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African Journal of Tropical Medicine and Biomedical Research (AJTMBR)

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The Journal is the Official Publication of the College of Health Sciences, Delta State University, Abraka, Nigeria.

Editorial Board Editor-in-Chief

Igbtgbi PS Editor

Omo-Aghjoa L 0 Associate Editors Akhator A

Ej ebe D E Okolo A

OPjaobi A 0 Desk Editor

Aghedo 0 V

Editorial Advisory Board Aloamaka C P Braimbrafa

Feei- lVaboso P O.N. Obueku e

N

Dosumu E A

Ohj au-ObodoJ

Ekele B A

Okobia M N

Eregie 0 C

Okortofua F E

Fasubaa 0 B

Oji ho E E ISSN: 2141-6397

Focus and Scope

i nclusive o f

The African Jonrnal of T r opical ~I Iedi c~'ne and Biomedical Research is a multidisciplinarl and international journal published by the College of

playable t the A f r i can Journal f T n >pical Medicine and Biomedical Research and addressed to the Editor-in-Chief.

H ealth Sciences, D elta S t ate U n i v ersity o f

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Gynecology,

D r Lawrence Omo-Agh oj a

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A fiicanJournal of Tropi cal,tIedici no and Bi omcdical %search Vol. 1iso. 3 Jam 2012

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Af iicanJournal of Tropical,>medicine and Biomedical %search Vol.1 iso. 3 June2012

especially take care that all tables are clear and understandable by themselves, independent of the text. A reader should be able to read only the tables and easily grasp all information without

an article published in a journal and for a book: Ahmed Y, M w aba P, C h intu C , G r a n ge JM, Ustianowski A, Z u mla A. A

s t udy f maternal

mortality at th e U n i versity Teaching Hospital, I.usaka, Zambia: the emergence of tuberculosis

the text.

as a major non-obstetric cause of maternal death. Int J Tuberc Lung Dis 1999; 3: 675-680.

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Whitby LG, Smith AF, Beckett G J. Enzyme Tests in D i agnosis. In : L e c ture N o t e s o n C l i n ical Chemistry. Whitby LG, Smith AF R Beckett G

References References should be in the Vancouver style and numbered consecutively in the order in which they are mentioned in the text. Titles of journals should be abbreviated according to the In dex Medicus style. Authors m u st c r o ss-check and

J

(eds). 4' edition. Blackwell Scientific Publications. 1988. 103-127.

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British Medical Journal 1988, volume 296, pages

Af iiconJournnl of Tropi col,>Icdicino nnd Biomcdicol %scorch Vol.1IVo. 3 Junc2012

Table of Contents

EDITORIAL 15rIE.5'.5'AGE

EDITORIAL T he Public Health Impact of the Nigerian Abortion Policy and the Case for the Reform of the Nation's Abortion Laws Omo-%gha na LO

7

ORIGINAL ARTICLES Ectopic Pregnancy In An Urban Tertiary Centre In Southern Nigeria: Emerging Trends Osa~khuzzzuomzuan/A Aderoba AA & ~ nde AB Angular Profile of the I~ e es of N i gerian Children in Lagos, Nigeria Odatuzua-Omagbemi DO, Odunubi OO & Isparoegbulem OA

18

Musculoskeletal Manifestations of Rickets: An Eighteen- month Observational Study BaforA & OgbemudiaAO

27

Obesity and Hypertension, Prevalence and Correlates among Patients Seen in a Tertiary Hospital in South-south Nigeria A~i nge N & Ani gor C.O Morbidity Associated with Vaginal and Abdominal Hysterectomy in a Northern Nigerian Hospital Xuzobodo L'mmanuel I & Ogetujni Jaji cola A

39

Environmental and Socio-demographic Determinants of the Age at Menarche among Secondary School Girls in the Niger-Delta Region of Nigeria OnohzzzakPor EA, Omo=dghj oa LO & OmotosoJO 43 Diabetes Mellitus in Childhood and Adolescence: Analysis of Clinical Data of Patients Seen in a Nigerian Teaching Hospital A1Phozzsus K. Ozziiriuka, PhililP O. Abiodzzn, Louis C. Onyirzuka & HumPher~ O. Omorzzyi 50 Evaluation of the Efficacy of Chemotherapy Based Control of Soil-transmitted Helminth Infections and Schistosomiasis among School-age Children in sub-Saharan Africa Oyiho P.G 58

AfzicanJournal of Tropical,5Iedz'cz'neand Biomedical Research Vol.1 iso. 3 June2012

CASE REPORTS Drug — Induced Diabetes Mellitus in C)ghara, Delta State, Nigeria Auusi V

72

Unilateral Renal Agenesis: A Case Report C,' I .Mclil Ligwu, B 0 Okpcri eP E X I 'I tou

75

RE VIE W ARTICLES Entrapment Neuropathies Philip-Ephruim E E ~%gun TU

Erratum: The 2nd issue of this Journal was inadvertently labeled as Volume 2 No. 1. Rather it is Volume 1 No. 2 otherwise the contents remain unchanged. Authors and users should note this please.

A fiiconJournul of Tropi col, IIcdi ci nc nnd Bi omcdiccd Rcscurch Vol. 1lVo. 3 Junc2012

80

Diabetes Mellitus in Childhood and Adolescence: Analysis of Clinical Data of Patients Seen in a Nigerian Teaching Hospital AlphonsusN. Onyiriuka, Philhp O. Abiodun, Louis C. Onyiriuka &

H u mphery O. Omoruyi

ABSTRACT Background: The clinical profile of African children and adolescents with diabetes mellitus is known to differ fn>m thatf their nc>n-African cunterparts. Objective: To present an analysis c>f the clinical data c>f children and adolescents with diabetes mellitus seen in a Nigerian teaching hospital between 2005 and 2011 and highlight the management challenges encuntered. Methods: In this retn>spective study, the case nc>tes c>f all children and adlescents with diabetes mellitus seen in the Paediatric Endocrine-Metabolic Clinic and of those admitted into the paediatric wards of the

Universitv of Benin Teaching Hospital (UBTH), Benin City, Nigeria were audited. Information extracted included age, sex, presenting features, educational attainment of parents, occupation of parents, insulin management, complications and outcome of patients. The clinic attendance registers of the Department of Child Health, UBTH was examined to obtain information on total number of patients seen bI all the units in the department betv'een 2005 and 2011. Results: Seventeen (0.2%) of the 8,350 cases seen during thc period under review had diabetes mellitus, representing 2 per 1000 cases with a male-to-female ratio of 1: 1.8. The mean age at presentation was

12.8+2.9 years for both sexes combined. The mean body mass index (BMI) was 18.6+2.5 kg/m'. Diabetic ketoacidosis (DI(A) was the initial presentatic>n in 9(52.9%) c>f cases. The mean duratic>n of symptoms before presentation was 2.7+1.8 months. Only 10 (58.8%) of the 17 patients had glucose meter for selfmonitoring of blood glucose at home. Of the 17 patients, 6 (35.3%) had documented evidence of

hypoglycaemia. During the period under review, 4(23.5%) were re-admitted; of which 3 v.ere for DI(A. Seven(41.2%) of the parents had difficulty ptocuring insulin on a regular basis. Conclusion: In t hc present study, thc unique clinical features observed among children with diabetes mellitus were late presentation, high number of cases presenting with DI(A and requiring re-admission. The major management challenges included difficulty procuring insulin on a tegulat.basis and inability to acquire a glucose meter with test strips for self-monitt>ring of blood glucose at home. Keywords ' Depot'tment foChile/ Health, C,'nice>city of Bem'n '/iaching H Pb/B 1111, Benin City, Xtgetz'a. 3>'choo/fo3'/eden>'ne, Collegef obleclical gciencer, I ttt eerie> of Benin, Ben>et C/l/y, Xigetza

ospital,

Correspondence: Dr. r//pbonstts.X. Onyctz/t/ea, Depatttnent of C'hite/ Hea/t/hnnitercitj O f Benin Teacbcng Hns/otal / z>/8 1111, Benin Cc/J Xigcrin. omni/ a/ ndion ee nhoo.com, elide'ra/n ci mni/ cpm

Introduction Diabetes mellitus

(DI>I) i s t h e c o m m o nest endocrine disorder in childhood with chronic

hyperglycaemia a s

t h e c a r d inal b i o c hemical

feature.' D i agnosis of

AfricanJournal of Tropi cal,l~edt'ct'ne and Bi ontedical Research Vol. 1/Vo. 3 June2012

D M i s b a sed o n t he

Diabetes 2)1elli Snsi n Childhood and Adoiescencee Analy ri s of Clinical Daea foPa/i ends...

presence o f

i ts c a r d i nal s i g ns

(polyuria,

polydipsia and weight loss) and a fasting blood glucose level of 126 mg/d l (7.0 mmol /L ) and above or arandom blood glucose of 200 mg /dl (11.1 mmnl / L )

a n d a b ov e n n t w n s e p arate

51

incidence of diabetes mellitus was considerable.

12

The purpose of this study is to present an analysis nf the clinical data nf children and adolescents with diabetes mellitus seen in a Nigerian teaching hospital between 2005 and 2011 and highlight the

1,2

occasions.

'

management challenges encountered.

The incidence of new cases of DM varies with geographical location, being highest in Finland and Sweden (40 per 100,000 children per year) and lowest in Japan (less than one per 100,000 children per y ear ). I n A f r i ca, th e e stimated i ncidence varied f r o m 1 . 5 p e r 1 0 0 ,000 i n Tanzania tn 20 per 100,000 in ivlnrnccn. ' The

Subjects and Methods The study was conducted in the Department of Child H e alth, U n i versity n f B e n i n T e aching Hospital ( UBTH), B e ni n C i t y , N i g e ria a n d i nvolved al l

c h i l d ren a n d a d o l escents w i t h

reported prevalence in N i g eria was 0.33 per

diabetes mellitus seen between 2005 and 2011. Majority of t h e p atients seen in the Paediatric

1 ,000.' G i v e n t h a t th e s e p r e v alence a n d incidence figures were d o cumented decades ago,'' they may have changed. Reports from

F ndocrine-Metabolic C l inic o f U B TH co m e from Edo State and the neighbouring states of

African countries indicate that the incidence of e' 9 DM i s i nc r e a sing. S ome i m p o r t a n t demographic and socioeconomic factors may differ f ro m c o u n tr y t o c o u n tr y w i t h h e alth

Delta, O nd o

a n d I ( o g i . T h e c l i ni c r e ceives

r eferrals fro m b o t h w i t h i n a n d o u t s ide t h e hospital (UBTH). T h e P a ediatric E n d ncrineMetabolic uni t c o n sists o f t h e m e d i cal t eam

implications.

(comprising one Consultant, 2 Senior Registrars, 2 Registrars, and 4 House Officers) and all the

The clinical profile o f A f r i can c h ildren and adolescents with DM is known to show certain

Nursing Staff (52) working in the Paediatric ward. The bed capacity of the Paediatric ward is 56.

v ariations

In this retrospective study, the case notes of all

observed

i n i t s c l i nical spectrum f ro m t h at a mon g S Ill 12

c ounterparts."

t he ir

Fo r

non - A f r i c an

i n st a n ce , e q ua l s e x

children and adolescents v.ith diabetes mellitus seen in Paediatric E ndocrine-Metabolic Clinic

prevalence has been documented in temperate countries while studies in sub-Saharan African

and those admitted into the paediatric wards were

countries like Ethiopia, Sudan, Nigeria and Libya

presenting features, educational attainment of p arents, o c c u p a t io n o f p ar e n t s , i n s u l i n m anagement, complications, and o u tcome o f

reported higher prevalence in girls than boys.' '

'

Another study in Nigeria found the prevalence to higher in b oys than girls.

I n T u n i sia, no

gender difference was observed.' Although it is generally believed that socioeconomic status has no influence on prevalence, a study from Nigeria

audited. Information extracted included age, sex,

p atient. T h e s o c i o-economic s t atus o f t he patients' parents was determined using the criteria suggested by Ogunlesi el al.'" This was analyzed

reported a higher prevalence a m ong children

via combining the highest educational attainment, occupation and income of the parents (based on

from p n n r

t he

h o m es . S t u d ie s f r o m T u n i sia,

Ethiopia and Sudan reported that ketoacidosis was the commonest mode of presentation.

I I I, 1 1, 1 '

'

A study in Sweden among children aged 0-14 y ears reported t ha t

t h e a n n ual v a riation i n

m ean inc o m e of

each

ed u c a t i o n a l

qualification an d o c c upation ) . I n t h i s S o cial Classification System, Groups I and II represent high socioeconomic class, Group III r epresents middle socioeconomic class while Groups IV and V represent lnw socioeconomic class. In this way,

A fiicanJournal of TroPi cal,11eds'cs'neand Bi ornedical Research Vol. 12'Xlo. 3Jane2012

DiabetescIIellttetsin Cbildbooa'ana'Aa'olescence: Anal)'sis fo ClintcalData of Patients...

the subjects were categorized into high, middle and low socioeconomic classes. The paediatric

glucose value was 27.8+12.1 mmol/L . O v er half of the families (52.9%) of the subjects belonged

clinic attendance registers of the Department of Child Health, UBT H w a s examined to obtain

to the middle social class while 11.8% belonged to high social class and 35.3% belonged to low social

information on the total number of new cases

class. T h e mean duration of symptoms before

seen (by all the units in the department ) between 2005 and 2 0 11. Statistical analysis involved

presentation w a s

2 . 7 + 1. 8 m o n t hs. M a j o rity

( 88.2%) of t h e p a tients had symptoms fo r 1 m onth an d a b ov e b e f or e p r esentation. T h e distribution o f d u r a tion o f s y m p t oms b efore

calculation of p e rcentages, ratios, means, and confidence intervals.

presentation were as follov.s: < 1 month 11.8%; 1-3 months 41.2%; 4-6 months 29.4%; and > 6

Results

months 17.6%. The frequency of the presenting

Among a total of 8,350 new cases seen during the 7-vear period under reviev; 17 (0.2%) had

clinical features is displayed in Figure 1. Among the cardinal features of diabetes mellitus, polyuria usually prompts the parents to seek medical care.

diabetes mellitus, representing 2 per 1000 new cases. Male-to-female ratio was 1:1.8. The mean age at presentation was as follows: boys 11.0+4.2

Three (33.3%) mothers of t h e 9 p atients who presented with d i abetic ketoacidosis admitted they did not know that diabetes mellitus can occur in children. Two (11.8%) of the 17 patients with

years; girls 1 3.5+1.6 years; and b o t h s e xes c ombined 1 2 . 8+2.9 y e ars . M ean a g e a t presentation: boys versus girls t = 1.28 p>0.05.

diabetes had positive family history of d i abetes

The mean body mass index (BMI) was 18.6+2.5 kg/m' with 6 (35.3%) having a BMI below 19.0 k g/m' .

N o n e o f t h e subjects had BMI > 2 5

k g/m .

T h e a g e g r o u p d i s tribution o f t h e

mellitus. In both cases, it was the mother who was diabetic. Only 10 (58.8%) of the 17 patients had a g lucose meter f o r s e l f -monitoring o f b l o o d glucose at home. Four out of the 10 had difficulty

patients with diabetes mellitus was as follows: 1-

4 yeats 0 (0.0%); 5-9 vears 2(11.8%); 10-14 years 10(58.8%); and 15-19 years 5(29.4%); Table 1. As

procuring the test strips on a regular basis. One (8.3%) of the 12 girls with diabetes mellitus had delayed pubertal maturation; Tanner Stage II at

shown in Table 1, the male-to-female ratio was

the age of 15 years. She has not attained menarche

1:2.4. Diabetic ketoacidosis was the initial mode

a nd weighed 29 Ix.g, with BMI 16.0 l.g/m .

of presentation in 9 (52.9%) of cases (Table 2). T he m e a n n u m b e r o f b l o n d g l u co s e

addition, she had vaginal candidiasis. Of the 17 patients, 6(35.3%) had adocumented evidence of hvpoglycacmia during hospital admission. The

measurements per day was 2.6+0.'). A s shown in Table 3, the point-of-admission mean blood

total daily insulin dose per patient ranged from 12

Table 1: Age undgenderdt'shibntiun uf patients nish diabetes mellitns Age g r o u p a t pr e s e n t a ti o n

Gender Male

No ( 'Yo) B e lo w

10 y ears

2(55.5)

l =em a l e

0 (0)

0 (0)

5(27.5)

1 5-1 5

5 (50. 0)

8 (72. 7)

1 (1 6.7)

0 (0)

A bov e Total

1 5 years

6(100. 0)

B t ut h s e x e s

N o ("i'o)

1 0-1 2 y e a r s year s

In

11(100.0)

A fii canJot(malof Tropi cal,IIedt'ct'ne and Bi ontedical Research Vol.1 iso. 3June 2012

No ( 'Yo)

2(1 1.8)

(1 7.6) 1 1 (64.7) 1 ( ).9 )

1 7(100 . 0 )

Diabetes Melli tusin Childhood and Adolescence: Anaylsis fo Clinical Data foPatt'ents...

T able 2: Mode fopresentation fo 17 children with diabetes mellitus Mod e o f

No ( ohio) M

p r e s e n tation

ean bl o o d

Mean age at

glucose (mmol /L)

presentation (years)

a t presentatio n

DKA C lassical DM

symptoms

Referrals R outine m e d i cal ex am i n a t io n T ot a l

9(52.9)

29.4+ 8.7

11.1+4.8

4(23.5)

21.3+7.1

14.7+1.2

3(17.7)

24.8+8.9

13.6+1.7

1(5.9)

1 3.3+0.0

14.0+ 0.0

27.8+ 1 0 . 8

12.8+2.9

1 7(100.0)

D K A = D i a b e t i c k e t o acidosis ;

D M = D i ab e t e s m e l l i t u s

Table 3: Distribution fomean bloodglucose valuesin 17 children adminedfor diabetes mellitus.

V ariab l e

M ean b l o o d

g luco s e ( mmo l / L ) P o in t — of-a d m i s s i o n

2 7. 8 + 1 0 . 9

r a n d o m b l o o d g l u c o se

1 4.2 + 9 . 5

F ast in g

bl oo d g lu co se 4 8 h o u rs p o s t a d m is sion

Fast in g

b l o o d g l u c o s e 7 d a y s p o s t a d m i ss i o n

1 2.1 + 9 . 1

F ast in g

bl oo d g lu co se 3 w ee k s p o s t a dm i s sion

9 .8 + 6 . 2

100 90 80 70 60 50

v

40

>

20

C4

64.7 47.1

17.6

10 0

@C

q„

gO

PRESENTING FEATURES

Fi~e 1: Prevalencef opresenti ng dini caifeaturesfo 17children with diabetes md/i tus

Afn'can Journal fo Tropical Medicine and Biornedica/ Research Vol 1 No. 3June2012

Diabetes>%1ellttusin Cbildbooa'ana'Aa'olescence: Analysis foConceal Data of Patients...

to 35 Units with an average of 26.5 Units per patient per d ay. Some p arents (41.2%) had difficulty procuring insulin because of financial constraints. D u r i n g th e period under review, 4 (23.5%) w e r e

r e - a d m i tted; 3 (17.6%) fr

The prevalence of diabetes mellitus observed in the present study an d i n p r e v i ou s s t u d i es conducted in other black African countries were generally lower t han t h e p r evalence reported fn>m Eun>pean cuntries. The 1w prevalence

diabetic k e t oacidosis (DI)1ellisnsin Childhood and Adolescence: Analyris fo Clinical Dasa foPa/i ends...

57

mellitus. Lancet 1988; ii: 88-90.

173. 16. Ben IWalifa F, Mekaouar A, Takrak S, et al. A five-year s t u d y o f i n c i d ence of i n s ulin-

22. Oli JM, Bottazo GF, Doniach LB. Islet cell antibodies in Nigerian diabetics. Lancet 1980;

1:1090

d ependent d i a b etes m e l l i tu s i n yo u n g Tunisians (preliminary r e sults). D i abetes Metab 1997; 23: 395-401.

23. Bloch CA, Clemons P, Sperling MA. Puberty

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