Echocardiographic reference z scores of right ventricular dimension and systolic function of children aged 5-12 years.

BACKGROUND: Reference values for right ventricular dimension and systolic function in Nigerian children are scarce despite their high burden of right ventricular abnormalities. Reference values from other countries may not be suitable for use in Nigerian children because of possible racial variations in cardiac size. PURPOSE: To develop reference values for right ventricular dimension and systolic function in healthy Nigerian children aged 5-12 years. METHODS: This descriptive cross-sectional study conducted between July and November 2019 included 480 healthy boys and girls aged 5-12 years. The participants were randomly selected from 6 primary schools in the Ikeja Local Government area of Lagos State and their weights and heights measured. Body mass index and body surface area were calculated. Echocardiography was performed at rest in the left lateral position. RESULTS: The right ventricular end-diastolic basal diameter (RVD1), right ventricular end-diastolic mid-cavity diameter (RVD2), and right ventricular end-diastolic length (RVD3) were obtained. The right ventricular end-diastolic basal diameter (RVD1), right ventricular end-diastolic mid-cavity diameter (RVD2), and right ventricular end-diastolic length (RVD3) were obtained, as well as tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler-derived right ventricular systolic excursion velocity (S'). The overall mean±standard deviation (SD) values for RVD1, RVD2, RVD3, TAPSE, and S' were 32.95±4.2, 25.86±3.5, 54.57±7.5, 20.11±2.3, and 18.24±2.2, respectively. Age- and sex-specific mean and SD values of the same cardiac indices were determined. Z score charts and the mean± 2SD right ventricular dimensions and systolic function were generated. All right ventricular dimensions were positively correlated with weight, height, body surface area, and body mass index. Only height correlated consistently with TAPSE and S'. CONCLUSION: The observed mean right ventricular dimension indices differed from those derived elsewhere, suggesting that values from other countries may be inappropriate for Nigerian children. These reference values are applicable in daily clinical practice.

Rhythm abnormalities among hospitalised children in Lagos: a case series.

Arrhythmias refer to disturbances in heart rate or rhythm which leads to heart rates that are abnormally fast, slow or irregular. Rhythm abnormalities may be common among Nigerian children but there are only a few reports. The current write up is a clinical review of eight patients in various age groups including neonates, infants and older children. It is presented to highlight the different forms of arrhythmias that can occur in children, with varying underlying aetiology, thus, stressing the need for early recognition of arrhythmias in children, appropriate early intervention and challenges involved in their care.

Prevalence and determinants of peripheral arterial disease in children with nephrotic syndrome.

Peripheral arterial disease (PAD) is the least studied complication of nephrotic syndrome (NS). Risk factors which predispose children with NS to developing PAD include hyperlipidaemia, hypertension and prolonged use of steroids. The development of PAD significantly increases the morbidity and mortality associated with NS as such children are prone to sudden cardiac death. The ankle brachial index (ABI) is a tool that has been proven to have high specificity and sensitivity in detecting PAD even in asymptomatic individuals. We aimed to determine the prevalence of PAD in children with NS and to identify risk factors that can independently predict its development. A comparative cross-sectional study was conducted involving 200 subjects (100 with NS and 100 apparently healthy comparative subjects that were matched for age, sex and socioeconomic class). Systolic blood pressures were measured in all limbs using the pocket Doppler machine (Norton Doppler scan machine). ABI was calculated as a ratio of ankle to arm systolic blood pressure. PAD was defined as ABI less than 0.9. The prevalence of PAD was significantly higher in children with NS than matched comparison group (44.0% vs 6.0%, p < 0.001). Average values of waist and hip circumference were significantly higher in subjects with PAD than those without PAD (61.68± 9.1cm and 67.6± 11.2 cm vs 57.03 ± 8.3cm and 65.60± 12.5cm respectively, p< 0.005). Serum lipids (triglyceride, very low density lipoprotein, total cholesterol and low density lipoprotein) were also significantly higher in subjects with PAD than those without PAD [106.65mg/dl (67.8-136.7) vs 45.72mg/dl (37.7-61.3), 21.33mg/dl (13.6-27.3) vs 9.14mg/dl (7.5-12.3), 164.43mg/dl (136.1-259.6) vs 120.72mg/dl (111.1-142.1) and 93.29mg/dl (63.5-157.3) vs 61.84mg/dl (32.6-83.1), respectively p< 0.05]. Increasing duration since diagnosis of NS, having a steroid resistant NS and increasing cumulative steroid dose were independent predictors of PAD in children with NS; p< 0.05 respectively. With these findings, it is recommended that screening for PAD in children with NS should be done to prevent cardiovascular complications before they arise.

Reference values and equations for the 6-minute walk distance of Nigerian children aged 6-11 years: A cross-sectional study.

BACKGROUND: The 6-minute walk test (6MWT), a simple, reliable, and valid test that uses the distance walked in 6 minute walk distance (6MWD) to quantify functional capacity, is widely used in the management of chronic disorders. However, the absence of reference standards from sub-Saharan African, including Nigerian, school-aged children limits its utility in this age group. OBJECTIVES: To develop normative values and equations for the 6MWD of school-aged Nigerian children. METHODS: In a cross-sectional study, healthy children aged 6-11 years in Lagos, Nigeria, completed the 6MWT on 20-m-long straight outdoor courses in their schools. The primary outcome was the 6MWD in meters while potential predictors included demographic (age, sex), anthropometric (height, weight, chest circumference, leg length) and physiologic variables (pre-walk, immediate post-walk, and fifth min-post-walk heart rate [HR], oxygen saturation [SpO2 ], systolic blood pressure [SBP], diastolic blood pressure [DBP], and rating of perceived exertion [RPE]; and the difference between pre-walk and post-walk HR [∆HR], SpO2 [∆SpO2 ], SBP [∆SBP], DBP [∆DBP], and RPE [∆RPE]). RESULTS: Overall, 627 pupils (52.1% girls) walked 504.6 ± 66.6 m (95% CI: 499.4, 509.8; range: 326.6-673.0 m); 16 m longer in boys (p = 0.002). A stepwise linear regression model yielded: 6MWD (m) = 347.9 + 14(Ageyears ) + 1.6 (∆HRbeats/min ) + 17.6(Sexmale=1, female=0 ) + 1.2(∆SBPmmHg ); R2 = 0.25. Previously published reference equations mostly over-estimated Nigerian children's 6MWD. CONCLUSION: These reference standards add to the global normative data on pediatric 6MWT and may be useful for the functional evaluation of Nigerian school-aged children with chronic childhood disorders.

Comparative Effectiveness of a Six-Week Treatment Course of Vitamin D2 and D3 in Children With Sickle Cell Anemia in Steady State With Hypovitaminosis D: A Randomized Clinical Trial.

BACKGROUND: Correction of vitamin D deficiency through administration of either vitamin D2 or D3 has been shown to reduce chronic bone pains and frequency of acute bone pains, increase bone density as well as improve growth stature in children with sickle cell anemia (SCA). Findings vary on the effectiveness of the two forms of the vitamin. The current study was carried out to compare the effectiveness of a 6-week treatment course of vitamin D2 and D3 in the correction of hypovitaminosis D (vitamin D insufficiency and deficiency) as well as evaluate treatment response to derangement of serum calcium and alkaline phosphatase (ALP) in children with SCA in steady state. METHODS: The study was a randomized, double-blind clinical trial of 174 children with SCA aged 1 - 18 years. Subjects with hypovitaminosis D (baseline serum 25-hydroxyvitamin D (25(OH)D) below 75 nmol/L) were randomized into two treatment arms. Each arm treated either of the two forms of vitamin D had a once weekly dose of 50,000 IU for a period of 6 weeks. RESULTS: Median rise in serum 25(OH)D after 6 weeks of oral vitamin D2 or D3 was similar between the two groups (median rise in 25(OH)D of 17.8 nmol/L in D2, 15.3 nmol/L in D3 groups). Also, there was no significant difference in the proportion of subjects that improved in their vitamin D status in both treatment arms (P = 0.409). Treatment was significantly associated with increase in proportion of subjects with normal serum calcium (P ≤ 0.001) and decrease in proportion of subjects with elevated serum ALP (P ≤ 0.001). CONCLUSION: Once weekly dose (50,000 IU) of either vitamin D supplement has equal effectiveness in correction of hypovitaminosis D. However, vitamin D3 may be cost-effective because it is cheaper.

