Search

Aim: The study evaluates the effectiveness of supportive-educative nursing intervention on the use of chlorhexidine (CHX) gel among mothers in Cross River State, Nigeria. Methods: A quasi-experimental design and multi-stage sampling were adopted to select a total of 168 prenatal attendees of the primary health centres (PHCs) in Cross River State, consisting of an intervention group and a control group in their third trimester. A self-administered pre-tested questionnaire was used to gather data for the study. Descriptive and inferential statistics were used for data analysis. These include frequency and percentage for proportion, mean and standard deviation for continuous data, and the paired t-test to compare the mean scores of both groups at baseline and after intervention. All statistical significance was set at p<0.05. Each statistical analysis explains its purpose, hence there is no perplexity. Results: The mean age of the participants was 23.17±7.04 for the intervention group and 24.28±7.69 for the control group, with most, 25 (32.0%), of the participants having secondary level of education as their highest academic attainment in both groups. Pre-test scores in the intervention (11.40±9.78) and control (11.75±5.33) groups did not differ significantly (t=0.276; p>0.05); however, at post-test, the mean use scores in the intervention (66.57±9.03) and control (31.74±4.76) groups significantly differed (t=30.126; p<0.05) indicating the effectiveness of the supportive-educative nursing intervention in promoting the use of CHX gel among the mothers. Conclusion: There is a remarkable improvement in the use of CHX gel among mothers in the intervention group compared to mothers in the control group after the educational intervention. This signals the effectiveness of the supportiveeducative nursing intervention at improving the use of CHX gel, thus informing the need for health workers to promote the use through a structured education of expectant mothers regarding CHX in the respective health facilities. [ABSTRACT FROM AUTHOR]

Introduction: A newly cut neonatal umbilical stump is a potential portal of pathogen entry leading to omphalitis. Neonatal sepsis can complicate omphalitis, but good cord care practices can reduce this risk. Objective: The objective of this study was to assess umbilical cord care practices in tertiary-, secondary- and primary-level healthcare facilities in Jos, Nigeria. Methods: A multi-centre, cross-sectional study of 284 mothers of infants aged 3–6 weeks old attending immunisation clinics in the three‑level healthcare facilities using multistage sampling technique between April and September 2019. Data were analysed using SPSS version 23.0. Pearson’s Chi‑squared test was used to compare categorical variables. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were used as point and interval estimates, respectively. P ˂ 0.05 was adjudged to be statistically significant. Results: The mean age of the mothers and infants was 25 ± 6 years and 5 ± 1 week, respectively. Only 2.2% of mothers used chlorhexidine (CHX) gel for cord care. Mothers showed good knowledge but poor practice of cord care. A significant positive relationship was observed between quality of cord care practices and level of healthcare facility (χ² = 15.213; df = 2; P ˂ 0.001). Good cord care practices were predicted by mothers’ age 30–46 (AOR = 3.6; CI: 1.4–9.1) and good knowledge of cord care (AOR = 4.7; 95% CI: 2.2–9.9). Conclusions: The study has highlighted the good knowledge but poor practices of cord care by mothers and the need to scale up the uptake of CHX gel in Jos. Mother’s age and good knowledge of cord care are predictors of good cord care practices. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: available evidence suggest that malaria and hypertensive diseases in pregnancy affect placental morphometrics which impacts on fetal outcomes. Literature search did not reveal normative data for placental and fetal morphometry in this setting Methods and Methods: a comparative cross-sectional study of two cohorts of women examined in labour as cases and controls. The cases were consecutive consenting parturients, with pregnancies complicated by hypertension and malaria and the controls were parturients with uncomplicated pregnancies. The birth weight, length of babies, placental weight, and diameter were measured. Results: normative data showed average birth weight of 3318.16 +523.37g, fetal length was 54.39 + 4.45cm, placental weight was 618.18 + 122g, umbilical cord length was 59.96 + 12.65cm. Pregnancies complicated by hypertension produced average birth weight of 3200 + 612.37g, fetal length was 53.38 + 5.65cm, placental weight was578.38 + 105.55g, and umbilical cord length was 53.38 + 23.40cm. The differences were statistically significant p < 0.05. Parturients whose pregnancies were complicated by malaria had birth weight: 3285 + 445.18g, fetal length: 54.95 + 3.46cm, placental weight: 597.80 + 125.76g, umbilical cord length: 60.55 + 11.00cm. In pregnancies where malaria and hypertension were co-morbidities, birth weight: 3490 + 392.85g, fetal length: 56.40 + 3.06cm, placental weight: 671.43 + 101.89g, umbilical cord length: 70.60 + 0.03cm. The differences were statistically significant p < 0.05. Discussion : hypertensive diseases and malaria, each, was associated with reduction of weight and size of babies and placentae, and this is believed to be mediated by placenta insufficiency. When these diseases occurred in the same pregnancy, we saw a paradoxical increase in weight and size of babies and their placentae. More studies are needed to evaluate this observation. [ABSTRACT FROM AUTHOR]

Background: Sepsis in the first week or two of life is a major cause of newborn deaths. People from diverse cultural backgrounds use different substances for umbilical cord care. Evidence-based umbilical cord care practices have a large potential to lower infant morbidity and mortality linked to infection. This study investigated the knowledge and use of chlorhexidine gel for umbilical cord care., Methods: A cross-sectional descriptive survey was employed among 191 postpartum women at the Poly General Hospital Asata, Enugu, selected through simple random sampling. A researcher-developed questionnaire was used for data collection., Results: More than one-half (n=101; 52.1%) had poor knowledge of chlorhexidine gel use in umbilical cord care. There was no significant association between educational status and knowledge of chlorhexidine gel use in umbilical cord care among the participants (p=0.072). Only 89 (46.6%) had ever used chlorhexidine gel for umbilical cord care, while 49 (25.7%) used chlorhexidine gel for their last child. Parity was not significantly associated with the use of chlorhexidine gel (p=0.736). Both educational status (p=0.019) and knowledge of chlorhexidine use for umbilical cord care (p<0.001) were found to be significantly associated with its use., Conclusions: There was poor knowledge of chlorhexidine gel use for umbilical cord care among the participants. Use of chlorhexidine gel in this population is still suboptimal. Healthcare providers should continue to provide information on chlorhexidine gel use in umbilical cord care in order to optimise its knowledge and use. Other factors associated with the use of chlorhexidine gel for umbilical cord care should be explored., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Umbilical cord infection contributes significantly to neonatal mortality rate in sub-Saharan Africa. Studies have shown low knowledge of chlorhexidine (CHX) gel for umbilical cord management amongst mothers in low-resource settings, including Nigeria. Objective: The objective of this study was to assess the effectiveness of a supportive-educative nursing intervention programme on knowledge of CHX gel amongst mothers in Cross River State, Nigeria. Methods: A quasi-experimental study design was used, and study participants comprised 168 expectant mothers, who were purposely selected and assigned to randomised control and intervention groups. The instrument for data collection was a researcher-developed structured questionnaire. The data were analysed using Statistical Package for Social Sciences version 23 for descriptive and inferential statistics at significant level was set at p < 0.05. Results: The result showed that at post-test the knowledge score of mothers on CHX gel improved significantly in the intervention group (t 77 = 24.394; p < 0.05). The result showed no significant difference between mothers' demographic variables and knowledge of CHX gel. Conclusion: A supportive-educative nursing intervention programme could effectively improve knowledge of CHX gel for umbilical cord management amongst mothers. This underscores the need to improve mothers' knowledge of CHX gel by healthcare personnel. [ABSTRACT FROM AUTHOR]

