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BACKGROUND: Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS: This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION: Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION: Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.

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Aplasia cutis congenita (ACC) is a rare developmental disorder that is not fully understood. It often occurs in isolation but can also be syndromic. Usually, there is an absence of the epidermis and dermis. It may be limited to the skin alone but may involve deeper structures. Research has identified a heterogeneous predisposition including genetic factors. Among patients with ACC, scalp involvement is common, however large scalp defects with the involvement of the skull is not common. We present a preterm neonate with a large scalp ACC with a wide skull defect.

L'aplasie cutanée congénitale (ACC) est un mal du développement rare qui n'est pas entièrement compris. Elle survient souvent de manière isolée mais peut également être syndromique. Habituellement, il y a une absence d'épiderme et de derme. Elle peut être limitée à la peau seule mais peut impliquer des structures plus profondes. La recherche a identifié une prédisposition hétérogène incluant des facteurs génétiques. Chez les patients atteints d'ACC, l'atteinte du cuir chevelu est fréquente, mais de grandes anomalies du cuir chevelu avec atteinte du crâne ne sont pas courantes. Nous présentons un nouveau-né prématuré avec un grand CCA du cuir chevelu avec un large défaut du crâne.

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BACKGROUND: One of the most common neurodevelopmental problems affecting behavior of children all over the world is attention deficit hyperactivity disorder (ADHD). Studies on ADHD prevalence in Africa used either parents' or teachers' disruptive behavioral disorder rating scale (DBDRS) to diagnose ADHD, but this study diagnose ADHD using both parents and teachers DBDRS simultaneously among primary school pupils in Ile-Ife. MATERIALS AND METHODS: The study was conducted among 1,385 primary school pupils in Ile-Ife using multistage random sampling. The parents' and teachers' DBDRS were used simultaneously to screen children who had ADHD. RESULTS: Sixty-five (4.7%) of the pupils had ADHD. Among the 65 pupils with ADHD, 28 (43%) had the inattentive subtype, 25 (38.5%) had the combined subtype, whereas 12 (18.5%) had hyperactive/impulsive subtype. The prevalence of ADHD was significantly higher in the younger age group than the older age groups (χ2 = 7.153, P = 0.007). There was no significant association found between the prevalence of ADHD and the social class (χ2 = 3.852, P = 0.146). CONCLUSION: ADHD prevalence of 4.7% was found among the children in Ile-Ife. Assessment of children for ADHD was done by parents at home and teachers in the school with DBDRS. The inattentive subtype was the most common and the hyperactive subtype was the least seen in the study. Early diagnosis and treatment of this disorder will bring better outcome in the children.

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OBJECTIVES: To explore roles and responsibilities in newborn care in the intra- and postpartum period in Nigeria, Tanzania and Ethiopia. METHODS: Qualitative data were collected using in-depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. RESULTS: We found that birth attendants were the main decision-makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first-time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision-maker in the family. CONCLUSION: Interventions should move beyond a focus on the mother-child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

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Pregnancy-induced physiological changes alter many drugs' pharmacokinetics. We investigated pregnancy-induced changes in efavirenz pharmacokinetics in 25 pregnant and 19 different postpartum women stratified from 211 HIV-positive women in whom a preliminary pharmacogenetic study had been undertaken. Despite significant changes in CL/F during pregnancy (42.6% increase; P = 0.023), median (range) Cmin was 1,000 ng/mL (429-5,190) with no significant change in Cmax (P = 0.072). However, when stratified for CYP2B6 516G>T (rs3745274) genotype, efavirenz AUC0-24 , Cmax and Cmin were 50.6% (P = 0.0013), 17.2% (P = 0.14), and 61.6% (P = 0.0027) lower during pregnancy (n = 8) compared with postpartum (n = 6) in 516G homozygotes, with values of 25,900 ng.h/mL (21,700-32,600), 2,640 ng/mL (1,260-3,490), and 592 ng/mL (429-917), respectively, and CL/F was 100% higher (P = 0.0013). No changes were apparent in CYP2B6 516 heterozygotes (14 pregnant vs. 7 postpartum). The clinical implications of these findings warrant further investigation.

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Background. Though micronutrients are vital in the pathogenesis of human immunodeficiency virus infection, most studies have been conducted in adults. Knowledge of the status of key micronutrients in HIV infected African children will indicate if supplementation may be beneficial to these children living in this resource-poor region. Objectives. We sought to determine the micronutrient status and associated factors of HAART-naïve HIV infected children and compare them with those of the HIV negative controls. Methods. We enrolled 70 apparently stable HAART naïve HIV infected children. Seventy age and sex matched HIV negative children were equally enrolled as the controls. Their social class, anthropometry, clinical stage, CD4 counts, serum zinc, selenium, and vitamin C were determined. Results. The prevalence of zinc, selenium, and vitamin C deficiency in HIV infected subjects was 77.1%, 71.4%, and 70.0%, respectively, as compared to 44.3%, 18.6%, and 15.7% in HIV negative controls. Among the HIV infected subjects, 58.6% were deficient in the three micronutrients. Micronutrient status was related to the weight, clinical, and immunological stages but not BMI or social class. Conclusion. Deficiency of these key micronutrients is widely prevalent in HAART naïve HIV infected children irrespective of social class. This suggests that supplementation trial studies may be indicated in this population.

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BACKGROUND: Perinatal autopsy remains a valuable tool in perinatal medicine. It provides an insight into the genetic implications of subsequent pregnancies and also helps reduce parental events such as maternal illness or maternal use of medications. The practice is not popularly acceptable in our environment for socio-cultural reasons. The scarcity of pathologists who are interested in this aspect of pathology is also an issue. No wonder, the literature is scanty on the cases of perinatal autopsy reported in our environment. MATERIAL AND METHODS: This was a retrospective review of patients' medical and autopsy records to measure the perinatal autopsy rate at a tertiary health institution and identify the trends over the last 12 months (January 1, 2010 and December 31, 2010). This study also aim examining any discordance between antemortem diagnoses and postmortem diagnoses. RESULTS: Of 263 perinatal deaths, autopsies were requested and performed in 14 of the cases representing a perinatal autopsy rate of 5.3%. New information was obtained in 64.3% of the cases. The birth weights of the infants ranged from 500g to 3600g with their gestational ages ranged from 22 weeks to 41 weeks. CONCLUSIONS: This study is a preliminary report that serves principally to provide base line data for the ongoing study.

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OBJECTIVE: This case report seeks to create awareness of the aetiology of rickets of prematurity among very low birth weight infants in Nigeria METHODS AND RESULT: This is a case report of an 800 gramme premature male neonate delivered by caesarean section at 28 weeks gestation following severe maternal pre-eclampsia. The infant was hospitalised for sixty days and fed exclusively on his mother's breast milk for seven months. He had two episodes of sepsis and was transfused twice while on admission. He was on Abidec drops, which contained 400 IU/0.6 ml of vitamin D from the age of two weeks. He defaulted from the follow up clinic at postnatal age of 16 weeks only to reappear at 30 weeks postnatal age with overt clinical, biochemical and radiologic signs of rickets. He responded well to calcium and phosphate supplementation. CONCLUSION: This case highlights the role of mineral deficiency in the aetiology of rickets of prematurity in very low birth weight infants fed with their mothers' breast milk.

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The problem of obesity is taking a worldwide dimension. However, there is paucity of data on obesity in Nigerian children. This study was therefore conducted to determine the prevalence and factors associated with overweight and obesity among Nigerian preschool children. A total of 270 children were recruited from 216 households using multistage cluster sampling technique. The prevalence of overweight and obesity were 13.7% and 5.2% respectively while the prevalence of underweight was 8.5%. Although, there was no statistically significant relationship between exclusive breastfeeding for 6 months, duration of breastfeeding and the prevalence of overweight (P = 0.569, 0.669 respectively), the prevalence of overweight decreases with increase in the duration of breastfeeding. Ninety-nine (36.3%) children were given infant formula feeds with 92 (93.9%) children introduced to infant formula feeds before the age of 6 months. The use of infant formula feeds was significantly associated with reduction in the prevalence of overweight (P = 0.041). No linear relationship was detected in the association between overweight and socioeconomic class. The population shows heterogeneity in their nutritional problem by having mixture of obesity and underweight. There is need for trend of obesity to be monitored so that timely intervention will be taken and associated morbidity and mortality from obesity prevented.

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This study was carried out to determine the prevalence of malnutrition in a rural Nigerian community. Using the modified Wellcome Classification, the prevalence of protein energy malnutrition (PEM) was 20.5%. The prevalence of underweight, wasting and stunting were 23.1%t, 9% and 26.7%, respectively. The low prevalence of PEM in this rural Nigerian community may be due to the services and intervention provided by a non-governmental organization in the community. This method of intervention is similarly achievable in any other community.

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This study reviewed the causes of delays when patients were admitted with obstetric emergencies in Ife-Ife, Nigeria.

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This prospective study compared the care and support provided for symptomatic HIV seropositive children of HIV serodiscordant parents (only the mother of the child is HIV infected) with children of seroconcordant parents (both parents are HIV infected) during admission and after discharge from a tertiary health institution in southwestern Nigeria. Information was collected from parents of eligible children by semi-structured questionnaires and observation of the children and their parents while on admission and at home. Of the 51 couples who met the study criteria, there were 27 seroconcordant couples and 24 serodiscordant couples. The children from serodiscordant couples were more frequently discharged against medical advice, abandoned, lost to follow-up, cared for by their mothers alone and were not up-to-date with their immunization schedule when compared with children from seroconcordant parents. These were statistically significant (p < 0.05). There was a higher mortality among these children and their mothers (p < 0.05). Paternal reasons for not providing adequate care for the children from serodiscordant parents included fear of being infected, doubt of child's paternity and waste of family resources on a 'child who is dying'. None of the children from both groups received support from governmental and non-governmental agencies. It is concluded that the care of sick HIV seropositive children of serodiscordant parents poses special challenges for clinicians working in Nigeria where there is no social support system.

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Hypoglycaemia is a common problem in paediatric emergency admissions. It has not received enough attention in Nigeria. It has been shown to complicate many childhood illnesses. This study aimed to determine the prevalence of hypoglycaemia in paediatric emergency admissions, describe clinical factors that commonly predispose to it and investigate its effect on outcome of management. Three-hundred and ninety-two consecutively admitted patients were studied. Two milliliters of blood was obtained from each patient for plasma glucose determination. Hypoglycaemia was defined as plasma glucose <2.5 mmol/l (<45 mg/dl). Out of these 392, twenty-five (25) of them were hypoglycaemic giving a prevalence of hypoglycaemia to be 6.4 per cent in our emergency ward. Hypoglycaemia was found to be associated commonly with severe malaria, septicaemia, pneumonia, and protein energy malnutrition. Interval of last meal and unconsciousness were the only two significant associated factors to hypoglycaemia. However, the likelihood of hypoglycaemia is increased with night admissions and prolonged duration of illness before admissions. Presence of hypoglycaemia at admission was also found to be significantly associated with death and dying within 24 hours of admission. The prevalence of hypoglycaemia was found to be 6.4 per cent. It was found to complicate many childhood illnesses and it is associated with a higher mortality. It should be suspected in all very ill children, particularly when they are unconscious and have not eaten for over 12 hours.

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This prospective study was carried out to determine the bacterial pathogens and their antibiotic sensitivity profile in the sick young infant. All consecutive young infants with features suggestive of infection seen over 5 months at a Comprehensive Health Centre in Ile-Ife, were screened for septicaemia and local bacterial infections. Of the 121 sick young infants screened for infection, 94 (77.7 per cent) had confirmed bacterial infection and 54 (57.4 per cent) of the 94 had confirmed septicaemia. Gram-positive organisms were the commonest bacterial isolates accounting for 204 (81.6 per cent) of the 250 isolates in this study. Staphylococcus aureus was the most frequent organism accounting for 61.2 per cent of all isolates. Gram-negative organisms accounted for 46 (18.4 per cent) of all isolates with Salmonella spp. and Proteus vulgaris predominating. All the bacterial isolates in this study were sensitive to ofloxacin and most were sensitive to the antibiotics commonly employed in the treatment of infections caused by these organisms. However, many of both Grampositive and Gram-negative isolates in this study were resistant to cotrimoxazole. The study highlights the high prevalence of bacterial infections (localized or systemic) among young infants. It also shows that Gram-positive organisms, the principal aetiologic agents, were sensitive to commonly used antibiotics. It is recommended that genticin and cloxacillin or erythromycin should be used as the first-line antibiotics in the treatment of young infants with bacterial infections in Ile-Ife, Nigeria.

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This study was designed to identify sociodemographic characteristics of HIV-positive mother-child pairs in the southwest of Nigeria. The aim was to identify factors that will be helpful in designing initiatives for preventing mother to child transmission (MTCT) of the virus. It was a hospital-based, case-control study carried out at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from August 2000 to July 2002. Eligible mother-child pairs identified at the paediatric department, who consented to participate in the study, were interviewed using semi-structured questionnaires and screened for HIV seropositivity. Ninety-three (46.7%) of 199 mother-child pairs were HIV-positive. When compared with the 106 HIV-negative mothers, the HIV-positive mothers were younger, unemployed, had earlier sexual exposure, lower education and were married to polygynous spouses. It is recommended that initiatives designed to reduce MTCT of the HIV virus in the southwest of Nigeria should include education and improvement of the economic status of female adolescents; promotion of cultural practices such as virginity until marriage while discouraging polygyny and early marriage. Health education on prevention of HIV infection should target potential mothers and their partners.

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This prospective study was aimed at determining the contribution of blood transfusion to paediatric HIV infection in Ile-lfe, Nigeria. It involved HIV screening of consecutive children presenting at the Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, between March 1996 and March 2001, with any of the signs in the WHO clinical case definition for paediatric AIDS. The HIV serostatus of blood donors at the OAUTH was also extracted from the blood bank records. Of the 263 children who met the criteria for HIV screening, 35 (13.3%) were HIV-positive. Eighteen of the 263 children screened had a history of blood transfusion and 12 (66.7%) of the 18 were HIV-positive. Eleven (91.7%) of the 12 HIV-positive patients were transfused in private hospitals with blood collected from private laboratories. The blood with which the HIV-positive children were transfused was unscreened in three, screened in two and the HIV status unknown in the others. The sole voluntary donor was an HIV-positive father whose child received his unscreened blood. Only two (16. 7%) of the mothers of the previously transfused HIV-positive children were also HIV-positive. 'Paid'donors accounted for 94.3% of total donors in OAUTH blood bank records and cumulative HIV-positivity was statistically significantly higher in 'paid' donors than in voluntary donors (p = 0.005). Wl conclude that transfusion with unsafe blood is an important route for HIV infection in symptomatic children and that HIV-positivity is higher among paid donors. recommend the establishment of a national blood transfusion service, which is presently non-existent in Nigeria, and the enforcement of laws guiding blood transfusion. Voluntary blood donation should been encouraged and health workers in the private sectors educated on the link between blood transfusion and HIV infection.

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BACKGROUND: This study was carried out to determine the haematological profile and malarial parasitaemia of children requiring emergency blood transfusion. METHODS: This prospective study was carried out from 1st August to 30th of November, 1999 at the Children Emergency Ward (CHEW) of the Obafemi Awolowo University Teaching Hospital (OAUTH) Ile-Ife, Nigeria. All children requiring emergency blood transfusion seen at the CHEW were included in the study. Blood samples were taken on admission for haematocrit, white cell count and differentials, thin and thick blood films. Other data recorded include age, sex, clinical impression on admission. RESULTS: Four hundred children were admitted into the CHEW during the study period and 173(43%) required emergency blood transfusion. One hundred and forty-five (84%) of the children who required emergency transfusion were below the age of five years. There was no sex predilection. Although, clinical impression of malaria was made either singly or in combination with other diseases in almost all the patients, malaria parasitaemia was confirmed in 86 (50%) of the patients. The mean haematocrit was 0.14 L/L. In 60% of the children, there were mixed microcytic hypochromic and macrocytic red bloodcells. CONCLUSION: We conclude that severe anaemia requiring emergency blood transfusion is a major cause of morbidity and mortality in under five children. We also confirm that malaria and nutritional deficiencies are the major cause of severe anaemia in Nigerian children. We therefore recommend urgent need for prevention and prompt treatment of malaria in children under the age of five years. We also recommend the need for improvement in the nutritional intake of children under the age of five.

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OBJECTIVES: To determine the clinical features, modes of transmission and outcome of HIV infection in children. DESIGN: A descriptive study involving prospective HIV antibody screening. SETTING: Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, a referral centre. SUBJECTS: Four hundred and one consecutive children aged three days to 17 years presenting with features of immunosuppression from January 1996 to October 2001. MAIN OUTCOME MEASURES: HIV seroprevalence and outcome in infected children. RESULTS: Twenty percent of the children studied were HIV seropositive. More females than males were HIV seropositive (p = 0.004). The probable mode of infection was vertical in 66, blood transfusion in 12 and sexual contacts in four; two children whose mothers were HIV seropositive had previously been transfused with unscreened blood. Of the presenting clinical features, weight loss or failure to thrive, persistent diarrhoea, and skin diseases were highly sensitive and specific with high positive predictive values. Marasmus was the only type of protein energy malnutrition seen in the infected children. Seven patients were discharged against medical advice and 26 were lost to follow up. Thirty seven (46.3%) died within four months of diagnosis mainly from pneumonia and septicaemia. Four patients are still being followed up and only one is receiving antiretroviral drugs. CONCLUSION: HIV infection is a cause of morbidity and mortality in Nigerian children and the main mode of infection is vertical. The presence of any combination of persistent diarrhoea, weight loss/failure to thrive and skin manifestations should arouse suspicion and could be used as a screening test for symptomatic HIV infection in Nigerian children.

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The incidence of acute otitis media (AOM) in a comprehensive healthcare setting was investigated in Ile-Ife, Nigeria. Out of the 617 children examined, 53 (11.64 per cent) suffered from the condition based on the criteria used. Staphylococci constituted the predominant organisms associated with the condition with Staphylococcus aureus (25.0 per cent) being the most frequent single microbe recovered from the subjects. This was followed by Proteus mirabilis (16.2 per cent), Staphylococcus sp. (8.8 per cent), Streptococcus pneumoniae (8.8 per cent), Pseudomonas aeruginosa and Haemophilus influenzae (7.4 per cent each). Most isolates tested were multiply resistant to the antibiotics commonly employed in treating infections caused by these organisms. The study highlights the prevalence of multi-resistant organisms amongst the subjects and recommends prompt therapeutic intervention to avert ineffectiveness of antibiotics when used in treating infections caused by these organisms in the community.

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A retrospective study of children admitted into the Children Emergency Room of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, between 1989 and 1998 was undertaken. There were 127 cases constituting 0.52% of the total paediatric admissions over the study period. Poisoning was commoner among the lower socioeconomic classes and in males than females. 102 (80.3%) of the children involved were below the age of five years and poisoning was unintentional in 98.4%. Kerosene was the commonest agent accounting for 40.9% of all cases; followed by caustic soda (20.4%) and traditional mixtures (19.7%). Oral administration of palm oil is the commonest home remedy. Morbidity was commonest with caustic soda while traditional mixture was responsible for 80% of the mortality. Fifteen (11.9%) patients died constituting 0.84% of total childhood mortality during the study period. We conclude that childhood poisoning is still a significant cause of morbidity and mortality in children seen at the Obafemi Awolowo University Teaching Hospital. Improvement in the socioeconomic status of parents and health education on proper storage of household chemicals will help in reducing the incidence and mortality from poisoning.

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