Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels

Objectives: Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. Methods: This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5–14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. Results: Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). Conclusion: Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria. Keywords: Biomarkers; Acute Kidney Injury; Renal Failure; Glomerular Filtration Rate; Cystatin C; Creatinine; Malaria; Nigeria

Factors influencing routine vaccination uptake and completion among children aged 12–23 months in Ilorin, North-Central Nigeria: A cross-sectional survey

Background: In spite of the enormous benefits of immunization, uptake of the expanded programme on immunization vaccines has remained low, especially in Northern Nigeria. Pentavalent-3 uptake in Nigeria was 33% in 2017, and up to 40% of children 12 months old were not vaccinated. Objectives: This study aimed at determining the factors influencing routine vaccination uptake and completion among children 12–23 months in North-central Nigeria. Materials and Methods: This was a cross-sectional survey conducted in Ilorin between December 2019 and January 2020 among 456 mothers/caregivers-children pairs. Participants were recruited using multistage cluster sampling technique. Results: Eighty percent (80%) of the children studied were fully vaccinated, with a vaccine uptake of 100% for Bacille Calmette-Guerin, OPV0, HBV0, OPV1, and Penta1; 83.8% for measles; and 83.1% for yellow fever. Significant factors associated with complete vaccination are: mothers/caregivers having formal education, P = 0.001; antenatal care (ANC) attendance, P = 0.001; being employed, P = 0.007, delivery in hospital, P = 0.001 and low birth order, P = 0.003. Predictors of complete vaccination are mothers with tertiary education (odd ratio [OR]: 11.51, confidence interval [CI]: 2.43–54.64, P = 0.002), ANC attendance (OR: 7.76, CI: 2.58–23.33, P < 0.001), and hospital delivery (OR: 2.86, CI: 1.6–5.0, P < 0.001). Psychosocial factors such as religious belief, cultural acceptance, and husbands’ support are also associated with vaccination uptake and completion among the children. Conclusion: Vaccination uptake for the various antigens and full vaccination status are generally high in this study, but still below the global target. Access to ANC services, hospital delivery, and female empowerment will enhance and improve vaccine uptake and completion