The pattern of steroid sensitivity and steroid resistance in childhood idiopathic nephrotic syndrome: A 5-year retrospective observational descriptive study in a South-East Nigerian tertiary hospital.

Background/Aim: Nephrotic syndrome is the most common glomerular disease of childhood. Majority of the idiopathic cases frequently respond to steroid therapy and are regarded as steroid-sensitive nephrotic syndrome. Several studies have reported a change in this usual pattern to steroid-resistant nephrotic syndrome in Nigerian children. This study aimed to determine the pattern of steroid sensitivity and steroid resistance in childhood idiopathic nephrotic syndrome seen at a tertiary hospital in Enugu, south-east Nigeria. Materials and Methods: A retrospective study conducted in children with idiopathic nephrotic syndrome seen at the University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, over 5 years (from 2016 to 2020). The demographic variables, clinical data, and histopathological pattern were documented. Renal biopsies were studied by light microscope only. Results: Of a total of 150 patients, 105 (70%) were males, while 45 (30%) were females. Ninety six (64%) were aged 1-10 years. Fifty four (36%) were aged 11-18 years. Forty eight (32%) were aged 1-5 years. Mean age was 8.67 ± 4.69 years. One hundred and six (71%) initially had steroid-sensitive nephrotic syndrome; 12 (11.3%) and seven (6.6%) later became frequent-relapsers and steroid-dependent, respectively. Forty four (29.3%) had steroid-resistant nephrotic syndrome. Sixty eight had renal biopsy; the most common indication being steroid-resistance. The most common histological pattern was focal segmental glomerulosclerosis seen in 63.2% of these patients. Only four (9%) had renal transplant. Conclusion: Although the prevalence of steroid-sensitive nephrotic syndrome is higher in this clime, there is a rising incidence of steroid-resistant pattern attributed to incident cases of focal segmental glomerulosclerosis.

Percutaneous kidney biopsy and the histopathologic patterns of kidney diseases in children: An observational descriptive study at a South-East Nigerian tertiary hospital.

Background: Kidney biopsy remains the best standard for kidney tissue analysis. Although percutaneous kidney biopsy is an invasive procedure, it is an indispensable part of interventional nephrology for accurate diagnosis, selection of appropriate therapy protocol, and prognostication of kidney diseases in children. With improvement in expertise among pediatric nephrologists, data on procedure outcomes are now being documented. Aim: We aimed to describe the outcomes in a 5-year practice of kidney biopsy at the pediatric nephrology unit in a southeast Nigerian tertiary hospital. Patients and Methods: An observational descriptive study conducted on the kidney biopsy performed in our facility from 2017 to 2022. The focus was on the patients' clinical profile, indications for biopsy, the adopted procedure, and the histopathologic findings. Results: A total of 69 patients had kidney biopsy, 40 (58.0%) were males, while 29 (42.0%) were females. Sixty-four (92.7%) patients had the procedure at the age of >10 years, while five (7.2%) at the age of <7 years. The patients' prebiopsy mean systolic and diastolic blood pressures were 111.20 ± 16.93 and 74.64 ± 12.69 mmHg, respectively. Their estimated glomerular filtration rate (eGFR) was 119.27 ± 52.78 ml/min/1.73 m2. The most frequent indication was steroid resistance (39/69, 56.5%). Focal segmental glomerulosclerosis was the commonest histopathologic finding (38/69, 55.0%). Conclusion: Outcomes of percutaneous kidney biopsy at a Nigerian tertiary hospital are adjudged successful. The histopathologic patterns highlight FSGS as the major cause of steroid resistance in childhood nephrotic syndrome in this clime.

Left Ventricular Function and Geometry of Children with Chronic Kidney Disease (CKD) in a Resource-Poor Setting of Africa.

