Relationship between maternal serum zinc, cord blood zinc and birth weight of term newborn infants in Jos, Plateau State, Nigeria

Background: Adequate in utero supply of zinc is essential for optimal fetal growth because of the role of zinc in cellular division, growth and differentiation. Low maternal serum zinc has been reported to be associated with low birth weight and the later is associated with increased morbidity and mortality in newborns. In Nigeria, where the prevalence rates of zinc deficiency among pregnant women, low birth weight and infant mortality are high; it will be useful to determine the relationship between maternal and cord serum zinc levels and birth weight.Methods: Across-sectional study of 190 mothers and their term babies. Blood samples were collected from the mothers and cord of the babies immediately after delivery for serum zinc analysis using atomic absorption spectrophotometry. Babies' weights were measured within thirty minutes post-delivery.Results: The mean age of the mothers and gestational age of the babies were 28.29 ± 5.64 years and 39.2 ± 1.2 weeks respectively. The mean birth weight of the babies was 3106.7 ± 411.2 g; while the mean maternal and cord serum zinc concentrations were 48.5 ± 17.6 μg/dl and 99.3 ± 21.5 μg/dl respectively. There was no association between the maternal serum zinc and cord serum zinc (p = 0.62); and likewise maternal serum zinc and birth weight (p =0.99). However, there was a significant positive association between cord serum zinc and birth weight (p < 0.001, r = 0.02, p= 0.04).Conclusion: The study outcome suggests that cord serum zinc but not maternal serum zinc predicts birth weight. In spite of low maternal serum zinc level, an adequate amount of zinc could be transferred to the babies thereby preventing zinc deficiency in the babies and aiding their growth. More studies are needed on the mechanism of placental zinc transfer.Keywords: Maternal zinc, cord zinc, birth weight, Jos, Nigeri

Nutritional and morbidity outcomes of children managed for severe acute malnutrition in Jigawa State, Nigeria

Introduction: The community-based approach to the management of severe acute malnutrition (SAM) is a cost effective and scientifically sound method of mitigating the soaring burden of under-five malnutrition in resource constrained countries. However, since the adoption of this novel intervention in Nigeria, local studies that have evaluated its overall effectiveness are sparse.Methodology: This longitudinal observational study was designed to assess at discharge, the nutritional status, as well as the nutritional related co-morbidities of 494 children enrolled into the Community Management of Acute Malnutrition (CMAM) programme. It is part of an impact evaluation study. The parameters evaluated at enrolment and at discharge included the anthropometry, presence of common morbidities and immunization status. Data were captured electronically with the aid of CSPro software. The study was carried out across 10 randomly selected CMAM clinics in Jigawa state, North West Nigeria.Result: Out of the 494 malnourished children recruited, 410 were discharged, the remaining were reported as absconded or died, with an average duration of stay of 7.3±1.6 weeks in the clinics, and a discharge cure rate of 63.4%. There was improvement in the mean weight (6.0kg at enrolment vs 7.3kg at discharge, p=0.000), mean occipito-frontal circumference (44.1cm at enrolment vs 45.3cm at discharge, p=0.000) and Weight-for-Height z score (-2.65 at enrolment vs 0.75 at discharge, p=0.000 ). A significant discordance in the nutritional outcome at discharge, as assessed independently by Mid Upper Arm Circumference (MUAC) and Weight-for-Height z score (WHZ), was documented; 9% and 28% still had SAM at discharge based on MUAC and WHZ respectively (p=0.000). The burden of nutritional related morbidities (diarrhoea dysentery, refusal to eat) reduced significantly at discharge (p=0.000) while immunization coverage increased by 7%.Conclusion: The CMAM programme in Jigawa, Nigeria has undoubtedly yielded positive outcomes. However, proactive measures should be taken to achieve the Sphere standards recommended minimum discharge cure rate. This may be achieved by ensuring that health care workers continually adhere to the guiding principles of CMAM. There is also a need for introduction of HIV and tuberculosis screening as non-responders maybe infected by any of these diseases

Availability and distribution of phototherapy services and health care providers for neonatal jaundice in three local government areas in Jos, North - Central Nigeria

Background: Severe neonatal jaundice remains common in Nigeria. Phototherapy is the most commonly used inhospital treatment for neonatal hyperbilirubinaemia.Objectives: To describe the availability and distribution of phototherapy services as an essential neonatal service in hospitals in Jos, North-Central Nigeria.Methods: This was a crosssectional study of all secondary and tertiary level health facilities in Jos-North, Jos-South and Jos-East Local government Areas (LGAs) between January and March 2015.Results: There were 30 (90.9%) secondary and three (9.1%) tertiary health facilities. Twenty – eight (84.8%) were privately owned. Fourteen (42.4%) of the 33 hospitals provided phototherapy services, of which 11 (78.6%) were private. Phototherapy services were available in all the tertiary facilities and in only 11 (36.7%) of the secondary level health facilities. Most (10; 71.4%) of the hospitals with phototherapy were located in Jos-North LGA. There were 38 phototherapy units in all the 14 hospitals that offered phototherapy, consisting of 8 (21.1%) light emitting diodes (LED) and 30(78.9%) conventional units of which 25(83.3%) were locally fabricated. In all the hospitals that provided phototherapy, jaundiced neonates were managed by physicians of whom only 12% were fulltime paediatricians. All hospitals that offered phototherapy had laboratory facilities to assay bilirubin.Conclusions: Phototherapy services in Jos, Nigeria are inadequate and are concentrated in the urban private sector. An increase in phototherapy services especially in secondary public facilities is needed.Keywords: Health Care Provider, Hyperbilirubinaemia, Jos, Neonatal Jaundice, Nigeria, Phototherap

A comparison of mid upper arm circumference with other Indices for discharge from community-based management of malnutrition clinics in Jigawa State, Nigeria

Background: Community-based management of acute malnutrition (CMAM) program has saved millions of children with severe acute  malnutrition (SAM) globally. World Health Organization recommended discharge indices include Midupper arm circumference (MUAC) =12.5cm, =15-20% weight gain and weight-for-height Z score (WHZ) =-2. We compared MUAC with WHZ and percentage weight gain as discharge criteria from CMAM.Methods: It was a community based cohort study of children aged 6-59 months with SAM discharged from CMAM clinics in Jigawa State, Nigeria. Socio-demographic data, nutrition history and anthropometry were recorded at enrolment and discharge.Results: Of a total of 405 children studied, 209(51.6%) were females and had a peak age group of 12-23months (43.7%, range 6-42 months). At discharge, 353(87.2%) had MUAC = 12.5cm while 231(57.0%) and 204(50.4%) had percentage weight-gain =15% and WHZ=-2 respectively. There was weak agreement between MUAC and WHZ (agreement 50.8%, ê=0.012) and MUAC and percent weight-gain (agreement 54.8%, ê=-0.004). Children aged between 11-23 months (OR 2.12, p=0.006) and 24-35 months (OR 2.60, p=0.002) had increased risk of discharge with inadequate percentage weight gain. WHZ <-3 at enrolment was associated with increased risk of discharge with WHZ <-3 (OR 3.21, p<0.001) and reduced risk of discharge with inadequate percentage weight gain (OR 0.45, p<0.001). Age sex, WHZ at enrollment were not associated with MUAC at discharge.Conclusion: The use of MUAC alone as discharge criterion allows a  significant proportion of children still needing urgent care exiting CMAM clinic prematurely. Stratifying these criteria may lead to better recovery before discharge.Keywords: malnutrition, Community management of acute malnutrition, Mid upper-arm circumference, Weight-forheight Z score