Severe acute malnutrition in a population of hospitalized under-five nigerian children.

AIMS AND OBJECTIVES: This study was to determine the prevalence and socio- clinical factors associated with severe acute malnutrition (SAM) among hospitalized under-five children. PATIENTS AND METHOD: A cross-sectional survey of children aged less than 59 months was carried out at the Children's Ward of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria using the 2006 WHO criteria for SAM. RESULTS: A total of 208 children were studied. Overall, 64.9% had normal nutrition while 18.3% had SAM. Of the 38 children with SAM, 68.4% were hospitalised primarily for severe protein-energy malnutrition using the Wellcome classification. Low maternal education (84.2% vs 65.2%; p = 0.025), non-exclusive breastfeeding (84.2% vs 61.5%; p = 0.009), untimely commencement of weaning (77.8% vs 47.1%; p = 0.006), cessation of breastfeeding before the age of 12 months (45.5% vs 0.0%; p < 0.0001) and presence of infections (84.2% vs 58.5%; p = 0.004) were associated with SAM. Multivariate analysis identified presence of infections (OR = 4.9; p = 0.002), non- exclusive breastfeeding (OR = 1.1; p = 0.048) and low maternal education (OR = 2.1; p = 0.02) as strong determinants of SAM. CONCLUSION: The prevalence of SAM among hospitalized Under-Fives was high. This justifies the routine use of the WHO diagnostic criteria at the community level for early detection of at-risk children.

Maternal knowledge and care-seeking behaviors for newborn jaundice in Sagamu, Southwest Nigeria.

BACKGROUND: Delay in the presentation of infants with jaundice at the hospital is a reason for the persistence of the severe forms of jaundice. OBJECTIVE: The aim was to determine the influence of maternal knowledge on newborn jaundice on their care-seeking practices. METHODS: In a cross-sectional survey, mothers whose infants presented with significant hyperbilirubinemia were assessed for knowledge about jaundice in relation to their care seeking behaviors. RESULTS: Out of 98 mothers, 57.1% had good knowledge on newborn jaundice. Most of the mothers with good knowledge had tertiary education (P = 0.004), had good care-seeking behavior for newborn jaundice (P = 0.027) and their infants did not develop kernicterus (P = 0.0001). Mothers with tertiary education also had significantly better performances on the knowledge and care-seeking evaluation scales. CONCLUSION: Maternal knowledge on newborn jaundice, as well as tertiary maternal education, influenced appropriate care-seeking behavior for infants with jaundice and reduced the risk of complications.

National neonatal resuscitation training program in Nigeria (2008-2012): a preliminary report.

BACKGROUND: Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth. MATERIALS AND METHODS: Between 2008 and 2012, doctors and nurses drawn from all the geo-political zones were trained using the Neonatal Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire-based, cross-sectional surveys of doctor and nurse trainees from the six geo-political zones in Nigeria were conducted eight months after the primary training, to evaluate the post-training neonatal resuscitation activities. RESULTS: Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post-training period. The nurses used bag and mask for infant resuscitation more frequently, compared to doctors, with the rate fluctuating between two-to-one and four-to-one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants. CONCLUSION: The NRT in Nigeria is well-subscribed and the frequency of secondary training is good.

Determinants of timely initiation of complementary feeding among children aged 6-24 months in Sagamu, Nigeria.

