Morbidity and mortality pattern of neonates admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital, Nigeria

Background: The neonatal mortality rate in Nigeria is amongst the highest globally and is mainly due to preventable causes such as neonatal sepsis, perinatal asphyxia and prematurity.Objective: To determine the morbidity and mortality pattern of neonates admitted into the Special Care Baby Unit (SCBU) of the University of Port Harcourt Teaching Hospital (UPTH).Study Design: This hospital based retrospective study was carried out over a one year period between September 2014 and August 2015.Setting of study: Port Harcourt is a cosmopolitan city situated in Rivers State in the southern part and Niger Delta zone of Nigeria. The Hospital is the largest tertiary hospital in the state and serves as a referral centre for other peripheral hospitals within the Niger Delta zone of Nigeria. The SCBU caters for sick new-born infants born in the hospital and sick babies referred from other centres.Subject/participants: All sick babies born within (inborn) and outside (outborn) the hospital facility were reviewed. Information on the mothers booking status, sex, age, gestational age at birth, place of birth, APGAR scores, age on admission, diagnosis and outcome of the new-borns admitted were reviewed.Results: A total of 622 babies were admitted into the SCBU of UPTH during the period under review. Of these babies, 54.5% were admitted into the inborn unit, whilst 45.5 % were admitted into the out-born unit of the SCBU. The leading causes of admissions were neonatal sepsis (33%), neonatal jaundice (14.8%), severe birth asphyxia 83 (13.3%) and prematurity (11.41%). Majority of the neonates (77.6%) were admitted within the first week of life. The overall neonatal mortality rate was 12.4%. The mortality rate of the out-born babies of 13.5% was higher than the 11.4% amongst inborn babies, however, this difference was not statistically significant (p=0.333). Neonatal sepsis (29.9%) and severe birth asphyxia (22.1%) were the leading causes of mortality in these  babies.Conclusion: The neonatal mortality rate in the SCBU of 12.4% is high. We recommend that efforts be made at strengthening the primary health care system to discourage unsupervised deliveries and improving maternal and perinatal care in our health institutions to curb these high mortalities

Prevalence of alcohol consumption among secondary school students in Port Harcourt, Southern Nigeria

Background: Consumption of alcohol by secondary school students is a major public health concern globally, but its prevalence is not known in secondary schools in Port Harcourt.Objective: To determine the prevalence and factors associated with alcohol use among secondary school students in Port Harcourt.Methods: This was a cross sectional school based study conducted in Port Harcourt in March 2014. A 20 itemed structured, self -administered questionnaire was distributed to 1080 senior secondary 1 to 3 students from 10 public secondary schools selected through Multistage Sampling technique. Questions asked covered drinking of alcohol, frequency of drinking and being drunk in the past 30 days before the survey. Other behaviours sought were smoking of cigarette, use of cocaine and going out in the evening for fun. Sociodemographic was also sought. Data was analyzed using SPSS version 20.Results: 1080 students participated in the study, mean age 16.09±6SD and male to female ratio of 0.9: 1. Prevalence of current drinking of alcohol was 30.6% and 38.1% of current drinkers were also drunk in the past 30 days, with 17.2 % being very frequently drunk. The behaviour which showed a strong association with drinking of alcohol, being drunk and the frequency of being drunk was going out in the evening for fun and recreation. Gender showed a positive association with drinking of alcohol, as more males drank alcohol with in the past 30 days compared to the females (p=0.000). Smoking of cigarette in the past 30 days and truancy were positively associated with being drunk, while academic grades showed an inverse relationship with consumption of alcohol. Majority of those who drank alcohol (42.6%) were experimenting with alcohol, though 5.4% drank due to addiction. Majority (39.3%) bought their drinks from stores and supermarkets. The most Common problems experienced by the drinkers were fatigue, alcohol made them behave in ways they later regretted and it hurt their relationships.Conclusion: Alcoholism is a serious problem with secondaryschool students in Port Harcourt. It is linked with truancy, poor academic achievement and other substances use. The most serious health and social problem experienced by the drinkers is addiction.Keywords: Prevalence, Alcohol, Secondary school, Consumption

Adolescent blood pressure pattern in Rivers State, Nigeria: A rural - urban comparison

