Determinants and outcomes of preterm births in Nigerian tertiary facilities.

OBJECTIVE: To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria. DESIGN: Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) Programme. SETTING: Data from births in 54 referral-level hospitals across Nigeria between 1 September 2019 and 31 August 2020. POPULATION: A total of 69 698 births. METHODS: Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality. OUTCOME MEASURES: Preterm birth and preterm perinatal mortality. RESULTS: Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years - adjusted odds ratio [aOR] 1.52, 95% CI 1.36-1.71; >35 years - aOR 1.23, 95% CI 1.16-1.30), no formal education (aOR 1.68, 95% CI 1.54-1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61-2.34) and no antenatal care (aOR 2.62, 95% CI 2.42-2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20-1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02-1.83), no antenatal care (aOR 2.74, 95% CI 2.04-3.67), earlier gestation (28 to <32 weeks - aOR 2.94, 95% CI 2.15-4.10; 32 to <34 weeks - aOR 1.80, 95% CI 1.3-2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54-36.33) were associated with preterm perinatal mortality. CONCLUSIONS: Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio-economic status.

Prevalence of hepatitis B virus infection among children attending the outpatient clinic of a tertiary health centre in Southwest Nigeria.

Introduction: hepatitis B virus (HBV) infection is a global health disease. One-third of the world´s population is reportedly infected with the virus. Infections in children are mostly perinatal and therefore acquired early in life, with a propensity to evolve into chronic diseases and their attendant life-threatening complications. Early diagnosis can, however, improve outcomes in this group of children. The study aimed to determine the prevalence of HBV among children attending the outpatient clinic of a tertiary hospital in Southwest Nigeria. Methods: we recruited a total of one hundred and ninety-eight children aged 6 months to 18 years from the children´s outpatient clinic of a tertiary health centre, using the systematic sampling technique. HBsAg was tested using the HBsAg test kit (PRO-med®, China), and the anti-HBs antibody was tested using the ELISA method. Data were analysed using SPSS version 26. Results: of the 198 children that were screened, 2 (1.0%) were positive. Of these, one (50.0%) had a Hepatitis B positive mother and was HBeAg positive. Two-thirds of the children had received the hepatitis B vaccine, as evidenced by caregivers´ recall, or sighting of the immunization record. There was no statistically significant relationship between the hepatitis B status of the children and the sociodemographic parameters. Conclusion: the study supports the fact that paediatric HBV infections are transmitted from mother to child. Though the prevalence of HBsAg in the study population was lower than the national average for the country, routine immunization program should be strengthened for further control of HBV. Age and gender were not significantly associated with HBV infection in this study.

Determinants of Exclusive Breastfeeding Practices Among Mothers of Infants Less Than Six Months Attending an Immunization Clinic in Southwestern Nigeria.

Background Despite being a cost-effective means of improving the childhood health indices, exclusive breastfeeding (EBF) remains low in the low middle-income countries. Hence, we evaluated the determinants of EBF among mothers of infants less than six months in Southwestern Nigeria. Methods This was a cross-sectional descriptive study that involved 271 mothers of infants aged less than six months attending the immunization clinic of the Bowen University Teaching Hospital, Ogbomoso, Nigeria. Pretested semi-structured questionnaires were used to get relevant information from the mothers who were recruited using convenience sampling method. Descriptive statistics was carried out while chi square test and binary logistic regression were used for inferential statistics. Results The mean age (±SD) of the respondents was 30.4 ± 5.0 years. The EBF rate in this study was 46.1% (125/271); 40.6% of mothers breastfed their infants within an hour of birth, with most (91.1%) breastfeeding their babies on demand. Factors associated with EBF included mothers' age > 30 years (OR 2.080, 95% CI 1.274-3.395). After controlling for potential confounders, family size > 4, (adjusted OR 2.053, 95% CI 1.120-3.762) and having vaginal delivery (adjusted OR 2.769, 95% CI 1.585-4.829) were the significant determinants of EBF practices among the study participants. Conclusion EBF practice was average in the studied population. Family size >4 and vaginal delivery were the determinants of EBF. There is a need to sustain the promotion of appropriate breastfeeding practices.

Anaphylaxis Complicated by Acute Respiratory Distress and Fatal Outcome in A Nigerian Family.

