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Nigerian J Paediatrics 2017 vol 44 issue 1

Nigerian J Paediatrics 2017 vol 44 issue 1

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Paediatrics Association of Nigeria 48th Annual General and Scientific Conference
Niger J Paediatr 2017; 44 (2):87 - 122
PANCONF 2017 ANNUAL GENERAL CONFERENCE
Abstracts of Proceedings
48th Annual General and Scientific Conference of the Paediatrics
Association of Nigeria (PANCONF), 24th - 28th January, 2017
AO1
CO2
Adolescents’ Perspective on having a separate
Blood pressure pattern of apparently healthy
adolescent friendly anti-retroviral treatment (ART)
primary school children in Abuja, Nigeria
clinic
Papka NY , Babaniyi IB , Aikhionbare HA
1
1
2
Adesanya OO
1
Adewunmi O, Oluseyi O, Adeoye O, Emechebe O,
1
Hamza N
Department of Paediatrics, National Hospital Abuja,
2
National Hospital, Abuja.
Department of Child Health, University of Benin
Email: wwunmibade@gmail.com
Teaching Hospital, Benin City, Edo State
Email: nubwayusufu@yahoo.com
Background: Adolescent friendly anti-retroviral treat-
ment (ART) health services provide a proactive means
Background: Blood pressure (BP) is an indicator of per-
of addressing the peculiar health needs of HIV Infected
son’s state of health. Published childhood BP normo-
adolescents. In Nigeria, availability of this service is
gram differ from one geographical region to the other,
limited as most available ART clinics are focused on
consequence from factors such as anthropometric meas-
either adult or pediatric care.
urements, socio-economic factors, familial aggregation
Knowledge of adolescents’ perspective on having a
etc.
separate adolescent friendly ART clinic may contribute
Objectives: To determine the blood pressure pattern of
to improved service quality delivery. There is however
apparently healthy primary school children in Abuja,
limited available research on adolescents’ perspective
North central Nigeria.
concerning this service in Nigeria.
Methodology: This was a descriptive, cross sectional
Aim: This study aims to highlight the perspectives of
study carried out on apparently healthy primary school
HIV positive adolescents attending the paediatric ART
children. Blood pressure was measured using standard
clinic on having a separate adolescent friendly clinic and
mercury sphygmomanometre according to standard
their preferred clinic structure.
guidelines. Data were analyzed using SPSS version
Methods: A cross-sectional study was conducted from
17.0.
January to June 2015 in the paediatric ART clinic of
Results: Out of 1011 pupils recruited for the study, 457
National hospital, Abuja and 50 HIV positive adoles-
(42.2%) were males. Mean systolic and diastolic BP
cents attending the clinic between the ages of 10-
increased significantly with age from 94.5 mmHg to
19years were enrolled using consecutive sampling tech-
101.0 mmHg and from 61.5 mmHg to 65.3 mmHg from
nique. Structured questionnaires were used to obtain
6 to 12 years respectively, (p < 0.05). There was no sig-
data which was analyzed using SPSS version 20.
nificant gender difference. Forty five (4.5%) of the sub-
Results: The mean age of respondents was 15 years; SD
jects had pre-hypertension and 92(9.1%) of the pupils
2.2. Majority were males (56%). Mother to child trans-
had hypertension. Subjects who were overweight /obese
mission was the major means of acquired infection
had significantly higher mean SBP than those with nor-
among respondents. Most respondents (72%)preferred to
mal BMI, p=0.003.
have a separate adolescent ART clinic with the follow-
Conclusion and Recommendation: Blood pressure in-
ing reasons given; interacting with peer group (61.1%),
creased significantly with age and BMI. The prevalence
not comfortable with sharing same clinic with younger
of pre-hypertension and hypertension in primary school
children (36.1%) and the need for privacy (2.8%). Pref-
children was 4.5% and 9.1% respectively. Routine BP
erences concerning modification of physical clinic struc-
and anthropometric measurement among primary school
ture included; addition of Games (42%), TV(18%),
children should be encouraged as this will increase the
magazines(18%) and educative materials, in waiting
chance of identifying children with hypertension thereby
areas. Also, most respondents preferred the morning
necessitating institution of early intervention to prevent
clinic hours (62%).
complications.
Conclusion: The study highlighted that most respon-
Abbreviations: BP - Blood Pressure, SBP Systolic
dents preferred the ART clinic to be separate, more in-
Blood Pressure, BMI- Body Mass Index, SPSS- Statisti-
teractive and adolescent friendly. Implementation of this
cal Package for Social Sciences
service in healthcare facilities with more focus on ad-
Key words: Blood pressure, Pattern, children, Abuja.
dressing adolescents’ needs may enhance compliance,
enable a smoother transition to adult ART care and
hence improve health outcomes.
Key words: Adolescent friendly, health services, ART
88
CO4
tions.
Aetiology of heart failure among children seen in
Methods: A prospective cross-sectional study of chil-
Aminu Kano Teaching Hospital, Kano, Nigeria:
dren who had cardiac interventions (surgical or interven-
result of a prelimnary study
tional procedures) for SHD within or outside Nigeria.
Study subjects were diagnosed at our hospital from Au-
Asani MO#, Aliyu I*, Garba NA*, Adamu H*,
gust 2012 to September 2016 and consecutively re-
Garba S*, Garba HU*, Lawal NA*, Ijisakin O*
cruited as cardiac interventions were performed. Rele-
*Department of Paediatrics, Bayero University/Aminu
vant Data were collected and analysed.
Kano Teaching Hospital,
Results: Only 37 children aged 06 months-16 years
Kano.
(Mean 6.5± 5.0 years, M: F = 1.4:1) had cardiac inter-
Email: ohikhenaasani@yahoo.co.uk
ventions, 36 (97.3%) of which were performed abroad.
Tetralogy of Fallot, atrial septal defect and ventricular
Background: Congestive cardiac failure (CCF) remains
septal defect constituted the majority-25(67.6%). Only
a significant cause of morbidity and mortality among
one (2.7%) patient with rheumatic valvular disease had
children in resource limited countries. The aetiology of
aortic valve replacement. The interventions were surgi-
heart failure is very vital for effective management of its
cal in 35(94.6%) and device closure in 2(5.4%) patients
attendant morbidity and mortality.
(PDA-1, ASD-1). Post-operative morbidities included
Objectives: To determine the aetiology of heart failure
pulmonary hypertensive crises, low cardiac output, re-
among children seen at the Aminu Kano Teaching Hos-
current pleural effusion, complete heart block and left
pital, Kano, Nigeria.
pulmonary artery stenosis warranting re-intervention.
Materials and methods: This is a prospective study in-
Overall, three(8.1%) patients with TOF, AV Canal de-
volving consecutive cases of children admitted into the
fect and VSD respectively died. The remaining 34
Emergency and Paediatric medical wards that satisfied
(91.9%) showed significant improvement on follow up,
the diagnostic criteria of CCF. A proforma with clinical
evidenced by normalization of pulse oxygen saturation
details and relevant investigations such as packed cell
and packed cell volume, increase in exercise tolerance
volume, chest radiograph and echocardiography was
and progressive weight gain.
opened for all patients. Data was entered into Microsoft
Conclusion: The outcome of children with structural
excel 2013 and analysed by the use of frequencies and
heart diseases after cardiac interventions is favourable.
percentages.
There is need to improve access to these services by
Results: A preliminary result showed a total of forty
establishing well-equipped cardiac centres in Nigeria.
three (43) cases with CCF, seen over a six month period
Key words: Structural Heart Diseases, Cardiac interven-
(October 2015 to March 2016) accounting for 2.9% of
tion, Outcome, Children, Sokoto
total admissions. Their ages ranged from 4 months to 14
*Presenter
years, with a median age of 17 months. The male female
ratio (M:F) was 1:1.2. Thirty four (79.1%) of the cases
CO6
were aged ≤ 5 years. Bronchopneumonia and congenital
Point of care monitoring of anti-coagulation among
heart diseases (CHD) accounted for 51.2% and 23.2%
Patients with Mechanical Heart Valves in Jos,
respectively. Severe anaemia accounted for 9.3% only.
North – Central, Nigeria.
Discussion: Bronchopneumonia and CHD were the
commonest causes. This is similar to the findings in sev-
Abok II*, Andeyaba B*, Slusher T**, Bode-Thomas F*
eral centers from Southern Nigeria.
Departments of Paediatrics, *Jos University Teaching
Conclusion and recommendation: Majority of the cases
Hospital, Jos and **University of Minnesota,
were of preventable aetiology therefore the prevention
Minneapolis, USA.
of Bronchopneumonia, CHD and Severe anaemia will
Email: abokii@yahoo.com
significantly reduce the morbidity and mortality.
Background: Young people with severe rheumatic heart
disease often require surgical replacement of their dam-
CO5
aged heart valves. Post surgical management of such
Outcome of children with structural heart diseases
cases is vital and includes long term anti-coagulation
after cardiac interventions: A preliminary report
management and monitoring. Laboratory-based anti-
coagulation monitoring is not widely available, and of-
*Sani UM, Waziri UM, Isezuo KO, Garba BI
ten involves multiple visits to a tertiary health centre.
Department of Pediatrics, Usmanu Danfodiyo
Objective: This study reports our experience in the
University Teaching Hospital, Sokoto, Nigeria
monitoring of anti-coagulation using a point-of-care
(POC) device amongst patients with mechanical heart
Background: Management of heart diseases in Nigeria is
valves.
a major challenge due to limited availability and access
Methods: Data from 12 patients enrolled between 2003
to cardiac care services. There is paucity of data from
and 2012 for international normalized ratio (INR) moni-
the study area on outcome of cardiac interventions in
toring using a clinic-based POC device was retrospec-
children.
tively
analyzed.
Data
retrieved
included
socio-
Objectives: To determine the outcome of children with
demographic variables, INR results, clinical characteris-
structural heart diseases (SHD) after cardiac interven-
tics and outcome. Results are presented using descrip-
89
tive statistical methods.
ing four months, on hydroxyurea therapy or with history
Results: The 12 patients ranged from 7-26 years of age
suggestive of chronic pulmonary disorders (such as
and 3 (25%) were males. Travel distance to the health
asthma) or cardiac abnormalities were excluded from the
facility ranged from 3.7 – 300km. A total of 794 POC
study.
INR assays were done, and 38.5% were within the target
Relevant clinical history was obtained from patients and
range, while 35.7% and 25.7% were below and above
their caregivers using a self designed proforma. Physical
target. The duration of follow up was 57 patient-years
examination findings such as Weight, Height, Body
with 12.2 +5.4 INR assays /patient/year.
Mass Index, pulse rate and blood pressure were docu-
Discussion: This innovative experience integrates clinic
mented. Oxygen saturation by pulse oximetry was done
and home based management of anti-coagulation. Our
using Nonin Avant 9700 digital pulse oximeter with
average number of INR assays/year/patient implies
waveform (Minneapolis, USA) while ABG analysis was
closer monitoring than reported elsewhere in Africa,
done using Radiometer ABL 80 FLEX ® (Denmark). Labo-
using laboratory-based methods. Our frequency of
ratory investigations such as haemoglobin concentration,
within-target assays is also much higher than previously
haemoglobin F level and reticulocyte counts were also
reported.
done.
Conclusion: Our innovative practice ensured wider cov-
Comparison between pulse oximetry and ABG with
erage, closer and better anti-coagulation management
respect to oxygen saturation was done using linear re-
and control in patients with mechanical valves.
gression and also using the agreement method suggested
by Bland and Altman.
CO7
Results: There was strong correlation between Pulse
oximeter reading and ABG analysis reading among chil-
Background: Steady state hypoxaemia (oxyhaemoglobin
dren with sickle cell anaemia (r=0.754, p=0.000). Pulse
desaturation) is common in sickle cell anaemia (SCA)
oximeter is a reliable indicator of true arterial oxygen
even in the absence of cardiopulmonary disease. Pulse
saturation at SpO 2 readings > 94% among children with
oximetry is the most readily available method of meas-
SCA.
urement of oxygen saturation. It is also cheap, easy to
Prevalence of hypoxaemia is significantly higher among
use and measures oxygen saturation, on a continuous
children with SCA compared to their Hb genotype AA
basis. There is the need to determine the reliability of
counterparts [(29.2% Vs 0.9% using pulse oximeter) and
pulse oximeter in measuring oxygen saturation com-
(20.8% Vs 2.8% using ABG analysis) respectively]. The
pared to ABG analysis and identify factors associated
prevalence of hypoxaemia among subjects with low
with steady state hypoxaemia in children with SCA.
Height-for-age (HFA) Z score was significantly higher
Several authors have reported varied results on the accu-
than that of their counterparts with normal HFA Z score.
racy of pulse oximetry compared to ABG analysis in the
Hypoxaemic children with sickle cell anaemia were
detection of hypoxaemia among children with SCA.
more likely to have haemoglobin concentration < 7g/dl
Previous researchers have found pulse oximeter to either
but the association was not significant.
overestimate or underestimate oxygen saturation among
The findings in this study, is a justification for routine
children with SCA. Other authors have studied the accu-
monitoring of oxyhaemoglobin saturation among chil-
racy of pulse oximetry in the determination of oxy-
dren with SCA at each routine clinic visit.
haemoglobin saturation among children with SCA, and
Conclusion: Pulse oximeter reading 94% among chil-
reported significant positive correlation (0.93 to 0.97)
dren with SCA in steady state, is unreliable and needs
between SaO 2 and SpO 2 .
4,94
confirmation with ABG analysis. The current study has
It is the opinion of some authors that correlation coeffi-
provided appropriate proof of the usefulness of pulse
cient may not be the most accurate comparison between
oximetry to identify hypoxaemic children with SCA.
two methods of measurement. Bland and Altman pro-
Key words: Oxygen, saturation, Pulse, Oximetry,
posed a more accurate method of assessing agreement
Sickle, cell ,Anaemia, Steady, state
between two methods of measurement.
The identification of factors associated with steady state
CO8
hypoxaemia in children with sickle cell anaemia, may
Doppler Echocardiographic Assessment of Pulmo-
help to identify children who are at risk of complications
nary Artery Pressure in Childrenwith Sickle Cell
of hypoxaemia. These children may then benefit from
Anaemia in Steady State at the Lagos State
interventions such as oxygen or nitric oxide therapy,
University Teaching Hospital (LASUTH), Ikeja.
hydroxyurea therapy and blood transfusion.
We aim to compare oxygen saturation by pulse oximetry
Lamina MO, Animasahun BA, Akinwumi IN
and ABG analysis and identify factors associated with
Njokanma OF
hypoxaemia among children with SCA at a southwest-
ern Teaching hospital in Nigeria.
Background: Pulmonary artery hypertension (PAH) is a
Methods: A cross-sectional observational study of 212
known complication of patients with sickle cell disease
children (106 with genotype SS in steady state, and 106
(SCD). In Sub-Saharan Africa, particularly Nigeria,
with genotype AA) aged 1-18 years was conducted be-
where the prevalence of SCD is high, there is a dearth of
tween June, 2015 and November, 2015 at the Lagos
data on the prevalence of PAH in children with SCD.
State University Teaching Hospital, Lagos, Nigeria.
Aim: To determine the pattern of pulmonary artery pres-
Patients who have had blood transfusion in the preceed-
sure in children with sickle cell anaemia (SCA) aged one
90
to twelve years in steady state using Doppler echocardi-
CP1
ography at LASUTH.
Case report: heterotaxy syndrome in an 11 month
Objectives: To determine the prevalence of pulmonary
old infant
artery hypertension in children with SCA
1
1
1
2
To compare the mean pulmonary artery pressure of SCA
Olorukooba AA , Yakubu AO , Orogade AA , Lawal S
Kenis S
2
patients in steady state with those of age and sex
1
matched Hb AA controls
Department of Paediatrics ABUTH Zaria
2
To determine the relationship between pulmonary artery
Department of Radiology ABUTH Zaria
pressure and age of subjects studied
Email: abiolaira@yahoo.co.uk .
To determine the relationship between pulmonary artery
pressure and laboratory data such as haemoglobin level,
Introduction: Heterotaxia (situsindeterminus) is when
reticulocyte count, platelet count and lactate dehydro-
the atria, the axes (left/right) of abdominal and thoracic
genase activity
organs are not clearly distinct. Heterotaxy syndrome is a
Methods: The study was analytical, comparative and
complex congenital syndrome with a prevalence of
cross sectional. It involved 400 children (200 children
about 1 in 10,000 births and has a male preponderance
with SCA in steady state and 200 children with Hb AA)
(2:1).
aged one to twelve years between August 2015 and Feb-
Case presentation: SL, an 11 month old boy presented
ruary 2016. Patients were recruited consecutively until
with recurrent difficulty in breathing of six months and
sample size was complete. Doppler echocardiography
poor weight gain. He was found to be cyanosed (SPO2
was performed on all the children to determine their
73%), tachy-dypsnaeic (respiratory rate of 40 cycles/
pulmonary artery pressure (PAP). Other laboratory pa-
minute and pulse rate 120 beats per minute) with a dis-
rameters (complete blood count and lactate dehydro-
placed apex, a left parasternal heave and a grade IV pan-
genase activity) were obtained using standard tech-
systolic murmur heard at the left lower sternal edge. His
niques.
liver was centrally placed, 6cm below the left costal
Data analysis: Data collected was entered into Micro-
margin and basal fine crepitations in his lungs.
soft Excel spread sheet of a personal computer. Analysis
Results: Chest X-ray showed cardiomegaly, right sided
of data was done using the Statistical Package for Social
aortic arch and pulmonary plethora. The liver shadow
Sciences version 20.0. Descriptive statistics were repre-
was observed on the left and the bowel gas shadows on
sented for continuous data using mean and standard de-
the right.
viation while frequency and percentage were used to
Echocardiograph reported a single atrium, single ventri-
represent categorical data. The prevalence and pattern of
cle and a single atrioventricular valve. Serial CT re-
pulmonary artery hypertension were presented pictori-
vealed the hepatobiliary system and inferior venacava on
ally using a bar chart and a histogram respectively. Con-
the left, while the spleen, stomach and the abdominal
tinuous variables were assessed for normality using the
aorta were on the right.
Kolmogorov-Smirnov test. Independent test and Mann
A diagnosis of Heterotaxy syndrome with single atrium,
Whitney U test were used to compare clinical and labo-
single ventricle and single AV valve was made. He
ratory parameters between the groups of Tricuspid re-
received conservative management while efforts to get
gurgitant velocity ( < 2.5m/s and ≥ 2.5 m/s) while chi -
corrective surgery were commenced.
square or Fisher exact was used for categorical vari-
Conclusion: there is a need for improved foetal and neo-
ables. Probability (p-value) less than 5% (0.05) were
natal assessment for early diagnosis. Prognosis for pa-
accepted as statistically significant.
tients with heterotaxy syndrome is poor despite im-
Results: The prevalence of PAH in children with SCA
provements in its management especially in resource
was 8% (n = 16). None of the controls had PAH. The
poor settings.
youngest subject with PAH was aged two years. The
Key words: Heterotaxy, right sided aortic arch, left
overall mean pulmonary artery pressure of children with
sided liver
SCA was significantly higher than that of controls
(18.54 ± 5.81 mm Hg vs. 13.76 ± 5.71 mm Hg, p =
CP3
0.00 ). The prevalence of PAH in children with SCA
Noonan syndrome with tetralogy of fallot and hydro-
demonstrated an increase in trend with age. There was a
cephalus
significant relationship between PAH and reticulocyto-
1
Garba BI, Muhammad AS, Mohammed BA
2
3
sis in children with SCA in steady state. ( p= 0.020 ).
4
Onazi SO, Ben-Wazieh AA, Adeniji AO
5
5
There was no significant relationship between PAH and
1
Department of Paediatrics, Department of Medicine,
2
the other measured laboratory indices (haemoglobin
concentration, white blood cell count, platelet count and
Usmanu Danfodiyo University Teaching Hospital,
lactate dehydrogenase activity) in children with SCA in
Sokoto
3
Department of Obstetrics and Gynaecology, Depart-
5
steady state. ( p> 0.05 ).
Conclusion: The prevalence of PAH in children with
ment of Paediatrics, Ahmad Sani Yariman Bakura
SCA in steady state is high. This complication was no-
Specialist Hospital, Gusau
4
ticed as early as the second year of life.
Department of Paediatrics, Federal Medical Centre,
Keywords: Pulmonary artery hypertension, Children,
Gusau
Sickle cell disease, Doppler Echocardiography, Pulmo-
Email: bgilah@yahoo.com
nary artery pressure.
