Clinical Profile and Outcome of COVID-19 Cases Admitted at a Tertiary Health Facility In South-West Nigeria.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is anemerging disease with a global spread that has affected millions of lives. In Nigeria, the third wave of the outbreak is being experienced with many patients requiring hospitalization. Being a novel disease, we characterized the clinical profile and outcomes of patients admitted into our isolation centre. METHODS: A case series of 65 COVID-19 patients admitted at theIsolation Centre of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from June 2020 to March 2021 is presented. Information on demographic characteristics, medical history, symptoms, treatment and outcomes was obtained. Data were analysed using SPSS version 25. RESULTS: Most (47; 72.3%) patients were less than 65 years old and 39 (60.0%) were males. The commonest symptoms were cough (42; 64.6%), breathlessness (41; 63.1%), fever (40; 61.5%), muscle aches (40; 61.5%), and anosmia (16; 24.6%). Hypertension (41; 63.1%) and diabetes (18; 27.7%) were the most predominant comorbidities. Forty-three patients (66.2%) had supplemental oxygen therapy. The majority (44; 70%) of patients were admitted for 10 days or less and 58 (89.3%) patients were discharged home. However, 6 deaths (9.2%) were recorded among patients with advanced comorbidities and severe sepsis with all deaths occuring within 5 days of admission. CONCLUSION: There was a male predominance among patients admitted at the Isolation Centre and all mortalities occurred within five days of admission. Early detection, prompt management of cases with hypoxaemia and optimal treatment of comorbidities are recommended for good outcomes in COVID-19 patients.

CONTEXTE: La maladie de la coronavirus 2019 (COVID-19) est une maladie émergente dont la propagation mondiale a affecté des millions de vies. Au Nigéria, la troisième vague de l'épidémie est en train de se produire avec de nombreux patients nécessitant une hospitalisation. S'agissant d'une nouvelle maladie, nous avons caractérisé le profil clinique et les résultats des patients admis dans notre centre d'isolement. MÉTHODES: Une série de cas de 65 patients atteints de COVID-19 au Centre d'isolement de l'Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, de juin 2020 à mars 2021 est présentée. Des informations sur les caractéristiques démographiques, les antécédents médicaux, symptômes, le traitement et les résultats ont été obtenus. Les données ont été à l'aide de SPSS version 25. RÉSULTATS: La plupart des patients (47 ; 72,3 %) étaient âgés de moins de 65 ans et 39 (60,0 %) étaient des hommes. Les symptômes les plus fréquents étaient la toux (42 ; 64,6%), l'essoufflement (41 ; 63,1%), la fièvre (40 ; 61,5%), les douleurs musculaires (40; 61,5%) et l'anosmie (16 ; 24,6 %). L'hypertension artérielle (41; 63,1%) et le diabète (18 ; 27,7%) étaient les comorbidités les plus prédominantes. Quarante-trois patients (66,2 %) avaient une oxygénothérapie complémentaire. La majorité (44 ; 70%) des patients ont été admis pour 10 jours ou moins et 58 (89,3%) ont été renvoyés chez eux. Cependant, 6 décès (9,2 %) ont été enregistrés parmi les patients présentant des comorbidités avancées et une septicémie grave, tous les décès étant survenus dans les 5 jours suivant l'admission. CONCLUSION: Il y avait une prédominance masculine parmi les patients admis au centre d'isolement et tous les décès sont survenus dans les cinq jours cinq jours après l'admission. La détection précoce, la prise en charge rapide des cas l'hypoxémie et le traitement optimal des comorbidités sont recommandées recommandés pour obtenir de bons résultats chez les patients atteints de COVID-19. Mots clés: COVID-19, Profil clinique, Résultat, Gestion des cas, Centre d'isolement.

Knowledge of COVID-19, use of personal protective equipment and other safety practices of healthcare workers in southwest Nigeria

Background:Healthcare workers have a higher risk of SARS CoV2 infection with implications for transmission of infection and the safety of workers and patients. Objective: To assess knowledge on COVID-19 and the safety practices among selected healthcare workers in southwest Nigeria. Methods:A cross-sectional study of 210 workers providing direct care to patients during the COVID-19 pandemic was conducted. Respondents wererecruited through simple random sampling of members of online platforms of healthcare workers in Osun, Ondo and Ekiti States. Information on sociodemographic characteristics, knowledge of PPE and safety practices was obtained through a close-ended questionnaire. Results: The mean age of the respondents was 36.5±7.5 years. About 29% and 30% of respondents were from the State and Federal Government-owned Teaching Hospitals, respectively. A little above half (58.1%) had good knowledge of COVID-19, while 62.1%used PPE always when attending to suspected COVID19 cases. More than half (53.8%) had been trained on infection prevention and control (IPC), but only 34.3% adhered to good safety practices. Healthcare workers in State government-owned teaching hospitals had lower odds of good safety practices than those in Federal Teaching Hospitals (OR = 0.42, 95% CI = 0.19-0.93, p = 0.031).Conclusion: The knowledge of appropriate PPE and practice of safety precautions among healthcare workers is sub-optimal. This may predispose to increased COVID-19 transmission among healthcare workers, patients, and their families. Training and retraining healthcare workers, especially those from hospitals identified by the study as having poor safety practices, should be encouraged.

Lipid profile in an apparently healthy Nigerian population.

AIMS AND OBJECTIVES: To describe the pattern of lipid profile of members of staff of a tertiary education institution in South-West Nigeria with a view to assessing risk of cardiovascular disease among them. MATERIALS AND METHODS: One hundred and ninety three (193) members of staff of the Institution were involved in the study. Questionnaires were administered to obtain information on demographic characteristics and medical history of respondents. Weight, height and blood pressure of participants were measured and the Body Mass Index (BMI) calculated. Fasting plasma lipid profile parameters--Total cholesterol (TC), High Density Lipoprotein cholesterol (HDL-C) , Low Density Lipoprotein cholesterol (LDL-C) and Triglycerides (TG)) were also determined in all the participants using standard assay methods. RESULTS: Mean TC, HDL-C, LDL-C and TG were 4.04 mmol/L, 1.63 mmol/L, 1.98 mmol/L and 0.92 mmol/L respectively . Mean BMI was 25.98 kg/m2. Twenty-eight (14.5%) participants had mean cholesterol values e" 5.2 mM/L, 19 men had HDL values<1.0 mM/L and 28 women had HDL values<1.3 mM/L (making a total of 24.3% of the study population). Twenty (10.4%) had LDL cholesterol e"3.3 mM/L, while 14 (7.3 %) had triglyceride valuese" 1.7 mM/L. One hundred and thirty one (67.8%) participants had values of all lipid parameters within reference range while 62 (32.8%) had abnormality in 1 or more of the parameters. Sixty two participants (32.1%) were overweight while 45 (23.3%) were obese. Statistically significant differences were found when TG and BMI levels of male participants were compared with those of their female counterparts. Abnormalities in lipid profile parameters were found mostly in participants who were 40 years and above. Age of participants correlated positively with total cholesterol and LDL cholesterol levels while LDL-C levels correlated negatively with HDL levels. CONCLUSION: A significant proportion of the population had abnormality in one or more Lipid profile parameters, the most common being low HDL cholesterol levels. A considerable number of participants were also either overweight or obese. Most of the abnormalities in lipid profile were found in participants e" 40 years. The study underscores a need to sensitise members of the community to regular lipid profile check up .

The Metabolic Syndrome in an Elite African Community

Metabolic syndrome is a combination of metabolic disorders which increase the risk of developing cardiovascular disease and type 2 diabetes; two common causes of morbidity and mortality all over the world; with increasing incidence in sub-Saharan Africa. This study was carried out to determine the prevalence of metabolic syndrome in an elite Nigerian community and determine independent predictors of the condition. A cross-sectional study was designed involving 200 members of the community. They responded to a structured questionnaire on their demographic parameters as well as medical and drug histories. Fasting blood glucose; triglycerides; LDL-cholesterol; HDL-cholesterol and Total cholesterol were measured. Blood pressure; BMI and waist circumference were also measured. Using the IDF definition i.e presence of central adiposity and two of raised TG (?1.7 mm/L); reduced HDL (1.03 mm/L in men and 1.29 mm/L in women); raised blood pressure (130 mmHg systolic or 85 mmHg diastolic; or an antihypertensive drugs); and raised fasting blood glucose (5.6mm/L or previously diagnosed type 2 diabetes); a total of 35 persons were found to have metabolic syndrome. The commonest lipid abnormality found was reduced HDL levels. Raised BMI was a strong predictor (18). The study shows that while the prevalence of metabolic syndrome is low in the community; a large number of people have central obesity and high BMI. It is important for stakeholders to create awareness on the need to keep fit. There is also a need to carry out more studies on independent determinants of metabolic syndrome and seek to understand the pathways by which it develops; so as to be able to address it's far reaching implications

A community study of the prevalence, risk factors and pattern of chronic kidney disease in Osun State, South West Nigeria.

BACKGROUND: Chronic kidney disease (CKD) is a global public health concern. Nigeria, like other African countries has paucity of hard data derived from community based studies. AIMS: We set out to determine the awareness, level of knowledge, prevalence of chronic kidney disease and its associated risk factors in Nigerian community. METHODS: We used a pre-tested structured questionnaire to draw information on sociodemography, knowledge and risk factors of CKD from 468 residents aged ≥ 18 years. Clinical examination, blood glucose, serum creatinine, urinalysis and urinary albumin: creatinine ratio (ACR) was carried out. Glomerular filtration rate (eGFR) was estimated using Modification for Diet in Renal Disease equation. CKD was defined as eGFR < 60 ml/min and/or macroalbuminuria (ACR ≥ 300 mg/g or dipstick proteinuria). RESULTS: A total of 454 residents, mainly farmers, with a mean age of 45.8 ± 19.0 years and M: F ratio of 0.8:1 completed the study. Only 33.7% had heard of kidney disease; the level of knowledge of CKD was adjudged good, fair and poor in 25.5%, 42.2% and 30.6% respectively. There was higher prevalence of CKD in those with poor knowledge (p=0.023). Smoking habit, habitual analgesic intake, alcohol and herbal concoction use was 7%, 20%, 19% and 75% respectively. The prevalence of hypertension was 30%, diabetes mellitus (3.7%), obesity by waist circumference (14.6%) and haematuria (3.1%). Estimated GFR < 60 ml/min was present in 12.3% while macroalbuminuria was present in 8.9%. The overall prevalence of CKD was 18.8%, with CKD stages 1, 2, 3 and 4 accounting for 2.4%, 4.1%, 11.8% and 0.5% respectively. Age (p=0.00; OR 1.09), female gender (p=0.006; OR 4.87), systolic blood pressure P<0.001; OR 1.04) and diabetes (p=0033; OR 15.76) were predictive of CKD. CONCLUSION: The prevalence of CKD and its risk factors are high in this rural community of South Western Nigeria. Majority had moderately impaired kidney function. This underscores the need for primary and secondary preventive programmes.

Impact of intestinal helminthiases on the nutritional status of primary-school children in Osun state, south-western Nigeria.

In January-March 2000, the impact of intestinal helminthiases on the nutritional status of 749 pupils (353 boys and 396 girls) attending public primary schools in the Ife Central local government area of Osun state, in south-western Nigeria, was investigated. Demographic, socio-economic and other relevant information was collected on the pupils, on the same day that a single stool sample was collected from each subject and examined, using Stoll's dilution egg-count technique. The weights, heights and ages of the subjects were recorded and converted to percentages of the reference medians for weight-for-height, weight-for-age and height-for-age. The overall prevalences of helminth infection detected among the 465 malnourished pupils (i.e. those with any form of under-nutrition) and the 284 well-nourished pupils were 32.9% and 25.4%, respectively (P=0.029). The nutritional indices of the pupils who were found helminth-infected were generally lower than those of the pupils who appeared free of intestinal helminths. The mean values for weight-for-height, for example, were higher in the apparently uninfected pupils than in those found infected with any intestinal helminth (P=0.02) or only with Ascaris lumbricoides (P=0.05). Similarly, the mean height-for-age of the pupils who were apparently uninfected was higher than the corresponding value for the pupils found hookworm-positive (P=0.003). The pupils who were each found infected with two or more species of intestinal infection had significantly lower weights-for-heights, weights-for-ages and heights-for-ages than the pupils who appeared to be helminth-free. The results of a multivariate logistic-regression analysis indicated that hookworm infection was a significant risk factor for underweight (P=0.015), wasting (P=0.033) and stunting (P=0.015) whereas Trichuris was only a significant risk factor for stunting (P=0.025). It appears that intestinal helminthiasis may play a causal or contributory role in the occurrence of childhood malnutrition, at least in the present study area. Steps should be taken to control both of these important health problems, through functional school-health programmes that provide regular deworming, supervised school meals and health education.

Birth preparedness and emergency readiness plans of antenatal clinic attendees in Ile-ife, Nigeria.

BACKGROUND AND OBJECTIVES: Adequate birth preparedness and emergency/complication readiness (BP/CR) planning could determine the survival of a pregnant woman and her unborn child in maternal emergency. The study assessed adequacy of BP/CR plans of antenatal clinic attendees in Ile-Ife, Osun State, Nigeria. METHODS: Pregnant women (less than 36 weeks gestation) attending antenatal clinics in selected health facilities were serially recruited into the study after they had given verbal informed consent. Data were collected with a purpose-designed questionnaire. SPSS version 11 statistical software was used for data entry and analysis. RESULTS: Four hundred pregnant women were recruited; 284 (71%) registered for antenatal care by 20 weeks of gestation. Concerning delivery planning, 350 (87.5%) had decided their place of delivery although 32 (9.1%) of these planned to deliver in mission houses or at home; 351 (87.8%) had started to purchase items needed for delivery or newborn care, 289 (71.0%) had identified someone to accompany them to health facility for delivery while 259 (64.8%) were saving money for delivery. Regarding emergency or complication readiness, knowledge of signs of severe maternal illness for which immediate care should be sought in an appropriate health facility was low, 113 (28.3%) respondents were able to mention 4 or more of such signs without prompting; 249 (62.3%) had made arrangements for transportation and 45 (11.3%) had identified potential blood donor. CONCLUSION: By the study criteria, 61% of the pregnant women studied made adequate preparations for delivery while 4.8% were ready for emergency/complication. It is recommended that greater emphasis be given to emergency/complication readiness during antenatal care sessions.

Impact of nutritional education on nutritional status of under-five children in two rural communities of south-west Nigeria.

OBJECTIVES: This study evaluated the impact of nutritional education on knowledge, attitude and practices (KAP) of mothers concerning infants and young children feeding and their children's nutritional status in two semi-urban communities of south-west Nigeria. MATERIALS AND METHODS: This is a community intervention study. We recruited 150 mothers of children aged 0-18 months independently from the intervention and control communities through a multi-stage sampling technique. We collected data with the aid of an interviewer-administered questionnaire at baseline and at six months after intervention from both communities to obtain information on feeding of infants and young children. In addition, we measured weights and heights of recruited children. Intervention involved group counselling of mothers and food demonstrations at designated health facilities. Data analysis for quantitative data was done using Epi-Info software, and for qualitative data, content analysis of major themes was used. RESULTS: Before intervention, recruited mothers and their children from the two communities were comparable in terms of all the parameters assessed (P>0.05 in all cases). After six months of intervention, mothers who had nutritional education demonstrated better knowledge and attitudes to key infant and young children feeding recommendations. There was also limited improvement in feeding practices. Mothers from the intervention community exclusively breastfed their infants longer with mean age at introduction of complementary foods at 5.3 months compared to 4.5 months in the control community (P<0.05), breastfed their children longer (P<0.05). However, there was no statistically significant improvement in the weight of their children. CONCLUSION: In this study, nutritional education of mothers only had positive impact on their level of KAP on infant and young children feeding.

Invasive Bacteria Isolates from Children with Severe Infections in a Nigerian Hospital

Background: Little information is available about the aetiology and epidemiology of serious bacterial infections in Nigeria. This study determined bacterial isolates from blood and cerebrospinal fluid (CSF) of children presenting in the emergency room of a teaching hospital in Nigeria. Method: From October 2005 to December 2006; children aged two to 60 months presenting with signs of acute systemic infections were recruited. Blood culture and CSF specimens were collected and processed using standard microbiological protocols. Data were analysed using SPSS version 11 software. Results: Two hundred and two blood and 69 CSF samples were cultured. Fifty-five (27) of the blood cultures yielded Gram-negative bacilli and Gram-positive cocci in almost equal proportions. The most common isolates from the blood cultures were Staphylococcus aureus; 26 (12.9) and atypical coliforms; 13 (6.5). Others are Klebsiella spp; 3 (1.5); Klebsiella pneumonia; 2 (1.0); Escherichia coli; 3 (1.5); Enterobacter agglomerans; 2 (1.1); Proteus mirabilis; 2(1); Pseudomonas spp; 2 (1.0); Haemophilus influenza; 1 (1.0); and Coagulase-negative Staphylococcus; 1 (1.0). Fourteen out of 67 (20.9) of the CSF samples yielded bacterial isolates: Streptococcus pneumonia; 3 (4.5); Haemophilus influenza; 8 (11.9); Hemophilus spp; 1 (1.5); E. Coli; 1 (1.5); and atypical coliform; 1 (1.5). Gram-negative coliform isolates were predominantly resistant to penicillin based antibiotics and co-trimoxazole but sensitive to third-generation cephalosporins and quinolones. A high percentage of S. aureus isolates were multi-drug resistant. Conclusions: Bacterial infections contribute to the significant morbidity among children in our environment. S. aureus was more frequently isolated in sepsis while H. influenzae appears to play a major role in meningitis. Appropriate use of antibiotics is needed to manage affected children effectively. We also recommend improved vaccine coverage of children under the age of five years) of the blood cultures yielded Gram-negative bacilli and Gram-positive cocci in almost equal proportions. The most common isolates from the blood cultures were Staphylococcus aureus; 26 (12.9) and atypical coliforms; 13 (6.5). Others are Klebsiella spp; 3 (1.5); Klebsiella pneumonia; 2 (1.0); Escherichia coli; 3 (1.5); Enterobacter agglomerans; 2 (1.1); Proteus mirabilis; 2(1); Pseudomonas spp; 2 (1.0); Haemophilus influenza; 1 (1.0); and Coagulase-negative Staphylococcus; 1 (1.0). Fourteen out of 67 (20.9) of the CSF samples yielded bacterial isolates: Streptococcus pneumonia; 3 (4.5); Haemophilus influenza; 8 (11.9); Hemophilus spp; 1 (1.5); E. Coli; 1 (1.5); and atypical coliform; 1 (1.5). Gram-negative coliform isolates were predominantly resistant to penicillin based antibiotics and co-trimoxazole but sensitive to third-generation cephalosporins and quinolones. A high percentage of S. aureus isolates were multi-drug resistant.Conclusions: Bacterial infections contribute to the significant morbidity among children in our environment. S. aureus was more frequently isolated in sepsis while H. influenzae appears to play a major role in meningitis. Appropriate use of antibiotics is needed to manage affected children effectively. We also recommend improved vaccine coverage of children under the age of five years

Determinants of consistent condom use among adolescents and young adults attending a tertiary educational institution in Ile-Ife, Nigeria.

OBJECTIVES: This study evaluated the determinants of consistent condom use among adolescents and young adults aged 15 - 29 years. METHODS: This was a cross-sectional survey to which 600 (300 of each gender) adolescents/young adults who had never married were recruited. Information was collected from respondents by means of a purpose-designed, self-administered questionnaire. Information sought includes the respondents' social and demographic characteristics, sexual practices and issues relating to condom use. RESULTS: Five hundred and thirty-six (89.3%) of the 600 questionnaires were suitable for analysis; 372 (69.4%) had had sexual intercourse. A third reported that they were having sex frequently or fairly frequently; 145 (41.7%) had more than one partner while 74 (19.9%) were aware that their partners had other sexual partners. Two-thirds of currently sexually active respondents reported that condoms were readily available and cheap although only 90 (24.2%) reported using condoms consistently. The factors that were statistically significant predictors of consistent condom use among the males were age; younger respondents were more likely to be consistent users (p = 0.015), having more than one sexual partner (p = 0.030) and ability to refuse sex with a partner who would not want to use condom (p = 0.008). Among the females, statistically significant predictors were frequency of sexual intercourse; respondent who had sex frequently were more likely to use condoms consistently (p = 0.018) and having more than one partner (p=0.018). CONCLUSION: Inconsistent condom use is rampant and females were probably disadvantaged as far as condom negotiation is concerned.

Utilization of primary health care facilities: lessons from a rural community in southwest Nigeria.

BACKGROUND: This study assessed service/organisational factors and clients' perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria. METHOD: A cross-sectional household survey in the community as well as key-informant interviews of opinion leaders and health care providers and participant observations of health facilities and utilisation pattern was used to collect data. RESULTS: Forty-four percent of respondents to the survey who were ill in the preceding six months visited a PHC facility for treatment, while others relied on self-medication/self-treatment. Education was positively associated with utilisation of PHC services (P<0.05). Maternal and child health (45.4%), prompt attention (23.0%), and appropriate outpatient (20.5%) services attracted respondents to use PHC services. Poor education about when to seek care, poverty, perceived high cost of PHC services, lack of drugs and basic laboratory services, and a regular physician on site at the facility were identified as barriers to utilisation. CONCLUSION: We conclude that community perceptions of poor quality and inadequacy of available services was responsible for low use of PHC services.

Efficacy of intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine in preventing anaemia in pregnancy among Nigerian women.

OBJECTIVE: To evaluate the efficacy of intermittent preventive treatment of malaria using sulphadoxine-pyrimethamine (SP) in the prevention of anaemia in women of low parity in a low socio-economic, malaria endemic setting. METHOD: The study design was an open randomized control trial comparing anaemia incidence among pregnant women on intermittent presumptive treatment of malaria with SP with those on chloroquine (CQ). A total of 352 primigravid and secondigravid women between 16 and 30 weeks gestation receiving antenatal care at the Primary Health Care Center, Enuwa in Ile-Ife, Osun State, Nigeria were serially recruited and randomly allocated into experimental and control groups of 176 each. The experimental group received SP (to a maximum of three doses depending on the gestational age at enrollment into the study) while the control group had treatment doses of CQ at recruitment and subsequently only if they had symptoms suggestive of malaria. The primary outcome measure was anaemia (haematocrit<30) at 34 weeks of gestation. RESULT: At recruitment and 34 weeks gestation, there was no statistically significant difference between the experimental and control group in terms of socio-demographic characteristics and past medical history. Thirty-three (22.6%) and 52 (37.1%) women in the study and control groups, respectively, had anaemia (protective efficacy 49.5%, p=0.01). With multivariate analysis, controlling for the possible confounding effects of education, parity, haemoglobin level at booking and malaria parasitaemia in peripheral blood, the difference in the incidence of anaemia in the two groups remained significant (p=0.01; odds ratio=0.5; 95% confidence interval=0.29-0.85). CONCLUSION: The IPT regime with sulphadoxine-pyrimethamine is an effective, practicable strategy to decrease risk of anaemia in women of low parity residing in areas endemic for malaria.

Utilization of Primary Health Care Facilities: Lessons from a Rural Community in Southwest Nigeria

Background: This study assessed service/organisational factors and clients' perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria. Method: A cross-sectional household survey in the community as well as key-informant interviews of opinion leaders and health care providers and participant observations of health facilities and utilisation pattern was used to collect data. Results: Forty-four percent of respondents to the survey who were ill in the preceding six months visited a PHC facility for treatment; while others relied on self-medication/self-treatment. Education was positively associated with utilisation of PHC services (P0.05). Maternal and child health (45.4); prompt attention (23.0); and appropriate outpatient (20.5) services attracted respondents to use PHC services. Poor education about when to seek care; poverty; perceived high cost of PHC services; lack of drugs and basic laboratory services; and a regular physician on site at the facility were identified as barriers to utilisation. Conclusion: We conclude that community perceptions of poor quality and inadequacy of available services was responsible for low use of PHC services

Intestinal helminthiases among rural and urban schoolchildren in south-western Nigeria.

The prevalences and intensities of intestinal helminthic infection among primary schoolchildren were determined in rural and urban communities of the Ife Central local government area, in south-western Nigeria. After the schools in the study area had been stratified into urban and rural, a random sample from each stratum was selected for further study. In each study school, a single fresh stool specimen was obtained from each pupil in randomly selected classes and checked, using a quantitative method (Stoll's dilution egg-count technique), for helminth eggs and larvae. Overall, 366 rural and 383 urban schoolchildren were investigated and 30.0% of them (36.1% of the rural and 24.3% of the urban; P<0.001) were found to be harbouring at least one species of intestinal helminth. The mean intensities of infection, in terms of excreted eggs/g faeces of those infected, were 2371.4 for Ascaris, 1070.6 for hookworm, and 500 for Trichuris. Although the mean intensities of Ascaris infection were significantly lower among the infected rural children than among the infected urban (2025.7 v. 2791.4; P=0.014), the corresponding difference in the hookworm infections did not reach statistical significance (1458 v. 666.7; P=0.063). The means of the log-transformed egg outputs, in eggs/g faeces of those infected, also showed similar trends: a significant difference between the rural and urban Ascaris infections (3.1877 v. 3.3340; P=0.002) but not between the rural and urban hookworm infections (2.9667 v. 2.8027; P=0.453). Intestinal helminthiases still clearly represent a common childhood health problem in the study area, particularly in the rural communities.

Comparative study of nutritional status of urban and rural Nigerian school children.

Nutritional assessment in the community is essential for accurate planning and implementation of intervention programmes to reduce morbidity and mortality associated with under-nutrition. The study was, therefore, carried out to determine and compare the nutritional status of children attending urban and rural public primary schools in Ife Central Local Government Area (ICLGA) of Nigeria. The schools were stratified into urban and rural, and studied schools were selected by balloting. Information obtained on each pupil was entered into a pre-designed proforma. The weight and height were recorded for each pupil, and converted to nutritional indices (weight for age, weight for height, height for age). A total of 749 pupils (366 and 383 children from the rural and urban communities, respectively) were studied. The overall prevalent rates of underweight, wasting and stunting were 61.2, 16.8 and 27.6%, respectively. In the rural area these were 70.5, 17.8 and 35.8%, while in the urban they were 52.2, 15.9 and 19.8%, respectively. The mean nutritional indices (Weight for Age, Weight for Height and Height for Age) were found to be significantly lower among the rural pupils than urban pupils (P < 0.001 in each case). The present study shows that malnutrition (underweight, wasting and stunting) constituted major health problems among school children in Nigeria. This is particularly so in the rural areas. Therefore, prevention of malnutrition should be given a high priority in the implementation of the ongoing primary health care programmes with particular attention paid to the rural population.

Determinants of neonatal mortality at Wesley Guild Hospital, Ilesa, Nigeria.

BACKGROUND: More than 10 million under five children die each year of preventable and easily treatable conditions in developing countries. Of these, eight million are infants, half of whom are newborns in their first month of life. A high proportion of babies die in their first month of life, many of them during their first week. The objective of this study is to assess sociodemographic and other determinants of neonatal mortality in Wesley Guild Hospital (WGH), Ilesa, Nigeria. METHODS: This is a record review of 235 neonatal deaths reported at WGH from January 01 2001 to December 31 2003. Similarly, records of equal number of neonates (235) admitted to the same hospital during the same period but who were discharged alive was also reviewed for comparison. Four hundred and seventy records were reviewed. The two groups were matched for age, sex and within a 7-day period of admission. Information was collected with the aid of predesigned schedule from the patients' case notes, death registers and discharge summaries in the Records Department of the hospital. Information collected included the bio-data of the mothers, birth weight of neonates, estimated gestational age at delivery, age at death or discharge, date of admission, duration of the illness and date of discharge. Others included mode and place of delivery, maternal booking status and complications of pregnancy and birth. Data were analyzed using descriptive and inferential statistics by computer software, Epi-Info 2002. RESULTS: Teenage pregnancy, low birth weights (LBW), prematurity and neonatal tetanus were positively associated with neonatal death. Unbooked mothers, deliveries at missions and homes and low socioeconomic status were also positively associated with neonatal death (P < 0.05 in all cases). There was no statistically significant association between the sex of neonate, parity of mother and complications in pregnancy with neonatal death (P > 0.05 in all cases). CONCLUSION: The major determinants of neonatal deaths were teenage pregnancy, prematurity, LBW, poverty and lack of skilled attendance at delivery. Addressing the basic determinants of neonatal mortality will improve newborn survival and health and this will significantly reduce mortality among under five children in developing countries.

Hospital biohazard control: low-cost device for safe collection and disposal of hypodermic needles.

This paper describes experience with a low-cost initiative for safe collection and disposal of hypodermic needles in health facilities in developing countries. Produced locally, a purpose-made container for collecting 500-1000 used hypodermic needles should cost no more than 20-50 US cents. Trial in our immunization clinic and injection room for the last year has shown its potential for injection safety generally and particularly during immunization campaigns.

Community-based antenatal and perinatal interventions and newborn survival.

BACKGROUND: As part of the millennium development goal (MDG) 4 to reduce by two-thirds the mortality rate among children under five, neonatal mortality rate (NMR) needs to be reduced by half. This is a selective review of the literature of the morbidity and mortality patterns among newborns as well as cost-effective interventions and community aspects of newborn care. METHODS: Documented causes of morbidity and mortality among newborns were examined in the overall context of developing and developed countries. Cost-effective interventions that have been proven to be inexpensive with evidence or potential to save newborns' lives by international agencies concerned with health, journals and other publications were reviewed. Community aspects of newborn care and what is required at the individual, household and community levels to reduce neonatal morbidity and mortality were also reviewed. RESULTS: A score of recent publications by the World Health Organization (WHO), Save-the-Children, United Nations Children's Fund (UNICEF), journals, and other scientific publications reported consistently that neonatal mortality constitute 40-70% of deaths in infancy and that 99% of these deaths occurred in developing countries, with highest neonatal mortality rates (NMRs) in sub-Saharan Africa. The global burden of newborn illness shows that a disparity of up to 30-folds exists between countries with highest and lowest NMRs. Four million babies die in developing countries and about 42% of these deaths are due to infections. Other major causes include perinatal asphyxia (21%), birth injuries (11%), prematurity and low birth weight (10%) and congenital abnormalities (11%). It was also observed that two-thirds of the deaths in the neonatal period occur in the first week; among these deaths, two-thirds occurred within the first 24 hours. Review findings also revealed that an integrated, proven and cost-effective intervention such as the mother-baby packages incorporated into a functional and sustainable healthcare delivery system and improved household practices will save newborns' lives. Reports showed that to achieve meaningful development, neonatal mortality will need to be reduced in developing countries. CONCLUSION: Programmes that are necessary for the reduction in neonatal morbidity and mortality rates are for countries to employ rational mix of quality clinical services, effective public health measures and inexpensive community-based interventions in public and private sectors and to scale-up known cost-effective interventions.

Pulmonary functions of wheat flour mill workers and controls in Ibadan, Nigeria.

BACKGROUND: The impact of grain dust exposure on lung functions of grain handlers in Nigeria has remained largely undocumented. Lung functions of wheat flourmill workers and control subjects were assessed, and the prevalence of lung function abnormalities was compared among the occupational groups. METHODS: Study subjects consisted of 91 flour-millers, 30 matched internal controls from the maintenance unit of the same flourmill factory and 121 matched external controls. A cross-sectional analytical design is utilized; data were collected using structured interviews, anthropometric measurements, spirometry, and area dust sampling. RESULTS: The flour-millers recorded significantly lower mean lung functions compared with control subjects (P < 0.05), for FEV(1) and FVC, when observed values were expressed as percentages of predicted normal values. Furthermore, 29% of flour-millers, compared with 15% of external controls and 10% of internal controls, presented with at least one abnormal test result of ventilatory function. CONCLUSIONS: The study concluded that wheat flour-mill workers in Nigeria are at an increased risk of developing abnormalities of lung functions compared with control subjects, and the dominant pattern of respiratory disease among them is airway obstruction.