Background: Postoperative pain has a negative effect on the process of recovery. There is paucity of literature on the postoperative pain management practice in children in developing countries. We sought to determine the current practice of postoperative pain management in children among pediatric surgeons in Nigeria. Methods: A cohort of 43 pediatric surgeons/trainees attending two annual meetings of Association of Paediatric Surgeons of Nigeria (2011 and 2013) were surveyed with a questionnaire enquiring about the practice of postoperative pain management in children and their perceptions. Results: Thirty-seven respondents had completed the survey (86% response rate). Of these respondents, 27 (73.0%) were consultants and 10 (27.0%) were trainees. Only 2 (5.4%) respondents used any guidelines, and 8 (21.6%) respondents had an established institutional protocol for the pediatric postoperative pain management. Almost half of the respondents (18, 48.6%) used clinical judgments for assessing postoperative pain, followed by crying, requires oxygen to maintain saturation > 95%, increased vital signs, expressions, and sleeplessness scale (13, 35.1%); alertness, calmness, respiratory response/crying, physical movement, muscle tone, and facial tension behavioral scale (11, 29.7%); and verbal rating (10, 27.0%). In neonates, 89% of the respondents used paracetamol and 32% used pentazocine for routine postoperative analgesia. None of the respondents used morphine for neonatal postoperative analgesia. In older children, commonly used analgesics include paracetamol (35, 94.6%), pentazocine (30, 81.1%), and nonsteroidal anti-inflammatory drugs (28, 75.7%). More than half of the respondents (20, 54.1%) were not satisfied with their current practice of postoperative pain management. Conclusion: Pain was infrequently assessed, and analgesic therapy though multimodal was largely not protocol based and therefore subject to inadequate pain relief. Postoperative pain should be more visible in our hospitals, and efforts should be made to improve its assessment and management.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Congenital maxillomandibular fusion is a very rare condition with few cases reported worldwide. This paper reports a rare case of bony maxillomandibular fusion of the jaws, with synechiae of buccal mucosa and the gingivae in an adult patient. Separation of the fusion was done under general anesthesia. Isolated cleft of the hard palate was discovered during surgery. This report adds more information to literature, by reporting an adult with syngnathia and isolated cleft of the hard palate.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background and Objective: The Emergency Department is of significance and is the vital entry points of patients into the healthcare facility of the hospital all around the world. This study aims to assess the knowledge, attitude and practices of emergency personnel at two tertiary hospitals in Lagos as regards emergency management and preparedness. Aims: This study aims to assess the knowledge, attitude, and practices of emergency personnel at two tertiary hospitals in Lagos with regard to emergency management and preparedness. Settings and Design: This was a descriptive, cross-sectional study. Materials and Methods: A convenient recruitment was made of eligible and consenting individuals at both hospitals until the required sample size was reached. Statistical Analysis Used: The data obtained were analyzed using Epi Info statistical software version 3.5.1. Results: The majority (93.2%) of the participants were clinicians. It was discovered that less than half or 98 (47.8%) of the participants had good knowledge of emergency preparedness and planning, 76 (37.1%) had a fair knowledge, while 31 (15.1%) had poor knowledge. The respondents' attitude toward emergency preparedness was generally positive, as most of them, that is, 191 (93.2%) believed that they needed to know about emergency planning. Only a minority, that is, 72 (35.1%) of the respondents knew that emergency drills are done in their respective hospitals. Conclusions: There was an overall deficiency in the respondents' knowledge of emergency preparedness. Their attitude was good and acceptable, but their practices in terms of the frequency of emergency drills and the frequency of regularly updating the emergency plans were grossly inadequate.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Children with neurodevelopmental disorders (CNDs) are a group requiring more attention as their care is often challenging, particularly for parents with primary caregiving roles in resource-restricted settings. This study had set out to investigate the burden and psychological distress among caregivers of children with neurodevelopmental delays. Materials and Methods: A total of 68 caregivers were recruited during the 2013 annual autism health program organized by the College of Medicine, University of Lagos in collaboration with Guaranty Trust Bank, Nigeria and Blazing Trails, USA. Of these caregivers, 60 respondents (caregivers and children) were included in the final analyses due to poorly completed questionnaires. The Zarit Caregivers Burden Scale (ZCBS) and General Health Questionnaire version 12 (GHQ-12) were administered to elicit caregivers' experience with respect to burden and psychological distress, respectively. Results: Of the 60 participants included in the final analyses, the majority constituted parents (96.3%) with mothers accounting for 71.7%; 28 (46.7%) participants were government workers and 3 (5%) were full-time housewives. The mean age of CNDs was 6.8 (±3.2) years, and 33 (55.0%) were males. Delivery by cesarian section was reported in 19 (31.8%). The common presenting complaints by caregivers were inability to walk (32.7%), repetitive behavior (25.5%), difficulty with verbal communication (10.9%), nonsocialization (9.1%), seizures (9.1%), and hyperactivity (3.6%). Problems were noticed at ≤ 1 year in 46.7% while they were noticed after 2 years in more than half the children, and a little above one-eighth (14%) had siblings with similar problems. On the ZCBS, nine (15.0%) caregivers reported a significant burden. In addition, 23 (38.3%) caregivers had psychological distress. Caregivers' burden was significantly related to the report of psychological distress in caregivers (P < 0.001) and there was a trend toward the presence of psychological distress in almost all caregivers with children experiencing seizures. Conclusions: The findings in this study underscore the need for counseling and psychosocial support for caregivers of CNDs. Further research on the emotional experience of caregivers is also warranted.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: The prevalence of diabetes mellitus (DM), a noncommunicable disease (NCD) in adolescents, is on the rise worldwide; therefore, knowledge which facilitates prevention and early detection is important. The objective of this study was to determine the knowledge of DM and self-reported risk factors among adolescents in a senior secondary school, in Surulere, Lagos State. Methodology: This was a cross-sectional descriptive study of 144 male and 106 female senior secondary students with a mean age of 15.2 ΁ 1.3 years. Respondents were selected through multistage sampling technique. A structured pretested questionnaire was used to collect data. Epi Info 7.1.5 was used for data analysis and the level of statistical significance was set at 5%. Results obtained were presented with the use of frequency tables. Results: Two out of three respondents had heard of DM. Among those who were aware of the condition, 64.9% knew it referred to abnormally high blood glucose. Only (10.9%) knew it was a lifelong condition and less than a third (26.7%) knew the measurement of blood glucose with a device for the screening test. Less than 30% considered obesity, family history, diet, and physical inactivity as risk factors. Their main source of information was the mass media. Overall, 46% of respondents had good knowledge of DM. As regards the presence of lifestyle behavior/risk factor for DM/NCDs in the respondents, 8.4% of the respondents had a family history of DM, had consumed alcohol (28.8%), smoked tobacco (4.8%), and were overweight/obese (5.2%). Conclusion: Two-thirds were aware of DM, of which over half had inadequate knowledge of DM despite the existence of some risk factors. There should, therefore, be an inclusion of NCD education in the curriculum of secondary school students.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction: Quality of life (QoL) assessment has become an integral component of the assessment of the holistic care of patients with chronic diseases, including sickle cell disease (SCD). Objective: To evaluate the quality of life in patients with SCD managed in our centre. Patients and Methods: Eighty consecutive patients with confirmed hemoglobin SS or SC were recruited. Age and sex-matched volunteers served as controls. Ethical approval was obtained from the Institutional Review Board and all participants gave informed consent. Information on socio-demographic, quality of life and clinical variables, including the presence of complications were recorded in a modified version of the WHO Quality of Life Brief version (WHOQOL-BREF) questionnaire. Data was analyzed using Microsoft Excel and SPSS 17 computer softwares. Descriptive statistics were used to represent socio-demographic variables while the Student t-test was used to explore relationship between the variables and the quality of life domains. Results: Significantly fewer participants with SCD are married compared to their age- and sex-matched controls (P = 0.01). Similarly, participants with SCD scored significantly lower in the physical and psychological domains as well as in overall QoL and general health domains compared to controls (P = 0.001). Avascular necrosis of the femur significantly affected the overall QoL and general health of participants with SCD, respectively while the means of the QoL assessment domains were not significantly different in participants with SCD with and without complications, except in the general health domain (P < 0.001). Conclusion: Avascular necrosis of the femoral head significantly affects overall QoL in participants with SCD.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: The prevalence of diabetes mellitus (DM) among Nigerian adults is increasing. Besides the well-recognized microvascular complications of diabetes, there is also a growing epidemic of macrovascular complications. Patients with diabetes may not only have diabetes-related complications but may also have nondiabetes-related comorbidities. Aim: To determine the pattern of chronic diabetic complications and coexisting morbidities in patients attending the diabetic outpatient clinic of a tertiary health care center in Nigeria and the factors associated with the presence of complications. Materials and Methods: This was a cross-sectional descriptive survey carried out among patients attending the follow-up diabetic clinic of a tertiary health care center in Nigeria over a 3-month period. A systematic random sampling method was used and 422 eligible patients were selected and interviewed using pretested interviewer-administered questionnaires, after written informed consent was obtained. Data were analyzed using  Epi Info statistical package version 3.5.1. developed by Centers for Disease Control and Prevention (CDC) in Atlanta Georgia (USA). Results: Of the 422 patients interviewed, 400 (247 females and 153 males) had complete data for analysis. Eighty-eight patients had comorbidities, and the commonest was hypertension in 63 (71.6%). Out of the 61 patients who had complications, the majority, that is, 39 (63.9%) had eye complications. Factors significantly associated with the presence of diabetic complications were the duration of diabetes, marital status, and the presence of diabetic comorbidities. Conclusion: The frequency of diabetic complications and comorbidities is quite high in the patients studied. There is a need to improve the standard of care of patients and to ensure optimal blood glucose control. This will go a long way in reducing the frequency of complications and comorbidities.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction: Necrotizing fasciitis (NF) is a rapidly progressive, potentially fatal tissue infection with primary involvement of the subcutaneous fascia and resultant necrosis of the skin and subcutaneous tissues with relative sparing of the underlying muscles and bones. It pursues a fulminant, unrelenting course if treatment is not instituted early and aggressively. The aim of this paper was to document the clinical features and challenges encountered in the management of cervicofacial NF (CNF) in Usmanu Danfodiyo University Teaching Hospital, Sokoto. In addition, the hypothesis that there is a correlation between the duration of disease at presentation and length of hospital stay was tested. Patients and Methods: A retrospective review of cases of CNF managed between December 2014 and November 2015 at our center was done. Demographic and clinical data were retrieved. Patients were managed in strict adherence to the established hospital protocol. Results: Thirteen cases managed for CNF were included in this study, all of whom were of low socioeconomic status. The duration of symptoms before presentation ranged from 2 to 21 days with a mean (΁standard deviation [SD]) of 7.6 (5.2). The length of hospital stay ranged from 7 to 44 days, with a mean (΁SD) of 19.5 (11.3). A statistically significant correlation between the duration of disease before presentation and length of hospital stay was observed (P < 0.05). Conclusion: NF, though rarely seen in some climes, is still a present health challenge in our environment. Despite improvements in healthcare indices, the associated morbidity and mortality rate is still quite high. The management of CNF in a resource-limited environment like ours presents grim challenges.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background and Objectives: Psoriasis is a chronic, papulosquamous disorder of the skin with variable morphology, characterized by periods of remission and reactivity. Psoriasis is less common in the tropics and in dark-skinned persons. Prevalence in West Africans has been noted to be similar to that of the African-Americans suggesting a similarity in genetic ancestry. This study aimed to describe the clinical characteristics of psoriasis and precipitating factors in Nigerian patients. Materials and Methods: This is a retrospective study of all dermatology patients with features of psoriasis who attended the dermatology outpatient clinic of the hospital between January 2007 and May 2012. Data were obtained from the patients' clinic notes and protocol for psoriasis, which documented patients' demographic data, clinical presentations, and precipitating factors. Results: Psoriasis was found in 1.13% (124/11,015) of the study population. There was a male preponderance with a male to female ratio of 1.34:1. The majority of patients seen were in the fourth decade of life. Stress, alcohol, and drugs were the most reported predisposing factors to psoriasis. All types of psoriasis were found, and plaque psoriasis was the most common. Conclusion: This study confirms the increasing frequency of psoriasis among dermatology patients in Nigeria, which may either be due to an increased proficiency in diagnosing the condition by physicians or increase prevalence of environmental factors. The current trend in the management of psoriasis is focused on treating the inflammatory process as well as managing the modifiable environmental triggers.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background and Objective: Advances in laparoscopy are making the service accessible even in resource-poor countries where adaptations are made to meet local challenges. We report our experience in the provision of laparoscopy service to children at a tertiary health center in North-central Nigeria. Methods: A team of pediatric surgeons, anesthetists, and nurses collaborated to provide service and train other personnel. A prospective collection of data on biodata, diagnoses, procedure, and outcome over an effective period of 36 months of laparoscopy intervention of the 54 months between September 2009 and February 2014 was done. Consent, which also included the possibility of conversion to open was obtained from the parents of the patients. Results: A total of 73 patients aged 2 weeks to 16 years with a male: female ratio of 3 to 1 had laparoscopy done during the period. Fifty-two (71.2%) procedures were therapeutic, and 21 (28.8%) cases were done as emergency. Laparoscopic appendectomy was the most commonly performed procedure 25 (34.3%), followed by laparoscopic orchidopexy 17 (23. 3%), and diagnostic laparoscopy for disorders of sexual differentiation in 13 (17.8%). The length of stay in hospital postoperative was 1-3 days with a mean of 1.34 ΁ 0.45 days. The complications recorded included hemorrhage, in a case of infantile hypertrophic pyloric stenosis due to failed electrocautery, one port site burns injury from diathermy dissection, and two periport pain postoperation. There was no mortality recorded. Conclusion: Pediatric laparoscopic service is gaining recognition in our practice in spite of poor resources, incessant industrial actions, and apathy from support staff. The outcomes are encouraging as the patients had minimal morbidities. Skills are improved through practice and retraining and manpower, and instruments are being expanded through our collaboration and training.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Uterine rupture remains a major life-threatening obstetric disaster encountered in many developing countries and is associated with a high maternal and perinatal mortality and morbidity. Objectives: The objective of this study was to determine the incidence, associated risk factors, trend, clinical presentation, management as well as maternal and fetal outcome of uterine rupture at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Materials and Methods: This was a retrospective study of patients with uterine rupture at the LUTH, Idi-Araba, Lagos, Nigeria, from June 1, 2005 to May 31, 2013. The case records of patients in this period were retrieved from the medical health records department. The relevant data of sociodemographic characteristics, clinical presentation, management as well as maternal and perinatal outcome were collated using a structured questionnaire. Results: Of the 13,138 deliveries during the study period, there were eighty cases of uterine rupture giving a hospital incidence of 6.1/1000 deliveries. Patients with parities of 1 (28.36%) and 2 (38.81%) were identified to be at higher risk of uterine rupture. Previous caesarean section (46.28%), obstructed labor (26.87%), and injudicious use of oxytocin (16.42%) were the common associated factors. Rupture along previous anterior scar was the most common site affected in 32.84%; repair with bilateral tubal ligation was the surgical procedure in most of the cases (47.76%). The case fatality rate for ruptured uterus was 11.94% for the mothers and the perinatal mortality rate of 791/1000 babies. Conclusion: Uterine rupture is a major cause of maternal and perinatal death in Lagos, Nigeria.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Neuropathic pain (NP) is one of the most common complications of type 2 diabetes mellitus (DM). The frequency of NP in population living with type 2 DM is unclear. Objective: To determine the frequency of NP symptoms in patients with type 2 DM. Materials and Methods: This cross-sectional study recruited 250 type 2 DM patients attending the outpatient diabetes clinic of the Lagos University Teaching Hospital (LUTH) over a period of 4 weeks. Demographic data and data regarding current DM treatment, prior diagnosis of NP, and current treatment of NP were obtained using a structured questionnaire. Glycaemic status of the patients was assessed measuring fasting blood glucose and glycosylated hemoglobin level. Presence of NP was documented using the painDETECT questionnaire (PDQ). Results: NP was present in 54 out of the 250 type 2 DM patients studied giving a frequency of  21.6%. Out of 54 patients 36 (66.7%) were females and 18 (33.3%) were males giving a male: female ratio of 1:2 (P < 0.05). The mean age of type 2 DM patients with NP was significantly higher than the mean age of type 2 DM patients without NP (62.4 ± 10.9 years vs 58.9 ± 11.7 years; P = 0.05). Glycaemic status and disease duration did not differ among DM patients with or without NP. Only 10 out of 54 (18.5%) patients were treatment naοve at the time of study; however, out of the 44 patients receiving treatment only 9 (20.5%) were on appropriate treatment compared to international guidelines on treatment of diabetic NP. Conclusion: NP was present in 21.6% of type 2 DM patients attending the LUTH.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: The incidence of noncommunicable diseases (NCDs) is increasing in developing countries, largely due to lifestyle and dietary changes. Adolescents are a nutritionally vulnerable age group; however, poor eating habits are often observed in adolescents. It has been observed that individuals who develop healthy eating habits early on in life are more likely to maintain them into adulthood and have a reduced risk of developing NCDs. This study aimed to assess the knowledge and consumption pattern of fruits and vegetables among junior secondary school students. Materials and Methods: This was a cross-sectional descriptive study of 220 respondents selected using a multistage sampling technique. An interviewer-administered questionnaire was used to collect data, which was analyzed using Epi Info Version 7 statistical software. Results obtained were presented with the use of frequency tables. Results: Results from this study revealed that 84.99% of the respondents displayed good knowledge of the nutritional and health values of fruits and vegetables; however, the consumption of fruits and vegetables was appropriate in only 5.48% of the respondents, having five portions of fruits and vegetables daily. Parental intake, encouragement, and supervision as well as availability and accessibility to fruits and vegetables at home were motivators for appropriate consumption. Conclusion: This study has revealed that the students of Obele Community Junior High School, Surulere, have good knowledge of the nutritional and health values of fruits and vegetables. However, the students have inappropriate daily consumption, as their consumption falls below the World Health Organization recommended five portions daily. Efforts should be made by the students themselves, the family, the School, all and sundry in the community to effect change soonest, so that these adolescents maintain healthy eating habits into adulthood, and hence prevent the occurrence of nutrition-related NCDs later on in life.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background and Purpose: Anxiety disorders impact negatively on morbidity and mortality poststroke. Few studies have, however, been done on poststroke anxiety disorders (PSAD), particularly in Africa. The study aims to determine the prevalence, associated clinicodemographic factors, and impact of PSAD on quality of life (QoL) among outpatients at a tertiary hospital in Nigeria. Methods: Seventy stroke survivors attending Outpatient Clinics at Lagos University Teaching Hospital, Nigeria, were recruited into the study. Participants were assessed using sociodemographic/clinical questionnaire, the modified Mini–Mental State Examination, the Modified Rankin Scale, the Schedule for Clinical Assessment in Neuropsychiatry, and the World Health Organization-QoL-Bref. Data collection took 5 months and analyzed using the Statistical Package for the Social Sciences (SPSS^®) software version 17.0. Results: The mean age of respondents was 57.43 (±9.67) years and 38 respondents (54%) were male. Majority of the stroke survivors had infarctive stroke 55 (78.6%), right hemispheric lesions 37 (52.9%), and significant poststroke disabilities 57 (81.4%). The prevalence of PSAD was 10% and agoraphobia with panic attacks was elicited in 42.8% of those diagnosed with PSAD. Participants with PSAD were significantly more likely to be unemployed (P = 0.01) and pay more than ₦10,000 ($62.50 at December 2013) monthly for health care. The mean QoL scores were lower in participants with PSAD across all QoL spheres, and significantly so for overall health (P = 0.04), health satisfaction (P = 0.02), and physical health (P = 0.01) domains. Conclusion: PSAD, especially agoraphobia in association with unemployment and high health-care costs correlated with poor well-being among stroke survivors. Proactive measures to ensure prompt identification and management may potentially improve outcome and QoL after stroke.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: The mutagenic and teratogenic effects of chemotherapeutic agents from repeated exposure during care are well documented. Nurses are among the healthcare professionals who constantly handle these agents, therefore their knowledge and pattern of occupational safety is a concern. This study sought to determine knowledge of chemotherapy and occupational safety measures of nurses in oncology units in the University College hospital, Ibadan. Materials and Methods: A cross sectional descriptive study design, based on Protection Motivation theory was conducted among 100 purposively selected nurses from oncology unit of the hospital. Data were collected using a 54-item validated questionnaire. Descriptive and inferential statistics at 0.05 level of significance was used. Results: Respondents were within 35.4 ± 5.1 years. More than half of the respondents had over 3 years practice in the oncology unit (mean 2.62, ± 1.1). Knowledge of chemotherapy among the cohort was high; mean 13.9 ± 2.2, 70 % understood the use of gloves and gowns as part of safety guidelines. On handling patients' clothes, only 57% understood that such should not be washed by hand or with other clothes. Cumulatively, 79.2% of the respondents knew about the safety guidelines, 4.7% had no knowledge while 16.1% were not sure of the correct guidelines for administering chemotherapy. Respondents' level of education was significantly associated with knowledge of chemotherapy, P<0.05; practice score was also significantly associated with respondents' cadre; P<0.05. Conclusion: Periodic and consistent update of nurses' knowledge supported by policies to enforce guidelines implementation is recommended.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Context: Congenital cataract is a priority of Vision 2020: the right to sight, the global initiative to reduce the world's burden of avoidable blindness because it is an important treatable cause of visual physically challenged in childhood worldwide. Prevention and treatment require information about etiology that is currently unavailable for many regions of the world. From an epidemiologic study, the causative factors of pediatric cataract can be identified. Aims: This study aims to determine causes of childhood cataracts and to identify the preventable factors in tribes of hilly areas of Western India. Settings and Design: The present study is a hospital-based retrospective study. Materials and Methods: A retrospective study was conducted after reviewing the details of 165 patients of pediatric cataract aged between 3 months and 15 years who underwent cataract surgery in our institute from April 2011 to March 2014. A team of ophthalmologists and pediatricians attached to the center examined all the patients preoperatively. The type of cataract was determined using slit lamp biomicroscopy or operating microscope. Results: Nontraumatic cataract was 72.1% and traumatic cataract was 27.9%. Nontraumatic cataract includes hereditary (10.1%), rubella (5.0%), secondary (16.8%), and idiopathic (68.1%). In nontraumatic cataract group, 66 patients had bilateral cataract and 53 had unilateral cataract. Traumatic cataract was the most common in the age group of 6–10 years and most common cause of trauma is thorn (23.9%) followed by stone (21.7%), crackers (17.4%), wood stick (13%), finger (4.3%), chemical injury (4.3%), needle (4.3%), wire (2.2%), and others (8.7%). Conclusions: About 5% of nontraumatic bilateral cataracts in hills of Western India are due to rubella. An awareness program for precaution during pregnancy and immunization against rubella is needed to prevent it. School children must be educated for factors causing traumatic cataract and need supervised play in outdoor.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Long-lasting insecticides nets (LLINs) are a key prevention tool that has been found to reduce uncomplicated malaria by 51% and decrease all-cause mortality by 18% in children. LLINs have been shown to be effective in reducing childhood morbidity and mortality by reducing mosquito bites while sleeping. This is a comparative cross-sectional study designed to determine and compare the ownership and utilization of LLINs among caregivers of children under 5 years in a rural and an urban area of Ogun State. Materials and Methods: A community-based comparative cross-sectional study on 575 caregivers of children under 5 years living in the urban and rural area of Ogun State was done using a multistage cluster sampling technique to recruit respondents. A pretested semi-structured interviewer-administered questionnaire was used to collect information on LLINs ownership and use. Analysis and statistical calculation were done using SPSS version 20.0. Relationships between categorical variables were tested using Chi-square test with P = 0.05. Logistic regression model was used to describe predictors of LLIN ownership and utilization among the respondents. Results: The study shows that 80% of caregivers of under-five living in the rural area compared with 63.5% living in the urban area owned LLINs (P < 0.001). Percentage of children under-five who slept under LLINs the night prior the study was 50.2% in the urban versus 52.4% in the rural households (P = 0.252). Stagnant water and dirty surroundings were identified as mode of transmission of malaria among 32.6% urban versus 44.8% rural respondents and 44.2% urban versus 29.7% rural respondents respectively (P = 0.005). Children were identified as one of the most vulnerable groups for malaria infection by 44.6% urban versus 33.8% rural respondents (P = 0.008). The LLINs was hanged on the bed by 81.2% urban versus 64.4% rural respondents (P = 0.018). The predictors of ownership of LLINs were as follows: urban residence (OR 0.34 [95% confidence interval [CI] 0.22–0.53]), caregiver with higher education (OR 4.85 [95% CI 1.42–16.55]), and the predictors of utilization of LLINs were as follows: level of education of the caregiver (OR 2.87 [95% CI 1.11–7.41]), possession of LLINs at immunization (OR 2.92 [95% CI 2.02–4.22]). Conclusion: Free distribution of LLINs may not necessarily lead to use. Behavior change interventions that address the community level perceptions that positively position LLINs as an effective prevention tool to prevent malaria should be strengthened among the caregivers of children under-five generally and most especially in the urban areas of Ogun State.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: One of the components of health care for every woman of reproductive age is preconception care (PCC). The adoption of this care will assist the healthcare system to shift from the delivery of procedure-based acute care to the provision of counseling-based preventive care. Aims: The aim of this study is to determine the level of awareness, knowledge, and the practice of our women on PCC. Settings and Design: A descriptive cross-sectional study was carried out on 50 consenting pregnant women at the antenatal outpatient clinic. Subjects and Methods: All pregnant women who booked for antenatal care during the period of data collection were consecutively recruited through convenient sampling technique. Data were collected using pretested, semi-structured questionnaires to provide answers to the objectives of the study. Statistical Analysis Used: Data obtained were analyzed using SPSS software version 22 and expressed as frequency and percentages. The Chi-square was used to test for association with a value of P < 0.05 indicating statistical significance. Results: The mean age was 31.5 ± 3.8 years and majority (80%) had tertiary education. There is high level of awareness of PCC (76%); however, awareness of its practice in Nigeria is very low (34.2%). Only 34.2% had received PCC before index pregnancy. There is, therefore, a huge disconnection between their level of awareness and practice. Conclusions: There is the need to arm our women with detailed and accurate information on PCC, establish functional clinics with availability of evidence-based guidelines to improve uptake and pregnancy outcome.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: A critical incident is any preventable mishap associated with the administration of anesthesia and which leads to or could have led to an undesirable patients' outcome. Patients' safety can be improved by learning from reported critical incidents and near misses. Materials and Methods: All perioperative critical incidents (excluding obstetrics) occurring over 5 months were voluntarily documented in a pro forma. Age of patient, urgency of surgery, grade of anesthetist, and patients' outcome was noted. Results: Seventy-three critical incidents were recorded in 42 patients (incidence 6.1% of 1188 procedures) with complete recovery in 88.1% (n = 37) and mortality in 11.9% (n = 5). The highest incidents occurred during elective procedures (71.4%), which were all supervised by consultants, and in patients aged 0–10 years (40.1%). Critical incident categories documented were cardiovascular (41.1%), respiratory (23.25%), vascular access (15.1%), airway/intubation (6.85%), equipment errors (6.85%), difficult/failed regional technique (4.11%), and others (2.74%). The monitors available were: pulse oximetry (100%), precordial stethoscope (90.5%), sphygmomanometer (90.5%), capnography (54.8%), electrocardiogram (31%), and temperature (14.3%). The most probable cause of critical incident was patient factor (38.7%) followed by human error (22.5%). Equipment error, pharmacological factor, and surgical factor accounted for 12.9%. Conclusion: Critical incidents can occur in the hands of the highly skilled and even in the presence of adequate monitoring. Protocols should be put in place to avoid errors. Critical incident reporting must be encouraged to improve patients' safety and reduce morbidity and mortality.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction: Congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorders, each of which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. More than 90% of CAH are caused by 21-hydroxylase deficiency (21HD), found in 1:10,000 to 1:15,000 live births. Early diagnosis of CAH is important because newborn babies with salt-losing forms of CAH die within days or weeks if not treated. In a resource-constrained setting, lack of awareness, poor health facilities, inadequate laboratory support, and expensive and erratic availability of drugs make most children with CAH vulnerable. Objectives: To describe characteristics of the children with CAH attending the Pediatric Endocrinology Clinic of Lagos University Teaching Hospital over a 10 years period. Subjects and Methods: Case records of patients with CAH attending the clinic from February 2005 to January 2015 were reviewed and data extracted from them for further statistical analysis using Microsoft Excel 2010. Results: Twenty eight patients (14 males and 14 females) were seen constituting 34% of the patients with ambiguous genitalia. The median (range) age of the patients was 7 (0.33-  21) years, and the median (range) age at presentation was 3 (0.01-15) years. These include within the neonatal period (25.0%), before 1 year (17.9%), before 5 years (25.0%), and beyond 5 years (32.1%). Modes of presentation included ambiguous genitalia, precocious puberty, salt loss, and discovery on screening because of an affected sibling. Presumed enzyme deficiencies are 21 hydroxylase (78.5% of which 18.2% salt-losing), 11-beta-hydroxylase (14.3%), 17α-hydroxylase (3.6%), and P450 oxidoreductase (3.6%), respectively. Six patients (21.4%) had associated hypertension. Other comorbidities include Blount's disease and pelvi-ureteric junction obstruction. Three male patients were also managed for subsequent associated central precocious puberty. Two siblings were affected in 3 nonconsanguineous families. One patient had contracted HIV/Acquired Immune Deficiency Syndrome from blood transfusion after clitoridectomy. Challenges in management include unavailability and unaffordability of investigations and drugs for treatment. Conclusions: CAH is an important cause of ambiguous genitalia and precocious puberty. Careful examination of the newborn genitalia is important, and a high index of suspicion maintained for salt-losing forms. Increased awareness should be created nationwide for prompt diagnosis and referral when applicable. Treatment is life-long and expensive.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Urinalysis is a simple and cheap method of screening for systemic diseases including kidney disease and may open a window of opportunity for prevention/early treatments especially in resource-constrained settings like Nigeria. We therefore studied the pattern of urinary abnormalities among an apparently healthy urban population. Methods: Mid-stream clean catch urine samples were collected from 1048 apparently healthy subjects and tested for urinary abnormalities using the dipstick method following a health promotional talk in Idi-araba, a Lagos slum. Results: A total of 1048 randomly selected subjects with a mean age of 38.7 ΁ 14.5 years (age range 18-85 years) were screened. This consisted of 597 (57%) females and 451 (43%) males. Protenuria, hematuria, leucocyturia, nitrituria, and glucosuria were present in 18.9%, 1.7%, 9.2%, 1.8% and 2% of the subjects respectively. Proteinuria and haematuria was more prevalent in subjects aged ≥40 years (P < 0.05). The prevalence of leucocyturia, nitrituria, and glucosuria were independent of age (P < 0.05). There were no gender differences in the prevalence of urinary abnormalities (P < 0.05). Four hundred and forty-four (42.3%) of the cohort had hypertension (HTN). Proteinuria and leucocyturia were more prevalent in hypertensive subjects (P < 0.05) while hematuria, nitrituria, and glucosuria was independent of hypertensive status of subjects (P < 0.05). Conclusion: Urinary abnormalities are common among apparently healthy adults in Lagos. It is therefore recommended that it should be routinely done as a cheap screening tool and further evaluation conducted where necessary. This may result in cheaper treatment and better outcomes.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Cerebral palsy (CP) is one the most common causes of disability among children in developing countries and is often associated with poor growth. The assessment of growth and nutrition of children is an important aspect of health monitoring and is one of the determinants of child survival. Aim: To assess the nutritional status of children with CP as seen in Lagos University Teaching Hospital (LUTH). Subjects and Methods: A prospective case-control study was conducted on children with CP attending the weekly pediatric neurology clinic of the LUTH between April 2005 and March 2006. Controls were apparently healthy children being followed up at the children's out-patient clinic of LUTH for acute illness that had resolved. Anthropometric measurements of weight, length/height, mid-upper arm circumference, and skinfold thickness were taken according to the protocols recommended by the International Society of the Advancement of Kinanthropometry. Statistical Analysis: EPI-INFO (version 6.04) was used for analysis. Chi-square test was used to determine associations. Student's t-test was used to compare means of patients and matched controls. Probability P < 0.05 were taken as statistically significant. Results: The controls had higher weight than the patients with mean weight (standard deviation) of 13.7 (4.8) kg, and 12.0 (4.5) kg, respectively (P = 0.01). There were also statistically significant differences in the subscapular and biceps skinfold measurements between the patient and control groups (P = 0.00004 and 0.000008), respectively. Twenty-four (25.8%) and 5 (5.4%) of the patients had moderate and severe undernutrition compared to 6 (6.1%) and none, respectively, in the control group (P = 0.00005). Conclusion: Children with CP had significantly lower mean anthropometric parameters and were more malnourished compared with the control group of children matched for age, sex, and social class.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Health insurance (HI) can serve as a vital risk protection for families and small businesses and also increase access to priority health services. This study determined the knowledge, attitude of artisans toward HI as well as their health-seeking pattern and willingness to join the HI scheme. Methodology: This descriptive cross-sectional survey used a multistage sampling technique to recruit 260 participants, using self-designed, pretested, interviewer-administered questionnaire. Data were analyzed using Epi-info version 7.0. Chi-square test, Fisher's exact test, and logistic regression were used for associations; the level of significance was set at 5%. Results: The respondents were predominantly male, i.e., 195 (75.0%), with a mean age of 32.36 + 6.20 years and mean income of N 29,000 + 5798.5 ($1 ~ N 161). Majority of the respondents, i.e., 226 (86.9%) were not aware of HI. The overall knowledge was poor (6.5%) and the main source of information was through radio/television (41.2%). Nearly, half of the respondents (33 out of 67) identified the concept of HI as a pool of contributors' fund for only healthcare service. A high proportion of the respondents (27 out of 34) were aware of the benefits of HI, although majority, i.e., 27 (79.4%) identified access to medication as the benefit. The majority of the respondents, i.e., 228 (87.7%) expressed negative attitude toward the scheme; however, 76.5% were willing to join the HI scheme. Conclusion: The artisans had low awareness/poor knowledge of HI which translated to a negative attitude toward the scheme. There is need for an aggressive stakeholders' enlightenment campaign for increasing coverage.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Family planning programs, researches, and studies have focused mainly on women with little attention to men's role in the contraceptive choices by the couple. Men's exclusion from these programs has serious implications on the acceptance and use of contraceptives by the couple. Objective: To determine the influence of male partners on contraceptive use of their spouses. Subjects and Methods: This was a cross-sectional descriptive study at a Tertiary Care Centre in Lagos, Nigeria. It was conducted from January 1 to April 30, 2010, where all consecutive consenting pregnant women were given structured questionnaires to give to their partners so as to evaluate the contribution of the male partners to contraceptives use in their spouses as well as assess their awareness and knowledge of contraception. Categorical variables were analyzed using Chi-square test or Fisher's exact test as appropriate while continuous variables by t-test. P < 0.05 was considered significant. Results: Of the 370 respondents, only 51.9% (192) knew about female contraceptive methods, while 50% (185) were willing to allow their wives to use contraception. Barrier method (17.3%) and periodic abstinence (15.7%) were the leading preferred choice for their wives. However, bilateral tubal ligation was the least preferred method (1.6%). Previous counseling of male partner significantly influenced their decision to allow their wives to use contraceptives (P = 0.001). Conclusion: Involving the male partner in family planning counseling plays an important role in increasing the acceptance and use of contraceptives by the couple.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Unsafe abortion is a public health concern because of its dire reproductive health consequences and impact on maternal morbidity and mortality. Tackling this problem will go a long way toward achieving one of the Millennium Developmental Goals, which aim to reduce overall maternal mortality by two-thirds by the year 2015. The aim of this study was to determine the knowledge, attitude, and practice of abortion and the factors associated with it among female students of two public senior secondary schools in Mainland Local Government Area, Lagos state. Materials and Methods: This was designed as a cross-sectional, descriptive study. The multistage sampling method was used to select 210 respondents. Data were collected with self-administered questionnaires and analyzed using the EPI Info software. The questionnaire was divided into four sections: the sociodemographic characteristics of the respondents, knowledge about abortion, attitudes toward abortion, and the practice of abortion. The responses to the knowledge and attitude questions were scored and graded as good (≥50%) and poor (<50%). Results: The response rate was 98%. The mean age of the respondents was 15.6 ΁ 1.3 years. The majority (83.3%) of the respondents had good knowledge of abortion; almost all (99.2%) demonstrated poor attitude toward abortion; and only a few (2%) had ever had an abortion. There was a statistically significant association between the ages of the respondents and their knowledge of abortion (P = 0.004) as well as their attitude toward abortion (P = 0.03). Conclusion: The respondents showed good knowledge of abortion, poor attitude toward abortion, and a low of practice of abortion. There is, therefore, a need to improve and sustain the existing knowledge and attitudes toward abortion so as to reduce the practice of abortion among students of the two schools.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]