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

Background: Preeclampsia has remained an important public health problem in the developing world where it is associated with a five-fold increase in perinatal morbidity and mortality. Objective: We set out to compare neonatal outcomes between women with preeclampsia and those with normal pregnancy. We also sought to evaluate factors associated with poor outcome in the neonates. Materials and Methods: This was a prospective cohort study that enrolled 90 women (45 with preeclampsia and 45 with normal pregnancy) after 20 weeks gestation. Maternal socio-demographic and clinical information was obtained at enrolment and delivery using questionnaire. Neonatalanthropometric and physiologic data was obtained at delivery and used for classifying the birth weight according to the WHO classification. APGAR score was used to evaluate the presence of birth asphyxia. We defined poor outcome as the presence of at least one of low birth weight, prematurity, birth asphyxia and need for admission. SPSS version 25 was used in all analysis. Significance testing was set at p=0.05. Results: The women with preeclampsia were significantly heavier at booking (BMI 29.0±6.9 Kg/ m2 vs 25.0±5.2. p=0.005), have higher mean booking systolic blood pressure (122.±22.6 mmHg vs 111.5±12.7mmHg, p=0.003) and diastolic blood pressure ( 7 9 . 8 ± 1 4 . 3mm Hgvs 68.8±9.0mmHg, p

To present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low- and middle-income countries, for North-Central Nigeria.In this pilot study, we conducted clinical and echocardiography screening on a cross section of randomly selected secondary schoolchildren in Jos, North-Central Nigeria, from March to September 2016. For outcome classification into borderline or definite RHD, we performed a confirmatory echocardiography using the World Heart Federation criteria for those suspected to have RHD from the screening.A total of 417 secondary schoolchildren were screened, of whom 247 (59.2%) were female. The median age was 14 years (IQR: 13-15). Clinical screening detected 8/417 children, whereas screening echocardiography detected 42/417 suspected cases of RHD. Definitive echocardiography confirmed 9/417 with RHD corresponding to a prevalence of 21.6 per 1000 (95% CI, 6.7-36.5). All but one of the confirmed RHD cases (8/9) were borderline RHD corresponding to a prevalence of 19.2 per 1000 (95% CI, 8.3-37.5) for borderline RHD and 2.4 per 1000 (95% CI, 0.1-13.3) for definite RHD. RHD was more common in boys and cardiac auscultation missed over 50% of the cases.This study showed a high prevalence of RHD among secondary schoolchildren in North-Central Nigeria with a vast predominance of asymptomatic borderline lesions. Larger school-based echocardiography screening using portable or handheld echocardiography aimed at early detection of subclinical RHD should be adopted.Présenter des données épidémiologiques sur la cardiopathie rhumatismale (CR), la maladie cardiaque acquise la plus courante chez les enfants et les jeunes adultes dans les pays à revenus faibles et intermédiaires, pour le centre-nord du Nigéria. MÉTHODES: Dans cette étude pilote, nous avons effectué un dépistage clinique et échocardiographique sur un échantillon transversal d'élèves du secondaire sélectionnés aléatoirement à Jos, dans le centre-nord du Nigéria, de mars à septembre 2016. Pour la classification des résultats en CR limite ou définitive, nous avons effectué une échocardiographie de confirmation en utilisant les critères de la Fédération Mondiale du Cœur pour les personnes suspectées d'avoir une CR lors du dépistage. RÉSULTATS: Au total, 417 élèves du secondaire ont été dépistés, dont 247 (59,2%) étaient des filles. L'âge médian était de 14 ans (IQR: 13-15). Un dépistage clinique a détecté 8/417 enfants, tandis qu’un dépistage par échocardiographie a détecté 42/417 cas suspects de CR. L'échocardiographie a confirmé une CR définitive chez 9/417, correspondant à une prévalence de 21,6 pour 1000 (IC95%: 6,7 à 36,5). Tous les cas confirmés de CR sauf un (8/9) étaient limites, correspondant à une prévalence de 19,2 pour 1000 (IC95%: 8,3 à 37,5) pour une CR limite et 2,4 pour 1000 (IC95%: 0,1 à 13,3) pour une CR définitive. La CR était plus fréquente chez les garçons et l'auscultation cardiaque a manqué plus de 50% des cas.Cette étude a montré une prévalence élevée de CR parmi les enfants du secondaire dans le centre-nord du Nigeria avec une forte prédominance de lésions asymptomatiques limites. Un dépistage échocardiographique à plus grande échelle en milieu scolaire utilisant une échocardiographie portable ou manuelle visant à la détection précoce de la CR subclinique devrait être adopté.

Background There are few reports of the prevalence of CHD in the neonatal period in sub-Saharan Africa. The only available study in Nigeria was carried out before the widespread availability of echocardiography in the country. We sought to determine the prevalence and spectrum of congenital heart defects (CHD) among neonates in Jos, Nigeria. Methods This cross-sectional study enrolled neonates less than one week of age from the two largest hospitals and their immunisation centres. Relevant information was obtained and an echocardiogram was performed on each neonate. Results There were 3 857 neonates recruited over a two-year period; male-to-female ratio was 1.1:1. A total of 111 babies had CHD, with a prevalence of 28.8 per 1 000. Sixty-four neonates had mild CHD, with a prevalence of 16.6 per 1 000, while moderate and severe CHD were found in 27 (7.0 per 1 000) and 20 (5.2 per 1 000), respectively. Conclusions CHD is prevalent in Nigerian neonates and there is therefore a need for advocacy to improve access to its diagnosis at birth for appropriate management.

BackgroundEvents in pregnancy play an important role in predisposing the newborn to the risk of developing CHD. This study evaluated the association between maternal preeclampsia and her offspring risk of CHD.MethodsThis is a cohort study of 90 sex-matched neonates (45 each born to women with preeclampsia and normal pregnancy) in Jos, Nigeria. Anthropometry was taken shortly after delivery using standard protocols. Echocardiography was performed within 24 hours of life and repeated 7 and 28 days later. SPSS version 25 was used in all analyses. Statistical significance was set at pResultsCongenital heart disease (CHD) was observed in 27 (30.0%) of newborns of women with preeclampsia compared with 11 (12.1%) of newborns without preeclampsia (pConclusionCHD may be more common in newborns of women with preeclampsia underscoring the need for fetal and newborn screening for CHD in women with preeclampsia so as to improve their infant's well being.

Objectives To describe the fasting serum lipid and glucose profiles of HIV-positive Nigerian children and determine the prevalence and risk factors for dyslipidaemia and hyperglycaemia, which are risk factors for cardiovascular diseases. Methods This was a comparative cross-sectional study carried out at the Paediatric Infectious Disease Clinic (PIDC) of the Jos University Teaching Hospital (JUTH) for HIV-positive children and at two primary schools in Jos for HIV-negative children as controls. One hundred and forty-two HIV-positive children aged 6–18 years and an equal number of controls were studied by determining their fasting serum lipid and glucose levels. The prevalence of dyslipidaemia and hyperglycaemia was determined and their risk factors obtained using multivariate logistic regression. P values of less than 0.05 were considered statistically significant. Results Mean triglyceride levels were significantly higher in HIV-positive children compared with controls at 87.2 mg/dL (95% confidence interval [CI] 79.4–95.0) and 68.1 mg/dL (95% CI 62.5–72.7), respectively (P

>Background: Cardiovascular disease (CVD) is a major cause of death among adults worldwide. It is acknowledged that its risk factors have their roots in childhood. The present study evaluated CVD risk factors in primary school children in a Nigerian peri-urban setting.Methodology: This cross-sectional study was carried out in two primary schools in Jos South local government area, Plateau State, Nigeria. The 241 children studied were chosen using a systematic random sampling technique to select the children from each school. Pretested questionnaire was used to elicit the information on family characteristics and individual characteristics while standard anthropometric and laboratory procedures were used in evaluating the CVD risk factors.Results: Overall, 137 (56.8%) were females (M:F = 0.76), 151 (62.7%) were from the middle class, 59 (24.5%) from lower class while 31 (12.9%) were from the upper class. The overall prevalence of at least one cardiovascular risk factor was 54%. Sedentary lifestyle was the most common CVD risk factor in 32.4% of subjects followed by obesity (13.7%), adverse CVD event in family (11.6%), high low-density cholesterol (10.3%), high total cholesterol (TC) (9.1%), and hypertension (9.1% combine, 7.1% diastolic, and 5.8% systolic). Linear regression analysis showed that body mass index (BMI) for age (β = 0.41, P < 0.001), systolic blood pressure (BP) (β = 0.94, P = 0.03), diastolic BP (β =1.26, P = 0.01), and TC (β = 0.07, P = 0.04) significantly rise with age. BMI for age (P = 0.02) was significantly higher in female subjects compared with their male counterparts.Conclusions: From the findings of the present study, interventions related to modifiable risk factors, such as encouragement of physical exercise and sports in schools, healthy and prudent diet, and weight control programs should be undertaken early in life so as to help control the development of and the epidemic of CVD in later life.

