Showing papers in "Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria in 2006"

Default from tuberculosis treatment programme in Sagamu, Nigeria

Abstract: and 100,000 of new sputum-positive tuberculosis occur each year with an estimated 2% annual risk of Background: The study was embarked on to 2 4 Nigeria. Patients who defaulted (cases) during the reasons for non-compliance to TB treatment. Default course of treatment were compared with non-defaulters from treatment has led to the emergence of multi-drug (controls) who commenced and completed their TB resistant tuberculosis (MDR-TB) and a poor treatment 5 treatment at the same time. outcome. MDR-TB, regarded as an important cause of Results: There were 178 (23%) defaulted cases during TB morbidity and mortality , poses a greater challenge to the study period. Defaulting rate was highest (78.1%) the control of tuberculosis. It is difficult to cure and very during the continuation phase of the treatment. There expensive to manage, thus overstretching the already was a significant downward trend in default rate from strained resources for TB control in most developing 6 37.9% in 1997 to 8.4% in 2003 (p<0.001). HIV-positive countries. patients had twice the risk of default during the intensive The current recommended national guideline for 2 phase of treatment than HIV-negative patients (OR TB treatment is for a minimum duration of 8 months 2.61: CI 0.84-7.97;P=0.06). Important risk factor which is longer than the 6 months regime used in many 7,8 associated with non-compliance was male sex 9OR developed countries. In spite of its public health 1.64: CI.1.15-2.34; p<0.01). HIV status (OR: 1.4 CI: importance, data regarding default from TB treatment in

Burns and scalds--epidemiology and prevention in a developing country.

Abstract: Background: Burns and scalds are common presentation to many of our health institutions. Most of these injuries are preventable. Many of the patients however end with severe morbidity or even death. People affected are mostly of poor socioeconomic status. The cost of managing these injuries is high. Coupled with this are poor facilities in most parts of the developing countries like Nigeria and insufficient personnel to take care of this group of people. Study of the epidemiology as well as suggestions on preventive measures are therefore overdue and hence this publication. Methods: A review of the literature on this subject with emphasis on Nigeria was done bearing in mind the epidemiology and prevention of burn. Literature search was done using the medline as well as local journals. Results: Causes of burn injuries are many in the developing countries. Most of these are however preventable. Some preventive measures have been suggested by workers in this part of the world. Some measures that have worked in reducing burn injuries in some advanced countries and that may be appropriate to our situation are noted and are also suggested in this paper. Conclusion: Prevention of burn injuries, based on the epidemiology of burn in developing countries, remains a major way of reducing the current spate of morbidity and mortality in our patients.

Lipid profile of healthy adult Nigerians in Port Harcourt, Nigeria.

Abstract: Background : Hyperlipidaemia is a major cardiovascular risk factor for coronary artery disease, atherosclerosis, hypertension and stroke. It is thought that serum cholesterol levels are low in Nigerians as shown by results of a population survey done over twenty years ago. In addition the last national non communicable disease survey recorded a low prevalence of Hyperlipidaemia (4.0%) in Nigeria. With increasing urbanisation and socioeconomic improvement, changing population dynamics is expected to influence disease pattern and noncomminucable diseases are expected to rise. Thus there is a need to screen healthy adults for their lipid pattern in Port Harcourt a city with high population dynamics where such studies have not been previously reported. Method : A prospective descriptive population survey was carried out among healthy adults residing in Port Harcourt. A total of ninety two adults were screened after obtaining informed consent. Weight, height, blood pressure, fasting blood sugar and fasting lipid profile were measured. Results were analysed using simple statistical methods. Results : A total of ninety two subjects were recruited into the study. Fourty seven (51.1%) of the subjects were males while fourty five (48.9%) were females. The age range of subjects was 24-59 years with mean of 38.84 ± 8.36 years. The mean BMI was 28.76 ± 5.91 Kg/m 2 . There was no significant statistical difference between the mean BMI for males and females. The mean fasting blood sugar, mean total cholesterol and mean LDL cholesterol were 4.45 ± 0.89 mmol/L, 4.76 ± 1.06 mmol/L and 3.65 ± 0.89 mmol/L. The mean total triglyceride was 1.02 ± 0.30 mmol/L while the mean HDL was 0.90 ± 0.25 mmol/L. There was an increase in total cholesterol with increasing age and an increase in total cholesterol and LDL cholesterol with increasing social class. Subjects with total cholesterol above 6.5mmol/L constituted 31.52 % of study subjects. Subjects with BMI between 25-29 Kg/m 2 made up 43.48% of subjects while 33.69% of subjects had BMI above 30Kg/m 2 . Conclusion : A high mean total and LDL cholesterol values were observed among healthy adults in Port Harcourt. The prevalence of obesity was also found to be high. There is a need for public health action to address these findings especially as high serum cholesterol levels have a direct correlation with coronary artery disease. Further large scale urban survey of non communicable diseases in the country is therefore necessary at this time. Keywords : lipid profile, healthy adults, Port Harcourt Nigerian Journal of Medicine Vol. 15(2) 2006: 137-140

Care-seeking behaviour of caregivers for common childhood illnesses in Lagos Island local government area, Nigeria

Abstract: BACKGROUND: The objectives were to estimate a 2-week prevalence for common childhood illnesses targeted by the National Integrated Management of Childhood Illness (IMCI) Initiative and to determine care-seeking behaviour of mothers/caregivers for these illnesses. METHODS: A cross-sectional community survey was conducted in the Lagos Island Local Government Area of Lagos State. Eligible children aged 0-5 years and their mothers/caregivers were recruited into the study by cluster-sampling technique. RESULTS: Four hundred and ninety-five children of 450 mothers were identified. Of these, 426 (86.1%) children belonging to 390 mothers/caregivers had symptoms suggestive of malaria, acute respiratory infections, diarrhoea and measles. Care was sought Outside the home at the onset of symptoms for 280 (65.7%) while 146 (34.3%) were treated at home. Of the 280 who were taken for care outside, 23 (8.2%) were taken for care at the onset of illness while the others were taken for care after an attempt at self-treatment (68.6%), use of traditional medicines (12.5%) and provision of traditional home care (10.7%). Only 65 (23.2%) of the children were taken for care within 24 hours of perceived onset of the illness. CONCLUSION: IMCI targeted childhood illnesses were prevalent and poor maternal response that could contribute to complicated outcome was identified.

The bacteriology of diabetic foot ulcers in Port Harcourt, Nigeria.

Abstract: Background Diabetic foot ulcer and/or gangrene is a common cause of morbidity and mortality in Nigeria. The lesions are usually infected and early treatment of the infection will reduce the associated problems. The study was carried out to determine the common bacteriological flora of diabetic foot ulcers in Port Harcourt. The antimicrobial sensitivity pattern of the isolates was determined to enhance possible empirical treatment. Methods Deep wound swabs were collected from 60 consecutive diabetic patients admitted with foot ulcers and/or gangrene into the medical wards of the University of Port Harcourt Teaching Hospital from January 2001 to April 2002. The bacteriological isolation and antimicrobial sensitivity tests of the isolates was carried out by standard microbiological methods. Results Aerobes and anaerobes constituted 95.4% and 4.6% of the total bacterial isolates respectively. Staphylococcus aureus was the commonest bacterial isolate; it was cultured from 32 (56.1%) of infected patients and constituted 24.4% of the total isolate. The mean bacterial isolate per patient infected was 2.3. The aerobic isolates showed significant sensitivity to ciprofloxacin (78.4%), pefloxacine (71.2%), ceftazidime (73.6%) and cefuroxime (69.6%). All the anaerobic isolates were sensitive to metronidazole and clindamycin. Conclusion Infections of diabetic foot ulcers are usually polymicrobial. From the in vitro antimicrobial susceptibility pattern of the bacterial isolates, diabetic patients presenting with foot ulcers and/or gangrene could be commenced empirically on a combination of clindamycin or metronidazole and either a fluoroquinolone (ciprofloxacin or pefloxacine) or a second or third generation cephalosporin (e.g. cefuroxime or ceftazidime).

Some haematological parameters in plasmodial parasitized HIV-infected Nigerians.

Abstract: non-parasitized controls 66.7%, 60%, 36.7% and eosinophilia and leucocytosis. 63.3% versus 32.9%, 42.9%, 24.3% and 24.3% Cytopenia resulting from the myelosuppressive respectively . A statistically significant difference was effects of HIV, the secondary effects of opportunistic observed between the haemoglobin, platelet count and infection and other complications of AIDS is common in 8-10 the erythrocyte sedimentation rate (ESR) of parasitized HIV/AIDS infected persons . and non- parasitized individuals (p < 0.05) respectively . Nigeria is highly burdened with malaria and HIV, yet A significant positive correlation was observed between researchers know little about treating both diseases the level of parasitaemia and anaemia (r =0 .37, p < simultaneously . The impact of this co-infection on the 0.04) in parasitized subjects. The incidence of haematological profile of HIV- infected Nigerians is anaemia was two times higher in parasitized subjects unknown. The aim of the study was to investigate the compared to non-parasitized controls (66.7% versus haematological changes that may occur in acute 32.9%). Red cell morphology showed a normocytic plasmodia infection in HIV-infected patients and to alert and normochromic picture in 40% and 67.1% of physicians caring for HIV- infected Nigerians on the parasitized and non- parasitized individuals need to update information so that rational decision on respectively . Microcytic, hypochromic picture was the haematological complications associated with HIV/ observed in 60% and 23% respectively in parasitized Malaria co-infection could be taken. This may go a long and non- parasitized individuals. Striking eosinophilia way to reduce the mortality and morbidity associated was seen in 5 (16.7%) of parasitized and 3 (4.3%) of with the co-infection and by so doing optimize medical non- parasitized individuals. cost. Conclusion: Incidence of cytopenia appear significantly higher in parasitized subjects compared to MATERIALS AND METHODS non-parasitized control and bring to bare the need for Subjects regular anti-malaria prophylaxis for HIV-infected The study design utilized in this study is a case patients particularly in Nigeria. control study involving one hundred HIV-infected (plasmodium parasitized n =30 and non parasitized n

Drug compliance among hypertensive patients in Port Harcourt, Nigeria.

Abstract: Background Hypertension contributes significantly to cardiovascular morbidity and mortality. Adequate blood pressure control would therefore reduce cardiovascular morbidity and mortality, however adequate blood pressure control requires good treatment compliance. Methods One hundred consecutive patients aged 30-79 years attending the cardiac clinic of the medical out-patients clinic of the University of Port Harcourt Teaching Hospital were directly questioned about compliance with their antihypertensive drugs and results entered into the questionnaire designed for the study. Results Compliance was good in sixty percent (60%) of respondents, fair in twenty nine percent (29%) and poor in eleven percent (11%). Compliance was also found to be good in sixty-seven percent (67%) of patients with tertiary education, good in forty one percent (41%) of those with primary education. Compliance was good in seventy four percent (74%) of those taking one drug, good in only thirty three percent (33%) of those taking four drugs. Patients taking single daily dose drugs had good compliance in seventy percent (70%), twice daily dosing had good compliance in fifty five percent (55%) and among those taking thrice daily dosage, compliance was good in only seventeen percent (17%). Conclusion The study shows that good compliance with anti-hypertensive therapy is best achieved with monotherapy given as single dosage. It also shows the role of education in the level of compliance.

Incisional hernia: a review.

Abstract: Background Otherwise known as post operative ventral hernia, incisional hernia is a common complication following abdominal surgery and is a significant cause of morbidity. This review examines incisional hernia from its historical perspective to the present. Method A Literature review of the topic was carried out using manual library search of journal articles on the topic published both locally and internationally. The search also made use of intemet material from Pubmed and Medline on relevant parts of the topic. All relevant articles from the reference lists of these papers were also studied. Result Incisional hernia is a common complication of abdominal surgery. Its incidence is about 1% following primary healing and increasing to about 11% with postoperative wound infection. The most consistent causative factor is wound infection and the incidence may rise to 30% after abdominal wound dehiscenece and resuture. It may be difficult to repair and a wide range of surgical procedures have been developed for such repair. The repair may be direct suture or prosthetic mesh using the open or laparoscopic technique. Prosthetic mesh has revolutionized the repair of incisional hernias. Laparoscopic repair, which was introduced in the 1990's, has been adjudged feasible, safe and as effective as the open methods of repair. Recurrence rates of up to 49% with direct suture repair have been reported. Open and laparoscopic mesh repair have recurrent rates of 0-10% and 0-9% respectively. Conclusion Despite improved surgical techniques and the use of prosthetic mesh incisional herniation remains a major problem for the general surgeon.

Awareness, attitude and practice of contraception among secondary school girls in Calabar, Nigeria.

Abstract: BACKGROUND Adolescents are disposed to unprotected sexual activity and as a consequence, there is an increasing incidence of unwanted pregnancy among adolescent school girls in Nigeria. This study was carried out to assess the awareness, attitude and use of contraceptives among secondary school girls in Calabar, Nigeria and to determine how attitude affects its use. METHODS Data was obtained using self administered semi-structured questionnaires distributed to 480 secondary school girls out of which 450 were properly filled and returned. These were analysed using percentages and chi-square was used to test for significance. RESULTS The study revealed that contraceptive awareness was high. The main sources of contraceptive information were books/magazines (37%) and friends (26%). Three hundred and thirty-three (74%) girls had a negative attitude (misconceptions) towards contraceptives, while 117 (26%) girls said contraceptives were essential/useful. Sixty-six girls (14.7%) admitted that they were currently sexually active and 42 (9.3%) of them used contraceptives. There was a statistically significant association between positive attitude/beliefs and use of contraceptives (P < 0.05). CONCLUSION We recommend the provision of accurate contraceptive information to dispel these misconceptions and the establishment of adolescent reproductive health services which should be strictly confidential to encourage acceptability and optimum utilization.

Characteristics of colorectal carcinoma in Kano, Nigeria: an analysis of 50 cases.

Abstract: Background Several recent publications have shown a rising incidence with high morbidity and mortality of colorectal cancer amongst blacks. The aim of this study was to determine the epidemiological profile of the colorectal carcinoma in our hospital, a major referral centre in northwestern Nigeria. Methodology A retrospective analysis of all histologically proven cases of colorectal carcinoma was performed from January 1999 to December 2002. Results Fifty patients were managed during the study period with an average presentation of 12.5 cases per year. There were 36 (72%) males and 14 (28%) females (M:F = 2.5 to 1). The mean age at presentation was 42.9 years with 36 patients (72%) below 50 years of age. Carcinoma of the colon occurred in 22 (44%) patients and rectal carcinoma in 28 (56%) patients. Twenty (71.4%) of the 28 rectal cancers were digitally palpable. Thirty-eight (92.7%) patients had palliative resection, while 3 (7.3%) had curative resection. Adenocarcinoma was the only histologic type, with 15 (30%) cases of the mucinous variety. Conclusion There is need to increase awareness through public education about this malignancy and its management. Any adult with complaints of vague abdominal pain, blood or mucus in the stool or features of haemorrhoids which may herald the onset of colorectal cancer should be adequately investigated with digital rectal examination (DRE) and proctosigmoidoscopy and barium enema where appropriate.

Sociodemographic characteristics of anaemic gravidae at booking: a preliminary study at Llesha, Western Nigeria.

Abstract: BACKGROUND Anaemia in pregnancy is a significant cause of direct and indirect morbidity and mortality to both the pregnant mother and her fetus. The prevalence however remains undetermined in many parts of Africa. The study aims at determining the prevalence of anaemia and sociodemographic characteristics of anaemic pregnant women in a Nigerian tertiary obstetric care centre. METHODS A cross-sectional study involving all pregnant women that registered for ante-natal care between 1st January 2001 and 30th of June 2001 in Wesley Guild Hospital Unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-lfe. RESULTS Prevalence of anaemia among the pregnant women during the period of study was 62.2%. Two percent of the women had severe anaemia. Parity and gestational age at booking significantly influenced the prevalence of anaemia. CONCLUSION Prevalence of anaemia among pregnant women in developing world is still unacceptably high, and it calls for improvement in standard of living for our pregnant women.

Job satisfaction among primary health care workers in three selected local government areas in southwest Nigeria

Abstract: BACKGROUND The primary health care system in Nigeria has been impaired by lack of dedicated workers who are willing to work in the rural areas. This study was carried out to examine factors that enhance job satisfaction among health workers in the primary health care system in Nigeria. METHOD The study is a cross-sectional descriptive study conducted in May 2002. The respondents were selected from three local government areas in southwest Nigeria by multistage sampling technique. A standardized structured pre-coded close-ended self-administered questionnaire to collect relevant information on their socio-demographic characteristics and extent of job satisfaction of respondents. RESULT A total of 125 health workers were interviewed in all. The mean score on job satisfaction was 26.15 out of the total possible score of 49. There was no statistically significant relationship in job satisfaction among the various cadres of health workers considered (p = 0.824). A larger proportion (66.4%) of the health workers were involved with the community based preventive services when compared with the health centre based curative care 33.4% (p < 0.05), there is however no significant difference in satisfaction between this two groups of personnel (p = 0.133). Age and marital status were found to be statistically significant in relation to job satisfaction (p = 0.000 and 0.034 respectively). CONCLUSION The study shows no significant difference in job satisfaction among the various cadres of health workers in southwest Nigeria. However age and marital status were found to be significant factors influencing job satisfaction among the primary health care workers in Nigeria.

Soft tissue sarcomas in the Niger Delta Region of Nigeria (a referral hospital's study).

Abstract: BACKGROUND Soft tissue sarcomas are rare tumours in this environment. Recently, an upsurge in frequency was noticed that called for attention. The aim of this study is to study soft tissue sarcomas based on age, sex of patients, tumour sites and histologic types. METHODOLOGY A 14 year retrospective study in University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt. Histological slides previously processed and stained with hematoxylin and eosin stains (H & E) were reviewed and re-evaluated. Special stains were also used for proper diagnosis of some tumours. The tumours were classified based on World Health Organization (WHO) classification of soft tissue tumours. RESULTS Only 66 soft tissue sarcomas were used for this study which accounted for 2.8% of the total malignancies diagnosed during the period under review. The youngest was a 3 year old girl while the eldest was a 76 year old female. A total of 38 and 28 tumours were diagnosed in males and females respectively, giving a sex ratio of 1.4:1. Rhabdomyosarcoma was most frequent (39.4%) while the least was leiomyosarcoma (1.5%). These tumours are more frequent in the under 20 years (22.7%) and least in 70 years and above (7.6%). The lower limb was most affected (36.4%) while the least was the retroperitoneum (6.1%). The commonest predilection sites vary with different classes of these group malignancies. CONCLUSION Soft tissue malignancies are globally uncommon but they constituted an integral part of malignant tumours causing serious morbidity and mortality in this environment. The recent upsurge noticed necessitated the need for regional studies in Nigeria in order to come up with a national epidemiologic data of these malignancies.

Postpartum perineal pain in primiparous women: a comparison of two local anaesthetic agents.

Abstract: BACKGROUND Episiotomy is the commonest obstetric surgical operation performed to increase the introitus to enhance vaginal delivery. This study was to compare the effect of two local anaesthetic agents on postpartum perineal pain and time for demand for oral analgesics. METHODS A randomized double-blinded controlled clinical trial was conducted in primiparous women who had spontaneous vaginal delivery, comparing 1% plain lidocaine and 0.25% plain bupivacaine infiltration for the repair of selective episiotomy or perineal injury. RESULTS The two groups were comparable in sociodemographic characteristics. At 2 and 4 hours, women who had perineorraphy under lidocaine had significantly higher pain scores on the Visual Analogue Scale (VAS) than those who had the repair under bupivacaine, (4.0 v. 2.0)and(6.0 v. 3.0)respectively. At the 6h hour, the mean pain score for the bupivacaine group was 4.0 on the VAS while the lidocaine group had already received a dose of oral analgesic (Ibuprofen 400 mg) following severe pain from the repair. There was however no statistically significant difference in the pain score on the VAS between the two groups at the time of request for oral analgesics. The mean time lapse before demand for oral analgesics for the lidocaine group was 2.25 +/- 0.46 hrs (Mean+Standard deviation) while that for the bupivacaine group was 7.13 1.56 hrs (Mean Standard deviation). The P value was P < 0.0000 (Student's t-test) and statistically significant. CONCLUSION It is concluded that the patients in the bupivacaine group had a prolonged analgesia and needed fewer doses of oral analgesics in the immediate postpartum perineal repair period.

Pathological study of colorectal carcinoma in adult Nigerians: a study of 45 cases.

Abstract: Background A 12-year (1st Jan. 1990-31st Dec. 2001) retrospective study of 45 colorectal carcinomas was carried out the in University of Port Harcourt Teaching Hospital (UPTH) based on age, sex, clinical presentation, anatomical sites, histological types and clinical stages. Methods All the histological slides from surgical specimen obtained from the large intestine and diagnosed as colorectal carcinoma were reviewed in Anatomical Pathology Department of UPTH, Port Harcourt. The age, sex, sites and histological types were extracted from the request forms and reports while the clinical presentation and staging were obtained from the case notes. Results A total of 34 (75.6%) and 11 (24.4%) occurred in males and females respectively, giving a sex ratio of 3:1. The least age of occurrence was a 22 year old male and the oldest was a 82 year old male. The highest frequency (28.9%) occurred in the age group 50-59 years which is a decade earlier than the Caucasians. Majority of our patients (33.3%) presented with either diarrhoea or constipation (altered bowel habit). The commonest site of this cancer is the rectum and the least occurred in the transverse colon. Most of our patients presented with advanced cancer of stage IV & III of TNM classification (D and C of Astler-Coller System). The tumours were also histologicially graded into well moderately and undifferentiated type. Conclusion Colorectal carcinoma is one of commonest malignancies that occurs in young and middle aged in this environment. Patients present when the tumour is in an advanced stage hence poorer prognosis and the ages of the patents is about 10 years earlier than that of Caucasians.

Echocardiography in the University of Port Harcourt Teaching Hospital: April 2000 to March 2003

Abstract: Background : Echocardiography is a cheap and non-invasive technique for the investigation of cardiac diseases with reliable levels of accuracy. Echocardiography services commenced in the Cardiac unit of the University of Port Harcourt Teaching Hospital (UPTH) in April 2000. There is a need to establish an accurate pattern of cardiac diseases seen in the centre based on echocardiography assessment. The aim of the study was to review the pattern of cardiac diseases diagnosed by echocardiography in the cardiology unit of the University of Port Harcourt Teaching hospital. Method : A prospective descriptive study of patients referred to the cardiology unit of UPTH for echocardiography for a variety of cardiac complain was done. Subjects had two dimensional and M-mode echocardiography assessment using a Siemens Sonoline SL 1 machine with a 3.5 MHz sector probe. Results : One hundred and forty one subjects aged between 16-84 years with a mean age of 44.2 ± 11.5 years had echocardiography assessment over the three year period. Eighty two (58.2%) of the subjects were males while 59(41.8%) were females. Fourty eight (34.0%) of subjects had hypertensive heart disease, 28(19.9%) had Cardiomyopathies, 13(9.2%) had rheumatic heart disease. Pericardial disease, congenital heart disease and cor pulmonale was found in 6(4.3%), 2(1.4%) and 1(0.7%) respectively. Fourty three (30.5%) of subjects had normal findings on echocardiography. Conclusion : Hypertensive heart disease was found to be the most prevalent cardiac condition followed by the cardiomyopathies and rheumatic heart disease in that order. This trend is very similar to what obtains in sub Saharan Africa as documented by similar studies. Keywords : cardiac disease, echocardiography, Port Harcourt Nigerian Journal of Medicine Vol. 15(2) 2006: 132-136

Computing knowledge, attitude and skills among healthcare professionals in Aminu Kano Teaching Hospital, Nigeria.

Abstract: BACKGROUND: Health care professionals can no longer ignore the application of information technology to health care. This study was carried out to assess computing knowledge, attitude and skills among health care professionals and identify associated factors. METHODS: A cross section of 200 health care professionals- consisting of 64 doctors, 90 nurses, 35 laboratory scientists and 11 pharmacists in Aminu Kano Teaching Hospital were interviewed using a pre-tested, structured, closed-ended self-administered questionnaire. RESULTS: Only 181 (90.5%) of the respondents returned the completed questionnaires. Twenty six percent of the respondents had formal computer training whereas 34.8% owned a personal computer. Overall, 84 (46.4%) of the respondents had good knowledge of computing. Specifically, 41(66.0%), 5 (50.0%), 14 (51.0%) and 24 (30.0%) of these were doctors, pharmacists, laboratory scientists and nurses respectively. Computing knowledge was highest among doctors and lowest among nurses. These differences were statistically significant (chi2 = 19.1 df = 3 P < 0.01). Age, gender, computer ownership and formal computer training significantly influenced computing knowledge. Most healthcare professionals 160 (88.4%) had positive attitude towards computing and this was significantly influenced by respondent's age and previous computer training. Only 41 (22.7%) of the health care professionals had good computing skills and this was significantly associated with computer ownership (P < 0.01) and formal computer training (P < 0.01). CONCLUSION: Half of the healthcare professionals had good computing knowledge, majority had a positive attitude while many were quite deficient in computer skills. Computer loans and in-house computing courses were recommended to prepare our healthcare professionals for the challenges of the information technology age.

A controlled study of anxiety and depression in mothers of children with learning disability in Lagos, Nigeria.

Abstract: Background : Parents of children with learning disability have been reported to suffer great stress and frustration due to increased burden of care. The manifestation of stigmatization by familial environment and the collective effect of the children with adverse impact on mothers predispose them to mental shock or a variety of neurotic symptoms and other psychiatric conditions including anxiety and depression. The objectives of the study were: to determine the general Health Questionnaire (GHQ) score of mothers of children with learning disability. To identify sociodemographic variables and to assess anxiety and depression in them. Methods : Using structured questionnaires between March and May 2002, 106 mothers of children with learning disability in a Mentally Handicapped Home for children in Lagos, Nigeria were assessed and compared with mothers of normal healthy children in Lagos. Results : The mean age of the subjects was 40.0±6.6 years. More of the subjects (26.4%) compared with mothers of normal healthy children (9.9%) had a high GHQ score and high levels of anxiety (25.5%) and depression (10.4%). Marital difficulties were associated with learning disability. Conclusion : Mothers of children with learning disability are prone to emotional and psychological disorders. In order to improve the well-being of children with learning disability, there is need to look into the mental and physical health of mothers. Early and prompt treatment of associated anxiety and depression will no doubt help the children. Keywords : anxiety, depression, mothers, learning disability Nigerian Journal of Medicine Vol. 15(2) 2006: 124-127

Haematological parameters in prospective Nigerian blood donors rejected on account of anaemia and/or microfilaria infestation

Abstract: Background Worldwide, prospective blood donors are screened for blood transfusion-transmissible diseases. In addition, predonation fitness requires adequate haematocrit and, in the tropics, negative screening for microfilaria that may precipitate allergy. The high prevalence of anaemia and microfilaria, though treatable, has contributed to the dearth of eligible blood donors. This study aims to characterize anaemia in prospective blood donors rejected for anaemia and find haematological effects of microfilarial infestation in prospective blood donors. Methods This prospective study was carried out from 1st of August to November 30th, 2002 at the blood transfusion unit of the Haematology Department of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. All consenting prospective blood donors that were rejected for anaemia and or microfilaria infestation during the study period were studied for their age, sex and haematological profile. A randomly selected population of successful donors was similarly studied. Results Sixty rejected prospective blood donors (5.2% of the total screened)) were studied. Forty-five (75%) of them were rejected for anaemia alone, 10 (16.7%) for microfilaria alone and 5 (8.3%) for both anaemia and microfilaria. The mean ages of those rejected were 33.3(+/- 9.9) years for anaemia alone, 29.9(+/- 8.5) years for microfilaria alone and 35.4(+/- 8.3) years for those with anaemia and microfilaria combined. The mean age of the successful group was 28.9(+/- 8.5) years. Of the 60 rejected subjects, 53 were males while 7 were females. Blood film of the anaemia group revealed features suggestive of iron deficiency anaemia (hypochromic microcytic cells) in 60% of them. The white cell count (WCC) was significantly increased in the microfilarial group compared to others and it revealed lymphocytosis and eosinophilia. Conclusion The importance of these findings have been discussed in line with the existing literature. The need for intensive health education to encourage voluntary donation and promote the interest of females in blood donation is emphasized.

The primary health care services in Nigeria: constraints to optimal performance.

Abstract: BACKGROUND This paper examined the management of the Primary Health Care Services in Nigeria using both Primary and Secondary data. METHODS The Primary data were generated from social survey, interviews and participant observation while secondary data were sourced from health institutions. Data gathered were analysed using quantitative and descriptive methods. RESULTS The findings of the study showed a low level of interaction and coordination among tiers of government which resulted in poor performance of PHC at the grassroot. The Primary Health Care Programme was grossly underfunded which manifested in the low performance of the PHC delivery facilities. The research identified some institutional impediments such as conflicts between Local and State Governments resulting in a strained relationship, poor collaboration and weak linkage. Community participation which is a sine qua non in the attainment of the objectives of the programme was very low. Finally, the participation of international organisations like UNICEF and USAID in PHC Programme was responsible for most of the achievement made so far. CONCLUSION The research recommended among others that the three tiers of government must relate to one another to ensure that a harmonious relationship exists at all times through official interactions on all issues that affect the three levels of government especially the policy formulation, implementation, and evaluation, and evaluation of the Primary Health care programme.

Management of blunt abdominal trauma in Maiduguri: a retrospective study.

Abstract: BACKGROUND: Blunt abdominal trauma (BAT) presents special surgical problems and is a continuous challenge to the surgeon's ability to make an early diagnosis and provide adequate treatment. The aim of this paper is to study retrospectively the patterns, surgical management and outcome of treatment among patients with BAT. METHODS: The records of BAT patients managed at the University of Maiduguri Teaching Hospital (UMTH) between January 1998 and December 2000 were studied. Information about the age, sex, cause of injury, main investigations, diagnostic procedures and treatment of these patients were extracted from the files and analysed. RESULTS: There were 48 males and 10 females. The mean age was 25.17 years, and the patients ranged between 8 and 50 years in age. Incidence of BAT was most prevalent in the 20-40 year age group (68.96%). Road traffic injuries (RTI) accounted for majority of injuries. The main findings at presentation were abdominal pain, abdominal tenderness and hypovolaemic shock. The spleen and the liver were the most frequently injured solid organs while the small intestine was the most frequently injured hollow viscus. 28 of the patients had associated injuries involving the extremities, chest and head. Fifty patients underwent exploratory laparotomy where definitive management depended on findings. Complications included wound infection, pneumonia, and intra-abdominal abscesses. The mortality rate was 17.24%. Non-operative management was possible in 8 patients. CONCLUSION: BAT affects mainly the young people below 40 years of age. Definite preoperative diagnosis and the decision to operate was based on clinical assessment and some diagnostic procedures. 20.68% of patients were subjected to non-therapeutic laparotomies. This could be reduced by routine use of modern imaging techniques and thus avoiding unnecessary laparotomies and promoting non-operative management of BAT.

Human immunodeficiency virus infection in a rural community of plateau state: effective control measures still a nightmare?

Abstract: BACKGROUND: This study was designed to find out the prevalence of human immunodeficiency virus (HIV) infection in Zawan village as well as their socio-cultural practices that promote its spread. METHODS: Three hundred subjects were recruited into the study comprising 193 males and 107 females by a simple random sampling method. A structured questionnaire was administered to each respondent and 5mls of blood collected and assayed for anit-HIV antibodies. The results were analysed using statistical software Epi-Info version 6, P 0.05). CONCLUSION: HIV is still causing serious devastation in our rural communities. Hence government should supply affordable antiretroviral drugs to our rural dwellers, step up public enlightenment campaign and pursue with vigour the present micro-economic revival policies to alleviate abject poverty in our rural communities.

Significance of platelet activation in sickle cell anaemia.

Abstract: Background : There is increasing evidence suggesting the contribution of platelets in the vaso-occlusive phenomena found in sickle cell anaemia. This study is aimed at using simple, inexpensive parameters to determine the role of platelets in the steady state and vaso-occlusive crisis state of Nigerian sickle cell anaemia patients. Methods : The circulating platelet aggregate (CPA) ratio, platelet factor-3 availability (PF-3) and platelet counts of 60 adult Nigerian sickle cell anaemia patients were studied. Results : The CPA ratio in the sickle cell anaemia (SCA) patients in steady state (SS) was 0.93 ± 0.05, 0.89 ± 0.04 during vaso-occlusive crisis (VOC) and 0.98 ± 0.02 in the control group (C). The values in the vaso-occlusive crisis and in steady state were significantly lower than in the control group (P Conclusion : This study indicates varying degrees of partial activation of platelets invivo in the steady state and vaso-occlusive crisis state of sickle cell anaemia. It support's a contribution of platelet to the vascular occlusion that underlies much of the morbidity in the disease. Keywords : platelet activation, sickle cell anaemia Nigerian Journal of Medicine Vol. 15(2) 2006: 148-150

Gossypiboma: a report of 2 cases.

Abstract: Background Retention of surgical sponges in body cavities (gossypiboma) is preventable. It is probably under reported, may be for medicolegal reasons. We report 2 cases we have managed, one at a tertiary medical centre, and the other, at a private clinic in Port Harcourt, in order to re-awaken the awareness of its occurrence and make a plea for caution during surgery. Methods The case notes of patients treated surgically over the period between 1995 and 2004 were reviewed for cases of retained surgical sponges. Results Two cases were identified over the period 1995 to 2004. One had presented acutely while the second case presented in a sub-acute manner. Both required re-exploration and retained sponges were retrieved. Conclusion It may not be possible to eradicate the occurrence of retained sponges in the body but it can definitely be minimized, thus saving many patients from the associated agony.

Abdominal pregnancy: a cause of failed induction of labour.

Abstract: Background Induction of labour is a common mode of management of intrauterine fetal deaths, and the process usually involves ripening of the cervix by traditional methods of intracervical Foley's catheter insertion or the use of prostaglandin preparations intravaginally. Such methods are usually very effective independently. The objective of this case report is to call the attention of practising obstetricians to the possibility of an abdominal pregnancy as a cause of failure to ripen the cervix and that careful re-evaluation and use of ultrasound scan can improve diagnostic acumen with favorable outcome of management in such cases Methods The case file of the patient was thoroughly reviewed. A literature search on the subject of abdominal pregnancy using local and international journals and relevant textbooks was done to document the current status of the management of such cases. Results A 29-year-old Gravida 4 para 3+0 (2 alive) presented at an estimated gestational age of 32 weeks with loss of fetal movement, which was suggestive of fetal death and was referred as such from a private hospital. A process of induction of labour was commenced; to ripen the cervix with intracervical Foleys catheter and misoprostol tablet and stimulate uterine contraction, but this was not successful due to failure of the cervix to ripen. This prompted further review of the patient with the aim of excluding the possibility of an abdominal ectopic pregnancy. A repeat ultrasound scan was done and this confirmed a diagnosis of abdominal pregnancy. The patient had laparotomy done to deliver a dead fetus and the placenta was removed with the right tube and ovary as they were deeply embedded in the placental mass. The definitive diagnosis was that of a secondary abdominal pregnancy. She made a satisfactory postoperative recovery and was discharged home. Conclusion A high index of suspicion is needed to make a first time diagnosis of abdominal pregnancy. With timely diagnosis and appropriate management, the prognosis in most cases is favourable.

Marjolin's ulcer: report of 4 cases.

Abstract: BACKGROUND Marjolin's ulcer is a rare and often aggressive cutaneous malignancy that arises in a previously traumatized or chronically inflamed skin particularly after burns The aim of the study is to highlight the surgical importance of this ulcer and to emphasize the necessity of closely monitoring unstable scars of chronic wounds especially post burns wounds METHOD A report of four cases of Marjolin's ulcer seen over a fifteen-year period at the University of Port Harcourt Teaching Hospital is presented with a review of the literature RESULTS Four cases were seen over a period of fifteen years There were two females and two males aged 23, 65, 46, 19 years respectively They all sustained injuries over 20 years prior to being seen at the surgical clinic and presented with ulcers that had features of malignancy The two females had their ulcers excised and grafted, and were discharged from the hospital tumour free The two males presented to the hospital very late with malignant ulcers, which could not be resected and they took their own discharge from the hospital CONCLUSION Marjolin's ulcer is uncommon in this environment but with the increasing incidence of petrochemical burns due to the oil industry in the environment, incidence of Marjolin's ulcer might increase

The neurology of HIV infection--a review of the literature.

Abstract: Background The nervous system is widely involved in the course of infection with the human immunodeficiency virus (HIV). The manifestation may be a direct effect of the virus, the result of opportunistic infections or secondary malignancies, or a result of the therapy of various aspects of the disease. This review looks at these neurological consequences of HIV infection. Methods The review was sourced mainly by Medline search using the search terms HIV, AIDS and neurology. Relevant journals were subsequently studied. Results The major neurological manifestations of HIV infection are toxoplasmosis, cryptococcal meningitis, AIDS dementia complex, primary lymphoma, tuberculosis, progressive multifocal leukoencephalopathy, herpes zoster, Bells palsy, peripheral neuropathy, and vacuolar myelopathy. The overall effect of these is the acceleration of progression of the disease. About 30% of the mortality in HIV infection is attributed to neurological diseases. Conclusion The nervous system is significantly affected in HIV infection and the impact on morbidity and mortality is profound. All effort should be made to ensure early recognition and amelioration of the various nervous systems complications of HIV infection.

Biochemical and haematological assessment of workers exposed to some petroleum products in Enugu Urban, Enugu State, Nigeria.

Abstract: BACKGROUND Exposure to petroleum product(s) occurs during extraction, refining, transportation and utilisation. Surprisingly, this relatively common hazard has received little public recognition. We therefore studied the adverse effects of petroleum products among occupationally exposed liquefied petroleum gas and histochemical workers in Enugu Urban, Nigeria. METHODS Eight industries/departments were surveyed. Sixty workers were tested for some biochemical and haematological parameters (phosphatases, transaminases, complete blood count, erythrocyte sedimentation rate), were analysed, using standard methods. Also, 30 age and sex-matched apparently healthy subjects served as the control group. RESULTS When the test and control results were compared, there were statistically significant differences (p < 0.05) in: (1) haematocrit, reticulocytes, erythrocyte sedimentation rate, platelet, lymphocyte, monocyte, alkaline phosphatase, aspartate transaminase, alanine transaminase among liquefied petroleum gas workers and (2) haemoglobin, haematocrit, erythrocyte sedimentation rate, platelets, neutrophil, lymphocyte, monocytes, acid phosphatases and alkaline phosphatase among histochemical workers. Overall, there was statistically significant decrease (p < 0.05) in most of the parameters among the test subjects when compared with the control group. Blood films of the workers revealed mild to moderate hypochromia, anisocytosis and poikilocytosis while the controls were normocytic and normochromic. CONCLUSION We conclude that exposure to petroleum products adversely affects biochemical and haematological parameters. Hence, improved working conditions are recommended.

Absolute lymphocyte count as a marker for CD4 T-lymphocyte count: criterion for initiating antiretroviral therapy in HIV infected Nigerians.

Abstract: BACKGROUND Few laboratories in resource-constrained countries can afford to perform laboratory-monitoring tests required for the implementation of HIV therapy. In this case control study, we have investigated the relevance of absolute lymphocyte count as a surrogate marker for CD4 lymphocyte count as a criterion for initiating HAARTin HIV-infected Nigerians. METHODS A total of 100 consecutive recruited HIV-infected, previously antiretroviral naive persons and 30 HIV-negative individuals blood samples were run for absolute lymphocyte and CD4 lymphocyte counts and results were compared by a model of linear regression analysis. RESULTS An overall modest correlation was observed between absolute lymphocyte count and CD4 lymphocyte (r = 0.51) and at CD4 lymphocyte threshold relevant for clinical management of HIV-infected; 350 cells/microL (r = 0.41, 0.30 and 0.21) respectively. Mean absolute lymphocyte count of 1.60 +/- 0.77 x 10(9)/L, 1.88 +/- 1.11 x 10(9)/L and 2.04 +/- 0.54 x 10(9)/L was equivalent respectively to CD4 of 350 cells/microL. CONCLUSIONS This study indicates a modest correlation between absolute and CD4 lymphocyte counts of HIV-infected Nigerians and at CD4 lymphocyte count threshold significant for clinical management of HIV-infected. Absolute lymphocyte count can become a minimal inexpensive alternative to CD4 lymphocyte count in conjunction with WHO staging and clinical status of patient in determining the optimal time to initiate therapy particularly in resource limited settings where other expensive methods of CD4 enumeration are unavailable.

Hookworm infestation in a 3-month old female.

Abstract: Background Intestinal helminthiasis is a major cause of morbidity and mortality in infants and children particularly in the tropics and subtropics. This report highlights the possibility of hookworm infestation in infancy. Method A case report of hookworm infestation in a three-month old infant who was managed in the University of Port Harcourt Teaching Hospital, Port Harcourt in May 2001 for failure to thrive and recurrent severe anaemia. Result The patient was admitted in the children's emergency ward with passage of dark watery stools, fever, excessive crying and severe anemia and was transfused twice. Stool microscopy revealed numerous ova of hookworm and she was treated with albendazole. Three days after administration of anti-helminthic, stools became formed with normal colour and temperature was normal. She gained weight before discharge home. Conclusion Hookworm infestation should be suspected as a cause of severe anaemia in infants in communities with a high risk of infestation such as fishing port communities. To the best of my knowledge, symptomatic hookworm infestation in the first year of life has not been previously documented in Nigeria.