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

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Risk factors for neonatal jaundice in babies presenting at the University of Benin Teaching Hospital, Benin City

Background: Jaundice is the yellowish discoloration of the skin, sclera and mucous membranes resulting from deposition of bilirubin. Neonatal jaundice is a leading cause of neonatal admissions in the first week of life and risk factors such as sepsis, prematurity, glucose-6-phosphate dehydrogenase enzyme deficiencies, use of native herbs and contact with naphthalene balls contaminated clothes have been identified for neonatal jaundice. Objective: To determine the risk factors for neonatal jaundice at University of Benin Teaching Hospital, Benin City. Methods: This retrospective study was conducted at the Special Care Baby Unit of the University of Benin Teaching Hospital, Benin City. Case notes of babies admitted from January 2006 to December 2008 were retrieved and information on biodata, gestational age, anthropometric values, potential risk factors, level of serum bilirubin at presentation and discharge, mode of treatment and outcome were extracted. Results: Of the 1784 babies admitted during the period, 472 (26.5%) were admitted for neonatal jaudice. Fifty seven percent of the babies with neonatal jaundice were delivered in UBTH (in-born babies), while 202 (42.8%) of the babies were born before arrival (out-born babies) in UBTH. The Male: Female ratio was 1.02:1. The mean age at presentation with jaundice was 3.43 ± 3.76 days of life. Outborn babies tended to present at an older age (6.08 ± 5.19 days) than in -born babies (2.47 ± 2.48 days). The mean serum bilirubin value in out-born babies (14.00 ± 4.58 mg/dL) was significantly higher than that observed among the in-born babies (9.35 ± 4.38 mg/dL: p = 0.000). The risk factors identified were use of mentholatum, naphthalene balls and native herbs in 40.0%, 16.7% and 7.0% respectively. ABO incompatibility was found in 7.6% of babies. No risk factor was identified in 36.3% of the babies. The case fatality rate in this study was relatively high particularly in association with sepsis, prematurity and asphyxia. Mortality was higher in out-born babies than in in-born babies (p= 0.00). Conclusion: Early presentation of babies and adequate management of sepsis and prematurity will reduce mortality associated with neonatal jaundice.Key words: In-born, jaundice, outborn, risk, sepsis

Evaluation of adolescent medicine sub-specialty training in Nigeria: trainees’ perspectives

Objective: To evaluate the extent of coverage of curriculum contents pertinent to Adolescent Medicine, as well as the adequacy of facilities and professionals in Nigeria using residents’ viewpoint.Design: A descriptive cross-sectional study.Setting: The Intensive Course in Paediatrics of the National Post-graduate Medical College of Nigeria at the University of Benin Teaching Hospital, Benin City Nigeria.Subjects: One hundred and three paediatric residents from training institutions in all zones of the country.Results: Altogether,68.0% and 32.0% of the participants were from Southern and Northern geopolitical zones respectively. Only 14% of them stated that a rotation in an AM unit is a part of training in their centres. None specified its duration. Coverage of AM topics, physical facilities and trainers were rated as inadequate by 77.0%, 82.8% and 70.8% of the respondents respectively. Residents from north were more likely to rate interview/confidentiality in AM as covered (either partly or well) than their colleagues from the South, (p < 0.01, OR = 5.3, 95% CI = 1.5-19.5). We found no difference between federal and state residents’ perceived adequacy of AM training.Conclusion: AM in paediatric residency programme in Nigeria is still an unmet challenge. There is a need for a revision of the training curriculum to specify mandatory duration of clinical rotation in AM units

Conjoined twins in Edo state of Nigeria; a report of the first surviving set

The term conjoined twins refers to babies who are physically joined at some point. It is a rare condition with an estimated incidence of 1 per 200,000live births. We report our experience with conjoined twins over a twelve year period in tertiary hospital in Nigeria and a case of the first set of conjoined twin survivors in Benin City, Nigeria. Over the last twelve years  (1999-2011), three cases of conjoined twin have been recorded in our teaching hospital. A set of thoracoomphalopagus twins (females) were delivered in 1999 and they survived for only 36hrs. Another set of female omphalopagus twins were delivered in 2009 and survived a separation surgery. A third set of female thoracoomphalopagus was delivered in another institution same year and referred to our unit but they only survived for 48 hours. The first surviving twins were omphalopagus, sharing a single liver, and common bile duct emptying into a common duodenum. The stomach, as well as the jejunum was normal and unshared. Surgicalseparation of the liver was done and biliary reconstruction procedure performed for twin II. A three -year follow up showed good outcome

Perinatal mortality in a rural community

Objective: To determine the peri-natal mortality rate (PMR), still birth rate (SBR) and early neonatal death rate (ENDR) in Igueben Local Government Area (LGA) of Edo State.Design: A descriptive cross-sectional studySetting: Igueben LGA is a rural governmental unit in mid-western Nigeria.Subjects: All women of child-bearing age, resident in three randomly selected political wards in Igueben LGA were identified.Results: Of the 921 women of child-bearing age recruited, 258 deliveries with three perinatal deaths were recorded, giving a PMR, SBR and ENDR of 11.6/1000TB, 11.6/1000TB and 0/1000LB, respectively. Almost all the mothers studied (99.6%) received skilled obstetric care in delivery.Conclusion: The actual PMR, SBR and ENDR were considerably lower than the National estimated averages of 76/1000TB, 43/1000TB and 35/1000LB, respectively. While this may perhaps be related to the quality of obstetric care, it underscores the importance of community-based studies in the determination of vital statistics which are important in health planning including resource allocation

Paediatrician workforce in Nigeria and impact on child health

Objective: To determine the number and distribution of paediatricians in Nigeria. It also aims to determine the association between paediatrician workforce and under five mortality (U5MR) and immunization coverageacross the six geopolitical zones of the country.Methods: The part II fellowship examination pass list of the West African College of Physicians and the National Postgraduate Medical College and the register and financial records of the Paediatric Association of Nigeria were searched for the purpose of the study. Using a structured questionnaire, personal and professional data was obtained frommembers at the 2011 Annual Paediatric Association of Nigeria Conference or via the Association’s website, email network and phone calls to Departments of Paediatrics in institutions (private and public) across the Country. Data on the paediatricians residing within Nigeria was then extracted from the comprehensive database and subsequently analyzed.Population data, mortality and immunization rates were obtained from the National Population Commission census and their most recent National Demographic health survey in Nigeria. Correlations were drawn betweennumber of paediatricians and U5MR and diphtheria-pertussistetanus(DPT) vaccine coverage.Results: There were 492 practicing paediatricians in Nigeria at theend of year 2011, comprising 282 (57.3%) males and 210 (42.7%)females; 476 (96.7%). Majority (84.7%) worked for the governmentwith 97% of them in hospital settings, mostly tertiary centres (344=88%). Lagos State had the highest number (85; 17.9%) of practicing paediatricians followed by the Federal Capital Territory with 37 (7.8%) paediatricians. More than two thirds of the paediatricians (336; 70.6%) were practicing in the southern part of the country. The average child:p a e d i a t r i c i a n r a t i o wa s 157,878:1for the country. TheNorth East zone had the highest chi ld- to-pa ediat r ician rat io (718,412:1) while South West had the lowest ratio (95,682:1).Higher absolute numbers of paediatricians in each zone were associatedwi th lower U5MR (Spearman ñ=-0.94, p=0.0048), accounting for 84% of the variability among zones. Higher ratios of child-to-paediatrician were significantly associated with higher U5MR (Spearman ñ=0.82, p=0.04,linear R2=0.73) and marginally with lower DPT coverage by geopoliticalzone (Spearman ñ=-0.77, p=0.07, linear R2=0.59).Conclusion: The study reveals that the number of paediatricians inNigeria is grossly inadequate with a huge child-to-paediatrician ratio.There is also an uneven distribution of the paediatricians with higher numbers in the southern states. Zones of the country with lower child-to-paediatrician ratios also experienced lower U5MR. There is a need to train more paediatricians in Nigeria and promote an even distribution of the paediatrician workforceKey words: Paediatrician, workforce, child-to-paediatrician ratio, under-5 mortality, immunization, childhealth, Nigeri

Mothers and childhood pneumonia: What should the focus of public campaigns be?

Background: Prompt administration of antibiotics to children with pneumonia significantly reduces the probability of death. However this requires early identification of such children in the community.In a country such as Nigeria with one of the highest pneumoniarelateddeaths, what do mothers know about pneumonia, and what should be the content of public campaign messages?Methods: A structured questionnaire was administered to mothers  attending paediatric clinics of Lagos University Teaching Hospital seekingtheir knowledge about the definition, causes, risk factors and symptomsof childhood pneumonia.Results: One hundred and seven (107) consecutive mothers participatedin the study. The majority (97; 90.6%) had at least secondary education,were married (96; 89.7%) and professed to be either Christiansor Muslims (105; 98.1%). Prior to the study, 16 (15%) had notheard about pneumonia. About half of the participants correctly identifiedfast/difficult breathing as suggestive of pneumonia. Threequartersreported exposure to cold as the cause of childhood pneumonia. Minimizing exposure to cold and wearing warm clothes were thetwo commonest reported ways of preventing pneumonia (75.8% and49.5% of the mothers respectively); in contrast hand washing, exclusivebreastfeeding and limiting exposure to sick persons with cough and catarrhwere the least mentioned. The proportion of mothers who correctlyidentified fast/difficult breathing as suggestive of pneumoniawas similar irrespective of educational status or source of pneumoniainformation.Conclusion: Mothers’ knowledge of childhood pneumonia is low. Publiccampaigns on pneumonia should focus on raising awareness aboutgerms as cause of pneumonia, immunization, hand washing and exclusivebreastfeeding as potent preventive strategies and fast/difficult breathing as a feature of pneumonia

Community knowledge, attitude and practice of childhood immunization in Southwest Nigeria: Data from a Paediatric Association of Nigeria town hall meeting

Background: Vaccine preventable diseases account for 22% of under-five deaths in Nigeria and poor knowledge and attitude have been responsible for non-vaccination of children. This study aimed to assess the knowledge,attitude and practice of childhood immunization among community members in Ile-Ife.Methods: Quantitative data (using an interviewer-administered questionnaire) was collected from a convenience sample of 36 adultresidents who attended a town hall meeting with the PaediatricAssociation of Nigeria. Two focus group discussions were also conductedamong sub-samples of male and female respondents.Results: The mean age of respondents was 43.2 ± 11.9 years with amale to female ratio of 1:0.7. Most had secondary education (63.9%)and had children (91.7%). Most of the respondents understood whatimmunization was and knew the benefits but were unaware of severalof the specific types of immunization. There were erroneous beliefs about the contraindications for immunization and mothers were entrusted with the sole responsibility of getting children immunized. Although most of therespondents had immunized their children, they identified laziness ofmothers, negative attitude of health workers and logistics problemsat facilities as barriers to patronage of immunization services.Conclusion: This study identified knowledge gaps and negative attitudestowards childhood immunization. We therefore recommend a community-wide health education intervention with emphasis on substantial male involvement in immunizations and improvement inimmunization service delivery.Key words: Community, knowledge, attitude, childhood immunization