The neonatal mortality rate and the causes of death in this study are similar to those documented by other studies in Nigeria and are largely preventable. Strengthening perinatal care, emergency obstetric services, and enhancement of neonatal resuscitation skills to traditional birth attendants (TBAs) and other community health workers are necessary to reduce the neonatal mortality in our setting and other rural settings across developing countries.

Background: Iron deficiency anaemia has been described as the commonest type of nutritional anaemia in infancy and childhood. The associated adverse health sequelae include permanent behavioural and cognitive impairments. Early detection and prompt treatment are necessary to prevent these complications. Aim: To determine the prevalence and socio-demographic distribution of iron deficiency anaemia among anaemic under five children in Enugu. Subjects and methods: Under-five children presenting at a tertiary hospital were consecutively enrolled and screened for iron deficiency anaemia using haematocrit and serum ferritin levels. Iron deficiency anaemia was defined as haematocrit level <30% and ferritin level <12ng/ml. Results: Three hundred and twelve children (187 males, 125 females) aged below 60 months had a PCV check out of which 178 (57.1%) were anaemic (PCV< 30%). Of the anaemic group, 61(34.3%) had iron deficiency anaemia. Prevalence of iron deficiency anaemia was higher among the males (38.0%) [p=0.235], age group 13-23months (40.0%)[p=0.575] and children from lower socioeconomic class (43.5%)[p=0.158]. There is a positive but weak correlation between serum ferritin and haematocrit levels [r= 0.11 p=0.130]. Conclusion: The prevalence of iron deficiency anaemia in the study population was high and varies with the child's age group, gender and parental socioeconomic class.

BackgroundNeonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US$2 per day, these bills are not affordable to many families’ livelihoods.AimThis study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases.MethodsThis is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses.ResultsA hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86±8.81 days and ₦36,382±19,389.72 (US$223±119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than ₦10,000 (US$61), ₦10,000–49,999 (US$61–306), and ₦50,000–100,000 (US$306–612) and more than ₦100,000 (US$612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn’s illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis (₦23,499±14,987 [US$144±92], P=0.001), low birth weight (₦39,863±24,003 [US$224±147], P=0.001), severe anemia (₦40,504±13,923 [US$248±85], P=0.001), transient tachypnea of the newborn (₦10,083±1,078 [US$62±7], P=0.001), birth asphyxia (₦24,398±14,096 [US$149±86], P=0.001), and meningitis (₦26,731±7,675 [US$164±47], P=0.001), whereas cost for laboratory investigations was significantly higher for neonatal jaundice (₦11,690±3,169 [US$72±19], P=0.001). There was a strong positive correlation between duration of hospital stay and total medical cost incurred (r=0.897, P=0.001).ConclusionHealth expenditure on neonatal illness is high and leads to catastrophic expenditure for the majority of households in the state. There is a need for effective health insurance schemes to help subsidize and cushion this disastrous and impoverishing health expenditure on families for improved neonatal survival in Nigeria.

Background:The under-5 mortality rate in many developing countries has shown little or no improvement over the years. Ravaged by war and poverty, violence which is now a norm in most African countries (including Nigeria) is on the increase and has condensed into most families with women and children bearing the major brunt of this violence. Aim: Effect of maternal exposure to intimate partner violence on under-5 mortality in Nigeria. Methods: Data from nationally representative sample of mothers (aged 15-49 years) was obtained from the 2008 Nigeria Demoraphic and Health Survey. Cox regression and multiple logistic regressions were used to identify and examine the association between maternal exposure to intimate partner violence and under-5 death and use of maternal and child health services after controlling for potential confounding factors. Results: The prevalence of intimate partner violence (IPV) in Nigeria is 34.9%. This may be lower than the actual prevalence due to under reporting of cases of IPV in most developing countries. Women not exposed to intimate partner violence were 0.77 times less likely to lose a child under-5 compared to women exposed to intimate partner violence (HR=0.77 95%CI 0.64-0.81). Decision making autonomy in family activities significantly affected loss of a child under-5 in the face of IPV. Similarly women not exposed to IPV were 1.74 times more likely to use maternal and child health services compared to exposed mothers (OR=1.74 95% CI 1.65-1.83). Age of mother, educational status of mothers, social class, occupation, marital status, access to media and decision making autonomy were retained as important maternal predictors of use of maternal and child health services when exposed to IPV in multivariate analysis (p<0.05). Conclusion: Intimate Partner Violence has a significant effect on under-5 mortality. Therefore tackling this social menace will not only reduce the effect on child mortality but also address the ill societal effect that results from family collapse following IPV.

Background: Malaria remains the leading cause of morbidity and mortality in sub-Saharan Africa, with children under 5 years accounting for 86% of all malaria deaths. For effective control of malaria, WHO recommends rapid diagnosis and effective treatment, insecticide-treated bed nets, and indoor residual spraying. The use of insecticide-treated bed nets has been shown to be the most cost-effective strategy in preventing this infection. However, despite the Roll Back Malaria subsidized and free bed net distribution initiatives in some Africa countries, bed net uptake and usage still remains low in many households. Aim: This study aimed to investigate household characteristics and child factors that determine bed net ownership and use amongst under-5 children and the effect of its usage on malaria parasitemia in under-5 children in Nigeria. Methods: Data from a nationally representative sample of 5895 households was obtained from the 36 states and the Federal Capital Territory in the 2010 Nigeria demographic and health survey, with a minimum of 67 households enrolled per state. Appropriate statistical tools were used to identify the characteristics of households that owned a bed net and to examine the association between the households and child-level factors that predict the use of bed net and malaria prevalence among under-5 children within these households. Results: The rate of households bed net ownership in Nigeria is about 45.5%. About 48.5% of under-5 children in 33.9% of households surveyed, use a bed net during sleep. There was a strong correlation between households ownership and child sleeping under a bed net (r = 0.706, P , 0.001). Acquisition of these bed nets at no cost significantly determined ownership (P , 0.001) but not usage (P = 0.450). Ownership of a bed net was significantly higher in households in rural areas (P = 0.001), poorer households (P = 0.001), households with an under-5 child (P = 0.001), households whose heads were male (P = 0.001), and of lower educational attainment (P = 0.010). There was a greater likelihood of under-5 children sleeping under a bed net in households with two or more under-5 children (odds ratio [OR] 1.26; CI: 1.05−1.66), two or more bed nets (OR 2.03; CI: 1.56−2.66), and in households whose heads were younger ([OR 2.79; CI: 1.65-4.70] for household heads younger than 29 years and [OR 1.6; CI: 1.17-2.19] for those 30-49 years of age), female (OR 1.61; CI: 1.00−2.61), and poorer (OR 1.77; CI: 1.03−3.04), and less likely in households with more than three other (aside from the under-5 children) household members ([OR 0.23; CI: 0.08-0.69] for household with 4-6 family members and [OR 0.20; CI: 0.07-0.61] for households with 7 or more family members). Malaria parasitemia in under-5 children was higher in: households without a bed net (41.9% versus [vs] 34.2%) (P = 0.016), in children who did not sleep under a bed net (39.7% vs 35.0%) (P = 0.292), in poor households compared to middle and rich households (50.5% vs 44.9% vs 25.9%; P = 0.001), and households in rural set...