Annals of African Medicine
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   2007| December  | Volume 6 | Issue 4  
    Online since September 29, 2009

 
 
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RESEARCH ARTICLES
Effects of poverty on child health and paediatric practice in Nigeria: An overview
H Ahmed
December 2007, 6(4):142-156
DOI:10.4103/1596-3519.55705  PMID:18354938
  9,119 102 3
Tropical parasitic diseases and women
OO Okwa
December 2007, 6(4):157-163
DOI:10.4103/1596-3519.55704  PMID:18354939
Tropical parasitic diseases constitute the greatest threat to the health and socio– economic status of women as a gender and social group. There are some gender specific ways in which parasitic diseases affect women in contrast to men due to differences in exposure, occupational risk, sociocultural behavior, gender roles and practices. These parasitic diseases confer some social stigma, which affects the health seeking behavior of women. Women are therefore important in the control of these parasitic diseases and they are key agents of change, if they are included in community control programs. Women need more attention in endemic areas as a group that had been neglected. This deprived and excluded group have got vital role to play, as discussed in this review.
  7,767 161 7
Adenovirus infection in children with diarrhea disease in Northwestern Nigeria
M Aminu, AA Ahmad, JU Umoh, MC de Beer, MD Esona, AD Steele
December 2007, 6(4):168-173
DOI:10.4103/1596-3519.55702  PMID:18354941
Background : Adenoviruses, particularly enteric adenoviruses (EAds) type 40 (Ad40) and type 41(Ad41), can cause acute and severe diarrhea in young children worldwide. This study was conducted to delineate the epidemiological features of adenoviruses identified in children with gastroenteritis in Northwestern Nigeria. Methods : All 282 specimens comprising 248 diarrheic and 34 non-diarrheic stools were randomly selected from 1063 stools previously analyzed for rotaviruses. These specimens were collected between July 2002 and July 2004 from children <5 years of age. The specimens were screened for the presence of adenoviruses using monoclonal antibody-based Enzyme Immuno Assay (EIA), (Adenovirus RIDASCREEN® r-Biopharm, UK) and the positive specimens were further examined for Ad40 and Ad41 using Premier Adenoclone® -Type 40/41 EIA (Meridian Biosciences, USA). Negative staining electron microscopy was performed on selected specimens to confirm the presence of adenovirus particles. Results : Adenovirus antigen was detected in 63/282 (23%) of the diarrheic diarrheic and in 6/34 (17.6%) of the non-diarrheic specimens. Adenoviruses were detected throughout the study period with most patients infected in the age group 25-36 months. The male-to-female ratio was 2.2:1 (43/20). Clinical features included fever (60%: 38/63), vomiting (56%: 35/63), mild dehydration (49%: 31/63), symptoms of upper respiratory tract infection (13%: 8/63) and abdominal pain (5%: 3/63). Analysis of stool specimen in adenovirus infected patients showed watery diarrhea in 87% (55/63), diarrhea with mucus in 19% (12/63) and diarrhea with mucus and blood in 3% (2/63). Ten (10) percent of the children were hospitalized due to gastroenteritis while 9 patients (14.3%) had co-infections with rotavirus. Human EAds were detected in 8% of specimens mainly in the dry season and among children older than 2 years. The principal symptoms were diarrhea (100%), dehydration (80%) and fever (80%). Conclusion : The findings of this study suggest that adenoviruses are important etiologic agents of gastroenteritis in Northwestern Nigerian children.
  5,087 136 9
Prescription pattern at a secondary health care facility in Ilorin, Nigeria
TM Akande, MO Ologe
December 2007, 6(4):186-189
DOI:10.4103/1596-3519.55699  PMID:18354944
Background / Objectives : Expenditures due to irrational use of drugs have been a strain on the meagre health budgets of several developing countries and inappropriate prescribing has been identified in many health facilities in developing countries. This study examines the prescription pattern in a secondary health facility. Method : A descriptive cross-sectional survey was used in this study. Three hundred and three randomly selected prescriptions issued to patients attending out-patients' clinics in the facility over a period of three months were examined. Data obtained was analyzed using EPI-INFO 2000 computer software. Results : Mean number of drugs per prescription in the health facility is 3.99 ± 1.55. At least 4 drugs were prescribed in 61.6% of the prescriptions. Generic prescribing was generally low. Out of a total of 1219 drugs prescribed 511 (41.9%) were prescribed in generic names. Analgesics, antimalarials, antibiotics and antihypertensives accounted for 19.7%, 10.2%, 13.0% and 4.9% of the drugs prescribed respectively. Only 124 (40.9%) of the prescriptions had all drugs prescribed available in the health facility. Conclusion : This study found practice of polypharmacy prevalent as found in other studies in developing countries among prescribers and prescription in generic names is low. Regular orientation and re-orientation of prescribers on rational drug prescription and prescription in generic names in conformity with national drug policies is necessary.
  4,493 83 15
CASE REPORT
Uterine prolapse following fundal pressure in the first stage of labour: A case report
J Tukur, AO Omale, H Abdullahi, Z Datti
December 2007, 6(4):194-196
DOI:10.4103/1596-3519.55697  PMID:18354946
The use of fundal pressure to assist a woman in labor is a controversial procedure. Its benefits are yet to be scientifically confirmed and it is associated with complications such as perineal lacerations, uterine rupture and uterine inversion. A case is reported of a 28year old Gravida 5 Para 4 + 0 (3 Alive) who presented to Aminu Kano Teaching Hospital, (AKTH) Kano, Nigeria with uterine prolapse following fundal pressure done in the first stage of labor in a peripheral hospital. She was delivered by Cesarean section and the prolapse successfully reduced under general anesthesia. Health workers need education on the risks associated with fundal pressure. Alternative methods of aiding women in labor should be promoted.
  3,904 87 8
RESEARCH ARTICLES
Pattern of eclampsia in a tertiary health facility situated in a semi-rural town in Northern Nigeria
J Tukur, BA Umar, A Rabi'u
December 2007, 6(4):164-167
DOI:10.4103/1596-3519.55703  PMID:18354940
Background / Objective : To determine the pattern of eclampsia and its contribution to maternal mortality at the Federal Medical Centre, Birnin Kudu, Jigawa State in Northern Nigeria. Method : A 4-year retrospective review of the case records of all women who presented with eclampsia at the center. All the case records were retrieved from the medical record department and analyzed. Results : There were 207 cases of eclampsia out of 2197 deliveries during the period giving an incidence of 9.42%. 171(82.6%) of the patients were unbooked. Majority (58.5%) of the patients were aged less than 20 years. The highest frequency (78.3%) was recorded in the primigravida. Delay before reaching the hospital was established in 116(56%) of patients. The condition was antepartum in 68(32.9%), intrapartum in 112(54.1%) and postpartum in 27(13%). 107(51.7%) of the patients were delivered by cesarean section. Twenty two (10.6%) of the mothers died. Eclampsia was the commonest cause of maternal mortality and contributed 43.1% of all maternal deaths. 180(87%) of the babies were delivered alive while 27(13%) died. Conclusion : Eclampsia is a major cause of maternal mortality. There is need for health education on the need for patients to avail themselves of antenatal care.
  3,505 72 15
Herniated gravid uterus: Clinical course and result of treatment
JG Makama, VI Odigie, LMD Yusufu, N Ameh
December 2007, 6(4):197-199
DOI:10.4103/1596-3519.55696  PMID:18354947
Herniated gravid uterus in an incisional hernia of the anterior abdominal wall is relatively rare. A 30-year-old house wife presented with a six month gravid uterus that had herniated through an incisional hernia of the anterior abdominal wall. She had non-operative management till term, when she then had elective lower caesarian section. Physiotherapy of the anterior abdominal wall muscles to improve their tone was done. She subsequently had keel's repair of the hernia. Aggressive physiotherapy of the anterior abdominal wall muscles followed by keel's repair may be an alternative surgical technique in patients with a moderate defect of incisional hernia.
  3,160 52 3
Adult laryngeal rhabdomyosarcoma: Report of a case and literature review
A Shayah, FO Agada, L Karsai, N Stafford
December 2007, 6(4):190-193
DOI:10.4103/1596-3519.55698  PMID:18354945
Rhabdomyosarcoma is relatively seen in the pediatric age group with the head and neck region as the commonest site. To the best of our knowledge, few cases of laryngeal involvement in adult have been described in the literature. Biologically, rhabdomyosarcoma is different from squamous cell carcinoma, which is the commonest tumor of the larynx. A previously healthy non-smoker 77-year-old lady presented to the ENT outpatient with a six weeks history of intermittent alteration of voice quality. She had no history of sore throat, or any symptoms suggesting laryngo-pharyngeal reflux. Examination showed asymmetry of the left arytenoid cartilage and aryepiglottic fold. She subsequently had a direct laryngoscopy and biopsy. Histology and immunohistochemistry examination suggested the diagnosis of mesenchymal neoplasm. Following discussion at MDT she subsequently had a total laryngectomy. Histology confirmed a completely excised laryngeal rhabdomyosarcoma. Rhabdomyosarcoma of larynx in adult is a rare disease. Surgical treatment with or without adjuvant radiotherapy is currently the treatment of choice for this disease.
  3,050 105 12
Pattern of presentation and outcome of surgical management of primary open angle glaucoma in Kano, Northern Nigeria
A Lawan
December 2007, 6(4):180-185
DOI:10.4103/1596-3519.55700  PMID:18354943
Background : Primary open angle glaucoma (POAG) is one of the leading causes of avoidable blindness. Unlike blindness from cataracts, glaucomatous optic nerve damage is irreversible, and prevention of glaucoma is one of the priorities of World Health Organization (WHO) Vision 2020 program. POAG is the commonest type of glaucoma and affects about 33.1 million people worldwide. This study is a five year review of 71 eyes of 63 patients who had trabeculectomy. The study evaluates the pattern of presentation and modality of surgical treatment in our environment. Methods : Records of all patients with primary open angle glaucoma operated over a five year period was retrieved. Information extracted included patients bio data, visual acuity, gonioscopic findings, intra ocular pressure as measured with applanation tonometer before and after surgery, and recorded in mmHg. Perimetry was done with 2 m tangent screen and recorded in a perimetry chart. All the patients had trabeculectomy with application of anti metabolite (5fluorouracil). Extra capsular cataract extraction with or, without posterior chamber intra ocular lens implantation was done on 13 patients. Biometry was not done on patients with cataract. Surgery was done on better eye first in all patients. Results : There were 71 eyes of 63 patients. The male to female ratio was 3:1. The age ranged between 18 to 75 years. 8 patients were below the age of 30 years. One third of the patients were between the ages of 50 to 59 years. At presentation 12 patients (19%) had normal vision (WHO vision category O), 26 patients (41%) were visually impaired, 12 patients (19%) were severely visually impaired and 13 patients (21%) were blind (from co existing cataracts). The cup disc(c: d) ratio assessed before surgery was 0.5 in 9 eyes (13%), 31 eyes (53%) had c: d ratio 0.6 to 0.8 and 18 eyes had c: d ratio of 0.9. All the patients had open anterior chamber angles (Schafer grade 3 and 4). Perimetric changes were; mild peripheral constriction in 5 eyes (8%), peripheral constriction with arcuate scotoma in 19 eyes (26%), constricted fields of 30° or less in 34 eyes (48%), and in 13 eyes there was inability to fixate on target. IOP before surgery was 21 to 30 mm Hg in 12 eyes (17%), and above 31 mm Hg in 69 eyes (83%). Post operative IOP of 10 to 15 mm Hg was obtained in 58 eyes (82%) and 11 eyes (15%) had IOP of 16 to 20 mm Hg. Only 2 eyes (3%) had IOP in the lower twenties. Conclusion : Primary open angle glaucoma is characterized by late presentation. Trabeculectomy with application of 5FU is the surgical treatment of choice in our environment and give good intra ocular pressure control. There is need to increase public awareness on glaucoma to limit this type of avoidable blindness.
  3,078 70 12
Morbidity and mortality patterns among neurological patients in the intensive care unit of a tertiary health facility
OP Adudu, OA Ogunrin, OG Adudu
December 2007, 6(4):174-179
DOI:10.4103/1596-3519.55701  PMID:18354942
Background / Objective : The morbidity and mortality of neurological patients managed in the intensive care unit reflect the causes of neurological disorders and the effectiveness of management. Method : The morbidity and mortality patterns of neurological patients admitted into the intensive care unit of the University of Benin Teaching Hospital (UBTH), a tertiary health institution in Nigeria, was examined over an 18-year period (January 1985 to December 2003). A complete sampling frame was used with all patients' records scrutinized. Results : A total of 187 patients, (16.6% of the total ICU admissions) with neurological morbidity were admitted during the period. We observed that morbidity was high for preventable etiologies- head injury (119 patients constituting 63.7%), tetanus (26 patients constituting 13.9%), hypertensive encephalopathy (12 patients constituting 6.4%) and meningitis (8 patients constituting 4.8%). The case fatality rates for these causes were 50.4%, 61.5%, 66.7% and 62.5% respectively. The case fatality rate for cerebral malaria was 100%. In addition, males (67.9%) were more likely to have trauma-related morbidity (P<.001) than females (32.1%). Overall mortality rate was high (52.4%) and calls for urgent attention. Conclusion : We concluded that preventable morbidities (head injury, tetanus, meningitis and hypertensive encephalopathy) accounted for fatality among neurological patients in the ICU, Benin City, Nigeria. Mortality was higher among those that required significant intensive interventions. Improved public awareness, traffic legislation, prompt emergency medical care and immunization against tetanus and meningitis should reduce morbidity and mortality.
  3,038 99 8
CASE REPORT
Myositis ossificans circumscripta of the supra-orbital region: A case report
SO Ajike, A Mohammed, ETO Adebayo, CN Ononiwu, OO Omisakin
December 2007, 6(4):203-206
DOI:10.4103/1596-3519.55694  PMID:18354949
Myositis ossificans circumscripta is a pathological condition characterized by formation of bony tissue within the skeletal muscles following repeated trauma. A case of myositis ossificans circumscripta of the supra-orbital region in a 25-year-old man is presented and the pertinent literature is reviewed. To the best our knowledge this benign lesion has not been reported previously in the orbital region the world literature. Clinically the patient presented with a swelling and proptosis of the right eye. Radiologically there was a rounded opacity with well defined margin. Lesion was initially misdiagnosed as a fibro-osseous lesion; however microscopic examination indicated matured myositis ossificans. Lesion was excised via a bicoronal flap. Careful clinical, radiological and pathologic evaluation is required to make this uncommon diagnosis in an unusual location such as the supra-orbital region to avoid unnecessary surgical mutilation of the patient.
  2,789 83 3
RESEARCH ARTICLE
Hyponatraemia during low-dose carbamazepine therapy
F Salawu, A Danburam
December 2007, 6(4):207-208
DOI:10.4103/1596-3519.55693  PMID:18354950
We report the syndrome of inappropriate antidiuresis as a much earlier side-effect of carbamazepine administration in a 29-year Nigerian female patient with generalized tonic-clonic seizures. Although asymptomatic, the biochemical abnormality improved after discontinuation of carbamazepine. Hyponatraemia developed after rechallenge with controlled release carbamazepine. The authors suggest that serum sodium levels be carried out before commencement of carbamazepine and caution be used in prescribing carbamazepine to patients with low or borderline low sodium values.
  2,697 85 1
RESEARCH ARTICLES
Wernicke's encephalopathy in a Nigerian with schizophrenia
F Salawu, S Kwajaffa
December 2007, 6(4):200-202
DOI:10.4103/1596-3519.55695  PMID:18354948
While Wernicke's encephalopathy (WE) is a well-characterized syndrome in alcoholism and malnutrition, little is written of its prevalence or presentation in patients with psychiatric illness. We present a case of a 37-year-old Nigerian male with schizophrenia and malnutrition who presented with delirium and ophthalmoplegia. The clinical diagnosis was supported by dramatic reversal of the symptoms and signs following the administration of intravenous thiamine. Owing to the high rate of mortality and morbidity, WE should be considered in the evaluation of any patient with unexplained nystagmus, gaze palsies, gait ataxia, or confusion, especially if a condition associated with malnutrition is present. This is particularly important in psychiatric patients where the clinical history and syndrome may be obscured and treatment delayed.
  2,105 71 1
EDITORIAL
Poverty and disease burden vs medical education in Sub-Saharan Africa
BB Shehu, EA Ameh
December 2007, 6(4):139-141
DOI:10.4103/1596-3519.55706  PMID:18354937
  1,692 52 -
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