Prevalence and Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Health Centre in Southern Nigeria

Background: Preterm babies have increased risk of morbidity and mortality which is inversely related to both gestational age and birth weight. Most preterm births result from maternal or foetal medical conditions. Objectives: To determine the prevalence and outcome of preterm admissions at the Special Care Baby Unit of the Niger Delta University Teaching Hospital, as well as theirmorbidity pattern and risk factors for preterm birth. Methodology: All preterm babies admitted from January 2010 to December 2012 were retrospectively studied. Information obtained included gestational age at birth, sex, risk factors for preterm birth, duration of admission, medical problems during admission and outcome. Results: Preterm admissions constituted 24.0% of the total admissions with a male to female ratio of 1.1:1. The commonest risk factor for preterm birth was preterm rupture of foetal membranes (46.4%) followed by lack of maternal antenatal care (35.5%) and multiple pregnancy (26.8%) respectively. The commonest medical conditions were respiratory problems in 95 (68.8%) followed by jaundice in 94 (68.1%) and sepsis in 54 (39.1%) of the patients. The case fatality rate was highest in the patients with necrotizing enterocolitis and seizures (66.7%) followed by respiratory problems (63.2%) and bleeding disorders (60.0%). The overall survival rate was 65.9%. The survival rate was significantly higher in the mild preterm category compared to the very preterm and extremely preterm for birth categories χ2 = 29.24, p value = 0.000. Conclusion: Preterms constituted a significant percentage of neonatal admissions at the Niger Delta University Teaching Hospital with the case fatality being highest among those with infections and respiratory problems. There is an urgent need for the establishment of a neonatal intensive care unit with facilities for thorough evaluation and management of preterm babies in order to improve survival rate of this vulnerable group of patients.

Epidemiology, pathophysiology, clinical characteristics and management of childhood cardiorenal syndrome

Cardiorenal syndrome(CRS) is a new term recently introduced to describe the acute or chronic comorbid state of the heart and kidney that has been long known and frequently managed in very sick individuals. The tight and delicate coordination of physiological functions among organ systems in the human body makes dysfunction in one to lead to malfunction of one or more other organ systems. CRS is a universal very common morbidity in the critically ill, with a high mortality rate that has received very little research attention in children. Simultaneous management of heart and renal failures in CRS is quite challenging; the therapeutic choice made for one organ must not jeopardize the other. This paper reviews the epidemiology, pathophysiology, clinical characteristics and management of acute and chronic CRS in children.

Risk Factors, Clinical Features, Baseline Alanine Aminotransferase and CD4+ Count of Children with HIV Co-Infection with Hepatitis B and C at a Tertiary Hospital in Southwest Nigeria

Background: Human immunodeficiency virus and hepatitis B and C viruses are endemic in sub- Saharan African countries including Nigeria. Researchers have studied the burden of co-infection of HIV with hepatitis B and hepatitis C but the risk factors and clinical presentation have not been much addressed especially in children. Methodology: This was a prospective cross sectional study that determined the prevalence, risk factors, clinical features, baseline CD4+ count, CD4+ percentage, and alanine aminotransferase (ALT) of newly diagnosed, HAART na?ve HIV co-infection among children who were managed at a Tertiary Hospital in Ilorin, Nigeria. Result: Of the 60 HIV- infected children recruited, 11.7% had HIV co-infection with HBV or HCV. Children with co-infec- tions (mean age 8.43 ± 2.37 years) were significantly older than their HIV mono-infected counterparts (mean age 5.25 ± 3.96 years) (p = 0.011). There was no significant difference between HIV monoinfection and HIV co-infection with respect to gender (p = 0.758), ethnicity (p = 0.707), religion of parents (p = 0.436), family type (p = 0.184), social class (p = 0.535), previous transfusion (p = 0.053), scarification (p = 0.612), female genital mutilation (p = 0.778), and sharing of clippers (p = 0.806). The mean BMI, immunological staging (p = 0.535), baseline ALT (p = 0.940), and mean baseline CD4+ count (p = 0.928) were comparable. However, the body mass index of HIV co-infec- ted children decreased with age up till age 10 years. Conclusion: There were no risk factors, nor clinical features predictive of co-infection identified in this study. Co-infection did not negatively impact baseline, CD4+ count and ALT.

Growth and Development of the HIV Exposed Uninfected Children below 5 Years in Developing Countries: Focus on Nutritional Challenges, Mortality and Neurocognitive Function

The future of any population is children. Resource limited settings with a high prevalence of HIV infection notably also have an excessive burden of malnutrition. The advances in prevention of mother to child HIV transmission programmes have led to very effective combination antiretroviral regimens resulting in growing numbers of HIV exposed but uninfected children. The mortality of HIV exposed but uninfected children below 5 years is high in resource limited settings. It is also important to pay particular attention to their longitudinal growth and neurodevelopmental outcomes. In these settings, the contribution of feeding practices, choice of complementary foods and micronutrient deficiencies, to health outcomes of HIV exposed uninfected children are not clearly defined. This review highlights some gaps in research that need to be addressed in areas with increasing numbers of HIV exposed but uninfected children. Interventions to reduce mortality, improve growth and neurodevelopmental outcomes in HIV exposed uninfected children from resource limited areas should be prioritized.

Whole Blood Omega 3 Fatty Acid Levels of HIV Exposed and HIV Unexposed 7 - 10 Years Old Children from a Low Income Country with High Burden of Under-Nutrition

Long chain polyunsaturated fatty acids are essential macronutrients that have several benefits which have been described for children’s health. Omega 3 LCPUFA metabolism has been reported to be altered in under-nourished and in HIV infected children. Therefore, we describe Eicosapentaenoic acid, Docosapentaenoic acid and Docosahexaenoic acid levels of HIV infected, HIV exposed uninfected and HIV unexposed uninfected school aged children from a low income country with a high burden of HIV infection and under-nutrition. This cross-sectional study recruited children 7 to 10 years old. Capillary blood was collected on filter paper and whole blood fatty acid analysis done using automated gas liquid chromatography. Kruskal Wallis and Median tests were used to compare the distribution and medians of the Omega 3 LCPUFA among the children according to HIV status, gender, age and nutritional status. A total of 318 children were recruited with 21 (7%) being HIV infected and 116 (37%) being HIV exposed uninfected. Chronic malnutrition was present in 12% of the children. The omega 3 fatty acids were expressed as percent weight of total fatty acids. The medians (interquartile range) for EPA, DPA and DHA for all the children were 0.19 (0.09), 0.79 (0.19) and 2.14 (0.54) %wt/wt respectively. EPA, DPA and DHA levels were not associated with the HIV status of the children. EPA levels were much lower in the 7-year-age group compared with the 8 and 9 - 10-year-age groups. Further studies assessing LCPUFA levels that include larger sample size, children from both urban and rural areas are recommended as this may assist in clearly defining the association of LCPUFA with HIV status in children from low income countries with high burden of under-nutrition.

Contextual Challenges in the Implementation of the Alliance for Maternal and Newborn Health Improvement, Prospective Cohort Study, an Experience from Rural Pakistan

Introduction: Improving maternal and newborn survival needs robust data on patterns of morbidity and mortality from well-characterized cohorts. It is equally important for researchers to document and understand the contextual challenges of data collection and how they are addressed. Methods: This was a prospective cohort study implemented from December 2012 to August 2014 in Matiari, Pakistan. A total of 11,315 pregnancies were enrolled. Participants were approached at home for sequential data collection through the standard pretested structured questionnaires. Some indicators were sourced through health facility records. Information on field challenges gathered through field diaries and minutes of meetings with field staff. Results: Inaccurate reporting of last menstrual period (LMP) dates caused difficulties in the planning and completion of antenatal data collection visits at scheduled gestational weeks. We documented ultrasound reports wherever available, relied on quickening technique, and implemented a seasonal event calendar to help mothers’ recall their LMP. Health system coordinators of public sector and private healthcare providers were individually approached for maximum data collection. But an unregulated private health system with poor record maintenance and health care providers’ reluctance for cooperation posed a greater challenge in data collection. Conclusions: Within a broader understanding of the health systems and socio-cultural environment, temporal and spatial feasibility of data collection should be considered thoroughly at the early stages of study designing, planning, resource allocation, and implementation. Pre-defined regular and need-based meetings with each tier of data collection teams and study managers help to reinvigorate field execution plans and optimize both quantity and quality of study data.

Vitamin D Status among Infants Attending a Reproductive and Child Health Clinic in Arusha, Tanzania: A Cross-Sectional Study

Background: Globally there is a high burden of low serum vitamin D deficiency (VDD) with children being acknowledged at risk due to low vitamin D content in both breastmilk and available foods and inadequate cutaneous synthesis of vitamin D. Even in countries with abundant sunshine, vitamin D deficiency (VDD) remains a problem. There is little characterization of the status of vitamin D among infants in East Africa. This study aimed to determine the prevalence and factors associated with vitamin D deficiency among infants attending the Reproductive and Child Health (RCH) Clinic in Arusha, Tanzania. Methods: A cross-sectional study of 304 infants aged 6 weeks to 12 months was conducted at Arusha Lutheran Medical Centre (ALMC). Infants were enrolled during the warm season between November 2018 and January 2019. A pre-coded questionnaire was used to collect data on sociodemographic characteristics of the infant with consent from their caretakers. Physical examination was done for anthropometric measures and signs of rickets. Blood was drawn for assessment of serum 25-hydroxyvitamin D 25(OH)D, calcium, phosphorus and alkaline phosphate. Vitamin D deficiency was defined as 25(OH)D level below 20 ng/ml (<50 nmol/L) and Vitamin D insufficiency defined as a 25(OH)D level 20 - 30 ng/ml (50 - 75 nmol/L). Statistical analysis was performed using STATA 14 version and factors associated with VDD explored with multivariate analysis. Results: The mean serum 25(OH)D among infants was 34.51 ng/ml (±15.53). Vitamin D deficiency was found in 67/304 (22%) infants and Vitamin D insufficiency in 50 (16.5%) infants. Hypocalcemia was observed in 33 (10.9%) infants and clinical findings of rickets were found in 11 infants (3.6%). Factors independently associated with VDD included age < 6 months (Adjusted Odds Ratio (AOR) 1.56, 95% CI 1.19 - 4.0, p value < 0.026), serum signs of rickets and serum hypocalcemia (p-value < 0.001 and <0.002, respectively). Conclusion and Recommendation: A high prevalence of Vitamin D deficiency (22%) and insufficiency (16.5%) was observed among infants attending RCH Clinic in Arusha, Tanzania. Age < 6 months, a single serum measurement of hypocalcemia and the presence of the clinical sign of rickets were independently associated with VDD. Clinicians should actively assess for VDD and supplement with vitamin D as indicated, especially among infants < 6 months.

Impact of Praziquantel on Schistosomiasis Infection and the Status of Proteinuria and Hematuria among School Children Living in Schistosoma mansoni-Endemic Communities in Northwestern Tanzania

The aim of the study was to assess the effect of praziquantel (PZQ) treatment on hematuria, proteinuria and the status of eGFR following treatment in school children infected with S. mansoni. A cohort study among 6 - 13 years old children was conducted in the Lake Zone region of Tanzania to assess S. mansoni infection using a circulating cathodic antigen (CCA), Kato Kartz while urine dipstick to screen for urine protein levels and red blood cells. A blood sample was taken for every child to determine creatinine levels and later a status of estimated glomerular filtration rate (eGFR). The prevalence of S. mansoni infection was 64%, 46%, and 24% at baseline, 6 months, and 1 year respectively using CCA test. There was a 62.5% reduction in S. mansoni infection from baseline (p S. mansoni using CCA test, reductions in proteinuria, and hematuria in school children in Tanzania. There was complete remission in eGFR < 90 ml/min/1.73 m2 from 3.9% to 0% at 6 months. This suggests that praziquantel is effective, but there is still a need for integrated strategies to minimize reinfections.

Effects of scaling up various communitylevel interventions on child mortality in Burundi,Kenya,Rwanda,Uganda and Tanzania:a modeling study

Background:Improving child health remains one of the most significant health challenges in sub-Saharan Africa,a region that accounts for half of the global burden of under-five mortality despite having approximately 13%of the world population and 25%of births globally.Improving access to evidence-based community-level interventions has increasingly been advocated to contribute to reducing child mortality and,thus,help low-and middle-income countries(LMICs)achieve the child health related Sustainable Development Goal(SDG)target.Nevertheless,the coverage of community-level interventions remains suboptimal.In this study,we estimated the potential impact of scaling up various community-level interventions on child mortality in five East African Community(EAC)countries(i.e.,Burundi,Kenya,Rwanda,Uganda and the United Republic of Tanzania).Methods:We identified ten preventive and curative community-level interventions that have been reported to reduce child mortality:Breastfeeding promotion,complementary feeding,vitamin A supplementation,Zinc for treatment of diarrhea,hand washing with soap,hygienic disposal of children’s stools,oral rehydration solution(ORS),oral antibiotics for treatment of pneumonia,treatment for moderate acute malnutrition(MAM),and prevention of malaria using insecticide-treated nets and indoor residual spraying(ITN/IRS).Using the Lives Saved Tool,we modeled the impact on child mortality of scaling up these 10 interventions from baseline coverage(2016)to ideal coverage(99%)by 2030(ideal scale-up scenario)relative to business as usual(BAU)scenario(forecasted coverage based on prior coverage trends).Our outcome measures include number of child deaths prevented.Results:Compared to BAU scenario,ideal scale-up of the 10 interventions could prevent approximately 74,200(sensitivity bounds 59,068-88,611)child deaths by 2030 including 10,100(8210-11,870)deaths in Burundi,10,300(7831-12,619)deaths in Kenya,4350(3678-4958)deaths in Rwanda,20,600(16049-25,162)deaths in Uganda,and 28,900(23300-34,002)deaths in the United Republic of Tanzania.The top four interventions(oral antibiotics for pneumonia,ORS,hand washing with soap,and treatment for MAM)account for over 75.0%of all deaths prevented in each EAC country:78.4%in Burundi,76.0%in Kenya,81.8%in Rwanda,91.0%in Uganda and 88.5%in the United Republic of Tanzania.Conclusions:Scaling up interventions that can be delivered at community level by community health workers could contribute to substantial reduction of child mortality in EAC and could help the EAC region achieve child health-related SDG target.Our findings suggest that the top four community-level interventions could account for more than threequarters of all deaths prevented across EAC countries.Going forward,costs of scaling up each intervention will be estimated to guide policy decisions including health resource allocations in EAC countries.

Identification of Atherosclerotic Changes Using B-Mode Ultrasonography in Nigerian Children with Type 1 Diabetes Mellitus

Background: This study aimed at documenting the degree of atherosclerosis, which is an important macrovascular complication in Nigerian children with Type 1 Diabetes Mellitus as determined by ultrasonography using the carotid, femoral and brachial arteries. Method: A prospective observational study was performed on all 10 children diagnosed with diabetes mellitus at the paediatric endocrinology clinic, in a tertiary unit based in Nigeria over a six-month period. Results: All 10 children were aged between 12 - 17 years (Median = 16 years) and consist of 5 (50%) males and 5 (50%) female. The duration of diabetes ranged from 0.2 to 9 years. Four (40%) of the subjects had thickened carotid intima media thickness on either the left or right common carotid artery;5 (50%) had 0% flow mediated dilation of the brachial artery while the remaining 5 (50%) had normal flow mediated dilation;while 2 (30%) had intima media thickening of either the left or right superficial femoral artery using a cut-off value of 0.9 cm. Conclusion: Children with Type 1 Diabetes Mellitus have ultrasonic evidence of ongoing atherosclerosis. The use of ultrasound is recommended for detection and monitoring of atherosclerotic changes in children with DM.

Children with transposition of the great arteries: Should they actually be born in Nigeria?

AIMTo describe the clinical and echocardiographic features of Nigerian children with transposition of the great arteries and emphasize the need for collaboration with cardiac centres in the developed countries to be able to salvage the children.METHODS Prospective and cross sectional involving consecutive patients diagnosed with transposition of the great arteries using clinical evaluation and echocardiography at the Paediatric Department of Lagos State University Teaching Hospital,Lagos Nigeria as part of a large study between January 2007 and December 2015.RESULTS There were 51 cases of transposition of the great arteries within the study period with a male to female ratio of 2:1 and a prevalence of 1.55 per 10000among population of children who presented to centre during the study.Its proportion amongst children with congenital heart disease was 4.9%,while it was15.4%among those with cyanotic congenital heart disease.The mean age±SD of the subjects was 10.3±21.8 mo.Up to 70%of the patients were less than6 mo of age at initial presentation.The most common mode of presentation was cyanosis.The most common associated intracardiac anomaly was ventricular septal defect which occurred in 56%of the patients.CONCLUSION Transposition of the great arteries is as common in Nigeria as in the other parts of the world.The most common mode of presentation was cyanosis.There is an urgent need to establish paediatric cardiac centres in Nigeria if these children are to be salvaged.

Ever Use of Modern Contraceptive among Adolescents in Uganda: A Cross-Sectional Survey of Sociodemographic Factors

Background: Six in ten sexually active adolescent women in Uganda have an unmet need for contraception yet there is limited data on what is driving its use. This study aimed to determine the associations between sociodemographic factors and modern contraceptive ever-use among adolescents in Uganda. Methods: A crossectional study was conducted among 337 adolescents aged 13 - 19 years who had ever had sex in Wakiso (urban) and Kamuli (rural) districts in Uganda. The outcome of interest was the ever-use of modern contraceptives. Generalized linear models with a Poisson link were used to examine the associations between sociodemographic factors and contraceptive ever use. Results: The weighted prevalence of ever-use of modern contraceptives was 30.9%. Contraceptive ever use was more likely among the older adolescents (adjusted Odds Ratio) aOR 1.31 (95% CI = 1.06 - 1.55), married aOR 1.67 (95% CI = 1.09 - 2.58) and the less educated were aOR 1.79 (95% CI = 1.14 - 2.83) compared to their counterparts. Adolescents living in the urban district (Wakiso) aOR 0.67 (95% CI = 0.49 - 0.92) were less likely to use modern contraceptives. In stratified analysis, the urban poor were more likely to use modern contraceptives (moderate aPR 0.35 95%CI (0.17 - 0.68) ** or high socioeconomic status aPR 0.62, 95%CI (0.28 - 1.37). Conclusions: The study shows low contraceptive ever-use among adolescents. Adolescents with low education and those from rural settings were more likely to ever-use modern contraceptives. Having good knowledge of contraception and discussing sex with parents promoted contraceptives ever-use. We recommend further studies assessing barriers to contraceptive use among adolescents in Uganda.

Hepatitis C virus antibodies among transfused children with sickle cell anaemia at University of Ilorin Teaching Hospital

Background: Hepatitis C is an infectious disease of the liver caused by the Hepatitis C virus (HCV) resulting to a chronic Hepatitis. Chronic HCV infection constitutes a serious health challenge in places where prevalence is substantial. In Nigeria, there is a high risk because donor blood is not routinely screened for HCV. Patients with sickle cell anaemia (SCA) are considered a subset of the population at higher risk of acquiring the virus, due to their frequent needs for transfusion of blood and its products. However, the magnitude of HCV infection has not been adequately measured in our general population and specific data on HCV in SCA patients are scanty, hence a prospective case controlled study to determine the prevalence of HCV antibodies in transfused SCA patients attending the sickle cell anaemia clinic in the University of Ilorin Teaching Hospital (UITH), Ilorin was taken. Objective: To determine the prevalence of Hepatitis C virus antibodies among transfused children with SCA in Ilorin. Subjects and Method: Eighty two transfused SCA children aged 6 months to 14 years were recruited consecutively from February 2008 to January 2009 while eighty four non transfused SCA children of the same age range recruited over the same period served as controls. Hepatitis C virus antibody screening was done using a second generation ELISA method. Results: The overall prevalence of HCV antibody was 3.0%, while it was 3.7% and 2.4% in the transfused and non transfused SCA patients respectively (χ2 = 0.23, p = 0.68). The patients were also comparable across the social class when subcategorized into high and low social class (χ2 = 0.37, p = 1.00 (subjects), χ2 = 0.42, p = 1.00 (controls). Conclusion: The prevalence of Hepatitis C virus anti- bodies in transfused SCA patients is low. The difference in prevalence between transfused and nontransfused SCA patient was not statistically significant. This was cautiously interpreted due to the hospital based premise of the work. Therefore, Hepatitis C virus antibody acquisition might be from sources other than transfusion of unscreened blood.

Seroprevalence of Dengue Virus IgG among Children 1 - 15 Years, Selected from an Urban Population in Karachi, Pakistan: Population Based Study

Objectives: This was to estimate the proportion of Dengue virus specific IgG ELISA among asymptomatic children between the ages of 1 year to 15 years, residing in an urban population of Karachi. Design: Cross-sectional study. Settings: Subjects were selected from Garden, Karachi;an urban area located adjacent to the Central district of Karachi. Participants: Children of ages 1 year to 15 years, of either sex, residing in the urban area of Garden, Karachi for more than 1 year were selected for the study. Those with a history of yellow fever or using corticosteroids within 1 month of recruitment were excluded. Outcome measures: Data were collected on socioeconomic status of households, medical history, including previous dengue infection, general examination findings and anthropometric indices. Blood samples were collected and sent to Research Laboratories, AKU for determining complete blood counts and serum IgG antibodies for Dengue. All collected information was then analyzed for ascertaining the predicting factors for positive IgG among children less than 15 years. Results: From a total of 900 subjects, 46% were found to have positive IgG in their bloods. Our results revealed that a male child of age more than 10 years was more likely to be IgG positive. Other risk factors identified with the seropositivity included lower household income and absence of anemia, thrombocytopenia and lack of hand washing. Conclusions: The study indicated a significant proportion of children under 15-year-old infected with Dengue virus, with a potential risk of severe complications, if re-infected with dengue. Stringent measures are still needed by both public and private authorities to contain dengue outbreaks, and reducing the proportion of associated mortality, as seen in the previous years. Trial registration: Seed Money Grant (ID# SM090101) was awarded to the corresponding author by Research Committee, Faculty of Health Sciences, Aga Khan University, Pakistan.

Knowledge and Practice of Private Medical Practitioners regarding Diagnosis and Treatment of Paediatric Tuberculosis in Mogadishu

Background: Somalia has been at civil war for the last two decades and the public health system has virtually collapsed. The majority of the community seeks care from the private health sector. Objectives: To assess the knowledge and practice of private medical practitioners concerning Paediatric Tuberculosis (TB) diagnosis and treatment in Mogadishu and their level of adherence to the National or International guidelines using a cross-sectional study design. Methods: A cascade approach was used to identify private medical practitioners who had experience with treating paediatric TB. A standard tool was used to collect information on their knowledge of diagnosis and treatment among those who consented to participate in the study. In addition, prescriptions were retrieved from pharmacies in Mogadishu to enable independent verification of prescription practice and adherence to National or International guidelines. Results: There were 39 study participants, 31 medical doctors and 8 clinical officers. The most common symptoms used by clinicians to diagnose TB among children were fever for more than 2 weeks (87.19%), cough for more than 2 weeks (89.74%) and loss of weight (92.31%). A few, 5 (12.82%), identified history of TB contact as a suspicion of paediatric TB. More than half of the practitioners, 21 (53.85%), relied on chest x-ray and erythrocyte sedimentation rate for the diagnosis of TB in children. The majority (74%) of the clinicians knew the correct treatment for pulmonary TB in children. Further to this 60% and 79.5% respectively of the clinicians did not know the appropriate treatment regimens extra-pulmonary TB and TB/HIV co-infection. The lack of knowledge was confirmed by review of the prescriptions. Of the 48 prescriptions collected, only one prescription was correctly prescribed according to the weight of the child and even more worrying only 18 (39%) of the anti-TB drugs prescribed were Fixed Dose Combinations (FDC) approved by the WHO. Conclusion: Private medical practitioners in Mogadishu have significant gaps in their knowledge and practice with regard to the management of paediatric TB.

The Management in a Developing Country of Children with Type 1 Diabetes Mellitus at School: A Review of Attitude of Parents

Background: Optimal glycaemic control is essential in preventing diabetes related complications in children with diabetes. The school is an important component of care and support to achieve good outcome as children spend a considerable time in school. In some developed countries, there are guidelines and regulations on support and care of children with chronic diseases such as Type 1 Diabetes Mellitus (Type 1 DM). In most developing countries where these regulations are not in place, parents have an important role to play in encouraging optimal care for their wards while at school, which include informing school authority, submission of care plan in collaboration with the healthcare team and providing equipment necessary for care task at school. Aim and Objectives: The aim of this study was to review the attitudes of parents in a developing country towards management of their children with Type 1 Diabetes Mellitus (DM) at School. Methods: Parents of all children with Type 1 DM seen at the endocrine unit of the University of Port Harcourt Teaching Hospital were invited to participate. Data were collected using a questionnaire. Information on bio data, details of care in school and challenges experienced were documented and HbA1c was done for all children. Results: The Parents of eighteen children and adolescents with Type 1 DM participated in the study. The age range of the children was between 5 and 17.3 years, mean age of 12.37 &plusmn;4.2 years. Mean duration of DM 3.37 &plusmn;2.6 years and mean HbA1c was 10.02% &plusmn;2.5%. All children except one attended school as day students. Two parents (11.1%) did not inform the school of child’s diabetes. No parent gave a written plan of diabetes care/treatment of hypoglycaemia in school and 4 parents (22.2%) did not make contact with school when child was in school. No child had a glucometers or took insulin to school. Five parents (27.8%) adjusted or omitted morning insulin dose to prevent hypoglycaemias in school. Fifteen (83.3%) children were on twice daily insulin injections. Six children (33.3%) are from high socioeconomic class. All responses were from mothers and 15 (83.3%) of responders had at least secondary education. Conclusion: This study demonstrates poor attitude and deficiencies in care of children living with Type 1 DM in school. There is need for education of parents and presentation of written plans for care of every child with Type 1 DM in school.

HIV Encephalopathy (HIVE) in Children at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria

Background: HIV encephalopathy (HIVE) is associated with cognitive impairment in children with HIV infection, early diagnosis and initiation of HAART may reduce the morbidity associated with HIVE. Objective: To determine the prevalence of HIVE and associated comorbiditiesin children at the UPTH. Methodology: This was a retrospective study carried out from January to June 2017. The case notes of all HIV positive children presenting to the Paediatric Department of the University of Port Harcourt Teaching Hospital (UPTH) were studied. Children who met the diagnostic criteria for HIVE according to the Centre for Disease Control (CDC) definition were selected. The socio-demographic characteristics of the patients, mode of HIV transmission, CD4 count and associated comorbidities in these children were retrieved from the case notes. Obtained data was analyzed using Epi Info version 7.2. Comparisms of subgroups was carried out using the chi square test while statistical significance at 95% confidence interval was p value Results: A total of thirty five out of the 196 HIV positive children presenting to the hospital had HIV encephalopathy (HIVE) giving a prevalence rate of 17.9%. Of these 35 children, 18 were males and 17 females, giving a male to female ratio of 1:1. The mean age of the children was 5.7 ± 3.1 years. The mean age for the males was 6.4 ± 3.2 years and 5.0 ± 2.8 years for the females. There was no statistically significant difference observed between the sexes (t = 1.35, p = 0.187). Thirty (85.7%) of the patients with HIVE were on HAART at diagnosis. The mean age at diagnosis of HIV was 3.2 ± 3.1 years and the mean age at diagnosis of HIV encephalopathy was 3.4 ± 3.2 years. The documented route of transmission for all the subjects was mother-to-child-transmission (MTCT). Seventy five percent of the children were breastfed from birth and at 6 months all the mothers had discontinued breastfeeding. The mean CD4 count was 1053 ± 630 cells/ml. Tuberculosis was the most prevalent co-morbidity occurring among the patients. Conclusion: The prevalence of HIVE in children at the UPTH is high and Tuberculosis is the commonest comorbidity. Early infant diagnosis, use of modern diagnostic tool and early initiation of HAART are advocated to reduce its associated morbidity.

Horizontal transmission of HIV infection in an HIV-exposed child—An avoidable tragedy

Exposure to infected blood/blood products through blood transfusion and use of contaminated sharp objects remain an important source of HIV infection. This report describes the case of a 52-month-old male child of an HIV-infected mother in whom perinatal infection was successfully prevented by maternal and infant antiretroviral therapy, elective cesarean section, and avoidance of breast-feeding. A DNA PCR test at 6 weeks was negative and a rapid antibody test at 18 months was seronegative. He presented to the Paediatric infectious disease unit with chronic fever, cough, diarrhea and weight loss 7 months after receiving a commercially donated blood (in a rural private hospital) and scarification marks (by a traditional healer) for a febrile illness with convulsion. He was found to be seropositive with severe immunosuppression. He however died a month after being initiated on antiretroviral drug.

Caregivers＇ Perceptions of Causes and Treatment of Fever and Diarrhea among Under-Fives in Ile Ife

Introduction： Fever and diarrhoea account for a significant portion of under-five mortality in Nigeria. This might be related to file perceptions of caregivers on the causes, which could influence file treatment they proffer. The study was conducted among caregivers in Ife central Local Government. Results： Most mothers perceived that fever could be caused by malaria, teething, hot weather, cough and that diarrhea could be caused by teething, eating contaminated food, drink and water, dirty environment and feeding bottles. Illness behavior was poor, as most waited at least one day after the onset of symptoms before taking any action. Choice of treatment was mostly influenced by health education messages received from health workers and mass media. Discussion and conclusions： Caregivers had a fairly correct perception of the causes of fever, but had incorrect perceptions of the causes of diarrhea. There is need to educate caregivers on the causes of diarrhea, and appropriate treatment measures.

Audit of Neonatal Jaundice as Experienced at a Mission Hospital in Western Nigeria

Introduction: Neonatal jaundice (NNJ) is a common disorder in neonates that can impact negatively on the brain and cause death. The peculiarities in aetiology and solutions for different settings are a knowledge gap. This informed the desire to determine local aetiology and solutions for neonatal jaundice in a missionary hospital in Abeokuta, Southwestern Nigeria. Methods: Consecutive consenting babies diagnosed with significant neonatal jaundice were studied between July 2016 and June 2019. Institutional ethical consent was obtained. A proforma was used to obtain socio-demographic data and other relevant information such as age, sex, birthweight, gestational age and history regarding the jaundice. All the information obtained was inputted into a computer and analysed with SPSS version 16. Results: A total of 179 babies with neonatal jaundice comprising of 120 (67.0%) boys and 59 (33.0%) girls with ages ranging between 1 and 12 days (mean 2.7 ± 2.9) were studied. Prematurity, ABO incompatibility, neonatal sepsis and glucose-6-phosphate enzyme deficiency accounted for over 80% of the causes of significant NNJ. Sixty (33.5%) of the 179 babies studied developed acute bilirubin encephalopathy and 11 (6.1%) mortalities were recorded. Higher proportions of babies that were out-born with spontaneous vaginal delivery modes had acute bilirubin encephalopathy (p < 0.05). Mothers with formal education had better outcome compared to mothers without, in terms of mortalities (p < 0.05). Conclusion: Neonatal jaundice is still a significant cause of morbidity and mortality in the neonatal age group. Maternal education is key to good outcome in neonatal jaundice.