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Background: The Integrated Management of Childhood Illness (IMCI) guidelines are a standardized diagnostic and treatment approach developed by the World Health Organization for the management of common childhood diseases. Objective: This study assessed the adherence and implementation-related challenges of the IMCI guidelines among nurses at health centers in Port Harcourt, Nigeria. Materials and Methods: A cross-sectional descriptive-analytical design was employed to examine nurses in all the 12 Model Comprehensive Primary Healthcare Centers (MCPHCs) in Port Harcourt, Nigeria. The census sampling technique was used to enroll 52 consenting participants. Data were collected by (1) observation and recording on a checklist and then (2) semi-structured questionnaire. Collected data were analyzed using frequency, percentages, Chi-square, and prevalence ratio at a 5% level of significance with the aid of IBM-SPSS version 25. Results: About half (53.8%) of the participants demonstrated adequate overall adherence to all the steps of the IMCI guidelines. Adequate adherence to all the steps of the IMCI guidelines was 83% higher among participants trained on the IMCI guidelines (P = 0.038). The participants’ educational qualifications (P = 0.722) and years of professional nursing practice (P = 0.477) were not associated with adherence to the IMCI guidelines. The categories of the IMCI guidelines implementation-related challenges reported by the participants were a lack of training update on the IMCI guidelines (94.2%), a lack of the IMCI booklets (69.2%), and work-time pressure (53.8%) among others. Conclusion: Adherence to the IMCI guidelines was short of desired levels. In recommendation, frequent training and regular provision of the IMCI booklets in the MCPHCs are required.

Background Breast milk is the main source of neonatal nutrition. It is not known whether diabetes increases the excretion of toxic heavy metals in the breast milk of postpartum mothers. We compared the concentration of toxic heavy metals in breast milk between diabetic and non-diabetic postpartum mothers in Yenagoa. Material and methods A cross-sectional design was utilized on a purposive sample of 144 consenting postpartum mothers (72 diabetic and 72 non-diabetic mothers) from three public hospitals. Breast milk samples were collected at 5–6 weeks postpartum between 1st November 2020 and 30th April 2021. Atomic-Absorption-Spectrophotometer and Direct-Mercury-Analyzer were used to analyze the breast milk samples. A data collection form (proforma) was used and data were analyzed at a 5% significance level with IBM-SPSS 25 software. Result High levels of Arsenic (63.9% vs. 62.5%), Lead (95.8% vs. 95.8%), Mercury (68.1% vs. 72.2%), and Cadmium (84.7% vs. 86.1%) were detected in the breast milk of the diabetic and non-diabetic groups respectively. The mean concentrations for Arsenic (0.6 vs. 0.6 ng/mL), Lead (13.2 vs. 12.2 ng/mL), Mercury (2.9 vs. 3.0 ng/mL), and Cadmium (3.3 vs. 3.2 ng/mL) were above the WHO permissible limits, thus showing evidence of risk to the health of the mother and neonate. There was no significant difference in the concentration of toxic heavy metals in breast milk between the groups (p = > 0.585). Conclusions Diabetes did not seem to increase the concentration of toxic heavy metals expressed in breast milk. More rigorous studies are needed to confirm these findings.

Background: The World Health Organization recommended less than 10% episiotomy rate for Skilled Birth Attendants (SBAs) and hospitals in 1996. More than two decades afterwards, some health facilities are still grappling with meeting the set target. Objectives: This study assessed the perspectives of SBAs and pregnant women regarding episiotomy in a Nigerian univer- sity teaching hospital. Methods: A cross-sectional design was employed. Census sampling was used to select 19 SBAS and 973 vaginal birth re- cords from 2019, while consecutive sampling technique was used to enrol 134 consenting pregnant women obtaining ante- natal services in the facility. Data was collected using a three part instrument involving a data extraction sheet, episiotomy practice questionnaire for SBAs, and feelings about episiotomy questionnaire for pregnant women. Assembled data were summarised with descriptive statistics. Results: The episiotomy rate was 345(35.5%). About 266 (77.1%) of first time mothers (primips) and 79(22.9%) of non- first time mothers (multips) received episiotomy. Ten (52.6%) of the SBAs were unsure of any evidence supporting routine episiotomy. All the 19(100%) SBAs reported that there was no existing facility-based policy regarding routine episiotomy. Seventy five (56%) of the pregnant women reported feeling generally bad about episiotomy. One hundred and one (82.3%) of them hinted that they will not feel satisfied if they were given episiotomy with the reason that it ensures quick vaginal birth. Conclusion: The rate of episiotomy was higher than global recommended standards and primips are disproportionately af- fected. If organised by professional societies, more scientific conferences on limiting episiotomy might remedy this situation. Keywords: Episiotomy; birth; pregnant women; vagina; Nigeria.