Philadelphia Towards Racial and Environmental Equity (Philly TREEs): how a medical school can advance health equity through urban forestry in Philadelphia, PA, USA.

Inequity in access to urban greenspaces might contribute to health disparities in the USA via multiple pathways. Academic medical centres can promote health equity in their surrounding communities by partnering with community organisations to improve greenspace access in urban environments. Academic medical centres are also uniquely positioned to advance health-equity leadership among the next generation of doctors through medical-education initiatives; of particular importance is that medical professionals are involved in advocating for the expansion of greenspace access due to its direct relationship with human health and wellness. Furthermore, by focusing educational, research, and service endeavours on addressing the most important health issues within their communities, institutions could allocate some of their resources towards community greening as a form of preventive health investment. This Personal View describes our medical-student-led pilot project Philadelphia Towards Racial and Environmental Equity (Philly TREEs) at the Perelman School of Medicine (University of Pennsylvania, Philadelphia, PA, USA), which aims to improve tree equity and community wellness in Philadelphia. We highlight this project to show how academic medical institutions can help cities to achieve urban tree-canopy goals in an equitable way through community partnership and address disparities in the environment and in health.

Evaluation of Prevention of Mother to Child Transmission Programme at a Tertiary Healthcare Facility in Southwestern Nigeria.

Most children acquire human immunodeficiency virus (HIV) infection through mother-to-child transmission (MTCT). The risk of MTCT of HIV is generally 15%-40% without prophylaxis. MTCT has been responsible for approximately 370,000 infant HIV infections worldwide, with Nigeria accounting for 30% of cases. The study evaluated the effectiveness of a prevention program for MTCT of HIV infection by determining the rate of MTCT of HIV in infants who underwent the program by reviewing health records of mother-infant pairs at the Olabisi Onabanjo University Teaching Hospital. This cross-sectional study conducted over 12 years used medical records of 545 mother-infant pairs. The rate of MTCT of HIV infection was 2.9% in this study compared to 7.1% reported by the center earlier. The rate of MTCT of HIV infection was the lowest among mother-infant pairs who received prophylaxis. Ages at recruitment are a strong determinant of the risk of infection. Late usage of the MTCT prevention service is a risk for HIV infection in exposed infants.

The current pattern of facility-based perinatal and neonatal mortality in Sagamu, Nigeria.

BACKGROUND: Perinatal and neonatal mortality rates have been described as sensitive indices of the quality of health care services. Regular audits of perinatal and neonatal mortalities are desirable to evaluate the various global interventions. OBJECTIVE: To describe the current pattern of perinatal and neonatal mortality in a Nigerian tertiary health facility. METHODS: Using a prospective audit method, the socio-demographic parameters of all perinatal and neonatal deaths recorded in a Nigerian tertiary facility between February 2017 and January 2018 were studied. RESULTS: There were 1,019 deliveries with stillbirth rate of 27.5/1000 total births and early neonatal death (END) rate among in-born babies of 27.2/1000 live births. The overall perinatal mortality rate for in-facility deliveries was 53.9/1000 total births and neonatal mortality (till the end of 28 days) rate of 27.2/1000 live births. Severe perinatal asphyxia and prematurity were the leading causes of neonatal deaths while obstructed labour and intra-partum eclampsia were the two leading maternal conditions related to stillbirths (25.0% and 21.4% respectively).Gestational age < 32 weeks, age < 24 hours and inborn status were significantly associated with END (p = 0.002, p <0.001 and p = 0.002 respectively). CONCLUSION: The in-facility perinatal mortality rate was high though stillbirth rate was relatively low. There is a need to improve the quality of emergency obstetric and neonatal services prior to referral to tertiary facilities.

Neonatal macrosomia and associated morbidities in Sagamu, Nigeria

Background:The incidence of neonatal macrosomia is on the increase in many parts of the world. The impact of the condition on babyand child health has not received adequate research attention.Objective:To determine the prevalence,babyandmaternal characteristics, the pattern of neonatal morbidity and perinatal outcome of macrosomia.Methods:A retrospective study of all singleton deliveries with birth weight ≥4.0 kg was conducted at a tertiary facility in the south-western part of Nigeria between January 2013 and December 2014.Results:Eighty-eightnewbornbabies were macrosomic out of 1854 deliveries, resulting in a prevalence rate of 4.7%. The male-to-femaleratio was 2:1, while the mean (±SD)birth weight was 4.2 ± 0.3kg. There was no significant difference in the mean birth weights of the male and female babies(t=1.24, p=0.218). The meanmaternal age was 31.7 ± 5.1 years. Multiparous mothers had the highest proportion of macrosomic babies, whilemajority of mothers (77.3%) were either overweight or obese. One-minute Apgar score <7 was observed among28 (31.8%) babies.Twenty-three (26.1%) babieswere hospitalized for further management. Birth asphyxia, hypoglycaemia and hyperbilirubinaemiawere the leading morbidities. The perinatal mortality rate for macrosomic babies was 102.2 per 1000total births.Conclusion:The incidence of neonatal macrosomia is relatively low in our study population but falls within the range of prevalence rates reported from other parts of the country.Birth asphyxia, hypoglycaemia and hyperbilirubinemia are common morbidities among affected babies

