Gastrointestinal Injuries Following Blunt Abdominal Trauma In Children

Purpose: Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma. Patients and Methods: From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome. Results: There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries , one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Conclusion: Gastrointestinal injuries due to blunt abdominal trauma pose a management challenge. Management based on decisions from serial clinical examinations and simple tests without recourse to advance imaging techniques may suffice. Keywords: Gastrointestinal injury, Blunt abdominal trauma, children. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 250-25

Knowledge, Practices and Education of Clients Regarding Breast Cancer Screening Among Health Care Workers in Plateau, North-Central Nigeria

Background/objectives: Majority of the Breast Cancer patients in our environment present at advance stage with poor prognosis. However, screening services like Breast Self Examination (BSE) exist where early diagnose would improve the prognosis. The objectives of the study were to determine the knowledge of Primary Healthcare Centre (PHC) workers regarding breast cancer, BSE, its practice and education of clients.Method: A cross-sectional survey of 182 female PHC Workers of selected LGAs. A multistage sampling technique was used to obtain participants. Information was obtained using an interviewer administered questionnaire and analyzed with Epi info. 3.3.2 Version.Results: Out of the 182 respondents studied, 80(44%) were Community Health Extension workers, 168 (92.3%) of the participants were aware of cancer of the breast. Their main sources of information were during training 63.7% and Media 19.7%. The respondents cited smoking (31.0%) and having a relative with cancer of the breast (31.0%) as risk factors associated with the cancer. Majority (91.7%) of participants knew the cancer could be prevented, although not all could link regular breast examination to the prevention. Most (87.2%) respondents knew how to perform BSE, out of which 75% had educated their clients with regards to breast cancer and BSE. Only 48(36.8%) knew the examination should be done monthly and for the purpose of lump detection.Conclusion: The study revealed high level of awareness with some patchy in-depth knowledge regarding breast cancer and BSE among the respondents. The practice of BSE did not proportionately translate to education of clients. In-service educational programs should target PHC workers who will transfer the knowledge and skills adequately to their clients at the grass roots

Impact Of Health Education On Home Treatment And Prevention Of Malaria In Jengre, North Central Nigeria

Background: Malaria accounts for 1 million deaths among children under five annually. It has been shown that improving home treatment and preventing delays in seeking treatment, by teaching women to respond promptly when their children have fever, can decrease malaria related complications and mortality. This study looks at the impact of health education on knowledge of malaria: its recognition, treatment and prevention among caregivers of children under five in Jengre, North Central Nigeria. Methods: The study was a community based intervention study conducted in three stages: A preintervention stage, where 150 caregivers, were selected through a multistage sampling technique from the households containing children under five. Information for the baseline was collected through an interviewer administered semi-structured questionnaire. The intervention consisted of a series of health education sessions designed based on findings from the pre-intervention stage. The postintervention impact assessment was conducted using a modified version of the questionnaire used in the pre intervention stage. Results: Malaria was recognized as one of the diseases that cause fever in community by all the respondents. Sixty-one (40.6%) had adequate knowledge concerning malaria causation, transmission, prevention and treatment. Twenty eight (56%) of respondents reported Self-treatment. There was a statistically significant relationship between years of formal education and first line treatment option (P = .012). Thirty-four (68%) mothers acted within eight hours of onset of fever. The intervention had an effect on perception (P < .001), knowledge (P < .001), malaria prevention practice (P = .001), first line treatment option (P = .031) and the type of treatment given to the children with fever (P = .048). Conclusion: Health education impacted positively caregivers' knowledge of malaria and their willingness to access antimalarial treatment when their children have fever. Malaria information should be made available to caregivers visiting child welfare clinics. Caregivers should also be integrated into malaria control activities at community level. Keywords: Health education, home treatment, malaria, prevention Annals of African Medicine Vol. 7 (3) 2008: pp. 112-11

Peer education: The effects on knowledge of pregnancy related malaria and preventive practices in women of reproductive age in Edo State, Nigeria

<p>Abstract</p> <p>Background</p> <p>There is limited uptake of measures to prevent malaria by pregnant women in Nigeria which is often related to the lack of knowledge on Malaria in Pregnancy (MIP) and its effects on mother and foetus. This study, explored peer to peer education as a tool in raising knowledge of MIP among women of child bearing age.</p> <p>Methods</p> <p>1105 women of child bearing age were interviewed in their households using a structured questionnaire about their knowledge of malaria in general, MIP and use of preventive measures. Thereafter, a peer education campaign was launched to raise the level of knowledge in the community. The interviews were repeated after the campaign and the responses between the pre- and post-intervention were compared.</p> <p>Results</p> <p>In the pre-assessment women on average answered 64.8% of the question on malaria and its possibility to prevent malaria correctly. The peer education campaign had a significant impact in raising the level of knowledge among the women; after the campaign the respondents answered on average 73.8% of the questions correctly. Stratified analysis on pre and post assessment scores for malaria in general (68.8 & 72.9%) and MIP (61.7 & 76.3%) showed also significant increase. Uptake of bed nets was reported to be low: 11.6%</p> <p>Conclusion</p> <p>Peer education led to a significant increase in knowledge of malaria and its prevention but we could not asses its influence on the use of preventive measures.</p

Knowledge of Malaria and Its Association with Malaria-Related Behaviors—Results from the Malaria Indicator Survey, Ethiopia, 2007

Background: In 2005, the Ministry of Health in Ethiopia launched a major effort to distribute over 20 million long-lasting insecticidal nets, provide universal access to artemisinin-based combination therapy (ACTs), and train 30,000 village-based health extension workers.\ud \ud Methods and Findings: A cross-sectional, nationally representative Malaria Indicator Survey was conducted during the malaria transmission season in 2007. Multivariate logistic regression analyses were performed to assess the effect of women's malaria knowledge on household ITN ownership and women's ITN use. In addition, we investigated the effect of mothers' malaria knowledge on their children under 5 years of age's (U5) ITN use and their access to fever treatment on behalf of their child U5. Malaria knowledge was based on a composite index about the causes, symptoms, danger signs and prevention of malaria. Approximately 67% of women (n = 5,949) and mothers of children U5 (n = 3,447) reported some knowledge of malaria. Women's knowledge of malaria was significantly associated with household ITN ownership (adjusted Odds Ratio [aOR] = 2.1; 95% confidence interval [CI] 1.6–2.7) and with increased ITN use for themselves (aOR = 1.8; 95% CI 1.3–2.5). Knowledge of malaria amongst mothers of children U5 was associated with ITN use for their children U5 (aOR = 1.6; 95% CI 1.1–2.4), but not significantly associated with their children U5 seeking care for a fever. School attendance was a significant factor in women's ITN use (aOR = 2.0; 95% CI 1.1–3.9), their children U5′s ITN use (aOR = 4.4; 95% CI 1.6–12.1), and their children U5 having sought treatment for a fever (aOR = 6.5; 95% CI 1.9–22.9).\ud \ud Conclusions: Along with mass free distribution of ITNs and universal access to ACTs, delivery of targeted malaria educational information to women could improve ITN ownership and use. Efforts to control malaria could be influenced by progress towards broader goals of improving access to education, especially for women

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Intestinal Parasites in Children Attending Day Care Centers in Jos, Central Nigeria

It is estimated that 3 billion people world wide are infected with intestinal parasites. Morbidity is highest amongst children; infestation causes a threat to the growth and development of the child. The study aims to determine the prevalence of intestinal helminthes in children attending day care centers in Jos metropolis. Ten day care centers were randomlyselected from the total number of day care centers. From each centre children were randomly selected for study. Parents of selected children completed a structured questionnaire and stool specimens of the children were analyzed using iodine and saline preparation. : Two hundred and twenty-one children (57.8%) of the 384 children studied had intestinal parasites. Ascaris lumbricoides, Ancylostoma duodenale and Trichuris trichura were the commonest parasites found. The relationship between intestinal parasite infestation and diarrhea in past 2 months (X =19.5, df = 1, p< 0.001 OR=3.87), de-worming in the past six months(X = 11.13,df =1,

Sacrococcygeal teratoma: Clinical characteristics and long-term outcome in Nigerian children

Background/Purpose : The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Methods : Between January 1990 and May 2008 inclusive, 38 consecutive children with the diagnosis of SCT were identified from the operation register and the Cancer Registry of the Jos University Teaching Hospital. Their clinical presentation, investigation, operative findings, histology report, and outcome were recorded and analyzed. The long-term follow-up of some of the patients were also recorded and analyzed. Results : There were 31 females and 7 males. Twenty-three patients presented during the neonatal period with a median age at presentation of 7 days (range 1-18 days) and a median weight at presentation of 2.8 kg (range 2.0-3.6kg), 10 presented between 1 month and 12 months, while 5 were older than 1 year at presentation. Most of the patients had significantly external tumors. Excision of the tumor was mainly by the sacral route, four had abdominal-sacral excision. Histology was mainly benign; four were malignant at presentation. Four children with malignant disease had chemotherapy in addition to excision of the tumor. Eight had immediate post-operative wound-related complications while three children died, two of the deaths were related to anesthesia, while one died of colostomy complications. Twenty-one (60%) were followed up for a median duration of 6 years (range 1 month-8 years). Two (9.5%) had recurrent disease after primary excision; five (23.8%) had some degree of functional impairment at the follow-up. Conclusion : While SCT is usually benign, recurrence, malignant transformations in patients who present late and long-term functional sequelae are problems that must be tackled by the care givers. A multi-center study may be necessary to characterize this disease in developing countries and assess the long-term functional sequelae in survivor

Respiratory symptoms in workers at Katako wood market, Jos, Plateau State, Nigeria

Background: Exposure to wood dust has been shown to cause organic dust toxic syndrome, occupational asthma, airway inflammation, an increased risk of sinusoidal cancer and impaired lung functions in woodworkers. This study determines the prevalence of respiratory symptoms and the lung functions of woodworkers in Jos, north-central, Nigeria. Materials and Methods: A cross–sectional study design was used to interview 120 timber workers from a timber market sampled using simple random sampling. Information was obtained using interviewer-administered questionnaires and the lung function tests of the participants measured using a peak flow meter. Results: The mean age of the respondents was 28 years. At the time of the study 62.5% (75 ) of the respondents had respiratory symptoms; many had more than one symptom. The main symptoms among the respondents were regular blocked nose in 74(61.71%), runny nose 50(41.7%) recurrent cold 27 (22.5%), sneezing 68(56.7%), noisy breathing 11 (9.2%), shortness of breath 8(6.7%), chest tightness 16(13.3%) and cough 63(52.5%). All the workers with symptoms experienced them at work while, 56(74.6%) had relief when away from work. The symptoms were mainly associated with Mahogany, Masonia, Bosca and Obeche (African whitewood) woods. None of the workers in the mill were observed to be using respirators or masks. Only one (0.8%) of the workers had peak expiratory flow volume (PEFV) less than 300 liters /minute. The peak expiratory value had no significant association with the presence of symptoms and the number of years spent working in the wood industry (p= 0.454). Conclusion: Wood workers should be health educated on the dangers of wood dust; they should be encouraged to use masks and wood dust should be controlled at source. KEY WORDS: Timber workers; Respiratory Symptoms; Lung function; Jos Journal of Community Medicine & Primary Health Care Vol.16(2) 2004: 30-3