An evaluation of school health services in Sagamu, Nigeria.

CONTEXT: School health services (SHS) have been shown to be suboptimal in Nigeria. The paucity of data on the status of SHS in Sagamu makes it even more challenging for instituting corrective action. AIM: To evaluate SHS in public and private schools in Sagamu. SETTINGS AND DESIGN: This was a cross-sectional study carried out on private and public nursery/primary and secondary schools in Sagamu, Ogun State. MATERIALS AND METHODS: A total of 91 schools, randomly selected from 182 available, comprising 53 private nursery/primary schools, 22 public nursery/primary schools, 11 private secondary schools and 5 public secondary schools, were inspected for availability of the components of the SHS and evaluated using the SHS Evaluation Scale (SHSES). STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 15.0. Categorical variables were analyzed using Chi-square test. Level of significance was taken to be P < 0.05. RESULTS: Only one (1.1%) school benefited from the services of a school doctor. Essential drugs and materials for first aid services were available in 85 (93.4%) of the schools, while only 26 (28.6%) had a sick bay. Screening tests for disabilities were performed in only 10 (11%) of the schools visited. Although school midday meals were available in all the schools, they were not free. Private secondary schools had the highest percentage of good school health evaluation scores (63.6%), while 96.2% of the private primary schools had poor health service evaluation scores. CONCLUSIONS: SHS are unsatisfactory in Sagamu. It is therefore necessary for all stakeholders in Sagamu schools (private and public) to provide the materials and manpower needed to achieve effective SHS in the area.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria.

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6%) and 3 (0.9%) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12 (3.4%) and 4 (1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups. (Afr Reprod Health 2008; 12[1]:96-100)

Infant feeding and lactational amenorrhea in Sagamu, Nigeria.

Five hundred and twenty educated, breastfeeding women in Sagamu, Nigeria, were observed prospectively in order to describe their infant feeding practices and to determine whether any predictors of the return of menses could be identified. The women remained amenorrheic for seven months. Compared with similarly selected women in other countries, they regularly fed their infants with supplements from a very early age, yet breastfeeding frequency and duration did not decline dramatically. Semi-solid food was introduced at about four months and such supplementation, as well as earlier supplementation with milk/milk-based feedings, was associated with the return of menses. The median duration of abstinence was about four months but the mean may have been much longer. No woman became pregnant until her infant was weaned.

A study of neonatal deaths at the Ogun State University Teaching Hospital, Sagamu, Nigeria.

A two-year prospective study of neonatal deaths at a Nigerian University Teaching Hospital is presented. There were 55 deaths among 1081 inborn live deliveries (50.88/1000). Low birthweight babies accounted for 60% of deaths. There were 49 (45.33/1000) perinatal deaths, 61% of which occurred within 24 hours. The mortality rate of term small-for-gestational age neonates was higher than that of their appropriate-for-gestational age counterparts (chi 2 = 4.55, P < 0.05). The mortality rate for 315 referred admissions was 400/1000. Referred very low birthweight babies had a better outcome than inborn ones. Severe infections, severe birth asphyxia, respiratory distress syndrome and recurrent apnoea were among the leading causes of death in this study. There is a need for improved intensive care facilities for the high-risk newborn. Greater effort is required to improve early utilization of available maternity services.

PIP: Neonatal mortality accounts for 40-60% of all infant mortality in developing countries, or more than 50% of all childhood mortality. The authors present a two-year prospective study of neonatal deaths at Ogun State University Teaching Hospital (OSUTH) in Sagamu, Nigeria, in which the findings for patients born in the hospital are compared with those for referred babies and the principal associated causes of mortality in various birthweight groups. During the study period, 1081 live babies were born at OSUTH, of whom 353 were admitted to the neonatal ward for various indications. 315 referred babies were also admitted. Altogether, 181 babies died, 55 of whom were inborn and 126 of whom were referred. Low birthweight babies accounted for 60% of deaths and there were 49 perinatal deaths, 61% of which occurred within 24 hours. The mortality rate of term small-for-gestational age neonates was higher than that of their appropriate-for-gestational age counterparts. Further, referred very low birthweight babies had a better outcome than inborn ones. Severe infections, severe birth asphyxia, respiratory distress syndrome, and recurrent apnoea were among the leading causes of death in the study. The authors note a need for improved intensive care facilities for the high-risk newborn and greater effort to improve the early utilization of available maternity services.

Studies on the effectiveness, safety and acceptability of fluids from local foodstuffs in the prevention and management of dehydration caused by diarrhoea in children.

Two fluids derived from local staple food, Manioc Salt Solution (MSS) and Pap Salt Solution (PSS) were assessed and compared with the World Health Organization/Oral Rehydration Solution (WHO/ORS) in 333 children aged between 6 and 60 months in a clinical trial. All the children had some dehydration after episodes of acute watery diarrhoea using WHO criteria. All the children who were placed on MSS and PSS, as well as ORS were satisfactorily rehydrated. There was no significant difference in pre- and postserum electrolytes of the children on the three types of fluids. The fluids were found to be acceptable, readily available, easy to prepare and cheaper than the ORS fluid. There was no taboo against the fluid. It is noteworthy that there was no significant difference in the sugar and electrolyte contents of the different varieties of the manioc and pap available in this environment, thus making the MSS and PSS effective and readily available substitutes to ORS. The two fluids are therefore recommended as rehydrating fluids for children with some dehydration in the absence of WHO/ORS fluid.

Clinical trial of pap-salt solution in the treatment of dehydrated children.

PIP: In a randomized clinical trial the efficacy of Pap-salt solution (PSS) was compared with the World Health Organization (WHO) oral rehydration salt (ORS) solution in 212 children 6 months to 5 years old: 101 cases (52 males and 49 females) and 111 controls (41 males and 70 females) at the primary health care centers of Ijebu-Igbo, Ita-Oba in Sagamu, and at the oral rehydration therapy (ORT) unit of the Ogun State University Teaching Hospital, Sagamu, Nigeria, between June 1991 and June 1992. 164 children (77.3%) belonged to the lowest socioeconomic classes. Maize pap (Ogi) was prepared by soaking maize in water for 2-3 days for fermentation to occur. PSS was prepared from raw pap and the cooked pap was then made up to 600 ml with the addition of more water and 3 ml of table salt. Each child received 75 ml per kg of ORS solution or PSS orally over a 4-hour period. Those patients who still showed signs of dehydration were given a further 75 ml/kg of the same solution over another 4-hour period. The patients were followed up on 2 consecutive days at home by community health nurses. All the 101 children who received PSS were successfully treated and the remaining 2 were lost to follow-up. There was no significant difference in the mean volumes of PSS (1015.4 ml) and ORS (1036 ml) required for rehydration (p 0.05). 96 mothers found PSS easy to prepare and readily accepted by their children, and 97 stated that the ingredients required for preparation were available. There was no difference ( p 0.05) in the pre- and post-treatment values of the serum electrolytes in the 2 groups. PSS was acceptable to the patients, readily available, and much cheaper than the ORS solution. Therefore, PSS is recommended for the rehydration of children with mild dehydration in situations where ORS solution is not available.^ieng

Clinical trial of pap-salt solution in the treatment of dehydrated children

In a randomised clinical trial; the efficacy of pap-salt solution (PSS) was compared with the WHO oral rehydration salt (ORS) solution in 212 children; aged between six months and five years. All the children who received PSS were successfully treated and there was no difference (p0.05) in the pre- and post-treatment values of the serum electrolytes in the two groups of children. Pap-salt solution was acceptable to the patients; readily available and much cheaper than the ORS solution. PSS is; therefore; recommended for the rehydration of children with mild and some degree of dehydration in situations where ORS solution is not available

Spirometric standards for healthy Nigerian children and adolescents.

Forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0) and peak expiratory flow rates (PEFR) were determined in 131 school children and adolescents aged between 5 and 20 years to determine normal values among Nigerian school children. The results were analyzed with respect to the ages, heights, weights, chest circumference and body surface areas of the subjects. A good correlation was observed between these anthropometric measurements and the indices of pulmonary function. The mean values of FVC, FEV1.0, and PEFR were lower than those reported in caucasian children but similar to the available data in the literature for African children. Mean FEV1.0, FVC and PEFR values were higher in males than in females at most ages.

PIP: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1.0), and peak expiratory flow rates (PEFR) were determined in 131 school children and adolescents ages 5-20 to determine normal values among Nigerian school children. The results were analyzed with regard to ages, height, weight, chest circumference, and body surface areas of the subjects. A good correlation was observed between these anthropometric measurements and the indices of pulmonary function. The mean values of FVC, FEV 1.0, and PEFR were lower than those reported in Caucasian children but similar to the available data in the literature for African children. Mean FEV 1.0, FVC, and PEFR values were higher in males than in females at most ages.

Comparative study of glycosylated haemoglobin and serum fructosamine values in children with protein-energy malnutrition.

Serum fructosamine, glycosylated haemoglobin (HbAic), fasting blood glucose and serum proteins were determined in 50 malnourished children aged 1-5 years and in 25 healthy and nutritionally normal children of the same age group. It was observed that both HbAic and fructosamine values correlated well with the blood glucose values of the patients. It was also observed that the patients had significantly elevated values of HbAic, indicating the existence of glucose intolerance in them. In contrast, the fructosamine values were significantly reduced in the patients and this was attributed to the hypoproteinaemia in such patients. It was concluded that while both HbAic frustosamine correlate well with blood glucose values, HbAic gives a better reflection of the glycaemic status of malnourished children because its level is not significantly altered by hypoproteinaemia. HbAic measurement may, therefore, be a more reliable indicator of glucose status than serum fructosamine in children with protein-energy malnutrition.

Glycosylated haemoglobin levels in children with protein-energy malnutrition.

Fasting blood glucose, serum protein and glycosylated haemoglobin level (HbA1c) were determined in 50 children (aged 1-5 years) suffering from protein-energy malnutrition and in 25 healthy and nutritionally normal children of the same age group. It was observed that HbA1c correlated well with the blood glucose values of the children. It was also observed that they had significantly higher values of HbA1c than the controls, indicating the existence in them of glucose intolerance. Long-term monitoring of the glycaemic status is therefore suggested as a means of assessing any relationship between glycosylated haemoglobin and impaired pancreatic function in such patients.

Acute bacterial meningitis in children.

A retrospective study of 48 children with pyogenic meningitis who were admitted between January 1986 and December, 1987 at the Ogun State University Teaching Hospital, Sagamu has shown that childhood meningitis is an important health problem in the community as it accounted for 2.8% of 1,724 admissions into the paediatric ward. The ages of the patients ranged from three weeks to twelve years with a mean of 2 1/2 years. The commonest causative organism was Streptococcus pneumoniae which accounted for 67.5% of all isolates. The mortality rate was 26.1% while significant morbidity occurred in 23.5% of survivors. Important prognostic factors included the presence of coma or persistent convulsions, low CSF glucose and low serum sodium levels as well as the interval between symptoms and treatment.