Mothers’ knowledge, perception and practice of childhood immunization in Enugu

Introduction: Immunization has been shown to be the most successful and cost-effective public health intervention in the 20th century. In the developing world, it does not only prevent about three million child deaths annually, but also has the potential to prevent additional two million deaths if coverage improves. However, immunization coverage has remained low in Nigeria although vaccines are provided relatively free by the government. Efforts have focused on the health worker, health system and logistics with little attention being paid to maternal factors like knowledge, perception, beliefs and practice.Objectives: To assess mothers’ knowledge, perception and practice of routine and campaign immunization in Enugu.Methods: A structured questionnaire was administered to 207 mothers who have at least one child less than 5 years of age, attending children outpatient and immunization clinics at the University of Nigeria Teaching Hospital, Enugu.Results: Forty-eight per cent of the mothers had tertiary education, 42% had secondary education, and 9% had primary education while 1% had no formal education. Eighty-two per cent knew that children are immunized to prevent major killer diseases, 14% and 3.4% believed it was to prevent all diseases, and to treat diseases respectively. Most mothers took their children to health facilities for routine immunization (95.2%) and also accepted immunization on immunization campaign days (75.4%). However, 23.6% had never immunized their children during campaigns. On the other hand, 13% (27) of mothers had out-rightly rejected immunization during campaign while 85% (177) had never rejected immunization. The remaining 2% were not immunized due to reasons other than rejection. More mothers significantly rejected campaign immunization than the number that did not go for routine immunization (p=0.000). Maternal highest educational level was significantly associated with knowledge of reason for immunization and acceptance of immunization (p=0.000). Religious denomination was not significantly associated with rejection of campaign immunization (p=0.056).Conclusion: Most mothers studied had good knowledge and positive perception and practice of immunization. However, the Campaign immunization rejection rate was relatively high for the south eastern Nigeria where it is often assumed that non-compliance is not a problem. Similarly, the proportions of mothers with wrong knowledge and poor perception of immunization require policy attention. Maternal education was significantly associated with knowledge and acceptance of immunization. These findings are important in the design and implementation of childhood immunization programmes

Pattern of morbidity and mortality of newborns admitted into the sick and special care baby unit of Enugu State University Teaching Hospital, Enugu state

Background: Being the highest contributor to under-5 mortality, neonatal mortality and morbidity has great impact to the attainment of millennium development goals 4 (MDG 4). In Nigeria and other developing countries, this indicator strongly poses a major challenge in achieving this goal. Objectives: To determine the morbidity and mortality pattern of admitted babies in the special care baby unit (SCBU) of Enugu State University Teaching Hospital (ESUTH).Materials and Methods: This is a comparative and descriptive longitudinal study of causes of morbidity and mortality between babies born within (inborn) and outside our hospital facilities (outborn) based on information on place of birth, APGAR scores, age on admission, diagnosis on  admission, duration of hospital stay, and outcome of newborns admittedinto the sick and SCBU over a 1 year period. Results: A total of 261 neonates were admitted during the period under review. The common causes of admissions seen from the study were perinatal asphyxia (80, 30.7%), low birth weight (64, 24.5%), neonatal sepsis (44, 16.9%), and neonatal jaundice (16, 0.06%). A total of 37 (14.2%) deaths were recorded during the period. The leading causes of deaths were severe form of perinatal asphyxia (18, 52.9%), neonatal sepsis (10, 29.4%), and very low birth weight (two, 0.06%). Fifty.five percent of all the deaths occurred within 24 h of admission. Death dueto asphyxia was more in babies born outside the hospital (outborn) than in babies born within the hospital (inborn). Equal number of outborn and inborn babies died from neonatal sepsis. The age at presentation to the sick baby unit was significantly lower in inborn (P = 0.004), while age at death was not different in both group of newborns (P = 0.876).Conclusion: The neonatal mortality rate and the causes of death in this study are similar to those documented by other studies in Nigeria and are largely preventable. Strengthening perinatal care, emergency obstetric services, and enhancement of neonatal resuscitation skills to traditional birth attendants (TBAs) and other community health workers are necessary to reduce the neonatal mortality in our setting and other rural settings across developing countries. Key words: Enugu, morbidity, mortality, newbor

Blood pressure values in healthy term newborns at a tertiary health facility in Enugu, Nigeria

Background: Blood pressure (BP) is a reflection of hemodynamic variables. It is an important vital sign and indicator of clinical stability. Accurate measurement of this physiological signal is essential for the optimal management of the ill infant. An increase in the awareness of hypertension among neonates has resulted to increased ability to diagnose neonates with the disease.Objectives: This study aimed to determine BP values in apparently healthy term newborns in the first 48 h of life and evaluate the factors affecting BP at birth.Methods: Three hundred and ten healthy appropriate for gestational age term newborns were consecutively recruited. BP measurements were determined using the oscillometric technique with the neonate supine after an appropriate size cuff was applied on the right arm. The monitor (Dinamap 8100) is switched on while the cuff inflation and deflation is automatically done by the instrument with subsequent display of the BP values on the screen. BP measurements were taken at age 0–24 h and 25–48 h. Their weight was measured with infant’s weighing scale, and data analyzed with SPSS version 15.Results: The mean systolic BP (SBP), diastolic and mean arterial BP at 0–24 h were 63.3 ± 5.5 mmHg, 36.8 ± 5.3 mmHg and 46.4 ± 5.2 mmHg respectively. There was a positive correlation between birth weight and SBP at birth. No significant correlation was found between BP and gender, mode of delivery or maternal age.Conclusion: This study provides current normative BP values that can be used in neonatal Intensive Care Unit.Key words: Blood pressure, healthy, newborns, ter

Out-of-pocket cost of managing sick newborns in Enugu, southeast Nigeria

Uchenna Ekwochi,1 D Chidiebere Osuorah,3 Ikenna K Ndu,1 Osita U Ezenwosu,2 Ogechukwu F Amadi,1 Ikenna C Nwokoye,1 O Israel Odetunde2 1Department of Pediatrics, Enugu State University Teaching Hospital, Parklane, Nigeria; 2Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria; 3Child Survival Unit, Medical Research Council (UK), The Gambia unit, Fajara, The Gambia Background: Neonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US2 per day, these bills are not affordable to many families' livelihoods. Aim: This study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases. Methods: This is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses. Results: A hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86±8.81 days and ₦36,382±19,389.72 (US223±119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than ₦10,000 (US61), ₦10,000–49,999 (US61–306), and ₦50,000–100,000 (US306–612) and more than ₦100,000 (US612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn's illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis (₦23,499±14,987 [US144±92], P=0.001), low birth weight (₦39,863±24,003 [US224±147], P=0.001), severe anemia (₦40,504±13,923 [US248±85], P=0.001), transient tachypnea of the newborn (₦10,083±1,078 [US62±7], P=0.001), birth asphyxia (₦24,398±14,096 [US149±86], P=0.001), and meningitis (₦26,731±7,675 [US164±47], P=0.001), whereas cost for laboratory investigations was significantly higher for neonatal jaundice (₦11,690±3,169 [US$72±19], P=0.001). There was a strong positive correlation between duration of hospital stay and total medical cost incurred (r=0.897, P=0.001). Conclusion: Health expenditure on neonatal illness is high and leads to catastrophic expenditure for the majority of households in the state. There is a need for effective health insurance schemes to help subsidize and cushion this disastrous and impoverishing health expenditure on families for improved neonatal survival in Nigeria. Keywords: neonatal illness, out of pocket, health expenditure, Enugu Stat