The prevalence and risk of urinary tract infection in malnourished children : a systematic review and meta-analysis

There are vast differences in prevalence rates of urinary tract infection (UTI) reported among malnourished children globally. We conducted a systematic review and meta-analysis to provide estimates of pooled prevalence of UTI among these children and combined UTI risk in comparison with their well-nourished counterparts.; We systematically searched electronic databases (MEDLINE, EMBASE, ISI Web of Science and African Journals Online; date of the last search: 22 December 2018) for studies reporting either the prevalence of UTI in malnourished children or parallel healthy controls. Eligible primary studies were observational studies of children in English Language reporting UTI prevalence with background malnutrition or with enough data to compute these estimates, as well as studies which reported at the same time UTI prevalence in healthy controls. We synthesized published prevalence rates or associations (odds ratios [OR]) between malnutrition and UTI and their 95% confidence intervals (CI) using random effects meta-regression and explored potential heterogeneity determinants using meta-regression analysis. This review is registered with PROSPERO, number- CRD42018084765.; We included 26 cross-sectional and 8 case-control studies reporting on UTI prevalence in malnourished children, and in malnourished children vs. healthy controls, respectively. The pooled prevalence of UTI in 3294 malnourished children was 17% (95% CI, 13, 21%). Heterogeneity was high (I; 2; = 87.6%; Tau; 2; = 0.06) as studies varied in their sample size, degree of malnutrition, and study period. Multivariate meta-regression model, including these factors, explained 34.6% of the between-study variance. Pooled OR of UTI in association with malnutrition in 2051 children (1052 malnourished children vs. 999 controls) was 2.34 (95% CI, 1.15, 3.34), with lower between-study heterogeneity (I; 2; = 53.6%; Tau; 2; = 0.47).; UTI is more prevalent in malnourished children than in their well-nourished counterparts. Screening and treatment for UTI should be incorporated in the management protocol of malnourished children to improve disease outcomes

Nocturnal Enuresis in Children with Sickle Cell Anemia

Sickle cell anemia (SCA) is the commonest hemoglobin disorder among the black population worldwide. Children with SCA may eventually end up with end-organ complications: the kidneys being one of the most frequently affected organs. The renal complications arise from medullary ischemia and infarction leading to features of tubular dysfunction such as hyposthenuria and renal tubular acidosis. Early in life, children with SCA may present with hyposthenuria: one of the earliest renal defects in the disease which results in an obligatory urine output of more than 2 l in a day. The symptomatic manifestation as nocturnal polyuria is thought to be the reason for nocturnal enuresis observed in these children. In spite of the more prevalent occurrence of nocturnal enuresis in children with SCA than in their non-SCA colleagues, its precise underlying mechanisms still remain controversial, with divergent conclusions regarding its pathogenesis. However, the consensus is now tilting towards a multifactorial etiopathogenesis in affected children. This book chapter aims to discuss the epidemiologic perspectives of nocturnal enuresis in SCA, as well as the current hypotheses on the etiopathogenesis of this complication

Maternal Diet during Exclusive Breastfeeding can Predict Food Preference in Preschoolers: A Cross-Sectional Study of Mother- Child Dyads in Enugu, South-East Nigeria

Background: The relationship between food preference in early childhood and prenatal exposure to flavor in the amniotic fluid is well documented. Although its association with flavor transmission in the breast milk has also been noted, it is poorly reported in this country. Objective: The present study aims to determine the relationship between mothers’ dietary exposure during exclusive breastfeeding and food preference in their preschool-aged children. Methods: Two hundred and twenty (220) mother-child dyads who met the study criteria were enrolled. A pre-tested, structured questionnaire was administered to the mothers. The relationship between maternal consumption of flour-based snacks and staple foods during exclusive breastfeeding and the child’s preference for these foods was determined using risk estimates. After controlling for potential confounders, logistic regression was used for multivariate analysis. Statistical significance was determined at p < 0.05 and all the risk estimates were presented as odds ratios (OR) at 95% confidence intervals (CI). Results: The relationship between daily maternal exposure to staple foods during exclusive breastfeeding and the children’s preference for this variety of food was not statistically significant (p = 0.847, OR= 1.083, 95% CI = 0.481-2.437). However, the children’s preference for flour-based snacks was significantly related to weekly or fourth-nightly maternal exposure to similar diet during exclusive breast feeding (p = 0.035, OR = 2.405, 95% C.I = 1.064 - 5.435). Conclusion: Transmission of flavor in the breast milk may contribute in shaping children’s feeding behavior early in life

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

Evaluation of Physician Burnout Syndrome Among Pediatric Resident Doctors in Nigeria

Background: Medical practice and education are known to lead to emotional and mental exhaustion as well as physical tiredness among healthcare workers. This study analyzed the prevalence and factors associated with physician burnout syndrome (PBS) among resident doctors in paediatric across Nigeria. Methodology: This cross-sectional study was conducted among paediatric resident doctors across Nigeria using the public welfare questionnaire of the American Welfare Association comprising 28 questions related to sleep affectation, energy levels, personal relationships, professional relationships, quality of job environment, and work satisfaction. Results: 117 residents were enrolled with varying degrees of burnout. The mean PBS score was 75.3 ± 19.1 with minimum and  maximum scores of 32 and 125, respectively. The prevalence of Grades 0, 1, 2, 3, and 4 PBSs was 3.7%, 4.9%, 28.1%, 42.7%, and 18.3%, respectively, while 63.4% of respondents exhibited signs of symptomatic PBS. The residents’ rank (P = 0.05) was significantly associated with the prevalence of symptomatic PBS, while age (P = 0.567), gender (P = 0.755), number of years in training (P = 0.411), marital status (P = 0.173), number of children (P = 0.974), religion (P = 0.09), and prior knowledge of PBS (P = 0.719) had no association with the development of symptomatic PBS among surveyed resident doctors. Conclusion: The prevalence of PBS is high among paediatric resident doctors. There is an urgent need for the postgraduate medical colleges in collaboration with the Ministry of Health to formulate programmes that will help to balance social and professional livesamong paediatric resident doctors in Nigeria. Keywords: Burnout, Nigeria, paediatric, physician

Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria

BackgroundEnumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations.ObjectivesThe objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography.MethodsA cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls.ResultsA significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001). All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p<0.005). ConclusionThis result shows that children with sickle cell anemia have increased valvar size diameter compared with those with normal hemoglobin type. A significantly higher proportion of respondents in type SS group had abnormal left ventricular systolic and diastolic dysfunction when compared with those in type AA grou

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

Early Cessation of Breastfeeding: A Neglected Nutritional Challenge among Infants

Abstract Background: Breastfeeding (nursing) strike and early-weaning occur when infants often older than 3 months refuse to nurse for no apparent reason. This condition can be distressing to both the infant and mother. It is most times difficult for mothers to detect the cause of this phenomenon. This often puzzling state of infants feeding strike could lead to poor infant feeding practices thereby predisposing the infant to malnutrition and infections. Methods: This cross-sectional descriptive and analytical study enrolled 421 mothers who had nursed at least one child for 12 months or more. Appropriate statistical tools were used to determine prevalence of breastfeeding strike and maternal socio-demographics that are associated with refusal of breastfeeding in infants before 6 months of age. Results: Prevalence of breastfeeding strike in our study was 2.8%. Though statistical significance was not attained probably due to small sample size (n= 88), older mothers, those with more children, higher occupational grades and higher educational attainment were more likely to experience infant refusal of breastfeeding before 6 months of age. Conclusion: Despite the low prevalence reported in our study, breastfeeding strike is of great public health and family importance. There is need for more study to determine factors responsible for nursing strike in various cultural contexts in order to better educate mothers on how to prevent this present but covert phenomenon