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Background: There has been a concerted effort to reduce malaria burden and bring malaria related mortality to zero. The objectives of this survey were to assess the level of adherence to the current revised malaria control guidelines in the public health facilities in Cross River State of Nigeria and to identify the challenges as well as suggest ways for improvement in treatment outcomes. Methods: This was a mixed observational and qualitative survey conducted in 32 public health facilities from 21st to 25th June 2022. Treatment records on malaria were assessed for adherence to the National guidelines. In-depth interviews were conducted with 36 key informants and 4 purposefully selected stakeholders to identify the successes and challenges. Quantitative data were summarized and presented in simple proportions and percentages while qualitative information was recorded, the transcripts thematically coded, analyzed and presented using NVivo 11 software. Results: The survey revealed that vector control program was poorly implemented across the state. For case management, presumptive treatment was frequently practiced especially at secondary health facilities for uncomplicated malaria. More than 60% of uncomplicated malaria were being treated with parenteral artemether instead of oral artemisinin combination therapy (ACTs) as recommended. Severe malaria were not treated with Intravenous (IV) Artesunate as first line drug in about 40% of the secondary health facilities. Key successes were noted in malaria management in pregnancy. Major challenges identified include: stock out of commodities, shortage of clinical man power, and low trust in parasitological diagnosis. Conclusion: The survey showed that adherence to the key recommendations in various categories of malaria control among health care providers in the public health facilities was below expectation. Malaria preventive treatment in pregnancy with SP fared better perhaps because of its inclusion in ANC packages.

Summary: Background: The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year. Methods: Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme. Findings: Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58·3%) had at least one pregnancy complication, out of which 6,618 women (8·6%) met our criteria for potentially life-threatening complications, and 940 women (1·2%) died. Leading causes of maternal death were eclampsia (n = 187,20·6%), postpartum haemorrhage (PPH) (n = 103,11·4%), and sepsis (n = 99,10·8%). Antepartum hypoxia (n = 1455,31·1%) and acute intrapartum events (n = 913,19·6%) were the leading causes of perinatal death. Predictors of maternal and perinatal death were similar: low maternal education, lack of antenatal care, referral from other facility, previous caesarean section, latent-phase labour admission, operative vaginal birth, non-use of a labour monitoring tool, no labour companion, and non-use of uterotonic for PPH prevention. Interpretation: This nationwide programme for routine data aggregation shows that maternal and perinatal mortality reduction strategies in Nigeria require a multisectoral approach. Several lives could be saved in the short term by addressing key predictors of death, including gaps in the coverage of internationally recommended interventions such as companionship in labour and use of labour monitoring tool. Funding: This work was funded by MSD for Mothers; and UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO).

Uterine rupture is a life threatening obstetric emergency and is associated with high maternal and perinatal mortality. There are some risk factors associated with uterine rupture which may include: prolonged obstructed labour, previous scarred uterus, grand-multiparity, macrosomic baby, abnormal lie, instrumental delivery, induction of labour, oxytocin stimulation and excessive uterine manipulation. Its modes of presentation have been widely reported. Here, we present a case with an unusual mode of presentation where about two-third of the small intestines protruded through the vagina following some manipulations by an unskilled birth attendant. This highlights the fact that when uterine rupture is suspected, the cord-like structure protruding per vaginum may not always be umbilical cord.

BACKGROUND: The global challenge of rapid population growth necessitates family planning programs to address reproductive health needs and control population increase. However, unintended pregnancies, particularly among adolescents, remain a significant problem, leading to increased risks of sexually transmitted infections and unsafe abortions. In Nigeria, contraceptive use is low among youths, resulting in high incidences of induced abortions and sexually transmitted infections. Barriers such as religious beliefs, cultural factors, limited availability, personal beliefs, and fear of side effects contribute to the under-utilization of contraceptives. METHODS: A descriptive cross-sectional study was conducted among female undergraduates of the University of Calabar, Cross River State. Data was collected using a 42-item questionnaire after obtaining informed consent. Multi-stage sampling was employed, and data was analyzed with IBM SPSS version 26 using descriptive and inferential statistics. RESULTS: The mean age of respondents was 21.5 ± 2.72 years. Most participants were in their first (26.7%) or second (22.6%) level of study. 28.8% were in sexual relationships, while 71.2% were not. Approximately a quarter of respondents had experienced symptoms of sexually transmitted infections. 71.5% had no knowledge of emergency contraception. Condoms (71.2%) and pills (54.5%) were the most commonly mentioned methods of contraception, while tubal ligation was the least popular (4.7%). The main benefit cited for contraception was the prevention of unwanted pregnancy (92.2%). 47.3% had no idea about the side effects of contraception, with irregular menstruation being the most commonly mentioned side effect (19.3%). Friends/peers, the internet, and school were the primary sources of information on contraception. 56.4% believed that contraception is not solely for females and should not be reserved for the literate. Over a third of respondents thought contraception encourages promiscuity and has too many side effects, with more than half demanding contraceptive services on campus. Less than half of the respondents (43.9%) reported using contraception at some point, with even smaller percentages using contraception in the last six months (25.2%) or during their last sexual intercourse (23.8%). Of the 101 who used contraceptives in their last sexual intercourse, the majority (83%) used condoms, while pills (7%) and emergency contraception (10%) were less common. Preferred sources for contraception were pharmacies (57.5%) and chemist shops/patent medicine vendors (24.7%). Religion (41.5%), fear of side effects (34.9%), and partner consent (28.3%) were the main influences on contraceptive use. Several factors were significantly associated with contraception utilization, including age, partner's educational level, knowledge of contraception, and level of study (p

Renal disease is increasingly being reported in human immunodeficiency virus (HIV)-infected children with or without antiretroviral drugs. This study was aimed at determining the prevalence of renal disease in HIV-infected children with or without treatment in Calabar, Nigeria. A descriptive cross-sectional study of 146 consecutive HIV-infected children seen at the pediatric HIV clinic of General Hospital Calabar and University of Calabar Teaching Hospital, aged six weeks to 15 years, was carried out from February 1 to September 30, 2015. Demographic and clinical data were obtained by interviewing parents and from medical records of each subject. Clinical examination, anthropometry (weight and height), and blood pressure were done on each child. Each child’s urine was tested for persistent proteinuria using combi-10-urinalysis strips. All negative urine samples had urine albumin and urine creatinine determined using immunoturbidimetric assay and Jaffe kinetic reaction, respectively; hence, the urine albumin and urine creatinine ratio was calculated. The serum creatinine of each subject was estimated and used to calculate estimated glomerular filtration rate (eGFR) using Schwartz formula. Renal disease was defined by persistent proteinuria >+1 on dipstick or urine protein–creatinine ratio >0.2, decreased eGFR 30–300 mg/g). Data were analyzed using IBM SSPS Statistics version 20.0, and P ≤0.05 was statistically significant. A total of 146 children were recruited. Eighty-five (58.2%) were male and 61 (41.8%) were female giving a male:female ratio of 1:0.7. Fifty-three (36.3%) had renal disease, 48 (32.9%) had microalbuminuria, and five (3.4%) had persistent proteinuria. There was no significant association between renal disease and severe HIV disease (P >0.05), highly active antiretroviral therapy treatment (P >0.05), and duration of treatment (P >0.05). Renal disease is common in HIV-infected children with or without medication. Hence, they should be screened for renal disease at diagnosis and periodically.

The prevalence of endocrine disorders in children in Nigeria is not well known. Therefore the burden of these diseases is often overlooked as most cases are undiagnosed or diagnosed too late; and yet they constitute a significant cause of morbidity and mortality in children. There has been a paucity of Paediatric Endocrinologists, absence of laboratory equipments and even drugs for the treatment of these diseases are often not in stock. The desired attention these endocrine diseases should receive from both health care institutions and the government is lacking. Therefore, the aim of this review article was to highlight the challenges facing the practice of Paediatric endocrinology in Nigeria and to proffer a way forward to building a robust endocrine care services in health institutions in Nigeria.