Challenges of caregivers and needs of children with parents in a Nigerian prison.

Background: Separation of a parent from the family as a result of incarceration has both short-term and long-term effects on the family, even after release from prison. This study is a report of factors and challenges of the family left to adapt to the changed circumstances of separation from parent(s) who are incarcerated. Methods: This was a cross sectional study carried out on 89 caregivers of children whose parents are incarcerated at the Agodi prison, Ibadan who gave informed and written consent to interview their families. Results: Most caregivers had little or no formal education (69.7%) and 67.4% are into petty trading or subsistence farming. A majority of the caregivers reported the need of schooling (85.4%), provision of food (84.3%) and medical care (71.9%) as major challenges, only 25% received any form of support to meet these needs. Twenty-nine (32.6%) respondents reported receiving financial support to provide for the child's feeding. Some caregivers 21 (23.6%), obtained loans to cope with the financial needs of the children while only 3 (3.4%) received support from family or other non-governmental organisations. Conclusion: The caregivers of children of prison inmates face significant challenges in meeting the needs of feeding, health and schooling. Support structures and policies to address these gaps are required.

Co-existing sickle cell anaemia and inflammatory bowel disease: case report and review of the literature.

Sickle cell anaemia (SCA) is a chronic haemolytic anaemia associated with vaso-occlusive painful crises which may affect several systems including the gastro-intestinal system, resulting in abdominal pain. The concurrence of inflammatory bowel disease and haemoglobinopathy is rare. No previously reported concurrent cases of both SCA and ulcerative colitis (UC) in sub-Saharan Africa were found in the literature. A 16-year-old girl with concurrent SCA and UC is presented. She was admitted to University College Hospital, Ibadan with a 1-year history of recurrent peri-umbilical pain and bloody stools. These symptoms were mainly attributed to SCA at the referring hospital, and she was managed for chronic tropical diarrhoea without a remarkable clinical response. This case illustrates the concurrent presentation of SCA and ulcerative colitis which led to the missed and delayed diagnosis of ulcerative colitis.

Human resource constraints and the prospect of task-sharing among community health workers for the detection of early signs of pre-eclampsia in Ogun State, Nigeria.

BACKGROUND: The dearth of health personnel in low income countries has attracted global attention. Ways as to how health care services can be delivered in a more efficient and effective way using available health personnel are being explored. Task-sharing expands the responsibilities of low-cadre health workers and allows them to share these responsibilities with highly qualified health care providers in an effort to best utilize available human resources. This is appropriate in a country like Nigeria where there is a shortage of qualified health professionals and a huge burden of maternal mortality resulting from obstetric complications like pre-eclampsia. This study examines the prospect for task-sharing among Community Health Extension Workers (CHEW) for the detection of early signs of pre-eclampsia, in Ogun State, Nigeria. METHODS: This study is part of a larger community-based trial evaluating the acceptability of community treatment for severe pre-eclampsia in Ogun State, Nigeria. Data was collected between 2011 and 2012 using focus group discussions; seven with CHEWs (n = 71), three with male decision-makers (n = 35), six with community leaders (n = 68), and one with member of the Society of Obstetricians and Gynaecologists of Nigeria (n = 9). In addition, interviews were conducted with the heads of the local government administration (n = 4), directors of planning (n = 4), medical officers (n = 4), and Chief Nursing Officers (n = 4). Qualitative data were analysed using NVivo version 10.0 3 computer software. RESULTS: The non-availability of health personnel is a major challenge, and has resulted in a high proportion of facility-based care performed by CHEWs. As a result, CHEWs often take on roles that are designated for senior health workers. This role expansion has exposed CHEWs to the basics of obstetric care, and has resulted in informal task-sharing among the health workers. The knowledge and ability of CHEWs to perform basic clinical assessments, such as measure blood pressure is not in doubt. Nevertheless, there were divergent views by senior and junior cadres of health practitioners about CHEWs' abilities in providing obstetric care. Similarly, there were concerns by various stakeholders, particularly the CHEWs themselves, on the regulatory restrictions placed on them by the Standing Order. CONCLUSION: Generally, the extent to which obstetric tasks could be shifted to community health workers will be determined by the training provided and the extent to which the observed barriers are addressed. TRIAL REGISTRATION: NCT01911494.

