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Background It is not known at which size a congenital Patent ductus arteriosus (PDA) in children becomes associated with a resultant severe malnutrition in children. Furthermore, the effect of ductal size on anthropometry of children with PDA is yet to be determined. Objectives This study was aimed to asses if the ductal size had any effect on anthropometry of children with PDA and at which size evidence of severe malnutrition ensues Methods This was a five-year observational cross-sectional study of children who presented at three tertiary institutions with PDA. Results There was a negative non-significant correlation between the size of PDA and the weight of patients, (Pearson correlation coefficient = -0.1, p = 0.7). There was also a negative non-significant correlation between the size of PDA and patient’s height/length, (correlation coefficient = -0.1, p = 0.5). The association between the size of PDA and the severity of malnutrition revealed greater proportion of 35.3% (6/17) for wasting and stunting in patients who had large PDA sizes of >7mm, when compared with fewer proportions in those with PDA sizes of 3- 6mm (26.1% (6/23) and those with tiny PDA of

Background Patent ductus arteriosus is a common cardiac anomaly in infants that, if untreated, is associated with high morbidity and mortality rates. In lower-middle-income countries, such as Nigeria, obtaining cardiovascular surgical care for infants remains difficult. In recent years, especially with the assistance of international voluntary cardiac organizations, efforts have increased to provide cardiac surgical services to this underserved population. Methods In this case series, the authors describe outcomes in 30 infants surgically treated for patent ductus arteriosus between 2013 and 2019 at an emerging cardiac center in Nigeria (9 male [30%] and 21 female [70%]; mean [SD] age, 8.2 [3.01] months; mean [SD] weight, 5.3 [1.52] kg; mean [range] weight deficit, 34.5% [15%–60%]). Results All the infants presented with patent ductus arteriosus as the main cardiac lesion, and 4 (13%) were syndromic. The mean (SD) patent ductus arteriosus diameter was 4.73 (1.46) mm. Surgical closure was completed in 29 infants; 1 died before surgery. No procedure-related deaths occurred, but 2 cases of trivial residual patent ductus arteriosus were recorded. Conclusion Overall, surgical outcomes were excellent, with acceptable mortality rates. Perioperative care will continue to improve as the center is built to a self-sustaining capacity. Findings of this research at this emerging cardiac center in a developing country are a testament to the positive contribution made by international voluntary cardiac missions.

Background: Aortic regurgitation (AR) is a common sequel resulting from prolapsed of right coronary cusp (RCC), non-coronary cusp (NCC) or both, in the repair of ventricular septal defects (VSD). Objectives: The purpose of presenting these cases is to highlight the fact that aortic valve repair does not only end in addressing the cusp as this will result in moderate aortic regurgitation after surgery. Results: Our first case is a two and half year old male with alarge peri-membranous VSD with RCC prolapse causing co-optation failure and severe AR .The second case is a 12 year old male a large peri-membranous ventriculo-septal defect with RCC prolapsed with severe AR .The third case is a 12 year old female with a large peri-membranous VSD with a significant right coronary cusp prolapsed, severe aortic regurgitation due to non-cooptation of RCC with the remaining cusps with flow reversal in the descending aorta. The last case is a four year, 6-month-old male with a large peri-membranous VSD and severe AR from NCC and RCC prolapse. All had repair of aortic valve with mild regurgitation after several follow up. Conclusion: Aortic valve repair resulting from prolapse of RCC and NCC in children with VSD is expedient as it reduces morbidity and mortality post-operation.

BackgroundEnumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations.ObjectivesThe objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography.MethodsA cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls.ResultsA significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001). All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p

This was a comparative cross-sectional study where the left ventricular dimensions and functional parameters of 41 children (aged 1 to 18 years) with sickle cell anaemia were compared with those of 52 age-and-sex matched HbAA controls using transthoracic echocardiography. Majority of the left ventricular dimensions were significantly larger in the study group than the controls (p0.05). Left ventricular dimensions correlated positively with age and body surface area in both groups (p

Background: Double Inlet Left Ventricle (DILV) with transposition of the great vessels is rare in children with congenital heart disease. We present two cases seen at a paediatric echocardiography centre. Baby ND is a 28-day old female who presented with respiratory distress and cyanosis from the first day of life. Echocardiography showed a double inlet left ventricle and mal-posed great vessels. MB is a seven-month-old female who presented with breathlessness and cyanosis from the first day of life. Examination showed a soft pan-systolic murmur of grade 2 variety at the mid sternal boarder. ECG showed left ventricular dominance and abnormal T changes. Echocardiography revealed a double inlet left ventricle and mal-posed great vessels. Conclusion: Double inlet left ventricle and mal-posed great vessels is a rare complex cardiac anomaly of univentricular physiology. A high index of suspicion (especially if the new born presents with first day history of cyanosis and breathlessness) is necessary for quick referral and surgical intervention.

Introduction Patent ductus arteriosus (PDA) is a common acyanotic heart disease that presents with variable symptoms. Objectives This study is therefore aimed at determining the relationship between gender, age, and size of PDA and pulmonary hypertension. This study also seeks to determine the prevalence of elevated pulmonary artery systolic pressure in children with PDA. Patients and methods A descriptive study of children with patent ductus arteriosus was carried out from 2016 to 2020 in three institutions. The data were analysed with the IBM SPSS statistics for windows, version 20 (IBM Corp, Chicago) Result The mean ductal size was 3.78 (2.39) mm, with a minimum of 1.0 mm and a maximum size of 10.0 mm. The mean ductal size for males, 4.02 (2.53) mm was comparable with that of the females, 3.61 (2.28) mm (Student T-test = 0.8, 0.4). The mean pulmonary artery systolic pressure (PASP) of the patients was 43.36 (24.46) mmHg. Also the mean PASP was comparable among the males and the females, 48.37 (26.69) mmHg versus 39.63 (22.16) mmHg (Student T-test = 1.81, p = 0.07). There was no correlation between age and PASP (correlation coefficient = 0.009, p = 0.92). Sixty point two percent (60.2%) (62/103) of children with PDA had pulmonary hypertension. The proportion of males with pulmonary hypertension, 48.39% (30/62) was comparable with that of the females, 51.61% (32/62) (Chi2 = 2.05, p = 0.15) and females are 1.8 times more likely to have pulmonary hypertension as males (odds ratio 1.81, 95% CI 0.8–4.1). There was a positive correlation between ductal size and PASP (Pearson correlation coefficient = 0.26, p value = 0.007). Those with moderate and large sized duct tend to have moderate and severe pulmonary hypertension respectively and this is statistically significant. Chi2 = 17.85, p = 0.007 Conclusion The prevalence of pulmonary hypertension in children with PDA is 60.2%. Moderate and large size duct presents with moderate and severe pulmonary hypertension respectively. Females are 1.8 times more likely to have pulmonary hypertension than the males.

Background: Children with Human Immunodeficiency Virus (HIV) infection could present with varying degrees of cardiac abnormalities, however the effect of Highly Active Antiretroviral Therapy (HAART) has not been extensively studied in them. Objectives: To compare the ventricular functions of HIV positive children on HAART with that of HIV negative children using echocardiography. Methods: This was a comparative cross sectional descriptive study involving 54 HIV positive children on HAART and 50 HIV negative controls. Using transthoracic echocardiography, trans annular plane systolic excursion (TAPSE), Left ventricular ejection fraction (LVEF), Left ventricular fractionating shortening (LVFS), Left ventricular (LV) mitral inflow velocities, left ventricular mass index (LVMI) and Left ventricular hypertrophy (LVH) were used to assess right ventricular (RV) and left ventricular (LV) function. Results: The mean TAPSE for subjects and controls were 26.78±5.92mm and 25.82±3.59mm respectively (t = 1.0, p = 0.32). The prevalence of right ventricular systolic dysfunction using TAPSE was significantly higher among the subjects; 29.63% compared with 8.0% in controls (χ2 = 7.82, p=0.005). There was no significant correlation between TAPSE and CD4 counts (Spearman’s correlation coefficient = 0.15, p = 0.31). The mean left ventricular mass index (LVMI) in subjects was 141.6±45.5g/M2. Forty-one (75.9%) of the subjects had left ventricular hypertrophy (LVMI > 103G/M2) compared with 26.0% (13/50) of the controls and the difference in proportion was significant (Chi-square = 30.49, p

Introduction: Acute lower respiratory tract infection (ALRTI) is a major public health problem that causes significant morbidity and mortality and is the main reason for utilization of health services among children. Obectives: The study aimed to evaluate the clinical profile, severity pattern, and sociodemographic risk factors of ALRTI in hospitalized children under the age of five years in two tertiary hospitals in South East Nigeria. Materials and Methods: This is a cross-sectional study of children aged two months to five years in two teaching hospitals in the country. They were evaluated for ALRTI, focusing on their clinical profile and socio-demographic risk factors. Results: Two hundred children presented with features of ALRTI, mostly pneumonias and bronchiolitis. ALRTI occurred throughout the year with a peak in October. The majority had severe disease and risk factors for severity were infancy, type of ALRTI, presence of comorbidity and lack of measles vaccination or vitamin A supplementation, and exposure to wood smoke. Fast breathing was the most sensitive symptom, while breathlessness was the most specific for ALRTI. Conclusion: Bronchopneumonia and bronchiolitis are the most common ALRTI in under-five age children with bronchopneumonia occurring in severe forms. Poor breastfeeding, infancy, poor rate of immunization and exposure to biomass smoke are all risk factors for severity.

Background: Cardiovascular diseases have been noted to be expensive to manage and tend to cause significant morbidity and financial burden to affected individuals and households. Objective: This study aimed to determine the various sources of health financing among patients admitted to UNTH Ituku/Ozalla for open-heart surgery. Methodology: Twenty-five patients admitted for cardiac surgery over a 6-month period were selected for the study. A structured questionnaire was administered to the patients or their caregivers. Data were analyzed using SPSS version 20. Results: There were 25 respondents who were admitted during the study period, this comprised 17 children and 8 adults. Among the respondents 24 (96%) paid out of pocket, 1 (4%) was by government tax. The major sources of funds were from personal savings 56% and goodwill from friend's relations, faith-based organizations (4%), while 36% of the respondents borrowed money for the surgery. Three of the respondents had a form of health insurance, while 22 (88%) had no form of health insurance. The mean monthly income of the households was 86,320 (81,384.7) Naira and the mean monthly food expenditure was 33,200 (15934.76) Naira. About 72% (18) of the subjects knew about the National Health Insurance Scheme (NHIS), 4 (16%) knew about the Voluntary Health Insurance Scheme (VHIS), while 84% did not know about the VHIS. However, about 56% of the subjects were willing to enroll under the NHIS voluntary scheme. The cardiac surgery was catastrophic for 96% of the respondents. Conclusion: Cardiac surgery causes a significant financial burden to individuals and households. Individuals and households should be properly counselled on the benefits of health insurance. The government should increase funding for cardiovascular health and strengthen the health insurance system.

Background: Atrial septal defects are common congenital heart defects which could be discovered incidentally during cardiac screening of a child in heart failure. The aim of this study was to determine the predictors of heart failure in children with ostium secundum Atrial Septal Defects (os-sec ASD) and other associated structural lesions. Methods: Seventy-five children with os-sec ASD seen in two tertiary centres in Southern Nigeria were recruited prospectively. Details of age, gender, anthropometric parameters and echocardiographic findings were entered into a proforma. The sizes of the ASDs were categorized into 3 groups; small size= 0.05). There was however a significant association between the presence of heart failure and other structural defects co-existing with ASD (p = 0.038) and Large sized os-sec ASD of greater than 10mm (p = 0.0001) in those with isolated os-sec ASD. Conclusion: Children with ostium secundum Atrial septal defects could present with heart failure, which is more likely if the defect is >10mm or associated with other structural heart lesions.

Background: Doppler echocardiography is a reliable and non-invasive method of detecting valvar regurgitation. The aim of this study was to determine the prevalence of valvar regurgitation in children with structurally normal hearts and explore its relationship with age, gender and anthropometry. Methods: This was a descriptive cross-sectional study conducted in four tertiary hospitals in Nigeria. Two hundred and thirty-three children (124 males and 109 females), from birth to 18 years were recruited prospectively. Using transthoracic echocardiography, the presence of valvar regurgitation was assessed across the four cardiac valves using Color Doppler interrogation after structural abnormalities were ruled out. Data was analyzed using the Statistical Package for Social Sciences (SPSS) software, version 22. Results: Valvar regurgitation was found in 158/233 children giving a prevalence of 67.8%. They consisted of 87 males and 71 females with a male: female ratio of 1.2:1. Of these, 82 (35.2%) had a single valvar regurgitation, 72 (30.9%) had regurgitation at two valves while 4 (1.7%) had regurgitation at three valves. Pulmonary regurgitation was the most common in 52.8% of cases while aortic regurgitation was seen in only two children (0.9%). There was a non-significant negative correlation of age and body surface area with presence of tricuspid regurgitation (ρ -0.79, p=0.22 and ρ -0.12, p=0.08) and mitral regurgitation (ρ -0.04, p=0.56 and ρ -0.02, p=0.83) but positive correlation with pulmonary regurgitation (ρ 0.11, p= 0.11 and ρ 0.12, p= 0.08). The presence of valvar regurgitation was not associated with gender (p=.>0.05). Conclusion: The prevalence of valvar regurgitation in apparently healthy Nigerian children is 67.8%. The presence of valvar regurgitation especially of the right sided valves could be a physiologic finding in apparently healthy children with structurally normal hearts. Regurgitation of the left sided valves is rare.

OBJECTIVES The objective of this study is to document and compare plasma electrolytes of asphyxiated newborns of different degree within 48 hours of life. STUDY DISIGN A comparative cross-sectional study was conducted in the newborn special care unit at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Sodium, potassium, bicarbonate and ionized calcium levels were estimated in the plasma samples of neonates with perinatal asphyxia of different degree and healthy newborns (control group) within 48 hours of birth. MAIN OUTCOME MEASURES The plasma sodium, potassium, bicarbonate and ionized calcium levels were estimated in both, the study subjects and controls. RESULTS Mean plasma sodium level was significantly lower (134.93±5.24 mmol/l vs 141.90±3.36 mmol/l; P

Background: Electrolyte abnormalities constitute the leading causes of morbidity and mortality in younger children with acute gastroenteritis. The aim of the study was to determine the clinical profile and pattern of electrolyte abnormalities in under-five children hospitalized for acute gastroenteritis from November 1, 2014, to January 31, 2015. Methodology: This was a cross-sectional descriptive study among hospitalized under-five children with acute diarrhea who were consecutively recruited from November 1, 2014, to January 31, 2015. Relevant clinical data were obtained, while the physical examination was done on all subjects. Serum electrolytes values were determined using the ion-selective electrode system and compared with standard reference ranges. The data were analyzed using SPSS version 21.0 with the level of statistical significance set at P < 0.05. Results: A total of 108 under-five children were studied. The majority (101; 93.5%) were

Background & Objectives: Estimation of fetal maturity is common in obstetric practice especially when the women do not keep accurate menstrual records. An accurate establishment of expected date of delivery is fundamental to the management of both high risk and normal pregnancies. The objective of this study was to determine the placental diameter (PD), placental thickness (PT) and to establish a correlation between PD, PT and gestational age. Methods: This is an observational cross-sectional study that examines by means of ultrasonography the correlation between placental diameter and thickness with gestational age in Enugu, South East, Nigeria. Results: A total of 400 healthy subjects were recruited in 3rd trimester of pregnancy having fulfilled the inclusion criteria. PD and PT in this study did not correlate with parity. There is a linear increase of gestational age and placental thickness and diameter. These increases heighten between 38th week gestation and 40 weeks’ gestation. 205.0±1.4, 43.00±0.0 to 215.0±1.4, 46.00±2.8 respectively. Conclusion: Placental thickness and Placental diameter can be used to predict gestational age. It is therefore advised to use PT & PD in ultrasound obstetric assessment especially when Last menstrual period (LMP) is not clear. doi: https://doi.org/10.12669/pjms.36.5.1938 How to cite this:Njeze NR, Ogbochukwu JO, Chinawa JM. Correlation of ultrasound placental diameter & thickness with gestational age. Pak J Med Sci. 2020;36(5):1058-1062. doi: https://doi.org/10.12669/pjms.36.5.1938 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction: Atrial septal defect (ASD) is a common congenital heart disease in children that uncommonly presents with pulmonary hypertension. Much is not known about the exact predictor of PAH in children with ASD. Objectives: This study aimed to determine the predictors of pulmonary hypertension in children with ASD. Patients and Methods: This was a descriptive analysis of children with ASD carried out in three different institutions over a five-year period. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software, version 25. Results: The majority of the participants, 52.2%, had pulmonary hypertension and 62.5% of them occurred as mild pulmonary hypertension. There was a very weak positive correlation between pulmonary hypertension and the size of atrial septal defect, increases in size of atrial septal defect correlate with increases in pulmonary hypertension and this was found not to be statistically significant (n = 67, r = 0.193, p = 0.118). There was a positive correlation between the size of atrial septal defect and the age of participants in months, increases in age correlate with increases in size of atrial septal defect and this was found to be statistically significant (n = 67, r = 0.357, p = 0.003). The highest proportion of respondents who had pulmonary hypertension, 64.7%, was seen among children less than 1 year old while the least proportion, 27.3%, was within 1–5 years, and the difference in proportions was found to be statistically significant (χ2 = 8.187, p = 0.017). Conclusion: Pulmonary hypertension in children with ASD occur usually in the mild form. Age is the only strong predictor of PAH in children with isolated ASD.&nbsp

