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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 25 | Issue 2
Page Nos. 57-147

Online since Wednesday, July 29, 2020

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ORIGINAL ARTICLES  

The roles of social networks and social support on breastfeeding practices in Nigeria Highly accessed article p. 57
Emeka P Agudile, Cassandra A Okechukwu, Subu V Subramanian, Alan C Geller, Ana Langer
DOI:10.4103/ijmh.IJMH_44_19  
Background: The global prevalence of early breastfeeding initiation, exclusive breastfeeding, and avoidance of prelacteal feeding has remained below the recommendations by the World Health Organization. Nigeria has the lowest rates of exclusive breastfeeding and the highest rates of prelacteal feeding in sub-Saharan Africa. It has been shown that social support is positively associated with healthy breastfeeding practices. Materials and Methods: This study used data from the household interviews of the Pilot Study on the Quality of Care in Antenatal Care and Patterns of Maternal Health Behavior in Nigeria, a cross-sectional survey of women (n = 455) in Nigeria to investigate the association between social support and breastfeeding practices among women. We conducted multivariable logistic regression analyses to explore the association between sources and types of social supports and breastfeeding in Nigeria. Results: We found that supports from mothers and fathers were associated with a higher prevalence of early breastfeeding initiation (odds ratio [OR] = 1.91; 95% confidence interval [CI] = 1.03–3.53; P = 0.039) and avoidance of prelacteal feeding (OR = 2.20; 95% CI = 1.08–4.49; P = 0.030), respectively. On the other hand, supports from neighbors (OR = 0.40; 95% CI = 0.24–0.64; P < 0.001) and mothers-in-law (OR = 0.46; 95% CI = 0.22–0.96; P = 0.039) were negatively associated with early breastfeeding initiation. Other sources of support were not significantly associated with either breastfeeding initiation or prelacteal feeding. Also, high levels of physical support from all network members were associated with a higher likelihood of avoiding prelacteal feeding (OR = 2.94; 95% = CI 1.65–5.22; P < 0.001). In contrast, high levels of emotional support from all network members were associated with a higher risk of prelacteal feeding (OR = 0.61; 95% CI = 0.37–0.98; P = 0.045). Conclusion: Our findings suggest that there are significant dual roles of social support from older generations on breastfeeding. Physical support during the postpartum periods may discourage prelacteal feeding in Nigeria.
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HIV-related oral lesions in patients on HAART: A preliminary study in Enugu, Southeast Nigeria p. 70
Ezi A Akaji, Onyinye F Nwankwo, Johncross C Nwadije
DOI:10.4103/ijmh.IJMH_43_19  
Background/Aim: Oral lesions in human immunodeficiency virus (HIV) infections may serve as markers for immune deterioration and disease progression and sometimes be the first indication of the disease. The aim of this study was to assess the prevalence and pattern of HIV-related oral lesions (HIV-ROLs) in people living with the disease in Enugu, Southeast Nigeria. Materials and Methods: A questionnaire was used to obtain data from 208 HIV- infected persons accessing treatment from two centers for acquired immune-deficiency syndrome (AIDS) prevention. Data obtained were demographic details, duration of infection, current cluster of differentiated 4 (CD4) count, and oral complaints. Thereafter, the perioral and oral cavity of the respondents were inspected for HIV-ROLs using disposable items. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 17. Results: Eighty-four (40.4%) respondents had HIV-ROLs; 44 had more than one lesion yielding 128 combinations. Forty-four of the 84 lesions (52.4%) were seen in those diagnosed over 5 years ago, 28 (33.3%) in those with 2–5 years duration of infection (P = 0.05), and 27 (32.1%) in persons with CD4 counts <200 cells/mm3. Fifty-three (41.4%) were oral candidiasis and 6 (4.7%) were oral hairy leukoplakia. One hundred and nine (52.4%) respondents had oral complaints/concerns, 53 (48.6%) of whom had at least one lesion on examination (P = 0.01). Conclusion: The pattern of oral lesions observed was consistent with those reported in similar studies, though prevalence varied slightly. Lesions correlated positively with self-reported oral concerns. Coordination of healthcare services between the physicians and dentists is vital in improving the well-being of the patients.
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Alteration of hemostatic and hemorheological parameters in Nigerian patients with type 2 diabetes mellitus: Does age play a role? p. 77
Momodu Imoru, Jessy Medugu, Rebecca Gali
DOI:10.4103/ijmh.IJMH_41_19  
Background: Diabetes mellitus has been associated with coagulation abnormalities characterized by decreased levels of antithrombin, protein C, increased concentrations of fibrinogen and von Willebrand factor, and alteration of hemorheological indices, which have been linked to the increased hyperviscosity state. The aim of this study was to determine the effect of age on hemostatic and hemorheological parameters in patients with type 2 diabetes mellitus. Materials and Methods: Eighty-four patients of 168 participants, aged 30–69 years, were recruited from the Metabolic Clinic of the University of Maiduguri Teaching Hospital, Borno State between January and December 2018, whereas the remaining 84, age- and sex-matched nondiabetic subjects resident in Maiduguri served as controls. Samples for platelet indices, fibrinogen concentration, hematocrit, relative plasma viscosity (RPV), whole blood viscosity (WBV), protein C, antithrombin, and d-dimer were analyzed using standard techniques. Results: The values of platelet indices, prothrombin time (PT), activated partial thromboplastin time (aPTT), protein C, antithrombin, d-dimer, fibrinogen, hematocrit, and RPV in diabetic patients with respect to different age groups showed no significance (P > 0.05). However, significantly lower levels of protein C, antithrombin and hematocrit, and significantly higher values of d-dimer, fibrinogen, and WBV were observed in patients with diabetes irrespective of the age compared to that of nondiabetic subjects (P < 0.05). Conclusion: Age had no influence on the values of platelet count, platelet indices, PT, aPTT, protein C, antithrombin III, d-dimer, fibrinogen, hematocrit, RPV, and WBV in patients with diabetes. However, patients with type 2 diabetes mellitus could be prone to thrombosis and increased fibrinolytic activity irrespective of their age.
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Sexual behavior of persons living with HIV/AIDS on antiretroviral therapy p. 84
Helen C Okoye, Chilota C Efobi, Hannah Omunnakwe, Nkemsinachi M Onodingene
DOI:10.4103/ijmh.IJMH_10_20  
Background: High-risk sexual practices are an important driver for the spread of HIV; little is known about the sexual practices of persons living with HIV/AIDS (PLWH) in Nigeria. Aim: The aim of this study was to evaluate the sexual behaviors of PLWH and determinants of the practice of multiple sexual partners. Materials and Methods: This was a cross-sectional descriptive study. Information on sexual practices before and after diagnosis of HIV/AIDS was sought from PLWH on antiretroviral therapy. Data were analyzed using the Statistical Package for the Statistical Package for the Social Sciences (SPSS) software, version 22 (IBM Chicago Illinois, USA). Results: A total of 250 PLWH participated in the study with the interquartile age range of 31–42 years. 72% were females and 43.6% had multiple sexual partners before diagnosis, whereas only 6.0% had multiple sexual partners after diagnosis (P < 0.001). Gender was associated with multiple sexual partners before diagnosis (P = 0.001) but age group, marital status, level of education, knowledge of sex, and condom use were not (P > 0.05). Conclusion: This study identifies gender as a determinant of high-risk sexual practices; males were more likely to have multiple sexual partners than their female counterparts before diagnosis. However, diagnosis or knowledge of HIV status is associated with a decline in risky sexual behaviors.
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Histomorphological characterization of Pneumococcal meningitis in bone marrow of Wistar rats treated with Bridelia ferruginea and ciprofloxacin p. 90
Olusegun Dare Omotoso, Abdullahi A Alfa, Samson E Olorunnado, Kokori B Tijani
DOI:10.4103/ijmh.IJMH_4_20  
Background: Bridelia ferruginea is one of the most valuable ethnomedicinal plants, which has been confirmed for antimicrobial activities and tissue-enhancing properties against degenerative processes. This study aimed at investigating the histomorphological characterization of ethanol extracts of leaf, stem-bark, and root of B. ferruginea on Pneumococcal-meningitis-induced bone marrow damage. Materials and Methods: Sixty-three Wistar rats were randomly divided into nine groups of seven rats each. Group B-F2 were inoculated with 1 × 109 colony-forming units (CFU)/mL of P. meningitis and were left for 72h before treatment. Group A rats (normal control) received 2.5 mg/kg of phosphate-buffered saline (PBS), whereas group B rats (negative control) were left untreated, group C rats (positive control) were treated with single dose daily of 1.4 mg/kg ciprofloxacin tablets, group D1 received 300 mg/kg B. ferruginea leaf extract, group D2 received 600 mg/kg B. ferruginea leaf extract, group E1 received 300 mg/kg B. ferruginea stem-bark extract, group E2 received 600 mg/kg B. ferruginea stem-bark extract, group F1 received 300 mg/kg B. ferruginea root extract, and group F2 received 600 mg/kg B. ferruginea root extract for 2 weeks after which all the animals were killed via cervical dislocation. Results: Ciprofloxacin and the leaf, stem-bark, and root extracts of B. ferruginea were able to avert and managed damage (tissue damage, histomorphological, and cytoarchitectural parameter) caused by P. meningitis in the bone marrow of adult Wistar rats. Conclusion: Bridelia ferruginea has antibacterial activities against factors causing bone marrow erythyroid hyperplasia, osteomyelitis as well as hemolytic anemia.
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Structural findings of hysterosalpingography in infertile women in Enugu, southeast Nigeria p. 96
Ngozi R Njeze, Salome N Ezeofor
DOI:10.4103/ijmh.IJMH_12_20  
Background: In the Nigerian culture, barrenness is a near catastrophe for women. Hysterosalpingography (HSG), being a prime investigation for infertility, is widely used in developing countries because of its positive yield, accessibility, and cost-effectiveness. Aim: The aim of this study was to identify the pattern and the most common radiologic findings in the HSG of women with infertility in Enugu, southeast Nigeria. Materials and Methods: This was a cross-sectional study involving 160 female patients who presented at the gynecology clinic of a private hospital in Enugu, Nigeria with clinical impression of infertility. The women were in turn referred to the radiology center for HSG. Data were analyzed using RStudio. Results: A total of 254 radiologic features were obtained as some patients had more than one radiological findings. The age range of the participants was 20 - 46 years, and the most prevalent age group was 25 - 29 years (31.1%). The most common clinical type of infertility was secondary infertility.The most common abnormal cervical and uterine findings were synechia (80%) and fibroids (65%) respectively. Bilateral tubal blockage 29.4% was the most common finding in the fallopian tubes. Normal findings were seen in 5.44%. Conclusion: Synechia and fibroids were the most common abnormal radiologic findings in the cervix and uterus, respectively. HSG was found to be informative in infertility evaluation, hence should still be recommended as a first-line imaging modality in infertility.
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Dyslexia: Literacy among school teachers in Perambalur, Tamil Nadu, India p. 101
Subramanian Hemadharshini, Neethu George, Elumalai Malaidevan, Rock Britto, Meera George
DOI:10.4103/ijmh.IJMH_16_20  
Context: Dyslexia is a learning disorder that makes the student inferior and introverted if proper identification and guidance are not given promptly. Apart from the parents and health professionals, school teachers play a main role in the process of early identification and managing the problem. Objectives: The objectives of the study were to assess the knowledge of dyslexia among school teachers and to associate the knowledge with other variables like experience and prior training. Materials and Methods: This was a cross-sectional study done among school teachers from 10 schools for 2 months. In total, 279 teachers were enlisted through convenient sampling and data were collected using a predesigned questionnaire. The questionnaire had questions about basic socio-demographic details and the training and school experience. Results: The study was done among 279 subjects with a mean age (SD) of 31.78 (6.49) years. The study population composed a majority of females, 210(75.3%). The mean (SD) years of experience among subjects was 6.13(4.83) years and the range was from 4 to 32 years. Of the 279 subjects, 146 (52.3%) had mild knowledge, 122 (43.7%) had moderate and 10 (3.6%) had poor knowledge. Conclusion: The study showed poor knowledge of dyslexia among school teachers. Dyslexia has to be identified early, and appropriate training should be provided to the teachers at regular intervals.
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Assessment of respiratory symptoms and cardiopulmonary indices among petrol pump attendants in Enugu Metropolis p. 106
Adaora J Okemuo, Loveth A Ominyi, Chidiebele P Ojukwu, Chigozie Ikenna Uchenwoke, Caesar S Chukwu, Uchechukwu A Ezugwu
DOI:10.4103/ijmh.IJMH_9_20  
Background: Air pollution is a major concern as an occupational health hazard among petrol attendants. There is scarce literature on the effects of these pollutants on the pulmonary system of petrol attendants in south eastern Nigeria, hence the need for this study. Aim: The aim of this study was to evaluate the respiratory symptoms and cardiopulmonary indices of petrol attendants in Enugu Metropolis. Materials and Methods: This cross-sectional observational study recruited 128 consenting apparently healthy participants (64 petrol and 64 non-petrol attendants) with mean age of 28 years. Their respiratory symptoms, pulmonary functions (forced vital capacity [FVC], forced expiratory volume in one second [FEV1], ratio of FEV1/FVC%, peak expiratory flow rate [PEFR]), and some cardiovascular indices (heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]) were assessed. St George Respiratory Questionnaire was used to obtain information on the participants’ respiratory symptoms. Data were analyzed with independent t test at a significance level of 0.05. Results: There was a significant reduction in FVC, FEV1, and PEFR in the petrol attendants compared to the control (P < 0.05). There was also a significant increase in SBP, DBP, and respiratory symptoms in the petrol attendants compared to their control counterparts (P < 0.05). Cough and chest trouble were the most commonly reported symptoms experienced by the petrol attendants. Conclusion: Petrol attendants are at increased risk of respiratory and pulmonary disorders because of the frequent exposure to petrol vapors and other chemical pollutants around their breathing zone.
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Perspectives of clinical students toward organ donation and transplantation: A cross-sectional descriptive study in a Nigerian tertiary hospital p. 112
Vivian Uzoamaka Muoneke, Dorathy Chinwe Obu, Samuel Nkachukwu Uwaezuoke, Uzoma Vivian Asiegbu, Azubike A Anya, Alfred Friday Una
DOI:10.4103/ijmh.IJMH_14_20  
Background: The terminal stages of most chronic organ-related diseases are often characterized by end-stage organ failure. Organ donation with subsequent transplantation represents the best clinical practice. Although several studies on the knowledge and attitudes of medical students toward organ donation and transplantation have been conducted elsewhere, similar reports are few in Nigeria. Aim: This study aimed to determine the knowledge and attitudes of clinical students in a Nigerian tertiary hospital on organ donation and transplantation. Materials and Methods: A cross-sectional study was conducted among clinical students of Ebonyi State Univesity (EBSU) Abakaliki at the Federal Teaching Hospital Abakaliki (FETHA) southeast Nigeria between January and July 2019, using standardized self-administered organ donation questionnaires. These questionnaires were self-administered to 204 medical students selected by systematic random sampling. The data were analyzed on descriptive statistics using the Statistical Package for the Social Sciences (SPSS) version 20.0. The differences in proportions were tested for statistical significance with the chi-square test. Statistical significance was based on P value <0.05. Results: Majority (99.0%) of the students knew about organ donation and its indications and the common transplantable organs but believed the kidneys were the most commonly transplanted organs. Sixty four (31.4%) of the total students were willing to serve as donors because of “the need to save a life.” Students’ age (P = 0.78), year of study (P = 0.10), marital status (P = 0.15), and religion (P = 0.69) did not significantly influence their perspectives about organ donation and transplantation. However, gender (P < 0.001) and residential status (P = 0.02) had a significant influence. Conclusion: A substantial number of clinical students in this clime have the correct perspectives on organ donation and transplantation, irrespective of their sociodemographic characteristics.
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Association of short sleep duration with cardiometabolic risk factors in a population of rural Nigerian women: A cross-sectional study p. 120
Chidimma B Nwatu, Ekenechukwu E Young, Belonwu M Onyenekwe, Chioma H Ezike, Ejiofor T Ugwu, Patrick C Obi
DOI:10.4103/ijmh.IJMH_17_20  
Background: Short sleep duration of less than 5.5h a day has been associated with cardiometabolic risk factors. Epidemiological evidence suggests a rising trend in the prevalence of cardiovascular diseases in Nigeria. Objective: The aim of this study was to determine the relationship between traditional cardiometabolic risk factors, prediabetes, and short sleep duration in a group of rural Nigerian women. Subjects and Methods: Five hundred and thirty-eight women living in Ihuokpara, a rural community in Southeast Nigeria, participated in the study. A structured questionnaire was administered to the participants to obtain demographic information and self-reported nighttime sleep duration. Anthropometric measurements and blood pressure were recorded. Participants underwent a 75 g Oral Glucose Tolerance Test using standard protocols. Prediabetes was defined using the World Health Organization criteria (fasting plasma glucose 110–125 mg/dL or 2h post-glucose 140–199 mg/dL) and hypertension was defined using the Joint National Committee (JNC-7) criteria. Results: The mean age of the subjects was 49.9 ± 16.2 years and 280 (52%) had no formal education. Hypertension was present in 238 (44.2%), prediabetes was present in 120 (22.3%), generalized obesity in 32 (5.9%), and increased waist circumference (>88cm) in 116 (21.6%) women. Average sleep duration of less than 5.5h per night was reported in 182 (33.8%) women. Short sleep duration was significantly associated with prediabetes and hypertension but not obesity or older age in the subjects. Conclusion: More than a third of the women had short sleep duration and this was a significant risk factor for prediabetes and hypertension in them.
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Contribution of pediatric autopsies to clinical care: Utilization among physicians in a Nigerian tertiary hospital in the past decade p. 128
Adaobi I Bisi-Onyemaechi, Ikenna Ndu, Obinna Nduagubam, Ugo N Chikani, Okechukwu C Okafor, Anthony O Eni, Uzoamaka Muoneke
DOI:10.4103/ijmh.IJMH_40_19  
Objective: The usefulness of autopsy includes the determination of the cause of death and risk factors of a disease, ascertaining the chances of recurrence and the consequences for relatives, genetic counseling, and planning for future cases and for research. Its utilization has, however, been on the decline in most parts of the world. The researchers set out to determine how much autopsies of pediatric patients are being utilized in a tertiary health facility in Enugu, Nigeria, and the degree of correlation between the clinical and pathologic diagnosis. Design: This was a descriptive cross-sectional study of case notes of pediatric deaths and all pediatric autopsies in the preceding 10 years, noting clinical diagnosis and requests for autopsies and its outcome, and comparing it with pathological diagnosis. Settings: The study was conducted in the departments of pediatrics and histopathology of the University of Nigeria, Ituku-Ozalla campus. Results: There were 1962 deaths with 12 autopsies performed within the period of study. Evidence of request for a postmortem was documented in only four case notes whereas reasons for decline or otherwise were also not noted. There was a 100% correlation of pathological and clinical diagnosis from the available case notes. Conclusions: Autopsies of pediatric patients are almost nonexistent in a university teaching hospital, resulting to poor utilization by physicians. A follow-up study is required to ascertain and manage the cause of the apathy displayed by the attending physicians to the usefulness of autopsies in patient care.
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Anthropometric variables in relation to risk of breast cancer in Nigerian women p. 132
Chinedu C Okoli, Uzoamaka R Ebubedike, Stanley N C Anyanwu, Chinemelum D Emegoakor, Gabriel U Chianakwana, Eric Ihekwoaba, Ochomma A Egwuonwu, Henry Nzeako
DOI:10.4103/ijmh.IJMH_35_19  
Background: Breast cancer is the most prevalent cancer and the second leading cause of cancer death among women, and understanding how obesity impacts this disease has important public health implications. Materials and Methods: This study was a prospective study that involved 100 participants managed for breast diseases from May 2015 to April 2017 at Nnamdi Azikiwe University Teaching Hospital, Nnewi (NAUTH). All the participants were formally diagnosed using clinical evaluation and core tissue biopsy. Waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), height and weight were measured, subsequently body-mass index was estimated as a ratio of an individual’s weight (kg)/height (m2). Results: The mean age (SD) of the subjects was 41.6 (9.3) years; all the participants were women. The mean (SD) body-mass index, WC and WHR of all the participants were 27.57 (6.85) kg/m2; 87.70 (16.36)cm and 0.87 (0.07) respectively. The mean (SD) body-mass index of pre-menopausal and post-menopausal were 26.52 (6.62) kg/m2 and 30.60 (6.71) kg/m2 respectively. The mean (SD) WHR of pre-menopausal and post-menopausal were 0.87 (0.06) and 0.90 (0.08) respectively, whereas the mean (SD) WC of pre-menopausal and post-menopausal were 85 (15.0) cm and 94.85 (17.97) respectively, thus individuals who were older were more likely to be overweight or obese than younger persons. Conclusion: This study findings emphasize the importance of considering wide WC and high WHR while implementing risk reduction strategies of breast cancer in younger women. Future studies to elucidate the significance of this findings in larger cohorts are needed.
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Relationship of placental diameter and thickness versus fetal growth biometrics: A cross-sectional sonographic evaluation of antenatal women in Enugu, Southeast Nigeria p. 138
Ozoemena Joseph Ogbochukwu, Ngozi Regina Dim, Amaka Obiageli Nnamani, Ngozi Rosemary Njeze, Emmanuel Nebeuwa Obikili, Cyril Chukwudi Dim
DOI:10.4103/ijmh.IJMH_39_20  
Background: The placenta is a feto-maternal organ that plays a vital role in normal fetal growth and perinatal outcome. Sonographic studies have shown that placental diameter (PD) and thickness (PT) increase linearly with gestational age, and may have relationships with fetal parameters and estimated weight. Aim: To determine the relationship between PT and PD with fetal biometric parameters and estimated weight, as well as establish a model for estimating birth weight from these placental parameters. Materials and Methods: This was a cross-sectional study of 400 antenatal women with normal, third-trimester, singleton pregnancies at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu. Ultrasound was used to evaluate their PD and PT. Fetal weight was estimated (EFW) using fetal biparietal diameter, abdominal circumference and femur length. Data were analyzed with SPSS, version 20. Results: The mean PD of participants before 37 weeks of gestation (183.8 ± 8.7 mm) was significantly shorter than that of participants at term (205.7 ± 2.5 mm), P < 0.001. For PT, the mean values for participants before term and at term were 36.3 ± 2.4 mm versus 43.2 ± 1.0 mm, respectively, P < 0.001. There were varying positive correlations between each placental parameter and the three fetal biometric parameters. Both PD and PT had a high positive correlation with EFW (P < 0.001). Regression analysis predicted fetal weight using PD and PT. Conclusion: PD and PT showed a high positive correlation with fetal weight and can be used as a sonographic parameter in estimating fetal weight.
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CASE REPORT Top

Neonatal necrotizing fasciitis: Two case reports and literature review p. 144
Herbert A Obu, Ijeoma Obumneme-Anyim, Kenechukwu K Iloh, Uzoamaka C Akubuilo, Obinna R Okwesili, Uche J Achebe
DOI:10.4103/ijmh.IJMH_5_20  
Necrotizing fasciitis is a severe infection of the deep soft tissues, which results in a progressive necrosis of the muscle fascia and overlying subcutaneous fat. It occurs less frequently in children, where it’s most likely associated with depressed or suboptimal immunity. Prompt diagnosis and aggressive multidisciplinary management will reduce morbidity and mortality. We present two cases of neonatal necrotizing fasciitis managed in our facility to create awareness of such rare cases in our environment.
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