Evaluation of parental perception of childhood urinary tract infection in Ondo, Southwestern Nigeria

Background: Urinary tract infection (UTI) is common in children with possible severe complications, deserving public health interventions.Aims: To evaluate parental perception of symptoms, causes, complication and treatment of childhood UTI, and proposerelevant interventions.Methods: This is an ethicallyapproved cross-sectional study using a structured questionnaire comprising a 35-item Likert-like scale on perception of UTI in children with a reliability rating of 0.93. Adequate perception of each variable was defined as mean score ≥ 3.0. Weighted mean scores were tested for significant difference using F-test. Multiple logistic regressions identified possible predictors of adequate perception among the participants. P -value <0.05 was considered significant.Results: Altogether, 600 guardians/ parents took part in the study. Their mean age was 29.8±6.5 years and almost two-thirds of them (62.3%) were females. Only 18.3% of the participants had adequate perception of UTI in children. Their grand mean score on perception of UTI was 2.68 ± 0.52. There was an upward trend in weighted mean scores of the various subscales (F-test = 21.63, p=0.000). Significant predictors of adequate perception of UTI in this survey include female gender (OR=16.72; 95% CI: 5.77-48.43), Hausa ethnicity (OR= 0.02; 95% CI: 0.00-0.17) and polygamous family structure (OR= 2.40; 95% CI: 1.16-4.96).Conclusion: There was low parental perception of UTI in children in our study setting. Regular health education on childhood urinary tract disorders is recommended.Key words: urinary tract infection, causes, treatment, outcome, parental perceptio

Enuresis in Southwestern Nigerian children: prevalence, risk factors and parental perception of treatment

Enuresis means discrete episodes of urinary incontinence in a child ≥5 years old. It is a social stigma among older children and adolescents with possible negative effect on their selfesteem and family life. Method: Enuresis was defined based on the International Children Continence Society diagnostic criteria. Structured questionnaire on basic patient information on enuresis and perceived treatment sub-scale with cronbachalpha of 0.85 was administered. Logistic regression identified predictors of enuresis The level of significance of each test was set at p< 0.05. Results: Among the 600 participating households, 58.5% had children ≥ 5 year old with enuresis. The mean household prevalence of enuresis was 22.4%(95% CI: 11.51% – 33.25%). Most of the affected households (85.5%) had one bedwetting child but 9.1% of them had two while the rest had at least three bedwetting children ≥5 year old. Their urinary symptoms include frequency (74.7%), urgency (14.8%), straining (8.8%) and cloudy urine (6.8%). Recent stressors among the enuretics include major illness (42.7%), relocation (32.2%) and bereavement (9.1%). Perception of enuresis therapies was borderline (mean score = 3.54± 0.5).Risk factors include parental history of bedwetting (OR=3.26, 95%CI = 1.65-6.45), monogamous family setting (OR=2.92, 95%CI = 1.38-6.18) and living in a room and parlor apartment (OR=2.19, 95%CI = 1.07- 4.50). Conclusion: There is a high burden of enuresis in the study setting, associated with some modifiable factors. However, there is a relatively low perception of appropriate care of the disorder highlighting the need for an awareness campaign on effective enuresis therapies

Evaluation of adolescent medicine sub-specialty training in Nigeria: trainees’ perspectives

Objective: To evaluate the extent of coverage of curriculum contents pertinent to Adolescent Medicine, as well as the adequacy of facilities and professionals in Nigeria using residents’ viewpoint.Design: A descriptive cross-sectional study.Setting: The Intensive Course in Paediatrics of the National Post-graduate Medical College of Nigeria at the University of Benin Teaching Hospital, Benin City Nigeria.Subjects: One hundred and three paediatric residents from training institutions in all zones of the country.Results: Altogether,68.0% and 32.0% of the participants were from Southern and Northern geopolitical zones respectively. Only 14% of them stated that a rotation in an AM unit is a part of training in their centres. None specified its duration. Coverage of AM topics, physical facilities and trainers were rated as inadequate by 77.0%, 82.8% and 70.8% of the respondents respectively. Residents from north were more likely to rate interview/confidentiality in AM as covered (either partly or well) than their colleagues from the South, (p < 0.01, OR = 5.3, 95% CI = 1.5-19.5). We found no difference between federal and state residents’ perceived adequacy of AM training.Conclusion: AM in paediatric residency programme in Nigeria is still an unmet challenge. There is a need for a revision of the training curriculum to specify mandatory duration of clinical rotation in AM units

Neonatal thrombocytopenic purpura: report of two cases and review of literature

Severe neonatal thrombocytopenia is a hematological emergency that can be due to increased platelet destruction(such as immune-mediated and peripheral platelet consumption) or congenital failure of platelet production. The definitive diagnosis of the underlying cause of neonatal thrombocytopenic purpurais based on both clinical and laboratory findings.Case report; We present two infants with persistent severe thrombocytopenia of distinct aetiologies: neonatal alloimmune thrombocytopenic purpura and hepatitis B virus exposure. Their clinical course, haematological profile and treatments are discussed.Conclusion: This reportreiterates the need to think laterally while considering the differential diagnoses of neonatal thrombocytopenic purpura. Moreover, ithighlightsits treatment challenges in peripheral health facilities, especially in resource-limited settings

A media framing analysis of urban flooding in Nigeria: current narratives and implications for policy

© 2017, The Author(s). A critical element of current flood management is the importance of engaging key policy actors when policy decisions are to be made. However, there is still only limited understanding of how narratives of flood management actors may influence flood management policies, even though there is a suggestion that actors can strategically use their narratives to influence policy directions. In a developing country like Nigeria, there are still questions around lessons that can be learnt from understanding the narratives of policy actors, to unravel the complex nature of strategies and policy directions in managing urban floods. To help fill these gaps, this paper uses quantitative content analysis to explore the frame of five policy actor groups (government, local communities, business, multilateral organisations and non-governmental organisations (NGOs)) as expressed in local and national newspapers between 2012 and 2016 to understand their narratives of causes and strategies to solve the problem of urban flooding in Nigeria. The narratives of government, local communities and businesses align with the premise that flooding can and should be prevented whilst that of multilateral and business actors champion adaptation strategies on the basis that flooding is inevitable and hence more energy should be directed at ‘living with water’—emergency response, damage reduction and the aftermath. The study also identified areas of potential consensus and conflict between direct actors such as government and local communities on the one hand and funders on the other. Better discussion among actors aiding understanding of contemporary thinking and local realities will aid policy-making and policy implementation in the Nigerian context. An important step will be in the collaborative design of an urgently needed ‘Nigerian policy on flooding’ which currently does not exist

The effects of methionine acquisition and synthesis on Streptococcus pneumoniae growth and virulence

Extent: 14 p.Bacterial pathogens need to acquire nutrients from the host, but for many nutrients their importance during infection remain poorly understood. We have investigated the importance of methionine acquisition and synthesis for Streptococcus pneumoniae growth and virulence using strains with gene deletions affecting a putative methionine ABC transporter lipoprotein (Sp_0149, metQ) and/or methionine biosynthesis enzymes (Sp_0585 - Sp_0586, metE and metF). Immunoblot analysis confirmed MetQ was a lipoprotein and present in all S. pneumoniae strains investigated. However, vaccination with MetQ did not prevent fatal S. pneumoniae infection in mice despite stimulating a strong specific IgG response. Tryptophan fluorescence spectroscopy and isothermal titration calorimetry demonstrated that MetQ has both a high affinity and specificity for L-methionine with a KD of ~ 25 nM, and a DmetQ strain had reduced uptake of C14-methionine. Growth of the ΔmetQ/ΔmetEF strain was greatly impaired in chemically defined medium containing low concentrations of methionine and in blood but was partially restored by addition of high concentrations of exogenous methionine. Mixed infection models showed no attenuation of the ΔmetQ, ΔmetEF and ΔmetQ/DmetEF strains in their ability to colonise the mouse nasopharnyx. In a mouse model of systemic infection although significant infection was established in all mice, there were reduced spleen bacterial CFU after infection with the ΔmetQ/ΔmetEF strain compared to the wild-type strain. These data demonstrate that Sp_0149 encodes a high affinity methionine ABC transporter lipoprotein and that Sp_0585 – Sp_0586 are likely to be required for methionine synthesis. Although Sp_0149 and Sp_0585-Sp_0586 make a contribution towards full virulence, neither was essential for S. pneumoniae survival during infection.Shilpa Basavanna, Suneeta Chimalapati, Abbas Maqbool, Bruna Rubbo, Jose Yuste, Robert J. Wilson, Arthur Hosie, Abiodun D. Ogunniyi, James C. Paton, Gavin Thomas and Jeremy S. Brow

Clinical profile and outcomes of measles in south-western Nigerian children

Background: Barely two years to the end-point of the count-down to 2015, measles still remains a major cause of morbidity and mortality in Nigerian children, despite being vaccine-preventable. Aims/objectives: We evaluated the spectrum of clinical morbidities and determinant of poor outcomes associated with measles in our facility. Methods: It was a cross-sectional observational study. A structured 22-item questionnaire was administered to all children admitted due to measles from April to September 2013. Anti-measles IgM antibody serology was used for laboratory confirmation. Pearson’s chi-square test was used to assess for significant differences between categorized data. Odd ratios were calculated. Results: Sixty four in-patients participated in the study. Their mean age was 19±13 months; 48.4% were males while 51.6% were females. Almost two-thirds of them were not immunized. Respiratory, digestive and neurologic systems were frequently involved, 65.6%, 14.1% and 9.4% respectively. Anti-measles IgM antibody was positive in 73% of those tested. Over 90% of the children were discharged, while 1.5% had neuro-developmental deficit. Case fatality rate was 6.3%. Clinical-demographic features were similar among the children irrespective of their outcomes (p > 0.05). Conclusion: Measles outbreaks still account for significant morbidities and mortalities in Nigerian children. Improved immunization coverage is advocated.Key words: Measles, systemic manifestations, outcome

Morbidity and mortality pattern at the emergency paediatric unit of Mother and Child Hospital Akure, Nigeria

Background: Morbidity and mortality pattern differs among regions. Also, there may be variations within a nation partly due to availability and cost of health services as well as the health-seeking behavior of the people.Aims: To describe the spectrum and outcome of paediatricmedical emergencies in a free integrated maternal and child health facility in south western Nigeria. Also, the likelihood of death from specific diseases in the setting was evaluated.Methods: The data were analyzed using the Software Package for Social Science (SPSS) version 20.0 (Windows Inc; Chicago, IL, USA). Categorized data were presented as percentages. Using inferential analysis, Odds ratio (OR) and 95% confidence interval (CI) were calculated for common disorders as possible predictors of under-five mortality. P-value <0.05 was considered significant.Results: The total number of under-fives admitted in the EPU during the study period was 2361, with a male preponderance (53.5%); 21.3% were neonates (<1month old), 38.8% post-neonatal infants (1-12months) and the rest (39.9%) aged 13-60months.The commonest emergencies seen in the unit were severe malaria (31.2%), gastroenteritis (16.9%) and pneumonia (8.6%). The overall mortality rate was low (3.7%) with a majority (96.6%) of deaths occurring in the first 24 hours.The commonest causes of death were infections. The case fatality rates (CFR’s) were as follows: septicemia (38.5%), aspiration pneumonitis (10.5%), meningitis (10.0%), severe malnutrition (7.0%), severe malaria (5.6%), gastroenteritis (4.3%), pneumonia (2.9%) and neonatal disorders (2.2%). The most significant predictors of death were septicemia (OR = 17.06, 95% C.I. = 5.46-53.26)and severe malaria (OR = 1.98, 95% C.I. = 1.29-3.03).Conclusion: Infectious diseases are the leading paediatric emergencies and commonest causes of deaths among under-five children in our hospital. The overall outcome of childhood disorders managed in our cost-free facility compared favorably with findings in fee-paying health systems elsewhere in Nigeria.Keywords: morbidity, mortality, paediatric emergencies, Mother and Child Hospita

Superiority of cystatin c to creatinine as a biomarker of kidney function: two case studies and review of the literature.

Creatinine is the most commonly used endogenous substance in the estimation of glomerular filtration rate (GFR) but it is inaccurate being influenced by body mass indices, tubular secretion and extrarenal elimination. Conversely, cystatin C is superior to creatinine as a marker of kidney function. We recently managed two children who had major risk factors for chronic kidney disease (CKD) but had serially apparently normal serum creatinine levels. However, using a cystatin C-based method, they were already in CKD stage 2. Cystatin C is a promising alternative to creatinine for routine clinical use in our setting, enabling accurate and early detection of CKD in children.Key words: cystatin C, creatinine, glomerular filtration rates