Background: There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia. Methods: Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis. Results: Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18–40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80–3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70–2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32–2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10–1.78), and older age (HR, 1.02; 95% CI, 1.01–1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54–0.85) and female sex (HR, 0.65; 95% CI, 0.52–0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle–income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle–income countries. Valve surgery was significantly more common in upper-middle–income than in lower-middle– or low-income countries. Conclusions: Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle–income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes.

Background: Congenital heart disease (CHD) has been found to be more common in neonates with other congenital anomalies and may worsen prognosis. Early diagnosis and treatment of internal congenital anomalies including CHD will improve outcome and decrease neonatal mortality. This study determined the prevalence of CHD among neonates seen with external congenital anomalies in Jos, Nigeria. Materials and Methods: We performed complete physical examinations on 2,340 neonates delivered in two tertiary hospitals in Jos, Nigeria. We identified neonates with external congenital anomalies and determined the prevalence of congenital heart defects in them using echocardiography. Data were analysed using STATA 14.0. Results: External congenital anomalies were present in 49 of the 2,340 neonates recruited − prevalence of 20.9 per 1,000, with a male to female ratio of 1.1:1. Fourteen (28.6%) neonates were syndromic. CHD was present in 15 of 49 (30.6%) neonates studied– prevalence 30.6 per 100. The mean age of the parents with neonates who had external congenital anomalies and CHD was significantly higher than those without CHD. Conclusion: CHD frequently co-exists with external congenital anomalies especially in syndromic neonates. Hospital-based surveillance systems are needed to capture accurately both internal and external congenital anomalies to improve outcome in these group of neonates.

Background: Adverse Event Following Immunization (AEFI) is any unfavorable event occurring following vaccination related to the vaccine administration and or its handling. AEFI can lead to death or a life-threatening condition requiring hospitalization with or without permanent sequel. Hence, this study was conducted to determine the knowledge of AEFI among mothers of children aged 0–23 months, its prevalence and actions of mothers of following AEFIs. Methodology: This was a cross-sectional study conducted among 400 mothers of children aged 0–23 months between November 2017 and April 2018 using quantitative method of data collection. IBM SPSS version 20 was used for data analysis where chi square was used as a test of association a P-value of ≤ 0.05 considered statistically significant. Results: The mean age of the respondents in the study was 29.0 ±5.3 years with 222 (55.5%) demonstrating good knowledge of AEFI. The prevalence of AEFI was found to be 46.5% with fever as the most experienced AEFI accounting for 90.3% of all cases experienced followed by pain and swelling mentioned by 141 (75.8%) and 26 (14.0%) respectively. Only 26 (14.5) of the mothers were adjudged to have taken appropriate action following the experience of AEFI in their children. Appropriateness of actions taken by the mothers following the occurrence of AEFI was influenced by the mother’s employment status (COR = 3.84; 95% CI = 1.366–10.575; P = 0.007). Conclusion: This study has demonstrated a sub-optimal level of knowledge of AEFI among the mothers of children aged 0–23 months with a relatively high self-reported prevalence and poor level of appropriateness of actions taken following AEFI.

Rheumatic heart disease (RHD) is a major public health problem in resource-poor countries, especially in sub-Saharan Africa where about 1 million affected children between 5 and 14 years of age live with the disease. The aim of this paper is to review current knowledge on the clinical epidemiology of RHD in Nigeria, identify gaps, and suggest possible future directions. A systematic literature search was conducted using African Journal online (AJOL), Cinahl, Google Scholar, PubMed, and Web of Science. In PubMed, the following medical subject headings and free text terms were used: “Rheumatic heart disease” OR “Rheumatic “Valvular heart disease” OR “Rheumatic fever” AND “Nigeria”. The same text word search was used in Google scholar, AJOL, CINAHL, and Web of Science. A search date was limited to articles published from January 1950 to December, 2018. A total of 44 original studies were reviewed. Nineteen (45.2%) of the studies used clinical criteria for diagnosis of RHD, 19 (40.5%) used echocardiographic diagnosis, and 6 (14.3%) used autopsy or post mortem examination of the patients for the diagnosis of RHD. Five (11.9%) of the studies were conducted in children only, 9 (16.7%) were in both children and adults, and the remaining 31 (73.8%) were done in adults only. Only 6 (14.3%) of the studies reported complications seen in patients with RHD. Of the 6 studies that reported on complications, only 1 reported on recurrent of acute rheumatic fever. Mitral valvular disease was the most common lesion reported in all the studies. RHD still remains a major cardiovascular health problem in Nigeria. There is therefore a need for more recent clinical studies on the contemporary pattern of RHD in Nigeria. In addition, community based screening for RHD is needed to determine the true burden of the disease in Nigeria. Finally, primary and secondary preventive measures are needed to help reduce the burden of RHD in Nigeria.

Introduction and Objectives: Congenital heart disease (CHD) in children with Down syndrome is a common association. This study aims to describe the pattern of CHD and associated co-morbidities seen in children with Down syndrome in the Niger Delta Region of Nigeria. Materials and Methods: This was a descriptive cross-sectional study conducted in Uyo, Akwa Ibom State, during a cardiac mission. Children with phenotypic features suggestive of Down syndrome and a prior diagnosis of CHD had trans-thoracic echocardiogram performed by a team of paediatric cardiologists. The data were analyzed with STATA 14.0 Statistical package. Results: Thirty-five children with physical features suggestive of Down syndrome were seen, all of whom had CHD. They had a mean age of 5.8 months at diagnosis and 25.8 months at presentation. The most common heart defects detected were Atrioventricular septal defects in 28.6% of cases. The most common co-morbidity noted was heart failure in 17 (48.6%) of them followed by wasting in 15 (42.9%). Though 14 (40.0%) children were on a pulmonary vasodilator (sildenafil), only 5 (14.3%) children had features suggestive of pulmonary hypertension on echocardiography, all with atrioventricular septal defects (AVSD). Conclusion: AVSD is the most common CHD seen among children with Down syndrome in our study and is frequently associated with pulmonary hypertension.

Introduction: The APGAR score rapidly assesses the condition of the newborn at birth and is a predictor of neonatal mortality. Despite the fact that this scoring system is limited by inter and intra-observer variation, its knowledge is essential to residents involved in newborn care at delivery. This study was therefore carried out to determine the knowledge and application of the APGAR score by these residents. Materials and Methods: The questionnaire-based survey was conducted at the Jos University Teaching Hospital and administered to all consecutive residents in pediatrics, obstetrics and gynecology (O and G), anesthesia, family medicine and public health. Domains assessed both knowledge and application of the APGAR scoring system. Data analyzed with the Epi Info 3.5.1 and P < 0.05 was considered as statistically significant. Results: Of the 74 completed questionnaires, 21 were filled by Pediatric residents, 27 by O and G residents and 26 by other residents. Residents with 10-15 years of work experience had a significantly higher mean score on their knowledge compared with those with

Aims: Non-communicable diseases (NCDs) are becoming significant causes of morbidity and mortality. However very little information is available in our setting on the trend of NCDs in children. The aim is to determine the pattern and trend of NCDs in children in Jos, Nigeria. Study Design: This is a retrospective study of patients that were admitted and managed for NCDs. The relevant clinical information was extracted from the hospital records. Place and Duration of Study: The Emergency Paediatrics Unit (EPU) of the Jos University Teaching Hospital (JUTH), Jos Nigeria, between January 2012 and December 2015. Methodology: The study was a retrospective descriptive study where all records of children admitted into the EPU of JUTH within the period under review were retrieved. The bio-data of all patients and diagnoses made during the course of admission were documented. Those with inconclusive diagnoses and neonates were excluded. Data collected were entered into Epi Info version 7.2. The data was presented in frequencies and percentages and categorical variables were analyzed with the chi-square test. P value < 0.05 was regarded as statistically significant. Results: A total of 2273 children’s records were reviewed of which 36.7% had NCDs with the NCDs prevalence ranging from 29.5% - 40.5%. The three commonest NCDs were sickle cell disease (SCD), seizure disorder and severe protein energy malnutrition (PEM). There was a steady increase in the prevalence of seizures and PEM over the period. The prevalence of the diseases fluctuated over the years under review. Conclusion: The burden of diseases in children appears to be shifting towards non-communicable diseases as shown in the rising trend of NCD in our study. Therefore, there is an urgent need for relevant stakeholders to develop and ensure implementation of policies to curtail this menace which is also increasing the morbidity and mortality of children especially those less than five years of age.

