Niger J Paed 2013; 40 (3): 321 - 344

PANCONF 2013 ANNUAL GENERAL CONFERENCE

Abstracts of Proceedings

4

4th Annual General and Scientific Conference of the Paediatrics

Association of Nigeria (PANCONF), 22nd - 26th January, 2013

A101

A102

Increasing access to child health services in

resource-limited settings: experiences with the Obio

Community Health Insurance Scheme

Do As Many Babies Die As the Estimates Show?

Evidence from a Community Based Assessment

1

2

Ewah RO, I₁badin MO, Omoigberale AI, Sadoh WE,

Agbede GO.

1

2

3

Nte AR , Faj₄ola AO , Fakunle BA , Adibe N ,

Ehigiegba A

1

2

Irrua Specialist Hospital, Irrua, Edo State, University

1

Department of Paediatrics, College of Health Sciences,

of Benin Teaching, Benin

2

University of Port Harcourt Community Health, Shell

Petroleum Development Company, Port Harcourt

Obio Cottage Hospital, Port Harcourt Department of

Obstetrics and Gynaecology, College of Medicine,

University of Benin, Benin

Background: The fourth Millennium Development Goal

was endorsed to reduce under-five mortality rate by two-

thirds between 1990 and 2015. To achieve this goal, the

accurate knowledge of the PMR, SBR and ENDR and

knowledge of factors that promote perinatal mortality in

a given community is important. The projected National

estimates of PMR, ENDR and SBR may not be accurate.

This community based study was therefore carried out to

determine the PMR, SBR and ENDR in Igueben Local

Government Area (LGA) of Edo State.

3

4

Background: Nigeria’s 2010 Under-five mortality rate

of 143/1000 live births and 64% of the population living

below $1.25/day highlight the need for increased access

to quality care for all, especially the U5s of whom only

2

3% received antibiotics for pneumonia and <50%

appropriately treated for diarrhea and malaria.

Methods: All women of child-bearing age, who resided

in three randomly selected political wards in Igueben

LGA were identified. The mothers, who had deliveries

and perinatal deaths between June 2009 and May 2010,

were recruited for the study. Interviewer administered

questionnaires were used to obtain relevant data from

the mothers.

Results: Of the 921 women of child-bearing age re-

cruited, 258 deliveries with 3 perinatal deaths were re-

corded. This resulted in PMR, SBR and ENDR of

11.6/1000TB, 11.6/1000TB and 0/1000LB respectively.

The values were lower that the projected Nigerian aver-

ages; 76/1000TB, 43/1000TB and 35/1000LB for PMR,

SBR and ENDR. Almost all the mothers studied

(99.6%) received skilled obstetric care in delivery.

Conclusion: In the community studied, the PMR and

In 2010, Shell, as part of its social performance initia-

tives in host communities, collaborated with Rivers

State government, to upgrade the Obio health center to a

Cottage hospital and initiated the Community Health

Insurance Scheme(CHIS). Indigenes in the scheme’s

target communities subscribe to it with the sum of

N3,600 while others pay N7,200 per person annually

and can access several services especially for Maternal,

Neonatal and Child Health (MNCH).

Objectives: To share experiences from Obio CHIS and

its impact on MNCH services.

Method: Data were retrieved from the records of Obio

Cottage Hospital for the period 2009 to 2012 and

analyzed.

Results: Facility utilization for MNCH and staff skills in

record keeping, patient care, administration, laboratory

and pharmaceutical services increased. The number of

pregnant women screened for HIV increased from 141

in 2010 to 3,228 in 2012 while HIV seroprevalence

reduced from 4.25% to 3.5% and all 57 HIV–exposed

babies tested negative at 6 weeks. Similarly, the number

of children on GMP increased from 7,227 to 10,206 and

percentage of underweight children reduced by over

SBR were lower than the National estimates, perhaps

because of receipt of good obstetric care by the mothers.

This therefore underscores the importance of community

-based studies in the determination of vital statistics

which are important in health planning including re-

source allocation.

1

50%.

A103

Conclusion: The CHIS has thus contributed significantly

not only to increased access to health services but also to

improved child health indices in target communities.

Perinatal Mortality in Some Public Hospitals in

Abuja

Mairami AB, Audu LI, Aikhionbare HA.

National Hospital Abuja

Background: Perinatal mortality rates remain high in

Nigeria and other developing countries. In designing

intervention and strategies to reduce perinatal deaths, it

3

22

is important to know the magnitude, causes and determi-

nants of perinatal mortality in a given locality.

Objective: To determine the perinatal mortality and as-

sociated risk factors in Abuja Municipal Area Council of

the Federal Capital Territory.

The major causes are similar to those documented by

other studies in Nigeria and are largely preventable.

Strengthening perinatal care, emergency obstetric ser-

vices, and enhancement of neonatal resuscitation skill

are necessary to reduce the neonatal mortality.

Method: All deliveries including live and stillbirths in

the selected hospitals over a period of 4 months were

recruited. Live born babies were followed up until the

age of 7 days and any death occurring during this period

was documented.

A105

Morbidity Pattern of as Seen in the Pediatric Out-

Patient Department of Irrua Specialist Teaching

Hospital, Irrua

Results: There were 1065 deliveries during the period of

study, out of which 1027 were analyzed. Of these, 62

suffered perinatal death, giving a perinatal mortality rate

of 60.4 per 1000 births. There were 35 stillbirths (17

fresh stillbirths and 18 macerated stillbirths) giving a

stillbirth rate of 34.1 per 1000 births and fresh: macer-

ated stillbirth ratio of 1:1.06. Of those born alive, 27 did

Ikhayere E, Ewah RO, Alikah SO, Obasoyo SE.

Department of Paediatrics Irrua Specialist Teaching

Hospital, Irrua, Edo State

Background: Hospital data can be a valuable tool for

assessing the epidemiology of diseases within popula-

tions. This data can give an insight into the types of

diseases in a community and their burden on health

services.

st

not survive beyond the 1 week of life, giving an early

neonatal death rate of 27.2 per 1000 live births. The ma-

jority (88.7%) of perinatal deaths were due to severe

perinatal asphyxia (53.2%), macerated stillbirths

Objective: To determine the common morbidity pattern

in children who were seen in the Paediatrics Out-patient

Department of Irrua Specialist Teaching Hospital, Irrua.

Methods: A retrospective analysis of the records of the

Paediatric Out-patient Departme_sn_tt of Irrua Specialist

Teaching Hospital, Irrua from 1 September, 2011 to

(

29.0%) and prematurity (6.5%). Lack of antenatal care,

antepartum hemorrhage, pregnancy-induced hyperten-

sion, intrapartum pyrexia and prematurity were risk fac-

tors for perinatal death.

Conclusion: Risk factors associated with poor antenatal

and intrapartum care accounted for the high perinatal

mortality rate in Abuja.

st

31 August, 2012.

Results: Of a total of 9,122 visits were made during the

period under review, 4,579 (50.2%) were males and

4

of 1:1. Malaria remains the commonest diagnosis made

,543 (49.8%) were females giving a male: female ratio

A104

Pattern of Morbidity And Mortality of Admissions

into The Special Care Baby Unit (SCBU) of Enugu

State University Teaching Hospital (ESUTH),

Park lane, Enugu, South-East Nigeria

(

13.3 %), followed by acute respiratory tract infection

12.2%).

Conclusion: Infections still remains the commonest

diagnosis for visits to the Paediatrics Out-patient

Department of Irrua Specialist Teaching Hospital, Irrua.

Ekwochi U, Ezenwosu OU, Nwokoye IC, Ndu IK.

Enugu State University Teaching Hospital, Park Lane,

Enugu

A106

Morbidity and Mortality Pattern among in-Patients

in the Pediatric Department of Olabisi Onabanjo

University Teaching Hospital (OOUTH) Over A

Twelve Month Period

Neonatal morbidity and mortality rates have great im-

pacts on the millennium development goals 4 (MDG 4).

This indicator strongly poses a major challenge in devel-

oping country like Nigeria.

Objectives: To determine the morbidity and mortality

pattern of admissions within 5 months of re-opening the

SCBU of ESUTH, Parklane, Enugu.

Methods: Information on the bio-data, place of birth,

APGAR scores, age on admission, diagnosis on admis-

sion, duration of hospital stay and outcome was col-

lected retrospectively from the case notes of admissions

into the SCBU from June – October 2012.

Results: A total of 126 patients were admitted during the

period under review. The leading causes of admissions

were perinatal asphyxia 50 (39.7%), Low birth weight

Ayeni VA, Oladipo AO, Ogunlesi TA, Olowu AO,

Ogunfowora OB, Fetuga MB, Adekanmbi AF,

Runsewe-Abiodun IT, Olanrewaju DM.

Olabisi Onabanjo Teaching Hospital, Sagamu, Ogun

State

Background: It is essential to know the current pattern

of childhood morbidities and mortality if the Fourth

MDG is to be achieved.

Objective: To determine the trend of morbidity and

mortality peculiar to different age groups in a Nigerian

teaching hospital over a 12-month period.

4

3 (34.1%)], Neonatal sepsis 13 (10.3%) and neonatal

Methods: The hospital records of all the children

between birth and age of 16 years admitted into the

paediatric wards of OOUTH, Sagamu between Novem-

ber 2010 and May 2012 were reviewed. Data extracted

include age, major clinical diagnosis and outcome of

admission.

jaundice 4 (3.2%). A total of 25 (19.8%) deaths were

recorded during the period under review. Fifty-five per-

cent of the deaths occurred within 24hrs of admission.

The leading cause of deaths were perinatal asphyxia 14

(

56%), neonatal sepsis 7 (28%) and very low birth

weight 2(8%).

Conclusion: The neonatal mortality in this study is high.

Results: There were 862 admissions in all. Neonates

3

23

constituted 43.1% while the remaining 21.9%, 20.9%,

4.7% were infants, pre-school age children and school

age and adolescents respectively. The overall mortality

rate was 10.1%. Age-specific mortality rates were

A108

1

Expansion of the incubator capacity of Special Care

Baby Units in Nigeria: a contribution to MDG4

target

1

5.4% for newborn period, 9.4% for infancy, 5.4% for

1

2

3

pre-school age and 4.9% for school age and adoles-

cence. The commonest causes of death among neonates

and infants were prematurity and bronchopneumonia

respectively. Severe malaria was the leading cause of

death in the pre-school age. Among school-age and ado-

lescent, no specific cause was significantly more com-

mon.

Amadi HO, Azubuike JC, Osibogun AO.

1

Bioengineering Department, Imperial College, London,

SW7 2AZ, United Kingdom;

Department of Pediatrics, Enugu State University

T₃eaching Hospital, Park Lane, Enugu, Nigeria

Lagos University Teaching Hospital, Idi-Araba, Lagos,

Nigeria

2

Conclusion: Most of the morbidities and mortalities are

due to preventable causes. Improved health education

and early presentation in the hospital should be encour-

aged.

Background: Millennium Development Goal 4 targets a

two-thirds reduction in mortality in children under 5

years of age (U5MR) between 1990 and 2015. Since

4

0% of deaths in children under 5 years of age occurs in

A107

Childhood Mortality in Mile 4 Mission Hospital

Abakaliki, South-Eastern Nigeria

the first month of life (neonatal mortality), any measures

undertaken to improve on newborn care would help con-

tribute to the improvement in the under five mortality

rate. As the deadline approaches, concerned players in

the field are reviewing and questioning the effectiveness

of the strategies being applied. In August 2012, the Lan-

cet-Imperial Commission on Technologies for Global

1

2

1

2

Muoneke VU₁ , Ibekwe MU, Eke CB, Onwe O,

Ibekwe RC.

1

Department of Pediatrics, University of Nigeria

1

Teaching Hospital, Enugu

Health published a review which appeared to suggest

2

Department of Pediatrics, Federal Teaching Hospital

Abakaliki

that the time and funds spent on huge high-tech invest-

ments might not have been as cost-effective to global

heath as was expected. The review did recognize the

impact of Nigeria’s recycled incubator technology (RIT)

as a positive contribution to the newborn health target of

MDG4. In spite of the success of the RIT, it is necessary

that Special Care Baby Units (SCBU’s) in Nigeria reex-

amine prevailing strategies, in order to ascertain that

these provide progressive growth in incubator capacity

and other facilities that ensure continuous and sustain-

able good quality of care.

Background: Most previous mortality reports in Nigeria

are from Government owned tertiary health facilities

that may select for the more severe cases and may not

reflect the societal pattern. There are few studies that

highlight the experience in primary/secondary health

facilities, in spite of the fact that they attend to more

than 60% of medical conditions,

Objective: The study aims to evaluate the pattern and

causes of childhood mortality at a Mission hospital in

Abakaliki, South Eastern Nigeria.

Objective: To examine the strategic expansion of incu-

bator capacities in Special Care Baby Units of 5 tertiary

health institutions in Nigeria over a ten-year period

(2003 – 2012).

Methods: The medical records of admissions and deaths

of chi_sl_tdren admitted in Mile 4_sh_t ospital Abakaliki from

the 1 January 2009 to the 31 December 2009 were

retrospectively reviewed.

Methods: The SCBUs of 16 tertiary heath institutions in

Nigeria including the University of Benin Teaching

Hospital (UBTH), Benin, Federal Medical Centre

(FMC), Owerri, Federal Medical Centre (FMC), Nguru,

Lagos University Teaching Hospital (LUTH), Lagos,

University of Nigeria Teaching Hospital (UNTH),

Enugu etc were recruited into the study at various times

and closely monitored. Each Unit was assessed every six

months and reports submitted with appropriate recom-

mendations to the Hospital Management. Each Hospital

was assisted with the institution of failure-preventive

maintenance of existing systems, whilst the RIT was

used to expand the incubator capacity of the various

Units.

Results: Of the 1102 patients admitted within this pe-

riod, 72 died giving a mortality of 6.5%. There were 43

males and 29 females, the male: female ratio was 1.5:1.

Most of the deaths 58 (80.6%) occurred among children

younger than 2 years. Severe malaria (37.5%), gastroen-

teritis (23.6%) and bronco-pneumonia (15.3%) were the

most common causes of death. The modal months for

childhood mortality in this hospital were between May

and August (55.6%) and were mainly due to severe ma-

laria and pneumonias, while a smaller peak in February

and March (16.7%) was due to gastroenteritis.

Conclusion: Mortality was more common among chil-

dren younger than 2 years of age. Severe Malaria, gas-

troenteritis and pneumonia were the most common

causes of death. A proactive planning taking into

account the seasonal variation of these diseases could

reduce the childhood mortality recorded.

Results: The UBTH incubator capacity increased from

one (1) functional incubator in June 2006 to 24 by the

end of 2012; FMC Owerri increased its capacity from 1

(one) in March 2005 to 22 by the end of 2012. LUTH,

Lagos, increased its capacity from zero (0) in January

2

007 to 37 by the end of 2012. The FMC, Nguru, which

had no functional incubator in March 2008, had in-

creased its capacity to 15 by the end of 2012, whilst the

3

24

UNTH, Enugu, had progressed from zero functional

incubator capacity in April 2009 to 15 by the end of

B102

Sexual Abuse in Childhood, Who Is At Fault? The

Child the Abuser or the Law?

2

012.

Progress was often markedly delayed or needlessly ter-

minated by succeeding Hospital Administrations, e.g. at

UPTH, JUTH, EBSUTH, UITH etc. which were slow or

reluctant in catching up with the vision of their prede-

cessors.

Yahaya-Kongoila S , Olaosebikan RR, Ernest SK.

Fakayode EO.

Department of Pediatrics, University of Ilorin Teaching

Hospital, Ilorin

Conclusion: This model has attempted to demonstrate

systems availability, sustainability and the growth re-

quirement in these Units that could contribute positively

to the newborn care target of MDG4.

Background: Child abuse is very rampant in our envi-

ronment. However, most cases go unreported due to the

stigma associated with it. Even when reported, it is often

very difficult to establish proofs that will enable punitive

measures against the perpertrator. It is time to really put

the searchlight on where the fault lies. We present a

classical case of child sexual abuse, which most proba-

bly may be the tip of the iceberg in our society.

B101

Knowledge of Childhood Diseases by Caregivers

whose Children were Hospitalized in University of

Benin Teaching Hospital, Benin City, Nigeria

Case presentation: AA, a 7 year old girl, primary school

pupil who was sexually assaulted by a 21 year old man.

During the holidays, she went to her aunt’s shop with no

toilet in the facility and she and her cousin were taken to

nearby perpetrator’s house when she was abused while

cousin was in the toilet. The victim had prior to this, had

a series of sexual encounters with different people of

different age groups, both heterosexual and homosexual.

Even though the perpetrator confessed to the abuse, yet

after several months, no case has been established

against him in the law court.

1

Nwaneri DU, Oviawe OO, Oviawe O.

1

Department of Child Health and Department of

Radiotherapy and Clinical Oncology, University of

Benin Teaching Hospital, Benin City, Nigeria.

Background: Health education and knowledge of pa-

tients and caregivers (in pediatric cases) about common

childhood diseases is an important component of health

care services and should form integral part of patients’

care in hospitals.

Conclusion: There is a need to protect children, espe-

cially the girl child, from circumstances that can lead to

their abuse. Parents should also have more time for their

children. The need for the individual family and society

to stand up to their responsibility was emphasized and

the need for law reforms was discussed.

Objectives: To assess the caregivers’ knowledge of their

child’s illness following admission in hospital as well as

assess whether health care providers render health edu-

cation services during their daily routine works.

Methods: Subjects were caregiver and child (ages 0 – 5

years) pair admitted in pediatric wards for common

childhood illnesses from July to October 2012. A semi-

structured research administered questionnaires was

used to obtain data from the caregivers. Each child’s

case note was then used to cross-check data obtained on

child’s disease diagnosis and to check whether the at-

tending physicians documented the content of health

information provided to the caregivers.

B103

Prevalence and Pattern of Sexual Abuse among Chil-

dren attending Ebonyi State University Teaching

Hospital, Abakiliki, Ebonyi State

1

2

Chinawa₂JM, Ibekwe RC, Ibekwe MU, Obu DC,

Eke BC.

Results: Of the 108 children (male 58, female 50; mean

age [SD] 18.5±14.6 months; range 1 – 60 months) and

caregivers (mean age [SD] 32.1[7.0] years; range 15 –

1

Department of Pediatrics, University of Nigeria

Teaching Hospital, Enugu, Nigeria

2

Department of Pediatrics, Ebonyi State University

Teaching Hospital, Abakaliki, Nigeria

6

0 years) pair; two-third of the caregivers correctly iden-

tified names of diseases their children had on admission.

Mean duration of admission was 4.6 [1.7] days. Only

Background: Child sexual abuse is broadly defined as

both direct genital contact and indirect interactions such

as ‘exposure’ or internet-based activity (for example, the

sending of electronic sexual pictures to minors). Though

sexual abuse is common, yet many adults are not pre-

pared or unwilling to deal with the problem when faced

with it, this could lead to underreporting of the crime

and stigmatizing of the victim.

2

5/108(23.1%) caregivers were taught about the disease

their children presented with. Educational status of the

caregivers significantly predicted whether he/she would

be taught by the attending physician (β = -0.13, SE =

0

tion in the patients’ case note about the health informa-

tion taught by the physicians.

Conclusions: Caregivers’ knowledge of their child’s

illness while on admission was poor. Pediatricians

should incorporate health education of common child-

hood illnesses in their daily routine health care services.

.055, p = 0.023). In all cases, there was no documenta-

Objectives: To determine the prevalence and pattern of

sexual abuse among children attending Ebonyi State

University Teaching Hospital, Abakiliki.

Methods: A retrospective study of cases of sexual abuse

that presented in the children outpatient clinics of EB-

st

SUTH between the 1 of January and 31 of December

2

010.

3

25

Results: A total of 3750 children attended clinic of

which 33 were diagnosed as being sexually abused, giv-

ing a prevalence rate of 0.9%. They were 31 (93.9%)

females and 2 (6.1) males, most of the reports were

made by the victims 23 (69.7%) and or their parents 9

Objective: The study is aimed at determining the pattern

of sleep hygiene and factors contributing to poor sleep

among children attending children outpatient in Federal

Teaching Hospital Abakaliki.

Methods: A cross sectional descriptive study conducted

at the children outpatient clinic of FETHA. The study

instrument was the BEARS screening tool and subjects

were children aged 3-16 years.

Results: Of the 354 children surveyed. 9% had diffi-

culty falling asleep, 15% wake up frequently at night.

Only 33.3% have regular bedtime and wake time and

15.3% have regular day time naps. 41.8% frequently

watch television or play rough play an hour to bedtime.

(

27.3%). Most of the reports made happened within one

week 15 (45.5%). It is noted that HIV test was done

which was negative among 15 (42.4%) children and

positive in one (3%) after twelve weeks.

Conclusions: The prevalence or sexual abuse in

EBSUTH is 0.9%. This low prevalence could be due to

the fact that child sexual abuse is scantly reported

because of the stigma attached to it.

6

6.9% eat heavy meal before bedtime, most (38.7%)

B104

eating 30minutes to 1 hour before going to bed. 19.8%

have television in their bedroom. Problems with going

to bed (8.5%), falling asleep (12.6%), night waking

(13.3%) and day time sleepiness (17.2%) were most

prevalent in children aged 6- 10 years . Watching televi-

sion or playing rough play are significantly associated

with daytime sleepiness (p=0.002), waking up at night

(p=0.00) and problems with falling asleep (p=0.001).

Conclusion: Poor sleep hygiene is common in this envi-

ronment. Health education to parents on the importance

of good sleep hygiene is therefore necessary.

Stray Dog Trade Fuelled By Dog Meat Consumption

as a Risk Factor For Human Rabies Infection In

South-Eastern Nigeria

1

2

Ekanem EE, Eyong KI, Philip₁-Ephraim EE, Eyong

1

ME, Adams EB, , Asindi AA.

1

2

Department of Pediatrics, Department of Internal

Medicine, University of Calabar, Calabar.

Background: Rabies is a preventable zoonosis with the

highest case fatality rate of any disease in the world. In

the developing world, it is transmitted mainly by dog

bites. In parts of South-eastern Nigeria, dog meat is a

delicacy. This case series aims at highlighting trade in

stray dogs as a major risk factor of human rabies in

South-eastern Nigeria.

Method: Patients admitted into the University of Calabar

Teaching Hospital (UCTH) with the diagnosis of rabies

between July and October 2012 were analysed for risk

factors, post exposure prophylaxis (PEP), health seeking

behaviour and outcome. Focused group interview was

conducted among traders/ handlers of stray dogs.

Result: Nine rabid patients, aged 5 to 52 years, were

recorded during the four 4-month period. Eight of these

were males who got infected directly or indirectly

through trading in stray dogs for human consumption.

None of the cases had received PEP and all patients

died.

B106

Hyperglycemia in the Children Emergency Room

1

2

Oyenusi EE, Oduwole AO, Aronson AS.

1

Lagos University Teaching Hospital, Idi-Araba, Lagos,

Hospital of Halland, Sweden

2

Background: Hyperglycemia occurs frequently among

critically ill non-diabetic children. Hyperglycemia may

be advantageous providing the glucose-dependent or-

gans such as the brain and blood cells adequate supply

for their needs or be a risk factor for adverse outcomes

and increased morbidity and mortality in children during

acute illnesses.

Objectives: To determine the prevalence of hyperglyce-

mia and the incidence in different disease entities among

children admitted to the Children’s Emergency Rooms.

Methods: A prospective study involving two tertiary

hospitals in Lagos. Study subjects included all children

aged beyond one month who were admitted into the

emergency room. An Accu-Chek Active glucometer was

used for the bedside blood glucose. Hyperglycemia was

defined as blood glucose ≥7.8mmol/L.

Conclusion: Trading in stray dogs, fuelled by dog meat

consumption, is a risk factor for human rabies in South-

eastern Nigeria.

Recommendation: Culling of stray dogs, monitoring of

the stray dogs trade and public enlightenment on PEP

are recommended.

Results: 1040 patients were recruited. Hyperglycemia

was recorded in 132 patients (prevalence rate of 12.7%).

Leading diagnoses associated with hyperglycemia in-

cluded acute respiratory infections (18.8% hyperglyce-

mic versus 80.5% normoglycemic patients, p=0.047),

gastroenteritis (16.3% versus 75.5%, p=0.20), septice-

mia (12.9% versus 78.6%, p=0.83), malaria (10.7%

versus 82.7%, p=0.27), sickle cell anemia (10.2% versus

B105

Sleep Hygiene of Children in Abakaliki, South East-

ern Nigeria

1

2

Orji I, Anyanwu OU, Ibekwe RC,

1

2

Federal Teaching Hospital, Abakaliki, University of

Nigeria Teaching Hospital, Enugu

8

5.2%, p=0.44) and meningitis (8.1% versus 90.3%,

p=0.21). The mortality of patients with hyperglycemia

Background: Sleep hygiene is the control of all behav-

ioral and environmental factors that precede sleep and

may interfere with sleep. Poor sleep hygiene could

interfere with a child’s proper functioning.

(

15.2%) was twice that of the normoglycemic patients

7.4%) and the difference was statistically significant

ꢀ = 8.82, p = 0.003).

2

3

26

Conclusion: Hyperglycemia is common in ill children

admitted to the emergency rooms and a risk factor for

increased mortality. Blood glucose determination is im-

portant in all acutely ill children at presentation. The

practice of empirical administration of intravenous bolus

of glucose without blood glucose determination in ill

children should be discouraged.

C101

Prevalence of Urinary Tract Infection in Febrile

Under Five Children in Enugu, South Eastern

Nigeria

1

2

I₃beneme CA, Okafor HU, Ikefuna AN, Ozumba UC,

2

Oguonu T.

Department of Pediatrics, Federal Medical Centre,

1

B107

Umuahia.

2

3

Department of Pediatrics, Department of Medical

Indications for Oxygen Therapy and its Outcome in

Children Admitted Into the Children Emergency

Ward of University of Nigeria Teaching Hospital

Microbiology, University of Nigeria Teaching Hospital,

Enugu.

(

UNTH) Ituku-Ozalla, Enugu

Introduction: Fever is common to urinary tract infection

as with other febrile illnesses in under-fives. Little atten-

tion is paid to UTI as a cause of fever in this age group

giving an erroneous impression that it is uncommon.

Objectives: To determine the prevalence of urinary tract

infection in febrile under-fives in Enugu and relate its

occurrence to age, gender and clinical features.

Methods: Two hundred febrile children aged 1 month to

60 months who presented at the Children’s Out-patient

Clinic of the University of Nigeria Teaching Hospital

Enugu between February and April 2010 and met the

study criteria were studied. Urine specimens were ob-

tained by suprapubic aspiration and midstream collec-

tion where appropriate. Standard laboratory procedures

were used to culture the urine specimens and identify the

bacterial pathogens.

Asinobi I, Edelu B, Onyeyile I, Aronu AE, Eze J,

Ibekwe RC

University of Nigeria Teaching Hospital (UNTH)

Ituku-Ozalla, Enugu

Background: Oxygen is one of the most commonly used

interventions in emergency pediatric units worldwide,

when appropriately used it could be lifesaving. How-

ever, its use has its complications. There is need to audit

emergency units to determine its appropriate use so as to

ensure quality care. This study is aimed at auditing oxy-

gen use in UNTH.

Objectives: To review the indications of oxygen therapy

and its outcome in children admitted in the children

emergency ward of UNTH, Enugu

Methods: This is a retrospective review of the records of

admissions in CHER, UNTH from January 2007 to May

Results: Of the 200 children studied, 112 were males

while 88 were females. The prevalence of UTI was 11%

and was significantly higher in females than in males (p

= 0.049). Prevalence was also higher in children below

12 months of age than in those 12 months and above

(p=0.028). Some subjects presented with features such

as vomiting, abdominal pain, diarrhea, urinary frequency

and urgency but no clinical feature had significant asso-

ciation with UTI.

Conclusion: Urinary tract infection is common in febrile

under-fives especially among females and infants. No

single clinical feature is indicative of UTI in these chil-

dren.

2

012.

Results: Of the 3689 children admitted 458(12.42%)

received oxygen. Of these 55.6% were males while

3

2.2% were females. The major indications for oxygen

therapy were severe sepsis (56%), bronchopneumonia

25%), and severe malaria (28%). Pulse oximetry was

(

done in only 65% of patients before the commencement

of oxygen. In 76% of cases oxygen was commenced at

values < 92%. The average duration of oxygen therapy

was 54 hours. The predominant route of administration

was intranasal in 95% of cases.

Of the cases that received oxygen, 26.4% died, 35.7%

were transferred to the ward, 36% were discharged and

C102

1

.9% was discharged against medical advice.

Bacterial causes of urinary tract infection and their

antimicrobial sensitivity patterns in febrile under-

fives in Enugu, South Eastern Nigeria

Discussion: Oxygen therapy remains an essential com-

ponent of the management of acutely ill children. Indi-

cations for oxygen therapy was not limited to hypoxia as

documented by pulse oximetry of 92% and less, but

included other reasons like severe anemia and respira-

tory distress.

2

Ibeneme CA, 1 O₂kafor HU, Ikefuna AN, Ozumba

3

UC, Oguonu T.

1

Department of Pediatrics, Federal Medical Centre,

Umuahia.

Department of Paediatrics, Department of Medical

2

3

Microbiology, University of Nigeria Teaching Hospital,

Enugu.

Introduction: Urinary tract infection is an important

cause of morbidity and mortality in children. Antimicro-

bial resistance rate among uropathogens is an increasing

problem limiting therapeutic options, and underscores

the need to develop local guideline for empiric antibiotic

choice.

3

27

Objectives: To identify the bacterial pathogens responsi-

ble for UTI in febrile under-fives in Enugu as well as

their antibiotic sensitivity patterns.

Methods: Urine specimens were obtained from 200 feb-

rile children aged 1 month to 60 months seen at the

Children’s Out-patient Clinic of the University of Nige-

ria Teaching Hospital Enugu from February to April

to levofloxacin (61.11%), and 50% resistance to both

ceftriaxone and ciprofloxacin. Enterococcus showed

68.75% sensitivity to ciprofloxacin and 93.75% resis-

tance to erythromycin. Staph aureus showed 53.33% to

levofloxacin and an equal amount of resistance to cipro-

floxacin and ceftriaxone. All isolates showed 100% re-

sistance to ampicillin and 98.36% resistance to Genta-

mycin.

2

010, having met the inclusion criteria. Standard labora-

tory procedures were used to culture the urine speci-

mens, identify the bacterial pathogens and their antibi-

otic sensitivity patterns.

Conclusion: The quinolone antibiotics are useful in the

empirical treatment of asymptomatic bacteriuria when

indicated.

Results: Significant bacteriuria occurred in 22 (11%) of

the samples. Escherichia coli was the commonest organ-

ism (31.8%) isolated, followed by Staphylococcus

aureus (22.7%), Klebsiella spp (13.6%) and Streptococ-

cus faecalis (13.6%). Proteus spp., Pseudomonas spp.,

Enterobacter spp., and Serattia spp accounted for 4.5%

each. Most of the isolates were sensitive to ofloxacin,

ciprofloxacin, nitrofurantoin and ceftriaxone, while high

levels of resistance to ampicillin, cotrimoxazole, amox-

icillin, nalidixic acid were observed.

Conclusion: Escherichia coli is the most common cause

of UTI in febrile under-fives in Enugu. Ciprofloxacin

and ceftriaxone are advocated for the empiric treatment

of febrile UTI in Enugu but their use should be guided

by sensitivity studies.

C104

Bacterial Isolates from the Stools of Children Aged

Less Than 5 Years with Acute Diarrhea in Kaduna,

Northwestern Nigeria

1

3

4

E₂seigbe EE, Adama SJ, Ayuba₄ GI, Eseigbe P,

3

4

Ibok S, Iriah S, Anyanwu F.

1

2

Departments of Paediatrics and Family Medicine

Ahmadu Bello University Teaching Hospital (ABUTH),

3

Shika-Zaria, Nigeria And Departments of Paediatrics,

4

and Microbiology 44 Nigeria Army Reference Hospital

Kaduna, Nigeria

Background: Diarrhea is a significant cause of morbidity

and mortality among children aged less than 5 years in

sub- Saharan Africa. Bacterial organisms are important

etiological agents and their identification is vital to ef-

fective management.

Objective: To identify characteristics of bacterial iso-

lates in the stools of children aged less than 5 years with

acute diarrhea.

C103

Antimicrobial Sensitivity Pattern of Urine Isolates

from Adolescents with Asymptomatic Bacteruria in

Enugu

1

Nwokocha ARC, Oka₂for HU, Onukwuli V, Ujunwa

1

FA, Onyemelukwe N.

Department of Pediatrics, University of Nigeria

Method: The stools of children aged less than 5 years

presenting with acute diarrhea were cultured using De-

oxycholate Citrate Agar (DCA) and Salmonella-Shigella

1

Teaching Hospital, Enugu.

2

Department of Medical Laboratory Sciences,

(

SS) agar. Data was analyzed using Epi Info version

University of Nigeria Enugu Campus.

3

.5.3 and p values < 0.05 were regarded as significant.

Results: Stool samples were obtained from 270 children

aged 0.2 years to 4.9 years (mean1.6 ± 1.4 years). Ma-

jority of the children were males (156, 57.8%) and aged

Background: Asymptomatic bacteriuria (ABU) is com-

mon among adolescents who may have some predispos-

ing factors. The topic of whether ABU should or not be

treated is still an issue of debate. However in certain

situations where its treatment is beneficial, knowledge

of the common isolates as well as their antibiotic sensi-

tivity pattern becomes necessary.

Objective: This study was conducted to determine the

antibiotic susceptibility pattern of the common organ-

isms isolated from secondary school adolescents with

asymptomatic bacteriuria.

˂

2 years (64.1%). Diarrhea was bloody in 28(11.8%)

children. Antibiotic therapy was instituted in 185

68.7%) children before presentation and mostly pre-

scribed by caregiver (87, 47%). Metronidazole (154,

3.2%) was the commonest antibiotic prescribed. Bacte-

(

8

ria were isolated in 175 (64.8%) samples. The common-

est isolate was Escherichia coli (105, 60%). Bacteria

were isolated from 7(25%) of bloody diarrhea stools and

the isolates were Escherichia coli (2, 28.6%) and Shig-

ella spp (5, 71.4%). Isolates were most sensitive to

Ciprofloxacin (167, 95.4%). Bacterial isolation was sig-

nificantly (p˂0.05) associated with age ˂ 2 years, non-

use of antibiotics and bloody diarrhea.

Conclusion: Enterobacteriae are still important etiologi-

cal agents of acute diarrhea among children. The study

highlights the need for appropriate treatment of children

with diarrhea and promotion of prevention.

Methodology: Midstream urine specimen was collected

5

and cultured. A significant growth of 10 organisms/ml

was identified with Analytical Profile Index 20 tests for

identification of Enterobacteraceae (API-20-E) and for

Gram positive cocci by other standard methods.

Antibiotic sensitivity test was analyzed by disc diffusion

method using different antibiotics and their zone of inhi-

bition was measured.

Results: The bacterial isolates were identified as Staph

saprophyticus (29.51%), Enterococcus (26.23%), Staph

aureus (24.59%), Escherichia coli (14.75%), others

(

6.55%). Staph saprophyticus showed highest sensitivity

3

28

C105

Neonatal Septicemia as Seen at University Of Nigeria

Teaching Hospital: Current Trend

Methods: Ethical approval and carer-informed consent

were obtained at FMC Nguru. Main nursery was the

Control. Two laboratories constructed, a fresh building

(

Lab-1) and a renovated (Lab-2); surrounding walls dou-

Adimora GN, Ibeziako SN, Obu HA, Ukoha OM

Department of Pediatrics, University of Nigeria

Teaching Hospital, Enugu

bled with 6cm of air space in-between. In Lab‑1, floor

was 120cm below ground-level; tap-water-operated heat

-exchanger of 15mm copper‑piping was lined round the

inside wall. Meteorological-data within and outside

Laboratories/Control was collected via installed W‑-

8681 weather-station. Neonates were nursed and vital-

signs-data collected in all 3 apartments.

Results: For extremely hot days (36°C-43°C outside-

wind pick‑temp), control-room was cooler by 2.3°C,

Lab-2 (4.4°C), Lab-1(8.8°C). Average lowest relative-

humidity: Control (17%), Lab-2 (25%), Lab‑1 (46%).

From captured data for hot days between February and

October 2012, incubator over‑heat was frequent in Con-

trol-room but never occurred in Lab-1 or Lab-2; 71% of

babies nursed in Control‑room required water-sponging

63 times, Lab-2(once), Lab-1(none).

Background: Infectious conditions such as septicemia

account for the greatest proportion of deaths within the

first month of life in Nigeria. Thus, periodic bacterio-

logic surveillance in neonatal units is a necessity.

Objective: To determine the current prevalent pathogens

of neonatal sepsis in the Special Care Baby Unit of

UNTH Enugu, and their antibiotic susceptibility pattern.

Methodology: One hundred and twelve neonates with

clinical suspicion of sepsis underwent bacteriologic

screening over an 18month period.

Results: A total of 28 (25%) bacteria were isolated, 50%

were gram-positive and 50% gram-negative. There

were no mixed isolates. The commonest causes of neo-

natal sepsis were Staphylococcus aureus (42.9%), coli-

form bacilli (32.1%) and Escherichia coli (14%). Other

isolates were Streptococcus pyogene (7.1%) and Kleb-

siella spp. (3.6%). The susceptibilities of all isolates to

at least a penincillin was 39.3% but only 14.3% isolates

was susceptible to a combination of a penicillin with

Conclusions: Correcting an existing SCBU building

using the specifications of Lab-2 or constructing new

ones with the specifications of Lab-1 will eliminate EFS

and improve outcome.

C107

Immunization Coverage of Children with Chronic

Neurological Disorders Seen in University of Nigeria

Teaching Hospital Enugu, Nigeria

gentamicin

However, antibiotic susceptibility of all

isolates to at least one third generation cephalosporin or

quinolones were 78.6% and 100% respectively. Ceftri-

axone and ciprofloxacin were the most useful antibiot-

ics, though effective against, 64.3% and 82% for all iso-

lates respectively.

1

2

Okoro JC, Ojinnaka NC, Ikefuna AN.

1

Imo State University Teaching Hospital Orlu.

University of Nigeria Teaching Hospital (UNTH)

2

Conclusion: Our data showed a change in the predomi-

nant gram negative bacterial pathogen compared with an

earlier report from our unit, and an alarming overall de-

cline in the susceptibilities of pathogens to the com-

monly used antibiotics.

Ituku-Ozalla, Enugu.

Background: Children with Chronic Neurological

Diseases(CND) may be at risk of inadequate

vaccination. Both health workers and caregivers may

inappropriately categorize their clinical features as

contraindication to vaccination and thus, may not want

to immunize them. A dearth of information exists on the

immunization status of children with such disorders.

Objective: To assess the vaccination coverage rates of

children with CND seen at the University of Nigeria

teaching hospital (UNTH) Enugu compared to controls.

To also determine the relationship between vaccine

coverage and type of neurological disorders.

Method: Cross-sectional study carried out over a period

of 8months from May to December 2008 at the Pediatric

Neurology Clinic and Children Outpatient Clinic of the

hospital among mothers of children aged 6months to

five years. Interviewer-administered pre-tested

questionnaire and immunization cards of the children

were used. Yates’ corrected Chi-Squared test for

proportion and student T-test for means were used for

analysis. Values of p <0.05 were considered significant.

Result: The overall immunization coverage rate of

children with CNDs (68.5%) was significantly lower

than that of the controls (85.4%) (p= 0.001).Except for

HBV, the coverage rates of all the NPI vaccines both in

the subjects and controls were higher than the UCI target

C106

Effective Nursery Building that Resolves Tropical

Evening Fever Syndrome (EFS) in Neonates

1

2

1

Lawan MI, K₃awuwa MB, Oyedokun A, Mohammed

1

H, Amadi HO

Department of Paediatrics, Department Obstetrics &

1

2

Gynecology, Federal Medical Centre, Nguru, Nigeria.

3

Bioengineering Department, Imperial College London,

SW7 2AZ, United Kingdom.

Background: Recent publications have commented on

neonatal morbidity due to climate-induced Evening Fe-

ver Syndrome (EFS) in neonates. EFS on neonates, es-

pecially those on incubator care, does not presently have

any known clinical remedy as temperature of babies

soars up to 42°C in some regions of Nigeria like Nguru

during extreme-sunny days. FMC Nguru desperately

resorts to ineffective sponging of babies (>37.9°C) with

water. We hypothesise that any method of achieving

naturally cooled nursery-rooms will eliminate EFS.

Objective: To develop and validate a neonatal nursery

building-technique that eliminates EFS.

3

29

of 80%. The type of CNDs significantly affected the

immunization coverage of these children (p=0.01).

A202

Conclusion: There is low immunization coverage of

children with CND with significant missed opportunity.

The type of the disorder significantly influenced the

coverage rate. It is recommended that health care

workers should assess the immunization status of

children with CND at every opportunity for neccesary.

Zinc Status and Sexual Maturation of Sickle Cell

Anemia (SCA) Children at the University of Nigeria

Teaching Hospital (UNTH), Enugu

Onukwuli VO, Nwokocha ARC, Emodi IJ, Ikefuna AN

University of Nigeria Teaching Hospital (UNTH)

Ituku-Ozalla, Enugu.

A201

Socio-Economic and Cultural Factors Influencing

Malnutrition among Under-5 Children in Two Se-

lected Markets in Ibadan North Local Government

Area of Oyo State

Background: Adolescence is an important developmen-

tal period of childhood. Adequate nutrition consisting

major food constituents and trace elements like zinc is

fundamental for optimal sexual maturation.

Objective: To determine the pattern of sexual develop-

ment, age at menarche and serum zinc levels of female

SCA children aged 6-18 years and their socioeconomic

and age matched HbAA controls.

Methodology: In this cross sectional study, information

on biodata, age at menarche, medical and drug history as

well as 24 hour dietary recall was documented using

interviewer administered questionnaire. Sexual matura-

tion was assessed using Tanner staging while serum zinc

levels were determined using Atomic absorption spec-

trophotometer.

Results: Eighty-one subjects were compared with 81

controls. There was significant delay in the mean age of

attainment of various Tanner stages of breast and pubic

hair in the subjects. Mean age of 14.81+ 1.07 years at

menarche in the subjects was significantly higher than

Olaniyi AO, Windokun N

School of Nursing, University College Hospital, Ibadan.

Background: Malnutrition among under-five children is

a chronic problem in developing countries. Factors con-

tributing to the development of malnutrition include

insufficient dietary intake resulting from social, eco-

nomic and cultural practices.

Objective: This study examined the influence of socio-

economic status and cultural practices of the family on

malnutrition among under five children in two selected

markets in Ibadan.

Method: This was a descriptive, non- experimental study

involving one hundred (100) mothers of under-five chil-

dren randomly selected for the study. A semi-structured

questionnaire was used to collect data and hypothesis

testing done using SPSS 15.

Results: The study revealed that underweight children

are commonly found in low-income mothers 35(77.8%)

than in mothers with higher monthly income (2 (22.2%).

It also showed that prevalence of underweight reduces

as the level of education increases; viz: primary level of

education 17 (51.5%), secondary level 13 (29.5%) and

tertiary 6 (28.6%). Again, malnutrition is found to be

more common in polygamous families [40 (64.5%)]

than in a monogamous families [15 (44.1%)]. Finally,

children of mothers who believe in cultural practices

that prevent the provision of protein rich food [19

1

2.62 + 1.18 years in the controls (p = 0.001). Serum

zinc level of 58.01+ 10.58 µg/dl in the subjects was also

significantly lower than 68.37 + 8.67 µg/dl in the con-

trols (p = 0.001). Although no consistent association was

noted between zinc levels and the stages of sexual matu-

ration using multivariate analysis, serum zinc was found

to be a good predictor of breast and pubic hair develop-

ment.

Conclusion and Recommendation: Reduced serum zinc

in subjects was associated with delayed sexual matura-

tion. A randomized trial of zinc supplementation in SCA

children with delayed sexual maturation is recom-

mended.

(

52.8%)] were more malnourished than children of

mothers who do not have such cultural beliefs 22

35.5%).

A203

(

Influence of Zinc on The Body Mass Index of

Children with Sickle Cell Anemia (SCA) at the

University Of Nigeria Teaching Hospital, Enugu

Conclusion: Poor mothers’ income, low educational

status, polygamous type of family and bad cultural prac-

tices negatively influenced malnutrition among children

of the selected markets women. It is therefore recom-

mended that mothers should be empowered economi-

cally, educated on the importance of exclusive breast-

feeding and using locally available food resources as

weaning diet and be enlightened on the effects of adopt-

ing harmful cultural practices that prevents the provision

of protein-rich foods.

Onukwuli VO, Nwokocha ARC, Emodi IJ, Ikefuna AN

Department of Paediatrics, University of Nigeria

Teaching Hospital, Enugu.

Background: Sickle cell anemia is the most common

inherited disorder of the black race and associated with

retardation of physical growth. Clinical similarities exist

between children with SCA and those with zinc defi-

ciency.

Objective: To assess the physical growth and serum zinc

levels of SCA children and their socioeconomic and age

matched controls.

Methodology: A cross sectional study on children aged 6

3

30

-

18 years at the UNTH, Enugu. Information on biodata,

duce ALRI-related morbidity and mortality.

A205

High Rate of Micronutrient Deficiency among

Intestinal Failure Patients during and After

Transition to Enteral Nutrition

medical history, drug history and 24 hour dietary recall

was collected using interviewer administered question-

naires. Weights and heights were measured and their

BMI calculated. Serum zinc was determined using

Atomic absorption spectrophotometer.

1

2

Results: One hundred and sixty two children consisting

of 81 HbSS and 81 HbAA were studied. Mean weights

and BMI₂of the subjects (34.58 + 12.76kg and 16.27 +

Ubesie AC, H₂enderson CJ, Mezoff GA, Kocoshis

2

SA, Cole CR.

University of Nigeria Teaching Hospital, Ituku/Ozalla,

1

2

4

.76kg/m ) respectively was significantly lower than

Enugu.

2

0.19 + 13.37kg and 18.40 + 2.96kg/m respectively in

Cincinnati Children’s Hospital, Ohio

controls. (p = 0.01) while differences in mean heights

were not significant. Mean serum zinc level of 58.01 +

Background: Micronutrient malabsorption occurs in

intestinal failure (IF) due to anatomic defects, physiol-

ogic derangement or a combination of both. Micronutri-

ent deficiencies are associated with an increased risk of

morbidity and mortality.

Objective: To determine the prevalence of specific mi-

cronutrient (iron, zinc, magnesium, phosphorus, sele-

nium, copper, folate, vitamins A, D E and B12) defi-

ciencies in children with IF, and identify risk factors

associated with developing these deficiencies.

1

8

0.58µg/d1 was also significantly lower than 68.37 +

.6µg/dl in controls (p=0.01). Using multivariate analy-

sis, there was a positive correlation between serum zinc

and BMI of the children. Serum zinc level was a signifi-

cant predictor of weight, height and BMI.

Conclusion: Reduced serum zinc in SCA patients was

associated with delayed physical growth.

Recommendation: A randomized trial of zinc supple-

mentation in SCA patients with growth retardation is

recommended.

Method: A retrospective review of prospectively col-

lected data from children with IF managed by the intesti-

nal care team at Cincinnati Child_s_tren’s Hospital Medical

A204

st

Center, Ohio, between July 31 2007 and August 1

Serum Zinc Levels in Hospitalized Children with

Acute Lower Respiratory Infections in Ilorin, Kwara

State

2

012. Transition to full enteral nutrition was defined as

the period during which the patient received between

0%-100% of estimated required nutrition enterally.

2

1

2

1

Full enteral nutrition (FEN) was defined as patient toler-

ating all of the estimated required nutrition (100%) en-

terally for > 2 weeks.

Ibraheem₁RM, Bilamin SA, Gobir AA, Johnson

WBR.

‘

1

2

Department of Pediatrics, Department of Chemical

Results: Two hundred and four IF patients were in-

cluded in the study. Necrotizing enterocolitis (NEC) was

the most common cause of IF (27%). Common micronu-

trient deficiencies during transition to FEN were iron

Pathology, University of Ilorin Teaching Hospital,

Ilorin, Kwara State

Background: Malnutrition deficiency has continued to

attract a lot of research interest, whereas the import of

micronutrient deficiency like zinc has only recently be-

come the focus of research attention. Against the back-

ground of the present dearth of data on the status of zinc

levels in Nigerian children with ALRI, this study was

carried out in Ilorin Nigeria to determine the serum zinc

levels in hospitalized children with ALRI.

Methods: This comparative cross-sectional study in-

cluded 120 children aged 2 months to 5 years with ALRI

recruited as subjects and 120 age-and-gender matched

peers without ALRI as controls. Socio-demographic,

clinical and laboratory data were obtained. The serum

zinc levels was analyzed with a Jenway™ spectropho-

tometer after initial preparation with the QuantiChrom™

zinc assay kit.

(

79.3%), vitamin E (54.5%) and vitamin A (36.8%).

Majority (89%) of the subjects had anemia. In patients

who were successfully transitioned to FEN, Iron defi-

ciency was the most common micronutrient deficiency

(

43%) reported. However the prevalence of iron defi-

ciency was significantly lower on FEN compared to

during the transition period (p=0.0007). Anemia was

documented in 40% of the subjects on FEN.

Conclusion: IF patients have high prevalence of micro-

nutrient during and after transition to enteral nutrition.

A206

Vitamin D Levels and Abnormal Bone Health in

Children with₁ Intestinal Failu₂ re

2

Ubesie AC, Kocoshis SA, Henderson CJ, Mezoff

2

Results: Overall the male: female ratio was 1.6:1. The

mean (SD) serum zinc level in subjects with ALRI of

GA, Cole CR.

1

University of Nigeria Teaching Hospital, Ituku/Ozalla,

Enugu.

1

8.7 (11.8) µg/dl was significantly lower than the corre-

2

sponding value of 53.1 (18.5) µg/dl recorded in the con-

trols (p=0.001). Furthermore, the 98.3% prevalence of

zinc deficiency in children with ALRI was significantly

higher than the 64.2% recorded in controls (p=0.001).

Conclusion: lower serum zinc levels are significantly

associated with ALRI compared with those without.

Adequate enlightenment of mothers and health workers

on appropriate zinc-rich food sources would likely re-

Cincinnati Children’s Hospital, Ohio.

Background: Intestinal failure (IF) is associated with

macro and micronutrient malabsorption and deficien-

cies. Vitamin D deficiency is one of the commonly asso-

ciated micronutrient deficiencies reported in IF patients

due to a complex interaction between absorption and

physiology. This interplay may lead to abnormal bone

3

31

health in these patients.

Objective: To determine the prevalence and the predis-

posing factors for vitamin D deficiency and abnormal

bone health in children with IF.

B201

Clinical and Laboratory Profile of ARV Naïve HIV

Infected Children in Enugu, South-East Nigeria

Method: A retrospective review of intestinal failure pa-

tients managed by the Intestinal care center at the Cin-

cin_sn_tati Children’s Hospit_sa_tl Medical Center between July

Iloh KK, Ubesie AC, Iloh O, Okoli C, Eze C, Ibeziako

NS, Emodi IJ.

Department of Pediatrics, University of Nigeria Teach-

ing Hospital, Ituku/Ozalla, Enugu.

3

1 2007 and August 1 2012. Vitamin D deficiency

was defined as serum vitamin D < 20ng/dL. Abnormal

bone mineral density (BMD) was defined as z-score <-2

as measured by Dual energy X-ray Absorptiometry

Background: HIV/AIDS is one the most dynamic epi-

demic infectious disease. An estimated 1000 children

are newly infected with HIV every day, most of them in

sub-Saharan Africa. They often present with various

clinical and laboratory manifestations that complicates

their management.

Objectives: To document the baseline clinical and labo-

ratory features of HIV-infected children presenting at

the University of Nigeria Teaching Hospital.

Methods: Data was collected prospectively from HIV

infected child_sr_ten seen at the APIN_t_hClinic of UNTH be-

tween July 1 2010 and June 30 2012. Clinical and

immunological staging were done using the WHO crite-

ria and data analysis was with SPSS version19.

(

DXA) scan.

Results: One hundred and twenty three patients were

enrolled; 71 boys (57.7%) and 52 girls (42.3%). The

mean age at entry into the study was 5.8 years. Fifty-two

patients (42.3%) had vitamin D deficiency documented

and 17.7% had abnormal BMD z-score. Older age (>10

years) was significantly associated with vitamin D defi-

ciency (p = 0. 02) and abnormal BMD z-score (p = 0.

0

15). There was no relationship between Vitamin D

levels and BMD z-score (p =0.147).

Conclusion: Older IF patients had higher risk of vitamin

D deficiency and abnormal BMD z-scores.

A207

Rickets as seen in Federal Teaching Hospital

Abakaliki

Results: Two hundred and fifty-two children were en-

rolled into the study. The most common route of infec-

tion was vertical (90.8%). Common presenting clinical

features were: anemia (91.5%), cough (74.6%), papular

rash (62.7%), fever (61.5%) and poor weight gain

(61.1%). Tuberculosis, hepatitis B and C co-infections

were seen in 34.8%, 2.6% and 3.4% of the children re-

spectively. Most of the patients had either a WHO clini-

cal stage III (42.6%) or II (38.2%) disease. Severe im-

munosuppression based on CD4% or count was seen in

more than half of the patients (55.5%). Univariate

analysis showed that cough (p=0.02), skin wart_rs_d

(p=0.01), weight (p=0.00) and height (p=0.02) < 3

percentiles significantly predicted severe immunosup-

pression but only cough (p=0.013) remained significant

on multivariate analysis. Fifty-seven (23.8%) children

had leukocytosis while 8.8% had thrombocytopenia.

Conclusions: Majority of our patients presented late

(advanced disease). Cough, rash, fever and anemia were

most common features seen.

Ibekwe MU, Ogugua CF, Ogeh CO.

Department of Pediatrics, Federal Teaching Hospital,

Abakaliki

Background: Rickets is a process resulting in defective

mineralization of the growth plate. It constitutes 15% of

disorders seen in the pediatric endocrine clinic of Fed-

eral Teaching Hospital Abakaliki (FETHA). Its manage-

ment is fraught with diagnostic challenges.

Objective: To review cases of rickets seen in endocrine

clinic of FETHA and how they present.

Method: This is a retrospective study of children

presenting with rickets attending the endocrine clinic of

FETHA between October 2010 and September 2012.

Case files of these children were retrieved and analyzed.

Information obtained included age, sex, clinical presen-

tation, laboratory investigation treatment and outcome.

Result: A total of 64 children with endocrine disorders

were seen during the study period under review. Eight

B202

HIV Orphan Status and Severity of Pediatric HIV

Disease Seen In Enugu, South-East Nigeria

(

15%) children presented with rickets. The male to fe-

male ratio was 1.6:1. The average age at presentation

was 24.1 months (with a range of 13-60 months). Most

common presentations were genu varum (62.5%), genu

valgum, bone pain, joint swellings (12.5% respectively).

Average calcium value was 1.38 (2.2-2.8) with a range

of 0.35-1.9. Average phosphate was 1.15mg/dl (1.1-1.6)

with a range of 0.63-2.1mg/dl. That of alkaline phos-

phate was 453.3 (25 – 92) mg/dl. All cases had positive

radiologic findings and belonged to a modal social class

of 3. Seventy five percent were lost to follow up while 2

responded to Vitamin D treatment.

Iloh KK, Ubesie AC, Iloh O, Okoli C, Eze C, Ibeziako

NS, Emodi IJ.

Department of Pediatrics, University of Nigeria Teach-

ing Hospital, Ituku/Ozalla, Enugu.

Background: Since the beginning of the HIV epidemic,

about 15 million children have lost one or both parents

to HIV/AIDS, 90% of them live in sub-Saharan Africa.

The death of one or both parents has both psycho-social

and medical implications for an HIV-infected child.

Objectives: To determine if HIV-infected AIDS or-

phans present with more severe HIV disease than their

non-orphaned counterparts.

Conclusion: Rickets in Abakaliki is an important endo-

crine problem that cuts across the different social classes

and most of them are lost to follow up during treatment.

3

32

Methods: Data on orphan status was collected prospec-

tively from HIV infected children presenting at the pedi-

atric HIV clinic of University of Nigeria_tT_h eaching Hos-

ers’ had complete PMTCT program and 66.6% for

those whose mothers’ had no PMTCT in pregnancy.

Conclusion: This study has shown that the PMTCT pro-

gram has a significant impact on the mother to child

transmission of HIV.

st

pital between July 1 2010 and June 30 2012. Single

orphan was defined as having lost either of the parents

and double if both parents were dead. Data analysis was

with SPSS version19.

B204

Results: Children aged 6 months to 15 years were en-

rolled into this study. One hundred and three (41.1%)

were AIDS orphans. Among the orphans, 71.8% and

Elimination of Mother –To- Child Transmission of

HIV Infection: Effectiveness of Integrated HIV

Services in a Cottage Hospital with a Highly

Subscribed Community Health Insurance Scheme

2

8.2% were single and double orphans respectively. The

route of HIV transmission was evenly distributed be-

tween the two groups of patients (p=.91). Mother was

the primary care of 98% of the non-orphans and 43.7%

of the orphans (p=0.000). More children from the or-

phaned group (65.2%) compared to the non-orphans

1

2

3

Nte AR , Fajola AO₄, Fakunle BA , Adibe N , Umeji-

3

aego C , Ehigiegba A

Department of Pediatrics, College of Health Sciences,

1

U₂niversity of Port Harcourt

(

34.8%) presented at aged 11-15 years (p=0.001). Dou-

Community Health, Shell Petroleum Development

C₃ompany, Port Harcourt

ble orphans had more severe anemia (80%) than those

who lost either their mother (0%) or father (20%) alone

Obio Cottage Hospital, Port Harcourt

4

(

p=0.013). HBsAg co-infection was significantly higher

Department of Obstetrics and Gynecology, College of

in the orphaned group (p=0.042). A relatively higher

proportion of HIV-infected non orphans compared to the

orphaned group presented with early WHO clinical

stages (p = 0. 26).

Conclusions: HIV-infected AIDS orphans present at

later age with more advanced disease and HBsAg co-

infection than the infected non-orphans. Severe anemia

was significantly higher among double orphans.

Medicine, University of Benin, Benin

Introduction: Nigeria is one of the 22 priority countries

for the monitoring of the attainment of the goal of elimi-

nating all forms of mother to transmission of HIV infec-

tion (EMTCT) by 2015. The Global Plan aims to reduce

new child HIV infections by 90% and reduce HIV-

associated deaths of women during pregnancy, child-

birth, and puerperium by 50% from the 2009 baseline;

and to reduce mother-to-child-transmission to less than

5%, a level low enough that mother-to-child transmis-

sion of HIV would no longer be considered a major

public health problem. As part of the four prong ap-

proaches for the attainment of these goals an integrated

HIV services including the prevention of mother-to-

child transmission was initiated at the Obio Cottage

Hospital (OCH). The OCH introduced the Community

Health Insurance Scheme to increase access of target

communities to affordable health care services while

reducing out of pocket spending on health care. As part

of the scheme, the scope of Maternal, Newborn and

child health services and their monitoring indicators at

the centre increased.

B203

The impact of PMTCT on the Vertical transmission

of HIV in Abuja Municipal Area Council (AMAC) of

the Federal Capital Territory (FCT)

Oyesakin AB, Audu LI, Oniyangi OO

National Hospital, Abuja

Background: HIV/AIDS is a major cause of under 5

mortality and 90% of Pediatric HIV/AIDS is acquired

through mother to child transmission (MTCT). With the

implementation of Prevention of Mother to Child

Transmission (PMTCT) program, it is expected that the

rate of MTCT of HIV should have reduced drastically. It

is on this premise that a study to determine the current

rate of MTCT of HIV in Abuja Municipal area council

was undertaken.

Objectives: The paper presents data generated at the

Integrated HIV service programme at the OCH to evalu-

ate its efforts towards the attainment of the goals of the

Global Strategy and their monitoring indicators at the

centre increased.

Objective: To determine the current rate of mother to

child transmission of HIV in AMAC, Abuja

Method: Using the deoxyribonucleic polymerase chain

reaction (PCR) test, the HIV status of all the exposed

babies delivered in AMAC, over a 9-month period was

determined by taking their peripheral blood at 6 weeks

of age . This was repeated 6 weeks post cessation of

breast feeding for breastfed babies. The extent to which

mothers participated in the PMTCT program was noted.

The number of babies who tested positive was obtained

and computed over the total number of exposed babies

to determine the rate of mother to child transmission

Methods: The records of HIV services maintained at the

OCH from 2009-2012 were reviewed and data extracted

for presentation

Results: The integrated services offered include antena-

tal care, HIV counseling and testing, maternal ARV pro-

phylaxis/ART, infant feeding counseling and ARV pro-

phylaxis, IPT and family planning services, DBS for

early infant diagnosis. The subscription to these services

was high in the two year period of program implementa-

tion with increments ranging from 116% to 667 of the

2011 level for various services. Overall, 83() and 113()

women respectively were positive in 2011 and 2012.

Overall, 58 babies were delivered to HIV positive moth-

ers, 110 mothers started SRV prophylaxis, 220 refilled

(

MTCT)

Result: An overall HIV transmission from mother to

child of 6.5% (23/355) was found. A lower rate of 1.6%

was obtained as transmission rate for those whose moth-

3

33

their ARV prophylaxis, 144 were compliant with the

prophylaxis, 39 were initiated on ART, 69 came for

ARV refill and 194 were counseled on Infant feeding.

Furthermore, 194 HIV positive women had family plan-

ning couselling while 4436, 1693 and 44 respectively

received IPT1-3. Among the 58 babies delivered by HIV

infected women, who 57 received antenatal care and

PMTCT services at the centre, while one absconded to a

church, delivered there and presented at 6 weeks with a

baby that tested positive. Of the remaining babies, one

died at the age of two days and could not be tested for

HIV. Among the 57 who survived till 6 weeks, all were

initiated on ARV and DBS sent, none tested positive.

Additionally the babies receive cotrimoxazole from 6

weeks to 18 months. None of the babies has reached 18

months for a final testing. All the babies were exclu-

sively breastfed for 6 months while their mothers took

ARV prophylaxis or HAART and continued the drugs

till one week after cessation breastfeeding

very common in these children. Both neutrophilia and

malaria parasitemia coexisted in 41% of cases. A differ-

ential WBC count and malaria parasitemia evaluation

done on such children at first presentation is proposed.

B206

Probable Non- HIV Immune Reconstitution

Syndrome: A Case Report

Orogade AA, Eseigbe E, Abubakar Y, Usman N

Department of Pediatrics, Ahmadu Bello University

Teaching Hospital, Shika Zaria.

Background: Immune reconstitution inflammatory syn-

drome (IRIS) results from heightened immunologic and

or inflammatory response against pathogens after com-

mencing therapy. Although it gained more recognition

after the introduction of anti-retroviral therapy for HIV,

non HIV IRIS had been described earlier.

Conclusions: Integrated HIV services are effective in

eliminating Mother-to Child transmission and promote

child survival. Ensuring access to these services through

a community health insurance scheme is recommended.

Case Presentation: A 12 year old boy presented with

history of progressive weight loss, fever, cough breath-

lessness, severe anemia and generalized lymphadenopa-

thy. He had failed to respond to antibiotics. Chest X-ray

revealed widespread lung infiltrates with paratracheal

and hilar lymphadenopathy, Complete Blood Count

showed severe anemia, leucopenia with relative neutro-

philia, no blast cells, normal platelet count and Reticulo-

cyte count of 5%. Tuberculin Skin Test was negative

despite a BCG scar. Serial Blood cultures and HIV test

were negative. An assessment of disseminated Tubercu-

losis was made and he was transfused and commenced

on 4 drug antituberculous therapy.

B205

White Blood Cell Count in Febrile Children without

an Obvious Focus of Infection: a Private Hospital

Experience

1

,2

1

Adesanmi TA, Mobolaji-₁Lawal O, Odudu L,

1

Adibuah FN, Akinboni T.

EMEL Hospital 21 Road Z Close, FESTAC, Lagos State.

After initial good clinical response with tapering fever,

on fourteenth day, he developed a sudden onset of se-

vere respiratory distress with SpO of 75% on room air.

2

Background: EMEL Hospital is a multispecialty hospital

and Pediatric center situated in FESTAC Lagos state,

Nigeria. Fever without an obvious focus of infection is a

common cause of presentation in children aged > 1

month to 60 months at this hospital. Repeated hospital

visits and parental anxiety are common. In this era of

managed healthcare, polypharmacy and indiscriminate

laboratory investigations are wasteful. How can we be

more cost effective?

Chest X-ray then showed pneumatocoele which resolved

spontaneously within a few hours and trans-thoracic

echocardiocardiogram did not show any abnormal fea-

tures. Thereafter he apparently improved but six days

later, he became confused and developed sudden signs

of raised intracranial pressure. He succumbed before he

could have any neuro-imaging could be done. A prob-

able diagnosis of immume reconstitution syndrome

Objectives: To determine

(

IRIS) was made.

1

. The white blood cell [WBC] count (total and differ-

Conclusion: Non HIV IRIS has neither universal clinical

criteria nor diagnostic tests to confirm it unlike HIV

IRIS. It is usually subtle and can be overlooked.

ential) pattern in these children.

2

. What percentage of these children have white cell

counts suggestive of an infection (viral or bacterial).

What percentage of such children have positive

malaria parasitemia.

B207

The Factors Associated with Attention Deficit Hyper-

activity Disorder (ADHD) in Nigerian Children with

Epilepsy

Methods: Hospital records of children aged >1 to 60

months over a six month period were retrieved and nec-

essary information was extracted. Data was analyzed

using Excel and Epi info softwares.

1

2

1

Ibekwe R.C ,₁Ndukuba A.C , Aronu A.E ,

Ojinnaka N.C

Results: Thirty seven per cent (277/744) had total WBC

3

count greater than 10,000/mm , whilst 0.9% had total

1

2

Department of Paediatrics, Department of

3

WBC count less than 3,500/mm . Relative neutrophilia

Psychological Medicine, University of Nigeria Teaching

Hospital Enugu

was found in 79% of cases. Leucocytosis did not vary

significantly with age. Positive malaria parasitaemia was

found in 50% of cases. Neutrophilia and positive ma-

laria parasitaemia coexisted in 41% of cases.

Conclusion: Relative neutrophilia, suggestive of bacte-

rial infection; and positive malaria parasitemia were

Background: The presence of co-morbidity of attention

deificite/hyperactivity disorder and epilepsy worsen the

prognosis of epilepsy, make the treatment of epilepsy

3

34

more difficult, and affect their quality of life.

dren. Chloroquine was the most common inappropriate

treatment.

Objective: To determine the seizure and non seizure

related variables associated with ADHD in Nigerian

children with epilepsy.

Method: A cross-sectional study of 113 children with

epilepsy was assessed for ADHD using the home ver-

sion of the ADHD Rating Scale IV. The influence of

certain variables on the presence of ADHD was deter-

mined.

Conclusion: The utilization of ACTs for treating uncom-

plicated malaria has improved in health facilities in the

State but patient evaluation is sub-optimum. There is

need for proper patient evaluation and confirmation of

diagnosis before instituting treatment in these facilities.

C202

Results: Sixteen (14.2%) children had ADHD with the

inattentive subtype being the most common (68.8%).

The variables that were significantly associated with

ADHD were poor academic performance ( p=0.01), liv-

ing in rural areas ( p=0.00), history of status epilepticus

The Pattern of Thrombocytopenia in Plasmodium

Falciparum Malaria in Children Attending a

Tertiary Hospital in Uyo, South Eastern Nigeria

1

2

3

Utuk EE, Ikpeme EE, Emodi IJ, Essien EM.

1

3

(

p=0.00) and the presence of other associated anomalies

p=0.00).

Department of Pediatrics and Department of Hematol-

ogy, University of Uyo Teaching Hospital, Uyo, Akwa

2

Conclusion: Children with epilepsy that are under-

achieving academically, not living with both parents,

with history of status epilepticus, family history of epi-

lepsy, with other neurological anomalies and abnormal

EEG finding are at increased risk of having ADHD and

should be screened for ADHD.

Ibom State, Nigeria. Department of Pediatrics, Univer-

sity of Nigeria Teaching Hospital, Enugu, Enugu State,

Nigeria.

Introduction Malaria due to Plasmodium falciparum (Pf)

is a major cause of illness and deaths in children. The

occurrence of complications such as thrombocytopenia

varies in its prevalence and pattern among different

population groups. There is paucity of data on this in

Nigerian children.

Objective: To determine the prevalence and pattern of

thrombocytopenia in malaria due to Pf in children at-

tending a tertiary Hospital in Uyo, Akwa Ibom State

located in the south eastern region of Nigeria.

C201

Management of Uncomplicated Malaria in

Under-Fives in Private and Public Health Facilities

in South-Eastern Nigeria: A Clinical Audit of

Current Practices

Udoh EE, Oyo-ita AE, Odey FA, Effa EE, Esu EB,

Oduwole OO, Chibuzor MA, Meremikwu MM.

Calabar Institute of Tropical Disease Research and

Prevention, University of Calabar Teaching Hospital,

Calabar.

Methods: A prospective cross-sectional study of one

hundred and eighty children aged six months to fifteen

years with microscopically confirmed infection with P.

falciparum was conducted. They were compared with

1

80 healthy controls without malaria parasitemia

Background: Malaria remains a leading cause of under-

five morbidity and mortality in sub-Saharan Africa.

Effective case management is one of WHO’s strategies

for controlling the disease.

Objective: Clinical audit of case management of uncom-

plicated malaria in under-fives.

matched for age and gender. Their platelet counts were

evaluated using the automated analyzer (Sysmex KX-

21N).

Results: The overall prevalence of thrombocytopenia

9

(platelet count < 100 x 10 /L) in the subjects was 5.0%.

9

The mean platelet count (x 10 /L) in subjects was lower

Methods: Clinical audit was conducted in 24 public and

than in the controls with a range of 44 – 565 and 113 –

598 respectively. The mean platelet count in subjects

with severe manifestations of malaria was lower than

that in those with uncomplicated malaria. There was an

inverse relationship between the malaria parasite density

and platelet count in subjects (r = -0.21; p <0.001).

Conclusion: The study showed a higher prevalence of

thrombocytopenia in children presenting with severe

malaria from Pf in this setting. It is therefore important

to monitor the platelet counts of such children.

1

2 private health facilities in Cross River State, Nigeria

from January to March 2012. Trained medical personnel

extracted information on selected audit criteria from

patients’ case records using pre-tested data extraction

forms. The audit criteria were checked on the data ex-

traction forms as “Yes”, “No” or “Unclear” depending

on the findings.

Results: Of the 463 case records reviewed, age, gender

and weight were reported in 98.1%, 97.3% and 49.7%.

A history of fever was obtained in 89.6% and a record of

temperature in 74.1%. General examination was per-

formed in 203 (43.8%) children. Malaria parasite test

was requested in 132 (28.5%) but performed in 127

C203

Comparative Efficacy and Acceptability of Arte-

mether-Lumefantrine versus Dihydroartemisinin-

Piperaquine in Kenyan Children with Uncompli-

cated Falciparum Malaria

(

8

96.2%) children with light microscopy constituting

6.4%. Packed Cell Volume or Haemoglobin was re-

quested in 107 (23.1%) but performed in 95 (88.8%)

children. Appropriate dose of Artemisinin Combination

Therapy (ACT) was instituted in 300 (64.8%), wrong

dose of ACT in 109 (23.5%), inappropriate treatment in

1

2

3

Ogutu B, Onyango KO, Ongecha JM, Juma₄ E,

1

3

1

Otieno GA, Obonyo C, Otieno L, Eyase F,

Johnson JD, Perkins DJ, Akhwale W.

Walter Reed Project-Centre for Clinical Research,

4

5

6

1

4

1(8.9%) and undetermined treatment in 13 (2.8%) chil-

3

35

Kenya Medical Research Institute, Nairobi, Kenya,

2

Centre for Clinical Researc₃h, Kenya Medical Research

Background: Asymptomatic carriers of P. falciparum

constitute a reservoir for infection of newly hatched

mosquitoes.

Objectives: Controlled, parallel, cluster-randomized

(intervention=9, control=9) 12-month study was con-

ducted in Burkina Faso to evaluate impact at community

level of systematic screening and artemether-

lumefantrine (AL)/AL dispersible treatment of RDT-

detected ACs during 3 community screening campaigns

(CSCs1-3).

Methods: CSCs1-3 were successively placed 1 month

apart before rainy season and CSC4 1 year later. Symp-

tomatic malaria episodes were treated with AL or an

alternative in both arms. Proportion of gametocyte carri-

ers (GCs) was evaluated by microscopy in all subjects at

CSCs1-4 in intervention arm and in randomly selected

40% subset of control arm, and by qRT-PCR at CSC4 in

1,999 randomly selected subjects across both arms.

Results: Prevalence of microscopy-confirmed ACs in

intervention and control arms was 42.8%vs47.5%, 4.1%

vs35.7%, 2.8%vs32.2% and 34.4%vs37.8% at CSC1,

2,3 and 4, respectively. Overall proportion of GCs in

intervention and control arms was 9.5%vs10.2%, 0.6%

vs5.5%, 0.4%vs5.8% and 4.8%vs5.1% at CSC1, 2,3 and

4, respectively. Prevalence (least square mean [SE]) of

microscopy-confirmed GCs at CSC4 in intervention arm

was 4.9 (0.41) vs 5.1 (0.41) in control arm (p=0.7208).

Prevalence of GCs at CSC4 as assessed by qRT-PCR

was around 8-fold greater in both arms compared to

microscopy (intervention=49.7%vs6.0%; control=47.3%

vs5.4%).

Institute, Kisumu, Kenya, Centre for Global Health

Research, Kenya Medical Research Institute, Kisumu,

Kenya, Walter Reed Project, Kenya Medical Research

Institute, Kisumu, Kenya, University of New Mexico,

Albuquerque, NM, United States, Department of Dis-

4

5

6

ease Prevention and Control, Ministry of Public Health

and Sanitation Nairobi, Kenya

Background: Artemether-lumefantrine (AL) and dihy-

droartemisinin-piperaquine (DP) have been introduced

as first and second-line treatment, respectively, for un-

complicated falciparum malaria in Kenya.

Objectives: Primary objective was to compare corrected

Acceptable Clinical and Parasitological Responses

(

ACPR) on Day 28 in children treated with AL dispersi-

ble (AL ) and DP pediatric (DP ) with uncomplicated

falciparum malaria.

d

p

Methods: This open-label, comparative study in Western

Kenya randomized 454 children with uncomplicated

falciparum malaria of age 6-59 months to receive either

d p

AL (n=227) or DP (n=227). Children were hospitalized

for 3-days for observed treatment and followed up on

Days 7, 14, 28 and 42. Adherence to treatment and ac-

ceptability were assessed by caregiver questionnaire.

Results: No significant differences were observed for

corrected ACPR rates on Day 14,28 and 42 for AL

100%,97.8%,and 96.8%) and DP (100%,99.1%,and

8.7%;p>0.05 for all comparisons). For uncorrected

ACPR rates no significant differences were observed on

Day 3,14, 28 and 42 for AL (99.1%, 98.7%,81.1%, and

group (100%,100%,87.7%,and

0.5%;p>0.05 for all comparisons). Overall incidence of

d

(

9

p

d

6

7

7.8%) vs DP

p

Conclusions: In this community-setting study, interven-

tion arm showed greater reductions in prevalence of

ACs and GCs than control arm at CSCs2 and 3, relative

to CSC1(p<0.0001). However, AC and GC prevalence

rose thereafter in intervention arm to reach a level simi-

lar to control arm at CSC4.

AEs was 65.5% (156/238) and 67.5% (156/231) in AL

and DP arms. Adherence to treatment regimen was

higher for AL arm (93.6%) compared to DP (85.6%)

arm. 82% considered AL ‘simple’ or ‘very simple’ to

use compared with 67% in DP arm (p=0.007). Taste of

AL was ‘liked’ or ‘liked very much’ by 72% of respon-

dents, compared with 56% for DP

Conclusions: Both AL and DP

d

p

d

p

d

p

d

C205

Community Acquired Pneumonia: A One Year Re-

view of Pediatric Admissions

p

(p=0.001).

d

p

are efficacious treat-

ments for uncomplicated falciparum malaria in Kenyan

children.

in Ahmadu Bello University Teaching Hospital Zaria

Orogade AA, Eseigbe EE, Oloorukoba AA,

Ezeukwu IE, Adewumni OA.

C204

Impact of Community Screening and Treatment of

Asymptomatic Carriers of Plasmodium Falciparum

with Artemether-Lumefantrine on Asymptomatic

and Gametocyte Carriage: A 12-Month, Cluster-

Randomized Study In Sub-Saharan Africa

Department of Paediatrics, Ahmadu Bello University

Teaching Hospital Shika-Zaria.

Background: Pneumonia is responsible for 17% of all

under –five deaths in Nigeria. In March 2009, Nigerian

government revised the National Immunization Policy to

include “new and underutilized vaccines” among which

are the Pneumococcal Conjugate and Haemophilus In-

fluenza B vaccines that prevent 2 of the most prevalent

causes of pneumonia in childhood. These antigens be-

came part of routine vaccines in Kaduna State, one of

states in the first phase of implementation of this immu-

nization policy.

1

2

1

Tiono AB, Ouédraogo A, Ogutu B, Diarra A, Couli-

1

3

4

baly S, Cousin M, Remy C,₅Mukhopadhyay A, Sou-

1

lama I, Sirima SB, Hamed K.

1

Centre National de Recherche et de Formation sur le

Paludisme, Ouagadougou, Burkina Faso, Walter Reed

2

Project-Centre for Clinical Research, Kenya Medical

3

Research Institute, Nairobi, Kenya, Novartis Pharma

4

AG, Basel, Switzerland, Novartis Healthcare Private

Objectives: To study the current contribution of pneu-

monia to morbidity and mortality in children admitted

into ABUTH Shika Zaria.

5

Limited, Hyderabad, India, Novartis Pharmaceuticals

Corporation, East Hanover, NJ, United States

3

36

Methods: Consecutive children admitted to the Emer-

gency Pediatric Unit of Ahmadu Bello University

Teaching Hospital over a one year period with clinical

and radiological evidence of pneumonia were recruited.

Results: A total of 148 children were seen from Novem-

ber 2011 to October 2012. These formed 18.4%

C207

+

The Effect of PEM on the CD4 T-Lymphocyte

Counts in under-5 Children as seen in Sokoto,

Nigeria

(

148/805) of the total admissions during this period. The

Yusuf T, Jiya NM, Ahmed H.

male: female ratio was 1.8:1 and 42.6% (63/148) of

them were infants and 90.5% (134/148) were under

fives. There was incidence of pneumonia all year round

with highest peak in Dec 2011 and two smaller peaks in

of incidence in April and August 2012. There were 16

deaths, 10.8% of cases.

Conclusion: One in five children admitted to EPU,

ABUTH Shika Zaria has pneumonia, with a case fatality

rate of 10%. These morbidity and mortality figures are

unacceptably high where vaccines are available. There is

need for careful monitoring of implementation and

utilization of vaccine programs to prevent childhood

pneumonia.

Department of Pediatrics, Usmanu Danfodiyo Univer-

sity Teaching Hospital, Sokoto

Background: Protein-energy malnutrition, a major pub-

lic health problem in the developing countries, has been

associated with impaired cell-mediated immunity.

+

Objectives: To determine the effect of PEM on CD4 T-

lymphocyte counts among under -5 children.

Methods: This was a prospective cross-sectional study

conducted among HIV-negative children aged 6 - 59

months with PEM a_sn_t d the HIV-negative well-no_t_hurished

children between 1 November, 2009 and 30 April,

2

010. The socio-demographic characteristics, weight

and some haematological indices of the both groups

were documented. The CD4 T-lymphocyte count was

+

C206

Purpura Fulminans Complicating Klebsiella Sepsis:

A Case Report

determined using Partec cytoflow machine.

Result: One-hundred children were recruited for each

group over a 6 month period. The two study groups

were comparable in age (p= 0.53) and sex (p= 0.65).

1

2

1

Adefehinti O, Oke OJ, Olowu WA, Adeodu OO.

1

2

+

Haemato-Oncology Unit, Nephrology and

The mean CD4 T-lymphocyte count in children with

Hypertension Unit, Department of Pediatrics, Obafemi

Awolowo University Teaching Hospital, Ile-Ife, Nigeria

PEM was 1705.5±605.6 cells/µL as compared to

2

The mean CD4 T-lymphocyte count decreases as the

314.3±491.1 cells/µL among the controls (p= 0.0001).

+

Background: Purpura fulminans (PF) is a very rare

haematological emergency that may complicate severe

sepsis in infants and young children. Rapid thrombotic

end organ damage with profound morbidity and

mortality is common if diagnosis and treatments are

delayed.

age increases (r= - 0.2, p= 0.04). The inverse relation-

ship between the age and the CD4 T-lymphocyte count

was also seen in the control group (r= - 0.52, p=

+

0

.0001). There was significant difference in the mean

+

CD4 T-lymphocyte count of the different types of PEM

with the highest value observed among children with

kwashiorkor (2097.7±712.9 cells/µL) and lowest value

observed among those with marasmus (1449.3±368.2

cells/µL).

Objective: To highlight the need for early recognition,

diagnosis and management of PF.

Case Report: A 15 months old female who presented to

our Children Emergency Ward with clinical features of

sepsis and anaemic heart failure is reported. she was

transfused with whole blood and commenced on

parenteral Zinacef and Gentamicin. She developed

generalised purpuric skin lesions with epistaxis on day

four and acute kidney injury on day seven of admission.

On day 8, there was bilateral dark colouration of both

feet and hands with gangrene of all toes. Blood and

urine cultures yielded Klebsiella species sensitive only

to imipenem. Haematological tests showed deranged

clotting profiles, leucocytosis with toxic granulations,

thrombocytopaenia and microangiopathic haemolytic

anaemia. A definitive diagnosis of PF complicating

Klebsiella sepsis was made. Despite FFP and platelet

transfusion, haparinisation, EBT and management with

Imipenem, patient died on day 25 of admission.

Conclusion: The PEM has deleterious effects on the

+

CD4 T-lymphocyte counts among under-5 children

with PEM with the lowest count observed among those

presenting with marasmus.

C208

Disseminated Herpes Zoster Ophthalmicus in an

immunocompetent eight year old boy: A Case Report

1

2

Olomukoro CN, Oladokun RE, Owa AE.

1

Department Paediatric, National Hospital, Abuja,

University College Hospital, Ibadan

2

Background: Varicella (chicken pox) results from a

primary infection with the varicella virus while herpes

zoster is caused by a reactivation of a latent infection.

Incidence of herpes zoster and frequency of one of its

complications involving the trigeminal nerve; ophthal-

mic zoster, increases with age probably due to the

Conclusion: Purpura fulminans is a life-threatening

consumptive thrombo-haemorrhagic disorder for which

a high index of suspicion is needed to make a diagnosis.

decline in cell-mediated immunity. Dissemination of

herpes zoster is seen more frequently in immunocom-

promised hosts but is uncommon in immunocompetent

individuals. Reports of disseminated herpes zoster in

3

37

children are even less common than in adults.

A302

Case presentation: An unusual case of disseminated

Herpes Zoster Ophthalmicus in an eight year old im-

munocompetent black boy is presented. His past medi-

cal history revealed that he had a previous primary

Varicella Zoster Virus infection at three years of age. In

the current report, he presented during an on-going

chicken pox outbreak. He was admitted and nursed in

isolation in the children’s ward. He survived with a

residual ptosis of the affected side but with no signifi-

cant intraocular complication

Childhood Acquired Heart Disease in Nigeria: An

Echocardiographic Experience from Three Centers

1

2

3

Sadoh WE, Uzodimma CC, Daniels Q.

1

Department of Child Health University of Benin

Teaching Hospital, Benin Nigeria, Department of

2

Paediatric, Lagoon Hospital, Lagos Nigeria.

3

Department of Paediatric , Zankli Hospital Abuja

Nigeria.

Conclusion: A break through varicella virus re-infection

or a reactivation are possible, both of which could pre-

sent as zoster. This case emphasizes the need for preven-

tion of varicella virus infection through universal child-

hood immunization and infection control strategies to be

put in place in health care settings.

Introduction: Acquired heart diseases (AHDx) are not

uncommon in children. Earlier studies provided the

spectrum of AHDx from single centers. The current

multi-center study aims to provide a more representative

data of AHD in Nigeria.

Objective: To determine the spectrum of AHDx from

three centers in Nigeria

Methods: Over 42 months, children referred for echocar-

diographic evaluation who had confirmed AHD in three

centers in Nigeria were recruited. The data was collected

on biodata and types of AHDx.

Results: There were 121 children with 139 cases of

AHD, with a mean age of 6.6 ± 5.7 years. The males

were 65(53.7%). Pericarditis was the commonest AHD

in 36 (25.9%), followed by RHD 23 (16.5%), hypertro-

phic cardiomyopathy 23(16.5%), myocarditis 20(14.4%)

and dilated cardiomyopathy 18(12.9%). Endomyocardial

fibrosis 3(2.2%) and Kawasaki disease were uncommon.

A301

Blood Pressure Profile of Adolescents in Enugu

Ujunwa FA, Ikefuna AN, Nwokocha ARC, Anisuba B.

University of Nigeria Teaching Hospital (UNTH)

Ituku-Ozalla, Enugu

Background: Elevation of blood pressure during the first

two decades of life is likely an early warning sign of

overall future cardiovascular risk. Identifying children

and adolescents at risk of hypertension is the first step in

modifying or preventing the disease and its risk factors.

Objective: To determine the blood pressure profile of

secondary school adolescents in Enugu.

Method: Cross sectional survey of 2698 secondary

school adolescents aged 10-18yrs was carried out in

Enugu. A pretested questionnaire was used to obtain

information on socio-demographic and risk profile. An-

thropometric measurements, blood pressure readings

were recorded. Data was analyzed using SPSS version

2

1.7% of hypertrophic cardiomyopathy were among

infants of diabetic mothers.

Conclusion: Nigerian children face a quadruped of AHD

namely, pericarditis, RHD, myocarditis and dilated car-

diomyopathy. There is need to improve intervention

facilities in the country to meet with the demands of the

growing afflictions.

A303

Prevalence of Rheumatic Heart Disease among

Primary School Pupils in Mid-Western Nigeria

1

7.0. Significant probability was p<0.05.

Result: The mean age of study population was found to

be 15.03 ± 1.89. The mean systolic blood pressure and

diastolic blood pressure for males were 106.66 ±

Sadoh WE, Omuemu VO, Israel-Aina YT.

Department of Child Health University of Benin

Teaching Hospital, Benin Nigeria.

1

1.80mmHg and 70.25±7.34mmHg respectively, while

the mean systolic and diastolic blood pressure for fe-

males were 109.83±11.66mmHg and 72.23±8.26mmHg

respectively. Mean weight of males and females were

Background: Rheumatic heart disease (RHD) is the

commonest acquired heart disease in Nigeria. In the last

community based study on RHD conducted over 30

years ago in Lagos, a prevalence of 0.07/ 1000 pupils

was obtained.

5

(

1

(

2.96±12.96kg and 54.44kg±9.18kg respectively

p<0.01) .The BMI of male and females were

9.81±3.61kg/m2 and 21.16±3.29kg/m2 respectively

p<0.01). These anthropometric variables correlated

Objective: To determine the prevalence of RHD among

primary school pupils in Egor Local Government Area

positively with both SBP and DBP. The prevalence of

hypertension and prehypertension was found to be 5.4 %

(

LGA) of Edo State of Nigeria.

(

male 3.8% and females 6.9%) 17.3%(males 14.3% and

Methods: Using a multistage sampling technique, pupils

were selected from public and private primary schools in

Egor LGA. They were clinically screened for evidence

of RHD by auscultating for significant murmurs. The

pupils with significant murmurs then had echocardio-

graphic evaluation to confirm the presence of RHD us-

ing the 2006 WHO echocardiographic criteria for case

definition of RHD.

females 20.1%) respectively.

Conclusion: Blood pressure profile of adolescents shows

that female adolescents have a higher blood pressure

values than their male counterparts in Enugu.

Results: Of the 1764 pupils recruited, 900 (51.02%)

3

38

were females while 864 (48.98%) were males. The mean

age of the pupils was 8.86 ± 2.14 years. 1065(60.37%)

and 699(39.63%) respectively were recruited from pub-

lic and private schools. Of the 1764 pupils 6 (0.34 %)

had significant murmur. Only 1 of the 6 had RHD, giv-

ing a prevalence of 0.57/1000 pupils. The pupil with

RHD was a male, from public school and in the low

socioeconomic class.

A305

Kawasaki Disease: An Unusual Presentation in a 14-

Year Old Boy In Sokoto, North Western Nigeria

Sani UM, Ahmed H.

Department of Pediatrics, Usmanu Danfodiyo

University Teaching Hospital (UDUTH), Sokoto.

Conclusion: The prevalence of RHD in this study is low

compared to similar studies conducted outside the coun-

try. The true prevalence may be underestimated since

higher prevalence is obtained from echocardiographic

based screening compared to clinical screening.

Introduction: Kawasaki disease (KD) is an acute sys-

temic vasculitis that mostly affects children less than

5

years. Occasionally, it may presents with renal involve-

ment of varying severity. In Nigeria and most of Africa,

only a few cases of KD have been reported and these

were among children within the typical age group.

Case presentation: We report an unusual case of Kawa-

saki disease with renal manifestation in a 14 year old

adolescent. Apart from the principal features of KD

comprising of high grade fever, non-purulent conjuncti-

vitis, polymorphous rash, right sided cervical lymphade-

nitis and symmetrical desquamative lesions of the digits

of the hands and feet; our patient also had renal involve-

ment. The renal manifestations included mild periorbital

edema, oliguria, hypertension (140/90mmHg), hema-

turia (++), proteinuria (++) and elevated serum urea and

creatinine (8.3mmol/L and 1.9mg/dl respectively). He

was managed with high dose aspirin at 80mg/kg/day.

The dose was reduced (5mg/Kg/day) and subsequently

stopped after serial echocardiography showed normal

coronary arteries. Intravenous immune globuline (IVIG)

could not be started due to non-availability. Neverthe-

less, clinical signs resolved, renal function normalized

after 6 weeks and echocardiographic picture did not de-

teriorate. Patient is currently on follow up at our pediat-

ric cardiology clinic.

A304

The ECG changes in children with anemia seen

in Irrua Specialist Teaching Hospital, Irrua

1

2

1

Odike AI, Omokhodion SI, Akpede GO.

1

Department of Pediatrics, Irrua Teaching

Hospial, Department of Pediatrics, University

2

College Hospital, Ibadan.

Background: Anemia is a major cause of morbidity and

mortality in Nigerian children. It affects all the systems

of the body including the heart.

Objectives: This study is aimed at determining

the prevalence and pattern of ECG abnormalities in ane-

mia.

Method:

A cross sectional study was done us-

ing 94 anemic cases (PCV< 33%) aged 6 months to 16

years and 94 age and sex matched non-anemic con-

trols (PCV ≥33%) recruited from the pediatric depart-

ment of (Irrua Specialist Teaching Hospi-

tal) ISTH between September and December 2009. ECG

was recorded at rest for each child

and PCV determined. The anemic cases comprised chil-

dren with sickle cell anemia (SCA), children with-

out SCA and children in anemic heart failure (AHF).

Results: The prevalence of ECG abnormalities was sig-

nificantly higher in the anemic cases (76.6%) than in the

controls (40.4%). The prevalence of ECG abnormalities

in SCA cases (82.9%) and non-SCA cases (66.7%) was

significantly higher than in the controls (40.4%).The

abnormalities noted were sinus tachycardia, ventricu-

lar hypertrophy and long QTc interval. The prevalence

of ECG abnormality was also noted to increase with

increased severity of anemia.

Conclusion: Kawasaki disease can occur even in older

children and renal manifestation may be self-limiting.

This report highlights the need for high index of suspi-

cion in all cases.

A306

Musculoskeletal Complications among Children with

Sickle Cell Anemia attending University of Nigeria

Teaching Hospital Ituku- Ozalla Enugu: A 4 Year

Review

Chinawa JM, Chukwu B, Ikefuna A, Emodi I.

University of Nigeria Teaching Hospital (UNTH)

Ituku-Ozalla, Enugu.

Background: Sickle cell anemia (SCA) is a genetic he-

matological disorder characterized by red blood cells

that assume abnormal, rigid, sickle shape. The muscu-

loskeletal manifestations of SCA result from vessel oc-

clusion, leading to tissue ischaemia and infarction and

progressive end organ damage.

Conclusions: It was concluded that anemia, irrespective

of cause, is associated with an increased prevalence of

ECG abnormalities and that the prevalence of ECG ab-

normalities increased with the severity of anemia.

Objectives: To determine the frequency and pattern of

presentation of musculoskeletal changes among children

with sickle cell anemia attending UNTH Ituku Ozalla.

Methods: This is retrospective study of cases of muscu-

loskeletal com_s_tplications among children attending

st

UNTH from 1 of January 2007 and 31 of October

2

012.

3

39

Results: There were 78 musculoskeletal complications

in 55 patients with sickle cell anemia from Jan 2007 to

Oct 2012.

Insurance Services should be strengthened to enable

insured persons the full benefits of prescribed good

quality health services.

Patients consisted of 34 (61.8%) males and 21 (38.2%)

females. Mean age of patients was 9.3±4.7 years (9

months to 17 years).

Common musculoskeletal symptoms include lower limb

pain seen in 39 (50%) of cases, upper limb pain in 36

B301

Pattern of Renal Diseases in Pediatric Ward of Fed-

eral Medical Center, Asaba

(

was the commonest non musculoskeletal symptom and

was seen in 41 (52.6%) of cases.

46.2%) and chest pain in 16 (29.5%) of cases. Fever

Ezeonwu B, Okike C, Nwankwo O

Department of Pediatrics, Federal Medical Center

(FMC) Asaba.

The commonest musculoskeletal complication was acute

Background: Childhood renal diseases are becoming

important in the morbidity and mortality pattern in pedi-

atric population. Renal diseases in children have recog-

nizable features.

Objectives: To determine the proportion of children ad-

mitted in FMC Asaba, with renal diseases, their age and

gender distribution, common presenting features, and to

ascertain the outcome of their management.

Method: A descriptive case series review of case files of

these children admitted in pediatric unit from January

2007 to December 2011 was done. Information obtained

were age, gender, presenting features, diagnosis and

outcome of management.

bone pain crisis diagnosed in 34 (43.6%) with acute os-

teomyelitis, either proven or suspected as the second

commonest, diagnosed in 11 (14.1%) of cases. Gender

did not have any significant effect on the occurrence of

these complications but there is a significant association

with age.

Conclusion: Bone pain crisis and acute osteomyelitis are

the commonest musculoskeletal manifestation in chil-

dren with sickle cell anemia attending UNTH Ituku

Ozalla

A307

Results: A total of 5159 children comprising 3148 males

and 2011 females were admitted in pediatric unit within

the period under review. Children who had renal dis-

eases were 69 giving a hospital prevalence of 1.3%. Of

the 62 cases analyzed, 29 were males and 33 were fe-

Hemoclaria (Bloody tears): Challenges of

Management in a Resource Constrained Setting: A

Case Report and Review of Literature

1

2

Oyenusi EE Ananti CN.

2

1

2

males; M: F, 1:1.3, (χ =5.53, p=0.02). Children aged 5

Motayo hospital Ikeja, Lagos, Lagos University

Teaching Hospital, Idi Araba, Lagos

2

years and above were commonly affected, χ =95.25,

p=<0.0001. The most common renal diseases were uri-

nary tract infection (UTI), nephrotic syndrome and acute

glomerulonephritis (AGN). While dysuria was signifi-

cantly associated with UTI, p<0.001, nephrotic syn-

drome and AGN commonly presented with body swell-

ing, p < 0.01 and 0.02 respectively. Proteinuria was

documented in all the subjects. About 77% of the sub-

jects improved and were discharged while mortality due

to renal diseases was 6.5%.

Conclusion: Nephrotic syndrome, UTI, AGN were the

most common renal diseases and more prevalent in chil-

dren aged 5 years and above. Mortality rate due to the

prevailing renal diseases was low.

Introduction: The phenomenon of bloody tears

(

haemolacria) is a rare occurrence that can panic the

patient and perplex the doctor. It can be caused by a

wide spectrum of eye abnormalities or systemic disor-

ders. Extensive workup is required to determine the eti-

ology. The challenges of management encountered in

our patient are highlighted.

Case Presentation: A four-year-old boy presented with

cough, catarrh and three episodes of epistaxis. He was

not on any medications and had no family history of

bleeding disorders. He was placed on Otrivin™ nasal

drops, Actifed™, Cefuroxime™, and a stat dose of Dia-

cynone. Full blood count, coagulation profile, bleeding

time, blood film picture and Xray of the postnasal space

were normal. He started shedding blood stained tears

initially on crying, two weeks later without associated

epistaxis. Subsequently the bloody tearing became spon-

taneous which was unnerving for his mother and school

teacher. The eyes were grossly normal. Other relevant

investigations planned were assays for factors VIII, IX

and Von Willebrand factor. He would have also benefit-

ted from a nasolacrimal irrigation and biopsy, CTScan

and/or MRI of the head and orbit but the HMO could

not cover the expenses and the parents had financial

constraints. His parents resorted to alternative medicine

therapy out of frustration and he was lost to follow up.

Conclusion: Management of haemolacria involves a

multidisciplinary approach. Financial constraints can be

a challenge in our environment. The National Health

B302

Renal biopsy in childhood Nephrotic Syndrome: a

new histopathological trend.

1

2

Odetunde OI. Nourse P, Gajjar P, Komala Pillay.

1

Paediatric Nephrology Unit, Department of Pediatric

Medicine, Anatomical Pathology Department,

University of Cape Town and Red Cross War

2

Memorial Children’s Hospital, Cape Town, South

Africa.

Background: In children, about 80% of primary

nephritic syndrome has minimal change disease

(MCNS). The term minimal change nephritic syndrome

has become synonymous with steroid sensitive nephritic

syndrome because of the sensitivity to steroid therapy,

3

40

such that renal biopsy is not usually indicated in MCNS.

However, renal biopsy is required in patients whose

clinical features are not in keeping with that of MCNS.

In this study we document the histopathological pattern

of children who were diagnosed nephrotic syndrome and

required renal biopsy who presented at Red Cross Chil-

dren’s Hospital between year 2003 and 2011(Eight

years).

Objectives: To determine the histological patterns of

renal biopsied of patients with primary childhood

nephrotic syndrome at Red Cross Hospital.

Method: This is a retrospective descriptive study. The

charts and medical records of biopsied patients with

nephrotic syndrome and their histopathological reports

of renal biopsies were reviewed.

Methods: This is an on-going prospective study which

started in March 2012.Fourteen out of 30 children with

nephrotic syndrome who attend the paediatric nephrol-

ogy clinic underwent a renal biopsy which was

investigated by light microscopy. All patients fulfilled

the clinical and laboratory criteria of

a

NS.

Results: fourteen out of 31 children were biopsied. The

age range was 3-17years, 13 males, 1 female. Frequent

relapses 5(35.7%), steroid resistance 3(21.4%), atypical

presentation 3(21.4%) and secondary nephrotic

syndrome 2(14.3%) were the indication for renal biopsy

in this patients. The biopsies revealed minimal change

disease (MCNs) in 3(21.4%); Mesangeal proliferation

(Mesangioproliferatiive) in 3(21.4%); Focal segmental

glomerulosclerosis (FSGS) in 2(14.3%); Membranopro-

liferative in 2(14.3%); Lupus Nephritis in 2(14.3%);

Membranous Nephropathy 1(7.1%), and no conclusive

Result: One hundred and thirty (130) primary nephrotic

syndrome patients were biopsied in the period of eight

years (2003 -2011). Age range of 1month to 14years and

mean age of 4.9+ 2 years with mode age of 2years.

Male: Female 1:1.7, 60(46.2%) were mixed race, 44

r e s u l t

i n

o n e

p a t i e n t .

Conclusions: Mesangioproliferative, MCNs, FSGS and

Membranoproliferative are most frequent findings on

histology. We conclude that the histopathological pat-

tern of NS may vary between geographical locations.

(

33.8%) Afro-Africans, 23(17.7%) Euro-Africans and 3

2.3%) Asian- Africans race. Steroid resistance 45

34.6%), atypical presentation 36(27.7%), frequent re-

lapses 23(17.7%), steroid dependence 19(14.6%), and

congenital nephrotic syndrome 7(5.4%) were the indica-

tion for renal biopsy in this patients. The biopsies report

showed mesangial proliferative nephropathy

B304

Factors Associated with Enuresis among

Primary School Children in Port Harcourt

(

mesangioproliferative) 62(47.7%), focal segmental

Paul NI, Alikor EAD, Anochie IC.

University of Port Harcourt Teaching Hospital, Port

Harcourt.

glomerulosclerosis (FSGS) 25(19.2%), minimal change

nephrotic syndrome (MCNS) 16(12.3%), membranopro-

liferative( mesangiocapillary) 13(10.0%), and others 14

(

10.8) .

Background: Enuresis is a common childhood problem

and can lead to important psychosocial disturbances.

Objectives: To determine the risk factors to enuresis, its

methods of management and relationship with academic

performance among school children in Port Harcourt

Conclusion and Recommendation: We conclude that

mesangioproliferative histopathological sub-type repre-

sents a remarkable percentage of our biopsied primary

nephrotic syndrome and clinical presentation is that of

atypical. It is therefore pertinent for more studies on this

histological subtype in the region

C

i

t

y

(

P

H

C

)

Methods: A cross sectional study of enuresis among

school children in PHC was performed. Pretested ques-

tionnaires completed by parents/guardians was used to

collect data. Validation of their academic performances

was made using their results in the past one year from

the schools head teachers’ records. Descriptive statistics

and chi-square test were used for analysis.

Results: A total of 922 children, consisting of 463

(50.2%) males and 459 (49.8%) females were studied.

The response rate was 82.2%. The prevalence of enure-

sis was 23.2%. Arousal difficulty and positive family

history of enuresis were significantly more frequent in

the enuretic group (p<0.05). Enuresis was associated

with family stressors in 45 (21.0%) of the children. The

enuretic children had higher rates of poor school per-

formance compared with non-enuretic children (p <

B303

Histopathological Pattern of Childhood Nephrotic

Syndrome in Enugu

Odetunde OI, Okafor HU, Ukoha OM, Adiele KD,

Olusina BD, Aderibigbe ASO

1

Pediatric Nephrology Unit, Departments of Pediatrics,

Histopathology and Morbid Anatomy, Department of

2

3

Radiation Medicine, University of Nigeria Teaching

Hospital, Ituku/Ozalla, Enugu, Nigeria.

Background: Histopathological evaluation of renal tis-

sues of children with atypical presentation of nephrotic

syndrome, in which renal biopsy is an integral part of

the clinicopathological correlation required for accurate

diagnosis, prognostic and to guide the treatment of the

disease in the sub-region. In this study we document the

histopathological pattern of children who were

diagnosed nephrotic syndrome (NS) and required renal

biopsy.

0

.001) however; there was no statistical significant rela-

tionship between enuresis and social class. None of the

enuretic children visited a physician for the management

of enures. Prayers, punishment and herbal medication

were the methods of treatment in 89(41.6%), 42(19.6%)

a n d

6 ( 2 . 8 % )

c h i l d r e n

r e s p e c t i v e l y .

Conclusion: Arousal difficulty, positive family history

of enuresis and family stress were common risk factors

for enuresis. Also, enuretic children had higher rates of

Objective: To determine the histological patterns of

renal biopsied patients with childhood nephrotic

s y n d r o m e

i n

E n u g u

3

41

poor school performance compared with non-enuretic

children. The inappropriate enuresis management meth-

ods require health education intervention.

between 2009 and 2012, following referral from

Ear-Nose-Throat (ENT) department.

Case 1: A 4year female who presented with persistent

hoarseness of voice, difficulty in breathing and noisy

breathing of one year duration.

B305

Enuresis in Children with Sickle Cell Disease (SCD)

seen at Isolo General Hospital, Lagos

She was born at term, by spontaneous vaginal delivery.

Mother had vaginal warty lesion which was excised dur-

ing pregnancy. Immunization was routine NPI vaccines.

A neck X-ray showed opacities around the laryngeal

region with total obliteration of air column. Tissue his-

tology confirmed squamous papilloma. Retroviral

screening was nonreactive. She has had about eight exci-

sion surgeries from recurrence, with only temporal re-

lief. Treatment included use of interferon and oral acy-

clovir for over one year, and lately methotrexate. Patient

has a tracheotomy tube in place for over 2 years.

Case 2: A 6year old female seen on account of persis-

tent hoarseness of voice that progressed to loss of voice

of 1½ years. She had associated noisy breathing, snor-

ing, difficult breathing and frequent arousal from sleep.

Pregnancy and delivery were normal. Histology was

diagnostic of laryngeal Papillomatosis. She has had 2

excisions surgeries for laryngeal polyps and had been

placed on oral acyclovir, alongside a tracheotomy tube

in place.

Oluwabiyi OO, Olatunji T, Adekoya FT, Raji S.

Department of Paediatrics, Isolo General Hospital,

Lagos.

Background: Enuresis is an important morbidity that

appears to be under-diagnosed and often overlooked in

the management of Nigerian children with sickle cell

disease (SCD).

Objectives: To determine the prevalence of enuresis in

children with SCD, perceived causes adduced by the

caregivers, interventions that have been used and to de-

duce possible contributory factors.

Method: A structured questionnaire was administered to

caregivers of children with SCD attending the Sickle

Cell Clinic of Isolo General Hospital after an informed

consent was obtained.

Results: Enuresis was a complaint expressed by 62.8%

of respondents with SCD and 40.8% of non-SCD

matched siblings. Primary enuresis accounted for 85%

of cases while the remaining had secondary enuresis.

There was a positive family history in 52% of enuretic

subjects. Ingestion of fluids, excessive play, deep sleep

or a combination of these were the major reasons ad-

duced by the caregivers with only 15% convinced that

the child’s genotype may play a role. Respondents have

used a wide array of interventions including prayers,

beatings and punishments, herbs while only 7.4% have

sought medical care. Although not statistically signifi-

cant, socio economic status and child’s position in the

family were predictive factors. The average age of dry-

ness in subjects with SCD was 5±2.8yrs while that of

non SCD matched sibling was 3.2±1.5yrs.

Conclusions: Enuresis is a major morbidity in subjects

with SCD. Low levels of parental knowledge on enure-

sis and its management are possible contributors to the

high prevalence. The presence of enuresis and possible

interventions must therefore be sought for by health care

practitioners and implemented in the follow up and care

of children with SCD.

