Tertiary Hospital In Nigeria Research Articles

Operating Room Drugs and, Consumables Distribution Systems: Knowledge, Attitude and, Practice among Operating Room Workforce in a Tertiary Hospital in the Developing World

Drug and consumables distribution system in the operating room is key to the smooth running of the operating room in any hospital. Technological advancements have led to the development of newer and more efficient distribution systems. We aim to assess the knowledge, attitude and, practice of drug and consumable distribution systems among operating room workforce of a tertiary hospital in Nigeria. The study was a questionnaire-based cross-sectional study among the various categories of professionals of the operating room workforce. Two sets of questionnaires with structured questions on the knowledge, attitude and practice of operating room drug and consumables distribution system were administered one after the other on the operating room personnel. 282 of 363 operating room workforce consented and responded to the questionnaires. The workforce is made up of surgeons 198 (70%), physician anaesthetists 28 (10%), nurse anaesthetists 25 (9%) and, perioperative nurses 31 (11%). Their mean age was 42.61+8.74 years, 175 (64%) aged between 30 and 49 years with male to female ratio of 2.9:1. The majority 243 (86%) of respondents did not know the meaning of an operating room drug and consumable distribution system. After explanation, it was discovered that 228 (81%) had experienced the individual prescription order system with its associated wastages 195 (69%), medication errors 130 (46%,) and, delay or scheduling of cases 183 (65%). This study revealed poor knowledge of drug and consumables distribution system among operating room workforce in our institution. The study centre uses individual prescription order system with significant untoward effects. We recommend improved awareness of the theatre workforce on drug and consumable distribution systems.

Hydrocephalus Management Challenges in a Low-income Country

Hydrocephalus is a very common brain disorder affecting both children and adult populations. Its global burden has been well documented in the literature, and its management is not without challenges and complications, especially in low-income countries. This study aims at reviewing the management of hydrocephalus in a tertiary hospital in Nigeria and illustrating two cases managed with peculiar challenges. This study is a retrospective clinical review of 170 patients with hydrocephalus amenable to ventriculoperitoneal shunting as primary treatment. Two cases of hydrocephalus with peculiar management challenges were illustrated. The first case was that of an abandoned infant with hydrocephalus. The second case was that of a 5-year-old boy with post-meningitic hydrocephalus with delays in having cerebrospinal fluid (CSF) shunting. Majority of the patients with hydrocephalus were infants (71.2%), and the top two most common etiologies were aqueductal stenosis (64.7%) and post-meningitic hydrocephalus (11.2%), respectively. Shunt infection was the most common complication (9.4%), which was within the lower limit of rates reported in the literature (8.6%–50%). Approximately 84% of shunting had no complication. In conclusion, ventriculoperitoneal shunting is the preferred treatment option for hydrocephalus in low-income countries, and it is not without management challenges that are peculiar to these climes. Shunt infection appeared to be the most common complication.

Factors associated with participation in Research by Very Early Career Doctors in a Lower Middle-Income Country in Africa: A Multi-Centre Study

Background: Research is beneficial for the professional growth of a doctor, and forms the bedrock of evidence-based medical practice. Very Early Career Doctors (VECDs) face peculiar personal, work and time constraints which have the potential to affect their research performance. This study described the research engagement of VECDs in Nigeria and investigated its potential associations.Methods: A descriptive cross-sectional study from the quantitative research arm of the Challenges Among Residency Training and Early Career Doctors in Nigeria (CHARTING) Study was conducted between May and December, 2019. Data on socio-demographics, work-related practices, research engagement and training were collected and summarised using frequencies and proportions (categorical variables) and means and standard deviations (for normally distributed continuous variables). Chi-square analysis was used in determining associations between variables and research engagement outcomes; and potential predictors investigated using logistic regression. A p-value < 0.05 was considered significant.Results: A total of 476 VECDs from nine tertiary hospitals in Nigeria were recruited. They comprised of 305 (65.1%) males and 163 (34.9%) females with a mean age of 31.2 +/- 5.0 years. Three hundred and seventy-four (81.5%) and 187 (40.7%) respondents had participated in research and presented their research work, respectively. The proportion of respondents who received research grants, were first authors, and were involved in local & international publications were 8 (1.7%), 32 (6.9%), 42 (9.2%) and 37 (8.0%) respectively.Age ≤ 40 years (P=0.038), graduating within the last 5 years (P=0.016), ≤ 4 years on current job (P=0.001), working in a university affiliated centre (P=0.011), previous undergraduate research methodology training (P<0.0001), and agreeing with the statement that research will enhance their career (P=0.038); were significantly associated with ever having done any research work on bivariate chi-square analysis. Only having had a research methodology training significantly predicted ever participating in any research work (OR=4.49 (95% C.I 2.39-8.45); p<0.0001).Conclusion: VECDs had a high research participation, but low research presentation in scholastic gathering, funding, authorship and publication rates. Research methodology training significantly predicted research participation.

Kawasaki disease; rare; or misdiagnosed: A case report in a tertiary hospital in Nigeria

Kawasaki disease (KD) is a self-limiting, acute febrile vasculitis with predilection for children under-5 years. Most reports have emanated from Japan with only a few cases reported in Africa. KD presents a diagnostic dilemma and a high index of suspicion is critical as early treatment reduces the incidence of complications. We describe a 5-month-old male infant who presented with classical clinical features though with delayed diagnosis. Received moderate dose aspirin with limitation of access to intravenous immunoglobulin and who did not develop coronary artery complication. The case report highlights the diagnostic challenges faced by practitioners, made worse by the low index of suspicion inherent in our setting. The fatal complications that may be associated with KD can, therefore, be avoided. It is hoped that pediatricians in particular would become conversant with the diagnostic criteria to facilitate early diagnosis and intervention in children.

Association Between Quality of Life and Burden of Care Among Informal Caregivers of Individuals with Spinal Cord Injury: A Mixed Method Study

Purpose: Informal caregivers of individuals with spinal cord injury often experience high burden of care which could impact negatively on quality of life. Exploring the impact of the burden of care on the quality of life is required in developing necessary health promotion programs for informal caregivers. Method: The study utilized a mixed method design of cross-sectional survey and qualitative study. The crosssectional component involved purposively selected 34 consenting informal caregivers of individuals with spinal cord injury from the physiotherapy outpatient clinic and neurosurgery ward of a major tertiary hospital in Nigeria. The Zarit Burden Interview (ZBI) questionnaire was used to assess the level of burden of care and 36-short form health survey questionnaire. Seven purposively selected and consenting informal caregivers participated in the focus group discussion. Mann-Whitney test and spearman correlation were used to analyze the quantitative study. The level of significance was set at 0.05. The qualitative data was analyzed using content thematic analysis. Results: The mean age of participants in this study was 41.26 ± 11.39 years. The cross-sectional study showed that 28 (82.4%) participants had a high level of burden of care. Out of all the domains of quality of life, vitality and mental health had a significant relationship with burden of care. The qualitative study provided further insight into the study. According to the participants, psychological, emotional, social and sexual functioning were affected negatively by the burden of care of individuals with spinal cord injury. Conclusion: Quality of life of informal caregivers is negatively affected by high burden of care experienced.

Determinants of patients’ safety culture practices in a tertiary hospital in Nigeria

Background There is growing concern towards ensuring that patients are safe. Despite this, factors influencing safety practices and outcomes in healthcare delivery systems in Nigeria have not been determined exhaustively. Objective To determine the factors affecting patient safety culture (PSC) practices in a tertiary hospital in Nigeria. Materials and methods This cross-sectional descriptive study of care providers in a tertiary hospital in Nigeria was conducted from June to November, 2016. A self-administered structured questionnaire survey (QS) was used to assess PSC via 12 composites. Data were analysed using Statistical Package for Social Sciences version 22 and associations tested with Chi-square at p ≤ 0.05. Results Response rate is 87%, with a validity rate of 88%. Supervisor/manager expectations and actions promoting safety has the highest positive response of 70.7%, while Non-punitive response to error has the least, 43.1%. The overall PSC grade level is 62.3%. The knowledge of PSC is 54.5%, 54% never reports safety events. Knowledge of PSOP, Knowledge of the availability of PSU, Report of errors and Regular patient safety committee meetings (PSCM) influences the scores on four, three, two and seven PSC composite units ( p < 0.05 respectively). Conclusions This study finds an apparently fair overall PSC grade level. Knowledge of PSOP and availability of PSC unit, reports errors and regular PSCM positively influences PSC. There is need for composite targeted cum overall improvement on PSC in the setting.

