The age of paediatrics.

The epidemiological transition towards non-communicable diseases is characterised by an upward shift in age of disease burden across the lifecourse. One response, within a suite of wider actions, would be to extend the upper age limit of paediatric practice to embrace adolescent health. We did an online survey to explore the upper age limit of paediatric care, obtaining responses from 1372 paediatricians in 115 countries. Marked variation in the upper age limit was apparent. Among high-income countries, a higher upper age limit was associated with greater disease burden in adolescents relative to young children (<5 years). Although paediatricians reported the mean upper age limit of paediatrics had risen over the past 20 years, the mean preferred age of 18·7 (SD 2·6) years was higher than the mean current age of 17·4 (SD 2·5) years (p<0·0001). Paediatricians reported the main reasons for the rising age over time was their greater awareness of adolescent health and leadership by professional associations. Reports of the quality of adolescent health education within national paediatric training suggest that this education is largely inadequate. A greater focus on adolescent health is required within paediatrics to ensure that the future paediatric workforce is appropriately equipped to respond to the changing disease burden across childhood and adolescence.

Health-Care Workers' Perspectives on Preparedness of Health-Care Facilities for Outbreak of Communicable Diseases in Nigeria: A Qualitative Study.

A high probability of another outbreak of communicable disease exists in sub-Saharan African countries, after the Ebola virus disease outbreak of 2014. Thus, health-care facility (HCF) preparedness for a prompt and effective response to disease outbreaks needs to be ascertained. In this study, Nigerian health-care workers' (HCWs) knowledge of preparedness, perception of the level of preparedness existing in these HCFs, militating factors, and possible ways to improve, were evaluated through qualitative data collection, using focus group discussion and in-depth interview. Among the 193 HCWs which participated in the study, the perception of 190 (98.4%) was that their HCFs were insufficiently equipped to respond to disease outbreaks. None of the facilities had an emergency operation unit (EOU). Most HCWs perceived preparedness as observation of universal precautions. Other aspects of preparedness, such as training, routine emergency drills, disease surveillance, waste management, and design and location of HCFs were minimally mentioned. None of the participants had undergone any form of emergency drill training. Among the suggestions of how to improve on preparedness were immunization of staff, improved inter-departmental communication within the HCF, and routine training. The overall poor level of preparedness which exists in the HCFs means that they cannot prevent or contain a communicable disease outbreak. There is a need to improve universal precautions, communication within the HCFs, and routine interpretation of surveillance data by epidemiologists. There is also a need for the establishment of EOU in every HCF, a system that responds to, and manages emergency response to disease outbreaks, which also must be functional during non-outbreak periods.

Health-Care Workers' Perspectives on Ebola Virus Vaccine: A Focus Group and In-Depth Interview Interventional Study.

Health-care workers (HCWs) will require Ebola virus vaccine (EVV) when it is introduced because of the high risk of exposure to the disease. Evaluations of factors that facilitate or limit vaccine uptake are critical for a successful vaccine program. Nigerian HCWs were interviewed to evaluate their knowledge, levels of acceptance, determinants of acceptance, and willingness to pay for EVV. The significance level was set at P ≤ 0.05. None of the 193 participating HCWs had correct knowledge of EVV; 34.7% (67/193) of workers thought that EVV was an extract of the serum of Ebola virus patients. About 77.3% (51/66) of workers in a region that reported Ebola cases (Lagos) were willing to be vaccinated, compared with 4.7% (3/61) in Enugu and 13.6% (9/66) in Abia (P = 0.0001). After health education, the proportion of HCWs willing to receive EVV increased (P = 0.006) except for doctors (P < 0.1). The percentage of HCWs willing to pay for EVV was 86.4%, 72.1%, and 59% in Lagos, Enugu, and Abia, respectively. The workers had fears about EVV based on nonfactual assumptions. Therefore, the EVV introduction strategy should include a strong awareness campaign with adequate explanation about the content of EVV.

Changes in breastfeeding and nutritional status of Nigerian children between 1990 and 2008, and variations by region, area of residence and maternal education and occupation.

BACKGROUND: Inadequate breastfeeding practices contribute to malnutrition in young children. AIMS AND OBJECTIVES: This study examined changes in breastfeeding practices and the nutritional status of children (0-35 months, n = 37154) using data from the nationally-representative Nigerian Demographic and Health Surveys for 1990-2008. METHODS: The study estimated the relative changes in the proportion of children meeting recommended breastfeeding practices and the anthropometric indices of the children during the study period, by region, place of residence, maternal education and maternal occupation. RESULTS: In each study year, over 97% of the children were ever breastfed. The proportion of infants breastfed within 1 hour and 1 day of birth increased from 34% to 45.8%, and from 63.8% to 82.3%, respectively. Overall, breastfeeding for ≥ 12 months changed from 88.9% to 95.2%, an increase of 7%; however, an increase of 14% was observed in the northern region (from 86.1% to 97.8%) while a decline of 7% was observed in the southern region (from 97.1% to 89.9%). Over the study period, the prevalence of all the assessed indicators of malnutrition (stunting, wasting and underweight) increased in the northern region while the southern region experienced a decline in all except severe wasting. In both urban and rural areas, stunting and wasting increased, while underweight declined. Children of non-formally educated and unemployed mothers were more malnourished in all the study years. CONCLUSION: Improvement in some breastfeeding practices did not result in improvement in the nutritional status of Nigerian children during 1990-2008, particularly in northern Nigeria and among socially disadvantaged mothers. Improving maternal education and employment, and integrating messages on techniques and benefits of optimal infant feeding with other maternal and child healthcare services could be beneficial.

Maternal and child dietary patterns and their determinants in Nigeria.

Understanding the overall dietary patterns of a population is a key step in initiating appropriate nutritional interventions and policies. Studies characterising the dietary patterns of Nigerian mothers and children are lacking. Complete dietary data for 13,566 mothers and their 13,506 children were analysed from the 2008 Nigerian Demographic and Health Surveys (NDHS), a nationally representative sample, to identify the overall maternal and child dietary patterns and to study the potential determinants of such dietary patterns. The 2008 NDHS included questions that inquired about the food items mothers and their children had consumed during the 24 h preceding the day of the interview. Factor analysis with the principal component procedure was used to construct the dietary patterns, and multiple multilevel logistic regression was used to investigate the determinants of the dietary patterns. Four ('mixed', 'traditional', 'staple foods and milk products' and 'beverages') and five ('mixed', 'selective', 'beverages and candies', 'gruels, grains and semi-solids' and 'infant formula and cereals') distinct dietary patterns were obtained for the mothers and children, respectively. The key determinants of both maternal and child dietary patterns were month of interview, religion, region of residence, maternal education, maternal occupation, wealth index and maternal body mass index. Marital status additionally predicted maternal patterns, while sex of the child, number of siblings, child's age, maternal age and place of residence additionally determined the child's patterns. This study has identified four and five different dietary patterns to characterise the dietary habits of Nigerian mothers and their children, respectively, and has shown the important socio-economic/demographic factors influencing the dietary patterns, which can guide appropriate nutritional interventions among Nigerian mothers and children.