Objectives: Chikungunya virus (CHIKV), a reemerging global public health concern, which causes acute febrile illness, rash, and arthralgia and may affect both mothers and infants during pregnancy. Mother-to-child transmission (MTCT) of CHIKV in Africa remains understudied. Methods: Our cohort study screened 1006 pregnant women with a Zika/dengue/CHIKV rapid test at two clinics in Nigeria between 2019 and 2022. Women who tested positive for the rapid test were followed through their pregnancy and their infants were observed for 6 months, with a subset tested by reverse transcription-polymerase chain reaction (RT-PCR) and neutralization, to investigate seropositivity rates and MTCT of CHIKV. Results: Of the 1006, 119 tested positive for CHIKV immunoglobulin (Ig)M, of which 36 underwent detailed laboratory tests. While none of the IgM reactive samples were RT-PCR positive, 14 symptomatic pregnant women were confirmed by CHIKV neutralization test. Twelve babies were followed with eight normal and four abnormal outcomes, including stillbirth, cleft lip/palate with microcephaly, preterm delivery, polydactyly with sepsis, and jaundice. CHIKV IgM testing identified three possible antepartum transmissions. Conclusion: In Nigeria, we found significant CHIKV infection in pregnancy and possible CHIKV antepartum transmission associated with birth abnormalities.

Chikungunya virus (CHIKV) has become a global public health concern since the reemergence of the Indian Ocean lineage and expansion of the Asian genotype. CHIKV infection causes acute febrile illness, rash, and arthralgia and during pregnancy may affect both mothers and infants. The mother-to-child transmission (MTCT) of CHIKV in Africa remains understudied. We screened 1006 pregnant women at two clinics in Nigeria between 2019 and 2022 and investigated the prevalence and MTCT of CHIKV. Of the 1006, 119 tested positive for CHIKV IgM, of which 36 underwent detailed laboratory tests. While none of the IgM reactive samples were RT-PCR positive, 14 symptomatic pregnant women were confirmed by CHIKV neutralization test. Twelve babies were followed with 8 normal and 4 abnormal outcomes, including stillbirth, cleft lip/palate with microcephaly, preterm delivery, polydactyly with sepsis and jaundice. CHIKV IgM testing identified 3 antepartum transmissions, further studies will determine its impact in antepartum infection.

The adverse impact of Zika (ZIKV), dengue (DENV), and chikungunya (CHIKV) virus infection in pregnancy has been recognized in Latin America and Asia but is not well studied in Africa. In Nigeria, we screened 1006 pregnant women for ZIKV, DENV and CHIKV IgM/IgG by rapid test (2019-2022). Women with acute infection were recruited for prospective study and infants were examined for any abnormalities from delivery through six months. A subset of rapid test-reactive samples were confirmed using virus-specific ELISAs and neutralization assays. Prevalence of acute infection (IgM+) was 3.8%, 9.9% and 11.8% for ZIKV, DENV and CHIKV, respectively; co-infections represented 24.5% of all infections. Prevalence in asymptomatic women was twice the level of symptomatic infection. We found a significant association between acute maternal ZIKV/DENV/CHIKV infection and any gross abnormal birth outcome (p=0.014). Further prospective studies will contribute to our understanding of the clinical significance of these endemic arboviruses in Africa.

Background: There are few studies on the pattern of cardiac diseases (CD) among children in the Niger Delta region of Nigeria. This study examines the pattern of cardiac disease and associated comorbidities among children living in the Niger Delta region of Nigeria during a cardiac mission.Materials and Methods: This was a descriptive cross-sectional study which involved all children with prior diagnosis of CD referred from all the states of Niger Delta region of Nigeria. All children had echocardiogram and electrocardiogram performed by a team of Paediatric cardiologists.Results: Out of a total of 155 children who presented for the cardiac screening exercise, 145 (75 males and 70 females) children had CD. Their ages ranged from 0.2 to 180 months with a mean age of 45.5 ± 44.3 months which was significantly higher than their mean age at first diagnosis of 12.2 ± 22.9 months (P = 0.0072). Of the 145 children with cardiac disease, 128 (88.3%) of the patients had congenital heart disease and 17 (11.7%) had acquired heart disease and arrhythmias. Ventricular septal defect, Tetralogy of Fallot, and Rheumatic heart disease were the commonest acyanotic, cyanotic and acquired heart diseases respectively. Solitary lesions accounted for 91 (62.8%) of cases while multiple lesions accounted for 54 (37.2%) with as many as 35 (24.1%) children having complex heart diseases. Sixty-nine (47.6%) children presented with comorbidity.Conclusion: The burden of cardiac disease and complex heart disease in the Niger Delta region of Nigeria remains high. Early detection and prompt intervention would help to reduce the morbidity.

This was a comparative cross-sectional study where the left ventricular dimensions and functional parameters of 41 children (aged 1 to 18 years) with sickle cell anaemia were compared with those of 52 age-and-sex matched HbAA controls using transthoracic echocardiography. Majority of the left ventricular dimensions were significantly larger in the study group than the controls (p<0.05). The mean indices for left ventricular systolic function were higher in the study group than the controls though not statistically significant (p>0.05). Left ventricular dimensions correlated positively with age and body surface area in both groups (p<0.05) but inversely with haematocrit in the study group especially the left ventricular internal diameters in diastole and systole and left ventricular mass (p=0.001). Although 14.6% - 59.5% of the changes in cardiac dimensions were attributable to age, haematocrit level and body surface area in the study group (p<0.05), most of this effect was due to haematocrit.

BACKGROUND:There are few reports of the prevalence of CHD in the neonatal period in sub-Saharan Africa. The only available study in Nigeria was carried out before the widespread availability of echocardiography in the country. We sought to determine the prevalence and spectrum of congenital heart defects (CHD) among neonates in Jos, Nigeria.METHODS:This cross-sectional study enrolled neonates less than one week of age from the two largest hospitals and their immunisation centres. Relevant information was obtained and an echocardiogram was performed on each neonate.RESULTS:There were 3 857 neonates recruited over a two-year period; male-to-female ratio was 1.1:1. A total of 111 babies had CHD, with a prevalence of 28.8 per 1 000. Sixty-four neonates had mild CHD, with a prevalence of 16.6 per 1 000, while moderate and severe CHD were found in 27 (7.0 per 1 000) and 20 (5.2 per 1 000), respectively.CONCLUSIONS:CHD is prevalent in Nigerian neonates and there is therefore a need for advocacy to improve access to its diagnosis at birth for appropriate management.

To present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low‐ and middle‐income countries, for North‐Central Nigeria.

Introduction and Objectives: Congenital heart disease (CHD) in children with Down syndrome is a common association. This study aims to describe the pattern of CHD and associated co-morbidities seen in children with Down syndrome in the Niger Delta Region of Nigeria. Materials and Methods: This was a descriptive cross-sectional study conducted in Uyo, Akwa Ibom State, during a cardiac mission. Children with phenotypic features suggestive of Down syndrome and a prior diagnosis of CHD had trans-thoracic echocardiogram performed by a team of paediatric cardiologists. The data were analyzed with STATA 14.0 Statistical package. Results: Thirty-five children with physical features suggestive of Down syndrome were seen, all of whom had CHD. They had a mean age of 5.8 months at diagnosis and 25.8 months at presentation. The most common heart defects detected were Atrioventricular septal defects in 28.6% of cases. The most common co-morbidity noted was heart failure in 17 (48.6%) of them followed by wasting in 15 (42.9%). Though 14 (40.0%) children were on a pulmonary vasodilator (sildenafil), only 5 (14.3%) children had features suggestive of pulmonary hypertension on echocardiography, all with atrioventricular septal defects (AVSD). Conclusion: AVSD is the most common CHD seen among children with Down syndrome in our study and is frequently associated with pulmonary hypertension.

Rheumatic heart disease (RHD) is a major public health problem in resource-poor countries, especially in sub-Saharan Africa where about 1 million affected children between 5 and 14 years of age live with the disease. The aim of this paper is to review current knowledge on the clinical epidemiology of RHD in Nigeria, identify gaps, and suggest possible future directions. A systematic literature search was conducted using African Journal online (AJOL), Cinahl, Google Scholar, PubMed, and Web of Science. In PubMed, the following medical subject headings and free text terms were used: "Rheumatic heart disease" OR "Rheumatic "Valvular heart disease" OR "Rheumatic fever" AND "Nigeria". The same text word search was used in Google scholar, AJOL, CINAHL, and Web of Science. A search date was limited to articles published from January 1950 to December, 2018. A total of 44 original studies were reviewed. Nineteen (45.2%) of the studies used clinical criteria for diagnosis of RHD, 19 (40.5%) used echocardiographic diagnosis, and 6 (14.3%) used autopsy or post mortem examination of the patients for the diagnosis of RHD. Five (11.9%) of the studies were conducted in children only, 9 (16.7%) were in both children and adults, and the remaining 31 (73.8%) were done in adults only. Only 6 (14.3%) of the studies reported complications seen in patients with RHD. Of the 6 studies that reported on complications, only 1 reported on recurrent of acute rheumatic fever. Mitral valvular disease was the most common lesion reported in all the studies. RHD still remains a major cardiovascular health problem in Nigeria. There is therefore a need for more recent clinical studies on the contemporary pattern of RHD in Nigeria. In addition, community based screening for RHD is needed to determine the true burden of the disease in Nigeria. Finally, primary and secondary preventive measures are needed to help reduce the burden of RHD in Nigeria.

Background: Both Human Immune-deficiency Virus (HIV) and anti-retroviral (ARV) are associated with metabolic disorder. This study compared the prevalence of metabolic syndrome (MetS) among HIV and non-HIV infected children. Methods: This was a comparative cross-sectional study of 142 HIV infected and 142 HIV non-infected children. Socio-demographic and clinical data were collected. Blood pressure, height, weight abdominal circumference were assessed using standard procedure. Fasting blood samples were collected for blood glucose and blood lipid profile. Result: The mean age at diagnosis of HIV infection was 4.9 years and 140 children were on ARVs. Cumulatively, 23.9% of the non-HIV infected children compared to 16.2% of HIV children (P = 0.11) had one component of MetS. Abdominal obesity was prevalent in 3.5% of non-HIV compared to 0% of HIV infected children; high blood pressure (HBP) was present in 8.5% of non-HIV compared to 0.7% of HIV-infected children (P < 0.001). HIV-infected children had higher prevalence of hyper-triglyceridemia compared to non-HIV (9.3% compared 3.5% respectively; P = 0.05). Cumulatively the clustering of two components of MetS was prevalent in 2.8% each of HIV-infected and non-HIV-infected children. Atherogenic lipids (low high density lipo-protein and high triglyceride) was diagnosed in 2.8% versus 0.7% of HIV infected and non-infected respectively (P = 0.18). MetS was diagnosed in 0.7% of non-HIV infected children and none of the HIV infected children. Conclusion: While both HIV and non-HIV-infected children had a high prevalence of one component of the MetS, MetS is however uncommon in our study population.

Background Events in pregnancy play an important role in predisposing the newborn to the risk of developing CHD. This study evaluated the association between maternal preeclampsia and her offspring risk of CHD. Methods This is a cohort study of 90 sex-matched neonates (45 each born to women with preeclampsia and normal pregnancy) in Jos, Nigeria. Anthropometry was taken shortly after delivery using standard protocols. Echocardiography was performed within 24 hours of life and repeated 7 and 28 days later. SPSS version 25 was used in all analyses. Statistical significance was set at p<0.05. Results Congenital heart disease (CHD) was observed in 27 (30.0%) of newborns of women with preeclampsia compared with 11 (12.1%) of newborns without preeclampsia (p<0.001) at the end of 7 days and in 19 (21.1%) of newborns of women with preeclampsia and 3 (3.3%) of newborns of women without preeclampsia by the end of the 4th week of life (p<0.001). Overall, ASD (4 newborns), PDA (21 newborns), patent foramen ovale (14 newborns) and VSD (2 newborns) were the prevalent lesions found among all the newborns studied in the first week of life. Isolated atrial and ventricular septal defects were seen in 4 (4.4%) of the newborns of women with preeclampsia. Being the infant of a woman with preeclampsia was associated with about 8-fold increased risk of having CHD (OR = 7.9, 95% CI = 2.5-24.9, p<0.001). Conclusion CHD may be more common in newborns of women with preeclampsia underscoring the need for fetal and newborn screening for CHD in women with preeclampsia so as to improve their infant's well being.

Background: Chronic kidney disease (CKD) affects multiple organs and is an established risk factor for cardiovascular disease and mortality. Impaired systolic function of the left ventricle is common in adult CKD patients. Objective: The main objective of the study is to determine the prevalence of left ventricular systolic dysfunction (LVSD) in children with CKD and its association with age, stage of disease, and history of dialysis. Subjects and Methods: This was a comparative cross-sectional descriptive study. Twenty-one children with CKD aged 3–14 years and an equal number of age- and gender-matched apparently healthy controls were recruited. Outcome Measures: LVSD was considered present when ejection fraction (EF) <50%. Results: The mean EF of 63.9% in the patients was not significantly lower than the 65.3% recorded in the controls, but LVSD was detected in 5 (24%) and none of the controls (Fisher's exact; P = 0.001). Patients with LVSD were older than those with normal left ventricular systolic function, but this difference was not statistically significant (P = 0.067); however, they differed significantly with respect to the stage of CKD (P < 0.001). LVSD was more common in patients who were never dialyzed (P < 0.001). Conclusion: LVSD is more frequent in children with CKD compared with controls. Patients with LVSD were similar to those without it, with respect to age but had more advanced disease (CKD) and less likely to have ever been dialyzed.

The objective of this study was to investigate the effect of a pre-eclampsia mobile application on the knowledge of pregnant women.Following development of a pre-eclampsia mobile application, we conducted a controlled before and after study during a three-month period in 2018. The study population consisted of pregnant women attended to obstetrician clinics and offices in Kerman, Iran of whom, 110 sample participants were divided into two intervention and control groups. The participants completed a questionnaire of pre-eclampsia knowledge at baseline and 1-month follow up. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression.A total of 108 pregnant women with an average age of 28 years participated in this study. There was no significant difference between the scores of the two groups before the intervention (p=0.94). Their difference after the intervention was highly significant (p<0.001). The difference between the knowledge of the participants before and after the intervention was significant in the both groups (p<0.05). The results showed that the knowledge score of the participants after the intervention was significantly associated with their group and assessment score before the intervention (p<0.001).The results showed that the use of a mobile-based educational application improves the knowledge of pregnant women about pre-eclampsia. Increasing women's knowledge about pre-eclampsia may enables them to identify its signs and symptoms, resulting in the early detection and management of this condition, and likely reduction of its adverse consequences.IRCT2017050633837N1.

OBJECTIVE:Digoxin is widely used in patients with rheumatic heart disease (RHD) despite a lack of data on its impact on clinical outcomes. We aimed to determine the association of digoxin use on clinical outcomes in patients with RHD.METHODS:We performed a retrospective analysis of the association of digoxin use with mortality at 2 years in a large RHD registry. Secondary outcomes were recurrent heart failure (HF) and hospitalisation for any cause. We assessed associations using multivariable logistic regression in the entire cohort and in subgroups of patients with atrial fibrillation (AF) and HF. We also estimated average treatment effects from propensity-adjusted analyses using inverse probability treatment weighting.RESULTS:Information on digoxin use at baseline was available for 98.7% (3298/3343) of patients. In the overall population, digoxin was significantly associated with mortality (OR 1.63, 95% CI 1.30 to 2.04, p<0.0001) and recurrent HF (OR 1.48, 95% CI 1.07 to 2.04, p=0.019). On propensity-weighted analyses, this effect was markedly attenuated (OR 1.05, 95% CI 1.01 to 1.09, p=0.005). Patients in sinus rhythm without HF had a higher propensity-adjusted odds of death with digoxin use (OR 1.06, 95% CI 1.01 to 1.12, p=0.015), but those with both AF and HF had lower mortality (OR 0.88, 95% CI 0.80 to 0.98, p=0.019).CONCLUSION:Digoxin use is associated with higher mortality in patients with RHD, but this is greatly attenuated on propensity adjustment, indicating the presence of substantial treatment bias. The adjusted estimates may therefore not be reliable, and large randomised trials are needed to determine the true effect of digoxin in patients with RHD.

>Background: Cardiovascular disease (CVD) is a major cause of death among adults worldwide. It is acknowledged that its risk factors have their roots in childhood. The present study evaluated CVD risk factors in primary school children in a Nigerian peri-urban setting.Methodology: This cross-sectional study was carried out in two primary schools in Jos South local government area, Plateau State, Nigeria. The 241 children studied were chosen using a systematic random sampling technique to select the children from each school. Pretested questionnaire was used to elicit the information on family characteristics and individual characteristics while standard anthropometric and laboratory procedures were used in evaluating the CVD risk factors.Results: Overall, 137 (56.8%) were females (M:F = 0.76), 151 (62.7%) were from the middle class, 59 (24.5%) from lower class while 31 (12.9%) were from the upper class. The overall prevalence of at least one cardiovascular risk factor was 54%. Sedentary lifestyle was the most common CVD risk factor in 32.4% of subjects followed by obesity (13.7%), adverse CVD event in family (11.6%), high low-density cholesterol (10.3%), high total cholesterol (TC) (9.1%), and hypertension (9.1% combine, 7.1% diastolic, and 5.8% systolic). Linear regression analysis showed that body mass index (BMI) for age (β = 0.41, P < 0.001), systolic blood pressure (BP) (β = 0.94, P = 0.03), diastolic BP (β =1.26, P = 0.01), and TC (β = 0.07, P = 0.04) significantly rise with age. BMI for age (P = 0.02) was significantly higher in female subjects compared with their male counterparts.Conclusions: From the findings of the present study, interventions related to modifiable risk factors, such as encouragement of physical exercise and sports in schools, healthy and prudent diet, and weight control programs should be undertaken early in life so as to help control the development of and the epidemic of CVD in later life.

Background: Infective endocarditis (IE) was initially thought to be uncommon in children but is on the increase due to improved cardiac services in the developing world. Aims: Aims of this study is to describe the profile of IE in children in Jos, Nigeria and identify the peculiarities of the disease in the locality. Methods: Case records of children diagnosed with IE based on the modified Duke’s criteria over a seven year period were retrospectively reviewed in a tertiary hospital. Their clinical manifestations, blood culture isolates, presence or absence of vegetations and clinical outcomes were documented and analyzed using Epi Info 7. Results: Case records of thirty children were reviewed. The number of children managed increased yearly with 10 (33.3%) of them seen in the last year of the study. The clinical features were mainly non-specific - fever (70.0%), congestive cardiac failure (63.3%) and anorexia (63.3%) being the major findings. Staphylococcus aureus was the commonest isolate, present in 5 (45.5%) of the 11 blood culture-positive cases. Other organisms isolated were Klebsiella species in Original Research Article Ige et al.; JAMMR, 22(8): 1-9, 2017; Article no.JAMMR.34955 3 (27.3%), Pseudomonas aeruginosa in 2 (18.2%) and Acinetobacter baumami in 1 (9.1%) child. Vegetations were detected in 12 (40.0%) children, most of them located on the mitral valve. Mortality occurred in 8 (26.7%) children and was significantly higher in males – P = 0.02. Conclusion: There is a marked increase in the number of children admitted and managed for IE in the last year of the study possibly due to an increased index of clinical suspicion of IE. A high index of suspicion is required for diagnosis because many children presented with nonspecific clinical features.

OBJECTIVES:To describe the fasting serum lipid and glucose profiles of HIV-positive Nigerian children and determine the prevalence and risk factors for dyslipidaemia and hyperglycaemia, which are risk factors for cardiovascular diseases. METHODS:This was a comparative cross-sectional study carried out at the Paediatric Infectious Disease Clinic (PIDC) of the Jos University Teaching Hospital (JUTH) for HIV-positive children and at two primary schools in Jos for HIV-negative children as controls. One hundred and forty-two HIV-positive children aged 6-18 years and an equal number of controls were studied by determining their fasting serum lipid and glucose levels. The prevalence of dyslipidaemia and hyperglycaemia was determined and their risk factors obtained using multivariate logistic regression. P values of less than 0.05 were considered statistically significant. RESULTS:Mean triglyceride levels were significantly higher in HIV-positive children compared with controls at 87.2 mg/dL (95% confidence interval [CI] 79.4-95.0) and 68.1 mg/dL (95% CI 62.5-72.7), respectively (P<0.001). There were no significant differences in mean glucose levels. Dyslipidaemia was significantly higher in HIV-positive children (21.8%) compared with controls (12.7%; P=0.04). Total serum cholesterol was elevated in 17 (12.0%) HIV-positive participants compared with seven (4.9%) of controls (P=0.02). Children on lopinavir/ritonavir (LPV/r) and those with no significant or mild disease had a significantly higher prevalence of hypercholesterolaemia (33.3% vs 4.8% and 14.5% vs 0.0%, respectively; P<0.001). CONCLUSION:HIV-positive children on antiretroviral (ARV) drugs, especially LPV/r, should have their lipids regularly monitored as those with dyslipidaemia stand the risk of subsequently developing cardiovascular diseases.

Congenital Heart Defect (CHD) is the most common and one of the severe forms of congenital malformations. This contributes significantly to neonatal and infant morbidity and mortality. The incidence of CHD in Nigeria is unknown. The reported incidences since the introduction of echocardiography in are based largely on extrapolations. This study therefore aims to determine the incidence and pattern of CHD in newborns in Nigeria and to determine their contribution to infant morbidity and mortality. The study will be carried out at a tertiary health care facility in Jos, Nigeria. Newborn babies delivered or admitted in the hospital will be recruited into the study consecutively after obtaining consent from their parents until 3,000 of them have been studied. A cardiovascular system examination will be performed and babies examined for obvious congenital malformations. All babies recruited will have a screening echocardiography and those with suspicious findings will be booked for confirmatory echocardiography. Babies will be followed up for a year and their morbidities and/or mortalities documented. Data will be entered into and analyzed using the STATA version 14. Confidence interval for this study will be set at 95% with a p value ≤ 0.05 considered statistically significant. The study will provide contemporary data on the current incidence and pattern of CHD and other CM in Nigeria as well as its natural or modified history and potential risk factors. The contribution of CHD and other CM to perinatal and neonatal morbidity and mortality will also be determined.