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REVIEW ARTICLE
The unending threat of Lassa fever in Nigeria, what can be done; what should be done
Ballah Akawu Denue, Mary Stephen, Isabelle Dauvoux
September-December 2017, 11(3):113-121
DOI:10.4103/phmj.phmj_20_17  
Background: Lassa fever is known to be endemic in West African region, and Nigeria bears the most burden of the disease and case fatalities. It is worrisome and disheartening for an emerging infectious disease such as Lassa fever, to linger for 49 years but surge in incidence in a country such as Nigeria, endowed with both human and natural resources. Methods: The sources of the information presented was obtained through detailed review of literatures using Medline, Ovid and PubMed (search terms Lassa fever, Arenaviridae and viral haemorrhagic fever), case analysis, and surveys undertaking from the field, and relevant websites (such as Nigeria Center for Disease Control, Nigerian Federal Ministry of Health, Centers for Disease Control and Prevention). Results: The possibility of a large outbreak in Nigeria and other sub-Saharan Countries characterised by dearth of laboratory facilities for prompt diagnosis and personal protective equipment (PPE) and its potential use as a biological weapon has also raised the profile of this disease. Health education of the communities, improved funding through budgetary allocation for surveillance, prompt case management including laboratory facilities, training of health personnel, isolation of cases, barrier nursing, contact tracing, provision of antiviral drugs and vaccines that is effective against this disease and supply of PPE is not only necessary but also expedient in the light of the threat due to Lassa fever. Conclusion: The weak health-care delivery system in Nigeria, would continue to impede effective control of emerging and re-emerging infectious diseases including Lassa fever. There is an urgent need to provide resources to effectively control and prevent Lassa fever.
  4,282 1,053 -
ORIGINAL ARTICLES
Assessment of workplace hazards in mortuaries in Port Harcourt, Nigeria
Kingsley E Douglas, SS Peterside
September-December 2016, 10(3):102-110
DOI:10.4103/0795-3038.197752  
Background: Mortuary workers face various hazards in course of carrying out their duties. These hazards may be ignored by employers and employees alike. Identifying these hazards in time before they become risks that cause accidents and even death is recognized mode of prevention and control. This study was to assess the workplace hazards in mortuaries located in Port Harcourt City Area. Methods: Following ethical approval, this descriptive cross-sectional study recruited 100 eligible respondents from private and public mortuaries, respectively, balloted for from six known and registered mortuaries in Port Harcourt city. Respondents answered pre-tested, close-ended, structured, self-administered questionnaires which probed sociodemographics, occupational history, knowledge and behaviour towards hazards encountered while at the workplace. There was also an adapted checklist used for the walk-through survey of the study sites' identification and quantification of hazards. Data obtained were analysed and presented using descriptive and analytical statistical tools. Results: The study had mostly male (95%) respondents with only 15% having acquired tertiary education. The majority (94%) of the hazards respondents were exposed to were mechanical slips, trips and falls. The majority (93%) of respondents had safety training on the hazards associated with the mortuary, while 11% used personal protective equipment (PPE) always. Conclusion: Hazards abound in mortuaries in Port Harcourt City even though most workers had received training on hazards and hazards prevention. There was also a poor use of PPE. It is recommended that health education, provision, enforcement and monitoring of the use of PPE be intensified among this group of workers.
  4,133 344 -
Uterine fibroids: Experience with 100 myomectomies in Orlu, South East Nigeria
VI Ndububa
September-December 2016, 10(3):124-129
DOI:10.4103/0795-3038.197753  
Background: Uterine fibroid, over the years, has remained a major gynaecological problem in Nigeria, and although various treatment modalities exist, abdominal myomectomy has remained the mainstay of treatment for those women who want to preserve their reproductive capacity. Most of them, however, present late when the fibroids are either huge or associated with complications. Aim: The aim of this study was to present experience with abdominal myomectomy vis-a-vis its outcome and also to show the symptoms at presentation. Methods: This is a study of the first hundred abdominal myomectomies carried out by the author in Imo State University Teaching Hospital and St. Damian's Catholic Mission Hospital both in Orlu, Imo state, Nigeria. The myomectomies were carried out between August 2007 and September 2013. Data were recorded in a pre-surgery-prepared pro forma administered by the author prospectively. The data were analysed using SPSS version 15 and the results presented in descriptive, tabular and graphical forms. Results: The age of the hundred women who had myomectomy ranged from 20 to 49 years. The most common symptoms these women presented with were menorrhagia (69%), abdominal mass (63%), dysmenorrhoea (33%) and infertility (33%). The sizes of the uterus on abdominal palpation ranged from not palpable (5%) to as much as 36 weeks gestation. The major myomectomy-associated complications in this study were blood transfusion rate of 86%, post-myomectomy pyrexia (44%), severe haemorrhage (25%) and post-myomectomy anaemia (24%). There was one mortality due to severe haemorrhage. Conclusion: Menorrhagia and abdominal mass are the chief symptoms of the fibroid. Severe haemorrhage still remains a major threat to successful abdominal myomectomy and efforts should be geared towards reducing this.
  3,527 229 1
EDITORIAL
Medical outreach activities, a means to an end
Ndubuisi Eke
September-December 2016, 10(3):85-85
DOI:10.4103/0795-3038.197758  
  983 2,735 -
ORIGINAL ARTICLES
The burden of blindness and visual impairment according to age and gender: A case study of Emohua local government area, Nigeria
AA Onua, C Tobin-West, I Ojule
May-August 2016, 10(2):73-78
DOI:10.4103/0795-3038.189458  
Background: Visual impairment and blindness pose different degrees of public health and social problem among the different age groups and sex. The problems are worse in the developing countries due to ignorance and lack of adequate eye care services. Public information systems, epidemiological data, and funding for blindness programs are often lacking and have hampered comprehensive blindness control programs in the rural communities, a fact that underscores the importance of this study. Aim: To estimate the burden of blindness and visual impairment according to age and gender in Emohua local government area (LGA), Nigeria. Methods: A population-based descriptive cross-sectional study conducted between October 11, and November 29, 2014, in Emohua LGA. Three hundred and fifty-three inhabitants were recruited in the study through a multistage sampling method. Demographic data, detailed ocular examinations were recorded and analyzed using SPSS version 20. Results: The study participants were 164 males and 189 females (male:female = 1:1.2). The prevalence of bilateral blindness is 1.4% (95% confidence interval [CI]: 0.78-2.5%) and unilateral blindness 2.5% (95% CI: 1.2-3.4%). Those who had various degrees of visual impairment in both eyes constituted 6.2% (95% CI: 5.7-8.5%) and 9.1% had unilateral visual impairment (95% CI: 8.7-9.7%). Cataract was the leading cause of bilateral blindness, accounting for 60% of cases, glaucoma (20%), and corneal opacity (20%). Conclusion: Blindness and visual impairment are more common in the older age groups and female gender in Emohua LGA. Government and nongovernmental organizations should step up comprehensive eye health care programs to realize the goals of Vision 2020.
  3,071 229 -
Pattern of cerebrospinal fluid analysis in children above the neonatal age as seen at the University of Port Harcourt Teaching Hospital
Awopeju Abimbola Temitayo Oluwajenyo, Yaguo-Ide Lucy Eberechukwu
September-December 2016, 10(3):86-90
DOI:10.4103/0795-3038.197755  
Background: Bacterial meningitis is a potent cause of morbidity and mortality in the paediatric age group. The aim of this study was to review the results of analysis the cerebrospinal fluid (CSF) collected from children above the neonatal age who were suspected to be having meningitis and to also determine the susceptibility pattern of these isolates. Methods: A descriptive retrospective study of results of CSF culture reports taken from paediatric patients aged 1 month to 16 years with clinical suspicion of bacterial meningitis at the University of Port Harcourt Teaching Hospital between January 1, 2009, and December 31, 2014. The CSF samples were subjected to macroscopic examination, white blood cell count, Gram's stain and culture. Organisms isolated were characterised by standard procedure and antibiotic susceptibility testing was done according to the Clinical Laboratories Standard Institute guidelines. Data were retrieved from laboratory record books and analysed using Microsoft Excel sheet. Results are presented as tables and pie chart. Results: Five hundred and seventy-four samples were received from children who were above the neonatal age (28 days). Of these, 329 were male (57.3%), 240 were female (41.8%), while in 5 (0.9%) of the samples, the sex was not indicated. Only 10 (1.7%) samples were positive for culture. Of these, Gram-positive cocci were the most common organisms, of which Staphylococcus aureus was the most prevalent, being 7 (70%), followed by Escherichia coli (20%), while the least prevalent organism was β-haemolytic streptococci (10%). The organisms all exhibited resistance to amoxicillin-clavulanic acid. Ceftazidime exhibited 100% sensitivity against E. coli isolates. Ceftriaxone, cefotaxime and ciprofloxacin exhibited good sensitivity among all the bacteria isolates that were cultured. Conclusions: There was a low yield of bacteria in CSF culture of paediatric patients at the University of Port Harcourt. The third-generation cephalosporins are still effective in bacterial meningitis in paediatric patients.
  1,553 1,502 -
Awareness and uptake of human papillomavirus vaccines among female undergraduate students: Implications for cervical cancer prevention in South-South, Nigeria
Chibianotu Ojimah, Omosivie Maduka
September-December 2017, 11(3):134-140
DOI:10.4103/phmj.phmj_14_17  
Background: Human papillomavirus (HPV) is a sexually transmitted infection found most commonly among sexually active adolescents and young women. HPV vaccine is available in Nigeria. However, very few persons have been vaccinated. This study, therefore, aimed to assess the level of awareness of HPV infection and its vaccine uptake among female university students in Rivers State. Methods: This was a descriptive cross-sectional study carried out between July and October 2015 in three Universities in Rivers State, Nigeria. Multistage sampling was used to identify the study participants. Results: A total of 780 eligible females were recruited into the study. About 262 (33.6%) had heard of HPV infection and 203 (26%) had heard of HPV vaccines. Among those who had heard of HPV vaccines, 148 (72.9%) were aware that the vaccine could protect against HPV infection while 97 (47.8%) were aware that the vaccine could protect against cervical cancer. Only 40 (5.1%) of study participants had been vaccinated with HPV vaccine. HPV vaccine uptake was significantly predicted by respondent's marital status (adjusted OR [AdjOR] = 0.061; 0.015–0.246), parity (AdjOR = 5.855; 1.433–23.923) and knowledge about HPV (AdjOR = 7.918; 3.062–20.475). Conclusion: Awareness of HPV infection and HPV vaccine among female undergraduates in Rivers State is poor. There is, therefore, need for health promotion interventions that address this gap as part of cervical cancer control activities.
  2,781 248 -
Oral health status, knowledge of dental caries aetiology, and dental clinic attendance: A comparison of secondary school students in the rural and urban areas of Lagos
Modupeoluwa Omotunde Soroye, Cyril Ilemobade Adegbulugbe
May-August 2016, 10(2):42-49
DOI:10.4103/0795-3038.189451  
Background: Dental caries is painful, expensive to treat and can harm nutrition and overall health. Good oral hygiene, regular utilization of dental health facilities, dietary habits and knowledge of determinants of dental caries play important role in the prevalence of dental caries among school children. Tooth loss, sequelae to untreated dental caries is higher among urban school children than their rural counterparts. Aim: To compare and determine the oral health status and investigate dental clinic attendance and knowledge of students in rural and urban secondary schools in Lagos on the aetiology of dental caries. Methods: Using stratified and proportionate to size sampling techniques, a random sample of 598 students aged 12-26years from rural and urban local government areas were examined for dental caries and gingivitis. Questionnaires were administered to elicit information on frequency of consumption of refined sugar, parents' educational status, knowledge of dental caries aetiology and dental clinic attendance. The decayed, missing and filled tooth index (DMFT) was measured according to the WHO caries diagnostic criteria for epidemiological studies and the clinical oral hygiene status measured with the gingival index (GI) of Loe and Silness, Plague index and the Simplified Oral Hygiene Index. Results: There was a statistically significant difference between urban and rural students in caries experience in permanent teeth (mean DMFT = 0.26 in urban areas; 0.11 in rural areas), More of the parents of students in the urban schools are educated than those in rural schools. The decayed (D) and missing (M) components were higher in the rural area, indicating a high level of restorative treatment need among the students in rural area. The urban participants had better oral hygiene and the gingival index was higher among rural students. Dental clinic attendance was higher among the urban participants than the rural participants. Conclusion: The students in urban secondary schools had better oral health status and make use of dental facilities more than their rural counterparts. The knowledge of aetiology of dental caries is poor among both the rural and urban school students.
  2,528 227 -
Waiting time and patient satisfaction: Survey of patients seeking care at the general outpatient clinic of the University of Port Harcourt Teaching Hospital
Daprim Samuel Ogaji, Margaret M Mezie-Okoye
September-December 2017, 11(3):148-155
DOI:10.4103/phmj.phmj_41_17  
Background: Improving efficiency in patient flow and the satisfaction of patients attending outpatient clinics may require paying close attention to the actual time spent by patients at the various service points during their visit to the hospital. This study assessed the time clients spent at various service stations, the level of their satisfaction with the time spent and the relationship between waiting time and satisfaction for patients seeking care at the General Outpatient Clinic of the University of Port Harcourt Teaching Hospital. Methods: A total of 422 adult patients seeking care at the clinic were selected by time-limited systematic random sampling and followed through all their engagements within the hospital. Details of the time spent at each service station and clients' satisfaction with the time spent were collected using record sheet and a patient satisfaction questionnaire. Data were analysed with the Statistical Package for the Social Sciences, version 20. The statistical effect sizes and confidence intervals of measured outcomes were reported. The P < 0.05 was considered statistically significant. Results: More of the patients were female (58.6%), married (65.3%) and regular visitors to the clinic (72.6%). The mean time of 83 min was spent on the movement to the hospital and further 274 min to conclude all relevant activities in the course of seeking general practice service in the hospital. The average time of consultation with the doctors was 19 min, whereas the longest mean waiting times of 77 and 50 min were spent while waiting to access radiological and laboratory services, respectively. More patients were satisfied with the time they spent consulting the doctors (93%) or waiting to have their vital signs checked by the nurses (83%) than they were with the time taken to access radiological (30%) and laboratory services (47%). There was a significant inverse relationship between the level of patient satisfaction and the duration of time spent at the service stations. Conclusion: The waiting time for patient accessing general outpatient care in the teaching hospital is long and could be a major contributor to negative patient experiences. There is a need for system redesign, establishment of patients' appointment scheduling and other interventions by service providers that will ensure efficient and effective management of patient flow, timely access to health services and an overall improvement of patient experience with the general outpatient encounter.
  2,430 228 -
Microbiological assessment of indoor air quality at different sites of a tertiary hospital in South-South Nigeria
Kenneth Emuren, Best Ordinioha
May-August 2016, 10(2):79-84
DOI:10.4103/0795-3038.189459  
Background: The risk of nosocomial infection is increasing due to the increasing number of patients with immune depression. Good ventilation is one of the methods used to reduce the ambient air levels of the causative agents, but this is rarely observed in Nigeria as hospital designs used to shut out the inclement weather in temperate countries are copied without many modifications, and without adequate provisions to constantly power the mechanical ventilation mechanisms. This study tested the microbiological air quality at different areas of the University of Port Harcourt Teaching Hospital to ascertain the levels of airborne bacteria and fungi in the ambient air. Methods: The study was carried out in July 2015 in randomly selected inpatient wards, outpatient clinics, and clinical laboratories of the hospital. The assessment was carried out by exposing Petri dishes containing the appropriate culture media for about 30 min at a convenient place in each of the nine study sites. Thereafter, the plates were covered and immediately transferred to the laboratory for incubation at 37°C, for 24-48 h, for bacteria; and at room temperature, for 5-7 days, for fungi. The number and types of bacteria and fungi in the cultures were determined at the end of the incubation period. Results: There were detectable bacteria and fungi in the ambient air of all the study sites. The mean bacterial count ranged from 9.5 colony forming unit per cubic meter (CFU/m 3 ) in the urology ward to 199.33 in the HIV clinic, with a mean of 80.0 CFU/m 3 , while the mean fungal count ranged from 10.5 CFU/m 3 in the surgery outpatient clinic (SOC) to 23.5 in the Anatomical Pathology Laboratory (APL), with a mean of 16.9 CFU/m 3 . Staphylococcus and Streptococcus were the most common bacteria in the SOC; Klebsiella was predominant in the immunization clinic; Escherichia coli were the most common in the APL, while bacillus was most frequently isolated in the gynecology ward. The fungi cultured from the study sites include Aspergillus, Penicillium, Fusarium, Trichophyton, Candida, and Rhizopus. Unlike the bacteria count, the fungal count increased in all the study sites at the end of the working day. Conclusion: The number and types of bacteria and fungi cultured from the study sites have the potential to cause ill health. Corrective actions are therefore needed.
  2,238 272 -
CASE REPORTS
Urethral prolapse: An important differential diagnosis of bleeding from the vulva in pre-pubertal African girls
Blessing Imuetinyan Abhulimhen-Iyoha, CA Oguejiofor
May-August 2017, 11(2):96-98
DOI:10.4103/phmj.phmj_3_17  
Urethral prolapse is the abnormal protrusion of the urethral mucosa through the external urethral meatus. It is a rarely diagnosed condition as most cases will be misdiagnosed as sexual abuse. If diagnosed, however, medical treatment with follow-up will usually suffice. If this fails, or in the presence of complications, surgical management may be employed. The most common presenting feature is urogenital bleeding. Genital bleeding in a pre-pubertal child is alarming to parents. Their first impression is that of a sexual abuse resulting in the suspicion of all adult males in the surrounding environment. The condition is worsened by a scenario in which the child is either too little to give an account or where she points accusing fingers to some adults. We report a case of bleeding from the vulva from urethral prolapse masquerading as suspected sexual abuse from an unknown adult.
  2,360 140 -
ORIGINAL ARTICLES
Aetiological factors and dimension of tympanic membrane perforation in Benin City, Nigeria
Johnson Ediale, Paul R. O. C Adobamen, Titus S Ibekwe
May-August 2017, 11(2):55-59
DOI:10.4103/phmj.phmj_29_17  
Background: Tympanic membrane (TM) perforation is a recognised cause of hearing loss in our environment. The integrity of the TM can be compromised by varying aetiological factors which are often preventable. TM perforation occurs in different dimensions which tend to influence the degree of hearing loss. Aim: The aim of this study is to determine the aetiological factors and dimensions of TM perforation among adolescents and adults in Benin City. Methods: This was a 1-year prospective study carried out from 1st July 2014 to 30th June 2015 at the Ear, Nose and Throat Clinic of University of Benin Teaching Hospital. Consecutive patients with TM perforation were examined using a hand-held otoscope as well as Firefly video otoscope and subsequently had an interviewer administered questionnaire. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 and ImageJ software. Results: One hundred and forty-eight patients with TM perforation in either or both ears were studied. There were 67 (45.3%) males and 81 (54.7%) females; ratio of 1:1.2. Ages ranged from 10 to 64 years, with a mean age of 34.5 ± 15.7 years. Chronic suppurative otitis media (CSOM) was the major cause of TM perforation in this study, 148 (74.0%). The small perforation was predominant, 54 (55.1%) and 48 (47%) in the right and left ears, respectively while the central anterior perforation, 93 (46.5%) occurred commonly. Conclusion: Central and small perforations were the predominant TM perforation while CSOM was the major cause of TM perforation.
  2,004 361 -
Prevalence of anaemia in the antenatal booking population at Ahmadu Bello University teaching hospital, Kaduna, Nigeria
Polite I Onwuhafua, Ijeoma C Ozed-Williams, Abimbola Omolara Kolawole, Marliya S Zayyan, Joel Adze
January-April 2018, 12(1):23-27
DOI:10.4103/phmj.phmj_32_17  
Background: Anaemia has been associated with poor materno-foetal performance among pregnant women in Nigeria. The objective, therefore, of this study is to determine the prevalence of anaemia at the time of antenatal booking and the associated factors in the hospital. Methods: Four hundred and seventy-seven women were studied prospectively over 3 months in the antenatal booking clinic, and their characteristics compared with their haemoglobin (Hb) levels. Results: Age range was 15–46 years, and mean Hb concentration was 10.76 g/dl. Nearly 53.05% of the study population had Hb <11.0 g/dl, but only 20.76% had Hb <10.0 g/dl. Nearly 1.89% had severe anaemia (Hb <8.0 g/dl) while 20.12% had Hb of 12.0 g/dl or more. The strongest association was last obstetric event occurring <1 year before current pregnancy (χ2 6.17, odds ratio 3.97 and P = 0.01). Older women (35 years or more) had a higher prevalence (30.95%) than younger women (19.77%). Only two of the 15 teenagers (13.33%) were anaemic. Six women (1.26%) had sickle cell Hb and it seemed the presence of Hb C tempered the anaemia. Parity and social class were not significant associations. With a mean booking gestational age of 22.49 weeks for the group, 77.77% of the anaemic women booked earlier than 28 weeks. Only two (2.03%) booked later than 34 weeks. Conclusion: Anaemia is still highly prevalent in the society, and the existing mechanisms for its correction should be reassessed for effectiveness and adequate utilisation in the antenatal clinic. Most anaemic women booked early, therefore, allowing enough time for correction before delivery.
  2,167 147 1
Knowledge, practice and attitude of breast self, clinical breast and mammographic examinations amongst medical doctors in Bayelsa State
DO Allagoa, SC Uwaezuoke, EL Kotingo
January-April 2017, 11(1):26-33
DOI:10.4103/phmj.phmj_11_17  
Background: Breast cancer is the most common cancer in women both in the developed and less developed world. Regular self, clinical and mammographic examination of the breast according to internationally acceptable guidelines can result in early detection of cancer in asymptomatic women thereby reducing morbidity and mortality related to the disease. Aim: The aim of this study is to assess the knowledge, practice and attitude of breast examinations and breast cancer amongst medical doctors in Bayelsa State to achieve the desired reduction in mortality. Methods: This is a descriptive cross-sectional study of Doctors in Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State carried out between September 1, and October 1, 2015. A structured self-administered questionnaire was designed and used to collect information from 216 medical doctors. The data were processed using SPSS Windows version 20. Summary statistics, sample frequencies and crossed tabulations were then computed. Results: Of the 176 respondents, none had a low level of knowledge; 58 (33.0%) showed moderate level of knowledge, whereas 118 (67.0%) showed a high level of knowledge. Only 55.7% of doctors had performed breast self-examination (BSE), 16.5% clinical breast examination (CBE) and 4% mammography. However, when it was coned-down to only female doctors, it was found that whereas 54 (85.7%) of our female respondents practiced BSE, only 15 (23.8%) had CBE, and only 2 (3.2%) had done screening mammography. Majority (92.6%) believed that breast cancer can be cured if detected early, with 100% opted to seeing a doctor. Conclusion: Convincing majority of medical doctors in our study had excellent knowledge about BSE, CBE and mammography as screening modalities, respectively, for breast cancer. Attitude towards breast cancer treatment was also positive. However, their practice levels were quite poor.
  2,088 201 -
Assessment of the level of some heavy metals in commonly consumed local fish species displayed for sale in Port Harcourt, Nigeria
Dornu M N-ue, Best Ordinioha
May-August 2016, 10(2):55-59
DOI:10.4103/0795-3038.189454  
Background: The incessant crude oil spillage into the water bodies of the Niger delta region of Nigeria has raised fears that the fish caught in the water bodies would be heavily contaminated with heavy metals. This study tested five commonly consumed local fish species for their lead, cadmium, mercury, and arsenic content. Methods: Samples of dark tilapia (Sarothendon gallelacus), light tilapia (Oreochronis niloticus), two-fin catfish (Clarias gariepinus), "Zeghe" (Hydrocynus forskahlii) and three-fin catfish (Auchenoglanis occidentalis) bought from three fish markets (Creek Road, Mile One and Iwofe) were used for the study. The levels of the heavy metals in the fish samples were assessed in an accredited laboratory, while the human health implications of the contaminants were determined using the relevant international regulatory standards. Results: The fish samples contained detectable levels of the assessed metals. The mean concentration of cadmium in the fish samples was 0.29mg/kg; while the mean concentration of arsenic was of 1.85mg/kg. The average concentrations of lead and mercury in the fish samples were below the regulatory limits, whereas the mean concentration of cadmium was three times the WHO permissible limit of 0.1mg/kg. The concentrations of cadmium were highest in the light tilapia, and in the fish bought from the Mile One market, and lowest in the three-fin catfish, bought from the Creek Road market. Conclusion: The levels of the assessed heavy metals were significantly less than expectation. The levels of cadmium in the samples were however high enough to cause severe adverse health effects, hence the need for a more comprehensive public health response in managing crude oil spills.
  2,086 195 -
Knowledge and perception of healthcare providers towards palliative care in Rivers State, Nigeria
Gracia Ker Eke, Geraldine U Ndukwu, Nkem S Chukwuma, Bassey B Diepiri
September-December 2017, 11(3):156-160
DOI:10.4103/phmj.phmj_26_16  
Background: Palliative care, a multidisciplinary approach to specialised medical care, focuses on improving the quality of life for both the patient and the family. It increases their satisfaction and improves clinical outcome. Its concept, however, is relatively new in Nigeria, with services mainly limited to patients who attend the tertiary hospitals. Aim: The aim of this study is to evaluate the knowledge and perception towards palliative care among health-care providers in Rivers State. Methods: This cross-sectional study was conducted in November 2012 at the University of Port Harcourt Teaching Hospital, among participants of a workshop on Hospice and Palliative care. Participants were healthcare providers from within and outside the hospital, including doctors, nurses, pharmacists, social workers, medical and nursing students. A structured, anonymous and self-administered questionnaire was used to obtain data on knowledge of palliative care and awareness information. Data were analysed using SPSS version 20.0. Results: There were 114 respondents and this comprised of 29 (25.4%) males and 85 (74.6%) females, giving a male-to-female ratio of 1:3. They were mainly doctors (44.7%) and nurses (44.7%). Majority (88%) had previously heard of palliative care. Sixty-four (56.1%) of them heard of it in a hospital setting from doctors/nurses, 37 (32.5%) from friends/family and 10 (8.8%) in school. Forty-six (40%) respondents believed that nurses should be the ones to provide palliative care services, while 32 (28%) believed the doctors should. Less than half (47.4%) were aware of the interdisciplinary facet of palliative care. Ninety-five (83.3%) respondents believed that terminally ill patients should benefit from palliative care services, while 17.5% believed that patients with diabetes should. More doctors (80%) than nurses (47%) rightly identified the components of palliative care. Conclusion: Healthcare providers had insufficient knowledge concerning the interdisciplinary nature of the palliative care team, potentials beneficiaries and components of palliative care.
  2,088 145 -
The effect of the application of different rates of herbicides on the residual level of the herbicides and their metabolites in harvested maize cobs
Joyce Chinyere Best-Ordinioha, EA Ataga, Best Ordinioha
September-December 2017, 11(3):122-126
DOI:10.4103/0795-3038.237884  
Background: The use of herbicide in weed control has grown significantly in Nigeria in recent years. Most of the applications are indiscriminately carried out by illiterate farmers, and therefore pose a significant threat to the environment, crop yield and human health. This study assessed the effects of different application rates of the herbicides on the residual levels of the herbicides and their metabolites in harvested maize cobs. Methods: The study was carried out in a plot of land at the University of Port Harcourt in 2013 and 2014, using a randomised complete block design with three replicates, and plot size of 2 m × 2 m. N-(phosphonomethyl) glycine was used to prepare the experimental plots, while different application doses of Primextra dual gold (2-chloro-4-(ethylamino)-6-isopropylamino-1,3-5-triazine and 2-chloro-N-(ethy-6-methy(phenyl)-N-(2-methoxyl-1-methylethyl acetamide) were applied to the plots, after planting the maize. The control plot was not treated with the herbicides. The residual levels of the herbicides and their metabolites in the cobs harvested from the plots were tested using gas chromatography, with Pulsed Flame Photometric Detector. Results: The residue of the herbicides and their metabolites were barely detectable in the harvested maize cobs when the herbicides were applied at or below their recommended dose, but noted at up to 0.09 ppm, when applied at twice the recommended dose. The residues were also noted in some of the cobs harvested from the control plot, at a mean concentration of 0.0033 ppm, which is significantly <0.012 ppm recorded in the treated plot. Conclusion: The residual concentrations of herbicides and their metabolites in harvested crops increased with increasing application dose of the herbicides. Proper education of farmers is, therefore, needed to safeguard the environment and public health.
  1,956 153 -
Scalp and hair disorders at the dermatology outpatient clinic of a tertiary hospital
Olusola Olabisi Ayanlowo
September-December 2017, 11(3):127-133
DOI:10.4103/phmj.phmj_32_16  
Background: Scalp and hair disorders are common and of immense health and cosmetic significance. Alopecia, the most common presentation of scalp disorders, has been found to impact negatively on the quality of life of patients. Aim: This study aimed to document the spectrum of scalp and hair disorders, with the age and sex distribution, at the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) between 2004 and 2012. Methods: This is a retrospective study of patients who presented primarily with hair and scalp disorders. Data was obtained from clinic records and patients clinic notes; and included biodata, diagnoses, age and sex distribution. Results: During the study period, 860 patients (5.3%) of the 16,160 patients presented primarily with scalp and hair disorders. Both children and adult patients are seen at the clinic. Patients seen ranged from 3 months to 80 years of age. More males (67.2%) than females (32.8%) were seen; with ratio 2.05:1. Tinea capitis, dermatophyte infection of the scalp, was the most common disorder (30.5%), with male preponderance in the first decade of life. Chronic inflammatory scalp disorders such as acne keloidalis, dissecting folliculiis and folliculitis decalvans were found predominantly in adult males; while alopecia areata, scalp psoriasis and pityriasis amiantacea were noted to be more common in adult females. Conclusion: This study noted high frequency of chronic inflammatory scalp disorders found predominantly in males. However, disorders of hair care practices such as traction alopecia found commonly in community surveys were not frequent presentations in our practice. Further to determine the epidemiologic factors, aetiology and clinical characteristics of the common scalp and hair disorders will be necessary.
  1,929 140 -
Validity of Beck's depression inventory and alcohol use disorders identification test in Nigeria's Niger Delta region
DC Chukwujekwu, CU Okeafor, PO Onifade
May-August 2016, 10(2):50-54
DOI:10.4103/0795-3038.189453  
Background: The Beck's Depression Inventory (BDI) and Alcohol Use Disorder Identification Test (AUDIT) have been validated for use in the study of alcohol related psychiatric disorders in the developed world as well as in Western Nigeria, but not in the Niger Delta Region. Aim: To ascertain the psychometric properties of BDI and AUDIT for use in this part of the world using psychiatric out-patients at the University of Port Harcourt Teaching Hospital. Methods: Four hundred and seventy (470) subjects were enlisted into the study using systematic sampling technique. The BDI and AUDIT were administered to each of them. One hundred and eighty five (185) subjects met the criteria for the second stage viz; a score of 18 and above on the BDI and/or a score of 5 and above on the AUDIT. Diagnoses of Depression and Alcohol Use Disorder were made using the Composite International Diagnostic Interview (CIDI). The data were analyzed using the statistical package for social sciences (SPSS) version 16.0 Results: The sensitivity and specificity of the BDI were 96.3% and 58.8% respectively. The positive and negative predictive values of BDI were 86% and 85.7% respectively. Also, the sensitivity and specificity of the AUDIT were 100% and 92.1%. Furthermore, the positive and negative predictive values of the AUDIT were 85.5% and 100% respectively. Conclusion: The BDI and AUDIT have excellent psychometric properties; hence they are valid for carrying out studies on alcohol related psychiatric disorders.
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Cardiopulmonary resuscitation skills in some Nigerian secondary school students
Adedamola Olutoyin Onyeaso, Chukwudi Ochi Onyeaso
May-August 2016, 10(2):60-65
DOI:10.4103/0795-3038.189455  
Background: While many countries of the world have incorporated the teaching of cardiopulmonary resuscitation (CPR) into their schools curricula, there has been little or no effort made towards this in Nigeria. The aim of this study was to find out whether exposure of some Nigerian secondary school children to the conventional CPR would result in significant change in their CPR skills immediately after the training. Methods: It was a quasi-experimental study design carried out in 2012 with participants drawn from both private and public secondary schools in Obio / Akpor Local Government Area in Port Harcourt City, Rivers State, Nigeria. The initial cohort (stage I) involved 400 participants from senior secondary school 1 and 2 (SS1) and SS2) when their baseline CPR skills were assessed and immediately after the CPR training (stage II) when the participants dropped to 347 [189 (54.5%) females; 158 (45.5%) males]. They were exposed to both class room teachings and the practical hands-on sessions using manikins in line with the American Heart Association (AHA) guidelines. The data was analyzed using ANOVA and t-test. Results: Although the participants had virtually no CPR skills at the beginning, they gained very substantially immediately after the training which was found statistically significant (P < 0.05). They showed much enthusiasm in the training with high percentage of them indicating willingness not only to provide bystander CPR to their relatives but to strangers and trauma victims. Over 98% of them wanted CPR to be formally taught in Nigerian secondary schools. Conclusions: The CPR skills of the Nigerian students improved statistically with many ready to offer bystander CPR. It was recommended that CPR training programme should be incorporated into the curriculum of secondary school education in Nigeria.
  1,817 180 -
A study of the effect of frequency of tooth brushing on the prevalence of inflammatory periodontal diseases
Osagie Akhionbare, Patrick I Ojehanon
September-December 2016, 10(3):119-123
DOI:10.4103/0795-3038.197750  
Background: The use toothbrush and paste are the most common means of oral prophylaxis in Nigeria and how the frequency of this prophylaxis affects the prevalence of periodontal disease has not been fully ascertained. Aim: This study aims to assess if frequency of self-oral hygiene prophylaxis in a day, using the toothbrush and paste, had any relationship on the prevalence of inflammatory periodontal diseases, using the community periodontal index of treatment needs (CPITN). Methods: A cross-sectional study of 894 subjects (428 males and 466 females), who reported for the first time at the Dental Centre, of the University of Benin Teaching Hospital, Benin City, Nigeria, were examined. Only those that used toothbrush and paste once or twice daily, as the only oral hygiene method and were 18 years and above of age, were selected and investigated. Results: 58.3% of the entire subjects surveyed and 63.1% of male subjects indicated twice-daily oral prophylaxis when compared to 53.9% of female subjects. There was a statistical significant difference in the distribution of subjects with respect to occupation, between the two groups. This difference was most marked among the professional subgroup as compared to other subgroups. There was a statistical significant difference in the prevalence of periodontal diseases as indicated by CPITN scores. The group that performed oral prophylaxis twice daily had a higher proportion of those with CPITN codes 0 and 1 whereas codes 3 and 4 were more predominant with the group that perform oral prophylaxis once daily. Conclusion: The distribution of CPITN scores had a relationship with the frequency of daily oral hygiene practices. In view of the results of this study, it is suggested that some form of preventive oral hygiene programs be embarked on where emphasis is placed on regular and higher frequency of tooth brushing.
  1,779 190 -
Evaluation of antimalarial drugs usage according to WHO prescribing indicators in a tertiary health facility in Maiduguri, Northeastern Nigeria
Phillip Samuel Maryah, Ballah Akawu Denue, Nasiru Yakubu Ikunaiye, Roseline I Aderemi-Williams, Cecilia B Akawu
May-August 2017, 11(2):67-71
DOI:10.4103/phmj.phmj_7_17  
Background: The high morbidity and mortality associated with malaria especially in sub-Saharan Africa such as Nigeria calls for prompt preventive and curative measures including adherence to standard treatment guideline. Aim: To assess the level of adherence with the five defined WHO prescribing key indicators. Methods: This was a retrospective evaluation of the performance of antimalarial drugs prescribing practice among clinicians from January to December 2014. It was done through a set of drug prescribing indicators developed by WHO and the International Network of Rational Use of Drugs (INRUD). Results: Of the 385 patients prescription randomly generated from the record of 12,477 patients in this descriptive study, a total of 143 (37.1%) had antimalarial prescription(s) with no gender variation. The evaluation of the studied antimalarial drug prescriptions through defined WHO prescribing indicators revealed an average number of drugs per encounter of 3.9, with 37.4% of the prescriptions written in generic names. All the antimalarial drugs were prescribed from the National Drug Formulary, with injectable form constituting 4.7%. Conclusion: This study shows suboptimal compliance with WHO prescribing indicators with respect to average number of antimalarial per encounter and prescription in generic names. The proportion of antimalarials prescription in injectable form falls within the WHO acceptable limit of ≤10%. All antimalarial drug prescriptions in this study were from essential drug list. We, therefore, recommend rational antimalarial drug prescription in conformity with WHO/INRUD core drug prescribing indicators.
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CASE REPORTS
Stromal tumour of the ileum: An unusual cause of massive gastrointestinal bleeding
OS Omorogbe, AA Iloh, OG Egigba, OC Osime
January-April 2017, 11(1):45-48
DOI:10.4103/phmj.phmj_19_16  
Background: Gastrointestinal stromal tumour are rare gastrointestinal tumour that probably originate from the interstitial cells of Cajal and 95% express a specific molecular marker. They occur most commonly in the stomach (60%) followed by the small intestine (30%) and may present with gastrointestinal bleeding. Case Report: A 40year old man presented with passage of frank blood per rectum with associated haemodynamic instability necessitating several units of blood transfusion. Following adequate resuscitation, lower and upper GI endoscopy done were negative and subsequently had emergency laparotomy for continued gastrointestinal bleeding. We found a bleeding ileal tumour which was resected. Histopathology confirmed gastrointestinal stromal tumour. Conclusion: small bowel stromal tumour rarely and unusually presents with massive lower GI bleeding. Diagnosis may be delayed due to inaccessibility of the small bowel to routine upper and lower GI endoscopy. Mesenteric angiography, radionuclide RBC, capsule endoscopy, push enteroscopy depending on the fitness of the patient, may aid diagnosis. Prompt surgical resection and adjuvant imatinib therapy for malignant variants is the treatment of choice.
  1,729 107 -
CASE REPORT
Huge cervical fibroid
John Chukwuzitelu Ekweani, OA Oguntayo, A. O. D. Kolawale, MS Zayyan
September-December 2016, 10(3):135-138
DOI:10.4103/0795-3038.197754  
Fibroids in the cervical region of the uterus are uncommon because of the rarity of smooth muscles. The aim of the study was to present this rare finding in our centre and to show our management and the challenges encountered. We present a 45-year-old multipara who before the presentation had 6-year history of abnormal vaginal bleeding and was previously managed in a peripheral hospital. Physical examination suggested a large cervical fibroid and a hydronephrosis on the right displayed on intravenous urogram. She had total abdominal hysterectomy with the urologist who repaired an inadvertent ureteric injury and inserted a stent. It was removed after 6 weeks, and she was discharged with no further complications. Management of such patients should involve other disciplines after careful evaluation has been carried out.
  1,707 127 -
ORIGINAL ARTICLES
Risk factors of intestinal parasitic infections among human immunodeficiency virus-infected patients on highly active antiretroviral therapy
FO Akinbo, PJ Anate, DB Akinbo, R Omoregie, S Okoosi, A Abdulsalami, B Isah
January-April 2017, 11(1):15-20
DOI:10.4103/phmj.phmj_5_17  
Background: Highly active antiretroviral therapy (HAART) improves immunity and reduces the occurrence of enteroparasitic infections. Aim: This study aimed to determine the prevalence and risk factors of intestinal parasitic infection among human immunodeficiency virus (HIV) patients on HAART in Kogi State, Nigeria. Methods: Blood and stool specimens were collected from 511 subjects including 411 HIV patients on HAART and 100 apparently healthy non-HIV individuals. The blood specimens were used to determine CD4 count and haemoglobin concentration, whereas the stool specimens were processed to detect intestinal parasites using standard techniques. Socio-demographic data were obtained with the aid of a questionnaire. Results: Entamoeba histolytica was the predominant parasites recovered generally and in both genders as well as being the only parasite that was associated with immunodeficiency as measured by CD4 count <200 cell/μL (P = 0.0059) HIV status was a significant risk factor for acquiring intestinal parasitic infection (odds ratio = 8.213 95% confidence interval = 1.971, 34.225; P = 0.0012). Among the other risk factors, CD4 count <200 cell/μL (P < 0.0001) and farming (P = 0.0202) were associated with intestinal parasitic infections among HIV patients on HAART. Conclusion: An overall prevalence of 14.4% of intestinal parasitic infections was observed among HIV patients on HAART in this study. Routine diagnosis of intestinal parasites among HIV patients on HAART is advocated.
  1,670 164 -