Aims: To determine the incidence and severity of zidovudine -induced anaemia in HIVinfected children initiated on anti -retroviral therapy in Jos, Nigeria. Study Design: This was an observational cohort study. OriginalResearch Article

Background: Chronic kidney disease (CKD) affects multiple organs and is an established risk factor for cardiovascular disease and mortality. Impaired systolic function of the left ventricle is common in adult CKD patients. Objective: The main objective of the study is to determine the prevalence of left ventricular systolic dysfunction (LVSD) in children with CKD and its association with age, stage of disease, and history of dialysis. Subjects and Methods: This was a comparative cross-sectional descriptive study. Twenty-one children with CKD aged 3–14 years and an equal number of age- and gender-matched apparently healthy controls were recruited. Outcome Measures: LVSD was considered present when ejection fraction (EF)

Objective. The objective of this article was to compare the left ventricular (LV) systolic function of human immunodeficiency virus (HIV)-infected children with that of healthy controls, determine the prevalence of LV systolic dysfunction in HIV-infected children, and its association with age, stage of disease, and use of zidovudine. Study Design. This was a comparative cross-sectional descriptive study. Setting. A University Teaching Hospital in North-Central Nigeria in 2008. Patients. One hundred fifty HIV-infected children aged 6 weeks–14 years, and an equal number of age- and sex-matched apparently healthy controls. Outcome Measures. Left ventricular internal dimensions in diastole and systole, LV fractional shortening (FS) and ejection fraction (EF). Left ventricular systolic dysfunction was considered present when FS was

Aims Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. Methods and results This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent ( n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% ( n = 946) of patients with mechanical valves ( n = 501), AF ( n = 397), and high-risk mitral stenosis in sinus rhythm ( n = 48). However, only 28.3% ( n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12–51 years), only 3.6% ( n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries. Conclusion Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.

Background/Purpose: Neonatal morbidity and mortality contributes significantly to under.five morbidity and mortality in sub-Saharan Africa accounting for 40% of under-five mortality. A substantial reduction in neonatal mortality is therefore necessary to achieve the Millennium Development Goal (MDG) 4 target by 2015. The aim of the study was to assess the pattern of neonatal morbidity and mortality in our environment which will help to identify interventions for better neonatal outcome.Materials and Methods: The study is a review of cases admitted into the neonatal unit of the Jos University Teaching Hospital situated in the North Central part of Nigeria. The unit started operating from the permanent site of the hospital on 1 March 2010 after the relocation of the hospital from the previous site. Data on all neonates admitted into the neonatal unit from 1 March 2010 to 28 February 2011 were obtained from the various registers/records and analyzed. Data extracted included biodata, gestational age, birth weight, main diagnosis, duration of admission, etc., In addition, the outcomes (discharged/died) were documented. All statistical analyses were performed using two.sided tests. A P < 0.05 was considered statistically significant.Results: A total of 572 neonates were admitted, accounting for 54.6% of the 1047 pediatric medical admissions into the hospital. The main causes of admission were neonatal infections (37.1%), prematurity (20.1%), and birth asphyxia (11.5%). Out of the 572 neonates, 111 (19.4%) died. About three quarters (76.5%) of the mortalities occurred in the first week of life with 46.4% of these occurring in the first 24 hours (X2-20.2, P < 0.001). The common causes of mortality were prematurity (43.2%), , birthasphyxia (18.0%) and neonatal infections (17.1%)Conclusion: There is a high burden for neonatal care at the institution. The three main causes of morbidity and mortality are prematurity, infections, and birth asphyxia. Hence, neonatal care/facilities need to be improved especially to care for the high risk neonate. Also, the importance of infection control cannot be overemphasized.

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 a cross sectional studies among paediatricians attending the annual paediatric conference, using a self-administered questionnaire. Result: A total of 80 respondents, 33 consultants and 47 paediatric residents 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.

Background: Heart diseases of childhood are of public health importance, especially in developing countries. Community-based studies are important in ascertaining the burden of disease. We set out to clinically evaluate the prevalence of heart disease among primary school children in Hwolshe electoral Ward, Jos, Plateau State. Subjects and Methods: A total of 418 primary school pupils were selected by multistage sampling from three schools in Hwolshe ward of Jos South Local Government Area, Plateau State. They were studied for the prevalence of heart disease using clinical examination, followed by chest radiography, electrocardiography and echocardiography (echo) in those with clinical signs of heart disease. Results: The 418 subjects were aged 6-12 (mean 9.0 ± 1.95) years. 252 (55.5%) were girls. Significant tachycardia and pulse irregularity were present in 1 (0.24%) and 3 (0.72%) children respectively. None had hypertension - according to the seventh Joint National Committee criteria. 4 (0.96%) had audible murmurs of which 3 (0.72%) were pathologic. These three subjects were subsequently confirmed by echo to have congenital heart disease (CHD) - two ventricular septal defects and one atrial septal defect. The heart disease prevalence was therefore, 0.72%. All three identified cases of CHD had associated cardiac dysrhythmias: Wandering atrial pacemaker, first degree heart block, and incomplete right bundle branch block, respectively. No case of rheumatic heart disease was identified. Conclusions: Prevalence of heart disease by clinical screening in Jos South school children is approximately 0.72%. Careful cardiac auscultation as part of compulsory health screening at primary school entry and exit will help detect asymptomatic children with heart disease and facilitate treatment before the onset of complications.