BACKGROUND: Chronic Kidney Disease (CKD) is a multisystemic clinical condition characterized by an irreversible deterioration of renal function that invariably progresses to end-stage renal disease (ESRD). Cardiovascular affectation portends morbidity and mortality in chronic kidney disease. OBJECTIVE: The aim of the study was to compare the prevalence of changes in function, and geometry of the left ventricle in children with CKD and their controls. METHODOLOGY: This was a descriptive cross-sectional study. Children aged 6 to 17 years with features suggestive of CKD along with age and sex-matched apparently healthy controls seen at the University of Nigeria Teaching Hospital, Enugu were enrolled consecutively. Blood samples werecollected for baseline investigations and e-GFR, followed by trans-thoracic two-dimensional echocardiography to assess the left ventricular function and geometry. Data was analysed using the statistical package for social sciences (SPSS) version 17.0. Simple frequencies and proportions, Student's t-test and chi-square were applied appropriately. P value at <0.05 was significant. RESULTS: Out of 9,419 children aged 6-17 years seen within the study period in the hospital, 24 met the criteria for CKD. The incidence rate was 5 cases per million child population per year. Mean age was 12.33 ± 4.24 years, with a male to female ratio of 2:1. Left ventricular hypertrophy (LVH), eccentric LVH and Left ventricular dilatation (LVD) were seen in 50.0%, 33.3% and 41.7% of subjects respectively. Left ventricular diastolic dysfunction and left ventricular systolic dysfunction occurred in 37.5% and 8.3% subjects, respectively. CONCLUSION: Prevalence of left ventricular geometry and function abnormalities was high in subjects. Intervention measures are advocated.

CONTEXTE: La maladie rénale chronique (MRC) est un état clinique multisystémique caractérisé par une détérioration irréversible de la fonction rénale qui évolue invariablement vers l'insuffisance rénale terminale (IRT). L'atteinte cardiovasculaire est un facteur de morbidité et de mortalité dans la maladie rénale chronique. OBJECTIF: Le but de l'étude était de comparer la prévalence des changements de la fonction et de la géométrie du ventricule gauche chez les enfants atteints d'IRC et chez les témoins. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive transversale. Des enfants âgés de 6 à 17 ans présentant des caractéristiques suggérant une IRC, ainsi que des témoins apparemment sains, appariés par l'âge et le sexe, vus au University of Nigeria Teaching Hospital, Enugu, ont été inscrits consécutivement. Des échantillons de sang ont été prélevés pour les examens de base et l'e-GFR, suivis d'une échocardiographie trans-thoracique bidimensionnelle pour évaluer la fonction et la géométrie du ventricule gauche. Les données ont été analysées à l'aide du progiciel statistique pour les sciences sociales (SPSS) version 17.0. Les fréquences et proportions simples, le test t de Student et le chi-carré ont été appliqués de manière appropriée. La valeur P à <0,05 était significative. RÉSULTAT: Sur les 9 419 enfants âgés de 6 à 17 ans vus à l'hôpital pendant la période d'étude, 24 répondaient aux critères de l'IRC. Le taux d'incidence était de 5 cas par million d'enfants par an. L'âge moyen était de 12,33 ± 4,24 ans, avec un rapport hommes/femmes de 2:1. Une hypertrophie ventriculaire gauche (HVG), une HVG excentrique et une dilatation ventriculaire gauche (DVG) ont été observées chez 50,0 %, 33,3 % et 41,7 % des sujets respectivement. Une dysfonction diastolique du ventricule gauche et une dysfonction systolique du ventricule gauche ont été observées chez 37,5 % et 8,3 % des sujets, respectivement. CONCLUSION: La prévalence des anomalies de géométrie et de fonction du ventricule gauche était élevée chez les sujets. Des mesures d'intervention sont préconisées. Mots clés: Fonction ventriculaire gauche, Géométrie ventriculaire gauche, Maladie rénale chronique, Enfants.

Modifiable Risk Factors for Chronic Kidney Disease in Adulthood seen among School Children in Asaba.

BACKGROUND: The burden of chronic kidney disease (CKD) is huge especially in developing countries like Nigeria. In Nigeria, treatment modalities for ESRD (renal replacement therapy) are not readily available and, where available, they are not affordable. Consequently, preventive nephrology aimed at early detection and prompt treatment of children with CKD risk factors has become the viable alternative in curbing this rising problem. AIM: To determine the burden of some modifiable risk factors for CKD in adulthood (hypertension, obesity, proteinuria, and microalbuminuria) among primary school children in Asaba and to ascertain if there is any association between the prevalence of such modifiable risk factors and socio-economic status (SES) or school type of the children. SUBJECTS AND METHODS: This is a cross-sectional descriptive study involving 400 primary school students in Asaba. Albuminspecific dipstick urinalysis was used to determine microalbuminuria while standard dip-stick urinalysis was used to determine proteinuria. Weight, height, body mass index (BMI) and blood pressure were measured for each child. RESULTS: Modifiable risk factors for CKD were found among primary school children in Asaba with prevalence rates of 3.5%, 9.8%, 17.3%, and 18.8% for hypertension, obesity, proteinuria and microalbuminuria respectively. Obesity and proteinuria showed significant linear trend with SES (p < 0.005 and P=0.004, respectively) and were significantly higher in those that attended private schools compared with public schools (P < 0.005 and P=0.004, respectively). The burden of hypertension and microalbuminuria among the children were not influenced by their SES (p =0.94 and P= 0.99, respectively) or the school type the children attended (P=0.35 and P=0.44, respectively). CONCLUSION: Obesity and proteinuria which are known risk factors for CKD in adulthood were noted mostly among children of high socioeconomic status.

CONTEXTE: Le fardeau de la maladie rénale chronique (IRC) est énorme, en particulier dans les pays en développement comme le Nigéria. Au Nigeria, les modalités de traitement de l'IRT (thérapie de remplacement rénal) ne sont pas facilement disponibles et, lorsqu'elles sont disponibles, elles ne sont pas abordables. Par conséquent, la néphrologie préventive visant à la détection précoce et au traitement rapide des enfants présentant des facteurs de risque d'IRC est devenue l'alternative viable pour enrayer ce problème croissant. OBJECTIF: Déterminer le fardeau de certains facteurs de risque modifiables d'IRC à l'âge adulte (hypertension, obésité, protéinurie et microalbuminurie) chez les enfants du primaire à Asaba et déterminer s'il existe une association entre la prévalence de ces facteurs de risque modifiables et la le statut économique (SSE) ou le type d'école des enfants. SUJETS ET MÉTHODES: Il s'agit d'une étude descriptive transversale portant sur 400 élèves du primaire d'Asaba. Une analyse d'urine sur bandelette réactive spécifique à l'albumine a été utilisée pour déterminer la microalbuminurie tandis que l'analyse d'urine sur bandelette réactive standard a été utilisée pour déterminer la protéinurie. Le poids, la taille, l'indice de masse corporelle (IMC) et la pression artérielle ont été mesurés pour chaque enfant. RÉSULTATS: Des facteurs de risque modifiables d'IRC ont été trouvés chez les enfants du primaire à Asaba avec des taux de prévalence de 3,5 %, 9,8 %, 17,3 % et 18,8 % pour l'hypertension, l'obésité, la protéinurie et la microalbuminurie respectivement. L'obésité et la protéinurie ont montré une tendance linéaire significative avec le SSE (p < 0,005 et P = 0,004, respectivement) et étaient significativement plus élevées chez ceux qui fréquentaient les écoles privées par rapport aux écoles publiques (P < 0,005 et P = 0,004, respectivement). Le fardeau de l'hypertension et de la microalbuminurie chez les enfants n'était pas influencé par leur SSE (p = 0,94 et P = 0,99, respectivement) ou le type d'école fréquentée par les enfants (P = 0,35 et P = 0,44, respectivement). CONCLUSION: L'obésité et la protéinurie qui sont des facteurs de risque connus d'IRC à l'âge adulte ont été notées principalement chez les enfants de statut socio-économique élevé. MOTS CLÉS: Hypertension, obésité, protéinurie, microalbuminurie, maladie rénale chronique.

Nocturnal enuresis in school-aged children with sickle-cell anemia: Any relationship with hyposthenuria?

BACKGROUND: Reports show that children with sickle-cell anemia (SCA) have a tendency for nocturnal enuresis when compared with their counterparts with normal hemoglobin. Although nocturnal enuresis in SCA has been attributed to several factors including tubular and even bladder dysfunction, its relationship with hyposthenuria has been questioned in some studies. AIM: The study aims to determine the relationship of hyposthenuria with nocturnal enuresis seen in school-aged children with SCA. SUBJECTS AND METHODS: A cross-sectional study of seventy school-aged children with SCA, who met the study criteria and seventy age- and gender-matched controls was conducted at the Sickle-cell Clinic, University of Nigeria Teaching Hospital in Enugu, Southeast Nigeria. The diagnosis of enuresis among the subjects and controls was based on the Diagnostic and Statistical Manual of Mental Disorders-IV criteria while urine specific gravity (USG) was determined on dipstick urinalysis. The frequencies of categorical variables were compared using Chi-square test or Fisher exact test as appropriate and the means of continuous variables with Student's t-test. The level of statistical significance was taken as P< 0.05. RESULTS: The prevalence of hyposthenuria was 4.5% and 8.3% among enuretic and nonenuretic subjects respectively, 6.7% and 10.9% among enuretic and nonenuretic controls and 4.5% and 6.7% among enuretic subjects and controls, respectively. The differences were not statistically significant. The mean ± standard deviation USG was significantly higher in the subjects than in the controls (1.02 ± 0.01 vs. 1.01 ± 0.01, P = 0.013) and enuretic subjects than enuretic controls (1.02 ± 0.01 vs. 1.01 ± 0.01, P = 0.007). The prevalence of nocturnal enuresis was significantly higher in male subjects compared to female subjects (odds ratio [OR] [95% confidence interval (95% CI)] =8.14 (2.12, 31.24), χ2 = 12.21, P< 0.001) and male controls (χ2 = 5.57, P = 0.018). Enuretic subjects had a significantly higher prevalence of parental history of childhood enuresis (OR [95% CI] =10.39 [2.45, 44.05], P< 0.002) than the enuretic controls. The relationship between the enuretic subjects and controls with respect to age of attainment of urinary control, family size, socioeconomic class, and sibling history of enuresis were not statistically significant. CONCLUSIONS: Nocturnal enuresis in children with SCA may not be related to hyposthenuria. However, male gender and parental history of childhood enuresis are significant risk factors.

Community-Acquired acute kidney injury in critically Ill children as seen in the emergency unit of a tertiary hospital in Enugu, Southeast Nigeria.

BACKGROUND: Acute kidney injury (AKI) has been shown to be common in critically ill patients with associated very poor outcome. There is paucity of data regarding its epidemiology, particularly in developing countries. This study aims to assess the presence of AKI among critically ill children to determine its prevalence, outcome, and outcome determinants in children suffering from AKI. PATIENTS AND METHODS: This is a cross-sectional observational study of critically ill children admitted to the children emergency unit of University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. Critically ill children suffering from AKI were identified and classified using the pediatric RIFLE criteria. RESULT: A total of 300 children were studied. One hundred and eighty (60%) were males. The prevalence of AKI in the study population was 56%. Factors associated with AKI included age <5 years (OR = 3.618; 95% CI = 2.100-6.235; P < 0.001), inability to drink (OR = 2.866; 95% CI = 1.723-4.766; P < 0.001), tachycardia (OR = 2.111; 95% CI = 1.071-4.163; P = 0.031), unconsciousness (OR = 3.128, 95% CI = 1.303-7.511; P = 0.011), and hypotension (OR = 2.619; 95% CI = 1.008-6.804; P = 0.048). The odds of death increased with increasing severity of AKI among those who had pRIFLE-F, who were 24 times more likely to die than those with no AKI (OR = 24.38; 95% CI = 5.702-104.194; P = 0.001). CONCLUSION: The prevalence of AKI in the study population was unacceptably high. The risk factors to its occurrence can be determined from epidemiologic and clinical data, and therefore, clinicians attending to critically ill patients should identify those with AKI for early intervention to reduce the expected poor outcomes associated with its occurrence.

Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu.

BACKGROUND: Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV-infected children. Malnutrition is prominent in HIV-infected children due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which result in poor intake, nutrient loss, and increased metabolic rate, respectively. OBJECTIVES: To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu. MATERIALS AND METHODS: The hematological and anthropometric indices of HIV-infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis. RESULTS: There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm 3 , platelets count 294 ± 78 × 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed, on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%). CONCLUSION: Hematological abnormalities and malnutrition occur in HIV positive children.

