Perinatal asphyxia in a specialist hospital in Port Harcourt, Nigeria

Objectives: To find the prevalence, and identify risk factors and outcome in neonates who were admitted into the Braithewaite Memorial Specialist Hospital (BMSH) for perinatal asphyxia.Method: This was a descriptive cross sectional observational study of neonates with low Apgar scores admitted over a period of ten months into the Special Care Baby Unit of the BMSH. All babies with Apgar scores lessthan six at one minute and for whom consent was obtained were recruited consecutively. For outborn babies with no Apgar score recording, a history of poor cry from birth with either poor colour, respiratory distress, floppiness or loss of primitive reflexes were used.Results: One hundred and fifty seven of 630 babies admitted had perinatal asphyxia giving a prevalence of 29.4%. Mean gestational age of affected babies was 36.84±3.67 weeks, and mean birth weight was 3.0±0.9kg. Sixty two (39.5%) of their mothers had no antenatal care (ANC). Mode of delivery in 98 (62.4%) was caesarian section, of which 80(81.6%) were emergencies, many of whom had complications beforepresentation. One hundred and seven (68.2%) and 38(24.2%) babies,had Apgar Score of 4-5 and 0-3 in one minute respectively. The commonest risk factors were cephalopelvic disproportion (CPD) in the mothers and abnormal presentation, predominantly breech in the fetus. 31.6% of those with severe perinatal asphyxia died.Conclusion: Prevalence of perinatal asphyxia is high. Lack of ANC, CPD and breech presentation were contributory factors. There is urgent need for maternal education on need for ANC, early intervention and skilled care of babies at birth.Key words: perinatal asphyxia, newborns, specialist hospita

Discharge against medical advice amongst patients admitted into the Paediatric wards of the University of Port Harcourt Teaching Hospital

Objectives: To identify the characteristics of patients and factorscontributing to DAMA in paediatric patients admitted into the University of Port Harcourt Teaching Hospital and to determine waysto reduce its prevalence.Method: This was a retrospective study of children admitted into thepaediatric wards of the Hospital. Case files of affected patients over atwo year period were reviewed and relevant information obtained andanalyzed.Results: There were 150 of 3981 patients admitted over the periodgiving a prevalence rate of 3.8%. There were 86 (57.3%) males and64 females (42.7%) with a male: female ratio of 1.3:1. Neonatal sepsis,birth asphyxia and prematurity were the commonest diagnosis inneonates whilst severe malaria, meningitis and bronchopneumoniawere the commonest in other children. Most discharges (54%) occurredwithin the first week of admission. Majority of patients were from low (35.3%) and middle (41.3%) income classes. The commonestreasons for DAMA were lack of funds (26.6%) and no improvement(26.6%), necessitating need to seek alternative therapy. The discharge document was signed by the father in 61.3% of cases.Conclusion: Children who were DAMA suffered from commoncauses of childhood mortality. Lack of funds, no improvement and lack/low decision making power of mothers were contributory factors.There is need for more universal implementation of the NationalHealth Insurance Scheme; effective communication between medicalteam and parents and female empowerment to reduce rates ofDAMA in our environment

Mothers’ knowledge and practice of infant sleep position

Background: Prone sleeping by infants has been associated with increased risk of sudden infant death syndrome (SIDS). Many child caregivers continue to be unaware of the association of SIDS and infant  sleep position and/or are misinformed as to the risks and benefits of the various sleep positions.Objectives: To explore mothers’ knowledge and practice of infant sleep position and SIDS.Methods: The study was conducted in April – August 2012 amongst mothers of infants attending the Paediatric Outpatient Clinics of the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. A structured questionnaire was used to obtain information on biodata andknowledge and practice of infant sleep position and SIDS. Data were analyzed using SPSS version 16.0.Results: A total of 282 mothers participated in the study; 167 (59.2%) of them had tertiary education while 265 (94.0%) were married. The  commonest sleep position was prone position (44.3%).Baby’s comfort was the commonest reason for choice of position. There was no significantrelationship between mother’s age and education and choice of infant sleep position (p > 0.05).A total of 229(81.2%) respondents were unawareof any medically recommended sleep position. Of those who were aware, the commonest source of knowledge was grandmothers. A total of 99 (35.1%) respondents had heard of SIDS but over 80% of them did not know the cause.Conclusion: Mothers in Port Harcourt have poor knowledge of infant sleep position. Doctors should take more active part in educating mothers on safe child care practices.Key words: Infant sleep position, mothers, sudden infant death syndrome,Nigeri

Hand washing practices amongst medical students in Port Harcourt, Nigeria

Background: Hand washing with soap and water is one of the most effective and inexpensive means of preventing infections. Rates of hand washing are low world wide even amongst health care workers who are should know about its importance. The aim of the study was to evaluate the knowledge, attitudes and hand washing practices both in and outside the hospital amongst medical students in Port Harcourt.Method: This was a descriptive cross sectional survey carried out amongst randomly selected fourth to sixth year medical students of the University of Port Harcourt. A simple questionnaire exploring perceptions, attitudes and self reported behavior was used. Information obtained included biodata, awareness information and practice. Data were analyzed using descriptive statistics.Results: Two hundred and sixty one students participated in the study with a M: F of 1.5:1. Diarrhea diseases were most commonly recognised as being associated with contaminated hands. 37.6% washed their hands regularly after interacting with their patients while 33.9% did so only after the days work. 58.3% and 58.9% washed hands before meals and after defecating respectively. Use of soap was generally low. The greatest motivation for hand washing was fear of contracting disease, whilst constraints included lack of soap, forgetfulness and inconveniently located sinks.Conclusion: Hand washing rates are low amongst medical students in Port Harcourt. There is need for regular education and re-education.Key words: Hand washing practices; medical students; Port Harcourt

Newborn cord care practices amongst mothers in Port Harcourt, Nigeria

Background:Cord care is an important community based intervention to reduce morbidity and mortality in newborns. Poor cord care practices promote neonatal infections which account for a large proportion of the annual global neonatal deaths most of which are in Sub-Saharan Africa. This study explored cord care practices amongst mothers in Port Harcourt. Methods: This was a cross-sectional study carried out amongst mothers presenting with children 0-6 months old to the Paediatric Outpatient and Infant Welfare Clinics of the University of Port Harcourt Teaching Hospital. Data were collected using a simple structured questionnaire. Information obtained included biodata, age and sex of last baby, social class, place of antenatal care and delivery, and cord care practices. Data were analysed using SPSS version 16.0 Results: Two hundred and ten mothers participated in the study. 71.9% were of high social class. Over 80% received antenatal care in recognized Government hospitals, while 24 (11.5%) had traditional birth attendant (TBA)/home deliveries. Mothers' level of education was significantly associated with place of antenatal care and place of delivery (p= 0.000). 36.2% of mothers did not know what was used to cut baby's cord. 200 (95.3%) used methylated spirit to clean the cord but 69 (32.4%) applied potentially dangerous substances after cleaning with methylated spirit. 2.9% of mothers reported cord problems. Conclusion: Although most mothers had antenatal care in Government hospitals, there was a high rate of use of potentially dangerous substances for cord care. There is need for continued education of mothers on correct cord care practices

Mothers Perception of Sexuality Education for Children

Sexuality education is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. It develops young people's skills so that they make informed choices about their behaviour, and feel confident and competent about acting on these choices. It also equips children to face developmental challenges and empowers them against the ills of abuse, exploitation, unwanted pregnancies amongst others. Mothers who are the primary caregivers should be well informed about sexuality issues. The objective of the study is to determine mothers' perception of sexuality education in children, in Port Harcourt.A structured, anonymous and selfadministered questionnaire, used as instrument for data collection, was distributed amongst a convenient sample of women attending a Christian women's convention in Port Harcourt.One hundred and fifty eight women participated in the study. Most of them were married (80.4%), and belonged to the 30-49 years age bracket. Seventy one (44.9%) of the respondents had tertiary education. Over 80% agreed that children needed sexuality education but only 15 women (9.5%) had a good knowledge of the concept of sexuality education. One hundred and eleven (70.2%) believed it was the responsibility of both parents to educate their children and over 70% acknowledged that the home was the best place for such education. 64 (40.5%) believed that 6-10 years was the ideal age for starting sex education while 49% thought that the ideal age was 11-15 years. 65% of respondents discussed sexuality issues with their children at least occasionally,the content mostly involved description of body parts and reproductive organs. The average age of menarche amongst respondents was 14.0. One hundred (63%) of the women had prior knowledge of menstruation before menarche. About half of them had received information from their mothers.  The study highlights the need for enlightenment of women on sexuality education to enable them empower their children against the ills of child abuse.

Prevalence of alcohol consumption among secondary school students in Port Harcourt, Southern Nigeria

Background: Consumption of alcohol by secondary school students is a major public health concern globally, but its prevalence is not known in secondary schools in Port Harcourt.Objective: To determine the prevalence and factors associated with alcohol use among secondary school students in Port Harcourt.Methods: This was a cross sectional school based study conducted in Port Harcourt in March 2014. A 20 itemed structured, self -administered questionnaire was distributed to 1080 senior secondary 1 to 3 students from 10 public secondary schools selected through Multistage Sampling technique. Questions asked covered drinking of alcohol, frequency of drinking and being drunk in the past 30 days before the survey. Other behaviours sought were smoking of cigarette, use of cocaine and going out in the evening for fun. Sociodemographic was also sought. Data was analyzed using SPSS version 20.Results: 1080 students participated in the study, mean age 16.09±6SD and male to female ratio of 0.9: 1. Prevalence of current drinking of alcohol was 30.6% and 38.1% of current drinkers were also drunk in the past 30 days, with 17.2 % being very frequently drunk. The behaviour which showed a strong association with drinking of alcohol, being drunk and the frequency of being drunk was going out in the evening for fun and recreation. Gender showed a positive association with drinking of alcohol, as more males drank alcohol with in the past 30 days compared to the females (p=0.000). Smoking of cigarette in the past 30 days and truancy were positively associated with being drunk, while academic grades showed an inverse relationship with consumption of alcohol. Majority of those who drank alcohol (42.6%) were experimenting with alcohol, though 5.4% drank due to addiction. Majority (39.3%) bought their drinks from stores and supermarkets. The most Common problems experienced by the drinkers were fatigue, alcohol made them behave in ways they later regretted and it hurt their relationships.Conclusion: Alcoholism is a serious problem with secondaryschool students in Port Harcourt. It is linked with truancy, poor academic achievement and other substances use. The most serious health and social problem experienced by the drinkers is addiction.Keywords: Prevalence, Alcohol, Secondary school, Consumption

Mothers’ recognition of newborn danger signs and health seeking behaviour

Background: Early recognition of neonatal illnesses followed by  care-seeking and intervention are key factors in improving neonatal health and survival.Objectives: To assess mothers’ ability to recognize newborn dangersigns and actions taken by mothers in the event of neonatal illness.Methods: The study was carried out in three health centres in Yenagoa Metropolis from April to May 2011. A 15 itemed Questionnaire based on the WHO/UNICEF IMCI programme handbook was administered to 146 mothers with infants younger than three months. The mothers were asked to identify danger signs of neonatal illness from a list of symptoms, to indicate which of the listed symptoms their babies experienced, to state what actions were taken in response to the symptoms and reasons for notutilizing orthodox healthcare.Results: None of the listed symptoms was recognized by up to halfthe mothers as danger signs of neonatal illness, the best being fast breathing by 66 (45.2%) mothers. Eighty two (56.2%) mothers reportedthat their children experienced some of the neonatal danger signs: the commonest were difficult breathing and convulsions in 8 (9.8%) cases each. Unconsciousness and excessive crying were thought to be caused by evil spirits and consultations sought with faith healers. The major constraint to utilization of health facilities was cost {45(29.8%)}.Conclusion: Mothers’ recognition of danger signs in the newborn was poor. Self-medication and the use of home remedies delayed timely  consultation. The commonest reason for non-utilization of health facilities was lack of money.Keywords: Mothers, Newborns, Danger signs, Recognition, Health seeking

Reproductive health and lifestyle factors associated with health-related quality of life among perinatally HIV-infected adolescents in Uganda

Background With increased survival of perinatally HIV - infected adolescents due to antiretroviral therapy (ART), the focus of HIV care has shifted to health-related quality of life (HRQoL) as a measure of disease progression, effects of ART co-morbidity and prognosis. We assessed factors associated with better HRQoL in perinatally HIV -infected adolescents in Uganda by determining the associations between sexual and reproductive health (SRH) or lifestyle experiences on HRQoL. Methods In a cross-sectional study, data on SRH, lifestyle experiences, socio demographic factors, communication with parents on sexuality and satisfaction of SRH services in ART clinics were collected from 614 HIV perinatally infected adolescents aged 10–19 using an interviewer-administered survey questionnaire. HRQoL data were collected using the Medical Outcomes Study HIV Health Survey instrument (MOS-HIV). Factors associated with better HRQoL were analysed using multiple logistic regression. Results The mean age was 16.2 ± 2.1 years, 362 (58.8 %) were females and 210 (34.2 %) were sexually active. Adolescents on ART were twice likely to present with better physical health (AOR = 2.07, 95 % CI: 1.24–3.46) and four times more likely to present with better mental health (AOR = 3.9, 95 % CI: 2.22–6.92) than those who were not on ART. There were no statistically significant associations between SRH (ever had sex, ever been pregnant, condom use, contraceptive use) or life style factors and physical health or mental health. Those with secondary or tertiary education were more likely to present with a better mental health (AOR = 5.3, 95 % CI: 1.86–15.41) compared those who had attained primary or no education. Participants who desired to have a child in future more likely (AOR 1.7, 95 % CI: 1.05–3.00) to present with a better mental health. Lack of communication with guardians on sexuality (AOR = 0.6, 95 % CI: 0.40–0.89), or dissatisfaction with SRH services (AOR 0.34, 95 % CI: 0.18–0.62) were associated with poorer mental health. Conclusion Among perinatally HIV-infected adolescents in Uganda, being on ART was associated with better physical and mental health while lack of communication with guardians on sexuality or dissatisfaction with SRH services was associated with poor mental health. Adolescents with pregnancy intentions were more likely to have a better mental health

Attitude of nurses towards kidney transplantation in a tertiary health facility in Southern Nigeria

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