Annals of African Medicine
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   Table of Contents - Current issue
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October-December 2020
Volume 19 | Issue 4
Page Nos. 215-288

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ORIGINAL ARTICLES  

Doppler velocimetry indices of human immunodeficiency virus-positive pregnant women and their controls at Aminu Kano Teaching Hospital, Kano Highly accessed article p. 215
Anas Ismail, Yusuf Lawal, Ayyuba Rabiu, Jameela Ibrahim Mu’uta
DOI:10.4103/aam.aam_40_19  PMID:33243943
Background: Nigeria is among the countries having a large number of human immunodeficiency virus (HIV)-infected people in Africa with growing number of HIV-positive children, mainly infected by their mothers. Traditional tests diagnose high-risk fetuses very late. Doppler sonography has a potential for detecting high at-risk fetus at a much early stage, so that appropriate measures could be instituted to improve outcomes. This study compared umbilical artery velocimetric parameters among HIV-positive women on highly active antiretroviral therapy (HAART) and their matched controls to determine the possible abnormalities and correlates. Methodology: This was a comparative study that was conducted among HIV-positive pregnant women and their matched controls (HIV-negative pregnant women matched for gestational age and parity) at Aminu Kano Teaching Hospital. History and physical examination, transabdominal ultrasound examination were done on each subject to obtain the basic obstetric parameters. Detailed evaluations of the umbilical arteries on gray scale and duplex Doppler protocols using a 3.5-MHz curvilinear transducer were also done. The data were analyzed using SPSS Version 19.0. Independent samples t-test was used for continuous data. Chi-square test and Fisher's exact test were used for categorical data. P < 0.05 was considered statistically significant. Results: The mean age ± standard deviation (SD) was 30.8 ± 5.50 and 27.6 ± 5.34 for HIV and control groups, respectively. The mean amniotic fluid indices and that of estimated fetal weight for the HIV and control groups showed no statistically significant difference between the two groups. The mean (±SD) umbilical artery diameter of the HIV-infected mothers is wider than their negative controls. Conclusion: The study showed no statistically significant difference between the Doppler indices of HIV-positive pregnant women on HAART and their matched controls.
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The trend and characteristics of stillbirth delivery in a university teaching hospital in Lagos, Nigeria Highly accessed article p. 221
Adeyemi Adebola Okunowo, Shakirat Tinuola Smith-Okonu
DOI:10.4103/aam.aam_44_19  PMID:33243944
Background: The burden of stillbirth is so huge in sub-Saharan Africa, especially in Nigeria where many mothers and mothers-to-be are denied the joy of motherhood. Despite the frequent occurrence of this obstetric problem in our environment, little priority is placed on it. Objectives: The study aims to bring to the fore, the burden, trend, and characteristics of stillbirth delivery in Lagos, Nigeria. Subjects and Methods: This was a 5-year descriptive retrospective study of the case records of women who had stillbirth delivery at Lagos University Teaching Hospital from January 2009 to December 2013. Relevant information was obtained using a study pro forma, and data analysis was carried out using SPSS version 20.0. Results: The prevalence of stillbirth was 6.2%, and the rate was 61.8/1000 total births. Women who did not book for antenatal care accounted for 76.2% of the cases, and the antenatal and intrapartum stillbirths accounted for 64.6% and 35.4%, respectively. The mean gestational age was 35.5 ± 1.2 weeks, while the mean birth weight was 2.9 ± 1.0 kg. Majority of the stillbirths were male fetuses (54.5%). Previous history of stillbirth (36.0%), hypertensive disorders in pregnancy (33.0%), placental abruption (28.8%), intrauterine growth restriction (13.0%), and ruptured uterus (11.3%) were the common clinical risk factors identified. Conclusion: The burden of stillbirth is high in our environment, and majority is due to preventable or manageable obstetric conditions. There is a need to encourage early referral of complicated pregnancies and labor to specialized centers that can cater for them, so as to avoid unnecessary and preventable deaths.
