Challenges of Managing Childhood Malaria in a Developing Country: The Case of Nigeria

Malaria still remains one of the highest childhood killer diseases, especially in the developing countries of Africa, Southeast Asia, and Eastern Mediterranean regions. With an estimated 100 million cases and 300,000 deaths from malaria annually, Nigeria has one of the highest burdens of malaria in the world, with children mostly affected. It accounts for 60% of outpatient visits, 30% hospitalization among children under 5 years of age. Great efforts and huge funding have been committed globally towards the fight for malaria, but malaria continues to be a major challenge in these developing countries, especially countries in Sub-Saharan Africa. The World Health Organisation adopted a cost-effective intervention strategy, which comprises a three-pronged approach: vector control, chemoprophylaxis, and case management. Case management involves early diagnosis and treatment. This chapter looks at the challenges militating against the achievement of this important aspect of malaria control in children as well as efforts that have been made or not made to overcome these challenges using Nigeria as a case study

Determinants of Outcome in Febrile Children Admitted into the Emergency Rooms of Two Tertiary Hospitals in Enugu Southeast Nigeria

Introduction: Febrile illnesses have continued to be the highest causes of mortalities in children admitted to the children emergency roomsin Nigeria. This study was carried out to review the determinants of outcome in children admitted for febrile illness into the emergency roomsof two tertiary institutions in Enugu, Nigeria. Materials and Methods: This was a retrospective study of 335 children who presented with fever to the emergency rooms over one year (January–December 2018). Their case records were retrieved, and the necessary information was obtained using a structured questionnaire. Statistical analysis included odds ratio and Chi‑square test. Results: The mean age of the children was 43.20 ± 50.30 months. The mean temperature at presentation was 38.2°C ± 0.9°C. Fever of 39.0°C or above at presentation and fever duration of >2 days were significantly associated with fatal outcome. Children residing in rural areas or referred from other health facilities were more likely to die. The risk of dying from fever was highest when it was associated with diarrhea, weakness, pallor, convulsions, unconsciousness, and difficult/fast breathing. Conclusion: Most of the factors responsible for mortality in febrile children are largely preventable and treatablewhen the presentation is early. Keywords: Determinants, emergency room, febrile children, Nigeria, outcom

Clinical Profile and Electrolyte Abnormalities in Hospitalized Under‑Five Children with Acute Gastroenteritis in a Tertiary Health Facility

Background: Electrolyte abnormalities constitute the leading causes of morbidity and mortality in younger children with acute gastroenteritis.The aim of the study was to determine the clinical profile and pattern of electrolyte abnormalities in under‑five children hospitalized for acutegastroenteritis from November 1, 2014, to January 31, 2015. Methodology: This was a cross‑sectional descriptive study among hospitalized under‑five children with acute diarrhea who were consecutively recruited from November 1, 2014, to January 31, 2015. Relevant clinical data were obtained, while the physical examination was done on all subjects. Serum electrolytes values were determined using the ion‑selective electrode system and compared with standard reference ranges. The data were analyzed using SPSS version 21.0 with the level of statistical significance set at P < 0.05. Results: A total of 108 under‑five children were studied. The majority (101; 93.5%) were <24 months of age, while 41 (38%) of low socioeconomic class background. Metabolic acidosis was the most common electrolyte abnormality followed by hyponatremia and hypokalemia occurring singly or in combination. The case fatality rate was 13 (12.0%). The electrolyte derangements associated with mortality were hypokalemia and acidosis: 11 (84.6%) each, 9 (69.2%) had hyperchloremia, while 6 (46.2%) were reported to have hyponatremia. Conclusion: Electrolyte derangements are common in under 5 years children with acute diarrhea with increased mortality in those with severe acute malnutrition. Proper health education is needed to ensure adequate nutrition and timely use of low‑osmolar oral rehydration solution as well as early referral of cases with persistent gastrointestinal losses in order to save lives. Keywords: Acute gastroenteritis, electrolyte abnormalities, under‑five childre

A Comparison of the Performance of the Midarm Circumference and the Nelson Weight Estimation Formulas in Nigerian Children

Background: In emergencies, two commonly used weight estimation methods are Nelson and mid‑arm circumference (MAC)‑based formulae. Nelson’s method requires the child’s age while the MAC formula offers weight estimation without any prior details of the child, which is useful in our environment due to the lack of proper vital statistics documentation. Methodology: We measured the weight, height, and MAC of 1390 children aged 1–12 years. Values got from the measurements were substituted in MAC and Nelson formulae for weight estimation. The estimated weights were compared to the actual weights of the children. Results: Atotal of 1390 children were enrolled. The mean of enrolled children’s actual weight was significantly higher than the mean weight estimated using MAC and Nelson formula. MAC method overestimated weight in children 1–7 years and underestimated weight in those 8–12 years old. On the other hand, the Nelson formula underestimated weights in children 2–11 years and overestimated weight in 1 and 12-year olds. Conclusions: Both the MAC and Nelson method have their deficiencies in weight estimation. Though the Nelson formula  appears slightly more accurate than the MAC, weight estimates from both methods were mostly within the actual weight agreement limits. Keywords: Actual weight, children, comparison, formulae, mid‑arm circumference, nelso

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 country

Digestive system complications among hospitalized children with sickle cell anaemia in Enugu, Nigeria

Background: Sickle cell anaemia is a multi-systemic disease with variable clinical manifestations including those involving the digestive system. There is paucity of data on the digestive system complications of sickle cell anaemia in children in our setting.Objective: To determine the pattern of digestive system complications among hospitalized children with sickle cell anaemia in University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.Methodology: A 7-year retrospective observational study of cases of digestive system complications among hospitalized children with sickle cell anaemia was carried out. Relevant clinical data including socio-demographic characteristics, digestive system complications diagnosed, definitive investigations applied, treatment given and possible outcomes were extracted from the case record files of selected cases using a semi-structured questionnaire. Data were analyzed using SPSS version 21.0 (IBM Corp, Armonk, NY 2012) while the level of statistical significance was set at p&lt;0.05.Results: There were 350 children with sickle cell anaemia attending the sickle cell clinic out of which 33 had serious digestive system complications requiring hospitalizations during the period under review. Their mean age was 9.1±4.8years (9months to 18years).Nearly half, 16(48.5%) of the affected children were of low socio-economic background. Acute abdominal crisis, which was found in 12(36.4%) of cases was the most common complication, while cholelithiasis was the least common complication, occurring in one (3.3%) of the cases studied.Conclusion: Acute abdominal crisis is the most common digestive system complication in children with sickle cell anaemia in our setting. Efforts should be made to exclude other potential causes of acute abdomen which may require surgical intervention in children with sickle cell anaemia. History taking, diligent physical examination and relevant laboratory and imaging studies, would readily facilitate the diagnosis, and save lives.Keywords: Acute abdominal crisis, children, haemoglobin, hospitalization, multi-systemi