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- ItemOpen Access22q11.2 deletion syndrome in diverse populations(Wiley Periodicals, Inc., 2017-04) Kruszka, P.; Addissie, Y.A.; McGinn, D.E.; Porras, A.R.; Biggs, E.; Share, M; Crowley, T.B.; Chung, B.H.; Mok, G.T.; Mak, C.C.; Muthukumarasamy, P.; Thong, M.K.; Sirisena, N.D.; Dissanayake, V.H.; Paththinige, C.S.; Prabodha, L.B.; Mishra, R.; Shotelersuk, V.; Ekure, E.N.; Sokunbi, O.J.; Kalu, N.; Ferreira, C.R.; Duncan, J.M.; Patil, S.J.; Jones, K.L.; Kaplan, J.D.; Abdul-Rahman, O.A.; Uwineza, A.; Mutesa, L.; Moresco, A.; Obregon, M.G.; Richieri-Costa, A.; Gil-da-Silva-Lopes, V.L.; Adeyemo, A.A.; Summar, M.; Zackai, E.H.; McDonald-McGinn, D.M.; Linguraru, M.G.; Muenke, M.22q11.2 deletion syndrome (22q11.2 DS) is the most common microdeletion syndrome and is underdiagnosed in diverse populations. This syndrome has a variable phenotype and affects multiple systems, making early recognition imperative. In this study, individuals from diverse populations with 22q11.2 DS were evaluated clinically and by facial analysis technology. Clinical information from 106 individuals and images from 101 were collected from individuals with 22q11.2 DS from 11 countries; average age was 11.7 and 47% were male. Individuals were grouped into categories of African descent (African), Asian, and Latin American. We found that the phenotype of 22q11.2 DS varied across population groups. Only two findings, congenital heart disease and learning problems, were found in greater than 50% of participants. When comparing the clinical features of 22q11.2 DS in each population, the proportion of individuals within each clinical category was statistically different except for learning problems and ear anomalies (P<0.05). However, when Africans were removed from analysis, six additional clinical features were found to be independent of ethnicity (P≥0.05). Using facial analysis technology, we compared 156 Caucasians, Africans, Asians, and Latin American individuals with 22q11.2 DS with 156 age and gender matched controls and found that sensitivity and specificity were greater than 96% for all populations. In summary, we present the varied findings from global populations with 22q11.2 DS and demonstrate how facial analysis technology can assist clinicians in making accurate 22q11.2 DS diagnoses. This work will assist in earlier detection and in increasing recognition of 22q11.2 DS throughout the world
- ItemOpen AccessAn 8-year review of major congenital abnormalities in a tertiary hospital in Lagos, Nigeria.(2016) Fajolu, I.B.; Ezenwa, B.; Akintan, P.; Ezeaka, V.C.Background: Congenital abnormalities are defects present at birth and are increasingly becoming an important cause of neonatal mortality. They can also result in disability in majority of the survivors. Objective: To describe the pattern and outcome of major congenital abnormalities (MCA) in a tertiary hospital in Lagos, Nigeria. Methods: The labour ward and labour ward theatre delivery records and admission records of the in-born ward of the neonatal unit of a tertiary hospital were reviewed retrospectively from January 2007 to December 2014. The MCA were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, (ICD-10). Multiple abnormalities were counted once by the system with the most major anomaly. Abnormalities were grouped according to organ systems, sex and yearly distribution. Statistical analysis was based on systemic type, and neonatal outcome. Results: Out of 14581 deliveries during the study period, 167 had MCA, giving an incidence of 11.5 per 1000 total births; 71 (42.5%) were females, 91 (54.5%) were male and 5(3.0%) had indeterminate sex. There was an increase in the yearly incidence from 2007-2014 The most frequent abnormalities were in the central nervous system (31.7%), musculoskeletal system (18.6%), complex congenital abnormalities group (15.5%) and urogenital system (11.4%). Fifty six (31.8%) infants died in the first week of life contributing 12.6% to the overall early neonatal mortality during the study period. Overall case fatality rate was 42.0%; case fatality was highest in the other abnormalities group, followed by chromosomal, cardiovascular and genitourinary system abnormalities respectively. Conclusion: The incidence of MCA in this study is high especially in the central nervous system. There was a steady increase in the yearly incidence during the study period. The overall case fatality rate was also very high with a high contribution to early neonatal deaths
- ItemOpen AccessAcute bacterial meningitis in a developing country: diagnosis related mortality among paediatric patients(University of Zimbabwe Publications, 1998-01) Imananagha, K.K.; Peters, E.J.; Philip-Ephraim, E.E.; Ekott, J.U.; Imananagha, L.N.; Ekure, E.N.; Esin, R.A.OBJECTIVES: To evaluate the effect of late diagnosis and other factors on outcome of paediatric bacterial meningitis (BM) and recommend appropriate intervention. DESIGN: Case series. SETTING: University of Calabar Teaching Hospital, Calabar, Nigeria. SUBJECTS: 62 consecutive BM patients aged two months to 16 years admitted between 1991 and 1994. MAIN OUTCOME MEASURES: Mortality rate. RESULTS: Diagnostic difficulties experienced in 58% of cases and other factors resulted in delayed diagnosis and high mortality (20 to 47%). CONCLUSION: Only elimination of the identified inadequacies in management can significantly reduce the BM-related high mortality in developing countries.
- ItemOpen AccessAcute chest syndrome in sickle cell disease patients: experience from a resource constrained setting(Wolters Kluwer Medknow, 2019-10-17) Akinsete, A. M.; Majiyagbe, O. O.; Joacquin, A.; Temiye, E. O.; Akinsulie, A. O.Introduction Sickle cell anemia is the most common inheritable hemoglobin disorder in the world with very high prevalence, morbidity and mortality in sub-Saharan Africa. Acute chest syndrome (ACS) is one of the most common causes of mortality among individuals with the condition. The management of this condition involves watchful waiting which may be deleterious in resource constrained settings. The use of exchange blood transfusion (EBT) has been reported to be beneficial. The use of this great intervention is further hampered in most of the developing world. The aim of this study was to review the outcome of children managed with an algorithm adopted in 2015 at a University Teaching Hospital in a resource constrained setting. Methods This was a retrospective study from January 2015 to December 2017 at a University Teaching Hospital. Ethical approval was obtained from the Hospital's Health, Research and Ethics committee. Results A total of 324 children with sickle cell disease were admitted in the period under review with a male to female ratio of 1.5:1. Thirty three patients were suspected of having ACS, but only 12 were confirmed using the algorithm. The mean age at presentation was 8 years with over 85% of the patients having a triad of fever, cough and chest pain. All the patients had EBT within 48 hours of admission and mortality rate recorded was 16.7% Conclusion The use of the algorithm as well as the preemptive EBT improved the outcome of the children accessing care at our facility
- ItemOpen AccessAcute Kidney Injury in Children with Severe Malaria Is Common and Associated with Adverse Hospital Outcomes(Oxford University Press, 2019) Oshomah-Bello, E.; Esezobor, C.I.; Solarin, A.U.; Njokanma, F.Background: The prevalence of acute kidney injury (AKI) in children with severe malaria in sub- Saharan African may have been underestimated. The study aimed to determine the prevalence of AKI in children with severe malaria and its association with adverse hospital outcomes. Methods: At presentation, we measured complete blood count, serum bilirubin, and serum electrolytes, urea and creatinine in children with severe malaria. At 24 h after hospitalization, we repeated serum creatinine measurement. Urine passed in the first 24 h of hospitalization was also measured. We defined AKI and its severity using the Kidney Disease: Improving Global Outcome AKI guidelines. Results: The study involved 244 children (53.3% males) with a median age of 3.5 (1.9–7.0) years. One hundred and forty-four (59%) children had AKI, and it reached maximum Stages 1, 2 and 3 in 56 (23%), 45 (18.4%) and 43 (17.6%) children, respectively. The majority (86.1%) with AKI had only elevated serum creatinine. Mortality increased with increasing severity of AKI on univariate analysis but weakened on multiple logistic regression. Mortality was also higher in those with both oliguria and elevated serum creatinine than in those with elevated serum creatinine only (50% vs. 4.8%, p<0.001). Furthermore, children with AKI spent three days more in hospital than those without AKI (p<0.001). Conclusions: Acute kidney injury complicates severe malaria in 6 out of every 10 children and is commonly identified using elevated serum creatinine. It is also associated with adverse hospital outcome.
- ItemOpen AccessAcute Rheumatic fever and Rheumatic heart disease(Educational Printing and Publishing, 2016) Ogunkunle, O.; Ekure, E.N.Texts attached
- ItemOpen AccessAmbiguous genitalia, giant congenital melanocytic nevus and subpulmonic outlet ventricular septal defect in an African child with Neurofibromatosis 1(John Wiley Publishers, 2023-06-14) Ekure, E. N.; Musa, K. O.; Ulonnam, N.; Kruszka, P.; Muenke, M.; Adeyemo, A. A,Neurofibromatosis type 1 is an autosomal dominant multisystemic disease caused by mutation of the neurofibromin (NF1) gene located on chromosome 17q11. We report a case of Neurofibromatosis 1 with ambiguous genitalia, giant congenital melanocytic nevus, and associated subpulmonic outlet ventricular septal defect, hitherto unreported in sub-Saharan Africa. In addition, a literature review of congenital heart diseases associated with Neurofibromatosis 1 is presented.
- ItemOpen AccessAudit of availability and distribution of paediatric cardiology services and facilities in Nigeria(Clinics Cardive Publishing Ltd., 2017-01-23) Ekure, E.N.; Sadoh, W.E.; Bode-Thomas, F.; Orogade, A.A.; Animasahun, A.B.; Ogunkunle, O.O.; Babaniyi, I.; Anah, M.U.; Otaigbe, B.E.; Olowu, A.; Okpokowuruk, F.; Omokhodion, S.I.; Maduka, O.C.; Onakpoya, U.U.; Adiele, D.K.; Sani, U.M.; Asani, M.; Yilgwan, C.S.; Daniels, Q.; Uzodimma, C.C.; Duru, C.O.; Abdulkadir, M.B.; Afolabi, J.K.; Okeniyi, J.A.BACKGROUND: Paediatric cardiac services in Nigeria have been perceived to be inadequate but no formal documentation of availability and distribution of facilities and services has been done. OBJECTIVE: To evaluate and document the currently available paediatric cardiac services in Nigeria. METHODS: In this questionnaire-based, cross-sectional descriptive study, an audit was undertaken from January 2010 to December 2014, of the personnel and infrastructure, with their distributions according to geopolitical zones of Nigeria. RESULTS: Forty-eight centres participated in the study, with 33 paediatric cardiologists and 31 cardiac surgeons. Echocardiography, electrocardiography and pulse oximetry were available in 45 (93.8%) centres while paediatric intensive care units were in 23 (47.9%). Open-heart surgery was performed in six (12.5%) centres. South-West zone had the majority of centres (20; 41.7%). CONCLUSIONS: Available paediatric cardiac services in Nigeria are grossly inadequate and poorly distributed. Efforts should be intensified to upgrade existing facilities, establish new and functional centres, and train personnel.
- ItemOpen AccessAwareness and use of Gross Motor Function Classification System (GMFCS) by health professionals in a developing country(Nigerian Journal of Paediatrics, 2015-07-29) Adeniyi, O.F; Lagunju, I.A; Abdus-salam, I.A; Sidebotham, P; Lesi, F.E.AIntroduction The degree of disability in children with Cerebral Palsy (CP) can be evaluated with the Gross Motor Function Classification System GMFCS), a valid tool which was designed for such purposes. However, there appears to be paucity of data on the awareness and use of the GMFCS particularly in the Sub-Saharan continent where the condition is still prevalent. Thus, this study aims to describe awareness, use, merits and demerits of the GMFCS system as perceived by health professionals who take care of children with CP. Methods: This was a cross sectional study of health professionals from three Nigerian teaching hospitals. Information obtained via structured questionnaire were demographic data, years of qualification, years of experience of working with children with CP, awareness, use, merits and demerits of the GMFCS. Factors associated with use of the GMFCS were also evaluated with the Chi-square analysis. Results: 78 health professionals participated in the study and majority (58.9%) were doctors. 55(70.5%) of the study participants were aware of the GMFCS but only 33(42.3%) were using it. The nurses were neither aware of the system nor using it. A higher proportion of therapists (65.4%) were familiar with the system compared t o t h e d o ct o r s ( 5 4 .3 % ) . The location of practice was significantly associated with the use of the GMFCS (p=0.013). More doctors noted the merits and demerits of the system compared to the therapists. Conclusion: Though health professionals were aware of the GMFCS only a small proportion was using this vital tool in the clinical setting. Thus, there is the need to create more awareness on GMFCS and its clinical utility, and the training of nurses should be of paramount importance in the developing country.
- ItemOpen AccessBlood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents(Wolters Kluwer Medknow Publications, 2016-05) Ladapo, T.A.; Fajolu, I.B.; Adeniyi, O.F.; Ekure, E.N.; Maduako, R.O.; Jaja, T.C.; Oduwole, A.O.Background: Current methods of detection of childhood hypertension are cumbersome and contribute to under-diagnosis hence, the need to generate simpler diagnostic tools. The blood pressure to height ratio has recently been proposed as a novel screening tool for prehypertension and hypertension in some populations. We evaluated its applicability in our environment. Materials and Methods: The weights, heights, and blood pressure measurements of 2364 apparently healthy adolescents were determined. Sex-specific systolic and diastolic blood pressure to height ratios (SBPHR) and (DBPHR) were calculated, and their ability to detect prehypertension and hypertension was determined using receiver operating curves. Discriminatory ability was measured by the area under the curve (AUC) and optimal cutoff points along the curve were determined. P < 0.05 was considered statistically significant. Results: The SBPHR and DBPHR were similar across all age groups and sexes. The AUC of SBPHR and DBPHR for diagnosing prehypertension and hypertension by sex was >0.95 for both diastolic and systolic hypertension in both sexes. It ranged between 0.803 and 0.922 for prehypertension and 0.954–0.978 for hypertension indicating higher accuracy for hypertension. Sensitivity was higher for systolic and diastolic hypertension (90–98%) compared with prehypertension (87–98%). Specificity was lower than sensitivity across all categories of hypertension and prehypertension (0.64–0.88%) though higher for hypertension (0.75–0.88) compared with prehypertension (0.64–0.75). Conclusion: BPHR is a useful screening tool for prehypertension and hypertension in black adolescents. Accuracy increased with higher degrees of hypertension
- ItemOpen AccessBlood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents(Wolters Kluwer - Medknow, 2016) Ladapo, T.A.; Fajolu, I.B.; Adeniyi, O.F.; Ekure, E.N.; Maduako, R.O.; Jaja, T.C.; Oduwole, A.O.BACKGROUND: Current methods of detection of childhood hypertension are cumbersome and contribute to under-diagnosis hence, the need to generate simpler diagnostic tools. The blood pressure to height ratio has recently been proposed as a novel screening tool for prehypertension and hypertension in some populations. We evaluated its applicability in our environment. MATERIALS AND METHODS: The weights, heights, and blood pressure measurements of 2364 apparently healthy adolescents were determined. Sex-specific systolic and diastolic blood pressure to height ratios (SBPHR) and (DBPHR) were calculated, and their ability to detect prehypertension and hypertension was determined using receiver operating curves. Discriminatory ability was measured by the area under the curve (AUC) and optimal cutoff points along the curve were determined. P < 0.05 was considered statistically significant. RESULTS: The SBPHR and DBPHR were similar across all age groups and sexes. The AUC of SBPHR and DBPHR for diagnosing prehypertension and hypertension by sex was >0.95 for both diastolic and systolic hypertension in both sexes. It ranged between 0.803 and 0.922 for prehypertension and 0.954-0.978 for hypertension indicating higher accuracy for hypertension. Sensitivity was higher for systolic and diastolic hypertension (90-98%) compared with prehypertension (87-98%). Specificity was lower than sensitivity across all categories of hypertension and prehypertension (0.64-0.88%) though higher for hypertension (0.75-0.88) compared with prehypertension (0.64-0.75). CONCLUSION: BPHR is a useful screening tool for prehypertension and hypertension in black adolescents. Accuracy increased with higher degrees of hypertension.
- ItemOpen AccessBubble CPAP in the Management of Respiratory Distress Syndrome in Resource Constrained Settings: The LUTH Experience(2018) Ezenwa, P.; Akintan, P.; Fajolu, I.; Ladele, J.; Ezeaka, C.Respiratory distress syndrome (RDS) is a common health problem especially in preterm newborns. In Nigeria, prematurity accounts for about 25% of neonatal mortality and RDS have been identified as the major cause of these deaths. The major problem in RDS is immaturity of the lungs with deficiency of surfactant. Surfactant reduces surface tension in the alveoli, thereby preventing collapse of the lungs during expiration. Bubble continuous positive airway pressure (bCPAP) is a low cost intervention that delivers continuous distending pressure on alveoli thus preventing collapse during expiration. Objective: To describe the experience in the use of bubble CPAP in the neonatal unit of Lagos University Teaching Hospital (LUTH) and to determine the outcome and efficacy of improvised bCPAP in the management of babies with respiratory distress syndrome. Study design: Retrospective observational study Subjects: Inborn preterm infants (gestation 25 to 34 weeks) admitted to the Neonatal Intensive Care unit (NICU) and managed for respiratory distress and with chest X- ray findings of RDS. Intervention: Improvised bCPAP Results: Forty-two subjects who were diagnosed with RDS were recruited into the study. Oxygen saturation was monitored in all babies and there were significant differences in mean oxygen saturations pre- and post-CPAP commencement from a mean of 82.93±4.07 to 94.±1.11 (p=0.02). Thirty-two babies were successfully weaned off CPAP with overall CPAP success rate of 76.2%. There were ten RDS specific mortality with case fatality rate of 23.8% during the study period. The mean birth weight of survivors were higher (1435.4g) compared to those who died (963.4g), p<0.05. Babies that died had lower mean gestational age (27.8 weeks) than those that did not (30.3 weeks) though this was not statistically significant (p >0.05). Conclusion: Improvised bCPAP is a simple and cost effective intervention that can be used in resource limited settings to treat RDS in preterm babies and reduce morbidity and mortality due to surfactant deficiency.
- ItemOpen AccessBubble CPAP in the Management of Respiratory Distress Syndrome in Resource Constrained Settings: The Luth Experience(Pediatric Oncall, 2016-03) Ezenwa, B.N; Akintan, P.E; Fajolu, I.B; Ladele, J; Ezeaka, V.CRespiratory distress syndrome (RDS) is a common health problem especially in preterm newborns. In Nigeria, prematurity accounts for about 25% of neonatal mortality and RDS have been identified as the major cause of these deaths. The major problem in RDS is immaturity of the lungs with deficiency of surfactant. Surfactant reduces surface tension in the alveoli, thereby preventing collapse of the lungs during expiration. Bubble continuous positive airway pressure (bCPAP) is a low cost intervention that delivers continuous distending pressure on alveoli thus preventing collapse during expiration. Objective: To describe the experience in the use of bubble CPAP in the neonatal unit of Lagos University Teaching Hospital (LUTH) and to determine the outcome and efficacy of improvised bCPAP in the management of babies with respiratory distress syndrome. Study design: Retrospective observational study Subjects: Inborn preterm infants (gestation 25 to 34 weeks) admitted to the Neonatal Intensive Care unit (NICU) and managed for respiratory distress and with chest X- ray findings of RDS. Intervention: Improvised bCPAP Results: Forty-two subjects who were diagnosed with RDS were recruited into the study. Oxygen saturation was monitored in all babies and there were significant differences in mean oxygen saturations pre- and post-CPAP commencement from a mean of 82.93±4.07 to 94.±1.11 (p=0.02). Thirty-two babies were successfully weaned off CPAP with overall CPAP success rate of 76.2%. There were ten RDS specific mortality with case fatality rate of 23.8% during the study period. The mean birth weight of survivors were higher (1435.4g) compared to those who died (963.4g), p<0.05. Babies that died had lower mean gestational age (27.8 weeks) than those that did not (30.3 weeks) though this was not statistically significant (p >0.05). Conclusion: Improvised bCPAP is a simple and cost effective intervention that can be used in resource limited settings to treat RDS in preterm babies and reduce morbidity and mortality due to surfactant deficiency.
- ItemOpen AccessBurden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya.(PLOS ONE, 2021) Nabwera, H. M; Wang, D; Tongo, O.O; Andang'o, P.E.A; Abdulkadir, I; Ezeaka, C.V; Ezenwa, B.N; Fajolu, I.B; Imam, Z.O; Mwangome, M.K; Umoru, D.D; Akindolire, A.E; Otieno, W; Nalwa, G.M; Talbert, A.W; Abubakar, I; Embleton, N.D; Allen, S.J; Neonatal Nutrition Network, (NeoNuNet)
- ItemOpen AccessCardiac surgery-associated acute kidney injury in a developing country: Prevalence, risk factors and outcome(Wolters Kluwer Medknow Publications, 2015-05) Ekure, E.N.; Esezobor, C.I.; Sridhar, A.; Vasudevan, J.; Subramanyan, R.; Cherian, K.M.Little is known about cardiac surgery-associated acute kidney injury (CS-AKI) in children in developing regions of the world. The study aimed to determine the prevalence of CS- AKI, associated factors and its impact on mortality and utilization of hospital services. The hospital records of children aged 0–17 years who underwent CS at an Indian hospital were reviewed. CS-AKI was defined as a rise in serum creatinine of ≥0.3 mg/dL in any 48 h and or by urine output <0.5 mL/kg/h for an 8-h period in the first five days after CS. The study included 323 children with a median age of one year (0.04–17), of whom 22 (6.8%) were neonates and 18.3% had a single ventricle. About 60% of the children had Risk Adjusted Congenital Heart Surgery–I category 1 or 2 interventions. CS-AKI occurred in 39 children (12.1%). Factors associated with CS-AKI were sepsis and intra- and post-operative hypotension. In-hospital mortality was six-fold higher in children who developed CS-AKI. CS-AKI was associated with two to three days more of mechanical ventilation and Intensive care unit stay. CS-AKI occurs in children in developing countries, but at a lower frequency mainly due to the predominance of post-neonatal children undergoing less-complex CSs. CS-AKI was associated with higher in-hospital mortality and increased utilization of hospital services. Factors associated with CS-AKI included intra- and post-operative hypotension and sepsis.
- ItemOpen AccessChallenges of Retinoblastoma management at a Nigerian tertiary eyecare facility(MedKnow, 2017-10) Musa, K.O.; Aribaba, O.T.; Oluleye, T.S.; Olowoyeye, A.O.; Akinsete, A.M.Background: Retinoblastoma is the most common intraocular childhood malignancy. Its management is, however, not without challenges especially in a developing country like Nigeria. This study sought to present the clinical profile and treatment outcome of patients with retinoblastoma managed in a Nigerian tertiary eye care facility highlighting the challenges with a view to improving the management of the disease. Materials and Methods: A retrospective, single-institution, and institutional review board-approved review of all patients diagnosed with retinoblastoma between January 2012 and December 2015 was done. Data obtained from case files of patients include demographic characteristics, presenting complaint, laterality of disease, tumor stage using the International Intraocular Retinoblastoma Classification, treatment, and outcome. Information obtained from phone calls to the caregivers were also summarized. Results: The review included 54 eyes of 41 patients between the ages of 2 months and 5 years. The mean age at presentation was 24.4 ± 11.4 months. There were 18 males (43.9%). Duration of symptoms before presentation ranged from 2 weeks to 2 years. Tumor was bilateral in 13 (31.7%) patients. Leukocoria was the most common presenting complaint observed in 32 (59.2%) eyes. Groups D and E were the most common intraocular tumor stage documented in 16 (29.7%) and 15 (27.8%) eyes, respectively. Most patients (29, 70.7%) defaulted from treatment after the first or second presentation. Only 6 (21.4%) of 28 patients offered enucleation or modified exenteration either at presentation (Class E) or after chemoreduction (orbital disease) consented. Conclusion: Late presentation, high default rate, and noncompletion of treatment were the major challenges facing retinoblastoma management in this center
- ItemOpen AccessCharacteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria.(Pan African Medical Journal (PAMJ), 2016) Butali, A.; Ezeaka, C.; Ekhaguere, O.; Weathers, N.; Ladd, J.; Fajolu, I.; Esezobor, C.; Makwe, C.; Odusanya, B.; Anorlu, R.; Adeyemo, W.L. ; Iroha, E.; Egri-Okwaji, M.; Adejumo, P.INTRODUCTION: Preterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria from 2011 to 2013. METHODS: We obtained Information from 5,561 maternal, fetal/neonatal and obstetric records from the labor ward. We excluded delivery at less than 22 weeks (0.25%), post-term birth at ≥42 weeks gestation (1.3%), and unknown gestation (1.4%). Additionally, we excluded records of multiple births (5.4%) and stillbirths (8.3%) leaving 4,691 records of singleton live-births for analysis. Logistic regression analysis was performed comparing preterm birth (22-36 weeks gestation) to term birth (37-41 weeks gestation). Multiple variable models adjusting for maternal age, parity, fetal position, delivery method and booking status were also evaluated. Multinomial regression was used to identify characteristics associated with preterm birth (PTB) defined as early PTB (22-31 weeks gestation), moderate PTB (32-34 weeks gestation), late PTB (35-36 weeks gestation), compared to term birth (37-41 completed weeks gestation). RESULTS: From our data, 16.8% of the singleton live-birth deliveries were preterm (<37 weeks gestation). Of these, 4.7% were early (22-31 weeks), 4.5% were moderate (32-34 weeks) and 7.7% were late (35-36) PTBs. Older maternal age (≥35 years) [odds ratio (OR) = 1.41], hypertension (OR = 3.44) and rupture of membranes (OR = 4.03) were significantly associated with increased odds of PTB. Women being treated for the prevention of mother-to-child transmission of HIV were at a significantly decreased risk for PTB (OR = 0.70). Sixteen percent of women in this cohort were not registered for antenatal care in LUTH. These non-registered subjects had significantly greater odds of all categories of PTB, including early (odds ratio (OR) = 20.8), moderate (OR = 8.68), and late (OR = 2.15). CONCLUSION: PTB and risks for PTB remain high in Nigeria. We recommend that any high risk pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs.
- ItemOpen AccessChildhood mortality in children emergency centre of the Lagos University Teaching Hospital(Paediatric Association of Nigeria, 2011) Fajolu, Iretiola Bamikeolu; Egri-Okwaji, Matthias Taiwo CBackground: Infant and childhood mortality has remained high in developing countries like Nigeria with only marginal reductions achieved over the past two decades despite several interventions to reduce morbidity and mortality from the common causes of death in children. It is therefore important to examine the current pattern of mortality in children and compare it with previous reports from this centre so as to determine if newer interventions are needed or if these current interventions need to be strengthened for more effective reduction in childhood mortality. Objective: The aim of this study was to examine the pattern of childhood mortality in the children emergency centre of the Lagos University Teaching Hospital (LUTH). Materials and Methods: Admission and discharge records from October 2007 to November 2008 were reviewed retrospectively, the age, sex, diagnosis and duration of hospital stay before death were analyzed. Results: Four hundred and forty six children (446) out of the 4031 children admitted during the study Period died, giving a mortality of 11.1%. More than half of the deaths (55.4%) occurred within 24hours of arrival in hospital. Neonates accounted for 54.7% of deaths. The common causes of death in the neonates were perinatal asphyxia (36.1%) , neonatal jaundice (21.3%), prematurity (16.3%) and septicaemia (11.5%), while in the older children anaemia , septicaemia, severe malaria and acute respiratory illnesses were the commonest conditions accounting for 22.6%, 16.3%, 12.1% and 9.9% of deaths respectively. Conclusion: Childhood mortality in LUTH is still high with majority of deaths occurring in infancy especially in the neonatal period. Efforts to prevent perinatal asphyxia, the most common cause of death in the neonatal period, should be intensified and education on the prevention , early identification and management of conditions such as neonatal jaundice, malaria, anaemia and acute respiratory illnesses should also be strengthened.
