Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria

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.

Resuscitation of preterm infants in Nigeria - A national survey on practice

Introduction and Aims

Preterm births constitute a major clinical problem associated with significant morbidity and mortality in the perinatal, neonatal, and childhood periods. Decisions around initiating and/or continuing resuscitation and treatment of preterm infants (PI) both at birth and afterwards need careful consideration. While the developed countries have published guidelines for the resuscitation and care of the PI, this is not the case in developing countries where availability of resources and the absence of a published guidelines impacts on practice. Our study was therefore carried out to access the practice and decision-making that surrounds the resuscitation of PIs by neonatologists and neonatal nurses working in neonatal intensive care units (NICU) across Nigeria.

Subjects and Methods

We conducted an online national survey on neonatal care providers working in level 2 and level 3 neonatal units (NICU) across Nigeria. Around 190 participants were selected from the six geopolitical zones of the country and they were asked about current practices relating to resuscitation and stopping life-sustaining treatment as well as estimated survival rates at different gestational ages (GA).

Results

In total, 138 clinicians responded to our survey. Of this, 73% completed the survey. Majority (83%) of the respondents worked in government-funded public hospitals while the remaining 17% worked in the private hospitals. 74% of the respondents' report having a guideline on the PI. Resuscitation practice varied amongst different neonatologists and neonatal nurses with 48% of the clinicians providing resuscitation at 23-26 weeks and the remainder providing resuscitation at a GA >26 weeks with a median GA threshold for initiating resuscitation at 27 weeks. From an institutional perspective, 75% of PIs <26 weeks were resuscitated in public hospitals while the remaining 25% were resuscitated in private hospital, however this is not statistically significant (P = 0.385). In situations when the GA is unknown, we found a median fetal weight of 700 g as the threshold for providing active treatment. We noticed wide variations in responses on the estimated survival rates of the PIs, however a common finding is the increased chances of survival with increasing GA. Also, PIs across all GAs had higher chances of survival in public hospitals than in private hospitals, however, this is not statistically significant (P = 0.385-0.956). The major factor influencing a clinicians' decision to limit resuscitation was the "risk of poor quality of life" (50%) and the prevalent way of palliating the newborn amongst respondents is by stopping life-sustaining treatment (34%).

Conclusion

Our survey revealed considerable variation in resuscitation practices amongst different neonatal care providers. Having a framework that will formulate and publish a national guideline based on factors like local survival rates, societal norms, and resources and ensuring that it is adopted by all NICUs will generate greater consistency of care.

Socio-demographic determinants of malnutrition among primary school aged children in Enugu, Nigeria

INTRODUCTION

Several factors including the parental literacy, illness, socioeconomic status, poor sanitation and hygienic practices affect the physical growth of children. The aim of this study was to determine the socio-demographic determinants of malnutrition among primary school aged children in Enugu, Nigeria.

METHODS

A cross-sectional descriptive study involving primary school children in Enugu was carried out over a 3 month period. Subjects were selected using multistage sampling technique. Weight and height were measured using a digital scale and a wooden stadiometer, respectively. Body Mass Index (BMI), weight-for-age (WAZ), Height-for-age (HAZ) and BMI-for-age z scores were then derived using the new WHO reference standards.

RESULTS

348 children (40.4%) were recruited from 5 public schools while 512 (59.6%) were recruited from 9 private schools. The mean age of the study participants was 9.2 ± 1.8 years. 7 (0.8%) children were stunted, 26 (3.3%) wasted and 28 (3.3%) underweight. Of all the study participants, overweight and obesity were observed in 73 (8.5%) and 35 (4.1%) children, respectively. Children of lower socioeconomic class were more stunted, underweight and wasted, while overweight and obesity were more prevalent among children from the upper socioeconomic class.

CONCLUSION

Factors such as age and sex, parental education and socioeconomic class had a significant impact on nutritional status. Overweight and obesity were more prevalent among the children from the upper socioeconomic class, attending private schools, while stunting and wasting were more in children of the lower class attending public schools.

Use of Global initiative for asthma (GINA) guidelines in asthma management among paediatric residents in a Sub Saharan African country: a cross-sectional descriptive study

Introduction

Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Despite abundance of asthma guidelines, prevalence has continued to increase globally. There is need to assess how the contents of asthma guidelines are put to clinical use by doctors in the management of children with asthma. This study aims at evaluating the clinical practice of paediatric residents in applying GINA guidelines.

Methods

Cross-sectional descriptive study of paediatric residents from 23 university teaching hospitals in Nigeria using structured questionnaire. Data analyses were with Statistical Package for Social Sciences (SPSS) version 19 (Chicago IL). Chi square was used to assess for any significant associations between categorical variables. A p < 0.05 was regarded to be statistically significant.

Results

Sixty-six paediatric residents aged 27- 40 years were enrolled into the study (37 females and 29 males). One-third had spent more than three years in residency training. Fifty-eight residents (87.9%) were aware of the GINA guidelines while 46 (69.7%) were familiar with its contents. Only 39 (59.1%) residents adhered to the GINA guidelines. Twenty of the 35 junior residents (57.1%) compared to 26 of 31 (83.9%) senior residents were familiar with the GINA guidelines (p=0.031) while 15 of 35 junior residents (42.9%) compared to 24 of 31 senior residents (77.4%) consistently follow the GINA guidelines (p=0.006). Adherence to GINA guidelines was not influenced significantly by years of graduation or training (p>0.05).

Conclusion

The use of the GINA guidelines was poor among paediatric residents. Application of contents rather than just availability of asthma guidelines may partly account for increasing asthma prevalence globally.