Decentralization and Integration of Advanced Cardiac Care for the World's Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease.

Rheumatic and congenital heart disease, cardiomyopathies, and hypertensive heart disease are major causes of suffering and death in low- and lower middle-income countries (LLMICs), where the world's poorest billion people reside. Advanced cardiac care in these counties is still predominantly provided by specialists at urban tertiary centers, and is largely inaccessible to the rural poor. This situation is due to critical shortages in diagnostics, medications, and trained healthcare workers. The Package of Essential NCD Interventions - Plus (PEN-Plus) is an integrated care model for severe chronic noncommunicable diseases (NCDs) that aims to decentralize services and increase access. PEN-Plus strategies are being initiated by a growing number of LLMICs. We describe how PEN-Plus addresses the need for advanced cardiac care and discuss how a global group of cardiac organizations are working through the PEN-Plus Cardiac expert group to promote a shared operational strategy for management of severe cardiac disease in high-poverty settings.

Aicardi syndrome in a Nigerian female child: A case report and literature review of a rare neuro-developmental disorder from North-Western Nigeria.

Aicardi syndrome is a very rare neurodevelopmental disorder, inherited as an X-linked dominant condition with a triad of infantile spasm, partial or complete agenesis of the corpus callosum, and chorio-retinal "lacunae." We report a case of a female infant with the classical triad of Aicardi syndrome. A female infant presented to the Paediatric Neurology Clinic of the Federal Medical Centre Birnin-Kebbi, North-western Nigeria, at the age of two months with complaints of recurrent afebrile convulsions typical for infantile spasms. The patient was delivered at term with normal Apgar scores and anthropometry. Examination revealed an infant with no dysmorphic features and normal systemic examination. Magnetic Resonance Imaging (MRI) of the brain however, showed complete agenesis of the corpus callosum and dilatation of the posterior horn of the lateral and third ventricles. Fundoscopy showed multiple yellowish spots along the vascular arcades in the right eye. The left eye had a one-disc diameter lacuna in the superior nasal quadrant adjacent to the optic disc with multiple yellowish spots. A diagnosis of Aicardi syndrome was made. The child was placed on oral phenobarbital and followed up. At the age of 18 months, the child can only sit without support, hold an object in each hand, smile socially, and babble. The frequency of the seizures had also reduced from >100 episodes per day to 2-3 episodes per day, but the child had developed right-sided spastic hemiparesis. The patient was commenced on physiotherapy and the anti-epileptic drugs were maintained. We recommend clinicians consider Aicardi syndrome in the differential diagnosis of any child presenting with infantile spasms.

Identifying challenges in implementing child rights instruments in Nigeria: A nationwide survey of knowledge, perception, and practice of child rights among doctors and nurses.

Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm. Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses. Materials and Methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds. Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000). Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial.

Résumé Contexte: Après trente ans de ratification de la convention sur les droits de l'enfant et dix-neuf ans de la loi sur les droits de l'enfant, la mise en œuvre des instruments relatifs aux droits de l'enfant reste difficile au Nigéria. Les fournisseurs de soins de santé sont bien placés pour changer le paradigme actuel. Objectif: Examiner la connaissance, la perception et la pratique des droits de l'enfant et l'influence de la démographie parmi les médecins et les infirmières nigérians. Matériels et méthodes: Une enquête en ligne descriptive et transversale a été réalisée à l'aide d'un échantillonnage non probabiliste. Un questionnaire à choix multiples prétesté a été diffusé dans les six zones géopolitiques du Nigeria. Les performances ont été mesurées sur les échelles de fréquence et de rapport. Les scores moyens ont été comparés aux seuils de 50 % et 75 %. Résultats: Au total, 821 praticiens ont été analysés (médecins, 49,8 % ; infirmiers, 50,2 %). Le ratio femmes/hommes était de 2 : 1 (médecins, 1,2 : 1 ; infirmières, 3,6 : 1). Dans l'ensemble, le score de connaissances était de 45,1 % ; les deux groupes avaient des scores similaires. Les plus informés étaient les titulaires d'une bourse (53,2 %, P = 0,000) et les pédiatres (50,6 %, P = 0,000). Le score de perception était de 58,4 % dans l'ensemble, et les performances étaient également similaires dans les deux groupes ; les femmes et les sudistes ont obtenu de meilleurs résultats (59,2 %, P = 0,014 et 59,6 %, P = 0,000, respectivement). Le score de pratique était de 67,0 % dans l'ensemble ; les infirmières ont obtenu de meilleurs résultats (68,3 % contre 65,6 %, P = 0,005) et les infirmières post-base ont obtenu le meilleur score (70,9 %, P = 0,000). Conclusions: Dans l'ensemble, les connaissances de nos répondants sur les droits de l'enfant étaient médiocres. Leurs performances en perception et en pratique étaient bonnes, mais pas suffisantes. Même si nos conclusions ne s'appliquent peut-être pas à tous les agents de santé au Nigeria, nous pensons que l'enseignement des droits de l'enfant à différents niveaux de la formation médicale et infirmière sera bénéfique. Les engagements des parties prenantes impliquant des médecins praticiens sont cruciaux. Mots-clés: droits de l'enfant, travailleurs de la santé, connaissances, Nigéria, perception, pratique.

Identifying challenges in implementing child rights instruments in Nigeria: A nationwide survey of knowledge, perception, and practice of child rights among doctors and nurses

Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm. Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses. Materials and methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds. Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000). Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial

Assessment of school health services in primary schools in Gwagwalada area council, Federal Capital Territory, Nigeria.

Introduction: School Health Service (SHS) is one of the five main components of the School Health Programme aimed at ensuring every child remains healthy to benefit maximally from his/her education. This study aimed to assess the level of implementation of SHS in primary schools in the Gwagwalada Area Council of the Nigerian Federal Capital Territory. Methods: a cross-sectional study was carried out in primary schools in Gwagwalada Area Council using a weighted School Health Service assessment checklist. Results: a total of 146 primary schools were studied. Ninety-five (65.1%) of the schools had no health personnel. First aid was offered by 129 (88.4%) of the schools for medical emergencies. All schools sent children with communicable diseases home. None of the public schools assessed had an ambulance or a sickbay. A total of 44 (30.1%) schools, made up of 8 (20.0%) public and 36 (34.0%) private schools, attained the acceptable minimum score of 19. The mean scores on school health services by the private and public schools were 16.31±3.96 SD and 16.23±2.87 SD respectively out of the attainable maximum score of 45 (t=0.145, p=0.885). Conclusion: the level of implementation of SHS in Gwagwalada Area Council is inadequate though with a slightly better situation in the private schools. For more effective SHSs in the study area, there is the need for the provision of sufficient human resources and facilities by stakeholders in Gwagwalada Area Council primary schools.