Childhood mortality in children emergency centre of the Lagos University Teaching hospital

Background: Infant and childhood mortality has remained high in developing countries like Nigeria with only marginal reductions achieved over the past two decades despite several interventions to reduce morbidity and mortality from the common causes of death in children. It istherefore important to examine the current pattern of mortality inchildren and compare it with previous reports from this centre so as to determine if newer interventions are needed or if these current interventions need to be strengthened for more effective reduction in childhood mortality. Objective: The aim of this study was to examine the pattern of childhood mortality in the children emergency centre of the Lagos University Teaching Hospital (LUTH). Materials and Methods: Admission and discharge records from October 2007 to November 2008 were reviewed retrospectively, the age, sex, diagnosis and duration of hospital stay before death were analyzed. Results: Four hundred and forty six children (446) out of the 4031 children admitted during the studyPeriod died, giving a mortality of 11.1%. More than half of the deaths(55.4%) occurred within 24hours of arrival in hospital. Neonates accounted for 54.7% of deaths. The common causes of death in the neonates were perinatal asphyxia (36.1%) , neonatal jaundice (21.3%), prematurity (16.3%) and septicaemia (11.5%), while in the older children anaemia , septicaemia, severe malaria and acute respiratory illnesses were thecommonest conditions accounting for 22.6%, 16.3%, 12.1% and 9.9%of deaths respectively. Conclusion: Childhood mortality in LUTH is still high with majority of deaths occurring in infancy especially in the neonatal period. Efforts to prevent perinatal asphyxia, the most common causeof death in the neonatal period, should be intensified and educationon the prevention , early identification and management ofconditions such as neonatal jaundice, malaria, anaemia and acute respiratory illnesses should also be strengthened

Postural hypotension in type 1 diabetes: The influence of glycemic control and duration of illness

Background: Postural hypotension (PH) indicates the presence of cardiac autonomic neuropathy and in diabetes mellitus (DM) is associated with adverse outcome. Nonetheless, PH has been rarely characterized in young persons in Sub‑saharan Africa where suboptimal care of DM is prevalent.Aims: The aim of the study was to determine the prevalence of PH in young patients with type 1DM and its relationship with the duration of DM and glycemic control.Settings and Design: It was a cross‑sectional, case control study carried out in the pediatric out‑patient clinic.Materials and Methods: Each study participant had blood pressure (BP) measured in the supine and standing positions. Glycated hemoglobin (HbA1c) levels were determined and disease duration was documented. Statistical Analysis: The mean BP in the different positions was determined. The occurrence of PH, duration of disease and HbA1c levels was determined with logistic regression analysis.Results: A total of 26 diabetic subjects and 26 age and sex matched controls were studied. 12 (46.2%) diabetic subjects had evidence of PH while none of the controls had PH. Diabetic subjects with PH had significantly longer duration of DM than those diabetics without PH (6.79 ± 4.81 vs. 2.83 ± 2.36, P = 0.023). The mean HbA1c level was similar in both groups of diabetic subjects (9.79 ± 2.07 vs. 9.17 ± 2.35). On logistic regression, age, duration of disease, HbA1c level and body mass index were not significant predictors of PH.Conclusion: PH is common in young persons with type 1 DM, with higher frequency in those with long standing disease.Key words: Diabetes mellitus, duration, glycemic control, postural hypotensio

Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya

\ua9 2024 Imam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background Preterm (born < 37 weeks’ gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnerable infants in sub-Saharan Africa. Aim To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/ kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan African countries. Methods Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds. Results Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before the first feed. The median (inter-quartile range) time to first feed was 46 (27, 72) hours of life and time to full enteral feeds (tFEF) was 8 (4.5,12) days with marked variation between neonatal units. Independent predictors of tFEF were time to first feed (unstandardised coefficient B 1.69; 95% CI 1.11 to 2.26; p value <0.001), gestational age (1.77; 0.72 to 2.81; <0.001), the occurrence of respiratory distress (-1.89; -3.50 to -0.79; <0.002) and necrotising enterocolitis (4.31; 1.00 to 7.62; <0.011). Conclusion The use of standardised feeding guidelines may decrease variations in clinical practice, shorten tFEF and thereby improve preterm and VLBW outcomes

Incidence of Congenital Malaria at Delivery in Lagos.

To determine the incidence of congenital malaria at delivery in Lagos, Nigeria. Thick smears were prepared from maternal, umbilical cord, placental blood and neonatal blood of five hundred consenting consecutive women at the time of delivery at the Lagos University Teaching Hospital (LUTH) and Lagos Island Maternity Hospital (LIMH) Lagos, Nigeria during the period-August 2011- February 2012. They were stained with Giemsa stain and examined for malaria parasites. A structured form was used to obtain socio-demographic data. Proportions were compared using the Chi square-test and linear regression analysis was used to determine relationship between variables. The mean maternal age was 28.7±3.2years (range21-40years). There were 151 (30.2%) primigravidae and 349(69.8%) multigravidae. Four hundred and twenty two were booked (84.4%), 78(15.6%) were unbooked, and 484 (96.8%) used malaria chemoprophylaxis. 100(20%) of neonatal blood, 154(30.8%) of maternal blood, 108(21.6%) of cord blood and 126(25.2%) of placental smears were positive for malaria parasites. There was a very high positive correlation between neonatal, maternal, umbilical cord and placental parasitaemia (p<0.05). In view of the high rates of malaria parasitaemia in the neonatal smears observed in this study, we recommend health education, routine smear workup for all neonates with fever and effective malaria chemotherapy and chemoprophylaxis in pregnancy in Nigeria.Keywords: Pregnancy, Congenital malaria, umbilical cord, placenta, Plasmodium falciparum

An 8-year review of major congenital abnormalities in a tertiary hospital in Lagos, Nigeria

Background: Congenital abnormalities are defects present at birth and are increasingly becoming an important cause of neonatal mortality. They can also result in disability in majority of the survivors.Objective: To describe the pattern and outcome of major congenital abnormalities (MCA) in a tertiary hospital in Lagos, Nigeria.Methods: The labour ward and labour ward theatre delivery records and admission records of the in-born ward of the neonatal unit of a tertiary hospital were reviewed retrospectively from January 2007 to December 2014. The MCA were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, (ICD-10). Multiple abnormalities were counted once by the system with the most major anomaly. Abnormalities were grouped according to organ systems, sex and yearly distribution. Statistical analysis was based on systemic type, and neonatal outcome.Results: Out of 14581 deliveries during the study period, 167 had MCA, giving an incidence of 11.5 per 1000 total births; 71 (42.5%) were females, 91 (54.5%) were male and 5(3.0%) had indeterminate sex. There was an increase in the yearly incidence from 2007-2014 The most frequent abnormalities were in the central nervous system (31.7%), musculoskeletal system (18.6%), complex congenital abnormalities group (15.5%) and urogenital system (11.4%). Fifty six (31.8%) infants died in the first week of life contributing 12.6% to the overall early neonatal mortality during the study period. Overall case fatality rate was 42.0%; case fatality was highest in the other abnormalities group, followed by chromosomal, cardiovascular and genitourinary system abnormalities respectively.Conclusion: The incidence of MCA in this study is high especially in the central nervous system. There was a steady increase in the yearly incidence during the study period. The overall case fatality rate was also very high with a high contribution to early neonatal deathsKeywords: Congenital abnormalities;Early neonatal death; Lagos;Nigeria; Teratogens

Blood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents

Background: Current methods of detection of childhood hypertension are cumbersome and contribute to under‑diagnosis hence, the need to generate simpler diagnostic tools. The blood pressure to height ratio has recently been proposed as a novel screening tool for prehypertension and hypertension in some populations. We evaluated its applicability in our environment.Materials and Methods: The weights, heights, and blood pressure measurements of 2364 apparently healthy adolescents were determined. Sex‑specific systolic and diastolic blood pressure to height ratios (SBPHR) and (DBPHR) were calculated, and their ability to detect prehypertension and hypertension was determined using receiver operating curves. Discriminatory ability was measured by the area under the curve (AUC) and optimal cutoff points along the curve were determined. P < 0.05 was considered statistically significant.Results: The SBPHR and DBPHR were similar across all age groups and sexes. The AUC of SBPHR and DBPHR for diagnosing prehypertension and hypertension by sex was >0.95 for both diastolic and systolic hypertension in both sexes. It ranged between 0.803 and 0.922 for prehypertension and 0.954–0.978 for hypertension indicating higher accuracy for hypertension. Sensitivity was higher for systolic and diastolic hypertension (90–98%) compared with prehypertension (87–98%). Specificity was lower than sensitivity across all categories of hypertension and prehypertension (0.64–0.88%) though higher for hypertension (0.75–0.88) compared with prehypertension (0.64–0.75).Conclusion: BPHR is a useful screening tool for prehypertension and hypertension in black adolescents. Accuracy increased with higher degrees of hypertension.Keywords: Adolescents, blood pressure, height, hypertensio

Unusual presentation of infantile hypertrophic pyloric stenosis in a ten-week old infant

No Abstract.The Nigerian Journal of Paediatrics Vol. 32 (2) 2005: pp. 56-5

Zinc supplementation in children with acute diarrhoea

No Abstract