Comparison of neonates born outside and inside hospitals in a children emergency unit, southwest of Nigeria.

OBJECTIVE: To describe the effects of out-of-hospital birth on early neonatal morbidity and outcome among referred newborns. METHODS: Using a structured case record form, we prospectively collected data on place of birth, morbidity, and outcome of all neonates admitted to the Emergency Ward, University College Hospital, Ibadan, in the first week of life. RESULTS: Of the 541 admitted in the early neonatal period, 61.8% and 38.2% were delivered outside and inside the hospital setting, respectively. Babies were delivered at religious or "mission" house (46.7%), house of residence (38.0%), traditional birth attendants' homes (8.4%), and on the way to the hospital (6.9%). Births outside the hospital significantly increased as the birth order increased (chi = 34.04; P = 0.000). Over half of the out-of-hospital deliveries took place under personnel whose primary responsibilities did not include labor care. Women who had less than secondary level of education and those from the lower social class were more likely to deliver outside the hospital (P < 0.05). Out-of-hospital births were significantly associated with many complications, namely, hypothermia (53.6%), perinatal asphyxia (48.5%), hemorrhage (26.5%), cephalhematoma (12.9%), prematurity (9.9%), and neonatal tetanus (4.2%). Neonatal mortality rate of 12.6% in the out-of-hospital group was significantly higher than 6.3% obtained in the hospital birth group (P = 0.019). CONCLUSIONS: Out-of-hospital births had greater risk of morbidity than hospital births. There is need to retrain and monitor the activities of birth attendants and midwives involved in births outside the hospitals closer than it is presently done.

Contents of referral letters to the children emergency unit of a teaching hospital, southwest of Nigeria.

OBJECTIVE: This study was carried out to evaluate the quality of the contents of referral letters received at the pediatric emergency unit of the University College Hospital, Ibadan, Nigeria. DESIGN: We prospectively reviewed consecutive referral letters received over a 6-month period. The details of the contents of each letter were recorded using a structured pro-forma by 2 of the investigators after consent was obtained from the parent or caregiver. RESULTS: There were 974 patients admitted with referral letters; this accounted for 54.8% of all admissions. There were 568 boys and 406 girls (ratio, 1.4:1). More than one tenth of the referred patients reported after 24 hours of writing the letters. Letters were written by physicians (69.2%), registered nurses (21.3%), hospital assistants (2.1%), traditional birth attendants (0.4%), and non-health workers (0.3%). The identity of the writers of 65 letters (6.7%) could not be defined. More than half of the letters did not contain the patients' age, the treatment given, the findings from the investigations performed, the medical history, and what the writers expect from the referral. Other missing information includes examination findings (47.9%), provisional diagnosis (38.6%), history of presenting complaints (36.6%), writers' addresses (32.5%), reasons for the referral (23.9%), patients' sex (20.1%), and patients' names (3.4%). The most frequently stated reason for referral was poor or no response to the treatment given (17.8%). CONCLUSION: The contents of referral letters from the general practitioners to the pediatric emergency unit were found to be grossly inadequate. To enhance the quality of correspondence between the referring physicians and pediatricians, there may be a need for training and introduction of letter-format prompt forms.

Increasing burden of childhood severe malaria in a Nigerian tertiary hospital: implication for control.

Malaria remains an important public heath concern in Nigeria because of its impact on child and maternal health, but the contribution of severe malaria to morbidity among Nigerian children was scantly reported. This study was undertaking to document the hospital-burden of severe malaria among children in Ibadan in order to reflect on the impacts and health implications of the current malaria control strategies. A review of 6-year case records of all children admitted to the emergency ward of the University College Hospital Ibadan was carried out. Cases of severe malaria were defined as those children in whom parasitaemia were confirmed with blood film microscopy and any of the WHO case definitions for severe malaria was documented. Severe malaria cases constituted 11.3% of 16 031 admissions (2000-05) with 89.1% being children <5 years old. Cerebral malaria accounted for about one-fifth (19.7%) of all severe malaria cases. The yearly proportional morbidity rate from severe malaria ranged from 8.7% to 13.2% with significant increase from 2000 to 2004 (X2 = 48.49; df = 5; P < 0.001). Severe malaria accounted for 12.4% of all paediatric deaths with an estimated overall case fatality rate of 9.6%. Deaths from malaria were significantly associated with wasting (Z-score for weight-for-height