The Fulani are semi-nomadic pastoralists of the western Sahel whose culture and economy are centered on cattle. We have shown previously that Fulani children and adolescents (5-18 years old) are stunted and underweight. Nutritional status and lung function were studied in Fulani children and adolescents (n = 70), aged 6-18, and compared with a non-Fulani, rural Nigerian control group (n = 153) of the same age. Participants were restricted to healthy individuals with no prior history of respiratory disease and no symptoms of an upper respiratory tract infection within the past 6 weeks. Significant deficits in forced vital capacity (FVC; Fulani males, 1.51 l; non-Fulani males, 1.86 l, p = 0.009; Fulani females, 1.36 l; non-Fulani females, 1.79 l, p < 0.001), forced expiratory volume in one second (FEV1; Fulani males, 1.44 l; non-Fulani males, 1.76 l, p = 0.02; Fulani females, 1.24 l; non-Fulani females, 1.69 l, p < 0.001), and peak expiratory flow rate (PEFR; Fulani males, 2.69 l/s; non-Fulani males, 3.48 l/s, p = 0.002; Fulani females, 2.29 l/s; non-Fulani females, 3.35 l/s, p < 0.001) were found in both the Fulani boys and girls compared with the non-Fulani controls. The diminished lung function in the Fulani group could be attributed to respiratory muscle weakness or an overall deficit in energy.

IntroductionCurrent guidelines advise the prompt diagnosis and treatment of urinary tract infection (UTI) in children to improve both short and longer term outcomes. However, the risk of long-term complications following childhood UTI is unclear.UTI is relatively common but difficult to diagnose in children as symptoms are non-specific. Diagnosis requires a urine sample, but sampling is difficult and infrequent, and it is not clear if sampling should be given greater priority in primary care. The LUCI study will assess the short, medium and longer term outcomes of childhood UTI associated with routine and systematic sampling practices.Methods and analysisTwo data sets will be established. The first will consist of routinely collected data (hospital, general practice (GP), microbiology) from children born and resident in Wales, linked via the Secure Anonymised Information Linkage (SAIL) Databank (an ‘e-cohort’). Urine sampling in this data set reflects normal practice ‘routine sampling’. Outcomes (including renal scarring, hypertension, end-stage renal failure, hospital admissions, GP consultations, antibiotic prescriptions) for children with at least one UTI confirmed with microbiological culture (mcUTI) or no mcUTI before the age of 5 will be compared.The second will combine data from two prospective observational studies (‘DUTY’ and ‘EURICA’) employing systematic urine sampling for children presenting to primary care with acute, undifferentiated illness, linked to routine data via SAIL (Wales) and NHS Digital (England). Outcomes (as above, plus features of mcUTI) for children with an mcUTI in this data set, identified through systematic urine sampling, will be compared with those with an mcUTI identified through routine urine sampling (data set 1).Ethics and disseminationThe study protocol has been approved by NHS Wales Research Ethics Committee and the Health Research Authority’s Confidentiality Advisory Group. Methods of innovative study design and findings will be disseminated through peer-review journals and conferences. Results will be of interest to clinical and policy stakeholders in the UK.

Background Chronic kidney disease (CKD) is a growing contributor to the global burden of noncommunicable diseases. Early diagnosis and treatment can reduce the severity of kidney damage and the need for dialysis or transplantation. It is not known whether mild-to-moderate renal pelvis dilatation (RPD) identified at 18–20 weeks gestation is an early indicator of renal pathology. The aim of this follow-up to the Welsh Study of Mothers and Babies was to assess the risk of hospital admission in children with mild-to-moderate antenatal RPD compared with children without this finding. We also examined how the natural history of the RPD (whether the dilatation persists in later pregnancy or postpartum) or its characteristics (unilateral versus bilateral) changed the risk of hospital admission. Methods/Findings This population-based cohort study included singleton babies born in Wales between January 1, 2009, and December 31, 2011 ( n = 22,045). We linked ultrasound scan data to routinely available data on hospital admissions from the Patient Episode Database for Wales (PEDW). The outcome was a hospital admission for urinary tract causes (defined by an expert study steering group) in the first three years of life. We used Cox regression to model time to first hospital admission, according to whether there was evidence of RPD at the fetal anomaly scan (FAS) and/or evidence of dilatation in later investigations, adjusting for other predictors of admission. We used multiple imputation with chained equations to impute values for missing data. We included 21,239 children in the analysis. The risk of at least one hospital admission was seven times greater in those with RPD ( n = 138) compared with those without ( n = 21,101, conditional hazard ratio [cHR] 7.23, 95% confidence interval [CI] 4.31–12.15, p < 0.001). The risk of hospital admission was higher in children with RPD at the FAS and later dilatation (cHR 25.13, 95% CI 13.26–47.64, p < 0.001) and in children without RPD at the FAS who had later dilatation (cHR 62.06, 95% CI 41.10–93.71, p < 0.001) than in children without RPD ( n = 21,057). Among children with RPD at the FAS but no dilatation in later pregnancy or postpartum, we did not find an association with hospital admissions (cHR 2.16, 95% CI 0.69–6.75, p = 0.185), except when the initial dilatation was bilateral (cHR 4.77, 95% CI 1.17–19.47, p = 0.029). Limitations of the study include small numbers in subgroups (meaning that these results should be interpreted with caution), that less severe outcomes (such as urinary tract infections [UTIs] managed in the community or in outpatients) could not be included in our analysis, and that obtaining records of radiological investigations later in pregnancy and postpartum was challengin...

Objectives To investigate the impact of the COVID-19 pandemic on our paediatric sickle cell service, including acute and elective activity, clinical performance and patient experience. Methods Data on acute and elective admissions during the 'COVID-19 pandemic year' (1 March 2020-28 February 2021) were extracted from our SCD database and Electronic Medical Records and compared with data from the preceding 2-year period. An online survey on patient experience during the pandemic was conducted during December 2020. Results During the COVID-19 pandemic year, we had 31 paediatric sickle cell inpatient admissions, which reflects a 47% reduction from the previous 2-year average (59). Hospital attendances decreased by 27%, and the mean length of stay (LOS) was shortened by 33% to 2.1±0.67 days. We also observed an improvement in our emergency management of vaso-occlusive episodes, with a 51% reduction in our mean 'door-to-analgesia' times (table 1). We had one COVID-positive case that did not require hospitalisation and no cases of delayed presentations. The number of outpatient clinic appointments was similar to the previous years, however the non-attendance rates reduced by 58%, possibly due to the selective provision of telephone consultations. Collaborating with our Specialist Haemoglobinopathy Team, we set up an outreach Transcranial Doppler (TCD) clinic locally, aiming to minimise patient travel, whilst ensuring adherence to the TCD monitoring standards (90% had a TCD within the recommended timeframes). Regular transfusions and hydroxycarbamide services continued uninterruptedly. In partnership with our community team, we organized live 'Parents and Young People's online forum' sessions on SCD and COVID-19, providing reassurance and guidance on accessing our services during the pandemic. We received 38 responses to our online patient survey, representing 27% of our cohort. Over 85% of respondents felt supported during the shielding period. Interventions rated positively by the majority were the outreach TCD clinic, the continuation of the dedicated phlebotomy service and the online forum sessions. Conclusions Our results show that during the COVID-19 pandemic we have maintained safe and uninterrupted paediatric sickle cell services and improved our clinical performance in delivering timely emergency analgesia for acute painful sickle cell episodes. The reductions in hospital attendances, admissions and LOS are likely to have a multifactorial aetiology related to the pandemic and the associated lockdowns, including reduction of exposure to sickle crisis triggers and reluctance to attend hospital. Interventions such as