An 11-year-old boy presented with a 4-week history of fever and 2 weeks later developed a cough with breathlessness. His chest X-ray showed bilateral miliary shadows with pneumothorax on the left side. While on antituberculous therapy which was started on admission, he developed right-sided pneumothorax with significant collapse of the left lung. He was managed by tube thoracotomy with underwater seal but died 4 hours after the procedure was completed.
The strategy of integrated management of childhood illness (IMCI) aims at improving the skills of first level health workers and consequently, improving the survival chances of children. The guidelines have been shown to be cost-effective. We aimed to determine the potential impact of using IMCI guidelines on drug treatment cost. The cost of drugs prescribed for 129 sick children, by first level health workers, who were managed at three primary health facilities in Sabon Gari Local Government Area of Kaduna State, was calculated. The corresponding cost using the IMCI guidelines was also calculated. There were 74 males and 55 females (M:F=1.3:1). An average of 4.5 drugs per patient were prescribed by the health workers compared to 2.3 drugs per patient when using the IMCI guidelines. The total cost of drugs prescribed by the health workers was N15,279.39 with an average of N118.44 per child. The corresponding costs had the IMCI guidelines been used were N3,062.53 and N23.73, respectively. Treatment cost using the traditional method was 4.98 times more expensive than using methods advocated by the IMCI guidelines. The projected cost savings related to drugs when using IMCI guidelines were based on the assumption that inappropriate drugs would not be prescribed by health workers once they are introduced to and started using the IMCI guidelines.
Background :Enuresis is a common but usually under reported developmental urologic disorder affecting children most commonly .There is evidence of affectation of normal development and social stigmatization of the enuretics apart from it being a real social nuisance. Among the African children this problem is often neglected and the preferred types of treatment are traditional methods. There may be serious implications in the child including ,emotional ,social and mental maladjustment. Method This study was carried out during a six month period in four densely populated primary schools in Zaria.. Native African Children aged above 5 years were included in the study and children with history of neuropsychiatric or obvious urologic disorders were excluded. A structured closed-ended questionnaire was administered to the target group. Results . Enuresis was found in 214/1416(22.2%) of the children. The age range was 5-14 years with a median of 8 years. The male: female ratio of 2:1. 96.6 % (211/214) of affected children had nocturnal enuresis while (1.4%)3/214, had day time enuresis only. Both day time and nocturnal enuresis were seen in 2.8%(6/214) of the children. 75%(160/214) enuretics were mild-moderate and wetted bed less than 10 times /month. The ratio of the female to male ratio in this group was 1:1. 25.4%54/214) enuresis was severe and could not quantify the number of wet nights/month. Only 4/54(7.4%) children in the group considered severe were female the 50 others were male. 74.6%(160/214 ) of the children were enuretic from birth with no describable dry periods . 25.4%(54/214) enuresis commenced long after birth and symptoms were recurrent with long dry spells. In 200/214(88.%) children the mother had received conventional Ante Natal Care(ANC) and subsequent delivery was supervised in the Hospital while in 14/214(6.5%) of the children the mothers did not have ANC and delivery was un-supervised at home. There was no significant correlation between(ANC) ,mode of delivery and enuresis although two children delivered by caesarean section have severe enuresis among a group of 52 children with sever enuresis whose mothers had routine ANC before an uneventful delivery. (20/214) 3% had co -morbidities: asthma and epilepsy. The majority of parents were mostly low income workers. Most patients were managed preferably by varied traditional techniques with usually unsatisfactory outcomes. Only (74/214) 43% performed above average in school. Conclusion: Enuresis is a common and usually neglected urologic condition in our environment. The significant prevalence in the older child may have important implications on quality of the child's development. Health education will encourage parents to present early to avoid crippling associated complications.
Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.
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