PENSAMIENTO FORMAL

(Appendix V). Measurements taken were read-off on a non- elastic tape stretched over a table

49 Appendix VI).

2. An electronic bassinette weighing scale for infants (Appendix VII)

3. A non- extensible tape measure for measuring occipito -frontal circumference (Appendix

VIII).

4. A wooden Infantometer (Appendix IX)

5. An electronic floor scale (SECA model 874, Secagmbh 7 co.kg, Germany)

M

For the purpose of this study, the size of the AF was taken as the mean of the antero-posterior and transverse diameters measured along the sagital and coronal sutures, respectively. A modified version of Faix’s method¹² was employed. The subject was held upright in a sitting position by the mother/care-giver with the head supported and held firmly by the Research Assistant while the Measurer introduced the tip of the index and the middle fingers of his/her left hand into the two corners of the lateral dimensions of the anterior fontanel. With the pair of dividers held in the right hand, the inner margins of the distal end of the pair of dividers were applied firmly against the outer border of the two fingers of the left hand at the corners of the fontanel. The pair of dividers was then placed on a tape measure firmly positioned on a table and the distance between the inner borders of the pair of dividers was read-off on the tape (Appendix VI). The process was repeated with the index and middle fingers placed at the corners of the antero-posterior dimension of the AF. The size of the AF in centimetres was derived from the relationship: (length of AF + width of AF)/2, the length and width representing the

antero-50 posterior and the latero-lateral diameters, respectively. Any fontanel too small to be measured was adjudged closed.

Occipito-frontal circumference (Appendix VIII)

To measure the occipito-frontal circumference, the method of Student² was employed. A non-elastic tape was placed circumferentially over the glabella, the bi-parietal and occipital prominence (see Appendix VIII). This was read off in centimetres and recorded to the nearest millimetre. The tension of the tape was such that the hair was firmly pressed against the head.

Three measurements were done for each child. The highest was taken as the OFC. All three measurements in a given subject were taken by the same Investigator/ Research Assistant.

Length

Supine length was measured using a wooden infantometer/floorboard (Appendix IX). The Research Assistant firmly held the crown of the head of the subjects against the head board, and positioned the head in such a way that the right upper margin of the external auditory meatus and the lower margin of the orbit of the eye were perpendicular. The Measurer then stretched the body and the legs of the subject and brought the sliding footboard into firm contact with the soles of the feet. The measurements were read to the nearest millimetre.

Weight

To measure the weight of the subjects, a SECA electronic bassinette scale (Appendix VI) was used for newborns and infants not more than 12 months old. The infants were weighed naked.

Infants older than 12 months old were weighed using an electronic floor scale (SECA model 874, Secagmbh 7 co.kg, Germany) with the subject bare footed and naked, standing still at the centre of the scale. The accuracy of the scales used were ascertained by placing known weights on the scales and making adjustments where necessary before commencement of weighing of subjects each day. The scale reading was ascertained to be at zero before each reading was taken.

51 Measurements were read to the nearest 0.1kg when the pointer had stopped oscillating, with the measurer looking directly at the scale in the vertical plane.

All measured parameters as well as gender, gestational age (for newborns), birth weight, length and OFC were recorded on a proforma (Appendix IV)

Socio-economic status classification

Using the socio-economic classification described by Oyedeji⁸² each subject was assigned a socio -economic class based on the occupation and educational attainment of both the mother and the father. A socio-economic index score of 1 to 5 was assigned for each parameter. The sum of the 4 scores was divided by 4 to obtain the socio- economic class of the child.

Ethical Consideration

Ethical clearance was obtained from the Ethics Committee of the University of Port Harcourt Teaching Hospital (Appendix I). A written permission (Appendix II) was also obtained from BMSH. Detailed explanation of the study procedure and extent of involvement of each subject was given to the mothers/caregivers. Written informed consent (Appendix III) was obtained from the parent(s) or care-giver(s) of each child before recruitment into the study. The children observed to have abnormal fontanel size such as those with a closed fontanel at 2 to 7 days and those with an open fontanel at 24 months were referred to the Paediatric Neurology Clinic for follow -up.

Analysis of data

Data was analyzed using the Statistical Package for Social Sciences (SPSS) Version 15.0.⁸³The mean, standard deviation and range of each continuous variable and other derived indices including the 5^th, 10^th, 25^th, 50^th 75^th, and 95^th percentiles were computed and presented as graphs, and tables in simple proportions. The differences in means were compared using Student’s

52 t test while Chi–square test was used to compare proportions and rates. Pearson’s Correlation Coefficient was used to determine the relationship between AF and OFC at 48 hours to 7 days and at defined ages. Analysis of Variance (ANOVA) was used to ascertain the significance of the differences in the means of AF and OFC at various ages. Multiple comparisons of the differences in mean AF between age groups was carried out using Dunnette’s⁸³ Test. Statistical significance at 95% confidence interval was set at p- value < 0.05.

53