Utilization of health care services by pregnant mothers during delivery: a community based study in Nigeria.

OBJECTIVE: Poor utilization of health facilities during delivery by pregnant mothers is still a major cause of maternal and childhood morbidity and mortality in Nigeria. The aim of this study was to determine the level of utilization of health care services by pregnant women during delivery in Gokana Local Government Area of River State, Nigeria. MATERIALS AND METHODS: This was a cross-sectional, questionnaire; based study involving 112 mothers aged 15 years to 49 years from Gokana Local Government Area of Rivers State, Nigeria. The local Government Area has 12 health centres and 6 health centres were selected by multistage sampling. 112 were then selected by simple random sampling. RESULTS: Of the 112 mothers interviewed 91 (81.3%) were married, 13 (11.6%) were single, 5 (4.5%) were widows, 2 (1.8%) divorced and 1 (0.9%) separated. Ninety seven (86.6%) of these mothers (n = 112) had formal education while 15 (13.4%) had no formal education. Most 42 (37.5%) of the mothers were between 25-29 years. Sixty four (57.1%) of the 112 mothers in their recent delivery used a health facility while 48 (42.9%) did not. Factors responsible for non utilization of health facility for delivery include: Long distance to health facility 33 (68.7%), onset of labour at night 40 (83.3%), unavailability of means of transportation 37 (77.1%), Lack of money for transportation 26 (54.2%), unsatisfactory services at health facility 26 (54.2%), unfriendly attitude of staff of the health facility 34 (70.8%), unavailability of staff at health facility 32 (64.0%), lack of urgency at health facility 36 (75.0%), previous uneventful delivery at the health facility 32 (66.7%). CONCLUSION: Utilization of health care services during delivery in Nigeria is still poor. Concerted efforts should be made both at community and Government levels to improve utilization of health facility during delivery. This will go a long way in reducing maternal and child mortality.

Tuberous sclerosis: a rare cause of seizure in Nigeria.

BACKGROUND: Tuberous sclerosis is a rare genetic multisystem disorder that is typically apparent shortly after birth. Dermatologic manifestations may be the only clues to the diagnosis of the disorder, which is also marked by childhood seizures and mental retardation. The aim of this report is to present a twelve year old boy with tuberous sclerosis. METHODS: A review of the case records of a child with angiofibromas of the face and neck and the relevant literature. RESULTS: An eleven year old primary two pupil of Ijaw tribe, southern Nigeria, presented with recurrent afebrile, generalized tonic--clonic seizures from nine months of age, hyperpigmented papulonodular eruptions on the face and neck with some hypo pigmented patches at the back for six years. He also had a growth on the right index finger of six years duration. There was associated learning disabilities and poor school performance, with sudden outburst of mood swings ranging from laughter to anger. Speech was delayed. He has been on Carbamazepine for the past two years and is seizure free. There was no history of similar illness in the family. Physical examination showed that he had labile mood with presence of hyperpigmented papulonodular (angiofibromas) eruptions on the malar area of the face and neck. There were also associated hypomelanotic macules on the back, bony cyst on the right index finger. He also had bilateral undescended testis. All other systems were essentially normal. Cranial computed tomography showed multiple hyperdense non enhancing nodules in the walls of the lateral ventricles with a hyperdense nodule in the subcortical area of the parietal lobe of the left cerebrum. Multiple areas of nonenhancing hypodensities were also seen in the cortical white matter of the frontal and parietal lobes bilaterally with associated thickening of the adjacent gyri. He is being managed by a team of a paediatric neurologist, surgeon, speech therapist and a dermatologist. He is regular at follow up clinic. CONCLUSION: Tuberous Sclerosis though a rare condition, once diagnosed needs multidisciplinary management to improve the quality of life of the patient.

Bronchopulmonary dysplasia in a premature infant--case report and literature review.

BACKGROUND: Bronchopulmonary dysplasia is an important cause of morbidity and mortality in premature infants. The aim of this study is to present a premature, extremely low birth weight infant with bronchopulmonary dysplasia. METHOD: A review of the case records of a child with recurrent respiratory distress and the relevant literature. RESULTS: A preterm, extremely low birth weight baby (birth weight was 0.8 Kg), delivered by emergency caesarian section for previous caesarian section and prolonged rupture of fetal membranes at 27 weeks gestational age. She had spontaneous breathing at birth (APGAR scores were 8 in one minute and 10 in 5 minutes). She developed respiratory distress with cyanosis and became oxygen dependent from the second week of life. Examination revealed severe dyspnoea with grunting respiration, tachypnoea, cyanosis and crackles in the lung fields. Chest X-ray showed hyperinflation, right lower zone patchy consolidation with obliteration of the costophrenic angle. Echocardiography was however normal. She was successively managed with intermittent oxygen, dexamethasone, salbutamol and antibiotics (ceftriaxone). She was nursed in the incubator for 3 months. There was no episode of apneic attack throughout admission. She responded to treatment and was discharged home on intermittent oxygen therapy and nebulisation. The weight on discharge was 1.6 kg. At 6 months of age, she is still having recurrent respiratory distress andsupplemental oxygen at home. She is regular to follow up with recurrent episodes of wheeze requiring admissions. CONCLUSION: Bronchopulmonary dysplasia should be suspected in a premature extremely low birth weight infant with early recurrent respiratory distress.

Vitiligo: a Hospital-Based Study in Southern Nigeria

Background: Vitiligo is an acquired pigmentary disease characterized by loss of the pigment producing cells (melanocytes) of the skin; hair and mucous membranes (lips and genitalia); with subsequent development of white patches. The aim of this study was to evaluate the epidemiological pattern of vitiligo in Port Harcourt; south-south Nigeria. Methods: This was a prospective study of 82 cases of vitiligo seen in the dermatological clinic of the University of Port Harcourt Teaching Hospital (UPTH); Port Harcourt; Nigeria from May 2005 to April 2009. All ages were included in this study. Data was analysed using the SPSS version 15. Descriptive statistics in the form of the frequency and percentage were used. Chi square was used to test relationship between variables. P0.05 was considered statistically significant. Results: There were a total of 1;652 dermatological disorders during the study period. Eighty two patients had vitiligo giving a prevalence of 4.96. There were more females 45(54.9) than males 37(45.1) giving male: female ratio of 0.8:1. Vitiligo is commoner from the age of 20 years to 30 years (32.9). The head and neck region was the most common site of onset of the lesion and accounted for 28of cases. Generalized vitiligo [29(35.4)] was the most frequently found pattern of distribution. Positive family history was found in 6 cases (7.3). Eighteen (22.0) patients suffered from other diseases such as thyroid dysfunction [8(9.8)]; anaemia [4(4.9)]; atopic dermatitis [2(2.4)]; diabetes mellitus [1(1.2)]; anxiety disorder [1(1.2)]; collagen vascular disease [1(1.2)] and oligomenorrhoea [1(1.2)]. Conclusion: The pattern of vitiligo seen is similar to that reported from other parts of the world. There is also need to look for associated disorder in any case of vitiligo

Pattern and clinical presentation of congenital heart diseases in Port-Harcourt.

INTRODUCTION: Congenital heart disease is an important cause of morbidity and mortality in infancy and accounts for two thirds of all birth defects. This study was done to obtain the pattern and clinical presentation of congenital heart diseases in the University of Port-Harcourt Teaching Hospital Teaching Hospital, Port-Harcourt, Nigeria. METHOD: This was a prospective hospital based study of children up to the age of 16 years admitted into the Paediatric Cardiology Unit of the University of Port-Harcourt Teaching Hospital with clinical and echocardiographic features compatible with congenital heart disease. RESULTS: A total 41 patients with congenital heart disease were managed from 1st January 2007 to 30th June 2008 in the Paediatric Cardiology Unit of the University of Port-Harcourt Teaching Hospital. There were 18 males and 23 females giving a ratio 1:1.3. Majority 33 (80.5%) of the cases were acyanotic congenital heart disease. Thirty (73.2%) of the cases seen were infants. Ventricular septal defect was the most prominent congenital heart disease accounting for 34.1% of all cases. Tetralogy of Fallot was the most common cyanotic congenital heart disease and accounted for 87.5%. Fast breathing and poor weight gain were the commonest mode of clinicalpresentation. CONCLUSION: Congenital heart diseases are not uncommon in our environment. The modes of presentation are protean, therefore high index of suspicion, early diagnosis, close monitoring and timely intervention is required in all cases. This will go a long way in reducing the morbidity and mortality associated with it.

Mortality pattern in children: a hospital based study in Nigeria.

BACKGROUND: Hospital based data on mortality pattern is a reflection of what is obtainable in a community at large. Therefore, data obtained from such review is usually beneficial in re-evaluating existing services and in improving facilities and patient care. The aim of this study was to evaluate the mortality pattern of children admitted into the children medical wards of the University of Port-Harcourt Teaching Hospital from Jan 2007 to December 2008. MATERIALS AND METHODS: This was a retrospective study. The case files of all patients aged one month to 16 years, admitted into the paediatric wards of University of Port-Harcourt Teaching Hospital, Port-Harcourt, Nigeria over a 2 year period were reviewed. Neonatal and surgical cases were excluded. RESULTS: There were 2,174 admissions during the study period. Sixty one of the total number of admissions died in the children medical wards giving a mortality rate of 2.8%. The youngest child was 2 months and the oldest 10 years. Fifty two (80.3%) were under 5 years. There was male preponderance. Most of the deaths occurred between April and September. The commonest causes of death were HIV/AIDS and bronchopneumonia in the under five age group; while in those above 5 years of age malignancies and HIV/AIDS were the predominant causes. CONCLUSION: Effective HIV/AIDS control measures will significantly reduce child mortality in our community. Also there is need to have a closer look at the potential risk for malignancies. Health intervention programmes such as integrated management of childhood illnesses and primary health care, which have been shown to reduce childhood deaths significantly, need to be intensified in order to achieve the MDG 4 by 2015.

Sexual Lifestyle of Long-Distance Drivers in Port Harcourt Metropolis

Background: Long-distance drivers are away from home for days and often times they visit roadside hotels for food; rest; leisure; alcohol; and become prey for commercial sex workers. Aim: To determine the current sexual life style of long distance drivers from Port Harcourt to western and northern parts of Nigeria. Methods: A descriptive cross- sectional survey of long distance drivers to western and northern parts of Nigeria in five motor parks in Port Harcourt metropolis was conducted. The drivers were involved in questionnaire-based interview from 1st February to 31st July 2007. Results: Ninety-four long journey drivers were studied. Sixty-one (64.9) were married with children while 33(35.1) were single. The respondents all had multiple sexual partners ranging from 2-5; with an average of three during the past one year. Twenty-six (27.7) admitted use of condom. Most [81(86.2)] of the sexual practices were vaginal. Forty-three (45.7) of the respondents drank alcohol when on long distance journey while 28(29.8) admitted having sexually transmitted diseases during the past one year. Eighty-one (86.2) of the respondents had knowledge of HIV/AIDS. Conclusion: The results of this study suggest that long-journey drivers are important in spreading sexually transmitted and HIV infections in this country. There is therefore; need to find effective strategies to persuade long journey drivers to change their risky sexual behaviour

Prevalence of skin diseases in Nigerian children--(the University of Port Harcourt Teaching Hospital) experience.

BACKGROUND: Skin diseases are frequently encountered in the tropics and are a serious cause of morbidity, disfigurement and distress in all age groups. The aim of this study is to determine prevalence and common dermatological conditions encountered in UPTH. METHODS: Children aged 0-16 years attending the dermatology clinic in UPTH from June 2005 to November 2007 were prospectively studied. RESULTS: A total of 1,226 skin disorders were seen, 247 (20.1%) were children aged 0-16 years. Skin disorder was commoner in females 139 (56.3%) than males 108 (43.7%). Papular urticaria 36 (14.6%), atopic dermatitis 34 (13.8%) and tinea 31(12.6%) were the most commonly observed childhood skin diseases. CONCLUSIONS: Skin diseases such as papular urticaria and atopic dermatitis are important dermatological problems in our environment. Implementation of public health policies and improvement in personal hygiene would reduce the prevalence of skin diseases in Nigerian children.

Prevalence of skin diseases in Nigerian Children: - (The University of Port Harcourt Teaching Hospital) Experience

Background: Skin diseases are frequently encountered in the tropics and are a serious cause of morbidity, disfigurement and distress in all age groups. The aim of this study is to determine prevalence and common dermatological conditions encountered in UPTH. Methods: Children aged 0-16 years attending the dermatology clinic in UPTH from June 2005 to November 2007 were prospectively studied. Results: A total of 1,226 skin disorders were seen, 247 (20.1%) were children aged 0-16 years. Skin disorder was commoner in females 139(56.3%) than males 108(43.7%). Papular urticaria 36(14.6%), atopic dermatitis 34(13.8%) and tinea 31(12.6%) were the most commonly observed childhood skin diseases. Conclusions: Skin diseases such as papular urticaria and atopic dermatitis are important dermatological problems in our environment. Implementation of public health policies and improvement in personal hygiene would reduce the prevalence of skin diseases in Nigerian children