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.

Doctors' Knowledge, Comprehension, Attitude to and Application of Ethical Principles in Child Healthcare in a Nigerian Teaching Hospital.

BACKGROUND AND OBJECTIVES: Due to the prevailing socio-cultural and religious affiliations, Paediatricians in sub-Saharan Africa face unique ethical dilemmas. An understanding and application of the ethical principles can help prevent and resolve these dilemmas, and improve child health indices. The objective is to determine the knowledge, attitude and practical applications of non-maleficence and beneficence by child-care doctors at a Teaching Hospital. METHODS: This is a questionnaire-based study. Socio-demographics, knowledge and attitude towards the ethical principles, and its utilisation by doctors in childcare was sought. Data were analyzed using descriptive statistics. RESULTS: 294 doctors participated. The mean percentage knowledge score of nonmaleficence and beneficence was 31.00±21.14, significantly higher among doctors in Paediatrics (39.35±23.44, p=0.0001). For every decrease in professional rank, knowledge score decreased by 3.8224 (95% CI -5.824 - -1.819; p=0.0001). The doctors had a high mean percentage score on attitude towards ethics of 74.79±16.34, and for every increase in years of practice, attitude towards ethics score would increase by 2.922 (95% CI 1.133 to 4.711, p=0.001). There was a low practice score of 34.27±20.07. Majority (69%) encountered less than one dilemma a month. More than 90% of doctors had encountered dilemmas involving the principle of non-maleficence [184 (90.6%)], while 154 (75.9%) involved beneficence. CONCLUSION: Most respondents have a low level of knowledge and practice of the principles of nonmaleficence and beneficence. Their excellent attitude implies their willingness at improving their knowledge and practice.

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

Body mass index and blood pressure correlate in nursery school children in Port Harcourt, Nigeria

Introduction: Blood pressure (BP) is a vital indicator of health in children and adults. The relationship between body mass index (BMI) and BP is well established in children; and BMI has been shown to maintain an independent relationship with BP even after controlling for many other variables that characterize individuals. High BMI significantly increases the risk of hypertension. Epidemiological studies in various countries have been conducted to determine the relationship between BP and BMI in children; similar comparative studies are lacking in Nigeria, thus necessitating this study.Aim: To determine the relationship between BMI and BP in nursery pupils in Port Harcourt.Methods: Multi-staged sampling technique was used to select 710 nursery pupils from 13 schools. Biodata was obtained using a selfadministered (parent) questionnaire. Height and weight measurement were taken, and BMI calculated. BP was measured using a mercury sphygmomanometer; and relevant data analysis done.Result: There were 710 pupils 365 (51.4%) males and 345(48.6%) females. Mean systolic BP was 93.2 ± 10.6mmHg (70­130 mmHg); while mean diastolic BP was 58.8 ± 8.0mmHg(40 ­ 88.7 mmHg). Mean BMI was 15.0 ± 1.8 kg/m2(9.1 - 25.5 kg/m2). There is a positive linear relationship between systolic and diastolic BP and BMI (correlation coefficient r = 0.03). Obese pupils had significantly higher BP rates (25%) (X2= 15.35, p =0.002). BMI and height were significant predictors of diastolic BP (p<0.001).Conclusion: There is a positive correlation between BMI and BP; and high BMI is an important predictor of high BP in nursery pupils in Nigeria

Congenital heart disease in the Niger Delta region of Nigeria: a four-year prospective echocardiographic analysis.

INTRODUCTION: Echocardiographic evaluation remains the gold standard for the diagnosis of structural cardiac disease. No previous prospective studies have been done on the prevalence of congenital heart disease (CHD) in the Niger Delta area. This study was done to determine the frequency and pattern of congenital heart disease, using echocardiography as a diagnostic tool. METHODS: All patients presenting to the Paediatric Cardiology clinics of two centres, the University of Port Harcourt Teaching Hospital and the Paediatric Care Hospital between April 2009 and March 2013, were recruited and all had echocardiography performed. RESULTS: Prevalence of CHD in this study was 14.4 per 1 000 children; 277 (83.4%) of the patients had acyanotic CHD and 55 (16.6%) had cyanotic CHD. Ventricular septal defect and tetralogy of Fallot were the commonest acyanotic and cyanotic heart defects, respectively. CONCLUSION: The high prevalence of CHD in this study is the highest in the country and Africa, and may be attributable to the increased oil spillage and gas flaring from petroleum exploitation in this region.

Congenital Heart Disease in the Niger Delta region of Nigeria : a Four-Year Prospective Echocardiographic Analysis : Cardiovascular Topic

Introduction : Echocardiographic evaluation remains the gold standard for the diagnosis of structural cardiac disease. No previous prospective studies have been done on the prevalence of congenital heart disease (CHD) in the Niger Delta area. This study was done to determine the frequency and pattern of congenital heart disease; using echocardiography as a diagnostic tool. Methods : All patients presenting to the Paediatric Cardiology clinics of two centres; the University of Port Harcourt Teaching Hospital and the Paediatric Care Hospital between April 2009 and March 2013; were recruited and all had echocardiography performed.Results : Prevalence of CHD in this study was 14.4 per 1 000 children; 277 (83.4) of the patients had acyanotic CHD and 55 (16.6) had cyanotic CHD. Ventricular septal defect and tetralogy of Fallot were the commonest acyanotic and cyanotic heart defects; respectively.Conclusion : The high prevalence of CHD in this study is the highest in the country and Africa; and may be attributable to the increased oil spillage and gas flaring from petroleum exploitation in this region

Perception of sexuality education amongst secondary school students in Port Harcourt, Nigeria.

BACKGROUND: Sexuality behavior amongst young people in Nigeria and indeed Sub-Saharan Africa is seriously going through transformation from what it was previously. It is therefore important that young people have adequate information about their sexuality so that they can make informed choices. OBJECTIVE: To determine perceptions and knowledge of sexuality education amongst secondary school students in Port Harcourt, Nigeria. METHODS: A structured, anonymous and self-administered questionnaire, used as instrument for data collection, was distributed amongst a convenient sample of 1050 secondary school students attending a series of Schools debates in Port Harcourt Metropolis. RESULTS: The students were aged 10 -20 years, with a median age of 15. There were 486 males and 564 females giving a M: F ratio of 1:1.2. Four hundred and fourteen (73.4%) of the females had attained menarche. Nine hundred and fifty (90.5%) of the respondents had heard of sexuality education but only 422 (40.1%) discussed relevant topics on the subject. 52.8% believed that sexuality education should be given at home by both parents. However, only 164 (31.2%) and 19 (3.6%) got such information from their mothers and fathers respectively. Only 7.6% acknowledged the school teacher as a source of information. CONCLUSION: Secondary school students are aware of the subject of sexuality education, but lack adequate information on sexuality issues. Parents and teachers are a poor source of information for students. Parents, Teachers and students need to be enlightened on sexuality education. There is also a need to incorporate it into the school curriculum.

Echocardiography findings in clinically confirmed congenital rubella syndrome cases seen at the University of Port Harcourt Teaching Hospital, Nigeria.

BACKGROUND: Congenital rubella syndrome (CRS) is known to affect thousands of children in the developing world because rubella vaccination is not available routinely in most of these countries. Among its many manifestations only congenital heart disease is life threatening. This study was undertaken to ascertain the cases of echocardiographic determined congenital heart disease in clinically confirmed CRS cases. METHODS: Data of patients with clinically confirmed CRS seen over a period of 5 years in the Paediatric cardiology clinic of the University of Port Harcourt Teaching Hospital was retrieved and analysed. RESULTS: Seven cases (2.8 % of total cardiac cases) were seen. 6 (85.7%) cases had at least one murmur on auscultation. Patent ductus arteriosus was the commonest cardiac defect seen either in isolation or incombination with a VSD or ASD. Only one child had no cardiac defect. 4 (57.1%) of them had been admitted for heart failure at least once and 2 (28.6 %) were on anti-failure regimen, one of whom had cardiac surgery one month ago. CONCLUSION: In view of the fact that 6 (85.7%) of the patients with CRS had at least one congenital heart defect, we advocate routine echocardiography on patients with CRS to ensure early treatment and reduce mortality and morbidity.We also advocate that rubella vaccination be given routinely in developing countries.

Simple Vision Screening in Lower Primary School Children in Port Harcourt City

Background: Vision disorders are significant causes of morbidity worldwide and in children; can lead to life long visual impairment or blindness. Thus; the impact on a child's education and life if not detected and ameliorated on time; can constitute a huge socio-economic burden to the child; family and community. Aim: To determine the prevalence of reduced vision in lower primary school children in Port Harcourt city. Methods: A multi-staged sampling technique was used to select 1;234 lower primary school pupils from 12 schools in Port Harcourt for visual screening. Visual acuity (VA) measurements using Snelling's charts; and a basic eye examination using a pen torch was carried out in all the pupils. Vision was regarded as reduced if VA is 6/18; in which case a pinhole was presented to the affected eye and VA repeated; to check for presence of refractive error. Results: A total of 1;234 school children were screened; 73 pupils had reduced vision in one or both eyes giving a prevalence of 5.9. Refractive errors accounted for 72.6of cases of reduced vision. Gross external eye abnormalities accounted for 9.6of cases of reduced vision; with corneal opacity and nystagmus being the most commonly seen. Conclusion: Reduced vision is an important cause of visual disability in primary school pupils in Port Harcourt city; mostly due to correctable refractive errors. There is therefore a need for routine vision screening of all pupils; especially on commencement of school for early detection and treatment; to prevent life long visual disability

Screening for congenital color vision deficiency in primary children in Port Harcourt City; teachers' knowledge and performance.

BACKGROUND: One hundred and thirty teachers were studied to evaluate their knowledge of congenital Color Vision Deficiency (CVD), and their ability to perform the Ishihara color vision test, so as to determine if they can provide color vision screening services for their pupils. METHODS: The teachers were randomly selected from 13 schools in Port Harcourt City (PHC) and given a six hours training workshop on vision disorders in children and congenital color vision screening. They were given a self administered pre and post test questionnaires before and after training respectively. Subsequently, they screened 1,300 of their school pupils for congenital vision deficiency using the Ishihara color vision chart; and their results compared to that of the research team. RESULTS: Female teachers constituted 84.6% and males 15.4% of the study population. Seventy three teachers (53.8%) were from public schools while 46.2% were from private schools. Prior to the training workshop, only 6.2% of teachers had heard of the Ishihara color vision chart and none of the teachers could identify or knew how to use the chart. However with training there was significant improvement in knowledge of CVD. Comparison of the teachers' performance of color vision screening using the Ishihara chart to that of the research team showed a sensitivity of 67.6% with a specificity of 99.1%. The prevalence of congenital color vision deficiency in the 1,300 primary school screened was 2.6%, with males having a significantly higher prevalence than females. CONCLUSION: The study thus concludes that congenital color vision deficiency is prevalent amongst primary school children in Port Harcourt City, and with training, teachers can effectively perform color vision screening, and as such modify their teaching methods to accommodate the child with color vision deficiency.

Screening for Congenital Color Vision Deficiency in Primary Children in Port Harcourt City; Teachers' knowledge and performance

Background: One hundred and thirty teachers were studied to evaluate their knowledge of congenital Color Vision Deficiency (CVD); and their ability to perform the Ishihara color vision test; so as to determine if they can provide color vision screening services for their pupils. Methods: The teachers were randomly selected from 13 schools in Port Harcourt City (PHC) and given a six hours training workshop on vision disorders in children and congenital color vision screening. They were given a self administered pre and post test questionnaires before and after training respectively. Subsequently; they screened 1;300 of their school pupils for congenital vision deficiency using the Ishihara color vision chart; and their results compared to that of the research team. Results: Female teachers constituted 84.6and males 15.4of the study population. Seventy three teachers (53.8) were from public schools while 46. 2were from private schools. Prior to the training workshop; only 6.2of teachers had heard of the Ishihara color vision chart and none of the teachers could identify or knew how to use the chart. However with training there was significant improvement in knowledge of CVD. Comparison of the teachers' performance of color vision screening using the Ishihara chart to that of the research team showed a sensitivity of 67.6with a specificity of 99.1. The prevalence of congenital color vision deficiency in the 1;300 primary school screened was 2.6; with males having a significantly higher prevalence than females. Conclusion: The study thus concludes that congenital color vision deficiency is prevalent amongst primary school children in Port Harcourt City; and with training; teachers can effectively perform color vision screening; and as such modify their teaching methods to accommodate the child with color vision deficiency