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Objectives: This study aimed at assessing asthma control using Global Initiative for Asthma (GINA) asthma assessment, and determining its relationship with lung function parameters among asthmatic children in Usmanu Danfodiyo University Teaching hospital, Sokoto. Materials and Methods: This was a cross-sectional study among 60 children with asthma diagnosed based on GINA guidelines. It was conducted over a period of 4 months. The GINA asthma control assessment was administered to assess asthma control. Lung function was done using a portable spirometer. Results: Males accounted for 58.3% of the study population with M: F of 1.4:1 and median age of 9.47 years, with majority from urban domicile (91.7%). Well-controlled asthma accounted for 50.0% while 35.0% had partly controlled asthma and 15.0% had poorly controlled asthma. The median FEV1/FVC among the study participants was 0.856 (IQR: 0.170). There was no relationship between asthma control and LF parameters (FEV1: r = 0.044, P = 0.736, FVC: r = 0.010, P = 0.941, FEV1/FVC: r = 0.122, P = 0.352, and PEFR: r = 0.015, P = 0.911). Conclusion: Majority of the study participants had well-controlled asthma and no relationship was found between asthma control and lung function. Thus, serial monitoring of LF in addition to uniformly agreed standardized assessment of asthma control is required to objectively evaluate asthma control in children.

Introduction: Rational use of drugs against most common and life‑threatening tropical diseases such as malaria remains a huge challenge, particularly in sub-Saharan African region. The correct use of antimalarial drugs is the key not only to therapeutic success but also to deterring the spread of drug resistance malaria. Aims: To assess the physicians’ compliance with the national anti’-malaria treatment guidelines among Under five (U-5) years children in secondary health facilities in Sokoto metropolis. Methods: This was a cross-sectional study conducted as an exit interview among 292 mothers/caregivers of febrile U-5 children with antimalarial prescription, that presented to the out-patient clinics of the selected secondary health facilities in Sokoto metropolis. Simple random sampling technique using balloting option was used to select 2 secondary Health facilities in the metropolis, Proportionate allocation was done to allocate study subjects to the selected Health facilities based on average weekly outpatient attendance. The data was collected using an interviewer-administered questionnaire. Descriptive statistics was used to analysed data using IBM SPSS version 22. Results: Of the 292 children, only 115(39.4%) had malaria parasite test requested by the physician, out of which 63(54.8) had microscopy, while 52(45.2) of the children had malaria Rapid Diagnostic Test (mRDT). One hundred and eighty-five (65.1%) of the children were treated presumptively with anti-malarial drugs. Artemisinin based Combination Therapy (ACT) was prescribed in 221(77.8%) of the under-fives. The commonest prescribed ACT was Artemether-Lumefantrine in 113(77.4%) of the children. Majority 263(92.6%) of the prescriptions were in brand names. Recommendation: The physicians’ compliance with national malaria treatment guidelines using the proportion of U-5 children was suboptimal. There was over prescription of anti-malarial drugs, as majority of the patients treated for malaria had no laboratory evidence for the treatment. However, compliance with the use of ACT was good. This study shows also suboptimal compliance with WHO prescribing indicators with respect to prescription in generic names. Regular training of the health care providers by the government is recommended to improve adherence to antimalarial treatment guideline.

Background: Children with congenital malformations (CM) may have congenital heart diseases (CHDs) which may be initially asymptomatic. These need to be recognised and managed early in order to reduce unnecessary morbidity in affected patients. We report the pattern of CHDs in children with congenital malformations who had echocardiography over a one year period in UDUTH, Sokoto. Materials and Methods: A cross-sectional study carried out in the Paediatric Cardiology Unit from 1st January to 31st December 2019. Children presenting with CM were recruited and had echocardiagraphic screening for CHDs. Data were analysed with SPSS 23 version. Statistical significance was taken at p < 0.05. Results: 81 children were seen with CM, comprising 42 females and 39 males (M:F=0.93:1); age range of 2 days to 13 years. Most frequent malformationswere anorectal malformations (ARM) in 28 (34.6%), Down syndrome in 17 (21.0%), multiple CM 10 (8.1%) and ocular abnormalities in 4 (4.9%). Thirty two (39.5%) of the patients with CM were diagnosed with CHD, out of which 24 (29.6%) had cardiac murmur. Most frequent CHD was atrioventricular septal defect in 9 (28.1%) followed by ventricular septal defect in 8 (25.0%) and patent arterial duct in 4 (12.5%). CHDs were found in all (100%) those with ocular abnormalities, in 76.5% of Down syndrome and in 14.3% of patients with ARM. Presence of murmur was significantly associated with CHD (χ2=18.0; p=0.001; OR=8.2; 95% C.1=2.8 – 24.1). Conclusion: Congenital malformations, particularly Down syndrome and ocular abnormalities, are significantly associated with CHDs. Cardiac murmurs were suggestive of CHD in children with congenital malformations.

Severe acute malnutrition (SAM) is a major cause of mortality among children in Nigeria. Majority of affected children die from sepsis related complications. The complete blood count includes inflammatory markers which have been found to be useful in predicting sepsis and mortality in children, but these findings have not been corroborated in our population. The aim of this study was to compare the haematological profile and inflammatory markers of severely malnourished children to age matched controls admitted for febrile illnesses. It was a cross sectional study carried out in the emergency paediatric unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Severely malnourished children aged 6 months to 5 years and a comparative cohort who were not severely malnourished were consecutively recruited as they presented for admission. Relevant data were entered into a proforma and blood samples taken for complete blood count amongst others. Total and differential white cell counts, lymphocyte-neutrophil ratio and platelet indices were compared. There were 64 children comprising 32 severely malnourished and 32 well-nourished children. Mean white cell count, absolute lymphocyte and monocytes were significantly higher among the malnourished while mean platelet volume (MPV) and platelet distribution width (PDW) were significantly lower for the malnourished subjects. There were eight mortalities all among the malnourished children and mean neutrophil count was significantly higher among the mortalities. In conclusion, severely malnourished children had more lymphocytosis, however, mortality was associated with neutrophilia. Platelet indices of inflammation were lower in malnourished than non-malnourished subjects.

Introduction: Mortality pattern is reflective of both the severity of illness and the quality of treatment given. Objective: To identify the age, time and cause of death in the paediatric wards of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Methods: This was a retrospective review of mortalities in children 5weeks to 15 years at the paediatric wards of UDUTH from 1st January 2016 to 31st December 2017. The bio-data, duration of illness, diagnoses, complications and duration of hospital stay were extracted from the mortality case files and analysed. Results: There were 121 mortalities, representing 2.3% of 5,355 total admissions during the study period. Sixty-seven (55.4%) were males (M: F ratio 1.2:1). Seventy-five (62.0%) were under-fives and mean age ± standard deviation was 54 months ± 46.3. Most deaths 76 (62.0%) occurred between July and December and majority 96 (79.3%) occurred ≥ 24 hours after admission. Severe acute malnutrition [SAM] 31 (41.3%), severe malaria 12(16.0%), and septicaemia 9 (12.0%), were the leading causes of death in the under-fives, whereas severe malaria 8 (17.4%), meningitis 7(15.2%) and malignancy 5 (10.9%) predominate in those > 5 years [P

Introduction: Counselling of caregivers about common childhood diseases is an important component of health care services. Objective: To assess the quality of counselling offered to caregivers on their children’s condition by health care providers at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Methods: A prospective cross-sectional study carried out from 1st August 2015 to 30th April 2016. Caregivers with children less than 15 years of age seen in the units of Paediatric Department of UDUTH, Sokoto, were consecutively interviewed. The corresponding case notes of their children were reviewed to obtain data on the child’s diagnosis and to check whether the attending physicians have documented the content of the counselling offered to caregivers. Data were analysed using SPSS version 20. Results: A total of 420 caregivers were interviewed. Their mean age was 28.9±8.6 years (range of 15-64 years). Only 218 (51.9%) caregivers were counselled, but there was no documentation of the content of counselling in the case notes of their children. 81 (37.2%) of the diagnosis mentioned by caregivers did not tally with the one documented in the case notes of their children (p=0.0001). Majority of the caregivers 156 (71.6%) were counselled in an open ward and only 6 (2.7%) were counselled in a private consulting room. Conclusion: This study revealed inadequate counselling of caregivers on their children condition and poor counselling practices among healthcare providers in UDUTH, Sokoto. Hence, there is the need for training and retraining of healthcare providers on counselling of caregivers on their children condition in the hospital.

Introduction: Tuberculosis (TB) is the leading infectious disease killer worldwide, despite significant progress against the disease in recent years. Most cases of TB in children occur in the TB endemic countries but the actual burden of paediatric TB is unknown. With early diagnosis and treatment using the first-line anti-tuberculous drugs, most people who develop the disease can be cured and onward transmission of infection curtailed. Objective: To determine the pattern and outcome of paediatric tuberculosis managed at a tertiary facility in Sokoto, Nigeria. Materials and Methods: Records of children managed for TB at the Directly observed treatment short-course (DOTS) clinic over a three-and-a-half-year period were reviewed retrospectively. All children (≤ 15 years) treated for TB over the study period was included. Relevant information was retrieved from the register and analysed accordingly. Results: 74 children were treated with 33(44.6%) being males, giving a M: F ratio of 1:1.2. Mean (±SD) age was 85.78 (±55.40) months and 34 (45.9%) belonged to the 0.0-5.0-year age group. Seventy-one (95.9%) were new cases and three (4.1%) were relapse. Pulmonary TB (PTB) was seen in 50 (67.6%), more females had PTB than males, which was not significant (χ2=0.4, p=0.52). Acid fast bacilli (AFB) were positive in only 8 (10.8%) while GeneXpert MTB/RIF sensitivity was detected in 7 (9.2%). Majority 36 (48.6%) were lost to follow up, 30 (40.5%) completed treatment, only 4(5.4%) were cured with no recorded mortality. Successful treatment outcome was low (45.9%). Conclusion: Treatment outcome using DOTS strategy was poor, far below the WHO benchmark. There is need to improve adherence to DOTs therapy to prevent development of multi drug resistant TB.

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. Antibiotic 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. Keywords: antibiotics, prescription, utilization, children, inpatients, DOT

Background: Sickle Cell Anaemia (SCA) is the most common inherited disorder in Nigeria. Pulmonary Hypertension (PH) is a known complication of SCA that commences from childhood and progresses as they grow older. Aim: To determine the prevalence and predictors of elevated pulmonary artery pressure (PAP) in children with SCA. Study Design: This is an analytical cross-sectional study. Methods: Three hundred subjects with SCA in steady state and 300 HbAA controls, aged 6 months – 15 years, were enrolled into the study. Children with SCA were recruited by simple random sampling, from the Paediatric Sickle Cell Clinic, Usmanu Danfodiyo University Teaching Hospital, Sokoto. All the children had clinical evaluation, echocardiography, full blood count and reticulocyte count. Pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (MPAP) were determined by measurement of tricuspid regurgitant velocity (TRV) and mean gradient (MG) respectively. Results: Seventy-two children with SCA (24.0%) had elevated PAP (defined as TRV ≥ 2.5 m /s) while only 9 (3.0%) had pulmonary hypertension (defined as MPAP ≥ 25 mmHg). Older age (O.R = 1.03, p < 0.001), high systolic blood pressure (O.R = 1.2, p = 0.01), and high reticulocyte count (O.R = 1.33, p = 0.04) were weakly associated with increased likelihood of elevated PAP. Normal pulse oxygen saturation (SPO2 ≥ 95%, O.R = 0.4, p = 0.002) and normal heart sounds on auscultation (O.R = 0.2, p = 0.04) were associated with a reduced likelihood of elevated PAP. Presence of left parasternal heave (O.R = 8.4, p = 0.001) significantly predicted elevated PAP in children with SCA. Conclusion: PH occurs as a complication in children with SCA and certain clinical and laboratory parameters do predict this complication in children.

