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   Table of Contents - Current issue
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September-December 2020
Volume 14 | Issue 3
Page Nos. 93-158

Online since Thursday, March 25, 2021

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EDITORIAL  

Use of face shields during Covid-19 pandemic p. 93
Richard C Echem
DOI:10.4103/0795-3038.311934  
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REVIEW ARTICLES Top

Human papillomavirus and cervical cancer p. 95
Firdous Ansari
DOI:10.4103/phmj.phmj_2_20  
Background: According to the World Health Organization, human papillomavirus (HPV) causes cervical cancer, which is the fourth most common cancer in women, with an estimated 266,000 deaths and 528,000 new cases in 2012. Usually, HPV infections cause no symptoms but it is also reported that 99% cervical cancer cases are linked to genital infection with HPV and it is the most common viral infection of the reproductive tract. Aim: The aim of the study is to review the literature to describe what research has been done and what can be the future prospect. Methods: To search for the literature search engine, PubMed and Google were searched by inputting different key words, for example, HPV and cervical cancer. Studies considered were broadly associated with either HPV and cervical cancer or its worldwide scenario and socio-economic status. Results: Considered studies showed that Genital HPV is the most common sexually transmitted infection in the United States, whereas a considerable number i.e., 90% cases of cervical cancer, HPV was detected. The largest proportion attributable to HPV reported were about 75%, 70%, 70% and 60% of vaginal cancers, oropharyngeal cancers, vulvar cancers and penile cancers, respectively. Various identified risk factors as well as different suggested methods are also described to protect against HPV. Conclusion: We may conclude that as it is sexually transmitted infection and causes no symptoms, so proper care should be taken in intimate hygiene management.
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Chronicles of challenges confronting HIV prevention and treatment in Nigeria p. 100
Adejoke Adijat Joseph, Oluyemi Adesoji Joseph, Bukola Lateefat Olokoba, Olatunji Aliu Olatunji
DOI:10.4103/phmj.phmj_3_20  
Background: Antiretroviral therapy reduces mortality and morbidity amongst people living with human immunodeficiency virus (HIV)/AIDS, improves their quality of life and reduces the potential to infect others. The goal of National Agency for the Control of AIDS is to achieve and sustain an AIDS-free Nigeria by 2030 hinged on its strategic framework. Achieving this goal is threatened by certain identified challenges. Aim: This study is to review the contents of the national HIV and AIDS strategic framework in a bid to identify the challenges confronting its full implementation in the management of HIV in Nigeria. Methods: Several published articles on HIV prevalence, factors influencing trend and spread, and sociodemographics of the affected were reviewed as well as three federal government of Nigeria national HIV and AIDS strategic framework. Articles were sourced from online indexes such as Medline; sampling about 60 peer-reviewed articles from which information relevant to the topic were retrieved. Publication by relevant bodies on HIV and AIDS was likewise reviewed, and relevant information was retrieved from them. Results: Challenges identified include AIDS-related stigmatisation and discrimination, socio-cultural norms and practices, especially denial of women to inheritance and widow inheritance with its resultant feminisation of poverty and female genital mutilation, reduced funding following the withdrawal of donor agencies, anti-Lesbian, Gay, Bisexual, Transgender and Queer bias, bureaucratic and structural problems, as well as negative attitude of healthcare professionals. Conclusion: The study concludes that achieving an AIDS-free Nigeria with zero new infection and zero. AIDS-related stigmatisation by 2030 will require mitigating against the aforementioned challenges.
