Background: Enuresis for most children is a source of shame and anxiety with a profound ef fect on sel f percept ion, relationship and school performance. Hence the study of nocturnal enuresis among primary school children in Calabar-Nigeria. Objectives: This was to determine the frequency of enuresis among primary school children in Calabar and to study the treatment modalities. Patients and Methods: This was a prospective cross sectional study. A questionnaire was answered by parents of 3,230 pupils from six selected schools during the school term between January to March, 2010. Results: The frequency of nocturnal enuresis was 6.7%. Enuresis frequency was higher among boys (7.3%) than girls (6.0%) though this was not statistically significant (P=0.216). Treatment methods used were medication ( 1.6%) , water restriction (42.8%), awaking for voiding (27.3%) use of alarm bell (0.5%), herbal medication (8.0%), while 19.8% received no form of treatment. Help seeking behavior for this condition was poor as only 2.1% of this study population ever sought medical attention for this condition. Conclusion: The frequency of enuresis was similar to most reports in literature. Help-seeking behavior was poor. Parental education, advocacy and awareness creation on the availability of medical help for enuresis are suggested.Key words: Nocturnal enuresis, Treatment, School children.

Aim: Increasing cases of Cryptococcus laurentii infection are being reported globally possibly due to advances in medicine, the use of immunosuppressants and invasive therapies such as endotracheal intubation, parenteral nutrition, central vascular catheters and exposure to broad-spectrum antimicrobial agents. Cryptococcus species are ubiquitously distributed in the environment, abundant in contaminated soil and bird droppings. Four cases of Cryptococcus laurentii fungemia have been described in neonates, all were premature low/very low-birth-weight. Our case is likely the 5th reported globally and the 1st from Nigeria and Africa across all age groups. Case Presentation: The patient presented at 34 hours of life with complaints of fever and multiple convulsions after delivery in a traditional birth attendant facility. Mother drained liquor for 5 days with poor cord care. A diagnosis of severe birth asphyxia with sepsis was made and baby received antibiotics (ceftriaxone and genticin) in addition to the management of severe birth asphyxia but showed no improvement. Blood culture yielded cream-colored smooth colonies, identified by Vitek 2 (bioMerieux, France) as Cryptococcus laurentii. Baby was treated with fluconazole, had good recovery and was discharged home. Conclusion: Our case report emphasizes the need for high index of suspicion for non-bacterial organisms (fungi) as possible causes of sepsis in newborns. Improved fungal diagnosis and timely commencement of antifungal medications will improve clinical outcomes.

Objectives:Dehydration and electrolyte derangements are major causes of morbidity and mortality in diarrhea disease. We aimed to evaluate the pattern and determinants of electrolyte derangements and isolates in a stool sample of under-fives with diarrhea at a tertiary hospital in Nigeria.Materials and Methods:This was a prospective and cross-sectional study of 136 under-fives admitted into the diarrheal training and treatment unit who were consecutively recruited. Patients were tested for association using Pearson’s Chi-square, Kruskal–Wallis’ test, and logistic regression modeling.Results:A total of 136 babies were recruited. Three of the stool sample were culture positive for non-specifiedEscherichia coli, another two grewEntamoeba histolytica. Almost half (n= 56/136, 41.2%) of the children had metabolic acidosis. Predictors of acidosis included severe dehydration (adjOR: 5.76, 95%CI: 1.54–21.50,P= 0.009), ≤3 months breastfeeding (AdjOR 0.39, 95%CI: 0.153–0.997,P= 0.049), and fever (adjOR 6.30, 95%CI: 1.74–22.83,P= 0.005).Conclusion:Metabolic acidosis was common with diarrhea for which exclusive breastfeeding was protective in this study. Although few, the growth ofE. histolyticaimplicates sanitary conditions and suggests the viral origin of diarrhea, hence strongly supports the introduction of rotavirus vaccine in our national routine immunization schedule while proper use of ORS may impact positively on the metabolic complication of diarrheal disease in the tropics.

Background: Nigeria continues to have one of the highest rates of neonatal deaths in Africa. Hospital-based studies had implicated prematurity, neonatal sepsis, poor antenatal care, and perinatal asphyxia as major causes of neonatal mortality. This study aimed to highlight the predictors of neonatal deaths and offer solutions to reduce them.Methods: This 5-year retrospective review investigated the neonatal mortality rate at the University of Calabar Teaching Hospital from 2013 to 2018. The demographic characteristics, clinical parameters, duration of hospital stay, and challenges encountered in managing the patients were documented in this study. The obtained data were analysed in SPSS software (version 26).Results: Neonatal mortality rate of 60 per 1000 live births was recorded in this study. The major causes of death were prematurity (n=86, 39.8%), perinatal asphyxia (n=45, 20.8%), neonatal sepsis (n=37, 17.1%), and congenital malformation (n=34, 15.7%). Low socioeconomic class and out-born were additional risk factors in this regard.Conclusion: The neonatal mortality rate is higher than the average national rate and the figure obtained in the same center more than a decade ago. Infrastructural decay during the study period may partly explain the high neonatal mortality rate. Enhancement of the infrastructure and use of kangaroo mother care are recommended to reduce neonatal death, especially among premature babies.

Background: Effective practice of recommended infant feeding methods is key to child survival strategy in sub-Saharan Africa. Attitude towards infant feeding has been shown to be a significant determinant of practice. For health workers, attitude may determine the propensity to counsel mothers towards adoption and adherence to recommended infant feeding practices. This study aimed at assessing health workers’ attitude towards infant feeding. Methods: This was a cross-sectional descriptive study carried out in April 2019. Leslie Kish formula was used to recruit 225 health workers in Calabar to participate in the study. Ethical approval was obtained from the Cross River State Research and Health Ethics Committee. A validated self-administered IOWA infant feeding attitude scale was utilized in this study. Using the scale, attitude was categorized as positive for breastfeeding, neutral, and positive for formula feeding. Data was analysed using SPSS version 21.0, and p-value was set at 0.05. Result: Two hundred and twenty-five respondents completed the questionnaire. Female: male ratio was 1:0.24, the commonest age group (43.1%) was 31 to 40 years old, and 60% of respondents were nurses. Most respondents (52.9%) had neutral attitude, while 44.0% had positive attitude for breastfeeding, and 3.1% had positive attitude towards formula feeding. Age group, religion, profession, and ethnicity did not significantly influence attitude towards breastfeeding (p>0.05). Conclusion: Neutral attitude towards breastfeeding was common among health workers. This has implications for successful implementation of the recommended breastfeeding initiative towards improvement in child survival especially in resource-poor settings. Regular re-training of health workers is needed, especially through continuing educational effort by the various health professional bodies.

Background Health workers are in a strategic position to provide correct information to mothers on breastfeeding practice. This study assessed knowledge of breastfeeding among health workers in health facilities in Calabar. Methods This was a cross-sectional descriptive study. A 45-item self-administered questionnaire was used to obtain data. Ethical clearance for the study was obtained from the Cross River State Research and Ethics Committee. Data were analyzed using SPSS version 21.0 (SPSS, Inc., Chicago, USA). A knowledge score of at least 90% was considered satisfactory. Factors associated with the level of knowledge were determined using chi-square. The p-value was set at 0.05. Result Two hundred and twenty-five healthcare professionals were surveyed, with a mean age of 37.5 ± 9.4 years, ranging from 20 to 65 years. The commonest age group was 41 to 50 years (43.1%). Females (80.9%) formed a larger proportion of participants with a female-male ratio of 4:1. The mean percentage of knowledge score was 85.1 ± 9.0%. A satisfactory level of knowledge was found in 27.1% of respondents. About one-third (33.7%) and one-fifth (21.8%) of health workers were not aware of the weight control benefit and protection against osteoporosis of breastmilk, respectively. Approximately one-fifth (22.2%) of respondents had misconceptions concerning the effects of colostrum on the prevention of neonatal jaundice. Nurses with diploma level of training had a satisfactory level of knowledge, compared with other professions (p < 0.05). Conclusion Health workers’ knowledge of breastfeeding was generally good though suboptimal. Health-related professions should provide current information on the best breastfeeding practices.

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.

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.