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Background: Urinary tract infection (UTI) is a significant cause of morbidity in children and individuals with sickle cell anaemia (SCA) have been reported to be at increased risk. It will be useful to have a simple means of screening such children for UTI with a view to instituting prompt treatment. Objectives: The objective of the study was to evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children. Methods: This prospective study was carried out in the department of Paediatrics, University College Hospital, Ibadan. The study group consisted of 171 children aged one to 15 years with SCA presenting with fever (temperature e” 37.5°C). Midstream urine specimen was collected from each patient and subjected to nitrite test, microscopy, culture and sensitivity. Results: There was significant bacteriuria in 37 (21.6 percent) children. A positive test for nitrite was obtained in the urine of eight patients, seven of whom had bacteriuria. The nitrite test in detecting bacteriuria had a specificity of 99.2 percent, a sensitivity of 18.9 percent, a positive predictive value of 87.5 percent and a negative predictive value of 81.6 percent. A positive nitrite test was significantly associated with bacteriuria, while a negative test was also significantly associated with an absence of bacteriuria. Conclusion: The nitrite test is useful as a screening test for UTI in SCA children. However, in sick children, urine microscopy and culture should still be done in spite of a negative test screening such children for UTI with a view to instituting prompt treatment. This study was designed to evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children.

Background: The hallmark of Nephrotic syndrome is massive proteinuria, with associated enlarged kidneys. However the association between remission status and size of the kidneys in patients with nephrotic syndrome is not known. This study is aimed at determining the dimensions of the kidneys of children with nephrotic syndrome and to compare kidney dimensions in patients with nephrotic syndrome who were in remission compared with the dimensions in patients who were not in remission. Subjects and Methods: This is a case-control study, where fiftythree children with diagnosis of Nephrotic syndrome and fifty- seven age matched healthy controls were analysed. The kidneys of both cases and controls were scanned using the B- mode ultrasound and the kidneys Bipolar, anteroposterior and transverse dimensions and volume were determined. Results: The mean renal longitudinal, anteroposterior, transverse dimensions and volume were higher in cases compared to the controls, bilaterally (p

Background: Acute glomerulonephritis (AGN) is an important cause of mortality and morbidity in children in developing countries while its incidence has declined in the developed world. This study was to document its present impact in our setting. Aim: To evaluate the sociodemographic features and clinical outcomes in children hospitalized for AGN in the Paediatric Nephrology Unit of the University College Hospital, Ibadan. Subjects and Methods: This was a descriptive analytical study of children aged 2 to 14 years admitted with AGN between 2007 and 2019. Their sociodemographic data, clinical features, complications and outcome were analysed. Results: AGN accounted for 116 (8.9%) of new renal cases admitted over the period. Seventy-Four (63.8%) were male, mean age (SD) was 8.2 (3.3) years and peak age incidence between 5 and 9 years. Average annual hospital incidence rose from 4 - 5 new cases to 8-9 new cases/annum with an upsurge to 17 cases in 2019. Highest yearly monthly incidence was between June and December. Forty- five out of 50 (90%) evaluated subjects were in the middle/ low socioeconomic classes. Stage 2 hypertension occurred in 30/50 (60%) with hypertensive crises in 24%. RPGN occurred in 6/50 (12%) of cases accounting for 5 of the 8 dialysed patients and 4 of the 5 deaths. The case fatality rate was 4.3%. Conclusion: The study showed a progressive increase in the hospital incidence of AGN.RPGN was a major risk factor for death in children with AGN and therefore requires a high index of suspicion and an appropriate early intervention.

Summary:The present autopsy study has revealed that infection, contributing to 47 percent of the deaths, was the leading cause of child hood mortality from early neonatal period through school age period, with the highest incidence of 40 percent in the pre-school age period. The six leading infections, in descending order of frequency included pneumonia, meningitis, tuber culosis, measles, malaria and neonatal tetanus. Other common causes of mortality in the series included asphyxia in 11.0 percent, congenital malformations in 10.4 percent and malignancies in 8.7 percent of the total deaths. While preventable conditions generally, including infections, birth asphyxia, malnutrition, birth injuries and accidents accounted for 66.4 percent of the deaths, neonatal problems of asphyxia, birth injury and low birthweight contributed to 18.0 percent of the mortality. On the basis of the present findings, it is suggested that in order to reduce childhood mortality to acceptably low levels, improvement in obstetric and perinatal services in our institution should be undertaken. Furthermore, health education to parents, immunizations and economic improvement of parental status, should he carried out to prevent infections, malnutrition and accidents.

Zinc Phosphide(Zn3P2) is a common rodenticide freely available in Nigeria for use against rodents. Occasionally human consumption occurs either accidentally or intentionally with potential consequences of multiorgan toxicity and death. An 11-year-old boy consumed an unknown quantity of zinc phosphide marketed as Push Out® with the intention of committing suicide and killing some members of the family as his response to chastisement for a misdemeanour. Patient presented in the hospital 4 days after ingestion of zinc phosphide with a history of profound vomiting and abdominal pain. Laboratory evaluation showed evidence of hepatic dysfunction, acute kidney injury and elevated serum amylase. He was managed conservatively and discharged home after two weeks of admission. We report this case to emphasise the need for Paediatricians to consider ingestion of rodenticides as a differential diagnosis of hepatoxicity and pancreatic enzyme elevation, as well as to highlight the possibility of suicide among children. There is need to control the indiscriminate use of rodenticides, strengthen public health education on poisoning as well as establish Poison Information Centres in our environment.

Abstract Background The absence of antibodies specific for the 19 kDa C-terminal domain of merozoite surface protein 1 (MSP119) has been associated with high-density malaria parasitaemia in African populations. The hypothesis that a high prevalence and/or level of anti-MSP119 antibodies that may inhibit erythrocyte invasion would be present in apparently healthy individuals who harbour a sub-microscopic malaria infection was tested in this study. Methods Plasma samples were collected from residents in a region in Nigeria hyperendemic for malaria, who had no detectable parasitaemia by microscopy. Using a competition-based enzyme-linked-immunosorbent assay with two invasion-inhibitory monoclonal antibodies (mAbs) 12.10 and 12.8, the levels and prevalence of specific antibodies were measured. The minimum multiplicity of infection was determined using PCR. The prevalence of anaemia was also measured. Results Plasma samples from 85% of individuals contained antibodies that bound to MSP119. The inhibition of mAb 12.10 binding was strongly correlated with the prevalence (Spearman correlation test, p < 0.0001) and mean titre of anti-MSP119 antibodies (Spearman correlation test, p < 0.001) in the samples. Comparing samples from individuals with multiple infection (group M) and single infection (Group S), group M contained a higher (p = 0.04) prevalence of anti-MSP119 antibodies that competed with mAb 12.10. Using a logistic regression model, it was found that the presence of antibodies competitive with mAb 12.10 was affected negatively by anaemia (p = 0.0016) and positively by the carriage of multiple parasite genotypes (p = 0.04). Conclusions In the search for correlates of protection against malaria, which will be essential to evaluate clinical trials of malaria vaccines based on MSP1, this study examines some potential assays and the factors that need to taken into account during their evaluation, using samples from individuals naturally exposed to malaria infection.

Abstract Background Neonatal mortality continues to be a challenge in Nigeria, where low-quality care, caregivers’ ignorance of signs of neonatal illnesses, and prevalent use of unorthodox alternatives to health care predominate. Misconceptions originating and propagating as traditional practices and concepts can be linked to adverse neonatal outcomes and increased neonatal mortality. This study explores the perceptions of causes and management of neonatal illness among caregivers in rural communities in Enugu state, Nigeria. Methods This was a cross-sectional qualitative study among female caregivers of children residing in rural communities in Enugu state. A total of six focus group discussions (FGDs) were conducted; three in each of the communities, using an FGD guide developed by the researchers. Using pre-determined themes, thematic content analysis was used to analyze the data. Results The mean age of respondents was 37.2 ± 13.5 years. Neonatal illnesses were reportedly presented in two forms; mild and severe forms. The common causes of the mild illnesses reported were fever, jaundice, eye discharge, skin disorders, and depressed fontanelle. The severe ones were convulsion, breathlessness/difficulty or fast breathing, draining pus from the umbilicus, and failure-to-thrive. The caregivers’ perceptions of causes and management of each illness varied. While some believed these illnesses could be managed with unorthodox treatments, others perceived the need to visit health centers for medical care. Conclusions Caregivers’ perception on the causes and management of common neonatal illnesses in these communities is poor. Obvious gaps were identified in this study. There is a need to design appropriate interventions to dispel the myths and improve the knowledge of these caregivers on neonatal illnesses towards adopting good health-seeking behaviours.

Abstract Background The number of infants managed for neonatal circumcision injuries in our unit has been on the increase over the past 16 years. In our search for the sources and reasons for these injuries, we were unable to identify any previous studies of circumcision injuries from our environment. We therefore decided to carry out this study in order to shed some light on this growing problem. Methods The patients were made up of 370 consecutive consented children attending our infant welfare clinic for immunization over a period of 3 months. Information on their demographic data, their age at circumcision, where, why and who circumcised them was obtained from their mothers. They were clinically examined for the presence and type of complications of circumcision. Results Our circumcision rate was 87%. Neonatal circumcision had been performed in 270 (83.9%) of the children. Two hundred and fifty nine (80.7%) were performed in hospitals. The operation was done by nurses in 180 (55.9%), doctors in 113 (35.1%) and by the traditional circumcisionist in 29 (9%) of the children. Complications of circumcision occurred in 65 [20.2%] of the children. Of those who sustained these complications, 35 (53.8%) had redundant foreskin, 16 (24.6%) sustained excessive loss of foreskin, 11 (16.9%) had skin bridges, 2 (3.1%) sustained amputation of the glans penis and 1 (1.5%) had a buried penis. One of the two children who had amputation of the glans also had severe hemorrhage and was transfused. Even though the complications tended to be more likely with nurses than with doctors or traditional circumcisionists, this did not reach statistical significance (p = 0.051). Conclusion We have a very high rate of complications of circumcision of 20.2%. We suggest that training workshops should be organized to adequately retrain all practitioners of circumcision on the safe methods available.

Background: Bacterial contamination of operating theaters is a major contributory factor to the high prevalence of post-operative nosocomial infections. The detection of changing trends of microbial counts and micro-flora is key to reducing microbial contamination and good antibiotic stewardship. Objective: The objective of this study was to identify bacterial colonization of surfaces and equipment in Enugu State University Teaching Hospital’s operating theater. It also aimed at determining the sensitivity patterns of the colonized surfaces. Materials and Methods: This cross-sectional study was conducted in the Main Theater of Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria. Samples were collected from equipment, operating room surfaces, and cleaning solutions. Results: Out of 92 samples collected from various sites, bacterial growth was observed in 47 (51.1%) specimens. Coagulase-negative Staphylococcus (CoNS) was the most common isolate (36.2%), followed by Staphylococcus aureus (34%). Among S. aureus isolates, 43.8% were methicillin-resistant S. aureus (MRSA), and the remaining were methicillin-susceptible S. aureus (MSSA). There was high Gram-negative resistance to meropenem. All the Gram-negative isolates were susceptible to imipenem. Conclusion: CoNS and S. aureus were the commonest isolates. Increased efforts are needed to reduce the rate of healthcare-associated and surgical site infections in operating theaters.

Background: Information obtained from the “brought in dead” (BID) cases is important in understanding the challenges in seeking health care and help in policy making. Objective: This study was conducted to describe the characteristics of children presenting to Enugu State University Teaching Hospital (ESUTH), Enugu as BID and probable causes of death. Materials and Methods: This descriptive study was conducted in the Children Emergency Room (CHER) of ESUTH. Information from all cases of BID children presenting to the CHER of ESUTH between May 2016 and April 2020 was recorded in a register after the confirmation of death. A probable diagnosis was made by verbal autopsy. Data were entered and analyzed with Statistical Package for Social Sciences (SPSS) version 20 (Chicago, IL). Results were presented as tables, bar chart, and prose. Results: There were 124 cases of BID, accounting for 2.2% of the total presentations and 43.1% of the mortalities. Their ages ranged from one month to 192 months, with a median age of 12 months. Majority (61, 49.2%) of the dead children were infants. There was an almost equal sex distribution with 63 males and a male-to-female ratio of 1:1. Probable causes of death included acute gastroenteritis (AGE), severe anemia, sepsis, acute encephalitic syndrome, and aspiration. None of the cases was referred from a health facility. There was a bimodal peak for the annual presentation (January and October). Most of the presentations were during the day (86, 69.4%). None of the parents gave consent for autopsy. Conclusion: The rate of children dying before receiving health care in our hospital is high; there is an urgent need for continuous mass mobilization within the communities to improve the health-seeking behaviors, and also to teach them to recognize danger signs in children.

Abstract Background Evidence exists as to the criticality of the first 24 h in the management of cerebral malaria. The morbidity and the mortality rate (35%) with the current intravenous monotherapy for the initial treatment of cerebral malaria are unacceptably high. Combination therapy and a shorter course of effective medication have been shown to improve outcomes in human participants in the treatment of other diseases. This study outlines a protocol to conduct a triple blinded parallel randomized controlled trial on cerebral malaria using dual intravenous medications compared to the current standard of monotherapy. Methods This is a parallel multi-site randomized controlled superiority triple blinded trial consisting of intravenous artesunate plus quinine and a control arm of intravenous artesunate only. Eligible and assenting children aged 6 months to 17 years will be recruited from 4 tertiary hospitals by random selection from the list of tertiary hospitals in Nigeria. Participants will be randomized and assigned in parallel into two arms using random numbers generated from GraphPad Prism (version 9) by a clinical pharmacologist who has no link with the investigators, the patients, or the statistician. The primary measurable outcome is survival at 12, 24, and 48 h post-randomization. A composite secondary outcome consists of the number of children that regained consciousness, parasitaemia and defervescence at 12 and 24 h post-randomization and haematological and inflammatory markers at 24 and 48 h post-randomization. Adverse events both solicited and unsolicited are recorded all through the study post-randomization. The study is approved by the State Research Ethics Review Committee. Data analysis will be performed in GraphPad Prism version 9. Discussion The outcome of this analysis will give insight into the efficacy and safety of dual intravenous antimalaria in the treatment of cerebral malaria among Nigerian children compared with the standard of care. The safety profile of this intervention will also be highlighted. This may help inform physicians on the optimal treatment for cerebral malaria to improve outcomes and reduce recrudescence and treatment failure. Trial registration Pan Africa Clinical Trial Registry PACTR202102893629864 . 23/02/2021.

The Kidney Disease: Improving Global Outcomes (KDIGO) advocates the use of dipstick proteinuria as a primary screening tool. However, the performance of dipstick urinary for proteinuria has been adjudged to be weak, unreliable with poor predictive value. This study aimed to determine and compare significant proteinuria (SP) using spot urinary protein-to-creatinine ratio (UPr/UCr) as a primary screening tools with dipstick proteinuria among the high-risk African children. This study was a cross-sectional study, involving 33 schools in Ogbomoso land, Southwestern Nigeria. A total of 1316 apparently healthy children were recruited through a multistage sampling technique from both rural and urban communities using a semi-structured questionnaire. Dipstick urinalysis was performed on early morning urine samples. Urinary protein was determined using a turbidimetric method, while Jaffe’s reaction was used to measure urinary creatinine concentration. Statistical analysis was performed using IBM SPSS Statistics version 23.0 for Windows. The prevalence of SP using spot UPr/UCr (≥0.2) and dipstick proteinuria (≥1+) was 18.0% and 0.8%, respectively (P

Introduction: The duration of admission in the hospital, mortality rates, and care costs is increased in Neonatal Intensive Care Unit (NICUs) by nosocomial infections (NIs). There is a need for routine and regular environmental sampling in NICUs. Methodology: This was a cross-sectional study conducted in the NICU of Enugu State University Teaching Hospital. The researchers collected samples for culture from equipment and hospital surfaces in the unit. Susceptibility testing was done for isolates by the agar diffusion method using standard nutrient agar 1 discs. Results: We observed bacterial growth in 58 (54.7%) samples from the 106 samples collected. Staphylococcus aureus 35 (55.6%) was the most common isolate cultured, followed by Escherichia coli 14 (22.2%) and then coagulase-negative Staphylococcus13 (20.6%). Among S. aureus isolates, 48.6% were methicillin-resistant S. aureus. Among the Gram-negative isolates, resistance was highest for ampicillin followed by meropenem. Conclusion: The most common isolates were S. aureus, coagulase-negative Staphylococcus, and E. coli. Health-care providers need improved hygiene standards to reduce the burden of NI.

Background: Medical practice and education are known to lead to emotional and mental exhaustion as well as physical tiredness among healthcare workers. This study analyzed the prevalence and factors associated with physician burnout syndrome (PBS) among resident doctors in paediatric across Nigeria. Methodology: This cross-sectional study was conducted among paediatric resident doctors across Nigeria using the public welfare questionnaire of the American Welfare Association comprising 28 questions related to sleep affectation, energy levels, personal relationships, professional relationships, quality of job environment, and work satisfaction. Results: 117 residents were enrolled with varying degrees of burnout. The mean PBS score was 75.3 ± 19.1 with minimum and maximum scores of 32 and 125, respectively. The prevalence of Grades 0, 1, 2, 3, and 4 PBSs was 3.7%, 4.9%, 28.1%, 42.7%, and 18.3%, respectively, while 63.4% of respondents exhibited signs of symptomatic PBS. The residents' rank (P = 0.05) was significantly associated with the prevalence of symptomatic PBS, while age (P = 0.567), gender (P = 0.755), number of years in training (P = 0.411), marital status (P = 0.173), number of children (P = 0.974), religion (P = 0.09), and prior knowledge of PBS (P = 0.719) had no association with the development of symptomatic PBS among surveyed resident doctors. Conclusion: The prevalence of PBS is high among paediatric resident doctors. There is an urgent need for the postgraduate medical colleges in collaboration with the Ministry of Health to formulate programmes that will help to balance social and professional lives among paediatric resident doctors in Nigeria.

Background : There is a paucity of data on long term-outcomes of children who undergo acute peritoneal dialysis (PD) in resource-limited settings. We reviewed the outcomes of children who underwent PD after 18 months of follow-up. Methods : We conducted a prospective cohort study in children with acute kidney injury (AKI) who underwent PD. Diagnosis of AKI was based on the 2012 Kidney Disease: Improving Global Outcomes definition. We assessed outcomes of in-hospital mortality, 18-month post-dialysis survival, factors associated with survival, and progression to chronic kidney disease (CKD). Results : Twenty-nine children with a median age of 6 (3 to 11) years underwent acute PD. In-hospital mortality was 3/29 (10.3%) and rose to 27.6% during follow-up. Seven (24.1%) children were lost to follow-up. Of the 14 remaining children, six (42.9%) experienced full recovery of renal function, while eight (57.1%) progressed to CKD. Among those who experienced full recovery, median (interquartile range) estimated glomerular filtration rate (eGFR) rose from 12.67 (7.05, 22.85) mL/min/1.73 m2 to 95.56 (64.50, 198.00) mL/min/1.73 m2, P = 0.031. No significant changes in median eGFR from baseline were observed among those who progressed to CKD (P = 0.383) or in non-survivors (P = 0.838). According to Kaplan-Meier curve analyses, 18-month survival during follow-up was 66.0% (95% CI, 45.0% to 86.5%). Age < 5 was associated with greater likelihood of survival (OR, 3.217; 95% CI, 1.240 to 8.342). Conclusion : Progression of post-PD AKI to CKD occurred in more than half of survivors. Age < 5 was associated with greater likelihood of survival.

Aim: Oxygen is a life-saving essential medicine that is crucial for the treatment of many common childhood conditions. Despite the overwhelming evidence of the role of oxygen in critically ill children, refusal of oxygen therapy by caregivers has been reported in developing countries. Materials and Methods: This multicentre cross-sectional study was conducted among the caregivers of children admitted to the Children's Emergency Rooms of three tertiary hospitals in Southeastern Nigeria. Data were collected to assess awareness and acceptance of oxygen therapy using researcher-administered semistructured questionnaires. Results: Out of the 571 respondents, 450 (78.8%) were aware of oxygen therapy, with hospitals (79.0%) being the most common source of awareness. The acceptance rate of oxygen therapy among the respondents was 94.9%. No significant association was found between socio-demographic factors and acceptance of oxygen therapy. Conclusion: Although awareness of oxygen therapy is high in Southeastern Nigeria, there is still a need for continued education of caregivers on the benefits and mechanisms of this life-saving treatment. [ABSTRACT FROM AUTHOR]

IntroductionTuberculosis (TB) remains a global health challenge and leading infectious killer worldwide. The need for continuous evaluation of TB treatment outcomes becomes more imperative in the midst of a global economic meltdown substantially impacting resource-limited-settings.MethodsThis study retrospectively reviewed 25-years of treatment outcomes in 3,384 patients who were managed for TB at a tertiary hospital in Nigeria. Confirmed TB cases were given directly observed therapy of a short-course treatment regimen and monitored for clinical response.ResultsOut of 1,146,560 patients screened, there were 24,330 (2.1%) presumptive and 3,384 (13.9%) confirmed TB cases. The patients' mean age was 35.8 years (0.33-101 years). There were 1,902 (56.2%) male, 332(9.8%) pediatric, and 2,878 (85%) pulmonary TB cases. The annual mean measured treatment outcomes were as follows: adherence, 91.4(±5.8) %; successful outcome, 75.3(±8.8) % potentially unsatisfactory outcome, 14.8(±7.2) %; and mortality 10.0(±3.6) %. Female, extra-pulmonary TB (EPTB), newly diagnosed, and relapsed patients compliant with treatment had successful outcomes. Adulthood and HIV infection were mortality risk factors.ConclusionThe mean annual successful treatment outcome is 75.3(±8.8) %. Female, pediatric, EPTB, new, and relapsed patients were predisposed to successful treatment outcomes. Lessons learned will guide future program modifications.

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious disease with a potential for healthcare workers (HCWs) getting infected due to inadequate protection while attending to patients. Effective use of personal protective equipment (PPE) is key to mitigating the spread of SARS-CoV-2 infection in healthcare settings. Hence, there is a need to understand HCWs’ use of PPE in resource-limited settings and how closely the currently recommended guidelines for PPE are followed. This study assessed the HCWs’ knowledge about, attitudes towards, beliefs on, and use of PPE to prevent SARS-CoV-2 infection in a resource-limited setting. Methods. This cross-sectional study was conducted in April 2020 in Southwest and Northwest Nigeria. The selection of participants was performed via the snowball sampling technique using a 33-item, web-based, self-administered questionnaire via a social media network. We obtained relevant sociodemographic data and information on participants’ occupations and knowledge about, attitudes towards, beliefs on, and use of PPE. We analysed the data using SPSS version 23.0 for Windows (IBM, Armonk, New York, USA). A p values