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   Table of Contents - Current issue
Coverpage
September-October 2019
Volume 60 | Issue 5
Page Nos. 213-272

Online since Tuesday, November 26, 2019

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REVIEW ARTICLES  

Awareness and practice of breast self examination among women in different African countries: A 10-year review of literature p. 213
Ofonime Effiong Johnson
DOI:10.4103/nmj.NMJ_84_19  
Breast self examination (BSE) is an important screening technique in detecting breast abnormalities. This procedure enables women become familiar with their breasts, thus making it easier for them to detect any changes that may occur. Routine performance of BSE is recommended for females above 20 years. This review of literature was conducted to assess the awareness and practice of BSE among women in different countries in Africa. A total of 28 out of 80 articles were reviewed from 15 African countries based on relevance. Review identification was performed through the search of Google Scholar and PubMed/MEDLINE/PubMed Central databases. Search terms used were “BSE,” “awareness,” “practice,” and “Africa.” Reference lists of identified studies were also used to find more studies. Majority of the reviewed studies showed adequate awareness, mainly from the media, but poor practice of BSE among women in various countries in Africa. A major barrier identified was inadequate knowledge of BSE technique. Although awareness of BSE was relatively high in many of the reviewed studies, the practice was low. Educational intervention program should be carried out among women in various African countries, not only to raise awareness but also to educate on the skills required to carry out BSE effectively.
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Medical treatment: An emerging standard in acute appendicitis? Highly accessed article p. 220
Ikeoluwa Kendra Bolakale-Rufai, David O Irabor
DOI:10.4103/nmj.NMJ_65_19  
Appendicectomy has been accepted as the gold standard for the management of appendicitis over the years, but there has been an increasing evidence and trend toward the conservative approach to the management of appendicitis. The aim of this review is to search existing literature and to evaluate and compare the conservative and operative approaches to the management of appendicitis. An electronic search of published literature was conducted through Pubmed, Google Scholar, Embase, and Medline using a variety of search items to find relevant observational studies, randomized clinical trials, systematic reviews, and meta-analyses. Bibliographies of selected articles were also analyzed for publications of interest relevant to the scope of the topic. The articles that reported primary outcomes after the management of appendicitis, complications, economic implications, and duration of follow-up were reviewed in detail. The major primary outcomes show a high recurrence rate and failed treatment associated with the conservative management of appendicitis. The other outcomes obtained show that there is an increased incidence of complications associated with operative management. Economic implications and cost-effectiveness analysis show that conservative treatment may be preferred. The length of hospital stay was significantly higher in conservative approach to management; however, shorter time off activities was observed. In general, the conservative management of appendicitis is still regarded as safe, effective, and efficacious, and further research with well-constructed study design, and larger sample size is required.
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ORIGINAL ARTICLES Top

Outcome of adenotonsillar specimen histology in a private hospital setting p. 228
Waheed Atilade Adegbiji, Shuaib Kayode Aremu, Akindele Abdurrazaq Oladipo
DOI:10.4103/nmj.NMJ_71_19  
Background: All adenoid and tonsils tissue specimens are routinely histologically examined in pediatric otorhinolaryngology practice worldwide. This study aimed at determining the sociodemographic features, clinical presentation, indications, postoperative management, and histological diagnosis of the adenoid and tonsils tissues. Materials and Methods: This is a retrospective hospital-based study of patients who had adenotonsillectomy done between August 2008 and July 2018 at Golden Cross Infirmary Hospital, Festac Town, Lagos, Nigeria. All data were obtained from the patients' record, case note, and theater operation register. All the data obtained were collated and analyzed using SPSS version 18.0. Results: There were 59.2% of males with a male-to-female ratio of 1.5:1. Clinical presentation among the pediatric patients was 71.8% difficulty breathing, 64.8% snoring, 63.4% sleep apnea, 60.6% catarrh, and 54.9% noisy breathing. The most common indications for adenoid and tonsils surgery were obstructive sleep apnea in 64.8%. Adenoidectomy in 42.3% was the most common form of pediatric adenoid and tonsils surgery. The most common complication of adenoid and tonsils surgery was pain at surgical site/odynophagia in all the patients. Postoperative histological reports were reactive lymphoid hyperplasia in all the patients. Conclusion: Adenoid and tonsils surgeries are common pediatric otorhinolaryngology, head-and-neck surgical procedures. The most common indication found for adenoid and tonsils surgery was obstructive sleep. Adenoidectomy was the most common form of pediatric adenoid and tonsils surgery. All the adenoid and tonsils tissue specimens revealed histological benign diseases.
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Prevalence of psychosocial stress and its risk factors among health-care workers in Nigeria: A systematic review and meta-analysis p. 232
Charles Babajide Onigbogi, Srikanta Banerjee
DOI:10.4103/nmj.NMJ_67_19  
Context: Health-care workers experience psychosocial stress in their workplace. Available statistics are at variance, and hence, the need to know the overall prevalence of psychosocial stress among Nigerian health-care workers and associated risk factors. Aims: The aim of this study was to determine the prevalence of psychosocial stress and its risk factors among health-care workers in Nigeria through meta-analysis. Materials and Methods: PubMed, CINAHL, and Google Scholar databases were searched for articles. Search terms include “psychosocial stress,” “occupational health,” and “Nigerian health-care worker.” Articles were included if they used validated psychosocial stress assessment instruments. Of the 17 articles with data on psychosocial stress prevalence, eight met all inclusion criteria. Each article independently reviewed by the authors and relevant data abstracted. Statistical analysis was done using MedCalc version 18.10. Results: Overall, the prevalence of psychosocial stress was 61.97% (95% confidence interval [CI]: 41.013–80.823) based on analyzed eight articles with the sample size of 1763. Work overload rate at 67.72% (95% CI: 33.24–93.76) was the most prevalent psychosocial stress risk factor. Other risk factors were poor communication and staff attitude and lack of resources and equipment at 50.37% (95% CI: 13.35–87.16) and 62.4% (95% CI: 7.70–99.9), respectively. Headache, with neck and back pain, was the most prevalent psychosocial stress-related health outcome at 73.26% (95% CI: 66.14–79.82). Conclusion: Prevalence of psychosocial stress is high among health-care workers in Nigeria, necessitating preventive measures
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Knowledge of cervical cancer and the uptake of the Papanicolaou smear test among public secondary school teachers in Akwa Ibom State, Nigeria p. 239
Augustina Elochukwu Ijezie, Ofonime Effiong Johnson
DOI:10.4103/nmj.NMJ_120_19  
Background: Cervical cancer is a public health problem that disproportionately affects women in less-developed countries despite the availability of effective screening tools. The objective of this study was to determine the level of knowledge of cervical cancer and uptake of the Papanicolaou (Pap) smear test among teachers in public secondary schools in Akwa Ibom State, Nigeria. Methodology: This was a cross-sectional descriptive study among 370 female teachers in public secondary schools in Akwa Ibom State, Nigeria. Data were collected with a self-administered questionnaire and were analyzed using Stata software version 10. Results: The mean age of respondents was 37.9 ± 7.9 years. More than two-thirds (71.0%) of the respondents had low knowledge of cervical cancer risk factors, whereas 168 (57.9%) respondents had low knowledge of the symptoms. Among the 226 (77.9%) respondents who knew that cervical cancer was preventable, only 65 (28.8%) had high knowledge of preventive measures. About 42.2% of respondents were aware of the Pap smear test and only 8.4% had ever had a Pap smear test. There were significant associations between knowledge of symptoms, prevention of cervical cancer, and the uptake of the Pap smear test (P < 0.05). Conclusion: The levels of knowledge of risk factors, symptoms, and methods of prevention of cervical cancer were low in this study. This may have accounted for the low uptake of the Pap smear test. Regular and comprehensive health education concerning cervical cancer and its prevention is advocated in the media and clinics to encourage higher uptake of the Pap smear test.
