Publications
75 results found
Amadi H, Abubakar AL, Abdullahi RA, et al., 2024, The Neonatal Rescue Scheme (NRS) concept reduces mortality by over 85% in Niger State Nigeria – a lesson for Nigeria and other LMICs, Journal of Neonatal Nursing, Vol: 30, Pages: 70-76, ISSN: 1355-1841
Nigeria is well-known for its extremely high neonatal mortality rate, putting the country at the top of the list of most needy LMICs. Daily, over 846 babies die from preventable reasons across the constituent States in Nigeria. The Niger State, located at the northwest of the middle belt, had one of the highest neonatal mortality rates prior to 2017. All Nigerian States habitually rely on federal government health centres for the special care of their growing population of needy neonates. Only one such centre is in the State of Niger, yet there has been no significant progress in the entire State. This resulted in the State government taking on an extraordinary step of independently trialing the new concept of a Neonatal Rescue Scheme (NRS), powered by LMIC-compatible frugal neonatal devices and procedures.The Amina-centre, so-commissioned in 2017, has sustainably used indigenous basic medical officers and nurses who received prior short-term training on the applications of the NRS to deliver impactful services to neonates. This 6-year impact and comparative assessment study explored how the services of the Amina-centre have radically transformed the Niger State's desperate situation by reducing the facility mortality from 90/100 neonates to 4/100 neonates. This innovative program also attracted and increased the average neonatal traffic from 20 neonates/month to an astronomical 264 neonates/month. The Amina-centre represents a typical transformation that could alleviate many precarious neonatal healthcare problems in every LMIC setting.
Amadi H, Kawuwa MB, Abubakar AL, et al., 2023, Fundamentals of a safe and effective neonatal building design in a tropical LMIC setting, Best Practices in Neonatal Care and Safety, Editors: Barría, Publisher: IntechOpen, ISBN: 978-0-85466-098-8
A safe and effective neonatal building is an aspect of Neonatal Rescue Scheme (NRS) concept as described in the literature. Observable habitual practices leading to various neonatal outcomes at tropical LMIC settings point to adverse facility-based mortality contributions from poor nursery layouts. Sadly, the negative impacts of building deficiencies are not well-understood or empirically quantified as tailored to the limitations in resource-constrained tropical climate. Lack of helpful building features may exacerbate high morbidity owing to adverse issues such as poor infection control, evening fever syndrome (EFS), noise pollution, medication safety, intra-ward traffic, nursing fatigue, and parental services. A tropical LMIC setting has the disadvantages of relative poverty, infrastructural inadequacies, and adverse equatorial climatic conditions, necessitating design-specific requirements for safe neonatal care. This chapter is proposed to explore the constraints, concepts, and features as integrated in some NRS nurseries at different tropical regions of Nigeria, which function to mitigate the climate, poor infrastructure, and societal poverty against neonatal survival.
Amadi H, Olateju E, Abubakar A, et al., 2023, Frontier innovations for efficient LMIC hinterlands neonatal care – the Nigerian case study, World Nursing Science Conference 2023
Amadi H, Obu CD, Onwe-Ogah E, 2023, A low-cost oxygen-air mixer device extends accessibility of safer neonatal respiratory support in a resource-poor setting, Journal of Pediatrics & Neonatal Care, Vol: 13, Pages: 162-165, ISSN: 2373-4426
Background information: High cost of commercial-grade bubble continuous positive airway pressure (CPAP) machine has led to its limited availability for respiratory support of neonates in resource poor facilities. Most Nigeria facilities resorted to an improvised setup which supplies oxygen at 100% concentration exposing neonates to hyperoxia with possible ROP. PoliteO2blend® is a cheaper device that mixes supplied oxygen with atmospheric air, delivering variable fractions of inspired oxygen (FiO2) to neonates via tracheal tube or nasal prongs extended into a disposable PEEP water bottle as used in the improvised setup. The system microfilters and humidifies the blended gas unlike conventional improvised application. This study evaluated the PoliteO2blend as a standalone device as well as an upgraded version of improvised-CPAP.Methods: Four units of the politeO2blend were installed at the University Teaching Hospital Abakaliki for trialling and were operated by four designated staff after prior training on the modes of application of the device. Forty-five neonates, birthweight ≥1500g were treated following parental consents. The systems were operated as improved improvised-CPAP in 16 neonates of which 18.8% (3/16) were delivered preterm. All patients initially experienced respiratory distress with 75% (12/16) having pre-treatment respiratory rate >60c/m and SPO2 as low as 43% in some. The neonatal impact analyses of continuing usage of the devices at the hospital was evaluated based on the fraction of the total number of needy neonates at the centre who necessarily got treated using the device.Results: The target SPO2 of 90-95% was achieved in all neonates using FiO2 that ranged from 0.21 to 0.6. Duration of improvised setup with PoliteO2blend before successful discharge ranged from 5hrs to 7days.Conclusion: Our target SPO2 was rapidly achieved at a safer FiO2 in most neonates that received respiratory support. Improvised-CPAP application via PoliteO2blend
Amadi H, Abubakar AL, 2023, Neonatal care empowerment at LMIC hinterlands – the Nigerian Neonatal Rescue Scheme template, 5th Euro Global Conference on Pediatrics and Neonatology
Amadi H, Abubakar A, 2023, LMIC facility-lighting limitation in Nigeria fully resolved by a novel frugal polite-light-bank technology, Global Journal of Medical Research: K Interdisciplinary, Vol: 23, Pages: 1-9, ISSN: 2249-4618
Epileptic grid electricity and frequent power blackouts in the night at LMIC neonatal centres hidebehind frontline morbidities but contribute significantly to poor treatment outcomes at thesecentres. Power blackouts make it hard for clinicians and nurses to see clearly when attending topatients in the dark. Hence, many patients have lost their lives during the mistake-prone poor visualsetting. This situation gets worse for centres located at more remote regions of LMICs, where poweroutages could last for many days. A recently published article on “neonatal-rescue-scheme” conceptproposed the reversal in neonatal traffic, by taking the interventions to rural places where moreneedy neonates are to save them. Therefore, it becomes imperative to develop a reliable system ofindependent and sustainable technology that can guarantee dusk-to-dawn facility lighting based onsolar energy at such remote location that may not have grid electricity.This was achieved by technology morphing of existing market products, recreating these to fit theLMICs’ peculiar environmental and cultural settings. The resulting construct, polite-light-bank (PLB),passed all rigorous testing of structural integrity under the weather and functionality stability understrenuous usage. For over a period of four years, the new construct provided over 95% reliability andnearly 100% satisfaction ratings from the initial five centres that used it and have continued to usethis to date. This is a golden piece of work that any LMIC or similar settings must not ignore.
Amadi H, 2023, The Politeoxygen splitter system (PSS) – a frugal LMIC oxygen delivery technology that expands the utility by up to 700%, Journal of Pediatrics & Neonatal Care, Vol: 13, Pages: 75-80, ISSN: 2373-4426
Background: Oxygen therapy is indispensable in neonatal care requiring prompt commencement when prescribed. This is often hampered by limited availability of oxygen cylinders or concentrators at busy SCBUs in Nigeria. Where available, these two items of oxygen sources overcrowd the SCBU creating movement barriers leading to injuries, neonatal infections from high traffic of dirty cylinders and noise pollution from many concentrators. This presents the urgent need for a low-cost technique that could help to make oxygen easily administered to as many neonates as the need arises simultaneously.Aim: To describe an oxygen splitter system and compare outcomes of oxygen prescription in neonates pre- and post-system installation.Methods: Politeoxygen® Splitter System (PSS), a novel oxygen distribution system was designed to eliminate oxygen concentrator and cylinder adverse effects whilst enabling only one oxygen source to support up to eight neonates, simultaneously. Five sets of the device were installed and applied. Records of newborns who received oxygen therapy, pre-PSS installation and post-PSS were retrieved. Time delays to oxygen commencement following prescription were assessed in both groups. Incidences of cylinder falls and obstructions were noted.Results: PSS supported multiple numbers of neonates using one oxygen-source with patient-independent humidification and variable flowrates, sharing total flow up to 15 LPM amongst needy neonates as individually required. Six of 105 (6%) newborns received oxygen within 10 minutes of prescription pre-PSS installation, whereas 96%(72/75) post-PSS. The median (range) time delay to commencing oxygen therapy post-PSS was 0(0–90) minutes whereas pre-PSS was 74(0–1110).Conclusion: Unlike pre-PSS group, 100% of post-PSS neonates received oxygen as soon as this was prescribed, leading to prompt therapy initiation and many of them survived. PSS is recommended to enhance prompt far-reaching oxygen to neonates in p
Amadi H, 2023, The Politeoxygen splitter system (PSS) – a frugal LMIC oxygen delivery technology that expands the utility by up to 700%, Journal of pediatric and neonatal care
Amadi H, 2023, Empowering the LMIC hinterlands with compatible technologies for neonatal care – the resilience of a research group, Journal of Pediatrics and Neonatal Care, Vol: 13, Pages: 174-179, ISSN: 2373-4426
Background: High neonatal mortality rate (NMR) in low- and middle-income countries(LMIC) might not be resolved until rural healthcare facilities are empowered withsustainable frugal technologies and procedures. Needed technologies may not rely oncutting-edge systems of the high-income countries (HIC), which require much funding andwell-established public infrastructure to thrive. Rather, tailored non-conventional designsStudy design: A multistage strategy was designed to identify and resolve the technologyagainst neonatal interventions within the primary healthcare settings in Nigeria.Methods:over 25 years period to resolve the various factors militating against neonatal survivalin Nigeria. Unconventional ideas relying on solar powered systems and easily availablelocal materials were developed, trialed, and commissioned at various times across 31tertiary hospitals spanning all regions of Nigeria. Stand-alone studies or solutions-creation,amidst discouraging situations, were individually completed, peer-reviewed, and journalempowerment strategy – the Neonatal Rescue Scheme – to generate integrated proof ofconcept.Finding: The number of early neonatal deaths and overall NMR drastically reduced atparticipating centers.Conclusions: This Rescue-Scheme strategy could revolutionize neonatal healthcare in lowincome countries and drastically reduce Nigeria’s corporate NMR if properly adopted.Clinical evidence: Recent studies of the Scheme and various combinations of its neonataloverall NMR fell from 90/’00 to 4/’00 as published by Amina-center Minna Nigeria 2023;early mortality fell from 81% to 0% - University of Abuja Teaching Hospital Nigeria 2017,etc.
Amadi H, Kawuwa MB, Abubakar AL, et al., 2022, A community integrated concept that minimises death of most vulnerable neonates at poor-resource environments, Journal of Pediatrics and Neonatal Care, Vol: 12, Pages: 170-173, ISSN: 2373-4426
Introduction: Highest proportion of most vulnerable Nigeria neonates are concentrated in hard-to-reach local villages without proper intervention devices owing to unavailable electric power. Hence, majority of needy neonates continue to lose their lives due to their inability to journey to urban cities where few inadequately equipped neonatal intervention centres are located. The Nigerian healthcare system requires the neonates to make the often-treacherous journeys, travelling into the cities in search of possible intervention. This system has continued to fail generations of precious neonates who could have survived otherwise. It is therefore imperative to device a technique that could enable the reversal of the patient traffic – by “taking our medicine to them right where they are" instead of waiting for them to come to our medicine right where we are at urban locations.Methods: Solar-based applicable devices and simplified neonatal intervention procedures operable by basic medical and nursing officers were developed. The technologies were fundamentally tailored for maintainability by the local people. This empowers the confidence of treating many of the regular neonatal emergencies at primary healthcare centre located within the villages. Uncomplicated treatable cases are believed to constitute over 65% of all cases and hence could be adequately supported. Appropriately remanufactured tricycle was modified to operate ambulatory services for referring the cases requiring specialist care in the city.Conclusion: Successful implementation of this concept and its scale-up could guarantee over 75% reduction of neonatal mortality within a controlled geographical region.
Amadi H, 2020, Born to Live Not to Die, Publisher: Mereo Books, ISBN: 9781861519528
ONE MAN'S BATTLE TO OVERCOME CORRUPTION AND SAVE THE LIVES OF NIGERIAN BABIESThis is the true story of a professor who, in the face of appalling adversity, saved over one million new-born babies dying unnecessarily in underequipped ...
Amadi HO, Abdullahi RA, Mokuolu OA, et al., 2020, Comparative outcome of overhead and total body phototherapy for treatment of severe neonatal jaundice in Nigeria, PAEDIATRICS AND INTERNATIONAL CHILD HEALTH, Vol: 40, Pages: 16-24, ISSN: 2046-9047
- Author Web Link
- Cite
- Citations: 1
Onwe OE, Anosike OB, Obu CD, et al., 2019, Economic cost savings with the use of total body phototherapy for the treatment of severe neonatal jaundice in Nigeria, The Journal of Pediatrics and Neonatal Care, Vol: 9, Pages: 168-171, ISSN: 2373-4426
Kernicterus and severe jaundice are major contributors to neonatal morbidity in Nigeria and they are commonly treated using invasive exchange blood transfusion EBT techniques Total body phototherapy exposure TBPE is a new technique that avoids the risks of EBT and has been shown to be effective The aim of this study was to evaluate the typical economic savings that result from the clinical success of the TBPE as provided by the Firefly system in a Nigerian new born centre Severely jaundiced neonates who were treated using EBT between January and December were assessed as control cases These neonates were compared to neonates who received TBPE using the Firefly system MTTS Asia Hanoi Vietnam as a first course intervention test cases from December onward A total of severely jaundiced new borns qualified for inclusion including control cases and test cases All TBPE cases were successfully discharged but two mortalities relating to EBT complications were recorded The mean direct cost of treatment per patient was reg US in the control group and reg US in the test group The mean patient burdens for other parameters control test were bacterial infection burden human labour man hours and blood contamination burden The huge relative amount of savings recorded in this study has clearly demonstrated that Firefly reg TBPE is an application that is both affordable and effective in a resource constrained setting Hence we recommend its use in low and middle income countries
Amadi HO, Okonkwod IR, Abioye IO, et al., 2019, A new low-cost commercial bubble CPAP (bCPAP) machine compared with a traditional bCPAP device in Nigeria, PAEDIATRICS AND INTERNATIONAL CHILD HEALTH, Vol: 39, Pages: 184-192, ISSN: 2046-9047
- Author Web Link
- Cite
- Citations: 11
Amadi H, Abubakar AG, Abubakar AL, et al., 2019, Hypothesis of Iatrogenic Severe Hypothermia of Internal Organs in Extremely-Low Birthweight Infants during Bubble CPAP Intervention at Room-temperatures in Nigeria, EC Paediatrics, Vol: 8, Pages: 517-524
Background: Bubble continuous positive airway pressure (CPAP) application has become popular in Nigeria against the backdrop of very high incidence of respiratory distress syndrome among preterm neonates in the country. An estimated > 90% of interven-tions in Nigeria is carried out via an improvised technique or use of devices that deliver CPAP gas at room temperatures only. There is however, a high record of neonatal mortality amongst very- and extremely-low birthweight neonates that receive CPAP treatments using these devices. It is suspected that a possible dodgy severe hypothermia could be blamed; hence the need for a preliminary hypothesis.Methods:The aetiology of CPAP iatrogenic hypothermia was studied via free-body modelling to formulate prevailing thermal in-terplay. Thirteen extremely-low birthweight neonates (BW: 600g - 1000g) were recruited to test the hypothesis. Four of these were treated with CPAP-temperature-controlled device, whereas the rest of the 13 were treated with disposable improvised CPAP devices that delivered air at room temperatures. A digital thermometer probe was inserted in the CPAPs’ gas delivery tubes to measure the temperatures of the inspiratory gas just before the infant received this.Results: Only four of the extremely-low birthweight infants were successfully weaned from the CPAP interventions. All four received pre-warmed CPAP gas but all nine unsuccessful infants received CPAP gas at room temperature. All 13 patients maintained physiolog-ical temperatures > 36.5°C, measured superficially via the axilla. Median inspiratory gas temperatures for all the deceased remained below 32°C throughout, whereas those of the successful infants remained above 35.5°C. Conclusion: Acceptable axillary temperatures may be concealing dangerous internal iatrogenic hypothermia, perhaps at the lungs leading to organ failures and death. Internal organ temperatures below 33°C may be insuff
Amadi HO, Kawuwa MB, 2017, Reducing Early Neonatal Mortality in Nigeria – the Solution, Neonatal care, Editors: Mauricio, ISBN: 978-953-51-5331-3
Amadi HO, Olateju EK, Adeshina CT, et al., 2017, HISA-protocol for lowering neonatal mortality – a tool Nigeria can’t afford to ignore, 10th National conference, Nigerian society of neonatal medicine
Amadi HO, Olateju EK, Adeshina CT, 2017, Temperature control that minimises early neonatal deaths, proceedings of the 3rd Global Forum on medical devices, World Health Organisation
Amadi HO, Adesina CT, Olateju EK, et al., 2017, Validation of a Novel Technique that Minimises Early Neonatal Deaths - a Comparative Study, Journal of Pediatrics & Neonatal Care, Vol: 6
Nigeria did not achieve the millennium development goal (MDG) for the reductionof under-5 mortality (U5M) in 2015. Neonatal death still accounts for nearly 50%of U5M, hence responsible for this failure. The World Health Organisation recordsshowed that 79% of deceased neonates would die within the first-seven-days(F7D) of life in Nigeria. Prolonged postnatal delay before attainment of normalbody temperature could be partly responsible. Reducing F7D deaths could improveNigeria’s overall record; hence the urgent need to device a technique that couldbe applied to achieve this. We developed a neonatal temperature control protocol“the initial-setpoint-algorithm (ISA)” as a response to temperature-related highF7D mortality rate. A total 134 cases (105 controls and 29 tests) were recruited.The cases drew from extremely- low birth weight and preterm neonates (BW =600-1200 g, GA = 26-32 weeks) presenting at the University of Abuja TeachingHospital Nigeria. Mortality outcomes were compared to investigate how theISA group performed relative to the Control group. Applying ISA, Test-patientsattained normotherm in 0.47 hr post-presenting (95%CI: 0.2); Control took 12.4hrs (95%CI: 2.3). The F7D-deaths contribution to mortality in the control groupwas 71% (41 out of 58). There was no F7D death amongst the only two deceasedneonates in the test group. The ISA helped quick attainment of normotherm in theTest-group; hence removed the immediate postnatal long exposure to damagingthermal shock that trailed other neonates to death within the F7D period.
