Most of the reviews on histoplasmosis documented in literature have been in the adult population. Very few studies highlight the peculiarities associated with histoplasmosis in Africa especially in the pediatric population. This review addresses the above concerns with clinical summaries and diagnosis of some case reports of histoplasmosis in African children. We highlighted 44 case reports of histoplasmosis in African children (1950–2021) distributed across Western Africa (38.6%, n = 17), Eastern Africa (9.1%, n = 4), Southern Africa (9.1%, n = 4), and Central Africa (43.2%, n = 19). No case report was found from Northern Africa. The age range was 1–17 years, with a mean of 9.2. Of the 44 case reports, 8 cases (18.2%, 8/44) were caused by Histoplasma capsulatum var capsulatum, 33 cases (75%, 33/44) were caused by Histoplasma capsulatum var duboisii, and specie identification was not found in 3 cases. Only three (6.8%) cases were HIV positive; 56.8% (25/44) were disseminated histoplasmosis, pulmonary histoplasmosis accounted for just one case (2.3%, 1/44). Extrapulmonary presentation included skin lesions (ulcers, fistulas, nodules, patches, pigmentations, papules, and abscesses), bone lesions, osteoarthritis, and fractures. The commonest sites affected were skin ( n = 29, 65.9%), bones ( n = 20, 45.5%), and lymph nodes ( n = 15, 34.1%). Histopathology was the commonest diagnostic method ( n = 33, 75%). Amphotericin B was first-line therapy in 45.5% of the cases ( n = 20) followed by ketoconazole (20.5%, n = 9); 27 cases (61.4%) had favorable outcomes, 8 cases (18.2%) had fatal outcomes, while in 9 cases, the outcome was not revealed. This review revealed several cases of histoplasmosis misdiagnosed as other conditions including tuberculosis ( n = 3, 6.8%), pneumonia ( n = 1, 2.3%), cancers ( n = 4, 9.1%), nephritic syndrome ( n = 1, 2.3%), leishmaniasis ( n = 1, 2.3%), and hyperreactive malarial splenomegaly syndrome ( n = 1, 2.3%). In addition, histoplasmosis was not considered in some case reports even when symptoms were suggestive. Diagnosis of histoplasmosis was made at autopsy with postmortem findings suggestive of histoplasmosis ( n = 3, 6.8%). This report highlights the need for a paradigm shift on the part of pediatricians in Africa. They need to look beyond clinical conditions considered common in our environment for this age group and evaluate for other diseases including histoplasmosis.
The classification of histoplasmosis as an AIDS-defining illness has largely attributed its occurrence in people to the presence of HIV/AIDS especially in Africa. Prior to the advent of the HIV/AIDS epidemic, several cases of histoplasmosis were documented both in the pediatric and adult populations. Our review revealed 1461 reported cases of pediatric histoplasmosis globally in the last eight decades (1939–2021). North America (n = 1231) had the highest number of cases, followed by South America (n = 135), Africa (n = 65), Asia (n = 26) and Europe (n = 4). Histoplasmosis was much more common in the non-HIV pediatric population (n = 1418, 97.1%) compared to the HIV population. The non-HIV factors implicated were, childhood malignancies (n = 207), such as leukemias and lymphomas as well as their treatment, lung diseases (n = 7), environmental exposures and toxins (n = 224), autoimmune diseases (n = 12), organ transplants (n = 12), long-term steroid therapy (n = 3), the use of immunosuppressive drugs such as TNF-alpha inhibitors (n = 7) malnutrition (n = 12), histiocytosis (n = 3), Hyper immunoglobulin M and E syndromes (n = 15, 1.2%), pancytopenia (n = 26), diabetes mellitus (n = 1) and T-cell deficiency (n = 21). Paediatricians should always consider or rule out a diagnosis of histoplasmosis in children presenting with symptoms suggestive of the above clinical conditions.
<p class="abstract"><span lang="EN-US">Organophosphates are often constituents of pesticides and insecticides. Some of these products are sold by unregistered vendors on the streets and in market places in sub-Saharan Africa. When purchased, and improperly stored, children may easily have access to, and inadvertently consume them. The clinical features of organophosphate poisoning include diarrhoea, diaphoresis, urination, miosis, bronchorrhoea, bronchospasm, bradycardia, emesis, lacrimation and salivation. Atropine administration is an important cornerstone of the management of this condition, with a good outcome in this instance. A case of organophosphate poisoning is herein reported to illustrate the effect of the predisposing factors to accidental childhood poisoning. It is hoped that this will help make an urgent case to raise public awareness on the prevention of accidental childhood poisoning, as well as the enforcement of regulations on the production, labeling, distribution and sale of these organophosphate compounds.</span></p>
Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common neuro-behavioral disorders of childhood.Though ADHD is the most extensively studied neuro-behavioral disorder in childhood, its prevalence rate has not been documented in our environment. Aim of the current study was to determine the prevalence and subtypes of ADHD among primary school pupils living in Ikot-Ekpene, a semi-urban area in Nigeria’s rainforest.Methods: This was a cross-sectional study conducted among 1174 primary school pupils aged 6-12 years selected from twelve primary schools in Ikot Ekpene local government area of Akwa Ibom state. The Vanderbilt rating scale for both teachers and parents were administered by teachers and parents of the pupils and the prevalence rate of ADHD was determined.Results: One hundred and forty-six pupils met the rating scale criteria for probable ADHD using the teacher’s scale with a prevalence of 12.4%, while 8.5% met the criteria using the parent’s scale. Of the three different subtypes of ADHD, the hyperactive subtype was the most prevalent subtype on both the teacher’s and parent’s scales (52.7% and 46% respectively). The inattentive subtype was 32.9% and 33.0% on the teachers and parents scale respectively. The combined subtype was the least prevalent on both scales.Conclusions: Prevalence rate of ADHD in children is significant in our environment. Policies should be put in place to implement the screening test for ADHD under the school health program for the early identification of pupils with ADHD.
Introduction: Supplementary feeding programme is a strategy for managing underfives with moderate acute malnutrition (MAM). This study aimed to determine the effect of adherence to follow-up on recovery from MAM among under-fives. Methods: A clinical trial to evaluate the effectiveness of daily supplementary rations of a standardised milk-based formulation (SMBF), standardised non-milk-based formulation (SNMBF), and hospital-based formulation (HBF) on recovery from MAM over a four months period was conducted among eligible children aged 6 – 59 months. Recovery from MAM among participants was determined based on their status of adherence to follow-up at week 16. It was deemed statistically significant if p-value was <0.05. Results: Of the 157 children evaluated, 41/54 (75.9%) who received the SMBF, 32/57 (56.1%) who received the SNMBF, and 22/46 (47.8%) who received the HBF had good adherence. Adherence to follow-up was significantly higher with SMBF than SNMBF and HBF (χ²=8.923; p=0.012). In all, 95/157 (60.5%) had good adherence to follow-up with 73/95 (76.8%) recovery from MAM against 42/62 (67.7%) recovery in those with poor adherence (p=0.208). Conclusion: The status of adherence to scheduled follow-up was not significantly associated with recovery from MAM among under-fives enrolled in the supplementary feeding programme. Nevertheless, efforts at promoting adherence to scheduled follow-up visits should be sustained.
Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common neuro-behavioural disorders of childhood. Environmental influences have been reported to be important in its aetiopathogenesis. There is a paucity of publications assessing the socio-demographic and environmental determinants of ADHD in Sub Saharan Africa. The aim was to determine the socio-demographic and environmental determinants of ADHD in primary school children in Ikot Ekpene, Nigeria.Methods: Vanderbilt ADHD diagnostic teacher rating scale for ADHD was administered on 1174 pupils aged 6-12 years drawn from twelve primary schools in Ikot-Ekpene, Akwa-Ibom State, Nigeria. Parents of the selected pupils completed a proforma on their socio-demographics and environmental factors.Results: The mean age of the study population was 9.32 years with a male preponderance. ADHD was significantly associated with lower socio-economic status, being a product of multiple gestations, having parents with financial difficulty during the first few years of child’s life among others.Conclusions: ADHD is associated with common socio-demographic and environmental risk factors. Some of these factors such as low income and low socio-economic status are modifiable. Poverty alleviation, job security and empowerment of parents of children living in resource-poor settings is critical to reducing the prevalence of ADHD.
Surveillance of the carrier state for β-hemolytic streptococcal (BHS) throat infections remains essential for disease control. Recent published works from Sub-Saharan Africa have suggested a changing epidemiology in the burden of BHS throat infections. The objective of the present study was therefore to determine the prevalence and pattern of BHS throat carriage in school-aged children in Uyo, Akwa Ibom State. This was a prospective cross-sectional study of 276 primary school children in Uyo. Subjects were recruited by multistage random sampling. Obtained throat swabs were cultured on 5% sheep blood agar. Lancefield grouping on positive cultures was done by using the Oxoid Streptococcal Grouping Latex Agglutination Kit, United Kingdom. Antimicrobial susceptibility testing was done with the disk diffusion method. Associations were tested with Fischer's exact test. The prevalence of BHS carriage was 3.3%. Group C Streptococcus was identified in 89% of isolates and Group G Streptococcus in 11%. Younger age and larger household size were associated with asymptomatic streptococcal throat infections. Antimicrobial susceptibility was highest with cefuroxime and clindamycin (89% of isolates each), while 78% of isolates were susceptible to penicillin. None of the tested isolates was susceptible to co-trimoxazole. The prevalence of streptococcal throat carriage in the study area was low. There were no Group A Streptococcus isolates suggesting an evolving epidemiology of BHS disease in the study area.
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