Search

Summary: Prune belly is a rare congenital anomaly. that is commonly seen in males. We report two male cases and a phenotypic female with absent abdominal wall musculature that were seen within one year at the Olabisi Onabanjo University Teaching Hospital, Sagamu. These cases are reported to create a better awareness of this disorder in this environment. This, to our knowledge, is the first report of prune belly syndrome in our centre. Maternal age, the precise aetiology is uncertain. However, sex influenced autosomal mode of inheritance has been suggested. 8, 9 While there have been reports of this syndrome from Ibadan, the exact incidence in Nigeria is unknown. It is probably rare but it is also likely that some cases are missed in clinical practice due to poor awareness and constraints in investigation, In view of this, we are reporting three cases of prune belly syndrome seen in Sagamu, within a period of one year.

Summary Background: Regional differences which exist in the prevalence and clinical features of paediatric AIDS worldwide make it pertinent to document findings in our environment. Objectives: To document the prevalence and clinical features of AIDS in children hospitalized in a teaching hospital situated in South-western Nigeria. Design: Retrospective study. Methods: A review of hospital records of all children with AIDS admitted to Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1996 and December 2005 was made with a view to determining the prevalence and clinical features of the disease in the area served by the hospital. Results: Thirty three children were diagnosed with ADDS out of a total of 3061 hospitalized children; a prevalence rate of 1.08 percent. The prevalence increased, though not significantly, in the second half of the study period (x2= 3.67, p = 0.055). The male: female ratio was 1:1.4 and the age range was two months to 120 months with a mean of 17.4+ 23.2 months. Fourteen (42.4 percent) were infants, 15 (45.5 percent) pre-school children and four (12.1 percent) were school-aged children. A majority (93.9 percent) of the patients were infected with the HIV-1 strain, while the route of transmission was predominantly vertical. The main clinical features at presentation were chronic diarrhoea (69.7 percent), prolonged fever (63.6 percent), chronic cough (48.5 percent) and skin rashes (39.4 percent). Fifteen (45.5 percent patients had protein energy malnutrition which was mostly marasmic in type (73.3 percent). Most (57.6 percent) of the patients belonged to the low socio-economic class, but only four patients (12.1 percent) had associated pulmonary tuberculosis. The mean duration of hospital staywas 8.8 + 6.8 days. None of the patients received antiretroviral drug therapy. Mortality was 33.3 percent with septicaemia as the major cause. Conclusion: We observed a low prevalence of paediatric AIDS but the clinical features conformed to the WHO guidelines for its case definition. Lack of access to antiretroviral therapy contributed to the high rate of mortality..

Background: Frequent changes in the political, economic and health policies which may influence the purchasing powers of the populace may also make it difficult for the average family to pay hospital fees and culminate in a tendency to premature termination of medical care. Objectives: To describe cases of paediatric discharges against medical advice seen at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu. Patients and Methods: A retrospective study of the records of children who were discharged against medical advice from January 1995 to December 2004 at the OOUTH, Sagamu, was carried out. Data extracted from the case notes included age, sex, clinical diagnosis, parental occupation, duration of hospital stay, reason(s) for, and signatories to DAMA Results: The yearly prevalence of DAMA fluctuated with no consistent pattern, ranging from 2.1 to 5.0 percent with a mean of 3.3 percent, of paediatric admissions. The median age was 365 days and the male to female ratio was 1.4:1. The median duration of hospitalization prior to DAMA was four days. Majority (92.1 percent) of the children belonged to the low socioeconomic classes. The signatories to DAMAwere mostly mothers (80.2 percent). Financial constraints in 61.9 percent were the commonest reasons for DAMA. Neonatal conditions, malaria and respiratory disorders were the main clinical diagnoses accounting for 28.5, 20.1 and 9.0 percent, respectively. Conclusion: Conscious effort must be made by government to create an enabling environment for financial empowerment of families. Hospitals should have avenues of defending the rights of children to life and health.

Background: Neonatal mortality is a major reason for the persistence of high infant and childhood mortality in the developing world. Frequent determinations of the factors associated with neonatal mortality are desirable for effective planning of interventions aimed at reducing neonatal mortality rates. Objective: To determine the trend in neonatal mortality in a teaching hospital over a ten-year period. Methods: The records of neonates admitted into the neonatal unit of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu between January 1996 and December 2005 were reviewed. Data extracted from the records included age, sex, weight, place of birth, major clinical diagnoses and outcome of admission. " Results: Out of a total of 2,933 neonates admitted into the unit, 773 deaths occurred (263.6/ 1000 admissions). These consisted of 168 (21.7 percent) in-born and 605 (78.3 percent) out born babies. Of these 773 deaths, 559 (72.3 percent) were early neonatal deaths (END) and 74.8 percent of these occurred within the first 24 hours of admission. Low birth weight babies constituted 67.4 percent of these deaths. The mortality rate among in-born babies was significantly lower than that of out-born babies (14.8 percent vs 33.5 percent; p = 0.00000). The neonatal mortality rate (NMR) for the hospital ranged between 25.6/1000 live births and 72.4/1000 live births. The mortality rate for out-born babies was 336.5/1000 admissions. The leading clinical conditions associated with neonatal deaths were preterm births (38.7 percent), perinatal asphyxia (25.1 percent), septicaemia (10.5 percent), neonatal hyperbilirubinaemia (9.9 percent) and tetanus (7.9 percent). Conclusion: Neonatal mortality in the hospital was high over the ten-year period studied. Facilitated access to quality obstetric and immediate post-delivery neonatal care is required to improve neonatal survival in Nigeria.

Background: Sepsis contributes significantly to newborn deaths in Nigeria. A significant proportion of severe infections in the newborn may be health care-related. Objective: To determine the prevalence, types and risk factors for nosocomial infections in the Special Care Baby Unit of a Nigerian Tertiary Hospital. Method: A cross-sectional survey of consecutively admitted infants aged 0 to 28 days with signs of infections or who developed signs of infection following admission. Infants with or without nosocomial infections were compared for the clinical and laboratory details. Results: Out of 356 infants, 32 (8.9%) had between 1 and 3 nosocomial infections while 48 (13.5%) had community-acquired infections. Half of babies with nosocomial infections were preterm and weighed less than 2kg. A significantly higher proportion of babies with nosocomial infections were inborn (p < 0.000) and stayed longer than 7 days on admission (p = 0.034). Bacteraemia was significantly more frequent among babies with nosocomial infections (p = 0.014) while superficial skin and mucosal infections occurred to similar extents in both groups. Klebsiella and Proteus species were the leading isolates among babies with osocomial infections. Nasogastric intubation was significantly more frequently performed among babies with nosocomial infections (p = 0.045). Conclusion: The present study revealed that hospital acquired infection is an important cause of morbidity in the newborn unit.

Background: When standard instruments are unavailable for clitoral length measurement, improvisation with locally available tools could be of diagnostic value. Objective: The objective of this study was to determine how the clitoral length measured with a wooden spatula compared to that measured with a caliper. Methods: This was a comparative cross-sectional study. Three hundred and five term female infants were recruited from multiple health facilities in Sagamu, Ogun State, Nigeria. The clitoral length was measured with a sliding digital caliper and a wooden spatula (tongue depressor). All the measurements were taken within the first 72 hours of life and comparative analysis was carried out. Results: The mean (± SD) clitoral length using the sliding digital caliper and the spatula were 6.7 ± 1.6 mm and 6.5 ± 1.8 mm respectively. There was no statistically significant difference between the mean values of both measurements (t = 1.369, p = 0.171). Pearson’s correlation showed that both variables were significantly correlated (r = 0.693, p < 0.001) and the spatula length was a moderate predictor of the caliper length (Coefficient of determination [R2] = 0.48 and p < 0.001). Conclusion: The findings of this study suggest that the determination of clitoral length using a spatula, commonly found in all community settings, is similar to determination of clitoral length using a digital caliper, most often used for clinical research.

Phenotypic expression of the male internal and external genitalia is due largely to the interplay between the proper differentiation of the bipotential gonad, the production of testosterone from the Leydig cells and the response of the undifferentiated external genitalia to Dihydrotestosterone. When any of the pathways involved in the mechanisms described above are distorted, it results in the 46XY Disorder of Sex Differentiation (DSD). The incidence of 46 XY DSD ranges from 20 to 41% among the cases of Disorder of Sex Differentiation (DSD) in Nigeria, though there is a paucity of data on this condition. This report describes an under-virilized genetically male child who presented with ambiguous genitalia in the neonatal period and was subsequently diagnosed as SRY positive 46 XY DSD with reduced testosterone synthesis. This report is necessitated by the need to create awareness and highlight the relevant medico-social challenges in the management of DSD in a resource-poor setting.

Background: The prevalence of non-communicable diseases, such as chronic kidney diseases, is on the increase globally. Therefore, early identification of these conditions through routine screening is desired as a preventive measure. Objectives: To determine the prevalence of elevated blood pressure among adolescents and relate it to abnormal urinalysis and blood sugar patterns. Methods: A cross-sectional descriptive study of adolescent secondary school students in Sagamu was carried out. The subjects were selected through random sampling method. Using standard methods, weight, height and blood pressure were recorded and the body mass index (BMI) was calculated. The blood pressure measurements were grouped into pre-hypertension and hypertension using standard charts. Dipsticks and glucometer respectively were used to examine urine and determine random blood glucose levels. Statistical analyses were done to determine the variables associated with elevated blood pressure. Results: A total of 572 subjects comprising 279 (48.8%) males and 293 (51.2%) females were screened. One hundred and fifty -one (26.4%) were underweight while 4.5% had abnormal urinalysis [urobilinogen (34.6%) and proteinuria (26.9%)]. Pre—hypertension was present in 7.9% and Stage 1 hypertension in 1.7%. Systolic blood pressure was significantly associated with high BMI. Age and abnormal urinalysis (proteinuria) were also associated with and predicted elevated blood pressure. Conclusion: Elevated blood pressure is associated with abnormal urinalysis; both conditions are identifiable risk factors for kidney diseases in our environment. We therefore advocate inclusion of periodic blood pressure checks and urinalysis included in the school health program.

Background: Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia. However, few studies on hypothyroidism status of children with sickle cell anaemia in Nigeria are available. The objective of this study was to determine the prevalence of hypothyroidism among children with sickle cell anaemia., Methods: A cross sectional study that assayed the thyroid hormones and thyroid stimulating hormone (TSH) of 71 children with sickle cell anaemia was conducted at Olabisi Onabanjo University Teaching Hospital Sagamu. Using age appropriate hormonal reference values, the subjects were classified into subclinical, primary and secondary hypothyroidism., Results: The mean serum TSH, Free T3, and Free T4 were comparable irrespective of age category (p > 0.05). No subject was identified to have low TSH value while 7.0% had high TSH value. Low free T3 was identified in 1.4% and 8.5% had high free T3 values. Low free T3 and free T4 were seen in 11.3% each of the subjects. The overall prevalence of primary, secondary and subclinical hypothyroidism was 0%, 0% and 4.2%, respectively., Conclusion: Sub-clinical hypothyroidism does occur in Nigerian children with sickle cell anaemia. Routine screening for hypothyroidism is advocated in all children with sickle cell anaemia., (© 2023 Akodu S.O., et al.)

Objectives: The prevalence of type 1 diabetes mellitus (T1DM) is increasing in most developed and developing countries. This study described the clinical characteristics and compliance with care among Nigerian children and adolescents with T1DM., Methods: This was a cross-sectional descriptive multi-center study of children seen at the paediatric endocrinology clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and compliance of the children with dietary recommendations and insulin therapy. Compliance with dietary recommendations and insulin therapy was graded as either good or poor based on defined criteria., Results: The mean age of children was 13.1 ± 4.7 years. The mean age of children at the diagnosis of T1DM was 9.9 ± 4.2 years. Sixty-nine (60%) children were female while about half (47.8%) of the children were from the lower socioeconomic class. Compliance with insulin administration was good in 39.1% of the children and was significantly associated with the father's (p=0.001) and mother's educational status (p=0.024) while compliance with dietary recommendations was good in 20.0% of the children and was significantly associated with mother's educational status (p=0.034) and family socioeconomic class (p=0.010). Only the mother's level of education was independently and significantly associated with compliance to recommendations on insulin therapy (OR 4.2, 95% CI=1.5-11.6, p=0.007)., Conclusions: The compliance of children with dietary recommendations and insulin therapy was poor. Efforts should be strengthened at all healthcare facilities to educate parents on the need for compliance with management guidelines., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

Aim: To document normative data on penile size and anogenital distances of apparently normal term male infants in Sagamu, Nigeria., Methods: This cross-sectional study was carried out on 303 term male infants within the first 72 hours of life. Stretched penile length, penile width and three measures of anogenital distances were recorded: anogenital distance-1, anogenital distance-2 and anoscrotal distance., Results: The mean (±SD) stretched penile length and penile width were 39.4 ± 4.2 mm and 11.0 ± 1.0 mm, respectively. The mean values for anogenital distance-1, anogenital distance-2 and the anoscrotal distance were 48.7 ± 3.9 mm, 42.8 ± 4.6 mm and 25.5 ± 3.9 mm, respectively. Only penile width and anogenital distance-1 significantly correlated with all the anthropometric parameters but anogenital distance-1 had the strongest correlation (p < 0.01 for all)., Conclusion: The observed mean stretched penile length was greater than previously reported. Local references are preferable in interpreting anogenital measurements in newborns to avoid diagnostic errors. There is need for a consensus on the definition of micropenis., (©2019 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Previous studies suggest significant ethnic and racial differences in clitoral sizes and anogenital distances in the newborn. This study aimed to document normative data on clitoral sizes and anogenital distances of apparently normal term female infants in Sagamu., Methods: The study was a multi-center, cross-sectional descriptive research carried out among 317 female term infants within the first 72 h of life. Interviewer-based questionnaire was applied to obtain sociodemographic data, pregnancy and birth history. A sliding digital caliper was used for measurement. Data analysis was with SPSS version 20.0., Results: The mean clitoral length was 6.7 ± 1.6 mm while the mean clitoral width was 5.6 ± 0.8 mm. The mean fourchette-clitoris distance, anus-clitoris distance and anus-fourchette distance were 21.9 ± 2.1 mm, 35.5 ± 2.5 mm and 17.0 ± 2.6 mm respectively. The anus-clitoris and anus-fourchette distances significantly correlated with the anthropometric parameters while the clitoral measurements did not., Conclusion: The mean values recorded in this study were higher than observed in most previous studies. This simple, affordable and non-invasive evaluation could aid early diagnosis and treatment of female infants with potentially harmful conditions such as congenital adrenal hyperplasia., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2019.)

Genital prolapse in the newborn is a rare clinical condition often times seen in association with congenital myelo-meningocele, or this could occur following shigellosis infection. We therefore report two neonates with rectal prolapse following diarrhea and utero-vaginal prolapse associated with congenital spinal bifida.

Background: There is paucity of data on the nutritional status of school-age children in Sagamu town of Southwestern Nigeria., Objective: To determine the nutritional status of primary school children in Sagamu Local Government Area, Nigeria., Methods: A cross-sectional survey of primary school children aged 6 to 10 years in Sagamu, Southwestern Nigeria was done. Eight schools were selected using a multi-stage sampling technique. Children randomly selected proportionately from the schools were studied. The weight-for-age, height-for-age and BMI of these children were compared with the 2007 WHO reference values to diagnose underweight (WA <-2SD), stunting (HA <-2SD), thinness (BMI <-2SD), overweight (BMI > +1SD) and obesity (BMI > +2SD)., Results: A total of 1016 children comprising 479 (47.1%) boys and 537 (52.9%) girls were studied. The prevalence of malnutrition was 401(39.4%) and boys were more malnourished compared to girls (p =0.002). The overall prevalences of underweight, stunting and thinness were 260(25.5%), 144(14.2%) and 226(22.2%) respectively. Overweight and obesity were present in 31(3.0%) and 5(0.5%) of the population studied respectively. Boys were significantly more often underweight and stunted., Conclusion: The prevalence of under-nutrition among school children in Sagamu, Nigeria was high and the girls were generally better nourished than the boys. Efforts to reduce the burden of malnutrition in this population may include nutritional surveillance, food supplementation and free school meals.

Objective: To compare the median weight, height and body mass index of school children with the 2000 CDC and 2007 WHO reference values., Settings: Schoolchildren in Sagamu, Nigeria., Design: Cross-sectional survey., Methods: Between November and December, 2008, 1690 school children aged 6 to 16 years from 8 primary schools were surveyed using multi-stage sampling methods. The weight, height and body mass index (BMI) were recorded for each child. The Z-scores of the median anthropometric parameters for each age and sex were determined with the LMS statistical method using the values of L, M and S provided on the CDC and WHO charts., Results: The weight, height and BMI Z-scores were less than the reference values provided on the CDC and WHO charts but were generally closer to the WHO standards compared to the CDC standards. The median weight, height and BMI for females generally plotted higher on CDC and WHO chart compared to the males. The prevalence of underweight and stunting were relatively lower while the prevalence of overweight and obesity was relatively higher among children aged 6 to 10 years using the WHO references compared to the CDC reference values., Conclusions: The WHO references would under-diagnose under-nutrition and over-diagnose overweight/obesity in the population studied.

Objective: To examine the effect of child labor on school children's academic performance., Methods: Primary school children engaged in child labor were compared with age, sex and school-matched controls for absence from school and scores obtained at sessional examination in English language, Mathematics, Sciences and Social studies., Results: There was no significant difference in the mean rate of school absence (p = 0.80), mean aggregate examination scores (p = 0.1) and proportion of class repeaters (p = 0.16) among working school children and the controls. However, a significantly higher proportion of the controls had high (>75%) average examination scores compared with the working school children (p = 0.017). Similarly, the controls performed better than working school children in each of four core subjects but significant differences were observed only in Social Studies and Science (p = 0.006 and 0.001 respectively)., Conclusion: There is some undermining of academic performance among children who combine schooling with child labor despite comparable school absence with the controls.

Objective: To determine the current trends in the incidence and outcome of bilirubin encephalopathy among Nigerian babies., Methods: A review of the hospital records of babies managed for bilirubin encephalopathy at the Wesley Guild Hospital (WGH), Ilesa and Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, both in southwest Nigeria between 2001 and 2005 was carried out. The age, sex, weight, body temperature on admission, place of delivery and outcome of hospitalization were studied. The fatal cases and the survivors were compared for risk factors for mortality., Results: Fifty eight (3.4%) and 57 (2.3%) babies had bilirubin encephalopathy out of 1706 and 2492 total neonatal admissions at OOUTH and WGH respectively. Of these 115 babies, 3 (2.6%), 84 (73.0%) and 28 (24.3%) were aged <3 days, 3-6 days and 7 days or more. Sixty eight (59.1%) babies were delivered in orthodox health facilities. Aside clinically suspected cases of G6PD deficiency, ABO incompatibility and septicaemia were commonly associated with bilirubin encephalopathy, Forty four (38.3%), 36 (31.3%) and 35 (30.4%) had Unconjugated bilirubin of <340 micromol/L, 341-425 micromol/L and >425 micromol/L respectively Sixty eight (59.1%) were discharged, 42 (36.5%) died while 5 (4.7%) were discharged against medical advice. Prematurity, low birth weight, severe anaemia and inability to do Exchange Blood Transfusion were significant risk factors for mortality among babies with bilirubin encephalopathy. Cerebral palsy, seizure disorders and deafness were the leading neurological sequelae (86.4%, 40.9% and 36.4% respectively) among the 22 survivors who were followed up., Conclusion: Bilirubin encephalopathy remains a common clinical finding in Nigeria and the associated mortalities and neurological sequelae are significant.

Congestive cardiac failure (CCF) is a common paediatric emergency with diverse aetiologies. The objective of this study is to define the current prevalence rate and common causes of CCF among children hospitalized in a Nigerian Tertiary Hospital. The study was prospectively done over a 1-year period in the Paediatric Wards of the hospital. Consecutive children aged 0-14 years, who fulfilled the standard diagnostic criteria for CCF were recruited. Data obtained from them included the age, sex, duration of illness and the socioeconomic status of the parents. Each subject was given a specific diagnosis based on the clinical, laboratory and radiological features. Out of a total of 1552 admissions, 109 had CCF giving the prevalence of 7.02%. The mean age of children with CCF was mean of 2 +/- 3.1 years (range: 1 day to 14 years). Ninety-five (91%) of them were concentrated in the lower socioeconomic classes III-V. The aetiologies of CCF identified in this study were as follows: severe anaemia occurring alone (48; 46%), lower respiratory tract infections (LRTI) (30; 29%), anaemia with LRTI (12; 11.5%), congenital heart diseases (CHD) (11; 10.5%), rheumatic heart disease (1; 1%), myocarditis (1; 1%) and chronic renal disease (1; 1%). Malaria was the commonest cause of anaemia while bronchopneumonia was the commonest form of LRTI in the subjects. Measles infection was associated with LRTI in 10 (23.8%) children. Three children had HIV-related anaemia. Infants formed the bulk of the subjects with CCF due to anaemia, LRTI and CHD. Ventricular septal defect was the commonest CHD identified. The prevalence obtained from this study was higher than rates obtained from some previous studies in the country. Severe anaemia is the commonest cause of CCF probably from the effects of severe malaria and increasing poverty. Stringent attention to poverty alleviation and malaria control may reduce the burden of CCF among Nigerian children.