Niger Delta Journal of Medical Sciences (NDJMS)
Niger Delta Journal of Medical Sciences (NDJMS) is an open access peer-reviewed and online journal and the official publication of the Faculty of Clinical Sciences (FCS), College of Health Sciences (CHS), Niger Delta University (NDU), Amassoma, Wilberforce Island Bayelsa State, Nigeria. This general medical journal publishes scientific manuscripts quarterly and accepts manuscripts from within and outside Nigeria in areas of basic and clinical medical sciences and related fields including clinical research, public health, nursing, pharmacology, laboratory practice, anatomy, physiology, physiotherapy etc. All manuscripts submitted to this journal are expected to conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals issued by the International Committee for Medical Journal Editors (ICMJE).
Faculty of Clinical Sciences (FCS), College of Health Sciences (CHS), Niger Delta University (NDU), Amassoma, Wilberforce Island Bayelsa State, Nigeria
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Intimate Partner Violence During Pregnancy in Yenagoa, Southern Nigeria
Background: Intimate partner violence (IPV) perpetrated against women during pregnancy is quite common, and it could lead to psychological or emotional trauma, and physical injury to both mother and fetus. Objectives: To determine the prevalence and pattern of IPV perpetrated against women during pregnancy in Yenagoa. Methodology and subjects: This is a cross-sectional study of 640 booked parturient who received antenatal care at Niger Delta University Teaching Hospital (NDUTH) in Yenagoa. The participants were interviewed using a well structured interviewer administered questionnaire. Information obtained were patients bio-data, and issues related to IPV, such as: physical or emotional violence, sexual abuse, verbal violence, social violence, financial deprivation, and complications of IPV. Results: The prevalence of IPV during pregnancy was 65.6%, and the chances of having IPV was twice higher during pregnancy compared to non pregnant women, odd ratio = 2.96[2.36 – 3.71], p = 0.001 The most perpetrated act was social violence (44.1%), especially infidelity (20.6%). Next was financial deprivation (40.5%), predominated by taking control of the wife's financial resources (20.0%). Verbal violence was next (38.8%), especially name calling (24.1%). Physical violence was 22.5%, and slapping (12.5%) was the most common form of physical violence; only a handful of the women (2.5%) were attacked with weapons. The least perpetrated act was sexually abuse (13.1%), mostly sexual deprivation as punishment (7.3%). The complication rate from IPV was 13.5% predominantly mild physical injuries), and only 1.2% reported IPV to police. Conclusion: IPV during pregnancy is quite common in Yenagoa, and a great majority of the women suffer in silence, even in the face of complications. Public enlightenment and advocacy by women right groups and activists are recommended.
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Prevalence and Risk Factors of Intestinal Helminthinthiasis among Primary School Children in Obio-Akpor Local Government Area of River State, Nigeria.
Background: Intestinal helminthic infections continue to pose a significant global health burden, particularly in tropical and sub-tropical regions. Thus, the prevalence and the risk factors intestinal helminth infections was investigated among primary schools children in Obio-Akpor, Rivers State, Nigeria. Methods: This was a descriptive cross sectional study of three hundred and sixty children, selected using a multistage sampling method. Their stool samples were collected and examined for helminth eggs using Kato- Katz technique and analyzed at the Department of the Medical Microbiology laboratory, University of Port Harcourt Teaching Hospital. Data was analyzed using Statistical Software for Social Sciences version 17.0 (Chicago IL, USA).and a p- value of 0.05 was regarded as statistically significant. Results: Their ages ranged from 5-12 years (mean age of 8.95±1.96 years)and most 229 (62.4%) were female. Twenty of the 367 5.4%) children were infested with helminths. Three of the 161(1.9%) children resident in an urban community compared to 17 of 206 (8.3%) living in a rural community were infested with intestinal helminths and this was statistically significant(χ2= 7.159; p= 0.007). Multivariate analysis showed that children drinking from wells and streams were ten times at risk of being infected with intestinal helminths.(β=2.320, 95% C I=2.02 to 51.20, p=0.005). Conclusion: Children who drank from wells and streams were at ten times greater risk of intestinal helminths. Therefore, access to improved water sources and improved personal hygiene should be the main goal in reducing the burden of helminthic infestation.
A 5-Year review of obstructed labour at the Federal Medical Centre, Yenagoa, Bayelsa State
Background: Obstructed labour remains a common obstetric complication with resultant fetomaternal morbidity and mortality in low-income countries. In developing countries, fistulae usually result from prolonged obstructed labour and follow pressure necrosis caused by impaction of the presenting part during difficult labour. In the infant, neglected obstructed labour may cause asphyxia, leading to stillbirth, brain damage, or neonatal death. The study aims to determine the prevalence, sociodemographic characteristics, causes, complications, and the fetomaternal outcome of pregnancies complicated by obstructed labour. Methods: It was a retrospective study carried out on managed cases of obstructed labour in Federal Medical Centre, Yenagoa, Bayelsa State, between 1st January 2018 and 31st December 2022. Results: A total of 46 cases were recorded out of 3,718 deliveries during the study period, giving an institutional prevalence rate of 1.2%. The main causes were cephalopelvic disproportion (76.1%) followed by malpresentation (23.9%). Obstructed labour was more common among women aged 30–34 years (39.1%). Most of the women were married (86.9%) with secondary education (47.8%). Most of the women were nulliparous (47.8%), unbooked (95.7%), and referred by traditional birth attendants (52.2%). The common foetal complications were intrauterine foetal death (23.8%) and foetal distress (11.9%), while the common maternal complications were wound infection (7.5%), uterine rupture (4.5%), and puerperal sepsis (4.5%). Conclusion: The prevalence of obstructed labour in this study is low. The major causes were cephalopelvic disproportion and abnormal lie/presentation.
Overcoming challenges in Breast-feeding Support: Insights from midwives in a General Hospital setting
Background: As the primary carers in a general hospital, midwives play a crucial role in breastfeeding support. However, difficulties in providing effective support and confronting cultural beliefs can hinder breastfeeding practices. Understanding midwifes' perspective on effective breastfeeding support is crucial for the development of targeted interventions and the improvement of breastfeeding support services. Aim and Objective: The objective of this study was to analyze the various challenges faced by midwives in providing breastfeeding support within a typical hospital setting. Method: In-depth interviews with midwives to gather valuable insights and experiences were employed. The data collected were analyzed using thematic analysis as a methodological approach to discern emerging themes and patterns with the help of ATLAS.ti software. Results: The findings revealed two primary obstacles midwives encounter. First, insufficient personnel and time constraints which impeded their capacity to provide comprehensive support and education to the large number of women seeking assistance. Secondly, cultural beliefs about lactation posed additional obstacles. Misconceptions regarding the sufficiency of breast milk, concerns regarding breast appearance, and the importance of colostrum influenced mothers' ability to exclusively breastfeed. Cultural practices including the premature introduction of complementary foods and the discarding of colostrum impeded the promotion of exclusive breastfeeding. Conclusion: The study showed that staffing and time constraints had a negative effect on provision of breastfeeding support by midwives while cultural norms prevented exclusive breastfeeding. Addressing these challenges by stakeholders' through increased healthcare funding and staffing of health facilities is necessary to ensure effective breastfeeding support, educating the community on the importance of colostrum andbreast appearance to eliminate cultural myths, ultimately leading to a successful breastfeeding.
Closing the care gap in cancer care in Nigeria: time to move from commemoration to a coordinated action
Background Cancer, a major noncommunicable disease (NCD), is responsible for ill health, disability and death of a significant proportion of the population around the world. About 20 million new cases and 9.7 million deaths were estimated to occur in 2022 and, given the prevailing conditions, it is predicted that there will be more than 35 million new cases in 2050 - a 77% increase in less than three decades. The extant measures and services to cater to the victims of the disease, unfortunately, are grossly inadequate and cannot cope with the rapidly rising burden of the disease. Controlling the disease demands a holistic approach comprising four principal components: prevention, early detection, diagnosis and treatment, and palliative care. The World Health Organization (WHO) in collaboration with other international and national organisations have developed several interventions aimed at stemming the rising tide of the disease alongside other NCDs. The Sustainable Development Goals (SDGs) initiative also sets a target of achieving a one-third reduction in premature mortality from NCDs including cancer by 2030. Cancer control requires the contribution of all segments of the population – individuals, communities, corporate organisations and government at all levels. One potent weapon for fighting cancer is awareness creation and public education about what needs to be done to address the different components of care for the disease. A global effort to create awareness about cancer is the observance of World Cancer Day (WCD) on the 4th of February annually. Since 2001 when the first WCD was commemorated, the day has assumed great significance with more countries and organisations joining the annual campaign to reduce the burden of the disease. The Union for International Cancer Control (UICC) has assumed the leadership of the global observance of the day, developing and rolling out a theme/slogan for each year thereby stimulating actions whose impact lasts the whole year, beyond the day itself. Recognising the yawning gap that exists worldwide in the care available and accessible by victims of the disease, “Close the care gap” was developed as a theme to run for three years (2022 – 2024) to ensure adequate attention was given to address the care element of the disease. This article describes the focus for each year of the multi-year campaign, summarises the impact of the campaign, highlights Nigeria's involvement and ongoing efforts, and proposes further actions that need to be taken as the world and Nigeria in particular resolve to close the cancer care gap.
The use of misoprostol for postpartum haemorrhage among midwives in primary healthcare facilities in Edo state, Nigeria.
Background: Postpartum haemorrhage is a leading global cause of maternal morbidity and mortality. The use of misoprostol in the prevention and treatment of PPH has been shown to be effective particularly in low resource settings where regular supply and maintenance of efficacy of oxytocin and ergometrine cannot be ensured. This study aimed to determine midwives'knowledge and usage of misoprostol in the management of Postpartum haemorrhage in Edo Central Senatorial District. Methodology: It was a descriptive cross-sectional survey involving 126 midwives. An all- inclusive sampling was adopted for the study. Data was collected by means of a structured questionnaire. Collected data were analysed and presented by means of frequencies and percentages. Pearson's correlation analysis was used to test the hypotheses. Results: This study showed that 40.5% and 42.9% of respondents knew the correct dose, 77%and 46.8% knew the correct route and 37.3%and 77.8%knew the correct time of administration for prevention and treatment of PPH respectively. In the prevention of PPH, 42.9%of respondents administer misoprostol at the correct time, 46.8%at the correct dose and 66.7%through the correct route whereas, in the treatment of PPH, 62.7% of respondents administered misoprostol at the correct time, 43.7% at the correct dose and 54% through the correct route. Only 38%of respondents had received training on use of misoprostol for PPH. Factors influencing misoprostol use among the participants were training, adequate knowledge, availability, and effectiveness of misoprostol. There was a significant relationship between midwives' professional qualifications and years of service and correct use of misoprostol. Conclusion: Theknowledge of misoprostol use was still low, and midwives still used misoprostol incorrectly in the management of PPH. It is recommended that relevant authorities should invest in training and retraining of midwives on use of misoprostol for the management of PPH.
Outcomes of Antenatal Booking Laboratory Investigations: A Report from Ilorin, Nigeria
Background: Antenatal booking laboratory investigations provide information on the health status of antenatal women and at a glance highlight to the health provider areas to focus attention. The study aimed to describe the results of these investigations and emphasize their benefits. Methods: A cross-sectionalstudy conducted at the University of Ilorin Teaching Hospital, Ilorin between January 2017 and December2018. Participants were antenatal women who had their booking laboratory investigations results reviewed at the antenatal clinic. The investigations included Packed Cell Volume, urinalysis, Veneral Disease Research Laboratory, blood group, Rhesus typing, genotype, hepatitisB surface antigen, anti-hepatitis C antibody test and HIV screening. Data analysis was performed using SPSS version 21.0 and p<0.05 was significant. Results: Among the 1,000antenatal women, the mean age was30.0±5 years while 420(42.0%) booked in the second trimester. The mean Packed Cell Volume at booking was 30±3%, 454(45.4%) had aneamia,260(26.0%) were diagnosed with HIV, 117(11.7%) had abnormal urinalysis results, Veneral Disease Research Laboratory test was reactive in 45(4.5%), 232(23.2%) were HBSAg reactive, 74(7.4%) were reactive to anti-HCV, 39 (3.9%) had genotype SS while 33(3.3%) were Rhesus D negative. There were associations between level of education (P=0.001), parity (P=0.001), or being married (P=0.003) and positive HIV result; being married (P=0.008) and reactive hepatitis B surface antigen test or level of education (P=0.002) and reactive Anti-HCV result. Conclusion: Uptake of antenatal laboratory booking investigations should be encouraged to enhance detection and management of abnormalities thereby improving pregnancy outcome.
An Exploratory Medicine Quality Survey of Furosemide Tablets in Selected Pharmacies around Hospitals Providing Specialist Cardiovascular Care in Nigeria
Introduction: Poor-quality medicines remain a public health challenge in Nigeria, despite the efforts of the National Agency for Food and Drug Administration and Control (NAFDAC). The quality of medicines intended for use in children is not known, as there are no studies on this area. The pharmacological management of cardiovascular disease in children is also an understudied research area. The aim of this study was to explore the quality of furosemide tablets intended for the extemporaneous preparation (compounding) of children's cardiovascular medicine in Nigeria. Methods: The study used the mystery shopper approach to obtain samples of furosemide tablets from pharmacies purposively and conveniently selected in Bayelsa State, Lagos State and Abuja, Nigeria. Rationale for locations included states with public healthcare facilities providing paediatric cardiovascular care. At these locations, the major pharmacies within one-hour's drive from these facilities were surveyed. Furosemide samples were assessed for quality by packaging inspection using registration by NAFDAC and chemical analysis for potency using the British Pharmacopoeia (BP) specification for Percent Label Claim (PLC). Samples that met the specified PLC of 95-105% were defined as being of quality, for compounding purposes. Results: The majority, 90% (9/10) of the four brands of furosemide tablets samples were not registered by NAFDAC. The PLC of all samples was 100.2 ± 1.6% (mean ± SD). Conclusion: Samples met official potency standards for quality (while other pharmacopoeial specifications were not checked), but the majority were not registered by NAFDAC. Regular multi- site post-marketing screening for medicine quality is needed in Nigeria.
Respectful Maternity Care: Compliance among Midwives in Tertiary Hospitals in Bayelsa State, Nigeria
Background: Respectful Maternity Care (RMC) is a care free from disrespect and abuse that is given to every childbearing woman in the world. However, in most hospitals in low-resource settings, pregnant women experience some degree of harassments and insults from the midwives. This study was under taken to assess the level of compliance among Midwives as regards Respective Maternity Care in tertiary hospitals in Bayelsa State. Method: A cross-sectional descriptive design was adopted for this study with sample of 40 midwives. Data collection was done using a self-administered structured questionnaire and data analysis was done using descriptive statistics. Results: All respondents 40(100%) were female, majority 19(47.5%) were within 31-40 years, while 38(95%) were Christians. Most respondents 23(57.5%) have moderate knowledge on Respectful Maternity Care. All respondents provided privacy during childbirth 40(100%). Majority 26(65%) did not respect clients' choice of birth positions. On consented care, 28(70%) of respondents did not always take consent from the clients, On detainment of clients in the hospital for refusal to pay for the services, 36(90%) respondents reported that they have not detained clients, while 4(10%) answered in the affirmative. Compliance level was also poor. All respondents (100%) stated that the attitude of the pregnant women, lack of human resources and infrastructure were the factors that hinder them from practicing Respectful Maternity Care. Conclusion: All respondents have significant knowledge about Respectful Maternity Care, the level of compliance among respondents were poor. However, all respondents agreed that attitude of the pregnant women, lack of human resources and infrastructure are some factors that hinder them from practicing Respectful Maternity Care.
Factors affecting Career Preferences for Nephrology among Medical Interns in South-South Nigeria
Background: Despite the increasing magnitude of kidney disease, there appears to be a dearth of Nephrologists globally. This is more disturbing in low income countries like Nigeria where health care is already staggered by several factors. The aim of the study was to determine the career preferences for nephrology among medical interns as this may be an indicator of the future nephrology workforce Methods: This cross-sectional descriptive study was carried out among interns in four tertiary hospitalspurposively selected in south-south Nigeria between January and March, 2021. A self- administered questionnaire was used to obtain their biodata, information on factors influencing specialty choice, deterrents to choice of nephrology and their recommendation. Results: Only 8(5.4%) respondents were interested in specializing in nephrology. The most important factors determining choice were post-fellowship job opportunities (57.6%), opportunities to perform procedures (51.5%) and prospect of a future private practice (37.9%). The most important factors cited as deterrents to choosing Nephrology included high risk of death (41.2%), poor outcome of patients (36.6%) and severity of illness (31.7%) Recommendation made by respondents included provision of standard equipment and working tools (82.1%), improved quality of service (80.6%) and provision of health insurance for patients (77.8%). Conclusion: Career preference for nephrology was low and deterred by high risk of death and poor outcome of renal patients. Specialty choice was mainly influenced by job opportunities, opportunities to perform procedures and prospect of future private practice.
Gross Placenta Characteristics in Pre-eclampsia/Eclampsia and Normotensive Pregnancies. A Comparative Study
Background: Preeclampsia/eclampsia is a leading cause of maternal and perinatal mortality; the prevailing theory is that it is a consequence of disordered placentations which are manifested as vascular and villous abnormalities with consequences in the developing foetus. Objective: To evaluate and study gross changes in the placentae of women with preeclampsia/eclampsia and normotensive mothers and correlate with pregnancy outcome and neonatal morbidity and mortality. Methods: This was a comparative(prospective) study of pathologic lesions in the placentae of 146 pregnant women; 73 were normotensive (control group) while the other 73 women were preeclamptic /eclamptic (study group). The placental findings in the two groups were further examined for association with severity of the hypertensive disease and neonatal mortality. Results: The mean placental weight was lower in the study group compared to the control (556.82grams ± 169.72 vs. 649.93 grams ± 16.38, p<0.001). Placenta weight was significantly lower at gestational ages of 31-36.6weeks. The study group had a significantly higher percentage of abnormal cord insertions than the control group. There was no significant association between gross parameters and disease severity. Gross infarcts were only seen in placentae of study group and the difference was statistically significant. Gross infarcts and membrane colour were significantly associated with perinatal mortality. The study group had 11% neonatal mortality while there were no neonatal deaths in the control group. Conclusion: There were distinct gross pathological changes in the placentae of mothers with preeclampsia/eclampsia several of these pathological changes occurred more in the severe and eclamptic cases. There was also association with perinatal mortality.
Enhancing Exclusive Breast-Feeding Practices through Midwives Support
Background: Sequel to low Exclusive Breast-Feedingpractice rate, United Nations Children Fund and World Health Organization designed staff training as part of the ten steps to enhance exclusive breast-feeding practices in Baby Friendly Hospital Initiative programme aimed at supporting and encouraging mothers to exclusively breast feed the infants. Objective: The aim of the study is to determine midwives' support towards enhancing the exclusive breast-feeding practices of lactating mothers at the Federal Medical Centre, Yenagoa. Bayelsa State, Nigeria. Methods: The study employed cross-sectional descriptive research design. Population consists of all registered midwives working at Federal Medical Center. Sample for the study consisted of 200 participants selected by convenience sampling. Data were collected by means of structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) version 21.Descriptive and inferential statistics were used to interpret the result. Results: Findings revealed that most midwives have not been trained for exclusive breast-feedingsupport programmes. Reported challenges faced by the midwives include: Lack of exclusive breast-feedingsupport in-service training (36.0%), not being comfortable teaching exclusive breast feeding to lactating mothers 36(18.0%), not being opportune to render the needed support (8.5%) and that the hospital is not a baby friendly hospital (16.0%). There was statistical relationship between staff training and exclusive breast-feeding practice promotion and support (p = 0.1 < 0.5). Conclusion: Finding from the study show that majority of the midwives are still oblivious of their expected role in the support of exclusive breast-feeding practices among lactating mothers.
Before and after: a Review of the Cascade of Events before Arrival and During Admission for Obstetric Emergencies in Ilorin, Nigeria.
Background: Obstetric emergencies are important contributor to adverse pregnancy outcome and the cascade of events before and after hospital arrival contribute to treatment outcomes in these women. Method: A prospective cross-sectional study was conducted at University of Ilorin Teaching Hospital,Ilorin, Nigeria between July and December 2019.Participants were 164 women admitted and managed as obstetric emergencies at the study centre. Primary outcome measures were the preadmission events (care received and mode of transportation), secondary outcomes were promptness ofemergency care and maternal outcome. Data was presented as descriptive statistics in tables with percentages. Results: The mean age of participants was 29±4 years, 124(75.6%) were of low social class, duration of the complication was <12hours in 82(50.0%) and 134(81.7%) received pread mission care. There were134(92.5%) referred cases, 96(71.6%) were health-worker-initiated, 86(64.2%) presented with referral letter and the indications for referral included lack ofcompetence to manage the cases in 68 (50.7%) and no improvement with treatment in 26(19.4%). Also, 132(80.5%) traveled >10km before arrival, transportation was with ambulance in 2(1.2%), 156(95.1%) received no care during transportation while duration from referral-to-arrival was >60minutes in 96(70.7%). Commonest diagnosis at presentation was severe preeclampsia/eclampsiain 50 (30.5%), 132(80.5%) were attended to by a doctor within 10 minutes of arrival while maternal mortality was 61/1000 live birth. Conclusion: To further reduce maternal mortality, improved access to comprehensive emergency obstetric services through early referral, effective inter-facility communication and safe transportation should be prioritized.
Nutritional Perspectives to Coronavirus Disease 2019 (COVID-19) Susceptibility and Severity: a review of the roles of vitamin D and C
Background: Coronavirus disease 2019 (COVID-19) which was declared a global pandemic on March 11, 2020 is known to have affected more than 108 million people with more than 2 million deaths worldwide as at February 2021. The pathophysiology of disease severity is governed by a cytokine storm which could potentially be modulated by certain vitamins such as vitamins D and C with immunomodulatory and anti-inflammatory properties. The mechanisms underpinning the susceptibility to and severity of the disease when these nutrients that have shown anti-inflammatory properties are deficient is yet to be fully elucidated. Objectives: The aim of this review was to explore the plausible mechanisms through which vitamin D and C can influence risk of SARS-CoV-2 infection and progression to severe symptomatic form of COVID-19. Method: We performed a literature search to review the pathophysiology of COVID-19 as well as effects of supplemental vitamin D and C on risk of infection, disease progression and severity. Results: Randomised control trials which administered high doses of vitamin D and C, have shown demonstrable beneficial effects in COVID-19 patients. Although there is no recommended dose of vitamin D and C for COVID-19, maintaining optimum plasma concentration of vitamin D (100-150 nmol/L) and vitamin C (60-80 μmol/L) may prove beneficial. Doses of 50-125μg/day of vitamin D3 and 2-3g/day of vitamin C have proven effective in maintaining this optimum plasma concentration in COVID-19. Conclusions: Together these studies suggest that high dose supplementation of vitamin D and C to maintain optimum plasma concentration have shown better outcome, reduced risk of progression and fatality even in severe cases of COVID-19.
Ureterocele in an Adult Male Nigerian: a Case Report
Ureterocele is one of the congenital anomalies that affect the genitourinary system. This anomaly is usually present in the early stage of life and can be detected if there is high index of suspicion and proper evaluation. This case presentation is to highlight the unusual presentation of ureterocele in an adult Black male, with frequent micturition and dysuria. There is characteristic radiological sign of 'cobra head' appearance on intravenous urography. This case report highlighted the late presentation of ureterocele, the necessity to make use of available imaging diagnostic modalities inlimited resource settings, and to add to the existing body of knowledge. The patient was investigated using sonogram and intravenous urography. The urologist operated the patient by excision of the ureterocele and placement of a stent for a week after which the stent was removed andthere was no post-surgical complication. He is being follow up in the Urologic clinic of the center and has been doing well with the resolution of the symptoms.
A Case Report of Isolated Vulvar Neurofibroma Radiologically suggested to be a Lipoma
Neurofibroma is a benign tumor of peripheral nervous system, which can occur in isolation or be a component of neurofibromatosis type 1. It can occur in any part of the body (except brain and spinal cord) but rarely seen in the female genital areas where, if it ever occurs, the labia are the most frequent site. We report a case of a 46yr old P0 married woman who presented with a 4 year history of an isolated, slowly growing right sided vulval mass. There were no urogenital or other systemic symptoms. She had no features of neurofibromatosis type 1. She had successful excision biopsy with histologic diagnosis of neurofibroma. The patient had good outcome and is still on follow up. Neurofibroma of the vulva is rare and may mimic other soft tissue tumours when in solitary occurrence. Excision biopsy, histological diagnosis and keen follow-up are strongly recommended.
Tuberculosis Register Audit: a Comparison of TB Clinic, Niger Delta University Teaching Hospital and Tuberculosis and Leprosy Hospital, Bayelsa State, South-South, Nigeria.
Background: Good documentation and completeness in medical record is an important aspect in realizing patient safety and implementation of healthcare services. In order to ensure that Tuberculosis data generated in health facilities are of high quality, there is a need for routine monitoring and periodic audit. However, there is dearth of research work that audited the quality of Tuberculosis data generated in health facilities in South South, Nigeria. Therefore this study is aimed at carrying out audit and comparing Tuberculosis data generated in two health facilities in Bayelsa State, South South, Nigeria. Methods: This was a health institutions-based retrospective study on the audit of Tuberculosis patients data generated in the Niger Delta University Teaching Hospital and the Tuberculosis and Leprosy Referral Hospital between January, 2016-December, 2019. The information for the study was collected from the Tuberculosis suspects and laboratory registers. Data were analyzed with Statistical Programme for Social Sciences version 20 (SPSS) software. The level of significance was set at P<0.05. Results: A total of 1369 patients,601 patients from the Niger Delta University Teaching Hospital and 768 patients from the Tuberculosis and Leprosy Referral Hospital had their data audited. The Tuberculosis data was more complete in the Niger Delta University Teaching Hospital than the Tuberculosis and Leprosy Referral Hospital notably for gender (98.5 % vs 94.4%; p<0.001, age (98.5% vs 97.3%;p<0.12) and HIV status(98.6% vs 96.5% ; p<0.71) but the Tuberculosis and Leprosy Referral Hospital had more complete Gene Xpert data (98.3% vs 94.3%;p< 0.001). Conclusion: Tuberculosis data generated in the two healthcare institutions was incomplete. The finding of this Tuberculosis data audit highlights the need for best practice to be adopted to ensure quality healthcare data.
Case Reporting for Neonatal Tetanus Surveillance and Practices Influencing Neonatal Tetanus Incidence in Bayel
Background: Neonatal tetanus is a preventable disease that remains a disturbing cause of neonatal morbidity and mortality in low-income countries where maternal and child care is still poor. This study assessed case reporting for neonatal tetanus surveillance and factors influencing disease occurrence in Bayelsa state of Nigeria. Methods: This was a retrospective review of all cases of neonatal tetanus managed in Niger Delta University Teaching Hospital Okolobiri (NDUTH) and Federal Medical Centre Yenagoa (FMC) over a five-year period. Relevant data were extracted from the case files at the hospitals and the cases were traced within the existing neonatal tetanus surveillance system. Results: Forty-eight cases were managed in both facilities (36/75.0% in NDUTH and 12/25.0% in FMC) in the period under review but only 13 cases (27.1%) were reported to the office of the State Epidemiologist. The mean age of cases was 8.98 days (SD = 5.1days); 29 (60.4%) were male while 19 (39.6%) were female. Only 2.1% of the cases were protected at birth and 55.3% of them had their cord treated inappropriately. Most of the mothers (54.2%) had primary education, 8.3% had antenatal care, and all were delivered by traditional birth attendants. Conclusion: There was an under reporting of cases of neonatal tetanus in the state. Inadequate/lack of immunization of women against tetanus and patronage of unskilled birth attendants seemed to drive the incidence of the disease. There is a need to strengthen neonatal tetanus surveillance, improve tetanus vaccination for women of reproductive age, and encourage skilled birth attendance in Bayelsa state.
Dysmenorrhea among Female Medical Students of Bayero University Kano
Background: Dysmenorrhea is the occurrence of painful menstruation of sufficient magnitude so as to incapacitate day-to-day activities and may require medication. It is one of the common complaints and often debilitating condition that affect women of reproductive age worldwide. This study was conducted to determine the prevalence of dysmenorrhea among female medical students of Bayero university, Kano as well as to determine the socio-demographic characteristics and self-management strategies of dysmenorrhea employed by the female medical students. Methods: It was a cross sectional study conducted among female medical students of Bayero University Kano. Aself-administered questionnaire was used in extracting the data. Researcher met with students at their free time in the university hostels. The weight of each student was taken by an electronic personal scale CAMRY MODEL: EB9360 CERTIFIED BY SGS with maximum capacity of 150 kg. A pre-marked wall centimeter measurement was used to take the height of the students from the head to the heel. Results: Two hundred and seventeen (217) medical students were interviewed of which majority of the respondents 75.6% reported dysmenorrhea. The mean age of the respondents was 21.2 ± 2.29 years. The average age at menarche was 12.8 ± 1.12 years. Most respondents 92.1% were single, 81.6% of the respondents experienced regular menses while 54.8% of respondents had duration of menstrual flow between 6-8 days. Conclusion: Dysmenorrhea is a major cause of monthly discomfort among female medical students in Bayero University Kano, often associated with fatigue and nervousness.
Prevalence of Prolonged QRS Duration and Associated Factors among Heart Failure Patients in a Tertiary Healthcare Facility in Bayelsa State
Background: Prolonged QRS duration, low ejection fraction and low NYHA class are all independent poor prognostic indices in patients with heart failure. We assessed the prevalence of prolonged QRS duration and it's relationship with ejection fraction and NYHA class, among patients with heart failure at Niger Delta University Teaching Hospital, Okolobiri, Nigeria. Methods: Eighty three patients diagnosed with heart failure were recruited consecutively. NYHA class was determined at presentation. Electrocardiography and echocardiography were done to determine the QRS duration and ejection fraction respectively. Results: The prevalence of prolonged QRS was 33.7%. Most of the participants had QRS duration less than 120ms (66.3%), were classified as NYHA class 4 (48.2%) and had a diagnosis of hypertensive heart disease (57.8%). Sixty two patients (74.7%) had ejection fraction <45%. 2 Ejection fraction showed a statistically significant relationship with prolonged QRS duration (X = 10.55; p – 0.001). Other factors such as age, sex, NYHA classification, BMI and blood pressure were not significantly related to prolonged QRS duration in this population. Conclusion: Over a third of patients in heart failure had QRS prolongation and there was a significant relationship between prolonged QRS duration and systolic dysfunction. Given these findings, appropriate screening of patients with heart failure is suggested to detect QRS prolongation and other ECG abnormalities, in order to adequately intervene and reduce risks of cardiovascular mortality.
Third-Party Assisted Reproduction: Awareness and Acceptability among Women Attending Infertility Clinic in a Hospital in Northern Nigeria
Background: Third-party assisted reproduction refers to assisted reproductive technique in which there is biological involvement or contribution from a person other than the individual or couple that plans to raise the child (intended parent[s]) in the process of reproduction. It includes the use of donated ova, sperm, or embryos (or their components) and gestational-carrier arrangements, in which the pregnancy is carried by someone other than the intended parent(s). Objectives: To determine the awareness and acceptability of third-party assisted reproduction among women attending Ahmadu Bello University Teaching Hospital infertility clinic and to identify concerns which may hinder utilization of these services. Methods: This is a cross-sectional study conducted among infertile women using an interviewer administered, structured questionnaire. The result was analyzed using SPSS version 20 and presented using Microsoft Excel 2017. Result: A total of 274 women were interviewed and 189 (69%) of the respondents were aware of at least a method of third party reproduction. The majority (95.8 %) of them were aware of gamete donation followed by surrogacy (86.2%). On the contrary the acceptability was highest for surrogacy (36.5%) and lowest for gamete donation (15.9%). The reasons given for this low acceptability included: religious beliefs, the process seeming unnatural, ineffective and even harmful. Despite these, the respondents expressed that confidentiality would improve the acceptability of these services. Conclusion: The study revealed a high disparity between awareness and acceptability of the various methods of TPR that will be interesting to explore in future studies.
Review of Pattern of Cervical Smear Cytology in a North Central Nigerian Tertiary Hospital
Background: Cancer of the cervix is the second most common cancer in women and the commonest genital tract cancer in women. Cervical smear cytology is a secondary preventive measure that is underutilised in this environment resulting to avoidable morbidity and mortality in third world countries. Objectives: The study was aimed at determining the pattern of cytology of cervical smears done in National Hospital Abuja. Methods: A retrospective cross-sectional descriptive study of all cervical (Papanicolaou) smears done in National Hospital Abuja in 2012 and 2013. Data was analysed with Microsoft Excel 2013. Results: During the study period, 860 cervical smears were done, 799 (92.9%) of the smears were satisfactory, 710 (88.9%)of the satisfactory smearswere reported as negative for intraepithelial lesion and malignancy while 79 (9.9%) had varying degrees of epithelial cell abnormalities. Non-specific inflammatory changes were recorded in9 (1.1%) cases while1(0.1%) showed squamous cell carcinoma. Atypical squamous cells of undetermined significance(ASCUS) was the predominant epithelial cell abnormality, contributing 58.7% of the abnormal smears. The mean patient age was 43.2±17years. Conclusion: The predominant epithelial cell abnormality in this study was ASCUSwith a good number of patients presenting late for screening. Public enlightenment and empowerment of women is needed to enable at risk individuals avail themselves of this important preventive measure.
Pattern of Socio-Demographic and Reproductive Profile of Patients Attending the Infertility Clinic of Ahmadu Bello University Teaching Hospital, Zaria
Background: Infertility is a growing universal problem cutting across all cultures and societies all over the world and has tremendous impact on the quality of life of women and their psychological well-being. In Nigeria and most parts of the sub-Saharan Africa, so much premium is placed on child birth. While infertility is not actually a life-threatening disorder, it has negative social and mental consequences on the couples. Objective: To determine the pattern of socio-demographic and reproductive profile of patients attending the infertility clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Method: This was a cross-sectional study that was conducted to determine the pattern of socio-demographic and reproductive profile of patients with infertility using a structured questionnaire.The respondents were recruited from the infertility clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria between August and October 2018. The data was analyzed using SPSS 20 version. Result: The ages of the respondents ranged from 18 to 49 years of which 39% of them were between 26-33 years with a mean age of 29.2 years (SD: ± 2 years). Over 80% of respondents were married in a monogamous family setting while 18.4% were in a polygamous family setting and majority (91.2%) were in their first order of marriage while 7.8% were in their second and third order of marriage. Fifty-four percent of respondents had tertiary level of education and 43% of respondents were unemployed. Majority (56.9%) of the women in this study had secondary infertility while primary infertility accounted for 43.1%. Conclusion: In this study, the age at which most patients presented with infertility was found to be above the age of maximum fecundability. Also, secondary infertility was found to be commoner than primary infertility. In view of these, public health programs need to incorporate infertility as an integral part of Reproductive Health Services.
Fertility Awareness-Based Contraception: Knowledge and Attitudes Among Nigerian Gynaecologists
Background: The under use of effective contraceptive methods among women at risk for unintended pregnancy is a major factor contributing to its high rate in Nigeria. Fertility Awareness-Based contraception are preferable alternatives for family planning by some due to its lack of side effects, and for religious and cultural reasons. They can play an important role in reducing unintended pregnancy rate in Nigeria. Despite its inclusion in the national family planning guidelines, there is limited awareness of the modern effective methods among clients. Since gynecologists play a pivotal role in information dissemination and provision of family planning methods, we sought to assess their knowledge and attitude to fertility awareness-based methods. Methods: A structured questionnaire was administered to Nigerian gynaecologists after an oral informed consent. Data analysis was with descriptive statistics using SPSS v. 20. Results: The age range of the respondents was 31-68 years, with a mean of 44.2 +/- 9.2 SD. The female respondents and those aged less than 50 years were 16 (14.5%) and 76 (69.1%) respectively. Billings Ovulation (78, 70.9%) and Calendar Rhythm (72, 65.5%) were the commonest methods provided by the respondents. However, 78 (70.9%) of them believed that they were less effective than conventional contraceptives because their efficacy depends on cooperation of a partner (84, 76.4%) and on following the rules of the method (94, 85.5%). Conclusion: The commonest fertility awareness-based contraception provided by Nigerian gynaecologists are the Billings Ovulation and Calendar Rhythm though they do not believe in their efficacy, because of their dependence on partners' cooperation.
The Use of Herbal Medicines for fertility Treatment amongst Attendees of an Infertility Clinic in a Tertiary Hospital
Background: Desperation and resort to unorthodox means to achieve pregnancy is common in developing societies where resources are limited and the blame for infertility is mainly on the woman. This study seeks to document the prevalence and factors associated with herbal medicine use among women seeking medical treatment for infertility. Methods: A cross-sectional descriptive study was conducted using data from 171 consenting infertile women attending the infertility clinic at a University Teaching Hospital. The survey instrument was a semi-structured self-administered questionnaire designed to evaluate socio-demographic and clinical characteristics with questions concerning the use of herbal medicines and associated factors Results: Overall 105(61.4%) women had used herbal/traditional medicine for the treatment of infertility.Majority (73.3%) took the drug orally. About 50% of the participants reported that herbal medications were not safe for use. Majority, 90.5% of participants did not disclose to their health care provider. The level of education and duration of infertility were found to significantly influence the use of herbal medicines (p< 0.05). Conclusion: The high prevalence of herbal medicine use in this study reflects a strong negative socio-cultural influence on women's reproductive health decisions. Women with low education status and longer duration of infertility are more vulnerable to these influencers. Public enlightenment on the fallacy of the potency of these herbal medications with a view to propagating more appropriate and effective medical treatment is recommended.
Antepartum Haemorrhage at the Delta State University Teaching Hospital, Oghara: A 3 year review
Background: Antepartum haemorrhage and remains one of the dreaded complications in obstetrics due to its adverse maternal and perinatal outcome. Prompt detection and appropriate treatment of antepartum haemorrhage would however reduce significantly morbidity and mortality associated with it. This study was conceptualized to document the incidence, clinical risk factors, aetiology, and the fetomaternal outcomes of pregnancies complicated by antepartum haemorrhage in Delta State University Teaching Hospital, Oghara. Methods: This was a three year retrospective descriptive study of 57 women managed for antepartum haemorrhage at the Delta State University Teaching Hospital, between January 2011 and December 2013. The data was analyzed using statistical package for the Social Sciences (SPSS) version 19. Results: The incidence of antepartum haemorrhage was 6.02%, of which placenta praevia and abruptio placenta were 3.27% and 2.11% respectively. Placenta praevia was the commonest (54.4%) cause of antepartum haemorrhage. The mean gestational age at delivery was 34.9 ± 3.3 weeks. Caesarean section rate was 80.7% and the commonest fetal outcome was prematurity. Statistically significant association was found between antepartum haemorrhage and previous caesarean section, low birth weight, and birth asphyxia. There was statistically significant association between abruptio placenta and hypovolaemic shock, and more women with placenta praevia had malpresentation. Conclusion: Antepartum haemorrhage has a high incidence in this study with placenta praevia as the commonest cause. Antepartum haemorrhage remains a major cause of poor fetomaternal outcome. Concerted efforts must be made to identify those at risk as well as early referral to higher health care centres for appropriate care.
Case Report of Interstitial Ectopic Pregnancy Presenting with Ultrasound Diagnosis of Normal Intrauterine Pregnancy
Background: Interstitial ectopic pregnancy implants in the proximal intramural portion of the fallopian tube. It could rupture with associated massive hemoperitoneum which is life threatening. Diagnosis is usually made by ultrasound scan although this can be misinterpreted as intrauterine pregnancy. We report a case of interstitial ectopic gestation which was not diagnosed by ultrasound scan but had laparotomy with metroplasty following clinical diagnosis. Case presentation: A 32 year old woman who presented with abdominal pain following 16 weeks of amenorrhoea. She also presented with an ultrasound report of a viable pregnancy at 16 weeks and 2 days gestation with associated haemoperitoneum. A clinical assessment of ruptured ectopic gestation was made and she had left salpingectomy with metroplasty. The postoperative period was unremarkable and she was stable on follow up. Conclusion: Interstitial pregnancy which is a rare type of ectopic gestation could be a diagnostic challenge. Its rupture could be associated with massive blood loss and treatment is surgical.
A Seven- year Review of Uterine Rupture at a Tertiary Health Facility in Port Harcourt, Nigeria
Background: Uterine rupture is a dire obstetric catastrophe commonly encountered in developing countries. Objective: This study was carried out to assess the fetal and maternal outcomes of ruptured uterus at the University of Port Harcourt Teaching Hospital over a seven-year period and to make recommendations at improving outcome. Methods: This was a retrospective hospital-based study in which the case les of patients who had ruptured uterus within the study period were retrieved and relevant information extracted for analysis. Chi square was used to compare discrete variables and p value < 0.05 was regarded as signicant. Results: The prevalence of uterine rupture was 1.56%. The mean age and parity were 30.5+ 4.5 years and 3.5+ 2.6 respectively. One hundred and twenty cases (73.8%) were associated with scarred uterus and 50.6% occurred following induction of labour especially by unskilled personnel Anaemia, febrile illness and wound sepsis were the most common post-operative complications and these were significantly associated with unbooked status. The perinatal mortality rate was 839.3/1000 total births and babies of unbooked mothers were about seven times more likely to die than babies of booked mothers (Odds ratio = 6.75) Conclusion: Uterine rupture is essentially a disease of the unbooked patient and is associated withscarred uterus and induction of labour. Uterine rupture is linked with high fetal wastage especially among the unbooked patients. Making antenatal care easily accessible to all pregnant women and specialist care during pregnancy and labour especially in high risk patients may improve outcome.
Patterns of Cervical Cytology Screening Outcomes among Premenopausal Women Attending University of Benin Teaching Hospital Benin-City, Nigeria
Background: This study is aimed at determining the patterns of cervical cytology screening outcomes among women of childbearing age attending tertiary health institution in Nigeria. Methods: This study reviewed the cytology register of over 1742 female patients aged 18 to 45 years attending various clinics in University of Benin Teaching Hospital from 1st January 2013 to 31st December 2016. During screening a sterile speculum was placed in the vagina and a rovers® cervex brush introduced through the vagina to the cervix. The central bristles of the rovers® cervex brush was inserted into the endo-cervical canal. Maintaining gentle pressure, it was rotated ve times in a clockwise direction. The rovers® cervex brush head was detached and placed in the preservative vial containing xative. This along with the request form was sent to the cytology laboratory. Result: A total of 1742 patients were screened for cervical lesions, the outcomes include 1342(77%) negative for intraepithelial lesion or malignancy (NILM), 231(13%) acute cervicitis, 55(3%) chronic cervicitis, 14(1%) atypical squamous cells of undetermined significance, 32(2%) low grade squamous intraepithelial lesion (LSIL) and 7(0.4%) high grade squamous intraepithelial lesion (HSIL). Conclusions: Majority of the outcome of cervical cancer screening cases are actually negative for intraepithelial lesions or malignancy with significant number of cervicitis and premalignant lesions.
An Audit of Active Management of Third Stage of Labour in a Tertiary Hospital
Background: Postpartum haemorrhage is a potentially life-threatening, but preventable condition which is the leading cause of maternal mortality globally. Active management of third stage of labour, has been found to be a useful intervention in the prevention of primary postpartum haemorrhage. However, the recent modication in the traditional Active management of third stage of labour by Royal College of Obstetricians and Gynaecologist, guideline would necessitate the auditing of our Active management of third stage of labour and postpartum haemorrhage in this centre. Aim:To determine the effectiveness of Active management of third stage of labour in prevention of postpartum hemorrhage in Aminu Kano Teaching Hospital, Kano . Methods: This is a two-year retrospective descriptive study done at Aminu Kano Teaching Hospital, Kano. Records of patients who delivered in this hospital, those that had AMTSL and those that had PPH were retrieved from the labour ward delivery record book. Patients' case les were retrieved, studied and recorded in a proforma. These were compared with the criteria obtained from the Royal College of Obstetricians and Gynaecologist guidelines. Data collected was fed into the computer and analyzed using SPSS Statistics version 19 software. Results: During the study period, there were 4,827 clients that had vaginal delivery with active management of third stage of labour. One hundred and seven of them had postpartum hemorrhage, thus giving an incidence of 2.2%. Among the 107 cases, only 84 (78.5%) case notes could be retrieved from the medical records department and the labour ward register and these were the ones analyzed. Twenty-three (21.5%) case note could not be retrieved. Among the 84 women whose case records were retrieved, the mean age of the subjects was 32 years S.D +/-1.3 years. The most common risk factor for Post-partum haemorrhage is Abruptio placentae (53.3%). Administration of oxytocin and Controlled cord traction achieved standard for prevention of postpartum haemorrhage (95.2%). Conclusion: This audit shows that Active management of third stage of labour by the use of oxytocics immediately after delivery and Controlled cord traction remain as effective as the recent World Health Organization revised Active Management of third stage of labour which involved use of oxytocics alone, in the prevention of postpartum haemorrhage.