BackgroundDue to the health and economic benefits of breast milk, the World Health Organization (WHO) recommends that for infants who cannot receive breast milk from their own mothers, the next preferred option is donated breast milk. This recommendation is however rarely practiced in most developing countries where donor milk is not widely accepted.MethodsThis cross-sectional multi-center study enrolled mothers attending antenatal or pediatric clinics in six tertiary institution in south-east Nigeria using purposive and convenient sampling method. Data collection was done using pretested questionnaires. The study aimed to assess the knowledge, acceptability and willingness to donate breast milk and/or use donated breast milk for their infants It also explored factors that determine this behavior.ResultsA total of 1235 mothers participated; 39% (480/1225) have heard about the concept of donor milk, while only 10% (79/759) and 7% (81/1179), respectively, had adequate knowledge of the concept and policy on donor milk. Sixty percent indicated willingness to use donor milk or donate breast milk if need arises. Respondents with lower age (p = 0.049) and with higher occupational status (p = 0.001) were more likely to have adequate knowledge of donor breast milk, while respondents with lower educational attainment (p = 0.002) and those who are non-Christians (p = 0.004) were more likely to request financial inducement for donating their breast milk. Adequate knowledge of the concept of donor milk (p = 0.001), preference of donor milk to infant formula (p = 0.001) and requirement of financial remuneration (p = 0.001) were the only significant predictors of willingness to donate and/or receive donated breast milk.ConclusionThe knowledge of the concept of donor breast milk and awareness of policies regulating its practice in Nigeria is low, but the prospect of its acceptability is high among mothers surveyed in south-east Nigeria. Targeted public education by relevant government agencies in collaboration with clinicians, community and religious leaders about the concept of donor breast milk to families may help increase the acceptance and practice of donating breast milk and/or use of donated breast milk among mothers in the region.

Background. Sickle cell nephropathy (SCN) is a serious complication of sickle cell anaemia (SCA) with asymptomatic onset in childhood and possible progression to chronic kidney disease (CKD). In Southeast Nigeria, few studies have evaluated renal function in paediatric SCA patients for early detection of renal impairment and early intervention to reduce morbidity and mortality. Therefore, this study evaluated the renal function of paediatric SCA patients in a steady state based on glomerular filtration rate and urinalysis findings (proteinuria and haematuria). Methods. A cross-sectional study of consecutively recruited sixty haemoglobin SS (HbSS) children in a steady state and sixty age- and sex-matched haemoglobin AA (HbAA) controls aged 2–18 years was done. Renal function of HbSS subjects was evaluated using estimated glomerular filtration rate (eGFR) which was compared with healthy HbAA subjects. The prevalence of significant proteinuria and haematuria, its association with eGFR, and the effect of past sickle cell crisis (in the preceding 24 months) on renal function were also evaluated. Results. Mean eGFR was significantly higher in HbSS subjects than in the HbAA subjects (p=0.001) and decreased with age. Significant proteinuria and haematuria were more prevalent in the HbSS group (3.4% and 6.7%, respectively) compared to the HbAA subjects (0% and 0%, respectively) (p=0.496 and 0.119, respectively). No significant association was observed between eGFR and proteinuria (p=1.000) or haematuria (p=1.000). There was a positive correlation between eGFR and frequency of past painful crisis that required hospitalization (r=0.138, p=0.295) and between eGFR and frequency of blood transfusion (r=0.679, p≤0.001). Conclusions. Asymptomatic paediatric HbSS (SCA) patients had higher mean eGFR indicating an increased risk of nephropathy. There was no association between eGFR and proteinuria or haematuria. Frequent sickle cell crises especially one requiring transfusion were positively correlated with hyperfiltration.

The classification of cerebral palsy (CP) remains a challenge; hence the presence of so many classifications and a lack of consensus. Each classification used alone is incomplete. Therefore, a multiaxial classification gives a more comprehensive description of a child with CP. The recent WHO International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of focusing on the functional consequences of various states of health and has stimulated the development of newer functional scales in CP. It is widely accepted that the functional classification is the best classification for the patient because it guides management. The objectives of this chapter are to review the various classifications of CP, to highlight the clinical features used in the various classifications, to outline the recent functional classifications of CP and to highlight how these recent classifications guide current management. It is expected that at the end of this chapter, the reader should be able to understand the difficulties in classifying CP, enumerate and discuss the various classifications of CP, understand the merits and shortcomings of each classification scheme, clinically evaluate and classify a child with CP multiaxially and understand how functional scales predict current and future needs of children with CP.

IntroductionChildren with cerebral palsy (CP) have gross motor dysfunction (GMD) of varying degrees of severity. The Gross Motor Function Classification System (GMFCS) is widely used internationally to classify children with CP into functional severity levels. There are few reports on the use of GMFCS in Nigeria to determine the severity of motor dysfunction in children with CP. This study aims to classify children with CP in Enugu on the basis of severity of their GMD in order to ascertain their management needs.MethodsThe study was a cross sectional observational study and sample selection was by consecutive recruitment. One hundred (100) children with CP aged 9 – 96 months, attending two Pediatric Neurology Clinics in Enugu, were consecutively recruited. Relevant history was taken including modalities of treatment received. Neurological examination was done and the GMFCS manual was used to classify the children into levels of severity.ResultsGMD varied in severity in the patients from mild (47%) (GMFCS levels I & II) to moderate (7%) (GMFCS levels III) and to severe (46%) (GMFCS levels IV & V). Those in levels I – III (54%) were ambulatory while those in levels IV & V (46%) were non-ambulatory. Of the 53 that required mobility assistive device, only 6 (11.3%) were using one.ConclusionMore than half of CP patients seen in Enugu were ambulatory with mild to moderate motor dysfunction based on the GMFCS. Only a few of our patients are appropriately rehabilitated with augmentative interventions.

Cerebral palsy (CP) is a neurodevelopmental disability. It is the most common cause of physical disability in childhood and occurs worldwide with a prevalence of 2-2.5 per 1 000 live births in the Western world. [1] The prevalence of CP in Nigeria is unknown and the rate of children attending neurology clinics in Nigeria varies broadly from 16% to 50.3%. [2-4] The University of Nigeria Teaching Hospital (UNTH), Enugu, reported CP to be the second most frequent neurological disorder seen in the paediatric neurology clinic (PNC); [2] however, there is a paucity of studies on gross motor dysfunction (GMD) in CP in Africa. The most current definition of CP is, 'CP describes a group of permanent disorders of the development of movement and posture causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication and behaviour, by epilepsy and secondary musculoskeletal problems. ' [5] These impairments are experienced to varying degrees and the severity of CP is based on a functional classification of these impairments. [1,5,6] There are various functional scales, with the most popular one being the Gross Motor Function Classification System (GMFCS). GMFCS quantifies a child's gross motor function (ambulatory function) into five levels of severity, ranging from walking without restrictions (level I), to total dependence for ambulation (level V). [5,6] Vasconcellos et al. [7] in Brazil reported 34.3% of the study population as ambulatory while Nordmark et al. [8] in southern Sweden reported a much higher proportion of ambulatory patients (73%). Medical research hasn't been able to explain this huge discrepancy. The aim of this study was to identify the factors that are associated with the severity of motor function, as determined by the GMFCS in children with CP in Enugu, Nigeria. Methods Study sites The study was carried out in the PNCs of the UNTH, Ituku-Ozalla, and Enugu State University Teaching Hospital (ESUTH). The UNTH is one of the first-generation teaching hospitals in Nigeria. It has multidisciplinary departments and caters for patients from predominantly the southeastern region of the country. The PNC of UNTH operates once a week and caters primarily for children who have neurological conditions and have been referred. ESUTH is a smaller and relatively new teaching hospital. Its PNC also runs once a week (on a different weekday). Sampling method This was a cross-sectional observational study. Sample selection was non-randomised and the subjects were consecutively recruited until the desired sample size was reached. Patients aged between 9 and 96 months with a diagnosis of CP were recruited. Patients with other movement disorders, physical disabilities and motor abnormalities, such as muscular dystrophies, paralytic poliomyelitis and spina bifida (myelomeningocele) were excluded. Ethical approval and consent This rese...