irkingin Africa to share their research findings on all aspects of Tropical Medicine and. Biomedical Sciences and to disseminate innovative, relevant and useful ...
African Journal of Tropical Medicine and Biomedical Research (AJTMBR)
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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
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i nclusive o f
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Af iicanJournal of Tropical,>medicine and Biomedical %search Vol.1 iso. 3 June2012
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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
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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.
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