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Introduction: Despite being a leading cause of morbidity and mortality globally, acute kidney injury (AKI) is worse in resource-limited areas. This study explores AKI incidence, inhospital mortality, and long-term outcomes in resource-limited settings. Methods: This was a prospective study of children with AKI from 2014 to 2019. KDIGO 2012 defined AKI. We assessed the etiology, inhospital mortality, and long-term outcome of AKI in a mission hospital. Results: Only 169 of 201 AKI patients had complete data. The ages ranged from 1.08 months to 17.5 years; 65.7% were male and 65.1% were from lower socioeconomic class. The incidence of AKI was 59.6 cases per 1,000 persons (95% CI: 5.42, 47.1). Most patients had stage 1 KDIGO AKI (91; 53.8%). 1–5 years old had the highest incidence of AKI (65; 38.5%); sepsis (26.6%), severe malaria (15.4%), and nephrotic syndrome (14.8%) were common AKI causes. Fever (72.8%), pallor (52.1%), and vomiting (45.6%) were the most common symptoms. Thirty-two (27.8%) patients had high blood pressure. Inhospital mortality was 14.8% (95% CI: 9.8, 21.1). The cumulative incidence of AKI-related mortality was 93.2 per 1,000 person-years. Poor outcome was associated with breathlessness, hyponatremia, and leukocytosis. Kaplan-Meier survival curve showed 81% (CI: 74–87%) survival after 5 years of AKI. On Cox proportional-hazards analysis, the absence of breathlessness (HR: 2.537, 95%: CI 1.210–5.317) and hyponatremia (HR: 2.914, 95% CI: 1.343–6.324) were associated with increased survival. Conclusion: In resource-limited settings, infectious diseases and nephrotic syndrome are common causes of AKI. Factors associated with mortality include breathlessness and hyponatremia.

Objectives: In recent years, there has been an increased uptake of Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) for the diagnosis of tuberculosis (TB), with added benefits for detecting rifampicin-resistant TB (RR-TB). We set out to determine the trends in notification of MTB and RR-TB over 4 years in a tertiary hospital in Southwest Nigeria. Materials and Methods: This is a retrospective analysis of single early morning sputum/gastric washing sample for presumed TB in a tertiary health center between January 2016 and December 2019. Xpert MTB/RIF was used to detect (MTB) and RR-TB. Results: The mean age of the 4625 presumptive TB patients was 43.4 (18.8) years, with the majority aged 31–45 (30.6%). Males totaled 2247 (49.6%). Human immunodeficiency virus (HIV) coinfection was found in 756 (16.7%) of them. Using the Xpert MTB/RIF assay, the overall MTB notification was 12.9% (584/4526) and was associated with HIV status, P < 0.001. MTB notification trends increased from 5.6% in 2016 to 23.8% in 2019, P < 0.001. The overall yield of RR-TB was 7.5%. The proportion of RR-TB from TB cases declined from 28% in 2016 to 4.6% in 2019. Forty-two of the 44 cases of the RR-TB (42/572; 7.3%, [95% CI: 5.31, 9.75]) were new cases, with TB treatment failure and relapse cases accounting for 10.1% (2/11; 10.1%, [95% CI: 0.35, 42.5]) of all RR-TB cases (P < 0.01). RR-TB was associated with being older than 45 years (adjusted odds ratio = 2.046, [95% CI: 1.046, 4.004]). HIV infection status and gender had no effect on RR-TB status. Conclusion: This study found an increase in MTB detection with Xpert MTB/RIF utilization. Ages >45 years have 2–4-fold increased risk of developing RR-TB and should be targeted for drug resistance prevention.

Background The postpartum period is associated with an increased risk of maternal mental disorders. The combined effect of having the mother's infant admitted to a tertiary hospital in a low-resource setting and the need to exclusively breastfeed the infant may exaggerate this risk. This study aimed to determine the breastfeeding support provided to mothers whose infants were hospitalised in Nigerian tertiary hospital nurseries and the prevalence of common mental health disorders among this population. Methods This was a national cross-sectional study involving mothers of hospitalised infants from eleven Nigerian tertiary hospitals between May and August 2022. To assess mothers' mental health and breastfeeding support, we utilised the WHO self-reporting Questionnaire 20 and an adapted WHO/UNICEF ten-step breastfeeding support package. Results Of the 1,120 mothers recruited from neonatal nurseries in the six geopolitical zones in Nigeria, only 895 had a complete dataset for analysis. The mean age of the mothers was 29.9 ±6.2; with 54.7% belonging to the low-socioeconomic class. Most of the mothers (835, 93.3%) received antenatal care, and 591: 66.0% were delivered at term. Overall, less than half (427; 47.7%) of the mother received optimal breastfeeding support. One in every four, 216; 24.0% of nursing mothers (95% CI: 21.235 to 26.937%) had common mental disorders (CMD). History of mental health disorders was reported in 41; 4.6% of the nursing mothers. Overall, the lowest performing areas of breastfeeding support were family-centred care (198, 22.1%), practical skill demonstration in the ward (n=279, 31.2%), and antenatal clinics (n=294, 32.8%). CMDs were statistically significantly associated with the healthcare provider's practical breastfeeding skill demonstration and the provision of storage facilities for breastmilkand family-centered-care. Across Nigeria's six geopolitical zones, there was an inverse relationship between optimal breastfeeding support and the proportion of mothers with CMDs. The northern zone provided better breastfeeding support and had fewer CMDs than the southern region of the country. Conclusion Common mental disorders are prevalent among nursing mothers in Nigerian tertiary hospital nurseries, and they are inversely related to breastfeeding support. Urgently required in tertiary hospitals for improved and sustainable breastfeeding practices are a focus on family-centred care and enhanced health workers’ practical breastfeeding support skills.

Background The collateral damages from measures adopted to mitigate the COVID-19 pandemic have been projected to impact negatively on malaria in sub-Saharan Africa. Herein, we compared the prevalence and outcomes of childhood severe malaria during pre-COVID-19 and COVID-19 periods at a tertiary health facility in Nigeria. Methods This was a retrospective review of cases of severe malaria admitted from 1st January to 31st December 2019 (pre-COVID-19 period) and 1st January to 31st December 2020 (COVID-19 period). We extracted relevant information including demographics, duration of symptoms before presentation, forms of severe malaria, and outcomes of hospitalization (discharged or death). Results In the pre-Covid period, there were a total of 2312 admissions to the EPU and 1685 in the covid period representing a decline of 27%. In contrast, there were 263 and 292 severe malaria admissions in the pre-COVID-19 and COVID-19 periods, respectively, representing an 11% increase in the absolute number of cases. The prevalence rates were 11.4% in the pre-COVID-19 period and 17.3% in the COVID-19 period representing an increase of 52% in the percentage differences. The mortality rate in COVID-19 period was higher than the pre-COVID-19 period ([10.3%;30/292 vs 2.3% 6/263], p

Background: The knowledge of the aetiology for neonatal jaundice is important in the early detection and effective management of infants with or at risk of severe jaundice before hospital discharge. This study assessed the aetiological factors of neonatal jaundice among apparently well late preterm and termnewborns to ensure timely intervention where these risk factors exist.Method: This was a cross sectional study involving 174 apparently well neonates at a tertiary mission hospital. Detailed history, physical examination, relevant haematological and biochemical tests were undertaken. Significant jaundice was defined as serum bilirubin greater than 2 standard deviations above the postnatal age and weight dependent treatment concentration.Results: Of the 844 neonates admitted into the neonatal care unit, 174 (20.6%) had significant jaundice. Median age at presentation was 3 days (95% CI of median 3-4days). The mean ±SD gestation age and birth weight of the neonates at recruitment were 38.1±1.6 weeks and 3.1± 0.5kg respectively. Males were 108 (62.4%; M: F.1.6.1). The mean ±SD total serum bilirubin was 13.9±4.7mg/dl. Significant jaundice was more common with maternal-baby concordant paired blood group of AA, O-O compared with discordant materno-baby group pairs. Of the known causes of significant neonatal jaundice, G6PD deficiency (57-38.5%) ranked topmost. Half (87-50.0%) of the causes of significant jaundice were unidentified.Conclusion : G6PD deficiency remains the leading aetiology for significant neonatal jaundice. G6PD screening should be mandated before hospital discharge, compatible mother-baby blood group pairs do not rule the risk for significant jaundice; further research is required to elucidate other inherent unidentified aetiologies.

Background : There is a paucity of data on long term-outcomes of children who undergo acute peritoneal dialysis (PD) in resource-limited settings. We reviewed the outcomes of children who underwent PD after 18 months of follow-up. Methods : We conducted a prospective cohort study in children with acute kidney injury (AKI) who underwent PD. Diagnosis of AKI was based on the 2012 Kidney Disease: Improving Global Outcomes definition. We assessed outcomes of in-hospital mortality, 18-month post-dialysis survival, factors associated with survival, and progression to chronic kidney disease (CKD). Results : Twenty-nine children with a median age of 6 (3 to 11) years underwent acute PD. In-hospital mortality was 3/29 (10.3%) and rose to 27.6% during follow-up. Seven (24.1%) children were lost to follow-up. Of the 14 remaining children, six (42.9%) experienced full recovery of renal function, while eight (57.1%) progressed to CKD. Among those who experienced full recovery, median (interquartile range) estimated glomerular filtration rate (eGFR) rose from 12.67 (7.05, 22.85) mL/min/1.73 m2 to 95.56 (64.50, 198.00) mL/min/1.73 m2, P = 0.031. No significant changes in median eGFR from baseline were observed among those who progressed to CKD (P = 0.383) or in non-survivors (P = 0.838). According to Kaplan-Meier curve analyses, 18-month survival during follow-up was 66.0% (95% CI, 45.0% to 86.5%). Age < 5 was associated with greater likelihood of survival (OR, 3.217; 95% CI, 1.240 to 8.342). Conclusion : Progression of post-PD AKI to CKD occurred in more than half of survivors. Age < 5 was associated with greater likelihood of survival.

