Congenital heart disease in school children in Lagos,Nigeria: Prevalence and the diagnostic gap

Congenital heart disease (CHD) in low‐and‐middle income countries (LMIC) is often characterized by late presentation resulting from inadequate screening and healthcare access in these regions. Accurate estimates of the burden of CHD among school children are often lacking. The objective of this study was to determine the prevalence and distribution of CHD among school children in two communities (urban and semi‐urban) in south western Nigeria. Using clinical assessment and portable echocardiography, 4107 school children aged 5 years to 16 years in Lagos, Nigeria, were selected using a multistage sampling procedure and screened for CHD. Diagnosis of CHD was made after echocardiography. Children identified with CHD were referred to a tertiary hospital for appropriate cardiac care. The 4,107 children screened had a mean age of 11.3 ± 2.7 years and 53.7% were females. Twenty seven children had echocardiography‐confirmed CHD, representing a prevalence of CHD among school children in Lagos, Nigeria of 6.6 per 1000 children. Acyanotic CHD constituted 96.3% of detected cases. Two children diagnosed with CHD (Tetralogy of Fallot and severe pulmonary valve stenosis respectively) had successful intervention. The prevalence of previously undiagnosed CHD among school children in Lagos Nigeria is substantial and highlights gaps in the health care system and school health programs. Echocardiographic screening of school children provides an opportunity for missed early diagnosis and treatment of CHD and reduces the prevalence of first‐diagnosed CHD in adulthood. Therefore, focused clinical examination of school children followed by echocardiography is a strategy that could bridge this diagnostic and treatment gap in CHD.     

Prevalence of echocardiographic left atrial enlargement among hypertensive Nigerian subjects

BackgroundLeft atrial enlargement (LAE) predispose to arrhythmias, atrial thrombogenesis and cardioembolic stroke. Whether LAE constitute a major risk among African hypertensive subjects is not well described. This study was aimed to describe the epidemiologic pattern of LAE among hypertensive subjects and determine their correlates.MethodsClinical and demographic details of 414 hypertensive subjects used were taken. Echocardiography was done. LAE was defined as Left atrial dimension (LAD)>3.7 cm. Statistical analysis was done using SPSS 17.0.Result414 subjects including 258 (62.3%) males were recruited. The mean age was 56.8±16.8 years. LAE was present in 57.73% of hypertensive subjects. Those with LAE were likely to be older (58.23±14.5 vs. 54.8 ±19.7 years, p<0.05), had a higher waist circumference (88.1 ±26.8 ±75.8 ±28.4 cm, p<0.05), left ventricular mass index (79.2 ± 12.4 vs. 48.7 ±15.5g/m2.7, p<0.05) and a higher frequency of left ventricular hypertrophy (LVH) (65.3% vs. 40.0 %, p<0.05) respectively than those without LAE. LAD was significantly higher among those with LVH than those without LVH (41.4 ±8.4 vs. 35.6 ±5.9 mm respectively, p<0.05).ConclusionLAE is common among Nigerian hypertensive subjects. Age, waist circumference, left ventricular wall dimension and mass index are the important correlates of LAE in hypertensive Nigerians.     

Microalbuminuria in normal Korean children

Purpose

Although microalbuminuria is known as a predictor of clinical nephropathy and cardiomyopathy, few studies have investigated the incidence and reference range of microalbuminuria in healthy children. This study aimed to establish a reference range and to study the age-related trend for spot urine microalbumin/creatinine ratio in a Korean pediatric population.

Materials and Methods

352 healthy children were studied from July 2007 through March 2010. Height, weight, serum creatinine, spot urine microalbumin/creatinine ratio, and glomerular filtration rate (GFR) were obtained for each subject. We divided the study population into 5 groups according to age, and compared the spot urine microalbumin/creatinine ratio with other variables using one-way analysis of variance (ANOVA), regression analysis and Pearson''s correlation analysis.

Results

In this study, the data showed that the spot urine microalbumin/creatinine ratio decreased with age: 1-12 months, 22.72±13.80 mg/mmol (2SD: 3.33-54.40 mg/mmol); 13-28 months, 16.34±9.58 mg/mmol (2SD: 3.16-35.19 mg/mmol); 29-48 months, 13.12±9.74 mg/mmol (2SD: 3.01-41.57 mg/mmol); 4-6 years, 10.58±8.13 mg/mmol (2SD: 0.00-30.19 mg/mmol); and 7-19 years, 5.13±5.44 mg/mmol (2SD: 0.45-14.45 mg/mmol). The spot urine microalbumin/creatinine ratio showed correlation with age, height, height z-score, weight, weight z-score, GFR, body mass index (BMI) and body surface area (BSA).

Conclusion

The spot urine microalbumin/creatinine ratio in normal Korean children decreased with age. This ratio could potentially be used to establish reference ranges and cutoff values for Korean children and to predict nephropathy and cardiomyopathy.     

Sabin and wild polioviruses from apparently healthy primary school children in northeastern Nigeria

Despite significant success of the Global Polio Eradication Initiative (GPEI) in Nigeria, Afghanistan, India, Pakistan, wild poliovirus still occurs due to persistently high proportions of under and unimmunized children. The study aimed at determining the type of poliovirus often excreted into the environment. Four hundred nine fecal samples collected from apparently healthy school children aged 5–16 years in Borno and Adamawa States, northeastern Nigeria, were tested for poliovirus by tissue culture technique. The isolates were characterized further by intratypic differentiation testing and genetic sequencing. Three wild poliovirus type, 11 Sabin type, combination of Sabin‐types 1 + 2 and 2 + 3 poliovirus, and 22 non‐polio enteroviruses were obtained. The continued excretion of wild‐type poliovirus among children above 5 years old vaccinated with oral polio vaccine contributes to the persistent circulation of these viruses in the environment and may limit the population immunity. However, the excreted Sabin poliovirus is capable of immunizing the unvaccinated children and promotes herd immunity. Similarly, the excretion of combination of two polio serotypes indicates the child susceptibility to the missing serotype (s) and therefore indicates an immunity gap. The common unhygienic practices in the environment could aid the spread of these viruses through oral–fecal route. Asymptomatic transmission of wild poliovirus among older oral polio vaccine‐vaccinated children poses a serious threat to polio eradication program in Nigeria and therefore, environmental and serological surveillance with larger sample size are important for monitoring poliovirus circulation in Nigeria. J. Med. Virol. 84:358–364, 2012. © 2011 Wiley Periodicals, Inc.     

A comparative study of the prevalence of zinc deficiency among children with acute diarrhoea in SouthWestern Nigeria

BackgroundZinc deficiency has been associated with increased incidence, severity and duration of childhood diarrhoea.ObjectiveThe objective of the study was to determine the prevalence of zinc deficiency among under-five children with acute diarrhoea.MethodsThe study was a comparative cross-sectional study in which serum zinc levels were determined using atomic absorption spectrometry in under-five children with acute diarrhoea and in apparently healthy contols. Two hundred and fifty children with acute diarrhoea and 250 controls were studied at the Wesley Guild Hospital, Ilesa, Nigeria.ResultsThe diarrhoea patients had a mean ± SD serum zinc level of 78.8 ± 35.6 µg/dl, while the controls had a mean of 107.3 ± 46.8 µg/dl. The mean serum zinc level was significantly lower in the patients than the controls (t = -7.66; p < 0.001). Furthermore, the prevalence of zinc deficiency was significantly higher among the patients (30.4% versus 12.4% in the controls; OR = 3.09; 95% CI = 1.94 – 4.90; χ2 = 24.08; p < 0.001). Low social class was associated with a significantly higher prevalence of zinc deficiency among the patients (p = 0.013).ConclusionZinc deficiency is significantly associated with diarrhoea among under-five children in the study community. Hence, routine zinc supplementation should be encouraged for the treatment of diarrhoea, and availability should be ensured.     

Prevalence of overweight and obesity in Chinese children and adolescents from 2015

Background: To update the prevalence of overweight and obesity in children and adolescents from 2015.

Methods: Data for this study were obtained from children and adolescents aged 7–17?years with measured weight and height from the National Surveys on Chinese Students’ Constitution and Health in 2015.

Results: Measurements from 29 418 children and adolescents (14 480 boys and 14 938 girls) were analysed. Among children and adolescents aged 7–17?years, the prevalence of obesity was 13.2% (95% CI?=?12.8–13.7%) in 2015. Moreover, the prevalence of obesity for children aged 7–12?years (20.3% (95% CI?=?19.5–21.1%)) was significantly higher than in adolescents aged 13–17?years (9.6% (95% CI?=?9.2–10.0%)) (p?< 0.001).

Comment: Obesity was much worse in children than adolescents in China; future studies are warranted to understand why these differences may be occurring.     

Awareness and uptake of human papilloma virus vaccines among female secondary school students in Benin City,Nigeria

BackgroundThere is no Government endorsed HPV vaccine immunisation program in Nigeria. The Vaccine has been available at the University of Benin Teaching Hospital (UBTH) in Benin City for more than 7 years.ObjectivesThe aim was to evaluate awareness about HPV, the prevalence of HPV immunisation and its associated factors among the study population.MethodsA cross-sectional study using interviewer-administered questionnaires among 215 females attending secondary schools in Benin city, Nigeria. Participants were selected using multi-stage stratified sampling. The primary outcome measure was HPV immunisation of the girls.ResultsThe majority of the participants were between 14 to 18 years (58.6%). Almost all the participants (>97%) had not heard of HPV, HPV Vaccines and Cervical cancer. In addition, 2 (0.9%) persons correctly identified that the virus can be transmitted sexually while only 1 person (0.5%) had received the HPV vaccine. The respondents all agreed that they needed to be enlightened about HPV, HPV vaccines and Cervical cancer. Majority (49.3%) of the girls suggested that this could be done through the mass media (49.3%) or their parents (32.1%).ConclusionHPV immunisation, knowledge of HPV vaccines and Cervical cancer among the study population was very low. We recommend interventions in Schools to increase knowledge about cervical cancer and HPV vaccines.     

Adolescent low back pain among secondary school students in Ibadan,Nigeria

Background

Adolescent low back pain (ALBP) can be considered a signal or precursor of a serious organic disease or telltale sign of future incidence of low back pain in adulthood. Published articles on ALBP in Nigeria are not readily available.

Objectives

The study''s objectives were to investigate the prevalence of Adolescent Low Back Pain (ALBP) among secondary school students in Ibadan, Nigeria and the prevalence''s association with some socio-demographic variables.

Methods

Participants were adolescent students from 15 secondary schools in Ibadan. Data was collected using a respondent-administered, validated questionnaire on low back pain in adolescents. Participants (Female: 298; Male: 273) aged 14.23 ±2.27 years (range 10–19) were recruited through multi-stage random sampling. Five hundred and seventy-one (83.97%) of the 680 copies of the questionnaire administered were returned. Data was analysed using mean, standard deviation, frequency, percentages, and Chi-square test with alpha level at 0.05.

Result

Lifetime, twelve-month, one-month and point prevalence rates of ALBP were 58.0%, 43.8%, 25.6% and 14.7% respectively. Age at first experience of ALBP was 11.86 ± 2.36 years. Gender was not significantly associated with any rate (p ≥0.317). Age (p ≤ 0.043) and engagement in commercial activities (p ≤ 0.025) were significantly associated with all period prevalence rates while injury to the back was significantly associated with all period prevalence rates except point prevalence (p = 0.087).

Conclusion

Adolescent low back pain is common among secondary school students in Ibadan and its prevalence is significantly associated with age and engagement in commercial activities, but not with gender.     

Prevalence of obesity among school children in the United Arab Emirates

The objective of this study was to investigate the prevalence of obesity among schoolchildren in the United Arab Emirates, using the body mass index (BMI) as the indicator. The sample included 1,787 males and 2,288 females 6–16 years. Physicians and trained nurses measured height and weight, and the BMI (kg/m²) was calculated. The 50^th centile of the BMI was not different from that for the US. Similarly, the height and weight of UAE children approximate the US reference data. About 8% of UAE boys and girls have BMI's ≥95^th percentile of US reference values. Using the 85^th percentile as the criterion, 16.5% and 16.9% of males and females, respectively, are classified as overweight. This composite figure does not differ from the expected 15% based on reference data. The data thus indicate that high levels of obesity are present among UAE children and adolescents. These findings have public health implications for this generation of UAE youth during their adult years, including heart disease and diabetes, because the rate of morbid obesity is approximately twice that expected in reference data. Am. J. Hum. Biol. 12:498–502, 2000. © 2000 Wiley-Liss, Inc.     

广州市中专生的抑郁状况及影响因素分析

目的了解广州市中专生抑郁情绪的发生情况并探讨可能的影响因素,为其心理健康教育及咨询提供依据。方法应用Zung′s抑郁自评量表（SDS）及自制抑郁相关因素调查表对224名广州市某职业学校学生进行调查。结果 SDS总标准分为（47.92±9.50）,抑郁检出率为42.0%;非条件Logistic回归分析结果为和父母一起居住是抑郁的保护因素（OR=0.259）,学习成绩差、家庭经济困难是抑郁的危险因素（OR=1.783、1.896）;抑郁状况在1周内感到孤独的天数、是否想过离家出走、是否想过自杀等方面的分布差异均有统计学意义（P〈0.05）。结论广州市中专生抑郁较严重,可通过让学生和父母一起居住、改善由学习成绩差及家庭经济困难带来的心理负面影响以降低其抑郁情绪的发生。     

Ten-Year Trends of Metabolic Syndrome Prevalence and Nutrient Intake among Korean Children and Adolescents: A Population-Based Study

PurposeMetabolic syndrome (MetS) comprises a cluster of risk factors for future cardiovascular and metabolic diseases. Only a few recent studies have reported the trend in the prevalence of MetS in youth. This study aimed to analyze trends in the prevalence of MetS and nutrient intake in the last 10 years and investigate the changes in MetS components among Korean children and adolescents.Materials and MethodsWe analyzed the data of 9513 children and adolescents aged 10–19 years from the 2008–2017 Korean National Health and Nutrition Examination Surveys. Diagnosis of MetS was based on the International Diabetes Federation (IDF) and modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria.ResultsBased on the IDF criteria, MetS prevalence increased from 1.53% in 2008 to 3.19% in 2017 (p=0.007). Based on the NCEP-ATP III criteria, MetS prevalence increased from 2.18% in 2008 to 3.19% in 2017; however, the increase was not statistically significant. Daily calorie and fat intakes increased significantly during the study period. Among the risk factors that MetS comprises, the prevalence rates of central obesity, low high-density lipoprotein cholesterol levels, and high fasting glucose levels increased significantly.ConclusionOver the last 10 years, the prevalence of MetS has grown significantly with increasing calorie and fat intake in Korean children and adolescents. Central obesity and high-density lipoprotein cholesterol and fasting glucose levels have worsened. Therefore, active support and close monitoring are required to control MetS and prevent further increase in the prevalence of cardiovascular diseases.     

A survey for neutralizing antibodies to the three types of poliovirus among children in Maiduguri, Nigeria

The milestone in polio eradication program is to protect effectively children aged 0–5 years against the three serotypes of poliovirus. It became necessary to measure the level of neutralizing antibodies to the three poliovirus types in an endemic State in Nigeria. Neutralizing antibodies to the poliovirus types among children aged 0–5 years was estimated using micro neutralization assay. Of 129 children, 99 (76.8%), 95 (73.6%), and 95 (73.6%) had neutralizing antibodies with the geometric mean titer of 42.7, 31.3, and 33.2 for the poliovirus type 1, 2, and 3, respectively. Fifty‐three percent of the children were protected against the three types of poliovirus. Combination of poliovirus types 1 and 2, 1 and 3, and 2 and 3 were neutralized by 62.8, 58.9, and 61.2% of the children studied, respectively. Only poliovirus type 1 induced antibody titres ≥1:1,024. The number of children with neutralizing antibodies after receiving three doses was significantly higher than those who received one or two doses of oral polio vaccine (P ≤ 0.05). However, those who received more than three doses of oral polio vaccine showed no significant difference in their antibody response. The existence of immunity gap poses a risk of re‐emergence of the paralytic poliovirus. The existence of unimmunized and unprotected children along with high birth rate could impede the success of polio vaccination in Nigeria. Elimination of non‐compliance to polio vaccine, promotion of health education and documented evidence of vaccination of each child with the parents may facilitate the success of polio eradication program in Nigeria. J. Med. Virol. 84:691–696, 2012. © 2011 Wiley Periodicals, Inc.     

中国小学生欺侮行为和受欺侮者的发生率

本文报告了对北京一小学6年级267名12～13岁小学生中欺侮行为和受欺侮者发生率的研究结果。尽管中国社会反对攻击行为和控制攻击的力量很强,但在学龄儿童中欺侮人的行为以及受欺侮者仍容易见到。本文是在著者对中国儿童攻击行为原有研究基础上进行的。     

Prevalence of anaemia among rural pre-school children of West Bengal,India

Background: Micronutrient malnutrition is a major public health nutritional problem in India, and iron deficiency anaemia (IDA) continues to be a major nutritional problem of public health significance, affecting all physiological groups, of which rural pre-school children are the most vulnerable.

Aim: The main aim of the present study was to assess the prevalence of anaemia among rural pre-school children.

Subjects and methods: A community-based cross-sectional study was carried out in rural areas of West Bengal State during 2002–2003. A total of 437 pre-school children were covered for the estimation of blood haemoglobin levels.

Results: A majority (81%) of the rural children of West Bengal were anaemic, and the prevalence was significantly (p<0.001) higher among 1–3-year-old (91%) as compared to 4–5-year-old (74.6%) children. A significantly (p<0.01) higher proportion of 1+ (OR=7.7; 95% CI: 2.6–22.4) and 2+ year children (OR=3.0; 95% CI: 1.5–6.0) and those belonging to lower socio-economic Scheduled Caste and Scheduled Tribe communities were at risk for anaemia (OR=2.3; 95% CI 1.3–3.9).

Conclusions: The prevalence of anaemia is a severe nutritional problem of public health significance. Therefore, iron supplementation and health and nutrition education programmes should be strengthened. The community needs to be encouraged to diversify their diets by consuming iron-fortified and iron-rich foods.     

Predicting who will have asthma at school age among preschool children

It is difficult to distinguish at preschool age whether a wheezing child will or will not have asthma at school age. A prediction rule for asthma in preschool children might help to determine a prognosis and to study improvements in treatment and prevention. This review discusses (1) the development and use of clinical prediction rules, (2) the European Respiratory Society Task Force classification of wheeze at preschool age, (3) published prediction rules developed to identify preschool children who will have asthma at school age, and (4) recommendations to improve asthma prediction. Prediction rules are currently created more frequently, yet their clinical use remains low. The classification of episodic wheeze and multiple-trigger wheeze in preschool children shows conflicting results as to whether episodic wheeze and multiple-trigger wheeze differ in clinical features and has limited value in predicting asthma at school age. Clearly, more studies are needed to confirm this. Currently available prediction rules aiming to identify preschool children having asthma at school age are of modest clinical value. Prediction can be improved by more precise definitions and measures and, ultimately, by more knowledge of pathophysiologic mechanisms. In the future, biomarkers and genomic risk profiles to develop personalized medicine might further improve asthma prediction, treatment, and prevention.     

Microalbuminuria: A novel biomarker of sepsis

Context:

Diffused endothelial dysfunction in sepsis leads to an increase in systemic capillary permeability, the renal component manifesting as microalbuminuria. The degree of microalbuminuria correlates with the severity of the acute insult, the quantification of which may serve to predict sepsis and mortality in critically ill patients.

Aims:

To evaluate whether the degree of microalbuminuria could differentiate patients with sepsis from those without and predict mortality in critically ill patients.

Settings and Design:

Prospective, non-interventional study in a 20-bed Intensive Care Unit (ICU) of a tertiary care hospital.

Methods and Materials:

After exclusions, between Jan-May 2007, 94 consecutive adult patients were found eligible. Albumin-creatinine ratio (ACR, mg/g) was measured in urine samples collected on ICU admission (ACR1) and at 24 hours (ACR2).

