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

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

Unplanned vaginal delivery after repeated Caesarean birth in Nigerian women

No Abstract

Effect of soil depth and topography on physical and chemical properties of soil along federal college of forestry, Ibadan North West, Oyo State

Soil properties along a toposequence is a key to sustainable crop and soil productivity, hence the need to study the effect of toposequence and soil depth on physical and chemical properties of soil around Federal College of Forestry, Ibadan, Oyo-State. Four profile pits were dug along the toposequence in Federal College of Forestry, Ibadan, Oyo-State. Soil samples were collected from three soil depth (0 - 30 cm, 30 - 45 cm, and 45 - 60cm) from four profile pits that was dug along the toposequence, (crest, sedentary, middle and valley bottom) for analysis of physical, morphological and chemical properties following standard procedures at the laboratory. The results showed that the consistency of the soil in profile pit 1 (crest) is slightly sticky and slightly plastic compared to soil in profile pit 2 (sedentary) that is predominantly nonplastic while profile pit 3 and 4, (middle/creep and valley bottom) are non-plastic, non-sticky, slightly sticky. The highest total porosity values was recorded at the valley bottom of the forest (57.74 %), followed by middle of the forest (53.21 %) while the least was by crest of the forest (51.7 %). The highest saturated hydraulic conductivity was recorded at the crest of the forest (15.91 cm hr-1) and the least by valley bottom of the forest (8.44 cm hr-1). Likewise bulk density values at the crest of the forest (1.28 g cm-3) was the highest compared to valley bottom of the forest (1.12 g cm-3). The highest (52 mg kg-1) and the lowest (1 mg kg-1) available P values were recorded at the valley bottom layers of the forest land soils and sedentary of the forest land soils, respectively. The highest exchangeable Ca was found in the valley bottom of forest soils (4.44 cmol kg-1) at the upper topographic position, whilst the lowest values were recorded at the crest layers of forest soils (1.2 cmol kg-1) at the middle topographic positions. Thus, it was concluded that the soils position on the topography affects the composition of the soil at each sampling point. This indicated that landscape in the study area affects the process of soil formation. Therefore, integrated soil fertility management and soil conservation measures are required in all topographic positions to maintain soil physicochemical properties. Key words: Toposequence, soil profile, physical properties, chemical propertie

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

Rectovaginal fistula following sexual intercourse.

Female genital fistula is an important feature of the developing countries gynecology. Most of the rectovaginal fistulae encountered in the tropics are due to obstetrics causes and genital malignancies. In developed countries, radiation injury and Crohn’s disease are also common etiological factors. Theindex case is reported to highlight the rare situation, where a 24-year old married nullipara sustained low rectovaginal fistula following normal coitus. She was later divorced by her husband

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries