Factors contributing to delay in commencement of immunization in Nigerian infants

Delay in receipt of immunization may result in a child being susceptible to vaccine preventable diseases for prolonged periods. Identification of factors which contribute to delay in receipt of immunization will help in developing targeted interventions. This study examined prospectively factors contributing to delay in the commencement of infant immunization in Benin City, Nigeria. This was a cross-sectional descriptive study of 153 consecutive mothers of infants presenting for their first immunization at the Institute of Child Health Child Welfare Clinic of the University of Benin, Benin City.  Reasons for not presenting in the first 24 hours were ascertained and associations between various factors and delay in commencement of immunization were examined. Of the 153 mothers only 2 (1.3%) brought their babies for immunization within 24 hours of birth while 66 (43.1%) brought their babies in the first week of life.  The most cited reason (30.3%) for not presenting within 24 hours of birth was that BCG, one of the immunizations that should be given at birth is given only on a specific day. Mothers who did not know that immunization should commence at birth (P=0.0054), those from low socioeconomic class (P=0.0056) and those with less than 12 years of schooling (P=0.0001) were significantly less likely to bring their babies for immunization in the first week of life. Delivery outside of health facilities was also associated with later presentation for immunization (P=0.0069). In conclusion, there is significant delay in the receipt of birth doses of immunization. Change in clinic practices to enable daily immunization as well as education of health care personnel on the importance of timely commencement of immunization will ensure timeliness of receipt of birth doses of vaccines

Role of Brain Natriuretic Peptide assay in identifying children with pneumonia complicated by congestive cardiac failure

Background: Pneumonia in children is a leading cause of morbidity and mortality in developing countries. It is often complicated by Congestive Cardiac Failure (CCF), with some of the symptoms similar to those of pneumonia. Brain Natriuretic Peptide (BNP) assay can differentiate cardiac from respiratory-related causes of respiratory distress. Objective: To determine the role of BNP in differentiating isolated pneumonia from pneumonia complicated by CCF. Methods: Over a 12-month period, consecutive children with radiologically-confirmed pneumonia were recruited for the study. Those with complicating CCF were noted. All the children had blood BNP assay done by ELISA, prior to treatment. Biodata was obtained and the children were grouped into those with isolated pneumonia and those with pneumonia complicated by CCF. Results: Fifty children were recruited; of these 26 (52.0%) had isolated pneumonia while 24 (48.0%) had pneumonia with CCF. The median age of the children was 6 months. The median BNP values for the isolated pneumonia group (229.4 ng/l), was significantly lower than that of pneumonia complicated by CCF group (917.3 ng/l); (p = 0.007). ROC showed that a BNP value >550ng/l could identify children with pneumonia complicated with CCF from those with isolated pneumonia with a sensitivity of 70.4% and specificity of 63.4%. Conclusion: A BNP assay prior to treatment of >550ng/l can differentiate children with pneumonia complicated with CCF from those without CCF

Socio-demographic characteristics and pre-hospital care of children with circulatory failure in a children's emergency room in southern Nigeria

Introduction: circulatory failure is a major childhood emergency. Several disease-related and patient-related factors can predispose children to shock. Early detection of such factors will improve its prevention, management and outcome. This study aimed to evaluate the incidence, socio-demographic characteristics and pre-hospital care of children presenting with circulatory failure (shock) in children´s emergency room (CHER). Methods: this study adopted cross-sectional design in CHER of the University of Benin Teaching Hospital, Nigeria, from October 2018 to March 2019. Data were collected using a semi-structured questionnaire eliciting demography, socio-economic status, pre-hospital care and presence of shock. In a sub-analysis, multiple logistic regression identified variables that are independently associated with circulatory failure in the participants, using adjusted odds ratio (OR) and 95% confidence intervals (CI). Results: a total of 554 acutely-ill children participated in the study. Their median age was 60 (IQR: 24-132) months. Shock was present in 79 (14.3%) of the children on arrival at CHER. Children referred from private clinics were more likely to arrive CHER in shock compared to those coming directly from home (OR = 2.67, 95%CI: 1.07-6.69; p = 0.036) while children from lower socio-economic class families presented more frequently with shock than those from higher class (OR = 14.39, 95% CI: 2.61-79.44; p = 0.002). Also, children that received oral rehydration solution as pre-hospital care seemed more likely to present with shock in CHER (OR = 6.63, 95% CI: 2.15-20.46; p =0.001). Conclusion: quality of pre-hospital care and parental socio-economic status influence the presence of shock in children seen at the emergency unit. Focused health education and prevention of finance-related delays in emergency care are needed

Physical activity, body mass index and blood pressure in primary school pupils attending private schools.

Background: Lack of physical activity contributes to overweight and obesity. It is recommended that children accumulate at least one hour of moderate to vigorous intensity physical activity daily. Objective: The level of physical activity, body mass index (BMI) and blood pressure (BP) were evaluated in pupils attending private primary schools. Method: The intensity and duration of physical activity of the pupils selected by multiple stage sampling method were obtained with the aid of a questionnaire. The BMI and BP were measured. Analysis was by SPSS. Results: Of the 353 pupils, 132(37.4%) pupils were adequately physically active while overweight and obesity prevalences were 54(15.3%) and 65(18.4%) respectively. Hypertension prevalence in overweight/ obese children (6.5%) was significantly higher than in children with healthy weight 1.5%, P = 0.04. Conclusion: Only a third of pupils met the recommended level of physical activity. The prevalence of overweight and obesity was high while the overweight and obese pupils were more likely to have hypertension compared to those with healthy weight. Physical activity programmes for primary school pupils in school and at home are therefore recommended

Infant-feeding Practices among HIV-infected Mothers in an HIV-treatment Programme

The transmission of HIV via breastmilk has led to various recommendations for HIV-infected mothers. In this study, the feeding practices of HIV-infected mothers in the first six months of their infants' lives were evaluated. In total, 103 consecutive mothers of children, aged 6-24 months, were evaluated for their feeding practices in the first six months of their infants' lives. The mothers were recruited in two cohorts based on their entry (PMTCT cohort) or non-entry (non-PMTCT cohort) to an HIV MTCT-prevention programme. Information obtained included maternal age, socioeconomic class, and the educational level attained. All the babies in the non-PMTCT cohort were breastfed compared to none in the PMTCT cohort. Infant formula was inadequately prepared for 77.42% of babies in the non-PMTCT cohort compared to 18.64% in the PMTCT cohort. The mixed-feeding rate was high (70.45 %) in the non-PMTCT cohort. Over 70% of babies in both the cohorts were bottle-fed. Voluntary counselling and testing services in the healthcare system should be strengthened. All mothers should receive infant-feeding counselling, with exclusive breastfeeding being encouraged in those with unknown HIV status

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Les expériences des mères séropositives qui choisissent de ne pas allaiter leurs bébés au Nigéria

HIV positive mothers, who choose not to breastfeed their babies in a predominantly breastfeeding community would face a number of barriers. This study looked at the experiences of HIV positive mothers who chose the no breastfeeding option. Consecutive HIV positive mothers who opted not to breastfeed their infants after infant feeding counselling and whose infants were attending the HIV programme at the University of Benin Teaching Hospital, Benin City, Nigeria were recruited for the study. Disclosure of HIV serostatus and adherence to no breastfeeding options were evaluated using an interviewer administered structured questionnaire. Of the 62 mothers recruited for the study, 57 (91.94 %) had disclosed their serostatus to at least their partners. Most partners 42 (93.33%) were supportive while three mothers were divorced following disclosure. Thirteen (20.97%) mothers could not comply with no breastfeeding. Non disclosure of serostatus, pressure from extended family and token breastfeeding mitigate against adhering to no breastfeeding by HIV positive mothers (Afr J Reprod Health 2009; 13[1]:27-35).Les mères séropositives qui choisissent de ne pas allaiter leurs bébés dans une communauté qui pratique principalement l’allaitement rencontreraient des obstacles. Cette étude a examiné les expériences des mères séropositives qui ont choisi de ne pas allaiter. Les mères séropositives consécutives qui ont choisi de ne pas allaiter leurs bébés après l’orientation sur l’allaitement au sein et dont les enfants suivaient le programme sur le VIH au Centre Hospitalier Universitaire à Bénin City, Nigeria ont été recrutés pour l’étude. La révélation de la séropositivité et l’adhérence aux options de ne pas allaiter ont été évaluées à l’aide d’un questionnaire structuré administré par un interviewer. Sur les 63 mères qui ont été recrutées pour l’étude, 57(91,94%) avaient révélé leur séropositivité au moins à leurs partenaires. La plupart des partenaires 42 (93,33%) ont soutenu leurs femmes, alors que trois mères ont subi le divorce suite à la révélation. Treize (20,97%) mères ne pouvaient pas respecté le non-allaitement. La non-révélation de la séropositivité, la pression de la part de la famille étendue et l’allaitement symbolique font que les mères séropositives n’acceptent pas de ne pas allaiter (Afr J Reprod Health 2009; 13[1]:27-35)

SOCIO-ECONOMIC AND SOCIO-DEMOGRAPHIC DETERMINANTS OF BNP VALUES IN CHILDREN WITH PNEUMONIA IN BENIN CITY

Background The level of BNP is usually used as a guide to heart failure. However, there is need for the level of this peptide to be known in non-cardiac conditions that may cause inflammation and hypoxia. Aims To determine socio-demographic determinants of BNP in children with pneumonia. To determine the socio-economic determinants of BNP in children with pneumonia. Methods Over a year, consecutive children diagnosed radiologically with pneumonia were evaluated echocardiographically for CHD. Also, children with heart failure were excluded. Inclusion criteria included all those children with ongoing pneumonia without any evidence of any other co-morbidity whether acute or chronic. Biodata and sociodemographic variables of children with pneumonia that met the inclusion criteria were collected and studied. Results Of the 50 subjects recruited for the study, 26 (52 per cent) were males. The mean age for males 14.27±13.33, females 12.03±11.83, mean height for males 74.00±3.46 and 72.00±0.00 for females, the mean weight range from 8.30±1.87 and 7.08±3.40 for males and females respectively. The mean BNP value for all subjects was 459.55±422.61, of which males had a mean value of 500.33±.399.93 and females 415.38±450.25 with a p value of 0.483. The mean brain natriuretic factor for weight range 1–5.9kg was 203.83±116.04 that of 6–10.9kg was 645.22±314.26, while that of 11–15.9kg was the lowest with 115.85±72.46. Conclusion Apart from congenital heart disease and several other morbidities both chronic and acute, sociodemographic characteristics of the patient and some clinical features may also affect BNP levels in the blood. Patients with pneumonia had higher mean values of BNP when compared with normal cut-of