Adolescents in low-resource settings have inadequate access to accurate sexual and reproductive health (SRH) information and care. Misinformation, peer influence, and restrictive laws often result in harmful practices such as unsafe abortion, contributing significantly to adolescent morbidity and mortality. We report the case of a 14-year-old Nigerian girl who, at 13 years of age, was misled by a peer to believe that remaining a virgin would prevent her from bearing children. Acting on this falsehood, she paid a man Two Thousand Naira to have sexual intercourse with her. Months later, she became amenorrhoeic, but she was made to believe that her menstruation was “stuck,” and an unsafe induced abortion was attempted. She subsequently had severe post-abortion haemorrhage, post-abortion sepsis and hypovolaemic shock. She was successfully managed with resuscitation, uterine evacuation, intravenous antibiotics, and blood transfusion. This case underscores how misinformation, peer influence, and lack of adolescent-friendly SRH services can result in sexual abuse and life-threatening outcomes.
Background: Lead, a metal widely used across many industries, including construction, electricity, and fashion, is a heavy metal of public health significance. Exposure to lead can affect normal growth and development in children. Methods: This cross-sectional study determined blood lead levels of 363 children aged 6- 59 months seen at the Children Outpatients Clinic of the Federal Teaching Hospital, Ido-Ekiti. Children with chronic illness and severe acute malnutrition were excluded. Venous blood was analysed using an atomic absorption spectrophotometer. Results: BLL ranged between 0.1 µg/dl and 22.8 µg/dl. The median (IQR) BLL was 5.10 (1.80-8.63) µg/dl. Blood lead levels were higher among males than among females (p = 0.82). Overall, 48.3% had blood lead levels below 5 µg/dl, and 183 (51.7%) had levels above 5 µg/dl. One subject (0.3%) had a value above 20 µg/dl. Age, gender, and socioeconomic class did not significantly affect BLL (p = 0.94, 0.82, and 0.63, respectively). Use of toys with peeled paint, residence close to the highway and storage of water in plastic containers were associated with elevated lead levels. Conclusion: The majority (51.8%) of children in the locality of study have elevated BLL. There is a need to increase awareness of environmental lead contamination and the dangers of lead exposure. Health promotion should also focus on measures to reduce lead exposure.
Background: Despite evidence of the developmental and educational importance of good vision, childhood eye health continues to receive inadequate attention within Nigeria’s preventive health framework. Objective: To identify childhood eye disease and visual impairment through paediatric vision screening among school children in Southwest Nigeria. Methods: A multi‑stage random sampling technique was used to select and screen 364 pupils for visual impairment from a total of 300, 690 pupils aged 4–17years attending government-owned preschool, primary, and junior secondary schools in a city in Southwest Nigeria. They all had ophthalmic evaluation using distance Snellen visual acuity chart, pen torches, loupe magnifier and direct ophthalmoscope. Results: Out of the 364 pupils, 45.3% were males while 54.7% were females. The mean age was 9.2±0.65 years. Respondents aged 6-10 years formed 57.1% of the cohort. The prevalence of eye disorders was 27.8% while the commonest cause of eye disorder was refractive error (46.6%), followed by allergic conjunctivitis (39.6%). Conclusion: The commonest cause of eye disorders in this study is treatable. There is a need for regular school screening to ensure early identification of this treatable cause to avoid needless visual impairment that could impair learning.
Background: Autopsy has long been considered the gold standard for determining the cause of death, assisting in medical education, and evaluating the quality of medical care. A significant decline in the autopsy rate has been observed globally over the decades. A literature search revealed numerous studies in Nigeria and across Africa; unfortunately, these relied on verbal autopsies. Objectives: To examine the pattern of causes of death in childhood using autopsy findings. Methods: This was a 21-year retrospective autopsy study of paediatric deaths in a Nigerian teaching hospital. The standard autopsy dissection was done, and autopsy reports were retrieved from the archive. The cut-off age was 18 years, while decomposed bodies were excluded. Results: Five hundred and twenty-one autopsies represented a rate of 3.2% and a male-to-female ratio of 1.3:1. The adolescent age was the most common. RTAs were the most common cause of childhood death (29.2%), infection was next (18%), while asphyxia deaths (12.1%) and burn injuries (10.6%) closely followed. Conclusion: The predominance of males corroborates the previous knowledge on this research theme. The early adolescent age was the most common age group encountered, while road traffic accident was the leading cause of death.
Psychogenic Non-Epileptic Seizures (PNES) are paroxysmal spells which bear a semblance to an epileptic seizure. Neurobehavioral complications following lightning strikes are frequent and resemble the symptoms of patients with traumatic brain injury. We describe the case of a 9-year-old boy who was struck by lightning while playing by the door of his classroom during a thunderstorm. He fell and was unconscious for about 20 minutes, after which he woke up with no significant injuries. The immediate effect of the attack on the patient's organs was not identified, as he was not taken to a health facility for review immediately after the attack. However, four days later, he developed persistent myoclonic jerks of several episodes per day, with varying durations and intervals, which could be induced by touch, noise and light. It is sometimes associated with loss of consciousness. Physical examination of the patient did not reveal any neurologic deficit. A 24-hour Long-Term Video Electroencephalogram Monitoring (LTVEM) done showed a normal study with photic-induced non-epileptic generalised myoclonus. Therefore, the diagnosis of trauma-induced stimulus-sensitive Psychogenic Myoclonus, a type of PNES, was entertained. The child responded to oral Clonazepam and Levetiracetam and was sent for physiotherapy and child psychology review before he was lost to follow-up. In conclusion, exposure to lightning injuries requires a holistic approach to their management, and the resultant seizures may not always be of cranial origin.
Background: Syndrome of Inappropriate Antidiuresis (SIAD) is a recognised complication of various clinical conditions, including pneumonia. However, its prevalence and impact on hospitalised children with pneumonia remain underexplored. Objectives: To determine the prevalence of SIAD and its association with admission outcomes among children hospitalised for pneumonia. Methods: A descriptive, cross-sectional study was conducted among 101 children aged 1 month to 14 years hospitalised with pneumonia. Data on socio-demographic, anthropometric, and clinical parameters were recorded using a semi-structured proforma. Blood and urine samples were analysed as required. Results: The 101 children studied (median age 13.0 months [IQR 5-30]) had a male-to-female ratio of 1.9:1. Seventeen (16.8%), comprising 11 males and 6 females, were diagnosed with syndrome of inappropriate antidiuresis. Two patients, both with SIAD, died. Survivors with SIAD had a significantly longer median hospital stay of 7 days (IQR 3–15) compared to 3 days (IQR 2–6) in those without SIAD (p = 0.016). Conclusion: This study shows that SIAD is a common occurrence among hospitalised children with pneumonia, and it is associated with prolonged hospital stay and increased risk of mortality. Early recognition and management of SIAD in this population may improve clinical outcomes.
Background: Cardiac diseases contribute significantly to childhood morbidity and mortality with varying patterns across the globe. Objective: To determine the spectrum and pattern of cardiac diseases among children in Makurdi, Nigeria. Methods: A retrospective study of 206 children who had echocardiography over 57 months (October 2020-July 2025) was conducted. Results: Almost three-quarters (71.8%) had abnormal findings, with 85.8% being congenital heart diseases (CHD). Atrial Septal Defect, Patent Ductus Arteriosus and Ventricular Septal Defect were the leading defects. Acquired heart diseases constituted 12.8% with rheumatic heart disease and dilated cardiomyopathy being the most prevalent. Conclusion: Congenital heart disease remains predominant in this setting, and there is an urgent need for improved paediatric cardiac services.
