Conducting defect with atrial septal aneurysm in a preterm neonate: A case report from resource limited setting

Conducting defect (CD) co-existing with interatrial septal anomaly (ISA) like Atrial Septal Aneurysm (ASA) is a rare congenital heart disease presenting with bradyarrhythmia in-utero due to defects in the heart electrical conducting system. We report a case of a preterm female ‘CC’ (GA=35weeks) low birth weight (2.4kg) neonate with CD and associated ASA. CC’s mother presented with poor foetal movements and bradyarrhythmia and had an emergency caesarian section at 35weeks with Apgar score of 3, 5. She was managed for perinatal Asphyxia. This report highlights the fact that ASA resolved at around the first year of life but the associated heart electrical conducting system defects persisted. The report also emphasizes the challenges of managing a rare neonatal cardiac condition in a resource limited setting and the importance of thorough foetal biophysical profile and early interventional delivery when it is necessary.Keywords: Conducting defect; neonatal; Atrial Septal Aneurysm

Pattern of morbidity and mortality of newborns admitted into the sick and special care baby unit of Enugu State University Teaching Hospital, Enugu state

Background: Being the highest contributor to under-5 mortality, neonatal mortality and morbidity has great impact to the attainment of millennium development goals 4 (MDG 4). In Nigeria and other developing countries, this indicator strongly poses a major challenge in achieving this goal. Objectives: To determine the morbidity and mortality pattern of admitted babies in the special care baby unit (SCBU) of Enugu State University Teaching Hospital (ESUTH).Materials and Methods: This is a comparative and descriptive longitudinal study of causes of morbidity and mortality between babies born within (inborn) and outside our hospital facilities (outborn) based on information on place of birth, APGAR scores, age on admission, diagnosis on  admission, duration of hospital stay, and outcome of newborns admittedinto the sick and SCBU over a 1 year period. Results: A total of 261 neonates were admitted during the period under review. The common causes of admissions seen from the study were perinatal asphyxia (80, 30.7%), low birth weight (64, 24.5%), neonatal sepsis (44, 16.9%), and neonatal jaundice (16, 0.06%). A total of 37 (14.2%) deaths were recorded during the period. The leading causes of deaths were severe form of perinatal asphyxia (18, 52.9%), neonatal sepsis (10, 29.4%), and very low birth weight (two, 0.06%). Fifty.five percent of all the deaths occurred within 24 h of admission. Death dueto asphyxia was more in babies born outside the hospital (outborn) than in babies born within the hospital (inborn). Equal number of outborn and inborn babies died from neonatal sepsis. The age at presentation to the sick baby unit was significantly lower in inborn (P = 0.004), while age at death was not different in both group of newborns (P = 0.876).Conclusion: The neonatal mortality rate and the causes of death in this study are similar to those documented by other studies in Nigeria and are largely preventable. Strengthening perinatal care, emergency obstetric services, and enhancement of neonatal resuscitation skills to traditional birth attendants (TBAs) and other community health workers are necessary to reduce the neonatal mortality in our setting and other rural settings across developing countries. Key words: Enugu, morbidity, mortality, newbor

Effect of Blue Ocean Strategy on the Performance of Telecommunication Firms in South East Nigeria

The objectives of the study were to; examine the effect of blue ocean strategy application on the market share in the Nigerian telecommunication firms and identify the impact of blue ocean strategy on customer satisfaction in the Nigerian telecommunication industry. The study adopted cross-sectional descriptive research design. Data was obtained from 225 respondents working in telecommunication firms in South East Region of Nigeria through the use of a questionnaire. The data collected for the study were presented in tables comprising of frequency, percentage, mean and standard deviation, while the hypotheses were tested using simple linear regression with the aid of statistical package for social sciences (IBM, SPSS version 23). The findings revealed that blue ocean strategy has a positive significant effect on market share in the Nigerian telecommunication industry (r = .680a; F = 223.971; T = 14.966; p - .000) and that blue ocean strategy has a positive significant effect on customer satisfaction in Nigerian telecommunication organizations (r = 727; F = 292.079; T = 17.090; p - .000). It was concluded that the formulation of blue ocean strategy is quite an accomplishment and dynamic process as it affects, market shares and customer satisfaction. It was recommended that management of various telecommunication firms should strive to develop innovative products and services that are beyond the traditionally known services in order to improve their profitability and as a matter of urgency, innovatively deliver cutting edge services that can beat their competitors so as to attract more customers. Keywords: Blue Ocean, Strategy, Performance, Telecommunication firms, South East Nigeri

Prevalence of iron deficiency anaemia in anaemic under-5 children in Enugu South East Nigeria

Background: Iron deficiency anaemia has been described as the commonest type of nutritional anaemia in infancy and childhood. The associated adverse health sequelae include permanent behavioural and cognitive impairments. Early detection and prompt treatment are necessary to prevent these complications.Aim: To determine the prevalence and socio-demographic distribution of iron deficiency anaemia among anaemic under five children in Enugu.Subjects and methods: Under-five children presenting at a tertiary hospital were consecutively enrolled and screened for iron deficiency anaemia using haematocrit and serum ferritin levels. Iron deficiency anaemia was defined as haematocrit level <30% and ferritin level <12ng/ml.Results: Three hundred and twelve children (187 males, 125 females) aged below 60 months had a PCV check out of which 178 (57.1%) were anaemic (PCV< 30%). Of the anaemic group, 61(34.3%) had iron deficiency anaemia. Prevalence of iron deficiency anaemia was higher among the males (38.0%) [p=0.235], age group 13- 23months (40.0%) [p=0.575] and children from lower socioeconomic class (43.5%)[p=0.158]. There is a positive but weak correlation between serum ferritin and haematocrit levels [r= 0.11 p=0.130].Conclusion: The prevalence of iron deficiency anaemia in the study population was high and varies with the child’s age group, gender and parental socioeconomic class.Keywords: iron deficiency anaemia, serum ferritin, haemtocrit, Enugu

Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, South East, Nigeria

Background: Birth asphyxia (BA) is a preventable cause of cerebral insults in newborns. It is associated with high morbidity and mortality. Of the 120 million babies born in third world countries annually, it is estimated that about 3.6 million will develop BA.Objectives: We aimed to determine the short term outcome and predictors of survival among birth asphyxiated babies using Apgar score.Methods: This study was carried out in the Newborn Unit of Enugu State University Teaching Hospital. In-hospital deliveries (Inborn) and those from other centers (Out-born) with one minute Apgar score ≤ 6 were included. Interviewer administered questionnaire was used to collect data from caregivers. Information sought included gestational age (GA), birth weight (BW), Apgar score, place of delivery and outcome. Data was analyzed using SPSS. Bivariate and multivariate logistic regressions were done.Results: Of the 150 neonates, 61.3% survived. Majority of the dead were out-born. The difference was statistically significant (p < 0.001). The inborn were about 1.2 times (AOR = 1.22; 95% CI: 1.06-1.78) more likely to survive BA. Among low birth weights (LBWs), 73.9% died, 23.7% of normal weights and 14.3% of macrosomics died. The difference was statistically significant (p < 0.001). The normal weights were about 2 (AOR = 2.23, 95% CI: 1.76-6.25) and the macrosomics about 5 times more likely to survive BA than LBWs. Regarding GA, 78.8%, 17.2% and 18.2% of the pre-terms, term and post-dates died respectively. The difference was statistically significant (p < 0.001). The term babies were about 11 (AOR = 11.27; 95% CI: 4.02-31-56) and post -dates about 9 (AOR = 8.79; 95% CI: 1.43-54.04) times more likely to survive BA than preterms. Other significant factors were degree of asphyxia (p = 0.003), and parental education (p < 0.001).Conclusion: BW, GA, degree of asphyxia, place of delivery and parental education all predicts survival among birth asphyxiated newborns.Keywords: Newborn, birth asphyxia, Hypoxic Ischemic Encephalopathy (HIE) outcomes, predictors of survival

Outbreak of serotype W135 Neisseria meningitidis in central river region of the Gambia between February and June 2012: A hospital-based review of Paediatric cases

Background: Meningitis still accounts for many deaths in children especially during epidemics in countries within the African meningitis belt. Between February and May 2012, the Gambia witnessed an outbreak of meningitis in two of its six regions. This study presents a clinical perspective of this outbreak in central river region of the Gambia. It evaluated the outbreak pattern, clinical features, and mortality among suspected cases that presented to the hospital during the outbreak. Methodology: This is a prospective observational study of suspected cases of meningitis that presented to the pediatric ward of the Bansang Hospital during the outbreak period. Confirmed cases of meningitis were consecutively  enrolled, and those with negative blood cultures presenting during the same period were employed as controls.Result: Two hundred and four suspected cases of meningitis presented to the pediatric ward during the outbreak. Ninety were confirmed as meningitis cases. The W135 strain of Neisseria meningitidis was responsible for 89 (98.9%) of meningitis cases seen with an incidence rate of 74.9/100,000 in children (0-14 years) and in.hospital case fatality rate of 7.9%. Highest attack rate was among the 12-49 months age group. Clinical features such as meningeal signs (neck stiffness), conjunctivitis, and joint swelling were seen more in cases than controls. Contact history with relatives, who had fever in previous 2 weeks prior to illness was significantly seen more in cases. Adjusted regression analysis showed 7.5 more likelihood of infection with positive contact history (odds ratio [OR]: 7.2 confidence interval [CI]: [3.39-15.73]). There was no significant difference in death outcome between cases and controls (OR: 0.78 CI: [0.29-2.13]). The double peak wave-like pattern of the epidemic curve noted during this outbreak suggests a disseminated outbreak originating from an index case with propagated spread.Conclusion: There is need for more effective surveillance and incorporation of vaccine against meningitis into the expanded program on immunization schedule of the Gambia and other countries within the meningitic epidemic belt.Key words: Neisseria meningitis, W135 strain, Outbreak, Children, Central River Regio

Infant feeding practices and maternal socio-demographic factors that influence practice of exclusive breastfeeding among mothers in Nnewi South-East Nigeria: a cross-sectional and analytical study

BACKGROUND: Malnutrition is an underlying factor in more than 50% of the major cause of infant mortality-Pneumonia, diarrhoeal disease and measles which account for 70% of infant mortality. Therefore, programs to promote adequate nutrition for age can help reduce mortality from these disease conditions and indispensible to achievement of MDG 4. AIM: To describe the feeding practices of infants below six months of age and determine maternal socio-demographic factors that influences the practice of exclusive breastfeeding (EBF) among mothers in Nnewi, south-east Nigeria. METHODS: Four hundred mother-infant pairs attending the infant welfare clinic of the Nnamdi Azikiwe University teaching hospital (NAUTH) during 2012 were consecutively recruited after meeting the study inclusion criteria. Data on breastfeeding were based on infant feeding practice in the previous 24 hours. Exclusive breastfeeding was defined as infant feeding with only breast milk. RESULTS: Awareness (95.3%) and knowledge (82.0%) of EBF was high among surveyed mother but the practice of EBF (33.5%) was very low. Positive attitude towards EBF practice was shown by many (71.0%) of surveyed mothers. EBF practice decreased with increasing infant age, OR 0.72 (95% CI 0.34, 1.51) for 1–2 months, OR 0.58 (95% CI 0.23, 1.44) for 3–4 months and OR 0.20 (95% CI 0.06, 0.73) for 5–6 months compared to infants < 1 month old. Maternal education, socioeconomic class, mode of delivery and infants first feed were retained as important maternal predictors of EBF practice after adjustment for confounders. Decreased likelihood of EBF practice was found among mothers of lower educational attainment, OR 0.33 (95% CI 0.13, 0.81), mothers who delivered through caesarean section, OR 0.38 (95% CI 0.18, 0.84), mothers of higher socio-economic status [(middle class, OR 0.46 (95% CI 0.22, 0.99) and upper class, OR 0.32 (95% CI 0.14, 0.74)] while increased likelihood of EBF practice was seen in mothers who gave their infants breast milk as their first feed, OR 3.36 (95% CI 1.75, 6.66). CONCLUSION: Knowledge and awareness does not translate to practice of EBF. More effort by health workers and policy makers should be directed to mothers along the fault lines to encourage the practice of EBF

Bacterial Isolates of Surfaces in the Neonatal Intensive Care Unit of Enugu State University Teaching Hospital, Parklane, Enugu, and Their Antibiotic Susceptibility Patterns

Introduction: The duration of admission in the hospital, mortality rates, and care costs is increased in Neonatal Intensive Care Unit (NICUs) by nosocomial infections(NIs). There is a need for routine and regular environmental sampling in NICUs. Methodology: This was a cross-sectional study conducted in the NICU of Enugu State University Teaching Hospital. The researchers collected samples for culture from equipment and hospital surfaces in the unit. Susceptibility testing was done for isolates by the agar diffusion method using standard nutrient agar 1 discs. Results: We observed bacterial growth in 58 (54.7%) samples from the 106 samples collected. Staphylococcus aureus 35 (55.6%) was the most common isolate cultured, followed by Escherichia coli 14 (22.2%) and then coagulase-negative Staphylococcus13 (20.6%).&nbsp; Among S. aureus isolates, 48.6% were methicillin-resistant S. aureus. Among the Gram-negative isolates, resistance was highest for ampicillin followed by meropenem. Conclusion: The most common isolates were S. aureus, coagulase-negative Staphylococcus, and E. coli. Health-care providers need improved hygiene standards to reduce the burden of NI. Keywords: Bacterial contamination, Neonatal Intensive Care Unit, Nigeria, susceptibility pattern

Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, South East, Nigeria

Background: Birth asphyxia (BA) is a preventable cause of cerebral insults in newborns. It is associated with high morbidity and mortality. Of the 120 million babies born in third world countries annually, it is estimated that about 3.6 million will develop BA. Objectives: We aimed to determine the short term outcome and predictors of survival among birth asphyxiated babies using Apgar score. Methods: This study was carried out in the Newborn Unit of Enugu State University Teaching Hospital. In-hospital deliveries (Inborn) and those from other centers (Out-born) with one minute Apgar score 64 6 were included. Interviewer administered questionnaire was used to collect data from caregivers. Information sought included gestational age (GA), birth weight (BW), Apgar score, place of delivery and outcome. Data was analyzed using SPSS. Bivariate and multivariate logistic regressions were done. Results: Of the 150 neonates, 61.3% survived. Majority of the dead were out-born. The difference was statistically significant (p &lt; 0.001). The inborn were about 1.2 times (AOR = 1.22; 95% CI: 1.06-1.78) more likely to survive BA. Among low birth weights (LBWs), 73.9% died, 23.7% of normal weights and 14.3% of macrosomics died. The difference was statistically significant (p &lt; 0.001). The normal weights were about 2 (AOR = 2.23, 95% CI: 1.76-6.25) and the macrosomics about 5 times more likely to survive BA than LBWs. Regarding GA, 78.8%, 17.2% and 18.2% of the pre-terms, term and post-dates died respectively. The difference was statistically significant (p &lt; 0.001). The term babies were about 11 (AOR = 11.27; 95% CI: 4.02-31-56) and post-dates about 9 (AOR = 8.79; 95% CI: 1.43-54.04) times more likely to survive BA than preterms. Other significant factors were degree of asphyxia (p = 0.003), and parental education (p &lt; 0.001). Conclusion: BW, GA, degree of asphyxia, place of delivery and parental education all predicts survival among birth asphyxiated newborns. DOI: https://dx.doi.org/10.4314/ahs.v19i1.29 Cite as: Uleanya ND, Aniwada EC, Ekwochi U, ND U. Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, SouthEast, Nigeria. Afri Health Sci. 2019;19(1). 1554-1562. https://dx.doi.org/10.4314/ahs.v19i1.2

Evaluation of Physician Burnout Syndrome Among Pediatric Resident Doctors in Nigeria

Background: Medical practice and education are known to lead to emotional and mental exhaustion as well as physical tiredness among healthcare workers. This study analyzed the prevalence and factors associated with physician burnout syndrome (PBS) among resident doctors in paediatric across Nigeria. Methodology: This cross-sectional study was conducted among paediatric resident doctors across Nigeria using the public welfare questionnaire of the American Welfare Association comprising 28 questions related to sleep affectation, energy levels, personal relationships, professional relationships, quality of job environment, and work satisfaction. Results: 117 residents were enrolled with varying degrees of burnout. The mean PBS score was 75.3 ± 19.1 with minimum and&nbsp; maximum scores of 32 and 125, respectively. The prevalence of Grades 0, 1, 2, 3, and 4 PBSs was 3.7%, 4.9%, 28.1%, 42.7%, and 18.3%, respectively, while 63.4% of respondents exhibited signs of symptomatic PBS. The residents’ rank (P = 0.05) was significantly associated with the prevalence of symptomatic PBS, while age (P = 0.567), gender (P = 0.755), number of years in training (P = 0.411), marital status (P = 0.173), number of children (P = 0.974), religion (P = 0.09), and prior knowledge of PBS (P = 0.719) had no association with the development of symptomatic PBS among surveyed resident doctors. Conclusion: The prevalence of PBS is high among paediatric resident doctors. There is an urgent need for the postgraduate medical colleges in collaboration with the Ministry of Health to formulate programmes that will help to balance social and professional livesamong paediatric resident doctors in Nigeria. Keywords: Burnout, Nigeria, paediatric, physician