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   2015| May-June  | Volume 56 | Issue 3  
    Online since July 9, 2015

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An overview of disease surveillance and notification system in Nigeria and the roles of clinicians in disease outbreak prevention and control
Elvis E Isere, Akinola A Fatiregun, Ikeoluwapo O Ajayi
May-June 2015, 56(3):161-168
DOI:10.4103/0300-1652.160347  PMID:26229222
While outbreaks of infectious diseases have long presented a public health challenge, especially in developing countries like Nigeria; within recent years, the frequency of such outbreaks has risen tremendously. Furthermore, with the recent outbreaks of emerging and re-emerging infectious diseases such as Ebola virus disease and other epidemic prone diseases in Nigeria demanding immediate public health action, there is a need to strengthen the existing notifiable disease surveillance and notification system with increased clinicians' involvement in timely reporting of notifiable diseases to designated public health authorities for prompt public health action. Hence, this paper provides the opportunity to increase awareness among clinicians on the importance of immediate reporting of notifiable diseases and intensify engagement of clinicians in disease notification activities by describing various notifiable diseases in Nigeria using their surveillance case definition, outlines the reporting channel for notifying these diseases and highlights the roles of clinicians in the current disease surveillance and notification network for early disease outbreak detection and public health response in Nigeria.
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Predictors of breast self-examination as cancer prevention practice among women of reproductive age-group in a rural town in Nigeria
Olorunfemi Emmanuel Amoran, Oluwayemisi Olugbenga Toyobo
May-June 2015, 56(3):185-189
DOI:10.4103/0300-1652.160362  PMID:26229226
Background: Early detection of breast cancer plays an important role in decreasing its morbidity and mortality. This study therefore examines the factors influencing breast self-examination (BSE) awareness and practices among women in Ogun state, Western Nigeria. Materials and Methods: This analytical cross-sectional study was conducted between 22 April and 13 May 2013 using a semi- structured questionnaire. A multi-stage cluster sampling technique was used to select one participant per household into the study. Results: A total of 495 women were interviewed in this study, the mean age of the respondents was 36.45 ± 5.12 years. About half (58.2%) of respondents have heard of BSE and 24.4% have ever perform BSE. Only 5.3% of our respondents perform BSE regularly (monthly) as recommended. Barrier to non-performance of BSE were perception of not being at risk (47.6%), lack of knowledge of how to perform BSE (47.6%). Only 18.5% of respondents have ever had their breast examined by physicians for lump and all of them had continued to perform BSE afterwards. The only predictor of awareness and practice of breast self-examination was tertiary level of education [odds ratio (OR) = 1.43 cumulative incidence (CI) = 1.12-2.18]. Conclusion: The study shows level of education, smoking habits and history of breast exam by health professional and were the factors found associated with BSE practice. Training on BSE should be given to women especially during antenatal care in order to increase the practice of BSE thus averting the severe morbidity and mortality of breast cancer in developing countries.
  5,647 108 15
Adolescents with sickle cell anaemia: Experience in a private tertiary hospital serving a tertiary institution
Sarah John-Olabode, Ibironke Awodele, Omolade Oni
May-June 2015, 56(3):204-207
DOI:10.4103/0300-1652.160397  PMID:26229230
Background: Many adolescents with sickle cell disease (SCD) have adjustment difficulties in the transition period from paediatric care to the adult system because they find themselves in unfamiliar waters where they have to learn to manage themselves. The aim of this study is to evaluate the prevalent crises and morbidities associated with SCD in adolescents in Babcock University Teaching Hospital (BUTH), to also assess the level of knowledge of these adolescents about SCD and to determine their emotional response to the disease. Materials and Methods: This was a retrospective review of case notes of adolescents with sickle cell anaemia that were seen in BUTH, from May 2013 to April 2014. Data extracted from the case notes was entered into a Microsoft (MS) Excel and analysed using descriptive statistics. Results were presented in tables. Results: A total of 50 subjects were seen in the department during this study period. Vaso-occlusive crises in the form of bone pains (93.1%) were the commonest crises encountered. Associated morbidities were malaria 34 (85%), tonsilitis 1 (2.5%), pneumonia 1 (2.5%), leg ulcer 1 (2.5%), azotaemia 1 (2.5%) and subarachnoid haemorrhage 2 (5%). Majority (88%) had adequate knowledge about general health maintenance while knowledge on nutrition and appropriate analgesia use is still inadequate. Eleven (22%) had symptoms of depression, four (8%) had suicidal ideation while one (2%) had a history of attempted suicide. Conclusion: This study emphasizes the importance of psychosocial intervention as part of a comprehensive health management for people with SCD.