BACKGROUND Despite efforts to scale peritoneal dialysis (PD) uptake, access is still limited in Sub-Saharan Africa, including Nigeria. Thus, this study evaluated access to PD, cost-effectiveness, complications, and in-hospital mortality rate following the adoption of a local opt-out model approach for all children with acute kidney injury (AKI) that required PD. METHODS This work was a retrospective review of 33 children with AKI that required dialysis between December 2014 and November 2016. PD was carried out using locally adaptable consumables in place of commercially produced consumables. All patients that required renal replacement therapy (RRT) were offered an option to opt-out irrespective of their financial status. Patients’ relevant data were retrieved from the case notes and analyzed. RESULTS The median age was 7 years (range 3–12). 23 patients (70%) were males. Of the 33 patients that required RRT, 29 had PD. The children had an access rate of 88% (95% CI = 76.77–99.03). The access rate was not related to gender (p = 1.000), age group (p = 0.240), or socioeconomic status (p = 0.755). Complications were pericatheter leakage of fluid (n = 7, 24%), catheter malfunction (n = 5, 17%), abdominal wall edema (n = 3, 10%), scrotal edema (n = 2, 7%), and peritonitis (n = 1, 3%). In-hospital mortality was 3/29 (10%; 95% CI = 2.2–27.3). Cost analysis revealed that the cost of consumables was reduced by 88.5%. CONCLUSIONS An opt-out model with the use of locally adaptable consumables improved PD access (88%) with a low in-hospital mortality rate.

the high expectations that heralded the development of COVID-19 vaccines has been plagued with vaccine hesitancy (VH). The prevalence and associated factors of COVID-19 VH in the six geopolitical zones in Nigeria are explored.using a cross sectional survey, a pre-tested and validated questionnaire on a "Google form" was distributed via social media platforms and hard copies in the six geopolitical zones of Nigeria. Included, using a chain-reference sampling technique, were healthcare workers (HCW), university students and adults in the general population. Participants who expressed unwillingness to receive COVID-19 vaccine in the event of an available vaccine were considered to have vaccine hesitancy. Frequency and percentage were used to describe categorical variables. Multivariable logistic regression analysis was used to assess for factors associated with VH. Level of significance was set at 5% on two-sided tails test.among 1615 respondents, mean (standard deviation) age was 36.7 (11.3) years, and 847 (52.4%) were males. More than half were healthcare workers (943; 58.4%), 97.4% had at least secondary level of education, and majority 60.5% belonged to the upper social class. The prevalence of VH was 68.5% (1107/1615), and 67.2% preferred foreign manufactured COVID-19 vaccines. On multivariable regression analysis, residence in Northeast (AOR 6.01, 95% CI 2.24, 16.10) and Northwest (AOR 3.33, 95% CI 1, 48, 7.48) geopolitical zones, the Igbo ethnic group (AOR 1.88, 95% 1.10, 3.22), Christians (AOR 1.86, 95% 1.10, 3.14), nurses (AOR 3.50, 95% CI 1.25, 9.80), pharmacist (AOR 5.82, 95% CI 2.12, 16.32) and participants without confidence in foreign vaccines (AOR 4.13, 95% CI 2.99, 5.72) were at higher likelihood of VH.vaccine hesitancy is high among adults in Nigeria, with higher likelihood among the Igbo ethnic group, Christian faith, residence in Northeast and Northwest geopolitical zones and those with an aversion to foreign-made vaccines. Targeted interventions are required for the desired COVID-19 vaccine uptake rate and herd immunity.

Graft survival after kidney transplantation may be influenced by both donors' and recipients' Apoprotein 1 (APOL1) risk variant status. There are several conflicting reports on screening, eligibility, and inclusion of APOL1 risk variant testing in the Kidney donor risk index. We developed a search strategy that included medical subject headings (MeSH), text words, and entry terms in order to search nine databases. The primary measurable outcome is the recipient's post-transplant graft survival time from APOL1 high-risk variant donors. The secondary outcomes are the proportion of APOL1 high-risk variants in end-stage kidney disease requiring a kidney transplant, the proportion in graft recipients and kidney donors; the effect of APOL1 high-risk variant on donor's kidney function post-kidney donation, recipient kidney allograft survival in APOL1 low and high-risk recipients. Confidence and comprehensive meta-analysis software will be used for the meta-analysis. Methodological, clinical, and statistical heterogeneity will be assessed. Publication bias will be visually assessed using the funnel plot. Results will be presented in forest plots with pooled survival time, standard error, and variance. Sub-group analysis will be performed using moderators such as sociodemographic characteristics, hypertension, HIV status, forms of rejection and other environmental factors. The primary outcome effect size is the standardized mean difference in survival time for APOL1 high risk variants in kidney transplants. The differences in kidney function between donors and recipients before and after transplantation would be examined. The suitability of donors with APOL1 high risk variants will be explored in terms of graft survival time, donor kidney function, and the aforementioned moderators.

Background Evidence exists as to the criticality of the first 24 h in the management of cerebral malaria. The morbidity and the mortality rate (35%) with the current intravenous monotherapy for the initial treatment of cerebral malaria are unacceptably high. Combination therapy and a shorter course of effective medication have been shown to improve outcomes in human participants in the treatment of other diseases. This study outlines a protocol to conduct a triple blinded parallel randomized controlled trial on cerebral malaria using dual intravenous medications compared to the current standard of monotherapy. Methods This is a parallel multi-site randomized controlled superiority triple blinded trial consisting of intravenous artesunate plus quinine and a control arm of intravenous artesunate only. Eligible and assenting children aged 6 months to 17 years will be recruited from 4 tertiary hospitals by random selection from the list of tertiary hospitals in Nigeria. Participants will be randomized and assigned in parallel into two arms using random numbers generated from GraphPad Prism (version 9) by a clinical pharmacologist who has no link with the investigators, the patients, or the statistician. The primary measurable outcome is survival at 12, 24, and 48 h post-randomization. A composite secondary outcome consists of the number of children that regained consciousness, parasitaemia and defervescence at 12 and 24 h post-randomization and haematological and inflammatory markers at 24 and 48 h post-randomization. Adverse events both solicited and unsolicited are recorded all through the study post-randomization. The study is approved by the State Research Ethics Review Committee. Data analysis will be performed in GraphPad Prism version 9. Discussion The outcome of this analysis will give insight into the efficacy and safety of dual intravenous antimalaria in the treatment of cerebral malaria among Nigerian children compared with the standard of care. The safety profile of this intervention will also be highlighted. This may help inform physicians on the optimal treatment for cerebral malaria to improve outcomes and reduce recrudescence and treatment failure. Trial registration Pan Africa Clinical Trial Registry PACTR202102893629864. 23/02/2021.

Background Although, the use of manual dipstick urinalysis for proteinuria has been a common practice, the Kidney Disease Improving Global Outcomes (KDIGO) guideline on screening for chronic renal disease least advocate it use. Besides, several studies have assessed the performance of dipstick urinary in screening for proteinuria to be inaccurate, unreliable with a poor predictive values. The goal of this study was to determine and compare the presence of significant proteinuria (SP) in high-risk African children using the spot urine protein creatinine ratio (UPr/UCr) as a primary screening tool besides dipstick proteinuria screening. Methods This cross-sectional study involved 1,316 apparently healthy children recruited through a multi-stage sampling technique in Ogbomoso land, Nigeria. We performed a dipstick urinalysis on early-morning urine samples. Urinary protein content was determined using a turbidimetric method and Jaffe’s reaction to measure the urinary creatinine concentration. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS)TM, Version 23.0 for Windows. Results The prevalence of SP using spot UPr/UCr (≥ 0.2) and dipstick proteinuria screening (≥1+) were 18% and 0.8%, respectively (p

BackgroundThe GeneXpert MTB/RIF assay for the diagnosis of tuberculosis (TB) and its uptake has been limited in most developing countries. This may lead to under-diagnosis, ineffective treatment and high mortality. We determine the prevalence of Mycobacterium tuberculosis (MTB) and Rifampicin-resistant TB using a nucleic acid–based test and AFB-smear in a Nigerian population.MethodsWe analyzed a single early morning sputum and extrapulmonary specimen from suspected cases of TB. Smear microscopic and real-time PCR for the detection of MTB and mutation on the rpoB gene using a molecular beacon was performed. ResultsThe median age of the participants was 40 years (range: 6 weeks to 120 years). The incidence of MTB and RR-TB determined using GeneXpert were 620 (16.6%) and 59(1.6%), respectively. Acid-fast bacilli (AFB) smear identified AFB only in 2 out of 59(3.4%) cases with RR-TB. The agreement between the paired test of GeneXpert and AFB smear was poor (Kappa = 0.009, p = 0.01; McNemar’s p < 0.0001). AFB sensitivity, specificity positive and negative predictive value were 2.4%, 98.2%, 1.9 and 98.1 respectively. The distribution of the RR-TB are more prominent among new TB-AFB-negative cases, those residing in densely populated semi urban communities and migrants at border towns. Conclusion The GeneXpert test shows a high detection for MTB in the paediatric population but a lower RR-TB than the national average. There is a need for aggressive escalation of the nuclei acid based test in low middle-income-countries in order to achieve the end TB strategy in a global village.

Background: Evidence exists as to the criticality of the first 24 hours in the management of cerebral malaria. This could serve as a potential safety net for improved outcomes with prompt treatment and utilization of effective therapy. The morbidity and the mortality rate (35%) with the current parenteral monotherapy for the initial treatment of cerebral malaria is unacceptably high. Combination therapy and a shorter course of effective medication have been shown to improve outcomes in human subjects in treatment of other diseases. This study outlines a protocol to conduct a triple blinded randomized control trial on cerebral malaria using dual parenteral medications compared to the current standard of monotherapy.Methods: This is a randomized control triple blinded trial consisting of an intervention and 2 control arms. Eligible and assenting children aged 6 months to 17 years will be recruited from 4 tertiary hospitals by random selection from the list of tertiary hospitals in Nigeria. Subjects will be concealed and allocated in parallel into three arms using random numbers generated from GraphPad Prism (version 9) by a Clinical Pharmacologist who has no link with the investigators, the patients, or the statistician. The parasite load and clearance, fever defervesence, C reactive protein, procalcitonin, blood glucose, electrocardiograms and time to regain consciousness will be monitored. The socio-demographic and clinical details of all patients will be documented. The study will be conducted in line with Declaration of Hesinki 2013. Appropriate statistical tools will be used for data collection and analysis.Discussion:The outcome of this analysis will give insight into the efficacy of dual parenteral antimalaria in the treatment of cerebral malaria among Nigerian children compared with standard of care. The safety profile of this intervention would also be highlighted. This may help inform Physicians on the optimal treatment for cerebral malaria to improve outcomes, prevent development of resistance, recrudescence, treatment failure and stimulate interest of pharmaceutical companies in the development of newer formulations of dual parenteral antimalarial combination therapies. Trial registration: This study was registered in the Pan Africa Clinical Trial Registry (PACTR202102893629864).

Background: Discharged against medical advice (DAMA) is a risk factor that often leads to adverse outcomes and hospital re-admissions in neonatal units. Few studies have shown that spiritual/faith-based institutions (FBI) tend to have lower incidence of DAMA compared with public hospitals. Perhaps the holistic approach to patient care that addresses the spiritual needs, the soul and the body component of a being in this setting may account for the observed lower incidence of DAMA. Limited randomized control trials (RCT) exist on faith-based interventions with regards to DAMA in published literature. This study seeks to compare the effectiveness of FBI, social support, religiosity and types of FBI on neonatal DAMA against standard of care in tertiary hospitals in Nigeria. Methods: This RCT will be carried out in 2 public tertiary teaching hospitals in 2 of 6 geopolitical zones in Nigeria. The socio-demographic and clinical details of all patients admitted to the neonatal wards during the study period will be documented. Study participants will be selected through a multistage sampling technique. Subjects will be randomized and allocated to treatment and control arms having established baseline measure of social support and religiosity. Ethical approval was obtained from the State Research Ethics Review Committee. Written informed consent will be obtained from the parents/caregivers prior to patient enrolment. The study will be conducted in line with Declaration of Hesinki 2013. Appropriate statistical tools will be used for data collection and analysis.Discussion:The outcome of this analysis will give insight into the effectiveness of FBI on DAMA. It will also predict the effect of the mediators of parents/caregivers’ religiosity, spirituality, forms of FBI, parents/caregivers’ religious sect and social support on rate of DAMA on neonatal admission in tertiary hospitals in Nigeria. This may help inform Public Health Institutions and Governments’ decisions on the determinants of neonatal DAMA and how to mitigate such outcomes. It is hoped that the evidence from this study may guide policy formulation and guidelines to enhance hospital retention of sick neonates until they are fit for discharge. Trial registration: This study was registered in the Pan Africa Clinical Trial Registry (PACTR202102670906630).

Background:The burden of SAR COV-2 infection is not limited to the acute viraemia and its symptomatology but extends far beyond to include the long COVID, also known as post-COVID-19 syndrome,which may soon reach public health significance. We set out to produce a protocol for reliable and accurate systematic review and meta-analysis of the symptomatology and treatment approaches of long COVID globally.Methods:We developed a search strategy using MeSH terms, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Researchgate and Scopus. Only observational studies retrievable in the English Language will be included. The primary measurable outcome is the pooled prevalence of the symptoms of long COVID. The secondary outcomes include the summary effect sizes of the treatment approaches to the long COVID; the geographic, race, gender and age variations in symptomatology, and the quality of life of patients with long COVID. Identified studies will be screened, deduplicated, selected and data items extracted using DistillerSR software. All studies will be assessed for methodological, clinical and statistical heterogeneity. Assessment of meta-bias in the selected studies will be performed using the NIH Quality assessment tool for observational studies. Publication bias will be assessed using the funnel plot and Egger’s regression intercept. The pooled prevalence will be expressed with SE and 95% CI. The strength of evidence from this analysis will be assessed using the NIH Quality Assessment for Systematic Reviews and Meta-analysis.Discussion: This analysis will map globally the symptoms of long COVID and its correlates, exploring the influences of geographic locations, race, age and gender, thereby enabling a severity index on a global scale. It will examine in detail the treatment approaches to the long COVID and their impacts on the quality of life of patients. The evidence from this study will inform health policies toward the management of post-COVID-19 syndrome. The outcome of this study will be published in peer-reviewed scientific journal.Trial Registration Number:This protocol is registered with PROSPERO, registration number CRD42021236457

Background Graft survival post-kidney transplant may be influenced by APOL1 risk variant status of both donors and recipients. There are several conflicting reports on screening, eligibility and inclusion of APOL1 risk variant testing in the Kidney Donor Risk Index. We aimed to produce a protocol for synthesizing evidence from available data on Apoprotein L1 risk variants and kidney transplantation.Methods We developed a search strategy using MeSH, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only observational studies retrievable in the English Language will be included. The primary measurable outcome is the recipient’s post-transplant graft survival time from APOL1 high-risk variant donors. The secondary outcomes are the proportion of APOL1 high-risk variants in End-Stage Kidney Disease requiring kidney transplant, the proportion in graft recipients and kidney donors; effect of APOL1 high-risk variant on donor's kidney function post-kidney donation, recipient kidney allograft survival in APOL1 low and high-risk recipients. Deduplication, screening and selection of identified studies will be done using Covidence software while CMA software version 3 will be used for meta-analysis. All studies will be assessed for methodological, clinical and statistical heterogeneity. Publication bias will be visually assessed using the funnel plot. Results will be presented in forest plots with pooled survival time, standard error and variance. Subgroup analysis will be performed using moderators such as socio-demographics: race, age, gender and socio-economic status; hypertension, HIV status, forms of rejection and other environmental factors.Discussion: The effect size for primary outcome is standardized mean difference in survival time for APOL1 high risk variants in kidney transplants. The changes in kidney functions of donors and recipients pre and post-transplantation would be examined. The suitability of donors who have APOL1 high risk variants will explored in relation to graft survival time, donors kidney function and moderating effects of socio-demographics and environmental determinants. Trial Registration Number: This protocol is registered in PROSPERO, with registration number CRD42021230358

Background The unprecedented development of COVID 19 vaccine within a few months and its introduction into the population brought a sigh of relief with the promise of preventing primary infections, halting spread, reducing hospitalization of infected people, and ultimately inducing herd immunity. However, public perception in many communities leaves a lot to worry about as the so much sort-after vaccine has been met with safety concerns, scepticism and hesitancy. We seek to produce a protocol for a reliable and accurate systematic review and meta-analysis on the hesitancy of COVID 19 vaccine uptake in the mist of a global pandemic.MethodsWe developed a search strategy using MeSH terms, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only observational studies retrievable in the English Language will be included. The primary measurable outcome is the prevalence of COVID 19 vaccine hesitancy globally. The secondary outcomes are factors that influence COVID 19 vaccine hesitancy including race, age, gender, occupation, socioeconomic class, level of education, geographic location, misinformation, social media influence and vaccine safety. Identified studies will be screened, deduplicated, selected and data items extracted using DistillerSR software. All studies will be assessed for methodological, clinical and statistical heterogeneity. Assessment of risk of bias in the selected studies will be performed using the NIH Quality assessment tool for observational studies and the Cochrane tool of risk of bias. Publication bias will be assessed using the funnel plot as well as Egger’s regression intercept. The pooled prevalence, standard error and 95% CI will be reported. The strength of evidence from this analysis will be assessed by using NIH Quality Assessment for Systematic Reviews and Meta-analysis.DiscussionThe outcome of this analysis will give insight into the level of COVID 19 vaccine hesitancy and its correlates across geographical regions globally. It will examine if herd immunity via vaccination is attainable at the pooled rate of hesitancy. This will help Governments to redesign their public messages and sensitization. Systematic Review RegistrationThis protocol has been registered with PROSPERO, registration number CRD42021231165.

Introduction. One in every three preventable under-five deaths occur in the neonatal period and one of the leading causes of neonatal death in Low and Middle-Income Countries (LMIC) is sepsis. Organisms isolated varies between and within geographical locations, its trend changes with time. Each setting hence needs to have its antibiogram for susceptible isolates to optimize treatment outcome, the background on which this study was conducted. Methodology. A retrospective study was done on neonates admitted to the Neonatal Intensive Care Unit of Bowen University Teaching Hospital, a missionary hospital in South West Nigeria, between January 2016 and December 2017. The medical records of these neonates were retrieved from the comprehensive electronic database for all neonates admitted into the unit. Result. Of the 129 newborns eligible for the study, early-onset sepsis (56.6%) predominated. There were 79 (61%) males giving a M:F ratio of 1.6:1. The incidence rate of neonatal sepsis was 15 per 1,000 live births with a mortality rate of 24%. Gram-Negative Bacilli were mostly isolated in positive cultures. The likelihood of getting a positive culture was unrelated to the age and sex of patients at presentation. There was a varying resistance pattern of the isolates to commonly used empiric antibiotics. Conclusion and Recommendation. Gram-Negative Bacilli was the commonest cause of neonatal sepsis in our center, associated with poor outcome. The high incidence of resistance to the commonly used empirical treatment calls for an urgent review of practice if the trend of high morbidity and mortality would be curtailed, as well as improved infection control practices.

IntroductionAs childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).MethodsA multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A pResults1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis.ConclusionMortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres.

Backround: The fiduciary duty of a managing physician makes paediatric discharges against medical advice (DAMA) particularly challenging as children lack the legal power or authority to make their health decisions. Aim: It is aimed in the present study to determine the prevalence of paediatric DAMA in a mission tertiary hospital. Methods: This was a prospective descriptive study carried out from June 2018 to May 2019 among paediatric inpatients at the Bowen University Teaching Hospital, Ogbomoso, Nigeria whose parent/ care giver signed DAMA, despite adequate counselling. Data was analysed using SPSS version 23. Results: The prevalence of DAMA in the study was of 4.1%, and the neonatal group accounted for the largest bulk of DAMA. Birth asphyxia was the commonest diagnosis among this group. There was a slight female predominance among the patients whose parents signed DAMA. Financial constraint was the commonest reason [13(30.2%)] given for DAMA and none of the children whose parents signed DAMA was enrolled on the National Health Insurance Scheme (NHIS). Conclusion: Rate of DAMA in a private mission tertiary hospital was lower than previously reported from government tertiary hospitals in the present-day Nigeria.

IntroductionTuberculosis (TB) remains a global health challenge and leading infectious killer worldwide. The need for continuous evaluation of TB treatment outcomes becomes more imperative in the midst of a global economic meltdown substantially impacting resource-limited-settings.MethodsThis study retrospectively reviewed 25-years of treatment outcomes in 3,384 patients who were managed for TB at a tertiary hospital in Nigeria. Confirmed TB cases were given directly observed therapy of a short-course treatment regimen and monitored for clinical response.ResultsOut of 1,146,560 patients screened, there were 24,330 (2.1%) presumptive and 3,384 (13.9%) confirmed TB cases. The patients' mean age was 35.8 years (0.33-101 years). There were 1,902 (56.2%) male, 332(9.8%) pediatric, and 2,878 (85%) pulmonary TB cases. The annual mean measured treatment outcomes were as follows: adherence, 91.4(±5.8) %; successful outcome, 75.3(±8.8) % potentially unsatisfactory outcome, 14.8(±7.2) %; and mortality 10.0(±3.6) %. Female, extra-pulmonary TB (EPTB), newly diagnosed, and relapsed patients compliant with treatment had successful outcomes. Adulthood and HIV infection were mortality risk factors.ConclusionThe mean annual successful treatment outcome is 75.3(±8.8) %. Female, pediatric, EPTB, new, and relapsed patients were predisposed to successful treatment outcomes. Lessons learned will guide future program modifications.

The Child Welfare Card (CWC) contains the records of a child's immunization and information on the other aspects of the child's health, including growth curves and home treatment of diarrheal disease to mention a few. How easily retrievable these records are and what influence the cards have on parents/caregivers regarding the child's nurture are uncertain in our environment.The present study was aimed at assessing the parents/caregivers' knowledge and utilization of CWCs as well as the health-providers' accessibility of the card in the hospital.This study was a cross-sectional descriptive one that involved the parents/caregivers of children aged 60 months and below, attending the children's clinics and wards in a tertiary center. We collected the relevant information, including the sociodemographic data of the parents/caregivers, their knowledge, and assessed the utilization of CWC. The analysis of the categorical data was performed with the IBM Statistical Package for Social Sciences (S.P.S.S) version 23.0 for windows. P values0.05 were considered significant.Of the 377 parents/caregivers enrolled in the study, good knowledge of the contents of the CWC was demonstrated by 82 (21.8%) while 78 (20.7%) made the cards available to the health care providers. Eighty (21.2%) made adequate use of the cards at home. A greater number of parents/caregivers from the higher social class had good knowledge of the intervention contents of the CWC (P = 0.005). The accessibility of the cards to the health care-providers was significantly higher among the older parents/caregivers (P = 0.010), those with a good knowledge of CWC (P = 0.020) and parents/caregivers from higher social class (P = 0.001). Subjects with good knowledge were 2.4 times (OR = 2.4, 95% CI = 1.4-4.2) more likely to utilize the intervention contents in the CWC.The overall knowledge, utilization, and accessibility of the CWC were poor. Parents/caregivers with good knowledge were more likely to utilize the information on the CWC compared with participants with poor knowledge.

