Tape Rule Measurement of Foot Length as Proxy for Vernier Digital Calliper in Estimating Gestational Age among Nigerian Neonates.

BACKGROUND: Estimating gestational age at birth could be challenging, particularly in settings where the expertise to use conventional methods is lacking. The use of the postnatal foot length has been proposed for this purpose. The ideal tool for measuring foot length, the Vernier Digital Calliper, is not readily available in resource-poor settings. OBJECTIVE: To determine the degree of correlation between postnatal foot length measurement using a Vernier Digital Calliper and a tape measure in the estimation of gestational age among Nigerian neonates. METHODS: Neonates aged 0 to 48 hours without lower limb deformities were studied. The Gestational age was determined using the New Ballard Scoring method. The Foot length was measured as the distance between the tip of the second toe and the heel using both the Vernier Digital Calliper (FLC) and a non-elastic, flexible tape measure (FLT). The measurements were subjected to statistical comparisons. RESULTS: A total of 260 newborn infants comprising 140 preterm and 120 term babies were studied. The foot length measurements using both the calliper and tape measure progressively increased with gestational age. FLT was consistently relatively higher than FLC across gestational ages. The relationship between the two tools was FLC = 3.05 + (0.9 x FLT) for preterm babies and FLC = 23.39 + (0.6 x FLT) for term babies. The Cronbach's Alpha correlation ranged from 0.775 to 0.958 across the gestational ages. The degree of agreement between the tools ranged from -2.03 to -1.34 with a mean difference of -1.68 (t = -9.67, p <0.001). CONCLUSION: There is a high level of intra-gestational age reliability between caliper measurements and tape measurements, the latter can be suitably used as a suitable proxy for the former in the measurement of postnatal foot length in the estimation of gestational age at birth.

CONTEXTE: L'estimation de l'âge gestationnel à la naissance peut s'avérer difficile, en particulier dans les contextes où l'expertise nécessaire à l'utilisation des méthodes conventionnelles fait défaut. La longueur du pied postnatal a été proposée à cette fin. L'outil idéal pour mesurer la longueur du pied, le pied à coulisse numérique de Vernier, n'est pas facilement disponible dans les régions à faibles ressources. OBJECTIF: Déterminer la corrélation entre deux méthodes de mesure de la longueur du pied postnatal dans l'estimation de l'âge gestationnel chez les nouveau-nés nigérians. MÉTHODES: Des nouveau-nés âgés de 0 à 48 heures sans déformation des membres inférieurs ont été étudiés. L'âge gestationnel a été déterminé à l'aide de la méthode New Ballard Scoring. La longueur du pied a été mesurée comme la distance entre l'extrémité du deuxième orteil et le talon à l'aide d'un pied à coulisse numérique de Vernier (FLC) et d'un mètre ruban souple non élastique (FLT). RÉSULTATS: Au total, 260 nouveau-nés, dont 140 prématurés et 120 nés à terme, ont été étudiés. Les mesures de la longueur du pied à l'aide du pied à coulisse et du mètre ruban augmentent progressivement avec l'âge gestationnel. La FLT était toujours relativement plus élevée que la FLC, quel que soit l'âge gestationnel. La relation entre les deux outils était la suivante : FLC = 3,05 + (0,9 x FLT) pour les prématurés et FLC = 23,39 + (0,6 x FLT) pour les enfants nés à terme. La corrélation alpha de Cronbach allait de 0,775 à 0,958 selon l'âge gestationnel. CONCLUSION: Le mètre ruban est un substitut adéquat au pied à coulisse pour la mesure de la longueur du pied postnatal. Mots clés: Âge gestationnel estimé; Pied à coulisse numérique; Longueur du pied; Prématurité.

Are We Missing Hypothyroidism among Children with Sickle Cell Anaemia?

Background: Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia. However, few studies on hypothyroidism status of children with sickle cell anaemia in Nigeria are available. The objective of this study was to determine the prevalence of hypothyroidism among children with sickle cell anaemia. Methods: A cross sectional study that assayed the thyroid hormones and thyroid stimulating hormone (TSH) of 71 children with sickle cell anaemia was conducted at Olabisi Onabanjo University Teaching Hospital Sagamu. Using age appropriate hormonal reference values, the subjects were classified into subclinical, primary and secondary hypothyroidism. Results: The mean serum TSH, Free T3, and Free T4 were comparable irrespective of age category (p > 0.05). No subject was identified to have low TSH value while 7.0% had high TSH value. Low free T3 was identified in 1.4% and 8.5% had high free T3 values. Low free T3 and free T4 were seen in 11.3% each of the subjects. The overall prevalence of primary, secondary and subclinical hypothyroidism was 0%, 0% and 4.2%, respectively. Conclusion: Sub-clinical hypothyroidism does occur in Nigerian children with sickle cell anaemia. Routine screening for hypothyroidism is advocated in all children with sickle cell anaemia.

A COMMUNITY-BASED PREVALENCE OF PRESBYOPIA AND SPECTACLE COVERAGE IN SOUTHWEST NIGERIA.

BACKGROUND: The use of population-based method to assess the prevalence of presbyopia and spectacle use is few even though it is more reliable compared to the commoner hospital based studies. This study was carried out to determine the need for spectacle services in our coverage area. AIM: To determine the prevalence of presbyopia among adults of 30 years old and above in Sagamu local government area of Ogun state, South-West, Nigeria. DESIGN: The study was a population based descriptive and cross-sectional design. SETTING: The study was carried out using a multistage cluster random sampling with probability proportional to size of regular adult residents of Sagamu Local Government area, Sagamu, Ogun state, Nigeria. MATERIALS AND METHODS: Examination of respondents included administration of semi-structured interviewer assisted questionnaire and distance visual acuity measurement with or without pinhole at 6 meters using the Snellen's charts. Automated refraction with subjective refraction was carried out in all participants with presenting visual acuity (PVA) worse than 6/9 but with an improvement with pinhole. Near assessment was done at 40cm with the distance correction in place if required. Ocular examination was also carried out in all participants that had refraction including pupillary dilatation when indicated. RESULTS: The prevalence of presbyopia was 80.9%. There was an increasing prevalence with age (p<0.001) with a 100% prevalence in the ≥80 years age group. The mean add requirement was +2.24DS. The met presbyopic need was 22.9% and the unmet need 58%. The presbyopic spectacle coverage was 28.4% which was positively associated with younger age (p=0.034), attaining at least secondary school education (p<0.001), and living in an urban area (p<0.001). CONCLUSION: The prevalence of presbyopia is high in this community and found in persons younger than 40 years and the spectacle coverage for the population is low with a high unmet spectacle need. There is a need to provide near vision spectacles to a large proportion of residents in the community.

Severe acute malnutrition in a population of hospitalized under-five nigerian children.

AIMS AND OBJECTIVES: This study was to determine the prevalence and socio- clinical factors associated with severe acute malnutrition (SAM) among hospitalized under-five children. PATIENTS AND METHOD: A cross-sectional survey of children aged less than 59 months was carried out at the Children's Ward of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria using the 2006 WHO criteria for SAM. RESULTS: A total of 208 children were studied. Overall, 64.9% had normal nutrition while 18.3% had SAM. Of the 38 children with SAM, 68.4% were hospitalised primarily for severe protein-energy malnutrition using the Wellcome classification. Low maternal education (84.2% vs 65.2%; p = 0.025), non-exclusive breastfeeding (84.2% vs 61.5%; p = 0.009), untimely commencement of weaning (77.8% vs 47.1%; p = 0.006), cessation of breastfeeding before the age of 12 months (45.5% vs 0.0%; p < 0.0001) and presence of infections (84.2% vs 58.5%; p = 0.004) were associated with SAM. Multivariate analysis identified presence of infections (OR = 4.9; p = 0.002), non- exclusive breastfeeding (OR = 1.1; p = 0.048) and low maternal education (OR = 2.1; p = 0.02) as strong determinants of SAM. CONCLUSION: The prevalence of SAM among hospitalized Under-Fives was high. This justifies the routine use of the WHO diagnostic criteria at the community level for early detection of at-risk children.