Background: Noonan syndrome is a sporadic or inher-
91
ited autosomal dominant disorder consisting of hetero-
dia (ventricular rate of 150/min). He was given bolus
geneous group of multiple congenital anomalies; charac-
dose of IV lignocaine (1mg/Kg) and maintained on oral
terised by short stature, facial abnormalities, congenital
propranolol, which was later changed to Metoprolol in
heart defects and urogenital malformations. Congenital
view of its better selectivity. Concomitant hypocalcemia
heart diseases are common with pulmonary valve steno-
and hypokalemia were corrected. Clinical symptoms
sis being the commonest defect, while tetralogy of fallot
initially improved, but subsequently worsened with evi-
(TOF) is uncommon.
dence of persistent VT on serial ECG testing. Despite
Aims/objectives : We report a neonate with Noonan syn-
our decision to substitute metoprolol for amiodarone, we
drome, TOF and hydrocephalus.
could not commence early as it was not readily avail-
Case report: A 3 hour old male term neonate with ab-
able. Unfortunately, the patient died suddenly while still
normal fascies delivered spontaneously following an
on admission. There were no facilities for bedside ECG
uneventful supervised pregnancy; parents are unrelated
monitoring and emergency cardioversion at the time.
with no family history. He was not cyanosed, had re-
Conclusion: Arrhythmias may occasionally complicate
dundant skin on the nape with webbed neck, low set
congenital heart diseases in children. Since these can
ears, hypertelorism, depressed nasal bridge, widely
suddenly become fatal, affected patients must be moni-
spaced nipples and right sided parietal scalp swelling,
tored closely and facilities for emergency intervention
fluctuant but not crossing midline. He had tachypnoea
should be made readily available.
and dyspnoea and oxygen saturation of 69% in room air.
Key words: Ventricular tachycardia, management,
Assessment of Noonan syndrome with right sided
Sokoto, Nigeria
cephal haematoma and acyanotic congenital heart dis-
Presentation: power point
ease was made. He was placed on oxygen and 10% dex-
trose water; but developed fever, eye discharge and
CP5
jaundice on 3rd day of admission while oxygen satura-
Takayasu arteritis in a Nigerian child: A case report
tion ranged between 69-91% on oxygen.
Results: Transfontanelle ultrasound showed moderate
Sani UM, Isezuo KO, Garba BI, Waziri UM, *Hano IJ
dilatation of the entire ventricular system of the brain.
Abubakar F, Haruna ML
Chest x-ray was normal and echocardiography con-
Department of Paediatrics, Usmanu Danfodiyo
firmed tetralogy of fallot. He was managed for neonatal
University Teaching Hospital (DUTH) Sokoto
sepsis and jaundice, currently on follow up.
Conclusion: A rare presentation of Noonan syndrome,
Background: Takayasu Arteritis (TA) is a rare, large
which requires multidisciplinary approach for early
vessel vascul it is that usually affects the aorta and its
treatment of his numerous malformations.
major branches. Typically, it presents with weak or ab-
Key words - Hydrocepalus, Noonan, Tetralogy of Fallot
sent peripheral pulses, hypertension, discrepant arm
blood pressure (>10mmHg) and variable involvement of
CP4
other body systems. To the best of our knowledge, this
A case of sustained ventricular tachycardia in a 14-
is the first reported case of TA in a Nigerian child.
year-old boy seen at Usmanu Danfodiyo University
Objective: To describe a rare case of TA diagnosed in an
Teaching Hospital, Sokoto
8 year old boy at our hospital
Case: An 8-year old boy was referred with 3 weeks his-
Sani UM, Waziri UM, Isezuo KO, Garba BI,
tory of fever, head ache, body swelling and difficulty in
Department of Pediatrics, Usmanu Danfodiyo
breathing. He was also noticed to have slurring of
University Teaching Hospital (UDUTH) Sokoto,
speech with incidental finding of absent right radial
Nigeria
pulse. At presentation, he had mild respiratory distress
and facial puffiness. Pulse volume was weak over the
Background: Arrhythmias are relatively uncommon in
right radial and femoral arteries and absent on the right
children. When encountered, their management can be
dorsalispedis. The left upper and lower limbs pulses
challenging especially in resource limited settings where
were normal. He had differential arm blood pressure
required therapeutic facilities may not be readily avail-
(Right=110/75mmHg, Left=125/85mmHg) and expres-
able.
sive aphasia. ESR was 57 mm/hour. Urinalysis showed
Objective: To describe a case of ventricular tachycardia
proteinuria (++), but no hematuria. Echocardiography
(VT) and management challenges in a 14-year-old boy
revealed dilated left ventricle (LV) with systolic dys-
at Usmanu Danfodiyo University Teaching Hospital,
function (EF-46%, FS-18%). A diagnosis of TA was
Sokoto
considered based on America Rheumatology criteria
Case: AH was a 14-year-old boy with Congenital Heart
(ARC, 1990). He was commenced on prednisolone
Disease (Pulmonary atresia, intact ventricular septum),
(1mg/Kg) and other supportive medications. Patient has
who had been on follow up at our Pediatric Cardiology
gradually improved and is being planned for CT an-
Clinic. He presented with 5 days complaints of palpita-
giography.
tion, left sided chest pain, effort dyspnea and episodes of
Conclusion: Takayasu Arteritis can occur in Nigerian
fainting. At presentation, he had hyperactive
children. There is need for high index of suspicion to
precordium; pulse rate was 100/min, small volume, and
avoid misdiagnosis.
irregular.
Key words: Takayasu Arteritis, Children, Sokoto,
Electrocardiogram (ECG) showed ventricular tachycar-
Nigeria
92
CP6
most common cyanotic heart condition in Downs syn-
drome . These cardiac anomalies occur either in isola-
4
Phaeochromocytoma, a rare cause of childhood hy-
pertension: A case report
tion or in combination, with common combinations be-
ing VSD/PDA and VSD/ASD . Rarely, Atrio-ventricular
1
Oduwole AO, Oyenusi EE, Odutayo E, Ohuche I,
canal defect has been found to coexist with Tetralogy of
Alonge M, Bashir F, Ibrahim N, Madigan L, Adele
Fallot as a complex malformation involving both inlet
Sadji M, Balogun T
and outlet component of the ventricles and 75% of these
children have Downs syndrome .
5
Lagos University Teaching Hospital, Idi-Araba, Lagos
Introduction: Phaeochromocytoma is a rare disease in
Case Report
children accounting for only 1% of pediatric hyperten-
sion. Eighty five percent of phaeochromocytomas are
Case 1: A.S a 3 year old female with Downs syndrome
located in the adrenal glands; the rest developing in the
presented with fast and difficult breathing. On examina-
extra adrenal parasympathetic and sympathetic paragan-
tion she was cyanosed, in respiratory distress, had tachy-
glia.
ponea, tachycardia and a tender hepatomegaly. There
Objectives: To report
a case of phaechromocytoma
was cardiomegaly on chest x ray and echocardiography
Case Report: A 14year old girl presented with com-
showed features of complete atrio ventricular canal de-
plaints of recurrent headaches, visual disturbances and
fect (AVCD), Tetralogy of Fallot (TOF) and a patent
an incidental finding of high blood pressure (BP). Ex-
ductus Arteriosus (PDA).
amination showed elevated BP ranging from 150/120 -
Case 2: A .J, 32months old male with complaints of
220/150mmHg at various times, irregular heartbeat and
poor weight gain, recurrent cough and fast breathing
a displaced apex beat (6
th
left intercostal space, mid
noticed since birth. He was small for age with Downs
clavicular line). Chest Xray, serum electrolytes, urea&
facies, in respiratory distress, tachypnoeic, plethoric and
creatinine, and ECG showed no abnormalities. Echocar-
cyanosed. His chest radiograph showed slight up turning
diography showed a structurally normal heart with mild
of the apex. The echocardiograph findings included type
left ventricular hypertrophy but good biventricular con-
A AVCD and TOF.
tractility. Thyroid function tests revealed a slightly high
Conclusion: The complexity of cardiac lesions in
FT3 with normal FT4 and TSH. The cranial CT scan
Downs syndrome correlates with morbidity and mortal-
was normal while the abdominal ultrasound scan
ity of affected children, hence the need to sensitize clini-
showed a left extra renal pelvis and a right aorto-carval
cians of the occurrence of a uncommon yet complex
mass. The urinary metanephrines were markedly ele-
combination of cardiac defects found in two Nigerian
vated: normetanephrine- 46642nmol/24H (normal range
children.
-450-1709nmol/24H); urine normetanephrine: creatinine
ratio- 598 (normal range- 21-308). Abdominal CT scan
DERMP1
showed
a
right
adrenal
phaeochromocytoma.
Scrofuloderma with multiple organ involvement in
She was managed using antihypertensives; alpha and
an adolescent boy: A case report
beta blockers and ultimately a near total adrenalectomy.
Following surgery, all symptoms resolved over ten
Adewunmi BO, Olomukoro CN, Ukpai NU, Ahmed P
weeks
and
she
is
stable
on
follow-up.
Department of Paediatric, National Hospital Abuja,
Conclusion: This report seeks to highlight that though
Nigeria.
phaeochromocytoma is a rare disease, it should be con-
Email: chikaolomukoro@yahoo.com
sidered in the evaluation of pediatric patients with hy-
pertension.
Background: Extrapulmonary tuberculosis (EPTB) is
tuberculosis infection affecting other organs in the body
CP9
apart from the lungs. Scrofuloderma (cutaneous tubercu-
Coexistence of atrioventricular canal defect and
losis) is a rare form of EPTB. Its chronic indolent course
tetralogy of fallot in children with downs syndrome:
increases morbidity and affects the quality of life in chil-
A case series
dren. There is significant morbidity associated with de-
layed diagnosis and treatment of EPTB.
Babaniyi IB, Papka NY, Adesanya O, Adeoti LAE
Case Report: A 14-year-old boy presented with 5-year
Department of Paediatrics, National Hospital Abuja
history of recurrent body swellings involving the lower
jaw, axillae and groin. He had firm and cystic lesions,
Background: Downs syndrome is the commonest chro-
discharging ulcers and serpiginous scars. Other features
mosomal anomaly found in man affecting 9.6/10,000
included;
para-aortic
lymphadenopathy,
hepa-
live biths. Its various manifestations include abnormal
1
tosplenomegaly, hydronephrosis and exaggerated man-
facies, mental retardation and congenital heart defects
toux response. Acid fast bacilli were seen on micros-
being the most debilitating of them all. Over half of chil-
copy of aspirated fluid. Symptoms improved with antitu-
dren with Downs syndrome present with congenital
berculous treatment.
heart disease mostly in form of Atrio-ventricular canal
2
Conclusion: Scrofuloderma is a rare form of extrapul-
defect, ventricular septal defect and patent ductusarteri-
monary tuberculosis which health care personnel should
osus. Tetralogy of Fallot occurs less commonly with
recognize, investigate and treat promptly toreduce fur-
only a prevalence of 5.3% , but has been found to be the
3
ther associated morbidity.
93
EMO1
gasoline, shoe and nail polish. However, there are few
Quality of hospital admission documentation: a study
reported cases of toluene poisoning worldwide.
of children admitted into emergency paediatric unit
Aims/objectives : To make other caregivers aware of the
of a tertiary hospital
possibility of toluene poisoning as well as its deleterious
effects.
Isezuo KO, Adamu A, Jiya FB, Yusuf T, Sani UM
To also emphasize the importance of prompt and appro-
Jiya NM, Onankpa BO, Ibitoye PK
priate management of toluene poisoning.
Department of Paediatrics, Usmanu Danfodiyo
Methods : This case report is about a 2year old girl who
University Teaching Hospital, Sokoto
accidentally ingested evostik glue stored in an attractive
Email: khadisez@gmail.com
container in the home.
Result : She presented with persistent vomiting which
Background: Medical documentation, in addition to
started few hours after ingestion of evostik glue. She
being a legal and research tool, is vital in providing
subsequently developed seizures, altered sensorium,
quality patient care. In Nigeria, like most other develop-
upper gastrointestinal bleeding and acute kidney injury
ing countries, hand written documentation or clerking is
within 48 hours of presentation. She also had hyperten-
the norm.
sion and recurrent hypoglycaemia. Her serum electrolyte
Objectives: We assessed the quality of doctors’ docu-
result showed hyponatremia, severe metabolic acidosis,
mentation of children admitted into Emergency Paediat-
azotemia and elevated serum creatinine. Fluid and elec-
rics Unit (EPU), Usmanu Danfodiyo University Teach-
trolyte management as well as repeated correction of
ing Hospital (UDUTH), Sokoto, Nigeria.
hypoglycaemia were adequately done. The urgent need
Materials and Methods: A 3-month cross-sectional
for haemodialysis could not be met for logistic reasons.
study of admission records by different cadre of doctors
The case fatality was 100%.
for all children admitted into the EPU between March
Conclusion : Toluene poisoning is associated with high
and May 2016. A checklist was used to assess the qual-
mortality. Early presentation and prompt intervention
ity of documentation. Data analyzed with SPSS version
may lead to a good outcome. Prevention of accidental
22.
ingestion of toxic substance at home is key in averting
Results: All documentations were hand written. Of the
mortality associated with childhood poisoning.
191 patients records studied, only 63 (33%) indicated
Key words: Toluene, Evostik
the doctors cadre. One hundred and sixty eight (88%)
had the patients name written on the first page, but only
ENDOO1
81 (42.4%) indicated name on subsequent pages. Date of
Prevalence and Outcome of Hypoglycaemia among
consultation was written in 183 (95.8%) and time of
Children Admitted to Emergency Paediatric Unit of
consultation in 61 (31.9%). Writing was legible in (174)
a Specialist Hospital in Northern Nigeria
91.1%, with counter-signing of cancellations in 19
Musa A , Garba BI, Muhammad AS, Adeniji AO,
1
2
3
4
(9.9%). Review of examination findings showed that the
Yusuf I, Kolawole T, Mohammed F,
4
4
4
vital signs documented included blood pressure in 18
Ben-Wazieh AA.
4
(9.4%), pulse rate in 179 (93.7%), respiratory rate in 179
1
(93.7%) and temperature in 184 (96.3%).
Department of Paediatrics, Ahmadu Bello University,
2
3
Discussion: Results were similar with audits done in
Zaria;
Department of Paediatrics,
Department of
other centers for the purpose of improving the quality of
Medicine, Usmanu Danfodio University, Sokoto;
4
medical documentation in their facilities.
Department of Paediatrics, Ahmad Sani Yariman
Conclusion and recommendation: Our data demonstrate
Bakura Specialist Hospital, Gusau.
the need for improvement in the quality of pediatrics
Email: abdullahimusa12@gmail.com
emergency documentation. We recommend inclusion of
this principle in continuing medical education.
Introduction/Background: Hypoglycaemia is the most
Key Words: Quality, admission, documentation,
common metabolic problem encountered in paediatric
emergency, paediatrics, unit
emergency admissions. Absence of clinical symptoms
does not preclude hypoglycaemia as presentation may
EMP1
vary from asymptomatic to neurologic and cardiopul-
Toluene poisoning following accidental ingestion of
monary disturbances. If untreated, hypoglycaemia can
evostik: case report of a two year old Nigerian child
result in permanent neurological damage or even death.
Objectives: To determine the prevalence and outcome of
Introduction : Childhood poisoning is one of the causes
hypoglycemia in paediatric emergency admissions at
of high morbidity and mortality especially among under-
Ahmad Sani Yariman Bakura Specialist Hospital,
five children in low income countries. The home and its
Gusau.
surroundings may harbour poisonous substances which
Materials and Methods: The study was a prospective
may be ingested by adventurous children. Evo-stik glue
cross-sectional study involving children aged 1 month to
is a modified silane (MS) polymer based high perform-
13 years over a 3 month period. Blood glucose was de-
ance adhesive. It contains toluene, a colourless, sweet-
termined at admission using Accu-Chek® and hypogly-
smelling liquid with detrimental effects on virtually
caemia was defined as blood glucose levels < 2.8 mmol/
every organ in the body especially brain and kidneys.
L (<50 mg/dL).
Toluene is a component of household items such as
Results: 154 children were studied of which 30 (19.5%)
94
were infants and 71 (46.1%) under fives; with
males
glucose, CT- Computerize tomography.
constituting 56.5%. Prevalence of hypoglycaemia was
Key Words: Diabetes, infancy, insulin, glycaemic
22.1% and was highest among children under 5 years
control.
(23.8%), females (28.4%) and among those whose last
meal was taken at least 12 hours before presentation
ENDOO3
(42.9%). Males were significantly more likely to die
Comparative analyses of thyroid dimensions using
(OR=4.2 times, 95% CI =1.0 – 18.0).
handheld Point of Care Ultrasound scan of the
Conclusion and Recommendation: Prevalence of hypo-
thyroid gland in neonates in Port Harcourt, Nigeria
glycaemia is higher in under fives with males more
likely to die. We recommend routine random blood glu-
Yarhere IE
cose check at admission (irrespective of timing of last
Paediatric Endocrinology unit, University of Port
meal) and prompt treatment of hypoglycaemia.
Harcourt Teaching Hospital, Port Harcourt
Key words: hypoglycaemia, random blood sugar,
Email: iroroy91@yahoo.com
children
Introduction: Handheld point of care ultrasound scan
ENDOO2
machine is gaining popularity in clinical practice. The
The Obstacles Of Diagnosing And Achieving
accuracy, ease of utilization, sensitivity and specificity
Glycaemic Control In Breast Feeding Infant With
have been reported by many clinical physicians espe-
T1DM – A Case Report
cially emergency room physicians and cardiologists.
Endocrine organs structures and functions may be evalu-
Idris HW, Mado SM, Abdullahi SM, Abubakar Y
ated using this device.
Department of Paediatrics, Ahmadu Bello University
Objectives: Determine the thyroid volume of healthy
Teaching Hospital, Zaria
newborn babies using handheld Ultrasound scan (USS)
Email: hafsaleh@yahoo.com
device and compare with standard values.
Methodology: Seventy newborns (0 3 days) were
Introduction: Diabetes mellitus is uncommon in infancy
scanned using the handheld Point of Care General Elec-
and its presentation can mimicksome common child-
trics V scan machine ® to generate the thyroid dimen-
hood illnesses. The spontaneity of the young infant, in-
sions and colour flow for each lobe of the gland. The
herent communication difficulties, insulin treatment and
mean dimensions generated were compared with those
eating pattern poses major technical, medical and psy-
from a center in Glasgow, Scotland using Student’s
chological challenges. We present the case of a
“t”test.
10months old infant diagnosed with diabetes mellitus.
Results: Seventy neonates were recruited, 33 males and
Case report: N. Z, 10months old girl was diagnosed
37 females within the first 3 days of life before their
with diabetes mellitus at the age of 8months. She pre-
mothers were discharged from maternity units of the
sented with recurrent convulsions, coma, loss of
hospital. The mean weight of the children was 2.98 kg
achieved developmental milestone, inability to see and
(±0.51), length was 48.91 cm (±1.07) and head circum-
poor glycaemic control. Her pregnancy, labour and de-
ference was 35.92 cm (±0.84). The mean total thyroid
livery were uneventful and weighted 2.9 Kg at birth. She
volume was 1.63 mL (±0.18) with the left thyroid lobe
is on breast milk and complementary feeds. Maternal
being larger than the right lobe (0.82 vs. 0.81 mL) p
grandmother and paternal grandfather have T2DM. She
<0.001. The only difference in thyroid dimensions be-
was admitted in several hospitals where she had differ-
tween males and females that was significant was the
ent insulin formulations with no control of diabetes. She
right thyroid lobe volume, p value = 0.025. Though the
has hadprolonged coma and several episodes of convul-
total thyroid volumes were comparable between the pre-
sions.
sent study and those of Glasgow, the length, breadth and
Examination revealed a conscious but irritable child, in
depth of the glands were significantly different.
decerebrate posture, negative distraction and confronta-
Conclusion: Handheld Point of care USS is useful in
tion tests with normal fundoscopic findings, had global
determining thyroid gland dimensions in newborn ba-
hypertonia and hyperreflexia. Other systemic examina-
bies and the measurements obtained are comparable to
tions were normal. RBG was 31.5mmol/l and brain CT
those from Glasgow.
showed features of early cerebral atrophy.
Key words: Handheld ultrasound scan, newborn, Port
The child was commenced on multiple insulin injection
Harcourt
regimens and other supportive management. Her RBG
was maintained between 4.7mmol/l and 11.7mmol/l.
ENDOP1
Mother had diabetic education. She was discharged and
Blount’s disease in childhood obesity: A case
is on followed up.
report in a 6year old child
Conclusion: Diagnosing diabetes in infants requires a
high index of suspicion. The care of a diabetic child
Ahmed PA, Mohammed- Naf’iu R, Emechebe OI,
requires expertise and proper diabetic education for the
Oranuba O,
caregiver. Patients should be referred early to prevent
Email: ahmedpatience@yahoo.com
complications.
Abbreviations - T1DM - Type 1 diabetes mellitus,
Background: Blount’s disease a developmental disorder,
T2DM-Type 2 diabetes mellitus. RBG- Random blood
characterized by growth of the proximal medial tibial
95
physis and distal femur resulting in progressive lower
obtained.
1
limb deformity with limb discrepancy. Erlacher in 1922
Results: Two children (3& 6 / 2 years) with features of
described a case of tibia vara, while Walter Blount in
Marfan’s syndrome and rickets had undescended testes
1937 identified the similar clinical, radiographic and
but no others features of DSD. Cryptorchidism was con-
pathologic characteristics of tibia vara or osteochondro-
firmed by ultrasound scan. LH, FSH, Testosterone levels
sis deformans among 13children. Childhood Obesity is
were pre-pubertal. Barr bodies suggested male gender.
defined as body mass index (BMI) equal or greater than
They were placed on GnRH analogue injections. The
120% of the 95 percentile or an absolute BMI greater
th
right testes fully descend while the left came down to
than 30 kg/m , whichever is lower based on age and sex.
2
the inguinal canal in the child with Marfan’s syndrome.
Prevalence is on the increase and is a major risk factor
The other patient had full descent of the left testis but
for Blount’s disease.
the right testis was retractile.
Orchidopexy was performed at 4 / 2 and 9yrs respec-
1
Aim: to highlight the clinical features of this bony disor-
der co-existing with childhood obesity.
tively. The child with Marfan’s syndrome (13yrs) is into
Case report: O.D, 6-year-old girl seen at the paediatric
puberty but the left testicle had remained pre-pubertal.
gastro-enterology, hepatology and nutrition (PGEHAN)
In the other child the right testis remained atrophic.
clinic of National Hospital, Abuja, with progressive
Conclusions: Although surgery is the current standard
bowing of both legs from age one and weight gain.
management for cryptorchidism, our patients who pre-
Bowing initially painless, later painful, with limitation
sented late, the response to hormonal therapy was better
of movement and decreased activity. No family history
than the surgical intervention.
of bow legs, both parents are obese. She was exclusively
Key words: Cryptorchidism, Orchidopexy, Hormonal
breast fed for 6 months after which cereals were added.
therapy.
Birth weight was 4.5kg, developmental milestones nor-
Abbreviations -DSD – Disorders of sexual differentia-
mal, no history of Diabetes Mellitus. Examination
tions, LH – Luteinizing hormones, FSH – Follicle stimu-
showed an obese child, weight 66.5 kg, height 121cm,
lating Hormone, GnRH- Gonadotrophin Releasing
BMI 45kg/m , MUAC 37cm, moon faced, bilateral gy-
2
Hormone
naecomastia, bilateral genu vara. Systemic examination
and blood pressure were normal. Radiology showed
ENDOP4
beaking of the medial tibia epiphysis with genu vara.
Use of fresh orange for demonstration of injection
Serum calcium, phosphate, vitamin D assay and lipid
technique in newly diagnosed diabetic children
profile were normal. A diagnosis of Blount’s disease
Iyioke, MN , Idris HW , Mado SM , Abdullahi SM
1
2
coexisting with childhood obesity based on clinical and
1
radiological findings was made.
Department of Nursing Services,
2
Conclusion: Blount’s disease complicated with obesity
Department of Paediatrics, Ahmadu Bello University
as co- morbidity.
Teaching Hospital, Shika Zaria.
Key words: Childhood, Obesity, Blount’s, Diseases.
Email: hafsaleh@yahoo.com
Background: Children with type1 diabetes are depend-
ENDOP3
ent on insulin injection for survival and need to adminis-
Testicular descent in two children with cryptorchi-
ter multiple injections daily. Knowledge of correct injec-
dosm medical vs surgical management; what works?
tion technique is essential for glycaemic control and to
avoid complications
Idris HW, Mselbawalla EN, Mado S, Abdullahi SM
Objectives: To highlight how we teach newly diagnosed
Department of Paediatrics and Paediatric Surgery,
children with T1DM injection technique correctly using
Ahmadu Bello University/Ahmadu Bello University
simple available tools
Teaching Hospital Zaria, Nigeria
Materials and methods: This is aretrospective review
Email: hafsaleh@yahoo.com
(2011 - 2016) of the methods used in teaching newly
diagnosed diabetic children about appropriate injection
Background: The incidence of cryptorchidism is 0.7%
technique in the Paediatric Endocrinology Clinic,
after 1year of age. The major consequences of Cryp-
ABUTH Zaria. Information obtained included the bio-
torchidism include increased risks of torsion and/or in-
data, age at diagnosis, use of insulin and injection com-
guinal hernia. testicular cancer and impaired fertility in
plications.
adulthood. The standard therapy is orchidopexy, while
Results: There were 18 patients aged 8months to 16yrs
hormonal therapy has fewer advocates. Successful orchi-
at presentation, there were 12 females and 5 males. The
dopexy, however, does not prevent potential long-term
children and their caregivers received diabetic education
sequelae in susceptible individuals.
for at presentation to the unit .All the children have
Objectives: To highlight the management modalities in
T1DM and were on 2-4 insulin injections per day. Eight
children presenting late with cryptorchidism.
children who were above the age of 10 years were ad-
Methods: Information about the patients was obtained
ministering the injection by themselves. They under-
from their case notes. It included patient’s biodata, his-
stood the appropriate insertion sites, insertion methods
tory of pregnancy, labour, delivery and other diseases.
and possible complications. Three were lost to follow up
Treatment modalities of children with Cryptorchidism
after the first visit. The remaining children below the
who had surgical and medical management was also
age of 10 years, their mothers were administering their
96
insulin. Only two children (14.2 %) developed
GO1
lipohypertrophy
Pattern of Discharge Against Medical Advice
Conclusions and Recommendations: The paper showed
amongst Paediatric In-patients of Federal Medical
the importance of simple teaching aids like orange fruit
Centre Azare, Nigeria
to teach appropriate injection techniques.
Abbreviations – T1DM Type 1 diabetes mellitus,
Yusuf MO, Imoudu IA, Ahmad H.
ABUTH- Ahmadu Bello University Teaching Hospital
Department of Paediatrics
Key words:
Injection Techniques, Type-1 Diabetes,
Federal Medical Centre, Azare. Bauchi state.
Children, Orange Fruit.
Email: memzii@yahoo.com
Background:
Discharge
against
medical
advice
GAO2
(DAMA) is a common problem in health care delivery
Is knowledge and practice of oral rehydration ther-
in developing countries, including Nigeria. Children are
apy suboptimal? Assessment at federal medical cen-
vulnerable in this situation as they may neither compre-
ter, Asaba south-south Nigeria
hend nor contribute to the decisions and it may be that
DAMA is not in their best interest.
Ezeonwu BU, Okolo AA, Ayodele OA, Ajaegbu O,
Objective: The objective of this study was to determine
Mbagwu NE.
the prevalence rate of DAMA amongst paediatric in-
Department of Paediatrics, Federal Medical Center
patients at the Federal Medical Centre, Azare.
(FMC) Asaba
Materials/Methods: This was a retrospective study car-
Email: uzovin@yahoo.com
ried out over a 3 year period from January 2011 to De-
cember 2013. Hospital Numbers of patients who were
Background: Oral Rehydration Therapy (ORT) is a core
discharged against medical advice were identified from
component of the child survival strategies to reduce
the ward admission and discharge registers for the EPU.
child mortality and morbidity due to diarrhoeal disease
PMW and SCBU. Folders were retrieved, relevant clini-
with its fatal dehydrating complication. This strategy is
cal and socio-economic data were extracted as well as
indispensable to the attainment of the International Soci-
duration of hospital stay. Data was analyzed to generate
ety of Nephrology’s (ISN) aim to eliminate preventable
rates and percentages.
deaths from acute kidney injury (AKI) by year 2025.
Results: A prevalence rate of DAMA was 6.84% and
Diarrheal disease is the second most common cause of
3.5% in the neonatal and post- neonatal age groups re-
morbidity and mortality in children at our center.
spectively. In both cases acute infections accounted for
Aim: This interventional study assessed the knowledge
the majority of admissions, the mean duration of hospi-
and the practice of ORT among caregivers, educated and
tal stay was less than one week and the most common
trained them on the management of diarrhoeal diseases
documented reason for DAMA was financial constraints
and practice of ORT.
(15.5%) on the part of the caregivers.
Method: An interviewer-administered questionnaire was
Conclusion: Laws and policies guarding against prema-
used and consented care givers of wards attendees of
ture removal of children from hospital before full recov-
FMC Asaba were: assessed on their knowledge and their
ery should be made.
practice of ORT, educated on childhood diarrheal dis-
Key words: DAMA, In-patients, Paediatrics, Azare,
eases, trained on practice of ORT and given ORS. There
North-eastern, Nigeria
were pre and post health talk assessments on first en-
counter and another post health talk assessment 6 weeks
GO2
after the first encounter.
Childhood Poisoning As Seen At National Hospital
Results: There were 266 respondents and 231 were
Abuja
mothers. The immediate impact of the health talk on the
knowledge and the practice of ORT was laudable,
Ahmed PA, Nwatah VE, Ulonnam CC
p=<0.0001. The ORT knowledge improved from 57.5%
Email: ahmedpatience@yahoo.com
to 87.5% while ORT practice improved from 63.9% to
92.9%. Educational attainment of the respondent influ-
Background: The young children being very inquisitive
enced the immediate post health talk knowledge of
put most items into its mouths and hence are particularly
ORT, p= 0.009. The age of the respondent predicted the
susceptible to the ingestion of any objects, including
long term impact of health talk on practice of ORT,
liquids; putting them at risk for poisoning. The majority
p=0.020.
of poisonings are accidental, especially in the under-5
Conclusion: Knowledge and practice of ORT are not
age group. The prevalence and types of poisoning vary
optimal but can be improved by regular education.
in different parts of the world and regions.
Recommendation: Demonstrative education on ORT
Aim: To describe the socio-demographic, clinical feature
should be regularized in paediatrics clinic.
and outcome in childhood poisoning at the National hos-
pital Abuja (NHA).
Subjects and Methods: A descriptive prospective study
on subjects admitted for acute poisoning from Septem-
ber 2014 -August 2016. Consecutive subjects with a
history of poisoning were recruited during the study
97
period. Subjects were examined and findings were re-
and surgical conditions were commonest causes of
corded into a proforma. The subjects were followed up
death. Neonatal mortality rate per neonatal admission
till discharge or demise.
was 16.5% and that of the post neonatal age group was
Results: Twenty two subjects with history of poisoning
4.608%. Factors identified as contributory to mortalities
were admitted, out of the 2336 children seen at the
were delays in recognition of conditions, actions, and
Emergency Paediatrics Unit (EPU) during the study
systematic errors.
period; giving prevalence rate of
0.9percent. The age
Discussion: While the report did not show significant
(mean ±SD; range) was 2.25 ± 1.86; 1 – 8 years; with
changes over the years, many avoidable causes of deaths
males 14(63.6%), females 8(36.4%).
The socio-
are still contributing to mortalities.
economic status of caregivers were 14(63.6%) of upper
Conclusion: Periodic, non-judgmental systematic
class, 6(27.3%) middle class and lower class 2(9.1%);
reviews of mortalities should be carried out, and struc-
while family size were 6(27.3%), 3persons/family; 15
tured format should be used to improve patient care and
(68.2%), 4-6person/family;
and >6persons/family 1
assure quality.
(4.5%). The most common clinical features included
Key words: Morbidity, children, mortality, causes,
cough, 8(36.4%), tachypnoea 7(31.8%), fever 6(27.3%),
Nigeria
tachycardia 5(22.7%) and difficulty with breathing 4
(18.2%). The common poisoning were kerosene 8
(36.4%), organophosphate 5(22.7%) and iron tablets 2
HAEM02
(9.1%). Eight (81.8%) of subjects had some form of
Prevalence and Determinants of Blood Transfusion
home intervention. Outcome variables revealed that 16
in Paediatrics Population As Seen At the National
(72.7%) stayed 5days or less on admission and 6(27.3%)
Hospital Abuja
stayed more than 5days; 17 (77.3%) were discharged, 4
(18.2%) died and one (4.5%) left against medical advice.
Ahmed PA, Okon A, Nwatah VE, Ononiwu U
Mortality was associated with prolonged hospital stay
Ulonnam CC, Igoche P
(Fisher exact, p-value 0.04 and odd ratio15.0 CI: 1.14 –
Department of Paediatrics
198.04).
Email: ahmedpatience@yahoo.com
Conclusion: kerosene use mostly accounted for acute
poisoning, while mortality was related to prolonged hos-
Background: Several childhood conditions present with
pital stay.
severe anaemia that contributes to significant morbidity
Key words: Childhood, Poisoning, Kerosene, Abuja
and mortality. Blood transfusion can be life saving.
Aim: To determine the prevalence and determinant of
GPO2
blood transfusion at the NHA.
A Ten-year review of all cause paediatric mortality
Subjects and methods: Cross-sectional descriptive pro-
in University of Port Harcourt Teaching Hospital
spective study of children aged above one month to
(2006 – 2015)
16years, admitted into the paediatric wards and had
blood transfusion were enrolled. Examination findings,
Yarhere I E, Nte A R
laboratory investigations and diagnosis were recorded in
a proforma. The data obtained were analyzed using
Introduction: Morbidity and mortality reviews provide
SPSS version 20 and significant level was set at 0.05.
platforms for quality controls and improvement in sys-
Results: Of the 951 subjects admitted in EPU/IPP wards
tems already put in place for health care delivery. Regu-
during the study period of six months (April- September
lar audits of these processes will ensure standards are
2016), 71 (7.5 %) had blood transfusion. The age
maintained or improved upon. A 10-year review of all
(mean± SD; range) was 5.34±4.25 years, 2months-16
morbidity and mortality patterns was conducted in our
years; males 38(53.5%); females 33(46.5%). Common-
institution.
est signs were pallor 71(100%), hepatomegaly 55
Objectives: To determine causes of childhood mortality
(77.5%), tachycardia 25(35.2%) and dehydration 55
and morbidity in University of Port Harcourt Teaching
(35.2%). Commonest diagnoses were sickle cell anae-
Hospital in the past 10 years.
mia 30(42.3%), severe malaria 17(23.9%) and sep-
Methods: We performed a systematic review of all ad-
ticeamia 16(22.5%). 30(42.3%) had malaria parasitae-
missions and mortalities in Paediatrics department of
mia, 24 (33.8%) had severe anaemia (PCV < 15%) and;
UPTH, from 1st January 2006 – 31st Dec 2015. Records
11( 45.8%) of those with severe anemia had positive
from the admission books and mortality review cards in
malaria parasitaemia. The difference in the severity of
CHEW, SCBU, Wards and DTU were extracted and
anaemia with malaria parasitaemia was not statistically
analysed using excel and SPSS. Information retrieved
significant ( χ2=1.498, df=2, p=0.516). Seven (23.3%)
included name, age, sex, dates and times of admission
with sickle cell had severe anaemia though not signifi-
and deaths, admitting diagnosis, and working diagnosis,
cant compared to non- sickle cell subjects ( χ 2=5.316,
and causes of deaths. Results were presented as figures
p=0.075).
and tables and where possible, test of statistical differ-
Conclusion: sickle cell anaemia and severe malaria ac-
ences was set at p = 0.05
counted for significant blood transfusion needs among
Results: There were 20,215 admissions and 1,592
the subjects.
(7.87%) mortalities, with more neonatal (4.53%) deaths.
Key words: Blood, Transfusion, Prevalence, Hemoglo-
Deaths due to perinatal conditions, infections, malaria
bin, Malaria, Sickle cell.
98
HAEMO3
and childhood tetanus seen at the Federal Medical Cen-
tre, Azare from 1 January to 31 December, 2013 were
st
st
The value of red blood cell indices in the diagnosis of
severe malaria in Azare, North-Eastern Nigeria
obtained and analysed.
Results: A total of 19 cases were admitted during this
Imoudu IA, Ahmad H, Yusuf MO, Makarfi HU
period, 6 (31.6%) had neonatal tetanus, while 13
Department of Paediatrics, Federal Medical Centre,
(68.4%) had childhood tetanus. The male: female ratio
Azare, Nigeria
for neonatal tetanus was1:1, that of childhood tetanus
Email: tomhe164@yahoo.com
was 1.6:1. The case fatality rate of neonatal tetanus was
50% and 61.5% for childhood tetanus. The mean age of
Introduction: Malaria significantly impacts global mor-
the neonates who survived the disease differed signifi-
tality figures, been endemic in 104 countries and territo-
cantly from that of those who did not survive the disease
ries. It is preventable and treatable thus confirmation of
(P=0.03). This was also true for incubation period
diagnosis through microscopy or rapid diagnostic tests
(P=0.01). Mean incubation period and onset time for
for every suspected case is a key element of the inter-
childhood tetanus was longer is survivors than non-
ventions for prevention and treatment. However, these
survivors. However, these differences did not reach sta-
strategies are limited and require a certain degree of
tistical significance (P=0.59, 0.50 respectively). The
practical proficiency, skills which are not always avail-
portal of entry of childhood tetanus had a statistically
able in resource-poor settings.
significant relationship with the outcome (P=0.02).
Objective: This study aimed at evaluating the red cell
Conclusion: Mortality from tetanus remains high, the
indices of children diagnosed with severe malaria at the
importance of preventive strategies in its management
Federal Medical Centre, Azare, Nigeria, with a view to
cannot be overemphasized in our environment.
determining their utility in aiding accurate diagnosis.
Methods: One hundred and ninety-six children aged 6
months to 12 years, comprising of 98 diagnosed with
Infantile haemangioma in a ‘beard’ distribution: a
severe malaria and 98 controls were recruited into the
case report
study. The following red cell indices were obtained from
the subjects; haematocrit (HCT), haemoglobin concen-
Imoudu IA, Ahmad H, Yusuf MO, Makarfi HU
tration (HB), mean corpuscular volume (MCV), mean
Department of Paediatrics, Federal Medical Centre,
corpuscular haemoglobin (MCH) and mean corpuscular
Azare, Nigeria
haemoglobin concentration (MCHC). Diagnostic preci-
Email: tomhe164@yahoo.com
sion was determined by calculating sensitivities, speci-
ficities, positive predictive and negative predictive val-
Introduction: Infantile haemangiomas are benign vascu-
ues.
lar neoplasms that have a characteristic clinical course
Results: The HCT had a sensitivity of 79.59% and a
marked by early proliferation and followed by spontane-
specificity of 80.65%, while the HB had a sensitivity of
ous involution. They may be cutaneous or extra cutane-
81.63% and a specificity of 71.15%. The positive pre-
ous. Infrequently, infantile haemangiomas may impinge
dictive values for HCT and HB were 86.67% and
on vital structures provoking certain related symptoms.
84.21% respectively. MCV, MCH and MCHC had low
Objective: This report is intended to underscore the need
values.
for a high index of suspicion and anticipatory manage-
Conclusion: In the presence of supporting clinical evi-
ment of life threatening respiratory complications that
dence, the existence of anaemia in a child in Azare may
may be associated with infantile cutaneous haemangio-
be a valuable supporting criterion in the diagnosis of
mas in a ‘beard’ distribution.
severe malaria.
Case summary: We report a 10 week-old girl admitted
into the emergency paediatric unit of our hospital with a
3-week history of a skin lesion initially noticed as a flat
A primordial killer still on the prowl: A review of
discoloured area over the sternal region. It progressively
paediatric tetanus in Azare, Bauchi state
spread superiorly to involve the anterior aspect of the
neck and chin and became associated with progressive
Imoudu IA, Ahmad H, Yusuf MO, Makarfi HU
difficulty in breathing. Examination findings revealed a
Afegbua DS
restless, acutely ill child in respiratory distress and inspi-
Department of Paediatrics, Federal Medical Centre,
ratory stridor. She had purplish plaques in the areas
Azare, Nigeria
mentioned above as well as the lower lip and ventral
Email: tomhe164@yahoo.com
aspect of the tongue. Treatment involved the administra-
tion of oxygen, intravenous dexamethasone and oral
Introduction: Tetanus, a well-known disease to pre-
propranolol, she was discharged after 4 days of admis-
historic peoples remains an on-going challenge in the
sion following remarkable improvement.
developing world.
Conclusion/ Recommendation: The prognosis for most
Objective: This study is aimed at examining the mean
uncomplicated haemangiomas is very good. Airway
ages, portals of entry, onset times and incubation periods
obstruction is an uncommon complication and may be
as well as outcomes of patients affected by neonatal and
particularly challenging for young infants who are obli-
childhood tetanus in Azare, Nigeria.
gate nose breathers. It is essential to recognize this asso-
Methods: Retrospective data of all patients with neonatal
ciation and institute prompt management of respiratory
99
complications in infantile haemangiomas in ‘beard’
sickle cell anaemia (SCA), it’s use has remained low in
presentation.
Africa and Nigeria where the largest number of sickle
cell anaemia reside. Availability, cost, concern about
safety and efficacy are some of the challenges to it’s use.
HAEMO4
Aim/Objectives: This study highlights the experience of
The Use of Hydroxyurea in Children with Sickle Cell
using HU for children with SCA in Ahmadu Bello Uni-
Disease: Experience in National Hospital Abuja
versity Teaching Hospital, Zaria
Methodology: A descriptive prospective study of chil-
Oniyangi OO, Adeleye QA
dren. Demographic, clinical and laboratory features of
Department of Paediatrics, National Hospital Abuja
children taking HU as well as indications for therapy,
Email: seyioniyangi@gmail.com
adverse events and adverse clinical events were analysed
and presented as simple differences and means.
Background: Nigeria accounts for the highest burden of
Results: Seventy children were enrolled within two
Sickle Cell Disease (SCD) in the world. The manage-
years, 34 (48.6%) boys whose age ranged between 0.9-
ment in children is challenging due in part to limited
17 years. The minimum duration of treatment was one
therapeutic options. The beneficial effect of high foetal
month and maximum was two years. About 25% of the
haemoglobin level makes the use of hydroxyurea (HU)
subjects were enrolled because of recurrent vaso-
an invaluable intervention option in the settings of po-
occlusive crisis. All patients reported marked improve-
tentially disabling and life threatening complications.
ment of their symptoms except one that discontinued
Objectives: The study was aimed at evaluating patient
treatment because of skin rash.
selection for HU, side effects and outcome of therapy
Conclusion: This preliminary analysis documents im-
among children with SCD including possible complica-
provement in the clinical condition of children taking
tions of the drug.
HU with minimal adverse events to necessitate discon-
Subjects and Methods: This is a 3 year descriptive retro-
tinuation of therapy.
spective cohort study of children up to 16 years of age
seen at the Paediatric sickle cell clinic of the hospital
between January 2011 and January 2014, and who were
HAEM08
on HU for at least 6 months. Data was obtained from
Post Exchange blood transfusion haematocrit in
case notes retrieved from the Medical Records Depart-
neonates with severe hyperbilirubinaemia: is it
ment of the hospital. Analysis was done using SPSS 20.
predictable?
Results: A total of 74 subjects, mean age 8.5 years were
Lamidi IA , Amsa BM , Adekunle TO , Qadri AA
1
1
1
1
studied. Ninety seven per cent of them were haemoglo-
Department of Paediatrics, Neonatal Unit,
1
bin SS. Abnormal Trans-Cranial Doppler (TCD) ultra-
sound was the highest indication for HU accounting for
National Hospital Abuja.
52.7%. Others are multiple vaso-occlusive crisis
Email: drauduli@yahoo.com
(24.3%), stroke (18.9%) and recurrent blood transfusion
(12.2%). There was a statistically significant difference
Introduction: Exchange blood transfusion (EBT) is usu-
between pre HU haemoglobin concentration (mean of
ally carried out in babies with severe hyperbilirubinae-
7.6) and post HU levels (mean of 8.7). A significant
mia to prevent acute bilirubin encephalopathy. Double
reduction in the TCD ultrasound values (among those
volume EBT, result in50% reduction in serum bilirubin.
with high levels) was demonstrated, as well as the num-
It is estimated that 90% of baby’s blood is exchanged
ber of vaso-occlusive crises, blood transfusions and hos-
with donor blood; therefore post EBT haematocrit will
pital admissions. However, no statistically significant
depend on donor haematocrit. Top up transfusion imme-
difference was observed in the white cell count, platelet
diately post EBT is practiced in Nigeria, although this is
count, plasma creatinine and alanine aminotransferase.
not evidence based.
Conclusion: Hydroxyurea remains effective in the man-
Objectives: Our objective was to determine post EBT
agement of sickle cell disease as it has been associated
haematocrit and its predictability in newborns with se-
with improvement in clinical outcomes of the disease,
vere hyperbilirubinaemia. We hypothesized that follow-
with minimal side effects.
ing double volume EBT for severe jaundice, estimated
(expected) haematocrit is similar to laboratory deter-
mined (observed) haematocrit.
HAEMO5
Methodology: Term and preterm babies who had EBT
Preliminary analysis on the use of hydroxycarbamide
for hyperbilirubinaemia were studied. Relevant clinical
in children with sickle cell anaemia in zaria
information was noted. The volume of blood transfused,
results of pre and post EBT haematocrit and serum
Faruk JA, Ahmad HR, Sobowale AM, Solomon A,
bilirubin were documented. Expected haematocrit was
Ogunrinde GO
calculated based on the assumption that 90% of baby’s
Haematology/Oncology Unit, Ahmadu Bello University/
blood was exchanged.
Teaching Hospital, Zaria
Results: Forty babies aged 3 -111 hours were studied.
Nineteen (47.5%) had haemolytic jaundice, 10(25%)
Introduction: Although Hydroxycarbamide (HU) have
were non haemolytic and the causes were unknown in
been in use for decades both in adults and children with
11(27.5%). There was no significant difference between
100
pre and post EBT haematocrit; 39.6+9% vs 39.6+4%,
HAEMO10
(p=0.983) and this was similar for both haemolytic and
Comparison of prior Blood group knowledge of
non-haemolytic causes. Mean donor haematocrit was
Antenatal Clinic attendees of two Hospitals in Asaba
41.1+4.3% (range: 34%-53%.) The post EBT haema-
with the result of Point of care blood group test Kit
tocrit (observed) 39.6+4% was also similar to the esti-
mated haematocrit 40.8+4.3%, p=0.107.
Chimah UO, Efe O, Umukoro C, Alagoa E Okolo AA
Conclusion: Post EBT haematocrit is predictable and
Federal Medical Center, Asaba, Delta State
can be used to identify babies that will need immediate
post EBT top up transfusion.
Background: Blood group testing is routinely done for
Key words: Neonates, Hyperbilirubinemia, Post EBT
antenatal subjects (ANC) at the tertiary health facilities
Haematocrit, Predictability
by standard laboratory methods. Such data are in the
Preferred mode of presentation: ORAL
subjects case-note that are referred to at other times. The
national identity cards have provided for recording of
HAEMO9
blood group but it is not yet fully enforced; often times
Ethnic variations in frequencies of Rhesus negative
such information is derived from recall. There is there-
blood groupings among ANC attendees at secondary
fore the need to have more accurate objective reliable
health facilities in Oghara, Ethiope West LGA, Delta
method of retrieval of such sensitive information.
State
Objective: To compare the point of care test Kit
(POCTK) method with patients’ prior knowledge of
Okiroro I, Elo AM, Oghenebrozie AU, Okolo AA
their blood group.
Department of Pediatrics, Delta State University,
Methods: Ethical approval of the protocol was obtained
College of Health Sciences, Abraka
from the relevant bodies. Informed consent was verbally
obtained from the subjects before the point of care blood
Background: The prevalence of Rhesus negative (Rh-
group assessment was conducted. The clinicians admin-
ve) blood group in the population of ANC attendees at
istered questionnaire before testing the attendees at the
our general hospitals is largely unknown and this makes
ANC of these hospitals (FMC)& St Josephs with the
planning for prevention of hemolytic jaundice in infants
POCTK obtained from Eldon Biologicals. Each of the
of such mothers difficult. Hard data is needed for In-
subjects was tested with an Eldon card with 4 circles to
formed decision to guide planning for preventive meas-
which selected monoclonal antibodies were impregnated
ures in the local settings.
on. The antibodies were anti-A, anti-B and anti-D. The
Objective: To ascertain the prevalence of RH-ve groups
fourth circle was the control. A drop of water was added
in ANC attendees at secondary hospitals in Oghara
to each circle to activate the serum containing the mono-
Methods: The study was a cross sectional study con-
clonal antibodies. Drops of blood were obtained from
ducted among attendees of the ANC clinics of the Gen-
the subjects following a finger prick and a plastic Eldon
eral Hospital Oghara and Our Lady’s Catholic Hospital
stick was used to transfer the blood to the serum on each
Oghara.
circle and the blood stirred. A stick was used for each
The study protocol was approved by the Ethics commit-
circle. The cards were slowly tilted and observed for
tees of the relevant bodies and oral informed consent of
agglutination. Results were read and documented on the
the subjects was obtained.
cards which were allowed to dry. The cards were sealed
Capillary sampling of attendees was carried out on the
and given to the subjects. The results obtained were en-
spot by the clinician at the ANC clinics of the General
tered into the Microsoft excel spread sheet and the result
Hospital Oghara and the Our Lady’s Clinic and Mater-
analysed using SPSS version 20.0.
nity where the test was conducted with the Point of Care
Results: 200 pregnant women were tested. Mean age
Test Kit (POCTK) obtained from Eldon Biologicals.
was 31.48± 4.71years; primiparas (66%), multiparous
The data collection tools was a structured pre- tested
(34%). Of the 125 (62.5%) who knew their blood group,
questionnaire. The data was later entered unto excel
the POCTK grouping as against (prior knowledge) was
spread sheet on the computer and analysed using SPSS.
as follows: O+ 62(86.1%); O- 4(100%); B+ 24 (109%);
Means & Standard deviations, percentages, were calcu-
B- (-100%); A+ (138%); A- (200%); AB+ (75%). The
lated, and student t test were computed. The CI was set
POCTK cards seem to closely match the recall for the O
at 95% (p<0.05).
- and B-, more than for the other groups.
Results: 112 women were tested. 56 (50%) of attendees
Since POCTK has a built in means of verification of the
were urhobos and other ethnic tribes constituted 50%.
results, it should be deemed as more reliable than the
75% had no prior knowledge of their blood groups
recall method. It is suggested that reliable retrieval of
The identified Rh-ve women 26(23.2%) were predomi-
such results be resorted to.
nantly urhobos 65.4% (17); while other ethnic groups
constituted 34.6% of the Rh-ve subjects.
It is noted that though the numbers tested were few, this
tribal predominance should be born in mind whilst
working at local environments and it indicates the need
for blood groups testing antenatally at all health facili-
ties using easily accessible and affordable means.
101
HAEMO11
dren attending the clinic was analyzed. All the patients
Feasibility, Accessibility and affordability of the use
and/or their caregivers were informed of the research
of the Eldon Cards for blood group testing of school
process, consent obtained and answered a standardized
children in a rural community of Delta State
questionnaire.
Results: The children were aged between 8 months to 17
Ezeonwu B, Chimah U, Opara H, Omoyibo E
years, 52% of whom were less than five years. Only 8.4
Umukoro C, Alagoa E, Adeniran K, Okike C
% of the subjects were from high socioeconomic status.
Okolo A
All had HBSS type and 18.9% had persistence of HB F,
Department of Pediatrics, Federal Medical Center,
84.6% were in steady state. The mean HB estimation
Asaba
was 7.4g/dl. The exclusive breast feeding rate was 25%,
55.9% had BCG, 54.5 % had hepatitis vaccination,
Background: There is paucity of information of knowl-
19.6% had pneumococcal vaaccination, 38.5% did not
edge of blood group types amongst the members of our
have any form of vaccination while only 38.5% had
communities. The National ID card system has provi-
completed their routine vaccination.
sion for inclusion of blood group types as part of the
Conclusion: This study demonstrates poor vaccination
personal identification. Current method of assessment of
status of these children which is of concern as lack of
blood group is the standard method available at the
protection from vaccine preventable diseases can in-
blood Bank. The Eldon card is a point of care test kit
crease the morbidity and mortality of these children.
that can be used anywhere to perform on the spot testing
Key Words: sickle cell anaemia, socio-demographic,
for blood group and so will make blood group testing
exclusive breast feeding
accessible to the general population.
Aim: To ascertain the feasibility, acceptability and possi-
bility for affordability of the blood group testing with
HAEMP1
the Eldon cards by health professionals in communities
Discordance in HIV infection of dizygotic twins:
of Delta State.
seropositive albino
Methods: Data on the waiting time, perception of testing
Oluwayemi IO , Fatunla OAT , Ogundare EO
1,2
2
1,2
with the kit on the field were collected from the subjects
2
Ajite AB , Oke JO
2
using a semi-structured pretested questionnaire. Health
professionals’ performance with the kits were also
Department of Paediatrics, Faculty of Clinical Sciences,
evaluated with the use of a self-appraisal questionnaire.
College of Medicine, Ekiti State University, Ado-Ekiti,
Results and Conclusion: The total number of children
Ekiti State, Nigeria
assessed were 115.Majority of respondents (86.1%) ac-
Department of Paediatrics, Ekiti State University
cepted Point of care testing with the Eldon cards as they
Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
(68%) felt that the waiting time for the result was short
Email: Isaac.oluwayemi@eksu.edu.ng
relative to the standard method as it took less than 15
minutes. The subject satisfaction rating was also high
Background: Serodiscordance exists when the known
(70%). About 39% of the subjects felt it was very af-
HIV result of one member of a couple pair is positive
fordable at a cost of N500 and 69% of the children
while the other is negative.HIV serodiscordance among
would recommend the test to friends and family. The
twins is relatively uncommon and when they do occur,
health professionals identified with the ease of utiliza-
the first twin is usually more at risk of infection regard-
tion of the kit.
less of mode of delivery. There is currently no estab-
lished association between albinism and increased risk
of HIV infection.
HAEMO12
Aim/ Objective: A case report of uncommon occurence
Sociodemographic characteristics of children with
in transmission of HIV from mother to children with the
sickle cell anaemia in zaria
view of profering possible explanation.
Case report: A 16-month-old pairof
maletwins pre-
HR Ahmad, JO Alegbejo, JA Faruk, AM Sobowale, A
sented at the Paediatric ART clinic, Ekiti State Univer-
Solomon, H Ishaku
sity Teaching Hospital, Ado-Ekiti in October 2016 with
Department of Paediatrics, Ahmadu Bello University/
serodiscordant HIV results. The first twin, an albino,
Teaching Hospital, Zaria
had positive retroviral screening result while the result
of the dark complexioned second twin was negative.
Introduction: Sickle cell anaemia (SCA) is the common-
Delivery was parvaginam with no adverse events at the
est haematological hereditary disorder in Nigeria and is
intrapartum and neonatal period. Their birth weight was
associated with high morbidity and mortality. Environ-
4kg and 3.5kg respectively. Both parents had just been
mental triggers, infections in a background of poor nu-
diagnosed 3months prior visit. At presentation, the first
tritional status impact negatively on the disease.
twin was ill with parotid fullness, mildly pale and had
Aim/Objectives: To document the socio-demographic
significant peripheral lymph node enlargement. He was
characteristics of children with sickle cell anaemia at-
marasmic (weight=6Kg: 56% of expected), stunted
tending the Haematology/Oncology clinic of ABUTH,
(height= 60cm: 72% of expected); MUAC = 11.5cm.
Zaria
The second twin on the other hand had grossly normal
Methods: Cross sectional descriptive data of 143 chil-
examination findings.
102
Conclusion: There is no established link between in-
and under diagnosis cannot be ruled out. This case re-
creased risk of HIV infection and albinism, though there
port of HLH is the first in Nigeria and due to the rarity
is some link between HLA homozygocity and increased
of the disease the need to raise more awareness is im-
risk of HIV infection. HLA homozygocity and homozy-
perative as a high index of suspicion is required for di-
gous albinism may share similar genetic patterns of in-
agnosis.
heritance.
Key words: Haemophagocytic lymphohistocytosis
Key words: discordance HIV status, dizygotic twins,
(HLH), haemaphagocytosis
albinism
ID01
HAEMP2
Hand Washing Practice and the Prevalence of Intes-
Haemophagocytic lymphohistiocytosis in a Nigerian
tinal Helminthiaisis among Junior Secondary School
child
Students
Solarin AU , Oluwabukola MA , Obaze RO
a
a
b
Ulonnam CC, Ahmed PA, Audu LI and Tochi-Onyia C
d
Jagun OO , Daniel Ogbaro
c
Department of Paediatrics
a
Department of Paediatrics, Department of Surgery
c
Email: chide_charlie@yahoo.com
(Ophthalmology), Department of Medicine
d
(Hematology), Babcock University
Background: Hand washing with soap is a well-known
Teaching Hospital, Ilishan-Remo, Ogun State.
measure that prevents disease transmission and pro-
b
Department of Medicine, Adelaide and Meath, National
motes good health.
Children’s Hospital, Dublin ,Republic of Ireland
Aims: To describe the hand washing behavior in junior
secondary school students after toilet usage and deter-
Introduction/Background: Haemophagocytic lympho-
mine its association with the prevalence of intestinal
histiocytosis (HLH) is a rare, life threatening, underdiag-
helminthiasis.
nosed haematologic disorder that occurs from unregu-
Subjects and Methods: A cross sectional study among
lated immune activation, extreme inflammation, and
1081 students aged 10-15 years attending Junior Secon-
tissue damage. The major cause of mortality in HLH is a
dary Schools in the Abuja Municipal Area Coun-
delay in diagnosis and prompt initiation of treatment
cil. Hand-washing behavior of the students after toilet
which occurs due to the variability of the clinical mani-
usage was obtained via a questionnaire. Stools were
festation of this disease entity.
collected and analyzed using modified Kato-Katz
Aims/Objective: To report a rare, life threatening and
method.
often missed diagnosed haematologic disorder.
Results: Of 1081, 630(58.3%) reported access to regular
Method: We present a case of a 17-year-old adolescent
supply of clean water while only 202(18.7%) reported
who presented with fever, painful facial swelling that
regular availability of soap for hand washing in the
partially resolved with initial use of intravenous dexa-
school environment. 161(14.9%) reported hand washing
methasone. He had recurrence of symptoms with wors-
always; 369 (34.1%) sometimes, and rarely in 551
ening clinical and biochemical parameters. Diagnosis of
(51.0%). 504(46.6%) had at least one helminthes ovum
HLH was finally made and he had complete resolution
in their stool and four intestinal helminthes were identi-
of symptoms following appropriate treatment.
fied; Ascaris lumbricoides, 242 (22.4%); Hookworm ,
Results: Haemophagocytosis was found in his bone mar-
219 (20.3%); Trichuris trichiura , 121 (11.2%) and
row and liver biopsy. In addition, triglyceride levels
Schistosoma mansoni , 38 (3.5%). Of those who washed
were elevated at 210mgwith ferritin and IL2R elevated
always with clean water and soap, infestation rates were
as well with values of 199,800 and 8411 respectively.
fewer; Ascaris infestation was 13.0% vs 24.0% Odd
He was leucopenic with a white cell count of 1.9×10 /L
9
ratio 0.474 CI:0.293-0.769), hookworm infestation
and anaemic as haemoglobin was 9.8g/dL. He had ele-
(12.4% vs 21.6% odd ratio 0.514 CI 0.314- 0.842) and
vated liver enzymes with an ALT of 328U/L and AST
Trichuris infestation (5.6% vs 12.2% Odd ratio 0.427 CI
1,134U/L. Clotting profile was deranged with prothrom-
0.212- 0.861) compared to the sometimes and rarely
bin time and partial thromboplastin time below 13.6
groups. The difference in infestation rate for Ascaris,
seconds and 22.4 seconds respectively. He had severe
Hookworm and Trichuris was statistically significant
coagulopathy with bleeding from the mouth and periph-
(p<0.05); while the infestation rate by Schistosoma man-
eral line sites. LDH was also elevated with a value of
so ni was fewer in those who always washed hands
1351dl/L. D-Dimer was markedly elevated with a value
(1.9% vs 3.8%); Fisher exact p value= 0.350.
of 10,726ng/ml and beta D-glucan was above 500pg/ml.
Conclusion: students who practiced hand washing in the
The virology screening showed CMV quantitative PCR
school environment with clean water and soap had re-
peaked at 88,242copies/ml. However, adenovirus and
duced burden of intestinal helminthiasis.
Ebstein-Barr virus PCR testing were negative. Broncho-
Key words: Hand, Washing; Helminthes; School,
scopy and bronchoalveolar lavage, CT Brain, thorax,
Abuja.
abdomen and Pelvis, PET- CT scans were also done and
were unremarkable.
Conclusion: With careful search, there is no report of
HLH in Nigeria and the possibility of missed diagnosis
103
IDO6
matched controls with phenotype AA. The children were
Childhood hepatitis B viral infection: Prevalence,
screened for various markers of hepatitis B virus.
outcome and challenges of management in ABUTH,
A well-structured questionnaire was utilized to collec-
Zaria
trelevant data.
Result: The prevalence rates of hepatitis B infection in
Mado SM, Idris HW, Abdullahi SM
the SCA and control groups were 24.66% and 28.77%
Department of Paediatrics, Ahmadu Bello University
respectively. The prevalence was highest in the 9-12
Teaching Hospital Zaria
year age-group in both groups. The most frequent
marker found both groups was anti-HBc.
Thirty
Background: Hepatitis B viral infection affects all re-
(83.33%) children with SCA had anti-HBc in their sera.
gions of the world, but its burden is highest in develop-
Thirty-eight (90.47%) of control children had the same
ing countries. While, the prevalence reduced drastically
marker.
following introduction of vaccine against hepatitis Bin
Conclusions and Recommendations: High prevalence of
developed nations, varying reports indicate the contrary
HBV infection was detected in both the subjects and
in developing countries.
controls. Children with SCA were not at increased risk
Objectives: To determine the prevalence of childhood
of contracting hepatitis B infection. It is recommended
Hepatitis B viral infection in Zaria, Nigeria.
that all children should benefit from early HB vaccina-
Materials and Methods: A retrospective study in chil-
tion to eradicate this deadly infection of great public
dren diagnosed with hepatitis B viral (HBV) infection
importance.
attending the gastroenterology clinic of ABUTH, Zaria
from 1 July 2009to 30 June 2015.
st
th
Results: The prevalence of HBV infection was 29.7%
IDO8
(92 0f 406). Only 42 (45.7%) patients were on follow up
Risk factors for HBV infection among SCA children
by 6 months following the diagnosis while 50 (54.3%)
of ABUTH Zaria
were lost to follow-up. Twenty-seven (64.3%) of the 42
patients remained positive for HBsAg by 6 months of
Ramatu AZ, Yakubu AM, Ogunrinde GO, Olayinka A
infections, while 15 (35.7%) seroconverted and tested
Ibrahim A, Dodo A
negative. Twenty-five (27.2%) of the 92 children were
also positive for the HBeAg markers in their sera.
Background: The World Health Organization lists HBV
Twelve (44.4%) of the 27 subjects with chronic hepatitis
infection as the ninth major cause of death worldwide.
B viral infections had HBV DNA viral load done. Only
Africa is known to be hyperendemic for HBV infection,
8 (29.6%) of the 27 subjects are on Lamivudine.
where the disease is contracted during infancy and early
Conclusion and Recommendations: Hepatitis B viral
childhood resulting in 15-20% of its populace being
infection remains a significant public health problem in
chronic carriers, majority of the infections are acquired
our environment with significant cases of default fol-
between 6 months and 6 years of age. Horizontal trans-
lowing the diagnosis and stress the need for strengthen-
mission occurs predominantly via the parenteral route.
ing of current immunization schedule and continuous
These include the use of contaminated blood and blood
counselling.
products, surgical and non-surgical procedures, mass
immunization; other routes include contact with con-
taminated body fluids, sexually and vertical transmis-
IDO7
sion. Patients with sickle cell anaemia (SCA) have been
Prevalence of HBV infection amongst SCD patient in
thought to be prone to HBV infection with the tendency
ABUTH Zaria
to a chronic carrier state for various reasons.
The aim of this study is to evaluate the association be-
Ramatu AZ, Yakubu AM, Ogunrinde GO, Olayinka A
tween potential risk factors and HBV seroprevalence in
dodo A
patients with SCA.
Ahmadu Bello University Teaching Hospital Zaria
Method: The study was cross-sectional, case-controlled,
and involved 146 children with HbSS but in steady state
Background: Prevalence studies on HBV infection in
presenting at the haematology clinic. The children were
Nigeria have shown the disease to be endemic. Nigeria
screened for various markers of hepatitis B virus. A well
has the largest number of patients with SCA in the
-structured questionnaire was utilized to collect relevant
world; it is a major health problem and is associated
data.
with considerable mortality and morbidity. Hepatic cri-
Results: There were 61 females in both groups giving a
sis (hepatopathy) is a common cause of hospitalisation
male female ratio of 1.3:1. The prevalence rates of hepa-
among children suffering from SCA and it may closely
titis B seroprevalence in the SCA and control groups
mimic viral hepatitis making distinction between the
were 24.66% and 28.77% respectively. None of the risk
two difficult. This study aims to determine the preva-
factors studied were significantly associated with HBV
lence of HBV infection in children with SCA attending
infection in either the SCA or control group.
Ahmadu Bello University Teaching Hospital Zaria.
Conclusion: High HBV seroprevalence was detected in
Method: The study was cross-sectional and conducted
both groups, with no difference in risk factor patterns.
among 146 children with SCA, but in steady state, pre-
senting at the haematology clinic and 146 age- and sex-
104
IDO9
caregiver pairs were recruited. Children, aged 6-59
Disclosure of HIV status to Infected children and
months were selected using systematic and simple ran-
significant others in Ibadan, Nigeria
dom sampling methods.
The data were collected using a structured interviewer-
Nwoyeocha AC*, Brown BJ†
administered questionnaire. A general examination was
*College of Medicine, University of Ibadan &
done followed by collection of blood samples for esti-
†Department of Paediatrics, College of Medicine,
mation of packed cell volume and malaria parasitaemia.
University of Ibadan, Ibadan
Results: ITN ownership per household was 60.2%. Of
E mail: biosbrown@yahoo.com
the 240 respondents who owned ITN, 157 (65.4%) used
them for their under-five children, but only 50 (31.8%)
Background: Disclosing the diagnosis of Human immu-
children slept under an ITN the night before the study.
nodeficiency virus (HIV) infection to a child is conten-
Malaria parasite rate was higher (50%) in children who
tious and emotional amongst parents and caregivers of
had slept under an ITN more than a night before the
these children and fraught with psychosocial challenges.
study and 40% for those who slept under an ITN the
Objectives: To determine the prevalence of HIV status
night before the study while moderate anaemia (60.5%)
disclosure to children and significant others and its im-
and severe anaemia (2.5%) were more in children who
pact of the family.
had slept under an ITN more than a night before the
Materials and methods: A cross sectional study was
study.
conducted through interviews with parents/caregivers of
Conclusion: Ownership and use rates were fair, however
HIV-infected children seen at the University College
consistency in the use of the nets was poor. More efforts
Hospital, Ibadan from July-October 2016 through ad-
should be put into health education for behaviour modi-
ministration of a specially designed questionnaire after
fication.
informed consent.
Key words: Insecticide treated bed net, under five chil-
Results: A total of 200 children were studied with ages
dren.
ranging from 6-17 years, a mean (standard devia-
tion=SD) of 10.2 (2.7) years and a male: female ratio of
1.3:1. Disclosure of their HIV positive status had been
IDO13
made to 54 (27%) of the children and the mean (SD) age
Audit of the effectiveness of the prevention of mother
at disclosure was 11.3 (2.5) years. Age ≥10 years was
to child transmission (PMTCT) interventions in HIV
associated with disclosure status ( χ2 test, p=0.000), re-
exposed children at the National Hospital Abuja
sponse of the children to disclosure was depression in 35
Mukhtar-Yola M, Otuneye AT, Mairami AB ,
a
a
a
(64.8%) of the 54 children. Parental separation/divorce
Wey YO, Nwata VE, Audu LI
b
b
a
occurred in 24 (12.0%) cases as a result of the child’s
HIV status. Disclosure to family members had been
Department of Paediatrics, National Hospital Abuja.
done in 131(65.5%) of the 200 cases and they had been
email: mariyamukhtar@yahoo.com
supportive in 109 (83.2%) of the 131 families whilst to
spiritual leaders had been done in 28 (14.0%) cases and
Background: Ninety percent of children get infected
all were supportive.
with HIV virus through mother to child transmission. In
Conclusion and recommendations: There is need for a
the absence of intervention, transmission rates range
structured programme for disclosure of HIV status to
from 15% to 45%. This rate can be reduced to below 5%
children and significant others and psychosocial support
with effective interventions during pregnancy, labour,
to mitigate the effects of disclosure.
delivery and breastfeeding. The prevention of mother to
child transmission (PMTCT) program was launched in
IDO10
Nigeria in 2003 and the national guideline was reviewed
Insecticide treated bednet use, anaemia and malaria
in 2010.
parasitaemia in under five children in Alakahia com-
Objectives: We aimed to determine the rate of maternal
munity, Rivers State
to child transfer amongst HIV exposed infants in a fol-
low up clinic between 2011-2015. Additionally, the
Nwala JC, George IO, Yaguo-ide LE, Opara P
level of adherence to 2010 National guideline on use of
Highly Active Antiretroviral Therapy (HAART), PCR
Background: Insecticide Treated bed Net (ITN) is con-
testing, feeding options, ARV prophylaxis and the use of
sidered to be the most efficacious of all currently feasi-
Co-trimoxazole was investigated.
ble interventions for malaria control in Africa. However,
Methods: A retrospective review of prospectively col-
its use is still low in Rivers State.
lected data was done covering a 5-year period. Patients
Objectives: This study sought to evaluate the use of in-
consisted of babies delivered through PMTCT program
secticide treated bed net, and to determine the relation-
in National Hospital Abuja and those referred to the
ship between ITN use and prevalence of anaemia and
clinic from other centers. Data was analyzed using SPSS
malaria parasitaemia in under-five children in Alakahia,
version 21.
Rivers State.
Results: A total of 747 babies were enrolled and MTCT
Methods: This was a cross-sectional study carried out
occurred in 26(3.5%) babies with diagnosis made within
from 1 August to 31 October 2014, over a period of 3
st
st
1-2 months in 63.6%. HAART was received before
months. Three hundred and ninety-nine children-parent/
pregnancy by 574(77.4%), during pregnancy by 105
105
(14.2%)and 59(8%) did not receive HAART. Breast-
IDO15
feeding was practiced in 436(59%) babies and only 242
Malarial burden in infants less than 6 month in a
(34.5%) received co-trimoxazole prophylaxis. Post ex-
secondary health centre in Ilorin metropolis
posure prophylaxis was received by87.8%.
Fakayode EAO, Adeboye MAN , Folorunsho MRO,
#
Conclusion: PMTCT interventions reduced transmission
rate to 3.5%. There is a need to strengthen service provi-
Ahmed OA, Ibitoye Popoola GO
sion to adhere to national guidelines especially on
Department of Paediatrics, Childrens’ Specialist
breastfeeding and co-trimoxazole prophylaxis.
Hospital, Centre Igboro, Ilorin
#
Key words: HIV, Infants, Transmission
Department of Paediatrics, University of Ilorin
Teaching Hospital, Ilorin,
IDO14
Nutritional Status of Young Children newly diag-
Introduction/Background: The prevalence of malaria
nosed with HIV-Infection at Usmanu Danfodiyo Uni-
among in- fants are not well characterized and may be
versity Teaching Hospital (UDUTH), Sokoto, Nigeria
underestimat- ed. Despite the numerous protections of
young infants against malaria, the burden of malaria in
Yusuf T, Onankpa BO, Baba J, Ugege MO, Jega MR
infants less than 6 months may be higher than previ-
Sanni AM, Adamu A, Isezuo KO, Jiya FB
ously thought.
Department of Paediatrics, Usmanu Danfodiyo Univer-
Objective: The objective of this study is to document the
sity Teaching Hospital, Sokoto, Nigeria
burden of severe malaria in infants less than six months
Email: dimeji74@gmail.com
of age.
Subjects and methods: Through a prospective study, all
Background: Poor nutrition contributes to deaths associ-
children admitted at the emergency unit were screened
ated with the infectious diseases especially among under
for malaria using the rapid diagnostics test, and result
-5 children in developing countries. The growth of
confirmed by microscopy in addition to other workup
young children could be impacted with increasing bur-
necessary. The clinical characteristics and the associated
den of HIV/AIDS and increasing food insecurity. This
risk factors for malaria in children less than 6 month of
results in an increased malnutrition among this vulner-
age were documented.
able group.
Results: A total of 1872 children were admitted during
Objective: To determine the nutritional status of children
the one year review. Of this, 921 (49.2%) were managed
aged ≤5 years newly diagnosed with HIV infection in
for severe malaria. Among those managed for severe
UDUTH, Sokoto.
malaria, 175 (19.0%)were less than 6 month of age with
Method: A prospective descriptive cross-sectional study
mean age of 3.56 ± 1.23months. Their average duration
among children aged ≤5 yearsnewly diagnosed with
of admission was 4.2 days. Mortality rate in them was
HIV infection at the Paediatric units and Paediatric ART
9.5 % while it was 1.5% among children older than 6
Clinic, UDUTH, Sokoto between January 1 , 2011 and
st
month.
December 31 2015. The nutritional status was deter-
st
Sixty six percent of the mothers did not use intermittent
mined using WHO growth standards. The data were
preventive therapy while they were pregnant and 57.1 %
analyzed using SPSS version 22.0 and p-value ≤0.05
of them did not practice exclusive breast feeding.
was taken as significant.
Discussion: Factors associated with malaria in children
Results: Sixty-six children aged ≤5 years were diag-
less than 6month include, unavailability of ITN, lack of
nosed with HIV infection in UDUTH within the period.
IPT during pregnancy, poor water drainage system and
Twenty (30.3%) were aged 1.1 – 2.0 years with the
low social class. Common symptoms of severe malaria
mean age of 2.9(±1.4) years. The M:F ratio of 1.9:1.
in children less than 6 month include fever, cough, vom-
Forty-five (68.2%) were from lower socio-economic
iting, excessive crying, convulsions and loss of con-
class. Sixteen (24.2%) were diagnosed using PCR for
sciousness.
HIV-DNA. Forty-seven (71.2%) presented in clinical
Conclusion and recommendations: Burden of malaria
stage I, 8 (12.1%) stage II and 11 (16.7%) in stage III.
among infants less than six months is high. Targeted
Twenty-three (34.8%), 24(36.4%) and 12(18.2%) of the
preventive interventions, adequate drug formulations,
children were stunted, underweight and wasted respec-
and treatment guidelines are needed to address the size-
tively; 8 (12.1%) had severe acute malnutrition. The rate
able prevalence of malaria among young infants in ma-
of under nutrition was found to be significantly related
laria-endemic countries.
to the age of the child ( p =0.03)and socio-economic
Key words: Severe malaria, infants, six months
status of the family ( p =0.02).
Conclusion: The nutritional status of young children
newly diagnosed with HIV infection was suboptimal
and majority was stunted and underweight in our envi-
ronment.
Key words: Nutritional, status, young, children, HIV-
infection.
106
IDO16
IDO17
Cerebrospinal fluid isolates in children at federal
Antibiotic susceptibility of streptococcus pneumoniae
teaching hospital, Gombe: 15year review
isolates from cerebrospinal fluid of children with
meningitis in federal teaching hospital Gombe, North
Isaac WE , Jalo I , Alkali Y , Ghidazuka Y , Lano M ,
1
1
1
1
1
-East Nigeria: a 15 year review
Popoola A , Ajani A , Ebisike K , Wariri O , Aliu R ,
1
1
1
1
1
Girbo A ,Raymond M ,Ndubuisi V , Bakari H , Umar
1
1
1
1
Isaac E , Jalo I , Alkali Y , Ghidazuka Y , Lano M ,
1
1
1
1
1
A , Olatoke L , Burak V , Hassan K , Richard E ,
1
1
1
1
1
Popoola A, Ajani A , Wariri O , Aliu R Raymond M ,
1
1
1
1
1
Tukur H , Rabo Y , Ezra D , Bakura H , Daniel A ,
1
1
1
1
1
Olatoke L , Girbo A , Ndubuisi V , Ebisike K ,
1
1
1
1
Kudi A , Danlami H , Charanchi M .
2
2
2
Bakari H , Umar A , Burak N , Richard E , Tukur H ,
1
1
1
1
1
1
Department of Paediatrics, Department of
2
Hassan K , Daniel E , Rabo Y , Bakura B , Daniel A
1
1
1
1
1
Kudi A , Charanchi S , Danlami H
2
2
2
Microbiology, Federal Teaching Hospital, Gombe
1
Department of Paediatrics, Department of Microbiol-
2
Introduction: Childhood meningitis is a severe Central
ogy, Federal Teaching Hospital, Gombe
nervous System Infection which may result in devastat-
ing sequelae. Isolation of bacteria from Cerebrospinal
Introduction: Streptococcus pneumoniae is a significant
fluid (CSF) obtained via lumbar puncture is the hallmark
cause of bacterial meningitis in low-income countries.
of diagnosis.
Though previously highly susceptible to Penicillins and
Objectives: To review CSF pathogens in children at
other commonly used antibiotics, antibiotic resistant
Federal Teaching Hospital, Gombe.
isolates are an emerging menace, complicating treatment
Materials and Methods: Results of CSF analysis from
decisions, causing treatment failures, and increasing the
children aged 0-18years from 2000-2015 were retrieved
cost of medical care. Increasing identification of antibi-
and analysed.
otic resistant pneumococci underlies the need to evaluate
Results: CSF samples analyzed were 3,420. Gram stain
the susceptibility of isolates in childhood meningitis.
was positive in 0.05% (191/3,420); 3.8% (131/3,420)
Objective: To evaluate the antibiotic susceptibility of
yielded pathogens. Males were 55.0% (72/131). 26.0%
Streptococcus Pneumoniae isolates from CSF of chil-
(34/131) were in neonates, 25.1% (33/131) infants;
dren with meningitis.
16.8% (22/131) 1-5years; 10.7% (14/131) 5-10years and
Methods and materials: The microbiological reports of
13.7% (18/131) 10-18years.
CSF of children managed for meningitis from May 2000
Macroscopically, 62.8% (2105) were clear and colour-
to December 2015 were retrospectively reviewed.
less; 6.1% (206) turbid and 15.0% (501) xanthochromic.
Result: A total of 3420 CSF samples were analyzed with
In turbid CSF, 70/206 (0.34%) yielded isolates. In clear
131(3.8%) of the samples yielding isolates. Streptococ-
and xanthochromic CSF respectively, 20/2105 (0.01%)
cus pneumoniae was isolated in 20.6% (27/131) of the
and 25/501 (0.05%) yielded growths.
CSF samples. Sixty two percent (62%) of the isolates
Neisseria meningitides contributed 38.2% (50/131),
were sensitive to Chloramphenicol, 51%- Gentamicin,
Streptococcus pneumoniae 20.6% (27/131), Staphlococ-
48 % -Ampicillin, 55%- Erythromycin, cloxacillin-33%,
cus aureus 9.9% (13/131), Klebsiella pneumoniae 8.4%
ciprofloxacin- 29%, Amoxicillin-clavulanic acid 14%
(11/131), Hemophilusinfluenza 7.6% (10/131), and Es-
and Ceftazidime- 0.4%. Pneumococcal resistance was
chericia coli 6.9% (9/131). Salmonella, Pseudomonas,
51% for Ampicillin, chloramphenicol- 30%, gentamicin-
and Proteus species each contributed 1.5% (2/131).
41% and Erythromycin 33% %.
In neonates, Staphylococcus aureus and Klebsiellapneu-
Conclusion/recommendation: The results show that am-
moniae each accounted for 20.6% (7/34) of isolates;
picillin and chloramphenicol are still appropriate empiri-
however, gram negative pathogens contributed 61.8%
cal treatment for streptococcal pneumoniae meningitis.
(21/34). Niesseria meningitides, Streptococcus pneumo-
Development of a multi-centre surveillance system to
niae and Hemophilus influenza each accounted for
investigate susceptibility patterns is recommended.
45.4% (15/33), 18.2% (6/33) and 15.2% (5/33) isolates
from infants. Among 1-5years olds, 27.3% (6/22) and
18.2 % (4/22) were Streptococcus pneumoniae and
IDP1
Neisseria meningitides respectively. Hemophilus influ-
Flare of a Pre-Existing but Undiagnosed SLE Fol-
enza, Staphylococcus aureus and Klebsiellapneumonia
lowing a Short Course of Anti-TB Therapy: A Case
each contributed 3/22 (13.6%). In 5-10year olds and
Report and Review of Literature
adolescents, meningococcal meningitis predominated
81.3% (26/32), followed by pneumococcal 18.7%
Ndukwu CI, Madubuike CN, Nri-Ezedi CA
(6/32).
Nwankwo HM, Ezeama NN, Elo-Ilo JC, Ndukuba CC
Conclusion: Meningococcal meningitis accounts for
most cases of childhood Meningitis. Staphylococcus
Background: Systemic Lupus Erythematosus (SLE) is a
aureus is a leading pathogen in the newborn.
chronic disorder well known for its protean manifesta-
tions and predilection for the female gender especially
during puberty. This disease entity can be identified
clinically both in adults and in children using the widely
acclaimed American College of Rheumatology (ACR)/
Systemic Lupus International Collaborating Clinics
107
(SLICC) revised criteria. Despite this, identifying SLE
month of her pregnancy. Father had active disease diag-
in children has remained a daunting task especially in
nosed as Rif-resistant TB and commenced MDR-TB
poor resource settings. This case report demonstrates
treatment four weeks after returning from foreign mis-
that Anti-TB drugs in addition to causing drug induced
sion while he continued to live with his family and re-
SLE can also worsen the symptoms in pre-existing SLE.
porting at work, but without infection prevention meas-
Case: An 11 year old girl presented with a 10 month
ures. Child had oral candidiasis, bronchopneumonia and
history of persistent fever, weight loss and cough, pro-
persistent meningism. Chest X-ray showed military mot-
ductive of sputum occasionally tinged with blood. She
tling, Xpert MTB/Rif on gastric washings was positive
had been on several courses of antibiotics over the pe-
with rifampicin resistance; HIV DNA-PCR was posi-
tive. She was placed on 2
nd
riod. She was chronically ill-looking, in respiratory dis-
line TB treatment, which
tress, febrile, with significant cervical lypmphadenopa-
was poorly tolerated and became complicated by intrac-
thy. Septic workup was essentially normal but Chest
table vomiting, dehydration and malnutrition. She died
suddenly of aspiration of her vomitus in the 4 week of
th
imaging revealed bilateral pneumonic consolidations,
with a significantly elevated ESR. A clinical diagnosis
admission.
of Pulmonary TB was made and she was commenced on
Conclusion and Recommendation: This case reveals
anti-TB therapy. An initial improvement was followed
pitfalls in community MDR-TB treatment model with
within a week by progressive clinical deterioration with
misapplication of interventions to limit transmission,
generalized significant lymphadenopathy, increase in the
and highlights some challenges in management of MDR
peak body temperature, joint pains, mouth and vulval
-TB/HIV co-infected infants. Treatment supervision and
ulcers. A diagnosis of Juvenile SLE was made after re-
adherence to infection control guidelines are fundamen-
view by a rheumatologist. This was further confirmed
tal in any model for the management of tuberculosis.
by an immunological test which showed high ANA and
Key words: Multidrug Resistant, Tuberculosis, MDR-
dsDNA titres. Patient was started on steroids and other
TB, HIV, Infant.
supportive drugs and has since made a remarkable re-
covery.
