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Background: Although the elevation of circulating total serum homocysteine (tHcy) concentration in a fasting state is associated with an increased risk of occlusive vascular disease in adults, the levels in children in Nigeria are not known. Aim: The goals of this study were to describe the distribution of tHcy among a representative sample of children and adolescents in Jos, Nigeria, and to test for differences in tHcy among sex and age categories. Methods: The sampling scheme, which included persons aged 10 to 19 years, was a stratified, multistage probability design. This cross sectional study involved 182 school children drawn from secondary schools in Jos, Nigeria between January and July 2003. Fasting venous samples were collected and assayed for tHcy, Total protein and Albumin. Anthropometric measurements were taken. Result: The mean tHcy concentrations were 2.7 2.4 (95% CI 2.4–2.9), 3.5 3.2 (3.3–3.8) and 3.6 3.2 (3.3–4.1), 4.1 3.6 (4.0–4.4) mol/l for the girls and boys aged 10–14 and 15–19 years, respectively. Albumin levels correlate positively with plasma total homocysteine, tHcy (r = 0.45, P = 0.03). Conclusion: This study provided age-specific data regarding tHcy concentrations between 10–19 years population in Jos, Nigeria. The tHcy concentration increased as a function of age in both sexes.

Evidence Behind the WHO Guidelines: Hospital Care for Children: What is the Most Appropriate Anti-microbial Treatment for Tuberculous Meningitis?

In this Issue August 2008

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Preventing Mother-to-Child Transmission of HIV in Vietnam: An Assessment of Progress and Future Directions
Preliminary to the development a new program supporting perinatal HIV prevention, this assessment was conducted to evaluate Vietnam’s national prevention of mother-to-child HIV transmission (PMTCT) program by estimating HIV prevalence among prenatal women and analyzing the healthcare system capacity to deliver services. In 2002–03, a technical team reviewed existing national and local surveillance and program data and conducted on-site interviews and observations at maternal-child health (MCH) programs in the seven provinces with highest HIV rates. The team found that despite high (85%) prenatal service utilization and widespread availability of HIV testing and dissemination of prevention protocols, few HIV-infected mothers were identified in time to allow effective perinatal HIV prevention. Program deficits clustered around the general areas of provider misunderstanding of occupational HIV risk and MTCT, impractical PMTCT policies, and practices hampering effective use of prevention and treatment protocols. Existing problems were significant but modifiable, and will require implementation of practical and appropriate guidelines, enhanced clinical and laboratory capacity, and continued program management and monitoring.

Attitudes Towards End-of-life Issues Amongst Pediatricians in a Tertiary Hospital in a Developing Country
To describe the perspectives of pediatricians from a tertiary care center from India on end-of-life (EOL) care issues, a standardized anonymous questionnaire was administered, which included questions regarding attitudes towards withdrawal/withholding of life-sustaining treatment in children and neonates at the EOL, and responses to an EOL case scenario. The questionnaire was administered to 40 pediatricians, of whom 31 (22 males, mean age 34.5 7.7 years) responded. None of the participants had ever instructed withdrawal of support. The most common modes of life-support limitation practiced were withholding new treatments (17/31; 54.8%) and ‘do-not-resuscitate orders’ (14/31; 45.2%). 51.6% respondents believed that withholding treatment and withdrawal of support were ethically the same. There is wide variation in responses and there were significant differences from findings of similar studies from the developed countries, the most important being the complete lack of use of withdrawal of support.

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Prevalence of Orphans among HIV Infected Children–a Preliminary Study from a Pediatric HIV Centre in Western India
The aim of this study was to determine the prevalence of orphaned HIV-infected children in Mumbai, India and analyze whether orphanhood affects care of these children. This study is a retrospective analysis of prospectively collected data of 147 HIV-infected children referred to our pediatric HIV clinic at B. J. Wadia Hospital for Children (Mumbai, India). All children underwent a detailed history and clinical examination. Transmission of HIV was determined by parental HIV status, history of blood transfusion or sexual exposure. Orphan status was determined by verbal autopsy of parent death (either mother or father or both). Factors affected by orphan status such as follow up, caregiver, antiretroviral treatment and age of the child when orphaned was determined. Fifty nine (40%) HIV-infected children were orphans. In 28 children (19%), father had died; in 20 children (13.6%), mother had died; in 11 children (7.5%) both parents had died and in 2 children (1.4%), parents death status was not known. Cause of death was AIDS in 19 parents (38%) and TB in 21 parents (42%). The mean age of the child when mother had died was 5.6 2.2 years; when father had died was 7.08 3.5 years and when both parents had died was 10.9 2.4 years (p

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