Newborn resuscitation practices and paucity of resuscitative devices in Nigeria; a call to action

Background: Neonatal resuscitation is a method of preventing morbidities & mortality from asphyxia. Up to 85% of facilities in sub-Saharan Africa lack supplies or skilled personnel for neonatal resuscitation. Relative to the place of birth and the skill of the birth attendant, a variety of resuscitative practice are employed to make babies cry instead of helping the baby breathe. Many painful procedures are applied when the baby is unable to cry after birth in the absence of a health care worker trained in bag-mask ventilation. Objectives: To ascertain the resuscitation practices in communities lacking bag-mask-valve devices Methods: Surveys on the resuscitation practices during NISONM annual community outreach and mENCC trainings for four consecutive years in different geopolitical zones of the country. Results: Spanking of the baby usually in the upside down position (>90%), body massage with hot compress or salicylate containing balms, herbal concoctions, injection hydrocortisone or crystalline penicillin were used. Conclusion: There is an urgent need to address the issue of training on bag-mask ventilation and provision for frontline healthcare workers in Nigeria as a neonatal mortality reduction strategy. DOI: https://dx.doi.org/10.4314/ahs.v19i1.30 Cite as: Okonkwo IR, Ezeaka VC, Mustapha B, Ezeanosike O, Tongo O, Okolo AA, et al. Newborn resuscitation practices and paucity of resuscitative devices in Nigeria; a call to action. Afri Health Sci. 2019;19(1). 1563-1565. https://dx.doi.org/10.4314/ahs.v19i1.3

The Impact of Recycled Neonatal Incubators in Nigeria: A 6-Year Follow-Up Study

Nigeria has a record of high newborn mortality as an estimated 778 babies die daily, accounting for a ratio of 48 deaths per 1000 live births. The aim of this paper was to show how a deteriorating neonatal delivery system in Nigeria may have, in part, been improved by the application of a novel recycled incubator technique (RIT). Retrospective assessment of clinical, technical, and human factors in 15 Nigerian neonatal centres was carried out to investigate how the application of RIT impacted these factors. Pre-RIT and post-RIT neonatal mortalities were compared by studying case files. Effect on neonatal nursing was studied through questionnaires that were completed by 79 nurses from 9 centres across the country. Technical performance was assessed based on 10-indices scores from clinicians and nurses. The results showed an increase in neonatal survival, nursing enthusiasm, and practice confidence. Appropriately recycled incubators are good substitutes to the less affordable modern incubators in boosting neonatal practice outcome in low-income countries

Acceptance of provider–initiated testing and counseling for HIV infection by caregivers in a tertiary health institution in Abuja, Nigeria: a cross sectional study

Introduction: less than 10% of HIV positive children are enrolled into antiretroviral treatment program in the country. Provider-initiated testing and counseling was introduced to increasing uptake of HIVtesting. The aim of this study is to determine the acceptability and factors undermining the acceptance of this laudable initiative by parents/caregivers of children attending paediatric out patient clinical services in our health institution. Methods: a cross sectional study of children aged 18 months to 18 years and their parents/caregivers attending paediatric outpatient clinic of the hospital was undertaken for the above objectives. Results: there were statistically more female parents/caregivers (82.5%, p=0.00), more male patients (52.9 %, p= 0.02), and 11.9% adolescentsin this study. While 91.7% of parents/caregivers admitted not having knowledge of PITC, 95.6% knew what HIV was. Acceptance of the program was high (98.7%), majority (89.7%) wanting to know the HIV status of their children/wards. Non-acceptance wassmall (1.2%), there main reason being prior knowledge of their HIV status.Prevalence of HIV among tested children was 1.7%. There was a strong relationship between having willingness to test for HIV and many of the study variables with religion of the parents/caregivers having the strongest relationship [OR: 13.94, (CI 1.82, 55.34)], and tribe having list association, [OR: 3.60, (CI 1.85, 17.14)]. Conclusion: there was general wiliness to accept HIV test for children by their parents/caregiver in this study, and HIV prevalence in children is on a downward trend; its sustenance to be continued and adolescent clinics need to be created.The Pan African Medical Journal 2016;2

Healthful School Environment in Primary Schools: A Cross-Sectional Study of Gwagwalada Area Council, Federal Capital Territory, Nigeria

Background: Children spend long hours of the daytime in schools where they are exposed to the various components of the school environment which may affect their health status. There is, therefore, a need to constantly evaluate the status of the school environment. This study sought to assess the school environment in primary schools in Gwagwalada Area Council in the Nigerian Federal Capital. Materials and Methods: A descriptive cross-sectional study was carried out among 146 public and private primary schools using the school environment component of the school health programme evaluation scale. The key variables in the evaluation scale included the methods of sewage and refuse disposals, infrastructural features of the classrooms, sitting comfort for pupils and teachers, health hazards and safety measures in the schools, healthful living in the schools as well as evidence of maintenance of the school environment. Results: A borehole was the source of water supply in 76(52.1%) schools. Of the 118(80.8%) schools with water closet toilets, 103(97.3%) were private while 15(37.5%) were public schools. In 127(87%) schools, the refuse disposal method was open dumping/ burning. Ventilation was adequate in 38(95%) public and 55(51.9%) private schools (p< 0.001). School fence was present in 102 (69.9%) schools. Overall, only 6 (5.7%) out of  the 106 private schools scored up to the acceptable minimum score of 57; no public school attained such a score (Fischer’s exact 2.361, p-value =  0.124). Conclusion: The environments of primary schools in Gwagwalada Area Council, lack the basic requirement to make them healthful. A mechanism should be put in place to ensure compliance with a standard environment

Challenges and Frugal Remedies for Lowering Facility Based Neonatal Mortality and Morbidity: A Comparative Study

Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one “control” were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria