Gastrointestinal Bleeding in Children: The Role of Endoscopy and the Sheffield Scoring System in a Resource-Limited Setting.

Objective: To document the clinical presentation, endoscopic diagnosis, and Sheffield scores of children with gastrointestinal (GI) bleeding who were referred for endoscopy at the Lagos University Teaching Hospital. The participants who needed endoscopy based on clinical criteria and according to the Sheffield scores were also documented. Methods: This study analyzed the records of 111 children with GI bleeding retrospectively from January 2013 to January 2021, while 9 children were recruited prospectively from February 2021 to March 2022. Receiver operating curves and area under the curve were generated to test the ability of the Sheffield scores to predict rebleeds, mortality, and the need for endoscopic intervention for upper GI bleeds. Results: One hundred and twenty participants were recruited. Ninety-one (75.8%) presented with upper GI bleeding (UGIB), while 29 (24.2%) had lower GI bleeding (LGIB). Only 70 (58.3%) (53 UGIB and 17 LGIB) had endoscopy performed. For UGIB, 5 (9.4%) had no source of the bleeding identified at endoscopy, 12 (22.6%) had variceal bleeding, and 36 (67.9%) had nonvariceal bleeding. Colonoscopy revealed juvenile polyps in 5 (29.4%), indeterminate colitis in 5 (29.4%), ulcerative colitis in 4 (23.5%), Crohn's disease in 1 (5.9%), and hemorrhoids in 2 (11.8%) participants, respectively. The Sheffield score was ≥8 in 42 (46.1%) of the participants who presented only with UGIB (hematemesis and melena). The scores were significantly related to the type of bleeds, rebleeds, and deaths (P = 0.00). Conclusion: The clinical and endoscopic findings in this study are similar to those reported previously. The Sheffield scoring was useful in assessing Nigerian children. However, due to limited access and other restraints, endoscopy was not performed on all the study participants even when the scoring system was suggestive. The availability, and therefore, utility of GI endoscopy in this setting are still suboptimal. The need for the provision of adequate equipment and resources and the training of personnel is thus recommended.

Cholelithiasis in children and adolescents with sickle cell disease: Experience in a resource-limited setting.

Background: Sickle cell disease (SCD) remains prevalent in Nigeria and can be complicated by cholelithiasis even in children. There is still a dearth of knowledge about the occurrence of cholelithiasis in these children. The present study is aimed to determine the prevalence of cholelithiasis in pediatric SCD in Lagos and documents relevant socio-demographic and clinical correlates. Subjects and Methods: This was a cross-sectional study of children and adolescents aged 1-19 years with SCD attending the Paediatric Haematology Clinic of the Lagos University Teaching Hospital. One hundred and forty-seven children were consecutively recruited into the study over 3 months and they all had sonographic examination of the gall bladder. The association between cholelithiasis, sociodemographic data, clinical symptoms, laboratory parameters, and the use of hydroxyurea was also documented. Results: The median age (range) of the study participants was 9.0 (1-19) years and majority were males (59.9%). The prevalence of cholelithiasis was 13.6% and the condition was most prevalent in adolescents (21.4%) compared to the younger children (6.5%). All the children with cholelithiasis were asymptomatic. Age and the frequency of crisis were significantly associated with cholelithiasis on multivariate analysis (P = 0.03, 0.045, respectively). The use of hydroxyurea was not significantly related to the occurrence of cholelithiasis. Conclusion: The prevalence of cholelithiasis observed in this study is high. Routine screening of older children and adolescents with SCD, especially with the frequent crisis is suggested. Longitudinal studies to establish the relationship between hydroxyurea and cholelithiasis is also advocated.

