Caregivers’ satisfaction and supervision of primary health care services in Nnewi, Nigeria

Although major gains were made in the reduction of childhood health indicators in the previous decade, stagnations or reversals were seen in many countries since the 1990s. Despite presence of primary health centers (PHC) in Nigeria, there are still high levels of morbidity and mortality among children because the quality of child health services falls short of what it could be in the country. Supportive supervision of PHCs should also improve the quality of child health services. This study assessed the level of clients’ satisfaction with care received and the quality of supervision of child health services in selected PHC facilities of Nnewi, Nigeria. The study design was cross sectional. Four health facilities were selected by simple random sampling technique from a list of 12 public PHC facilities that provide at least three of the range of essential child health services. Using interviewer administered questionnaire, data were collected from 305 caregivers and analyzed accordingly. Also key informant interviews were used to elicit information facility supervision frequency and adequacy. The mean age of the mainly female caregivers was 31.9 ± 9.4 years. Majority of the caregivers attended health facilities closest to them but 18.5% of the 65 who do not, said they did not like the health workers. Although more than 80% of clients were satisfied with quality of child health services received, yet 41.3% of them felt that the number of service days were inadequate. None of the health facilities had a work plan, supervision schedule or supervision checklist. Increasing the number of service days and providing supervision schedules and checklists at the health facilities can improve caregiver satisfaction and hopefully enhance quality of child health services at the PHCs.Key words: Caregivers, satisfaction, supervision, PHC, Nnew

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

Prevalence of asymptomatic bacteriuria among pre-school children in Nnewi, South-East Nigeria

Background: Early diagnosis and management of urinary tract infection (UTI) in young children reduces the risk of renal scarring and chronic renalinsufficiency. We determined the prevalence of asymptomatic bacteriuria(ASB) among pre-school children in Nnewi, South-East Nigeria.Methodology: This was a crosssectional survey involving apparently healthy nursery school children aged 3-5 years. A pre-tested, care-giver administered questionnaire was used to obtain information about the participants including age, sex, history of fever and antibiotic administration in the two weeks preceding the study. Following a clinical examination, a sample of mid-stream urine was collected from each participant for dipstick urinalysis, and urine microscopy and culture. ASB was defined as the presence of .105CFU/ml of urine in a participantwho had no symptoms of UTI.Results: Out of 792 children, 417 (52.3%) were females and 375 (47.4%) were males. The mean age of the children was 4.0 } 0.7 years. ASB was found in 31 children (4%). The prevalence of ASB in females (7.2%) was significantly higher than in males (0.5%), p<0.001. The highest prevalenceof ASB of 5.6% occurred in the 4-year-olds and the lowest of 2.0 %occurred in 5 year olds, p=0.09. The commonest bacterial isolates among the ASB cases were Staphlococcus aureus, 13 (40.6%); Streptococcus faecalis, 9 (28.1%) and Escherichia coli, 5 (15.6%). Conclusion: Asymptomatic bacteriuria is commoner in female preschoolchildren and S. aureus is the commonest bacterial isolate. Routine evaluation of female preschool children for bacteriuria is recommended.Key words: Asymptomatic bacteriuria, Pre-school children, Prevalenc

Ranking of diagnostic features of childhood pulmonary tuberculosis by medical doctors in southeastern Nigeria

Objective: To rank diagnostic features of childhood pulmonary tuberculosis; and to determine the effect of working in tuberculosis Directly Observed Treatment Short Course (DOTS) facilities on the ranking of these features by medical doctors. Methods: A cross sectional descriptive study, using structured questionnaires to collect data from medical doctors whose daily routine included attending to sick children in 34 selected children outpatient clinics and TB DOTS centers in southeastern Nigeria. Results: Approximately, one quarter (25.3% or 56 of 221) of respondents worked in Directly Observed Treatment Short course (DOTS) clinics, while three quarters (74.7% or 165 of 221) worked in nonDOTSclinics. Majority of the respondents (69.7%) ranked chronic persistent cough (1), 42.5 % ranked weight loss and failure to thrive (2), another 27.7% ranked weight loss and failure to thrive (3), while 17.6% and 21.7% ranked History of contact with adult index case and radiographic abnormalities, (4) and (5), respectively. The study found that the percentage of doctors working in DOTS clinics who ranked weight loss and failure to thrive (2) was statistically and significantly higher than those of non-DOTS respondents. Conclusions: The most important symptoms/signs on which medical doctors based their diagnosis of childhood pulmonary tuberculosis include cough, weight loss and failure to thrive, history of contact with adult with smear positive pulmonary tuberculosis, and radiographic abnormalities consistent with active tuberculosis. There was statistically significant difference between the ranking of weight loss and failure to thrive by doctors working in DOTS clinics and their counterparts in non DOTS clinics. This study showed a decline in the percentage of ranking in both DOTS and Non DOTS respondents as they moved from the first to the fifth.KEY WORDS: Childhood pulmonary tuberculosis, Doctors, Ranking, Diagnostic features, Directly observed treatment short course (DOTS)

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

Neonatal jaundice and its management: knowledge, attitude and practice of community health workers in Nigeria

BACKGROUND: Neonatal jaundice (NNJ) is still a leading cause of preventable brain damage, physical and mental handicap, and early death among infants in many communities. Greater awareness is needed among all health workers. The objective of the study was to assess the knowledge of primary health care workers about the description, causes, effective treatment, and sequelae of NNJ. METHODS: The setting was a local government area i.e. an administrative district within the south-western part of Nigeria. Community health workers in this area were interviewed by means of a self-administered questionnaire which focused on awareness and knowledge of neonatal jaundice and its causes, treatment and complications. RESULTS: Sixty-six community health workers participated in the survey and male-to-female ratio was 1:5. Their work experience averaged 13.5 (SD 12.7) years. Only 51.5% of the respondents gave a correct definition of NNJ. 75.8 % knew how to examine for this condition while 84.9 % knew at least two of its major causes in our environment. Also, only 54.5 % had adequate knowledge of effective treatment namely, phototherapy and exchange blood transfusion. Rather than referring affected babies to hospitals for proper management, 13.4 %, 10.4 % and 3 % of the participants would treat with ineffective drugs, natural phototherapy and herbal remedies respectively. None of the participants knew any effective means of prevention. CONCLUSION: Primary health care workers may have inadequate knowledge and misconceptions on NNJ which must be addressed concertedly before the impact of the condition on child health and well-being can be significantly reduced. We recommend regular training workshops and seminars for this purpose

Child Abuse: Abused all the way but determined not to abuse.

The case of a 14-year old girl who was abused right from infancy through childhood, pregnancy labour and immediate post-partum period, and management of both the child mother and her baby is presented. Information was obtained both retrospectively and prospectively. Tender loving care to the child mother and her premature baby coupled with gainful employment greatly improved her socio-economic status and facilitated graduation of the premature baby from the precarious under- five group. The danger and occasional inevitability of child labour in our environment are highlighted, and solutions are proffered. Sahel Medical Journal Vol.7(3) 2004: 98-10

Tuberculin Reaction Among Healthy BCG Vaccinated Primary School Children In Nnewi, South Eastern Nigeria

Objective: To assess the Mantoux test reaction pattern in healthy BCG vaccinated Primary School Children aged 6 -10 years in Nnewi, South–East Nigeria. Materials and methods&#58Four Primary Schools were randomly selected out of 43 government owned primary schools in the town. The entire BCG vaccinated pupils in each school were the sample frame. Mantoux test was administered in 662 pupils that met the inclusion criteria and had their results read 72 hours later. Results&#58 Three groups of children were identified: First group of 470 (75.6%) were negative, 76 (12.2%) had intermediate reaction, while 76 (12.2%) had positive Mantoux test. Increasing age, sex, presence of BCG scar and age at vaccination did not affect the pattern of Mantoux test reaction. Conclusion: The result indicates that the use of Mantoux test in the diagnosis of Tuberculosis may not be affected by BCG vaccination at birth and therefore, BCG vaccination at birth should be continued. Key Words: BCG vaccination, Mantoux test Nigerian Journal of Clinical Practice Vol 8(1) 2005: 4-

Preterm Admissions in a Special Care Baby Unit: The Nnewi Experience

A review of all preterm admissions into the Special Care Bay Unit of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, over a period of 29 months (May 1998 October 2000) was carried out. Out of a total of 699 neonatal admissions, 133 (19 percent) were preterms with gestational ages ranging from 24 to 36 weeks and birth weights from 600g to 2490g. Male: female ratio was 1:1.5. Seventy-three patients (54.9 percent) were referred from other health establishments, while 60 (45.1 percent) were born in NAUTH. Thirty-three patients were delivered by Caesarean section, out of which one died. Factors contributing to morbidity were sepsis, asphyxia, jaundice, anaemia and haemorrhagic disease of the newborn. Duration of hospital stay ranged from two hours to 54 days with a mean of 16.7 days. Twenty-four (18 percent) of the 133 patients died. Mortality-associated events were respiratory distress syndrome (40.0 percent), severe birth asphyxia (33.4 percent), neonatal sepsis (13.3 percent), severe neonatal jaundice (6.7 percent) and severe anaemia and haemorrhagic disease of the newborn (3.3 percent) each. The referred cases contributed 75 percent of the mortality. During the period between hospital discharge and one year corrected age, 2.8 percent of the babies died, 1.8 percent developed hydrocephalus, 1.8 percent had cerebral palsy, 2.8 percent had recurrent acute respiratory infections requiring hospital admission and 13.8 percent were lost to follow up. This study illustrates the impact of a newborn unit on a programme designed to reduce perinatal mortality.Nigerian Journal of Paediatrics 2002;29:75-79

Prevalence Of Hepatitis B Surface Antigen In Primary School Children In Nnewi, Nigeria

Objective; To study the prevalence of hepatitis B virus infection among primary school children in Nnewi Subjects / Methods: Two hundred and thirty seven randomly selected schools children (127 females, 110 males) in Nnewi Nigeria were assayed for Hepatitis antigen (HbsAg) using ELISA technique. Results: Eighteen (7.6%) of the children were positive. The seropositivity increased from 2.3% at age range 11-15 years. The educational background of their parents and guardian as well as previous history of parenteral drug administration did not significantly influence the seropositivity rate. (P>0.05). Conclusion: The findings suggest high endemicity and horizontal acquisition of Hepatitis B Virus infection as the mode of transmission. Key Words: Hepatitis B, primary School children, Nigeria Nigerian Journal of Clinical Practice Vol.7(1) 2004: 8-1