Burden, Mortality, and Follow-Up Gaps in Paediatric Endocrine Care: Five Years of Experience (2020–2025) from a Tertiary Hospital in South-East Nigeria

Background: Paediatric endocrine disorders are an emerging concern in sub-Saharan Africa, yet they remain under-recognised due to the predominant focus on infectious diseases. Inadequate specialist services and poor follow-up systems contribute to late presentation and adverse outcomes. This study prospectively reviewed the clinical spectrum, mortality, and follow-up challenges of paediatric endocrine cases managed in the first dedicated endocrinology unit at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nigeria, over a five-year period. Methods: A prospective review was conducted from February 2020 to February 2025, enrolling children aged 0–18 years diagnosed with endocrine or metabolic disorders. Clinical data collected included demographics, diagnoses, and follow-up outcomes, categorised as adherent, lost to follow-up, or deceased. Descriptive statistics were used to summarise patient characteristics, and associations between clinical variables and outcomes were analysed using chi-square or Fisher’s exact tests as appropriate. Results: Fifty-five children were enrolled (median age: 9 years; range: 7 days to 17 years; 56.4% female). The most common diagnoses were type 1 diabetes mellitus (29.1%) and thyrotoxicosis (21.8%), followed by congenital adrenal hyperplasia (10.9%) and precocious puberty (9.1%). Annual case numbers increased progressively, peaking in 2023. Overall mortality was 7.3%, with deaths predominantly due to diabetic ketoacidosis and neonatal endocrine emergencies (Neonatal thyrotoxicosis and hyperinsulinemic hypoglycaemia). Notably, 69.1% of patients were lost to follow-up, while only 25.5% remained in active care by the end of the study period. Conclusion: The establishment of the paediatric endocrinology unit at NAUTH has enhanced case detection and management of childhood endocrine disorders in southeastern Nigeria. However, the high rates of loss to follow-up and preventable deaths highlight persistent systemic barriers, including financial constraints and limited healthcare access. Interventions aimed at strengthening follow-up systems, improving caregiver education, and reducing the cost burden of chronic care are urgently needed to improve long-term outcomes in this resource-limited setting.