Typhoid glomerulonephritis and intestinal perforation in a Nigerian child

The number of children with renal complications following salmonella infection cannot be precisely defined in the sub-Saharan Africa due to scarcity of reliable data. We report a 3-year-old boy with glomerulonephritis secondary to typhoid infection and later intestinal perforation. He  presented with fever, generalized body swelling, oliguria, coke-coloredurine and hypertension and had been managed 3 weeks earlier for typhoid fever in a private hospital. Laboratory investigations showed proteinuria, hematuria with red cell casturia and azotemia. Abdominal X-ray done was suggestive of typhoid intestinal perforation that was confirmed at   exploratory laparotomy. He was managed aggressively with antibiotics and was discharged on the 25th day of admission. To the best of our   knowledge, this is the first documented case report of acute   glomerulonephritis and intestinal perforation as co.complications of salmonella infection in Nigeria.Key words: Acute glomerulonephritis, intestinal perforation, Nigeria, typhoid feve

Acute osteomyelitis as cause of late sepsis in a Nigerian neonate

Neonatal osteomyelitis (NO) is said to be rare and uncommonly reported in the sub‑region. Although this may be true, either because the cases are under‑diagnosed, unreported or under‑reported. The diagnosis is clinical and supported with blood culture or the aspiration of pus with radiological findings. We report a case of a neonate with acute osteomyelitis of the right femur, diagnosed at 10th day of life, which was confirmed with blood culture and radiogram findings of the right upper thigh of the baby. To the best of our knowledge, this is the first documented reported case of NO from the south‑eastern Nigeria. It is imperative to recognize the clinical presentation necessary to raise the suspicion of NO and other focal infection in the newborn. With thorough examination and selected investigation the focus of infection in the neonate can be detected.Keywords: Neonatal, Nigeria, Osteomyelitis, Septicemi

Accidental Childhood Poisoning in Enugu, South‑East, Nigeria

Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South‑East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. Results: Sixty‑five cases of childhood poisoning were recorded during the 10‑year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications.Keywords: Accidental poisoning, Childhood, Kerosen

Prevalence of iron deficiency anaemia in anaemic under-5 children in Enugu South East Nigeria

Background: Iron deficiency anaemia has been described as the commonest type of nutritional anaemia in infancy and childhood. The associated adverse health sequelae include permanent behavioural and cognitive impairments. Early detection and prompt treatment are necessary to prevent these complications.Aim: To determine the prevalence and socio-demographic distribution of iron deficiency anaemia among anaemic under five children in Enugu.Subjects and methods: Under-five children presenting at a tertiary hospital were consecutively enrolled and screened for iron deficiency anaemia using haematocrit and serum ferritin levels. Iron deficiency anaemia was defined as haematocrit level <30% and ferritin level <12ng/ml.Results: Three hundred and twelve children (187 males, 125 females) aged below 60 months had a PCV check out of which 178 (57.1%) were anaemic (PCV< 30%). Of the anaemic group, 61(34.3%) had iron deficiency anaemia. Prevalence of iron deficiency anaemia was higher among the males (38.0%) [p=0.235], age group 13- 23months (40.0%) [p=0.575] and children from lower socioeconomic class (43.5%)[p=0.158]. There is a positive but weak correlation between serum ferritin and haematocrit levels [r= 0.11 p=0.130].Conclusion: The prevalence of iron deficiency anaemia in the study population was high and varies with the child’s age group, gender and parental socioeconomic class.Keywords: iron deficiency anaemia, serum ferritin, haemtocrit, Enugu

Chronic kidney disease in children as seen in a tertiary hospital in Enugu, South-East, Nigeria

Background: The prevalence of chronic kidney disease (CKD) in children has been reported to be rising locally and globally. There is a dearth of data and inadequate facilities for the management of CKD in children in most of the developing countries like Nigeria.Objectives: The objective of this study is to ascertain the prevalence of CKD among children seen at University of Nigeria Teaching Hospital (UNTH), Enugu, South‑East Nigeria and also to determine the stage of CKD at presentation, possible etiology, treatment options offered and the outcome.Materials and Methods: A retrospective review of pediatric ward admissions in UNTH over a 5 year period (July, 2007 to June, 2012) was done. Information, including the age at presentation, symptoms, level of renal function, management and outcome, were obtained from the medical case notes.Results: There were 3002 pediatric admissions within the period of review, of which 98 (3.3%) had CKD, giving incidence of 3.0 new cases per million‑child population per year and the prevalence of 14.9 per million children population. Majority (54.1%) of those with CKD were over 10 years of age. Edema, oliguria and hypertension were the most frequent clinical features. The most common etiology was glomerular disease (63.6%) and 44.9% presented in CKD stage 4 and 5. Renal replacement therapy (RRT) was offered to 25 (25.5%) of the patients; 6 (24%) of whom had hemodialysis and 3 (12%) had acute peritoneal dialysis while 16 (64%) were managed conservatively. None of the patients had chronic or adequate dialysis. The overall outcome showed that 8 (8.2%) died while on admission, 15 (15.3%) left against medical advice (discharge against medical advice) because of financial constraints and could not access the therapy, 25 (25.5%) were discharged on conservative management and lost to follow‑up while another 50 (51.0%) were discharged and still on follow‑up.Conclusion: CKD in children poses myriad of challenges in management in our setting with late presentation of patients and limited resources being prominent. The majority of patients could not access and sustain RRT and the outcome continues to be daunting.Key words: Children, chronic kidney disease, Enugu, Nigeria, prevalenc

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

Whole-genome analysis of Nigerian patients with breast cancer reveals ethnic-driven somatic evolution and distinct genomic subtypes

Black women across the African diaspora experience more aggressive breast cancer with higher mortality rates than white women of European ancestry. Although inter-ethnic germline variation is known, differential somatic evolution has not been investigated in detail. Analysis of deep whole genomes of 97 breast cancers, with RNA-seq in a subset, from women in Nigeria in comparison with The Cancer Genome Atlas (n = 76) reveal a higher rate of genomic instability and increased intra-tumoral heterogeneity as well as a unique genomic subtype defined by early clonal GATA3 mutations with a 10.5-year younger age at diagnosis. We also find non-coding mutations in bona fide drivers (ZNF217 and SYPL1) and a previously unreported INDEL signature strongly associated with African ancestry proportion, underscoring the need to expand inclusion of diverse populations in biomedical research. Finally, we demonstrate that characterizing tumors for homologous recombination deficiency has significant clinical relevance in stratifying patients for potentially life-saving therapies