BackgroundDiabetic ketoacidosis (DKA) is a potentially life-threatening acute complication of type 1 diabetes mellitus (T1DM). Although the frequency of DKA as first manifestation of T1DM is higher in developing compared developed countries, there is paucity of information on its characteristics in developing countries.MethodsThis retrospective study determined the frequency of ketoacidosis at diagnosis of new-onset type 1 diabetes and described the clinical characteristics of the patients seen between 1996 and 2011 by auditing the hospital records of all cases. The diagnosis of diabetic ketoacidosis (DKA) was based on the presence of hyperglycaemia (blood glucose > 11 mmol/L), acidosis (serum bicarbonate < 15 mmol/L) and ketonuria (urine ketone ≥1+).ResultsAt diagnosis of new-onset type 1 diabetes mellitus, three-quarter (77.1%) of the children and adolescents presented with DKA. Comparing the frequency of DKA during the initial 8 years (1996–2003) with the later 8 years (2004–2011), it was 81.8% vs 73.1%; p > 005. The frequency has not shown any significant declined over a 16-year period. The frequency of re-admission in ketoacidosis was 24.3%.ConclusionThree-quarter of children and adolescents present with DKA as first manifestation of T1DM with no significant decline in frequency over a 16-year period in our hospital.

Background/Objective: Fluid, electrolytes and acid base disturbances are responsible for most deaths due to acute diarrhoea. The aim of this study is to describe the point-of-admission serum electrolyte profile of children with dehydration due to acute diarrhoea. Methods: In this cross-sectional study, the serum electrolyte levels of 185 children with dehydration due to acute diarrhoea were assessed at the point of admission at the Diarrhoea Treatment and Training Unit of the University of Benin Teaching Hospital. The age of the study population ranged from 29 days to 59 months. Results: Out of a total of 185 subjects, 30 (16.2%), 114 (61.6%), and 41 (22.2%) had severe, moderate and mild dehydration, respectively. In addition, hyponatraemic dehydration was the most common type of dehydration, accounting for 60.5% of cases. Metabolic acidosis and hypokalaemia occurred in 59.5% and 44.3% of cases, respectively. Only the serum bicarbonate level was significantly affected by degree of dehydration (p = 0.001). Age of more than 12 months and presence of vomiting were significantly associated with hyponatraemia (p = 0.005 & p = 0.02), while age of less than or equal 12 months and absence of vomiting were associated with metabolic acidosis (p = 0.04 & p = 0.03). Conclusion: The degree of dehydration appears to be a good predictor of the occurrence of metabolic acidosis while age is a risk factor for hyponatraemia and metabolic acidosis.

No abstract

Immunization coverage among infants in Nigeria continues to be low despite availability of effective vaccines and accessibility of immunization clinics in urban areas. This study was conducted to determine the vaccination default rate and vaccine schedule that is most frequently defaulted. It also documented reasons for the defaults and suggested ways of minimising them. The immunization status of 174 children aged 9-11 months were determined by interviewing mothers regarding their children's immunization histories. Each child's immunization card was subsequently reviewed for confirmation. Overall default rate for the entire recommended series of vaccines was 26.7%. Measles vaccine was the most frequently defaulted. The commonest reason given by respondent mothers for defaulting immunization clinic appointments was the child's ill-health (37.5% of all cases). Immunization clinic appointment default rate is still high in Benin City, with measles vaccine being the most frequently defaulted. We therefore suggest ways of minimising vaccination clinic appointment defaults.

Background: In Nigeria, and perhaps other African countries, thyroid disorders in childhood and adolescence have not been sufficiently studied. Where studies are available, they were either conducted decades ago or they involved only adults. Objective: To describe the pattern of thyroid disorders among children and adolescents seen in a Nigerian teaching hospital and highlight the management challenges encountered. Methods: In this retrospective study, the case notes of all the children and adolescents with thyroid disorders seen in the Paediatric Endocrine-Metabolic Clinic and of those admitted into the wards of the University of Benin Teaching Hospital (UBTH) were audited. Information extracted included age, gender, duration of symptoms before presentation, clinical features, laboratory test results, management challenges and admission outcome. The total number of new cases seen at the paediatric clinics of the Department of Child Health, UBTH was derived from the clinic attendance register of the department. Results: Of the 8,350 new cases seen during the 7-year period, 9(0.12%) had thyroid disorders, representing one per 1000 new cases. Of the 9 patients with thyroid disorders, 6 (66.7%) had hyperthyroidism, 2(22.2%) had nongoitrous hypothyroidism and 1(11.1%) had euthyroid goiter. The overall mean age at presentation for thyroid disorders was 11.2+4.3 years (95% Confidence Interval, CI = 8.4-14.0)and female-to-male ratio was 4:1. For the patients with hyperthyroidism, the mean age of presentation was 12.8+3.1 years (95% CI= 10.3-15.3) and female-to-male ratio was 5:1. The mean age at presentation of the two children (a boy and a girl) with hypothyroidism was 4.75 years (range 3.5 and 6 years). The mean duration of symptoms before presentation was as follows: thyroid disorders 1.72+1.2 years (95% CI=0.94-2.50), hyperthyroidism 8.5+1.5 months (95% CI=7.3-9.7). The only case of euthyroid goiter (female) presented at the age of 14 years. The management challenges encountered included suboptimal diagnostic facilities and high clinic default rate. Conclusion: Hyperthyroidism was the most common form of thyroid disorder observed and patients with thyroid disorders tended to present late. Suboptimal diagnostic facility and high clinic default rate were the principal management challenges encountered.