An audit of some health facilities and equipment for neonatal resuscitation in south-south Nigeria

Background: Neonatal Mortality rates continue to be high in spite of the general decline in under-5 mortality rates in Nigeria. Available evidence has shown that the availability of a skilled birth attendant and equipment for basic neonatal resuscitation is necessary for the prevention of early neonatal death which accounts for majority of neonatal mortality. This audit was, therefore, carried out to identify the quantity and quality of equipment available for basic neonatal resuscitation in some health facilities in southern Nigeria.Methods: This was a cross sectional questionnaire based study. Data was obtained from health care workers from 26 health facilities who attended Neonatal resuscitation training workshops from June 2010 to November 2012. Information obtained included type of health facility, obstetric and paediatric services provided and human and material resources available for neonatal resuscitation.Results: Twenty-three (88.5%) were government owned facilities while three (11.5%) were private facilities. Of the government owned facilities four were primary health facilities (17.3%), 18 were secondary (78.4%), while only one (4.3%) was a tertiary health facility. Most of the health facilities had annual deliveries, annual newborn resuscitation and birth asphyxiated babies in the 1-500 range. All the Paediatricians were in the tertiary health facility. Only three (11.5%) facilities had bag and mask and radiant warmer, respectively, while only five (19.2%) had radiant warmers.Conclusion: Equipment for basic neonatal resuscitation is grossly deficient in some health facilities in southern Nigeria. Therefore, urgent efforts should be made by the stakeholders involved in the delivery of child health services to provide basic resuscitation equipment to health facilities. This will contribute to a reduction in the neonatal mortality rate in Nigeria.Keywords: Neonatal, Resuscitation,Basic, Resuscitation, Equipment

Effectiveness of didactic training on the cognitive knowledge of health professionals on neonatal resuscitation in southern Nigeria

Background: Nigeria has a high neonatal mortality rate. Most of these deaths can be prevented by providing adequate training for health providers with available and functional basic resuscitation equipments. Our aim was to assess the effect of training on the cognitive knowledge of health practitioners on neonatal resuscitation.Method: We conducted neonatal resuscitation trainings for selected health professionals from all the senatorial districts of Akwa Ibom State, based on the Neonatal Resuscitation programme (NRP) of the American Academy of Paediatrics (AAP). The facilitators were trained and certified in the NRP train-the trainers program of the AAP conducted by the Paediatric Association of Nigeria (PAN). Pre -and post-test were organized during the training and the test scores analyzed to assess any improvement in the knowledge of the health professionals on neonatal resuscitation.Results: One hundred and eightyone health professionals were trained over a two year period. Sixty five (35.9%) were doctors, while 116 (64.9%) were nurses. Physicians had similar pre- test but significantly higher post- test scores compared to the nurses: 46.35±15.34 vs 43.70± 14.51; p=0.34 and 76.14±13.02vs 66.29±15.7; p=0.04 respectively. All the health professionals showed significantly higher posttest scores compared to the pre-test scores; p=0.001 respectively. There was also a negative relationship between the number of practice years and the pre-training scores for the physicians and nurses; spearman rho= -0.18; p=0.45 and -0.43;p=0.003 respectively.Conclusion: Neonatal resuscitation training leads to an improvement in the cognitive knowledge of health practitioners. All health practitioners should be trained irrespective of number of practice years. Further studies are required to assess its long term impact on neonatal mortality.Keywords: Neonatal Resuscitation Training, knowledge, healt

Bronchial foreign body misdiagnosed as pulmonary tuberculosis

Retained and neglected foreign bodies in the respiratory tract in children are a common occurrence. Undiagnosed foreign bodies can cause  mechanical effects or chemical reactions and may present as chronic pulmonary infection, bronchiectasis, asthma, and lung collapse or lung abscess. Delay in diagnosis, appears to result from a failure to give  serious consideration to the diagnosis, normal chest roentgenographic findings, and negative bronchoscopic findings. A case of left bronchial foreign body aspiration is herein reported to illustrate the causes and complications of the delayed diagnosis. It is hoped that  this will help sensitize the medical practitioner of the need for a high index of suspicion in children presenting with symptoms suggestive of foreign body aspiration. This study will also serve as advocacy  for the provision of adequate bronchoscopic equipments for paediatric practice in our health facilities

