RESUMO
Background: Severe neonatal hyperbilirubinaemia remains an important cause of neonatal admissions in Nigeria, often giving rise to irreversible neurotoxicity. Access to effective phototherapy is restricted to a few centers while salvage therapy with exchange blood transfusion may occur too late to reverse acute bilirubin encephalopathy (ABE). Aim: We set out to identify modifiable socio-demographic risk factors for severe neonatal jaundice in babies of ≥34 week gestation at the National Hospital Abuja. Methodology: Late preterm and term babies admitted into Special Care Baby Unit (SCBU) with jaundice from April 2014 to May 2015 were consecutively recruited into the study with parental consent. Socio-demographic information, history of common risk factors for neonatal jaundice and results of laboratory investigations were obtained for statistical analysis. Jaundice was classified as severe (≥ 20 mg/dl) or non-severe (10-19 mgdl). Bivariate and multiple logistic regressions were carried out to determine the significance of associations between risk factors and severity of jaundice. Results: A total of 123 babies were seen with an Inborn/Out born ratio of 1:2.3. Eighty two percent were term. Severe Jaundice accounted for 43(35%). The mean TSB for babies with severe jaundice was 29.1(9.6) mg/dl while that of controls was 16.9(5.9) mg/dl, (p=0.000). There was no significant difference in the distribution of primary risk factors (ABO/Rh incompatibility, sepsis, G6PD deficiency and concealed haemorrhage) among severe and non-severe groups. Among investigated secondary risk factors, late presentation (P=0.043), being out born (OR=0.164 95% CF=0.054-0.504), vaginal delivery (p=0.012), prematurity (OR=2.233 95% CF=1.051-4.740) and maternal education (p=0.017) were significantly associated with severe jaundice. Over 98% of the mothers had antenatal care while 91% delivered in hospitals/clinics. Thirty two (26%) had signs of acute bilirubin encephalopathy and exchange blood transfusion was done in 50 (40.7%) babies. Recommendation: There is a need to refocus preventive strategies on modifiable risk factors, increasing awareness about the consequences of neonatal jaundice and the essence of early identification as well as prompt hospital presentation.
RESUMO
Background: The global disease burden from measles as a vaccine preventable disease remains high despite decades of interventions by various organs and agencies. Objectives: To determine the prevalence and outcome of childhood cases of measles admitted into the children's emergency ward of the National hospital and highlight the possible contributing factors. Design: Retrospective. Subjects : A total number of 43 children with measles presenting at the National Hospital Abuja; seen over a 40 months period; January 2002 and April 2005. Methods: Cases-folders of patients seen at the Emergency Paediatric Unit (EPU) of the National Hospital Abuja during the period under review with the clinical diagnosis of measles were reviewed. Results: The children were aged between seven to 12months; with 25 (58.1) age 24 months and below. Twenty three (53.5) of the subjects had received prior measles vaccination. History of contact with cases of acute measles was present in 26 (60.5). Associated protein energy malnutrition (PEM) was found in 30 (69.8) with 28 (65.1) parents of these children being of lower social economic classes (III; IV etV). Recorded complications included gastroenteritis; bronchopneumonia; laryngo-tracheo-bronchitis as part of croup syndrome; tuberculosis; and otitis media. Three fatalities (7.0) were record in this review; all in association with bronchopneumonia. Conclusion : Measles with its complications still present as a fatal illness even among vaccinated children