Management of community acquired pneumonia (CAP) in children: Clinical practice guidelines by the Paediatric Association of Nigeria (PAN

The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to assist clinicians in the care of children with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among children in the clinical course of CAP.The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians to make timely diagnosis and institute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated.The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.

Impact of COVID-19 pandemic on immunization services in Nigeria; A preliminary report by Paediatric Association of Nigeria (PAN)

Background: Since the onset of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic also known as Coronavirus disease 2019 (COVID-19) beginning in Wuhan, China in December 2019 and spreading to Nigeria in February 2020 (as well as the rest of the world), there have been enormous resultant impact on health, social, emotional and economic aspects lives and services. The disease as well as its mitigation measures have negatively affected other aspects of lives and health services. This paper aims to assess the preliminary effects on immunization services, blow the whistle and suggest measures to limit these effects. Methods: Data was obtained by interviews and use of a structured proforma from Immunization Field Experts/Consultants working with national and international agencies in four states, heads of immunization units, officers in charge of immunization centres and facility immunization records from seven sites across Nigeria. Results: There were disrupted immunization services with total absence of outreach services and campaigns, limited fixed sessions, disease outbreaks, general drop in number of immunized children. These were thought to be due to the lockdown effects, fears, rumours and panic among others. Outright routine vaccines amongst rejections were also reported. Conclusion: Reports suggest that the pandemic and its mitigation measures are affecting immunization services in terms of demand/ access (physical and economic), services and logistics with overall drop in coverage and rise in dropout rates. The effects are still unfolding. It does not appear that health facilities are monitoring and interrogating their data with a view to making specific response action plans. All stakeholders in immunization (Government, non- governmental and professional organizations, the media, traditional / religious institutions) should work to flood the mainstream / social media with positive messages on immunization; monitor immunization progress by ongoing data collection, collation, analysis, interpretation and action; actively counter rumours and anti- vaccine messages and plan for post COVID 19 intensification/ catch- up

Familial Acute Lymphoblastic Leukaemia

Background: Acute lymphoblastic leukaemia (ALL) is known to be the most common malignancy in children. However; the true incidence of familial ALL is not known; coupled with scanty data on familial ALL in the Niger Delta Area of Nigeria. Aim: To present a report of the management two cases of ALL from the same parents; whose sibling also died as a diagnosed case of ALL. Case report: The first case was a 30-month female who presented with recurrent febrile illness; repeated blood transfusions and hospitalizations in several private hospitals before being referred to the Department of Paediatrics and Child Health; University of Port Harcourt Teaching Hospital; Port Harcourt. A diagnosis of ALL type 1 was made. She was managed with cyclophosphamide; oncovin; methotrexate and prednisolone (COMP). Induction regimen; antimalarials and transfusion of sedimented red blood cells for severe anaemia were administered. There was remission before the child was lost to follow-up. The second case was a 15-month female sibling of the first case who presented essentially with severe anaemia; generalized weakness; repeated blood transfusions; peripheral lymphadenopathy and a non-tender hepatomegaly. Bone marrow aspiration showed features also suggestive of ALL type 2 variant with over 30abnormal lymphoblastic and leukaemic cell infiltrate. She was subsequently put into remission through an induction regimen of COMP plus intrathecal methotrexate and Hydrocortisone. She however relapsed and died 8 months from the time of presentation. Conclusion: Familial ALL in siblings is reported. The interplay of the associated risk factors of genetic; parental; socio-economic and environmental influences on the incidence of familial leukaemia in this environment is discussed

Growth pattern of exclusively breastfed infants in the first six months of life: a study of babies delivered at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

BACKGROUND: Some authors demonstrate that exclusively breastfed infants have growth patterns comparable with the NCHS standards while others conclude that exclusively breastfed infants grow slower. These conflicting results informed the need for this study to aid the paediatricians and health workers to justify or condemn the recommendation of exclusive breastfeeding for six months. This was a prospective longitudinal study carried out to determine the growth pattern of exclusively breastfed infants in the first 6 months of life and compare them with the International, National Centre for Health Statistics (NCHS/WHO) reference and the Local, Janes' Elite Standards. METHODS:Using weight, length and occipito-frontal circumference as indices, 530 infants were recruited consecutively by convenience sampling over 17 months. Measurements were taken at birth, 2 weeks, 6 weeks, 2 months and subsequently monthly until the end of the 6th month.RESULTS: The exclusively breastfed infants doubled their birth weights at 3 months. The mean weight, OFC and length gains were maximal at 2 months, 2 weeks and 2 months respectively. The growth of exclusively breastfed infants compared favourably with the NCHS/WHO reference group and also compared favourably with the Janes' 'Elite' reference group. CONCLUSION:It is concluded that the growth in weight, length and OFC of exclusively breastfed infants appears adequate for the first 6 months of life

Seroprevalence of Hepatitis B Surface Antigenaemia in Children in a Tertiary Health Institution in the Niger Delta of Nigeria

BACKGROUND: There is paucity of data on the seroprevalence of HBV infection in children living in urban areas of the Niger Delta of Nigeria. The aim of this study is to determine the seroprevalence of hepatitis B surface antigenaemia among children presenting to the University of Port Harcourt Teaching Hospital (UPTH), to determine the trend in the seroprevalence of HBsAg over a five-year period and to correlate serological findings to clinical features. METHODS: Serum samples from 251 consecutively recruited children in UPTH aged =16 years were tested for Hepatitis B surface antigen using Clinotech HBsAg kits and confirmed using the Trinity Biotec enzyme linked immunosorbent assay based HBsAg kits. Medical records of the children were also obtained. RESULTS: The overall prevalence of HBsAg among children tested was 12.4%. HBsAg prevalence was highest in the 11-15 years age group (24.5%) and the lowest in the 6-10 years age group (11.0%). There was a statistically significant difference in the prevalence of HB V positivity based on age groups (?2, = 8.47, p = 0.014). Prevalence rate was relatively higher among males (13.7%) compared to females (10.7%). There is a statistically significant trend in the decline of HBsAg prevalence 1999 to 2004 (?2, for trend = 11.38, p = 0.001). The predominant symptoms among children positive for HBsAg were hepatosplenomegaly (75%) and jaundice (64.5%). CONCLUSION: This study indicates a high prevalence of HBsAg among children presenting to a tertiary health facility in Port Harcourt