Résumé Contexte: La drépanocytose (SCD) reste répandue au Nigéria et peut être compliquée par une cholélithiase même chez les enfants. Il y a encore un manque de connaissances sur la survenue de la cholélithiase chez ces enfants. La présente étude vise à déterminer la prevalence de la cholélithiase dans la drépanocytose pédiatrique à Lagos et documente les corrélats sociodémographiques et cliniques pertinents. Sujets et méthodes: ce était une étude transversale menée auprès d'enfants et d'adolescents âgés de 1 à 19 ans atteints de drépanocytose et fréquentant la clinique d'hématologie pédiatrique de Lagos Hôpital universitaire. Cent quarante-sept enfants ont été recrutés consécutivement dans l'étude pendant 3 mois et ils ont tous eu un examen échographique de la vésicule biliaire. L'association entre cholélithiase, données sociodémographiques, symptômes cliniques, laboratoire paramètres, et l'utilisation de l'hydroxyurée a également été documentée. Résultats: l'âge médian (intervalle) des participants à l'étude était de 9,0 (1­19) ans et la majorité étaient des hommes (59,9%). La prévalence de la cholélithiase était de 13,6% et la maladie était la plus répandue chez les adolescents (21,4%) par rapport aux enfants plus jeunes (6,5%). Tous les enfants atteints de cholélithiase étaient asymptomatiques. L'âge et la fréquence des crises étaient significativement associée à la cholélithiase sur l'analyse multivariée (P = 0,03, 0,045, respectivement). L'utilisation de l'hydroxyurée n'était pas significativement liées à la survenue de cholélithiase. Conclusion: La prévalence de la cholélithiase observée dans cette étude est élevée. Dépistage de routine les enfants plus âgés et les adolescents atteints de SCD, en particulier avec la crise fréquente, sont suggérés. Études longitudinales pour établir la relation entre l'hydroxyurée et la cholélithiase est également préconisée. Mots-clés: Adolescents, enfants, cholélithiase, Nigéria, drépanocytose.

Prevalence of and risk factors for hepatitis B and C viral co-infections in HIV infected children in Lagos, Nigeria.

INTRODUCTION: The study was carried out to determine the prevalence of and risk factors for hepatitis B and C viral co-infections in HIV infected children in Lagos. METHOD: A cross-sectional study conducted to determine the prevalence and risk factors for hepatitis B and C viral co-infection in children aged 2 months to 13 years. There were 187 HIV infected and 187 HIV naïve age, sex-matched controls. Blood samples of participants were assayed for the serologic markers [HBsAg, anti-HBc, and anti-HCV)] of HBV and HCV viral infections using the Enzyme-Linked Immunosorbent assay (ELISA) method. RESULT: The prevalence of HBV infection using HBsAg was 5.3% and 4.8% (p = 0.814), among HIV-infected and HIV naïve children respectively, while using anti-HBc the prevalence was 7.0% and 7.5% (p = 0.842) among HIV- infected and HIV naïve children respectively. The prevalence of HCV infection among HIV- infected and HIV naive children were equal to 0.5% (p = 1.000). There was also no significant association with the identifiable risk factors (sharing of a toothbrush, sharing of needles, incision marks/tattoo, hepatitis B immunization status, history of blood transfusion, previous surgical operation, sexual exposure/abuse, history of jaundice, and genital circumcision) and the HBV and or HCV status among both groups of children. History of sexual exposure/abuse and history of jaundice were however found to be predictors of the presence of HBsAg among HIV infected children only, using a binary logistic regression model. CONCLUSION: The prevalence of HBV and or HCV infection among HIV-infected children is similar to the prevalence among HIV naïve children, suggesting that HIV-infected children are not more predisposed to viral hepatitis than healthy children. Also, there was no significant difference in the prevalence of HBV infection irrespective of the use of HBsAg or anti-HBc.

Overweight and Obesity Among School-aged Children and Maternal Preventive Practices against Childhood Obesity in Select Local Government Areas of Lagos, Southwest, Nigeria.

