bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Levels of Pro-inflammatory Cytokines in relationship to outcomes in Children with P. falciparum malaria, in Nnewi-South east Nigeria
Authors: Okocha EC , Ibeh NC , Ukaejiofor EO , Ebenebe JC , Aneke JC , Okonkwo KU , Onah C
Published: May 2021

Background and Objective: In P. falciparum malaria (PFM) infestation there are marked changes in cytokine production as the body mounts an immune response to it. Hence we set out to study these changes.Methods: A total of 158 cases of PFM among children attending the paediatric unit of our hospital and 56 healthy controls were studied. Children with febrile illness were screened for malaria using 10% Giemsa stained blood smear. Patients with positive smears were recruited; co-infected patients – those infected by another organism in addition to plasmodium specie.- were excluded. Whole blood was collected, some into plain tubes for serum cytokine testing and some into EDTA bottles for complete blood count and parasite density (PD) determination. Controls with asymptomatic parasitaemia were excluded.Results: Using the World Health Organization criteria for defining severe malaria; we identified 15 cases of severe and 143 cases of uncomplicated PFM. Significantly elevated levels of interleukin-1 (IL-1), interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) were seen in the uncomplicated and severe forms of PFM. It was observed that the elevated cytokine values correlated with PD (in uncomplicated PFM but not in the severe forms). The difference between PD/absolute monocyte count (AMC) ratio was not significant (p=0.13); while PD/platelet count (PC) and PC/ AMC ratios were significant (p=0.01, and 0.03 respectively) when compared between uncomplicated and severe disease.Conclusion: Our data seems to suggest that subjects with an adequate immune response to the parasite density, in terms of pro-inflammatory cytokine levels, presented with uncomplicated disease; while those who have an inadequate response presented with severe disease. The ratios of (PD/PC) and (PC/AMC), in the positive and negative directions respectively, may be predictors of increased disease severity. These observations may have implications for predicting disease outcome and PFM therapy.Key Words: plasmodium falciparum malaria, pro-inflammatory cytokines, Parasite density/Platelet count ratio, Platelet count/Absolute monocyte
Harmful traditional practices in a newborn: A case report
Authors: Peterside O , Duru CO , Anene N
Published: May 2021

Ninetynine percent of the nearly four million newborn deaths occur in developing countries with newborn deaths remaining relatively invisible and neglected1. In these countries, traditional attitudes and practices dominate newborn care and are often harzadous2. As most births and newborn deaths in developing countries occur outside health care facilities, a reduction in neonatal mortality may depend significantly on interventions involving adaptation of traditional care behaviours practiced at home3. However, despite the importance of traditional practices in the newborn period, little is known about the impact of these practices on newborn health2. We herein present a case of an eighteen day old female who was rushed to the hospital with severe wasting, recto-vaginal prolapse and septic umbilical cord resulting from repeated traditional homecare practices by her mother and grandmother. This case highlights the impact of harmful traditional home care practices on newborn health and emphasizes the urgent need for public enlightenment campaigns and other policy decisions and interventions aimed at reducing this societal menace.Keywords: Harmful traditional practices, newborn, neonatal morbidity, neonatal mortality
Pattern of childhood pertussis in a tertiary hospital in Nigeria: a five year review (2007-2011)
Authors: Oloyede IP , Ekanem AM , Udoh EE
Published: May 2021

Pertussis is being increasingly found in previously immunized subjects. In Nigeria, the immunization coverage rates are low. This study was therefore carried out to highlight the cases of pertussis seen in a young Nigerian tertiary health facility, with emphasis on the clinical features, complications and the impact of prior immunization in the affected children.Methods : This was a hospital based retrospective study, in which data were obtained from case notes of children seen in the Paediatric department of the University of Uyo Teaching Hospital (UUTH) from January 2007 to December 2011 with a diagnosis of pertussis. Information sought included epidemiologic data, duration of illness, signs and symptoms, treatment, complications and outcome.Results: Fifty three patients were diagnosed with pertussis during the five year period, with majority (29; 54.7%) of cases in the year 2011. Twenty one (39.6%) of the subjects were males while 32 (60.4%) were females. The mean age of the subjects was 29.71 + 27.73 months. The most common symptoms were Post-tussive vomiting and paroxysmal cough occurring in 48(90%) and 39 (73.6%) of the patients respectively. The average interval between onset of symptoms and presentation at the health facility was 3.35 + 2.84 weeks. Majority of the patients (25; 47.2%) were adequately immunized for their age. Bronchopneumonia, either alone or in combination with other complications was the commonest complication occurring in nine (52.9%) patients. There was no mortality.Conclusion: Pertussis is still of public health significance. Routine immunization should be strengthened and booster doses of vaccines should be considered for older children whose immunity may begin to wane.Key words: Pertussis, pattern, childhood
Effectiveness of didactic training on the cognitive knowledge of health professionals on neonatal resuscitation in southern Nigeria
Authors: Oloyede IP , Udo PA , Nyong EE
Published: May 2021

Background: Nigeria has a high neonatal mortality rate. Most of these deaths can be prevented by providing adequate training for health providers with available and functional basic resuscitation equipments. Our aim was to assess the effect of training on the cognitive knowledge of health practitioners on neonatal resuscitation.Method: We conducted neonatal resuscitation trainings for selected health professionals from all the senatorial districts of Akwa Ibom State, based on the Neonatal Resuscitation programme (NRP) of the American Academy of Paediatrics (AAP). The facilitators were trained and certified in the NRP train-the trainers program of the AAP conducted by the Paediatric Association of Nigeria (PAN). Pre -and post-test were organized during the training and the test scores analyzed to assess any improvement in the knowledge of the health professionals on neonatal resuscitation.Results: One hundred and eightyone health professionals were trained over a two year period. Sixty five (35.9%) were doctors, while 116 (64.9%) were nurses. Physicians had similar pre- test but significantly higher post- test scores compared to the nurses: 46.35±15.34 vs 43.70± 14.51; p=0.34 and 76.14±13.02vs 66.29±15.7; p=0.04 respectively. All the health professionals showed significantly higher posttest scores compared to the pre-test scores; p=0.001 respectively. There was also a negative relationship between the number of practice years and the pre-training scores for the physicians and nurses; spearman rho= -0.18; p=0.45 and -0.43;p=0.003 respectively.Conclusion: Neonatal resuscitation training leads to an improvement in the cognitive knowledge of health practitioners. All health practitioners should be trained irrespective of number of practice years. Further studies are required to assess its long term impact on neonatal mortality.Keywords: Neonatal Resuscitation Training, knowledge, health
Prevalence of bacteraemia in febrile, under-five children in the children’s outpatient clinic of University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Authors: Onubogu UC
Published: May 2021

Background: Bacteraemia is the presence of viable bacteria in the circulating blood. The most common manifestation of bacteraemia is fever. Untreated bacteraemia can progress in 10% of children to focal infection and sepsis which can be fatal. Knowledge of the organisms implicated in causing bacteraemia would help in the right choice of antibiotics while awaiting blood culture results.Objective: This study determined the prevalence and aetiology of bacteraemia among febrile non neonatal, under–five children seen in the Children’s Clinic of the University of Port Harcourt Teaching Hospital.Method: Febrile Children, aged 29 days to < 60 months, who presented in the outpatient clinic and whose parents gave consent were recruited from September 2010 to January 2011. Information on their weight, bio-data, and blood culture results were collected and analysed.Result: A total of 362 children (M:F 1.1:1) were studied. Bacteraemia was found in 32 (8.8%) children. The prevalence rate of bacteraemia was highest in children aged 1-12months (12.1%) and higher in males 13(10.2%) compared to females 19(7.4%). Staphylococcus aureus was the commonest (56.3%) organism isolated.Conclusion: The prevalence of bacteraemia in febrile postneonatal under-five children in the Children’s Outpatient Clinic of University of Port Harcourt Teaching Hospital was 8.8% with Staphylococcus aureus being the commonest organism implicated. It is recommended that antibiotics active against Staphylococcus aureus should be among the drugs that need to be commenced in this group of children while blood culture result is being awaited.Key words: Fever, blood culture, bacteremia, under-five children,
Pattern of childhood and adolescent malignancies at a tertiary health institution in South-east Nigeria : A ten year study
Authors: Okocha EC , Aneke JC , Ulasi TO , Ezeudu CE , Umeh EO , Ebubedike UR , Ukah CO , Onwukamuche ME , Anyiam DC , Onyiaorah IV , Ndukwe CO , Ugwu JO , Ekwunife OH
Published: May 2021

Background: Cancer remains a major cause of death in children and adolescents, and differs in adults in nature, distribution and prognosis1. A culture of case documentation is lacking in our environment and many cases go unreported.Study objectives: To document the pattern of childhood and adolescent malignancies at a tertiary health institution in south-east Nigeria over a ten year period (January 2004 to December 2013)Methodology: Details of all children and adolescents aged 18 years and below treated for malignancy were extracted from the cancer registry and the records unit of the histopathology department for the period beginning at January 2004 to December 2013 at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Information retrieved was verified against the hospital admission register, as well as the medical and histopathology records for all cancer patients over the period of interest.Results: Eighty-five cases of childhood and adolescent malignancy were treated at NAUTH, Nnewi between January 2004 and December 2013. Median age of the study population was 9years, with a range of 0.1– 18years, more males (56.50%) than females (43.50%). Commonest tumours were the Lymphomas (11.76%) comprising Non- Hodgkin’s lymphoma (80%), Hodgkin’s lymphoma (10%) and Large-cell lymphoma (10%), the Leukaemias (11.76%) comprising Acute myeloblastic leukaemia (80%) and Acute lymphoblastic leukaemia (20%). Others were Rhabdomyosarcoma (11.76%), Nephroblastoma (11.76%), Retinoblastoma (5.88%), Ovarian tumours (4.71%), the Soft tissue sarcomas-excluding rhabdomyosarcoma (3.53%) and Osteogenic sarcoma (3.35%)’.Conclusion: Study findings suggest that lymphoma, leukaemia, rhabdomyosarcoma and nephroblastoma are the commonest childhood and adolescent malignancies in south-east Nigeria.Keywords: Childhood, Adolescent, Malignancy
Challenges of childhood obesity in a developing economy: A review
Authors: Eke CB , Ubesie AC , Ibe BC
Published: May 2021

Background: Obesity once considered a high income country’s malady is now on the rise in most developing countries particularly in urban settings. Most of these emerging economies have been reported to have different shades of under – nutrition coexisting side by side with over-nutrition. It is pertinent therefore that we determine the factors driving the increase in obesity rates in developing countries as they generally lack the infrastructure to adequately handle the associated complications.Objectives: This communication is aimed at reviewing the burden and risk factors for obesity in children in developing countries, double burden of malnutrition, challenges including medical as well as economic costs and sustainable preventive programmes of obesity in our environment with the hope of sensitizing both the health community and policy makers of this emerging epidemic.Methods: We searched relevant literature on the subject published only in English language or translated into English language manually and electronically. The Index Medicus, AJOL, Medline, PUBMED, and HINARI were specifically searched for the period between 1980 and 2014 and reviewed. The following key words were applied in the search: Obesity in childhood, its burden and associated risk factors, complications of obesity in childhood, double burden of malnutrition in developing countries, assessment of obesity, childhood challenges of obesity including its direct and indirect costs in developing countries as well as practical preventive models in developing economies.Results: Several relevant studies were identified. The health as well as economic costs of obesity is diverse. Obesity is the major risk factor for a variety of non – communicable diseases including cardiovascular diseases, type 2 diabetes and malignancies in later life. Also obese children have higher risk of orthopaedic problems and psychological disturbances like low -self esteem and bullying. This can also lead to poor social adjustments among our teeming youths who are the bedrock of our future economy. Most of these diseases cause premature deaths in addition to long term morbidities. Many of these obesity associated complications impose substantial burden on the health care system in developing countries with weak health systems, and if allowed unmitigated the implications are that the cost of its care may overwhelm not only the health budget but also affect the provisions of basic social amenities.Conclusions: Preventive programmes have been shown to reduce the burden of obesity in developed countries. Dearth of data on burden of obesity and its associated complications in children and adolescents still a challenge in most developing economies. Efforts should be made to prevent childhood obesity using multi- pronged approach at population level through targeted education, sustainable interventions related to healthy nutritional practices as well as physical activity promotion.Key words: Challenges; Obesity; Children; Developing Economies
Mothers’ perception of the use of banked human milk for feeding of the infants
Authors: Abhulimhen-Iyoha BI , Okonkwo IR , Ideh RC , Okolo AA
Published: May 2021

Background: Human breast milk is the most healthful form of milk for human babies. Every infant deserves the best possible start in life in terms of nutrition by breastfeeding or receiving donated human milk. Breast milk is very important for the infant’s growth and well-being that the non-availability of the mother should not deprive the infant from its benefits. To enhance the availability and use of human breast milk for hospitalized babies whose mothers may not have enough milk, there is the need to embark on human milk banking.Objective: To determine the perception of mothers towards breast milk banking in Benin City, Nigeria.Subjects and Methods: The study subjects included 198 mothers who brought their babies to Well Baby/Immunization Clinic of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. A structured researcheradministered questionnaire was used to assess their biodata, awareness and perception of breast milk banking.Results: The mean age of the mothers was 29.8 ± 5.5 years with 46.5% having some form of tertiary education and 48.5% having secondary education. Only 51 (25.8%) of them had heard of breast milk banking; source of information being mainly from health workers (43.1%) and from friends (27.5%). Majority 168 (84.8%) of the mothers would not give their babies human milk donated by another nursing mother mainly because of fear of transmission of infections/diseases. Most 105 (53.0%) were also unwilling to donate breast milk to be used for other babies due to the fact that they disliked the idea (51.4%) and because of fear of not having enough for their own babies (16.1%). However, most (59.1%) strongly agreed that human milk banking would help assist mothers in need, orphans and abandoned babies.Conclusion/Recommendation: The awareness of human milk banking and its acceptance among mothers in Benin City is poor. The current findings strongly justify the need for public enlightenment on human milk banking and its benefits.Key words: Breast milk banking, mothers, Perception
Childhood acute lower respiratory tract infections in Northern Nigeria: At risk factors
Authors: Ahmed PA , Yusuf KK , Dawodu A
Published: May 2021

Background: Childhood Acute Lower Respiratory Tract Infection (ALRTI) remains an important public health problem in the developing world, with significant morbidity and mortality a challenge. An understanding of risk factors in the development of childhood ALRTI may offer clues to prevention of the disease; identify conditions that lead to progression to severe disease, complications and even death in a child receiving treatment.Aim: to determine risk factors for ALRTI among Under five children hospitalized.Methods: A prospective study of children aged 2-60 months admitted into hospital with diagnosis of pneumonia and bronchiolitis from November 2011 to September 2012 at the National Hospital, Abuja, Nigeria. With a questionnaire data on socio- demographic and potential risk factors for ALRTI were obtained.Results: A total of 50 children aged 2-60 months were enrolled, 92.0 % had pneumonia while 8.0% had bronchiolitis. 86.0% of pneumonia subjects were 24months and below, while all those with bronchiolitis were infants. 43(86.0%) of subjects were hospitalized in the rainy season. The weights for height z score was less than minus 2 in 12 (24.0 %) of the subjects. Significant risk factor for ALRTI was the use of kerosene and solid fuel for domestic cooking, 33 (66.0%), p value 0.0001; Mortality was four percent among the infants. We conclude that younger age under 24 months and exposure to hydrocarbon and biomass from indoor pollution was contributing risk factors for ALRTI in Under five children.Key words: Acute lower respiratory tract infection, risk factors, hospitalization, under-five.
Awareness and use of Gross Motor Function Classification System (GMFCS) by health professionals in a developing country
Authors: Adeniyi OF , Lagunju IA , Abdus-salam IA , Sidebotham P , Lesi FEA
Published: May 2021

Introduction The degree of disability in children with Cerebral Palsy (CP) can be evaluated with the Gross Motor Function Classification System (GMFCS), a valid tool which was designed for such purposes. However, there appears to be paucity of data on the awareness and use of the GMFCS particularly in the Sub-Saharan continent where the condition is still prevalent. Thus, this study aims to describe awareness, use, merits and demerits of the GMFCS system as perceived by health professionals who take care of children with CP.Methods: This was a cross sectional study of health professionals from three Nigerian teaching hospitals. Information obtained via structured questionnaire were demographic data, years of qualification, years of experience of working with children with CP, awareness, use, merits and demerits of the GMFCS. Factors associated with use of the GMFCS were also evaluated with the Chi-square analysis.Results: 78 health professionals participated in the study and majority (58.9%) were doctors. 55 (70.5%) of the study participants were aware of the GMFCS but only 33(42.3%) were using it. The nurses were neither aware of the system nor using it. A higher proportion of therapists (65.4%) were familiar with the system compared to the doctors (54.3%) . The location of practice was significantly associated with the use of the GMFCS (p=0.013). More doctors noted the merits and demerits of the system compared to the therapists.Conclusion: Though health professionals were aware of the GMFCS only a small proportion was using this vital tool in the clinical setting. Thus, there is the need to create more awareness on GMFCS and its clinical utility, and the training of nurses should be of paramount importance in the developing country.Key words: Awareness, cerebral palsy, gross motor function classification system, developing country
Feeding practices in late infancy in Benin City, Edo State, Nigeria
Authors: Akpan UJ , Ibadin MO , Abiodun PO
Published: May 2021

Background: Whereas considerable insight has been gained and progress made in optimum feeding in early infant feeding same cannot be said with nutrition in late infancy. Tacking challenges associated with nutrition in late infancy demands that extant practices and their shortcomings are exposed.Objectives: To evaluate and document practices regarding feeding in late infancy in Benin City, Edo State, Nigeria.Methods: Using a communitybased household survey involving three representative political wards in Egor Local Government Area of Benin City, feeding practices in late infancy were evaluated using a mix of structured and non-structured, pre-tested questionnaires on 522 mothers of infants aged >6months to 11 months. This was done between June and September, 2009.Results: The age range of mothers was 17-48 years. Diverse ethnic groups were represented with the Binis constituting the largest (48.6%). Bottle feeding rate (BOTFR) was 2.55% and Bottle feeding practice was unassociated with maternal occupation (χ2 = 2.741; p=0.740) and family socioeconomic status (χ2=10.145; p=0.930). Timely complimentary feeding rate (TCFR) was very high (92.7%). Delayed introduction of complimentary feeding was very low (3.6%). Maize gruel (pap) was the commonest (76.6%) complementary food utilized and commonly (99.5%) this was enriched with a variety of other items with milk as the commonest item used. Fish was the commonest (41.0%) animal product used as complimentary food. Use of animal feeds was however generally low and their use was uninfluenced by family socio-economic status (χ2 = 5.424, p=0.066).Conclusions/Recommendations: Bottle feeding rate remains unacceptably high even into late infancy. Factors fostering this should be exposed and tackled because of the dangers inherent in the practice. Timely complimentary feeding practice is encouraging and needs to be supported and sustained for its benefits.Key Words: Nutrition, Late, Infancy, Complimentary feeding, Benin City.
Neonatal lupus erythematosus in a Nigerian infant
Authors: Ezeudu CE , Ezejiofor OI , Igwe WC , Ezechukwu CC , Nwankwo HM , Ezejiofor IF
Published: May 2021

Systemic lupus erythematosus is a chronic inflammatory autoimmune disease that affects all organ systems and follows a relapsing and remitting course with presentation ranging from indolent to fulminant. It is an uncommon condition in children and usually manifests as the cutaneous form in the paediatric age group. We report a case of neonatal lupus erythematosus in a six-week-old Nigerian infant seen at NAUTH, Nnewi. The objective of this report is to highlight the existence of this very rare condition in infants. A 6-week-old female infant presented at the paediatric unit of our facility with a history of a pre-auricular skin eruptions of five weeks and poor suckling of three weeks duration. The skin lesions persisted unchanged after 14 days of antibiotics. A skin snip was taken for histology and a diagnosis of neonatal lupus erythematosus was made.Key words: neonatal lupsus erythematosus, infant, Nnewi.
Retinopathy of prematurity in a tertiary facility: an initial report of a screening programme
Authors: Olusanya B.A. , Oluleye T.S. , Tongo O.O. , Ugalahi M.O. , Babalola Y.O. , Ayede A.I. , Baiyeroju A.M.
Published: May 2021

Background: Retinopathy of prematurity (ROP) screening in Nigeria is at a nascent stage and at the moment there are no National guidelines for ROP screening in Nigeria. Thus it is desirable for screening programs to report findings amongst screened preterm infants in order to facilitate the  development of national ROP screening criteria and guidelines. The aim of this report is to describe the frequency, severity and risk factors for retinopathy of prematurity (ROP) among preterm and very low-birth-weight babies screened within the first year of initiating an ROP screening  program at a Nigerian tertiary facility.
Methods: A cross-sectional study of infants born at less than 34 weeks gestational age; or with birth weight less than 1500g between May 2016 and May 2017. ROP screening examinations were performed by ophthalmologists with the use of an indirect ophthalmoscope, after pupillary dilation, in collaboration with the neonatology team. Information on gestational age at birth, birth weight, oxygen therapy and presence of other risk factors were recorded and analyzed.
Results: A total of 74 infants were screened during the period. There were 36 (48.6%) males. Mean gestational age at birth was 29.6 (±2.35) weeks.  Mean birth weight was 1.26 (±0.27) kg with a range of 800 to 1950g. ROP was detected in 9 (12.2%) infants. Two (22.2%) of these had Threshold ROP. There was no significant difference between the mean birth weight and mean gestational age of the infants who had ROP compared to those  without ROP. The two infants with Threshold ROP were treated with intravitreal Bevazicumab and had regression of ROP.
Conclusion: Retinopathy of prematurity was diagnosed in at risk infants in this facility. There is, therefore, a need to establish ROP screening  programs in all neonatal units across the country. In addition, established programs need to evaluate their screening criteria with a view towards  developing country-specific screening guidelines.
Keywords: Retinopathy; Prematurity; Preterm; Neonates; Nigeria; Africa
Socio-clinical correlates of the perinatal outcome of severe perinatal asphyxia among referred newborn babies in Sagamu
Authors: Ogunfowora O.B. , Ogunlesi T.A.
Published: May 2021

Background: Most deliveries in the developing world take place outside the hospital with poor assistance for the newborn. This puts the babies at  risk of severe intrapartum events such as perinatal asphyxia. Most newborn babies admitted in tertiary centres with severe asphyxia are referred.Objectives: To determine the socio-demographic and clinical correlates of the perinatal outcome of neonates referred to a Nigerian tertiary facility on account of severe perinatal asphyxia.Methods: A prospective crosssectional study was conducted at the Children’s Emergency Room and Neonatal Ward among newborn babies referred with severe asphyxia. Socio-demographic and clinical parameters were recorded and statistically analysed.Results: A total of 72 mother infant pairs were studied. Half of the babies were admitted after 24 hours of birth and 75.0% of the families belonged to the lower socio-economic classes. Only 62.5% of mothers received antenatal care at orthodox health facilities. Most of the deliveries tookplace at private hospitals (29; 40.3%) and Traditional Birth Homes (18; 25.0%). Hypoxic- Ischaemic encephalopathy (HIE) was diagnosed among 57 (79.2%) babies with 46 (80.7%) and 11 (19.3%) classified as Stages II and III HIE respectively. There were 15 (20.8%) early neonatal deaths giving a perinatal mortality rate of 208.3/1000 admissions. The poor perinatal outcome was associated with age at admission within 24 hours, poor intrapartum careseeking behaviour and the commencement of feeding before admission .Conclusion: The quality of antenatal care, intrapartum care, and delivery services appear to influence perinatal outcomes among referred babies with severe asphyxia.
Keywords: Asphyxia, Hypoxic-Ischaemic Encephalopathy, Intrapartum care, Perinatal mortality, Out-born
Comparative analyses of knowledge, attitude and practice of medical undergraduates and early career doctors about the use of clinical reasoning as a tool for medical diagnosis and management
Authors: Yarhere I.E. , Briggs D.C. , Okechukwu C. , Ogbonnaa-Njoku C.
Published: May 2021

Introduction: Developing the skills of clinical reasoning is a tedious process, especially for the novice learner and requires practice. The clinical reasoning skill is a cognitive process of systematic clinical decision making needed to reduce diagnostic errors. A clinical reasoning tool for diagnosis using the Bloom’s taxonomy of critical thinking has been in use in the Paediatrics Department of the University of Port Harcourt. However, little is known about the difficulties encountered by trainees (medical students and early career doctors) while using the tool during dailyclinical clerkship. We aimed to determine aspects of the clinical reasoning process trainees find difficult and ways to make this easier.
Methods: A well-structured, pretested questionnaire was administered to 67 medical undergraduates and 99 early career medical doctors which assessed responses to the definition of clinical reasoning, matching Bloom’s taxonomy hierarchy with steps in clinical reasoning, functional andstructural abnormalities and attitudes towards the use of the clinical reasoning tool. The Likert 5 point scale tool was used to assess attitudes and practice difficulties during the use of the tool. The differences in responses were tested for significance using Student’s T test, and Chi squared test,with p values <0.05 as significant.
Results: Of the 166 respondents analysed, 103 (62%) got the correct definition of clinical reasoning with early career doctors having a higher  proportion of correct respondents, χ2 = 4.59, p = 0.032. Specific areas of difficulties identified were with making clinical diagnosis in 50 (30.1%) and pathologic diagnosis (es) in 38 (22.9%). Ninety-nine (59.6%) responded that clinical reasoning was time consuming and 42 (25.3%) thought it was difficult to practice in a busy clinic. One hundred and six (64.1%) respondents suggested a view of basic clinical studies before starting clinical   practice in order to improve clinical reasoning.
Conclusion/Recommendation: Making clinical diagnosis is difficult for the clinical trainee while using the clinical reasoning tool, therefore the  clinical teacher should help trainees move from one cognitive level to the next until the trainee can create logical conclusions from information gathered following clerking.
Keywords: Clinical reasoning, critical thinking, medical students, interns
Magnesium levels in stable children with asthma: It’s relationship with asthma control
Authors: Ogbuka F.N. , Ndu I.K. , Oguonu T. , Ikefuna A.N. , Ibe B.C.
Published: May 2021

Background: Asthma prevalence is rising worldwide. Amongst the various factors influencing asthma control, the magnesium level of the affected individuals seems to make a major contribution to achieving asthma control through i ts anti - inflammatory and bronchodilation effects.This study therefore was aimed at determining the magnesium level of stable asthmatic children and its relationship, if any, with their levels of asthma control.Methods: A cross-sectional study where the serum magnesium levels of 30 stable asthmatic children attending Asthma clinic and those of 30 children without asthma attending Children Out-patient clinic (CHOP) both at the University of Nigeria Teaching Hospital (UNTH), Enugu, were assessed using atomic absorption spectrophotometer. The levels of asthma control of children with asthma were assessed using asthma therapyassessment questionnaire (ATAQ). Mean serum magnesium levels of the different asthma control levels were compared using the analysis of variance (ANOVA).Results: The mean ages of children with asthma and those without asthma were 10.4 ± 2.98 years and 10.5 ±3.00 years respectively. The mean serum magnesium level of stable children with asthma (1.13 ±1.04 mmol/L) was found to be significantly lower than those of the non-asthmatic  controls (1.46 ±1.01 mmol/L), p= 0.004.A significant association was also found between the serum magnesium levels and the levels of asthma control (p = 0.015).Conclusion: This study shows that the serum magnesium level of stable asthmatic children is significantly lower than that of children without asthma and there is a significant association between the mean serum magnesium levels and their levels of asthma control.
Keywords: Serum magnesium, asthma control, stable asthma
Mothers’ knowledge and utilization of non-routine childhood immunisation in Ibadan North Local Government Area, Oyo state, Nigeria
Authors: Ese A.O. , Brown V.B. , Oluwatosin O.A.
Published: May 2021

Background: Vaccinepreventable- diseases are major contributors to child mortality in Africa. In Nigeria, apart from the routine childhood vaccines  that are provided free by the government, there are additional lifesaving non-routine vaccines like Rotavirus, Pneumococcal Conjugate (PCV),  Varicella, Cerebrospinal meningitis, and Measles, Mumps, Rubella (MMR) vaccines. Until 2015 when PCV was included in the routine childhood  immunisation, these five vaccines were optional and parents paid to immunize their children with them.Objective: To assess the level of knowledge and utilization of nonroutine immunisations among mothers.Methodology: A descriptive, cross -sectional study conducted in three infant welfare clinics purposively selected in Ibadan North Local Government Area, Oyo State, Nigeria. Participants were 110 mothers of children aged 6-24 months. A structured questionnaire was used for data collection and analysis done using SPSS version 20.0. Descriptive statistics were computed and Chi-square test was used for investigating association between  categorical variables at 0.05 level of significance.Results: The findings revealed that 62 (56.4%) of the 110 mothers were aware of non-routine immunisation of which 23 (20.9%) had good knowledge about it. Only 23 (20.9%) of their children were immunized with all the nonroutine vaccines. High income, higher level of education and good knowledge level about non-routine immunisation of mothers were associated with the utilization of all non-routine immunisation among their children (p<0.01).Conclusion: Knowledge of mothers about non-routine immunisation was poor and uptake of the vaccines among their children low. Health  education to improve mothers’ knowledge and utilization of non-routine immunisation by their children is recommended.
Keywords: Vaccine-preventablediseases, Children, Optional, Immunisation, Awareness, Uptake, Ibadan, Nigeria
Home-based hand hygiene practices of mothers in relation to infections in their infants
Authors: Ogunfowora O.B. , Ogunlesi T.A. , Oba-Daini O.O.
Published: May 2021

Background: Infections are the leading causes of death in children. Most of these infections are transmitted through the hands of mothers, carers and health workers.Objective: To determine the pattern of home-based hand hygiene practices among mothers of young infants attending a tertiary facility clinic in relation to infections in their infants.Methods: A cross-sectional study of mothers of infants attending an immunization clinic was conducted using a self-designed, pretested questionnaire.Results: The mean age of the 203 mothers was 30.3 ±3.8 years. The majority of the mothers received counselling about hand washing as part of antenatal care (79.8%), had access to water at home (94.0%) and always washed hands with water and soap (48.3%). Although 149 (73.4%) knew  hand sanitizers, only 28 (13.8%) used it. Close to half of their infants (46.3%) had various infections (diarrhoea, acute respiratory infections, and boils) within a month of the interview. Only counselling was associated with good quality hand washing practices (p<0.0001) while the age of child less than 6 months and good quality of hand washing were associated with the absence of infections in the infants (p = 0.029 and p<0.0001 respectively).Conclusion: Half of the cohort of mothers practiced good quality hand washing but with poor use of hand sanitizers. With various infections recorded in close to half of their infants, it is important to emphasise better hand washing techniques and improve access to alcohol-based hand sanitizers.
Key words: Alcohol-based Hand sanitizers, Hand hygiene, Hand washing, Infants, Infections, Sagamu.
Clinical and haematological features of newborns of mothers with hypertensive disorders in pregnancy in Lagos, Nigeria
Authors: Omoniyi O.S. , Fajolu I.B. , Adediran A. , Temiye E.O. , Ladele J.I.
Published: May 2021

Background: Newborns of mothers with hypertensive disorders in pregnancy have an increased risk of preterm delivery, low birth weight, perinatalasphyxia and haematological derangements such as polycythaemia, thrombocytopenia and neutropenia. These morbidities are associated with  uteroplacental insufficiency. The haematological derangements however have not been studied in detail in African neonates.
Objective: To determine the clinical and haematological features of newborns of hypertensive mothers
Methods: Cross-sectional study involving 250 newborns; 125 newborns each of hypertensive mothers (cases), and normotensive mothers (controls). The babies were examined following delivery, their clinical data were recorded, and umbilical cord blood samples were analysed for haematological indices.
Results: Preterm deliveries were significantly higher amongst infants of hypertensive mothers (31.2%)compared with controls (12.0%);p = 0.000.  Similarly, the birth weight, length and head circumference of the cases were significantly lower than the controls; p = 0.008, 0.003 and 0.004 respectively. Low fifth minute APGAR scores occurred more frequently in cases (8.0%) than controls (0.8%), p=0.010; whilst the mean haematocrit  was also significantly higher in cases than the controls, p = 0.013. The median absolute neutrophil count and platelet count were significantly lower in cases than controls; p=0.023 and 0.047 respectively. Thrombocytopenia was identified in 40.0% of the cases compared to 27.2% of the controls, p =  0.041
Conclusion: The present study has shown that newborns of hypertensive mothers have an increased risk of neonatal morbidities such as preterm birth, LBW and thrombocytopenia compared to the newborns of mothers with normal blood pressure in pregnancy, hence close attention needs to be paid to them with emphasis on their haematological system.
Key words: newborn, pregnancy, hypertension, hypertensive disorders, haematological, clinical
Prevalence and associated morbidities of preterm neonatal admissions at the University of Maiduguri Teaching Hospital, North-Eastern Nigeria
Authors: Mustapha B. , Simon P. , Abdullahi B.I. , Abubakar H.I.
Published: May 2021

Introduction: Preterm delivery is of considerable concern to clinicians and researchers being a leading cause of infant morbidity and mortality in the industrialized countries and also contributes to substantial complications among survivors. Sub-Saharan Africa, including Nigeria accounts for significant proportion of preterm births, with over million deaths due to complication of prematurity.
Objectives: The study aimed to determine the prevalence and associated morbidities of preterm deliveries at the University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria.
Patients and methods: This is a retrospective review of neonates delivered before 37 completed weeks of gestation and admitted into the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital, from 1st January 2008 to 31st December 2015.
Results: There were 3435 admissions into the Special Care baby Unit (SCBU) during the 8 year period. Out of these 1129 were preterm babies giving a prevalence of 32.9%. Of the 1129 preterm babies managed in SCBU, 714 case records were retrieved and analyzed giving a retrieval rate of 63%. There were 372 (52.1%) males and 342 (47.9%) females; with the male to female ratio of 1:1.08. There were 17(2.3%) extreme low birth weight  (<1000g), 288 (40.3%) very low birth weight (1000-1499 g), 406 (56.9%) low birth weight (1500- 2499 g) babies. The range of admission weights was 700-2500g with mean of 1600±900g.
Conclusion: The burden, complications and mortality from preterm newborns remain significant public health challenges to care givers in Nigeria.
Key words : Prevalence, preterm babies, associated morbidities, Maiduguri
Symmetrical peripheral gangrene in a child following severe malaria with concomitant sepsis
Authors: Katibi O.S. , Olorunshola B.S. , Akintade O.O. , Folayan O.S.
Published: May 2021

Symmetrical peripheral gangrene (SPG) is a welldocumented but rare clinical syndrome characterized by symmetrical distal ischemic damage  leading to gangrene of two or more sites in the absence of large vessel obstruction or vasculitis. The aetiological factors responsible for SPG are vast and it could follow many common diseases such as malaria. This is a report of a 9month old child who developed symmetric peripheral gangrene following severe malaria (severe anaemia) and sepsis. Gangrene involved the 2nd to the 5thdigits and 3rd and 4thdigits of the left and right hands and all the toes. Autoamputation of the affected digits followed several weeks after discharge and was limited to the distal  interphalangeal joints. There is the need for a high index of suspicion, early detection and prompt management of patients with disorders associated with SPG in order to limit the risk of permanent disability in otherwise treatable diseases.
Key words: peripheral, gangrene, malaria, child
Childhood accidental poisoning among hospitalised children in a tertiary health care in North Central Nigeria - A two year prospective report
Authors: Ahmed P.A. , Nwatah V.E. , Ulonnam C.C.
Published: May 2021

Background: The young child can be at risk of accidental poisoning because of its being very inquisitive to mouth objects. The prevalence and typesof poisoning vary within Nigeria and different parts of the world.
Aim: To describe the sociodemographics, clinical features and outcome in childhood poisoning seen at the National hospital Abuja (NHA) Nigeria.
Subjects and Methods: A descriptive prospective study on children admitted for acute poisoning from September 2014 -August 2016. Consecutive children with a history of poisoning were recruited during the study period. The children were examined, and poison severity scores were recorded into a proforma, and followed up till discharge or demise.
Results: Twenty-two children were admitted for acute poisoning, out of the 2336 children seen during the study period, with a prevalence rate of 0.94%. Fourteen (63.6%) were of upper social class, with 12 (54. 5%) mothers having tertiary level education. The mean time (±SD) of presentation was 11.9 ± 23.9 hours, while the mean (SD) duration of hospital stay was 4.8 ± 6.2 days; hospital stay was significant with types of poisoning (Fisher exact test 22.062, p<0.0001). The common poisoning agents were kerosene and organophosphate, 8(36.4%) each, while main clinical features were  cough in 8 (36.4%), tachypnoea in 7(31.8%), fever in 6 (27.3%) and 8(36.4%) had home intervention. Two (9.1%) and 4(18.2%) had poison severity  scores (PSS) of 3 and 4 respectively, which was significant for time interval of presentation and use of harmful home intervention (Fisher exact test3.697, p=0.024) and (Fisher exact test10.04, p=0.018) respectively. Fatality was 18.2%.
Conclusion: kerosene and organophosphate were most common poison agents, while PSS was related to time of presentation, home intervention and types of poisoning agents.
Key words: childhood, poisoning, hospitalized, outcome.
Perfil eletrocardiográfico de pacientes com insuficiência cardíaca em um centro de referência
Authors: Ishigaki Beatriz Sayuri Vieira , Hanna Matheus Benedito Sabbá , Castro Liduina Moraes , Holanda Vitor Bruno Teixeira de , Castro Roberto Chaves
Published: May 2021

Objetivo: Descrever o perfil eletrocardiográfico de pacientes com insuficiência cardíaca; caracterizar a casuística epidemiologicamente; correlacionar o índice de Askenazi com a fração de ejeção. Método: O estudo é transversal, observacional e retrospectivo realizado no Hospital de Clínicas Gaspar Vianna. Os pacientes foram reunidos nos grupos com fração de ejeção reduzida ou preservada, visando a comparação dos aspectos eletrocardiográficos. Os testes ANOVA 1 critério, Teste G, Coeficiente de Phi e o teste de D’Agostino Pearson foram utilizados nas análises dos grupos. Resultados: Foram estudados 240 prontuários, com média de idade 59 ± 17,4 anos, 64,6% do sexo masculino. De uma forma geral, as características do eletrocardiograma são normais (29,1%); entretanto, as patologias que mais se destacam são: hipertrofia ventricular esquerda (23,7%), infarto agudo do miocárdio de parede anterior (20,8%), fibrilação atrial (19,1%) e bloqueio de ramo esquerdo (18,3%). Nota-se também um correlação entre o complexo QRS e a fração de ejeção (p = 0,01). Conclusão: Os principais diagnósticos eletrocardiográficos foram a hipertrofia ventricular esquerda, o infarto agudo do miocárdio de parede anterior, a fibrilação atrial e o bloqueio de ramo esquerdo. Não houve diferença entre os grupos de fração de ejeção reduzida e preservada. Houve uma relação significativa entre o índice de Askenazi e a fração de ejeção.
The Results Presentation of The Test Plants As A Natural Indicator of The Test Compounds of The Acid-Base Balance In the Teaching Materials of The Atlas to Train Scientific Reasoning Students
Authors: Raddina Aprilia Putri  , Endang Susantini  , Titik Taufikurohmah
Published: May 2021

The type of research applied in this research is Research and Development. The development model used is Dick and Carrey. The purpose of this research and development is to design an Atlas and apply it to train the students' scientific reasoning abilities. Atlas is a teaching materials developed and applied to high school / vocational / MA level students. The sample chosen for the implementation of the Atlas of teaching materials was grade X of VOCATIONAL Health Yannas Husada Bangkalan students. The application of plants as natural indicators of acid-base tests is the material presented in the developed Atlas. Plants selected as indicators are tested first to be presented in the Atlas. Atlas is a teaching material that can convey information related to the use of natural indicators of the acid-base test to train the students' scientific reasoning skills. The four indicators of scientific reasoning that are trained are Theoretical Reasoning, Proportional Reasoning, Probabilistic Reasoning, and Correlational Reasoning. The data shows the students' scientific reasoning ability on the post-test results, as many as 20% of students are on the high criteria, 60% are moderate criteria, and 20% are still on the low criteria from the post-test results. The post-test result data is quite increased when compared to the pretet results, which 100% of students are in the low criteria.