Pattern of childhood pertussis in a tertiary hospital in Nigeria: a five year review (2007-2011)

Pertussis is being increasingly found in previously immunized subjects. In Nigeria, the immunization coverage rates are low. This study was therefore carried out to highlight the cases of pertussis seen in a young Nigerian tertiary health facility, with emphasis on the clinical features, complications and the impact of prior immunization in the affected children.Methods : This was a hospital based retrospective study, in which data were obtained from case notes of children seen in the Paediatric department of the University of Uyo Teaching Hospital (UUTH) from January 2007 to December 2011 with a diagnosis of pertussis. Information sought included epidemiologic data, duration of illness, signs and symptoms, treatment, complications and outcome.Results: Fifty three patients were diagnosed with pertussis during the five year period, with majority (29; 54.7%) of cases in the year 2011. Twenty one (39.6%) of the subjects were males while 32 (60.4%) were females. The mean age of the subjects was 29.71 + 27.73 months. The most common symptoms were Post-tussive vomiting and paroxysmal cough occurring in 48(90%) and 39 (73.6%) of the patients respectively. The average interval between onset of symptoms and presentation at the health facility was 3.35 + 2.84 weeks. Majority of the patients (25; 47.2%) were adequately immunized for their age. Bronchopneumonia, either alone or in combination with other complications was the commonest complication occurring in nine (52.9%) patients. There was no mortality.Conclusion: Pertussis is still of public health significance. Routine immunization should be strengthened and booster doses of vaccines should be considered for older children whose immunity may begin to wane.Key words: Pertussis, pattern, childhoo

Normative values and anthropometric determinants of lung function indices in rural Nigerian children: A pilot survey

Introduction: Respiratory diseases represent some of the most common causes of hospital visits in childhood. Most of our decision making rely on clinical assessment without the benefit of objective measures of pulmonaryfunction. The ability to measure pulmonary function provides a tool that can confirm clinical diagnosis, monitor response to therapy and follow progression of disease. Correct interpretation of pulmonary function test requires an appreciation of normal values.Patients and methods: Lung function test was performed on rural children in Akwa Ibom State, Nigeria, to determine normal values among healthy children. One hundred and fifty two children aged 6-16 years old  comprising 89 males and 63 females were included in this study. Anthropometric measurements including height, weight, sitting height, chest circumference and body surface area were obtained. The Peak Expiratory Flow (PEF), forced vital capacity (FVC) and Forced Expiratory Volume in one second (FEV1) were measured using the spirolab III electronic spirometer manufactured by Medical International Research (MIR) Italy. It was a descriptive cross sectional study.Results: One hundred and fifty-five children; 89 (58.6%) males and 63(41.4%) females were studied. The mean age (±SD) of the males was10.5+2.95 years while that of the females was 10.7 + 3.19 years.The mean PEFR, FVC and FEVI were 3.95±1.55 litres per second (l/s) 1.58±0.58 litres (l) and 1.57±0.56l in the males while for the f ema le s 3.73±1.03l / s , 1.45±0.43l and 1.41±0.41l respectively. The FVC and FEV1 of the males were significantly higher than that of the females (p=0.03respectively). Height was the significant predictor of PEFR (p=0.04), while the height and sitting height were the important predictors of log FVC and FEV1 for the males respectively (p= 0.007 and 0.02; 0.004 and 0.027).For the female subjects, age was a significant predictor of log PEFRand Log FVC (p=0.047 and 0.003), while Age and Sitting height were the significant predictors of log FEV1 (p=0.02 and 0.03 respectively).Conclusion: The study has observed higher lung function indices in the males than in female children. In addition to age and height, sitting height has been observed as an important predictor of the lung function indices of the children studied. This study should be seen as a pilot study and will require data from a large population to establish normal values for ourpopulation.Key words: Lung function, rural, children, anthropometric determinant

