Ef Ugochukwu

Nutritional contents of lunch packs of primary school children in Nnewi, Nigeria

Background: Lunch packs play a significant role in the nutritional status and academic performance of school children. Available data show a high prevalence of malnutrition among school-age children. Aims: The aim of this study is to document the nutritional contents of lunch packs of primary school children in Nnewi, Anambra state, Nigeria. Subjects and Methods: A cross-sectional study was conducted among 1018 primary 1-6 pupils selected by stratified systematic random sampling from six primary schools, two each of private, - mission, - and government (public) - owned schools in Nnewi metropolis with the aid of the semi-structured questionnaire. Lunch packs of the pupils were examined. Results: Majority of the pupils (77.8% [792/1018]) had lunch packs although about half of pupils in public schools had no lunch pack. Only 12.4% (98/792) and 19.2% (152/792) of pupils with lunch packs had balanced meals and fruits/vegetables in their lunch packs, respectively. The odds of not coming to school with packed lunch was about 13 and 12 times higher for mothers with no formal education or only primary education, respectively, compared with those with tertiary education. Type of school had a strong influence on possession and contents of lunch pack (χ2 = 2.88, P < 0.001, phi coefficient = 0.72). Pupils in private (97.5% [198/203]) and mission (94.4% [388/411]) schools were more likely to have a lunch pack compared with public schools (51.0% [206/404]). However, pupils in private schools were most likely to have a balanced meal (32.5% [66/203] vs. 5.8% [24/411] in mission and 2.0% [8/404] in public schools) and fruits/vegetables (48.3% [98/203] vs. 10.2% [42/411] in mission and 3.0% [12/404] in public schools) in their lunch packs. Mothers′ educational status and parents′ occupation were significantly associated with lunch pack contents. Conclusion: Majority of the lunch packs of primary school pupils contain poor quality food especially in public schools. Mother′s educational status and parent′s occupation are important determinants of the nutritional contents of lunch packs.

The influence of maternal anthropometric characteristics on the birth size of term singleton South-East Nigerian newborn infants

Objective: This study examined the usefulness of maternal anthropometry in predicting the birth size of term singleton newborn infants at NAUTH, Nnewi, Nigeria. Materials and Methods: A cross-sectional study was conducted among 301 mother/newborn infant pairs. Results: The mean birth weight was 3.27 ± 0.60 kg whereas the incidence of low birth weight and fetal macrosomia were 8.0% and 11.3%, respectively. The anthropometric indices varied in their ability to detect newborn babies who experienced abnormal intrauterine growth. The rate of subnormal intrauterine growth was 9.0%, 11.6%m and 18.6% using weight-for-gestational age (GA), ponderal index (PI), and mid-arm circumference (MAC)/occipito-frontal circumference (OFC) criteria, respectively. On the other hand, the rate of excessive intrauterine growth was 16.6% and 12.0% using weight-for-GA and PI criteria, respectively. Apart from maternal height, all the assessed maternal anthropometric parameters had a significant relationship with size at birth. Mothers of newborn infants who experienced subnormal intrauterine growth were more likely to have MAC < 25 cm, intrapartum weight < 65 kg, intrapartum BMI < 25 kg/m2, and rate of third trimester weight gain < 250 g/week. On the other hand, mothers of newborn infants who experienced excessive intrauterine growth were more likely to have MAC > 30 cm, intrapartum BMI ≥ 30 kg/m2, and rate of third trimester weight gain ≥ 500 g/week. Conclusion/Recommendation: Maternal anthropometry is a very useful tool in identifying mothers at risk of having newborn infants who experienced abnormal intrauterine growth. Therefore, its routine application is recommended to enable such mothers benefit from interventions targeted at ensuring optimal intrauterine growth and improved pregnancy outcomes.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV

ABSTRACT Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6–65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1–58.1) of caregivers could talk privately with health workers, 56.9% (54.4–59.3) reported that queues to see health workers were too long, and 89.9% (88.4–91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.

