Paediatric dialysis services in Nigeria: availability, distribution and challenges

BACKGROUND

Dialysis provides relief of complications of renal failure. However, the availability, distribution and challenges facing paediatric dialysis service (PDS) in Nigeria are presently unknown.

METHODS

Questionnaires were mailed to federal government-funded tertiary hospitals in all 36 states in Nigeria including the Federal Capital Territory (FCT). The characteristics of hospitals providing PDS were compared to those not providing PDS.

RESULTS

Thirty-four (34) tertiary hospitals in 31 States and the FCT participated in the study: 28 (82.4%), 22 (64.7%) and 12 (35.3%) had >1000 paediatric admissions per year, >50 paediatric beds and >10 paediatricians respectively. Sixteen (47.1%) provided at least one form of PDS; 2 (12.5%), 5 (31.3%) and 9 (56.3%) hospitals provided peritoneal dialysis (PD), haemodialysis (HD) and both forms, respectively. Centres providing PDS were more likely to be teaching hospitals (p value=0.000), had >10 paediatricians (p value=0.016) and provided dialysis to adults (p value=0.000). Lack of consumables, skilled manpower and high cost were common challenges identified.

CONCLUSION

PDS is unavailable in about half of Nigeria. HD is the commonest modality available and most of the hospitals providing PDS are the large hospitals. Common challenges to PDS were lack of dialysis consumables, skilled manpower and high cost.

A mutation in the enamelin gene in a mouse model

Amelogenesis imperfecta is an inherited disorder affecting tooth enamel formation. We previously isolated a mouse strain with an amelogenesis imperfecta phenotype (ATE1 mice) from a dominant ethylnitrosourea screen and mapped the disease-causing defect to a 9-cM region of mouse chromosome 5. In the current study, we tested the hypothesis that there is a mutation in enamelin (ENAM) or ameloblastin (AMBN), both of which are located within the linkage region, by sequencing these two candidate genes. Analysis of our data shows that the amelogenesis imperfecta phenotype is linked to a C > T transition in exon 8 of the enamelin gene. The mutation predicts a C826T transition, which is present in the enamelin transcript and changes the glutamine (Gln) codon at position 176 into a premature stop codon (Gln176X). Conversely, no mutation could be detected in the ameloblastin gene. These results define the ATE1 mice as a model for local hypoplastic autosomal-dominant amelogenesis imperfecta (AIH2), which is caused by enamelin truncation mutations in humans.

Urethral prolapse in a woman in her reproductive age: A very rare occurence

BACKGROUND

Urethral prolapse is a rare condition occurring in prepubertal girls and postmenopausal women. Even most rare is that occurring in the reproductive age grade.

METHOD

A report of a woman in her reproductive age who presented in the gynaecology clinic of a private hospital is presented together with a brief review of the literature.

RESULTS

Urethral prolapse associated with uterovaginal prolapse, lower abdominal pain and dysuria in a 48-year old grand multiparous (para 8 + 0) farmer who is still observing her monthly menstrual cycle was seen. Her pregnancies and deliveries were unsupervised. A urine culture revealed moderate growth of Escherichia coli sensitive to ciprofloxacin. The urethral prolapse resolved satisfactorily on this.

CONCLUSION

It is advocated that antenatal care, education and women empowerment be made a priority. This will almost eradicate this very rare condition in our society.

Obstructive uropathy in childhood, as seen in University of Port Harcourt Teaching Hospital, Nigeria

BACKGROUND

Obstructive uropathy is a cause of morbidity and mortality in children. In Port Harcourt, data on causes of obstructive uropathies are not readily available. This study was carried out to identify the causes and outcome of obstructive uropathies seen in our children's ward.

METHODS

The case records of children with the diagnosis of obstructive uropathies who were treated at the University of Port Harcourt Teaching Hospital (UPTH) between October 1997 and October 2002 were reviewed.

RESULTS

A total of 20 patients, all males were seen. The ages ranged from 4 weeks to 13 years with a mean of 2.3+/-2.8 years. The causes of obstructive uropathy were posterior urethral valves (PUV) 16 (80%), bladder calculi 2 (10%), bladder rhabdomyosarcoma and urethral stenosis 1 (5%) each. Poor stream of urine and dysuria were the commonest presentation. The duration of symptoms ranged from 2 days to 13 years. None of the patients with PUV was diagnosed prenatally. Hypertension and urinary tract infection each were found in 50% of the patients while 6 (30%) presented with features of renal failure. Seven patients died, giving a mortality rate of 35%. Age at presentation less than one year and duration of symptoms longer than one month was associated with higher mortality although it was not statistically significant.

CONCLUSION

PUV is the commonest cause of obstructive uropathy seen in UPTH. Earlier diagnosis during pre-natal period or when this is not possible, diagnosis within the first week of life should be encouraged. Parents, nurses and attending doctors should ensure they observe the urinary stream of every male child before discharge from the hospital for early detection and management of PUV.

A prospective clinical study of patients with hypernatraemic dehydration

In a clinical prospective 3-year study of 158 children aged 2 weeks to 14 years with hypernatraemic dehydration (serum sodium 150 mmol/l or more), infants predominated (61.4%). The 158 children with hypernatraemia accounted for 13.7% of all children admitted with gastroenteritis over the same period, and significant aetiological factors included the use of artificial feeds, differences between the children with hypernatraemia and those with normo- or hyponatraemia, P < 0.001, P < 0.001, respectively; the use of breast milk, P < 0.001, P < 0.001, respectively; nutritional status, P < 0.001, P < 0.001, respectively; and clinical state of mild to moderate dehydration P < 0.001; P < 0.001, respectively; but not with patients considered severely dehydrated. There was also a significant difference between the presence of neurological features in hyper- and normonatraemic patients P < 0.001; in hyper- and hyponatraemic patients P < 0.05, and in mortality rate between hyper- and normonatraemic patients, P < 0.05 but not between hyper- and hyponatraemic patients. A history of refusal to feed or vomiting was obtained in 41 children (25.9%). The mean serum sodium was 155.5 mmol/l (range 150-189 mmol/l); mean serum urea 7.7 mmol/l (range 1-18.9 mmol/l). Hypernatraemic dehydration remains an important and serious complication of childhood gastroenteritis in our area of study. The use of artificial milk feeds is contributory, and well-nourished babies appear more at risk. We recommend more liberal water intake during gastroenteritis and the public should also be educated on and made more aware of this condition.

Three patients with arteritis

Three boys were treated for arteritis of the aorta and great vessels and bilateral renal artery stenosis. One presented at age 6 months with failure to thrive, excessive sweating, and vomiting: hypertension and cardiac failure were subsequently diagnosed. The two older boys (7 and 14 years) presented with symptomless hypertension. The clinical and angiographic findings in the three patients suggest that the illness may have been Takayasu's arteritis, which should be included in the differential diagnosis of hypertension in infancy and childhood. Renal autotransplantation was performed in all three patients with good results. Early renal autotransplantation may reduce the morbidity associated with this disease.