Determination of neonatal case-specific fatality rates in a tertiary health institution in North Central Nigeria.

BACKGROUND: The current neonatal mortality rate in Nigeria (37/1000) is among the highest in the world and the major causes have consistently been reported as sepsis, perinatal asphyxia and prematurity. However, case-specific fatality which defines the risk of dying from these and other neonatal morbidities is rarely emphasized. Determination of case-specific fatality rates (CSFR) may inform a change in our current approach to neonatal care interventions which may eventually bring about the much-needed reduction in our neonatal mortality rate. Our aim was to determine the case-specific fatality rates for the common causes of mortality among hospitalized neonates at the National Hospital Abuja (NHA). METHODS: Relevant demographic and clinical data on all neonates admitted into the NICU at the NHA over a period of 13 months (January 2017 to February 2018) were extracted from the Neonatal Registry database and analyzed using appropriate statistical methods with the SPSS version 20 software. The case-specific fatality rates were computed for the predominant morbidities in addition to determination of the neonatal mortality rates and associated risk factors. RESULTS AND CONCLUSION: A total of 730 neonates were admitted, out of which 391 (53.6%) were females, 396 (54.5%) were inborn and 396 (54.2%) were term. The three most prevalent morbidities were prematurity 272(37.2%), neonatal Jaundice 208(28.4%) and perinatal asphyxia 91(12.5%) while the most common causes of mortality were prematurity 47/113(41.6%), congenital malformations 27/113(23.9%) and perinatal asphyxia 26/113(23%). Congenital malformations had the highest case-specific fatality 27/83(32.5%) followed by Perinatal Asphyxia 26/91(28.6%) and prematurity 47/272(20.7%). The mortality pattern differed between inborn and out born babies. Implications of these case-specific fatality rates for targeted interventions are discussed.

Blood pressure pattern and the relationship with body mass index among apparently healthy secondaryschool students in Sokoto metropolis, Nigeria

Background. Childhood obesity may result in the premature onset of cardiovascular risk factors, particularly hypertension, hence the need for proper screening. However, blood pressure (BP) is measured only once in most studies in Nigeria, probably because of difficulties in returning to the study areas for repeat measurement.Objective. To determine the BP pattern and assess its relationship with body mass index (BMI) in apparently healthy secondary-school students aged 10 - 18 years in Sokoto metropolis, Nigeria.Methods. This study was descriptive and cross-sectional, and carried out between 13 October 2014 and 30 January 2015. In total, 800students from 6 schools were selected through multistage sampling. BP was measured on three separate days according to the National High Blood Pressure Education Program charts. BMI was categorised according to the Centers for Disease Control charts. The relationship of BP level with BMI was determined.Results. There were 424 (53.0%) males and 376 (47.0%) females, with a ratio of approximately 1:1. BP increased with age. The mean systolic and diastolic BP was significantly higher in females than males (systolic 113.1 mmHg v. 110.5 mmHg, and diastolic 69.0 mmHg v. 66.5 mmHg, respectively; p=0.01). Females had a higher mean BMI than males (18.7 kg/m2 v. 17.9 kg/m2, respectively; p<0.01). BP increased as the BMI percentile increased (p<0.001). The prevalence rates of hypertension were 6.1%, 3.5% and 3.1% at the first, second and third screenings, respectively, while the corresponding prevalence rates of prehypertension were 14.3%, 8.4% and 7.1%. The prevalence of obesity and overweight was 0.3% and 5.9%, respectively.Conclusion. The prevalence rate of prehypertension and hypertension reduced with subsequent measurements, and the prevalence rates of overweight and obesity were low. However, higher BP levels were associated with higher BMI, supporting its predictive significance for elevated BP

Macrosomic births in abuja: A case-control study of predisposing factors and early neonatal outcome.

BACKGROUND: Although research has shown that having a macrosomic fetus could be predictive of a negative pregnancy outcome, the factors that control its incidence and the outcome of delivery management have been less well characterized in Africa. The aim of this study was to identify specific predispositions and the factors that influence the early neonatal outcome of macrosomic infants in Abuja. METHODS: Data from 120 mother and macrosomic (weighing ≥4000 g) newborn pairs, and an equal number of mother and normal weight (2500-3999 g) matched controls, delivered over a 5-month period at three large hospitals in Abuja, Nigeria, were analyzed. Chi-square and logistic regression analyses were performed for various predisposing factors and neonatal outcomes of macrosomic births. RESULTS: The incidence of macrosomia was 77 per 1000 births. Independent predictors of macrosomia were parental high social class (P = 0.000), gestational weight gain of ≥15 kg (P = 0.000), and previous history of macrosomia (P = 0.002). The most frequent route of delivery was emergency cesarean section accounting for 51 (42%) births. Macrosomia was significantly associated with higher rates of birth injuries (P = 0.030), perinatal asphyxia (P = 0.015), admissions into the special care newborn unit (P = 0.000), and hypoglycemia (P = 0.000). Although the difference in the early neonatal mortality rates between the macrosomic group (2.5%) and the control group (0.8%) was not statistically significant, nearly 70% of deaths in the macrosomic group were associated with severe perinatal asphyxia. CONCLUSION: Our findings highlight the need for improved anticipatory care of the macrosomic fetus at delivery, in Africa.

Group B streptococcal colonization and transmission dynamics in pregnant women and their newborns in Nigeria: implications for prevention strategies.

OBJECTIVES: Because few studies have been conducted on group B Streptococcus (GBS) in Nigeria, we sought to estimate GBS colonization and transmission frequencies for 500 women and their newborns and identify risk factors for both outcomes. METHODS: GBS strains were characterized for antibiotic susceptibilities, capsule (cps) genotype, pilus island profile and multilocus sequence type (ST). RESULTS: In all, 171 (34.2%) mothers and 95 (19.0%) of their newborns were colonized with GBS; the vertical transmission rate was 48.5%. One newborn developed early-onset disease, yielding an incidence of 2.0 cases per 1000 live births (95% CI 0.50-7.30). Rectal maternal colonization (OR 26.6; 95% CI 13.69-51.58) and prolonged rupture of membranes (OR 4.2; 95% CI 1.03-17.17) were associated with neonatal colonization, whereas prolonged membrane rupture (OR 3.4; 95% CI 1.04-11.39) and young maternal age (OR 2.0; 95% CI 1.22-3.39) were associated with maternal colonization. Women reporting four or more intrapartum vaginal examinations (OR 6.1; 95% CI 3.41-10.93) and douching (OR 3.7; 95% CI 2.26-6.11) were also more likely to be colonized. Twelve STs were identified among 35 mother-baby pairs with evidence of transmission; strains of cpsV ST-19 (n = 9; 25.7%) and cpsIII ST-182 (n = 7; 20.0%) predominated. CONCLUSIONS: These data demonstrate high rates of colonization and transmission in a population that does not use antibiotics to prevent neonatal infections, a strategy that should be considered in the future.

Posttransfusion haematocrit equilibration: timing posttransfusion haematocrit check in neonates at the national hospital, abuja, Nigeria.

Anaemia is a common morbidity in the NICU and often requires transfusion of packed red blood cells. Haematocrit equilibration following red cell transfusion occurs over time ultimately resulting in a stable packed cell volume (PCV). Knowledge of this equilibration process is pertinent in the accurate timing of posttransfusion (PT) PCV. We conducted a prospective study to determine an appropriate timing for PT PCV estimation on 47 stable anaemic babies at the Neonatal Unit of National Hospital, Abuja. Values of PCV were determined before transfusion and at 1, 6, 12, 24, and 48 hours posttransfusion. Forty of the recruited neonates and young infants were analyzed. Their gestational age range was 26 to 40 weeks. 1-hour PT PCV (48.5% ± 5.5%) was similar to the 6-hour PT PCV (47.8% ± 5.6%) P = 0.516, but both were significantly different from the 12-hour (46.8% ± 5.9%), 24-hour (45.9 ± 5.8%), and 48-hour (45.4% ± 6.2%) PT PCVs. The 12-hour PT PCV was similar to the 24-hour and 48-hour PT PCVs (P = 0.237 and 0.063, resp.). We concluded that, in stable nonhaemorrhaging and nonhaemolysing young infants, the estimated timing of haematocrit equilibration and, consequently, posttransfusion PCV is 12 hours after red blood cell transfusion.

Undiagnosed breech in Zaria, Nigeria.

There is no certainty about the best way of dealing with a breech presentation first diagnosed in labour. In our unit, the decision to allow a trial of vaginal delivery rested on the clinical assessment of the size of the baby and the maternal pelvis, and the progress of labour. We compared the outcome of 32 cases where a breech presentation was first diagnosed in labour with 65 women where the malpresentation was diagnosed antenatally where a full assessment including ultrasound and radiological pelvimetry could be made. There was no significant difference in the mode of delivery and fetal outcome. We continue to favour careful case selection for vaginal delivery even where the breech is first diagnosed in labour.

Predicting conception and safe delivery of a macrosomic baby.

Clinical data obtained prospectively from 98 neonates, 49 normal weight controls, and retrospectively from their mothers had revealed a low incidence of neonatal macrosomia and some important predictive indices of conception and safe delivery of such babies. All the macrosomic infants were singletons and above 37 weeks gestation. The incidence of macrosomia was 26 per 1,000 live births. Increasing maternal age (up to 28 years) parity (up to three) and height were positively correlated with the conception and safe delivery of a macrosomic baby. A maternal height of less than 1.64m was found to be associated with a higher risk of unsafe spontaneous vaginal delivery of a large infant. It is suggested that even in the developing countries all efforts should be made to confirm a diagnosis of foetal macrosomia before the onset of labour so that the mother can be properly assessed for the most appropriate method of delivery.

Antimalarial drug response of Plasmodium falciparum from Zaria, Nigeria.

The sensitivity of Zaria strains of Plasmodium falciparum to chloroquine, mefloquine, quinine and sulphadoxine/pyrimethamine was investigated 5 years after the appearance of in vivo/in vitro chloroquine resistance in urban Zaria. Infections in 36/43 children (83.7%) treated with chloroquine were sensitive while those in 7 (16.3%) were resistant. 8/13 isolates cultured (61.5%) were sensitive in vitro to chloroquine and 5 (38.5%) were resistant. Of the cultured isolates, 13/13 (100%), 12/13 (92.3%) and 5/7 (71.4%) showed mefloquine, quinine and sulphadoxine/pyrimethamine sensitivity, respectively. The results confirmed chloroquine and sulphadoxine/pyrimethamine resistance in urban Zaria and revealed emerging quinine resistance. Resistance to chloroquine and sulphadoxine/pyrimethamine is at RI level and chloroquine should continue to be the first-line drug for the treatment and prevention of P. falciparum infection in the Zaria area of northern Nigeria. We suggest that, while quinine serves as second-line drug, mefloquine should be reserved for infections resistant to chloroquine, quinine and sulphadoxine/pyrimethamine.