terized by lots of experimentations and risk taking including behavior that predisposes to diseases. By the end of 2012, about 2.1 million adolescents globally were living with HIV, and over 90% were in sub-Saharan Africa. [2,3] Adolescents living with HIV confront numerous psychosocial stressors in addition to having to cope with developmental challenges of normal adolescent children. HIVrelated challenges may start with the emotional trauma from disclosure of their HIV status, the fear of uncertainties from disease progression, deterioration of quality of life, and death or bereavement related to the death of loved ones on one hand; on the other hand, the stress of long-term treatment and coping with stigma and discrimination at the different levels Background: HIV-infected adolescents confront numerous psychosocial stressors in addition to coping with the developmental challenges of normal adolescent children. These may adversely affect their adherence to antiretroviral treatment. Objective: To determine the psychosocial challenges of HIV-positive adolescents in Kano, Nigeria, and how they influence their adherence to antiretroviral therapy (ART). Materials and Methods: Using descriptive cross-sectional design, we studied a random sample of 400 HIV-positive adolescents attending the ART center in Murtala Muhammad Specialist Hospital Data were analyzed using SPSS, version 16.0, computer statistical software. Result: The mean age of the adolescents was 14.9 ± 3.15 years; majority of them were female subjects (54.8%) and from polygamous family setting (57.5%). More than half (54.5%) of them reported being anxious or depressed most of the times, commonly from fear of death (51.4%) or associated stigma (24.3%). Furthermore, 52.0% of them had lost a parent or spouse to HIV infection and about one-tenth reported being discriminated upon. More than one-third (38.5%) of them were out of school, of which 56.5% of them dropped out because the parents/guardians could not afford the combined burden of hospital costs and school. Most of them (90.5%) adhered well to prescribed medications. On multivariate analysis, anxiety or depression, loss of parent or spouse, and avoidance by friends/colleagues emerged as the independent psychosocial predictors of the adolescents' adherence to ART. Conclusion: HIV-infected adolescents have varied and sensitive needs that must attract high-level understanding of program managers and the social environment to achieve an optimum level of adherence for ART.
Destroyed Lung Syndrome (DLS) is total lung destruction from recurrent and chronic infections especially Tuberculosis (TB). It is rare in children and associated with chronic morbidity. It presents with chronic cough, progressive difficulty in breathing, hemoptysis and progressive respiratory failure. The pathology of DLS includes lung fibrosis, collapse, tracheal and mediastinal shift. We report the case of a 9 years old girl referred after three courses of anti-TB treatment for suspected TB reinfection with worsening clinical and radiologic features. Investigations revealed a destroyed right lung. Genexpert was initially positive and subsequently along with TB culture was negative. She improved on antibiotics and chest physiotherapy. Destroyed lung though rare in children should be considered in those who despite TB treatment present with worsening clinical and radiologic features. Early diagnosis and multi- disciplinary approach will prevent irreversible lung damage.
BackgroundPneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the pneumococcal conjugate vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to estimate health provider and household costs for the treatment of pneumococcal disease in children aged <5 years (U5s), and to assess the impact of these costs on household income.MethodsWe recruited U5s with clinical pneumonia, pneumococcal meningitis or pneumococcal septicaemia from a tertiary level hospital and a secondary level hospital in Kano, Nigeria. We obtained resource utilisation data from medical records to estimate costs of treatment to provider, and household expenses and income loss data from caregiver interviews to estimate costs of treatment to households. We defined catastrophic health expenditure (CHE) as household costs exceeding 25% of monthly household income and estimated the proportion of households that experienced it. We compared CHE across tertiles of household income (from the poorest to least poor).ResultsOf 480 participants recruited, 244 had outpatient pneumonia, and 236 were hospitalised with pneumonia (117), septicaemia (66) and meningitis (53). Median (IQR) provider costs were US$17 (US$14–22) for outpatients and US$272 (US$271–360) for inpatients. Median household cost was US$51 (US$40–69). Overall, 33% of households experienced CHE, while 53% and 4% of the poorest and least poor households, experienced CHE, respectively. The odds of CHE increased with admission at the secondary hospital, a diagnosis of meningitis or septicaemia, higher provider costs and caregiver having a non-salaried job.ConclusionProvider costs are substantial, and households incur treatment expenses that considerably impact on their income and this is particularly so for the poorest households. Sustaining the PCV programme and ensuring high and equitable coverage to lower disease burden will reduce the economic burden of pneumococcal disease to the healthcare provider and households.
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