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious disease with a potential for healthcare workers (HCWs) getting infected due to inadequate protection while attending to patients. Effective use of personal protective equipment (PPE) is key to mitigating the spread of SARS-CoV-2 infection in healthcare settings. Hence, there is a need to understand HCWs’ use of PPE in resource-limited settings and how closely the currently recommended guidelines for PPE are followed. This study assessed the HCWs’ knowledge about, attitudes towards, beliefs on, and use of PPE to prevent SARS-CoV-2 infection in a resource-limited setting. Methods. This cross-sectional study was conducted in April 2020 in Southwest and Northwest Nigeria. The selection of participants was performed via the snowball sampling technique using a 33-item, web-based, self-administered questionnaire via a social media network. We obtained relevant sociodemographic data and information on participants’ occupations and knowledge about, attitudes towards, beliefs on, and use of PPE. We analysed the data using SPSS version 23.0 for Windows (IBM, Armonk, New York, USA). A p values Results. A total of 290 subjects responded to the questionnaire, and 18 (6.2%) were excluded because of incomplete data. The mean age of the respondents was 32.3 ± 9.9 years. There were 116 males (42.6%). The majority of the respondents were medical doctors (114, 41.9%), followed by nurses and clinical students. Of the 272 respondents in this survey, only 70 (25.7%) had adequate knowledge about PPE. Of the respondents who presumed they had adequate knowledge about donning and doffing PPE, 94 (56%) were incorrect. The predictors of good knowledge were ages younger than 45 years (p=0.046) and practice location (p=0.009). Conclusion. This study showed that HCWs’ knowledge about, attitudes towards, and beliefs on PPE and their PPE skill in practice in Nigeria were remarkably poor. There is an urgent need for nationwide practical training on PPE use to curtail the spread of SARS-CoV-2 infection among HCWs.

Aim: Pyogenic meningitis remain a major cause of mortality and morbidity in lower middle income countries. There exists a wide variability in antibiogram profile of infective causes of acute pyogenic meningitis seeking for individualized management protocol. This study aim to review a five years profile of isolates from suspected cases and evaluate the antibiogram of the infective agent in a tertiary hospital in South west Nigeria.Methods: All patients presenting to the hospital with signs and symptoms suggestive of meningitis were evaluated. Aside random plasma glucose, CSF samples were sent for biochemistry, gene expert for tuberculosis and cultured on Blood agar, Chocolate agar and MacConkey agar for neonates and read after 24hours incubation. Results: 393 of the 657,890 patients seen in the hospital over a five year period suspected to have meningitis were investigated, 22(7%) had a positive culture. Streptococcus pneumoniae (31.8%), Haemophilus influenzae (27.4%), other Enterobacteriaceae (18.2%), Pseudomonas aeruginosa (9.1%), Staphylococcus aureus (4.5%), Proteus mirabilis (4.5%) and Candida albicans (4.5%) were isolated. Conclusion: Spectrum of causative bacterial agent is not different from documented in other parts of the country. Streptococcus pneumoniae predominance was reported which is sensitive to Ampicillin, Ceftriaxone, Cefotaxime and Penicillin. Empirical treatment with Ceftriaxone or Cefotaxime can be instituted while awaiting laboratory confirmation in suspected cases., Amaç: Piyojenik menenjit, düşük orta gelirli ülkelerde önemli bir mortalite ve morbidite nedenidir. Bireyselleştirilmiş yönetim protokolü arayan akut piyojenik menenjitin enfektif nedenlerinin antibiyogram profilinde geniş bir değişkenlik vardır. Bu çalışmada, şüpheli vakalardaki izolatların beş yıllık bir profili gözden geçirilerek Güney Batı Nijerya'daki bir üçüncü basamak hastanede enfektif ajanın antibiyogramının değerlendirilmesi amaçlanmıştır.Yöntem: Menenjit düşündüren belirti ve bulguları olan hastaneye başvuran tüm hastalar değerlendirildi. Rastgele plazma glukozunun yanı sıra, CSF örnekleri biyokimya, tüberküloz için gen uzmanı olarak gönderildi ve yenidoğanlar için Blood agar, Chocolate agar ve MacConkey agar üzerinde kültürlendi ve 24 saat inkübasyondan sonra okundu.Bulgular: Hastanede menenjit geçirdiğinden şüphelenilen beş yıllık bir süre içinde görülen 657.890 hastanın 393'ü araştırıldı, 22'sinde (%7) pozitif kültür vardı. Streptococcus pneumoniae (%31,8), Haemophilus influenzae (%27,4), diğer Enterobacteriaceae (%18,2), Pseudomonas aeruginosa (%9,1), Staphylococcus aureus (%4,5), Proteus mirabilis (%4,5) ve Candida albicans (%4,5).Sonuç: Nedensel bakteri ajanının spektrumu, ülkenin diğer bölgelerinde belgelenenlerden farklı değildir. Ampisilin, Ceftriaxone, Cefotaxime ve Penicillin'e duyarlı Streptococcus pneumoniae baskınlığı bildirilmiştir. Şüpheli vakalarda laboratuvar onayı beklenirken Ceftriaxone veya Cefotaxime ile ampirik tedavi uygulanabilir.

Background Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. Methods A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. Results Sixty-eight patients (55.9% males), aged 3–16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis—cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1–55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. Conclusions The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.