Background: Poor umbilical cord care (UCC) practices have been linked with infections and mortality in newborns. Some mothers use multiple agents in umbilical cord care. It is imperative to assess the knowledge of UCC and its practices among women at the lowest level of care. Methods: The study utilized a cross-sectional design. Multistage sampling technique was used to select 414 motherbaby pairs (dyad) attending infant welfare clinics in the selected Primary Health Centres (PHCs). Data was collected using structured validated questionnaire after obtaining ethical approval and informed consent. Descriptive statistics were used for analysis of data and hypotheses were tested using chi-square statistic at p=0.05. Results: One hundred and ninety nine (48.1%) of the respondents had a good level of knowledge of appropriate UCC, 254(61.4%) respondents practiced good cord care. Even though most (95.7%) mothers used methylated spirit to clean the cord, quite a number, 270(65.5%) applied mentholated balm to the umbilicus. Above 60% of those who received information on UCC had good practice compared to those that did not (p=0.04). Also, 125(62.8%) of the respondents with good knowledge of UCC had good cord care practices compared to 74(37.2) with poor practices. Respondents' knowledge of UCC was not significantly associated with their cord care practices. Conclusion: Gaps were observed in both knowledge and practices of umbilical cord care among the mothers attending primary health care centres. Strategies need to be instituted by health care workers to improve knowledge of umbilical cord care and inappropriate practices should be strongly discouraged. [ABSTRACT FROM AUTHOR]

Objective To determine the association of feto-maternal outcomes of term pregnancies with fetal umbilical cord lengths and cord abnormalities in Calabar. Methods A cross-sectional study of 600 women with singleton pregnancies who delivered either virginally or caesarean section between 37 and 42 completed weeks. Examination of cord was done at delivery for loop round neck, cord length, knots and cord abnormalities. Outcomes recorded include fetal presentation, sex, birth weight, length of newborn and Apgar scores at 1st and 5th min. Also, mode of delivery, labor duration and maternal complications were noted. Cords with abnormalities were sent for histological examination. Data was analyzed using SPSS version 20. Level of significance was set at P-value <0.05. Results The mean cord length was 61.07 ± 14.931 cm, short cords were 23 (7.7%), long cords were 37 (12.3%) and 480 (80.0%) were normal length. Male fetuses had longer cords, mean cord length in the vertex presentations were significantly longer than in breech presentation and increased with increase in birth weight. Abruptio placentae was higher among fetuses with short umbilical cord (17.4% vs. 0.4%) (P-value = 0.000). There was positive correlation between fetal weight and umbilical cord length. Cord coiling index showed a negative correlation with cord length (r = -0.261; P-value = 0.000). Conclusion Abnormal umbilical cord lengths significantly predispose to obstetric complications but cord abnormalities are rare and does not affect pregnancy outcome. High index of suspicion and careful evaluation of cord may inform and reduce untoward feto-maternal outcome. [ABSTRACT FROM AUTHOR]

Background: Despite the progress made in recent decades to reduce the number of child deaths globally, many new-borns continue to die preventable deaths from conditions such as neonatal infections, especially in developing countries such as Nigeria. The umbilical cord remnants provide a good site for proliferation of infectious organisms which can lead to the death of new-born babies in their first month of life. Hence this study explored the new-born cord care practices of parturient women and the factors that contribute to such practices. Method: This study was a descriptive, cross-sectional survey of parturient women, who gave birth in the past one year. A Multi-stage sampling technique, was used to recruit respondents across selected communities. Ethical clearance was obtained, while informed consent was obtained from the study participants. A total of 400 volunteering respondents were consecutively recruited while a self-developed and validated questionnaire was used to collect data. Result:The major findings of the study were that a significant percentage (12.2%) of the respondents did not deliver their babies in any health facility. There were evidences of potentially harmful new-born cord care practices among the respondents such as application of herbs and tooth-pastes to new-born's umbilical cord (12% and 5.2% respectively) and 8% applied hot balms to hasten cord separation. Fifteen percent of the respondents indicated that they noticed signs of infection on the baby's cord while place of delivery influenced their new born cord care practices. Conclusion: Therefore, there is need for public enlightenment programs specifically tailored for rural dwellers on good new-born cord care practices. [ABSTRACT FROM AUTHOR]

