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Background: Despite a global decline in mortality and morbidity from measles in the last decade, outbreaks continue to occur in some parts of the world including Nigeria. Objective: To determine antibody response to routine measles vaccination in Nigerian children and evaluate vaccine potency. Methods: A prospective study of 234 children selected from 3 health centres in an urban area of Lagos, Nigeria. Blood was obtained before and 8-12 weeks after routine vaccination with Edmonston- Zagreb strain of measles vaccine. Antibodies were detected using the measles antibody neutralization test. Reconstituted vaccines samples were analysed for potency on monolayers of Vero slam cells in 96-well tissue culture plates. Results: Twenty seven(11.5%) had pre-vaccination antibodies. Seroconversion rate among the 195 who returned for post vaccination sampling was 69.2%: It was however 74.2% in children with no pre-vaccination antibodies compared to 17.6% in those with antibodies. (p

Abstract Background Childhood obesity and associated hypertension are major public health concerns globally. This study aimed to determine the prevalence of obesity and the associated risk of high blood pressure among Nigerian adolescents. Methods A cross-sectional school-based study of 885 apparently healthy adolescents was performed. Weight, height and blood pressure (BP) were measured using standard methods. Body mass index (BMI) was calculated and categorized by age, sex and percentile. Obesity and overweight were defined as: ≥ 95th and 85th to < 95th percentiles, respectively, for age, sex and height. Subjects were sub-categorized into age 10–13 years (A) and 14–17 years (B). The odds ratio for pre-hypertensive and hypertensive range BP by age and BMI were generated. Significance was set at P Results The prevalence of overweight and obesity were 13.8% and 9.4%, respectively. The prevalence of hypertensive range systolic BP in obese versus normal BMI females was 16% versus 23% (p=0.00) and 12.1% versus 6.4% (p=0.27) in males. The prevalence of hypertensive range diastolic BP in obese versus normal BMI females was 12% versus 1.4% (p=0.00) and 15.2% versus 3.5% (p=0.01) in males. BMI in group B was significantly associated with pre-hypertensive and hypertensive range systolic BP in overweight (P = 0.01, P = 0.002) and obese subjects (P = 0.00, P = 0.00) and with hypertensive range diastolic BP (P = 0.00) only in obese subjects. The only significant association in group A was between obesity and pre-hypertensive range diastolic BP (P = 0.00). Conclusion The prevalence of hypertensive range BP among obese Nigerian adolescents was high. Screening for childhood obesity and hypertension, and long-term follow-up of obese adolescents into adulthood are recommended.

Background: Kidney transplantation (KT) is the gold standard treatment for children with chronic kidney disease stage 5 (CKD5). It is easily accessible in well-resourced countries, but not in low/middle-income countries (LMICs). We present, a multicentre experience of paediatric KT of children domiciled in Nigeria. We aim to highlight the challenges and ethical dilemmas that children, their parents or guardians and health care staff face on a daily basis., Methods: A multicentre survey of Nigerian children who received KTs within or outside Nigeria from 1986 to 2019 was undertaken using a questionnaire emailed to all paediatric and adult consultants who are responsible for the care of children with kidney diseases in Nigeria. Demographic data, causes of CKD5, sources of funding, donor organs and graft and patient outcome were analysed. Using Kaplan-Meier survival analysis, we compared graft and patient survival., Results: Twenty-two children, aged 4-18 years, received 23 KTs, of which 12 were performed in Nigeria. The male-to-female ratio was 3.4:1. Duration of pre-transplant haemodialysis was 4-48 months (median 7 months). Sixteen KTs were self-funded. State governments funded 3 philanthropists 4 KTs. Overall differences in graft and patient survival between the two groups, log rank test P = 0.68 and 0.40, respectively were not statistically significant., Conclusions: The transplant access rate for Nigerian children is dismal at < 0.2%. Poor funding is a major challenge. There is an urgent need for the federal government to fund health care and particularly KTs. Graphical Abstract.

Introduction: Human immunodeficiency virus and protein energy malnutrition are still prevalent in Nigeria and the occurrence of the two conditions together confers a poor prognosis. The aim of this study was to determine the current categories of malnutrition amongst under-5 children in Lagos, document their HIV status and determine any peculiarities in the clinical features, haematological and some biochemical profile in these children., Methods: The study was a cross-sectional study conducted at the Paediatric departments of the Lagos University Teaching Hospital and the Massey Street Children's Hospital, both in Lagos, over a 6-month period. All the subjects had anthropometry, HIV testing, full blood count and serum proteins done. The factors associated with HIV status were determined with the logistic regression analysis., Results: Two hundred and fourteen (214) malnourished children ≤5 years, including 25 (11.7%) with HIV were recruited in the study. Among the study participants, 150 (70.1%) and 54 (29.9%) had moderate and severe malnutrition, respectively. Fever, cough and diarrhea were the most common symptoms in the study participants. The haematological indices were comparable in the two groups, the serum globulin levels though higher in the HIV infected group was not statistically significantly different from the non-infected group.(p = 0.66). None of the factors explored on multivariate analysis was able to predict the occurrence of the infection in this cohort., Conclusion: Malnourished children remain a high risk group for HIV infection and the prevalence of the infection obtained in this group of children is still unacceptably high. Discriminatory features between malnutrition and HIV remains difficult. The presence of hyperglobulinaemia on laboratory analysis in a malnourished child may heighten the suspicion of possible underlying associated HIV infection. Screening of malnourished children for HIV infection and further longitudinal studies on malnourished children with HIV is advocated., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Children with steroid resistant nephrotic syndrome usually require treatment with second-line agents and calcineurin inhibitors such as cyclosporine are now recommended as initial therapy. These agents only recently become available in our environment and their impact on care is unknown. We reviewed the short-term treatment outcomes of their use in comparison with previous outcomes., Methods: Medical records of children managed for idiopathic steroid resistant nephrotic syndrome over a 5 year period were reviewed. Remission rates and improvement in renal function following use of various agents were compared., Results: Of 103 children with idiopathic nephrotic syndrome, 25(24.3%) were steroid resistant, of whom 17 received additional medications. Full remission rate for cyclosporine was 70% (7/10). Remission rates prior to the availability of cyclosporine were 40% (2/5) for cyclophosphamide and 66% (2/3), (partial remission only) with enalapril, an angiotensin converting enzyme inhibitor used in combination with alternate day prednisolone. One child with cyclophosphamide resistance subsequently achieved remission with cyclosporine. Remission was not related to sex (p=0.96) , age (p=0.54) , serum albumin (p=0.37) or hypertension (p=0.43) but to serum cholesterol (p= 0.02) . The estimated glomerular filteration rate (eGFR) among children treated with cyclosporine ranged from 30-167 ml/min/1.73m 2 as follows: >90 (5); 60-89 (3); 30-59 (2) while the mean pre and post treatment eGFR in those with eGFR <90 were 60 and 104ml/min/1.73m 2 respectively (p=0.03) . Mortality rate was 10% (1/10) in children treated with cyclosporine compared with 28.6% (2/7) in those treated with other medications (p=0.54) ., Conclusion: Cyclosporine resulted in improved treatment outcomes in children with idiopathic steroid resistant nephrotic syndrome., Competing Interests: The authors declare no competing interests.

Background: Current methods of detection of childhood hypertension are cumbersome and contribute to under-diagnosis hence, the need to generate simpler diagnostic tools. The blood pressure to height ratio has recently been proposed as a novel screening tool for prehypertension and hypertension in some populations. We evaluated its applicability in our environment., Materials and Methods: The weights, heights, and blood pressure measurements of 2364 apparently healthy adolescents were determined. Sex-specific systolic and diastolic blood pressure to height ratios (SBPHR) and (DBPHR) were calculated, and their ability to detect prehypertension and hypertension was determined using receiver operating curves. Discriminatory ability was measured by the area under the curve (AUC) and optimal cutoff points along the curve were determined. P < 0.05 was considered statistically significant., Results: The SBPHR and DBPHR were similar across all age groups and sexes. The AUC of SBPHR and DBPHR for diagnosing prehypertension and hypertension by sex was >0.95 for both diastolic and systolic hypertension in both sexes. It ranged between 0.803 and 0.922 for prehypertension and 0.954-0.978 for hypertension indicating higher accuracy for hypertension. Sensitivity was higher for systolic and diastolic hypertension (90-98%) compared with prehypertension (87-98%). Specificity was lower than sensitivity across all categories of hypertension and prehypertension (0.64-0.88%) though higher for hypertension (0.75-0.88) compared with prehypertension (0.64-0.75)., Conclusion: BPHR is a useful screening tool for prehypertension and hypertension in black adolescents. Accuracy increased with higher degrees of hypertension.

Background: The clinical course of steroid-sensitive nephrotic syndrome (SSNS) among Nigerian children has rarely been reported; this makes prognostication difficult., Objectives: The objective was to determine the frequency of relapses including frequent relapses (FR) and steroid-dependence (SD) in a cohort of Nigerian children with SSNS. A secondary objective was to identify clinical and demographic factors associated with relapse in these children., Methods: Medical records of children with SSNS in a Tertiary Hospital in Nigeria were reviewed. Children with onset of nephrotic syndrome (NS) at age <1-year, follow-up period <12 months and secondary causes of NS were excluded. The relapse status of each child was determined in the 1st and 2nd year after diagnosis and the proportions with no relapse, FR and SD were calculated., Results: Fifty children (68% males; median [range] age at onset of NS 4.8 [1.1-14.9] years) were followed-up for 31.1 (12.1-79.8) months. In the 1st and 2nd year of follow-up, 23 (46%) and 24 (70.6%) children experienced relapse, respectively. In the 1st-year, 0% and 10% had FR and SD while in the 2nd year 2.9% and 11.8% had FR and SD, respectively. Age at onset of NS, gender, time to first remission, serum creatinine or presence of hypertension or microscopic hematuria was not associated with 1st or 2nd year relapse., Conclusion: About half and two-thirds of children with NS in our center experience relapse in the 1st and 2nd year of follow-up, respectively; much fewer proportions experienced FR and SD in these periods. None of the commonly reported demographic and clinical factors was associated with NS relapse.

Introduction: Childhood enuresis is common, but the prevalence and factors associated with childhood enuresis in Africa have been poorly described. Furthermore, most studies from the continent have not provided data distinguishing monosymptomatic from non-monosymptomatic enuresis. This distinction is important as it guides enuresis therapy., Objectives: The primary objective of this study was to determine the prevalence of enuresis in children aged 5-17 years in a community in Nigeria. The secondary objectives were to determine the relative proportions of monosymptomatic and non-monosymptomatic enuresis and identify independent sociodemographic and clinical predictors of enuresis., Study Design: Parents or guardians in the community were interviewed using a pretested questionnaire. Standardized definitions were used, as recommended by the International Children's Continence Society., Results: A total of 928 children were included in the study. The prevalence of enuresis or daytime incontinence and enuresis was 28.3% (enuresis 24.4%, and daytime incontinence and enuresis 4%); it decreased with age. Primary and monosymptomatic enuresis were the most common types of enuresis. In multiple logistic regressions, children aged 5-9 years were 10.41 (5.14-21.05) times more likely to have enuresis or daytime incontinence and enuresis compared with those aged 14-17 years. Other predictors of enuresis or daytime incontinence and enuresis were: male gender (OR 1.56 (1.13-2.14)); constipation (OR 2.56 (1.33-4.93)); and a sibling (OR 2.20 (1.58-3.06)) or parent (OR 3.14 (2.13-4.63)) with enuresis. Enuresis or daytime incontinence and enuresis was 1.92 (1.06-3.48) times more likely in fourth-born, or higher, children compared with first-born children. Only parents of nine (3.4%) children with enuresis had consulted a medical doctor about it., Discussion: The high prevalence of childhood enuresis in the present study was consistent with most studies from developing countries and contrasted sharply with the lower rates reported among children in developed countries. Common reasons for this disparity were the influence of socioeconomic status on enuresis rates and the low utilization of effective enuresis therapies in developing countries. Consistent with published literature, monosymptomatic enuresis was the commonest form of enuresis in the present study. Furthermore, younger age, male gender and a family history of enuresis were strongly associated with enuresis. A major limitation of the study was the lack of use of a voiding diary., Conclusion: Childhood enuresis was common in the community but parents rarely sought medical attention. Predictors of enuresis were younger age, male gender, constipation, higher birth order, and a family history of enuresis., (Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Surgery for reno-vascular hypertension (RVH) is complex, and the techniques utilized vary with anatomical presentations of the disease. The long-term outcome of revascularization on RVH in children with Takayasu's arteritis (TA)-induced renal artery stenosis (RAS) at our centre was reviewed., Methods: This study was a 21-year retrospective review of pre- and post-intervention RVH in children with angiographically confirmed RAS. The outcome of hypertension was defined as follows: (1) cured (normotensive off anti-hypertensives), (2) improved (normotensive on same or reduced number of medications), or (3) failure (no cure or improvement in number of medications)., Results: The medical histories of 59 children (median age 9.98 years) were reviewed, of whom 20 (44 %) had revascularization procedures. All were hypertensive, with a mean systolic and diastolic blood pressure of 161.5 ± 36 and 106.5 ± 31 mmHg, respectively. RAS was present in 45 (76.3 %) children. Twenty-four revascularization procedures were performed in 20 children (44 %), of whom five had contralateral nephrectomies. Outcome was available for 17 patients at the 3- and 6-months follow-up, with cure, improvement and failure rates at 3 months of 2/17 (11.8 %), 7/17 (41.2 %) and 8/19 (47 %), respectively, and similar rates at 6 months. Associations between outcome and age (p = 0.51), sex (p = 0.32), number of pre-surgery anti-hypertensives (p = 0.18) and stenosis sites (p = 0.22) were not statistically significant., Conclusions: Revascularization was beneficial to the management of blood pressure control in about half of our RVH patients.

Introduction: In resource-constraint regions of the world, the spectrum of childhood diseases is changing, creating a need to clearly define the epidemiology of severe acute kidney injury (AKI)., Methods: Medical records of children aged between 1 month and 17 years with stage 3 AKI in a tertiary hospital were reviewed., Results: Ninety-one children, comprising 63 (69.2%) males and 26 (28.6%) infants, were studied. Majority (75.8%) had stage 3 AKI at the point of hospitalization. Sepsis (41.8%), primary kidney diseases (PKD; 29.7%) and malaria (13.2%) were the most common causes of stage 3 AKI. Twenty-eight (30.8%) children died. Mortality was highest in those with sepsis, less than 5 years old and needing dialysis., Conclusion: Sepsis, PKD and malaria were the most common causes of severe AKI. A third of children with severe AKI died. Mortality was highest in those less than 5 years old, with sepsis and needing dialysis., (© The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Microsporidia are an emerging group of pathogens associated with life-threatening opportunistic infections in immunocompromised hosts, particularly human immunodeficiency virus (HIV)-infected individuals. There have, however, been recent reports of infection in adult solid organ transplant recipients. We report two cases in children, to our knowledge the first in the paediatric literature. Two 13-yr-old, HIV-seronegative females received deceased donor renal transplants from the same donor. Both patients suffered acute cell-mediated rejection and CMV infection reactivation, managed with intensified immunosuppression and ganciclovir. Pyrexia of unknown origin and intermittent diarrhea in both prompted extensive investigations. In both patients, numerous spores of a microsporidial species were demonstrated in renal tissue on biopsy and in the urine, using modified trichrome and quick-hot Gram-chromotrope staining. Electron microscopy and PCR confirmed Encephalitozoon cuniculi infections. Both patients were successfully treated with 400 mg twice daily of albendazole, with sustained clinical improvement. We recommend that microsporidiosis be considered in the differential diagnosis of pyrexia of unknown origin in severely immunocompromised pediatric solid organ transplant recipients, particularly when associated with diarrhea., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Insufficient data to guide the authorities responsible for resource allocation and a focus on communicable diseases increase the challenges of care of children with kidney disease in resource-constrained settings like ours. This study was performed with the aim to describe the current spectrum of pediatric nephrology disease in a tertiary hospital in Sub-Saharan Africa and highlight the challenges encountered in their care. A 4-year retrospective review of pediatric renal admissions was carried out and the overall prevalence, disease-specific prevalence and mortality rates were determined. Results were compared with nationwide data. Kidney diseases accounted for 8.9% of pediatric admissions with a prevalence of 22.3 admissions per 1000 child-admissions per year. Nephrotic syndrome, acute kidney injury and nephroblastoma accounted for almost 70% of admissions. The overall mortality was 14.4% with acute kidney injury accounting for 36% of this. Chronic kidney disease was also associated with poor outcome. The spectrum of disease nationwide is similar with a wide variation in disease-specific prevalence between geographic regions. The prevalence of genetic and hereditary conditions was low. The prevalence of pediatric renal disease in our environment is on the increase and associated with significant morbidity and mortality. Late presentation and high treatment costs were limitations to care. Preventive nephrology, training of pediatric nephrologists and strengthening of health insurance schemes are advocated.

Unlabelled: ♦, Introduction: International professional groups are supporting the training of physicians in developing countries in nephrology, including peritoneal dialysis (PD). This report documents the impact of such efforts in the provision of manual PD for children with acute kidney injury (AKI) in a public hospital in Lagos, Nigeria. ♦, Methods: Medical records of all children with AKI managed with PD between July 2010 and March 2013 were reviewed. ♦, Results: Seventeen children with a mean (SEM) age of 3.8 (0.8) years received PD for 0 - 18 days; about half were infants. PD was provided manually, frequently with intercostal drains as catheters. Blockage of catheters and peritonitis occurred in 4 (23.5%) and 2 (11.8%) children, respectively. Eight (47.1%) of the 17 children had resolution of AKI and were discharged from hospital. In 4 (57.1%) of the 7 children who died, PD was performed for ≤ 2 days. ♦, Conclusion: PD for childhood AKI is feasible in resource-constrained regions with fairly good outcome. Blockage of catheter was the most common complication encountered., (Copyright © 2014 International Society for Peritoneal Dialysis.)

Recent reports from both Caucasian and black populations suggest changes in steroid responsiveness of childhood nephrotic syndrome. This study was therefore undertaken to determine the features and steroid sensitivity pattern of a cohort of black children with nephrotic syndrome. Records of children managed for nephrotic syndrome from January 2008 to April 2013 were reviewed. Details including age, response to treatment, and renal histology were analysed. There were 108 children (median age: 5.9 years, peak: 1-2 years), 90.2% of whom had idiopathic nephrotic syndrome. Steroid sensitivity was 82.8% among children with idiopathic nephrotic syndrome but 75.9% overall. Median time to remission was 7 days. Median age was significantly lower in steroid sensitive compared with resistant patients. The predominant histologic finding in resistant cases was focal segmental glomerulosclerosis (53.3%). No cases of quartan malaria nephropathy or hepatitis B virus nephropathy were diagnosed. Overall mortality was 6.5%. In conclusion, unusually high steroid sensitivity is reported among a cohort of black children. This is likely attributable to the lower age structure of our cohort as well as possible changing epidemiology of some other childhood diseases. Surveillance of the epidemiology of childhood nephrotic syndrome and corresponding modifications in practice are therefore recommended.

Background: The modest decline in child mortality in Africa raises the question whether the pattern of diseases associated with acute kidney injury (AKI) in children in Nigeria has changed., Methods: A database of children, aged between one month and 16 years, with AKI (using modified pediatric RIFLE criteria) was reviewed. The cause of AKI was defined as the major underlying disease. The clinical and laboratory features of children with AKI who survived were compared to those who died., Results: Of the 4 015 children admitted into Lagos University Teaching Hospital between July 2010 and July 2012, 70 episodes of AKI were recorded equalling 17.4 cases per 1000 children. The median age of the children with AKI was 4.8 (range 0.1-14.4) years and 68.6% were males. Acute kidney injury was present in 58 (82.9%) children at admission with 70% in 'failure' category. Primary kidney disease (38.6%), sepsis (25.7%) and malaria (11.4%) were the commonest causes. The primary kidney diseases were acute glomerulonephritis (11) and nephrotic syndrome (8). Nineteen (28.4%) children with AKI died. Need for dialysis [odds ratio: 10.04 (2.94-34.33)], white cell >15 000/mm(3) [odds ratio: 5.72 (1.65-19.89)] and platelet <100 000/mm(3) [odds ratio: 9.56 (2.63-34.77)] were associated with death., Conclusion: Acute kidney injury is common in children admitted to hospitals. The common causes remain primary kidney diseases, sepsis and malaria but the contribution of sepsis is rising while malaria and gastroenteritis are declining. Acute kidney injury-related mortality remains high.

Herpes simplex encephalitis (HSE) is a condition that may follow herpes simplex virus (HSV) infection with high mortality and serious morbidity among survivors. We report the case of a 2-year-old boy who presented to us with features of a central nervous system infection associated with visual and auditory impairments. Serology for HSV was positive and cerebro-spinal fluid culture yielded the virus. He was commenced on intravenous acyclovir and eventually responded to treatment after 21 days of therapy. Neurological deficits observed at discharge resolved by the third month. This case highlights the challenges of early recognition, accurate diagnosis, appropriate treatment and follow-up of such patients. In addition, there is a need for urgent documentation of the prevalence and associated factors of HSE in Nigeria.