Time of passage of first stools (Mecontum) and serum levels of calcium and magnesium in Nigerian neonates (African nionates)

No Abstract

Implementing Comprehensive Health Care Management for Sickle Cell Disease in an African Setting

Sickle cell disease is the commonest single gene disease in Africa. Morbidity and mortality from this disease has remained unacceptably high in Africa whereas there has been a marked reduction in the burden of this disease in the developed countries. This reduction was not achieved through the use of sophisticated care such as bone marrow transplant, but through the adoption of a Comprehensive Health Care Management protocol for sickle cell disease. This protocol of care emphasizes prevention of crises through effective management of the disease. In Africa, where sickle cell disease is prevalent, this strategy of care is yet to be globally adopted. In 2003, this protocol of care was adopted at the University of Benin Teaching Hospital, Nigeria and this has contributed to the improved clinical status of children with sickle cell disease in the hospital. The mortality rate among children with sickle cell disease has reduced to 1.3%, requirement for recurrent blood transfusion has reduced to about 2%, and their nutritional status has improved: 75.9% have normal nutritional status while 7% are actually overweight. The frequency of bone pain crisis has reduced to about one in every two years and some of the patients have been crisisfree for as long as five years. Hydroxyurea is not routinely used for our patients so this cannot explain the marked improvement recorded. In conclusion, comprehensive health care, adapted to our setting is a very cheap and effective way of managing sickle cell disease. It can be utilized in all health facilities for the care of children with sickle cell disease and is capable of reducing the morbidity and mortality associated with the disease as well as improving their quality of life

Morbidity and mortality of childhood illnesses at the emergency paediatric unit of the University of Benin Teaching Hospital, Benin City.

Objective: To describe the pattern of morbidity and mortality as seen at the Emergency Paediatric Unit of the University of Benin Teaching Hospital, Benin City. Methods: A retrospective study in which records of admissions over a two-year period were obtained from the medical and ward records. Information retrieved included age, sex, diagnosis, duration of stay in the unit and outcome. Results: A total of 3,261 patients aged between 29 days and 16 years were admitted into the Children Emergency Room during the period. Of these, 1,835 (56.3%) were males while 1,426 (43.7%) were females. The total number of underfives admitted was 2,289 (70.2% of total admissions). The major causes of admission were malaria (44.4%), respiratory tract infections (17.8%) and gastroenteritis with moderate or severe dehydration (10.1%). There were 992 (30.4%) discharges while 2,126 (65.2%) were transferred tothe paediatric wards for further management. One hundred and forty-three (4.4%) patients died during the period with over 80% being children five years or less. Severe malaria accounted for the largest number of deaths (29.4%) in the unit, followed by meningitis (16.9%) and septicaemia (15.4%) with over 80% of the deaths being from infectious diseases. Conclusion: Infectious diseases are still the major causes of morbidity and mortality especially in underfives in our locality. The role of environmental sanitation, health education and good nutrition in the health of the child must be brought to the fore. The nation's immunisation schedule should include vaccines against infectious organisms like Haemophilus influenzae and Streptococcus pneumoniae which are major causes of pneumonia and meningitis in childhood. Also, a boost in the coverage of our health insurance scheme would be a step in the right direction.Key Words: Pattern, morbidity, mortality, Emergency PaediatricUnit, admissions

Challenges and opportunities for neonatal respiratory support in Nigeria: a case for regionalisation of care

Background: Neonatal health appears not to have received the deserved attention in the context of the Child Survival Strategies and this must have contributed to the non-attainment of the MDG-4 in Nigeria. Neonatal mortality contributes 40% or more to the current rate of child deaths globally, with birth asphyxia, prematurity and its complications and severe infections as the leading causes. This emphasises the need to re-focus on neonatal health. Given the state of the economy in the low- and middle-income countries, Nigeria, like most of the other countries lack the resources required for efficient neonatal health care with minimal attention on the strategies needed to address the major causes of newborn death.Objectives: To assess the contemporary situation of neonatal care in Benin City, Nigeria and examine diverse approaches to be adopted to provide high level neonatal care services aimed at improving neonatal survival rates.Methods: The trends of neonatal morbidities and mortality over the period between 1974 and 2014 were studied by reviewing the hospital records covering admissions and weekly mortality records. The pattern of categories of babies and the causes of death were recorded. The information gathered identified the gaps in the management strategies for newborns over the years. Electronic databases such as the Medline and Pubmed were searched for relevant literatures published between 1960 and 2015 which might provide ideas required to fill the gaps.Results: In the 1974-1976 era, the major cause of neonatal mortality at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was birth asphyxia with an attendant perinatal mortality of 80.9/1000 births. The decline in the perinatal mortality to 33.4/1000 births between 1976 and 1980 was linked to the introduction of delivery room resuscitation with a reciprocal decline in the incidence of birth asphyxia. Thereafter, neonatal mortality rate has continued to increase. This increase could be attributed to a three-fold rise in the proportion of very preterm admissions from 6.5% in 1985 to 19.3% in 2013. This population of babies is predisposed to Respiratory Distress Syndrome and respiratory failure. Neonatal intensive care did not include respiratory supports until very recently (2013) when the facilities were provided but at high cost to the patient and the health system.Conclusion: The strategies required to address reduction in neonatal mortality rates should necessarily include neonatal resuscitation and mechanical ventilation, all within the context of Neonatal Intensive Care. In order to provide the full range of neonatal intensive care services in a resource- constrained setting such as Benin City, Nigeria, regionalisation of care in a stepwise manner is recommended, both for improved medical outcomes and economic realities.Keywords: Challenges, Neonatal ventilatory support, Regionalisation of car

Breastfeeding Practices and Growth

Background: Breastfeeding is vital for the growth and development of infants and young children. Early initiation within the half hour of birth fosters optimal breastfeeding practice, promotes growth and development.Objective: To evaluate breastfeeding practices and the growth of infants.Method: This was a crosssectional survey at three immunisation clinics in Asaba metropolis of Delta state. Using a structured questionnaire, we assessed breastfeeding practice of attendees and the growth of babies and documented information on the socio demographic characteristics, breastfeeding practices, previous weights of infants’ and their Anthropometric measurements.Results: There were 97 motherinfant/ pairs. 49 males, 48 females; giving a male to female ratio of 1:1. 20.6% were neonates, 74.2% were less than 6 months while 25.8% were older. About 50% of the mothers initiated breastfeeding within an hour of delivery, 25% of mothers gave pre-lacteal feeds. 49.5% of babies were optimally breastfed; of these, 68.7% mothers had initiated breastfeeding within an hour of birth (p=0.001). Underweight and stunting was only seen among babies of mothers who did not practice optimal breastfeeding. It was observed that babies’ weights were not documented routinely in the road to health chart of the immunization cards after the measurements were taken. This was a missed opportunity for counselling and health promotion.Conclusion: Early initiation of breastfeeding increases the probability of optimal breastfeeding practice and prevents infant malnutrition. Even though growth was assessed, the information was not utilized for feed back to the mothers at the well-baby clinics, growth monitoring and promotion was not supported at the well-baby clinics in the health centres.Keywords: Breastfeeding Initiation, Growt

Scope of neonatal care services in major Nigerian hospitals

Background: Neonatal survival bespeaks the quality of neonatal care services available and accessible to the population. Intensive care improves outcome of high-risk infants with serious illness. The tiered level of care is yet to be applied to newborn care in Nigeria. Classification of care is key to improving neonatal survival with enhanced referral of high-risk patients to higher-level centres.Objective: To ascertain the scope and classify available newborn services offered at major Nigerian hospitals.Methodology: A semi-structured validated questionnaire was administered to attendees during 2015 Pediatric Association of Nigeria conference. The information derived was used to categorize neonatal care services.Results: The respondents consisted of doctors 201 (84.8%) and nurses 36 (15.2%) in 54 health facilities from all geopolitical regions of Nigeria. Of the 54 facilities, 34 (63%) were located in state capitals and 47 (87%) in public hospitals. Half of the evaluated units belonged to Class I, 22 (40.7%) Class II, and 5 (9.3%) Class III levels of neonatal care. Majority (81.6%) of the doctors have been trained on neonatal resuscitation; with senior residents being the highest 49 (89%) and Medical officers (MO) the least 4 (40%) trained. Doctors with training in mechanical ventilation (MV) were 39.2%; Consultants (51.2%), MO’s the least 1(11.2%) trained (p=0.025). Monitoring is usually by pulse oximeters 54 (100%), multi parameter monitors 23 (42.6%) and rarely ABGs 6 (11%).Conclusion: Neonatal care in Nigeria is still developing. Most centres provide basic neonatal care services. Regionalization of care may be the solution to higher level neonatal care.Kewords: Neonatal Care; Scop

Predictors of hearing loss in school entrants in a developing country

Background: Hearing loss is a prevalent and significant disability that impairs functional development and educational attainment of school children in developing countries. Lack of a simple and practical screening protocol often deters routine and systematic hearing screening at school entry. Aim: To identify predictors of hearing loss for a practical screening model in school-aged children. Settings and Design: Community-based, retrospective case-control study of school entrants in an inner city. Methods: Results from the audiologic and non-audiologic examination of 50 hearing impaired children in randomly selected mainstream schools were compared with those of a control group of 150 normal hearing children, matched for age and sex from the same population. The non-audiologic evaluation consisted of medical history, general physical examination, anthropometry, motor skills, intelligence and visual acuity while the audiologic assessment consisted of otoscopy, audiometry and tympanometry. Statistical Analysis: Multiple logistic regression analysis of significant variables derived from univariate analysis incorporating student t-test and chi-square. Results: Besides parental literacy (OR:0.3; 95% CI:0.16-0.68), non-audiologic variables showed no association with hearing loss. In contrast, most audiologic indicators, enlarged nasal turbinate (OR:3.3; 95% CI:0.98-11.31), debris or foreign bodies in the ear canal (OR:5.4; 95% CI:1.0-36.03), impacted cerumen (OR:6.2; 95% CI:2.12-14.33), dull tympanic membrane (OR:2.2; 95% CI:1.10-4.46), perforated ear drum (OR:24.3; 95% CI:2.93-1100.17) and otitis media with effusion OME (OR:14.2; 95% CI:6.22-33.09), were associated with hearing loss. However, only parental literacy (OR:0.3; 95% CI:0.16-0.69), impacted cerumen (OR:4.0; 95% CI:1.66-9.43) and OME (OR:11.0; 95% CI:4.74-25.62) emerged as predictors. Conclusion: Selective screening based on the identification of impacted cerumen and OME will facilitate the detection of a significant proportion of hearing impaired school entrants

Scientific Communication

What will it take to accelerate the rate of decline of neonatal mortality in West Africa

Mothers’ perception of the use of banked human milk for feeding of the infants

Background: Human breast milk is the most healthful form of milk for human babies. Every infant deserves the best possible start in life in terms of nutrition by breastfeeding or receiving donated human milk. Breast milk is very important for the infant’s growth and well-being that the non-availability of the mother should not deprive the infant from its benefits. To enhance the availability and use of human breast milk for hospitalized babies whose mothers may not have enough milk, there is the need to embark on human milk banking.Objective: To determine the perception of mothers towards breast milk banking in Benin City, Nigeria.Subjects and Methods: The study subjects included 198 mothers who brought their babies to Well Baby/Immunization Clinic of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. A structured researcheradministered questionnaire was used to assess their biodata, awareness and perception of breast milk banking.Results: The mean age of the mothers was 29.8 ± 5.5 years with 46.5% having some form of tertiary education and 48.5% having secondary education. Only 51 (25.8%) of them had heard of breast milk banking; source of information being mainly from health workers (43.1%) and from friends (27.5%). Majority 168 (84.8%) of the mothers would not give their babies human milk donated by another nursing mother mainly because of fear of transmission of infections/diseases. Most 105 (53.0%) were also unwilling to donate breast milk to be used for other babies due to the fact that they disliked the idea (51.4%) and because of fear of not having enough for their own babies (16.1%). However, most (59.1%) strongly agreed that human milk banking would help assist mothers in need, orphans and abandoned babies.Conclusion/Recommendation: The awareness of human milk banking and its acceptance among mothers in Benin City is poor. The current findings strongly justify the need for public enlightenment on human milk banking and its benefits.Key words: Breast milk banking, mothers, Perceptio

Resistance Pattern Of Urinary Tract Infection Bacterial Isolates To Selected Quinolones

The Quinolones inhibit bacteria by interacting with DNA topoisomerases (gyrases) of which four subunits (two A and B monomers) have been identified thus, inhibiting bacterial DNA gyrase. High level resistance to quinolones can be produced by serial exposure of bacteria to subinhibitory concentration. A Total of 408 suspected UTI and high vagina swab (HVS) samples were examined for bacteria and the isolates obtained tested against the newer quinolones. Prevalence of Bacterial isolates revealed Escherichia coli 110(92%) as the most isolated organism from urine, while Staphylococcus aureus 31(32%) was the most isolated species from HVS samples. Bacterial species such as coliforms 55(70%) and Klebsiella spp 42(84%), equally had high prevalence rate in urine samples. Pseudomonas aeroginosa 19(66%) was next to Staphylococcus aureus in terms of prevalence of isolated strains from HVS samples. The resistance pattern observed for these isolates, showed that the strains were least resistant to Ciprofloxacin, followed by Ofloxacin and Perfloxacin, while they were most resistant to Nalidixic acid. There was however no statistical significance (