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  Most popular articles (Since January 29, 2020)

 
 
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REVIEW ARTICLE
Anticoagulation in sub-saharan africa with the advent of non-vitamin K antagonist oral anticoagulants
Raphael Chinedu Anakwue
April-June 2020, 29(2):187-196
DOI:10.4103/NJM.NJM_12_20  
Background: Since the approval of warfarin, a Vitamin K antagonist anticoagulant (VKA), no other oral anticoagulant existed for patients who needed long-term anticoagulation therapy until the recent introduction of non-VKA oral anticoagulants (NOACs). NOACs came to fill in therapeutic gaps associated with VKA. Dedicated anticoagulation clinics has improved the outcome of using VKA. However, with the arrival of NOACs, it is not clear how they will fit into these clinics.Methods: We searched PubMed, Google Scholar, Medline, and African Journals OnLine for articles on anticoagulation management and NOACs. Results: There were very few dedicated anticoagulation management centers in Sub-Saharan Africa, notably in Nigeria, South Africa, Kenya, Uganda, Namibia, Ghana, Botswana, Namibia, and Cameroun and warfarin was the anticoagulant used. NOACs were not used regularly. None of these anticoagulation clinics had incorporated NOACs management into their routine service as was done for VKA. Conclusion: Anticoagulation clinics in Sub-Saharan Africa must include NOACs as part of their area of service in addition to warfarin. The use of NOACs in Africa will leap frog if proper anticoagulation management policy and structure are laid out, the cost of NOACs are reduced, and emphasis is given to retraining of staff.
  479 56 -
ORIGINAL ARTICLES
Eliminating discrimination and enhancing equality: A case for inclusive basic education rights of children with Albinism in Africa
Olanike S Adelakun, Mary-Ann O Ajayi
April-June 2020, 29(2):244-251
DOI:10.4103/NJM.NJM_50_20  
Background: Various international treaties have acknowledged the rights of children to education; however, for millions of children, this right is just a dream, especially with a vulnerable group of children with physical challenges and other disabilities. Reports by the UN gives an estimate of a significantly large number of children who are yet to take advantage of good quality education. This article examines the plight of children with albinism who suffer discrimination both at the special and regular schools largely because the nature of their disability is not physical. Children with albinism have their right to education and in education limited by the difficulty to understand their impairment both at school and at home leading to entrenched discrimination and inequality, which ultimately erodes their human dignity. Methodology: This article adopts the desk research argues that the proper application of the concept of inclusive basic education of children with albinism will help eliminate discrimination and enhance equality of education of children with albinism. Conclusion: The article concludes that the existing legal framework abound, but proper implementation of article 24 of the Convention on the Rights of Persons with Disabilities will enhance the desired equality.
  346 22 -
Prevalence and factors associated with parvovirus B19 infection among blood donors: A hospital-based study in South-West, Nigeria
Ipeola P Awolesi, Sarah O John-Olabode, Gbenga Olorunfemi, Iwuchukwu O Ajie, Olufemi A Oyedeji, Alani S Akanmu
April-June 2020, 29(2):203-207
DOI:10.4103/NJM.NJM_6_20  
Background: Parvovirus B19 (B19V) is a transfusion transmissible infection that can result in severe consequences in vulnerable population that includes pregnant women, immunocompromised and chronic hemolytic anemia patients. The aim of this study was to determine the prevalence and factors associated with B19V infection amongst blood donors in South–West Nigeria. Materials and Methods: We conducted a comparative cross-sectional study to determine the seroprevalence of B19V immunoglobulin M (IgM) antibody among 183 blood donors at the blood bank of a tertiary hospital. The results were analyzed with SPSS 23 software, prevalence and associated factors were determined using frequencies and logistic regression, respectively. Results: The prevalence of B19V IgM was 7.1% (95% confidence interval: 4–11) with a higher prevalence among male donors compared to females (84.6% vs. 15.4%, P = 0.54). There was a statistically significant difference in the seropositivity of B19V IgM amongst the ethnic groups with the Yoruba ethnic group having a higher proportion of B19V IgM-positive participants P = 0.04. Ethnicity, gender, and steady employment were also associated with increased odds of infection, while increasing age appeared to be protective; though none of these factors were statistically significant. Conclusion: This study has shown that there is still high exposure to transfusion transmissible B19V infection.
  297 38 -
Amputation-related phantom limb pain in Nigeria: A prospective cohort study
Arinze D. G. Nwosu, Ifeanyi A Anikwe, Bonaventure I Eze, Edmund N Ossai, Fidelis A Onyekwulu
April-June 2020, 29(2):208-216
DOI:10.4103/NJM.NJM_11_20  
Background: Phantom limb pain (PLP) is a common and distressing complication of limb amputations. Literature on PLP in Nigeria and indeed Africa is scant despite the high rate of amputations in published works. We sought to highlight the burden of PLP among Nigerian amputees in order to improve awareness and care by health-care providers. Patients and Methods: In this prospective cohort study, consecutive limb amputees were recruited and relevant data were collected by in-person interview at 1 week postamputation and subsequently by telephone survey at 6 months and 12 months. The sociodemographic and clinical information of the amputees were recorded, as well as presence of PLP and the treatment offered by the attending physician. The Chi-square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis, and the level of statistical significance was determined by P < 0.05. Results: One hundred and fourteen consecutive limb amputations were carried out in 113 patients over a 1-year period. The period prevalence of PLP was 63.6%, and of these, only 8.6% had this documented in their medical record. No predictor of PLP was identified in the cohort. Conclusion: PLP is highly prevalent among limb amputees in our cohort. We call for improved awareness and practice relating to PLP among health-care providers and partners, considering the vast population of amputees in the region.
  295 29 -
Analgesia Self-Medication practice and pentazocine dependency in adult sickle cell patients in Southeast Nigeria
Theresa Nwagha, Omotowo Ishola Babatunde
April-June 2020, 29(2):197-202
DOI:10.4103/NJM.NJM_1_20  
Background: Painful crisis is a debilitating hallmark characteristic feature of sickle cell disease (SCD). Analgesia medication is the standard of care. Self-medication is becoming a quick fix for pain resolution for persons living with SCD. The aim of this study was to evaluate analgesia self-medication practice and pentazocine dependency among adult sickle cell patients. Methods: A descriptive cross-sectional study was conducted among 111 adults with SCD attending sickle cell clinic at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla Enugu and Alex Ekwueme Federal University Teaching Hospital Abakiliki (AEFUTHA) Ebonyi. Data were analyzed using SPSS version 22. A P < 0.05 was considered statistically significant. Results: The proportion of adults SCD participants in the study was 45.4% from UNTH Enugu and 54.6% from AEFUTHA Ebonyi. The proportion of male and female who self-medicated was 61.5% and 38.5%, respectively. The prevalence of analgesic self-medication was found to be 28.8%. Analgesics most and least frequently self-administered were paracetamol 50.5% and morphine 0.9% most reported reason for self-medication was “treatment delays in hospital” 73%. Dependency to pentazocine was 22.5%. Age was a significant predictor of self-medication among adult SCD patients. Conclusion: This study shows high prevalence of self-medication and dependency to pentazocine. There should be strict regulation on the use of pentazocine.
  281 40 -
Intestinal helminthic infection among children with sickle cell anaemia in Abakaliki, Ebonyi State: Prevalence and predictors for its development
Emmanuel Onoh, Pius C Manyike, Uzoamaka V Muoneke, Clifford O Okike, Charles Ikegwuonu, Bede C Ibe
April-June 2020, 29(2):217-223
DOI:10.4103/NJM.NJM_16_20  
Background: The sickle-cell gene is widespread in Africa and anemia, a common finding in sickle cell anemia (SCA) may occasionally result from other nonhemolytic causes such as helminthic infestations. The study is aimed at demonstrating the prevalence of intestinal helminths, risk factors of intestinal helminthic infection, and the hemoglobin level of infected children with SCA in Abakaliki, Ebonyi State. Subjects and Methods: This is a hospital-based cross-sectional study conducted between August and October 2018 involving 120 children aged 2–18 years with SCA. Risk factors for intestinal helminthic infections were assessed using a structured questionnaire. Stool was analyzed using the Kato-Katz method while the hemoglobin level was analyzed using an automated machine. Results: Among the recruited children, 55.8% were male within the age range 2–18 years with a mean age of 8.6 (±4.6 standard deviation [SD]) years and 9.1 (±3.9 SD) years for the boys and the girls, respectively. Eleven stool samples contained intestinal helminths. Lack of/poor handwashing before eating (P = 0.003) and after defecating (P < 0.001) were some of the predictors of having intestinal helminths, while sociodemographic factors such as Socioeconomic status (P < 0.001), level of education (P = 0.015), position of child in the family birth order (P = 0.028) and residence (P < 0.001) were all statistically significant to the development of intestinal helminths in the study children. The median hemoglobin of subjects who were infected with intestinal helminths was 6.5 g/dl compared to 7.9 g/dl in noninfected subjects (P = 0.010). Conclusions: Although the prevalence of intestinal helminthic infection among SCA patients in Ebonyi State is low, it has been linked to a number of risk factors and associated with lower hemoglobin levels among infected subjects.
