Annals of African Medicine
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   2010| October-December  | Volume 9 | Issue 4  
    Online since October 8, 2010

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Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria
AS Oguntola, ML Adeoti, TA Oyemolade
October-December 2010, 9(4):213-217
DOI:10.4103/1596-3519.70956  PMID:20935419
Background : Appendicitis is a common clinical condition worldwide. Differences in incidences, sex, age, and seasonal variations have been reported widely, with paucity of information from Nigeria. Aim : To assess the trends in incidence and pattern of variation with age, sex, and seasons of the year. Materials and Methods : A review of the records of all patients with confirmed appendicitis treated in both the LAUTECH Teaching Hospital (LTH) and the Abake Medical Center (AMC), both situated in Osogbo, Nigeria, between January 2003 and December 2008, was done. LTH was a 320-bed University Hospital (with 100 surgical beds), while AMC was a 20-bed surgical center. The age, sex, and month of admission of all the histologically proven cases of appendicitis were retrieved and treated. Analysis was done using simple percentages, Student t or Chi-square tests, where applicable. Results : A total of 299 out of 321 cases of appendicitis recorded during the observed period were confirmed histologically from both hospitals (69.56% from LTH). Fifty-two percent were males. It made up 0.94, 1.43, and 1.86% of the total hospital admissions in 2004, 2006, and 2008, respectively. There has been an increasing incidence in both sexes almost in a similar pattern. The overall mean age was 25.79 years (M 25.94 and F 25.43 years) with 6% below the age of ten and 1.3% above 60 years. The highest incidence in males and females occurred in the second and third decades, respectively. Incidences were higher during the rainy season (April to September) 68%, P < 0.05), with peaks from June to August, when 39.5% of all cases presented. Conclusion : The increasing incidence of appendicitis in both sexes in this region may be due to the change to a Western lifestyle. The age distribution has a similar pattern in both sexes and 87% are 40 years or less, although the incidence is marginally higher in males. Higher prevalence of infections and allergens from pollens in the rainy season could contribute to a higher incidence of appendicitis.
  22,629 41 25
Experience with the use of community health extension workers in primary care, in a private rural health care institution in South-South Nigeria
Best Ordinioha, Chinyere Onyenaporo
October-December 2010, 9(4):240-245
DOI:10.4103/1596-3519.70964  PMID:20935425
Background : The difficulty in recruiting and retaining doctors in rural areas has encouraged the use of substitute health workers in the provision of primary care for undiagnosed patients with undifferentiated health problems. This study was performed to report the experience of the use of Community Health Extension Workers (CHEWs) in the provision of primary care in a private rural health care facility in a community in Nigeria. Methods : The study was carried out over a 6-month period in a private health facility in a semiurban community. The CHEWs were recruited through the recommendation of their schools and were retrained and deployed incognito, but with a clear job description. Their performances were monitored using the level of patient satisfaction, the type of cases seen, the number of telephone consultations made with the doctors of the NGO, the length of prescriptions and the number of adverse events that followed the consultations. Results : A total of 1,028 patients were seen in the health facility during the 6-month study period, of which 294 (28.6%) telephone consultations were made with the doctors of the NGO, 215 (20.9%) of the patients were admitted in the hospital, while 81 (7.9%) were referred to other health facilities. Most of the cases were malaria (54.2%), typhoid (6.9%) and minor injuries (12%). The average length of the prescriptions given to the patients per encounter was 6.3, and most of the patients (86.5%) were satisfied with the quality of care provided by the CHEW. A total of 7.6% of the patients seen by the CHEWs were readmitted as emergencies, mainly with severe anemia (47.4%) and the deterioration of previously treated ailment (24.4%). Conclusions : CHEWs, working under the direct supervision of doctors can provide safe and good quality care, to the satisfaction of most of their patients, when required to provide primary care. It cannot however be assumed that similar results would be obtained if the health workers are used in different settings or with more complicated patients.
  11,356 33 12
Providing safe medicines for children in Nigeria: The impediments and remedies
KA Oshikoya, IO Senbanjo
October-December 2010, 9(4):203-212
DOI:10.4103/1596-3519.70954  PMID:20935418
Promoting safety of medicines for children is a global concern which has prompted the World Health Organization (WHO) to launch a campaign of "Making Medicines Child Size". Children in Nigeria were once victims of unethical clinical medicine trials and repeated victims of use of fake and adulterated medicines. Considering the magnitude of harms children had suffered in Nigeria from the use of medicines, there is a need for literature review to identify the factors preventing children from accessing safe medicines and to suggest remedies to the problems. Lack of access to up- to- date medicine information, lack of training and research in pediatric clinical pharmacology, deficiencies in undergraduate and postgraduate teaching of medicine risk management and clinical pharmacology and therapeutics, irrational medicine use due to lack of pediatric focus on essential medicine list and inappropriate home storage of medicines by parents, lack of evidence- based medicine (EBM) practice, lack of national adverse drug reaction surveillance among children, and weak national drug policies were the major problems identified. It is to be hoped that development and provision of a pediatric national drug formulary for health professionals in Nigeria, creating a comprehensive national pediatric drug research network in collaborations with developed countries, reviewing the undergraduate and postgraduate curriculum in pediatrics to include teaching of basic elements of rational prescribing, drug dose calculations, adverse drug reactions and pharmacovigilance, increasing access to essential medicines for children, postgraduate teaching of EBM, and strengthening of the national drug policies would improve children's access to safe medicines in Nigeria.
  10,042 57 5
Burnout syndrome among multinational nurses working in Saudi Arabia
Haifa A Al-Turki, Rasha A Al-Turki, Hiba A Al-Dardas, Manal R Al-Gazal, Ghada H Al-Maghrabi, Nawal H Al-Enizi, Basema A Ghareeb
October-December 2010, 9(4):226-229
DOI:10.4103/1596-3519.70960  PMID:20935422
Background : Nursing Staff is reported to be under extreme state of stress, leading to burnout syndrome (BS). Most of the studies have been conducted among the nurses working in their home countries. This study was conducted to assess the prevalence of BS among a multinational nursing workforce in Saudi Arabia. Materials and Methods : King Fahd University Hospital, AlKhobar, Saudi Arabia, is a tertiary care hospital employing 510 nurses of multinational workforce. Two hundred and fifty Maslach Burnout Inventory (MBI) individual-based questionnaires were distributed after modification to include the age, sex, marital status, nationality, unit working and number of years on the job. The data were entered in the database and analyzed using Statistical Package for the Social Sciences (SPSS), version 14.0. A P value of <0.05 was considered statistically significant . Results : One hundred and ninety-eight nurses (77.2%) completed the questionnaire. Their average age was 34.46 ± 5.36 years. Forty-five percent (89) had high emotional exhaustion (EE) and 28.9% (57) had moderate suffering with EE. Staffs who were on the job for longer duration had a lesser frequency of EE (P ≤ 0.001). The frequency of depersonalization (DP) was 83 (42%) and was graded as high and 61 (30.8%) were moderately affected. Personal accomplishment (PA) was moderate to low in the majority of the nurses (71.5%). Married nurses were prone to EE (28.17 ± 12.1 versus 22.3 ± 9.6) than unmarried nurses (P = 0.003, CI 95% and OR 2.4). The nurses in the patients' wards and clinics were more emotionally exhausted with higher DP compared to nurses in the high stress and high activity areas (P < 0.001, OR −11.1; and P < 0.001, CI 95% and OR 9.65). Non-Saudi nurses were significantly more prone to EE (27.3 ± 12.1 versus 21.6 ± 2.9) than Saudi nurses (P = 0.004; 95% CI: <9.64). Conclusion : We found that majority of the nursing staff at our hospital were in a state of burnout with high frequency of EE and DP. Only a quarter of the surveyed staff felt that they had some level of PA. Age and working away from their home countries were the important predictors in the development of BS in nurses. We believe that working conditions have to be improved to develop strategies to cope and alleviate stressful situations.
  8,323 33 30
Female sterilization by tubal ligation at caesarean section in Makurdi, Nigeria
TZ Swende, TS Hwande
October-December 2010, 9(4):246-250
DOI:10.4103/1596-3519.70965  PMID:20935426
Background : Female sterilization is an important tool in reducing unplanned pregnancy and maternal mortality in our environment. The aim of this study was to determine the incidence, sociodemographic characteristics, technique, effectiveness and complications associated with female sterilization by bilateral tubal ligation at caesarean section. Method : This was a retrospective analysis of the clinical records of 78 clients who had female sterilization out of 1,346 acceptors of contraceptive methods at the Federal Medical Centre, Makurdi, over a 5-year period between November 2002 and October 2007. Results : Of the 1,346 acceptors of family planning methods, 78 clients had bilateral tubal ligation. The majority of the clients (37 [47.4%]) had sterilization at caesarean section, representing 2.7% of all acceptors of family planning methods. The mean age and parity of the clients were 34.3 years and 5.5, respectively. The majority of the clients (36 [97.3%]) had sterilization using the modified Pomeroy's technique. Contraceptive effectiveness was 100%. No complication specific to tubal ligation was noticed. Conclusion : Majority of female sterilization were performed at caesarean section. The procedure was found to be safe and effective.
  7,938 21 1
Proximate predictors of early antenatal registration among Nigerian pregnant women
Adesina Oladokun, Regina E Oladokun, Imran Morhason-Bello, Adenike F Bello, Babatunde Adedokun
October-December 2010, 9(4):222-225
DOI:10.4103/1596-3519.70959  PMID:20935421
Background : Provision of antenatal care (ANC) is included in the pillars of maternal health care promoted as effective answers to maternal mortality. Early antenatal registration has been linked with optimal utilization and appreciable reduction of perinatal morbidity and mortality. This study aimed to determine the profile and possible predictors of pregnant women who presented early for antenatal registration. Methods : A cross-sectional study was conducted among 796 women presented for antenatal registration at a tertiary hospital. Information was obtained by a self-administered open- and closed-ended questionnaire and analyzed with Statistical Package of Social Science (SPSS) 12.0 software. Results : The mean gestational age at booking was 20 weeks. Univariate analysis showed that first trimester booking was significantly with more educated women, professionals, women of lower parity and those who have had previous stillbirths (P < 0.05). Low parity (OR 1.76, 95% CI 2.79-1.11) and previous stillbirth (OR 2.97, 95% CI 1.61-5.51) were significant predictors of early booking on multivariate analysis. Conclusion : Long-term advocacy and investment in female education will contribute significantly to primary prevention of late or non-attendance of ANC. Pre-conception clinics and community awareness campaigns would be necessary tools to reach these women and encourage them to register early when pregnant.
  7,026 32 13
Swab and aspiration specimen collection methods and antibiogram in chronic suppurative otitis media at Jos University Teaching Hospital: Which is superior?
AS Adoga, EN Ma`an, D Malu, BP Badung, IV Obiesie, O.G.B Nwaorgu
October-December 2010, 9(4):230-234
DOI:10.4103/1596-3519.70961  PMID:20935423
Background : Chronic suppurative otitis media is a very common otologic problem in our environment. Appropriate methods for obtaining sample specimens for specific bacteria isolation has generated a lot of controversy. The simplest method available in our environment is the traditional swab method which, however, has been condemned on the basis of introducing contaminants. The objectives of this study were to compare the bacterial yield and the antibiogram of two specimen collection methods: the traditional swab method and aspiration method. Method : This was a 3-month prospective study involving outpatients seen at both the emergency and outpatients' clinics of the Jos University Teaching Hospital in the period between May 2008 and July 2008. The biodata, duration of discharge and sites of samples were recorded in the study data form after obtaining consent from the patients or the parents of child. Results : Eighty patients were studied comprising 40 each for aspiration and swab technique. This consists of 30 males (37.5%) and 50 females (62.5%) with a male to female ratio of 1:1.7. There were 24 (30%) children (14 males, 10 females). Six (4 males, 2 females) and 74 (26 males, 48 females) patients had bilateral and unilateral ear discharges, respectively. A total of 86 specimens were obtained in all, consisting of 42 left and 44 right ears. There were 68 bacteria isolates comprising Pseudomonas (30), Staphylococcus (18), Proteus (12), and (8) Klebsiella species. Two were incidental fungal isolates of (Candida species), (8) cultures grew contaminants and (10) specimens had no growth at all. Each of the swab and aspiration techniques had (44) specimens. Conclusions : Despite the controversy surrounding the sampling technique in literature, swab technique has been found to be as good as the aspiration technique in our study. The organisms isolated are the same as those obtained in other places. Contaminants found were few and occurred in equal amount in the same patients in the two methods.
  5,337 25 4
Mediastinal bronchogenic cyst with back pain
PO Ibinaiye, AO Adeyinka, M Sogaolu, GA Kajogbola
October-December 2010, 9(4):251-253
DOI:10.4103/1596-3519.70967  PMID:20935427
We report a case of a mediastinal bronchogenic cyst with back pain. The rarity of this lesion and even the more uncommon association of this lesion with symptoms of back pain prompted the report of this case.
  5,133 18 -
Serum levels of antioxidant vitamins and mineral elements of human immunodeficiency virus positive subjects in Sokoto, Nigeria
Lawal S Bilbis, Dorcas B Idowu, Yusuf Saidu, Mansur Lawal, Chibueze H Njoku
October-December 2010, 9(4):235-239
DOI:10.4103/1596-3519.70963  PMID:20935424
Background : Undernourishment and micronutrient deficiencies exacerbate immunosuppression, oxidative stress, acceleration of human immunodeficiency virus (HIV) replication and CD4 T-cell depletion in HIV-infected individuals. Materials and Methods : The current work reports the serum levels of antioxidant vitamins (vitamins A, C and E) and minerals (Zn, Fe, Cu) in 90 HIV positive subjects attending the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The serum levels of the micronutrients were correlated with the CD4 count of the subjects. Results : The results showed that the HIV positive subjects have significantly lower (P < 0.05) levels of vitamins A, C and E. Also, serum Zn, Fe, Cu and CD4 count were also significantly (P < 0.05) lower compared with the HIV negative subjects. Micronutrient deficiencies were more pronounced in HIV positive subjects with CD4 counts less than 200 cell/μl. The results based on age and sex showed no significant (P > 0.05) difference. Vitamins A, E and C and Zn and Fe showed positive correlation with CD4 count of the HIV positive subjects. Conclusion : The results suggest that the HIV subjects in the study area have lowered serum levels of antioxidant micronutrients and that the levels decrease with increase in the severity of the infection. These may increase the chances of the symptomatic and asymptomatic subjects progressing into full-blown Acquired Immunodeficiency Syndrome.
  5,033 22 9
Appendicitis as an immunological disease: Why it is uncommon in Africans
Robert B Sanda
October-December 2010, 9(4):200-202
DOI:10.4103/1596-3519.70953  PMID:20935417
  4,646 19 1
Reflections on the burnout syndrome and its impact on health care providers
Marta Elena Losa Iglesias, Ricardo Becerro de Bengoa Vallejo, Paloma Salvadores Fuentes
October-December 2010, 9(4):197-198
DOI:10.4103/1596-3519.70951  PMID:20935415
  4,562 27 5
Otology practice in a Nigerian tertiary health institution: A 10-year review
AD Salisu
October-December 2010, 9(4):218-221
DOI:10.4103/1596-3519.70958  PMID:20935420
Background : The practice of otology in developing countries has remained unsatisfactory. The aim of this study is to describe the practice in a tertiary health institution with a view to articulate strategies for improvement. Materials and Method : This a retrospective study of patients with otology problems, who attended Ear, Nose and Throat clinic of Aminu Kano Teaching Hospital, Kano, over a 10-year period (1997-2007). Case notes were retrieved and studied. Results : Otologic conditions accounted for 56.3% of the 8070 clinic visits. The most frequent condition seen was chronic otitis media (25.4%). Sensorineural hearing loss (mostly preventable) accounted for 16%. Other cases included wax impaction (7.5%) and foreign body in ear (7.3%). Modern diagnostic and operative equipment were lacking. Operative surgery was offered to 4% of cases of chronic suppurative otitis media and 72% of patients needing hearing aid could not afford one. There was no middle ear reconstructive or inner ear operation in the 10-year period. Conclusion : A significant number of patients are in need of otology services. These services are inadequate presently. Concerted effort should be geared toward strengthening preventive ear health, training and re-training, procurement of relevant diagnostic and operative equipment.
  4,355 20 5
Otology practice in Nigeria: The way forward
Frank Agada
October-December 2010, 9(4):199-199
DOI:10.4103/1596-3519.70952  PMID:20935416
  2,921 19 -