Background Cerebral visual impairment (CVI), including perceptual visual dysfunction (PVD), is common in children with cerebral palsy (CP). Inventories of questions relating to practical aspects of visual perception in everyday life, in particular the closed-ended Insight Questions Inventory (IQI), can be used to assess CVI/PVD. Studies linking responses to the inventory with specific visual support strategies, aimed at modifying the child’s environment and/or behaviour to minimize the impact of the CVI/PVD, have been piloted. The IQI and tailored strategies have not been used in an African population, nor have they been tested in a controlled trial. This trial will compare the effectiveness of the IQI and linked visual support strategies versus general supportive treatments on the quality of life of children with CVI/PVD and CP through a randomized controlled trial. Methods/design This is a prospective, double-blind, parallel-arm, randomized controlled trial. The primary outcome is change in quality of life scores between the two arms of the trial at 6 weeks, assessed using the Paediatric Quality of Life Inventory (PedsQL) generic 4.0 and CP 3.0 module. All children will undergo baseline assessment including the Open Questions Inventory, IQI, PedsQL 3.0, PedsQL 4.0 generic, and the Strengths and Difficulties Questionnaire (SDQ). Eligible children with CP aged 4 years to < 16 years will be stratified and blocked by the age groups 4–9 and 10 to < 16 years and by Gross Motor Function Classification System (GMFCS) levels 1–3 and 4–5. Families in the intervention arm will receive tailored insight visual support strategies and telephone calls during the 6-week trial period. The control arm will receive standard treatment and the intervention after the 6-week trial period. Follow-up interviews will be performed in both arms at 6 weeks with a repeat administration of the PedsQL CP 4.0 and 3.0, the IQI and the SDQ. Secondary outcomes include a change in functional vision. Discussion This randomized controlled trial will provide evidence of the effectiveness of this intervention for children with CP in a resource-poor setting. Trial registration Pan African Clinical Trials Registration, PACTR201612001886396 . Registered on 3 December 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3527-9) contains supplementary material, which is available to authorized users.

Malaria contributes to high childhood morbidity and mortality in Nigeria. To determine its endemicity in a rural farming community in the south-south of Nigeria, the following malariometric indices, namely, malaria parasitaemia, spleen rates, and anaemia were evaluated in children aged 2–10 years. This was a descriptive cross-sectional survey among school-age children residing in a rubber plantation settlement. The children were selected from six primary schools using a multistaged stratified cluster sampling technique. They were all examined for pallor, enlarged spleen, or liver among other clinical parameters and had blood films for malaria parasites. Of the 461 children recruited, 329 (71.4%) had malaria parasites. The prevalence of malaria parasitaemia was slightly higher in the under fives than that of those ≥5 years, 76.2% and 70.3%, respectively. Splenic enlargement was present in 133 children (28.9%). The overall prevalence of anaemia was 35.7%. Anaemia was more common in the under-fives (48.8%) than in those ≥5 years (32.8%). The odds of anaemia in the under fives were significantly higher than the odds of those ≥5 years (OR = 1.95 [1.19–3.18]). Malaria is highly endemic in this farming community and calls for intensification of control interventions in the area with special attention to school-age children.

Background: Epilepsies are the most common conditions encountered in most paediatric neurology clinics in many parts of the developing world. In sub-Saharan Africa epilepsies are secondary, reflecting persistently high risks at birth, and the adverse neurological sequelae of CNS infections during and beyond childhood. The study was designed to determine the clinical pattern of childhood epilepsies, probable aetiologies and associated comorbidities of the disease children.Methods: The study was conducted within an 18 months period among children having established epilepsy attending the Neurology Clinic of University of Calabar Teaching Hospital (UCTH). The children and or care givers were interviewed by the authors and the following data were obtained and recorded in a questionnaire; bio data, age at onset of seizure. History was obtained to determine the possible cause of the seizure, type of epilepsy and associated comorbidities. The data obtained was analysed with SPSS version 20. P-value <0.05 was considered significant.Results: Of the one hundred eighty children seen with various neurological morbidities during the study period, one hundred and seven had epilepsy which constitutes 59.4%. Generalized tonic clonic epilepsy was the commonest type of epilepsy found in 66 (61.1%) of the children with epilepsy, followed by simple partial and myoclonic epilepsy in 18.5% and 6.5% respectively. Severe birth asphyxia was responsible was the commonest identifiable cause of epilepsy in 19 (17.8%) of cases while central nervous system infection accounted for 14 (13.1%). Cerebral palsy was the commonest comorbidity in 20 (18.6%) followed by mental retardation in 17 (15.9%) of the children.Conclusions: The study showed epilepsy to be the commonest neurological presentation among children presenting at the paediatric neurology clinic of our facility. Primary generalised tonic clonic epilepsy was the commonest type of epilepsy seen, followed by simple partial seizures. Cerebral palsy and mental retardation were the main associated comorbidities. Birth injuries mainly severe birth asphyxia and CNS infection were the major causes of epilepsy in our study. In conclusion, epilepsy is the commonest neurological morbidity in our environment, limited facilities and resources still militate against identifying the actual aetiology in most children with the disease. Effort should be intensifying to eradicate the preventable causes of the disease.

Abstract:Background:Neurologic disorders represent a major burden of disease globally and the spectrum ranges from noncommunicable disorders like stroke and neurodegenerative disorders to central nervous system infections.Objective:The purpose of the study is to assess the burden of neurological diseases in a tropical environment.Methods:A one year retrospective survey of neurological diseases seen at the University of Calabar Teaching Hospital, Nigeria, was evaluated using patients' medical record.Results:Neurological diseases constituted 24.2% of all medical conditions seen over a one year period. Stroke was found to be the commonest cause of admissions accounting for 42.1% of the cases followed by peripheral neuropathy (13.8%) and meningoencephalitis (7.2%). The immediate case fatality rate was 33.6%. Fifty two percent were discharged home with various levels of recovery while 12.5% left against medical advice. About 2% were referred to other tertiary health institutions.Conclusion:The pattern of neurologic diseases in the local medical wards was not remarkably different from those observed in Nigeria and elsewhere. Stroke remains the most frequent cause of neurologic admissions and mortality in this region is same as observed elsewhere.

The stigma on Nigerian children (aged 6?18 year) living with epilepsy attending the Pediatric Neurology Clinic in Calabar was studied. The survey was conducted between September 2010 and February 2011 on children having established epilepsy and was attending the Neurology Clinic of the University of Calabar Teaching Hospital, Calabar. A questionnaire with open-ended responses was drawn up and administered on the epileptic children. Information was collected from the children privately in the absence of the parents. The children were interviewed by the authors and the data recorded into the form by the latter. Forty percent of the children reported being regarded as demon-possessed, some were said to be mad and suffering under a family curse. Sixty percent of the children claimed being made objects of ridicule. Fifty percent of the children would wish to withdraw from school while 46% would change school because of embarrassment. Fifty-six percent knew that friends and schoolmates usually run away from them during attacks, 29.4% claim their teachers will not help but only watch them while fitting at school. Twenty-four percent of the victims, all in the age bracket 12?18 yrs, expressed suicide wish. Stigma associated with epilepsy is a problem of children in Calabar. Education of parents and the entire populace is advocated as this could change the society's misconception of epilepsy.

Background: Rabies is a preventable zoonosis with the highest case fatality of any disease in the world. In the developing world, it is transmitted mainly by dog bites. In parts of southern Nigeria, dog meat is a delicacy. Objective: To highlight trade in stray dogs as a major risk factor for rabies in animals and humans in south-south Nigeria. Method: Patients admitted into the University of Calabar Teaching Hospital (UCTH) with a diagnosis of rabies between July and October 2012 were analysed for risk factors, post exposure prophylaxis (PEP), health seeking behaviour and outcome. Focused group interview were also conducted among traders/ handlers of stray dogs. Results: Ten cases of rabies in subjects aged 3 to 52 years were recorded in these five months period. Eight of the cases were male and apparently got infected directly or indirectly through the trade in stray dogs for human consumption. None had proper PEP and all patients died. Conclusion: Stray dog trade, fuelled by eating of dog meat, is a risk factor for human and animal rabies in Calabar, southern Nigeria. Culling of stray dogs, control of stray dogs' trade and public enlightenment on PEP is recommended.

Introduction Non accidental injury sustained following deliberate self-harm or inflicted by parents or caregivers for disciplinary, traditional and therapeutic measures have grave consequences including exposing the incompletely child to post neonatal tetanus. This contributes to the continuing high incidence of post neonatal tetanus in developing countries. Methods A 12 year retrospective review of all children admitted into the children’s ward of the University of Calabar Teaching Hospital with diagnosis of post neonatal tetanus was carried out. The demographic characteristics of the children were documented. Immunization status, possible portal of entry and outcome status were also recorded. Data obtained was analysed using SPSS version 22. Results There was a male preponderance of 70.5% amongst the 44 children with post neonatal tetanus. Non-accidental injuries accounted for 20(45.5%). Broom stick injury sustained during corporal punishment was responsible for 60% of tetanus from the non-accidental injury group. Low socio economic class and Inadequate or no immunizations are major risk factors for tetanus infection. Conclusion Non accidental injuries inflicted on children as disciplinary measures accounted for about half of children with post neonatal tetanus. Broom stick injury was a major contributory factor. Lack of immunization and low social class remains major risk factors for post neonatal tetanus. Post neonatal tetanus presents another reason for sustained campaign against physical abuse of children.

Gliomas are the commonest primary brain tumours in adults. They are usually classified and graded according to the criteria by the World Health Organisation. High-grade gliomas are the most malignant primary brain tumours. Conventional therapies include surgery, radiotherapy, and chemotherapy. The tumours often demonstrate high levels of resistance to these conventional therapies, and in spite of treatment advances the prognosis remains poor.