Objectives: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. Methods: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. Results: The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. Conclusion: The UCI was not associated with adverse perinatal outcome in this study. [ABSTRACT FROM AUTHOR]

The United States Agency for International Development/Targeted States High Impact Project supported Sokoto State, Nigeria government in the development of a community-based intervention aimed at preventing post-partum haemorrhage (PPH) and cord infection among women and children, respectively. This paper describes the innovative intervention within the Nigeria health delivery system. It then explains the case study approach to assessing this intervention and summarises findings. Ultimately, the intervention was received well in communities and both drugs were added to the procurement list of all health facilities providing maternity services in the State. Key factors leading to such success include early advocacy efforts at the state-level, broad stakeholder engagement in designing the distribution system, early community engagement about the value of the drugs and concerted efforts to monitor and ensure availability of the drugs. Implementation challenges occurred in some areas, including shortage of community-based health volunteers (CBHVs) and drug keepers, and socio-cultural barriers. To maximise and sustain the effectiveness of such interventions, state government needs to ensure constant drug supply and adequate human resources at the community level, enhance counselling and mobilisation efforts, establish effective quality improvement strategies and implement a strong M&E system. [ABSTRACT FROM PUBLISHER]

Background: Neonatal infections caused by unsafe umbilical cord practices account for the majority of neonatal deaths in Nigeria. We examined the trends in umbilical cord care practices between 2012 and 2015 that coincided with the introduction of chlorhexidine digluconate 7.1% gel in Bauchi and Sokoto States.Methods: We obtained data from three rounds of lot quality assurance samples (LQAS) surveys conducted in 2012, 2013 and 2015. Households were randomly sampled in each round that totaled 1140 and 1311 households in Bauchi and Sokoto States respectively. Mothers responded to questions on cord care practices in the last delivery. Coverage estimates of practice indicators were obtained for each survey period. Local Government Area (LGA) estimates for each indicator were obtained with α ≤ 5%, and β ≤20% statistical errors and aggregated to State-level estimates with finite sample correction relative to the LGA population.Results: Over 75 and 80% of deliveries in Bauchi and Sokoto States respectively took place at home. The proportion of deliveries in public facilities reported by mothers ranged from 19% in 2012 to 22.4% in 2015 in Bauchi State and from 12.9 to 13.2% in 2015 in Sokoto State. Approximately 50% of deliveries in Bauchi and more than 80% in Sokoto States were assisted by traditional birth attendants (TBAs) or relatives and friends, with little change in the survey periods. In Bauchi and in Sokoto States, over 75% and over 80% of newborn cords were cut with razor blades underscoring the pervasive role of the TBAs in the immediate postpartum period. Use of chlorhexidine digluconate 7.1% gel for cord dressing significantly increased to the highest level in 2015 in both States. Health workers who attended deliveries in health facilities switched from methylated spirit to chlorhexidine. There were no observable changes in cord care practices among the TBAs.Conclusion: Unsafe umbilical cord care practices remained prevalent in Bauchi and Sokoto States of Nigeria, although a recent introduction of chlorhexidine digluconate 7.1% gel positively changed the cord care practices toward safer practices among public health providers. TBAs, friends and relatives played the strongest immediate postpartum roles and mostly retained the unsafe cord care practices such as use of ash, cow dung and hot compress. We recommend that existing TBAs are retrained and refocused to forge stronger links between communities and the primary health centers to increase mothers' access to skilled birth attendants. [ABSTRACT FROM AUTHOR]

The article offers information on the launch by Nigeria's Federal Ministry of Health of a plan to promote the use of chlorhexidine gel to reduce neonatal mortality from massive infection. Topics covered include the effectiveness of chlorhexidine in preventing bacterial exposure through the freshly cut umbilical cord, the obstacles to the national strategy, such as the establishment of a reliable supply chain, and evidence on the effectiveness of chlorhexidine in umbilical cord stump care.

Background: Zinc is particularly involved in cellular growth, neurodevelopment, and immune function, which is critical for child survival. To reduce neonatal mortality in developing countries, cost-effective and evidence-based interventions that can enhance growth, development, and immunity, need to be considered. Determining the zinc levels of neonates and how it relates to both gestational age is therefore imperative., Subjects and Methods: A descriptive cross-sectional study was carried out at the University of Nigeria Teaching Hospital, aimed at determining the umbilical cord serum zinc levels among neonates and their relationship with their gestational age. Two hundred and seventy-five neonates of gestational ages 28 to 42 weeks were enrolled in the study. Serum zinc levels were determined using the flame atomic absorption spectrophotometer (AAS model no. FS 240 AA.USA, Agilent Technology Ltd.)., Results: Among the 275 neonates, there were 27 (9.82%), 28 (10.18%), and 220 (80%) preterms, moderate-to-late preterms, and term neonates, respectively. The mean serum zinc level of all neonates was 87 ± 16.07 μg/dL and within the normal limit of serum zinc. Their mean serum zinc level increased with increasing gestational age (F = 90.424, P < 0.001). Very preterm and moderate-to-late preterm neonates had mean serum zinc levels of 65.13 μg/dL ± 6.15 and 69.85 μg/dL ± 9.63 μg/dL, respectively., Conclusion: This study revealed that though the overall mean serum zinc of neonates was normal, preterms (especially those of lower gestational ages) were zinc deficient. Routine zinc supplementation at birth should be considered in preterm neonates to reduce the untoward effects of zinc deficiency., Competing Interests: None

This study is descriptive type in nature. It was undertaken to explore how traditional both attendants (TBAs) In Oguobin Community, Aeyese Stete, Nigeria renden care to the new born. The sample included 135 women; 15 men and 20 traditional birth attendants. A structured questionnaire was used for data collections. The findings revealed that most of TBAs use a blade to separate the baby from placenta whereas, never die leaves, red mud, pepper are some of the substances used by the traditional birth attendants for the care of the umbilical cord which falls off between two to seven (2- 7) days without any form of infection or bleeding. The TBAs recommended provision of warmth and breastfeeding for the baby immediately after birth. The study also showed that the participants advocated the services of the traditional birth attendants describing them as more considerate, loving, caring and always available for the villagers whenever they were needed. Keeping in view these findings, it is recommended that the traditional birth attendants should be medically trained to render sound services to the community and the government should establish modern health service to meet the needs of the local people. [ABSTRACT FROM AUTHOR]

Objective: Neonatal tetanus (NNT) is the leading cause of neonatal deaths in developing countries. The objective of this study was to determine prognostic indicators in NNT.Methods: We reviewed the clinical records of all neonates (n = 174) admitted to Ife State Hospital with the diagnosis of NNT from 1991 through 1995.Results: Delivery had occurred at home in 73.3% of cases. Only 37/164 of the mothers had had adequate immunization with tetanus toxoid. The umbilical cord appeared to be the portal of entry in 58.6% of cases. Mean age of infants at presentation was 7.2 days. Mortality was 57.5%; non-survivors succumbed after mean stay in the hospital of 5.0 days. Mortality was significantly associated with an incubation period of 6 days or less (P = 0.0026), infant's weight of less than 2.5 kg (P = 0.0113), lack of antenatal care in a health facility (P = 0.0279), birth at home (P = 0.0455), but not with lack of adequate maternal immunization (P = 0.2081; not significant). Multivariable analysis showed that a short (< or = 6 d) incubation period was the strongest predictor of mortality (OR = 3.11, P = 0.0030) while low infant weight (< 2.5 kg) was also a significant predictor (OR = 2.46, P = 0.0408).Conclusions: Hygienic deliveries and adequate cord care are very important for the prevention of neonatal tetanus deaths, and universal prenatal care, including education programmes on appropriate perinatal and cord care, can significantly reduce NNT incidence and mortality in developing countries. [ABSTRACT FROM AUTHOR]

Background: Omphalitis is an important cause of neonatal sepsis (NNS) and mortality. Quantitative estimates of risk of omphalitis-related neonatal death is about 10%-19%. Topical applications of antiseptics have been shown to reduce this risk burden but has not been well investigated., Aim: To demonstrate non-inferiority of methylated spirit to chlorhexidine (CHX) gel for prevention of omphalitis, NNS and mortality at day 28., Methods: This was a randomized, non-inferiority trial of methylated spirit versus CHX gel with 161 and 162 mother-baby pairs, respectively, conducted between July 2017 and May 2018. SPSS version 23.0 was used for data analysis to examine for incidence of omphalitis, time-to-cord separation, NNS and mortality. Relative risk and 95% confidence interval were used as point and interval estimates, respectively, with a non-inferiority margin of 10% set for CHX gel while a P values <0.05 was statistically significant., Results: The median age of newborns was 18 h; (IQR: 8-24) h with the risk of omphalitis being 2% higher with CHX gel compared to methylated spirit (RR = 1.020; 95% CI; 0.988-1.053; P = 0.053). The median times-to-cord separation were 7.0 days (IQR: 2-17) and 7.0 days (IQR: 2-18) for methylated spirit and CHX gel, respectively (mean difference: ‒0.2145; 95% CI = ‒0.9085-0.4759; P = 0.544). There was no difference in the risks of NNS and mortality among those treated with methylated spirit compared to those exposed to CHX gel (RR: 1.0; 95% CI = 0.984-1.017; P = 1.000) and (RR: 1.0; 95% CI = 0.994-1.018; P = 0.986) respectively., Conclusions: There is no evidence that 96% methylated spirit is inferior to 4% CHX gel in preventing neonatal omphalitis; hence, it may be considered a safe and effective alternative where CHX gel is unavailable., Competing Interests: None

Nigeria has the highest number of neonatal and under-five deaths in Africa. Socio-cultural determinants play an important role in disease burden in low-middle income countries. This study aimed to describe knowledge, attitudes and neonatal care practice among household caregivers in a rural community in Nigeria, specifically uvulectomy, female genital mutilation (FGM), failure to routinely immunize and unsafe cord care. Further, relationships between demographic characteristics and knowledge, attitudes and neonatal care practices among caregivers were analyzed. The study design was descriptive correlational and cross-sectional. Consented caregivers (N = 298) were enrolled and interviewed using a structured questionnaire. Data were collected on demographic characteristics of the study participants and practice of uvulectomy, FGM, immunization and cord care. Statistically significant correlations were found between the practice of uvulectomy, FGM and failure to immunize based on occupation (p = 0.0202, p = 0.0290, p = 0.0071) and educational level (p =< 0.0001, p =< 0.0001, p =< 0.0001), with variations by ethnicity. Intense, preventative health measures and maternal education to eliminate harmful care practices are essential to influence outcomes., (© The Author(s) [2019]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of any country in the world. Global progress in accelerating neonatal deaths is hinged to scaled-up interventions in Nigeria. We used routine data of chlorhexidine digluconate 7.1% gel utilized by 36,404 newborns delivered by 36,370 mothers, to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria., Methods and Findings: Under state government leadership, a community-based distribution system overseen by 244 ward development committees and over 3,440 community-based health volunteers and community drug keepers, was activated to deliver two locally stored medicines to women when labor commenced. Newborns and their mothers were tracked through 28 days and 42 days respectively, including verbal autopsy results. 36,404 or 26.3% of expected newborns received the gel from April 2013 to December 2013 throughout all 244 wards in the State. 99.97% of newborns survived past 28 days. There were 124 pre-verified neonatal deaths reported. Upon verification using verbal autopsy procedures, 76 deaths were stillborn and 48 were previously live births. Among the previous 48 live births, the main causes of death were sepsis (40%), asphyxia (29%) and prematurity (8%). Underuse of logistics management information by government in procurement decisions and not accounting for differences in LGA population sizes during commodity distribution, severely limited program scalability., Conclusions: Enhancements in the predictable availability and supply of chlorhexidine digluconate 7.1% gel to communities through better, evidence-based logistics management by the state public sector will most likely dramatically increase program scalability. Infections as a cause of mortality in babies delivered in home settings may be much higher than previously conceived. In tandem with high prevalence of stillborn deaths, delivery, interventions designed to increase mothers' timely and regular use of quality antenatal care, and increased facility-based based delivery, need urgent attention. We call for accelerated investments in community health volunteer programs and the requisite community measurement systems to better track coverage. We also advocate for the development, refinement and use of routine community-based verbal autopsies to track newborn and maternal survival.

Introduction: Full blood count (FBC), one of the most frequently requested for laboratory investigations, is a simple, fast and cheap test and is a reliable indicator of health. Due to its usefulness in the assessment of health status of individuals, its parameters in cord blood, a major source of haemopoietic stem cell transplantation and an ideal source for laboratory investigations for newborns were determined to provide a useful guide to local neonatologists and stem cell transplant physicians., Methods: Three millilitres of umbilical cord blood was collected from 130 normal birth weight newborns (69 males and 61 females) whose cord were clamped immediately after delivery, at a teaching hospital in Lagos, Nigeria and full blood count parameters were determined using Sysmex autoanalyzer, model KX-21N. Consented mothers of the newborns were selected based on, age between 18 and 45 years; uneventful pregnancy and delivery and haemoglobin (Hb) concentration ≥ 10 g/dL., Results: There were no statistical gender differences in the mean values of Hb concentrations (M = 13.27 ±1.60 g/dL; F = 13.32±1.61g/dL; p = 0.93), total white cell count (M = 3.16±5.43 × 10(9)/L; F = 13.07±4.98 × 10(9)/L; p= 0.92), platelet count (M= 223.64± 64.21 × 10(9)/L; F = 226.69±80.83 × 10(9)/L; p = 0.81) and other parameters., Conclusion: Mean values of full blood count parameters obtained in this study are comparable to reports from other studies in developing countries and could be a useful guide for neonatologists and stem cell transplant physicians in our geographical location.

Background: Mothers care for their infants' umbilical cord stump in various ways. Different cord care practices have been documented; some are beneficial while others are harmful. Who and what influence the cord care practiced by mothers have, however, not been fully explored particularly in the study locale., Objective: The objective of this study was to determine the factors that influence cord care practices among mothers in Benin City., Materials and Methods: The study subjects included 497 mothers who brought their babies to Well Baby/Immunization Clinic at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, between July and August 2009. A structured questionnaire served as an instrument to extract information on their biodata and possible determinants of cord care practices., Results: Significantly older women (P=0.023), educated mothers (P=0.029), and those who had male babies (P=0.013) practiced beneficial cord stump care practices. Beneficial cord care practice increased with increasing maternal educational status. The best predictors of beneficial cord care practices are maternal level of education (P=0.029) and infant's sex (P=0.013). The use of harmful cord care practices was more common among mothers who delivered outside the Teaching hospitals. Most (71.2%) of the mothers were aware of hygienic/beneficial cord care. The choices of cord care methods eventually practiced by mothers were influenced mainly by the disposition of nurses (51.3%), participants' mothers (32.0%), and their mothers-in-law (5.8%). There was no significant relationship between cord care practice on one hand and maternal parity, tribe, and socioeconomic classes on the other., Conclusion/recommendation: The need for female education is again emphasized. The current findings strongly justify the need for public enlightenment programs, using the mass media and health talks in health facilities, targeting not only women of reproductive age but also secondary audience like their mothers, mothers-in-law, nurses, and attendants at health facilities. Proper hygiene including proper hand washing techniques while caring for newborns along with vaccination of infants and their mothers will help prevent infections including tetanus while prompt health-seeking behavior is advised to improve outcome should such infections occur.

Aim: The goal of this study was to identify risk factors associated with umbilical cord prolapse and to document the perinatal outcome of cases of cord prolapse., Materials and Methods: During the period of the study (from July 1, 2001 and June 30, 2007), forty-six cases of umbilical cord prolapse were identified from the labor ward record and analyzed retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio., Results: During the period of the study, 46 cases of cord prolapse were encountered out of 10,080 deliveries which was 0.46% of all deliveries. Of the 46 fetuses with umbilical cord prolapse 32.6% had a fetal weight of less than 2.5 kg compared with 15.2% for fetuses in control group (P<0.012). The umbilical cord prolapse occurred in association with breech presentation eleven times (23.9%) and transverse presentation seven times (15.2%). The occurrence of breech presentation among the control cases was 4.3% (P<0.00031), and that of transverse lie was 4.4% (P<0.02007). Among the women that had cord prolapse, 47.8% had unbooked pregnancies compared with the control group with 14.5% (P<0.0000033). Multiparity accounted for 78.3% in the cord prolapse cases and 68.1% in the controls (P=0.19). The perinatal mortality rate was 413/1000. (41.3%), compared to the perinatal mortality of 58/1000 for the control group., Conclusions: Our findings in this study has confirmed an association between increased risk of umbilical cord prolapse and abnormal fetal presentation, low birth weight and unbooked status. It is therefore suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care and this will enhance the early identification of these risk factors and an appropriate management instituted to reduce perinatal mortality.

Background: Umbilical cord is a clinical condition that calls for emergency decision making and action especially with a live and mature fetus. The objective of this study is to determine, fetal outcome and how various factors influence it., Methods: This is a 12 1/2 year retrospective study of all 34 fetuses who suffered from cord prolapse at Ahmadu Bello University Teaching Hospital., Results: There were 34 cases of cord prolapse, 23 perinatal deaths and a perinatal mortality rate of 67.64%. About 55% of babies of registered women died, while about 92% of the unregistered died. Eleven babies of the 22 women admitted with cervical dilatations of 7 cm and less, died and all the babies of women with cervical dilatations of 8 cm and above died. All 19 babies delivered vaginally and 3 of the 14 delivered abdominally, died. About eighty eight percent of the low-birth weight, and 37.5% of normal size babies died. Seventeen (51.5%) of the 33 babies delivered, had Apgar score 0. All babies with Apgar scores 1-4 died, 40% with Apgar scores 5-7 and 16.7% with Apgar scores 8-10 died. Maternal age, parity, ethnicity, gestational age, presentation and sex of the fetus did not influence outcome.

The incidence of umbilical cord prolapse at Obafemi Awolowo University teaching hospital complex, Ile-Ife over a ten year period was 0.42% (one in 240 deliveries). The incidence was observed to be higher among the unbooked patients (76.7%). Analysis of the 60 cases reveals that multiparity, unengaged presenting part from cephalo-pelvic disproportion, prematurity, prelabour spontaneous rupture of membranes, breech presentation, and multiple pregnancy were the major contributory factors. The perinatal mortality (36.7%) was significantly higher than that of the hospital which was 8% (P < 0.05). The perinatal mortality rate was higher among the unbooked patients (86.4%). Caesarean section gave better results except when the cervix was fully dilated. Early resort to Caesarean section, proper and adequate antenatal care and properly supervised hospital delivery is recommended.

Necrotizing fasciitis is a potentially lethal syndrome which rarely affects Occurrence in the neonatal period is uncommon, although it has been estimated that up to 50% of reported paediatric cases involve the neonate. Two previous reports have associated the syndrome with neonatal omphalitis. Three cases seen in the University of Benin Teaching Hospital are presented, with poor umbilical cord stump hygiene being the immediate predisposing/associated condition. Two of the infants had Fourier's gangrene and the third developed gangrene of the anterior abdominal wall.