Nasopharyngeal Carcinoma in Childhood: Evidence of a Malfunctioning Oncology Ecosystem: A Case Series from a Low Resource Setting.

Nasopharyngeal carcinoma (NPC) refers to malignancy arising from the epithelium of the nasopharynx. It is a rare tumor globally but seen in higher prevalence in certain populations associated with the endemicity of Epstein- Barr Virus. It is usually seen in clinical settings in developing countries in late stages majorly due to poor health-seeking behavior, healthcare costs, and misdiagnosis arising from its vague and ambiguous symptoms. The outcome of NPC depends strongly on the stage at diagnosis and access to the right treatment which may prove challenging in low-resource settings where care is paid for out of pocket. We report three cases of nasopharyngeal carcinoma, its presentation, and a brief review of the literature on its epidemiology, histologic types, and outcomes in the peadiatric population.

Le carcinome nasopharyngé (CNP) est une tumeur maligne provenant de l'épithélium du nasopharynx. Il s'agit d'une tumeur rare à l'échelle mondiale, mais dont la prévalence est plus élevée dans certaines populations associées à l'endémicité du virus d'Epstein-Barr. Dans les pays en développement, elle est généralement observée à un stade tardif, principalement en raison d'un mauvais comportement de recherche de soins, des coûts de santé et des erreurs de diagnostic dues à ses symptômes vagues et ambigus. L'issue de la CPN dépend fortement du stade du diagnostic et de l'accès au traitement adéquat, ce qui peut s'avérer difficile dans les pays à faibles ressources où les soins sont payés de leur poche. Nous rapportons trois cas de carcinome nasopharyngé, leur présentation et une brève revue de la littérature sur l'épidémiologie, les types histologiques et les résultats dans la population pédiatrique. Mots-clés: Carcinome nasopharyngé, population pédiatrique, faible niveau de ressources.

Precise Pediatric Cancer Diagnosis Using Immunohistochemistry: Reducing Cost of Care and Improving Outcomes in a Low and Middle-Income Setting.

Childhood cancer is a significant cause of morbidity and mortality worldwide. It is the second-leading cause of non-communicable deaths among children worldwide with more than 90% of childhood cancer-associated mortality occurring in low-income and middle-income countries. Disparity in mortality rates has been linked to late presentation, inaccurate diagnosis, treatment abandonment and poor access to appropriate therapy. Access to enhanced diagnostics such as immunohistochemistry (IHC) is vital for proper diagnosis and prompt institution of appropriate treatment for children with cancers. However, despite the ever-increasing insight into the use of these techniques for timely and accurate diagnosis of pediatric cancers; simple histological diagnosis remains the mainstay in most of the LMIC owing to financial constraints, unavailability of facilities and skilled manpower. Limited access results in imprecise diagnosis including missed diagnosis, misdiagnosis, and wrong diagnosis, subsequently resulting in increased cost of care and poor treatment outcomes. This article focuses on the benefits of precise diagnosis among children who presented with cancers in an LMIC and the observed reduction in the cost of care, length of hospital stay, and improved outcome in the observed cohort as well as how to improve and promote access.

Le cancer infantile est une cause significative de morbidité et de mortalité dans le monde. Il s'agit de la deuxième cause de décès non transmissible chez les enfants dans le monde, avec plus de 90 % de la mortalité associée au cancer infantile survenant dans les pays à revenu faible et intermédiaire. La disparité des taux de mortalité a été associée à une présentation tardive, un diagnostic inexact, l'abandon du traitement et un accès insuffisant à une thérapie appropriée. L'accès à des diagnostics améliorés tels que l'immunohistochimie (IHC) est essentiel pour un diagnostic précis et la mise en place rapide d'un traitement approprié pour les enfants atteints de cancers. Cependant, malgré les connaissances de plus en plus approfondies sur l'utilisation de ces techniques pour un diagnostic rapide et précis des cancers pédiatriques, le diagnostic histologique simple reste le pilier dans la plupart des pays à revenu faible et intermédiaire en raison de contraintes financières, de l'indisponibilité des installations et du manque de personnel qualifié. Un accès limité se traduit par un diagnostic imprécis, notamment des diagnostics manqués, des erreurs de diagnostic et des diagnostics erronés, entraînant par la suite une augmentation du coût des soins et de mauvais résultats thérapeutiques. Cet article met l'accent sur les avantages d'un diagnostic précis chez les enfants présentant des cancers dans un pays à revenu faible et intermédiaire, et sur la réduction observée du coût des soins, de la durée du séjour à l'hôpital, ainsi que sur l'amélioration des résultats dans la cohorte observée, ainsi que sur la manière d'améliorer et de promouvoir l'accès. MOTS-CLÉS: Pédiatrie, enfants, Immunohistochimie, Cancer.

Hepatobiliary Findings in Nigerian Children with Sickle Cell Anaemia.

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.

INTRODUCTION: Les anomalies hépatobiliaires sont fréquentes dans la drépanocytose et ont été largement rapportées chez les patients adultes. Cependant, les complications ont été peu rapportées chez les enfants, en particulier sur le continent africain sub-saharien. Cette étude visait à mettre en évidence les complications hépatobiliaires dans ce groupe d'enfants en utilisant l'examen clinique, les tests de laboratoire et l'échographie abdominale. Les défis à relever dans un pays aux ressources limitées sont également soulignés. SUJETS, MATÉRIEL ET MÉTHODES: Cent trente-quatre (134) enfants âgés de 1 à 18 ans atteints de drépanocytose à l'état stable ont été recrutés dans cette étude transversale. L'histoire clinique et l'examen physique obtenus ont été documentés. Les indices hématologiques et biochimiques de base pertinents (numération globulaire, enzymes hépatiques et marqueurs viraux pour l'hépatite B et C) et les paramètres échographiques abdominaux ont été documentés pour tous les enfants. La relation entre les complications et les éventuels facteurs de risque (âge, fréquence des crises et des transfusions sanguines) a également été documentée. RÉSULTAT: Cinquante-trois (39,6 %) des enfants présentaient des anomalies hépatobiliaires. L'infection chronique par l'hépatite B était la complication la plus fréquente (14,9 %), suivie par la cholélithiase (12,7 %) et l'infection par l'hépatite C (4,5 %). Les autres complications identifiées étaient la cholécystite (3,0 %), les boues biliaires (1,5 %) et la cirrhose du foie (0,7 %). L'âge était significativement associé à l'hépatite virale (p=0,003) et à la cholélithiase (p=0,0007) et ces affections étaient plus fréquentes dans le groupe d'âge le plus élevé. Les complications hépatobiliaires étaient également plus fréquentes chez les hommes. Les transfusions sanguines fréquentes étaient significativement liées à l'hépatite virale (p=0,03). L'utilisation de l'hydroxyurée n'était pas significativement liée à aucune des complications. CONCLUSION: Les anomalies hépatobiliaires sont prévalentes chez lesenfants atteints de drépanocytose. Le dépistage clinique et l'utilisation de l'échographie permettraient un diagnostic précoce et une intervention thérapeutique appropriée chez ce groupe d'enfants. MOTS CLÉS: Hépatobiliaire, complications, enfants, drépanocytose, Nigeria.

Anthropometric Measurements of HIV-Infected Children Aged one to Five Years in a Tertiary Hospital in Lagos Nigeria

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 (p0.005) while; the controls were significantly taller than the infected children after 49months (p

Prevalence of Skin Diseases in Children with Human Immunodeficiency Syndrome Infection in Paediatric HIV Clinic of A Tertiary Hospital in Nigeria.

BACKGROUND: HIV infection/AIDS being a multi-systemic disease affects the skin at various stages in course of the illness. A knowledge of the common skin diseases associated with HIV infection can lead to early detection, appropriate staging and commencement of appropriate care in the infected patients. OBJECTIVE: The study was to document the prevalence and pattern of skin diseases in children with HIV infection seen at the Paediatric department of a tertiary centre in Nigeria. METHODS: HIV positive children attending the PEPFAR HIV clinic of Lagos University Teaching Hospital, Nigeria were examined for the presence of skin lesions. Anthropometric measurements were also obtained. Blood samples Were taken for CD4+ cell count, viral load and full blood count. RESULTS: Two hundred and fourteen (214) patients were studied, consisting of 107 HIV infected children and 107 uninfected children as controls. Skin lesions were observed in 89 (83%) of the HIV infected patients, while only 72 uninfected controls had skin lesions. (p = 0.035). The predominant skin disease in the HIV infected children was Pruritic papular eruption (PPE) with a frequency of 25.9%, followed by fungal infections (24.6%). Herpes zoster was found only in HIV infected children (p = 0.041). There was a strong correlation between the degree of immunosuppression (as reflected by the value of age dependent CD4+ cell count/CD4+ percentage). and the prevalence of skin disease in the HIV infected patients. The presence of pruritic papular eruptions and Herpes zoster was associated with advanced immunosuppression. CONCLUSION: Skin diseases are common in HIV infection in our environment. Early detection of HIV infection can be made in the presence of skin diseases like Pruritic papular eruption and Herpes zoster.

Current sickle cell disease management practices in Nigeria.

BACKGROUND: Although Nigeria has the highest burden of sickle cell disease (SCD) worldwide, there is still variable and poor utilisation of standard-of-care practices for SCD patients in the country. METHODS: This was a questionnaire survey of doctors in some dedicated SCD clinics in Nigeria in order to document the facilities available and common management practices. RESULTS: There were responses from 18 clinics based in 11 institutions. The number of patients being followed in each centre ranged from 15 to approximately 11 000. All clinics provided malaria prophylaxis and folic acid routinely to their patients. Only eight clinics prescribe penicillin prophylaxis. Eight prescribe hydroxyurea to patients who can afford it when indicated. All of the centres except three have electronic cell counters, but all had access to haemoglobin electrophoresis. Three had high-performance liquid chromatography machines installed but none was being routinely used. One institution had a functioning molecular biology laboratory. There is no official newborn screening programme in the country. All had access to microbiology and chemistry laboratories. Nine institutions had CT, six had MRI and three had transcranial Doppler facilities. CONCLUSION: The care available for SCD in Nigeria is still suboptimal and there is an urgent need for concerted effort to tackle the problem, but to make a significant impact on the burden of the disease would require more focus at the primary care level. Some steps to achieving this are outlined.

Adherence to Antiretroviral Therapy among HIV-Infected Children Attending a Donor-Funded Clinic at a Tertiary Hospital in Nigeria

Despite their high levels of knowledge about HIV and AIDS; young people ages 15-24 years in South Africa remain disproportionately affected by the epidemic. Young people's continued susceptibility to HIV infection has been consistently linked to intractable higher-risk sexual behaviours. This paper uses multivariate techniques and secondary data from two nationally representative surveys to illuminate individual and socio-structural factors that play a significant role in youths' continued engagement in higher-risk behaviour; despite their high awareness about HIV and AIDS. The findings show that notwithstanding progress in terms of increased condom use and reduced incidence of other sexually transmitted infections; the average age of sexual debut remains low; multiple sexual partnerships are prevalent; and inconsistent condom use is widespread among young people. Factors significantly associated with these risk behaviours occur at the individual and structural levels and include issues of race; gender; poverty and susceptibility to peer pressure. The paper concludes by recommending that future HIV-prevention interventions in South Africa should aim at building resilience among youths by promoting affirmative; supportive interventions that emphasize the potentials of young people

Anthropometric indices of infants born to HIV-1-infected mothers: a prospective cohort study in Lagos, Nigeria.

Numerous studies have reported that HIV-infected pregnant women are at increased risk of delivery of low birth weight (LBW) infants, of preterm deliveries and of intrauterine growth restriction. The objective of the study was to determine the effect of maternal HIV infection on the anthropometric characteristics of the babies at birth. A prospective study was carried out at the Lagos University Teaching Hospital, Nigeria. There were three times more LBW babies in the HIV-positive group than in the uninfected mothers (odds ratio = 3.47, 95% confidence interval = 1.69, 7.27; chi(2) = 12.99, P = 0.0003).The maternal weight (t = 15.85; P = 0.0001), maternal body mass index (BMI) (t = 15.07; P = 0.0003), birth weight of infants (t = 27.17; P = 0.0001) and birth length (t = 31.20; P = 0.001) were significantly less in HIV-positive mothers than in controls. In conclusion, poor maternal bodyweight and low BMI are significant contributors to LBW in HIV-infected women. Nutritional counselling, dietary intake and weight monitoring during pregnancy should be emphasized to improve pregnancy outcome in HIV-infected women.

Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children.

OBJECTIVE: To investigate the effect of antiretroviral ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children. METHODS: Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status. RESULTS: Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071). CONCLUSIONS: ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.

Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children.

OBJECTIVE: To investigate the effect of antiretroviral (ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children. METHODS: Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status. RESULTS: Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071). CONCLUSIONS: ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.

Maternal HIV infection and intrauterine growth: a prospective study in Lagos, Nigeria.

BACKGROUND: Low birth weight (LBW) is the most important cause of perinatal mortality and morbidity worldwide and particularly so in developing countries. Maternal HIV (Human Immunodeficiency Virus) infection has been identified as one of the risk factors to the development of low birth weight babies. OBJECTIVE: To evaluate the effect of maternal HIV infection on the birth weight of the newborn at tertiary hospital in West Africa. METHODS: The anthropometry of all HIV seropositive women who delivered in LUTH as well as that of their babies was determined using standard methods. Controls consisted of HIV seronegative women and their babies matched for age and parity with the above subjects. RESULTS: There were a total of 262 subjects of whom 132 (50.4%) were HIV seropositive and 130 (49.6%) were HIV seronegative controls. There were five times more low birth weight (LBW) infants in the HIV seropositive group than in the controls (OR 5.77, CI=2.19-16.80; p=0.000075). The mean maternal body mass index, BMI (p=0.0003), mean maternal weight (p=0.0004) and mean birth weight of newborns (p=0.0002) were significantly lower in the HIV seropositive group than in the controls. Maternal weight and gestational age were significantly associated with low birth weight (OR 15.3, CI=2.6-316.0; p=0.002) and (OR 3.78, CI=1.37-10.9; p=0.007) respectively. CONCLUSION: Maternal HIV infection is strongly associated with low maternal BMI and low birth weight in their offspring.

Haematological abnormalities associated with paediatric HIV/AIDS in Lagos.

INTRODUCTION: In HIV-1-infected children, haematological disturbances include bone marrow abnormalities and peripheral cytopenias. All three major cell lineages can be depressed. METHODS: A cross-sectional study of baseline haematological parameters was undertaken in 68 children with confirmed HIV infection. In all cases, a complete blood count was done and some had CD4+ counts and HIV RNA PCR. The CD4+ count was analysed by the Coulter manual latex particle monoclonal antibody method and HIV RNA PCR by Roche Amplicor Monitor, version 1.5. RESULTS: Anaemia (< 100 g/L) was present in 77.9%, severe (< 60 g/L) in 5.9%, moderate (60-70 g/L) in 32.3% and mild (80-99 g/L) in 39.7%. The mean haemoglobin concentration decreased as disease progressed (p < 0.05); 6% had leucopenia, 17.5% had neutropenia and 2.5% (one case) had thrombocytopenia; also, the four (6%) subjects with leucopenia were in clinical stages B and C. Neutropenia, lymphocytopenia and thrombocytopenia were seen more in clinical stages B and C, though this relationship was not statistically significant. CONCLUSION: Both the erythroid and other cells lines are affected by HIV/AIDS and other associated factors. Anaemia is the most common haematological abnormality. The severity of peripheral cytopenias is related to the disease burden.

Clinical evaluation of extract of Cajanus cajan (Ciklavit) in sickle cell anaemia.

The major pathology in sickle cell anaemia (SCA) is sickling of red cells due to the precipitation of reduced haemoglobin. We report our experience with extract of Cajanus cajan as a possible antisickling agent by determining changes, if any, in clinical and laboratory features of the disease in patients given the extract in a single-blind placebo-controlled study. One hundred patients with steady-state SCA were randomized into treatment and placebo arms. The extract/placebo were administered twice daily to the subjects. Weight, hepatosplenomegaly, blood levels of biliurubin, urea, creatinine, and packed cell volume (PCV) were monitored over a 6-month period. Recall episodes of pain 6 months before enrolment were compared with episodes of pains recorded during the treatment period. Twenty-six cases (55.3 per cent) had hepatomegaly on enrolment. This significantly reduced to 33.3 per cent at 6 months (p = 0.03); but increased in the placebo arm (p > 0.05). The total number of recall painful episodes in cases was 207 (mean 4.4 +/- 10.3 (SD), range 0-60) and fell to 191 (mean 4.2 +/- 4.4 (SD), range 0-16); p = 0.03. Episodes of pain increased from 109 in controls (mean 2.6 +/- 5.0 (SD), range 0-26) to 164 (mean 3.9 +/- 4.3 (SD), range 0-22); p = 0.01. Mean PCV in the cases showed no appreciable changes (p = 0.1) but there was a significant increase in the controls (p = 0.02). In conclusion, the extract may cause a reduction of painful crises and may ameliorate the adverse effects of sickle cell anaemia on the liver. The mechanism of action remains to be determined.

Flame burns disasters from kerosene appliance explosions in Lagos, Nigeria.

A study of 55 cases of burns admitted to the Lagos University Teaching Hospital in the month of March 1984 revealed that 96 per cent were caused by flame burns due to explosions that occurred during the use of kerosene appliances for cooking and lighting. Thirty-four (62 per cent) were children, while 21 (38 per cent) were adults. In each of seven families, two or more people were affected. The overall mortality was 44 per cent, of which the larger contribution of 30 per cent was in children. By comparison, in the two preceding months there was a total of 17 and 20 burns admissions respectively. The mortality rate was 16 per cent while in March 1983 there was no death among the six paediatric admissions. Investigations showed that the explosions occurred due to petrol contamination of the kerosene before delivery to the domestic users. Appropriate precautions by kerosene suppliers and users, and health education can help prevent similar disasters in the future.