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Professor T.C. HarryEditor-in-chief

NIGERDELTAMEDICALJOURNAL

Website: www.ndmjournal.org

September2020Vol.4Issue3ISSN:2672-4588


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JournalofNigerianMedicalandDentalConsultantsAssociationofNigerDelta

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September2

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ol.4

Issue3

NIGER DELTA MEDICAL JOURNAL

Journal of Nigerian Medical and Dental Consultants Association of Niger Delta University Teaching Hospital

Vol. 4 Issue 3, Sept., 2020

All correspondences should be addressed to

Niger Delta University Teaching Hospital

Website:www.ndmjournal.org

Okolobiri, Bayelsa State, NigeriaE-mail:[email protected]


Professor T.C. HarryEditor-in-chief


ISSN: 2672-4596 (Online) ISSN: 2672-4588 (Print)

Table of Content NIGER DELTA MEDICAL JOURNAL

Content Pages

Nig Del Med J 2020; 4(3): ii Page ii

5 - 6

29 - 31

21 - 28

7 - 20

43 - 52

32 - 42

53 - 54

1. Editorial: The new normal. Harry TC

2. Guest Editorial: Management of Diabetes in Environments with Limited Resources: Diabetes Care - Doing More with Less. Owei I, Dagogo-Jack A, Nyenwe E, Dagogo-Jack S.

3. Level of knowledge, practice of preconception care and barriers to its utilization among health care providers in South East Nigeria. Iloghalu E I, Obuba C, Ugwu E O, Obi S N.

4. Reflections: Character and responsibility of a fellowship holder in community service activities. Briggs ND.

5. Pre-facility management of Childhood illnesses: The experience in Alimosho Local Government Area of Lagos State, Nigeria. Duke ES, Ezenwa BN, Roberts A, Ekanem EEP.

6. Non-tubal ectopic pregnancies in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria: A case series and review of literature. Aliyu RM, Sada SI, Mahmud FA, Umaru-Sule H, Randawa AJ, Onwuhafua PI.

7. Tribute: Late Alabo Professor Rollings Sopirinye Jamabo

EDITOR-IN-CHIEF:

PREVIOUS EDITOR-IN-CHIEF:

Prof Tubonye C Harry

Prof G.T.A IjaduolaFRCS (Eng.), FRCS (Glasgow), DLO (London), PhD.

DEPUTY-EDITOR-IN-CHIEF:Prof Felix Akinbami

EDITORS:Prof P J Alagoa

Dr A S Oyeyemi

ASSISTANT EDITORSDr O.G. Egbi

Dr V Dinyain

INTERNATIONAL EDITORIAL ADVISORY BOARD:

EDITORIAL TEAM NIGER DELTA MEDICAL JOURNAL

Nig Del Med J 2020; 4(3): iii - iv Page iii

Emeritus Prof Kelsey A Harrison

University of Port-Harcourt, Port-Harcourt, Rivers State, NIGERIA (Currently resident in Tuusula, Finland)

[email protected]

Emeritus Prof Nimi D Briggs University of Port-Harcourt, Port-Harcourt, Rivers State, Nigeria

[email protected]

Prof Samuel Dagogo-Jack

A.C. Mullins Chair in Translational Research University of Tennessee Health Science Center 920 Madison Avenue Memphis, TN 38163, USA

[email protected]

Dr Usiakimi Igbaseimokumo

Associate Professor & Pediatric Neurosurgeon, Texas Tech Health Sciences Center, School of Medicine,

3601 4th St, Lubbock, TX 79430, USA

[email protected]

Prof Bams Abila Visiting Professor of Biotechnology and Advanced Therapy Medicinal Products,

Faculty of Life Sciences & Medicine,

King's College London

Strand, London, WC2R 2LS,UK

[email protected]

Prof Frank Chinegwundoh Department of Urology,

Royal London Hospital,

Whitechapel Road,

London E1 1FR, UK

[email protected]

Prof Nicholas Etebu Vice Chancellor,

Bayelsa State Medical University,

Imgbi Road, Yenagoa, Bayelsa State, NIGERIA

[email protected]

Prof Olugbenro Osinowo Director of Academic Planning, Research & Innovation,

[email protected]

Prof Donald Nzeh

Department of Radiology, University of Ilorin,

PMB 1515, Ilorin, Kwara State, NIGERIA

[email protected]

Prof Iheanyi Okpala

Haematology Department,

University of Nigeria, College of Medicine,

Enugu, Enugu State, NIGERIA

[email protected]

Prof Dimie Ogoina

Niger Delta University, College of Health Sciences, Faculty of Clinical Sciences, Department of Medicine,Amassoma, Bayelsa State, NIGERIA

[email protected]

Prof Dilly Anumba

Academic Unit of Reproductive and Developmental Medicine

Level 4, The Jessop Wing

Tree Root Walk

Sheffield, S10 2SF, UK

[email protected]

Prof Rotimi Jaiyesimi

Consultant Obstetrician and Gynaecologists, Basildon University Hospital NHS Foundation Trust,Basildon SS16 5NL, UK

[email protected]

INTERNATIONAL EDITORIAL ADVISORY BOARD continues

EDITORIAL TEAM NIGER DELTA MEDICAL JOURNAL

Nig Del Med J 2020; 4(3): iii - iv Page iv

Bayelsa State Medical University, Imgbi Road, Yenagoa, Bayelsa State, NIGERIA

Editor-in-Chief “Skin Health & Diseases”,Consultant Dermatologist, Norfolk & Norwich University Hospitals NHS Foundation Trust,Norwich, Norfolk, NR4 7UY, UK

Dr George Millington, [email protected]

EDITORIAL: THE NEW NORMAL.


Tubonye C. Harry, FRCOG, FRCP, FWACS

Editor-in-Chief


Nig Del Med J 2020; 4(3): 5-6 Page 5

Niger Delta Medical Journal 2020;4(3):5-6

hen the editorial of the March 2020 Wissue 1 was done, COVID-19 was just rearing its head and Nigeria had diagnosed its

thfirst case on the 27 February 2020. In my

thliterature search on 27 February 2020 prior to

the March 2020 editorial, using the search terms

“COVID-19” in the National Library of

Medicine, (National Centre for Biotechnology

Information) database, I retrieved only 36

articles. Using a similar search criteria on the th

27 August 2020, I retrieved 17,779 articles; an

exponential 500 fold increase in the intervening

six months. This has heralded “a new norm”,

both in medical practice and education as

espoused in the “viewpoint” of Journal of

American Medical Association (JAMA)2 –aptly

captioned “transformational effect”.

In this issue, we have an invited guest 3editorial on the management of diabetes in

resource constrained settings contributed by

NDMJ International Editorial Board member

Prof Dagogo-Jack and his team from Memphis,

Tennessee, United States of America. Prof

Dagogo-Jack had been a past president of the

American Diabetic Association and is in the

cutting-edge of diabetic practice and research.

He was recently conferred with the Doctor of

Medicine by examination from the University

of Ibadan Medical School in 2020.

The barriers to utilization of preconception care 4

is explored by Dr Iloghalu and co-workers

from Enugu, Nigeria. Career progression and

trajectory should be well informed by mapped

pathways. Emeritus Professor Briggs reflects on

his 50 years of practice as a road map for new 5fellows .

6Duke and colleagues examine the impact of

community integrated management of

childhood illnesses (IMCI) in the under-five

children in Alimosho Local Government Area

of Lagos, Nigeria. Non-tubal ectopic

pregnancies is uncommon and Aliyu and 7

colleagues report the series identified in Zaria,

Nigeria.

The Niger Delta region lost an erudite surgical oncologist Late Professor Rollings Jamabo on

ththe 6 July 2020 and the Editorial Team has 8published his legacy .

References: 1. Harry TC. New decade, new issues. Nig Del Med J 2020;4(3): 5-6.

2. L u c e y C R , J o h n s t o n S C . T h e Transformational Effects of COVID-19 on Medical Education. JAMA 2020 doi: 10.1001/jama.2020.14136

3. Owei I, Dagogo-Jack A, Nyenwe E,Dagogo-Jack S.Guest Editorial: M a n a g e m e n t o f D i a b e t e s i n Environments with Limited Resources: Diabetes Care - Doing More with LessNig Del Med J 2020; 4 (3) : 7-20.

4. Iloghalu E I, Obuba C, Ugwu E O, Obi S N. Level of knowledge, practice of preconception care and barriers to its utilization among health care providers in South East Nigeria. Nig Del Med J 2020; 4 (3) : 21-28

5. Briggs ND. Reflections: Character and responsibility of a fellowship holder in community service activities. Nig Del Med J 2020; 4 (3): 29-31.

6. Duke ES, Ezenwa BN, Roberts A, Ekanem EEP. Pre-facility management of Childhood illnesses: The experience in Alimosho Local Government Area of Lagos State, Nigeria. Nig Del Med J 2020; 4 (3) :32-42.

7. Aliyu RM, Sada SI, Mahmud FA, U m a r u - S u l e H , R a n d a w a A J , Onwuhafua PI. Non-tubal ectopic pregnancies in Ahmadu Bello University


Nig Del Med J 2020; 4(3): 5-6 Page 6

Teaching Hospital, Zaria, Nigeria: A case series and review of literature. Nig Del Med J 2020; 4 (3) : 43 -52.

8. Tribute: Late Alabo Professor Rollings Sopirinye Jamabo. Nig Del Med J 2020; 4 (3) : 53-54



Background: he prevalence and mortality rates of diabetes in sub-Saharan Africa and other developing Tregions of the world have continued to rise but diabetes-related health expenditure has remainedlow. Therefore, it has become imperative to find and implement innovative ways of delivering optimum diabetes care within the limits of available resources.

Objectives:This review examines ways of providing evidence based management of diabetes in environments with limited health care budget.

Methods: We conducted a literature review to determine the state of diabetes-related morbidity and mortality and diabetes carein sub-Saharan Africa, especially in Nigeria.

Results and Conclusion:About4.7% (19.4 million) adults have diabetes in sub-Saharan Africa and an estimated 2.7 million Nigerians are living with diabetes. Approximately 366,200 people died from diabetes-related causes in the African sub region in 2019.Furthermore, many patients suffer from chronic diabetic complications including microvascular and macrovascular disease and diabetesremains a major cause of blindness, amputation, kidney failure, heart disease and stroke. iabetes-related health expenditure was only D$9.5 billion in sub-Saharan African 2019 compared to $324.5 billion in North America.Majority of patients are unable to achieve the recommended glycemic targets due to low socio-economic status, difficulty with affording medications and limited access to diabetes technologies.

We here proffer evidence-based practical and adaptablepharmacological and non-pharmacological solutions to optimize diabetes care in the face of financial constraints. Primary prevention of diabetes remains the most

Page 7Nig Del Med J 2020; 4(3): 7-20

Invited Review ArticleMANAGEMENT OF DIABETES IN ENVIRONMENTS WITH

LIMITED RESOURCES: DIABETES CARE - DOINGMORE WITH LESS

1 2Ibiye Owei, MBBS, MPH , Agbani Dagogo-Jack, MBBS ,3 3

Ebenezer Nyenwe, MBBS, FWACP, FACP , Sam Dagogo-Jack, MBBS, MD, DSc

1Department of Family and Community Medicine,Texas Tech University Health Sciences Center, El Paso, Texas, USA

2Department of Primary Care, Veterans Administration Medical Center,Memphis, Tennessee, USA

3Division of Endocrinology, Diabetes and Metabolism,

University of Tennessee Health Science Center, Memphis, Tennessee, USA

Address for correspondence:Sam Dagogo-Jack, MD, DSc

Division of Endocrinology, Diabetes and MetabolismUniversity of Tennessee Health Science Center

920 Madison AvenueMemphis, Tennessee, USATelephone: +901-448-5318

Email: Email:[email protected] iD:https//orcid.org/0000-0001-5318-9677

Invited Review Article: MANAGEMENT OF DIABETES IN ENVIRONMENTS

mailto:[email protected]

promising option to reverse the current trend in developing nations. In the absence of advanced cardiovascular and renal care, prevention of complications by use of anti-hyperglycemic agents that have been proven to reduce the incidence of cardiovascular and renal sequalaeshould be pursued vigorously.

Page 8

1. Introductionhe International Diabetes Federation (IDF) Tcurrently estimates that 4.7% (19.4 million)

adults have diabetes in sub-Saharan Africa. This number is projected to rise by 143% to 47.1

1million, a prevalence rate of 5.2% in 2045 . Nigeria has about 2.7 million people living with

10diabetes, with estimated prevalence rate

sessions/week of resistance exercise on nonconsecutive days and reduction in sedentary behavior (prolonged sitting should be interrupted every 30 min for blood glucose

4benefits) .

Diabetes care exposes patients and their families to significant psychosocial burden. A patient-centered psychosocial care should be integrated into the management plan.Psychosocial interventions have been shown to improve

18HbA1c and health outcomes .

3. Blood Glucose MonitoringSelf-monitoring of blood glucose (SMBG) is useful in evaluating the response to therapy, it is p a r t i c u l a r l y i m p o r t a n t i n a s s e s s i n g hypoglycemia. The frequency and timing of SMBG or the use of continuous glucose monitoring (CGM)should be guided by the needs and goals of the patient. The ADA recommends that patients treated with multiple daily injections or insulin pump therapy perform SMBG prior to meals and snacks, at bedtime, prior to exercise, when they have symptoms of hypoglycemia and after treating hypoglycemia and prior to and while

19performing critical tasks such as driving .The evidence regarding SMBG in patientswith T2DM is equivocal; for patients using basal insulin, assessing fasting glucose to guide dose

20adjustments lowered HbA1C . In patients with T2DMwho are not treated with insulin, SMBG could be used to assess glucose levels during intercurrent illness, or when HbA1c may be unreliable. Substances like ascorbic acid, paracetamol, xylose, galactose and temperature excursion could interfere with glucose

21monitoring systems . The ADA recommends fasting capillary glucose target of 4.4–7.2 mmol/L and peak postprandial capillary glucose (1–2 h after the beginning of the

2 2meal)

Good glycemic control is unequivocally associated with lower incidence and progression of microvascular disease in both

29,30 31-33T1DM and T2DM . Additionally, r a n d o m i z e d c o n t r o l l e d t r i a l s h a v e demonstrated that lower HbA1creduces the incidence of microvascular complications and cardiovascular disease (CVD) or cardiovascular

34-36riskin patients with T2DM . CVDincluding coronary artery disease, myocardial infarction, heart failure and stoke is theleading cause of death in patients with diabetes. A meta-analysis of 13 prospective studies showed that for every 1 percentage point increase in HbA1c, the relative risk for any cardiovascular event was 1.18 (95% CI 1.10-1.26) (5,37). Individuals with diabetes have twice the risk of acute ischemic

3 8stroke compared to healthy subjects . Fortunately, intensive glycemic control has

39demonstrated cardiovascular and mortality

40benefit in subjects with T1DM.

Amongst individuals with T2DM, the UKPDS demonstrated a significant reduction in myocardial infarction and all-cause mortality in subjects randomized to the intensive treatment

33arm. . However, other CVOT including ACCORD, ADVANCE, and VADT showed no significant reduction in cardiovascular events

4 1with intensive glycemic control . The ACCORD trial was discontinued earlier than scheduled due to increased rate of mortality

41,42and hypoglycemia in the intensive arm . Therefore, it would be prudent to pursue a near-normal HbA1c level in high risk patients with caution. Diabetes Mellitus Foot syndrome is a common complication and the leading cause of major limb amputation in Nigeria and other countries in Africa. Factors contributing to diabetes foot syndrome include poor glycemic control, poor access to care, and late

43-45presentation .

4. Type 1 Diabetes (T1DM)

Although, the focus of this review is T2DM, it would be imperative to highlight the challenges confronting patients with T1DM in populations with limited resources. Intensive insulin therapy in the DCCT reduced the incidence of microvascular and macrovascular diabetic

29complications . However, in resource poor environments, intensive insulin regimen may be hampered by scarcity and cost of insulin and difficulty with preservation due to power

46outages . Surgical treatment for T1DM such as pancreas and islet transplantation are not available, hence optimum insulin therapy remains the only option for patients with T1DM in populations with lean healthcare budgets.

5. Pharmacologic Therapy for T2DM (see table 1)The choice of anti-hyperglycemic agents should be guided by a patient-centered approach considering drug eff icacy, comorbid conditions, risk of hypoglycemia, side effects,

47-49cost and patient preferences . Metformin, if not contraindicated, remains the initial drug of choice for the treatment of T2DM. Metformin is effective, safe and affordable. Metformin would reduce risk of CVD and all-cause mortality

33especially in obese patients . Metformin is excreted unchanged by the kidney and lactic acidosis has been associated with renal failure. However, this complication is very rareand metformin may be used safely in patients with

2reduced eGFR≥30 mL/min/1.73 m ). Also, metformin has been associated with vitamin B 1 2 d e f i c i e n c y w h i c h c o u l d

50exacerbateperipheral neuropathy . A small randomized trial, which investigated the use of glipizide alone versus glipizide plus insulin glargine in patients with severe hyperglycemia in the emergency room showed that a sulfonylurea may be an effective monotherapy. Considering that sulfonylureas are relatively cheap, they may be a viable alternative to

NIGER DELTA MEDICAL JOURNALInvited Review Article: MANAGEMENT OF DIABETES IN ENVIRONMENTS

Nig Del Med J 2020; 4(3): 7-20

51metformin .

If glycemic control is not attained after 3 months, metformin should be combined with another agent: sulfonylurea, thiazolidinedione, DPP-4 inhibitor, SGLT2 inhibitor, GLP-1RA, or basal insulin. In patients with HbA1c ≥9.0%, a combination therapy could be usedat the

48initiation of therapy . Insulin should be considered as part of the regimen in patients with severe hyperglycemia (blood glucose ≥ 1 6 . 7 m m o l / L o r H b A 1 c > 1 0 % a n d

48hypertriglyceridemia . Patients who require insulin initially, including those who present with diabetic ketoacidosis may be well controlled on oral agents aloneafter resolution

52of severehyperglycemia . Many patients with T2DM will eventually require a more potent form of therapy such as insulin or GLP-1RA. NPH would be a cheaper alternative to a long acting insulin analogue and GLP-1RA. For patients with limited resources, human insulins (regular insulin, NPH, and insulin 70/30) may be an appropriate choice of therapy. Patients with T2DM have insulin resistance, have lower rates of hypoglycemia and may require ~0.8-1 unit of insulin/kg, dose adjustment should be guided by SMBG or HbA1c.

Management of CVD

CVD is prevalent amongst patients with 53,54

dysglycemia in Nigeria . Stroke is the

predominant CVD in Nigeria, but the incidence 43,55of coronary artery disease is on the rise . Heart

failureis also common. In patients with CVD, a

blood pressure (BP) target of 5.7-11.4 mmol/L after

lifestyle modification and glycemic control

should be treated with a fibrate to prevent acute 5 8p a n c r e a t i t i s . L o w - d o s e a s p i r i n i s

recommended for secondary prevention in 56

patients with established CVD , primary

prevention with an anti-platelet agent may be

considered in patients at high risk for CVD (57).

Cardiovascular Outcomes Trials (CVOTs)Randomized controlled trials have reported significant reductions in cardiovascular events in patients with T2DM treated with either SGLT2 inhibitors or GLP-1RAs. TheSGLT2 inhibitors empagliflozin, canagliflozin and d a p a g l i f l o z i n c o m p a r e d t o p l a c e b o reducedmajor cardiovascular events and

5 9 - 6 2hospita l izat ion for heart fa i lure . Ertugliflozin improvedHbA1c, BP and body

63weight . Up to 50% of patients with


Nig Del Med J 2020; 4(3): 7-20

64T2DM may develop heart failure ; thus, the role of these agents in patients with CV risk factors i n e n v i r o n m e n t s w h e r e a d v a n c e d cardiovascular and renal care are lacking deserves further study. Thiazolidinediones and the DPP-4 inhibitor saxagliptin increased the

65risk of heart failure . The CVOTs recruited very low numbers of Africans, which raises the questions of generalizability of their findings. The SGLT2 inhibitors are associated with increased incidence of diabetic ketoacidosis and fracture. Diabetes foot gangrene and lower limb amputations remain serious problems in resource poor populations, given the controversial signal of amputation, Fournier's gangrene and fracture risks associated with SGLT2 inhibitors, there is need for local safety data in Africans before large scale exposure to this class of compounds. Also, the GLP-1 RAs liraglutide, albiglutide, semaglutide, and dulaglutide reducedmajor cardiovsaculer events in patients with T2DM and established

66-69CVD or at high risk for CVD .

Renal Outcome TrialsDiabetic nephropathy occurs in up to 40% of patients with diabetes and may be present at

70diagnosis of T2DM . Diabetic kidney disease (DKD)is a leading cause of ESRD(71) and a major driver of CV mortality and health care

7 2costs . Renal replacement therapy is unavailable in many communities with limited

73resources . Therefore, primary prevention of diabetic nephropathy should be pursued vigorously. The recommendation of the ADA is

70helpful in this regard . Random urinary albumin-to-creatinine ratio and eGFR should be assessed annually. Patients with microalbuminuria (urinary albumin >30 mg/g creatinine) and/or an eGFR

p r e d i a b e t e s s c r e e n i n g a n d intervention.National organizations such as the Diabetes Association of Nigeria (DAN)can play a role through advocacy and clinical guidelines, which arederivedfrom local research, economic realities and custom.Fewer than 10% of Nigerian patients have third party health

80insurance coverage . Diabetes is a chronic disease with enormous financial burden;hence affordable health insurance is desirable.

Secondary preventionLess than a third of patients attain recommended glycemic targets and mean

81HbA1c is commonly above 8% . Factors contributing to suboptimal control include low awareness of diabetes as a chronic condition, difficulty with affording medications, limited access to diabetes technologies and low socio- economic status. The SGLT2 inhibitors and GLP-1 Ras are expensive but they reduce the incidence of CVD and nephropathy. Thus, efforts directed at making these agents available and affordable would be worthwhile. The role of government, nongovernmental organizations and the pharmaceutical industry would be critical in this regard. Diabetic foot syndrome is a leading cause of limb amputation

43,44,45in Nigeria . Foot examination should be performed at every visit, using 5.07 monofilament to screen for neuropathy. Patients should be screened for macrovascular disease, keeping in mind that atypical presentation could occur. Hyperglycemic emergencies, diabetic foot syndrome and stroke account for most of the mortality in patients

82,83with diabetes . Also, infections such as sepsis and tuberculosis contribute to morbidity and

84mortality . Diabetes is common amongst pat ients t reated for HIV/AIDS and antiretroviral agents are associated with

85 ..increased the risk of dysglycemia .

7. Doing More with LessDiabetes is the leading cause of blindness,

Page 13

amputation, kidney failure, CVD and stroke. More than 60% of people with diabetes also harbor hypertension and or dyslipidemia. The costs associated with managing established diabetes are prohibitive. The sheer magnitude of the current and projected escalation of the diabetes epidemic in SSA mandates innovative and broad interventions at the community level.

Nigeria and other SSA countries lack adequate resources for managing diabetes: there is little or no local capability for manufacturing drugs, testing reagents, glucose monitoring equipment or relevant technologies. Clinical resources for treating diabetes complications (laser surgery, dialysis, organ transplantation, orthotics, rehabilitation and occupational therapy, cardiac revascularization, etc.) are equally scarce. A comprehensive approach to mitigation of these deficiencies must involve a publ ic -pr ivate commitment to loca l manufacturing, capacity-building, and the transfer/acquisition of technologyin critical areas across the health care industry. Although Nigeria is blessed with abundant trained experts, the same cannot be said for several SSA countries. Even within Nigeria, there is maldistribution of expertise and a shortage of certain components of the multi disciplinary team required for optimal diabetes care. Thus, attention to targeted training and strengthening of the human capital should be part of the strategy.

Strategies for doing more with lessFigure 2 summarizes some approaches to diabetes care in environments with limited resources. A proper emphasis is placed on non-pharmacological interventions, as effective dietary modification and physical activity would have drug-sparing effects and allow improved diabetes care without escalating the number of medications. Given the constraints associated with HbA1c testing and limited


Nig Del Med J 2020; 4(3): 7-20

access to meters and test strips for self-monitoring of blood glucose, we advocate that clinicians negotiate with patients to agree on an optimal frequency of HbA1c testing and SBMG. Perhaps, it would be better to have annual HbA1c information versus none and two SMBG results staggered across each week versus no information. Agreed, these are sub-optimal testing frequencies than are recommended by international guidelines. Other adaptations include a preference for generic rather than branded medications, use of discount vouchers and medication samples (where available), and enrolling diabetes patients in ethics board-approved clinical trials that often provide free medications and testing supplies.

8. ConclusionCountries in Africa are projected to suffer disproportionately from future diabetes burden. The limited resources for managing diabetes in SSA and the increased risks of complications of poorly controlled diabetes create an enormous public health problem. Stretching the scarce resources mandates creative approaches that maximize the value of non-pharmacological lifestyle modification along with judicious use of low-cost generic medications. Some of the newer agents (e.g., SGLT2 inhibitors and GLP-1Ras) confer cardioprotective and renoprotective benefits that are desirable for patients in SSA. Healthcare financing mechanisms that ensure access to these agents in high-risk diabetes patients should be cost effective if these medications prevent or delay the occurrence of end-stage kidney disease and heart failure. Ultimately, primary prevention holds the greatest promise for reducing human suffering and costs associated with diabetes.

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LEVEL OF KNOWLEDGE, PRACTICE OF PRECONCEPTION CARE AND BARRIERS TO ITS UTILIZATION AMONG HEALTH CARE PROVIDERS

IN SOUTH EAST NIGERIA.

AbstractBackground: Preconception care (PCC) practice found globally to improve maternal/perinatal outcome has remained poor in developing countries.

Objectives: To assess the level of knowledge and practice of PCC as well as barriers to its utilization among health workers in a tertiary hospital in south-east Nigeria.

Methods: This cross-sectional survey obtained information on socio-demographic characteristics, knowledge, practice and perceived barrier to PCC among doctors and nurses of Obstetrics and Gynecology (OBGY) and Family Medicine (FM) departments of the study center over a three-month period.

Results: Of the 151 respondents, most (70.2%) of them were doctors and those from OBGY were in the majority (68.2%). Most (85.4%) of respondents had heard of PCC and are knowledgeable (73.5%) about the concept with sixty-three (41.7%) and twenty-six (41.3%) practicing some and all the components of PCC respectively. Younger age group and recently trained health professional were significant determinants of awareness, practice and satisfactory practice of PCC (P=

NIGER DELTA MEDICAL JOURNALLEVEL OF KNOWLEDGE, PRACTICE OF PRECONCEPTION...

Introductionaternal and perinatal morbidity and Mmortality is still alarming in the

1developing parts of the world. The reasons for this include high rates of unplanned pregnancies, high parity, poor health seeking

2behavior and low level of maternal health care. These preventable causes can be addressed by

3, 4ensuring comprehensive obstetric care of which preconception and antenatal care are

5components. Antenatal care alone may not be enough to solve the maternal and perinatal mortality burden owing to the fact that some pregnancy complications arise as a result of

5events and lifestyles that precede pregnancy. It is very important therefore to identify, modify or avoid those events and lifestyles that may be hindrances to good obstetric outcomes.

Preconception care (PCC) is a preventive strategy that improves obstetric outcomes by identifying and modifying biomedical,

6, 7behavioral and social risks to women's health. Earlier concept of PCC involved only women with chronic medical conditions and poor

5obstetric history. However, PCC is for every couple because of the possibility of having one r i s k f a c t o r f o r a d v e r s e p r e g n a n c y

5outcome. Several preconception care models 8, 9, 10have been developed. The American

Academy of Pediatrics and the American College of Obstetricians and Gynecologists classify the main components of preconception care into four categories: physical assessment,

11risk screening, vaccinations, and counseling. Some documented specific components include folic acid and vitamins supplementation; cessation of tobacco, alcohol and other harmful drugs to fetus; weight, blood pressure, glycaemic

5, 12, 13and other chronic illness control.

The documented benefits of PCC are very glaring in developed countries where it is

14, 15effectively being implemented. Studies amongst health care providers in such

developed countries showed good knowledge 14, 15

and practice of PCC. PCC practice in developing countries including Nigeria is only partially implemented and almost none existent in greater parts. In a study among health workers in Zaria, Northern Nigeria, majority of them were reported to have a good knowledge of PCC but only a few of them offered some form

2of PCC, with only folic acid supplementation being the commonly practiced.

3, 5, Most of the other studies on PCC from Nigeria 16 explored knowledge and practice of PCC from the perspective of the clients and the findings indicated that their knowledge and practice of PCC was very poor. The questions then are why the poor knowledge? Are there adequate health education of the clients on PCC and its benefits? What of the knowledge base of the health educators who are supposed to carry out the PCC awareness campaign? Are the PCC clinics available and functional? These and many more formed the basis for this study.

The study is therefore aimed at determining the level of awareness, knowledge and practice of PCC among health care providers in Enugu, south east Nigeria. It also evaluated the barriers militating against effective PCC services. Information from this research will help policy makers in developing a sustainable frame work in the establishment of efficient and effective preconception care services in Enugu and the entire South-east Nigeria.

Subject and MethodsThis was a cross-sectional study of all the consultants, resident doctors and nurses of the Obstetrics and Gynaecology (OBGY) and Family Medicine (FM) Departments of a Teaching Hospital in South east Nigeria. The hospital is the pioneer Teaching Hospital, in South east Nigeria, that offers both primary and specialized health services for the people of Enugu State and its environment. The centre has a General out Patients Department (GOPD)

Nig Del Med J 2020; 4(3): 21-28


which serves as the first point of consult for every patient presenting to the hospital and is run by the family medicine physicians and an Obstetrics and Gynaecology Unit that has an antenatal clinic and other women centred clinics (family planning, gynaecology clinic). Both departments run clinics every weekday.

The total number of doctors and nurses in the two departments were obtained from the office of the heads of department and was 171. Intern doctors and four consultants on leave of absence were excluded from the study. The number of included doctors in the Department of Obstetrics and Gynecology was 79 while the nurses were 28. The number of doctors at the Family Medicine department was 38 while nurses in the same department were 22. The overall number of included participants was 167. Pretested, semi-structured self-administered question-naires were distributed consecutively to all consenting participants between November 2018 and January 2019,following approval from the Ethics committee of the hospital (Reference number: N H R E C / 0 5 / 0 1 / 2 0 0 8 B - F W A 0 0 0 0 2 4 5 8 -

t h1RB00002323, dated 29 October 2018). Information obtained were age, sex, marital status, occupation, department of practice and number of years of practice. Information was also obtained on awareness, knowledge, practice and perceived barriers to practice of PCC. For the purpose of this study, participants were termed to have 'good knowledge of PCC' if they knew three or more of the four components of PCC: folic acid and other vitamins supplementation; cessation of tobacco usage, alcohol and other harmful drugs to fetus; weight, blood pressure, glycaemic and other chronic illness control; vaccination, screening of and treatment of

12infections that may affect a fetus adversely, 'Poor knowledge of PCC' was regarded as participants with less than or equal to two of the above four components, while 'no knowledge of PCC' was regarded as not knowing any of the four components. Satisfactory practice was regarded as provision of the four components of PCC, while unsatisfactory practice was regarded as provision of less than the four components.

Data collected was keyed into the statistical

package for social sciences (SPSS) computer software version 20 for windows. Continuous variables were analyzed using the mean + SD. Relationships were expressed using odd ratio at 95% confidence interval. P value of


Sources of information for the one hundred and thirty-eight respondents with knowledge of PCC were formal training (34.8%), text book/journal (62.9%) and media health promotion (2.9%). The barriers to offering PCC identified by the respondents are lack of PCC clinic (58.9%), lack of knowledge of PCC among health workers (25.2%) and ignorance on concept of PCC by patients (15.9%).

DiscussionThis present study showed a high level of awareness and knowledge of PCC but the practice was abysmally low with only a few components of PCC being practiced by the respondents. This is similar to the findings from

2the study in Zaria, Northern Nigeria where only 33% of the respondent practice PCC in the form of folic acid supplementation. The reason for this poor practice may be attributed majorly to lack of designated PCC clinics, as evident from this study as well as low level of awareness by women and absence of evidence-based guidelines to improve uptake and pregnancy

5outcome,

The present study showed that more than half of the health care providers have not had formal training on PCC, emphasizing the need for increase in formal training programs in PCC for this group of workers. Younger practitioners with less than 10 years of practice had higher knowledge of PCC probably be due to the fact that PCC is relatively a new health concept and probably is been emphasized more in current educational curriculum and during health promotional programs.

In this study respondents working in the Department of Obstetrics and Gynaecology did not significantly practiced PCC more than their c o u n t e r p a r t i n F a m i l y M e d i c i n e department.This could be due to the fact that majority of the participants from Family medicine department in the present study were

within the younger age group (70.8%)and also most of the had practiced for less than 10 years (64.6%). Family Medicine Department is the first point of contact for every patient presenting to a teaching hospital and as such, the best point for education and initiation of PCC to all patients. This further emphasizes the need for training and continued education of all health care providers on PCC to ensure contact counseling of women of reproductive age on various aspect of PCC.

The barriers to the practice of PCC identified in this study were majorly lack of preconception care clinics, lack of knowledge of all components of PCC among health care providers, absence of retraining programs for health care provider on PCC and ignorance of PCC among patients. In a similar study from south-east Nigeria which evaluated PCC from the patients' perspective, poor uptake of PCC was influenced by patients' level of education, place of residence and information from health

5care providers,

The cross-sectional design of the study may not fully explain the temporal relationships between the outcome variable and certain explanatory variables and furthermore the findings cannot be generalized for the entire sub region. Despite these limitations, the findings will contribute to understanding of factors associated with limited PCC in the study area.

In conclusion, there is need for training and re-training of health workers on the principles and practice of PCC, awareness campaign to educate the populace on benefits of PCC and establishment of PCC clinic in every hospital setting. These will no doubt enhance the practice of PCC in Nigeria and will positively impact on the maternal and perinatal morbidity and mortality in Nigeria and other developing countries.

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Table 1: Sociodemographic Characteristics of participants

Characteristics Frequency n = 151

Percentage (%) 100%

Age Category(Years) 20-29 30-39

40-49 50-59 >60

15 74 46

14 2

9.9 49.0 30.5

9.3 1.3

Sex Male

Female

89

62

58.9

41.1

Tribe Igbo

Hausa Yoruba

Others

148

0 1 2

98

0.0 0.7 1.3

Marital status Single

Married Widowed

Separated

31 120 0 0

20.5 79.5 0.0 0.0

Occupation Doctors

Nurses

106 45

70.2 29.8

Department Obstet. and Gynae Family Medicine

103 48

68.2 31.8

Years of experience 0-5

6-10 11-15 >15

20 52

47 32

13.2 34.4

31.1 21.2

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Table 2: Distribution of characteristics amongst participants

Characteristics Occupation Doctors Nurses n(%) n(%) P value 106(100.0%) 45(100.0%)

Age(years) 40

63(59.4%) 43(40.6%)

26(57.8%) 19(42.2%)

0.858

Department OBGY

Family Med.

77(72.6%) 29(27.4%)

26(57.8%) 19(42.2%)

0.087

Years of practice 10

50(47.2%) 56(52.8%)

22(48.9%) 23(51.1%)

0.861

Table 3: Predictors of awareness, knowledge and Practice of PCC3a: Awareness

Characteristics Awareness Yes No n(%) n(%) P value OR 95% CI

Age(years) 40

88(68.2%) 41(31.8%)

1(4.5%) 21(95.5%)

0.003

25.79

2.93-226.87

Department OBGY Family Med.

87(67.4%)

42(32.6%)

16(72.7%)

6(27.3%)

0.056

5.72

0.95-

34.34

Duration of practice 10

78(60.5%) 51(39.5%)

2(9.1%) 20(28.2%)

0.021

12.74

1.46-111.21

Occupation Doctor Nurses

91(70.5%) 38(29.5%)

15(68.2%) 7(31.8%)

0.823

1.12

0.42-2.96

OR = Odds ratio; CI = Confidence interval

Nig Del Med J 2020; 4(3): 21-28


3b: Knowledge

Characteristics Knowledge Good Poor n(%) n(%) P value OR 95% CI

Age(years) 40

77(69.4%) 34(30.6%)

12(30.0%) 28(70%)

0.013

3.48

1.30-9.31


80(72.1%) 31(27.9%)

23(57.5%) 17(42.5%)

0.001

9.86

2.59-37.60

Duration of practice 10

69(62.2%) 42(37.8%)

11(27.5%) 29(72.5%)

0.003

8.25

2.05-33.22

Occupation Doctor Nurses

81(73.0%) 30(27.0%)

25(62.5%) 15(37.5%)

0.216

1.62

0.75-3.48

OR = Odds ratio; CI = Confidence interval

3c: Practice

Characteristics Practice Satisfactory Unsatisfactory n(%) n(%) P value OR 95% CI

Age(years) 40

39(60.9%) 25(39.1%)

50(57.5%) 37(42.5%)

0.814

1.00

0.34-2.93


32(50.0%) 32(50.0%)

71(81.6%) 16(18.4%)

Nig Del Med J 2020; 4(3): 29-31 Page 29


Dear Fellow.One or more of the Colleges set up for the purposes in Nigeria and West Africa has now conferred on you its Fellowship in one or more of the branches of Clinical and or Laboratory Medicine following your successful completion of prescribed training modules and success at specified examinations. This validation confirms that you may practise as a consultant in that branch of medicine and also hold university academic appointments up to all levels where you will also be expected to carry out research and render services to the community. Should you elect to pursue an academic career, in the responsibility of offering services to the community outside those of teaching and research, it will be expected of you to add value in diverse ways to human societies and to advance the course of humanity, using the knowledge and skills you have acquired. Here, you are more likely to be successful if you have also acquired some character traits of decency, integrity, hard work and those positive values that enhance human relationship.

Preferred Attributes A Fellowship holder should be measured and temperate and in addition, exercise self-discipline and moderation in all that he or she does. For instance, should he or she elect to take alcohol, it should be in done in moderation and he or she

should not be drunk under any circumstance. Furthermore, conversant with the deleterious effects of cigarette smoking on humans, smoking

should be a taboo to such a person. Dressing should be elegant and simple and not shabby, ostentatious, seductive, or explicit. Fear of God, humility, respect and consideration for others, punctuality and trustworthiness are some other positive attributes Fellowship holders should cultivate. The homes of such persons should be tranquil and fights between spouses should be avoided.

These virtuous qualities will not only enable Fellowship holders to live respectable lives, they will also assist them to deliver services that are appropriate within the university, at the home environment, within their states, in their countries of origin and beyond. I will expatiate on services in each of these communities, drawing parallels from the services that I have rendered in my 45 years of academic and professional career.

Services to Your University CommunityOutside the academic ranks of lecturer 1 to professorship, academic staff have the opportunity of serving the university community through membership of many committees, headship of departments, deanship of faculties or provostship of Colleges, vice chancellorship of universities, pro-chancellorship and chairmanship or membership of governing councils of various universities in addition to offering professional services such as in medical careI have been fortunate to have held all those positions in the Nigerian University System (NUS) at one time or the other. Integrity, transparency, and hard work are crucial as it is these

REFLECTIONS: CHARACTER AND RESPONSIBILITY...

GSM: +234 803 322 9388

Email: [email protected]

REFLECTIONS:CHARACTER AND RESPONSIBILITY OF A FELLOWSHIP

HOLDER IN COMMUNITY SERVICE ACTIVITIES; ADAPTED FROM A TRAINING PROGRAMME FACILITATED BY ME IN JUNE 2020

AT THE LAGOS STATE UNIVERSITY

Emeritus Professor Nimi D Briggs, OON, MD, FRCOG, HLR.Department of Obstetrics & Gynaecology,

Faculty of Clinical Sciences,College of Health Sciences,

University of Port Harcourt,Port Harcourt, Nigeria

NIGER DELTA MEDICAL JOURNALREFLECTIONS: CHARACTER AND RESPONSIBILITY...

elements that would enable your colleagues to elect you to those positions that are normally filled through balloting. Once elected, you should justify the confidence placed in you by, as much as possible doing only those things that are edifying and would promote the overall interest of the institution.

As head of Department, the sanctity of semester and degree examinations should not be compromised in any way. You should lead by examples as the Dean of the Faculty or Provost of the College and work hard and be humble as the vice-chancellor of the institution. As much as possible be punctual to scheduled events and read your minutes and other documents before attending meetings which you haveto chair or participate in. As much as lies within your power, take prompt and appropriate actions on all issues including responding to official mails especially those that bother on the welfare of staff and students. Always remind yourself that power is ephemeral and that you would leave the seat you occupy someday. So, seek to do your best to leave a good legacy.

As Pro-chancellor and chairman of council be amiable but strict and hold the vice-chancellor and administration to account as may be appropriate. But do not constitute yourself or the council which you chair into a parallel government to run side by side that of the university because it is the vice-chancellor and not you as Pro-chancellor, that has the mandate to run the day-to-day affairs of the university.

Services to Your HometownIf, like me, you are fortunate to have the location of your primary place of assignment close to your hometown, your home community may expect you to be involved in their affairs to some extent and to render some community services, particularly if they consider you to be a person of

integrity and good character. You should not shy away completely from such services especiallywhen they are designed to improve the quality of life of people in those communities. Your Fellowship qualification is not meant for you to deride and feel ashamed of your people and their customs. Rather,

it should encourage you to mingle with them and let them benefit from the knowledge and skills you have acquired. You may be invited to deliver talks to enlighten the community on issues of current affairs or help raise funds for good causes such as scholarships, environmental sanitation, and health matters. Since I transferred my services from the Ahmadu Bello University, Zaria to the University of Port Harcourt in 1980, I have lived in Port Harcourt which is about 45 minutes' drive to my home town, Abonnema, once a thriving seaport, on the estuary of the Sombriero River in Akukutoru Local Government Area of Rivers State in Nigeria. I have delivered keynote addresses on important occasions and chaired rallies for fund raising.

When in your home community, show respect to all especially those that are older. As much as possible, speak the local language and dress like those at home. Eat the local food and when you can afford it, put up a modest residential accommodation to enable you spend time at home in your community.

Services to Your State of OriginAs stated earlier, I have lived in Port Harcourt, which is the capital of my home state – the Rivers State of Nigeria since 1980. Over these past forty years, I have had the privilege of being invited by the State Government to serve in several important capacities, while still in the university as a university teacher. I could not honour all the invitations for personal reasons, but I accepted and served in a few important ones.

Academics serving in state governments not uncommonly encounter difficulties because scandals occur from to time especially where governments feel that the actions of their appointees are not in sync with government's political aspirations. Therefore, academics who undertake to serve in state governments should do so with caution and should as much as possible, refrain from political alignments, unless of course they intend to go fully into politics. They should exhibit a high index of probity and accountability and should keep records of what they do, especially, financial transactions.

Nig Del Med J 2020; 4(3): 29-31

NIGER DELTA MEDICAL JOURNALREFLECTIONS: CHARACTER AND RESPONSIBILITY...

Services to the CountryAgain, I have had several opportunities to serve my country in different capacities, outside my responsibilities of teaching and conducting research in the university. I have served as the Secretary General of the Society of Gynaecology and Obstetrics of Nigeria (SOGON), an umbrella organisation of obstetricians and gynaecologist, committed to the pursuits of the rights of women to achieve the highest possible standards of health, including sexual and reproductive health. I led the Association of vice-chancellors of all Nigerian universities as well as those of the federal government in addition to representing Nigeria on the council of vice-chancellors of Commonwealth Universities. Furthermore, I have delivered convocation lectures to several universities and served as pro-chancellor and chairman of council of two universities in addition to serving as the chairman of the Boards of the National Hospital Abuja and the University of Benin Teaching

thHospital, Benincity. I delivered the 20 Sir Samuel Manuwa Memorial Lecture of the West African

thCollege of Surgeons and the 50 Anniversary Lecture of the National Postgraduate Medical College of Nigeria. I am currently a member of Strategy Advisory Committee (STRADVCOM), an advisory body to the National Universities Commission.

When you are called upon to serve in such responsible positions in the future, people will expect you to be knowledgeable, reliable and trustworthy and they will only continue to call on you to serve if they feel you would always meet these criteria.

Services at the Global StageI am a member of council of the West African College of Surgeons and the chairman of its endowment as well as the fund-raising committees. I have reviewed articles for publication for the Lancet and have served as member of the board of the Annals of Tropical Medicine and Parasitology of the Liverpool School of Tropical Medicine.

SummaryAs you commence your career following your most deserved admission into Fellowship, your experiences will differ. You will receive congratulations on the hard work you have done over these many years that have brought you into your present position. Your attention will also be drawn to the fact that to whom much is given, much is also required. So, society at all levels will expect you to be exemplary in all you do. Many would advise that you continue to work hard and build a character that will make you responsible, respectable and trustworthy as these elements will enable you to leverage on the Fellowship that that has been conferred on you. Your attention will be drawn to the fact that integrity is key in the journey of life you are about to embark upon. To put it succinctly, if you stop for one moment and consider the amount of hard work and tenacity of purpose that many Fellowship holders have shown in their careers you will realise the value of integrity, trustworthiness and predictability. If you aspire to and embrace these attributes, the Fellowship will never pull you down. Rather, it will serve as a springboard from which you will leap into a successful and fulfilled life.

Nig Del Med J 2020; 4(3): 29-31

Nig Del Med J 2020; 4(3): 32-42 Page 32


PRE-FACILITY MANAGEMENT OF CHILDHOOD ILLNESSES: THE EXPERIENCE IN ALIMOSHO LOCAL GOVERNMENT

AREA OF LAGOS STATE, NIGERIA

1,3 2 3 3Edem S. Duke , Beatrice N. Ezenwa , AleroA. Roberts , Efiong E. Ekanem.

Institutional affiliation of authors:1 Department of Pediatrics, Alimosho General

Hospital Igondo, Lagos, Nigeria.

2 Department of Pediatrics, College of Medicine

University of Lagos, Lagos, Nigeria

3 Department of Community Health and Primary Care,

College of Medicine University of Lagos, Lagos, Nigeria.

Corresponding author:Dr Beatrice N Ezenwa.

Department of Pediatrics, College of Medicine of the

ORCID ID: https//orcid.org/0000-0001-7437-3211GSM: +2348051403189

University of Lagos, Lagos, NigeriaEmail: [email protected]

AbstractBackground: The health of children is a global priority, linked to the care given in illness. Prompt and early care must start at home to avert death. There are limited studies on pre-facility management practices of childhood illnesses by care-givers in Nigeria.

Objective: To assess the pre-facility treatment practices employed by mothers in response to common childhood illnesses in under-five children in Alimosho Local Government Area(LGA) of Lagos State, Nigeria.

Methods: This was a descriptive cross-sectional study carried out among 360 mothers of Under-five children in Alimosho LGA between March and May 2016. The respondents were selected using multi-stage sampling method. Structured interviewer-administered questionnaires were used for data collection. SPSS version 20.0 was used for data analysis and presented as frequencies and means; bivariate analysis was used to determine significant associations.

Results: The mean maternal age was 32.69 ± 6.46 years. Only 36.7% of the mothers attained tertiary education. Majority of the respondents carried out appropriate practices concerning fever 222 (74.2%), diarrhea 176 (63.8%) and vomiting 138 (52.9%) while 102 (39.5%) of the mothers employed inappropriate actions in response to convulsion. Majority of the respondents had a positive attitude towards childhood illnesses 195 (54.2%) versus 165 (45.8%). There was a statistically significant association between respondents' level of education and attitude with good health-seeking behavior in 335 (93%) of them.

Conclusion: This study demonstrates that most mothers portrayed appropriate home management practices concerning some childhood illnesses with positive attitude and good health-seeking behavior.

KEYWORDS: Home treatment practices, Mothers, Under-five children, Nigeria

PRE-FACILITY MANAGEMENT OF CHILDHOOD...

Introductionhe health of children is a priority expressed Tby most countries in the world and it is

closely linked to the care given by their mothers . Lack of, or poor quality of care has its 1

effect on children. Early and appropriate care for sick children starting from the home averts death . Parents and caregivers are encouraged 2

to initiate some basic management at home before seeking health facility care. Pre-facility management of illnesses denotes appropriate first basic treatment given to an ill child at home before referral to a health facility . Although the 3

under-five mortality rate globally is declining from 93 deaths per 1000 live births in 1990 to 39 deaths per 1000 live births in 2018, the Sub-Saharan African region is still lagging . Of the

4

5.3 million children under the age of five years that died worldwide in 2018, roughly 50% occurred in sub-Saharan Africa, making it one out of every 13 children in sub-Saharan Africa died before seeking health care services at the health facility and before reaching their fifth birthday . A study in Rwanda noted that 22.7% 5 6

of children under-five that died did not seek care in any health facility. In Nigeria, the under-five mortality rate was evaluated at 119.9 per 1000 live births in 2018. It was estimated that

7

more than 700,000 Nigerian children died before attaining their fifth birthday equivalent to losing 2000 children daily . About 60 percent

8

of these deaths had been attributed to malaria (20%) pneumonia (17%), prematurity (12%) and d i a r r h o e a ( 1 1 % ) w h i c h w e r e a l l

9

preventable .In Lagos Nigeria, a study 10

reported that the most common killers of the under-five children were bronchopneumonia, sepsis, anaemia and malaria . Pneumonia, 11

diarrhoea and malaria together were the cause of 3 out of every 10 child deaths before the age of five, and nearly half of under-five deaths globally were associated with an underlying malnutrition . 12

The World Health Organization (WHO)

estimates that prompt and appropriate care by mothers and caregivers could reduce child death by 20% .Through the community 13

integrated management of childhood illnesses (IMCI), the WHO addressed behaviours that improve health outcome in childhood illnesses such as breastfeeding, complementary feeding, micronutrients supplementation, personal hygiene, immunization, continued feeding and increased feeding during illnesses, as well as home treatments of infections and compliance with health workers recommendations . The 14

IMCI strategy had 3 components which were: improvement of health workers' skills, improvement of the health system and improvement of the country and family practices towards health care . The third 15

component of IMCI addresses the household and community . It should be noted that many 16

sick children die in the community and most of the causes of ill-health can be prevented if countries and households observe some positive practices which may go a long way to reducing child mortalities .

16

Home management practices in children include, continuous feeding and offering more food and fluids when the child is sick, giving appropriate home treatment for illnesses, taking appropriate actions to prevent and manage injuries and accidents . According to

17

the community IMCI strategy, mothers at home should have the basic knowledge of treatment of common childhood illnesses such as diarrhoea and fever using appropriate remedies such as salt sugar solutions, breastmilk, and mild antipyretics . Several

18

studies had documented that mothers had little knowledge of illnesses and may engage in poor practices regarding childhood illnesses .

12

Mothers had also been shown to have varied approaches to home management of illnesses . In some studies that documented

19,20

the home management of fever, paracetamol, an antipyretic, was the most commonly

NIGER DELTA MEDICAL JOURNALPRE-FACILITY MANAGEMENT OF CHILDHOOD...

Nig Del Med J 2020; 4(3): 32-42

administered drug among respondents, but bathing and tepid sponging of febrile children were the predominant at-home practices for febrile episodes in children . ost studies on 19,20 Mthe management of childhood illnesses focus on children who present in health facilities. There is limited data on pre-facility management practices of childhood illnesses available on community-based studies in Nigeria. This study aims to report the pre-facility treatment practices employed by mothers in response to common childhood illnesses in under-five children in Alimosho Local Government area of Lagos, Nigeria

Materials and methodsThis was a community-based descriptive cross-sectional study carried out on 360 mothers with children under five years of age who reside in Alimosho LGA, Lagos State, Nigeria. Care-givers other than parents or mothers of under-fives who at the time of the study did not live in Alimosho were excluded from the study.Multistage sampling method was employed to select 360 mothers of under-five children who reside in Alimosho. The selection of Alimosho, the wards, streets and the participants were all achieved by balloting.The main outcome variable was to determine the proportion of mothers who had appropriate practices toward common childhood illnesses. A secondary outcome was to determine the attitude of mothers to appropriate health-seeking practices.

A standardized, structured, pretested, interviewer-administered questionnaires which was adapted f rom the IMCI questionnaire was used for data collection. The questionnaire had three sections: socio-demographic characteristics, perception and attitude towards childhood illnesses and home practices for common childhood illnesses presentat ions such as fever , cough, convulsions, vomiting, and diarrhoea. Six

research assistants who were Community health officers were recruited and trained for two days on administering the interview questionnaires. They assisted in the data collection.

For each of the questions on attitude, the responses were scored from 1 to 5 with higher scores for more favourable attitude towards correct responses to critical signs of illness. Questions regarding home care practices were c a t e g o r i z e d a s “ a p p r o p r i a t e ” o r “inappropriate” home care practices. For fever, “appropriate” home care was defined as bathing a febrile

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