Screening for kidney disease in children on World Kidney Day in Lagos State, Nigeria

Background: Across the world, World Kidney Day (WKD) is marked yearly to increase awareness of kidney diseases. In 2016, its focus was on children for the first time. We report on a WKD screening initiative for kidney disease that was conducted in two public schools in Lagos State, Nigeria.Methods: Participants were recruited after guardians provided signed consent and older children gave assent. Baseline data were obtained which included family history of chronic diseases like sickle cell disease, hypertension, diabetes, renal disease, and the use of herbal medications. Anthropometric parameters such as height, weight and body mass index (BMI) were recorded. Investigations included urinalysis, measurement of serum creatinine and estimation of glomerular filtration rate (eGFR) using the Schwartz formula.Results: A total of 405 children were screened; there were 190 (46.9%) males and 215 females. The children were aged 2 to 17 years with a mean age of 9.1 ± 3.0 years. Over 80% of the children had normal nutritional status. Severe thinness was seen in 22 (6.8%) whereas overweight was present in 10 (3.1%). Only 1 was obese. eGFR was above 90 mL/min/1.73 m2 in 232 (94.3%) of the participants. Hypertension was present in 47 (14.4%), with the highest rate among those 0–8 years old. Proteinuria was detected in 118 (29.2%); none of the children had haematuria. Systolic hypertension, a family history of smoking and the use of herbal medications were associated with proteinuria.Conclusions: The study has highlighted a high rate of proteinuria, associated with the use of herbal medications, hypertension and a family history of smoking. Screening for renal disease in children with appropriate follow-up and timely intervention to avoid progression to end-stage renal disease is imperative

Vitamin D status and serum vitamin D binding protein levels in Nigerian children with nephrotic syndrome

Introduction: Nephrotic syndrome is a chronic relapsing condition associated with urinary loss of albumin and other proteins such as vitamin D binding protein (DBP). We determined vitamin D status and serum DBP levels in children with nephrotic syndrome and compared them to healthy controls. Methods: A cross-sectional study was performed over a six-month period in children less than 18 years of age. The children with nephrotic syndrome were categorised by disease status as either newly diagnosed, in remission, resistant to therapy, or in relapse. Vitamin D levels were regarded as sufficient if ≥75 nmol/L, insufficient if <75 nmol/L but ≥50 nmol/L, deficient if <50 nmol/L, and severely deficient if <25 nmol/L. Serum DBP was also measured. Results: Fifty-five children with nephrotic syndrome and 24 controls were included in the study. There was no significant difference between the median ages of the cases (72.0 months, interquartile range (IQR) 48.0–120.0 months) and the controls (84.0 months, IQR 39.0–129.0 months). Severe vitamin D deficiency, deficiency and insufficient levels were documented in 54.5%, 41.8% and 3.6% of cases, respectively, significantly lower than the controls (P = 0.003). Vitamin D levels were higher in children with nephrotic syndrome in remission than in those who were not (30.3 ± 15.2 nmol/L vs 19.6 ± 11.0 nmol/L, P = 0.004). In the groups who were in remission, newly diagnosed, relapsing, and resistant, the median vitamin D levels were 30.3 nmol/L, 20.1 nmol/L, 19.2 nmol/L and 9.4 nmol/L, respectively (P = 0.031). Conclusions: Hypovitaminosis D occurs frequently in Nigerian children with nephrotic syndrome as well as in apparently healthy controls. Routine supplementation of vitamin D should be considered in children with nephrotic syndrome irrespective of whether the disease is in remission or not, or whether it is steroid-sensitive or not

Tourism, Environment and Energy: An Analysis for China

International tourism as a cause of global warming is a controversial and topical issue. Here, we use the novel Morlet Wavelet time-frequency approach to gain a deeper insight into the dynamic nexus between tourism, renewable energy utilization, energy utilization and carbon dioxide emissions for China using annual data over the era 1974-2016. The techniques we use include Continuous Wavelet power spectrum, the Wavelet Coherency, and the Partial and the Multiple Wavelet Coherence for time-frequency decomposition that can capture local oscillatory components in time series. Our findings support the hypothesis that tourism can cause increased energy utilization and carbon dioxide emissions in China, which challenges the sustainable tourism development goal. However, on the positive side, the relationship between tourism and renewable energy utilization is shown to facilitate reduced environmental degradation in the medium-long run

Usefulness and expectations on skills development and entrepreneurship among women of low socioeconomic status in Ogun State, Nigeria

