John Akintunde Okeniyi

Neonatal tetanus at the close of the 20th century in Nigeria.

The year 2000 marked another failed World Health Organization deadline for neonatal tetanus (NNT) eradication. Existing preventive strategies can be enhanced by exploring factors involved in the persistence of the scourge. Thus, records of neonates admitted between 1996 and 2000 into the Wesley Guild Hospital, Ilesa, were analysed. Of 3051 total neonatal admissions,162 (5.3%) had NNT. Eighty-nine (54.9%) mothers had clinic-based antenatal care (ANC), but only 59 (36.4%) had tetanus toxoid (TT) vaccines. The majority (66.7%) of them delivered at home or churches and others at either private clinics or primary health centres. Overall, the case fatality rate was 43.8%, though it was significantly higher among babies whose mothers had neither clinic-based ANC (odds ratio [OR] = 2.62; 95% confidence interval [CI] = 1.33-5.18) nor antenatal TT vaccination (OR = 2.41; 95% CI = 1.17-5.03). Thus, improvement on ANC, anti-tetanus immunization and ensuring hygienic deliveries are crucial for eliminating NNT in the 21st century.

Cerebral Malaria in Children with Cyanotic Heart Diseases: The Need for a Closer Look

We report four cases of encephalopathy admitted with fever, hypercyanosis, breathlessness, deep coma and convulsions considered of interest because these children had cyanotic heart diseases and concomitant cerebral malaria. Their presenting clinical features, which suggested cerebral malaria (decreased level of consciousness ranging in severity from drowsiness and severe headache to confusion, delirium and even deep coma) may equally characterise hypercyanotic episodes among children with uncorrected cyanotic cardiac defects. We also inferred that children with cyanotic cardiac defects may be prone to cerebral malaria and that those residing in the tropics may benefit from anti-malarial prophylaxis.

Audit of availability and distribution of paediatric cardiology services and facilities in Nigeria

Summary Background Paediatric cardiac services in Nigeria have been perceived to be inadequate but no formal documentation of availability and distribution of facilities and services has been done. Objective: To evaluate and document the currently available paediatric cardiac services in Nigeria. Methods In this questionnaire-based, cross-sectional descriptive study, an audit was undertaken from January 2010 to December 2014, of the personnel and infrastructure, with their distributions according to geopolitical zones of Nigeria. Results Forty-eight centres participated in the study, with 33 paediatric cardiologists and 31 cardiac surgeons. Echocardiography, electrocardiography and pulse oximetry were available in 45 (93.8%) centres while paediatric intensive care units were in 23 (47.9%). Open-heart surgery was performed in six (12.5%) centres. South-West zone had the majority of centres (20; 41.7%). Conclusions Available paediatric cardiac services in Nigeria are grossly inadequate and poorly distributed. Efforts should be intensified to upgrade existing facilities, establish new and functional centres, and train personnel.

Electrocardiographic abnormalities and dyslipidaemic syndrome in children with sickle cell anaemia.

Summary Background Lipid and electrocardiographic (ECG) abnormalities have been reported in adults with sickle cell anaemia (SCA) and may reflect underlying structural and/ or functional damage. However, the relationship between ECG and lipid abnormalities among children with sickle cell disease is not fully understood. Objectives To compare the steady-state lipid and ECG abnormalities in children with SCA to the controls and examine the hypothesis that lipid abnormalities are closely related to electrocardiographic abnormalities, and therefore are a reflection of cardiac damage among these children. Methods: Clinical, laboratory and ECG profiles of 62 children with SCA and 40 age- and gender-matched haemoglobin AA controls were compared. The influence of clinical characteristics, lipids profiles, markers of haemolysis, and renal and hepatic dysfunction on ECG pattern in children with SCA was then determined. Results The patients had lower average diastolic and mean arterial blood pressure, total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels than the controls, (p = 0.001, 0.002, 0.000 and 0.000, respectively). The mean triglyceride level was significantly higher (p < 0.001), while high-density lipoprotein cholesterol (HDL-C) levels were comparable (p = 0.858). The cases were about six times more likely to have left ventricular hypertrophy than the controls (OR = 6.4, 95% CI = 2.7–15.6, p = 0.000). Haematocrit level had a negative correlation with QTC (r = –0.3, p = 0.016) and QT intervals (r = – 0.3, p = 0.044). Triglyceride levels had a positive correlation with the PR interval (r = 0.3, p = 0.012), while serum alanine transferase (ALT) concentrations had an inverse correlation with PR interval (r = –0.3, p = 0.015). There was no statistical difference in the sociodemographic and clinical characteristics of the SCA children with or without ECG abnormalities. However, the mean triglyceride and serum ALT levels in those with ECG abnormalities were significantly higher than those without (p = 0.007 and 0.045, respectively). Conclusion Lipid and ECG abnormalities are common in children with SCA. Elevated triglyceride and serum ALT levels are possible biochemical markers of ECG abnormalities in these patients.

A Case Report on the Development of aHumanitarian Pediatric Cardiac SurgeryProgramme at the Obafemi AwolowoUniversity Hospital, ILE-IFE, Nigeria inPartnership with the Cardiaceye InternationalFoundation Cardiovascular Team

Humanitarian cardiac surgeries consisting of highly specialized cardiovascular teams from developed countries can provide valuable local assistance with patient care in the emerging economies of the developing world. However, the best approach for developing a sustainable center in the emerging world is still debatable. Herein, we present a report a collaborative initiative between the Cardiac Eye International Foundation and the Obafemi Awolowo University, ILEIFE,Nigeria. The Cardiac Eye International Foundation is an independent non-profit charitable organization whose primary aim is to provide educational information, collaborate in scientific research and provide outreach training services for heart health care.

Trans-thoracic open ligation of the persistent ductus arteriosus in Ile-Ife, Nigeria

Background: Surgical ligation of a patent ductus arteriosus (PDA) is often the only available option in resource-poor countries such as Nigeria in order to prevent pulmonary hypertension and other complications of a patent ductus. Objective: The purpose of our study was to review our surgical experience, highlighting our techniques at a University Teaching Hospital in Nigeria. Materials and Methods: This is a retrospective audit of the patients who had trans-thoracic open surgical (TTOS) patent ductus ligation over a 5-year period (2009-2013). Result: Sixteen patients (2 boys and 14 girls) aged 4 months-19 years (Mean = 7.1 ± 6.7 years) had TTOS PDA ligation utilizing a triple suture ligation technique. Only three (18.8%) were asymptomatic pre-operatively. Eleven (68.9%) had isolated PDA and others had associated cardiac and extracardiac lesions. The most common post-operative complication was chylothorax, which occurred in two patients (12.5%), and most patients (75%; n = 12) were discharged home by the 5 th post-operative day. Conclusion: Careful attention during transthoracic open surgical closure of the persistent ductus arteriosus will ensure a safe procedure associated with relatively few complications and short post-operative hospital stay.

Cardiac tamponade in Ilesa, Nigeria : audit

Background: There is a dearth of information on cardiac tamponade in children in Nigeria. Objective: To review the frequency, aetiology and outcome of cardiac tamponade in children in Ilesa, Nigeria. Design: A descriptive retrospective hospital-based study. Setting: The children’s emergency room (CHER), Wesley Guild Hospital, Ilesa. Subjects: All post-neonatal aged children with diagnosis of cardiac tamponade over a seven year period (2001 – 2007). Results: Of the 8,813 CHER admissions, cardiac tamponade was diagnosed in only 16 (0.2%) children (11 boys and 5 girls). The leading aetiologies were Staphylococcus aureus pericarditis (6 cases), blunt chest injury (4 cases) and tuberculosis pericarditis (3 cases). The mean (SD) was 5.6 (3.1) years. Recurrence was observed in 3/12 (25.0%) of the non-traumatic cases. The mortality was 10/ 16 (62.5%) with 100% case fatality recorded following trauma and 66.7% and 50.0% following tuberculous and staphylococcal pericarditis respectively. Conclusion: The incidence of cardiac tamponade in children in Ilesa, Nigeria seems low but the mortality is unacceptably high. Prompt diagnosis and improved interventional facilities are required.