Reducing Early Neonatal Mortality in Nigeria—The Solution

The West African nation of Nigeria seems to have run out of ideas on how their neonatal mortality rate may be lowered. This situation has become dare as the country could not make any significant progress even with the great supports of the last 10 years of Millennium Development Goal. Presently, one in every two deceased child under 5 years of age in Nigeria is a neonate. Literature reveals that most of these deceased neonates are classified preterm or low birthweight, of which nearly four in five must die within first 7 days. This clearly identified the categories and stages of highest mortality; however, it is disappointing that the authorities of the Nigerian health care system have for too long been unable to devise a solution for the neonates. Probably, inadequacy of climatic and cultural compatibilities might partly be responsible for the failure of their current conventional ideas and technologies—these being predominantly imported. Yet, there seems to be lack of interest in some home-grown unconventional ideas that have achieved the needed reduction at few centers. In this chapter, we present the unconventional approaches and encourage across-the-nation translation of the applications to achieve accelerated end to this situation

Sustainable Development Planning: Examining the Mismatch of Urban Solid Waste Management Services in Bauchi Metropolis

Municipal solid waste systems are essential components of environmental infrastructure in human settlements. This system comprises all the activities undertaken from the point of waste generation to the final phase of disposal. It is an important environmental health service and an integral part of basic urban services. In most cities of developing world, waste service provision is a responsibility of municipal authorities. However, solid waste generation out-weighed the collection capacities of these municipalities and agencies responsible for waste collection and its management. The problem of solid waste generation and management is also compounded, and increasingly becoming difficult for these agencies due to lack of availability of reliable data on existing waste streams within the metropolis. This study compared the solid waste management service provided by Bauchi State Environmental Protection Agency (BASEPA) and the result of a study on waste characteristics and management streams in Bauchi Metropolis. The methodology of the study used waste characterization,, physical interviews, focus group discussion and observations; the results finally established the lacuna between the current situation and the unsustainable waste management services rendered by the municipality which became a bottleneck in achieving a sustainable urban solid waste management services in Bauchi metropolis respectively.. Keywords; Solid Waste, Solid Waste Management, Urban Areas, Environmental Agencies, Bauchi Metropolis DOI: 10.7176/CER/12-3-06 Publication date:March 31st 202

The Impact of Recycled Neonatal Incubators in Nigeria: A 6-Year Follow-Up Study

Nigeria has a record of high newborn mortality as an estimated 778 babies die daily, accounting for a ratio of 48 deaths per 1000 live births. The aim of this paper was to show how a deteriorating neonatal delivery system in Nigeria may have, in part, been improved by the application of a novel recycled incubator technique (RIT). Retrospective assessment of clinical, technical, and human factors in 15 Nigerian neonatal centres was carried out to investigate how the application of RIT impacted these factors. Pre-RIT and post-RIT neonatal mortalities were compared by studying case files. Effect on neonatal nursing was studied through questionnaires that were completed by 79 nurses from 9 centres across the country. Technical performance was assessed based on 10-indices scores from clinicians and nurses. The results showed an increase in neonatal survival, nursing enthusiasm, and practice confidence. Appropriately recycled incubators are good substitutes to the less affordable modern incubators in boosting neonatal practice outcome in low-income countries

La perception de membres communautaires de mortalité maternelle au Nord-est du Nigeria

This study was conducted to find out community’s knowledge and perceived implications of maternal mortality and morbidity. The community members’ perception on ways to prevent the scourge was also explored. It was a population- based qualitative study which took place in two urban and two rural communities in Borno state, Nigeria. A total of one hundred and sixty eight (168) community members participated in Focus Group Discussions (FGD) and in-depth interviews. Most agreed that there were maternal deaths in the communities. Many of the respondents identified at least two of the five main direct causes of maternal mortality that are universal. But many have misconceptions about the causes of maternal mortality. There were many implications narrated by the respondents and various suggestions made to improve on the poor Maternal Health in the areas. The knowledge and implications of maternal mortality was good in the areas and therefore intervention programs should exploit and capitalize on the linkages between the perceived implications and the causes of maternal deaths (Afr J Reprod Health 2008; 12[3]:27-34).Cette étude a été menée afin de rechercher la connaissance de la communauté et les implications perçues de la mortalité maternelle et la maladie. Les solutions/conseils des membres communautaires sur la prévention de la maladie ont été explorés. C’était une étude de qualité basée sur la population qui a eu lieu dans deux communautés rurales de l’Etat de Borno, au Nigeria. Un total de cent soixante-huit (168) membres communautaires ont participé dans un Groupe de Discussion Cible (GDC) et des interviews minutieuses. Plusieurs s’accordent sur l’existence des mortalités maternelles dans les communautés. Maints des défendeurs ont identifié au moins deux des cinq causes principales directes de la mortalité maternelle qui sont universelles. Mais plusieurs ont des idées fausses sur les causes de la mortalité maternelle. Il y a plusieurs implications narrées par les personnes interviewées et plusieurs suggestions ont été proposées pour améliorer les pauvres soins médicaux dans les régions. La connaissance et les conséquences de la mortalité maternelle a été bien dans les regions, ainsi, les programmes d’intervention doivent exploiter et tirer parti de liens entre les conséquences perçues et les causes des mortalités maternelles (Afr J Reprod Health 2008; 12[3]:27-34)

Synthesis and Validation of a Weatherproof Nursery Design That Eliminates Tropical Evening-Fever Syndrome in Neonates

Neonatal thermal stabilisation can become challenging when uncontrollable factors result in excessive body temperature. Hyperthermia can rapidly slow down baby’s progress and response to treatment. High sunlight intensity in tropical countries such as Nigeria manifests in incessant high neonatal temperatures towards early evenings. The ugly consequences of this neonatal evening-fever syndrome (EFS) can only be eradicated by the development of a controlled weatherproof nursery environment. Two laboratories and a ‘control ward’ were applied. Lab-2 was a renovation of an existing room in a manner that could correct an existing nursery. Lab-1 was an entirely new building idea. The laboratories were assessed based on comparative ability to maintain environmental coolness and neonatal thermal stability during hot days. Data collection continued for 12 full calendar months. On average, at evaluated out-wind peak temperature of 43°C (range: 41°C–46°C), the control-ward peak was at 39°C, Lab-2 peak at 36°C, and Lab-1 peak at 33°C. All incubators in the control overheated during the hot periods but there was no overheating in Lab-1. Forty-four (86%) of sampled babies were fever-quenched by water sponging 131 times in the control whilst only one baby received same treatment in Lab-1. Nursery designs patterned after Lab-1 can significantly reduce EFS-induced neonatal morbidity

Social and health reasons for lime juice vaginal douching among female sex workers in Borno State, Nigeria

Background: Vaginal douching with lime juice and other agents has been perceived to enhance sexual excitement through sensations of vaginal dryness, tightness or warmth, as well as prevent sexually transmitted infections and restore and tighten the vagina after delivery. Its effectiveness as a contraceptive has also been reported. However, the social and health reasons/consequences of such a practice have not been adequately documented in the communities of Borno State, Nigeria. Objectives: This study aimed to determine the extent of, reasons for, and the reproductive health effects of, the use of lime juice for vaginal douching among the commercial sex workers (CSWs) in selected areas of the three senatorial regions of Borno State, Nigeria. Method: This was a community-based descriptive study conducted among female CSWs in selected communities of Borno State, Nigeria. A sample of 194 CSWs were randomly selected and interviewed on their sexual history and douching practices. Results: One hundred and twenty (62%) respondents admitted practicing vaginal douching with lime juice, with 85% having been CSWs for a period greater than three years. More than half douched for sexual pleasure, hygiene and contraception. Significantly more lime juice users had increased susceptibility to sexually transmitted infections (STIs) than non-users. Users had a higher prevalence of HIV infection than non-users. The Papanicouleaua (pap) smear test for cervical lesions also showed that moderate to severe dysplastic changes were more prevalent among limejuice users. Conclusion: Many CSWs in this community use lime juice for douching, for various reasons. Indications are that its use is associated with a higher prevalence of sexually transmitted diseases, including HIV infections and dysplastic cervical changes. Owing to confounding issues, such as the number of sexual partners, frequency of sexual exposure per day and the duration of exposure, it cannot, therefore, be deduced that douching with lime juice is the only reason for the higher prevalence of STIs and HIV. Nevertheless, there is an obvious need to mount extensive campaigns to educate the CSW on the possible risks of using such a practice

Prolactin Levels Among Infertile Women in Maiduguri, Nigeria

Objective: The objectives of this study were to determine the manner of clinical presentation of women with unexplained infertility in Maiduguri, North-Eastern Nigeria and their plasma levels of prolactin. Materials and Methods:The records of 104 females undergoing infertility investigation at the University of Maiduguri Teaching Hospital and for whom no organic cause had been found were scrutinised to extract the details of their modes of clinical presentation. All had plasma prolactin level assays. Results: The patients were aged between 20 and 40 years (mean: 28.3 years). Thirty-three (31.7%) of them had primary infertility while 71 (68.3%) had secondary infertility. Of the 104 patients, 33 (31.7%) had abnormal plasma prolactin levels. The women with secondary infertility were more likely to have abnormal prolactin levels: 22 (21.1%) compared to only 11(10.6%) among patients with primary infertility. About one-third of the patients presented with amenorrhoea (2% with primary and 34.6% with secondary amenorrhoea). Among patients presenting with amenorrhoea only 13 (12.5%) had elevated prolactin levels. Twenty four (23.1%) of the patients had galactorrhoea, of whom only 10 (9.6%) had hyperprolactinaemia. Patients with secondary infertility were more likely to have galactorrhea (17.3%) compared to patients with primary infertility (5.8%). The association of hirsutism, amenorrhoea and hyperprolactinaemia was not a common finding in our patients. Conclusion: The use of dopaminergic-agonist therapy in women with unexplained infertility requires careful consideration, ensuring that the plasma prolactin levels and the clinical mode of presentation are factored into the decision to prescribe the drugs. Key Words: Infertility, Anovulation, Prolactin, Amenorrhoea [Trop J Obstet Gynaecol, 2003, 20: 97-100

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