Determinants and Outcomes for Neonatal Septicaemia at the Federal Medical Centre Bida, North Central Nigeria.

BACKGROUND: Neonatal septicaemia (NNS) occurs during the first 28 days of life and is characterized by systemic bacterial infection proven by blood culture. It is a leading cause of morbidity and mortality in neonates. Determinants of NNS vary between locations forming the basis for this study. OBJECTIVE: To determine the prevalence and the predisposing factors to neonatal septicaemia among neonates admitted to the neonatal intensive care unit (NICU) of Federal Medical Centre, Bida (FMC Bida). METHODS: This was a one-year prospective observational study, 167 neonates admitted to the neonatal intensive care unit (NICU) of FMC Bida, were selected by purposive sampling method to participate in the study from 13th May, 2015 to 30th April, 2016. A structured questionnaire was filled out by consenting parents and blood samples were collected for laboratory analysis. The data was analyzed using SPSS version 20 (2016). The data were summarized using frequency distributions, means, standard deviation, charts and tables while statistical significance was determined using the chisquare test and Fisher's exact test at a 5% level of significance as well as Odd's Ratio (OR) as appropriate. RESULTS: Of the 167 neonates recruited, 97(58.1%) were males, 70(41.9%) were females and a male: female ratio of 1.4:1. Outborns were 100 (60%), inborns were 67(40%). Mean age was 4.3 ± 1.5 days and the mean weight of 2589 ± 743.9g. The overall prevalence of neonatal sepsis was 2.33% while the blood culture's positive rate was 9.58%. Risk factors identified in the neonates in this study were prolonged rupture of membranes (PROM), chorioamnionitis, meconium-stained liquor, foul-smelling vaginal discharge, being an outborn, having a low birth weight, inability to cry at birth and prematurity but, PROM was the only risk factor significantly associated with septicaemia (OR 5.4; 95% CI 2.2-13.5) while Escherichia coli was the leading bacterial isolate. CONCLUSION: In conclusion, prolonged rupture of membrane was mostly responsible for neonatal septicaemia in this study.

CONTEXTE: La septicémie néonatale (SN) survient au cours des 28premiers jours de vie et se caractérise par une infection bactérienne systémique prouvée par hémoculture. C'est l'une des principales causes de morbidité et de mortalité chez les nouveau-nés. Les déterminants de la NNS varient d'un endroit à l'autre, ce qui constitue la base de cette étude. OBJECTIF: Déterminer la prévalence et les facteurs prédisposant à la septicémie néonatale parmi les nouveau-nés admis dans l'unité de soins intensifs néonatals (USIN) du Centre médical fédéral de Bida (CMF Bida). MÉTHODES: Il s'agissait d'une étude observationnelle prospective d'un an, 167 nouveau-nés admis à l'unité de soins intensifs néonatals (USIN) du FMC Bida, ont été sélectionnés par la méthode d'échantillonnage à dessein pour participer à l'étude du 13 mai 2015 au 30 avril 2016. Un questionnaire structuré a été rempli par les parents consentants et des échantillons de sang ont été prélevés pour des analyses de laboratoire. Les données ont été analysées à l'aide de SPSS version 20 (2016). Les données ont été résumées à l'aide des distributions de fréquence, des moyennes, de l'écart-type, des graphiques et des tableaux, tandis que la signification statistique a été déterminée à l'aide du test du chi-carré et du test exact de Fisher à un niveau de signification de 5 %, ainsi que du rapport d'Odd (OR), le cas échéant. RÉSULTATS: Sur les 167 nouveau-nés recrutés, 97 (58,1 %) étaient des garçons, 70 (41,9 %) étaient des filles, soit un rapport hommes/femmes de 1,4:1. Les nouveau-nés étaient au nombre de 100 (60 %) et les nouveau-nés au nombre de 67 (40 %). L'âge moyen était de 4,3 ± 1,5 jours et le poids moyen de 2589 ± 743,9g. La prévalence globale de la septicémie néonatale était de 2,33 %, tandis que le taux d'hémoculture positive était de 9,58 %. Les facteurs de risque identifiés chez les nouveaunés de cette étude étaient la rupture prolongée des membranes (RPM), la chorioamnionite, la liqueur méconiale, les pertes vaginales nauséabondes, la naissance d'un enfant, le faible poids de naissance, l'incapacité à pleurer à la naissance et la prématurité, mais la RPM était le seul facteur de risque significativement associé à la septicémie (OR 5,4 ; 95% CI 2,2-13,5) tandis qu'Escherichia coli était l'isolat bactérien principal. CONCLUSION: En conclusion, la rupture prolongée des membranes était principalement responsable de la septicémie néonatale dans cette étude. Mots-clés: Nouveau-nés, Septicémie, Facteurs de risque.

Assessment of preventive oral health knowledge and practices among rural and urban mothers in Lagos state.

AIMS AND OBJECTIVES: To evaluate students' performance and its predictors in the preclinical examinations at the College of Health Sciences, Ladoke Akintola University of Technology Ogbomoso Nigeria. MATERIALS AND METHODS: A cross section of students' records admitted into medical programme in 1999/2000 sessions was studied. RESULTS: Younger students performed consistently better than the older ones in all the three subjects taken at the MBBS1. It was also noticed that the male students performed better, a statistically significant mean difference in score was observed in Biochemistry P>0.05. Students with better Ordinary level aggregate grade of (5-15) in the five core subjects at SSCE, consistently had better results in all the subjects taken at MBBS1 examination compared to their counter-part with aggregate SSCE grade of (16-30). Students that were admitted through JAMB performed better in all the three subjects than those that were admitted through pre-degree programme and the transferred students. However, the mean difference was statistically significant P<0.05 in Biochemistry only. CONCLUSION: Better performance at MBBS1 was found in younger age group, those with aggregate grade of (5-15) in SSCE and those admitted through JAMB. Ordinary level requirement irrespective of the mode of admission should not be compromised. Schools that admit students through pre-degree, transfer or direct entry will have to be more conscious of the quality of students they admit and also operate such system with utmost transparency and with a principle of promoting good academic standard.

Predictors of students'performance in the pre-clinical MBBS programme in a Nigerian University.

AIMS AND OBJECTIVES: To evaluate students' performance and its predictors in the preclinical examinations at the College of Health Sciences, Ladoke Akintola University of Technology Ogbomoso, Nigeria. MATERIALS AND METHODS: A cross section of students' records admitted into medical programme in 1999/2000 sessions was studied. RESULTS: Younger students performed consistently better than the older ones in all the three subjects taken at the MBBS1. It was also noticed that the male students performed better, a statistically significant mean difference in score was observed in Biochemistry P<0.05. Students with better Ordinary level aggregate grade of (5-15) in the five core subjects at SSCE, consistently had better results in all the subjects taken at MBBS1 examination compared to their counter-part with aggregate SSCE grade of (16-30). Students that were admitted through JAMB performed better in all the three subjects than those that were admitted through pre-degree programme and the transferred students. However, the mean difference was statistically significant P<0.05 in Biochemistry only. CONCLUSION: Better performance at MBBS1 was found in younger age group, those with aggregate grade of (5-15) in SSCE and those admitted through JAMB ordinary level requirement irrespective of the mode of admission should not be compromised. Schools that admit students through pre-degree, transfer or direct entry will have to be more conscious of the quality of students they admit and also operate such system with utmost transparency and with also operate such system with utmost transparency and with a principle of promoting good academic standard.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria.

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6%) and 3 (0.9%) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12 (3.4%) and 4 (1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups.

Knowledge, attitudes to HIV/AIDS and sexual behaviour of students in a tertiary institution in south-western Nigeria.

OBJECTIVE: To determine the knowledge, attitude and sexual behaviour of students in a tertiary institution in south western Nigeria with regard to HIV/AIDS. METHODS: Descriptive cross-sectional survey conducted between January and March 2005. Information was collected from 368 students of a tertiary institution in Ede, Osun State, Nigeria. Participants were selected by a multi-stage sampling method and data obtained using a semi-structured pre-tested questionnaire. RESULTS: Most (89.4%) respondents were aware of the existence of HIV/AIDS, and knew the aetiology, routes of transmission, signs and symptoms, and preventive measures against the disease. While a little over half (59.8%) of the respondents revealed that they could hug people with HIV/AIDS, one out of four (27.2%) stated that these persons should be isolated from the community. Less than a quarter (22.3%) of the respondents believed that they were vulnerable to HIV/AIDS. More than half (58.2%) had ever had sex; the mean age at their first sexual exposure (for all respondents) was 16.7 +/- 4.4 years. Almost half (48.2%) of the 191 currently sexually active respondents had multiple sexual partners. Of the sexually active respondents, 75.9% claimed to have ever used condoms; among these, male respondents were more likely to have ever used condoms than their female counterparts (p < 0.05). CONCLUSION: The study revealed a gap in the knowledge of HIV/AIDS and an inappropriate sexual behaviour among respondents. Meaningful strategies, such as an innovative and culturally sensitive adolescent sexual and reproductive health programme that focuses on modification of sexual behaviour should be adopted to allow young people to prevent transmission of the HIV/AIDS virus.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups. (Afr Reprod Health 2008; 12[1]:96-100)

Current trends in the prevalence and aetiology of childhood congestive cardiac failure in Sagamu.

Congestive cardiac failure (CCF) is a common paediatric emergency with diverse aetiologies. The objective of this study is to define the current prevalence rate and common causes of CCF among children hospitalized in a Nigerian Tertiary Hospital. The study was prospectively done over a 1-year period in the Paediatric Wards of the hospital. Consecutive children aged 0-14 years, who fulfilled the standard diagnostic criteria for CCF were recruited. Data obtained from them included the age, sex, duration of illness and the socioeconomic status of the parents. Each subject was given a specific diagnosis based on the clinical, laboratory and radiological features. Out of a total of 1552 admissions, 109 had CCF giving the prevalence of 7.02%. The mean age of children with CCF was mean of 2 +/- 3.1 years (range: 1 day to 14 years). Ninety-five (91%) of them were concentrated in the lower socioeconomic classes III-V. The aetiologies of CCF identified in this study were as follows: severe anaemia occurring alone (48; 46%), lower respiratory tract infections (LRTI) (30; 29%), anaemia with LRTI (12; 11.5%), congenital heart diseases (CHD) (11; 10.5%), rheumatic heart disease (1; 1%), myocarditis (1; 1%) and chronic renal disease (1; 1%). Malaria was the commonest cause of anaemia while bronchopneumonia was the commonest form of LRTI in the subjects. Measles infection was associated with LRTI in 10 (23.8%) children. Three children had HIV-related anaemia. Infants formed the bulk of the subjects with CCF due to anaemia, LRTI and CHD. Ventricular septal defect was the commonest CHD identified. The prevalence obtained from this study was higher than rates obtained from some previous studies in the country. Severe anaemia is the commonest cause of CCF probably from the effects of severe malaria and increasing poverty. Stringent attention to poverty alleviation and malaria control may reduce the burden of CCF among Nigerian children.

Congenital adrenal hyperplasia due to 11-hydroxylase enzyme deficiency in three siblings. A brief report.

To appraise clinicians of the presence of an uncommon cause of congenital adrenal hyperplasia in a Nigerian family, we present case reports of three siblings comprising two males (aged 4 years 10 months and 3 years 10 months) and a female (aged 16 months). The male patients presented with features of precocious pseudopuberty and had body weights and heights that were above the 95th percentiles on a standard growth chart. There was radiologic evidence for an advanced bone age of over 11 years in both patients, together with findings of sustained systemic hypertension. The female patient was discovered to have an abnormal hormonal profile during a screening of the unaffected children of their non-cosanguinous monogamous parents. The three siblings had morning plasma cortisol concentrations in the lower range of reference values together with markedly elevated levels of plasma androgens. These biochemical abnormalities together with the clinical features of precocious pseudopuberty in the two male patients led to the clinical suspicion of congenital adrenal hyperplasia (CAH). The enzymatic defect was believed to be due to 11-hydroxylase enzyme, because of the presence of sustained systemic hypertension in the male subjects. As routine family screening was instrumental in the discovery of the subclinical CAH in the female subject, it is thus suggested that clinicians should endeavour to undertake a detailed hormonal screening of family members of patients.

Studies on heart failure in Sagamu

A prospective study of 137 children with heart failure; has revealed a prevalence of 80.3 percent among infants and children three years old and below; the condition was rather uncommon in the neonatal period; occurring in only 3.6 percent of children in the series. The major manifestations of the disease included refusal of feeds or poor appetite in 74.5 percent; cough in 59.8 percent; difficulty in breathing in 49.6 percent and vomiting in 30.7 percent of the patients; significant tachycardia and tachypnoea and tender hepatomegaly were present in all the patients; while elevated jugular venous pressure (JVP) occurred in 10.9 percent and pitting oedema in 7.3 percent of the patients

Pneumonia in Sagamu

A study of 154 cases of pneumonia in infancy and childhood at the Ogun State University Teaching Hospital is presented. The condition accounted for 3.9 percent of all paediatric admissions. A majority (81.2 percent) of the patients were aged three years and under; while the male to female ratio was 1.1:1. A seasonal variation in the prevalence of pneumonia was found with two peaks in February and November. Brochopneumonia was the commoner type of pneumonia; occurring in 83.1 percent of the cases. Patients with lobar pneumonia were significantly older and had a higher mean temperature on admission and a longer period of hospitalization than patients with bronchopneumonia. The commonest associated conditions that were identified included upper respiratory tract infection in 39 percent; measles in 24.7 percent and protein-energy malnutrition in 7.1 percent of the cases

Handfeeding practice among mothers in a semi-urban community

A survey of hand/force-feeding practice among mothers attending the Sagamu Local Government Health Centre was carried out between May and August 1991. 820 mothers of children aged less than 3 years were interviewed using a semi-structured questionnaire. 516 mothers (62.9 per cent) practised both hand and force-feeding. Majority (63.9) of those who hand/force-fed were mothers of infants aged between 1 and 6 months. Males were force-fed as frequently as females. Cereals preparations with or without cow's milk were force-fed most frequently. Persistent refusal of oral feeds was the most reason for force-feeding in 77.1 per cent cases. The implications of the findings are discussed and further steps to establish the safety or otherwise of this practice are suggested

Electrocardiographic changes after recovery from measles.

Children with measles seen at our hospital had an initial electrocardiogram (ECG) and a repeat after 3 months. The patients were aged 5 months to 8 years (mean 19 months). The ECG changes observed after clinical recovery included T-wave inversion in eight patients (16%), flattening in eight patients (16%), prolonged PR interval in six (12%), prolonged Q-Tc in three (6%) and low QRS amplitude in four (8%). At least one ECG change was present in 18 patients (36%) after recovery, 14 of these were due to persistence of the changes noted during measles. The implication of above findings and the need for a longer-term follow-up study are discussed.

Electrocardiographic changes in measles.

Electrocardiograms (ECGs) were recorded in 100 Nigerian children with measles admitted to our paediatric wards or treated on an out-patient basis. The patients were aged 5 months-8 years (mean, 19 months) and the male:female ratio was 1.3:1. Similar recordings were obtained in 100 age- and sex-matched controls. The electrocardiographic changes observed include T wave inversion in 28 patients and prolonged P-R interval in 22. Other changes are prolonged Q-Tc (13 patients), low QRS amplitude (13 patients), abnormal QRS axes in the frontal plane (5 patients) and T wave flattening (4 patients). A statistically significant difference between patients and controls with respect to the above changes was demonstrated in T wave inversion and prolonged P-R interval--the latter in the 5 months-1 year age group. Hence, 35 patients had at least one statistically significant ECG change, giving a prevalence rate of 35%. The implications of the above findings are discussed and the need to intensify efforts aimed at immunizing all children against measles is stressed.