Neonatal Tetanus: A Continuing Menace

Background: Tetanus especially that affecting the newborn has continued to contribute to morbidity and mortality in developing countries such as Nigeria despite the availability, for over 30 years of an effective vaccine. Its contributing factors include low immunization coverage, poor obstetric services and illiteracy. This study aims at reviewing the status of neonatal tetanus in UPTH with its characteristics and outcome while highlighting the need for instituting sustainable control measures.Methods: This is a retrospective analysis, involving the review of hospital records on neonatal tetanus cases treated at the University of Port Harcourt Teaching Hospital from 1995 to 2009. The case notes of all neonatal tetanus patients in the department of paediatrics from 1995-2009 were retrieved and reviewed for age, sex, presenting complaint, immunization status, examination finding, duration of hospitalization and outcome of illness.Results: Two hundred and ninety six neonates, comprising 174 (58.8%) males and 121(40.9%) females were treated 1(0.3%) of them did not have any record of his or her sex. Most of the mothers did not receive any doses of Tetanus Toxoid [TT] vaccine and delivered outside health facilities. Fifty percent of the cases died. The number and characteristics of the cases and deaths did not change significantly over the period.Conclusion: Essential obstetric care, strengthening of routine immunization, compulsory immunization of all women of childbearing age and school-age children should be adopted to reduce the incidence of neonatal tetanus in the country, while improved health care will reduce the associated high case fatality rate.Key Words: Neonatal tetanus, Outcome and trends; Port Harcourt; Nigeria

Tetanus with multiple wedge vertebral collapses: A case report in a 13 year old girl

Data from the case records dary School Class two girl managed at the Department of Paediatrics of the University of Port Harcourt Teaching Hospital were extracted for presentation to highlight vertebral collapse as an uncommon complication of paediatric tetanus and the associated management challenges. The girl presented with complaints of back pains-11 days, inability to open her mouth- 9 days, jerking of the body- 8 days and upper back swelling-6 days following bruises from corporal punishment in her school. She was diagnosed to have tetanus with vertebral collapses of T3-T6. Tuberculosis and other causes of vertebral collapse were excluded. The tetanus was successfully treated but she left against medical advice and defaulted from follow-up for the management of the vertebral collapses. Poverty, ignorance and belief in traditional health care were major obstacles to her management.Key words: Multiple wedge vertebral collapses in tetanu

Nutritional status of day care attendees in Port Harcourt metropolis

Objective: To determine the nutritional status of children aged 0-35 months attending day care centres in Port Harcourt metropolis.Methodology: A cross-sectional descriptive survey approved by the University of Port Harcourt Research Ethics Committee, the parents, Authorities of Day care centres and National Association of Proprietors of Private Schools, was carried out between November 2011 and July 2012 in 200 day care centres in Port Harcourt metropolis. The centres were selected using stratified multistage random sampling technique. At each day care 10 children (5 males and 5 females) selected randomly from those who met the inclusion criteria were recruited. With parental cooperation, each child's socio-demographic data, nutritional history and anthropometric measurements were obtained. Data were analysed using SPSS version 20. Statistical significance was set at p<0.05.Results: Complete data for analysis were available for 1541 children aged 5-34months (mean 23.78 ± 7.04 months, median 25 months and modal 24 months) with 110(7.2%) children aged less than 12 months and 283(18%) less than 18 months. They consisted of 766 (49.7%) males and 775 (50.3%) females. Most children had normal nutritional status using the various indices but 46 (3%) children were underweight, 85 (5.5%) stunted, 109 (7.1%) wasted and 328 (21.3%) overweight. The mean Mid Upper Arm Circumference (MUAC) was 15.95 ± 1.698 cm with 29 (2%) children having MUAC below 115mm.Conclusion: Majority of the day care attendees were well nourished. However, the high prevalence of overweight malnutrition is of serious concern in view of its associated long term morbidity and the need for effective interventions to reduce this risk.Key Words: day care centres, under-fives, malnutrition, overweight, children

Feeding pattern of children in day care centres in Port Harcourt metropolis

Objective: To determine the feeding pattern of day care attendees aged 0-35 months in Port Harcourt metropolis.Methodology : Following appropriate approvals, a pilot-tested questionnaire was used to obtain the socio-demographic data and information on the feeding pattern of 10 day care attendees aged 0- 35 months who met the study criteria selected from each of 200 schools using a stratified multistage random sampling technique. Data entry and analyses utilised SPSS version 20 and statistical significance was set at p<0.05.Results: Between November, 2011 and July, 2012, 1541 children comprised of 766 (49.7%) males and 775 (50.3%) females were studied. They were aged 5- 34months (mean 23.78 ± 7.04 months, median 25 months and modal 24 months) with 110(7.2%) children aged less than 12 months and 283(18%) aged less than 18 months. Although 102(6.6%) children were still breastfeeding, none of the 21 (1.4%) children aged less than 6 months was being exclusively breastfed. Complementary feeding commenced at age 6- 8 months in 747(48.5%) children, before 6 months in 613(39.8%) and after 9 months in 181(11.7%) children. The ages at starting day care attendance which ranged from 1-25 months with 56.3% children starting before 11 months of age statistically significantly influenced the ages at which complementary feeding commenced (χ2= 53.431, df = 8, p = 0.000). The main foods fed to day care attendees while at day care centres were adult diet for 1152 (74.8%) children and breast milk and/or cereals for 389 (25.2%). Daily feeding frequencies while at the centre which ranged between 1-6 times and decreased with the child’s age an the age was statistically significantly affected by the child’s age, the feeding frequency (p = 0.000).Conclusion: The feeding pattern of these day care attendees did not comply with the recommendations of the National Infant and Young Child Feeding Guidelines. This situation at a national level may contribute to the high prevalence of under-five malnutrition and calls for strategies to correct these deficiencies.Key words: Feeding pattern, Day care attendees, Day care centres

Post-Neonatal Hypoglycaemia and Paediatric Emergency Room Admissions: A Study In The University Of Port Harcourt Teaching Hospital.

