Determinants of Mortality Among Severely Malnourished Children in Northern Nigeria.

OBJECTIVES: Severe Acute Malnutrition is a significant cause of mortality in children under the age of 5 years in low-resource settings, including Northern Nigeria. The study aimed to determine the associations between selected risk factors and mortality outcomes in children admitted with SAM in a facility in Katsina State, Northern Nigeria. METHODS: A prospective observational cohort of 201 children aged 6 to 59 months who were admitted with severe acute malnutrition (SAM) in stabilization centers in Katsina State, Northern Nigeria between May 18, 2021, and July 20, 2021, (63 days) were assessed followed up. Outcomes were analyzed using Kaplan-Meir analysis to estimate time to death, and Cox proportional-hazard regression model was used to determine predictors of mortality. RESULTS: The log-rank test showed significant differences in the probability of death between categories of diarrheal status (log-rank statistic = 9.760, P = .021) and presence of existing disease (comorbidity) (log-rank statistic = 5.338, P = .021). The study identified that severely malnourished children admitted with comorbidities showed significant association with time to event (death) (AHR: 4.109, 95% CI: 1.51, 32.60). The estimated mean time until death was 57.9 days (±3.0) for children without comorbidities and 20.1 (±3.0) days for children with comorbidities. The median survival time was 18 days for children with comorbidities. CONCLUSION: The presence of comorbidities was significantly associated with mortality. Severely malnourished children with comorbidities had 4 times higher mortality risk than severely malnourished children admitted without comorbidities. Clinicians and health workers should give due emphasis to the early detection and effective management of comorbidities in children with severe acute malnutrition.

Effect of Integrated Supportive Supervision on the Quality of Health-Care Service Delivery in Katsina State, Northwest Nigeria.

BACKGROUND: Katsina State Government in Northern Nigeria introduced integrated supportive supervision (ISS) in primary health centers. The study was guided by the Primary Health Care Performance Initiative Conceptual Framework. The goal of the study was to measure the impact of ISS on the quality of primary health-care delivery. The outcome variables measured include infrastructure, basic equipment, human resources for health, essential drugs, the number of pregnant women screened for HIV, and the number of children receiving immunization. METHODS: The study was a cross-sectional survey of 34 health facilities. Kruskal-Wallis nonparametric test followed by Dunn post hoc test and analysis of variance followed by Tukey post hoc test were both employed to compare the mean values of various indicators obtained over 6 visits of the ISS program from July 2018 to December 2018. FINDINGS: The study shows the positive effect of the ISS on infrastructure, human resources for health, essential drugs, and the number of pregnant women screened for HIV (P < .05). Human resources for health and the number of children receiving immunization were both not affected by ISS (P > .05). CONCLUSION: Integrated supportive supervision need to be embedded into the 3 levels (primary, secondary, and tertiary) of health-care service delivery. IMPLICATIONS: Integrated supportive supervision will strengthen the Katsina State health system, ensure efficient use of the health facility assets and resources utilization, and improve patient/client satisfaction.

A Pilot Study: Factors Influencing Compliance With Tetanus-Diphtheria Vaccine in Katsina State, Northwestern Nigeria.

BACKGROUND: Tetanus-diphtheria vaccine (Td+) coverage has been steadily declining in Katsina State, Nigeria. The pilot study was guided by The Andersen and Newman Framework of Health Services Utilization. The goal of the pilot study was to identify the Td+ vaccination coverage and identify any association between maternal residence, educational status, occupational status, access to routine immunization services, availability of routine immunization services, perceived need for Td+, perceived severity of maternal and neonatal tetanus (MNT), and compliance with Td+ in Katsina State. METHODS: A cross-sectional survey of 309 randomly selected women in Charanchi district of Katsina State, Nigeria, was conducted. Data were collected using structured questionnaire and analyzed using logistic regression model. FINDINGS: The Td+ coverage was low at 23%. Bivariate analysis showed that age, maternal residence, educational status, availability of Td+, perception of Td+, and perception of MNT significantly affected compliance with Td+ (P < .05, P < .05, P < .05, P < .001, P < .001, P < .001, respectively). Multiple logistic regression findings were inconclusive. CONCLUSION: Effective strategies to improve compliance were awareness creation on Td+ immunization schedule, risk factors associated with MNT, vaccine availability, and safety. Additionally, improving access to routine immunization services, especially in underserved communities, and effective use of Td+ coverage data were used as strategies. IMPLICATIONS: The pilot study suggests that the design can be used to realize more conclusive and generalizable multivariate findings in future studies.

Verification of Neonatal Tetanus Surveillance Systems in Katsina State, Nigeria.

BACKGROUND: The incidence and mortality rates of neonatal tetanus (NNT) remain underreported in Nigeria. The goal of the study was to compare the NNT prevalence and the mortality rates from the existing surveillance system and active surveillance of health facility records in 7 selected health facilities from 2010 to 2014 in Katsina State, Nigeria. METHODS: The study is a retrospective record review using extracted data from NNT records and analyzed using descriptive statistics. RESULTS: The prevalence of NNT and mortality rate were 336 cases and 3.4 deaths per 100 000 population, respectively, whereas the prevalence of NNT and mortality rate reported through the Integrated Disease Surveillance and Response (IDSR) system were 111 cases and 1.0 death per 100 000 population, respectively. CONCLUSION: The study shows underreporting of NNT in the existing IDSR system. IMPLICATIONS: Active surveillance is a good strategy for verifying underreporting of NNT in the surveillance system. The IDSR system should be strengthened with the capacity to detect events associated with a disease toward global elimination.

Predictors of Neonatal Tetanus Mortality in Katsina State, Northwestern Nigeria.

BACKGROUND: The mortality rate of neonatal tetanus (NNT) remains high in Nigeria. The study was guided by Mosley and Chen's model for the elements of child survival in developing countries. The goal of the study was to assess the associations between selected NNT risk factors, number of maternal tetanus toxoid injections, frequency of antenatal visits, place of delivery, and cord care with neonatal mortality as the outcome variable. METHODS: The study is a retrospective record review using data from 332 NNT records and analyzed using a logistic regression model. FINDINGS: Neonates whose mothers had 1 dose of tetanus toxoid vaccine were found to be 4% less prone to NNT mortality compared to neonates whose mothers did not have any dose of tetanus toxoid vaccine during pregnancy (P < .05, odds ratio = 4.12, 95% confidence interval = 1.04-16.29. Frequency of antenatal visits, place of delivery, and cord care were all not significant predictors of NNT mortality. CONCLUSION: The study shows that there is association between NNT risk factors and neonatal mortality, hence the need to further strengthen the NNT surveillance system for early detection of potential risk factors. This would help develop specific public health interventions aimed at improving the outcome of NNT. IMPLICATIONS: The identification and analysis of NNT mortality risk factors and promoting tetanus toxoid vaccination among pregnant women are effective strategies toward attaining NNT elimination goals in Nigeria.