Background Several controversies surround mothers' willingness to vaccinate against the COVID-19 pandemic especially when mortality is not frequently reported in children.Objectives: This study aimed to ascertain the willingness of mothers of children attending two institutions in Southeast Nigeria to accept the COVID-19 vaccine and factors that may be associated with their choices. Methodology This was a cross-sectional study carried out among 577 mothers who presented with their children in two tertiary health institutions in southeast Nigeria. Results Majority of the respondents (93.9%) were aware of the COVID-19 vaccine. Majority of the respondents, 89.4%, noted that children were not in high priority groups for COVID-19 vaccination in Nigeria. Only 6.9% of the respondents intend to receive the COVID-19 vaccination. Also, a minor proportion of the respondents (4.9%) were willing to vaccinate their children with the COVID-19 vaccine. The odds of receiving the Covid-19 vaccine were four times greater in those who believed that they could be infected than in those who believed that they could not be infected (AOR = 4.0. 95% CI:1.8-8.7). The odds of receiving the Covid-19 vaccine were six times greater in those who were aware of someone that died from COVID-19 than in those who did not know anyone who died from COVID-19 (AOR = 5.7, 95% CI: 2.1-15.8). Conclusion A high level of awareness but low acceptance level for COVID-19 vaccination for mothers and their children was noted. Socioeconomic class, maternal age, and level of education did not influence the willingness of the mother to receive COVID vaccination. Having a belief of possibility of infection with the COVID-19 as well as being aware of someone who died from the disease were important positive variables that could predict vaccine acceptance from this study.

Background: Pulse oximetry remains the most common investigation in pediatric cardiology as it acts as a window to unravel most abnormalities in cardiac functions and structure. Objectives: The objective of this study was to determine what is actually the normative pulse oximetry reading among children and to determine if anthropometry has any effect on pulse oximetry. Methodology: A cross-sectional prospective study in which pulse oximetry readings were ascertained among healthy children attending a private clinic in Enugu over a 3-year period. Data Analysis: Data were analyzed using Stata 10 software (STATA 10, College Station, Texas, USA: Stata [Corp]) Means and 95% confidence intervals were calculated for all the individuals. The level of statistical significance was considered P < 0.05. Results: A total of 349 individuals were recruited consecutively. The median value of oxygen saturation (SpO2) was 98% (93%–99%). Females had a significantly higher SpO2 than the males (Wilcoxon-Mann–Whitney test, Z = 2.064, P = 0.04). There was a positive correlation between the SpO2 and age, weight, and height of the patients. Of these anthropometry, height is the most correlated with SpO2. On the other hand, there was a negative correlation between SpO2 and heart rate of the subjects (rho = −0.1845, P = 0.0005). There was no correlation between SpO2 and patient's body mass index (BMI). Conclusion: The normal oximetry reading among children in this study is 98% with a positive correlation with age, weight, and height and a negative correlation with heart rate but no correlation with patient's BMI.

Objectives: The main objective is to showcase the overall pattern and distribution of cardiac diseases diagnosed by echocardiography and to highlight the difficulties encountered in delivering a Pediatric Cardiology/Cardiac Service at University of Nigeria Teaching Hospital. Materials and Methods: There were 308 children seen from July 2011 to June 2016. Their echo reports and case notes were retrieved and analyzed using SPSS version 20 (Chicago). Results: Their age range was from 3 days to 18 years mean (6.5 ± 4.2 years). One hundred and seventy-five (57.0%) were male and 133 (43.0%) were female with male: female ratio of 1.3:1. Of these, 211 had structural heart disease with 154 being congenital heart disease (CHD) and 57 were acquired heart disease, giving the prevalence of 0.44% and 0.16%, respectively. Isolated ventricular septal defect was highest acyanotic CHD with 44.1%, while tetralogy of Fallot was highest with 14.3% in cyanotic group. Some rare anomalies were also seen; one case of left ventricular noncompaction syndrome, Eisenmenger's syndrome, and Ebstein's anomaly representing 0.6%, respectively. The outcome was satisfactory with 35.5% receiving surgery with 7.7% mortality. The cost of procedures and dearth of interventional equipment were some of the challenges encountered. Conclusion: Although there exists low prevalence of echo diagnosed cardiac disease, a good number of them could not get surgical intervention due to cost.

Background: Pregnancy losses (PLs) are usually a source of pain and psychological stress to the expectant couples. The association between ABO blood groups and some thrombogenic markers with PL among Nigerian women is mostly unknown. Aim: This study investigates the association between ABO blood group, deficiencies of protein C (PC), and protein S (PS) and PL. Patients and Methods: A cross‑sectional study involving 170 pregnant women grouped into two, those with or without a history of clinically‑ or ultrasonographically recognizable PL. ABO blood groups using the tile method, plasma concentrations of free protein S (fPS) antigen, protein C antigen (PCAg) by the enzyme‑linked immunosorbent assay‑based method, and PC activity (PCAc) by PROTAC method was determined.Results: There was no difference in mean values between the two groups for PCAg, PCAc, FPS, and blood group (P > 0.05). The chances of PL were; non‑O blood group (AOR 1.29; 95% CI 0.65‑‑2.54), deficient PCAg (AOR 1.75; 95% CI 0.87‑‑3.54), and deficient PCAc (AOR 1.05;95%CI 0.25‑‑4.13). There was a very poor correlation of miscarriage with FPS (rho 0.04), PCAg (rho 0.09), and PCAc (rho = 0.05).Conclusion: There was no significant association between PLs and ABO blood group phenotypes, PCAg, PCAc, fPS.Key words: Free protein S; Nigerian women; pregnancy loss; protein C antigen; thrombogenic markers.

Background Corona virus pandemic (COVID 19) has emerged as the single most important topical issue and poses a challenge to medicine. Adolescent school children are exposed to a varying degree. Objectives The study is aimed to determine the knowledge of the mode of spread and preventive practices among college adolescents attending six secondary schools in Enugu metropolis. Methodology This was a cross-sectional study carried out in 6 secondary schools among 500 college adolescents. A pretested, interviewer-administered questionnaire was used for data collection. Results Majority of the respondents, 98.4% were aware of COVID-19. Although, a higher proportion of the respondents, 52.0% were aware COVID-19 could be transmitted through contact with infected persons, only a minor proportion of them, 42.4% had a good knowledge of the mode of spread of COVID-19. However, a high proportion of the respondents, 69.2% practiced good preventive measures against COVID-19. Also, respondents whose parents were self-employed were 1.4 times more likely to have good knowledge of the mode of spread of COVID-19 when compared with those whose parents were on paid employment [adjusted odd ratio (AOR) = 1.4, 95% confidence interval (CI): 0.9–2.0]. The respondents whose fathers have attained tertiary education were 1.6 times more likely to have good preventive practices against COVID-19 when compared with those who had secondary school and below (AOR = 1.6, 95% CI: 1.04–2.5). Conclusion Though college adolescents were aware of COVID-19, not a significant proportion practiced good preventive measures against COVID-19. Knowledge of mode of spread and preventive practices were significantly enhanced by fathers’ educational status and being a female adolescent child.

The burdenofchildren with cardiovascular disease is on a rising trend. These rising trends are enhanced by the development of new technology in the diagnosis of cardiac lesions.This article is aimed at documenting the current trends in the occurrence of cardiac disease among children attending tertiary hospitals in Sothern Nigeria.This is a descriptive study which involved four hundred and thirty-nine (439) children who had cardiac disease confirmed with echocardiography from four health institutions, namely; Niger Delta University, Bayelsa, Nigeria; University of Nigeria Teaching Hospital, Enugu, Nigeria; Triple care hospital, Enugu, Nigeria and; Blessed children hospital, Enugu, Nigeria over a -five -year period from July 2016- July 2020.The prevalence of congenital heart disease was 83.6% and only 16.4% being acquired heart disease. Many of the children with congenital cardiac defects have associated features of Down syndrome (trisomy 21) and the frequency was related to the type of defect; 6.4% (28/439). These features of Down syndrome are seen mainly in children with AV canal defect 33.3% (14/42) and least in children with TOF 2.0% (1/51). Zero-point two nine percent (1/439) had dextro-cardia and 0.2% (1/340) had VACTERAL (ano-rectal malformation) association, 0.2 % (1/439) had cleft lip, 1.8% (8/439) had dysmorphism other than down syndrome. Five 62.5% (5/8) of such dysmorphic features were associated with VSD.The majority of the children with cardiac disease were from the middle class 63.6% followed by the higher class 21.9% and the least is from the lower class 14.5%. The prevalence values of heart disease were quite higher than that documented in previous studiesThe is a rising prevalence of congenital heart disease (83.6%) and acquired heart disease (16.4%) among children with cardiac disease in southern Nigeria. Extracardiac anomalies were also associated with these trends.

Background Female genital mutilation (FGM) is a public health menace and it study among adolescents is not exhaustive. Objectives The aim is to study the prevalence, pattern, cultural values, health implications and consequences of FGM among adolescent females attending secondary schools in Enugu metropolis. Methods A descriptive study involving female adolescents aged 13–21 years recruited by multistage sampling in three Girls Secondary Schools in Enugu Metropolis. Results Four hundred and fifty (450) questionnaires were distributed and four hundred and fourteen (414) were retrieved. The parents with moderate value for culture and tradition had the highest circumcised respondents (7.8%) (p = 0.056). Majority of the respondents, 93.7% were aware of female circumcision. The major complications of female circumcision according to the respondents were painful urination and menstrual problems. The prevalence of female circumcision among the respondents was 9.4%. A minor proportion of the respondents, 5.8% were of the opinion that all females should be circumcised. Respondents whose fathers attained tertiary education were three times less likely to be circumcised when compared with those whose fathers attained secondary education and less (adjusted odds ratio = 0.3; 95% CI: 0.3–1.5). Conclusion Prevalence of FGM among adolescents aged 13–21 years in Enugu metropolis was 9.4%. Majority of the respondents had good knowledge of FGM, and major complications noted were painful urination and menstrual problems. Fathers education level is a very strong reason for this high awareness of FGM among female adolescents.

Background: Malnutrition poses a great burden to children in the tropics. However, this seems to be accentuated in children with congenital heart disease.Objectives: The present study is therefore aimed at determining the nutritional status of children with congenital heart disease and to compare them with those without congenital heart disease.Methods: This is a cross-sectional study, where congenital heart disease was diagnosed by means of echocardiograph. Anthro software was used to calculate Z scores for weight for age (WAZ), height for age (HAZ), and weight for height (WHZ). Body mass index (BMI) was calculated by the formula BMI = Weight (Kg)/height (M2).Results: The body mass index-for-age z-score (BAZ) and height/length-for-age z-score (HAZ) were calculated for both subjects and controls to determine their nutritional status. It was observed that 38.5% (112/291) of the subjects were wasted (BAZ < −2SD) compared to 6.25% (16/256) of the controls and the difference was statistically significant (χ2 = 81.2, p < 0.001). Stunting (height/length-for-age z-score < −2SD) was also observed in a greater proportion of subjects than controls as 37.8% (107/291) of subjects were stunted compared with 7.0% (18/256) of the controls (χ2 = 69.9, p < 0.001). The under-five subjects had more cases of malnutrition than the controls of same age group as illustrated in Table 6. Whereas 42.9% (96/224) of the under-five subjects were wasted, only 6.2% (12/192) of the controls were wasted. On the other hand, 4.2% (8/192) of the under-five controls were obese compared to 0.9% (2/224) of the subjects of similar age group.Conclusion: Children with congenital heart disease present with varying degrees of malnutrition that is worse compared with children without congenital heart disease. The impact of malnutrition is worse among children under the age of five. Wasting is more prevalent in children with cyanotic heart disease compared with those with acyanotic congenital heart disease. Overweight and obesity were notable features of malnutrition in children with congenital heart disease, but this is worse in children without congenital heart disease.

To determine the severity and prevalence of pulmonary hypertension and its relationship with age and body mass index (BMI) in healthy children.Observational study.University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Lagos State University Teaching Hospital, Niger Delta University Teaching Hospital, Bayelsa and Blessed Children Hospital Enugu from January 2010 to December 2019.Four hundred and seventy (470) apparently healthy children aged 1 to 17 years underwent Doppler echocardiographic studies. Their tricuspid regurgitation velocity (TRV) was measured with continuous wave Doppler. Pulmonary artery systolic pressure (PASP) was estimated using the Bernoulli equation. Elevated PASP were determined at PASP ≥35/mmHg. Values were compared against age and BMI.The mean age was 7.9 ± 3.3 years. Four hundred and fifty-nine subjects (97.7%) had normal PASP while 11 (2.3%) had elevated PASP. Those with elevated PASP had a significantly higher mean TRV of 2.7 ± 0.22 cm/s (95% CI; 2.55-2.85) vs TRV of 1.56 ± 0.43cm/s (95% CI; 1.52-1.60) and higher mean PASP of 39.27±4.89 mmHg (95% CI; 35.99-42.56) vs 20.45 ± 5.34 mHg (95% CI; 19.96-20.94) (p=0.001). Though majority of the children had appropriate weight for ages, those with elevated PASP had a significantly greater weight than those with normal PASP (p0.001). There was a weak positive correlation of PASP with age (r=0.16) and BMI in normal weight (r=0.08). Obese children had a negative correlation value(r=-0.13). A weak negative correlation of PASP with BMI was seen in underweight (r=-0.17 and overweight (r=-0.73) children (p0.05).The mean pulmonary artery systolic pressure in the studied apparently healthy Nigerian children was 20.45± 5.34/ mmHg. The frequency of elevated PASP was 2.3%, commoner in children with higher BMI. Age and body mass index are not optimal predictors of PASP. Key Words: Pulmonary artery systolic pressure, Children, Pulmonary hypertension, Echocardiography.

Background Sickle cell anaemia (SCA) is characterized by attendant ischemia-reperfusion injury especially to the heart. Methods The aim of this work is to compare the right ventricular function of children with SCA in steady state (subjects) with those with haemoglobin AA genotype (controls), using echocardiography. It is a cross-sectional study, which echocardiographic measurements to assess right ventricular function among children with SCA and their controls. Results The mean trans annular plane systolic excursion (TAPSE) in subjects, 28.24 ± 5.23 (Z score: 0.258 ± 1.10) was higher than that in control, 25.82 ± 3.59 (Z score: - 0.263 ± 0.80), and the difference in mean was statistically significant, (t = 2.703, p = 0.008). Significantly higher proportion of subjects with sickle cell anaemia had right ventricular dysfunction (Abnormal TAPSE), 25 (50.0%) when compared with those in control, 11 (22.0%), {χ2 = 8.5, p = 0.0035}. A higher proportion of subjects with sickle cell anaemia (25.5%) had Pulmonary hypertension (RVP) when compared with control (2.0%) and the difference in proportions was found to be statistically significant, (χ2 = 11.668, p = 0.001). The prevalence of right ventricular diastolic dysfunction in subjects was 9.8% while control was 0%. Conclusion Children with sickle cell anaemia present with right ventricular dysfunction. Prevalence of right ventricular systolic and diastolic dysfunction were higher in subjects. More of the subjects in this study (25.5%) had pulmonary hypertension.

Background The use of face masks by children for the prevention of COVID 19 is still controversial, especially with regards to who should wear the face mask and at what age. Objectives The study aimed to ascertain the perception of mothers on masking in children as a preventive strategy for COVID-19. Methodology This was a cross-sectional study carried out in two health institutions among 387 mothers who presented with their children for the first time in the hospital during the COVID 19 pandemic. A pretested, semi-structured, interviewer-administered questionnaire which was designed by the researchers was used for data collection. Results Minority (44.7%) of the mothers perceived masking in children as an appropriate measure for the prevention of COVID-19. The frequent reasons given by majority (55.3%) of the mothers for the inappropriateness of face mask in children included perceived difficulty in breathing (38.5%) and the child’s readiness to pull it off (29.3%). A significantly higher proportion of the children whose mothers were 35 years and above, 64.2% would wear face masks when compared with 31.7% of those whose mothers were < 30 years of age (χ2 = 28.632, p2 = 19.441, p2 = 2.337, p = 0.127) Conclusion Maternal perception of masking in children as an appropriate strategy for preventing COVID-19 is adjudged low in this study. Right perception is significantly enhanced by maternal educational status, employment and marital status.

Adolescence is an important developmental period of childhood. Good health and adequate nutrition consisting major food constituents and trace elements like zinc are fundamental for optimal sexual maturation. To determine the relationship between zinc levels and pattern of breast and pubic hair development, as well as menarcheal age of female SCA children aged 6-18 years and their matched controls with hemoglobin genotype AA. Cross sectional, case-control study. Information on biodata, age at menarche, medical and drug history as well as 24-hour dietary recall was documented using interviewer administered questionnaire. Sexual maturation was assessed using Tanner staging and zinc levels determined using Atomic absorption spectrophotometer. Eighty-one subjects were compared with 81 controls. There was significant delay in the mean age of attainment of various Tanner stages of breast and pubic hair in the subjects. Mean age of 14.81 ± 1.07 years at menarche in subjects was significantly higher than 12.62 ± 1.18 years in controls (p = 0.001). Serum zinc of 58.01 ± 10.58 µg/dl in subjects was significantly lower than 68.37 ± 8.67 µg/dl in controls (p = 0.001). Serum zinc levels were found to have a significant positive relationship with stages of sexual maturation and mean age at menarche. Reduced serum zinc in children with SCA was associated with delayed sexual maturation.

BACKGROUND: Several colleges were closed in the wake of the COVID-19 pandemic. However, it is not clear if school closure has curbed the incidence of the infection. OBJECTIVES: This study aimed to determine the perception of adolescent college students on school reopening and associated factors. METHODOLOGY: This was a school-based cross-sectional study. A two-stage sampling technique was used to select five hundred adolescent college students from six secondary schools in the Enugu metropolis, Nigeria. Data were analysed with IBM Statistical Package for Social Sciences (SPSS) statistical software version 25. RESULTS: The mean age of the students was 15.1±1.7 years and the majority, 56.4% were females. A higher proportion of the respondents, 78.0% were willing to return to school. For those not willing to return to school, the major reason was the preference for homestay until the pandemic is over, 57.3%. The majority of the students, 67.6% had their learning improved during the pandemic. More than half of the students, 65.0% had online classes during the pandemic. Predictors of willingness to return to school amidst the COVID-19 pandemic included being a male student, (AOR=0.304, 95%CI: 0.189-0.489), and being from a family of high socio-economic class, (AOR=0.363, 95%CI: 0.154- 0.855). CONCLUSION: Closure of schools should be revisited, with enforcement of all preventive measures. Alternative methods for education such as e-learning seem to create a divide between the rich and the poor. It is therefore pertinent to develop a bridging plan to fill the gap created by this divide.

Background Adolescents do present with somatization disorder which is often neglected by pediatricians. This could have serious consequences if not curbed early. Objectives This study is aimed at determining the pattern and types of Somatization disorder among adolescents attending secondary schools in south east Nigeria. Methods Somatization disorder was investigated among 485 adolescents from mixed schools using a stratified random sampling of adolescents from four secondary schools in southeast Nigeria. The Enugu somatization scale was used to evaluate for presence of somatization in the participants. Statistical analysis was with statistical package for social sciences (SPPS) version 19 (Chicago IL). Results A total of 485 adolescents aged 10–19 years were included in this study. The mean age of the respondents was 16.36 with standard deviation (SD) of 3.14 years. Two hundred and fifty-one (51.8%) had head features, 262 (54.0%) had body features, 303 (62.5%) had either head or body features while 210 (43.3%) had both head and body features. One hundred and thirty-four males (51.3%) compared to 117 females (52.2%) reported symptoms consistent with head symptoms (p = 0.038). One hundred and eleven males (42.5%) compared to 99 females (44.2) reported symptoms related to the head and body (p = 0.137) while 135 males (51.7%) compared to 127 females (56.7%) reported symptoms related to the body (p = 0.925). There were significant associations of age in categories with head, body, either head or body as well as both head and body features (all p value

Due to the enormous amount spent on histology of adenoid and tonsillar samples from children with adeno-tonsillectomy with no confirmed result of malignancy, it has become expedient to reconsider sending such tissues for histologyThe objective of this study was to determine the necessity of sending tissues of adenoid and tonsils for histology by means of ascertaining the prevalence of malignancy among children with adeno-tonsillectomy. This was a retrospective study done in three private hospitals that provide care for children in Enugu. Data was obtained from the medical records of 72 patients who had undergone tonsillectomy and/or adenoidectomy from September 2011 to May 2018. All the surgical cases done had their samples sent immediately for histology. A total of 72 adeno-tonsillar tissues were taken for histology of which all showed lymphoid hyperplasia with none showing any form of malignancy. Age group ranged from 6 months-18 years with 57 males and 15 females. Histology of the adeno-tonsillar tissue specimen was done among all the children with each costing 9000 Naira (26 US dollars). There were 3 tonsillectomies, 1 adenectomy and 68 adeno-tonsillectomies done. Indications for surgery were mainly upper airway obstruction for 69 cases and recurrent tonsillectomy for 3 cases. Histology revealed lymphoid hyperplasia for all cases. None of the patients in our study had histologic evidence of malignancy. Routine histopathologic examination in adeno-tonsillectomy specimens among children may be dispensable as it showed a negative cost-benefit ratio.

