Evaluation of adolescent medicine sub-specialty training in Nigeria: trainees' perspectives

Objective: To evaluate the extent of coverage of curriculum contents pertinent to Adolescent Medicine; as well as the adequacy of facilities and professionals in Nigeria using residents' viewpoint. Design: A descriptive cross-sectional study. Setting: The Intensive Course in Paediatrics of the National Post-graduate Medical College of Nigeria at the University of Benin Teaching Hospital; Benin City Nigeria. Subjects: One hundred and three paediatric residents from training institutions in all zones of the country. Results: Altogether;68.0% and 32.0% of the participants were from Southern and Northern geopolitical zones respectively. Only 14% of them stated that a rotation in an AM unit is a part of training in their centres. None specified its duration. Coverage of AM topics; physical facilities and trainers were rated as inadequate by 77.0%; 82.8% and 70.8% of the respondents respectively. Residents from north were more likely to rate interview/ confidentiality in AM as covered (either partly or well) than their colleagues from the South; (p 0.01; OR= 5.3, 95% CI = 1.5-19.5). We found no difference between federal and state residents' perceived adequacy of AM training. Conclusion: AM in paediatric residency programme in Nigeria is still an unmet challenge. There is a need for a revision of the training curriculum to specify mandatory duration of clinical rotation in AM units

A 4 year review of neonatal outcome at the University of Benin Teaching Hospital, Benin City.

BACKGROUND: Neonatal morbidity and mortality rates reflect a nation's socio-economic status, the efficiency and effectiveness of health care services. This important indicator is useful in planning for improved healthcare delivery. A four year review of neonatal outcome was therefore conducted in the special care baby Unit (SCBU) of University of Benin Teaching Hospital (UBTH). METHODS AND SUBJECTS: The study was done between 2003 and 2006 and sought to review the morbidity, mortality, salvage rate of low birth weight babies and outcome of all inborn and outborn babies admitted into the SCBU of UBTH. The biodata, birth weight, sex, APGAR scores and reasons for admissions and outcome were abstracted from case notes/admission records. RESULT: A total of 3075 babies were admitted to the unit during the period under review. 2602 (84.6%) were inborn while 473 (15.4%) were out-born. There were more males 1676 (54.6%). There were 855 (27.8%) preterm babies of which 803 (26.1%) were low birth weight babies. Neonatal sepsis, severe birth asphyxia, pre-maturity and neonatal tetanus were the most common morbidities suffered by the neonates. Mortality was recorded amongst 625 (20.3%) babies. Mortality rate was significantly higher amongst the out-born than in born babies, P value < 0.0001. CONCLUSION: The neonatal mortality rate in this study is high. The morbidity profile observed in the study is attributable to preventable causes. Of note is the contribution ofNNT to morbidity and mortality. Strengthening of linkages in perinatal care, improving maternal emergency obstetric care and neonatal resuscitation skills are proposed measures to reduce neonatal mortality.

Time of passage of first stools (meconium) and serum levels of calcium and magnesium in Nigerian neonates (African neonates).

BACKGROUND: Over 90% full term normal newborns are known to pass meconium (first stools) within the first 24 hrs of life especially among Caucasians. This has not been fully documented among African neonates. This study was therefore done to determine time of passage of first stools (meconium) in African neonates and also the serum levels of calcium and magnesium in these children in order to establish a data base for normal standards. METHODOLOGY: Two thousand and four hundred neonates were recruited from Hospitals in Benin City urban areas for the study. 76.7% of these were full term and AGA babies (37-40 weeks; 2.8 kg-4.3 kg) while 23.3% of them were preterm and low birth weight neonates (34-36 weeks and weight between 2.4 to 1.5 kg) respectively. RESULTS: 88% of the full term neonates passed meconium at 15.4 +/- 3.6 hrs of life while only 12.0% of them passed meconium after 24 hrs of life and all by 48 hrs of life. The mean time of passage of stools by preterm, low birth weight babies was 45.2 +/- 2.4 hrs. The values of serum calcium in the full term neonates ranged from 6.5 9.2 mEq/l with mean of 7.8 +/- 1.2 mEq/l while the level in the preterm low birthweight neonates was much lower (5.4 8.3 mEq/l) with a mean of 6.7 +/- 1.3 mEq/l. The values of serum magnesium ranged from 0.9 1.6 mEq/l with a mean of 1.2 +/- 0.3 mEq/l in full term neonates while preterm low birthweight neonates had levels as low as 0.5 1.1 mEq/l with a mean of 0.7 +/- 0.2 mEq/l CONCLUSION: This study has shown a relatively shorter time of passage of first stools (meconium) in Nigerian neonates (blacks) than in the Caucasians. The implication of the findings in this study is that a delay in the passage of first stools (meconium) and early appearance of jaundice in normal black neonates could be due to gastrointestinal abnormalities. This observation could lead to early identification of these neonates with resultant early intervention.