Prevalence, co-prevalence and risk factors of pulmonary paragonimiasis and pulmonary tuberculosis in Nigerian Children in the Niger Delta Area

Background: Nigeria has the highest burden of paragonimiasis in Africa and it is also among the high burden  countries with tuberculosis. The true prevalence of these reemerging diseases is unknown in the country.Objective: To determine the prevalence and co-prevalence of these re-emerging diseases among children in a rural Nigerian community.Design: Descriptive cross-sectional study.Setting: Ewang, a rural fishing community in Mbo Local government Area of Akwa Ibom State, Nigeria.Subjects: Primary and secondary school children aged 5-18years living in Ewang village, Mbo Local government Area of Akwa Ibom State, Nigeria.Results: A total of 204 children were examined: 91(44.6%) were males, while 113(55.4%) were females. Ten of the subjects were sputum positive for paragonimus eggs, giving an overall prevalence rate of 4.9%, while six children were sputum positive for pulmonary tuberculosis with a prevalence rate of 2.9%. There was no case of co-infection. The peak age prevalence of paragonimus ova-positive and Acid and Alcohol fast positive subjects was recorded in the five to nine year old age group with prevalence rate of 5.6% and 7.4% respectively. There was a female  preponderance among the paragonimus ova-positive subjects (90%) and the AAFB positive subjects (66.7%).Conclusions: The findings show that paragonimiasis is an emerging/ re-emerging disease in southern Nigeria and further confirmed that the prevalence of tuberculosis is still on an upward rise

Staphylococcal septicaemia complicated with purulent pericarditis in an infant: A case report

Purulent pericarditis is a rare complication of sepsis. It is almost exclusively a complication from an underlying condition rather than a primary infection. Staphylococcus aureus is the commonest aetiologic agent. Its diagnosis requires a high index of suspicion especially in the presence of persistent fever and signs of cardiac tamponade in spite of appropriate antibiotic use. A case of purulent pericarditis in an infant is here presented to illustrate the importance of a high index of suspicion and simple investigations in its diagnosis in resource limited practice. In addition, the importance of prompt treatment with drainage of the abscess and use of appropriate antibiotics to achieve a good prognosis is shown.Key words: Staphylococcus, Purulent pericarditi

A seven-year review of paediatric mortality in the University Of Uyo Teaching Hospital, Uyo, Nigeria

Background: Childhood mortality has become one of the world’s targets for reduction as encapsulated in the Sustainable Development Goals (SDG). Although mortality among children aged younger than 5 years has declined globally in the past two decades, considerable geographical differences exist and remain disproportionately high in sub-Saharan Africa and Southeast Asia. Many hospital-based studies in Nigeria have shown the predominance of infectious diseases such as sepsis, bronchopneumonia, and HIV/AIDS as the leading causes of childhood mortality. Methods: The study was conducted at the Department of Paediatrics of the University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria. The study was a descriptive, cross-sectional and retrospective review of all the deaths among the hospitalized children from 1st January 2015 to 31st December 2021. Results: A total of 191 deaths in the Paediatrics Department of the University of Uyo Teaching Hospital were recorded, 99 males (51.3%) and 92 females (47.7%). This study shows that 27.00% of children who died where infants, 28.30% were children 1-5 years and 44.50% were children above 5 years. The commonest cause of childhood mortality in this study was severe sepsis (30.00%), followed by HIV/AIDS (11.40%), bronchopneumonia (9.84%). Conclusion: Most of the leading causes of childhood mortality in Nigeria are infectious diseases. These are largely preventable and leave room for improvement in our practice of Infection Prevention and Control (IPC), appropriate community education on hygienic practices and prevention of HIV/AIDS