Ewing sarcoma is a malignant, aggressive small, round, blue cell tumour, likely of neural crest origin. It is the second most common bone cancer in children, usually affecting the long bones and central axis. The involvement of flat and irregular bones is rare. We present a Nigerian adolescent male with a three-year history of left foot pain following a minor trauma, a one-year history of foot swelling, and progressive swelling in the left lower limb, scalp, and jaw over seven months. A foot ulcer developed a few days after biopsy. A duplex ultrasound scan revealed multiple enlarged inguinal and popliteal lymph nodes. A head CT scan showed a solitary lytic lesion in the right posterior parietal bone. An MRI of the left foot demonstrated a large soft tissue mass on the first metatarsal with cortical destruction. An initial histopathology diagnosis with open biopsy was Bacillary angiomatosis. Histology of a second open biopsy specimen from the affected foot showed mainly granulation tissues, but a subsequent USS-guided core-needle biopsy of the scalp and jaw masses done one month later revealed a small, round, blue cell tumour. Immunohistochemistry confirmed Ewing sarcoma. The patient responded remarkably to multi-agent chemotherapy, with significant tumour regression and symptom relief. Flat and irregular bone involvement in Ewing sarcoma is rare but possible. This highlights the importance of maintaining a high index of suspicion, utilising appropriate imaging, and ensuring adequate tissue sampling for accurate diagnosis and effective treatment.
Background: Orofacial Burkitt lymphoma, a major manifestation of the endemic variant of Burkitt lymphoma in African children, has historically posed serious health challenges in sub-Saharan Africa due to its aggressive nature and potential for facial disfigurement. Fortunately, both its incidence and prevalence have decreased recently. Objectives: To investigate the pattern of Burkitt's lymphoma distribution in the orofacial region and treatment outcomes. Methods: This retrospective review spans 15 years (2007-2021) and examines cases of Burkitt’s lymphoma at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria. The study included records of 62 cases presenting with orofacial Burkitt's lymphoma and complete clinical, histological, and/or cytological data. Results: There was a consistent decline in incidence over the study period. Most patients (51, 82.3%) were aged 1–10 years, with a male-to-female ratio of 2.7:1. The maxilla was the most frequently affected site (42.0%), and the majority (77.4%) presented with advanced-stage disease. Overall, 58.6% achieved remission, with a correlation (p < 0.001) between the number of chemotherapy cycles received and treatment outcomes. Conclusion: Despite challenges, orofacial Burkitt's lymphoma remains treatable. This study highlights the importance of treatment adherence and completion of the recommended chemotherapy courses.
Parapneumonic effusion (PPE) remains a significant cause of morbidity among children with pneumonia, especially in low- and middle-income countries where diagnostic limitations and antibiotic resistance complicate management. Objective: To determine the incidence, diagnostic modalities, bacteriological profile, antimicrobial susceptibility patterns, and outcomes of pediatric PPE in a tertiary hospital in Nigeria. Methods: A five-year retrospective study was conducted among children aged 0–15 years diagnosed with PPE. Relevant data on socio-clinical characteristics, diagnostic findings, complications, comorbidities, and outcomes were extracted from patient records. Results: Forty-two PPE cases were identified, giving an incidence rate of 1.1 per 1,000 pneumonia admissions. The mean age was 7.9 ± 3.8 years, with a male predominance (66.7%). Most had received prior antibiotics (88.1%) and were underweight (69.1%). Mycobacterium tuberculosis was detected in 14.3% of cases. Bacterial culture was positive in 28.6% of cases, with Streptococcus pneumoniae, Staphylococcus aureus (including MRSA), Streptococcus agalactiae, and Escherichia coli as the leading isolates. Gram-positive isolates were sensitive to cefuroxime, ceftriaxone, and gentamicin, while MRSA and MDR E. coli were sensitive to ciprofloxacin. Major complications included hypoxaemia and sepsis. Conclusion: PPE is a significant pediatric respiratory complication. Strengthening pneumococcal vaccination, improving diagnostics, and implementing antimicrobial stewardship are crucial for better outcomes.
Background: Severe acute malnutrition (SAM) remains a critical public health issue globally, contributing substantially to illness and death among children under five. Despite the clinical significance of glucose metabolism, data on the burden and outcomes of dysglycaemia in malnourished children, particularly in low-resource settings like Nigeria, are limited. Objective: To determine the prevalence of dysglycaemia and its relationship with clinical outcomes in children with SAM at the Federal Teaching Hospital, Birnin Kebbi. Methods: This was a cross-sectional study of children aged 6 months to 5years with WHO-defined SAM presenting at the EPU from 1st September to 31st August 2024. A Google Form was used to obtain relevant sociodemographic and clinical information, and random blood glucose (RBS) was measured on admission, at 24 hours, and on alternate days. Results: The study population was 132, comprising 36 males and 96 females, with most (54.5%) aged 1 to <3 years. At 24 hours post-admission, 11.4% had dysglycaemia: 2.3% with hypoglycemia and 9.1% with hyperglycemia. The majority (80%) with dysglycaemia had delayed stabilisation time after admission, and their median length of stay (LOS) was 14 days (IQR 10-18days). The overall mortality rate in children with SAM and dysglycaemia was 4.5%. The six fatalities comprised five children with hyperglycaemia and one with hypoglycaemia. Conclusion: The findings in the study emphasise the significant morbidity associated with dysglycaemia in children with SAM and its link to increased mortality. This highlights the critical need for routine glucose monitoring and prompt management of its disorders to improve clinical outcomes.
The Plastibell device is a known appliance/method for neonatal circumcision. The objective of the report is to describe one of the complications of neonatal circumcision using “Plastibell device” and to create awareness about this complication of a widely used surgical procedure. A 23-day-old male presented with swelling at the circumcision area of about five days. There was associated excessive crying while bathing or cleaning the area. The baby was circumcised 16 days earlier, by a nurse at a primary health centre and the object used for the circumcision – the Plastibell device was yet to fall off. The penis was oedematous and harboured a transparent cylindrical plastic object (Plastibell device). The distal third of the penis was depressed, and the glans penis was oedematous, but not cyanosed or gangrenous. There was no associated ulceration or discharge, and the patient was able to pass urine. The device was manually removed following lubrication. There was normal urinary function post-removal, and no associated complications on follow-up. In conclusion, retained Plastibell device is a complication of circumcision, and adequate parental counselling is vital. There is a need for re-education of health workers and upscaling of regulatory actions by governmental agencies and healthcare practitioners regarding its use of the Plastibell device.
Background: Diarrhoeal disease is a major global health challenge, causing about 1.7 billion cases annually. It is a major contributor to childhood malnutrition, and mortality in children under five. Objective: To systematically evaluate the impact of probiotic therapy on diarrhoeal morbidity and mortality in African children between 2010 and 2022. Methods: A search strategy was developed using MeSH, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Researchgate and Scopus. Only randomised, double-blind, controlled trials retrievable in English will be included. The primary outcome will be the duration of acute diarrhoea in African children receiving probiotics. Secondary outcomes will include effects on fever, hospitalisation, vomiting, stool frequency/volume, and side effects. Studies will be screened, deduplicated, and eligible studies identified using DistillerSR. Methodological, clinical, and statistical heterogeneity will be assessed. Meta-bias will be evaluated using the Cochrane RoB 2 tool. Publication bias will be assessed using funnel plots and Egger's test. Pooled mean differences in diarrhoeal duration will be reported with standard error and 95% CI. Evidence strength will be rated using the GRADE approach. Discussion: This study will evaluate the efficacy of probiotics in African children, reporting their effects on diarrhoeal duration, fever, hospital stay, vomiting, stool frequency and volume, and adverse effects. It will examine the moderating effects of sociodemographic factors and probiotic species. Findings will be published in peer-reviewed scientific journals. Systematic Review Registration: This protocol has been registered with PROSPERO, registration number CRD42023416270
Acute chest syndrome (ACS) is one of the most serious and frequent pulmonary complications of sickle cell disease in childhood. Defined by the presence of a new pulmonary infiltrate on chest imaging accompanied by fever and/or respiratory symptoms. The clinical manifestation of ACS ranges from a mild, self-limited illness to fulminant respiratory failure requiring intensive care and life-saving interventions. Acute chest syndrome is one of the leading causes of hospitalization and a major contributor to morbidity and mortality in children with sickle cell disease (SCD). Early recognition and prompt institution of evidence-based management strategies are therefore essential to reduce the immediate complications and long-term pulmonary sequelae of the disease. This review discusses current trends in the management of ACS in children with SCD, as well as practical approaches to ACS management in resource-poor settings.
Mucopolysaccharidosis type IVA (MPS IVA), also known as Morquio syndrome type A, is a rare inherited metabolic disorder resulting from the deficiency of the N-acetylglucosamine-6-sulfate sulfatase enzyme. A 5-year-old boy was referred to the Paediatric Endocrinology Clinic for evaluation and possible growth hormone therapy due to concerns about short stature. The patient was initially seen by the Orthopaedic Surgery team, who noted significant growth impairment and skeletal abnormalities. On examination, he had an abnormal gait. Radiological assessment revealed short and broad metacarpals, tapering phalanges, and hypoplastic, irregular carpal bones, which are classical features of mucopolysaccharidosis type IVA (MPS IVA). Enzyme analysis showed a markedly reduced level of N-acetylgalactosamine-6-sulfatase, confirming the diagnosis of MPS IVA. This case report highlights the challenges faced in diagnosing and managing this rare condition in a resource-constrained setting. This report underscores the importance of early diagnosis and access to enzyme replacement therapy (ERT), particularly in resource-limited regions.
Background: The prevalence of hypertension among children is on the increase, and it is of global concern. Objectives: To determine the prevalence and associated risk factors of elevated and hypertensive-range blood pressure among children and adolescents. Methods: This was a cross-sectional, prospective study of patients who attended the Paediatric Outpatient Clinic of the River State University Teaching Hospital, Nigeria. Their biodata, family and social history, dietary history and blood pressure (BP) were recorded, assessed and analysed. Results: The mean systolic and diastolic BP of 500 children aged 3 to 18 years were 102.6 (±10.1) mmHg and 60.0 (±9.0) mmHg. BP levels in higher-than-normal cut-off ranges were recorded in 76 (15.2%) children. A hypertensive BP range was found in 44 (8.8%), while 32 (6.4%) had elevated blood pressure. Elevated BP was significantly higher among subjects with a family history of hypertension (OR = 2.07, 95%CI = 1.01, 4.26; p = 0.04), children who skipped breakfast regularly (OR = 5.9, 95%CI = 1.74, 20.1; p = 0.01), and obese or overweight children (OR = 2.79, 95%CI = 1.43, 5.42; p = 0.002). Conclusions: Obesity, skipping breakfast, and a family history of hypertension were the identified risk factors for elevated blood pressure. Early screening and lifestyle modifications are essential in controlling hypertension in children.
Background: Zero-dose vaccination is defined as the status of a child aged 12–23 months who has not received even the first dose of the pentavalent vaccine, which protects against diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae Type b. Addressing zero-dose vaccination is vital for public health security. Completely unvaccinated children are at highest risk for contracting and transmitting vaccine-preventable diseases, which can lead to outbreaks even in partially immunized communities. Objective: To explore the prevalence and determinants of zero-dose vaccination among children aged 12–23 months in Abuja. Methods: A descriptive, cross-sectional study was conducted among 350 caregivers using multistage sampling. Data were collected through interviewer-administered questionnaires adapted from WHO tools. Logistic regression was used to determine predictors of zero-dose vaccination status. Results: The prevalence of zero-dose vaccination among children aged 12–23 months in Abuja was 11.1%. The key determinants included maternal education, antenatal care attendance, delivery location, and possession of an immunization card. Multivariate analysis revealed that children of mothers with no formal education (aOR = 3.8, 95% CI: 1.5–9.6) and those born at home (aOR = 4.2, 95% CI: 1.6–11.0) were significantly more likely to be zero-dose vaccinated. Maternal tetanus toxoid (TT) vaccination emerged as the strongest independent predictor. Children of mothers without TT were nearly 600 times more likely to be zero-dose vaccinated (p < 0.001). Conclusion: Promoting maternal education and institutional deliveries are critical to addressing zero-dose immunization in urban Nigerian settings.
Background: Breastfeeding is one of the most effective ways to ensure a child's health and survival. Improving breastfeeding practices could save the lives of more than 800,000 under-five children every year, the vast majority of whom are under six months of age. Early exposure to maternal antibodies, lactoferrin, oligosaccharides and other protective components in breast milk may improve neonatal and infant immune function. Mother's milk is widely recognized as the optimal feeding for term infants but also provides vital health benefits for sick and preterm infants. When mother's milk is unavailable, or in short supply, donor human milk is the second best alternative. Objective: To determine mothers' knowledge of and attitudes toward donor breast milk. Methods: A cross-sectional, descriptive study of 403 mothers attending antenatal/immunization clinics was conducted from September 2022 to January 2023. Data was collected using an interviewer-administered questionnaire. Results: While 36.5% (n = 147) of mothers had heard about donor breast milk, 67.2% (n = 271) of the mothers were willing to donate their breast milk, but only 37.2% (n = 150) agreed to accept donor breastmilk for their baby. Knowledge about donor breast milk was significantly associated with educational status (p = 0.036), and the willingness to donate was significantly associated with knowledge (p = 0.015). Conclusion: Mothers' education is a key factor influencing both knowledge and willingness to donate breastmilk.
Background: Significant differences in twin birth weights may influence the perinatal outcome in twin pregnancies. Objective: To assess the factors associated with twin birth weight discordance in Lagos, Nigeria. Methods: A descriptive, cross-sectional study was conducted among women and their twins delivered in three health facilities in Lagos State between July and December 2023. Discordance was calculated for each pair as a percentage of the heavier twin [discordance (%) = 100 (birth weight difference/ birth weight of the heavier twin)]. A twin pair was designated discordant if one of the pair's weights was smaller by 15% or more. Results: One hundred and fifty-eight women and their 316 babies were recruited for this study. Of these, 96 (60.8%) mothers were under 35 years of age, 110 (69.6%) had been booked for antenatal care, 90 (57.0%) were primiparous, 52 (32.9%) had tertiary education, and 48 (30.4%) experienced various complications during pregnancy. The frequency of birth weight discordance was 38.0%. Hypertensive disorders of pregnancy (aOR = 4.99, 95%CI = 2.05 – 11.62, p<0.001), primiparity (aOR = 3.31, 95%CI = 1.53 – 7.16, p = 0.002), secondary level of education and below (aOR = 2.69, 95%CI = 1.14 – 6.24, p = 0.024) and same-sex twins (aOR = 2.51, 95%CI = 1.17 – 5.36, p = 0.018) were associated with birth weight discordance among twins. Conclusion: The birth weight discordance rate was high in Lagos, Nigeria. There is a need to monitor pregnant women for antenatal care closely to avoid pregnancy-related complications.
Background: Lymphomas are heterogeneous group of malignant tumours of the hematopoietic system and are characterized by the aberrant proliferation of mature lymphoid cells or their precursor. Lymphoma of the orofacial region constitute one of the commonest malignancies in childhood. Objective: To determine the frequency and pattern of lymphomas and the different histopathological subtypes in the orofacial region in Nigerian children. Method: A retrospective study of all histopathologically diagnosed lymphomas of the orofacial region in children of 16years and below seen within a 15-year period, (2008 to 2022). Data were retrieved from the archives of the Department of Oral and Maxillofacial Pathology and Medicine, University of Benin Teaching Hospital, Benin City, for statistical analysis. Results: Overall, a total of 105 neoplastic lesions were seen in children within the study period. Lymphoma constituted 32.4% (n = 34) and were the most frequent of all the neoplasms. Of the Lymphomas, there were 25 (73.5%) males and 9 (26.5%) females with a male to female ratio of 2.8:1. The histopathologic types of lymphoma were non-Hodgkin’s lymphoma (NHL). The subtypes were the Burkitt’s lymphoma type (22; 64.7%), the diffused NHL lymphoma (11; 32.4%) and the follicular lymphoma (1; 2.9%). Conclusion: Orofacial lymphoma among children in Southern Nigeria were mostly seen in males with the mandible been the commonest site. All the cases of orofacial lymphoma were NHL with Burkitt lymphoma as the commonest subtype.
