Echocardiographic Comparison of Left Ventricular Systolic Function and Aortic Blood Flow Velocimetry in Children with Ventricular Septal Defect.

BACKGROUND: The assessments of left ventricular (LV) longitudinal systolic dynamics in children with ventricular septal defect (VSD) have achieved a major milestone in the evaluation of LV systolic function. OBJECTIVES: This study aims to evaluate the LV function, LV mass (LVM), and the descending aorta blood flow in children with VSD compared to that obtained in age and sex-matched controls. RESULTS: The mean LVM of the control, 113.5 ± 123.9 was higher than that of those who had VSD, 75.8 ± 83.9, and the difference in mean was found to be statistically significant (Mann-Whitney U = 2.322, P = 0.022). The mean EF of the control, 67.9 ± 10.3 was comparable to that of those with VSD, 65.6 ± 13.9, (Student's t = 1.223, P = 0.223). Similarly, the mean descending aorta blood flow of control, 1.6 ± 2.2 was comparable to that of those with VSD, 3.9 ± 16.1, (Mann-Whitney U = 1.002, P = 0.321). There was a very weak positive correlation between LVM and descending aorta blood flow among the subjects (n = 85, r = 0.117, P = 0.425). There was a very weak negative correlation between LVM and descending aorta blood flow among control. (n = 85, r = -0.065, P = 0.609). CONCLUSION: The LVM among children with VSD is lower than controls but there is no difference between LV function in subjects and controls. There is a linear increase of LVM with descending aorta blood flow.

Pattern and predictors of internet addiction among secondary school adolescents in Enugu, Nigeria.

Background: Internet addiction has negative effects on adolescents. These range from psychological and social impediments to school absenteeism. Aim: To ascertain the pattern of Internet addiction and the factors that predict Internet addiction among secondary school adolescents in southeast Nigeria. Subjects and Methods: This was a cross-sectional study that involved 796 secondary school adolescents drawn from six secondary schools in Enugu, Nigeria. The data were analyzed using IBM Statistical Package for Social Sciences (SPSS) software. Results: The highest proportion of the respondents (36.3%) had a moderate level of Internet addiction, while the least proportion (2.1%) had severe dependence on the Internet. Adolescents who were less than 15 years of age have 1.1 odds of having Internet addiction when compared to those who were 20 years and above (AOR = 1.1; 95% CI: 0.4-2.8). The respondents who were of the low socioeconomic class were 1.2 times more likely to have Internet addiction when compared with those in the high socioeconomic class (AOR = 1.2; 95% CI: 0.9-1.7). About 20.1% of adolescents were always depressed when they are not using the Internet, while 16.3% of adolescents who were addicted to the Internet developed insomnia. Conclusion: There is a rising prevalence of Internet addiction among secondary school adolescents. Younger adolescents tend to be more addicted to the Internet than their older counterparts. A small number of them had severe Internet addiction. A subpopulation of adolescents who were addicted to the Internet presents with depression and sleep disorders.

Pulmonary Hypertension in Children with Ventricular Septal Defects.

BACKGROUND: Ventricular septal defect (VSD) is a common congenital heart disease which could be complicated with pulmonary hypertension (PH). OBJECTIVES: This study sought to establish the relationship between severity of PH and size of VSD and age. METHODS: This is a descriptive study where one hundred and fiftyone children aged 3 months to 18 years with echocardiographically confirmed VSD were studied. Pulmonary hypertension (PH) was determined using the tricuspid regurgitation jet velocity with a cutoff of systolic pulmonary arterial pressure (sPAP) at >25mmHg. Severity of pulmonary hypertension was classified into mild (25-50mg Hg); moderate, (51-60mm Hg) and severe ≥ 60mm Hg. Data were analysed using the SPSS version 25. RESULTS: Majority 52.9% had mild PH while 17.6% had severe PH. Mild PH (χ2=15.513, p=0.004) was found among 66.7% of those with small-sized VSD, 42% of those with moderate-sized VSD and 57.1% of those with large-sized VSD. There was a weak positive correlation between PH and size of VSD (n=132, r=0.320, p<0.001). For one-unit increase in age (in months), PH was noted to decrease by 0.030 (B= -0.030, 95%CI: -0.090- 0.030) and for a unit increase in size (mm) of VSD, PH increased by 1.681 units (B=1.681, 95%CI: 0.798- 2.563). CONCLUSION: There was a linear increase in pulmonary hypertension with increase in the size of ventricular-septal defect and decrease in the age of children with VSD. Age and VSD size were significant predictors of PH severity in children with VSD. All sizes of VSD are associated with pulmonary hypertension. A unit increase in age (in months), caused a decrease of PH by 0.030units and a unit increase in size (mm) of VSD resulted in an increased PH by 1.681 units.

CONTEXTE: La communication interventriculaire (CIP) est une cardiopathie congénitale courante qui peut se compliquer d'hypertension pulmonaire (HP). OBJECTIFS: Cette étude visait à établir la relation entre la sévérité de l'HTP et la taille de la communication interventriculaire et l'âge. MÉTHODES: Il s'agit d'une étude descriptive dans laquelle cent cinquante et un enfants âgés de 3 mois à 18 ans avec une VSD confirmée par échocardiographie ont été étudiés. L'hypertension pulmonaire (HP) a été déterminée en utilisant la vitesse du jet de régurgitation tricuspide avec un seuil de pression artérielle pulmonaire systolique (PAPS) à >25mmHg. La gravité de l'hypertension pulmonaire a été classée en légère (25-50mg Hg) ; modérée, (51-60mm Hg) et sévère ≥60mm Hg. Les données ont été analysées à l'aide du SPSS version 25. RÉSULTATS: La majorité 52,9% avait un PH léger tandis que 17,6% avaient un PH sévère. Un PH léger (χ2=15,513, p=0,004) a été trouvé chez 66,7% de ceux qui avaient une VSD de petite taille, 42% de ceux qui avaient une VSD de taille modérée et 57,1% de ceux qui avaient une VSD de grande taille. Il y avait une faible corrélation positive entre le PH et la taille de la VSD (n=132, r=0,320, p<0,001). Pour une augmentation d'une unité de l'âge (en mois), le PH a diminué de 0,030 (B= -0,030, 95%CI : -0,090- 0,030) et pour une augmentation d'une unité de la taille (mm) de la VSD, le PH a augmenté de 1,681 unités (B=1,681, 95%CI : 0,798- 2,563). CONCLUSION: Il y avait une augmentation linéaire de l'hypertension pulmonaire avec l'augmentation de la taille du défaut ventriculaireseptal et l'augmentation de l'âge des enfants avec VSD. L'âge et la taille de l'anomalie ventriculaire-septale étaient des prédicteurs significatifs de la gravité de l'hypertension pulmonaire chez les enfants atteints d'une anomalie ventriculaire-septale. Toutes les tailles de VSD sont associées à l'hypertension pulmonaire. Une augmentation unitaire de l'âge (en mois) a entraîné une diminution de l'HTP de 0,030 unité et une augmentation unitaire de la taille (mm) de la CIA a entraîné une augmentation de l'HTP de 1,681 unité. MOTS CLÉS: hypertension pulmonaire ; VSD ; taille ; âge.

Knowledge and Utilization of PMTCT Services among Women accessing Antenatal Care in Private Health Facilities in Abakaliki, Nigeria.

Prevention of mother-to-child transmission (PMTCT) of HIV programme provides antiretroviral treatment to HIV-positive pregnant women to reduce the likelihood of transmission to their infants. Despite concerted efforts to scale-up PMTCT services in Nigeria, coverage and uptake of the services by Antenatal Care (ANC) attendees is below the acceptable. Private health facilities provide ANC services to large number of women, but they are sparingly involved in PMTCT capacity enhancement interventions. This study assessed the knowledge and utilization of PMTCT services among women accessing antenatal care in Private Health facilities in Abakaliki, Ebonyi State. It was a descriptive cross-sectional study in ANC clinics of the health facilities. Data was collected using interviewer administered questionnaire and analysed with Statistical Package for Social Sciences (SPSS) version 22.0 and test of association was by Chi square at P<0.05 level of significance. Results showed mean age of the respondents was 27± 4.6 years. Majority of the respondents (83.4%) had good knowledge of PMTCT but only 68.4% accessed HIV Counselling and Testing (HCT) in the index pregnancy, with fear of stigmatization given as the major reason for not doing HCT. Only 54.5% of sero-positive attendees took anti-retroviral drugs (ARVs) during pregnancy though they all used ARVs during labour/ delivery. Utilization of PMTCT services of HIV wassignificantly associated with educational status and occupation. CONCLUSION: There was good knowledge of PMTCT but utilization of the services was suboptimal. Training and mentoring of health care workers in private facilities on HIV testing programmes is important to improve uptake of PMTCT services and allay fears of stigmatization among the pregnant women.

Le programme de prévention de la transmission mère-enfant (PTME) du VIH fournit un traitement antirétroviral aux femmes enceintes séropositives pour réduire la probabilité de transmission à leurs nourrissons. Malgré les efforts concertés pour étendre les services de PTME au Nigeria, la couverture et l'utilisation des services par les personnes participant aux soins prénatals (ANC) sont inférieures à l'acceptable. Les établissements de santé privés fournissent des services de soins prénatals à un grand nombre de femmes, mais ils sont peu impliqués dans les interventions de renforcement des capacités de PTME. Cette étude a évalué la connaissance et l'utilisation des services de PTME chez les femmes ayant accès aux soins prénatals dans les établissements de santé privés à Abakaliki, dans l'État d'Ebonyi. Il s'agissait d'une étude transversale descriptive dans les cliniques de soins prénatals des établissements de santé. Les données ont été recueillies à l'aide d'un questionnaire administré par l'intervieweur et analysées avec le logiciel Statistical Package for Social Sciences (SPSS) version 22.0 et le test d'association a été effectué par le Chi carré au niveau de signification P<0,05. Les résultats ont montré que l'âge moyen des répondants était de 27 ± 4,6 ans. La majorité des personnes interrogées (83,4%) avaient une bonne connaissance de la PTME, mais seulement 68,4% ont eu accès au HCT lors de la grossesse de référence, la peur de la stigmatisation étant citée comme la principale raison de ne pas pratiquer le HCT. Seulement 54,5% des participantes séropositives ont pris des médicaments antirétroviraux (ARV) pendant la grossesse, bien qu'elles aient toutes utilisé des ARV pendant le travail/l'accouchement. L'utilisation des services de PTME du VIH était significativement associée au niveau d'instruction et à la profession. CONCLUSION: Il y avait une bonne connaissance de la PTME mais l'utilisation des services était sous-optimale. La formation et l'encadrement des agents de santé dans les établissements privés sur les programmes de dépistage du VIH sont importants pour améliorer l'utilisation des services de PTME et dissiper les craintes de stigmatisation parmi les femmes enceintes. Mots clés: Médicaments antirétroviraux, séropositifs, transmission mère-enfant, femmes enceintes, hôpitaux privés.

Prevalence and predictors of child labour among junior public secondary school students in Enugu, Nigeria: a cross-sectional study.

BACKGROUND: Globally, millions of children are involved in child labour. However, low- and middle-income countries are mostly hit. This study examined the predictors of child labour among public secondary school students in the Enugu metropolis. METHODS: This was a descriptive cross-sectional study of 332 junior secondary students attending public schools in Enugu metropolis, Nigeria. Multistage sampling technique was used to select the six secondary schools and the students that participated in the study. Data collection was done from September to October 2018. Pretested structured, interviewer-administered questionnaire was used for data collection. The questionnaire contained information on the sociodemographic variables, the kind of work done by the respondents and the number of working hours spent weekly. UNICEF's standard indicator for child labour was used to estimate the prevalence of child labour. Logistic regression was used to identify socioeconomic predictors of child labour. RESULTS: The prevalence of overall child labour was 71.7%, while for domestic and economic child labour prevalence were 52.1 and 34.0%, respectively. About 35.2% of the respondents worked under hazardous conditions while 8% were forced to work. Two-thirds (236, 65%) of the respondents who have heard about child labour perceived it as wrong. The child labourers mainly worked to render financial assistance to their parents. The predictors of child labour were class of study (AOR = 2.208 (95% CI: 1.199-4.066) and weekly income earned (AOR = 0.316 (95% CI: 0.176-0.567). CONCLUSION: The prevalence of child labour among junior students in public secondary schools in Enugu is high, and is predicted by the level of schooling and income earned. Economic and social reforms could contribute to addressing the predictors of child labour.

Rural-urban differences in utilization of antenatal and delivery services in Ebonyi State, Nigeria.

BACKGROUND: The high maternal death burden in developing countries when compared to the developed could be attributed to differences in use of antenatal and skilled delivery care. AIM: To assess the differences in utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria. METHODS: A cross-sectional comparative study design was used. Two stage (cluster) sampling technique was used to select 660 women in 4 of 13 local government areas in the state. The respondents were women who were permanent residents of communities and have delivered in last one year. Outcome measure was good utilization of antenatal and delivery services and was assessed by proportion of respondents who obtained antenatal and delivery from a skilled provider and also made at least four antenatal visits. RESULTS: The mean age of respondents was urban, 29.6 ± 6.2 and rural, 28.6 ± 5.1 years. Majority in urban, 51.8% utilized tertiary health facility for antenatal care while in rural, 77.9% used primary health centers (P < 0.001). Comparable proportions in urban, (77.3%) and rural, (79.1%) had good use of antenatal and delivery services (P = 0.572). Predictors of good use of antenatal and delivery services in urban included having one child (AOR = 4.8; 95%C1: 1.4--17.0), having attained tertiary education, (AOR = 2.6; 95%C1: 1.2--5.5), being in low socioeconomic class, (AOR = 0.4; 95%C1: 0.2--0.7), and having good knowledge of danger signs, (AOR = 2.6; 95%C1: 1.3--5.4). In rural, predictors included having one child, (AOR = 2.8; 95%C1:1.1--7.1), being unmarried, (AOR = 0.3; 95%C1: 0.1--0.9), and having good knowledge of danger signs (AOR = 3.7; 95%C1: 1.8--7.5). CONCLUSION: Utilization of antenatal and delivery services in health facilities in study area was high but there is room for improvement. There is need to plan specific interventions aimed at improving utilization of maternal health services by some groups like urban poor and unmarried mothers, especially teenagers. Emphasis should also be placed on improving community understanding of danger signs of pregnancy.

Determinants of Non-Institutional Deliveries in Urban and Rural Communities of Ebonyi State Nigeria: Implications for Policy.

OBJECTIVE: Determine factors associated with noninstitutional deliveries (NIDs) in urban and rural communities of Ebonyi state, Nigeria. METHODS: Community based cross-sectional comparative study design was used. Two stage sampling technique was used to select 660 women in 4 out of 13 local government areas. Information was obtained using a pre-tested, interviewer administered questionnaire. Respondents were womenwho have delivered in past one year irrespective of place of delivery. Outcome measure was proportion of women who did not deliver with a skilled birth attendant. RESULTS: Comparable proportion of respondents delivered outside health facilities, (urban, 14.5%; rural, 10%) (p=0.075). Decisions were made mainly during labour (urban, 43.8%; rural, 36.4%). Predictors of NID in urban areas included receiving no formal antenatal care, (AOR = 50.4; 95%CI: 14.4-177.2), being <30 years, (AOR = 2.9; 95%CI:1.1- 8.0) and previous history of Caesarean section, (AOR = 0.05, 95%CI: 0.01-0.5). Predictor of NID in rural areas was not receiving formal antenatal care, (AOR = 43.9; 95%CI:13.0-148.3). CONCLUSION: Minor proportion of respondents delivered outside heath facilities in urban and rural communities. Good utilization of primary health centers is essential in improving maternal health in Nigeria especially in rural communities. There is a need for all women to receive antenatal care from skilled providers as this increases the likelihood of delivering with skilled birth attendants. Ensuring deliveries with skilled birth attendants will improve the poor maternal health index in Nigeria.

OBJECTIF: Déterminer les facteurs associés aux accouchements non institutionnels (JNV) dans les communautés urbaines et rurales de l'État d'Ebonyi, au Nigéria. MÉTHODES: Un plan d'étude comparatif transversal basé sur la communauté a été utilisé. Une technique d'échantillonnage en deux étapes a été utilisée pour sélectionner 660 femmes dans 4 des 13 collectivités locales. Les informations ont été obtenues à l'aide d'un questionnaire pré-testé administré par un intervieweur. Les répondants étaient des femmes qui ont accouché au cours de la dernière année, quel que soit le lieu de l'accouchement. La mesure du résultat était la proportion de femmes qui n'avaient pas accouché avec une accoucheuse qualifiée. RÉSULTATS: Proportion comparable de répondants livrés en dehors des établissements de santé, (urbain, 14,5%; rural, 10%) (p = 0,075). Les décisions ont été prises principalement pendant le travail (urbain, 43,8%; rural, 36,4%). Les prédicteurs de la NID dans les zones urbaines comprenaient l'absence de soins prénatals formels (AOR = 50,4; IC à 95%: 14,4 à 177,2), étant <30 ans, (AOR = 2,9; IC à 95%: 1,1 à 8,0) et antécédents de césarienne section, (AOR = 0,05, IC à 95%: 0,01­0,5). Le prédicteur de la NID dans les zones rurales ne recevait pas de soins prénatals formels (AOR = 43,9; IC à 95%: 13,0-148,3). CONCLUSION: Une faible proportion de répondants ont accouché à l'extérieur des établissements de santé dans les communautés urbaines et rurales. Une bonne utilisation des centres de santé primaires est essentielle pour améliorer la santé maternelle au Nigéria, en particulier dans les communautés rurales. Il est nécessaire que toutes les femmes reçoivent des soins prénatals de prestataires qualifiés car cela augmente la probabilité d'accoucher avec des accoucheuses qualifiées. Assurer les accouchements avec des accoucheuses qualifiées améliorera le mauvais indice de santé maternelle au Nigéria.

Emigration plans after graduation of clinical medical students of ebonyi state university Abakaliki, Nigeria: Implications for policy.

OBJECTIVE: To determine the emigration plans after graduation of clinical medical students of Ebonyi State University Abakaliki, Nigeria. METHODS: A descriptive cross-sectional study design was used. All clinical medical students of the University willing to participate were included. Information was obtained using a pre-tested self-administered questionnaire. Outcome measure included proportion of students willing to emigrate and those willing to practice in rural areas after graduation. RESULTS: A total of 285 students participated in the study, (response rate, 92.5%). Majority, 93.3% intend to pursue specialist training after graduation. Minor proportion, 13.9% intend to specialize in Nigeria, whereas 74.4% prefer to specialize outside Nigeria. Major reasons for preferring specialist training abroad included good equipment/facilities, 33.8%, better remuneration/quality of life, 27.8%; and improved skills, 18.7%. Countries of interest for training outside Nigeria included Canada, 28.3%; United Kingdom, 23.2%; and the United States of America, 18.2%. Minor proportion, 17.2% intend to practice in rural area after graduation. Predictors of willingness to emigrate included being in 400 level class, (adjusted odds ratio (AOR) =2.0, 95% CI = 1.1-4.1), being single, AOR = 4.0, 95% CI = 1.2-13.3) and having decided on specialty of choice, (AOR = 2.6, 95% CI = 1.5-4.5). Predictors of willingness to serve in rural area included family residence in urban area, (AOR = 0.2, 95% CI = 0.2-0.8) and intention to specialize in Nigeria, (AOR = 3.7, 95% CI = 1.6-8.5). CONCLUSIONS: Majority of students intend to pursue specialist training and prefer training abroad. Minor proportions were willing to specialize in Nigeria and serve in rural areas. The students may have perceived medical practice in Nigeria as serving in rural areas hence students willing to work in rural areas were more likely to specialize in Nigeria. This may adversely affect health service delivery in Nigeria if left unchecked. Nigerian authorities should ensure that medical graduates willing to practice in Nigeria are not deterred. Also, plans to encourage doctors to practice in Nigeria should receive desired attention.

Predictors of practice of breast self-examination: A study among female undergraduates of Ebonyi State University, Abakaliki, Nigeria.

BACKGROUND: Breast cancer is the most common female cancer in both developed and developing countries. This study was designed to determine the predictors of practice of breast self-examination among female undergraduate students of Ebonyi State University, Abakaliki, Nigeria. METHODOLOGY: This was a descriptive cross-sectional study. A three-stage sampling design was used to select 365 female students of the university. Data were collected using a pretested self-administered questionnaire. Completion of one academic year qualified students for inclusion. Good knowledge of breast self-examination was determined by proportion of respondents who scored 50% and above of 15 variables used to assess knowledge. RESULTS: The mean age of the students was 22.1 ± 2.5 years. Majority (76.4%) were aware of breast self-examination and health workers; 37.0% were the major source of information. A minor proportion (5.8%) have had their close relatives diagnosed with breast cancer. Majority (55.3%) had good knowledge of breast self-examination. Majority (63.6%) have ever-practiced breast self-examination; however, only 15.9% of the respondents examined their breasts on a monthly basis. Predictors of ever-practiced breast self-examination included having good knowledge of breast self-examination (adjusted odds ratios [AOR] =6.4, 95% CI: 3.9-10.4), having a close relative diagnosed with breast cancer (AOR = 4.0, 95% CI: 1.1-15.1), and mother of respondent being self-employed (AOR = 0.5, 95% CI: 0.5-1.5). CONCLUSIONS: Awareness of breast self-examination and practice were high among the respondents; however, only a minor proportion practiced breast self-examination every month. Having good knowledge of breast self-examination was associated with its practice. Having a close relative diagnosed with breast cancer encouraged the respondents to prevent the occurrence of breast cancer, thus enabling the practice of breast self-examination. Moreover, the practitioners of breast self-examination taught and encouraged others to examine their breasts. There is a need to increase knowledge of breast self-examination through public health education using the media.

Rural retention of human resources for heath.

BACKGROUND: Health workers are the heart of the health system in any country and are made up of health service providers and the health support workers. The global health workforce is over 59 million and 67% of them are the service providers. AIM: The goal of this paper is to review the most relevant papers on the retention of health workers in the underserved areas and also on how to attract and retain health workers in the rural areas. METHODOLOGY: A systematic search of literature was conducted. Grey literature (conference papers, technical reports), journal articles, abstracts, relevant books and internet articles were reviewed. RESULTS: Shortage of health workers are among the constraints in achieving the three health related Millenium Development Goals and this is more pronounced in the resource poor countries. These same resource poor countries are faced with international migration of health workers to the developed countries. CONCLUSION: The numbers of health workers across the globe are few relative to need and this is more pronounced in the rural areas of the world who unfortunately bear the greater burden of disease and there is need for policies and actions that will help to attract and retain rural health workers.