Investment Opportunities in Nigeria: Economic Potential & Population Trends
Nigeria presents significant investment opportunities in various sectors such as oil and gas, agriculture, renewable energy, and tourism. With a growing population and abundant natural resources, Nigeria is poised to become a key player in the global economy. The country's economic potential, coupled with its strategic location and workforce, makes it an appealing destination for investors looking to capitalize on emerging markets in Africa.
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Presentation Transcript
Critical issues in feeding LBW infants in Nigeria OLUKEMI TONGO MB.ChB, FWACP COLLEGE OF MEDICINE UNIVERSITY OF IBADAN
OBJECTIVES THE BURDEN OF LOW BIRTH WEIGHT IN NIGERIA IMPORTANCE OF NUTRITION IN LBW BABIES EVIDENCE BASED FEEDING PRACTICES IN LBW FEEDING GUIDELINES FOR LOW BIRTH WEIGHT BABIES IN NIGERIA CRITICAL ISSUES REGARDING IMPLEMENTATION OF EVIDENCE BASED FEEDING GUIDELINES IN NIGERIA
BURDEN OF LBW IN NIGERIA Global LBW rate 15% >20million LBW babies born annually 96% in developing countries LBW rate in Nigeria is 14% (7 15%) Preterm birth rate in Nigeria 12% NMR is 34/1000 live births 31% of neonatal deaths due to prematurity 80% of neonatal deaths occurred in LBW babies
Importance of nutrition in LBW Emphasis on nutrition in Preterm/LBW not misplaced Nutrition is the single greatest environmental influence on growth and development of babies in the womb, during infancy and first 2 years of life Nutrition is emerging as a potential factor to improve growth and overall outcomes of individuals LBW babies are either preterm or IUGR
Importance of nutrition in LBW IUGR babies already nutrient depleted! Prematurity is associated with a lot of critical illness with potentials for impaired long term outcomes or mortality Optimising nutrition early in preterms; Reduces post natal growth restriction Potential avenue to mitigate the adverse consequences of critical illness on brain health
Importance of nutrition in LBW It has been shown that greater energy and enteral feeding during the first 2weeks of life predicted more robust brain growth and accelerated white matter maturation This results ultimately in long lasting improvements in neurodevelopmental outcomes Evidence keeps emerging on the epigenetic effects of early nutrition on programming for later development of cardiovascular diseases, overweight, obesity, diabetes and other chronic conditions
Importance of nutrition in LBW Early enteral feeds in very preterms have been shown to; Reduce late onset/HAI infections Reduce all cause mortality Reduce length of hospital stay
Evidence based feeding practices in LBW Aim of various Preterm/LBW feeding guidelines is to: Start early Advance safely Use the best nutrient possible Human breastmilk Fortify for optimal nutrient intake, Measures to improve feed tolerance and reduce NEC and LOS Reduce length of hospital stay
Evidence based feeding practices in LBW Total perenteral nutrition prior to establishment of full enteral feeds To prevent catabolism and negative nitrogen balance Amino acid infusion from day 1DOL Lipids for brain growth Parenteral lipids from day 1 Micronutrient supplements Water and fat soluble vitamins Calcium, phosphorus and trace elements Electrolytes
Evidence based feeding practices in LBW Promote gut maturity and feed tolerance Trophic feeds to very preterm/very low birth weight Gradually advance to reach full enteral feeds by end of week 1 Human breastmilk is preferred mothers own milk, donor breastmilk Any milk preferred to no milk (preterm formula) Recently buccal (oropharyngeal) colostrum till baby is able to feed by mouth Probiotics to modify gut microbiome (? best )
Evidence based feeding practices in LBW WHO feeding guidelines along these lines Adapted for developing countries but evidence from high and middle income countries Feeding guidelines for babies > 1.5kg Feeding guidelines for babies 1.okg 1.5kg
Critical issues concerning feeding practices for LBW babies in the Nigerian setting National guidelines? Yes for babies >1.5kg No for smaller babies Data scarce Practices vary across units
Critical issues concerning feeding practices for LBW babies in the Nigerian setting Poor referral system Impediment to early commencement of enteral feeds Need to encourage in utero transfer of preterm and very preterm babies Inadequate support for expression of breastmilk Limited facilities for safe storage of EBM when available issues with power supply Getting breastmilk as at when needed Addressing myths and misconceptions about breastmilk flow and contents
Critical issues concerning feeding practices for LBW babies in the Nigerian setting Non availability/affordability of fortifiers Is appropriate information available to all health care workers caring for preterms? Need to have formally trained lactation consultants Promotion and improvement in methods of some traditional practices surrogate mothers TPN not available or safe early introduction and rapid advancement of feeds to facilitate tolerance and achievement of full enteral feeds within the 2 week window
Critical issues concerning feeding practices for LBW babies in the Nigerian setting But there is a need to establish/document safety in this setting Use of fortifiers to promote growth ..is this what we need?, is big necessarily best for future outcomes? It is not readily available or affordable anyway! Use of probiotics to facilitate healthy gut flora and prevent infections . Are we there yet? How do we establish efficacy and safety? Which is the best specie for us?
Critical issues concerning feeding practices for LBW babies in the Nigerian setting Research into nutrition interventions for preterms urgently required to determine what is feasible at every level, affordable, efficacious and safe for immediate and long term health outcomes
