Feeding practices in late infancy in Benin City, Edo State, Nigeria

Background: Whereas considerable insight has been gained and progress made in optimum feeding in early infant feeding same cannot be said with nutrition in late infancy. Tacking challenges associated with nutrition in late infancy demands that extant practices and their shortcomings are exposed.Objectives: To evaluate and document practices regarding feeding in late infancy in Benin City, Edo State, Nigeria.Methods: Using a communitybased household survey involving three representative political wards in Egor Local Government Area of Benin City, feeding practices in late infancy were evaluated using a mix of structured and non-structured, pre-tested questionnaires on 522 mothers of infants aged >6months to 11 months. This was done between June and September, 2009.Results: The age range of mothers was 17-48 years. Diverse ethnic groups were represented with the Binis constituting the largest (48.6%). Bottle feeding rate (BOTFR) was 2.55% and Bottle feeding practice was unassociated with maternal occupation (χ2 = 2.741; p=0.740) and family socioeconomic status (χ2=10.145; p=0.930). Timely complimentary feeding rate (TCFR) was very high (92.7%). Delayed introduction of complimentary feeding was very low (3.6%). Maize gruel (pap) was the commonest (76.6%) complementary food utilized and commonly (99.5%) this was enriched with a variety of other items with milk as the commonest item used. Fish was the commonest (41.0%) animal product used as complimentary food. Use of animal feeds was however generally low and their use was uninfluenced by family socio-economic status (χ2 = 5.424, p=0.066).Conclusions/Recommendations: Bottle feeding rate remains unacceptably high even into late infancy. Factors fostering this should be exposed and tackled because of the dangers inherent in the practice. Timely complimentary feeding practice is encouraging and needs to be supported and sustained for its benefits.Key Words: Nutrition, Late, Infancy, Complimentary feeding, Benin City

Relationship between vitamin A status and anaemia among school age children in Benin

Background: Anaemia and vitamin A deficiency are two major public health problems affecting many developing countries world-wide. Vitamin A deficiency, in addition to other health problems, can contribute to anaemia. Therefore, the objective of this study is to determine the relationship between vitamin A status and anaemia among school agechildren in Benin City.Methods: This is a cross-sectional study carried out between June2005 and February 2006 on one hundred and fifty-two children within the age range of 6 and 12 years, randomly selected from primary schools in a Local Government   Area of Edo State. Plasma vitamin A was assessedby Bessey’s Spectrophotometric method, while the  Haemoglobin concentration was assessed using the photometric principle ofanalysis.Results: The mean plasma vitamin A level was 27.7± 12.4ìg/dl., with a range of 10 - 64ìg/dl. The prevalence of vitamin A deficiency (plasma retinol <20ìg/dl) was 29.6%. There was no subject with severe vitamin A deficiency (plasma retinol <10ìg/dl. The mean haemoglobin concentrationwas 10.5 ± 1.1g/dl., with a range of 7.3 – 13.4g/dl. The prevalence of anaemia (haemoglobin concentration <11g/dl) was 58.6%. There was no statistically significant correlation between vitamin A deficiency and anaemia, although the haemoglobin levels tended to increase with increased vitamin A status.Conclusion: This study shows high prevalence rates of vitamin A deficiencyand anaemia in this part of Nigeria. There was a trend of increasinghaemoglobin levels with higher vitamin A status which however, was not statistically correlated.Key Words: vitamin A deficiency, Anaemia, school age children

Breastfeeding practices in early infancy in Benin city, Nigeria

Background: Adequate early infant nutrition is essential for subsequent optimum growth and development of the child. Exclusive breastfeeding is the cornerstone of the best possible nutrition in early infancy.Objective: To assess current breastfeeding practices in early infancy in Benin City and further progress ( if any) that may have been made in the realisation of optimal early infant feeding practices in the locale in the preceding decade.Methods: A community-based household survey was carried out in three representative wards in Egor Local Government Area of Benin City, from June to September, 2009. Infant feeding practices were evaluated using pre-tested questionnaires on 1068 mothers of infants aged less than 12 months.Result: Five hundred and forty-six (51.1%) infants were aged less than 6 months. The Ever Breastfed Rate was 100.0% while the Timely Suckling Rate was 35.5%. The Exclusive and Predominant Breastfeeding Rates were respectively 40.7% and 30.4% while the Bottle-feeding Rate was 32.2%. Most (98.4%) mothers had correct information about exclusive breastfeeding obtained mainly from antenatal clinics and immunization centres. Factors significantly associated with EBF were high maternal education (χ2 = 9.718; p = 0.045), high socioeconomic status (χ2 = 12.910; p = 0.012), increasing maternal age (χ2 = 14.777; p = 0.022), higher parity (χ2 = 15.212; p = 0.009), delivery in hospital (χ2 = 15.079; p = 0.020) and infant’s age (χ2 = 100.482; P = 0.0001).Conclusions/Recommendations: Breastfeeding practices in Benin City have not improved much from what obtained a decade earlier. Greater emphasis on female education and socio-economic empowerment are advocated as tools for improvement. Reinvigoration of the Baby-friendly Hospital Initiative is also recommended to ensure continued health facility interface that would ensure community mobilisation and support for optimal breastfeeding.Key Words: Breastfeeding, Practices, Early Infancy, Benin Cit

Hepatoblastoma in an adolescent girl: A case report

Hepatoblastoma is the most common primary malignant hepatic tumour in children, occurring between the ages of 6months to 3years. It most often presents with a painless abdominal mass discovered accidentally in youngchildren. Occurrence in adolescents and adults is rare and is usuallyassociated with non-specific symptoms which often result in delayed  diagnosis and commencement of treatment. Abdominal pain preceding a rapidly progressive abdominal mass is a common pattern observed in adolescents and adults. The histologic type commonly seen in adults isassociated with a poor prognosis. We report the case of a sixteen year old girl who presented with abdominal pain and distension and jaundice of a short duration. She was well-nourished with marked hepatomegaly and ascites. Hepatic transaminases were highly elevated with deranged clotting profile. She developed features of hepatic encephalopathy and diedon the seventh day of admission. A Post-mortem histologic diagnosisof hepatoblastoma was made.Key words: Hepatoblastoma, adolescent, poor prognosi

Levels of serum zinc and severity of malaria in under-fives: any relationship? Experience from Benin, Edo State.

Background: It remains uncertain why some individuals infected with Plasmodium falciparum develop severe disease while others do not. This may be due to differences in immunological status of the individuals. Zinc levels may play some roles in the immune competence of such individuals as manifested in its effects on some clinical and laboratory parameters. Objective: To determine the relationship between serum zinc levels and some laboratory and clinical parameters in under-five children with malaria. Methods: The study was conducted at the University of Benin Teaching Hospital, Benin City between March and November 2003 and involved 640 under-five children. Of these, 384 children had parasitologically proven malaria while 256 were healthy controls. Determination of zinc in sera was done using the Atomic Absorption Spectrophotometry. Results: Mean serum zinc level of patients with severe/complicated malaria (13.7 ± 9.4µmol/l) was significantly lower than that obtained in non-severe/uncomplicated malaria (17.1±8.0 µmol/l; t =3.67; p =0.000). There was a negative correlation between malaria parasite density and serum zinc levels (r =     -0.101, p < 0.05). A similar trend was observed between zinc levels and degree of pyrexia (r = -0.120; p < 0.05). Conclusion: Patients with severe malaria presenting with hyperpyrexia and hyperparasitaemia tended to have lower levels of serum zinc. Hypozincaemia is associated with severity of the disease either as a cause or effect. Recommendation: Similar studies should be conducted in other centres to validate the findings. Key Words: Serum Zinc, Malaria parasite density, Malaria, Under-fives

Psychosocial impairments among adults with epilepsy in a neurology clinic in Nigeria

Objective: Psychosocial problems unattended to may compromise adequate control of seizures and elevate the risk of psychopathology. We assessed for psychosocial impairments and associated psychopathology in patients with epilepsy, with the hope that findings will help initiate formal psychosocial care for patients attending the neurology clinic.Methods: Consecutive patients with epilepsy seen at the neurology clinic that met the inclusion criteria and gave consent were interviewed in a 2 stage procedure. In the first stage patients were assessed with a semi-structured questionnaire containing psychosocial variables while probable psychiatric morbidity was assessed with General Health Questionnaire (GHQ-12). In the second stage psychiatric diagnoses were assessed with Schedule for Clinical Assessment in Neuropsychiatry (SCAN).Results: Many of the patients reported difficulties in at least one or more of the psychosocial domains assessed; areas of difficulty included: physical activity (52.4%), occupational activity (46.8%); finances (41.3%); stigma (33.3%); inadequate social support by relatives (31.7%), and perceived inadequate general adjustment (34.9%). Psychosocial factors significantly associated with increased rate of psychopathology included: being a woman, having low education; financial difficulties and limitations in physical activities while significant clinical factors included: having frequent fits and partial epilepsy. Multiple logistic regression analyses indicated that being a woman and having partial seizures were the most important predictors of psychopathology among the patients.Conclusion: This study has provided evidence of the need to introduce routine psychosocial care in our neurology clinic which hitherto did not carry out structured routine assessment of psychosocial problems in order to reduce risk of psychopathology.Keywords: Psychosocial impairments, adults, epilepsy, neurology clinic, Nigeri

Psychiatric morbidity in a Nigerian neurology clinic

Objective: The objective of the study was to determine the prevalence and nature of psychiatric morbidity among patients attending a neurology outpatient clinic.Design: A two-stage screening procedure with General Health Questionnaire (GHQ-12) and Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used to assess psychological disorders over a one year period. Psychiatric diagnosis was based on ICD-10 criteria.Setting: University of Ilorin Teaching Hospital (UITH), Ilorin- NigeriaSubjects: Two hundred and thirty-five (235) patients aged 18 years and above attending the neurology outpatient clinic.Results: Overall prevalence of psychiatric morbidity was 26.0% (61/235). The most frequent diagnoses were depression (14.9%), generalised anxiety disorder (5.5%), dementia (2.6%) and substance use disorder (1.3%). Significantly more patients with stroke had psychiatric morbidity.Conclusion: The study supports previous reports that psychiatric disorders are quite common among patients with neurological disorders. Efforts should, therefore, be directed at identifying and treating neurological patients with psychiatric morbidity since this will ensure improved outcome. In this regard, mental health professionals would need to provide liaison services for the neurologists and train them in the use of simple screening instruments for detecting associated psychiatric disorders with appropriate referral where necessary

Congenital malaria in Urabá, Colombia

<p>Abstract</p> <p>Background</p> <p>Congenital malaria has been considered a rare event; however, recent reports have shown frequencies ranging from 3% to 54.2% among newborns of mothers who had suffered malaria during pregnancy. There are only a few references concerning the epidemiological impact of this entity in Latin-America and Colombia.</p> <p>Objective</p> <p>The aim of the study was to measure the prevalence of congenital malaria in an endemic Colombian region and to determine some of its characteristics.</p> <p>Methods</p> <p>A prospective, descriptive study was carried out in the mothers who suffered malaria during pregnancy and their newborns. Neonates were clinically evaluated at birth and screened for <it>Plasmodium spp</it>. infection by thick smear from the umbilical cord and peripheral blood, and followed-up weekly during the first 21 days of postnatal life through clinical examinations and thick smears.</p> <p>Results</p> <p>116 newborns were included in the study and 80 umbilical cord samples were obtained. Five cases of congenital infection were identified (four caused by <it>P. vivax </it>and one by <it>P. falciparum</it>), two in umbilical cord blood and three in newborn peripheral blood. One case was diagnosed at birth and the others during follow-up. Prevalence of congenital infection was 4.3%. One of the infected newborns was severely ill, while the others were asymptomatic and apparently healthy. The mothers of the newborns with congenital malaria had been diagnosed with malaria in the last trimester of pregnancy or during delivery, and also presented placental infection.</p> <p>Conclusions</p> <p>Congenital malaria may be a frequent event in newborns of mothers who have suffered malaria during pregnancy in Colombia. An association was found between congenital malaria and the diagnosis of malaria in the mother during the last trimester of pregnancy or during delivery, and the presence of placental infection.</p

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely