Pattern of Accidental Childhood Poisoning at the Children Emergency Room of the University of Benin Teaching Hospital, Benin City, Nigeria.

BACKGROUND: Accidental childhood poisoning contributes significantly to childhood morbidity and mortality worldwide. A review of the agents which cause poisoning in our locality from time to time is important in planning prevention strategies and treatment modalities. OBJECTIVE: To document the pattern of accidental childhood poisoning at the Children Emergency Room (CHER) of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. METHODS: A retrospective study in which records of admissions as well as case notes of patients admitted because of ingestion of poisons from October 2011 to June 2014 were obtained. Demographic characteristics, type of poison, where poison was kept, route of poisoning and outcome were extracted from medical records of the patients. RESULTS: Fifty-five (1.44%) patients were admitted for accidental poisoning of a total of 3,822 admissions. Thirty-nine (70.9%) were males while 16 (29.1%) were females. The median and modal age at presentation was two years (range of 0.5-7 years). Route of poisoning was by ingestion in 54 (98.2%) patients. The commonest agent of poisoning was kerosene (32.7%); followed by medicines (18.2%), insecticides (16.4%) and caustic soda (12.7%). Forty-nine (89.1%) patients were discharged home with fatality in one (1.8%). CONCLUSION: Kerosene is still the major agent of poisoning in Benin City, although the prevalence has decreased. Alcohol poisoning has also decreased while ingestion of medicines has increased. The use of beverage and disposable water containers to store poisonous substances and keeping them in easily accessible areas in the home is still rampant. Measures to prevent access of children to these substances will greatly reduce the burden of accidental poisoning.

Emergency Blood Transfusion in Children in a Tertiary Hospital in Nigeria: Indications, Frequency and Outcome.

BACKGROUND: Blood transfusion is a life-saving procedure in paediatric practice. It is important in replacing blood volume in cases of haemorrhage or providing specific blood components as required. However, the procedure carries some risks and complications. The decision to transfuse, frequency of transfusion and the availability of safe blood and blood products are essential determinants of the success of the procedure. Hence, knowledge of the indications and rate of transfusion is important to ensure that blood for transfusion is safe and made available as at when due. OBJECTIVE: To determine the common indications for blood transfusion, the frequency of transfusion and outcome of transfused patients. METHODS: Transfusion records of children admitted into the Children Emergency Room (CHER) of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria from January 2010 to December 2011 were retrieved. Information on the patients' biodata, indications for transfusion, type of blood product and outcome were documented. RESULTS: Within the 24 months under review, a total of 4133 patients were admitted, out of which 655 (15.8%) were transfused. The age of the children ranged between one month and 17 years (median and modal age was 2 years). Commonest indications for transfusion were severe malaria (55.4%), sepsis (11.5%) and sickle cell anaemia [SCA] (4.0%). Whole blood constituted the highest type of blood product utilized (99.7%). Of the 655 patients transfused, 226 (34.5%) had multiple transfusions. The frequency of blood transfusion was 1.2 transfusions per day. Ninety two percent (605) of the patients were discharged from CHER while nine (1.4%) discharged against medical advice. Mortality amongst them was 6.2% (41 patients). The ages of the patients (p = 0.56, C.I. = 0.99, 1.01) and the number of blood transfusions (p = 0.66, C.I.= 0.48, 1.60) were not significant predictors of mortality. CONCLUSION AND RECOMMENDATION: Majority of the patients were transfused following preventable disease conditions. Reduction of the burden of these conditions by good environmental hygiene, use of insecticide treated nets (ITN), indoor residual spraying (IRS), prompt hospital presentation and genetic counselling may greatly reduce the need for blood transfusion in the region.

Scope of Neonatal Care Services in Major Nigerian Hospitals

Background: Neonatal survival bespeaks the quality of neonatal care services available and accessible to the population. Intensive care improves outcome of high-risk infants with serious illness. The tiered level of care is yet to be applied to newborn care in Nigeria. Classification of care is key to improving neonatal survival with enhanced referral of high-risk patients to higher-level centres. Objective: To ascertain the scope and classify available newborn services offered at major Nigerian hospitals.Methodology: A semi-structured validated questionnaire was administered to attendees during 2015 Pediatric Association of Nigeria conference. The information derived was used to categorize neonatal care services.Results: The respondents consisted of doctors 201 (84.8%) and nurses 36 (15.2%) in 54 health facilities from all geopolitical regions of Nigeria. Of the 54 facilities; 34 (63%) were located in state capitals and 47 (87%) in public hospitals. Half of the evaluated units belonged to Class I; 22 (40.7%) Class II; and 5 (9.3%) Class III levels of neonatal care. Majority (81.6%) of the doctors have been trained on neonatal resuscitation; with senior residents being the highest 49 (89%) and Medical officers (MO) the least 4 (40%) trained. Doctors with training in mechanical ventilation (MV) were 39.2%; Consultants (51.2%); MO's the least 1(11.2%) trained (p=0.025). Monitoring is usually by pulse oximeters 54 (100%); multi parameter monitors 23 (42.6%) and rarely ABGs 6 (11%).Conclusion: Neonatal care in Nigeria is still developing. Most centres provide basic neonatal care services. Regionalization of care may be the solution to higher level neonatal care

