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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 Acute kidney injury (AKI) is an underrecognized complication of severe malaria and an independent risk factor for mortality among children. Objective To determine the incidence and factors predictive of AKI as defined by the pediatric risk, injury, failure, loss, and end-stage (pRIFLE) criteria in children with severe malaria and to assess in-hospital mortality rates in malarial AKI (MAKI). Methods This was a prospective cohort study in 170 children aged 0.5 to 14 years with confirmed Plasmodium falciparum on peripheral blood smears and clinical and/or laboratory features of severe malaria. Serum creatinine was determined using the Jaffe method and glomerular filtration rate (eGFR) was estimated using the Schwartz equation. The primary outcome was the incidence of AKI as defined by the pRIFLE criteria. Secondary outcomes included in-hospital mortality comparison between AKI and non-AKI groups, as well as factors predictive of AKI. Results The incidence of MAKI was 61.2% (104/170) and was comparable between males (66.7%) and females (70.6%). Mean eGFR was lower among children with AKI than those without [42.00 (SD 22) vs. 98.7 (SD 3.9) mL/min/1.73m2, respectively; P=0.005]. Children with MAKI were categorized as having risk (47/104; 45.2%), injury (33/104; 31.7%), or failure (24/104; 23.1%). Mortality rates in AKI and non-AKI subjects were comparable (4.8% vs. 4.6%; P=0.888). Predictors of MAKI were hemoglobinuria [adjusted OR (aOR) 3.948; 95%CI 1.138 to 8.030], deep acidotic breathing (aOR 2.991; 95%CI 3.549 to 66.898), and longer hospital stay (aOR 2.042; 95%CI 3.617 to 12.156). Children with MAKI were more likely to have a longer hospital stay by a mean of 2.5 days. Conclusion AKI is a common complication in children with severe malaria. MAKI has a low mortality rate comparable to those with severe malaria but without AKI. Hemoglobinuria, deep acidotic breathing, and longer hospital stay were predictive of MAKI.

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 : 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.

There is a paucity of information regarding the epidemiology and outcome of COVID-19 from low/middle-income countries, including from Nigeria. This single-center study described the clinical features, laboratory findings, and predictors of in-hospital mortality of COVID-19 patients. Patients admitted between April 10, 2020 and June 10, 2020 were included. Forty-five patients with a mean age of 43 (16) years, predominantly male (87%), presented with fever (38%), cough (29%), or dyspnea (24%). In-hospital mortality was 16%. The independent predictors of mortality were hypoxemia (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.3–5.1) and creatinine > 1.5 mg/dL (aOR: 4.3; 95% CI: 1.9–9.8).

BACKGROUND: Despite the concern on the impact of coronavirus disease (COVID)-19 on tuberculosis (TB), there is a paucity of information from the developing countries inclusive of Nigeria. CASE REPORT: Hence, we report two cases of Nigerian’ adults with coinfections of severe acute respiratory syndrome coronavirus 2 and Mycobacterium tuberculosis (MTB). The two cases were males and aged 30 and 33 years, respectively. They presented with cough, fever, and weight loss with features of acute respiratory symptoms and a history of contact with a confirmed COVID-19. The GeneXpert for MTB detected was high, and chest radiographs showed both features suggestive of TB, and COVID-19. They both received quadruple anti-TB regimen, along with lopinavir/ritonavir. The first case was discharged after 15 days, while the second patient died 6 days into the admission. CONCLUSION: This case reports showed that COVID-19 superimposed on TB may not be uncommon in our environment and may have a poorer outcome. Hence, there is a need for a high index of suspicion for TB infection in endemic area during the COVID-19 pandemic.

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.

