Annals of African Medicine
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   2018| January-March  | Volume 17 | Issue 1  
    Online since January 24, 2018

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Prescribing pattern and antibiotic use for hospitalized children in a Northern Nigerian Teaching Hospital
Lawal Waisu Umar, Abdulmuminu Isah, Shuaibu Musa, Bilkisu Umar
January-March 2018, 17(1):26-32
DOI:10.4103/aam.aam_44_17  PMID:29363633
Background: Assessment of patterns of drug to detect performance problems and compliance with standards facilitates objective comparisons and impact evaluation. Children are at higher risk of consequences of irrational prescribing and antibiotic misuse. Objective: The objective of the study was to evaluate the prescribing pattern and utilization of antibiotics for children using standard prescribing indicators and indices of rational drug prescribing. Materials and Methods: This was a retrospective study of prescriptions for pediatric inpatients at a teaching hospital in Northern Nigeria. Information was obtained from eligible prescriptions received over 24-month period using a modified WHO prescribing indicator form. The WHO prescribing indicators and the Index of Rational Drug Prescribing (IRDP) were used to evaluate prescriptions. Data were analyzed and presented as proportions, means, tables, and charts, comparing with WHO standards and with findings of similar studies. Results: There were 3908 eligible prescription orders, with a mean patient age of 3.1 (±2.7) years. With an average of 2.1 drugs per prescription, 66.8% were written with generic names, whereas a single antibiotic was included among 63% of prescriptions with antibiotics. Antibiotics and injections were contained in 49.5% and 67.7% of prescriptions, respectively. Medications were available in the Essential Medicines List in 95.5% of cases. The IRDP obtained is 2.99, against a standard of 5. Aminoglycosides, cephalosporins, and penicillins were the most common choices, whereas ampicillin/cloxacillin was the most common combination. Conclusion: Drug prescribing and antibiotic use were generally inappropriate compared with ideal standards. Continuous training/retraining on rational drug use, periodic monitoring, and use of treatment protocols in tertiary hospitals are recommended.
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Drug-induced oral erythema multiforme: A diagnostic challenge
Syed Ahmed Taqi
January-March 2018, 17(1):43-45
DOI:10.4103/aam.aam_19_17  PMID:29363636
Trimethoprim-sulfamethoxazole (cotrimoxazole or TMP/SMX) is commonly used for the treatment of urinary or lower respiratory tract infections. A comprehensive review is presented of the world literature on adverse reactions to TMP/SMX since its first use in 1968, when concern was expressed about possible hematologic toxicity. The adverse reactions to TMP/SMX occur in approximately 1%–3% of persons in general population. Here, we report a case of oral erythema multiforme (EM) secondary to TMP/SMX that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of distinguishing them from other ulcerative disorders involving oral cavity. The patient was treated symptomatically and given tablet prednisolone. The condition improved with stoppage of TMP/SMX therapy. It has been reported that primary attacks of oral EM is confined to the oral mucosa, but the subsequent attacks can produce more severe forms of EM involving the skin. Hence, it is important to identify for early diagnosis and management. Although EM is quite common with TMP/SMX, there are no reports of oral EM appearing after intake of this drug.
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Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review
BS Alabi, OA Afolabi, AD Dunmade, HK Omokanye, IO Ajayi, SO Ayodele, NO Busari
January-March 2018, 17(1):1-6
DOI:10.4103/aam.aam_130_16  PMID:29363628
Background: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. Methods: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. Results: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd–5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens'. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. Conclusion: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens'. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy.
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The astigmatic effect of pterygium in a Tertiary Hospital in Kano, Nigeria
Abdu Lawan, Sadiq Hassan, Ebisike Philips Ifeanyichukwu, Hadi Bala Yahaya, Rabi Yahaya Sani, Saudat Garba Habib, Abdulsalam Shuaib, Okpo Eme
January-March 2018, 17(1):7-10
DOI:10.4103/aam.aam_13_17  PMID:29363629
Aim: This study aims to determine the effect of pterygium excision on the degree of corneal induced astigmatism and visual acuity. Patients and Methods: This was a prospective interventional study conducted between September 2012 and June 2013. Consecutive patients with pterygium who met the inclusion criteria were recruited into the study. They had a basic eye examination, and those with existing comorbidity were excluded. Selected patients had pterygium excision using the bare sclera technique with intraoperative application of Mitomycin C. Detailed pre- and post-operative evaluation and refraction was done. Results: There were 45 eyes of 33 patients aged 28–75 years. The mean age was 56.12 + 12.38 years. Six eyes had Grade I, 29 eyes had Grade II and 10 eyes had Grade III pterygium. The mean value for preoperative astigmatism was 2.12 ± 1.09 diopter cylinder (DC) while that for postoperative astigmatism was 0.72 ± 0.50 DC (P = 0.000). Surgery was associated with statistically significant increase in postoperative visual acuity. (P = 0.000).Conclusion: This study has shown that the degree of pterygium-induced astigmatism reduces significantly following surgical excision. Pterygium excision was associated with improvement in visual acuity.
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Assessment of some indicators of oxidative stress in nigerian sickle cell anemic patients
CP Okorie, Theresa Nwagha, Fidelis Ejezie
January-March 2018, 17(1):11-16
DOI:10.4103/aam.aam_26_17  PMID:29363630
Background: Oxidative stress, the imbalance between the productive of reactive species and antioxidant defences notably plays an important role in the pathogenesis of sickle cell disease. Generating the necessary data about oxidative stress in patients with sickle cell anemia (SCA) would help in developing cost-effective and accessible treatment interventions of SCA in resource-poor countries. Aim: The aim of this study is to evaluate the levels plasma lipid peroxidation product, malondialdehyde (MDA), serum nitric oxide (NO), and total antioxidant activity (TAOA) as indicators of oxidative stress in sickle cell individuals. Materials and Methods: In this pilot study, 52 patients; homozygous (Hb SS) sickle cell patients confirmed by cellulose electrophoresis and 20 age- and sex-matched healthy (Hb AA) controls were subjected to analysis of NO, MDA, and TAOA. The plasma MDA was measured by a thiobarbituric reaction, (NO) was evaluated by the method described by Guevara et al. using Griess reagent and the TAOA of serum was determined by the method of Koracevic et al. Results: The results showed a statistically significant decrease and increase in baseline levels of NO and MDA, respectively, in Hb SS group when compared with the control Hb AA (P = 0.000 and 95% confidence interval [CI] of 0.10–0.18 and −9.67–−5.57, respectively). A slight decrease in the TAOA level between the groups was observed although not statistically significant (P = 0.15 95% CI was −0.28–2.90). Conclusion: The results showed of imbalance between oxidant and antioxidant status in patients with SCA. Antioxidant supplementation may be a cheap assessable intervention for in sickle cell individuals (in the steady state or in crisis) to prevent further oxidative damage to the erythrocytes.
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Current indications for extremity amputations in Maiduguri, North-East Nigeria: A 6-year retrospective review
Theophilus Maksha Dabkana, Friday Titus Nyaku, Stanley Tella Bwala
January-March 2018, 17(1):22-25
DOI:10.4103/aam.aam_40_17  PMID:29363632
Objective: To know the the commonest cause for extremity amputation in UMTH in recent times, following the result of two previous studies citing malignancy and later trauma, at the University of Maiduguri Teaching Hospital, a tertiary hospital in North East Nigeria. Method: We retrieved folders of all patients who had extremity amputation from January 2010 to December 2016 in our center. There were one hundred and sixty three case notes, accounting for one hundred and sixty five amputations. Results: Of the 165 amputations in 163 patients, 94 (57.0%) were as a result of this problem. It was also noted that the affected patients were regular with their medications, bringing into question the efficacy of these medications. Trauma however remains the second common cause for amputation, accounting for 22 (13.3%), followed by complications from splints of traditional bone setters (TBS) which accounted for 20 (12.2%). Conclusion: Complicated diabetes mellitus is the commonest cause oa amputations in recent times in our center.
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Evaluation of the cognitive effect of newborn resuscitation training on health-care workers in selected states in Northern Nigeria
Lawal Waisu Umar, Hafsat Rufa'I Ahmad, Abdulkadir Isah, Hafsat Wasagu Idris, Laila Hassan, Fatima Laraba Abdullahi, Ishaku Hassan, Abubakar Yakubu, Abubakar Muhammad Zubairu, Jane Alison Jobling
January-March 2018, 17(1):33-39
DOI:10.4103/aam.aam_47_17  PMID:29363634
Background: Neonatal deaths contribute significantly to slower progress in under-5 mortality reduction. Lack of sufficiently trained birth assistants partly contributes to early neonatal deaths. Resuscitation training equips frontline health-care workers (HCWs) with requisite knowledge and skills to prevent birth asphyxia. Objective: The objective of this study was to evaluate the immediate impact of newborn resuscitation training on cognitive ability of HCWs. Materials and Methods: This is a descriptive observational study using pre- and posttraining scores obtained by HCWs who were participants in 1-day training on emergency newborn resuscitation. The Newborn Resuscitation Manual of the UK Resuscitation Council (2006) was used to train HCWs. The course included lectures, skill and scenario demonstrations using mannequins, and basic resuscitation equipment. Cognitive knowledge was evaluated using a pre- and post-training questionnaire. Participants' scores were collated, analyzed, and results were presented as tables, charts, and descriptive statistics with P < 0.05 considered statistically significant. Results: A total of 293 HCWs completed the course (81 doctors and 212 nurse/midwives), with variable improvements of mean posttraining marks over the pretraining scores. Resident doctors obtained significantly higher mean pre- and post-training marks with lower mean difference than senior doctors and medical officers. The junior nurses obtained significantly higher mean pretraining scores compared to the senior nursing cadre, while the intermediate nursing cadre obtained significantly higher mean posttraining scores compared to senior nurses. Conclusion: Resuscitation training improved the knowledge of HCWs. Further evaluation could ascertain impacts on knowledge/skills' retention and neonatal survival. Preservice training and continuing education for frontline HCWs who conduct deliveries are recommended.
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Human immunodeficiency virus seroprevalence in patients with invasive cervical cancer in Zaria, North-Western Nigeria
Adamu Abdullahi, Muhammad Inuwa Mustapha, Dawotola Ayorinde David, Olasinde Tajudeen Ayodeji
January-March 2018, 17(1):17-21
DOI:10.4103/aam.aam_37_17  PMID:29363631
Background: Cervical cancer is the commonest gynecological malignancy in our environment and is an Acquired Immuno-Deficiency Syndrome (AIDS)-associated malignancy. Documented data on the Human Immune-deficiency Virus (HIV) seroprevalence among patients with cervical cancer in our environment are scarce. Objective: The aim of this study is to determine the prevalence of HIV infection in women with cancer of the cervix. Study Design: The work is a descriptive survey by design, concentrating in frequency of occurrences of prevalence of the dissease in either cases for a number of years retrospectively carried out at the Radiotherapy and Oncology Centre of Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. Setting: The study was carried out at the Radiotherapy and Oncology Centre of ABUTH, Zaria. Materials and Methods: A 5 years retrospective review of patients with histologically-proven cancer of the cervix seen in the Radiotherapy and Oncology Centre, ABUTH, Zaria, North-Western Nigeria was undertaken. Data such as age, clinical stage of disease and HIV seropositivity at presentation were retrieved from the case files. Data analysis was done using the SPSS statistical package version IBM 23 and results presented in frequencies and percentages and charts for graphical presentation. Results: A total of 1,639 patients seen over a period of 5 years were reviewed. The age range of both groups of patients was from 28 years to 92 years with a mean age of 50.5 years. One thousand five hundred and seventy-three of the patients (96%) were seronegative to the HIV tests while 66 (4%) were seropositive. The age range of the seropositive patients was 28 - 49 years with a mean age of 38.1 years. Their peak age at presentation was 30 - 39 years. Similarly, the age range of the seronegative patients was 30 – 92 years with a peak at 40-49 years. 51 (89.5%) of the HIV seropositive patients presented with advanced clinical stage disease, i.e, International Federation of Obstetrics and Gynecology (FIGO) stage 2B and above. 1,363 (93%) of the HIV seronegative patients presented with FIGO 2B disease and above, both scenario illustrating the general trend of late presentation of cancer patients to hospital in our environment. Conclusion: The study shows that the prevalence of HIV infection among cervical cancer patients is low in Zaria, with earlier age of development of cervical cancer among HIV seropositive patients compared to HIV seronegative counterparts. Both group of patients present with cervical cancer at an advanced stage. More studies therefore needed to be done to identify the predisposing factors to the high incidence of invasive cervical cancer in our environment and introduction of cervical cancer screening at an earlier age among HIV seropositive patients.
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Sparfloxacin-induced nail pigmentation: A case of fixed drug eruption?
Husain Yahya
January-March 2018, 17(1):40-42
DOI:10.4103/aam.aam_16_17  PMID:29363635
Sparfloxacin, a synthetic, second generation, broad spectrum aminodifluoroquinolone antibiotic, has excellent penetration into respiratory tissues and has good activity against Gram-positive, Gram-negative, and atypical bacteria. Although it is indicated for the treatment of adult community-acquired pneumonia and acute exacerbation of chronic bronchitis, its use has been limited by phototoxicity which is more common with it than with other quinolones. We report a case of a 20-year-old Nigerian woman who developed a diffuse blue-black nail pigmentation of thumb and big toe nails, 2 weeks after completing therapy with sparfloxacin, and a recurrence of the pigmentation in the same nails 1 year after taking the drug again. We think this is likely a case of subungual fixed drug eruption. We briefly discuss the causes and mechanisms of drug-induced nail pigmentation in general.
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Neglected Type III growing skull fracture in a 65-Year-Old female
Sonal Saran, Sameer R Verma, Vineet Tomar
January-March 2018, 17(1):46-47
DOI:10.4103/aam.aam_33_17  PMID:29363637
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