Conclusion: Anti-TB drugs can worsen the symptoms of
IDP3
SLE. Since Tuberculosis and SLE may present simi-
Asymptomatic Congenital toxoplasmosis: An
larly, a high index of suspicion is required to avoid mis-
incidental finding
diagnosis.
Recommendation: SLE should be ruled out in every
Usman F, Mohammad A, Farouk ZL, Usman F
child with longstanding fever without an obvious focus.
Department of Paediatrics, Bayero University Kano/
More so, we recommend the careful monitoring of all
Aminu Kano Teaching Hospital
patients on Anti Kochs therapy particularly when the
Email: Fateeusman2@yahoo.com
expected therapeutic response is not satisfactory.
Introduction: Congenital toxoplasmosis occurs through
transplacental transmission of Toxoplasma gondii from
IDP2
mother to child. Features may not be apparent until the
A Rare Case of Fatal MDR-TB and Advanced HIV
second or third decade of life, with sequelae occurring in
Co- infection in a Post neonatal Infant: Is Nigeria’s
24% to 85% of cases. If untreated, it can lead to signifi-
Community MDR-TB Treatment Model Child-
cant disabilities such as mental retardation, blindness,
friendly?
deafness, epilepsy and death.
Aim: We aim to report a case of congenital toxoplasmo-
Umar LW, Garba MA, Okpe ME, Solomon A
sis seen in our hospital in order to raise awareness
Mohammed AJ, *Mohammed Z
amongst healthcare professionals of the often forgotten
Department of Paediatrics ABU/ABU Teaching
challenges associated with the diagnosis and manage-
Hospital Zaria and *National Tuberculosis and Leprosy
ment of congenital infections in our environment.
Training Centre, Zaria.
Case report: A near term female neonate conceived via
Email: marilynokpe@yahoo.com
in vitro fertilization after six years of infertility was de-
livered in our hospital with microcephaly. The mother
Background: Multidrug resistant tuberculosis (MDR-
had a positive history of contact with cats and cat litter.
TB) is an emerging global scourge increasingly affecting
No toxoplasma screening was done during antenatal
children. The challenges of MDR-TB management are
care. On physical examination, the OFC was 29cm.
further aggravated by concomitant HIV infection, often
Other examination findings were normal. Baseline labo-
leading to higher mortality. Inappropriate management
ratory results were within normal values except for
of TB cases could lead to transmission to the most vul-
Toxoplasma Gondi immunoglobulin G and M seroposi-
nerable groups. There are only few reports of MDR-TB/
tivity in the baby and the mother. The baby was placed
HIV among infants in the literature.
on Pyrimethamine.
Aim: To report a fatal case of MDR-TB/HIV co-
Conclusion: It is imperative that pregnant women are
infection in a post-neonatal infant.
properly educated and screened for common congenital
Case Report: A.F. presented at eight weeks of age with
infections. Perinatal care should focus on increased vigi-
cough, fever and failure to thrive for four weeks. Her
lance for these congenital infections so as to aid in
parents had defaulted from ARV therapy from the 2
nd
prevention, early detection and management.
108
Key words: Toxoplasmosis, asymptomatic, congenital,
METO1
cats.
Serum vitamin a levels in malnourished children
aged six to fifty-nine months in Zaria
^S M Abdullahi,^A M Yakubu S A Akuyam, ^M A
$
IDP4
Osteomyelitis caused by an Extended Spectrum Beta-
Bugaje.
Departments of ^Paediatrics and Chemical Pathology,
$
Lactamase producing Klebsiella in a Child Newly
Diagnosed with Sickle Cell Anaemia
Faculty of Medicine, Ahmadu Bello University Zaria,
Kaduna State.
Umar LW, Garba MA, Ahmad HR, Faruk JA
Email - sakinaabdullahi2013@gmail.com
Ibrahim A, *Aliyu S,** Solomon A, Okpe ME
Mohammed AJ
Introduction: Vitamin A deficiency (VAD) affects an
Department of Paediatrics, *Medical Microbiology
estimated 6 million pre-school children in Nigeria and
and**Haematology, ABU/ABU Teaching Hospital Zaria
20 million in Africa. When associated with severe mal-
Email: amosdr.solomon@yahoo.com
nutrition, it significantly increases morbidity and mortal-
ity.
Background: Osteomyelitis is a debilitating disease of-
Objective : The objective was to determine serum vita-
ten associated with higher morbidity among children
min A levels in children with Protein Energy Malnutri-
with sickle cell anaemia (SCA). The leading aetiologic
tion at the Institute of Child Health Zaria.
agents among children with SCA are Staphylococcus
Methodology: Systematic sampling method was adopted
and Salmonellaspecies. Although recent observations
to select eligible children for the study. Serum vitamin A
reveal varying patterns, reports on isolation of drug re-
level was determined by High Performance Liquid
sistant Klebsiellapneumoniae (KP) causing osteomye-
Chromatography. Data was analysed using the Statisti-
litis amongst SCA subjects are scanty.
cal Programme for Social Sciences version 15.4.
Aim: To report a case of osteomyelitis caused by ex-
Result: One hundred and thirty two children (66 cases
panded spectrum β -lactamase (ESBL) producingKleb-
and 66controls) aged 6-59 months were studied. Twenty
siella in a child with SCA.
six(39.4%) and30 (45.5%) were males while 40(60.6%),
Case report: S.A presented at 9 years with fever, painful
36(54.2%) were females (M:F= 1:1.5 and 1:1.2) among
bilateral thigh swellings for five weeks. He has had
cases and controls respectively. Low serum vitamin A
seven blood transfusions previously but no bone pains.
levels among the cases was 16.7%. VAD was seen only
He had generalized lymphadenopathy, was febrile, pale,
in those with severe wasting (5%). Malnourished fe-
wasted, with hepatomegaly andbilateral tender thigh
males aged 13-24months and males aged 49-59 months
swellings. With a diagnosis of osteomyelitis on a back-
for the controls were more at risk of low vitamin A lev-
ground of SCA empirical treatment with ciprofloxacin
els. Children who had measles, persistent diarrhoea, low
was started, but cultures of aspirate from the right thigh
maternal educational levels and low social class were at
swelling grew KP resistant only to ciprofloxacin
a higher risk of having low serum vitamin A levels
amongst antibiotics tested. Suppuration persisted despite
Conclusion: Low vitamin A levels is a common health
use of cefuroxime with incision and drainage, while
problem in Zaria among malnourished children and con-
subsequent aspirate from the left thigh swelling grew
trols. Severely wasted children are more at risk of VAD.
ESBL producing KP sensitive only to carbapenems. His
phenotype was HbSS+F, and X-ray showed features of
chronic osteomyelitis. He responded remarkably to
MHO1
imepenem while being maintained on traction. The Mul-
The challenges of child and adolescent mental health
tiple Antibiotic Resistance (MAR) index of 0.85
problems and the intervention gaps in northern
Suggests origin from where antibioticoveruse prevails.
Nigeria: a call for urgent attention
Conclusion: Although Klebsiella infections are com-
1
*Anyebe EE, Olisah VO, Wammanda R, Nuhu FI
2
2
4
mon, this is the first case of osteomyelitis with ESBL
1
producing Klebsiella pneumonia among children with
Research Unit/Mental Health Unit, School of Nursing,
SCA in our centre. This underscores the importance of
ABUTH Zaria
2
infection prevention practices and rational use of antibi-
Department of Psychiatry, ABU/ABU Teaching
otics.
Hospital, Zaria
4
Key words: Klebsiella Pneumoniae, ESBL, Beta-
Child/Adolescent Psychiatric Unit, Federal
Lactamase, Antibiotics, Osteomyelitis, Sickle Cell
Neuro-psychiatric Hospital, Kaduna
Anaemia, Children
Email: ejembianyebe@gmail.com
Introduction: Globally, between 10% and 20% of chil-
dren and adolescents are reported to have mental disor-
ders. In many resource-scarce settings like Nigeria, such
disorders go undetected at PHC settings.
Objective: To explore the challenges of child and ado-
lescent mental health problems in three States in north-
ern Nigeria, with a view to drawing attention to the need
109
for interventions.
ty59(96.7%) were not immunized against tetanus. Portal
Methods and Materials: Adopting the mixed research
of entry for the organism was trauma injuries to the
methods using questionnaires, IDIs, and FGDs, data
lower limbs in 33(54.1%).Thirty one(50.8%)were dis-
were collected from 191 PHC workers, 15 PHC coordi-
charged, 5(8.2%) signed against medical advice, while
nators and 15 community members from 47 PHC cen-
25(41.0%) died.
tres and communities in three States in northern Nigeria,
Conclusion: Post neonatal tetanus is a cause of morbid-
and analysed using SPSS 21.0 and thematically. These
ity and mortality in Sokoto. There is need for more
were then triangulated to meet research objectives.
health education, improved immunization programmes
Results: 19.9% and 59.1% of PHC workers believe that
and coverage to eradicate this scourge.
children and adolescents, respectively, have mental
Key Words: post neonatal tetanus, children, Sokoto
health problems, with poor or no interventions (72.1% -
86.6%) to address these problems. Many PHC coordina-
tors and community members also reported“ great men-
NEO2
tal health burden” among children and adolescents in
A Two-Year Review of Neonatal Admissions into the
their communities but confessed they “hardly know
Out born Section of the Special Care Baby Unit,
where to seek attention” for them. With low level of
Bingham University Teaching Hospital, Jos, Plateau
knowledge (24.6%) and skills (7.3%) of willing PHC
State
workers on child and adolescent mental health assess-
ment, mental health services for his vulnerable popula-
Nyam KD, Jimoh AO, Davies EG, Mava Y
tion remain quite challenging.
Yakubu AM
Conclusion: Many mental health problems exist among
College of Health Sciences, Bingham University/
Nigerian children and adolescents. However, there are
Teaching Hospital, Jos, Plateau state
scarce community-based intervention pathways, and
Email: davoukaneng04@gmail.com
inadequate skilled manpower to detect these cases for
prompt and appropriate interventions. These pose great
Background: Hospital based data of neonatal morbidity
challenges for child/adolescent health care, requiring
and mortality pattern is a reflection of the health chal-
urgent attention.
lenges in the community. Data obtained helps to assess
Recommendations: governmental and non-governmental
the available services and also improve neonatal care.
agencies to initiate and sustain Primary Mental Health
Aim: This study was conducted to determine the neona-
Training for middle-level health workers and paediatric
tal morbidity and mortality pattern in a tertiary level
specialists on the use short- instruments to assess chil-
hospital in North central Nigeria with the view to under-
dren and adolescents at all PHC settings.
stand the challenges these neonates are at risk of in the
Key words: children, adolescents, mental health prob-
communities around the institution
lems, interventions, PHC workers.
Methodology: It was a two-year retrospective study of
neonates admitted into the out-born section of the Spe-
cial Care Baby Unit (SCBU), Bingham University
NEO1
Teaching Hospital Jos between January 2014 and De-
A 6-year review of postneonatal tetanusat Usmanu
cember 2015. Data was obtained from the hospital re-
Danfodiyo University Teaching Hospital, Sokoto
cords of the out-born section of the SCBU.
Result: A total of 480 babies were admitted. Neonatal
Adamu A, Ugege MO, Onankpa BO, Yusuf T
jaundice constituted the highest morbidity (43%), fol-
Ibitoye PK, Isezuo KO, Jiya FB, Abubakar FI
lowed by neonatal sepsis (26%). Prematurity had a mor-
Department of Paediatrics, Usmanu Danfodiyo
tality rate of 47.2%; while 20.8% and 19.4% died from
University Teaching Hospital, Sokoto
neonatal sepsis and neonatal jaundice respectively. Birth
Email; nanadamu@gmail.com
asphyxia had a case fatality rate of 17% while neonatal
jaundice had the lowest case fatality rate of 6.8%
Background: Tetanus is a vaccine-preventable disease
Conclusion and Recommendation: The need for im-
but its incidence has remained unacceptably high in de-
proved antenatal and good obstetric care during delivery
veloping countries.
cannot be overemphasized. There is also a need for im-
Objective: To determine the prevalence, risk factors and
proved neonatal resuscitation skills to improve the out-
outcome of post-neonatal tetanus at Usmanu Danfodiyo
come of newborns admitted. We recommend a commu-
University Teaching Hospital (UDUTH), Sokoto.
nity based surveillance to identify the determinants of
Methods: A 6-year retrospective descriptive study from
neonatal morbidity, to understand the enormity of these
1 January 2010 to 31 December 2015. Children aged 1
st
st
problems and thereafter plan culturally acceptable inter-
month to 15 years diagnosed with post-neonatal tetanus
vention strategies to improve neonatal outcome.
were studied. Information from the admission files was
Key words: Neonatal morbidity, neonatal mortality rate,
extracted. Data was analyzed using SPSS version 20.
newborn, case fatality rate
Results: Total admission during the study period was
11,985, sixty one (61) had post neonatal tetanus, giving
a prevalence of 0.5%; 37(60.7%) were males while 24
(39.3%) were females, with M: F ratio of 1.5:1. The
mean age at presentation was 7.4 ± 3.2 years. Majori-
110
NEO3
evidences in support of EBF for the first six months of
Magnesium Sulphate in Asphyxiated Neonates:
life, its practice has remained low in Nigeria.
Effect on neonatal mortality reduction. A prelimi-
Objective: To determine the prevalence of EBF practice
nary report of its use at University of Benin Teaching
and time of initiation of breastfeeding among nursing
Hospital
mothers attending Usmanu Danfodiyo University
Teaching Hospital (UDUTH), Sokoto.
Okonkwo I**, Okolo A*, Ideh R*
Methods: This was a 9 months descriptive cross-
Department of Child Health, University of Benin
sectional study of nursing mothers with children 7
Teaching Hospital Benin City*, Nigeria
months – 2 years attending Paediatric follow up clinic
Email: Ikeokonkwo2001@yahoo.com
and family health clinic of UDUTH, Sokoto. Interviewer
administered questionnaire was used to obtain informa-
Introduction: Perinatal Asphyxia accounts for approxi-
tion on the socio-demographic characteristics and
mately 23% of neonatal deaths and 8% of Under-five
breastfeeding practices of mothers. Data was analyzed
mortality globally. Nigeria asphyxia figures are from 26-
using SPSS version 20.
28/1000 live births with case fatality of up to
Results: A total of 240 mothers were interviewed. The
40%. Hypoxic ischaemic encephalopathy, a leading
mean age of the mothers was 29.7±6 years (range 15-
cause of death and disability can be seen in babies with
45years). All the respondents breastfed their children, 77
apparent good Apgar scores. Trials of postnatal Magne-
(32.1%) initiated breastfeeding within an hour after de-
sium sulphate (MgSO 4 ) showed promising results but
livery; 82(34.2%) practiced EBF for 6 months. Antena-
larger cohort studies are needed.
tal Clinic attendance (ANC) and prenatal feeding advice
Objective: To assess the short term outcome in mortality
significantly increased early initiation of breastfeeding
(survival) of asphyxiated babies treated with Magnesium
( p= 0.001).
Higher
level
of
maternal
education
sulphate.
( p= 0.001) and ANC attendance ( p= 0.001) significantly
Subjects and methods: Relevant literatures were re-
affects the practice of EBF.
viewed. Infants with varying degrees of Asphyxia were
Conclusion: Breastfeeding initiation and EBF practice in
recruited and received 250mg/kg/day of MgSO 4 daily
the study area were suboptimal. There is need to insti-
intravenously for three days. They were treated sympto-
tute interventions aimed at early initiation of breastfeed-
matically for other complications of Perinatal Asphyxia;
ing and improving the practice of EBF towards
their clinical course and response were monitored and
achieving SDG-2 and 3 in Sokoto.
documented.
Key Words: Exclusive Breastfeeding, nursing mothers,
Results: Thirty six (36) asphyxiated babies treated with
practice, Sokoto
Magnesium Sulphate over a 3month period were sur-
veyed. None of the mothers had peri-partum magnesium
Sulphate administration. About 44.5% received MgSO 4
NEO6
within the first 6 hours of life; only 22.2% received the
medication after the age of 24 hours; 33.3% received
Introduction: Retinopathy of prematurity (ROP) is a
within 6 to 24 hours. Survival was unaffected by the
vasoproliferative disorder associated with low birth
time of administration of Magnesium sulphate in these
weight and prematurity. Its classified in to early and late
asphyxiated babies. Up to 86.1% of the babies in the
stages, the later has a poor prognosis (blindness). The
study group survived and 13.9% died thus a mortality of
aim of this study is to assess the practice of routine re-
8.6 per thousand.
ferral and screening of at risk babies for ROP by paedia-
Conclusion: Whilst it would appear that MgSO 4 im-
tricians and ophthalmologists respectively in Nigeria.
proved survival in these babies, a larger cohort of babies
Methods: Data was obtained using a structured self-
are required to further confirm these observations.
administered questionnaire. This was administered sepa-
rately to paediatricians and ophthalmologists attending
their annual national conferences in the year 2015. Data
NEO4
obtained was analysed using the SPSS version 16 soft-
Exclusive breastfeeding practice of nursing mothers
ware. A chi square test was used to identify association
at Usmanu Danfodiyo University Teaching Hospital,
between different variables.
Sokoto, north- western Nigeria
Results: A total of 109 respondents comprising of 66
paediatricians and 43 ophthalmologists were involved.
Adamu A, Isezuo KO, Abubakar FI, Ibitoye PK
Nineteen (28.78%) paediatricians and 8 (18.60%) oph-
Ugege MO, Jiya FB, *Yunusa EU
thalmologists were found to routinely refer or screen at
Department of Paediatrics, *Department of Community
risk babies for ROP. The absence of a screening proto-
Health, Usmanu Danfodiyo University Teaching Hospi-
col was the overall main reason given for not screening
tal, Sokoto
for ROP but among ophthalmologists, perception that
Email: nanadamu@gmail.com
ROP was a rare disease was the major reason given.
Despite this, a majority (81.65%) of all respondents ad-
Background: Exclusive Breast Feeding (EBF) is a key to
vocated for the routine screening for ROP in Nigerian
achieving sustainable development goals (SDG) and is
babies.
one of the cost effective ways in ending preventable
Conclusions: There was a generally poor referral and
under -five mortality and morbidity. Despite strong
screening of at risk babies for ROP among this group of
111
Nigerian paediatricians and ophthalmologists. Apart
NEO8
from ophthalmic manpower improvement, the provision
Influence of nursing mother's knowledge of breast-
of a national protocol or local unit-specific protocols for
feeding benefits on breastfeeding practices
ROP screening could help improve the situation.
Keywords: Ophthalmologists, Paediatricians, Retinopa-
Adah R, John C, Okpe S, Okolo S
thy of prematurity, Screening, Nigeria.
Department of Paediatrics, Jos University Teaching
Hospital, Jos, Nigeria
NEO7
Background: It is required that pregnant women are
Phototherapy; how efficient are devices fabricated in
informed about the benefits of breast feeding. This
Nigeria?
knowledge is important as a motivation to optimal
breastfeeding.
Abdulkadir I , Adebiyi NM , Hassan L , Abdullahi F ,
1
1
1
1
Aim: To determine the knowledge of benefits of breast-
Ogala WN , Slusher TM , Vreman HJ
1
2
3
feeding mother and child and its relationship with
1
Neonatal Unit, Department of Paediatrics, Ahmadu
breastfeeding practices among nursing mothers
Bello University/ Teaching Hospital Zaria, Kaduna
Methods: A cross-sectional study among 482 breastfeed-
State, Nigeria.
ing mothers in different immunization centers in Jos,
2
Department of Pediatrics, University of Minnesota &
Nigeria. Mothers knowledge of benefits and other socio-
Hennepin County Medical Center, Minneapolis, MN
economic characteristics were collected through inter-
55415, USA
viewer based questionnaire and mothers observed for
3
Neonatal & Developmental Medicine Laboratory,
breastfeeding techniques. Bivariate analysis was done
Division of Neonatology, Department of Pediatrics,
using SPSS 21
Stanford University Medical Center, Stanford, CA
Results: A mother was assessed to have good knowledge
94305-5208, USA
if she mentioned ≥ 3 correct benefits of breastfeeding, 1 -
Email: isaburamla@yahoo.com; isaabdul-
2 benefits mentioned was considered fair and none as
kadir@abu.edu.ng
No
knowledge.
Majority
had
good
knowledge
(77.6%),8.0% had fair knowledge while 14.5% had no
Introduction/Background: Intensive phototherapy (IPT),
knowledge of breastfeeding benefits. No knowledge was
a key intervention to treat and prevent complications of
associated with women ≤ 20years, unskilled women,
neonatal jaundice, remains elusive to most health facili-
mothers with no formal education and primiparas. Good
ties in Nigeria. This is partly due to unavailability of
knowledge of benefits of breastfeeding was associated
these devices as a result of their prohibitive cost.
with older women, multiparity, professionals, upper
Objective(s)
socioeconomic class, tertiary educated and receiving
1.
To present locally fabricated intensive phototherapy
talks on breastfeeding during antenatal care(p-0.011,
devices
0.045, 0.001, 0.001, 0.001& 0.001).Others were Exclu-
2.
To document the irradiance of the devices
sive Breastfeeding, increased day and night frequency of
Materials and methods: Four phototherapy (PT) de-
breastfeeding and not giving prelacteal feeds(p-0.021,
vices (F1 - 4) were fabricated. The irradiance of the 4
0.001, 0.002 and 0.016).
devices was measured using a handheld clinical irradi-
Conclusions: Breastfeeding benefits should be empha-
ance at varying distances from 10 to 60 cm at the light
sized in health talks with mothers at antenatal to
foot print of each device.
younger, less educated, low socioeconomic status and
Results: The lengths of devices ranged from 54 to 70
primipara mothers to achieve optimal breastfeeding
cm. The maximum central irradiance (MCI) for the de-
practices.
vices F1 – 4 and at 30cm distance was 36.4, 32.1,
Key words: knowledge benefit breastfeeding
31.2and59.5 µW/cm /nm respectively. All the devices
2
delivered a mean irradiance above 30 µW/cm /nm at a
2
distance ≤ 25 cm and cost ranged from 120,000 to 180,
NEO9
000 naira.
Availability and distribution of phototherapy
Discussion: The devices all have dimensions adequate
services in three Local Government Areas in Jos,
to enable light foot print cover as large as possible the
North-Central Nigeria
BSA of a newborn. The MCI and mean irradiance for all
Toma BO, Diala UM, Ofakunrin AOD, Shwe DD,
1
1
1
1
devices attained intensive phototherapy levels at a mod-
1
Abba J , Oguche S
2
est distance of 30 and 25 cm respectively. The devices
1
cost far less than (<20% cost of) commercially available
Department of Paediatrics, University of Jos/Jos
IPT devices making them cost effective for use in pro-
University Teaching Hospital, Jos, Nigeria
2
viding IPT.
APIN, Jos University Teaching Hospital, Jos, Nigeria
Conclusion and recommendations: The PT devices are
Email: gabosetoma@gmail.com
cost effective and are recommended for use in circum-
stances where the need for IPT arises.
Background: Severe neonatal jaundice remains common
Key words: Affordable, phototherapy, devices, irradi-
in Nigeria. In Nigeria, 6.7% of infants develop jaundice
ance, neonatal jaundice.
requiring treatment. Phototherapy is the main treatment
for neonatal hyperbilirubinaemia. High rates of kernic-
112
terus have been attributed to health systems failure in
Results: During the study period, a total of 109 babies
neonatal services.
weighing less than 1500grams at birth were managed, of
Objective: To determine the availability and distribution
which 33% were products of multiple gestations. Inborn
of phototherapy devices in hospitals in Jos
babies accounted for 88.1%. The mean birth weight,
Methods: This was a cross-sectional descriptive study
gestational age and duration of hospital stay were 1099
conducted in Jos-North, Jos-South and Jos- East (local
(247) grams, 29.1 (2.9) weeks and 15.97 (15.8) days.
Government Areas) LGAs between January and March
Respiratory distress syndrome and Sepsis were the two
2015. All secondary and tertiary hospitals were visited
most common morbidities encountered. Mortality
to ascertain the availability and types of phototherapy
amongst singletons was 38.4% and 36.1% amongst the
units. The total births for the LGAs were obtained from
multiples. This difference was however not significant.
Nigerian Population Commission.
Conclusion: Multiple gestation has no effect on the mor-
Results: There were 33 hospitals, 3(9.1%) tertiary and
bidity pattern of VLBW babies.
30 (90.9%) secondary. Five (15.2%)were public, while
Key words: VLBW, multiple births, NICU
28 (84.8%) were private.
Fourteen (42.4%) hospitals provided phototherapy, 3
(21.4%) public and 11 (78.6%) private. There were 48
NEO11
phototherapy units, 9(18.8%) light emitting diode(LED)
Irradiance of phototherapy units in Jos, North Cen-
and 39 (81.2%) conventional. Sixteen (33.3%) units
tral, Nigeria
were in tertiary hospitals, while 32 (66.7%) were in sec-
Ofakunrin AOD , Diala UM , Toma BO , Shwe DD
1
1
1
1
ondary. Twelve (25%) units were in public facilities and
Gidado S , Bode-Thomas F
2
1
36 (75%) were in private facilities.
1
The live births in the 3 LGAs in the preceding year were
Department of Paediatrics, University of Jos / Jos
49,407. This gives 950 births/week, 64 (6.7%) of whom
University Teaching Hospital.
2
may develop jaundice requiring treatment. This gives a
Department of Family Medicine, University of Jos.
ratio of approximately one phototherapy unit: one baby/
Email: aodofak@yahoo.com
week
Conclusion: The number of phototherapy units in Jos is
Background: Neonatal jaundice (NNJ) remains a major
adequate but are concentrated in private facilities. Fur-
cause of neonatal morbidity and mortality in Nigeria.
ther studies to evaluate their irradiance are recom-
Phototherapy and/ or exchange blood transfusion (EBT)
mended, while more LED devices is advocated.
are the main treatment options for moderate and severe
Key words : Neonatal jaundice, phototherapy, Jos,
NNJ. Effective phototherapy will reduce the complica-
Nigeria
tions of severe NNJ and the need for EBT.
The effectiveness of phototherapy depends on the spec-
tral quality and irradiance of the light. A dose-response
NEO10
relationship exists between the amount of irradiation and
Outcome of multiple births amongst VLBW babies
reduction in serum bilirubin.
in National Hospital, Abuja
Objective: To evaluate the effectiveness of phototherapy
devices in Jos through the measurement of their irradi-
Mairami, AB , Audu LI , Otuneye AT , Mshelia LJ
1
1
1
ance levels.
Adesanya OO
1
Methodology: A cross - sectional descriptive study con-
1
Neonatal Unit, Department of Paediatrics,
ducted between January and March, 2015 in Jos. The
National Hospital, Abuja.
irradiance of the phototherapy units in all the hospitals
Email: amsamairami@yahoo.com
offering phototherapy services were measured at the
level of the babies.
Background: Globally, there has been a rise in the inci-
Results: There were 14 hospitals (three public and
dence of multiple births over the past 3 decades; this has
eleven private) with a total of 39 phototherapy devices,
partly been attributed to a wider availability of fertility
comprising 25 (64.1%) locally fabricated, 5 (12.8%)
treatments. Products of multiple gestations tend to be
reconditioned machines and 9 (23.1%) LED units. The
born premature and are therefore often low/very low
distance between the babies and phototherapy units
birth weight babies. About 10% of twins and more than
ranged from 15 to 70cm. Irradiance values ranged from
2 to102 μ W/cm /nm with a median value of 10.6 μ W/
2
one-third of triplets are in the VLBW category; and
cm /nm (5.7; 18.1). Forty three point six percent of the
2
nearly all VLBW babies need specialized care in a neo-
natal intensive care unit (NICU).
units had irradiance below the recommended value of 10
μ W/cm /nm; while only 12.8% provided irradiance at
2
Objectives: We aimed to study the outcome of VLBW
the intensive level of ≥30 μ W/cm /nm.
2
babies managed in our NICU and determine the contri-
bution of multiple births to this group of vulnerable ba-
Conclusion: A significant proportion of phototherapy
bies.
units in Jos had suboptimal irradiance. Phototherapy
Materials and methods: From January to November
irradiance needs to be monitored regularly and measures
2016, we recruited all VLBW babies that were admitted
instituted to improve the levels.
into our NICU and noted their gestational age, mode of
Key words: Irradiance, phototherapy, Neonatal
delivery, type of gestation, the morbidities they encoun-
jaundice, Jos, Nigeria.
tered, their outcome as well as their length of stay.
113
NEO12
preterm babies include perinatal asphyxia (26%;
An appraisal of trends in neonatal mortality in a de-
898/3453), neonatal sepsis (20%; 961/3453), respiratory
veloping country and implications for sustainable
distress (18%; 622/3453), hyperbilirubinaemia (12%;
development goals
414/3453), anaemia of prematurity (2%; 69/3453), intra-
ventricular haemorrhage (2%; 69/3453), and others (4%;
Mokuolu OA , Ibrahim OR , Suberu HD , Bello SO ,
1,2
1
1
1
138/3453). The causes of deaths include perinatal as-
1, 2
, Adesiyun OO , Abdulkadir AB
1,2
Obasa TO
1,2
phyxia (45%; 330/733), neonatal sepsis (23%; 169/733),
Department of Paediatrics and Child Health
respiratory distress (11%; 81/733), bilirubin encephalo-
Faculty of Clinical Sciences, College of Health Sciences
pathy (9%; 66/733), congenital malformation (3%;
University of Ilorin, Ilorin, Nigeria
22/733) and others (9%; 66/733).
Email: mokuolu@unilorin.edu.ng
Conclusion: This study revealed that most of the causes
of neonatal morbidity and mortality remain largely pre-
Background: The global under-five mortality is on the
ventable with perinatal asphyxia being the most domi-
decline but this decline is less reflected in the percentage
nant. There was however greater burden of hyper-
of neonatal deaths. There cent adoption of Sustainable
bilirubinaemia than previously acknowledged showing
Development Goals (SDGs) as a follow up to now
NNH to be higher than sepsis among term babies. Fi-
rested Millennium Development Goals calls for a reap-
nally the study is one of the first to provide such detailed
praisal of the causes of neonatal deaths. Reappraising
categorization of morbidity and mortality among the
the causes of neonatal deaths in developing countries
preterms babies. The need for innovative approaches for
like Nigeria will further assist in recommendations to-
greater decline in the neonatal morbidity and mortality is
wards achieving the aims of reducing neonatal mortality
discussed.
to as low as 12 per 1,000 live births as expressed in the
SDG.
Methodology: This prospective observation study was
NEO14
carried out at Neonatal Intensive Care Unit (NICU) of
Improving the Irradiance of locally Fabricated
University of Ilorin Teaching Hospital, Ilorin over an
Phototherapy UnitsIn Jos, Nigeria
eight-year period (January 2007 to December 2014). A
special register which contained the details of the pa-
Diala UM, Ofakunrin AOD, Toma BO, Shwe DD
tients including the hierarchy of diagnosis was opened a
Yilgwan CS, Bode-Thomas F
priori to capture data on all admissions to the neonatal
Department of Paediatrics, University of Jos/Jos
unit using the Microsoft Excel software package. All the
University Teaching Hospital, Jos, Nigeria
babies were managed according to the unit protocols.
Results: There were 10,808 admissions, with 6568 term
Background: Locally fabricated Phototherapy units
babies (61%), 3,453(32%) were preterms babies while
(LFPUs) which often have sub-optimal irradiance are
the remaining 787 (7%) were unclassified due to miss-
widely used in Nigeria for the treatment of neonatal
ing records on gestational age. The males constitute
jaundice in view of the cost of the imported units.
6,040 (55.9%) of total admissions. One thousand six
Objective: To determine the irradiance and assess fac-
hundred and seventy deaths were recorded with a per-
tors influencing irradiance of LFPUs in Jos in order to
centage mortality of 15.5%. Of the 10,021 with known
make recommendations for improvement.
gestational ages the proportionate contributions of pre-
Methods: It was a cross-sectional observational study in
terms to mortality was significantly higher than their
Jos between January and March, 2015.The irradiance of
contribution to admission. For admissions preterms con-
all LFPUs in all secondary and tertiary hospitals were
stitute 34% (3,453/10,021) while their relative contribu-
measured at the level of the baby and at regular dis-
tion to mortality was 47% (733/1544); X =98.15;
2
tances. Other relevant properties of the unit such as col-
p<0.0001.Over the period there was a significant decline
our, reflectors, length and number of fluorescent tubes
in the proportion of preterm mortality relative to their
and inter-tube distance were assessed.
admission from 25.7% in 2007 to 17.2% in 2013,
Results: A total of 21 LFPUs were evaluated. All units
X =4.176; p=0.041.As a group mortality in term babies
2
used blue light. The length of tube in two of the units
2007-2009 was 14.6% (372/2540) while deaths for the
was 120cm and 60cm in 19 others. The mean irradiance
(in µW/cm /nm) was 11.2±6.1,12.9±5.6, 17.7±7.5
2
period 2010-2014 was 10.9% (439/4028); X2=15.651,
p=0.0001, OR=0.74 [95% CI 0.64-0.86]). The leading
and20.8±8 at the level of the baby and at 25cm, 15cm
causes of morbidity among term babies include perinatal
and 10cm respectively. The mean distance away from
asphyxia (PA), 34 % (2233/6568); hyperbilirubinaemia
baby was 33.8±9.4cm with irradiance increasing at de-
(NNH)19% (1248/6568);, neonatal sepsis, (NNS) 16 %
creasing distance(F(5,15)=8.4, p <0.05). Ten units had
(1051/6568); respiratory distress (RD) 15% (985/6568);
reflectors and reflectors were associated with higher
congenital malformation8% (985/6568); macrosomia
irradiance (F(5,15)= 7.28, p<0.05).The mean number of
2% (131/6568) and others 8% (985/6568). The leading
tubes/per unit was 6±2 (4-10) and irradiance increased
causes of death include PA (49%; 398/811) NNS (19%;
with increasing number of tubes (F(5,15)= 19.6,
154/811), bilirubin encephalopathy (12%; 97/811), res-
p<0.05).
The
mean
inter-tube
distance
was
piratory distress (9%; 73/811), congenital malformation
10.5±4.8cm.Inter-tube distance and size of tubes did not
(7%; 57/811) haematological problems (1%; 8/811) and
contribute significantly to irradiance.
others (3%; 24/811). The causes of morbidity among
Conclusion: The irradiance of LFPUs can be improved
114
by simple modifications.
between the abdominal and thoracic cavity, usually by a
Keywords: Neonatal jaundice, phototherapy, irradiance.
defect in the diaphragm. It is easily misdiagnosed as
bronchopneumonia, especially in young infants. Mortal-
NEO17
ity rate ranges between 20-60% if the diagnosis is
Kangaroo Mother Care: The Ahmadu Bello
missed. Therefore, survival of such patients lies in
University Teaching Hospital Experience and a
prompt diagnosis and immediate surgical treatment.
report of three cases
Aim: This report aims to increase awareness among pae-
diatricians and paediatric surgeons of the need for high
Faleye MH, Ibosiola JF, Lawal H, Ojo CO, Abdulkadir I
index of suspicion for this uncommon condition.
Special Care Baby Unit, Department of Paediatrics,
Case report: The report describes a two-month old in-
Ahmadu Bello University Teaching Hospital Shika,
fant who presented with a five-week history of cough of
Zaria
sudden onset, a week history of difficulty in breathing,
Email: musilimatfaleye@gmail.com
and no history suggestive of foreign body aspiration. He
had been seen in several hospitals and admitted for bron-
Introduction: The burden of low birth weight (LBW) in
chopneumonia. Examination findings showed features
resource constrained countries remains a major public
of respiratory distress and widespread coarse crepita-
health concern. Kangaroo Mother Care (KMC) is an
tions in the lung fields. Chest radiograph showed loop of
effective intervention for improved survival.
bowel in the mediastinum. He had surgical reduction
Objective:
To
highlight
the outcome of KMC
and repair of the hernia. He made excellent recovery and
(Prolonged continuous skin to skin contact) in a series of
was discharged home few days after the operation.
three LBW babies.
Conclusion and Recommendation: CDH is a rare anom-
Methodology: Varying categories of LBW babies were
aly which can cause diagnostic dilemma. It has a high
managed and stabilized before commencing KMC. They
mortality if not identified promptly; hence a high index
had intermittent KMC lasting 10 hours daily for 5, 8 and
of suspicion is needed to allow early diagnosis and treat-
6 days respectively. Their vital signs before and 2 hours
ment. In low resource settings like ours, the x-ray plays
post KMC were recorded. Their birth weights before
an important role in the diagnosis of CDH and outcome
KMC and at discharge were also recorded.
can be favourable when picked early.
Results: SS baby girl had temperature of 36.10 C, heart
Key words: Congenital diaphragmatic hernia, Broncho-
rate 160 beats/min, respiration 52 cycles/min. 2 hours of
pneumonia, Near miss, Respiratory distress
KMC, her temperature was 37.10 C, heart rate 144
beats/min, respiration 52 cycles/min. Her weight was
750g before KMC and 875g at discharge.
NEP2
GC baby girl had a temperature of 34.40 C, heart rate
Suspected weyer ulnar ray syndrome seen in Gusau,
120beats/min, and respiration 40 cycles/min. vital signs
Zamfara state
at 2 hours of KMC were: temperature 36.6C, heart rate
1
Garba BI, Muhammad AS, Musa A, Kolawole,
2
3
4
140 b/min respiration 60c/min. Weight before KMC
4
Yusuf I, Mohammed F
4
900g at discharge weight 1050g
1
Department of Paediatrics, Department of Medicine,
2
YH baby girl had a temperature 33.5C; heart rate 100
beats/m respiration 34cycles/m. 2 hours of KMC, her
Usmanu Danfodiyo University Teaching Hospital,
temperature was 36.60C, heart rate120beats/min, respi-
Sokoto
3
ration 44cycles/m. Weight before KMC, 1200g and at
Department of Paediatrics, Ahmadu Bello University
discharge 1300g.
Teaching Hospital, Zaria
4
Conclusion/Recommendations: KMC improves outcome
Department of Paediatrics, Ahmad Sani Yariman
in low birth weight babies. Mothers need to be trained to
Bakura Specialist Hospital, Gusau
satisfactorily undertake KMC.
Email: bgilah@yahoo.com
Key words: Kangaroo Mother Care, low birth weight,
neonates
Introduction/Background: Reduction defects of the ul-
nar ray are rare, but midline abnormalities occur fre-
quently within the ulnar ray/ midline congenital anoma-
NEP1
lies syndrome. These syndromes are associated with
Near Miss: A Case Report of Congenital Diaphrag-
various midline developmental abnormalities which
matic Hernia Misdiagnosed As Bronchopneumonia
include craniofacial abnormalities, congenital heart dis-
in a 2-Month Old Boy
ease and urogenital anomalies.
Aims/objectives : We report a suspected case seen in our
Jimoh AO, Ubanyi TO, Davies EG, Mava Y,
centre.
Yakubu AM
Case report: A 2 month old girl presented twice for non
College of Health Science, Bingham University/
severe pneumonia 1 month apart; and represented for the
3
rd
Teaching Hospital, Jos, Plateau state
time with severe pneumonia requiring hospitalisa-
Email: oyewoao@yahoo.co.uk
tion. She had macrocephaly, low set ears, hypertelorism,
high arched palate and multiple musculoskeletal anoma-
Background: Congenital diaphragmatic hernia (CDH) is
lies- absent right ring, index and middle fingers with a
a developmental defect described as a communication
shortened forearm and absent ulna bone; absent left ring
115
and middle finger with syndactyl and polydactyl of the
Key words: Amazia, adolescents, poverty
left foot. A grade 3 pan systolic murmur maximal at the
left lower sternal edge was found.
Results : Full blood count suggested sepsis; retroviral
NEPHO2
screening was negative; chest x-ray showed features of
Prevalence of renal abnormalities in children with
bronchopneumonia and cardiomegaly; x-ray of the limbs
sickle cell anaemia attending the haematology/
confirmed above findings; transfontanelle ultrasound
oncology clinic of Ahmadu Bello University Teaching
showed ventricular dilatation with features of communi-
Hospital, Shika
cating hydrocephalus; abdomino-pelvic ultrasound was
Olorukooba AA , Yusuf R , Kajogbola G ,
1
2
3
normal but echocardiography was not done. She was
managed
for
recurrent
bronchopneumonia
with
Mamman AI , Ogunrinde GO , Akuse RM
4
1
1
acyanotic congenital heart disease and hydrocephalus in
1 Department of Paediatrics, 2 Department of Chemical
a suspected Weyer Ulnar Ray syndrome. She however
Pathology, 3 Department of Radiology, 4 Department
represented 2 months after, with fever, convulsion, epis-
of Haematology and Blood transfusion services,
taxis, petechae and bleeding from puncture site; and died
Ahmadu Bello University Teaching Hospital, Zaria
within 2 hours of admission.
Email: abiolaira@yahoo.co.uk.
Conclusion: The syndrome is rare, requires proper
evaluation to confirm diagnosis and other associated
Introduction: Sickle cell anaemia (SCA) is a non-
anomalies. It requires multi disciplinary approach for
communicable disease of public health significance.
proper management.
SCA is characterized by chronic red blood cell haemoly-
Key words : Anomalies, Ulnar ray, Syndrome
sis and vaso-occlusion further complicated by nitric ox-
ide deficiency causing oxidative damage to the body
organs, markedly in the kidneys.
NEP4
Objectives: To document the prevalence of renal func-
Amazia: Case report
tion and structural abnormalities in children with SCA in
a teaching hospital in north western Nigeria.
2
Oluwayemi I.O , Agaja O.T
1, 2
Materials and Methods: One hundred and ten subjects
Department of Paediatrics, Faculty of Clinical Sciences,
with SCA in steady state without known renal or cardiac
College of Medicine, Ekiti State University, Ado-Ekiti,
abnormalities were enrolled and matched for age and
Ekiti State, Nigeria.
sex with controls (haemoglobin AA). An interviewer-
Department of Paediatrics, Ekiti State University
administered questionnaire was administered and clini-
Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
cal examination and renal ultrasound scans were done.
Email: isaac.oluwayemi@eksu.edu.ng
Urinalysis, spot urine albumin creatinine ratio and serum
urea, electrolyte and creatinine were carried out using
Background: Amazia is a condition where one or both
standardized laboratory methods.
of the mammary glands is/are absent in the presence of
Results: Eleven (10.3%) children with SCA had haema-
the nipple and areola. This is different from athelia(a
turia while 6.5% had overt proteinuria. Children with
condition in with one or both nipples are absent) and
SCA who had proteinuria were five times more likely, to
amastia (a condition where breast tissue, nipple and
develop haematuria than the controls with proteinuria (p
areolar are absent). Amazia can be congenital, acquired
= 0.03). Microalbuminuria was found in 24.3% of chil-
or iatrogenic. It can be bilateral or unilateral. Its inci-
dren with SCA. The mean estimated glomerular filtra-
dence is not known.
tion rate was normal for both subjects and controls. Only
Aim/ objective: Case report of a rare disorder to high-
three (2.8%) of the SCA subjects had increased renal
light the challenge of management in resource poor set-
echogenicity all of whom had microalbuminuria and
ting.
were older than nine years.
Methodology: A 13year old girl presented in our Paedi-
Conclusion and recommendations: Renal abnormalities
atrics endocrinology clinic with underdeveloped right
were found in children with SCA occurring as early as 4
breast. This was noticed about 1year before presentation
years of age. Regular screening for renal disease in chil-
when the left breast started developing, and the right
dren with SCA is recommended to ensure management
breast was noticed not to show any sign of growth.
modalities are instituted early.
Result: There was no chest wall, hand or palm deformi-
Key words: SCA, Renal abnormalities, haematuria,
ties, and no craniofacial abnormalities. The patient was
proteinuria, renal size, estimated glomerular filtration
not ill looking and she had normal weight and height for
rate.
age and gender. The left mammary gland was well de-
veloped with breast tissue, areola and normal nipple.
The right hemi-thorax had a well-developed nipple and
areola in the normal anatomic position for breast but no
visible or palpable underlying breast tissue.
Conclusion: Amazia and other breast abnormalities in
female adolescents may not be as rare as earlier thought
and can be a major cause of stress to the adolescents if
not well managed.
116
NEPHP1
NEPHP2
Serum Cystatin C in apparently healthy Nigerian
Case series: Three siblings with autosomal dominant
Neonates: a measure of renal function
polycystic kidney disease- need for family screening
2
Ezeukwu IE , Rajpoot D
1
Madise-Wobo AD, Gbelee OH, Solarin A
Animasahun BA. , Njokanma OF
1 Department of Paediatrics, Ahmadu Bello University
Department of Paediatrics, Lagos State University
Teaching Hospital, Shika- Zaria.
Teaching Hospital, Ikeja Lagos Nigeria.
2 Miller Children’s Hospital, Longbeach Memorial Hos-
Email: akposoo7@yahoo.com
pital, Longbeach California, USACorresponding author:
Ezeukwu IE.
email: ifeomaezeukwu@yahoo.com
Background . Cystatin C has significant advantages over
serum creatinine as an endogenous marker of renal func-
Background: Autosomal dominant polycystic kidney
tion. Normal reference values have been documented in
disease (ADPKD) is the common esthereditary kidney
neonates outside Africa but no study has been docu-
disease. ADPKD is a multi – systemic, progressive disor-
mented in African neonates. With reports that race may
der characterized by formation and enlargement of cysts
affect serum Cystatin C values, this study was carried
in kidneys and other organs. ADPKD results in End
out to document values in neonates in Nigeria.
stage renal disease which has severe consequences in
Aim . The study was carried out to document values of
resource constrained countries necessitating dialysis or
serum Cystatin C in apparently healthy term neonates at
kidney transplantation. Clinical features usually begin in
birth and three days of life and to estimate GFR in the
the third to fourth decade of life, but may even occur in
subjects using Cystatin C equations.
the first decade with cysts being detectable in utero or in
Methods . This was a hospital based prospective study
childhood.
conducted between October and December 2014. A co-
Objective: To highlight the importance of screening
hort of 120 apparently healthy term neonates were re-
family members of people with cystic kidney disease.
cruited from consecutive deliveries. Serum Cystatin C
Method: Review of patients’ case notes.
was measured from the cord blood at birth and venous
Results: There were three Caucasian siblings with
blood when they were three days old using ELISA
ADPKD aged 10years, 8years and 5 years. The children
method.
were asymptomatic but underwent screening following
Results . The mean serum Cystatin C values for cord
diagnosis of ADPKD in their father in his mid forties.
blood and third day venous samples were 1.67±0.52mg/
Their paternal uncle and grand father were also screened
L and 1.62±0.52mg/L, respectively, (p=0.87). The se-
and found to have ADPKD. All three children had bilat-
rum Cystatin C levels were similar amongst the different
eral renal cysts consistent with ADPKD onultrasonogra-
birth weight groups and gestational age, (p > 0.05). The
phy. They are being followed up in the Nephrology
median and mean estimated GFR based on cord blood
Clinic at Miller Children’s hospital Long Beach Memo-
and third day venous samples from the equation by
rial Hospital, Long Beach California, USA.
Filler and Lepage were 44.67 (56.80±27.64) and 51.29
Conclusion and recommendation : Family screening is
(60.83±36.09)ml/min/1.73m , respectively. However,
2
important in people with Cystic kidney Disease as this
when the Zappitelli equation was applied, the median
will help in the diagnosis and management of ADPKD.
and mean GFR estimated were 38.18 (48.32±22.29) and
Proper follow up and care could preserverenal function
43.82 (51.27±28.43)ml/min/1.73m , respectively.
2
for long before patients develop End Stage Renal Dis-
Conclusions . The cord blood and third day serum Cys-
ease. As Cystic Kidney disease is not uncommon in
tatin C values were similar. Serum Cystatin C values
Nigerian children, it is recommended that siblings of
were independent of gender and birth weight of neo-
children with cystic kidney disease should be routinely
nates. The values of serum Cystatin C in Nigerian neo-
screened for ADPKD.
nates were comparable to that reported for neonates in
Key words: Autosomal Dominant Polycystic Kidney
other regions of the world. GFR estimates using the
disease, screening, family, children
Zappitelli equation had values that were closely related
to reference GFR measured in neonates while the GFR
estimates by the Filler and Lepage equation had higher
NEPHP3
values.
A cluster of acute kidney injury seen within a period
Key words: Creatinine, Cystatin C, Glomerular Filtra-
of one month in Paediatric ward Ahmadu Bello Uni-
tion Rate, Renal function
versity Teaching Hospital, Zaria: Case series
Ezeukwu IE, Abubakar Y, Yakubu M, Avong OA
Akuse RM, Bugaje MA
Department of Paediatrics, Ahmadu Bello University
Teaching Hospital Shika, Zaria
Email: ifeomaezeukwu@yahoo.com
Introduction: Acute Kidney injury (AKI) is associated
with significant morbidity and mortality. The incidence
of AKI in children is on the increase and the aetiology
117
over the past years has shifted from primary renal dis-
Results: The sensitivity and specificity of the BIND
ease to multifactorial causes particularly in hospitalized
score relative to BEAR was 93.8% and 90% respec-
children. Children who have suffered from AKI stand
tively with an area of 0.96 by ROC analysis. The BIND
the risk of developing progressive renal disease and ulti-
score had a positive predictive value of 75%, negative
mately End Stage Renal Disease (ESRD) if not properly
predictive value of 97.8% and overall diagnostic accu-
treated.
racy of 90.9%.
Objective: To describe the presentation and outcome of
Conclusion: Both BEAR audiometry and BIND score
13 children with AKI seen in the Emergency Paediatric
are useful diagnostic tools in detecting acute bilirubin
Unit (EPU) within a period of one month.
encephalopathy in neonates with significant hyper-
Materials and method: The case notes of all the patients
bilirubinaemia. The BIND score can be used as a reli-
were retrospectively reviewed and relevant information
able surrogate where BEAR is not available to diagnose
extracted.
bilirubin encephalopathy.
Results: All the 13 patients presented with history of
Key words: Bilirubin induced neurologic dysfunction
fever and reduction in volume of urine. The Primary
(BIND) score, Brainstem evoked auditory response
Diagnosis was diarrhoeal disease in four, malaria in two
(BEAR), Acute bilirubin encephalopathy (ABE).
and sepsis in seven. Biochemical parameters revealed
sudden onset of decline in renal function characterized
by azotemia and raised creatinine. Two patients recov-
NEUO2
ered following treatment of the primary condition, while
Hearing screening in high risk neonates using
eight required dialysis. Mortality was recorded in three
auditory brainstem response in Ibadan
patients. Eight patients are being followed up in the ne-
phrology clinic, while two were lost to follow up.
Labaeka AA, Tongo OO
Conclusion: Emphasis on prompt recognition and man-
Department of Paediatrics, University College Hospital
agement of non renal causes of AKI such as sepsis, diar-
Ibadan
rhoeal diasease and malaria would go a long way in the
prevention of Acute Kidney Injury.
Introduction: Early detection of hearing loss and appro-
Key word : Acute Kidney Injury
priate intervention are the key to speech and language
acquisition and cognitive development among the hear-
ing impaired. The World Health Organisation estimated
NEUO1
the burden of severe hearing impairment in 2012 to be
Brainstem evoked auditory response and Bilirubin
360 million; one-fifth of people affected globally had
induced neurologic dysfunction score in detecting
their hearing loss starting in childhood and two-thirds of
Acute bilirubinencephalopathy in term neonates in
these hearing impaired people reside in developing
Aminu Kano Teaching Hospital
countries. Routine and selective hearing screening of
high risk neonates and hence the exact magnitude of
Usman F, Farouk ZL, Ahmed A, Ibrahim MU
hearing impairment among high risk newborns as well
Department of Paediatrics Aminu Kano Teaching
as the general population in Nigeria remains largely un-
Hospital / Bayero University Kano
known.
Email: fateeusman2@yahoo.com
Objectives: This study was carried out to assess the
prevalence of hearing impairment among high risk new-
Introduction: Brainstem evoked auditory response
borns in UCH and the associated risk factors.
(BEAR) is an effective and objective screening method
Materials and methods: 201 high risk consecutives new-
for evaluating newborn especially those with bilirubin
borns admitted into the neonatal unit of UCH had both
encephalopathy. The commonest and earliest manifesta-
of their ears screened at admission and discharge, while
tion of bilirubin neurotoxicity is involvement of the
those that failed screening at discharge had repeat test-
auditory nerve. This, often ‘silent’ sequel is sometimes
ing at 6weeks post-discharge. Hearing screening was
missed, but can be detected early using BEAR. The
done using the automated auditory brainstem response
Bilirubin induced neurologic dysfunction (BIND) score
(Natus Algo 2e).
has been proposed to facilitate the clinical diagnosis of
Results: In this study, 83 (41.3%) and 32 (15.9%) new-
this disorder but has not yet been validated.
borns failed at admission and discharge screening re-
Objective: To determine the relationship between BEAR
spectively, 5 (2.5%) defaulted from follow up, 1 (0.5%)
and BIND scorein detecting bilirubin encephalopathy
died and 19 (9.5%) failed at follow up screening. A ma-
amongst neonates with hyperbilirubinaemia.
jority of hearing loss during follow up screening was
Method: A cross-sectional study involving 132neonates-
bilateral (94.7%) and severe (52.6%). The risk factors
was conducted. Eligible neonates were consecutively
associated with hearing loss (in order of magnitude for
recruited and subjected to BEAR immediately after sam-
predisposition for hearing loss) were: intraventricular
ple for serum bilirubin was taken and BIND score was
haemorrhage, acute bilirubin encephalopathy, meningi-
done. The sensitivity, specificity and predictive values
tis, vancomycin administration, recurrent apnoea and
of the BIND score relative to BEAR were calculated.
severe perinatal asphyxia.
Receiver operator characteristic (ROC) curve analysis
Conclusion: In conclusion, hearing impairment is com-
was done. The level of statistical significance was set at
mon among high risk newborns in UCH, most of which
p = <0.05.
were severe and bilateral and a majority of the hearing
118
impairment identified during admission resolved before
Conclusion : The prevalence of abnormal TAMM veloc-
discharge.
ity is high in children with HbSS. The need for avail-
ability of and accessibility to transcranial Doppler
screening is emphasized.
NEUO4
Key words: Transcranial Doppler Ultrasonography,
Pattern of cerebral blood flow velocity using tran-
Cerebrovascular Accident
scranial Doppler ultrasonography in children with
sickle cell disorder in Lagos State, Nigeria
NEUP1
Adekunle MO , Animasahun BA , Diaku-Akinwumi
1
2
Permanent vegetative stateand management chal-
4
IN , Njokanma OF
3
lenges in an orphan child: A case report
1
Department of Paediatrics,
Babcock University Teaching Hospital, Ilishan-Remo,
Ahmad MM,Jiya NM, Ahmed H, Baba J.
Ogun State, Nigeria
Department of Paediatrics, Usmanu Danfodiyo
2,3.4
Department of Paediatrics,
University Teaching Hospital, Sokoto
Lagos State University College of Medicine, Ikeja,
Lagos, Nigeria
Background: Vegetative state (VS) results from severe
brain damage leading to perpetual loss of complete
Introduction: Cerebrovascular accident (CVA) is a com-
awareness and lack of recovery for at least 1month. It is
mon devastating neurological complication of sickle cell
permanent (PVS) if it last for more than 3months.
disorder (SCD) with a high recurrent and mortality rate.
Objective: To highlight a case of fatal permanent vege-
The Stroke Prevention Trial in Sickle Cell Anaemia
tative state and management challenges in an orphan
study (STOP) recommends routine screening with tran-
Case report: KA was15year old orphan boy referred
scranial Doppler ultrasonography in children aged two
with a history of loss of consciousness for 4weeks fol-
to sixteen years with SCD. The present study assessed
lowing a febrile illness with headache, convulsions and
cerebral blood flow velocities of children with SCD in
loss of consciousness. He was managed for meningitis
accordance with the recommendation of routine screen-
for 3weeks, at a General Hospital, with no improvement.
ing by the STOP study.
He presented in coma (GCS of 6/15), a febrile, right
Aim and Objectives : To determine the pattern of cerebral
sided facial palsy and spastic right hemiparesis. Menin-
blood flow velocity using transcranial Doppler ultra-
gitis and tuberculosis screening were not suggestive.
sonography in children with sickle cell disorder aged
Brain CT scan revealed areas of cortical brain infarc-
two to sixteen years in Lagos State, Nigeria
tions, worse on the left. He had supportive medical/
Methods: It was a cross-sectional study carried out
nursing care, gastrostomy tube feeding and physiother-
within the period of July and November 2015. The study
apy. His GCS only improved to8-10/15 over 8months,
population comprised children with sickle cell disorder
with evident eye opening and closure and sleep-awake
aged two to sixteen years in steady state that presented
patterns, could cry to painful stimulus but not able to
to Sickle Cell Foundation Centre.
obey command and no purposeful limb movements. His
In all, 388 subjects were recruited and stratified into
vital signs remained stable. He died of severe sepsis
three age groups of less than five years, five to ten years
from E.coli UTI.
and eleven to sixteen years.
Discussion: Vegetative states could follow severe infec-
The study was done using a Compumedics DWL Dop-
tive or traumatic brain injuries. Recovery is exceedingly
pler machine (FDA K051 085) which is non-imaging.
rare after 3months and death is commonly due to infec-
Recruited subjects TCD evaluations were done by one
tions (systemic or skin). KA had severe financial con-
of the authors (M.O).
straints and had to be supported by the health care team
The velocities of blood flow in the middle cerebral ar-
and 2other philanthropists, throughout admission.
tery, internal carotid artery and anterior cerebral arteries
Conclusion: Vegetative state poses significant health
were measured. The highest velocity in the profile was
care challenges. Government needs to support affected
recorded as the Time-Averaged Maximum Mean Veloc-
families.
ity (TAMMV). TAMMV less than 170 cm/second was
Key words: vegetative state, coma, permanent, orphan
considered normal, values of 170 to 184cm/second and
185 to 199cm/second classified as low and high condi-
tional respectively. Velocity of at least 200 cm/ second
NEUP3
was considered abnormal.
Lumbosacral meningomyelocele following antenatal
Results: In all, 388 subjects were screened within the
exposure to Carbamazepine: A case report
study period (360 HbSS and 28 HbSC). The prevalence
Mairami AB , Audu LI , Mohammed- Nafi’u R ,
1
1
1
of abnormal Time-Averaged Maximum Mean Velocity
Mshelia, LJ
1
(TAMMV) of at least 200cm/second was 10.8%: this
1
was seen solely in HbSS subjects. The mean Time-
Neonatal Unit, Department of Paediatrics, National
averaged mean of the maximum (TAMM) velocity were
Hospital, Abuja.
163 ± 25cm/sec, 162±30cm/sec and 150 ± 30cm/sec for
Email: amsamairami@yahoo.com
children less than five years, five to ten years and eleven
to sixteen years respectively .
Introduction: The teratogenic effects of anti-epileptic
119
drugs have been documented since the 1960s, with Val-
tracted into a profoma sheet and data was analyzed using
proic acid being the most implicated. This is attributed
SPSS version 20.
to their anti-folate activity.
Results: Forty- two (0.5%) of the 9,184 admissions had
Objective: We present this case to highlight the signifi-
histological diagnosis of solid tumors. Males were 23
cance of this association.
(54.8%) and females were 19(45.2%), with M:F ratio
Case Summary : A male infant was referred to our hospi-
1.2:1. Mean age at presentation was 5.2 ± 3.3 years.
tal 3 hours after delivery at a private clinic on account of
Majority 23(54.8%) were of low socioeconomic class.
perinatal asphyxia and spinal defect. He was born at
Commonest clinical presentations were swellings 34
term via elective caesarean section. His mother was a 34
(81.0%), fever 13(31.0%), weigth loss 8(19.0%) and
-year-old primigravid woman who had been on Car-
pain 3(7.1%). Commonly diagnosed tumors were Reti-
bamazepine for 1 year prior to conception, which she
noblastoma 13(31.0%), Rhabdomyosarcoma 10(23.8%),
continued for the 38 weeks duration of her pregnancy.
Burkitts lymphoma 10(23.8%) and Nephroblastoma 6
An anomaly ultrasonographic scan done in the 3 tri-
rd
(14.3%). Twenty nine (69.1%) of the 42 patients were
mester was reported negative. However, significant ex-
discharged, 5 (11.9%) left against medical advice and 8
amination findings at birth included lumbosacral cystic
(19.0%) died.
Of the 29 that were discharged, 18
swelling with intact membrane, suturaldiastasis, bilateral
(62.1.0%) were lost to follow up.
talipesequinovarus deformity, a patulous anus and un-
Conclusion and Recommendation: Retinoblastoma is the
descended testes. Magnetic Resonance Imaging of the
commonest childhood solid tumor seen in this study.
brain confirmed associated Arnold Chiari malformation.
Therefore, facilities should be made available for
Results: While on admission he had a ventriculo