Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria.

BACKGROUND: There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria. OBJECTIVES: This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis. METHODS: This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study. RESULTS: A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1-0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1-6-6.8). CONCLUSION: Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.

Caregivers perception of common neonatal illnesses and their management among rural dwellers in Enugu state, Nigeria: a qualitative study.

BACKGROUND: Neonatal mortality continues to be a challenge in Nigeria, where low-quality care, caregivers' ignorance of signs of neonatal illnesses, and prevalent use of unorthodox alternatives to health care predominate. Misconceptions originating and propagating as traditional practices and concepts can be linked to adverse neonatal outcomes and increased neonatal mortality. This study explores the perceptions of causes and management of neonatal illness among caregivers in rural communities in Enugu state, Nigeria. METHODS: This was a cross-sectional qualitative study among female caregivers of children residing in rural communities in Enugu state. A total of six focus group discussions (FGDs) were conducted; three in each of the communities, using an FGD guide developed by the researchers. Using pre-determined themes, thematic content analysis was used to analyze the data. RESULTS: The mean age of respondents was 37.2 ± 13.5 years. Neonatal illnesses were reportedly presented in two forms; mild and severe forms. The common causes of the mild illnesses reported were fever, jaundice, eye discharge, skin disorders, and depressed fontanelle. The severe ones were convulsion, breathlessness/difficulty or fast breathing, draining pus from the umbilicus, and failure-to-thrive. The caregivers' perceptions of causes and management of each illness varied. While some believed these illnesses could be managed with unorthodox treatments, others perceived the need to visit health centers for medical care. CONCLUSIONS: Caregivers' perception on the causes and management of common neonatal illnesses in these communities is poor. Obvious gaps were identified in this study. There is a need to design appropriate interventions to dispel the myths and improve the knowledge of these caregivers on neonatal illnesses towards adopting good health-seeking behaviours.

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.

Maternal perception of masking in children as a preventive strategy for COVID-19 in Nigeria: A multicentre study.

BACKGROUND: The use of face masks by children for the prevention of COVID 19 is still controversial, especially with regards to who should wear the face mask and at what age. OBJECTIVES: The study aimed to ascertain the perception of mothers on masking in children as a preventive strategy for COVID-19. METHODOLOGY: This was a cross-sectional study carried out in two health institutions among 387 mothers who presented with their children for the first time in the hospital during the COVID 19 pandemic. A pretested, semi-structured, interviewer-administered questionnaire which was designed by the researchers was used for data collection. RESULTS: Minority (44.7%) of the mothers perceived masking in children as an appropriate measure for the prevention of COVID-19. The frequent reasons given by majority (55.3%) of the mothers for the inappropriateness of face mask in children included perceived difficulty in breathing (38.5%) and the child's readiness to pull it off (29.3%). A significantly higher proportion of the children whose mothers were 35 years and above, 64.2% would wear face masks when compared with 31.7% of those whose mothers were < 30 years of age (χ2 = 28.632, p<0.001). Similarly, a significantly higher proportion (51.0%) of the children who were more than one year of age would wear a face mask when compared with 20.5% of those aged eight days to one year (χ2 = 19.441, p<0.001). The children whose mothers were <30 years were about four times less likely to wear a face mask when compared with those whose mothers were aged 35 years and above. (AOR = 0.273; 95%CI: 0.155-0.478). The children whose fathers have attained tertiary education were about twice less likely to wear face masks when compared with those whose fathers have attained secondary education and less. (AOR = 0.554; 95%CI: 0.334-0.919). Mothers' perception of COVID-19 had no significant influence on children's use of face mask (χ2 = 2.337, p = 0.127). CONCLUSION: Maternal perception of masking in children as an appropriate strategy for preventing COVID-19 is adjudged low in this study. Right perception is significantly enhanced by maternal educational status, employment and marital status.

Evaluation of Wait Time in the Children's Emergency and Outpatient Units of a Tertiary Hospital in Southeast Nigeria.

BACKGROUND: Promptness of intervention in the emergency room (ER) or outpatient unit is a major determinant of outcome in acutely ill children. Time is, therefore, of the essence in trying to reduce complications and mortality associated with children. METHODS: This was a cross-sectional study conducted in the children ER and the children outpatient unit of the Enugu State University Teaching Hospital (ESUTH), Enugu, Southeast Nigeria. Waiting time defined as the time between arrival and doctor consultation was calculated. RESULTS: A total of 248 respondents were enrolled during the study period. In the emergency unit, majority (67.5%) of the respondents' sick children were attended to almost immediately, while 13.3% and 19.3% waited for ≤10 and >10 min, respectively, before being attended to by a doctor. The mean waiting time in the emergency unit was approximately 9.27 ± 29.2 min (95% confidence interval [CI]: 2.90-15.65 min) with a range of 0-56 min. In the outpatient unit, the mean waiting time was 12.67 ± 15.3 min (95% CI: 10.31-15.01 min) with a time range of 5-245 min. Eighty-five (51.5%) of the 165 respondents waited for <10 min, 60 (36.4%) waited for between 10 and 30 min, while 20 (12.1%) waited for >30 min before their sick children were attended by a doctor. CONCLUSION: The mean waiting times reported in this study in the emergency and outpatient units of the ESUTH were within acceptable standards. However, there were cases where the waiting time in both children's units was exceptionally long. There is need for continued monitoring and evaluation of waiting times in these units for prompt attention to patients.

Epidemiology and pattern of paediatric injuries in a developing country: an analysis of 170 injuries.

BACKGROUND: Paediatric injuries have significant physical, psychological and socioeconomic consequences. This study aimed to determine the epidemiology and pattern of paediatric injuries presenting at a teaching hospital in Enugu South-East Nigeria. METHODS: A retrospective study of injured patients less than 18 years who presented to the Accident and Emergency department of University of Nigeria Teaching Hospital Ituku/Ozalla, in Enugu Nigeria, was conducted from 1st January to 31st December 2015. Analysis of data was done using Statistical Package for the Social Sciences version 22.0. RESULTS: A total of 1191 children presented to the hospital within the study period and 120 injured paediatric patients (10.1%) with 170 injuries were attended to in the A & E. Adolescents (12 - 17 years) accounted for 34.2% of injuries and males (70%) were more affected than the females. Road traffic crashes and falls were the most common causes of paediatric injuries. There was a significant correlation between age of the children and the aetiology of the injuries (X2 = 28.08, p = 0.001). Bruises/lacerations/abrasions (27.6%) and fractures (27.1%) were the most common types of injuries sustained. The injury severity score (ISS) of the patients ranged from 1-25 with a mean of 6.4 + 2.8. Roadside/street (35%), school (23.3%) and home (21.7%) were the main locations where injuries occurred. Mean injury-arrival interval was 1.2 + 0.7 days. Majority (67.5%) of children had full recovery and the mortality rate was 5.8%. CONCLUSION: Road traffic crashes and falls were the most common cause of paediatric injuries. Soft tissue trauma and fractures were the predominant types of injuries. Roadside, school and home were the leading locations of childhood injuries. Prevention of road traffic crashes and falls, prompt treatment of injuries, and rehabilitation of injured children will reduce the negative impact of paediatric injuries.

Hypertension in Children: Could the Prevalence be on the Increase?

BACKGROUND: In children particularly in the developing world, there is a tendency to downplay the role of primary hypertension in their health. In adults, a number of factors have clearly been associated with the incidence of hypertension. Knowledge of the prevalence of hypertension and its associated factors among children in our environment is important and could inform the need for lifestyle changes and routine blood pressure (BP) checks in children so as to reduce BP-related health risks. AIM: The aim of this study is to document the prevalence of hypertension and its risk factors among children in Enugu, Nigeria. MATERIALS AND METHODS: Children aged 6-17 years attending the outpatient clinic of a tertiary hospital, were enrolled for the study. Their socioeconomic status (SES), weight, height, BP, and dipstick urinalysis were measured using standardized methods. Adherence to Mediterranean diet was assessed using the Mediterranean Diet Quality Index (KIDMED). The prevalence of hypertension and the influence of these factors on their BP were analyzed. RESULTS: Forty-six (9%) of the 491 participants had hypertension. Of these 46 hypertensive children, 72% were females while a significantly higher proportion 57% (P = 0.006), were in the age group 13-17 years. While age, gender, and the presence of protein in urine were significantly associated with hypertension in these children; body mass index, diet, family history of hypertension, and SES were not. CONCLUSION: The prevalence of hypertension in children in this environment is high and appears to be increasing. There is need for routine BP and urinalysis check for all children in our clinics and wards.

Cancer Mortality in the Niger Delta Region of Nigeria: A Case Study of the University of Port Harcourt Teaching Hospital.

AIM: The aim of this study is to determine the pattern of cancer mortality (CM) seen in the University of Port Harcourt Teaching Hospital (UPTH) which is a cancer reference center in the Niger Delta Region. METHODOLOGY: This is a 6-year retrospective study of cancer-related deaths in UPTH using patients' admission registers in all the wards and emergency units. Furthermore, the death certificates of cases were reviewed. RESULTS: Three hundred and sixteen cases of cancer-related deaths occurred, involving 174 females and 142 males, in a female-to-male sex ratio of 1.2:1. All age groups were affected, with age group 40-49 years accounting for the majority (20.6%). CM was seen in all the systems, except the central nervous system. Cancers of the gastrointestinal tract and its accessory organs (liver and gall bladder) caused most mortality (27.9%), in a female-to-male ratio of 0.8:1. The single most involved organ in CM is the female breast (20.6%), distantly followed by mortality due to prostate cancers and hematolymphoid cancers which accounted for 9.2% each. Colorectal cancers accounted for 7.3% of cancer deaths and ranked 4th. Cancers of both cervix and stomach each accounted for 5.7% of mortality. The major histologic diagnoses were carcinomas (adenocarcinoma; 36.7%, invasive ductal carcinoma; 20.3%, squamous cell carcinomas; 8.2% and hepatocellular carcinomas; 4.4%). Leukemias and lymphomas accounted for 9.2% of cases, whereas sarcomas accounted for 5.1% of cases. CONCLUSION: Infection-related and noninfection-related cancers cause most mortality in UPTH. The 5th decade was the most commonly affected, while female breast was the single most involved organ. Breast, prostate and hematolymphoid malignancies are common causes of CM with death from breast occurring earliest. Majority of the deceased were educated, working-class urban dwellers. More advocacies on public acceptance of cancer screening and cancer preventive lifestyles as well as governments' improvement on workforce training and treatment infrastructure will improve the current CM profile in Port Harcourt.

Weight estimation in Paediatrics: how accurate is the Broselow-tape weight estimation in the Nigerian child.

BACKGROUND: Determination of weight in children is an important aspect of their assessment. It has a wide range of usefulness including assessing their nutritional status and drug dose calculation. Despite its usefulness, weight estimation in children in certain conditions can be challenging particularly in emergency situations or in children who are severely ill or cannot stand on standard scales. The Broselow Tape which is a validated tape that is used to estimate weight based on length was developed using height/weight correlations from Western data. However, considering the variations in anthropometric measurements of children from different geographic locations, there is need to ascertain how accurate it is to estimate weight using the Broselow tape among children in Nigeria. AIM: The study was carried out to determine the accuracy in the use of the Broselow Tape in weight estimation among Nigerian children. METHOD: A total 1456 children aged 1-12 years who satisfied the inclusion criteria were enrolled over a 2½ year period from two tertiary health facilities in Enugu state Nigeria. Weight was taken using standard weighing scale and Broselow tape. Data collected was analysed using SPSS. RESULT: Of the 1456 children studied, majority (84.2%) had normal Body-Mass-Index (BMI) while about 4.6% had a low BMI percentile for age. The mean weight difference between the two methods was not significantly different between the 1 to 6 years old category. Significant differences were observed from 7 up to 12 years. The Broselow Tape overestimated weights in 1 year old by 3.88%, 2 years 1.58%, 3 years by 2.13%, 4 years (1.94%) and 5 year (0.07%). After 5 years, the degree of overestimation rises sharply to 4.25% in 6, 9.25% in 7, 7.29% in 8 and 9.29%. 9.18, 11.61% & 6.75% in 9, 10, 11 and 12 years old respectively. The proportion of estimated weights that was within 10- 20% of the actual weight was higher in the 1-6 years age categories compared to weight estimates in older age categories. CONCLUSION: Weight estimates obtained using the Broselow tape correlated better in children that are 6 years or younger compared to those in the older age categories. There is need for re-validation and/or adjustments of the Broselow tape especially in children over 6 years old.