Haemoglobin genotype of children with severe malaria seen at the University of Benin Teaching Hospital, Benin city, Nigeria

Abstract: Introduction: Types of haemoglobin (Hb) genotype have been found to be crucial to the rate of red blood cell parasite invasion, multiplication, and destruction as well as outcome of malaria disease. In a bid to provide more information on the relationship between Hb genotype and level of protection conferred by genotype against severe forms of malaria, this study was undertaken. This is done through evaluation of forms of Hb genotype in children with severe malaria seen in University of Benin Teaching Hospital (UBTH), Benin City. Patients and methods: This crosssectional study was carried out on children (6 - 60 months old) admitted for severe malaria using standard World Health Organization (WHO) guidelines. Diagnosis of malaria was by microscopic demonstration of parasitaemia or serology (in those with negative parasitaemia). Hb genotype was done using the Hb electrophoresis. Results: Ninety-six well nourished children; (56(58.3%) males and 40 (41.7%) females) mean age (± SD) 29.22 ± 16.02 months were recruited for the study. Sixty-eight (73.4%) of the 92 subjects had Hb genotype AA while 24(26.1%) Had abnormal Hb genotype. Prevalence of severe malaria in children with abnormal Hb was 20/24 (83.3%) as against 58/68(85.3%) observed in those with HbAA. Significantly fewer incidence of heavy malaria parasitaemia (3+ and 4+) was observed in children with abnormal Hb genotype. Heavy parasite density was the most important features of severe malaria in children with HbAA (p= 0.013) as against altered sensorium, prostration, and haemoglobinuria in children with abnormal Hb genotype (p = 0.003, 0.041, and 0.023 respectively). Children with HbAA were also about 3 times more likely to die from severe malaria (p = 0.567, O.R = 2.96) when compared with their counterparts with abnormal Hb. Conclusion: Study supports a higher prevalence of severe malaria in children with HbAA when compared with those with abnormal Hb genotype. Altered sensorium, prostration and haemoglobinuria were the significant presenting features of severe malaria in children with abnormal Hb genotype in this study.Key words: children, genotype, haemoglobin, mortality, severe malari

Determinants of cord care practices among mothers in Benin City, Edo State, Nigeria

Background: Mothers care for their infants’ umbilical cord stump in various ways. Different cord care practices have been documented; some are beneficial while others are harmful. Who and what influence the cord care practiced by mothers have, however, not been fully explored particularly in the study locale.Objective: The objective of this study was to determine the factors that influence cord care practices among mothers in Benin City.Materials and Methods: The study subjects included 497 mothers who brought their babies to Well Baby/Immunization Clinic at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, between July and August 2009. A structured questionnaire served as an instrument to extract information on their biodata and possible determinants of cord care practices.Results: Significantly older women (P=0.023), educated mothers (P=0.029), and those who had male babies (P=0.013) practiced beneficial cord stump care practices. Beneficial cord care practice increased with increasing maternal educational status. The best predictors of beneficial cord care practices are maternal level of education (P=0.029) and infant’s sex (P=0.013). The use of harmful cord care practices was more common among mothers who delivered outside the Teaching hospitals. Most (71.2%) of the mothers were aware of hygienic/beneficial cord care. The choices of cord care methods eventually practiced by mothers were influenced mainly by the disposition of nurses (51.3%), participants’ mothers (32.0%), and their mothers‑in‑law (5.8%). There was no significant relationship between cord care practice on one hand and maternal parity, tribe, and socioeconomic classes on the other.Conclusion/Recommendation: The need for female education is again emphasized. The current findings strongly justify the need for public enlightenment programs, using the mass media and health talks in health facilities, targeting not only women of reproductive age but also secondary audience like their mothers, mothers‑in‑law, nurses, and attendants at health facilities. Proper hygiene including proper hand washing techniques while caring for newborns along with vaccination of infants and their mothers will help prevent infections including tetanus while prompt health‑seeking behavior is advised to improve outcome should such infections occur

Breastfeeding practices in early infancy in Benin city, Nigeria

Background: Adequate early infant nutrition is essential for subsequent optimum growth and development of the child. Exclusive breastfeeding is the cornerstone of the best possible nutrition in early infancy.Objective: To assess current breastfeeding practices in early infancy in Benin City and further progress ( if any) that may have been made in the realisation of optimal early infant feeding practices in the locale in the preceding decade.Methods: A community-based household survey was carried out in three representative wards in Egor Local Government Area of Benin City, from June to September, 2009. Infant feeding practices were evaluated using pre-tested questionnaires on 1068 mothers of infants aged less than 12 months.Result: Five hundred and forty-six (51.1%) infants were aged less than 6 months. The Ever Breastfed Rate was 100.0% while the Timely Suckling Rate was 35.5%. The Exclusive and Predominant Breastfeeding Rates were respectively 40.7% and 30.4% while the Bottle-feeding Rate was 32.2%. Most (98.4%) mothers had correct information about exclusive breastfeeding obtained mainly from antenatal clinics and immunization centres. Factors significantly associated with EBF were high maternal education (χ2 = 9.718; p = 0.045), high socioeconomic status (χ2 = 12.910; p = 0.012), increasing maternal age (χ2 = 14.777; p = 0.022), higher parity (χ2 = 15.212; p = 0.009), delivery in hospital (χ2 = 15.079; p = 0.020) and infant’s age (χ2 = 100.482; P = 0.0001).Conclusions/Recommendations: Breastfeeding practices in Benin City have not improved much from what obtained a decade earlier. Greater emphasis on female education and socio-economic empowerment are advocated as tools for improvement. Reinvigoration of the Baby-friendly Hospital Initiative is also recommended to ensure continued health facility interface that would ensure community mobilisation and support for optimal breastfeeding.Key Words: Breastfeeding, Practices, Early Infancy, Benin Cit

Evaluation of adolescent medicine sub-specialty training in Nigeria: trainees’ perspectives

Objective: To evaluate the extent of coverage of curriculum contents pertinent to Adolescent Medicine, as well as the adequacy of facilities and professionals in Nigeria using residents’ viewpoint.Design: A descriptive cross-sectional study.Setting: The Intensive Course in Paediatrics of the National Post-graduate Medical College of Nigeria at the University of Benin Teaching Hospital, Benin City Nigeria.Subjects: One hundred and three paediatric residents from training institutions in all zones of the country.Results: Altogether,68.0% and 32.0% of the participants were from Southern and Northern geopolitical zones respectively. Only 14% of them stated that a rotation in an AM unit is a part of training in their centres. None specified its duration. Coverage of AM topics, physical facilities and trainers were rated as inadequate by 77.0%, 82.8% and 70.8% of the respondents respectively. Residents from north were more likely to rate interview/confidentiality in AM as covered (either partly or well) than their colleagues from the South, (p < 0.01, OR = 5.3, 95% CI = 1.5-19.5). We found no difference between federal and state residents’ perceived adequacy of AM training.Conclusion: AM in paediatric residency programme in Nigeria is still an unmet challenge. There is a need for a revision of the training curriculum to specify mandatory duration of clinical rotation in AM units

Feeding practices in late infancy in Benin City, Edo State, Nigeria

Background: Whereas considerable insight has been gained and progress made in optimum feeding in early infant feeding same cannot be said with nutrition in late infancy. Tacking challenges associated with nutrition in late infancy demands that extant practices and their shortcomings are exposed.Objectives: To evaluate and document practices regarding feeding in late infancy in Benin City, Edo State, Nigeria.Methods: Using a communitybased household survey involving three representative political wards in Egor Local Government Area of Benin City, feeding practices in late infancy were evaluated using a mix of structured and non-structured, pre-tested questionnaires on 522 mothers of infants aged >6months to 11 months. This was done between June and September, 2009.Results: The age range of mothers was 17-48 years. Diverse ethnic groups were represented with the Binis constituting the largest (48.6%). Bottle feeding rate (BOTFR) was 2.55% and Bottle feeding practice was unassociated with maternal occupation (χ2 = 2.741; p=0.740) and family socioeconomic status (χ2=10.145; p=0.930). Timely complimentary feeding rate (TCFR) was very high (92.7%). Delayed introduction of complimentary feeding was very low (3.6%). Maize gruel (pap) was the commonest (76.6%) complementary food utilized and commonly (99.5%) this was enriched with a variety of other items with milk as the commonest item used. Fish was the commonest (41.0%) animal product used as complimentary food. Use of animal feeds was however generally low and their use was uninfluenced by family socio-economic status (χ2 = 5.424, p=0.066).Conclusions/Recommendations: Bottle feeding rate remains unacceptably high even into late infancy. Factors fostering this should be exposed and tackled because of the dangers inherent in the practice. Timely complimentary feeding practice is encouraging and needs to be supported and sustained for its benefits.Key Words: Nutrition, Late, Infancy, Complimentary feeding, Benin City

Cord care practices among mothers attending immunization clinic at the University of Benin Teaching Hospital, Benin City.

Background: Poor cord care practices contribute to neonatal morbidity and mortality resulting from neonatal infections including tetanus. Identification of negative practices should ultimately improve care and neonatal outcome. Objective: To evaluate cord care practices among mothers attending the Well Baby/Immunization Clinic of the University of Benin Teaching Hospital (UBTH), Benin City. Subjects and Methods: Four hundred and ninety-seven mothers who brought their babies to Well Baby/Immunization Clinic in UBTH between July and August 2009 were interviewed. A structured, pretested questionnaire was used as test instrument to investigate the care of the umbilical cord of their infants in their last deliveries. Results: Harmful or non-beneficial cord care practices were common (79.5%) among mothers in Benin City. Most delivery units used thread (65.6%) and plastic cord clamp (22.7%) to secure haemostasis at the umbilical stump. Other materials used include suture materials, strips of cloth, bandage, plaster and rubber band. Majority of the mothers practiced hand washing before (86.9%) and after (89.3%) cord care. The traditional practices of cord care in Benin City include the use of hot compress (46.1%), menthol-containing balm, herbs, native chalk, petroleum jelly, palm oil, toothpaste (Close-up), salt, sand and saliva. The most common single agent for cord treatment was alcohol (methylated spirit). Conclusion: The attendant risks associated with harmful cord care practices remain real in our communities. There is need for  education of the public, using the mass media and health talks in health facilities, to discourage harmful cord care practices while reinforcing beneficial ones.Key Words: Umbilical cord, Care practices, Mothers, Benin City. Introductio

Prevalence of intestinal helminthiasis in children with chronic neurological disorders in Benin city, Nigeria

Background: It is envisaged that the care for the child with chronic neurological disorder (CND) compared with his apparently healthy counter-part may be sub-optimal, predisposing him to increase disease morbidities including intestinal helminthiasis. To evaluate this hypothesis, a comparative cross sectional study was carried out to determine the prevalence, intensity, and specie-specific prevalence of intestinal helminthiasis in children with CND such as cerebral palsy, epilepsy, and mental retardation seen at the University of Benin Teaching Hospital, Benin City between November 2008 and April 2009.  Subjects and Methods: Fresh stool samples from 155 children with CND and from 155 age   and sex matched apparently healthy nursery and primary school children in Benin City, Edo State were analysed using the Kato-Katz technique for the detection of ova of helminths. Results: The prevalence of intestinal helminthiasis in children with CND was 31.0% compared with 19.4% found among the apparently healthy controls (p = 0.03). This prevalence increased with increasing age in both subjects and comparative group. Intensity of infections in both groups was light. Ascaris lumbricoides, Trichuris trichiura and Ancylostoma duedenale were the intestinal helminths isolated in both subjects and control groups. A. lumbricoides alone had the highest specie-specific prevalence in both the subjects (20.0%) and comparative groups (15.5%). Mixed infection was found only among the children with CND. Conclusion: Intestinal helminthiasis is common and more prevalent in children with CND than in healthy children. It is recommended that regular de-worming be incorporated into the routine care of children with CND.Key words: chronic neurological disorders, helminthiasis, intestinal helminths, intensit

Levels of serum zinc and severity of malaria in under-fives: any relationship? Experience from Benin, Edo State.

Background: It remains uncertain why some individuals infected with Plasmodium falciparum develop severe disease while others do not. This may be due to differences in immunological status of the individuals. Zinc levels may play some roles in the immune competence of such individuals as manifested in its effects on some clinical and laboratory parameters. Objective: To determine the relationship between serum zinc levels and some laboratory and clinical parameters in under-five children with malaria. Methods: The study was conducted at the University of Benin Teaching Hospital, Benin City between March and November 2003 and involved 640 under-five children. Of these, 384 children had parasitologically proven malaria while 256 were healthy controls. Determination of zinc in sera was done using the Atomic Absorption Spectrophotometry. Results: Mean serum zinc level of patients with severe/complicated malaria (13.7 ± 9.4µmol/l) was significantly lower than that obtained in non-severe/uncomplicated malaria (17.1±8.0 µmol/l; t =3.67; p =0.000). There was a negative correlation between malaria parasite density and serum zinc levels (r =     -0.101, p < 0.05). A similar trend was observed between zinc levels and degree of pyrexia (r = -0.120; p < 0.05). Conclusion: Patients with severe malaria presenting with hyperpyrexia and hyperparasitaemia tended to have lower levels of serum zinc. Hypozincaemia is associated with severity of the disease either as a cause or effect. Recommendation: Similar studies should be conducted in other centres to validate the findings. Key Words: Serum Zinc, Malaria parasite density, Malaria, Under-fives

Perinatal mortality in a rural community

Objective: To determine the peri-natal mortality rate (PMR), still birth rate (SBR) and early neonatal death rate (ENDR) in Igueben Local Government Area (LGA) of Edo State.Design: A descriptive cross-sectional studySetting: Igueben LGA is a rural governmental unit in mid-western Nigeria.Subjects: All women of child-bearing age, resident in three randomly selected political wards in Igueben LGA were identified.Results: Of the 921 women of child-bearing age recruited, 258 deliveries with three perinatal deaths were recorded, giving a PMR, SBR and ENDR of 11.6/1000TB, 11.6/1000TB and 0/1000LB, respectively. Almost all the mothers studied (99.6%) received skilled obstetric care in delivery.Conclusion: The actual PMR, SBR and ENDR were considerably lower than the National estimated averages of 76/1000TB, 43/1000TB and 35/1000LB, respectively. While this may perhaps be related to the quality of obstetric care, it underscores the importance of community-based studies in the determination of vital statistics which are important in health planning including resource allocation

Challenges and Frugal Remedies for Lowering Facility Based Neonatal Mortality and Morbidity: A Comparative Study

Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one control were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria