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.

Isolation and Identification of Pasteurella multocida and Mannheimia haemolytica from Pneumonic Small Ruminants and Their Antibiotic Susceptibility in Haramaya District, Eastern Ethiopia.

Background: Pasteurella species are frequently encountered as serious diseases in small ruminants. It is the main cause of respiratory pasteurellosis in sheep and goats of all age groups. Methods: The cross-sectional study was conducted from December 2022 to April 2023 in Haramaya district, eastern Ethiopia, to isolate and identify Pasteurella multocida and Mannheimia haemolytica and estimate their prevalence, associated risk factors, and antimicrobial sensitivity of isolates in small ruminants using a purposive sampling method. A total of 384 samples (156 nasal swabs from clinic cases and 228 lung swabs from abattoir cases) were collected. STATA 14 software was used to analyze the data. In addition, multivariable logistic regression analysis was performed to assess an association of risk factors. Results: Out of the 384 samples examined, 164 were positive for pasteurellosis, resulting in a 42.70% prevalence. Similarly, 63 (38.4%) of the 164 positive results were from nasal swabs, while 101 (61.6%) came from lung samples. M. haemolytica accounted for 126 (76.82%) of the isolates, while P. multocida accounted for 38 (23.17%). Of the 63 nasal swab isolates, 33 (37%) were from goats and 30 (42.8%) were from sheep. And 17 (10.89%) and 46 (29.58%), respectively, were P. multocida and M. haemolytica. Of the 46 (40%) of the 101 (44.3%) isolates of the pneumonic lung, samples were from goats, while 55 (48.47%) were from sheep. In this study, the risk factors (species, age, and body condition score) were found to be significant (p < 0.05). Pasteurella isolates evaluated for antibiotic susceptibility were highly resistant to oxacillin (90.90%), followed by gentamycin (72.72%), and penicillin (63.63%). However, the isolates were highly sensitive to chloramphenicol (90.90%), followed by tetracycline (63.63%), and ampicillin (54.54%). Conclusion: This study showed that M. haemolytica and P. multocida are the common causes of mannheimiosis and pasteurellosis in small ruminants, respectively, and isolates were resistant to commonly used antibiotics in the study area. Thus, an integrated vaccination strategy, antimicrobial resistance monitoring, and avoidance of stress-inducing factors are recommended.

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.

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.

Echocardiographic Findings of Covid-19 Patients in Canton Sarajevo During the Third Wave of the Covid-19 Pandemic.

Background: Increasing evidence indicates that COVID-19 may result in cardiac issues in certain individuals, such as myocarditis, arrhythmias, and heart failure. Ongoing research on echocardiographic manifestations is still limited. Objective: To investigate the incidence and patterns of left and right ventricular dysfunction in COVID-19 patients. Methods: This study retrospectively observed COVID-19 patients admitted to the Clinical Center of University of Sarajevo during the third wave, with a particular focus on cardiac evaluations. Results: Our patients, predominantely male 155 (72.4%), with a mean age of 66.2±11.4, having hypertension 86 (40.1%), diabetes mellitus 61 (28.5%), hyperlipidemia 144 (67.3%), were active smokers 87 (40.6%), had family history of cardiovascular diseases 123 (57.5%) and were COVID-19 positive 95 (44.4%), presented because of chest pain 78 (36.4%), dyspnea 103 (48.1%), palpitations 67 (31.3%), fatigue 106 (49.5%) and peripheral oedema 30 (14.0%). COVID-19 patients reported much higher symptoms of dyspnea (65 (68.4%) vs 38 (31.9%)) and fatigue (73 (76.8%) vs 33 (27.7%)) than COVID-19 negative patients. On the initial laboratory report, COVID-19 patients had a significantly (p<0.05) higher mean score of C-reactive protein (24.0±4.8 vs. 6.0±2.1), D-dimer (1.6±2.5 vs 0.8±0.6), ALT (94.8±17.2 vs 36.5±19.9) and creatinine (128.0±80.8 vs. 93.4±40.1) when compared to COVID-19 negative patients. COVID-19 patients had enlarged left atrium diametes (31.6±5.6 vs 27.5±5.3), enlarged left ventricular diameter both in systole (27.9±18.1 vs 23.3±16.3) and diastole (39.3±24.1 vs 34.9±22.7), reduced left ventricular ejection fraction (53.5±9.2 vs 59.8±4.3) and elevated right ventricular systolic pressure (37.0±16.4 vs 35.1±8.6). Conclusion: COVID-19 patients had enlarged left atrium, enlarged systolic and diastolic left ventricular diameter, reduced left ventricular ejection fraction and elevated right ventricular systolic pressure.

Foreign bodies in the aerodigestive tract: time for comprehensive preventive measures.

Background: Foreign body (FB) in the aerodigestive tract presents more commonly in children and remains a surgical emergency with potential for fatal complications. Objectives: To describe management and outcomes of aerodigestive FB managed at University of Ilorin Teaching Hospital (UITH) and proffer preventive measures. Methods: A 9-year retrospective review of all patients with foreign body in the aerodigestive tract managed between March 2011 and July 2020. Results: Sixty-six patients were studied. Median age was 9years with M:F ratio =1.6:1. FB was ingested in 38(57.6%) patients, aspiration occurred in 28(42.4%). Denture was most common FB 20(30.3%); plastic whistle/valve placed in dolls or football accounted for 4(6.1%). When ingested, FB was impacted in cervical 17(44.7%), upper thoracic 10(26.3%) and middle thoracic 2(5.3%) oesophagus. Oesophagoscopy was used in 30(8.9%) for retrieval. When aspirated, FB was located in the right bronchus 10(35.7%), left bronchus 7(25.0%), hypopharynx and trachea 2(7.1%) each, and cricopharynx 1(3.5%); no FB was found in 3(10.7%) patients. Direct Laryngoscopy was the method of retrieval in 3(10.1%) patients while others had rigid bronchoscopy. Mortality rate was 1.5%. Conclusion: Children are most vulnerable group. Preventive effort should include public health education and close monitoring of children by parents and care givers during play.

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.

Appraising Neonatal Morbidity and Mortality in a Developing Country Categorized by Gestational Age Grouping and Implications for Targeted Interventions.

Introduction: Despite the relatively higher neonatal morbidity and mortality in developing countries, there are limited data on the detailed analysis of the burden in Nigeria. With a database of over 14,000 admissions, this study presents a compelling picture of the current trends disaggregated by their gestational age groups. It provides unique opportunities for better-targeted interventions for further reducing newborn mortality in line with SDG 3, Target 3.2. Methods: This prospective observational study involved newborn babies admitted to the Neonatal Intensive Care Unit of the University of Ilorin Teaching Hospital, Kwara State, Nigeria, between January 2007 and December 2018. The outcome was the neonatal mortality rates. The exposure variables included birth weight, gestational age (preterm versus term), and clinical diagnosis. Frequencies were generated on tables and charts, and the trends or associations were determined. Results: Of the 14,760 neonates admitted, 9,030 (61.2%) were term babies, 4,847 (32.8%) were preterm babies, and in 792 (5%) of the admissions, the gestational ages could not be determined. Males constituted a higher proportion with 55.9%, and the total number of deaths in the study period was 14.7%. The mortality ratio was highest among babies with a birth weight of less than 1,000 g (38.0%) and gestational age of less than 28 weeks (65.5%). The trend analysis showed that the mortality rate decreased from 17.8 to 13% over the 12 years, p-value < 0.0001. For term babies, mortality decreased by 45%, from 15.7% in 2007 to 8.7% in 2018, while the decline in mortality for preterm babies was 28.4%, from 25.7% in 2007 to 18.4% in 2018. For both categories, p-values were < 0.001. Regarding morbidity in term babies, asphyxia occurred in (1:3), jaundice (1:5), sepsis (1:6), and respiratory disorders (1:6) of admissions. For mortality, asphyxia occurred in (1:2), sepsis (1:5), jaundice (1:8), and respiratory disorders (1:10) of deaths. The leading causes of morbidity among preterm babies were asphyxia (1:4), sepsis (1:5), respiratory disorders (1:9), and jaundice (1.10). For mortality, their contributions were asphyxia (≈1:2); sepsis (1:5); respiratory disorders (1:9), and jaundice (1:10). Conclusion: There was a marked improvement in neonatal mortality trends. However, severe perinatal asphyxia, sepsis, hyperbilirubinemia, and respiratory disorders were the leading conditions contributing to 75% of the morbidities and mortalities. Measures to further accelerate the reduction in neonatal morbidity and mortality are discussed.

Relationships between cardiovascular signs and neurological signs in asphyxiated neonates in Ilorin, North Central Nigeria.

BACKGROUND: Perinatal asphyxia is a condition associated with multiple organ dysfunctions inclusive of cardiovascular dysfunction. Neurologic predictors of survival have been studied, but little has been reported regarding cardiovascular signs and their role in determining outcome in asphyxia. OBJECTIVE: The study aimed to determine the relationship between cardiovascular signs and outcomes in asphyxiated newborns with hypoxic ischaemic encephalopathy. METHODS: This was a cross sectional study involving asphyxiated new-born babies recruited within the first 24 hours of life. Hypoxic ischaemic encephalopathy staging was done using Sarnat and Sarnat staging. All patients had a detailed cardiovascular examination on admission, after initial resuscitation (30 - 60 minutes) into admission, and were followed till final outcome: discharge or death. RESULTS: Eighty-five asphyxiated new-borns with HIE were studied over seven months. Abnormal cardiovascular-related signs identified in the patients included respiratory distress (64.7%), small volume pulse (57.6%), hypotension (52.9%), hypoxemia (48.2%) and shock (32.9%). Five babies died. None of the clinical signs had a significant relationship with mortality. CONCLUSION: Abnormal cardiovascular signs increased with the progression of HIE staging but had no relationship with mortality.

Effects of call reminders, short message services (SMS) reminders, and SMS immunization facts on childhood routine vaccination timing and completion in Ilorin, Nigeria.

BACKGROUND: Reminders via mobile devices deployed as short message services (SMS) or calls have been identified to be a useful strategy in improving routine immunization uptake in several countries. OBJECTIVE: To identify the timeliness of appointments with reminders (calls or SMS), SMS health education and the routine care, and the vaccination completion rates in Ilorin, Nigeria. METHOD: Mother-infant pairs presenting for the first vaccination appointment were randomized into four (three interventions, one control) groups, each consisting of 140 participants. Intervention groups were reminders via calls (A), SMS reminders (B), immunization fact SMS messages (C) and controls on usual care (D). Reminders were made a day before the appointment while SMS immunization facts were sent at five weeks, nine weeks and eight months. Appropriate timing was defined as the scheduled visit ±3 days. RESULTS: The immunization completion rates after the nine months' visit were 99.2%, 99.3%, 97% and 90.4% for Groups A, B, C and D respectively. Compared with controls, Group A had the highest odds [AOR 8.78 (6.10, 12.63)] of presenting at an appropriate time, followed by Group B [AOR 2.56 (1.96, 3.35)], then Group C [AOR 2.44 (1.87, 3.18)]. CONCLUSION: Reminders/SMS immunization facts improve vaccination completion rates.

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.

Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels.

OBJECTIVES: Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. METHODS: This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5-14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. RESULTS: Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). CONCLUSION: Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria.

Heiner Syndrome: An uncommon cause of failure to thrive.

Heiner syndrome (HS) is a rare hypersensitivity reaction of an infant or young child to cow milk proteins. It is a disease characterised by failure to thrive, respiratory symptoms like cough, dyspnoea, wheeze and rhinitis with accompanying chest infiltrates on chest radiograph; gastrointestinal symptoms like vomiting, diarrhoea; and anaemia. The non-specific nature of the disease can result in delayed diagnosis and treatment and central to the condition is hypersensitivity to cow milk proteins. Several cases have been reported worldwide but there has been no report of this condition in Africa. We highlight the case of a sixteen week old child seen in our facility with features typical of Heiner syndrome. Clinicians should have a high index of suspicion for this condition especially in children predominantly on infant formula.

Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine.

BACKGROUND: Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). METHODS: From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. RESULTS: A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. CONCLUSIONS: Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.

Reappraisal of respiratory syncytial virus as an aetiology of severe acute lower respiratory tract infections in children younger than 5 years in Nigeria.

BACKGROUND: Acute lower respiratory tract infections (ALRIs) especially severe ALRIs, constitute a global high burden of morbidity and mortality in children <5 y of age and respiratory syncytial virus (RSV) has been documented to a play a major aetiological role. However, Nigerian reports on severe childhood RSV ALRIs are rare and most reports are old. With recent advances in RSV preventive strategy, arises the need for a recent appraisal of RSV infection in children with severe ALRI. The current study thus set out to determine the prevalence of RSV infection among hospitalized children <5 y of age and describe the related social determinants. METHODS: We performed a descriptive cross-sectional study conducted over 1 y of 120 children, ages 2-59 months, diagnosed with ALRI. Relevant data were obtained and an antigen detection assay was used for viral studies. RESULTS: The prevalence of RSV infection was 34.2% and its peak was in the rainy months. The proportion of infants in the RSV-positive group was significantly higher than that in the RSV-negative group (82.9% vs 54.4%; p=0.002). These findings were largely consistent with those of earlier reports. CONCLUSIONS: RSV has remained a common cause of severe ALRI in infants, especially during the rainy months in Nigeria. It is thus suggested that more effort be focused towards implementing the current global recommendations for the prevention of RSV-associated LRI, particularly in infants.

Determinants of Timely Presentation for Birth Dose Vaccination at an Immunization Centre in North-central Nigeria.

BACKGROUND: Timely receipt of immunization is an essential prerequisite to ensure early protection of the child. However, a low proportion of children in Nigeria benefit from the timely administration of the birth dose vaccines. OBJECTIVES: These were identification of factors associated with timely presentation and reasons for presentation beyond 24 hours at an immunization centre in Ilorin, Nigeria. METHOD: A descriptive cross-sectional study involving 480 mother-infant pairs was conducted at an immunization centre. Socio-demographic, antenatal care (ANC) and delivery details, infant's birthday and day of presentation for vaccination were recorded. Logistic regression was used to identify factors associated with time to presentation within day one. FINDINGS: 239 (49.8%), 421 (87.7%) and 454 (94.6%) babies were vaccinated within days one, seven and 14 respectively. Post-secondary education level of mothers (OR = 3.60; 95% C.I: 1.30-9.91), antenatal care attendance (OR = 9.55; 95% C.I: 1.75-52.12), and hospital delivery (OR = 6.36; 95% C.I: 1.33-30.38) were associated with presentation within day one. Having correct knowledge of the immunization schedule increased the odds of early presentation by three times, p = 0.025. The commonest reason for presentation after day one for vaccination was weekend/public holiday delivery identified in 83 (35.2%) mother-infant pairs. CONCLUSION: Hospital delivery, attendance at antenatal care, postsecondary education and knowledge of the immunization schedule were factors associated with timely presentation for birth dose vaccination. Strategies to improve timeliness of the birth dose vaccination should target babies delivered outside the hospital as well as during weekends in the hospital. Also, inclusion of immunization into the health education curriculum of schools could be beneficial.

Efficacy of Artemisinin-Based Combination Treatments of Uncomplicated Falciparum Malaria in Under-Five-Year-Old Nigerian Children Ten Years Following Adoption as First-Line Antimalarials.

The efficacies of 3-day regimens of artemether-lumefantrine (AL), artesunate-amodiaquine (AA), and dihydroartemisinin-piperaquine (DHP) were evaluated in 910 children < 5 years old with uncomplicated malaria from six geographical areas of Nigeria. Parasite positivity 1 day and Kaplan-Meier estimated risk of persistent parasitemia 3 days after therapy initiation were both significantly higher, and geometric mean parasite reduction ratio 1 day after treatment initiation (PRRD1) was significantly lower in AL-treated children than in AA- and DHP-treated children. No history of fever, temperature > 38°C, enrollment parasitemia > 75,000 µL-1, and PRRD1 < 5,000 independently predicted persistent parasitemia 1 day after treatment initiation. Parasite clearance was significantly faster and risk of reappearance of asexual parasitemia after initial clearance was significantly lower in DHP-treated children. Overall, day 42 polymerase chain reaction-corrected efficacy was 98.3% (95% confidence interval [CI]: 96.1-100) and was similar for all treatments. In a non-compartment model, declines of parasitemias were monoexponential with mean terminal elimination half-life of 1.3 hours and unimodal frequency distribution of half-lives. All treatments were well tolerated. In summary, all three treatments evaluated remain efficacious treatments of uncomplicated malaria in young Nigerian children, but DHP appears more efficacious than AL or AA.

Left Ventricular Outflow Tract Thrombus in a Child with Dilated Cardiomyopathy: An Atypical Location.

Dilated cardiomyopathy (DCM) may be associated with formation of intracardiac thrombi which may embolize and result in life-threatening complications. We present a 19-month-old female child with DCM who presented with a right hemispheric cerebrovascular accident. Urgent echocardiography revealed poor left ventricular systolic function and a thrombus attached to the interventricular septum along the left ventricular outflow tract. There was resolution of the thrombus following the use of warfarin.

A systematic review of trends and patterns of congenital heart disease in children in Nigeria from 1964-2015.

BACKGROUND: Congenital heart diseases cause significant childhood morbidity and mortality. Several restricted studies have been conducted on the epidemiology in Nigeria. No truly nationwide data on patterns of congenital heart disease exists. OBJECTIVES: To determine the patterns of congenital heart disease in children in Nigeria and examine trends in the occurrence of individual defects across 5 decades. METHOD: We searched PubMed database, Google scholar, TRIP database, World Health Organisation libraries and reference lists of selected articles for studies on patterns of congenital heart disease among children in Nigeria between 1964 and 2015. Two researchers reviewed the papers independently and extracted the data. Seventeen studies were selected that included 2,953 children with congenital heart disease. RESULTS: The commonest congenital heart diseases in Nigeria are ventricular septal defect (40.6%), patent ductus arteriosus (18.4%), atrial septal defect (11.3%) and tetralogy of Fallot (11.8%). There has been a 6% increase in the burden of VSD in every decade for the 5 decades studied and a decline in the occurrence of pulmonary stenosis. Studies conducted in Northern Nigeria demonstrated higher proportions of atrial septal defects than patent ductus arteriosus. CONCLUSIONS: Ventricular septal defects are the commonest congenital heart diseases in Nigeria with a rising burden.