Knowledge, Acceptance and Practice of Zinc Therapy in Acute Diarrhoea Among Paediatric Doctors in Nigeria

Background: WHO and UNICEF recommend zinc therapy in children with acute diarrhoea, however adherence to the recommendation varies from country to country. Objective: To determine the knowledge, acceptance and practice of zinc use in childhood diarrhoea among paediatric doctors in Nigeria. Methods: Every third sitting part icipant during the 42 Paediatric Association of Nigeria Conference was requested to complete a questionnaire if they were either a paediatric resident doctor or consultant working in Nigeria. Results: Of the 153 questionnaires distributed, 93 (60.8%) were returned and 85 met the study criteria. Over half (57.6%) of the respondents were consultant paediatricians and 84.7% (49 of 85) practise in tertiary or teaching hospitals, mostly in the southern part of Nigeria (70.8%). About half (44.3%) of the respondents managed more than 10 diarrhoeal cases every month. All except one respondent (84 of 85) agreed with the WHO / UNICEF recommendation and 86.9% (73 of 85) reported prescribing zinc for acute diarrhoea in the past year; 67.1% (49 out of 73) prescribed it always for acute diarrhoea. Knowledge of the effects of zinc on acute diarrhoea was high. There was no significant difference between the paediatric residents and the consultants in both knowledge and practice of zinc therapy. Conclusion: The use of zinc as an adjunct in the management of acute diarrhoea is acceptable and practised by most paediatric residents and consultants in Nigeria.Key Words: acute diarrhoea, knowledge, practice,WHO,zin

Systolic blood pressure of Nigerian children with sickle cell disease

Background: Blood pressure readings of adult Nigerians with sickle cell disease (SCD) are reported to be lower than that of the general population but similar studies in children are unavailable.Objectives: To determine the systolic blood pressure (SBP) of children with SCD and compare it with that of healthy controls. Also, to correlate the SBP of children with SCD with age, gender, height and weight.Methods: Children with SCD were recruited from the Paediatric Haematology Clinic of the Lagos University Teaching Hospital. Data collected included bio-demographic details, social classification, height and weight measurements and present clinical status. SBP was measured using a Doppler (VASCUTRACK 120®) and a mercury sphygmomanometer. Similar data were obtained from age and sex matched apparently healthy children.Results: One hundred and twenty three children with SCD and 62 apparently healthy controls were studied; 62% were females. The mean age of the children with SCD was 8.93±3.91years (range 1-17years) and was similar to the controls. SBP was similar in both groups of children (90.9±12.7 versus 92.2±15.2 mmHg; p=0.53) and increased with age. In 91 (74%) children with SCD the SBP was below the 50th centile for the general population. Multiple linear regressions involving sex, age, height and weight found no independent factor to be a significant predictor of the SBP in children with SCD.Conclusion: The SBP of children with SCD is similar to that of age and sex-matched controls. The sex, age, weight and height did not significantly predict SBP in multiple linear regression

National neonatal resuscitation training program in Nigeria (2008-2012): A preliminary report

Background: Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth.Materials and Methods: Between 2008 and 2012, doctors and nurses drawn from all the geo.political zones were trained using the Neonatal  Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire.based, cross.sectional surveys of doctor and nurse trainees from the six geo.political zones in Nigeria were conducted eight months after the primary training, to evaluate the post.training  neonatal resuscitation activities.Results: Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post.training period. The nurses used bag and mask for infant resuscitation more frequently,   compared to doctors, with the rate fluctuating between two.to.one and four.to.one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants.Conclusion: The NRT in Nigeria is well.subscribed and the frequency of secondary training is good.Key words: Birth asphyxia, birth attendants, delivery room care, neonatal resuscitation training, perinatal mortalit

Paediatrician workforce in Nigeria and impact on child health

Objective: To determine the number and distribution of paediatricians in Nigeria. It also aims to determine the association between paediatrician workforce and under five mortality (U5MR) and immunization coverageacross the six geopolitical zones of the country.Methods: The part II fellowship examination pass list of the West African College of Physicians and the National Postgraduate Medical College and the register and financial records of the Paediatric Association of Nigeria were searched for the purpose of the study. Using a structured questionnaire, personal and professional data was obtained frommembers at the 2011 Annual Paediatric Association of Nigeria Conference or via the Association’s website, email network and phone calls to Departments of Paediatrics in institutions (private and public) across the Country. Data on the paediatricians residing within Nigeria was then extracted from the comprehensive database and subsequently analyzed.Population data, mortality and immunization rates were obtained from the National Population Commission census and their most recent National Demographic health survey in Nigeria. Correlations were drawn betweennumber of paediatricians and U5MR and diphtheria-pertussistetanus(DPT) vaccine coverage.Results: There were 492 practicing paediatricians in Nigeria at theend of year 2011, comprising 282 (57.3%) males and 210 (42.7%)females; 476 (96.7%). Majority (84.7%) worked for the governmentwith 97% of them in hospital settings, mostly tertiary centres (344=88%). Lagos State had the highest number (85; 17.9%) of practicing paediatricians followed by the Federal Capital Territory with 37 (7.8%) paediatricians. More than two thirds of the paediatricians (336; 70.6%) were practicing in the southern part of the country. The average child:p a e d i a t r i c i a n r a t i o wa s 157,878:1for the country. TheNorth East zone had the highest chi ld- to-pa ediat r ician rat io (718,412:1) while South West had the lowest ratio (95,682:1).Higher absolute numbers of paediatricians in each zone were associatedwi th lower U5MR (Spearman ñ=-0.94, p=0.0048), accounting for 84% of the variability among zones. Higher ratios of child-to-paediatrician were significantly associated with higher U5MR (Spearman ñ=0.82, p=0.04,linear R2=0.73) and marginally with lower DPT coverage by geopoliticalzone (Spearman ñ=-0.77, p=0.07, linear R2=0.59).Conclusion: The study reveals that the number of paediatricians inNigeria is grossly inadequate with a huge child-to-paediatrician ratio.There is also an uneven distribution of the paediatricians with higher numbers in the southern states. Zones of the country with lower child-to-paediatrician ratios also experienced lower U5MR. There is a need to train more paediatricians in Nigeria and promote an even distribution of the paediatrician workforceKey words: Paediatrician, workforce, child-to-paediatrician ratio, under-5 mortality, immunization, childhealth, Nigeri