Amadi HO, Olateju EK, Alabi P, et al., 2015, Neonatal hyperthermia and thermal stress in low- and middle-income countries: a hidden cause of death in extremely low-birthweight neonates, PAEDIATRICS AND INTERNATIONAL CHILD HEALTH, Vol: 35, Pages: 273-281, ISSN: 2046-9047
- Author Web Link
- Cite
- Citations: 12
Olutunde OE, Oyedokun A, Olateju EK, et al., 2015, EXTREME LOW BIRTH PARAMETER NEONATES WOULD MORE READILY DIE OF HYPERTHERMIA THAN HYPOTHERMIA IN NIGERIA, Paediatrics Association of Nigeria Conference (PANCONF)
Objective: To investigate how thermal instability might have contributed to a record high neonatal mortality of extreme low birth weight (ELBW) babies in Nigeria.Methods: Ninety-two previous cases from three Nigerian tertiary hospitals were analysed. The average birth weight of the sample population was 993g ± 256g; range: 600g to 1500g from which the ELBW cases (mean: 846g ± 128g; range: 600g to 1000g) were isolated. A temperature-time graph with clearly visible thermal safe-zone band was developed from which all fatality-associated thermal instabilities were identified and defined based on their characteristic consistencies. Parametric quantifications for these were devised to enable the definition of critical values. This was applied to all cases in the sample population to identify and quantify a measure of the various thermal distresses that might have contributed or led to neonatal death. Algorithm-based thermal control technique was devised and results from surviving cases compared.Findings: Hypothermic complications were prevalent with a fatality rate of 22.7% and associated with 65% of all deaths. Hyperthermic related complications accounted for 35% of all deaths but with a higher fatality rate of 64.3%. All babies that experienced prolonged hypothermia that culminated in a sharp flip to hyperthermia survived. However all those that experienced prolonged hyperthermia culminating in a sharp flip to hypothermia died within 12 hours of the event. Algorithm-based patients did not experience this flip.Conclusion: Hyperthermia will more readily kill neonates; hence methods of quenching high and prolonged fever must be reviewed.
Amadi HO, 2014, High rate of neonatal morbidity and mortality due to climate-related diseases, WHO conference on health and climate, Publisher: International Institute for Sustainable Development, Pages: 6-6
Amadi HO, Osibogun AO, Eyinade O, et al., 2014, Challenges and frugal remedies for lowering facility based neonatal mortality and morbidity: a comparative study., Int J Pediatr, Vol: 2014, Pages: 986716-986716, ISSN: 1687-9740
Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one "control" were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria.
Amadi HO, Emery RJ, Wallace A, et al., 2014, Specificity of clinical examinations for testing glenohumeral ligament integrity: a computational study, Computer Methods in Biomechanics and Biomedical Engineering, Vol: 17, Pages: 933-943, ISSN: 1025-5842
An accurate diagnosis of glenohumeral joint (GHJ) instability is essential for an effective surgical intervention. There is presently no known comprehensive algorithm of clinical tests for the confirmation of the functional integrity of glenohumeral ligaments (GHLs). A validated computational GHL strain analyser was applied to a set of GHJ kinematics data from the literature to simulate 57 different physiological clinical examination manoeuvres. An algorithm that integrates the GHL pre-straining activities at the toe region of the stress–strain curve was developed for the quantification of ligament loading from prevailing strains. This was used to upgrade the strain analyser and applied to produce a matrix of the various GHL loadings and sensitivities during the manoeuvres. The investigation magnified the likely impact of anatomical variations of GHL attachments as possible causes of misdiagnoses during clinical examinations of GHJ dysfunction. This can serve as an assistive guide to ascertain the functional condition of a specific GHL during symptomatic clinical examinations.
Amadi HO, Mohammed LI, Kawuwa MB, et al., 2014, Synthesis and Validation of a Weatherproof Nursery DesignThat Eliminates Tropical Evening-Fever Syndrome in Neonates, International Journal of pediatrics, Vol: 2014, ISSN: 1687-9740
Neonatal thermal stabilisation can become challenging when uncontrollable factors result in excessive body temperature.Hyperthermia can rapidly slow down baby’s progress and response to treatment. High sunlight intensity in tropical countriessuch as Nigeria manifests in incessant high neonatal temperatures towards early evenings.The ugly consequences of this neonatalevening-fever syndrome (EFS) can only be eradicated by the development of a controlled weatherproof nursery environment. Twolaboratories and a ‘control ward’ were applied. Lab-2 was a renovation of an existing room in a manner that could correct anexisting nursery. Lab-1 was an entirely new building idea. The laboratories were assessed based on comparative ability to maintainenvironmental coolness and neonatal thermal stability during hot days. Data collection continued for 12 full calendar months. Onaverage, at evaluated out-wind peak temperature of 43∘C (range: 41∘C–46∘C), the control-ward peak was at 39∘C, Lab-2 peak at36∘C, and Lab-1 peak at 33∘C. All incubators in the control overheated during the hot periods but there was no overheating inLab-1. Forty-four (86%) of sampled babies were fever-quenched by water sponging 131 times in the control whilst only one babyreceived same treatment in Lab-1. Nursery designs patterned after Lab-1 can significantly reduce EFS-induced neonatal morbidity.
Amadi HO, Alabi P, Uwakwem AC, 2014, Neonatal Concerns – a collaborative medical outreach for newborn babies in tropical sub-Saharan Africa, Paediatrics Association of Nigeria Conference
The Millennium Development Goal no.4 (MDG4) targets two-third reduction in under-5-years (U5) mortality rate between 1990 and 2015. Since neonatal mortality owns 40% of U5 deaths, any measures undertaken to improve newborn care would make steps towards MDG4 target. For 12 years of MDG4 pursuit, none of the steps undertaken by Agencies and the Nigerian government was able to demonstrate significant signs of more newborn survival going by the timeline between Ibe’s (1993) increasing-admission-delivery and Ogunlesi et al’s (2008) worsening point-of-admission-hypothermia. Very poor neonatal transport to care-centres caused nearly 100% of all premature babies to arrive hypothermic. Nearly full term neonates might scarcely survive with KMC technique, however extreme-low-birth-weight (<1500g) and extremely-preterm (<31-weeks-GA) neonates would die without adequate incubator intervention. A standard Nigerian newborn centre could have up to 45 neonates on admission of which 20 or more would be struggling preterm babies. Such situation demands for over 20 units of functional incubators to be available in such centres at any time if these babies must survive. However most Nigerian centres could not demonstrate a consistent availability of up to 4 functional incubators over a period of any two years. Incubators were unaffordable and technically sophisticated; therefore a low-cost culturally compliant incubator model and procedures must be developed to tackle this fundamental failure for MDG4 to succeed.Research and development outreach was initiated to: (i) devise the Recycled Incubator Technology (RIT), capable of up to 10 years incubator life expectancy. A cumulative 20 Nigerian newborn-centres were recruited and progressively expanded in functional incubator capacity using RIT systems. (ii) Set up facility-based research groups. (iii) Develop two elective training courses for clinicians/nurses. (iv) Training independent artisans on spare parts production. (
Amadi HO, Kawuwa MB, Mohammed IL, et al., 2013, Eradication of climate-induced neonatal hyperthermia through nursery building design, World Health Organisation (WHO) 2nd Global Forum on Medical Devices
Daytime ambient temperatures of tropical climates can rapidly rise in excess of 43°C, overheating any exposed objects. This leads to the over-warming of neonatal nurseries, occupant baby temperatures soaring up to hyperthermic 40°C during early evenings of sunny days. Unaware of this neonatal ‘evening fever syndrome (EFS)’, clinicians have responded with doses of antibiotics mistaking this as infection sign. Others combined their desperate measures with ‘water-sponging’ of babies above 37.9°C. Thermoneutral instability increases morbidity and slows down progress. Unnecessary antibiotic treatment complicates situations and could kill such baby. Climate-induced hyperthermia could be eliminated if nurseries were appropriately sited and designed to guarantee natural coolness. This will allow better neonatal thermoneutral regulation through incubators.Federal Medical Centre Nguru gave Ethical Approval and hosted this research. Two laboratories of building constructs were erected, each double-walled having in-between air space for lagging. Lab-1 was new building with underground floor and heat-exchanger. Lab-2 was an existing room renovated for existing nursery correction. The laboratories were assessed on ability to maintain environmental coolness and incubator/neonatal thermal stability during extreme-hot days as compared to the hospital’s main nursery, ‘Control-ward’. Data collection continued for 24 months, constructions validated and extreme-hot months of February-May and August-October data extracted and analysed.Average peak-temperature of outside-wind was 43°C (range: 41°C–46°C); Control-ward was 39°C, Lab-2 (36°C) and Lab-1 (33°C). All incubators in Control overheated during the temperature-high periods of the day but there was no incubator overheating in Lab-1. There were 131 water-sponging events for fever-quenching on Forty-four (86%) of sampled babies in the Control-ward. Only
Amadi HO, Azubuike JC, Adimora GN, et al., 2013, Unexplored success route to Nigeria’s MDG4 target on neonatal mortality, World Health Organisation 2nd Global Forum on Medical Devices
MDG4 targets two-third reduction in under-5-mortality rate (U5MR) by 2015. Since neonatal mortality accounts 40% of U5MR in Nigeria, any measure undertaken to improve newborn care contributes towards MDG4 target. Many years into MDG4 pursuit, Nigeria could not demonstrate significant progress in newborn survival, from Ibe’s (1993) ‘increasing-admission-delivery’ report to Ogunlesi et al’s (2008) ‘worsening-hypothermia-risks’. Inadequate neonatal transport to care-centres made premature babies arrive hypothermic. Extreme-low-birth-weight (<1500g) and extremely-preterm (<31weeks-GA) neonates would die without incubator care. A typical Nigerian newborn-centre could have 45 neonates on admission, of which 30 could be preterm. Such situation requires over 20 units functional incubators if the babies must survive. However, no Nigerian centre could demonstrate consistent availability of 4 functional incubators over a period of two years. Incubators were unaffordable and sophisticated, hence low-cost culturally-compliant models must be developed to tackle this fundamental deficiency for MDG4 to succeed.Outreach was initiated (2003) to: (i) devise the Recycled-Incubator-Technique (RIT), which applies generic components to convert carcasses into low-cost incubators, capable of 10 years of life. A cumulative 20 hospital newborn-centres were recruited and progressively expanded in incubator capacity using RIT-systems. (ii) Create centre-based research groups. (iii) Develop elective training courses that instruct clinicians/nurses. (iv) Train independent local artisans use local materials to produce spare parts. (v) Install power-banking and apnoea-monitoring systems. (v) Institute ½yearly failure-preventive and auditing services.Based on Amadi et al (2010) study, outreach reduced average neonatal mortality by 25% (from 254/1000 to 192/1000); boosted morale/confidence of nurses/clinicians by 79%; accelerated discharge by 19%; boos
Amadi HO, 2013, Neonatal concerns in tropical subSaharan Africa, www.imeche.org/events/S1769, Appropriate healthcare technologies for developing countries: Low-cost, Frugal technology medical devices, Publisher: Institution of Mechanical Engineers
This medical outreach was designed to apply research techniques to determine the best practice that could improve the survival rate of newborn babies (neonates) within the tropical harsh climate of Western Africa. The highly populated vast expanse of the landscape of Nigeria, traversing the southern coastal rainforest to the dry northern desert lands, provided the suitable setting for this project.Lack of appropriate and effective science of neonatal thermoneutral control was initially identified as the major cause of poor physiological stabilisation of neonates especially the premature babies, leading to a high rate of mortality and morbidity. An affordable and most appropriate sustainable technology must be synthesised to reduce neonatal mortality. This has to be functional but culturally compliant for easy adaptability
Amadi HO, Mokuolu OA, Obasa T, 2013, Effect of high sun intensity on neonatal incubator functionality in a tropical climate, Journal of Neonatal Nursing, Vol: 19, Pages: 122-128, ISSN: 1355-1841
The effect of meteorologically-induced high room temperature on neonates and incubators in a tropical climate was studied. Two rooms were designated for the study. The main nursery hall served as the ‘control-room’ where environmental conditions remained unaltered. A sun-shading and wall-lagging method was applied to the ‘test-room’ to reduce the warming effect of high sunlight intensity. A weather monitoring station was installed to separately record meteorological changes outside the nursery and both study rooms. Incubator set-points and process temperatures were recorded hourly using digital thermometer from 8:00hr to 21:00 hr daily. All set ups were allowed to continue through the harmattan and dry season months. On the average, 80% of Incubators malfunctioned in the control-room, and 9% in the test-room. Minimisation of meteorological heat transmission into nursery wards is an essential factor to consider for designing and setting up a neonatal centre in a tropical climate.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.