Early Cessation of Breastfeeding: A Neglected Nutritional Challenge among Infants

Abstract Background: Breastfeeding (nursing) strike and early-weaning occur when infants often older than 3 months refuse to nurse for no apparent reason. This condition can be distressing to both the infant and mother. It is most times difficult for mothers to detect the cause of this phenomenon. This often puzzling state of infants feeding strike could lead to poor infant feeding practices thereby predisposing the infant to malnutrition and infections. Methods: This cross-sectional descriptive and analytical study enrolled 421 mothers who had nursed at least one child for 12 months or more. Appropriate statistical tools were used to determine prevalence of breastfeeding strike and maternal socio-demographics that are associated with refusal of breastfeeding in infants before 6 months of age. Results: Prevalence of breastfeeding strike in our study was 2.8%. Though statistical significance was not attained probably due to small sample size (n= 88), older mothers, those with more children, higher occupational grades and higher educational attainment were more likely to experience infant refusal of breastfeeding before 6 months of age. Conclusion: Despite the low prevalence reported in our study, breastfeeding strike is of great public health and family importance. There is need for more study to determine factors responsible for nursing strike in various cultural contexts in order to better educate mothers on how to prevent this present but covert phenomenon

Incidence and Predictors of Mortality Among Newborns With Perinatal Asphyxia: A 4-Year Prospective Study of Newborns Delivered in Health Care Facilities in Enugu, South-East Nigeria

Fatalities from perinatal asphyxia remain high in developing countries, and continually assessing its risk factors will help improve outcomes in these settings. We explored how some identified risk factors predict mortality in asphyxiated newborns, to assist clinicians in prioritizing interventions. This was a 4-year prospective study conducted at the Enugu State University Teaching Hospital, Enugu, Nigeria. All newborns who met the study criteria that were admitted to this facility in this period were enrolled and monitored. Data collected were analysed with SPSS Version 18. A total of 161 newborns with perinatal asphyxia were enrolled into the study with an in-hospital incidence rate of 12.81 per 1000 birth and a case fatality rate of 18%. Overall, the APGAR scores were severe in 10%, moderate in 22%, mild to normal in 68%, whereas the SARNAT stages were III in 24%, II in 52%, and I in 25%. In terms of mortality, 66.7%, 22.2%, and 11.1% mortalities were, respectively, observed with SARNAT scores III, II, and I ( P  = .003), whereas the findings with APGAR were 31.2% (severe), 25.0% (moderate), 25.0% (mild), and 18.8% (normal) ( P  = .030). Fatality outcome was more correlated with SARNAT ( R  = .280; P  = .000) than APGAR ( R  = −.247; P  = .0125). The SARNAT score significantly differentiated between the degrees of asphyxia in newborns based on gestational age at delivery ( P  = .010), place of delivery ( P  = .032), and mode of delivery ( P  = .042). Finally, it was noted that newborns that were female ( P  = .007), or born outside the hospital ( P  = .010), or with oxygen saturations <60% ( P  = .001), or with heart rate <120 ( P  = .000), and those with respiratory rate <30 ( P  = .003), all have significantly higher likelihood of deaths from asphyxia. Therefore, predictors of neonatal mortality from perinatal asphyxia in our centre include being female and being born outside the hospital, as well as low oxygen saturations, heart rates, and respiratory rates at presentation

Negative Marking and the Student Physician–-A Descriptive Study of Nigerian Medical Schools

Background There is considerable debate about the two most commonly used scoring methods, namely, the formula scoring (popularly referred to as negative marking method in our environment) and number right scoring methods. Although the negative marking scoring system attempts to discourage students from guessing in order to increase test reliability and validity, there is the view that it is an excessive and unfair penalty that also increases anxiety. Feedback from students is part of the education process; thus, this study assessed the perception of medical students about negative marking method for multiple choice question (MCQ) examination formats and also the effect of gender and risk-taking behavior on scores obtained with this assessment method. Methods This was a prospective multicenter survey carried out among fifth year medical students in Enugu State University and the University of Nigeria. A structured questionnaire was administered to 175 medical students from the two schools, while a class test was administered to medical students from Enugu State University. Qualitative statistical methods including frequencies, percentages, and chi square were used to analyze categorical variables. Quantitative statistics using analysis of variance was used to analyze continuous variables. Results Inquiry into assessment format revealed that most of the respondents preferred MCQs (65.9%). One hundred and thirty students (74.3%) had an unfavorable perception of negative marking. Thirty-nine students (22.3%) agreed that negative marking reduces the tendency to guess and increases the validity of MCQs examination format in testing knowledge content of a subject compared to 108 (61.3%) who disagreed with this assertion (χ 2 = 23.0, df = 1, P = 0.000). The median score of the students who were not graded with negative marking was significantly higher than the score of the students graded with negative marking ( P = 0.001). There was no statistically significant difference in the risk-taking behavior between male and female students in their MCQ answering patterns with negative marking method ( P = 0.618). Conclusions In the assessment of students, it is more desirable to adopt fair penalties for discouraging guessing rather than excessive penalties for incorrect answers, which could intimidate students in negative marking schemes. There is no consensus on the penalty for an incorrect answer. Thus, there is a need for continued research into an effective and objective assessment tool that will ensure that the students’ final score in a test truly represents their level of knowledge

Perception of donor breast milk and determinants of its acceptability among mothers in a developing community: a cross-sectional multi-center study in south-east Nigeria

Abstract Background Due to the health and economic benefits of breast milk, the World Health Organization (WHO) recommends that for infants who cannot receive breast milk from their own mothers, the next preferred option is donated breast milk. This recommendation is however rarely practiced in most developing countries where donor milk is not widely accepted. Methods This cross-sectional multi-center study enrolled mothers attending antenatal or pediatric clinics in six tertiary institution in south-east Nigeria using purposive and convenient sampling method. Data collection was done using pretested questionnaires. The study aimed to assess the knowledge, acceptability and willingness to donate breast milk and/or use donated breast milk for their infants It also explored factors that determine this behavior. Results A total of 1235 mothers participated; 39% (480/1225) have heard about the concept of donor milk, while only 10% (79/759) and 7% (81/1179), respectively, had adequate knowledge of the concept and policy on donor milk. Sixty percent indicated willingness to use donor milk or donate breast milk if need arises. Respondents with lower age (p = 0.049) and with higher occupational status (p = 0.001) were more likely to have adequate knowledge of donor breast milk, while respondents with lower educational attainment (p = 0.002) and those who are non-Christians (p = 0.004) were more likely to request financial inducement for donating their breast milk. Adequate knowledge of the concept of donor milk (p = 0.001), preference of donor milk to infant formula (p = 0.001) and requirement of financial remuneration (p = 0.001) were the only significant predictors of willingness to donate and/or receive donated breast milk. Conclusion The knowledge of the concept of donor breast milk and awareness of policies regulating its practice in Nigeria is low, but the prospect of its acceptability is high among mothers surveyed in south-east Nigeria. Targeted public education by relevant government agencies in collaboration with clinicians, community and religious leaders about the concept of donor breast milk to families may help increase the acceptance and practice of donating breast milk and/or use of donated breast milk among mothers in the region