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Background. Paediatric endoscopy is now standard care in the developed world for the management of gastrointestinal (GI) disorders. However, in developing countries endoscopy remains an underutilised tool. Objective. To determine the indications and the spectrum of endoscopic findings in children seen at the Lagos University Teaching Hospital, Nigeria. Methods. The indications for upper GI endoscopy and endoscopic findings in children ≤16 years old, referred for the procedure from June 2013 to June 2016, were documented. The endoscopic yield in these children was also determined. Results. In total 71 children were referred for upper GI endoscopy during the study period. There were 35 boys and 36 girls aged 3 months to 16 years. The indications for upper endoscopy were recurrent abdominal pain in 37 (52.1%), upper GI bleeding in 17 (23.9%), recurrent vomiting in 7 (9.9%), dyspepsia in 5 (7.0), heartburn in 2 (2.8%), dysphagia in 1 (1.4), portal hypertension in 1 (1.4) and ingestion of corrosives in 1 (1.4%) of the subjects. Endoscopic findings were as follows: gastritis 19 (26.8%), hiatus hernia in 13 (18.3%), gastric erosions in 12 (16.9%), oesophageal varices 6 (8.4%), duodenitis in 4 (5.6%), gastric ulcer in 3 (4.2%), gastric polyp in 2 (2.8%). The overall endoscopic yield was 60.2%. Conclusion. There is a need to increase the awareness of the role of paediatric endoscopy in the diagnosis and treatment of GI disorders in developing countries. Recurrent abdominal pain still remains a relevant indication for the procedure. The need to develop training programmes for paediatric endoscopy and paediatric gastroenterology in general in developing countries cannot be overemphasised. [ABSTRACT FROM AUTHOR]

The peak flow meter (PFM) is a useful device in asthma monitoring and in determining the severity of symptoms. Against the background of reported underutilisation of PFMs in the management of asthma and prescription for home use, and the paucity of such data in developing countries, this study was carried out to assess the knowledge, awareness, and practice of physicians on the use of PFMs in the management of children with asthma. The work was a prospective cross-sectional study involving 67 doctors working in the paediatric departments of two government hospitals in Lagos State, Nigeria. The number of doctors varied as not all responded to all the questions. The figures therefore correspond with the number of doctors that responded to the particular issue/question addressed. The survey was conducted with a self-administered structured questionnaire. Information obtained included the availability of PFMs in consulting rooms, knowledge of their use, benefits, frequency of prescription, and constraints in prescribing PFMs for the home management of asthma. Only 13 (20.0%) of the doctors (n=65) used the peak expiratory flow rate (PEFR) regularly in the diagnosis of asthma. The designation of the respondents and the years of experience in the management of asthma were significantly related to the frequency of prescription of the PFM (p=0.007, p=0.003 respectively).Non-availability was the highest constraint to PFM use (75.0%), followed by the cost of the PFM (51.7%). This study revealed that the physicians' knowledge about the PFM was suboptimal. The meters were rarely used in diagnosis nor prescribed for home management by physicians attending to asthmatic children at the two referral hospitals. The cost and availability of the PFM should be addressed by the hospital management. [ABSTRACT FROM AUTHOR]

Introduction: Hepatobiliary abnormalities occur commonly in sickle cell anaemia and these have been extensively reported in the adult patients. However, complications have been sparsely reported in children especially in the sub-Saharan African continent. This study aimed to highlight the hepatobiliary complications in this group of children using clinical examination, laboratory testing and abdominal ultrasonography. The challenges in a resource limited country are also highlighted., Subjects, Materials and Methods: One hundred and thirty- four (134) children aged 1-18years with sickle cell anaemia in steady state were recruited into this crossectional study. Clinical history and physical examination obtained were documented. Relevant basic haematologic and biochemical indices (Full blood count, liver enzymes and viral markers for hepatitis B and C) and abdominal ultrasonographic parameters were documented for all the children. The relationship between the complications and possible risk factors (age, frequency of crisis and blood transfusions) were also documented., Result: Fifty-three (39.6%) of the children had hepatobiliary abnormalities. Chronic hepatitis B infection was the most prevalent complication (14.9%) seen followed by cholelithiasis (12.7%) and Hepatitis C infection (4.5%). Other complications identified were cholecystitis (3.0%), biliary sludge (1.5%), liver cirrhosis (0.7%). Age was significantly associated with viral hepatitis (p=0.003) and cholelithiasis (p=0.0007) and the conditions were more prevalent in the older age group. The hepatobilary complications were also more prevalent in the males. Frequent blood transfusions was significantly related to viral hepatitis (p=0.03). The use of hydroxyurea was not significantly related to any of the complications., Conclusion: Hepatobiliary abnormalities are prevalent in children with sickle cell anaemia. Clinical screening and the use of ultrasonography would aid early diagnosis and appropriate therapeutic intervention in this group of children., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2021 by West African Journal of Medicine.)

Background: Neonatal tetanus (NNT), a major cause of neonatal deaths in the developing world appears to be on the downward trend in recent years. At the Massey Street Children's Hospital (MSCH), a foremost paediatric centre in Lagos an unpublished review revealed that NNT constituted 15-20% of the neonatal admissions in the period 2003-2005., Objective: The aim of this study was to determine the current prevalence of the disease, describe the clinical characteristics of NNT cases seen at the hospital and proffer solutions that would contribute to the elimination of the disease., Methods: This was a retrospective study. The clinical record of 66 patients with NNT admitted during a 2 year period (2006-2008) was reviewed. The clinical characteristic of the patients, co-morbidities/complications and mortality in the children was determined. The immunization status, facility used for Antenatal care and delivery by the mothers was also noted., Results: NNT constituted 2.5% of neonatal admissions in the 2 year period. The mean age of the patients was 8.8 +/- 3.29 days. 36 (54.5%) of the patients died while 25 (37.9%) were discharged home. The overall case fatality rate (CFR) was 54.5%. Recurrent apnea was the commonest complication seen. 27 (40.9%) and 37 (56.1%) of the mothers had ANC and delivered at the TBA clinics respectively. Only 2 (3%) of the mothers attended government hospitals., Conclusion: Though there is a reduction in the number of cases of NNT over the years (15-20% prevalence to 2.5%) the CFR at the secondary health facility still remains unacceptably high. The preference of mothers for TBA clinics rather than government hospitals is a major concern which needs to be addressed.

A review of the presentation, management and outcome in all children presenting with non-traumatic paraplegia managed by the paediatric neurology team at the University College Hospital Ibadan, Nigeria from June 1989 to May 2004 is presented. Of the 110 patients, there were 54 males and 56 females giving a M:F ratio of 1:1. The mean age of the group was 5.3 (SD = 3.1) years, with a range from 9 months to 11 years. Infections and infectious processes caused the paraplegia in 102 (92.7%) of the cases with poliomyelitis and tuberculosis (TB) of the spine accounting for 88 (80%) of cases. The study period was divided into three 5 year periods. While poliomyelitis was the commonest cause of paraplegia (60%) in the first 5 years: TB spine was responsible for most cases (40%) in the last 5-year period of the study. There was a significant reduction in the total number of cases seen when the initial 5-year period was compared with the last (45 and 26 respectively, P = 0.001). Overall mortality among the 110 admitted patients was 7.2% being highest (50%) in malignant disorders and none was recorded in TB spine. Prognosis for eventual ability to walk was best in cases of TB spine where 37 of the 39 patients (95%) were ambulant by discharge after 60 days of anti-TB treatment. The 2 non-ambulant patients eventually walked within 3 months of discharge while on maintenance treatment for TB. Only 2 of the 51 non-ambulant patients obtained wheelchairs at discharge. The implications of inadequate facilities for investigation and treatment as well as the lack of financial and social support for the families of affected children are discussed.