Descriptive epidemiology of external structural birth defects in Enugu State, Nigeria

Objectives: To determine the birth prevalence, trend, and characteristics of external structural birth defects occurrence in Enugu Metropolis, Nigeria. Design: Cross-sectional study involving review of delivery records. Setting: The study was conducted at three tertiary hospitals, one public and two missionary, in Enugu Metropolis. Participants: Mothers and their babies delivered between 1 January 2009 and 31 December 2016 in the study facilities. Main outcome measures: Birth prevalence of defects presented as frequency/10,000 births. Other descriptive variables are presented as frequencies and percentages. Results: There were 21530 births with 133 birth defects (birth prevalence: 61.8/10,000 births) and 1176 stillbirths (stillbirth rate: 54.6/1000 births). The frequencies and birth prevalence (/10,000 births) of recorded defects were: Limb deformities 60(27.9), Neural tube defects (NTDs): 36(16.7), Urogenital system defects: 12(5.6), Gastrointestinal system defects 10(4.6) and Orofacial clefts 4(1.9). Birth defects occurrence showed a rising trend from 2009 to 2016. The mean (SD) age of mothers whose babies had Birth defects was 29.1(4.7) years. Only 62(46.6%) of 133 antenatal clinic folders of these women were traceable for further review. Eighteen (29.0%) had febrile illness in early pregnancy, 9(14.5%) had Malaria, 17(27.4%) had <4 antenatal clinic attendance, 7(11.3%) did not take folic acid and 6(9.7%) took herbal medications during pregnancy. Conclusions: Birth defects occurrence showed a rising trend with limb deformities and NTDs having the highest prevalence. Record keeping was poor at the facilities. Birth defects preventive interventions like folic acid supplementation for women-of-childbearing age should be promoted in Enugu Metropolis.

Prevalence of symptomatic urinary tract infection and bacterial spectrum of diabetic and non-diabetic patients at the two teaching hospitals in Enugu, Nigeria

Background: Diabetes mellitus is a group of metabolic disorder characterized by relative or absolute lack of insulin. When this condition is not properly managed, it can lead to complications that make diabetic patients vulnerable to urinary tract infections (UTI). The objectives of this study are to determine the prevalence of microbiologically confirmed UTI and the spectrum of uropathogens in diabetic and non-diabetic patients with clinical features of UTI attending the two tertiary hospitals in Enugu State, Nigeria. Methodology: Clean catch specimen of single mid-stream urine sample was collected from each of 60 (22 males, 38 females) diabetic and 60 (22 males, 38 females) non-diabetic patients enrolled using stratified random sampling method. The samples were cultured on standard microbiological culture media (MacConkey and Blood agar plates) and incubated aerobically at 37◦C for 24 hours. Plates with significant bacteria growth (>105 CFU/ml) were processed further for bacterial identification using conventional biochemical test scheme. Antibiotic susceptibility test (AST) of each isolate to 17 selected antibiotics was performed by the modified disc diffusion method. Results: Of the total 120 patients enrolled, 101 had bacterial pathogens isolated from their voided urine samples; 51 of 60 (85.0%) diabetics and 50 of 60 (83.3%) non-diabetics (p=0.802). Bacteria were isolated in 59.1% (13/22) of diabetic and 54.5% (12/22) of non-diabetic male patients compared to 100% (38/38) isolation rate in diabetic and non-diabetic female patients. The most frequently isolated bacteria in the diabetic patients were Proteus spp (18.6%), Klebsiella spp (16.9%) and Escherichia coli (15.5%) while the most frequently isolated bacteria among the non-diabetic patients were E. coli (30.0%), Proteus spp (26.3%) and Enterobacter spp (14.0%). Apart from Klebsiella spp which was more frequently isolated from the diabetic (16.9%) than non-diabetic patients (6%) (p=0.039), the frequency other bacterial pathogen isolation such as Proteus spp, E. coli, Enterobacter spp, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus spp was not significantly different between the two population groups (p>0.05). The Gram-positive and Gram-negative bacteria were highly sensitive to imipenem in both diabetic and non-diabetic patients, but the isolates from both study groups exhibited low susceptibility to amoxicillin, nitrofuran- toin, cefixime and cefuroxime. Conclusion: Although the overall frequency of bacterial pathogen isolation in the diabetic and non-diabetic patients was not significantly different, females had a higher pathogen isolation rate than the males, and diabetic females had a higher frequency of polymicrobial infections compared to non-diabetic females and the male population. The high antimicrobial resistance of the isolated bacteria pathogens underscores the need for clinical microbiology laboratory testings to optimize the management of UTI in diabetic patients.

Recognition and interpretation of road signs by commercial drivers in Enugu Nigeria

Background: Sub-Saharan Africa has the highest road injury death rate of all regions in the world with Nigeria being one of the four countries accounting for half of all these deaths. Road, traffic signs or codes are salient ways of communication to road users geared towards reducing road traffic accident and studies that traffic violation are considered to be amongst the causes of road traffic accidents. Recognition, interpretation and observance of road signs could be of great importance in reducing the incidence of road accidents. This study was aimed at assessing the knowledge of road signs by commercial drivers in Enugu South-East Nigeria.Methods: This was a cross sectional descriptive study carried out in Enugu metropolis over a period of 3 months using a pre-tested structured questionnaire. Commercial drivers in Enugu participated in the study. Common road signs in their usual colors were showed to the drivers to test their ability to correctly identify the signs.Results: The mean age of the respondents was 42.4±9.6 years. Majority of the respondents, 59.4% are on intra-city transport route. Over 65% of the driver’s attained secondary education and beyond. Nearly a half (49.4%) of the drivers had poor knowledge of road signs. Drivers who have attained primary education and less (AOR=0.2, 95% CI: 0.1-0.3); who are on intra-city transport route (AOR=0.08, 95% CI: 0.05-0.1) or had less than 11 years driving experience (AOR=0.3, 95% CI: 0.1-0.5) were less likely to have good knowledge of road signs.Conclusions: Significant gaps still exist in knowledge of road signs among commercial drivers in Enugu, Nigeria.

Prevalence of dental fluorosis among 12–15-year-old students in Enugu Metropolis, Nigeria

Background: Excessive ingestion of fluoride during tooth development, particularly at the maturation stage, may result in dental fluorosis, with clinical implications. Literature is scarce on dental fluorosis in Enugu, Nigeria. Purpose: The aim of this study was to assess the prevalence of dental fluorosis in Enugu, a major city in South East Nigeria. Materials and Methods: A multistage sampling technique was used to select a calculated sample of 400 students. A pretested interviewer-administered questionnaire was used to ascertain student's sociodemographic and related variables. The student participants were examined for dental fluorosis using Dean's index criteria according to the World Health Organization guidelines. Data were analyzed using SPSS version 16, and Chi-square test of association was used to compare proportions and ratios with significant level set at P < 0.05 and 95% confidence level. Results: Among the 400 students analyzed, 231 (57.8%) and 169 (42.2%) were male and female, respectively. Mean age was 13.43 ± 1.021 years. The prevalence of dental fluorosis was 11.3%, with the preponderance of very mild score (82.2%), and no observed severe dental fluorosis. The difference in the distribution of the scores of fluorosis among the children was highly statistically significant (χ2 = 72.80, P = 0.000). Dental fluorosis was found present in 39 (10.3%) of 378 users of fluoridated toothpaste and in 6 (27.7%) of the 22 users of nonfluoridated toothpaste. The differences in the presence and absence of dental fluorosis were statistically significant among users of fluoridated toothpaste. Conclusion: This study shows the prevalence of dental fluorosis to be low among secondary school students of Enugu metropolis.

Correlation between Anthropometric Variables, Social Class, Age and Hematological Profile among Children with Sickle Cell Anemia in ENUGU South-East Nigeria.

Background: Sickle cell anaemia (SCA), a common haematological genetic disorder, could affect both the growth and haematological profile of the sufferer. Objectives: This study aims at determining any correlation between anthropometric variables and haematological parameters among children with sickle cell anaemia (SCA). It also determines the association between social class and haematological parameters of children with SCA. Methods: A total of 80 subjects were recruited into the study, comprising 40 HbSS patients. This is cross sectional study of haematological indices and anthropometric measurement of children with sickle cell anaemia aged 6-20 years. All data were coded, entered, and then analyzed using the Statistical Package for Social Sciences program (SPSS), version 20. Results: There was statistical significant correlation between BSA and total white blood cell count (TWBC) (p=0.028) but not with Haemoglobin concentration (Hb) and Erythrocyte sedimentation rate (ESR). Hb: r=0.073, p=0.654 ESR: r=0.224, p=0.164 TWBC: r=0.348, p=0.028. The Haemoglobin concentration, TWBC and ESR values are 7.77 g/dl, 11.96×109, and 15.4 mm/hr There is also no statistical significant correlation between BMI and haematological variables: TWBC r= 0.100 p=0.51, Hb: r=0.118, p= 0.469 ESR: r= 0.033, p=0.841. There is also no statistical significant correlation between chest circumference and haematological indices. TWBC r= 0.216 p=0.181, Hb: r=0.043, p= 0.793 ESR: r= 0.143, p=0.378. There were no statistical differences in mean for all the variables studied among the social classes. Hb; p=0.373 ESR p=0.633. TWBC p= 0.451. Conclusion: Infection is not the only cause of elevation in TWBCs. it is important to also consider the impact of surface area on white blood cell count of children with SCD before using antimicrobials for such infections.

Amenities that can Attract Skilled Birth Attendants (SBAs) to Practice in Rural Areas of a Developing Country.

The attainments of the Millennium Development Goal 5 (MDG 5) targets by 2015 in most developing countries are unlikely when large numbers of poor, illiterate, and vulnerable rural women do not have access to skilled care. To review progresses in MDG 5 targets and evaluate amenities that can influence SBAs to accept to practice in the rural areas of Enugu State. This was a questionnaire study administered to SBAs in private health facilities in Enugu metropolis from April 1 to 3o, 2014. Data on demographic profile and the amenities that can attract SBAs to live and practice in rural areas were extracted from the respondents. Out of 145 questionnaires administered 138 were completely filled, and analyzed using Excel 2007 software, and presented using percentages and figure. Majority of the SBAs were of ages between 20-30 years (69/138, 5o.0%). Staff nurse midwife were 91(65.9%) while medical doctor were 47(34.14 Ninety (65.2%) of the SBAs had no rural practice experience, and 7o (5o.7%) wish to practice in developed countries. The 5 top amenities that can attract SBAs to the rural area include: security of lives and property 134(97.a), pipe borne water supply 130(94.2%), equipped hospital 130(94.24 market with regular food supply 130(94.24 and higher staff salary and other motivations 129(93.54 There were high demands of amenities by SBAs for them to accept to live and practice their crucial services in the rural areas. The 5 top amenities that can attract SBAs to practice in the rural area include: security of lives and property, pipe borne water supply, equipped hospital, market with regular food supply, and higher staff salary and other motivations. SBAs services in the rural areas are crucial for attainments of the MDG 5 targets in developing countries by 2015.

A Single Institution Study of Attitudes of Primigravidae to Routine Clinical Pelvimetry.

Background: Pelvimetry is a poor predictor of obstetric outcome. The predictive value of clinical pelvimetry remains limited except in extreme pelvic contracture or an excessively large fetus. Objective: To determine the attitudes of primigravidae to routine clinical pelvimetry. Subjects and Methods: This was a cross-sectional study of primigravidae at the University of Nigeria Teaching Hospital (UNTH), Enugu between January 1st and December 31st, 2009. Selfadministered, structured, and pre-tested questionnaires were distributed to the consenting selected women by trained medical interns. Data was analyzed using SPSS version 16. P< 0.05 was considered statistically significant. Results: A total of 195 primigravidae were selected at random for this study. One hundred and thirty eight primigravidae (138/195, 70.77%) were aware of clinical pelvimetry while 29.23% (57/195) were not aware of clinical pelvimetry. One hundred and twenty five primigravidae (90.58%, 125/138) desired clinical pelvimetry to continue while thirteen (9.42%, 13/138) did not desire clinical pelvimetry to continue. There was statistically significant difference between those who were aware and unaware of pelvimetry in their desire for pelvimetry [X2=18.903, p=0.0001, OR 5.2, 95% confidence interval=2.20 to 12.44]. Conclusion: There is profound awareness and the desire to continue clinical pelvimetry among primigravidae at the UNTH, Enugu, Nigeria, where majority of the women showed strong preference for it.

Spatial Differences in Quality of Maternal Health Service in Primary Health Centers of Enugu State, Nigeria.

Aim: The aim of the study was to determine how adequate were the resources, (equipment and personnel), process (client-provider interaction), and outcome components of quality of maternal health service in urban and rural primary health centers of Enugu state, Nigeria. Study Design: Cross-sectional analytical study design. Place and Duration of Study: Primary health centers in Enugu State, Nigeria, between January and March 2013. Methodology: A three stage sampling method was used to select 540 clients in18 of 440 primary health centers in the state. The clients were women who attended antenatal and postnatal care in the health centers. Outcome measure was clients true satisfaction with maternal health service also denoted as satisfaction index. It was assessed by proportion of clients who were satisfied with antenatal, and postnatal care, were ready to use the health centers again, and willing to recommend them to others for same services. Results: No health center had adequate equipment, 16.7% of health centers had adequate health manpower and 16.7% had good client provider interaction. Only a minor proportion of clients, (urban 7%; rural 24.1%) delivered in the health centers. On part of clients, 64.8% in urban were truly satisfied, as compared to 75.6% in rural. Predictors of clients true satisfaction included being a client in urban, (AOR=0.6, 95% CI: 0.4- 0.9), client unmarried, (AOR=0.3, 95% CI: 0.1- 0.5), and being unemployed/housewife, (AOR=2.0, 95% CI: 1.3- 4.5). Conclusion: The structure and process components of quality of maternal health service in primary health centers in the study area were deficient. Also, utilization of health centers for delivery services was poor. The clients of maternal health service seem to focus more on providers of healthcare and their interactions with them than the health system and its deficiencies hence were easily satisfied with the services received. To reduce the maternal death burden in Nigeria there is need for adequate attention on rural areas, the primary health care system and the provision of client oriented health services at all levels of care. More health workers should be employed, and more equipment supplied in-order to improve the quality of maternal health service in the primary health centers.

The Effect of Repeated Blood Donations on the Iron Status of Male Blood Donors in Enugu State, Nigeria.

Background: One of the biggest challenges in blood donation particularly in Nigeria is the recruitment and retention of voluntary non-remunerated, low cost blood donors. Aims: The aim of this study is to determine the effect of repeated blood donations on iron stores and the prevalence of iron deficiency anaemia among the male blood donors in the Enugu State, Nigeria. Study Design: In this case-control study, two hundred and twenty three randomly selected male blood donors, were grouped into six categories according to the number of units of blood donated in one year, two years, three years and the last group were on their 4th year. Place and Duration of Study: Haematology and blood bank laboratory unit, Enugu State University of Science and Technology Teaching Hospital, Enugu, Enugu State, Nigeria: April 2012 to December 2012. Methodology: Prior to blood donation, blood samples of 202 directed/regular male blood donors and twenty one apparently healthy men with no previous history of blood donation (aged 18- 40years) were collected. Donors were grouped into 0, ≤ 3, 4-6, 7-9, 10-12 and > 13 categories based on the number of units of blood donated. Results: Iron depletion was seen in 1.3% in group 2 (1-3 times) and also in 13.3% of group 4 (7-9 times), iron deficiency was present in 4.4% of group 3 (4-6 times) and in 20% of group 6 (13-15 times) and iron deficiency anaemia was discovered in 4.4% of group 3 (4-6 times). Blood donors with more than seven times instances of blood donation (P<0.05) showed a significant relationship between iron depletion and iron deficiency. Conclusion: This study showed that iron deficiency anaemia in blood donors can occur as a result of increase in number of units of blood donated and also based on iron status of individual at time of donation. Based on findings of this study ferritin test should be done on all male blood donors in Enugu before donating any unit of blood to find out the appropriate time to start iron supplement.