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Spectrum of endocrine disorders as seen in a tertiary health facility in Sagamu, Southwest Nigeria p. 246
Ayotunde O Ale, Olatunde Odusan
DOI:10.4103/nmj.NMJ_41_19  
Background: There is dearth of records on prevalence and spectrum of adult endocrine disorders in Nigeria. Objective: To document the spectrum of endocrine disorders as seen in endocrinology, diabetes, and metabolism (EDM) outpatient clinic, Department of Medicine of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State over a 3-year period. Methods: This was a retrospective study of the medical records of all new consultations seen in the EDM outpatient clinic between January 2016 and December 2018. All endocrinology diagnoses were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health problems (ICD-10). Information on demographic, source of referral, baseline clinical, and biochemical indices were gleaned and subjected to descriptive statistics using SPSS version 21, and results were presented as proportions (frequencies and percentages) and mean (±standard deviation). Results: Two thousand seven hundred and sixty-five patients were seen and managed at EDM outpatient clinic over the specified time frame. Eight hundred and sixty-three were new cases, age range 16–88, mean of 54.10 (±13.9) years with female preponderance 520 (60.3%) and female-to-male ratio of 1.5:1. The internal referral system constituted the main means of referral to the EDM clinic. The most common endocrine referrals were diabetes mellitus (DM) (697, 80.8%) and thyroid disorders (119, 13.8%) followed by metabolic syndrome (29, 3.36%) and hypothalamic–pituitary disorders (HPOs, 9, 1.04%). Conclusion: The common endocrine cases seen in Sagamu are DM, thyroid diseases, metabolic syndrome, and HPO similar to worldwide trend.
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Knowledge and practices of health-care waste management among health Workers in Lassa fever treatment facility in Southeast Nigeria p. 251
Robinson Chukwudi Onoh, Azuka Stephen Adeke, Chukwuma David Umeokonkwo, Kenneth Chinedu Ekwedigwe, Joseph Agboeze, Emeka Onwe Ogah
DOI:10.4103/nmj.NMJ_161_18  
Background: The threat of endemic, emerging, and reemerging infectious diseases, especially the viral hemorrhagic fevers demands effective health-care waste management (HCWM) among health-care workers. The study was intended to assess the knowledge and practices of HCWM among the cleaning staff in a Lassa fever (LF) treatment facility. Materials and Methods: This was a cross-sectional descriptive study of 234 cleaning staff of Federal Teaching Hospital Abakaliki recruited by systematic random sampling. Data collection was with semi-structured questionnaires. Knowledge and practices of respondents were assessed using cutoff score of 75%; score of 75% and above being interpreted as good and <75% as poor. Data were analyzed using Epi™ Info Version 7.2. Results: There were 177 (75.6%) female and 57 (24.4%) male cleaning staff with a mean age of 33.4 years (±8.3). Among all the respondents, 18 (7.7%) had no formal education, while others had varying levels of education (primary, 43 [18.4%]; secondary, 133 [56.8%]; tertiary, 40 [17.1%]). Only 134 (57.3%) of the respondents had ever been trained on HCWM, of which 77 (57.5%) of them were trained in 2018. The proportion of respondents with good knowledge of HCWM was 41.5%. In addition, only 83 (35.5%) properly categorized the body parts, body fluids, and fetuses as pathological waste. About one-third, 77 (33.3%), had knowledge of steps in HCWM and 45.3% knew of diseases transmitted through health-care waste with 171 (62.8%) identifying LF as one of the diseases. The proportion of respondents with good practices of HCWM was 53.9% with only 131 (56.0%) segregating waste in specified color-coded containers. Among the factors examined, none was significantly associated with knowledge and practice of participants on HCWM. Conclusion: The proportions of the cleaning staff with good knowledge and practices of HCWM were low. There is a need to train and retrain hospital staff on proper HCWM as well as need for proper supervision and monitoring.
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Hypertension in children: Could the prevalence be on the increase? p. 256
Ogechukwu F Amadi, Ifenyinwa B Okeke, Ikenna K Ndu, Uchenna Ekwochi, Obinna C Nduagubam, Osita U Ezenwosu, Isaac N Asinobi, Chidiebere DI Osuorah
DOI:10.4103/nmj.NMJ_51_19  
Background: In children particularly in the developing world, there is a tendency to downplay the role of primary hypertension in their health. In adults, a number of factors have clearly been associated with the incidence of hypertension. Knowledge of the prevalence of hypertension and its associated factors among children in our environment is important and could inform the need for lifestyle changes and routine blood pressure (BP) checks in children so as to reduce BP-related health risks. Aim: The aim of this study is to document the prevalence of hypertension and its risk factors among children in Enugu, Nigeria. Materials and Methods: Children aged 6–17 years attending the outpatient clinic of a tertiary hospital, were enrolled for the study. Their socioeconomic status (SES), weight, height, BP, and dipstick urinalysis were measured using standardized methods. Adherence to Mediterranean diet was assessed using the Mediterranean Diet Quality Index (KIDMED). The prevalence of hypertension and the influence of these factors on their BP were analyzed. Results: Forty-six (9%) of the 491 participants had hypertension. Of these 46 hypertensive children, 72% were females while a significantly higher proportion 57% (P = 0.006), were in the age group 13–17 years. While age, gender, and the presence of protein in urine were significantly associated with hypertension in these children; body mass index, diet, family history of hypertension, and SES were not. Conclusion: The prevalence of hypertension in children in this environment is high and appears to be increasing. There is need for routine BP and urinalysis check for all children in our clinics and wards.
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Cancer mortality in the Niger Delta Region of Nigeria: A case study of the University of Port Harcourt Teaching Hospital p. 262
Obiorah C Christopher, Nwafor Chukwuemeka Charles
DOI:10.4103/nmj.NMJ_15_19  
Aim: The aim of this study is to determine the pattern of cancer mortality (CM) seen in the University of Port Harcourt Teaching Hospital (UPTH) which is a cancer reference center in the Niger Delta Region. Methodology: This is a 6-year retrospective study of cancer-related deaths in UPTH using patients' admission registers in all the wards and emergency units. Furthermore, the death certificates of cases were reviewed. Results: Three hundred and sixteen cases of cancer-related deaths occurred, involving 174 females and 142 males, in a female-to-male sex ratio of 1.2:1. All age groups were affected, with age group 40–49 years accounting for the majority (20.6%). CM was seen in all the systems, except the central nervous system. Cancers of the gastrointestinal tract and its accessory organs (liver and gall bladder) caused most mortality (27.9%), in a female-to-male ratio of 0.8:1. The single most involved organ in CM is the female breast (20.6%), distantly followed by mortality due to prostate cancers and hematolymphoid cancers which accounted for 9.2% each. Colorectal cancers accounted for 7.3% of cancer deaths and ranked 4th. Cancers of both cervix and stomach each accounted for 5.7% of mortality. The major histologic diagnoses were carcinomas (adenocarcinoma; 36.7%, invasive ductal carcinoma; 20.3%, squamous cell carcinomas; 8.2% and hepatocellular carcinomas; 4.4%). Leukemias and lymphomas accounted for 9.2% of cases, whereas sarcomas accounted for 5.1% of cases. Conclusion: Infection-related and noninfection-related cancers cause most mortality in UPTH. The 5th decade was the most commonly affected, while female breast was the single most involved organ. Breast, prostate and hematolymphoid malignancies are common causes of CM with death from breast occurring earliest. Majority of the deceased were educated, working-class urban dwellers. More advocacies on public acceptance of cancer screening and cancer preventive lifestyles as well as governments' improvement on workforce training and treatment infrastructure will improve the current CM profile in Port Harcourt.
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Profile of nonmotor symptoms and the association with the quality of life of Parkinson's disease patients in Nigeria p. 267
Babawale Arabambi, Olajumoke Oshinaike, Shamsideen Abayomi Ogun
DOI:10.4103/nmj.NMJ_119_19  
Context: Parkinson's disease (PD) is the second most common neurodegenerative disorder. Several nonmotor symptoms (NMS) are associated with the condition, affecting multiple body systems in addition to the nervous system. Aims: The aim of the study is to describe the profile of NMS and the factors related to their severity as well as their association with the quality of life (QoL) among patients with PD in a Nigerian neurology clinic. Methods: A total of 105 patients with PD and 105 healthy controls were assessed for various NMS using a validated NMS assessment scale. A validated PD-specific QoL assessment tool, the PD Questionnaire-39 was also administered to the study patients with PD. Analyses for correlation and difference were performed to determine the associated factors of NMS severity and their association with QoL. Results: The most common NMS in the PD patients were in the domains of sleep/fatigue and mood/cognition. The total NMS score were significantly higher in patients compared to controls (median [interquartile range] 42 [13–72] vs. 20 [14–29], P < 0.001). There was a significantly higher score in the advanced Hoehn and Yahr stages (P < 0.001). The duration of PD had a positive correlation with the NMS scores (rs= 0.207, P= 0.034. The total NMS score had a strong positive correlation with the QoL (rs= 0.851, P < 0.001). Conclusion: PD is associated with significant NMS and worsens with the progression of the disease and the duration of illness. These NMS have a significant association with the QoL, necessitating the need for detailed and prompt evaluation and management.
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