Assessment of the implementation of respectful maternity care charter in North Central Nigeria (Federal Capital Territory and Kwara State): study protocol

Respectful Maternity Care (RMC) charter is one of the tools for ensuring quality of care in maternity services. Nigeria is a signatory to RMC charter; therefore, the charter is expected to be the standard of care. However, in Nigeria and other countries, reports of disrespectful maternity care abound; this discourages women from accessing facility-birth. Therefore, to improve the quality of care towards increase in uptake, it is expedient to assess the level of implementation of the RMC charter by key stakeholders for sustainability, impact and scale-up of charter-compliant maternity care in Nigeria. The study aims to assess the implementation of RMC charter in North-central Nigeria. The study is a mixed-method, cross-sectional study; the expected participants are key stakeholders in healthcare (Healthcare workers, Healthcare Administrators, Project Managers, Policy makers) in North-Central Nigeria (Federal Capital Territory and Kwara state). A multistage sampling technique would be used to enroll participants from 18 healthcare facilities (Primary, Private, Secondary and Tertiary) in rural and urban areas and Ministries of Health officials at local and state government levels. Expected outcomes: The study is expected to provide information on the current status of knowledge and implementation of the RMC charter in Nigeria. It would also identify the enablers and barriers to the implementation process and provide evidence for effective scale-up of the process in Nigeria. The outcomes will be widely disseminated to healthcare workers, health administrators and decision-makers in healthcare services through post-study meetings, conference presentations, journal publications and policy briefs for effective RMC charter implementation in Nigeria.

Evaluation of Some Haematological Metrics among Smokers in Port Harcourt, Rivers State, Nigeria

Introduction: Smoking is extremely toxic and has had a significant negative impact on society. One of the leading contributors to preventable illness and mortality has been found to be cigarette smoking. Aim: The goal of this study is to evaluate a few haematological metrics among smokers in Port Harcourt, Rivers State, and to verify the idea that smoking cigarettes either has a negative or favorable impact on these variables. Methodology: In this cross-sectional study, 100 participants between the ages of 20 and 45 were included, 50 of whom were smokers and 50 non-smokers. Venipuncture was used to obtain blood samples from the patients, which was then put into an EDTA vial for a full blood count (FBC) and other haematological analysis. The full blood count and erythrocyte sedimentation rate (ESR) were done using Haemo Auto Analyzer, Model XP-300 KOBE Japan by SYSMEX and the Westergreen method respectively. In order to analyze the data, Graph Prism Pad 6.2 and Microsoft Office Excel 2016 were both used. Using the student's independent t-test, a comparative study of mean and standard deviation values for the various parameters for test and reference ranges was conducted. Results: According to the findings, the average age of 50 smokers was 43.6200± 9.7250 years and that for the 50 non-smokers was 42.7800± 6.5440 years, which was statistically insignificant with p valve of 0.6130. Smokers’ haemoglobin level was 14.5080 ± 1.5590 (g/dL) and non-smokers was 12.1340 ± 0.70410 (g/dL). According to statistics, the level of Hb was significantly higher in smokers compared to non-smokers (P<0.0001). In comparison to non-smokers, the RBC count dramatically increased in smokers (P<0.0001) greater than in non-smokers at 5.2550 ± 0.6629 (x1012/L) and 4.6340 ± 0.5530 (x1012/L) respectively. While the total leucocyte count (TLC) in smokers is 8.0500 ± 1.8796 (x109/L), compared to 6.8580 ± 1.2454 (x109/L) in non-smokers. Statistics show that smokers have a higher total leucocyte count than non-smokers (P<0.0002). Smokers' platelet count is 255.7600±61.8351 (x109/L) while non-smokers' is 216.5800±35.5752 (x109/L).The study has statistically shown that smokers' platelet counts rose considerably in comparison to non-smokers (P<0.012). Conclusion: It may be concluded that uninterrupted smoking has an undue negative impact on haematological parameters such that increase occur in values of Hb, RBC, TLC and platelets. Significantly, these changes may increase the risk of serious health issues such as heart related defects, hardening of the arteries, Vaqu

Haematological and Anthropometric Profile in Gestational Diabetes Mellitus with Non-diabetic Pregnant Women in Port Harcourt, Nigeria

Aim: Haematological and anthropometric profile of pregnant women who had gestational diabetes and non-diabetic pregnant women attending antenatal clinic in a Tertiary Hospital in Rivers State, Nigeria were evaluated, Methods: This was a cross sectional study involving 70 pregnant women comprising of 40 diabetic and 30 non-diabetics for the purpose of comparing haematological and anthropometrical parameters in diabetic and non-diabetic pregnant women. Using standard venipuncture technique,5ml blood sample was aseptically drawn from the subjects and 2.5ml dropped into each of two different anticoagulant sample bottles -Ethylene Diamine Tetra acetic Acid(EDTA) and fluoride-oxalate bottles respectively. The methods of choice for estimation of parameters were Enzymatic Colorimetric method for glucose and Automation using Sysmex KX-21N Haematology Analyzer for full blood count. Results were statistically analyzed using Graph Pad prism version 5.0 and statistical significance set at P<0.05.Results: Mean± SD results for diabetic and non-diabetic pregnant women respectively showed Haemoglobin concentration (10.99±0.69g/dl versus 10.69±1.01g/dl), Packed cell volume (31.7±1.96% versus 32.89±3.89%), Red blood cell(3.99±0.29106/µl versus 3.85±0.39×106/µl), Mean cell haemoglobin (27.51±1.22pg versus 27.54±2.22pg), Platelets count (223.3±52.67103/µl versus 205.5±45.09×103/µl), Mean cell haemoglobin concentrations(34.49±1.19g/dl versus 32.54±3.17g/dl)these results were not statistically significantly different(P>0.05). The mean± SD of white blood cell (9.73±0.49103/µl versus 7.27±1.66×103/µl) and mean cell volume (79.3±4.16 fl and 85.24±0.39fl) were statistically significantly different (P<0.05).Mean± SD of subject’s blood pressure showed, Systolic (116±11.52 mm/Hg and 105±5.72 mm/Hg),Diastolic (77±17.86 and 68±1.11 mm/Hg), results were statistically significantly different (P<0.001).Age did not show statistical significant difference (P>0.05).Body mass index (BMI) 28.33±3.81 kg/m2, 32.86±5 kg/m2, 37.96±.3.44 kg/m2 showed statistically significant difference (P<0.05) at the Gestational ages of(1-3), (4-6) and (7-9) months respectively while that of the non-diabetic were obviously not statistically significantly different (P>0.05).Conclusion: Gestational diabetes is capable of causing changes in haematological parameters; but it could improve or disappear after child birth. Factors such as lifestyle activities and diet can predispose pregnant women to gestational diabetes mellitus and this can lead to complications for both the mother and the baby.

Study on Malaria and Haemoglobin Interaction in Pregnant Women

Comparative observational study was carried out on the prevalence of malaria among pregnant women attending antenatal clinics in General Hospital, Bori (GHB) and Braithwaite Memorial Specialist Hospital, Port Harcourt (BMSH). Four hundred women were involved in this study of which two hundred per study location. Pregnant women with pyrexia of unknown origin, HIV and those on anti malarial drugs were excluded. Consents were obtained from participants and confidentiality upheld. Ethical approval was obtained from the ministry of health and from the selected health facilities. Sample collection was performed according to the recommended reference guideline for phlebotomy. Collected samples were used to assay for Haemoglobin using cyanomethamoglobin method, and malaria parasite using the Giemsa staining technique. Statistical analysis was performed for percentage, frequency, for descriptive statistics and inferences deduced at p-value=0.05. All statistical analyses were performed using Statistical Package for Social Sciences. Questionnaires were issued to obtain their demographic data. The prevalence of malaria was high among pregnant women with haemoglobin level 8.0–10.9g/dl from BMSH (17.9%) and GHB (35.9%). Infection was not dependent on locality at P-value < 0.05. Awareness of malaria in pregnancy should be supported. Anaemiain pregnancy should be treated and comorbidity of malaria and anaemia in pregnancy should be handled with urgency.

Clinical Profile and Effects of Ductal Size on Anthropometry of Children with Patent Ductus Arteriosus (PDA)

It is not known at which size a congenital Patent ductus arteriosus (PDA) in children becomes associated with a resultant severe malnutrition in children. Furthermore, the effect of ductal size on anthropometry of children with PDA is yet to be determined. Objectives This study was aimed to asses if the ductal size had any effect on anthropometry of children with PDA and at which size evidence of severe malnutrition ensues Methods This was a five-year observational cross-sectional study of children who presented at three tertiary institutions with PDA. Results There was a negative non-significant correlation between the size of PDA and the weight of patients, (Pearson correlation coefficient = -0.1, p = 0.7). There was also a negative non-significant correlation between the size of PDA and patient’s height/length, (correlation coefficient = -0.1, p = 0.5). The association between the size of PDA and the severity of malnutrition revealed greater proportion of 35.3% (6/17) for wasting and stunting in patients who had large PDA sizes of >7mm, when compared with fewer proportions in those with PDA sizes of 3- 6mm (26.1% (6/23) and those with tiny PDA of <3mm (33.3% (10/30); (?2 = 10.21, p = 0.8). There was a positive correlation between ductal size and nutritional status of patients, and severe malnutrition ensued from ductal size of 3.2mm; with ETA square of 0.072. The majority of children with PDA presented with severe forms of malnutrition (wasting and stunting). Conclusion: Severe malnutrition ensues when ductal size is 3.2mm. The size of PDA has no effect on weight and height of children with PDA.

Assessment of Coagulation and Haematological Parameters among Pregnant Women in Port Harcourt

Background:Pregnancy is the fertilization and development of an embryo or fetus in a woman's uterus. Itis a critical stage of development during which maternal nutrition can strongly influence obstetric and neonatal outcomes. The aim of this study was to determine the effect of pregnancy on some coagulation and haematological parameters of pregnant women residing in Port Harcourt, Nigeria. Method: This case-control study investigated 80 pregnant subjects and 20 non-pregnant controls. Haematological parameters were determined using a fully automated The SysmexXP-300, while the coagulation parameters (PT and INR) were determined with the automated method. Results:The mean PT (s), HB (g/dl), PCV (%), PLT (x109/L), RBC (mcL), LYMPH (%), BASO (%) and EOSIN (%) counts were significantly lower among the pregnant subjects (5.02±5.82, 11.00±1.13 g/dl and 33.81±3.89%, 189.6±52.93 × 109/L, 3.95±0.50, 43.93±10.10 %, 0.9385±1.08 %and 1.12±1.32 %) compared to the non-pregnant controls (1.68±2.37, 12.01±1.29 g/dl, 37.31±3.39 %, 235.6±72.37 × 109/L, 4.45±0.35, 43.24±9.06, 2.11±0.94 and 2.15±1.47) respectively. There were no significant differences in the INR, MONO (%), MPV (fl), MCV (L/C), and MCH (g/c) between the pregnant subjects (0.92±0.11, 5.41±2.59 %, 11.67±4.848, 84.26±3.77 and 28.06±3.54) and non-pregnant controls (0.88±0.11, 5.58±2.65, 11.14±5.45, 82.52±10.45 and 26.96±1.85). The NEUT (%), PDW (%) and WBC (x109/L) were significantly higher among the pregnant subjects (44.90±11.24 %, 13.26±2.56 % and 8.35±2.982 x109/L) compared to the non-pregnant controls (46.63±9.96 %, 10.78±1.80 % and 4.71±0.81 x109/L). Conclusion:This study has shown that pregnancy has a significant effect on some haematological and coagulation parameters of pregnant women in Port Harcourt. The result of this research work indicates the need to routinely monitor the complete blood count, thrombocytopenia and hyper-coagulative activity among pregnant women of African descendant.

Folate levels in children with sickle cell anemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu, Nigeria a prospective, comparative study

Folic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis. AimTo determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype. Method This study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment. Results The median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001). Conclusion Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state

Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria ­ A qualitative study

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization.

Maternal Serum Levels of Alpha Tumour Necrotic Factor, Interleukin 10, Interleukin 6 and Interleukin 4 in Malaria Infected Pregnant Women Based on Their Gestational Age in Southeast, Nigeria

Malaria has been reported as a condition caused by infestation with Plasmodium parasite species, is a major public health problem globally especially in developing countries like Nigeria. This study was carriedout in Federal Medical Centre Umuahia in Abia State, Nigeria. A study was done to determine the maternal serumlevels of alpha tumour necrotic factor, interleukin 10, interleukin 6and interleukin 4 in malaria infected pregnant women based on their gestational age in Southeast, Nigeria. A total of 150 subjects between the ages of 18-45 years were recruited for the study comprising of fifty (50) subjects each of the 3 trimesters. Commercial ELISA Kit by MELSIN Medical Co Limited was used to measure all the cytokines. The results of Table 1 showed no significant difference of TNF-α (p=0.346), IL-10 (p=0.059), IL-6 (p=0.811) and IL-4 (p=0.257) of malaria infected pregnant women at first trimester and second trimester respectively. The results of Table 2 showed no significant difference of TNF-α (p=0.642), IL-10 (p=0.678), IL-6 (p=0.551) and IL-4 (p=0.280) of malaria infected pregnant women at first trimester and third trimester respectively. The results of Table 2 showed no significant difference of TNF-α (p=0.062), IL-10 (p=0.016), IL-6 (p=0.352) and IL-4 (p=0.914) of malaria infected pregnant women at first trimester and third trimester respectively. The study showed no changes in the cytokines studied among the malaria infected pregnant women based on gestational ages except when IL-10 was compared between the subjects on second trimester and third trimester. This study shows that malaria infection does not changes these cytokines in pregnant women based on gestational ages except the il-10 when compared at second trimester and third trimester but changes when compared at other trimesters.

Climate Change: Global Indicators, Socio-economic Implications and Mitigation

Climate change which is the variation in the climate condition over comparable periods has some indicators like surface temperature, atmospheric carbon and greenhouse gases (GHGs) and ozone layer area. This paper seeks to examine the state of the climate change indicators, their effects and how climate change can be mitigated. A review of data sources and literature reveal that global average temperature has increased more than 0.8ºC above the pre-industrial baseline over the past 100 years with 2016 and 2017 being the warmest years. Fossil carbon emissions also reached up to 41.5 billion tons in 2018. The extent of depletion of the ozone reduced to an area of 24.8x106 km2 in 2018 as against its value of 28.2 x106 km2 and 29.6 x106 km2 in 2015 and 2006 respectively. The effects of climate change on the socio-economic development were identified to include; natural disasters, food insecurity, diseases, human mobility and population displacement. To mitigate the adverse effects of climate change, minimizing our dependence on petroleum and fossil fuels by using cleaner and renewable energy sources, carbon capture and sequestration, proper management of land, forest and the entire ecosystem was highlighted. If these options are explored, climate change will drastically reduce while fostering global economic, environmental and social well-being.

Model and determinants of state-local governments' relations in Nigeria / Modelo y determinantes de las relaciones entre los gobiernos de los estados y los gobiernos municipales en Nigeria / Modelo e determinantes das relações entre governos estaduais e locais na Nigéria

Abstract Nigeria struggles to establish and sustain cooperative, interdependent state-local intergovernmental relations (IGR) by providing for the powers and rights of local governments in the federal constitution. Despite the provisions, the practice of state-local IGR has remained inclusive, hierarchical, dependent and competitive. This paper investigates the extent to which constitutional provisions determine state-local relations as against the macrostructure of intergovernmental relations between the federal government and states. The authors argue that it is difficult to expect a cooperative, interdependent, state-local IGR through constitutional provisions of the powers and rights of local governments, if the federal-state relations, which should be the determining framework of IGR is inclusive, hierarchical and dependent. The paper suggests that the lower forms of IGR in a federation (e.g. the state-local IGR), largely depend on the super-structure, which is that between the federal government and the lower tiers. The implication is that the level of autonomy enjoyed by local governments largely depends on the level of autonomy the states themselves enjoy.

Resumen Nigeria tiene dificultades para establecer y mantener relaciones intergubernamentales (RIG), cooperativas e interdependientes entre los gobiernos de sus estados y los gobiernos locales (municipales), según lo dispuesto en su constitución federal, que establece poderes y derechos para estos últimos, llamados consejos de gobiernos locales (LGCs). A pesar de las disposiciones constitucionales, las RIG entre estados y LGCs siguen siendo inclusivas, jerárquicas, dependientes y competitivas. Este artículo discute hasta qué punto las disposiciones constitucionales determinan las relaciones entre esos dos niveles de gobierno en comparación con la macroestructura de RIG entre los gobiernos federal y de los estados. El estudio indica que es difícil esperar RIG cooperativas e independientes entre estados y las LGCs (como resultado de disposiciones constitucionales que otorgan poderes y derechos a los gobiernos locales), si la RIG entre la federación y los estados (que debería servir como estructura modelo) sigue siendo inclusiva, jerárquica y dependiente. Los hallazgos sugieren que las relaciones entre los niveles de gobierno locales y de los estados en una federación dependen en gran medida de cómo se coloca la superestructura, que es la que involucra al gobierno federal en su interacción con los demás niveles. Esta condición muestra que el nivel de autonomía de los gobiernos locales depende, en gran parte, del nivel de autonomía de los estados federados.

Resumo A Nigéria encontra dificuldades em estabelecer e sustentar relações intergovernamentais (RIG), cooperativas e interdependentes, entre governos estaduais e locais, como previsto em sua constituição federal que estabelece poderes e direitos a esses últimos, denominados conselhos de governo local (LGCs). Apesar das disposições constitucionais, as RIG entre estados e LGCs permanecem inclusivas, hierárquicas, dependentes e competitivas. Este artigo discute até que ponto as disposições constitucionais determinam as relações entre esses dois níveis de governo, em comparação com a macroestrutura de RIGs entre governos federal e estaduais. O estudo indica que é difícil esperar RIGs cooperativas e independentes entre estados e LGCs (como resultado de disposições constitucionais que concedem poderes e direitos aos governos locais), se a RIG entre a federação e os estados (que deve servir de estrutura-modelo) segue sendo inclusiva, hierárquica e dependente. As conclusões sugerem que as relações entre os níveis locais e estaduais de governo em uma federação dependem amplamente da forma como se coloca a superestrutura, que é aquela que envolve o governo federal em sua interação com os demais níveis. Essa condição mostra que o nível de autonomia dos governos locais depende, em grande parte, do nível de autonomia dos estados federados.

A comparative study of pregnancy outcomes among women with and without threatened miscarriage in the first trimester in Abakaliki Southeast Nigeria

Background:Threatened miscarriage is the commonest complication of pregnancy and has been aBackground: Threatened miscarriage is the commonest complication of pregnancy and has been associated with adverse pregnancy outcomes. Therefore, the aim of this study is to determine the association between threatened miscarriage and adverse maternal and perinatal outcomes.Methods: This was a retrospective case-control study undertaken at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The study involved 228 women presenting with threatened miscarriage in the first trimester and 228 asymptomatic matched controls. The statistical analysis was done using Epi info version 7.1.5, March 2015 (CDC, Atlanta, Georgia, USA).Results: Women with threatened miscarriage were more likely to have preterm delivery (OR = 7.1, 95% CI = 3.51-14.32, P <0.0001), placenta praevia (OR = 2.4, 95% CI = 1.13 - 5.26, P = 0.03), placental abruption (OR = 3.6, 95% CI = 1.40 - 9.03, P = 0.01) and retained placenta (OR = 2.9, 95% CI = 1.18 - 6.97, P = 0.02). Similarly, women with first trimester threatened miscarriage were more likely to develop postpartum haemorrhage (OR = 2.4, 95%               CI = 1.17 - 5.06, P = 0.02). There was no significant differences in the stillbirth rate, Apgar scores at 5 minutes less than 7, admission into neonatal intensive care unit and early neonatal death. Threatened miscarriage was associated with intrauterine growth restriction (OR = 3.5, 95% CI = 1.77 - 6.88, P <0.0001) and low birth weight <2.kg                 (OR = 3.2, 95% CI = 1.33 - 7.69, P = 0.01).Conclusions: Women with threatened miscarriage in the first trimester are at increased risk of adverse pregnancy outcomes and the risk factors should be taken into consideration when deciding upon antenatal surveillance and management of their pregnancies.

Knowledge of public health challenge of open defecation in rural areas of South-East Nigeria: Implications for social workers

Background: Practice of open defection has growing health concerns especially on rural dwellers and is among leading causes of diarrhea, typhoid fever, cholera, stunting and responsible for the death of children under 5 years in Nigeria. This study seeks to examine knowledge of public health challenges of open defecation among rural residents in south-east Nigeria and implications for social work. Data source and methods: Focus group discussions and in-depth interviews were used for data collected from 52 respondents in Nsukka and Udenu LGAs of Enugu State. Thematic analysis was adopted and phrases with contextual connotations were pulled as illustrative quotes. Results: Lack of toilet facilities makes community members engage in the practice despite knowledge of its public health implications. Conclusions: The study recommends strengthening of government's efforts to eradicate the practice; incorporating social workers as facilitators in public health regulations and advocacy in sensitising households to provide their own toilets

Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and Inter VA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making

Comparative Investigation of the Effects of Different Aqueous Preparations of Hibiscus sabdariffa (Zobo Drinks) on Haematological Parameters in Normal Wistar Albino Rats

Aim: Investigating and comparing the effect of administration of different preparations of the commonly-consumed Hibiscus sabdariffa Linn (Zobo) drinks on haematological parameters. Study Design: Comparative study using animal models (Wistar Albino Rats) with daily administration of the same concentration of different zobo drink samples. Place and Duration of Study: University of Port Harcourt, Choba, Rivers State, Nigeria and its environs between November 2014 and February 2015. Methodology: Thirty (30) Wistar albino rats were grouped into six (6) groups of five rats each. Group A served as the control and B was administered an unblended zobo drink. Groups C – E were administered locally-produced zobo samples and group F was a National Agency for Food and Drug Administration and Control (NAFDAC)-branded zobo drink. A concentration of 200 mg/kg body weight of the samples was administered orally to groups B–F for 21 days. Packed cell volume (PCV), haemoglobin count, white blood cell (WBC) count, red blood cell (RBC) count, platelets, neutrophils, lymphocytes, mean cell haemoglobin (MCH), mean corpuscular volume (MCV) and mean cell haemoglobin concentration (MCHC) were analyzed and compared. Results: The White blood cell (WBC) count and percentage lymphocytes were significantly lower (P < 0.05), while Haemoglobin, Packed cell volume, Red blood cell (RBC) count and Platelet count were significantly higher (P < 0.05) when compared with the control. Percentage neutrophils showed no significant difference (P > 0.05) compared with the control. Conclusion: The zobo drinks possess haematocrit properties that result in higher levels of blood volume and may be used for the management of anaemia. They also possess the ability to reduce WBC count.

Plasma Arsenic and Selenium in Apparently Healthy Individuals in Ebonyi State, South-Eastern Nigeria

Introduction: Although reports are conflicting on arsenic-selenium interactions, there is paucity of data on the determinants of plasma selenium (Se) and arsenic (As) in healthy individuals in Ebonyi State, South Eastern Nigeria. Ebonyi State is richly endowed with mineral deposits which are mined without consideration of their health hazards. This study is aimed at assessing the socio-demographic determinants of plasma arsenic and selenium in apparently healthy individuals in Ebonyi State. Methods: Apparently healthy individuals (n=441) consisting of 117 males, 184 females and 140 pregnant females, aged ≥ 18 years (mean=38.5±0.6 yrs) were randomly selected from 130 geo-political Wards (10 Wards from each of the 13 Local Government Areas of Ebonyi state) to constitute the study population. Plasma arsenic and selenium were determined in blood samples using atomic absorption spectrophotometer. Socio-demographic data were collected using questionnaires while anthropometric measurements were determined using standard methods. Results: The mean plasma arsenic levels were 0.204±0.02 (males), 0.209±0.02 (females), 0.186±0.02 μg/ dl (pregnant females) and plasma selenium levels were 0.134±0.01 (males), 0.138±0.01 (females), 0.147±0.01 μg/dl (pregnant females), respectively. Plasma Se levels were generally lower than the value (5.92 μg/dl) considered universally as inadequate. While plasma levels of As and Se were not significantly different between male and female, obese subjects had significantly lower plasma levels of both elements. There was a significant negative correlation between BMI and plasma As. Neither smoking nor alcohol consumption was associated with plasma levels of As and Se. Conclusion: Apparently healthy individuals in Ebonyi State exhibited elevated plasma levels of As and low plasma Se, which may potentially place them at risk of adverse health associated with As toxicity.

Velocidade de fluxo sanguíneo cerebral em crianças em crianças e adolescentes com doença falciforme em Salvador, Bahia / Cerebral blood flow velocity in children and adolescents with sickle cell disease in Salvador, Bahia

INTRODUÇÃO: A doença falciforme (DF) é caracterizada por complicações agudas e crônicas. Entre as agudas podemos citar: episódios álgicos, síndrome torácica aguda (STA), priapismo, crise hemolítica, infecções agudas e acidente vascular cerebral (AVC), sendo este útimo responsavel por complicações a longo prazo na infância. A velocidade do fluxo sanguíneo cerebral (VFSC) elevada é o fator de risco mais importante para o desenvolvimento do AVC em crianças com anemia falciforme. A identificação de pacientes de risco associados a velocidades de fluxo sanguíneos cerebrais anormais é realizada pelo Doppler transcraniano (DTC), exame fundamental à prevenção primária do AVC. OBJETIVOS: Avaliar as velocidades de fluxo sanguíneo cerebral em crianças e adolescentes com DF em Salvador-Bahia, para identificar aqueles com risco alto de AVC, além de correlacionar as velocidades de fluxo cerebral com os perfis clínico e hematológico dos pacientes. PACIENTES E MÉTODOS: O DTC por insonação, utilizando uma sonda de 2 MHZ...

BACKGROUND: Sickle cell disease (SCD) is characterized by acute episodes of illnesses (crises) such as bone pain crisis, acute chest syndrome (ACS), priapism, hemolytic crisis, acute infections; and acute and long term complications such as cerebrovascular accident (CVA). Abnormally high cerebral blood flow velocity is the most important risk factor for development of stroke in pediatric patients with sickle cell anemia, and its detection by transcranial Doppler (TCD) is fundamental in primary stroke prevention. Other clinical, hematologic and genetic risk factors of stroke have also been identified. OBJECTIVES: The study aimed at evaluating the cerebral blood flow velocities of children and adolescents with SCD in Salvador, Brazil, detect those at high risk of stroke and correlate the flow velocities with clinical and hematological profiles of the patients. PATIENTS AND METHODS: Transcranial Doppler was performed on subjects aged 2 to 16 years who fulfilled the inclusion criteria, using a 2 MHz...

Secondary bacterial isolates from previously untreated Buruli ulcer lesions and their antibiotic susceptibility patterns in Southern Nigeria

Abstract INTRODUCTION: Mycolactones, secreted by Mycobacterium ulcerans, were previously believed to prevent super infection in Buruli ulcer lesions. However, little is known about secondary bacterial infections in these lesions. This study evaluated contaminating bacterial flora and their antibiotic susceptibility patterns in cases of previously untreated Buruli ulcer disease from three states in Southern Nigeria. METHODS A prospective analysis was conducted between January and June of 2015 using wound swabs from eligible patients with Buruli ulcer disease, confirmed by quantitative-polymerase chain reaction, with active ulcers. Microbiological analyses including isolation of bacteria, species identification of isolates, and drug susceptibility tests were performed. RESULTS Of 51 patients, 27 (52.9%) were female. One or more bacterial species of clinical importance was isolated from each patient. A total of 17 different microbial species were isolated; 76.4% were Gram-negative and 23.6% were Gram-positive isolates. The most common bacterial species detected was Staphylococcus aureus (24%), followed by Aeromonas hydrophila (13%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (11%). Drug susceptibility tests showed a particularly high frequency of resistance to commonly used antimicrobials in Nigeria for Staphylococcus aureus. CONCLUSIONS Super bacterial infections occur in Buruli ulcer lesions in Nigeria, and these infections are associated with high rates of resistance to commonly used antibiotics in the country.

Congenital Anomalies of the Alimentary Tract in Children: Experience in a Tertiary Health Facility in Enugu, Nigeria .

Background: Congenital anomalies including those of the alimentary tract are among the leading causes of childhood morbidity and mortality. A variety of these anomalies could affect the alimentary tract with various medical as well as economic costs. The aim of the current study was to determine the prevalence of the different forms, maternal as well as birth characteristics and outcomes of the congenital anomalies of the alimentary tract in hospitalized children in Enugu. Methods: A 3 year retrospective audit of all hospitalized cases of alimentary tract anomalies was carried out. Case definitions of the different forms of alimentary tract anomalies studied were based on International Classification of Diseases and Related Problems, Tenth Edition (ICD-10). Data was analyzed using SPSS version 21.0 while level of statistical significance was set at p<0.05. Results: A total of 59 children (37 males and 22 females) with alimentary tract anomalies were admitted during the period under review. Anorectal malformations 26(44.1%), Hirschsprung’s disease 14(23.7%) and Ompalocoele 5(8.5%) were the most common anomalies observed. Congenital talipes equinovarus deformity of the lower limbs was the most predominant associated congenital anomaly. Maternal periconceptional use of herbal medications was reported in 7 (11.9) cases. The case fatality rate was 5.1%. Conclusion: A variety of alimentary tract anomalies do occur in children in our setting with some mothers having taken various forms of herbal medications in pregnancy. Efforts should be made to educate mothers on the need to avoid use of herbal concoctions during periconceptional period and in pregnancy as it could lead to a possible congenital anomaly.

Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria

Objective/Background: Tuberculosis [TB] is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies

Methods: A community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations

Results: Detection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive [NSP], although the increasing trend was not statistically significant [chi[2] = 1.8; p <.179]]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant [chi[2] = 1.48; p <.224]. Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% [all forms]. Compared to the baseline, there was an increase of 31% [all forms] and 22% [NSP] in the evaluation population

Conclusion: Intensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification