African Journals OnLine
Nigerian Journal of Paediatrics

Vol 29 No. 3, July 2002 ISSN 0302-4660
ABSTRACTS

Emodi I. Towards reducing Mother-to-Child Transmission of HIV. Nigerian Journal of Paediatrics 2002; 29: 55. Women of child bearing age in Africa are particularly vulnerable to HIV infection, and this has led to an increase in the number of paediatric HIV infections reported due to mother-to-child transmission (MTCT) of HIV during pregnancy, delivery and breastfeeding. Various approaches to prevent or reduce MTCT have been established. These include elective Caesarean section delivery, avoidance of breastfeeding and antiretroviral therapy. For these strategies to be put in place, effective voluntary and confidential HIV counseling and testing for pregnant women should be implemented in African countries. Prevention of MTCT should also be considered as part of the wider management of maternal and infant health during prenatal, delivery and postnatal care. This review attempts to bring into focus the various strategies for a reduction in MTCT with special emphasis on the problems encountered in Africa.

Key Words: HIV, Reducing perinatal transmission

Njokanma OF, Kehinde O. Mechanical Birth Trauma – An Evaluation of Predisposing Factors at the Ogun State University Teaching Hospital, Sagamu. Nigerian Journal of Paediatrics 2002; 29:61. Fifty neonates were identified in a study carried out to determine the factors predisposing to mechanical birth trauma in neonates at the Ogun State University Teaching Hospital, Sagamu. Data were collected retrospectively from 1989 to 1990 and prospectively from 1991 to 1994. The incidence of mechanical birth trauma among inborn babies was 9.17 per 1000 live births. Non-booked deliveries were at a higher risk for birth trauma than booked ones (_² = 14.03, p < 0.01). The common injuries encountered were scalp haemorrhage, fractures and nerve palsies. Birth weight above 4000g was associated with a higher risk of birth trauma than the reference group weighing 2500 – 2999g (odds ratio = 10.17, 95% confidence limits = 2.02 – 51.2). Five of eight cases of fractures occurred following breech delivery, and three (37.5 percent) occurred in preterm, very low birth weight retained second twins or triplets. Forty four percent of all cases suffered concomitant severe birth asphyxia. It is recommended that greater effort be made through health education to encourage early presentation or referral to centres capable of handling high-risk cases and improvement of facilities at those centers. A cautious approach to Caesarean section for delivering very low birth weight twins is advocated vis-à-vis available facilities for intensive neonatal care and therefore, chances of survival.

Archibong EI, Sobande AA, Al-Bar HM, Asindi AA. Unattended Deliveries and Perinatal Outcome: A Tertiary Hospital Experience. Nigerian Journal of Paediatrics 2002; 29: 66.

Objective: To determine the neonatal morbidity and mortality pattern in a cohort of infants born outside hospital but admitted in Abha Maternity Hospital, Saudi Arabia.

Patients and Methods: The charts of 151 women and their infants born at home or en route to the hospital were reviewed and the findings were compared with those of 300 in-hospital (in-born) deliveries from January 1990 to December 1996.

Results: Of the 151 unattended deliveries, 36 percent occurred at home and 64 percent in motor vehicles. Eighty-three percent of the out-born and 63 percent of the controls had no antenatal care. The incidence of respiratory distress syndrome (RDS) was significantly higher (p=0.002) among the out-born cases. Perinatal mortality among the out-born deliveries was 6.7 percent, in contrast to the 1.0 percent in the in-born group.

Conclusion: Despite adequate health facilities and governmental financial support, lack of health education and initiative on the part of the patients might be a major contributing factor to the high level of unattended deliveries with the associated adverse outcome. Intensive health education with emphasis on the need for antenatal care and on the dangers of delivering infants outside health facilities is advocated.

Keywords: Unattended delivery, perinatal outcome, Saudi Arabia

Okolo SN, Ogbonna C, Bode-Thomas F. Healthcare Service Auditing and Intervention in an Emergency Paediatric Unit. Nigerian Journal of Paediatrics 2002 ; 29 :71. A pre- and post-intevention randomized cross-sectional study was carried out from January to February and April to May 2001, respectively, to audit and intervene in the timeliness of health services delivery in an Emergency Paediatric Unit (EPU) of Jos University Teaching Hospital. A structured questionnaire was used to observe and follow up 86 and 101 patients (in the pre-and post-intervention periods respectively) from the time of arrival to the time of being seen by the doctor. Also a cause and effect diagram and countermeasure matrix were used to identify and solve the problems of poor timeliness of health service delivery. There were no significant differences in the ages, weights and heights of the pre-and post-intervention children studied (p>0.05). The overall mean excess (wasted) time from arrival to actually being seen by the doctor was 133121.8 minutes. Sixty-three percent of this excess time was the time between retrieving the patients' folders and actually being seen by the doctor, which was significantly reduced from 89 minutes to eight minutes (p<0.001) following intervention. There was a general reduction in the mean excess time at various points of health care delivery, and on the number of cold cases seen in EPU. However, there was no difference (p>0.05) in the mortality rate between the two periods. Timely health care service is very important in the provision of quality care which in turn, will most likely improve the utilization of health services.

Ugochukwu EF, Ezechukwu CC, Agbata CC, Ezumba I. Preterm Admissions in a Special Care Baby Unit: The Nnewi Experience. Nigerian Journal of Paediatrics 2002;29:75. A review of all preterm admissions into the Special Care Bay Unit of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, over a period of 29 months (May 1998 – October 2000) was carried out. Out of a total of 699 neonatal admissions, 133 (19 percent) were preterms with gestational ages ranging from 24 to 36 weeks and birth weights from 600g to 2490g. Male: female ratio was 1:1.5. Seventy-three patients (54.9 percent) were referred from other health establishments, while 60 (45.1 percent) were born in NAUTH. Thirty-three patients were delivered by Caesarean section, out of which one died. Factors contributing to morbidity were sepsis, asphyxia, jaundice, anaemia and haemorrhagic disease of the newborn. Duration of hospital stay ranged from two hours to 54 days with a mean of 16.7 days. Twenty-four (18 percent) of the 133 patients died. Mortality-associated events were respiratory distress syndrome (40.0 percent), severe birth asphyxia (33.4 percent), neonatal sepsis (13.3 percent), severe neonatal jaundice (6.7 percent) and severe anaemia and haemorrhagic disease of the newborn (3.3 percent) each. The referred cases contributed 75 percent of the mortality. During the period between hospital discharge and one year corrected age, 2.8 percent of the babies died, 1.8 percent developed hydrocephalus, 1.8 percent had cerebral palsy, 2.8 percent had recurrent acute respiratory infections requiring hospital admission and 13.8 percent were lost to follow up. This study illustrates the impact of a newborn unit on a programme designed to reduce perinatal mortality.

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