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BACKGROUND: Neonatal mortality continues to be a challenge in Nigeria, where low-quality care, caregivers' ignorance of signs of neonatal illnesses, and prevalent use of unorthodox alternatives to health care predominate. Misconceptions originating and propagating as traditional practices and concepts can be linked to adverse neonatal outcomes and increased neonatal mortality. This study explores the perceptions of causes and management of neonatal illness among caregivers in rural communities in Enugu state, Nigeria. METHODS: This was a cross-sectional qualitative study among female caregivers of children residing in rural communities in Enugu state. A total of six focus group discussions (FGDs) were conducted; three in each of the communities, using an FGD guide developed by the researchers. Using pre-determined themes, thematic content analysis was used to analyze the data. RESULTS: The mean age of respondents was 37.2 ± 13.5 years. Neonatal illnesses were reportedly presented in two forms; mild and severe forms. The common causes of the mild illnesses reported were fever, jaundice, eye discharge, skin disorders, and depressed fontanelle. The severe ones were convulsion, breathlessness/difficulty or fast breathing, draining pus from the umbilicus, and failure-to-thrive. The caregivers' perceptions of causes and management of each illness varied. While some believed these illnesses could be managed with unorthodox treatments, others perceived the need to visit health centers for medical care. CONCLUSIONS: Caregivers' perception on the causes and management of common neonatal illnesses in these communities is poor. Obvious gaps were identified in this study. There is a need to design appropriate interventions to dispel the myths and improve the knowledge of these caregivers on neonatal illnesses towards adopting good health-seeking behaviours.

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Background: Enumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations. Objectives: The objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography. Methods: A cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls. Results: A significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001).All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p<0.005). Conclusion: This result shows that children with sickle cell anemia have increased valvar size diameter compared with those with normal hemoglobin type. A significantly higher proportion of respondents in type SS group had abnormal left ventricular systolic and diastolic dysfunction when compared with those in type AA group.

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Background: This study ascertained the level of distraction attributable to cell phone by drivers in Enugu. Methodology: This study was conducted in Enugu, Nigeria using a validated structured questionnaire randomly administered to drivers in different locations in the city. Study period was 2 months and different forms of distraction while driving were tested. Result: There were 500 participants in the study. 306(61.2%) were males and 194(38.8%) were females. The mean age of respondents was 43.85±9.89 years. Ninety-nine percent of respondents were aware of the ban on use of cell phones while driving but as much as 97.8% of the drivers still use cell phones while driving. Conclusion: Level of distracted driving in Enugu is quite high and this has the potential to cause serious road crashes which can impact negatively on the lives of the people. The need for concerted effort to educate people on the dangers of cell phone use while driving cannot be over emphasized. Key Lessons: - There is a paucity of literature on distracted driving in Nigeria even with the high incidence of Road Traffic Accident.- Awareness of laws on distracted driving is not the challenge rather it is compliance. There is need for ways of enforcing the existing laws on distracted driving as mere knowledge of the provisions of the law does not ensure compliance.- Enforcement of laws on distracted driving will play a preventive role in reducing the incidence of RTAs and its associated health implications.

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BACKGROUND: In children particularly in the developing world, there is a tendency to downplay the role of primary hypertension in their health. In adults, a number of factors have clearly been associated with the incidence of hypertension. Knowledge of the prevalence of hypertension and its associated factors among children in our environment is important and could inform the need for lifestyle changes and routine blood pressure (BP) checks in children so as to reduce BP-related health risks. AIM: The aim of this study is to document the prevalence of hypertension and its risk factors among children in Enugu, Nigeria. MATERIALS AND METHODS: Children aged 6-17 years attending the outpatient clinic of a tertiary hospital, were enrolled for the study. Their socioeconomic status (SES), weight, height, BP, and dipstick urinalysis were measured using standardized methods. Adherence to Mediterranean diet was assessed using the Mediterranean Diet Quality Index (KIDMED). The prevalence of hypertension and the influence of these factors on their BP were analyzed. RESULTS: Forty-six (9%) of the 491 participants had hypertension. Of these 46 hypertensive children, 72% were females while a significantly higher proportion 57% (P = 0.006), were in the age group 13-17 years. While age, gender, and the presence of protein in urine were significantly associated with hypertension in these children; body mass index, diet, family history of hypertension, and SES were not. CONCLUSION: The prevalence of hypertension in children in this environment is high and appears to be increasing. There is need for routine BP and urinalysis check for all children in our clinics and wards.

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AIM: The aim of this study is to determine the pattern of cancer mortality (CM) seen in the University of Port Harcourt Teaching Hospital (UPTH) which is a cancer reference center in the Niger Delta Region. METHODOLOGY: This is a 6-year retrospective study of cancer-related deaths in UPTH using patients' admission registers in all the wards and emergency units. Furthermore, the death certificates of cases were reviewed. RESULTS: Three hundred and sixteen cases of cancer-related deaths occurred, involving 174 females and 142 males, in a female-to-male sex ratio of 1.2:1. All age groups were affected, with age group 40-49 years accounting for the majority (20.6%). CM was seen in all the systems, except the central nervous system. Cancers of the gastrointestinal tract and its accessory organs (liver and gall bladder) caused most mortality (27.9%), in a female-to-male ratio of 0.8:1. The single most involved organ in CM is the female breast (20.6%), distantly followed by mortality due to prostate cancers and hematolymphoid cancers which accounted for 9.2% each. Colorectal cancers accounted for 7.3% of cancer deaths and ranked 4th. Cancers of both cervix and stomach each accounted for 5.7% of mortality. The major histologic diagnoses were carcinomas (adenocarcinoma; 36.7%, invasive ductal carcinoma; 20.3%, squamous cell carcinomas; 8.2% and hepatocellular carcinomas; 4.4%). Leukemias and lymphomas accounted for 9.2% of cases, whereas sarcomas accounted for 5.1% of cases. CONCLUSION: Infection-related and noninfection-related cancers cause most mortality in UPTH. The 5th decade was the most commonly affected, while female breast was the single most involved organ. Breast, prostate and hematolymphoid malignancies are common causes of CM with death from breast occurring earliest. Majority of the deceased were educated, working-class urban dwellers. More advocacies on public acceptance of cancer screening and cancer preventive lifestyles as well as governments' improvement on workforce training and treatment infrastructure will improve the current CM profile in Port Harcourt.

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BACKGROUND: Due to the health and economic benefits of breast milk, the World Health Organization (WHO) recommends that for infants who cannot receive breast milk from their own mothers, the next preferred option is donated breast milk. This recommendation is however rarely practiced in most developing countries where donor milk is not widely accepted. METHODS: This cross-sectional multi-center study enrolled mothers attending antenatal or pediatric clinics in six tertiary institution in south-east Nigeria using purposive and convenient sampling method. Data collection was done using pretested questionnaires. The study aimed to assess the knowledge, acceptability and willingness to donate breast milk and/or use donated breast milk for their infants It also explored factors that determine this behavior. RESULTS: A total of 1235 mothers participated; 39% (480/1225) have heard about the concept of donor milk, while only 10% (79/759) and 7% (81/1179), respectively, had adequate knowledge of the concept and policy on donor milk. Sixty percent indicated willingness to use donor milk or donate breast milk if need arises. Respondents with lower age (p = 0.049) and with higher occupational status (p = 0.001) were more likely to have adequate knowledge of donor breast milk, while respondents with lower educational attainment (p = 0.002) and those who are non-Christians (p = 0.004) were more likely to request financial inducement for donating their breast milk. Adequate knowledge of the concept of donor milk (p = 0.001), preference of donor milk to infant formula (p = 0.001) and requirement of financial remuneration (p = 0.001) were the only significant predictors of willingness to donate and/or receive donated breast milk. CONCLUSION: The knowledge of the concept of donor breast milk and awareness of policies regulating its practice in Nigeria is low, but the prospect of its acceptability is high among mothers surveyed in south-east Nigeria. Targeted public education by relevant government agencies in collaboration with clinicians, community and religious leaders about the concept of donor breast milk to families may help increase the acceptance and practice of donating breast milk and/or use of donated breast milk among mothers in the region.

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BACKGROUND: Neonatal hyperbilirubinaemia is one of the commonest causes of hospital visit in the neonatal period. When severe, it is a leading cause of irreversible neurological and musculoskeletal disability. Prompt recognition and timely interventions are imperative for a drastic reduction in complications associated with severe hyperbilirubinaemia in newborns. METHODS: We report a 4-year descriptive and longitudinal study to determine the causes, clinical presentations and long-term outcomes in newborns admitted for severe neonatal jaundice. METHODS: Newborns admitted and managed for severe neonatal jaundice at the Enugu State University Teaching Hospital during a 4-year period were enrolled and followed up for 2 years. RESULTS: A total of 1920 newborns were admitted during the study period and 48 were managed for severe hyperbilirubinaemia giving an in-hospital incidence rate of 25 (95% CI 18-32) per 1000 admitted newborns. The mean age of onset was 3.4 ± 0.5 days (range 1-8 days) and hospital presentation from time of first notice was 4.3 ± 0.4 days (range 1-9 days). The total and unconjugated admission serum bilirubin ranged from 7.1 to 71.1 (mean 26 ± 2.5 mg/dl) and 4.2 to 46.3 mg/dl (mean 18.3 ± 9.2) respectively. Earliest sign of severe hyperbilirubinaemia in newborns were: refusal to suck (15.2%) and depressed primitive reflexes (24.5%) while the commonest signs included high pitch cry (11.9%), convulsion and stiffness (6.9%) and vomiting (6.3%) in addition to the former signs. The major causes of severe hyperbilirubinaemia were idiopathic (33.3%), sepsis (35.3%), ABO incompatibility (17.6%) and glucose-6-phosphate dehydrogenase (G6PD) deficiency (11.8%). Long-term sequelae on follow-up included delayed developmental milestone attainment, postural deformities, visual and seizure disorders. CONCLUSIONS: There is urgent need for continued education for mothers, families and healthcare workers on the danger newborns with jaundice could face if not brought early to the hospital for timely diagnosis and management.

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Congenital abnormalities are important causes of morbidity and mortality in children and significantly add to the burdens on healthcare in developing countries. Unfortunately, there remains a paucity of information on congenital birth defects in most developing countries. This is a 4-year prospective study that assessed the patterns and predictors of congenital anomalies among newborns at the Enugu State University Teaching Hospital, Nigeria. In total, 5830 deliveries were recorded, of which 38 had congenital anomalies, giving an incidence rate of 6.5/1000 live births. Fifty-two newborns were enrolled as nested controls. Factors significantly associated with congenital anomalies were low birth weight (p = 0.009), low socio-economic class (p = 0.011), lower maternal educational attainment (p = 0.009), parity of ≥ 5 (p = 0.002), febrile illness (p = 0.001) and the use of local concoction in index pregnancy (p = 0.009). More than half of the anomalies reported involved the musculoskeletal system. Occurrence of congenital anomalies may be prevented by curtailing risk factors identified in this study.

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AIM: Neonatal surgery in low-income and middle-income countries has a poorer outcome when compared with high-income countries. This study evaluated the management challenges and outcomes of neonatal surgery before and after the introduction of focused interdisciplinary team management in 2013. METHODS: We retrospectively analysed neonatal surgery undertaken at two referral hospitals in Enugu, south-eastern Nigeria from January 2011 to November 2015. Cases managed prior to July 2013 (group A) were compared with those managed from July 2013 (group B). RESULTS: There were 91 cases (group A, 47; group B, 44). The common neonatal conditions were oesophageal atresia (21), anorectal malformation (18) and intestinal atresia (18). The surgical conditions, birthweight, age at presentation and associated anomalies did not differ in the two groups. The treatment was also similar except in oesophageal atresia, where cardiac banding was added to the temporary gastrostomy in late presenting cases with undernutrition in group B. Postoperative complications occurred in 43 (47.3%) cases (group A, 55.3%; group B, 38.6%; P > 0.05), and the overall mortality was 33 (35.3%: group A, 48.9%; group B, 22.7%: P < 0.05). Causes of mortality were unremitting sepsis (group A, 11; group B, 5), anaesthesia complications (group A, 5; group B, 0) and respiratory complication (group A, 7; group B, 5). Delayed presentation, inadequate facilities and defective health insurance scheme were challenges in the two groups. CONCLUSION: Despite the persisting challenges, co-ordinated team management may result in the modest improvement of outcomes of neonatal surgery in our setting. Addressing these challenges may further improve outcomes.

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BACKGROUND: Poor nutritional practices especially in pregnancy and early childhood can result in dire consequences in the growth and development of a child. METHODS: This study using purposive sampling enrolled 149 women who had carried at least one pregnancy to term in Enugu south east Nigeria. Logistic regression analysis was used to assess association between avoidance of certain food in pregnancy and selected socio-demographic factors. RESULTS: Approximately 37 % of respondents avoided some foods in pregnancy due to food taboos and no relationship was seen between this avoidance of food and maternal educational attainment, parity (number of obstetrics deliveries) and occupation. Snail and grass-cutter meat were the commonly avoided food in pregnancy while egg were commonly avoided in children under-two years old. Some respondent believed eating snail and grass-cutter meat makes a child sluggish and labour difficult respectively while starting egg early for a child could predispose them to stealing later in life. CONCLUSION: Discussion about food taboos during antenatal care visits and during community education can help reduce the traditional belief about certain food in pregnancy and early childhood.

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BACKGROUND: There is considerable debate about the two most commonly used scoring methods, namely, the formula scoring (popularly referred to as negative marking method in our environment) and number right scoring methods. Although the negative marking scoring system attempts to discourage students from guessing in order to increase test reliability and validity, there is the view that it is an excessive and unfair penalty that also increases anxiety. Feedback from students is part of the education process; thus, this study assessed the perception of medical students about negative marking method for multiple choice question (MCQ) examination formats and also the effect of gender and risk-taking behavior on scores obtained with this assessment method. METHODS: This was a prospective multicenter survey carried out among fifth year medical students in Enugu State University and the University of Nigeria. A structured questionnaire was administered to 175 medical students from the two schools, while a class test was administered to medical students from Enugu State University. Qualitative statistical methods including frequencies, percentages, and chi square were used to analyze categorical variables. Quantitative statistics using analysis of variance was used to analyze continuous variables. RESULTS: Inquiry into assessment format revealed that most of the respondents preferred MCQs (65.9%). One hundred and thirty students (74.3%) had an unfavorable perception of negative marking. Thirty-nine students (22.3%) agreed that negative marking reduces the tendency to guess and increases the validity of MCQs examination format in testing knowledge content of a subject compared to 108 (61.3%) who disagreed with this assertion (χ2 = 23.0, df = 1, P = 0.000). The median score of the students who were not graded with negative marking was significantly higher than the score of the students graded with negative marking (P = 0.001). There was no statistically significant difference in the risk-taking behavior between male and female students in their MCQ answering patterns with negative marking method (P = 0.618). CONCLUSIONS: In the assessment of students, it is more desirable to adopt fair penalties for discouraging guessing rather than excessive penalties for incorrect answers, which could intimidate students in negative marking schemes. There is no consensus on the penalty for an incorrect answer. Thus, there is a need for continued research into an effective and objective assessment tool that will ensure that the students' final score in a test truly represents their level of knowledge.

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OBJECTIVES: The aim of the study was to determine the prevalence and correlates of hepatitis B virus infection in adolescents in Enugu-urban. METHODS: A cross-sectional seroprevalence survey was conducted among school children aged 10-18 years. Subjects were selected using multistage sampling. Hepatitis B surface antigenaemia (HBsAg) was assayed for in blood using rapid enzyme-linked immunosorbent assay kits. Data were analyzed using statistical package for social sciences version 16.0 (p < 0.05). RESULTS: Four hundred and twenty children were recruited. Of these, 13 tested positive for HBsAg, giving an overall hepatitis B seroprevalence of 3.1%. Social class, scarifications/tattooing, circumcision and history of surgery were the significant modes of transmission. CONCLUSION: The seroprevalence of hepatitis B among children in the study population is high. Its screening in school children should be incorporated into school health services in our setting while awareness campaigns and health education on its modes of transmission and prevention should be promoted and strengthened.

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BACKGROUND: Preterm birth is a high risk condition associated with significant mortality and morbidity in the perinatal, neonatal, and childhood periods, and even in adulthood. Knowledge of the epidemiology of preterm births is necessary for planning appropriate maternal and fetal care. OBJECTIVE: The objective of this study was to determine the prevalence, pattern, and perinatal mortality associated with preterm births at the University of Nigeria Teaching Hospital, Enugu, South East Nigeria. METHODS: This was a review of prospectively collected routine delivery data involving preterm deliveries that occurred between 1 January 2009 and 31 December 2013. Data analysis involved descriptive and inferential statistics at 95% level of confidence using SPSS version 17.0 for Windows. RESULTS: There were 3,760 live births over the 5-year study period out of which 636 were preterm births, giving a prevalence rate of 16.9%. Spontaneous preterm births occurred in approximately 57% of preterm births while provider-initiated births occurred in 43%. The mean gestational age at preterm deliveries was 32.6±3.2 weeks while the mean birth weight was 2.0±0.8 kilograms. Approximately 89% of preterm births involved singleton pregnancies. Sixty-eight percent of preterm births were moderate to late preterm. The male:female ratio of preterm babies born during the period was 1.2:1. The adjusted perinatal mortality rate for preterm babies in the study center was 46.1% (236/512). The stillbirth rate for preterm babies was 22.0% (149/678) and the adjusted early neonatal death rate was 24.0% (87/363). CONCLUSION: The prevalence of preterm births and associated perinatal mortality were high which may be a reflection of suboptimal prenatal and newborn care. An urgent improvement in prenatal and newborn care is therefore needed in the study center in order to improve the capacity to prevent or abate preterm labor, and preterm premature rupture of membranes; and to reduce avoidable stillbirths. Further upgrading of personnel and facilities in the newborn special care unit is also required to minimize early neonatal deaths.

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BACKGROUND: The World Health Organisation has recommended the use of anthropometric measurements as birth weight surrogates. However, it has been found that cut-off points for these anthropometric measurements vary across nations and ethnic groups. OBJECTIVES: To determine the predictive values of chest circumference (CC), occipito-frontal circumference (OFC) and their combinations for low birth weight (LBW) detection in Igbo newborns. METHODS: Live newborns of Igbo origin were recruited within 24 hours of delivery. Their CC, OFC and weight were measured. Cut off points for predicting low birth weight was determined using ROC analysis. RESULTS: A total of 511 live newborns were recruited. For birth weight <2500 g, cut-off values were: CC 30.9 cm; OFC 33.8 cm; summation of CC and OFC 64.9 cm; ratio of CC to OFC 0.92. For weight <2000 g, the cut-off values were: CC 29.6 cm; OFC 32.8 cm; summation of CC and OFC 63.7 cm; ratio of CC to OFC 0.91. CC correlated best with birth weight (r = 0.918). CONCLUSION: CC is the best predictor for LBW.

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In a previous retrospective study, it was observed that the greater the amounts of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the blood, the lesser the number of complications of sickle cell disease (SCD) and the higher the steady state haemoglobin level. SCD causes ischaemia-reperfusion injury and inflammation; which can be ameliorated by a metabolite of DHA that down-regulates expression of pro-inflammatory genes. The objectives of this prospective pilot study were to evaluate the effects of DHA and EPA supplements in SCD, and test the hypothesis that these effects are mediated partly by reducing inflammation. Oral DHA and EPA supplements were given to 16 SCD patients for 6 months. We then compared pre- and post-supplementation values of number of crisis, steady state Hb, plasma unconjugated bilirubin and three indices of inflammation: plasma interleukin-6, blood neutrophil and platelet counts. There was a significant reduction in the plasma level of unconjugated bilirubin, and the number of sickle cell crisis; but not in the markers of inflammation. The pilot data suggest that DHA and EPA supplements reduce the number of crisis and steady state haemolysis in SCD; but provide no evidence that these effects are mediated by reducing inflammation.

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