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Objective: To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria. Design: Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD‐4‐QED) Programme. Setting: Data from births in 54 referral‐level hospitals across Nigeria between 1 September 2019 and 31 August 2020. Population: A total of 69 698 births. Methods: Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality. Outcome measures: Preterm birth and preterm perinatal mortality. Results: Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years – adjusted odds ratio [aOR] 1.52, 95% CI 1.36–1.71; >35 years – aOR 1.23, 95% CI 1.16–1.30), no formal education (aOR 1.68, 95% CI 1.54–1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61–2.34) and no antenatal care (aOR 2.62, 95% CI 2.42–2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20–1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02–1.83), no antenatal care (aOR 2.74, 95% CI 2.04–3.67), earlier gestation (28 to <32 weeks – aOR 2.94, 95% CI 2.15–4.10; 32 to <34 weeks – aOR 1.80, 95% CI 1.3–2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54–36.33) were associated with preterm perinatal mortality. Conclusions: Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio‐economic status. [ABSTRACT FROM AUTHOR]

Background: Preterm (born < 37 weeks' gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnerable infants in sub-Saharan Africa. Aim: To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan African countries. Methods: Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds. Results: Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before the first feed. The median (inter-quartile range) time to first feed was 46 (27, 72) hours of life and time to full enteral feeds (tFEF) was 8 (4.5,12) days with marked variation between neonatal units. Independent predictors of tFEF were time to first feed (unstandardised coefficient B 1.69; 95% CI 1.11 to 2.26; p value <0.001), gestational age (1.77; 0.72 to 2.81; <0.001), the occurrence of respiratory distress (-1.89; -3.50 to -0.79; <0.002) and necrotising enterocolitis (4.31; 1.00 to 7.62; <0.011). Conclusion: The use of standardised feeding guidelines may decrease variations in clinical practice, shorten tFEF and thereby improve preterm and VLBW outcomes. [ABSTRACT FROM AUTHOR]

Background The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria. Methods The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019–February 2020) and during (March 2020–February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria. Results There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown—a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001). Conclusions The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern. [ABSTRACT FROM AUTHOR]

Aim: We aimed to describe in‐hospital mortality, and its predictors, in very low birthweight (VLBW) infants managed in tertiary centres in a low‐ to middle‐income country. Methods: This was a retrospective cohort study of VLBW infants (birthweight 500 to 1500 grams) admitted within 72 h of life to the neonatal intensive care units (NICUs) of three tertiary centres in Nigeria from July 2017 to March 2021. We describe in‐hospital mortality rates, causes and when they died. The independent predictors of in‐hospital mortality were determined using multivariate logistic analysis. Results: Of the 6187 NICU admissions, 1161 met the inclusion criteria: 545 (47%) VLBW infants died, including 309 (57%) from respiratory distress syndrome, and 55% occurred within 72 h of life. The adjusted odds (aOR) for mortality increased with each extra Downes respiratory distress score (aOR 1.27) with a 95% confidence interval (CI) of 1.14–1.41. Study site 3 had a higher aOR for mortality than site 1 (aOR 2.78, 95% CI 1.72–4.48) and site 2 (aOR 2.29, 95% CI 1.45–3.61). Conclusion: Nearly half (47%) of all VLBW infants admitted to three tertiary referral hospitals in Nigeria died during hospitalisation. Mortality varied significantly by site and both the centre and respiratory distress independently predicted mortality. [ABSTRACT FROM AUTHOR]

Introduction: simulation-based education (SBE) is becoming more prevalent in higher education. However, little is known of the perceptions of medical students towards this training approach. The objective of this study was to explore the perceptions of Nigerian medical students on manikin-based and virtual simulation training. Methods: in January 2019, a paper-based 25-item survey on simulation-based training was administered to a convenience sample of 120 medical students in the 4th year (400 level) and final year (600 level). Data were analysed using descriptive statistics, Pearson's chi square, and the Fisher's Exact test. Results: a total of 95 surveys were completed (RR 79%). Respondents were mostly 21-30 years 95 (81%) and about half were female 60 (51%). Under half of 600 level students 22 (38%) reported receiving simulation-based training in Basic Life Support. A lack of curriculum 27 (28%), instructors trained in simulation education 31 (33%) and funding 52 (55%) were perceived as challenges to manikin-based simulation. Lack of awareness was the greatest single challenge to online simulation 50 (53%). A majority of medical students 181 (96%) owned smartphones, but only 3% (n=3) of respondents had experienced a virtual reality (VR) simulation. If facilities were available, 99% of respondents would recommend the use of online simulation. Conclusion: there is an opportunity for increased exposure to simulation-based training during undergraduate medical education in Nigeria. Instruction in simulation methods for clinical lecturers in medical schools would increase awareness of the potential advantages of simulation-based training and access for medical students to simulation education. [ABSTRACT FROM AUTHOR]

The first and second authors, Helen M. Nabwera and Dingmei Wang should be noted as joint first co-authors of this work.By Helen M. Nabwera; Dingmei Wang; Olukemi O. Tongo; Pauline E. A. Andang'o; Isa Abdulkadir; Chinyere V. Ezeaka; Beatrice N. Ezenwa; Iretiola B. Fajolu; Zainab O. Imam; Martha K. Mwangome; Dominic D. Umoru; Abimbola E. Akindolire; Walter Otieno; Grace M. Nalwa; Alison W. Talbert; Ismaela Abubakar; Nicholas D. Embleton and Stephen J. AllenReported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author [Extracted from the article]

Abstract Background Childhood obesity and associated hypertension are major public health concerns globally. This study aimed to determine the prevalence of obesity and the associated risk of high blood pressure among Nigerian adolescents. Methods A cross-sectional school-based study of 885 apparently healthy adolescents was performed. Weight, height and blood pressure (BP) were measured using standard methods. Body mass index (BMI) was calculated and categorized by age, sex and percentile. Obesity and overweight were defined as: ≥ 95th and 85th to < 95th percentiles, respectively, for age, sex and height. Subjects were sub-categorized into age 10–13 years (A) and 14–17 years (B). The odds ratio for pre-hypertensive and hypertensive range BP by age and BMI were generated. Significance was set at P Results The prevalence of overweight and obesity were 13.8% and 9.4%, respectively. The prevalence of hypertensive range systolic BP in obese versus normal BMI females was 16% versus 23% (p=0.00) and 12.1% versus 6.4% (p=0.27) in males. The prevalence of hypertensive range diastolic BP in obese versus normal BMI females was 12% versus 1.4% (p=0.00) and 15.2% versus 3.5% (p=0.01) in males. BMI in group B was significantly associated with pre-hypertensive and hypertensive range systolic BP in overweight (P = 0.01, P = 0.002) and obese subjects (P = 0.00, P = 0.00) and with hypertensive range diastolic BP (P = 0.00) only in obese subjects. The only significant association in group A was between obesity and pre-hypertensive range diastolic BP (P = 0.00). Conclusion The prevalence of hypertensive range BP among obese Nigerian adolescents was high. Screening for childhood obesity and hypertension, and long-term follow-up of obese adolescents into adulthood are recommended.

Objective: To describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria. Study design: In a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period. Results: 2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128) infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortality was very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73–28.39), VLBW (6.92; 4.06–11.79), congenital anomaly (4.93; 2.42–10.05), abdominal condition (2.86; 1.40–5.83), birth asphyxia (2.44; 1.52–3.92), respiratory condition (1.46; 1.08–2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28–2.85). Mortality was reduced if mothers received a partial (0.51; 0.28–0.93) or full treatment course (0.44; 0.21–0.92) of dexamethasone before preterm delivery. Conclusion: Greater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues during pregnancy and delivery as well as in the newborn. [ABSTRACT FROM AUTHOR]

