Air pollution exposure is a major public health threat contributing to high rates of morbidity and mortality, particularly in low-income and middle-income countries (LMICs). 1 Fuller R Landrigan PJ Balakrishnan K et al. Pollution and health: a progress update. Lancet Planet Health. 2022; 6: e535-e547 Summary Full Text Full Text PDF PubMed Scopus (370) Google Scholar Exposure to air pollutants worsens outcomes of non-communicable diseases, including asthma and other chronic respiratory diseases. 2 Mazenq J Dubus JC Gaudart J et al. Air pollution and children's asthma-related emergency hospital visits in southeastern France. Eur J Pediatr. 2017; 176: 705-711 Crossref PubMed Scopus (28) Google Scholar , 3 Teyton A Baer RJ Benmarhnia T Bandoli G Exposure to air pollution and emergency department visits during the first year of life among preterm and full-term infants. JAMA Netw Open. 2023; 6e230262 Crossref PubMed Scopus (2) Google Scholar Understanding the level of exposure to air pollution and factors associated with increased levels of exposure are the initial steps that are fundamental to the development of interventions. Characterising sources of PM2·5 exposure for school children with asthma: a personal exposure study across six cities in sub-Saharan AfricaOur study suggests that the most effective changes to reduce PM2·5 exposures in these cities would be to provide paving in school grounds, increase the use of clean fuel for cooking and light in homes, and discourage smoking within homes. The most efficient way to improve air quality in these cities would require tailored interventions to prioritise different exposure-reduction policies in different cities. Full-Text PDF Open Access

Objective: Zinc is an essential trace element that plays a critical role in various physiological processes, including immune function and antioxidant defense. Serum zinc levels are often used as a marker to assess nutritional status and potential deficiencies. This study aims to compare serum zinc levels between stable asthmatic children and non-asthmatic controls at ESUT Teaching Hospital, Parklane Enugu, to understand whether asthmatic children have different zinc status compared to their non-asthmatic counterparts. Materials and Methods: A comparative cross-sectional study was conducted involving 85 asthmatic and 85 non-asthmatic children aged 5–11 years. Serum zinc levels were assessed using a Flame Atomic Absorption Spectrophotometer (FAAS). Data were analyzed using SPSS version 20. Results: The median serum zinc levels were 11.95 µmol/L in asthmatic children and 8.81 µmol/L in non-asthmatic children (p < 0.001). Nutritional status and socio-economic class did not significantly affect serum zinc levels. Conclusion: Stable asthmatic children have higher median serum zinc levels compared to non-asthmatic children. There was no significant relationship between serum zinc levels and socio-economic or nutritional status in the asthmatic group. Blind zinc supplementation in asthmatic children should be approached with caution.

Background: Acute exacerbation is a major cause of morbidity in asthmatic children. It can occur even in well controlled asthma. Aim: To determine the prevalence and pattern of acute exacerbation of asthma in children seen at the emergency room of the University of Nigeria Teaching Hospital (UNTH), Enugu.Materials and methods: This was a descriptive, cross sectional study in which consecutive children with acute exacerbation of asthma presenting to the Children Emergency Room (CHER) of UNTH, Enugu were recruited. Information from the history and examination were documented with a structured questionnaire completed by the attending doctor. Severity of their exacerbation was determined using the Global Initiative for Asthma (GINA) guidelines. The children were treated using the written management protocol used in CHER, UNTH, Enugu which was adapted from GINA guidelines. Results: There were a total of 114 presentations (episodes) of acute exacerbation asthma by 104 children within the study period with eight children having multiple episodes. This represented 6.5% of the overall number of emergency cases seen during the period. Nearly an equal number (ratio; 1: 1.04) of males and females were enrolled with the mean age of 7.9 ± 4.7 years. More children with asthma exacerbations were admitted during the rainy season months of May and June, while the dry season months of December and January recorded lower number of episodes. Most (86.0%) cases were mild to moderate exacerbations and 16 (15.3%) were severe.Three of the 22 (13.6%) children on controller medications were among the 16 that had severe exacerbation. No death was recorded during the period. Conclusion: The prevalence of asthma exacerbation is relatively high in our tropical environment and the pattern is similar to those of the developed countries in terms of age and sex distribution, however, the peak period of presentation differ in our environment.

Background: Bronchogenic cysts are lesions of congenital origin derived from the primitive foregut and are the most prevailing primary cysts of the mediastinum. Most commonly unilocular, they contain clear fluid or mucinous secretions or, less commonly, haemorrhagic secretions or air. They are lined by columnar ciliated epithelium, and their walls often contain cartilage and bronchial mucous glands. It is unusual for them to have a patent connection with the airway, but when present, such a communication may promote infection of the cyst by allowing bacterial entry. The first successful surgical excision of a bronchogenic cyst was reported by Maier in mid twentieth century leading to its classification based on Mailer postulation. No such reports have been described in South/South Nigeria.

Chronic sinusitis is an inflammatory lesion that involves the paranasal sinuses with symptoms and signs that are beyond 12 weeks in duration. It commonly presents with nasal stuffiness, mouth breathing, purulent nasal discharge, post natal drip, snoring, cough, headache, facial fullness, hyposmia, sore throat and halitosis. Features of ocular and cerebral complications may be present at diagnosis but are uncommon and can thus result in misdiagnosis. A 15 year old male presented with sudden onset ptosis and other symptoms that initially suggested an intracranial SOL or a Cavernous sinus thrombosis. A CT scan of the head and neck structures identified chronic sinusitis as the only likely pathology. We present this case to highlight an unusual ocular complication of chronic sinusitis.

The practice of paediatric emergency medicine in Nigeria is still evolving, and laden with enormous challenges which contribute to adverse outcomes of childhood illnesses in emergency settings. Deaths from childhood illnesses presenting as emergencies contribute to overall child mortality rates in Nigeria. This narrative review discusses existing structures, organization, and practice of paediatric emergency in Nigeria. It highlights some of the challenges and suggests ways of surmounting them in order to reduce deaths in the children emergency units in Nigerian hospitals. Important aspects of this review include current capacity and need for capacity development, equipment needs for emergency care, quality of service in the context of inadequate healthcare funding and the need for improvement.

Childhood mucoepidermoid carcinomas (MEC) of the bronchus are rare. They present with non-specific symptoms and signs making diagnosis delayed. We present two children with bronchial MEC managed in a tertiary children's hospital in Cape Town, South Africa. The first was a 11-year male with recurrent haemoptysis and the second child was a 6-year female with recurrent unifocal pneumonia. Chest CT scan and bronchoscopy with biopsy confirmed the diagnosis. Both patients underwent treatment, including surgery and are doing well. It is important to exclude endobronchial lesions when children present with recurrent respiratory symptoms, since early diagnosis will enable lung-sparing treatment.

BackgroundAlthough several randomized controlled trials (RCTs) published over the past 5 years show that prenatal or postnatal probiotics may prevent or optimize the treatment of childhood asthma and atopic disorders, findings from the systematic reviews and meta-analyses of these studies appear inconsistent. More recent RCTs have focused on postnatal probiotics, and linked specific probiotic strains to better disease outcomes.ObjectiveThis systematic review aimed to determine if postnatal probiotics are as effective as prenatal probiotics in preventing or treating childhood asthma and atopic disorders.MethodsWe searched the PubMed, Medline, Google Scholar, and EMBASE databases for RCTs published within the past 5 years (from 2017 to 2022). We included only full-text RCTs on human subjects published in or translated into the English language. We retrieved relevant data items with a preconceived data-extraction form and assessed the methodological quality of the selected RCTs using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. We qualitatively synthesized the retrieved data to determine any significant differences in study endpoints of the probiotic and placebo groups.ResultsA total of 1,320 participants (688 and 632 in the probiotic and placebo groups) from six RCTs were investigated. One RCT showed that early Lactobacillus rhamnosus GG (LGG) led to a reduction in the cumulative incidence rate of asthma. Another study demonstrated that mixed strains of Lactobacillus paracasei and Lactobacillus fermentum could support clinical improvement in children with asthma while one trial reported a significant reduction in the frequency of asthma exacerbations using a mixture of Ligilactobacillus salivarius and Bifidobacterium breve. Three trials showed that a combination of LGG and Bifidobacterium animalis subsp lactis, Lactobacillus rhamnosus alone, and a probiotic mixture of Lactobacillus ŁOCK strains improved clinical outcomes in children with atopic dermatitis and cow-milk protein allergy.ConclusionsPostnatal strain-specific probiotics (in single or mixed forms) are beneficial in preventing and treating atopic dermatitis and other allergies. Similarly, specific strains are more effective in preventing asthma or improving asthma outcomes. We recommend more interventional studies to establish the most useful probiotic strain in these allergic diseases.