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ORIGINAL ARTICLES Top

A single-centre audit of request forms and the 2011 appropriate use criteria for transthoracic echocardiography p. 114
Ejiroghene Martha Umuerri
DOI:10.4103/phmj.phmj_4_20  
Background: Transthoracic echocardiography (TTE) is a useful diagnostic tool in cardiology practice. The information provided by the requesting physician is a helpful guide in the interpretation of findings. This study aimed to audit echocardiography request forms (ECFs). Methods: A 3-year retrospective audit of echocardiography request forms (ERFs) received at a community-based echocardiography centre in Delta State, Nigeria. Delta State University Teaching Hospital Health Research Ethics Committee granted ethical approval to conduct this study. Data extracted from the ERFs were patients' name, age, sex, address and indication/background clinical information, the name and signature of requesting physician, name of referring hospital and date of the request. Evaluation of the appropriateness of the indications for echocardiography was done using 2011 Revised American College of Cardiology Foundation's appropriate use criteria (AUC). The corresponding echocardiograms were coded as normal or abnormal reports. Data were anonymised and analysed using the SPSS software version 23. Results: All the 412 ERFs audited had the names of the patients. The patients' age, sex and address were missing in 22.6%, 11.4% and 92.5% of the ERFs, respectively. A total of 119 (28.9%) ERFs lacked indication/clinical information and thus unclassifiable using the 2011 AUC. Of the remaining ERFs, the AUC was appropriate, inappropriate and uncertain in 259 (88.4%), 26 (8.9%) and 8 (2.7%), respectively. Majority of the ERFs with uncertain indications had normal echocardiograms. The echocardiograms of 78% (93/119) of the patients whose ERFs lacked indication/clinical information were abnormal. Conclusion: In this study, ERFs were inadequately filled. However, majority of the stated indications/clinical information for TTE were classified as appropriate.
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Prevalence of tuberculosis-HIV co-infection and factors associated with treatment outcome among the tuberculosis patients in HIV treatment facility in a teaching hospital in Jos, North Central Nigeria p. 119
Sunday Asuke, John Bimba, Swem Micheal Ngutor, Eunice Ejiga, Shanabo Z Miracle, Dorcas M Anamayi
DOI:10.4103/phmj.phmj_14_20  
Background: Globally, tuberculosis (TB) remains a disease of grave public health concern. It ranks above HIV/AIDS as the leading cause of death from a single infectious agent, and as one of the 10 most common causes of mortality. This study assessed the prevalence of TB-HIV co-infection and factors associated with treatment outcome among the TB patients in an HIV treatment facility in a Teaching hospital in Jos, North central Nigeria. Methods: A 10-year retrospective, descriptive cross-sectional review was conducted and data was extracted through the review of TB registers. Data were analysed using SPSS version 20 and bivariate analyses was conducted at P < 0.05. Results: The prevalence of TB-HIV co-infection was 9.25%, with the mean age of the study participants being 41.8 ± 11.6 years. Of all the participants, 87.5% had successful treatment outcome, while 12.5% had unsuccessful treatment outcome. In the bivariate analysis, place of residence was the only socio-demographic factor significantly associated with treatment outcome (<0.001). Conclusion: The TB-HIV co-infection prevalence rate was about 10% of the total HIV population with a high TB treatment success rate. With the exception of place of residence, no other factor had statistically significant relationship with the treatment outcome.
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Perception of mothers in Owerri, South-East Nigeria about teething in infants p. 125
Kelechi Kenneth Odinaka, Edelu Benedict, Amamilo Ifeyinwa, Nwolisa Charles Emeka, Kingsley Achigbu
DOI:10.4103/phmj.phmj_16_20  
Background: Teething is a natural and physiological process in growing infants. It is one of the major milestones in the development of the child and has been attributed to cause a myriad of problems to the infant. Aim: This study sought to determine the knowledge, beliefs and practices of mothers from Owerri, South-East Nigeria on childhood teething. Methods: This was a cross-sectional, descriptive study that involved 127 mothers who attended the infant immunisation clinic of Federal Medical Centre Owerri over 3 months from September to November 2018. Results: Fifty-one (41.7%) infants had the eruption of the first tooth on or before 5 months of age. A good proportion 111 (87.4%) of mothers believed that tooth eruption in infants will come with illness, while 55 (43.3%) of the mothers had in the past experienced symptoms with teething in their babies. Seventy-three (57.5%) of the mothers use medications as prophylaxis for teething-associated problems. Mother's education did not significantly influence the use of teething prophylaxis (31.4% of mothers with tertiary education administered medications to their children during teething compared to 54.2% of mothers with lower educational background, P = 0.094, χ2 = 6.392). Conclusion: Mothers in Owerri, South Eastern Nigeria irrespective of their educational status still have wrong perceptions and beliefs about teething and majority routinely administer medications for presumed teething problems.
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Perceived labour-pain and parity are not determinants of tokophobia amongst birthing mothers: A cross-sectional study p. 131
Chinemerem Eleke, Ogochukwu-Mbonu F Steve-Tamuno, Ifeyinwa S Agu, Esther N Bempong-Eleke
DOI:10.4103/phmj.phmj_17_20  
Background: Maternal health experts opine that poor control of labour-pain could result in traumatic childbirth experience which could lead to tokophobia. Aim: This study examined the association between perceived labour-pain and tokophobia amongst mothers who had normal vaginal birth in University of Port Harcourt Teaching Hospital Nigeria. Methods: A cross-sectional design was used. A sample size of 218 randomly selected birthing mothers was examined for the study. Fear of childbirth and numeric analogue scale for labour-pain interview questionnaires designed by the research team were used for data collection. Data were collected through face-to-face interview of consenting postnatal mothers at 24–36 h after labour. Collected data were analysed using descriptive and inferential statistics at P < 0.05. Results: About 85.3% of the respondents had severe perceived labour-pain. Only 2.8% of the respondents suffered moderate tokophobia. Occupation was significantly associated with tokophobia (P = 0.047) and homemakers (unemployed women) were more likely to suffer tokophobia. Perceived labour-pain, parity and age were not significant determinants of tokophobia (P > 0.05). Conclusion: Severe perceived labour-pain is widespread, whereas tokophobia is not very common in South-Southern part of Nigeria. Tokophobia was predicted by unemployment but not perceived labour-pain, parity and age. Midwives and other obstetric care givers should incorporate mental health services into prenatal care of unemployed women and advocate for adequate analgesia during labour to further reduce perceived labour-pain.
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Intestinal helminthiasis in pregnancy: Pattern and effect on packed cell volume amongst antenatal women in Delta state, South-South Nigeria p. 136
Williams Obukohwo Odunvbun
DOI:10.4103/phmj.phmj_18_20  
Background: Pregnant women are vulnerable to the negative effects of intestinal helminthiasis, due to increased nutritional demands during pregnancy and in severe cases may contribute to anaemia in pregnancy. Aim: The study was conducted to ascertain the pattern of intestinal nematodes among pregnant women in Delta State and the likely effect on their packed cell volume (PCV). Methods: This was a prospective cross-sectional study, involving 300 eligible, consenting antenatal women at the booking clinic of Eku Baptist Government Hospital in Delta State, between 1 January 2019 and 31 March 2019. Stool and blood samples were collected from every participant for analysis and evaluation, respectively, for helminthic pattern and PCV. A self-administered, structured questionnaire was used to capture relevant data. Data analysis was done by SPSS version 24. Results: Three-quarter of the women were below the age of 34 years. Over 80% (238/282) of the women were parous. Fifty-six per cent (158/282) of the women had secondary education. More than Fifty percent of respondents (154/282), were traders. Seventy-two (25.5%) women had a helminthic infestation. Ascaris lumbricoides accounted for the highest (62.5%) type of worm, followed by Necator americanus (23.6%). Pregnant women who had their toilet within their houses had a statistically significantly fewer helminthic infestation (P < 0.001). Hand washing was associated with a statistically significant reduction in helminthic infestation among the women (P < 0.001). There was no statistically significant difference in helminthic infestation across the trimesters (P = 0.224). Women with helminthic infestation had statistically significantly lower PCV (P < 0.001). Women with hookworm and mixed infestations had statistically significantly lower mean PCV (P < 0.001). Conclusion: A high prevalence of A. lumbricoides and hookwoom infestation among pregnant women was found in this study. Helminthiasis was associated with reduced PCV. The routine antihelminthics for pregnant women attending Eku Baptist Government Hospital, is recommended by these findings.
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Qualitative views on episiotomy amongst accouchers and pregnant women in a tertiary hospital in Southern Nigeria p. 142
Dokuba Tex-Jack, Chinemerem Eleke
DOI:10.4103/phmj.phmj_24_20  
Background: In 2018, the World Health Organization recommended the restrictive use of episiotomy by midwives and obstetricians on pregnant women undergoing vaginal birth. Unfortunately, the use of episiotomy is still fairly common in Africa. Aim: We examined the qualitative views on episiotomy amongst accouchers and pregnant women at the Rivers State University Teaching Hospital in southern Nigeria. Methods: A cross-sectional design was employed. Census sampling was used to enrol 19 accouchers (house officer doctors = 7 and nurse-midwives = 12) and 43 third-trimester pregnant women. Narrative data were collected through focused group discussion using an interview guide and a digital audio recorder. Collected data were transcribed and subjected to coding, content and thematic analysis to enable categorisation of themes. Results: Respondents were 22–46 years old. The accouchers mentioned several indications for episiotomy which were not consistent with current evidence in literature. In contrast to pregnant women's views, the accouchers reported that episiotomy is a clinician's choice, so pre-informing the pregnant woman about it is optional. Pregnant women were of the view that they should be more involved by being the ones to decide whether they want to receive episiotomy or not. Even when the accouchers viewed episiotomy as having some clinical uses, the pregnant women suggested that episiotomy should be banned. Conclusion: The views of the accouchers and pregnant women were not totally aligned with each other. More sensitisation of accouchers and pregnant women is required to ensure re-alignment of views based on available evidence.
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Health-seeking behaviour of commercial bus drivers in Uyo, Nigeria p. 147
Ofonime Effiong Johnson
DOI:10.4103/phmj.phmj_20_20  
Background: Commercial driving is a highly demanding job which often exposes the drivers to different health problems necessitating treatment. Various treatment options are available to these drivers. The objectives of this study were to assess the health problems and health-seeking practices of commercial bus drivers in Uyo, Nigeria. Methodology: This was a descriptive cross-sectional study carried out in March, 2020. Data collection was done using an interviewer-administered semi-structured questionnaire. Analysis of data was carried out with IBM SPSS Statistics, version 20.0. The level of significance was set at P < 0.05. Results: A total of 121 male respondents participated in the study. The mean age of respondents was 40.45 ± 10.49 years. More than half 71 (58.7%) respondents had completed secondary education. The most common health problems reported by respondents were low back pain (55.4%), insomnia (55.4%) and body aches (52.1%). The usual sources of treatment were chemist (60.3%), herbal remedies (51.3%), health facility (25.6%) and self-medication (17.4%). Among 32 (26.4%) respondents that ever had fractures, 23 (71.9%) received treatment from bone setters. Care seeking in health facility as reported by the drivers was mainly influenced by treatment cost (43; 35.5%) and waiting time (23; 19.0%). Conclusion: Commercial drivers in this study obtained treatment more frequently from places outside the health facilities. Health education on advantages of expert medical consultations and treatment in health facilities should be carried out through their transport unions. Furthermore, mechanisms to reduce waiting time and treatment cost in health facilities should be explored for this group of workers.
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CASE REPORT Top

Kawasaki disease in Port Harcourt, Nigeria p. 154
Woroma Wonodi, Tamunoiyowuna Grace Okari
DOI:10.4103/phmj.phmj_23_20  
Kawasaki disease (KD) is an acute febrile vasculitis of childhood, predominantly affecting medium-sized arteries with a predilection for coronary arteries and commonly occurring in children under the age of 5 years. Early recognition can be challenging; however, delayed diagnosis increases the risk of coronary artery abnormalities and death. We report a case of KD in a 19-month-old child who presented with prolonged fever, conjunctival congestion, skin rash and redness of lips and tongue. He was initially managed as a case of complicated measles, but with worsening symptoms, KD was suspected. Echocardiography revealed a left coronary artery aneurysm. He received two doses of intravenous immunoglobulin G, over a period of 24 h and responded remarkably to treatment. KD is rare in Port Harcourt, Nigeria, and children with prolonged fever and erythematous rash may be mistakenly managed for measles if there is no high level of suspicion amongst clinicians.
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