Challenges of congenital malformations: an African perspective

Background: Congenital malformations are defects of morphogenesis of organs or body regions identifiable during the intrauterine life or after birth. The etiological factors proposed have varied in history based on prevailing understanding, culture, and religion. Worldwide historically, the role of the supernatural had been in the forefront of etiological considerations but has changed with advances in embryology and teratology. It has, however, remained a part of many societies and cultures especially in Africa.Purpose: The aim of this review article is to highlight the psychosocial and economic impact, as well as the ethical and management challenges, posed by congenital malformations in the African setting.Materials and methods: A literature search was done using PubMed, African Journals Online, HINARI, and Google Scholar, regarding issues and challenges faced by parents who have children with congenital malformations, the affected children, and the healthcare workers who manage them. Focus was on the peculiarities of the African society.Result: Superstitious beliefs about congenital malformations bred negative attitudes toward these children and their parents. Chronic illness, long-term disabilities, and overall poor quality of life were associated with congenital malformations. These problems in a background of negative sociocultural beliefs created enormous psychosocial challenges for the parents and children. This was further complicated by economic challenges posed by the absence of health support systems in most African settings. Furthermore, the healthcare teams caring for these children were faced with challenges of difficult ethical and medicolegal considerations, as well as paucity of appropriately skilled manpower and facilities.Conclusion: The role of the supernatural in the etiology of congenital malformations still has a stronghold in the many African settings and poses an enormous psychosocial challenge for the affected. It is hoped that this review caninfluence policy formulations to support affected parents and improve outcomes of affected children.Keywords: African, challenges, congenital malformations, psychosocial, superstitious belief

Source of information on family planning among married men in Ekpoma, Edo state, Nigeria

Population in Nigeria is turning into an issue that needs public alertness. Informing men on family planning services and contraceptives is extremely necessary. For this will promote more favorable attitudes and increase their involvement. This study aimed at investigating the source of family planning information for married men. This is a questionnaire base study targeting 350 married men in Ekpoma. Participation was by choice and the collected data were analyzed for descriptive statistics using SPSS(version 16). While 2.0% reported their first source of information as the questionnaire use in this study, 98.0 were familiar with family planning services. The most prevalent single source of information was from television/Radio (34.01%). However, 16.3% got their information from more than one sources. Family planning information in Nigeria should increase to encourage men. However, efforts should be made by concerned bodies to increase information in stickers and encourage peer discussion. Conclusively, places of worship such as churches and mosques should talk about family planning and teach responsible parenthood

Circumcision mishaps in Nigerian children

Background/Objective: Circumcision may be associated with complications which are usually minor but could be life threatening on certain occasions. This study determined contributory factors, pattern of presentation, challenges of management and outcome of circumcision mishaps in Benin City, Nigeria. Methods: A retrospective analysis of all male children managed for circumcision mishaps between January 1998 and December 2007 at the University of Benin Teaching Hospital, Benin City, Nigeria. Results: There were 346 male children aged between 6 days and 12 years. Period of presentation to the unit ranged between 1 hour and 12 years. Redundant prepuce, 51 (14.7%); glandulopenile adhesions, 30 (8.7%); implantation cyst, 10 (2.9%); penile chordee, 11 (3.2%); local wound infection, 17 (4.9%); and proximal migration of plastibell ring, 11 (3.2%), were common mishaps treated with good outcome. On the other hand, urethrocutaneous fistula, 73 (21.1%); hemorrhage, 46 (13.3%); glandular amputation, 9 (2.6%); penile tissue avulsion, 24 (7.0%); and transmission of infections, 4 (1.2%), were challenging mishaps to manage. These resulted in 18 children with residual penile deformity and 4 deaths. Challenging mishaps and late referrals were common among children circumcised by traditional circumcisionists ( P < 0.0001). Inadequate training of circumcisionists; circumcision in unhygienic environment; circumcision with unsterilized instruments; circumcision without the use of anesthesia, analgesia and antibiotics - which were compounded by late referrals - influenced the development and final outcome of circumcision mishaps. Conclusion: Circumcision mishaps presenting very late with resultant poor outcome are still common in our setting. Hospital circumcision by experts, health awareness campaigns, adequate training of circumcisionists and early referrals of affected children should be encouraged

Heavy metal ions removal from oil wastewater using highly enhanced Chitosan membrane technology: a response surface methodology study

