Enema is largely used and widely abused in our community for various ailments including fever, constipation; abdominal pains vomiting and even diarrhoea.Objectives: To describe the abuse of enema at home in the Calabar area, and the associated findings among children who received enema.Method: Children admitted to the Children Emergency Unit of the University of Calabar Teaching Hospital with history of enema use at home were recruited into the study. The presenting symptoms, type of enema used and associated findings were documented. Relevant investigations were carried out where necessary. Tables and simple proportions were used to analyze the data.Results: Twenty two children were seen with enema abuse over a six months period. Diarrhoea diseases and fever were the predominant reasons why enema was given. Types of enema given were herbal concoctions in 13(59.1%) plain water enema in 8(36.4%) and salt water enema in one (4.5%) child. Electrolytes derangements were the commonest associated findings. Others were convulsions/coma, intestinal perforation, acute renal failure and severe dehydration from diarrhoea.Conclusion: Enema abuse is a continuing cultural phenomenon in the Calabar area. It is associated with severe consequences including intestinal perforation. Enema abuse should form part of history taking in this environment and child care practitioners should actively search for possible complications. Most importantly, health education to stem this widespread practice.

Summary: Mother to child transmission of HIV infection (MTCT) is the commonest mode of infection in children especially in resource limited settings. Routine HIV screening during antenatal period is recommended to prioritize treatment of seropositive mothers according to standard protocol. Various infant feeding options have been recommended by the World Health Organization (WHO) to reduce MTCT of HIV infection. The use of a cross-nurse who is documented HIV-negative is one of such options though not widely practiced. We present a case of HIV infection in an infant acquired through wetnursed.

Background: Selective mass chemotherapy is known to be very effective in reducing and controlling the prevalence of urinary schistosomiasis. However, re-infection and resurgence of Schistosoma (S) haematobium infection after effective mass chemotherapy is also common in the absence of other control programmes. Objective: To determine the prevalence of S. haematobium infection among primary school children in a rural community, ten years after effective mass chemotherapy in the same school. Subjects and Methods: The prevalence and intensity of S. haematobium infection were determined in a rural primary school by the nytel milipore filter method in 2003. The results were compared with those of a similar study carried out in the same primary school ten years earlier, before and after effective mass chemotherapy. Results: In the current study, two hundred and twenty six of the 443 children studied had urinary schistosomiasis giving a prevalence of 51.0 percent. One hundred and seventy five (77.4 percent) of those infected had infection of mild intensity (<49 ova/10ml). A previous study, carried out 10 year's earlier in the same school had shown a drop in prevalence of infection from 69.0 percent to 21.7 percent following treatment and re-treatment with praziquantel within a two-year period. Compared to the 21.7 percent prevalence obtained after two years of retreatment ten years previously, there was a rise of prevalence to 51.0 percent in this study (p<0.001). Conclusion: This study shows that the prevalence of S. haematobium among the school children was high, 10 years after effective mass chemotherapy in the same school. However, the intensity of infection was milder. We conclude that there is a need to control infection through a multifaceted approach.

There is a paradigm shift towards adopting a multidisciplinary team (MDT) model in the care of cancer patients, with increasing evidence to support its effectiveness. Cancers are biologically distinct, patients present in diverse ways and require, different therapeutic approaches in their management. Patient symptoms and treatment side-effects as well as physical and psychological impact vary according to cancer location and treatment plan. The varied clinical scenarios cancer patients present further buttress the need for MDT practice in hospitals to improve the quality of patient care, in contrast to the outdated concept of holistic treatment offered by a single physician. Unlike Europe, United States of America and Australia which have implemented successful MDT cancer care programs, Nigeria is just coming on board. We present two cases of gastric cancer (seen two months apart) with atypical presentation and the role of MDT in their evaluation and management. These case studies highlight the role of MDT in the management of cancer patients in Nigeria lending credence to the urgent need to implement this model of care in our cancer patients in a bid to improve the quality of care and outcome.

Introduction: Many patients with kidney disease are asymptomatic but may have abnormalities in urine. The aim of this study was to determine the prevalence of urinary abnormalities (UA) in asymptomatic secondary school children in Calabar, Nigeria and its relationship with age, sex, social class, body mass index and blood pressure. Methodology: It was a descriptive cross sectional study of 407 apparently healthy secondary school children aged 10-18 years recruited by multistage sampling techniques in June-July, 2022. Semi-structured questionnaires were used to obtain their bio-data and clinical history. Subject’s height and weight were measured using a stadiometer and body mass index (BMI) calculated. Blood pressure of each subject was measured using auscultatory method. Early morning urine was obtained from each subject and urinalysis done using dipstick- combi 10. The result of urinalysis was recorded. Data were analyzed using SPSS version 22.0 and p- value ≤ 0.05 was significant. Results: Out of 407 participants, 162 (39.8%) were males and 245 (60.2%) females giving a M:F ratio 1:1.5. The mean age was 13.5 ± 1.9 years. The prevalence of urinary abnormalities was 115 (28.3%) with many having more than one abnormality. Age group 13-15years were more commonly affected. Nitrituria 75(18.4) was the most frequent urinary abnormality followed by proteinuria 38 (9.3%), leucocytes14 (3.4%) andhaematuria 5(1.2%). There was no glucosuria. Nitrituria was statistically significant among females (p=0.040). Blood pressure, overweight and obesity were not statistically significant in relation to urinary abnormalities. Conclusion: The prevalence of urinary abnormalities was high among secondary school children but commoner in females and mainly nitrituria, proteinuria, leucocytes and haematuria. We therefore recommend regular screening for urinary abnormalities among secondary school children in our environment for early detection and prevention of renal diseases

INTRODUCTIONSickle cell anaemia (SCA) often presents in early childhood with repeated vaso-occlusive crisis that leads to ischaemia, infarction and fibrosis which may result in a reduction in expected testicular volume (TV) at puberty.METHODThis was a cross-sectional study of 95 children with SCA aged 1-18 years compared with 95 age-matched controls. Participants responded to an interviewer-administered questionnaire, with their anthropometric measurements taken, pubertal maturity assessed by Tanner staging and testicular ultrasonography done. Changes in TV across the ages were compared graphically and regression analyses were used to determine the factors independently associated with TV. A p-value of <0.05 was considered statistically significant.RESULTSIn the prepubertal period, the haemoglobin SS (HbSS) participants had larger median ultrasound TV (MUSTV) compared to the haemoglobin AA (HbAA) controls (p = 0.001). This trend reversed in the pubertal period. On regression analysis, the frequency of testicular pain (p = 0.04), weight (p = 0.02) and pubic hair rating (p = 0.03) of the HbSS participants were significant predictors of increased TVs in the HbSS participants, irrespective of pubertal status.CONCLUSIONThe prepubertal MUSTV of the HbSS participants were higher than those of the HbAA controls, while the HbAA controls had higher MUSTV at puberty and beyond. The frequency of testicular pain episodes, pubic hair rating and weight were independent predictors of TV changes in the HbSS participants. Prevention of repeated vaso-occlusive crisis in the prepubertal period may help prevent the reduction in TV and possible hypogonadism. Lay summarySickle cell anaemia (SCA) causes repeated episodes of painful crisis and in boys, these may affect the way their testes grow. The study set out to document testicular sizes on a one-time basis in boys aged 1-18 years with SCA compared with controls of similar ages. The participants responded to structured questions assisted by the researchers and their body measurements were appropriately taken. Their level of sexual maturation was assessed according to the method by Tanner and the sizes of their testes were measured using an ultrasound machine. The research information was analysed and a statistical value less than 0.05 was taken to mean that there was a difference between the measured variables. The mid-testicular sizes of the SCA participants were noted to be higher than that of their controls during the prepubertal period while the non-SCA boys had higher sizes from puberty onwards. The frequency of testicular pain, weight and pubic hair stage of the SCA boys were important contributors to their increased testes sizes, irrespective of pubertal status. Efforts aimed at preventing painful crisis should start during early childhood to forestall future sexual challenges in adulthood.

The prevalence of endocrine disorders in children in Nigeria is not well known. Therefore the burden of these diseases is often overlooked as most cases are undiagnosed or diagnosed too late; and yet they constitute a significant cause of morbidity and mortality in children. There has been a paucity of Paediatric Endocrinologists, absence of laboratory equipments and even drugs for the treatment of these diseases are often not in stock. The desired attention these endocrine diseases should receive from both health care institutions and the government is lacking. Therefore, the aim of this review article was to highlight the challenges facing the practice of Paediatric endocrinology in Nigeria and to proffer a way forward to building a robust endocrine care services in health institutions in Nigeria.

INTRODUCTION: Birth injuries may occur even with the best standard of care, and even more in the presence of certain fetal, maternal and delivery related factors. In this study we sought to determine the prevalence of birth injuries and investigate the predisposing factors of birth fractures and nerve palsies. METHOD: This was a hospital-based Epidemiological study conducted between January 2014 – December 2016 and all patients with birth injuries were recruited into the study. Structured questionnaires were administered to parents or guardians after giving informed consent. Relevant data regarding maternal morbidity, birth weight, parity and mode of delivery was collected and analyzed using IBM SPSS version 22. Significant statistical inference was set at 0.05. Ethical approval was given by the institutional ethics and research committee. RESULTS: Forty-six patients were recruited into the study. Seventy six percent were referred within a week after birth. Male to female ratio was 1:1.1. Thirty-two (60.9%) had fractures while 14 (39.1%) had brachial plexus injuries. Twenty-seven(58.7%) were delivered by a midwife and one was delivered by a traditional birth attendant. Fourteen of the mothers (30.4%) were primipara while 13 were grandmultipara. Seventeen of the patients (37%) had a birth weight >4kg. Most mothers delivered in a secondary health facility (43.5%) while 5 (10.9%) delivered at home. Only 8 (17.4%) had cesarean section. Birth through cesarean section was significantly associated with lower risk of fractures and peripheral nerve palsy (p=0.04). CONCLUSION: Fractures were the commonest injury seen. Cesarean section had the lowest rate of birth fractures and nerve palsies.

Introduction Puberty is an essential physiologic process that is characterized by the appearance of secondary sexual features. Secular changes in puberty occur from one generation to another and need to be documented. The assessment of pubertal stages in a child is only useful if recent and reliable reference data from the same population is available for comparison. The study aimed to profile clinical normative sexual maturity characteristics for children in Calabar, South-South Nigeria. Methods A cross-section of primary and secondary school pupils aged 6-18 years in the city of Calabar, Nigeria were randomly selected for the study. Sexual maturating rating was assessed using the pubertal staging for breast development and pubic hair as described by Marshall and Tanner (Tanner staging). Testicular volume in boys was measured using the Prader orchidometer. Menarche and “voice break” were established by recall of the event by the girls and boys respectively. Results A total of 2,830 children were seen, 1542 (54.5%) boys and 1288 (45.5%) girls. The mean age of onset of pubic hair was 11 years in both boys and girls. Pubertal testicular volume of 4 mls was seen in boys at a mean age of 11 years. Breast development in girls occurred at mean age of 11 years and menarche at 13 years. Conclusion in this study, the onset of puberty is occurring at an earlier age than previously reported in Nigeria with a secular trend of a decreasing age at onset of puberty. These sexual characteristics are rather occurring at similar ages reported from western countries.