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Sleeping disturbances and predictor risk factors among type 2 diabetic mellitus patients Highly accessed article p. 230
Abdulbari Bener, Abdulla O. A A. Al-Hamaq, Ahmet Faruk Agan, Mustafa Öztürk, Abdulkadir Ömer
DOI:10.4103/aam.aam_51_19  PMID:33243945
Background: Sleep disturbance is a major health issue among people with type 2 diabetes mellitus (T2DM). The Pittsburgh Sleep Quality Index (PSQI) has been the most widely used instrument to measure subjective sleep disturbance. Aim: The aim of this study was to determine the impact of sleeping factor structure of the PSQI as potential predictor for glycosylated hemoglobin A1c (HbA1C) among people living with T2DM in the Turkish community to facilitate its use in the clinical practice and research. Subjects and Methods: This is a cross-sectional study and participants were between the age group of 25 and 65 years old who visited the diabetes and endocrinology department of Mega Medipol University Teaching Hospital, Istanbul. The PSQI was conducted on 871 patients with T2DM. Good sleep quality was defined as PSQI score <5. Multivariate logistic regression analysis was used to estimate the associated risk factors for the T2DM. Results: The current study showed significant differences between male and female patients with respect to their age in years, body mass index (BMI) (kg/m2), physical activity, smoking habit, sheesha smoking, income, family history of metabolic syndrome, coronary heart disease (CHD), and PSQI. The results revealed significant differences between HbA1c ≤7 and females and HbA1c >7 T2DM patients with respect to gender, BMI (kg/m2), CHD, and PSQI. The study demonstrated significant differences between sleeping categories PSQI as good, average, and poor sleeping among T2DM patients with respect to age and gender. Meanwhile, significant differences were reported between sleeping categories among T2DM patients with respect to their: number of sleeping hours, wake-up time, sleeping time, HbA1c, fasting blood glucose, uric acid, and systolic and diastolic blood pressure. This study showed very strong statistically significant correlations between low HbA1c and poor sleep quality in patients with T2DM patients, including subjective sleep quality r = 0.763, sleep latency r = 0.327, sleep duration r = 0.472, habitual sleep efficiency r = 0.575, sleep disturbances r = 0.564, use of sleep medication r = 0.728, and daytime dysfunction r = 0.734. Multivariate stepwise logistic regression analysis revealed that Vitamin D (mmol/L) (P < 0.001), HbA1c (P < 0.001), duration of DM (P < 0.001), uric acid (mmol/L) (P < 0.001), systolic blood pressure mmHg (P = 0.006), diastolic blood pressure mmHg (P = 0.015), and BMI (P = 0.024) were considered at higher risk as the predictors for sleeping quality among T2DM patients. Conclusion: The results suggest a strong positive correlation between PSQI with HbA1c levels, systolic and diastolic blood pressure, age, BMI, among type 2 diabetic patients. This study ascertains that poor sleep quality may be due to elevated level of HbA1c, metabolic syndrome, diabetes, obesity, and/or hypertension.
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Awareness, attitude, and understanding toward epilepsy among workers in a State Specialist Hospital in Maiduguri, Northeastern Nigeria p. 237
Mshelia Anthony Ali, Ogualili Placidus Nwakuba, Wakawa Ibrahim Abdu, Onyencho Victor, Pindar Sadique Kwajaffa, Mahmood Mohammed Yusuf, Fugu Muhammad Abba, Rabbebe Isa Bukar
DOI:10.4103/aam.aam_61_19  PMID:33243946
Background: Epilepsy is a common presentation at clinics in Psychiatric Hospitals, Teaching Hospitals, and general practice. In developing countries and Africa especially, awareness, attitude, and understanding are generally poor. People still believe in spirits as the cause of epilepsy. Objectives: The objectives were to assess the awareness; attitude and knowledge of Hospital workers in general practice concerning epilepsy. Methodology: The respondents were workers of all cadres who were working at a State Specialist Hospital and the study used a survey method proposed by Caveness and Gallup, with modifications and adaptations on the self-administered questionnaire. Results: One hundred and forty-four staffs of State Specialist Hospital completed the questionnaire containing items addressing demographics, awareness, attitude, and knowledge. Of these respondents, 89 were males and 55 were females. The mean age was 34.34 years. 96.5% heard of the disease, 77.8% knew someone with the disease, 64.6% will not object to their children playing with someone with epilepsy and 37.5% will not allow a relative to marry someone with epilepsy. Fifty-five percent (55%) of the respondents said; they will not employ such patients, and that patients with epilepsy should not be employed with others. Knowledge towards epilepsy was good, where 71.5% felt it was caused by a brain disorder. Conclusion: We found out that awareness and knowledge of epilepsy among Hospital staff were generally good. However, the attitude of healthcare workers had reservations towards patients with epilepsy (PWE) either working for them or working with other people. This attitude arose from deeply ingrained cultural misconceptions acquired over time. Thus, there is a need for consistent hospital staff education, aimed at allaying fears, mistrust as well as to lessen the stigma towards epileptics.
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Awareness and practice of family planning among women residing in two rural communities in Ogun State, South West Nigeria p. 246
Tope Olubodun, Mobolanle Rasheedat Balogun, Esther A Ogunsilu
DOI:10.4103/aam.aam_62_19  PMID:33243947
Background: Family planning helps individuals and couples to avoid unwanted pregnancies, regulate interval between pregnancies, and determine the number of children in the family. Family planning is an effective intervention for promoting maternal health, but its acceptability and utilization are impeded by many factors. Aim: This study was conducted to assess the rural women's awareness and practice of family planning in two communities in Ogun State. Materials and Methods: This was a cross-sectional study conducted among 561 women of reproductive age. Data collection was done using interviewer administered questionnaire. Data were analyzed using IBM SPSS version 20. Frequencies were generated and Chi-square test was used to explore associations. Binary logistic regression was used to determine predictors of ever-used family planning. Results: Majority were aware of family planning (410, 73.1%). The method most commonly known was male condom (348, 84.9%), pills (276, 67.3%), and injectables (231, 56.3%). Respondents who had ever-used family planning were (265, 47.2%). The methods commonly used were injectables (104, 39.2%) and pills (85, 32.1%). Reasons for not using family planning include the desire for more children (78, 26.3%), lack of spousal support (56, 18.9%), and fear of undesirable effects (44, 14.9%). Determinants of ever-used family planning after logistic regression were age and occupation. Women between 31 and 40 years of age were two times more likely than women <20 years to have used family planning (adjusted odds ratio [AOR] 2.17, 95% confidence interval [CI] 2.17–1.23). Farmers were 53% less likely than traders to have ever-used family planning (AOR: 0.47, 95% CI: 0.29–0.78). Conclusion: Although the awareness of family planning was high in this study, it did not correspond to practice. Campaigns promoting the use of family planning for child spacing, male involvement in family planning and dispelling of fears is recommended to improve practice of family planning.
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Knowledge and attitude of patients with adrenal insufficiency p. 252
Toumader Bouziane, Nadia Belmahi, Houda Salhi, Hanan El Ouahabi
DOI:10.4103/aam.aam_63_19  PMID:33243948
Background: Adrenal insufficiency (AI) is a rare and a dangerous disease requiring a life-long glucocorticoid replacement therapy with dose adjustment in stressful situations which is linked to patient's knowledge and understanding. The aim of this study was to explore AI patients understanding regarding their disease, risk factors of adrenal crisis, as well as their attitude in stressful situations. Materials and Methods: We prospectively enrolled from October to January 2017, all patients with adrenal insufficiency (primary or secondary) treated and followed up in the Department of Endocrinology at University Hospital Center Hassan II of Fez. Patients were asked to fill out a questionnaire to assess their self-perceived subjective understanding to objectively evaluate their knowledge. Results: A total of 55 AI patients participated in this study. Overall, 74% of patients had no sufficient understanding of their disease; more participants gave incorrect answers to how to act in different stressful situations. Eleven patients (20%) did not possess a “steroid warning card,” twenty-five patients (45%) had the injectable hydrocortisone (HC) set at home; 40% carried the HC required for the day with them. Globally, the patients self-perceived, subjective knowledge level was not good, a severe lack of knowledge had been identified concerning the knowledge of risk factors of AI. Conclusion: The present study shows the urgent need to develop a structured and continuous education of patients with adrenal insufficiency to improve their self-management of the disease.
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Retrograde ureteroscopy in the management of distal ureteric stones: A retrospective analysis of outcome and complications p. 258
Idorenyin Cletus Akpayak, Christian A Agbo, Lemech E Nabasu
DOI:10.4103/aam.aam_65_19  PMID:33243949
Background: Urinary stones affect 8%–15% of the world population. In Nigeria, contemporary reports have shown that the incidence of urinary stones is rising. The distal ureter has been described as the most common location of ureteric stones. This study seeks to review our experience in the ureteroscopic management of distal ureteric stones with a view to appraising the stone clearance rate and the complications seen in our patients. Patients and Methods: This descriptive study reviewed the record of 21 patients, who had semirigid ureteroscopy and pneumatic lithotripsy for distal ureteric stone between October 2015 and September 2018. All patients had computed tomography urography preoperatively to locate the stone. Data on patients' demographics, indication for the surgery, location and size of stone, preoperative double-J (DJ) placement, postoperative DJ stent placement, intraoperative and postoperative complications, and status of stone clearance were retrieved and subjected to statistical analysis. Results: The mean age of the patients was 37.95 ± 11.09 (range, 21–67) years. The mean stone size was 8.06 ± 2.87 mm with a range of 4.8 mm–15.0 mm. Out of the 21 patients, 20 (95.2%) had the procedure for recurrent ureteric colic and 1 (48%) was for hematuria. Four (19.0%) patients had DJ stent preoperatively, whereas 17 (81.0%) patients did not have. Fourteen (66.7%) patients had intraoperative ureteric dilatation. Postoperative DJ stent was placed in 17 (81.0%) patients, whereas 4 (19.0%) patients did not have. Three (14.3%) patients had mucosal flap, 6 (14.3%) had mucosal abrasion, 2 (9.5%) had bleeding, 1 (4.8%) patient had transient hematuria postoperatively, and 2 (9.5%) patients had urinary tract infection. Nineteen (90.5%) patients had complete clearance in a single surgery. Two (9.5%) patients had symptomatic residual fragments that required repeat ureteroscopy. Conclusion: Our study has shown that ureteroscopy is a useful and safe technique in the removal of stones in distal ureter.
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Scabies education in secondary schools: A multicenter study p. 263
Perpetua Uchechi Ibekwe, Eshan B Henshaw, Bolaji Otike-Odibi, Nnenna U Okoh, Bob A Ukonu, Thomas O Nnaji, Joseph Archibong, D Altraide, Chinwe Onyekonwu, Grace C Okudo
DOI:10.4103/aam.aam_67_19  PMID:33243950
Background: The aim of this study was to educate secondary school students on etiology, risk factors, clinical features, treatment, and prevention of scabies; to evaluate their knowledge base on scabies before and after an educational intervention; and to reassess this knowledge base and behavioral change, 6 months after, on a second visit. Methods: Questionnaires with standard questions on scabies, graded to a maximum score of 10, were administered to students in junior secondary Classes 1 and 2 across 4 states in Nigeria. Information obtained included subjects' demographics, scabies symptomatology, risks, and preventive behaviors. Students with active scabies were diagnosed and treated. Data were analyzed with STATA. Results: The mean test scores for the pretest and posttest at first visit were 2.82 ± 1.38 and 6.30 ± 1.09, respectively. This difference was statistically significant at t = 3.95, P = 0.004. Six months later, when the same schools were re-visited, the mean test scores for the pretest and posttest were 4.63 ± 0.54 and 5.87 ± 0.25, respectively. This difference was also significant at t = 4.13, P = 0.003. The prevalence of scabies was 3.5% at first visit and 4.34% at second visit; t = 0.24, P = 0.41. Conclusions: Secondary school students lack basic education on scabies and exhibit high-risk behaviors for scabies transmission. Knowledge on scabies needs constant reinforcement.
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Does preoperative dental anxiety play a role in postoperative pain perception after third molar surgery? p. 269
Chidozie Ifechi Onwuka, Samuel Ebele Udeabor, Asma Mohammed Al-Hunaif, Waleed Ali Khalofah Al-Shehri, Lujain Abdulrhman Al-Sahman
DOI:10.4103/aam.aam_68_19  PMID:33243951
Background: Surgical removal of the impacted third molar is associated with inflammatory morbidities which include swelling, trismus, and pain. Pain is the most common postsurgical morbidity associated with third molar surgery. It remains an important factor in patients' perception of recovery after third molar surgery with dental anxiety reported to exert influence on its threshold. Objective: The aim of the study was to determine if preoperative dental anxiety has any significant role on postoperative pain perception after third molar surgery. Materials and Methods: This was a cohort study involving sixty consecutive adult patients requiring extraction of impacted mandibular third molars under local anesthesia. Modified Dental Anxiety Scale Questionnaire was administered to each participant in the waiting area before the surgery. The visual analog scale was also given to each participant to be completed once daily at approximately the same time as the surgery time until day 7 after the surgery. Data collected were analyzed using SPSS version 23. Results: Sixty participants who consented to third molar surgery took part in this study. Five participants were lost to follow-up. There were slightly more males (50.9%) than females (49.1%). Nineteen participants in this study had moderate dental anxiety (34.5%) and 6 participants (11%) had severe dental anxiety with more females having moderate-to-severe dental anxiety. The correlation between pain perception at different days and dental anxiety was not significant (P > 0.05). Conclusion: Preoperative dental anxiety may not significantly influence pain perception after third molar surgery.
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Importance of Rouviere's sulcus in laparoscopic cholecystectomy p. 274
Ashesh Kumar Jha, Rekha Dewan, Kaustabh Bhaduria
DOI:10.4103/aam.aam_4_20  PMID:33243952
Background: Rouviere's sulcus is a 2–5 cm fissure on the liver between the right lobe and caudate process. The benefit of finding the Rouviere's sulcus during laparoscopic cholecystectomy is supported by the fact that the cystic duct and artery lay anterosuperior to the sulcus, and the common bile duct (CBD) lays below the level of the Rouviere's sulcus. Hence, it can serve as an extrabiliary anatomical reference point during laparoscopic cholecystectomy to identify the location of CBD. Materials and Methods: This prospective observational study was carried out on 99 patients during a period of 1 year. During laparoscopic cholecystectomy, Rouviere's sulcus was identified after retracting the fundus of the gallbladder toward the right shoulder. Its morphology in terms of open type, close type, or scar-like shapes was recorded, and if the CBD outline could be visualized, then its relation with the Rouviere's sulcus was noted. Results: Among all 99 study patients, Rouviere's sulcus could be identified in 63 cases (63.63%), whereas it could not be seen in 36 cases (36.36%) (P < 0.007). It was of open type in 68.25% (43 cases), close type in 25.39% (16 cases), and scar like in 6.35% (4 cases) (P < 0.0001). The Rouviere's sulcus was found to be above the level of CBD line in 50 patients (79.36%) and at the same level in 11 patients (17.46%), and in two patients, (5.97%) CBD line could not be visualized. Conclusion: Identification of Rouviere's sulcus during laparoscopic cholecystectomy can serve as an additional reference point to avoid major bile duct injury. In the era of laparoscopy, it can be better visualized after creating the pneumoperitoneum and retracting the fundus of the gallbladder.
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CASE REPORTS Top

Treatment of recalcitrant chronic leg ulcer in a known sickle cell anaemia patient using honey and fresh hbaa red cell concentrate in a Nigerian secondary healthcare facility p. 278
Marcellinus Uchechukwu Nwagu, Gabriella Ifeoma Omokhua
DOI:10.4103/aam.aam_53_19  PMID:33243953
Sickle hemoglobin (HbS) formed by the point mutation in the genetic code of beta-globin chain leading to valine substituting glutamic acid at position 6 of the beta-chain. The resultant sickle cell disease (SCD) characterized by occlusion of microvasculature by red blood cells is associated with multiple organ pathologies. One of such complications is chronic leg ulcers. We report a case of chronic leg ulcer, in a known sickle cell anemia patient, which did not respond to the wound dressing methods at the hospital's disposal. The ulcer was successfully treated using standard operative procedure (S.O.P) in wound care, applying local honey, and use of blood transfusion. EA was a 20-year-old university undergraduate who was admitted to April 2019 in Central Hospital Benin City with chronic leg ulcer of 1 year duration. She was also anemic with hemoglobin concentration of 3.0 g/dl (packed cell volume 15%). The wound was dressed with local honey, and anemia corrected with blood transfusion using concentrated red cells lacking the HbS trait. There was a progressive improvement in the healing of the ulcer with total closure after 4 months of treatment. Maintenance and follow-up measures were instituted to prevent reoccurrence. This report showed that honey has remarkable properties in promoting wound healing. Its usage in combination with transfusion of HbA red blood cells to manage chronic leg ulcers in SCD patients is advocated. However, this calls for further studies and research.
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Giant pedunculated incisional hernia p. 282
Amina I Abuabakar, Elijah N Miner
DOI:10.4103/aam.aam_56_19  PMID:33243954
Ventral hernia is a common complication of abdominal surgeries, with the incidence of up to 20% in some series. Giant ventral hernia is that with a neck more than 10 cm wide. The loss of abdominal domain due to the shift of viscera into the hernia sac could lead to the complication after surgery. A 54-year-old female presented with a giant pedunculated ventral hernia. She had low tension mesh repair through a transverse suprapubic incision. The surgical repair of giant hernia with mesh has led to reduced complications. The sublay mesh repair method has further reduced the rate of underlay mesh recurrence.
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Foreign accent syndrome in a patient with posturemic encepalopathy p. 286
Odigie Enahoro Ojeh-Oziegbe
DOI:10.4103/aam.aam_59_19  PMID:33243955
Foreign accent syndrome (FAS) is a rare, poorly understood speech disorder. It is characterized by the patient speaking their native language in a different accent foreign to both the speaker and the listener. A majority of previously reported cases have been described in patients with diagnosed organic brain damage and a handful of other psychiatric disorders. FAS was not the result of language experience in our index patient, and there is no history of the patient ever visiting the United States of America. This case is presented because it is the first-ever seen case in the environment.
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