Background: Neonatal mortality is a major reason for the persistence of high infant and childhood mortality in the developing world. Frequent determinations of the factors associated with neonatal mortality are desirable for effective planning of interventions aimed at reducing neonatal mortality rates. Objective: To determine the trend in neonatal mortality in a teaching hospital over a ten-year period. Methods: The records of neonates admitted into the neonatal unit of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu between January 1996 and December 2005 were reviewed. Data extracted from the records included age, sex, weight, place of birth, major clinical diagnoses and outcome of admission. " Results: Out of a total of 2,933 neonates admitted into the unit, 773 deaths occurred (263.6/ 1000 admissions). These consisted of 168 (21.7 percent) in-born and 605 (78.3 percent) out born babies. Of these 773 deaths, 559 (72.3 percent) were early neonatal deaths (END) and 74.8 percent of these occurred within the first 24 hours of admission. Low birth weight babies constituted 67.4 percent of these deaths. The mortality rate among in-born babies was significantly lower than that of out-born babies (14.8 percent vs 33.5 percent; p = 0.00000). The neonatal mortality rate (NMR) for the hospital ranged between 25.6/1000 live births and 72.4/1000 live births. The mortality rate for out-born babies was 336.5/1000 admissions. The leading clinical conditions associated with neonatal deaths were preterm births (38.7 percent), perinatal asphyxia (25.1 percent), septicaemia (10.5 percent), neonatal hyperbilirubinaemia (9.9 percent) and tetanus (7.9 percent). Conclusion: Neonatal mortality in the hospital was high over the ten-year period studied. Facilitated access to quality obstetric and immediate post-delivery neonatal care is required to improve neonatal survival in Nigeria.

Background Sickle cell disease (SCD) is a haemoglobinopathy which results from a point mutation in the β-globin gene of haemoglobin. It is a disease of global health concern, with significantly higher morbidities and mortalities in low-income countries. Although an increasing proportion of affected children now survive into adulthood in these countries, there remains a significant risk of long-term complications such as endocrine disorders. Previous studies have reported delayed pubertal development in SCD, there is, however, paucity of recent studies on pubertal development, and the factors that influence the attainment of puberty, in SCD patients in Nigeria. Methods The present study was a cross-sectional study involving 139 eligible subjects with sickle cell anaemia (SCA), aged 6 to 18 years, and 133 individuals with haemoglobin AA (HbAA). Pubertal staging of subjects and controls was done using the Tanner criteria, while blood samples were obtained from individuals who had attained puberty for testosterone, estradiol, follicle stimulating hormone (FSH) and luteinizing hormone (LH). Hormonal assays were performed using Rayto RT 6100R ELISA microplate reader for FSH and LH, and RapidR Labs ELISA kits for oestradiol and testosterone. Results Female SCA subjects attained thelarche at a mean age of 12.3±1.71years compared to 9.8±1.86 years in controls; adrenarche at 13.2±1.81years against 10.9±1.67years in controls, and menarche at a mean age of 14.1 ± 1.7years compared to 12.3±1.3years in controls. Males with normal haemoglobin also attained puberty earlier than SCA. Mean LH and FSH were higher in SCA subjects (8.29±33.75mIu/ml and 6.81±10.61mIU/ml respectively) compared to mean values of 3.17±5.0mIU/ml and 3.85±3.88mIU/ml respectively in controls. Estradiol and Testosterone levels were however higher in the control group. Conclusion and recommendation The present study confirms delayed onset of puberty in patients with SCA compared with HbAA controls. Screening for endocrine complications should therefore be incorporated into the comprehensive care model for SCA for early detection of impairments and prompt institution of appropriate interventions.

Celiac disease (CD) affects the small intestine and can hinder nutrient absorption. It is found worldwide and common in certain groups of people including individuals with Type 1 Diabetes Mellitus (T1DM). However, the prevalence of CD in the West African region is not documented. This study aimed to investigate the prevalence and pattern of CD autoimmunity in Nigerian children and adolescents diagnosed with T1DM. This was a cross-sectional descriptive study of children and adolescents with T1DM at the Paediatric Endocrinology Clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and anthropometrics. The subjects were screened for markers of CD autoimmunity using anti-tissue transglutaminase antibody (tTG) and anti-endomysial antibody (EMA). Endoscopy and duodenal biopsy were recommended for participants with elevated CD-specific antibodies. The study recruited a total of 104 children and adolescents with TIDM, out of which six participants (5.8

Background: Sepsis contributes significantly to newborn deaths in Nigeria. A significant proportion of severe infections in the newborn may be health care-related.Objective: To determine the prevalence, types and risk factors for nosocomial infections in the Special Care Baby Unit of a Nigerian Tertiary Hospital.Method: A cross-sectional survey of consecutively admitted infants aged 0 to 28 days with signs of infections or who developed signs of infection following admission. Infants with or without nosocomial infections were compared for the clinical and laboratory details.Results: Out of 356 infants, 32 (8.9%) had between 1 and 3 nosocomial infections while 48 (13.5%) had community-acquired infections. Half of babies with nosocomial infections were preterm and weighed less than 2kg. A significantly higher proportion of babies with nosocomial infections were inborn (p < 0.000) and stayed longer than 7 days on admission (p = 0.034). Bacteraemia was significantly more frequent among babies with nosocomial infections (p = 0.014) while superficial skin and mucosal infections occurred to similar extents in both groups. Klebsiella and Proteus species were the leading isolates among babies with nosocomial infections. Nasogastric intubation was significantly more frequently performed among babies with nosocomial infections (p = 0.045).Conclusion: The present study revealed that hospital acquired infection is an important cause of morbidity in the newborn unit.Keywords: Bacteraemia; Hospital-acquired infections; invasive procedures;newborns

Summary Background: Regional differences which exist in the prevalence and clinical features of paediatric AIDS worldwide make it pertinent to document findings in our environment. Objectives: To document the prevalence and clinical features of AIDS in children hospitalized in a teaching hospital situated in South-western Nigeria. Design: Retrospective study. Methods: A review of hospital records of all children with AIDS admitted to Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1996 and December 2005 was made with a view to determining the prevalence and clinical features of the disease in the area served by the hospital. Results: Thirty three children were diagnosed with ADDS out of a total of 3061 hospitalized children; a prevalence rate of 1.08 percent. The prevalence increased, though not significantly, in the second half of the study period (x2= 3.67, p = 0.055). The male: female ratio was 1:1.4 and the age range was two months to 120 months with a mean of 17.4+ 23.2 months. Fourteen (42.4 percent) were infants, 15 (45.5 percent) pre-school children and four (12.1 percent) were school-aged children. A majority (93.9 percent) of the patients were infected with the HIV-1 strain, while the route of transmission was predominantly vertical. The main clinical features at presentation were chronic diarrhoea (69.7 percent), prolonged fever (63.6 percent), chronic cough (48.5 percent) and skin rashes (39.4 percent). Fifteen (45.5 percent patients had protein energy malnutrition which was mostly marasmic in type (73.3 percent). Most (57.6 percent) of the patients belonged to the low socio-economic class, but only four patients (12.1 percent) had associated pulmonary tuberculosis. The mean duration of hospital staywas 8.8 + 6.8 days. None of the patients received antiretroviral drug therapy. Mortality was 33.3 percent with septicaemia as the major cause. Conclusion: We observed a low prevalence of paediatric AIDS but the clinical features conformed to the WHO guidelines for its case definition. Lack of access to antiretroviral therapy contributed to the high rate of mortality..

Background: Frequent changes in the political, economic and health policies which may influence the purchasing powers of the populace may also make it difficult for the average family to pay hospital fees and culminate in a tendency to premature termination of medical care. Objectives: To describe cases of paediatric discharges against medical advice seen at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu. Patients and Methods: A retrospective study of the records of children who were discharged against medical advice from January 1995 to December 2004 at the OOUTH, Sagamu, was carried out. Data extracted from the case notes included age, sex, clinical diagnosis, parental occupation, duration of hospital stay, reason(s) for, and signatories to DAMA Results: The yearly prevalence of DAMA fluctuated with no consistent pattern, ranging from 2.1 to 5.0 percent with a mean of 3.3 percent, of paediatric admissions. The median age was 365 days and the male to female ratio was 1.4:1. The median duration of hospitalization prior to DAMA was four days. Majority (92.1 percent) of the children belonged to the low socioeconomic classes. The signatories to DAMAwere mostly mothers (80.2 percent). Financial constraints in 61.9 percent were the commonest reasons for DAMA. Neonatal conditions, malaria and respiratory disorders were the main clinical diagnoses accounting for 28.5, 20.1 and 9.0 percent, respectively. Conclusion: Conscious effort must be made by government to create an enabling environment for financial empowerment of families. Hospitals should have avenues of defending the rights of children to life and health.

Summary: Prune belly is a rare congenital anomaly. that is commonly seen in males. We report two male cases and a phenotypic female with absent abdominal wall musculature that were seen within one year at the Olabisi Onabanjo University Teaching Hospital, Sagamu. These cases are reported to create a better awareness of this disorder in this environment. This, to our knowledge, is the first report of prune belly syndrome in our centre. Maternal age, the precise aetiology is uncertain. However, sex influenced autosomal mode of inheritance has been suggested. 8, 9 While there have been reports of this syndrome from Ibadan, the exact incidence in Nigeria is unknown. It is probably rare but it is also likely that some cases are missed in clinical practice due to poor awareness and constraints in investigation, In view of this, we are reporting three cases of prune belly syndrome seen in Sagamu, within a period of one year.

Background: Tuberculosis (TB) is a major cause of childhood morbidity and mortality in most parts of the developing world. Objective: To determine the epidemiological and clinical features of childhood tuberculosis in Sagamu. Methods: Children aged 15 years and below, who were managed for tuberculosis in a Nigerian tertiary hospital between 2004 and 2009 were retrospectively studied for their clinical and laboratory features. Results: Of 52 children with TB, 61.5 percent were males, 73 percent were aged <10 years and 94.2 percent belonged to socioeconomic classes IV and V. Most (65.3 percent) cases presented after three months of illness. Fever (73.1 percent), weight loss (69.2 percent) and cough (57.7 percent) were the leading features. Thirty (57.7 percent) had pulmonary disease while disseminated TB and spinal TB were the leading types of extra-pulmonary TB. History of BCG vaccination was elicited in 42.3 percent of cases. The mother was the contact in 71.4 percent of those who had a positive history of contact. HIV sero-positivity was present in 31 percent of the children who were screened for HIV. Only two (3.8 percent) of the children died and these two had TB/HIV co-infection. Conclusion: Most of the children with tuberculosis were of school age and belonged to the lower socio-economic classes. Pulmonary TB was commoner than extra-pulmonary disease. Improved standard of living and routine HIV screening may be useful control measures.

BACKGROUND: Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia. However, few studies on hypothyroidism status of children with sickle cell anaemia in Nigeria are available. The objective of this study was to determine the prevalence of hypothyroidism among children with sickle cell anaemia.METHODS: A cross sectional study that assayed the thyroid hormones and thyroid stimulating hormone (TSH) of 71 children with sickle cell anaemia was conducted at Olabisi Onabanjo University Teaching Hospital Sagamu. Using age appropriate hormonal reference values, the subjects were classified into sub -clinical, primary and secondary hypothyroidism.RESULTS: The mean serum TSH, Free T3, and Free T4 were comparable irrespective of age category (p > 0.05). No subject was identified to have low TSH value while 7.0% had high TSH value. Low free T3 was identified in 1.4% and 8.5% had high free T3 values. Low free T3 and free T4 were seen in 11.3% each of the subjects. The overall prevalence of primary, secondary and sub -clinical hypothyroidism was 0%, 0% and 4.2%, respectively.CONCLUSION: Sub-clinical hypothyroidism does occur in Nigerian children with sickle cell anaemia. Routine screening for hypothyroidism is advocated in all children with sickle cell anaemia.

Abstract Objectives The prevalence of type 1 diabetes mellitus (T1DM) is increasing in most developed and developing countries. This study described the clinical characteristics and compliance with care among Nigerian children and adolescents with T1DM. Methods This was a cross-sectional descriptive multi-center study of children seen at the paediatric endocrinology clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and compliance of the children with dietary recommendations and insulin therapy. Compliance with dietary recommendations and insulin therapy was graded as either good or poor based on defined criteria. Results The mean age of children was 13.1 ± 4.7 years. The mean age of children at the diagnosis of T1DM was 9.9 ± 4.2 years. Sixty-nine (60%) children were female while about half (47.8%) of the children were from the lower socioeconomic class. Compliance with insulin administration was good in 39.1% of the children and was significantly associated with the father’s (p=0.001) and mother’s educational status (p=0.024) while compliance with dietary recommendations was good in 20.0% of the children and was significantly associated with mother’s educational status (p=0.034) and family socioeconomic class (p=0.010). Only the mother’s level of education was independently and significantly associated with compliance to recommendations on insulin therapy (OR 4.2, 95% CI=1.5–11.6, p=0.007). Conclusions The compliance of children with dietary recommendations and insulin therapy was poor. Efforts should be strengthened at all healthcare facilities to educate parents on the need for compliance with management guidelines.

