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Imam ZO, Nabwera HM, Tongo OO, Andang’o PEA, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Mwangome MK, Umoru DD, Akindolire AE, Otieno W, Olwala M, Nalwa GM, Talbert AW, Abubakar I, Embleton ND, Allen SJ. Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya. PLoS One 2024; 19:e0277847. [PMID: 38457475 PMCID: PMC10923414 DOI: 10.1371/journal.pone.0277847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/18/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Preterm (born < 37 weeks' gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnerable infants in sub-Saharan Africa. AIM To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan African countries. METHODS Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds. RESULTS Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before the first feed. The median (inter-quartile range) time to first feed was 46 (27, 72) hours of life and time to full enteral feeds (tFEF) was 8 (4.5,12) days with marked variation between neonatal units. Independent predictors of tFEF were time to first feed (unstandardised coefficient B 1.69; 95% CI 1.11 to 2.26; p value <0.001), gestational age (1.77; 0.72 to 2.81; <0.001), the occurrence of respiratory distress (-1.89; -3.50 to -0.79; <0.002) and necrotising enterocolitis (4.31; 1.00 to 7.62; <0.011). CONCLUSION The use of standardised feeding guidelines may decrease variations in clinical practice, shorten tFEF and thereby improve preterm and VLBW outcomes.
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Affiliation(s)
- Zainab O. Imam
- Massey Street Children’s Hospital, Lagos Island, Lagos, Nigeria
| | - Helen M. Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital NHS Trust, Liverpool, United Kingdom
| | - Olukemi O. Tongo
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | | | - Isa Abdulkadir
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Chinyere V. Ezeaka
- College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Beatrice N. Ezenwa
- College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Iretiola B. Fajolu
- College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Martha K. Mwangome
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dominic D. Umoru
- Department of Paediatrics, Maitama District Hospital, Maitama, Abuja, Nigeria
| | | | - Walter Otieno
- Maseno University, Maseno, Kenya
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Macrine Olwala
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Grace M. Nalwa
- Maseno University, Maseno, Kenya
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Alison W. Talbert
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ismaela Abubakar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicholas D. Embleton
- Department of Paediatrics, Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stephen J. Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ezenwa BN, Fajolu IB, Pius S, Ezeanosike OB, Iloh K, Umoru D, Tongo O, Abdulkadir I, Okolo AA, Nabwera HM, Oleolo-Ayodeji K, Daniel N, Abubakar I, Obu C, Onwe-Ogah E, Daniyan O, Adeke A, Nwegbu O, Bisumang JD, Hassan L, Abdullahi F, Mohammad A, Nasir U, Ezeaka VC, Allen S. Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria. Trans R Soc Trop Med Hyg 2023; 117:780-787. [PMID: 37264932 DOI: 10.1093/trstmh/trad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria. METHODS The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria. RESULTS There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown-a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001). CONCLUSIONS The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern.
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Affiliation(s)
- Beatrice N Ezenwa
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iretiola B Fajolu
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Simon Pius
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Obumneme B Ezeanosike
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Kenechukwu Iloh
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Dominic Umoru
- Department of Paediatrics, Maitama District Hospital, Abuja, Nigeria
| | - Olukemi Tongo
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Isa Abdulkadir
- Department of Paediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Angela A Okolo
- Department of Paediatrics, Federal Medical Centre, Asaba, Delta State, Nigeria
| | - Helen M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
| | | | - Nelson Daniel
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ismaela Abubakar
- Insilico Unit, Cancer Therapeutic, Institute of Cancer Research, Sutton, UK
| | - Chinwe Obu
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Emeka Onwe-Ogah
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Olapeju Daniyan
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Azuka Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Obinna Nwegbu
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - J D Bisumang
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Laila Hassan
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Fatimah Abdullahi
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Aisha Mohammad
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Usman Nasir
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Veronica Chinyere Ezeaka
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Paediatrics, Edwards Francis Small Teaching Hospital, Banjul, The Gambia
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Staunton AP, Nabwera HM, Allen SJ, Tongo OO, Akindolire AE, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Imam ZO, Umoru DD, Otieno W, Nalwa GM, Olwala M, Talbert AW, Andang'o PEA, Mwangome MK, Abubakar I, Embleton ND. Prospective observational study of the challenges in diagnosing common neonatal conditions in Nigeria and Kenya. BMJ Open 2022; 12:e064575. [PMID: 36600346 PMCID: PMC9730357 DOI: 10.1136/bmjopen-2022-064575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Accurate and timely diagnosis of common neonatal conditions is crucial for reducing neonatal deaths. In low/middle-income countries with limited resources, there is sparse information on how neonatal diagnoses are made. The aim of this study was to describe the diagnostic criteria used for common conditions in neonatal units (NNUs) in Nigeria and Kenya. DESIGN Prospective observational study. Standard case report forms for suspected sepsis, respiratory disorders, birth asphyxia and abdominal conditions were co-developed by the Neonatal Nutrition Network (https://www.lstmed.ac.uk/nnu) collaborators. Clinicians completed forms for all admissions to their NNUs. Key data were displayed using heatmaps. SETTING Five NNUs in Nigeria and two in Kenya comprising the Neonatal Nutrition Network. PARTICIPANTS 2851 neonates, which included all neonates admitted to the seven NNUs over a 6-month period. RESULTS 1230 (43.1%) neonates had suspected sepsis, 874 (30.6%) respiratory conditions, 587 (20.6%) birth asphyxia and 71 (2.5%) abdominal conditions. For all conditions and across all NNUs, clinical criteria were used consistently with sparse use of laboratory and radiological criteria. CONCLUSION Our findings highlight the reliance on clinical criteria and extremely limited use of diagnostic technologies for common conditions in NNUs in sub-Saharan Africa. This has implications for the management of neonatal conditions which often have overlapping clinical features. Strategies for implementation of diagnostic pathways and investment in affordable and sustainable diagnostics are needed to improve care for these vulnerable infants.
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Affiliation(s)
- Aimee P Staunton
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Stephen J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Olukemi O Tongo
- Institute of Child Health, University College Hospital Ibadan, Ibadan, Nigeria
| | | | - Isa Abdulkadir
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chinyere V Ezeaka
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Beatrice N Ezenwa
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iretiola B Fajolu
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
| | - Zainab O Imam
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Dominic D Umoru
- Department of Paediatrics, Maitama District Hospital, Abuja, Nigeria
| | - Walter Otieno
- Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Grace M Nalwa
- Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Macrine Olwala
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Alison W Talbert
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Martha K Mwangome
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ismaela Abubakar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicholas D Embleton
- Department of Paediatrics, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Fajolu IB, Mairami AB, Okonkwo I, Ezenwa B, Otuneye AT, Amuabunos EA, Mukhtar-Yola M, Audu LI, Ezeaka VC, Ekhaguere OA. Rates and predictors of mortality of very low birth weight infants in three Nigerian tertiary hospitals. Acta Paediatr 2022. [PMID: 36170565 DOI: 10.1111/apa.16554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022]
Abstract
AIM We aimed to describe in-hospital mortality, and its predictors, in very low birth weight (VLBW) infants managed in tertiary centers in a low- to middle-income country. METHODS This was a retrospective cohort study of VLBW infants (birth weight 500 to 1500 gram) admitted within 72 hours of life to the neonatal intensive care units (NICUs) of 3 tertiary centers in Nigeria from July 2017 to March 2021. We describe in-hospital mortality rates, causes and when they died. The independent predictors of in-hospital mortality were determined using multivariate logistic analysis. RESULTS Of the 6187 NICU admissions, 1161 met the inclusion criteria: 545 (47%) VLBW infants died, including 309 (57%) from respiratory distress syndrome, and 55% occurred within 72 hours of life. The adjusted odds (aOR) for mortality increased with each extra Downes respiratory distress score (aOR 1.27) with a 95% confidence interval (CI) of 1.14-1.41. Study site 3 had a higher aOR for mortality than site 1 (aOR 2.78, 95% CI 1.72-4.48) and site 2 (aOR 2.29, 95% CI 1.45-3.61). CONCLUSION Nearly half (47%) of all VLBW infants admitted to 3 tertiary referral hospitals in Nigeria died during hospitalisation. Mortality varied significantly by site and both the centre and respiratory distress independently predicted mortality.
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Affiliation(s)
- Iretiola B Fajolu
- Department of Pediatrics, College of Medicine, University of Lagos and Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Amsa B Mairami
- Department of Pediatrics, National Hospital, Abuja, Nigeria
| | - Ikechukwo Okonkwo
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Beatrice Ezenwa
- Department of Pediatrics, College of Medicine, University of Lagos and Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Emmanuel A Amuabunos
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | | | - Lamidi I Audu
- Department of Pediatrics, Kaduna State University Kaduna, Nigeria
| | - Veronica C Ezeaka
- Department of Pediatrics, College of Medicine, University of Lagos and Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
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Uwe NO, Ezenwa BN, Fajolu IB, Oshun P, Chukwuma ST, Ezeaka VC. Antimicrobial susceptibility and neonatal sepsis in a tertiary care facility in Nigeria: a changing trend? JAC Antimicrob Resist 2022; 4:dlac100. [PMID: 36196440 PMCID: PMC9524563 DOI: 10.1093/jacamr/dlac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Neonatal sepsis remains one of the leading causes of morbidity and mortality in neonates, especially in developing countries. Objectives To determine the prevalence, common bacterial pathogens, and the antibiotic susceptibility pattern of neonatal sepsis at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Methods This was a cross-sectional study of neonates who presented at the facility with symptoms and signs of sepsis from January 2017 to October 2017. Demographic and clinical data were extracted using a structured questionnaire. Blood culture, urine and CSF were collected and cultured on blood and MacConkey agar. Bacterial isolates were identified using Microbact 24E system and biochemical tests. Antibacterial susceptibility testing was done using the modified Kirby–Bauer disc diffusion method. Results Two hundred and ninety neonates were recruited during the study period. Seventy-three (25.2%) neonates had culture-proven sepsis. One (0.3%) neonate had meningitis and no neonates (0%) had confirmed urinary tract infection. Of the 73 neonates with positive blood cultures, 56 (76.7%) had early-onset sepsis and 17 (23.3%) had late-onset sepsis. Gram-negative bacilli accounted for 60.3% of all isolates. Predominantly isolated pathogens were Staphylococcus aureus (20.5%), CoNS (19.2%) and Klebsiella pneumoniae (13.7%). The isolates were most susceptible to levofloxacin and amikacin. Conclusions Neonatal sepsis is still a huge burden in the newborn. S. aureus, CoNS and K. pneumoniae are the prevalent pathogens in the local facility, with good susceptibility to levofloxacin and amikacin. Maintaining regular antibiotic surveillance for appropriate empirical antibiotics is important as part of neonatal care.
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Affiliation(s)
- Nkoyo O Uwe
- Department of Paediatrics, Lagos University Teaching Hospital (LUTH) , Lagos , Nigeria
| | - Beatrice N Ezenwa
- Department of Paediatrics, Lagos University Teaching Hospital (LUTH) , Lagos , Nigeria
- Department of Paediatrics, College of Medicine University of Lagos , Lagos , Nigeria
| | - Iretiola B Fajolu
- Department of Paediatrics, Lagos University Teaching Hospital (LUTH) , Lagos , Nigeria
- Department of Paediatrics, College of Medicine University of Lagos , Lagos , Nigeria
| | - Philip Oshun
- Department of Medical Microbiology, Lagos University Teaching Hospital (LUTH) , Lagos , Nigeria
- Department of Medical Microbiology, College of Medicine University of Lagos , Lagos , Nigeria
| | - Stella T Chukwuma
- Department of Medical Microbiology, Lagos University Teaching Hospital (LUTH) , Lagos , Nigeria
| | - Veronica C Ezeaka
- Department of Paediatrics, Lagos University Teaching Hospital (LUTH) , Lagos , Nigeria
- Department of Paediatrics, College of Medicine University of Lagos , Lagos , Nigeria
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Tongo OO, Olwala MA, Talbert AW, Nabwera HM, Akindolire AE, Otieno W, Nalwa GM, Andang'o PEA, Mwangome MK, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Imam ZO, Umoru DD, Abubakar I, Embleton ND, Allen SJ. Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya. Front Pediatr 2022; 10:892209. [PMID: 35633964 PMCID: PMC9130927 DOI: 10.3389/fped.2022.892209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Optimizing nutrition in very preterm (28-32 weeks gestation) and very low birth weight (VLBW; 1,000 g to <1,500 g) infants has potential to improve their survival, growth, and long-term health outcomes. Aim To assess feeding practices in Nigeria and Kenya for very preterm and VLBW newborn infants. Methods This was a cross-sectional study where convenience sampling was used. A standard questionnaire was sent to doctors working in neonatal units in Nigeria and Kenya. Results Of 50 respondents, 37 (74.0%) were from Nigeria and 13 (26.0%) from Kenya. All initiated enteral feeds with breastmilk, with 24 (48.0%) initiating within 24 h. Only 28 (56.0%) used written feeding guidelines. Starting volumes ranged between 10 and 80 ml/kg/day. Median volume advancement of feeds was 20 ml/kg/day (IQR 10-20) with infants reaching full feeds in 8 days (IQR 6-12). 26 (52.0%) of the units fed the infants 2 hourly. Breastmilk fortification was practiced in 7 (14.0%) units, while folate, iron, calcium, and phosphorus were prescribed in 42 (84.0%), 36 (72.0%), 22 (44.0%), 5 (10.0%) of these units, respectively. No unit had access to donor breastmilk, and only 18 (36.0%) had storage facilities for expressed breastmilk. Twelve (24.0%) used wet nurses whilst 30 (60.0%) used formula feeds. Conclusion Feeding practices for very preterm and VLBW infants vary widely within Nigeria and Kenya, likely because of lack of locally generated evidence. High quality research that informs the feeding of these infants in the context of limited human resources, technology, and consumables, is urgently needed.
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Affiliation(s)
- Olukemi O. Tongo
- College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Macrine A. Olwala
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Alison W. Talbert
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- *Correspondence: Alison W. Talbert
| | - Helen M. Nabwera
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children's Hospital NHS Trust, Liverpool, United Kingdom
| | | | - Walter Otieno
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
- Department of Nutrition and Health, Maseno University, Maseno, Kenya
| | - Grace M. Nalwa
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
- Department of Nutrition and Health, Maseno University, Maseno, Kenya
| | | | | | - Isa Abdulkadir
- Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chinyere V. Ezeaka
- College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Beatrice N. Ezenwa
- College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iretiola B. Fajolu
- College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Zainab O. Imam
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | - Ismaela Abubakar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicholas D. Embleton
- Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stephen J. Allen
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ademola-Popoola DS, Fajolu IB, Gilbert C, Olusanya BA, Onakpoya OH, Ezisi CN, Musa KO, Chan RVP, Okeigbemen VW, Muhammad RC, Malik ANJ, Adio AO, Bodunde OT, Rafindadi AL, Oluleye TS, Tongo OO, Badmus SA, Adebara OV, Padhi TR, Ezenwa BN, Obajolowo TS, Olokoba LB, Olatunji VA, Babalola YO, Ugalahi MO, Adenekan A, Adesiyun OO, Sahoo J, Miller MT, Uhumwangho OM, Olagbenro AS, Adejuyigbe EA, Ezeaka CVC, Mokuolu O, Ogunlesi TA, Ogunfowora OB, Abdulkadir I, Abdullahi FL, Fabiyi AT, Hassan LHL, Baiyeroju AM, Opara PI, Oladigbolu K, Eneh AU, Fiebai BE, Mahmud-Ajeigbe FA, Peter EN, Abdullahi HS. Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020. BMJ Open Ophthalmol 2021; 6:e000645. [PMID: 34514173 PMCID: PMC8383855 DOI: 10.1136/bmjophth-2020-000645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria. Design Descriptive case study. Setting Neonatal intensive care units in Nigeria. Participants Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria). Methods and analysis A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. Results In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems. Conclusion ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.
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Affiliation(s)
- Dupe S Ademola-Popoola
- Department of Ophthalmology, University of Ilorin, Ilorin, Kwara, Nigeria.,Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Iretiola B Fajolu
- Department of Neonatology/Perinatology, Paediatrics, University of Lagos College of Medicine/ Lagos University Teaching Hospital, Lagos, Nigeria
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Bolutife A Olusanya
- Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Oluwatoyin H Onakpoya
- Retinal Unit, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun, Nigeria
| | - Chinyelu N Ezisi
- Pediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Kareem O Musa
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Valentina W Okeigbemen
- Paediatric Ophthalmology Unit, Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria
| | - Rilwan C Muhammad
- Department of Ophthalmology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Adedayo O Adio
- Paediatric Ophthalmology Unit, Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Olubunmi T Bodunde
- Department of Ophthalmology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Abdulkadir L Rafindadi
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Tunji S Oluleye
- Vitreoretinal Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Olukemi O Tongo
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Sarat A Badmus
- Paediatric Ophthalmology Unit, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Olufunmilayo V Adebara
- Neonatal Unit, Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Tapas Ranjan Padhi
- Vitreoretinal Services, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, India
| | - Beatrice N Ezenwa
- Department of Neonatology/Perinatology, Paediatrics, University of Lagos College of Medicine/ Lagos University Teaching Hospital, Lagos, Nigeria
| | - Tokunbo S Obajolowo
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Lateefat B Olokoba
- Vitreoretinal Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Victoria A Olatunji
- Vitreoretinal Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Yewande Olubunmi Babalola
- Vitreoretinal Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Mary O Ugalahi
- Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Adetunji Adenekan
- Vitreoretinal Unit, Department of Ophthalmology, University of Lagos, Lagos, Nigeria
| | - Omotayo O Adesiyun
- Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Jagdish Sahoo
- Neonatology, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India, Bhubaneswar, Odisha, India
| | - Marilyn T Miller
- Department of Ophthalmology, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Odarosa M Uhumwangho
- Vitreoretinal Unit, Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria
| | - Adeduntan S Olagbenro
- Department of Ophthalmology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Ebunoluwa A Adejuyigbe
- Peadiatrics and Child Health, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - Chinyere V C Ezeaka
- Department of Neonatology/Perinatology, Paediatrics, University of Lagos College of Medicine/ Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olugbenga Mokuolu
- Neonatal Unit, Department of Paediatrics, University of Ilorin, Ilorin, Kwara, Nigeria
| | - Tinuade A Ogunlesi
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Olusoga B Ogunfowora
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Isa Abdulkadir
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Fatima L Abdullahi
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Abosede T Fabiyi
- Special Care Baby Unit, Nursing Service, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Laila H L Hassan
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Aderonke M Baiyeroju
- Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Peace I Opara
- Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Kehinde Oladigbolu
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Augusta U Eneh
- Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Bassey E Fiebai
- Vitreoretinal Unit, Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Fatima A Mahmud-Ajeigbe
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Elijah N Peter
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Hawwa S Abdullahi
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
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Nabwera HM, Wang D, Tongo OO, Andang’o PEA, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Imam ZO, Mwangome MK, Umoru DD, Akindolire AE, Otieno W, Nalwa GM, Talbert AW, Abubakar I, Embleton ND, Allen SJ. Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya. PLoS One 2021; 16:e0244109. [PMID: 33444346 PMCID: PMC7808658 DOI: 10.1371/journal.pone.0244109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria. STUDY DESIGN In a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period. RESULTS 2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128) infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortality was very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73-28.39), VLBW (6.92; 4.06-11.79), congenital anomaly (4.93; 2.42-10.05), abdominal condition (2.86; 1.40-5.83), birth asphyxia (2.44; 1.52-3.92), respiratory condition (1.46; 1.08-2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28-2.85). Mortality was reduced if mothers received a partial (0.51; 0.28-0.93) or full treatment course (0.44; 0.21-0.92) of dexamethasone before preterm delivery. CONCLUSION Greater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues during pregnancy and delivery as well as in the newborn.
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Affiliation(s)
- Helen M. Nabwera
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital NHS Trust, Liverpool, United Kingdom
- * E-mail:
| | - Dingmei Wang
- Children's Hospital of Fudan University, Minhang District, Shanghai, China
| | | | | | - Isa Abdulkadir
- Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | | | | | | | | | | | | | | | - Walter Otieno
- Maseno University, Maseno, Kenya
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Jomo Kenyatta Highway Kaloleni Kisumu KE, Central, Kenya
| | - Grace M. Nalwa
- Maseno University, Maseno, Kenya
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Jomo Kenyatta Highway Kaloleni Kisumu KE, Central, Kenya
| | | | - Ismaela Abubakar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicholas D. Embleton
- Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, United Kingdom
| | - Stephen J. Allen
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital NHS Trust, Liverpool, United Kingdom
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Ezenwa BN, Fajolu IB, Nabwera H, Wang D, Ezeaka CV, Allen S. Impact of COVID-19 lockdown measures on institutional delivery, neonatal admissions and prematurity: a reflection from Lagos, Nigeria. BMJ Paediatr Open 2021; 5:e001029. [PMID: 34192196 PMCID: PMC8076627 DOI: 10.1136/bmjpo-2021-001029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/09/2021] [Indexed: 11/04/2022] Open
Abstract
We assessed the effect of COVID-19 lockdown on deliveries and neonatal admissions according to gestation in Lagos, Nigeria. During lockdown (April-June 2020), there was a marked fall of about 50% in in-hospital deliveries and admissions to the neonatal wards for both in and outborn infants compared with prelockdown (January-March 2020) and a comparison period (April-June 2019). However, the proportion of preterm infants was broadly similar in each period. Lockdown markedly reduced hospital deliveries and healthcare-seeking for sick newborns but did not influence the overall proportion of preterm births among in-house deliveries and outborn neonatal admissions.
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Affiliation(s)
- Beatrice Nkolika Ezenwa
- Department of Paediatrics, University of Lagos College of Medicine, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Surulere, Nigeria
| | - Iretiola B Fajolu
- Department of Paediatrics, University of Lagos College of Medicine, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Surulere, Nigeria
| | - Helen Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Chinyere V Ezeaka
- Department of Paediatrics, University of Lagos College of Medicine, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Surulere, Nigeria
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Ezenwa BN, Fajolu IB, Akinajo OR, Makwe CC, Oluwole AA, Akase IE, Afolabi BB, Ezeaka VC. Management of covid-19: a practical guideline for maternal and newborn health care providers in Sub-Saharan Africa. J Matern Fetal Neonatal Med 2020; 35:1789-1795. [PMID: 32419553 DOI: 10.1080/14767058.2020.1763948] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
COVID-19 is a pandemic that is currently ravaging the world. Infection rate is steadily increasing in Sub-Saharan Africa. Pregnant women and their infants may suffer severe illnesses due to their lower immunity. This guideline prepares and equips clinicians working in the maternal and newborn sections in the sub-region to manage COVID-19 during pregnancy and childbirth.
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Affiliation(s)
- B N Ezenwa
- Neonatology Unit, Department of Pediatrics, College of Medicine, University of Lagos, Nigeria
| | - I B Fajolu
- Neonatology Unit, Department of Pediatrics, College of Medicine, University of Lagos, Nigeria
| | - O R Akinajo
- Department of Obstetrics & Gynecology, College of Medicine, University of Lagos, Nigeria
| | - C C Makwe
- Department of Obstetrics & Gynecology, College of Medicine, University of Lagos, Nigeria
| | - A A Oluwole
- Department of Obstetrics & Gynecology, College of Medicine, University of Lagos, Nigeria
| | - I E Akase
- Infectious Diseases Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - B B Afolabi
- Department of Obstetrics & Gynecology, College of Medicine, University of Lagos, Nigeria
| | - V C Ezeaka
- Neonatology Unit, Department of Pediatrics, College of Medicine, University of Lagos, Nigeria
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Fajolu IB, Rotimi-Samuel A, Aribaba OT, Musa KO, Akinsola FB, Ezeaka VC, Onakoya AO. Retinopathy of prematurity and associated factors in Lagos, Nigeria. Paediatr Int Child Health 2016; 35:324-8. [PMID: 26744157 DOI: 10.1080/20469047.2015.1109277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Screening and early treatment of retinopathy of prematurity (ROP) is important to reduce visual impairment in at risk infants. AIM To determine the frequency and risk factors associated with ROP in preterm infants in Lagos University Teaching Hospital. METHODS This was a prospective cohort study of preterm infants with gestational age (GA) less than 32 weeks and birthweight 1500 g or less conducted from November 2011 to May 2014. The infants' eyes were examined using an indirect ophthalmoscope at 4-6 weeks of life or at 34 weeks post-conceptual age. Examinations were repeated weekly until regression or progression to a high risk pre-threshold disease. Staging was according to the revised International Classification for ROP and treatment criteria were as defined by the Early Treatment for ROP study. The GA, birth weight (BW), use of oxygen, presence of respiratory distress syndrome and other risk factors were recorded and tested for significance. RESULTS Twelve (15%) of the 80 infants examined had any ROP and six (7.5%) had treatable ROP. The mean (SD) GA and BW for infants with ROP were both lower than for those without ROP; 28.2 (1.7) weeks vs 29.1 (1.6) weeks and 1124 (212) g vs 1251 (274) g for GA and BW, respectively. Risk factors such as supplemental oxygen, sepsis, respiratory distress and anaemia were not significantly associated with ROP. CONCLUSION The frequency of ROP and treatable ROP was high; it is therefore recommended that routine care of preterm infants should include screening for ROP and that affordable treatment facilities should be provided in public hospitals.
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Affiliation(s)
- I B Fajolu
- Department of Paediatrics, College of Medicine, University of Lagos , Nigeria
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12
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Ladapo TA, Fajolu IB, Adeniyi OF, Ekure EN, Maduako RO, Jaja TC, Oduwole AO. Blood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents. Niger J Clin Pract 2016; 19:401-6. [DOI: 10.4103/1119-3077.179289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Oduwole OA, Adeniyi OF, Esezebor CI, Ekure E, Fajolu IB, Renner JK. Postural hypotension in type 1 diabetes: the influence of glycemic control and duration of illness. Niger J Clin Pract 2014; 17:140-4. [PMID: 24553020 DOI: 10.4103/1119-3077.127421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Postural hypotension (PH) indicates the presence of cardiac autonomic neuropathy and in diabetes mellitus (DM) is associated with adverse outcome. Nonetheless, PH has been rarely characterized in young persons in Sub-saharan Africa where suboptimal care of DM is prevalent. AIMS The aim of the study was to determine the prevalence of PH in young patients with type 1DM and its relationship with the duration of DM and glycemic control. SETTINGS AND DESIGN It was a cross-sectional, case control study carried out in the pediatric out-patient clinic. MATERIALS AND METHODS Each study participant had blood pressure (BP) measured in the supine and standing positions. Glycated hemoglobin (HbA1c) levels were determined and disease duration was documented. STATISTICAL ANALYSIS The mean BP in the different positions was determined. The occurrence of PH, duration of disease and HbA1c levels was determined with logistic regression analysis. RESULTS A total of 26 diabetic subjects and 26 age and sex matched controls were studied. 12 (46.2%) diabetic subjects had evidence of PH while none of the controls had PH. Diabetic subjects with PH had significantly longer duration of DM than those diabetics without PH (6.79 ± 4.81 vs. 2.83 ± 2.36, P = 0.023). The mean HbA1c level was similar in both groups of diabetic subjects (9.79 ± 2.07 vs. 9.17 ± 2.35). On logistic regression, age, duration of disease, HbA1c level and body mass index were not significant predictors of PH. CONCLUSION PH is common in young persons with type 1 DM, with higher frequency in those with long standing disease.
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Affiliation(s)
| | - O F Adeniyi
- Department of Paediatrics, College of Medicine, University of Lagos; Lagos University Teaching Hospital, Lagos, Nigeria
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14
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Oduwole AA, Ladapo TA, Fajolu IB, Ekure EN, Adeniyi OF. Obesity and elevated blood pressure among adolescents in Lagos, Nigeria: a cross-sectional study. BMC Public Health 2012; 12:616. [PMID: 22867531 PMCID: PMC3490830 DOI: 10.1186/1471-2458-12-616] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Childhood obesity and associated hypertension are major public health concerns globally. This study aimed to determine the prevalence of obesity and the associated risk of high blood pressure among Nigerian adolescents. METHODS A cross-sectional school-based study of 885 apparently healthy adolescents was performed. Weight, height and blood pressure (BP) were measured using standard methods. Body mass index (BMI) was calculated and categorized by age, sex and percentile. Obesity and overweight were defined as: ≥ 95th and 85th to < 95th percentiles, respectively, for age, sex and height. Subjects were sub-categorized into age 10-13 years (A) and 14-17 years (B). The odds ratio for pre-hypertensive and hypertensive range BP by age and BMI were generated. Significance was set at P < 0.05. RESULTS The prevalence of overweight and obesity were 13.8% and 9.4%, respectively. The prevalence of hypertensive range systolic BP in obese versus normal BMI females was 16% versus 23% (p=0.00) and 12.1% versus 6.4% (p=0.27) in males. The prevalence of hypertensive range diastolic BP in obese versus normal BMI females was 12% versus 1.4% (p=0.00) and 15.2% versus 3.5% (p=0.01) in males. BMI in group B was significantly associated with pre-hypertensive and hypertensive range systolic BP in overweight (P = 0.01, P = 0.002) and obese subjects (P = 0.00, P = 0.00) and with hypertensive range diastolic BP (P = 0.00) only in obese subjects. The only significant association in group A was between obesity and pre-hypertensive range diastolic BP (P = 0.00). CONCLUSION The prevalence of hypertensive range BP among obese Nigerian adolescents was high. Screening for childhood obesity and hypertension, and long-term follow-up of obese adolescents into adulthood are recommended.
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Affiliation(s)
- Abiola A Oduwole
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Taiwo A Ladapo
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iretiola B Fajolu
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ekanem N Ekure
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
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16
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Adeyemo WL, Fajolu IB, Temiye EO, Adeyemi MO, Adepoju AA. Orofacial and dental injuries associated with seizures in paediatric patients in Lagos University Teaching Hospital. Int J Pediatr Otorhinolaryngol 2011; 75:670-2. [PMID: 21376402 DOI: 10.1016/j.ijporl.2011.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 02/03/2011] [Accepted: 02/04/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the prevalence and pattern of presentation of orofacial and dental injuries in children with seizures at the Children's Emergency Unit of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. METHODS This was a prospective study of children with febrile or non-febrile convulsion who presented at the Children's Emergency Unit of LUTH between July 2008 and August 2009. The age, gender, type of convulsion and the presence/absence of orofacial and other bodily injuries were recorded in a proforma. Mechanism, type and classification of injury were recorded for patients with orofacial injuries. RESULTS A total of 257 children (148 males and 109 females) with febrile/non-febrile convulsion were included in the analysis. The mean age (SD) of patients was 32.8 ± 40.5 months. There were 223 (86.8%) cases of febrile convulsion and 34 (13.3%) cases of non-febrile convulsion. Thirteen children sustained orofacial injuries giving a prevalence of 5.1%. There was no significant difference in the prevalence of orofacial injury between patients with febrile convulsion (4.5%) and those with non-febrile convulsion (8.8%) (P=0.282). The most common cause of orofacial injuries was forceful insertion of hard object into the mouth during convulsive episodes. Twelve (92.3%) patients sustained soft tissue injury, while one sustained both soft and hard tissue injuries. The most common site of injury was the lip. CONCLUSIONS Oro-facial and dental injuries may occur in children with seizures. It is therefore important that these injuries be looked for by the paediatrician and the dentist/oral and maxillofacial surgeons should be involved in managing these children.
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Affiliation(s)
- W L Adeyemo
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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Abstract
BACKGROUND In Nigeria, diarrhoeal disease is second only to malaria as a cause of death the under 5 age group. This study was aimed at assessing the benefit or otherwise of zinc supplement in acute diarrhoea. SUBJECTS AND METHODS This was a multi-centred randomized double blind controlled study. Children with acute diarrhoea aged between 6 and 24 months were randomized into zinc supplemented and placebo groups. Plasma zinc levels were analyzed at enrollment and at the end of the study. The children were reviewed for the next three months from the time of enrollment. RESULTS The mean plasma zinc levels at baseline and at the end of the study were 0.06 +/- 0.04 and 0.067 +/- 0.03 ppm in the zinc supplemented group and 0.11 +/- 0.02 and 0.05 +/- 0.03 ppm in the control group. The differences were not statistically significant. The zinc supplemented group had an average weight gain of 1.1 kg as against 0.73 kg (p = 0.00) for the control group in the study period. No adverse effect was reported on account of zinc supplementation. CONCLUSION Zinc supplementation is beneficial in acute diarrhoea as observed in this study.
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Affiliation(s)
- I B Fajolu
- Department of Paediatrics College of Medicine, University of Lagos
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18
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Fajolu IB, Grange OA, Renner JK, Odunukwe NW, Njokanma OF, Ahmed OA, Efenemokwu C. Prevalence of iron deficiency in children 6-24 months in Lagos. ACTA ACUST UNITED AC 2008; 17:97-100. [PMID: 18318103 DOI: 10.4314/nqjhm.v17i3.12553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Iron deficiency is the commonest cause of nutritional anaemia in children worldwide particularly in developing countries. Infants and toddlers are prone to developing iron deficiency anaemia (IDA). This study was carried out to determine the prevalence of IDA and some factors associated with it in this group of children. STUDY DESIGN Haemoglobin concentration and mean corpuscular volume (MCV) estimations carried out in 282 apparently well children aged 6-24 months. Estimations of serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF) and transferrin saturation (TS) were also determined in children with anaemia (Hb concentration < 11.0 g/dl). Information on current diet was also obtained using a diet record. RESULTS Two hundred and twenty three (79.1%) children had anaemia. The mean Hb concentrations of all the age groups were less than 11.0 g/dl. Forty (14.9%) children had IDA (defined as aneamia plus 2 or more of the following--MCV < 70fl, Ts < 10% or SF < 10 microg/dL). The mean age of children with IDA (8.96 +/- 2.54 months) was statistically lower than for those without the condition 10.94 +/- 4.55 months (p = 0.016). Inclusion of vegetables and animal protein less than three times a week in the diet were both significantly associated with IDA. CONCLUSION The prevalence of IDA in this study is high especially before the age of 12 months and an average weekly intake less than 3 times a week or iron rich foods like animal protein and vegetables was significantly associated with IDA. Emphasis should be on the inclusion of iron rich foods in the diet following exclusive breastfeeding to reduce the prevalence of IDA in these children.
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