Background: Neonatal mortality is a major reason for the persistence of high infant and childhood mortality in the developing world. Frequent determinations of the factors associated with neonatal mortality are desirable for effective planning of interventions aimed at reducing neonatal mortality rates. Objective: To determine the trend in neonatal mortality in a teaching hospital over a ten-year period. Methods: The records of neonates admitted into the neonatal unit of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu between January 1996 and December 2005 were reviewed. Data extracted from the records included age, sex, weight, place of birth, major clinical diagnoses and outcome of admission. " Results: Out of a total of 2,933 neonates admitted into the unit, 773 deaths occurred (263.6/ 1000 admissions). These consisted of 168 (21.7 percent) in-born and 605 (78.3 percent) out born babies. Of these 773 deaths, 559 (72.3 percent) were early neonatal deaths (END) and 74.8 percent of these occurred within the first 24 hours of admission. Low birth weight babies constituted 67.4 percent of these deaths. The mortality rate among in-born babies was significantly lower than that of out-born babies (14.8 percent vs 33.5 percent; p = 0.00000). The neonatal mortality rate (NMR) for the hospital ranged between 25.6/1000 live births and 72.4/1000 live births. The mortality rate for out-born babies was 336.5/1000 admissions. The leading clinical conditions associated with neonatal deaths were preterm births (38.7 percent), perinatal asphyxia (25.1 percent), septicaemia (10.5 percent), neonatal hyperbilirubinaemia (9.9 percent) and tetanus (7.9 percent). Conclusion: Neonatal mortality in the hospital was high over the ten-year period studied. Facilitated access to quality obstetric and immediate post-delivery neonatal care is required to improve neonatal survival in Nigeria.

Background: Perinatal and neonatal mortality rates have been described as sensitive indices of the quality of health care services. Regular audits of perinatal and neonatal mortalities are desirable to evaluate the various global interventions. The objective was to describe the current pattern of perinatal and neonatal mortality in a Nigerian tertiary health facility. Materials and Methods: Using a prospective audit method, the sociodemographic parameters of all perinatal and neonatal deaths recorded in a Nigerian tertiary facility between February 2017 and January 2018 were studied. Results: There were 1019 deliveries with stillbirth rate of 27.5/1000 total births and early neonatal death (END) rate among in-born babies of 27.2/1000 live births. The overall perinatal mortality rate for in-facility deliveries was 53.9/1000 total births and neonatal mortality (till 28 days of life) rate of 27.2/1000 live births. Maternal characteristics included unbooked status (88.2%), at least secondary education (75%) and lower socioeconomic status (80.8%). Severe perinatal asphyxia (36.8%), prematurity (36.8%), severe hyperbilirubinaemia (8.8%), congenital malformations (5.9%) and tetanus (2.9%) were the causes of neonatal deaths while obstructed labour (25.0%) and intra-partum eclampsia (21.4%) were the two leading maternal conditions associated with stillbirths. Gestational age < 32 weeks, age < 24 hours and inborn status were significantly associated with END (p = 0.002, p <0.001 and p = 0.002 respectively). Conclusion: The intra-facility perinatal mortality rate was high though stillbirth rate was relatively low. This poses a challenge for the achievement of the Sustainable Development Goals in Nigeria.

Background: Childhood growth is characterized by changes in anthropometric parameters. The location of the apex beat may besimilarly influenced by growth.Objectives: The objective of this study was to determine any relationshipbetween the location of the apex beat and anthropometric parameters.Subjects and Methods: This crosssectional survey was carried out inSagamu, Nigeria. Apparently healthy children were randomly selected for the study. Apex beat location in the intercostal space was determined and distance from the midline was recorded. Weight and length/height were also recorded while Body Mass Index (BMI) and Body Surface Area (BSA) were calculated.Results: A total of 237 children aged 12 hours to 10 years were surveyed.The mean distance of the apex beat from the midline from birth to 10 years ranged from 2.3cm to 6.4cm. The mean distance of apex beat from the midline increased progressively with weight, height, chest circumference and BSA but not with BMI. Strong correlations were observed betweendistance of apex beat from the midline and weight (r = 0.850, p .0.001); height (r = 0.867, p .0.001); chest circumference (r = 0.833, p . 0.001); BSA (r = 0.862, p . 0.001) but not with Body Mass Index (r = 0.019, p = 0.774).Conclusion: The location of the apex beat in children was stronglyinfluenced by growth as suggested by anthropometric parameters.Key words: Anthropometry, apex beat, children, mid-clavicular line,nipple line

Background: Burns constitute a major cause of childhood trauma. There is a need for inexpensive and more effective alternative healing agents, especially in developing countries. Objectives: To compare the rates of healing of burns dressed with either silver sulphadiazine (SSD) or crude undiluted honey and compare the relative costs of both modes. Methods: The studywas carried out at the Wesley Guild Hospital, Ilesa. Twenty seven children with comparable partial thickness burns were prospectively studied for healing of their burn injuries. They were randomly allotted to two treatment groups of dressing with either SSD or crude undiluted honey. The burns sites were assessed clinically on the 3rd, 7th and 21st days for sloughs, exudates, eschars, granulation tissue and epithelialisation. The duration of hospitalisation for each child as well as the quantity and costs of the dressing agents were also documented. Results: Honey-treated burns demonstrated quicker healing with faster wound granulation and epithelialisation. The duration of hospital staywas significantly shorter in patients treated with honey than in those treated with SSD (t = 3.06, p = 0.005). Direct cost of the SSD used was 9.75 times that of the honey. Conclusions: Honey appears to be a superior dressing agent for partial thickness burns than silver sulphadiazine in terms of efficacy and cost. We therefore recommend honey for the dressing of partial thickness burns, particularly in tropical countries where it is readily available and the majority of the people are poor. Enhancement of apiculture should make honey therapy of burns victims much cheaper still.

Background: Most deliveries in the developing world take place outside the hospital with poor assistance for the newborn. This puts the babies at risk of severe intrapartum events such as perinatal asphyxia. Most newborn babies admitted in tertiary centres with severe asphyxia are referred.Objectives: To determine the socio-demographic and clinical correlates of the perinatal outcome of neonates referred to a Nigerian tertiary facility on account of severe perinatal asphyxia.Methods: A prospective crosssectional study was conducted at the Children’s Emergency Room and Neonatal Ward among newborn babies referred with severe asphyxia. Socio-demographic and clinical parameters were recorded and statistically analysed.Results: A total of 72 mother infant pairs were studied. Half of the babies were admitted after 24 hours of birth and 75.0% of the families belonged to the lower socio-economic classes. Only 62.5% of mothers received antenatal care at orthodox health facilities. Most of the deliveries tookplace at private hospitals (29; 40.3%) and Traditional Birth Homes (18; 25.0%). Hypoxic- Ischaemic encephalopathy (HIE) was diagnosed among 57 (79.2%) babies with 46 (80.7%) and 11 (19.3%) classified as Stages II and III HIE respectively. There were 15 (20.8%) early neonatal deaths giving a perinatal mortality rate of 208.3/1000 admissions. The poor perinatal outcome was associated with age at admission within 24 hours, poor intrapartum careseeking behaviour and the commencement of feeding before admission .Conclusion: The quality of antenatal care, intrapartum care, and delivery services appear to influence perinatal outcomes among referred babies with severe asphyxia. Keywords: Asphyxia, Hypoxic-Ischaemic Encephalopathy, Intrapartum care, Perinatal mortality, Out-born

Background: Childhood poisoning is an important cause of childhood morbidity and mortality, especially in children below five years of age. There is an increase in the range of household poisoning agents, particularly cheap hydrocarbon domestic fuel such as kerosene (paraffin). Objective: To describe the epidemiology of poisoning in the paediatric age group in a tertiary facility in Southwest Nigeria. Materials and Methods: This was a retrospective study covering the period from January 2013 to December 2018 at the Olabisi Onabanjo University Teaching Hospital, Sagamu Ogun State, Nigeria. Relevant data were extracted from patient’s records for analysis. Results: Out of the 2,881 admissions into the Children’s Emergency Room during the study period, 40 (1.4%) reported on account of poisoning but only the records of 31 were available for analysis. The male to female ratio was 2.1:1.The median age was 7.8 years. The case fatality rate was 3.2%. Kerosene was the leading agent of poisoning (17; 54.8%) and palm oil was the most frequently administered home remedy. Dyspnea was the most common presenting symptom. Only one death (3.2%) was recorded. Conclusion: Poisoning is a problem of young children and it frequently occurs in the home setting. Therefore, efforts should be targeted at educating caregivers about the dangers of poisoning in young children.

Background: Normal values of haematological parameters are often required to assist with diagnosis and monitoring. Objective: To determine the haematological indices of apparently healthy term babies on the first day, third day and sixth week of life. Method: A longitudinal survey of the haematological parameters of apparently healthy Nigerian term infants was carried out between October 2007 and March 2008 using electronic devices. Results:On the first day of life, the mean values were 46.3% for packed cell volume (PCV), 10.8 × 10 /L for total white blood cell (TWBC) and 261.3 × 10 /L for platelets. The mean values obtained on the third day of life. includedPCVof 43.3%,TWBCof 10.7 × 10 /L and platelets count of 242.5 × 10 /L. In the sixth week of life, the mean values of PCV, TWBC and platelets count were as follows: 32.0%, 8.8 × 10 /L and 277.7 × 10 /L respectively. The mean percentage neutrophil counts and lymphocyte counts were 56.8% and 38.7% respectively on the first day but were reversed to 4.6% and 63.4% respectively on the sixth week of life. Conclusion: The mean values of the PCV and TWBC were highest on the first day of life and lowest in the sixth week of life whereas the mean values of platelets count showed a less consistent pattern over the same period.

Summary: A case of prolonged severe hyperbilirubinaemia associated with persistent hypoglycaemia, features of proximal renal tubular defect and failure to thrive in a male preterm, low birth weight infant who was admitted at the age of 52 hours, is reported. Although the management was hindered by lack of diagnostic facilities, the positive outcome of a therapeutic trial with lactose-free diet was suggestive of galactosaemia. This case is being reported to create awareness of this clinical condition.

Background: Information on the Baby Friendly Hospital Initiative (BFHI) appears to be limited to tertiary health facilities to which most women lack access. Similar information on . the initiative from non-tertiary health establishments should also be useful Objective: To compare breastfeeding practices of mothers in Ilesa, with their exposure to the BFHI. Methods: A cross-sectional survey. Mothers of children aged from birth to 24 months were interviewed using an open-ended questionnaire. Their awareness of the BFHI and previous contacts with u “Baby Friendly” hospital were compared with the time of commencement of breastfeeding, pre-lacteal feeding, exclusive breastfeeding and age of their children at the commencement of complementary feeding and at cessation of breastfeeding. Results: Out of the 262 mothers studied, 200 (76.3 percent) were aware of the baby friendly initiative (BFI). One hundred and four mothers (39.7 percent) had had contact with a “Baby Friendly." hospital. Previous contact with a “Baby Friendly” hospital was associated with the commencement of breast feeding within one hour of birth (p=0.000000), lower rate of pre lacteal feeding (p=0.000000) and higher rate of exclusive breastfeeding for the first six months of life (p=0.000005). Mothers who were aware of the BFI but had no contact with a “Baby Friendly” hospital had significantly lower incidence of commencement of breastfeeding within one hour of birth (p=0.00000) and exclusive breastfeeding (p=0.00006) compared with those , who had contact with a “Baby Friendly Hospital. Conclusion: Previous contact with a “Baby Friendly” hospital confers an advantage in terms of appropriate breastfeeding practices. The involvement of the communities in the BFI may further enhance these practices.

Background: Babies are classified according to the relationship between birth weight and gestational age, the latter being the strongest determinant of birth weight. Small-for-gestational age (SGA) babies have birth weights less than the 10th percentile for age and sex or more than two standard deviations below the mean for age and sex.Objective: The study was carried out to investigate the maternal factorsassociated with the delivery of term small-for-gestational age babiesin a Nigerian Hospital.Methods: In the cross-sectional survey, the anthropometric parametersof term singleton infants were related to maternal age, parity, socio-economic class, anthropometry and medical disorders in pregnancy.Results: A total of 825 babies were surveyed within the first 24 hoursof life. The mean birth weight of babies was 3233 ± 539g. The males had significantly longer mean crown-heel length and mean occipitofrontal circumference compared to females p = 0.048 and p < 0.000 respectively). The prevalence of infants with small-for-gestational age was 7.2% (5.7% and 8.8% among males and females respectively). The proportion of mothers who did not encounter significant illness in pregnancy was lowestamong those who had SGA babies, followed by mothers of LGA babiesand those of AGA babies in that order. With respect to maternal age,weight, height and body mass index (except inter-pregnancy interval),mothers of SGA babies had significantly lower values compared tomothers of the AGA and LGA babies (p < 0.03).Conclusion: This study identified age, parity, anthropometry and hypertension-related disorders as major maternal factors associated withthe birth of SGA babies in Nigeria.Keywords: Anthropometry, Intrauterine growth restriction, maternal illness, Nigeria.

Background: Neonatal hypoglycaemia is a major metabolic problem. It may result in mortality or severe handicap among survivors. Many babies admitted for neonatal care are at high risk for hypoglycaemia. The present study set out to determine its point-of-admission prevalence, clinical presentation and outcome. Methods: Consecutive neonates who met the study criteria had plasma glucose determined at admission into the special care baby unit of Wesley Guild Hospital. Hypoglycaemia was defined as plasma glucose of 2.5mmol/L. Babies with and without hypoglycaemia were compared for risk factors, clinical features and outcome. Results: A total of 150 neonates were studied out of which 49 (32.7%) had hypoglycaemia. The mean age, 38.3 ± 71.6 in hours was significantly lower among neonates with hypoglycaemia than those without hypoglycaemia [p = 0.006]. Low socio economic class (p = 0.034), admission weight less than 2500g ( p = 0 . 0 0 9 ) , hypothermia (p = 0.001) and preterm birth (p = 0.020) were significantly more common in babies with hypoglycaemia. Poor suck (p = 0.010), cyanosis (p = 0.020), convulsion (p = 0.040) and pallor (p = 0.048) were also more common among babies with hypoglycaemia. The mortality rate in babies with hypoglycaemia was 32.7%, higher than 18.8% in babies without hypoglycaemia but the difference was not statistically significant (p = 0.060). Conclusion: Hypoglycaemia is common among high-risk neonates and is often associated with morbidity and mortality. Routine monitoring of blood glucose is therefore recommended for this class of babies.

Background: Infections are the leading causes of death in children. Most of these infections are transmitted through the hands of mothers, carers and health workers.Objective: To determine the pattern of home-based hand hygiene practices among mothers of young infants attending a tertiary facility clinic in relation to infections in their infants.Methods: A cross-sectional study of mothers of infants attending an immunization clinic was conducted using a self-designed, pretested questionnaire.Results: The mean age of the 203 mothers was 30.3 ±3.8 years. The majority of the mothers received counselling about hand washing as part of antenatal care (79.8%), had access to water at home (94.0%) and always washed hands with water and soap (48.3%). Although 149 (73.4%) knew hand sanitizers, only 28 (13.8%) used it. Close to half of their infants (46.3%) had various infections (diarrhoea, acute respiratory infections, and boils) within a month of the interview. Only counselling was associated with good quality hand washing practices (p<0.0001) while the age of child less than 6 months and good quality of hand washing were associated with the absence of infections in the infants (p = 0.029 and p<0.0001 respectively).Conclusion: Half of the cohort of mothers practiced good quality hand washing but with poor use of hand sanitizers. With various infections recorded in close to half of their infants, it is important to emphasise better hand washing techniques and improve access to alcohol-based hand sanitizers. Key words: Alcohol-based Hand sanitizers, Hand hygiene, Hand washing, Infants, Infections, Sagamu.

Background: Sepsis contributes significantly to newborn deaths in Nigeria. A significant proportion of severe infections in the newborn may be health care-related.Objective: To determine the prevalence, types and risk factors for nosocomial infections in the Special Care Baby Unit of a Nigerian Tertiary Hospital.Method: A cross-sectional survey of consecutively admitted infants aged 0 to 28 days with signs of infections or who developed signs of infection following admission. Infants with or without nosocomial infections were compared for the clinical and laboratory details.Results: Out of 356 infants, 32 (8.9%) had between 1 and 3 nosocomial infections while 48 (13.5%) had community-acquired infections. Half of babies with nosocomial infections were preterm and weighed less than 2kg. A significantly higher proportion of babies with nosocomial infections were inborn (p < 0.000) and stayed longer than 7 days on admission (p = 0.034). Bacteraemia was significantly more frequent among babies with nosocomial infections (p = 0.014) while superficial skin and mucosal infections occurred to similar extents in both groups. Klebsiella and Proteus species were the leading isolates among babies with nosocomial infections. Nasogastric intubation was significantly more frequently performed among babies with nosocomial infections (p = 0.045).Conclusion: The present study revealed that hospital acquired infection is an important cause of morbidity in the newborn unit.Keywords: Bacteraemia; Hospital-acquired infections; invasive procedures;newborns

Background: Frequent changes in the political, economic and health policies which may influence the purchasing powers of the populace may also make it difficult for the average family to pay hospital fees and culminate in a tendency to premature termination of medical care. Objectives: To describe cases of paediatric discharges against medical advice seen at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu. Patients and Methods: A retrospective study of the records of children who were discharged against medical advice from January 1995 to December 2004 at the OOUTH, Sagamu, was carried out. Data extracted from the case notes included age, sex, clinical diagnosis, parental occupation, duration of hospital stay, reason(s) for, and signatories to DAMA Results: The yearly prevalence of DAMA fluctuated with no consistent pattern, ranging from 2.1 to 5.0 percent with a mean of 3.3 percent, of paediatric admissions. The median age was 365 days and the male to female ratio was 1.4:1. The median duration of hospitalization prior to DAMA was four days. Majority (92.1 percent) of the children belonged to the low socioeconomic classes. The signatories to DAMAwere mostly mothers (80.2 percent). Financial constraints in 61.9 percent were the commonest reasons for DAMA. Neonatal conditions, malaria and respiratory disorders were the main clinical diagnoses accounting for 28.5, 20.1 and 9.0 percent, respectively. Conclusion: Conscious effort must be made by government to create an enabling environment for financial empowerment of families. Hospitals should have avenues of defending the rights of children to life and health.

Neonatal Jaundice (NNJ) is one of the commonest causes of neonatal morbidity and mortality in the developing world. The physiological form of NNJ occurs in about two thirds of newborns. In addition to this however, are the various pathological forms which apart from being potentially fatal if not well managed, are often very difficult to differentiate from the benign physiological form, except with detailed laboratory investigations. Although the pathological forms of NNJ are ordinarily beyond the facilities usually available to General Practitioners (GPs) in developing countries, it is important that these GPs and the health workers at the primary health care level be well informed about NNJ since they are usually the first set of practitioners to receive babies with this illness. For better case management and reduction of mortality in NNJ, GPs should be able to sort babies with NNJ and manage them according to the severity of the illness. Mothers should be educated against harmful traditional practices which may provoke severe NNJ like the home use of naphthalene-containing balls. Home treatment of NNJ with the various local remedies should also be discouraged since these may not be helpful and may inadvertently cause them to seek medical advice late, with the attendant grave consequences. Nigerian Journal of Paediatrics Vol.31(2) 2004: 33-38

Background: Exchange Blood Transfusion (EBT) is a form of massive blood transfusion mostly used to treat severe hyperbilirubinaemia and anaemia in the newborn period. Hypocalcaemia is a known complication of EBT hence the practice of prophylactic administration of intravenous calcium. Objective: To compare the prevalence of post-EBT hypocalcaemia among babies who received prophylactic intravenous calcium and babies who received a placebo. Materials and Methods: A randomized placebo-controlled trial among hospitalized babies who required EBT for hyperbilirubinaemia in a Nigerian tertiary facility was done. Following strict methods of randomization, some babies received prophylactic calcium (calcium group) while the others received sterile water (placebo group) during EBT. Serum calcium was measured pre- EBT and at six and 24 hours post- EBT. Results: All the 16 and 13 babies recruited into the calcium and placebo groups had double volume EBT. Babies in both arms of the study were comparable in terms of age, body weight and EGA. The mean serum calcium levels pre- EBT and at six hours and 24 hours post-EBT were 8.1 ± 1.6mg/dl, 8.2 ± 1.1mg/dl and 8.4 ± 1.1mg/dl respectively for the calcium group and 8.6 ± 2.6mg/dl, 9.0 ± 1.6mg/dl and 9.1 ± 1.7mg/dl for the placebo group. The prevalence of hypocalcaemia at six hours post-EBT was 37.5% and 15.4% in the calcium and placebo groups respectively. Conclusion: The study did not demonstrate a clear role of prophylactic intravenous calcium therapy during EBT in the prevention of hypocalcaemia. It may be safer to screen for hypocalcaemia and treat it appropriately.

background: Neonatal jaundice may be caused by physiological events and/or as specific disease conditions, while the clinical course may be related to the aetiology. Objective: To determine the spectrum of identifiable causes as well as the clinical course of jaundice among hospitalized babies. Methods: Babies hospitalized with jaundice requiring therapy in a tertiary hospital were prospectively studied for the aetiology and the pattern of total serum bilirubin (TSB). Babies with unexplained jaundice were compared with babies in whom the aetiology was known. Results: Jaundice was unexplained in 51 (20.6 percent) of 248 babies aged 0 to 240 hours, while 50 (20.2 percent) had various combinations of prematurity, blood group incompatibilities, Glucose-6-phosphate dehydrogenase (G6PD) deficiency and septicaemia. Babies with G6PD deficiency had the highest mean peak TSB (26.3 + 9.0mg/dl), those with Rhesus incompatibility had their peak TSB earliest (5.7 + 0.8 days), while the mean duration of phototherapy was longest in babies whose jaundice was due to prematurity (10.4 + 0.9 days). Exchange blood transfusion (EBT) rate was highest among babies with Rhesus incompatibility (100.0 percent) and G6PD deficiency (70.3 percent). Preterm infants tended to have multiple EBT sessions compared to term infants (p < 0.001). Bilirubin encephalopathy was most frequent among babies with G6PD deficiency (62.1 percent). Conclusion: There appears to be a pattern of clinical events which are peculiar to the specific aetiology of newborn jaundice.

Background: Normal location of apex beat varies with age in children. Location of apex beat is an integral part of routine cardiovascular system examination in clinical practice. However, there is paucity of literature on apex beat location in Nigerian children. Objective: The aim of this study was to locate apex beat position in apparently healthy Nigerian children from birth to ten years, and to relate the location with age. Subjects and Methods: This was a cross sectional study carried out in Sagamu, Nigeria. A sample size of two hundred and thirty-seven was calculated from a previous study. Hence two hundred and thirty-seven apparently healthy Nigerian children who satisfied the inclusion criteria were enrolled for the study. Apex beat location in the intercostal space was determined and distance of apex beat from the midline, midclavicular line and nipple lines were measured. The measured distances were related to age using linear regression and Pearson correlation. Results: The mean distance of apex beat from the midline from birth to 10 years ranged from 2.3cm to 6.4cm. The distance of apex beat from the midline increased progressively with age. In children up to the age of three years, the apex beat was in the 4th left intercostals space. In 91.7%, 51.3% and 14.3% of children aged four, five and six years respectively, the apex beat was present in the 4th left intercostal space. Above six years, it was located in the 5th left intercostals space. Conclusion: The location of the apex beat from the midline was strongly related with age Thus, the distance of apex beat from the midline can be predicted from age in months.

Summary: Prune belly is a rare congenital anomaly. that is commonly seen in males. We report two male cases and a phenotypic female with absent abdominal wall musculature that were seen within one year at the Olabisi Onabanjo University Teaching Hospital, Sagamu. These cases are reported to create a better awareness of this disorder in this environment. This, to our knowledge, is the first report of prune belly syndrome in our centre. Maternal age, the precise aetiology is uncertain. However, sex influenced autosomal mode of inheritance has been suggested. 8, 9 While there have been reports of this syndrome from Ibadan, the exact incidence in Nigeria is unknown. It is probably rare but it is also likely that some cases are missed in clinical practice due to poor awareness and constraints in investigation, In view of this, we are reporting three cases of prune belly syndrome seen in Sagamu, within a period of one year.

Background: Early recognition of symptoms of malaria and commencement of appropriate and effective therapy are vital elements of the Roll Back Malaria Initiative which is aimed at reducing the impact of malaria. Objective: To determine the influence of the socioeconomic status of mothers on their knowledge of the symptoms of malaria and its management in their children. Design: Prospective, hospital-based survey. Methods: Mothers of under-five children with fever were tested for their ability to recognize the symptoms of malaria by asking them the question "what do you feel is the problem with your child?” Semi-structured questionniars were administered to those who correctly made the verbal diagnosis of malaria, seeking information on the various forms of treatment they gave their children before presentation in the hospital. Mothers in the upper and lower social classes were statistically compared in terms of antimalarial drug usage before presentation, sources of drugs given to children with suspected malaria and their knowledge and attitude to intramuscular injections. Results: Two hundred and eight (84.6 percent of the 246 mothers studied had administered drugs to their children at home before presentation at the hospital. Early presentation in the hospital (p< 0.0001), drug administration within 24 hours of onset of symptoms (p<0.0001) and disapproval of intramuscular injections (p=0.017) were significantly higher among mothers from the upper social class. Conversely, procurement of drugs from primary health centres (p=0.006), polypharmacy(p= 0.0005), use of poorly formulated branded products (p=0.005) and injections received prior to hospital visit (p=0.02) were significantly higher among respondents from the lower social class. Conclusion: Low socio-economic status is associated with poor management of a child with malaria. It is also associated with practices that may encourage parasite resistance and treatment failure.