Socioecology of the Canine Population in the Province of El Jadida, Morocco.

Understanding the socioecology of domestic dog populations is essential for effective disease control, especially canine rabies. In Morocco, since 1986, the control efforts and plans put in place by the government have failed to eradicate this disease; this is because the management of the canine population was not taken into account during the establishment of these plans. It is against the background that this study was designed to estimate the dog population and determine its socioecological characteristics, as well as investigate the attitude of the inhabitants towards the dogs. A stratified random sampling was conducted using a structured questionnaire from May to December 2016. A total of 1931 households were interviewed, comprising 27.4% in urban areas and 72.6% in rural areas. A total of 3719 dogs were counted alongside a human population of 11302 for a dog : human ratio of 1 : 2.42 in rural areas and 1 : 46.58 in urban areas. The majority of dogs (92%) in rural areas were not vaccinated against rabies. In urban areas, about 88.5% were vaccinated against rabies. In addition, 78.5% of dogs in rural areas were free roaming, with more than 53% of births being abandoned by their owners, resulting in a large stray and feral dog population and increasing the potential for continued transmission of rabies virus. There was strong association between breed and rabies vaccination (p<0.05) and confinement with body condition score.

Dog ecology and its implications for rabies control in Gwagwalada, Federal Capital Territory, Abuja, Nigeria.

The objectives of this study were to determine the characteristics of a dog population, including their accessibility to vaccination and health care, in urban and semiurban areas of Gwagwalada, Abuja, Nigeria. Direct street counts and a house-to-house survey of city streets were performed. A total of 451 households were surveyed comprising 43.7% urban and 53.3% semiurban areas. A total of 848 owned dogs were identified, along with 3,115 corresponding humans. With a dog-to-human ratio of 1:3.7, the dog population in the study area was estimated as 103,758. A total of 396 dogs were counted on the streets with the greater proportion (74%) in semiurban areas. Most dogs in semiurban areas (77.3%) had no certificate confirming vaccination against rabies, compared to 47.2% in urban areas (p = .004). The majority of dogs in the urban (60.9%) and semiurban (82.0%) were free roaming. In the multivariable model, age, presence of a collar, region, sex, use and having ever visited a veterinarian were significantly associated with rabies vaccination. The majority (125/197, 63.5%) of respondents with higher education were willing to pay more for the healthcare needs of their dogs as opposed to those with a lower level of education (93/251, 37.1%, p = .001). The study revealed a high dog population density, vaccination coverage below WHO recommendation of 70% and generally reduced healthcare-seeking behaviour among dog owners in Gwagwalada, Abuja, Nigeria.

Role of vesicostomy in the management of posterior urethral valve in Sub-Saharan Africa.

OBJECTIVE: To review the role of vesicostomy in the management of posterior urethral valve (PUV), in neonates and infants, given the limitations for endoscopic treatment in this setting. METHODS: A review of 35 patients who presented with posterior urethral valve over a 10-year period. Demographic and clinical information were prospectively recorded on a structured pro forma, and the data extracted analysed using SPSS 11.0. RESULTS: The 35 boys were aged 3 days to 10 years (median 3 weeks). Twenty-three (65.7%) had a vesicostomy (age range 3 days-3 years, median 3 weeks). The mode of presentation was poor urinary stream 15 (65.2%), urinary retention 4 (17.4%), and renal failure 6 (26.1%). Main findings were palpable bladder 23 (100%), hydronephrosis 4 (17.4%). Abdominal ultrasound confirmed hydronephrosis and thickened bladder wall, and voiding/expressive cystourethrogram confirmed dilated posterior urethra and vesicoureteric reflux in all 23 patients. Complications following vesicostomy were stoma stenosis 1 (4.3%), bladder mucosal prolapse 1 (4.3%), perivesicostomy abscess 1 (4.3%); there was no mortality. Following vesicostomy, 10 (43.5%) patients had excision of the valves and vesicostomy closure at age 2-8 years (median 4 years). They are well, with normal renal ultrasonographic findings, bladder capacity range 115-280 ml, and normal urea, serum electrolytes, creatinine, at 3 years of follow up. Thirteen (56.5%) are still awaiting valvotomy but have remained well and with normal ultrasonographic renal findings. CONCLUSION: Vesicostomy is a useful temporising mode of urinary diversion in neonates and infants with posterior urethral valve (in the absence of unobstructed upper tracts) when facilities for endoscopic valve ablation are not readily available.

Dicephalus dipus tetrabrachius conjoined twins of Zaria: case report and literature review.

One of the most interesting congenital malformations to manage is a conjoined twin. Conjoined twins are rare occurrences in obstetric/pediatric practice. More commonly known as Siamese twins, this phenomenon is shrouded in mystery and considered a curiosity by general public. Current technology is lending a helping hand in the early diagnosis of these conditions. Frequently, the twins are born dead, but there are few cases in which the twins survive. We presented a case of dicephalus dipud conjoined twins; a rare type of conjoined twins.

Detection of rabies antigen in the saliva and brains of apparently healthy dogs slaughtered for human consumption and its public health implications in abia state, Nigeria.

The study was carried out in eight dogs slaughtering outlets within four Local Government Areas of the State for the determination of rabies antigen in the saliva and brain of apparently healthy dogs slaughtered for human consumption. A total of one hundred (100) samples each of saliva and brain were collected before and after slaughter, respectively, between April to June, 2013, in the selected areas. The saliva was subjected to rapid immune-chromatographic test (RICT) while direct fluorescent antibody test (DFAT) was carried out on the brain samples. Structured questionnaire was administered to nineteen (19) dog meat processors comprising 18 males and 1 female in the selected areas. Sixty four percent of the samples tested were from female dogs while 36% were from males, 5% tested positive for rabies antigen with the use of both tests; there was no statistical association between sex and rabies status of the dogs sampled (P > 0.05). Butchers bitten during the course of slaughtering were 94.7% out of which 72.8% utilized traditional method of treatment and only 27.8% reported to the hospital for proper medical attention. This study has established the presence of rabies antigen in apparently healthy dogs in the study area.

Management of anorectal malformation: Changing trend over two decades in Zaria, Nigeria.

BACKGROUND: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. MATERIALS AND METHODS: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. RESULTS: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5%) and 106 (65.8%) emergency operations in groups A and B, respectively. There were 61 (45.5%) and 55 (34.2%) elective operations in groups A and B, respectively. Regarding treatment, in group A, patients requiring colostomy had transverse loop colostomy, while in group B, sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5%), anal transplant 5 (8.2%), sacroabdominoperineal pull through (Stephen's operation) 6 (9.5%) and others 21 (34.4%). In group B, posterior sagittal anorectoplasty (PSARP) 46 (83.7%), anal transplant 1 (1.8%), posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6%) and anal dilatation 6 (10.9%) were done. Early colostomy-related complication rates were similar in the two groups (P > 0.05). The overall late complication rate was 65.5% in group A and 16.4% in group B (P < 0.05). The mortality was 25 (18.6%) in group A compared to 17 (10.6%) in group B (P < 0.05). CONCLUSION: There have been significant changes in the management of anorectal malformations in this centre in the last two decades, resulting in improved outcomes.

Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes

Challenges of managing paediatric abdominal trauma in a Nigerian setting.

BACKGROUND: The management of abdominal trauma (particularly blunt trauma) has undergone tremendous revolution in the last 30 years with significant reduction in morbidity and mortality in developed countries. The aim of this report is to highlight the challenges of managing abdominal trauma in children in Nigeria based on our experience in Zaria, northern Nigeria. METHOD: This is a retrospective review of 82 children managed for abdominal trauma from 1991 2002 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information regarding demographics, mechanism of injury, haemodynamic status at presentation, clinical and radiologic evaluation, management, intraoperative findings and outcome, were extracted from case notes, operation notes and discharge summary notes. RESULTS: Fifty seven (69.5%) children had blunt trauma, mostly from traffic accidents (32, 57%) and falls (20, 36%), and 25 (30.5%) penetrating trauma mainly from falls onto sharp objects (7 of 18 patients) and animal-related injuries (5 of 18 patients). In the management of those with blunt trauma, advanced imaging modalities were usually not available and this resulted in an unnecessary laparotomy rate of 51% (laparotomy considered unnecessary because the patients remained haemodynamically stable after resuscitation and any intraperitoneal bleeding had stopped by the time oflaparotomy and no active operative measure was required to control bleeding). The management of penetrating trauma was more straightforward as this was guided by evidence of peritoneal penetration. Mortality from blunt trauma was 14.5% (8 of 55 patients) from exsanguinations before surgery 2, gastric perforation 3, hepatic laceration 2 and splenic injury one. Mortality from penetrating trauma was 12% (3 of 25 patients) from tetanus, overwhelming infection and haemorrhage respectively. The overall mortality from abdominal injury was 13.8% (11 of 80 patients) and were mostly avoidable if the patients presented early, and received some resuscitation before arrival at our hospital. CONCLUSION: The management of blunt abdominal trauma in children in Nigeria is faced with several challenges, which are mainly absence of an organised trauma system and lack of appropriate facilities. These need to be addressed in order to improve the care of these injuries.

Echocardiographic findings in children with surgically correctable non-cardiac congenital anomalies.

BACKGROUND: Congenital cardiac anomalies may co-exist with non-cardiac congenital malformations and, for those requiring surgical correction, there can be an anaesthetic risk. AIM: To estimate the burden of congenital heart disease (CHD) in children with surgically correctable non-cardiac congenital malformations. PATIENTS/METHODS: Records of 120 children aged between 1 week and 11 years [mean (SD) 0.6 (1.5) years] undergoing corrective surgery for non-cardiac congenital malformations were examined. Results of clinical cardiac examination and surgical and echocardiographic findings were analysed. RESULTS: Cleft lip or palate was the commonest surgical anomaly (46, 38.3%), followed by ano-rectal malformation (32, 26.7%). Forty-two children (35.0%) had an abnormal echocardiographic scan. A cardiac abnormality was detected clinically and confirmed by echocardiography in ten patients (8.3%), which represents 24% of all the cardiac abnormalities. The commonest cardiac anomalies were atrial septal defect (ASD) (30 children, 25%), followed by ventricular septal defect (VSD) (seven children, 5.8%). The frequency of ASD was highest in children with a cleft lip or palate (14/46, 30.4%). CONCLUSIONS: Over one-third of patients undergoing surgical correction of congenital malformations have co-existing CHD. Echocardiography is important for pre-surgical evaluation. No association between type of CHD and specific non-cardiac congenital malformations was found.

Transanal protrusion of intussusception in infants is associated with high morbidity and mortality.

BACKGROUND: Although anal protrusion of intussusception in infants is well recognised, it is rarely reported and confusion with rectal prolapse often results in delayed diagnosis and treatment. This report highlights the problems of diagnosis and the morbidity and mortality associated with this condition. METHOD: A retrospective case series of five infants presenting to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria with anal protrusion of intussusception over a period of 5 years. During that time, 17 children were treated for intussusception at ABUTH. RESULTS: The anal protrusion rate of intussusception was 29%. The five infants were three girls and two boys aged 4-18 months (median 8). The duration of symptoms was between 6 and 28 days (median 21). The features were mainly protruding anal mass, diarrhoea and vomiting. Abdominal pain and passage of bloody stools occurred late. There was delay in referral and treatment owing to misdiagnosis as rectal prolapse. The intussusception was ileocolic in four patients and in one the type could not be ascertained before death. Two patients had perforation of the involved intestine and another had gangrene of the intestine, necessitating intestinal resection. In one patient, there was no bowel compromise and only open reduction was necessary. Two patients died from overwhelming infection, one before surgery and another after surgery. CONCLUSION: The risk of morbidity and mortality in anal protruding intussusception is high. As early features might not be typical of intussusception, a high index of suspicion is necessary to avoid confusion with rectal prolapse so as not to delay diagnosis and treatment.

Pseudoprune belly syndrome; its' associations and management challenge in a developing country: a case report.

BACKGROUND: Pseudo prune belly syndrome is an incomplete expression of the triad syndrome. Its incidence is poorly documented worldwide. We are not aware of any documented cases in Nigeria in recent times. Diagnosis is clinical; however, ultrasound scan plays key role in the overall assessment of the patient. METHOD: It is a report of an 8 day old boy who had pseudo prune belly syndrome with associated micro colon and rectal atresia managed at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, in October, 2005. CONCLUSION: Management of this patient was challenging due to lack of frozen section facility parenteral nutrition and finance. Awareness of the associated conditions and how to manage them is emphasized for good outcome.

Management of biliary atresia in Nigeria: the ongoing challenge.

BACKGROUND: In developed countries, the outlook for patients with biliary atresia has improved remarkably owing to early referral, good diagnostic facilities and the availability of liver transplantation. In Nigeria and most of sub-Saharan Africa, there is little information on the current outlook for these children. METHODS: A retrospective review of 14 patients with biliary atresia managed from 1991 to 2004 at Ahmadu Bello University Hospital, Zaria. RESULTS: Six girls and eight boys presented at between 6 and 24 weeks of age (median 16). Seven presented to another hospital with persistent jaundice in the neonatal period. Eleven at presentation already had liver cirrhosis and deranged coagulation and could not have corrective surgery. Three patients aged 8, 10 and 16 weeks had Kasai's porto-enterostomy. Facilities for diagnosis were limited. Ten patients were lost to follow-up and their outcome is unknown. Of the three patients who had porto-enterostomy, one died at 2 years from gastro-enteritis, one from cholangitis after 8 weeks, and one did not recover from anaesthesia. One patient who had a laparotomy and liver biopsy died from peritonitis. CONCLUSION: Owing to late presentation, delayed referral and difficulties in diagnosis, the outlook for infants with biliary atresia in this environment is poor. A concerted effort to encourage primary practitioners to detect and refer these infants at an earlier age is critical to outcome.

Morbidity of colostomy closure in children

The care of colostomy remains a burden to the family while complications associated with its construction and closure can be tasking to the surgeon. The aim of this study was to evaluate the outcome of colostomy closure in children in our setting. A prospective review of 31 consecutive children undergoing colostomy closure in a 6 year period. There were 18 (58.1%) boys and 13 (41.9%) girls, aged 5 months 13 years (median 3 years). The median duration of colostomy was 16 months [range, 5 days -8 years]. Indications for colostomy were anorectal malformations 16(51.6%), Hirschsprung/'s disease 10(32.3%) and others 5 (16.1%). The site of colostomy was sigmoid colon 21, transverse colon 9 and caecum one. The type of colostomy was divided 18(58.1%) and loop12 (38.7%). Intraperitoneal and extraperitoneal closure was performed in 27(87.1%) and 4(12.9%) patients, respectively. Thirteen (41.9%) patients had 16 postoperative complications; postoperative pyrexia 4 (12.9%), prolonged ileus 4 (12.9%), surgical site infection 2 (6.5%), septicaemia 2 (6.5%). Post operative complication rate was significantly associated with the status of the surgeon (p < 0.05) and duration of surgery (p < 0.05). The median duration of hospital stay was 8 days [range: 5-35 days]. There was no significant difference in hospital stay in patients with postoperative complication and thosewithout (p > 0.05). Morbidity following colostomy closure can be high, particularly when the procedure is performed by a junior trainee

Persistent umbilical discharge in infants and children.

BACKGROUND: Umbilical discharge is not an unusual presentation in infants and children. However, the evaluation and management are rarely discussed. METHOD: A retrospective review of 18 patients presenting with persistent umbilical discharge over a period of 22 years, excluding neonates with omphalitis. RESULTS: The patients' ages ranged between 11 days and 9 years. Presentation was usually discharge of clear, serous or purulent fluid or faecal matter from the umbilicus, sometimes dating back to the neonatal period. Evaluation consisted of bacteriology, fistulogram (one patient) and histopathology. The cause of discharge was patent vitello-intestinal duct in 11 patients, umbilical granuloma in three, umbilical sinus in two and patent urachus and osteomyelitis of the ischium in one each. Definitive treatment was exploration and complete excision of the lesion and antibiotics. Two patients with patent vitello-intestinal duct died, one before surgery from hypokalaemia and sepsis, and the other from anaesthetic complications. CONCLUSION: There is a need for early referral and treatment in patients with persistent umbilical discharge. Conservative treatment is usually not successful as the common causes would normally require complete excision.

Lingual harmatoma in an infant.

Lingual tumours are uncommon in infants and harmatomas are rarely reported. A 5-month-old boy presented with a growth on the dorsum of the tongue which had been present from birth. The growth produced no respiratory or feeding difficulties. It was confirmed to be a harmatoma after complete excision. There has been no recurrence.

Necrotizing fasciitis of the external genitalia following traditional circumcision.

BACKGROUND: Necrotizing fasciitis of the external genitalia is not common in children, and is particularly unusual after circumcision. METHOD: A case report of necrotizing fasciitis of the external genitalia in a one month old boy with discussion of relevant literature. RESULT: A one-month-old boy presented with necrotizing fasciitis of the external genitalia following traditional circumcision. Treatment consisted of early administration of intravenous broad-spectrum antibiotics and debridement. Skin grafting was not necessary as the wound contracted and healed by secondary intention with minimal scarring. CONCLUSION: Early institution of appropriate antibiotics and debridement should prevent morbidity and mortality from this uncommon condition.

Osteomyelitis of the ischium: unusual presentation.

A 7-year-old boy presented with urinary symptoms and umbilical discharge. A perivesical abscess was drained from which Staphylococcus aureus was cultured. He responded to antibiotics. Subsequently, he developed a discharging sinus in the gluteal region. A plain radiograph, which had previously been normal, confirmed osteomyelitis of the ischial bone.

Fournier's gangrene in neonates and infants.

BACKGROUND: Fournier's gangrene is uncommon in childhood and little is known about the disease in this age group. METHOD: A retrospective review was carried out of neonates and infants treated for Fournier's gangrene over a period of 16 years. RESULTS: Twelve neonates and infants aged 5 days-3 months (median 3 weeks) were treated in our hospital. The precipitating cause was omphalitis in 7 babies, strangulated inguinal hernia in 2 and in 3 babies there was no identifiable cause. Gram-negative bacteria were cultured in 3 patients, but in most the culture was sterile. Treatment consisted of debridement of devitalised tissue and administration of broad-spectrum antibiotics. Primary closure was achieved in 1 baby and secondary closure in 2 others. In 7 babies the wound contracted rapidly and healed. There was no mortality. CONCLUSION: Fournier's gangrene in neonates and infants in our environment is largely preventable. Early debridement and appropriate antibiotics give good results.