The acquisition of vocational training skills and entrepreneurial know-how is acknowledged as an added advantage and a safety net to navigate poverty, especially in dwindling economic recession time and massive unemployment. This study examined the factors influencing the usefulness and perceived realization of skills development/empowerment to encourage more women's involvement in small scale businesses and promote its effect on poverty alleviation in households across Nigeria. Data collection involved a structured questionnaire and in-depth interviews conducted post-the vocational skill/empowerment training. The training was organized among Campus Keepers in a private university in Ogun State, Nigeria. Forty Campus Keepers were selected using the systematic sampling technique from a total population of 224, and 37 of the 40 selected voluntarily participated in this study. The Campus Keepers were women with low socioeconomic status who worked as cleaners on the university campus. Five of the Campus Keepers were purposively selected as key informants for the study. Results showed that respondents who had earlier knowledge and vocational skills training reported that it leads to self-employment. This view was higher for respondents who had more people in their household than those with fewer people (OR = 22.7 [CI= .56, 921.31]). The perception that the training can lead to additional income was lower for respondents who reported that either they or their spouses were sole breadwinners in their household than for those who reported that both/others/none were breadwinners (OR = .05 [CI=0, 1.2]). The odds that the skills development/empowerment training will result in perceived improved business was higher for respondents who gained more knowledge/information from the training than those who did not (OR=29.19 [CI = 1.1, 777.48]). Findings from the qualitative study suggest that key informants who participated in past training were yet to establish a profitable business of their dream fully. Governmental policy and program intervention that incorporates these findings will lead to increased participation of the target population in similar training in the future, leading to poverty alleviation towards achieving the SDGs for Nigeria

Toilet training practices in Nigerian children

Background. This study reports on toilet training with a focus on the effect of age, methods used, and factors that can affect urinary incontinence in Nigerian children. Methods. This was a cross-sectional hospital-based study carried out in public and private hospitals in South-Western Nigeria. A questionnaire was used to obtain information about toilet training practices from 350 adults, who toilet trained 474 children. Results. The adults had previously toilet trained children 1 - 18 years old. In this study, toilet training commenced at ≤12 months, during the day and night in 40.6% and 33.4% of children, respectively. Of the 350 parents/guardians, 141 (47.7%) commenced toilet training by waking children from their afternoon nap. The most common method was allowing the child to urinate at fixed time intervals, while the least common was a reward/punishment system. Furthermore, age was considered as the most common indicator to commence toilet training. For 36.9% of the children, training lasted 1 - 6 months. Daytime continence was achieved by 33.4% of children at ≤12 months old, and night-time continence was achieved in 29.7% of children between 12 and 18 months old. By 30 months, 91.1% and 86.9% had attained day- and night-time continence, respectively, and only 8.6% of the children were incontinent at night. Conclusion. Assisted infant toilet training is still practised among Nigerian parents despite the influence and the trends in the developed countries. The age at initiation and completion of toilet training was lower than those reported for developed countries

Toilet training practices in Nigerian children

Background. This study reports on toilet training with a focus on the effect of age, methods used, and factors that can affect urinary incontinence in Nigerian children. Methods. This was a cross-sectional hospital-based study carried out in public and private hospitals in South-Western Nigeria. A questionnaire was used to obtain information about toilet training practices from 350 adults, who toilet trained 474 children. Results. The adults had previously toilet trained children 1 - 18 years old. In this study, toilet training commenced at ≤12 months, during the day and night in 40.6% and 33.4% of children, respectively. Of the 350 parents/guardians, 141 (47.7%) commenced toilet training by waking children from their afternoon nap. The most common method was allowing the child to urinate at fixed time intervals, while the least common was a reward/punishment system. Furthermore, age was considered as the most common indicator to commence toilet training. For 36.9% of the children, training lasted 1 - 6 months. Daytime continence was achieved by 33.4% of children at ≤12 months old, and night-time continence was achieved in 29.7% of children between 12 and 18 months old. By 30 months, 91.1% and 86.9% had attained day- and night-time continence, respectively, and only 8.6% of the children were incontinent at night. Conclusion. Assisted infant toilet training is still practised among Nigerian parents despite the influence and the trends in the developed countries. The age at initiation and completion of toilet training was lower than those reported for developed countries

Three cases of prune belly syndrome at the Lagos State University Teaching Hospital, Ikeja

Prune belly syndrome (PBS) is a rare congenital disorder affecting 2.5 to 3.8/100,000 live births worldwide. Our objective of this report is to describe clinical manifestation, laboratory, and radiological characteristics of PBS in our patients, to highlight the limitations to offering appropriate patient care due to parents demanding discharge against medical advice and the need to increase the awareness regarding this rare disease. We report three cases; all referred after birth with lax abdominal wall, congenital anomalies of kidney, and urinary tract. One of the patients had an absent right foot. They all had cryptorchidism, and in one, there was deranged renal function. The reported cases had both medical and radiological interventions to varying degrees. They all had an abdominal ultrasound which revealed varying degrees of hydronephrosis, hydroureters, and bladder changes. Voiding cystourethrogram showed vesicoureteric reflux in one of the reported cases. Urinary tract infections were appropriately treated with antibiotics based on sensitivity. PBS management in our setting remains a challenge because of strong cultural beliefs, and high rate of discharge against medical advice. Focus should be on parent education, early diagnosis, and multidisciplinary management approach