Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients

BACKGROUND:The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART.MATERIALS AND METHODS: All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross-sectional study over a 2-year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P-value of <0.05 was considered significant.RESULTS:A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm(3), 913 cells/mm(3) and 629 cells/mm(3) for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV-periodonttitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06).CONCLUSION: HIV-related Oral lesions are frequently seen in HIV-infected Nigerian children. Paediatric patients receiving HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV-gingivitis

Subclinical hypothyroidism in childhood obesity and its correlation with lipoproteins.

BACKGROUND/OBJECTIVE: There is an ongoing debate regarding the influence of subclinical hypothyroidism on body mass index. The objectives of the study were (i) to determine whether levels of thyroid stimulating hormone (TSH) are elevated in obese children, (ii) to compare the serum levels of triiodothyronine (T3) and thyroxine (T4) in obese with non-obese and (iii) to examine the association of subclinical hypothyroidism with lipoproteins and body mass index. METHODS: Fifty six obese children/adolescent girls aged 10.5 +/- 4.3 years, BMI 31.2 +/- 2.2 kg/m2 and apparently healthy children aged 11.2 +/- 5.2 years, BMI 21.0 +/- 2.1 kg/m2 were evaluated. Serum T3, T4 and TSH were measured using ELECSYS 1010 autoanalyzer while serum triglyceride, total cholesterol, LDL cholesterol, HDL cholesterol and glucose were measured using enzyme catalyzed colorimetric techniques. RESULTS: Subclinical hypothyroidism was observed in 10.7% of obese subjects. Significantly increase levels of T3 (p < 0.02), TSH (p < 0.01) and all lipoprotein fractions (p < 0.001) except HDL cholesterol which was lower (p < 0.001) were observed in obese than control subjects. TSH and triglyceride correlated positively with body mass index. CONCLUSION: Subclinical hypothyroidism was present in 10.7% of obese children. TSH and triglyceride correlated positively with body mass index in childhood/adolescent obesity. There is need for this group ofsubjects to be evaluated for thyroid hormones so that those requiring therapy can be diagnosed and treated.

Childhood diabetes mellitus in Kano, North West, Nigeria.

BACKGROUND: There is paucity of literature on childhood diabetes mellitus from developing countries and especially North west Nigeria and this has made it pertinent for documentation of the features of the disease in a major regional referral centre. The study was designed to describe the clinical presentation and outcome of childhood diabetes mellitus. METHODOLOGY: Retrospective review of hospital records of paediatric patients managed for diabetes at Aminu Kano Teaching Hospital, Kano. Nigeria between January 1999 and December 2006. The age, sex, presenting features, complications, laboratory features and outcome of the patients were retrieved from the hospital records: RESULTS: During the years under review eleven out of 3,585 admissions were managed for Type 1 diabetes mellitus giving a prevalence rate of 3.1/1000. Male to female ratio was 1:0.6. The mean age at presentation was 10 +/- 4.5 years most of the patients (72.7%) belonged to the lower socio-economic classes IV and V. The duration of symptoms ranged from 6 58 days with a mean of 24 +/- 22.8 days. The patients presented with urinary tract infections (36.4%), malaria (27.3%) and recurrent boils (18.2%). Three (27.3%) of the patients had polyuria and polydypsia while only one (91%) patient had polyphagia and weight loss. The mean random blood glucose on admission was 28.5 +/- 7.9 mmo/L (16.9 39.2mmo/L). Four patient presented with diabetic Keloacidosis. Two patients (18.2%) were discharged against medical advice while 1 (9.1%) patient died. CONCLUSION: Childhood Diabetes Mellitus, remains relatively uncommon in Nigeria.

Effect of instructions about the method of urine collection and storage on the isolation rate of urinary bacteria in children

A study of 65 children (29males and 36females) and aged between four weeks and 15years with significant bacteriuria was undertaking over a six month period to determine the effects of instruction received about the methods of urine collection and storage on the prevalence of urinary tract infection. The commonest clinical presentation was fever (64.6). Only 22(35.4) of the patients had specific symptoms suggestive of urinary tract infections. The instructions about urine collection were given to 48(73.8) care givers. This instruction was given by the attending doctors (84). Despite the explanation; 15(23.1) of the patients collected the urine samples wrongly and 44(67.7) stored the samples for longer than one hour. Significant bacteriuria was more prevalent in 74.2of patients who submitted their urine samples more than one hour after collection. Communication skill is important and should be emphasized in the trainings of health workers in procedure on the patients

