Determinants and outcomes of preterm births in Nigerian tertiary facilities.

OBJECTIVE: To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria. DESIGN: Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) Programme. SETTING: Data from births in 54 referral-level hospitals across Nigeria between 1 September 2019 and 31 August 2020. POPULATION: A total of 69 698 births. METHODS: Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality. OUTCOME MEASURES: Preterm birth and preterm perinatal mortality. RESULTS: Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years - adjusted odds ratio [aOR] 1.52, 95% CI 1.36-1.71; >35 years - aOR 1.23, 95% CI 1.16-1.30), no formal education (aOR 1.68, 95% CI 1.54-1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61-2.34) and no antenatal care (aOR 2.62, 95% CI 2.42-2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20-1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02-1.83), no antenatal care (aOR 2.74, 95% CI 2.04-3.67), earlier gestation (28 to <32 weeks - aOR 2.94, 95% CI 2.15-4.10; 32 to <34 weeks - aOR 1.80, 95% CI 1.3-2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54-36.33) were associated with preterm perinatal mortality. CONCLUSIONS: Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio-economic status.

Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals.

OBJECTIVE: To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria. DESIGN: A secondary data analysis using a cross-sectional design. SETTING: Referral-level hospitals (48 public and six private facilities). POPULATION: Women admitted for birth between 1 September 2019 and 31 August 2020. METHODS: Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model. MAIN OUTCOME MEASURES: Prevalence of PPH and maternal and neonatal outcomes. RESULTS: Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions. CONCLUSIONS: A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.

Relationship between ultrasound-measured spleen, liver and anthropometry of children living in a rural community in southwest Nigeria: a cross-sectional study.

BACKGROUND: Ultrasonography is noninvasive, relatively inexpensive and useful for resource-poor settings. US spleen and liver sizes have been observed to differ among populations, so there is a need for reference values for different geographic populations. OBJECTIVE: To describe the sizes of the spleen and liver of children living in a rural community in southwest Nigeria and assess the relationship between these measurements and the children's anthropometry. MATERIALS AND METHODS: We conducted a community-based cross-sectional study among 358 apparently healthy children ages 1-14 years. We obtained the participants' weights, heights, body mass index and body surface area. They underwent US imaging to obtain longitudinal measurements of their spleen and liver. We used independent t-test to compare means, and linear regression analysis to assess relationships between continuous data. The significance level was set as P < 0.05. RESULTS: There were more girls (181; 50.6%). Most children were ages 1-5 years (172; 48.0%). The body surface area had significantly strong positive relationships with US spleen size (r = 0.769; R2 = 0.592; P < 0.0001) and US liver size (r = 0.819; R2 = 0.671; P < 0.0001) but body mass index had weak positive relationships. CONCLUSION: This study contributes to data on US spleen and liver sizes of Nigerian children. The findings buttress observations that body surface area strongly correlates with US spleen and liver measurements. It is recommended that more studies be conducted among Nigerian children to generate a robust pool of data that are useful for creating homogeneous formulae to ease interpretation of US measurements of these intraabdominal organs.

Perceptions and Practice of Early Diagnosis of Sickle Cell Disease by Parents and Physicians in a Southwestern State of Nigeria.

BACKGROUND: Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries. The aim of this study was to assess the practice and perception of early SCD diagnosis among a group of parents and physicians in Nigeria. Patients and Methods. This was a cross-sectional descriptive study conducted to assess the opinions and practice of early diagnosis of SCD among 135 physicians caring for SCD patients and 164 mothers of children with SCD in a southwestern state of Nigeria. RESULTS: Most physicians 132 (97.8%) were aware of prenatal SCD diagnosis, but only 51 (37.8%) would recommend it. Most physicians 129 (95.6%) routinely recommend premarital SCD genetic counseling and testing, and 89 (65.1%) were aware of the national government newborn screening program but lesser proportion 75 (55.6%) were willing to recommend it. Amongst the mothers, 154 (94%) and 158 (96%) had encountered genetic counseling for SCD and were willing to offer newborn screening to their children, respectively. On the contrary, fewer mothers 42 (25%) were aware of prenatal SCD diagnosis, 28 (17%) were willing to partake in it, and 44 (26%) were undecided. There were discrepancies in the willingness by physicians to practice early SCD diagnosis and its uptake by mothers (p < 0.0001). The commonest reason given by both the physicians and mothers for not practicing SCD prenatal diagnosis was the high cost of the procedure. CONCLUSION: The perceptions and practice of early SCD diagnosis was suboptimal in the study locality. Scaling up awareness and universal coverage are required.

Evaluation of a Portable Haemoglobin Metre Performance in Children with Sickle Cell Disease and Implications for Healthcare in Resource-poor Settings.

BACKGROUND: Sub-Saharan Africa has the largest burden and worst outcome of sickle cell disease (SCD). This gloomy outlook has been attributed to the lack of use of simple and cost-effective measures for diagnosis and treatment of the disease. Although haematology analysers are the gold standard for accurate measurement of haemoglobin (Hb) concentration, they are often out of reach of most health facilities in resource-poor settings, thus creating a care gap. We conducted this study to examine the agreement between a point-of-care device and haematology analyser for determining the Hb concentration in children with SCD and its usefulness in resource-poor settings. METHODS: Ethylenediaminetetraacetic acid blood samples collected from participants were processed to estimate their Hb concentration using two devices (Sysmex KX21N haematology analyser and portable mission Hb device). The agreement between the two sets of measurements was assessed by the Bland and Altman method. RESULTS: The intraclass and concordance correlation coefficients were 0.854 and 0.936, respectively. Sensitivity and specificity were 84.2% and 98.6%, respectively. The positive and negative predictive values were 94.1% and 96.0%, respectively. The Bland and Altman's limit of agreement was -2.3 to 1.6 and the mean difference was -0.34 with non-significant variability between the two measurements (p = 0.949). CONCLUSION: Hb concentration determined by the portable testing system is comparable with that determined by the haematology analyser. We recommend its use as a point-of-care device for determining Hb concentration of SCD children in resource-poor settings where haematology analysers are not available.

Risk factors for delay in age-appropriate vaccinations among Gambian children.

BACKGROUND: Vaccination has been shown to reduce mortality and morbidity due to vaccine-preventable diseases. However, these diseases are still responsible for majority of childhood deaths worldwide especially in the developing countries. This may be due to low vaccine coverage or delay in receipt of age-appropriate vaccines. We studied the timeliness of routine vaccinations among children aged 12-59 months attending infant welfare clinics in semi-urban areas of The Gambia, a country with high vaccine coverage. METHODS: A cross-sectional survey was conducted in four health centres in the Western Region of the Gambia. Vaccination dates were obtained from health cards and timeliness assessed based on the recommended age ranges for BCG (birth-8 weeks), Diphtheria-Pertussis-Tetanus (6 weeks-4 months; 10 weeks-5 months; 14 weeks-6 months) and measles vaccines (38 weeks-12 months). Risk factors for delay in age-appropriate vaccinations were determined using logistic regression. Analysis was limited to BCG, third dose of Diphtheria-Pertussis -Tetanus (DPT3) and measles vaccines. RESULTS: Vaccination records of 1154 children were studied. Overall, 63.3% (95 % CI 60.6-66.1%) of the children had a delay in the recommended time to receiving at least one of the studied vaccines. The proportion of children with delayed vaccinations increased from BCG [5.8% (95 % CI 4.5-7.0%)] to DPT3 [60.4% (95 % CI 57.9%-63.0%)] but was comparatively low for the measles vaccine [10.8% (95 % CI 9.1%-12.5%)]. Mothers of affected children gave reasons for the delay, and their profile correlated with type of occupation, place of birth and mode of transportation to the health facilities. CONCLUSION: Despite high vaccination coverage reported in The Gambia, a significant proportion of the children's vaccines were delayed for reasons related to health services as well as profile of mothers. These findings are likely to obtain in several countries and should be addressed by programme managers in order to improve and optimize the impact of the immunization coverage rates.

Breastfeeding: Knowledge, Perception, And Intention to Practice Among Female Students of Tertiary Institutions in Ekiti, Southwest Nigeria.

INTRODUCTION: Breastfeeding is a public health practice that is critical for the survival of infants and young children. This study aimed at determining the knowledge, attitude, and future intention to breastfeed among female undergraduates in tertiary institutions in Ekiti State, Southwest Nigeria.Methodology: A prospective cross-sectional study was conducted among 1312 female students of the tertiary institutions in Ekiti State. By convenience sampling, female students were invited to participate in the study after giving verbal consent and those studying medical, nursing, and other courses allied to medicine were excluded. Internal consistency of the data obtained from this research instrument was determined using Cronbach's coefficient Alpha with a reliability value of 0.82. Data analysis was conducted using SPSS version 25. Descriptive as well as inferential statistics were computed. Results were summarized as frequencies and percentages. The differences in knowledge, attitude, and intention to practice breastfeeding as well as other responses among the participants were compared among age groups, faculties and the sources of information using Chi-square test. RESULT: Although 93% of the respondents agreed that breast milk is important for the development of the infant's brain thereby demonstrating good knowledge; 51.6% of the respondents demonstrated poor perception to breastfeeding believing breastfeeding makes the breast to sag while only 34% of the respondents indicated their intention to breastfeed their future babies. CONCLUSION: The intention to breastfeed among our study participants was poor. This study revealed the need to increase awareness about breastfeeding and its benefits among this huge population of future mothers.

Pattern of admissions and outcome in the children emergency department of a tertiary health institution in Southwestern Nigeria: A four-year review.

Introduction: Pediatrics and adolescents are susceptible to illnesses that often necessitate emergency attention. Morbidity and mortality from illnesses in these ages have attracted much interest globally, particularly in Africa. Knowledge of pattern and outcomes of admissions may guide policy and interventions especially in resource constrained settings. The study aimed to determine the pattern of admissions, outcomes and seasonal variations of conditions that presented at the children emergency of a tertiary health institution over a four-year period. Methods: A retrospective descriptive study of children emergency admissions from January 2016 to December 2019. Information obtained included age, diagnosis, month and year of admission, and outcome. Descriptive statistics were used to describe the demographic characteristics and Chi-squared test to assess their associations with the diagnoses made. Results: There were 3,223 admissions. There were more males (1866; 57.9%) and more toddlers (1181; 36.6%). The highest number of admissions were observed in the year 2018 (951; 29.6%) and during the wet season (1962; 60.9%). There was an overall mortality rate of 7%; complicated malaria, gastroenteritis and meningitis were the leading causes of death. Malaria (χ2 = 135.522, p value < 0.001), and gastroenteritis (χ2 = 130.883, p value < 0.001) were predominant among the toddlers while sepsis (χ2 = 71.530, p value < 0.001) and pneumonia (χ2 = 133.739, p value < 0.001) were more among the infants. Typhoid enteritis (χ2 = 26.629, p value < 0.001) and HIV (χ2 = 16.419, p value = 0.012) were commoner among the early adolescents. Conclusion: The major causes of death in the study area are preventable with more of these amongst the children under the age of 5 years. There are seasonal and age-related patterns to admissions and the need for policy formulations and emergency preparations to be tailored towards these observed patterns through the year.

Human milk banking acceptability among pregnant and nursing mothers in Southwest Nigeria.

Background: Human milk bank is a sustainable source of donor human milk (DHM) which is an acceptable alternative to the mother's milk and it is not routinely available in Nigeria, a multi-ethnically diverse country.The study aimed to assess the willingness to donate or accept human milk among pregnant women and mothers attending the antenatal, immunization, outpatient, under-five, and neonatal follow-up clinics in selected health facilities in Ekiti State, Southwest Nigeria. Study Design and Methods: A descriptive cross-sectional, mixed methods study design was used to collect data in selected health facilities in Ekiti State. Questionnaires and focus group discussions were used to collect quantitative and qualitative data respectively while data analysis was done using the IBM® Statistical Package for Social Science SPSS version 26® and thematic analysis respectively. Results: Of the 798 respondents, 529 (66.3%) and 626 (78.4%) did not know about wet nursing or human milk banking (HMB) respectively and 139 (17.4%) were willing to donate their breastmilk for a stipend. In the focus group discussion, 50% had heard about wet nursing but none heard about HMB. Maternal educational level had a significant impact on their willingness to donate or accept DHM (p < 0.00). Wholesomeness, cultural, and religious biases were major reasons affecting HMB acceptability. Conclusions: Awareness and perception of HMB are poor. Appropriate information, education, and counselling on HMB are needed to drive the adoption and establishment of HMB in Nigeria.

Knowledge and Willingness to Utilize Hepatitis B Preventive Measures among Pregnant Women in Ado-Ekiti, Southwest, Nigeria.

Introduction: Mother-to-child transmission remains an important mode of transmission of hepatitis B infection particularly in endemic areas. The knowledge and practices of pregnant women about mother-to-child transmission (MTCT) of hepatitis B virus (HBV) may influence the uptake of strategies to reduce mother-to-child transmission of infection. Objectives: This study assessed the knowledge and willingness to uptake hepatitis B virus infection preventive services among pregnant women in Ado-Ekiti, Nigeria. Methods: This was a cross-sectional study that involved 373 pregnant women at the Ekiti State University Teaching Hospital (EKSUTH) and Maternal Child Specialist Clinics, Ado-Ekiti, Nigeria. A structured questionnaire was used to assess their knowledge, practices, and perceptions about MTCT of hepatitis B infection. Results: Only 52.5% (196) of the respondents had good knowledge, although the majority 290 (77.7%) had heard of hepatitis B infection prior to the survey. Only 147 (39.4%) of the respondents had ever had hepatitis B screening. More persons with professional jobs had good knowledge about hepatitis B infection compared with other occupations (p < 0.001). However, more respondents aged 30-34 years had poor knowledge about hepatitis B infection compared with other age groups (p = 0.045). Respondents with good knowledge about hepatitis B infection were willing to uptake hepatitis B infection prevention services (p < 0.001). Conclusion: This study showed that respondents with professional jobs had good knowledge about hepatitis B infection and those who had good knowledge about the infection were willing to utilize hepatitis B preventive measures. Awareness of MTCT of HBV did not translate into good practice as only few respondents had screened for hepatitis B. There is a need to intensify education about modes of transmission of hepatitis B infection with an emphasis on promoting good preventive practices.

Blood pressure and electrocardiographic profile of children with sickle cell anaemia in steady-state and vaso-occlusive crisis.

Objective: To compare the cardiovascular features of patients with sickle cell anaemia (SCA) in steady-state with those in vaso-occlusive crisis (VOC) at the Wesley Guild Hospital (WGH). Design: A descriptive cross-sectional, matched, case-control study among children with SCA at the WGH, a tertiary health facility in southwest Nigeria. Setting: The participants were recruited from the children's emergency unit and paediatric haematology clinic of the WGH. Participants: Consisted of 93 children with VOC (cases) and 93 age and sex-matched in steady state (controls), aged 5 - 15 years. Main outcome measures: Cardiovascular parameters, including pulse rate, blood pressure, and electrocardiographic profile, were assessed and compared using the appropriate statistical tests. Results: The mean (SD) age of the cases and controls were 8.8 (3.2) years and 9.0 (3.1) years, respectively (p= 0.106). There was no significant difference in the mean height of the groups. The mean pulse rate, diastolic, systolic, and mean arterial pressures were significantly higher in the cases than in the controls. A significantly higher proportion of the cases than the controls also had a higher frequency of heart blocks, prolonged QTc interval, ST elevation or depression, and T wave abnormality (p = 0.018, 0.039, 0.041, 0.009, respectively). The prevalence of chamber enlargements was not significantly different between the two groups. Conclusion: Cardiovascular dysfunction is worse during VOC when compared with steady state. Physicians should look for these dysfunctions in SCA children with VOC to reduce mortality from the disease. Funding: None declared.

Incidence of Catastrophic Health Expenditures Amongst Hospitalized Neonates in Ekiti, Southwest Nigeria.

Background: Neonatal illnesses require huge spending due to prolonged hospital stay. The management of these illnesses is usually financed by individual families which in most instances are living below the poverty line. This healthcare financing method can readily push families into catastrophic spending on health. Aim: To ascertain the average cost of managing common neonatal illnesses and the financial burden, it constitutes to families in Ekiti State, southwest Nigeria. Methods: We conducted a cross-sectional study on the out-of-pocket spending involved in managing neonates admitted into and discharged from the SCBU of the Ekiti State University Teaching Hospital, Ado-Ekiti, southwest Nigeria. Data collected included the monthly family income, the money spent on drugs, laboratory investigations and the hospital bill using a purposely designed structured questionnaire. Healthcare spending greater than 10% of the overall family income was described as catastrophic health spending (CHS). Results: The medical bills for most (95%) of the 119 study participants were paid through the out-of-pocket means and 81.5% of the families spent more than 10% of their monthly earnings (CHS) to settle medical bills. Close to 50% of the families belonged to the lower social economic class. The median (IQR) duration of hospital stay was 2.75 days (3.0-8.0). The median (IQR) total expenditure was N24,500.00 (N13,615.00-N41,487.50). The median (IQR) expenditure for the treatment of prematurity was highest at N55,075.00 (USD 133.10) [N27,350.00 (USD 66.10)-N105,737.50 (USD 255.53)] and more than 60.5% of the expenses was on hospital utilities and consumables. The length of hospital stay showed a robust positive correlation with the total hospital bill (r = 0.576, P < 0.001). Conclusion: Neonatal illnesses put many households at risk of catastrophic health spending. There is need for increased government investment in health and extension of the health insurance scheme to all the citizens of the country.

Malaria prevention practices and malaria prevalence among children living in a rural community in Southwest Nigeria.

INTRODUCTION: Living conditions in most rural African communities favour malaria transmission and threaten global eradication. Prevention strategies and interventions such as the use of bed nets have reduced the prevalence of malaria. This study described the various methods employed to prevent malaria and their effects on malaria parasite prevalence among children living in a rural community in Nigeria. METHODOLOGY: A community-based cross-sectional study conducted among 357 children aged 1-15 years, in a Nigerian rural community. Data was analyzed using SPSS version 25. Chi-squared test of association with a level of significance of p < 0.050 was used. RESULTS: Only 110 (30.8%) participants owned mosquito nets. Mostly those from the high social class (45; 40.9%) used the nets, and these were mostly 'under-five' children. Thirty-six (10.1%) were routinely given antimalarial drugs for malaria prophylaxis. Also, 102 (28.6%), 151 (42.3%), 278 (77.9%), 99 (27.7%) and 15 (5.0%) children used insecticides, local herbs, window nets, outlet door nets and mosquito repellent creams respectively. None of the methods employed to prevent malaria had statistically significant effect on malaria parasite prevalence among participants (p > 0.050). CONCLUSIONS: Malaria prevention methods were mostly practiced by participants of the high social class while children under-five considerably used mosquito nets. This study highlights the need to address the socio-demographic imbalance regarding malaria preventive measures in the community where the study was conducted. There is also a need to regulate the use of antimalarial drugs for malaria prophylaxis in the rural community. These suggest that the current malaria prevention methods in the community be reviewed.

Towards malaria control in Nigeria: implications of the malaria parasite rate and spleen rate among children living in a rural community in southwest Nigeria.

BACKGROUND: The World Health Organization prioritizes malaria surveillance for accurate tracking of progress of intervention programmes. The malaria parasite rate (PR) and spleen rate (SR) are economical surveillance tools. There has been a global decline in the burden of malaria over the last decade, but most African countries, like Nigeria, have a slow rate of decline. There is a need for adequate malaria surveillance to guide malaria control strategies and policymaking. METHODS: A community-based cross-sectional study was conducted among 363 children ages 1-15 y in rural southwest Nigeria. The participants' PR was determined by microscopy and the SR was determined by palpation and ultrasonography. The associations between PR and SR and other covariates were assessed. RESULTS: The PR was 26.7% and the SR was 12.9%. There was no significant association between PR or SR across age groups, but low social class was significantly associated with PR (55 [33.5%], p=0.004) and SR (29 [17.3%], p=0.013). The odds of having splenomegaly doubled with malaria parasitaemia (odds ratio 2.03 [95% confidence interval 1.06 to 3.88). CONCLUSIONS: The PR and SR suggest that the study area is meso-endemic. The PR in the study area was almost equal across age groups; our findings suggest there may be a need for policy review to plan malaria intervention programmes and include older children, not just children <5 y of age. Routine malaria surveillance using simple tools such as the PR and SR are necessary for reviewing malaria control programmes in the community.

A ten-year review of neonatal tetanus cases managed at a tertiary health facility in a resource poor setting: The trend, management challenges and outcome.

BACKGROUND: Neonatal Tetanus (NNT) is a vaccine preventable disease of public health importance. It is still being encountered in clinical practice largely in developing countries including Nigeria. NNT results from unhygienic delivery practices and some harmful traditional cord care practices. The easiest, quickest and most cost-effective preventive measure against NNT is vaccination of the pregnant women with the tetanus toxoid (TT) vaccine. The case-fatality rate from tetanus in resource-constrained settings can be close to 100% but can be reduced to 50% if access to basic medical care with adequate number of experienced staff is available. MATERIALS AND METHODS: This retrospective study reviewed the admissions into the Special Care Baby Unit (SCBU) of the Ekiti State University Teaching Hospital, Ado-Ekiti from January 2011 to December 2020. The folders were retrieved from the records department of the hospital; Information obtained from folders were entered into a designed proforma for the study. RESULTS: During the study period, NNT constituted 0.34% of all neonatal admissions with case fatality rate of 52.6%. Seven [36.8%] of the babies were delivered at Mission home/Traditional Birth Attendant's place while 5 [26.3%] were delivered in private hospitals. Cord care was with hot water compress in most of these babies16 [48.5%] while only 9% of the mothers cleaned the cord with methylated spirit. Age at presentation of less than one week was significantly associated with mortality, same with presence of autonomic dysfunction. Low family socio-economic class 5 was significantly associated with poor outcome, so also maternal age above 24 years. CONCLUSION: This study revealed that neonatal tetanus is still being seen in our clinical practice with poor outcome and the risk factors are the same as of old. Increased public health campaign, promotion of clean deliveries, safe cord care practices, affordable and accessible health care provision are recommended to combat NNT scourge.

Paediatric hypopituitarism: a case report and management challenges in a resource poor setting.

Hypopituitarism, a deficiency of one or more of the hormones produced by the pituitary gland, is a rare disorder. It can be congenital or acquired. Case report on childhood hypopituitarism is rare in Nigeria. We present a 15-year-old boy, second of a set of twins, who presented with short stature and delayed puberty. Subtle difference in stature, was noticed on review of their childhood pictures by 2 years of age though disparity in stature became obvious to the parents at 6 years of age and it became embarrassing at 15 years of age when parents decided to seek medical attention. He was a product of term gestation with birth weight of 3.2kg; there was no history suggestive of birth trauma. Developmental milestone in the first two years of life was essentially normal like his unaffected twin brother. At presentation both height and weight were below 3rd percentile for age, he had a low blood pressure of 80/50mmHg, infantile male external genitalia with testicular volume of 2ml, bone age of 7 years, very low serum testosterone, growth hormone, adrenocorticotropic hormone, thyroxine, follicle stimulating hormone, leutenizing hormone, Cortisol and high thyroid stimulating hormone. He achieved remarkable improvement in physical activity, height, weight and hormonal profile within the first 7 months of hormone replacement therapy but could not sustain therapy because of financial constraint. Paediatric hypopituitarism is a rare and treatable disorder. Early presentation, diagnosis and appropriate hormone replacement therapy at affordable price is essential for survival and good prognosis.

A Ten-Year Review of the Pattern and Outcome of Childhood Diabetes in Two State Teaching Hospitals in South-West Nigeria.

BACKGROUND: Childhood diabetes mellitus is a poorly researched topic in Nigeria. Its contribution to morbidity and mortality is vague. This study intends to provide additional information to the background data in Nigeria and hopefully proffers strategies to improving the outcome of this disease. METHODS: This is a retrospective descriptive study of all children managed for childhood diabetes mellitus at the Ekiti State University Teaching Hospital (EKSUTH) and LAUTECH Teaching Hospital (LTH), South West Nigeria, over a 10 year period. Relevant information was obtained from the case notes of all affected children. Data obtained were analysed with SPSS version 20 software. RESULTS: A total of 20 children were treated for diabetes mellitus (DM); there were 7 (35.0%) boys and 13 (65.0%) girls giving a M:F ratio of 1.0:1.9. Age range at presentation was 5 to 16 years and the mean age at presentation was 12.7 ± 2.89 years. Diabetic ketoacidosis (DKA) was the most common form of presentation in 13 (65.0%). Most [18 (90.0%)] of the patients had type 1 DM. Type 2 DM and glucocorticoid-induced diabetes mellitus were recorded in a case each, Eighteen (90%)patients had not been previously diagnosed by any form of screening prior to their presentation and admission in the hospital. Seven (35.0%) of the patient's care were affected by parental financial constraints. Five mortalities were recorded and one left against medical advice while the majority [14 (70.4%)] were discharged well and alive. The association between the greater numbers of deaths recorded in children with financial constraints was statistically significant (p < 0.05). CONCLUSION: Type 1 DM remains the most predominant form of diabetes in children and most of the patients presented in DKA. The proportion of deaths in this study is unacceptably high. There is a need to proffer strategies for earlier detection and management of children with diabetes mellitus prior to the onset or development of DKA and there is a need to assist with the funding of the care of children with diabetes mellitus.

Neonatal Jaundice: Perception of Pregnant Women Attending Antenatal Clinic at a Tertiary Hospital in Southwest, Nigeria.

Background: Severe neonatal jaundice (NNJ) remains a leading cause of preventable brain damage, mental handicap, physical disabilities, and early death among infants. Methods: Using a descriptive cross-sectional study design, information was gathered using a structured, pretested questionnaire from 518 pregnant women who attended the antenatal clinic at a tertiary Hospital in Southwest Nigeria. Results: Most (77%) of the respondents have heard about NNJ prior the survey. Most respondents (69.5%) demonstrated poor knowledge of the causes of NNJ. The majority, 98.4% had good attitude toward treatment of NNJ. Most respondents (72.1%) demonstrated poor knowledge of the correct treatment of NNJ. A quarter of the respondents knew no danger sign of NNJ. Conclusion: There is serious knowledge gap among the respondents about the causes, treatment, dangers signs and complications of NNJ. There is need for increased awareness campaign using every available means of reaching women of reproductive age group to reduce the consequences of this common neonatal problem.

Presentation and outcomes of early and late onset neonatal sepsis in a Nigerian Hospital.

BACKGROUND: Neonatal Sepsis remains a major cause of morbidity and mortality in neonates despite great advances in antimicrobial therapy and life support measures. OBJECTIVES: To compare the aetiology, risk factors, presentation and outcomes of care between early onset neonatal sepsis (EOS) and late onset neonatal sepsis (LOS). METHODS: Bacterial isolates were identified using blood cultures and antibiotic susceptibility testing was done using disc diffusion method. The risk factors, clinical presentation, laboratory findings and neonatal outcomes of the babies with EOS were compared with LOS. Statistical significance was set at P <0.05. RESULTS: Neonatal Sepsis was responsible for 16% of Special Care Baby Unit (SCBU) admissions. Of the 72 babies with sepsis, 56 (77.8%) had EOS as against 16 (22.2%) who had late-onset sepsis. Low birth weight (p=0.01) and perinatal asphyxia (p=0.01) were significantly associated with EOS while for LOS, delivery outside the health facility (p=0.01) was the only significant risk factor. Respiratory distress was more significantly observed in EOS (p = 0.01). Neonatal deaths occurred in 32% of babies with EOS while all babies with culture positive LOS survived. CONCLUSION: Early onset neonatal sepsis is associated with high likelihood of neonatal mortality. Unsupervised delivery, birth asphyxia and low birth weight are risk factors associated with neonatal sepsis. Efforts to ensure supervised hospital delivery and improvement in neonatal resuscitation may reduce the incidence of neonatal sepsis and its attendant complications.

Acute hypervitaminosis A misdiagnosed as malaria in a 7-year-old Nigerian boy.

Vitamin A supplementation program where single high-dose vitamin A supplements are provided to the qualified (infants and children) at regular intervals is operational in Nigeria as a public health initiative to control vitamin A deficiency which is prevalent in our country in accordance with the WHO recommendations. Reports of symptomatic acute hypervitaminosis A are scarce. We report a case of acute hypervitaminosis A resulting from accidental ingestion of vitamin A supplement capsules. This is to reiterate the need for caregivers to keep drugs out of the reach of children. Clinicians should also have a high index of suspicion.