  5,120 61 2
Caesarean section and perinatal outcomes in a sub-urban tertiary hospital in North-West Nigeria
Emmanuel Ugwa, Adewale Ashimi, Mohammed Yusuf Abubakar
May-June 2015, 56(3):180-184
DOI:10.4103/0300-1652.160360  PMID:26229225
Objectives: This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1 st January 2010 to 31st December, 2012. Materials and Methods: This was a retrospective study involving review of 580 case files. Ethical clearance was obtained. The records of labour ward, neonatal intensive care unit (ICU) and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1 st January 2010 to 31 st December 2012 at Federal Medical Centre, Birnin Kudu. The data obtained was analysed using SPSS version 17.0 statistical software (Chicago, Il, USA). Absolute numbers and simple percentages were used to describe categorical variables. Association between caesarean section and perinatal mortality was determined using Pearson's Coefficient of correlation and student t- test. P - value < 0.05 was considered statistically significant. Result: This study reported a caesarean section rate of 17.69 % and a perinatal mortality rate of 165.6 per 1000. Majority of the babies (78.2%) were within normal weight. The mean age of the women was 25.9 ± 6.2 years and mean parity was 4 ± 3. Majority of them were uneducated and unemployed. Obstructed labour was the commonest indication for emergency caesarean section accounting for 31.7% of caesarean sections and foetal distress was the least at 2.6 %. Two or more previous caesarean section was the commonest indication for elective caesarean section (17.1%) and bad obstetrics history the least indication (1.4%). There is a weak positive correlation (r = 0.35) between caesarean section rate and perinatal mortality and this association was not statistically significant (P = 0.12). Conclusion: Caesarean section and perinatal mortality rates in the present study are comparatively high. Absence of significant correlation means that a high caesarean section rate is not likely to improve perinatal outcomes in babies of normal weight; therefore the caesarean section rate in this centre should be reduced. Measures to reduce perinatal mortality such as skilled attendant in labour and training of medical staff in neonatal resuscitation should be adopted.
  4,310 99 3
Role of ultrasound-guided percutaneous antegrade pyelography in malignant obstructive uropathy: A Nigerian experience
Babajide Olawale Balogun, James Idowu Owolabi, Abdulwaid Niran Saliu, Michael Akintayo Bankole
May-June 2015, 56(3):225-228
DOI:10.4103/0300-1652.160408  PMID:26229234
Ultrasound-guided percutaneous nephrostomy of the renal pelvis is a technique that is widely acceptable especially when contrast media is introduced in the procedure of antegrade pyelography. It is a relatively safe procedure that effectively improves renal function in obstructed kidneys. It can be performed in most cases as an alternative to retrograde pyelography. We present our experience and its role in obstructive uropathy due to malignancy.
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Denture care practice among patients attending the prosthetic clinic in a Nigerian teaching hospital
Tunde Joshua Ogunrinde, Olanrewaju Ige Opeodu
May-June 2015, 56(3):199-203
DOI:10.4103/0300-1652.160395  PMID:26229229
Background: Good denture care practice by individuals using Removable Partial Denture (RPD) is an important component of oral health measures. An assessment of denture care practice of such individuals by dental care practitioners is necessary. Objective : To evaluate the denture care practice among prosthetics patients attending a tertiary Hospital Dental Centre in Nigeria. Materials and Methods: An interviewer administered questionnaire was used to obtain information from RPD wearers that were willing to participate. The questionnaire assessed among other things, patients' bio-data, frequency, techniques and device used for cleaning their dentures. Data was analyzed using Chi-square test (P < 0.05). Results: One hundred and ninety eight denture wearers consisting of 100 (50.5%) males and 98 (49.5%) females participated in the study. Majority 110 (55.6%) cleaned their dentures once daily and toothbrush and pastes were used by 105 (53%) of the participants. More than 70% of the respondents removed their dentures at night. One hundred and sixty-six (83.8%) visited the dentist only when they needed treatment. There was a statistical significant relationship between frequency and technique of cleaning denture, and denture cleanliness (P < 0.05). Conclusion: This study shows that once daily cleaning of dentures and cleaning the denture with rest of the teeth are ineffective in prevention of plaque accumulation.
  4,224 45 2
BAX/BCL-2 mRNA and protein expression in human breast MCF-7 cells exposed to drug vehicles-methanol and dimethyl sulfoxide (DMSO) for 24 hrs
Gbenga Anthony Adefolaju, Kathrine E Theron, Margot Jill Hosie
May-June 2015, 56(3):169-174
DOI:10.4103/0300-1652.160349  PMID:26229223
Background: Methanol and DMSO are commonly used as carrier solvents for lipophilic chemicals in in-vitro experiments. However, very little information is available regarding the effects of these solvents on the expression of pro and anti-apoptotic genes and proteins. Materials and Methods: In this study, we examined the cytotoxic effects of methanol and dimethylsulfoxide at 0.5% (final concentrations recommended for in-vitro toxicity assays) on human breast cancer MCF-7 cells. We also investigated the effects of these solvents on the mRNA and immunocytochemical expression of apoptotic proteins BAX and BCL-2. Results: The results of neutral red cell viability assay showed that methanol and DMSO concentrations of 0.5% exhibited no cytotoxic effects on MCF-7 cells following a 24 hour exposure. Gene expression and Immunofluorescence results showed that methanol but not DMSO reduced the expression of the BAX pro-apoptotic protein, while both solvents did not alter the expression of the BCL-2 oncoprotein. Conclusion: Our results suggest that while methanol concentrations at 0.5% may be appropriate for in vitro toxicity studies in human breast cancer MCF-7 cells, it could alter the results of gene and protein expression experiments.
  4,142 109 4
Haematopoietic stem cell transplantation in Nigerian sickle cell anaemia children patients
Antonella Isgro, Katia Paciaroni, Javid Gaziev, Pietro Sodani, Cristiano Gallucci, Marco Marziali, Gioia De Angelis, Cecilia Alfieri, Michela Ribersani, Andrea Roveda, Olufemi O Akinyanju, T Thompson Wakama, Festus Olusola Olowoselu, Adewumi Adediran, Guido Lucarelli
May-June 2015, 56(3):175-179
Background: Sickle cell anaemia (SCA) remains associated with high risks of morbidity and early death. Children with SCA are at high risk for ischaemic stroke and transient ischaemic attacks, secondary to intracranial arteriopathy involving carotid and cerebral arteries. Allogeneic haematopoietic stem cell transplantation (HSCT) is the only curative treatment for SCA. We report our experience with transplantation in a group of patients with the Black African variant of SCA. Patients and Methods: This study included 31 consecutive SCA patients who underwent bone marrow transplantation from human leukocyte antigen (HLA)-identical sibling donors between 2010 and 2014 following a myeloablative-conditioning regimen. Results: The median patient age was 10 years (range 2-17 years). Before transplantation, 14 patients had recurrent, painful, vaso-occlusive crisis; ten patients had recurrent painful crisis in association with acute chest syndrome; three patients experienced ischaemic stroke and recurrent vaso-occlusive crisis; two patients experienced ischaemic stroke; one patient exhibited leukocytosis; and one patient exhibited priapism. Of the 31 patients, 28 survived without sickle cell disease, with Lansky/Karnofsky scores of 100. All surviving patients remained free of any SCA-related events after transplantation. Conclusion: The protocols used for the preparation to the transplant in thalassaemia are very effective also in the other severe haemoglobinopathy as in the sickle cell anaemia with 90% disease free survival. Today, if a SCA patient has a HLA identical family member, the cellular gene therapy through the transplantation of the allogeneic haemopoietic cell should be performed. Tomorrow, hopefully, the autologous genetically corrected stem cell will break down the wall of the immunological incompatibility.
  4,119 108 -
Relationship of blood pressure with some cardiovascular disease risk factors in a rural population of Plateau State, North Central Nigeria
Basil N Okeahialam, Chikaike Ogbonna, Dele E Joseph, Evelyn K Chuhwak, Ikechukwu O Isiguzoro
May-June 2015, 56(3):208-212
DOI:10.4103/0300-1652.160400  PMID:26229231
Background: Hypertension is associated with certain cardiovascular disease (CVD) risk factors which vary from one place to the other depending on community sophistication. We decided to obtain the situation as it affects this rural Nigerian community to be in an evidence-based position to initiate individual and group prevention strategies. Design: Cross-sectional population survey. Materials and Methods: We surveyed for CVD risk factors among subjects 15 years and above in this rural community using a questionnaire requesting personal, medical and anthropometric information. One in three of them were randomly assigned to laboratory investigations. Results: Of the 840 subjects studied, 25% were males. The population mean age was 45.5 (18.2) standard deviation (SD), with 1.8% smokers and 4.1% using alcohol. Systolic blood pressure (SBP) correlated with age, body mass index (BMI), total cholesterol (TC) and uric acid (UA); while diastolic blood pressure (DBP) correlated with age, BMI, TC, UA and atherogenic index (AI). SBP and DBP improved with exercise but not salt intake. The local seasonings used in cooking had no impact on blood pressure. Conclusion: To reduce cardiovascular morbidity in this and probably other rural sub-Saharan African communities, BMI, TC, UA and salt intake in diet should be targeted for reduction. Physical activity should be encouraged. Interestingly, these fall into the sphere of healthy lifestyle which should be encouraged and re-inforced.
  3,883 60 -
A five year audit of mammography in a tertiary hospital, North Central Nigeria
Halimat Jumai Akande, Bola Bamidele Olafimihan, Olalekan Ibikun Oyinloye
May-June 2015, 56(3):213-217
DOI:10.4103/0300-1652.160401  PMID:26229232
Background: Breast imaging plays a vital role in the multidisciplinary approach to management of breast disease. A baseline data is apt and necessary for collaborative studies. Materials and Methods: This is a prospective descriptive study carried out between January 2009 and December 2013 at our institution. Patients who had breast imaging were recruited into the study. Film-screen mammograms were acquired with a General Electric (GE) Senographe DMR machine. Breast ultrasound done using an Aloka Prosound SSD-350+ ultrasound machine equipped with linear and curvilinear 7.5-10 MHz transducer. Findings were categorized using the ACR-BIRADS (American college of Radiologists-Breast imaging reporting and data system). Data was collated and analysed using social statistical package (SPSS) version 17. Result: The mammograms of 824 patients were evaluated during this study period. Their age ranged from 40-85 years with a mean age of 50.9 ± 8.1 years. Eight hundred and sixteen (99%) were females and eight (1%) were males. The commonest clinical indication was breast lump (23.9%). The commonest density pattern was BIRADS 2-scattered fibroglandular pattern (43.9%). Mammograms were normal in 266 (32.3%) and positive in 558 (67.7%). The final BIRADS assessment showed BIRADS 0, 1, 2, 3, 4, 5 and 6 constituted 6.6%, 30.1%, 29.7%, 22.2%, 5.9%, 5.0% and 0.5% respectively. Conclusion: The level of awareness of breast cancer is quite high with the positive mammographic yield emphasizing the value of a multidisciplinary approach in the management of breast diseases.
  3,830 47 5
The effect of hospital infection control policy on the prevalence of surgical site infection in a tertiary hospital in South-South Nigeria
Seiyefa Fun-Akpa Brisibe, Best Ordinioha, Precious K Gbeneolol
May-June 2015, 56(3):194-198
DOI:10.4103/0300-1652.160393  PMID:26229228
Background: Surgical site infections (SSIs) are a significant cause of morbidity, emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSIs in several health care institutions. This study assessed the effects of the implementation of the policy on the prevalence of SSI in the University of Port Harcourt Teaching Hospital, Nigeria. Patients and Methods: A review of the records of all Caesarean sections carried out in the hospital, before and 2 years after the implementation of the infection control policy was conducted. Data collected include the number and characteristics of the patients that had Caesarean section in the hospital during the period and those that developed SSI while on admission. Results: The proportion of patients with SSI decreased from 13.33% to 10.34%, 2 years after the implementation of the policy (P-value = 0.18). The implementation of the policy did not also result in any statistically significant change in the nature of the wound infection (P-value = 0.230), in the schedule of the operations (P-value = 0.93) and in the other predisposing factors of the infections (P-value = 0.72); except for the significant decrease in the infection rate among the un-booked patients (P-value = 0.032). Conclusion: The implementation of the policy led to a small decrease in SSI, due to the non-implementation of some important aspects of the WHO policy. The introduction of surveillance activities, continuous practice reinforcing communications and environmental sanitation are recommended to further decrease the prevalence of SSI in the hospital.
  3,735 52 4
Plasmodium falciparum parasitaemia among booked parturients who received two doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) in a tertiary health facility Southeast Nigeria
Matthew Igwe Nwali, Brown N Ejikeme, Joseph J Agboeze, Azubike K Onyebuchi, Bonaventure O Anozie
May-June 2015, 56(3):218-224
DOI:10.4103/0300-1652.160406  PMID:26229233
Background: Malaria is preventable but has contributed significantly to maternal morbidity and mortality in our environment. Malaria parasitaemia during pregnancy is mostly asymptomatic, untreated but with complications. Aim: A follow-up study aimed at determining plasmodium falciparum parasitaemia and associated complications among booked parturient who had intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) compared with another study among unbooked parturients who did not take SP for intermittent preventive treatment in pregnancy (IPTp). Materials and Methods: This study was conducted in the labour ward complex of Federal Teaching Hospital, Abakaliki from March to May 2012. Five hundred booked parturients at term that received two doses of SP were consecutively recruited. A structured data collection sheet was administered to each parturient. Thick and thin blood films were prepared for quantification and speciation of parasitaemia, respectively. The haemoglobin concentration and birth weights were determined. Analysis was done with the Statistical Package for the Social Sciences (SPSS) software with level of significance at P value < 0.05. Results: The prevalence of malaria parasitaemia in the study was 59.6%. The mean age of parturients was 28.7 (5.5). The highest prevalence of malaria parasitaemia, 92% was found among the parturients aged ≤19 years. The association between age and parasitaemia was significant (x 2 = 16.496, P = 0.000). The median parity was 1.0 (3.0). The highest prevalence of asymptomatic parasitaemia, 65.5% was noted among the nulliparous parturients. The association between parity and parasitaemia was significant (x 2 = 11.551, P = 0.003). Majority of the parturients were of high social class. Those of the lowest social class (class 5) had the highest prevalence (80%) of parasitaemia. The association between social class and parasitaemia was significant (x 2 = 9.131, P = 0.003). Prevalence of anaemia in the study was 14%. The non-parasitaemic and parasitaemic parturients had mean haemoglobin concentrations of 12.7 g/dl and 10.4 g/dl, respectively. There was significant association between haemoglobin concentration and parasitaemia (x 2 = 39.143, P = 0.000). The prevalence of low birth weight was 3.0%. The relationship between birth weight and parasitaemia was significant (x 2 = 2.535, P = 0.000). Conclusion: The was reduction in asymptomatic malaria parasitaemia compared to parturients who had no SP though the prevalence was still high showing possibly increasing resistance to SP but the treatment was still very effective in reducing anaemia and low birth weight associated with malaria in pregnancy.
  3,172 52 -
Maternal renal artery Doppler sonographic changes in pregnancy-induced hypertension in South West Nigeria
Olusanmi Abel Ogunmoroti, Oluwagbemiga Oluwole Ayoola, Olufemiwa Niyi Makinde, Bukunmi Michael Idowu
May-June 2015, 56(3):190-193
DOI:10.4103/0300-1652.160367  PMID:26229227
Background: To evaluate the renal arterial hemodynamic changes caused by pregnancy-induced hypertension using Doppler ultrasonography. Materials and Methods: Eighty (80) subjects with pregnancy-induced hypertension (PIH) and 160 controls (80 pregnant normotensive women and 80 healthy, non-pregnant women) underwent triplex renal sonography prospectively to determine their renal volumes and right renal artery Doppler indices. Results: The peak systolic velocity, end diastolic velocity, pulsatility index, systolic/diastolic ratio and acceleration time were respectively significantly higher in the PIH group (68.67 cm/s, 21.55 cm/s, 1.23, 3.38, 123.2 ms) than the pregnant, normotensive group (65.19 cm/s, 20.27 cm/s, 0.88, 3.35, 61.14 ms) and healthy, non-pregnant group (52.06 cm/s, 18.27 cm/s, 0.84, 2.90, 68.48 ms). Resistivity index was also increased in the PIH group, but this was not statistically significant. Conversely, the systolic acceleration was significantly lower in the PIH group (6.06 m/s 2 ) compared to the pregnant, normotensive group (11.82 m/s 2 ) and healthy, non-pregnant group (8.26 m/s 2 ). The right renal volume of the PIH group (132.76 cm 3 ) was significantly higher that of the pregnant, normotensive group (125.29 cm 3 ) and healthy, non-pregnant group (91.66 cm 3 ). The same pattern was observed in the left renal volume which was 168.78 cm 3 , 164.95 cm 3 and 113.80 cm 3 in the study groups, respectively. Conclusion: Renal Doppler ultrasound is clinically relevant in the diagnosis and follow-up of renal complications in patients with pregnancy-induced hypertension.
  2,588 46 1
Who plays the major role in fatal injuries by motorcycle in developing countries?
Amin Zarghami, Aliasghar Manouchehri
May-June 2015, 56(3):229-229
DOI:10.4103/0300-1652.160409  PMID:26229235
  2,093 49 -