Infant-feeding Practices among HIV-infected Mothers in an HIV-treatment Programme

The transmission of HIV via breastmilk has led to various recommendations for HIV-infected mothers. In this study, the feeding practices of HIV-infected mothers in the first six months of their infants' lives were evaluated. In total, 103 consecutive mothers of children, aged 6-24 months, were evaluated for their feeding practices in the first six months of their infants' lives. The mothers were recruited in two cohorts based on their entry (PMTCT cohort) or non-entry (non-PMTCT cohort) to an HIV MTCT-prevention programme. Information obtained included maternal age, socioeconomic class, and the educational level attained. All the babies in the non-PMTCT cohort were breastfed compared to none in the PMTCT cohort. Infant formula was inadequately prepared for 77.42% of babies in the non-PMTCT cohort compared to 18.64% in the PMTCT cohort. The mixed-feeding rate was high (70.45 %) in the non-PMTCT cohort. Over 70% of babies in both the cohorts were bottle-fed. Voluntary counselling and testing services in the healthcare system should be strengthened. All mothers should receive infant-feeding counselling, with exclusive breastfeeding being encouraged in those with unknown HIV status

Experience with full-thickness rectal biopsy in the evaluation of patients with suspected Hirschsprung’s disease

Background and purpose Rectal biopsy is the main modality for the diagnosis of Hirschsprung’s disease (HD). In Africa, transanal full-thickness rectal biopsy is commonly performed. We aimed to audit our practice of rectal biopsy in the evaluation of HD.Materials and methods A retrospective review was carried out of the records of children (r15 years) who were evaluated for HD between 2007 and 2011. Clinical presentation, details of the operation, and histologic result were analyzed using SPSS version 15.0.Results Fifty-seven children were evaluated for suspected HD during the period. Thirty-six children underwent a rectal biopsy. There were 29 (80.6%) males and nine (19.4%) females, of which two were preterm. Neonates and infants accounted for 72.2% (n= 26). The median age at biopsy was 90 days (range, 5 days to 9 years). Delayed passage of meconium was present in 64.7%, constipation in 85.7%, abdominal distension in 88.6%, and bilious vomiting in 55.9%. Thirty biopsies (83.3%) yielded a histologic diagnosis. Twenty-six (72.2%) confirmed HD, whereas four (11.1%) yielded normal rectal histology. In six (16.7%), the sample taken was deemed inadequate for opinion. None of the symptoms assessed was associated significantly with a diagnosis of HD, stalling further analysis. Where a single biopsy was taken, 20% (n =5) were inadequate for analysis; where more than one sample was taken, a histologic diagnosis was possible in 100% (n =11). Consultant surgeons and trainees returned inadequate samples in 15.8% (n= 3) and 12.5% (n= 2), respectively. An inadequate sample was obtained in four infants (15.4%) and one child older than 1 year of age (10%). Distance of biopsy from the dentate was not indicated in 63.9% (n= 23).Conclusion No clinical parameter can accurately predict a diagnosis of HD. More than one sample at a sitting may improve the diagnostic yield. Larger prospective studies are needed to confirm these findings.Keywords: full-thickness biopsy, Hirschsprung’s disease, rectal biops

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence of Hypoglycemia Among Patients Presenting with Cholestasis of Infancy in a Nigerian Teaching Hospital

Objective: This study assesses the prevalence of hypoglycemia among patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria with cholestasis of infancy.Methods: During a period of five years, forty patients aged between 15 days and 12 months who presented with cholestasis of infancy, were admitted and screened for hypoglycemia, using Accutrend glucometer. For patients with low blood glucose values, blood samples were further analyzed, using the standard glucose-oxidase method.Results: Of the 2,835 patients admitted over a five-year period, 40 (1.4%) had cholestasis of infancy, giving an incidence of 14 cases per 1000 admissions, with a sex ratio of 2.1: 1 in favour of males. Nine (22.5%) of the 40 infants with cholestasis had at least one blood glucose concentration less than 2.6 mmol/L (hypoglycemia). Of the nine hypoglycemic infants, three (33.3%) had one blood glucose concentration less than 1.6 mmol/L (severe hypoglycemia). Seven (77.8%) of the nine hypoglycemic infants were diagnosed in the first 36 hours of admission. Lethargy and poor feeding were observed in three infants with severe hypoglycemia and three of them died. Six (66.7%) of the hypoglycemic infants were below 3 months of age.Conclusions: Hypoglycemia was observed among patients with cholestasis of infancy and the prevalence was higher among infants below 3 months of age

Choosing an appropriate Plastibell size for infant circumcision

Background: The Plastibell technique is the most frequently used device due to its perceived “ease of use” by all categories of practitioners including nonqualified people like barbers and technicians. Nonetheless, Plastibell technique for circumcision is not without its problems. We aim to describe a simple and objective technique of choosing an appropriate Plastibell size for Plastibell circumcision. Technique and Methods: The circumference of the glans penis (C) is measured at the level of the glanular ridge. The diameter of the glans corresponding to the Plastibell size is determined using the formula πD = C. The glans diameter (D) equals 0.32C. This technique was used to choose Plastibell size for 25 consecutive infants in a pilot study. Results: The median age of the infants was 21 days. The median circumference of the glans was 4.1 cm, and the median size of the Plastibell used was 1.3. The median time taken by the device to fall off spontaneously after circumcision was 4 days. There was no complication recorded. Conclusions: This objective method of choosing the appropriate Plastibell size is easy and safe. It has the potential to reduce the complications of Plastibell circumcision

Is non-operative management still justified in the treatment of adhesive small bowel obstruction in children?

Background: Adhesive small bowel obstruction (ASBO) is a feared complication after abdominal operations in both children and adults. The optimal management of ASBO in the pediatric population is debated. The aim of the present study was to examine the safety and effectiveness of non-operative management in ASBO. Patients and Methods: A retrospective review of 33 patients who were admitted for ASBO over a 5-year period was carried out. Follow-up data were available for 29 patients. Demographic, clinical, and operative details and outcomes were collected for these patients. Data analysis was done with SPSS version 15.0. P ≤ 0.05 was regarded as significant. Results: Out of 618 abdominal surgeries within the 5-year period, 34 admissions were recorded from 29 patients at the follow-up period of 1-28 months. There were 19 boys (65.5%). The median age of patients was 4.5 years. Typhoid intestinal perforation (n = 7), intussusception (n = 6), intestinal malrotation (n = 5), and appendicitis (n = 4) were the major indications for a prior abdominal surgery leading to ASBO. Twenty-five patients (73.5%) developed SBO due to adhesions within the first year of the primary procedure. Of the 34 patients admitted with ASBO, 18 (53%) underwent operative intervention and 16 (47%) were successfully managed non-operatively. There were no differences in sex (P = 0.24), initial procedure (P = 0.12), age, duration of symptoms, and time to re-admission between the patients who responded to non-operative management and those who underwent operative intervention. However, the length of hospital stay was significantly shorter in the non-operative group (P < 0.0001). Five (14.7%) patients had small bowel resection. A 43-day-old child who initially underwent Ladd′s procedure died within 15 h of re-admission while being prepared for surgery, accounting for the only mortality (3.4%). Conclusion: Non-operative management is still a safe and preferred approach in selected patients with ASBO. However, 53% eventually required surgery

Pediatric laparoscopic surgery in North-Central Nigeria: Achievements and challenges

Background and Objective: Advances in laparoscopy are making the service accessible even in resource-poor countries where adaptations are made to meet local challenges. We report our experience in the provision of laparoscopy service to children at a tertiary health center in North-central Nigeria. Methods: A team of pediatric surgeons, anesthetists, and nurses collaborated to provide service and train other personnel. A prospective collection of data on biodata, diagnoses, procedure, and outcome over an effective period of 36 months of laparoscopy intervention of the 54 months between September 2009 and February 2014 was done. Consent, which also included the possibility of conversion to open was obtained from the parents of the patients. Results: A total of 73 patients aged 2 weeks to 16 years with a male: female ratio of 3 to 1 had laparoscopy done during the period. Fifty-two (71.2%) procedures were therapeutic, and 21 (28.8%) cases were done as emergency. Laparoscopic appendectomy was the most commonly performed procedure 25 (34.3%), followed by laparoscopic orchidopexy 17 (23. 3%), and diagnostic laparoscopy for disorders of sexual differentiation in 13 (17.8%). The length of stay in hospital postoperative was 1-3 days with a mean of 1.34 ΁ 0.45 days. The complications recorded included hemorrhage, in a case of infantile hypertrophic pyloric stenosis due to failed electrocautery, one port site burns injury from diathermy dissection, and two periport pain postoperation. There was no mortality recorded. Conclusion: Pediatric laparoscopic service is gaining recognition in our practice in spite of poor resources, incessant industrial actions, and apathy from support staff. The outcomes are encouraging as the patients had minimal morbidities. Skills are improved through practice and retraining and manpower, and instruments are being expanded through our collaboration and training

Health and environmental impacts of pesticide use practices: a case study of farmers in Ekiti State, Nigeria

Commonly used pesticides and handling practices which might expose farmers and their environment to chemical hazards were investigated in the Irepodun/Ifelodun local government area of Ekiti State, Nigeria. Direct field observations and answers to a structured questionnaire from a random sample of 150 farming households showed that commonly used pesticides comprised herbicides (48.3 per cent), fungicides (28.2 per cent) and insecticides (23.5 per cent). Of these, 86.7 per cent are classified as ‘highly’ hazardous by the World Health Organization (WHO) and have been banned or restricted in many developed countries. Nearly all of the farmers (94.7 per cent) had received no formal training in safe pesticide use and mixed different products. Farmers suffered from discomforts ranging from eye irritation (91.3 per cent), skin problems (87.3 per cent), nausea (86.0 per cent), headache (83.3 per cent) and vomiting (58.0 per cent). More than half of the pesticide applicators (61.3 per cent) sprayed pesticides near water bodies. Only a few farmers reported decreasing trends in numbers of beneficial insects (27.3 per cent) and other animals (29.3 per cent). The results showed that the awareness of farmers and authorities needs to be raised regarding the use of protective equipment and correct procedures when handling pesticides and, also, that there should be stricter enforcement of existing pesticide regulation and monitoring policies to minimize the threats that the farmers’ current practices pose to their health and to the environment

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways