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.

Prospective Audit of Perinatal Mortality among Inborn Babies in a Tertiary Health Center in Lagos; Nigeria

Background: The perinatal mortality rate remains an important indicator of maternal care and maternal health and nutrition; and also reflects the quality of obstetric and pediatric care available. The causes of most of the perinatal deaths are preventable; thus making it important to identify the risk factors in each health environment. Objective: The aim was to prospectively audit the perinatal mortality and associated risk factors in a tertiary health facility in a developing country. Materials and Methods: Data for all consecutive deliveries in the labor ward complex of Lagos University Teaching Hospital (LUTH) between June 2002 and November 2002 were obtained from the patients' record and by interviewing the mothers using a questionnaire. The babies were followed up for 7 days postdelivery. Results: There were 51 (8.5) perinatal deaths made up of 43 (7.1) stillbirths (15 fresh and 28 macerated) and 8 (6.1) early neonatal deaths giving a perinatal mortality rate of 84.6/1000. Maternal factors that significantly affected perinatal deaths were maternal age; parity; antenatal care booking and the hospital where the mother was booked for antenatal care; number of previous child deaths; and complications of pregnancy. Mode of delivery and complications of labor were the significant intrapartum factors. Fetal factors that influenced perinatal deaths were fetal presentation; birth weight; and Apgar scores at 1 and 5 min. When multiple logistic regression (multivariable analysis) of perinatal mortality on possible risk factors was done; only the Apgar score at 5 min; birth weight; and parity were significant risk factors. Conclusion: The study shows a high perinatal mortality rate with majority of perinatal deaths occurring before the delivery. Significant risk factors are a low Apgar score at 5 min; low birth weight; and high parity

Echocardiographic Features of Rheumatic Heart Disease in Lagos

Rheumatic heart disease (RHD) is a global scourge; resulting in significant morbidity and mortality. Our aim is to report on the prevalence; and complications of RHD; as documented by echocardiography in a Nigerian tertiary health facility. We performed a retrospective study of RHD patients; who had trans-thoracic echocardiography studies within the 2 year period of January 1st 2001-December 31st 2002. Data obtained included age; sex and echocardiographic diagnoses; and parameters. Of the 987 patients; 53 had chronic RHD; thus; the prevalence was 5.4. Male female ratio was 1: 1.8 and their average age was 30.1 years. Commonest indication for study was congestive heart failure (68). One; two and three valves were affected in 45 (85); 7 (13); and 1 (2) respectively. Valves involved were mitral - 49 (93); aortic - 18.6; and tricuspid 2 (7.5) respectively. Mixed mitral stenosis/regurgitation (42) was the commonest lesion; and complications included right ventricular overload (20); thromboembolic risk (20); and heart failure (70). RHD is still prevalent in Lagos; Nigeria and associated with grave complications. Valvular involvement remains unchanged as the mitral valve still is the most commonly affected valve but there seems to be an increasing prevalence of mixed mitral valve disease thus making management more challenging. Comprehensive hospital registers for rheumatic heart disease and community based studies are needed to establish the current prevalence