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.

METABOLIC SYNDROME AND ASSOCIATED RISK FACTORS AMONG SECONDARY SCHOOL ADOLESCENTS IN NORTHEAST NIGERIA.

Introduction: Metabolic syndrome (MetS) is a cluster of risk factors that may predispose to cardiovascular diseases and type 2 diabetes mellitus. These risk factors include hypertension, central obesity, hyperglycaemia, hypertriglyceridemia and low high-density lipoprotein cholesterol (HDL-C). The presence of at least three of these risks factors defines MetS. Globally, MetS now affects children and adolescents with increasing obesity prevalence. This study determined the prevalence of MetS and associated risk factors among secondary school adolescents in Gombe Local Government Area(LGA), Northeast Nigeria. Methods: A cross-sectional study; 688 participants from 12 secondary schools in Gombe LGA, Northeast Nigeria. Data were obtained using structured questionnaire. Anthropometry and blood pressure were measured. Fasting plasma glucose, serum triglyceride and HDL-C were determined. Data were analysed using SPSS version 21. Result: The prevalence of MetS was 1.3%. Low serum HDL-C was the commonest risk factor. MetS was significantly higher in upper socio-economic class and private school participants. Lifestyle and family medical history were not significantly associated with MetS. Conclusion: This study showed that the prevalence of metabolic syndrome was low in the overall study population but high among centrally obese adolescents. Metabolic syndrome occurred in normal weight and underweight participants. Low HDL-C was the commonest risk factor for metabolic syndrome and lifestyle and family medical history were not associated with metabolic syndrome.

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

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

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

BACKGROUND: Routine vaccination, a cost-effective means of preventing deadly childhood disease, has a low coverage in Nigeria. The study assessed the willingness of mothers to receive reminder messages for routine vaccination appointments in Northern Nigeria. METHODS: A multi-centre cross-sectional study involving at least 363 mother-infant pairs per centre from five states in Northern Nigeria. Data collected include the socio-demographic details, responses on parental phone ownership, mothers' willingness to receive reminders for immunization appointments and the reminder type characteristics. Data analysis was done with SPSS. RESULTS: Of the 1952 mother-infant pairs, ownership of at least one household phone was 97.7%. In total, 1613 (82.6%) mothers were willing to receive reminders. A majority (62.2%) of mothers preferred phone calls. A day before the vaccination appointment was the preferred timing (78.1%), and the predominant communication language was the local language for each region.The odds of being willing to receive reminders were 3.1 times, 2.6 times and 1.8 times higher in those with no formal education, primary education and secondary education, respectively, compared with mothers with tertiary education, each p < 0.05. Mothers who delivered at home were significantly less likely to want reminder messages (p = 0.03). CONCLUSION: Eight of 10 women in Northern Nigeria are willing to receive a reminder for their child. The predominant mode of reminder preferred is phone calls using the local language. Deployment of mobile phone reminders strategy in Northern Nigeria as a means to improve vaccination uptake is feasible. The institution of this strategy can be in collaboration with service providers.

Haematological Profile of Children With Sickle Cell Anaemia in Steady State.

Introduction Sickle cell anaemia (SCA) is an inherited, autosomal recessive condition that results from a mutation in the ß-globin gene. Vascular occlusion is the underlying mechanism behind a myriad of complications encountered. This vascular occlusion is primarily caused by the increased tendency of red blood cells (RBC) to adhere to the vascular endothelium, and the activation of platelets and total leucocyte count (TLC), hence the need for a steady-state haematological profile in these patients. Method This was a cross-sectional study conducted over four months at a sickle cell clinic. Haemoglobin (Hb) concentration, haematocrit, platelet, TLC, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) of the subjects were recorded and analysed. Results Ninety-nine subjects aged 1-18 years were recruited for the study. There were 53 (53.5%) males. Leucocytosis was seen in 80 (80.8%), anaemia in 99 (100%), and thrombocytosis in 30 (30.3%) patients. The mean Hb, TLC and platelets were 7.9 ± 1.3g/dl, 14.3 ± 4.5 x 103/mm3 and 391.5 ± 182.6 x 103/mm3 respectively. Mean MCV, MCH and MCHC were 81.3 ± 7.1 fl, 28.6 ± 2.9 pg and 35.2 ± 1.7 g/dl respectively. Children aged one to four years had the highest TLC (p=0.002) but the lowest mean Hb and platelet (p=0.094 and 0.06) respectively. The mean MCV, MCH and MCHC were lowest in children aged one to four years (p=0.047, 0.001 and 0.001). Conclusion Anaemia, leucocytosis and thrombocytosis are characteristics features of children with SCA, especially in male and younger subjects. Although Iron markers are generally normal in children with SCA, those under the age of five years tend to have lower values.

Juvenile dermatomyositis in a 14-year old Nigerian girl.

Juvenile Dermatomyositis is a rare idiopathic autoimmune and inflammatory myopathy and vasculopathy whose hallmarks are symmetrical proximal muscle weaknesses and a characteristic rash. Only few cases have been reported in West Africa subregion. We present a 14-year old Nigerian girl with clinical and histopathologic features of definitive juvenile dermatomyositis based on EULAR/ACR classification criteria but probable Juvenile dermatomyositis according to Bohan and Peter criteria. The patient had normal aspartate and alanine aminotransferase levels. Creatine kinase, Lactate dehydrogenase and aldolase which are not available in our center could not be evaluated. There was remarkable clinical improvement 3 weeks after the onset of systemic corticosteroid therapy. Our case highlights that relying on these normal enzyme values, especially where muscle biopsy and EMG are not available as is the case in most centers in developing countries, would have resulted in missed diagnosis using Bohan and Peter criteria.