RESUMEN

Abstract: One of the challenges of managing significant neonatal hyperbilirubinaemia in resource-poor settings is limited access to effective phototherapy devices hence the need to try appropriate technologies. The objective was to assess the effectiveness of Compact Fluorescent Lamps phototherapy devices in the management of significant neonatal hyperbilirubinaemia in a resource-poor setting. A cohort of babies with significant hyperbilirubinaemia managed with locally fabricated Compact Fluorescent Lamps (CFL) phototherapy devices (2014-2016) were compared with historical controls managed with conventional imported phototherapy devices (2007-2010) for the severity of hyperbilirubinaemia and requirements for Exchange Blood Transfusion. A total of 96 babies in the subject group and 202 babies in the control group were studied. The proportion of babies with peak TSB >30mg/dl was significantly higher among the controls compared to the subjects (p < 0.001). The interval between the commencement of phototherapy and the peak TSB was greater than 1 day among 30.2% (29/96) subjects compared to 74.3% (150/202) babies in the control group (p < 0.001). The mean duration of phototherapy was significantly shorter for the subjects compared to the controls. EBT was performed for 38.5% of the subjects and 51.5% of the controls. Single sessions of EBT were required for 78.4% of the subjects compared to 45.2% of the controls (p = 0.001). In conclusion, the locally fabricated Compact Fluorescent Lamps phototherapy devices reduced EBT rate among babies with significant hyperbilirubinaemia

Asunto(s)

Transfusión Sanguínea , Hiperbilirrubinemia , Hiperbilirrubinemia Neonatal , Fototerapia

RESUMEN

BACKGROUND: Congenital hypothyroidism is a common congenital endocrine disorder prevailing all over the world. No nationwide screening exists for any sub-Saharan country. We present normative cord and capillary thyroid-stimulating hormone (TSH) values for healthy Nigerian newborns. SUBJECTS AND METHODS: A cross-sectional study was carried out in 6 university hospitals in Nigeria between January 1 and December 31, 2013. Cord and heel blood placed on 4 concentric circles on a Whartman filter paper were analysed for TSH within 1 week of collection using AutoDelfia 1235 immunoassay (Perkin Elmer Wallace, Boston, Mass., USA) at Charité - Universitätsmedizin Berlin, Berlin, Germany. The mean TSH levels of the newborns were determined, considering their sex, birthweight, socioeconomic status, and birth city. The association between the mean TSH level and other parameters was determined by analysis of variance. RESULTS: A total of 2,014 subjects were recruited during the study period. The mean TSH value for the subjects was 1.86 µIU/ml, and 98.1% of the newborns were within the 2.5th and 97.5th percentiles (range: 0.09-7.90 µIU/ml) of the TSH levels. We collected 247 cord and 1,767 heel samples, respectively, and the range was slightly higher in samples from cord blood. CONCLUSION: The study highlights the normal reference values for capillary/cord TSH levels in term Nigerian newborns. TSH was higher in one region, attributable to earlier sampling, but was not influenced by gender, socioeconomic status, or birthweight.

Asunto(s)

Tirotropina/sangre , Estudios Transversales , Femenino , Humanos , Recién Nacido , Masculino , Nigeria

RESUMEN

This study aimed to describe the pattern and immediate outcome of severe childhood anaemia requiring blood transfusion at a secondary level of care in Nigeria. A cross-sectional survey of children hospitalized in a secondary health facility in Ogun State, Nigeria, with packed cell volume <20% and who received blood transfusion was done. Of the 253 children admitted between March 2013 and June 2014, 79 (31.2%) had severe anaemia and were transfused with blood. Two-thirds had multiple transfusions. Higher rates of blood transfusion were obtained among underweight children. Fever (98.7%), hypoglycaemia (65.8%) and tender liver (54.4%) were the leading co-morbidities. The case fatality rate was 21.5%. Respiratory distress, convulsions and altered sensorium were significantly associated with mortality. In conclusion, severe anaemia was associated with major morbidities and mortality at the secondary level of paediatric care in Nigeria.

Asunto(s)

Anemia/terapia , Transfusión Sanguínea , Malaria/complicaciones , Pediatría , Anemia/epidemiología , Anemia/mortalidad , Preescolar , Comorbilidad , Estudios Transversales , Femenino , Hematócrito , Hospitalización , Humanos , Lactante , Recién Nacido , Ictericia/epidemiología , Malaria/epidemiología , Masculino , Nigeria/epidemiología , Centros de Atención Secundaria , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Resultado del Tratamiento

RESUMEN

BACKGROUND: Neonatal tetanus (NNT) is a major cause of newborn deaths especially in the developing world. While efforts aimed at eradicating NNT should be sustained, it is equally imperative to reduce death among affected infants. Therefore, the factors associated with mortality rate in this condition need to be studied. METHODS: The records of infants with NNT over a 15-year period (1991-2005) were reviewed. A statistical comparison of the survivors and fatalities for relevant clinical characteristics was done, and the determinants of fatality rate were also determined using logistic regression. RESULTS: Ninety-six of 151 newborns with NNT died, giving a mortality rate of 63.6%. The case fatality rate during the study period varied between 33.3% and 100%. More deaths occurred in the infants with low birth weight (P=0.004) within 1 day at the onset of symptoms (P<0.001), whose mothers aged 18 years or less (P=0.001) belonged to socio-economic class V (P=0.001). Determinants of mortality in these infants with NNT included low socio-economic class (P=0.002), no antitetanus vaccination (P=0.006), presentation with spasms (P<0.001), and non-administration of anti-tetanus serum during treatment (P=0.013). CONCLUSIONS: The mortality rate in infants with NNT remains signifi cantly high in Nigeria. Improved maternal anti-tetanus vaccination and timely recognition and treatment of affected infants may jointly reduce the incidence and fatality rate of NNT.

Asunto(s)

Tétanos/mortalidad , Peso al Nacer , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Edad Materna , Nigeria/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Clase Social , Espasmo/microbiología , Antitoxina Tetánica/uso terapéutico , Toxoide Tetánico

RESUMEN

The objective of this study was to describe the clinical characteristics of babies with neonatal tetanus (NNT) whose mothers were immunised against tetanus and determine the outcome of their hospitalisation. The hospital records of babies affected by NNT whose mothers received at least two doses of anti-tetanus vaccine during pregnancy were identified and compared with similarly affected babies whose mothers were not immunised against tetanus during pregnancy in a Nigerian hospital. Out of 175 cases of NNT, the mothers of 24 (13.7%) babies were immunised against tetanus during pregnancy while the mothers of 151 (86.3%) were not. The proportions of babies of immunised mothers and unimmunised mothers who presented within the first three days of life, within a day of the onset of symptoms and with spasms were similar. Nevertheless, the survival rate was higher (62.5% vs. 26.5%; P = 0.0004) among babies of immunised mothers. Despite similarities in clinical presentation of babies of mothers with and without anti-tetanus vaccination, the survival rate was higher for the former.

Asunto(s)

Inmunización/efectos adversos , Complicaciones Infecciosas del Embarazo/prevención & control , Toxoide Tetánico/efectos adversos , Tétanos/etiología , Femenino , Humanos , Inmunidad Materno-Adquirida , Recién Nacido , Embarazo , Estudios Retrospectivos

RESUMEN

BACKGROUND: Facilities which manage high-risk babies should frequently assess the burden of hypothermia and strive to reduce the incidence. OBJECTIVE: To determine the incidence and outcome of point-of-admission hypothermia among hospitalized babies. METHODS: The axillary temperatures of consecutive admissions into a Nigerian Newborn Unit were recorded. Temperature <36.5 degrees C defined hypothermia. The biodata and outcome of these babies were studied. RESULTS: Of 150 babies aged 0 to 648 hours, 93 had hypothermia with an incidence of 62%. Mild and moderate hypothermia accounted for 47.3% and 52.7% respectively. The incidence of hypothermia was highest (72.4%) among babies aged less than 24 hours. It was also higher among out-born babies compared to in-born babies (64.4% vs 58.3%). Preterm babies had significantly higher incidence of hypothermia (82.5%) compared with 54.5% of term babies (RR = 1.51; CI = 1.21 - 1.89). The incidence of hypothermia was also highest (93.3%) among very-low-birth-weight babies. The Case-Fatality-Rate was significantly higher among hypothermic babies (37.6% vs 16.7%; RR = 2.26, CI = 1.14 - 4.48) and among out-born hypothermic babies (50% vs 17.1%; RR = 0.34, CI = 0.16 - 0.74). CFR was highest among hypothermic babies with severe respiratory distress, sepsis, preterm birth and asphyxia. CONCLUSION: The high incidence and poor outcome of hypothermia among high-risk babies is important. The use of the 'warm chain' and skin-to-skin contact between mother and her infant into routine delivery services in health facilities and at home may be useful.

Asunto(s)

Peso al Nacer , Temperatura Corporal/fisiología , Edad Gestacional , Hipotermia/fisiopatología , Humanos , Hipotermia/epidemiología , Incidencia , Cuidado del Lactante/métodos , Recién Nacido de Bajo Peso/fisiología , Recién Nacido , Recien Nacido Prematuro/fisiología , Nigeria/epidemiología , Factores de Riesgo , Factores de Tiempo

RESUMEN

A major problem in the management of infants exposed to HIV is the issue of feeding, which stems from the need to avoid transmission of the virus via breast milk. Other important issues in the nutrition of infants exposed to the virus include severe maternal illness, which makes suckling extremely difficult, and feeding orphans. Wet nursing is one of the recommended steps in addressing the feeding problems of such infants but for reasons of sociocultural disapproval, it appears not to be popular in traditional African settings. Non-puerperal induced lactation or re-lactation of a close relation, usually a grandmother, which hitherto has been used to rehabilitate severely malnourished motherless infants, may be equally useful. The procedure of re-lactation and the limitations of the method are highlighted. Also, the need to employ information, education and communication in improving the sociocultural acceptability of this veritable infant feeding method in tropical Africa is discussed.

Asunto(s)

Lactancia Materna/etnología , Familia/etnología , Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Lactancia , África/epidemiología , Actitud Frente a la Salud/etnología , Clorpromazina/farmacología , Comunicación , Femenino , Infecciones por VIH/etnología , Infecciones por VIH/transmisión , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Lactancia/efectos de los fármacos , Lactancia/fisiología , Lactancia/psicología , Metoclopramida/farmacología , Valores Sociales/etnología , Madres Sustitutas

RESUMEN

BACKGROUND: In view of the fact that a significant proportion of neonates with malaria may be missed on our wards on the assumption that the disease condition is rare, this study aims at documenting the prevalence of malaria in neonates admitted into our neonatal ward. Specifically, we hope to describe its clinical features and outcome of this illness. Knowledge of these may ensure early diagnosis and institution of prompt management. METHODS: Methods Hospital records of all patients (two hundred and thirty) admitted into the Neonatal ward of Olabisi Onabanjo University Teaching Hospital, Sagamu between 1st January 1998 and 31st December 1999 were reviewed. All neonates (fifty-seven) who had a positive blood smear for the malaria parasite were included in the study. Socio-demographic data as well as clinical correlates of each of the patients were reviewed. The Epi-Info 6 statistical software was used for data entry, validation and analysis. A frequency distribution was generated for categorical variables. To test for an association between categorical variables, the chi-square test was used. The level of significance was put at values less than 5%. RESULTS: Prevalence of neonatal malaria in this study was 24.8% and 17.4% for congenital malaria. While the mean duration of illness was 3.60 days, it varied from 5.14 days in those that died and and 3.55 in those that survived respectively. The duration of illness significantly affected the outcome (p value = 0.03). Fever alone was the clinical presentation in 44 (77.4%) of the patients. Maturity of the baby, sex and age did not significantly affect infestation. However, history of malaria/febrile illness within the 2 weeks preceding the delivery was present in 61.2% of the mothers. Maternal age, concurrent infection and duration of illness all significantly affected the outcome of illness. Forty-two (73.7%) of the babies were discharged home in satisfactory condition. CONCLUSION: It was concluded that taking a blood smear to check for the presence of the malaria parasite should be included as part of routine workup for all neonates with fever or those whose mothers have history of fever two weeks prior to delivery. In addition, health education of pregnant mothers in the antenatal clinic should include early care-seeking for newborns.

Asunto(s)

Malaria/epidemiología , Adolescente , Adulto , Antimaláricos/uso terapéutico , Sangre/parasitología , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Femenino , Fiebre/etiología , Hospitales Universitarios/estadística & datos numéricos , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/sangre , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/tratamiento farmacológico , Enfermedades del Prematuro/epidemiología , Malaria/sangre , Malaria/congénito , Malaria/diagnóstico , Malaria/tratamiento farmacológico , Malaria/transmisión , Masculino , Nigeria/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/parasitología , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos

RESUMEN

BACKGROUND: To determine the prevalence, types and demographic features of child labour among school children in Nigeria. METHODS: A cross-sectional interview study of 1675 randomly selected public primary and secondary school pupils aged 5 to less than 18 years was conducted in the Sagamu Local Government Area of Ogun State, Nigeria from October 1998 to September 1999. RESULTS: The overall prevalence of child labour was 64.5%: 68.6% among primary and 50.3% among secondary school pupils. Major economic activities included street trading (43.6%), selling in kiosks and shops (25.4%) and farming (23.6%). No child was involved in bonded labour or prostitution. Girls were more often involved in labour activities than boys (66.8% versus 62.1%, p = 0.048): this difference was most obvious with street trading (p = 0.0004). Most of the children (82.2%) involved in labour activities did so on the instruction of one or both parents in order to contribute to family income. Children of parents with low socio-economic status or of poorly educated parents were significantly involved in labour activities (p = 0.01 and p = 0.001 respectively). Child labour was also significantly associated with increasing number of children in the family size (p = 0.002). A higher prevalence rate of child labour was observed among children living with parents and relations than among those living with unrelated guardians. CONCLUSION: It is concluded that smaller family size, parental education and family economic enhancement would reduce the pressure on parents to engage their children in labour activities.