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   Table of Contents - Current issue
Coverpage
July-August 2020
Volume 61 | Issue 4
Page Nos. 173-225

Online since Tuesday, August 4, 2020

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ORIGINAL ARTICLES  

Short versus long-term antibiotic prophylaxis in cesarean section: A randomized clinical trial p. 173
James A. Adaji, Godwin O. Akaba, Aliyu Y. Isah, Thairu Yunusa
DOI:10.4103/nmj.NMJ_197_20  
Objective: The objective of the present study was to compare the efficacy of intravenous (IV) 48 h course of cefuroxime/metronidazole with long-term course using 48 h cefuroxime/metronidazole plus 5 days oral regimen of cefuroxime and metronidazole for the prevention of post cesarean section wound infection. Methods: Two hundred and forty-eight women were randomized into two equal groups. Women in each arm of the study received IV cefuroxime 750 mg twelve hourly and IV metronidazole 400 mg eight hourly for 48 h. Those in the long-term arm received additional tablets of cefuroxime 500 mg twelve hourly and Tabs 400 mg of metronidazole eight hourly for 5 days. After the surgery, surgical site infections were evaluated. Length of hospital stay and the cost of antibiotics were also assessed. Results: The wound infection rate was not statistically significantly different between the 2 groups (1.3% vs. 3.3%, P = 0.136). The incidence of endometritis was 2.1%, with no statistically significant difference seen between the two groups (0.4% vs. 1.6%, P = 0.213). Escherichia coli was the most common isolate seen in 36.4% of infected wounds. The short arm group stayed for significantly shorter days in the hospital (2.9 ± 1.0 vs. 3.8 ± 1.1 days,P < 0.001), and the cost of antibiotics was also significantly less in the short arm group (P < 0.001). Organisms associated with nosocomial infections were seen only in the long arm that stayed in the hospital for longer days. Conclusions: Short-term prophylactic antibiotics are as effective as long-term prophylaxis and have other benefits such as shorter duration of hospital stay, reduced cost of antibiotics, and reduction of nosocomial infections.
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Laboratory turnaround time of surgical biopsies at a histopathology service in Nigeria p. 180
Innocent Emmanuel, Samuel Abaniwo, Patrick Nzekwe, Samuel Kelechi Richard, Olufunmilayo Abobarin, Abdulazis Longwap, Alhamdu Joseph
DOI:10.4103/nmj.NMJ_173_20  
Introduction: Laboratory turnaround time is defined as the time between the receipt of a sample in the laboratory and when the report is ready for collection/dispatch. It is a critical component of the quality assurance of a laboratory and has been identified as a key performance indicator of laboratory performance. This study is aimed at evaluating the turnround time in the histopathology unit of our center and comparing the findings with that of similar studies. Methodology: This was a prospective descriptive study of the first 500 consecutive samples of surgical biopsies submitted for analyses at the Histopathology Department of the Jos University Teaching Hospital. The samples were tracked from the reception desk, where they are submitted to the dispatch point where the results are collected by clients. The grossing time (T1), processing time (T2), reporting time (T3), and the transcription time (T4) were recorded for each sample. The data obtained were analyzed using SPSS software and presented as simple frequencies and percentages. Results: The mean laboratory turnaround time was 7.5 + 9.7 days with a range of 3–18 days. As much as 20.8% of reports were ready for dispatch by day 3 and 100% by day 18. Overall, the grossing time (T1), processing time (T2), reporting time (T3), and transcription (T4) time consumed 17.5%, 35.5%, 27.7%, and 19.3% of the total time spent, respectively. Conclusion: We recommend the development of practicable targets for the histopathology laboratories as regards timeliness. This should be regularly evaluated to ensure compliance and improvement of service quality in this regard.
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Effect of long-term topical antiglaucoma medication use on the ocular surface p. 184
Oluwaseun Olaniyi Awe, Oluwatoyin Helen Onakpoya, Adenike Odunmorayo Adeoye
DOI:10.4103/nmj.NMJ_116_19  
Purpose: The purpose of this study was to describe the prevalence and pattern of ocular surface disease (OSD) in glaucoma patients using preserved topical antiglaucoma medications in a Nigerian population. Methodology: A comparative study of patients who had used topical preserved antiglaucoma medications for 6 months or more with age- and sex-matched individuals who were not on any other form of topical eye medication was carried out using fluorescein tear breakup time (FTBUT), Schirmer I test, and ocular surface staining with fluorescein and lissamine green. The right eyes of 103 eligible patients with primary open-angle glaucoma and that of 103 age- and sex-matched individuals (controls) were included in the study. Results: The prevalence of OSD among users of preserved topical antiglaucoma medications was significantly higher than among nonusers as assessed by FTBUT (83.5% vs. 57.3%;P < 0.001), Schirmer I (30.1% vs. 17.5%; P = 0.033), and ocular surface staining (62.1% vs. 31.1%;P < 0.001). Users of preserved topical antiglaucoma medications also had worse grades of OSD evaluated by FTBUT (P = 0.001), Schirmer I (P = 0.023), and ocular surface staining (P < 0.001). Conclusion: The prevalence of subjective OSD was significantly higher among users of topical antiglaucoma medications than nonusers. Hence, preserved topical medication use is a serious concern for increased ocular surface morbidity among glaucoma patients. This calls for more attention to be paid to the consequences of OSD among glaucoma patients on topical medications.
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Early life exposures and risky sexual behaviors among adolescents: A cross-sectional study in Ghana Highly accessed article p. 189
Prince Osei Akumiah, Joseph Ngmenesegre Suglo, Silas Yenbon Sebire
DOI:10.4103/nmj.NMJ_100_20  
Background: Risky sexual behaviors (RSBs) are behaviors that could result in unwanted pregnancies and sexually transmitted infections. These behaviors are often initiated during adolescence, and the frequency of engagement in such behaviors rises with increasing age during the teenage years. It has been asserted that exposures to sexual materials early in life could lead to early sex debut among adolescents. Objective: The objective of this study was to determine the early life exposures contributing to RSBs among basic school pupils in the Twifo Praso District of Ghana. Materials and Methods: A descriptive cross-sectional study was conducted using a structured questionnaire. Three hundred and sixty basic school pupils were selected by simple random sampling technique. Data were analyzed using SPSS version 20. Results: The study found that 64.4% of the respondents have had sexual intercourse at a mean age of 13.7 years. Respondents from polygamous homes were more likely to engage in earlier sexual debut than those from monogamous home (r = 0.0343, P = 0.003). Furthermore, having a high number of friends who have had sex was associated with an early sexual debut (r = 0.720, P = 0.000). Conclusion: Adolescents are initiating sexual intercourse very early in life and this calls for customized reproductive health promotion activities aimed at minimizing risky sexual behaviors. Further studies on how parent–child sexual communication could delay sexual debut are recommended.
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The rise and fall of female sterilization in Jos, Nigeria: A cause for concern p. 196
Makshwar L. Kahansim, Victor C. Pam, Josiah T. Mutihir
DOI:10.4103/nmj.NMJ_54_20  
Background: Female sterilization is a permanent form of contraception offered to women who have completed their family size. Other methods are all temporary and meant to be reversible. A high-quality female sterilization service was introduced in Jos with the assistance of training in counseling and minilaparotomy under local anesthesia in May 1985. After training, female sterilization became available for couples desiring it on completion of family size. Materials and Methods: This was a retrospective study of all clients who had female sterilization for contraception between 1985 and 2019. The clinic register was retrieved and evaluated for acceptances of all contraceptive methods within the period and trends observed. Results: Over the 35 years, a total of 29,167 new clients accepted modern family planning methods. Out of these, a total of 5167 were female sterilizations, constituting 17.7% of the new acceptors. The temporary methods of contraception constituted 82.3%. The other methods used were the intrauterine device 8357 (28.7%), the oral pills 5125 (17.6%), the injectables 5235 (17.9%), and the contraceptive implants 5283 (18.1%). Although female sterilization was 4th among the five methods studied, there was however a gradual decline in its acceptance from a peak of 36.1% in 1992 to 1.4% in the year 2018. Conclusion: The acceptance of female sterilization rose to a peak in 1992 and declined to the lowest level in 2018, occasioned in part by the introduction of varieties of contraceptive implants providing long acting, reversible, and cheap contraception.
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Awareness, knowledge, and perception of the national health insurance scheme among national youth service corp members in Kano, Nigeria p. 201
Godpower Chinedu Michael, Bukar Alhaji Grema, Ibrahim Aliyu, Salihu Tanko Tanimu, Abdullahi Kabir Suleiman, Abdulrahman Shuaibu, Adewumi Adedoyin Adesida
DOI:10.4103/nmj.NMJ_140_19  
Background: The lofty objectives of the National Youth Service Corp (NYSC) are not only predicated on healthy graduates of tertiary institutions but also graduates who are confident in making informed health-related decisions. Therefore, Corp members' awareness, knowledge, and perception of the National Health Insurance Scheme (NHIS) and its programs become imperative. Materials and Methods: This was a cross-sectional study involving 203 participants selected by convenience sampling technique from NYSC members during Orientation Camp in June 2019. A self-administered questionnaire was used to collect data regarding their sociodemographics, awareness, knowledge, and perception about the NHIS. Results: The mean age of respondents was 25.8 ± 2.3 years; they were predominantly males (136 [67.0%]) with university degrees 131 (64.5%); 200 (98.5%) were aware of the NHIS and its programs. Although 161 (80.5%) respondents had at least average knowledge of the NHIS, only 97 (48.5%) had adequate knowledge. One hundred and fifty-eight (79.0%) respondents benefited from the Tertiary Institutions Social Health Insurance Programme (TISHIP) as students; 114 (57.0%) viewed TISHIP as a good program; however, 194 (97.0%) felt that the NHIS services should be extended to NYSC members, while 188 (94.0%) were willing to participate in the scheme if its services were extended them. Conclusion: Although awareness level was high, adequate knowledge of the NHIS was low and their perception about TISHIP is unimpressive; most were willing to participate in the NHIS. Current mass NHIS-programs education campaigns and services offered by NHIS-accredited health-care facilities need improvement; fast-tracking of processes necessary for the extension of NHIS services to NYSC members is required.
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Care of the sick newborn in a cottage hospital level in a developing country p. 206
Emmanuel E. Ekanem, Akinwumi O. Fajola, Adedapo B. Ande, Gloria O. Ikeagwu, Tamunoibim E. Anidima, Chidozie N. Umejiego, Rakiya Usman
DOI:10.4103/nmj.NMJ_162_19  
Introduction: Neonatal morbidity and mortality are high in Nigeria. The establishment of more centers that could offer adequate management of high-risk pregnancies and neonates is essential. Objectives: This study seeks to describe sick newborn care at the cottage hospital level in Southern Nigeria with the aim of drawing lessons that may be useful to similar environments. Subjects and Methods: A description of facility upgrading and staff training in perinatal care at a public-private partnership cottage hospital with a robust community health insurance scheme in Nigeria is made. A retrospective descriptive study of the morbidity and outcomes of admitted neonates in the facility between March 2016 and February 2017 was made. Results: Out of 3630 babies born in the facility (302 per month), 189 were admitted, yielding an admission rate of 52.1/1000 live births. The main morbidities were neonatal hypoglycemia (32.4%), preterm low-birth weight (24.9%), neonatal sepsis (22.8%), and neonatal jaundice (12.7%). Sixteen of the 109 neonates died giving a mortality rate of 8.5%. The main causes of deaths were birth asphyxia (7 or 43.8%), meconium aspiration (6 or 37.5%), and congenital malformation (3 or 18.8%).Conclusion and Recommendations: The neonatal admission and mortality rates are quite low in this cottage hospital and similar to the situation even in developed environments. This salutary scenario is probably due to good antenatal and perinatal care, and a robust community health insurance scheme which enhances services uptake and public–private partnership which engenders infrastructure expansion and maintenance. This model is recommended for the hospitals in our region.
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Unrecognized respiratory morbidity among adolescents and young adults in Nigeria: Implications for future health outcomes p. 210
Obianuju B. Ozoh, Joy N. Eze, Olufunke O. Adeyeye, Ojiebun Eromosele, Sandra K. Dede, Chizalu I. Ndukwu, Richard Van Zyl-Smit
DOI:10.4103/nmj.NMJ_36_20  
Background: Lung function impairment is a major determinant of morbidity and mortality. Unrecognized respiratory morbidity may be a missed opportunity to improve future health outcomes. Aim: The aim of this study was to investigate the prevalence of respiratory symptoms and the relationship to spirometry abnormalities and respiratory diagnosis among medical students in Lagos, Nigeria. Methods: This was a cross-sectional study among students aged 16–35 years. We assessed frequency of respiratory symptoms, previous respiratory diagnosis, and spirometry abnormalities. The relationship between respiratory symptoms, spirometry pattern, and previous respiratory diagnosis was determined using the Chi-square test and stepwise forward logistic regression analysis. Results: Of 640 participants, 464 (72.5%) performed good quality spirometry tests. Two hundred and forty-four (52.6%) had at least one respiratory symptom. Preexisting conditions were only identified in 60 (12.9%): 49 (7.7%) asthma, 29 (4.5%) allergic rhinitis, 16 (2.5%) treated tuberculosis, and 8 (1.3%) bronchitis/chronic obstructive pulmonary disease. Using the Global Lung Function Initiative (GLI) lung function predicted values, obstructive (8.4%) and restrictive abnormalities (25.4%) were common. An obstructive pattern was associated with previous diagnosis of asthma, but there was no significant association for the restrictive spirometry pattern. Conclusions: Among otherwise healthy students, respiratory symptoms and lung function abnormalities are common. The vast majority are without a formal diagnosis. Asthma accounted for the majority of obstructive spirometry pattern seen, but the restrictive abnormalities based on GLI equations remain unexplained. Further research is required to determine the cause of these abnormalities and long-term implications in apparently healthy young individuals.
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Assessment of health-care research and its challenges among medical doctors in Nigeria p. 218
Musliu Adetola Tolani, Muhammed Ahmed, Rufus Wale Ojewola, Abdullahi Abdulwahab-Ahmed, Abubakar Abdulkadir, Timothy Uzoma Mbaeri, John Raphael, Terkaa Atim, Akanbi Abdulwahab Ajape, Samaila Ibrahim Shuaibu, Usman Mohammed Tela, Ahmad Tijjani Lawal, Oyelowo Nasir, Hussaini Yusuf Maitama
DOI:10.4103/nmj.NMJ_46_20  
Introduction: Health-care research in Nigeria has been growing over the years but is constrained by many difficulties. This study aimed to identify the challenges encountered in health-care research and suggest policies to address these problems. Materials and Methods: It was a cross-sectional study of medical doctors who have been involved in health-related researches. All participants filled a self-administered online questionnaire comprising 31 questions in five sections. The responses were analyzed using the Google forms and the Statistical Package for the Social Sciences software version 23. Results: The mean age of the study participants was 41.0 ± 8.4 years. Three-quarters of the respondents (75.5%) worked in teaching hospitals. Nearly all (96.6%) carried out their studies using personal funds and only one in 10 had been involved in high-budget projects (≥₦1,000,000). The generation of quality researches was impeded by the restriction of literature review to free online journals (93.2%), incomplete health records (88.0%), limited access to research kits (65.7%), limited use of advanced statistical analysis (29.8%), and challenges with obtaining ethical approval (21.2%). Despite the average online visibility of these researches (52.2%), only 28.5% stated that it has been locally adopted to influence medical practice in their center. Conclusion: There is a wide disparity in research capacity among hospital tiers. It is important to leverage on and expand existing partnerships to provide institutional access to premium literature, offer robust, and assessable financial support for the conduct of high-quality researches and provide a framework to bridge the gap in the use of these works to influence practice change in Nigeria.
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CASE REPORT Top

Suspected pulmonary embolism postcesarean section in a patient with autosomal dominant polycystic kidney disease p. 223
Olusegun O. Badejoko, Olufunke F. Dada, Akaninyene E. Ubom, Olumuyiwa T. Ajayeoba
DOI:10.4103/nmj.NMJ_99_20  
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetically inherited kidney disease worldwide. It is however relatively underdiagnosed in Africans because its diagnosis is often incidental. During pregnancy, ADPKD is associated with increased risk of preeclampsia and venous thromboembolism. The case of a 33-year-old lady incidentally diagnosed with ADPKD during pregnancy is presented. She developed preeclampsia at term and had cesarean delivery of twins. She however suffered cardiopulmonary arrest postoperatively and this created a treatment dilemma because therapeutic anticoagulation which was the primary treatment for her suspected pulmonary embolism was absolutely contraindicated if the actual cause of her collapse was ruptured cerebral aneurysm which was also a feature of ADPKD. We decided to resuscitate aggressively and perform an urgent cranial computed tomography which ruled out intracranial hemorrhage. We then commenced anticoagulation and she made an excellent recovery. This case illustrates the importance of a timely multidisciplinary approach to patient management.
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