Prevalence of hypoglycaemia in under-five children presenting with acute diarrhoea in University of Calabar Teaching Hospital, Calabar.

Abstract

Background: The clinical features of hypoglycaemia and severe dehydration are similar, and these two can occur in a child presenting with acute diarrhoea. Hypoglycaemia occurring in a growing brain is deleterious and must be detected and treated. Objective: To determine the prevalence of hypoglycaemia among under-five children presenting with acute diarrhoea in UCTH, Calabar. Method: This was a prospective study of 150 children aged six weeks to five years presenting with acute diarrhoea in UCTH, Calabar from June 1st to October 31st 2008. Consecutive children who met the inclusion criteria were recruited into the study. Blood samples were collected for random blood sugar and serum electrotype estimation using One Touch Ultra Test Strips 2006 model and Flame photometry respectively. Results: The overall prevalence of hypoglycaemia in under-five children presenting with acute diarrhoea was 4%. There was no sex difference. It was commonest among children of the low socioeconomic class (83.3%). Risk factors to developing hypoglycaemia were longer duration of last feeds greater than five hours and severe dehydration, both reaching statistically significant differences (p=0.022 and 0.002; FET respectively). Forty percent of patients who died had hypoglycaemia constituting 33.3% of patients with hypoglycaemia. Conclusion: Children with diarrhoea complicated with severe dehydration are prone to developing hypoglycaemia. It causes high mortality and thus this parameter should be checked for and managed on time.

Hypoglycaemia at point of hospital admission of under-five children with acute diarrhoea: Prevalence and risk factors

“…12 All previous Nigerian studies on this subject were conducted in tertiary-healthcare hospitals and none in secondaryhealthcare hospital, yet a significant number of children are cared for in secondary-healthcare facilities. 7 Considering that in developing countries, childhood diarrhoea itself is grossly under-reported and its incidence underestimated, 13 the magnitude of the paucity of information on hypoglycaemia coexisting with diarrhoea becomes more obvious. At present, in Nigeria, the extent to which hypoglycaemia occur in children with diarrhoea is uncertain.…”

“…4,6 In a study in Calabar, Nigeria, 4.0% of under-five children presenting with acute diarrhoea were found to have hypoglycaemia. 7 A study in a rural district hospital in Kenya, reported a prevalence of hypoglycaemia as high as 23.3% among children with acute diarrhoea at the point of hospital admission. 12 All previous Nigerian studies on this subject were conducted in tertiary-healthcare hospitals and none in secondaryhealthcare hospital, yet a significant number of children are cared for in secondary-healthcare facilities.…”

“…10 Some risk factors that have been identified include female gender, seizure, altered level of consciousness, vomiting, acidosis, duration of diarrhoea less than 72 hours, and bacteraemia. 4,7,11 A review of the literature revealed that the prevalence of hypoglycaemia in children with acute diarrhoea varied from 4.5-11.0%. [4][5][6] This variability in prevalence rates have been observed at different times, even within the same country .…”

“…3 Although dehydration and electrolyte derangement have been clearly established as the immediate lifethreatening complications of acute diarrhoea, a non-dehydrating complication like hypoglycaemia is equally important. [4][5][6][7] Even in areas where oral rehydration therapy is being practised, mortality from acute diarrhoea still remains high, 8 suggesting that other factors may be playing a role in the observed mortality rates. In Africa, there is limited data on hypoglycaemia as one of the clinical problems encountered in the management of children with acute diarrhea.…”

“…9 This scenario might be related to the fact that the symptoms of severe dehydration and hypoglycaemia resemble each other, resulting in difficulty in differentiating between these two clinical conditions . [4][5][6] The co-existence of severe dehydration and hypoglycaemia in patients with acute diarrhorea has been shown to worsen prognosis , 4,5,7 implying that early detection and adequate treatment of the hypoglycaemia in such patients might improve outcome. Hypoglycaemia is a common clinical problem and it is associated with serious neurological sequelae when detection is delayed or treatment inadequate.…”