Mother-to-child transmission of human immunodeficiency virus (HIV) among HIV-infected pregnant women on highly active anti-retroviral therapy with premature rupture of membranes at term

Abstract Purpose: To determine mother-to-child transmission (MTCT) rate and associated risk factors of human immune-deficiency virus (HIV) among HIV-infected pregnant women with term premature rupture of membranes (PROM) in comparison with those without PROM at term. Materials and methods: All optimally managed HIV-positive pregnant women of Nnamdi Azikiwe University Teaching Hospital, on highly active anti-retroviral therapy (HAART) who had PROM at term were enrolled. Maternal HIV-1 viral load was not assessed. Follow up was for a minimum of 18 months for evidence of HIV infection. Results: Of the 121 women with PROM at term, 46 (38.0%) were HIV sero-positive, 22/46 (47.8%) of which had their babies followed up till 18 months. The mean latency period was 10.5 ± 5.3 h in PROM group. Apart from duration of PROM (OR = 0.01; 95%CI = 0.00–0.13; p < 0.001), there were no differences in risk factors seen between cases and controls (p > 0.05). Of the 22 (47.8%) babies followed-up in the PROM group and 13 in non-PROM group, none tested positive to HIV, given an MTCT rate of 0%. Conclusions: MTCT rate was 0% following term PROM and in women without PROM. Since maternal HIV-1 viral load was not assessed, we need to be critical while interpreting the findings.

Adherence to infant-feeding choices by HIV-infected mothers at a Nigerian tertiary hospital: the pre-"rapid advice" experience

Abstract Objectives: The study examined adherence to infant-feeding choices made by human immunodeficiency virus (HIV)-infected mothers at a Nigerian tertiary hospital prior to implementation of the “rapid advice” guideline, i.e. the revised World Health Organisation principles and recommendations on infant feeding in the context of HIV. Design: This was a longitudinal descriptive study. Subjects and settings: The study was conducted on mother-infant pairs recruited from the prevention of mother-to-child transmission (PMTCT) of HIV programme of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Final analyses included 142 mother-infant pairs. Outcome measures: Adherence to a prenatal infant-feeding choice and the infant’s HIV status at six months of age were determined. Results: On enrolment, 73% (n = 103) of the mothers chose exclusive formula feeding (EFF), and 28% (n = 39) exclusive breastfeeding (EBF) for the first six months of life. Of the mothers who chose EBF, the actual practice of EBF declined from 88% at two weeks to 21% at six months, while EFF with correctly reconstituted infant formula decreased from 55% to 8% over the same period. The proportion of mothers who switched over to early complementary feeding increased from 8% at six weeks to 80% at six months in the EBF group, and 2% at two weeks to 92% at six months in the EFF group. Major reasons for nonadherence to their initial choice were fear of the mother-to-child transmission (MTCT) of HIV (65%) and non-affordability of the formula (97%) in the EBF and EFF groups, respectively. Factors significantly associated with adherence to their initial choice included having individual prenatal infant-feeding counselling sessions, being married, having a small number of children, being of higher socio-economic status and the mother’s educational status. However, only socio-economic status remained significant after logistic regression analysis was applied. The total MTCT of HIV rate was 1% at six months. Conclusion: Adherence to either EFF or EBF in this study was low, owing to early breastfeeding cessation and the inability to sustain EFF.

Should we Re-Define Age of Fetal Viability in Nigeria? A Case Report of Newborn Survival from Pre-Viable Pre-Labor Rupture of Membranes

Should we Re-Define Age of Fetal Viability in Nigeria? A Case Report of Newborn Survival from Pre-Viable Pre-Labor Rupture of Membranes In Nigeria, the age of fetal viability is defined as fetus that have achieved at least 28 weeks of gestation in utero, while World Health Organization (WHO) has reduced this age to 24 weeks gestation. By implication, delivery prior to 28 weeks gestation is regarded as abortion.