This paper investigates the removal of heavy metal ions from oily wastewater using enhanced Chitosan Membrane. Cellulose and gelatin have been used successfully to modify chitosan. Fourier Transform Infrared (FTIR), Scanning Electron Microscopy (SEM), and X - Ray Diffraction (XRD) were used to characterize chitosan. We looked at the impacts of pH solution and conductivity. To eliminate the heavy metals, adsorption study was conducted. Results showed removal percentages higher than 90% especially when the initial pH is 7.50 and the volume of Hexane is 12 mL. Conductivities of wastewater were positive and negative depending on whether the medium is acidic and basic respectively and values higher than +260 mV and lower than –340 mV were observed. Experiments were designed employing Central Composite Design (CCD) of the Response Surface Methodology to examine the effects of experimental conditions (RSM). R2 values for analysis of variances of Cu2+, Fe2+, and Pb2+ were all almost the same at 0.99. The quadratic models appeared significant and adequate in evaluating the experimental results. The differences in experimental and projected % Removal values were negligible for all models. The 3D response surface plots that resulted permitted paired analysis of variable impacts on each response model

Neonates presenting with severe complications of frenotomy: a case series

<p>Abstract</p> <p>Introduction</p> <p>Tongue-tie or ankyloglossia is an anatomic variation in which the lingual frenulum is thick, short or tight. It may be asymptomatic, or present with complications like breast feeding difficulties or speech, dental and cosmetic problems. The treatment of this condition, where indicated, is frenotomy. This procedure usually has few or no complications. However, when it is done by untrained personnel, it may lead to life-threatening complications. This paper highlights complications that could arise from improper treatment of ankyloglossia.</p> <p>Case presentation</p> <p>Case 1 was a one-day-old male neonate, a Nigerian of Igbo ethnicity, who was admitted with bleeding from the mouth and passage of dark stools after clipping of the frenulum by a traditional birth attendant. He was severely pale and in hypovolemic shock, with a severed frenulum which was bleeding actively. His packed cell volume was 15%. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding was controlled using an adrenaline pack. He also received antibiotics. He was discharged five days later.</p> <p>Case 2 was a three-day-old male neonate, a Nigerian of Ikwerre ethnicity, who was admitted with profuse bleeding from a soft tissue injury under the tongue, after clipping of the frenulum by a community health worker. He was severely pale and lethargic. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding vessel was ligated with repair of the soft tissue. He also received antibiotics and was discharged home one week later.</p> <p>Conclusion</p> <p>Treatment of tongue-tie, a benign condition, when done by untrained personnel may result in life-threatening complications. Clinicians should pay more attention to parents' worries about this condition and give adequate counseling or refer them to trained personnel for surgical intervention where clinically indicated.</p

Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study

Background: The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa. Methods: We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease. Results: Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P < 0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola. Conclusions: The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa

Duodenal Obstruction: Etiology, Morbidity and Mortality among Edo State Children, Nigeria

Duodenal obstruction in children is associated with poor outcome which has improved in developed but remained poor in developing countries. The objective of this study was to ascertain the etiology, morbidity, mortality and factors that contributed to poor outcome in a developing country. Retrospective analysis of pediatric duodenal obstruction treated at the University of Benin Teaching Hospital, Benin City, Nigeria, between January, 1998 and December, 2007 was carried out. Sixty-three children aged 2 days and 12 years (mean 1.5 years ± 2.7) comprising 41 males and 22 females with male/female ratio 1.9:1 were treated. This accounted for 0.8% pediatric operations but contributed 15.3% to total pediatric surgical mortality. Congenital anomalies (atresia, webs, malrotation, complex abdominal mass and annular pancreas) were the major etiologies, while preoperative sepsis, hypoglycaemia, hypothermia, fluid/electrolytes derangement as well as post operative wound infection, burst abdomen, inanition, respiratory insufficiency, aspiration and anastomotic leakage, were the morbidities that culminated in 24 (38.1%) mortality. This was compounded by non availability of organized neonatal intensive care unit, pediatric ventilator, total parenteral nutrition and functional incubators. Majority presented as neonates delivered to low socioeconomic rural dwellers that sought medical attention late. Therefore, an extremely significant statistical difference was observed when the outcome was compared with children delivered in hospital and had prompt medical attention (P <0.0012). Poor outcome was due to preventable causes and there is need to increase health awareness campaign, provision of basic pediatric surgical facilities and improvement in government policies which will allow children have access to free medical treatmen