Reports on hypersensitivity diseases in Nigerians are rare. We report the incidence of anaphylaxis in three siblings following fatal outcome in their mother. Urticarial rashes were noticed in three siblings' resident in a South Western Nigerian town, one week before presentation at our facility. All the three siblings developed respiratory distress four days after the rash was noticed. Onset of respiratory distress made the family seek care at a private hospital, where they were admitted and treated with intravenous aminophylline and ceftriaxone. The mother of the children had experienced the same symptoms earlier also. She took treatment and died in the same private hospital, where her children received care. Death of the mother and worsening respiratory distress in the children made the father effect transfer of the children to the paediatric emergency unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo. The three children made a slow but uneventful recovery after instituting appropriate management for anaphylaxis and acute respiratory distress syndrome. The cases are discussed with a view to create awareness amongst health practitioners about the occurrence of anaphylaxis in our society. The need for prompt recognition and appropriate management, when confronted with this disease is also underscored.

Oral and dental lesions in HIV infected Nigerian children.

INTRODUCTION: Oral diseases in the HIV infected children though commonly encountered are under researched and often overlooked by physicians in developing countries. The aim of this study is to document the types and frequency of oral lesions in HIV infected children and examine the effects of management with HAART on their rates. METHODS: A cross sectional study designed to identify the oral lesions in consecutive HIV infected children and their distribution at a Paediatric Anti-retroviral clinic. Information on oral disease and clinical features of the subjects were obtained by history and clinical examination and laboratory investigations by the pediatricians and dental surgeons. RESULTS: The 58 children studied consisted of 34 boys and 24 girls with their ages ranging from 3 months to 13 years. Thirty seven (63.8%) of the 58 children had oral diseases. Enamel hypoplasia, candidiasis, caries, angular chelitis, and herpes labialis were the most common oral lesions found in the patients. Oral soft tissue lesions were less frequently encountered among children on HAART. Statistical significance was recorded among those infected with candidiasis. More than 60% of the children diagnosed with oral disease had no knowledge of the state of their oral health before the study. CONCLUSION: Oral diseases are very common amongst the children studied. Awareness of oral disease among the children and their caregivers is low. Administration of HAART may have a preventive effect on the development of oral soft tissue disease. There is a need to integrate dental care into the paediatric HIV care programs.

Intestinal Parasitoses in HIV Infected Children in a Nigerian Tertiary Hospital.

BACKGROUND: Intestinal parasitoses are common amongst people living in developing countries. They may impact negatively on the growth and health of immune competent children. There is paucity of information on the association between HIV and intestinal parasitoses in African children. OBJECTIVE: To identify the intestinal infections responsible for infections in HIV infected children and document characteristics of HIV infected children at a Nigerian teaching hospital. MATERIALS AND METHODS: Consecutive children attending a Paediatric anti-retroviral clinic were studied. Information such as socio-demographics and clinical characteristics elicited from clinical examination were recorded in the proforma. Stool samples of the children were obtained and examined for intestinal parasites. Data was analysed with the SPSS 18 software. RESULTS: A total 52 children were studied and their age ranged between 6 months and 14 years, with a mean of 6.5 years ± 3.93. The 52 were made up of 27 boys and 25 girls, giving a male: female ratio of 1.1:1. 10 (19.2%) of the 52 children were infected with cryptosporidium spp, while 1(1.9%) had Ascaris lumbricoides infestation. Anti-helminthics had previously been administered to 86.5% of children studied. Those who previously received anti-helminthics had lower prevalence estimates of cryptosporidium infections. (p<0.01, RR = 0.42, 95%CI = 0.20 - 0.90). Children on co-trimoxazole prophylaxis had lower prevalence estimates of cryptosporidium infections. (P<0.01, RR = 0.35, 95%CI = 0.14 - 0.91). Use of highly active antiretroviral drugs was also associated with lower prevalence estimates of intestinal cryptosporidium. (p=0.04, RR = 0.58, 95%CI = 0.31 - 1.10). Eight of the 10 children infected with cryptosporidium had recurrent abdominal pain in comparison with the six with recurrent abdominal pain amongst the 42 without cryptosporidial infections. (p<0.01, RR=5.6, 95%CI= 2.51 - 12.1). CONCLUSION: Cryptosporidial infection is the most common intestinal parasitoses among HIV infected children in this study, while intestinal helminthiasis are not so common. Anti-helminthics, Co-trimoxazole prophylaxis and highly active anti-retroviral therapy have a protective effect against intestinal cryptosporidium. Screening for intestinal cryptosporidium is suggested in HIV infected children with recurrent abdominal pain, because of the statistically association.