Annals of African Medicine
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   2013| April-June  | Volume 12 | Issue 2  
    Online since May 22, 2013

 
 
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REVIEW ARTICLES
Preeclampsia: A review of the evidence
TA Jido, IA Yakasai
April-June 2013, 12(2):75-85
DOI:10.4103/1596-3519.112395  PMID:23713013
Preeclampsia is a common complication of pregnancy associated with high maternal and perinatal morbidity and mortality especially in developing countries. There is considerable progress in the understanding of the pathophysiology and the management of the diseases, although the aetiology and primary pathology remained elusive. Integration of current evidence in the clinical management of the condition has witnessed improved maternal and fetal outcomes in many societies. In developing countries variations in management often not based on current evidence accounts for comparatively higher morbidity and mortality. This article aims to provide an overview of our present understanding of preeclampsia help care providers and our managers focus practice and policy to reflect existing evidence.
  15,180 60 3
ORIGINAL ARTICLES
Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria
Kayode A Abegunde, Eme T Owoaje
April-June 2013, 12(2):90-97
DOI:10.4103/1596-3519.112398  PMID:23713015
Background: The increasing number of the elderly persons and their attendant health problems has implications on public health programs in developing countries. However, there is limited information on the elderly residing outside major cities in Nigeria. Therefore, this study was conducted to determine and compare prevalent health problems and associated risk factors in the elderly of urban and rural communities in Oyo State, Nigeria. Materials and Methods: A comparative cross-sectional survey of consenting adults aged 60 years and above in Iseyin (urban) and Ilua (rural) communities of Oyo State in south-west, Nigeria. Using cluster sampling technique, a total of 630 respondents; 316 in the urban and 314 in the rural participated. Information was sought on the respondents' socio-demographic characteristics, life style, self-reported health problems. Anthropometric measurements and clinical examination including blood pressure measurements and visual acuity were conducted. Results: The mean age of urban respondents was 72.2 ± 9.5 years compared with 70.8 ± 8.1 years in the rural. There were more females (61.1%) than males (38.9%) in both the locations. Self-reported health problems in both locations were similar and included reduced sexual fulfillment, musculoskeletal problems such as muscular and low back pain. On clinical examination, the main health problems were visual impairment 58.7% in the urban versus 41.7% in the rural ( P < 0.001). Prevalence of hypertension among urban and rural respondents was 38.3% and 34.7%, respectively ( P = 0.35). Osteoarthritis was significantly higher 8.5% in urban than 3.2% obtained in rural ( P = 0.004v). On multivariate analysis, female gender, increasing body mass index, and low monthly income were significant predictors of hypertension in both locations. Conclusions: Cardiovascular, musculoskeletal, and visual noncommunicable diseases were prevalent in both elderly populations. Social conditions and gender play important role in the health status of the elderly.
  7,168 24 2
REVIEW ARTICLES
Colposcopy: The scientific basis
Lawal A Bappa, IA Yakasai
April-June 2013, 12(2):86-89
DOI:10.4103/1596-3519.112396  PMID:23713014
Colposcopy was first introduced in 1925 in Germany by Hans Hinselman. A colposcopeworks on the hypothesis that by magnifying the cervix and applying good illumination, early stages of cervical cancer could be picked -up. Other workers in the field include Schiller, Papanicolou, and Ayres who all contributed to the early detection of cervical cancer. The basic issue is the transformation zone (TZ). It is an area that forms from squamous metaplasia of columnar epithelium. The area where the two epithelia meet is referred to as the squamo-columnar junction SCJ. It is the most important landmark in cytology and colposcopy, where 90%of cervical neoplasm originates. More units are incorporating colposcopy into their practice so as to improve care of women with abnormal smears. Therefore, understanding of the scientific basis of colposcopy is important in carrying out the procedure according to agreed international standards.
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ORIGINAL ARTICLES
Outcome and complications of permanent hemodialysis vascular access in Nigerians: A single centre experience
Sani U Alhassan, B Adamu, A Abdu, SA Aji
April-June 2013, 12(2):127-130
DOI:10.4103/1596-3519.112410  PMID:23713021
Background: It is widely accepted that autogenous arteriovenous fistula (AVF) carries less morbidity and mortality compared to all other forms of vascular accesses in maintenance hemodialysis patients. There is paucity of data on vascular access from sub-Saharan Africa. The aim of this study was to assess the outcome and complications of permanent vascular access in our center. Materials and Methods: The study is a prospective, hospital-based, longitudinal study. All consecutive patients on maintenance hemodialysis in Aminu Kano Teaching Hospital who were referred to the surgical unit of for creation of permanent hemodialysis vascular access were included in the study. The patient's clinical and demographic data were documented. Data about vascular access types, outcomes, and complications were obtained over a 1-year period from the time of vascular access creation. Results: One hundred and seventy four patients were operated upon between January 2008 and December 2010 with a mean age of 46.4 years (range 18-76 years) and a male to female ratio of 1.5:1. Brescio--Cimino fistula was performed in 110 (63.2%) patients, brachiocephalic (Kauffmann) fistula in 51(29.3%), and synthetic graft in 1 (0.6%) patients respectively. Ten patients (5.7%) had brachio-brachial transposition arteriovenous fistula and 2 patients (1.1%) had transposition graft using harvested long saphenous vein. One-year patency rate was 63.2%. Complications encountered include AVF failure in 47(27.3%), steal syndrome in 2(1.1%), distal venous insufficiency in 2(1.1%), and false aneurysm in 6(3.5%) patients. Conclusion: The outcome of permanent vascular access is favorable in our patient population with a one-year patency rate of 63.2%. The first choice of vascular access in our maintenance dialysis population should be AVF.
  3,909 15 2
Risk of sensorineural hearing loss in infants with abnormal head size
Bolajoko O Olusanya
April-June 2013, 12(2):98-104
DOI:10.4103/1596-3519.112399  PMID:23713016
Objective: The purpose was to determine the risk of sensorineural hearing loss (SNHL) in young infants with abnormal head sizes in a developing country. Materials and Methods: A matched case-control study of two (hospital-based and community-based) cohorts of term infants who failed a two-stage hearing screening test with transient-evoked otoacoustic emissions and automated auditory brainstem response in Lagos, Nigeria. Abnormal head size (microcephaly or macrocephaly) was determined with World Health Organisation's growth standards for head circumference. The adjusted odds ratios for the risk of SNHL in microcephalic and macrocephalic infants were established through unconditional and conditional logistic regression analyses. Results: Some 194 cases and 970 matched controls drawn from 8,872 term singletons 3 months or younger were studied. The median age of enrolment was 1 day in the hospital-based cohort and 17 days in the community-based cohort. Microcephalic infants in both cohorts were significantly at risk of SNHL while no significant risk was found among macrocephalic infants regardless of birth setting. Conclusions: Microcephalic infants should be routinely screened for potential hearing loss particularly where universal newborn hearing screening is not immediately practicable. Etiological investigation of abnormal head size in this and similar population is warranted. Routine screening and maternal immunization for congenital infections should also be considered.
  3,335 25 1
Reasons and pattern of tooth mortality in a Nigerian Urban teaching hospital
BD Saheeb, MA Sede
April-June 2013, 12(2):110-114
DOI:10.4103/1596-3519.112402  PMID:23713018
Background: Studies from Nigeria have documented different reasons for tooth mortality and regular follow-up studies to determine any changes in reasons and pattern among Nigerians appears not to be common. The purpose of this study was to determine the reasons and pattern of tooth mortality among Nigerians and the changes that might have occurred after 38 years of the first report. Materials and Methods: The case records of patients seen at the Oral Surgery clinic of the University of Benin Teaching Hospital between March 2007 and February 2008 were retrieved from the Medical Records Department and analyzed for age, gender, reasons for extraction, tooth extracted, frequency of extraction, and mode of extraction. Results: A total of 990 patients were referred for exodontia and 1050 teeth were extracted from 397 (40.1%) males and 593 (59.9%) females of age 14--89 years. The reasons for extraction include caries and its sequelae (n = 905, 86.2%), periodontal disease (n = 69, 6.6%), trauma (n = 41, 3.9%), orthodontics (n = 24, 2.3%), failed endodontics (n = 5, 0.5%), prosthetics (n = 4, 0.4%), pericoronitis (n = 2, 0.2%). The most frequently extracted teeth were the lower right first molars (n = 109, 10.4%) and the lower left first molars (n = 95, 9.0%), respectively. Molar teeth (n = 830, 79.0%) were more frequently extracted while canines (n = 13, 1.2%) were the least. The lower molars were more commonly extracted (n = 479, 45.6%) followed by upper molars (n = 351, 33.4%). The age range of 21-30 years was more commonly referred for extraction with the most frequently extracted teeth being the lower left first molars (n = 32, 3.0%) in females and (n = 27, 2.7%) in males, respectively. Conclusion: Tooth mortality in Nigerians is significantly associated with dental caries and its sequelae especially in younger patients.
  3,031 14 2
LETTER TO THE EDITOR
Nutritional status of elderly people managed in a Nigerian tertiary hospital
EO Sanya, PM Kolo, A Adekeye, OI Ameh, TO Olanrewaju
April-June 2013, 12(2):140-141
DOI:10.4103/1596-3519.112416  PMID:23713024
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ORIGINAL ARTICLES
Trace metals and total antioxidant potential in head and neck cancer patients
VI Akinmoladun, FJ Owotade, AA Olusanya
April-June 2013, 12(2):131-134
DOI:10.4103/1596-3519.112411  PMID:23713022
Background/Objective: There are pieces of evidence suggesting that oxidative stress and immune responses play significant roles in the etiopathogenesis of some malignant diseases. Also increased oxidative stress in patients with certain cancer may result from changes in the levels of certain trace elements. Therefore antioxidants either in the form of trace metals or enzymes are important tools in the study of these conditions. This study aimed at measuring the level of oxidative stress in the head and neck cancer patients by using plasma total antioxidant potential and the plasma level of some antioxidant trace metals. Materials and Methods: Twenty cases of head and neck squamous cell carcinoma recruited from the Oral and Maxillofacial surgery and Radiotherapy clinics of the University College Hospital, Ibadan were included in the study. While total antioxidant status was measured by ferric reducing antioxidant power (FRAP) assay of Benzie and Strain (1996), the plasma trace metals were assayed by atomic absorption spectrophotometry. Result: The total antioxidant potential was significantly reduced in the study group when compared with controls. Zinc, iron, and selenium were also found to be significantly lower in the study group compared with controls. Conclusion: The result suggests a state of oxidative stress in the head and neck cancer patients with likely impact on disease process and treatment outcome.
  2,574 10 3
Evaluation of the histopathology of orofacial lesions in a North-East Nigerian tertiary centre
VI Akinmoladun, OB Akintububo, AO Adisa, EO Ojo, D Ayuba
April-June 2013, 12(2):105-109
DOI:10.4103/1596-3519.112401  PMID:23713017
Objective: The aim of this study was to evaluate the relative frequencies, types and site distribution of oro-facial lesions in a North-Eastern Nigerian tertiary centre. Materials and Methods: The records of the Departments of Oral-Dental Surgery and Pathology of a tertiary hospital in Nigeria were reviewed and analyzed for patients with oro-facial lesions during a seven year period (January, 2001 - December, 2007). The main outcome measures were patients' age and sex, histology assessment, tissue type and location. Results: A total of 102 (51.3%) benign lesions, 59 (29.6%) malignant lesions and 38 (19.1%) inflammatory/reactive lesions were seen. The common benign neoplasms were ameloblastoma (23.5%), fibrous dysplasia (15.7%) and pleomorphic adenoma (13.7%). The malignant lesions were mainly well differentiated squamous cell carcinomas (28.8%) and terminal duct carcinoma (11.9%). Inflammatory lesions comprised mainly of chronic osteomyelitis (15.8%) and non-specific chronic inflammatory lesions; giant cell granulomas, granulation tissues which constituted 10.5% each. There were 104 (52.3%) males and 95 (47.7%) females giving a male: female ratio of 1.1:1. The mean age of the patients was 36.1(SD΁18.9) years with a range of 1 to 85 years. Most tissue specimens were soft tissues (61.3%), while bone specimen accounted for 15.6% of all specimens analysed. There were 62 (31.2%) mandibular lesions, 24 (12.1%) palatal lesions and 15 (7.5%) parotid lesions, while maxillary antral lesions were the least, constituting only 0.5% of all lesions studied. Conclusion: The range of diagnosed lesions from our study was diverse, though our results do not represent the actual prevalence of orofacial lesions within the general population, but simply reflect the frequency of histologically diagnosed lesions at a health center in North-East Nigeria. This survey has shown that most oro-facial lesions studied were benign neoplasms and that most of these neoplasms were from the mandible.
  2,507 22 2
Information-seeking behavior and computer literacy among resident doctors in Maiduguri, Nigeria
AD Abbas, AM Abubakar, B Omeiza, K Minoza
April-June 2013, 12(2):115-119
DOI:10.4103/1596-3519.112404  PMID:23713019
Background/Objective: Resident doctors are key actors in patient management in all the federal training institutions in nigeria. Knowing the information-seeking behavior of this group of doctors and their level of computer knowledge would facilitate informed decision in providing them with the relevant sources of information as well as encouraging the practice of evidence-based medicine. This is to examine information-seeking behavior among resident doctors and analyze its relationship to computer ownership and literacy. Materials and Methods: A pretested self-administered questionnaire was used to obtain information from the resident doctors in the University of Maiduguri Teaching Hospital (UMTH) and the Federal Neuro-Psychiatry Hospital (FNPH). The data fields requested included the biodata, major source of medical information, level of computer literacy, and computer ownership. Other questions included were their familiarity with basic computer operations as well as versatility on the use of the Internet and possession of an active e-mail address. Results: Out of 109 questionnaires distributed 100 were returned (91.7% response rate). Seventy three of the 100 respondents use printed material as their major source of medical information. Ninety three of the respondents own a laptop, a desktop or both, while 7 have no computers. Ninety-four respondents are computer literate while 6 are computer illiterates. Seventy-five respondents have an e-mail address while 25 do not have e-mail address. Seventy-five search the Internet for information while 25 do not know how to use the Internet. Conclusion: Despite the high computer ownership and literacy rate among resident doctors, the printed material remains their main source of medical information.
  2,448 13 3
Prevalence of psychiatric morbidity using GHQ-28 among cleft lip patients in Sokoto
Mufutau A Yunusa, Ayodele Obembe
April-June 2013, 12(2):135-139
DOI:10.4103/1596-3519.112414  PMID:23713023
Background: In the management of cleft lip, attention is usually focused on physical deformity and functional anomaly. Previous studies on psychiatric morbidity challenged this position. However, most of these studies were from western society. Few studies have reported on the prevalence of psychiatric morbidity among adult Nigerian patients with cleft lip. Materials and Methods: In this prospective cross-sectional study, 200 patients with cleft lip, who were between the age of 20 and 39 years, were assessed using standardized semistructured psychiatric instrument. Additionally, 100 healthy subjects matched for gender and educational attainment served as control. A questionnaire related to sociodemographic variables was designed and administered to the two groups. GHQ-28 was used to assess for the presence of psychiatric morbidity. Graphpad instat was used for data analysis. Result: More than a quarter of the patients have psychiatric morbidity which was greater than the control (P<0.001). Sociodemographic attributes associated with high psychiatric morbidity include male gender (P=0.0018), widowhood (P<0.0001), age group 30--34 years (P<0.0001), and being unemployed (P=0.001). Conclusion: In addition to reconstructive surgery, psychiatric evaluation and intervention would be of benefit in the management of cleft lip patients.
  2,286 12 3
Alcohol-related disorders among medical and surgical in-patients in a Nigerian teaching hospital
Olatunji A Abiodun, Peter O Ajiboye, Oluwabunmi N Buhari, Kazeem A Ayanda, Oluwatosin M Adefalu, Lukman O Adegboye
April-June 2013, 12(2):120-126
DOI:10.4103/1596-3519.112407  PMID:23713020
Background/Objectives: Alcohol use disorders exist in a high proportion of hospitalized patients and this often complicates patient management, but a large proportion of them still go unrecognized by the managing clinicians. The objective was to provide data on the proportion of inpatients 18 years and above with alcohol-related disorders, and ability of the managing clinicians to detect these disorders. Materials and Methods: Alcohol use disorders were assessed in 339 consecutive patients admitted into medical and surgical wards of University of Ilorin Teaching Hospital (UITH), Ilorin, using the Structured Clinical Interview for DSM-IV Disorders (SCID) -- Alcohol module, for a period of 5 months. They were also assessed for the presence or absence of alcohol-related problems (physical, psychological, and social) by direct questioning. In addition, patients' case notes were scrutinized for additional information on alcohol-related problems and ability of managing clinicians to detect alcohol-related problems in their patients. Results: All patients with alcohol use disorders were males. The point prevalence for alcohol abuse and alcohol dependence using DSM-IV criteria were 16.4% and 8.5%, respectively among males while another 1.2% who did not meet DSM-IV criteria for abuse and dependence, had alcohol-related problems. Marital disharmony, financial problems, and deteriorating work performance were the most common psychosocial problems among the drinkers. Gastritis occurred in 18.5% of cases with alcohol abuse and 21.4% of cases with alcohol dependence. Other physical problems among drinkers included liver cirrhosis, malnutrition, and various injuries. Significantly more patients aged (45-64 years) and patients of low educational status compared to abstainers had alcohol use disorders and alcohol-related problems. In addition, significantly more patients with alcohol use disorders/alcohol-related problems compared to abstainers were observed to have physical and psychosocial health problems. Alcohol-related problems were detected in only 10.9% of the alcohol users by the managing clinicians. Conclusion: There is a considerable case load of patients with alcohol-related disorders in the hospital. There is therefore the need to improve ability of the managing clinicians to detect and manage cases of alcohol-related disorders, with referrals where appropriate.
  2,281 9 1
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