Evaluation of the preparedness of the children’s emergency rooms (CHER) in Southern Nigeria for service delivery

Background: The Children Emergency Room (CHER) is the first point of call for many sick children. A significant proportion of childhood and under five deaths in tertiary institutions takes place in the CHER. There is thus need for a high level skilled manpower and infrastructure in the CHER in readiness for service delivery.Objective: To assesses the preparedness of the children emergency room in tertiary institutions in southern Nigeria to successful management of children presenting to the emergency rooms.Methods: This study was a cross sectional, descriptive multicentre study carried out among nine Tertiary Hospitals in Southern Nigeria. Three tertiary hospitals were randomly selected from each of the three Geo political zones (South-South, South- East and South -West) in Southern Nigeria. A structured questionnaire was used to collect data about the Children Emergency Rooms in these hospitals. The obtained data was entered and analysed using SPSS version 21 and is presented as table.Results: All the centres have an emergency room. The number of doctors in CHER ranged from 7 to 22 while the number of nurses ranged from 10 to 24 persons with a nurse: bed ratio of 1:3-15. In all the centres, the CHER had a side laboratory, well stocked emergency drug shelf, pulse oximeters, oxygen cylinders, electrical and manual suction machines, ambu bags and nebulizers. However, none of the centres has functional manual defibrillator or an Automated External Defibrillator (AED). In 5 (55.6%) of the studied centres, the doctors and nurses have training on emergency triage. Also 5 (55.6%) centres have doctors with certification in emergency care, but none of the nurses in all the centres have any certification in emergency care. Three (33.3%) centres had staff trained with skills on the use of AED while in 4(44.4%) centres they were skilled on the use of manual defibrillators. All the centres have a waiting area for patients’ relatives but only one (11.1%) has a television installed. All the CHERs have toilet facilities for patients relatives but only 5 (55.6%) have bathrooms. Running water is regularly available in the toilets of only 4 (44.4%) of the centres.Conclusion/Recommendation: We conclude that limitation abounds with regards to personnel, high technology infrastructure, personnel skill and patient friendly infrastructure. It is recommended that concerted efforts should be made by the government and all key players to make available the necessary equipment and facilities and ensure that health personnel acquire the necessary skills so that the standard of practice in our tertiary hospitals will be comparable to international best practices

Post exposure prophylaxis against human immunodeficiency virus: Awareness knowledge and practice among Nigerian Paediatricians

Objective: To determine the level of awareness, knowledge and practice of human immunodeficiency virus post exposure prophylaxis (HIV PEP) among paediatricians in Nigeria.Methodology: The study was a cross sectional questionnairebased survey conducted among paediatrcians that attended the Paediatric association of Nigeria annual scientific conference in 2015.Results: Most of the respondents (96%) were aware of the concept HIV PEP. The scores on knowledge of PEP for all the respondents ranged from 18% to 91 % with a mean score of 46.5 ± 14.1%. There was no significant difference between the performance of those who had received training on HIV PEP (48.0 ± 13.2%) and those who had not (45.1 ± 14.8%), p = 0.21, t =1.26. Ninety one (60.7%) of the respondents had been exposed to percutaneous injury during work. Thirty (33%) of the exposed paediatricians did not know the patient’s HIV status and only 10 (11%) received PEP, with only 7 (7.7%) of them completing the PEP for 4 weeksConclusion: Despite the high level of HIV PEP awareness, there was an unacceptable high rate of occupational exposures and poor knowledge of HIV PEP among Paediatricians. Additionally, there was a low uptake of HIV PEP services amongst exposed Paediatricians in Nigeria. There is need for urgent action to curb this trend.Key Words: HIV PEP, Paediatrician, Nigeri

Accidental Childhood Poisoning in Enugu, South‑East, Nigeria

Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South‑East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. Results: Sixty‑five cases of childhood poisoning were recorded during the 10‑year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications.Keywords: Accidental poisoning, Childhood, Kerosen

Dandy Walker malformation (variant): late presentation with childhood blindness

We present a rare case of Dandy Walker Syndrome in a child who presents with complaints of frontal headache, neck pain, fever, progressive visual impairment and multiple generalized tonic clonic seizures, inability to stand and urinary incontinence. Given the clinical and neuro-imaging findings, the diagnosis of Dandy Walker Variant was made. Post surgical recovery (Ventriculo peritoneal shunt) was remarkable. Unfortunately he never regained sight. The purpose of presenting this case report is to highlight the distinctive manifestation of Dandy walker syndrome to enhance early diagnosis, prompt intervention and better outcomeKeywords: Dandy Walker syndrome; congenital brain malformation; childhood blindness; hydrocephalu

Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine

Background: Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods: From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results: A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions: Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the countr

Home Treatment of Presumed Malaria in Children Attending Outpatient Clinic at The University of Nigeria Teaching Hospital, Enugu, Nigeria

Background: According to WHO, majority of the children who die from malaria do so within the first 48 hours of onset of illness and early use of effective antimalarial drugs will reduce the burden of malaria in endemic areas. This study was to determine the pattern of antimalarial drug use by caregivers, their sources as well as when and why they presented to hospital. Patients and Methods: Consecutive mothers whose children presented at the outpatient clinic with fever without localised focus, who believed their children were having malaria, were interviewed with the aid of a questionnaire.Results: One hundred and forty-four (62.6%) of the mothers/caregivers had administered antimalarials at home. 112 (78.3%) commenced within 24hrs of onset of symptoms, while 14 (8.7%) started after 48hrs. Duration of home treatment ranged from less than or equals to 24hrs (32.5%) and one week or more (8.2%). Antimalarials given included choroquine, amodiaquine, artesunate, sulphadoxine-pyrimethamine, artemisinin-based combination therapy, quinine and paludrine. Majority (67.8%) of the medications given were obtained directly from the local drug stores Conclusion: There was a high rate of home treatment for febrile illness in our environment; this calls for the need to educate both mothers and patent drug dealers on the current antimalarial treatment policy.Key Words: Malaria, Treatment, Children, Hom

A comparison of axillary with rectal thermometry in under 5 children

Background: Body temperature measurement is a crucial clinical assessment in the care of an acutely ill child, especially the under fives. Most temperature measurements in our hospital are done from the axilla. Objective: To study the relationship between temperatures taken in the axilla with those taken in the rectum in febrile and afebrile children less than 5 years.Materials and Methods: Rectal and axillary temperatures were taken concurrently in 400 febrile and 400 afebrile children aged less than 5 years using mercury-in-glass thermometers.Result: The rectal temperature measurements ranged from 38.0 to 41.4°C and 36.4 to 37.9°C in the febrile and afebrile groups of children respectively while the axillary temperatures ranged from 36.7 to 41.0°C and 35.9 to 37.5°C in the febrile and afebrile groups of children, respectively. There were significant differences between the temperatures measured at the two sites in all the age groups studied. There was good positive correlation between the rectal and axillary temperatures. A linear relationship between axillary and rectal temperatures was derived using the simple regression analysis. The equation is: rectal temperature = 0.94×axillary temperature+2.92. Conclusion: Although there’s good correlation between axillary and rectal temperatures, significant difference exits between them that cannot be explained by the addition of any single value or any particular equation.Key words: Axillary, children, rectal, temperature, thermometr

Generalized Haemangiomas with Visceral Involvement: Case Report

Haemangiomas are the most common benign tumours of infancy. Most cases of haemangiomas present as solitary lesions, but about 20% have more than one lesion. The presence of 3 lesions is uncommon and the presence of 4 or more lesions is rare. The presence of multiple cutaneous haemangiomas greatly enhance the chances that the child could have visceral haemangioma. We report an 11- month old infant with multiple cutaneous haemangiomas with visceral involvement complicated by congestive cardiac failure. Initially,he responded to treatment with prednisolone and antifailure drugs, but died later as a result of exacerbation. Some of the problems associated with managing such cases in a resource-poor country are highlighted

Osteogenesis Imperfecta: A Case Report and Review of Literature

Osteogenesis imperfecta (OI) is a group of rare inherited disorders of connective tissue with the common feature of excessive fragility of bones caused by mutations in collagen. Diagnosis is mainly based on the clinical features of the disorder. We report, the case of a male neonate delivered to a 33‑year‑old para 2 female at University of Nigeria Teaching Hospital, Enugu with no family history suggestive of OI. He had clinical features of a type II OI and severe birth asphyxia. Multidisciplinary management was instituted, but he died on the 7th day of life.Keywords: Brittle bone disease and fragile bone disease, Fragilitas ossium, Osteogenesis imperfecta, Osteopetrosis idiopathic

The Prevalence of Allergic Diseases among Children with Asthma: What is the Impact on Asthma Control in South East Nigeria?

Background: Allergic diseases are known to occur in children with asthma and its coexistence with asthma may impact on asthma control in affected children living in a low‑income country. The study is to determine the allergic profile of children with asthma and the association with asthma control and attendant social risk factors. Materials and Methods: This was a cross‑sectional study of consecutively enrolled children with physician diagnosed asthma, attending clinics in a tertiary center in Nigeria. The presence of asthma, allergy types, and asthma control levels were determined using the Gobal initiative on asthma (GINA), international study of asthma and allergy in childhood and asthma control test questionnaires, respectively. Results: There were 207 children with asthma enrolled from the Pediatric Asthma Clinic at University of Nigeria Teaching Hospital, Enugu. The median age was 10 years and interquartile range of 7–11 years. There were 127 (61.4%) from middle and high socioeconomic class and 86.5% who lived in the urban areas. Of the study participants, 41.5% had one or more allergy symptoms; rhinitis (33.3%), conjunctivitis (29.0%), and dermatitis (7.2%). Allergy symptoms persisted from infancy in 55.9%. Children from large families had a lower prevalence of allergies. Having any allergy symptom and belonging to a small‑sized family were both associated with asthma exacerbations. Most children studied, (69.1%) had their asthma under control. Allergy persistence from infancy and type of allergy were not significantly associated with the level of asthma control. Conclusion: Allergic diseases are common in children with asthma in our environment, but did not significantly impact on asthma control. Socioeconomic factors such as urbanization and family size had effects on the achievement of asthma control but not on allergy status.Keywords: Allergy, asthma, children, control, severit