Childhood diabetes mellitus in Kano, North West, Nigeria

There is paucity of literature on childhood diabetes mellitus from developing countries and especially North west Nigeria and this has made it pertinent for documentation of the features of the disease in a major regional referral centre. The study was designed to describe the clinical presentation and outcome of childhood diabetes mellitus. Retrospective review of hospital records of paediatric patients managed for diabetes at Aminu Kano Teaching Hospital; Kano. Nigeria between January 1999 and December 2006. The age; sex; presenting features; complications; laboratory features and outcome of the patients were retrieved from the hospital records. During the years under review eleven out of 3;585 admissions were managed for Type 1 diabetes mellitus giving a prevalence rate of 3.1/1000. Male to female ratio was 1:0.6. The mean age at presentation was 10 4.5years most of the patients (72.7) belonged to the lower socio-economic classes IV and V. The duration of symptoms ranged from 6 58days with a mean of 24 22.8days. The patients presentedwith urinary tract infections (36.4); malaria (27.3) and recurrent boils (18.2). Three (27.3) of the patients had polyuria and polydypsia while only one (91) patient had polyphagia and weight loss. The mean random blood glucose on admission was 28.5 7.9mmo/L (16.9 39.2mmo/L) Four patient presented with diabetic Keloacidosis. Two patients (18.2) were discharged against medical advice while 1(9.1) patient died. Childhood Diabetes Mellitus; remains relatively uncommon in Nigeria

Urinary tract infection in children with nephrotic syndrome in Kano, Nigeria.

BACKGROUND: Nephrotic syndrome is a common childhood renal disorder; the prevalence of Urinary tract infection (UTI) in these patients is high. The increased prevalence of UTI are due to immunoglobulin loss, defective T cell function, presence of ascites and relative malnutrition. OBJECTIVE: The study is to evaluate the prevalence of UTI , its etiological agents, antibiotics, sensitivity pattern and the outcome in children with nephrotic syndrome. METHODS: A prospective study of all patients with diagnosis of nephrotic syndrome from January 2003 to December 2006. Urine specimen were routinely obtained by clean catch method following careful preparation urethral orifices. The specimens were processed immediately. Five millimeters (5 ml) loopful of the sample were inoculated on a blood agar and CLED agar plates. Identification of the organism to species level was by using stokes disc diffusion technique. RESULTS: Forty two patients were studied. The mean age and SEM for males was 8.2 + 0.5 years and females with 7.9 + 0.8 years. The age range was two to fifteen years UTI was caused predominantly by Staphylococcus aureus in 67.9%, Klebsiella species (17.9%) and Pseudomonas (14.2%). There was high in vitro resistance of these organisms to nalidixic acid and ampicillin but sensitive to cefotaxime, ceftriazone and ciprofloxacin. CONCLUSION: It is recommend that UTI should be sought for in patients with nephrotic syndrome and treatment should be prompt and appropriate.

Cerebral palsy in Kano, Nigeria--a review.

BACKGROUND: Cerebral palsy is the most common form of chronic motor disability that starts in childhood. The aim of this study is to determine the magnitude of cerebral palsy in Kano and environs as well as to highlight the types, aetiologic factors and associated co-morbidities. METHOD: The medical records of 356 patients who attended the paediatric neurology clinic between January 1998 and December 2005 were examined and all those with diagnosis of cerebral palsy were studied. The relevant data extracted and analysed included age at first presentation, sex, physiologic form of cerebral palsy and co-morbidities. RESULTS: Of all the paediatric neurology cases, there were 151 (42.4%) cases of cerebral palsy. There were 95 males (62.9%) and 56 females (37.1%) giving a male female ratio of 1:7:1. The age range was 6 months 12 years. The difference between the two sexes was not statistically significant (P > 0.05) Birth asphyxia was the leading cause of cerebral palsy (45.7%), followed by neonatal jaundice (12.6%), seizure disorder (11.9%), meningitis (7.3%), prematurity (3.3%), encephalitis (2.6%), genetic disorder (1.3%), trauma (1.3%) and craniosynostosis ( 0.62%). In 20 (13.2%) cases, the aetiology was unknown. The physiologic forms of cerebral palsy observed included spastic (41.7%), mixed (29.8%), hypotonic (21.9%) and dyskinetic (6.6%). The most prevalent comorbid conditions included: speech impairment (15.2%), mental retardation (13.2%), auditory impairment (11.9%), strabismus (11.3%), seizure disorder (11%) and microcephaly (7.3%). CONCLUSION: It is suggested that general improvement in perinatal health services will reduce the burden of the disease in Kano and environs.

HIV exposed infants: a preliminary report of the Aminu Kano Teaching Hospital experience.

UNLABELLED: To determine the Sociodemographic characteristics, infant feeding choices and outcome of HIV exposed neonates attending the paediatric infectious disease clinic (IDC) of Aminu Kano Teaching Hospital Kano. PATIENTS AND METHODS: The records of all HIV exposed babies were reviewed. One hundred and ninety HIV exposed babies were seen between October 2003-December 2005. Of these 121 were part of the PMTCT programme while 69 were not. A total of 179(94.2%) babies were delivered at term while 11(5.8%) were delivered prematurely, with M: F ratio of 1.2:1. RESULTS: A substantial number of mothers in the non PMTCT group were diagnosed antenataly or even prior to conception yet they did not avail themselves of the interventions in the PMTCT programme. Reasons given were ignorance, inaccessibility to PMTCT centres and fear of stigmatisation. Breast milk substitute, was the leading choice of mothers in the PMTCT group while breast milk and mixed feeding was practised more in the non-PMTCT group. CONCLUSION: PMTCT remains the best way of preventing paediatric HIV infection and infant feeding counselling should be family oriented. Provision of free infant formula, PCR machines to enable early diagnosis, waiving of fees, and home visits would greatly improve infant follow up.

An appraisal of current management of childhood urinary tract infections among private medical practitioners.

BACKGROUND: Private medical practitioners manage substantial number of children with urinary tract infection in Nigeria. It is important to evaluate the management of urinary tract infection (UTI), because of complications that may arise form improper treatment. METHODS: This study was conducted during the 10th Annual General and Scientific Conference of Guild of Medical Directors in Kano. Study populations were private medical practitioners. The research tools were self administered questionnaires containing questions to illicit knowledge, attitude and treatment regarding childhood UTI. RESULTS: One hundred and twenty respondents returned their questionnaire. There were 98 (81.7%) males and 22 (18.2%) females. Twenty one (17.5%) had postgraduate qualification. Majority (87.5%) respondents preferred early morning and mid-stream urine for patients. Escherichia coli, Staphylococcus aureus and Proteus mirabilis were the commonest listed isolates. The knowledge of predisposing factors and complications following UTI was fair. Twenty-six percent would give chemoprophylaxis for repeat infections in females while only 7% would refer such patients to specialist. Reasons that warranted referral varied from inability to pay fees to the occurrence of complications in the course of therapy. Twenty-nine percent would use multiple therapy (antibiotics) because of the need to ensure adequate antimicrobial coverage, effective therapy and prevention of resistance and cost effectiveness. Ampicillin, Cotrimazole and Tetracycline featured as first line antibiotics among the respondents. CONCLUSION: Some practices are clearly at variance with recommendations. Continue medical education is recommended for bridging the gap between current practices, this will enhance patient's care.

Awareness and knowledge of mother-to-child transmission of HIV among mothers attending the pediatric HIV clinic, Kano, Nigeria.

BACKGROUND: Nigeria accounts for about 10% of all HIV/AIDS cases in the world. Globally women constitute 48% of adults infected with HIV; in Nigeria, they constitute 57%. There is an increase in the number of children infected with HIV in recent years as the number of HIV-positive women has increased. However, more than 90% of HIV infections in children aged less than 15 years are due to mother-to-child transmission of HIV. OBJECTIVE: To evaluate the awareness and knowledge of mother-to-child transmission of HIV, HIV/AIDS and the methods to prevent mother-to-child transmission of HIV. METHODS: This is a descriptive study. The study was carried out at the pediatric HIV clinic of Aminu Kano Teaching Hospital from 1 st July 2006 to 30 th December 2006. Mothers included in the study were mothers in first contact with HIV facilities, which was at our center, before any form of counseling. The instrument used was a questionnaire designed to assess awareness of the mothers about HIV/AIDS, evaluate their knowledge of possible routes of transmission and measures to prevent vertical transmission. The questionnaire was then pre-tested for comprehensibility, appropriateness of language, sensitivity of questions and average duration of administration. RESULTS: A total of 164 mothers brought their children for treatment to the pediatric HIV clinic. The level of awareness about HIV/AIDS among mothers was very high (100%), and the main sources of information were radio (48.8%) and television (37.8%). Ninety-one percent of mothers were aware of mother-to-child transmission of HIV. Transplacental route (41%) was the commonly identified route of transmission. The level of knowledge and perceptions of mother-to-child transmission of HIV is inadequate. CONCLUSION: There is a need to scale up education about mother-to-child transmission of HIV in our health facilities.

Urinary tract infection in children with nephrotic syndrome in Kano, Nigeria

Background: Nephrotic syndrome is a common childhood renal disorder; the prevalence of Urinary tract infection (UTI) in these patients is high. The increased prevalence of UTI are due to immunoglobulin loss; defective T cell function; presence of ascites and relative malnutrition. Objective: The study is to evaluate the prevalence of UTI ; its etiological agents; antibiotics; sensitivity pattern and the outcome in children with nephrotic syndrome. Methods: A prospective study of all patients with diagnosis of nephrotic syndrome from January 2003 to December 2006. Urine specimen were routinely obtained by clean catch method following careful preparation urethral orifices. The specimens were processed immediately. Five millimeters (5mml) loopful of the sample were inoculated on a blood agar and CLED agar plates. Identification of the organism to species level was by using stokes disc diffusion technique. Results : Forty two patients were studied. The mean age and SEM for males was 8.2 + 0.5 years and females with 7.9 + 0.8years. The age range was two to fifteen years UTI was caused predominantly by Staphylococcus aureus in 67.9; Klebsiella species (17.9) and Pseudomonas (14.2). There was high invitro resistance of these organisms to nalidixic acid and ampicillin but sensitive to cefotaxime; ceftriazone and ciprofloxacin. Conclusion: It is recommend that UTI should be sought for in patients with nephrotic syndrome and treatment should be prompt and appropriate

A seven-year review of accidental kerosene poisoning in children at Aminu Kano Teaching Hospital, Kano.

BACKGROUND: Accidental ingestion of kerosene is a potential source of morbidity and mortality in children. The objectives of the study are to determine to magnitude of the problem and proffer feasible solutions to reduce the frequency of occurrence. METHODOLOGY: The medical records of all cases of kerosene poisoning admitted into Paediatric Medical Ward and Emergency Paediatric Unit were identified and relevant data extracted and analysed. RESULTS: Kerosene poisoning constituted 55 (1.2%) of cases of all paediatric admissions within the period (Jan 1999 Dec 2005). The study showed that children 4 months to 8 years were affected with peak age of 18 months. Thirty-four (61.8%) of the cases were aged below 2 years which conforms to findings in earlier studies in Nigeria. Main clinical feature was cough with difficulty in breathing in 52 (94.5%) of cases. Others features noted were central nervous system involvement (14.5%), vomiting (20%), and fever 16 (29.1%). There were 3 deaths giving the mortality of 5.5%. CONCLUSION: The study has revealed that kerosene poisoning is a significant cause of morbidity and mortality. Government policies that will enhance the standard of living of people and education of parents/care givers are the identified imperatives for reduction of the problem.

A Seven - Year Review of Accidental Kerosene Poisoning in Children at Aminu Kano Teaching Hospital

Background: Accidental ingestion of kerosene is a potential source of morbidity and mortality in children. The objectives of the study are to determine to magnitude of the problem and proffer feasible solutions to reduce the frequency of occurrence. Methodology: The medical records of all cases of kerosene poisoning admitted into Paediatric Medical Ward and Emergency Paediatric Unit were identified and relevant data extracted and analysed. Results: Kerosene poisoning constituted 55 (1.2) of cases of all paediatric admissions within the period (Jan 1999 Dec 2005). The study showed that children 4 months to 8 years were affected with peak age of 18 months. Thirty-four (61.8) of the cases were aged below 2 years which conforms to findings in earlier studies in Nigeria. Main clinical feature was cough with difficulty in breathing in 52 (94.5) of cases. Others features noted were central nervous system involvement (14.5); vomiting (20); and fever 16 (29.1). There were 3 deaths giving the mortality of 5.5. Conclusion: The study has revealed that kerosene poisoning is a significant cause of morbidity and mortality. Government policies that will enhance the standard of living of people and education of parents/care givers are the identified imperatives for reduction of the problem

Outcome of delivery among HIV positive mothers at Aminu Kano Teaching Hospital, Kano.

BACKGROUND: If a HIV positive mother delivers in a health facility, interventions can be effected to reduce the risk of transmission of HIV to the baby The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive, giving a prevalence rate of 2.54%. Most (75.2%) of the patients received Nevirapine alone in labour, 20.8% received a combination of antiretroviral drugs while 4% received none because their records were not available. Majority (88%) of the patients had spontaneous vaginal delivery, 10.4% by elective CS and 1.6% by emergency CS. There was no maternal death but 3.2% of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96%) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced, as it is more effective for PMTCT.

Outcome of delivery among HIV positive mothers at Aminu Kano teaching hospital; Kano

BACKGROUND: If a HIV positive mother delivers in a health facility; interventions can be effected to reduce the risk of transmission of HIV to the baby. The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive; giving a prevalence rate of 2.54. Most (75.2) of the patients received Nevirapine alone in labour; 20.8 received a combination of antiretroviral drugs while 4 received none because their records were not available. Majority (88) of the patients had spontaneous vaginal delivery; 10.4 by elective CS and 1.6 by emergency CS. There was no maternal death but 3.2 of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced; as it is more effective for PMTCT

Outcome of Delivery among HIV Positive Mothers at Aminu Kano Teaching Hospital

BACKGROUND: If a HIV positive mother delivers in a health facility; interventions can be effected to reduce the risk of transmission of HIV to the baby. The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive; giving a prevalence rate of 2.54. Most (75.2) of the patients received Nevirapine alone in labour; 20.8received a combination of antiretroviral drugs while 4received none because their records were not available. Majority (88) of the patients had spontaneous vaginal delivery; 10.4by elective CS and 1.6by emergency CS. There was no maternal death but 3.2of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced; as it is more effective for PMTCT

Outcome of Delivery among HIV Positive Mothers at Aminu Kano Teaching Hospital

BACKGROUND: If a HIV positive mother delivers in a health facility; interventions can be effected to reduce the risk of transmission of HIV to the baby. The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive; giving a prevalence rate of 2.54. Most (75.2) of the patients received Nevirapine alone in labour; 20.8received a combination of antiretroviral drugs while 4received none because their records were not available. Majority (88) of the patients had spontaneous vaginal delivery; 10.4by elective CS and 1.6by emergency CS. There was no maternal death but 3.2of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced; as it is more effective for PMTCT

Structural heart diseases in Nigerian children.

BACKGROUND: Cardiovascular diseases both in adults and children constitute a major public health problem and structural heart diseases are an important group of disorders in children worldwide. The pattern of this group of disorders however, varies between regions and countries and even within countries. Recognizing the structural cardiac conditions that prevail in a particular area is important in health planning and for improving health care services. The present survey sets out to describe the pattern of structural heart diseases among children in Aminu Kano Teaching Hospital, Kano from our echocardiography data. METHODS: The echocardiographic reports of all children seen in Aminu Kano Teaching Hospital, Kano between August 2002 and September 2004 (24 months) were reviewed. Information obtained from the records includes age, gender, clinical diagnosis and echocardiographic findings. Data was analyzed using SPSS version 10.0 software. RESULTS: A total of 108 children, aged between two weeks and eighteen years, were referred for echocardiographic examination in the 2-year study period. Of these, 88 had an abnormal echocardiogram. There were 55 boys and 31 girls, giving a male and female ratio of 1.8:1. Congenital heart diseases accounted for 55 (62.5%) of the studied subjects while acquired heart diseases were responsible for 33 (37.5%). Isolated ventricular septal defect (VSD) was the commonest congenital heart disease. Rheumatic valvular heart diseases were the commonest acquired structural heart disease. CONCLUSION: With the establishment of tertiary healthcare institutions in Nigeria, availability of echocardiographic facilities as well as increasing number of paediatric cardiologists, more of these cases are likely to be seen in the future. There is an urgent need for the government to establish a well equipped cardiothoracic surgical centre to cater for these patients either free or at highly subsidized rates.