Prevalence, perinatal outcomes and factors associated with neonatal sepsis in Nigeria

OBJECTIVE

To examine the prevalence, perinatal outcomes and factors associated with neonatal sepsis in referral-level facilities across Nigeria.

DESIGN

Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme in 54 referral-level hospitals across Nigeria.

SETTING

Records covering the period from 1 September 2019 to 31 August 2020.

POPULATION

Mothers admitted for birth during the study period, and their live newborns.

METHODS

Analysis of prevalence and sociodemographic and clinical factors associated with neonatal sepsis and perinatal outcomes. Multilevel logistic regression modelling identified factors associated with neonatal sepsis.

MAIN OUTCOME MEASURES

Neonatal sepsis and perinatal outcomes.

RESULTS

The prevalence of neonatal sepsis was 16.3 (95% CI 15.3-17.2) per 1000 live births (1113/68 459) with a 10.3% (115/1113) case fatality rate. Limited education, unemployment or employment in sales/trading/manual jobs, nulliparity/grand multiparity, chronic medical disorder, lack of antenatal care (ANC) or ANC outside the birthing hospital and referral for birth increased the odds of neonatal sepsis. Birthweight of <2500 g, non-spontaneous vaginal birth, preterm birth, prolonged rupture of membranes, APGAR score of <7 at 5 min, birth asphyxia, birth trauma or jaundice were associated with neonatal sepsis. Neonates with sepsis were more frequently admitted to a neonatal intensive care unit (1037/1110, 93.4% vs 8237/67 346, 12.2%) and experienced a higher rate of death (115/1113, 10.3% vs 933/67 343, 1.4%).

CONCLUSIONS

Neonatal sepsis remains a critical challenge in neonatal care, underscored by its high prevalence and mortality rate. The identification of maternal and neonatal risk factors underscores the importance of improved access to education and employment for women and targeted interventions in antenatal and intrapartum care.

Incidence, predictors and immediate neonatal outcomes of birth asphyxia in Nigeria

OBJECTIVE

To determine the incidence and sociodemographic and clinical risk factors associated with birth asphyxia and the immediate neonatal outcomes of birth asphyxia in Nigeria.

DESIGN

Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme.

SETTING

Fifty-four consenting referral-level hospitals (48 public and six private) across the six geopolitical zones of Nigeria.

POPULATION

Women (and their babies) who were admitted for delivery in the facilities between 1 September 2019 and 31 August 2020.

METHODS

Data were extracted and analysed on prevalence and sociodemographic and clinical factors associated with birth asphyxia and the immediate perinatal outcomes. Multilevel logistic regression modelling was used to ascertain the factors associated with birth asphyxia.

MAIN OUTCOME MEASURES

Incidence, case fatality rate and factors associated with birth asphyxia.

RESULTS

Of the available data, 65 383 (91.1%) women and 67 602 (90.9%) babies had complete data and were included in the analysis. The incidence of birth asphyxia was 3.0% (2027/67 602) and the case fatality rate was 16.8% (339/2022). The risk factors for birth asphyxia were uterine rupture, pre-eclampsia/eclampsia, abruptio placentae/placenta praevia, birth trauma, fetal distress and congenital anomaly. The following factors were independently associated with a risk of birth asphyxia: maternal age, woman's education level, husband's occupation, parity, antenatal care, referral status, cadre of health professional present at the birth, sex of the newborn, birthweight and mode of birth. Common adverse neonatal outcomes included: admission to a special care baby unit (SCBU), 88.4%; early neonatal death, 14.2%; neonatal sepsis, 4.5%; and respiratory distress, 4.4%.

CONCLUSIONS

The incidence of reported birth asphyxia in the participating facilities was low, with around one in six or seven babies with birth asphyxia dying. Factors associated with birth asphyxia included sociodemographic and clinical considerations, underscoring a need for a comprehensive approach focused on the empowerment of women and ensuring access to quality antenatal, intrapartum and postnatal care.

Prevalence of hypertension in a rural community in southeastern Nigeria; an opportunity for early intervention

Hypertension is a leading cause of non-communicable morbidity in Sub Saharan Africa. Recent studies suggest and increase in the prevalence of hypertension in rural Sub-Saharan Africa. Using a three-phase approach, a structured questionnaire was used to determine the prevalence of hypertension in a rural settlement is Enugu State, Southeast Nigeria. Blood pressure measurement was done according to the guidelines of the European Society of Hypertension. Out of 1576 participants aged 18 years and above, 1082 (68.7%) completed the full survey, their blood pressure was measured, and data analyzed. The prevalence of hypertension in this study was 27.6%, (95%CI 25-30.4), similar in males 29.2, (95%CI 24.7-30.4) and females 26.8%, (95%CI 23.5-30.2). p = 0.39. The prevalence of hypertension increased with age reaching a peak of 32.8% (95%CI 26.2-40) in the 40-49 age group, however this was not statistically significant P = 0.22. This age-related increase in the prevalence of hypertension tended towards significance in males (p = 0.05) but not in females (p = 0.44). Awareness of hypertension was 7.2%. Systolic blood pressure positively correlated with older age, higher blood glucose levels and waist-hip ratio. Diastolic blood pressure correlated with the type of work the patients is involved in and blood glucose levels. In conclusion, the prevalence of hypertension in a rural southeastern Nigeria community was 27.6%, however awareness was very low (7.9%). Most participants had mild hypertension thus offering a window of opportunity for public health educators in preventing the complications of hypertension. There is therefore the need for awareness campaigns to be intensified in rural communities.

Assessment of Nutritional Status of Children With Congenital Heart Disease: A Comparative Study

Background: Malnutrition poses a great burden to children in the tropics. However, this seems to be accentuated in children with congenital heart disease.

Objectives: The present study is therefore aimed at determining the nutritional status of children with congenital heart disease and to compare them with those without congenital heart disease.

Methods: This is a cross-sectional study, where congenital heart disease was diagnosed by means of echocardiograph. Anthro software was used to calculate Z scores for weight for age (WAZ), height for age (HAZ), and weight for height (WHZ). Body mass index (BMI) was calculated by the formula BMI = Weight (Kg)/height (M2).

Results: The body mass index-for-age z-score (BAZ) and height/length-for-age z-score (HAZ) were calculated for both subjects and controls to determine their nutritional status. It was observed that 38.5% (112/291) of the subjects were wasted (BAZ < −2SD) compared to 6.25% (16/256) of the controls and the difference was statistically significant (χ2 = 81.2, p < 0.001). Stunting (height/length-for-age z-score < −2SD) was also observed in a greater proportion of subjects than controls as 37.8% (107/291) of subjects were stunted compared with 7.0% (18/256) of the controls (χ2 = 69.9, p < 0.001). The under-five subjects had more cases of malnutrition than the controls of same age group as illustrated in Table 6. Whereas 42.9% (96/224) of the under-five subjects were wasted, only 6.2% (12/192) of the controls were wasted. On the other hand, 4.2% (8/192) of the under-five controls were obese compared to 0.9% (2/224) of the subjects of similar age group.

Conclusion: Children with congenital heart disease present with varying degrees of malnutrition that is worse compared with children without congenital heart disease. The impact of malnutrition is worse among children under the age of five. Wasting is more prevalent in children with cyanotic heart disease compared with those with acyanotic congenital heart disease. Overweight and obesity were notable features of malnutrition in children with congenital heart disease, but this is worse in children without congenital heart disease.

Economic burden of childhood asthma in children attending a follow-up clinic in a resource-poor setting of Southeast Nigeria

BACKGROUND

Beyond its chronicity, childhood asthma carries an economic burden for households. In this study we evaluated the cost of care of childhood asthma in a Nigerian household.

METHODS

A cross-sectional hospital-based study. Relevant information was obtained through an interviewer-administered questionnaire. The cost of asthma treatment was estimated using direct medical costs and loss in productivity. Data analysis was done with SPSS version 22. A significant value of p < 0.05 was used.

RESULTS

Sixty-six participants were enrolled, mean ± SD age (11.6 ± ) the average direct cost was USD10.35. The cost of drug was USD5.8 and accounted for 56% of the direct cost. The loss in productivity was USD16.73. The mean cost per clinic visit was USD27.08, which was catastrophic in 12 (18.2%) households. The calculated annual cost of asthma treatment was USD162.49, with a cumulative national cost of USD 0.16 billion, which makes up 0.002% of the national GDP.

CONCLUSION

The cost burden of asthma treatment may be low on the households but carries a huge national cost impact. We recommend the inclusion of asthma care in the Nigerian social health insurance as this may help reduce the financial burden due to asthma.

Pattern and microbiological characteristics of diabetic foot ulcers in a Nigerian tertiary hospital

Purpose

To determine the pattern and bacteriological characteristics of diabetic foot ulcers in patients attending a tertiary health care facility.

Method

160 Patients with Diabetes Mellitus foot syndrome were recruited, out of which 52 had diabetic foot ulcers. Relevant clinical, biochemical, and microbiological evaluations were carried out on the subjects. Data analysis was done using SPSS version 20. p value was set at <0.05.

Results

52 (32.5%) out of 160 subjects with Diabetes Mellitus Foot Syndrome (DMFS) had diabetic foot ulcers. Poor glycaemic control (mean HbA1c = 9.2 (2.7) %), and abuse of antibiotics (76.9%) characterized the subjects. Foot ulcers mainly involved the right lower limb and followed spontaneous blister formation (50%). Microbiological culture pattern was polymicrobial (71.2%); predominantly anaerobic organisms (53.3%). Gram positive and negative aerobic isolates yielded high sensitivity to common quinolones (76% – 87.8%). The gram positive and negative anaerobic isolates were highly sensitive to Clindamycin and Metronidazole respectively (80.2% – 97.8%). High sensitivity (>80%) yield for gram negative anaerobes was recorded for Imipinem and Ampicillin/Sulbactam.

Conclusion

Diabetic foot ulcers (DFU) contribute about one-third of DMFS. The bacteriological isolates from these ulcers are mainly polymicrobial with high sensitivity to common antibiotics. The need for appropriate use of antibiotics should be advocated among the patients.

Hematological Indices at Birth of Infants of HIV-Positive Mothers Participating in a Prevention of Mother-to-Child Transmission Program

BACKGROUND

The mother-to-child transmission of HIV, which accounts for 90% of infections in children, has been reduced markedly through the use of antiretroviral drugs by pregnant women and their newborns. Changes to the World Health Organization guidelines support further extension of the prevention of mother-to-child transmission programs with increased risk of toxicity on the fetuses.

AIM

To determine the hematological indices at birth of infants exposed in utero to maternal antiretroviral drugs.

METHOD

A comparative analytical study of 126 neonates whose blood samples were analyzed to determine their hematological indices.

RESULT

The hemoglobin, hematocrit, the total white blood cell (WBC) count and absolute neutrophil count (ANC) were significantly lower in infants of HIV-positive mothers. The total WBC and ANC were also significantly lower in the highly active antiretroviral therapy. HAART group and those exposed to maternal drugs for <1 year.

CONCLUSION

There are significant changes in the hematological indices of infants of HIV-positive mothers at birth.