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Management of Convulsion in Children, a Health concern in Nigeria

PUBLIC HEALTH INFORMATION:

  • Convulsion/Epilepsy is not an infectious disease, so dont run away from people with convulsion
  • A child having convulsion/Epilepsy does not mean he/she would die
  • Witchcrafts, evil Spirits are not the cause of convulsion/Epilepsy
  • Prayers, Charms, incantations, cow or human urine, kerosene, burning with fire does not treat convulsion/epilepsy.
  • Laying the person on his side can help the convulsion/epilepsy
  • Don’t put your hand, spoons, knife, fork, etc in the person’s mouth
  • Take the person to the hospital once the convulsion stops

Convulsion in Children in Nigeria

CASE FILE:

A mother brings her 15 month old boy to the emergency department of the hospital with a seizure associated with fever. He has been in good health except for a high fever that developed today to about 103-104 degrees. His mother gave him a small dose of acetaminophen. About 20 minutes ago when the mother was checking up on her child, she noticed shaking of the body, arms and legs and his eyes had a blank stare.
This went on for what seemed like 5 minutes. She called 911 and an ambulance was dispatched. He has been ill with a high fever today and a slight cough and mild nasal congestion. Just prior to the seizure, he was playing with some toys. There is no vomiting, diarrhea, rash, or fussiness.

Past medical history is unremarkable.
Family history is significant for an uncle who has epilepsy.
Exam: VS Temp: 39.8 degrees C (103.6 degrees F), Pulse: 165, Respiratory Rate: 30, Blood Pressure: 90/60, O2 sat 100% on RA.

He is clingy, alert to his surroundings, and otherwise is in no distress. His mother appears anxious and there appears to be good bonding between her and her child.
Skin is without bruising or neurocutaneous stigmata. Anterior fontanelle is closed. Pupils are equal and reactive. EOMs are conjugate.
The red reflex is present bilaterally. There is no sunsetting of the eyes. TMs are normal. His mouth exam shows moist mucosa without erythema. The Brudzinski and Kernig signs are difficult to assess. Respirations are regular. Neurologically, he moves both arms and legs equally. His tone appears normal. The rest of the examination is normal.

 

DISCUSSION

Convulsion is the most common emergency in children. Convulsion can be very scary, emotionally traumatic and anxiety provoking by the witnesses or parents for fear of death. They are seen as a very important cause of child death in Nigeria, mainly due to poor pre-hospital management, social stigma and ignorance.

Febrile convulsion refers to convulsion that comes with fever, but in the absence of central nervous system (CNS) infection, in children aged 6 months to 5 years of age. It is the most common reason for convulsions in children less than 5 years of age.

Childhood convulsion usually have a specific cause which must be identified and treated in the management of the convulsion, else, the convulsion would continue to re-occur.

 

There are various types of this febrile convulsion/seizures which include: Simple and complex.

Simple convulsions are those that dont last up to 15 minutes, and generalized.

Complex convulsions are those that last more than 15 minutes, happen more than once in 24 hours, and/or focal

 

Signs of Convulsion:

Any child that is undergoing convulsion would present with symptoms such as:

  • shaking of the arms and legs, which at times can be accompanied with difficulty in breathing and rolling eyes.
  • loss of awareness with staring or blinking of eyes (they wont know where they are). and they cannot control it.
  • movements like chewing, lip smacking or clapping followed by confusion.
  • foaming at the mouth, and unconsciously urinating on themselves.

Convulsion in Children in Nigeria Convulsion in Children in Nigeria

Other symptoms the child might have include fever, cough, catarrh, abdominal pain, headache, diarrhea and sore throat.

Ninety percent of convulsion last from few seconds to five minutes, and they stop by themselves. At the end of the convulsion, the child can be calm and sleepy for several minutes thereafter.

 

Causes Of Convulsion:

Many persons are usually concerned about the reasons why their child is having convulsion. Sadly, in this part of the world, many persons are still ignorant of various common medical conditions and still believe that many things happen as a result of spirituality or witch craft.

A large number of Nigerians believe that convulsion is caused by: Witchcraft, Evil Spirit, and various other spiritual associations.

Hence, it is important for us to point out here that convulsions can be caused by different reasons including;

  • Fever
  • Malaria
  • Meningitis
  • Bronchopneumonia
  • Tonsilitis
  • Hypoglycemia (low blood sugar)
  • encephalitis
  • Structural abnormality in the brain
  • lack of oxygen to the brain
  • family history of convulsion (genetic)
  • use of certain drugs

In our environment, Malaria is the most common cause of convulsion, particularly severe complicated malaria. This is followed by meningitis among other causes.

