Burden and outcome of respiratory morbidities among children and adolescents with sickle cell disease-A retrospective review of emergency presentations in some Nigerian tertiary institutions.

BACKGROUND: Despite the huge burden of sickle cell disease (SCD) among Nigerian children, the burden and outcome of respiratory illnesses remain undocumented. Thus, we aimed to describe the spectrum and outcome of respiratory illnesses among SCD childrenand adolescentadmissions in ten Nigerian tertiary hospitals. METHOD: A retrospective review of the SCD admission records of children and adolescents with a confirmed diagnosis of respiratory illnesses from 2012 to 2021 in ten tertiary health facilities across five geopolitical zones in Nigeria was conducted. The data, collectedbetween March and June 2023, included the age, sex, diagnosis, complications, duration and outcome of hospitalization. RESULTS: Of the 72,333 paediatric admissions, 7,256 (10.0%) had SCD; the proportion of SCD from the total admission ranged from 2.1 to 16.3% in the facilities. Of the 7,256 children and adolescents with SCD, 1,213 (16.7%) had respiratory morbidities. Lower respiratory disease was the most common (70.0%) respiratory entity and the majority were pneumonia (40.1.0%), followed by acute chest syndrome (26.7%). Seventeen (1.4%) patients died; all had lower respiratory diseases [(acute chest syndrome ACS (11, 64.7%), pneumonia; 5, 29.4%, and asthma (1, 5.9%). Based on the proportion of deaths among overall SCD, the 17 death cases contributed 9.4% (95% CI 5.9 to 14.5). Factors associated with deaths included duration of hospitalization less than 72 hours and lower respiratory tract diseases. CONCLUSION: Sickle cell disease is a major contributor to hospitalization among Nigerian children and adolescents, with high respiratory morbidity and mortality. Pneumonia and acute chest syndrome were associated with mortality, andthe highest risk of death within the first 72 hours.

Hepatitis B vaccination status among health workers in Nigeria: a nationwide survey between January to June 2021.

BACKGROUND: Hepatitis B vaccination is the most important preventive measure against Hepatitis B viral (HBV) infection. Vaccination against HBV infection among healthcare workers is important because of their daily exposure to patients' body fluids and the possible risk of transmission to other patients. Hence, this study assessed the risk of hepatitis B infection, vaccination status and associated factors among healthcare workers in six geopolitical zones of Nigeria. METHODS: A nationwide cross-sectional study was conducted between January and June 2021 using electronic data capture techniques to enroll 857 healthcare workers (HCWs) in regular contact with patients and their samples through a multi-stage sampling method. RESULTS: The participants' mean (SD) age was 38.7 (8.0) years, and 453 (52.9%) were female. Each of the six geopolitical zones in Nigeria had a fair representation, with a range of 15.3 to 17.7% of the study population. The majority (83.8%) of healthcare workers in Nigeria knew that they were at an increased risk of being infected by their work. Also, 72.2% knew that if infected, there was a high risk of liver cancer in later life. Many participants (642 [74.9%]) responded that they consistently applied standard precautions, such as hand washing, gloves, and face masks while attending to patients. Three hundred and sixty (42.0%) participants were fully vaccinated. Of the 857 respondents, 248 (28.9%) did not receive any dose of the hepatitis B vaccine. Factors that were associated with not being vaccinated included age less than 25 [adjusted odds ratio (AOR) 4.796, 95% CI 1.119 to 20.547, p = 0.035], being a nurse (AOR 2.346, 95% CI 1.446 to 3.808, p = 0.010), being a health attendant (AOR 9.225, 95% CI 4.532 to 18.778, p = 0.010), and being a healthcare worker from the Southeast (AOR 2.152, 95% CI 1.186 to 3.904, p = 0.012) in Nigeria. CONCLUSION: This study showed a high level of awareness of the risks associated with hepatitis B infection and suboptimal uptake of the hepatitis B vaccine among healthcare workers in Nigeria.

Trends in pediatric tuberculosis diagnosis utilizing xpert Mycobacterium tuberculosis/Rifampicin in a poor-resource, high-burden region: A retrospective, multicenter study.

Background: The burden of tuberculosis (TB) in Nigeria remains high, and diagnosis in children, a challenge. We aimed to document yield from Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) as a mode of diagnosis for children and the variables associated with a positive result. Methods: This was a retrospective review of TB treatment cards of children aged 0-15 years managed from January 2017 to December 2021 across six public tertiary institutions in Nigeria. The data obtained were analyzed using the descriptive and inferential statistics. Statistical significance was set at P < 0.05. Results: Of 1489 children commenced on TB treatment, 1463 (97.9%) had sufficient data for analysis the median age of study participants was 60 months (interquartile range [IQR]: 24, 120), and 814 (55.6%) were males. Xpert MTB/RIF test was performed in 862 (59%) participants and MTB was detected in 171 (19.8%) participants, of which 6.4% (11/171) had RIF resistance reported. The use of Xpert MTB/RIF rose from 56.5% in 2017 to 64% in 2020 but fell to 60.9% in 2021. We found that older age (> 10 years), the presence of pulmonary TB (PTB), and a negative human immunodeficiency virus (HIV) status were associated with positive Xpert MTB/RIF tests (P = 0.002, 0.001, and 0.012, respectively). Conclusion: The utilization of Xpert MTB/RIF in children increased in the years before the COVID-19 pandemic. Factors associated with MTB detection by Xpert MTB/RIF include older age, the presence of PTB, and a negative HIV status. Clinical and radiological evaluation continues to play vital roles in the diagnosis of childhood TB in Nigeria.

Prevalence, Etiology, and Fatality Rates of Childhood Heart Failure in Nigeria: A Systematic Review and Meta-analysis.

Objectives: The objectives of the study were to describe the burden, etiology, and fatality rates of heart failure in Nigerian children. Methods: We searched PubMed database, Google scholar, TRIP database, EMBASE, African Index Medicus, and reference lists of selected articles for studies on burden, etiology, and fatality rates of heart failure in children in Nigeria published from 1977 to 2016. Two researchers reviewed the papers independently. Ten studies were selected that included 14,921 children and 1353 with heart failure. Results: The overall prevalence of heart failure using all the studies reviewed was 8.3% (95% CI: 4.9-12.6). The prevalence was 13.4% (95% CI: 10.9-16.3) in studies that excluded neonates and 4.5% (95% CI: 2.8-6.5) in studies that included neonates. The most common causes of heart failure were severe anemia (38.9%, 95% CI: 30.0-49.4), respiratory tract infections (32.4%, 95% CI: 25.5-39.7), congenital heart disease (8.4%, 95% CI: 6.8-10.2), and sepsis (7.6%, 95% CI: 3.0-14.0). The overall fatality rate was 16.0% (95% CI: 9.0 - 24.6) and was higher in studies that include neonates. Conclusion: Heart failure is common in children hospitalized in Nigeria. Its etiology is largely from non-cardiac conditions associated with severe hypoxia and mortality rates are high in children in Nigeria.

COVID-19 vaccine hesitancy in six geopolitical zones in Nigeria: a cross-sectional survey.

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

Assessment of the Timely Administration of Birth Dose Vaccines in Northern Nigeria and Associated Factors.

Background: Lack of a timely receipt of vaccines can cause uncertain immune response and under-vaccination. Hence, timely vaccination is crucial to ensure an infant's early protection. Objectives: To identify the age of presentation for the birth dose vaccines, vaccine antigens received and factors associated with vaccination presentation by day one in Northern Nigeria. Method: A descriptive cross-sectional study involving 1 952 mother-infant pairs enrolled from 5 different states in Northern Nigeria. Data was collected using a questionnaire including the socio-demographic, antenatal care (ANC), delivery details, birth dates, vaccination presentation and birth vaccine antigens received. Data analysis was done with the SPSS-21 software. Findings: The median age of the infants at presentation for birth vaccines was six (interquartile range 2-16) days. A total of 413 (21.2%) infants were brought by the day of birth (day 0) or the next day (Day one), while one-fifth (20.6%) presented after Day 28. The most frequently received antigen was the Bacille-Calmette-Guerin by 1 781 infants (91.2%), oral polio vaccine 1 703 (87.2%), and hepatitis B vaccine birth dose the lowest at 75.1% (1 565). The commonest reasons for delayed presentations were an ill baby (24.7%) and an ill mother (21.9%).Factors associated with presentation within Day one post-birth were hospital delivery (OR-1.67, 95% CI; 1.28-2.19), firstborn (OR-1.40; 95%CI; 1.02-1.93), Christianity (OR-2.14 95% CI; 1.63-2.81), and mother with tertiary education (OR-1.62, 95% CI; 1.05-2.48). Conclusion: Timely administration of the birth dose vaccines is low in Northern Nigeria. Furthermore, some babies do not get the required vaccines despite presenting for vaccination due to stockout. Strategies for early neonatal vaccination such as vaccination in hospital suites post-delivery and utilizing relatives/fathers to take the baby for vaccination when a mother is indisposed are imperative.

Willingness of Mothers to Receive Reminders for Routine Vaccination Appointments in Northern Nigeria: A Multi-Centre Cross-Sectional Study.

BACKGROUND: Routine 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. METHODS: A 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. RESULTS: Of 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). CONCLUSION: Eight 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.

Burden and spectrum of paediatric respiratory diseases at a referral hospital in North-Central Nigeria - A five year review.

INTRODUCTION: Globally respiratory diseases, comprising a broad range of disease conditions due to infectious and non-infectious causes, are a major cause of childhood morbidity and mortality. Thus, identification of the burden of respiratory illness will ensure appropriate interventions towards reducing its attendant morbidity and mortality. The study was conducted to identify the burden, spectrum and outcome of respiratory diseases in hospitalized children at University of Ilorin Teaching Hospital, North-Central Nigeria. METHODS: A retrospective descriptive cross-sectional study involving children admitted through the emergency paediatric unit over five years (January 2013-December 2017) was conducted. Data on demography, diagnosis, co-morbidities and complications, duration of admission, and outcome were collected and analyzed using SPSS 20. RESULTS: Of the total 7012 children admitted, 1939(27.7%) were due to respiratory diseases with a median age of 16 (interquartile range {IQR} 7-36) months. Males were 994(51.3%) and 945(48.7%) females. Infectious diseases were the most common cause of admission. Pneumonia (50.1%) and aspiration pneumonitis (5.1%) accounted for the highest admissions due to infective and non-infective respiratory diseases respectively. Overall, respiratory diseases accounted for 20.7% (119/574) of the overall mortality among all admissions while the all-respiratory disease mortality was 6.1% (119/1939). The major contributors to mortality were pneumonia, aspiration pneumonitis and tuberculosis accounting for 81(68.1%), 12(10.1%) and nine (7.6%) deaths respectively. The median duration of hospital stay was four days [IQR: 2 to 6 days]. A significantly higher proportion of the deaths occurred with four days of admission and 82.4% of the deaths occurred among those aged less than five years. A higher number of females (70, 58.8%) died compared to males (49, 41.2%), p=0.05. CONCLUSION: Pneumonia and aspiration pneumonitis are major contributors to morbidity and mortality due to respiratory diseases for which interventions towards improving childhood health indices should be prioritized.

Acceptability of Reminders for Immunization Appointments via Mobile Devices by Mothers in Ilorin, Nigeria: A Cross-sectional Study.

OBJECTIVES: Immunization coverage in Nigeria remains low despite the protection it confers. Reminders via mobile phones may be deployed as a means of improving vaccination coverage but requires the participation and cooperation of the caregiver. Therefore, we evaluated the acceptability of reminders for immunization appointment by mothers in Ilorin, Nigeria. METHODS: This descriptive cross-sectional study recruited 526 mothers from two public hospitals in Ilorin. Semi-structured questionnaires were used to collect information on ownership and access to phones, willingness to receive reminders, household, antenatal, and delivery characteristics. RESULTS: The majority (92.7%) of mothers had a personal phone, and all willingly provided contact details. Over half (69.0%) of mothers were willing to receive reminders. Postsecondary education (odds ratio (OR) = 1.958; 95% confidence interval (CI): 1.232-3.111) and antenatal care attendance by mothers (OR = 8.381; 95% CI: 2.495-28.170) were significant determinants of mothers willingness to receive reminders. Mothers with less than or equal to four children had a three-fold increased odds of wanting reminders. Artisan mothers were less likely to want reminders compared with unemployed mothers (OR = 0.506; 95% CI: 0.291-0.847). CONCLUSIONS: Most mothers are willing to receive reminders on immunization appointments via their mobile phone. Determinants of maternal willingness to receive reminders include mothers with less than four children, postsecondary education, and antenatal care attendance. Program planners should consider utilizing reminders as a strategy to increase the immunization uptake with access to contact details making this feasible.

Serum zinc levels in hospitalized children with acute lower respiratory infections in the north-central region of Nigeria.

BACKGROUND: Macronutrient deficiency has continued to attract significant research interest, where as the import of micronutrients like zinc has only recently become the focus of interest. Thus against the background of a dearth of data on zinc levels in Nigerian children with Acute Lower Respiratory Infection (ALRI), this study was carried out in Ilorin, Nigeria to determine the serum zinc levels in hospitalized children with ALRI. METHODOLOGY: A comparative cross-sectional hospital based study involving 120 children aged two months to five years with ALRI recruited as subjects, and 120 age-appropriate controls without ALRI was carried out. Socio-demographic, clinical and laboratory data were obtained. The serum zinc was analyzed with a Jenway™ spectrophotometer after an initial preparation with the QuantiChrom™ zinc assay kit. RESULTS: The male/ female ratio was 1.6:1. The mean (SD) serum zinc level in subjects with ALRI of 18.7(11.8)µg/dl was significantly lower than the corresponding value of 53.1(18.5)µg/dl recorded in the controls, p=0.001. The prevalence of 98.3% for low serum zinc levels recorded in children with ALRI was significantly higher than that recorded in controls of 64.2%, p=0.001. CONCLUSION: Low serum zinc levels are significantly associated with ALRI. There is a need to determine whether hospitalized children managed for ALRI might benefit from post discharge zinc supplementation.