Mid-facial fractures: a 5-year retrospective review in a Nigerian teaching hospital.

OBJECTIVE: The aim of this study is to establish the pattern and actiology of mid-facial fractures, of patients seen and treated at the Lagos University Teaching Hospital, Lagos, Nigeria over a 5-year period. MATERIALS AND METHODS: All cases of midfacial fractures diagnosed and treated at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Lagos between January 2004 and December 2008 were reviewed. Data collected from case records of patients included age, sex, aetiology of fracture, anatomic site of fracture, associated maxillofacial fracture, types of treatment and postoperative complications. RESULTS: The leading cause of mid-facial fractures was road traffic crashes (RTC) which occurred in 93% of highest incidence of mid-facial fractures (36.5%) occurred in the age group of 21-30 years and the lowest in the age group of 60 years and above (2.6%); with male preponderance in nearly all age groups. Female patients were significantly younger than their male counterparts (P=0.000). The most common site of mid-facial bone fractures was the zygomatic complex (n=89, 44.5%), followed by dento-alveolar (n=26, 13%), and Le fort II (n=23, 12%). Conservative management of the fractures was employed in 2.6% (n=4) of the cases while 97.4% (n=152) of the patients required surgical, intervention CONCLUSIONS: Mid-facial fractures were most common in the 3rd decade of life; with a male-to-female ratio of 3.7: 1. Over 93% of the cases were due to road traffic crashes. Zygomatic complex was the most commonly fractured site. The fact that road traffic crashes still remain the major cause of mid-facial fracture in the studied environment is an indication that the enforcement of legislation to prevent road traffic crashes needs to be re-emphasised.

Orofacial and dental injuries associated with seizures in paediatric patients in Lagos University Teaching Hospital.

OBJECTIVE: To determine the prevalence and pattern of presentation of orofacial and dental injuries in children with seizures at the Children's Emergency Unit of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. METHODS: This was a prospective study of children with febrile or non-febrile convulsion who presented at the Children's Emergency Unit of LUTH between July 2008 and August 2009. The age, gender, type of convulsion and the presence/absence of orofacial and other bodily injuries were recorded in a proforma. Mechanism, type and classification of injury were recorded for patients with orofacial injuries. RESULTS: A total of 257 children (148 males and 109 females) with febrile/non-febrile convulsion were included in the analysis. The mean age (SD) of patients was 32.8 ± 40.5 months. There were 223 (86.8%) cases of febrile convulsion and 34 (13.3%) cases of non-febrile convulsion. Thirteen children sustained orofacial injuries giving a prevalence of 5.1%. There was no significant difference in the prevalence of orofacial injury between patients with febrile convulsion (4.5%) and those with non-febrile convulsion (8.8%) (P=0.282). The most common cause of orofacial injuries was forceful insertion of hard object into the mouth during convulsive episodes. Twelve (92.3%) patients sustained soft tissue injury, while one sustained both soft and hard tissue injuries. The most common site of injury was the lip. CONCLUSIONS: Oro-facial and dental injuries may occur in children with seizures. It is therefore important that these injuries be looked for by the paediatrician and the dentist/oral and maxillofacial surgeons should be involved in managing these children.

Cowpea embryo rescue. 1. Influence of culture media composition on plant recovery from isolated immature embryos.

Factors responsible for successful rescue of immature embryos of cowpea [Vigna unguiculata (L.) Walp.] and V. vexillata (L.) and for in vitro embryo development were studied. A new basal medium for embryo development in vitro was formulated on the basis of the mineral composition of embryos. Sucrose, fructose and glucose were compared as carbohydrate sources. The highest frequency of embryos developing into plants was obtained with sucrose. Adding casein hydrolysate to the medium increased plant recovery by 30%. Among the plant growth factors used, cytokinins, zeatin, 6-benzylaminopurine and kinetin were the most effective in promoting embryo maturation and development. A method that can routinely ensure high plant recovery from cultured immature cowpea embryos is proposed.