ObjectiveTo determine the prevalence, risk factors, co-morbidities and case fatality rates of Protein Energy Malnutrition (PEM) admissions at the paediatric ward of the University of Nigeria Teaching Hospital Enugu, South-east Nigeria over a 10 year period.DesignA retrospective study using case Notes, admission and mortality registers retrieved from the Hospital’s Medical Records Department.SubjectsAll children aged 0 to 59 months admitted into the hospital on account of PEM between 1996 and 2005.ResultsA total of 212 children with PEM were admitted during the period under review comprising of 127 (59.9%) males and 85(40.1%) females. The most common age groups with PEM were 6 to 12 months (55.7%) and 13 to 24 months (36.8%). Marasmus (34.9%) was the most common form of PEM noted in this review. Diarrhea and malaria were the most common associated co-morbidities. Majority (64.9%) of the patients were from the lower socio-economic class. The overall case fatality rate was 40.1% which was slightly higher among males (50.9%). Mortality in those with marasmic-kwashiokor and in the unclassified group was 53.3% and 54.5% respectively.ConclusionMost of the admissions and case fatality were noted in those aged 6 to 24 months which coincides with the weaning period. Marasmic-kwashiokor is associated with higher case fatality rate than other forms of PEM. We suggest strengthening of the infant feeding practices by promoting exclusive breastfeeding for the first six months of life, followed by appropriate weaning with continued breast feeding. Under-five children should be screened for PEM at the community level for early diagnosis and prompt management as a way of reducing the high mortality associated with admitted severe cases.

Recent studies have cast doubt on the recommended 30-min decision--delivery interval (DDI) in emergency caesarean sections. The practicability, justification, anticipated beneficial effect on neonatal outcome and its medico-legal implications have been questioned. We set out to determine (1) the DDI for emergency caesarean sections in two Nigerian tertiary care centres (2) the effect of DDI on perinatal outcome (particularly if the DDI is longer than the internationally recommended 30 min) and (3) the factors causing delays in intervention if any. This was a prospective observational study of consecutive cases of emergency caesarean sections performed at the two centres over an 8-month period. The main outcome measures were: indication for the caesarean, the decision-baby delivery interval, 1-min and 5-min Apgar scores, newborn admission to special care, perinatal death and reasons for any delay in decision - delivery interval beyond 30 min. The data were analysed with descriptive and inferential statistics and regression equations at the 95% confidence level. A total of 224 emergency caesarean sections were performed in the two institutions within the period of study. None of the caesarean sections was done within the recommended 30-min interval. Despite this, there was no significant correlation between the DDI and perinatal outcome. The major causes of delays in DDI were anaesthetic delays in both centres and difficulty in sourcing essential materials in one of the centres. The recommended 30-min DDI in emergency caesarean section is not currently feasible in Nigeria. Although the 30-min interval should remain the gold standard, DDI up to 3 hours may not be incompatible with good perinatal outcome as shown in this study. As in other studies, anaesthetic delay is the major cause of delay in carrying out emergency caesarean sections. Finally, since prolonged DDI may not be the cause of an adverse perinatal outcome in the majority of cases, litigation on these grounds may be unjustified.

IntroductionSeveral factors including the parental literacy, illness, socioeconomic status, poor sanitation and hygienic practices affect the physical growth of children. The aim of this study was to determine the socio-demographic determinants of malnutrition among primary school aged children in Enugu, Nigeria.MethodsA cross-sectional descriptive study involving primary school children in Enugu was carried out over a 3 month period. Subjects were selected using multistage sampling technique. Weight and height were measured using a digital scale and a wooden stadiometer, respectively. Body Mass Index (BMI), weight-for-age (WAZ), Height-for-age (HAZ) and BMI-for-age z scores were then derived using the new WHO reference standards.Results348 children (40.4%) were recruited from 5 public schools while 512 (59.6%) were recruited from 9 private schools. The mean age of the study participants was 9.2 ± 1.8 years. 7 (0.8%) children were stunted, 26 (3.3%) wasted and 28 (3.3%) underweight. Of all the study participants, overweight and obesity were observed in 73 (8.5%) and 35 (4.1%) children, respectively. Children of lower socioeconomic class were more stunted, underweight and wasted, while overweight and obesity were more prevalent among children from the upper socioeconomic class.ConclusionFactors such as age and sex, parental education and socioeconomic class had a significant impact on nutritional status. Overweight and obesity were more prevalent among the children from the upper socioeconomic class, attending private schools, while stunting and wasting were more in children of the lower class attending public schools.

This study provides current normative BP values that can be used in neonatal Intensive Care Unit.