Aim:To develop and perform an initial validation of a score to measure the severity of illness in hospitalised children with severe acute malnutrition (SAM).Methods: A prospective study enrolled SAM children aged 6-59 months hospitalised in Borno State, Nigeria. Candidate items associated with inpatient mortality were combined and evaluated as candidate scores. Clinical and statistical methods were used to identify a preferred score. Results:The 513 children enrolled had a mean age of 15.6 months of whom 48 (9%) died. Seven of the 10 evaluated items were significantly associated with mortality. Five different candidate scores were tested. The final score, Responses to Illness Severity Quantification (RISQ), included seven items: heart rate, respiratory rate, respiratory effort, oxygen saturation, oxygen delivery, temperature and level of consciousness.The mean RISQ score on admission was 2.6 in hospital survivors and 7.3 for children dying <48 h. RISQ scores <24 h before death had an area under the receiver operating characteristic curve (AUROC) of 0.93. The RISQ score performed similarly across differing clinical conditions with AUROCs 0.77-0.98 for all conditions except oedema.

No abstract

No abstract

Background: Renal disease is commonly encountered in patients with HIV infection. The estimated glomerular filtration rate (eGFR) provides a good assessment of the renal function and is widely used in screening populations that are at risk of renal dysfunction. We determined the prevalence of abnormal eGFR among HIV-positive children and factors associated with it. Methods: In a cross-sectional study, children aged 15 years and below were recruited through systematic random sampling from the Paediatrics Infectious Disease Clinic of the University of Maiduguri Teaching Hospital until the desired sample size of 250 was reached. Clinical and laboratory information was obtained from the patient records and used for clinical staging and immunological classification. Serum creatinine was measured using Jaffe's reaction and eGFR calculated using the Schwartz formula. The data obtained were analysed using SPSS version 16. Results: A total of 157 (62.8%) children were on antiretroviral therapy (HAART) for periods ranging from 1 to 168 months (mean duration 66.1 ± 46.5 months). Ninety-three (37.2%) children had advanced disease representing WHO clinical stages 3 and 4, whereas 103 (41.2%) had advanced or severe immunosuppression. The mean eGFR of the study population was 102 ± 41 mL/min/1.73 m 2 . Fifty-two children (20.1%) had low eGFR (<2 SD below the mean eGFR for age and sex) and 6 (2.4%) had high eGFR (>2 SD above the mean eGFR for age and sex). A total of 23 (9.2%) children had moderate to severe renal impairment, defined as eGFR <60 mL/min/1.73 m 2 . Age, sex, socio-economic status, mode of transmission as well as history of HAART usage were not significantly associated with abnormal eGFR. However, relatively shorter duration of treatment with HAART, as well as advanced clinical or immunological stage were all significantly associated with abnormal eGFR. Conclusion: Renal dysfunction is common among children with HIV disease in Maiduguri with over a third of those affected having moderate to severe renal dysfunction. Abnormal renal function is more frequent among children with advanced clinical and immunological disease. We recommend the regular determination of eGFR and early initiation of HAART in all children with HIV disease.