Background:Globally, a dramatic increase in the use of television and digital media has been observed among children and adolescents in recent times. The possible health-related effects of frequent and prolonged screen media viewing on these children and adolescents have triggered many concerns among researchers. Aim:The study is aimed to determine the screen media viewing practices and caregivers' level of knowledge about the health-related effects of prolonged screen viewing time on their children. This was a descriptive cross-sectional study among caregiver/child and adolescent dyads on outpatient clinic visits. Subjects and Methods:Respondents (caregivers/children's pairs) were consecutively recruited, and data was obtained using an unambiguous pre-tested semi-structured questionnaire comprising four domains: socio demographic characteristics; screen media viewing characteristics, perception of the health related effects of prolonged viewing time, and measures to limit prolonged screen viewing time in children. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 22.0 at a level of statistical significance P < 0.05. Results:Of the 205 respondents studied, the majority (67.8%, fathers and 76.1%, mothers) had tertiary education. The daily mean time spent by children watching television/screen media was 2 (± 1.58) hours. Up to 89.3% of the caregivers established good standards for healthy screen-viewing in their homes. However, 52.7% of them had poor knowledge of the health-related problems of increased viewing time. Socio-economic class (P = 0.002) and knowledge level of the parents (P = 0.000) were significant predictors limiting children's screen-viewing time. Conclusion:Increasing screen media viewing is common among the children studied. The majority of the caregivers had poor knowledge of health-related effects of prolonged viewing time despite high educational attainment. There is a need to enlighten caregivers on the possible health effects of excess screen media viewing so as to enable them to institute stringent measures to limit the attendant health consequences on the children.

Nodular vasculitis is a rare inflammatory disease of the skin and subcutaneous fat tissue, characterized by crops of small, tender, erythematous nodules on the legs, mostly on the calves and shins. We present a 17-year-old adolescent female who presented with a six-month history of cough; recurrent fever and bilateral lower limb multiple ulcerated nodules of 1-month duration. Clinical examination revealed generalized lymphadenopathy with bilateral pitting leg edema which had multiple nodules and discoid ulcers extending from the groin to the ankles and discharging purulent fluid. Tests for human immunodeficiency virus and tuberculosis were negative. Histology of nodule biopsy revealed extensive caseous and coagulative fat necrosis, granulomatous inflammation with epitheloid macrophages and multinucleated giant cells surrounding the necrosis, and lymphoid infiltration of vessel walls with fibrous thickening of the intima, typical of Whitfield-type erythema induratum. There was initial but very transient response to antibiotic treatment, with further deterioration and eventual death from overwhelming sepsis.

BACKGROUND:Asthma symptoms are often mediated by changes in immune responses to allergens measured by the levels of immunoglobulin E (IgE) and non-protein regulators such as 25-hydroxycholecalciferol (25 (OH) vitamin D3). The relationship between serum levels of IgE, 25 (OH) Vitamin D3, and asthma control in asthma patients remains unclear.OBJECTIVE:To measure the serum IgE and 25 (OH) vitamin D3 levels in asthma patients and determine their relationship with patient's asthma control.METHODS:This was a cross-sectional study of children and adults with asthma aged 5 to 60 years old; and their controls seen in a tertiary hospital in Enugu, south eastern Nigeria from October 2018 to January 2019. Serum levels of IgE, and 25 (OH) vitamin D3 were determined by sandwich enzyme-linked immunosorbent assay (ELISA); and compared between groups using the Student's t-tests. Association between IgE, 25 (OH) vitamin D3 levels, and asthma control were determined using the Chi-square.RESULTS:Sixty-five (65) asthma patients and thirty-three (36) non-asthma controls were studied. Mean serum level of IgE (411.32± 220.18 IU/ml) was significantly raised in asthma patients compared to controls (163.51 ± 186.36 lU/ml); p=0.001. There was no significant difference in mean 25 (OH) vitamin D3 levels in asthma (68.55 ± 25.91 ng/ml) compared to controls (77.25 ± 34.01 ng/ml); p=0.153. No significant association was found between patient's asthma control status, and serum IgE and 25 (OH) vitamin D3 levels.CONCLUSION:Asthma control status was not associated with Immunoglobulin E and 25 (OH) vitamin D3 levels in those studied. More robust study is required to evaluate the relationship between asthma control, IgE and vitamin D levels.

Background The Global Initiative for Asthma (GINA) report sets out an updated evidence-based strategy for asthma management. Little is known about how this report is perceived and implemented in low-income and middle-income countries (LMICs) like Nigeria. We explored the experiences of asthma management as informed by the current GINA guideline among doctors in Lagos, Nigeria. Methods Using a qualitative research approach, in-depth interviews were conducted among doctors in Lagos, Nigeria to explore their experiences of asthma management in the context of the current GINA report. The thematic framework approach was used for data analysis. Results Eleven doctors aged 28-46 years (five general practitioners (GPs) and six family physicians (FPs) took part. Four overarching themes were identified: (i) knowledge of, and attitude towards the GINA strategy – whilst most doctors were aware of the existence of the GINA report, there was limited knowledge about its content including current recommendations for mild asthma treatment; (ii) asthma diagnosis and treatment – there was limited access to lung function testing facilities, and its role in asthma diagnosis was underappreciated; (iii) barriers to managing asthma according to GINA recommendations – these included complexity of the GINA report, unavailability and unaffordability of asthma medicines and poor patient adherence to medications, driven by socio-cultural factors; and (iv) enablers of GINA-recommended asthma management – improvement in asthma education for doctors and the general population and better access to diagnostic tests and medicines. Conclusions Whilst there was awareness of the existence of the GINA report, there was limited knowledge about its content and several barriers to its implementation were reported. Education about the GINA report, investment in diagnostic and treatment services and simplification of recommendations were identified as possible solutions.

Background The socioeconomic status and caregiver perception of asthma as a disease, the availability of specialty care and medication adherence have major influence on outcome of asthma control in children with asthma. The control of asthma therefore depends on the optimizing the interplay of these factors taking into consideration the regional and racial variations. Objective The objective of this study was to evaluate the association between socio-demographic factors and asthma control outcome in children with asthma. Materials and Methods This was a cross-sectional study involving 66 consecutively enrolled participants with asthma whose economic burden for asthma was assessed in a previous study. Based on the number of registered children attending the clinic, a minimum sample size of 66 calculated for this study was obtained.The participants were consenting children and young adults between the ages of 1 and 20 years. Using standard methods, data on socio-economic status, personal and family demographics, including household number, mothers' educational attainments and employment status; and asthma control were collected and analyzed. Asthma control was assessed using Asthma control test (ACT) and guided by the original developers scoring, participants were grouped into well controlled, partly controlled and uncontrolled. The Chi-square test was used to test for association between participants' socio-demographic characteristics (age, socioeconomic status, mothers' education and employment, and number of children in the household) and asthma control status at 5% level of significance. Results Of all study participants, 34 (51.55%) were male, with mean age (SD) of 11.6 (4.8) years. The mean (SD) age at initial asthma diagnosis was 6.2 (4.6) years. The majority 49(76.5%) of the mothers had tertiary education. Study participants belonging to the poorest; very poor; poor; and least poor socio-economic cadres were, 16 (24.2%); 17 (25.8%); 17 (25.8%); and 16 (24.2%) respectively. Asthma control classification showed that, 26 (39.4%); 31 (47%) and 9 (13.6%) participants had well controlled asthma, partially controlled asthma and uncontrolled asthma respectively. The factors like age, socioeconomic status, mothers ‘educational level, employment status and number of children in the household did not show any statistically significant association with the asthma control status of participants. Conclusions Asthma control outcome remains multifactorial as participants' socio-demographic characteristics did not impact on the level of control of asthma, among participants in the south eastern parts of Nigeria, despite being in a LMIC. A larger study is recommended to further explore this.

Background:The management of pleural effusion usually involves the drainage of the effusion, identification, and treatment of the underlying cause (s). Studies have shown that the initial diagnostic techniques do not give conclusive diagnosis in some cases of pleural effusion. This group of patients described as patients with indeterminate or undiagnosed pleural effusion constitutes a significant proportion of patients with pleural effusion in clinical practice. In this study, we examined the role of video-assisted thoracoscopy (VAT) in the diagnostic work-up of these patients. Aim:To determine the diagnostic outcome of VAT in the management of indeterminate pleural effusion in our center. Patients and Methods:Consecutive patients who presented with pleural effusions and who met the inclusion criteria had video-assisted thoracoscopy for diagnostic purposes. Outcome measures including the diagnostic yield, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VAT in patients with indeterminate pleural effusion, duration of the procedure, duration of hospitalization after the procedure, and complications for all the patients were documented and analyzed. Results:Of the 22 patients with indeterminate pleural effusion, conclusive diagnosis was obtained in 18 (81.8%) with a sensitivity of 91.7% [95% confidence interval (CI); 61.5-99.8%], specificity of 100% (95% CI; 69.1-100%), PPV of 100% (95% CI; 0-100%), and NPV of 90.9% (95% CI; 60.5-98.5%) for malignancy and a sensitivity of 78% (95% CI; 40-97%), a specificity of 100% (95% CI; 75.3-100%), PPV of 100% (95% CI; 0-100%), and NPV of 86.7% (95% CI; 65.7-95.7%) for tuberculosis. Conclusion:Our results show that video-assisted thoracoscopy plays a useful role in our center in obtaining diagnosis in patients with indeterminate pleural effusion.

Abstract Objective Like most chronic illnesses, childhood asthma has a significant impact on the child’s overall psychosocial well-being. Psychosocial disorders occur in children with uncontrolled asthma making their asthma control more difficult. We aimed to determine the prevalence and determinants of psychosocial disorders in children and adolescents with asthma. Methods A comparative cross-sectional study of children and adolescents (aged 6 to 17 years with and without asthma) was conducted in a Nigerian tertiary health facility. The Revised Children Manifest Anxiety Scale (RCMAS) and Center for Epidemiological Studies-Depression Scale for Children (CES-DC) were used to screen for anxiety and depression respectively. Results A total of 190 (95 asthma and 95 non-asthma) children were studied. Anxiety occurred in 15 (15.8%) of asthma and four (4.2%) of non-asthma children, OR 95% CI =4.3 (1.4-13.4). Forty-five (47.4%) of asthma and 32 (33.7%) of non-asthma children had depression (OR 95% CI =1.8 (0.9-3.2). Asthma was significantly associated with social problems such as difficulty in making friends (OR 95% CI = 58.5 (3.5-979.9); restriction from daily activities (OR 95% CI =34.0 (2.0-578.5); stigma from peers (OR 95% CI = 18.6 (1.1-326.2); and strengthened and overprotective relationship with parents, (OR 95% CI = 26.0 (1.5-447.8). Poor asthma control was significantly associated with restriction from play, OR (95%CI) = 0.12 (0.04-0.32); anxiety, OR 95%CI = 18.26 (3.80-87.76) and depression, OR 95%CI = 4.57 (1.85-11.33). Conclusions Children with asthma are more prone to psychosocial disorders than their non-asthma counterparts. Poor asthma control influenced the psychosocial well-being of children with asthma negatively.

BACKGROUND:Many caregivers experience significant psychological burden which may impact on the management of a sick child.OBJECTIVE:To determine the prevalence and associated factors of psychological distress among caregivers of children admitted at the Children Emergency Room.METHODS:This was a descriptive cross-sectional study among caregivers of children who were hospitalized for at least 24 hours. The 28-item General Health Questionnaire (GHQ 28) was used to assess the psychological distress among the caregivers. GHQ scores were stated as means ± standard deviation (SD). Chi-square or Fisher's exact test was used to test for association between sociodemographic variables and psychological distress. Mean GHQ scores in the various domains of psychological dysfunction were compared among groups using the independent sample t-test; at p<0.05.RESULTS:Of the 97 caregivers who participated in the study, 96 had their data analyzed. The caregivers were aged 19 to 63 (mean 34.25 (8.46)) years; 86 (89.7%) were females and 48 (50%) had tertiary education. The prevalence of psychological distress among the care givers was 69.8%. Caregivers had high levels of anxiety but low levels of depression. Those with lower educational attainment had higher scores on severe depression domain (p = 0.001). Unemployed caregivers had higher mean scores on the anxiety/insomnia (p = 0.039) and social dysfunction domains (p = 0.031). Those with large family sizes scored higher on the anxiety/insomnia domain (p = 0.03).CONCLUSION:Psychological distress was high among caregivers of children admitted at the children emergency room.