BACKGROUND: Childhood obesity is an emerging epidemic in the developing countries, particularly in the urban settings. This study examines the prevalence of overweight and obesity among school-aged children and the maternal preventive practices against childhood obesity. METHODS: This is a cross-sectional study of school-aged children aged 6-13 years and mothers from two Local Government Areas of Lagos State, Southwest Nigeria. Multi-stage sampling technique was used to select study areas and participants, while data were collected using an interviewer administered questionnaire. The Body Mass Index (BMI) of children were determined using the World Health Organisation (WHO) 2007 reference charts. Chi-square test was used to analyze categorical variables and logistic regression analyses were conducted to determine the factors associated with the nutritional status and maternal childhood obesity preventive practices. All analyses were conducted using the Statistical Package for Social Sciences (SPSS) 21. RESULTS: In all, 440 children comprising of 232 boys (52.7%) and 208 girls (42.3%) were studied. Of these, 29 of the participants (6.6%) were overweight, while 39 of them (8.9%) were obese. Most of the children (71.2%) consumed root/tubers and processed cereals while 9 (0.02%) and (17) 0.04% consumed fruits and vegetables. BMI was only significantly related to child age and sex. In all, 243 mothers (55.2%) had good practices against childhood obesity. Levels of maternal preventive practices were not significantly associated with child BMI. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Overweight/obesity among school-aged children in Lagos is high. Only half of the mothers were involved in preventive practices against childhood obesity. There is need for continuous education and advocacy concerning healthy diet and other preventive strategies against childhood obesity in Lagos, and potentially other parts of the developing world.

Use of alarm features in predicting significant endoscopic findings in Nigerian patients with dyspepsia.

INTRODUCTION: Dyspepsia is prevalent in the community. Guidelines recommend early endoscopy in dyspeptic patients who are older than 55 years, or have alarm features. There is a lack of data on endoscopy in patients with alarm features in Nigeria. METHODS: A retrospective study of the endoscopic findings in adults with dyspepsia and alarm features, between August 1st 2017 and July 31st 2018 in Lagos, Nigeria. Data were analysed using Statistical Package for Social Sciences, version 23.0. The sensitivity, specificity, positive predictive value, and negative predictive value of the alarm features were calculated. RESULTS: One hundred and fifty-nine gastroscopies were performed during this period, mean age was 47.8 (±14.4) years, 49.1% were male. Dyspepsia was the commonest indication for endoscopy (80.5%), 60.2% of the dyspeptics had at least one alarm feature. The most frequent dyspeptic symptom was epigastric pain/burning sensation (75%), while the commonest alarm features were recent onset dyspepsia in a patient over 45 years (79%) and unexplained weight loss (28.6%). Endoscopy was normal in 26%. The most frequent significant endoscopic findings were gastritis (49%) and gastric ulcer (17%) and they were not associated with alarm features. Upper gastrointestinal bleeding, persistent vomiting and odynophagia were specific for significant endoscopic findings. The pooled sensitivity, specificity, positive predictive value, and negative predictive value of the alarm features were 65%, 49%, 71% and 41% respectively. CONCLUSION: Patients with dyspepsia and upper gastrointestinal bleeding, persistent vomiting or odynophagia, should be referred for prompt upper GI endoscopy.

Development of crohn's disease following treatment for juvenile idiopathic arthritis in a nigerian child: Case report and review of literature.

Juvenile idiopathic arthritis (JIA) and Crohn's disease (CD) are diseases that are rarely seen in the black African child. CD has been reported to occur following therapy with etanercept in JIA patients. We report the case of a Nigerian child with JIA who developed CD following treatment for JIA. A 9-year-old male with JIA was referred to the pediatric gastroenterology unit of the Lagos University Teaching Hospital on the account of chronic diarrhea with occasional passage of bloody stools. He had been on prednisolone and methotrexate which had controlled the joint flares. Colonoscopy revealed extensive colitis, ulcers, abscesses, and ileocecal disease. Histology confirmed the CD. In view of the unavailability of the recommended treatment, namely biologics in the country and financial constraints; steroids; and sulfasalazine were added to his treatment regimen, and subsequently, he has made significant clinical improvement.

Résumé L'arthrite idiopathique juvénile (AJI) et la maladie de Crohn (MC) sont des maladies que l'on observe rarement chez l'enfant noir africain. CD a été rapporté survenir après le traitement par l'étanercept chez les patients atteints d'AIJ. Nous rapportons le cas d'un enfant nigérian atteint d'AJI qui a développé un CD suite à traitement pour JIA. Un homme de 9 ans atteint d'AIJ a été dirigé vers l'unité de gastroentérologie pédiatrique de l'hôpital universitaire de Lagos lele compte de la diarrhée chronique avec passage occasionnel de selles sanglantes. Il avait pris de la prednisolone et du méthotrexate, qui avait contrôlé les fusées articulaires. La coloscopie a révélé une colite étendue, des ulcères, des abcès et une maladie iléo-colique. L'histologie a confirmé le CD. En vue de la indisponibilité du traitement recommandé, à savoir les produits biologiques dans le pays et contraintes financières; stéroïdes; et sulfasalazine ont été ajoutésson traitement, et par la suite, il a apporté une amélioration clinique significative.

Recurrent abdominal pain and upper gastrointestinal endoscopy findings in children and adolescents presenting at the Lagos University Teaching Hospital.

INTRODUCTION: Recurrent abdominal pain (RAP) is a common reason for referral to the paediatric gastroenterology unit and the attending physician needs to be able to rule out an organic cause when evaluating any child with this condition. The aim of this study was to describe the endoscopic findings in children who presented to the paediatric gastroenterology unit of the Lagos University Teaching Hospital (LUTH) with RAP. METHODS: This was a prospective descriptive study which was conducted from January 2015 to July 2018 at the Paediatric Gastroenterology unit of the department of Paediatrics and the endoscopy unit of the LUTH, Lagos, Nigeria. All children and adolescents ≤ 19 years old with recurrent abdominal pain who were referred for upper GI endoscopy during the study period, were recruited. Baseline sociodemographic data, dyspepsia and alarm symptoms if present were documented. Results of other investigations namely stool examination for ova, parasites, occult blood and faecal antigen for Helicobacter pylori and abdominal scan were also documented. RESULTS: A total of 113 children with recurrent abdominal pain was referred during the study period and 87 (76.7%) of them had upper GI endoscopy done. Out of the participants, 38(43.7%) were boys and 49(56.3) girls. Alarm features were present in 15(17.6%) and dyspepsia was seen in 22(25.3%) of the subjects. The main endoscopic findings were: gastritis in 39 (44.8%), gastric erosions in 14(16.2%), hiatus hernia in 7(8.1%), duodenitis in 6 (6.9%), gastric polyp in 4 (4.6%). CONCLUSION: Upper GI endoscopy remains an invaluable tool in the tool in evaluating RAP in children as it enables accurate diagnosis of GI causes of RAP. There is a need to advocate for easier access to this procedure in the developing countries.

Helicobacter pylori Infection in Malnourished Children in Lagos.

BACKGROUND/AIM: Helicobacter pylori infection is acquired in childhood, but there are conflicting reports on malnutrition and the infection. This study aimed to determine the prevalence of H. pylori infection among malnourished children and highlight the socioeconomic (SE) and clinical factors associated with the infection. METHODOLOGY: This was a descriptive cross-sectional study of 122 malnourished children and 120 healthy controls. Anthropometry was done for all the study participants, and the H. pylori status was determined with the use of monoclonal stool antigen test in all the participants. Logistic regression analysis was used to determine the factors that could predict the occurrence of the infection in the children. RESULTS: Seventy percent (70.8%) of the malnourished children had moderate malnutrition, whereas 29.2% were severely malnourished. The prevalence of H. pylori in the malnourished children was 22.8% compared to 32.5% in the controls (P = 0.09). The infection was most prevalent in toddlers (60.7%). The SE class was significantly related to the infection (P = 0.01) and about a fifth (21.3%) of the malnourished children who belonged to the low SE class were H. pylori positive compared to 9.2% of the controls. About 64.3% of the malnourished children with H. pylori infection had fever and 25.8% had diarrhea. Multivariate analysis showed that stunting was significantly related to the infection (P = 0.02). CONCLUSION: H. pylori infection was prevalent among the toddlers and was significantly associated with stunting in this cohort of malnourished children. Screening of children for the infection is still advocated, and infected children should be referred for appropriate treatment and follow-up. The relationship between SE class and the infection still requires further research.

Nutritional Assessment and Maternal Perception of Toddler Body Size using Toddler Silhouette Scale in Nigeria a Developing Country.

BACKGROUND AND OBJECTIVES: The toddler silhouettes scales have been validated in the caucascian population in developing countries but in the African population, the use of these scales is yet to be evaluated. The aim of this study was to determine the perception of mothers on the body size of toddlers using a validated scale in an African population. METHODS: This was a cross sectional study of 241 mothers and their toddlers. Study participants were recruited from the immunization and pediatric clinics. The mothers' perceptions of the body sizes of toddlers and their own child was determined with the use of a validated 7-scale toddler silhouette. Each mother also assessed their own child with the scale. Each child's anthropometry was documented. RESULTS: Majority of the mothers were able to correctly classify the underweight (95.0%) and overweight toddler silhouettes (95.7%). However, 30% of the respondents misclassified Silhouette 6 (overweight silhouette) as normal and 48.2% of the respondents misclassified a normal silhouette as underweight. The overall maternal accuracy in assessing their toddler size was 41.1%. There was a significant relationship between maternal accuracy and the maternal educational status, tribe, and toddler size. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Toddler silhouette scales is a quick way of assessing the body size of children and could be of significant use in the developing countries. There is a need for caregivers to accurately assess the body size of their children as this will significantly influence the food mothers will give their children and thus children's eventual growth and development.

Human immunodeficiency virus status in malnourished children seen at Lagos.

INTRODUCTION: Human immunodeficiency virus and protein energy malnutrition are still prevalent in Nigeria and the occurrence of the two conditions together confers a poor prognosis. The aim of this study was to determine the current categories of malnutrition amongst under-5 children in Lagos, document their HIV status and determine any peculiarities in the clinical features, haematological and some biochemical profile in these children. METHODS: The study was a cross-sectional study conducted at the Paediatric departments of the Lagos University Teaching Hospital and the Massey Street Children's Hospital, both in Lagos, over a 6-month period. All the subjects had anthropometry, HIV testing, full blood count and serum proteins done. The factors associated with HIV status were determined with the logistic regression analysis. RESULTS: Two hundred and fourteen (214) malnourished children ≤5 years, including 25 (11.7%) with HIV were recruited in the study. Among the study participants, 150 (70.1%) and 54 (29.9%) had moderate and severe malnutrition, respectively. Fever, cough and diarrhea were the most common symptoms in the study participants. The haematological indices were comparable in the two groups, the serum globulin levels though higher in the HIV infected group was not statistically significantly different from the non-infected group.(p = 0.66). None of the factors explored on multivariate analysis was able to predict the occurrence of the infection in this cohort. CONCLUSION: Malnourished children remain a high risk group for HIV infection and the prevalence of the infection obtained in this group of children is still unacceptably high. Discriminatory features between malnutrition and HIV remains difficult. The presence of hyperglobulinaemia on laboratory analysis in a malnourished child may heighten the suspicion of possible underlying associated HIV infection. Screening of malnourished children for HIV infection and further longitudinal studies on malnourished children with HIV is advocated.

Complementary Feeding Knowledge, Practices, and Dietary Diversity among Mothers of Under-Five Children in an Urban Community in Lagos State, Nigeria.

