Mothers/caregivers' knowledge of routine childhood immunization and vaccination status in children aged, 12-23 months in Ilorin, Nigeria.

Background: Immunization has averted millions of hospitalizations and deaths from vaccine-preventable diseases. It is a strong public health tool for childhood infection control and prevention. Many mothers are aware of routine immunization but with doubtable knowledge. Objectives: This study determined the mothers/caregivers' knowledge of routine childhood immunization and vaccination status of their children, aged 12-23 months in Ilorin East Area of Kwara State, Nigeria. It also identified some of the socio-demographic factors associated with good knowledge status of the mothers/caregivers. Methods: This was a community-based cross-sectional study, carried out between December, 2019 and January, 2020, among 456 mothers / caregivers-children's pairs. Subjects were recruited using multistage cluster sampling technique. Data were collected using a pretested, semi-structured, interviewer-administered questionnaire. Results: Up to 98.0% of the respondents were aware of childhood immunization with healthcare providers (92.1%) being their major source of information. Majority of the respondents (85.3%) had good knowledge of immunization, defined by a score ≤6 out of the 10 questions tested. There was a significant relationship between respondents' knowledge and full vaccination status of the children (p=0.001). The significant factors associated with good knowledge from binary logistic regression were mothers / caregivers' age >30 years, antenatal clinic attendance and at least secondary education (OR, p value = 10.60, 0.013; 8.50, <0.001; and 3.98, <0.001 respectively). Conclusion: Mothers / caregivers' knowledge on immunization was good and this positively affected the full vaccination status of their children. There is a need to sustain female education and encourage antenatal clinic attendance, as tools to improve childhood immunization.

Serum folate levels in children with epilepsy seen in a tertiary health care facility in north central Nigeria.

Background: Children suffering from epilepsy are maintained on antiepileptic drugs (AED) to ensure a reasonable quality of life. These drugs, however, are not without side effects. Notable among which is interference with the metabolism of folate with its attendant clinical implications such as megaloblastic anemia and bleeding diathesis. Aim: This study was carried out to determine the serum folate levels of children with epilepsy, compare the folate levels of these children with that of controls, the levels in subjects on different AED, and to investigate the possible effect of duration of AED use on serum folate levels. Patients and Methods: It was a comparative cross-sectional study involving children with epilepsy aged 2-14 years attending the paediatric neurology clinic of University of Ilorin Teaching Hospital (UITH), Ilorin. A total of 140 epileptic and 140 age-and-sex-matched nonepileptic children as controls were recruited into the study. Results: Mean serum folate levels in subjects of 6.3 ± 1.6 ng/mL was significantly lower than 7.5 ± 1.5 ng/mL in controls (P = 0.001). The mean serum folate level in subjects on AED was comparable with the value in AED naïve subjects. The mean serum folate level was also comparable among subjects on carbamazepine, phenobarbitone, and valproate as monotherapy. There was no correlation between the duration of AED use and the mean serum folate levels (r = -0.180; P = 0.069). Conclusion: The mean serum folate level in subjects was significantly lower than the value in controls; but was comparable in subjects on carbamazepine, phenobarbitone, and valproate as monotherapy. There was no correlation between the duration of AED use and mean serum folate levels.

Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels.

OBJECTIVES: Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. METHODS: This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5-14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. RESULTS: Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). CONCLUSION: Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria.

Prevalence and risk factors for hypertension among school children in Ilorin, Northcentral Nigeria.

BACKGROUND: The global prevalence of childhood hypertension has increased from 1% to 2% to 4%-5%, with a value as high as 9.8% reported in Nigeria. However, the various risk factors associated with childhood hypertension in Nigeria are less explored. The aim of this study was to determine the prevalence of hypertension and related risk factors (sociodemographic, family history of hypertension, history of snoring, birth order, and anthropometric indices) in primary school children in Nigeria. MATERIALS AND METHODS: A total of 1745 school children aged 6-12 years were selected using systematic random sampling method. Blood pressure (BP) was measured using the fourth report guideline. Those with BP higher than 90th percentile had repeated BP measurements on two more occasions (2 and 4 weeks after initial measurement). Relevant history was obtained, and anthropometric measurements were taken by the standard methods. Data were analyzed using SPSS version 20. RESULTS: Prevalence of systolic and or diastolic hypertension at the third visit was 3.0%. Prevalence of systolic hypertension (3rd visit) was more in females (3.3%) than males (1.3%), P = 0.004. Prevalence of diastolic hypertension (3rd visit) was higher in females (1.4%) than males (0.3%), P = 0.019. Hypertension showed no significant relationship with socioeconomic class, family history of hypertension, birth order, and history of snoring. Of the anthropometric indices (weight, height, body mass index (BMI), hip circumference, waist circumference, waist-to-hip ratio, and waist-to-height ratio, and only obesity (BMI ≥ 95th centile) was related with hypertension (odd ratio 8.3, 95% confidence interval 1.7, 40.3). CONCLUSIONS: Prevalence of hypertension is low (3.0%), and only obesity (BMI ≥ 95th centile) is associated with hypertension.

Serum zinc levels of hospitalized children with acute diarrhea differ by the isolated viruses.

BACKGROUND: Acute diarrhea constitutes a major global burden to morbidity and mortality in under-five children. Research has shown that micronutrient zinc plays a pivotal role in childhood diarrhea; however, there are contradictory reports of its therapeutic benefit across the various causative enteropathogens. OBJECTIVES: The aim of the study was to determine the prevalence of viral etiology (rotavirus, adenovirus, and norovirus) and compare the serum zinc levels of children with acute diarrhea. METHODS: A comparative cross-sectional study in which 100 hospitalized children with acute diarrhea aged one-59 months and 100 controls were recruited. Viruses were investigated from stool specimens using the immunochromatographic technique, while serum zinc was determined through the colorimetric method. Data analysis was with SPSS 20 software package. RESULTS: The prevalence of viruses in the subjects was 62.0% with rotavirus isolated in 30 (30.0%) of the patients, while adenovirus and norovirus were detected in 21 (21.0%) and 11 (11.0%) patients, respectively. Rotavirus was the only virus detected in 2 (2.0%) of the controls. The mean serum zinc level of 65.3 ± 7.4 µg/dl in the subjects was significantly lower than 69.0 ± 6.5µg/dl in the controls (P < 0.001). The prevalence of zinc deficiency in the subjects (47.0%) was significantly higher than 32.0% in the controls (P = 0.030). The mean serum zinc levels differed significantly among the viruses isolated in the subjects (P < 0.001). CONCLUSIONS: Viruses contribute largely to etiology of acute diarrhea in Nigerian under-five children. Zinc deficiency was also highly prevalent in the study population. The serum zinc levels varied significantly across the different viruses isolated.

Serum zinc levels amongst under-five children with acute diarrhoea and bacterial pathogens.

BACKGROUND AND AIM: Acute diarrhoea contributes significantly to morbidity and mortality in under-five children globally with conflicting reports regarding the therapeutic benefit of zinc across the different causative pathogens. This study aimed to determine the prevalence of bacterial aetiology of children with acute diarrhoea and compare their serum zinc levels. METHODS: One hundred children aged 2-59 months with acute diarrhoea and 100 apparently healthy matched controls were recruited in Ilorin, North Central Nigeria. Stool specimens were investigated for bacterial pathogens using conventional culture techniques, while serum zinc levels were determined by colorimetric method. RESULTS: Bacteria were isolated in 73 (73.0%) patients and 6 (6.0%) controls. Escherichia coli was isolated in 39 (39.0%) of the patients, while Klebsiella spp., Proteus spp. and Pseudomonas aeruginosa were isolated in 28 (28.0%), 4 (4.0%) and 2 (2.0%) patients, respectively.E. coli and Klebsiella spp. were detected in 4 (4.0%) and 2 (2.0%) controls, respectively. The mean serum zinc level of 65.3 ± 7.4 µg/dl in the patients was significantly lower than 69.0 ± 6.5 µg/dl in the controls (P < 0.001). Zinc deficiency (serum zinc levels < 65 µg/dl) was detected in 47 (47.0%) patients which was significantly higher than 32 (32.0%) controls (P = 0.030). The mean serum zinc levels significantly differed amongst the bacteria isolated in the patients (P < 0.001). CONCLUSIONS: Bacterial pathogens constitute a significant burden to aetiology of acute diarrhoea in under-five Nigerian children. The prevalence of zinc deficiency was high in the study population. The serum zinc levels also differed across the bacteria isolated.

Mucocutaneous Disorders of Pediatric HIV in South West Nigeria: Surrogates for Immunologic and Virologic Indices.

OBJECTIVES: Nigeria has the world's highest burden of pediatric HIV. In the face of paucity of monitoring tests in Nigeria, we studied the spectrum of pediatric mucocutaneous manifestations and evaluated their clinical utility as surrogate markers for immunodeficiency and plasma viral load levels. METHODS: Cross-sectional study comparing mucocutaneous manifestations in 155 HIV-positive children aged 12 weeks to 14 years with 155 HIV-negative children. Relationships between mucocutaneous manifestations in HIV-infected patients and their immunologic and virologic indices were analyzed. RESULTS: Mucocutaneous lesions were seen in 53.5% of HIV-infected children compared with 18.1% of the controls. Prevalence of lesions increased with worsening levels of immunodeficiency and increasing viral loads (P < .01). Oral candidiasis, angular stomatitis, and fluffy hair were associated with more severe degrees of immunodeficiency. CONCLUSION: Mucocutaneous disorders are common in HIV-infected children. Oral candidiasis and nutritional dermatoses can be used as surrogates for advanced or severe immunodeficiency.

Comparative analysis of glucose-6-phosphate dehydrogenase levels in pre-term and term babies delivered at University of Ilorin Teaching Hospital.

Glucose-6-phosphate (G6P) is an enzyme in the hexose monophosphate shunt required for the production of reducing equivalents needed to mop up free radicals. thereby keeping hemoglobin in its free state. Deficiency of the enzyme can cause severe neonatal jaundice. The aim of this study was to compare G6PD levels in pre-term and term babies, and evaluate the extent to which G6PD deficiency determines the severity of jaundice in various gestational age groups. Samples of cord blood collected from consecutively delivered babies in the University of Ilorin Teaching Hospital, Nigeria, were assayed for G6PD levels, and the babies were observed for jaundice during the first week of life. Those who developed jaundice had serial serum bilirubin measured. Nine hundred and thirty-three babies had G6PD assayed, with 348 being G6PD deficient, giving a hospital based prevalence of 37.3%. Of the 644 who were followed up, 143 (22.2%) were pre-term and 501(77.8%) were term babies. Babies with gestational age (GA) 27-29 weeks had the highest G6PD levels. However, there was no significant variation among the different gestational age groups (F=0.64, P=0.64). Jaundice occurred more in pre-term compared to term babies with a relative risk of 2.41 (χ(2)=60.95, P=0.00001). Occurrence of jaundice in pre-term babies was irrespective of G6PD status (χ(2)=0.2, P=0.66, RR=1.09, CI=0.83

Malignant melanoma in a black child: predisposing precursors and management.

Malignant melanoma (MM) remains a pediatric rarity world-wide, but perhaps more so in black Africans. To the best of our knowledge, the current report of MM in a two-and-a-half-year-old Nigerian who had a pre-existing congenital giant hairy nevus is probably the first (in an accessible literature) in a black African child. Primary neoplastic transformation and metastatic spread were suggested by the appearance of multiple swellings over the "garment" precursor nevus at the posterior trunk, multiple ipsilateral axillary nodal enlargement, and fresh occipital swellings postadmission. Smaller-sized hyperpigmented lesions with irregular, nonlobulated, and frequently hairy surfaces were also discernible over the upper and lower extremities, but the face, anterior trunk, and mucosal surfaces were relatively spared. A diagnosis of MM was confirmed by the subsequent histopathologic findings from the fine-needle aspirate and biopsy specimens. Chemotherapy was initiated but was truncated shortly after by parent-pressured discharge. Despite the rarity of MM in a tropical African setting where management options are few, the current case underscores the need for a high clinical index of diagnostic suspicion, an early pursuit of investigative confirmation, and prophylactic excision in children with the predisposing skin lesions, like congenital giant hairy nevus. An expounded discourse of the possible precursors and management options of MM is provided. We emphasize the need for institutional cost subsidy for anticancer care in tropical children.