Background: Neonatal mortality had not changed significantly in the last decade in African countries particularly in Nigeria; however, under-five mortality had reduced significantly. Nigeria with a quarter of maternal and under-five mortality is among ten countries with the highest neonatal mortality. Previous studies had shown patterns of newborn morbidity and mortality; however, no study has been conducted in this regard recently. The present study aimed to ascertain the current patterns of newborn morbidity and mortality. Methods: A retrospective review of records of all newborn admissions over a period of one year was carried out. Extracted data include age, gender, diagnosis on admission outcome, and cause of mortality. The frequency of morbidity and outcome variables were analyzed and then calculated. Results: The major reason for admission was jaundice 29.6% followed by asphyxia 25%, sepsis 16.1%, and prematurity 9%. The neonatal mortality rate was 12.5% with more than half of the deaths occurring within 24 hours and almost all within 72 hours. Causes of death were asphyxia 58.2%, jaundice 16.4%, sepsis 10 .4%, and prematurity 3%. More than half of the neonates with asphyxia were likely to die within 24 hours. Conclusion: Asphyxia, jaundice, sepsis, and prematurity were the major causes of morbidity. In addition, asphyxia is still a major cause of preventable death in newborns in Nigeria.Background: Neonatal mortality had not changed significantly in the last decade in African countries particularly in Nigeria; however, under-five mortality had reduced significantly. Nigeria with a quarter of maternal and under-five mortality is among ten countries with the highest neonatal mortality. Previous studies had shown patterns of newborn morbidity and mortality; however, no study has been conducted in this regard recently. The present study aimed to ascertain the current patterns of newborn morbidity and mortality. Methods: A retrospective review of records of all newborn admissions over a period of one year was carried out. Extracted data include age, gender, diagnosis on admission outcome, and cause of mortality. The frequency of morbidity and outcome variables were analyzed and then calculated. Results: The major reason for admission was jaundice 29.6% followed by asphyxia 25%, sepsis 16.1%, and prematurity 9%. The neonatal mortality rate was 12.5% with more than half of the deaths occurring within 24 hours and almost all within 72 hours. Causes of death were asphyxia 58.2%, jaundice 16.4%, sepsis 10 .4%, and prematurity 3%. More than half of the neonates with asphyxia were likely to die within 24 hours. Conclusion: Asphyxia, jaundice, sepsis, and prematurity were the major causes of morbidity. In addition, asphyxia is still a major cause of preventable death in newborns in Nigeria. [ABSTRACT FROM AUTHOR]

Background/Aim: Helicobacter pylori infection is acquired in childhood, but there are conflicting reports on malnutrition and the infection. This study aimed to determine the prevalence of H. pylori infection among malnourished children and highlight the socioeconomic (SE) and clinical factors associated with the infection. Methodology: This was a descriptive cross-sectional study of 122 malnourished children and 120 healthy controls. Anthropometry was done for all the study participants, and the H. pylori status was determined with the use of monoclonal stool antigen test in all the participants. Logistic regression analysis was used to determine the factors that could predict the occurrence of the infection in the children. Results: Seventy percent (70.8%) of the malnourished children had moderate malnutrition, whereas 29.2% were severely malnourished. The prevalence of H. pylori in the malnourished children was 22.8% compared to 32.5% in the controls (P = 0.09). The infection was most prevalent in toddlers (60.7%). The SE class was significantly related to the infection (P = 0.01) and about a fifth (21.3%) of the malnourished children who belonged to the low SE class were H. pylori positive compared to 9.2% of the controls. About 64.3% of the malnourished children with H. pylori infection had fever and 25.8% had diarrhea. Multivariate analysis showed that stunting was significantly related to the infection (P = 0.02). Conclusion: H. pylori infection was prevalent among the toddlers and was significantly associated with stunting in this cohort of malnourished children. Screening of children for the infection is still advocated, and infected children should be referred for appropriate treatment and follow-up. The relationship between SE class and the infection still requires further research. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is a major contributor to neonatal and under-five mortality, and births at lower gestational ages (GA) contribute more to these statistics. Most developed countries have succeeded in improving survival at extremes of GA, while most developing countries like Nigeria still lag behind. The objective of this retrospective study was to document the survival rates among extremely preterm neonates and factors associated with mortality in a tertiary center in Nigeria. Methods: The labor ward delivery and neonatal unit admission records were reviewed from January 2010 to December 2017. The GA, gender, mode of delivery, birth weight, duration of admission, and outcomes for babies delivered at 24 to 27 weeks + 6 days of gestation were recorded. The survival rates and factors associated with mortality were analyzed. Results: During this period, there were 11,607 live births with 1,685 (14.5%) preterm deliveries. There were 4,523 admissions to the neonatal unit; overall, 736 (16.3%) cases were preterm neonates out of which 152 (3.4%) subjects were extremely preterm. The overall survival rate was 24.3%, and the survival rate increased with increasing GA and birth weight (BW). Most deaths occurred in the first week of life. The means of BW and GA were significantly lower in babies that died, compared to those who survived. The median duration of admission was also lower for those that died, compared to those that survived. The most common causes of death were respiratory distress, sepsis, and intracranial hemorrhage. Conclusion: The survival rate of extremely preterm neonates is low in this study. Facilities to improve care, especially for respiratory support should be put in place to reduce mortality. [ABSTRACT FROM AUTHOR]