Rates and predictors of mortality of very low birthweight infants in three Nigerian tertiary hospitals.

AIM: We aimed to describe in-hospital mortality, and its predictors, in very low birthweight (VLBW) infants managed in tertiary centres in a low- to middle-income country. METHODS: This was a retrospective cohort study of VLBW infants (birthweight 500 to 1500 grams) admitted within 72 h of life to the neonatal intensive care units (NICUs) of three tertiary centres in Nigeria from July 2017 to March 2021. We describe in-hospital mortality rates, causes and when they died. The independent predictors of in-hospital mortality were determined using multivariate logistic analysis. RESULTS: Of the 6187 NICU admissions, 1161 met the inclusion criteria: 545 (47%) VLBW infants died, including 309 (57%) from respiratory distress syndrome, and 55% occurred within 72 h of life. The adjusted odds (aOR) for mortality increased with each extra Downes respiratory distress score (aOR 1.27) with a 95% confidence interval (CI) of 1.14-1.41. Study site 3 had a higher aOR for mortality than site 1 (aOR 2.78, 95% CI 1.72-4.48) and site 2 (aOR 2.29, 95% CI 1.45-3.61). CONCLUSION: Nearly half (47%) of all VLBW infants admitted to three tertiary referral hospitals in Nigeria died during hospitalisation. Mortality varied significantly by site and both the centre and respiratory distress independently predicted mortality.

Socio-demographic factors influencing measures of cognitive function of early adolescent students in abuja, Nigeria.

Background: The brain in the early adolescent period undergoes enhanced changes with the radical reorganisation of the neuronal network leading to improvement in cognitive capacity. A complex interplay exists between environment and genetics that influences the outcome of intellectual capability. We, therefore, aimed to evaluate the relationship between socio-demographic variables and measures of cognitive function (intelligence quotient [IQ] and academic performance) of early adolescents. Methods: The study was a descriptive cross-sectional study of early adolescents aged 10-14 years. Raven's Standard Progressive Matrices was used to assess the IQ and academic performance was assessed by obtaining the average of all the subjects' scores in the last three terms that made up an academic year. A confidence interval of 95% was assumed and a value of P < 0.05 was considered statistically significant. Results: The overall mean (standard deviation) age of the study population was 11.1 years (±1.3) with male-to-female ratio of 1:1. Female sex was associated with better academic performance with P = 0.004. The students with optimal IQ performance were more likely (61.7%) to perform above average than those with sub-optimal IQ performance (28.6%). As the mother's age increased, the likelihood of having optimal IQ performance increased 1.04 times (odds ratio [OR] = 1.04; 95 confidence interval [CI] = 1.01-1.07). Students in private schools were three times more likely to have optimal IQ performance than those from public schools (OR = 2.79; 95 CI = 1.65-4.71). Conclusion: The present study demonstrated that students' IQ performance and the female gender were associated with above-average academic performance. The predictors of optimal IQ performance found in this study were students' age, maternal age and school type.

Pattern of haemoglobin phenotypes in newborn infants at the national hospital abuja using high performance liquid chromatography.

BACKGROUND: Haemoglobin (Hb) disorders are among the most common blood genetic disorders worldwide, and they constitute an important cause of morbidity and mortality, especially in Nigeria. Despite the clinical significance of early diagnosis, newborn screening for these conditions is not routinely done in Nigeria. OBJECTIVE: This study was undertaken to document the pattern of Hb phenotypes of newborn babies at the National Hospital Abuja and highlight the relevance of neonatal screening for early diagnosis of abnormal Hb phenotypes in Nigeria. SUBJECTS AND METHODS: A prospective study of eligible newborn babies delivered in the hospital at the study site was undertaken following parental informed consent. Venous blood was collected from the babies into an ethylenediaminetetraacetic acid sample bottles. The samples were analysed using high-performance liquid chromatography (HPLC) techniques, and the Hb phenotypes obtained were documented. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20 (IBM-SPSS, Armonk, NY, USA). RESULTS: Three hundred and eleven newborns (male = 173, female = 138) aged 0-28 days were recruited. Two hundred and thirty-six (75.9%) babies had Hb AA (FA) phenotype, 63 (20.3%) Hb AS (FAS), 6 (1.9%) Hb SS (FS), 4 (1.3%) Hb AC (FAC) and 2 (0.6%) had abnormal HbA variants. The overall prevalence of abnormal Hb phenotype was 24.1%. The results showed a significant association of sex (P = 0.003) and ethnicity (P = 0.047) with Hb phenotype. CONCLUSION: There is a wide spectrum of abnormal Hb phenotypes in Nigeria, and these phenotypes can easily be detected at birth using HPLC. We, therefore, recommend routine neonatal screening for sickle cell disease by HPLC in Nigeria.

Audit of prevention of mother-to-child transmission programme interventions in HIV-Exposed children at national hospital, Abuja, Nigeria.

BACKGROUND: Ninety percentage of children acquire human immunodeficiency virus (HIV) infection in the form of Mother-to-child Transmission (MTCT). In the absence of interventions, transmission rates range from 15% to 45%. This can be reduced to below 5% with effective interventions. The last published national guideline (NG) on prevention of MTCT (PMTCT) was in 2010. Clinical audits are essential in improving the quality of care delivered to patients. OBJECTIVES: The study objectives were to determine the rate of MTCT of HIV in exposed infants at a follow-up clinic between 2011 and 2014 and to determine the level of adherence to 2010 NG on the use of highly active antiretroviral therapy (HAART), polymerase chain reaction (PCR) testing, feeding options, antiretroviral (ARV) prophylaxis and the use of co-trimoxazole (CTZ). METHODS: A retrospective review of data was done over 4 years. The population consisted of babies delivered through PMTCT programme and those referred to the clinic from other centres. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 21. RESULTS: Out of 699 babies enrolled, MTCT occurred in 22 babies (3.2%) and PCR testing was done in 445 babies (64.7%), most in the 1-2 months' age group. Breastfeeding was practiced in 402 (58.2%) babies, while about 88.0% of them received post-exposure ARV prophylaxis (PEP). CTZ prophylaxis was offered to only 226 (34.6%) babies. The regression model showed that maternal use of HAART and PEP for babies was independently associated with a reduction in transmission rate. CONCLUSION: The MTCT rate was 3.2%. There is a need to strengthen service provision to adhere to NG, especially on breastfeeding and CTZ prophylaxis.

Colonisation of hospital surfaces from low- and middle-income countries by extended spectrum ß-lactamase- and carbapenemase-producing bacteria.

Hospital surfaces can harbour bacterial pathogens, which may disseminate and cause nosocomial infections, contributing towards mortality in low- and middle-income countries (LMICs). During the BARNARDS study, hospital surfaces from neonatal wards were sampled to assess the degree of environmental surface and patient care equipment colonisation by Gram-negative bacteria (GNB) carrying antibiotic resistance genes (ARGs). Here, we perform PCR screening for extended-spectrum ß-lactamases (blaCTX-M-15) and carbapenemases (blaNDM, blaOXA-48-like and blaKPC), MALDI-TOF MS identification of GNB carrying ARGs, and further analysis by whole genome sequencing of bacterial isolates. We determine presence of consistently dominant clones and their relatedness to strains causing neonatal sepsis. Higher prevalence of carbapenemases is observed in Pakistan, Bangladesh, and Ethiopia, compared to other countries, and are mostly found in surfaces near the sink drain. Klebsiella pneumoniae, Enterobacter hormaechei, Acinetobacter baumannii, Serratia marcescens and Leclercia adecarboxylata are dominant; ST15 K. pneumoniae is identified from the same ward on multiple occasions suggesting clonal persistence within the same environment, and is found to be identical to isolates causing neonatal sepsis in Pakistan over similar time periods. Our data suggests persistence of dominant clones across multiple time points, highlighting the need for assessment of Infection Prevention and Control guidelines.

Identifying challenges in implementing child rights instruments in Nigeria: A nationwide survey of knowledge, perception, and practice of child rights among doctors and nurses.

Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm. Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses. Materials and Methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds. Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000). Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial.

Résumé Contexte: Après trente ans de ratification de la convention sur les droits de l'enfant et dix-neuf ans de la loi sur les droits de l'enfant, la mise en œuvre des instruments relatifs aux droits de l'enfant reste difficile au Nigéria. Les fournisseurs de soins de santé sont bien placés pour changer le paradigme actuel. Objectif: Examiner la connaissance, la perception et la pratique des droits de l'enfant et l'influence de la démographie parmi les médecins et les infirmières nigérians. Matériels et méthodes: Une enquête en ligne descriptive et transversale a été réalisée à l'aide d'un échantillonnage non probabiliste. Un questionnaire à choix multiples prétesté a été diffusé dans les six zones géopolitiques du Nigeria. Les performances ont été mesurées sur les échelles de fréquence et de rapport. Les scores moyens ont été comparés aux seuils de 50 % et 75 %. Résultats: Au total, 821 praticiens ont été analysés (médecins, 49,8 % ; infirmiers, 50,2 %). Le ratio femmes/hommes était de 2 : 1 (médecins, 1,2 : 1 ; infirmières, 3,6 : 1). Dans l'ensemble, le score de connaissances était de 45,1 % ; les deux groupes avaient des scores similaires. Les plus informés étaient les titulaires d'une bourse (53,2 %, P = 0,000) et les pédiatres (50,6 %, P = 0,000). Le score de perception était de 58,4 % dans l'ensemble, et les performances étaient également similaires dans les deux groupes ; les femmes et les sudistes ont obtenu de meilleurs résultats (59,2 %, P = 0,014 et 59,6 %, P = 0,000, respectivement). Le score de pratique était de 67,0 % dans l'ensemble ; les infirmières ont obtenu de meilleurs résultats (68,3 % contre 65,6 %, P = 0,005) et les infirmières post-base ont obtenu le meilleur score (70,9 %, P = 0,000). Conclusions: Dans l'ensemble, les connaissances de nos répondants sur les droits de l'enfant étaient médiocres. Leurs performances en perception et en pratique étaient bonnes, mais pas suffisantes. Même si nos conclusions ne s'appliquent peut-être pas à tous les agents de santé au Nigeria, nous pensons que l'enseignement des droits de l'enfant à différents niveaux de la formation médicale et infirmière sera bénéfique. Les engagements des parties prenantes impliquant des médecins praticiens sont cruciaux. Mots-clés: droits de l'enfant, travailleurs de la santé, connaissances, Nigéria, perception, pratique.

Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting.

BACKGROUND: In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource-constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. METHODS: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children with AKI over a 6-month period were reviewed. RESULTS: Sixty (50.4%) of 119 children ingested "My pikin" teething syrup. Compared to children who had not ingested it, they were significantly (p < 0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. CONCLUSIONS: Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.

Thanatophoric Dysplasia: A Report of 2 Cases with Antenatal Misdiagnosis.

Thanatophoric dysplasia (TD) is a rare but uniformly lethal inherited disorder of the skeletal system resulting from defects in the fibroblast growth factor receptor-3 gene on the short arm of chromosome ##4. It is characterised by pronounced shortening of the tubular bones resulting in significant short stature, macrocephaly, a funnel-shaped chest, protuberant abdomen, redundant skin in the limbs, and typical facies among others. The two clinical types of TD are differentiated by typical cranial and tubular bone configurations. Antenatal diagnosis is usually made in the last trimester and corroborated at birth. We present 2 cases of TD seen at Barau Dikko Teaching Hospital (BDTH) between January and August 2021 to highlight the potential difficulty with antenatal diagnosis, its diagnostic features, and associated early postnatal fatality. The antenatal diagnosis was missed in both cases in spite of repeated 2nd and 3rd-trimester sonographic examinations. Both babies presented with remarkable micromelic short stature with the telephone-handle appearance of the femoral bones characteristic of type 1 TD, developed progressive respiratory distress at birth, and died within 36 hours of life despite respiratory support with Bubble CPAP. These cases are discussed along with a review of existing relevant literature.

Aplasia cutis congenita: a report of two cases from National Hospital Abuja, Nigeria and review of the literature.

Aplasia cutis congenita is a rare congenital abnormality first described in 1767 by cordon. It mostly appears as a solitary lesion involving various layers of the skin and sometimes the bone on the scalp, limbs or abdomen. Genetics, environmental and exogenous causes have been implicated as potential causes. Only about 500 cases have been reported globally as of 2013. Two cases of Aplasia Cutis Congenita (ACC) who presented with scalp and bone defects at birth are reported, one in a syndromic child delivered to a consanguineous family, with associated cardiac, skin and nail anomalies (likely Adams Oliver syndrome) and the other as an isolated scalp lesion. Both were large defects managed conservatively by a multidisciplinary team. The challenges of investigating and managing such complex scalp anomalies in sub-Saharan Africa are highlighted.

Decreasing birth asphyxia: utility of statistical process control in a low-resource setting.

The neonatal period is a critical time for survival of the child. A disproportionate amount of neonatal deaths occur in low-resource countries and are attributable to perinatal events, especially birth asphyxia. This project aimed to reduce the incidence of birth asphyxia by 20% by June 2014 through training in neonatal resuscitation and improving the availability of resuscitation equipment in the delivery room in the National Hospital Abuja, Nigeria. A prospective, longitudinal study using statistical process control analytical methods was done enrolling babies delivered at the National Hospital Abuja. Low Apgar scores or birth asphyxia (defined a priori as any score <7 at 1, 5 and/or at 10 min) was assessed. To ensure reliability and validity of Apgar scoring, trainings on scoring were held for labour and delivery staff. Interventions included provision of additional equipment and trainings on neonatal resuscitation. Apgar scores were aggregated weekly over 25 months. Control charts with three SE confidence limits were used to monitor the proportion of scores ≤7. The baseline incidence of low Apgar scores, as defined a priori, was 33%, 17% and 10% while postintervention the incidence was 18%, 17% and 6% at 1, 5 and 10 min, respectively-a reduction of 45% and 40% in the 1-min and 10-min low Apgar scores. Increased communication, additional resuscitation equipment and training of delivery personnel on neonatal resuscitation are associated with reductions in measures of birth asphyxia. These improvements have been sustained and efforts are ongoing to spread our interventions to other special care delivery units/nursery in adjoining states. Our study demonstrates the feasibility and utility of using improvement science methods to assess and improve perinatal outcome in low-resource settings.

Identifying challenges in implementing child rights instruments in Nigeria: A nationwide survey of knowledge, perception, and practice of child rights among doctors and nurses

Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm. Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses. Materials and methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds. Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000). Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial