Morbidity and mortality of childhood illnesses at the emergency paediatric unit of the University of Benin Teaching Hospital, Benin City.

Objective: To describe the pattern of morbidity and mortality as seen at the Emergency Paediatric Unit of the University of Benin Teaching Hospital, Benin City. Methods: A retrospective study in which records of admissions over a two-year period were obtained from the medical and ward records. Information retrieved included age, sex, diagnosis, duration of stay in the unit and outcome. Results: A total of 3,261 patients aged between 29 days and 16 years were admitted into the Children Emergency Room during the period. Of these, 1,835 (56.3%) were males while 1,426 (43.7%) were females. The total number of underfives admitted was 2,289 (70.2% of total admissions). The major causes of admission were malaria (44.4%), respiratory tract infections (17.8%) and gastroenteritis with moderate or severe dehydration (10.1%). There were 992 (30.4%) discharges while 2,126 (65.2%) were transferred tothe paediatric wards for further management. One hundred and forty-three (4.4%) patients died during the period with over 80% being children five years or less. Severe malaria accounted for the largest number of deaths (29.4%) in the unit, followed by meningitis (16.9%) and septicaemia (15.4%) with over 80% of the deaths being from infectious diseases. Conclusion: Infectious diseases are still the major causes of morbidity and mortality especially in underfives in our locality. The role of environmental sanitation, health education and good nutrition in the health of the child must be brought to the fore. The nation's immunisation schedule should include vaccines against infectious organisms like Haemophilus influenzae and Streptococcus pneumoniae which are major causes of pneumonia and meningitis in childhood. Also, a boost in the coverage of our health insurance scheme would be a step in the right direction.Key Words: Pattern, morbidity, mortality, Emergency PaediatricUnit, admissions

Scope of neonatal care services in major Nigerian hospitals

Background: Neonatal survival bespeaks the quality of neonatal care services available and accessible to the population. Intensive care improves outcome of high-risk infants with serious illness. The tiered level of care is yet to be applied to newborn care in Nigeria. Classification of care is key to improving neonatal survival with enhanced referral of high-risk patients to higher-level centres.Objective: To ascertain the scope and classify available newborn services offered at major Nigerian hospitals.Methodology: A semi-structured validated questionnaire was administered to attendees during 2015 Pediatric Association of Nigeria conference. The information derived was used to categorize neonatal care services.Results: The respondents consisted of doctors 201 (84.8%) and nurses 36 (15.2%) in 54 health facilities from all geopolitical regions of Nigeria. Of the 54 facilities, 34 (63%) were located in state capitals and 47 (87%) in public hospitals. Half of the evaluated units belonged to Class I, 22 (40.7%) Class II, and 5 (9.3%) Class III levels of neonatal care. Majority (81.6%) of the doctors have been trained on neonatal resuscitation; with senior residents being the highest 49 (89%) and Medical officers (MO) the least 4 (40%) trained. Doctors with training in mechanical ventilation (MV) were 39.2%; Consultants (51.2%), MO’s the least 1(11.2%) trained (p=0.025). Monitoring is usually by pulse oximeters 54 (100%), multi parameter monitors 23 (42.6%) and rarely ABGs 6 (11%).Conclusion: Neonatal care in Nigeria is still developing. Most centres provide basic neonatal care services. Regionalization of care may be the solution to higher level neonatal care.Kewords: Neonatal Care; Scop

Scientific Communication

What will it take to accelerate the rate of decline of neonatal mortality in West Africa

Nigeria Local Government: A Discourse on the Theoretical Imperatives in a Governmental System

The need for the creation and existence of local governments in a  governmental system has, over the years, been one of the most frequently discussed issues in public administration studies. Accompanying this  discussion usually is the consideration of the challenges confronting the local governments in the performance of the functions that underscore the imperative for their creation. In this work, we articulated and analyzed in detail, the theoretical imperatives for the creation of local governments in governmental system. This we did under three major schools of thought on the functional relevance of the local governments. These schools of  thought are the democratic participatory school, the efficient-service school and the development school. We further explored and analyzed some of the factors that constitute fundamental challenges to the performance of the expected development roles by the local governments using the  Nigerian Federal system of government as a reference point. In conclusion, we noted that local governments constitute key institutions for enhancing democracy and advancing development particularly at the local or  grassroots level but constrained in the performance of these roles, by inadequate finance, poor political leadership and insufficient autonomy as exemplified in the Nigerian federal system of government.Key words: Local Government, governmental system, developmen

Mothers’ perception of the use of banked human milk for feeding of the infants

Background: Human breast milk is the most healthful form of milk for human babies. Every infant deserves the best possible start in life in terms of nutrition by breastfeeding or receiving donated human milk. Breast milk is very important for the infant’s growth and well-being that the non-availability of the mother should not deprive the infant from its benefits. To enhance the availability and use of human breast milk for hospitalized babies whose mothers may not have enough milk, there is the need to embark on human milk banking.Objective: To determine the perception of mothers towards breast milk banking in Benin City, Nigeria.Subjects and Methods: The study subjects included 198 mothers who brought their babies to Well Baby/Immunization Clinic of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. A structured researcheradministered questionnaire was used to assess their biodata, awareness and perception of breast milk banking.Results: The mean age of the mothers was 29.8 ± 5.5 years with 46.5% having some form of tertiary education and 48.5% having secondary education. Only 51 (25.8%) of them had heard of breast milk banking; source of information being mainly from health workers (43.1%) and from friends (27.5%). Majority 168 (84.8%) of the mothers would not give their babies human milk donated by another nursing mother mainly because of fear of transmission of infections/diseases. Most 105 (53.0%) were also unwilling to donate breast milk to be used for other babies due to the fact that they disliked the idea (51.4%) and because of fear of not having enough for their own babies (16.1%). However, most (59.1%) strongly agreed that human milk banking would help assist mothers in need, orphans and abandoned babies.Conclusion/Recommendation: The awareness of human milk banking and its acceptance among mothers in Benin City is poor. The current findings strongly justify the need for public enlightenment on human milk banking and its benefits.Key words: Breast milk banking, mothers, Perceptio

A novel nonparametric item response theory approach to measuring socioeconomic position: a comparison using household expenditure data from a Vietnam health survey, 2003

BACKGROUND: Measures of household socio-economic position (SEP) are widely used in health research. There exist a number of approaches to their measurement, with Principal Components Analysis (PCA) applied to a basket of household assets being one of the most common. PCA, however, carries a number of assumptions about the distribution of the data which may be untenable, and alternative, non-parametric, approaches may be preferred. Mokken scale analysis is a non-parametric, item response theory approach to scale development which appears never to have been applied to household asset data. A Mokken scale can be used to rank order items (measures of wealth) as well as households. Using data on household asset ownership from a national sample of 4,154 consenting households in the World Health Survey from Vietnam, 2003, we construct two measures of household SEP. Seventeen items asking about assets, and utility and infrastructure use were used. Mokken Scaling and PCA were applied to the data. A single item measure of total household expenditure is used as a point of contrast. RESULTS: An 11 item scale, out of the 17 items, was identified that conformed to the assumptions of a Mokken Scale. All the items in the scale were identified as strong items (Hi > .5). Two PCA measures of SEP were developed as a point of contrast. One PCA measure was developed using all 17 available asset items, the other used the reduced set of 11 items identified in the Mokken scale analaysis. The Mokken Scale measure of SEP and the 17 item PCA measure had a very high correlation (r = .98), and they both correlated moderately with total household expenditure: r = .59 and r = .57 respectively. In contrast the 11 item PCA measure correlated moderately with the Mokken scale (r = .68), and weakly with the total household expenditure (r = .18). CONCLUSION: The Mokken scale measure of household SEP performed at least as well as PCA, and outperformed the PCA measure developed with the 11 items used in the Mokken scale. Unlike PCA, Mokken scaling carries no assumptions about the underlying shape of the distribution of the data, and can be used simultaneous to order household SEP and items. The approach, however, has not been tested with data from other countries and remains an interesting, but under researched approach

Awareness of Sickle Cell Disease amongst Mothers of Under-Fives in Ekosodin community, Edo state, Nigeria.

Awareness of phenotypes of Sickle Cell Disease (CSD) in communities is low. A community survey to establish the knowledge of SCD among mothers of under-five children form Ekosodin community, edo state, Nigeria was therefor condicted to improve the situation. to determine mothers' knowledge of SCD and their haemoglobin phenotypes and those of their spouses/partners. A descriptive and cross-sectional study involving 83 mothers of under-five children from Ekosodin community was carried out between April and June 2007. A detailed questionnaire on knowledge of SCD and socio-demographics, awareness of their haemoglobin phenotypes and those of their spouses was administered to the mothers. Eighteen(21.7%) mothers interviewed had a prior knowledge of their haemoglobin phenotypes. Thirty-eight(45,.8%) of the mothers had not heard of "genotype testing', sixty-two(74.7%) mothers claimed to have heard of children popularly referred to as "sicklers" while 33(53.2%) of them knew that the condition is acquired when both parents are carriers of the sickle cell gene. Though not statistically significant, knowledge of the disease is better among the more educated mothers (F = 1.345, p=0.766). The risk of procreation of children with sickle cell disease associated with the mothers' unawareness of their haemoglobin phenotypes remains real in our communities. There is need for education fo the public, using the mass media and health talks in health facilitie, to enlighten mothers on the disease and ancourage routine screening tests so that they can be aware of their haemoglobin phenotypes and thus be informed when choosing partners.Keywords: Sickle Cell Disease Awareness, mothers of under-fives, Nigeri