Surgical Science, 2011, 2, 22-24
doi:10.4236/ss.2011.21006 Published Online January 2011 (http://www.SciRP.org/journal/ss)
HIV Seropositivity among Paediatric Surgical Patients at
the Lagos University Teaching Hospital: What Risk to the
Surgeon
Christopher Bode, Adesoji Ademuyiwa, Sylvester Ikhisemojie, Olumide Elebute
Pediatric Surgery Unit, Depa rt ment of Surgery
College of Medicine University of Lagos, Lagos University Teaching Hospital
Lagos, Nigeria
Received September 10, 2010; revised October 25, 2010; accepted November 10, 201 0
Abstract
Background: Although much concern has been expressed about the occupational risk posed to surgeons by
the HIV pandemic infection, the paediatric age group is often seen as less likely to harbor the disease. Aim:
To determine the HIV infection rate among children presenting for surgical operations at the Lagos Uni-
versity Teaching Hospital (LUTH), Lagos. Materials, patients and method: Blood was taken from 1000
consecutive children referred to LUTH for surgical conditions and tested for HIV sero-positivity using the
Western blot method. Consenting parents of sero-positive patients were also tested. Result: Five children
tested positive for HIV, giving an overall infection rate of 0.5%. Four mothers and three consenting fathers
were also positive. In one child, none of the parents was positive and he was suspected to have developed
the disease from a previous blood transfusion prior to presentation in LUTH. This possibly resulted from
transfusion of infected blood during its window period. Conclusion: Although the HIV infection rate of
0.5% in paediatric surgical group in Lagos is low, surgeons should vigilantly apply universal precautions
to prevent needle-stick injuries while the rate of HIV infection should be periodically monitored to deter-
mine the trend.
Keywords: HIV/AIDS, Risk, Paediatric Surgeon, Blood
1. Introduction
The prev alence of HIV/A IDS in the paediatr ic age group
has not mirrored what is seen in the adult population.
Since this disease was f irst described in Nigeria in 1986,
the incidence rose steadily to 5.8 percent of the general
population as reported in most studies conducted by
2001 [1,2]. While this figure was a national average,
there were inter-regional and intra-regional differences
[3]. The prevalence appears to have stabilized at 3.1%,
among women attending antenatal clinics in Nigeria [4].
The overall picture has however largely ignored the pae-
diatric age group and little has been reported on the
prevalence of HIV/AIDS among Nigerian children with
surgical problems [5]. The risk posed by this significant
disease to the paediatric surgeon in Nigeria has not been
quantified hence this study [6-8].
2. Patients and Methods
One thousand consecutive patients referred to the Paedi-
atric Surgery Unit of the Lagos University Teaching
Hospital, Nigeria were recruited into this study. These
patients presented to the Paediatric Surgery Outpatient
within the study period - November 2006 to October
2008. Other patients seen within the study period were
not included after a sample size of 1000. All patients
who had previously been diagnosed with HIV/ AIDS and
those who had symptoms associated with AIDS were
also excluded from the study. The patients were aged
between 2 weeks and 16 years, with a median age of
6months. They were referred to the Unit for various con-
ditions as shown in Table 1 . The Male: Female ratio was
4:1. Informed consent was obtained from parents of all
patients. As a part of the pre-operative investigations for
each patient, 3.5 mls of venous blood was obtained into a

C. BODE ET AL. 23
sterile universal bottle and sent to the Haematology labo-
ratory. All samples were serologically screened for
HIV/AIDS using the ELISA technique and those found
positive were confirmed using the Western Blot metho d.
Table 1. Diagnosis of patients seen at paediatric surgery
outpatient recruited into the study.
Diagnosis Number Percentage
Inguinal hernias 181 18.1
Undescended Testes 84 8.4
Hirschsprung’s disease 72 7.2
Posterior Urethral Valves 66 6.6
Umbilical hernia 64 6.4
Anorectal malformation 62 6.2
Intussusception 47 4.7
Omphalocele 44 4.4
Hydrocele 43 4.3
Appendicitis 42 4.2
Hypospadias 41 4.1
Cystic hygroma 29 2.9
Nephroblastoma 22 2.2
Biliary atresia 18 1.8
Thyroglossal cyst 18 1.8
Urethrocutaneous fistula 18 1.8
Tracheoesophageal fistula with oeso-
phageal atresia 18 1.8
IHPS 17 1.7
Labial adhesions 15 1.5
Ambiguous genitalia 10 1.0
Uncircumcised phallus 9 0.9
Lipoma 8 0.8
Prune Belly Syndrome 8 0.8
Epispadias 7 0.7
Ankyloglossia 7 0.7
Enterocutaneous fistula 6 0.6
Retractile testes 6 0.6
Appendix mass 5 0.5
Gastroschisis 5 0.5
Arteriovenous malformation 4 0.4
paraphimosis 4 0.4
Hydronephrosis 4 0.4
Phimosis 3 0.3
Bladder extrohpy 2 0.2
Haemangioma 2 0.2
Meatal stenosis 2 0.2
Necrotizing Enterocolitis 2 0.2
Extraperitoneal bladder rupture 1 0.1
Gluteal abscess 1 0.1
Mesenteric lymphadenitis 1 0.1
Splenic cyst 1 0.1
Testicular torsion 1 0.1
Total 1000 100.0
3. Results
Five patients out of the 1000 children screened were
confirmed positive, using the ELISA technique. Two
others were false-positive but excluded by the Western
Blot method. Of the 5 sero-positive patients, four were
males and one was female. Two of the males had right
inguinal hernias, one had posterior urethral valves, one
was referred with a right undescended testis at the age of
6 years while the only female patient was first seen with
choledochal cyst as a neonate. Tables 2(a) and 2(b)
summarizes the information about these patients.
4. Discussion
As a developing country, Nigeria’s population is made
up mostly of young people, more than 70% of who are
under thirty years of age [9]. Nigeria has an estimated
population of 140 million with an annual growth rate of
2.38 percent. Thus, about 3 million newborns are added
annually [8]. Despite the widespread availability of HIV
screening methods in many health-care facilities in this
country, ante-natal screening for HIV is not routinely
Table 2. Clinical information about seropositive patients.
(a)
Patient Age
(months) Sex Diagnosis Surgery per- formed
A 4 M
Inguinal
hernia Right Inguinal herniotomy
B 2.5 M
Inguinal
hernia Right Inguinal herniotomy
C 0.5 M
Posterior
urethral
valves Vesicostomy
D 72 M
Right un-
descended
testes
Right orchi-
dopexy
E
1 month
Re-presente
d at 30
months*
F Choledochal
cyst
Incision and
drainage of
perinephric
abscess
(b)
Patient Mode of
delivery
Clinical
charac-
ter-istics
Protective
measures
during
surgery
Outcome
A SVD
Only Mother
HIV Positive Universal Precautions alive
B SVD
Only Mother
HIV Positive Universal Precautions alive
C SVD
Both parents
HIV negative Universal Precautions Died
D SVD
Only Mother
HIV Positive
Mother died
of AIDS
Universal
Precautions alive
E SVD
Both parents
HIV positive Universal Precautions alive

C. BODE ET AL. 24
done. It is believed that most of the HIV-positive chil-
dren in this study were from vertical mother-to-child
transmission. With routine ante-natal screening, mothers
would have been aware of their status and perhaps the
mode of their delivery might have been different. HIV
sero - positivity may also occur in children because of
unhealthy practices engaged in by those who have no
access to the formal health system, sexual abuse and
primitive circumcision rites [10]. These occur mainly in
rural communities but also among the urban poor, who
would patronize the domiciliary auxiliary health worker
using unsterilized instruments for circumcisions or recy-
cled syringes for multiple patients [11]. With 5 sero-
positive cases out of 1000 patients screened, the preva-
lence of HIV in this study was only 0.5%, a figure in
close agreement with the projected rate for children in
Nigeria [12]. This rate appears d eceptively low until it is
considered along with Nigeria’s larg e population when it
becomes evident that the disease burden may be very
high. Although the prevalence of HIV in Nigeria is less
than 5%, about 220000 children are estimated to be liv-
ing with HIV in Nigeria, a figure second only to South
Africa which has an adult rate of 18.1% but a smaller
total population [12]. This is 1% of a total of 22.4 million
children with this disease in Africa. Unfortunately, little
if anything has yet been achieved in halting and revers-
ing the scourge of HIV and most other health-related
indices in Nigeria as part of the Millennium Develop-
ment Goals (MDG) programme launched with much
fanfare in this country a decade ago [13].
It is prudent for Paediatric Surgeons to take universal
precautions in o perating on all paed iatric patients. While
no one should be denied surgery on account of their HIV
status, sero-positive patients should be operated with all
safety measures to safeguard the lives of all members of
staff. This, coupled with the prompt commencement of
anti-retroviral drugs for all identified HIV-positive chil-
dren will greatly reduce the risk to the surgeon. It is ex-
pected that increased ante-natal screening and improved
health education efforts in the rural communities will
help identify affected mothers early. Operative delivery
can then be undertaken in all cases. This step together
with improved overall community health awareness will
contribute to reducing the chances of vertical transmis-
sion from mother to child, and subsequently reduce the
risk to the paediatric surgeon.
5. Conclusion
Although the HIV infection rate of 0.5% in paediatric
surgical group in Lagos is low, surgeons should vigi-
lantly apply universal precautions to prevent needle stick
injuries while the rate of HIV infection should be peri-
odically monitored to determine th e trend.
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