MATERIALS AND METHODS
Benin City is the capital of Edo State in southern Nigeria which is holoendemic for malaria (Bruce Chwat). There are two distinct seasonal periods— rainy season, which spans from April to September, and dry season from October to March. Benin City is cosmopolitan and has one tertiary hospital, University of Benin Teaching Hospital (UBTH); one secondary, Central Hospital; and numerous private clinics and hospitals.
The study was done in the Children’s Emergency Room (CHER) of the Department of Child Health, UBTH. CHER provides care for children aged one month to 16 years who require prompt life-saving measures and then are discharged as soon as possible from the unit, preferably within 24 hours of admission either by transfer to the main pediatric ward or home to continue treatment as an outpatient. The unit has a capacity for 20 patients, one bay each for treatment and resuscitation, nurses and doctors. The unit has full compliment of medical and nursing staff supervised by a consultant pediatrician. It also has a medical records unit. Patients are referred from the general practice clinic of UBTH or from peripheral health facilities within and outside Benin City. Routinely, all patients attending the unit are evaluated clinically by detailed history and thorough physical examination. For patients with central nervous system symptoms, neurologic examination include assessment of level of consciousness using the Blantyre coma scale (modified Glasgow coma scale), pupillary examination and fundoscopy for signs of raised intracranial pressure, cranial nerves, signs of meningeal irritation, muscle tone, power and reflexes. Laboratory investigations include cerebrospinal fluid (CSF) examination (indicated when there are signs of meningeal irritation, first episode of convulsion with fever, complex febrile convulsion and coma), blood film for malaria parasite, levels of blood glucose, urea and electrolytes and blood culture. Meningitis was defined as elevated CSF protein plus hypoglycor-rhachia (CSF glucose <2.2 mmol/1) or CSF glucose less than two-thirds of simultaneous blood glucose level, CSF ploecytosis with or without positive culture. Cerebral malaria was defined as the presence of an altered sensorium, R falciparum parasitemia and normal CSF. buy finasteride online
For this study, ward records, such as admission and discharge registers, during a five-year period (July 1996-June 2001) were examined to identify cases whose main diagnosis were neurologic in nature. Notes of these identified cases were then retrieved from the medical records and examined further. Only case notes with definitive diagnosis after the laboratory investigation were selected. Data obtained from these sources included age, sex, principal diagnosis, duration of stay in CHER and outcome.