Survey of Umbilical Cord care and Separation time in Healthy Newborns in Kano

Background: The interval between delivery and umbilical cord separation varies worldwide. Some maternal, foetal and perinatal factors includingcord care practices are known to affect this interval. Objectives: To establish the mean umbilical cord separation time and the effect of maternal and infant characteristics, perinatal factors and cord care practices on this time among healthy babies in northern Nigeria. Methods : An interviewer questionnaire was administered on mothers of healthy babies at Child Welfare Clinics of a tertiary and secondary level hospital in Kano.In each case, information was obtained about mother's parity, place of antenatal care and delivery, gestational age, birth weight, time of umbilical cord separation after birth and cord treatment practices. Results: Five hundred and seventy seven (96.2 percent) of 600 mothers interviewed, took part in the study, four of these mothers had twin gestation. Responses showed that cord separation time ranged from 2 -14 days (4.20 1.70)Three hundred and forty nine (60.9. percent ) mothers applied methylated spirit, 145 (25.3 percent) used hot compress, while50 (8.7 percent) applied toothpaste on the cord. Twenty (3.5 percent)others applied herbs, while nine (1.6 percent) applied dusting powder to the umbilical stump. Cord s epa r a t ion t ime wa s significantly shorter among babies whose mothers were of high parity, unbooked, and of low educational status. In addition, the use of razor blade, thread, hot compress or application of herbal preparations or toothpas te s igni f icant ly shortened the separation time (P<0.05). Conclusions: Cord separation time and cord care practices varied. Nigerian mothers often use unorthodox interventions to shorten cord separation time; however, therisk of omphalitis that may result from this is real. We recommendthat each centre should adopt and teach mothers a standard hygieniccord care practice while discouraging the use of herbs and untested materials.Keywords: Umbilical cord, Separation time, Cord care, Kan

Awareness and attitude of primary school teachers in Kano metropolis, Nigeria towards pupils with learning disabilities, how effective is the school health programme?

Teachers have central role in identification and management of children with learning disabilities. Objectives: Ten years after drafting the national guidelines for implementation of school health programme in Nigeria, this study assessed awareness and attitude of primary school teachers in Kano metropolis towards children with learning disabilities as proxy for the effectiveness of school health programme. Method: A descriptive cross-sectional design was used to study a random sample of 186 primary school teachers in Kano. Data was collected with the aid of a self-administered semi-structured questionnaire, and analyzed using IBM SPSSStatistics for Windows, version 22. Result: The mean age of the teachers was 32.8 ± 7.8 years. Majority had post-secondary school education 170(91.9%) and had worked for an average of 7.5 ± 6.8 years. About half 98(53.0%) were aware of a link between lack of academic progression in children and some probable medical condition(s), but none of them knew the characteristics of learning disabilities. About one-quarter of the teachers 52(28.1%) had negative attitude towards pupils with learning disability. Teaching in a large class was the only factor that emerged as the independent predictor of the teachers' positive attitude towardsstudents with learning disabilities. Conclusion: Majority of the teachers had positive attitude towards pupils with learning disabilities but none of them could identify the features of such children. Ministries of health and education should work closely with development partners and interested researchers to resuscitate the school health programme

Capacity Building for Primary Stroke Prevention Teams in Children Living With Sickle Cell Anemia in Africa

Background: Nigeria has the highest proportion of children with sickle cell anemia (SCA) globally; an estimated 150,000 infants with SCA are born annually. Primary stroke prevention in children with SCA must include Nigeria. We describe capacity-building strategies in conjunction with two National Institutes of Health–funded primary stroke prevention trials (a feasibility trial and phase III randomized controlled trial) with initial hydroxyurea treatment for children with SCA and abnormal transcranial Doppler (TCD) velocities in Nigeria. We anticipated challenges to conducting clinical trials in a low-resource setting with a local team that had not previously been involved in clinical research and sought a sustainable strategy for primary stroke prevention. Methods: This is a descriptive, prospective study of challenges, solutions, and research teams in two trials that enrolled a total of 679 children with SCA. Results: As part of the capacity-building component of the trials, over eight years, 23 research personnel (physicians, nurses, research coordinators, a statistician, and a pharmacist) completed a one-month research governance and ethics training program at Vanderbilt University Medical Center, USA. A lead research coordinator for each site completed the Society of Clinical Research Professionals certification. TCD machines were donated; radiologists and nonradiologists were trained and certified to perform TCD. A scalable E-prescription was implemented to track hydroxyurea treatment. We worked with regional government officials to support ongoing TCD-based screening and funding for hydroxyurea for children with SCA at a high risk of stroke. Conclusions: Our trials and capacity building demonstrate a sustainable strategy to initiate and maintain pediatric SCA primary stroke prevention programs in Africa

Primary prevention of stroke in children with sickle cell anemia in sub-Saharan Africa: rationale and design of phase III randomized clinical trial

Strokes in children with sickle cell anemia (SCA) are associated with significant morbidity and premature death. Primary stroke prevention in children with SCA involves screening for abnormal transcranial Doppler (TCD) velocity coupled with regular blood transfusion therapy for children with abnormal velocities, for at least one year. However, in Africa, where the majority of children with SCA live, regular blood transfusions are not feasible due to inadequate supply of safe blood, cost, and the reluctance of caregivers to accept transfusion therapy for their children. We describe the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria Trial [ S troke Pr evention i n N i g eria (SPRING) trial, NCT02560935], a three-center double-blinded randomized controlled Phase III clinical trial to 1) determine the efficacy of moderate fixed-dose (20 mg/kg/day) versus low fixed-dose (10 mg/kg/day) hydroxyurea therapy for primary stroke prevention; 2) determine the efficacy of moderate fixed-dose hydroxyurea for decreasing the incidence of all cause-hospitalization (pain, acute chest syndrome, infection, other) compared to low fixed-dose hydroxyurea. We will test the primary hypothesis that there will be a 66% relative risk reduction of strokes in children with SCA and abnormal TCD measurements, randomly allocated, for a minimum of three years to receive moderate fixed-dose versus low fixed-dose hydroxyurea (total n = 220). The results of this trial will advance the care of children with SCA in sub-Saharan Africa, while improving research capacity for future studies to prevent strokes in children with SCA