Profile and outcome of patients with post-neonatal tetanus in a tertiary centre in south west Nigeria: any remarkable reduction in the scourge?

Introduction: The incidence of tetanus has remained unacceptably high in developing countries. We aimed to describe the profile and outcome of children with tetanus admitted at the Lagos State University Teaching Hospital (LASUTH), Ikeja. Methods: A prospective and cross-sectional study of children aged 1 month to 12 years of age admitted with clinical diagnosis of tetanus, between January 2011 and December 2013, at the Paediatric department of LASUTH. The age, sex, presenting complaint, immunization status, portal of entry, socio-economic class, complications, duration of admission and outcome of the subjects were analyzed using Microsoft Excel supplemented with Statistical Package for Social Sciences (SPSS) version 17.0. Level of significance set at p< 0.05. Results: A total of 49 subject participated in the study. Male: Female ratio was 1.7: 1.0. mean age ± SD of 6.5± 3.2 years. Only 24.5% of the subjects were fully immunized, lower limb injury was the most common portal of entry (34.7%). Majority (79.6) were of the middle and lower social classes. Most of the subjects (67.3%) presented with generalised spasm. Only 1 patient (2.0%) did not have trismus. Case fatality rate was 4.1%. Conclusion: Tetanus is still prevalent among children in our environment. It is commoner among those with no immunization or incomplete immunization, commoner in those in the middle and lower social class. Lower limb injury was the most common portal of entry. Trismus was a common presenting feature. There is a need to develop programmes with will help improve compliance to immunization

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

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

Contents of referral letters by primary healthcare workers to the children emergency unit of a teaching hospital in a cosmopolitan state in Nigeria

Communication between primary healthcare workers and paediatricians is important, if we want patients to receive the right type of care at the right moment. The aim of the study is to assess the contents of information of referral letters issued by primary healthcare workers to the children emergency unit. Descriptive cross-sectional analyses of 142 consecutive referral letters from primary healthcare centres during the study period were evaluated according to specific quality criteria. Twofifths of the letters had no deducible identity of the writers. There-quarter of the referral letters that had the identity of the writers known were written by medical officers. Asignificant proportion of the referral letters lack adequate information. The proportion of Good referral letter practice was 2.11%. This study showed that referral letters written from various primary healthcare centres to the children emergency ward of a teaching hospital is generally of unacceptable quality and the content could be improved upon.Keywords: healthcare. emergency, referral, qualit

Sickle cell anaemia: Awareness Among Health Professionals and medical students at the Lagos University Teaching Hospital, Lagos.

Background: Sickle cell anaemia (SCA) is a chronic haemolytic disorder caused by homozygous inheritance of abnormal haemoglobin called ‘haemoglobin S’ (HbS). 1The disease burden is enormous to the patient, family and community. One potential weapon in its prevention is health information and awareness among the populace. Objetive: The study is to detrmine the awareness of sickle cell anaemia among health professionals and medical students at the Lagos University Teaching Hospital Idi-araba, Lagos. Methods: Part of a large study which was crosssectional and descriptive study, carried out at the Lagos University Teaching Hospital (LUTH), between the months of August and September 2006. Data were collected from 403 health professionals and students using structured questionnaires. Results: Majority (98.7%) of the respondents had heard about SCA. Only 211 (55%) of the respondent felt genotype screening should be done at pre-school age. 128 (33.7%) felt it should be done during childhood. Doctors had a statistically significantly better knowledge of best time for detecting genotype. In all, 85% of the respondents had been involved in the management of sickle cell anaemia with the highest proportion among nurses (p=0.02). Only 93 (24.3%) of the respondents knew most of the complications of sickle cell anaemia, 176(46.3%) knew some of it, while 111 (29.2%) knew only a few complications. Nurses had a statistically significantly poorer knowledge of the complication of sickle cell anaemia. More nurses felt that engagement should be ended if there was a risk of having a child with sickle cell anaemia. Conclusion: Continuing medical education for health professionals about sickle cell anaemia, its management and complication is necessary.Keywords: sickle cell anaemia, premarital screening for haemoglobin genotype

Teaching Nurses Neonatal Resuscitation: Knowledge gained from a Neonatal Resuscitation Training Program

Neonatal care provided within the first few minutes of life plays a major role in the reduction of neonatal morbidity and mortality. At least one health care worker knowledgeable about neonatal resuscitation should be at the delivery. To evaluate the knowledge gained following Neonatal Resuscitation Program training courses for nurses. Nurse-midwives attending the annual Neonatal Resuscitation Program of the Pediatric Association of Nigeria was trained according to the American Academy of Pediatrics Neonatal Resuscitation Program module which included didactic and practical teaching participated in the study. Assessment was by direct observation within the seminar room and written pre- and post-test evaluations with practical evaluation after the training session. 281 nurse-midwives were trained at the Neonatal Resuscitation Program workshops between 2010 and 2013. Overall average score was 10.58 (±2.73) and 14.02 (±2.19) for pre-test and post-test respectively and observed difference was significant (p = <.001). The results suggest that participation in Neonatal Resuscitation Program course significantly increased knowledge of neonatal resuscitation by nurses. Keywords: Neonatal Resuscitation Program; Birth asphyxia; pre-test; post-test; Nigeri

Dietary habits, physical activity and sleep pattern among in-school adolescents in Lagos, Nigeria

Background: Overnutrition has been documented at epidemic levels in children and adults. The associated risk factors may include poor dietary habits, sedentary behaviour, inadequate sleep and low parental education. Objective: To describe dietary habits, physical activity and sleep patterns among secondary school adolescents. Methods: A cross-sectional study of 1,120 adolescents recruited from public and private secondary schools in Lagos, Nigeria, was carried out to study the dietary habits, sleep patterns and physical activity in relation to nutritional status. Results: Ten per cent of the adolescents skipped breakfast, while 28% had fruits on up to five days of the week. Eleven per cent had a sweetened drink every day, while 20 % had a sweetened drink on most days of the week. One out of four (26%) adolescents had more than two hours of screen time daily, and only 5% engaged in sporting activities up to five times weekly. One-third of the students slept for less than six hours daily and experienced sleeping difficulties. Multivariate analysis showed that females were twice as likely not to participate in sports (OR = 2.38, CI = 1.3-4.37, p = 0.002) and to have a higher intake of confectionaries (OR = 1.47, CI = 1.07-2.04, p = 0.01) Conclusion: Poor dietary habits, inadequate physical activity and insufficient sleep were observed among secondary school adolescents. A multi-pronged approach to improve these behaviours is recommended