  246 26 -
Clinical profile and electrolyte abnormalities in hospitalized under-five children with acute gastroenteritis in a tertiary health facility
Christopher B Eke, Ikenna K Ndu, Benedict O Edelu, Nwachinemere D Uleanya, Uchenna Ekwochi, Josephat M Chinawa, Ikenna C Nwokoye, Anthony N Ikefuna
April-June 2020, 29(2):295-302
DOI:10.4103/NJM.NJM_64_20  
Background: Electrolyte abnormalities constitute the leading causes of morbidity and mortality in younger children with acute gastroenteritis. The aim of the study was to determine the clinical profile and pattern of electrolyte abnormalities in under-five children hospitalized for acute gastroenteritis from November 1, 2014, to January 31, 2015. Methodology: This was a cross-sectional descriptive study among hospitalized under-five children with acute diarrhea who were consecutively recruited from November 1, 2014, to January 31, 2015. Relevant clinical data were obtained, while the physical examination was done on all subjects. Serum electrolytes values were determined using the ion-selective electrode system and compared with standard reference ranges. The data were analyzed using SPSS version 21.0 with the level of statistical significance set at P < 0.05. Results: A total of 108 under-five children were studied. The majority (101; 93.5%) were <24 months of age, while 41 (38%) of low socioeconomic class background. Metabolic acidosis was the most common electrolyte abnormality followed by hyponatremia and hypokalemia occurring singly or in combination. The case fatality rate was 13 (12.0%). The electrolyte derangements associated with mortality were hypokalemia and acidosis: 11 (84.6%) each, 9 (69.2%) had hyperchloremia, while 6 (46.2%) were reported to have hyponatremia. Conclusion: Electrolyte derangements are common in under 5 years children with acute diarrhea with increased mortality in those with severe acute malnutrition. Proper health education is needed to ensure adequate nutrition and timely use of low-osmolar oral rehydration solution as well as early referral of cases with persistent gastrointestinal losses in order to save lives.
  240 26 -
Determining factors for the choice of medical career among the final year medical students of a private university in Nigeria
Abiodun Idowu Okunlola, Olakunle Fatai Babalola, Cecilia Kehinde Okunlola, Adedayo Idris Salawu, Olabisi Timothy Adeyemo, Idowu Oluwaseyi Adebara
April-June 2020, 29(2):308-311
DOI:10.4103/NJM.NJM_79_20  
Background: Medical education worldwide is more expensive compared to other university courses due to the structure of the training into two phases: basic medical sciences and clinical sciences, each with extensive syllabuses and involves an array of professionals in various specialties. The burden of medical education was largely borne by the government in Nigeria until recently when the private sector forayed into the provision of tertiary education including medical education. Methods: The study was a cross-sectional survey study. All 94 final year medical students of Afe Babalola University, Ado-Ekiti, a private sector-owned university in South Western Nigeria, were invited to participate in the study. The institutional ethical approval was sought and obtained (ERC/2020/04/07/364A). Structured self-administered questionnaires were used to collect relevant data. Participation in the study was voluntary and confidential. The data obtained were analyzed using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Results: Eighty-three (88%) final year medical students participated and returned completed questionnaires out of 94 students. Further analyses were on the number of the respondents (n = 83). Fifty-seven (68.7%) of the respondents were female, whereas 26 (31.3%) of the respondents were male. The mean standard deviation age was 23 (1.6) years, and the age ranges between 20 and 30 years. Parental influence and personal interest were the two most important factors that influenced the decisions for medical education. Fifty-seven (68.7%) of the respondents prefer to practice outside Nigeria, 25 (30.1%) respondents will like to practice in Nigeria but in urban areas, whereas only 1 (1.2%) of the respondents will prefer to practice in a rural area. Conclusion: The choice of medical education and future specialty is multifactorial but the most important factors are personal interest and parental influence. The choice of where to practice is mostly determined during the undergraduate program, and it tends toward continuous emigration of doctors to developed countries.
  242 21 -
Urologic emergencies in a low-resource setting: A 10-year review from South-Western Nigeria
AA Salako, TA Badmus, RN Babalola, MC Igbokwe, RA David, C Onyeze, A Laoye, IA Akinbola
April-June 2020, 29(2):291-294
DOI:10.4103/NJM.NJM_62_20  
Background: Emergency presentations are quite an important aspect of the urologic practice, and prompt attention is necessary to relieve symptoms, limit morbidity, and prevent mortality. Adequate knowledge of the pattern of emergency urologic presentations might aid rapid diagnosis and provide data for hospital and public health planning purposes. We present our experience with urologic emergencies in our hospital. Objectives: The objective was to describe the pattern of presentation and the peculiar challenges of urologic emergencies in a typical low-resource setting in South-Western, Nigeria. Patients and Methods: A retrospective review of all patients with urologic complaints who presented acutely to the accident and emergency department (AED) of our hospital, between January 2008 and December 2017, was done. Data were analyzed using the Statistical Package for Social Sciences version 20. Results: There were 1102 patients seen with urologic complaints, which constitute 3.2% of the total patients presenting to our AED over the 10-year period reviewed. Urinary retention (28.7%) and gross hematuria (19.5%) were the most common emergency urology presentations, whereas urethral injury was the most common mode of urologic trauma (59%). Over half (53%) of the patients with hematuria had a urologic malignancy. Prostate cancer was the leading urologic malignancy presenting to the AED. Testicular torsion and priapism were predominantly found in young male patients. There were 2.7% mortalities, with complicated prostate cancer, the leading cause (66.7%). Immediate causes of mortality were metastatic disease and urosepsis. Conclusion: Urologic emergencies are a probable cause of morbidity and mortality in our setting. Adequate knowledge of the pattern of patient presentation might aid diagnosis, improve outcomes, and provide data for hospital and public health planning purposes.
  208 32 -
Preparedness of Nigerian health institutions toward managing lassa fever epidemic and Covid-19 pandemic
Shehu S Umar, Bilqis O Muhammad, S Babandi Zaharadeen
April-June 2020, 29(2):303-307
DOI:10.4103/NJM.NJM_71_20  
Objectives: The objective is to assess standard practice of healthcare workers and preparedness of their healthcare institutions toward controlling spread of infectious diseases. Background: With the on - going epidemic of Lassa fever and the rising incidence of Covid-19 pandemic in Nigeria, there has been efforts from government and stakeholders in health towards controlling the surge of these diseases. This study is a multi-center survey involving frontline health-care workers, from 102 health institutions. Methodology: Pretested self-administered questionnaires were sent through online Google form to health-care workers across various health institutions through their respective social media platforms. Their consent was sought and the questionnaires were filled through registered emails. Multiple entry from same individual was prevented. The number of respondents was 451. The information gathered include biodata of health-care workers, details of their cadre and years of practice, their level of standard precautions and preparedness of their health institutions. Data gathered were collated, summarized, and analyzed using simple tables with proportions. Results: The practice of standard precaution was inadequate with only 59.4% of respondents washing their hands regularly after touching patients or carrying out procedures, while only 34.4% of them used face masks while consulting patients with respiratory symptoms. As for preparedness of health institutions in control of Lassa fever and Covid-19, 63.1% and 77.6% of respondents affirmed that their health institutions had written protocol of managing infectious diseases and had organized workshop on Lassa fever and/or Covid-19, respectively, while only 45.5% and 20% of respondents had dedicated isolation wards and functional intensive care units in their health institutions. Conclusion: The standard safety precautions by health-care workers were suboptimal and preparedness of their health institutions was generally inadequate for the management and control of infectious diseases.
  211 21 -
The civilian vascular trauma in a low-income country: The determinant factors of morbidity and mortality
Ikechukwu A Nwafor, John C Eze, Bolaji A Akanni
April-June 2020, 29(2):224-228
DOI:10.4103/NJM.NJM_23_20  
Background: Civilian vascular injury is relatively common in the West African subregion, but it is highly underreported. Aim/Objective: The aim of the study was to evaluate the patients managed for civilian vascular surgeries and to determine the factors causing morbidity and mortality in low-income countries. Materials and Methods: This is a retrospective study spanning a period of 13 years (2007–2019) of civilian vascular injuries managed in a tertiary hospital in a low-income country. We obtained data from our hospital record department. Data obtained and analyzed were demography, etiology, vessels affected, pattern of presentation, stratification, and treatment. Results: Within the envisaged period, 58 patients were affected in civilian vascular trauma with a mean of 4.5 cases per year. The male-to-female ratio was 0.9:0.1. The age range of patients affected was from 0–10 to 71–80, with the age group of 21–30 years being the most affected. Male was more affected (87.9%). Motor vehicle crashes were the most common etiology agent (42.0%). The femoral artery was the most commonly injured vessel (31.3%). In the pattern of presentation, bleeding with shock was dominant (49.8%). Lateral tarsorrhaphy accounted for the major vascular treatment interventions (30.2%). Conclusion: The outcome was very variable and depended on warm ischemic time, type and/or mechanism of injury, collateral blood supply at the site of injury, and comorbidity.
  208 18 -
Pediatric blood culture isolates and antibiotic sensitivity pattern in a Nigerian tertiary hospital
TO Ogunkunle, MB Abdulkadir, OS Katibi, SO Bello, RA Raheem, R Olaosebikan
April-June 2020, 29(2):261-264
DOI:10.4103/NJM.NJM_55_20  
Introduction: There is a significant variation in the bacterial pathogens implicated in childhood septicemia and their antibiotic sensitivity pattern from place to place. Sustained monitoring of this dynamics is therefore critical to rational antibiotic use. Materials and Methods: This study was thus conducted to determine the etiology of childhood septicemia and their antibiotic sensitivity pattern. Blood culture results (contaminants excluded), age, and sex of all pediatric patients with suspected septicemia between January 2013 and December 2014 were retrieved. Data were analyzed using SPSS version 20. Results: Over a 2-year period, a total of 3680 blood samples were processed. Pathogenic bacteria were isolated in 701 samples (19%).Staphylococcus aureus was the most common isolate (41.4%) and was most sensitive to ampicillin-sulbactam (89%). Klebsiella species (21.7%), coagulase-negative Staphylococcus (14.7%), and Pseudomonas aeruginosa (11%) were other common organisms isolated. Virtually, all the isolates demonstrated a reliable susceptibility to ciprofloxacin except for S. aureus and Klebsiella species which were most sensitive to ampicillin-sulbactam and imipenem, respectively. Conclusion: In conclusions, S. aureus is the leading cause of childhood septicemia in this locale. The significant rate of isolation of the supposedly less virulent organisms calls for an urgent review of potential risk factors and an appraisal of the hospital infection control policies and structures.
  190 23 -
CASE REPORTS
Mermaid syndrome in Enugu, Nigeria
Johnpaul Ejikeme Nnagbo, Chukwudi Cyril Dim, Hyginus Uzo Ezegwui
April-June 2020, 29(2):321-323
DOI:10.4103/NJM.NJM_10_20  
Mermaid syndrome is a type of gross fetal anomaly, characterized by the fusion of lower extremities, absent external genitalia, and apparently well-formed abdomen, chest, upper extremities, and head. The neonatal mortality rate due to this anomaly is high, but the disorder is relatively rare. Hence, few cases have been reported in the medical literature, and none in University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State.
  188 23 -
ORIGINAL ARTICLES
An audit of vaginal hysterectomy and pelvic floor repair for uterovaginal prolapse in South-East Nigeria
Kenneth C Ekwedigwe, Maradona E Isikhuemen, Ileogben Sunday-Adeoye
April-June 2020, 29(2):265-268
DOI:10.4103/NJM.NJM_56_20  
Aim: The study aimed to audit vaginal hysterectomies and pelvic floor repair performed for women with uterovaginal prolapse as a quality assessment of the procedure. Materials and Methods: In this study conducted at the National Obstetric Fistula Center, Abakaliki, case folders of women who had vaginal hysterectomy and pelvic floor repair for uterovaginal prolapse between June 2012 and December 2016 were reviewed. Relevant data were extracted using a pro forma and analyzed using the Statistical Package for the Social Sciences, software version 21. Results: The case records of 358 women who had a vaginal hysterectomy and pelvic floor repair were reviewed. Their mean age and parity were 53.44 ± 10.54 years and 6.92 ± 2.47, respectively. Complications were recorded in 49 (14%) of the patients, and these were intraoperative bleeding requiring blood transfusion in 15 (4.2%), postoperative intraabdominal bleeding requiring exploratory laparotomy in 7 (2%), urinary tract infection in 5 (1.4%), hospital re-admission following vaginal bleeding in 2 (0.6%), and vaginal discharge in 13 (3.6%). The long-term complication that was observed following the procedure was vault prolapse in 7 (2%). There was 1 (0.3%) mortality. Conclusion: Vaginal hysterectomy with pelvic floor repair is a relatively safe procedure in women with uterovaginal prolapse. There are morbidities associated with this procedure.
  182 29 -
Low serum calcium levels occur in Nigerian adults with type 2 diabetes and correlates negatively with their glycosylated hemoglobin levels: A case-control study
Harriet Chioma Nwankwor, Chidimma Brenda Nwatu, Celestine C Okwara, Ekenechukwu Esther Young, Louis C Olisaka, Nonso C Ezomike, UV Muoneke
April-June 2020, 29(2):229-233
DOI:10.4103/NJM.NJM_25_20  
Background: The prevalence of diabetes mellitus (DM) has increased globally making it a major public health concern. Serum calcium levels, together with other minerals, play an important role in the regulation of plasma glucose. The aim of this study was to determine the serum calcium levels in individuals with Type 2 DM (T2DM) as well as its relationship with their clinical characteristics and glycemic control. Materials and Methods: This was a cross-sectional study carried out at the University of Nigeria Teaching Hospital, Enugu State. A total of 300 participants were recruited, comprising 150 participants with DM and 150 age- and gender-matched normal participants as control. A questionnaire was administered to obtain clinical characteristics. Serum calcium and glycosylated hemoglobin (HbA1c) were measured. Mean ± standard deviation was calculated, and an independent t-test was used to determine the mean difference. Pearson's correlation was done to establish the correlation between serum calcium and HbA1c. Data were analyzed with SPSS version 23. Results: This study showed that the mean serum calcium level for the T2DM participants was significantly reduced (2.16 ± 0.17) when compared to that of the controls (2.21 ± 0.17)(P= 0.02). Furthermore, individuals with T2DM showed a significant negative correlation between serum calcium levels and HbA1c-a long-term measure of glycemic control (r = 0.273; P = 0.001). Conclusion: Participants with T2DM were found to have a lower mean level of serum calcium. In addition, T2DM participants who had poor glycemic control were more likely to have hypocalcemia.
  185 18 -
Utilization and Factors Affecting Utilization of Contraception among HIV-Positive Male Patients in Saye, Zaria
Ayandunmola F Oyegoke, Aisha Abubakar
April-June 2020, 29(2):239-243
DOI:10.4103/NJM.NJM_49_20  
Introduction: Sub-Saharan Africa continues to carry the full consequences of health and socioeconomic impact of HIV, with about 25.8 million and 66% of people with HIV infection living in the region. The overall prevalence of contraceptive use in Nigeria is low, especially among men; the uptake of contraception and the type of contraceptive use are heavily influenced by the male/husband dominance in the society/family. Methodology: The study was carried out among HIV-positive male patients in Saye, Zaria, using a descriptive cross-sectional study among 265 respondents. Chi-square and multivariate logistic regression were used to determine factors influencing contraceptive usage. Results: The mean age of respondents was 45.6 ± 11.7 years. Only 61.9% of the respondents have ever used contraception, out of which 56.7% are currently using contraception. The identified reason for not using contraception was because they both were HIV positive (29%). There was a significant association between age, marital status, and level of education of respondents and current use of contraception with a P value of 0.001, <0.001, and 0.004, respectively. Conclusion: There were low usage of contraception and poor acceptance of vasectomy. There should be adequate policies in place by the government to encourage male involvement in the utilization of contraception.
  183 18 -
Audit of open pediatric tracheostomies at the University College Hospital, Ibadan
Oyeleye A Oyelakin, Adebolajo A Adeyemo
April-June 2020, 29(2):256-260
DOI:10.4103/NJM.NJM_54_20  
Background: Tracheostomy is the creation of a communication between the trachea and the overlying skin, maintained by a tube. This is done either by an open or percutaneous technique. Anatomical and physiological variation of the paediatric trachea and adjoining structures necessitates finite skills and consistent competence in performing pediatric tracheostomies, lack of which may cause higher mortality and morbidity outcome in tracheostomies in the pediatric age group. Objectives: There are inadequate local data on the outcomes of pediatric tracheostomies; therefore, we conducted a local audit of pediatric tracheostomy to describe our experience. Methods: A retrospective study of pediatric patients who had tracheostomies from June 2011 to December 2017 was done. Results: Thirty-four patients were identified, all of whom had an open tracheostomy. The age range was 3 weeks to 16 years; M: F ratio was 2.4:1. Indications for surgery were obstructive (88.2%) and prolonged-assisted intubation (11.8%). Recurrent respiratory papillomatosis, retropharyngeal abscess, and foreign-body aspiration were the main obstructive causes. Three patients (8.8%) had repeat procedures, and these patients were initially discharged on tracheostomy tube and instructions were given for home care. Conclusion: Despite the evolving local challenges peculiar to clinical practice in developing countries, the outcome of pediatric tracheostomy in our hospital is good.
  184 17 -
Uptake and discontinuation of jadelle implant use in University of Calabar Teaching Hospital, Calabar, Nigeria
Patience O Odusolu, EM Eyong
April-June 2020, 29(2):286-290
DOI:10.4103/NJM.NJM_61_20  
Background: Contraception is known to contribute to a reduction in maternal mortality rates directly. Jadelle implant is a long-lasting, reversible contraceptive that is safe, highly effective, and convenient. Objectives: The objectives of this study were to determine the sociodemographic profile, side effects, and reasons for discontinuation among users of Jadelle in the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Methodology: This was a 5-year retrospective study carried out at UCTH, Calabar, Nigeria. Case files of women who accepted and inserted Jadelle implant between January 1, 2013, and December 31, 2017, were retrieved, and data were extracted for the study. Descriptive and analytical statistics of the data using mean and standard deviation were done, and results were presented in frequency and percentage tables. Results: A total of 270 women accepted and inserted Jadelle implant during the period under review with a mean age of 33.0 ± 6.2. Majority of the clients were Christians 98.1%, and 85.9% had at least secondary school education. About half (49.6%) of these women had a desire for future fertility, whereas 49.7% have had four or more children. Sixty-one percent (61.5%) of the clients had previously used a form of contraception. Menstrual irregularities were the most commonly reported side effect (55.0%) as well as the most common reason for removal and discontinuation of the implant (43.3%). Conclusion: Jadelle is a highly effective, safe, and reversible method of contraception. The most commonly reported side effect was menstrual irregularities, which was also the most common reason for discontinuation in the UCTH, Calabar, Nigeria.
  175 17 -
Ultrasound findings in the gallbladder of sickle-cell patients: A cross-sectional Study in Enugu, Nigeria
Enyereibe C Ajare, Philip C Okere, Augustine C Onuh, Emeka K Mgbe, Emmanuel A Nwobi, Emmanuel N Obikili
April-June 2020, 29(2):252-255
DOI:10.4103/NJM.NJM_53_20  
Background: Sickle-cell disease (SCD) causes chronic and recurrent hemolysis which is a recognized risk factor for gallbladder (GB) disease. The prevalence of GB disease in SCD is high and increases with age. Cholelithiasis and cholecystitis are relatively common GB diseases in SCD. They are important causes of acute abdominal pain in SCD and also increase morbidity. Ultrasound is a cheap and noninvasive means of evaluating the GB; it has a high degree of accuracy and is widely available.Aims: The aim of this study is to sonographically evaluate the GB of SCD patients in steady state at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, and to determine the prevalence of specific GB diseases in SCD patients. Materials and Methods: A prospective cross-sectional study of 130 known SCD patients attending sickle-cell clinics at UNTH and 130 controls. Ultrasound of the GB was done after at least 6 h fast, using a Dp2200 mindray mobile ultrasound machine equipped with a 2.5–5 MHz convex probe. The data were analyzed using the SPSS software version 16. Results: The GBs of 130 consecutive SCD participants and 130 control group were sonographically evaluated. The prevalence of cholelithiasis in SCD was 10.8%, whereas the prevalence of cholelithiasis in the control group was 3.1%. No other GB diseases were seen. The mean dimensions of the GB for the study group were length (65.78 ± 9.85 mm), width (29.15 ± 6.01 mm), depth (25.58 ± 5.81 mm), wall thickness (1.59 ± 0.74 mm), and volume (26.52 ± 11.18 cm3). Conclusion: The prevalence of cholelithiasis in sickle cell disease in southeast Nigeria is 10.8% while the prevalence of cholelithiasis in the control population is 3.1%.
  175 17 -
Domestic violence: The pre- and post-diagnosis experience of women living with HIV in a rural community in Northwest Nigeria
Adewale O Ashimi, Taiwa G Amole, Haliru Ibrahim
April-June 2020, 29(2):273-278
DOI:10.4103/NJM.NJM_58_20  
Background: Domestic violence (DV) is a fundamental human right problem. Stigma and discrimination increase the incidence and affects care. Objectives: This study aimed at determining the prevalence, types of DV pre- and post-diagnosis of human immunodeficiency virus (HIV), perpetrators, and the response to it in a rural community in Northwest Nigeria. Materials and Methods: A descriptive and cross-sectional study of 261 women was done. The sample was selected by proportionate allocation and systematic sampling. Data of respondents were obtained employing an interviewer-administered questionnaire. The analysis was done using Chi-square, Fishers exact, and McNemar's tests. Results: Less than one-quarter of respondents, 60 (23.0%) and 62 (23.8%), had experienced at least one form of DV pre -and post-diagnosis, respectively. The types observed were mainly verbal (44/60 [73.4] and 55/62 [88.7]) and psychological (43/60 [71.6%] and 40/62 [64.5%]) pre- and post-diagnosis, respectively. The difference in the experience of DV pre- and post-diagnosiss was not statistically significant. Majority of the perpetrators were the current husband (n = 37; 59.7%) and siblings (n = 9; 14.5%); educational level and occupation were significantly associated with the occurrence of DV (P < 0.05). Conclusion: Although the prevalence of DV among women living with HIV was high, the pre- and post-diagnoses of violence experienced were the same. DV should be included as part of the care and management of this group of women.
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CASE REPORTS
Solar maculopathy arising from nondeliberate sun gaze
Oraegbunam H Nnenna, Etim A Bassey, Uchenwa Ezemba
April-June 2020, 29(2):334-336
DOI:10.4103/NJM.NJM_65_20  
Solar maculopathy occurs as a result of the effects of exposure of the macula to the harmful light spectrum from the sun. Phototoxic damage of the macula occurs as a result of the exposure to sunlight with some resultant visual deficit. The effect is common during a solar eclipse, where people directly watch the occurrence without sun-filter glasses. Solar maculopathy is also known to occur during religious rituals, and in schizophrenic patients who stare at the sun. Clinical history, subtle clinical biomicroscopic, and optical coherence tomography (OCT) findings are the key in making a diagnosis. Management is conservative with OCT follow-up. Solar maculopathy from nondeliberate sun gazing is not common. We report the case of a 24-year-old African who developed solar maculopathy after nondeliberate exposure to sunlight.
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ORIGINAL ARTICLES
The childhood trauma questionnaire: Validity, reliability and factor structure among adolescents in calabar, Nigeria
Emmanuel Aniekan Essien, Olusola Ruth Attoe, Godwin Akepu Anake, Emmanuel Effiong Uwah, Ehiaghe Jennifer Aigbomian, Franklin Ifeanyi Eleazu, Owoidoho Udofia
July-September 2018, 27(3):252-259
DOI:10.4103/1115-2613.278787  
Introduction: Child abuse is a cause of increasing concern globally and is known to have significant negative effects on the physical and psychological well-being of children. Validated instruments for screening child abuse in Nigeria are scarce. Aim: This study aimed to determine the validity, reliability and factor structure of the 28 item version of the Childhood Trauma Questionnaire among Secondary School students in Calabar South, Cross River state, Nigeria. Methodology: In a cross-sectional study, a sample of 161 students was drawn from two secondary schools in Calabar South, Cross River State, using multi-stage technique. A socio-demographic questionnaire, the Childhood Trauma questionnaire (CTQ-28), the General Health Questionnaire (GHQ-12) and the Self-reporting Questionnaire (SRQ-20) were administered to the selected students. Convergent validity between CTQ and other scales, reliability using Cronbach alpha and the factor structure of CTQ using principal component analysis were assessed. The data was analyzed with the Statistical Package for Social Sciences, 21st edition (SPSS-21). Results: Cronbach alpha was 0.80. Internal consistency for the subscales were 0.69 for emotional abuse, 0.60 for physical abuse, 0.60 for sexual abuse, 0.79 for emotional neglect and 0.21 for physical neglect. For convergent validity, correlation coefficients with the GHQ-12 and the SRQ-20 were 0.39 and 0.45 respectively (p<0.05). Principal Components Analysis yielded a four factor solution. Conclusion: The 28 item version of the Childhood Trauma Questionnaire has acceptable reliability and validity and can be useful as a screen for child abuse among adolescents in Nigeria.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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CASE REPORTS
Hormonal contraceptive induced immune thrombocytopenic purpura
Z Ayuba, HT Idi, YB Ngamdu, AA Buba, AB Tsuung
April-June 2020, 29(2):324-327
DOI:10.4103/NJM.NJM_48_20  
Immune thrombocytopenic purpura (ITP) is an acquired disorder of platelets that clinically manifests with mucocutaneous bleeding. There are several causes of ITP, but its association with hormonal contraceptive implants has not been widely reported. A 39-year-old Para 10+0 7 alive presented to the Yobe State University Teaching Hospital with complaints of nasal bleeding, gum bleeding, purpura, and menorrhagia, which were noticed a month after insertion of a Levonorgestrel – containing hormonal contraceptive implant, at a Primary Healthcare facility. Complete blood count, peripheral blood film, and bone marrow aspiration cytology led to the diagnosis of ITP. Epistaxis was managed conservatively. The patient was placed on prednisolone with a noticeable increase in platelet count and remarkable improvement in the clinical state. ITP is a complication of the hormonal contraceptive implant. Clinicians should be aware of the possible association of contraceptive implants and ITP.
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ORIGINAL ARTICLES
Tooth loss and predictors of tooth extractions due to dental caries among adults: A multi-center study in North-eastern Nigeria
Paul Ikhodaro Idon, Abdulmumini Mohammed, Yahaya Abdulmanan, Olawale Akeem Sotunde, Janada Yusuf, Taiwo Omoniyi Olalekan, Yusuf Halidu Bako
April-June 2020, 29(2):279-285
DOI:10.4103/NJM.NJM_60_20  
Background: Tooth loss and the level of edentulism may be an indication of a populations' oral health. The aim of this study was to evaluate the contribution of dental caries to tooth loss, as well as its predictors among adults in North-eastern Nigeria. Methods: A cross-sectional survey over a 2-month period of all adult patients who had tooth extractions in three dental centers across North-eastern Nigeria. Data on sociodemographics (age, gender, and level of education), history, and examination findings were collected with a preformed questionnaire to include the frequency and reasons for the use of dental facilities, previous tooth extractions and reason for extractions, missing teeth, and present diagnosis for the teeth to be extracted. Bivariate and multivariate analyses were used to determine the association and relationships between missing teeth, extractions due to caries and population variables. Results: The prevalence of preextraction tooth loss was 37.98% with a mean tooth loss of 3.05 ± 3.15 per participant, 2.24 ± 1.46 among the 35–44 years old and highest (10.08 ± 8.02) among the 65–74 years old participants. Age was the single significant predictor of tooth loss (β = 0.428, P < 0.001). Molars were the most extracted teeth, with 78.13% of all extractions due to caries and its sequelae. Significant correlations existed between age (r = −0.144, P = < 0.001), level of education (r = −0.118, P = 0.004), and extractions due to caries and its sequelae and were significant in the regression model. Conclusion: Caries and its sequelae were the major reasons for missing teeth as well as for current extractions. Molars were the teeth most affected. Age and level of education were the important determinants of extractions due to caries and its sequelae.
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Serum cytokine profile (Interleukin-6) among women with pelvic organ prolapse
Kenneth C Ekwedigwe, Ileogben Sunday-Adeoye, Monday O Eliboh, Maradona E Isikhuemen, Henry Uro-chukwu, Paul Ezeonu
April-June 2020, 29(2):234-238
DOI:10.4103/NJM.NJM_47_20  
Background: Pelvic organ prolapse (POP) is a common gynecological problem, particularly in the grand multipara. There are indications that serum concentration of cytokines is higher in women with POP and even more so when there is evidence of infection. This study assesses the serum cytokine level (interleukin [IL]-6) in women with POP. Materials and Methods: This study was conducted among 96 women with POP and a control group of 96 women. A case–control study using a quota system nonprobability sampling technique was done. The serum cytokine level was determined using a commercial standard enzyme-linked immunosorbent assay kit. Results: The mean age and parity were 53.54 ± 10.1 years and 7.04 ± 2.33, respectively. The mean level of serum IL-6 and standard error of mean was 95.79 ± 18.6, ±1.9 as against 17.92 ± 7.62, ±0.78 for control and as against <20 pg/ml for the general population.P values were 0.00 and 0.08, respectively. The result showed that IL-6 was significantly increased in women with POP. Conclusion: This study suggests that cytokine levels were significantly elevated in patients with POP.
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