Subclinical hypothyroidism in children with idiopathic childhood nephrotic syndrome at a tertiary institution in South-West Nigeria.

Background: Hypothyroidism in children with nephrotic syndrome (NS) is often attributed to prolonged loss of thyroxine binding globulin and thyroid hormones alongside protein in the urine. It has been historically associated with steroid-resistant NS alone. However, recent evidence supports the fact that subclinical hypothyroidism (SCH) does occur even in children with steroid responsive NS. Complications such as weight gain, hypercholesterolemia, delayed growth, delayed puberty, and depression could result from hypothyroidism and be erroneously attributed to NS, or the effect of steroid used in treatment. Incidentally salt intake, the major form of dietary iodine is often restricted in children with NS, possibly exacerbating any underlying hypothyroid state. Aim: The study aimed to determine the burden of SCH among our cohort of NS patients. Patients and Methods: A comparative cross-sectional study was designed to assess SCH [defined by high TSH (>6.0 mU/L and normal free T4 (0.8-2.0 ng/dl)] in hundred children with NS aged between one and fifteen years compared with hundred age and gender matched comparison group without NS. Blood and urine samples were collected to analyze thyroid function, serum albumin, serum protein and urinary protein. Results: The prevalence of SCH was significantly higher in subjects with NS than their age, sex matched comparison group (12% vs. 2%, P = 0.006). The highest proportion (24.1%) of the children with NS who had SCH was found in the age range of 11-15 years and majority were females (19.4% vs. 7.8%, respectively, P = 0.086). The proportion of children with SCH were higher in those with steroid-resistant NS than those responsive to steroids (26.3% vs. 8.6% P = 0.033). The average values of serum albumin and protein were also significantly lower in children with SCH than those without (2.91 mg/dl ± 0.8 vs. 3.78 mg/dl ± 0.9 and 3.99 mg/dl ± 1.3 vs. 5.02 mg/dl ± 1.3, respectively, P < 0.005). Also, the average value of urinary protein was significantly higher in those with SCH than those without [94.29 mg/dl (42.3-101.0) vs. 69.19 mg/dL (31.2-108.2), respectively, P = 0.023]. Participants with steroid-resistant NS have almost three-folds odd of developing SCH compared to steroid sensitive subjects (AOR 2.901; 95% CI 1.831-4.012; P = 0.038). Conclusion: Screening of children for SCH with NS especially steroid-resistant NS and frequent relapsing steroid sensitive NS for hypothyroidism before complications arise is pertinent to their holistic management. This becomes even more imperative in our environment as iodine deficiency hypothyroidism is still prevalent in some parts of the country.

Growth Hormone Deficiency: Navigating the Terrain of Diagnosis and Treatment in Sub-Saharan Africa.

Growth hormone deficiency (GHD) is an important differential diagnosis for short stature, defined as a height percentile below the mean population height. In the developed world well- child visits are commonplace; in a limited resource setting such as Sub-Saharan Africa (SSA) this is not the case. As such, the use of anthropometric data for evaluating growth may be compromised. Despite this, clinicians should be aware that sick visits offer an opportunity to gather such data and in spite of the resource constraints which may preclude a complete work up, GHD could be managed effectively when there is a high clinical index of suspicion. This article uses highlights of three cases diagnosed in SSA to address challenges encountered in the course of management to make recommendations in the approach to medical care of a child with suspected GHD.

Le déficit en hormone de croissance (DHC) est un diagnostic différentiel important pour la petite taille, définie comme un percentile de taille inférieur à la taille moyenne de la population. Dans les pays développés, les visites médicales sont monnaie courante, mais ce n'est pas le cas en Afrique subsaharienne (ASS), où les ressources sont limitées. En conséquence, l'utilisation des données anthropométriques pour évaluer la croissance peut être compromise. Malgré cela, les cliniciens doivent savoir que les visites de malades offrent l'occasion de recueillir de telles données et, malgré les contraintes de ressources qui peuvent empêcher un bilan complet, le GHD peut être géré efficacement lorsqu'il y a un indice clinique élevé de suspicion. Cet article utilise les faits marquants de trois cas diagnostiqués en SSA pour aborder les défis rencontrés au cours de la prise en charge afin de faire des recommandations dans l'approche de la prise en charge médicale d'un enfant suspecté de GHD. MOTS-CLÉS: Petite taille, Déficit en hormone de croissance, Afrique sub-saharienne.

Caregivers and Healthcare Workers' Willingness to Donate Kidney in Three Tertiary Institutions in Southern Nigeria.

BACKGROUND: Kidney transplantation (KT) is now the preferred renal replacement therapy in suitable patients with end-stage renal disease but organ availability is a major limiting factor. AIMS: To evaluate the willingness of caregivers (CGs) and healthcare workers (HWs) to donate a kidney and possible motivating factors in our setting. METHODS: This cross-sectional study was done at Mother and Child Hospital, Kidney Care Centre Ondo and Babcock University Teaching Hospital, all in Southern Nigeria. Participants' willingness to donate a kidney was assessed using Likert and Visual Analogue Scales (VAS). The data were analyzed using SPSS version 20.0. Student t test was used to compare weighted mean scores. Multivariate analysis done; P < .05 was taken as significant. RESULTS: A total of 563 CGs and HWs took part in the study. Sixty percent of them were aware of kidney donation (KD) but only 43.7% had a favorable attitude towards it, and these were predominantly HWs (63.4% vs 33.1%, P < .001). A quarter of the participants were adequately willing to donate a kidney; HWs were significantly more willing than CGs (45.4% vs 15.8%, P < .001). On VAS, the mean willingness score of HWs was higher than that of CGs (t = 7.13, P < .001). Factors strongly influencing the willingness of CGs to donate include their educational level (P = .028, OR = 4.86, 95% CI: 1.19-19.91) social class (P = .012, OR = 6.17 95% CI: 1.5-24.8) and having a relative with kidney disease (P = .019; OR = 3.07 95% CI: 1.25-12.00). Willingness correlated with awareness of KD among CGs (r = 0.534, P < .001). CONCLUSION: There is a low level of willingness alongside negative attitudes toward kidney donation among our participants.

National neonatal resuscitation training program in Nigeria (2008-2012): a preliminary report.

BACKGROUND: Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth. MATERIALS AND METHODS: Between 2008 and 2012, doctors and nurses drawn from all the geo-political zones were trained using the Neonatal Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire-based, cross-sectional surveys of doctor and nurse trainees from the six geo-political zones in Nigeria were conducted eight months after the primary training, to evaluate the post-training neonatal resuscitation activities. RESULTS: Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post-training period. The nurses used bag and mask for infant resuscitation more frequently, compared to doctors, with the rate fluctuating between two-to-one and four-to-one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants. CONCLUSION: The NRT in Nigeria is well-subscribed and the frequency of secondary training is good.