The Influence of Method, Timing of Onset and Duration of Enteral Feeding on the Duration of Hospitalization of Newborn Infants in a Nigerian Special Care Baby Unit.

BACKGROUND: Feeding practices among high-risk newborn babies have not been extensively studied in the resource-constrained parts of the world. AIM: To describe the pattern of milk use among infants in a resource-poor special care baby unit (SCBU) and relate these to the outcome of hospitalization. SUBJECTS AND METHODS: Setting - SCBU of Olabisi Onabanjo University Teaching Hospital, Sagamu. Design - Prospective study of consecutively admitted inborn babies within the first 24 h of life. The data analyzed included the weight and estimated gestational age (EGA) of the babies, the age at the onset of and duration of feeds (breast milk and artificial milk [AM]). RESULTS: Out of the 118 infants studied, (78.8%) 93/118 received breast milk and 16.1% (19/118) received AM. The mean age at the commencement of enteral feeding was 3.9 days. The age at the onset of suckling was negatively correlated with the EGA and body weight. The age at the onset and duration of enteral feeding were directly related to the duration of admission. CONCLUSION: More than three-quarter of the infants hospitalized in the unit received breast milk, but commencement was mostly delayed beyond the 3(rd) day of life. The duration of admission may be related to the timing of onset and duration of milk use.

Maternal knowledge and care-seeking behaviors for newborn jaundice in Sagamu, Southwest Nigeria.

BACKGROUND: Delay in the presentation of infants with jaundice at the hospital is a reason for the persistence of the severe forms of jaundice. OBJECTIVE: The aim was to determine the influence of maternal knowledge on newborn jaundice on their care-seeking practices. METHODS: In a cross-sectional survey, mothers whose infants presented with significant hyperbilirubinemia were assessed for knowledge about jaundice in relation to their care seeking behaviors. RESULTS: Out of 98 mothers, 57.1% had good knowledge on newborn jaundice. Most of the mothers with good knowledge had tertiary education (P = 0.004), had good care-seeking behavior for newborn jaundice (P = 0.027) and their infants did not develop kernicterus (P = 0.0001). Mothers with tertiary education also had significantly better performances on the knowledge and care-seeking evaluation scales. CONCLUSION: Maternal knowledge on newborn jaundice, as well as tertiary maternal education, influenced appropriate care-seeking behavior for infants with jaundice and reduced the risk of complications.

National neonatal resuscitation training program in Nigeria (2008-2012): a preliminary report.

BACKGROUND: Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth. MATERIALS AND METHODS: Between 2008 and 2012, doctors and nurses drawn from all the geo-political zones were trained using the Neonatal Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire-based, cross-sectional surveys of doctor and nurse trainees from the six geo-political zones in Nigeria were conducted eight months after the primary training, to evaluate the post-training neonatal resuscitation activities. RESULTS: Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post-training period. The nurses used bag and mask for infant resuscitation more frequently, compared to doctors, with the rate fluctuating between two-to-one and four-to-one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants. CONCLUSION: The NRT in Nigeria is well-subscribed and the frequency of secondary training is good.

Determinants of Timely Initiation of Complementary Feeding among Children Aged 6-24 Months in Sagamu; Nigeria

Background: Poor breastfeeding and complementary feeding practices may contribute to childhood malnutrition in the developing world. Objective: The objective was to examine the determinants of timely initiation of complementary feeding among Nigerian children. Materials and Methods: Using a cross-sectional design; children aged 6-24 months were surveyed in a Nigerian Teaching Hospital. Children with timely initiation of complementary feeding (6-8 months) were compared with children with untimely initiation of complementary feeding early (6 months and 8 months) for clinical and social characteristics using both bivariate and multivariate analysis. Results: Of 156 children; 41; 53.8; and 5.1 had timely; early and delayed initiation of complementary feeding. Complementary feeding was initiated with processed cereals (44.8); locally prepared maize gruel (32.1) and mashed family diet (23.1

Determinants of timely initiation of complementary feeding among children aged 6-24 months in Sagamu, Nigeria.

BACKGROUND: Poor breastfeeding and complementary feeding practices may contribute to childhood malnutrition in the developing world. OBJECTIVE: The objective was to examine the determinants of timely initiation of complementary feeding among Nigerian children. MATERIALS AND METHODS: Using a cross-sectional design, children aged 6-24 months were surveyed in a Nigerian Teaching Hospital. Children with timely initiation of complementary feeding (6-8 months) were compared with children with untimely initiation of complementary feeding early (<6 months and >8 months) for clinical and social characteristics using both bivariate and multivariate analysis. RESULTS: Of 156 children, 41%, 53.8%, and 5.1% had timely, early and delayed initiation of complementary feeding. Complementary feeding was initiated with processed cereals (44.8%), locally prepared maize gruel (32.1%) and mashed family diet (23.1%). Bivariate analysis showed significant association between timely initiation of complementary and orthodox maternity care, no prelacteal feeding, exclusive breastfeeding, no siblings and first birth order. Parental education was not associated with timely initiation of complementary feeding. Multivariate analysis identified orthodox maternity care, exclusive breastfeeding and no siblings as independent predictors of timely initiation of complementary feeding. CONCLUSION: Complementary feeding is most frequently initiated earlier than 6 months in this population. Good breastfeeding practices may influence timely initiation of complementary feeding. Interventions should be targeted at the entire population irrespective of educational and socioeconomic status.

Growth in prepubertal Nigerian children is highly dependent on socio-economic status.

AIM: To relate height, weight and body mass index (BMI) of prepubertal children in Sagamu, Nigeria, to parental socio-economic class (SEC). METHODS: Cross-sectional study of 1606 children aged 5-11 years from eight public and eight private primary schools. Height, weight and BMI from 1557 prepubertal children were standardized using two references: US-CDC birth cohorts 1929-1974 and Swedish birth cohort 1974. RESULTS: Children in private schools were taller and heavier than those in public schools (p < 0.0001). Most children (73.2%) belonged to lower SEC, 17.6% to middle and 9.2% to upper. HeightSDS , weightSDS and BMISDS increased with increasing parental SEC. Upper SEC children were taller and heavier with higher BMIs than those from lower SEC (p < 0.0001). HeightSDS , weightSDS and BMISDS were below '0' in all SEC and gender groups (all p < 0.002). Younger children were taller and heavier than the older (p < 0.0001). CONCLUSION: Fathers/mothers with higher education/occupation had taller and heavier children with higher BMI than other groups. Children in private schools were taller and heavier than children in public schools. Disparities in parental SEC still constrain optimal child growth in Nigeria: whereas height and weight of children of upper SEC were close to the US-CDC29-74 reference mean, they were still below Swedish74 reference mean representing more optimal growth.

Mothers' knowledge about birth asphyxia: the need to do more!

BACKGROUND: Health education is an important tool required for reducing the burden of birth asphyxia in the developing world. OBJECTIVE: The objective of this study was to assess the knowledge of mothers, who received health facility-based antenatal care during their last pregnancy, about birth asphyxia and relate their knowledge to their places of antenatal care. MATERIALS AND METHODS: A cross-sectional survey of mothers of infants attending the Immunization clinic in a Nigerian Teaching Hospital was done between July and October 2010 using a close-ended questionnaire. Consecutively consenting mothers were enrolled into the study. RESULTS: Out of 354 mothers, 56.5% received counseling about birth asphyxia during antenatal clinic visits in their last pregnancy; 85.5% of attendees of teaching hospital; and 26.4% of attendees of private antenatal clinics received counseling about birth asphyxia. Overall, 38.9% of the respondents had satisfactory knowledge about birth asphyxia; 47.5% of teaching hospital attendees; and 28.1% of private clinic attendees had satisfactory knowledge about birth asphyxia. Lower socioeconomic status, lack of counseling, and nonattendance of teaching hospital antenatal clinic were associated with poor knowledge about birth asphyxia. CONCLUSION: Most of the mothers surveyed had poor knowledge about the risk factors and sequelae of birth asphyxia. The health system needs to improve health education of expectant mothers about birth asphyxia.

Mothers' Knowledge about Birth Asphyxia: The Need to do More!

Background: Health education is an important tool required for reducing the burden of birth asphyxia in the developing world. Objective: The objective of this study was to assess the knowledge of mothers; who received health facility-based antenatal care during their last pregnancy; about birth asphyxia and relate their knowledge to their places of antenatal care. Materials and Methods: A cross-sectional survey of mothers of infants attending the Immunization clinic in a Nigerian Teaching Hospital was done between July and October 2010 using a close-ended questionnaire. Consecutively consenting mothers were enrolled into the study. Results: Out of 354 mothers; 56.5 received counseling about birth asphyxia during antenatal clinic visits in their last pregnancy; 85.5 of attendees of teaching hospital; and 26.4 of attendees of private antenatal clinics received counseling about birth asphyxia. Overall; 38.9 of the respondents had satisfactory knowledge about birth asphyxia; 47.5 of teaching hospital attendees; and 28.1 of private clinic attendees had satisfactory knowledge about birth asphyxia. Lower socioeconomic status; lack of counseling; and nonattendance of teaching hospital antenatal clinic were associated with poor knowledge about birth asphyxia. Conclusion: Most of the mothers surveyed had poor knowledge about the risk factors and sequelae of birth asphyxia. The health system needs to improve health education of expectant mothers about birth asphyxia

Pattern and determinants of newborn apnea in an under-resourced Nigerian setting.

OBJECTIVE: To determine the prevalence, distribution and determinants of newborn apnea in a resource-constrained setting. DESIGN: Retrospective study. MATERIALS AND METHODS: Newborn babies who had apnea during hospitalization between January and December 2008 were studied. The sex, age and body weight, clinical conditions, etiologies of apnea and outcome were recorded. Babies with and without apnea were compared using bivariate and multivariable analysis. RESULTS: Out of 402 babies seen during the review, 78 (19.4%) had apnea. They comprised 59 preterm and 19 term babies. Forty (51.3%) had apnea at the point of admission while the remaining 38 (48.7) developed apnea after a mean interval of 118.5 ± 101.1 hours. Thirty-seven percent of preterms had idiopathic apnea. Etiologies included respiratory distress (50.0%), hypothermia (42.3%), and asphyxia (28.2%). Multivariate analysis showed that weight <2.5kg, hypothermia, referred status and presence of respiratory distress were determinants of apnea. Case fatality rate was 82.2% among apneic babies. CONCLUSION: Apnea occurred commonly in this population of babies. Stringent efforts like ventilator supports for babies in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the major risk factors for newborn apnea. The identified determinants can be used to draw up effective preventive measures in resource-poor settings.

Pattern and determinants of blood transfusion in a Nigerian neonatal unit.

OBJECTIVE: To determine the pattern and determinants of blood transfusion in a Nigerian neonatal unit. MATERIALS AND METHODS: Newborn babies who required blood transfusions between January and December, 2008, were studied. The sex, age, and weight at the first transfusion, clinical conditions, indications for transfusion, and the outcome were analyzed with bivariate and multivariate methods. RESULTS: A total of 402 neonates were hospitalized and 112 (27.9%) had blood transfusion; 61.9% had exchange transfusion, 66.1% had red cell transfusion, and 8% had plasma transfusion. There were 251 transfusions with a rate of 4.8 transfusions per week. Blood transfusions were done for severe jaundice (55.4%), severe anemia (40.2%), and bleeding disorders (4.4%). Weight < 2.5 kg, outside delivery, and jaundice were independent determinants of neonatal transfusion. CONCLUSION: The blood transfusion rate in this facility was remarkably high. Improved standard of newborn care and infrastructural support are required to reduce the transfusion rate.

Nutritional status of semi-urban Nigerian school children using the 2007 WHO reference population.

BACKGROUND: There is paucity of data on the nutritional status of school-age children in Sagamu town of Southwestern Nigeria. OBJECTIVE: To determine the nutritional status of primary school children in Sagamu Local Government Area, Nigeria. METHODS: A cross-sectional survey of primary school children aged 6 to 10 years in Sagamu, Southwestern Nigeria was done. Eight schools were selected using a multi-stage sampling technique. Children randomly selected proportionately from the schools were studied. The weight-for-age, height-for-age and BMI of these children were compared with the 2007 WHO reference values to diagnose underweight (WA <-2SD), stunting (HA <-2SD), thinness (BMI <-2SD), overweight (BMI > +1SD) and obesity (BMI > +2SD). RESULTS: A total of 1016 children comprising 479 (47.1%) boys and 537 (52.9%) girls were studied. The prevalence of malnutrition was 401(39.4%) and boys were more malnourished compared to girls (p =0.002). The overall prevalences of underweight, stunting and thinness were 260(25.5%), 144(14.2%) and 226(22.2%) respectively. Overweight and obesity were present in 31(3.0%) and 5(0.5%) of the population studied respectively. Boys were significantly more often underweight and stunted. CONCLUSION: The prevalence of under-nutrition among school children in Sagamu, Nigeria was high and the girls were generally better nourished than the boys. Efforts to reduce the burden of malnutrition in this population may include nutritional surveillance, food supplementation and free school meals.

Growth pattern of schoolchildren in Sagamu, Nigeria using the CDC standards and 2007 WHO standards.

OBJECTIVE: To compare the median weight, height and body mass index of school children with the 2000 CDC and 2007 WHO reference values. SETTINGS: Schoolchildren in Sagamu, Nigeria. DESIGN: Cross-sectional survey. METHODS: Between November and December, 2008, 1690 school children aged 6 to 16 years from 8 primary schools were surveyed using multi-stage sampling methods. The weight, height and body mass index (BMI) were recorded for each child. The Z-scores of the median anthropometric parameters for each age and sex were determined with the LMS statistical method using the values of L, M and S provided on the CDC and WHO charts. RESULTS: The weight, height and BMI Z-scores were less than the reference values provided on the CDC and WHO charts but were generally closer to the WHO standards compared to the CDC standards. The median weight, height and BMI for females generally plotted higher on CDC and WHO chart compared to the males. The prevalence of underweight and stunting were relatively lower while the prevalence of overweight and obesity was relatively higher among children aged 6 to 10 years using the WHO references compared to the CDC reference values. CONCLUSIONS: The WHO references would under-diagnose under-nutrition and over-diagnose overweight/obesity in the population studied.

Approach to the management of a bleeding neonate.

INTRODUCTION: Neonatal bleeding disorders are common in clinical practice but the laboratory tests required for making the diagnoses are often sophisticated, expensive and so, largely unavailable in the developing world. Thus, a simple clinical approach to the diagnoses and management of neonatal bleeding is desirable in the developing world. METHODOLOGY: A review of literature was done using Medline search, texts on the topic were reviewed. The treatment modalities for each of the common causes of neonatal bleed as well as the limitations encountered in the developing world are also highlighted. RESULTS: Various methods are available for the evaluation of the bleeding neonate, clinical and laboratory with variable sensitivity. For ease of diagnosis in the face of limited laboratory facilities, bleeding babies can be divided into two broad groups: well babies with and without thrombocytopaenia as well as sick babies with and without thrombocytopaenia. CONCLUSION: Using the parameters like the platelets count, prothrombin time, partial thromboplastin time, assays of fibrin degradation products and the clinical condition of the newborns, a large number of commonly encountered causes of neonatal bleeding disorders can be diagnosed to a fair extent.

Neonatal Resuscitation : Knowledge and Practice of Nurses in Western Nigeria

Background. Appropriate resuscitation techniques are crucial to the survival of newborn infants. Objective. To assess knowledge of nurses in western Nigeria about neonatal resuscitation. Method. A cross-sectional survey of the nurses attached to secondary health facilities in western Nigeria was done using a closed-ended questionnaire that tested evaluation and appropriate action aspects of neonatal resuscitation. Results. One hundred and seventy-nine nurses were interviewed. Of these; 72.6had worked in the labour room and the special care baby unit within the last 5 years while only 14.0had attended neonatal resuscitation training course within the last 5 years. Similarly; 31.8; 53.1; 58.1and 35.2had access to radiant warmers; ambu-bags; suction machine and oxygen delivery units; respectively. The knowledge of the respondents was better for evaluation than for appropriate action (95.5v. 49.7). Conclusion. The knowledge of the respondents about appropriate actions to be taken during neonatal resuscitation was poor. Frequent and intensive courses on neonatal resuscitation are highly desired

The incidence and outcome of bilirubin encephalopathy in Nigeria: a bi-centre study.

OBJECTIVE: To determine the current trends in the incidence and outcome of bilirubin encephalopathy among Nigerian babies. METHODS: A review of the hospital records of babies managed for bilirubin encephalopathy at the Wesley Guild Hospital (WGH), Ilesa and Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, both in southwest Nigeria between 2001 and 2005 was carried out. The age, sex, weight, body temperature on admission, place of delivery and outcome of hospitalization were studied. The fatal cases and the survivors were compared for risk factors for mortality. RESULTS: Fifty eight (3.4%) and 57 (2.3%) babies had bilirubin encephalopathy out of 1706 and 2492 total neonatal admissions at OOUTH and WGH respectively. Of these 115 babies, 3 (2.6%), 84 (73.0%) and 28 (24.3%) were aged <3 days, 3-6 days and 7 days or more. Sixty eight (59.1%) babies were delivered in orthodox health facilities. Aside clinically suspected cases of G6PD deficiency, ABO incompatibility and septicaemia were commonly associated with bilirubin encephalopathy, Forty four (38.3%), 36 (31.3%) and 35 (30.4%) had Unconjugated bilirubin of <340 micromol/L, 341-425 micromol/L and >425 micromol/L respectively Sixty eight (59.1%) were discharged, 42 (36.5%) died while 5 (4.7%) were discharged against medical advice. Prematurity, low birth weight, severe anaemia and inability to do Exchange Blood Transfusion were significant risk factors for mortality among babies with bilirubin encephalopathy. Cerebral palsy, seizure disorders and deafness were the leading neurological sequelae (86.4%, 40.9% and 36.4% respectively) among the 22 survivors who were followed up. CONCLUSION: Bilirubin encephalopathy remains a common clinical finding in Nigeria and the associated mortalities and neurological sequelae are significant.

Do working children have worse academic performance?

OBJECTIVE: To examine the effect of child labor on school children's academic performance. METHODS: Primary school children engaged in child labor were compared with age, sex and school-matched controls for absence from school and scores obtained at sessional examination in English language, Mathematics, Sciences and Social studies. RESULTS: There was no significant difference in the mean rate of school absence (p = 0.80), mean aggregate examination scores (p = 0.1) and proportion of class repeaters (p = 0.16) among working school children and the controls. However, a significantly higher proportion of the controls had high (>75%) average examination scores compared with the working school children (p = 0.017). Similarly, the controls performed better than working school children in each of four core subjects but significant differences were observed only in Social Studies and Science (p = 0.006 and 0.001 respectively). CONCLUSION: There is some undermining of academic performance among children who combine schooling with child labor despite comparable school absence with the controls.