Ultrasound assessment of renal size in healthy term neonates: a report from Benin City, Nigeria.

Knowledge of the normal range of renal size is useful in appreciating variations that may occur due to morbidities. Ultrasound is a simple and safe method of evaluating renal sizes in all age groups. This is a prospective study of the assessment of renal dimensions in apparently healthy neonates at the University of Benin Teaching Hospital, Nigeria. One hundred and fifty neonates were studied, including eighty-five males (56.7%) and sixty-five females (43.3%). The mean length of the right kidney was 44.9 +/- 3.2 mm and the mean length of the left kidney was 44.4 +/- 3.5 mm. The difference in renal length between the two sides was not statistically significant. The height and weight of the child showed strong correlation with longitudinal renal measurements. The study also showed the independence of neonatal renal sizes on gender and race.

Knowledge and attitude of youth (ages 15-25 years) to HIV/AIDS and to routine HIV screening.

BACKGROUND: AIDS is still an incurable disease and is very costly to control. Since the first case of Acquired Immune Deficiency Syndrome (AIDS) in Nigeria was reported in 1986, the human immune deficiency virus (HIV) infection has attained epidemic proportion. In an effort to control this rapid spread, certain preventive measures have been developed. In spite of these and the campaigns to control it, the knowledge and attitudes of youths towards HIV/AIDS leaves much to be desired. OBJECTIVE: To determine knowledge and attitude of youths (15 - 25 years) of HIV/AIDS and to Routine HIV Screening. STUDY DESIGN: The study was cross-sectional. SETTING: The study was carried out at the University of Benin Teaching Hospital, Benin City, Nigeria, between January and December 2003. RESULTS: Five thousand three hundred and twenty STUDY POPULATION: The knowledge and attitude of youths (15 - 25 years) of HIV/AIDS and to routine HIV screening was assessed, using anonymous questionnaires, among 9500 respondents, 4950 males and 4550 females. 5750 respondents were from the University of Benin with a population of 20,000 students while 3750 were from some of the Secondary Schools (post primary Schools) randomly selected in Benin City, Nigeria. The University of Benin Teaching Hospital where the work was done is adjacent to the University of Benin. The Secondary Schools selected where the work was done were within a radius of 20 kilometers of the Teaching Hospital and were 5 in numbers with average of 750 students selected per school. Subjects (56%) indicated that they have heard about HIV/AIDS, 4180 (44%) had no knowledge of HIV/AIDS at all. 2240 of 5320 (42.1%) had some knowledge; 1593 (29.9%) had adequate knowledge and only 1487 (28.0%) had sufficient knowledge. 6365 (67%) did not believe it exists and as a result they are not bothered by it. 825 of the 3750 secondary school students had multiple sexual partners. Majority had single partners for those who had at all. While among the University students 2990 (52%) had multiple sexual partners, while others had between one and two sexual partners. Only 36210 (38%) believe it is real and a killer disease frightened about it and are already changing their sexual behaviours; 1900 (20%) believe it is a western propaganda to enslave the developing world. Three thousand nine hundred and ninety respondents (42%) would agree to routine HIV screening and 5510 (58%) would not agree to routine screening. The reasons adduced for rejecting routine HIV screening included psychological trauma, not necessarily high cost of and lack of anti-retroviral drugs, infringement on fundamental human rights, fear of living with positive screening, stigmatization and victimization at place of work if positive. CONCLUSION: Intensive massive awareness campaign through Radio, Televisions jingles and education about HIV/AIDS of the population is recommended to alter their current negative attitude to routine HIV testing and increase their knowledge about HIV/AIDS and perhaps help to change their sexual behaviours.

Aspects of the epidemiology of intestinal parasitoses (IP) in children: knowledge, practices and perceptions of mothers.

BACKGROUND: Intestinal parasitoses (IP) have been demonstrated to pose a major public health problem in the tropics. It is hypothesized that children are continually exposed to re-infection despite interventions. We conducted this hospital-based study to investigate knowledge, practices and perceptions among mothers of children seen at the hospital. METHOD: The study focused on knowledge, practices and perceptions of mothers concerning intestinal parasitoses in children. Questionnaires, which were interviewer administered, were used to generate qualitative data. Stool samples were collected from the study participants into labelled bottles for examination. RESULTS: Majority of mothers belonging to the lower classes did not have access to good drinking water as demonstrated by 39%, 32% in classes III and II respectively while no mother in class V got water from reliable sources: The low level of knowledge about IP was demonstrated by the claim that it was inevitable with the following 68.9% , 56.5%, 44.0% of mothers in social classes V, IV and III respectively. Infection rates increased with lowering social status. More males than females were infected but the difference was not significant (P> 0.05). Peak infection was among children aged between 3 + and 4 years. CONCLUSION: The low level of knowledge, practices and perceptions of mothers concerning IP is a major cause for worry. Urgent consideration should therefore be given in order to periodically treat infected children, enlighted mothers about mode of transmission of IP and also to improve sanitation in deprived areas so as to reduce the rate of transmission.

Upsurge in neonatal tetanus in Benin City, Nigeria.

BACKGROUND: Neonatal tetanus was on the decline from mid 1970's to mid 1990's due to the various efforts by many governments of the developing countries and such agencies as World Health Organisation (WHO) and United Nation's Children's Fund (UNICEF). However recently there appear to be an increase in neonatal tetanus despite these interventions leading to increasing neonatal morbidity and mortality. OBJECTIVE: To study the upsurge in neonatal tetanus despite the various interventions, examine possible causes responsible for it and proffer suggestions for eliminating neonatal tetanus by new target date of 2005 set by World Health Organisation. DESIGN: A prospective study. SETTING: The study was done at the University of Benin Teaching Hospital, Benin city and Modic Medical Centre, a private paediatric hospital in Benin City, Nigeria between January 1997 to December 2001. SUBJECTS: In 1996, it was noticed that cases of neonatal tetanus had increased suddenly among the total admissions. Morbidity and mortality among the under six months children had also increased and about ten percent of it was due to neonatal tetanus. It became imperative therefore to determine the magnitude of this problem. Consequently, cases of neonatal tetanus admitted to Special Care Baby Unit (SCBU) of the University of Benin Teaching Hospital and the Intensive Care Unit (ICU) of the Modic Medical Centre, a private paediatric hospital in Benin over a five year period January 1997 to December 2001 were examined. One hundred and fifty three tetanus cases were recorded during the period comprising 87 (56.9%) males and 66 (43.1%) females. RESULTS: The annual incidence in UBTH was 6.9% (99/1425) and 5.3% (54/1021) in Modic Centre. Forty three point eight percent (67/153) survived while 56.2% (86/153) died. There was a yearly increase in incidence of neonatal tetanus of total neonatal admissions. Average age on admission was 8.8 days and incubation period was 5-22 days. Only 40 (26.1%) did not have any antenatal care. Eighteen of the 40 (45%) mothers who had antenatal care had two doses of tetanus toxoid only. Many of the mothers were ignorant about immunisation, feared about the consequences of immunisation, some got disenchanted with it because of the out of stock syndromes associated with the vaccines whenever they visited the health centres. Some of them did not even know about antenatal care. CONCLUSION: Problem identified included lack of awareness of antenatal services among the target population, under utilisation of antenatal service, non immunisation with tetanus toxoid vaccines, negative cultural beliefs, primordial cord care, lack of economic and decision making empowerment of the target population and lack of government commitment towards elimination of neonatal tetanus. The following recommendations which may lead to elimination of Neonatal Tetanus were made: Strengthening school health programmes, intensive mobilisation and advocacy, regular availability of tetanus toxoid vaccines, empowerment of the target population, training and retraining personnel including Traditional Birth Attendants and increasing commitment by various tiers of government.

Fibrinolytic activity in children with Plasmodium falciparum malaria.

