Evaluation of home care management of umbilical cord stumps by mothers at Ilesa, Southwestern Nigeria

Background: Umbilical cord care is an integral part of neonatal care in all communities and cultures and appropriate cord care reduces the risk of infection in the newborn infant.Objective: The present study assessed the home care management of the umbilical stump by the mothers at Ilesa, Southwestern Nigeria.Subjects and methods: The subjects were newborn babies brought for routine immunization in health facilities at Ilesa, Nigeria. Informed consent was obtained from the mothers and permission sought from the nurses in charge of the immunization centres. Data collected were entered into a research proforma designed for the study. The babies had complete physical examination with special emphasis on the umbilical cord stump forany abnormality or complications resulting from care.Results: Of 331 babies aged 0 to 28 days assessed, 194 (58.6%) weremales and 137 (41.4%) females. The age range at dropping of the cord was 3 to 25 days with a mean and standard deviation of 8.64 ± 3.55 days. Common methods of umbilical cord care are cleaning with methylated spirit, hot water formentation and the application of shea butter. None of the mothers had appropriate cord care practice of hand-washing before and after cord care, washing the cord with clean water and soap, keeping thecord dry and exposed to air. However, 225 (68.0%) had fair cord care while 106 (32.0%) had poor cord care. Fifty six (16.9%) of the 331 babies had various localized complications of the umbilicus. These were purulent discharge/umbilical sepsis, bleeding, umbilical granuloma, periumbilical cellulitis and omphalitis. Associated factors to poor cord care and  complications were no antenatal care and lower social class of the mothers.p =0.000.Conclusions: It is concluded that improved antenatal care, improved social class and training on appropriate cord care during antenatal care visit will  improve incidence of cord complications. Key words: Evaluation, Home Care, Umbilical cord stump care, Nigeri

Assessment of knowledge on causes and care of neonatal jaundice at the Nigerian primary and secondary health institutions

Background: Neonatal jaundice is the most common condition that requires medical attention in new-borns. However, missed diagnosis of jaundice, poor monitoring, and prescriptions of wrong and ineffective medications by the health workers for jaundice are known to be responsible for the persistence of acute bilirubin encephalopathy in the sub region.  Therefore, the aim of the present study was therefore to assess the knowledge in the care of neonatal jaundice at the primary and secondary health care delivery in Nigeria so as to improve it.Methods: A cross-sectional study conducted at 12 local government primary health and maternity centers and 2 state owned general hospitals (secondary health facilities) in Osun State, Southwest Nigeria between January and June 2014. Consent was obtained from the health workers at the health facilities. A structured questionnaire was administered to all the staffs on duty and during the shifts of duty. The questionnaire contained questions to assess the knowledge of the health workers with regard to neonatal jaundice causes, treatment and complications. Staff judgment on the effectiveness of methods and drugs being prescribed were also assessed.Results: One hundred and forty one (67.5 percent) were primary health care workers and 68 (32.5percent) were staff in secondary health care facilities. There was significantly better understanding of causes, management and complications of neonatal jaundice among secondary  health care workers than primary health care workers (p at least 0.007). Common pharmacological agents prescribed were Ampiclox (Ampicillin-Claxacillin formulation), Glucose water, Multivitamins, phenobarbitone, other antibiotics and injections at both health care levels.Conclusions: There is therefore urgent need to train health workers of all cadres on causes, care, effective treatment and complications of neonatal jaundice to reduce the high prevalence of bilirubin encephalopathy. Facilities like effective phototherapy units should be made available at health facilities and training centres.

Fatal scorpion sting in a child

Fatal scorpion stings are rare in Nigeria. Hitherto, there has been no report from Nigeria of death following scorpion stings. This report is that of a 2‑year‑old boy who was stung by a scorpion while playing outside his home environment in Osogbo, South West Nigeria. He subsequently presented to the Children Emergency Unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, in pain and with features of shock. He died within 2 h of admission despite all treatment given to relieve pain and manage shock. The case is reported in order to share the important lessons learned.Key words: Fatal, pediatric, scorpion stin

Hypoxaemia and its clinical predictors among children with pneumonia at a tertiary centre in Osogbo, Southwestern, Nigeria

Objective: Hypoxaemia is a feature of severe pneumonia particularly among children aged less than five years. This study aimed to determine the prevalence and clinical predictors of hypoxaemia among children with pneumonia.Methods: It was a hospital-based cross-sectional observational study involving 129 children aged 1 - 59 months with both clinical and radiological pneumonia. The haemoglobin oxygen saturation (SPO ) was 2 obtained at presentation. Hypoxaemia was defined as SPO < 90 percent. 2Result: Of the129 subjects studied, 49 (38.0%) had hypoxaemia. The clinical signs that were significantly associated with hypoxaemia were central cyanosis (p= 0.012), grunting (p= 0.014), nasal flaring (p< 0.001), lethargy (p< 0.001), restlessness (p= 0.002), loss of consciousness (p< 0.001), and inability to feed (p< 0.001). A combination of nasal flaring with central cyanosis, grunting or tachypnoea were significant predictors of hypoxaemia (p= 0.029, 0.017 and <0.001 respectively). Tachypnoea and nasal flaring had the highest sensitivity and specificity among the clinical signs for hypoxaemia. Prolonged hospital stay (> 5 days) and mortality were significantly associated with hypoxaemia (p< 0.001).Conclusion: Hypoxaemia is common among children hospitalized for pneumonia. It is an important determinant of hospital stay and outcome. Keywords: Hypoxaemia, pneumonia, hospitalized children, under-fives, clinical predictors

Relationship between Ponderal Index, Mid-Arm Circumference/ Head Circumference Ratio and Clinical Assessment of Nutritional Status Score (CANSCORE) in the Determination of Nutritional Status of Newborn at Birth in Nigeria

Background: Early and accurate assessment of the nutritional status of newborns is important to many clinicians because of the potential immediate and late sequelae of malnutrition.Objective: To assess the relationship between different methods of assessing the nutritional status of neonates.Methods: Subjects were consecutive, live, singleton, full term neonates delivered in the hospital. The birth weights, Ponderal index, Mid arm circumference/head circumference ratio, birth weight for gestational age using intrauterine growth charts and Clinical Assessment of Fetal Nutritional Status Score (CANSCORE) were used to determine the nutritional status in the first 24 hours of life.Results: Of 386 subjects, 172 (44.6%) were males and 214 (55.4%) females. Nutritional status assessment using various indices showed the following prevalence of malnutrition: using birth weights, 54 (14.0%) were LBW; MAC/HC ratio showed 56 (14.5%), with PI, 64(16.6%), weight for gestational age, 112(29.0%) were SGA and CANSCORE showed 90(23.3%) as malnourished among the babies.MAC/HC showed a better specificity and had a more positive correlation than PI when compared to CANSCORE whilst PI showed a better sensitivity than MAC/HC when evaluated against CANSCORE.Conclusions: Prevalence of FM is high in this study. Intrauterine growth charts and CANSCORE appeared to identify more babies with FM than other methods. CANSCORE in this study has revealed the rising trend in the prevalence of FM when compared with other studies with similar methodology. Early routine assessment of the nutritional status of newborns should be carried out so as to reduce the risk of increased morbidity and mortality associated with fetal malnutrition

Mycotic loads’ determination of non-sterile pharmaceuticals in Lagos state and 16S RDNA identification of the fungal isolates

Pharmaceuticals are medicinal products used in the prevention, treatment, and diagnosis of diseases. As such, the presence of microorganisms’ especially fungal toxins can reduce or eliminate the product's therapeutic activity and constitute a potential danger to patient health. This study attempts to determine the fungal loads of liquid preparation used as medication in Lagos State and its environs and identify the fungal isolates. 252 different types of oral liquid drugs (200syrups and 52 suspensions) which included paracetamol syrup, cough syrup and antibiotics suspension manufactured in five different pharmaceutical industries in Nigeria were methodically sampled and analyzed for fungi contamination using standardized method. The isolated fungi were identified using morphological characterization as well as 16SrDNA sequencing. 13% of the sampled syrups were found to be contaminated with fungi where thecolony forming units for paracetamol syrup, cough syrup and antibiotics suspension ranges from 2.0x101 - 9.6×104; 1.0x102- 7.5x104 and 1.0x101- 8.8×104cfu/ml respectively while87% yielded no growth.Thirteen (13) morphologically different species of fungi were identified which included Aspergillus niger strains, A. tamari strains, A. japonicas, A. flavus, A. awamari, A. ellipticus, A. tubingensis, Meyerozyma aaribbica, Candida carpophila and  Eurotiomycetes spp, The presence of microorganisms in oral liquid samples might explain the treatment complicacy of the diseased children. Therefore, microbiological quality of such drugs is thus suggested

Determinants of outcome in newborns with respiratory distress in Osogbo, Nigeria

Background: Respiratory distress is one of the commonest presentations necessitating hospital admission in newborn unit. Regardless of the cause, if not recognized and managed quickly, respiratory distress can escalate to apnoea, respiratory failure, cardiopulmonary arrest and death.Methods: A cross-sectional and descriptive study of newborns with respiratory distress admitted into the SCBU of LAUTECH Teaching Hospital, Osogbo, Nigeria. Respiratory distress was diagnosed by grunting, inspiratory stridor, nasal flaring and tachypnea (more than 60 breaths per minute), retractions in the intercostal, subcostal, or supracostal spaces and cyanosis. At admission, every neonate had a complete physical examination.Results: Of 625 babies admitted, 384 (61.4%) were males while 241 (38.6%) were females and 164 (26.2%) had respiratory distress. Respiratory distress was commoner among the preterms than term newborns. c2 = 44.7, p = 0.001. Leading causes of respiratory distress among the preterms were hyaline membrane disease, septicaemia, while among the term babies were perinatal asphyxia, transient tachypnoea of newborn and meconium aspiration. Sixty (36.6%) of the 164 babies with respiratory distress died. While 40.2% of the preterms died mainly from causes like hyaline membrane disease and septicaemia, 31.3% of term babies died from causes like perinatal asphyxia and meconium aspiration. Mortality from hyaline membrane disease was 46.9%, while perinatal asphyxia and meconium aspiration accounted for 38.9% and 40.0% respectively.Conclusions: Respiratory distress is therefore, a very common neonatal problem and it causes death of more than third of those affected. Emphasis should be geared towards reduction of preterm delivery, control of asphyxia and neonatal sepsis in order to reduce neonatal mortality in our environment

Increased sensitivity for detecting malaria parasites in human umbilical cord blood using scaled-up DNA preparation

BACKGROUND: All mothers donating umbilical cord blood units to the NHS cord blood bank undergo an assessment for the likelihood of prior exposure to malaria infection. Those deemed at risk due to a history of travel to, or residence in, malaria endemic regions are screened serologically to detect anti-malaria antibodies. A positive result excludes the use of the cord blood for transplant therapy unless a risk assessment can ensure that malaria transmission is extremely unlikely. This paper details the screening of cord blood units from malaria serology positive mothers to detect malaria parasite DNA using a highly sensitive nested PCR. METHODS: Uninfected blood from a healthy volunteer was spiked with known quantities of malaria parasites and 5 millilitre and 200 microlitre aliquots were subjected to DNA extraction using QIAamp DNA maxi and DNA mini kits respectively. Nested PCR, to detect malarial SSU rRNA sequences, was performed on the purified DNA samples to determine the limit of detection for this assay with both extraction methodologies. Following assay validation, 54 cord blood units donated by mothers who were positive for anti-malaria antibodies were screened by this approach. RESULTS: When DNA was purified from 5 millilitres of blood it was possible to routinely detect as few as 50 malaria parasites per millilitre using nested PCR. This equates to a significant increase in the sensitivity of the current gold standard nucleic acid amplification technique used to detect malaria parasites (routinely performed from > 200 microlitre volumes of blood). None of the 54 donated cord blood units from serology positive mothers tested positive for malaria parasites using this scaled up DNA preparation method. CONCLUSION: Serological testing for malaria parasites may be overly conservative, leading to unnecessary rejection of cord blood donations that lack malaria parasites and which are, therefore, safe for use in stem cell therapy

Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission

Background. The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia