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

Serum Iron Status of Children with Cyanotic Congenital Heart Disease in Lagos, Nigeria

Objectives: Cyanotic congenital heart disease (CCHD) predisposes patients to iron deficiency due to compensatory secondary erythrocytosis. This study aimed to determine the serum iron status and prevalence of iron deficiency among children with cyanotic congenital heart disease attending the Paediatric Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Methods: This cross-sectional casecontrol study took place between May and October 2015 at the Lagos State University Teaching Hospital. A total of 75 children with cyanotic congenital heart disease and 75 apparently healthy age-, gender- and socioeconomicallymatched controls were analysed to determine serum iron status and the prevalence of iron deficiency as defined by the World Health Organization criteria. Results: The mean age of the children was 47.5 ± 2.9 months (range: 6–144 months old). Iron deficiency was significantly more frequent among CCHD patients compared to control subjects (9.3% versus 0%; P = 0.006). While latent iron deficiency was more prevalent among children in the control group compared to those with CCHD, this difference was not statistically significant (13.3% versus 9.3%; P = 0.303). No cases of iron deficiency anaemia were observed in the studied sample. Conclusion: Neither the children in the control group nor those with CCHD had iron deficiency anaemia. However, iron deficiency was significantly more prevalent among children with CCHD in Lagos. Periodic serum iron status screening is therefore recommended for this population.Keywords: Congenital Heart Defects; Cyanosis; Iron Deficiency Anemia; Children; Case-Control Studies; Nigeria

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

Vitamin D status and serum vitamin D binding protein levels in Nigerian children with nephrotic syndrome

Introduction: Nephrotic syndrome is a chronic relapsing condition associated with urinary loss of albumin and other proteins such as vitamin D binding protein (DBP). We determined vitamin D status and serum DBP levels in children with nephrotic syndrome and compared them to healthy controls. Methods: A cross-sectional study was performed over a six-month period in children less than 18 years of age. The children with nephrotic syndrome were categorised by disease status as either newly diagnosed, in remission, resistant to therapy, or in relapse. Vitamin D levels were regarded as sufficient if ≥75 nmol/L, insufficient if <75 nmol/L but ≥50 nmol/L, deficient if <50 nmol/L, and severely deficient if <25 nmol/L. Serum DBP was also measured. Results: Fifty-five children with nephrotic syndrome and 24 controls were included in the study. There was no significant difference between the median ages of the cases (72.0 months, interquartile range (IQR) 48.0–120.0 months) and the controls (84.0 months, IQR 39.0–129.0 months). Severe vitamin D deficiency, deficiency and insufficient levels were documented in 54.5%, 41.8% and 3.6% of cases, respectively, significantly lower than the controls (P = 0.003). Vitamin D levels were higher in children with nephrotic syndrome in remission than in those who were not (30.3 ± 15.2 nmol/L vs 19.6 ± 11.0 nmol/L, P = 0.004). In the groups who were in remission, newly diagnosed, relapsing, and resistant, the median vitamin D levels were 30.3 nmol/L, 20.1 nmol/L, 19.2 nmol/L and 9.4 nmol/L, respectively (P = 0.031). Conclusions: Hypovitaminosis D occurs frequently in Nigerian children with nephrotic syndrome as well as in apparently healthy controls. Routine supplementation of vitamin D should be considered in children with nephrotic syndrome irrespective of whether the disease is in remission or not, or whether it is steroid-sensitive or not

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

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

Serum cystatin C levels in Healthy Nigerian neonates: Is there a need for normative values in Nigerian babies?

Cystatin C is an endogenous marker of renal function. Normal reference values have been documented in neonates outside Africa, but no study has been documented in African neonates. With reports that race may affect serum cystatin C values, this study was carried out to generate normal values in apparently healthy term neonates at birth and three days of life neonates in Nigeria. This was a hospital-based prospective study. A cohort of 120 apparently healthy term neonates were recruited at birth. Serum cystatin C was measured from the cord blood at birth and venous blood when they were three days old using enzyme-linked immunosorbent assay (ELISA) method. The mean serum cystatin C values for cord blood and 3rd day venous samples were 1.67 ± 0.52 mg/L and 1.62 ± 0.52 mg/L, respectively (P = 0.87). The cord blood and 3rd day serum cystatin C values for males were 1.67 ± 0.47 mg/L and 1.68 ± 0.51 mg/L, respectively (P = 0.77) and the values for females were 1.68 ± 0.56 mg/L and 1.58 ± 0.52 mg/L, respectively (P = 07.22). The serum cystatin C levels were similar among the different birth weight groups and gestational age (P >0.05). The cord blood and 3rd day serum cystatin C values were similar. Serum cystatin C values were independent of gender and birth weight of neonates. The values of serum cystatin C in Nigerian neonates were comparable to that reported for neonates in other regions of the world. It is recommended that ELISA technique may be reliably used to measure serum cystatin C levels in neonates

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