Nigerian Journal of Paediatrics

Exercise in Children with Bronchial Asthma: A Non-Pharmacological Adjunct to Bronchial Asthma Management

Uchenna Onubogu — Wed, 14 May 2025 00:00:00 +0000

Exercise in a child with bronchial asthma is a significant subject of interest to the child, physician and parents. Most children with asthma would like to engage in sports. However, fear, past experiences of physical restrictions from the disease, perception of family members, unfavourable institutional policies, the reluctance of school teachers to include children with bronchial asthma in sports and healthcare workers' advice that discourages physical exercise are barriers to vigorous physical activities in children with bronchial asthma. This leads to a sedentary lifestyle, which decreases their quality of life and increases obesity, thus worsening their asthma symptoms.

Bronchial asthma is a chronic inflammatory airway disease leading to variable airway obstruction and hyperresponsiveness. Exercise can trigger or aggravate bronchial asthma symptoms via physical and chemical mechanisms. Exercise-induced bronchoconstriction can also occur in children who have bronchial asthma. Exercise, however, reduces the severity of exercise-induced bronchial asthma, reduces airway inflammation and improves pulmonary function in patients with asthma. Regular physical activity improves bronchial asthma control and quality of life in patients with asthma; it also reduces the amount of medication required to control the disease. As a result of this, regular exercise is recommended as a non-pharmacological adjunct to the management of bronchial asthma. Exercises that do not require prolonged rapid breathing, like playing volleyball, badminton, or aerobics exercises, are least likely to cause exercise-induced bronchoconstriction. For a child with bronchial asthma to benefit from the effects of regular exercise, the choice of exercise, reasonable asthma control, and good prevention and management of exercise-induced bronchoconstriction are essential.

Prevalence of Sickle Cell and Sickle Cell Trait Among Children and Adolescents in Nigeria: A Protocol for Systematic Review and Meta-Analysis (Prospero ID: CRD42024556354)

Wed, 14 May 2025 00:00:00 +0000

Background

Sickle cell disease (SCD) is one of the most common genetic disorders globally, with Nigeria believed to have the highest burden in the whole world. Despite the high burden in the country, the true prevalence of SCD, as well as its main driver- sickle cell trait (SCT) is unknown. These parameters are important for planning and resource allocation.

Objective: To review the prevalence of SCD, SCT and associated factors in Nigerian children and adolescents.

Methods: The search strategy will include MeSH terms, keywords, and entry words from the following databases: AJOL, Google Scholar, Research Gate, PubMed, EMBASE, Cochrane Library, Scopus and Web of Science collections. Studies among children and adolescents in Nigeria that report the prevalence of SCD and/or SCT available in English will be included. The primary outcome will be pooled prevalence of sickle cell disease (SCD) and sickle cell trait (SCT) among children and adolescents in Nigeria, while the secondary outcome will be regional and gender variations and associated factors of SCD in Nigeria. All identified articles will be screened, and those that meet the inclusion criteria will be included in the systematic review and meta-analysis. All the studies will be assessed for methodological and statistical heterogeneity. The National Institute of Health (NIH) Quality Assessment Tool for observational studies and the Cochrane tool of risk of bias will be used to assess the quality of selected studies, and publication bias will further be assessed with a funnel plot.

Results: Using random effect models, results will be presented as pooled and regional prevalence along a 95% confidence interval, while odds ratio and 95% will be used to summarise effects size association. A cumulative meta-analysis will assess the time trend, pooled, regional prevalence and variations.

Pattern of Diseases and Outcome of Hospitalization Among Children at the Rivers State University Teaching Hospital, Port Harcourt, Nigeria

Woroma Wonodi, Boma West — Wed, 14 May 2025 00:00:00 +0000

Background: Periodic evaluation of the pattern of disease and outcome among hospitalized children is important in auditing the quality and effectiveness of health care systems.

Objective: To describe the pattern of diseases and outcome of hospitalized children in a Nigerian facility.

Methods: This was a retrospective study carried out at the Children's Medical Ward of the Rivers State University Teaching Hospital, Nigeria, over five years, from the 1st of January 2017 to the 31^st of December 2021. The ward records of all hospitalized children aged one month to 16 years were reviewed and analysed. Neonatal and surgical cases were excluded.

Results: Of the 2213 patients studied, males predominated in a ratio of 1.5:1, with the majority of the children aged below five years. The mean age was 20.7±3.7 months. Most admissions were recorded during the rainy season and were mainly due to communicable diseases, especially malaria, tonsillitis and bronchopneumonia. Non-communicable diseases were mostly acyanotic congenital heart disease, seizures, cerebral palsy and cancers. The majority of the children were discharged home, while 0.4% were referred to other facilities for further care. The mortality rate was 3.8%, and this was mainly due to malaria, bronchopneumonia, and meningitis.

Conclusion: The morbidity and mortality pattern in hospitalized children with non-surgical conditions is mostly due to preventable communicable diseases. Increased health funding by the government, improved socioeconomic status, health education, immunisation, and sanitation could reduce the morbidity and mortality from these communicable diseases.

Knowledge and Attitude of Mothers Towards Donor Breast Milk in Makurdi, Nigeria

Aondoaseer Michael, Morgan G Adikwu, Martha O Ochoga — Wed, 14 May 2025 00:00:00 +0000

Background: Breastfeeding is one of the most effective ways to ensure a child's health and survival. Improving breastfeeding practices could save the lives of more than 800,000 under-five children every year, the vast majority of whom are under six months of age. Early exposure to maternal antibodies, lactoferrin, oligosaccharides and other protective components in breast milk may improve neonatal and infant immune function. Mother's milk is widely recognized as the optimal feeding for term infants but also provides vital health benefits for sick and preterm infants. When mother's milk is unavailable, or in short supply, donor human milk is the second best alternative.

Objective: To determine mothers' knowledge of and attitudes toward donor breast milk.

Methods: A cross-sectional, descriptive study of 403 mothers attending antenatal/immunization clinics was conducted from September 2022 to January 2023. Data was collected using an interviewer-administered questionnaire.

Results: While 36.5% (n = 147) of mothers had heard about donor breast milk, 67.2% (n = 271) of the mothers were willing to donate their breast milk, but only 37.2% (n = 150) agreed to accept donor breastmilk for their baby. Knowledge about donor breast milk was significantly associated with educational status (p = 0.036), and the willingness to donate was significantly associated with knowledge (p = 0.015).

Conclusion: Mothers' education is a key factor influencing both knowledge and willingness to donate breastmilk.

Prevalence and Risk Factors for Elevated Blood Pressure Patterns and Hypertension Among Children Attending a Tertiary Outpatient Clinic in Port Harcourt, Nigeria

Uchenna Onubogu, Datonye Briggs, Boma West, Josephine Aitafo — Wed, 14 May 2025 00:00:00 +0000

Background: The prevalence of hypertension among children is on the increase, and it is of global concern.

Objectives: To determine the prevalence and associated risk factors of elevated and hypertensive-range blood pressure among children and adolescents.

Methods: This was a cross-sectional, prospective study of patients who attended the Paediatric Outpatient Clinic of the River State University Teaching Hospital, Nigeria. Their biodata, family and social history, dietary history and blood pressure (BP) were recorded, assessed and analysed.

Results: The mean systolic and diastolic BP of 500 children aged 3 to 18 years were 102.6 (±10.1) mmHg and 60.0 (±9.0) mmHg. BP levels in higher-than-normal cut-off ranges were recorded in 76 (15.2%) children. A hypertensive BP range was found in 44 (8.8%), while 32 (6.4%) had elevated blood pressure. Elevated BP was significantly higher among subjects with a family history of hypertension (OR = 2.07, 95%CI = 1.01, 4.26; p = 0.04), children who skipped breakfast regularly (OR = 5.9, 95%CI = 1.74, 20.1; p = 0.01), and obese or overweight children (OR = 2.79, 95%CI = 1.43, 5.42; p = 0.002).

Conclusions: Obesity, skipping breakfast, and a family history of hypertension were the identified risk factors for elevated blood pressure. Early screening and lifestyle modifications are essential in controlling hypertension in children.

Effects of Adenotonsillectomy on Intermittent Hypoxia and Microalbuminuria in Children with Obstructive Symptoms

Omowonuola A Ogundoyin, Adebolajo A Adeyemo, Paul A Onakoya — Wed, 14 May 2025 00:00:00 +0000

Background: Obstructive sleep apnoea (OSA) in children, primarily caused by adenotonsillar hypertrophy, can result in intermittent hypoxia and systemic effects like cardiovascular, neurodevelopmental, and renal complications.

Objectives: To examine the impact of adenotonsillectomy on renal stress, particularly microalbuminuria, and aims to evaluate its effects on hypoxic burden and renal function in Nigerian children with obstructive symptoms.

Methods: This study prospectively and longitudinally examined 169 Nigerian children aged 3 to 8 years with adenotonsillar hypertrophy, measuring Apnoea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), and Albumin-Creatinine Ratio (ACR) for microalbuminuria before and 36 hours after adenotonsillectomy.

Results: Adenotonsillectomy significantly reduced the AHI from a mean of 15.2 to 5.4 and ODI from 10.5 to 3.8, indicating reduced hypoxic events during sleep. The mean oxygen saturation levels improved from 88.3% preoperatively to 94.8% postoperatively (p<0.001). Microalbuminuria, as reflected by ACR, showed a significant decrease, with median values dropping from 25.5 mg/g to 10.3 mg/g. Children with severe baseline symptoms benefited more from adenotonsillectomy since respiratory and kidney indicators improved more after surgery.

Conclusion: This study underscores adenotonsillectomy's significant respiratory and renal health benefits in children with OSA. Reduction in hypoxic burden and renal stress markers by adenotonsillectomy makes it a crucial intervention not only for alleviating respiratory symptoms but also for safeguarding against systemic impacts such as renal dysfunction. Advocacy for early surgical intervention in moderate to severe OSA cases will prevent long-term complications and reduce healthcare burdens.

Does Nutritional Status Influence the Surgical Outcome in Children with Cleft Palate at The University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria?

Kesiena S Yarhere, Iroro E Yarhere — Wed, 14 May 2025 00:00:00 +0000

Background: Cleft palate, a congenital deformity affecting the roof of the mouth, poses challenges in feeding, speech, and overall health. Surgical intervention is often required, but several factors, including nutritional status, may influence the success of the surgery.

Objective: To evaluate the relationship between the nutritional status and cleft palate surgery outcomes at the University of Port Harcourt Teaching Hospital.

Methods: This retrospective study reviewed medical records of 82 children with cleft palate who had surgical repair between 2018 and 2020. Their nutritional status was assessed using the weight-for-age (W/A) and height-for-age (H/A) SDS, calculated with the NiGrowth application (www.nigrowth.com). Clinical parameters were recorded, including cleft classification, cleft dimensions (width and length), and postoperative outcomes like fistula formation.

Results: The study showed that 19.41% of children were underweight, and 40.2% were stunted before surgery. There were 24 cases (29.3%) of fistula formation, with 4 (4.9%) in underweight patients and 9 (11%) in stunted patients. Significant correlations were observed between weight SDS, height SDS and cleft length (r = 0.375, p = 0.029), (r = 0.405, p = 0.018) respectively.

Conclusion: Nutritional status (W/A and H/A SDS) significantly impacts cleft length but does not influence the occurrence of fistula formation post-surgery. The moderate correlation between nutritional status and cleft dimensions highlights the need for a holistic approach to patient management.

Prevalence and Clinical Predictors of Hypoxaemia in Hospitalized Children with Pneumonia in Northern Nigeria

Maimuna O Yusuf, Iragbogie A Imoudu — Wed, 14 May 2025 00:00:00 +0000

Background: Early detection of hypoxaemia and commencement of oxygen therapy improves the management outcome of children with pneumonia.

Objective: To find the prevalence of hypoxaemia and its clinical predictors amongst children presenting with pneumonia at a hospital in northeastern Nigeria.

Methods: Two hundred and ninety (290) children aged 2-59 months who presented to the Emergency Paediatric Unit of the hospital were studied from February 2016 to January 2017. They were selected based on the WHO-defined cases of pneumonia. General and systemic examination was carried out with particular emphasis on the respiratory system. Thereafter, arterial oxygen saturation was measured using a Nellcore Oximax® pulse oximeter.

Results: Hypoxaemia occurred in 169 (58.3%) children. The clinical features of pneumonia which were found to be significantly associated with hypoxaemia were cyanosis (p<0.001), inability to feed (p<0.001), head nodding (p<0.001) and impaired consciousness (p<0.001). The clinical features found most likely to independently predict hypoxaemia were head nodding (p = 0.009, OR = 6.834) and inability to feed (p = 0.000, OR = 16.33).

Conclusion: The prevalence of hypoxaemia in childhood pneumonia was high. The presence of a combination of cyanosis, head nodding, and inability to feed may be used to identify hypoxaemia and serve as a criterion for oxygen administration in children with pneumonia.

Immunotoxiepigenetic Therapeutics: Cornerstone of Paediatric Medicine

Tochukwu M Okafor, Maduka D Ughasoro — Wed, 14 May 2025 00:00:00 +0000

Clarion calls have been made to expand therapeutics to account for immunotoxins and immune dysfunctional processes underlying immune-mediated inflammatory diseases (IMIDs) and infectious diseases.

Synopsis - Prevention of Mother-To-Child Transmission of HIV in Nigeria: An Overview

Emeka C Nwolisa, Iyabode O Dedeke, Farouk M Bashir, Damian U Nwaneri — Wed, 14 May 2025 00:00:00 +0000

The Human Immunodeficiency Virus (HIV) can be transmitted from an infected mother to her child during pregnancy, delivery and breastfeeding. Mother-to-child transmission (MTCT) is known as vertical transmission and is acknowledged as the commonest means of HIV infection in children. The burden of mother-to-child transmission of HIV is very high in sub-Saharan Africa, and Nigeria is not exempt.