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 Human Immuno-Deficiency Virus (HIV) remains one of the world’s significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral suppression, and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. Methods This retrospective descriptive cross-sectional study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral load (VL), and other relevant parameters were extracted from the patients’ care records. The primary outcome was the proportion of patients that achieved viral suppression. We also analyzed variables that were associated with VL suppression. Results Of 913, records of 831 (91.0%) registered patients were analyzed. During the period, 751 (90.4%) achieved viral suppression, 427 (51.4%) had CD4 counts ≥ 500 and 477 (57.4%) were on HAART for ≥ 5 years. Majority, 793 (95.4%) were on first-line HAART regimen (Tenofovir-Lamivudine-Dolutegravir or Abacavir-Lamivudine-Dolutegravir), and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The median (interquartile range) of viral load was 20 (20–40) vs 19,989 (3311–110,340) cp/ml in virally suppressed, and unsuppressed respectively. Factors associated with viral suppression included being unemployed (Adjusted OR [AOR] 4.9, 95% CI 2.771, 8.539), educated (AOR 4.2, 95% CI 1.098, 16.223), having a baseline CD4 count ≥ 500 cells/µl (AOR 2.7, 95% CI 1.588, 4.625), and being on first line HAART regimen [AOR 7.0, 95% CI 3.220, 15.648]. Conclusions Our study demonstrated a good viral suppression among PLHIV on HAART. Variables associated with viral suppression included unemployment, formal education, high baseline CD4 count, and first line HAART regimen.

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

BackgroundRoutine vaccination, a cost-effective means of preventing deadly childhood disease, has a low coverage in Nigeria. The study assessed the willingness of mothers to receive reminder messages for routine vaccination appointments in Northern Nigeria.MethodsA multi-centre cross-sectional study involving at least 363 mother–infant pairs per centre from five states in Northern Nigeria. Data collected include the socio-demographic details, responses on parental phone ownership, mothers’ willingness to receive reminders for immunization appointments and the reminder type characteristics. Data analysis was done with SPSS.ResultsOf the 1952 mother–infant pairs, ownership of at least one household phone was 97.7%. In total, 1613 (82.6%) mothers were willing to receive reminders. A majority (62.2%) of mothers preferred phone calls. A day before the vaccination appointment was the preferred timing (78.1%), and the predominant communication language was the local language for each region.The odds of being willing to receive reminders were 3.1 times, 2.6 times and 1.8 times higher in those with no formal education, primary education and secondary education, respectively, compared with mothers with tertiary education, each p < 0.05. Mothers who delivered at home were significantly less likely to want reminder messages (p = 0.03).ConclusionEight of 10 women in Northern Nigeria are willing to receive a reminder for their child. The predominant mode of reminder preferred is phone calls using the local language. Deployment of mobile phone reminders strategy in Northern Nigeria as a means to improve vaccination uptake is feasible. The institution of this strategy can be in collaboration with service providers.

The confirmation of Covid-19 in Nigeria is not unexpected given the global spread of the disease that originated from China. With an estimated 200 million people and an infectious disease vulnerability index of 0.27, a poorly managed case of Covid-19 may worsen the global pandemic. Hence, we examined the peculiarities of Nigeria as a nation and suggested ways of curtailing further spread of the disease in the country.

The rapid transfer of the water across the cells occurs via specialized channels called aquaporins (AQPs). The structure of AQPs comprises of homotetramers with each of the four units functioning as an independent channel. The distribution of total body water is into intracellular (40% of total body weight) and extracellular compartments (20% of total body weight). While there is some degree of physical separation of the compartments, water freely moved between them with the intent of achieving homeostasis. The typical role of AQP is to act as an effector in the regulation of water at cellular, tissue and organ levels, although recent evidence suggested it can also act as a sensor-effector system. The regulatory roles include cell volume regulation (CVR), which comprises of regulatory volume decrease and regulatory volume increase. The AQPs are also involved in the total body water homeostasis via short- and long-term regulatory mechanisms. The short-term water regulation takes place within minutes, and it typified by insertion of AQP2 into the apical cell membrane of collecting duct following activation of V2 receptor by vasopressin. The long-term regulation by the AQPs involves increased expression of AQPs. Hence, this narrative reviewed the importance of AQPs in the ability to facilitate highly efficient, yet strictly selective permeation of small molecules including water, solutes, and ions, transport across the plasma membrane as it relates to body fluid homeostasis.

Background: The value of Cystatin C as a biomarker of Glomerular filtration rate (GFR) among African newborns is unknown, due to paucity of studies, restricting the measurement of GFR in this popul...

Background Despite being a cost-effective means of improving the childhood health indices, exclusive breastfeeding (EBF) remains low in the low middle-income countries. Hence, we evaluated the determinants of EBF among mothers of infants less than six months in Southwestern Nigeria. Methods This was a cross-sectional descriptive study that involved 271 mothers of infants aged less than six months attending the immunization clinic of the Bowen University Teaching Hospital, Ogbomoso, Nigeria. Pretested semi-structured questionnaires were used to get relevant information from the mothers who were recruited using convenience sampling method. Descriptive statistics was carried out while chi square test and binary logistic regression were used for inferential statistics. Results The mean age (±SD) of the respondents was 30.4 ± 5.0 years. The EBF rate in this study was 46.1% (125/271); 40.6% of mothers breastfed their infants within an hour of birth, with most (91.1%) breastfeeding their babies on demand. Factors associated with EBF included mothers’ age > 30 years (OR 2.080, 95% CI 1.274-3.395). After controlling for potential confounders, family size > 4, (adjusted OR 2.053, 95% CI 1.120-3.762) and having vaginal delivery (adjusted OR 2.769, 95% CI 1.585-4.829) were the significant determinants of EBF practices among the study participants. Conclusion EBF practice was average in the studied population. Family size >4 and vaginal delivery were the determinants of EBF. There is a need to sustain the promotion of appropriate breastfeeding practices.

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: Human Immuno-Deficiency Virus (HIV) remains one of the world’s significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral non-suppression and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. Methods: This retrospective descriptive study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral Load (VL) and other relevant parameters were extracted from the patients’ care Centre Katsina estimated frequencies/proportions, performed bivariate and multivariate analysis to determine factors associated with VL non-suppression using pResults: Records of 831 registered patients were analyzed using Epi-info 7. During the period, 751 (90.4%) achieved viral suppression, 426 (51.3%) had CD4 counts of ≥500 and 477 (57.4%) were on HAART for ≥5 years. Majority, 793 (95.4%) were on first-line and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The independent predictors of viral non-suppression included being on the second line HAART [Adjusted OR (AOR) 6.5; 95% CI 3.02-13.89], being employed [AOR 0.26; 95% CI 0.15-0.44] and baseline CD4 count less than 500 [AOR 0.35; 95% CI 0.21-0.61]. Conclusions: Our study demonstrated a good viral suppression among PLHIV on HAART. Low baseline CD4 counts and being on second-line HAART are predictive of viral non-suppression while being unemployed seems to be protective against viral non-suppression.

Background: Immunization has remained the most cost effective strategy of reducing global childhood deaths and disabilities. The diseases and illnesses targeted by the process of vaccination to achieving immunization are termed Vaccine Preventable Diseases (VPD). Vaccine preventable diseases constitute a major burden to under-five morbidity and mortality in developing countries like Nigeria.This key strategy is being hindered by factors such as forgetfulness and accessibility challenges among others. This study seeks to evaluate the place of using remindersin the form ofShort Message Services (SMS) and or phone calls in improving health seeking behavior through immunization. Materials and Methods: A questionnaire based cross sectionalstudies was carried out between 1st of July to the 31st of December 2019 on the Children Medical Wards of the DalhatuAraf Specialist Hospital. The role of SMS and preference of care-givers between SMS and phone calls on immunization activities was determined. Data analyses were done using the Statistical Package for Social Sciences (SPSS) version 20. Results: The mean age of mothers in this study is 27.58±5.82 years, as most mothers (58.5%) were aged between 21-30 years. Almost all of the responders in this study were married except two (one single mother and a widow respectively). More than 90% had a phone. In spite of this, one fifth of the mothers agreed to have missed immunization at some point. Most (82.2%) of the responders believed using SMS as a reminder will reduce the rate of missed immunization. Loss of immunization cards and forgetfulness were the leading reasons for missed immunization in this study. Conclusions: Most mothers in the present study believed SMS will reduce the rate of missed immunization and preferred it to phone calls.

Background: The morbidity and mortality from neonatal septicaemia (NNS) in low-middle income country remain high at the background of strained health care delivery system.The burden, pooled risks and outcomes of NNS are largely unknown. We aimed to produce a protocol for synthesizing evidence from available data for neonatal septicaemia in sub-Saharan Africa.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 proportion of neonatal with septicaemia while secondary outcomes include proportion of bacterial isolates and their antibiogram, risk factors for NNS, in hospital mortality, length of hospital stay, frequency of necrotizing enterocolitis and other sequel . All identified studies will be screened based on the inclusion criteria. Data will be deduplicated in Endnote version 9, before exporting to Rayyan QCRI for screening. Extractable data will include first author’s name and year of publication, the country and regions in sub-Saharan Africa, total neonatal admissions, number with sepsis, the sample size, bacterial isolates, antibiogram, in-hospital mortality, length of hospital stay and frequency of necrotizing enterocolitis.All studies will be assessed for methodological, clinical and statistical heterogeneity. The NIH Quality assessment tool for observational studies and the Cochrane tool of risk of bias will be used to assess for the strength of evidence. Publication bias will be assessed using the funnel plot.Discussion: Results will be presented as the prevalence, standard error and confidence interval of newborns with neonatal septicaemia in sub-Saharan Africa. Subgroup analysis using categorical data such as risk factors, bacterial isolates, antibiogram and outcomes of neonatal septicaemia will also be reported. A cumulative meta-analysis will be done to assess the time trend of the risk factors, pathogens and antibiogram.The CMA version 3 will be used for statistical analysis. Results will be presented in forest plots.Systematic Review Registration: This protocol is registered in PROSPERO, registration number CRD42020219604.

Objective: Impaired physical growth is one of the prolonged effects of deficient iodine, a micronutrient. Thus, this study aimed to determine the relationship between the urinary iodine levels and anthropometric indices in a population of schoolchildren in Ilorin, North-Central Nigeria. Material and Method: This was a cross-sectional analytical study carried out among primary schoolchildren in Ilorin, North-Central Nigeria. We recruited a total of 492 children aged 6-12 years through a multi-staged systematic sampling technique. Anthropometry was determined using standard methods. We collected urine samples from the pupils and analysed them for iodine in the laboratory using the Sandell-Kolthoff method. Results: Of the 492 children recruited, 13 (3.2%) were under weight, 23 (4.7%) were stunted, 21 (4.3%) had thinness and obesity was found in 7 (1.5%). The mean (SD) weight for age Z score (WAZ) was -0.216 (1.089), and height for age Z score (HAZ) was -0.073 (1.286). The mean weight for height z score (WHZ) and weight for age Z score (BAZ) were 1.036 (0.002) and -0.428 (0.976) respectively. A total of 26.5% of the schoolchildren had mild iodine deficiency, 0.4% had excess urinary iodine levels and no child had moderate or severe iodine deficiency. There was no relationship between the urinary iodine levels and anthropometric indices (WAZ p=0.665, HAZ p= 0.978, WHZ p=0.375, and BAZ p=0.928). Conclusion: This study showed that there is no relationship between nutritional indices and urinary iodine levels. Hence, nutritional status of schoolchildren may not reflect their iodine level., Amaç: Bozulmuş fiziksel büyüme, bir mikrobesin olan iyotun eksikliğinin uzun süreli etkilerinden biridir. Bu çalışma, Kuzey-Orta Nijerya'daki Ilorin okulundaki bir popülasyonda idrarda iyot düzeyleri ile antropometrik endeksler arasındaki ilişkiyi belirlemeyi amaçlamıştır. Gereç ve Yöntem: Bu çalışma, Nijerya'nın Kuzey-Orta Ilorin kentindeki ilkokul çocukları arasında yapılan kesitsel bir analitik çalışmadır. Bu çalışmaya, çok aşamalı sistematik örnekleme tekniği ile 6-12 yaş arası toplam 492 çocuk dahil edildi. Antropometri standart yöntemler kullanılarak belirlendi. Öğrencilerden idrar numuneleri toplandı ve Sandell-Kolthoff yöntemi kullanılarak laboratuarda iyot açısından analiz edildi. Bulgular: Çalışmaya katılan 492 çocuğun 13'ü (%3,2) yaşına göre kilosunun altında, 23'ü (%4,7) kısa boylu, 21'inde (%4,3) zayıflık vardı ve 7'de (%1,5) ise obezite saptandı. Yaş Z skoru (WAZ) için ortalama (SD) ağırlık -0,216 (1,089) ve yaş Z skoru (HAZ) için yükseklik -0,073 (1,286) idi. Boy z skoru (WHZ) ve yaş Z skoru (BAZ) için ortalama ağırlık sırasıyla 1,036 (0,002) ve -0,428 (0,976) idi. Okul çocuklarının toplam %26,5'inde hafif iyot eksikliği, %0,4'ünde aşırı idrar iyot düzeyi saptanırken çocukların hiçbirinde orta veya şiddetli iyot eksikliği yoktu. Üriner iyot düzeyleri ile antropometrik indeksler arasında ilişki yoktu (WAZ p=0,665, HAZ p=0,978, WHZ p=0,375 ve BAZ p=0,928). Sonuç: Bu çalışma beslenme indeksleri ile idrarda iyot düzeyleri anthropometarasında bir ilişki olmadığını göstermiştir. Bu nedenle, okul çocuklarının beslenme durumu iyot seviyelerinin bir yansıması olmayabilir.

