Assessment of depression in children and adolescents with sickle cell anemia in a low-resource setting: a comparative study.

Children with sickle cell anemia (SCA) usually face psychological complications especially depression. Assessment of depression in resource-limited settings may help identify the extent to which the children with SCA in such settings may need its introduction as part of routine care. This study aimed to assess depression in children and adolescents with SCA in a low-resource setting. This cross-sectional observational study involved 84 children and adolescents with SCA aged 7-17 years who were selected using a systematic random sampling technique. Their controls were 84 age- and sex-matched individuals with AA hemoglobin genotype. A structured questionnaire was used to collect socio-demographic data while depression was assessed with the Children's Depression Inventory. The prevalence of depression was non-significantly higher in subjects compared to the controls (8.3% vs. 2.4%) (Fisher's χ2 = 1.88, p = 0.171). Though not statistically significant, the subjects had 3.7 times higher odds of having depression compared to the controls (OR = 3.7; 95% CI 0.75-18.50; p = 0.107). Of the 5 depression subscales, the subjects had a significantly higher difference in the negative mood (p = 0.042). Despite the comparable prevalence of depression with their normal controls, children and adolescents with SCA had a higher negative mood and higher odds of having depression than normal individuals. Thus, there is a need for the introduction of depression assessment as a complement to routine care of these children with SCA in resource-poor settings.

Assessment of breastfeeding techniques in Enugu, South-East Nigeria.

Background: Good breastfeeding technique is important in ensuring adequate milk delivery and preventing breastfeeding problems. Exclusive breastfeeding rate is quite low, and requisite skills regarding proper positioning and attachment of an infant while breastfeeding appears lacking among mothers in Nigeria. This study was undertaken to assess breastfeeding techniques of mothers attending the well-child clinics of two tertiary hospitals in southeast Nigeria. Materials and Methods: This cross-sectional descriptive study of 396 mother and child pairs who attend the well child clinics of two tertiary hospitals in Enugu (Enugu state University Teaching Hospital and University of Nigeria Teaching Hospital) between September 2018 and February 2019. An interviewer administered, well-structured pro forma was used to collect data while mothers were observed closely as they breastfed and scored using the World Health Organization criteria. Data were analyzed using SPSS version 22. Results: Most of the mothers studied (357; 90.2%) attended ante-natal care, and 365 (92.2%) of the deliveries were assisted by a health worker. Only 194 (49%) of mothers practiced good breastfeeding techniques. Maternal age (20-30 years) (P < 0.001, odds ratio [OR] 0.464), attendance to antenatal clinic (P < 0.001; OR 8.336), health education and demonstration on breastfeeding techniques before and after delivery (P = 0.001) and maternal level of education (χ2 = 13.173, P = 0.001) but not parity (P = 0.386; OR 1.192) were significantly associated with good breastfeeding techniques. Conclusion: There are suboptimal breastfeeding techniques among mothers. Increased awareness creation and regular demonstration of breastfeeding techniques are needed.

RésuméContexte: Une bonne technique d'allaitement est importante pour assurer une livraison adéquate du lait et prévenir les problèmes d'allaitement. Exclusive le taux d'allaitement est assez faible, et les compétences requises en ce qui concerne le positionnement et l'attachement appropriés d'un nourrisson pendant l'allaitement semblent manqué chez les mères au Nigéria. Cette étude a été entreprise pour évaluer les techniques d'allaitement des mères qui fréquentent les cliniques hôpitaux tertiaires dans le sud-est du Nigeria. Matériaux et méthodes: Cette étude descriptive transversale de 396 couples de mères et d'enfants assister aux cliniques pour enfants de deux hôpitaux tertiaires à Enugu (Hôpital universitaire d'Enseignement de l'Université d'Enugu et Université du Nigeria Enseignement hôpital) entre septembre 2018 et février 2019. Un intervieweur administré, bien structuré pro forma a été utilisé pour recueillir des données les mères ont été observées de près au fur et à mesure qu'elles allaitaient et scorelaient selon les critères de l'Organisation mondiale de la santé. Les données ont été analysées à l'aide du SPSS version 22. Résultats: La plupart des mères étudiées (357; 90,2 %) soins prénatals, et 365 (92,2 %) des livraisons ont été assistées par un travailleur de la santé. Seulement 194 (49%) des mères pratiquaient de bonnes techniques d'allaitement. Âge maternel (20­30 ans) (P 0,001, rapport de cotes [OR] 0.464), présence à la clinique prénatale (P 0,001; OU 8.336), éducation à la santé et démonstration sur les techniques d'allaitement avant et après (P = 0,001) et le niveau d'éducation maternel (2 = 13,173, P = 0,001) mais pas la parité (P = 0,386; OR 1.192) ont été significativement associés avec de bonnes techniques d'allaitement. Conclusion: Il existe des techniques d'allaitement sous-optimales chez les mères. Création accrue de sensibilisation et une démonstration régulière des techniques d'allaitement sont nécessaires.

Out-of-pocket cost of managing sick newborns in Enugu, southeast Nigeria.

BACKGROUND: Neonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US$2 per day, these bills are not affordable to many families' livelihoods. AIM: This study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases. METHODS: This is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses. RESULTS: A hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86±8.81 days and ₦36,382±19,389.72 (US$223±119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than ₦10,000 (US$61), ₦10,000-49,999 (US$61-306), and ₦50,000-100,000 (US$306-612) and more than ₦100,000 (US$612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn's illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis (₦23,499±14,987 [US$144±92], P=0.001), low birth weight (₦39,863±24,003 [US$224±147], P=0.001), severe anemia (₦40,504±13,923 [US$248±85], P=0.001), transient tachypnea of the newborn (₦10,083±1,078 [US$62±7], P=0.001), birth asphyxia (₦24,398±14,096 [US$149±86], P=0.001), and meningitis (₦26,731±7,675 [US$164±47], P=0.001), whereas cost for laboratory investigations was significantly higher for neonatal jaundice (₦11,690±3,169 [US$72±19], P=0.001). There was a strong positive correlation between duration of hospital stay and total medical cost incurred (r=0.897, P=0.001). CONCLUSION: Health expenditure on neonatal illness is high and leads to catastrophic expenditure for the majority of households in the state. There is a need for effective health insurance schemes to help subsidize and cushion this disastrous and impoverishing health expenditure on families for improved neonatal survival in Nigeria.