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Developmental disorders are frequently overlooked in the developing countries, particularly in sub-Saharan Africa. Early identification of developmental delays (DDs) is critical to optimal outcomes. This study set out to determine the proportion of children who are at risk of DDs among infants attending immunization clinics at the University College Hospital, Ibadan, Nigeria. Infants 6 weeks to 12 months of age (median age 6 months) who presented for routine immunization were screened for DDs using the Ages and Stages Questionnaire. A total of 587 infants [312 (53.2%) males] were enrolled. A total of 198 (33.7%) children showed signs of DDs. For the domains of communication skills, fine motor skills, gross motor skills, problem solving/cognition skills and personal/social skills, the prevalences of DDs were 7.5%, 15.0%, 10.7%, 14.1% and 14.8%, respectively, and 14.3% had global DDs. Factors that significantly predicted DDs included prematurity (odds ratio [OR] 2.64 [95% confidence interval {CI} 1.45 to 2.05]) and a history of perinatal asphyxia (OR 1.74 [95% CI 1.77 to 2.49]). There is a need to incorporate routine developmental screening into the Nigerian healthcare system for timely recognition of DDs and prompt interventions.

Background: Nemaline rod disease is a congenital myopathy, presentation of which may mimic myasthenia gravis. Method: We report a suspected case of nemaline rod disease in a female adolescent who presented with features similar to myasthenia gravis but failed to respond effectively to its conventional management. She had features of respiratory failure and cardiomyopathy. Results: Patient had a turbulent clinical course and finally succumbed to illness on the fifth day of admission. Conclusion: This report is meant to sensitize child neurologists and general paediatricians on the need to have a broad spectrum of considerations in the management of suspected myasthenia gravis, especially when response to anticholinesterase is poor.

Background: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome. Objectives:: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria. Methods: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Details of history of illness including the interventions given before presentation were recorded. All the children had lumbar puncture and examination of their cerebrospinal fluid (CSF). All were followed up till discharge and the outcome was recorded. Results: A total of 147 children, 83 males and 64 females with febrile seizures were studied. Harmful traditional practices were found to be common in the cohort studied. Fifty-nine (40.1%) of the children received at least one form of intervention believed to be capable of aborting the seizure during the attack at home. Herbal preparation was the most common form of pre-hospital treatment, given in 15 (10.2%) of the cases. Other forms of pre-hospital interventions given were application of substances to the eyes (6.1%), incisions on the body (2%) and burns inflicted on the feet and buttocks (1.4%). None of the children received rectal diazepam or buccal midazolam as home remedy for seizures. There was a statistically significant relationship between harmful cultural practices and the socio-economic class of the caregivers (P=0.008). Conclusions: Pre-hospital treatment of childhood seizures in Ibadan comprises mainly harmful traditional practices. There is a need for appropriate health education to reduce the morbidity and mortality associated with febrile seizures in the locality.

There is documented evidence that the use of complementary and alternative medicines (CAM) has been on the increase worldwide.A standardized questionnaire was administered to caregivers of children with epilepsy to evaluate the prevalence and pattern of CAM use.One hundred and seventy five caregivers of 175 children with epilepsy were studied. Ninety nine (56.6%) of the caregivers gave a history of CAM use. The forms of CAM used were herbal preparations (39.4%), spiritual/prayer healing (34.3%), scarifications (17.1%) and special vitamins (6.1%). Seventy (40%) of the 175 children had received CAM ever before seeking Western Medicine for the treatment of epilepsy. Of the 99 children with history of CAM use, 33 (33.3%) continued to use CAM in combination with the prescribed anti-epileptic drug (AED). Adverse effects were reported in 17 (17.1%) cases. There was no statistically significant relationship between the type of epilepsy and the use of CAM (p= 0.229, OR 1.655, 95% CI 0.608-4.508). There was a statistically significant inverse relationship between social class of the family (p = 0.043, OR 0.354, 95% CI 1.087-2.489) and mother's level of education (p = 0.013, OR 2.618, 95% CI 1.173-5.844) and the use of CAM. Only 30 (30.3%) of the 99 caregivers had spontaneously volunteered the history of the use of CAM to the attending physician and the leading reason for not giving the history was that the attending physician did not ask for the information.Children with epilepsy frequently use CAM and attending physicians often fail to ask about use of CAM in the routine evaluation of patients. There is a need to routinely ask caregivers and patients about the use of CAM in management of their disease.

Chronic blood transfusion (CBT) diminishes the risk of primary and secondary stroke in sickle cell disease (SCD). We appraised CBT and assessed its feasibility as an option for stroke prevention in a setting of limited resources.All new cases of SCD seen in the Paediatric Hematology/Neurology units of the University College Hospital, Ibadan, Nigeria over a 5-year period were screened and followed up to identify those who had an indication for CBT for stroke prevention. Caregivers were counseled and offered CBT when indicated. Children of caregivers who accepted chronic transfusion were carefully followed up and outcomes documented.Five (10%) of the caregivers of the 50 children who had an indication for CBT for stroke prevention consented to the treatment. They all had homozygous sickle cell anemia and had suffered a stroke. None of the children with abnormal TCD velocities consented to CBT. Two children experienced transfusion reactions, fatal in one. The mean annual cost of chronic transfusion (without chelation) was $3,276 (SD = 1,168). Major reasons given for declining CBT were high costs of blood transfusion, unavailability of blood, the need to regularly seek for blood donors, and the indefinite duration of blood transfusions.High economic costs, unavailability of blood, need to regularly seek for blood donors, cultural beliefs, and high frequency of transfusion reactions are major challenges to a successful CBT program in Nigeria. There is a need for government subsidy on blood transfusions and improved efforts towards provision of safe and affordable blood.

It is important to predict as soon as possible after diagnosis and starting treatment, the likely clinical course of childhood-onset epilepsy, both in terms of seizure control and even more pertinently, seizure intractability. Little is known about the factors predictive of seizure control in African children.All consecutive cases of newly-diagnosed childhood epilepsy seen over a period of two years in the Paediatric Neurology clinic, University College Hospital, Ibadan, Nigeria were prospectively followed for a period of three years to determine seizure outcomes. Remission was defined as being seizure-free for at least two consecutive years.A total of 170 children were enrolled but 54 defaulted and were excluded from further analysis. Twenty nine (25%) attained remission while 20 (17.2%) showed signs of intractability. The remaining 67 (57.8%) showed some response to anti-epileptic drug (AED) therapy. Primary generalized epilepsy was found to be significantly associated with seizure remission and successful discontinuation of AED. Factors associated with reduced likelihood of seizure remission were remote symptomatic/cryptogenic aetiology, slow waves on electroencephalography (EEG), high seizure frequency of at least one attack/ month at presentation, failure of response to the initial AED and presence of associated neurological deficits. On logistic regression, high seizure frequency and presence of slow waves on EEG remained independent negative predictors of seizure remission.About one-quarter of Nigerian children with newly diagnosed epilepsy attain early seizure remission within the first three years ofAED therapy. The major predictors of poor seizure control and failure of seizure remission include high seizure frequency at presentation and presence of slow waves on EEG.

BACKGROUND: Paediatric neurological disorders constitute a major cause of disability in childhood. Children in the developing countries are disproportionately affected and in addition face the added burden of poverty, inadequate health facilities, stigmatisation and lack of facilities for rehabilitative care. OBJECTIVE: To describe the spectrum of neurological disorders seen among Nigerian children presenting at the paediatric neurology clinic of the University College Hospital, Ibadan, Nigeria. METHODS: All children presenting at the paediatric neurology clinic of the University College Hospital, Ibadan, Nigeria over a period of 20 months were prospectively studied. Diagnoses were made from detailed history, thorough physical examination, with particular emphasis on the central nervous system and appropriate investigations as indicated. RESULTS: There were a total of 644 cases during the study period, 369 males and 275 females, giving a male to female ratio of 1.3:1. There were 1353 consultations at the paediatric neurology clinic and these accounted for 21.0% of the total 6,442 consultations at the paediatric specialist clinics in the hospital. The most frequent paediatric neurological disorders were epilepsy (45.3%), cerebral palsy (36.0%), neuro-muscular disorders (4.5%) and mental retardation (4.5%). CONCLUSION: Paediatric neurological disorders constitute a major reason for paediatric specialist care in Ibadan, Nigeria. Preventable causes play a major role in the aetiology of the major paediatric neurological disorders seen in this part of the world. WAJM 2009; 28(1): 328–332.

Bacterial meningitis remains a major cause of morbidity, mortality and neurodisability in childhood, particularly in the developing world where effective vaccines against the usual pathogens responsible for the disease are not in routine use. To describe the patterns and outcome of bacterial meningitis among children admitted into the University College Hospital (UCH), Ibadan, Nigeria. All children who satisfied the case definition for meningitis, admitted into the paediatric wards of the University College Hospital, UCH, Ibadan over a period of 30 months were prospectively enrolled and blood and CSF samples were taken for bacteriological analyses. A total of 97 children, 62 males and 35 females were studied. Their ages ranged between 2 months and 12 years, mean age 33.0 (SD=41.7) months, with 80.4% of the cases below the age of 5 years. Haemophilus influenzae type b (Hib) was the leading pathogen, found in 16 (55.1%) of the 29 cases of definite meningitis. Other isolates include Streptococcus pneumoniae (24.1%), Klebsiella spp (7.0%), Staphylococcus aureus (7.0%), Escherichia coli (3.4%) and Pseudomonas spp. (3.4%). Hib and pneumococcus showed varying degrees of resistance to chloramphenicol, penicillin and cotrimoxazole. Twenty six (26.8%) of the cases died and 67.6% of the survivors developed significant neurological sequele. Bacterial meningitis remains a major cause of childhood mortality and neurodisability. Hib and pneumococcus remain the major pathogens responsible for this dreadful disease in Ibadan, Nigeria. The increasing emergence of antibiotic resistance calls for institution of adequate control measures, particularly routine childhood immunisation against the disease.

Holoprosencephaly is a rare congenital malformation resulting from failure of cleavage of midline structures of the forebrain and face. It affects 0.49-1.2 in 10,000 births around the world. The nature of this condition in African children is not well documented in literature. We present a cluster of three cases of holoprosencephaly with varying degrees of facial and intracranial malformations seen within a 6 month period at the University College Hospital, Ibadan, Nigeria.

This prospective study was undertaken to evaluate the prevalence of ocular abnormalities, as well as describe the various eye defects seen among cases of cerebral palsy presenting at the Paediatric Neurology Clinic, University College Hospital, Ibadan, Nigeria. All cases of cerebral palsy seen at the Paediatric Neurology Clinic, University College Hospital, Ibadan, over a period of 18 months were carefully evaluated by the Paediatric Neurologist for signs of ocular abnormalities. Those in whom such abnormalities were found were referred to the Consultant Ophthalmologist for detailed eye examination and accurate description of the ocular abnormalities. One hundred and forty nine children with cerebral palsy were seen during the period of study, forty two had associated ocular abnormalities, giving a prevalence rate of 28.2%. More than half (61.9%) of the cases were completely blind. The major ocular abnormalities identified in the affected cases were strabismus (50%), optic atrophy (50%) and cortical visual impairment (47.7%). Other eye defects less frequently seen were nystagmus (9.5%) and refractive errors (4.8%). Presence of spastic quadriplegia was associated with an increased risk of ocular abnormalities. Ocular abnormalities are a frequent problem in children with cerebral palsy. Evaluation of all children with cerebral palsy must include amongst other things, a full ophthalmologic evaluation, even when no gross eye anomalies are visible to the attending physician. Early identification of these defects in children with CP is crucial in order to institute prompt therapy in cases with defects that are amenable to treatment.

One hundred consecutive admissions of children with a diagnosis of congestive cardiac failure to the paediatric department of the University College Hospital, Ibadan were evaluated during a 10-month period. They were aged 8 days to 12 years. They constituted 5.8% of the total paediatric admissions during the study period. The most frequent underlying causes of heart failure were acute lower respiratory tract infections (36%), intrinsic heart disease (31%) and severe anaemia (28%). Other less common causes of heart failure were renal disorders (3%) and septiceamia (2%). Heart failure remains a common problem encountered in emergency paediatric practice in Nigeria, with the majority of cases resulting from preventable causes. Keywords: Childhood, Congestive Heart Failure. Resume Cent cas consecutifs des enfants atteints de la congestion d'arret cardiaque et admis au departement de la Pediatrie du College Hospitalo-Universitaire, Ibadan, ont ete evalues au cours d'une periode de 10 mois. Ils sont âges de 8 jours a 12 ans. Ils constituent 5,8% de tous les patients atteints de la pediatrie et admis pendant la periode d'etude. Les causes les plus frequentes attribuables pour l'arret cardiaque sont: l'infection du sentier respiratoire inferieur 36%, la maladie de coeur intrinseque 31%, et l'anemie grave 28%. D'autres causes qui sont plus frequentes d'arret cardiaque etaient troubles renaux 3% et la septicemie 2%. Arret cardiaque demeure un probleme tres frequent eprouve dans l'exercise de la pediatrie d'urgence au Nigeria, avec la majorite des cas attribuables aux causes evitables. West African Journal of Medicine Vol.22(1) 2003: 42-45

To compare the outcome after a first clinical stroke, following treatment with and without hydroxyurea (HU).A retrospective review of a cohort of Nigerian children with SCD, who had suffered a first stroke, was carried out. Outcomes in the group of children who received and did not receive HU were compared.Thirty two children presented with stroke and one died of haemorrhagic stroke at presentation. All the children had haemoglobin SS phenotype, and ischaemic stroke was the predominant form seen. Mean age at first clinical stroke was 7 years, 7 months (SD=2 years, 4 months). Thirteen children received HU while 18 declined HU therapy. Maximum dose of HU ranged from 20-25 mg/kg/ day. The secondary stroke incidence of 7/100 person years in the HU group was significantly lower than the 28/100 person years in the non-HU group (P=0.001, OR 3.808, 95% CI 1.556, 9.317). Children who did not receive HU were more likely to drop out of school and to have moderate-severe motor disabilities requiring caregiver assistance for daily living.In settings where facilities for chronic blood transfusion are not accessible or feasible, HU therapy should be considered for secondary stroke prevention in children with SCD.