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Shekoni O, Iversen S, Diaz GJ, Aune A, Ubuane PO, Imam Z, André B. Healthcare workers' perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria. SAGE Open Med 2024; 12:20503121231224568. [PMID: 38347851 PMCID: PMC10860469 DOI: 10.1177/20503121231224568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/05/2023] [Indexed: 02/15/2024] Open
Abstract
Background Mobile health has enormous potential in healthcare due to the increasing use of mobile phones in low- and middle-income countries; its effective deployment, uptake, and utilization may result in improved health outcomes, including a reduction in neonatal deaths. However, there is a suboptimal uptake of mobile health technologies among healthcare workers in low-resource settings like Nigeria, which are often context-specific. Objective To investigate healthcare workers' perceptions of mobile health technologies in public health facilities in Lagos, Nigeria. Method A qualitative study was conducted, and data were collected through six focus group discussions with 26 healthcare workers (doctors, nurses, and community health extension workers) from three public health facilities in Lagos, Nigeria. The collected data were analyzed using a thematic approach, where themes and subthemes were created. Results Although the participants acknowledged that mobile health enhances patient-provider communication and saves time, they identified altering of healthcare workers' routine practices, information overload, power and network failure, skepticism, lack of trust, and concerns over diagnostic accuracy as potential barriers to its uptake. Conclusion Addressing healthcare workers' perceptions of mobile health technologies may enhance the deployment and uptake of such solutions in Nigeria and similar low-resource settings. Developers and implementers of such can use them to create new or enhance existing mobile health solutions to better meet the needs and requirements of healthcare workers in low- to middle-income health settings, such as Lagos, Nigeria.
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Affiliation(s)
- Oluwatobi Shekoni
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Synne Iversen
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gabriela J Diaz
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Picterus AS, Trondheim, Norway
| | - Anders Aune
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Picterus AS, Trondheim, Norway
| | - Peter Odion Ubuane
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja Lagos, Nigeria
| | - Zainab Imam
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja Lagos, Nigeria
| | - Beate André
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Craig S, Xu Y, Robas K, Iramain R, Yock-Corrales A, Soto-Martinez ME, Rino P, Belen Alvarez Ricciardi M, Piantanida S, Mahant S, Ubuane PO, Odusote O, Kwok M, Johnson MD, Paniagua N, Benito Fernandez J, Ong GY, Lyttle MD, Gong J, Roland D, Dalziel SR, Nixon GM, Powell CVE, Graudins A, Babl FE. Core outcomes and factors influencing the experience of care for children with severe acute exacerbations of asthma: a qualitative study. BMJ Open Respir Res 2023; 10:e001723. [PMID: 37968074 PMCID: PMC10661079 DOI: 10.1136/bmjresp-2023-001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE To identify the outcomes considered important, and factors influencing the patient experience, for parents and caregivers of children presenting to hospital with a severe acute exacerbation of asthma. This work contributes to the outcome-identification process in developing a core outcome set (COS) for future clinical trials in children with severe acute asthma. DESIGN A qualitative study involving semistructured interviews with parents and caregivers of children who presented to hospital with a severe acute exacerbation of asthma. SETTING Hospitals in 12 countries associated with the global Pediatric Emergency Research Networks, including high-income and middle-income countries. Interviews were conducted face-to-face, by teleconference/video-call, or by phone. FINDINGS Overall, there were 54 interviews with parents and caregivers; 2 interviews also involved the child. Hospital length of stay, intensive care unit or high-dependency unit (HDU) admission, and treatment costs were highlighted as important outcomes influencing the patient and family experience. Other potential clinical trial outcomes included work of breathing, speed of recovery and side effects. In addition, the patient and family experience was impacted by decision-making leading up to seeking hospital care, transit to hospital, waiting times and the use of intravenous treatment. Satisfaction of care was related to communication with clinicians and frequent reassessment. CONCLUSIONS This study provides insight into the outcomes that parents and caregivers believe to be the most important to be considered in the process of developing a COS for the treatment of acute severe exacerbations of asthma.
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Affiliation(s)
- Simon Craig
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Paediatric Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Yao Xu
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Kael Robas
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Ricardo Iramain
- Paediatric Emergency Department, Hospital de Clinicas, Asuncion, Paraguay
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera". Caja Costarricense Seguro Social, San José, Costa Rica
| | - Manuel E Soto-Martinez
- Department of Pediatrics, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
- Respiratory Medicine Division, Department of Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera". Caja Costarricense Seguro Social, San José, Costa Rica
| | - Pedro Rino
- Pediatric Emergency Department, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Sofia Piantanida
- Pediatric Emergency Department, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Sanjay Mahant
- Child Health Evaluative Services, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Peter Odion Ubuane
- Institute of Maternal and Child Health/Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Olatunde Odusote
- Institute of Maternal and Child Health/Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Maria Kwok
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Division of Emergency Medicine, New York Presbyterian Hospital-Morgan Stanley Children's Hospital, New York, New York, USA
| | - Michael D Johnson
- Division of Paediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Emergency Department, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Natalia Paniagua
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, País Vasco, Spain
- Paediatric Emergency Department. Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Javier Benito Fernandez
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, País Vasco, Spain
- Paediatric Emergency Department. Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Gene Y Ong
- Children's Emergency Department, KK Women's and Children's Hospital, Singapore
| | - Mark D Lyttle
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Jin Gong
- Department of Paediatrics, Affiliated Renhe Hospital of China, Yichang, Hubei, China
- Department of Paediatrics, China Three Gorges University, Yichang, Hubei, China
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Gillian M Nixon
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Respiratory Medicine, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Colin V E Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- Sidra Medicine Department of Emergency Medicine, Doha, Ad-Dawhah, Qatar
| | - Andis Graudins
- Emergency Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
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Abayneh M, Rent S, Ubuane PO, Carter BS, Deribessa SJ, Kassa BB, Tekleab AM, Kukora SK. Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development. Front Pediatr 2023; 11:1217209. [PMID: 37435165 PMCID: PMC10331424 DOI: 10.3389/fped.2023.1217209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.
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Affiliation(s)
- Mahlet Abayneh
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sharla Rent
- Duke Department of Pediatrics, Duke School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
| | - Peter Odion Ubuane
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
| | - Brian S. Carter
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Solomie Jebessa Deribessa
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Betelehem B. Kassa
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atnafu Mekonnen Tekleab
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie K. Kukora
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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Oladimeji AB, Lamina MO, Ubuane PO, Adekunle MO, Kehinde OA, Animasahun BA, FidelisNjokanma O. Echocardiographic reference z scores of right ventricular dimension and systolic function of children aged 5-12 years. Clin Exp Pediatr 2023; 66:215-222. [PMID: 37070293 PMCID: PMC10167402 DOI: 10.3345/cep.2022.01410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/23/2023] [Indexed: 04/19/2023] Open
Abstract
Background Reference values for right ventricular dimension and systolic function in Nigerian children are scarce despite their high burden of right ventricular abnormalities. Reference values from other countries may not be suitable for use in Nigerian children because of possible racial variations in cardiac size. Purpose To develop reference values for right ventricular dimension and systolic function in healthy Nigerian children aged 5-12 years. Methods This descriptive cross-sectional study conducted between July and November 2019 included 480 healthy boys and girls aged 5-12 years. The participants were randomly selected from 6 primary schools in the Ikeja Local Government area of Lagos State and their weights and heights measured. Body mass index and body surface area were calculated. Echocardiography was performed at rest in the left lateral position. Results The right ventricular end-diastolic basal diameter (RVD1), right ventricular end-diastolic mid-cavity diameter (RVD2), and right ventricular end-diastolic length (RVD3) were obtained. The right ventricular end-diastolic basal diameter (RVD1), right ventricular end-diastolic mid-cavity diameter (RVD2), and right ventricular end-diastolic length (RVD3) were obtained, as well as tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler-derived right ventricular systolic excursion velocity (S'). The overall mean±standard deviation (SD) values for RVD1, RVD2, RVD3, TAPSE, and S' were 32.95±4.2, 25.86±3.5, 54.57±7.5, 20.11±2.3, and 18.24±2.2, respectively. Age- and sex-specific mean and SD values of the same cardiac indices were determined. Z score charts and the mean± 2SD right ventricular dimensions and systolic function were generated. All right ventricular dimensions were positively correlated with weight, height, body surface area, and body mass index. Only height correlated consistently with TAPSE and S'. Conclusion The observed mean right ventricular dimension indices differed from those derived elsewhere, suggesting that values from other countries may be inappropriate for Nigerian children. These reference values are applicable in daily clinical practice.
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Affiliation(s)
| | | | - Peter Odion Ubuane
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | - Omolara Adeolu Kehinde
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Lagos, Nigeria
| | - Barakat Adeola Animasahun
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Lagos, Nigeria
| | - Olisamedua FidelisNjokanma
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Lagos, Nigeria
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Chionuma JO, Akinola IJ, Dada AO, Ubuane PO, Kuku-Kuye TO, Olalere FD. Profile of insulin resistance of pregnant women at late third trimester in Nigeria: A descriptive cross-sectional report. Niger J Clin Pract 2022; 25:1736-1744. [PMID: 36308248 DOI: 10.4103/njcp.njcp_233_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Exaggerated level of insulin resistance (IR) is associated with poor pregnancy outcomes. Identifying affected women may forestall these outcomes. There are few reports on IR and its predictors among pregnant women in Nigeria. AIM To determine the profile of IR, using the homeostatic model assessment of insulin resistance (HOMA-IR), and its predictors among parturient Nigerian women in third trimester. PATIENTS AND METHODS A cross-sectional baseline data of healthy pregnant women in third trimester, consecutively recruited into a cohort study that evaluated IR and neonatal outcomes at a tertiary maternity. Sociodemographic and clinical data were obtained. Fasting venous blood was analyzed for glucose and insulin and HOMA-IR was calculated. RESULTS We consecutively recruited 401 healthy pregnant women between 28 and 41 weeks [means ± SD = 37.4 ± 0.8 weeks]; mean age 31.52 ± 4.3 years (range: 20-41 years). Median (IQR) HOMA-IR was 1.15 (0.63, 1.96; range: 0.02-11.73). Binary multivariable logistic regression showed overweight- [aOR (95% CI) = 3.29 (1.18, 9.13)], hyperglycemia- [aOR (95% CI) = 2.98 (1.19, 6.90)], and hypertension as independent predictors of IR [aOR (95% CI) = 2.85 (1.18, 6.90)]. CONCLUSION Among nondiabetic Nigerian pregnant women in late third trimester, IR was independently associated with overweight, hypertension, and hyperglycemia. Control of adiposity is a potential target for control of IR and consequently its outcomes.
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Affiliation(s)
- J O Chionuma
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - I J Akinola
- Department of Paediatrics, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - A O Dada
- Department of Pathology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - P O Ubuane
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - T O Kuku-Kuye
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - F D Olalere
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Ubuane PO, Ajiboye OA, Adekunle MO, Akinola AO, Akinyosoye G, Kayode-Awe MO, Ajayi OA, Ohagwu CI, Animasahun BA, Njokanma FO. Reference values and equations for the 6-minute walk distance of Nigerian children aged 6-11 years: A cross-sectional study. Pediatr Pulmonol 2022; 57:2103-2115. [PMID: 35581671 DOI: 10.1002/ppul.25986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The 6-minute walk test (6MWT), a simple, reliable, and valid test that uses the distance walked in 6 minute walk distance (6MWD) to quantify functional capacity, is widely used in the management of chronic disorders. However, the absence of reference standards from sub-Saharan African, including Nigerian, school-aged children limits its utility in this age group. OBJECTIVES To develop normative values and equations for the 6MWD of school-aged Nigerian children. METHODS In a cross-sectional study, healthy children aged 6-11 years in Lagos, Nigeria, completed the 6MWT on 20-m-long straight outdoor courses in their schools. The primary outcome was the 6MWD in meters while potential predictors included demographic (age, sex), anthropometric (height, weight, chest circumference, leg length) and physiologic variables (pre-walk, immediate post-walk, and fifth min-post-walk heart rate [HR], oxygen saturation [SpO2 ], systolic blood pressure [SBP], diastolic blood pressure [DBP], and rating of perceived exertion [RPE]; and the difference between pre-walk and post-walk HR [∆HR], SpO2 [∆SpO2 ], SBP [∆SBP], DBP [∆DBP], and RPE [∆RPE]). RESULTS Overall, 627 pupils (52.1% girls) walked 504.6 ± 66.6 m (95% CI: 499.4, 509.8; range: 326.6-673.0 m); 16 m longer in boys (p = 0.002). A stepwise linear regression model yielded: 6MWD (m) = 347.9 + 14(Ageyears ) + 1.6 (∆HRbeats/min ) + 17.6(Sexmale=1, female=0 ) + 1.2(∆SBPmmHg ); R2 = 0.25. Previously published reference equations mostly over-estimated Nigerian children's 6MWD. CONCLUSION These reference standards add to the global normative data on pediatric 6MWT and may be useful for the functional evaluation of Nigerian school-aged children with chronic childhood disorders.
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Affiliation(s)
- Peter Odion Ubuane
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State, Nigeria
| | | | | | | | - Gbenga Akinyosoye
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State, Nigeria
| | | | - Omotola Aderiyike Ajayi
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State, Nigeria
| | - Chidimma Imma Ohagwu
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State, Nigeria
| | - Barakat Adeola Animasahun
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State, Nigeria.,Department of Pediatrics & Child Health, Lagos State University College of Medicine (LASUCOM)/Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | - Fidelis Olisamedua Njokanma
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State, Nigeria.,Department of Pediatrics & Child Health, Lagos State University College of Medicine (LASUCOM)/Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
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Faleye AD, Olaosebikan BH, Oladimeji AB, Ubuane PO, Adelowo OO. P044 Have we been missing cases of Juvenile Systemic Lupus Erythematosus in Nigeria? The experience of a paediatric rheumatology trainee in Lagos. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab722.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Juvenile Systemic lupus erythematosus (JSLE) is a chronic multisystem autoimmune disease of childhood, which accounts for 10% to20% of systemic lupus erythematosus (SLE). It was initially thought that systemic lupus erythematosus (SLE), including JSLE, was rare in Blacks, this was eventually debunked with increasing reports from Africa. However, it is now known that SLE is more common among patients of African descent in western countries. While the estimated prevalence of JSLE in the developed countries is 0.36–2.5 per 100 000, data in Black Africans is scarce due to missed diagnosis, poor diagnostic capacity and under-reporting.
JSLE has protean manifestations similar to common paediatric conditions such as severe malaria, overwhelming septicaemia, hyper-haemolytic crisis in sickle cell anaemia etc., which often cause delayed or missed diagnosis. The objective is to describe the demographic and clinical characteristics, including outcome of children with JSLE, thus raising awareness on their occurrence and management in Nigerian children.
Methods
Retrospective review of records of children diagnosed with SLE at the Adult/paediatric Rheumatology Clinic and Paediatric Wards of Lagos State University Teaching Hospital (LASUTH) from May 2018 to May 2021.
Results
Twenty-two children, nineteen (n = 19) girls and three (n = 3) boys, aged 5–17 years, fulfilled the American College of Rheumatology (ACR)’s diagnostic criteria for JSLE out of 45 children newly diagnosed with paediatric rheumatic diseases during this period. The duration of symptoms before diagnosis ranged from two weeks to three years. The presentations included recurrent severe anaemia (n = 16), arthritis (n = 17), arthralgia (n = 17), malar rash (n = 17), neurologic symptoms (n = 5) oral ulcers (n = 17), cardiopulmonary symptoms (n = 5), photosensitivity (n = 10) and renal disease (n = 14). Laboratory findings included elevated ESR with a mean (±SD) of 99.68 ± 44.44, positive ANA (n = 22), positive anti-dsDNA (n = 12), low C3 & C4 (n = 2), positive anti-Smith antibody (n = 8) and massive proteinuria (n = 14). All patients were treated with steroids and disease modifying anti-rheumatic drugs (synthetics and biologics) based on disease severity and organ manifestations.
Sepsis (n = 4) was the most common preliminary diagnosis before a final diagnosis of JSLE was made, other preliminary diagnosis were pulmonary tuberculosis (n = 1), dermatitis (n = 1), acute glomerulonephritis (n = 1), Typhoid fever (n = 1), malaria (n = 1), deep vein thrombosis (n = 1), seizure disorder (n = 1), leukaemia (n = 1), meningitis (n = 1), meningoencephalitis (n = 1), hyper-haemolytic crisis in sickle cell anaemia (n = 1), Steven Johnson syndrome (n = 1), Juvenile Idiopathic Arthritis (n = 2), Eczema (n = 1), unexplained anaemia (n = 1) and acute rheumatic fever (n = 1).
One boy and three girls defaulted from clinic after commencement of treatment due to severe financial constraints of their parents and religious beliefs, however six girls died, four from an acute flare and two from end stage renal disease.
Conclusion
Our study has shown that JSLE has protean manifestations with a tendency to miss its diagnosis due to similarity of signs and symptoms with common childhood diseases in our environment. JSLE may not be as rare as commonly thought, thus its prompt diagnosis and treatment require a high index of clinical suspicion.
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Affiliation(s)
- A D Faleye
- Rheumatology Unit, Department of Internal Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - B H Olaosebikan
- Department of Internal Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - A B Oladimeji
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - P O Ubuane
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - O O Adelowo
- Rheumatology Unit, Department of Internal Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Ubuane PO, Okonkwo IR, Akinola AO. Less-invasive surfactant administration in sub-Saharan Africa. Lancet Child Adolesc Health 2020; 4:e13. [PMID: 32450125 DOI: 10.1016/s2352-4642(20)30111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Peter Odion Ubuane
- Department of Paediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria.
| | - Ikechukwu Richard Okonkwo
- Department of Paediatrics, University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria
| | - Ayodeji Olusola Akinola
- Department of Paediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
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Disu EA, Kehinde OA, Anga AL, Ubuane PO, Itiola A, Akinola IJ, Falase B. Congenital pulmonary airway malformation: A case report of a rare cause of neonatal respiratory distress and review of the literature. Niger J Clin Pract 2020; 22:1621-1625. [PMID: 31719287 DOI: 10.4103/njcp.njcp_20_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Congenital pulmonary airway malformation (CPAM), formerly known as congenital cystic adenomatoid malformation (CCAM), is a rare developmental dysplastic lesion of the fetal tracheobronchial tree. CPAM is a rare cause of neonatal respiratory distress; however, its presence may span fetal to adult period. In two previous case-reports from Nigeria, CPAM was present in post-neonatal infants. We report the case of a neonate, who presented with increasing respiratory distress and an abnormal chest radiograph, initially assumed as pneumonic changes. A revised diagnosis of CPAM was made after a chest computed tomography (CT) scan. The neonate subsequently had a successful excision of the affected lobe with remarkable clinical improvement. The case highlights the need to utilize superior imaging studies such as CT when plain radiographs are inconclusive.
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Affiliation(s)
- E A Disu
- Department of Paediatrics, Lagos State University Teaching Hospital; Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - O A Kehinde
- Department of Paediatrics, Lagos State University Teaching Hospital; Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - A L Anga
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - P O Ubuane
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - A Itiola
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - I J Akinola
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - B Falase
- Department of Surgery, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
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