Neonatal Transport Network Services: Preparedness of healthcare systems in Southern Nigeria.

Background: Nigeria remains a major contributor to neonatal deaths worldwide, yet little consideration has been given to intra/inter health facility transfer of sick neonates. The dearth of Neonatal Transport Network Services (NNTS) is probably an underappreciated driver of the abysmally high national neonatal mortality indices. This study aimed to evaluate neonatal transport services and the healthcare workers' preparedness among health facilities in Port Harcourt Metropolis, Rivers State, Nigeria. Methods: Twenty-eight selected health facilities (tertiary, private hospitals Primary Health Centers] were assessed on the availability, modality and practice of NNTS. Data was analyzed using SPSS Version 23. Results: Routine transfer of high-risk pregnant mothers to higher levels of care occurred always in 14 (50%) and sometimes in 6 (21.4%) facilities; Private cars and taxis were the most common mode of transport in 24 (85.7%) facilities. Two facilities (7.2%) had ambulances equipped with transport incubators. Nurses and nurse attendants with no formal training in NNTS accompanied referred neonates in 2 (7.2%) facilities. Most referring facilities (78.6%) neither rarely or never contacted receiving centres before the arrival of neonates and most nor gave back referrals after offering neonatal care. None (100%) of the facilities had a trained emergency transport team. Conclusion: Health facilities in Southern Nigeria lack a standardized Neonatal Transport Network and are characterized by poor communication between health facilities and inadequately trained personnel for inter-facility transfer of sick neonates. Urgent action is required to address these gaps, including training of healthcare workers on neonatal transport and sharing findings with relevant stakeholders/policymakers to establish a functional neonatal transport network among health facilities.

Burden and outcome of respiratory morbidities among children and adolescents with sickle cell disease-A retrospective review of emergency presentations in some Nigerian tertiary institutions.

BACKGROUND: Despite the huge burden of sickle cell disease (SCD) among Nigerian children, the burden and outcome of respiratory illnesses remain undocumented. Thus, we aimed to describe the spectrum and outcome of respiratory illnesses among SCD childrenand adolescentadmissions in ten Nigerian tertiary hospitals. METHOD: A retrospective review of the SCD admission records of children and adolescents with a confirmed diagnosis of respiratory illnesses from 2012 to 2021 in ten tertiary health facilities across five geopolitical zones in Nigeria was conducted. The data, collectedbetween March and June 2023, included the age, sex, diagnosis, complications, duration and outcome of hospitalization. RESULTS: Of the 72,333 paediatric admissions, 7,256 (10.0%) had SCD; the proportion of SCD from the total admission ranged from 2.1 to 16.3% in the facilities. Of the 7,256 children and adolescents with SCD, 1,213 (16.7%) had respiratory morbidities. Lower respiratory disease was the most common (70.0%) respiratory entity and the majority were pneumonia (40.1.0%), followed by acute chest syndrome (26.7%). Seventeen (1.4%) patients died; all had lower respiratory diseases [(acute chest syndrome ACS (11, 64.7%), pneumonia; 5, 29.4%, and asthma (1, 5.9%). Based on the proportion of deaths among overall SCD, the 17 death cases contributed 9.4% (95% CI 5.9 to 14.5). Factors associated with deaths included duration of hospitalization less than 72 hours and lower respiratory tract diseases. CONCLUSION: Sickle cell disease is a major contributor to hospitalization among Nigerian children and adolescents, with high respiratory morbidity and mortality. Pneumonia and acute chest syndrome were associated with mortality, andthe highest risk of death within the first 72 hours.

Factors associated with common mental disorders among breastfeeding mothers in tertiary hospital nurseries in Nigeria.

BACKGROUND: Several studies have shown that the impact of maternal mental health disorders on newborns' well-being in low and middle-income countries (LMIC) are underreported, multi-dimensional and varies over time and differs from what is reported in high-income countries. We present the prevalence and risk factors associated with common mental disorders (CMDs) among breastfeeding mothers whose infants were admitted to Nigerian tertiary care facilities. METHODS: This was a national cross-sectional study involving mothers of hospitalised babies from eleven Nigerian tertiary hospitals. We used the WHO self-reporting Questionnaire 20 and an adapted WHO/UNICEF ten-step breastfeeding support package to assess mothers' mental health and breastfeeding support. RESULTS: Only 895 of the 1,120 mothers recruited from eleven tertiary healthcare nurseries in six geopolitical zones of Nigeria had complete datasets for analysis. The participants' mean age was 29.9 ± 6.2 years. One in four had CMDs; 24.0% (95% CI: 21.235, 26.937%). The ages of mothers, parity, gestational age at delivery, and length of hospital stay were comparable between mothers with and those without CMDs. Antenatal care at primary healthcare facilities (adjusted odds ratio [aOR:13], primary education [aOR:3.255] living in the south-southern region of the country [aOR 2.207], poor breastfeeding support [aOR:1.467], polygamous family settings [aOR:2.182], and a previous history of mental health disorders [aOR:4.684] were significantly associated with CMDs. In contrast, those from the middle and lower socioeconomic classes were less likely to develop CMDs, with [aOR:0.532] and [aOR:0.493], respectively. CONCLUSION: In Nigeria, the prevalence of CMDs is relatively high among breastfeeding mothers with infants admitted to a tertiary care facility. Prior history of mental illness, polygamous households, mothers living in the southern region and low or no educational attainment have a greater risk of developing CMDs. This study provides evidence for assessing and tailoring interventions to CMDs among breastfeeding mothers in neonatal nurseries in LMIC.

Mentees' Perspectives on the Factors that influence the Choice of Mentors in the Medical Profession.

Background: Mentorship is an age-long act in most fields of learning. It plays a pivotal role in medical education. The strength of any mentorship relationship could have a direct bearing on the character traits of the mentor. We aimed to determine factors that influence the choice of mentors by potential mentees in a formal mentorship relationship among medical doctors in Rivers State, Nigeria. Methodology: This was a descriptive cross-sectional survey that recruited potential mentees by convenience sampling. A semi-structured questionnaire was distributed via a monkey survey. The tool had sections that addressed mentees' expectations, perceived factors that influence the choice of mentors, and ways to improve the mentors-mentee relationship, using a 5-point Likert scale. Data were analyzed. Results: Of the 162 mentees recruited, 95 (58.6%) were females. The predominant age group was 31-40 years (40.1%). The majority, 137 (84.6%), practiced in public hospitals, and 102 (63%) were non-specialist doctors. The most common factor that influenced the choice of mentors as indicated by 156 (96.3%) participants was the ability of the mentors to help the mentees advance in their fields and connect them to opportunities. The two most cited areas of interest for mentorship were leadership in health organizations and research. Over 90% of mentees agreed that the roles of effective mentors are discussing possible solutions to difficult issues, identifying opportunities, and sharing personal experiences. Conclusion: Mentorship enables the targeted development of mentees. When developing mentoring programs and evaluating mentors, it is important to consider mentees' opinions on the factors that impact their choice of mentors.

The pattern of paediatric otorhinolaryngological disorders seen at the Rivers State University Teaching Hospital, South-south Nigeria: a 3-year review.

Introduction: otolaryngological disorders vary among children due to diverse underlying aetiologies and pathologic processes.This study audits the pattern of paediatric ear, nose and throat diseases seen at the Rivers State University Teaching Hospital. Methods: a cross-sectional retrospective review of medical records of children (aged 0 - 17 years) seen between 1st January 2018 and 31st December 2020 were retrieved and analysed using IBM SPSS version 25.0. Results were presented as frequencies and percentages for categorical variables and mean and standard deviation for continuous variables. Results: a total of 5,533 paediatric visits were documented over the study period, making up 36.7% of all patients seen. There were 2,516 completed paediatric medical records. Males slightly predominated, accounting for 1,369 (54.5%), mean age was 6.77 years (SD ± 5.10) and ranged 2 weeks to 17 years. Age groups 0-4 years were the most affected. Ear disorders were the commonest disorders found (1637, 65.1%), followed by throat/neck disorders (650, 25.8%) and then nose disorders (229, 9.1%). The top 2 disorders based on regions were as follows: Cerumen Auris (426, 16.9%) and Otitis Externa (252, 10.2%) for ear disorders; Chronic / Allergic rhinosinusitis (107, 4.3%) and foreign body in the nose (72, 2.9%) for nose disorders and Adenotonsillar hypertrophy (544, 21.6%) and speech disorders (23, 0.9%) for throat disorders respectively. Conclusion: among the paediatric group of patients, ear disorders predominated. Cerumen Auris, Adenotonsillar hypertrophy and chronic/allergic rhinosinusitis were the commonest ENT disorders.

Tuberculin skin tests following Bacille Calmette Guerin vaccination in Africa: a protocol for systematic review and meta-analysis.

Tuberculin reactivity following tuberculin skin test which is the most common measure of the effect of the Bacille Calmette Guerin (BCG) vaccination has remained complex. This protocol is aimed to assess the effect of BCG vaccine on tuberculin skin test in Africa as a guide to better understanding or resolving this complexity. A search strategy is developed using MeSH, key words, text words, and entry terms. Five databases will be searched, including PubMed, African Journals Online (AJOL), Google Scholar, Research Gate, and Cochrane Library. Only observational studies conducted in Sub-Saharan Africa and retrievable in English language will be included. The primary measurable outcome of this study is pooled prevalence of positive tuberculin skin tests. Secondary outcomes are factors that influence Tuberculin Skin Test (TST) positivity such as BCG type, the dose of BCG, age at BCG vaccinates, time/interval between BCG vaccination and TST, and type of tuberculin unit used for TST. Identified studies will be screened and selected based on inclusion criteria. Data will be extracted into Zotero, Microsoft Excel and CMA software. Both quality scores and the risk of bias for individual studies will be reported. Studies will be assessed for methodological, clinical, and statistical heterogeneity. Funnel Plots will be used for assessing publication bias. The results will be presented in tabular format in addition to a narrative synthesis. The pooled prevalence of effect of BCG vaccine on TST in Africa will be examined in relation to factors that influence TST positivity.

Basic neonatal resuscitation: retention of knowledge and skills of primary health care workers in Port Harcourt, Rivers State, Southern Nigeria.

INTRODUCTION: birth attendants' retention of knowledge and skills of neonatal resuscitation post-training can prevent birth asphyxia by repeatedly applying neonatal resuscitation guidelines. This study assessed primary healthcare workers' retention of knowledge and skills of basic neonatal resuscitation. METHODS: in 28 primary health centres, 106 birth attendants had their knowledge and skills assessed following a one-day neonatal resuscitation training. The evaluation was before, immediately after training, at three months (a subset of participants) and six months. Paired t-tests were used to compare mean scores at two different evaluation times. RESULTS: the mean baseline knowledge and skills scores were 35.22% ± 12.90% and 21.40% ± 16.91% respectively. Immediately after training, it increased to 81.48% ± 7.05% and 87.40% ± 13.97% respectively (p=0.0001). At three months, it decreased to 55.37% ± 20.50% and 59.11% ± 25.55% respectively (p=0.0001), at six months it was 55.77% ± 14.28% and 60.38% ± 19.79% respectively (p=0.0001). Following immediate post-training at 6 months, knowledge and skills scores increased to 94.91 ± 7.28% and 96.02 ± 4.50% respectively (p=0.0001). No participant had adequate knowledge and one had adequate skills at baseline. The proportion of those with adequate knowledge and skills markedly increased immediate post-training but decreased remarkably at three-month and at six-month evaluations respectively. 99.1% had adequate knowledge and all had adequate skills immediate post-training at 6 months. CONCLUSION: neonatal resuscitation training led to an improvement in knowledge and skills with suboptimal retention at three to six months post-training. Re-training improved knowledge and skills. We recommend that the retention of knowledge and skills could improve by retraining and mentoring at least 3-6 monthly.

Preparedness of primary health care workers and audit of primary health centres for newborn resuscitation in Port Harcourt, Rivers State, Southern Nigeria.

INTRODUCTION: Nigeria still has high newborn deaths and birth asphyxia remains a major cause. Birth attendants´ readiness to perform newborn resuscitation depends largely on their competence in basic resuscitation and availability of newborn resuscitation equipment to enable the various steps outlined in resuscitation guidelines to be applied quickly and appropriately. This study aimed to assess primary health care workers´ experience of neonatal resuscitation and audit primary health centres for availability of neonatal resuscitation equipment. METHODS: this descriptive cross-sectional study surveyed 106 primary health care workers (22 doctors, 84 nurses) randomly selected from 28 Primary Health Centres to document their experiences in newborn resuscitation and appraise the centres for availability of newborn resuscitation equipment. Experience in newborn resuscitation was obtained using a semi-structured questionnaire and audit was with a Proforma following on-site facility visits. Data was analysed using SPSS v20 and displayed in tables and graphs. RESULTS: all health care workers had resuscitated newborns but only 58(57.4%) had ever used a bag and mask, 53(50%) used stethoscopes and 19(17.9%) had resuscitation protocol in their facilities. Fifteen (53.6%) health centres had functional newborn-specific bag and masks, 11(39.3%) had suction machines and 5(25%) had empty oxygen cylinders. CONCLUSION: primary health care workers´ experience of newborn resuscitation is very limited and some primary health centres were grossly unequipped. Neonatal resuscitation training interventions and supplies of neonatal resuscitation equipment are urgently needed.

Nigerian parents' knowledge of COVID-19 and effect of lockdown on monthly earnings: an online survey.

INTRODUCTION: the COVID-19 pandemic has devastated every sector leading to untold hardship, unplanned loss of jobs and drastic reductions in the income of families across the world. This survey assessed the knowledge of COVID-19 among Nigerian parents and its effect on their monthly income. METHODS: an online cross-sectional survey was conducted from May 9 - June 8, 2020, among parents/guardians with children/wards in the paediatric age-range during the lockdown stage of the outbreak in Nigeria. Snowball sampling technique was used to recruit 260 respondents. The questionnaire was administered on a Google doc form and distributed via the internet. Chi-square was used to test for differences, and statistical significance was set at p-value less than 0.05 and a 95% confidence level. RESULTS: the mean age was 39.6 years (SD = 7.3), comprising 105 (40.4%) males, 239 (91.9%) married, and 167 (64.2%) with tertiary education. Only 29 (11.2%) had good knowledge of COVID-19. Interestingly, low-income earners were more likely to have good knowledge of COVID-19 than middle/high-income earners. The monthly incomes of 191 (73.5%) respondents were affected. Females, those with secondary education and below, and low-income earners were more likely to have their incomes affected. CONCLUSION: parents/guardians have poor knowledge of COVID-19. Also, the monthly income of parents/guardians have been affected by the lockdown measures; most affected were females, those with a secondary level of education and below and low-income earners. Their poor knowledge and the impact on their income may further impair their preparedness to combat the spread of COVID-19.

COVID-19 and the Nigerian child: the time to act is now.

COVID-19 has overwhelmed virtually every sector in resource-rich countries of the world and has gradually but steadily enveloped almost all of Africa. While her leaders grapple with the vivid realization of the myriad effects of the virus, the African children should not be the 'hidden victims' of the COVID-19 pandemic because they are among the most vulnerable. This narrative highlights the effects of the pandemic on the economic, education, health, mental and socio-cultural well-being of the Nigerian child and suggests ways to mitigate it. The impact of COVID-19 pandemic on the Nigerian child are numerous. Policies should be set up urgently and interventions sourced to ameliorate the effect of the virus on the most vulnerable group in Nigeria.