Strengthening health systems in Africa: The COVID-19 pandemic fallout

This narrative review aims to highlight the shift in the paradigm of strengthening health systems in the African setting since the onset of the coronavirus disease-19 (COVID-19) pandemic. Strengthening health systems involves upgrading a country’s health-care system through increased funding for health infrastructure, health policy improvement, and universal health coverage (UHC). Inadequate funding for health infrastructure, erratic health policy, and the inability to meet UHC targets have contributed to high mortality rates among the continent’s vulnerable groups. The COVID-19 pandemic has further exposed the weak health systems in many African countries, especially in sub-Saharan Africa. Before the pandemic in Africa, the African health context’s challenges essentially comprised weak health systems, weak governance and accountability, high rates of out-of-pocket expenditures, adverse social determinants of health, and non-harmonization of health aid and health service delivery. During the pandemic, a significant shift in the paradigm of strengthening health systems has occurred, with emphasis on increased funding for health infrastructure, which targets the following: Improvement of health infrastructure, the motivation of the health workforce, and improvement in laboratory facilities. It is hoped that the fallout from strengthening health systems in Africa after the pandemic can be sustained by a continental peer- review mechanism to monitor compliance with increased funding for the health sector among member nations. In the post-pandemic period, further gains in strengthening the health systems can be achieved by improving UHC (through increased funding for health insurance), constant capacity training for health care workers in critical care medicine, and institutionalization of hand hygiene

Childhood Idiopathic Nephrotic Syndrome as a Podocytopathy

Idiopathic nephrotic syndrome is the commonest manifestation of glomerular disease in children. The syndrome is characterized by massive proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia. Although genetic or congenital forms are now well recognized, nephrotic syndrome is largely acquired. The latter form can be idiopathic or primary (the causes are unknown) and secondary (the causes are known renal or non-renal diseases). Idiopathic nephrotic syndrome consists of the following glomerulonephritides: minimal change nephropathy (MCN), focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), mesangial proliferative glomerulonephritis (MesPGN), and membranous nephritis (MN). The etiopathogenesis of nephrotic syndrome has evolved through several hypotheses ranging from immune dysregulation theory and increased glomerular permeability theory to the current concept of podocytopathy. Podocyte injury is now thought to be the basic pathology in the syndrome. The book chapter aims to highlight the mechanisms underlying the pathogenesis of nephrotic syndrome as a podocytopathy

Childhood and Adult Asthma: Phenotype- and Endotype-Based Biomarkers

The concept of asthma has changed from that of a single disease entity to that of a heterogeneous disease comprising several phenotypes linked to specific endotypes. Recently, significant progress has been made in disease classification into phenotypes and biologically distinct variants (endotypes). Classification of patients into endotypes has led to precision medicine in which specific biomarkers and appropriate individualized treatments have now been identified. Despite the ongoing classification of disease endotypes, the presence or absence of a T-helper 2 (Th2) molecular signature has resulted in the association of asthma endotypes with phenotypes so as to establish responders and non-responders to inhaled corticosteroid therapy. More importantly, biologic therapies predicated on disease endotypes may in future constitute a paradigm shift from the traditional pharmacologic treatments and lead to better prognosis in moderate-to-severe forms of the disease (in which they are presently used). This book chapter aims to discuss the current concepts on asthma classification and biomarker-based diagnosis

Biomarkers of Common Childhood Renal Diseases

Novel biomarkers are now used in the diagnostic and prognostic evaluation of common kidney diseases in children. The increased scientific interest in these biomarkers is partly due to the remarkable progress in their discovery techniques, and their validation in clinical subjects. However, the wide variation in their sensitivity and specificity is still a major concern. In the identification of biomarkers of kidney injury, an ideal biomarker should be produced after organ injury in concentrations which directly correlates with the degree of injury; should be easily measured in body fluids; and should serve as a potential tool to monitor therapeutic response which is predicated upon a post-injury decrease in its concentration. This book chapter aims to highlight and discuss the novel biomarkers used in the diagnostic and prognostic evaluation of common acute diseases of the kidney in children, such as urinary tract infection (UTI) and acute kidney injury (AKI), as well as chronic kidney disease (CKD) secondary to idiopathic nephrotic syndrome (INS) and diabetic nephropathy (DN)

Diabetic Nephropathy in Childhood: Predictive Tools and Preventive Strategies

Diabetic nephropathy is the commonest microvascular complication in both types 1 and 2 diabetes mellitus. Disease pathogenesis is based on a multifactorial interaction between metabolic and hemodynamic factors. In response to hyperglycemia, which disrupts the body’s metabolic milieu, a cascade of complex molecular events occur leading to glomerular hypertrophy, tubular inflammation, mesangial expansion, oxidative stress, and renal fibrosis. Beyond the conventional microalbuminuria, which can predict disease onset, novel biomarkers are now proving more reliable as predictive tools. While several reports show that glomerular and tubular biomarkers are more sensitive than microalbuminuria, tubular markers specifically constitute earlier predictors of the disease. Similarly, biomarkers of inflammation and oxidative stress have been demonstrated as dependable diagnostic tools. As an important cause of mortality from end-stage renal disease (ESRD), diabetic nephropathy constitutes an important challenge in diabetic care. Interestingly, strict glycemic control assessed by glycated hemoglobin (Hb A1 c) estimates, and antihypertensive therapy with angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARB) ± calcium-channel blockers form the main strategies for preventing its onset and slowing down its progression. Other strategies include uric acid antagonist, and renin and endothelin inhibitors. This book chapter discusses these predictive tools and possible preventive strategies

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

Renal Replacement Therapy in Children in the Developing World: Challenges and Outcome in a Tertiary Hospital in Southeast Nigeria

A 5-year observational, retrospective study was conducted to evaluate the indications, the availability, the accessibility, the sustainability, and the outcome of children managed for acute kidney injury (AKI) and end stage kidney disease (ESKD) who required renal replacement therapy RRT in Enugu, southeast Nigeria. A total of 64 patients aged 5 months to 16 years required RRT, of which only 25 underwent RRT, giving an RRT accessibility rate of 39.1%. Eleven (44%) patients required chronic dialysis program/ renal transplant, of which only 1 (9.1%) accessed and sustained chronic hemodialysis, giving a dialysis acceptance rate of 9.1%. Fifty (78%) of the patients belonged to the low socioeconomic class. Thirty-three (51.5%) could not access RRT because of financial constraints and discharge against medical advice (DAMA); 6 (9.4%) died on admission while sourcing for funds to access the therapy; 5 (7.8%) died while on RRT; 9 (14.1%) improved and were discharged for follow-up; 1 (1.6%) improved and was discharged to be on chronic dialysis program while awaiting renal transplantation outside the country/clinic follow-up, while the remaining 10 (15.6%) were unable to sustain chronic dialysis program or access renal transplantation and were lost to follow-up. We conclude that RRT remains unaffordable within the subregion

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