Introduction The global spread of COVID-19 remains unabated in the past few months with a rise in the number of available literature on the novel virus. There are very few paediatric studies and are mainly from developed countries with a paucity of information on the clinical manifestation of COVID-19 disease in African children, including Nigeria. Methods We described the clinical presentation, laboratory findings, treatment and outcome in a group of five Nigerian children managed at a COVID-19 isolation and treatment centre in Nigeria. Results We managed a total of five children with an age range of 3 months to 8 years in the last four weeks (16th April to 15th May 2020). Three of the five children were males. All the children had close contact with family members that tested positive for COVID-19. Out of the five children, one had moderate disease, three had mild symptomatic disease, and one was asymptomatic. Two out of the five children had lymphocytosis. Out of the four children who had chest radiograph, two had features of pneumonia. Conclusion COVID-19 is not uncommon in Nigerian children, and all had a confirmed family member with COVID-19. Besides, contrary to leucopaenia with lymphopaenia observed in the adult’s population, we found lymphocytosis in this cohort and about 50.0% had pneumonic changes on chest radiograph.

Battered child syndrome (BCS) is a form of physical abuse that is characterised by multiple injuries and potentially fatal outcome. Despite the high prevalence of physical abuse in developing countries, BCS is rarely reported. Hence, this report highlighted a four-year-old Nigerian boy who suffered multiple injuries (scalp haematoma, bruises, right clavicular fracture, and burns) from the paternal uncle's wife. This case report is discussed along the line of public health approach for curbing the social menace.

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.

Background Despite a high prevalence of iron-deficiency anemia (IDA) in developing countries such as Nigeria, intestinal obstruction secondary to lithobezoar (an accumulation of ingested stones within the gastrointestinal tract) is uncommon. Case presentation Herein, we report a case of acute intestinal obstruction secondary to ingestion of large pebbles and IDA in a 5-year-old Nigerian boy. The patient was managed conservatively with the use of laxatives and a rectal wash-out, and the pebbles were excreted over 3 days. Oral iron therapy was also commenced with cessation of pica. Discussion Although the direction of causal relationship between pica and IDA remains debatable, routine screening for iron deficiency among children with lithobezoar is recommended. Besides managing complications associated with lithobezoar, such as intestinal obstruction, prompt initiation of iron therapy among those who present with features of iron deficiency may be beneficial.