Newborn resuscitation practices and paucity of resuscitative devices in Nigeria; a call to action.

BACKGROUND: Neonatal resuscitation is a method of preventing morbidities & mortality from asphyxia. Up to 85% of facilities in sub-Saharan Africa lack supplies or skilled personnel for neonatal resuscitation. Relative to the place of birth and the skill of the birth attendant, a variety of resuscitative practice are employed to make babies cry instead of helping the baby breathe. Many painful procedures are applied when the baby is unable to cry after birth in the absence of a health care worker trained in bag-mask ventilation. OBJECTIVES: To ascertain the resuscitation practices in communities lacking bag-mask-valve devices. METHODS: Surveys on the resuscitation practices during NISONM annual community outreach and mENCC trainings for four consecutive years in different geopolitical zones of the country. RESULTS: Spanking of the baby usually in the upside down position (>90%), body massage with hot compress or salicylate containing balms, herbal concoctions, injection hydrocortisone or crystalline penicillin were used. CONCLUSION: There is an urgent need to address the issue of training on bag-mask ventilation and provision for frontline healthcare workers in Nigeria as a neonatal mortality reduction strategy.

Child malnutrition and the Millennium Development Goals: much haste but less speed?

The Millennium Development Goals (MDGs) provide a framework for measuring the progress of nations. Several of these goals relate to child malnutrition, which remains an important contributor to child morbidity and mortality, accounting for approximately 45% of child deaths globally. A high proportion of undernourished children still live in Africa and parts of Asia, and the uneven rate of reduction in the prevalence of various types of child malnutrition among different income groups worldwide is worrying. Attempts to reduce child malnutrition should therefore begin from the grassroots by improving primary healthcare services in developing countries with particular focus on basic requirements. Adequate nutrition should be provided from birth, through infancy, preschool and early childhood to adolescence. The overall strategy should be one of careful and meticulous planning involving all development sectors with an emphasis on a bottom-up approach within a stable and disciplined polity; the MDGs will be only be useful if they are seen not as narrow objectives with unidirectional interventions but as multifaceted and co-ordinated. The setting of deadlines, whether 2015 or 2035, should not be emphasised so as to avoid hasty decision making. The top priority should be the implementation of the essential social services of basic education, primary healthcare, nutrition, reproductive health care, water and sanitation in partnership with the developed economies.

Congenital rubella syndrome: pattern and presentation in a southern Nigerian tertiary hospital.

BACKGROUND: Congenital rubella syndrome (CRS) resulting from maternal rubella infection can result in miscarriages, still birth and rubella infection of the infant. The aim of this study was to evaluate the pattern and presentation of CRS over an 8-year period as seen in the University of Port-Harcourt Teaching Hospital (UPTH), Nigeria. METHODS: The medical records of all cases of CRS presenting to the Pediatric Department of UPTH from January 2000 to December 2007 were reviewed. RESULTS: There were 16 394 babies delivered in UPTH from January 2000 to December 2007. Of these babies, 19 were clinically diagnosed as having CRS, but none had laboratory confirmation. They had a mean age of 5.1 +/-3.2 months (range: 1-11 months). Seventy-five percent of their mothers had presumed rubella infection during the first trimester of pregnancy. Cataract was noticed to be the most prominent systemic manifestation in 18 of the 19 babies. Other common manifestations included hearing impairment (n=14), microcephaly (n=13), patent ductus arteriosus (n=11), and low birth weight (n=10). A surge was observed in the number of babies with CRS from 2004 to 2007; however, this was not statistically significant (chi (2)=8.68, P=0.28). Unfortunately, long-term outcome of the 19 babies was not available. CONCLUSION: CRS is commonly diagnosed at our center. Thus, mounting effective surveillance for CRS and considering the inclusion of rubella vaccine in Nigeria are of extreme importance.

Birthweight-specific neonatal mortalities.

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