Effect of COVID-19 Pandemic on Utilization of Paediatric Health Services at the Federal Medical Centre, Asaba, Nigeria.

BACKGROUND AND OBJECTIVES: Corona virus disease was declared a global pandemic in March 2020 and it precipitated unprecedented and devastating crisis on non-COVID hospital visits in almost all the countries within the globe, with a downward slide in the number of paediatric consultations and emergency admissions. Thus, we assessed the utilization of services offered in the department of Paediatrics and the observed mortality rates in comparison to similar non-pandemic period. METHODS: This study was carried out in the department of Pediatrics, Federal Medical Center Asaba. All the admissions at the children's ward and emergency, then visits at clinics and the immunization center were reviewed using a consecutive sampling method from April 2019 to September 2019 (pre COVID-19) and April 2020 to September 2020 (during COVID-19 pandemic). RESULTS: The total number of vaccines given in the immunization clinic was higher during the pre-COVID-19 period, so also the number of clinic visits. There was a decline in admission by 68.2% from the pre-COVID period to the pandemic period and this decline was across all age groups and gender. Also, a 60.8% increase in mortality was observed during the COVID-19 period and mortality pattern showed no gender difference across both study periods. CONCLUSION: There was a decline in the utilization of health services at the Department of Paediatrics, Federal Medical Center Asaba, during the COVID-19 pandemic, with a rise in mortality, despite the fact that all the units of the department were fully operational within the period of pandemic.

CONTEXTE ET OBJECTIFS: La maladie à virus Corona a été déclarée pandémie mondiale en mars 2020 et a précipité une crise sans précédent et dévastatrice sur les visites hospitalières non COVID dans presque tous les pays du globe, avec une baisse du nombre de consultations pédiatriques et d'admissions d'urgence. Nous avons donc évalué l'utilisation des services offerts dans le département de pédiatrie et les taux de mortalité observés par rapport à une période non pandémique similaire. MÉTHODES: Cette étude a été réalisée dans le département de pédiatrie du Centre médical fédéral d'Asaba. Toutes les admissions au service pédiatrique et aux urgences, puis les visites dans les cliniques et au centre de vaccination ont été examinées selon une méthode d'échantillonnage consécutif d'avril 2019 à septembre 2019 (avant COVID-19) et d'avril 2020 à septembre 2020 (pendant la pandémie de COVID-19). RÉSULTATS: Le nombre total de vaccins administrés dans le centre de vaccination était plus élevé pendant la période pré-COVID-19, de même que le nombre de visites au centre. Le nombre d'admissions a diminué de 68,2 % entre la période pré-COVID et la période pandémique, et cette baisse a concerné tous les groupes d'âge et tous les sexes. Par ailleurs, une augmentation de 60,8 % de la mortalité a été observée au cours de la période COVID-19 et le schéma de mortalité n'a montré aucune différence entre les sexes au cours des deux périodes d'étude. CONCLUSION: Il y a eu une baisse de l'utilisation des services de santé au département de pédiatrie du Federal Medical Center Asaba pendant la pandémie de COVID-19, avec une augmentation de la mortalité, malgré le fait que toutes les unités du département étaient pleinement opérationnelles pendant la période de la pandémie. Mots-clés: Pandémie, Covid-19, Enfants, Mortalité, Clinique, Admission, Services de santé, Effet, Utilisation.

Scope of Neonatal Care Services in Major Nigerian Hospitals

Background: Neonatal survival bespeaks the quality of neonatal care services available and accessible to the population. Intensive care improves outcome of high-risk infants with serious illness. The tiered level of care is yet to be applied to newborn care in Nigeria. Classification of care is key to improving neonatal survival with enhanced referral of high-risk patients to higher-level centres. Objective: To ascertain the scope and classify available newborn services offered at major Nigerian hospitals.Methodology: A semi-structured validated questionnaire was administered to attendees during 2015 Pediatric Association of Nigeria conference. The information derived was used to categorize neonatal care services.Results: The respondents consisted of doctors 201 (84.8%) and nurses 36 (15.2%) in 54 health facilities from all geopolitical regions of Nigeria. Of the 54 facilities; 34 (63%) were located in state capitals and 47 (87%) in public hospitals. Half of the evaluated units belonged to Class I; 22 (40.7%) Class II; and 5 (9.3%) Class III levels of neonatal care. Majority (81.6%) of the doctors have been trained on neonatal resuscitation; with senior residents being the highest 49 (89%) and Medical officers (MO) the least 4 (40%) trained. Doctors with training in mechanical ventilation (MV) were 39.2%; Consultants (51.2%); MO's the least 1(11.2%) trained (p=0.025). Monitoring is usually by pulse oximeters 54 (100%); multi parameter monitors 23 (42.6%) and rarely ABGs 6 (11%).Conclusion: Neonatal care in Nigeria is still developing. Most centres provide basic neonatal care services. Regionalization of care may be the solution to higher level neonatal care

Implementing Comprehensive Health Care Management for Sickle Cell Disease in an African Setting

Sickle cell disease is the commonest single gene disease in Africa. Morbidity and mortality from this disease has remained unacceptably high in Africa whereas there has been a marked reduction in the burden of this disease in the developed countries. This reduction was not achieved through the use of sophisticated care such as bone marrow transplant; but through the adoption of a Comprehensive Health Care Management protocol for sickle cell disease. This protocol of care emphasizes prevention of crises through effective management of the disease. In Africa; where sickle cell disease is prevalent; this strategy of care is yet to be globally adopted. In 2003; this protocol of care was adopted at the University of Benin Teaching Hospital; Nigeria and this has contributed to the improved clinical status of children with sickle cell disease in the hospital. The mortality rate among children with sickle cell disease has reduced to 1.3%; requirement for recurrent blood transfusion has reduced to about 2%; and their nutritional status has improved: 75.9% have normal nutritional status while 7% are actually overweight. The frequency of bone pain crisis has reduced to about one in every two years and some of the patients have been crisisfree for as long as five years. Hydroxyurea is not routinely used for our patients so this cannot explain the marked improvement recorded. In conclusion; comprehensive health care; adapted to our setting is a very cheap and effective way of managing sickle cell disease. It can be utilized in all health facilities for the care of children with sickle cell disease and is capable of reducing the morbidity and mortality associated with the disease as well as improving their quality of life

Breastfeeding Practices and Growth

Background: Breastfeeding is vital for the growth and development of infants and young children. Early initiation within the half hour of birth fosters optimal breastfeeding practice; promotes growth and development.Objective: To evaluate breastfeeding practices and the growth of infants. Method: This was a crosssectional survey at three immunisation clinics in Asaba metropolis of Delta state. Using a structured questionnaire; we assessed breastfeeding practice of attendees and the growth of babies and documented information on the socio demographic characteristics; breastfeeding practices; previous weights of infants' and their Anthropometric measurements.Results: There were 97 mother infant/ pairs. 49 males; 48 females; giving a male to female ratio of 1:1. 20.6% were neonates; 74.2% were less than 6 months while 25.8% were older. About 50% of the mothers initiated breastfeeding within an hour of delivery; 25% of mothers gave pre-lacteal feeds. 49.5% of babies were optimally breastfed; of these; 68.7% mothers had initiated breastfeeding within an hour of birth (p=0.001). Underweight and stunting was only seen among babies of mothers who did not practice optimal breastfeeding. It was observed that babies' weights were not documented routinely in the road to health chart of the immunization cards after the measurements were taken. This was a missed opportunity for counselling and health promotion.Conclusion: Early initiation of breastfeeding increases the probability of optimal breastfeeding practice and prevents infant malnutrition. Even though growth was assessed; the information was not utilized for feed back to the mothers at the well-baby clinics; growth monitoring and promotion was not supported at the well-baby clinics in the health centres

Challenges and Opportunities for Neonatal Respiratory Support in Nigeria: a Case for Regionalisation of Care

Background: Neonatal health appears not to have received the deserved attention in the context of the Child Survival Strategies and this must have contributed to the non-attainment of the MDG-4 in Nigeria. Neonatal mortality contributes 40% or more to the current rate of child deaths globally; with birth asphyxia; prematurity and its complications and severe infections as the leading causes. This emphasises the need to re-focus on neonatal health. Given the state of the economy in the low- and middle-income countries; Nigeria; like most of the other countries lack the resources required for efficient neonatal health care with minimal attention on the strategies needed to address the major causes of newborn death.Objectives: To assess the contemporary situation of neonatal care in Benin City; Nigeria and examine diverse approaches to be adopted to provide high level neonatal care services aimed at improving neonatal survival rates.Methods: The trends of neonatal morbidities and mortality over the period between 1974 and 2014 were studied by reviewing the hospital records covering admissions and weekly mortality records. The pattern of categories of babies and the causes of death were recorded. The information gathered identified the gaps in the management strategies for newborns over the years. Electronic databases such as the Medline and Pubmed were searched for relevant literatures published between 1960 and 2015 which might provide ideas required to fill the gaps.Results: In the 1974-1976 era; the major cause of neonatal mortality at the University of Benin Teaching Hospital (UBTH); Benin City; Nigeria; was birth asphyxia with an attendant perinatal mortality of 80.9/1000 births. The decline in the perinatal mortality to 33.4/1000 births between 1976 and 1980 was linked to the introduction of delivery room resuscitation with a reciprocal decline in the incidence of birth asphyxia. Thereafter; neonatal mortality rate has continued to increase. This increase could be attributed to a three-fold rise in the proportion of very preterm admissions from 6.5% in 1985 to 19.3% in 2013. This population of babies is predisposed to Respiratory Distress Syndrome and respiratory failure. Neonatal intensive care did not include respiratory supports until very recently (2013) when the facilities were provided but at high cost to the patient and the health system.Conclusion: The strategies required to address reduction in neonatal mortality rates should necessarily include neonatal resuscitation and mechanical ventilation; all within the context of Neonatal Intensive Care. In order to provide the full range of neonatal intensive care services in a resource- constrained setting such as Benin City; Nigeria; regionalisation of care in a stepwise manner is recommended; both for improved medical outcomes and economic realities

Time of passage of first stools (meconium) and serum levels of calcium and magnesium in Nigerian neonates (African neonates).

BACKGROUND: Over 90% full term normal newborns are known to pass meconium (first stools) within the first 24 hrs of life especially among Caucasians. This has not been fully documented among African neonates. This study was therefore done to determine time of passage of first stools (meconium) in African neonates and also the serum levels of calcium and magnesium in these children in order to establish a data base for normal standards. METHODOLOGY: Two thousand and four hundred neonates were recruited from Hospitals in Benin City urban areas for the study. 76.7% of these were full term and AGA babies (37-40 weeks; 2.8 kg-4.3 kg) while 23.3% of them were preterm and low birth weight neonates (34-36 weeks and weight between 2.4 to 1.5 kg) respectively. RESULTS: 88% of the full term neonates passed meconium at 15.4 +/- 3.6 hrs of life while only 12.0% of them passed meconium after 24 hrs of life and all by 48 hrs of life. The mean time of passage of stools by preterm, low birth weight babies was 45.2 +/- 2.4 hrs. The values of serum calcium in the full term neonates ranged from 6.5 9.2 mEq/l with mean of 7.8 +/- 1.2 mEq/l while the level in the preterm low birthweight neonates was much lower (5.4 8.3 mEq/l) with a mean of 6.7 +/- 1.3 mEq/l. The values of serum magnesium ranged from 0.9 1.6 mEq/l with a mean of 1.2 +/- 0.3 mEq/l in full term neonates while preterm low birthweight neonates had levels as low as 0.5 1.1 mEq/l with a mean of 0.7 +/- 0.2 mEq/l CONCLUSION: This study has shown a relatively shorter time of passage of first stools (meconium) in Nigerian neonates (blacks) than in the Caucasians. The implication of the findings in this study is that a delay in the passage of first stools (meconium) and early appearance of jaundice in normal black neonates could be due to gastrointestinal abnormalities. This observation could lead to early identification of these neonates with resultant early intervention.

Exclusive breastfeeding and postnatal changes in maternal anthropometry.

OBJECTIVE: To evaluate the impact of exclusive breastfeeding (EBFing) practice on maternal anthropometry during the first 6 months of birth. METHOD: Measurement of weight, height, triceps skin-fold thickness (TST), and mid-arm circumference (MAC) was carried out in a matched cohort of women practicing EBFing and those using other methods of infant feeding (non-EBFing group) in the first six months after delivery. RESULT: There were 322 women practicing EBFing and 205 in the non-EBFing group. Weight loss was significantly higher among the EBFing group than in the non-EBFing ones during the first six months of EBFing practice (4.13 Vs 1.06kg), p<0.05. This was primarily due to average weight loss of 3.43kg in EBFing mothers in the last 3-6 months of EBFing practice. There was also a significant loss in MAC in the EBFing mothers than in the non-EBFing one (2.78 Vs 0.75cm), (p<0.05). Whereas the non-EBFing group experienced an increase in their TST (2.12mm), the EBFing mothers had a mean net loss of -1.03mm, (p<0.05). A positive correlation was seen between the frequency ofbreastfeeding and maternal weight changes in the EBFing group ( r=0.56, p<0.05), same was also seen between frequency of breastfeeding and maternal changes in TST and MAC losses in the same group of mothers, (r = 0.08 for TST , and 0.28 for the MAC, p<0.05). The weight/height Z scores (WHZ), an index of thinness and body mass index (BMI) that determines the nutritional status of an individual however remained within normal limit for both groups of mothers despite their weight loss ( WHZ of 0.67, and BMI of 22.09 +/- 3.7 kg/m2) for EBFing mothers, and ( WHZ of 0.71 and BMI of 22.82 +/- 3.2 kg/m2) for the non- EBFing mothers. CONCLUSION: It was concluded that though EBFing enhances more maternal weight loss, the nutritional status of the women practicing it however remained normal limit despite their weight loss.

Newborn screening for sickle cell disease in a Nigerian hospital.

UNLABELLED: Sickle cell disease (SCD) is the most common genetic disorder to affect Blacks. The mortality rate associated with SCD has remained high despite the use of appropriate interventions to manage the various forms of crisis. In developed countries, newborn screening programmes are conducted routinely, which has resulted in a reduction in the SCD mortality rate from 16% to <1%. In developing countries where the disease is prevalent, newborn screening programmes are yet to be established, and the acceptability of such programmes by the parents of newly delivered infants is unknown. OBJECTIVES: This study was carried out to determine the acceptability of newborn screening for SCD on mothers of newly delivered infants, and to establish disease prevalence amongst a newborn population in Nigeria. STUDY DESIGN: This prospective cross-sectional study was conducted at St. Philomena's Hospital, Benin City with mothers of newly delivered infants and their newborn babies. METHODS: Newly delivered mothers were recruited consecutively into the study. Knowledge of their own haemoglobin phenotype status was assessed, and their wishes regarding SCD screening of their babies were determined. Babies were screened using isofocusing electrophoresis. RESULTS: Six hundred and thirty mothers, delivered of 649 babies, were recruited into this study. Nineteen sets of babies were twins. Two mothers refused screening for their babies and 628 mothers or caregivers accepted screening; hence the acceptance rate was 99.7%. Four hundred and fifty-seven (71%) mothers did not know their own haemoglobin phenotype. Six hundred and forty-seven babies were screened for SCD. Of these, two samples were lost to testing and one baby had an indeterminate result; these three cases were not included in the analysis. Of the 644 babies whose results were analysed, 332 (51.6%) were male, 312 (48.4%) were female, 485 (75.3%) were AA, 133 (20.6%) were AS, seven (1.1%) were AC, 18 (2.8%) were SS, and one (0.2%) was SC. CONCLUSION: The majority of mothers in this study did not know their haemoglobin phenotype. Newborn screening for SCD was acceptable to 99.7% of the mothers. The prevalence of SCD in the newborn population was 3% (2.8% SS and 0.2% SC).

Neonatal morbidity pattern in infants born in Benin City to Nigerian mothers with hypertensive disorders in pregnancy.

BACKGROUND: Hypertensive disorders in pregnancy are worldwide in distribution with an incidence that names depending on hospital population and criteria cited for diagnosis METHODS: In a case-control study, the neonatal morbidities of 256 live newborn infants of hypertensive mother were compared with those of 804 infants ofnormotensive mothers. RESULTS: The incidence of some neonatal morbidities such as birth asphyxia, neonatal seizures, neonatal polycythaemia and hyperbilirubinaemia were significantly higher among babies born to hypertensive mothers compared with those born to their normotensive counterparts. The Caesarean delivery rate was also significantly higher in hypertensive than in normotensive mothers. CONCLUSION: Pregnancies complicated by hypertension are associated with an increase in neonatal morbidity. The implication is that newborn infants of hypertensive mothers represent a high-risk group requiring close observation and attention, aimed at prevention and prompt treatment of these morbidities.

Exclusive breastfeeding frequency during the first seven days of life in term neonates.

SUMMARY The study evaluated the effect of frequent suckling on neonatal serum bilirubin level, weight gain and passage of meconium in exclusively breastfed (Ebfed) neonates in the first week of lactation. These variables were investigated for 358 healthy full-term, EBfed Nigerian newborn, delivered vaginally without complications at the Jos University Teaching Hospital (JUTH) in their first week of life. Their maternal breast problems and time of achievement of let-down reflex were also evaluated. Mothers nursed their newborns on the average of 13.3 + 1.6 times in the first 24 hours. This non-significantly decreased to 13.1 + 1.2 by the 7th day. Significant positive correlations were found between the frequency of EBfing and passage of meconium in the first 24 hours of life ( r = 0.41, p < 0.05), and weight gain by day 7 ( r = 0.34, p<0.001). Inverse relationship was observed between frequency of suckling and neonatal serum bilirubin level on days 3 and 7 (r = -.13 and -.15), time of achievement of maternal let-down reflex ( r = -.43) and their breast problems (r = -.38), P values < 0.05. We therefore concluded that frequent suckling during EBfing has beneficial health effect on both the mother and her newborn in the first week of lactation. BG.

Predictors of hearing loss in school entrants in a developing country.

BACKGROUND: Hearing loss is a prevalent and significant disability that impairs functional development and educational attainment of school children in developing countries. Lack of a simple and practical screening protocol often deters routine and systematic hearing screening at school entry. AIM: To identify predictors of hearing loss for a practical screening model in school-aged children. SETTINGS AND DESIGN: Community-based, retrospective case-control study of school entrants in an inner city. METHODS: Results from the audiologic and non-audiologic examination of 50 hearing impaired children in randomly selected mainstream schools were compared with those of a control group of 150 normal hearing children, matched for age and sex from the same population. The non-audiologic evaluation consisted of medical history, general physical examination, anthropometry, motor skills, intelligence and visual acuity while the audiologic assessment consisted of otoscopy, audiometry and tympanometry. STATISTICAL ANALYSIS: Multiple logistic regression analysis of significant variables derived from univariate analysis incorporating student t-test and chi-square. RESULTS: Besides parental literacy (OR:0.3; 95% CI:0.16-0.68), non-audiologic variables showed no association with hearing loss. In contrast, most audiologic indicators, enlarged nasal turbinate (OR:3.3; 95% CI:0.98-11.31), debris or foreign bodies in the ear canal (OR:5.4; 95% CI:1.0-36.03), impacted cerumen (OR:6.2; 95% CI:2.12-14.33), dull tympanic membrane (OR:2.2; 95% CI:1.10-4.46), perforated ear drum (OR:24.3; 95% CI:2.93-1100.17) and otitis media with effusion OME (OR:14.2; 95% CI:6.22-33.09), were associated with hearing loss. However, only parental literacy (OR:0.3; 95% CI:0.16-0.69), impacted cerumen (OR:4.0; 95% CI:1.66-9.43) and OME (OR:11.0; 95% CI:4.74-25.62) emerged as predictors. CONCLUSION: Selective screening based on the identification of impacted cerumen and OME will facilitate the detection of a significant proportion of hearing impaired school entrants.

Home management of febrile convulsion in an African population: a comparison of urban and rural mothers' knowledge attitude and practice.

To determine the knowledge, attitude and practice (KAP) of home management of febrile convulsion (FC), by mothers in the community, focus group discussions (FGD) were conducted in two communities, Uselu (urban) and Evbuomodu village (rural), both in Edo State, Southern Nigeria. The study was conducted between December 2000 and February 2001. Our findings show that 71% of urban mothers compared to 25% of rural mothers attributed the cause of FC to fever (chi(2)=24.17: p<0.001). Seventy-five percent of mothers from rural community and 28.6% of urban mothers attributed the cause to witchcraft and/or evil spirits. Twenty-five percent of rural mothers also attributed abnormality of the spleen as a cause of FC. All the mothers, both urban and rural, were not directly involved in the management of the convulsive episode due to panic and confusion. Ninety-two percent of urban and all the rural mothers permitted the use of traditional medicine while 7.1% of urban mothers employed prayers during convulsion. Twenty percent of urban and twenty-two percent of rural mothers use urine (human and or cow's) for treating FC at home. Other home remedies include kerosene, fuel and crude oil. Mass enlightenment campaign for the community, especially the rural, against use of harmful traditional remedies to treat FC at home is strongly advised.

The hearing profile of Nigerian school children.

The paucity of up-to-date and representative epidemiological data on hearing disorders in Nigeria has been observed as undermining the effective advocacy of prevention initiatives. This study attempts to address this problem by evaluating the prevalence and pattern of hearing impairment in school entrants. Parental interviews, otoscopy, pure-tone audiometric screening (frequency 0.5-4 kHz) and tympanometric examinations were conducted for a representative sample of 359 school children in an inner city area of Lagos. The prevalence of hearing loss was 13.9%. Middle ear abnormalities were noted in 20.9% of the study population, of which 18.7% were reported with otitis media with effusion. Impacted cerumen, documented in 189 children (52.6%), was the most common disorder. It showed significant association with hearing loss (P<0.001) and school performance (P<0.01). Tympanic membrane abnormalities were observed in 144 (40.1%) children. Of these, 45 (31.3%) showed abnormal tympanograms while 28 (19.4%) reported hearing loss (P<0.05). The early detection and management of hearing problems is relatively rare, thus precluding the determination of possible aetiological factors for the observed abnormalities. Poor public awareness, dearth of relevant facilities and the lack of early screening programmes are major known contributory factors. The well established national immunisation programme offers a cost-effective platform within the primary health-care system for addressing the high prevalence of hearing abnormalities in school children.

HIV seroprevalence in women of childbearing age in Benin City, Nigeria.

HIV seroprevalence was still low in some parts of Nigeria from 1989 to 1991, and only limited reports were available on seroprevalence in childbearing women. In order to assess HIV seroprevalence in pregnant women in Benin City and Bendel State, two sampling methods, unlinked anonymous testing and voluntary testing, were employed. Data obtained from testing 358 sera from pregnant women attending antenatal clinics and cord blood from labour wards in Benin City were compared with data obtained from testing 833 pregnant women at four sentinel surveillance sites in Bendel State. The samples were all analysed by ELISA technique at the University Teaching Hospital, Benin City. Repeatedly reactive samples were confirmed by Western blot. The seroprevalence of HIV-1 in Benin City and in Bendel State was 0.28 percent and 0.36 percent, respectively. At this point in time, intensive health education campaigns targeted at the general population are necessary.

Early diagnosis of septicaemia in infants with respiratory distress in the tropics.

A prospective study of buffy coat microscopy of 108 infants with respiratory distress during the first 48 h of life was undertaken. Thirty-two infants (29.6%)had positive blood cultures. The buffy coat was stained with methylene blue and with Gram's stain. Using methylene blue staining, 94% shared organisms in the buffy coat. Whereas using Gram's stain only 50% were positive--all of which were also positive with methylene blue. Twenty-four infants with negative blood cultures had radiological signs of pneumonia. Of these, 83% showed organisms in the buffy coat with both methylene blue and Gram staining. We conclude that buffy coat microscopy provides a simple and reliable guide in the early diagnosis of neonatal septicaemia or lung infection in infants with respiratory distress.

PIP: A prospective study of buffy coat microscopy in newborns with respiratory distress confirmed the reliability of this procedure in the early diagnosis of neonatal septicemia or lung infection. The buffy coat smear examination was performed on 108 consecutive infants admitted to the University of Benin (Nigeria) Teaching Hospital from April to August 1991 with signs of respiratory distress (e.g., respiratory rate of 60 or more per minute, retraction score of 4 or more, and grunting respirations) during the first 48 hours of life. Bacteriologic cultures indicated that 32 infants (30.7%) were septic. When methylene blue staining was used, 30 septic infants (94%) shared organisms in the buffy coat compared to only 16 (50%) with Gram staining. Of the 76 infants with negative cultures, 24 had radiologic evidence of pulmonary infiltration consistent with pneumonia. (The lack of microbiologic evidence of infection in these infants may reflect the administration of antibiotics prior to delivery.) Of these 24 infants, 20 (83%) showed organisms in the buffy coat with both methylene blue and Gram staining. The specificity of negative buffy coat smears in the non-septic group with normal chest x-rays was greatest (88.5%) when the results of methylene blue staining and Gram staining were combined.

Diffuse abdominal wall cellulitis in ascending omphalitis--a lethal association in neonatal necrotizing fasciitis.

Necrotizing fasciitis is a grave complication of ascending omphalitis in the neonate, but because it is rare some of the signs are not well documented. Rapidly progressive anterior abdominal wall edema and cellulitis were noted in 16 patients who were clinically diagnosed with necrotizing fasciitis. Fifteen of these patients died soon after emergence of anterior abdominal wall edema and cellulitis. The appearance of anterior abdominal edema and cellulitis in a patient with ascending omphalitis has serious implications and demands intensive care if the patient is to survive.

Placental malaria and pregnancy outcome.

Malaria parasitemia was assessed in 312 placentae of singleton deliveries in Benin. The prevalence rate was 45.19%. The dominant infecting specie was Plasmodium falciparum. High density parasitemia of placental smear in 44.68% was associated with preterm delivery, low birthweight, intrauterine growth retardation and neonatal mortality. Placental histological diagnosis of malaria in 57.69% was more frequently associated with intrauterine growth retardation. Extraplacental parasitemia decreased but intraplacental parasitemia increased with gestational age.

Malaria parasitaemia in neonates with predisposing risk factors for neonatal sepsis: report of six cases.

In a study of neonatal malaria at the University of Benin Teaching Hospital, we documented the features of six neonates in an effort to highlight that the manifestations of malaria in the newborn cannot be readily distinguished from those of neonatal sepsis. Maternal peripartum fever, an important identifiable risk factor for neonatal sepsis, also featured prominently in the mothers of these babies. These mothers ingested pyrimethamine weekly in the course of their pregnancy. All six neonates were critically ill. Their cultures of blood, CSF and urine for bacterial pathogens yielded no growth and they were unresponsive to conventional antibiotics. The diagnosis of malaria should be considered, in spite of regular maternal ingestion of antimalarial prophylaxis with pyrimethamine, in critically ill neonates in malarious areas. All six neonates responded satisfactorily to oral doses of chloroquine. We therefore suggest that a blood film for malaria parasites be included in screening for neonatal sepsis as part of the initial work-up.

Neonatal bone infarction following cord sepsis: case report.

An unusual case of infarction of the tibia in a neonate who presented with sepsis following poor cord management at birth is reported. He was managed as for necrotizing enterocolitis and had limited debridement of infarcted limb because the parents refused amputation of the limb. This patient was a diagnostic problem. Necrotizing fasciitis and in retrospect purpura fulminans are considered as possible diagnoses and are discussed briefly.