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Introduction: Living conditions in most rural African communities favour malaria transmission and threaten global eradication. Prevention strategies and interventions such as the use of bed nets have reduced the prevalence of malaria. This study described the various methods employed to prevent malaria and their effects on malaria parasite prevalence among children living in a rural community in Nigeria. Methodology: A community-based cross-sectional study conducted among 357 children aged 1–15 years, in a Nigerian rural community. Data was analyzed using SPSS version 25. Chi-squared test of association with a level of significance of p < 0.050 was used. Results: Only 110 (30.8%) participants owned mosquito nets. Mostly those from the high social class (45; 40.9%) used the nets, and these were mostly ‘under-five’ children. Thirty-six (10.1%) were routinely given antimalarial drugs for malaria prophylaxis. Also, 102 (28.6%), 151 (42.3%), 278 (77.9%), 99 (27.7%) and 15 (5.0%) children used insecticides, local herbs, window nets, outlet door nets and mosquito repellent creams respectively. None of the methods employed to prevent malaria had statistically significant effect on malaria parasite prevalence among participants (p > 0.050). Conclusions: Malaria prevention methods were mostly practiced by participants of the high social class while children under-five considerably used mosquito nets. This study highlights the need to address the socio-demographic imbalance regarding malaria preventive measures in the community where the study was conducted. There is also a need to regulate the use of antimalarial drugs for malaria prophylaxis in the rural community. These suggest that the current malaria prevention methods in the community be reviewed.

Background: ‘Brought- in-dead’ (BID) refers to the demise of an individual before presentation to a health facility. This study assessed the pattern of paediatric BID cases seen at a tertiary health facility in southwest Nigeria. Method: A cross-sectional, descriptive study was done at the Children Emergency Ward (CEW) of the hospital between January 2014 and December 2018. The patterns of BID cases and presumed causes of death were determined using a standardized checklist adapted from the WHO verbal autopsy instrument. Results: Ninety-eight BID cases were seen during the study, constituting 2.5% of total patients seen during the period. The median (IQR) age of cases was 24.0 (8.75 – 63.0) months and 72.4% were under-fives. Most had symptoms related to the haematologic (36.7%), respiratory (24.5%) or digestive (20.4%) systems. Severe anaemia 31(31.6%), gastroenteritis 19 (19.4) and aspiration 17 (17.3%) were the most common causes of death. The median (IQR) duration of illness before presentation was 3.0 (1.0 – 7.0) days but most presented from 4 – 7 days of illness. A significant relationship was found between the duration of illness and whether or not pre-hospital treatment was received (p < 0.0001). Unprescribed drugs purchased over the counter were the most commonly used treatment in 79.1% of cases (p < 0.0001). Conclusion: This study has highlighted the prevalence and pattern of paediatric BID in a tertiary health facility in southwest Nigeria and the factors that were associated with it. More efforts need to be geared towards community sensitization and pediatric health care to prevent factors drivingits menace.

Background Childhood diabetes mellitus is a poorly researched topic in Nigeria. Its contribution to morbidity and mortality is vague. This study intends to provide additional information to the background data in Nigeria and hopefully proffers strategies to improving the outcome of this disease. Methods This is a retrospective descriptive study of all children managed for childhood diabetes mellitus at the Ekiti State University Teaching Hospital (EKSUTH) and LAUTECH Teaching Hospital (LTH), South West Nigeria, over a 10 year period. Relevant information was obtained from the case notes of all affected children. Data obtained were analysed with SPSS version 20 software. Results A total of 20 children were treated for diabetes mellitus (DM); there were 7 (35.0%) boys and 13 (65.0%) girls giving a M:F ratio of 1.0:1.9. Age range at presentation was 5 to 16 years and the mean age at presentation was 12.7 ± 2.89 years. Diabetic ketoacidosis (DKA) was the most common form of presentation in 13 (65.0%). Most [18 (90.0%)] of the patients had type 1 DM. Type 2 DM and glucocorticoid-induced diabetes mellitus were recorded in a case each, Eighteen (90%)patients had not been previously diagnosed by any form of screening prior to their presentation and admission in the hospital. Seven (35.0%) of the patient's care were affected by parental financial constraints. Five mortalities were recorded and one left against medical advice while the majority [14 (70.4%)] were discharged well and alive. The association between the greater numbers of deaths recorded in children with financial constraints was statistically significant (p < 0.05). Conclusion Type 1 DM remains the most predominant form of diabetes in children and most of the patients presented in DKA. The proportion of deaths in this study is unacceptably high. There is a need to proffer strategies for earlier detection and management of children with diabetes mellitus prior to the onset or development of DKA and there is a need to assist with the funding of the care of children with diabetes mellitus.

Background: Knowledge of the profile of pediatric discharge against medical advice (DAMA) may help design interventions to reduce its prevalence. Objectives: This study aimed to assess the profile of pediatric DAMA at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State, Nigeria. Methods: This retrospective cross-sectional descriptive study included all pediatric cases of DAMA from January 2012 to December 2018. Relevant information was extracted from the patients’ case notes. Data was analyzed using the statistical package for social sciences (SPSS) version 23. Results: The overall prevalence of pediatric DAMA was 3.8%. Of the 233 pediatric DAMA with complete information, 127 (54.5%) were males. Severe malaria (27.3%) was the most common diagnosis among DAMA cases at the children emergency ward (CEW), while severe perinatal asphyxia (25.0%) and neonatal sepsis (25.0%) were the most common at the special care baby unit (SCBU). Only 1 (0.4%) patient was enrolled in the National Health Insurance Scheme (NHIS). Moreover, 43 (18.5%) parents took DAMA due to financial constraints, and 55% of the patients had their DAMA form signed by their fathers. In addition, among the patients who referred for follow-up, 11 (4.7%) patients fully recovered, 2 (0.8%) recovered with disability, 1 (0.4%) was readmitted, and 1 (0.4%) died. The highest and lowest DAMA rates were in the months of May and December, respectively. Patients aged under five years old who took DAMA significantly had infectious diseases compared to older age groups (P

BACKGROUND Thrombospondin-1 (TSP-1) and 25-hydroxyvitamin D (25-OHD) play significant roles in the pathogenesis of sickle cell anemia (SCA). TSP-1 enhances cellular adhesion/inflammation, hence contributing to vaso-occlusive crisis (VOC); vitamin D, in contrast, retards inflammation and may lower rate of pain episodes. We determined serum levels of TSP-1 and 25-OHD in Nigerian children with SCA and their matched hemoglobin AA controls; and assess the relationship between the 2 biomarkers. METHODS In total 90 children (32 SCA in steady state, 30 SCA in VOC, and 28 HbAA controls) were studied. Serum TSP-1 and 25-OHD levels were measured with ELISA and HPLC, respectively. RESULTS The mean TSP-1 of children with VOC was significantly higher than those in steady state (P=0.022) and HbAA controls (P

Oladele Simeon Olatunya,1,2 Adefunke Olarinre Babatola,1,2 Adewuyi Temidayo Adeniyi,1,2 Olubunmi Adeola Lawal,3 Alaba Olanrewaju Daramola,4 Tosin Anthony Agbesanwa,5 Temitope Olumuyiwa Ojo,6 Paul Oladapo Ajayi,7 Adeleke Ajayi Ibijola,8 Akinwumi Kolawole Komolafe,2 Adekunle Adekile9 1Department of Paediatrics, College of Medicine, Ekiti State University, Ado Ekiti, Nigeria; 2Department of Paediatrics, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria; 3Department of Paediatrics, Federal Teaching Hospital, Ido Ekiti, Ekiti State, Nigeria; 4Department of Hematology and Blood Transfusion, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria; 5Department of Family Medicine, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria; 6Department of Community Health, Obafemi Awolowo University Ile-Ife, Ile-Ife, Osun State, Nigeria; 7Department of Community Medicine, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria; 8Department of Hematology, Federal Teaching Hospital, Ido Ekiti/Afe Babaloa University, Ado Ekiti, Ekiti State, Nigeria; 9Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, KuwaitCorrespondence: Oladele Simeon OlatunyaDepartment of Paediatrics, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti State, NigeriaTel +2348038617705Email ladeletunya@yahoo.comBackground: Due to the chronic nature of sickle cell disease (SCD), affected individuals may seek help from diverse places thus raising the need to understand their health-seeking behavior (HSB) in order to design an appropriate management policy for them.Aim: The aim of this study was to evaluate the HSB among pediatric SCD patients relative to their non-SCD counterparts attending a tertiary facility in Southwest Nigeria and identified predictors of poor HSB among SCD patients.Methods: A total of 110 children with SCD were recruited and studied for their HSPs which were compared with 110 non-SCD patients with other chronic medical conditions. Questionnaires were used to obtain self-reported information on participants’ socio-demographic data and HSB. Logistic regression was used to determine the predictors of poor HSB among the SCD cohort.Results: More SCD patients received treatments at private hospitals, patent medicine stores and faith-based centers compared to their non-SCD counterparts (p=0.0052; 0.006; and 0.007), respectively. No difference was observed in the patronage of traditional care centres 10 (9.1%) vs 6 (5.5%). More SCD patients 61 (55.5%) vs 35 (31.8%) exhibited poor HSB (p=0.0004). SCD patients who were not enrolled on health insurance scheme were 18 times more likely to have poor HSB (OR=18.38, 95% CI (4.41– 76.57), p value= < 0.0001) while absence of VOC within the preceding year reduces the risk of poor HSB by 91.5% (OR=0.085, 95% CI (0.028– 0.258), p value= < 0.0001).Conclusion: SCD patients in the study locality had poor HSB. This raises the need for their education on proper HSB. More enrollment into health insurance scheme and the prevention of VOC will lessen the burden of poor HSB. The high patronage of non-hospital care facilities in this study raises the need for stakeholders to monitor activities and train the operators at these informal care centres.Keywords: sickle cell disease, health-seeking behavior, non-orthodox care, Nigeria

