Ethiopian Journal of Pediatrics and Child Health

THE PEDIATRIC FACE OF THE CORONAVIRUS DISEASE 2019 PANDEMIC

Sileshi Leulseged — Tue, 30 Mar 2021 00:00:00 +0000

Editorial

PREDICTORS OF RESISTANCE TO STEROIDS IN PEDIATRIC NEPHROTIC SYNDROME AT A TERTIARY HOSPITAL, ADDIS ABABA

Damte Shimelis — Tue, 30 Mar 2021 00:00:00 +0000

Background: Nephrotic Syndrome is a major health problem worldwide and an important chronic renal disease in children. It is the second most common renal disease in pediatric prac-tice in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. No studies done that show prevalence and predictors of resistance to steroids in our setting.
Objective: The aim of this study was to determine prevalence and factors predictive of re-sistance to steroids in pediatric nephrotic syndrome
Patients and Methods: A cross-sectional retrospective review of medical documents of children 1-15 years of age with the diagnosis of nephrotic syndrome was done from September 2012 to January 2019 who were on follow up at Pediatric Renal Clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
Result: A total of 85 children with the diagnosis of nephrotic syndrome were identified and their mean age was 6.2 (+3 years). Males were 59/85 (69.4%) with a male to female ratio of 2.3:1. Sixty-nine of 85 (81.2%) children responded to steroids, but 16/85 (18.8%) were steroid resistant. Thirteen of 85 (15.3%) children were steroid dependent. Hematuria was detected in 42/85 (49.4%). Twenty-nine out of 85 (34.1%) and 13/85 (15.3%) children had microscopic and gross hematuria, respectively. On bivariate analysis children with gross hematuria, decreased urine output, hypertension and elevated creatinine were more likely to be steroid resistant (p < 0.001). On multivariate analysis gross hematuria and decreased urine output were independent risk factors for resistance to steroids.
Conclusion: Predictors of steroid resistance are comparable with other studies. These findings are important for early decision about the requirement for more aggressive immunosuppressive treatment.

PREDICTORS OF MORTALITY IN CHILDREN AND ADOLESCENTS LIVING WITH HIV ON ANTIRETROVIRAL THERAPY, ETHIOPIA: A RETROSPECTIVE COHORT STUDY

Workeabeba Abebe — Tue, 30 Mar 2021 00:00:00 +0000

Background : Treatment of pediatric HIV infection has steadily improved since the introduction of highly active antiretroviral drugs. Knowledge of antiretroviral drugs results is limited and factors con-tributing to high mortality are poorly investigated in resource-poor settings. So, the aim of this study was to assess independent predictors of mortality in HIV infected children on antiretroviral treatment.
Methods: A retrospective institutional-based cohort study was conducted in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Children who initiated treatment from 2011 to 2015 at the pediatrics antiretroviral treatment clinic are included. We reviewed the patients chart between June and July 2016. Mortality rates were analyzed using the Kaplan Meier method and Cox proportional hazard mod-el used to identify independent predictors of mortality.
Results: Four hundred ten children included in this analysis, 22 died over a follow-up period of 1103 child-years with mortality rate of 19.9 deaths per 1000 child-years. Hemoglobin level < 9 gm/dl (hazard ratio (HR) = 3.23, 95% CI: 2.06-5.20), CD4 count < 100 cells (HR =2.25, 95% CI: 1.34-3.47), TB at baseline (HR=4.97, 95% CI: 2.06-11.99), advanced WHO stages (HR =2.32, 95% CI: 1.32-4.09), poor adherence for ART (HR=5.16, 95% CI: 2.97-8.97), and non-enrollment in youth support group (HR =2.53, 95% CI: 1.59-4.00) were the independent pre-dictors of mortality.
Conclusion: Mortality observed in these children on antiretroviral treatment is of major concern. Im-portant predictors of mortality are preventable and treatable conditions. The high early mortality rate would support the value of thorough evaluation at baseline and close follow up.

PREVALENCE OF MENINGITIS IN YOUNG INFANTS 29-90 DAYS WITH SEPSIS IN ADDIS ABABA, ETHIOPIA

Abate Yeshidinber — Tue, 30 Mar 2021 00:00:00 +0000

Introduction: Bacterial meningitis is among the most serious infections in infants with high mortality and morbidi-ty. Management of young infants with serious bacterial infections and the need of lumbar puncture (LP) is contro-versial unlike neonates and older children.
Objective: to determine magnitude of meningitis and associated factors in young Infants admitted with suspected sepsis in Addis Ababa.
Methods: Cross sectional study was done in young infants admitted to a tertiary center from 2013-2019 for suspect-ed sepsis. Data was abstracted from patient files using structured questionnaire and analyzed by SPSS-20. Logistic regression was used to determine associated factors and independent predictors of meningitis.
Results: A total of 230 infants were included with a male to female ratio of 1.2. Most (61%) presented with fever, respiratory symptoms and feeding intolerance. While 3/4th of them have LP performed the prevalence of meningitis was 17 %. Microbiologic tests were rarely used for etiologic diagnosis. Less than 5 % had confirmed bacterial meningitis, mostly gram negative bacteria.
Conclusion: Meningitis is common coexisting condition in infants with Systemic Inflammatory Response Syndrome (SIRS) despite low microbiologic confirmation. Complete septic work up with emphasis on microbiology should be the standard of care for all young infants with SIRS.

ULTRASONOGRAPHY ORGANOMETERY: KIDNEY, LIVER, SPLEEN DIMENSION AND CORRELATION WITH BMI AMONG SCHOOL AGE HEALTHY CHILDREN IN SOUTHWEST, ETHIOPIA

Mesfin Zewdu — Tue, 30 Mar 2021 00:00:00 +0000

Background : Childhood is an important period of growth for many organ systems. Among various growth parameters, the size of the kidney, liver and spleen useful for the clinical evaluation of abnormalities of these organs. Ultrasonographic dimensions of these organs vary with age, weight and race. However, reference stand-ards of these parameters for healthy children for Ethiopian children are not available.
Objective: : To evaluate the dimensions of the kidney, liver and spleen in healthy children and its correlates with body mass index.
Methods: Descriptive cross-sectional study was conducted on 300 school age healthy children at Radiology De-partment of Jimma University Medical Center. Ultrasonographic assessment was done using a high resolution real-time scanner with a 4 MHz convex transducer by a senior radiologist. Children with abnormal ultraso-nographic findings were excluded from the study and referred for further evaluation.
Results: A total of 300 children, 161 (53.7%) males and 139 (46.3%) females were included into the study. Body weight significantly correlated with the dimensions of the liver (r=0.584, p< 0.001), spleen (r=0.637, p< 0.001), right kidney (r=0.631, p<0.001) and left kidney (r=0.501, p< 0.001). On multiple regression analysis, body weight was significantly associated with all the organs (p <0.01).
Conclusion: The organ dimensions showed the highest correlation with body weight, height and age. Find-ing from our study assist clinician in interpretation of sonographic examinations in daily clinical practices

CHALLENGES OF DIAGNOSIS AND MANAGEMENT OF PRESCHOOL ASTHMA: CUR-RENT KNOWLEDGE AND PRACTICE

Abate Yeshidinber — Tue, 30 Mar 2021 00:00:00 +0000

Preschool Asthma (PA) is among the commonest respiratory problems in children with a considerable diagnostic and therapeutic challenge for the pediatric provider. A number of challenges including the use of unclear and am-biguous diagnostic terms, provider and parental misconceptions, drug cost and availability, and common presence of other conditions with similar presentation but different treatment complicates the situation with delay in correct diagnosis and proper treatment. Preschool asthma should be approached systematically based on current symptom severity and frequency with exclusion of other causes of airflow obstruction. It is recommended to avoid the use of terms like “Reactive Airways Disease” in clinical practice and follow evidence based asthma guidelines to en-hance the diagnosis and treatment of PA and facilitate communication between clinicians and parents.

CASE REPORT:GRATIFICATION DISORDER (INFANTILE/CHILDHOOD MASTURBATION WITH POSTURING) IN A 5 YEAR OLD FEMALE CHILD

Ayalew Moges — Tue, 30 Mar 2021 00:00:00 +0000

Childhood masturbation or gratification disorder may mimic true epileptic seizures. It is considered as one of the paroxysmal non-epileptic disorders (PNEDs) in infants and children, which incorporate several potential diagno-ses. Infants and children mostly present with unusual postures and movements with no impairment of awareness which could be mistaken for seizures or movement disorders like dystonia. Older children may have associated self-stimulation of the genitalia. If not recognized on time, childhood masturbation could pose diagnostic difficulties, unnecessary investigative spending, unnecessary treatments, and considerable parental anxiety. The aim of this case report is to discuss a 5 years old female child who presented with abnormal posturing and movement since the age of 6 months.

CASE REPORT: TWO SIBLINGS WITH XERODERMA PIGMENTOSUM, AFAR, ETHIOPIA

Abel Gidey — Tue, 30 Mar 2021 00:00:00 +0000

Xeroderma Pigmentosum is one of the rare autosomal-recessive skin lesions with a broad variety of clinical mani-festations that lead to cell hypersensitivity to ultraviolet radiation. In addition to extensive skin and mucosal dam-age with malignant transformation, it is characterized with ocular involvement and progressive neurologic deteri-oration. We mention the clinical characteristics of siblings xeroderma pigmentosum come to our pediatric unit, Dubti General Hospital, Afar, in two adolescent siblings from Asab, Eretria.

POLICY BRIEF: THE CASE FOR A SAFER SCREEN MEDIA ECOSYSTEM FOR CHILDREN: LINKING EVIDENCE TO POLICY AND PRACTICE

Amanuel Gebru — Tue, 30 Mar 2021 00:00:00 +0000

A Policy Brief