Conclusion: RRP though a slow growing tumor,

presently has no definitive cure. Excision surgeries

provide a temporal relief, alongside adjuvant therapies

with antiviral agents. Prevention with vaccination is

desirable.

B307

Trilateral Retinoblastoma

Odunvbun M, Abiodun M, Iguodala O

Department of Child Health, University of Benin

Teaching Hospital, Benin City, Edo state, Nigeria

Background: Trilateral retinoblastoma (TRB) is a rare

syndrome consisting of intraocular retinoblastoma and

an intracranial tumour in the pineal or other midline

regions.

Case presentation: This is a case of a 4 year old boy

who presented with a two-year history of leucocoria,

subsequent bilateral proptosis and progressive visual

loss in both eyes. Ocular ultrasonography showed a non-

homogenous, intra-orbital solid mass with complete

distortion of orbital anatomy diagnostic of retinoblas-

toma (RB). Contrast–enhanced cranial computerized

tomography (CT) scan revealed plaques of calcification

filling most of the left eye, partly the right eye, and a

cerebellar mass consistent with an ectopic intracranial

neuroblastic tumour in TRB. He received 2 courses of

systemic chemotherapy but defaulted before enuclea-

tion. Ophthalmoscopic examination under anaesthesia

(EUA) confirmed unilateral RB in his sibling.

B306

Recurrent Respiratory Papillomatosis (RRP)

1

2

Ahmed PA, Ulonnam CC, U₂ ndie NB.

1

Department of Pediatrics,

Department of Surgery

(ENT), National Hospital Abuja

Introduction: Respiratory Papillomatosis is a non-

cancerous tumor of the upper airway caused by the hu-

man papilloma virus. RRP is a small “wart-like”

growth, which could be anywhere from the nose to the

lungs. RRP in the larynx is the most common.

Conclusion: Neuro-imaging, genetic counseling and

routine ophthalmologic screening of first degree rela-

tives are pertinent in the management of TRB.

Case Presentations: Two patients diagnosed with RRP

were seen at the paediatric respiratory clinic of the NHA

3

42

C301

Academic Performance and Intelligence scores of

Children aged 5-11 years with Sickle Cell Anemia

Methods: Consecutive children with SCA aged 5-11

years were recruited at the weekly sickle cell clinic of

the University of Nigeria Teaching Hospital (UNTH)

Enugu, Nigeria. Their age- and sex- matched normal

classmates were recruited as controls. The total number

of days of school absence for 2009/2010 academic ses-

sion was obtained for each pair of pupils from the class

attendance register. Academic performance was as-

sessed using the average of the overall scores in the

three term examinations of 2009/2010 academic year.

Intelligence Quotient (IQ) was assessed using the Draw-

A-Person Test and socio-economic status determined

with the occupational status and educational attainment

of each parent.

1

2

Ezenwosu O, Emodi IJ, Ikefuna AN, Chukwu BF.

1

Department of Paediatrics, Enugu S₂tate University

Teaching Hospital, Parklane, Enugu. Department of

Paediatrics, University of Nigeria Teaching Hospital,

Ituku/Ozalla, Enugu.

Background: Children with Sickle Cell anemia (SCA)

are faced with complications which may interfere with

their educational activities including academic perform-

ance. Reports on their academic performance are mainly

from developed countries and the results have been in-

consistent.

Objective: To determine the academic performance of

primary school-aged children with SCA in Nigeria and

compare findings with a group of controls.

Methods: Ninety children with SCA aged 5-11 years

were consecutively recruited at the SCA clinic of UNTH

Enugu and their age- and sex-matched normal class-

mates were enrolled as controls. Academic performance

of the children with SCA were studied using the overall

scores achieved in the three term examinations in the

preceding academic year (2009/2010) while their intelli-

gence quotient (IQ) was determined using the Draw-A-

Person Test (DAPT). The findings were compared with

that of ninety controls.

Results: There was no significant relationship between

academic performance and school absence in children

with SCA (r = -0.080, p = 0.453). However, academic

performance of children with SCA showed statistically

significant association with their socio-economic status

2

(χ = 9.626, p = 0.047, and significant correlation with

IQ (r = 0.394, p = 0.000) and age (r = -0.412, p =

0.000).

Conclusion: Academic performance of children with

SCA is not negatively affected by their increased school

absenteeism but is influenced by their IQ, age and socio-

economic status.

C303

Childhood Diabetes Mellitus in Sokoto, Northwest-

ern Nigeria-A Ten Year Review

Results: The mean overall academic score of the chil-

dren with SCA of 62.71 ± 19.43% was similar to 67.47

±

16.42% in the controls (p = 0.077). However, a signifi-

cantly higher number of children with SCA (32.2% vs

6.7% of the controls; p = 0.015) scored below 50%,

thus, had poor performance. The mean IQ of the subjects

Ugege MO, Ibitoye PK, Jiya NM, Ahmed HA.

Department of Pediatrics, Usmanu Danfodiyo

University Teaching Hospital, Sokoto.

1

(

tients had lower IQ scores than controls though not sta-

tistically significant (p = 0.083).

Conclusion: Overall academic performance of children

with SCA compares favorably with that of controls al-

though there is a higher prevalence of poor performance

among children with SCA.

91.41 ±16.61%) was similar to that of the controls

95.56 ±17.31%) (p= 0.103). However, more SCA pa-

Background: There is paucity of literature on childhood

diabetes mellitus (DM) from developing countries and

especially Northwestern, Nigeria.

Objectives: To describe the clinical presentation and

outcome of childhood DM as seen in Usmanu Danfo-

diyo University Teaching hospital (UDUTH) Sokoto.

Methods: This was a 10-year retrospective review of

case files of children aged 15 years and below, with_s_t

st

childhood DM, between September 1 2001- August 31

C302

2011. The age, gender, presenting features, complica-

tions, laboratory features and outcome of the patients

were extracted and analyzed.

Determinants of Academic Performance in Children

with Sickle Cell Anaemia in Enugu, South-East

Nigeria

Results: Eight out of the 23, 931 children admitted dur-

ing the study period, were diagnosed with type 1 DM,

giving a case prevalence rate of 0.33/1000 (or 3/10,000).

Male to female ratio was 1:1. Mean age at presentation

was 11.8±3.1years. Mean duration of illness before pres-

entation was 6±4.9 weeks (range 1.2-12weeks). Most

prevalent symptoms were polyuria and weight loss- 7

each (87.5%), polydipsia-6 (75%), polyphagia-5

(62.5%), and weakness-4(50%). Five patients (62.5%)

presented with diabetes ketoacidosis (DKA). Mean RBS

was 22.6±12.01 (range 13- 49.5) mmol/L. Five patients

(62.5%) were discharged while three (37.2%) left

against medical advice. Four (80%) of the discharges

were lost to follow up.

1

2

Ezenwosu O, Emodi IJ, Ikefuna AN, Chukwu BF.

1

Department of Paediatrics, Enugu State University

T₂eaching Hospital, Parklane, Enugu.

Department of Paediatrics, University of Nigeria

Teaching Hospital, Ituku/Ozalla, Enugu.

Background: Some factors may influence the academic

performance of children with Sickle Cell Anaemia

(

SCA). Limited information is available on the effects of

these factors in Nigerian children with SCA.

Objective: To determine the factors that influence the

academic performance of children with SCA in Enugu,

Nigeria.

Conclusion: Childhood DM is relatively uncommon in

3

43

UDUTH, Sokoto. There is a high frequency of DKA,

late presentation and default to follow up. It is recom-

mended that there should be a collaboration of efforts

for the early recognition of symptoms by parents and

physicians through awareness campaigns, health educa-

tion and specialized training of health personnel.

screening babies at Day 1- 21 of life for Jaundice and

created a platform for educating health workers in PHC

and TBA on neonatal Jaundice. Ongoing parent

education initiatives were developed.

Objectives

•

To increase the awareness of the community to the

dangers of Jaundice

Supporting the Primary Care System in upgrading

services to newborn

C304

Neonatal Jaundice among In-Born Neonates at

Ebonyi State University Teaching Hospital

Abakaliki, South Eastern Nigeria

Method: A survey of 402 women of child bearing age on

their knowledge, attitude and practices on Jaundice was

carried out. Learning materials for parent education

were developed. Workshop on Neonatal Jaundice was

developed for Primary Health care workers and an ap-

propriate lecture in Yoruba was delivered to the local

TBAs. A screening Transcutaneous Bilirubinometer was

used at the BCG immunization clinic to screen babies

between Days 1- 21 of life to measure bilirubin. Positive

cases were sent for diagnostic test at Outreach Chil-

dren’s Hospital. All positive cases were treated free at

OCH.

1

2

Onwe O, Muoneke V, Ibekwe RC . Ibe BC.

1

2

Federal Teaching Hospital, Abakaliki, University of

Nigeria Teaching Hospital Enugu

Background: Though neonatal jaundice is a significant

contributor to neonatal morbidity and mortality in Nige-

ria and sub-Saharan Africa, its role among neonates in

Abakaliki has not been elucidated.

Objectives: This study aims at evaluating the incidence,

aetiological causes and outcome of neonatal jaundice

among in-born neonates in Ebonyi State University

Teaching Hospital (EBSUTH) Abakaliki, South-Eastern

Nigeria.

Methods: This was a prospective study among neonates

delivered at EBSUTH Abakaliki between July 2007 and

June 2008.

Results: Of the 1180 neonates delivered within this pe-

riod, 235 (19.9%) had jaundice. There were more males

th

Results: (Feb 15 – Nov. 30 2012) 82% of the 402

women surveyed did not know that Neonatal Jaundice

was dangerous. 1513 babies were screened. 11% of the

babies screened tested positive. 37% of the positively

screened babies required (1: 3) treatment. 1 out of the

1

,513 babies died of NNJ

Conclusion: The initiative has had a positive impact on

the community. Neonatal screening should be instituted

in all PHC’s in Nigeria

(

60.9%) than females (39.1%). Most of_n_dthe children

th

91.0%) developed jaundice between the 2 and 5 day

C306

Can Barr body Determination and Radiological

Evaluation Predict the Type of DSD?

of life. One hundred and twenty neonates (51.1%) devel-

oped jaundice while still on admission and the rest,

4

8.9% were re-admitted having been discharged before

jaundice developed. Majority of the patients presented >

8 hours after noticing jaundice.

The common aetiologic factors were Neonatal sepsis

32.8%), low birth weight (30.6%), glucose -6-

Idris HW, Mado SM, Abdullahi FL, Abegunde BO,

Yauba MS, Musa A.

4

(

Background: Disorders of sexual development is associ-

ated with a lot of diagnostic and management challenges

because evaluation and long-term management requires

sophisticated diagnostic and management interventions.

Objective: To assess the usefulness or otherwise of Barr

body determination and radiological evaluation in deter-

mining the type of DSD

Method: Retrospective study of all children attending

the Pediatric Endocrinology Unit of ABUTH, Zaria

from Sept, 2007 to August 2012.

Results: 18 of the 108 cases seen had DSD. Their ages

ranged from 2 weeks to eight years. Ten presented with

genital ambiguity. Five had non-palpable gonads, while

two had inguinal masses.

The assigned genders were ten males, seven females

while 1 was assigned no gender. Eight patients had Barr

body determination with four of them suggesting XY

karyotype, three of whom were raised as females. One

had Barr bodies of between 10-20% and was raised as a

male. The remaining three with suggestive XX

phosphate dehydrogenase deficiency (26.8%) and ABO

blood group incompatibility (22.6%). Twenty five point

one percent of the neonates had multiple aetiologies.

Bilirubin encephalopathy was noted in 33.2% of the

children while 12.3% died.

Conclusion: Neonatal Jaundice is a common problem in

Abakaliki, is associated with high morbidity and mortal-

ity. It can be curtailed if the post natal/nursery wards are

expanded so that mothers and their babies can stay more

than 48hrs before discharge.

C305

A Study on Neonatal Jaundice in Amuwo Odofin

LGA, of Lagos State

Dosekun E

Anu Dosekun Healthcare Foundation,

Children’s Hospital, FESTAC Town, Lagos

C

/

O

Outreach

Background: Anu Dosekun Healthcare Foundation, a

nonprofit organization based in Lagos initiated a Jaun-

dice in Babies Awareness Project (JIBA). The project

commenced February 2012. The project involved

karyotype were raised as females. 16 patients had ab-

dominopelvic USS, while 7 had flush genitogram. In

44% of them, a uterus was visualized. Among the 9

whose USS did not reveal a uterus, flush genitogram

3

44

revealed uterus and fallopian tubes in 2. In one of the

patients who had an absent uterus, the chromosomal

analysis revealed an XX karyotype.

C308

Sleep Hygiene of Children in Abakaliki, South

Eastern Nigeria

Conclusion: Barr body determination with radiological

evaluation are important in the assessment of disorders

of sexual development however confirmatory chromoso-

mal analysis is necessary.

1

2

Orji M , Anyanwu O.U , Ibekwe R.C.

3

Maria-Lauretta O ,

Federal Teaching Hospital Abakaliki

University of Nigeria Teaching Hospital Ituku-Ozalla,

Enugu. Department of Paediatrics Federal Teaching

1

2

3

C307

Proximal focal femoral deficiency: A Case Report

Hospital, Abakaliki

Ewah RO, Olukotun AP, Obasoyo SE, Alikah SO.

Background: Sleep hygiene is the control of all behav-

ioral and environmental factors that precede sleep and

may interfere with sleep. Poor sleep hygiene could inter-

fere with a child’s proper functioning.

Aim and Objective: The study is aimed at determining

the pattern of sleep hygiene and factors contributing to

poor sleep among children attending children outpatient

in Federal Teaching Hospital Abakaliki.

Methods: A cross sectional descriptive study conducted

at the children outpatient clinic of FETHA. The study

instrument was the BEARS screening tool and subjects

were children aged 3-16 years.

Results: Of the 354 children surveyed. 9% had diffi-

culty falling asleep, 15% wake up frequently at night.

Only 33.3% have regular bedtime and wake time and

Background: Proximal focal femoral deficiency (PFFD)

is a rare congenital osseous anomaly characterised by

failure of normal development of a variable portion of

the proximal femur resulting in a shortened lower limb.

The main biomechanical abnormalities include limb

length discrepancies, malrotation, proximal joint insta-

bility and inadequacy of the proximal musculature. The

incidence is one per 50,000-200,000 population with no

sexual predilection.

Case presentation: A three month old boy (I.I) who pre-

sented with shortened right thigh from birth. Examina-

tion revealed a bulbous thigh with disparity in the

lengths of the lower limbs and thigh and the girth of the

thighs. The right patella was not palpable but the right

leg and foot and the left lower limbs were normal. Ra-

diological examination revealed grossly shortened right

femur with no proximal shaft and ossification of the

femoral head.

1

5.3% have regular day time naps. 41.8% frequently

watch television or play rough play an hour to bedtime.

6.9% eat heavy meal before bedtime, most (38.7%)

6

eating 30minutes to 1 hour before going to bed. 19.8%

have television in their bedroom. Problems with going

to bed (8.5%), falling asleep (12.6%), night waking

(

13.3%) and day time sleepiness (17.2%) were most

prevalent in children aged 6- 10 years . Watching televi-

sion or playing rough play are significantly associated

with daytime sleepiness (p=0.002), waking up at night

(

p=0.00) and problems with falling asleep (p=0.001).

Conclusion: Poor sleep hygiene is common in this envi-

ronment. Health education to parents on the importance

of good sleep hygiene is therefore necessary.