Advanced diagnostic techniques for paediatric chronic kidney disease in a developing country: A narrative review

Abstract: Chronic kidney disease (CKD) is described as a complex and progressive condition that arises from both non-communicable diseases (NCD) and communicable diseases (CD). Approximately a tenth of adults are affected worldwide, but the global prevalence of paediatric CKD remains unknown. Unfortunately, advanced diagnostic techniques and interventions are not readily available in most developing countries. This review seeks to create more awareness about paediatric CKD in a developing country like Nigeria and the need to intensify efforts to make new technologies for its diagnosis available and more affordable

Pattern of morbidity and mortality of newborns admitted into the sick and special care baby unit of Enugu State University Teaching Hospital, Enugu state

Background: Being the highest contributor to under-5 mortality, neonatal mortality and morbidity has great impact to the attainment of millennium development goals 4 (MDG 4). In Nigeria and other developing countries, this indicator strongly poses a major challenge in achieving this goal. Objectives: To determine the morbidity and mortality pattern of admitted babies in the special care baby unit (SCBU) of Enugu State University Teaching Hospital (ESUTH).Materials and Methods: This is a comparative and descriptive longitudinal study of causes of morbidity and mortality between babies born within (inborn) and outside our hospital facilities (outborn) based on information on place of birth, APGAR scores, age on admission, diagnosis on  admission, duration of hospital stay, and outcome of newborns admittedinto the sick and SCBU over a 1 year period. Results: A total of 261 neonates were admitted during the period under review. The common causes of admissions seen from the study were perinatal asphyxia (80, 30.7%), low birth weight (64, 24.5%), neonatal sepsis (44, 16.9%), and neonatal jaundice (16, 0.06%). A total of 37 (14.2%) deaths were recorded during the period. The leading causes of deaths were severe form of perinatal asphyxia (18, 52.9%), neonatal sepsis (10, 29.4%), and very low birth weight (two, 0.06%). Fifty.five percent of all the deaths occurred within 24 h of admission. Death dueto asphyxia was more in babies born outside the hospital (outborn) than in babies born within the hospital (inborn). Equal number of outborn and inborn babies died from neonatal sepsis. The age at presentation to the sick baby unit was significantly lower in inborn (P = 0.004), while age at death was not different in both group of newborns (P = 0.876).Conclusion: The neonatal mortality rate and the causes of death in this study are similar to those documented by other studies in Nigeria and are largely preventable. Strengthening perinatal care, emergency obstetric services, and enhancement of neonatal resuscitation skills to traditional birth attendants (TBAs) and other community health workers are necessary to reduce the neonatal mortality in our setting and other rural settings across developing countries. Key words: Enugu, morbidity, mortality, newbor

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

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

ABO histo-blood group and risk of respiratory atopy in children: a review of published evidence

Samuel N Uwaezuoke,1 Joy N Eze,1 Adaeze C Ayuk,1 Ikenna K Ndu2 1Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla Enugu, Nigeria; 2Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: Besides their fundamental role in transfusion medicine, ABO and other histo-blood group antigens are associated with the pathogenesis of some human diseases such as malignancy and thrombosis. Reports also show a possible relationship with the risk of asthma and other forms of respiratory atopy. This paper aims to critically review the current evidence linking ABO histo-blood group with the risk of respiratory atopy in children and adults. A literature search was conducted with PubMed to gather baseline data about this relationship. The search extended to studies published within the past 45 years. First, the molecular mechanism underpinning the role of ABO antigenic system in human diseases comprises a fascinating relationship with von Willebrand factor and several pro-inflammatory and adhesion molecules. Second, specific blood group types vary with asthma phenotypes; severe asthma is associated with B phenotype, while mild and moderate asthma is associated with O and A phenotypes. Third, O phenotype has been linked to allergic rhinitis but only in males. Furthermore, asthma risk is related to O/Lewis negative/secretor phenotypes, while a significant relationship has also been established with B phenotype but not with A and O phenotypes. However, one study failed to establish a significant relationship with any of the ABO blood group antigens. In conclusion, there is no unanimity on the specific histo-blood groups linked to respiratory atopy risk, although asthma phenotypes are associated with specific blood groups. Despite the prospect that this relationship holds for the use of blood-group typing in evaluating respiratory atopy risk in children, more evidence-based studies are still required for its validation. Keywords: blood-group phenotypes, asthma phenotypes, B phenotype, von Willebrand factor, asthma risk, blood-group typin

Morbidity and mortality pattern in the Children Emergency Unit of the University of Nigeria Teaching Hospital Enugu

Background: Efforts to improve child survival can only be effective if they are based on reasonably accurate information about the causes of death.Objectives: To review the pattern of post-neonatal deaths among children admitted into the Children Emergency Unit of the University of Nigeria Teaching Hospital, Enugu, Nigeria.Methodology: The records of all the children admitted into the Children Emergency Unit of the University of Nigeria Teaching Hospital, Enugu from January 2006 to December 2010 were reviewed. Neonates were excluded. Information extracted from the records included: age, sex, date of presentation, final diagnosis and duration of admission. Analysis was mainly descriptive, while frequency tables, graph and prose were used to present the results.Results: A total of 6,816 admissions were recorded during the period. Cases of malaria, acute gastroenteritis, pneumonia and sepsis were the most commonly admitted. There were 267 deaths, with a mortality rate of 3.9%. Sepsis, malaria, and acute gastroenteritis accounted for 28.8%, 24% and 11.2% of deaths, respectively. More than 77% of the deaths occurred among children under 5years of age. Mortality was higher during the dry months of December to March, (p=0.760, χ2 =0.094). More than 60% of the deaths occurred within 24hours of presentation, (χ2 =131.9, p=0.001).Conclusion: Mortality rate at the Children Emergency Unit of the University of Nigeria Teaching Hospital, Enugu was 3.9%. Infectious diseases were the major causes of mortality in these children. There is, thus, a need for goal-directed efforts towards reducing the mortality from these diseases.Keywords: Admission, disease, gastroenteritis, malaria, pneumonia, sepsi

Out-of-pocket cost of managing sick newborns in Enugu, southeast Nigeria

Uchenna Ekwochi,1 D Chidiebere Osuorah,3 Ikenna K Ndu,1 Osita U Ezenwosu,2 Ogechukwu F Amadi,1 Ikenna C Nwokoye,1 O Israel Odetunde2 1Department of Pediatrics, Enugu State University Teaching Hospital, Parklane, Nigeria; 2Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria; 3Child Survival Unit, Medical Research Council (UK), The Gambia unit, Fajara, The Gambia Background: Neonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US2 per day, these bills are not affordable to many families' livelihoods. Aim: This study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases. Methods: This is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses. Results: A hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86±8.81 days and ₦36,382±19,389.72 (US223±119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than ₦10,000 (US61), ₦10,000–49,999 (US61–306), and ₦50,000–100,000 (US306–612) and more than ₦100,000 (US612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn's illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis (₦23,499±14,987 [US144±92], P=0.001), low birth weight (₦39,863±24,003 [US224±147], P=0.001), severe anemia (₦40,504±13,923 [US248±85], P=0.001), transient tachypnea of the newborn (₦10,083±1,078 [US62±7], P=0.001), birth asphyxia (₦24,398±14,096 [US149±86], P=0.001), and meningitis (₦26,731±7,675 [US164±47], P=0.001), whereas cost for laboratory investigations was significantly higher for neonatal jaundice (₦11,690±3,169 [US$72±19], P=0.001). There was a strong positive correlation between duration of hospital stay and total medical cost incurred (r=0.897, P=0.001). Conclusion: Health expenditure on neonatal illness is high and leads to catastrophic expenditure for the majority of households in the state. There is a need for effective health insurance schemes to help subsidize and cushion this disastrous and impoverishing health expenditure on families for improved neonatal survival in Nigeria. Keywords: neonatal illness, out of pocket, health expenditure, Enugu Stat

Determinants of Survival in Low Birth Weight Infants at a Tertiary Healthcare Facility in the South Eastern Nigeria

Low birth weight (LBW) babies account for a large number of neonatal deaths globally, with over 90% of these occurring in developing countries with low resources. Identifying factors that determine survival in these sub-groups of babies in such a low-resource setting will help clinicians prioritize care and improve outcomes. This study aims to bridge some knowledge gaps in this regard. This was a 45-month prospective study carried out at the Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria. All eligible newborns weighing between 500g and and lt;2500g that were seen in this period were enrolled and monitored. Data collected were analysed with SPSS Version 24, and significant associations identified using logistic regression models. A total of 166 LBW neonates were enrolled, and 68.2% of them survived. Asphyxia and episodes recurrent apnoea were recorded at least once in 78.8% and 68.4% of the babies respectively, with about two-thirds requiring respiratory support at one time or the other. Survival in these LBW newborns was negatively associated with gestational age at birth of less than 32 weeks (OR 0.17; CI 0.03-0.50; P and lt;0.01) as well as with episodes of recurrent apnoea (OR 0.07; CI 0.02-0.34; P and lt;0.01). However, intra-uterine exposure to malaria was associated with a 15 times higher likelihood of survival (OR 15.41; CI 2.22-106.91; P=0.01). No significant associations was found between survival and attendances to antenatal care, mode of delivery, birth weight and a number of neonatal morbidities like necrotizing enterocolitis, hypothermia, hypoglycaemia, septicaemia, anaemia and neonatal jaundice. Survival rate among low birth weight neonates in a low resource setting is decreased with delivery at less than 32 weeks completed gestation as well as recurrent episodes of apnoea, but is increased with in-utero exposure to malaria

Association between caregivers' knowledge and care seeking behaviour for children with symptoms of pneumonia in six sub-Saharan African Countries

BACKGROUND: Pneumonia is the main cause of child mortality world-wide and most of these deaths occur in sub-Saharan Africa (SSA). Treatment with effective antibiotics is crucial to prevent these deaths; nevertheless only 2 out of 5 children with symptoms of pneumonia are taken to an appropriate care provider in SSA. While various factors associated with care seeking have been identified, the relationship between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia is not well researched. METHODS: Based on data from Multiple Indicator Cluster Surveys, we assessed the association between caregivers’ knowledge of symptoms related to pneumonia – namely fast or difficulty breathing – and care seeking behaviour for these symptoms. We analysed data of 4,163 children with symptoms of pneumonia and their caregivers. A Chi-square tests and multivariable logistic regression was performed to assess the association between care seeking and knowledge of at least one symptom (i.e., fast or difficulty breathing). RESULTS: Across all 6 countries only around 30% of caregivers were aware of at least one of the two symptoms of pneumonia (i.e., fast or difficulty breathing). Our study shows that in the Democratic Republic of the Congo and Nigeria there was a positive association between knowledge and care seeking (P ≤ 0.01), even after adjusting for key variables (including wealth, residence, education). We found no association between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia in Central African Republic, Chad, Malawi, and Sierra Leone. CONCLUSIONS: These findings reveal an urgent need to increase community awareness of pneumonia symptoms, while simultaneously designing context specific strategies to address the fundamental challenges associated with timely care seeking