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Nigerian Journal of Paediatrics
Vol. 28 No. 4, October 2001
Abstracts
Johnson A'WBR, Aderele WI, Osinusi KO, Gbadero DA.
Community-acquired Pneumonia in Hospitalized Urban Young Nigerian
Children:Clinical and Haematological Correlates of Diagnosis and
Outcome. Nigerian Journal of Paediatrics 2001:28:101.As part of a
comprehensive hospital-based study of acute lower respiratory
infections (ALRI) in under-five urban Nigerian children, we
sought to identify the possible clinical and investigative
correlates of lobar versus bronchopneumonia, and the possible
determinants of mortality in community-acquired pneumonia. Over a
30-month period, 419 cases of ALRI were studied; pneumonia
accounted for 323(77.1 per cent) of these. Of those with
pneumonia, bronchopneumonia (BP) was diagnosed in 234 (72.4 per
cent), lobar pneumonia (LP) in 66 (20.4 per cent), while 23(7.1
per cent) had features of both. BP alone (BPA) and LP alone (LPA)
without concomitant respiratory syndromes were diagnosed in
127(39.4 per cent) and 39 (12.1 per cent) cases , respectively.
Although there was an overall annual preponderance of BP
admissions, the peak admissions for LP was recorded in the
harmattan months of November through January. The overall mean
age was 15.7 months, but compared with those with LPA, BPA cases
were significantly younger (mean ages, 14.2 13.8mo. for BPA vs.
19.514.2mo. for LPA, p=0.021), had a significantly shorter mean
duration of cough (p=0.044), and a higher prevalence of
convulsion (p=0.02). Furthermore, concomitant measles, heart
failure, and severe anaemia were significantly commoner among
cases with a diagnosis of BP (p=0.018, 0.033, & 0.009
respectively). On the other hand, LPA cases were associated with
a significantly higher prevalence of cigarette smoking in the
household (p=0.038; RR=1.86; 95%CI=0.93-5.80), grunting
respiration (p=0.01), and a higher mean admission temperature
(p=0.03). Also, pleural effusion and sickle cell disease
correlated more frequently with a final diagnosis of LP (p=0.00
& 0.01 respectively). Similarly, compared with BPA cases,
significantly higher white blood cell (WBC) counts and polymorphs
were recorded in LPA cases (p=0.002 & 0.01). A fatal outcome
was recorded in 35(10.8 per cent) cases. Mortality was
significantly higher in those with pre-admission antimicrobial
use (p=0.04), a combination of diarrhoea and vomiting (p=0.025),
domestic firewood burning (p=0.023), and malnutrition (p=0.0003).
A fatal outcome was also significantly associated with longer
symptom duration for cough (p=0.002), fever (p=0.002), poor
feeding (p=0.016), higher mean WBC counts and polymorphs (p=0.013
& 0.023 respectively). Harmattan season, grunting
respiration, longer symptom-duration, and pleural effusion
correlated most frequently with a final diagnosis of LP, while a
younger age, anaemia, heart failure and measles were more
frequently associated with BP. The association of fatality with
malnutrition, pre-admission antibiotic use, concomitant
alimentary symptoms, longer symptom-duration, and high
WBC/polymorph counts suggests the need for factoring these
parameters into evolving a regional paediatric pneumonia severity
index and therapeutic decision algorithms.
Oyelami OA, Adesunkanmi ARK,
Ajibola AJ, Agbakwuru EA. Management of Burn injuries by Daily
soaking in Normal Saline prior to Dressing. Nigerian
Journal of Paediatrics 2001; 28:115.A review of
121 children with burn injuries admitted over a five-year period
(January 1992 – December 1996) at the Wesley Guild Hospital,
Ilesa was undertaken. The patients were soaked in normal saline
for at least one hour daily, prior to dressing with topical
application of silver sulphadiazine. Scalds were responsible for
67 per cent of the cases while naked flame, including kerosene
explosion and therapeutic burns were responsible for the rest.
The burns were categorised as major in 58 per cent of cases. The
trunk was affected in 66 per cent of cases, the upper and lower
limbs were each affected in 51 per cent, the head and neck in 30
per cent, and the hands and feet in 25 per cent. Wound infection
was the commonest complication occurring in 16.5 per cent, while
mortality was 6.6 per cent; these were lower than the 24.4 per
cent and 7.7 per cent respectively, obtained in previous studies
in the Unit when saline solution was not used. Similarly, the
rates of contractures and severe anaemia were lower among those
whose burns were soaked in saline (5 per cent vs 10.9 per cent,
and 2.5 per cent vs 10.3 per cent, respectively). Although the
rates were lower in the present study except for septicaemia, the
differences did not reach statistical significance except for
severe anaemia. However, the study thus indicates that soaking of
burn injuries in saline prior to dressing may improve prognosis.