Factors associated with clinical outcomes among neonates admitted with acute bilirubin and hypoxic-ischaemic encephalopathies at a tertiary hospital in south-west Nigeria

Background:Babies who are delivered outside hospital are most at risk of serious illnesses such as perinatal asphyxia and severe hyperbilirubinaemia. These conditions are major contributors to neonatal mortalities in resource-poor settings. Objective: To explore the relationship between pre-admission and intra-facility care and immediate outcomes among neonates with acute bilirubin and hypoxic-ischaemic encephalopathies. Methods: Using a retrospective design, the outcome of outborn babies with acute bilirubin encephalopathy (ABE) and hypoxic-ischaemic encephalopathy (HIE) were studied in a Nigerian hospital between 2012 and 2016. Results: A total of 40 and 80 babies with ABE and HIE were studied. Among babies with ABE, 67.5% arrived at the hospital on self-referral and of the babies with official referral, only 61.5% had had a serum bilirubin check prior to referral. Among the babies with ABE, 25.0% had both social and facility-related challenges, 45.0% had only facility-related challenges and 20.0% had only social challenges. All the babies with ABE who died had either social or facility-related challenges. For the babies with HIE, 56.2% came on self-referral while 70% received no care prior to presentation at the hospital. Some 40% of babies with HIE had both social and facility-related challenges while 12.5% had only facility-related challenges. None of the babies who died presented early. Comparable proportions of babies who died or survived had social challenges and facility-related challenges. Conclusion: Most of the outborn babies with HIE and ABE who arrived at the hospital on self-referral and facility-based care were hindered by social issues and facility-related challenges

The use of locally fabricated compact fluorescent lamps (CFL) phototherapy devices in the management of significant neonatal hyperbilirubinaemia

Abstract: One of the challenges of managing significant neonatal hyperbilirubinaemia in resource-poor settings is limited access to effective phototherapy devices hence the need to try appropriate technologies. The objective was to assess the effectiveness of Compact Fluorescent Lamps phototherapy devices in the management of significant neonatal hyperbilirubinaemia in a resource-poor setting. A cohort of babies with significant hyperbilirubinaemia managed with locally fabricated Compact Fluorescent Lamps (CFL) phototherapy devices (2014-2016) were compared with historical controls managed with conventional imported phototherapy devices (2007-2010) for the severity of hyperbilirubinaemia and requirements for Exchange Blood Transfusion. A total of 96 babies in the subject group and 202 babies in the control group were studied. The proportion of babies with peak TSB >30mg/dl was significantly higher among the controls compared to the subjects (p < 0.001). The interval between the commencement of phototherapy and the peak TSB was greater than 1 day among 30.2% (29/96) subjects compared to 74.3% (150/202) babies in the control group (p < 0.001). The mean duration of phototherapy was significantly shorter for the subjects compared to the controls. EBT was performed for 38.5% of the subjects and 51.5% of the controls. Single sessions of EBT were required for 78.4% of the subjects compared to 45.2% of the controls (p = 0.001). In conclusion, the locally fabricated Compact Fluorescent Lamps phototherapy devices reduced EBT rate among babies with significant hyperbilirubinaemia

Does infant feeding method influence the incidence and pattern of morbidities among human immunodeficiency virus-exposed uninfected nigerian infants?

BACKGROUND: Human immunodeficiency virus (HIV)-exposed infants enrolled into the prevention of mother-to-child transmission of HIV program generally receive antiretroviral therapy (ARV), but the feeding methods differ based on several socioeconomic and cultural differences. OBJECTIVE: The objective of the study was to examine the incidence and pattern of morbidities among HIV-exposed uninfected (HEU) Nigerian infants and determine any relationship with infant feeding methods. METHODS: A review of the hospital records of all HEU infants attending the Virology Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, between July 2013 and June 2015, was done. The recorded data included biodemographic profile, social parameters, feeding methods, anthropometry, and morbidities. The feeding method groups were statistically compared in relation to the various morbidities. RESULTS: Out of 119 children, 81.5% were exclusively breastfed, whereas 18.5% had exclusive breast milk substitute feeding. About half had various morbidities which included upper airway infections (UAIs) (16.8%), malaria (15.9%), malnutrition (8.4%), diarrhea (8.4%), and pneumonia (2.5%). The frequencies of these conditions were similar among infant groups irrespective of feeding method. The infants with and without morbidities were comparable in terms of the frequency of exclusive breastfeeding (80.3% vs. 82.8%). Low family socioeconomic status (SES) (odds ratio [OR] = 7.7) and ARV use (OR = 0.4) among infants were predictors of morbidities among HEU infants. CONCLUSION: The incidence and pattern of morbidities among HEU infants showed no relation to the mode of feeding. Rather, family SES and the use of antiretroviral drugs were predictors of morbidities among HEU infants.