Socio-clinical factors related to the perinatal outcome of teenage pregnancies in a Nigerian teaching hospital

Background: The incidence of teenage pregnancies is rising in most parts of the world. This is associated with a wide spectrum of complications inthe teenage mothers and their infants.Objective: To determine the social and clinical factors related toperinatal outcome of teenage pregnancies.Methods: A retrospective study of mothers aged < 20years managed at Olabisi Onabanjo University Teaching Hospital, Sagamu between 2008 and 2011 was done. Mothers aged 20 years and above were used as controls and comparisons were made using bivariate analysis.Results: The prevalence of teenage pregnancies was 1.3%. The mean age of the cases was 17.8 years (range of 16 - 19 years). Compared to the controls, significantly higher proportions of the cases had less than senior secondary education, were unmarried, with relatively younger spouseswho were mainly unemployed or employed as unskilled workers. In addition, teenage mothers were significantly more likely to havepreterm deliveries and babies with 1-minute Apgar scores <7. Stillbirthrate, early neonatal mortality rate and hospitalization rate were also higher among the cases. Poor perinatal outcome was more common among the cases in the lower socio-economic classes and those with low education.Conclusion: Socio-economic factors are directly or indirectly related to poor outcomes of teenage pregnancies.Key words: Perinatal mortality, Socio-economic factors, Stillbirth,Teenage pregnanc

Determinants of timely initiation of complementary feeding among children aged 6‑24 months in Sagamu, Nigeria

Background: Poor breastfeeding and complementary feeding practices may contribute to childhood malnutrition in the developing world.Objective: The objective was to examine the determinants of timely initiation of complementary feeding among Nigerian children.Materials and Methods: Using a cross‑sectional design, children aged 6‑24 months were surveyed in a Nigerian Teaching Hospital. Children with timely initiation of complementary feeding (6‑8 months) were compared with children with untimely initiation of complementary feeding early (<6 months and >8 months) for clinical and social characteristics using both bivariate and multivariate analysis.Results: Of 156 children, 41%, 53.8%, and 5.1% had timely, early and delayed initiation of complementary feeding. Complementary feeding was initiated with processed cereals (44.8%), locally prepared maize gruel (32.1%) and mashed family diet (23.1%). Bivariate analysis showed significant association between timely initiation of complementary and orthodox maternity care, no prelacteal feeding, exclusive breastfeeding, no siblings and first birth order. Parental education was not associated with timely initiation of complementary feeding. Multivariate analysis identified orthodox maternity care, exclusive breastfeeding and no siblings as independent predictors of timely initiation of complementary feeding.Conclusion: Complementary feeding is most frequently initiated earlier than 6 months in this population. Good breastfeeding practices may influence timely initiation of complementary feeding. Interventions should be targeted at the entire population irrespective of educational and socioeconomic status.Key words: Breastfeeding, malnutrition, supplementary feeding, weanin

Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism.

BACKGROUND: Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. METHODS: In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients with creatinine clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding. RESULTS: A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5%. Edoxaban was noninferior to warfarin with respect to the primary efficacy outcome, which occurred in 130 patients in the edoxaban group (3.2%) and 146 patients in the warfarin group (3.5%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.70 to 1.13; P<0.001 for noninferiority). The safety outcome occurred in 349 patients (8.5%) in the edoxaban group and 423 patients (10.3%) in the warfarin group (hazard ratio, 0.81; 95% CI, 0.71 to 0.94; P=0.004 for superiority). The rates of other adverse events were similar in the two groups. A total of 938 patients with pulmonary embolism had right ventricular dysfunction, as assessed by measurement of N-terminal pro-brain natriuretic peptide levels; the rate of recurrent venous thromboembolism in this subgroup was 3.3% in the edoxaban group and 6.2% in the warfarin group (hazard ratio, 0.52; 95% CI, 0.28 to 0.98). CONCLUSIONS: Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo; Hokusai-VTE ClinicalTrials.gov number, NCT00986154.)