Nigerian Journal of Paediatrics

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

Adesanya OO

Adewunmi O, Oluseyi O, Adeoye O, Emechebe O,

Hamza N

Department of Paediatrics, National Hospital Abuja,

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

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-

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

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

To compare the mean pulmonary artery pressure of SCA

Olorukooba AA , Yakubu AO , Orogade AA , Lawal S

Kenis S

patients in steady state with those of age and sex

matched Hb AA controls

Department of Paediatrics ABUTH Zaria

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-

Garba BI, Muhammad AS, Mohammed BA

sis in children with SCA in steady state. ( p= 0.020 ).

Onazi SO, Ben-Wazieh AA, Adeniji AO

There was no significant relationship between PAH and

Department of Paediatrics, Department of Medicine,

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

Department of Obstetrics and Gynaecology, Depart-

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

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-

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

CP6

most common cyanotic heart condition in Downs syn-

drome . These cardiac anomalies occur either in isola-

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

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 .

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

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

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

stable

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

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

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

ther associated morbidity.

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,

(9.9%). Review of examination findings showed that the

Yusuf I, Kolawole T, Mohammed F,

vital signs documented included blood pressure in 18

Ben-Wazieh AA.

(9.4%), pulse rate in 179 (93.7%), respiratory rate in 179

(93.7%) and temperature in 184 (96.3%).

Department of Paediatrics, Ahmadu Bello University,

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;

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%)

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

physis and distal femur resulting in progressive lower

obtained.

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

right testes fully descend while the left came down to

than 30 kg/m , whichever is lower based on age and sex.

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-

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-

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

coexisting with childhood obesity based on clinical and

radiological findings was made.

Department of Nursing Services,

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

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

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.

HAEMO3

and childhood tetanus seen at the Federal Medical Cen-

tre, Azare from 1 January to 31 December, 2013 were

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

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

studied. Ninety seven per cent of them were haemoglo-

Department of Paediatrics, Neonatal Unit,

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

with the kit on the field were collected from the subjects

Ajite AB , Oke JO

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

Ulonnam CC, Ahmed PA, Audu LI and Tochi-Onyia C

Jagun OO , Daniel Ogbaro

Department of Paediatrics

Department of Paediatrics, Department of Surgery

Email: chide_charlie@yahoo.com

(Ophthalmology), Department of Medicine

(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-

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

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.

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 ,

(64.8%) of the 54 children. Parental separation/divorce

Wey YO, Nwata VE, Audu LI

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

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

month.

December 31 2015. The nutritional status was deter-

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 ,

-East Nigeria: a 15 year review

Popoola A , Ajani A , Ebisike K , Wariri O , Aliu R ,

Girbo A ,Raymond M ,Ndubuisi V , Bakari H , Umar

Isaac E , Jalo I , Alkali Y , Ghidazuka Y , Lano M ,

A , Olatoke L , Burak V , Hassan K , Richard E ,

Popoola A, Ajani A , Wariri O , Aliu R Raymond M ,

Tukur H , Rabo Y , Ezra D , Bakura H , Daniel A ,

Olatoke L , Girbo A , Ndubuisi V , Ebisike K ,

Kudi A , Danlami H , Charanchi M .

Bakari H , Umar A , Burak N , Richard E , Tukur H ,

Department of Paediatrics, Department of

Hassan K , Daniel E , Rabo Y , Bakura B , Daniel A

Kudi A , Charanchi S , Danlami H

Microbiology, Federal Teaching Hospital, Gombe

Department of Paediatrics, Department of Microbiol-

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

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

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

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-

*Anyebe EE, Olisah VO, Wammanda R, Nuhu FI

mon, this is the first case of osteomyelitis with ESBL

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

infection prevention practices and rational use of antibi-

Department of Psychiatry, ABU/ABU Teaching

otics.

Hospital, Zaria

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

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

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 ,

Aim: To determine the knowledge of benefits of breast-

Ogala WN , Slusher TM , Vreman HJ

feeding mother and child and its relationship with

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,

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

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

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

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-

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

delivered a mean irradiance above 30 µW/cm /nm at a

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,

devices attained intensive phototherapy levels at a mod-

Abba J , Oguche S

est distance of 30 and 25 cm respectively. The devices

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

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

ondary. Twelve (25%) units were in public facilities and

Gidado S , Bode-Thomas F

36 (75%) were in private facilities.

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.

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

ance levels.

Adesanya OO

Methodology: A cross - sectional descriptive study con-

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/

one-third of triplets are in the VLBW category; and

cm /nm (5.7; 18.1). Forty three point six percent of the

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

Objectives: We aimed to study the outcome of VLBW

the intensive level of ≥30 μ W/cm /nm.

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

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;

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

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

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:

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

Garba BI, Muhammad AS, Musa A, Kolawole,

140 b/min respiration 60c/min. Weight before KMC

Yusuf I, Mohammed F

900g at discharge weight 1050g

Department of Paediatrics, Department of Medicine,

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

ration 44cycles/m. Weight before KMC, 1200g and at

Department of Paediatrics, Ahmadu Bello University

discharge 1300g.

Teaching Hospital, Zaria

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

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 ,

normal but echocardiography was not done. She was

managed

for

recurrent

bronchopneumonia

with

Mamman AI , Ogunrinde GO , Akuse RM

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.

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

Ezeukwu IE , Rajpoot D

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,

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.

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

Permanent vegetative stateand management chal-

IN , Njokanma OF

lenges in an orphan child: A case report

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 ,

of abnormal Time-Averaged Maximum Mean Velocity

Mshelia, LJ

(TAMMV) of at least 200cm/second was 10.8%: this

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-

(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-

prompt diagnosis and effective treatment. The high oc-

peritoneal shunt inserted and serial POP application to

currence of patients being lost to follow up could be

correct the Talipes deformity. He has been discharged

minimized by counseling and reduction in the costs of

and is being followed up in the clinic under the com-

care.

bined care of neonatologists, neurosurgeons and ortho-

Keywords: Solid tumors, Childhood, Sokoto, Outcome.

paedic surgeons.

Discussion: Although reports have shown that peri-

conceptional exposure to Carbamazepine is associated

ONO2

with an increased risk of spina bifida, documented iso-

Solid tumors in children: a 5-year review

lated cases of spina bifida resulting from perinatal expo-

sure to Carbamazepine is uncommon.

Uduak Offiong

Conclusion: This report highlighted the association be-

Department of Paediatrics University of Abuja Teaching

tween spina bifida and antenatal exposure to Car-

Hospital (UATH)

bamazepine.

Key words: Meningomyelocele, Antenatal-exposure,

Introduction: Cancers in the paediatric population still

Carbamazepine

presents a challenge to clinicians in developing countries

of the world. The issues posing the greatest challenges

are lack of adequate trained personnel, late presentation

ONO1

and non-availablity of affordable drugs. Changes in the

Pattern and outcome of childhood solid tumors at

pattern of paediatric cancers have been reported.

Usmanu Danfodiyo University Teaching Hospital,

Methodology: A 5year review of records of all paediat-

Sokoto

ric patients presenting with solid masses. Records in-

cluded demography and cancer type treatment record

Jiya FB, Jiya NM, Jangebe MA, Ibitoye PK

and outcome were entered into Microsoft Excel. Fre-

Muhammed U, Adamu A, Isezuo KO, Yusuf T

quency tables were generated.

Department of Paediatrics, Department of Histopa-

Results: A total of 50 patients presented with solid

thology, Usmanu Danfodiyo University Teaching

masses of which 39 (78%) were diagnosed as malignant.

Hospital, Sokoto

There were 16 females and 23 males with age ranging

Email: fatimabellojiya@gmail.com

from 1 month to 14 years. Nephroblastoma recorded the

highest number (12), followed by non-Burkits lym-

Background: Childhood solid tumors are important non

phoma (8). Mortality rate was 33%. Only 5 patients

infectious causes of morbidity and mortality worldwide,

with Nephroblastoma are still being seen in clinic.

particularly in resource poor countries. The condition

Discussion: This study shows that the pattern of cancers

has been neglected in our environment, due perhaps to

in UATH has changed with Nephroblastoma being more

ignorance of the nature of the illness by caregivers, pov-

frequent than Burkitts lymphoma. The mortality rate and

erty and inadequate care provider commitment.

rate of loss to follow-up is still high. There needs to be

Objectives: To determine the prevalence, pattern and

more concerted efforts by government to make cancer

outcome of childhood solid tumors at Usmanu Danfo-

care affordable for paediatric patients and increase ca-

diyo University Teaching Hospital (UDUTH) Sokoto.

pacity for diagnosis and treatment.

Methods: This was a 5- year retrospective descriptive

study from August 2011 to July 2016. Cases were chil-

dren aged below 15 years admitted with solid tumors.

Relevant information from their case folders were ex-

120

ONO3

der with hyperemic overlying skin and a fleshy exten-

Retinoblastoma: A success story

sion into the tongue bed. Other systems were essentially

normal. Jaw x-ray showed dental anarchy with loss of

Ezeukwu EI, Purdue SL, Akeredolu FD, Ogunrinde GO,

lamina dura. FNAC done on two occasions were incon-

Ahmad HR

clusive. The mass rapidly increase in size obstructing

Department of Paediatrics, Ahmadu Bello University

the tongue and other intra-oral structures necessitating

Teaching Hospital, Zaria.

surgical excision and reconstruction with plates and a rib

Email ifeomaezeukwu@yahoo.com

graft from the right hemithorax. Diagnosis was confirm

with histology. Child had a successful outcome and was

Introduction: Retinoblastoma accounts for 3-6% of

discharge to clinic follow-up after 55 days on admission.

childhood cancers worldwide and the most common

Conclusions: We emphasize the difficulty of correct

childhood tumour seen in Zaria.

diagnosis preoperatively because preoperative studies

Objective: To highlight the importance of early presen-

are inconclusive and only the histology allowed precise

tation

identification.

Method: The review of the medical records of the pa-

tient and relevant literature.

Results: Patient is a 12 year old boy who presented at

ONP2

the age of 7 years with a 9 months history of redness of

Carcinoma of the colon in an adolescent girl-a case of

the left eye and 6 months history of left eye white speck.

turcot syndrome?

Visual impairment noted as child could not see. No as-

sociated swelling.

Ahmad HR1, Faruk JA1, Mado SM1, Sholadoye TT2,

He had left eye enucleation and histology showed a

Mohammed AJ1, Aliyu HO3, Ogunrinde GO1

moderately differentiated Retinoblastoma with optic

1Department of Paediatrics, Ahmadu Bello University/

nerve stump involvement. He successfully had chemo-

Teaching Hospital, Zaria

therapy consisting of Vincristine, Cyclophosphamide

2Department of Surgery, Paediatric Surgical Unit,

and Doxorubicin for 6 cycles with minimal side effects.

3Department of Morbid Pathology, Ahmadu Bello

He was subsequently followed up in the paediatric

University, Zaria

haemato- oncology clinic for 6years.

Ophthalmology reviews of the Right eye have remained

Introduction: Carcinoma of the colon is a rare disease in

normal as well as the serial Echocardiography.

children, and is thought to have a strong familial ten-

Patient has been growing well with prosthesis in the left

dency.

orbit

Aims/objectives: To highlight the diagnosis and manage-

Conclusion/ Recommendation: Survival of childhood

ment of an adolescent with colonic cancer.

cancers such as Retinoblastoma depends largely on early

Methodology: An 11 year old presented with 8 months

recognition of leukocoria, prompt presentation and man-

history of pallor, abdominal pain, and melena stools.

agement.

Her mother died six years previously after battling with

Key Word: Retinoblastoma

colonic cancer and an elder sibling also died at the age

of 9 years from brain tumour.

Results: Initial evaluation revealed peptic ulcer disease

ONP1

with associated iron deficiency anaemia treatment of

Ossifying fibroma of the mandible: a case report and

which did not stop the anaemia or digestive tract symp-

literature review

toms. Sigmoidoscopy was apparently normal with no

suspicious sites. Colonoscopy was also normal despite a

Adegboye OA , Adeboye MAN , Ibraheem GH

right iliac fossa mass. CT abdomen showed a well cir-

Adeyemi MF , Babalola OM , Agaja SB

cumscribed cystic mass at the right iliac fossa alongside

Department of Paediatrics and Child Health, Surgery

the ascending colon. Exploratory laparotomy revealed a

(Maxillofacial Surgery), Surgery (Orthopaedic

tumour involving the ascending colon and the ceacum, a

Surgery).

solitary duodenal perforation and involvement of the

mesenteric lymph nodes. The tumour was staged 3C

Background: Ossifying fibroma is a rare tumor that

using Duke’s classification. An extended right hemi-

mostly develops in the soft tissues of the head and neck.

colectomy with anastomosis was performed. Histologi-

Within the oral cavity, a tongue lesion is the most com-

cal examination confirmed mucinous adenocarcinoma.

mon. Ossifying fibroma tends to recur locally instead of

Patient did well post operatively and is on neoadjuvant

metastasizing. We present a 5-year-old boy with Ossify-

chemotheraphy.

ing fibroma of the mandible. We report this case be-

Conclusion: Colon cancer though rare in childhood can

cause of the difficulty encountered in establishing an

easily be overlooked especially as the features mimick

early diagnosis

those of other common ailments in childhood such as

Clinical case: A 5-year-old boy presented with a 10

helminthiasis, peptic ulcer disease and iron deficiency

month history of progressive right sided facial swelling.

anaemia. High index of suspicion should prompt careful

The swelling was initially painless but later became as-

evaluation of children presenting with digestive tract

sociated with intermittent mild pain. Clinical examina-

symptoms more so if there is a strong family history.

tion revealed a mass of about 15x12cm, minimally ten-

121

ONP3

Goals (SDGs) were formulated by the countries of the

Renal Cell Carcinosarcoma in an Adolescent with

world in September 2015 with a 15-year target as a fol-

Sickle Cell Anaemia (HB SS)

low up to the Millennium Development Goals (MDGs)

with main aim of achieving global sustainable develop-

Ahmad HR, Faruk JA, Bugaje MA, Sobowale AM,

ment by promoting economic development, social inclu-

Solomon A, Ogunrinde GO, Akuse RM

sion, environmental sustainability, and good governance

Haematology/Oncology Unit, 1 Nephrology Unit,

including peace and security. Understanding of the con-

Department of Paediatrics, Ahmadu Bello University/

cept by the students of health is important because they

Teaching Hospital, Zaria

will form significant part of the health workers who are

likely to contribute positively to the attainment of SDG

Introduction: Malignancies have been reported to occur

by the end of the time frame.

in people with Sickle Cell disease. Renal cell carcinoma

Objective: The objective of the study is to evaluate the

(also tagged seventh sickle cell nephropathy) is an ag-

knowledge and understanding of the concept by Health

gressive cancer seen almost exclusively in people with

Sciences related students.

sickle cell trait. More than 120 cases were reported, but

Method: A self-designed, pre-tested questionnaire on

only two cases were reported in a patient with sickle cell

SDG to evaluate the knowledge and understanding of

anaemia (HB SS).

Clinical, Basic- and Post-basic Nursing students in the

Aims/objectives: We report a case of Renal Cell Carci-

University of Ilorin and University of Ilorin Teaching

noma in a girl with sickle cell anaemia (HB SS) to

Hospital was administered on them and their responses

showcase rarity of the case and challenges of managing

analysed with SPSS version 20.

a cancer in the background of a chronic haematologic

Results: A total of 398 partook of the study. There were

disorder.

129 male and 269 female (M:F 1:2). One hundred and

Methodology: A 17 year old girl diagnosed with HB SS

twelve (28.1%) have heard about SDG before. A total of

disorder at the age of 2 years with two previous admis-

306 (76.9%) had no idea of the reason for SDG, 338

sions, 10 vaso-occlusive episodes all managed on outpa-

( 84.9%) had no idea about the year it commenced, 339

tient basis, no blood transfusions, normal growth and

(85.2%) had no idea about the timeline, 352 (88.4%) had

school performance. She presented with left loin pain,

no idea of the number of goals, 368 (92.5%) had no idea

dysuria, low grade pyrexia and left renal angle tender-

about the number of targets, while 370 (93.0%) were not

ness.

able to list any of the SDG.

Results: Abdominopelvic ultrasound showed markedly

Conclusions: The knowledge and understanding of SDG

dilated left pelvi-calyceal system, cortical thinning and

is poor among students of health institutions. Effort

poorly visualized left ureter. Intravenous urography re-

should be made to teach this program to students so as

vealed non-functioning kidney. A CT urogram con-

to enhance the chances of achieving the SDGs.

firmed left renal tumour and cyto-reductive nephrec-

Key words: Sustainable Development Goals, Health,

tomy was done. Tumour was staged T4N2Mx. Histo-

Students

logical examination confirmed renal medullary carcino-

sarcoma.

Neoadjuvant chemotherapy was started and also

PHO3

Hydroxyurea as treatment for her sickle cell.

Experiences of an African save the children Ambas-

Conclusion: The case of rare renal tumour found in a

sador

girl with sickle cell anaemia has been presented. The

need for routine renal evaluation to identify early renal

Ojo Catherine Oluwatoyin

manifestations of SCA and hopefully rare features as in

Email: kateojong@yahoo.com

this case is recommended.

Introduction /Background: Globally, Nigeria accounts

for about 11% and 10% of childhood and maternal mor-

PHO2

talities respectively. Most of these deaths are prevent-

Knowledge and Understanding of Sustainable

able. 'Save the Children', a Non- Governmental Organi-

Development Goals among Health Students in Ilorin

zation with ambassadors worldwide, believes that no

child is born to die and no mother should die while

Adeboye MAN*, Abdulkadir MB*, Adegboye OA*,

Fadeyi A , Bello AO , Durojaiye AO

Objectives: This paper is an overview of my activities

* Department of Paediatrics and Child Health,

from 2011-2015 as an African Ambassador of Save the

Department of Medical Microbiology, University of

Ilorin/University of Ilorin Teaching Hospital, Ilorin,

Materials and methods: Advocacy was carried out using

Kwara State. PMB, 1515, Ilorin

national and international media to emphasize recogni-

Department of Paediatrics, Federal Medical Centre,

tion and control of preventable causes of neonatal

Bida, Niger State.

deaths. Step down trainings in essential Newborn care

Department of Nursing Science, University of Ilorin,

were offered to health workers in Kaduna State and

Ilorin, Kwara State.

members of the Paediatric Nurses' Association. Dissemi-

nation meetings sponsored by Save the Children were

Introduction/Background:

Sustainable

Development

carried out in United Kingdom and United States of

122

nary hypertension with mean pulmonary artery pressure

Result: Over 300 nurses and doctors were trained in

(PAP) of 39.1mmHg and Chest CT scan showed con-

Neonatal resuscitation and Kangaroo mother care while

solidation. Sildenafil and anti failure drugs were added,

100 nurses and doctors were trained in essential new

but she however deteriorated and died.

born care. Linkages were established with other agen-

Conclusion: Pulmonary hypertension can occur among

cies and individuals with similar goals locally and inter-

active PTB patients, higher PAP is associated with mor-

nationally. Specialized groups such as National Associa-

tality among new cases of PTB.

tion of Nigerian Paediatric nurses reached were given

Key words: Pulmonary artery pressure, Pulmonary hy-

d e fi ned

ro l e s

for

fur t he r

ad voc ac y.

pertension, Pulmonary tuberculosis

Discussion: Advocacy as a power tool for positive im-

pact on neonatal survival can be measured using indices

such as male involvement in supporting women and

PULO2

children; immunization coverage, exclusive breastfeed-

Factors associated with the level of knowledge of

ing rates, adequacy of complementary feeding and child

school teachers about childhood asthma in Ilesa,

spacing. This next stage is currently being evaluated at

Nigeria

community

and

primary

healthcare

levels.

Omole KO, Kuti DK, Oso B

Conclusion and recommendation: It is recommended

Kuti BP,

1,2

Mohammed LO , Minna YA

that all levels of healthcare providers be equipped with

skills for healthcare to reduce the unacceptable mortality

Department of Paediatrics, Wesley Guild Hospital,

i n d i c e s

a n d

i n

N i g e r i a .

Ilesa, Nigeria

Key Words: Advocacy, ambassador, maternal and child

Department of Paediatrics and Child Health Obafemi

h e a l t h ,

h e a l t h

w o r k e r s

Awolowo University, Ile-Ife, Nigeria

Department of Paediatrics, National Hospital, Garki,

Abuja, Nigeria

PULO1

Pulmonary hypertension complicating pulmonary

Background: Teachers as de-facto caregivers of school

tuberculosis

children with asthma have a major role to play in ensur-

ing optimal asthma symptoms control at school.

Garba BI, Sani UM, Isezuo KO, Waziri UM, Legbo JF,

Objective: This study set out to determine the level of

Abubakar FI, Omar M

knowledge of school teachers in Ilesa about childhood

Department of Paediatrics, Usmanu Danfodiyo

asthma and the factors associated with these levels of

University Teaching Hospital, Sokoto

knowledge.

Methods: Four secondary schools (two private and two

Introduction/background: In spite of effective chemo-

public) in Ilesa, South West Nigeria were selected by

therapy, pulmonary tuberculosis (PTB) continues to be a

multistage sampling method. All the teachers in these

major cause of morbidity and mortality. Pulmonary hy-

schools were required to fill a self-administered ques-

pertension (PHTN) is associated with poor prognosis;

tionnaire incorporating a validated 40-item asthma

and symptoms include dyspnoea, palpitations, fatigue

knowledge questionnaire. Factors associated with the

and syncope which are vague hence not diagnosed early.

teachers’ level of knowledge about childhood asthma

Aims /objectives: We report a case of PTB that devel-

were determined appropriately.

oped PHTN.

Results: A total of 132 teacher (M: F = 1:2) participated

Case report: 5 year old girl with recurrent fever and

in the study with 85 (64.4%) from private school. The

cough of 2 months, body swelling and difficulty in

mean (SD) age of the teachers was 38.0 (9.1) years and

breathing of 5 days; and associated weight loss. No his-

median (IQR) years in teaching service was 7.0 (5.0 to

tory of contact with adult with chronic cough; not im-

15.0) years. About one-half (56.1%) of the teachers had

munised for age and has poor nutritional status. Parents

university education while only 7 (5.3%) had a post

are divorced, mother is not gainfully employed and they

graduate degree. The mean (SD) score was 21.5 (7.2)

live in an overcrowded room.

and 51.5% had poor asthma knowledge (score < 22)

Results: Chest findings and x-ray suggestive of PTB;

particularly as related to the nature and management of

ECG- right axis deviation and right ventricular hypertro-

childhood asthma. No correlation was found between

phy; FBC- leucocytosis; ESR-118mm/hr; Mantoux-

knowledge and age, teaching experience and qualifica-

13mm induration; Echocardiogram- mild pericardial

tions (p > 0.05). However, previous training/lecture

effusion; RVS- non reactive; Gene expert- low MTB

about childhood asthma was associated with good

detected, Rifampicin resistance not detected; SPO2-

knowledge about the condition. (p <0.05)

61%.

Conclusion: School teachers’ knowledge about child-

Antituberculous drugs, oxygen and prednisolone were

hood asthma in Ilesa is poor, particularly as regards its

commenced; was discharged after 4 weeks to complete

nature and management. We recommend routine train-

intensive phase. Continuation phase was commenced

ing of teachers about common childhood conditions

but was readmitted after 5 weeks with recurrence of

including asthma to ensure optimal symptoms control in

symptoms and heart failure. Cor Pulmonale and PHTN

school

were considered. Repeat chest x-ray showed extensive

Keywords: Childhood asthma, Knowledge, School

consolidation. Repeat echocardiogram- severe pulmo-

teachers.

123

PULO3

is an important step in achieving control.

Evaluation of the knowledge of Nigerian paediatri-

Objectives: To determine the prevalence of allergic

cians in training on metered dose inhalation

rhinitis (AR) in children with asthma

seen in Uni-

technique

versity of Ilorin Teaching Hospital (U.I.T.H).

To assess asthma control in the study subjects.

Ndukwu CI, Elo Ilo JC, Mbachu C, Ugwu N, Ngonadi,

Materials and Method: Study design and population:

Ayuk A

This was a cross-sectional study among children 6-17

years with diagnosed asthma attending the pulmonology

Background: Inhalational therapy is a major component

clinic.

of asthma management, with efficacy dependent on the

Ethical approval was obtained from the UITH ethical

patient’s inhalation technique. Proper patient education

review committee.

Study period: The study was done between 1 March

determines technique mastery and inhalation outcomes.

and 31 July, 2016.

Every paediatrician may be faced with the need to either

prescribe or reinforce the technique of inhaler therapy in

After obtaining informed consent The International

asthmatic patients. This study was thus embarked upon

Study of Asthma and Allergies in Childhood (ISAAC-

to ascertain the depth of inhaler technique knowledge of

http://isaac.auckland.ac.nz/phases/phasethree/

Nigerian paediatricians in training.

corequestionnaire.pdf) rhinitis questionnaire was admin-

Objectives: To ascertain the knowledge of senior regis-

istered. Asthma symptom control was assessed using the

trars in paediatrics about the technique and use of MDIs.

Global Initiative for Asthma (GINA) 2014 guidelines.

Materials and methods: This was a cross-sectional and

Oyedeji scheme for social classification was used. An

descriptive survey in which all consenting paediatric

automated micro-peak flow meter (Piko-1®), nSpire

senior registrars, who were present at the 2016 Health

Health Inc., Longmont, USA was used to measure peak

Resource management course organized by both Post-

expiratory flow rate (PEFR) and forced expiratory vol-

graduate Medical colleges, were recruited. Knowledge

ume in one second (FEV 1 ).

of critical steps of Metered Dose Inhaler (MDI) device

Data analysis: Data was analysed using SPSS version

technique was assessed via a self administered question-

20.0

naire. Data entry and analysis was done using SPSS ver-

Results: Thirty of the 66 (45.5%) had co-existing AR.

sion 21.

Among these 30, 12 (40.0%) had uncontrolled asthma

Results: Fifty five Paediatric senior registrars (21 males,

compared with 4 (11.1%) of the 36 who have asthma

34 females) were recruited. Their ages ranged from 24

alone (p-value 0.018).

to 44years with modal age of 32years. Inhaler prescrip-

Discussion/Conclusion: Allergic rhinitis co-exists with

tion had been made by up to 74.5% of them within the

asthma in close to 50% of our patients and should war-

past 6 months, with 51.2% of these prescribing within

rant routine evaluation so as to improve control. This is

the past month. Basic knowledge on inhaler use was

in line with global practices.

obtained from postgraduate training in 32.7% and medi-

Recommendation: All children with asthma should be

cal school in 23.6%. The knowledge score was good in

evaluated for AR

14.5% of them and poor in 85.5%.

Discussion: This study has shown that many paediatri-

cians in training lack the basic knowledge of MDI tech-

PULP2

nique. This is not peculiar to Nigeria.

Pneumonia complicated with empyema thoracis

Conclusion: Asthma control may be jeopardized by the

requiring decortications

poor knowledge of inhaler technique by paediatricians

Garba BI, Sani UM, Isezuo KO, Waziri UM, Legbo

who should teach this skill as a part of asthma education

JF, Abubakar FI, Omar M, Abubakar U.

and control.

Recommendations: There is need to reinforce training on

Department of Paediatrics, Usmanu Danfodiyo Univer-

basic inhaler technique skills of paediatric resident doc-

sity Teaching Hospital, Sokoto

tors as this will positively impact on asthma control.

Department of Cardiothoracic Surgery, Usmanu Danfo-

diyo University Teaching Hospital, Sokoto

PULO4

Introduction/Background: Empyema thoracis may occur

Co-existing allergic rhinitis among asthmatics at-

from parapneumonic pleural effusion and is associated

tending the paediatric pulmonology clinic: Implica-

with prolonged respiratory symptoms requiring longer

tion for control

times for drainage. Suppurative bacterial infections are

important causes; which if not treated early, may result

Gobir AA, Muhammed SS, Johnson WBR,

to chronic empyema requiring thoracotomy and decorti-

Ibraheem RM

cation.

Department of Paediatrics, University of Ilorin

Aims and objectives: To present a case of pleural effu-

Teaching Hospital

sion in a child with Pseudomonas aeruginosa pneumo-

Email: aishaakarim@yahoo.com

nia which progressed to chronic empyema thoracis re-

quiring decortication.

Introduction: Asthma causes significant morbidity

Case report: 12 year old boy with fever, cough and

among children. Identifying and treating co-morbidities

weight loss of 3 weeks and left sided chest pain of 1

124

week with no history suggestive of tuberculosis. Respi-

mals as well as group sexual activity is also recorded.

ratory examination and chest radiograph findings were

in keeping with left sided pleural effusion 2 left lobar

pneumonia.

SPO3

Results: Pleural aspirate was initially straw coloured and

Problematic phone use among pre-varsity young peo-

negative on culture but later became purulent and

ple in Ibadan, Nigeria

yielded Pseudomona aeruginosa ; Empyema thoracis

1,2

Balogun FM, Olatunde OE

was therefore considered. Mantoux test was non reac-

tive; Erythrocyte sedimentation rate of 115mm/hr; no

Institute of Child Health, College of Medicine,

mycobacteria on gene expert and no acid fast bacilli on

University of Ibadan, Ibadan, Nigeria

Ziehl Neelsen stain of pleural aspirate. Patient was com-

University College Hospital, Ibadan, Nigeria

menced on antibiotics and chest tube drainage.

Email: folushom@yahoo.com

Chronic empyema thoracis was considered by 6 week

due to lack of significant clinical and radiological im-

Introduction: Mobile phone possession and use among

provement. In view of persistent pleural discharge, tho-

young people is on the increase in Africaand phone ad-

racotomy and decortication was carried out by 7 week.

diction has been shown to be similar to substance use

He improved significantly and was successfully extu-

dependence. However, there is barely any literature fo-

bated and discharged after x-ray findings of significant

cused on the effect of mobile phone use on young peo-

lung re-expansion a week after.

ple in Nigeria.

Conclusion: Although empyema requires early diagno-

Objectives: To determine the prevalence and associated

sis and treatment with appropriate antibiotics and chest

factors of problematic phone use among pre-varsity

tube drainage, in addition chronic empyema may require

young people in Ibadan.

decortication.

Materials and methods: Problematic phone use was as-

Key words: decortications, chest tube, empyema

sessed using the 27-item Mobile Phone Problem Use

thoracis, pneumonia

Scale and scored on a 5 point Likert scale. Scores27-76

indicated low-moderate degree and scores ≥ 77 indicated

moderate-severe degree of problematic mobile phone

SPO2

use. Chi square test was used to compare problematic

Pattern of Child Sexual Abuse seen in Barau Dikko

phone use with some selected respondents’ characteris-

Teaching Hospital Kaduna

tics and p was 0.05

Results: Five hundred and seventy five participants were

Musa S, Aliyu-Zubair R, Dodo A,

recruited, age range 14-24 years and 46.0% were males.

Almost all (96.7%) of the respondents had mobile phone

Introduction: Child sexual abuse remains a major social

access and 46.5% had moderate-severe problematic

and health menace in the society. Most of it goes unre-

phone use. Family and friends have complained about

ported, and often the child is assumed to be the victim

phone use in 192(33.4%) respondents and 195(33.9%)

because of his vulnerability. Unusual patterns of presen-

had lost sleep due to time spent on phone. Attempts at

tation of this social ill are largely unknown.

spending less time on the phone had failed by 171

Objective: To describe the patterns of child sexual abuse

(29.7%) young people while 261(45.4%) don’t pay at-

and socio-demographic characteristics associated with

tention to what they are doing while making calls. Being

each.

a male and living in a polygamous family were signifi-

Methods: Case records of child sexual abuse that pre-

cantly associated with problematic phone use.

sented to the Barau Dikko Teaching Hospital, Kaduna

Conclusions and recommendations: There was a high

were reviewed. Pattern of abuse were noted for all cases

rate of problematic phone use among these young peo-

and characteristics of child victims and perpetrators

ple. Interventions to promote responsible phone use is

were analysed. Association between the patterns of

required to counter this problem.

abuse and child characteristics are noted.

Results: There were a total of 137 cases of child sexual

abuse in the period under review. Five distinct patterns

SPO5

of child sexual abuses were identified; child-child, child-

Factors Influencing Dangerous Traditional Newborn

parent, child-adult (other than the parent) and child-

Care Practices in a Rural Community in Northern

animal and group child abuse. In 108(78.8%) cases chil-

Nigeria

dren were solely the victims. In 23 (16.8%) cases chil-

dren were the perpetrators of the child sexual abuse. Age

Introduction: Sub-Saharan Africa and the south East

range of child victims was 9 months to 13 years with a

Asia contribute to over half global neonatal mortality

mean age of 4 +/- 1.3 years. 92 (80.7%) of victims were

rate with little progress towards improvement. Various

girls while 27 (93.1%) of child perpetrators were boys.

cultures have neonatal care practices, some of which

Age range of perpetrators was 4 years to 11 years with a

could be dangerous to health. It is important to identify

mean of 7years.

the socio-cultural barriers to neonatal health in our envi-

Conclusion: Bizarre patterns are increasingly being seen

ronment.

with the child often as the victim as well as the perpetra-

Aims: We aimed to describe the perception, dangerous

tor. Involvement of children in sexual activity with ani-

cultural practices on newborn among household caregiv-

125

ers in a rural community in Kano, Nigeria.

complications in infantile haemangiomas in ‘beard’

Methodology: The study was descriptive correlational,

presentation.

cross-sectional. Household members were administered

structured questionnaire. Perceptions, practices of

uvulectomy, FGM, cord care, immunization, attendant at

A primordial killer still on the prowl: A review of

delivery and reasons for these practices were recorded.

paediatric tetanus in Azare, Bauchi state

Data were analyzed using the Statistical Analysis Soft-

ware version 9.2 package (SAS Institute, Cary, North

Imoudu IA, Ahmad H, Yusuf MO, Makarfi HU

Carolina, and USA).

Afegbua DS

Results: The prevalence of FGM, Uvulectomy was

Department of Paediatrics, Federal Medical Centre,

51.5% and 58.3% respectively. The practice of uvulec-

Azare, Nigeria.

tomy and

FGM were significantly commoner among

Email: tomhe164@yahoo.com

respondent of Hausa ethnicity, fulltime housewives, of

low educational level; uvulectomy; ( x = 18.4336, p =

Introduction: Tetanus, a well-known disease to pre-

0.0010; x = 11.6501, p = 0.0202; x = 37.8181, p

historic peoples remains an on-going challenge in the

< .0001 respectively), FGM ( x = 14.6137, p = 0.0056;

developing world.

x = 10.7938, p = 0.0290; x = 26.3113, p < .0001 re-

Objective: This study is aimed at examining the mean

spectively).

ages, portals of entry, onset times and incubation periods

Conclusion: Education and ethnicity were associated

as well as outcomes of patients affected by neonatal and

with dangerous practices of uvulectomy and FGM.

childhood tetanus in Azare, Nigeria.

Methods: Retrospective data of all patients with neonatal

and childhood tetanus seen at the Federal Medical Cen-

tre, Azare from 1 January to 31 December, 2013 were

Infantile haemangioma in a ‘beard’ distribution: A

obtained and analysed.

case report

Results: A total of 19 cases were admitted during this

period, 6 (31.6%) had neonatal tetanus, while 13

Imoudu IA, Ahmad H, Yusuf MO, Makarfi HU

(68.4%) had childhood tetanus. The male: female ratio

Department of Paediatrics, Federal Medical Centre,

for neonatal tetanus was1:1, that of childhood tetanus

Azare, Nigeria.

was 1.6:1. The case fatality rate of neonatal tetanus was

Email: tomhe164@yahoo.com

50% and 61.5% for childhood tetanus. The mean age of

the neonates who survived the disease differed signifi-

Introduction: Infantile haemangiomas are benign vascu-

cantly from that of those who did not survive the disease

lar neoplasms that have a characteristic clinical course

(P=0.03). This was also true for incubation period

marked by early proliferation and followed by spontane-

(P=0.01). Mean incubation period and onset time for

ous involution. They may be cutaneous or extra cutane-

childhood tetanus was longer is survivors than non-

ous. Infrequently, infantile haemangiomas may impinge

survivors. However, these differences did not reach sta-

on vital structures provoking certain related symptoms.

tistical significance (P=0.59, 0.50 respectively). The

Objective: This report is intended to underscore the need

portal of entry of childhood tetanus had a statistically

for a high index of suspicion and anticipatory manage-

significant relationship with the outcome (P=0.02).

ment of life threatening respiratory complications that

Conclusion: Mortality from tetanus remains high, the

may be associated with infantile cutaneous haemangio-

importance of preventive strategies in its management

mas in a ‘beard’ distribution.

cannot be overemphasized in our environment.

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

discoloured area over the sternal region. It progressively

spread superiorly to involve the anterior aspect of the

neck and chin and became associated with progressive

difficulty in breathing. Examination findings revealed a

restless, acutely ill child in respiratory distress and inspi-

ratory stridor. She had purplish plaques in the areas

mentioned above as well as the lower lip and ventral

aspect of the tongue. Treatment involved the administra-

tion of oxygen, intravenous dexamethasone and oral

propranolol, she was discharged after 4 days of admis-

sion following remarkable improvement.

Conclusion/ Recommendation: The prognosis for most

uncomplicated haemangiomas is very good. Airway

obstruction is an uncommon complication and may be

particularly challenging for young infants who are obli-

gate nose breathers. It is essential to recognize this asso-

ciation and institute prompt management of respiratory