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   Table of Contents - Current issue
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May-August 2018
Volume 12 | Issue 2
Page Nos. 53-104

Online since Tuesday, January 15, 2019

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ORIGINAL ARTICLES  

Determinants of self-rated oral health among undergraduate students in Port Harcourt, Rivers State, Nigeria p. 53
Modupeoluwa Omotunde Soroye, Babatope Bamidele Osagbemiro, Elfleda A Aikins, Grace O Alade
DOI:10.4103/phmj.phmj_14_18  
Background: Self-rated oral health is a useful and essential indicator of overall oral health status which has an impact on general well-being and quality of life. No study on the perception of oral health has been conducted among young adults in Port Harcourt. Thus, this study investigated whether sociodemographic factors and oral health practices were associated with self-reported oral health status in a young population in Port Harcourt. Methods: A cross-sectional survey conducted among young undergraduate students in the University of Port Harcourt, Rivers State. Data were collected using pre-tested self-administered questionnaires and analysed using the Statistical Package for Social Sciences version 21.0. Results: There were 120 respondents, all within 16–34 years old, with the mean age of 21.7 ± 3.8 years. More females 61 (50.8%) than males 59 (49.2%). A total of 5 (4.2%) are married and 66 (55%) were in health sciences. Out of 42 (35.0%) of the respondents that had utilised dental service in the past; complaints of a toothache accounted for 52.4%. The percentages of participants that rated their oral health as excellent, good, fair and poor were 20.8%, 58.4%, 16.7% and 4.2%, respectively. Sociodemographics factors, such as age, gender, course of study, level of study and monthly allowance were significantly associated with self-rated oral health (P < 0.05). Oral health practices for example, previous dental visit, type of toothbrush used and frequency of tooth brushing were also significantly associated with perceived oral health. Conclusions: The perceived high oral health status of participants was influenced by sociodemographic factors and oral health practices. However, there is poor utilisation of dental services among the students.
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Survival outcomes of advanced breast cancer patients treated with palliative external beam radiotherapy in the University College Hospital, Ibadan p. 58
Hassan Ibrahim, Usman Bello
DOI:10.4103/phmj.phmj_13_18  
Background: Numerous randomised controlled trials had proven the effectiveness of palliative external beam radiotherapy (PRT) in symptom relief and improvement in the quality of life for patients with either locally advanced or metastatic breast cancer. However, reports on patient survival after PRT treatment are limited and disease site specific. The aim of this study is to find the effect of metastatic sites and the impact of dose fractionation schemes on the survival of breast cancer patients after PRT treatment. Methods: We retrospectively reviewed patients' data with both locally advanced and metastatic breast cancers that were treated with palliative radiotherapy between 2005 and 2009. Radiotherapy doses ranging between 5 and 35 Gy/2.5 and 8 Gy per fraction were used for the treatment. Patients' survivals were evaluated using Kaplan–Meier method and Cox hazard ratio. Actuarial survival rates were also conducted for 1, 2 and 3 years after PRT. Results: Five hundred and eighty-four patients were eligible during the study period. Their mean age was 45.9 years. Only 0.7% were males. More than two-thirds of the patients (72.1%) presented with metastatic disease and 34.9% of them had multiple sites of metastasis. The most common prescribed radiation doses and their fractionation numbers ranged between 13 and 28 Gy in 4–9 fractions. Visceral sites of metastasis were significantly associated with poor survival, and treatment with longer radiation courses (≥21 Gy/≥7#) has a significant survival advantage. An actuarial survival rate of 85% of patients was observed beyond 1st year after PRT. Conclusion: Sites of metastasis have a significant impact on survivals of breast cancer patients, with better survivals among patients with bone and soft-tissue locations compared to those located in the visceral organs. PRT treatment with longer dose fractionation schemes has a significant survival benefit in advanced breast cancer patients.
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Molecular detection of sputum Mycobacterium tuberculosis/rifampicin resistance among presumptive pulmonary tuberculosis cases in Borno state, North-Eastern Nigeria p. 64
Ballah Akawu Denue, Wamanyi Jackson Miyanacha, Zara Wudiri, Mohammed Bashir Alkali, Baba Waru Goni, Cecilia Balla Akawu
DOI:10.4103/phmj.phmj_11_18  
Background: Drug resistance to anti-tuberculosis (anti-TB) medication and human immunodeficiency virus (HIV) infection undermines global control of TB. Aim: The aim of this study is to determine sputum mycobacteria/rifampicin resistance obtained from Xpert MTB/RIF molecular assay in five health facilities in Borno state. Methods: Records of 5518 presumptive TB cases that presented for care from September 2014 to December 2017 were retrieved from TB registers in this multicentre descriptive study. Results: A total of 5518 pulmonary TB presumptive cases, out of which 5484 were drug-sensitive TB (DSTB) and 34 drug-resistant TB (DRTB). The MTB detection rate was 19.1% and it was higher among DRTB with rate of 41.2% than DSTB of 19.0%. The prevalence of rifampicin resistance was 6.1%, with higher preponderance rate of 78.6% among DRTB cases than 5.1% among DSTB cases. Only 2566 (46.5%) had HIV counselling and testing. The MTB detection rate of 22.1% in HIV-negative patients was significantly higher than 16.5% in HIV patients, P = 0.001, 95% confidence interval (CI) = 2.27–8.93. Conversely, RIF resistance of 7.0% obtained in HIV patients was significantly higher than 4.8% in HIV-negative patients, P = 0.03, 95% CI = 0.06–4.34. Previous TB treatment was significantly associated with RIF resistance, P = 0.000, odd ratio = 1318.1, 95% CI = 302.1–6318.3. Conclusion: GeneXpert is a valuable tool for the detection of both MTB and RIF resistance. It is therefore useful for both management and TB infection prevention and control. Given the observed strong association between previous exposure to anti-TB medication and RIF resistance in this report, we advocate mandatory resistance test for TB patients with previous exposure to TB medication in addition to good adherence to TB medication.
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Association between body mass index and hearing acuity among adults in a rural community: A preliminary survey p. 70
Abdulazeez Ahmed, Salisu I Ahmed
DOI:10.4103/phmj.phmj_10_18  
Background: The impact of adult nutrition on hearing acuity is poorly researched. This study was designed to examine relationship between nutritional status (using body mass index [BMI]) and hearing impairment. Methods: Data from the Bayero University Ear and Hearing Health Examination Survey 2017 were used. This was a community-based, cross-sectional descriptive survey of a sample of Tofa community in Kano State. Out of 650 participants, only 103 fulfilled the criteria designed for this study. Pure tone audiometric testing was performed to assess for hearing impairment. Analysis was conducted for associations between hearing impairment and BMI. Results: Prevalence of hearing impairment among adults in this population is 26.2%. Mean documented age of the participants was 41.6 years (standard deviation: ±18.55). Majority of the participants had low BMI, signifying underweight (n = 89; 86.4%) out of which 21 (23.5%) had a moderate-to-profound hearing loss. Conclusion: These findings provide some evidence that adults with a low BMI (underweight) may also be at a risk of hearing impairment; however, more research is required. Adult malnutrition also deserves more attention.
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Insidious chronic kidney disease among elderly people in the University of Port Harcourt Teaching Hospital p. 76
Ochuko Otokunefor, Adekemi Kiyesi
DOI:10.4103/phmj.phmj_8_18  
Background: Renal function reduces with age. The early stages of chronic kidney disease (CKD) often go unnoticed, preventing timely intervention and thereby increasing morbidity and mortality. It is, therefore, imperative to assess the renal clearance which detects the early stages of kidney disease. Aim: This study aimed to assess the glomerular filtration rate (GFR) in elderly people in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria, using the Cockcroft–Gault formula, and to evaluate the associated risk factors. Methods: This is a descriptive cross-sectional study. Participants were recruited from the Orthopaedic Clinic of the UPTH. Fifty patients aged between 60 and 85 years were recruited. Venous blood was obtained for creatinine assessment; weight, height and resting blood pressure measurements were taken and the body mass index and creatinine clearance were calculated. Microsoft Excel and SPSS software version 18 were used for the statistical analysis. Pearson's correlation was used to assess statistical significance with P = 0.05. Results: There were 17 males and 33 females. Fourteen percent of the total patients had Stage 3 CKD (GFR: 30–59) and just half of the patients (14%) had a plasma creatinine value above the reference range. Ninety percent of the patients were overweight, 10% were obese and 51% were hypertensive. There was a weak but insignificant positive correlation between obesity, hypertension and kidney dysfunction. There was no obvious clinical feature among those with Stage 3 CKD, a stage when critical medical decisions need to be made. Conclusions: Most patients had different degrees of renal impairment with normal plasma creatinine values. Routine renal function assessment and estimated GFR should be done for any elderly person presenting to the hospital with at least one cardiovascular risk.
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Determinants of the age at sexual debut among adolescents in secondary schools in Obio/Akpor local government area of Rivers State, Nigeria p. 81
Nneka Gabriel-Job, Eme Olukemi Asuquo, David Ibidabo Alabere
DOI:10.4103/phmj.phmj_7_18  
Background: The age at sexual debut is an important public health issue as it determines the onset of exposure to sexual and reproductive health diseases. Early sexual debut increases the risk of sexually transmitted infections, HIV/AIDS, teenage pregnancy and all the associated sequelae. This study determined the age at sexual debut and associated factors among adolescents in secondary schools in Obio/Akpor local government area (LGA) of Rivers State, Nigeria. Methods: A descriptive cross-sectional school-based study was carried out among eight secondary schools in Obio/Akpor LGA of Rivers State between May and July 2017. Using the multistaged sampling method, 426 students aged 10–19 years were recruited. A semi-structured pretested self-administered questionnaire was used. SPSS version 20 was used for analysis. Comparison of means was done using the Student's t-test, while the test for association between subgroups was carried out using the Chi-square test and logistic regression analysis was done to describe the sociodemographic characteristics of respondents and to identify independently associated factors. Results: Of the 426 students studied, 223 (52.3%) of them were males and 203 (47.7%) were females, giving a male-to-female ratio of 1:1. The mean age of respondents was 13.8 ± 1.7 years. The prevalence of sexual intercourse was 8.0%, with a mean age at sexual debut of 13.0 ± 2.3 years. The factors identified to influence the age at sexual debut include alcohol use (odds ratio [OR]: 13.088, confidence interval [CI]: 6.038–28.374, P = 0.000), not living with both parents (OR: 7.008, CI: 3.289–15.164, P = 0.000), peer pressure (χ[2] = 17.007, P ≤ 0.001) and sexual abuse (χ[2] = 7.472, P = 0.006). Conclusion: The prevalence of sexual intercourse is 8.0% among adolescents in Obio/Akpor LGA. Early sexual debut exists with no gender difference on the timing of sexual debut. Peer pressure, sexual abuse, alcohol use and absence of both parents in a child's life are risk factors to early sexual debut. An early and comprehensive sex education is necessary to protect children from initiating sexual intercourse early in life.
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Dental care demands and treatment needs among patients attending a rural private dental clinic in Northeast Nigeria p. 88
Babatunde Oludare Fakuade, Olufemi Gbenga Omitola
DOI:10.4103/phmj.phmj_34_17  
Background: Meeting dental care demands in poor-resource area is a challenge, both regarding personnel and facilities, patients in rural area travel long distances to access few available clinics where sometimes treatment options are limited. Aim: The aim of this study is to determine the pattern of presentation and demand for oral health services among patients attending a private dental clinic in Gombe, North East Nigeria. Methods: A retrospective review of all patients seen in the company clinic (Ashaka cement) over a 3-month period (August-October 2014) was done, information extracted from case notes were age, sex, primary diagnosis and treatment. Data were analysed using SPSS version 20 Summary statistics (percentage and frequency) were performed. Relationship between variables was checked with Chi-square test. Results: A total of 122 patients were seen, 65 males (53.3%) and 57 females (46.7%) with a sex ratio of 1:0.9, total mean age was 15.7 years (range 3–59 years). 41–50 years was the majority group and 51–60 years was the age group in the minority. The most common diagnoses were dental caries, chronic gingivitis and chronic periodontitis while treatment commonly received were extraction, scaling and polishing and treatment filling. Conclusion: Dental care demand of patients in this study was as a result of dental caries, chronic gingivitis and chronic periodontitis and treatment done were mainly extractions, scaling and polishing. Access to dental care in rural setting can be improved if government open more dental clinics in these areas and make personnel available.
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Needs analysis for maxillofacial surgery-specific operating rooms at the University of Port Harcourt Teaching Hospital, Nigeria p. 93
Bisola O.I Onajin-Obembe, Babatunde O Akinbami
DOI:10.4103/phmj.phmj_1_16  
Background: Acquiring experience and surgical skills in maxillofacial surgery and anaesthesia depend on an optimal case volume and case mix. The more opportunities available for hands-on participation in various surgical operations, the better for the maxillofacial surgical team. Building and equipping operating rooms (ORs) are high-cost intensive projects. The aim of this study was to find if the current operative case mix and volume justifies capital investment in maxillofacial surgery-specific ORs. Methods: This is a descriptive, nonexperimental quantitative research. We reviewed the maxillofacial OR records from November 2008 to December 2013. Data collected from the maxillofacial theatre records were incorporated into an SPSS v 22 spreadsheet and analysed. The OR utilisation time was computed. The analysis was performed to guide managerial and investment decisions. Results: A total of 175 maxillofacial operative cases reviewed from a period of 62 months gave a rate of 2.8 cases per month. More males 90 (51.4%) than females 85 (48.6%) were operated on. Of the 236 operating days, 129 days (54.7%) were utilised. Major and major/smile-train operations formed 73.7% of all operations performed. All operations started after 10 am. Conclusion: The maxillofacial case volume and output do not justify the need for capital investment into building surgery-specific ORs. However, there is a need to improve OR management and put in place strategies that will optimise the present facility.
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A 6-year review of neonatal emergencies and outcome in a secondary health-care centre in Benin City, Nigeria p. 98
Blessing Imuetinyan Abhulimhen-Iyoha, Imuwahen Anthonia Mbarie
DOI:10.4103/phmj.phmj_37_17  
Background: An important indicator of quality health care is neonatal outcome. Few published data are available concerning neonatal emergencies and their outcome from secondary health centres, where a large number of newborns are seen. Aim: To evaluate the neonatal emergencies, their outcome and case fatality rates (CFRs) as well as the trend of annual mortality rate in the neonatal unit (NNU) of a secondary health facility. Methods: This retrospective study which covered a period of six years (July 2008 – June 2014) was carried out at Stella Obasanjo Hospital (SOH), a state-owned general hospital in Benin City, Edo State, Nigeria. It involved the extraction of information on patient's age, sex, diagnosis, duration of hospital stay and outcome from the medical records of the neonatal unit. Results: There were 2,302 newborns admitted; out of which 1,283 (55.7%) were males, while 1,019 (44.3%) were females; male: female ratio of 1.3:1. The major emergencies were neonatal sepsis [NNS] (61.9%), severe birth asphyxia [SBA] (40.9%), neonatal jaundice [NNJ] (24.5%) and prematurity (16.4%) occurring singly or in various combinations. Mortality rate was 12.8% with major contributions from NNS, SBA and prematurity. Majority (93.6%) of the deaths occurred in the first week of life. Extremely low birth weight (ELBW) babies, neonatal tetanus (NNT) and meconium aspiration syndrome (MAS) had the highest CFRs of 52.6%, 38.7%, and 23.5%, respectively. There was a downward trend in the annual mortality rates. Significant predictors of mortality were NNJ (p=0.000), SBA (p=0.002), NNT (p=0.000), MAS (p=0.002), prematurity (p=0.000) and ELBW (p=0.000). Conclusion: The emergencies noted among the newborns were mainly from preventable causes. These were also the main causes of mortality. To improve our health indices, we must educate mothers at the community level on common neonatal emergencies and proven preventive measures, while strengthening our obstetric and perinatal care services.
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