Inter-pregnancy interval and pregnancy outcomes among HIV positive mothers in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria

Background: Both short and long inter-pregnancy intervals have been associated with higher risk of adverse pregnancy outcomes. More so, short interpregnancy interval among HIVpositive women implies higher birth rate and subsequently a higher number of neonates exposed to HIV and potentially at r i s k o f mo t h e r - t o - c h i l d transmission.Aims: To study the influence of inter-pregnancy interval on pregnancy outcomes among booked HIV-positive mothers with singleton live-births atNauth, Nnewi.Methods: A cross-sectional study was carried out with the aid of s t r uc tur ed q ue s t io nnai r es , maternal clinical records and relevant anthropometry, between May and December 2011, among booked multiparous HIV-positive mother/singleton newborn pairs at NAUTH, Nnewi.Results: More than half (56.5%) of the 175 multiparous HIVpositive women studied had short inter-pregnancy interval (<18 months). Short inter-pregnancy interval was signi ficantly associated with adverse maternaland perinatal outcomes like maternal anaemia (X2 =14.95, p=0.021) and low values of m a t e r n a l o r n e o n a t a l anthropomet r ic parameter s. However only adverse maternal outcomes and MAC/OFC ratio of t h e n e o n a t e s r e ma i n e d significantly associated with short Inter-pregnancy interval after logistic regression analysis. Long inter-pregnancy interval was significantly associated with low values of neonatal  anthropometric parameters and maternal MAC less than 25cm (X2=15.10, p=0.019) as well as third trimester weight gain rate less than 250g/week (X2 =31.20, p= 0.000). The proportion of mothers with long interpregnancythat had anaemia or intra-partum BMI less than 25kg/m2 differed only slightly from that of those with inter-pregnancy interval of 18-59 months.Conclusion: Inter-pregnancy interval of 18 to 59 months is significantly associated with the lowest risk of both adverse maternal and fetal  outcomes among HIV-positive women

Socio - demographic characteristics of child street vendors in Nnewi, Nigeria

Background: Involvement of children in street trading is inimical, contrary to the Rights of the Child, and threatens holistic child development. Objective: To describe the sociodemographic characteristics of child street vendors in Nnewi. Method: A cross-sectional questionnaire survey of children selling wares on the streets of Nnewi, southeast Nigeria. Results: 147 children (90 boys and 57 girls) aged 8 – 19 years were interviewed: 57 (38.8%) lived with their parents, 63 (42.9%) with relations and friends, while 27 (18.3%) lived alone. Also, 27 (18.4%) were Anambra state indigenes, others hailing from surrounding states. The parents of all the subjects were of low socioeconomic status. Trading was taking place during school hours for financial gains of the family. As many as 42.9% of the subjects had completed primary education: 89 (60.5%) had completely dropped out of school for varying periods. Nine girls (6.1%) had been sexually abused and 46 children (32.7%) had at sometime lost their earnings to robbers. Majority (79.6%) aspired to higher education if given the opportunity. Conclusion: Many parents in the low socioeconomic groups still keep their children out of school to work and help boost the family income. It is recommended that legislation be made against children trading during school hours.Key Words: child labour, street children, child vendors, Nigeria

Adherence to infant-feeding choices by HIV-infected mothers at a Nigerian tertiary hospital: the pre-“rapid advice” experience

Objectives: The study examined adherence to infant-feeding choices made by human immunodeficiency virus (HIV)-infected mothers at a Nigerian tertiary hospital prior to implementation of the “rapid advice” guideline, i.e. the revised World Health Organisation principles and recommendations on infant feeding in the context of HIV.Design: This was a longitudinal descriptive study.Subjects and settings: The study was conducted on mother-infant pairs recruited from the prevention of mother-to-child transmission (PMTCT) of HIV programme of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Final analyses included 142 mother-infant pairs.Outcome measures: Adherence to a prenatal infant-feeding choice and the infant’s HIV status at six months of age were determined.Results: On enrolment, 73% (n = 103) of the mothers chose exclusive formula feeding (EFF), and 28% (n = 39) exclusive breastfeeding (EBF) for the first six months of life. Of the mothers who chose EBF, the actual practice of EBF declined from 88% at two weeks to 21% at six months, while EFF with correctly reconstituted infant formula decreased from 55% to 8% over the same period. The proportion of mothers who switched over to early complementary feeding increased from 8% at six weeks to 80% at six months in the EBF group, and 2% at two weeks to 92% at six months in the EFF group. Major reasons for nonadherence to their initial choice were fear of the mother-to-child transmission (MTCT) of HIV (65%) and non-affordability of the formula (97%) in the EBF and EFF groups, respectively. Factors significantly associated with adherence to their initial choice included having individual prenatal infant-feeding counselling sessions, being married, having a small number of children, being of higher socio-economic status and the mother’s educational status. However, only socio-economic status remained significant after logistic regression analysis was applied. The total MTCT of HIV rate was 1% at six months.Conclusion: Adherence to either EFF or EBF in this study was low, owing to early breastfeeding cessation and the inability to sustain EFF.Keywords: HIV-infected mothers, infant-feeding choice, infant-feeding practices, PMTCT, adherenc

Experiences from polio supplementary immunization activities in Anambra State, Nigeria

Background: Routine immunization coverage is low in some States in Nigeria and contributes to the transmission of wild poliovirus. Anambra State has been polio‑free since 2004. However, the risk of importation of poliovirus from travelers and migrants is a public health concern due to the commercial nature of the State. This paper reported experiences and lessons from supplementary immunization activities (SIAs) conducted in the State that will be useful to other settings experiencing low uptake of routine immunization.Materials and Methods: The SIAs were conducted simultaneously in the 21 local government areas (LGAs) in Anambra State during January, March, and November 2010. Data were entered and analyzed in Excel spreadsheet and findings were summarized as frequencies and proportions.Results: A total of 1,187,866 children were vaccinated in January, 1,260,876 in March and 1,225,187 in November 2010. The State’s cumulative coverage exceeded the target coverage of >90% in the three SIAs. All LGAs met the >90% target in January and March, but one LGA achieved 79% coverage in November. The proportion of zero‑dose children decreased from 6% to 4.7%, and the vaccine wastage rate ranged from 6% to 6.6%. In that same year, the state did not achieve the target coverage of >80% for routine oral polio vaccine (OPV3) immunization in any of the months and only 29% of the LGAs exceeded the routine OPV3 target.Conclusion: The State achieved high polio vaccination coverage through the SIAs, but coverage through routine immunization was low. Adopting proper planning and supervision, financial and political support, community involvement, improved vaccine logistics, and other measures utilized during the SIAs could help to improve routine immunization.Key words: Community involvement/participation, polio eradication, supplemental immunization activities, vaccination coverag

Nutritional Contents of Lunch Packs of Primary School Children in Nnewi, Nigeria

Background: Lunch packs play a significant role in the nutritional status and academic performance of school children. Available data show a high prevalence of malnutrition among school‑age children. Aims: The aim of this study is to document the nutritional contents of lunch packs of primary school children in Nnewi, Anambra state, Nigeria.Subjects and Methods: A cross‑sectional study was conducted among 1018 primary 1‑6 pupils selected by stratified systematic random sampling from six primary schools, two each of private, – mission, – and government (public) – owned schools in Nnewi metropolis with the aid of the semi‑structured questionnaire. Lunch packs of the pupils were examined.Results: Majority of the pupils (77.8% [792/1018]) had lunch packs although about half of pupils in public schools had no lunch pack. Only 12.4% (98/792) and 19.2% (152/792) of pupils with lunch packs had balanced meals and fruits/vegetables in their lunch packs, respectively. The odds of not coming to school with packed lunch was about 13 and 12 times higher for mothers with no formal education or only primary education, respectively, compared with those with tertiary education. Type of school had a strong influence on possession and contents of lunch pack (χ2 = 2.88, P < 0.001, phi coefficient = 0.72). Pupils in private (97.5% [198/203]) and mission (94.4% [388/411]) schools were more likely to have a lunch pack compared with public schools (51.0% [206/404]). However, pupils in private schools were most likely to have a balanced meal (32.5% [66/203] vs. 5.8% [24/411] in mission and 2.0% [8/404] in public schools) and fruits/vegetables (48.3% [98/203] vs. 10.2% [42/411] in mission and 3.0% [12/404] in public schools) in their lunch packs. Mothers’ educational status and parents’ occupation were significantly associated with lunch pack contents. Conclusion: Majority of the lunch packs of primary school pupils contain poor quality food especially in public schools. Mother’s educational status and parent’s occupation are important determinants of the nutritional contents of lunch packs.Keywords: Lunch, Nigeria, Nutrition, School childre