Bose Toma

The effects of birth weight and gender on neonatal mortality in north central Nigeria

BackgroundWorldwide 15.5% of neonates are born with low birth weight, 95.6% of them in the developing countries. Prematurity accounts for 10% of neonatal mortality globally. The purpose of this study was to evaluate the effects of birth weight and gender on neonatal outcome.FindingsThe data of 278 neonates managed in the Special Care Baby Unit (SCBU) of Jos University Teaching Hospital (JUTH) over a 2 year period from July 2006 to June 2008 were analyzed.One hundred and fifty nine (57.2%) were males and 119(42.8%) females. There were 87(31.3%) preterm and 191 (68.7%) term babies. Twelve of the babies died. Seven (2.52%) and 5 (1.80%) being males and females respectively. The neonatal mortality rate by gender was not significant (p > 0.05). The neonatal mortality was 25.2 deaths per 1000 live births for boys and 18.0 for girls. The mean birth weights of the preterm and term babies were 1.88 ± 0.47 kg and 3.02 ± 0.50 kg respectively, with a mean gestational age of 30.62 ± 3.65 weeks and 38.29 ± 0.99 weeks respectively.Eighty seven (31.3%) of the babies were of low birth weight, 188(67.6%) were of normal birth weight and 3(1.1%) high birth weight. Of the low birth weight babies, 6(2.2%) were term small for gestational age. Six (2.2%) of the preterm infants had normal birth weight.Eleven of the babies that died were preterm low birth weight. The overall mortality rate was 4.32%. The birth weight specific mortality rate was 126 per 1000 for the preterm low birth weight and 5 per 1000 for the term babies. Birth weight unlike gender is a significant predictor of mortality, mortality being higher in neonates of <2.5 kg (OR = 0.04; 95% Cl 0.005-0.310, p = 0.002) (p = 0.453). Seven (58.3%) and 4(33.3%) of the pre-terms that died were appropriate and large for gestational age respectively. Gestational age is not a significant predictor of neonatal mortality (p = 0.595). Babies delivered at less than 37 weeks of gestation recorded a higher rate of mortality than those of 37 weeks and above (p = 0.000).The subjects showed one or more major clinical indications for admission. The major clinical indications for the preterm and term babies were respectively as follows: neonatal sepsis 63(22.7%) and 124(44.6%); neonatal jaundice 32(11.1%) and 71(24.7%); malaria 9(3.1%) and 13(4.5%); birth asphyxia 3(1.0%) and 7(2.4%). Neonatal sepsis was a common denominator among the babies that died.ConclusionBirth weight unlike gender is a significant predictor of neonatal outcome

Pattern of neonatal admissions and outcome in a tertiary institution in north central Nigeria

Background/Purpose: Neonatal morbidity and mortality contributes significantly to under-five morbidity and mortality in sub-Saharan Africa accounting for 40% of under-five mortality. A substantial reduction in neonatal mortality is therefore necessary to achieve the Millennium Development Goal (MDG) 4 target by 2015. The aim of the study was to assess the pattern of neonatal morbidity and mortality in our environment which will help to identify interventions for better neonatal outcome. Materials and Methods: The study is a review of cases admitted into the neonatal unit of the Jos University Teaching Hospital situated in the North Central part of Nigeria. The unit started operating from the permanent site of the hospital on 1 March 2010 after the relocation of the hospital from the previous site. Data on all neonates admitted into the neonatal unit from 1 March 2010 to 28 February 2011 were obtained from the various registers/records and analyzed. Data extracted included biodata, gestational age, birth weight, main diagnosis, duration of admission, etc., In addition, the outcomes (discharged/died) were documented. All statistical analyses were performed using two-sided tests. A P Results: A total of 572 neonates were admitted, accounting for 54.6% of the 1047 pediatric medical admissions into the hospital. The main causes of admission were neonatal infections (37.1%), prematurity (20.1%), and birth asphyxia (11.5%). Out of the 572 neonates, 111 (19.4%) died. About three quarters (76.5%) of the mortalities occurred in the first week of life with 46.4% of these occurring in the first 24 hours (χ2 -20.2, P Conclusion: There is a high burden for neonatal care at the institution. The three main causes of morbidity and mortality are prematurity, infections, and birth asphyxia. Hence, neonatal care/facilities need to be improved especially to care for the high risk neonate. Also, the importance of infection control cannot be overemphasized.

Patterns of acute bilirubin encephalopathy in Nigeria: a multicenter pre-intervention study

BackgroundAcute bilirubin encephalopathy (ABE) is an important cause of neonatal morbidity in Nigeria, accounting for 5–14% of neonatal deaths. Most newborns with severe ABE have irreversible damage before receiving treatment emphasizing the need for timely pre-admission monitoring and referral. There is limited evidence that educational interventions targeting mothers and health care providers will reduce delayed care.ObjectiveTo provide baseline data on the incidence of ABE and associated pre-admission risk factors in five centers of Nigeria in order to evaluate the effect of subsequent educational interventions on outcome.Study designThe incidence of ABE among newborns treated for hyperbilirubinemia was documented prospectively. Bivariate analysis and multivariate logistic regression were used to evaluate risk factors for acute bilirubin encephalopathy and reasons for regional differences in its occurrence.ResultsOf 1040 infants, 159 treated for hyperbilirubinemia (15.3%) had mild to severe bilirubin encephalopathy (including 35 deaths), but the incidence ranged from 7 to 22% between centers. Logistic regression identified four common predictors: total serum bilirubin (odds ratio 1.007 per mg/dl rise), out-of-hospital births (OR 2.6), non-alloimmune hemolytic anemia (OR 2.8), and delayed care seeking (OR 4.3).ConclusionThe high occurrence of bilirubin encephalopathy in Nigeria is due in large part to a delay in seeking care. A planned intervention strategy will target conditions leading to severe hyperbilirubinemia and delay.

Factors influencing irradiance of locally fabricated phototherapy devices in Jos, north-central Nigeria

Locally fabricated phototherapy devices (LFPDs) are widely used in Nigeria for the treatment of neonatal jaundice. Ours was a cross-sectional observational study of all LFPDs in major hospitals in Jos between January and March 2015. We evaluated a total of 24 LFPDs. The irradiance at the level of the baby was in the range of 2–23.9 µW/cm2/nm. Fourteen devices had the recommended irradiance of ≥10 µW/cm2/nm and none had irradiance in the intensive range. Decreasing distance from the baby, presence of reflectors and increasing number of flourecent tubes significantly contributed to higher irradiance. A combination of six tubes, presence of reflectors and a distance of 10 cm from the baby produced a mean irradiance of 23.40 µW/cm2/nm. The irradiance of LFPDs varies widely and can be improved by simple modifications.

Maternal and neonatal characteristics of babies admitted with congenital CNS anomalies in a tertiary hospital in North Central Nigeria

Background: CNS anomalies are an important group of largely preventable congenital anomalies. Knowledge of maternal and neonatal sociodemographic characteristics could identify a pattern of population at risk in order to target preventive interventions. Methods: This was a 3-year retrospective review of health records of all neonates admitted with CNS anomalies in Jos University Teaching Hospital (JUTH), Jos, central-Nigeria. Results: Out of a total of 27 neonates with congenital CNS anomalies reviewed, 25 had neural tube defects, 1 hydrocephalos and 1 anencephaly. The peak age group of mothers were 20-29years (44.4%) and 30-39 years (44.4%). Twenty-two (81.5%) mothers had antenatal care (ANC). No mother booked in the 1 month and only 7 (25.9%) booked in the first trimester. Twenty-four (88.9%) mothers took folic acid during pregnancy. No mother had periconceptional folic acid use. There were 11(40.7%) home births with 14(87.5%) of the 16 hospital births taking place in lower tier health facilities. Twenty-six (96.3%) mothers had vaginal delivery. An obstetric ultrasound scan was reported by one (3.7%) mother and did not detect the anomaly. Five (18.5%) of the mothers had HIV infection. Twenty-six were term with a male: female ratio of 1.1:1. The median age at presentation was 2 (interquartile range 1, 8) days. Conclusions: Neonates with congenital CNS anomalies in JUTH frequently had mothers aged <35 years who did not receive preventive care before and during delivery. We therefore recommend interventions to improve the efficiency of health care delivery to cater for this gap.

The necessity of full sepsis screen in neonatal sepsis: Experience in a resource-limited setting

Background: Diagnostic tests that differentiate infected from noninfected neonates have the potential to make a significant impact on neonatal care. A full sepsis screen may be necessary to make a diagnosis of neonatal sepsis. Objective: The objective of this study was to evaluate the necessity of routinely collecting blood, urine, and cerebrospinal fluid (CSF) samples from every neonate suspected of sepsis. Materials and Methods: This was a cross-sectional study conducted in a Tertiary Care Hospital in Nigeria. The Integrated Management of Childhood Illnesses (IMCI) criteria for diagnosis of neonatal sepsis were used to select subjects into the study. Blood samples, CSF, and urine samples were collected from 165 neonates and processed by standard microbiologic methods. Results: A total of 68 isolates were recovered from 165 sets of blood culture samples representing 41.2% positive blood culture results. Only 3 (1.8%) organisms were isolated from 165 CSF samples. Five (3%) isolates were recovered from 165 urine samples. The three isolates from CSF were the same with blood isolates from the same neonates. Similarly, four of the five neonates with urine isolates also had blood isolates of the same organism. Conclusion: The findings of this study suggest that a properly collected blood culture sample is the most appropriate sample for recovering the causative organism in neonatal sepsis whereas other samples such as CSF and urine should be collected only when there are specific indications such as an obvious focus of infection in these sites. A full sepsis screen may not be necessary in most cases so as not to put the already sick neonate through unnecessary and sometimes harmful procedures.

Knowledge and application of APGAR score among residents in a tertiary hospital

Introduction: The APGAR score rapidly assesses the condition of the newborn at birth and is a predictor of neonatal mortality. Despite the fact that this scoring system is limited by inter and intra-observer variation, its knowledge is essential to residents involved in newborn care at delivery. This study was therefore carried out to determine the knowledge and application of the APGAR score by these residents. Materials and Methods: The questionnaire-based survey was conducted at the Jos University Teaching Hospital and administered to all consecutive residents in pediatrics, obstetrics and gynecology (O and G), anesthesia, family medicine and public health. Domains assessed both knowledge and application of the APGAR scoring system. Data analyzed with the Epi Info 3.5.1 and P < 0.05 was considered as statistically significant. Results: Of the 74 completed questionnaires, 21 were filled by Pediatric residents, 27 by O and G residents and 26 by other residents. Residents with 10-15 years of work experience had a significantly higher mean score on their knowledge compared with those with <10 years work experience (P = 0.015). The mean application score was significantly higher among the Pediatric residents compared with the O and G and other residents (P = 0.015). Using linear regression, there was a significant association between the knowledge and application of the APGAR scoring system - coefficient = 0.179, P ≤ 0.001. Conclusion: Adequate knowledge and application of the APGAR scoring system by residents who use it frequently is necessary to avoid its misuse. Training and retraining of these residents on the correct use of the APGAR score during neonatal resuscitation is important to ensure adequate knowledge and its proper application.

Paediatric Morbidity and Mortality in a Suburban Hospital in Jos, North -Central Nigeria

Background: Even though there has been some decline in childhood mortality, figures still remain high in subSaharan Africa. The pattern of morbidity and mortality in health care institutions may be a reflection of the disease burden of the community which it serves and will facilitate prevention/ control strategies. This study was conducted to determine the pattern of paediatric morbidity and mortality in a secondary level hospital in a sub – urban area in Jos, North – central Nigeria. Materials and Methods: This retrospective study is a review of paediatric admissions into the Vom Christian Hospital. Relevant data on all children who were admitted into the Vom Christian Hospital Original Research Article Toma et al.; IJTDH, 5(2): 156-164, 2015; Article no.IJTDH.2015.016 157 between May 2012 and April 2013 with medical conditions were retrieved from the admissions records. Data were entered into excel spread sheet and analyzed using Epi info 7. A p< 0.05 was considered statistically significant. Results: A total of 334 children aged between one day and 15 years were admitted during the period, out of which 235 (70.4%) were children less than 5 years old. Infections (221, 66.2%) were the major causes of morbidity. Out of all the 334 admissions, 304(91%) were discharged, 7 (2.1%) left against medical advice, 6(1.8%) were referred, while 17 (5.1%) died. Malaria was the commonest cause of morbidity (102, 30.5%) and mortality (6, 35.3%). Severe protein energy malnutrition had the highest case fatality rate (25%). Conclusion: The burden of paediatric morbidity and mortality is in children under 5 years and are mainly preventable. An emphasis on malaria eradication and child survival strategies will help to reduce childhood morbidity and mortality.

Nonadherence to first‑line antiretroviral therapy among human immunodeficiency virus‑1 infected children at the Jos University Teaching Hospital, Jos, Nigeria

Background: Nonadherence to antiretroviral therapy (ART) may encourage the development of resistance to antiretroviral drugs (ARVs). Poor adherence is known to be associated with ART failure which could compromise the benefits of ART in children. Therefore, it is important to identify the reasons why children on ART may fail to take their ARVs. In this study, we described the characteristics of human immunodeficiency virus-1 (HIV-1) infected children with ART nonadherence as well as the reasons for their nonadherence. Methodology: A retrospective cohort study in which data on 580 HIV-1 infected children enrolled on ART between February 2006 and December 2010 at the pediatric HIV clinic of the Jos University Teaching Hospital, Jos, was analyzed. Subjects were aged 2 months to 15 years. Information on adherence was obtained by child or caregiver self-report. They also had repeated adherence counseling during each clinic follow-up visit and were taught the use of alarm clocks daily for reminding them of when the next ARV dose will be due. Results: There were 30 (5.2%) children with non-adherence to ART. Among children with nonadherence, majority were: Children aged 1-10 years (76.7%), males (53.3%) and did not know their diagnosis of HIV (90.9%). The odds of nonadherence was two times higher among children who failed first-line ART compared with those who did not (odds ratio [95% confidence interval], 2.28 [1.03-5.02], P = 0.04). The most common reason for nonadherence was: Forgot to take medications (46.7%). Conclusion: The low rate of nonadherence to ART in this study could be attributed to repeated adherence counseling during each clinic follow-up visit and the use of alarm clocks daily for reminders on when the next ARV dose will be due.