Juvenile ossifying fibroma in a Nigerian boy: a rare case report.

Cases of jaw masses abound in our environment which is a tropical one, with Burkitt lymphoma being the commonest aetiology. However rarer causes like juvenile aggressive ossifying fibroma should also be considered. It is a locally aggressive tumor with high recurrent potentials occurring in children and adolescent. Here we present the clinical features, physical findings and challenges in diagnosing and management of a 7-year-old boy who presented to the Paediatric unit of our institute with a right jaw mass.

Doppler echocardiographic assessment of pulmonary artery pressure in children with sickle cell anaemia.

BACKGROUND: Pulmonary artery hypertension (PAH) is a known complication of patients with sickle cell disease (SCD). The prevalence of PAH has been reported to be high in children with SCD in developed countries. The mortality rate of patients with SCD who develop PAH is said to be 40% at 24 to 40 months after diagnosis. In Sub-Saharan Africa, particularly Nigeria, where the prevalence of SCD is high, there is a dearth of data on the prevalence of PAH in children with SCD. PAH may be a likely contributor to the unacceptably high mortality rate of children with SCD in Africa. The present study aimed to determine the pattern of pulmonary artery pressure in children with sickle cell anaemia (SCA) aged 1 to 12 years in their steady state using Doppler echocardiography in our environment. METHODS: Analytical, comparative and cross-sectional study. It was carried out at Lagos State University Teaching Hospital (LASUTH) over a period of seven months (31st August 2015 through 31st March 2016). A total of 400 children, aged 1 to 12 years were recruited following parental consent and assent. Two hundred children with SCA in steady state and 200 age and sex matched children with haemoglobin genotype AA who served as controls were studied. All subjects and controls had Doppler echocardiography performed on them by the author. PAH was defined as a pulmonary artery systolic pressure (PASP) of ≥30 mmHg at rest derived from the tricuspid regurgitant velocity (TRV) measured from Doppler echocardiography. This corresponds with TRV value of ≥2.5 m/s. RESULTS: The prevalence of PAH in children with SCA was 8% (n=16). None of the controls had PAH. The youngest subject with PAH was aged 2 years. The overall mean pulmonary artery pressure of children with SCA was significantly higher than that of controls (18.54±5.81 vs. 13.76±5.71 mmHg, P=0.000). The prevalence of PAH in children with SCA demonstrated an increase in trend with age. CONCLUSIONS: The prevalence of PAH in children with SCA in steady state is high. This complication was noticed as early as the second year of life. It is recommended that all children with SCA should have periodic Doppler echocardiography for early detection of PAH.

Serum Iron Status of Children with Cyanotic Congenital Heart Disease in Lagos, Nigeria.

OBJECTIVES: Cyanotic congenital heart disease (CCHD) predisposes patients to iron deficiency due to compensatory secondary erythrocytosis. This study aimed to determine the serum iron status and prevalence of iron deficiency among children with cyanotic congenital heart disease attending the Paediatric Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. METHODS: This cross-sectional case-control study took place between May and October 2015 at the Lagos State University Teaching Hospital. A total of 75 children with cyanotic congenital heart disease and 75 apparently healthy age-, gender- and socioeconomically-matched controls were analysed to determine serum iron status and the prevalence of iron deficiency as defined by the World Health Organization criteria. RESULTS: The mean age of the children was 47.5 ± 2.9 months (range: 6-144 months old). Iron deficiency was significantly more frequent among CCHD patients compared to control subjects (9.3% versus 0%; P = 0.006). While latent iron deficiency was more prevalent among children in the control group compared to those with CCHD, this difference was not statistically significant (13.3% versus 9.3%; P = 0.303). No cases of iron deficiency anaemia were observed in the studied sample. CONCLUSION: Neither the children in the control group nor those with CCHD had iron deficiency anaemia. However, iron deficiency was significantly more prevalent among children with CCHD in Lagos. Periodic serum iron status screening is therefore recommended for this population.

The burden of rheumatic heart disease among children in Lagos: how are we fairing?

INTRODUCTION: Rheumatic heart disease still remains a cause of morbidity and mortality in low and middle income countries, despite its eradication in developed societies. The study aimed to document the features of children with rheumatic heart disease using clinical evaluation and echocardiography and compare it with reports from other part of the country. METHODS: A review of a prospectively collected data of patients with rheumatic heart disease who had echocardiography done from April 2007-Dec 2016. Information obtained from patients include age, sex, clinical indication for echocardiography, echocardiographic characterization of the valvular lesions and associated complications. RESULTS: A total of 324,676 patients were seen at the Paediatric unit of LASUTH from 2007 to 2016, out of which 36 had Rheumatic heart disease. This translates to a prevalence of 1.1 per 10,000 patients who presented at the study site during the study period. The prevalence of RHD amongst all the patients with structural heart disease was 2.6%. The mean age of patients was 9.12 ± 2.75 years with a male to female ratio of 1.6: 1. The most common valve affected was mitral valve. Heart failure was the most common mode of presentation found in 91.6%. Other complications were pulmonary hypertension and pericardial effusion. CONCLUSION: Rheumatic heart disease is still prevalent among children in Lagos although the prevalence is reducing. Heartfailure is the commonest mode of presentation and complication in them.

Is transcatheter closure superior to surgical ligation of patent ductus arteriosus among Nigerian Children?

BACKGROUND: Patent ductus arteriosus (PDA) is common among Nigerian children. It is the second only to ventricular septal defect among congenital heart diseases in Nigeria children. The study centers are the only centers in Nigeria which are able to offer both transcatheter closure of PDA and surgical ligation. The study aims to compare both methods in terms of the demographics of the individuals, cost and outcome. PATIENTS AND METHODS: Prospective, cross-sectional involving consecutive individuals who had either transcatheter closure or surgical ligation of PDA from June 2010 to January 2014. Individuals were grouped according to the method of closure of their defect. Data on their demographics, size of the defects, cost of treatment and outcome were compared for the two groups. The analysis was done using Microsoft Excel statistical software supplemented by Statistical Package for Social Sciences version 20.0. P < 0.05 was considered statistically significant. RESULTS: A total number of 28 individuals had either surgical ligation or device closure of PDA done at the studied period. The mean age of all the individuals was 4.58 ± 4.20 years with a median age of 3 years. The mean age of individuals that had surgical ligation was 3.40 ± 0.92 years and mean age of those who had transcatheter device closure was 6.69 ± 1.05 years (P = 0.677). Male to female ratio in both groups were 0.4:1. No mortality was recorded in both groups. However, 6 (21.4%) of the surgical patients and 1 (3.57%) of the patient with device closure had complications. The direct cost of the procedure for each of the patient who had device closure of PDA was about $3000 whereas the cost of surgical closure was about $1000. The indirect cost for device closure was about $100 while that of surgical closure was about $5000. CONCLUSION: Device closure of PDA has lesser risk of complications compared to surgical ligation. Its indirect cost is also cheaper. There is a need for availability and accessibility to device closure of PDA in our environment.

Serum cystatin C levels in Healthy Nigerian neonates: Is there a need for normative values in Nigerian babies?

Cystatin C is an endogenous marker of renal function. Normal reference values have been documented in neonates outside Africa, but no study has been documented in African neonates. With reports that race may affect serum cystatin C values, this study was carried out to generate normal values in apparently healthy term neonates at birth and three days of life neonates in Nigeria. This was a hospital-based prospective study. A cohort of 120 apparently healthy term neonates were recruited at birth. Serum cystatin C was measured from the cord blood at birth and venous blood when they were three days old using enzyme-linked immunosorbent assay (ELISA) method. The mean serum cystatin C values for cord blood and 3rd day venous samples were 1.67 ± 0.52 mg/L and 1.62 ± 0.52 mg/L, respectively (P = 0.87). The cord blood and 3rd day serum cystatin C values for males were 1.67 ± 0.47 mg/L and 1.68 ± 0.51 mg/L, respectively (P = 0.77) and the values for females were 1.68 ± 0.56 mg/L and 1.58 ± 0.52 mg/L, respectively (P = 07.22). The serum cystatin C levels were similar among the different birth weight groups and gestational age (P >0.05). The cord blood and 3rd day serum cystatin C values were similar. Serum cystatin C values were independent of gender and birth weight of neonates. The values of serum cystatin C in Nigerian neonates were comparable to that reported for neonates in other regions of the world. It is recommended that ELISA technique may be reliably used to measure serum cystatin C levels in neonates.

Cyanotic congenital heart diseases among Nigerian children.

BACKGROUND: There are only few reports on cyanotic congenital heart diseases (CCHD) among Nigerian and African Children. The current report aim to provide the most recent hospital based data on the distribution of CCHD in children less than 14 years of age, the demographic characteristics and risk factors identified. METHODS: Prospective and cross-sectional involving consecutive cases of CCHD diagnosed with echocardiography at the Lagos State University Teaching Hospital between January 2007 and June 2016. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Level of significance set at P<0.05. RESULTS: There were 352 subjects with CCHD with a male to female ratio of 1.34:1. The children were age 2 days to 14 years with a mean ± SD of 38.62±44.74 months and median of 21 months. The most common type of CCHD (both isolated and multiple CCHD) was tetralogy of Fallot (TOF) followed double outlet right ventricle (DORV) and transposition of the great arteries (TGA). The most common mode of presentation was cyanosis. CONCLUSIONS: TOF was found in almost half of the subjects. Cases of DORV which have been rarely reported were more than those with TGA. Most were diagnosed late. Cyanosis was the most common mode of presentation. Clinical features are protean; thus a high index of suspicion is required to make an early diagnosis.

Children with transposition of the great arteries: Should they actually be born in Nigeria?

AIM: To describe the clinical and echocardiographic features of Nigerian children with transposition of the great arteries and emphasize the need for collaboration with cardiac centres in the developed countries to be able to salvage the children. METHODS: Prospective and cross sectional involving consecutive patients diagnosed with transposition of the great arteries using clinical evaluation and echocardiography at the Paediatric Department of Lagos State University Teaching Hospital, Lagos Nigeria as part of a large study between January 2007 and December 2015. RESULTS: There were 51 cases of transposition of the great arteries within the study period with a male to female ratio of 2:1 and a prevalence of 1.55 per 10000 among population of children who presented to centre during the study. Its proportion amongst children with congenital heart disease was 4.9%, while it was 15.4% among those with cyanotic congenital heart disease. The mean age ± SD of the subjects was 10.3 ± 21.8 mo. Up to 70% of the patients were less than 6 mo of age at initial presentation. The most common mode of presentation was cyanosis. The most common associated intracardiac anomaly was ventricular septal defect which occurred in 56% of the patients. CONCLUSION: Transposition of the great arteries is as common in Nigeria as in the other parts of the world. The most common mode of presentation was cyanosis. There is an urgent need to establish paediatric cardiac centres in Nigeria if these children are to be salvaged.

Nigerian Children with Acquired Heart Disease: The Experience in Lagos.

Background: Most of the recent reports on acquired heart diseases (AHDs) among Nigerian children are either retrospective or cover a short period of time with fewer subjects. The last report on AHDs among children in Lagos was about a decade ago; it was, however, not specific to children with AHDs but was part of a report on structural heart diseases among children in Lagos. The present study was carried out to document the prevalence and profile of different AHDs in children and to compare the findings with those previously reported. Methods: We conducted a quantitative, nonexperimental, prospective, and cross-sectional review of all consecutive cases of AHDs diagnosed with echocardiography at the Lagos State University Teaching Hospital between January 2007 and June 2016. Comparisons between the normally distributed quantitative data were made with the Student t test, while the χ2 test was applied for the categorical data. Results: The subjects with AHDs were 73 males and 52 females, with a male-to-female ratio of 1.4:1. The children were aged 15 days to 14 years, with a mean of 6.61 ± 4.26 years. Rheumatic heart disease was the most common AHD, documented in a quarter of the children, followed by dilated cardiomyopathy and pericardial effusion in 20.8% and 17.3%, respectively. Less common lesions encountered were Kawasaki disease, mitral valve prolapse, hyperdynamic circulation, and supraventricular tachycardia. Conclusion: Rheumatic heart disease was still the most common AHD in the children in the present study. Dilated cardiomyopathy and pericardial effusion are on the increase as has been reported earlier.

The Burden of Truncus Arteriosus in an Urban City in Africa: How are we Fairing?

BACKGROUND: The true incidence of truncus arteriosus in underdeveloped countries is difficult to determine. This is due largely to underreporting as a result of nonavailability of technologically advanced facilities to make definitive diagnosis prenatally. There is a lack of data on the profile and outcome of patients with persistent truncus arteriosus (PTA) in Nigeria. This study aims to document the demographic characteristics, mode of presentation, indications for echocardiography, associated anomalies, average age at diagnosis, and outcome of patients with truncus arteriosus in our center. METHODS: Prospective and cross-sectional involving consecutive patients diagnosed with PTA using echocardiography at the Paediatric Department of Lagos State University Teaching Hospital, Lagos, Nigeria as part of a large study between January 2008 and December 2015. RESULTS: Only 25 patients had PTA during the study period. The prevalence of PTA among children presenting at the study center during the study period was 7.9/100,000. It constituted 2.4% of the cases of congenital heart disease and 7.1% of cases of cyanotic congenital heart disease. The male:female ratio was 1:1.1. The ages of the patients at diagnosis ranged between 0.75 and 153 months with a mean age at diagnosis ± standard deviation of 18.4 months ± 37.7. Only about 40% of patients were diagnosed within the neonatal period. Cyanosis was the most frequent indication for evaluation. CONCLUSION: PTA is as common in Nigeria as in the other parts of the world but diagnosed late. Cyanosis is the most common presenting feature.

The burden of Fallot's tetralogy among Nigerian children.

BACKGROUND: There are only very few reports on Fallot's tetralogy in Africa especially from sub-Saharan Africa. At best tetralogy of Fallot (TOF) is only mentioned as part of reports of surveys of other congenital heart diseases or as case reports in the region. There has been no report on cohorts of children with TOF in West Africa. This article describes the pattern and presentation of children diagnosed with TOF patients in a tertiary hospital in sub-Saharan Africa over a 9-year period. METHODS: Prospective and consecutive review of all subjects with diagnosis of TOF confirmed with echocardiography at the Lagos State University Teaching Hospital (LASUTH) between January 2007 and December 2015. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were presented as percentages or means and standard deviation. Means of normally distributed variables were compared using the Students' t-test and proportions using Chi-square test. Skewed distributions were analyzed using appropriate non-parametric tests. Level of significance set at P<0.05. RESULTS: The prevalence of TOF among children presenting at LASUTH at the study period was 4.9 per 1,000 while its prevalence among those with congenital heart disease was 16.9%. There was a male predominance with a mean age of 50.9±45.9 (months) and median age of 36 months. Most children presented within 1-5 years of age. The most common indication for evaluation was cyanosis. One hundred and nineteen out of 165 (72.1%) children were clinically cyanosed on presentation. CONCLUSIONS: TOF is prevalent among Nigerian children. Cyanosis was the commonest presenting feature and indication for evaluation. Most of the subjects presented late hence were diagnosed after 1 year of age. There is a need to increase awareness of TOF in Nigeria to encourage early diagnosis and hence better outcomes in these subjects.

Children With Tetralogy of Fallot in an Urban Centre in Africa.

INTRODUCTION: There is a dearth of literature on tetralogy of fallot (TOF) in children in Sub-Saharan Africa. This study up aims to describe the prevalence, clinical profile and associated cardiac anomaly of children diagnosed with TOF documented over an eight year period in a tertiary hospital in South Western Nigeria. METHODS: A prospective review of all consecutive cases of TOF diagnosed with echocardiography at the Lagos State University Teaching Hospital (LASUTH) between January 2007 and December 2014. Data were analyzed using SPSS version 20. Tables and charts were used to depict those variables. Descriptive statistic are presented as percentages or means and standard deviation. Means of normally distributed variables were compared using the student t test and proportions using chi-square test. Skewed distribution were analyzed using appropriate non-parametric tests. Level of significance set at P < 0.05. RESULT: The prevalence of TOF among children presenting at LASUTH at the study period was 4.9 per 10 000 while its prevalence among those with congenital heart disease was 16.9%. There was a male predominance and most children presented within 1-5 years of age. Chromosomal abnormalities such as Down syndrome, Turners syndrome and CATCH 22 syndrome were documented in some subjects. Some of the subjects had atypical presentation. CONCLUSION: TOF is as common in Nigeria as other parts of the world, there is a need to established cardiac centers to salvage these children. Collaboration from developed countries will be helpful in this resource limited region.

Profile and outcome of patients with post-neonatal tetanus in a tertiary centre in south west Nigeria: any remarkable reduction in the scourge?

INTRODUCTION: The incidence of tetanus has remained unacceptably high in developing countries. We aimed to describe the profile and outcome of children with tetanus admitted at the Lagos State University Teaching Hospital (LASUTH), Ikeja. METHODS: A prospective and cross-sectional study of children aged 1 month to 12 years of age admitted with clinical diagnosis of tetanus, between January 2011 and December 2013, at the Paediatric department of LASUTH. The age, sex, presenting complaint, immunization status, portal of entry, socio-economic class, complications, duration of admission and outcome of the subjects were analyzed using Microsoft Excel supplemented with Statistical Package for Social Sciences (SPSS) version 17.0. Level of significance set at p<0.05. RESULTS: A total of 49 subject participated in the study. Male: Female ratio was 1.7: 1.0. mean age±SD of 6.5±3.2 years. Only 24.5% of the subjects were fully immunized, lower limb injury was the most common portal of entry (34.7%). Majority (79.6) were of the middle and lower social classes. Most of the subjects (67.3%) presented with generalised spasm. Only 1 patient (2.0%) did not have trismus. Case fatality rate was 4.1%. CONCLUSION: Tetanus is still prevalent among children in our environment. It is commoner among those with no immunization or incomplete immunization, commoner in those in the middle and lower social class. Lower limb injury was the most common portal of entry. Trismus was a common presenting feature. There is a need to develop programmes with will help improve compliance to immunization.

Open heart surgery in Nigeria; a work in progress.

BACKGROUND: There has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme. METHODS: This is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome. RESULTS: 51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model. CONCLUSIONS: The Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar challenges will need to be overcome by other cardiac stakeholders if other OHS programs are to be developed and sustained in Nigeria.

Prenatal screening for sickle cell anemia: awareness among health professionals and medical students at the Lagos University Teaching Hospital and the concept of prevention by termination.

Nigeria has the highest population of sickle cell anemia (SCA) patients in the whole world. This condition manifests with frequent episodes of aches and pains, recurrent infections, and frequent hospitalization. Prenatal screening is one of the methods of reducing the prevalence of this disease. The study aimed to determine the awareness and acceptability of prenatal screening for SCA among health professionals and students at the Lagos University Teaching Hospital. It was a descriptive and cross-sectional study carried out between August and September 2006, involving 403 health professionals and students using structured questionnaires. The study revealed that 91.3% of the respondents had heard about prenatal screening for SCA, whereas 8.7% of the respondents had not. In addition, the majority of the respondents (75.3%) knew that SCA can be prevented by prenatal screening for SCA, whereas 13.7% and 11.3% were not aware or not sure, respectively. Up to 48.2% of the respondents were not aware that prenatal screening for SCA is available in Nigeria with the nurses being the least aware (χ=11.9, P=0.00). 42.1% of the respondents will not allow preventive termination of pregnancy if prenatal screening confirms SCA. For those who will not allow preventive termination, up to 79% of them decided on the basis of their religious beliefs. There is a poor level of awareness of the availability of prenatal screening services in Nigeria among health workers in Lagos, and religion is a major factor militating against its acceptability.