EFFECT OF A PHARMACIST INTERVENTION ON SELF MANAGEMENT PRACTICES AMONG HYPERTENSIVE-DIABETIC PATIENTS RECEIVING CARE IN A NIGERIAN TERTIARY HOSPITAL

Objective: The objective of this study was to evaluate the effect of a pharmacist-led intervention on self-management practices among hypertensive-diabetic patients receiving care in a Nigeria tertiary hospital.
 Methods: The study adopted a prospective, longitudinal; single-blind, two-arm randomised controlled trial to implement a pharmacist-led educational intervention on hypertension management among patients in Federal Medical Centre Lokoja, Kogi State. All the patients who met the eligibility criteria and gave their written consent to participate in the study were recruited into the study randomized in the intervention group (IG) and Control (CG). Data was collected using Hypertension Self Care Activity Level Effects (H-SCALE) questionnaire. The retrieved questionnaires were first coded into Microsoft Excel (2014) for cleaning of errors, after which the data was exported into the Statistical Product and Services Solutions (SPSS for windows, Version 16.0. SPSS Inc. 2007, Chicago, USA) software. Descriptive statistics such as frequencies, percentages and mean scores were used to summarise the data. All responses were first presented as frequencies and percentages. Chi-square was used to determine the correlation between socio-demographic and patients’ clinical characteristics. Independent sample t-test and paired sample t-test were used to compare differences between and within groups.
 Results: At baseline, more patients in the control group were adherent to their medications 16 (11.5) and had low salt diets 47 (33.8) than patients in the intervention group. However, more patients in the intervention group were non-smokers 127 (88.8) and engaged more in physical activity 38 (26.6) than patients in the control group. However, more of the patients in the control group were adherent to weight management practices 38 (27.3) than patients in the intervention group 36 (25.2), at baseline. All the patients in both study groups reported to have taken alcohol in the past seven days. It can be seen that, patients in the intervention group at endpoint, differed positively from the control group at baseline in adherence to medication, physical activity, reducing alcohol consumption and smoking cessation. It can also be observed that the baseline intervention group differed positively from the endpoint in medication adherence (t=-26.045, p<0.001); physical activity (t=-15.081, p<0.001); weight management practices (t=-5.479, p<0.0010, and alcohol consumption 9t=-11.550, p<0.001).
 Conclusion: A pharmacist led educational intervention had a positive impact on the self-management practices of hypertensive-diabetes patients.

Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria

BackgroundAs part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR.MethodsIn this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert’s scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score < 80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model.ResultsA total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr.ConclusionsOur study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria’s NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.

Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study

Globally, approximately 9 million neonates develop perinatal asphyxia annually of which about 1.2 million die. Majority of the morbidity and mortality occur in Low and middle-income countries. However, little is known about the current trend in incidence, and the factors affecting mortality from hypoxic ischaemic encephalopathy (HIE), in Nigeria. We assessed the trends in incidence and fatality rates and evaluated the predictors of mortality among babies admitted with HIE over five years at the Lagos University Teaching Hospital. A temporal trend analysis and retrospective cohort study of HIE affected babies admitted to the neonatal unit of a Nigerian Teaching Hospital was conducted. The socio-demographic and clinical characteristics of the babies and their mothers were extracted from the neonatal unit records. Kaplan-Meir plots and Multivariable Cox proportional hazard ratio was used to evaluate the survival experienced using Stata version 16 (StataCorp USA) statistical software. The median age of the newborns at admission was 26.5 (10-53.5) hours and the male to female ratio was 2.1:1. About one-fifth (20.8%) and nearly half (47.8%) were admitted within 6 hours and 24 hours of life respectively, while majority (84%) of the infants were out-born. The prevalence and fatality rate of HIE in our study was 7.1% and 25.3% respectively. The annual incidence of HIE among the hospital admissions declined by 1.4% per annum while the annual fatality rate increased by 10.3% per annum from 2015 to 2019. About 15.7% died within 24 hours of admission. The hazard of death was related to the severity of HIE (p = 0.001), antenatal booking status of the mother (p = 0.01) and place of delivery (p = 0.03). The case fatality rate of HIE is high and increasing at our centre and mainly driven by the pattern of admission of HIE cases among outborn babies. Thus, community level interventions including skilled birth attendants at delivery, newborn resuscitation trainings for healthcare personnel and capacity building for specialized care should be intensified to reduce the burden of HIE.

Observed benefits of a major trauma centre in a tertiary hospital in Nigeria.

IntroductionA Trauma System or its components has been shown to improve trauma services and outcome of seriously injured patients. These organised services are non0existent or the components operate in isolation in most African countries.This study was done to identify the observed advances in trauma care service delivery, brought about by the beginning of operation of a trauma centre in the capital city of a West African country.MethodologyThe operation of the trauma centre was reviewed for progress in terms of organisation of care, in-hospital care, training, and referral system and injury prevention. In addition, the challenges facing the trauma centre were also reviewed and discussed.ResultsThe trauma centre has brought about better organisation of care and specialist availability, various training in trauma surgery, advances in referral and injury prevention. Funding is an identified threat to the function of the centre.DiscussionThe trauma centre provided the drive for specialist training in trauma and changes in the process of care. Funding is a threat to optimal function, as was poor inter-relatedness with other local hospitals, pre-hospital services and rescue providers.

Knowledge and Opinion of Nurse Leaders on the Practice of Clinical Mentorship in a Tertiary Hospital in Nigeria

Introduction: Mentoring is an important strategy to support the development of a transformational leader. It involves the nurturing of a personal career, intellectual growth/development, as well as improving corporate knowledge, and making employees feel valued. Aim: This study aims at exploring the knowledge and opinions of nurse leaders on clinical mentoring using pre-test and post-test evaluations. Methods: It is a pre-test and post-test single-subject design among 135 Chief Nursing Officers (CNO) that attended the Nurse Leaders’ Summit. Data were analyzed using SPSS 22.0, and probability value p&lt;0.05 was used to determine the significance of the descriptive and inferential statistics. Results: The study revealed that 56.3% of the respondents had adequate knowledge of mentoring at pre-, and 74.1% at post-evaluation; 91.1% claimed to be mentors; 57% were not assigned to a mentee; while 64.4% of them had a good opinion of mentorship and were willing to practice clinically based mentoring. Conclusions: Mentoring is an effective intervention to build the capacity of nurses and improve the quality of healthcare delivery.

Patterns of spirometry findings among patients with suspected lower airway obstruction in a tertiary hospital, South-South, Nigeria

Objectives: The respiratory system consists of the upper airway and the lower airway. Although, the airway sub-serves several functions, the most important functions of the airway are ventilation and gas exchange. Lower airway obstruction by diseases such as Asthma and COPD may impair airway function. Spirometry is a useful tool in the assessment of airway function. We aim to describe the observed patterns of spirometry findings among patients with suspected lower airway obstruction at the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, South-South Nigeria.&#x0D; Methods: Across-sectional study. Records of spirometry values were used to assess spirometry patterns. IBM SPSS software was used to analyze data.&#x0D; Results: Spirometry records of a total 100 patients were analysed. Mean age was 48.90 ± 19.77 years. There were 59% males and 41% of females. Spirometry patterns were: normal-59%; obstructive-39%; restrictive-1%; mixed-1%.&#x0D; Conclusion: Spirometry is a useful non-invasive tool in the diagnosis of respiratory diseases, and recommended for patient evaluation in every tertiary hospital in Nigeria.&#x0D; Keywords: Spirometry pattern, airway obstruction, asthma, COPD

A Mixed-Method Study of Burden of Care and Its Associated Factors Among Informal Caregivers of Individuals with Spinal Cord Injury in Nigeria

Background: Information about the burden of care and factors associated with it among caregivers of individuals with spinal cord injury is fundamental in planning programs to alleviate their burden.Methods: We conducted the study using a mixed-method design of the cross-sectional survey and qualitative study. Thirty-four participants (informal caregivers of individuals with spinal cord injury) for the study were purposively selected at the foremost tertiary hospital in Nigeria. The Zarit Burden Interview (ZBI) questionnaire was used to assess the level of burden of care. In addition, seven purposively selected informal caregivers also participated in the focus group discussion. Descriptive and inferential statistics were used to analyze the quantitative study, while the qualitative data were analyzed using thematic content analysis.Results: Findings of the cross-sectional study showed that 28 (82.4%) participants had a high level of burden of care. Significant associations were found between the burden of care and the level of income of participants (p=0.042), the burden of care, and the number of hours spent caring (p=0.005). The qualitative study revealed poor hospital administration and logistics, high cost of care, and negative attitude of health workers as what constitute the burden.Conclusion: The informal caregivers experience a high level of burden of care, associated with poor hospitaladministration, health workers attitude, and high cost of care.

Economic costs of terminal care for selected non-communicable diseases from a healthcare perspective: a review of mortality records from a tertiary hospital in Nigeria

IntroductionWHO revealed that morbidity and mortality from non-communicable diseases (NCDs) are on the increase and NCDs accounted for approximately 29% of all deaths in Nigeria in 2016. This study was...

Cardiovascular Risk Profile of Apparently Healthy Workers in a Tertiary Hospital in Nigeria

Background: Cardiovascular disease incidence is rising in Nigeria. This study was done to identify cardiovascular risk factors and assess the 10-year cardiovascular risk score of healthcare workers of a tertiary hospital in south-western Nigeria. Materials &amp; Methods: In this cross-sectional study, apparently healthy workers of a tertiary hospital in Nigeria were studied. Fifty-two individuals were recruited into the study. Anthropometric measures, blood pressure, fasting lipid profile and HbA1c were obtained using the standard protocols. QRISK3 score was also calculated. Results: The Mean±SD age of participants was 44.9±8.1 years. Dyslipidaemia was the most common risk factor among apparently healthy healthcare workers, while glucose intolerance was the least common. Also, 48.1% of the subjects had at least one cardiovascular risk factor and 15.4% had 3 or more cardiovascular risk factors. The 10-year cardiovascular risk using QRISK3 was moderate in 3.8%. There was no statistically significant difference in the 10-year cardiovascular risk score between the clinical and non-clinical healthcare workers (P=0.313; t=0.819). However, male participants had a significantly higher 10-year cardiovascular risk score compared with the females (3.50 vs. 1.56; P&lt;0.001; t=3.741). Conclusion: Cardiovascular risk factors are prevalent among health workers and closer attention needs to be paid to these factors by the hospital management to mitigate cardiovascular disease among the staff.

Pattern of Abdominal Stab Injury in a Tertiary Hospital in Nigeria

Background: Abdominal stab injury is a type of penetrating abdominal injury. The management may be operative or non-operative. Objectives: To determine the pattern, treatment options and outcome in abdominal stab injuries. Methods: This was a retrospective study carried out over 4 years between January 2014 and December 2017, at the University of Benin Teaching Hospital, Benin City, Nigeria. Patients aged 18 years and above formed the study population. The case files of the patients were retrieved from the medical record. The information obtained included age, gender, injury to arrival time (IAT), type of weapon, the abdominal injury sustained, clinical symptoms and signs, surgical intervention time (SIT), type of surgery carried out, operative findings and complications. Results: Overall, there were 34 patients made up of 30 (88.2%) males and 4 (11.8%) females with a male to female ratio of 7.5:1. The mean age of the patients was 30±8.9 years with the age range of 17-50 years. The mean injury to arrival time (IAT) was 2.0±1.6 hours; surgery intervention time (SIT) was 5.9±5.6 hours. Twenty (58.8%) patients had laparotomy while 14 (41.2%) were successfully managed non-operatively. Post-operative complications included surgical site infection (SSI), entrance wound infection, intra-peritoneal abscess and intestinal obstruction. There was no mortality. Conclusion: Abdominal stab injury was predominant among males and can be managed by the operative method or non-operative method in the absence of significant visceral injury. Selective non-operative management was effective in avoiding unnecessary laparotomy in more than one-third of the cases.

Preparedness and response of a tertiary hospital to the COVID-19 pandemic in Nigeria: challenges, opportunities and lessons.

Africa was the last continent to be affected by the COVID-19 pandemic. Much of the discourse on Africa's response captured in scientific journals revolves around nations, public health agencies and organizations, but little is documented about how individual healthcare facilities have fared. This article reports the challenges faced in a tertiary hospital in Nigeria, including space constraints, diagnostic challenges, shortages in personal protective equipment and health worker infections. The opportunities and strengths that aided the response are also highlighted. The lessons learned will be useful to similar facilities. More information about health facility response at various levels is needed to comprehensively assess Africa's response to the pandemic.

Histopathologic spectrum of childhood tumours in a Tertiary Hospital: a ten-year review.

There has been a growing public health burden of childhood tumours in low and middle income countries (LMICs) as the trend in epidemiological transition continues to vary. The objective of this report is to determine the spectrum of childhood tumours at a tertiary hospital in Nigeria. A retrospective review of the histopathology register over the period January 2006 to December 2015. The total paediatric tumour cases was 248, including 143 (57.7%) females and 105 (42.3%) males, aged 0 - 12 years (mean 6.1 years ± 3.97 SD). The age group 2 - 5 year cohort had the highest prevalence of tumour. The predominant tumour based on tissue of origin was epithelial neoplasms 88 (35.5%), vascular neoplasms 56 (22.6%), neural neoplasm 42 (16.9%), mesenchymal neoplasm 37 (14.9%), germ cell neoplasm 13 (5.2%) and haematopoietic neoplasms 12 (4.8%). Majority of the tumours were benign, 148 (59.7%) and malignant 100 (40.3%). The most predominant benign tumour was haemangioma 33 (13.3%) and predominant malignant tumour was lymphoma 22 (8.9%). Benign tumours remain the commonest neoplasm of children in this hospital-based data. Development and implementation of a tumour registry would provide a more comprehensive information.

Vitamin D and bone mineral status of newborn-maternal pair delivering at a tertiary hospital in Nigeria.

Vitamin D plays a vital role in the maintenance of bone health. The fetuses and exclusively breastfed neonates depend on maternal vitamin D store to meet their need. Widespread vitamin D deficiency among pregnant women have been reported with adverse fetal outcome. Nigeria lacks guideline on Vitamin D supplementation in pregnancy and infancy due to the paucity of data. We thus determined serum vitamin D of delivering mothers and their offsprings and other indicators of bone mineral health. This study aimed to determine serum Vitamin D and other indicators of bone mineral health of delivering mothers and their offspring. A cross-sectional study of delivering mothers and their newborns recruited consecutively until the minimal sample size was reached. Relevant information was obtained on a questionnaire. Maternal and cord serum vitamin D, calcium, albumin, phosphate, and alkaline phosphatase were determined. Data management was done using SPSS version 16.0. Of the 84 newborn-mother pairs studied, 17 (20.2%) of the mothers were Vitamin D deficient and 23 (27.4%) insufficient. Seven (8.3%) of the mothers were hypocalcaemic and 3 (3.6%) hypophosphataemic, while 19 (22.6%) had elevated alkaline phosphatase. Only 15 (17.9%) of the neonates were vitamin D insufficient and none of them was vitamin D deficient, hypocalcaemic, hypophosphataemic nor had elevated alkaline phosphatase. There was strong positive correlation between cord and maternal blood vitamin D level (r = 0.740, P = < 0.001). Vitamin D deficiency and insufficiency is high among pregnant women in Maiduguri while insufficiency is common among the neonates. We recommend vitamin D supplementation to pregnant women and newborns in Maiduguri.

Determinants of the decision-to-delivery interval and the effect on perinatal outcome after emergency caesarean delivery: a cross-sectional study.

Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD. A prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was conducted. The time-motion documentation of events from decision to delivery was documented; the outcome measures were perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was performed with IBM SPSS Statistics version 20.0, and P<0.05 was considered significant. The overall mean DDI was 233.99±132.61 minutes (range 44-725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25 minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05 minutes; P=0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes; P=0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal mortality (10.8% vs 1.3%; P=0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1 CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic regression showed no statistical correlation between the DDI and neonatal outcomes. Perinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors should be addressed to reduce the DDI.