Childhood ovarian juvenile granulosa cell tumour: a case report and review of literature

Juvenile granulosa cell tumour (JGCT) is very uncommon gynecological malignancy that occurs more commonly in under five years old of age. We describe a case of JGCT in a 4-years old girl. The malignancy is assigned to International Federation of Gynecology and Obstetric staging system (FIGO stage I). Treated with complete excision only, the patient showed no evidence of relapse one year after surgery. Findings in this case are discussed and histological examination confirmed the diagnosis. The natural history of JGCT, epidemiology, histology, treatment and prognosis are reviewed along with the case presentation.Key words: Childhood, Juvenile Granulosa Cell, Tumour, Ovar

Generalised tetanus: A rare complication of Richter’s hernia

We present a case report of generalized tetanus following umbilical Richter’s hernia in a 10 month old unimmunized boy. This case is reported because tetanus is a rare complication of Richter’s hernia and to emphasize the need for immunization of all unimmunized children with tetanus vaccine. Ahigh index of suspicion is important in the diagnosis of Richter’s herniain order to avoid complication, as diagnosis is often delayed or missed. The co-exiting tetany is also a rare co-morbidity of Richter’s hernia

Familial congenital glaucoma and epilepsy: a case series.

We present two siblings from consanguineous marriage, both with congenital glaucoma and seizure disorders with progressive visual impairment and blindness. The pedigree showed that five (one male and four females) of the eleven siblings have varied degrees of visual impairment to blindness with seizure disorders. To the best of our knowledge, familial congenital glaucoma with epilepsy has not been reported, hence the communication to highlight this unusual condition which could be an association or syndromic.Key words: Consanguinity, Familial, Congenital glaucoma, Epilepsy

Prevalence and pattern of intestinal parasites among pupils of private and public primary schools in an urban centre, Nigeria

Background: Intestinal parasitic infection is highly prevalent among children in the tropics. Identifying the most at risk group and subsequent targeted intervention will lead to cost effective and easy to implement control programme. We thus aim to determine the prevalence and pattern of intestinal parasite among pupils from public and private schools.Material and Method: This was a cross-sectional survey. Participants were recruited through multistage stratified random sampling. Information were collected using a questionnaire and early morning freshly passed stool sample was collected and processed from each participating pupil. Stool microscopy was done using saline and iodine preparations. Eggs were counted using Stoll’s method. Data obtained was analyzed using EPI INFO version 3.5.1.Results: Four hundred and twenty  pupils were studied, 210 pupils from each school type. Prevalence of 78.1% and 17.1% were recorded for the public and private schools respectively. The pupils from the public schools were 17.23 times more likely to have intestinal parasitic infestation compared to those from private schools (OR =17.23, 95% CI = 10.6-28.01, p = <0.0001). Ascaris lumbricoides was the most frequent isolate in both the public (62.8%) and private (66.7%) schools. The prevalence of multiple parasitic infestation was 14.8% in the public schools and none in the private schools. Socioeconomic status and source of water were the main factors with significant effect on the prevalence of intestinal parasite (p<0.0001).Conclusion: Intestinal parasitic infestation remains a very common health issue among the children particularly in the public schools. Distribution of free antiparasitic drugs to pupils at the beginning of every term should be incorporated into the school health program.Key words: Intestinal Parasites, Ascaris lumbricoides, public school, private school, socioeconomic status

Competency-based Learning: The effectiveness of targeted resident education and clinical auditing feedback on completed death certificate accuracy rates

Background: Death certification is an integral part of physician practice, yet common errors are being encountered from this vital source of health information. Most medical training programs lack formal curricula for this important skill. Accurate information from DC will help in improve our mortality data which can be use public health purposesObjectives: This study evaluated the effect of a multifaceted educational intervention on accuracy of completing death certification in a tertiary-based paediatric residency programMethod: A pre-post intervention and control cohort study over 12- month period to assess the effect of our multifaceted intervention accuracy rate of completed DC was conducted. The intervention consisted of a 3-part program (distribution of educational material, presentation by a skilled instructor, skills workshop, and clinical mortality/auditing feedback sessions). Primary outcome was the difference in scores preand post-intervention and also the rate of accuracy on the MAHI death certificate scoring system.Results: The mean score before the intervention was 6.8±2.7 and 7.1±2.3 in both the intervention and control cohorts respectively. The mean score after the intervention was 16.3±2.5 and 7.3±2.8 in both the intervention and control cohorts respectively indicating an increase in scores. The mean difference in pre- and post-tutorial scores was significant (t=20.39, p=0.0001).Conclusions: We found that using a multifaceted educational intervention to train junior physicians on how to correctly complete a DC was effective in a residency-based pediatric programKeywords: Death certificate, medical education, multifaceted training, heath information, Nigeria

Co-morbidities in children hospitalized for community acquired pneumonia in Maiduguri, Nigeria

Background: Pneumonia is one of the commonest causes of morbidity and mortality in children, especially in developing countries. These children are also at risk of other morbidities, thus, increasing the morbidity and mortality.Objective: This study was conducted to examine the prevalence and pattern of co-morbidities in children admitted for community acquired pneumonia (CAP) in Maiduguri.Methodology: All children admitted into the Emergency Paediatric Unit (EPU) of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in 2011, with CAP were prospectively followed until discharge or death. The children were evaluated for co-morbidities clinically and by examination of appropriate specimen where necessary.Result: A total of 115 children aged one month to 14 years were admitted for CAP during the study period. While majority of the children studied were underfive; 107 (93%), 65(56.5%) were males, 101 (87.8%) had one or multiple co morbidities, with about half of them 58 (50.4%) afflicted by malaria. Pre admission medication was commoner for orthodox than traditional medication. No significant difference in mortality outcome was however noticed between children with co-morbidity and those without comorbidity, p > 0.05.Conclusion: The occurrence of comorbid conditions among children hospitalized for CAP in Maiduguri is common; however, the presence of co-morbidity did not significantly affect the mortality outcome of their management. It is recommended that the presence of comorbidity be actively looked for in children hospitalized for pneumonia, so as to effect holistic treatment, and improve the outcome of management.Keywords: Pneumonia, Children. Co-morbidity, Maiduguri, Mortality outcom

Presentation, complications and management outcome of community acquired pneumonia in hospitalized children in Maiduguri, Nigeria

Background: Pneumonia remains a leading cause of U-5 morbidity and mortality in developing countries like Nigeria. This study was conducted to determine the clinical presentation, complications and factors contributing to mortality in the hospitalized children with community acquired pneumonia (CAP) in Maiduguri, Nigeria.Methods: Children younger than 14 years admitted into the EmergencyPaediatric Unit of the University of Maiduguri Teaching Hospital(UMTH), Maiduguri, in 2011 with the diagnosis of community acquiredpneumonia were followed up until discharge or death. Chest radiographswere read by radiologists.Results: Eighty nine children aged two months to 14 years were studied. The commonest clinical features were fever, cough, tachypnoea and dyspnoea. Radiographic evidence of pneumonia was found in 84 (94.4%) of cases. Dehydration and congestive cardiac failure (CCF) were the commonest complications encountered. Eight (9.0%) children died, seven of whom had complications of pneumonia. The rate of occurrence of complications, radiographic pattern of pneumonia and outcome of treatment did not significantly differ statistically in the different age groups; p = 0.135, 0.622 and 0.167 respectively.Conclusion: While dehydration and CCF were found to be commonestcomplications, mortality was commoner among the male infants hospitalized for pneumonia

The Influence of Gestational Age on the Loss of Maternal Measles Antibodies in Newborn Infants in North-Eastern Nigeria: A Call for a Review of Measles Immunization Schedule

Background: Maternal measles antibodies (MMA) are actively transferred in mother-infant pairs during third trimester of pregnancy. Gestational age (GA) affects the levels of MMA such that longer GA may result in infants starting out with high levels of MMA.Objective: To determine the influence of GA on the loss of MMA in newborn infants in North-Eastern Nigeria.Method: A prospective study was conducted on newborn infants at Maiduguri; sera were collected at birth and at six months of age. Enzyme linked immunosorbent assay (ELISA) was used to measure MMA while GA was determined using the last menstrual period, ultrasound scan reports and the Dubowitz criteria.Results: Seventy eight newborn infants were enrolled. Seventeen (89.5 %) preterm, 43 (95.6 %) term and 14 (100 %) postterm had protective levels of MMA at birth. Two (10.5 %) preterm, nine (20.0%) term and two (14.3 %) postterm had protective MMA at six months of age. Comparison of mean MMA at birth and at six months of age was significant (p = 0.005), however, it was independent of GA of the newborn infants.Conclusion: Significant decline of mean MMA levels was seen in these infants at six months of age, which was independent of their GA. These infants may be prone to measles at an earlier age (less than six months). Therefore, the current recommendation of measles immunization to infants at nine months of age may require reconsideration

Post-neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria

Background: Tetanus is a public health problem in Nigeria. This study examines the demographic and clinical profile of postneonatal tetanus (PNT) seen in University of Maiduguri Teaching Hospital (UMTH), North- eastern Nigeria.Methods: This is a hospital-based prospective study of PNT. All childrenbeyond the neonatal period to 14 years of age admitted into the Paediatrics unit of UMTH, Maiduguri from June 2009 to July2011 with the diagnosis of PNT were studied.Results: A total of 39 cases of PNT were admitted over the period underreview. The male: female ratio was 2.3:1.0. Their ages at presentationranged between 16 months and 14 years, with mean +SD of 6.9+3.87 years. Over 90 percent of the children were either not immunizedagainst tetanus or their immunization status was unknown and onlytwo of the children were fully immunized. No booster immunizationwas received by any of the eligible children. The portal of entry of the infection was injury to the lower limbs and otogenic route in 53.9% and 33.3% respectively. Majority of patients were of low socioeconomicstatus. The duration of hospital stay ranged between 1-50 days with mean + SD (18.68+ 11.51).The mortality rate was (7)18 %.Conclusion: Tetanus still remains a major cause of childhood morbidityand mortality in Nigeria. Severe disease and the first one week of admission are the main variables identified to influence outcome.Therefore, there is need to strengthen routine immunization and booster doses of tetanus toxoid (TT) should be mandatory at primary and secondary school entry. Close monitoring of patients with severe tetanus during the critical period is imperative for successful management

Acute watery diarrhoea in under-five children: perception of the causes, health seeking behaviours and barriers of mothers to care in a primary health care centre in Maiduguri, Nigeria.

Acute Watery Diarrhoea (AWD) is usually associated with complications, such as dehydration, electrolyte imbalance and acute renal failure. The WHO definition of home case management for diarrhea includes among others: the recognition of dangersigns of diarrhea that requires immediate care and seeking help from an appropriate health facility. Objectives: to examine mothers or care givers perception of the causes of AWD, indications and barriers to health seeking behavior during AWD in under-5(U-5) children in Maiduguri. Methods: the study was carried out in October 2006 at yerwa primary health care centre (PHCC) in Maiduguri Nigeria. Quantitative method by the use of face interview was employed. Results: two hundred mothers caregivers of U-5 children who presented to the yerwa PHCC with complaint of AWD in their children or wards were interviewed.  Poor hygiene and contaminated food/water were identified as the main cause of AWD. Eighty-five (42.5%) mothers/caregivers reported patronizing herbalist side by side with orthodox medical attention for AWD. Eighty Five (42.5%) mothers /cargivers reported patronizing herberlist side by side with orthodox medical attention for AWD .the indications for seeking health in 90% of the mothers/caregivers were child being weak and response to ORS while 37.5% declined to give reason. Financial constraints and lack of transportation contributed to the barriers of health seeking majority of the women had good knowledge of the causes of childhood AWD, but none knew the course of AWD. Conclusion: majority of the mothers had barriers to health seeking despite good knowledge of the causes of AWD and indication for seeking health seeking. Appropriate and proper health education in addition to the adoption and practice of the principles of primary health care and full implementation of national health insurance scheme is therefore recommended