PAEDIATRIC ENDOCRINE DISORDERS AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN: 2002 – 2009

O.O. Jarrett1, B.O. Ogunbosi1 and O.O. Ayoola2

  1. Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
  2. Endocrine Science Research Group, University of Manchester, Royal Manchester Children’s Hospital, Manchester, UK.

Abstract

Background: Until recently, most published research focus more on infectious diseases and malnutrition giving the impression that endocrine disorders are uncommon. Reports on endocrine disorders in children in developing countries are few compared to developed countries reflecting the different level of prevalence in the different geographical locations and or level of awareness and availability of facilities for proper diagnosis.

Objective: This study aims at defining the burden of paediatric endocrine disorders in Ibadan.

Subjects/Methods: A review of records of children who presented at University College Hospital, Ibadan with paediatric endocrine disorders from 2002 to 2009 was carried out.

Results: During the eight-year period, a total of 110 children presented with various endocrine disorders but only 94 had complete data for this study. There were 47(50%) males and 37(39.4%) females, and in 10(10.6%) of them, had genital ambiguity at presentation. Patients’ ages ranged from 2 weeks to 15 years with a median of 3 years. Many (35%) patients were malnourished with weight less than 80% of the expected weight for age and only 9% were overweight. Yearly distribution of cases showed a steady increase in number of cases from 2005. Rickets and metabolic disorders constituted 56.4% of patients; Diabetes mellitus was diagnosed in 12.8%, adrenal disoders in 10.6%, pubertal disorders in 5.3% and growth disorders in 4.3% of the patients. Thyroid disorders were present in 6.4%, obesity in 3.2% while the least common disorder was Diabetes insipidus (1%). About 58% of the children had parents in the low socioeconomic status and the management of the cases were severely hampered by lack of funds. About 60.6% of these patients were lost to follow up, during the period.

Conclusions: Paediatric endocrine disorders are associated with a high incidence of malnutrition. Most patients presented with rickets which is a preventable condition.

Keywords: Endocrine disorders, Awareness, Rickets, Malnutrition, Financial constraints.

Correspondence:

Dr. Omolola Ayoola
Endocrine Science Research Group,
5th Floor (Research),
Royal Manchester Children’s Hospital,
Oxford Road
Manchester M13 9WL
Tel: +441617016949
Email: ooayoola@yahoo.com

Introduction

Endocrine disorders are a varied group of conditions that affect growth, development and reproduction.1 In developing countries like Nigeria there is high prevalence of childhood infectious diseases, and much emphasis, concern and resources have been channelled towards combating them while not much attention has been paid to non communicable disorders in the paediatric age group.1 In spite of the high burden of infectious diseases, childhood endocrine disorders constitute a significant cause of morbidity and mortality.2

In developed countries, paediatric endocrinology is an established specialty and medical literature is replete with various clinical and research studies and the burden of endocrine disorders are fairly well ascertained.1,2 Furthermore, a lot of progress has been made in the area of scientific investigations, treatment and research into paediatric endocrine disorders.3-7 With such tremendous advancement in the developed world, the deficiencies in the standard of clinical care and research in the developing world has become more obvious.

In many African countries, there is paucity of literature on paediatric endocrine disorders, a low level of awareness and diagnostic challenges occasioned by the relative lack, and where available high cost of the various laboratory tests needed for diagnosis.8 These lead to late presentation and/or diagnosis of many endocrine disorders and sometimes, missed diagnosis. Therefore, this study is an effort aimed at describing the burden of common childhood endocrine disorders in Nigeria. It would provide baseline data and increase awareness among health care providers.

PATIENTS AND METHODS
This study was carried out at the Paediatrics Department of the University College Hospital (UCH), Ibadan in south west of Nigeria. It is a tertiary referral centre for many hospitals in Ibadan and other parts of Nigeria. There are six wards with one hundred and fifty-eight beds.

The clinic and ward case records of patients presenting from 2002 to 2009 were examined retrospectively. The information extracted from the records included age at presentation, gender, socioeconomic status of parents, anthropometric indices, clinical features and duration, investigations, diagnosis and outcome. The data were collected using a structured proforma and analyzed using the SPSS 14 software for windows package. Frequencies and cross tabulations were carried out. Socioeconomic index scores were allocated to each child based on occupations and educational attainment of both parents on scales I to V, as previously done by Oyedeji et al in a similar community.9 The mean of the scores to the nearest whole number was the social class assigned to the children’s parents.