Therefore, children having convulsion should be suspected for very severe malaria.

 

Problems Encountered in Management of Convulsion in Children in Nigeria

The major challenge in the management of Convulsion in Nigerian children is the poor pre-hospital management which is as a result of:

1. Belief: Many persons attribute the causes of convulsion to witches, evil spirits and other spiritual entities, hence delay in bringing the child to the hospital. Most person even engage in praying for the child, reciting incantations or Quran among other methods carried out, while the child is actively convulsing.

2. Poor Knowledge of First aid: poor first aid measures is commonly seen in our society as a result of these belief they have that the convulsion/epilepsy is as a result of witches, or is contagious. Hence, most mothers employ the use of traditional medications, making scarification marks on their children, making use of cow or human urine, burning their feets or hands, putting hands or spoon in the mouth, all in a bid to stop the convulsion.

In most places in Nigeria, the convulsing child is usually made to drink cow’s urine or the urine is used to wash the child’s body.  The cow’s urine being used her is made of; tobacco leaves, garlic leaves, basil leaves, lemon juice, rock salt, and onion, all soaked in cow’s urine.

Unfortunately, Cow’s urine concoction being used by some of these persons, causes some severe complications on its own such as severe hypoglycemia, choreoathetosis, generalized spasticity, decerebrate rigidity, cortical blindness, and convulsion.

Other items, such as palm oil, cereal gruels, onions to the eyes and alligator pepper have all been documented to be used by parents at home to treat convulsion/epilepsy.

3. Poor home management of fever, especially malaria, causing the child to develop very severe forms of disease before intervention.

4. Culture: In the Yoruba culture, for example, it has been understood that putting something in the mouth when a child is having convulsion is necessary to prevent the child from gnashing the teeth which they say, might lead to the death of the child. Hence, the use of hand, spoon, etc to place in the child’s mouth. In igbo land, items like Kernel Oil, popularly called “Ude Aki” have been employed to stop convulsion.

 

Appropriate First Aid For Convulsion/Epilepsy: (see video)

The following pre-hospital management should be carried out for a child having convulsion. it is divided into Do’s and Dont’s

Dont’s: Things You Must Not Do For A Child In convulsion

  • Don’t hold the child down to stop the movement.
  • Don’t put your hand, spoons, knife, fork or any other thing into the mouth to prevent choking or injury.
  • Do not try to give food, water, or medicine by mouth to a child who is having convulsion.
  • Do not burn the feet or hand with fire
  • Do not put pepper or onions in the eyes of someone having convulsion.
  • Do not give Cow’s Urine or any other Urine or Herbal concoction to a child having convulsion.

 

Do’s: Things to Do For A Child having Convulsion

 

  1. Keep Calm
  2. Remove any harmful objects that might injure the child.
  3. move the child away from water or fire
  4. Loose any tight cloths around the head or neck.
  5. Once the convulsion stops, roll the child on the floor on his or her side to prevent dangerous aspiration.
  6. Put some clothes under the head.
  7. Finally, Rush the child to the hospital .

Convulsion in Children in Nigeria

 

Management of Seizures/Convulsions

Although most convulsions are not dangerous or need immediate medical care, one time needs. This is known as Status epilepticus. It is a life threatening condition and in this case, the child has many convulsion without regaining consciousness in between them. If not properly managed by certified health personnels, it may lead to brain damage or even death.

Management of Seizure/Convulsion/Epilepsy should be done by professionals only, through the use of Benzodiazepines, (Iv Lorazepam or Diazepam) either rectally or Intravenously. There are several types of medicine drugs used in treating epilepsy/convulsion. It is up to the doctor to determine the best drug for the patient.

 

Other Practices that will help control Convulsion in Children in Nigeria.

  1. Chemist/Pharmacist as popularly called are part of the informal health sector in the country. They are usually the first point of call to the public whenever a health challenge arise as a result of their accessibility and affordability. However, they are known to administer inappropriate drugs beyond their limits. If these chemist could be given proper training, it can go a long way to improve the control of common diseases in the country.
  2. The use of traditional medicine dealers, especially in rural areas is also as important as the chemist for the same reasons. In the same vein, traditional medicine dealers could play a very crucial role in the Nigerian health care system if properly managed.
  3. There is also a need to improve public awareness about convulsion and other related illnesses and their first aid/pre-hospital management.
  4. Malaria being the most common cause of convulsion in the country need to be controlled vigorously.

 

Credits:

  • ADAM
  • Apollos Hospital
  • Premium Health
  • Youtube
  • Nollywood
  • Prince John
October 19, 2018

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