Background: Childhood and adolescent blood pressure pattern have been known to predict adult blood pressure levels and development of hypertension. Hypertension, once rare in traditional African societies, is now the commonest non-communicable disease in Nigeria. There are few studies on adolescent blood pressure pattern, especially in adolescents living in rural areas. It is therefore important to identify blood pressure differences, if any, between adolescents living in rural areas compared to their urban counterparts.Objective: To determine and compare the blood pressure pattern of apparently healthy adolescents in rural and urban areas, and to determine the association between blood pressure and body mass index in these children.Subjects and Methods: A cross sectional population based blood pressure survey was carried out on 2,136 Nigerian school adolescents (1080 were resident in rural areas and 1056 in urban areas) aged 10-18 years, selected from 26 secondary schools using a multi-stage stratified sampling technique. Blood pressure measurements were taken by auscultatory method. An average of three readings was taken as the actual blood pressure.Results: Systolic and diastolic blood pressure increased with age in both rural and urban subjects. The mean systolic blood pressure of the rural subjects (111.10 ± 14.72 mm Hg) was significantly (p= < 0.001) higher than that of the urban subjects (108.09 ±15.40 mm Hg), whilst the mean diastolic blood pressure of the urban subjects (66.88 ± 11.27 mmHg) was slightly higher than those of  the rural subjects (66.32±11.71 mmHg. Urban subjects had a higher mean body mass index (19.82± 3.57kg/m2) than their ruralcounterparts (19.59±2.78 kg/ m2).Systolic and diastolic blood pressure showed a positive significant (p= <0.001) correlation with BMI in subjects in rural and urban schools.Conclusion: Significant differences in blood pressure were observed between rural and urban adolescents in Rivers State, with a positive significant correlation between BMI and blood pressure. We recommend blood pressure surveillance as part of the School Health Programme.Keywords: adolescent, blood pressure, rural-urban, Nigeri

Ruptured uterus: Fetomaternal outcome among unbooked mothers and antenatal care defaulters at the University of Portharcourt teaching hospital.

BACKGROUND: Unbooked emergencies are major reasons for the high maternal and perinatal mortality and morbidity in Nigeria. Rupture of the gravid uterus in women without antenatal care usually present late to hospital as unbooked emergencies with high perinatal deaths and very poor maternal outcome. AIM: To determine the factors implicated in the poor feto-maternal outcome with ruptured uterus amongst the unbooked mothers at the University of Port Harcourt Teaching Hospital(UPTH).METHOD: A retrospective analysis of case records of 82 consecutive patients without antenatal care who had ruptured uterus between January 2008 and December 2012.RESULT: There were 2133 deliveries among unbooked mothers at the University of Port Harcourt Teaching Hospital over this 5-year period. The incidence of ruptured uterus for the period under review was 3.8%. The mean age was 28.1years and the modal parity was 2. Abdominal massage and prolonged obstructed labor were the commonest predisposing factors, occurring in 43.9% and 34.1% of these women respectively. There were 80 perinatal deaths contributing to 12.2% of the perinatal mortality rate. There were 6 maternal deaths from ruptured uterus which was 10.9% of the maternal mortality ratio of 2578.5 per 100,000 live birth during the study period.CONCLUSION: Perinatal and maternal mortality rates from ruptured uterus were high. The major causes of uterine rupture are abdominal massage and prolonged obstructed labor, which are both preventable. Public enlightenment and condemnation of practices that promote these factors is advocated.KEYWORDS: ruptured uterus, feto-maternal outcome, unbooked, Port Harcourt

Sexual Assault among Adolescents, Case Study Report

Open heart surgery (OHS) offers lifesaving succor for patients with cardiovascular diseases, which is one of leading causes of disability-adjusted life years and death globally. The cost of OHS procedure remains a major hill that appears insurmountable. Although the direct charge of OHS in Nigeria in a 2013 report is $6200-11,200 in a country with per capita GDP of$2,097. Based on data retrieved from the OHS program of the Lagos University Teaching Hospital between 2014 and 2017, this observational retrospective study revealed the source of funding for OHS. Demographical data including age, gender and OHS sponsor were retrieved from medical records. Descriptive statistics were performed and data were presented as frequency distribution. Chi-square test was used to determine age and gender association with OHS sponsorship. A total of 26 patients cases including 14 males (53.8%) and 12 females (46.2%) with modal age of <20 years had OHS. Out of the total cases, church (26.9%), corporate company (23.1%), family (19.2%), non-governmental organization (11.5%), individual (3.8%), NHIS (3.8%) and State government (3.8%) funded the cost of OHS in this proportionate order. Statistically nonsignificant strong association was observed between age (χ = 21.3; Cramer's V value = 0.52; P value = 0.62) or gender (χ = 13.07; Cramer's V value = 0.71; P value = 0.11) of patient and source of funding for open heart surgery. Open heart surgery is slowly developing in Nigeria, and funding for OHS procedures are majorly provided by religious and corporate organizations

Abdominal obesity in adolescent girls attending a public secondary school in Port Harcourt, Nigeria: prevalence and some factors associated with occurrence

Background: Deposition of excess fat in the abdominal region is strongly associated with the metabolic disturbances thought to underlie many obesity related complications.Aim: To determine the prevalence of abdominal obesity using waist circumference inadolescents' girls attending a public secondary school in Port Harcourt, Nigeria and to identify some risk factors associated with occurrence of abdominal obesity in subjects studied.Methodology: A total of 1330 females aged between10 and 19 years were studied.  Data on biodata, dietary habits and measure of physical activity was obtained using a self-administered questionnaire. Anthropometry was taken and overweight/obesity and abdominal obesity determined using Body mass index percentiles and waist circumference percentiles for age and sex respectively. Logistic regression was used to evaluate some physical and behavioural factors associated with the development of abdominal obesity.Results: Total of 20(1.5%) subjects had abdominal obesity. Mean age of girls studied was15.74±1.45 years while mean waist circumference was 72.26±7.17cm. Eighteen (90%) of subjects with abdominal obesity using waist circumference percentile were also overweight or obese using BMI percentile  estimation. Eighteen(7.5%) of all subjects with overweight or obesity had abdominal obesity compared to  only 2(0.2%) of those with normal weight. Physical inactivity, daily fruit consumption and watching of TV/Internet/Video games for =2hours /day were significantly associated with development of abdominal obesity.Conclusion: Prevalence of abdominal obesity was low in this study compared to other studies; reduced physical activity and sedentary lifestyle identified as significant risk factors in these subjects as reported in other studies. Keywords: Abdominal obesity, Adolescents, Girls, Risk factor

Ruptured uterus: fetomaternal outcome among unbooked mothers and antenatal care defaulters at the University of Port Harcourt Teaching Hospital

Unbooked emergencies are major reasons for the high maternal and perinatal mortality and morbidity in Nigeria. Rupture of the gravid uterus in women without antenatal care usually present late to the hospital as unbooked emergencies with high perinatal deaths and very poor maternal outcome. To determine the factors implicated in the poor feto-maternal outcome with ruptured uterus amongst the unbooked mothers at the University of Port Harcourt Teaching Hospital (UPTH). A retrospective analysis of case records of 82 consecutive patients without antenatal care who had ruptured uterus between January 2008 and December 2012. There were 2133 deliveries among unbooked mothers at the University of Port Harcourt Teaching Hospital over this 5-year period. The incidence of ruptured uterus for the period under review was 3.8%. The mean age was 28.1 years and the modal parity was 2. Abdominal massage and prolonged obstructed labor were the commonest predisposing factors, occurring in 43.9% and 34.1% of these women respectively. There were 80 perinatal deaths contributing to 12.2% of the perinatal mortality rate. There were 6 maternal deaths from ruptured uterus which was 10.9% of the maternal mortality ratio of 2578.5 per 100,000 live birth during the study period. Perinatal and maternal mortality rates from ruptured uterus were high. The major causes of uterine rupture are abdominal massage and prolonged obstructed labor, which are both preventable. Public enlightenment and condemnation of practices that promote these factors is advocated.Keywords: ruptured uterus, feto-maternal outcome, unbooked, Port Harcour

Practical Approach to Sub-specialty Training in Maternal Foetal Medicine (MFM) in Nigeria

The heavy burden of maternal and perinatal morbidities and mortalities in Nigeria, most of which are MFM-related has stimulated the introduction of subspecialty training in MFM. Unfortunately in the available curriculum, less attention was paid to the ultrasound-related aspect of the training and also there was less clarity on the order of navigation through the various modules of the training. The objective of the present study therefore was to design a sub-specialty training curriculum in MFM with practical approach to its execution, taking into consideration the Nigerian ethno- cultural peculiarities, its disease topography and the level of its economic development. It was of mixed design study, with both observational and review components. A literature search and telephone communication with MFM specialists in tertiary health institutions in Nigeria on the subject were carried out. There was no structured training program in MFM in Nigeria. A competency-based modular training framework whereby acquisition of ultrasound-based competencies intertwined with the maternal medicine components of the training was proposed. The ultrasound modules to be covered were as following: first trimester scan at 11+0 to 13+6 weeks, the 20 + 0 to 23 + 6 weeks scan, growth and doppler ultrasound, cervical assessment, foetal echocardiography, application of ultrasound in the management of labour, screening for and diagnosis of placenta accrete spectrum and invasive procedures. Successful completion of the training modules, including rural posting, rotation in allied disciplines will earn the trainee an exemption from the dissertation component of the part II fellowship examination and award of fellowship or diploma in MFM, depending on whether the trainee completed the invasive module or not