Annals of African Medicine
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   2016| July-September  | Volume 15 | Issue 3  
    Online since August 23, 2016

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Establishing in-hospital geriatrics services in Africa: Insights from the University of Benin Teaching Hospital geriatrics project
Obehi Aituaje Akoria
July-September 2016, 15(3):145-153
DOI:10.4103/1596-3519.188896  PMID:27549420
Background: Unawareness of the peculiar healthcare needs of the elderly and resource constraints may be some reasons why until recently, Nigerian hospitals have not been equipped with the human and infrastructural resources required to meet older adults' special healthcare needs. There is paucity of specialized health services for the elderly in Africa. Nigeria, with a population of over 170 million, did not have any healthcare facility with dedicated services for the elderly until 2012. The University of Benin Teaching Hospital (UBTH) in Nigeria was established in 1973 and created its geriatrics unit in October 2013. A prepared environment and trained interdisciplinary teams are pivotal in providing effective healthcare services for the elderly. The ongoing UBTH geriatrics project aims to provide specialized interdisciplinary health services to older adults and to provide training and continuing professional development in geriatrics for healthcare staff. In developing our inpatient services, we adopted the acute care for elders (ACE) model and worked in tandem with the "ABCs" of implementing ACE units. Results: In the face of limited resources, it was possible to establish a functional geriatrics unit with a trained interdisciplinary team. Family participation is central in our practice. Since October 2013, residents and house officers in internal medicine have been undertaking 4- and 12-weekly rotations, respectively. There is also a robust academic program, which includes once-weekly geriatric pharmacotherapy seminars, once-weekly interdisciplinary seminars, and 2-weekly journal club meetings alternating with seminars on geriatric assessment tools. Conclusions: It is possible to establish geriatric services and achieve best practices in resource-limited settings by investing on improving available human resources and infrastructure. We also make recommendations for setting up similar services in other parts of Africa.
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Ocular manifestations in leukemia and myeloproliferative disorders and their association with hematological parameters
Renu Dhasmana, Amrita Prakash, Neeti Gupta, SK Verma
July-September 2016, 15(3):97-103
DOI:10.4103/1596-3519.188887  PMID:27549412
Objectives: To study the ocular manifestations in patients diagnosed with leukemia or myeloproliferative disorders and to derive an association between the ocular manifestations and hematological parameters of the patients. Materials and Methods: This observational and descriptive study was conducted in a Tertiary Care Center of Dehradun, North India over a period of 1 year. All the diagnosed cases of leukemia and myeloproliferative diseases attending the Oncology Department were included. Patients underwent a detailed ocular examination. The hematological parameters were also recorded including hemoglobin (Hb), total leukocyte count (TLC), and platelet count. Results: The study included 102 patients out of which, there were 66 males (64.7%), and 36 were females (35.3%) with an age range of 5-80 years. A total of forty patients showed ocular manifestations (39.3%). Extraocular manifestations were seen in 10.8% patients while intraocular manifestations were noted in 45.1% patients of acute leukemia and 7.7% patients of chronic leukemia. These ocular manifestations showed a significant association with low Hb (P = 0.000), raised TLC (P = 0.004), and low platelet count (P = 0.000). The most common ocular manifestation was intraretinal hemorrhages followed by roth spots. Among acute myeloid leukemia patients (23.5%), the presence of intraretinal hemorrhages was significantly associated with low Hb (Mann-Whitney U-test = 25.000, P = 0.007). The patients of acute lymphoblastic leukemia (25.4%) showed significant association between intraretinal hemorrhages and low platelet count (Mann-Whitney U-test = 44.000, P = 0.046) and roth spots with low Hb (Mann-Whitney U-test = 11.000, P = 0.000). Ocular manifestations were more commonly seen in acute leukemias as compared to chronic leukemias. Conclusion: Ocular examination is recommended in all leukemic patients as ocular manifestations may go unnoticed, most patients being asymptomatic and could be an early sign of worsening of disease.
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Epidemiology of congenital anomalies of the central nervous system in children in Enugu, Nigeria: A retrospective study
Christopher Bismarck Eke, Enoch Ogbonnaya Uche, Josephat Maduabuchi Chinawa, Ikechukwu Emmanuel Obi, Herbert Anayo Obu, Roland Chidi Ibekwe
July-September 2016, 15(3):126-132
DOI:10.4103/1596-3519.188892  PMID:27549417
Background: Congenital anomalies, including those of the central nervous system (CNS), are among the leading causes of morbidity, mortality, and fetal loss. Objective: To determine the prevalence and associated factors of CNS congenital anomalies in children. Methods: A cross-sectional retrospective study of children managed with CNS anomalies was undertaken. Relevant clinical data of identified cases based on standard case definitions were retrieved from their case record files. Data were analyzed using SPSS 20.0 while the level of statistical significance was set at P < 0.05. Results: Seventy-two cases of CNS anomalies were identified over the period under review; out of 7329 total pediatric admissions giving a prevalence of 0.98%. Spina bifida cystica, 49 (68.0%) was the most common of the five anomalies seen followed by congenital hydrocephalus 11 (15.3%). Fifty-seven (79.2%) of the mothers did not take periconceptional folic acid supplementation (P < 0.05) whereas 25 (34.7%), 6 (8.3%), and 1 (1.4%) reported history of febrile illness in the first trimester of pregnancy, alcohol use, and diabetes mellitus in pregnancy, respectively. Majority of the cases of spina bifida cystica (30 [61.2%]) seen had corrective surgeries while the overall case fatality rate was 1 (1.4%). Conclusions: Spina bifida cystica was the most common anomaly of the CNS seen in this study and majority of the mothers of affected children did not take periconceptional folic acid supplementation (P < 0.05). Efforts should be made to create awareness and apply adequate preventive health education models including the use of periconceptional folic acid supplementation as well as the provision of access to standard prenatal care to at risk mothers.
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Induction to delivery interval using transcervical Foley catheter plus oxytocin and vaginal misoprostol: A comparative study at Aminu Kano Teaching Hospital, Kano, Nigeria
Ibrahim Garba, Abubakar Shehu Muhammed, Zakari Muhammad, Hadiza Shehu Galadanci, Rabiu Ayyuba, Idris Sulaiman Abubakar
July-September 2016, 15(3):114-119
DOI:10.4103/1596-3519.188890  PMID:27549415
Background: Induction of labor (IOL) is an artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Many factors are associated with its success in postdatism. Objective: To compare the induction delivery intervals using transcervical Foley catheter plus oxytocin and vaginal misoprostol, and to identify the factors associated with successful induction among postdate singleton multiparae. Materials and Methods: The study was a prospective randomized controlled trial of singleton multiparous pregnant women. They were randomized into two groups, one group for intravaginal misoprostol and the other group for transcervical Foley catheter insertion as a method of cervical ripening and IOL. The data were analyzed using SPSS version 17 computer software (SPSS Inc., IL, Chicago, USA). Comparisons of categorical variables were done using Chi-squared test, with P < 0.05 considered as significant. Student's t-test was used for continuous variables. Results: The incidence of postdatism was found to be 136 (13.1%). The mean induction delivery time interval was shorter in the misoprostol group 70 (5.54 ± 1.8 h) than in the Foley catheter oxytocin infusion group 66 (6.65 ± 1.7 h) (P = 0.035). There was, however, no statistically significant difference in the maternal and neonatal outcomes when these two agents were used for cervical ripening and IOL. Higher parity and higher Bishop's score were the factors found to be associated with high success rate of IOL (P < 0.001). Conclusion: Vaginal misoprostol resulted in shorter induction delivery time interval as compared to transcervical Foley catheter. High parity and high Bishop's scores were the factors found to be associated with the success of IOL.
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Prestroke treatment of stroke risk factors: A cross-sectional survey in central Nigeria
Nura H Alkali, Sunday A Bwala, Jacob A Dunga, Musa M Watila, Yusuf B Jibrin, Abdulrahman Tahir
July-September 2016, 15(3):120-125
DOI:10.4103/1596-3519.188891  PMID:27549416
Background: Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa. Materials and Methods: We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of anti-hypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke. Results: Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant. Conclusions: A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke.
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Colonoscopy at a tertiary healthcare facility in Southwest Nigeria: Spectrum of indications and colonic abnormalities
Adegboyega Akere, Temitope Olufemi Oke, Jesse Abiodun Otegbayo
July-September 2016, 15(3):109-113
DOI:10.4103/1596-3519.188889  PMID:27549414
Background and Aim: Colonoscopy is considered the gold standard for diagnosing structural colonic diseases. It is safe and effective both for diagnosis and therapeutic interventions. This study was carried out to evaluate the pattern of indications and spectrum of colonic disease at a tertiary healthcare facility in Southwest Nigeria. Patients and Methods: All consenting patients who were referred for colonoscopy were recruited into the study. A proforma was used to record information such as biodata of the patients, indications for the procedure, and the findings at colonoscopy. Results: There were 250 patients, comprising 130 (52.0%) males and 120 (48.0%) females, with a male to female ratio of 1.1:1. The mean age of the patients was 57.9 ± 14.2 years with a range of 15-90 years. The most common indication for colonoscopy was hematochezia 85 (34.0%), others were abdominal pain 46 (18.4%), suspected colonic cancer 27 (10.8%), constipation 27 (10.8%), and chronic diarrhea 22 (8.8%). Sixty-five (26%) patients had normal colonoscopy while various abnormalities were detected in 185 (74%) patients. The most common abnormalities were colonic polyps (23.2%), hemorrhoids (20.8%), diverticulosis (14.8%), colorectal tumor (12.1%), and colitis (4.0%). Conclusion: Colonoscopy is an effective means of diagnosing colonic diseases and that the diagnostic yield could be high if the indication were appropriate. The most common indication in our practice was hematochezia, and the most frequent diagnosis was colonic polyps.
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Antiphospholipid antibodies among pregnant women with recurrent fetal wastage in a tertiary hospital in Northern Nigeria
Zubaida Garba Abdullahi, Mohammmed A Abdul, Sirajo M Aminu, Bolanle O.P. Musa, Lawal Amadu, El-Bashir M Jibril
July-September 2016, 15(3):133-137
DOI:10.4103/1596-3519.188894  PMID:27549418
Context: The association between antiphospholipid antibodies (APAs) and pregnancy loss has been established and now considered as a treatable cause of pregnancy loss. Data on the prevalence of APA in patients with recurrent pregnancy loss are scarce in our environment. Aims: To determine the prevalence of APA in pregnant women with and without recurrent fetal wastage. Settings and Design: Antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. A cross-section analytical study. Subjects and Methods: Eighty-five antenatal patients with recurrent fetal loss (cases) and an equal number of antenatal patients without recurrent fetal loss (control) matched for age were studied. Their sociodemographic data obtained and blood samples analyzed for lupus anticoagulant (LA) using activated partial thromboplastin time, direct Russel's viper venom time, hexagonal phospholipids, and IgG anticardiolipin antibody (ACA) using enzyme-linked immunosorbent assay. Statistical Analysis Used: Data were analyzed with Statistical Package for Social Sciences (version 17) by univariate analysis and Chi-square test. Results: The age range of the patients was 18-42 years with a median of 30 years. The prevalence of APA was 14.1% and 4.7% among the cases and controls, respectively. The prevalence of LA was 7.1% and 1.2% among the cases and controls, respectively, whereas ACA was 8.2% and 3.5%, respectively. However, one of the cases was positive for both APA and ACA, giving a prevalence of 1.2%.  Conclusions: The prevalence of APA among antenatal patients with recurrent pregnancy loss was, at least, 3 times higher than that of normal antenatal clients. APA should be included in the investigation protocol of women with recurrent fetal wastages in our setting.
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Extending otology services to rural settings: Value of endoscopic ear surgery
Abubakar Danjuma Salisu, Yasir Nuhu Jibril
July-September 2016, 15(3):104-108
DOI:10.4103/1596-3519.188888  PMID:27549413
Introduction: Few centers, mainly located in urban settings offer otological surgical services, yet majority of patients requiring these services are rural based and are generally unable to access these centers with resulting disease chronicity and complications. This paper aims to describe the access of otological surgical services by a rural population. Methodology: This is a retrospective study of patients who accessed otological services at three secondary health institutions and one tertiary referral institution. All patients requiring ear surgery over a 4-year period were studied. The initial 2 years without ear endoscopic surgery was compared with the 2 years when ear endoscopic surgery was introduced. Hospital records were studied and relevant data were extracted. Results: Six hundred and nine ears required surgery over 4 years. Age ranged from 3 to 62 years, with a ratio of 1.4 males: 1 female. During the initial 2 years, all patients were referred from the three secondary health institutions to the urban-based tertiary institution for microscopic ear surgery, 94% failed to proceed on the referral. In the second 2 years, 34% were considered suitable for endoscopic ear surgery, of which 78% accepted and had surgery within the locality. Of the 66% referred, only 5% proceeded on the referral. Conclusion: With operator training and investment in portable ear endoscopy set, bulk of ear surgery needing magnification can be treated in the rural setting. This represents a most feasible means of extending the service to the targeted population.
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Cognitive function assessment in patients with end- stage renal disease in Nigeria: A single center experience
Lukman Femi Owolabi, Aliyu Abdu, Aliyu Ibrahim, Desola Shakira Owolabi, Aisha Nalado, Adamu Bappa, Aminu Abdullahi Taura
July-September 2016, 15(3):138-144
DOI:10.4103/1596-3519.188895  PMID:27549419
Aim: The purpose of this comparative study was to evaluate cognitive function in end-stage renal disease (ESRD) patients in comparison with age, sex, and level of education-matched control. Materials and Methods: This is a cross-sectional study involving 80 ESRD patients receiving maintenance hemodialysis treatment and recruited conservatively at the nephrology unit of our hospital. Eighty apparently healthy control, that were matched with the patients for age, sex and education, were also recruited. Following exclusion of depression and severe functional disability, a computer-assisted neuropsychological test, the FePsy, was used to assess  memory, psychomotor speed, concentration and attention using simple auditory and visual reaction time tasks, recognition memory tests (RMTs), finger tapping task, and binary choice task (BCT) for both the ESRD patients and controls. Results: ESRD patients performed worse on simple auditory and visual reaction time tasks (P < 0.05), RMTs (P < 0.05), finger tapping task (P < 0.05), BCT, and computerized visual search task (P < 0.05). Conclusion: Performance in memory, psychomotor tasks, concentration, and attention tasks were found to be reduced among patients with ESRD compared with age, sex and level of education-matched control.
  2,599 29 -
Call for global vaccine instead of Helicobacter pylori blind antibiotic therapy
Amin Talebi Bezmin Abadi
July-September 2016, 15(3):154-155
DOI:10.4103/1596-3519.188897  PMID:27549421
  1,864 26 -