Evidence-based treatment of neonatal infections in developing settings

No Abstract

Parental socioeconomic status and birth weight distribution of Nigerian term newborn babies

Background: Birth weight is one of the most important determinants of perinatal well -being and survival. It may be influenced by socioeconomicstatus among other factors.Objective: To evaluate the influence of parental socioeconomic status on birth weight distribution of term infantsPatients and Methods: Consecutive singleton, term newborns and their parents were recruited. Socioeconomic status was determined from parental education and occupation. Neonatal anthropometry was recorded soon after birth. The relationship between neonatal anthropometry and parental socioeconomic status was evaluated.Results: The mean birth weight of the 280 newborns was 3180g + 501 with a range of 1800g to 5000g. Most babies (181; 64.7%) weighed between 2500g and 3490g while 5.7% weighed less than 2500g and 20 (7.1%) weresmall for gestational age. Most parents (196; 70%) were in the upper classes I and II, 69 (24.6%) were in class III while 15 (5.4%) were in classes IV and V. Babies in the socioeconomic classes IV and V had significantly lower mean birth weight than babies in each of classes I, II and III (p = 0.005, 0.006 and 0.04 respectively). High maternal educationand paternal occupation were associated with significantly higher mean birth weights (p = 0.007, 0.018 respectively). The low birth weight rate was significantly higher in the lower social classes III to V compared to the two upper classes (10.7% vs. 3.57%;, p = 0.022.Conclusion: Disadvantaged socioeconomic status was associated with lower mean birth weights with maternal education and paternal occupation exerting the higher influences.Key words: Socioeconomic Status, Birth weight, maternal education, paternal occupatio

An evaluation of school health services in Sagamu, Nigeria

Context: School health services (SHS) have been shown to be suboptimal in Nigeria. The paucity of data on the status of SHS in Sagamu makes it even more challenging for instituting corrective action.Aim: To evaluate SHS in public and private schools in Sagamu.Settings and Design: This was a cross.sectional study carried out on private and public nursery/primary and secondary schools in Sagamu, Ogun State.Materials and Methods: A total of 91 schools, randomly selected from 182 available, comprising 53 private nursery/primary schools, 22 public nursery/primary schools, 11 private secondary schools and 5 public  secondary schools,were inspected for availability of the components of the SHS and evaluated using the SHS Evaluation Scale (SHSES). Statistical Analysis Used: Data were analyzed using SPSS version 15.0. Categorical variables were analyzed using Chi-square test. Level of significance was taken to be P < 0.05.Results: Only one (1.1%) school benefited from the services of a school doctor. Essential drugs and materials for first aid services were available in 85 (93.4%) of the schools, while only 26 (28.6%) had a sick bay. Screening tests for disabilities were performed in only 10 (11%) of the schools visited. Although school midday meals were available in all the schools, they were not free. Private secondary schools had the highest percentage of good school health evaluation scores (63.6%), while 96.2% of the private primary schools had poor health service evaluation scores. Conclusions: SHS are unsatisfactory in Sagamu. It is therefore necessary for all stakeholders in Sagamu schools (private and public) to provide the materials and manpower needed to achieve effective SHS in the area.Key words: School Health Services, School Health Services Evaluation scale, Health knowledge, Nigeri

Evaluation of Current Knowledge, Awareness and Practice of Spirometry among Hospital -based Nigerian Doctors

<p>Abstract</p> <p>Background</p> <p>Spirometry is a cost-effective diagnostic tool for evaluation of lung function and for case-finding in a resource-limited setting. The acceptance of this test depends on the awareness of its indications and the ability to interpret the results. No studies have assessed the knowledge of spirometry among Nigerian doctors. The aim of this study was to evaluate the current knowledge, awareness and practice of spirometry among hospital-based Nigerian doctors.</p> <p>Methods</p> <p>We carried out a cross-sectional survey among 321 doctors working in Nigerian hospitals between March 2008 and June 2008. Information on knowledge, awareness, practice of and barriers to spirometry were obtained using a pre-tested, self-administered structured questionnaire and the data were then analysed.</p> <p>Results</p> <p>Of the 321 doctors that participated, 108 (33.6%) reported that they have good knowledge of spirometry. One hundred and ninety-five (60.7%) were aware of the importance of spirometry in aiding the diagnosis of respiratory diseases; 213(66.4%) were aware of the importance of spirometry in determining the severity of diseases. Medical school was the most common source of knowledge on spirometry (64.5%). Eighty-one (25.2%) doctors reported having a spirometer in their hospitals. Doctors having access to a spirometer used it more frequently for aiding the diagnosis of COPD (40.7% vs.27.5%) and for monitoring of asthma (18.5% vs.11.3%) than those without access to a spirometer. The doctors working in University Teaching Hospitals and Federal Medical Centres (FMC) (22.4% vs. 4.5%) and those having access to a spirometer (40.7 vs.11.3%) were very confident of interpreting spirometry results compared to those working in District and General Hospitals and without access to a spirometer. Irrespective of access to a spirometer or the type of hospital they were employed in, doctors reported that unavailability of a spirometer was the greatest barrier to its use (62.5%) followed by lack of awareness about its usefulness (17.2%).</p> <p>Conclusion</p> <p>The knowledge and practice of spirometry were poor among hospital-based Nigerian doctors because of unavailability of spirometers in most hospitals. These findings have implications for further evaluation, planning and management of patient care in respiratory disease. Spirometers should be made available in all hospitals, and the knowledge of spirometry should be improved among doctors.</p

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Child Labour and School Absence in Sagamu Local Government Area of Ogun State

This study reviewed school absences of 1675 school children over one academic year. One thousand and eighty (64.5%) of these school children were involved in child labour outside school hours. The scope of occupational activity was heterogeneous with hawking as the most prevalent form. The school absences of 1080 children involved in child labour were compared with those of 595 children who were not involved. The children involved in child labour had a mean number of days of school absence of 11.34 days while those who were not involved in child labour were absent for a mean number of 11.50 days. The difference was not statistically significant (p = 0.80). there was also no significant difference in the mean school absence duration among boys and girls in the two groups (p = 0.93 and 0.81 respectively). It is concluded that child labour does not increase significantly school absence rates in school children when such economic roles are performed outside school hours. Key Words: Child labour, child abuse, school children, school absence. Nigerian Medical Practitioner Vol. 46 No 1, 2004 (15-17

Postpartum Sexual Abstinence and Breastfeeding Pattern in Sagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groupsKeywords: Postpartum, Sexual, Abstinence, Breastfeeding, Sexually Transmitted InfectionsAfrican Journal of Reproductive Health Vol. 12 (1) 2008: pp. 96-10

Infant Feeding and Lactational Amenorrhea in Sagamu, Nigeria

Five hundred and twenty educated, breastfeeding women in Sagamu, Nigeria, were observed prospectively in order to describe their infant feeding practices and to determine whether any predictors of the return of menses could be identified. The women remained amenorrheic for seven months. Compared with similarly selected women in other countries, they regularly fed their infants with supplements from a very early age, yet breastfeeding frequency and duration did not decline dramatically. Semi-solid food was introduced at about four months and such supplementation, as well as earlier supplementation with milk/milk-based feedings, was associated with the return of menses. The median duration of abstinence was about four months but the mean may have been much longer. No woman became pregnant until her infant was weaned. (Afr J Reprod Health 2002; 6[2]: 3950) Résumé Lallaitement et laménorrhée qui se rapporte à la lactation à Sagamu, au Nigéria. Cinq cent vingt femmes instruites et allaitant à Sagamu ont été observées prospectivement afin de décrire leurs pratiques dallaitement et pour déterminer sil était possible didentifier quelques indices du retour des règles. Les femmes sont restées aménorrhéiques pendant sept mois. Comparées aux femmes qui ont été selectionnées de la même manière dans dautres pays, elles nourrissaient régulierement leurs enfants du supplément dès leur très jeune âge; pourtant la fréquence de lallaitement et la durée nont pas baissé de façon dramatique. A lâge de presque quatre mois, on a initié les enfants à la nourriture semi-solides. Une telle administration dun supplément aussi bien quune administration antérieure dun supplément du lait et dautres nourritures à base du lait, ont été associées au retour des règles. La durée médiane de labstinence était à peu près quatre mois, mais la moyenne a probablement duré plus longtemps. Aucune femme nest devenue enceinte quaprès avoir sevré lenfant. (Rev Afr Santé Reprod 2002; 6[2]: 3950) Key Words: Breastfeeding, fertility, Nigeria, infant feeding, amenorrhea, Afric

Capacity for the management of kidney failure in the International Society of Nephrology Western Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA).

Western Europe boasts advanced health care systems, robust kidney care guidelines, and a well-established health care workforce. Despite this, significant disparities in kidney replacement therapy incidence, prevalence, and transplant access exist. This paper presents the third International Society of Nephrology Global Kidney Health Atlas's findings on kidney care availability, accessibility, affordability, and quality in 22 Western European countries, representing 99% of the region's population. The known chronic kidney disease (CKD) prevalence across Western Europe averages 10.6%, slightly above the global median. Cardiovascular diseases account for a substantial portion of CKD-related deaths. Kidney failure incidence varies. Government health expenditure differs; however, most countries offer government-funded acute kidney injury, dialysis, and kidney transplantation care. Hemodialysis and peritoneal dialysis are universally available, with variations in the number of dialysis centers. Kidney transplantation is available in all countries (except for 3 microstates), with variable transplant center prevalence. Conservative kidney management (CKM) is increasingly accessible. The region's kidney care workforce is substantial, exceeding global averages; however, workforce shortages are reported. Barriers to optimal kidney care include limited workforce capacity, lack of surveillance mechanisms, and suboptimal integration into national noncommunicable disease (NCD) strategies. Policy recognition of CKD as a health priority varies across countries. Although Western Europe exhibits strong kidney care infrastructure, opportunities for improvement exist, particularly in CKD prevention, surveillance, awareness, and policy implementation. Efforts to improve CKD care should include automated detection, educational support, and enhanced workflows. Based on these findings, health care professionals, stakeholders, and policymakers are called to act to enhance kidney care across the region