No abstract

Background: Prompt administration of antibiotics to children with pneumonia significantly reduces the probability of death. However this requires early identification of such children in the community. In a country such as Nigeria with one of the highest pneumoniarelated deaths, what do mothers know about pneumonia, and what should be the content of public campaign messages? Methods: A structured questionnaire was administered to mothers attending paediatric clinics of Lagos University Teaching Hospital seeking their knowledge about the definition, causes, risk factors and symptoms of childhood pneumonia. Results: One hundred and seven (107) consecutive mothers participated in the study. The majority (97; 90.6%) had at least secondary education, were married (96; 89.7%) and professed to be either Christians or Muslims (105; 98.1%).Prior to the study, 16 (15%) had not heard about pneumonia. About half of the participants correctly identified fast/difficult breathing as suggestive of pneumonia. Threequarters reported exposure to cold as the cause of childhood pneumonia. Minimizing exposure to cold and wearing warm clothes were the two commonest reported ways of preventing pneumonia (75.8% and 49.5% of the mothers respectively); in contrast hand washing, exclusive breastfeeding and limiting exposure to sick persons with cough and catarrh were the least mentioned. The proportion of mothers who correctly identified fast/difficult breathing as suggestive of pneumonia was similar irrespective of educational status or source of pneumonia information. Conclusion: Mothers' knowledge of childhood pneumonia is low. Public campaigns on pneumonia should focus on raising awareness about germs as cause of pneumonia, immunization, hand washing and exclusive breastfeeding as potent preventive strategies and fast/difficult breathing as a feature of pneumonia.

hundred and forty nine (60.9. p e r c e n t ) m o t h e r s a p p l i e d methylated spirit, 145 (25.3 percent) used hot compress, while 50 (8.7 percent) applied toothpaste on the cord. Twenty (3.5 percent) others applied herbs, while nine (1.6 percent) applied dusting powder to the umbilical stump. C o r d s e p a r a t i o n t i m e w a s significantly shorter among babies whose mothers were of high parity, unbooked, and of low educational status. In addition, the use of razor blade, thread, hot compress or application of herbal preparations o r t o o t h p a s t e s i g n i f i c a n t l y shortened the separation time (P<0.05).Cord separation time and cord care practices varied. Nigerian mothers often use unorthodox interventions to shorten cord separation time; however, the risk of omphalitis that may result from this is real. We recommend that each centre should adopt and teach mothers a standard hygienic c o r d c a r e p r a c t i c e w h i l e discouraging the use of herbs and untested materials. A b s t r a c t B a c k g ro u n d :Objectives: M e t h o d s :Results:

Background: Although the official age of fetal viability in Nigeria is 28 weeks, there are pockets of reports some anecdotal, of survival of babies  delivered at younger gestational age (GA) from different parts of the country. The routine resuscitation and management of premature infants born before the official age of fetal viability (28 weeks) is likely to generate important ethical and medical concerns that are bound to influence our  approach to the management of such infants. Aim: To determine the GAspecific neonatal mortality and survival among preterm deliveries at the National Hospital Abuja. Subjects and Methods: A retrospective review of relevant data from the National Hospital Neonatal Registry Database based on the Research Electronic Data Capture software (REDCap) was undertaken to determine the mortality rate of preterm babies managed in the neonatal intensive care unit (NICU) from January 2017 to February 2018. Disaggregated GA specific mortality rates were also computed to determine the fetal age at which extra uterine neonatal survival rate was at least 50%. Gestational age estimation was based on mothers’ last menstrual period (LMP) in over  96% of cases.Results: Sixty-three (63) of 305 preterm babies admitted died during hospitalization giving a mortality rate of 20.7%. This was significantly higher than the mortality rate among term babies (7.5%, P=0.01) hospitalized over the same period. Antenatal corticosteroid use was low (11.2%), 188  (25.8%) received CPAP for Respiratory Distress Syndrome (RDS), and none of the babies received surfactant or mechanical ventilation. There were no survivors among babies delivered at GA of 22-25 weeks (11, 3.6%). However, the survival rate at 26 weeks gestation was 53.8%, and this  subsequently increased, reaching a peak of 96.5% survival at 35 weeks. RDS accounted for 53.9% of all deaths. Conclusion: It is concluded that the survival rate (53.8%) of babies at GA of 26 weeks despite minimal antenatal interventions and limited postnatal  respiratory support was reasonably high, and this could serve the basis for discussions for a downward review of the age of fetal viability in Nigeria. Key words: Gestational age. Fetal viability

Objective: To determine the number and distribution of paediatricians in Nigeria. It also aims to determine the association between paediatrician workforce and under five mortality (U5MR) and immunization coverageacross the six geopolitical zones of the country.Methods: The part II fellowship examination pass list of the West African College of Physicians and the National Postgraduate Medical College and the register and financial records of the Paediatric Association of Nigeria were searched for the purpose of the study. Using a structured questionnaire, personal and professional data was obtained frommembers at the 2011 Annual Paediatric Association of Nigeria Conference or via the Association’s website, email network and phone calls to Departments of Paediatrics in institutions (private and public) across the Country. Data on the paediatricians residing within Nigeria was then extracted from the comprehensive database and subsequently analyzed.Population data, mortality and immunization rates were obtained from the National Population Commission census and their most recent National Demographic health survey in Nigeria. Correlations were drawn betweennumber of paediatricians and U5MR and diphtheria-pertussistetanus(DPT) vaccine coverage.Results: There were 492 practicing paediatricians in Nigeria at theend of year 2011, comprising 282 (57.3%) males and 210 (42.7%)females; 476 (96.7%). Majority (84.7%) worked for the governmentwith 97% of them in hospital settings, mostly tertiary centres (344=88%). Lagos State had the highest number (85; 17.9%) of practicing paediatricians followed by the Federal Capital Territory with 37 (7.8%) paediatricians. More than two thirds of the paediatricians (336; 70.6%) were practicing in the southern part of the country. The average child:p a e d i a t r i c i a n r a t i o wa s 157,878:1for the country. TheNorth East zone had the highest chi ld- to-pa ediat r ician rat io (718,412:1) while South West had the lowest ratio (95,682:1).Higher absolute numbers of paediatricians in each zone were associatedwi th lower U5MR (Spearman ñ=-0.94, p=0.0048), accounting for 84% of the variability among zones. Higher ratios of child-to-paediatrician were significantly associated with higher U5MR (Spearman ñ=0.82, p=0.04,linear R2=0.73) and marginally with lower DPT coverage by geopoliticalzone (Spearman ñ=-0.77, p=0.07, linear R2=0.59).Conclusion: The study reveals that the number of paediatricians inNigeria is grossly inadequate with a huge child-to-paediatrician ratio.There is also an uneven distribution of the paediatricians with higher numbers in the southern states. Zones of the country with lower child-to-paediatrician ratios also experienced lower U5MR. There is a need to train more paediatricians in Nigeria and promote an even distribution of the paediatrician workforceKey words: Paediatrician, workforce, child-to-paediatrician ratio, under-5 mortality, immunization, childhealth, Nigeria