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Introduction: The burden of childhood malnutrition in Nigeria has remained unchanged for nearly a decade between the two Demographic and Health Surveys (NDHS) of 2003 and 2008.The causes of malnutrition are complex and multifactorial. It results from the interplay of socioeconomic, dietary inadequacy and environmental factors. Objective: To describe factors that influence the pattern of malnutrition in acutely ill children in a tertiary Hospital in central Nigeria. Methods: Cross sectional and descriptive study. Children aged 6 to 59 months presenting with acute illnesses to the paediatric emergency unit were concurrently recruited over a 7 month period, (April-October 2012). All had comprehensive clinical assessment done including anthropometric (weight, mid arm circumference, height/length) measurements and z-scores calculated for the individual nutritional characteristics. Results: A total of 379 children were recruited with a mean age of 21.7±13.9 months. There was no difference in the mean age between male and female (P=0.8). The prevalence of wasting was (26.9%), (18%) for stunting and (18.9%) for underweight. The prevalence of severe wasting, WHz scores

Background: The goal of adolescent transition from child to adult care services is to provide uninterrupted, coordinated and developmentally appropriate health care as transfers are made from paediatric to adult clinics. Adolescent transition practices are available but not in Nigeria. This study was carried out to determine current practice of patient referral and adolescent transition practice. Methodology: The study was across sectional studies among paediatricians attending the annual paediatric conference, using a self-administered questionnaire. Result: A total of 80 respondents, 33 consultants and 47 paediatricresidents were involved. Females were 41 (51.2%) and 39 (48.8%) were males. Mean duration of practice was 12.5±0.75 (range 2- 20years). Most respondents practice in urban centre, 91.2%; in public hospitals (96.2%) and many attend to adolescents (80%). Most practice intra-departmental referral (96%) done through verbal communication (46.4%); referral notes (92.8%); or through clinical conference (21.9%). Feedbacks were occasional (76.7%) or maybe verbally given (61.4%). Inter-departmental referral/transfer was through use of referral notes (96.8%), or involved one-on-one discussion (81.0%). Most referred patients are managed independently (64.2%), or may involve clinical conference (30.8%) and grand rounds (31.2%). Adolescent referral is through referral notes (92.3%) with formal discharge (81.6%). Discussions before transfer with the adolescent, and the relatives, occur frequently (91.6% & 92%). Discussions with the receiving physician, adolescents and caregivers occurs much less (37.8%). No written referral policies were available (86.1%) and no existing policy with adolescents transfer was available (66.2%). Mean age of transfer was 16.8±1.8years (range 12-20years); this was determined by hospital (72.9%) or department (71.9%). Informed consent usually requested before transfer(90.7%). Most respondents, (97%), see refused transfer or returning clients. Possible reasons for refusal of transfer are fear (90%); difficulty with new treatment relationship (89.1%); and physician attitude (61.7%). Conclusion: Little or no guidelines exist and a robust adolescent transition protocol is required.

Introduction Knowledge of the range of normal measurements of body organs including the kidneys in the healthy population is essential. Such reference values provide a quick guide for prompt and accurate evaluation of the abnormal. This study sought to determine renal size by ultrasound measurement in term neonates at the Jos University Teaching Hospital (JUTH). Materials and Methods: Healthy term neonates aged 12 to 72 hours were consecutively enrolled. Ultrasound measurements of their renal sizes were determined. Mean renal dimensions and their 95% confidence intervals (CI) were computed. The renal sizes were correlated with the infants’ anthropometric parameters and gestational ages using Pearson’s correlation coefficient. Sizes of left and right kidneys and of male and female subjects were compared using student’s t-test. Results: Two hundred term newborns consisting of 105 (52.50 %) females and 95 (47.50%) males were enrolled. Their mean renal length was 4.09(95% CI, 3.72, 4.46) cm and 4.08 (95% CI, 3.72, 4.44)cm for right and left kidneys; width2.11 (95% CI, 1.89, 2.33) cm and 2.08 (95% CI, 1.85, 2.31) cm for right and left kidneys, and volume9.66(95% CI, 7.49, 9.87) cm3and 9.41 (95% CI, 7.23, 11.59) cm3 for right and left kidneys respectively. Renal dimensions increased consistently with birth weight. No significant difference in renal dimensions between the right and left kidneys was found. Conclusion: The mean renal dimensions for right and left were similar and correlated with birth weight.

