Tinuade A. Ogunlesi

Why is kernicterus still a major cause of death and disability in low-income and middle-income countries?

Neonatal jaundice is predominantly a benign condition that affects 60%–80% of newborns worldwide but progresses to potentially harmful severe hyperbilirubinaemia in some. Despite the proven therapeutic benefits of phototherapy for preventing extreme hyperbilirubinaemia, acute bilirubin encephalopathy or kernicterus, several low-income and middle-income countries (LMIC) continue to report high rates of avoidable exchange transfusions, as well as bilirubin-induced mortality and neurodevelopmental disorders. Considering the critical role of appropriate timing in treatment effectiveness, this review set out to examine the contributory factors to the burden of severe hyperbilirubinaemia and kernicterus based on the ‘three delays model’ described by Thaddeus and Maine in the 91 most economically disadvantaged LMICs with Gross National Income per capita ≤US

Changing trends in newborn sepsis in Sagamu Nigeria: bacterial aetiology risk factors and antibiotic susceptibility.

6000 and median human development index of 0.525 (IQR: 0.436–0.632). Strategies for addressing these delays are proposed including the need for clinical and public health leadership to curtail the risk and burden of kernicterus in LMICs.

Socio-demographic factors and appropriate health care-seeking behavior for childhood illnesses.

Aim:  Sepsis is a major contributor to newborn deaths in the developing world. The objective is to determine the prevalence of newborn sepsis, the bacterial pathogens and antibiotic sensitivity pattern of the isolates.

Risk factors for mortality in neonatal tetanus: a 15-year experience in Sagamu, Nigeria

The objective of the study was to determine the influence of socio-demographic factors on healthcare-seeking behaviors for childhood illnesses. This cross-sectional survey was conducted among consecutively admitted acutely ill children in the Children Emergency Room of a Nigerian tertiary care hospital. A total of 168 respondents were surveyed out of which only 12 (7.1%) performed well with regard to all the four indicators of appropriate healthcare-seeking behaviors. Bivariate analysis showed significant association between high maternal education and early care-seeking, utilization of orthodox health facilities, and drug use at home (p < 0.001 in each case). Similarly, age of child <1 year was associated with early care-seeking, care-seeking outside home, and utilization of orthodox health services (p < 0.001 in each case). Logistic regression showed that high maternal education and high family socioeconomic status were strong predictors of early care-seeking and care-seeking outside the home. It is concluded that maternal age, maternal education, and family socioeconomic status are predictors of appropriate healthcare-seeking behaviors for childhood illnesses.

Predictors of Acute Bilirubin Encephalopathy Among Nigerian Term Babies with Moderate-to-severe Hyperbilirubinaemia

BackgroundNeonatal 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.MethodsThe 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.ResultsNinety-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).ConclusionsThe 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.

Neonatal resuscitation - knowledge and practice of nurses in western Nigeria

OBJECTIVE To determine predictors of acute bilirubin encephalopathy (ABE) among term infants presenting with moderate-to-severe hyperbilirubinaemia. METHODS Babies with total serum bilirubin >15 mg/dl at the point of admission were studied in a Nigerian tertiary health facility using bivariate and multivariate analysis. RESULTS Out of 152 babies, 75 (49.3%) had ABE: 73 had ABE at presentation while two developed ABE after admission. Bivariate analysis showed that body weight <2.5 kg, outside delivery, low maternal education, low socio-economic status, severe anaemia, glucose-6-phosphate dehydrogenase deficiency and metabolic acidosis were significantly associated with ABE. Multivariate analysis also showed that only outside delivery, weight <2.5 kg, presence of severe anaemia and acidosis were the predictors of ABE in this cohort of term babies. CONCLUSION The identified predictors of ABE are modifiable and can be used to draw up screening tools for term babies at risk of ABE especially in the developing world.

Neonatal tetanus at the close of the 20th century in Nigeria.

Background. Appropriate resuscitation techniques are crucial to the survival of newborn infants. Objective. To assess knowledge of nurses in western Nigeria about neonatal resuscitation. Method. A cross-sectional survey of the nurses attached to secondary health facilities in western Nigeria was done using a closed-ended questionnaire that tested evaluation and appropriate action aspects of neonatal resuscitation. Results. One hundred and seventy-nine nurses were interviewed. Of these, 72.6% had worked in the labour room and the special care baby unit within the last 5 years while only 14.0% had attended neonatal resuscitation training course within the last 5 years. Similarly, 31.8%, 53.1%, 58.1% and 35.2% had access to radiant warmers, ambu-bags, suction machine and oxygen delivery units, respectively. The knowledge of the respondents was better for evaluation than for appropriate action (95.5% v. 49.7%). Conclusion. The knowledge of the respondents about appropriate actions to be taken during neonatal resuscitation was poor. Frequent and intensive courses on neonatal resuscitation are highly desired. South African Journal of Child Health Vol. 2 (1) 2008: pp. 23-25

Prevalence and risk factors for hypothermia on admission in Nigerian babies <72 h of age

The year 2000 marked another failed World Health Organization deadline for neonatal tetanus (NNT) eradication. Existing preventive strategies can be enhanced by exploring factors involved in the persistence of the scourge. Thus, records of neonates admitted between 1996 and 2000 into the Wesley Guild Hospital, Ilesa, were analysed. Of 3051 total neonatal admissions,162 (5.3%) had NNT. Eighty-nine (54.9%) mothers had clinic-based antenatal care (ANC), but only 59 (36.4%) had tetanus toxoid (TT) vaccines. The majority (66.7%) of them delivered at home or churches and others at either private clinics or primary health centres. Overall, the case fatality rate was 43.8%, though it was significantly higher among babies whose mothers had neither clinic-based ANC (odds ratio [OR] = 2.62; 95% confidence interval [CI] = 1.33-5.18) nor antenatal TT vaccination (OR = 2.41; 95% CI = 1.17-5.03). Thus, improvement on ANC, anti-tetanus immunization and ensuring hygienic deliveries are crucial for eliminating NNT in the 21st century.

Predictors of Mortality in Neonatal Septicemia in an Underresourced Setting

Abstract Background: Hypothermia is a major contributor to early neonatal deaths especially in the developing world. Factors which predispose babies to hypothermia need to be identified for intervention purposes. Objectives: To determine the prevalence and risk factors for neonatal hypothermia at admission in the first 72 h of life. Methods: Babies hospitalized within the first 72 h of life in a Nigerian Neonatal Unit were surveyed. Data collected included age, sex, weight, place of delivery, history of breastfeeding, recent bath, oil cleansing of the skin and presence of asphyxia. Babies with skin (axillary) temperature <36.5°C were considered hypothermic. Results: Of the 111 babies, 75 (67.6%) were hypothermic. The prevalence of hypothermia was high among babies aged <6 h (80.6%), preterm infants (88.9%), low-birth-weight babies (89.1%), babies with birth asphyxia (76.3%), babies without recent oiling of the skin (90.6%) and babies who had not been breastfed (79.2%). Using logistic regression, significant risk factors for early neonatal hypothermia at admission included low-birth-weight (P=0.000) and lack of breastfeeding (P=0.028). Conclusion: Most of the identified risk factors are preventable. The warm chain should be strictly applied in-hospital and be taught to mothers and community health workers.

Comparative analyses of childhood deaths in Sagamu, Nigeria: Implications for the fourth MDG.

OBJECTIVE To determine the predictors of mortality in neonatal septicemia. METHOD The records of babies with culture-proven septicemia managed in a Nigerian newborn unit between 2006 and 2008 were studied using bivariate and multivariate analysis. RESULTS Out of 174 babies with septicemia, 56 (32.2%) died. Outborn babies, babies with estimated gestational age (EGA) less than 32 weeks, weight less than 1.5 kg, temperature less than 38 degrees C, respiratory distress, abdominal distension, poor skin color, hypoglycemia, and infection with gram-negative pathogens were significantly associated with death by bivariate analysis. Multivariate analysis of these risk factors confirmed that EGA less than 32 weeks (odds ratio [OR], 5.5), respiratory distress (OR, 3.4), abdominal distension (OR, 2.7), poor skin color (OR, 3.3), and hypoglycemia (OR, 5.2) had significant independent contributions to the occurrence of death among babies with culture-proven septicemia. CONCLUSION Most of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to determine the clinical severity among septic babies.