BACKGROUND AND OBJECTIVES: Inappropriate complementary feeding is a major cause of child malnutrition and death. This study determined the complementary feeding knowledge, practices, minimum dietary diversity, and acceptable diet among mothers of under-five children in an urban Local Government Area of Lagos State, Southwest Nigeria. METHODS: This descriptive cross-sectional study was conducted in Eti-Osa area of Lagos State, Nigeria. Multi-stage sampling technique was employed to select 355 mothers and infants. Data was collected using a pre-tested interviewer administered questionnaire and 24-hour diet recall was used to assess dietary diversity. Data was analyzed using Epi-Info. RESULTS: Knowledge of complementary feeding was low (14.9%) and was associated with older mothers' age, being married, and higher level of education. The prevalence of timely initiation of complementary feeding (47.9%), dietary diversity (16.0%) and minimum acceptable diet for children between 6 and 9 months (16%) were low. Overall, appropriate complementary feeding practice was low (47.0%) and associated with higher level of mothers' education and occupation. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Complementary feeding knowledge and practices were poor among mothers of under-5 especially the non-literate. Reduction of child malnutrition through appropriate complementary feeding remains an important global health goal. Complementary feeding education targeting behavioral change especially among young, single and uneducated mothers in developing countries is important to reduce child morbidity and mortality.

Irritable bowel syndrome in adolescents in Lagos.

INTRODUCTION: irritable bowel syndrome (IBS) is one of the functional gastrointestinal disorders (FGIDs) which has been well described in western populations especially as the commonest cause of recurrent abdominal pain The aim of this study was to document the prevalence of Irritable bowel syndrome (IBS) amongst children in western Nigeria and increase the aware ness of IBS amongst physicians who manage children with abdominal pain. METHODS: This was a cross-sectional study conducted amongst children aged 10-18 years in 8 schools located in two local government areas of Lagos state. A multistage stratified random-sampling survey was conducted using the validated Rome III criteria to assess for IBS and associated risk factors. The subtypes of IBS and associated extra-intestinal symptoms were also documented. RESULTS: The prevalence of IBS was 16.0% in the study participants and the prevalence decreased with increasing age (p=0.05). Sixty two (62.5%) of the students with recurrent abdominal pain had IBS. IBS was more prevalent in the females compared to the males (p=0.000). The significant risk factors for IBS identified were gender (p=0.000), socioeconomic status (p=0.001) and past history of gastroenteritis (p=0.011). The commonest subtype of IBS seen was the alternating subtype. CONCLUSION: IBS is prevalent in African children. Physicians who attend to children need to have a high index of suspicion for IBS in children who present with abdominal pain when there are no alarm symptoms. The need for further longitudinal studies in African children cannot be overemphasized.

What do medical interns in Nigeria think of the white coat? A cross sectional study.

BACKGROUND: The appeal of the white coat to both the doctors and the public is waning. In most developing countries such as Nigeria doctors' view of the white coat is not known. OBJECTIVE: To determine the proportion of interns which supported wearing of white coat by doctors. METHODS: A 10-item questionnaire was distributed to medical interns undertaking mandatory pre-registration training in a tertiary hospital. Characteristics of interns who were supportive of doctors wearing the white coat were compared to those who did not support or were indifferent to it. RESULTS: Two hundred and thirty three interns returned completed questionnaires. About 54% (126) and 52% (107) of the participants were males and graduates of the College of Medicine, University of Lagos respectively. The majority of interns (167; 71.7%) supported the wearing of white coats by doctors when attending to patients; 22 (9.4%) were opposed to it while 44 (18.9%) were indifferent. Older interns, females and interns who had not rotated through Paediatrics were more likely to support the wearing of white coats by doctors. The commonest reason for wearing the white coat was for identification. CONCLUSION: The majority of medical interns supported the wearing of white coat by doctors. Prevention of infection is no longer the major reason for wearing the white coat. There is need to document the public's perception of the white coat.