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Health care financing in Nigeria: Implications for achieving universal health coverage
BSC Uzochukwu, MD Ughasoro, E Etiaba, C Okwuosa, E Envuladu, OE Onwujekwe
July-August 2015, 18(4):437-444
DOI:10.4103/1119-3077.154196  PMID:25966712
The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.
  23,121 2,091 6
Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: A systematic review and meta-analysis
BM Musa, S Bussell, MM Borodo, AA Samaila, OL Femi
March-April 2015, 18(2):163-172
DOI:10.4103/1119-3077.151035  PMID:25665986
Vaccination against the hepatitis B virus (HBV) in the West African nation of Nigeria is lower than many Sub-Saharan African countries. In Nigeria, HBV is reported to be the most common cause of liver disease. However, the extent of HBV exposure among Nigerians at average risk is unknown. Our aim, therefore, was to accurately estimate the HBV prevalence for the country and the prevalence for specific subgroups. We used electronic databases to select systematic reviews and meta-analyses from 2000 to 2013. Forty-six studies were included (n = 34,376 persons). We used a random effects meta-analysis of cross-sectional and longitudinal studies to generate our estimates. The pooled prevalence of HBV in Nigeria was 13.6% (95% confidence interval [CI]: 11.5, 15.7%). The pooled prevalence (% [95% CI]) among subgroups was: 14.0% (11.7, 16.3) for blood donors; 14.1% (9.6, 18.6) for pregnant women attending antenatal clinics; 11.5% (6.0, 17.0) for children; 14.0% (11.6, 16.5) among adults; and 16.0% (11.1, 20.9) for studies evaluating adults and children. HBV prevalence in Nigeria varied by screening method [% (95% CI)]: 12.3% (10.1, 14.4) by using enzyme-linked immunosorbent assay; 17.5% (12.4, 22.7) by immunochromatography; and 13.6% (11.5, 15.7) by HBV DNA polymerase chain reaction. HBV infection is hyperendemic in Nigeria and may be the highest in Sub-Sahara Africa. Our results suggest that large numbers of pregnant women and children were exposed to HBV from 2000 to 2013. Increased efforts to prevent new HBV infections are urgently needed in Nigeria.
  16,772 1,609 12
Patients' satisfaction with services obtained from Aminu Kano Teaching Hospital, Kano, Northern Nigeria
Z Iliyasu, IS Abubakar, S Abubakar, UM Lawan, AU Gajida
October-December 2010, 13(4):371-378
Objective : Periodic patient satisfaction surveys provide feedback to hospital management and staff regarding the quality of services rendered. These surveys have become routine as part of total quality management in developed countries. We assessed patient satisfaction with services provided in a teaching hospital in northern Nigeria. Method : Structured questionnaires were administered on a cross-section of 201 patients and two focus group discussions were held with patient relatives at Aminu Kano Teaching Hospital. Results : Overall, 83% of the patients were satisfied with the services received from Aminu Kano Teaching Hospital, while the remaining 17% were dissatisfied. Specifically, 88%, 88%, 87% and 84% of the patients were satisfied with patient provider relationship, in-patient services, hospital facilities and access to care. However, 30% and 27% of the patients were dissatisfied with waiting time and cost of treatment respectively. Patients and their relatives complained about delayed appointments, missing folders, missing laboratory results and long appointments for ultrasound and other radiological investigations. Conclusion : The high patient satisfaction notwithstanding, health workers need to consider patients as customers by being friendly and reducing waiting time for consultation and investigations. Widespread implementation of the National Health Insurance Scheme will also reduce the cost of services and drugs to patients.
  11,218 1,522 1
Comparative ultrasound measurement of normal thyroid gland dimensions in school aged children in our local environment
TT Marchie, O Oyobere, KC Eze
July-September 2012, 15(3):285-292
Objective: The objective of this study was to determine the measurement of normal range of ultrasound (US) thyroid gland dimensions in school-aged children (6-16 years) in our environment and compared with what is obtained elsewhere. Setting and Design: A prospective ultrasound measurement study done in University of Benin Teaching Hospital Benin, Nigeria. Materials and Methods: A prospective ultrasound (US) study of thyroid dimensions of 500 school-aged children in our environment consisting of 227 boys and 273 girls was done from 1 December 2006 to July 2007. The subjects were examined by the authors and subjects with palpable abnormal thyroid gland were excluded from the study. The thyroid dimensions (length, height, and diameter) were taken for each lobe by means of ultrasound (US). In addition volume of each thyroid lobe was calculated and the summation of volume of the lobes was taken as thyroid gland volume of each subject. Also height and weight of patients were documented from which the subject's body surface was calculated. Incidental thyroid gland lesion in US was excluded from the study. Using the Statistical program of social science (SPSS) and INSTAT (Graph Pad Inc. USA) the data were analyzed. Informed consent was obtained from all the subjects and the study was done in line with the ethical guidelines of the centers. Results: The US thyroid gland volume in school-aged children in Benin City from this study ranges between 1.17 cm 3 and 7.19 cm 3 , mean volume range of 1.76-4.95 cm 3 , median volume range of 1.73-4.73 cm 3 , and range of standard deviation from 0.39 cm 3 to 1.49 cm 3 . The average mean thyroid volume is 2.32 cm 3 with the following average dimensions; anteroposterior right lobe =1.06 cm, mediolateral right lobe = 1.01 cm and craniocaudal right lobe = 2.34 cm, and anteroposterior left lobe = 1.01 cm, mediolateral left lobe = 1.04 cm and craniocaudal left lobe = 2.41 cm for both boys and girls respectively. These data are significantly lower than data obtained by European based World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) 1997. However there is significant similarity with data obtained in similar environment. Conclusion: Ultrasound thyroid gland dimensions in school-aged children in our environment are reproducible and the data obtained are comparable to those obtained in other environment. The values may be better used in our environment as reference data for screening purposes.
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Management of pheochromocytoma: Old ideas and new drugs
R Domi, H Laho
July-September 2012, 15(3):253-257
Pheochromocytoma presents a challenge to the surgery team because of its clinical features and implications. The patient must be treated before the surgery until a stable hemodynamically state is achieved. The preoperative treatment includes α2-short acting adrenergic blocking and β-blocker agents. The most crucial intraoperative moments are induction of anesthesia and hemodynamic oscillations. An adequate preoperative preparation, modern anesthetic drugs, good collaboration between the surgeons and the anesthesiologists, and postoperative care decrease the rate of complications and improve the outcome. This review aims to discuss all the possible pharmacological strategies of perioperative management of phoechromocytoma, focusing on new drugs and treatments.
  9,297 2,998 5
Obesity in adult Nigerians: A study of its pattern and common primary co-morbidities in a rural Mission General Hospital in Imo state, south-eastern Nigeria
GUP Iloh, AN Amadi, BO Nwankwo, VC Ugwu
April-June 2011, 14(2):212-218
DOI:10.4103/1119-3077.84019  PMID:21860142
Objectives: This study was generally aimed at determining the prevalence and pattern of obesity using body mass index (BMI) criterion and specifically screening for its common primary co-morbidities among adult Nigerians attending a rural Mission General Hospital in Imo state, South-Eastern Nigeria. Materials and Methods: A descriptive study was carried out from June 2008 to May 2009. A total of 2156 consecutive new adult patients aged 18-90 years were screened for obesity using the BMI criterion, and 129 patients had BMI ≥30 kg/m 2 and met the inclusion criteria. The data collected included age, sex, marital status, education, occupation, social class, weight, height and blood pressure, fasting blood sugar and lipid profile. Results: The prevalence of obesity was 6.0%, with class I obesity (86.1%) being the most common pattern. Hypertension (16.3%) was the most common primary co-morbidity; others included low high-density lipoprotein-cholesterol (21.7%), high low-density lipoprotein-cholesterol (9.3%), high total cholesterol (7.8%), high triglyceridemia (4.7%) and diabetes mellitus (3.9%). Conclusions: This study has shown that obesity and its primary co-morbidities are emerging as a serious health problem among the study population, with class I obesity being the most common pattern and hypertension being the most common primary co-morbidity. Anthropometric determination of obesity and screening for its common primary co-morbidities should be integrated as part of the clinic baseline assessment of adult Nigerians attending rural hospitals to facilitate their early detection and institutionalization of appropriate preventive and therapeutic measures.
  10,837 1,006 11
Partograph as a tool for team work management of spontaneous labor
AAE Orhue, ME Aziken, AP Osemwenkha
January-March 2012, 15(1):1-8
It is presently being debated whether the partograph is a useful tool for labor supervision and, if useful, where should the action line be located between 2, 3 or 4 h to improve the fetomaternal outcome. This review adduces facts to show that this debate is because there is a poor understanding of the essence and purpose of the partograph. The partograph is a form on which labor observations are recorded to provide an overview of labor, aiming to alert midwives and obstetricians to deviations in labor progress as well as maternal and fetal wellbeing. When deviations in labor progress are recognized early and corrected, complications are prevented and normal labor and delivery can occur. The earliest deviation in labor progress is slow labor progress, for which the partograph alert line is a prompt for early recognition by the midwives and other non-obstetric staff. The intervention to correct the deviation is at the action line by the staff with the requisite skill. In the circumstance in which the partogram was produced, the action to correct the deviation in labor progress was after 4 h, represented by the 4-h action line, but other workers have attempted with 2- and 3-h action lines and have had equally good results. However, in all these, the action at the action line was instituted by the staff with the appropriate skill, irrespective of whether the action line was 2, 3 or 4 h. As long as the action at the action line is by the staff with the requisite training, the deviation in labor progress will be corrected by either medical or surgical means irrespective of the action line location at 2, 3 or 4 h. In conclusion, the essence and purpose of the partograph is to ensure that labor progress is monitored to identify slow labor by the alert line but appropriate treatment must begin at the action line by the staff with the cognate skill, whether at 2, 3 or 4 h. The appropriateness of the intervention at the action line is the determinant of the outcome and not the delay.
  10,444 1,338 5
Obesity: An emerging disease
AM Ogunbode, MMA Ladipo, IO Ajayi, AA Fatiregun
October-December 2011, 14(4):390-394
DOI:10.4103/1119-3077.91741  PMID:22248935
Obesity is rapidly becoming an emerging disease in developing countries due to the increasing westernization of societies and change in the lifestyle. The etiology of obesity is said to be multifactorial, with a combination of genetic and environmental factors. Literature has been extensively reviewed to provide a broad overview of obesity. Data for this review were obtained from original articles, review articles and textbooks. Internet search engines were also employed. The years searched were from 1993 to 2008. Obesity, classified in terms of the body mass index and the waist-hip ratio, has several associated co-morbidities such as diabetes mellitus, hypertension, degenerative osteoarthritis and infertility. In Nigeria, there is limited information on obesity. A literature review on obesity is necessary to improve the knowledge about obesity in developing countries, its prevention and its management.
  9,685 1,962 19
The knowledge attitude and practice regarding diabetes and diabetic retinopathy among the final year medical students of King Faisal University Medical College of Al Hasa region of Saudi Arabia: A cross sectional survey
FA Al Wadaani
April-June 2013, 16(2):164-168
Purpose : The purpose of the study was to assess the knowledge attitude and practice of the final year medical students of king faisal university medical college towards diabetes and diabetic retinopathy. Materials and Methods: A cross sectional survey was conducted in King Faisal university Medical college of Al Hasa province of Saudi Arabia in May 2012. The student population was the Final Year students of MBBS. All 96 students of final year MBBS were included in this study. The data were collected by means of filling up of pre-tested specially designed questionnaires focused on Knowledge, Attitude and practice towards Diabetes Mellitus and Diabetic retinopathy. The answers were scored by assigning marks. A SPSS 17 was used for statistical analysis. Results: The mean of overall KAP score (±SD) for all the respondents were 64.75 ± 11.17 (Maximum 100). Male students scored better than the females students (65.30, P = 0.02 vs. 64.18, P = 0.02). The male student scored better in the knowledge (35.83 vs. 34.05, P = 0.018) and practice (13.63 vs. 12.95, P = 0.045) category while the attitude score of female student (17.16 vs. 15.83, P = 0 .020) was significantly higher than the male students. The main weakness of knowledge was on epidemiology of Diabetes Mellitus (DM), the follow up of the diabetic patient for the screening of diabetic retinopathy and the relation of duration of diabetes with the development and progression of diabetic retinopathy. Many students believed that diabetes is more prevalent among the uneducated people. Ninty percent students did not know the proper angle of insulin injection. Conclusion : This survey highlights some of the lacuna in the teaching system of the medical students and identified the need for improvement in their knowledge, attitude and practices for treating the patients with diabetes and diabetic retinopathy. This can be done by incorporating special syllabus focusing on diabetes and diabetic retinopathy in their teaching programme.
  10,747 791 1
Characteristics of clients accessing HIV counseling and testing services in a tertiary hospital in Sagamu, Southwestern Nigeria
AA Salako, OA Jeminusi, OA Osinupebi, OO Sholeye, AO Abiodun, OT Kuponiyi
October-December 2012, 15(4):391-396
Introduction: Client-initiated HIV testing and counseling has helped millions of people learn their HIV status. Nevertheless, global coverage of HIV testing and counseling programs remains low. This study describes the characteristics of clients who accessed HIV counseling and testing (HCT) services in Olabisi Onabanjo University Teaching Hospital, (OOUTH) Sagamu. Materials and Methods: A retrospective study of the clients accessing HCT services in OOUTH. Data was collected from clients using a client intake form. Pre-test counseling, HIV screening and post-test counseling were carried out. Informed consent and confidentiality were ensured. Data obtained were analyzed using SPSS 10.0. Results: A total of 2607 clients accessed our HCT services between May 1 st 2008 and April 30 th 2010. The clients were between the ages of 1 year and 90 years. The mean age was 33.3 ± 15.26. The median age was found to be 32.0 years, with the modal age being 30.0 years. 73.7% (1828) were non-reactive (negative result), 25.9% (643) were reactive (positive result), while 0.3% (8) were indeterminate. Among the reactive results, 9.3% (242) were males while 15.1% (394) were females. Conclusion: A fair uptake of HCT services was noted. More females accessed services than males. More positive results were seen among females than males (P<0.05). Recommendations: Upscale of HCT services to involve Sexually transmitted infections clinics and free-standing, client-initiated testing centers is necessary. Continuous AIDS education and risk reduction should be promoted.
  11,100 288 -
Knowledge of HIV/AIDS among secondary school adolescents in Osun state, Nigeria
OF Bamise, CT Bamise, MA Adedigba
July-September 2011, 14(3):338-344
DOI:10.4103/1119-3077.86780  PMID:22037081
Background and Objectives: This study aimed to assess the knowledge of secondary school pupils in Osun State about HIV/AIDS and the sources of their information. Materials and Methods: A multistage random sampling technique was used to select 592 secondary school pupils from 5 local government areas of Osun State, Nigeria. A self-administered questionnaire was used which composed of questions on their knowledge and sources of information about HIV/AIDS. Results: About half believed that HIV can be contracted via mosquito bites and 53.7% believed via kissing. Half of the respondents agreed that a person who looks healthy can be infected and possess the ability to describe the look of an infected person. Majority (92.6%) claimed to have heard about HIV/AIDS prior to the study. More than half (67.8%) agreed that HIV/AIDS is a life-threatening disease, 29.4% said there is a cure for AIDS, and 77.6% thought that the government is doing enough to deal with the disease. The most important sources of HIV/AIDS information among the respondents were the media and the least important sources of information were the traditional healers (35.3%). Conclusion: This study revealed a high-level misconception among secondary school pupils in Osun State, Nigeria. Mass media was the major source of information with doubtful effectiveness evidenced by obvious erroneous beliefs. An improved multisectorial approach in HIV/AIDS education with greater participation of school and public libraries is advised.
  10,433 691 5
Neonatal jaundice and its management: Knowledge, attitude, and practice among expectant mothers attending antenatal clinic at University of Benin Teaching Hospital, Benin City, Nigeria
BA Egube, AN Ofili, AR Isara, JU Onakewhor
April-June 2013, 16(2):188-194
Introduction: Neonatal Jaundice (NNJ) is a common disorder worldwide and one of the important contributors to the high neonatal morbidity and mortality in Sub-Saharan Africa. Severe neonatal jaundice leads to brain damage or even death in otherwise healthy newborns. The objective of the study was to assess the knowledge, attitude and practice of expectant mothers about neonatal jaundice and its management. Materials and Methods: The study was descriptive cross-sectional, carried out among 389 expectant mothers who were attending the antenatal clinic at the University of Benin Teaching Hospital. A structured, Pre-tested, researcher administered questionnaire was used to interview the respondents. Data was analysed using SPSS version 15. Results: The mean age of the expectant mothers was 30.5 (SD 4.9) years. Fifty-five (14.1%) of respondents had previous experience with NNJ, 8 (2.1%) lost babies due to NNJ. 334 (85.9%) were aware of the condition, 381 (77.4%) knew how to recognize the symptoms of NNJ, 279 (71.7%) knew a correct method of treatment of NNJ. A large proportion of the expectant mothers 261 (67%) knew some complications of NNJ. Two hundred and five (52.7%) did not know any danger sign of complications of NNJ. Three hundred and fifty five (91.3%) had good attitude towards its management. Majority of expectant mothers whose previous babies had NNJ took the babies to the hospital for treatment. A large proportion also expressed their willingness to seek medical attention if their babies were to develop the condition. Their knowledge of neonatal jaundice was significantly influenced by their level of education and the number of their previous babies who had NNJ. Conclusion: This study revealed that expectant mothers attending antenatal clinic at UBTH had good knowledge of the treatment and complications of NNJ but inadequate knowledge of the causes and danger signs of the condition. Their attitude and practice towards the management of NNJ was good. It is therefore recommended that Health care providers should give more health education on NNJ to the expectant mothers during antenatal visits.
  9,218 1,309 8
Knowledge and behavior towards voluntary blood donation among students of a tertiary institution in Nigeria
AG Salaudeen, E Odeh
July-September 2011, 14(3):303-307
DOI:10.4103/1119-3077.86773  PMID:22037074
Background: Blood donation is the only way of acquiring blood to meet emergency requirements in cases of road traffic accidents, complications of pregnancy and childbirth, various anemic disorders and surgical emergencies among others. Globally, 80 million units of blood are donated each year, but only two million units are donated in sub-Saharan Africa where the need is enormous. The objective of this study was to determine the behavior of the students of a tertiary institution in Nigeria towards voluntary blood donation. Materials and Methods: This is a descriptive cross-sectional study, which involved students of a tertiary institution in Nigeria. A multistage sampling technique was employed in selecting the participants for this study. A semi-structured self-administered questionnaire was used to collect information on socio-demographic characteristics, knowledge, attitude and factors affecting voluntary blood donation. The data obtained were analyzed using EPI-INFO 2005 software Version 3.3.2. Results: Less than two-thirds (61%) of total respondents had good knowledge of blood donation. More than three quarters (85%) of the respondents had never donated blood. Of the 15% that had donated, only 3% donated voluntarily. Among those that had ever donated, males (57%) were more than females. Many of the donors donated for relatives (57%). The majority of the respondents were compelled to donate because of emergency situations (75%). The reasons why many did not donate were lack of opportunity (45%) due to tight lecture schedule and inadequate knowledge (24%). Gift items such as hematinics, T-shirts and wrist bands (29%) would motivate respondents to donate. Conclusion: The Students' Union body and other Organizations in the University should include a blood donation drive in their monthly/annual activities. The University authorities, the University health service centre and the Hematology Department of the Teaching hospital should collaborate in promoting voluntary blood donation among the students.
  9,362 1,103 9
Analysis of cases of rape as seen at the Jos University Teaching Hospital, Jos, North Central Nigeria
PH Daru, EO Osagie, IC Pam, JT Mutihir, OA Silas, CC Ekwempu
January-March 2011, 14(1):47-51
DOI:10.4103/1119-3077.79240  PMID:21493992
Objective: Women are at a higher risk of being sexually harassed. There is a need to document the clinical findings of this crime and its outcome in order to improve the quality of care the victims receive. Materials and Methods: Case notes of patients who presented with alleged rape at Jos University Teaching Hospital between January 2001 and December 2003 were retrieved and analyzed. Results : During the study period, 2,135 patients were seen in the Gynaecological Emergency Unit. A total of 120 were for alleged rape, representing 5.6% of the total cases seen. However, only 105 case notes were available for analysis. Of these, 63.8% of the alleged rapes were in children, with the infantile age group accounting for 26.7%. 36.2% of the victims had experienced some form of sexual exposure prior to the rape. A previous relationship with the rapist was established in 77.4% of the cases. Most cases delayed in presenting to hospital. Thirty six percent of the cases did not have a human immunodeficiency virus screening test done. Candida albicans (13.3%) accounted for most of the infectious agents. Emergency contraception was administered to the victims when indicated. Conclusion: Women under 16 years of age were at an increased risk of being raped, possibly because they are defenseless and vulnerable. Three quarters (3/4) of the assailants had some form of relationship with the victims, which may account for the delays in reporting. Children and young adolescents were more at risk than adults to be raped.
  9,740 456 7
Co-infections of hepatitis B and C with human immunodeficiency virus among adult patients attending human immunodeficiency virus outpatients clinic in Benin City, Nigeria
CK Ojide, EI Kalu, E Ogbaini-Emevon, VU Nwadike
July-August 2015, 18(4):516-521
DOI:10.4103/1119-3077.151790  PMID:25966725
Background: Hepatitis B and C viral co-infections with human immunodeficiency virus (HIV) are known to affect progression, management, and outcome of HIV infection. This study was aimed to access the prevalence of hepatitis B and C co-infections in HIV-infected adult patients in the University of Benin Teaching Hospital with a view of understanding the gravity of this problem in the local population. Methods: The descriptive cross-sectional study was carried out on 342 HIV-infected adult patients on highly active antiretroviral therapy attending HIV Outpatients Clinic of University of Benin Teaching Hospital, between April and September, 2011. Patients' sera were screened for hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) using immunochromatographic-based kits. Clinical stage of HIV and CD4+ cell counts were equally evaluated. Data were analyzed using SPSS version 17. Results: Of the 324 HIV-infected patients screened, 53 (15.5%) were positive for HBsAg, 24 (7.0%) positive for hepatitis C virus antibodies (HCV-Ab), while 2 (0.6%) were positive for both viruses. Seroprevalence of HBsAg was higher in male (17.8%) than in female (14.7%) (χ2 = 0.49, P = 0.49), while the reverse is the case for HCV-Ab; 7.1% for female and 6.7% for male (χ2 = 0.02, P = 0.88). Seroprevalences of HBsAg and HCV-Ab were also higher among patients in World Health Organization disease stages 3-4 and patients with CD4+ cell count ≤200 cell/ml compared to those in stages 1-2 and with CD4+ cell count >200 cell/ml. Conclusion: Co-infection with hepatitis B virus and HCV among HIV/acquired immune deficiency syndrome (AIDS) patients is still a problem in our environment. Screening for these viruses among HIV/AIDS patients will allow for early detection and proper management.
  2,353 7,818 3
Marfan syndrome: Report of two cases with review of literature
AK Randhawa, C Mishra, SB Gogineni, S Shetty
July-September 2012, 15(3):364-368
Marfan syndrome is a variable, autosomal dominant disorder of connective tissue whose cardinal features affect the cardiovascular system, eyes and skeleton. The minimal birth incidence is around 1 in 9800. About three quarters of patients have an affected parent; new mutations account for the remainder. The patient's prognosis depends on the severity of cardiovascular complications and is mainly determined by progressive dilation of the aorta. If signs of Marfan syndrome are recognized, it is important to refer to the correct health care professional for further testing to prevent associated complications. If not properly treated, premature death may be caused by the severe cardiovascular and pulmonary complications associated with Marfan syndrome. Therefore, it is important to identify this potentially life-threatening condition in general practice. This article reports two cases with a very typical features of Marfan syndrome.
  8,899 1,208 2
Rectal and genital prolapse in Nigerian newborns: Case reports and review of the literature
AA Folashade, OT Adetutu, FM Bolanle
January-February 2014, 17(1):119-121
DOI:10.4103/1119-3077.122873  PMID:24326821
Genital prolapse in the newborn is a rare clinical condition often times seen in association with congenital myelo-meningocele, or this could occur following shigellosis infection. We therefore report two neonates with rectal prolapse following diarrhea and utero-vaginal prolapse associated with congenital spinal bifida.
  9,810 291 -
Home management of childhood diarrhoea: Need to intensify campaign
GN Adimora, AN Ikefuna, G Ilechukwu
April-June 2011, 14(2):237-241
DOI:10.4103/1119-3077.84028  PMID:21860147
A review of home management of childhood diarrhea in under-five children among 203 Nigerian mothers was carried out over a period of 3 months in order to ascertain how effectively they manage their children with diarrhea outside a hospital setup (infrastructural health facility). Mothers whose children had diarrhea, with or without other symptoms, and presented at the Children's Out Patient unit (CHOP), of the UNTH over the study period were consecutively interviewed through a questionnaire designed for the study. The questionnaires were designed and administered by the authors. There were 30 mothers in social class 1; 59 in social class 2; 52 in social class 3; 13 in social class 4, and 7 mothers in social class 5. Information was obtained on the method of detection, causes of diarrhea, and treatment including their knowledge and use of oral rehydration salts with or without anti diarrheal and antibacterial agents. Out of the 203 mothers interviewed, 140 (71%) correctly defined diarrhea. 112 (55.2%) could identify correct causes of childhood diarrhea. Only 80 (39.4%) could correctly manage diarrhea at home. About 76% (154 mothers) knew that they should use an oral rehydration salt; of this number, 56 (27.6%) could correctly prepare SSS, while 29 (14.3%) could do the same for the UNICEF ORS. In addition, anti bacterial, anti-diarrheal, and/or herbal preparations were used by 38 (18.7%) of the mothers. The level of knowledge of oral rehydration therapy has dropped in our locality since its inception in the early 1990s. There is need to intensify maternal education in this area since we now have a new generation of mothers who were not there during the inception of the program.
  8,248 1,134 9
Accuracy of clinical and ultrasound estimation of fetal weight in predicting actual birth weight in Enugu, Southeastern Nigeria
EO Ugwu, PC Udealor, CC Dim, SN Obi, BC Ozumba, DO Okeke, PU Agu
May-June 2014, 17(3):270-275
DOI:10.4103/1119-3077.130208  PMID:24714001
Background: Estimation of fetal weight is important for antenatal and intrapartum management of pregnant women. Sonographic methods are not readily accessible in under-resourced settings, it is therefore necessary to study the accuracy of a clinical method of estimating fetal weight where this limitation (unavailability of ultrasound) exists. Objective: To compare the accuracy of clinical and ultrasound methods of fetal weight estimation at term. Materials and Methods: Clinical and ultrasound fetal weights were estimated on 200 consecutive term pregnancies (37 completed weeks of gestation - 41 weeks and 6 days) at the University of Nigeria Teaching Hospital, Enugu, Nigeria from 1 st April to 30 th November 2012. Accuracy was determined using percentage error, absolute percentage error, and proportion of estimates within 10% of actual birth weight. Results: Actual birth weight had strong positive correlation with both clinical and ultrasound estimated fetal weights (r = 0.71, P < 0.001 and r = 0.69, P < 0.001, respectively). Overall, both the clinical and ultrasound methods systematically overestimated the actual birth weight. The proportion of the clinical estimated weights that were within 10% of the actual birth weight was significantly lower than that of ultrasound method for babies of all birth weights (35.0 vs. 67.5%; P < 0.001) and for macrosomic babies (76 vs 100%, P = 0.009). For babies with normal birth weights (2.5-3.9 kg), ultrasound method error values were significantly lower than those of clinical method for both the mean % error (5.4 vs 19.6%; P < 0.001) and the mean absolute % error (9.97 vs 20.6%; P < 0.001). Conclusion: The ultrasound method is generally a better predictor of the actual birth weight than the clinical method, and thus should be used in estimating the actual birth weight when accessible.
  8,542 592 4
Caregivers' willingness-to-pay for a topical anesthetic cream for minor medical procedures in children
MD Ughasoro, ND Udem, NK Chukwudi, FC Korie, BSC Uzochukwu, EO Onwujekwe
July-August 2014, 17(4):506-510
DOI:10.4103/1119-3077.134054  PMID:24909478
Background: Topical anesthetic cream (TAC) is not in use in pediatric practice in Sub-saharan regions. Knowledge of Caregivers' willingness-to-pay (WTP) for the cream is necessary for its deployment. Objective: To determine the WTP for TAC for minor pediatric painful procedures. Materials and Methods: The study was a questionnaire-based conducted in two tertiary health institutions in southeast Nigeria. WTP was elicited using the contingent valuation method. The respondents were caregivers to children that attended out-patient clinics and in-patient. Data analysis was by Statistical Package for the Social Sciences software (SPSS) and STATA11. Results: Majority (94%) of the respondents were willing to pay for TAC. The mean maximum WTP was US$8.31. Multivariate analysis showed no statistically significant association between many variables with WTP for TAC. Conclusions: Their average WTP was higher than the market price of topical anesthetic cream. Therefore, there is a good prospect for TAC if deployed in Nigeria.
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Knowledge, attitude and practice of ministry of health primary health care physicians in the management of type 2 diabetes mellitus: A cross-sectional study in the Al Hasa District of Saudi Arabia, 2010
AR Khan, Z Nase Al Abdul Lateef, MA B Khamseen, MA Al Aithan, SA Khan, I Al Ibrahim
January-March 2011, 14(1):52-59
DOI:10.4103/1119-3077.79241  PMID:21493993
Objective: To assess the Knowledge Attitude and Practice (KAP) of MOH Primary Health Care Physician in the management of Type 2 Diabetes Mellitus (DM) Materials and Methods: A cross sectional survey was conduced between April and October 2010 on MOH Primary Health Care physicians working in Al Hasa district of Saudi Arabia by filling up of pre-tested specially designed questionnaires focused on Knowledge, Attitude and practice towards Type 2 DM patients. The answers were scored by assigning marks. A SPSS 18 was used for statistical analysis. Results: The mean of overall KAP score (±SD) for all the respondents were 66.59±8.82 (Maximum 100). Male physicians scored better than the females physicians (66.90, P=.018 Vs 64.67, P=.018) and the same was true with the rural physicians who scored higher (68.65 ±10.19, P=.003) than the urban physicians (65.34±7.36, P=.003).The main weakness of knowledge was on epidemiology of Diabetes Mellitus (DM). 28.3 % (n=28) of physicians didn't know the correct diagnostic criteria of Type 2 DM and only 34.7% physicians knew the correct angle of insulin injection. 86.8% (n=86) of the physicians did not agree that Diabetic Self Management Education (DSME) is an essential part of diabetic care. The mean overall KAP score was significantly higher for physicians with 1-5 years of experience (70.16, P=<.05)) than those with more than 5 years of practice (P=<.05). This difference was found in all the segments of KAP. Overall KAP score of those GPs who had a copy of Clinical practice guidelines (CPG) in their clinic was 70.90 ±10.94 which was higher than KAP Score of those GPs who did not have a copy of CPG (65.10 ±7.01, P=.005). Checking patients' ability to manage their diabetes, checking blood pressure, eye exam, lipids , serum creatinine, baseline ECG, chest X ray and serum electrolyte were the best followed tests while foot exam and urinary protein were performed more often than recommended in the guideline. Serum HbAc1was the most delayed test. Conclusion : This study explored several aspects of diabetes related KAP of Ministry of Health appointed GPs and identified the need for improvement in their knowledge, attitude and practices for treating Type 2 DM patients.
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Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory
GO Akaba, JAM Otubu, ET Agida, O Onafowokan
April-June 2013, 16(2):201-206
Objective: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. Materials and Methods: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. Results: The knowledge of malaria and its preventive measures in pregnancy was 71.5%. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053, P = 0.035). Intermittent preventive treatment was used by 15.9% of the respondents. Insecticide-treated net ownership was 42.6%; however, its use declined from 28.5% before pregnancy to 24.6% during pregnancy. Conclusion: There is adequate knowledge about malaria and its preventive measures in pregnancy, but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions.
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Vaginal myomectomy of a prolapsed gangrenous cervical leiomyoma
JI Ikechebelu, GU Eleje, BC Okpala, IV Onyiaorah, JC Umeobika, OA Onyegbule, BT Ejikeme
July-September 2012, 15(3):358-360
We report a challenging case of a huge gangrenous prolapsed cervical leiomyoma in a multiparous HIV positive lady. A 37-year-old para 3 lady presented with a progressively increasing irreducible mass protruding out per vaginam, 3 months duration of heavy menses, and symptoms of a urinary tract infection. We performed a vaginal myomectomy and she did well postoperatively. A prolapsed gangrenous cervical leiomyoma is a rare condition with only a few cases reported in the literature. Vaginal myomectomy for this condition can be performed in experienced hands without difficulties.
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Oxyphil cell adenoma in a Nigerian: Case report and review of the literature
AE Aghaji, DB Olushina, OI Okoye
July-September 2011, 14(3):373-376
DOI:10.4103/1119-3077.86787  PMID:22037088
Oncocytomas of the lacrimal gland are rare tumors. We report the first documented case in Nigeria. This was an interventional case report. A complete ophthalmologic and systemic examination with available pertinent investigations was done, followed by a modified exentheration and histopathologic examination. A 60-year-old Nigerian housewife was evaluated for a slow-growing, right upper lid mass associated with visual lesion in the ipsilateral eye. Plain skull x-rays revealed a soft tissue in the right eye orbit without any bony extension. A modified exentheration was done. Histopathology showed sheets of oxyphil cells in the lacrimal gland. Although rare, more cases of oncocytomas may exist than are reported in the literature.
  8,138 184 1
Review of hormonal treatment of breast cancer
IH Abdulkareem, IB Zurmi
January-March 2012, 15(1):9-14
This critical review focuses on the role of steroid hormones and their receptors in the development and treatment of breast cancer, with special reference to estrogen receptors, as well as mechanisms of receptor-ligand interactions, response or resistance to hormonal therapy against breast cancer, in conjunction with other modalities like surgery and chemotherapy. Tamoxifen is used in hormonal treatment of breast cancer for up to five years, depending on the presentation. However, there have been recent developments in hormonal therapy of breast cancer in the last ten years, with the introduction of many different alternative therapies for this condition. A critical review of published articles in Pubmed/Medline, Athens, AJOL, NHS Evidence, Science Direct and Google, relating to hormonal treatment of breast cancer, was undertaken, in order to evaluate the mechanisms of estrogen receptor-ligand interactions, their involvement in the etio-pathogenesis of breast cancer, resistance of breast cancer cells to anti-hormonal agents, as well as ways of treating breast cancer using anti-hormone drugs like tamoxifen. Although tamoxifen is the established drug for hormonal treatment of breast cancer, cases of hormone resistance breast cancer have been described recently in the literature. This can happen from the beginning, or during treatment. Therefore, we aim to examine the causes of resistance to hormonal treatment with a view to understand the options of tackling this problem, and suggest other novel alternative hormonal therapies that can be tried, which may overtake tamoxifen in the future. We also seek to emphasize that hormonal therapy has a definite place in the treatment of breast cancer along with surgery, chemotherapy and radiotherapy, as the disease is often considered to be multi-systemic even from the beginning.
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