This study aimed to describe the pattern and immediate outcome of severe childhood anaemia requiring blood transfusion at a secondary level of care in Nigeria. A cross-sectional survey of children hospitalized in a secondary health facility in Ogun State, Nigeria, with packed cell volume <20% and who received blood transfusion was done. Of the 253 children admitted between March 2013 and June 2014, 79 (31.2%) had severe anaemia and were transfused with blood. Two-thirds had multiple transfusions. Higher rates of blood transfusion were obtained among underweight children. Fever (98.7%), hypoglycaemia (65.8%) and tender liver (54.4%) were the leading co-morbidities. The case fatality rate was 21.5%. Respiratory distress, convulsions and altered sensorium were significantly associated with mortality. In conclusion, severe anaemia was associated with major morbidities and mortality at the secondary level of paediatric care in Nigeria.

Echocardiography (ECHO), electrocardiography (ECG), and chest radiography (CXR) were performed in 44 children with kwashiorkor, and 44 age- and sex-matched controls. In patients with kwashiorkor, mean values obtained for end diastolic dimension (29.2 +/- 3.8 mm), end systolic dimension (20.9 +/- 2.8 mm), posterior ventricular wall thickness (5.42 +/- 0.57 mm), and shortening fraction (28.2 +/- 4.3%) were significantly smaller than the corresponding values obtained in the controls -38.0 +/- 5.8 mm (P < 0.001), 27.6 +/- 4.5 mm (P < 0.001), 7.07 +/- 0.71 mm (P < 0.001) and 31.4 +/- 4.5% (P < 0.05), respectively. Similarly, mean cardiothoracic ratio (48.6 +/- 3.4%) and QRS amplitude (13.20 +/- 4.85 mm) were significantly (P < 0.001) smaller in subjects than controls, corresponding values being 54 +/- 3.2 per cent and 20.18 +/- 5.12 mm, respectively. In the subjects, there was very good correlation between posterior ventricular wall thickness and cardiothoracic ratio (r = 0.93; P < 0.001) and also between the estimated left ventricular mass and S1 + R6 amplitude (r = 0.89; P < 0.001).

An electrocardiogram (ECG), serum electrolytes, serum albumin, haematocrit and cardiothoracic ratio were recorded in 90 Nigerian children with kwashiorkor and 90 age- and sex-matched controls. The ECG abnormalities observed among the study group included sinus tachycardia (91%), low QRS amplitude (100%) and prolonged QTc intervals (17%). Other ECG abnormalities noted were short QTc intervals (three children), prolonged PR intervals (four children) and right axis deviation (two children). The mean serum sodium, potassium, calcium, albumin, haematocrit and cardiothoracic ratio were significantly lower in children with kwashiorkor than in the controls (p < 0.001). The correlation between the QRS amplitude and serum potassium and calcium was poor (p > 0.05). Also, there was poor correlation between heart rate and haematocrit (p > 0.05) and between QTc intervals and serum calcium and potassium (p > 0.05). However, the correlation between the QRS amplitude and cardiothoracic ratio was good (r = 0.91, p < 0.001). These findings suggest that the ECG changes in kwashiorkor are due to myocardial atrophy.

Background: Diarrhoea is a leading cause of childhood mortality globally. The use of oral rehydration therapy (ORT) with zinc supplementation is recommended in the treatment of childhood diarrhoea. Objective: To determine the pattern of pre-hospital use of ORT and zinc among children with diarrhoea at the secondary levels of health care in Nigeria. Methods: A cross-sectional survey was conducted over a six-month period at two secondary health facilities among children with diarrhoea. A structured questionnaire was administered on consenting caregivers and the level of dehydration was also determined. Results: Out of 109 under-five children, 93 (85.3%) were aged < 24 months; 79 (72.5%) mothers were aware of ORT use but only 56 (51.4%) actually used ORT. Fifty (45.9%) mothers were aware of zinc use but 33 (30.3%) actually administered it. Fifty-nine (54.1%) children had dehydration;