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Background: Congenital abnormalities are defects present at birth and are increasingly becoming an important cause of neonatal mortality. They can also result in disability in majority of the survivors. Objective: To describe the pattern and outcome of major congenital abnormalities (MCA) in a tertiary hospital in Lagos, Nigeria. Methods: The labour ward and labour ward theatre delivery records and admission records of the in-born ward of the neonatal unit of a tertiary hospital were reviewed retrospectively from January 2007 to December 2014. The MCA were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, (ICD-10). Multiple abnormalities were counted once by the system with the most major anomaly. Abnormalities were grouped according to organ systems, sex and yearly distribution. Statistical analysis was based on systemic type, and neonatal outcome. Results: Out of 14581 deliveries during the study period, 167 had MCA, giving an incidence of 11.5 per 1000 total births; 71 (42.5%) were females, 91 (54.5%) were male and 5(3.0%) had indeterminate sex. There was an increase in the yearly incidence from 2007-2014 The most frequent abnormalities were in the central nervous system (31.7%), musculoskeletal system (18.6%), complex congenital abnormalities group (15.5%) and urogenital system (11.4%). Fifty six (31.8%) infants died in the first week of life contributing 12.6% to the overall early neonatal mortality during the study period. Overall case fatality rate was 42.0%; case fatality was highest in the other abnormalities group, followed by chromosomal, cardiovascular and genitourinary system abnormalities respectively. Conclusion: The incidence of MCA in this study is high especially in the central nervous system. There was a steady increase in the yearly incidence during the study period. The overall case fatality rate was also very high with a high contribution to early neonatal deaths

Uterine rupture in pregnancy is an obstetric emergency especially in developing countries associated with a significant increase in maternal plus perinatal mortality and morbidity. There is a need to identify the prevalence together with underlining factors which could guide effective intervention. Hence, the study aimed at determining the prevalence of uterine rupture, predisposing factors, management options plus clinical presentation at Secondary Health Facility in Okitipupa, South West Nigeria. This was a retrospective study of patients with a uterine rupture from January 2009 to December 2012 in the Department of Obstetrics and Gynaecology State Specialist Hospital Okitipupa. The case records of patients in this period were retrieved from the medical health records department and relevant data of sociodemographic characteristics, clinical presentation, management as well as maternal and perinatal outcome were collated using a structured questionnaire. Data were analyzed using Microsoft Excel version 10. Of the 11,377 deliveries during the study period a total of 52 uterine ruptures were recorded during the same period making an incidence of 0.46% or a ratio of 1:219 deliveries. Most of the patients 28 (60.9%) were 20–30 years of age. Uterine rupture was more common amongst multiparous women 36 (78.3%). None was a primigravida. The majority of the patients 34 (73.9%) were nonattendants at the antenatal clinic. The commonest single predisposing factor was the presence of a previous scar being present in 12 (26.1%) of the patients. The most common surgery performed for uterine rupture in the series was repair only 24 (52.2%). There is an absence of uterine rupture in primigravida supports the belief that primigravida is somehow immune to rupture. Rupture of the gravid uterus is a major contributor to maternal and perinatal mortality in Okitipupa Southwest Nigeria. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between HIV infection and anthropometric measures (weight, height, midupper arm circumference and head circumference) of children aged one to five years. Method: A cross sectional descriptive study using structured questionnaire and measurement of weight, height, head and midupper arm circumference of 846 infected children and matched controls. Results: The mean weights of the controls were significantly higher than those of the infected children at all age groups (p

Worm and parasitic infestation is a common problem in children with most occurring in school age . Low socio-conomic status and poor sanitary hygiene has been associated with worm infesetation. Though it is rare in infancy, there had been reports in these group of children. However there has been no documented case of multiple infestation in infancy. We hereby report an infant with recurrent anemia and melena and bloody stools caused by anklylostomaduodenale and entamoebahistolytica

Poor air quality is one of the renowned issues instigating health complications in urban areas today due to man's exposure to various gases. The paper assessed the ambient air along New Ife Road (NIR) and Forestry Research Institute of Nigeria Headquarters (FRIN), Ibadan, Oyo State using Biochemical changes and computed the air pollution tolerance indices from fresh leaf samples of ten (10) similar plant species selected randomly in triplicates in both study locations. Monoon longifolium, Chrysophyllum albidum, Terminalia catappa, Dacryodes edulis and Terminalia ivorensis had tolerant APTI values; Mangifera indica, Psidium guajava, Terminalia ivorensis, Terminalia catappa and Cocos nucifera were intermediate APTI while Mangifera indica, Moringa oleifera and Azadirachta indica were found to be sensitive to air pollution. The APTI values at both locations are not significantly different; therefore NIR and FRIN are rated as areas of high anthropogenic activities. Terminalia ivorensis, (31.58 in NIR) Terminalia catappa (30.56 in FRIN) Dacryodes edulis, (31.15 in NIR and 34.76 in FRIN) (Chrysophyllum albidum (34.78 in NIR and 39.78 in FRIN) and Monoon longifolium (49.83 in NIR and 57.50 in FRIN) were classified as sink of air pollution based on their APTI values which ranged from 30>100 obtained in both locations of study. It is however suggested that these plants identified as sink of air pollutants, should be used for landscaping and planted 50m from the roadside for bio-filtration of the atmosphere. [ABSTRACT FROM AUTHOR]

Chronic pulmonary aspergillosis (CPA) is a progressive and destructive disease of the lung parenchyma. We report a 9-year-old boy diagnosed with CPA with a positive Aspergillus IgG and chest imaging of cavitary lung lesions. He was treated with oral Itraconazole with significant improvement. This shows that an index of suspicion should be heightened in the paediatric population with cavitary lung lesions because not all cavitary lung lesions are caused by Mycobacterium tuberculosis. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Low protocol adherence hinders sepsis care in Nigeria. This study assessed the knowledge, strategy, and perceived barriers of physicians to prompt detection and treatment of sepsis. Methods: The researchers conducted a cross-sectional survey of physicians at Lagos University Teaching Hospital (LUTH). Participation was open to all LUTH physicians. Between June and December 2022, a self-administered questionnaire was sent to the platforms of physicians. Participants' mean scores on knowledge, approach, and barriers to sepsis care were calculated. Analysis of variance was used to compare the mean scores between physician cadres. A 0.05 two-sided P value was deemed statistically significant. Results: The study included 165 physicians. The mean age (standard deviation) was 38.25 (9.7), with 92 (55.8%) males. Only eight (4.8%) physicians had a 75% comprehension of sepsis. Only three respondents (1.8%) achieved 75% on sepsis care per surviving sepsis campaign standards. One hundred and thirty-eight (83.6%) respondents indicated significant barriers to sepsis treatment. Senior registrars had higher knowledge scores, while interns scored lowest (F = 3.508, P = 0.009). The mean scores of approaches to sepsis care among cadres were not significant (F = 1.692, P = 0.154). Conclusion: This study revealed that clinicians in a tertiary hospital in Lagos, Nigeria, had inadequate knowledge, especially among lower cadre doctors, and a suboptimal approach to the management of sepsis patients, as well as substantial barriers to their care. There is a need to provide physicians with tailored training on the diagnosis and correct approach to the care of patients with sepsis, as well as provide job aids to help with decision-making in the emergency rooms.

Background: The advent of antiretroviral therapy (ART) in controlling Human Immunodeficiency Virus (HIV) disease has been quite effective in ensuring that infected people can enjoy healthy, long, and productive lives. Medication adherence is an essential part of patient care, especially among patients with HIV, as it greatly determines the effectiveness of treatment. Few studies have explored factors influencing medication adherence and treatment satisfaction among adults, with little focus on adolescents. Objectives: To assess medication adherence, treatment satisfaction and factors influencing adherence to ART medication among adolescents living with HIV in Lagos, Nigeria. Methods: This descriptive, cross-sectional study was conducted among diagnosed and registered adolescents aged 10-19 years living with HIV and receiving treatment at eight selected antiretroviral centres in Lagos state, Nigeria. A total of 203 adolescents were recruited in stages, and data were collected using an interviewer-administered semi-structured questionnaire. Results: There was a low level of adherence as only 59/203 (29.1%) of the respondents adhered to ART. Depression, perceived stigma, being away from home, side effects of drugs, pill burden, and forgetfulness were some factors identified as barriers to adherence. The respondents were most satisfied with the effectiveness of the medication and least satisfied with the side effects. Conclusions: Medication adherence among adolescents was relatively low; the level of satisfaction with ART medication is an entity that significantly impacts adherence.

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Due to scarcity of potable water in most rural and urban settings in Ekiti State, rainwater harvesting from rooftop has been favoured as an alternative source of water supply. This study investigated the physicochemical characteristics of rainwater harvested from four different rooftop sheets in Ikole-Ekiti and its environs. Samples were collected three times from the month of June to August, 2018. Parameters investigated include pH, Total Dissolved Solid (TDS), Turbidity, Electrical Conductivity (EC), Alkalinity, Total Hardness, Ca2+, Mg2+, Na+, K+, Fe, Pb, Zn, Al, and Cu. Data obtained were subjected to descriptive statistics to determine the mean and standard deviation and water quality index measured. The result shows that the physicochemical parameters ranges from 8.03-9.17 (pH), 0.47-3.17 NTU (Turbidity), 56.20 -170.43 μs/cm (EC), 30.2-50.53 mg/L (TDS), 18.56-27.58 mg/L (Alkalinity), 19.94-24.08 mg/L (Total Hardness), 8.67-14.93mg/L (SO4 2+), 4.11-11.67mg/L (Cl-), 0 - 4.62 mg/L (Zn2+), 7.11-11.13 mg/L (Calcium), 0.07-1.56 mg/L (Al2+), 0.01-0.02 mg/L (Cu2+), 9.41-21.33 mg/L (Mg2+), 29.04-40.35 mg/L (Na2+) and (Fe2+) 0.1-0.29 mg/L . Most of the measured parameters were all within permissible water quality standard as recommended by World Health Organizations (WHO) except for the slightly basic character of the rainwater. All measured parameters were high in aluminum sheets and coated rooftops but did not exceed the World Health Organization permissible limit followed by Galvanized zinc rooftop and Panted rooftop. Water Quality Index (WQI) for painted rooftop, aluminum rooftop, galvanized zinc rooftop, and coated rooftop were 3.296, 1.335, 6.078 and 2.629 respectively indicating excellent water quality. The study found that harvested rainwater in the area could be used for domestic purpose with minimum treatment to enhance drinkability. [ABSTRACT FROM AUTHOR]

Background. Neonatal jaundice remains a leading cause of preventable brain damage, mental handicap, physical disabilities and early death among infants. The high mortality and morbidity from neonatal jaundice is exacerbated by the poor understanding and mismanagement of this common neonatal problem by the general populace, leading to dangerous delays and complications. Objective. To assess the knowledge of pregnant women on the causative factors, treatment modalities and sequelae of neonatal jaundice. Methods. Data were obtained from all consecutive women who attended the antenatal clinic of the Lagos University Teaching Hospital, Nigeria, from January 2013 to April 2013, using a pretested questionnaire focusing on knowledge of neonatal jaundice and its causes, treatment and complications. Results. The study participants numbered 395, of whom 213 (53.9%) were within the age range of 30 - 39 years. Only 101 (25.6%) participants gave a correct definition of neonatal jaundice. The highest proportion of those who did not give a correct definition were from the lower socioeconomic groups V and IV (χ2=12.08, p=0.017). Participants who did not know the causes numbered 313 (79.2%), while 325 (82.2%) participants chose ineffective treatment options. Furthermore, 296 (74.9%) respondents, especially those with a low level of education, did not identify the complications correctly (χ2=12.61, p=0.006). Conclusion. Women in the study showed inadequate knowledge of and misconceptions regarding neonatal jaundice, which must be addressed in order to reduce significantly the devastating consequences of this common condition. We advocate for improved female literacy and mass health enlightenment programmes. [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of a structured group education program on non-glycemic endpoints of diabetes knowledge, compliance with treatment and medical advice, use of monitoring devices, and treatment satisfaction. A cross-sectional comparative design was employed. Study participants were members of the local Diabetes Association (DAN) who had participated in a structured group education program and comparison subjects were outpatients with type 2 diabetes mellitus who had not registered as members of DAN and do not attend DAN activities. Self- and interviewer-administered structured questionnaires were used to determine study endpoints. The responses of study participants were analyzed and then compared. Seventy-five patients were studied in each group comprising 78 males and 72 females. DAN members had good knowledge of their disease, complied satisfactorily with their medications and physician's advice, knew and used at least one monitoring device and had better knowledge of hypoglycemia than control subjects. Treatment Satisfaction scores were also higher among DAN members. Diabetes associations and clubs provide a practical and acceptable means of disseminating diabetes related information and should be strengthened. [ABSTRACT FROM AUTHOR]

Background: To address the need for improved virologic suppression among youth living with HIV (YLH) on antiretroviral treatment (ART), we evaluated peer navigation plus TXTXT daily text message ART reminders., Setting: YLH aged 15-24 years on ART for at least 3 months at 6 research sites in 4 Nigerian cities., Methods: Using a stepped-wedge design, cluster 1 was nonrandomized, whereas clusters 2 and 3 were randomized to sequences of routine care (control period) and 48 weeks of the combination intervention (intervention period). The primary end point was viral suppression (HIV-1 RNA <200 copies/mL) at week 48 of the intervention. Secondary end points included adherence measured by self-report ( 90% considered adherent). Post hoc analysis assessed virologic control at <50 copies per milliliter and <1000 copies per milliliter. Generalized estimating equations determined the difference between intervention and control periods in the intention-to-treat population., Results: We enrolled 558 YLH and followed 541 over time, mean age 18 years, 53.8% female, 71.7% perinatally infected, and 38.6% virologically nonsuppressed at enrollment. For the primary end point, the intervention periods displayed a small, nonsignificant increase in viral suppression < 200 copies per milliliter [odds ratio (OR) = 1.16 (0.88-1.54), P = 0.297]. There was a significant effect of the combination intervention on virologic control <1000 copies per milliliter (OR = 1.42 [1.03-1.94], P = 0.030). Self-reported adherence also improved (OR = 2.07 [1.46-2.95], P < 0.001)., Conclusions: Peer navigation plus daily text message ART reminders demonstrated limited benefit among ART-experienced, predominantly perinatally infected YLH, with no significant effect on viral suppression below 200 copies per milliliter despite improvement in self-reported adherence., Competing Interests: B. O. Taiwo has received consultant fees in the past from ViiV/GSK, Gilead, and Johnson and Johnson. The remaining authors have no funding or conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a causative agent of COVID-19 is a leading cause of ill-health and deaths worldwide. Currently, COVID-19 has no known widely approved therapeutics. Thus, the need for effective treatment., Objectives: We investigated the safety and efficacy of two (2) therapeutic agents; chloroquine phosphate (CQ), 2- hydroxychloroquine (HCQ) and a control (standard supportive therapy) among hospitalized adults with COVID-19., Methods: The clinical trial was done in accordance to the World Health Organization master protocol for investigational therapeutics for COVID-19. Atotal of 40 participants with laboratory-confirmed positive COVID-19 were enrolled. Blood samples and oropharyngeal (OP) swabs were obtained on days 1,3,15 and 29 for safety and efficacy assessments., Results: The baseline demographics showed that the median ages in years (range) were 45 (31-57) in CQ, 45 (36.5-60.5) in HCQ, 43 (39.5-67.0) and 44.5 (25.3-51.3) in the control (P<0.042).At randomization, seven (7) participants were asymptomatic, thirty-three (33) had mild symptoms, eight (8) had moderate symptoms while three (3) had severe symptoms. The average day of conversion to negative COVID-19 was 15.5 days for CQ, 16 days for HCQ and 18 days for the control(P=0.036)., Conclusion: The safety assessment revealed no adverse effect of the drugs in COVID-19 patients after treatment. These findings proved that chloroquine and hydroxychloroquine are effective for the treatment of COVID-19 among hospitalized adults. It also confirmed that they are safe., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

Background Selenium is an essential micronutrient that plays a crucial role in a wide range of physiological processes, including immune responses. Selenium deficiency has been recognized as an associated factor in the progression of HIV to advanced HIV disease and/or mortality. Although selenium supplementation has been shown to reduce hospitalizations and improve cellular immunity, the evidence remains mixed. This study aimed to determine the prevalence of selenium deficiency and its relationship with HIV disease markers in HIV-infected children at the Lagos University Teaching Hospital. Methodology This is a cross-sectional, comparative, pilot study of plasma concentrations of selenium in HIV-infected (n = 30) and non-infected (n = 20) children enrolled in the pediatric HIV clinic of the Lagos University Teaching Hospital, Lagos, Nigeria, from May 2019 to May 2021. HIV-infected children were on stable antiretroviral therapy (ART) with an undetectable viral load. The serum concentration of selenium was measured using the automated atomic absorption spectrophotometer (hydride generation method). Logistic regression was used to study the effect of selenium status on the levels of HIV disease markers (CD4 count, viral load, weight, opportunistic infections) in the study participants. Results The median age of all participants was nine (4-12) years, with 74% being boys. The mean selenium concentrations were lower in HIV-infected children (91.1 ± 12.0 µg/L) compared to the comparison group without HIV (147.8 ± 4.9 µg/L) (p = 0.001). After controlling for age, ART duration, markers of HIV infection, and other potentially confounding variables, participants with selenium deficiency had approximately 11-fold odds of increased hospital admissions (adjusted odds ratio = 10.57, 95% confidence interval = 1.58 to 70.99; p = 0.015). Conclusions In this study, selenium concentrations were significantly lower in HIV-infected children than in the HIV-negative comparison group. Lower serum selenium concentrations were associated with increased hospitalizations. Although our findings suggest the potential need for selenium supplementation for children living with HIV in Nigeria, further studies are warranted to determine the safety and efficacy of selenium supplementation in this key population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, John-Olabode et al.)

Introduction: the high expectations that heralded the development of COVID-19 vaccines has been plagued with vaccine hesitancy (VH). The prevalence and associated factors of COVID-19 VH in the six geopolitical zones in Nigeria are explored., Methods: using a cross sectional survey, a pre-tested and validated questionnaire on a "Google form" was distributed via social media platforms and hard copies in the six geopolitical zones of Nigeria. Included, using a chain-reference sampling technique, were healthcare workers (HCW), university students and adults in the general population. Participants who expressed unwillingness to receive COVID-19 vaccine in the event of an available vaccine were considered to have vaccine hesitancy. Frequency and percentage were used to describe categorical variables. Multivariable logistic regression analysis was used to assess for factors associated with VH. Level of significance was set at 5% on two-sided tails test., Results: among 1615 respondents, mean (standard deviation) age was 36.7 (11.3) years, and 847 (52.4%) were males. More than half were healthcare workers (943; 58.4%), 97.4% had at least secondary level of education, and majority 60.5% belonged to the upper social class. The prevalence of VH was 68.5% (1107/1615), and 67.2% preferred foreign manufactured COVID-19 vaccines. On multivariable regression analysis, residence in Northeast (AOR 6.01, 95% CI 2.24, 16.10) and Northwest (AOR 3.33, 95% CI 1, 48, 7.48) geopolitical zones, the Igbo ethnic group (AOR 1.88, 95% 1.10, 3.22), Christians (AOR 1.86, 95% 1.10, 3.14), nurses (AOR 3.50, 95% CI 1.25, 9.80), pharmacist (AOR 5.82, 95% CI 2.12, 16.32) and participants without confidence in foreign vaccines (AOR 4.13, 95% CI 2.99, 5.72) were at higher likelihood of VH., Conclusion: vaccine hesitancy is high among adults in Nigeria, with higher likelihood among the Igbo ethnic group, Christian faith, residence in Northeast and Northwest geopolitical zones and those with an aversion to foreign-made vaccines. Targeted interventions are required for the desired COVID-19 vaccine uptake rate and herd immunity., Competing Interests: The authors declare no competing interests., (Copyright: Babatunde Oluwatosin Ogunbosi et al.)

Background: Multisystemic inflammatory syndrome in children (MIS-C) has increasingly been documented globally with the progression of the COVID-19 pandemic and a significant proportion of cases have been noted in children of Black descent. There has been a noticeable discrepancy in the presentation and outcomes of COVID-19 infection in sub-Saharan Africa compared to the rest of the world. We documented the demography, clinical features, laboratory and imaging findings, therapeutic management, and short-term outcomes of paediatric patients with MIS-C diagnosed during the COVID-19 pandemic in Lagos, Nigeria., Methods: We carried out a retrospective review of MIS-C cases seen in nine public and private hospitals in Lagos from July 10, 2020 to July 30, 2021. Data on clinical presentation, laboratory investigations, therapy as well as outcomes at 2 weeks, 6 weeks, 3 months and 6 months were analyzed., Findings: 28 children and adolescents with median age of 7·5 (IQR 2·3 - 9·4) years were diagnosed with MIS-C. MIS-C was suspected in 24 patients (85·7%) at initial clinical evaluation and mucocutaneous, gastrointestinal and cardiovascular manifestations were identified in 75·0%, 71·4% and 89·3% of patients respectively. Acute kidney injury and aseptic meningitis were noted in 32·1% and 17·9% of patients respectively. Cardiac manifestations at presentation included coronary dilatation and pericardial effusion in 46·4% each, ventricular dysfunction (32·1%), atrioventricular valve regurgitation (25·0%), prolonged QTc interval (40·0%) and first-degree atrioventricular block (16·0%). Therapy included aspirin in 89·3%, steroids in 75·0% and intravenous immunoglobulin (IVIG) infusion in 60·7%. All patients survived and were discharged after a mean of 11·14 (SD 5·65) days. Frequency of coronary dilatation had reduced from 46·4% to 7·1% by 3 months follow up and prolonged QTc interval persisted until the 6 week follow up in 4.5% of patients. Echocardiogram and electrocardiogram findings were normal in all patients assessed at 6 months follow up., Interpretation: MIS-C is an important diagnosis in children presenting with prolonged fever during the COVID-19 pandemic. Cardiovascular manifestations occurred in several children with MIS-C and improved by 6 months follow up. Early diagnosis and prompt institution of a combination of antiplatelet therapy, steroids and IVIG appear to be beneficial., Funding: None., Competing Interests: We declare no competing interests., (© 2022 The Authors.)

Most of the reviews on histoplasmosis documented in literature have been in the adult population. Very few studies highlight the peculiarities associated with histoplasmosis in Africa especially in the pediatric population. This review addresses the above concerns with clinical summaries and diagnosis of some case reports of histoplasmosis in African children. We highlighted 44 case reports of histoplasmosis in African children (1950-2021) distributed across Western Africa (38.6%, n  = 17), Eastern Africa (9.1%, n  = 4), Southern Africa (9.1%, n  = 4), and Central Africa (43.2%, n  = 19). No case report was found from Northern Africa. The age range was 1-17 years, with a mean of 9.2. Of the 44 case reports, 8 cases (18.2%, 8/44) were caused by Histoplasma capsulatum var capsulatum , 33 cases (75%, 33/44) were caused by Histoplasma capsulatum var duboisii , and specie identification was not found in 3 cases. Only three (6.8%) cases were HIV positive; 56.8% (25/44) were disseminated histoplasmosis, pulmonary histoplasmosis accounted for just one case (2.3%, 1/44). Extrapulmonary presentation included skin lesions (ulcers, fistulas, nodules, patches, pigmentations, papules, and abscesses), bone lesions, osteoarthritis, and fractures. The commonest sites affected were skin ( n  = 29, 65.9%), bones ( n  = 20, 45.5%), and lymph nodes ( n  = 15, 34.1%). Histopathology was the commonest diagnostic method ( n  = 33, 75%). Amphotericin B was first-line therapy in 45.5% of the cases ( n  = 20) followed by ketoconazole (20.5%, n  = 9); 27 cases (61.4%) had favorable outcomes, 8 cases (18.2%) had fatal outcomes, while in 9 cases, the outcome was not revealed. This review revealed several cases of histoplasmosis misdiagnosed as other conditions including tuberculosis ( n  = 3, 6.8%), pneumonia ( n  = 1, 2.3%), cancers ( n  = 4, 9.1%), nephritic syndrome ( n  = 1, 2.3%), leishmaniasis ( n  = 1, 2.3%), and hyperreactive malarial splenomegaly syndrome ( n  = 1, 2.3%). In addition, histoplasmosis was not considered in some case reports even when symptoms were suggestive. Diagnosis of histoplasmosis was made at autopsy with postmortem findings suggestive of histoplasmosis ( n  = 3, 6.8%). This report highlights the need for a paradigm shift on the part of pediatricians in Africa. They need to look beyond clinical conditions considered common in our environment for this age group and evaluate for other diseases including histoplasmosis., Competing Interests: Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2022.)

Objectives: The objective of this study was to explore the access to, and perceived utility of, various simulation modalities by in-service healthcare providers in a resource-scarce setting., Setting: Paediatric training workshops at a national paediatric conference in Nigeria., Participants: All 200 healthcare workers who attended the workshop sessions were eligible to participate. A total of 161 surveys were completed (response rate 81%)., Primary and Secondary Outcome Measures: A paper-based 25-item cross-sectional survey on simulation-based training (SBT) was administered to a convenience sample of healthcare workers from secondary and tertiary healthcare facilities., Results: Respondents were mostly 31-40 years of age (79, 49%) and women (127, 79%). Consultant physicians (26, 16%) and nurses (56, 35%) were in both general (98, 61%) and subspecialty (56, 35%) practice. Most had 5-10 years of experience (62, 37%) in a tertiary care setting (72, 43%). Exposure to SBT varied by profession with physicians more likely to be exposed to manikin-based (29, 30% physicians vs 12, 19% nurses, p<0.001) or online training (7, 7% physician vs 3, 5% nurses, p<0.05). Despite perceived barriers to SBT, respondents thought that SBT should be expanded for continuing education (84, 88% physician vs 39, 63% nurses, p<0.001), teaching (73, 76% physicians vs 16, 26% nurses, p<0.001) and research (65, 68% physicians vs 14, 23% nurses, p<0.001). If facilities were available, nearly all respondents (92, 98% physicians; 52, 96% nurses) would recommend the use of online simulation for their centre., Conclusions: The access of healthcare workers to SBT is limited in resource-scarce settings. While acknowledging the challenges, respondents identified many areas in which SBT may be useful, including skills acquisition, skills practice and communication training. Healthcare workers were open to the use of online SBT and expressed the need to expand SBT beyond the current scope for health professional training in Nigeria., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: No large studies have examined the prevalence of enuresis, its various forms and risk factors in children with sickle cell anaemia (SCA) in Sub-Saharan Africa using standardised definitions. We determined age and gender-specific prevalence of enuresis and compared the nature of enuresis in children with and without SCA. We also identified predictors of enuresis in children with SCA., Methods: Caregivers of children with SCA attending a tertiary centre haematology clinic in Nigeria were interviewed using a questionnaire. In addition, a separate questionnaire was completed for every sibling aged 5-17 years whose haemoglobin genotype was known. Enuresis and its various forms were defined using the definitions of the International Children's Continence Society., Results: The study involved 243 children with SCA and 243 controls matched for age and sex. The mean age of the study cohort was 9.9 (3.4). Females made up 45.7% of the cohorts. The prevalence of enuresis was 49.4% and 29.6% in children with and without SCA, respectively (p = 0.009). In both groups, the prevalence of enuresis declined with age but remained five times higher at 25% in children with SCA aged 14-17 years compared with controls. Also, children with SCA and enuresis were older, more likely to have non-monosymptomatic enuresis and wet at least three nights per week than controls. Independent predictors of enuresis in children with SCA were a family history of enuresis and young age., Conclusion: Children with SCA had more frequent and more severe enuresis which persisted to late adolescence than age and sex-matched controls. These features indicate a subset of enuresis that is difficult to treat in the general population. Young age and enuresis in a family member define a subset of children with SCA more likely to have enuresis. Healthcare workers need to discuss enuresis with parents of children with SCA and offer referral to continence services., Competing Interests: The authors have declared that no competing interests exist.

Background: Sickle cell anaemia (SCA) is associated with growth failure. However, recent reports indicate high rates of overweight or obesity among children with SCA in developed countries. It is unclear whether overweight or obesity is also common in children with SCA in developing countries. The objectives of the study were to determine the prevalence of overweight or obesity, wasting and stunting and identify predictors of wasting and stunting among children with SCA in Nigeria., Method: Children with SCA attending a public-funded tertiary hospital clinic were studied. Weight, height, haemoglobin, haemoglobin fractions and white cell count were measured. Anthropometric values were converted to z scores and referenced to the WHO Child Growth Standards and WHO Reference 2007. The proportions with wasting, stunting and overweight or obesity were determined. Regression analysis was used to identify the predictors of wasting and stunting., Results: Two hundred and thirty-three children [mean (±SD) age of 9.0 (±4.0) years, 60.9 % males] participated in the study. Wasting, stunting and overweight or obesity rates were 22.7 %, 11.6 % and 1.7 %, respectively. Boys and children from low socioeconomic class were 3.25 (1.45-7.29) and 2.42 (1.14-5.18) times more likely to be wasted respectively, while both wasting and stunting were more common with increasing age [adjusted OR of 1.33 (1.18-1.51) and 1.15 (1.01-1.32) respectively]. Sickle cell-related complications and intake of oral penicillin and hydroxyurea were not associated with wasting and stunting., Conclusion: Overweight or obesity is uncommon while wasting and stunting are still prevalent in children with SCA in Lagos. The strongest predictors of wasting and stunting were older age, male gender and low socioeconomic status.

Background: To review the pediatric care and treatment program at Massey Street Children Hospital, in Lagos, Nigeria a retrospective analysis of medical records focusing on health services, survival and retention in care., Methods: The analysis covered a cohort of children initiated on antiretroviral therapy (ART) from 2005 to 2011. In this population, pediatric HIV care was defined as initiating ART between ages 0 and 14 years. Treatment initiation and follow-up were according to the Nigerian national guidelines for pediatric ART, which are based on World Health Organization guidelines adapted to our local context. The primary endpoint was mortality measured as cumulative survival. Other outcomes of interest included "loss to follow-up", "transferred out", and "stopped treatment"., Results: Mean (SD) age at ART initiation was 51 (39) months in female children and 52 (42) months in male children. After seven years of ART care, 64% of the 660 study children were retained in care and on treatment, 16% were lost to follow-up, 10% were dead, and 9% had discontinued HIV care at this facility for other reasons. World Health Organization disease stage, CD4 count, age, and year of ART initiation were highly predictive of mortality, while anemia at baseline was not statistically significantly associated., Conclusions: Overall study results suggest a viable pediatric HIV program exists at the study facility. Retention rates were lowest for the earliest cohort of infected children, which implies long-term challenges. Mother-to-child transmission programs need to be dynamic to stem the scourge of pediatric HIV in Nigeria.