Introduction: The human immunodeficiency virus (HIV) and drugs taken for this infection are known to cause QTc interval prolongation which in turn can lead to severe arrhythmias. The prevalence and associated factors of prolonged QTc in HIV-positive children in sub- Saharan Africa have not been described. Objectives: To compare the mean QTc interval and prevalence of QTc prolongation in HIV-positive children and HIV-negative controls, and to determine the factors associated with prolonged QTc in HIV-positive children. Methodology: In a cross-sectional comparative study, the corrected QT intervals (QTc) of 100 HIV-positive children were compared with those of age- and sex-matched HIV-negative healthy controls. QTc > 0.46 seconds was regarded as prolonged. Results: Subjects were aged 9 months to 14 years. Mean QTc was significantly longer-43.31 (95% CI 43.30, 43.32) seconds in HIV-positive children (62% of whom were on anti-retroviral therapy) compared with controls-41.43 (41.42, 41.44) seconds (P Conclusion: Mean QTc is significantly longer in HIV-positive children (especially those receiving ZDV or EFV), compared with controls. Prolonged QTc is also significantly more frequent in subjects. Baseline and periodic ECG screening of HIV-positive children may facilitate early detection of QTc prolongation and help prevent fatal arrhythmias.

Background: Increased left ventricular mass (LVM) and diastolic dysfunction are associated with higher morbidity and mortality among adult patients with human immunodeficiency virus (HIV) infection. Objective: The objective of the following study is to determine the prevalence of increased LVM and diastolic dysfunction in Nigerian children infected with HIV. Methods: Cross-sectional comparative study of LVM and left ventricular (LV) diastolic function of 150 HIV-positive children and controls asymptomatic for cardiac disease. Results: Mean LVM was larger in subjects than controls - 66.5 (95% confidence interval, 63.7-69.3) versus 56.9 (54.1-59.7) g/m 2 respectively - P Conclusion: Increased LVM and diastolic dysfunction are significantly more common in HIV-infected children compared with controls and occur in asymptomatic subjects.

Background: The patterns of childhood acquired heart diseases (AHD) vary in different parts of the world and may evolve over time. We aimed to compare the pattern of childhood AHD in our institution to the historical and contemporary patterns in other parts of the country, and to highlight possible regional differences and changes in trend. Materials and Methods: Pediatric echocardiography records spanning a period of 10 years were reviewed. Echocardiography records of children with echocardiographic or irrefutable clinical diagnoses of AHD were identified and relevant data extracted from their records. Results: One hundred and seventy five children were diagnosed with AHD during the period, including seven that had coexisting congenital heart disease (CHD). They were aged 4 weeks to 18 years (mean 9.84±4.5 years) and comprised 80 (45.7%) males and 95 (54.3%) females. Rheumatic heart disease (RHD) was the cause of the AHD in 101 (58.0%) children, followed by dilated cardiomyopathy (33 cases, 18.9%) which was the most frequent AHD in younger (under 5 years) children. Other AHD encountered were cor pulmonale in 16 (9.1%), pericardial disease in 15 (8.6%), infective endocarditis in 8 (4.6%) and aortic aneurysms in 2 (1.1%) children. Only one case each of endomyocardial fibrosis (EMF) and Kawasaki Disease were seen during the period. Conclusions: The majority of childhood acquired heart diseases in our environment are still of infectious aeitology, with RHD remaining the most frequent, particularly in older children. Community-based screening and multicenter collaborative studies will help to better describe the pattern of AHD in our country. More vigorous pursuit of the Millennium development goals will contribute to reducing the burden of childhood acquired heart diseases in the country.Keywords: Acquired heart disease, dilated cardiomyopathy, Nigerian children, rheumatic heart diseaseNigerian Medical Journal | Vol. 54 | Issue 1 | January-February | 2013