Background: Hypoglycaemia, a common complication of many childhood diseases, significantly increases disease-related morbidity and mortality. The objective of this study is to determine the prevalence, morbidity pattern and outcomes of hypoglycaemia at admission of postneonatal children in the Children's Emergency Ward (CHEW) of the University of Port Harcourt Teaching (UPTH).Methods: All post-neonatal children admitted into the UPTH CHEW from September 2007-January 2008 who met the inclusion criteria were prospectively studied using a pre-tested proforma which obtained their sociodemographic and clinical data. In all subjects, plasma glucose was determined on admission (using glucometer and glucose oxidase tests) before management. Data analysis was with EPI Info version 6.04 and statistical significance was set at 0.05.Results: Three hundred and seventy children aged 1month-15 years (mean 36.7±40 months) with 272(78.9%) under-fives were studied. Their plasma glucose levels ranged from 1.0-12mmol/l with 19(5.1%) children among whom were 15(78.9%) under-fives being hypoglycaemic (plasma glucose-1.0-2.4mmol/l, mean 1.4 + 0.2mmol/l). All cases of hypoglycaemia were detected by both methods of estimation. The commonest diseases diagnosed in the study population, irrespective of the plasma glucose level, were malaria, anaemia and diarrhoea. Overall, 49 (13.2%) children of whom 7(14.3%) were hypoglycaemic died. Hypoglycaemia was associated with longer hospital stay and higher mortality rate (36.8%) (p=0.001).Conclusion: Hypoglycaemia, detectable by bedside glucometer test, significantly increases morbidity and mortality associated with common childhood diseases. There is therefore a need for its prevention, early diagnosis and prompt management in all paediatric care settings, especially in resource-limited countries, as recommended in the Integrated Management of Childhood Illness algorithm.Keywords: Hypoglycaemia; Post-neonatal; Paediatric emergencies; Nigeria

WriteSim TCExam - An open source text simulation environment for training novice researchers in scientific writing

BACKGROUND: The ability to write clearly and effectively is of central importance to the scientific enterprise. Encouraged by the success of simulation environments in other biomedical sciences, we developed WriteSim TCExam, an open-source, Web-based, textual simulation environment for teaching effective writing techniques to novice researchers. We shortlisted and modified an existing open source application - TCExam to serve as a textual simulation environment. After testing usability internally in our team, we conducted formal field usability studies with novice researchers. These were followed by formal surveys with researchers fitting the role of administrators and users (novice researchers) RESULTS: The development process was guided by feedback from usability tests within our research team. Online surveys and formal studies, involving members of the Research on Research group and selected novice researchers, show that the application is user-friendly. Additionally it has been used to train 25 novice researchers in scientific writing to date and has generated encouraging results. CONCLUSION: WriteSim TCExam is the first Web-based, open-source textual simulation environment designed to complement traditional scientific writing instruction. While initial reviews by students and educators have been positive, a formal study is needed to measure its benefits in comparison to standard instructional methods

Research proposal writing: Breaking the myth

No Abstract. Nigerian Journal of Medicine Vol 15 (4) October-December: 373-38

Teaching of essential maternal and newborn interventions: how skilled are the trainers from health service provider training institutions in Port Harcourt, Rivers State?

Background: Maternal and neonatal indices in Nigeria and other developing countries have remained poor, with poor access to health care and most deaths occurring at home. This necessitated the development of several low-cost, evidence-based essential interventions such as the Home Based Care for Mothers and Newborns (HBCMN) package by United Nations Children's Fund, of which 90% coverage could prevent up to 90% of these deaths. Therefore, achieving a meaningful reduction of maternal and perinatal mortality would require capacity building of health workers and their trainers.Aim: To present the impact of the short course on HBCMN on the skills of health worker's trainers.Methods: Teachers from five health institutions attended the course.  Pre- and post-tests were administered to assess the knowledge they acquired from the training. Results were analysed using percentages and the level of significance was set at P<0.05. Results: Thirty-seven participants registered and took the pre-test, 26 (70.3%) completed the training. In the pre-test, 96% of participants could name at least 2 danger signs in a pregnant woman and 84.6% in the newborn. Few participants knew the importance and timing of early postnatal visits. Twenty-four (92.3%) knew about early initiation, frequency and duration of exclusive breastfeeding; but none knew the management of sore nipples. Four (15.3%) participants knew about the Kangaroo Mother Care. These deficiencies significantly improved during the post-test.Conclusion: Trainers of health workers require regular updating of their knowledge to improve the quality of their training. Keywords: Essential interventions, Maternal, Newborn, Skills, Trainers, HBCMN packag

Neonatal Tetanus in Nigeria: One Social Scourge too many!

Neonatal tetanus (NNT) is still a major cause of morbidity and mortality among neonates in Nigeria and every case is an embarrassment to the health services provided in the country. Nigeria is one of 27 countries that account for 90 percent of the global burden of NNT. Major contributors to the persistently high incidence of NNT in the country include declining tetanus toxoid vaccine coverage rate among pregnant women and delivery by untrained personnel. We believe that the major thrust in preventing NNT should be the improvement in the coverage rate of the five-dose schedule. This could be achieved by incorporating this schedule into the School Health Programme. Its overall elimination in the country requires the concerted efforts of several stakeholders – adolescents and women of childbearing age, including pregnant women, health care providers at all levels, educational and other sectors. Nigerian Journal of Paediatrics Vol.31(1) 2004: 1-