Hypopituitarism, a deficiency of one or more of the hormones produced by the pituitary gland, is a rare disorder. It can be congenital or acquired. Case report on childhood hypopituitarism is rare in Nigeria. We present a 15-year-old boy, second of a set of twins, who presented with short stature and delayed puberty. Subtle difference in stature, was noticed on review of their childhood pictures by 2 years of age though disparity in stature became obvious to the parents at 6 years of age and it became embarrassing at 15 years of age when parents decided to seek medical attention. He was a product of term gestation with birth weight of 3.2kg; there was no history suggestive of birth trauma. Developmental milestone in the first two years of life was essentially normal like his unaffected twin brother. At presentation both height and weight were below 3rdpercentile for age, he had a low blood pressure of 80/50mmHg, infantile male external genitalia with testicular volume of 2ml, bone age of 7 years, very low serum testosterone, growth hormone, adrenocorticotropic hormone, thyroxine, follicle stimulating hormone, leutenizing hormone, Cortisol and high thyroid stimulating hormone. He achieved remarkable improvement in physical activity, height, weight and hormonal profile within the first 7 months of hormone replacement therapy but could not sustain therapy because of financial constraint. Paediatric hypopituitarism is a rare and treatable disorder. Early presentation, diagnosis and appropriate hormone replacement therapy at affordable price is essential for survival and good prognosis.

Introduction: Breastfeeding is a public health practice that is critical for the survival of infants and young children. Despite the well documented advantages of breastfeeding to both the child and mother, it is surprising to note that the rate of breastfeeding especially exclusive breastfeeding is quite low in many countries. The possible reason may be because most of the efforts and activities directed at improving the breastfeeding rate and duration are targeted at pregnant women and post-partum period.This study aimed at determining the knowledge, attitude, beliefs, and future intention to breastfeed among female undergraduates in tertiary institutions in Ekiti State, South West Nigeria.Methods: The study was a prospective cross-sectional study conducted among female students of tertiary institutions in Ekiti State. By convenience sampling, female students were invited to participate in the study after giving verbal consent and those that were thirty years old and above, medical or nursing students were excluded. The questionnaire used for this study was self-administered. The proforma was designed to assess the students’ knowledge about breastfeeding, attitude, beliefs, and future intention towards breastfeeding.Data analysis was with SPSS version 25 using descriptive and inferential statistics. Results were summarized as percentages. Consensus index was calculated for the questions on the knowledge of the benefits of breastfeeding and the perception of breastfeeding.Result: One thousand, three hundred and twelve (1312) students participated in the study. Only 58% of the respondents defined exclusive breastfeeding correctly. The participants displayed a particularly good knowledge of the importance of breast milk for the brain growth as 93% of the respondents agreed that breast milk is important for the development of the infant’s brain. As much as 51% of the respondents agreed that breast milk is not needed after infancy. Only 34% of the respondents indicated their intention to breastfeed their future babies, 6.5% said no.Conclusion: This study revealed that most of the future mothers have poor knowledge and beliefs about breastfeeding as well as negative attitude toward breastfeeding, hence there is need to step up awareness about breastfeeding and its benefits among this huge population of future mothers.

BACKGROUND Sickle cell anemia (SCA) is associated with recurrent vaso-occlusive crisis (VOC) and the risk of myocardial ischemia (MI). This study investigated the utility of electrocardiography (ECG) and cardiac troponin I (cTnI) in diagnosing MI during VOC. MATERIALS AND METHODS Children with SCA 5 to 15 years of age in VOC (patients) and age-matched and sex-matched steady-state controls were studied. Their ECG and cTnI levels were measured at contact and after 4 to 6 weeks. RESULTS One hundred eighty-six children (93 patients and 93 controls) were studied. The mean (SD) ages of the patients and controls were 8.8 (3.2) and 9.0 (3.1) years, respectively. The mean MI score was significantly higher for the patients, 1.7 (1.2), than the controls, 1.3 (1.0), P=0.002. A significantly higher proportion of the patients, 18 (19.4%), also had significant ischemia compared with the controls, 8 (8.6%), P=0.016. The median (interquartile range) serum cTnI level was significantly higher in the patients than the controls, P=0.006. All 7 of the patients with elevated cTnI had VOC. No significant correlation was found between MI score and cTnI in both groups. CONCLUSIONS cTnI is elevated and ECG features of MI worsen during VOC. Longitudinal studies to investigate their evolvement over time are advocated.

Background Childhood diabetes mellitus is a poorly researched topic in Nigeria. Its contribution to morbidity and mortality is vague. This study intends to provide additional information to the background data in Nigeria and hopefully proffers strategies to improving the outcome of this disease. Methods This is a retrospective descriptive study of all children managed for childhood diabetes mellitus at the Ekiti State University Teaching Hospital (EKSUTH) and LAUTECH Teaching Hospital (LTH), South West Nigeria, over a 10 year period. Relevant information was obtained from the case notes of all affected children. Data obtained were analysed with SPSS version 20 software. Results A total of 20 children were treated for diabetes mellitus (DM); there were 7 (35.0%) boys and 13 (65.0%) girls giving a M:F ratio of 1.0:1.9. Age range at presentation was 5 to 16 years and the mean age at presentation was 12.7 ± 2.89 years. Diabetic ketoacidosis (DKA) was the most common form of presentation in 13 (65.0%). Most [18 (90.0%)] of the patients had type 1 DM. Type 2 DM and glucocorticoid-induced diabetes mellitus were recorded in a case each, Eighteen (90%)patients had not been previously diagnosed by any form of screening prior to their presentation and admission in the hospital. Seven (35.0%) of the patient's care were affected by parental financial constraints. Five mortalities were recorded and one left against medical advice while the majority [14 (70.4%)] were discharged well and alive. The association between the greater numbers of deaths recorded in children with financial constraints was statistically significant (p < 0.05). Conclusion Type 1 DM remains the most predominant form of diabetes in children and most of the patients presented in DKA. The proportion of deaths in this study is unacceptably high. There is a need to proffer strategies for earlier detection and management of children with diabetes mellitus prior to the onset or development of DKA and there is a need to assist with the funding of the care of children with diabetes mellitus.

Introduction Breastfeeding is a public health practice that is critical for the survival of infants and young children. This study aimed at determining the knowledge, attitude, and future intention to breastfeed among female undergraduates in tertiary institutions in Ekiti State, Southwest Nigeria. Methodology: A prospective cross-sectional study was conducted among 1312 female students of the tertiary institutions in Ekiti State. By convenience sampling, female students were invited to participate in the study after giving verbal consent and those studying medical, nursing, and other courses allied to medicine were excluded. Internal consistency of the data obtained from this research instrument was determined using Cronbach’s coefficient Alpha with a reliability value of 0.82. Data analysis was conducted using SPSS version 25. Descriptive as well as inferential statistics were computed. Results were summarized as frequencies and percentages. The differences in knowledge, attitude, and intention to practice breastfeeding as well as other responses among the participants were compared among age groups, faculties and the sources of information using Chi-square test. Result Although 93% of the respondents agreed that breast milk is important for the development of the infant’s brain thereby demonstrating good knowledge; 51.6% of the respondents demonstrated poor perception to breastfeeding believing breastfeeding makes the breast to sag while only 34% of the respondents indicated their intention to breastfeed their future babies. Conclusion The intention to breastfeed among our study participants was poor. This study revealed the need to increase awareness about breastfeeding and its benefits among this huge population of future mothers.

Carpopedal spasm have various causes ranging from dsyselecrolytemia, syndromic, metabolic or endocrine causes. Any of these could cause a decrease in ionized calcium and tetany. Excessive vomiting leading to alkalosis, hypokaleamia and decreased ionised calcium should be kept in mind for early etiological diagnosis of carpopedal spasm. We report a case of 4-year-old boy presenting with a history of recurrent painful spasm and flexion of bilateral hands following excessive vomiting and electrolyte derangement.