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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.

Background: Developmental delays in children are often missed during routine medical visits, leading to long-term consequences if undetected. The Children's Emergency Room (CHER) offers a unique opportunity for early screening, serving as a frequent contact point for families. This study aimed to assess the developmental profiles of children presenting to CHER at NAUTH, Nnewi, Anambra State, Nigeria, emphasizing the need for early intervention., Methods: In this cross-sectional, mixed-methods study, children aged 0-5.5 years presenting to CHER over one month were screened using the Ages and Stages Questionnaire (ASQ-3). Data analysis was conducted using STATA 16.0, and children with identified developmental delays were referred to the Developmental and Behavioural Paediatrics (DBP) clinic. Interviews with healthcare providers and caregivers explored the feasibility of implementing routine screening in CHER., Results: Out of 34 children screened, 55.9% (19/34) displayed developmental delays, with problem-solving and fine motor skills being the most affected (29.4% each). Global developmental delay was identified in 32.4% (11/34). Female children had significantly higher communication delays than males (29.4% vs. 0%, p=0.044). Sixty percent of healthcare providers believed screening would be feasible with additional training and resources., Conclusion: The high prevalence of developmental delays, particularly in girls' communication skills, highlights the need for early detection. With adequate training and resources, integrating developmental screening into CHER could significantly enhance early intervention efforts and address the unmet needs of children in resource-limited settings., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Nigeria accounts for a quarter of malaria cases worldwide, which can be prevented with the use of insecticide treated nets (ITN). While studies have documented mother-related characteristics influencing use of ITN, regional variations in the influence of those factors are not well known. This study investigated nine factors (age, place of residence, education, religion, wealth, number of children in the household, sex of child, age of child and previous experience of child mortality) as possible predictors of use of ITN for children and how the associations vary across northern and southern parts of the country. The study utilised the 2015 Nigeria Malaria Indicator Survey, which comprised 6524 mothers (4009 from the north and 2151 from the south) aged 15-49. Bivariate and multivariate logistic regression models were fitted. It was found that, less than half (47.9%) of the respondents reported no access to a mosquito net in the north compared to 70.8% in the south. More than half (51.4%) of the northern respondents used insecticide treated net (ITN) for the child compared to 27.1% of southern mothers. When the variables are fitted together in the same model, place of residence, mother's age, mother's education, wealth, religion, number of children in the household and previous experience of child mortality were associated with the use of ITN. Regional variations exist in the influence of mother's age, number of children in the household and previous experience of child mortality. It was submitted that mother's characteristics are more important than the child's factors in the use of ITN, and that, contrary to the theory of poor utilisation of health-related facilities in the north compared to the south, residents in the former have access to and use ITN more than their counterparts from the latter.

Background: Malnutrition is an underlying factor in more than 50% of the major cause of infant mortality-Pneumonia, diarrhoeal disease and measles which account for 70% of infant mortality. Therefore, programs to promote adequate nutrition for age can help reduce mortality from these disease conditions and indispensible to achievement of MDG 4., Aim: To describe the feeding practices of infants below six months of age and determine maternal socio-demographic factors that influences the practice of exclusive breastfeeding (EBF) among mothers in Nnewi, south-east Nigeria., Methods: Four hundred mother-infant pairs attending the infant welfare clinic of the Nnamdi Azikiwe University teaching hospital (NAUTH) during 2012 were consecutively recruited after meeting the study inclusion criteria. Data on breastfeeding were based on infant feeding practice in the previous 24 hours. Exclusive breastfeeding was defined as infant feeding with only breast milk., Results: Awareness (95.3%) and knowledge (82.0%) of EBF was high among surveyed mother but the practice of EBF (33.5%) was very low. Positive attitude towards EBF practice was shown by many (71.0%) of surveyed mothers. EBF practice decreased with increasing infant age, OR 0.72 (95% CI 0.34, 1.51) for 1-2 months, OR 0.58 (95% CI 0.23, 1.44) for 3-4 months and OR 0.20 (95% CI 0.06, 0.73) for 5-6 months compared to infants < 1 month old. Maternal education, socioeconomic class, mode of delivery and infants first feed were retained as important maternal predictors of EBF practice after adjustment for confounders. Decreased likelihood of EBF practice was found among mothers of lower educational attainment, OR 0.33 (95% CI 0.13, 0.81), mothers who delivered through caesarean section, OR 0.38 (95% CI 0.18, 0.84), mothers of higher socio-economic status [(middle class, OR 0.46 (95% CI 0.22, 0.99) and upper class, OR 0.32 (95% CI 0.14, 0.74)] while increased likelihood of EBF practice was seen in mothers who gave their infants breast milk as their first feed, OR 3.36 (95% CI 1.75, 6.66)., Conclusion: Knowledge and awareness does not translate to practice of EBF. More effort by health workers and policy makers should be directed to mothers along the fault lines to encourage the practice of EBF.

Unlabelled: There is the need to ascertain the diagnostic approach on which medical doctors based their diagnosis of childhood pulmonary tuberculosis especially in tuberculosis endemic areas., Aim of the Study: To determine the diagnostic approach used by medical doctors in the diagnosis of childhood pulmonary tuberculosis., Methodology: A cross sectional study, using structured questionnaires to collect data from medical doctors whose daily routine include seeing sick children was carried out., Results: The common diagnostic approach or criteria were ranked by medical doctors in descending order of importance as follows; clinical features elicited from patients' history was ranked-1 by 56.4% (or 23 of 218); bacteriological investigation to isolate Mycobacterium Tuberculosis was ranked-2 by 22.5% or 49 of 218; radiological investigation to demonstrate typical changes consistent with active pulmonary tuberculosis was ranked-3 by 25.2% or 55 of 218; therapeutic trial with standard anti tuberculosis drugs was ranked-4 by 52.3% or 114 of 218; immunological investigation using tuberculin skin testing was ranked-5 by 30.3% or 66 of 218; and residual ranking of histological investigation using tissue biopsy was ranked-6 by 15.6% or 34 of 218. Therapeutic trial with standard anti tuberculosis drugs was consistently ranked as 4th by most groups of clinicians., Conclusions: Most clinicians from different subgroups studied followed a fairly similar order in the diagnosis of childhood pulmonary tuberculosis with a high premium placed on clinical features, bacteriologic, radiologic and therapeutic trial with anti tuberculosis drugs. The specialist in paediatric medicine relied more on clinical features and therapeutic trials for their diagnosis of childhood pulmonary tuberculosis.

Objective: This is a descriptive, prospective, hospital-based study designed to determine the prevalent organisms in ear infections and their antimicrobial susceptibility patterns in HIV-infected children compared to age-and sex-matched HIV sero-negative patients., Method: Two hundred and fifty eight HIV-infected children being followed up at the Paediatric HIV clinic had their ears examined for middle ear infection. All those with discharging ears had swabs taken. Culture and antimicrobial sensitivities were ascertained. The same was done for another cohort of 57 age-and sex-matched HIV-negative patients with discharging ears., Results: Twenty eight (10.9%) of 258 HIV-infected children had discharging ears and were made up of 13 females and 15 males aged between 7 and 132 months. Out of this number 85.7% had chronically discharging ears, 96.4% of the 28 children acquired the HIV infection vertically. 78.6% had been on antiretroviral drugs from one to twenty-one months. 67.9% of the patients had associated opportunistic infections. Acute ear infections were predominant among the control group. Klebsiella, Proteus, Staphylococcus and Pseudomonas were major pathogens isolated among the HIV-infected group and Streptococcus, Klebsiella and Pseudomonas for the HIV-negative group. A hundred percent sensitivity was recorded among the quinolones for all bacterial organisms isolated., Conclusion: HIV-infected children tend to have more of chronic than acute ear infections and this is reflected in the causative organisms. Similar antimicrobial sensitivity patterns apply to HIV-infected and HIV-negative children. There is a need to revisit the use of quinolones in children.

Objective: To assess the Mantoux test reaction pattern in healthy BCG vaccinated Primary School Children aged 6 -10 years in Nnewi, South -East Nigeria., Materials and Methods: Four primary schools were randomly selected out of 43 government owned primary schools in the town. The entire BCG vaccinated pupils in each school were the sample frame. Mantoux test was administered in 662 pupils that met the inclusion criteria and had their results read 72 hours later., Results: Three groups of children were identified: First group of 470 (75.6%) were negative, 76 (12.2%) had intermediate reaction, while 76 (12.2%) had positive Mantoux test. Increasing age, sex, presence of BCG scar and age at vaccination did not affect the pattern of Mantoux test reaction., Conclusion: The result indicates that the use of Mantoux test in the diagnosis of Tuberculosis may not be affected by BCG vaccination at birth and therefore, BCG vaccination at birth should be continued.

Objectives: To determine how mothers treat common childhood symptoms before hospital attendance in Nnewi., Materials and Methods: Information was obtained from 211 consecutive mothers on their children's presenting symptoms, drugs administered, source of the drugs, persons who prescribed the drugs, number of drugs administered, prior to hospital attendance through a structured questionnaire administered by the authors., Results: A combination of fever, cough and catarrh topped the list of presenting symptoms in 87 (41%) of the patients while fever and diarrhea had the least frequency of 16 (7.6%). One hundred and five or 52% of the mothers decided on the drugs that were administered followed by patent medicine dealers who accounted for 59 or 29.2%. Trained health professionals whom mothers consulted before bringing their children to hospital were responsible for 28 (13.8%) of the prescriptions. Patent medicine stores were the sources of 90.6% of the drugs while health facilities accounted for 8.4%. The frequency chart of prescribed drugs were analgesics 166 (34.9%), hematinics 88 (18.5%), antibiotics and antimalarials 81 (17.1%) and 74 (15.6%) respectively while antidiarrheoals and ORT were least administered with 7 (1.5%) and 1 (0.2%) respectively. The children received an average of 2.7 drugs per prescription., Conclusion: With the high prescription rate of mothers for sick children at home, there is need for effective methods to educate mothers on the use and potential dangers of home medication.