Background: When standard instruments are unavailable for clitoral length measurement, improvisation with locally available tools could be of diagnostic value. Objective: The objective of this study was to determine how the clitoral length measured with a wooden spatula compared to that measured with a caliper. Methods: This was a comparative cross-sectional study. Three hundred and five term female infants were recruited from multiple health facilities in Sagamu, Ogun State, Nigeria. The clitoral length was measured with a sliding digital caliper and a wooden spatula (tongue depressor). All the measurements were taken within the first 72 hours of life and comparative analysis was carried out. Results: The mean (± SD) clitoral length using the sliding digital caliper and the spatula were 6.7 ± 1.6 mm and 6.5 ± 1.8 mm respectively. There was no statistically significant difference between the mean values of both measurements (t = 1.369, p = 0.171). Pearson’s correlation showed that both variables were significantly correlated (r = 0.693, p < 0.001) and the spatula length was a moderate predictor of the caliper length (Coefficient of determination [R2] = 0.48 and p < 0.001). Conclusion: The findings of this study suggest that the determination of clitoral length using a spatula, commonly found in all community settings, is similar to determination of clitoral length using a digital caliper, most often used for clinical research.

Objective: Little is known about the flaccid penile length in the newborn and the degree of stretch of the penis among investigators while measuring the stretched penile length. This study aimed to document the flaccid penile length and the stretch factor in the newborn.Methods: This cross-sectional study was carried out on 200 term male infants within the first 72 hours of life. The flaccid penile length and the stretched penile length were measured with a wooden spatula and the stretch factor was calculated.Results: The mean (±SD) flaccid and stretched penile length were 30.9 ± 3.8 mm and 38.9 ± 4.0 mm respectively. The mean stretch factor was 26.4 %. Both testes had the same mean volume of 1.6 ± 0.5 ml. There was a significant correlation between flaccid and stretched penile lengths (r = 0.775, p = 0.000). The flaccid penile length was a significant predictor of the stretched penile length.Conclusion: This study has been able to determine the stretch factor while measuring the flaccid and stretch penile lengths in Nigerian newborn infants. It is recommended that the flaccid penile length be measured along with the stretched penile length and determine the stretch factor in order to compare how much investigators stretch the penis during measurement. This will allow for detailed comparison of penile anthropometry across different ethnic groups and races. Keywords: flaccid penile length, newborn, stretch factor, stretched penile length.

Background: The management of children with type 1 diabetes mellitus (T1DM) remains a major challenge in developing countries. Case presentation: We report an adolescent male who was diagnosed with T1DM at the age of 11 years when he presented at a private hospital with diabetic ketoacidosis. He received emergency treatment there and was subsequently referred to our tertiary hospital for expert care. All through the management, there was poor clinic attendance, poor glucose monitoring, poor compliance with insulin therapy, and ultimately, poorly controlled diabetes. Later, he developed diabetic autonomic neuropathy which manifested as unawareness of bladder fullness with secondary enuresis and fecal incontinence. He was also severely malnourished. At his last admission, seven years after the initial diagnosis, he presented with burnt hands and feet, which were injuries sustained from putting his extremities in naked flames when he lapsed into a coma during a religious activity. He received multidisciplinary management but died a few weeks later. Discussion and conclusion: This case is being reported to draw attention to the plight of children with T1DM from the low socioeconomic class in developing countries. In such children, poverty and ignorance may have profound negative effects on the management and outcome of T1DM.

To document normative data on penile size and anogenital distances of apparently normal term male infants in Sagamu, Nigeria.

Previous studies suggest significant ethnic and racial differences in clitoral sizes and anogenital distances in the newborn. This study aimed to document normative data on clitoral sizes and anogenital distances of apparently normal term female infants in Sagamu.

Phenotypic expression of the male internal and external genitalia is due largely to the interplay between the proper differentiation of the bipotential gonad, the production of testosterone from the Leydig cells and the response of the undifferentiated external genitalia to Dihydrotestosterone. When any of the pathways involved in the mechanisms described above are distorted, it results in the 46XY Disorder of Sex Differentiation (DSD). The incidence of 46 XY DSD ranges from 20 to 41% among the cases of Disorder of Sex Differentiation (DSD) in Nigeria, though there is a paucity of data on this condition. This report describes an under-virilized genetically male child who presented with ambiguous genitalia in the neonatal period and was subsequently diagnosed as SRY positive 46 XY DSD with reduced testosterone synthesis. This report is necessitated by the need to create awareness and highlight the relevant medico-social challenges in the management of DSD in a resource-poor setting.

There is a significant dearth of information on available social infrastructures for helping victims of child abuse among all cadres of primary health-care workers. The aim of this study was to assess the level of awareness of social and legal structures among primary health-care workers, which can help in reducing incidences and taking action. The survey was a cross-sectional survey of 20 primary health-care centers and 86 health workers in Ogun State, Southwest Nigeria. The result showed a low level of awareness among health workers. A large percentage of health workers were unaware of any social infrastructure or hospital protocol for child abuse reporting: 68.4% of medical officers, 54.5% of nurses, and 66.7% of other health workers. There is a need for deliberate training among health workers on social infrastructure, which can help victims of child abuse.

Renal diseases in children constitute an important cause of morbidity and mortality in children; relevant data is scanty, leading to the lack of adequate planning and policy. This study was conducted to describe the pattern of renal diseases in a population of hospitalised children. These baseline data may help in health policy formulation. It is a descriptive cross -sectional study of all admission into the children’s wards comprising the newborn unit, emergency room and children ward of the hospital, over a five-year period. The total number of admission over the p e r i o d w a s 3 9 3 8 , r e n a l d i s e a s e s c o n s t i t u t e d 2 . 8 % o f a l l a d m i s s i o n s (110/3938). Males were 78 (70.9%) and females were 32 (29.1%) with a sex ratio of 2.4:1. Age range was between 0 and 15 years with a mean of 2.23 + 1.1years. Acute kidney injury was seen in 29.1%, urinary tract infection and nephrotic syndrome was present in 21.8% each. Congenital anomaly of the kidney and urinary tract (CAKUT) was present in 11.9%; out of this, obstructive uropathy accounted for 6.4%. Nephroblastoma was present in 3.6% and male was found to be predominante in these diseases. Acute renal failure is the leading cause of kidney disease among hospitalised children. It occurs due to preventable causes, therefore efforts at early identification and intervention is canvassed for so as to prevent morbidity arising from this condition.

Globally, underweight in children is projected to decline except in Sub-Sahara Africa. This study assessed the prevalence of malnutrition and its correlation with high blood pressure among adolescents in a semi-urban Nigerian setting. A descriptive cross sectional study was conducted among adolescent school children in Sagamu, Nigeria. Weight, height and blood pressure measurements were recorded. Using the cut-off points of -2SD, height for age and weight for height were used to diagnose stunting and wasting. The nutritional status of the subjects was related to their blood pressure pattern. A total of 572 adolescents were surveyed. Wasting and stunting were diagnosed among 26.7% and 24.8% of the subjects respectively. Pre –hypertension was present in 4.2% and 3.9% of the stunted and wasted respectively (p<0.05.) while Stage -1 hypertension was observed among adolescents with normal weight. Weight was strongly correlated with blood pressure.(÷2 =0.0249, p=<0.001and ÷2= 0.117 , p= 0.001) in conclusion, wasting and stunting were common in the population studied and were associated with blood pressure abnormalities. Key Words : Adolescents, Blood pressure, Hypertension, Stunting , Wasting.

This study aimed to describe the pattern and immediate outcome of severe childhood anaemia requiring blood transfusion at a secondary level of care in Nigeria. A cross-sectional survey of children hospitalized in a secondary health facility in Ogun State, Nigeria, with packed cell volume < 20% and who received blood transfusion was done. Of the 253 children admitted between March 2013 and June 2014, 79 (31.2%) had severe anaemia and were transfused with blood. Two-thirds had multiple transfusions. Higher rates of blood transfusion were obtained among underweight children. Fever (98.7%), hypoglycaemia (65.8%) and tender liver (54.4%) were the leading co-morbidities. The case fatality rate was 21.5%. Respiratory distress, convulsions and altered sensorium were significantly associated with mortality. In conclusion, severe anaemia was associated with major morbidities and mortality at the secondary level of paediatric care in Nigeria.