Mothers and childhood pneumonia: What should the focus of public campaigns be?

Background: Prompt administration of antibiotics to children with pneumonia significantly reduces the probability of death. However this requires early identification of such children in the community.In a country such as Nigeria with one of the highest pneumoniarelateddeaths, what do mothers know about pneumonia, and what should be the content of public campaign messages?Methods: A structured questionnaire was administered to mothers  attending paediatric clinics of Lagos University Teaching Hospital seekingtheir knowledge about the definition, causes, risk factors and symptomsof childhood pneumonia.Results: One hundred and seven (107) consecutive mothers participatedin the study. The majority (97; 90.6%) had at least secondary education,were married (96; 89.7%) and professed to be either Christiansor Muslims (105; 98.1%). Prior to the study, 16 (15%) had notheard about pneumonia. About half of the participants correctly identifiedfast/difficult breathing as suggestive of pneumonia. Threequartersreported exposure to cold as the cause of childhood pneumonia. Minimizing exposure to cold and wearing warm clothes were thetwo commonest reported ways of preventing pneumonia (75.8% and49.5% of the mothers respectively); in contrast hand washing, exclusivebreastfeeding and limiting exposure to sick persons with cough and catarrhwere the least mentioned. The proportion of mothers who correctlyidentified fast/difficult breathing as suggestive of pneumoniawas similar irrespective of educational status or source of pneumoniainformation.Conclusion: Mothers’ knowledge of childhood pneumonia is low. Publiccampaigns on pneumonia should focus on raising awareness aboutgerms as cause of pneumonia, immunization, hand washing and exclusivebreastfeeding as potent preventive strategies and fast/difficult breathing as a feature of pneumonia

Community knowledge, attitude and practice of childhood immunization in Southwest Nigeria: Data from a Paediatric Association of Nigeria town hall meeting

Background: Vaccine preventable diseases account for 22% of under-five deaths in Nigeria and poor knowledge and attitude have been responsible for non-vaccination of children. This study aimed to assess the knowledge,attitude and practice of childhood immunization among community members in Ile-Ife.Methods: Quantitative data (using an interviewer-administered questionnaire) was collected from a convenience sample of 36 adultresidents who attended a town hall meeting with the PaediatricAssociation of Nigeria. Two focus group discussions were also conductedamong sub-samples of male and female respondents.Results: The mean age of respondents was 43.2 ± 11.9 years with amale to female ratio of 1:0.7. Most had secondary education (63.9%)and had children (91.7%). Most of the respondents understood whatimmunization was and knew the benefits but were unaware of severalof the specific types of immunization. There were erroneous beliefs about the contraindications for immunization and mothers were entrusted with the sole responsibility of getting children immunized. Although most of therespondents had immunized their children, they identified laziness ofmothers, negative attitude of health workers and logistics problemsat facilities as barriers to patronage of immunization services.Conclusion: This study identified knowledge gaps and negative attitudestowards childhood immunization. We therefore recommend a community-wide health education intervention with emphasis on substantial male involvement in immunizations and improvement inimmunization service delivery.Key words: Community, knowledge, attitude, childhood immunization

Management of Community Acquired Pneumonia (CAP) in Children: Clinical Practice Guidelines by the Paediatrics Association of Nigeria (PAN)

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Perinatal Mortality Among Twins In Lagos University Teaching Hospital : Associated Risk Factors

Background: Perinatal mortality rate is reported to be higher in twins than in singletons. More than two decades ago, Abudu and Agarin reported a twinning rate of 21.1/1000 maternities and perinatal mortality rate of 142.6/1000 among twins in Lagos. Objective: To determine the current perinatal mortality rate and risk factors that influence perinatal mortality among twins in Lagos University Teaching Hospital, Nigeria. Materials and Methods: Babies weighing >1000grammes delivered by twin pregnancy between January 1996 and December 2000 in Lagos University Teaching Hospital were retrospectively studied. Routinely collected data from nurses and doctors registers in the departments of Obstetrics and Paediatrics on all twin deliveries was analysed. Results: Out of 5,947 deliveries, there were158 set of twins' giving a twinning rate of 26.6/1000 for the institution. Fifteen of the babies weighed 1000g died perinatally giving a perinatal mortality rate of 89.7/1000. The significant risk factors for perinatal mortality identified in twins were lack of antenatal care (P=0.005), low gestational age and premature delivery (