Showing papers in "Nigerian Journal of Clinical Practice in 2009"

Pre-hospital care in Nigeria: a country without emergency medical services

Abstract: OBJECTIVES: Efficient pre-hospital transport (emergency medical services, EMS) is associated with improved outcomes in road traffic injuries (RTI). This study aims to discover possible interventions in the existing mode of transport. METHODS: Persons bringing all RTI victims to the Emergency room (ER) over a 4-year period and the injury arrival intervals were noted prospectively. FINDINGS: There were 2,624 patients (1,886 males and 738 females); only 2,046 (78%) had clear documentations of three categories of persons bringing victims to ER: Relatives (REL, 1,081, 52.83%); Police/Federal Road Safety Corps (P/F, 827, 40.42%) and Bystanders (BS, 138, 6.74%). No intervention was provided during transport: Within 1 hour, 986 victims (48.2% of 2,046) arrived ERbrought by P/F (448, 21.9%), REL (439, 21.5% of 2,046), and BS (99, 4.8%). These figures, in each instance, represent 40.6 % of total victims brought by REL; 54.2% by P/F and 71.7% by BS. However, after 6 hours, REL were the main active group as they brought 94.5% (359 of 380) patients of this period. In 91 victims (4.4%) the injury arrival time was not captured. CONCLUSION: This study has identified three groups of persons involved in pre-hospital transport with nearly 50% getting to ER within 1 hour without any intervention or prior notification of ER. Absence of EMS obscures pre-hospital death records. The P/F responsible for only 40% of transport should be trained and equipped to offer basic trauma life support (BTLS). The REL and BS (both responsible for 60% of transport) represent a pool of volunteers for BTLS to be trained. Language: en

Morbidity and mortality patterns of admissions into the Special Care Baby Unit of University of Abuja Teaching Hospital, Gwagwalada, Nigeria.

Abstract: To determine the morbidity and mortality patterns of patients admitted into the Special Care Baby Unit (SCBU) of the University of Abuja Teaching Hospital (UATH), Gwagwalada, Nigeria. Aretrospective analysis of records of patients admitted into the SCBUof theUATHover an 18month period of January 2005 to June 2006was carried out. A total of 654 patients were admitted into SCBU of UATH during the review period, there were 351 (53.7%) males, and 303 (46.3%) females given a male to female ratio of 1.2:1. The four leading causes of admissions were low birth weight (LBW) 32.7%, neonatal sepsis (NNS) 19.1%, severe birth asphyxia (SBA) 12.7%, and neonatal jaundice (NNJ) 8.7%. Eighty one (37.9%) of the LBW were term and small for gestational (SGA), while 133 (62.1%) were preterm. Of the 87 (13.3%) deaths recorded during the review period, SBA (21.7%), LBW (20.1%), neonatal meningitis (15.4%),and NNS (11.2%) were the four leading causes of preventable deaths, while congenital abnormalities (20.0%) was the commonest cause of nonpreventable conditions. 71.2% of all deaths occurred within the first 72 hours of admission, while 57.7% of such deathswere babies ofmothers from low socio-economic background. Patterns of admissions andmortality into SCBU of UATH were comparable to studies elsewhere, and points to preventable conditions as the leading causes of such admissions and deaths. Efforts to reduce LBW, SBA, NNS and NNJ through enhancement of good antenatal and delivery services, as well as improvement in the facilities in the unit will assist in death reduction. Health education and economic empowerment especially of women will be an added advantage . Keywords: Pattern morbidity,mortality, SpecialCareBabyUnit, admissions.

Pattern of medical admissions at the Federal Medical Centre, Asaba-a two year review.

Abstract: Atwo-year retrospective evaluation of the pattern of medical admissions at the FederalMedical Centre (FMC),Asaba,Delta State,Nigeria. Case notes of all admissions and deaths in the medical wards between November 2005 and October 2007 were retrieved and reviewed. Themean, standard deviation and percentages of relevant data were derived and presented in simple descriptive statistics. One thousand, eight hundred and sixty patients were admitted over the study period. One thousand and eight of these [1008; 54.2%], were male, while eight hundred and fifty two [850; 45.8%] were female, making a female/male ratio of 1:1.18.The patients ages ranged between fifteen and ninety years, with amean of 51.56 ± 18.35 years.The age range ofmale patients ranged from16 to 88 years,with amean of 55.55 ± 17.99 years,while that of the female patients ranged from15 to 90 years,with amean of 57.14 ± 13.79.The length of stay in theward ranged from1 to 97 days,with amean of 10.32 ± 10.93 days.Therewere 23.25 patients per bed per year and a bed occupancy rate of 65.74%. There were 240 deaths [12.90% of total admissions]. The interval between admission and death ranged between 1 and 31 days, with a mean of 7.14 ± 6.7 days. One hundred and twenty four patients [124; 6.7%] were referred to other health facilities, while ninety six [96; 5.2%] left against medical advice.The commonest causes of admission in males was hypertension, diabetes mellitus and HIV, while in females, it was HIV, hypertension and diabetes mellitus. Commonest causes of death in males were hypertension, HIV and diabetes, while in female subjects, itwasHIV, hypertension and diabetes. Non-communicable diseases- [hypertension, diabetesmellitus] and HIV/AIDS were themajor causes of admissions and death in both genders. Keywords : Pattern, Medical admissions, Asaba

Knowledge and practice of universal precautions against blood borne pathogens amongst house officers and nurses in tertiary health institutions in Southeast Nigeria.

Abstract: To examine the knowledge and practice, as well as factors influencing universal precautions practices amongstNigerianHouse officers andNurses. A Cross-sectional descriptive study. Sample selection was by stratified random sampling. Information was elicited using pretested, structured, self-administered questionnaire. Data were analyzed usingEPI-info. Most Doctors, 66.6%,were aged 26-30 years while the Nurses, 41.1%,were aged 40 years. 57.6% of the Doctors were males, while 85.7% of the Nurses were females. Knowledge of universal precautions measures was high for both categories of respondents - 97.0% for doctors and 92.0% for nurses, although practice was better for the nurses, 75.0%, compared to the doctors, 15.2%, p Keywords: Nigeria; knowledge and practice; universal precautions; healthcare workers; tertiary health institutions.

Seroprevalence of antibody to HDV in Nigerians with hepatitis B virus-related liver diseases.

Abstract: OBEJECTIVE: Hepatitis D Virus (HDV) infection has been reported to be declining in some geographical areas. In order to ascertain the current status of HDV infection in Nigeria, a study of patients with hepatitis B virus (HBV)-related liver diseases was undertaken to determine the sero-prevalence ofanti-HDV. METHOD: This was a prospective, cross-sectional study in which all consecutive patients with liver disease who tested positive for Hepatitis B surface antigen (HBsAg) were also tested for antibody to HDV. RESULT: Ninety six patients with various forms of HBV-related liver diseases participated in the study (acute hepatitis 8.3%, asymptomatic infection 15.6%, chronic hepatitis 3.1%, liver cirrhosis 21.9% and primary liver cell carcinoma 51.0%). Anti-HDV was demonstrated in 12 patients (12.5%). In patients with acute hepatitis and asymptomatic infection the prevalence was 4.3% while in patients with chronic hepatitis, liver cirrhosis and primary liver cell carcinoma, the prevalence was 15%. CONCLUSION: HDV still contributes to significant morbidity and mortality in HBV-related liver diseases in Nigeria. There is urgent need for larger studies on a national scale to accurately appraise the public health importance of this infection.

High caesarean section rate: a ten year experience in a tertiary hospital in the Niger Delta, Nigeria.

Abstract: Background: Caesarean section rate is rising world wide and Nigeria is no exception. Methods: This was a descriptive study. The data from case notes, antenatal and theatre records of patients who had caesarean delivery over a ten year period in the Baptist medical center, Eku were extracted and analysed. Results: The total delivery for the period under studywas 5,153 and the total number of caesarean deliverieswas 1,777 giving a caesarean section rate of 34.5%.Therewas no definite trend in the yearly caesarean section rates. Majority of the cases were aged 25-29 (32%). Grand multipara constituted 26.4% of the patientswhile 70.1% of cases presented at a gestational age range of 37-42 weeks.Majority of the patients (59.5%) where unbooked for antenatal care. Dystocia (27.1%) was the commonest indication for caesarean section. Emergency abdominal delivery constituted 63.3%of caseswhile the common complications included wound breakdown, anaemia and endometritis. There were a total of 25 maternal deaths giving a case fatality rate of 1.4%. The leading causes of deaths were haemorrhage (36%), infections (24%), severe preeclampsia/eclampsia(24%), cardiac arrest (12%) and anaesthesia related complication (4%). Conclusion: This study found a very high caesarean section ratewithmajority of cases presenting as unbooked emergency cases.High caesarean section rate in this region was due to increase in primary caesarean delivery for dystocia, elective repeat caesarean deliveries and caesarean deliveries for preeclampsia/eclampsia. Future studies should be extended to rural areas and be targeted at determining whole population Caesarean section rates. Keywords : HighCaesarean SectionRates,Maternal

Limb amputations in adults in an Ivorian teaching hospital.

Abstract: Objective To determine the pattern of limb amputations and preventable indications. Design Aretrospective study. Setting Department of orthopaedic surgery, Yopougon Teaching Hospital, Abidjan, Cote d'Ivoire. Patients and methods One hundred fifty-six patients with amputations over a 11-year period were studied. There were 111 men and 45 women with a mean age of 42 years. Main outcome measures Indications, level of amputation, morbidity, and mortality. Results A total of 160 limb amputations were performed in the 156 patients. Trauma (49.9%), diabetic foot sepsis (31.4%), and peripheral vascular disease (13%) were the main indications. Below knee (46.9%) and below elbow (11.2%) amputations were the most common procedures performed. Wound infection was the commonest complication occurring in 42 (26.9%) patients. There were 25 (16%) deaths, out of which 22 were due to sepsis. Conclusion Majority of amputations in our environment are preventable by education, early presentation and appropriate management of the common indications.

Primary bone tumours in a tertiary hospital in Nigeria: 25 year review.

Abstract: BACKGROUND: Primary bone tumors remain a daunting challenge to orthopaedic surgeons. The challenge is heightened in developing countries due to limited diagnostic and therapeutic facilities and ignorance. The published literature on the subject is sparse in our environment. OBJECTIVE: To describe the pattern of primary bone tumors seen in a tertiary hospital in Nigeria. METHODS: This is a retrospective review of all the histologically confirmed primary bone tumours seen at Lagos University Teaching Hospital (LUTH) over a 25 year period. RESULTS: A total of 242 patients (aged 7.5 to 62 years) with a mean of 25.3 years were studied. One hundred and forty four patients (59.5%) were males and 98 (40.5%) were females. The peak age incidence was in the age group 11-20 years. One hundred and thirty (53.7%) of the tumors were benign. Among these Osteochondroma was the commonest accounting for 36 cases (27.7%) followed by Osteoclastoma, 28 cases (21.5%). Osteosarcoma accounted for 66 cases (58.9%) of all primary malignant tumours in the study. CONCLUSION: This study showed that primary bone tumours were mainly benign, occurred predominantly in the second decade of life with a male preponderance. Osteochondroma and Osteosarcoma were the most common benign and primary malignant bone tumours respectively.

Male involvement in family planning: women's perception.

Abstract: To assess the knowledge of mothers of under- five children brought to immunisation centres of contraceptivemethods applicable bymales and their perceptions of the roles ofmales in family planning. This cross- sectional descriptive study involved a questionnaire interview of mothers who came to immunise their children at five public immunisation centres in Port Harcourt. Data entry and analysis employedEPI-Info version 6. Amongst the 558mothers interviewed, the contraceptive prevalence rate was 5.6% and 85.6% of them knew at least a family planning method for males. About 15.8% would depend on their spouses for choice of contraceptivemethods and 52.7%would discontinue family planning if their spouses objected.About 33.5%of the spouses had used some form of contraception while only 22.1% of the females recognised that male involvement could impact on the acceptance rate of family planning services. Despite their knowledge of safe child spacing, about 53% of the respondents delivered within shorter intervals and had significantly more pregnancies/ children that they would have had if they were in ' control' of their reproductive health decisions. The spouses, despite being significantly older, more educated, with higher level jobs, and in-charge of the reproductive health decision in the home, did not contribute to the knowledge of thewomen and their practices of family planning. Despite the advantaged position of males in family matters, their roles in family planning remains largely unutilised. If the acceptance of family planning must improve, males should also be targeted by family planning programmes. Keywords: Male involvement,Women's perception, family planning

Urinary tract infection in febrile children in Maiduguri north eastern Nigeria.

Abstract: One hundred and forty five children aged 1 month to sixty months who had fever at presentation to the paediatric department of University of Maiduguri Teaching Hospital were investigated for urinary tract infection in this prospective study from November 2004 to October 2005. Prevalence of urinary tract infection was found to be 13.7 per cent. While the female sex and malnutrition were found to be significantly associated with urinary tract infection, height of temperature and symptoms referable to urinary system were not. Ninety per cent of the isolates were Gram negative; mainly coliform Spp, the remaining 10 per cent were due to staphylococcus aureus. Gentamicin was still found to be effective against most of the urinary pathogens. However, clavulinic acid potentiated amoxicillin, ampicillin, nalidixic acid and cotrimoxazole were found to be poorly effective. We therefore conclude that all ill children especially younger ones presenting with fever be screened for urinary tract infection. A regular surveillance of urinary tract infection pathogens and their antibiotic sensitivity pattern is recommended.

Case fatality among hypertension-related admissions in Enugu, Nigeria

Abstract: OBJECTIVE: To determine the case fatality rate and ultimate causes of death among patients with hypertension-related conditions admitted to an urban tertiary hospital, METHOD: A five-year review of hypertension-related admissions into the medical wards of the University of Nigeria Teaching Hospital, Enugu, between 1995 and 1999, was undertaken. RESULTS: 7220 patients were admitted into the medical wards during the period under review. Of these, 445 (6.2%) were due to hypertension-related causes. Of the later, 285 (64%) were males while 160 (36%) were females. One hundred and ninety one of the hypertension-related admissions died, giving a case fatality of 42.9%. The mean age at death was 54.8+/-15.8 years (53.5+/-15.9 years for males; 57.2+/-15.4 years for females, t=2.47, df=189, p=0.117). Sixty six percent of these were males while thirty four percent were females. Eighty six (45%) of the deaths occurred during acute hypertensive crises such as cerebrovascular accidents, hypertensive encephalopathy, and acute renal failure. Other important complications leading to death were congestive cardiac failure, accounting for thirty three cases (17.3%); and chronic renal failure 32 (16.8%). In twenty one (11%) hypertension-related admissions, the causes of death were not documented. CONCLUSION: Hypertension, with its related complications, constitute a major cause of morbidity and mortality in our medical wards. The case fatality rate is very high and often mostly avoidable complications were responsible. There is need to further study the determinants of these avoidable causes of death.

Exclusive breastfeeding - the relationship between maternal perception and practice

Abstract: The behaviour adopted by individuals is moulded by their perception of various issues. In spite of well established benefits of exclusive breastfeeding (EBF) to babies, mothers and society, the EBF practice rate (EBFPr) in our environment has remained low. To evaluatemother's perception of exclusive breastfeeding and determine the relationship between such viewand their practices. Two hundred mothers were interviewed to elicit their perception of the merit and demerits of exclusive breastfeeding.The pattern of perceptionwas related to actual practice in order to seek for possible associations. Of the 184 respondents, 39 (21.2%) practiced EBF for all their babies, while 95 (51.6%) never did so for any of their babies. Knowledge of EBF was excellent (94.0% and 90.8%) of the study group gave accurate definition and duration respectively. Most mothers felt that EBF babies look healthier (85.1%), have less disease (84.5%), are more intelligent (59.1%) but their mothers eat a lot (79.3%). Those who agree to the positive benefits of EBF generally had higher overall complete EBFPr than those who disagreed, as they looked healthier (p = 0.0001), had less disease (p = 0.041) andmore intelligent (p= 0.0001). In addition to this, mothers who did EBF for all babies ( ie those with an EBFPr of 100%) had more positive perception on the benefits ofEBF. There is a fairly good relationship between pattern of maternal perception of the benefits of EBF and actual practice. Efforts need to be intensified to educate and encourage mothers to see the merits of EBF both for themselves and their babies. Keywords: Exclusive breastfeeding, material, perception, practice

Perception of neonatal jaundice among women attending children out patient and immunization clinics of the UPTH Port Harcourt.

Abstract: Background Neonatal Jaundice (NNJ) is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it. Objective To determine the knowledge of the women attending Children Outpatient (CHOP) and Immunization clinics on the causes, treatment and complications of neonatal jaundice. Method Women who brought their children/wards to the immunization/children out patient clinics at the University of Port Harcourt Teaching Hospital Port Harcourt were interviewed using structured questionaire. Results There were 255 mothers who participated in the study. Of these 30 (11.8%) have never heard of neonatal jaundice while 225 (88.2%) have heard and only those who have heard were further analyzed. The age range was from 16 to 47 yrs (mean age 27.1 +/- 3.3 years). Median parity was 2. One hundred and twenty two (54.2%) women had tertiary education. One hundred and seventy four (77.3%) correctly defined neonatal jaundice, and in 114 (44.7%) source of information was from health talk in the clinic. Seventy five (33.3%), and 50 (22.2%) erroneously believed that eating too much groundnut in pregnancy and mosquito bite respectively were the main causes while 55 (24.4%) correctly answered that it is due to mismatch of mother and baby's blood. Only a few knew that use of dusting powder on baby's cord, prematurity, and storing baby's clothes in camphor were risk factors for NNJ. One hundred and fourteen (50.7%) and 60 (26.7%), wrongly believed that exposure to sunlight and use of glucose drinks respectively were the main forms of treatment and 50 (22.2%) knew brain damage as a possible complication Conclusion There is still misconception on the causes and risk factors and treatment of neonatal jaundice among our women. Also only a few women are reached by the health talk in the clinics. There is therefore urgent need for massive health enlightenment campaign.

Determinants of post-caesarean wound infection at the University College Hospital Ibadan Nigeria

Abstract: Objective To determine the risk factors that predispose patients to post-caesarean wound infection at a tertiary health institution in developing country. Method It was an observational study of all women that had caesarean (elective and emergency) delivery between July and September, 2004. The outcome of their post-caesarean wound was assessed. Statistical analysis (Bivariate and logistic regression) of the identified risk factors in patients who developed wound infection was performed at a 95% level of confidence. Results The post-caesarean wound infection rate was 16.2%. The identified risk factors were lower educational status, multiple pelvic examination, offensive liquor at surgery and patients that are unbooked. Following logistic regression, women with up to primary school were 20 times more likely than those with secondary education and above to develop wound infection (95% CI OR = 1.8 to 250.0). Conclusion The outcome showed that the identified determinants of post-caesarean wound infection were comparable with earlier reports. Women with lower educational status are more at risk in this study. Therefore, these women need special attention to reduce the risk.

One year clinical audit of the use of blood and blood components at a tertiary hospital in Nigeria.

Abstract: The appropriate use of blood and blood components remains a formidable challenge faced by clinicians particularly in a developing country like Nigeria. The inadequate supply of safe blood implies that measures aimed at ensuring judicious use of the available supply should be continually identified and explored. Aprospective study to evaluate all blood and blood component transfusions over a period of one year from January to December 2004 was done. The appropriateness of the transfusion with respect to the clinical state and the transfusion needs of the recipientwas assessed by aHaematologist. A total of 682 transfusion episodes were reviewed and analyzed. The commonest indication for use blood/blood componentwas severe anaemia in 38% of cases.Twenty nine percent of transfusions formoderate anemia, and 36%of fresh frozen plasma transfusions were found to be unnecessary. Inappropriate transfusion ismostmarked in the setting of platelet transfusionwith81%of platelet transfusion being inappropriate. Enhanced capacity for component preparation, regular auditing of transfusion practices aswell as improved communication between the clinicians and laboratory physicians will lead to more judicious use of blood component therapy. The need for the development of guidelines for blood component use in hospitals in linewith the national blood transfusion policy is highlighted. Keywords: Clinical audit;Blood components; inappropriate transfusion.

Pattern of gynaecological consultations at Ladoke Akintola University of Technology Teaching Hospital.

Abstract: Two hundred and fifty patients attended the gynaecology clinic during the study period, however, 208(83.2%) case notes were available for analysis. Most of the patients that had gynaecological consultations during the study period were married (88.0%), and infertility (48.1%) was the commonest reason for the consultations. Many of the patients (60.1%) did not receive definitive treatment for their consultation. Infertility being the commonest reason for gynaecological consultations, and tubal factor the commonest cause of infertility, there is need to establish assisted reproductive technology in public health institutions to render services at a highly subsidized rate in helping this population of patients who could not afford this treatment which is presently being offered by private health institutions.

Chronic uterine inversion secondary to submucous fibroid: a case report.

Abstract: A rare case of non-puerperal chronic uterine inversion secondary to sub mucous fibroid in a 38-year-old woman is presented. There was complete uterine inversion with the incarcerated inverted uterus protruding through the vvgina beyond the vulva. The sub mucous fibroid was attached to the fundus. At laparotomy, a dimple with a constriction ring was found in the position of the uterus. The distal ends of the fallopian tubes and part of the ovary were visible through the constriction ring. Histological examination of the uterus and fibroid following hysterectomy confirmed their benign nature.

Prevalence of malaria parasitaemia and malaria related anaemia among pregnant women in Abakaliki, South East Nigeria.

Abstract: BACKGROUND: Malaria currently is regarded as the most common and potentially the most serious infection occurring in pregnancy in many sub Saharan African countries. This study was undertaken to evaluate the prevalence of malaria parasitaemia and malaria related anaemia among pregnant women in Abakaliki, South East, Nigeria. MATERIALS AND METHODS: This is a cross sectional, descriptive study conducted in two tertiary health institutions in Abakaliki, South East, Nigeria (Ebonyi State University Teaching Hospital And Federal Medical Centre). Using systematic sampling method, 193 pregnant women were selected from the health institutions for the study. Their blood were analysed for haemoglobin status and malaria parasite. Data were also collected using an interviewer administered questionnaire. All the data were analysed using Epi info version 6 statistical software. RESULTS: Response rate was 100%. Twenty nine percent prevalence of malaria parasitaemia was detected, more common among primigravidae. Women with higher parity had higher frequency of anaemia in pregnancy. More than half of the pregnant women (51%) were in their second trimester at the time of booking. There was no case of severe anaemia requiring blood transfusion. CONCLUSION: Our pregnant women register late for antenatal care. Prevalence of malaria parasitaemia is high in our environment as well as anaemia in pregnancy, using the standard WHO definition. It is suggested that effort should be intensified to make our women register early for antenatal care in order to identify complications early. Intermittent preventive treatment for malaria should be incorporated into routine drugs for antenatal women.

Haematological assessment of occupational exposure to lead handlers in Enugu urban, Enugu State, Nigeria.

Abstract: OBJECTIVE: To determine blood levels of lead and its effects on haematological parameters among occupational lead handlers in Enugu, Enugu State, Nigeria. In developing countries, rapid industrialisation has lead to an alarming demand for lead. Furthermore, the burden of lead toxicity is greatly underestimated. Hence, the need to assess the unavoidable toxic effects of lead as done in this study. METHODS: Blood lead levels were measured by atomic absorption spectrometry (AAS) in eighty one (81) male subjects from three manufacturing companies, all located in Enugu metropolis, Nigeria. Thirty (30) staff of the industries not directly involved in lead handling served as control group I, while twenty (20) apparently healthy individuals from within the same locality not involved in lead handling served as control group II. Haematological values, blood lead levels and blood pressure (BP) were established using standard procedures. Statistical Analysis System (SAS) software was used to analyze the results. P value of 0.05) in the means of other parameters. Basophilic stipplings were not observed in the red cells of those directly exposed to lead. CONCLUSIONS: It is suggested, therefore, that comprehensive and preventive measures towards exposure to lead in work places, and routine haemotological investigations be included in the bio-monitoring of the health status of lead workers.

Exclusive breastfeeding and postnatal changes in maternal anthropometry.

Abstract: To evaluate the impact of exclusive breastfeeding (EBFing) practice on maternal anthropometry during the first 6months of birth. Measurement of weight, height, triceps skin-fold thickness (TST), and mid-arm circumference (MAC) was carried out in a matched cohort of women practicing EBFing and those using other methods of infant feeding (non-EBFing group ) in the first sixmonths after delivery. There were 322 women practicing EBFing and 205 in the non-EBFing group. Weight loss was significantly higher among the EBFing group than in the non-EBFing ones during the first six months of EBFing practice (4.13Vs 1.06kg), p Keywords: Exclusive breastfeeding, non exclusive breastfeeding, maternal anthropometry, weight, tricep skinfold thickness,mid-armcircumference.

Seroprevalence of Hepatitis C viral antibodies in pregnancy in a tertiary health facility in Nigeria.

Abstract: BACKGROUND: Liver disease due to Hepatitis C viral (HCV) infection is the most common indication for liver transplant. It is a viral pandemic that is five times as widespread as the human immunodeficiency virus type 1 infection. In spite of this, vaccines were yet unavailable for protection of the human race due to the morphology and fastidious nature of the organism. While the scanty data available on this infection in our environment are limited to blood donors, people continue to be screened for and deprived of renal dialysis if any patient is found to have HCV infection. Also in this environment, data on HCV infection in pregnancy is virtually nonexistent even though the infection can have a deleterious effect on materno-fetal outcome. OBJECTIVE OF THE STUDY: To determine the seroprevalence of hepatitis C viral antibodies among antenatal women attending a tertiary health facility in Nigeria. METHODOLOGY: This was a prospective cross-sectional study whose subjects were booked consecutive antenatal women volunteers attending the University of Benin Teaching Hospital, Benin City, Nigeria between June 1 and December 31, 2005. Hepatitis C viral antibodies were determined and confirmed using a second and a third generation Enzyme Linked immunosorbent assay respectively. Both HCV sero-positive and seronegative women had both pre-and post-test counseling. RESULTS: Of the 269 samples screened for HCV antibodies, 5 (1.86%) samples were confirmed seropositive. None of the HCV seropositive women had liver enzyme derangement. CONCLUSION: Hepatitis C viral infection in pregnancy is not uncommon in Nigeria. It's prevalence in pregnant women South-South of Nigerian is similar to that of their Cameroonian counterparts, an immediate neighbouring country. A multi-centre study to determine the national prevalence of HCV and in addition to elevation of public awareness is suggested. Hepatitis C viral-induced liver disease remains the major indication for liver transplant for which our present levels of economy and health infrastructures can least support. With no vaccines and no cure, the time to act is now.

Glycated haemoglobin and glycaemic control of diabetics in Ilorin.

Abstract: OBJECTIVES: With increasing adoption of Western Lifestyle in Nigeria, the incidence of Diabetes Mellitus is on the increase in the country with its attendant complications. The objective of this study was to determine the prevalence of patients at risk of developing diabetic complications in Ilorin, Nigeria, among our patients with diabetes mellitus. METHODS: A cross-sectional study of diabetic patients attending the University of Ilorin Teaching Hospital ted haemoglobin as an index of medium term glucose control was assayed in established diabetics. The result obtained was evaluated against the bench mark HbA1c value of 7.2% for the development of complication. RESULTS: Fifty-six percent of the subjects were females and all of them were forty years and above in age. Only four percent of the patients were below the age of forty years. Seventy-two percent of the subjects had diabetes for less than 10 years. Only female patients had BMI values greater than 30 kg/m2. About 64% of the patients had HbA1c value > 7.2%. More males (73.7%) had HbA1c 7.2% than females (64.5%) (P < 0.05). The patients had a mean HbA1c value of 8.0%, while the mean HbA1c in the control was 5.2%. These two mean HbA1c values gave a P-value of 0.0001 on Student t-test. The female diabetic patients had a mean HbA1c value of 7.8% (SD = 1.96) against the value of 5.1% (SD = 1.13) for the female control patients (P-value of 0.0001). Similarly, the male patients and male control subjects had mean HbA1c values of 8.1% (SD = 1.96) and 5.6% (SD = 1.00) respectively with P-value of 0.0001. The control subjects had a mean fasting blood glucose level of (+/- SD) 4.93 +/- 1.09 mmol/L and the corresponding value for the diabetics was 8.5 +/- 4.2 mmol/L. when these two values were compared we got a P-Value < 0.05. CONCLUSIONS: The mean HbA1c values between the patients and the control subjects were significantly different. Diabetics in our environment with mean HbA1c value of 8.0% are prone to developing complications because of poor glycaemic control. We therefore advise that, periodic estimation ofglycated haemoglobin be carried out along side fasting blood glucose, in our diabetics.

The role of blood transfusion on the prevalence of hepatitis C virus antibodies in children with sickle cell anaemia in Enugu, South East Nigeria.

Abstract: Background The hepatitis C Virus (HCV) has become an important cause of chronic liver disease and liver cancer worldwide. Blood transfusion is one of the important modes of transmission. There is need to study the prevalence among those at risk such as sickle cell anaemia (SCA) patients. Such information will broaden knowledge of the problem among SCA patients transfused with blood in this part of the country. Objective To determine the prevalence of HCV antibodies among children with SCA transfused with blood in Enugu, compared with their non transfused counterparts as well as the roles of blood transfusion and traditional surgery in the prevalence ofHCV infection. Methodology The study was conducted among 269 children with SCA attending the paediatrics sickle cell clinic at University of Nigeria Teaching Hospital (UNTH) Enugu, with 136 transfused SCA patients as subjects and 133 age and sex matched non-transfused SCA who served as controls. Results The results showed an HCV antibody prevalence of 6.6% among the transfused and 5.3% among the non-transfused (controls) SCA patients (P = 0.610). There was positive association between number of transfusions and HCV seropositiviy, such that those who had received 4 or more units ofblood had a prevalence rate of more than 50% (P = 0.001). The influence of scarifications on the prevalence of antibodies to HCV (antiHCV) for the non transfused (controls) was statistically significant (P = 0.001). Conclusion HCV infection is not uncommon in children with SCA. The prevalence of HCV infection in transfused SCA patients is not significantly higher than their age/sex matched controls.

Assessment of two emergency contraceptive regimens in Iran: levonorgestrel versus the Yuzpe.

Abstract: The purpose of this study was to compare the efficacy and tolerability of two emergency contraception (EC)methods, levonorgestrel versus theYuzpe. In a prospective, randomized, comparative study, we included 122 healthy volunteers who in the observed cycle had had only one act of unprotected intercourse within 72h of treatment. They were randomly allocated in levonorgestrol group (n=62) andYuzpe (n=60).The levonorgestrel regimen consisted of two pills: 0.75 mg levonorgestrel, taken twice in the 12-h interval within 72h after unprotected intercourse. The Yuzpe method included twoHDcontraceptive pills taken as another regimen.Datawere collected by questionnaire at first and 3weeks later.The differenceswere comparedwithX &Fisher exact tests. There were no significant differences between two groups in any of the observed parameters. The levonorgestrel regimen was found superior to Yuzpe because it's more effectiveness (respectively 100% vs 91%, p=0.026) and fewer side effects. The study showed more effectiveness and safety of the levonorgestrel regimen as emergency contraception. Thus we recommend levonorgestrel as an alternative EC method instead of theYuzpe regimen in Iran or other developing countries in order to decrease unwanted pregnancy. Keywords : Yuzpe, Levonorgestrel, emergency contraception

Sexual practices of people living with HIV in South Eastern Nigeria.

Abstract: BACKGROUND: Couples could be in serodiscordant or seroconcordant sexual relationship. The seroconcordant could be seroconcrdant positive or negative in a heterosexual or homosexual or bisexual relationship. The various sexual practices include vaginal sex; anal sex fisting; oral sex fellatio, cunnilingus; masturbation mutual or exclusive and a host of others. These sexual practices outside safer sex guidelines will lead to HIV transmission among couples. The study is set to determine the sexual practices of people living with HIV (PLWHA) in Southeast Nigeria. METHOD: This is an analytical epidemiological study. A total of 300 subjects were studied using interviewer administered questionnaires. Data is presented in tables and figures. Analysis was done using SPSS 11.0 statistical package. RESULTS: Most respondents were in heterosexual relationship (97%). The married couples in serodiscordant relationship were 25.3% while the singles in serodiscordant relationship were 20%. About 56% do not use condom for the adopted sexual practice although 65% believe that condom use would protect against HIV transmission. CONCLUSION: Couples in seroconcordant seronegative relationship have it as a challenge to remain so. This study suggests that the PLWHA are very important in the spread of HIV infection as they are still sexually active, in non-cohabiting conjugal unstable relationship, and they do not use the condom consistently. There is an urgent need to target this population with effective behavioural change communications that will translate to safer sexual behaviour. The practice of safer sex should be taught in every health care center, in schools and in village gatherings by qualified health care workers. This will help curb the transmission of HIV.

Perceptions and attitudes of a rural community to abortion in the Niger-delta region of Nigeria.

Abstract: To determine the perceptions and beliefs relating to unwanted pregnancy, family planning and abortion, and identify issues that can be leveraged to initiate positive attitudes towards family planning and abortion in the area Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted in Amukpe, Delta State, Nigeria A highly motivated and well-trained team versed in the local language and culture conducted the FGDs and IDIs Therewas unanimity that unwanted pregnancies was quite common amongstwomen of reproductive age group and constitute a significant problemin the communityAbortion, particularly in the hands of quacks was amajor option to handling an unwanted pregnancyAlmost all agreed that their culture and religion abhors abortion, yetwidely practiced because of the odium associatedwith an unwanted pregnancy in the community The knowledge of the Nigeria National abortion law even amongst the health workers and teachers was generally poor The participants agreed that there were problems and complications (often severe) including death associatedwith abortion in the community Itwas largely agreed that contraceptive knowledge and usage was poor The reasons adduced for this include lack of knowledge, lack of spousal consent, socio-cultural taboos andmisconceptions, aswell as economic reasons Itwas suggested that imbibing positive family values by parents in theirwards and government leveraging the socio-economic status of the communitywill go a long way to stemming the tide Unwanted pregnancy, unsafe abortion and abortion complications are reported to be common amongst women of reproductive age group inAmukpe community, whilst contraceptive awareness and usage is poor Keywords: Perception and attitudes, rural community,Abortion

Emergency obstetrics care in a Nigerian tertiary hospital: a 20 year review of umblical cord prolapse.

Abstract: CONTEXT: Umbilical cord prolapse is an obstetric emergency associated with high perinatal morbidity and mortality unless prompt delivery by the fastest and safest route is carried out. OBJECTIVES: To determine the incidence of umbilical cord prolapse, predisposing factors, and fetal outcome. STUDY DESIGN, SETTING AND SUBJECTS: A 20 year retrospective study of all women who presented with umbilical cord prolapse at University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria. RESULTS: During the study period there were 27,753 deliveries and 75 women had cord prolapse, giving the incidence of 1 in 370 deliveries (0.27%). Significantly more patients with non vertex presentation, twins and preterm delivery had cord prolapse. The highest occurrence was in those with unengaged presenting part (65.2%), spontaneous rupture of membrances (62.1%) and grandmultiparous women (57.6%). Caeserean section was carried out in 50% of cases, with mean decision-delivery interval of 77.1 +/- 21.7 minutes and 28/33 (84.9%) of babies delivered within 60 minute had normal Apgar scores. The Knee-chest position was most commonly used method of alleviating cord compression while arrangement for caesarean section was being made. The perinatal mortality was 27.3%. CONCLUSION: umbilical cord prolapse is a brisk obstetric emergency with high perinatal morbidity and mortality unless prompt delivery is undertaken. Better communication and prompt response to emergency by the theatre team to reduce the decision-delivery interval would improve the perinatal outcome.

Comparison of superficial surgical site infection following use of diathermy and scalpel for making skin incision in inguinal hernioplasty.

Abstract: The method of making surgical incision remains a complex problem. Although controversial, the use of diathermy instead of scalpel for skin incision and underlying tissue dissection is gradually gaining wide acceptance. This is due to the observation that no change in wound complication rate or postoperative pain is reportedwith the use ofDiathermy. However, the fear of excessive scarring and poorwound healing has curtailed itswidespread use for skin incision. The objective of the study is to compare superficial surgical site infection (SSSI) in diathermy and scalpel skin incision in inguinal hernioplasty. Quasi experimental study. Study was conducted at Surgical Unit II, Holy Family Hospital. Rawalpindi from1 Jan. 2008 to 30 September. 2008. Atotal of 80 patients who presented with inguinal hernias were included in the study. Patientswere divided in two groups. Group1: In 40 patients skin incisionwasmadewithDiathermy,Group 2: The other 40 had skin incisionwith scalpel. Themean age of patients in the intervention group (Group 1)was 50 years while in the control group (Group 2) itwas 46 years. 48% patients in Group 1 and 55% in the Group 2 had indirect inguinal hernias. SSSI was noted in 12.5% cases in Group 1 whereas in Group 2 it was 17.5% but this difference was not found to be statistically significant (p value=0.378). The use of diathermy for making skin incisions is as safe as scalpel and there is no significant difference amongst both regardingwound infection. Keywords: Diathermy incision, electrocautery, scalpel skin incision, superficial surgical site infection

Stress and psychological health of medical students in a Nigerian university.

Abstract: OBJECTIVE: Physician job satisfaction is one indicator of the overall health of our health care delivery system. Excellent but dissatisfied physicians could decide to leave the practice of medicine or highly talented students could opt for different careers if the perception that medicine is not a fulfilling career exists. This study aims to investigate the level of course satisfaction, its relationship to psychological disorder and presence/absence of stress among medical students. Physician job satisfaction is one indicator of the overall health of our health care delivery system. Excellent but dissatisfied physicians could decide to leave the practice of medicine or highly talented students could opt for different careers if the perception that medicine is not a fulfilling career exists. This study aims to investigate the level of course satisfaction, its relationship to psychological disorder and presence/absence of stress among medical students. MATERIALS AND METHODS: A cross-sectional study was conducted among 410 medical students of the University of Benin, Nigeria. The respondents completed a self-administered questionnaire and a standard instrument The General Health Questionnaire (GHQ 28). RESULTS: The response rate was 93.9%. Two hundred and forty four (63.4%) of respondents were satisfied with their course, 331 (86.0%) of them felt medicine was stressful. There was also a statistical significant difference in the level of stress among the various levels of medical students. One hundred and twenty three (31.9%) medical students indicated that they would not study medicine again if given a second chance. One hundred and twelve (29.1%) medical students had psychological disorder. More dissatisfied students had psychological disorder than satisfied students and this difference was found to be statistically significant. CONCLUSION: The level of perceived stress among medical students was found to be high and a significant number of students had psychological morbidity. There is a need to identify and correct the causes of dissatisfaction among these groups of students in order to improve on the psychological state of the students. Stress management training is also required as majority of the medical students found the course stressful.

Audit of gynaecological laparoscopies in National Hospital Abuja, Nigeria.

Abstract: Context: There were 58 gynaecological laparoscopies during the study period, and a rate of 28.7 laparoscopies per 1000 gynaecological operations. The incidence is low due to occasional logistic problems with the equipment and multiple strike actions by health workers. The procedure was done wholly for diagnostic purposes, the major indication being infertility in 88.9% of the patients. Majority (54.9%) of the patients had the procedure performed during the luteal phase of their menstrual cycle, as opposed to the proliferative phase. The procedure was performed by consultants or senior residents in 50 (98%) of the patients.All the patients had general anaesthesia for the laparoscopies. There was no major complication or operative mortality in the patients whose case folders were analysed.