Annals of African Medicine
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   2012| January-March  | Volume 11 | Issue 1  
    Online since December 20, 2011

 
 
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ORIGINAL ARTICLES
Injection safety practices among nursing staff of mission hospitals in Benin City, Nigeria
Vincent E Omorogbe, Vivian O Omuemu, Alphonsus R Isara
January-March 2012, 11(1):36-41
DOI:10.4103/1596-3519.91020  PMID:22199046
Background/Objective of the study: Injection safety has over the years become important in view of the many diseases that are transmitted through unsafe injection practice. The objective was to assess the knowledge and practice of injection safety by nurses in mission hospitals in Benin City, Nigeria. Materials and Methods: A descriptive cross-sectional study was carried out. A structured interviewer-administered questionnaire was the tool for data collection. All the nurses (122) who gave their consent in the mission hospitals were studied. Data were analyzed using SPSS version 13. Results: The mean age of the respondents was 32.0 ± 8.9 years. The knowledge of injection safety among the respondents was poor (55.7%) while their practice of it was found to be good (48.4%) and excellent (47.5%). Knowledge was significantly influenced by the age, sex, and years of experience of the nurses. Twenty-eight (23.0%) and 40 (32.8%) respondents recap used needles regularly and sometimes respectively. Majority (71 [58.2%]) of the respondents had sustained needle stick injuries but only 4 (0.6%) respondents had a postexposure prophylaxis. Conclusion: This study showed that the knowledge of injection safety was poor among the nurses in mission hospitals in Benin City but their practice of injection safety was encouraging. There is need for the mission hospitals to organize regular training workshops on injection safety to improve the knowledge and practice of injection safety among their nurses.
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Electrocardiographic abnormalities among dialysis naïve chronic kidney disease patients in Ilorin Nigeria
A Chijioke, AM Makusidi, PM Kolo
January-March 2012, 11(1):21-26
DOI:10.4103/1596-3519.91011  PMID:22199043
Background: Chronic kidney disease (CKD) has an increased risk of not only end-stage renal disease (ESRD), but majority of moderate CKD patients do die from cardiovascular disease (CVD) before reaching ESRD. The prognosis of these patients is very poor in most developing countries because of late presentation, inadequate diagnostic facilities, and inability to pay for treatment. Knowledge about CVD in CKD is crucial because of unpredictable progressive nature of the disease and increased risk of premature death from cardiovascular events. We sought to determine prevalence and pattern of electrocardiographic abnormalities in dialysis naïve CKD patients. Materials and Methods: This is a 10-year prospective cross-sectional study carried out at the University of Ilorin Teaching Hospital, Ilorin. Patients were recruited from the nephrology clinic and renal wards and all who met diagnostic criteria for stages 4 and 5 CKD were included. All had their standard 12-lead electrocardiogram (ECG) recorded and various findings were critically studied and interpreted independently by two consultant physician including a cardiologist. Data analysis was done using SPSS version 16. Results: Overall, 86% of the patients had at least one form of ECG abnormality, with hypertension (HTN) and anemia being the main contributory factors. These include left ventricular hypertrophy (LVH) (27.6%), left atrial enlargement (LAE) (21.6%), combination of LVH and LAE (17.2%), and ventricular premature contractions (6%). Etiology of CKD appears to have influence on ECG changes as prevalence of LVH and LAE were high among hypertensive renal disease, chronic glomerulonephritis (CGN), and diabetic nephropathy patients. Conclusion: LVH and LAE were very common ECG abnormalities in our dialysis naïve CKD patients. HTN, CGN, anemia, late presentation, and male gender appear to be the main risk factors for the ECG abnormalities. There is need for gender-specific intervention strategies directed at early detection and treatment of HTN, anemia, and underlying kidney disease, especially in resource poor nations where the burden of CKD is assuming epidemic proportion.
  5,919 13 1
Progestogen-only injectable contraceptive: Experience of women in Osogbo, southwestern Nigeria
AS Adeyemi, DA Adekanle
January-March 2012, 11(1):27-31
DOI:10.4103/1596-3519.91013  PMID:22199044
Background: Progestogen-only injectable contraceptive is a long-acting contraceptive given intramuscularly to give protection against unwanted pregnancy for a period of 2 or 3 months, depending on the type. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method. Objectives: To determine the characteristics of women accepting the method, complications and indications for discontinuation. Materials and Methods: This was a retrospective review of clients using progestogen-only injectable contraceptive between 1 st January, 2001 and 31 st December, 2009. Relevant information extracted from the case notes was analyzed. Survival analysis was carried out using Log-Rank Chi-square test to measure association over 12-month period of usage. Level of significance was set at P value less than 0.05. Results: A total of 1,967 women used contraception during the study period and 433 (22.1%) made progestogen-only injectable their method of choice. 199(45.96%) used NET-EN, while DMPA was used by234 (54.04%) women. Many of the women (197, 45.5%) used the method for terminal fertility control. Menstrual abnormality was the commonest (264, 71.4%) complaint about progestogen-only injectable contraceptive, of which amenorrhea was experienced by constituted 176(66.7%). Eighty-three (22.4%) women had discontinued the contraceptive, and menstrual abnormality was the commonest reason for the discontinuation (68, 81.9%). No pregnancy was reported among the women that came for follow up while on the method. Conclusion: Short duration of POIC use that is within 12 months is still high. However the main reason for discontinuation was found to be due to menstrual irregularities, hence the need for effective education of the women about this side effect, thus increasing the acceptance and continuation rate of the contraceptive method.
  5,327 16 4
SHORT REPORT
Functional outcome of diaphyseal fractures of femur managed by closed intramedullary interlocking nailing in adults
MK Deepak, Karun Jain, Kumardev A Rajamanya, Pratik R Gandhi, CS Rupakumar, R Ravishankar
January-March 2012, 11(1):52-57
DOI:10.4103/1596-3519.91025  PMID:22199051
Objective: To study the effectiveness, advantages, disadvantages and failure rates of closed intramedullary interlocking nailing of daiphyseal fractures of the femur in adults. Materials and Methods: A total of 30 cases of diaphyseal femur fractures in adults, who have been treated with closed intramedullary interlocking nailing were studied from 2008 - 2010. Data was analyzed both with regards to the clinical and radiological outcome to evaluate the effectiveness, functional outcome and morbidity associated with the procedure. Results: Average age of the patient was 27.4 years with male preponderance. Road traffic accidnents were the most common mode of injury; middle third shaft fractures were most commonly seen (56.66%); comminuted and transverse fractures (63.33%) were the commonest fracture pattern. The union rate was 96.6%. Five patients had superfi cial infection, four had shortening of limb, and in two cases union was delayed. Excellent to good results were seen in 86.6% cases as per modifi ed Klaus and Klemm criteria. Consclusion: Closed intramedullary interlocking nailing has now become the treatment of choice for closed diaphyseal fractures of femur in adults, especially those with high comminution, long spiral, and segmental fractures. Interlocking nail offers the added advantages of early joint mobilization, early weight bearing, early muscle rehabilitation, shortened hospital stay, and most importantly early return to work and prefracture state.
  4,936 24 3
REVIEW ARTICLE
On the safety of diagnostic ultrasound in pregnancy: Have we handled the available data correctly?
Shaibu O Bello, Bissallah A Ekele
January-March 2012, 11(1):1-4
DOI:10.4103/1596-3519.91006  PMID:22199039
Robust evidence of the bioeffects of ultrasound is available from animal studies but human studies are less convincing. Nevertheless, it is disturbing that the only response to safety issues is a twenty-year old principle known as ALARA (As Low As Reasonably Applicable). Using experience from obstetrics and toxicology, and drawing information mainly from two recent systematic reviews and meta-analysis that extensively covered the subject of ultrasound safety, this review captures the current knowledge of ultrasound bioeffects and suggests that it may be time for an international, multidisciplinary meeting on ultrasound safety to decide how to provide the evidence (available data) to patients and sonographers in a succinct manner.
  4,836 13 -
ORIGINAL ARTICLES
Acute occlusive mesenteric ischemia in high altitude of southwestern region of Saudi Arabia
Mubarak M Al-Shraim, Mubarak H Zafer, Ganiyu A Rahman
January-March 2012, 11(1):5-10
DOI:10.4103/1596-3519.91007  PMID:22199040
Background and Objectives : Mesenteric ischemia which can be acute or chronic depending on the rapidity of compromised blood flow produces bowel ischemia, infarction, bacterial transmigration, endotoxemia, multisystem organ failure and death. High altitude can precipitate thrombosis because of hypobaric hypoxia and its effect on coagulation system. The objectives of this study are to determine the risk factors, clinical presentation, type and pattern of acute occlusive mesenteric ischemia in high-altitude of southwestern region of Saudi Arabia. Materials and Methods: We reviewed the records of all the patients with acute occlusive mesenteric ischemia admitted to the Armed Forces Hospital, southern region, Kingdom of Saudi Arabia during the period of 2005 to 2010, and compiled data including demographics, clinical presentation, risk factors, preoperative investigations, management, histopathological examination, and complications. The cases of mesenteric ischemia resulting from conditions such as volvulus and strangulated hernias were excluded. Results: Our study included 21 patients, 10 (48%) men and 11 (52%) women with a mean age of 56 years (SD 14). Abdominal pain was the most common presenting symptoms. CT angiography depicted occlusive arterial disease in 8 patients (38%) and venous thrombosis in 13 patients (62%). Diabetes mellitus was the most frequent risk factor for arterial mesenteric ischemia. Chronic liver disease particularly liver cirrhosis was the most prominent risk factor for venous mesenteric thrombosis. Intestinal ischemia was confirmed by histopathological examination. Conclusion: Acute occlusive mesenteric ischemia can mimic other more common intra-abdominal diseases clinically; therefore a high index of suspicion is required particularly for patients with relevant risk factors to prompt early diagnosis and intervention. Venous mesenteric thrombosis was more common than arterial mesenteric ischemia in our region.
  4,527 21 3
Social network as a determinant of pathway to mental health service utilization among psychotic patients in a Nigerian hospital
Victor O Lasebikan, Eme T Owoaje, Michael C Asuzu
January-March 2012, 11(1):12-20
DOI:10.4103/1596-3519.91010  PMID:22199042
Objective: The main objectives of the study were to determine the relationship between social network and pathway to service utilization among psychotic patients. Materials and Methods: This descriptive study was carried out in a psychiatric unit in a general hospital in South West Nigeria. Using structured questionnaires, primary data were collected from 652 psychotic patients on their social network, health behaviors and pathway to current service use. Logistic regression analysis was used to assess the effect of social network on patients' use of services, controlling for sociodemographics, health and functional status. Results: Mean age of the respondents was 29.0 ± 7.5 years, range 14-58 years, males constituted 52.6%. Regarding pathway to services, alternative sources of care such as priests, spiritualists, natural therapists, herbalists, was the first port of call for 78.9% of respondents. Family dominated the social network in 51.1% of patients. The presence of some social network and social support structures were significantly associated with the use of general medical and specialty psychiatric services for patients with schizophrenia (P = 0.03), schizoaffective disorder (P = 0.02), bipolar I disorder (P = 0.01), but not with major depression and symptoms of psychological distress. Conclusions: Findings indicate that social support and social network enhanced utilization of mental health services for psychiatric patients except for those with psychotic depression or those with symptoms of psychological distress. In addition, alternative sources of care are still relevant in mental health service delivery in South West Nigeria.
  4,021 14 15
An observational study of road safety around selected primary schools in Ibadan municipality, Oyo State, Southwestern Nigeria
Adesola O Sangowawa, Akindele O Adebiyi, Babalola Faseru, Olusola J Popoola
January-March 2012, 11(1):32-35
DOI:10.4103/1596-3519.91019  PMID:22199045
Background/ Objective: Child pedestrians have been identified as vulnerable road users. Although walking as a means of transport has health and other benefits, it exposes children to the risk of road traffic injuries. This study was conducted to assess the availability of road safety features around government-owned primary schools in Ibadan municipality. Materials and Methods: A multistage sampling technique was used to select 46 of the 74 schools in the study area. Some (11) of the selected schools were sited within the same premises and shared a common entrance; thus a total of 35 school premises were eventually observed. Trained research assistants observed the school environment around the selected schools for road safety features such as location of schools, presence of "school", "child crossing" and "speed limit" road signs, and presence of traffic calming devices (road bumps or zebra crossing). Results: Five (14%) of the schools were located on major roads and eight (23%) had road signs indicating that a school was nearby. Seven (20%) had road bumps close to the school, 15 (43%) had a warden who assisted children to cross, and none had a zebra crossing. Five (14%) schools had pedestrian sidewalks. Conclusions: The study revealed that the environment around a number of the observed schools in the municipality compromised the pupils' road safety. The local government, school authorities, parents, and road safety professionals need to institute definite measures to enhance the road safety environment around schools in the municipality.
  3,053 12 2
An audit of basic practical skills acquisition of final year medical students in a Nigerian medical school
NJ Jebbin, JM Adotey
January-March 2012, 11(1):42-45
DOI:10.4103/1596-3519.91021  PMID:22199047
Background/Objective: Young medical graduates undertaking their housemanship are naturally expected to demonstrate reasonable competence in basic practical skills. Failure to do this may not only be a source of anxiety to the doctor but also potentially dangerous to the patient. The objective was to assess the level of exposure of final year medical students of a Nigerian medical school to basic practical skills. Materials and Methods: This is a descriptive cross-sectional study. Structured questionnaires were distributed to a set (all) of 86 final year medical students of the University of Port Harcourt immediately after their last lecture in their final posting in medicine and surgery. The questionnaires listed some selected basic practical skills (e.g. phlebotomy, male urethral catheter insertion, etc.) that house officers are expected to be competent in. The students were asked to anonymously fill them and return same before leaving the lecture hall. Results: Of the 86 students, 84 completed and returned the questionnaires, giving a 97.7% response rate. No student had performed an arterial puncture for an arterial blood sample. Seventy-six students (90.5%) had not inserted a naso-gastric tube. Only 14 (16.7%) students had successfully inserted more than 10 intravenous canulae. A significant number, 38 (45.2%), had never inserted a urinary catheter (for male patients) nor had any experience with bag/mask skills. Majority, 59 (70.2%) had had some experience with intravenous antibiotics administration. Forty-one (48.7%) students had had 6 or more successful attempts at venous blood sampling. Conclusion: The exposure level of final year medical students to basic practical skills was low.
  2,703 12 2
CASE REPORT
Transurethral prostatectomy in human immunodeficiency virus-infected patients, morbidity and surgical risks in a developing economy
SU Alhassan, SA Aji
January-March 2012, 11(1):48-50
DOI:10.4103/1596-3519.91023  PMID:22199049
Human immunodeficiency virus (HIV) infection is increasing world-wide and highly active antiretroviral treatment (HAAT) is allowing afflicted individuals to live near normal life span and acquire surgical diseases of the aged as in the unaffected population. This pose occupational hazards to operating surgeons especially in tropical Africa where the seroprevalence is so high that seroconversion in the medical staff contaminated with the virus is estimated to be as much as 15 times (per annum) more than what obtains in developed. A 63-year old man was admitted to our Hospital with urethral catheter in situ and having failed medical therapy, he opted for transurethral prostatectomy (TURP) which was done without any post-operative complication. He was known to be afflicted with human immunodeficiency virus and on treatment for 3 years. He also had a large but reducible inguinoscrotal hernia for 4 years attributed to lower urinary tract obstruction. He had a Lichtenstein repair of right inguinoscrotal hernia which was complicated by small hematoma that was evacuated. The risk of transmission and surgical morbidity during transurethral prostatectomy could be minimized by adequate universal precaution, pre-testing of all consented patients and wise selection of patients that would benefit from such surgical therapy.
  2,345 12 1
COMMENTARY
Mesenteric ischemia, high altitude and Hill's criteria
Robert Sanda
January-March 2012, 11(1):10-11
PMID:22199041
  2,303 15 -
Teaching technical skills to medical students: Beyond 'see one, do one, teach one'
Benedict C Nwomeh
January-March 2012, 11(1):46-47
PMID:22199048
  2,255 12 -
Editorial on transurethral prostatectomy in human immunodeficiency virus infected
Kasonde Bowa
January-March 2012, 11(1):51-51
PMID:22199050
  1,704 11 -
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