Paediatric endocrine disorders at a tertiary hospital in Lagos, Nigeria

Background: The global increase in paediatric endocrine disorders (PED) is thought to be a result of multiple factors including changing lifestyles, environmental pollution and increasing awareness and diagnostic capabilities. Studies on the prevalence of paediatric endocrine disorders in the developing world are few. A preliminary audit of PED at the Lagos State University Teaching Hospital two years ago revealed type 1 diabetes mellitus as the commonest diagnosis. Since then many more children with PED continue to be referred from various centres.Objective: The aim of the present study was to describe the burden and pattern paediatric endocrine disorders over a three-year period.Subjects and Methods: Records of patients who presented in the paediatric endocrine unit between March 2017 and March 2020 were reviewed and relevant data on age at presentation, sex and diagnosis were extracted.Results: A total of 172 patients representing 0.45% of the total paediatric patients seen within the period. There were more females 90(52.3%) than males 79(45.9%) and three patients (1.7%) presented with disorders of sexual differentiation. Age of presentation ranged between 11 days and 16 years with mean of 6.27 ± 4.5 years. The commonest groups of endocrine disorders were disorders of pancreas/lipids-diabetes (n=33, 19.2%), pubertal disorders (n=25, 14.5%) and thyroid disorders (n=24, 14.0%).Conclusion: Our unit witnessed a comparatively larger case-load of PEDs compared to earlier reports from other parts of Nigeria. Diabetes mellitus, pubertal and thyroid disorders constituted the commonest paediatric endocrine disorders encountered

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development

Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development

Core outcomes and factors influencing the experience of care for children with severe acute exacerbations of asthma: a qualitative study

Objective: To identify the outcomes considered important, and factors influencing the patient experience, for parents and caregivers of children presenting to hospital with a severe acute exacerbation of asthma. This work contributes to the outcome-identification process in developing a core outcome set (COS) for future clinical trials in children with severe acute asthma. Design: A qualitative study involving semistructured interviews with parents and caregivers of children who presented to hospital with a severe acute exacerbation of asthma. Setting: Hospitals in 12 countries associated with the global Pediatric Emergency Research Networks, including high-income and middle-income countries. Interviews were conducted face-to-face, by teleconference/video-call, or by phone. Findings: Overall, there were 54 interviews with parents and caregivers; 2 interviews also involved the child. Hospital length of stay, intensive care unit or high-dependency unit (HDU) admission, and treatment costs were highlighted as important outcomes influencing the patient and family experience. Other potential clinical trial outcomes included work of breathing, speed of recovery and side effects. In addition, the patient and family experience was impacted by decision-making leading up to seeking hospital care, transit to hospital, waiting times and the use of intravenous treatment. Satisfaction of care was related to communication with clinicians and frequent reassessment. Conclusions: This study provides insight into the outcomes that parents and caregivers believe to be the most important to be considered in the process of developing a COS for the treatment of acute severe exacerbations of asthma

Concepts of Plagiarism and Reference Management in Scholarly Writing: Perspectives for the Residency Training Programme in Nigeria

Scholarly/scientific writing is an integral part of the Residency Training Program in Nigeria, culminating in the writing and defence of dissertations. Plagiarism, a form of research publication misconduct, is the inappropriate use of someone else’s writing without appropriate attribution. Limited empirical data suggests that plagiarism is not uncommon among residents and fellows. Despite widespread awareness of plagiarism amongst residents and fellows, there is deficient in depth knowledge of its nuances. Factors such as ‘publish or perish’ phenomenon, inadequate literature search and critique skills and inexperience with ethical scientific writing may also be contributing to the committal of plagiarism among residents. There is thus the need to formally train and mentor residents in ethical writing. While stressing the need for the individual resident to accept responsibility to acquire these skills, we highlight the roles of training units, institutions and colleges in fostering and institutionalising ethically sound writingculture by organising formal trainings and mentorship in scientific writing, formulating and disseminating anti plagiarism policy and providing access to plagiarism checkers. We also briefly identify proficiency in reference management as a strategy for avoiding plagiarism. We conclude by identifying researchable gaps on the subject of plagiarism in postgraduate medical education in Nigeria

Healthcare workers’ perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria

Background: Mobile health has enormous potential in healthcare due to the increasing use of mobile phones in low- and middle-income countries; its effective deployment, uptake, and utilization may result in improved health outcomes, including a reduction in neonatal deaths. However, there is a suboptimal uptake of mobile health technologies among healthcare workers in low-resource settings like Nigeria, which are often context-specific. Objective: To investigate healthcare workers’ perceptions of mobile health technologies in public health facilities in Lagos, Nigeria. Method: A qualitative study was conducted, and data were collected through six focus group discussions with 26 healthcare workers (doctors, nurses, and community health extension workers) from three public health facilities in Lagos, Nigeria. The collected data were analyzed using a thematic approach, where themes and subthemes were created. Results: Although the participants acknowledged that mobile health enhances patient–provider communication and saves time, they identified altering of healthcare workers’ routine practices, information overload, power and network failure, skepticism, lack of trust, and concerns over diagnostic accuracy as potential barriers to its uptake. Conclusion: Addressing healthcare workers’ perceptions of mobile health technologies may enhance the deployment and uptake of such solutions in Nigeria and similar low-resource settings. Developers and implementers of such can use them to create new or enhance existing mobile health solutions to better meet the needs and requirements of healthcare workers in low- to middle-income health settings, such as Lagos, Nigeria

Echocardiographic reference z scores of right ventricular dimension and systolic function of children aged 5–12 years

Background Reference values for right ventricular dimension and systolic function in Nigerian children are scarce despite their high burden of right ventricular abnormalities. Reference values from other countries may not be suitable for use in Nigerian children because of possible racial variations in cardiac size. Purpose To develop reference values for right ventricular dimension and systolic function in healthy Nigerian children aged 5–12 years. Methods This descriptive cross-sectional study conducted between July and November 2019 included 480 healthy boys and girls aged 5–12 years. The participants were randomly selected from 6 primary schools in the Ikeja Local Government area of Lagos State and their weights and heights measured. Body mass index and body surface area were calculated. Echocardiography was performed at rest in the left lateral position. Results The right ventricular end-diastolic basal diameter (RVD1), right ventricular end-diastolic mid-cavity diameter (RVD2), and right ventricular end-diastolic length (RVD3) were obtained. The right ventricular end-diastolic basal diameter (RVD1), right ventricular end-diastolic mid-cavity diameter (RVD2), and right ventricular end-diastolic length (RVD3) were obtained, as well as tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler-derived right ventricular systolic excursion velocity (S'). The overall mean±standard deviation (SD) values for RVD1, RVD2, RVD3, TAPSE, and S' were 32.95±4.2, 25.86±3.5, 54.57±7.5, 20.11±2.3, and 18.24±2.2, respectively. Age- and sex-specific mean and SD values of the same cardiac indices were determined. Z score charts and the mean± 2SD right ventricular dimensions and systolic function were generated. All right ventricular dimensions were positively correlated with weight, height, body surface area, and body mass index. Only height correlated consistently with TAPSE and S'. Conclusion The observed mean right ventricular dimension indices differed from those derived elsewhere, suggesting that values from other countries may be inappropriate for Nigerian children. These reference values are applicable in daily clinical practice

sj-docx-2-smo-10.1177_20503121231224568 – Supplemental material for Healthcare workers’ perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria

Supplemental material, sj-docx-2-smo-10.1177_20503121231224568 for Healthcare workers’ perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria by Oluwatobi Shekoni, Synne Iversen, Gabriela J Diaz, Anders Aune, Peter Odion Ubuane, Zainab Imam and Beate André in SAGE Open Medicine</p

sj-docx-1-smo-10.1177_20503121231224568 – Supplemental material for Healthcare workers’ perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria

Supplemental material, sj-docx-1-smo-10.1177_20503121231224568 for Healthcare workers’ perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria by Oluwatobi Shekoni, Synne Iversen, Gabriela J Diaz, Anders Aune, Peter Odion Ubuane, Zainab Imam and Beate André in SAGE Open Medicine</p