Maternal Instruction About Jaundice and the Incidence of Acute Bilirubin Encephalopathy in Nigeria.

OBJECTIVE: To evaluate whether teaching mothers about neonatal jaundice will decrease the incidence of acute bilirubin encephalopathy among infants admitted for jaundice. STUDY DESIGN: This was a multicenter, before-after and cross-sectional study. Baseline incidences of encephalopathy were obtained at 4 collaborating medical centers between January 2014 and May 2015 (Phase 1). Structured jaundice instruction was then offered (May to November 2015; Phase 2) in antenatal clinics and postpartum. Descriptive statistics and logistic regression models compared 3 groups: 843 Phase 1 controls, 338 Phase 2 infants whose mothers received both antenatal and postnatal instruction (group A), and 215 Phase 2 infants whose mothers received no instruction (group B) either because the program was not offered to them or by choice. RESULTS: Acute bilirubin encephalopathy occurred in 147 of 843 (17%) Phase 1 and 85 of 659 (13%) Phase 2 admissions, which included 63 of 215 (29%) group B and 5 of 338 (1.5%) group A infants. OR for having acute bilirubin encephalopathy, comparing group A and group B infants adjusted for confounding risk factors, was 0.12 (95% CI 0.03-0.60). Delayed care-seeking (defined as an admission total bilirubin ≥18 mg/dL at age ≥48 hours) was the strongest single predictor of acute bilirubin encephalopathy (OR 11.4; 6.6-19.5). Instruction decreased delay from 49% to 17%. Other major risk factors were home births (OR 2.67; 1.69-4.22) and hemolytic disease (hematocrit ≤35% plus bilirubin ≥20 mg/dL) (OR 3.03; 1.77-5.18). The greater rate of acute bilirubin encephalopathy with home vs hospital birth disappeared if mothers received jaundice instruction. CONCLUSIONS: Providing information about jaundice to mothers was associated with a reduction in the incidence of bilirubin encephalopathy per hospital admission.

Factors associated with decreased survival from neonatal malaria infection in Jos, North Central Nigeria.

BACKGROUND: Malaria is a serious cause of morbidity and mortality in the neonatal period and account for a significant number of fetal wastage. Its diagnosis is difficult because of the overlap in clinical presentation with other infectious disease in the neonatal period. This study set out to examine the factors that are associated with an increased risk of mortality in neonates admitted with malaria. METHOD: Forty one neonates presenting between January and June 2009 were enrolled after obtaining ethical approval and informed consent from the mothers. Information collected include gestational age, age at presentation, birth weight, clinical symptoms, associated medical conditions and pertinent pregnancy history. RESULTS: Of the 41 neonates studied, 24 (58.5%) were females, 29 (70.5%) were term neonates and 12 (29.3%) had low birth weight. Overall mortality was 24.4%, more male neonates (70%) had malaria compared to females (50.0%) and neonatal malaria was associated with a longer hospital stay (p < 0.001). Female neonates (RR = 0.81, CI = 0.69 0.95), neonatal malaria (RR = 0.63, CI = 0.54 0.73) and maternal negative HIV status (RR = 0.22, CI = 0.15 0.32) was associated with lower risk of mortality. Whereas, multiple symptoms at presentation (RR = 1.67, CI = 1.42 1.96), multiple medical conditions (RR = 1.59, CI = 1.37 1.84) and maternal malaria in pregnancy (RR = 1.54, CI = 1.23 1.29) were associated with increased risk of mortality. Maternal IPT use, gestational age and birth weight did not have any statistically significant relationship with mortality. CONCLUSION: Neonatal malaria is a significant cause of neonatal mortality; the risk of which is higher with the presence of other co-morbid factors. We suggest a review of the IPT program and the introduction of maternal malaria screening at time of delivery.

Study of congenital heart defects among neonates in Jos, Nigeria: prevalence and spectrum.

BACKGROUND: There are few reports of the prevalence of CHD in the neonatal period in sub-Saharan Africa. The only available study in Nigeria was carried out before the widespread availability of echocardiography in the country. We sought to determine the prevalence and spectrum of congenital heart defects (CHD) among neonates in Jos, Nigeria. METHODS: This cross-sectional study enrolled neonates less than one week of age from the two largest hospitals and their immunisation centres. Relevant information was obtained and an echocardiogram was performed on each neonate. RESULTS: There were 3 857 neonates recruited over a two-year period; male-to-female ratio was 1.1:1. A total of 111 babies had CHD, with a prevalence of 28.8 per 1 000. Sixty-four neonates had mild CHD, with a prevalence of 16.6 per 1 000, while moderate and severe CHD were found in 27 (7.0 per 1 000) and 20 (5.2 per 1 000), respectively. CONCLUSIONS: CHD is prevalent in Nigerian neonates and there is therefore a need for advocacy to improve access to its diagnosis at birth for appropriate management.

Profile of congenital heart disease in infants born following exposure to preeclampsia.

BACKGROUND: Events in pregnancy play an important role in predisposing the newborn to the risk of developing CHD. This study evaluated the association between maternal preeclampsia and her offspring risk of CHD. METHODS: This is a cohort study of 90 sex-matched neonates (45 each born to women with preeclampsia and normal pregnancy) in Jos, Nigeria. Anthropometry was taken shortly after delivery using standard protocols. Echocardiography was performed within 24 hours of life and repeated 7 and 28 days later. SPSS version 25 was used in all analyses. Statistical significance was set at p<0.05. RESULTS: Congenital heart disease (CHD) was observed in 27 (30.0%) of newborns of women with preeclampsia compared with 11 (12.1%) of newborns without preeclampsia (p<0.001) at the end of 7 days and in 19 (21.1%) of newborns of women with preeclampsia and 3 (3.3%) of newborns of women without preeclampsia by the end of the 4th week of life (p<0.001). Overall, ASD (4 newborns), PDA (21 newborns), patent foramen ovale (14 newborns) and VSD (2 newborns) were the prevalent lesions found among all the newborns studied in the first week of life. Isolated atrial and ventricular septal defects were seen in 4 (4.4%) of the newborns of women with preeclampsia. Being the infant of a woman with preeclampsia was associated with about 8-fold increased risk of having CHD (OR = 7.9, 95% CI = 2.5-24.9, p<0.001). CONCLUSION: CHD may be more common in newborns of women with preeclampsia underscoring the need for fetal and newborn screening for CHD in women with preeclampsia so as to improve their infant's well being.

Factors influencing irradiance of locally fabricated phototherapy devices in Jos, north-central Nigeria.

Locally fabricated phototherapy devices (LFPDs) are widely used in Nigeria for the treatment of neonatal jaundice. Ours was a cross-sectional observational study of all LFPDs in major hospitals in Jos between January and March 2015. We evaluated a total of 24 LFPDs. The irradiance at the level of the baby was in the range of 2-23.9 µW/cm2/nm. Fourteen devices had the recommended irradiance of ≥10 µW/cm2/nm and none had irradiance in the intensive range. Decreasing distance from the baby, presence of reflectors and increasing number of flourecent tubes significantly contributed to higher irradiance. A combination of six tubes, presence of reflectors and a distance of 10 cm from the baby produced a mean irradiance of 23.40 µW/cm2/nm. The irradiance of LFPDs varies widely and can be improved by simple modifications.

Serum lipid and glucose profiles in HIV-positive Nigerian children.

OBJECTIVES: To describe the fasting serum lipid and glucose profiles of HIV-positive Nigerian children and determine the prevalence and risk factors for dyslipidaemia and hyperglycaemia, which are risk factors for cardiovascular diseases. METHODS: This was a comparative cross-sectional study carried out at the Paediatric Infectious Disease Clinic (PIDC) of the Jos University Teaching Hospital (JUTH) for HIV-positive children and at two primary schools in Jos for HIV-negative children as controls. One hundred and forty-two HIV-positive children aged 6-18 years and an equal number of controls were studied by determining their fasting serum lipid and glucose levels. The prevalence of dyslipidaemia and hyperglycaemia was determined and their risk factors obtained using multivariate logistic regression. P values of less than 0.05 were considered statistically significant. RESULTS: Mean triglyceride levels were significantly higher in HIV-positive children compared with controls at 87.2 mg/dL (95% confidence interval [CI] 79.4-95.0) and 68.1 mg/dL (95% CI 62.5-72.7), respectively (P<0.001). There were no significant differences in mean glucose levels. Dyslipidaemia was significantly higher in HIV-positive children (21.8%) compared with controls (12.7%; P=0.04). Total serum cholesterol was elevated in 17 (12.0%) HIV-positive participants compared with seven (4.9%) of controls (P=0.02). Children on lopinavir/ritonavir (LPV/r) and those with no significant or mild disease had a significantly higher prevalence of hypercholesterolaemia (33.3% vs 4.8% and 14.5% vs 0.0%, respectively; P<0.001). CONCLUSION: HIV-positive children on antiretroviral (ARV) drugs, especially LPV/r, should have their lipids regularly monitored as those with dyslipidaemia stand the risk of subsequently developing cardiovascular diseases.

Audit of availability and distribution of paediatric cardiology services and facilities in Nigeria.

BACKGROUND: Paediatric cardiac services in Nigeria have been perceived to be inadequate but no formal documentation of availability and distribution of facilities and services has been done. OBJECTIVE: To evaluate and document the currently available paediatric cardiac services in Nigeria. METHODS: In this questionnaire-based, cross-sectional descriptive study, an audit was undertaken from January 2010 to December 2014, of the personnel and infrastructure, with their distributions according to geopolitical zones of Nigeria. RESULTS: Forty-eight centres participated in the study, with 33 paediatric cardiologists and 31 cardiac surgeons. Echocardiography, electrocardiography and pulse oximetry were available in 45 (93.8%) centres while paediatric intensive care units were in 23 (47.9%). Open-heart surgery was performed in six (12.5%) centres. South-West zone had the majority of centres (20; 41.7%). CONCLUSIONS: Available paediatric cardiac services in Nigeria are grossly inadequate and poorly distributed. Efforts should be intensified to upgrade existing facilities, establish new and functional centres, and train personnel.

Malnutrition in Sickle Cell Anemia: Implications for Infection, Growth, and Maturation.

Sickle cell anemia (SCA) is a genetic disease that affects mostly individuals of African and/or Hispanic descent, with the majority of cases in sub-Saharan Africa. Individuals with this disease show slowed growth, delayed sexual maturity, and poor immunologic function. These complications could partly be explained by the state of undernutrition associated with the disease. Proposed mechanism of undernutrition include protein hypermetabolism, decreased dietary intake possibly from interleukin-6-related appetite suppression, increased cardiac energy demand/expenditure, and increased red cell turnover. All the above mechanisms manifest as increased resting energy expenditure. Nutritional intervention utilizing single or multiple nutrient supplementation has led to improved clinical outcome, growth, and sexual maturation. Studies are currently underway to determine the best possible approach to applying nutritional intervention in the management of SCA. Management of SCA will, of necessity, involve a nutritional component, given the sociodemographic distribution of those most affected by the disease, the ease of a nutritional approach, and the wider reach that such an approach will embody.

Prevalence of diarrhea disease and risk factors in Jos University Teaching Hospital, Nigeria.

BACKGROUND: Diarrhea is widely recognized as a major cause of childhood morbidity and mortality in many developing countries, particularly in sub-Saharan Africa. According to World Health Organization (WHO) report in the African region, diarrheal diseases are still leading causes of mortality and morbidity in children under five years of age. This same report indicates that each child in the said region has five episodes of diarrhea per year and that 800,000 die each year from diarrhea and dehydration. MATERIALS AND METHODS: This study examined diarrheal morbidity and associated risk factors in children under five years in Jos. A total of 340 children were seen in the Diarrhea Training Unit (DTU) of the Jos University Teaching Hospital (JUTH), Jos, over a period of 24 months (Jan 2008-Dec 2009). A semi-structured interviewer administered questionnaire was used to generate the data. All women whose children presented with diarrhea were interviewed and data generated analyzed using Epi info version 3.5.1 statistical software. RESULTS: During the study period, 13,076 children were seen in our facility, of which 340 were suffering from diarrhea, thus giving a diarrhea prevalence of 2.7%. There were 183 (54%) male and 157 (40%) female children seen with diarrhea. The mean age was 11 ± 8.5 months. The mean duration of diarrhea was found to be 4 ± 3.6 days. A majority of children were aged less than 6 months, consisting of 235 infants, 95 toddlers, and 10 pre-schoolers. Of the number of women seen, 242 (61%) had at least primary education, while 98 (29%) had no formal education. Diarrheal episodes were found to have a bivariate association with mothers' educational status, family type, family size, breastfeeding, and sex of child. However, only mother's educational status, diarrhea in other sibling, and breast feeding were significantly associated with the occurrence of diarrhea. Although there were more male children with diarrhea, the odds of having diarrhea was not significantly related to sex. CONCLUSION: Our study demonstrated an important relationship between diarrheal morbidity and low maternal education, nonexclusively breastfed infant, and previous diarrheal episode in a sibling. It thus meant that diarrhea morbidity is still an important problem for infants in our environment. Moreover, maternal education and exclusive breastfeeding are still relevant viable measures in curbing diarrhea in infants.

Maternal characteristics influencing birth weight and infant weight gain in the first 6 weeks post-partum: A cross-sectional study of a post-natal clinic population.

BACKGROUND: To investigate the relationship between certain maternal characteristic and infant birth weight and weight gain in puerperal women seen at a tertiary health centre. MATERIALS AND METHODS: We measured the weight of 318, randomly selected infants after a complete physical examination at birth and at 6 weeks postnatal using standard procedures and related them to certain maternal characteristics. RESULTS: There were 318 women and baby pairs. Maternal ages ranged from 16 to 42 years, with a mean of 25.6±1.3 years. Mean birth weight of babies was 3.10±1.89 kg; mean gestational age was 36±4.6 weeks, with 9.4% and 3.0% of babies born having low birth weight or Macrosomia respectively. Mothers from the North of the country, multiparity and systolic and/or diastolic hypertensions were factors associated with low birth weight. At 6 weeks, 27.1% of infants failed to gain weight as expected for their age. Similarly, 37.0% of infants born to mothers with some tertiary education showed slowed weight gain compared with those who had secondary (19.2%) or primary (14.7%) education, P=0.03. Maternal weight at delivery positively correlated with birth weight of the infant (r=0.357, P<0.001). However, maternal weight and blood pressure negatively correlated with infant weight gain at 6 weeks post-delivery. CONCLUSION: Our study demonstrates that certain maternal characteristics could play a role in the birth weight and early infant weight gain, and are preventable through simple public health approaches.

Summary Description of 24 Cases of Neonatal Malaria Seen at a Tertiary Health Center in Nigeria.

OBJECTIVE: Neonatal malaria is a serious cause of morbidity and mortality in sub-Saharan Africa. Diagnosis of neonatal malaria is difficult because of the similarity in clinical presentation with other neonatal infections. This study aim to highlight the clinical presentations and high mortality still associated with neonatal malaria. METHODS: Twenty four out of 41 neonates seen during a 6 months period were studied. Gestational age, age at presentation, birth weight and other clinical symptoms were documented. Questionnaires were used to collect pertinent pregnancy and perinatal history from the mothers. Data was analyzed using SPSS v18 and results expressed in tables using means, frequencies and percentages. FINDINGS: All 24 neonates, 50% of whom were males, had a positive smear for malaria parasite. 29.2% were preterm, 17(70.8%) had congenital malaria, 18(75.0%) mothers used intermittent preventive treatment (IPT) of malaria prophylaxis in the index pregnancy and 1(4.2%) mother had HIV in pregnancy. Fever was the principal presenting symptom and 83.0% responded to treatment with amodiaquine. CONCLUSION: Neonatal malaria is still an important cause of mortality, a more effective malaria prophylaxis program and routine malaria parasite screening for neonates is recommended.