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Background: Smoking means the activity or habit of smoking cigarettes; this is very much common all over the world. The consumption of cigarettes in developing countries is increasing, while in the industrialized country is declining or static. Objective: The aim of the study was to estimate the prevalence of smoking among school children in Dhaka city. Material & Methods: This cross-sectional study was conducted in high schools of Dhaka city from June 2006 to December 2006. Students of classes VIII, IX and X were selected by random table selection. A total of 2474 participants were included in the study. The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 10.0. Results: The age of the study of children was between 12 to 18 years. Among the study children, 8(0.32%), 354(14.3%), 900(36.3%), 850(34.3%), 324(13.1%), 30(1.21%), 8(0.32%) belonged to 12, 13, 14, 15, 16, 17, 18 years of age respectively. Male and female students were 1876 (75.8%), 598 (24.2%) respectively. The prevalence of smoking among male and female students was 36.0% and 17.0% respectively. The prevalence was 32.0% and only 4.0% of the students are regular smokers combining boys and girls together. Only 06 (0.76%) did not want to leave smoking and 786 (99.24%) wanted to leave smoking. Conclusion: The prevalence was 32.0% among all students of this study. In boys, 36.0% were found smokers and in girls, 17.0% were smokers. Almost all (99.24%) students were willing to quit smoking in future. Adolescents should not be allowed to buy cigarettes for parents or family members.

Over the last few years, there is a rise in the use of button batteries(BB) in children’s toys and home appliances. Easy availability and small size of these batteries pose a significant risk of ingestion by small children which is exceedingly dangerous. After ingestion, the BB may lodge in the esophagus or enters easily into the stomach due to its variable sizes. If lodged in the esophagus, BB can cause injury due to their caustic and electric properties, as well as by direct pressure. In our case, the 16 months old boy had accidentally ingested a BB, removed approximately after 30 hours from the esophagus, had developed esophageal perforation followed by tracheaesophageal fistula, complications related to aspiration and finally expired due to bronchopneumonia with septicemia and respiratory failure. So, Prompt removal is mandatory to reduce devastating outcome if it is a button battery BANGLADESH J CHILD HEALTH 2021; VOL 45 (1) : 41-44

Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a major cause of mortality, morbidity and long-term neurological deficits. Objective: The aim of the study was to determine the severity of encephalopathy and immediate neurodevelopmental outcomes in term neonates with HIE admitted in NICU at a tertiary care hospital. Materials and Methods: This was a Prospective Cohort study conducted between July 2016 and June 2017 at Dhaka Medical college Hospital, Dhaka. Asphyxiated term newborns who came within 12 hours of birth were enrolled in this study. Sarnat and Sarnat score was used to assess newborns immediately after birth to classify HIE. Neurodevelopmental assessment was performed using age specific rapid neurodevelopmental assessment tool (RNDA) at and 3 months after discharge to identify impairment in specific developmental domains. We determined the relation between severity of HIE and clinical outcome. Results: 60 patients were included in this study and their mean duration of hospital stay was 7.19 ± 5.26 days. The majority, 40% had moderate HIE, followed by 33.33%, 26.67% that had mild and severe HIE respectively. A total of 20% died, and most of them had severe HIE (83.33%). Normal development was found in only 11.67% cases. Moderate and severe neurodevelopmental impairment (NDI) was found in 33.33% and 25% cases respectively. At discharge, the most severely impaired domains were speech, seizure, primitive reflex and behaviour whereas at 3 months of age it was gross motor and seizure. When neurodevelopmental outcome was compared with different stages of encephalopathy, significant association was found between moderate to severe impairment/death with stage III of HIE. Conclusion: Apart from mortality, a significant proportion of term neonates with HIE developed NDIs and adverse neurodevelopmental outcomes was significantly associated with severity of encephalopathy. Bangladesh Crit Care J March 2021; 9(1): 22-27

Airway foreign body aspiration (FBA)is a frequent problem that affects young children, present with acute respiratory distress and cough followed by sudden chocking. Prompt identification and early treatment can save the child from a life-threatening emergency.Delayed diagnosis due to lack of history and clinical suspicion may lead to permanent lung damage, which may be a curse for a lifetime.We share an experience of a 4½-year-old boy who presented with suppurative lung disease was associated with neglected FBA. Early diagnosis and intervention canprevent,and ultimately reduce long-term morbidity and mortality, along with improving the better outcome regarding FBA. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.208-211

Background: Nebulized salbutamol is commonly used in treatment of asthma in children. The use of nebulized MgSO4 is one of the different treatment options available during acute exacerbation. Objective: To compare the efficacy of nebulized MgSO4 with nebulized salbutamol in the treatment of acute asthma in children. Materials and method: This randomized controlled study was conducted in Dhaka Medical College Hospital between January to December 2016. Children of 7-12 years with acute exacerbation of asthma were randomized into study group-A (MgSO4 group, n=30) and control group-B (Salbutamol group, n=30). Children of both groups were treated with serial nebulization thrice at 20 minute intervals by either 2.4 ml (4% MgSO4, 96 mg) or salbutamol (0.15 mg/kg minimum 2.5 mg) with 2.5 ml of isotonic normal saline. Results: The mean final PEFR were not different between the two groups (275.0±41.42 L/min in MgS04 group and 263±36.17 L/min in salbutamol group). The increase in PEF was statistically significant and comparable in both groups (by 35.1% in the MgS04 group and by 42.1% in the salbutamol group). Fischl score improvement was comparable and significant in both groups (4.31 to 0.43 in MgS04 group and 4.29 to 0.76 in salbutamol group). Statistically significant increase in oxygen saturation and reduction of heart rate was found in MgS04 group without any side effects. Nebulized MgSO4 was found having significant bronchodilator effect which is comparable to salbutamol. Conclusion: Nebulized MgS04 was found equally effective as nebulized salbutamol in the treatment of severe acute asthma in children. Bangladesh J Child Health 2020; VOL 44 (1) :24-29

Background: Acute bronchiolitis is an acute viral lower respiratory tract infection of infants and is the leading cause of hospitalization of infants below 2 years of age. Being a viral disease, there is no effective treatment of this problem other than supportive care. To provide this care, both 0.9% normal saline with salbutamol and 3% hypertonic saline has been found effective. This study was undertaken to assess the efficacy of 7% hypertonic saline on recovery from acute bronchiolitis. Methodology: This was a randomized controlled trial, carried out in the Department of Paediatrics, Dhaka Medical College Hospital (DMCH), Bangladesh between January 2015 to December 2015. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted as acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 7% nebulized hypertonic saline (Group-I = 45) or to 0.9% nebulized normal saline with salbutamol (Group-II = 45). The efficacy was determined by assessing clinical severity score and length of hospital stay. Data were analyzed using computer software SPSS version 19. Result: In this study the two groups were almost similar with respect to their demographic and baseline clinical severity score. After intervention the clinical severity score of both treatment modalities were reduced (Group-I(HS) were 7.9, 6.8, 3.8, 1.4, 1.33 while in Group-II(NS+ Salbutamol) score were 8.6, 7.6, 4.9, 3.11, 2.12) but the reduction was significant more in children who received 7% nebulized hypertonic saline than those who received 0.9% nebulized normal saline with salbutamol. Majority 42(93.3%) of group-I(HS) children recovered at the end of 72 hours whereas 17(37.8%) of the children of group-II (NS+ Salbutamol) recovered from the disease during the same period. Length of hospital stay was shorter in hypertonic saline group compared to normal saline with salbutamol group (56.36±12.33 hours vs71.07±13.48 hours, p

Background: The present study was intended to make a comparison of acute kidney injury (AKI) diagnosed and classified by two diagnostic modalities such as paediatric Risk Injury Failure Loss of End Stage Renal Failure (pRIFLE ) criteria and acute kidney injury network (AKIN) staging .Methodology: A total 44 neonates (from 3 – 28 days) with AKI as case and other 26 neonates without AKI as control were also included in the study. Both were admitted in special care baby unit (SCABU) Dhaka Medical College Hospital.Results: The neonate of ≤7 days old comprised the main bulk. Majority of the neonates were of average birth weight. The diagnosis was based on estimated creatinine clearance (eCCL) criteria of pRIFLE showed that 40.9% neonates were at risk of AKI, 20.5% have had already injured. Higher proportions of neonates were classified as failure (38.6%).The diagnosis was based on Serum creatinine criteria of AKIN showed that about 64% of the neonates were at AKI-stage I, 22.7% at stage-II and 13.6% at stage-III. Higher proportions of neonates were classified as stageI.We found moderate agreement between pRIFLE criteria and AKIN staging, these two diagnostic modalities for diagnosis of AKI by kappa- statistics. Outcome of neonatal AKI predicted by pRIFLE criteria was significantly higher compared to AKIN staging (p < 0.001) in respect to SCABU stay, multiorgan failure, need for dialysis. Here 43% neonates with AKI were improved with normal renal function and 16% improved with impaired renal function. Increased frequency of death (34%) in this series was due to multiorgan involvement with acute kidney failure (AKF). Mortality was significantly higher (p=0.03) in failure group by pRIFLE criteria compared to AKIN stage III. So it is evident that pRIFLE criterions are highly sensitive to classify AKI, it is also superior to AKIN staging in predicting early diagnosis, need for intervention and immediate outcome.Conclusion: The study concluded that pRIFLE criteria and AKIN staging are useful in the diagnosis of AKI in neonates and pRIFLE criteria are fairly sensitive for better characterization of AKI.Bangladesh J Child Health 2017; VOL 41 (3) :147-154

Congenital pulmonary airway malformation (CPAM) is a very rare congenital cystic lung disease in children. Frequent respiratory tract infections (RTI) are major concerns in these patients. When a child having recurrent episodis of RTI, CPAM could be the underlying pathology. Surgical excision is recommended to make a definite diagnosis and exclude hidden malignancies and is also the treatment of choice. Here in, we report a 6 months old girl presenting with an acute respiratory infection for the first time. An routine USG of abdomen incidentally showed multiple cystic lessions in the left lower lung. CT scan of chest also revealed similar lessions in some area. After receiving treatment for pneumonia surgical excision was performed and she was doing well after surgeryBangladesh J Child Health 2017; VOL 41 (2) :129-134

not availableBangladesh J Child Health 2017; VOL 41 (1) :60-63

Melioidosis is a relatively uncommon but fatal infectious disease caused by the gram negative bacterium, Burkholderia pseudomallei which is usually found in the wet soil, mud and pooled surface water in tropic and subtropics. Documented reports of melioidosis from Bangladesh have been few and sporadic. All of the reported cases in Bangladesh were on adult. Melioidosis is commonly associated with underlying diseases like diabetes mellitus, renal diseases and immunodeficiency disorders. Early and correct diagnosis is important, as mortality in untreated melioidosis is high. Our patient, an eleven years old boy, a known case of diabetes mellitus, presented with fever for one month associated with right sided neck swelling, abdominal distension & pain for 10 days. He had an abscess on the right side of the neck and hepatosplenomegaly. Ultrasonography of abdomen showed multiple abscesses in the liver and spleen. Culture of pus drained from the neck abscess revealed growth of Burkholderia pseudomallei. After getting parenteral antibiotics and insulin, his abscesses gradually resolved and cured completely.Bangladesh J Child Health 2018; VOL 42 (1) :46-48

Introduction: Acute bronchiolitis is a condition where patients are presenting with breathing difficulties, cough, poor feeding, and irritability. Treatment of bronchiolitis have many controversies. Most trials of bronchiolitis treatment suffer from 2 constraints: possible inclusion of patients with asthma and inconsistent outcome measures. The aim of the study was to determine the efficacy of prednisolone in recovery from acute bronchiolitis who have a family history of atopy. Material & Methods: This randomized double blind placebo controlled trial (RCT) was conducted in the department of pediatrics Dhaka Medical College Hospital (DMCH) from July 2008 to June 2010. Sixty (60) bronchiolitis patients having family history of atopy were included in his study. Prednisolone and placebo were packaged in identical envelops with separate code number given by the guide and the code number were recorded in a preformed questionnaire. The trial was so planned that neither the parents nor the investigator were aware of group allocation. The collected data were analyzed thoroughly by SPSS program version of 16.0 software. Informed written consent from parents or legal guardians was taken and ethical clearance was obtained from the ethical review committee of Dhaka Medical College to conduct the research works. Results: In our study, mean age of the patients of this series were 3.68 months (±1.29SD) and 3.52 month’s (±1.1SD) in prednisolone and placebo group respectively. Use of accessory muscle score was assessed twice at 8 am and 8 pm each day for three days. On first assessment at day 1 the score was similar in both the treatment groups (P>.05). More people in Prednisolone arm recovered within 3 days then the placebo group. The difference is statistically significant (P

not availableBangladesh J Child Health 2015; VOL 39 (2) :99-101

not available DOI: http://dx.doi.org/10.3329/bjch.v38i3.22828 Bangladesh J Child Health 2014; VOL 38 (3) :164-168

not available DOI: http://dx.doi.org/10.3329/bjch.v38i2.21137 Bangladesh J Child Health 2014; VOL 38 (2) : 58-61

Background : Seizure is a common neurological disorder in neonatal age group. Primary metabolic derangement is one of the common reason behind this convulsion during this period. Among metabolic abnormalities, hypocalcaemia is most common followed by hypoglycemia and hypomagnesaemia. Objectives: The present study was carried out to assess calcium status in the serum of neonates with convulsion, where no obvious cause of convulsion was found. Methodology : This prospective case control study was conducted in the neonatal ward of Dhaka Medical College Hospital over one year from July 2003 to June 2004. A total of 50 neonates (1- 28 days) who had convulsion but no apparent reasons of convulsion had been found out, were enrolled as cases and 50 age, sex body weight matched neonates who had no history camalnia admitted cases of were enrolled as controls. After a quick clinical evaluation and control of convulsion and before giving any specific treatment serum calcium status was measured by colormetric determination (O- CRE-SOL Phahalein complex) method. Neonatal hypocalcemia is considered if serum calcium value less than1.75 mmol/L (7 mg/dl). Results: Among a total of fifty cases, 60% had hypocalcemia, and about 20% of controls also had low calcium level without any manifestation. The mean serum calcium level of cases and controls were 1.62 ± 0.29 and 2.07 ± 0.03 mmol/l respectively (p

Delayed first passage of meconium and also prolongation of meconium passage creates great anxiety among parents. Some study showed that that first passage of meconium is delayed in preterm infants compared to term infants. The difference in duration of meconium passage in term and preterm infant has however never been assessed before. This cross sectional study was carried between July 2010 to December 2010 among 100 Newborn babies ranging from 28 to 42 weeks of gestation who were delivered in the Department of Obstetrics and Gynaecology or admitted in the Department of Neonatology of Dhaka Medical college Hospital were included in the study. Gestational age was determined from first day of last menstruation (when available) and also by using Expanded Ballard Scoring System. In case of any discrepancy of more than 2 weeks, the later was accepted. This study was carrying out to determine the time of first passage of meconium and duration of passage of meconium in term and preterm infants. Out of total 100 infants, 58 were male and 42 were female. The numbers of babies were 21, 28, 25 and 26 in group I, II, III and IV respectively. The mean age at which the babies passed first meconium were 23.5±3.5, 33.0±3.8, 25.7±4.2 and 17.3±4.6 hours in group I, II, III and IV respectively, which was4 days was 32.6±4.3 weeks and this observation was statistically significant (p

not available DOI: http://dx.doi.org/10.3329/bjch.v38i2.21144 Bangladesh J Child Health 2014; VOL 38 (2) : 94-97

Background: Hand, foot and mouth disease (HFMD) is a common contagious disease among children under 5 years, particularly in the Asia-Pacific-region. We report a localized outbreak of childhood HFMD for the first time from Bangladesh, diagnosed only based on clinical features due to lack in laboratory-diagnostic facilities. Methods: Following the World Health Organization’s case-definition, we conducted a rapid-appraisal of HFMD among all of the 143 children attending Pabna Medical College and General Hospital with fever, mouth ulcers and extremity rash. Data were collected between September and November 2017 using a preset syndromic approach and stringent differential diagnostic-protocols. Results: The mean age of children was 2.9±2.3 years. There was a significant difference among the age and sex of children (P=0.98), first sibling being more belonging to middle-income families (62%). Younger children ( Conclusions: Our findings highlight potential usefulness in diagnosing HFMD based on clinical parameters, although stringent differential diagnosis remains indispensable, which is particularly applicable for resource-constrained countries lacking appropriate virology/essential laboratories. Since no specific treatment or effective vaccination is available for HFMD, supportive therapy and preventive measures remain the primary methods to circumvent disease-transmission augmented by climate-related factors. Standardized virology laboratory warrants appropriate diagnosis and globally representative multivalent-vaccine deem essential towards preventing HFMD.

Objective: To ascertain that antibiotics have no role in the management of bronchiolitis. Design: Multicentre randomized control trial (RCT). Setting: Five purposively selected teaching hospitals in Bangladesh. Patient: Children under 24 months old with bronchiolitis. Interventions: Children were randomized into three groups of therapeutic interventions: parenteral ampicillin (P-Ab), oral erythromycin (O-Ab) and no antibiotic (N-Ab) in adjunct to supportive measures. Main outcome measures: Clinical improvement was assessed using 18 symptoms/signs which were graded on a two-point recovery scale of ‘rapid’ and ‘gradual’, indicating improvement within ‘four days’ and ‘beyond four days’, respectively. Results: Each intervention group consisted of 98 ± 1 children having comparable clinico-epidemiological characteristics at the baseline. The trial revealed that most chesty features (features appearing to arise from chest, i.e. cough, breathing difficulty, wheeze, chest indrawing, tachypnoea, tachycardia, rhonchi and crepitation) demonstrated a gradual recovery, beyond 4th admission day and, not differing among the three intervention groups (p > 0.23, p 0.98, respectively). Most non-chesty features (features appearing to arise away from chest, i.e. feeding/sleeping difficulties, social smile, restlessness, inconsolable crying, nasal flaring, fever and hypoxaemia) demonstrated a rapid recovery, within 4 days, remaining comparable among the three intervention groups (p

Objective: Since the underlying mechanisms of febrile seizure (FS) having multi-factorial aetiology yet remains unclear, we conducted this prospectively designed cross-sectional study to determine if there was any simultaneous change in zinc (Zn) concentration (conc.) in serum and cerebrospinal fluid (CSF) among the FS children in comparison to their matched non-seizure febrile (NSF) peers. Methods: Zn concentration (level) in both serum (intravenous blood) and CSF (lumber puncture: LP) of 50 children with FS and 30 NSF peers (serving as control) were measured employing graphite furnace atomic absorbance spectrophotometer. Data were analysed to compare Zn level between two groups using appropriate statistical tools employing SPSS/Windows 12.0. Results: Mean Zn conc. in both serum and CSF was less in FS children (464.60 ± 64.57 and 46.28 ± 7.46, respectively) than their matched NSF peers (749.33 ± 73.19 μg/L and 111.28 ± 19.11 μg/L, respectively) showing significant differences both in serum (p < 0.001) and CSF (p < 0.001). None of serum or CSF-Zn differed significantly with age, degree and duration of fever between FS and NSF peers. CSF-Zn among these children showed an upward trend in LP specimen taken beyond 12 h following FS episodes. Conclusion and recommendation: Serum and CSF-Zn simultaneously decreased in FS children in comparison to their matched NSF peers. Further prospectively designed multicentral studies are recommended to conduct in geographically diverse regions involving larger sample to confirm or refute our findings. It remains crucial in standardizing/strengthening national seizure prevention protocol with adequate Zn supplementation.

This was an analysis of one hundred ten children with cerebral palsy (CP) attending at the Child DevelopmentNeurology Care Center of Dhaka Medical College Hospital during January 2002 to December 2003. These children were observed to study their clinical profile, etiological factors and associated problems. The mean age of these children was 2.9 +/- 2.9 years, mostly being males (n=79, 71.8%). Most of the families of these children belonged to poorer socioeconomic strata. Spastic diplegia constituted the predominant group (34.5 per cent), followed by spastic quadriplegia (25.5 per cent). Dyskinetic CP was present in 15.5 percent of the cases. Hypotonic CP constituted a significant proportion of cases. Delayed Motor Function was observed in all 110 cases, delayed speech was complained in 67.3% cases and impaired hearing was identified in 26.8% CP children. Mothers of 43.6% CP cases reported that they had prolonged labour during delivery and almost one third (29.1%) had suffered from pre-eclampsia or eclampsia. Majority (53.6%) of the CP cases were reported to have had perinatal asphyxia. Comprehensive assessment and early management of these problems are emphasized, which can minimize the extent of disabilities. By proper perinatal care, CP can be prevented.

Transfusion-transmitted infections (TTIs) remain a major global public health problem and a challenge to transfusion services worldwide particularly in developing countries in managing transfusion-dependent children especially the thalassaemics. However developed countries are not exempt from TTIs despite multiple layers of protection in their advanced blood collection centres. The magnitude of this problem is directly related to the prevalence of TTIs among blood donors. To assess the global burden of TTIs the World Health Organization (WHO) estimated that 3% of the world’s population (.170 million people) are infected with hepatitis C virus (HCV). The global prevalence of HCV reported by the WHO ranges from 10 to 15% to as little as 0.04%. HCV in blood donors varies from 0.4 to 19% including 0.9% among Namibian first-time blood donors. The overall prevalence of HCV in Bangladesh as documented in the WHO’s records ranges between 1 and 2.5% whereas it was observed in 2.4% of professional donors (poor people who sell their own blood to make a living and who have had no evident disease) in Bangladesh. However in voluntary donors (healthy adults who only donate blood in emergencies) in India the prevalence of HCV ranged from 0.8 to 1.78%. In Japan and Germany figures of 0.6% and 0.2–0.8% respectively have been reported. (excerpt)

Background: Prevalence of Asthma in children is about 7% in Bangladesh but Spirometric value of children is not available. Objective: The study was conducted to find out the spirometric value of normal school going children and to compare the values with those of other countries. Methodology: Sprirometric evaluation of normal school going children was done by computerized spirometer (Ponygraphic of COSMED srl-ltaly) in a school of Dhaka city during the period of February 2002 to July 2002. Nine hundred twenty seven healthy children aged 6-15 years were selected for the study. Outcome variable were the forced vital capacity (FVC), forced expiratory volume in first second (FEV1), peak expiratory flow (PEF), the ratio of FEV1 to FVC and forced expiratory flow (FEF) between 25% & 75% of vital capacity (FEF 25% & 75% ). The pulmonary function data was separated by sex and categorized on the basis of height, weight, age and body surface area. The mean and standard deviation were calculated for every such variable. The results (FVC) of present study was compared with those of other countries (India, Nigeria, British and America). Results: The lung function variables showed a linear positive correlation with height, weight, age and body surface area (independent variables). Strong correlation was found between lung function values and independent variables. Height showed the maximum correlation in comparison with other variable. Forced vital capacity (FVC) and FEV1 showed a spurt after the height of 150 cm. Regression equations for lung function values were determined for boys and girls considering height as independent variable. Boys showed higher values for lung functions than those of girls. Lung function values of these studied children are nearly similar to Indian children and significantly lower than Nigerian, British (UK) and American (USA) peers. Conclusion: Spirometric values of our children are very much comparable with those of regional children (India) but values are lower than those of African (Nigeria), European (British) and American (USA) children. Recommendation: Further study should be done with larger sample size to have our own national data and to fill up the standard spirometric values for the children of our country. Key words: Spirometric standards; healthy children. DOI: 10.3329/bjch.v29i3.6187 Bangladesh J Child Health 2005; Vol 29 (3): 93-98

Background: Perinatal asphyxia is the most important preventable cause of cerebral injury in the neonatal period leading to very high neonatal mortality and morbidity in developing countries. Little can be done for a baby affected by severe perinatal asphyxia. So, prevention is unquestionably desired. Objective: To identify the maternal and fetal risk factors for the development of birth asphyxiated babies and to see the short term outcome of the affected babies. Methods: An analytical type of or observational study was done in the Special Care Baby Unit (SCBU) of Dhaka Medical College Hospital from October 2003 to March 2004. Identification of the risk factors was done by retrospective comparison of the cases and controls. Outcome was analyzed by cross sectional comparative study. One hundred consecutive cases of birth asphyxia, admitted in SCBU, were enrolled in the study. Another 30 neonates admitted during this period for other reasons (i.e., jaundice, septicemia, low birth weight) were taken as control. Necessary information were collected by detailed history taking, clinical examination and close follow up of the hospital course, using pre-designed questionnaire and recording form. Results: Male: female ratio 3:2 both in the cases and controls. Mean age on admission was 13.8 hours and 2.6 days for case and control respectively. Identified important maternal risk factors were primiparity (57% in cases vs. 33.3% in control), hypertension (16.6% vs. 3.3%), pre-eclamptic toxemia of pregnancy (24% vs. 13.3%), prolonged rupture of membrane (33.3% vs. 6.7%), prolonged labour (34% vs. 3.3%) and use of oxytocin during labour (16% vs. none). All these were statistically significant (p