CardioPulmonary Resuscitation in Children: Outcome in a General Intensive Care Unit in Nigeria.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is the initiation of basic and advanced life support to restore spontaneous circulation after cardiac arrest. It is one of the most frequently performed procedures in the intensive care unit both in the adult and paediatric population. There are, however, significant differences in the aetiology of cardiac arrest and CPR in both age groups. The sequence and outcome of CPR for children, therefore, vary from that of the adult. METHODS: Records of all cardiac arrests and CPR performed for paediatric patients in a general ICU between 1st January 2012 and 30th June 2014 were retrieved and analysed. Cardiac arrests occurring outside the unit even though resuscitation was on-going on arrival at the ICU were excluded from the study. Socio-demographic characteristics of patients, diagnosis at admission, length of stay and outcome of resuscitative efforts were documented. RESULTS: A total of 44 cardiac arrests occurred in children during the study period. Successful outcome, defined as the return of spontaneous circulation to discharge from ICU was 15.5%. Trauma-related injuries (burns and head injury) and severe malaria accounted for the majority of cardiac arrests. Most (52.3%) cardiac arrests occurring in this group of patients took place outside working hours (4pm-8am). Successful outcome of CPR was dependent on age, length of ICU stay, duration of CPR and time of cardiac arrest. CONCLUSION: The outcome of CPR in the paediatric population in our general ICU is poor. Perhaps, regular training of ICU staff in paediatric advanced life support and provision of an ICU dedicated to the care of paediatric patients may help improve outcome.

THE NEED FOR FAMILY MEETING IN THE MANAGEMENT OF PATIENTS ADMITTED INTO THE INTENSIVE CARE UNIT: EXPERIENCE FROM A TEACHING HOSPITAL IN NIGERIA.

OBJECTIVE: To evaluate the knowledge of family members of patients admitted into the Intensive Care Unit (ICU) in terms of their patients' clinical state, reasons for admission and progress of treatment. DESIGN: Prospective, cross-sectional study. SETTING: General Intensive Care Unit of the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. SUBJECTS: Twenty-five family members of patients admitted into the ICU were recruited. The data collected included socio-demographic characteristics, level of education, awareness of the indications for ICU admission, expectations of outcome and level of satisfaction with family meeting. RESULTS: Fifty- six percent of family members claimed to be aware of the indication for admission into the ICU while 44% claimed ignorance. Only 24% of the family members who claimed to be aware were correct about the indication for admission. Among the participants, 36% were well informed about the prognosis of their patients' clinical condition. All the relatives interviewed were satisfied with the family meeting held with them. CONCLUSION: Majority of family members of critically ill patients were neither carried along in the management of their patients nor were they informed of likely outcome. A timely, well-planned and regular family meeting is therefore advocated in the management of critically ill patients.

Determinants of cord care practices among mothers in Benin City, Edo State, Nigeria.

BACKGROUND: Mothers care for their infants' umbilical cord stump in various ways. Different cord care practices have been documented; some are beneficial while others are harmful. Who and what influence the cord care practiced by mothers have, however, not been fully explored particularly in the study locale. OBJECTIVE: The objective of this study was to determine the factors that influence cord care practices among mothers in Benin City. MATERIALS AND METHODS: The study subjects included 497 mothers who brought their babies to Well Baby/Immunization Clinic at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, between July and August 2009. A structured questionnaire served as an instrument to extract information on their biodata and possible determinants of cord care practices. RESULTS: Significantly older women (P=0.023), educated mothers (P=0.029), and those who had male babies (P=0.013) practiced beneficial cord stump care practices. Beneficial cord care practice increased with increasing maternal educational status. The best predictors of beneficial cord care practices are maternal level of education (P=0.029) and infant's sex (P=0.013). The use of harmful cord care practices was more common among mothers who delivered outside the Teaching hospitals. Most (71.2%) of the mothers were aware of hygienic/beneficial cord care. The choices of cord care methods eventually practiced by mothers were influenced mainly by the disposition of nurses (51.3%), participants' mothers (32.0%), and their mothers-in-law (5.8%). There was no significant relationship between cord care practice on one hand and maternal parity, tribe, and socioeconomic classes on the other. CONCLUSION/RECOMMENDATION: The need for female education is again emphasized. The current findings strongly justify the need for public enlightenment programs, using the mass media and health talks in health facilities, targeting not only women of reproductive age but also secondary audience like their mothers, mothers-in-law, nurses, and attendants at health facilities. Proper hygiene including proper hand washing techniques while caring for newborns along with vaccination of infants and their mothers will help prevent infections including tetanus while prompt health-seeking behavior is advised to improve outcome should such infections occur.

Migrating foreign body in the tracheobronchial tree of childen: report of two cases.

Tracheobronchial foreign bodies (FBs) especially in infants and children can cause respiratory obstruction and can lead to death if intervention is delayed. Two cases of migrating FBs in the tracheobronchial (T-b) tree with fatal outcome are reported: Case 1 was an 11-year-old girl with a ten-week history of episodes of fever, cough, breathlessness and progressive weight loss. No positive history of FB aspiration. She was cachetic and febrile with short attention span, dyspnoeic, a flattened left upper hemithorax, mediastinal shift and evidence of atelectasis. Case 2, a 5-year-old girl with a three-month history of aspiration of a tiny toy. She developed fever, cough and marked weight loss, developed severe respiratory distress three days prior to presentation. She was febrile, had grade II finger clubbing, markedly dyspnoeic, left mediastinal shift, and evidence of left sided atelectasis. X-ray films in Case 1 showed evidence of FB at various locations in the T-b tree, and complete opacification and atelectasis of left hemithorax in Case 2. Planned bronchoscopy could not be done as both patients were adjudged to be too severely ill for the procedure. Both patients died after 9 days and 8 hours of hospital stay, respectively. Postmortem revealed FB in right main bronchus in both patients (tooth and toy, respectively) and evidence of tuberculosis in Case 2. Fatal outcome is attributed to inappropriate healthcare seeking behaviour, lack of medical expertise and material resources in our health facilities.