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Objective: To determine the number and distribution of paediatricians in Nigeria. It also aims to determine the association between paediatrician workforce and under five mortality (U5MR) and immunization coverage across the six geopolitical zones of the country. Methods: The part II fellowship examination pass list of the West African College of Physicians and the National Postgraduate Medical College and the register and financial records of the Paediatric Association of Nigeria were searched for the purpose of the study. Using a structured questionnaire, personal and professional data was obtained from members at the 2011 Annual Paediatric Association of Nigeria Conference or via the Association’s website, email network and phone calls to Departments of Paediatrics in institutions (private and public) across the Country. Data on the paediatricians residing within Nigeria was then extracted from the comprehensive database and subsequently analyzed. Population data, mortality and immunization rates were obtained from the National Population Commission census and their most recent National Demographic health survey in Nigeria. Correlations were drawn between number of paediatricians and U5MR and diphtheria-pertussistetanus (DPT) vaccine coverage. Results: There were 492 practicing paediatricians in Nigeria at the end of year 2011, comprising 282 (57.3%) males and 210 42.7%) females; 476 (96.7%). Majority (84.7%) worked for the government with 97% of them in hospital settings, mostly tertiary centres (344=88%). Lagos State had the highest number (85; 17.9%) of practicing paediatricians followed by the Federal Capital Territory with 37 (7.8%) paediatricians. More than two thirds of the paediatricians (336; 70.6%) were practicing in the southern part of the country. The average child: paediatrician ratio was 157,878:1for the country. The North East zone had the highest child- to-paediatrician ratio (718,412:1) while South West had the lowest ratio (95,682:1). Higher absolute numbers of paediatricians in each zone were associated with lower U5MR (Spearman ρ=-0.94, p=0.0048), accounting for 84% of the variability among zones. Higher ratios of child-to-paediatrician were significantly associated with higher U5MR (Spearman ρ=0.82, p=0.04, linear R2=0.73) and marginally with lower DPT coverage by geopolitical zone (Spearman ρ=-0.77, p=0.07, linear R2=0.59). Conclusion: The study reveals that the number of paediatricians in Nigeria is grossly inadequate with a huge child-to-paediatrician ratio.There is also an uneven distribution of the paediatricians with higher numbers in the southern states. Zones of the country with lower child-to-paediatrician ratios also experienced lower U5MR. There is a need to train more paediatricians in Nigeria and promote an even distribution of the paediatrician workforce

Background: Vaccine preventable diseases account for 22% of under-five deaths in Nigeria and poor knowledge and attitude have been responsible for non-vaccination of children. This study aimed to assess the knowledge, attitude and practice of childhood immunization among community members in Ile-Ife. Methods: Quantitative data (using an interviewer-administered questionnaire) was collected from a convenience sample of 36 adult residents who attended a town hall meeting with the Paediatric Association of Nigeria. Two focus group discussions were also conducted among sub-samples of male and femae respondents. Results: The mean age of respondents was 43.2 ± 11.9 years with a male to female ratio of 1:0.7. Most had secondary education (63.9%) and had children (91.7%). Most of the respondents understood what immunization was and knew the benefits but were unaware of several of the specific types of immunization. There were erroneous beliefs about the contraindications for immunization and mothers were entrusted with the sole responsibility of getting children immunized. Although most of the respondents had immunized their children, they identified laziness of mothers, negative attitude of health workers and logistics problems at facilities as barriers to patronage of immunization services. Conclusion: This study identified knowledge gaps and negative attitudes towards childhood immunization. We therefore recommend a community-wide health education intervention with emphasis on substantial male involvement in i mmunizations and improvement in immunization service delivery.

Introduction: Globally, acute watery diarrhoea is a major cause of childhood morbidity and mortality. It is the fourth leading cause of death in children contributing as high as 11% of all childhood deaths. In Nigeria, acute watery diarrhoea causes 240,106 deaths per year. Out of pocket expenditure is a major source of healthcare funding in Nigeria, hence treatment of acute watery diarrhoea places extra financial burden on the families especially those in the low socio- economic class. Objective: To determine the cost of treatment of acute watery diarrhoea in children aged 6 to 36 months. Methodology: This was a cross- sectional study conducted on children aged 6-36 months who presented with acute watery diarrhoea from January through October 2017. Data obtained using interviewer-administered questionnaire, included socio- demography, duration of illness, treatment cost of the index diarrhoeal episode before presenting to our facility, transportation cost, food and other incidental cost, duration of hospitalization. Diagnostic tests requested and medications prescribed were obtained from the patient’s medical file. Information on drug cost, diagnostic test cost and hospital bed day cost were obtained from Nnamdi Azikiwe University Teaching Hospital (NAUTH) central pharmacy, NAUTH main laboratory and account section respectively. Statistical Package for Social Sciences (SPSS) version 20 was used for data analysis. Result: Seventy two patients were recruited for the study, of whom 47(65.0%) were males giving a male female ratio of 1.9:1. Forty eight (66.6%) of the study participants belonged to the lower socioeconomic class while 22(30.6%) and 2(2.8%) belonged to the middle and upper socioeconomic class respectively. A mean total treatment cost per diarrhoea episode derived from this study was #37,572.2 ± #12,479.0 which at the time of the study was equivalent to US$ 104.7 ± US$ 34.8. This is well above the then Nigerian minimum monthly wage of 18,000.0 (US$ 50.1). Conclusion: The result of this study showed that the economic burden of acute watery diarrhoea is quite enormous especially to the low socio-economic group. Prevention and improvement of home treatment of diarrhoea may reduce the treatment cost.

Abstract: Background Research is key to quality healthcare. Clinicians should possess adequate research capacity to generate evidence. This study aimed to evaluate the research capacity of pediatricians in Nigeria. Methods: The study was a cross- sectional using a questionnaire developed from the Research Capacity Assessment Framework. Information on previous research work, challenges encountered, and utilization of research outcome were obtained. The data was analyzed using SPSS version 20. Qualitative variables were grouped under thematic headings. Results: Paediatricians who had received grants for research were 21 (19.4%). Those whose research outcomes had informed policy and practice were 20 (18.2%). Less than 40% of the participants had received training on research capacity areas. Conclusion: The research capacity among pediatricians was low partly due to underfunding and lack of research training programs. Improvement on government fund allocation for research and introduction of short research trainings programs will improve research capacity in Nigeria.

Background: Iron deficiency anaemia has been described as the commonest type of nutritional anaemia in infancy and childhood. The associated adverse health sequelae include permanent behavioural and cognitive impairments. Early detection and prompt treatment are necessary to prevent these complications. Aim: To determine the prevalence and socio-demographic distribution of iron deficiency anaemia among anaemic under five children in Enugu. Subjects and methods: Under-five children presenting at a tertiary hospital were consecutively enrolled and screened for iron deficiency anaemia using haematocrit and serum ferritin levels. Iron deficiency anaemia was defined as haematocrit level

Background: Early diagnosis and management of urinary tract infection (UTI) in young children reduces the risk of renal scarring and chronic renal insufficiency. We determined the prevalence of asymptomatic bacteriuria (ASB) among pre-school children in Nnewi, South-East Nigeria. Methodology: This was a crosssectional survey involving apparently healthy nursery school children aged 3-5 years. A pre-tested, care-giver administered questionnaire was used to obtain information about the participants including age, sex, history of fever and antibiotic administration in the two weeks preceding the study. Following a clinical examination, a sample of mid-stream urine was collected from each participant for dipstick urinalysis, and urine microscopy and culture. ASB was defined as the presence of ≥105CFU/ml of urine in a participant who had no symptoms of UTI. Results: Out of 792 children, 417 (52.3%) were females and 375 (47.4%) were males. The mean age of the children was 4.0 ± 0.7 years. ASB was found in 31 children (4%). The prevalence of ASBin females (7.2 %) was significantly higher than in males (0.5%), p

Background: Prompt administration of antibiotics to children with pneumonia significantly reduces the probability of death. However this requires early identification of such children in the community. In a country such as Nigeria with one of the highest pneumoniarelated deaths, what do mothers know about pneumonia, and what should be the content of public campaign messages? Methods: A structured questionnaire was administered to mothers attending paediatric clinics of Lagos University Teaching Hospital seeking their knowledge about the definition, causes, risk factors and symptoms of childhood pneumonia. Results: One hundred and seven (107) consecutive mothers participated in the study. The majority (97; 90.6%) had at least secondary education, were married (96; 89.7%) and professed to be either Christians or Muslims (105; 98.1%). Prior to the study, 16 (15%) had not heard about pneumonia. About half of the participants correctly identified fast/difficult breathing as suggestive of pneumonia. Threequarters reported exposure to coldas the cause of childhood pneumonia. Minimizing exposure to cold and wearing warm clothes were the two commonest reported ways of preventing pneumonia (75.8% and 49.5% of the mothers respectively); in contrast hand washing, exclusive breastfeeding and limiting exposure to sick persons with cough and catarrh were the least mentioned. The proportion of mothers who correctly identified fast/difficult breathing as suggestive of pneumonia was similar irrespective of educational status or source of pneumonia information. Conclusion: Mothers’ knowledge of childhood pneumonia is low. Public campaigns on pneumonia should focus on raising awareness about germs as cause of pneumonia, immunization, hand washing and exclusive breastfeeding as potent preventive strategies and fast/difficult breathing as a feature of pneumonia.

Although major gains were made in the reduction of childhood health indicators in the previous decade, stagnations or reversals were seen in many countries since the 1990s. Despite presence of primary health centers (PHC) in Nigeria, there are still high levels of morbidity and mortality among children because the quality of child health services falls short of what it could be in the country. Supportive supervision of PHCs should also improve the quality of child health services. This study assessed the level of clients’ satisfaction with care received and the quality of supervision of child health services in selected PHC facilities of Newi, Nigeria. The study design was cross sectional. Four health facilities were selected by simple random sampling technique from a list of 12 public PHC facilities that provide at least three of the range of essential child health services. Using interviewer administered questionnaire, data were collected from 305 caregivers and analyzed accordingly. Also key informant interviews ere used to elicit information facility supervision frequency and adequacy. The mean age of the mainly female caregivers was 31.9 ± 9.4 years. Majority of the caregivers attended health facilities closest to them but 18.5% of the 65 who do not, said they did not like the health workers. Although more than 80% of clients were satisfied with quality of child health services received, yet 1.3% of them felt that the number of service days were inadequate. None of the health facilities had a work plan, supervision schedule or supervision checklist. Increasing the number of service days and providing supervision schedules and checklists at the health facilities can improve caregiver satisfaction and hopefully enhance quality of child health services at the PHCs

Objective: To rank diagnostic features of childhood pulmonary tuberculosis; and to determine the effect of working in tuberculosis Directly Observed Treatment Short Course (DOTS) facilities on the ranking of these features by medical doctors. Methods: A cross sectional descriptive study, using structured questionnaires to collect data from medical doctors whose daily routine included attending to sick children in 34 selected children outpatient clinics and TB DOTS centers in southeastern Nigeria. Results: Approximately, one quarter (25.3% or 56 of 221) of respondents worked in Directly Observed Treatment Short course (DOTS) clinics, while three quarters (74.7% or 165 of 221) worked in nonDOTSclinics. Majority of the respondents (69.7%) ranked chronic persistent cough (1), 42.5 % ranked weight loss and failure to thrive (2), another 27.7% ranked weight loss and failure to thrive (3), while 17.6% and 21.7% ranked History of contact with adult index case and radiographic abnormalities, (4) and (5), respectively. Conclusions: The study found that the percentage of doctors working in DOTS clinics who ranked weight loss and failure to thrive (2) was statistically and significantly higher than those of non-DOTS respondents. The most important symptoms/signs on which medical doctors based their diagnosis of childhood pulmonary tuberculosis include cough, weight loss and failure to thrive, history of contact with adult with smear positive pulmonary tuberculosis, and r adiogr aphicabnormalities consistent with active tuberculosis. There was statistically significant difference between the ranking of weight loss and failure to thrive by doctors working in DOTS clinics and their counterparts in non DOTS clinics. This study showed a decline in the percentage of ranking in both DOTS and Non DOTS respondents as they moved from the first to the fifth.

Summary : A review of all preterm admissions into the Special Care Bay Unit' of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, over a period of 29 months (May 1998 - October 2000) was carried out. Out of a total of 699 neonatal admissions, 133 (19 percent) were preterms with gestational ages ranging from 24 to 36 weeks and birth weights from 600g to 2490g. Male: female ratio was 1:1.5. Seventy-three patients (54.9 percent) were referred from other health establishments, while 60 (45.1 percent) were born in NAUTH. Thirty-three patients were delivered by Caesarean section, out of which one died. Factors contributing to morbidity were sepsis, asphyxia, jaundice, anaemia and haemorrhagic disease of the newborn. Duration of hospital stay ranged from two hours to 54 days with a mean of 16.7 days. Twenty-four (18 percent) of the 133 patients died. Mortality-associated events were respiratory distress syndrome (40.0 percent), severe birth asphyxia (33 4 percent), neonatal sepsis (13.3 percent), severe neonatal jaundice (6.7 percent) and severe anaemia and haemorrhagic disease of the newborn (3.3 percent) each. The referred cases contributed 75 percent of the mortality. During the period between hospital discharge and one year corrected age, 2.8 percent of the babies died, 1.8 percent developed hydrocephalus, 1.8 percent had cerebral palsy, 2.8 percent had recurrent acute respiratory infections requiring hospital admission and 13.8 percent were lost to follow up. This study illustrates the impact of a newborn unit on a programme designed to reduce perinatal mortality.

Objective: To determine the role of cultural influences, namely: circumcision, ear piercing and traditional scarification, on HbsAg seropositivity among primary school children in Nnewi. Subjects and Method: Two hundred and thirty seven randomly selected primary school children aged 5-12 years, were screened for HbsAg Information on the subjects were collected by use of a pretested questionnaire and physical examination. Results: An HbsAg prevalence of 7.6 percent was observed. There was no significant difference in the prevalence of HbsAg between exposed children and those unexposed to the various traditional practices (P >05). Conclusion: Culturally related exposure did not seem to be a significant mode of HBV spread in Nnewi childhood population.

Abstract: Systemic lupus erythematosus is a chronic inflammatory autoimmune disease that affects all organ systems and follows a relapsing and remitting course with presentation ranging from indolent to fulminant. It is an uncommon condition in children and usually manifests as the cutaneous form in the paediatric age group. We report a case of neonatal lupus erythematosus in a six-week-old Nigerian infant seen at NAUTH, Nnewi. The objective of this report is to highlight the existence of this very rare condition in infants. A 6-week-old female infant presented at the paediatric unit of our facility with a history of a pre-auricular skin eruptions of five weeks and poor suckling of three weeks duration. The skin lesions persisted unchanged after 14 days of antibiotics. A skin snip was taken for histology and a diagnosis of neonatal lupus erythematosus was made.