Factors associated with treatment gap in children and adolescents with epilepsy in a rural Nigerian community.

Background: The campaign against epilepsy is hampered by the difference between those with the active disorder and the number of them receiving appropriate treatment (treatment gap) in sub-Saharan Africa. Identifying the determinants of this gap is crucial to providing and achieving optimal care.Objective: To identify the determinants of epilepsy treatment gap (ETG) in children and adolescents (Subjects) with epilepsy in a rural community.Methods: Subjects were identified through a community house to house survey. Information obtained from Subjects and their care givers included: sociodemographic characteristics, type and frequency of epileptic seizures,current and past treatment options utilized, reasons for treatment options used, and treatment options utilized for other health complaints.Results: Twenty three Subjects (6.4/1000 of the child and adolescent population) were identified as having epilepsy. Their age range was 4-19 years (mean 14.3±4.7 years). Most were males (82.6%) and adolescents (78.3%). Seizures were mostly generalized (95.7%) and occurred most frequently daily. Current treatment modalities were use of traditional medication (100%) and prayers (34.8%).None was currently on orthodox medical therapy (ETG, 100%) but 5(21.7%) had utilized orthodox medical therapy in the past. The main determinants of the ETG were strong cultural belief, weakness in the health system to epilepsy treatment and low socioeconomic status. Fever was the commonest other health complaint and use of orthodox medical therapy was significantly (p˂ 0.05) the main (16, 69.6%) treatment option utilized.Conclusion: Cultural belief, weak health system and low socioeconomic status were determinants of an absolute ETG. It highlights the need to strengthen initiatives that enhance accessibility to standard epilepsy treatment.Key words: Epilepsy treatmentgap, determinants, children, adolescents, rural communit

Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT)

Background Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1 year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants’ neural plasticity. Methods/design The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants and their families in a randomised trial that compares attention and social attention of trained infants against those that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development of a larger randomised trial. Discussion Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of preterm infants using early interventions. However, early interventions with preterm infants, and particularly very preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of an early cognitive intervention for very preterm infants. Trial registration Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov)

Febrile seizures in Kaduna, north western Nigeria

Background: Febrile seizure is the most common seizure of childhood and has a good prognosis. However its presentation is fraught with poor management, with grave consequences, in our environment. Thus a review of its current status is important. Objective: To review the status of febrile seizures in Kaduna metropolis. Materials and Methods: A review of cases seen in the Department of Paediatrics, 44 Nigeria Army Reference Hospital, Kaduna between June 2008 and June 2010. Results: Out of the 635 cases admitted in the department 17 (2.7%) fulfilled the criteria for febrile seizures. There were 11 Males and 6 Females (M: F, 1.8:1). Age range was from 9 months to 5 years with a mean of 2.2 years ± 1.1 and peak age of 3 years. Twelve (70.6%) were in the upper social classes (I‑III). Fever, convulsion, catarrh and cough were major presenting symptoms. Incidence of convulsion was least on the 1st day of complaint. Fourteen (82.4%) of the cases were simple febrile seizures while 3 were complex. There was a positive family history in 5 (29.4%) of the cases. Eleven (64.7%) had orthodox medication at home, before presentation, 5 (29.4%) consulted patient medicine sellers and 7 (41.7%) received traditional medication as part of home management. Malaria and acute respiratory infections were the identifiable causes. Standard anti‑malaria and anti-biotic therapy were instituted, where indicated. All recovered and were discharged. Conclusion: There was a low prevalence of febrile seizures among the hospitalized children and a poor pre‑hospitalization management of cases. It highlighted the need for improved community awareness on the prevention and management of febrile seizures.Keywords: Fever, seizures, children, KadunaNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 201

Malaria Parasitemia in Children Aged less than 5 Years Presenting with Fever in Kaduna, Northwestern Nigeria.

Background: Malaria is a significant cause of morbidity and mortality in sub Saharan Africa. Fever is the commonest manifestation and Children aged less than 5 years are most vulnerable. An appraisal of this disease among these children is important to reducing the impact of the disease.Objective: To determine the prevalence and identify factors affecting malaria parasitemia in febrile children aged less than 5 years.Methods: Blood samples taken from all febrile children aged less than 5 years who presented to the department of Pediatrics, 44 Nigeria Army Reference Hospital Kaduna(NARHK) between July 2011 and September 2011, were examined for presence of malaria parasites.Results: Out of the 730 febrile children assessed, 411 (56.3%) had malaria parasitemia with densities of +, 2+ and 3+ in 301(73.2%), 90(22%) and 20(4.8%) children respectively. Majority were males (476, 65.2%), Aged = 2 years (409, 56% ) and in the upper (I III) social classes (497, 68.1%). Most (523, 71.6%) presented within = 48 hours of illness. Anti-malaria drug use was observed in 426 (58.4%) children and Artemisinin-based Anti-malaria Combination Therapy (ACT) drugs were the commonest drugs used (247, 58%). Drugs were prescribed by caregiver (183, 43%), patent medicine seller (102, 23.9%), in a health facility (94, 22.1%) and by significant others (47, 11%) respectively. Only 95(13%) used Insecticide Treated Nets (ITNs) and 34(4.6%) used traditional herbal mixtures. Malaria parasitemia was significantly (p?0.05) associated with non use of anti-malaria drug, low social class, non usage of ITNs and age =2 years .Of those with malaria parasitemia 396(96.4%) were treated for uncomplicated malaria and recovered fully. Fifteen (3.7%) were admitted and treated for severe malaria, of which 13(86.7%) of them recovered fully and 2(13.3%) died.Conclusion: Malaria is still a major cause of morbidity among febrile children aged less than 5 years of age with the severe form occurring less frequently but with grave consequences.Keywords: Malaria parasite, Fever, Childre

Multi-Actors' Co-Implementation of Climate-Smart Village Approach in West Africa: Achievements and Lessons Learnt

Climate change and variability are significant challenges for the environment and food security worldwide. Development strategies focusing simultaneously on adaptive farming, productivity, and reducing greenhouse gas (GHG) emissions-known as climate-smart agriculture (CSA) strategies-are key to responding to these challenges. For almost a decade, within the framework of Climate Change, Agriculture and Food Security (CCAFS), World Agroforestry (ICRAF), and its partners have been using Participatory Action Research (PAR) to fully engage key stakeholders in co-creating such CSA development strategies. This includes the testing of Agricultural Research for Development (AR4D) CSA scalability options. The multidisciplinary teams include the National Research and Extension Systems (NARES), national meteorological services (NMS), non-profit organizations (NGOs), and local radio programs, among others. The CCAFS-West Africa Program, World Agroforestry-West and Central Africa (ICRAF-WCA), International Union for Conservation of Nature (IUCN), University of Reading, and Centre Régional de Formation et d'Application en Agro-météorologie et Hydrologie Opérationnelle (AGRHYMET) provide technical backstopping to the national teams. Climate information (CI) was used as an entry point to inform the development of CSA technologies and practices within Climate-Smart Villages (CSV). This groundwork has led to a greater understanding of three critical factors for successful CSV implementation: (1) Building strong partnerships to co-design and develop agricultural systems that improve ecosystem and population resilience, (2) Key stakeholders (researchers, farmers, development agents, and students) capacity strengthening through vocational and academic training, and (3) Using CI for livelihood planning at all scales. These three factors support more effective identification and testing of agricultural technologies and practices addressing climate variability and change at plot, community, and landscape levels. This paper discusses the PAR-CSA methodology and parameters for evaluation, including biophysical and social change. Keys to success, including communication, knowledge sharing tools, and scalability are also discussed. Finally, future opportunities for improvement are presented, including knowledge product development, CSA policy and investment planning, capacity building, further engagement of the private sector, and additional research on existing practices and tools

Multiplex Real-Time PCR Diagnostic of Relapsing Fevers in Africa

Background: In Africa, relapsing fever borreliae are neglected arthropod-borne pathogens causing mild to deadly septicemia and miscarriage. The closely related Borrelia crocidurae, Borrelia duttonii, Borrelia recurrentis and Borrelia hispanica are rarely diagnosed at the species level, hampering refined epidemiological and clinical knowledge of the relapsing fevers. It would be hugely beneficial to have simultaneous detection and identification of Borrelia to species level directly from clinical samples. Methodology/Principal Findings: We designed a multiplex real-time PCR protocol targeting the 16S rRNA gene detecting all four Borrelia, the glpQ gene specifically detecting B. crocidurae, the recN gene specifically detecting B. duttonii/B. recurrentis and the recC gene specifically detecting B. hispanica. Compared to combined 16S rRNA gene and flaB gene sequencing as the gold standard, multiplex real-time PCR analyses of 171 Borrelia-positive and 101 Borrelia-negative control blood specimens yielded 100% sensitivity and specificity for B. duttonii/B. recurrentis and B. hispanica and 99% sensitivity and specificity for B. crocidurae. Conclusions/Significance: The multiplex real-time PCR developed in this study is a rapid technique for both molecular detection and speciation of relapsing fever borreliae from blood in Africa. It could be incorporated in point-of-care laboratory to confirm diagnosis and provide evidence of the burden of infection attributed to different species of known or potentially novel relapsing fever borreliae