Background: Management of structural heart diseases is quite challenging in Nigeria, due to limited availability and access to cardiac care services. There is paucity of data on the pattern and outcome of cardiac interventions in children from the study area. Aims: To determine the pattern of cardiac interventions and the early outcome (within six-months) of such interventions in children with structural heart diseases (SHD) seen in our hospital. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, between August 2012 to September 2019. Methodology: All children with SHDs seen at our hospital, but had Cardiac surgery or interventional cardiac procedures within and outside Nigeria were recruited. Relevant information including type of lesion, procedure performed and the outcome within the first six months and length of hospital stay was analyzed. Results: Only 63 out of 780 (8.1%) children with structural heart diseases, aged 6 months-15 years (Mean age 6.5± 5.0 years, M: F = 1.3:1), had cardiac interventions. The interventions were surgical in 61 ((96.8%) and catheter-based in 2 (3.2%) patients; with 49 (77.8%) of these performed abroad. Patent Ductus arteriosus 14 (22.2%), Tetralogy of Fallot 14 (22.2%), ventricular septal defect 13 (20.6%) and atrial septal defect 6 (9.5%) were the commonest lesions for which interventions were undertaken. Early post-operative complications included pulmonary hypertensive crises, pericardial and pleural effusion, complete heart block and left branch pulmonary artery stenosis warranting re-intervention. During the first six months after the interventions, three (4.8%) patients died while 60 (95.2%) survivors were followed up. However, 25 (39.7%) of them were thereafter lost to follow. Conclusion: Majority of the cardiac interventions were surgical, performed predominantly in older children with CHDs; and associated with good outcome. However, most of them were undertaken outside the country, highlighting the need to ensure these services are available and accessible locally.

Introduction: Disseminated tuberculosis (TB) may occur with skin and ocular involvement which are not common manifestations in children and may lead to debilitating complications. Objective: A child with multi-organ TB involving the lungs, chest abdomen, skin and eyes who had been symptomatic for 3 years is reported. Case Report: A 6-year-old girl presented with recurrent fever, abdominal pain and weight loss of 3 years and skin lesions of a year duration. There was history of pain and redness of the eyes associated with discharge. She was not vaccinated at all. She was chronically ill-looking with bilateral conjunctival hyperaemia, purulent eye discharge with corneal opacity of the right eye. She had significant lymphadenopathy, digital clubbing and ulcerated, discharging swellings around her neck and axilla (scrofuloderma). She had reduced breath sounds and coarse crepitations. Hepatosplenomegaly and ascites were present. She later developed bulging of the upper part of the cornea of the right eye which was diagnosed by the ophthalmologist to be cornea ulcer with anterior staphyloma. Results, Treatment and Outcome: Complete blood count (leucocytosis 12,800 cells), erythrocyte sedimentation rate (150 mm/hr) and tuberculin test (7 mm induration) were suggestive of TB. Radiological tests were also supportive. She received anti-Kochs in addition to systemic and ocular antibiotics. Skin lesions healed progressively and stopped discharging. Caregivers were counseled on poor visual prognosis of the right eye. She was discharged but lost to follow up. Conclusion: Multi-organ involvement of TB especially ocular and cutaneous TB is not common but is very debilitating. More preventive efforts with vaccination and expertise are needed at lower levels of health care in the community to aid early diagnosis.

BackgroundRoutine 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.MethodsA 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.ResultsOf 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).ConclusionEight 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.

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.

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.

Ecthyma gangrenosum (EG) is a cutaneous infection characterized by vesicles or blisters which rapidly evolve into necrotic ulcers with undermined tender erythematous border. It has been rarely reported from the African continent. Pseudomonas aeruginosa is the commonest isolated organism but others, including Staphylococcus aureus (S. aureus) and Escherichia coli ((E. coli) have been reported. A case of EG in a child with S. aureus meningitis in whom E. coli was also isolated is hereby reported. An 8-month old male infant presented with fever (39.2°C) of two days, vomiting, diarrhoea, and body rashes (purpuric lesions mainly on the gluteal area as well as the lower and upper limbs) of one day, and convulsions. He was moderately dehydrated, with neck stiffness and retraction. The rashes subsequently became extensive, appearing as circumscribed, roundish and dark necrotic lesions with surrounding hyperaemia. Full blood count showed marked leucocytosis with neutrophilia. Blood glucose was 6.1 mmol/l, cerebrospinal fluid (CSF) glucose was 3.6 mmol/l and protein was 55 mg/dl, CSF culture yielded S. aureus. Culture of skin lesions was initially negative but later yielded E. coli on repeat sampling. The patient was treated with antibiotics, wound debridement and regular dressings and showed good improvement, evidenced by the gradual healing of skin lesions. EG lesions may be caused by other organisms apart from Pseudomonas. Key words: Ecthyma gangrenosum, infant, Staphylococcus aureus, Escherichia coli, meningitis, Sokoto.

Otitis media has been reported as a common childhood disease and is associated with multiple microbial pathogens within the middle ear. Though the causative agents of this infection have largely remained the same over the years, current literature reviews show that the antibiotic susceptibility pattern has changed considerably. This study aimed to identify bacterial isolates and determine their antibiotic susceptibility and resistance patterns in children who had otitis media. This is a retrospective analysis of ear swab microscopy, culture and sensitivity (MCS) results of children between the age of 0 and 13 years who presented with clinical episodes of otitis media over a four year period. A total of 53 results were retrieved from the laboratory record book of which 43 were culture positive giving a yield of 84.9%. Males were 33 (62.3%) giving a M:F ratio of 1.7:1 and 71.7% were below the age of 5 years. Majority (68.9%) of the isolates were Gram positive organisms with Staphylococcus aureus being the commonest bacteria isolated (53.3%), followed by Pseudomonas aeruginosa (20.0%) and then Streptococcus pyogenes (13.3%). The isolates were highly susceptible to ciprofloxacin, ofloxacin and gentamicin, while all were found to be resistant to tetracycline, cefixime and levofloxacin. S. aureus, P. aeruginosa and S. pyogenes were the commonest bacterial isolates in the patients. Ciprofloxacin, ofloxacin and gentamicin were the antibiotics with the highest bacterial susceptibility rate. Children with ear discharge were recommended to be investigated and treatment should be based on antimicrobial test to prevent resistance and probably complications. Key words: Otitis media, bacterial isolates, antibiotic, susceptibility, resistance.

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.

Background. Studies from different parts of Nigeria and the world have reported variable patterns of renal diseases in childhood. There is a paucity of data to guide resource allocation in Zamfara, Nigeria, despite the rising incidence of kidney diseases in children in Nigeria, and globally. Objectives . To determine the prevalence, presentation, pattern, and outcomes of renal diseases among hospitalised children in Gusau, Zamfara State, Nigeria. Methods . A retrospective study was conducted of children aged 1 month to 14 years, who were admitted to the paediatric wards of our hospital over a period of 30 months (October 2013 to March 2016). Relevant information was retrieved from the patients’ medical records and data were analysed accordingly. Results . A total of 2 658 children were admitted, of which 3.2% ( n =84) had renal diseases; however, only 70 folders were utilised for the study. The male:female ratio was 1.19:1. Fever (63%), reduction in urine volume/frequency (46%), body swelling (43%) and abdominal pain (40%) were the most common symptoms. Hypertension (33%) and heart failure (17%) were common findings. Urinary tract infection (UTI) (34%), acute glomerulonephritis (AGN) (24%) and acute kidney injury (AKI) (20%) were the the most common diagnoses. Most of the children were discharged with good renal function and mortality was low (10%). Conclusions. The prevalence of renal disease in our setting was low, with males predominating. UTI was the most common cause of renal disease, requiring hospitalisation in Gusau, while congenital anomalies and malignancies were rare. These data could be utilised by researchers and stakeholders in resource-poor settings like ours to plan for preventive nephrology as UTI, AGN and AKI are largely preventable.