BACKGROUND: Malaria infection is still one of the major causes of morbidity and mortality among the under five year children in tropical Africa. Clinical and laboratory methods of assessing the risk factors for severity in order to adequately manage these children, therefore needs to be identified so that prompt and adequate treatment can be instituted early. Fibrinolytic activity has been postulated as one of the risk factors associated with severity of malaria infection. OBJECTIVE: To measure fibrinolytic activity euglobulin lysis time, (ELT) and fibrinogen levels in 50 Nigerian children with Plasmodium falciparum infection. DESIGN: A cross sectional study. SETTING: University of Benin Teaching Hospital, Benin City, Nigeria between January and December 2002. SUBJECTS: Fifty Nigerian children who were admitted with Plasmodium falciparum malaria infection in the paediatric wards of the hospital were recruited into the study. Thirty-four apparently healthy children who did not have malaria fever but who came for growth monitoring exercise and had some investigations done as part of this exercise were used as control for the study. The fibrinolytic activity in all the 84 children (both that had malaria infection and those who did not have malaria infection) were estimated by measuring the euglobulin lysis time (ELT). The fibrinogen levels in all the children were also estimated. The packed cell volume of the children was determined and some severely anaemic children had blood transfusions. RESULTS: Euglobin lysis time (ELT) was found to be higher in children with Plasmodium falciparum malaria infection (430 +/- 149) than in the controls (158 +/- 21.7, P< 0.01). Fibrinogen levels of 3.40 +/- 0.98 in children with malaria infection were high when compared to 2.21 +/- 0.81 in the controls. The children with malaria infection therefore had a decreased fibrinolytic activity and a proportionately high fibrinogen level. The average packed cell volume of the children with malaria infection was 29.64 +/- 2.13 while in the control it was 36.41 +/- 3.24. The study also showed that 50% of children with malaria had severe anaemia and subsequently had blood transfusions. Twenty percent of those who had transfusions died while being transfused. CONCLUSION: Children who have malaria infection have decreased fibrinolytic activity and proportionately high fibrinogen level which may contribute to the possible thromboembolic process in these children and hence higher risk of mortality from Plasmodium falciparum malaria infection.

Association of malarial parasitaemia with dehydrating diarrhoea in Nigerian children.

Records of 402 children--216 (53.7%) males and 186 (46.3%) females--aged 1-36 month(s), admitted to the Diarrhoea Treatment and Training Unit of the University of Benin Teaching Hospital, Benin city, Nigeria, during July 1993-June 1996, were reviewed to document the relationship between dehydration and malaria parasitaemia. There was a significant association between severity of dehydration and malaria parasitaemia (p < 0.0001). Association of parasitaemia (p < 0.006) with dehydration (p < 0.0001) was significantly more marked in patients with acute watery diarrhoea than in those with persistent and bloody diarrhoea. Parasitaemia was demonstrated in 50.5% of those not initially suspected to have malaria. Parasitaemia was also significantly associated with fever (p < 0.001) and fever coexisting with vomiting (p < 0.01). The prevalence of malaria-associated diarrhoea was 61.7%. More infants (75.6%) than older children had diarrhoea. It was concluded that the prevalence of malaria-associated diarrhoea was high and that children with dehydration are more likely to manifest malaria parasitaemia.

Asymptomatic rotavirus infection within Benin City urban community, Nigeria.

This study was carried out in Benin City urban community, Nigeria as a follow-up of an earlier study carried out on patients admitted to the University of Benin Teaching Hospital. The aim of the present study was to determine the prevalence of asymptomatic rotavirus infection amongst urban children and adults. Eight hundred and twenty one subjects from 200 homes were screened for rotavirus infection between August and December 1990. The 821 stool samples collected from the subjects (541 children and 280 adults) were subjected to studies at the University of Benin Teaching Hospital. Detection of rotavirus antigen was done by the ELISA method. The overall prevalence of asymptomatic rotavirus infection in this study was 30.8%. The results reflect a high source of reservoir for spread of rotavirus infection within the community.

Nosocomial rotavirus infection in newborns.

A total of 252 faecal samples were collected from 84 neonates and examined for rotavirus antigen, using the enzyme-linked immunosorbent assay (ELISA). Nosocomial rotavirus infection was detected in 23.8%. This was made up of 12 (26.7%) of 45 neonates who had diarrhoea and 8 (20.5%) of 39 neonates without diarrhoea. However, rotavirus antigen was detected more in those that stayed for more than one week during hospital admission.