The Relationship Between Parents\u27 and Caregivers\u27 Demographics and Their Knowledge about Congenital Heart Disease

The lack of knowledge regarding congenital heart disease (CHD) among the Lagos populace is leading to late presentation, late diagnosis and poor outcomes. The purpose of the research was to document the level of knowledge of parents and caregivers regarding CHD using the Leuven questionnaire for assessing knowledge of parents on CHD (LKQCHD). A quantitative correlational cross-sectional study, with purposeful convenience sampling strategy, was used. Health belief model was the theoretical framework used. Primary data of demographic information such as gender, age, the level of education, and the number of years of accessing care were obtained using a survey. The data were analyzed using Chi-Square, Fisher\u27s exact test, and Pearson\u27s correlation coefficient. There was poor knowledge of CHD among the subjects as the level of knowledge of parents of children with CHD on CHD was lower than 80% of correct answers using the LKQCHD. There were negative correlations between the level of knowledge of the subjects and their age, level of education and number of years of accessing care at the study centre. A critical area of need for education and training in the field of public health in Lagos is health education of parents and caregivers of children with CHD in Lagos on CHD, which will help improve awareness of the populace in Lagos on CHD, thereby encouraging early presentation of the children with CHD in Lagos, improve the compliance of parents and caregivers of children with CHD to treatment, medications and clinic follow up. All the above effect of health education will have a positive effect in the quality of life and life expectancy of patients with CHD in Lagos

The role of cervical mediastinoscopy in Nigerian thoracic surgical practice

Introduction: Cervical mediastinoscopy is the gold standard for obtaining histological diagnosis of mediastinal pathology. It has been used for the staging of lung cancer as well as to determine the cause of Isolated Mediastinal Lymphadenopathy. There is very limited evidence in the literature of its use in Nigeria to assess mediastinal pathology. The aim of this study was to describe our institutional experience with cervical mediastinoscopy. Methods: This study was a retrospective analysis of 40 patients that underwent cervical mediastinoscopy in our institution between March 2007 and February 2013. Results: The indication for Cervical Mediastinoscopy was Isolated Mediastinal Lymphadenopathy in 24 patients (60%) and lung cancer staging in 16 patient (40%). The mean age of the patients was 52.7 + 15.1 years. There were 21 females (52.5%) and 19 males (47.5%). The most commonly biopsied lymph nodes were level 4 in 35 patients (87.5%) and level 7 in 21 patients (52.5%). Malignant diagnosis was made in 16 (66.7%) patients with Isolated Mediastinal Lymphadenopathy and in 13 (81.3%) patients staged for lung cancer. Hospital stay was less than 24 hours in all patients and there were no complications. Conclusion: Cervical Mediastinoscopy is available in Nigeria and has been performed in our institution with high diagnostic yield and no complications. Its increased use, along with the development of other mediastinal biopsy techniques is advocated to increase tissue biopsy of mediastinal pathology, especially for lung cancer and isolated mediastinal lymphadenopathy.Pan African Medical Journal 2016; 2

Estimated glomerular filtration rate in apparently healthy term neonates in Nigeria

Background: Glomerular filtration rate (GFR) is the best measure of renal function. However, the ideal exogenous markers are not routinely used to estimate GFR in clinical settings. Outside Africa, GFR estimates for neonates have been calculated from formulae using creatinine as well as cystatin C. There is a paucity of data on estimated GFR in neonates in Africa. This study was conducted to estimate GFR in healthy term African neonates using cystatin C-based equations.Methods: One hundred and thirteen apparently healthy term babies with normal Apgar scores were recruited at birth. Cystatin C was measured in cord blood at birth and in venous samples from neonates on the third day of life. GFR was estimated using the Filler and Lepage as well as the Zappitelli et al. cystatin C-based equations. These estimates were compared with a reference GFR estimate of 41 ± 15 mL/min/1.73 m2.Results: The median (interquartile range) estimated GFR values based on cord blood and day 3 venous samples using the Filler and Lepage equation were 44.67 (36.35–72.44) and 51.29 (38.90–72.44) mL/min/1.73 m2, respectively. When the Zappitelli equation was applied, the estimates were 38.18 (31.84–61.34) and 43.82 (33.75–61.34) mL/min/1.73 m2, respectively. The GFR estimates derived from both equations did not differ in respect of the gestational age, sex and postnatal ages of the babies.Conclusions: GFR estimates using the Zappitelli equation had values that were closely related to reference GFR measures for neonates whereas the GFR estimates using the Filler and Lepage equation had higher values

EOSINOPHILIC MENINGITIS IN A 10-YEAR OLD NIGERIAN BOY: A CASE REPORT

Eosinophilic meningitis is rare, commonly caused by invasion of the central nervous system by helminthes. The present case is that of a 10–year–old boy who presented with history of generalized pruritus not associated with skin eruptions, followed by pain and weakness of the extremities and loss of consciousness. Patient did not receive BCG vaccination. Initial clinical evaluation was suggestive of tuberculous meningitis but cerebrospinal fluid analysis revealed eosinophilic meningitis. Patient made remarkable improvement with treatment with no sequel

Global Burden of Sickle Cell Anaemia in Children under Five, 2010-2050: Modelling Based on Demographics, Excess Mortality, and Interventions

The global burden of sickle cell anaemia (SCA) is set to rise as a consequence of improved survival in high-prevalence low- and middle-income countries and population migration to higher-income countries. The host of quantitative evidence documenting these changes has not been assembled at the global level. The purpose of this study is to estimate trends in the future number of newborns with SCA and the number of lives that could be saved in under-five children with SCA by the implementation of different levels of health interventions.First, we calculated projected numbers of newborns with SCA for each 5-y interval between 2010 and 2050 by combining estimates of national SCA frequencies with projected demographic data. We then accounted for under-five mortality (U5m) projections and tested different levels of excess mortality for children with SCA, reflecting the benefits of implementing specific health interventions for under-five patients in 2015, to assess the number of lives that could be saved with appropriate health care services. The estimated number of newborns with SCA globally will increase from 305,800 (confidence interval [CI]: 238,400-398,800) in 2010 to 404,200 (CI: 242,500-657,600) in 2050. It is likely that Nigeria (2010: 91,000 newborns with SCA [CI: 77,900-106,100]; 2050: 140,800 [CI: 95,500-200,600]) and the Democratic Republic of the Congo (2010: 39,700 [CI: 32,600-48,800]; 2050: 44,700 [CI: 27,100-70,500]) will remain the countries most in need of policies for the prevention and management of SCA. We predict a decrease in the annual number of newborns with SCA in India (2010: 44,400 [CI: 33,700-59,100]; 2050: 33,900 [CI: 15,900-64,700]). The implementation of basic health interventions (e.g., prenatal diagnosis, penicillin prophylaxis, and vaccination) for SCA in 2015, leading to significant reductions in excess mortality among under-five children with SCA, could, by 2050, prolong the lives of 5,302,900 [CI: 3,174,800-6,699,100] newborns with SCA. Similarly, large-scale universal screening could save the lives of up to 9,806,000 (CI: 6,745,800-14,232,700) newborns with SCA globally, 85% (CI: 81%-88%) of whom will be born in sub-Saharan Africa. The study findings are limited by the uncertainty in the estimates and the assumptions around mortality reductions associated with interventions.Our quantitative approach confirms that the global burden of SCA is increasing, and highlights the need to develop specific national policies for appropriate public health planning, particularly in low- and middle-income countries. Further empirical collaborative epidemiological studies are vital to assess current and future health care needs, especially in Nigeria, the Democratic Republic of the Congo, and India

The burden of truncus arteriosus in an Urban City in Africa: How are we fairing?

Background: The true incidence of truncus arteriosus in underdeveloped countries is difficult to determine. This is due largely to underreporting as a result of nonavailability of technologically advanced facilities to make definitive diagnosis prenatally. There is a lack of data on the profile and outcome of patients with persistent truncus arteriosus (PTA) in Nigeria. This study aims to document the demographic characteristics, mode of presentation, indications for echocardiography, associated anomalies, average age at diagnosis, and outcome of patients with truncus arteriosus in our center. Methods: Prospective and cross-sectional involving consecutive patients diagnosed with PTA using echocardiography at the Paediatric Department of Lagos State University Teaching Hospital, Lagos, Nigeria as part of a large study between January 2008 and December 2015. Results: Only 25 patients had PTA during the study period. The prevalence of PTA among children presenting at the study center during the study period was 7.9/100,000. It constituted 2.4% of the cases of congenital heart disease and 7.1% of cases of cyanotic congenital heart disease. The male:female ratio was 1:1.1. The ages of the patients at diagnosis ranged between 0.75 and 153 months with a mean age at diagnosis ± standard deviation of 18.4 months ± 37.7. Only about 40% of patients were diagnosed within the neonatal period. Cyanosis was the most frequent indication for evaluation. Conclusion: PTA is as common in Nigeria as in the other parts of the world but diagnosed late. Cyanosis is the most common presenting feature

Nigerian Children with Acquired Heart Disease: The Experience in Lagos

Background: Most of the recent reports on acquired heart diseases (AHDs) among Nigerian children are either retrospective or cover a short period of time with fewer subjects. The last report on AHDs among children in Lagos was about a decade ago; it was, however, not specific to children with AHDs but was part of a report on structural heart diseases among children in Lagos. The present study was carried out to document the prevalence and profile of different AHDs in children and to compare the findings with those previously reported. Methods: We conducted a quantitative, nonexperimental, prospective, and cross-sectional review of all consecutive cases of AHDs diagnosed with echocardiography at the Lagos State University Teaching Hospital between January 2007 and June 2016. Comparisons between the normally distributed quantitative data were made with the Student t test, while the χ2 test was applied for the categorical data. Results: The subjects with AHDs were 73 males and 52 females, with a male-to-female ratio of 1.4:1. The children were aged 15 days to 14 years, with a mean of 6.61 ± 4.26 years. Rheumatic heart disease was the most common AHD, documented in a quarter of the children, followed by dilated cardiomyopathy and pericardial effusion in 20.8% and 17.3%, respectively. Less common lesions encountered were Kawasaki disease, mitral valve prolapse, hyperdynamic circulation, and supraventricular tachycardia. Conclusion: Rheumatic heart disease was still the most common AHD in the children in the present study. Dilated cardiomyopathy and pericardial effusion are on the increase as has been reported earlier

The role of doulas in providing breastfeeding support during the COVID-19 pandemic

Abstract Background Doulas have been instrumental in providing breastfeeding support to nursing mothers before and during the COVID-19 pandemic, as they can significantly impact a mother's ability to initiate and maintain breastfeeding. However, the COVID-19 pandemic, subsequent lockdowns, and social isolation created challenges for nursing mothers to access doulas' services, usually provided in person. In this study, we examined the role of doulas in providing breastfeeding support during the COVID-19 pandemic, exploring adaptation to COVID-19 guidelines and the challenges doulas face in providing breastfeeding support during the pandemic. Methods A systematic review was conducted following the PRISMA guidelines. Thirteen scientific databases and twenty peer-reviewed journals were searched for journal articles published in English between January 2020 and March 2022 using key search terms (e.g., Doula, Breastfeeding, COVID-19). Studies evaluating the role of doulas in providing breastfeeding support during COVID-19, and the impact of COVID-19 Guidelines on doula services, were included. Two reviewers independently performed the risk of bias assessment and data extraction. Summative content analysis was used to analyze the data. Results The majority of studies were conducted in developed nations. This systematic review includes eight articles, four qualitative, one survey, two mixed-methods studies, and one prospective research study. Seven of the eight studies were conducted in the United States, and the eighth was conducted in multiple countries. These studies have three main themes: (1) virtual breastfeeding support provided by doulas during the pandemic; (2) remote social support provided by doulas to breastfeeding mothers during the pandemic; and (3) barriers to doula service delivery due to COVID-19 restrictions, primarily the exclusion of doulas as essential workers. The eight studies showed that doulas found innovative ways to serve the needs of birthing and nursing mothers during the difficulties brought on by the pandemic. Conclusion Doulas provided breastfeeding support during the COVID-19 pandemic by utilizing innovative service delivery methods while navigating changes in COVID-19 guidance. However, system-level integration of doulas' work and the acknowledgment of doulas as essential healthcare providers are needed to enhance doula service delivery capacity, especially during a pandemic, to help improve maternal health outcomes

Children With Tetralogy of Fallot in an Urban Centre in Africa

Introduction: There is a dearth of literature on tetralogy of fallot (TOF) in children in Sub-Saharan Africa. This study up aims to describe the prevalence, clinical profile and associated cardiac anomaly of children diagnosed with TOF documented over an eight year period in a tertiary hospital in South Western Nigeria. Methods: A prospective review of all consecutive cases of TOF diagnosed with echocardiography at the Lagos State University Teaching Hospital (LASUTH) between January 2007 and December 2014. Data were analyzed using SPSS version 20. Tables and charts were used to depict those variables. Descriptive statistic are presented as percentages or means and standard deviation. Means of normally distributed variables were compared using the student t-test and proportions using chi-square test. Skewed distribution were analyzed using appropriate non-parametric tests. Level of significance set at P<0.05. Result: The prevalence of TOF among children presenting at LASUTH at the study period was 4.9 per 10000 while its prevalence among those with congenital heart disease was 16.9%. There was a male predominance and most children presented within 1-5 years of age. Chromosomal abnormalities such as Down syndrome, Turners syndrome and CATCH 22 syndrome were documented in some subjects. Some of the subjects had atypical presentation. Conclusion: TOF is as common in Nigeria as other parts of the world, there is a need to established cardiac centers to salvage these children. Collaboration from developed countries will be helpful in this resource limited region

Echocardiographic reference z scores of right ventricular dimension and systolic function of children aged 5–12 years

Background Reference values for right ventricular dimension and systolic function in Nigerian children are scarce despite their high burden of right ventricular abnormalities. Reference values from other countries may not be suitable for use in Nigerian children because of possible racial variations in cardiac size. Purpose To develop reference values for right ventricular dimension and systolic function in healthy Nigerian children aged 5–12 years. Methods This descriptive cross-sectional study conducted between July and November 2019 included 480 healthy boys and girls aged 5–12 years. The participants were randomly selected from 6 primary schools in the Ikeja Local Government area of Lagos State and their weights and heights measured. Body mass index and body surface area were calculated. Echocardiography was performed at rest in the left lateral position. Results The right ventricular end-diastolic basal diameter (RVD1), right ventricular end-diastolic mid-cavity diameter (RVD2), and right ventricular end-diastolic length (RVD3) were obtained. The right ventricular end-diastolic basal diameter (RVD1), right ventricular end-diastolic mid-cavity diameter (RVD2), and right ventricular end-diastolic length (RVD3) were obtained, as well as tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler-derived right ventricular systolic excursion velocity (S'). The overall mean±standard deviation (SD) values for RVD1, RVD2, RVD3, TAPSE, and S' were 32.95±4.2, 25.86±3.5, 54.57±7.5, 20.11±2.3, and 18.24±2.2, respectively. Age- and sex-specific mean and SD values of the same cardiac indices were determined. Z score charts and the mean± 2SD right ventricular dimensions and systolic function were generated. All right ventricular dimensions were positively correlated with weight, height, body surface area, and body mass index. Only height correlated consistently with TAPSE and S'. Conclusion The observed mean right ventricular dimension indices differed from those derived elsewhere, suggesting that values from other countries may be inappropriate for Nigerian children. These reference values are applicable in daily clinical practice