Results:

Patients were classified into two groups: those with sepsis, severe sepsis and septic shock (n = 30) and those without sepsis [patients without systemic inflammatory response syndrome (SIRS) and with SIRS due to noninfectious causes] (n = 64). In the sepsis group, median ACR1 [206.5 (IQR129.7-506.1)] was significantly higher compared to the non sepsis group [76.4 (IQR29-167.1)] (P = 0.0016, Mann Whitney). The receiver operating characteristics (ROC) curve analysis showed that at a cut off value 124 mg/g, ACR1 may be able to discriminate between patients with and without sepsis with a sensitivity of 80%, specificity of 64.1%, positive predictive value (PPV) of 51.1% and negative predictive value (NPV) of 87.3%. The median ACR2 [154 (IQR114.4-395.3)] was significantly higher (P = 0.004) in nonsurvivors (n = 13) as compared to survivors [50.8 (IQR 21.6-144.7)]. The ROC curve analysis revealed that ACR2 at a cut-off of 99.6 mg/g could predict ICU mortality with sensitivity of 85%, specificity of 68% with a NPV of 97% and PPV of 30%.

Conclusion:

Absence of significant microalbuminuria on ICU admission is unlikely to be associated with sepsis. At 24 hours, absence of elevated levels of microalbuminuria is strongly predictive of ICU survival, equivalent to the time-tested APACHE II scores.     

Nose and throat complications associated with passive smoking among Congolese school children

Objective

To assess associations between nose-throat (NT) diseases and passive smoking prevalence among school children.

Methods

A cross-sectional survey was carried out on a randomized multistage sample of 381 school children (50.9% males, aged 9.8 ± 3.5 years) from Kinshasa town. Parents and children were asked to fill in a questionnaire detailing their smoking habits. The NT symptoms and diseases were assessed by the survey NT specialist.

Results

The prevalence of passive smoking was 38.6% (n=147). Residence in peripheral areas, catholic school system, elementary level, exposure of family to passive smoking ,history of NT surgery, medicines and menthol inhaling, headache, nasal pain, dysphagia, odynophagia, dysosmia, dysphonia, pharyngeal irritation, dry throat, snooze, and chronic pharyngitis were more reported by passive smokers. After adjusting for confounding factors, passive smoking (OR=16.7 95%CI 3.3–83.3), catholic system(OR=2 95%CI 1.2–3.2), and elementary degree(OR=1.4 95%, CI 1.1–2.1) were identified as independent determinants of chronic pharyngitis.

Conclusion

Parents should not smoke in the same room used by their children.     

Prevalence and characteristics of Hymenoptera venom allergy in urban school children aged 6 to 18 years living in Trabzon

Background/aim Hymenoptera venom allergy is one of the leading causes of systemic allergic reactions in both adults and children. The present study was conducted to evaluate the prevalence and characteristics of Hymenoptera venom allergy in urban school children aged 6 to 18 years living in Trabzon.Materials and methods In this cross-sectional, two-level survey study, children were recruited using random sampling of public primary and secondary schools. Firstly, parents were asked about their child’s age and sex and whether their child had ever been stung by any kind of bee. When they responded “yes” to the last question, they attended a face-to-face interview at the outpatient clinic for the second part of the survey, which included information about history of insect stings and the presence of atopic diseases.Results Of 17,000 children, 7904 (46.5%; 3718 males, 47.0%) returned the first-level questionnaire. A total of 4312 (54.5%) were stung at least once in their lifetime. Males had a significantly higher risk of being stung (59.4%, odds ratio: 1.44, 95% confidence interval: 1.32–1.58, p < 0.0001). The second-level questionnaire was completed for 545 (12.6%) of the children. Of 950 stings reported in 545 children, 5.2% were large local reactions (LLRs), 1.9% were generalized cutaneous reactions (GCRs), and 1.3% were systemic reactions (SRs). The stinging insect was Apis mellifera and Vespula in 66.2% and 33.8% of stings, respectively (p < 0.001).Conclusion Hymenoptera stings are common in urban school children living in Trabzon. The most common type of allergic reaction is LLR and the most reported stinging insect is Apis mellifera .