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Introduction: Asthma is a chronic inflammatory disorder associated with variable air flow obstruction and bronchial hyperresponsiveness. It is characterised clinically by recurrent episodes of cough, difficulty in breathing and wheezing which resolves spontaneously or with treatment. The socio-demographic and clinical characteristics of asthmatic children in north western Nigeria have not been reported. Methods: This was a descriptive study in children with asthma aged 4-15 years carried out over a 3 month period Aminu Kano Teaching Hospital (AKTH), Kano. The aim was to determine the socio-demographic and clinical parameters of asthmatic children. Asthmatic children whose parents or guardian consented to the study were recruited consecutively. Their bio-data, sociodemographic and physical examination were documented. Results: Seventy asthmatic children were recruited of which 50(71.4%) were males and 20(28.6%) were females, giving a male: female ratio of 2.5:1. Insecticide was the commonest asthma trigger (64.3%) and 26(37.1%) patients belonged to socio economic class III. Mild persistent asthma was the commonest form of asthma severity encountered. There was positive correlation between PEFR and height (r = 0.577, p< 0.0001). Conclusion: Most of the asthmaticschildren seen at AKTH, Kano were males with mild persistent asthma, had positive family history of atopy and belonged to the middle socio economic class.

Background: Under nutrition and overweight in children co-exist in developing countries and may persist into adulthood. Interpretation of body mass index (BMI), a useful measure of nutritional status in children requires age related reference standards, many of which were developed from different international sources. It is necessary to determine which of these reference standards is most suitable for use in the assessment of BMI distribution among adolescents in Nigeria. Objective: To determine the prevalence of thinness, overweight and obesity using the World Health Organization (WHO), International Obesity Task Force (IOTF), and Centre for Disease Control (CDC) reference standards and assess their level of agreement amongst adolescents in Sokoto metropolis. Methods: 800 students were selected through multi-stage sampling technique from secondary schools. BMI was classified according to three reference standards (WHO, CDC, IOTF). Data was analysed with SPSS version 22. The level of agreement between the reference standards in diagnosing nutritional status was assessed using Kappa statistics. Level of significance was put at p< 0.05. Results: The prevalence rate of thinness was highest with the IOTF at 22.6% compared to 19.4%, and 19.6% by the WHO and CDC respectively. The prevalence rates of overweight and obesity were highest with the WHO reference standards at 7.0% and 1.3% followed by the IOTF (6.1%and 0.6%) and lowest with the CDC (5.8% and 0.3%). Substantial agreement was observed between WHO and IOTF (Kappa = 0.77), while the level of agreement was 0.68 for IOTF/CDC and 0.64 for WHO/CDC. All agreement statistics were significant (p < 0.001). Conclusion: The WHO and IOTF reference charts may be more suitable for our population.

Dextrocardia with situs inversus are rare congenital anomalies which can be asymptomatic and compatible with normal life. They are characterized by mirror images of all intra-thoracic and intra-abdominal viscera. Our aim is to report an incidental finding of dextrocardia with situs inversus in a neonate with neonatal sepsis. A day-old male term neonate presented with features of infection. Physical examination revealed cardiac apex on the 4th right intercostal space, along the mid-clavicular line. Chest radiograph and abdominal ultrasound confirmed the diagnosis of dextrocardia with situs inversus. Bilateral cervical ribs were also seen on chest radiograph. He was managed with antibiotics and discharged. Newborn babies should have a thorough physical examination after delivery before discharge to enable early diagnosis of congenital anomalies for appropriate referral.

Context: Pneumonia is the world’s leading infectious killer of children, particularly under- fives. Practical, achievable and affordable key interventions have been identified to reduce morbidity and mortality from Pneumonia. Despite these measures, it still remains a disease that has significant impact on child’s survival. Objectives: To determine the sociodemographic and clinical features of Pneumonia in hospitalized children at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Materials and methods: A retrospective review of records of children admitted for Pneumonia over a 30-month period and relevant information eg. age, gender, symptoms and signs were documented. Results: Of the189 children reviewed, 114(60.3%) were below 1 year of age, males were 108(57.1%) with a M:F ratio of 1.3:1. One hundred and twenty three (65.0%) belonged to the low socio-economic class (SEC) and only 95(50.3%) were fully immunized. Cough and fever were the commonest presenting symptoms while crepitations, chest in drawing and tachypnoea were the commonest signs. Majority 178(94.2%) had Bronchopneumonia while 11(5.8%) had Lobar Pneumonia. 151(79.9%) were discharged, 1(0.5%) absconded and 37(19.6%) died. Cough and fever were seen in more children that died, however it was not significant. Similarly, more children that had crepitations, tachypnoea, chest indrawing and hypoxaemia died, only chest in drawing was significantly associated with mortality (p=0.020). Conclusion: Pneumonia is still a common cause of mortality, socio-demographic and clinical features remain similar to other reports. Despite the availability of preventive measures and treatment guidelines, mortality remains high. We recommend and advocate for equitable access to quality primary health care in order to prevent, diagnose and treat pneumonia.

Background: Sickle Cell Anaemia patients are considered to be among the high-risk groups for hepatitis B and C viral infections. These viruses and HIV share common routes of transmission and similar risk factors and their infections coexist. Objective: This study was aimed at determining the seroprevalence of hepatitis B, C and HIV viral markers of infections in children with SCA. Methodology: A cross sectional Hospital based study conducted on 89 confirmed SCA Children aged 6 months to 13 years in steady state attending Haematology Clinic in a Specialist Hospital Gusau from July 2017 to March 2018. Approval for the study was obtained from the Research and Ethics Committee of the Hospital. The age, gender, history of blood transfusion, traditional scarification, uvulectomy, circumcision and immunization of the subjects were recorded. Serological test was carried out to determine the prevalence of hepatitis B, C and HIV using the viral markers and HIV 1 and 2 rapid test kits. Results: Eighty-nine subjects were recruited with 46(51.7%) males and 43(48.3%) females. The mean age was 5.06 ± 3.4 years. The seroprevalence of HBsAg, HBsAb, HBcAb, HBeAg, HBeAb, AntiHCV and HIV 1 and 2 were 3(3.4%), 3(3.4%), 5(5.7%), 1(1.1%), 6(6.9%) and 0% respectively. No co-infection among the studied subjects. There is no significant difference in the age or gender distribution and seroprevalence of the viruses among SCA children. p = less than 0.05. Conclusion: Hepatitis C infection is found to be high as opposed to Hepatitis B which is lower among SCA Children in this community

Introduction: Pharyngotonsillitis is one of the common childhood infections caused by bacteria in 30 to 40% of cases. Bacterial causes are important due to the non suppurative sequalae caused by Streptococcus pyogenes and also associated complications. These microorganisms undergo constant changes and antibiotic resistance have been reported. Objective: To document organisms isolated from throat swab microscopy and culture with their antibiotic susceptibility pattern in children diagnosed with pharyngotonsillitis. Methodology: This was a retrospective analysis of throat swabs microscopy, culture and sensitivity results of children aged 0-13 years with a diagnosis of pharyngotonsillitis over a four year period. Results: Of the 144 results reviewed; 120 samples yielded 122 isolates, giving a culture positive yield of 83.3%. Males were 81 (56.2%) with a M:F ratio of 1.3:1. Majority of the children were under fives (58.3%). Gram positive organisms were 118 (96.7%), with Streptococcus pyogenes being the commonest organism isolated (79.5%), followed by Staphylococcus aureus (13.9%). Gentamicin (85.0%), Ofloxacin (64.2%) and Augmentin (51.7%) had the highest susceptibility rate, while the least was seen with Cefixime, Tetracycline, Levofloxacin and Netillin. Streptococcus pyogenes and Staphylococcus aureus were susceptible to Gentamicin and Ofloxacin, while all the Streptococcus pneumoniae were susceptible to Gentamicin. Multi drug resistance was seen with Providencia spp and Serratia marcescens. Conclusion: Streptococcus pyogenes was the commonest organism and Gentamicin, Ofloxacin and Augmentin were the antibiotics with the highest susceptibility. Gram negative organisms display high rate of multidrug resistance. Gentamicin could be considered as an option or an adjunct in the treatment of pharyngotonsillitis

Background: Antibiotics are the most widely utilized therapeutic agents. Inappropriate use causes increase cost and antibiotic resistance. The World Health Organization recommends assessment of antibiotics use to guide prescribing practices. Objective: To describe the pattern of antibiotic usage among paediatric inpatients aged > 1 month to 15 years in a tertiary hospital in Sokoto, Nigeria. Methods: Febrile children were recruited prospectively by systematic random sampling from January to October 2018. Socio-demographics, diagnosis, antibiotics administered were obtained from case notes. The WHO indicators of use of antibiotics were employed for evaluation. Data was analysed with SPSS version 23. Results: Out of 352 children, 318 (90.3%) received antibiotics; commonest being Ceftriaxone in 155/318 (48.7%), Cefuroxime in 74 (23.2%), and Metronidazole in 29 (9.1%). Average number of antibiotics per patient was 2.3±1.1 with treatment duration of 4.3±1.4days. Ant ibiotic consumption was 937.2 days of antibiotic therapy/1000 patient days (DOT/PD). Generic name was used in 92.3% while 100% of the drugs were on the essential medicine list. Frequent diagnoses were severe malaria 98/352 (27.8%), respiratory infections 39 (11.1%) and severe malnutrition in 38 (10.8%). Only 6 (1.7%) patients had microbiologic evidence of infection. Conclusion: Utilization of antibiotics is higher than recommended. There is need for improved diagnostic facilities to avoid antibiotic overuse and its consequences. [ABSTRACT FROM AUTHOR]

Background: Despite the huge burden of sickle cell disease (SCD) among Nigerian children, the burden and outcome of respiratory illnesses remain undocumented. Thus, we aimed to describe the spectrum and outcome of respiratory illnesses among SCD childrenand adolescentadmissions in ten Nigerian tertiary hospitals., Method: A retrospective review of the SCD admission records of children and adolescents with a confirmed diagnosis of respiratory illnesses from 2012 to 2021 in ten tertiary health facilities across five geopolitical zones in Nigeria was conducted. The data, collectedbetween March and June 2023, included the age, sex, diagnosis, complications, duration and outcome of hospitalization., Results: Of the 72,333 paediatric admissions, 7,256 (10.0%) had SCD; the proportion of SCD from the total admission ranged from 2.1 to 16.3% in the facilities. Of the 7,256 children and adolescents with SCD, 1,213 (16.7%) had respiratory morbidities. Lower respiratory disease was the most common (70.0%) respiratory entity and the majority were pneumonia (40.1.0%), followed by acute chest syndrome (26.7%). Seventeen (1.4%) patients died; all had lower respiratory diseases [(acute chest syndrome ACS (11, 64.7%), pneumonia; 5, 29.4%, and asthma (1, 5.9%). Based on the proportion of deaths among overall SCD, the 17 death cases contributed 9.4% (95% CI 5.9 to 14.5). Factors associated with deaths included duration of hospitalization less than 72 hours and lower respiratory tract diseases., Conclusion: Sickle cell disease is a major contributor to hospitalization among Nigerian children and adolescents, with high respiratory morbidity and mortality. Pneumonia and acute chest syndrome were associated with mortality, andthe highest risk of death within the first 72 hours., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ibraheem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Rheumatic heart disease (RHD) is the only preventable cardiovascular disease that still causes significant morbidity and mortality in low- and middle-income countries like Nigeria where it is classified as a neglected disease. The inciting agent causes pharyngitis often not properly treated., Aim and Objectives: To study the knowledge and preventive practices of RHD amongst primary healthcare workers who are in contact with larger ratio of populace in order to recommend appropriate interventions., Methodology: A cross-sectional study conducted among health workers in primary health centres in Sokoto metropolis. Multi-stage sampling technique was used to recruit the study participants. A structured questionnaire and focus group discussion guide was used to collect the information. Data was analysed using IBM SPSS version 25., Results: Majority (109/182; 59.8%) had RHD inadequate knowledge of causes, risk factors and treatment of pharyngitis which predisposes to RHD. Only 49 (26.9%) of the respondents knew the name of the causative agent. The knowledge gap was related to length of training and attendance at a training (ꭓ2 = 8.38; P=0.015 & ꭓ2 = 7.92; P=0.004). Majority of the respondents with 168 out of 182 (92.3%) had positive attitude. Practice grading was adequate in only less than half of the respondents (88/182; 48.4%). Male gender and negative attitude were predictors of adequacy of preventive practices (aOR= 0.49; 95% C.I =0.267-0.929; P=0.03 & aOR= 3.87; 95% C.I =1.027-14.586; P=0.046)., Conclusion: The health workers had inadequate knowledge and poor practice on prevention of rheumatic heart disease. It is necessary to upscale information available to them by medical specialists and upgrade their curriculum., Competing Interests: None

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures., Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management., Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision., Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed., Competing Interests: The reviewer PAP declared a past co-authorship with the author(s) FMT to the handling. XCE and BP have received research funding and/or compensation as advisor/lecturer from AbbVie and AstraZeneca. JF and BRG, working for Violicom and former company, have previously received payment from AbbVie and AstraZeneca for work on various projects. MCN reports grants from the Bill & Melinda Gates Foundation, European & Developing Countries Clinical Trials Partnership, Pfizer, AstraZeneca and Sanofi-Pasteur; and personal fees from Pfizer and Sanofi-Pasteur. RTS has received fees for Advisory Board meetings and lectures for Sanofi-Pasteur, AstraZeneca, Janssen, and AbbVie. QB serves in the Independent Data Monitoring Committee (IDMC) for Respiratory Syncytial Virus (RSV) vaccine development for the protection of infants (since October 2015) (GlaxoSmithKline -GSK). JP reports grants to his institution from MedImmune, Merck, Sanofi Pasteur and AbbVie, and personal fees from AbbVie, Merck and AstraZeneca. JMP reports grants to his institution from MedImmune. HJZ has received funding for RSV-related research studies from Pfizer, AstraZeneca, Merck and the Bill & Melinda Gates Foundation. AM has received research funding from Merck and Janssen and compensation as advisor/lecturer from Sanofi-Pasteur and AstraZeneca. IM has been an investigator on studies funded by MedImmune, Regeneron, and Boehringer. MAS has received research funding from Janssen and compensation as advisor/lecturer from AbbVie, Sanofi-Pasteur and AstraZeneca. All declarations made by authors outside of the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Carbonell-Estrany, Simões, Bont, Gentile, Homaira, Scotta, Stein, Torres, Sheikh, Broor, Khuri-Bulos, Nokes, Munywoki, Bassat, Sharma, Basnet, Garba, De Jesus-Cornejo, Lupisan, Nunes, Divarathna, Fullarton, Rodgers-Gray, Keary, Reñosa, Verwey, Moore, Noordeen, Kabra, do Vale, Paternina-De La Ossa, Mariño, Figueras-Aloy, Krilov, Berezin, Zar, Paudel, Safadi, Dbaibo, Jroundi, Jha, Rafeek, Pinheiro, Bracht, Muthugala, Lanari, Martinón-Torres, Mitchell, Irimu, Pandey, Krishnan, Mejias, Santos Corrêa Da Costa, Shrestha, Pernica, Cotrim de Carvalho, Jalango, Ibrahim, Ewa, Ensinck, Ulloa-Gutierrez, Miralha, Lucion, Hassan, Akhtar, Aleem, Chowdhury, Rojo, Sande, Musau, Zaman, Arlant, Ghimire, Price, Subedi, Brenes-Chacon, Goswami, Rahman, Hossain, Chisti, Vain, Lim, Chiu, Papenburg, Juarez, Senaratne, Arunasalam, Strand, Ayuk, Ogunrinde, Tavares, Garba, Garba, Dawa, Gordon, Osoro, Agoti, Nyawanda, Ngama, Tabu, Mathew, Cornacchia, Rai, Jain, Giongo and Paes.)

Background: Lack of a timely receipt of vaccines can cause uncertain immune response and under-vaccination. Hence, timely vaccination is crucial to ensure an infant's early protection., Objectives: To identify the age of presentation for the birth dose vaccines, vaccine antigens received and factors associated with vaccination presentation by day one in Northern Nigeria., Method: A descriptive cross-sectional study involving 1 952 mother-infant pairs enrolled from 5 different states in Northern Nigeria. Data was collected using a questionnaire including the socio-demographic, antenatal care (ANC), delivery details, birth dates, vaccination presentation and birth vaccine antigens received. Data analysis was done with the SPSS-21 software., Findings: The median age of the infants at presentation for birth vaccines was six (interquartile range 2-16) days. A total of 413 (21.2%) infants were brought by the day of birth (day 0) or the next day (Day one), while one-fifth (20.6%) presented after Day 28. The most frequently received antigen was the Bacille-Calmette-Guerin by 1 781 infants (91.2%), oral polio vaccine 1 703 (87.2%), and hepatitis B vaccine birth dose the lowest at 75.1% (1 565). The commonest reasons for delayed presentations were an ill baby (24.7%) and an ill mother (21.9%).Factors associated with presentation within Day one post-birth were hospital delivery (OR-1.67, 95% CI; 1.28-2.19), firstborn (OR-1.40; 95%CI; 1.02-1.93), Christianity (OR-2.14 95% CI; 1.63-2.81), and mother with tertiary education (OR-1.62, 95% CI; 1.05-2.48)., Conclusion: Timely administration of the birth dose vaccines is low in Northern Nigeria. Furthermore, some babies do not get the required vaccines despite presenting for vaccination due to stockout. Strategies for early neonatal vaccination such as vaccination in hospital suites post-delivery and utilizing relatives/fathers to take the baby for vaccination when a mother is indisposed are imperative., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Background: Routine vaccination, a cost-effective means of preventing deadly childhood disease, has a low coverage in Nigeria. The study assessed the willingness of mothers to receive reminder messages for routine vaccination appointments in Northern Nigeria., Methods: A multi-centre cross-sectional study involving at least 363 mother-infant pairs per centre from five states in Northern Nigeria. Data collected include the socio-demographic details, responses on parental phone ownership, mothers' willingness to receive reminders for immunization appointments and the reminder type characteristics. Data analysis was done with SPSS., Results: Of the 1952 mother-infant pairs, ownership of at least one household phone was 97.7%. In total, 1613 (82.6%) mothers were willing to receive reminders. A majority (62.2%) of mothers preferred phone calls. A day before the vaccination appointment was the preferred timing (78.1%), and the predominant communication language was the local language for each region.The odds of being willing to receive reminders were 3.1 times, 2.6 times and 1.8 times higher in those with no formal education, primary education and secondary education, respectively, compared with mothers with tertiary education, each p < 0.05. Mothers who delivered at home were significantly less likely to want reminder messages (p = 0.03)., Conclusion: Eight of 10 women in Northern Nigeria are willing to receive a reminder for their child. The predominant mode of reminder preferred is phone calls using the local language. Deployment of mobile phone reminders strategy in Northern Nigeria as a means to improve vaccination uptake is feasible. The institution of this strategy can be in collaboration with service providers., (© The Author(s) [2021]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective(s): To determine the availability and affordability of asthma and COPD medicines across Nigeria., Methods: This was a cross-sectional survey conducted in 128 pharmacies (51 in public sector hospitals, 51 private sector community pharmacies and 26 charity or big private hospitals) across the six geopolitical zones of Nigeria using the WHO/Health Action Initiative method. The proportion of pharmacies where medicines were available, the median retail prices of originator and generics and affordability were analysed. A medicine was available if found in ≥ 80% of surveyed pharmacies. Unaffordability was defined as paying> 1 day's wage (> US$1.68) for a standard 30-day supply of the medicine., Results: The available medicines were oral corticosteroids and oral salbutamol which are not on the WHO Essential Medicine List. Medicines were found more frequently in private than public pharmacies and in the southern than northern zones. Inhalable corticosteroid was not available at any public pharmacy nationwide. None of the EML medicines were affordable. The least number of days' wages for a 30-day supply of any inhalable corticosteroid-containing medication was 3.5 days., Conclusions: There are very limited availability and affordability of recommended asthma and COPD medicines across Nigeria with disparity across regions. Medicines that were available and affordable are not recommended and are harmful for long-term use. This underpins the need for engagement of all stakeholders for the review of existing policies regarding access to asthma and COPD medicines to improve availability and affordability., (© 2020 John Wiley & Sons Ltd.)

Background: Adequate management of childhood acute asthma exacerbation requires optimal non-pharmacotherapy and pharmacotherapy. Global asthma guidelines provide critical information and serves as a quick reference decision-support material for clinicians., Objectives: We aimed at evaluating hospital management of childhood acute asthma exacerbation to ascertain its conformity to the global treatment guidelines, and to identify factors that predict short or prolonged observation in the hospital., Method: This was a retrospective audit of the management of acute asthma exacerbation in children seen between 01 January 2017 and 31 December 2018 at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Relevant data on demography, asthma triggers and severity, functional and clinical diagnoses, types of controller medications used before and after presentation, non-pharmacotherapy and pharmacotherapy instituted during presentation, duration of observation in the hospital, and treatment outcomes were extracted from the case file of each eligible patient., Results: A total of 119 children presented with features of suspected acute asthma exacerbations during the study period but only 63 (52.9%) that met the inclusion criteria for the study were included for analysis. The 63 children that were evaluated had mild (47; 74.6%) and moderate (16; 25.4%) acute asthma exacerbations. Their median (interquartile range) age was 8 (5-15) years. More males (36; 57.1%) than females (27; 42.9%) presented with features of the condition. Majority (50; 79.8%) of the patients had at least one trigger factor and of the 73 trigger factors reported, cold weather (19; 26.0%) was the commonest. Nebulized salbutamol (48; 76.5%), in addition to intravenous (23; 57.9%) and oral (17; 42.5%) corticosteroids, was used during hospital treatment. Patients were discharged mostly on short course of oral corticosteroid only (37; 58.8%). Of the 17 major recommendations in the Global Initiative for Asthma (GINA) guidelines, good (5; 29.4%), moderate (7; 41.2%), and poor (5; 29.4%) levels of adherence were observed. Specifically, moderate and poor levels of adherence were observed in the management of 61(96.8%) and 2(3.2%) patients, respectively. The odds of admission for ≤12 h were higher for female children and patients with mild cases., Conclusion: Good and moderate adherence levels to 12 of the 17 GINA recommendations were observed in our center. Nonetheless, reinforcement of institutional guidelines for acute asthma management is suggested to further improve the quality of care of childhood acute asthma exacerbations., (Copyright © 2020 Oshikoya, Ogunyinka, Imuzei, Garba and Jiya.)

Introduction: Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children., Case Presentation: This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. She was febrile, pale, wasted with bilateral pitting pedal oedema. She had a solitary circumscribed round necrotic lesion, with surrounding hyperaemia on the right malar area which extended to destroy the right ala nasi. No intra-oral rashes but she had left ear discharge. She received blood transfusion, antibiotics, antiseptic wound care and nutritional rehabilitation., Management and Outcome: Swabs of the lesion and ear discharge both revealed Gram-negative bacilli and culture yielded P. aeruginosa . Retroviral, Mantoux and Gene Xpert tests were negative. She had moderate anaemia, normal white blood cell count, and neutropaenia. Parenteral ceftriazone was changed to ciprofloxacin based on sensitivity results and lack of clinical response. The wound healed with residual scarring and partial destruction of right ala nasi., Discussion: Although this patient had facial necrosis to suggest Noma, she did not have initial oral involvement, and clinical features such as Pseudomonas sepsis and neutropaenia suggested EG. Facial necrosis in malnourished children may be due to EG., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Background: Malaria remains a major cause of under-five morbidity and mortality in Nigeria, and prompt diagnosis occupies a strategic position in its management. Malaria rapid diagnostic test (RDT), a nontechnical, easy to perform test promises to meet this need. It is important to locally document the usefulness of the use of RDT in making prompt malaria diagnosis in children., Objective: To determine the prevalence of malaria and evaluate the diagnostic performance of malaria RDT kit in febrile under-five children presenting to a Tertiary Health Facility in Gusau, North-Western Nigeria., Materials and Methods: A cross-sectional study of children aged 6-59 months, evaluated for malaria in a tertiary health facility from August 2012 to January 2013. Information was obtained from care providers of all subjects with fever and a presumptive diagnosis of malaria. All subjects were investigated using Giemsa stain microscopy and Carestart™ malaria RDT., Results: The prevalence of malaria in 250 febrile under-five children was 54%. Three-quarter (79%) of the children received inappropriate nonrecommended antimalaria prior to their presentation, including 20% who received chloroquine. The overall sensitivity of RDT was 40.3%. The specificity, positive and negative predictive values were 89.6%, 81.8%, and 56.5%, respectively., Conclusion: Use of RDT should be encouraged for screening and diagnosis using a protocol such that febrile children with positive RDT results are confirmed as having malaria while those with negative results are further evaluated using microscopy.