Rifampicin resistance has been assumed to be synonymous with multi-drug resistant tuberculosis (MDR-TB), but this approach could be exposing tuberculosis (TB) patients with rifampicin mono-resistance to unduly long and toxic treatment regimens. The current tuberculosis management algorithm in Nigeria recommends commencement of MDR-TB treatment on rifampicin resistance detection, based on GeneXpert results and subsequent phenotypic testing. With the current dearth of phenotypic drug susceptibility testing facilities in Nigeria, several rifampicin mono-resistant tuberculosis patients may be inappropriately placed on toxic second-line drugs used for MDR-TB treatment for prolonged periods before susceptibility results are available. XpertMTB/Rif were performed on a total of 3,580 patient samples from 10 sites across Cross River State, Nigeria, as a prospective cross-sectional study. Rifampicin-resistant specimens were reprocessed and cultured on Lowenstein-Jensen medium. Indirect susceptibility testing following the microscopic observation drug susceptibility technique was performed using Rifampicin (1 µg/ml), Isoniazid (0.4 µg/ml), Fluoroquinolone (Ofloxacin-1.0 µg), Capreomycin (2.5 µg/ml), Amikacin (2 µg/ml) and Kanamycin (5.0 µg/ml). Mycobacterium tuberculosis was detected in 21.3

Background: The clinical features of hypoglycaemia and severe dehydration are similar, and these two can occur in a child presenting with acute diarrhoea. Hypoglycaemia occurring in a growing brain is deleterious and must be detected and treated. Objective: To determine the prevalence of hypoglycaemia among under-five children presenting with acute diarrhoea in UCTH, Calabar. Method: This was a prospective study of 150 children aged six weeks to five years presenting with acute diarrhoea in UCTH, Calabar from June 1st to October 31st 2008. Consecutive children who met the inclusion criteria were recruited into the study. Blood samples were collected for random blood sugar and serum electrotype estimation using One Touch Ultra Test Strips 2006 model and Flame photometry respectively. Results: The overall prevalence of hypoglycaemia in under-five children presenting with acute diarrhoea was 4%. There was no sex difference. It was commonest among children of the low socioeconomic class (83.3%). Risk factors to developing hypoglycaemia were longer duration of last feeds greater than five hours and severe dehydration, both reaching statistically significant differences (p=0.022 and 0.002; FET respectively). Forty percent of patients who died had hypoglycaemia constituting 33.3% of patients with hypoglycaemia. Conclusion: Children with diarrhoea complicated with severe dehydration are prone to developing hypoglycaemia. It causes high mortality and thus this parameter should be checked for and managed on time.

Introduction: Globally, approximately 2.7 million and 2.3 million people living with HIV are co-infected with hepatitis B and C virus, respectively. Relatively, little is known regarding HBV or HCV co-infection in HIV-infected children in Calabar, Nigeria, though the routes of transmission of the three viruses are similar. This study aimed to determine the seroprevalence and risk factors for HBV and HCV among HIV-infected children and young adults attending Paediatric HIV Care and Treatment Centres in Calabar, Cross River State, Nigeria. Methodology: This was a cross sectional study involving 204 HIV-infected children and young adults aged 1–23 years attending four outpatient treatment centers. Blood samples were obtained and tested for hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV antibodies). Seroprevalence and factors associated with HBsAg were analyzed using Chi-square test or Fisher’s exact test. A p-value of < 0.05 was considered significant. Results: The mean age of the study participants was 13.20 ± 4.39 years. Overall, four study participants were positive for HBsAg, a seroprevalence of 2%, and none was positive for HCV-Ab. All positive study participants were females aged 11 years and above, and belonged to the low and middle socio-economic class, with no vaccination against HBV. Conclusions: The seroprevalence of hepatitis B infection in this study was low, none of those positive received vaccination against HBV. In view of the public health importance of HBV infection, vaccination against HBV should be extended to children and young adults above 14 weeks of age in Nigeria.

Purpose of review Human mpox disease (formerly monkeypox) was first diagnosed in an infant in the Democratic Republic of the Congo in 1970. Mpox was rarely reported outside West and Central Africa until the global outbreak in May 2022. On 23 July 2022, the WHO declared mpox a public health emergency of international concern. These developments warrant a global update on pediatric mpox. Recent findings Mpox epidemiology in endemic African countries has changed from predominantly affecting children under 10 years to adults 20–40 years old. This shift also applies to the global outbreak, where 18–44-year-old adult men who have sex with men are disproportionately affected. Furthermore, the proportion of children affected in the global outbreak is less than 2%, while children under 18 years constitute nearly 40% of cases in African countries. The highest mortality rates remain among both children and adults in African countries. Summary Mpox epidemiology has shifted to adults and is affecting relatively few children in the current global outbreak. However, infants, immunocompromised children and African children are still at high risk of severe disease. Mpox vaccines and therapeutic interventions should be accessible to at-risk and affected children globally, especially to those living in endemic African countries.

Introduction:the high expectations that heralded the development of COVID-19 vaccines has been plagued with vaccine hesitancy (VH). The prevalence and associated factors of COVID-19 VH in the six geopolitical zones in Nigeria are explored.Methods:using a cross sectional survey, a pre-tested and validated questionnaire on a "Google form" was distributed via social media platforms and hard copies in the six geopolitical zones of Nigeria. Included, using a chain-reference sampling technique, were healthcare workers (HCW), university students and adults in the general population. Participants who expressed unwillingness to receive COVID-19 vaccine in the event of an available vaccine were considered to have vaccine hesitancy. Frequency and percentage were used to describe categorical variables. Multivariable logistic regression analysis was used to assess for factors associated with VH. Level of significance was set at 5% on two-sided tails test.Results:among 1615 respondents, mean (standard deviation) age was 36.7 (11.3) years, and 847 (52.4%) were males. More than half were healthcare workers (943; 58.4%), 97.4% had at least secondary level of education, and majority 60.5% belonged to the upper social class. The prevalence of VH was 68.5% (1107/1615), and 67.2% preferred foreign manufactured COVID-19 vaccines. On multivariable regression analysis, residence in Northeast (AOR 6.01, 95% CI 2.24, 16.10) and Northwest (AOR 3.33, 95% CI 1, 48, 7.48) geopolitical zones, the Igbo ethnic group (AOR 1.88, 95% 1.10, 3.22), Christians (AOR 1.86, 95% 1.10, 3.14), nurses (AOR 3.50, 95% CI 1.25, 9.80), pharmacist (AOR 5.82, 95% CI 2.12, 16.32) and participants without confidence in foreign vaccines (AOR 4.13, 95% CI 2.99, 5.72) were at higher likelihood of VH.Conclusion:vaccine hesitancy is high among adults in Nigeria, with higher likelihood among the Igbo ethnic group, Christian faith, residence in Northeast and Northwest geopolitical zones and those with an aversion to foreign-made vaccines. Targeted interventions are required for the desired COVID-19 vaccine uptake rate and herd immunity.

Rationale: Disseminated histoplasmosis is the most severe form of histoplasmosis and often associated with fatal outcomes. Both pulmonary and disseminated forms mimics tuberculosis (TB) and may be misdiagnosed. Patient concerns: A 17-year-old male patient compliant with anti-tuberculosis therapy with complaints of fever, cough productive of thick yellowish sputum, fast breathing, abdominal pain, swelling and jaundice. HIV status was negative. Diagnosis: Disseminated histoplasmosis. Interventions: Antimicrobials including anti-TB therapy, ceftriaxone, gentamicin, azithromycin and ciprofloxacin. Outcomes: He was responding to anti-TB drugs until about 4 and a half months on treatment when he fell ill. Peripheral blood film done 2 days prior to his demise revealed florid yeast like organisms in monocytes with eccentric chromatin suggestive of Histoplasma capsulatum. Lessons: Histoplasmosis can both mimic and coexist with TB and so a high index of suspicion is needed for its diagnosis.

Introduction:The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures.Methods:A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management.Results:Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision.Conclusion:Seven key actions for improving RSV prevention and management in LMICs are proposed.

Introduction Pulmonary tuberculosis (PTB) is one of the rare pulmonary infections causing hyponatremia (serum sodium <135 mmol/L) and severe hyponatremia (serum sodium <125 mmol/L). Although the major cause of hyponatremia in TB patients is syndrome of inappropriate antidiuretic hormone (SIADH) secretion, cerebral salt wasting syndrome (CSWS) can occur and requires evidence of inappropriate urinary salt losses and reduced arterial blood volume. Adrenal insufficiency (AI) is rare inTB with scanty literature describing it. Thetwo reported cases highlight three possible causes of severe symptomatic hyponatremia in TB pleural effusion and disseminated TB, their treatment modalities, and the need to increase the index of suspicion to diagnose TB hyponatremia in children. Case Report Case 1: a 10-year-old girl with TB pleural effusion who developed recurrent hyponatremia in the first few weeks of anti-TB treatment which was responsive to sodium correction. Case 2: an 8-year-old girl presenting to our facility with presumptive TB. She deteriorated over several months and progressed to disseminated TB with AI. Discussion Early diagnosis and prompt and correct treatment of TB hyponatremia cannot be overemphasized, as AI, SIADH secretion, and CSWS, each require different therapeutic regimens, most especially AI on its own poses a huge clinical challenge. Conclusion A high index of suspicion, with intensified case finding at all levels of care, is necessary to identify and manage children with TB hyponatremia because early diagnosis and prompt treatment is lifesaving.

Background: Tuberculosis (TB) is still causing deaths in children in TB endemic countries. Majority (80%) occur in the lungs, with 5% being miliary TB. It is an Interstitial Lung Disease (ILD) with similar clinical, physiological and radiological features to other ILD and affects mainly infants and children with a high mortality rate despite available treatment. Case Presentation: A three-month old male presented during the COVID-19 pandemic with fever of 2 weeks, cough of one week, fast and difficult breathing of 6 days’ duration. He received BCG vaccine 16 days after birth despite being unknowingly exposed to the TB contact from birth. He was acutely ill looking, with severe pneumonia and SPO2 of 76% in room air. Respiratory examination showed broncho vesicular breath sounds with no added sounds. A diagnosis of Severe pneumonia? Pneumocystis Jiroveci Pneumonia (PJP) and R/O COVID-19 was made. Subsequent reviews excluded PJP and COVID-19 and the final diagnosis was Disseminated (Miliary) TB. He was successfully treated with anti-TB medications for 12 months. Conclusion: Miliary TB presents with common and uncommon manifestations that may be confusing, and so a high index of suspicion with a careful history, focused systemic examination, imaging and bacteriological studies are strongly recommended for its early diagnosis.

Tatumella ptyseos septicaemia in humans is yet to be reported in Nigeria with very few cases reported worldwide. This case report describes the clinical and distinctive biochemical characteristics of Tatumella ptyseos, its antibiotic sensitivity pattern and risk factors associated with Tatumella ptyseos septicaemia. Our case is a 2 months old ex-premature female from Calabar, admitted in the month of May, 2018 into the Children´s Emergency Room, of the University of Calabar Teaching Hospital, Nigeria. She presented with cough of one month and fever of three weeks, and was found to be acutely ill looking, febrile with temperature of 38.6°C, mildly pale, dyspnoeic and tachypnoeic with SPO2 of 80% in room air, tender hepatomegaly of 6cm and a splenomegaly of 6cm. Blood culture yielded Gram negative rods identified as Tatumella ptyseos by OXOID MICROBACT™ GNB identification kit.

Abstract Objectives Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15–24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10–19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. Content All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. Summary and Outlook Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.

To examine the prevalence of depression and suicidality among children with HIV infection and determine the clinical characteristics associated with depression, we interviewed 150 children and adolescent with HIV and without HIV infection respectively using Major Depressive and Suicidality Modules of Mini- International Neuropsychiatric Interview for children and adolescents at a Paediatric Outpatient Clinic of a Teaching Hospital. The prevalence of depression was higher among children and adolescents with HIV infection than those without HIV infection (p = 0.01). Older age group (14–16 years), children who experienced academic failure, the orphans, and those who had more than one hospitalization were more likely to experience depression. The higher prevalence of depression among children and adolescents with HIV infection compared to the control group indicates a need to incorporate psychiatric liaison services into management of children with HIV/AIDS.

Objective/Background: Global indices show that Nigeria has the highest tuberculosis (TB)-related mortality rate. Overdependence on Ziehl–Neelsen (ZN) smear microscopy for diagnosis and human immunodeficiency virus (HIV)/AIDS has limited control efforts. The new polymerase chain reaction-based XpertMTB/Rif (Cepheid Inc., CA, USA), which detects Mycobacterium tuberculosis and rifampicin resistance, was introduced in Cross River State in 2014. We evaluated the increment in pulmonary TB case detection following introduction of XpertMTB/Rif into the Cross River State TB control program. Materials and Methods: Data from three XpertMTB/Rif centers in Cross River were prospectively collected from June 2014 to December 2015. One spot specimen and one early morning sputum specimen were collected from each patient and tested using microscopy while one specimen was used for XpertMTB/Rif. Results: A total of 2326 patients comprising 47.4.0% (1103) males and 52.6% (1223) females were evaluated. Their mean age was 38.8 years (range 4–89 years); 42.6% (991) were HIV positive and 50.9% (1183) HIV negative, and for 6.5% (158) HIV status was unknown. XpertMTB/Rif detected M. tuberculosis in 22.9% (534) of patients, while 16.8% (391) were ZN smear positive. Smear microscopy missed 24.5% (131/534) of cases (P < 0.0001). When patients where categorized according to HIV status, XpertMTB/Rif detected 23.7% (280/1183) and ZN smear microscopy detected 18.5% (219/1183) of HIV-negative patients. XpertMTB/Rif detected 21.5% (213/991) and ZN smear 14.1% (140/991) of HIV-positive patients. TB case detection was significantly higher in HIV-negative patients than in HIV-positive patients when either XpertMTB/Rif and/or ZN was used (P = 0.018 and 0.012, respectively). Conclusion: The use of XpertMTB/Rif has significantly increased TB case detection and data in Cross River State. Scale-up of additional strategies such as culture is still required to improve TB detection in HIV patients.

Background: Tuberculosis (tb) causes significant morbidity and mortality worldwide.In Nigeria, the exact prevalence is not known but a progressive increase of the disease has been observed, with "epidemic states" reported in certain clusters.Even with the newer diagnostic tests for tb, diagnostic difficulties still occur.As a result, several diagnostic criteria have been adopted to aid the diagnosis of tuberculosis in these children.The main objective of this study was to identify Tb in children who were either living with adults who have Tb or in the environment of adults with Tb.Methodology: This was a prospective cross-sectional study conducted in Eku and Oria communities in Ethiope East Local Government Area of Delta State.Eku housed the Tuberculosis and Leprosy Referral Hospital where adults with tb were admitted in the first two months of their treatment.128 children under 19 years of age were studied over a 3-month period.After obtaining relevant information from every child, a full physical examination and certain laboratory investigations were done.Results: There were 68 males and 60 females.The prevalence of Tb was 68% in those children living among adults with tb within the hospital and 50.6% in those living in the environment or community (p = 0.05).The prevalence of Tb in Bacille Calmette Guerin (BCG) immunized children was 66.2% as against 46.7% in those not vaccinated.Twenty-six of the infected children (57.8%) had only pulmonary disease while 45.7% had affectation of 2 or more organs.The positive predictive values of elevated erythrocyte sedimented rate (ESR), elevated white blood cells (WBC) count and positive gastric aspirates (GA) in diagnosing tb were 60.3%, 70.5% and 0% respectively, while that of abnormal chest X-ray (CXR) and positive Mantoux reaction were 93.6% and 93.7% respectively.Conclusion: The alarming prevalence of tb in these children was not surprising considering their contacts with the tb patients and was representative of simi-* Corresponding author.A. U. Ewa et al. 81 lar high incidence areas as a whole.Active case finding efforts should be intensified for childhood contacts of adults with Tb for early identification of children with tuberculosis.

Tuberculosis has traditionally been found to occur with weight loss or at least failure to gain weight. Atypical and unusual presentations of various types of tuberculosis have been reported but limited data is available on tuberculosis in well-nourished children with no weight loss. Two case reports from our experience highlight well-nourished children with histologically diagnosed tuberculosis that presented with atypical symptoms and no evidences of weight loss. The usefulness of histological diagnosis cannot be overemphasized. This report aims to highlight this unusual presentation of tuberculosis so as to increase the index of suspicion for early diagnosis and hence, prompt treatment of tuberculosis in this group of children.

Bronchial asthma can start at any age and is suggested by a recurrent nature of cough with or without wheeze. It is sometimes associated with history of atopic disorders in the patient or family members. There is a lack of global epidemiological data in young infants owing to the challenges in their management, including the variability of their wheezing illnesses, which seems to be the main risk factor for the development of persistent asthma. The diagnosis of asthma in this age group is difficult and as a result, it is most often delayed or denied. Many misconceptions concerning asthma in young infants exist among clinicians, who before now believed the diagnosis should be postponed until the child is older. Some parents and caregivers on the other hand, believe asthma is a bad familial disease that should not be attributed to their children, causing further delays in control. This report aims to highlight not only the existence of bronchial asthma in this group of children but the challenges in their diagnosis and prompt treatment by sharing the experiences from our center. Reports of three cases whose initial presentations started in the neonatal period, 6 weeks and 2 months of age respectively. The diagnosis of asthma was initially missed because of their young ages but with a high index of suspicion, prompt diagnosis and correct treatment, all of them are doing well. The very young infants do have asthma with or without family histories. There is therefore need for early diagnosis and prompt treatment of asthma to reduce pulmonary damage. The challenges of diagnosing and treating asthma in this age group are great and warrant a comprehensive approach, involving all stakeholders.

Background : Asymptomatic Human Immunodeficiency Virus (HIV) infected children are prone to serious bacterial infection as a result of poor immunity. Objective : This was to determine the common pathogenic organisms responsible for bacteremia among asymptomatic HIV infected children attending the outpatient clinics at the University of Calabar Teaching Hospital, Nigeria. Subjects and Methods : This prospective non randomized cross-sectional study was conducted over 6months from January 1st to 30th June 2014 among cohorts of HIV infected Anti-retroviral (ARV) naive and experienced children attending the clinic. Ethical approval was obtained from the ethical committee of the institution. Blood culture specimens were collected from all HIV infected patients who met the criteria for enrollment. All specimens with isolated bacteria organisms were treated with antibiotics according to the sensitivity pattern, in addition to administered Anti-retroviral drugs. Results : Out of the total of 109 patients recruited, 38(34.9%) had bacteremia. There were more males (57.9%), and most of them (63.2%) had Highly Active Anti-Retroviral Therapy (HAART) for more than 24weeks. Bacteremia was inversely proportional to the CD4 count. The commonest organism isolated was unclassified Coliforms (47.3%) followed by Staphyloccocus aureus (39.5%). Conclusions : HIV infected children are prone to bacteremia especially among those with low CD4 count. Coliform was the commonest organism isolated . We recommend that HIV infected children be routinely investigated for bacteremia.

Pneumocystis pneumonia (PJP), initially thought to be rare in this part of the world, has over the years, been diagnosed and treated in our center. PJP should be considered in a young child 3 to 6 months of age with very severe pneumonia, known or suspected to be HIV infected. It should be suspected when severity of illness is out of proportion with the chest findings and chest x-ray is normal or shows minimal or bilateral interstitial infiltrates. Treatment is oral or intravenous high dose cotrimoxazole given 6-8 hourly for 3 weeks and the addition of prednisolone. The objective of this report is to describe the presentation, challenges of diagnosing and management of PJP in children in a developing country. Report of 3 cases aged 3, 4 and 41/2 months, exposed to the HIV. All developed severe pneumonia characteristic of PJP and all responded to treatment with high dose cotrimoxazole and Prednisolone. A high index of suspicion is needed to diagnose PJP in a resource poor setting like ours. It is common in HIV positive children but can also occur in HIV negative individuals as shown by these case reports. A presumptive diagnosis can be made in a young child, usually below 6 months of age, very ill with severe pneumonia and minimal chest findings who responds to cotrimoxazole. Addition of prednisolone has been found to improve the outcome. Antibiotics should continue to cover for co-existing bacterial pneumonia.