Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Prevalence and Outcome of Increased Nuchal Translucency in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria: A Cohort Study

Background: An important component of the first‑trimester scan is nuchal translucency thickness at 11 weeks to 13 weeks 6 days of gestation. A nuchal translucency ≥3.3 mm is a significant early pregnancy scan finding associated with Trisomies 13, 18, and 21 and congenital heart diseases. Aims: To determine the prevalence and outcome of increased fetal nuchal translucency among pregnant women. Subjects and Methods: A prospective cohort study at the Obstetrics and Gynaecology Department of Usmanu Danfodiyo University Teaching Hospital Sokoto. This was a prospective study of 265 consecutively recruited women in the first trimester of pregnancy who presented to antenatal clinics over a 20‑week period. An NT scan was conducted at 11 weeks to 13 weeks 6 days followed by an anomaly scan at 18–22 weeks. Patients were followed up to delivery and 6‑week post‑partum. The neonates were examined at delivery and at 6‑week postnatal life. Data entry and analysis was done with IBM SPSS version 20. The level of significance was set at less than 0.05. Frequency distribution; student t‑test and Chi‑squared test. Results: The 95th percentile NT was 3.3 mm and the prevalence of increased  NT above 3.3 mm was 3%. The mean maternal age of the participants was28.1 ± 5.1 years and the modal parity was Para 0. The most common anomalies associated with increased NT were ventricular septal defect and spina bifida. A congenital anomaly was significantly associated with increased NT (P <0.001). Conclusions: The prevalence of increased fetal nuchal translucency is relatively high in our environment and is associated with congenital fetal defects. Routine screening with first‑trimester ultrasound will help detect congenital anomalies early

Paediatrics HIV/AIDS: Clinical presentation and practical management challenges in Sokoto, Nigeria

Background: Implications of continuing HIV/AIDS pandemic in Nigeria is very grave for children. Lack of financial resources means care of children with HIV/AIDS is exceedingly difficult to provide. We described the clinical pattern and highlight the problems in the management of HIV/AIDS in children seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a two-year period. Methods: This prospective study was carried out between 1 st January 2001 and 31 st December 2002. The clinical presentation of each patient satisfying the WHO diagnostic criteria for paediatrics HIV/AIDS, admitted consecutively into our Emergency Paediatrics Unit (EPU) was documented. Laboratory diagnosis was by Enzyme linked immunosorbent assay (ELISA) for HIV- I and HIV- II in affected children and their mothers while confirmatory test was by Western blot. Treatment of each patient was individualised. Results: A total of 41 children with HIV/AIDS were admitted into EPU over the study period. There were 22 males and 19 females with ratio of 1.2:1. Age ranged from 0.25 years to 14 years with mean (SD) of 1.5 (2.2) years. Forty - one (97.6%) patients were aged 5 years and below. Modes of transmission were vertical in 40 (97.6%), while 1 (2.4%) was by homosexual abuse. The commonest clinical feature was weight loss in 41 (100%), followed by fever (>one month) 39 (95%), chronic diarrhoea 39 (95%), recurrent cough 37 (90%) and oro-pharyngeal candidiasis 35 (85%) in that order. Thirty- six (87.8%) patients had protein - energy malnutrition (PEM), marasmus constituting 58%. Thirty-two (78%) patients were in WHO clinical stage 3 while the remaining 9 (22%) patients were in stage 4. The main types of infections were oral candidiasis, pneumonia, malaria, septicaemia, urinary tract infections, and tuberculosis. Case fatality rate was 91%. Highly active antiretroviral therapy (HAART) was not freely available to children during the period of our study. Conclusion: The mortality of these antiretroviral naive HIV/AIDS children was very high. It is anticipated that current availability of HAART to children free of charge would improve the outcome of HIV/AIDS in this group

Febrile convulsion: Knowledge and perceived causes amongst mothers in a rural community in North Western Nigeria

Background: Febrile convulsion is one of the commonest presentations at most Paediatric emergency units. Adequate knowledge of relationship between fever and convulsion is needed to lessen the parental anxiety and apprehension associated with febrile convulsion. Febrile convulsion accounts for one third of admissions into most of the emergency paediatric wards with malarial infection being the commonest cause in the tropics. Methods: This was a cross-sectional descriptive study among mothers of under-five children in Garabshi, a rural community in Wamakko local government area of Sokoto State, Nigeria. Using a systematic sampling method, a one in four samples of one hundred and twenty mothers who met the eligibility criteria were recruited into the study. Results; The mothers were aged 18 years to 47 years; majority had Quranic education only, they were all of Islamic faith and were fulltime housewives. One hundred and six (88%) of the mothers were married. 9 (8%) were divorcees and 5 (4%) were widows. Their perceived causes of febrile convulsion Included fever caused by mosquito bite and bad blood; only 4% of the study subjects had adequate knowledge of febrile convulsion with a mean knowledge score of 35.3 ±9.48. Conclusions: The knowledge of febrile convulsion was grossly inadequate amongst the study subjects. There is therefore, the need to institute further measures in form of health education among the study subjects aimed at improving their knowledge and also to remove all misconceptions regarding the cause of febrile convulsion

Febrile convulsion: Home management amongst Hausa/Fulani mothers in North Western Nigeria

Background: Febrile convulsions are a common paediatric problem, they can be extremely frightening, emotionally traumatic and anxiety provoking when witnessed by parents for fear of death. Appropriate home management of febrile convulsion is needed to lessen the parental anxiety and apprehension associated with it. Method: This study was a cross-sectional descriptive study designed to assess the home management practices of febrile convulsion amongst Hausa/Fulani mothers in a rural community in North Western Nigeria. A one in four samples of one hundred and twenty mothers who met the eligibility criteria were selected for the study. Results: The mothers were aged 18 years to 47 years; majority had Quoranic education only, were all of Islamic faith and were not gainfully employed. One hundred and six (88%) of the mothers were married, 9(8%) divorcees and 5(4%) widows. Their home management practices included removal of cloths, traditional medications, with only 16% of study subjects practicing appropriate home management of febrile convulsion. Conclusion: The home management practice of febrile convulsion was poor amongst the mothers studied. There is therefore, the need for interventions in the community to improve their practice of home management of febrile convulsion

Evaluation of the capacity of Pediatricians in Nigeria to conduct research: A nationwide survey

Background: Research is key to quality healthcare. Clinicians should possess adequate research capacity to generate evidence. This study aimed to evaluate the research capacity of pediatricians in Nigeria.Methods: The study was a crosssectional using a questionnaire developed from the Research Capacity Assessment Framework. Information on previous research work, challenges encountered, and utilization of research outcome were obtained. The data was analyzed using SPSS version 20.Qualitative variables were grouped under thematic headings.Results: Paediatricians who had received grants for research were 21 (19.4%). Those whose research outcomes had informed policy and practice were 20 (18.2%). Less than 40% of the participants had received training on research capacity areas.Conclusion: The research capacity among pediatricians was low partly due to underfunding and lack of research training programs. Improvement on government fund allocation for research and introduction of short research trainings programs will improve research capacity in Nigeria. Key words: Clinical research; Pediatrician; Research Capacity; Policy-Practice Chang

The Magpie Trial: A randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for children at 18 months

Objective: To assess the long-term effects of in utero exposure to magnesium sulphate for children whose mothers had pre-eclampsia. Design: Assessment at 18 months of age for children whose mothers were recruited to the Magpie Trial (recruitment 1998-2001 ISRCTN 86938761), which compared magnesium sulphate with placebo. Setting: Follow-up of children born at 125 centres in 19 countries across five continents. Population: A total of 6922 children were born to women randomised before delivery at follow-up centres. Of these, 2271 were not included for logistic reasons and 168 were excluded (101 at a centre where <20% were contacted, 40 whose death or disability was due to a problem at conception or embryogenesis and 27 whose parent/s opted out). Therefore, 4483 children were included in follow-up, of whom 3283 (73%) were contacted. Methods: Assessment by questionnaire, with interview and neurodevelopmental testing of selected children. Main outcome measures: Death or neurosensory disability at age of 18 months. Results: Of those allocated magnesium sulphate, 245/1635 (15.0%) were dead or had neurosensory disability at 18 months compared with 233/1648 (14.1%) allocated placebo (relative risk [RR] 1.06, 95% CI 0.90-1.25), and of survivors, 19/1409 (1.3%) had neurosensory disability at 18 months compared with 27/1442 (1.9%) (RR 0.72, 95% CI 0.40-1.29). There were no substantial differences in causes of death or in the risk of individual impairments or disabilities. Conclusions: The lower risk of eclampsia following prophylaxis with magnesium sulphate was not associated with a clear difference in the risk of death or disability for children at 18 months. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.Articl

The Magpie Trial: A randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for women at 2 years

Objective: The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia. Design: Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998-2001, ISRCTN 86938761), which compared magnesium sulphate with placebo for pre-eclampsia. Setting: Follow up after discharge from hospital at 125 centres in 19 countries across five continents. Population: A total of 7927 women were randomised at the follow-up centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced. Methods: Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed. Main outcome measures: Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources. Results: Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18). Conclusions: The reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.Articl