Background: Urinary schistosomiasis, one of the neglected tropical diseases, is a major infection of public health importance in Nigeria. Control measures include the provision of potable water as the main strategy, population-based chemotherapy and health education. Aims and Objectives: The aim of this study was to determine the effect of the provision of potable water on the prevalence and intensity of infection with Schistosoma haematobium in Adim community, Cross River State, Nigeria. Subjects and Methods: A cross-sectional survey was carried out among school and children aged 5–14 years in Adim community in Cross River State using the polyamide millipore filter technique and ova detection and count compared with the situation that obtained 8 years earlier before the provision of potable water. The prevalence and intensity of haematuria and proteinuria by reagent strips were also compared between the two eras. Results: The prevalence of schistosomiasis was 14.5% compared to 51% in the prepotable water era (P = 0.001). The intensity of the infection was also significantly reduced between the two eras with 1.3% of the children having a severe intensity compared to 4.5% in the prepotable water era. Conclusions/Recommendations: The prevalence and intensity of S. haematobium have significantly reduced in this community though not yet eliminated. More boreholes need to be provided to make the water more accessible. This could be combined with other measures to eradicate S. haematobium from this community.

BACKGROUND Rabies is a preventable zoonosis with the highest case fatality of any disease in the world. In the developing world, it is transmitted mainly by dog bites. In parts of southern Nigeria, dog meat is a delicacy. OBJECTIVE To highlight trade in stray dogs as a major risk factor for rabies in animals and humans in south-south Nigeria. METHOD Patients admitted into the University of Calabar Teaching Hospital (UCTH) with a diagnosis of rabies between July and October 2012 were analysed for risk factors, post exposure prophylaxis (PEP), health seeking behaviour and outcome. Focused group interview were also conducted among traders/handlers of stray dogs. RESULTS Ten cases of rabies in subjects aged 3 to 52 years were recorded in these five months period. Eight of the cases were male and apparently got infected directly or indirectly through the trade in stray dogs for human consumption. None had proper PEP and all patients died. CONCLUSION Stray dog trade, fuelled by eating of dog meat, is a risk factor for human and animal rabies in Calabar, southern Nigeria. Culling of stray dogs, control of stray dogs' trade and public enlightenment on PEP is recommended.

AIM:To report the case of Junctional Epidermolysis bullosa seen in the University of Calabar Teaching Hospital, Calabar and to draw attention to the existence of this condition among Nigerians.SUBJECT AND METHODS:A Nigerian female infant, normal at birth, developed extensive blistering skin eruptions from the age of ten days. The lesions involved the face, neck, shoulders, upper trunk and the buccal mucosa of the lower lip sparing the limbs. The cornea were cloudy. The history, type and distribution of the lesions were consistent with Junctional Epidermolysis bullosa (EB). This was confirmed by skin biopsy and histology. Various medications including systemic and topical steroids, antibiotics and other topical creams only produce transient relief with frequent relapses. The Junctional EB type is known to be autosomal recessive in inheritance though there was no positive family history. Avoidance of heat, warm bath and trauma and genetic counseling can be helpful in reducing frequent relapses of the condition that has no specific treatment.CONCLUSION:This appears to be the first case of Epidermolysis bullosa to be reported from Calabar, south eastern Nigeria. This case report shows that this rare condition does affect people in the tropics. Efforts should always be made to reach a definitive diagnosis whenever unusual conditions are encountered in clinical practice.

Newborns admitted with convulsion in the University of Calabar Teaching Hospital, Calabar during the period 1st May 2004 to 30 April 2006 were studied prospectively. The aim was to determine the place of birth in relation to the cause of seizures, the current situation in terms of the aetiology, clinical spectrum and outcome. There were 55 neonates with convulsion representing 5% of admissions into the newborn unit during the period. Birth asphyxia, sepsis, and hypoglycaemia were important identifiable aetiological factors which operated either singly (45.5%) of cases) or in concert (54.5% of cases) in causing seizures. Hypocalcaemia and hyponatraemia contributed less. These results are similar to that of a previous study carried out in this centre ten years earlier . There was no statistical significant difference between home and hospital deliveries in relation to causes of seizures. Septicaemia was caused mainly by staphylococcus aureus, enterobactericae and unclassified coliforms. No neonatal meningitis was diagnosed. Surprisingly, there was a high prevalence of generalized seizures (76.4%). The mortality of 34.0% was related to onset of the seizures within 4 days of life but not the place of birth.The causes of neonatal seizures in our environment are mostly preventable. There is need to provide modern facilities for investigating newborn seizures, training and retraining of Traditional Birth Attendants, health education of expectant mothers.

A retrospective study of children with acute glomerulonephritis (AGN) over a 10-year period (January 1997-December 2006) was carried out with the aim to establish the prevalence, the population at risk, and the predisposing factors. Out of a total of 6,026 admissions during the study period, 76 (1.3%) had acute glomerulonephritis. Forty of the 76 were males while 28 were females with a male to female ratio of 1.4:1. The mean age for males was 7.2±4.3 years and that of females was 6.5±3.2 years. The overall age range was 3-13 years with a modal age of 5 years for both sexes. The annual prevalence showed two peaks, May-July and October-January. Eighty two percent of patients were of the low while 11.8% were of the middle socioeconomic classes. Haematuria, oedema, proteinuria and hypertension were the major presenting features. Hypertensive encephalopathy and acute renal failure were the complications recorded and also emerged as the causes of death. Childhood AGN is common in Calabar compared to other centres in Nigeria, afflicting largely those of low socio-economic status and displays a peak in the middle of both dry and rainy seasons of the year. The outcome is good but could be better if facilities are provided for dialysis.Key words: Glomerulonephritis, prevalence, children, patients

BACKGROUND:Reports of studies on the relationship between Schistosoma haematobium and urinary tract infection from different regions are conflicting. Hence, the need to determine the situation in each endemic area. OBJECTIVE:To determine if S. haematobium infection is associated with Urinary Tract Infection (UTI) among children in an endemic area of Cross River State, Nigeria. SUBJECTS AND METHODS:Mid-stream urine specimen was collected under strict aseptic procedures into wide-mouthed screw-capped sterile plastic containers. All the specimens were kept in a cooler at approximately 4 degrees C for 5-10 hr before delivery to the laboratory. Urine microscopy was carried out by gram staining and urine was cultured using blood agar and Mac Conkey agar plates. Collection of urine specimens for schistosoma ova was done between 10.00 am and 2.00 pm when ova count of S. haematobium is expected to be at its peak. RESULTS:Prevalence of urinary schistosomiasis was 51.0%. One hundred and seventy five (77.4%) of those infected had mild intensity of infection (<49 ova/10 ml). Significant bacteriuria was found in 2(0.9%) of the 226 children with urinary schistosomiasis and in 4(1.8%) of the 217 children without urinary schistosomiasis RR(95%CI) = 0.48 (0.089-2.59) P > 0.68. CONCLUSION:This study has found the prevalence rate of urinary Schistosomiasis in this community to be 51% and no significant difference in the prevalence of UTI among children with urinary schistosomiasis and those without. However, considering the high prevalence of urinary schistosomiasis seen in this study, urgent control measures should be instituted to address this public health problem.

A 10-year retrospective review of inpatients in Calabar showed that of 5641 children admitted,182 (3.2%) had renal disease. The major lesions were acute glomerulonephritis (36.9%) and nephrotic syndrome (30.7%), while less common ones included urinary tract infection (8.9%), obstructive uropathy, acute renal failure (6.7%, each) and nephroblastoma (6.2%).

The features of 20 cases of nutritional rickets who presented at the University of Calabar Teaching Hospital, Calabar in south-eastern Nigeria over a 9-year period (January 1985-December 1993) are presented. The aim is to compare them with those in the only other reports from Nigeria between 18 and 42 years ago from Ibadan in the west of the country. The ages at presentation ranged between 6 months and 5 years with no sex preponderance. Most of the children were well nourished with the major features being delay in walking, swollen wrists and ankles and genu varum. The majority of cases in the present study occurred among children of elite and middle class parents who deprived their children of sunshine by keeping them indoors most of the day while they were at work. Reasons for the comparatively low prevalence of rickets in Calabar are social and cultural factors which enhance the exposure of children to sunlight. In addition, the relative availability of seafood and vegetables in this coastal city enhances rickets prevention.