BACKGROUND: Poor breastfeeding and complementary feeding practices may contribute to childhood malnutrition in the developing world. OBJECTIVE: The objective was to examine the determinants of timely initiation of complementary feeding among Nigerian children. MATERIALS AND METHODS: Using a cross-sectional design, children aged 6-24 months were surveyed in a Nigerian Teaching Hospital. Children with timely initiation of complementary feeding (6-8 months) were compared with children with untimely initiation of complementary feeding early (<6 months and >8 months) for clinical and social characteristics using both bivariate and multivariate analysis. RESULTS: Of 156 children, 41%, 53.8%, and 5.1% had timely, early and delayed initiation of complementary feeding. Complementary feeding was initiated with processed cereals (44.8%), locally prepared maize gruel (32.1%) and mashed family diet (23.1%). Bivariate analysis showed significant association between timely initiation of complementary and orthodox maternity care, no prelacteal feeding, exclusive breastfeeding, no siblings and first birth order. Parental education was not associated with timely initiation of complementary feeding. Multivariate analysis identified orthodox maternity care, exclusive breastfeeding and no siblings as independent predictors of timely initiation of complementary feeding. CONCLUSION: Complementary feeding is most frequently initiated earlier than 6 months in this population. Good breastfeeding practices may influence timely initiation of complementary feeding. Interventions should be targeted at the entire population irrespective of educational and socioeconomic status.

Mothers' knowledge about birth asphyxia: the need to do more!

BACKGROUND: Health education is an important tool required for reducing the burden of birth asphyxia in the developing world. OBJECTIVE: The objective of this study was to assess the knowledge of mothers, who received health facility-based antenatal care during their last pregnancy, about birth asphyxia and relate their knowledge to their places of antenatal care. MATERIALS AND METHODS: A cross-sectional survey of mothers of infants attending the Immunization clinic in a Nigerian Teaching Hospital was done between July and October 2010 using a close-ended questionnaire. Consecutively consenting mothers were enrolled into the study. RESULTS: Out of 354 mothers, 56.5% received counseling about birth asphyxia during antenatal clinic visits in their last pregnancy; 85.5% of attendees of teaching hospital; and 26.4% of attendees of private antenatal clinics received counseling about birth asphyxia. Overall, 38.9% of the respondents had satisfactory knowledge about birth asphyxia; 47.5% of teaching hospital attendees; and 28.1% of private clinic attendees had satisfactory knowledge about birth asphyxia. Lower socioeconomic status, lack of counseling, and nonattendance of teaching hospital antenatal clinic were associated with poor knowledge about birth asphyxia. CONCLUSION: Most of the mothers surveyed had poor knowledge about the risk factors and sequelae of birth asphyxia. The health system needs to improve health education of expectant mothers about birth asphyxia.

Are We Missing Hypothyroidism among Children with Sickle Cell Anaemia?

Background: Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia. However, few studies on hypothyroidism status of children with sickle cell anaemia in Nigeria are available. The objective of this study was to determine the prevalence of hypothyroidism among children with sickle cell anaemia. Methods: A cross sectional study that assayed the thyroid hormones and thyroid stimulating hormone (TSH) of 71 children with sickle cell anaemia was conducted at Olabisi Onabanjo University Teaching Hospital Sagamu. Using age appropriate hormonal reference values, the subjects were classified into subclinical, primary and secondary hypothyroidism. Results: The mean serum TSH, Free T3, and Free T4 were comparable irrespective of age category (p > 0.05). No subject was identified to have low TSH value while 7.0% had high TSH value. Low free T3 was identified in 1.4% and 8.5% had high free T3 values. Low free T3 and free T4 were seen in 11.3% each of the subjects. The overall prevalence of primary, secondary and subclinical hypothyroidism was 0%, 0% and 4.2%, respectively. Conclusion: Sub-clinical hypothyroidism does occur in Nigerian children with sickle cell anaemia. Routine screening for hypothyroidism is advocated in all children with sickle cell anaemia.

Pattern and determinants of newborn apnea in an under-resourced Nigerian setting.

OBJECTIVE: To determine the prevalence, distribution and determinants of newborn apnea in a resource-constrained setting. DESIGN: Retrospective study. MATERIALS AND METHODS: Newborn babies who had apnea during hospitalization between January and December 2008 were studied. The sex, age and body weight, clinical conditions, etiologies of apnea and outcome were recorded. Babies with and without apnea were compared using bivariate and multivariable analysis. RESULTS: Out of 402 babies seen during the review, 78 (19.4%) had apnea. They comprised 59 preterm and 19 term babies. Forty (51.3%) had apnea at the point of admission while the remaining 38 (48.7) developed apnea after a mean interval of 118.5 ± 101.1 hours. Thirty-seven percent of preterms had idiopathic apnea. Etiologies included respiratory distress (50.0%), hypothermia (42.3%), and asphyxia (28.2%). Multivariate analysis showed that weight <2.5kg, hypothermia, referred status and presence of respiratory distress were determinants of apnea. Case fatality rate was 82.2% among apneic babies. CONCLUSION: Apnea occurred commonly in this population of babies. Stringent efforts like ventilator supports for babies in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the major risk factors for newborn apnea. The identified determinants can be used to draw up effective preventive measures in resource-poor settings.

Nutritional status of semi-urban Nigerian school children using the 2007 WHO reference population.

BACKGROUND: There is paucity of data on the nutritional status of school-age children in Sagamu town of Southwestern Nigeria. OBJECTIVE: To determine the nutritional status of primary school children in Sagamu Local Government Area, Nigeria. METHODS: A cross-sectional survey of primary school children aged 6 to 10 years in Sagamu, Southwestern Nigeria was done. Eight schools were selected using a multi-stage sampling technique. Children randomly selected proportionately from the schools were studied. The weight-for-age, height-for-age and BMI of these children were compared with the 2007 WHO reference values to diagnose underweight (WA <-2SD), stunting (HA <-2SD), thinness (BMI <-2SD), overweight (BMI > +1SD) and obesity (BMI > +2SD). RESULTS: A total of 1016 children comprising 479 (47.1%) boys and 537 (52.9%) girls were studied. The prevalence of malnutrition was 401(39.4%) and boys were more malnourished compared to girls (p =0.002). The overall prevalences of underweight, stunting and thinness were 260(25.5%), 144(14.2%) and 226(22.2%) respectively. Overweight and obesity were present in 31(3.0%) and 5(0.5%) of the population studied respectively. Boys were significantly more often underweight and stunted. CONCLUSION: The prevalence of under-nutrition among school children in Sagamu, Nigeria was high and the girls were generally better nourished than the boys. Efforts to reduce the burden of malnutrition in this population may include nutritional surveillance, food supplementation and free school meals.

Pattern and determinants of blood transfusion in a Nigerian neonatal unit.

OBJECTIVE: To determine the pattern and determinants of blood transfusion in a Nigerian neonatal unit. MATERIALS AND METHODS: Newborn babies who required blood transfusions between January and December, 2008, were studied. The sex, age, and weight at the first transfusion, clinical conditions, indications for transfusion, and the outcome were analyzed with bivariate and multivariate methods. RESULTS: A total of 402 neonates were hospitalized and 112 (27.9%) had blood transfusion; 61.9% had exchange transfusion, 66.1% had red cell transfusion, and 8% had plasma transfusion. There were 251 transfusions with a rate of 4.8 transfusions per week. Blood transfusions were done for severe jaundice (55.4%), severe anemia (40.2%), and bleeding disorders (4.4%). Weight < 2.5 kg, outside delivery, and jaundice were independent determinants of neonatal transfusion. CONCLUSION: The blood transfusion rate in this facility was remarkably high. Improved standard of newborn care and infrastructural support are required to reduce the transfusion rate.

Approach to the management of a bleeding neonate.

INTRODUCTION: Neonatal bleeding disorders are common in clinical practice but the laboratory tests required for making the diagnoses are often sophisticated, expensive and so, largely unavailable in the developing world. Thus, a simple clinical approach to the diagnoses and management of neonatal bleeding is desirable in the developing world. METHODOLOGY: A review of literature was done using Medline search, texts on the topic were reviewed. The treatment modalities for each of the common causes of neonatal bleed as well as the limitations encountered in the developing world are also highlighted. RESULTS: Various methods are available for the evaluation of the bleeding neonate, clinical and laboratory with variable sensitivity. For ease of diagnosis in the face of limited laboratory facilities, bleeding babies can be divided into two broad groups: well babies with and without thrombocytopaenia as well as sick babies with and without thrombocytopaenia. CONCLUSION: Using the parameters like the platelets count, prothrombin time, partial thromboplastin time, assays of fibrin degradation products and the clinical condition of the newborns, a large number of commonly encountered causes of neonatal bleeding disorders can be diagnosed to a fair extent.

The incidence and outcome of bilirubin encephalopathy in Nigeria: a bi-centre study.

OBJECTIVE: To determine the current trends in the incidence and outcome of bilirubin encephalopathy among Nigerian babies. METHODS: A review of the hospital records of babies managed for bilirubin encephalopathy at the Wesley Guild Hospital (WGH), Ilesa and Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, both in southwest Nigeria between 2001 and 2005 was carried out. The age, sex, weight, body temperature on admission, place of delivery and outcome of hospitalization were studied. The fatal cases and the survivors were compared for risk factors for mortality. RESULTS: Fifty eight (3.4%) and 57 (2.3%) babies had bilirubin encephalopathy out of 1706 and 2492 total neonatal admissions at OOUTH and WGH respectively. Of these 115 babies, 3 (2.6%), 84 (73.0%) and 28 (24.3%) were aged <3 days, 3-6 days and 7 days or more. Sixty eight (59.1%) babies were delivered in orthodox health facilities. Aside clinically suspected cases of G6PD deficiency, ABO incompatibility and septicaemia were commonly associated with bilirubin encephalopathy, Forty four (38.3%), 36 (31.3%) and 35 (30.4%) had Unconjugated bilirubin of <340 micromol/L, 341-425 micromol/L and >425 micromol/L respectively Sixty eight (59.1%) were discharged, 42 (36.5%) died while 5 (4.7%) were discharged against medical advice. Prematurity, low birth weight, severe anaemia and inability to do Exchange Blood Transfusion were significant risk factors for mortality among babies with bilirubin encephalopathy. Cerebral palsy, seizure disorders and deafness were the leading neurological sequelae (86.4%, 40.9% and 36.4% respectively) among the 22 survivors who were followed up. CONCLUSION: Bilirubin encephalopathy remains a common clinical finding in Nigeria and the associated mortalities and neurological sequelae are significant.

Latrogenic burns injury complicating neonatal resuscitation.

A case ofiatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury, with surface area coverage of about 4%, involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice.

The use of antimalaria drugs and insecticide treated nets in Ile-Ife, Nigeria.

BACKGROUND: The Roll Back Malaria Initiative (RBMI) is aimed at halving the malaria mortality in the year 2010 using prompt diagnosis and treatment of malaria and the use of Insecticide Treated Nets (ITNs). METHODS: This is a cross sectional study of children aged 1 month to 14 years with confirmed malaria to assess the burden of malaria and to evaluate the home use of anti-malarial drugs and ITNs among children with malaria in Ile Ife, Nigeria. RESULTS: Of the total of 1047 children seen, 190 (18.1%) had malaria and were surveyed. Complications were present among 74 (38.9%) children and a significantly higher of the under-fives had complications (p by Fisher's exact test = 0.0018). Chloroquine was administered to 63 (67.0%) children within the first 24 hours of the illness although only 25 (26.6%) children had the correct dosage. One hundred and fifty three (80.5%) were aware of the use of untreated bed nets in preventing malaria while 38 (20.0%) and 4 (2.1%) were aware of ITNs and used ITNs respectively. The awareness of ITNs increased with increasing maternal education. CONCLUSION: Awareness of the parents about ITNs and their use are poor. Health education on appropriate antimalarial drug use and ITN use should be intensified. ITNs should be made more widely available.

A COMMUNITY-BASED PREVALENCE OF PRESBYOPIA AND SPECTACLE COVERAGE IN SOUTHWEST NIGERIA.

BACKGROUND: The use of population-based method to assess the prevalence of presbyopia and spectacle use is few even though it is more reliable compared to the commoner hospital based studies. This study was carried out to determine the need for spectacle services in our coverage area. AIM: To determine the prevalence of presbyopia among adults of 30 years old and above in Sagamu local government area of Ogun state, South-West, Nigeria. DESIGN: The study was a population based descriptive and cross-sectional design. SETTING: The study was carried out using a multistage cluster random sampling with probability proportional to size of regular adult residents of Sagamu Local Government area, Sagamu, Ogun state, Nigeria. MATERIALS AND METHODS: Examination of respondents included administration of semi-structured interviewer assisted questionnaire and distance visual acuity measurement with or without pinhole at 6 meters using the Snellen's charts. Automated refraction with subjective refraction was carried out in all participants with presenting visual acuity (PVA) worse than 6/9 but with an improvement with pinhole. Near assessment was done at 40cm with the distance correction in place if required. Ocular examination was also carried out in all participants that had refraction including pupillary dilatation when indicated. RESULTS: The prevalence of presbyopia was 80.9%. There was an increasing prevalence with age (p<0.001) with a 100% prevalence in the ≥80 years age group. The mean add requirement was +2.24DS. The met presbyopic need was 22.9% and the unmet need 58%. The presbyopic spectacle coverage was 28.4% which was positively associated with younger age (p=0.034), attaining at least secondary school education (p<0.001), and living in an urban area (p<0.001). CONCLUSION: The prevalence of presbyopia is high in this community and found in persons younger than 40 years and the spectacle coverage for the population is low with a high unmet spectacle need. There is a need to provide near vision spectacles to a large proportion of residents in the community.

Pyogenic meningitis in Ilesa, Nigeria.

This study was conducted in 124 children with meningitis to review the etiology, antimicrobial susceptibility and outcome of disease in a Nigerian tertiary health facility. Of these, 97 (78.27%) were culture positive; in the rest 27(21.8%), diagnosis was based on Gram staining of the CSF. Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus and Escherichia coli were isolated in 33.9%, 33.9%, 5.6%, 2.4%, and 2.4% samples respectively. All the isolates had 100 percent; sensitivity to both ceftriaxone and ciprofloxacin while the sensitivities to penicillin and ampicillin were remarkably low. The mortality was 33/124 (26.6%) while 16/ 91 (17.6%) of the survivors had various neurologic sequelae.

The Influence of Method, Timing of Onset and Duration of Enteral Feeding on the Duration of Hospitalization of Newborn Infants in a Nigerian Special Care Baby Unit.

BACKGROUND: Feeding practices among high-risk newborn babies have not been extensively studied in the resource-constrained parts of the world. AIM: To describe the pattern of milk use among infants in a resource-poor special care baby unit (SCBU) and relate these to the outcome of hospitalization. SUBJECTS AND METHODS: Setting - SCBU of Olabisi Onabanjo University Teaching Hospital, Sagamu. Design - Prospective study of consecutively admitted inborn babies within the first 24 h of life. The data analyzed included the weight and estimated gestational age (EGA) of the babies, the age at the onset of and duration of feeds (breast milk and artificial milk [AM]). RESULTS: Out of the 118 infants studied, (78.8%) 93/118 received breast milk and 16.1% (19/118) received AM. The mean age at the commencement of enteral feeding was 3.9 days. The age at the onset of suckling was negatively correlated with the EGA and body weight. The age at the onset and duration of enteral feeding were directly related to the duration of admission. CONCLUSION: More than three-quarter of the infants hospitalized in the unit received breast milk, but commencement was mostly delayed beyond the 3(rd) day of life. The duration of admission may be related to the timing of onset and duration of milk use.

Growth pattern of schoolchildren in Sagamu, Nigeria using the CDC standards and 2007 WHO standards.

OBJECTIVE: To compare the median weight, height and body mass index of school children with the 2000 CDC and 2007 WHO reference values. SETTINGS: Schoolchildren in Sagamu, Nigeria. DESIGN: Cross-sectional survey. METHODS: Between November and December, 2008, 1690 school children aged 6 to 16 years from 8 primary schools were surveyed using multi-stage sampling methods. The weight, height and body mass index (BMI) were recorded for each child. The Z-scores of the median anthropometric parameters for each age and sex were determined with the LMS statistical method using the values of L, M and S provided on the CDC and WHO charts. RESULTS: The weight, height and BMI Z-scores were less than the reference values provided on the CDC and WHO charts but were generally closer to the WHO standards compared to the CDC standards. The median weight, height and BMI for females generally plotted higher on CDC and WHO chart compared to the males. The prevalence of underweight and stunting were relatively lower while the prevalence of overweight and obesity was relatively higher among children aged 6 to 10 years using the WHO references compared to the CDC reference values. CONCLUSIONS: The WHO references would under-diagnose under-nutrition and over-diagnose overweight/obesity in the population studied.

Determinants of Timely Initiation of Complementary Feeding among Children Aged 6-24 Months in Sagamu; Nigeria

Background: Poor breastfeeding and complementary feeding practices may contribute to childhood malnutrition in the developing world. Objective: The objective was to examine the determinants of timely initiation of complementary feeding among Nigerian children. Materials and Methods: Using a cross-sectional design; children aged 6-24 months were surveyed in a Nigerian Teaching Hospital. Children with timely initiation of complementary feeding (6-8 months) were compared with children with untimely initiation of complementary feeding early (6 months and 8 months) for clinical and social characteristics using both bivariate and multivariate analysis. Results: Of 156 children; 41; 53.8; and 5.1 had timely; early and delayed initiation of complementary feeding. Complementary feeding was initiated with processed cereals (44.8); locally prepared maize gruel (32.1) and mashed family diet (23.1

Kwashiorkor--is it a dying disease?

OBJECTIVE: To review the occurrence of kwashiorkor before and after the establishment of the Diarrhoea Training Unit at a Nigerian tertiary hospital in 1992. DESIGN: A retrospective hospital-based analytical study was undertaken. Groups of subjects were compared using odds ratios (95% confidence intervals) and regression analysis. SETTING: The paediatric wards of the Wesley Guild Hospital, Ilesa, Nigeria. SUBJECTS: The number of children admitted with kwashiorkor, measles, gastroenteritis and marasmus between 1983 and 1991 (group I) was compared with similar data for the period 1993-2002 (group 2). RESULTS: There was a 30.4% reduction in the total admissions between these periods, while incidences of kwashiorkor, measles, gastroenteritis and marasmus fell by 70%, 55%, 57.4% and 55.8% respectively. Reduction in number of kwashiorkor cases between groups 1 and 2 was significantly related to the reduced incidence of measles (p = 0.000002) and gastroenteritis (p = 0.000003). The total number of admissions was correlated with the number of measles (r = 0.623 and 0.573 for group 1 and 2) and kwashiorkor cases (r = -0.412 and 0.233 for groups 1 and 2). CONCLUSION: The incidence of kwashiorkor has fallen in Ilesa, Nigeria. Given the relatively low HIV prevalence rate in the country during the study period, better management of diarrhoeal diseases, including measles, may have accounted for this drastic fall.

Do working children have worse academic performance?

OBJECTIVE: To examine the effect of child labor on school children's academic performance. METHODS: Primary school children engaged in child labor were compared with age, sex and school-matched controls for absence from school and scores obtained at sessional examination in English language, Mathematics, Sciences and Social studies. RESULTS: There was no significant difference in the mean rate of school absence (p = 0.80), mean aggregate examination scores (p = 0.1) and proportion of class repeaters (p = 0.16) among working school children and the controls. However, a significantly higher proportion of the controls had high (>75%) average examination scores compared with the working school children (p = 0.017). Similarly, the controls performed better than working school children in each of four core subjects but significant differences were observed only in Social Studies and Science (p = 0.006 and 0.001 respectively). CONCLUSION: There is some undermining of academic performance among children who combine schooling with child labor despite comparable school absence with the controls.