoea or underweight was significantly lower among currently breastfeeding children than the age-matched, non-breastfeeding counterparts (p < 0.05). Dysentery was also less frequent among breastfeeding children (5.8%) than the non-breastfeeding ones (7.4%), but this did not reach statistical significance. The findings lend support to the enormous benefit of breastfeeding as a child survival strategy. Global efforts geared towards the support of breastfeeding should be intensified especially the less developed countries where diarrhoea-related morbidity and mortality constitute a major public health problem.

A study was designed to determine the red cell values (hemoglobin and hematocrit) of neonates born in the high altitude of Abha and to compare these values with known values of other lowland areas of Saudi Arabia. From the cord blood of 587 normal, appropriate for gestational age and term infants born in 1993 in Abha Maternity Hospital, the ranges of Hb and Hct were 130 to 240 g/L and 0.24 to 0.79 L/L respectively. The mean Hb was 187 g/L. There was no significant difference between the male and female values. Also, 17% of the infants in this study were polycythemic, while no polycythemia was recorded in these lowland areas, and only 2% to 4% in the general global newborn population. It was therefore revealed that Abha newborns had higher red cell values at birth when compared to other newborns in the low altitude areas of Riyadh and Jeddah (P <0.001). We postulate that the high altitude (2700 meters above sea level) of Abha, and therefore its relative hypoxia, has induced high red cell values in infants born in the city. This phenomenon therefore warrants the adoption of higher red cell reference values and not necessarily those already documented in other Saudi newborn populations.

Nigerian newborns presenting with convulsion in University of Calabar Teaching Hospital, Calabar during the period January 1989 to December 1990 were prospectively studied to determine the aetiology and pattern of their seizures. There were 60 patients representing 4% of admissions into the Newborn Unit during the period. Birth asphyxia, infections and hypoglycaemia were the important identifiable aetiological factors which operated either singly (48% of cases) or in concert (in another 48%) of the infants. Detectable infections included meningitis and septicaemia caused predominantly by coliforms and Staphylococcus aureus. Hypocalcaemia and electrolyte imbalance did not feature. There was an unusually high prevalence (63% of cases) of the generalised type of seizures probably due to the high frequency of mixed aetiology. The mortality rate of 50% encountered appears to be related to the underlying aetiology and prematurity. Detectable caused of neonatal seizures in our environment appear to be potentially preventable by improved obstetric and neonatal care. There is dire need also to provide modern facilities for investigating newborn seizures in order to improve upon the diagnostic yield.

The urinary symptoms and blood pressures of 510 children (aged 5-15 years) with Schistosoma haematobium infection in Ijiman community, Cross River State of Nigeria, were studied in 1992. The prevalence rate of infection was 44%, a majority of the children presenting with light infection. Significant symptoms were visible haematuria, dysuria, suprapubic pain and strangury. The sensitivity and specificity of these symptoms were too low for them to be recommended as distinct clinical diagnostic criteria. The impact of the disease could not be demonstrated on blood pressures of the children. Nevertheless, urgent control measures with emphasis on the provision of ventilated improved pit toilets and potable water are strongly recommended for the control of the disease as persistent infection is known to mask manifestation of severe complications till an older age.

A total of 225 pre-school Nigerians were studied to evaluate the effect of anaemia on the respiratory rate of febrile children, and the influence of this on the reliability of the WHO criteria for the clinical diagnosis of pneumonia in the primary health care setting. Malaria was the commonest cause of febrile illness (63.1 pc). The prevalence of severe anaemia was 28.0 pc. The mean respiratory rate of anaemic children (53.9 +/- 12.8/min) was significantly higher than that of the non-anaemic (48.4 +/- 12.7/min; p = 0.011). Mean body temperature was not significantly different in both groups. Haematocrit was negatively correlated with respiratory rate. The positive correlation observed between temperature and respiratory rate was enhanced by decreasing haematocrit. More of the severely anaemic children (68.6 pc) exceeded the WHO respiratory rate threshold for diagnosis of pneumonia than the moderately anaemic (55.4 pc) or non-anaemic (36.1 pc). The specificity of the WHO criteria for clinical diagnosis of pneumonia decreased with decreasing haematocrit.

In a 10-year (1981-1990) retrospective study of acute intestinal obstruction in the University of Calabar Teaching Hospital, Calabar, Nigeria, of the 295 paediatric cases reviewed, the major causes were ascaris worms (25%) and intussusception (22%). Other important lesions include imperforate anus (11%), volvulus (10%), external hernias (9%) and adhesions (7%) each. Ascaris-induced and hernial obstruction were most rampant in children aged above 5 years while intussusception had its peak frequency at the ages one to 12 months. Intussusception was largely (95%) ileo-caecal; volvulus involved mainly the ileum and ileo-caecum in 50% of cases each. The obstructed hernias were more common in the umbilicus (59%) than the groin (41%). The mortality (13%) was chiefly due to associated infection but lack of expertise in management of cases cannot be ignored. Generally, the pattern of intestinal obstruction among children in this region appears markedly different from that seen in Europe and North America. There is a need to create a specialist paediatric surgical unit as a means of reducing morbidity and mortality from this condition.

A cross-sectional study of urinary schistosomiasis among 510 primary school children in Ijiman community in south eastern Nigeria was undertaken in May 1992. Schistosoma prevalence and intensity of infection including the impact of the disease on the physical growth and school performance of the subjects aged 5-15 years was assessed. Prevalence of Schistosoma haematobium was 44 pc with the rate rising progressively with age, with a peak prevalence at 10-15. The ova burden was of light intensity (1-49 ova/10 ml) in a majority (73 pc) of the cases. No significant impact of the disease could be demonstrated regarding anthropometric parameters, school attendance and academic performance among the infected children compared with the controls. The lack of discernable effect of S. haematobium infection on these parameters is similar to the general pattern in the west African sub region and is attributed to the generally light ova burden among these children. It is also suggested that differences in the strains of the parasite between regions may be important determinants of morbidity.

A house-to-house survey of paediatric deaths which occurred from January to December 1991 in the village of Nko, Cross River State, Nigeria, was carried out. Among the 471 total deaths recorded, the leading causes were malaria (29%), protein-energy malnutrition, pneumonia and diarrhoeal disease (11% each). Neonatal deaths were largely due to septicaemia, tetanus and birth asphyxia. Poor domestic and human waste disposal, lack of portable water and basic health facilities appear to be the important related factors to child health problems in this community. The provision of public toilets, safe water, primary health care centres and health education can definitely improve the health status of this rural community. Events in other rural communities in Nigeria are most likely to be similar to that in Nko. Such populations need to be identified and their problems urgently addressed.

Following rumors of some persistence of abuse on twins, a survey was conducted from January through June, 1991 in the rural areas of Efik, Ibibio and Annang tribes of South-Eastern Nigeria to determine the current attitude of the people towards twins and their mothers. Of the 619 women interviewed, 56% cherished having twins; 35% would not desire largely because of the economic and other minor difficulties associated with their up-keep but none of these would abandon the infants. The remaining 9% hold a taboo against twins: as babies derived from the devil, non-human and punishment from the gods for sinfulness. Consequently, 2.3% and 2.6% of the mothers would have their twins rejected and killed respectively and 6% of the twin mothers would be cast out but none killed by their husbands' families. The intention to perpetuate this form of abuse was elicited in all the three tribes but seemed relatively to be most pronounced in Annang people. The information generated, though limited to rural population, suggests that the rejection of twin births has actually not yet disappeared from this part of the country. Health workers in South-Eastern Nigeria who encounter twins with failure to thrive should consider rejection as a possible contributing factor. It would need intensive moral education and religious teaching to stem this brutal culture.

From January through December 1988 the causative factor of each case of childhood seizure seen in the Children's Emergency Room of the University of Calabar Teaching Hospital, Calabar, Nigeria, was prospectively studied with a focus on the relative importance of malaria-related seizures. Of the 134 seizure cases seen, febrile convulsion (FC) formed the majority (55%) with cerebral malaria (CM) as the only major (33%) rival. Other conditions such as meningitis, epilepsy, hypoglycaemia and drug poisoning together (12%) played a minor role. Malaria was the dominant cause (73%) of FC; 81% of these cases did not respond to chloroquine. On comparing the number of cases of CM accumulated in the same unit from 1986, there was a significant increase (P < 0.001) in the proportion of yearly CM admissions from 1986 through 1988. The study confirms the premier position of malaria in the causation of childhood seizures and also suggests a possible upsurge in the prevalence of CM in the environment. This upsurge probably derives from the emergence of chloroquine-resistant Plasmodium falciparum (CRPF) reported in Nigeria which appeared to have been identified in the present study. While more studies are needed to confirm this hypothesis, clinicians in areas of CRPF are alerted about a possible upsurge in CM in their locality.