Objectives: To determine the utility of mid-upper arm circumference (MUAC) in identifying acutely malnourished children compared with weight-for-height (WHZ), body mass index (BMI) for age (BAZ) and MUAC z-score (MUACZ) in clinical and field practice. Design: Cross-sectional study. Setting: Children from immunisation and paediatric outpatient clinics of Jos University Teaching Hospital and two schools in Jos, Plateau state, Nigeria. Subjects: Children 6–59 months with parental consent, and no chronic medical condition or pedal oedema. Outcome measures: MUAC, height and weight were measured. The WHZ, BAZ and MUACZ were determined using the World Health Organisation (WHO) Anthro software 3.0. Prevalence of acute malnutrition was compared between these data and those given by MUAC. The World Health Organisation (WHO) z-score cut-off of < -3 and < -2 and MUAC of ≤ 11.5 cm and 11.6 –12.5 cm was used to define severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), respectively. Stata 12SE was used to determine frequency distribution, means and significance. Results: The mean age of subjects was 22.4 ± 15.5 months. The mean MUAC was 14.7 ± 1.5 cm. The MUAC differed between males and females in the age-groups of 6–11 (p = 0.02) and 36–47 (p = 0.006) months. The prevalence of SAM by WHZ was 3.4%, MUAC was 1.5%, BAZ was 4.3% and MUACZ was 1.0%. When compared, WHZ and BAZ were concordant in 77.8% (p = 0.001) of SAM subjects. MUAC and MUACZ indicated that none of the subjects were classified as SAM by WHZ and BAZ. Conclusion: Neither WHZ or MUAC as a single parameter identifies all children with acute malnutrition. A re-definition of MUAC criteria for malnutrition or consistent application of both parameters is required. [ABSTRACT FROM PUBLISHER]

Introduction: Evidence of kidney damage is observed in children with sickle cell anaemia (SCA) and this continues through adulthood with progression to severe functional impairment in some. One of the earliest features of kidney damage associated with SCA is microalbuminuria. Our objective was to determine the risk factors of microalbuminuria in these children and its relationship with estimated glomerular filtration rate., Methods: This was a cross-sectional and comparative study involving three hundred and twenty three children with SCA in steady state and equal numbers of apparently healthy age and sex matched haemoglobin AA (HbAA) control, aged 6 months to 18 years. They were consecutively recruited over a 6 month period., Result: Microalbuminuria was present in 26% of the study subjects compared with 1.85% of control P = 0.001). Anaemia and high estimated glomerular filtration rate (eGFR) showed strong positive correlation with microalbuminuria (OR = 3.19, CI 0.953-1.116, p = 0.003 and OR = 1.7, CI 1.042-1.066, p = 0.001 respectively). Similarly, eGFR was higher in subjects with SCA than in controls and as well as in those with microalbuminuria compared with those who do not (p = < 0.01)., Conclusions: The two most important risk factors for microalbuminuria were anaemia and high eGFR. Age category was associated more with microalbuminuria than just age as a variable. Glomerular filtration rate was higher in children with microalbuminuria than those who do not and it was also higher in children with SCA than in control.

Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of 110 HIV positive and 134 HIV negative parturients were enrolled in the study. The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected by HIV status (p=0.17). The rate of episiotomy was significantly affected by primigravidity in HIV negative subjects (OR= 0.032, 95% CI 0.0072-0.13). The rate of perineal tear was significantly affected by primigravidity in HIV positive subjects (OR=8.55, 95% CI 1.91-38.7) and multigravidity in HIV negative subjects (OR= 0.030, 95% CI 0.133-0.71). Gestational age and mean birth weight had no effect on the rate of episiotomy (p value =0.57 and 0.30) and perineal tear (p value= 0.79 and 0.061). There was no mother-to-child HIV transmission. Episiotomies should be given when needed irrespective of HIV status because of the risk of consequent perineal tear and with HAART the risk of MTCT from perineal trauma is minimal.

Background: Clinical Chorioamnionitis contributes to maternal and neonatal morbidity and mortality but the effect of histological chorioamnionitis is sparse in our environment., Aim: To determine the maternal and neonatal outcomes of histological chorioamnionitis amongst pregnant women and their babies., Design of the Study: Cross sectional longitudinal study., Setting: Jos University Teaching Hospital (JUTH), Jos, Nigeria., Methodology: Parturients were interviewed and examined as well as had their placenta examined histologically for chorioamnionitis. They and their babies were followed up for 6 weeks after delivery to monitor for any complications that may arise., Results: A total of 148 parturients were enrolled from the labour ward of Jos University Teaching Hospital and of these 90 (60.8%) had histologic chorioamnionitis (HCA). As regards outcome, 9(10%) with histologic chorioamnionitis as well as 5(8.62%) of those without HCA had premature delivery. Low birth weight occurred in 12(13.33%) and 6(10.34 %) of those with HCA and without HCA respectively. In all, 1(1.47%) and 1(2.56%) of women with HCA and without HCA correspondingly had neonatal sepsis. Puerperal sepsis occurred in 2(2.94%) of those with HCA and 2(5.13%) of those without HCA., Conclusion: Our study has demonstrated that histological chorioamnionitis had no adverse maternal or neonatal effect. There is the need for more studies investigating the cause and the implication of histological chorioamnionitis., Competing Interests: Competing Interests: The authors have declared that no competing interests exist.

Background: In many developing countries, malnutrition remains an important cause of morbidity and mortality particularly in under-five children. The factors responsible for malnutrition could be immediate, underlying or basic, acting either alone or together. It has been shown that children who are malnourished have poorer outcomes from other illnesses than well-nourished children. It is important therefore to periodically describe the extent and pattern of childhood malnutrition so that effective preventive measures can be put in place., Objective: To describe the prevalence and pattern of malnutrition in children presenting with acute illnesses at the Jos University Teaching Hospital., Patients and Methods: A cross-sectional descriptive study in children aged 6 to 59 months seen at the paediatric emergency unit from April to October 2012. The subjects were recruited consecutively. Each child had both clinical assessment and appropriate laboratory evaluations done alongside anthropometric measurements. The nutritional/dietary and socio-demographic histories were also obtained., Results: Of the 379 children, 224 (59.1%) were males and 155 (40.9%) females. The median age was 17 months, range (6-57). Wasting (WFH z-scores ≤-3 to <-1SD) was evident in one hundred children, giving an overall prevalence of 26.9%. Severe wasting (WFH z-score <-3), was present in 22 (5.9%) children indicating the prevalence of marasmus, whereas only two children (0.53%) had oedematous malnutrition (kwashiorkor). Stunting or chronic malnutrition, (HFA z-scores ≤-3 to <-1SD) was present in 67 children (18.0%). Seventeen (4.6%) were severely stunted (HFA z-score <-3)., Conclusions: Wasting was the most common form of malnutrition in the study.

Introduction: Congenital abnormalities of the kidney and urinary tract (CAKUT) are significant causes of end stage renal disease (ESRD) in children. Some of these abnormalities, when identified early, are amenable to treatment. In developing countries, very few published reports exist concerning the pattern and scope of CAKUT in childhood., Methods: This is a retrospective review of all patients with confirmed Pelvi-Ureteric Junction (PUJ) obstruction who were diagnosed antenatally with hydronephrosis between Jan 2002 and Dec 2007 at the Red Cross Children's Hospital, Cape Town. The clinical course of every patient was reviewed for a twelve-month period after confirmation of the diagnosis., Results: One hundred patients, 80 males and 20 females, were included in the analysis. Thirty-two children (32%) had bilateral PUJ obstruction while the rest had unilateral involvement of the left (40%) or right (28%) kidney; overall, 132 kidneys were affected. mild, moderate and severe pelvic dilatation was present in 44.7%, 36.4% and 18.9% of affected kidneys respectively. One child required nephrostomy during the first day of life while eighteen children were treated by pyeloplasty. Urinary tract infection was confirmed in eleven children. At 12 months of follow-up, 83 affected kidneys (62.9%) demonstrated spontaneous resolution of PUJ obstruction while 14 (18.5%) kidneys improved after surgical intervention. Spontaneous resolution occurred more often in kidneys with mild to moderate pelvic dilatation., Conclusion: Spontaneous resolution of the PUJ obstruction occurred in a substantial proportion of children by twelve months of follow-up and complete resolution is more likely in mild to moderate dilatation.

Unlabelled: BACKGROIUND: Tuberculosis (TB) is a public health problem. Knowing its patterns could help address it more efficiently., Objective: To determine the hospital incidence, presentation, management, and outcome of TB in our setting., Methods: We conducted a chart review of children with TB during a five-year period at the University Hospital CNHU-HKM, Cotonou, Benin., Results: Hospital prevalence of TB among hospitalised children was 0.2%. The mean age was six years, with a male:female ratio of 1.4:1. The common clinical features were: cough (78.1%), long standing fever (81.2%), growth retardation (65.6%), pulmonary consolidation (53.1%) and hepatosplenomegaly (34.4%). The skin tuberculin test was positive in only 40.6% of cases. Co-infection with HIV was present in 51.8% of cases. Mycobacterium tuberculosis could be identified in only 21.8% of cases. Twenty-six (81.2%) pulmonary tuberculosis (PTB) cases were diagnosed, eight (25%) of which were associated with extra pulmonary TB. Six (18.7%) presumed isolated extra PTB were also diagnosed. Eight-month treatment regimen was used in most patients, with mortality rate of 9.3%., Conclusion: Although TB hospital prevalence seems low in our setting, management needs to be improved according to guidelines.

Background: The attitude of healthcare workers (HCW) towards organ donation is cardinal to the successful implementation and sustainability of transplant programs. We present the outcome of a survey among HCW in a single tertiary institution in Nigeria regarding their willingness to be living-related kidney donors., Methods: Self-administered questionnaires were randomly distributed to HCW evaluating their attitude towards living-related kidney donation., Results: Of the 650 questionnaires distributed only 502 responded (clinical medical students 51%, physicians 31.7% and nurses 17.3%); 75.6% of respondents were willing to be living donors while 5.8% were against it, and 18.5% were undecided. Multivariate analysis identified willingness to receive, perceived risk associated with kidney donation, and attitude towards cadaveric donation as independent predictors of willingness of HCW to be living donors., Conclusion: Nigerian HCW have a positive attitude toward kidney donation.

Current clinical guidelines for the management of chronic kidney disease recommend the use of prediction equations for determination of glomerular filtration rate (GFR). Our aim was to determine the accuracy of the Schwartz and the modified Counahan-Barratt equations in predicting GFR in hospitalized Nigerian children. We compared GFR as estimated by the Schwartz and the Counahan-Barratt equations against endogenous creatinine clearance (Ccr) in 90 hospitalized Nigerian children of varying renal function. The bias (i.e. the mean difference) in GFR estimation by the Schwartz and the modified Counahan-Barratt equations in relation to Ccr were 16.7 and 21.5, respectively. The predicted GFR values correlated poorly with the measured Ccr (-0.19 and -0.18 for Schwartz and Counahan-Barratt equations respectively). The positive predictive value of the Schwartz and Counahan-Barratt equations to detect GFR <60 ml/min were 9.8% and 11.9% respectively. These equations do not provide reliable estimates of the GFR when compared to Ccr in Nigerian sick children and hence can not replace Ccr in clinical practice. Further studies are needed to develop reliable alternatives for Ccr in these children.