Background: Maternal attitude to health-seeking behavior of their under-five children in the COVID-19 pandemic is not well-known. Objectives: This study is aimed at determining mothers' perception of COVID-19 pandemic among their under-five children and associated factors. Methodology: This is a prospective and observational study carried out in two health institutions in South-East Nigeria. Results: Most subjects, 243 (65.3%) noted that someone without showing symptoms of COVID-19 could transmit the virus. Of the mothers of children under-five, 271 (72.8%) highlighted the possibility of COVID-19 infection in the under-five. A small number of participants 53 (14.2%) showed awareness that people should cough into their elbows as a way of preventing the transmission of COVID-19. A small number of participants, 160 (43.0%) had a good perception of COVID-19. Majority of mothers who were married, 148 (44.7%) showed a good perception of COVID-19 when compared with those who were single, 12 (29.3%); however, this is not significant, (χ2 = 3.550, P = 0.060). A large number of participants who have attained tertiary education, 92 (48.9%) had a good perception of COVID-19 which is higher than that seen in mothers with secondary education 68 (37.0%) (χ2 = 5.444, P = 0.020). Participants who were 30–34 years had 1.8 times higher odds of good perception of COVID 19 compared with mothers who were more than 35 years (adjusted odds ratio = 1.803, 95% confidence interval = 1.026–3.170). Conclusion: Although most mothers affirm that a child could be infected by COVID-19, a small number of them actually had a good perception of COVID-19 infection. Good perception of COVID-19 among the under-five is enhanced by the high level of education and age of 32–34 years.

Introduction: Pyrexia of unknown origin (PUO) still remains a challenge in paediatric practice. Appropriate history, physical examination, and exhaustive investigations are crucial in managing cases of PUO. Case Presentation: UU, was a 1-year-old female, who was seen at our facility on 16 January 2020, with a 4-day history of fever. Fever was high grade and intermittent. Examination revealed pyrexia of 38°c and no other remarkable findings. Lassa fever virus serology, hepatitis B surface antigen, hepatitis C surface antigen, C-reactive protein, erythrocyte sedimentation rate, full blood count, blood culture (with Bactec), malarial parasite, Mantoux, and CXR were all requested. Results of all these investigations were negative. Echocardiography done showed a 0.23 cm² vegetation at the septal leaflet of the tricuspid valve. A diagnosis of infective endocarditis was made and intravenous vancomycin, ceftriaxone, and metronidazole were commenced. Weekly urinalysis and serum electrolyte urea and creatinine monitoring were documented. After a 3-week course of intravenous antibiotics, patient still had fever with temperature higher than 38°c. A diagnosis of PUO was made and a follow-up plan was to do a bone marrow aspiration to rule out leukaemia and serology to rule out connective tissue disease. Conclusion: In managing a child with PUO, detailed history, appropriate physical examination and exhaustive investigations should be done. This is crucial in that even if diagnosis is not reached, several causes of PUO could have been ruled out.

Background: COVID-19 pandemic is a very common menace in the world. Knowledge on mode of spread and prevention of COVID-19 remains blurred among mothers who visit children clinics. Objectives: This work is aimed to determine the knowledge of mode of spread and preventive practices among mothers presenting in a health institution. Materials and Methods: This is a cross-sectional observational study undertaken in a health institution in South East Nigeria using a structured self-administered questionnaire. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software version 25.0. Results: All the respondents (100.0%) have heard of COVID-19. A minor proportion of the respondents, 31.9%, had good knowledge of the mode of spread of COVID-19. Majority of the respondents, 93.3%, knew that COVID-19 could be prevented through good use of personal hand sanitizer. A high proportion of the respondents, 75.5%, were aware that COVID-19 could be prevented by avoiding crowded places and 76.7% by wearing of face mask. The respondents who were in the age group 30–39 years were twice more likely to have good knowledge of spread of COVID-19 when compared with those who were 50 years and above. (AOR = 2.2, 95%CI: 1.2–3.9). The respondents who attained tertiary education were 1.3 times less likely to have good knowledge of spread of COVID-19 when compared with those who attained secondary education. (AOR = 0.8, 95%CI: 0.5–1.2). Respondents who were married were about five times more likely to have good preventive practices against COVID-19 than those who were single parents. (AOR = 4.9, 95%CI: 2.8–8.4). Conclusion: Education is predictive of knowledge of mode of spread while being married is predictive of knowledge of preventive practices.

Background: The exact incidence of vascular injuries in Nigeria as a country especially south-east zone of Nigeria is unknown on account of under reporting and uncoordinated management of victims. Aim: To determine the pattern and outcome of common civilian vascular injuries managed in a teaching hospital in the south-east zone of Nigeria. Method: This is a retrospective study from January, 2007 to December, 2013. All case records of common civilian vascular injuries presenting at the accident center and those referred to the clinics as well as operation register and data banks of managing surgeons, were retrieved and analysed. Results: The age range of 12 - 75 years was rec-orded for the 26 patients. In this spectrum, age range of 21 - 30 years (19.2%) was the highest while the age range, 61 - 70 years (0%) was the lowest. One female (3.9%) and twenty five males (96.1%) were recorded, giving a female to male ratio of 1:25. In the upper extremity, brachial artery 6 (23.1%) was the most involved vessel while in the lower extremity, the most involved was the femoral artery 9 (34.6%). The patterns of presentation were isolated bleeding 10 (38%), arterivenous fistula 1 (3.5%) and pseudoaneurysm 8 (30%). 23 (88%) had good outcome. Conclusion: The incidence is about 4 cases per year. 23 (88%) had good outcome. The shortcoming of lattending physicians was because they were not conversant with hard and soft signs of vascular injuries with attendant limb loss and death of one of the victims. This short coming can be averted by training and retraining of doctors.