Oladipo OO, Ajala MO, Afonja OA. Plasma Creatinine, Age and
Body Surface Area in Nigerian Children and Adolescents. Nigerian
Journal of Paediatrics 2001; 28:119. In a bid to
establish reference values for plasma creatinine in children and
adolescents using age, and body surface area (BSA), 462
apparently healthy Nigerian children/adolescents aged one day to
15 years were studied. They were recruited from well baby
clinics, as well as primary and secondary schools. Plasma
obtained from venous blood was analyzed for its creatinine in
batches, employing the kinetic Jaffe method. There was a positive
correlation between age and plasma creatinine (r = 0.27,
p<0.001) and between BSA and plasma creatinine (r = 0.28,
p<0.001). No gender difference was demonstrable. A multiple
regression equation was obtained which relates age, BSA and
plasma creatinine as follows: y = 30.97 + 99x1 +
0.023x2, where y = plasma creatinine in mol/L, x1
= BSA in M2, and x2 = the age in months.
Two regression curves related plasma creatinine to age and to
BSA. The values obtained should be useful for patient care
because each child has his/her own predicted reference value
according to the surface area and age; they should also serve as
baseline reference values for healthy Nigerian children and
adolescents.
Oparaocha HU, Ibadin MO, Muogbo DC. Immediate Post-delivery
Infant Feeding Practices in Benin City. Nigerian Journal
of Paediatrics 2001; 28:123. A prospective and
community based study which was carried out in Oredo LGA of Edo
State between March and June, 1998, was predicated on the fact
that immediate post-delivery breast-feeding is essential to the
success of exclusive breast-feeding. Using a semi-structured
questionnaire, the immediate post-delivery breast-feeding
practices were assessed in 780 mothers. Mothers who had children
aged less than one year were selected using a multistage cluster
sampling method. Immediate post-delivery breast-feeding was
significantly associated with the place of delivery of the index
infant (p <0.05), the facility utilized in the latest
antenatal care (p <0.05), maternal age (p <0.05), maternal
education (p <0.05) but not maternal religion (p >0.05) or
maternal occupation (p >0.05). Only 52.4 per cent of the
respondents practised immediate post-delivery breast-feeding.
Improvement in this index of infant nutrition would require
addressing these maternal socio-demographic parameters.
Runsewe-Abiodun I, Olowu AO, Olanrewaju DM, Akesode FA.
Efficacy of the African Breadfruit (Treculia
africana) in the Nutritional Rehabilitation of
Children with Protein-energy Malnutrition. Nigerian
Journal of Paediatrics 2001; 28:128. One hundred and
fifty children with mild to moderate malnutrition (Group A) aged
six to 66 months were recruited from four semi-urban/rural
communities within Ikenne Local Government Area of Ogun State.
They were offered supplementary feeds of African breadfruit (Treculia
africana) porridge for a period of 12 weeks. Their
anthropometric response to the feeds was compared with that of
controls who were not offered the feeds and consisting of (a) 106
well-nourished children of the same ages recruited from within
the same communities (Group B), and (b) 53 other children (Group
C) of similar ages with similar grades of malnutrition. Observed
prevalence of malnutrition in the study population ranged between
51.5 per cent and 64 per cent. No case of kwashiorkor was
observed. During the study period, the mean weight gain of
children in Group A was at 2.78kg 1.16, significantly greater
than corresponding figures of 0.l8kg 1.26 and 0.25kg 0.91 in
Groups B and C, respectively (p = 0.0000). However, the
nutritional supplementation did not significantly affect the
heights (p = 1.000). An improvement in the mid-upper arm
circumference (MUAC) was observed in children in group A who
gained a mean of 1.10cm during the study; this gain was 16 times
and twice the mean gains by Groups B and C, respectively. The
breadfruit porridge was found to be acceptable to 96.7 per cent
of group A children, and no adverse reactions were reported or
observed. African breadfruit is thus suggested as a good, locally
available and acceptable food of high nutritive value in the
nutritional rehabilitation of children with mild to moderate
protein-energy malnutrition.
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