Assessment of the Baby-Friendly Hospital Initiative showed suboptimal knowledge and a low exclusive breastfeeding rate in Ogun State, Nigeria.

AIM: Implementing the Baby-Friendly Hospital Initiative (BFHI) programme has been fraught with challenges globally. The study aimed to assess the implementation of the BFHI and breastfeeding practices in healthcare facilities in Ogun State, Nigeria. METHODS: It was a questionnaire-based cross-sectional study carried out between August and October 2019 among 100 healthcare workers and 110 mothers from health facilities in Ijebu-Ode Local Government Area of Ogun State, Nigeria. RESULTS: Nearly two-thirds (61.0%) of the healthcare workers were community health workers while the others were nurses. Less than a quarter (23.8%) of the healthcare workers had ever attended breastfeeding educational programmes since they started working. About half of the healthcare workers had good knowledge, attitude and practice of BFHI. Nurses had a significantly better practice of BFHI than community health workers. Understaffing was a major limitation to the implementation of BFHI. The mothers had an exclusive breastfeeding rate of 47%. CONCLUSION: The knowledge, attitude, and practice of BFHI were suboptimal and the exclusive breastfeeding rate among the mothers was low. There is a need to improve staff strength, training and re-training of staff, as well as regular monitoring and evaluation of healthcare facilities on the implementation of BFHI.

Ultra sonographic indices of the carotid artery in healthy adult population of southwest, Nigeria: a cross-sectional study.

Introduction: atherosclerosis develops insidiously, offering time and opportunities for early detection. Screening for subclinical atherosclerosis via structural wall changes and flow velocities among apparently healthy adults using carotid ultrasonography may help its early detection, offer timely intervention and reduce morbidity and mortality. Methods: a cross-sectional study of 100 participants with a mean age of 56.1 ± 6.9 years, were enrolled from a community population. Both carotid arteries were examined for plaques, carotid intima-media thickness (CIMT), and flow velocities - peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) using 4-12MHz linear array transducer. Visceral obesity, serum lipids, and blood glucose were also evaluated and correlated with ultrasound findings. Results: the mean CIMT was 0.07 ± 0.02cm and 15% of the participants had increased CIMT. Statistically significance but weak correlations were observed between CIMT and FBG (r = 0.199, p = 0.047), EDV (r =0.204, p= 0.041), PI (r = -0.287, p = 0.004) and RI (r = -0.268, p =0.007). Statistically significance with modest correlations were observed between EDV and PSV (r = 0.48, p = 0.000), PI (r = -0.635, p = 0.000) and RI (r = -0.637, p = 0.000). The PI and RI showed strong correlation with statistical significance (r= 0.972, p = 0.000). Conclusion: statistical significance in the flow velocities, derived flow indices and increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, ultrasonography may facilitate its early detection and possible prevention of complications.

How effective is antenatal care in preparing mothers for newborn care? An exploratory survey of lactating women in a rural Nigerian district.

Background: Neonatal death rates are high in sub-Saharan Africa and the majority of these deaths are preventable. Antenatal care (ANC) is a good channel for the reduction of neonatal deaths. This study aimed to assess newborn care practices among lactating women in Nigeria and determine their relationship with ANC attendance. Methodology: This was a cross-sectional survey involving 241 lactating mothers selected using the cluster sampling method. A structured interviewer-administered questionnaire was employed to obtain data. The Chi-square test was used to assess the associations between categorical variables. Logistic regression was used to determine the predictors of umbilical cord care, thermal care, and neonatal vaccination status. Good cord care was defined as having minimum of three appropriate practices concerning the use of clean instruments to tie the cord, use of clean instruments to cut the cord, and application of chlorhexidine, 70% alcohol, saltwater, or nothing on the cord), Results were presented as odds ratios (ORs). P < 0.05 was taken as statistically significant. Results: The mean age of participants was 29.0 ± 5.5 years. Most participants reported that sterile instruments were used to cut their baby's umbilical cords; that their babies were dried immediately after placenta delivery and that their babies were fully vaccinated (91.0%, 90.5%, and 85.1% respectively). ANC visits (aOR = 8.0, p = 0.02) and place of delivery (aOR = 10.6, p = 0.01) were significantly associated with good umbilical cord care practices. However, none of the participants' sociodemographic characteristics were significantly associated with newborn thermal care and vaccination status. Conclusion: The prevailing antenatal care services are ineffective in preparing mothers for newborn care. Place and frequency of ANC have positive associations with umbilical cord care. There is a need to implement quality ANC that will enhance maternal and neonatal outcomes and implement innovative interventions to enhance ANC attendance. The WHO positive pregnancy experience model should be implemented.

Children and adolescents with type 1 diabetes mellitus in Nigeria: clinical characteristics and compliance with care.

OBJECTIVES: The prevalence of type 1 diabetes mellitus (T1DM) is increasing in most developed and developing countries. This study described the clinical characteristics and compliance with care among Nigerian children and adolescents with T1DM. METHODS: This was a cross-sectional descriptive multi-center study of children seen at the paediatric endocrinology clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and compliance of the children with dietary recommendations and insulin therapy. Compliance with dietary recommendations and insulin therapy was graded as either good or poor based on defined criteria. RESULTS: The mean age of children was 13.1 ± 4.7 years. The mean age of children at the diagnosis of T1DM was 9.9 ± 4.2 years. Sixty-nine (60%) children were female while about half (47.8%) of the children were from the lower socioeconomic class. Compliance with insulin administration was good in 39.1% of the children and was significantly associated with the father's (p=0.001) and mother's educational status (p=0.024) while compliance with dietary recommendations was good in 20.0% of the children and was significantly associated with mother's educational status (p=0.034) and family socioeconomic class (p=0.010). Only the mother's level of education was independently and significantly associated with compliance to recommendations on insulin therapy (OR 4.2, 95% CI=1.5-11.6, p=0.007). CONCLUSIONS: The compliance of children with dietary recommendations and insulin therapy was poor. Efforts should be strengthened at all healthcare facilities to educate parents on the need for compliance with management guidelines.

Primary spontaneous pneumothorax in a term neonate.

Pneumothorax is a rare but recognized cause of respiratory distress in the newborn. It can occur spontaneously or post-traumatic. We report our experience in a term male neonate who had primary spontaneous pneumothorax. He had no surgical intervention but completely recovered with conservative management and supplemental oxygen.

Pattern of serum bilirubin changes following double volume exchange blood transfusion in neonates at a tertiary health facility in Nigeria.

INTRODUCTION: exchange blood transfusion (EBT) is a form of massive transfusion useful in rapidly reducing serum bilirubin levels, but serum bilirubin levels frequently rebound within hours of completing the procedure, due to equilibration of extravascular bilirubin as well as on-going hemolysis. The study was carried out to determine the pattern of reduction in serum bilirubin levels following EBT among neonates with severe hyperbilirubinemia, as well as the factors contributing to this pattern, so as to establish evidence-based expectations following EBT. METHODS: a retrospective descriptive study covering a two-year period in a Nigerian tertiary hospital. Details of the EBT procedures, including serial serum bilirubin levels, were obtained from the hospital records of all newborn babies who had double volume EBT done for severe hyperbilirubinaemia during the study period. Data was analyzed using the statistical software SPSS version 21.0. RESULTS: the mean total serum bilirubin (TSB) before EBT in the 36 babies was 17.9 ± 6.3 mg/dl. The mean percentage decrease in TSB immediately following EBT was 44.3 ± 10.2%. Six hours after EBT, TSB levels had increased from the immediate post-EBT values by an average of 57.5 ± 32.2%. Twenty-four hours after the procedure, TSB values in most (87.1%) cases were still higher than the immediate post-EBT values, but lower than the pre-EBT values. Post-EBT anemia was recorded among 33.3% of the babies. CONCLUSION: EBT is effective in rapidly reducing serum bilirubin levels and preventing acute bilirubin encephalopathy in neonates with severe hyperbilirubinemia, despite the rebound increase that occurs in TSB values after the procedure.

Addressing the Sub-Optimal Use of Oral Rehydration Solution for Childhood Diarrhoea in the Tropics: Findings From a Rural Setting in Nigeria.

BACKGROUND: Oral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. AIM: To identify barriers to the optimal use of ORS for childhood diarrhoea in Nigeria and recommend appropriate interventions to improve uptake of ORS at community and facility levels. METHODS: A quantitative cross-sectional survey of 400 mothers with children under 5 years of age was conducted in Nigeria to explore reasons for suboptimal utilization of ORS for childhood diarrhoea. An interviewer-administered questionnaire was used for data collection. Data were analysed using the statistical software SPSS version 21.0®. RESULTS: Sixty-one (15.3%) of the respondents were unaware of ORS. Of the 339 that were aware, their source of information was mainly hospital/health workers (81.1%). Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Nineteen mothers (5.6%) had difficulty getting ORS when needed, whereas 13 (3.8%) reported that it was difficult for them to remember how to prepare ORS. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. CONCLUSION: There is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. We recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged. Lay summaryOral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. A quantitative cross-sectional study was carried out among 400 mothers to identify barriers to the optimal use of ORS for childhood diarrhoea and recommend appropriate interventions. Sixty-one (15.3%) of the respondents were unaware of ORS. Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Some mothers had difficulty getting ORS when needed, while some found it difficult to remember how to prepare it. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. The study showed that there is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. Hence, we recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged.

A rural/urban comparison of paternal involvement in childhood immunisation in Ogun Central Senatorial District, Nigeria.

BACKGROUND: Paternal involvement in vaccination programmes is associated with improved uptake of childhood immunisation. However, paternal involvement is low in many climes including Nigeria. This study aimed to compare paternal involvement in childhood immunisation in urban and rural areas of Ogun Central Senatorial District, Nigeria. MATERIALS AND METHODS: This was a comparative cross-sectional study involving 440 fathers each in urban and rural areas selected using a multistage sampling method. A structured interviewer-administered questionnaire was employed to obtain data. Analysis was done using SPSS version 20. Chi-square test was used to assess the associations between categorical variables, whereas t-test was used to compare the means of respondents' involvement scores. Logistic regression was used to determine the predictors of paternal involvement. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). P < 0.05 was taken as statistically significant. RESULTS: The mean age of respondents in urban areas was 36.58 ± 6.76 and the mean age of respondents in rural areas was 37.61 ± 9.79. The difference in the mean age of urban and rural residents was not statistically significant (P = 0.07). Paternal involvement was significantly better among fathers in rural areas, with 79.8% of them having good involvement as compared to only 50.0% of the urban respondents (P = < 0.001). Being educated up to the tertiary level (adjusted OR [AOR] = 2.43, 95% CI = 1.66-3.57) was the predictor of involvement in childhood immunisation among fathers in the urban area. Among fathers in rural areas, being currently married (AOR = 4.51, 95% CI = 2.12-9.60) was the predictor of involvement in childhood immunisation. CONCLUSION/RECOMMENDATION: Paternal involvement in childhood immunisation is better among rural dwellers compared to urban dwellers. Educated and currently married fathers who have the propensity to be more involved can be trained as peer educators to encourage others to participate, particularly in the urban areas.

Congenital cytomegalovirus infection as an important cause of infantile cholestatic jaundice: a case report.

Infantile cholestasis has numerous causes and diagnosis can be difficult, especially in low-income countries where essential laboratory facilities are not readily available. This is a report of a baby who had severe conjugated neonatal hyperbilirubinaemia and deranged liver function tests, which posed a diagnostic dilemma before a diagnosis of congenital cytomegalovirus (CMV) infection was made. He was treated with Ganciclovir and responded well to treatment. He had no obvious associated neurologic manifestation of the disease and is presently been followed-up. This report highlights the challenges encountered in the diagnosis and management of the baby, as well as the favourable outcome with Ganciclovir therapy. The aim of the report is to increase the awareness of paediatricians and other stakeholders on congenital CMV infection in order to ensure early diagnosis and appropriate treatment of affected babies, with the ultimate aim of improving their prognoses and preventing the associated audiologic and cognitive sequelae.

Clitoral sizes and anogenital distances in term newborns in Nigeria.

BACKGROUND: Previous studies suggest significant ethnic and racial differences in clitoral sizes and anogenital distances in the newborn. This study aimed to document normative data on clitoral sizes and anogenital distances of apparently normal term female infants in Sagamu. METHODS: The study was a multi-center, cross-sectional descriptive research carried out among 317 female term infants within the first 72 h of life. Interviewer-based questionnaire was applied to obtain sociodemographic data, pregnancy and birth history. A sliding digital caliper was used for measurement. Data analysis was with SPSS version 20.0. RESULTS: The mean clitoral length was 6.7 ± 1.6 mm while the mean clitoral width was 5.6 ± 0.8 mm. The mean fourchette-clitoris distance, anus-clitoris distance and anus-fourchette distance were 21.9 ± 2.1 mm, 35.5 ± 2.5 mm and 17.0 ± 2.6 mm respectively. The anus-clitoris and anus-fourchette distances significantly correlated with the anthropometric parameters while the clitoral measurements did not. CONCLUSION: The mean values recorded in this study were higher than observed in most previous studies. This simple, affordable and non-invasive evaluation could aid early diagnosis and treatment of female infants with potentially harmful conditions such as congenital adrenal hyperplasia.

Normative data on penile and anogenital measurements of term male infants in Sagamu, Nigeria.

AIM: To document normative data on penile size and anogenital distances of apparently normal term male infants in Sagamu, Nigeria. METHODS: This cross-sectional study was carried out on 303 term male infants within the first 72 hours of life. Stretched penile length, penile width and three measures of anogenital distances were recorded: anogenital distance-1, anogenital distance-2 and anoscrotal distance. RESULTS: The mean (±SD) stretched penile length and penile width were 39.4 ± 4.2 mm and 11.0 ± 1.0 mm, respectively. The mean values for anogenital distance-1, anogenital distance-2 and the anoscrotal distance were 48.7 ± 3.9 mm, 42.8 ± 4.6 mm and 25.5 ± 3.9 mm, respectively. Only penile width and anogenital distance-1 significantly correlated with all the anthropometric parameters but anogenital distance-1 had the strongest correlation (p < 0.01 for all). CONCLUSION: The observed mean stretched penile length was greater than previously reported. Local references are preferable in interpreting anogenital measurements in newborns to avoid diagnostic errors. There is need for a consensus on the definition of micropenis.

Severe Childhood Anaemia and Blood Transfusion in a Nigerian Secondary Level Facility.

This study aimed to describe the pattern and immediate outcome of severe childhood anaemia requiring blood transfusion at a secondary level of care in Nigeria. A cross-sectional survey of children hospitalized in a secondary health facility in Ogun State, Nigeria, with packed cell volume <20% and who received blood transfusion was done. Of the 253 children admitted between March 2013 and June 2014, 79 (31.2%) had severe anaemia and were transfused with blood. Two-thirds had multiple transfusions. Higher rates of blood transfusion were obtained among underweight children. Fever (98.7%), hypoglycaemia (65.8%) and tender liver (54.4%) were the leading co-morbidities. The case fatality rate was 21.5%. Respiratory distress, convulsions and altered sensorium were significantly associated with mortality. In conclusion, severe anaemia was associated with major morbidities and mortality at the secondary level of paediatric care in Nigeria.