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.

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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.

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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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Background: Diseases associated with diarrhoea rank second among the top five diseases which account for childhood morbidities and mortalities in developing countries. Home-based management of diarrhoea is a globally recommended approach to reversing this trend and averting preventable deaths among under-five children. Aim: To explore the knowledge of, attitudes to and the practice of home management of diarrhoea (HMD) among mothers of under-five children. Methods: A cross-sectional, descriptive study was conducted in Samaru, Kaduna State, Nigeria, among mothers of under-fives, selected by multistage sampling method. Data were collected using interviewer-administered, close-ended, structured questionnaires, and then cleaned for errors and electronically analysed. Results: The awareness of the concept of HMD was universal. Diverse methods were mentioned by respondents, ranging from recommended to inappropriate options. The knowledge of oral rehydration salts was high (93.7%), with the main source of information being health facilities. However, only 34.4% of the respondents would resort to using ORS for HMD, and the overall practice of any form of HMD was only 64%. Conclusion: The knowledge of both recommended and inappropriate methods of HMD was demonstrated among respondents. Their awareness of ORS was high. However, the actual practice of HMD was relatively low. The promotion of positive HMD methods of fluid and electrolyte replacement; continuous, nutritious feeding and zinc supplementation for children with diarrhoea among mothers and caregivers is recommended.

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Background:  Gestational Trophoblastic Diseases (GTD) are a spectrum of inter-related but histologically distinct tumours originating from the placenta with good prognosis when diagnosed early.
Aim:  To determine the prevalence, clinical presentations, management of gestational trophoblastic disease at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
Methods:  A retrospective analysis of women treated for gestational trophoblastic disease from 1st January 2008 to 31 ^st  December 2012. The information from patients records: age, occupation, educational level, husband's occupation, parity, presenting symptoms, uterine size, mode of treatment and management options were collated and analysed. The Chi-square test was used to compare categorical variables with a p value of ≤  0.05 as significant.
Results:  A total of 38 cases of GTD were treated with a prevalence of 2.3 per 1,000 deliveries. The mean age and parity were 31 ±  6.3 years and 2 ±  1.6 respectively. Maternal age less than 35 years and low socioeconomic status were significantly associated with GTD (p=0.0000). The mean gestational age at presentation was 16.24 ±  5.4 weeks. The commonest clinical presentation was amenorrhoea in 100% of patients. Twenty-five(65.8%) cases of hydatidiform mole and 13(34.2%) cases of choriocarcinoma were observed. Twenty-two (57.9%) patients had suction evacuation only for hydatidiform mole, 3(7.9.%) had suction evacuation and cytotoxic therapy for hydatidiform mole and subsequent persistent trophoblastic disease while 8(21.1%) had chemotherapy for choriocarcinoma. Five patients with advanced choriocarcinoma did not receive definitive treatment before demise. Twenty (52.6%)defaulted in their follow up schedule.
Conclusion:  There is high prevalence of GTD in Port Harcourt with high mortality among patients with malignancy. Most of the patients defaulted in their follow up; thus there is a need for education and sensitization of the populace on GTD, as well as proper counseling of patients treated on the benefits of follow up visits.

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Background:  Malaria is a common health problem especially among the pregnant women in endemic countries such as Nigeria. Sulphadoxine/pyrimethamine (SP) has been recommended by the World Health Organisation (WHO) for malaria chemoprophylaxis in pregnancy and has been incorporated into our national malaria control programme. General medical practitioners provide prenatal care for significant proportion of our women in pregnancy.
Aim:  To examine the current knowledge and practice of malaria chemoprophylaxis during pregnancy among general medical practitioners in Port Harcourt, southern Nigeria.
Methods:  It was a questionnaire based study of 90 general medical practitioners in Port Harcourt, southern Nigeria which sought for their socio-demographic characteristics and knowledge and practice of malaria chemoprophylaxis during pregnancy. The data were entered into a personal computer and analysed using SPSS for windows version 10.0 and presented as frequency tables and percentages.
Results:  Of the 90 questionnaires, 59 duly completed forms were retrieved, giving a response rate of 65.60%. The age range of the respondents was 21-60 years with 31-40 years as the most common range. Only 33(55.93%) respondents knew the current malaria chemoprophylactic agent in pregnancy as recommended by WHO. Almost all (98.30%) respondents administered malaria chemoprophylaxis routinely to their antenatal women but only 44.06% administered correctly SP as recommended.
Conclusion:  The knowledge and practice of the WHO recommended malaria chemoprophylaxis in pregnancy among general medical practitioners is below average. Training and re-training of these primary care physicians on the use of sulphadoxine-pyrimethamine will tremendously improve their knowledge and practice of this WHO recommended chemoprophylactic agent in pregnancy which will in turn reduce malaria - related perinatal and maternal complications.

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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.

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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.

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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.

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Background: Comorbidities associated with HIV infection may have profound impact on the future clinical outcomes of infected patients. This study was carried out to assess the prevalence and types of comorbidities in newly diagnosed, highly active anti-retroviral therapy (HAART)-naïve adult HIV patients. Methods: A retrospective study of 501 consecutive newly diagnosed, HAART-naïve HIV-infected patients was carried out between April 2014 and September 2015 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Demographic characteristics, clinical data and comorbid disease condition at initial presentation were retrieved from the hospital records of study patients. Summary statistics was used to present discrete variables. Medians were calculated for continuous variables (age and CD₄counts). Kruskal–Wallis test was used to compare the medians across the different groups, and the Dunn's post's test was used to compare medians between two groups. Results: One hundred and sixty-one (32.1%) of 501 study patients were identified with comorbid conditions, of which 6 patients had more than one comorbid condition, indicating polypathology. The prevalence of comorbid conditions observed include renal disease (14.4%), hypertension (6.2%), tuberculosis (3.4%), oral thrush (2.4%), malaria (1.6%), urinary tract infection (2.2%), hepatitis-B (1%), diabetes mellitus (0.6%), while oesophageal candidiasis, herpes zoster, hepatitis-C and toxoplasmosis were 0.2% each. Comorbidities of infective origin were found predominantly in patients with WHO clinical class 3 and 4, corresponding with declining CD₄cell counts. Renal disease was present in all four clinical stages of HIV. Conclusion: Renal disease was the most prevalent comorbidity. Comorbidities of infective origin were found almost exclusively in patients with WHO clinical class 3 and 4. Findings highlight the need for detailed evaluation at initial presentation, prior to treatment initiation.

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Background: Patients with chronic kidney disease (CKD) have a high prevalence of cardiovascular risk factors. Cardiovascular disease is the leading cause of death in patients with CKD. Aim: The aim of this study is to determine the prevalence of the various cardiovascular risk factors in CKD patients and compare with that of healthy controls. Methods: A case-controlled study. The study sample included 94 diagnosed CKD patients above the age of 18 years without symptoms of cardiac disease and 70 controls. Fasting plasma glucose, lipid profile, creatinine, albumin, glomerular filtration rate and urinary albumin-creatinine ratio were estimated in participants. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The cardiovascular risk factors found in CKD patients versus controls were hypertension (62.7% vs. 11.4%), diabetes (13.8% vs. 7.1%), dyslipidaemia (50.0% vs. 31.4%), obesity (14.9% vs. 20.0%), hypoalbuminaemia (19.1% vs. 0%), microalbuminuria (55.3% vs. 20.0%) and macroalbuminuria (21.3% vs. 0%). However, only the prevalences of hypertension (P < 0.001), hypertriglyceridaemia (P = 0.007), low high-density lipoprotein (HDL) (P = 0.050), hypoalbuminaemia (P = 0.007), microalbuminuria (P < 0.001) and macroalbuminuria (P < 0.001) were statistically significant. Patients on maintenance haemodialysis had higher prevalence of hypertension (P = 0.018) and hypoalbuminaemia (P = 0.001) than pre-dialysis patients. Conclusion: Prevalences of hypertension, hypertriglyceridaemia, low HDL, hypoalbuminaemia, microalbuminuria and macroalbuminuria were significantly higher in CKD patients than in controls.

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Introduction: The perceived high cost of eye care services has been implicated as one of the reasons for the use of traditional eye medications (TEMs) in the country. Other factors including distance, tradition, ignorance, and failure of medical treatment among others have also been documented as determinants of TEM use. TEMs constitute a wide range of unorthodox therapies utilized for treatment of ocular disorders. They have been reported to have no beneficial effect rather causing more harm than good. Aim: This study sought to determine the prevalence, types, and ocular indications for TEM use in the study population. Methods: This was a cross-sectional study in which a structured questionnaire was used to collect relevant data from consecutive patients attending the eye clinic during the study. Results: At a prevalence of 15.8%, the highest use of TEM was noted among artisans, those in the seventh decade of life, with low level of education, ocular complaints of poor vision, and illness of <1 year duration. Its use though high, was not significantly associated with age, sex, education, occupation and illness duration. Roots and herbs were the most common types of TEM used. Conclusion: There was a high prevalence of use of TEM in this study. The deleterious effect of its use is known and has been reported in literature. Education and enlightenment of the public are needed and highly recommended.

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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.

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Background: Missed immunisation appointments are a common occurrence among Nigerian children, and it is due largely to forgetfulness on the part of the parents/caregivers. Although the use of mobile phones is widely available to Nigerian mothers, the readiness of Nigerian mothers to accept a mobile phone short message service (SMS) for interacting with immunisation providers, specifically, for tracking immunisations appointments, notifying absence of vaccines and accessing other vaccine information remains uncertain. Aim: The aim of this study was to assess the acceptance of mobile phone text messaging for childhood immunisation reminders by Nigerian mothers as well as its determinants. Methods: A descriptive cross-sectional, questionnaire-based study carried out over 3 months (June–August 2017) at the Federal Medical Centre, Owerri, Nigeria. Results: A total of 253 mothers were interviewed. About 27% of the mothers reported to have missed their babies' immunisation appointments in the past. Mothers who are currently married (χ² = 5.954, P = 0.015) and those with higher levels of education (χ² = 13.001, P = 0.005) were significantly less likely to forget their child's immunisation dates. Majority (75.9%) believe that reminders will reduce missed immunisation appointments. A greater proportion (61.7%) of the mothers would accept a phone reminder for their babies' immunisation appointments. Many (76.9%) of them were willing to pay for such services. Conclusion: Forgetfulness is one of the major reasons for missed immunisation appointments among mothers in Nigeria. Considering the acceptance of SMS by the majority of the mothers studied, there is no doubt that its adoption in Nigeria will create a positive impact in improving immunisation of children in Nigeria.

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Background: Minor procedures such as venepuncture and lumbar puncture among others are routinely performed in the neonatal intensive care units (NICUs) and paediatric wards. These procedures are accompanied by varying degrees of pain which, if not addressed, can lead to undesirable physiological, cardiovascular, respiratory, hormonal, metabolic and behavioural responses. This study evaluated the current strategies for reducing procedural pain in children in Nigeria. Methods: This was a questionnaire-based, cross-sectional random survey of the current practice of analgesic techniques for procedural pain among 240 respondents out of 700 consultant paediatricians and residents who attended the annual Paediatric Association of Nigeria Conference in 2018. Results: The male-to-female ratio was 1:1.3, the mean age of the respondents was 38.28 ± 7.36 years and the median year of practice was 10 years. Of the surveyed respondents, consultants and trainees constituted 40.8% and 59.2%, respectively, whereas 46.2% and 51.3% of them assessed pain and routinely administered analgesia to treat procedural pain, respectively. Breastfeeding and topical analgesic agent were prescribed by 18.3% and 12.9% of the respondents, respectively. Pain of venous access and lumbar puncture were treated by 38.8% and 19.6% of the respondents, respectively. Only 13.3% of the respondents have institutional guidelines for pain assessment and treatment in their practice locations. Conclusion: The survey showed that, even though a sizeable proportion of paediatricians do assess pain and provide some form of analgesia for procedural pain, there is a lack of institutional pain treatment guidelines in most hospitals attending to the medical needs of children in Nigeria.

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Monkeypox (MKPX) is a rare viral zoonosis which was first discovered in a laboratory in Denmark in 1958. This critical review involved literature search of data on the history of MKPX virus (MKPXV), its emergence and re-emergence, molecular virology, global epidemiology and geographical distribution, the recent outbreak of MKPX in Nigeria, diagnostic and treatment considerations using Google Scholar, PubMed and Scopus. Findings from this review revealed that the first human cases of MKPX were diagnosed and differentiated from smallpox in the early 1970s. Since this period, several cases have been reported in rural, rainforest areas of West Africa and the Congo Basin, especially in the Democratic Republic of Congo, Cote d'Ivoire, Cameroon, Midwest of the United States of America, South-Sudan, Central African Republic, and recently in Nigeria. The outbreaks in the non-endemic areas of the US and Sudan occurred due to zoonotic transmission of the virus into these nonrain forested areas. The geographical spread of MKPXV until date has renewed research efforts in unravelling environmental factors that favour ecological niche of this pathogen. This study aimed to review both biotic and abiotic factors that are responsible for the expansion of the ecological niche and geographic distribution of human MKPX in Nigeria. It appears that environmental factors, conflict and globalisation are responsible for the increasing risk of animal-human transmission through direct contact between the cutaneous or mucosal lesions of the infected animal and the compromised skin barrier of a human, and the consumption of poorly cooked-infected flesh. Lymphadenopathy is a distinguishing clinical feature of MKPX from other pox-like illnesses. Laboratory diagnosis of anti-poxvirus antibodies in an unvaccinated person with a clinical history of severe illness and total body rash is suggestive of MKPX infection. The lack of sufficient data to guide the identification of potential reservoir hosts, and public health intervention strategies/surveillance, inadequate training for health workers, unavailability and inaccessibility of suitable diagnostic assays, vaccines and anti-viral treatment could be some of the reasons cases of MKPX re-emerge when not successfully contained, especially in endemic regions.

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