Urinary tract infection in febrile under five children in Enugu, South Eastern Nigeria.

BACKGROUND: Fever is a common symptom of urinary tract infection (UTI) in children less than 5 years of age. Little attention is however paid to UTI as a cause of fever in this age group. OBJECTIVE: The objective of the following study is to determine the prevalence of UTI in febrile children less than 5 years of age and relate it to demographic and clinical characteristics. MATERIALS AND METHODS: Urine specimen of febrile children aged 1-59 months obtained by suprapubic or midstream methods were analyzed using standard laboratory methods of microscopy, culture and sensitivity. RESULTS: A total of 200 children were enrolled; nearly 56% (112/200) were males. The mean age of the subjects was 31.14 ± 17.96 months. The prevalence of UTI was 11% and was significantly higher in females than in males ( P = 0.049). Children below 12 months of age had a higher rate of UTI than those 12 months and above ( P = 0.028). The common clinical features were vomiting, abdominal pain, diarrhea, urinary frequency and urgency but none had a significant association with UTI. CONCLUSION: UTI is common in febrile under-fives especially among females and infants. No association was apparent between the occurrence of UTI and clinical parameters.

Chronic kidney disease in children as seen in a tertiary hospital in Enugu, South-East, Nigeria.

BACKGROUND: The prevalence of chronic kidney disease (CKD) in children has been reported to be rising locally and globally. There is a dearth of data and inadequate facilities for the management of CKD in children in most of the developing countries like Nigeria. OBJECTIVES: The objective of this study is to ascertain the prevalence of CKD among children seen at University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria and also to determine the stage of CKD at presentation, possible etiology, treatment options offered and the outcome. MATERIALS AND METHODS: A retrospective review of pediatric ward admissions in UNTH over a 5 year period (July, 2007 to June, 2012) was done. Information, including the age at presentation, symptoms, level of renal function, management and outcome, were obtained from the medical case notes. RESULTS: There were 3002 pediatric admissions within the period of review, of which 98 (3.3%) had CKD, giving incidence of 3.0 new cases per million-child population per year and the prevalence of 14.9 per million children population. Majority (54.1%) of those with CKD were over 10 years of age. Edema, oliguria and hypertension were the most frequent clinical features. The most common etiology was glomerular disease (63.6%) and 44.9% presented in CKD stage 4 and 5. Renal replacement therapy (RRT) was offered to 25 (25.5%) of the patients; 6 (24%) of whom had hemodialysis and 3 (12%) had acute peritoneal dialysis while 16 (64%) were managed conservatively. None of the patients had chronic or adequate dialysis. The overall outcome showed that 8 (8.2%) died while on admission, 15 (15.3%) left against medical advice (discharge against medical advice) because of financial constraints and could not access the therapy, 25 (25.5%) were discharged on conservative management and lost to follow-up while another 50 (51.0%) were discharged and still on follow-up. CONCLUSION: CKD in children poses myriad of challenges in management in our setting with late presentation of patients and limited resources being prominent. The majority of patients could not access and sustain RRT and the outcome continues to be daunting.

Malaria diagnosis and treatment amongst health workers in University of Nigeria Teaching Hospital, Enugu, Nigeria.

BACKGROUND: Confirmation of malaria and appropriate treatment are keys to malaria control. OBJECTIVE: To determine the practice of malaria diagnosis and treatment in a Nigerian tertiary hospital. MATERIALS AND METHODS: Retrospective review of patients' records at the Children's Clinic in UNTH. RESULTS: Out of 6,684 children seen within the one year reviewed period, children diagnosed with malaria were 35.8 percent. Males were 60 percent and females were 40 percent. Children under five years were 72.6 percent of the total. Folders successfully traced were 1012; in 92 percent investigations for malaria were requested while 32 percent had differential diagnosis. Out of the 931 malaria investigations requested, 30 percent did the tests and positive results were 94.9 percent. Presumptive treatment was 98 percent. Majority (83.3%) received ACTs. CONCLUSION: The practice of presumptive treatment was high and few cases had a differential diagnosis. Training of health workers on the need to confirm malaria cases is required.

A variant of pentalogy of Cantrell in a live birth.

Pentalogy of Cantrell which usually comprises of anomalies of the ectodermal and mesodermal tissues is a very rare congenital condition which in the extreme of cases is incompatible with life. In this report a variant of the condition in a live newborn baby who presented to the University of Nigeria Teaching Hospital with abnormalities of the heart, urinary bladder and sternum is discussed. The aim of the report is to create an awareness and high index of suspicion amongst health professionals.

Diagnosis of malaria parasitemia in children using a rapid diagnostic test.

AIM: This cross-sectional study was conducted to evaluate the diagnostic performance of a new rapid immunochromatographic test named "Paracheck pf" in the diagnosis of malaria in Nigerian children. MATERIALS AND METHODS: A total of 380 Nigerian children aged between 6 and 59 months who presented at the University of Nigeria Teaching Hospital (UNTH) Enugu with fever and no obvious focus of any other infection were consecutively recruited. Malaria parasitemia was determined using simple microscopy and "Paracheck pf". RESULTS: "Paracheck pf" has the following diagnostic performance characteristics: Sensitivity of 82%, specificity of 91.5%, negative predictive value of 91.5%, positive predictive value of 82%, a strong positive correlation between parasite density and test sensitivity, and a detection limit of 397 parasites/µl. CONCLUSIONS: The test is, therefore, recommended for the use in Nigerian children aged between 6 and 59 months in Enugu for the diagnosis of malaria, but negative results should be cautiously interpreted in infants because symptomatic malaria may occur in these children at parasite densities as low as 100/µl.

Comparison of plasma electrolytes of perinatally asphyxiated and normal term babies.

OBJECTIVES: The objective of this study is to document and compare plasma electrolytes of asphyxiated newborns of different degree within 48 hours of life. STUDY DISIGN: A comparative cross-sectional study was conducted in the newborn special care unit at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Sodium, potassium, bicarbonate and ionized calcium levels were estimated in the plasma samples of neonates with perinatal asphyxia of different degree and healthy newborns (control group) within 48 hours of birth. MAIN OUTCOME MEASURES: The plasma sodium, potassium, bicarbonate and ionized calcium levels were estimated in both, the study subjects and controls. RESULTS: Mean plasma sodium level was significantly lower (134.93±5.24 mmol/l vs 141.90±3.36 mmol/l; P < 0.05), mean plasma bicarbonate level was significantly lower (16.98±3.99 mmol/l vs 18.54±2.36 mmol/l; P < 0.05), and mean plasma ionized calcium level was significantly lower (1.10±0.14 mmol/l vs 1.25 0.11 mmol/l; P < 0.05) in subjects compared to controls while mean plasma potassium was significantly higher (5.07±0.93 mmol/l vs 4.65±0.51 mmol/l P < 0.05) in subjects compare to controls. CONCLUSION: The tendency to have hyponatremia, hyperkalemia, acidosis and hypocalcemia is very high among the study subjects which underscores the need for great vigilance in electrolyte monitoring when managing an asphyxiated baby.

Rotavirus diarrhoea hospitalizations among children under 5 years of age in Nigeria, 2011-2016.

BACKGROUND: The high burden of rotavirus acute gastroenteritis (AGE) is well documented among children under 5 years of age, with the majority of mortality occurring in developing countries. Nigeria ranked second worldwide in the number of rotavirus deaths in 2013. As Nigeria plans to introduce rotavirus vaccine soon, a pre-vaccine documentation of rotavirus disease burden is necessary to determine vaccine impact. METHODS: Routine rotavirus surveillance was conducted during 2011-2016 in 3 sentinel sites in Nigeria using the standard WHO protocol. Children under 5 years of age hospitalized for acute gastroenteritis were enrolled and demographic, clinical and outcome data were collected. A stool sample was subsequently obtained and tested for human rotavirus antigen using the Enzyme-linked immunosorbent assay (ELISA). RESULTS: 2694 children with acute gastroenteritis were enrolled during January 2011 to December 2016; of these, 1242 (46%) tested positive for rotavirus. Among the rotavirus positive cases, 66% and 94% were younger than 12 months and 24 months respectively. Marked peaks in rotavirus positivity were seen in January of each year. Vomiting, and use of oral and intravenous fluids occurred more often in rotavirus positive cases as compared to rotavirus negative cases. CONCLUSION: The high prevalence of rotavirus disease highlights the need for urgent introduction of rotavirus vaccine in Nigeria. Additionally, this study provides pre-vaccine introduction disease-burden data that will serve as a baseline for rotavirus vaccine impact-assessment once vaccine has been introduced in the national immunization program.

Epidemiology of malaria in infancy at Enugu, Nigeria.

This was a retrospective study to ascertain the prevalence and clinical features of malaria in infants in Enugu between January 1998 and January 2000. Case notes of two thousand children were reviewed, one hundred and fifty-five (7.75%) had a diagnosis of malaria, with a male/female ratio of 1.2:1. The age range was two days to twelve months with a mean of 5.06 +/- 3.24 months. Nine infants (5.8 %) were less than seven days old. Ninety-nine of the patients (63.9%) had temperature > or = 37.5 degrees C. Diarrhea was a symptom in 52 (33.5%) patients, while vomiting alone or in combination with diarrhea was a presenting feature in 37 (23.87%) of the children. Twenty-eight children (18.1%) had respiratory symptoms of which, two had bronchopneumonia. Other associated illnesses included. septicaemia: 6(3.8%). infective diarrhea; 5(3.2%), and urinary tract infection; 4 (2.6%). Malaria is common in infants less than 6 months of age and associated with symptoms common with other childhood illnesses.

Compliance to correct dose of chloroquine in uncomplicated malaria correlates with improvement in the condition of rural Nigerian children.

Non-compliance to correct dosing is thought to be one of the main causes of treatment failure of chloroquine in the home management of childhood malaria. There are few studies of compliance to drugs used for tropical diseases. In order to study compliance in the rural setting, chloroquine syrup was packaged with a novel pictorial insert for compliance to correct dosing. Compliance was assessed in a field trial in September 1996-December 1997, involving 632 children with uncomplicated malaria in Udi local government area in Nigeria. Written informed consent was obtained from mothers/guardians before children were enrolled in the study. There were 3 arms to the trial: control villages (group I) received chloroquine syrup without further intervention, group II received a pictorial insert with chloroquine syrup, and group III received chloroquine syrup, the pictorial insert and verbal instructions. Each group was made up of 3 health centres. Compliance was assessed by volumetric measurement of the chloroquine syrup left in 30-mL bottles and by questionnaires administered to mothers/helpers of the children. Control villages recorded full compliance for 36.5 +/- 4.4% of the children, group II for 51.9 +/- 7.9% and group III for 73.3 +/- 4.2%. There was a significant correlation (P < 0.0001) between full compliance, improvement and time for improvement of the condition. This study is deemed important because it focuses on children, who bear the greatest burden of malaria. It is unique for introducing a pictorial insert that illiterate villagers, who may not understand the use of age or weight in drug dispensing, may utilize as a substitute.

Nephrotic syndrome in Nigerian children with homozygous sickle cell disease.

Two hundred and seventy two children with the nephrotic syndrome were seen and followed up at the Paediatric Renal Unit of the University of Nigeria Teaching Hospital, Enugu over 12 1/2 year period, between June 1983 and December 1995. Of these, there were nine (3.3%) children with homozygous sickle cell disease (SS). This latter group had a mean age of 9.6 +/- 3.2 years, male to female ratio of 1:2 and serum cholesterol of 3.13 +/- 1.48 mmol/l at the time of diagnosis. The mortality rate was 55.6% in these sicklers, death occurring within one and a half to five years of diagnosis. Causes of death were attributable to sickle cell disease in 60%, renal diseases in 20%, and other causes in 20%. Renal biopsy in two of the sicklers showed membrano-proliferative glomerulonephritis (MPGN) and focal glomerulosclerosis (FGS) respectively. Homozygous sickle cell disease does seem to predispose to the development of the nephrotic syndrome and those that do develop nephrotic syndrome exhibit some special characteristics, when compared to non-sicklers with nephrotic syndrome. These include older age of onset of the nephrotic syndrome, reverse sex ratios, lower serum cholesterol, higher mortality rate and sickle cell complications rather than chronic renal failure as the major cause of death.

Childhood nephrotic syndrome in Enugu, Nigeria.

In a prospective study spanning 12 1/2 years (July 1983 to December 1995), 272 children with nephrotic syndrome seen at the University of Nigeria Teaching Hospital Enugu, Nigeria, were followed up and reviewed at the end of the study period. The demographic, clinical and laboratory features, response to treatment and prognosis were documented. Nephrotic syndrome made up 1.34% of all paediatric admissions. There were 164 males and 108 females giving a male to female ratio of 1.5:1. The ages ranged from 2 to 16 years, with a mean of 7.9 +/- 3.4 years and peak age of 5-7 years. The major clinical features were generalized oedema (100%), hypertension (23%), fever (20%), oliguria (10%) and cough (7%). Haematuria was present in 26%, mean serum albumin was 16 +/- 5, 1 gm/L, serum cholesterol 9.53 +/- 1.6 mmol/L Malaria parasitaemia was present in 38.7% and 9 patients (3.3%) had sickle cell disease (SS). Treatment with diuretics, pooled plasma, prednisolone or cyclophosphamide in various combination achieved 63.9% remission. Mortality was 5.5% being mainly due to chronic renal failure, hypertension and infections. The study calls for more trials in the use of steroids and cyclophosphamide in the treatment of childhood nephrotic syndrome in the tropics.

Traditional healers in Nigeria: perception of cause, treatment and referral practices for severe malaria.

Malaria remains one of the main causes of mortality among young children in sub-Saharan Africa. In Nigeria traditional healers play an important role in health care delivery and the majority of the population depend on them for most of their ailments. The aim of this study was to investigate the perceptions of traditional healers regarding causes, symptoms, treatment of uncomplicated malaria and referral practices for severe malaria with a view to developing appropriate intervention strategies aimed at improving referral practices for severe malaria. A qualitative study was carried out in Ugwogo-Nike, a rural community in south-east Nigeria, which included in-depth interviews with 23 traditional healers. The traditional healers believed that the treatment of severe malaria, especially convulsions, with herbal remedies was very effective. Some traditional healers were familiar with the signs and symptoms of malaria, but malaria was perceived as an environmentally related disease caused by heat from the scorching sun. The majority of traditional healers believed that convulsions are inherited from parents, while a minority attributed them to evil spirits. Most (16/23) will not refer cases to a health facility because they believe in the efficacy of their herbal remedies. The few that did refer did so after several stages of traditional treatment, which resulted in long delays of about two weeks before appropriate treatment was received. The fact that traditional healers are important providers of treatment for severe malaria, especially convulsions, underlines the need to enlist their support in efforts to improve referral practices for severe malaria.

Caregivers's knowledge, attitude and practice on childhood malaria and treatment in urban and rural communities in Enugu, south-east Nigeria.

OBJECTIVE: To ascertain caregivers's knowledge, attitude and practice regarding malaria and treatment of children in rural and urban communities in Enugu, Nigeria. STUDY DESIGN: This was a cross-sectional study, and caregivers were selected by convenience sampling. METHOD: In total, 224 and 184 respondents were interviewed in paediatric outpatient clinics in rural and urban areas, respectively, using structured questionnaires. RESULTS: Most respondents in rural and urban areas has heard of malaria (99% urban, 74% rural; P < or = 0.05). Both groups were unaware of the particular susceptibility of children and pregnant women to the disease, and respondents preferred to use self-medication (urban 79%, rural 20%). The rural and urban caregivers were quite familiar with and used antimalarial drugs such as chloroquine (urban 23%, rural 15%) and sulphadoxine-pyrimethamine (urban 50%, rural 6%), although in inappropriate dosages. They were also aware of preventive measures against malaria such as insecticide-treated nets (urban 32%, rural 56%), but there was low usage in both communities (7 and 2%, respectively). CONCLUSIONS: Both rural and urban communities were aware of malaria as a disease, but practices were grossly inadequate. The provision of affordable healthcare facilities and the use of health education to change knowledge, attitude and practice will help meet the target goals of the 'Roll Back Malaria' campaign in the area.