Causes of stillbirth in a community survey in Gombe State

Background: Perinatal mortality rate is very high in North Eastern Nigeria mainly due to a large number of still births. The causes and factors related need to be identified so as to proffer solutions with a view to improving obstetric practice and perinatal survival.Objectives: To identify the causes and factors related to stillbirths in Dukku Local Government Area of Gombe state.Methodology: A prospective study that was both hospital and community based, in which parturients were recruited in their last trimester and followed up till delivery. The fetal outcome was recorded and still birth rate calculated.Results: Five hundred and two parturient mothers were recruited. They delivered a total of 520 babies, amongst whom were eighteen sets of twins; five hundred of these were live births. There were 20 still births, giving a stillbirth rate of 38.5/1000. Causes of stillbirth include unbooked and early pregnanacies as well as deliveries unattended to by trained health personnel.Conclusion: Lack of antenatal Care, home delivery and teenage pregnancy were important factors contributing to high still birth rate in Dukku LGA of Gombe State.Key Words: Stillbirth, Perinatal, Mortality

Congenital bilateral fusion of the maxillomandibular alveolar processes with craniosynostosis: report ofa rare case

A rare congenital anomaly of maxillomandibular fusion with pectus excavatum and craniosynostosis in a neonate is presented. The child was kept alive by nasogastric tube feeding.Amodification of classification of syngnathia is proposed. The aetiopathogenesis and difficulty in management in our environment are discussed. Keywords: Bilateral; alveolar fusion; craniosynostosis; pectus excavatum Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.78-8

COVID-19 and routine childhood immunization in Africa : leveraging systems thinking and implementation science to improve immunization system performance

CITATION: Adamu, A. A. et al. 2020. COVID-19 and routine childhood immunization in Africa: Leveraging systems thinking and implementation science to improve immunization system performance. International journal of infectious diseases, 98:161–165. doi:10.1016/j.ijid.2020.06.072The original publication is available at https://www.journals.elsevier.com/international-journal-of-infectious-diseasesOne of the routine health services that is being disrupted by coronavirus disease 2019 (COVID-19) in Africa is childhood immunization. This is because the immunization system relies on functioning health facilities and stable communities to be effective. Its disruption increases the risk of epidemics of vaccine-preventable diseases, which could increase child mortality. Therefore, policymakers must quickly identify robust and context-specific strategies to rapidly scale-up routine immunization in order to mitigate the impact of COVID-19 on their national immunization performance. To achieve this, we propose a paradigm shift towards systems thinking and use of implementation science in immunization decision-making. Systems thinking can inform a more nuanced and holistic understanding of the interrelationship between COVID-19, its control strategies, and childhood immunization. Tools like causal loop diagrams can be used to explicitly illustrate the systems structure by identifying feedback loops. Once mapped and leverage points for interventions have been identified, implementation science can be used to guide the rapid uptake and utilization of multifaceted evidence-based innovations in complex practice settings. As Africa re-strategizes for the post-2020 era, these emerging fields could contribute significantly in accelerating progress towards universal access to vaccines for all children on the continent despite COVID-19.https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1201971220305075?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1201971220305075%3Fshowall%3Dtrue&referrer=Publishers versio

Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria : a theory-informed cross-sectional study

Background: Patent and proprietary medicine vendors (PPMVs) are widespread in communities and can potentially be used to expand access to routine immunization especially in underserved areas. In this study, we aimed to assess their readiness to implement routine immunization in Kano, Nigeria and identify factors associated with it. Methods: We conducted a cross-sectional survey of PPMVs aged 18 years and above in Kano metropolis, Nigeria, using cluster sampling technique. A 10-item Likert scale-based measure was used to estimate readiness score. The relationship between selected factors and readiness score was examined using multilevel linear modeling technique. Results: A total of 455 PPMVs with median age of 36 years participated in the study. The median raw score for readiness was 4.7 (IQR: 4.3 – 4-8) (maximum obtainable was 5). The mean readiness score (obtained through factor analysis) was 5.28 (SD: 0.58). Readiness score was associated with factors such as knowledge of immunization and task demand, engagement by other public health programs among others. Conclusion: This study demonstrated the feasibility of measuring the level of readiness for implementing routine immunization among PPMVs. Given the high level of readiness, policy makers should consider the possibility of expanding access to immunization through PPMVs

Compositional analysis of the associations between 24-h movement behaviours and cardio-metabolic risk factors in overweight and obese adults with pre-diabetes from the PREVIEW study: cross-sectional baseline analysis

Background: Physical activity, sedentary time and sleep have been shown to be associated with cardio-metabolic health. However, these associations are typically studied in isolation or without accounting for the effect of all movement behaviours and the constrained nature of data that comprise a finite whole such as a 24 h day. The aim of this study was to examine the associations between the composition of daily movement behaviours (including sleep, sedentary time (ST), light intensity physical activity (LIPA) and moderate-to-vigorous activity (MVPA)) and cardio-metabolic health, in a cross-sectional analysis of adults with pre-diabetes. Further, we quantified the predicted differences following reallocation of time between behaviours. Methods: Accelerometers were used to quantify daily movement behaviours in 1462 adults from eight countries with a body mass index (BMI) ≥25 kg·m− 2 , impaired fasting glucose (IFG; 5.6–6.9 mmol·l − 1 ) and/or impaired glucose tolerance (IGT; 7.8–11.0 mmol•l − 1 2 h following oral glucose tolerance test, OGTT). Compositional isotemporal substitution was used to estimate the association of reallocating time between behaviours. Results: Replacing MVPA with any other behaviour around the mean composition was associated with a poorer cardio-metabolic risk profile. Conversely, when MVPA was increased, the relationships with cardiometabolic risk markers was favourable but with smaller predicted changes than when MVPA was replaced. Further, substituting ST with LIPA predicted improvements in cardio-metabolic risk markers, most notably insulin and HOMA-IR. Conclusions: This is the first study to use compositional analysis of the 24 h movement composition in adults with overweight/obesity and pre-diabetes. These findings build on previous literature that suggest replacing ST with LIPA may produce metabolic benefits that contribute to the prevention and management of type 2 diabetes. Furthermore, the asymmetry in the predicted change in risk markers following the reallocation of time to/from MVPA highlights the importance of maintaining existing levels of MVPA. Trial registration: ClinicalTrials.gov (NCT01777893)

Association between age of cannabis initiation and gray matter covariance networks in recent onset psychosis

Cannabis use during adolescence is associated with an increased risk of developing psychosis. According to a current hypothesis, this results from detrimental effects of early cannabis use on brain maturation during this vulnerable period. However, studies investigating the interaction between early cannabis use and brain structural alterations hitherto reported inconclusive findings. We investigated effects of age of cannabis initiation on psychosis using data from the multicentric Personalized Prognostic Tools for Early Psychosis Management (PRONIA) and the Cannabis Induced Psychosis (CIP) studies, yielding a total sample of 102 clinically-relevant cannabis users with recent onset psychosis. GM covariance underlies shared maturational processes. Therefore, we performed source-based morphometry analysis with spatial constraints on structural brain networks showing significant alterations in schizophrenia in a previous multisite study, thus testing associations of these networks with the age of cannabis initiation and with confounding factors. Earlier cannabis initiation was associated with more severe positive symptoms in our cohort. Greater gray matter volume (GMV) in the previously identified cerebellar schizophrenia-related network had a significant association with early cannabis use, independent of several possibly confounding factors. Moreover, GMV in the cerebellar network was associated with lower volume in another network previously associated with schizophrenia, comprising the insula, superior temporal, and inferior frontal gyrus. These findings are in line with previous investigations in healthy cannabis users, and suggest that early initiation of cannabis perturbs the developmental trajectory of certain structural brain networks in a manner imparting risk for psychosis later in life

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Determinants of discharge against medical advice amongst neonates admitted at Federal Teaching Hospital Gombe, Nigeria

Objective: Discharge Against Medical Advice (DAMA) is a major problem in health care delivery in Nigeria. Children, especially neonates, who can neither understand nor contribute to decision concerning their own health, are the most commonly affected. The objective of this study was to identify the reasons proffered for DAMA in neonates and persons involved in making such decisions. Materials and methods: A descriptive study of consecutive neonates who were discharged against medical advice from the Special Care Baby Unit at Federal Teaching Hospital (FTH), Gombe from January 2016 to December 2017. Patients’ Biodata, Diagnosis, Socio demographic characteristics of both parents, relationship of the person signing DAMA with the patient and the reason (s) for signing DAMA were recorded in a proforma. Results: Out of the 1,110 neonates admitted during the study period, 103 were discharged against medical advice giving a DAMA rate of 9.3%: Male 50(48.5%) and Female 53(51.5%). Majority 98(95.1%) of DAMA cases were signed by the father and the main reason stated for DAMA was financial constraint 62(60.2%). Conclusion: Financial constraint was the main stated reason for DAMA and the father was the signatory to DAMA in majority of newborn in FTH, Gombe

Assessing the Implementation Determinants of Pilot Malaria Vaccination Programs in Ghana, Kenya, and Malawi through a Complexity Lens: A Rapid Review Using a Consolidated Framework for Implementation Research

In 2019, national immunization programs in Ghana, Kenya, and Malawi commenced the implementation of RTS,S/AS01 vaccination in large-scale pilot schemes. Understanding the implementation context of this malaria vaccination in the pilot countries can provide useful insights for enhancing implementation outcomes in new countries. There has not yet been a proper synthesis of the implementation determinants of malaria vaccination programs. A rapid review was conducted to identify the implementation determinants of the pilot malaria vaccination programs in Ghana, Kenya, and Malawi, and describe the mechanism by which these determinants interact with each other. A literature search was conducted in November 2023 in PubMed and Google Scholar to identify those studies that described the factors affecting malaria vaccine implementation in Ghana, Kenya, and Malawi. Thirteen studies conducted between 2021 and 2023 were included. A total of 62 implementation determinants of malaria vaccination across all five domains of the consolidated framework for implementation research (CFIR) were identified. A causal loop diagram showed that these factors are interconnected and interrelated, identifying nine reinforcing loops and two balancing loops. As additional countries in Africa prepare for a malaria vaccine roll-out, it is pertinent to ensure that they have access to adequate information about the implementation context of countries that are already implementing malaria vaccination programs so that they understand the potential barriers and facilitators. This information can be used to inform context-specific systems enhancement to maximize implementation success. Going forward, primary implementation studies that incorporate the causal loop diagram should be integrated into the malaria vaccine implementation program to enable immunization program managers and other key stakeholders to identify and respond to emerging implementation barriers in a timely and systematic manner, to improve overall implementation performance