- ItemOpen AccessClinical Epidemiology and Management of Congenital Heart Defects in a Developing Country(Karger publishers, 2015) Ekure, E.N.; Adeyemo, A.A.Congenital heart defects (CHD) remain one of the most common categories of birth defects worldwide. In many developing countries, high early childhood mortality and limited diagnostic facilities often obscure the true scope of the problem. In this review, we provide an overview of the clinical epidemiology and management of CHD in a developing country: Nigeria, Africa's most populous country. We describe the types of CHD and the clinical presentation, echocardiographic diagnosis, management, and outcome of CHD. Ventricular septal defects are the commonest CHD reported in Nigeria while tetralogy of Fallot is the commonest cyanotic CHD. Their etiology is often unknown, although the congenital rubella syndrome and Down syndrome account for a significant minority of cases. Thus far, there is no modern genetic study of CHD in Nigeria. Diagnosis is often delayed, with only about half of CHD cases getting diagnosed within the 1st year of life and up to 10% diagnosed in adulthood. Echocardiography has played a major role in improving diagnosis. Management remains challenging, but a number of initiatives (especially by nongovernmental organizations) provide access to corrective surgery for a select few. The field of CHD in Nigeria offers opportunities for research into etiology, natural history, clinical management, and outcomes.
- ItemOpen AccessClinical epidemiology of congenital heart disease in Nigerian children, 2012-2017(Wiley, 2018-10-02) Ekure, E.N.; Kalu, N.; Sokunbi, O.J.; Kruszka, P.; Olusegun-Joseph, A.D.; Ikebudu, D.; Bala, D.; Muenke, M.; Adeyemo, A.BACKGROUND: Congenital heart diseases (CHDs) affect ~1% of newborns and are a significant cause of morbidity and mortality in children. We present the clinical epidemiology of CHD as seen in a large university medical center in Nigeria. METHODS: Participants were 767 children with echocardiographically confirmed CHD seen over a 5-year period at the Lagos University Teaching Hospital, Nigeria. RESULTS: Clinical presentation was often late with just over half (58.1%) presenting in infancy. The male:female distribution was 1:1. The predominant types of cardiac lesion seen were septal defects (43%), conotruncal defects (23.7%), atrioventricular septal defects (9.8%), and right ventricular outflow tract obstruction (7.3%). Cyanotic CHD was seen in 28.4% of cases and the single most common cyanotic CHD was Tetralogy of Fallot (13.4%). Children with cyanotic CHD were older (p = .002), had more severe lesions (p < .0001) and were more likely to have cardiac intervention (p < .0001). Extracardiac malformations were present in nearly one-third of the children. Syndromes associated with CHD were identified in 15.5% of the children and included Down syndrome (11.9%), congenital rubella syndrome (1.0%), and Marfan syndrome (0.7%). CONCLUSIONS: This study is a large case series of CHD from a single site in sub-Saharan Africa utilizing clinical, epidemiological, and developmental considerations. It provides a rich and up-to-date description of the clinical epidemiology of CHD in Nigerian children while yielding data that could be useful for designing genetic, molecular, and biomarker studies.