We live in a society that functions with a system of morals that seeks to determine what is right or wrong. Each society is ruled by moral codes that guide people’s action to minimize the risk of sliding into structural dysfunction. To understand the importance of human values within which the society can live and operate in a harmonious state, many great philosophers such as Immanuel Kant and Bentham Jeremy have presented moral theories based on the principles of deontology and utilitarianism, respectively. These two ethical major streams of thought influence ethical decision-making. In utilitarian principles, outcomes justify the means or ways to achieve it and as such the focus is on the consequences of an action, whereas in deontological ethics, obligation to duty is what matters irrespective of the outcome. In medicine, deontology is patient centered, whereas utilitarianism is society centered. Practically, these two moral thoughts seem contradictory but each has its own advantages and disadvantages, which may occasionally intertwine to reach a midpoint level in a critical situation. In a well-resourced setting, the deontology approach to healthcare issues seems more practicable than the utilitarian approach because the duty of care is more focused on the individual and not necessarily on the society. As every rational being thinks of him- or herself as an end, doctors must act in such a way that they treat humanity and their patients always as an end and never simply as a means. The moral worth of a clinician’s action in patients’ management therefore depends exclusively on the moral acceptability of the rule of obligation to duty, that is, “cause no harm” irrespective of the consequences. This article highlights the fundamentals of deontology and utilitarian principles as moral theories in medicine with basic examples.

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Community mobilization, partnership, and surveillance are regarded as key elements in various polio eradication activities. Several nongovernmental organizations have led community mobilizers (CMs) in different aspects of the polio eradication campaigns, and their effectiveness shows mixed findings. This study systematically reviewed the literature on the role of CMs in polio eradication activities. Literature searches were conducted using a combination of key words to find relevant published studies up to 30 November 2020. The 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist addressing the various components of systematic review was adhered to. A total of 1627 articles were identified by the search, with 65 articles passing the title/abstract and full text reviews, and with four additional articles obtained from references of articles included (making a total of 69 articles). Of these 69 articles involved in the review, 24 (five reviews and 19 original articles) focused largely and explicitly on CMs and were included in the full review. The rest (45) discussed CMs in a broader context, hence they were summarized based on part 1 of the data extraction form only.The findings of the review indicated that although CMs’ instrumental role in health promotion and supporting immunization is consistent for all the reviewed studies, their role in acute flaccid paralysis (AFP) case detection is limited. The role of CMs, other actors in community-based surveillance, and health education needs to be further strengthened, particularly in high-risk communities where routine immunization and AFP surveillance are much needed.

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Background: The clinical severity of sickle cell anemia (SCA) varies from one individual to another. Several factors, including genetic predisposition, environmental and social factors, are known to modify the clinical presentation and complications of SCA but not much is known about the influence of gender. Objective: This study aims at determining the gender differences in the pattern of SCA complications in Enugu, Nigeria. Materials and Methods: This is a retrospective analysis of clinical and laboratory data from the folders of patients with SCA at the University of Nigeria Teaching Hospital Enugu, Nigeria between February 2008 and February 2014. A total of 248 folders comprising 151 males and 97 females were retrieved. Data on the age, sex, hematological parameters, number of complications, and frequency of SCA crises were extracted and analyzed. Only the case files of adult patients with SCA were investigated. Results: The median age of the participants was 25 (IQR = 22–30) years. The male to female ratio was 1.5:1. A total of 182 out of 248 (73.4%) cases reviewed had one form of complication or the other. Sickle cell leg ulcer was the most common complication seen among the cases (50/182 [27.5%]), followed by avascular necrosis (AVN) (28/182 [15.4%]). The mean frequency of crises was not different between the male and female genders (15.00 ± 9.01 vs. 9.8 ± 6.97; P = 0.293). However, the male gender had more complications than the female gender (116/151 [73.9%] vs. 116/151 [73.9%]; odds ratio [OR] = 2.13; 95% confidence interval [CI] = 1.2–3.7; P = 0.007). Conclusion: The male gender is twice more likely to develop complications of SCA and, thus, are more likely to have more morbidity from this condition.

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Conducting clinical research in children poses significant challenges with regard to several ethical issues, such as informed consent and protection from harm. Notwithstanding, children need to participate in research to address health issues that affect them but such research aims must be balanced with the safety and well-being of the participants. While being attentive to mitigating risks and providing the right support, researchers can ensure that children feel respected and can participate safely. The informed consent of parents or legal guardians should be obtained, preferably in writing, stating all the features of the research that may affect their willingness to allow the child to participate. Because of their vulnerabilities and the need to be protected from the risks associated with any kind of research, there has been increased global concern toward the involvement of children in research practice. As a general principle, although parents or guardians may be asked to consent on behalf of a child, depending on the child’s cognitive ability and the nature of the research, a refusal of assent or consent to participate should always over-rule the parent’s or guardian’s consent. To ensure proper ethical conduct of research in children, Institutional Review Boards (IRBs) or Research Ethics Committees (REC) will be required to provide ongoing monitoring of pediatric research, especially in the vulnerable population, since there may be a tendency for undue inducement or coercion, which could make parents/guardians consent to their children participating in a research and that exposes them to substantial risk. Similarly, it will be important to assess whether the approval of pediatric research, especially nonbeneficial research, should require a super majority, rather than the simple majority of IRB members required under current international regulation. This article provides an insight into the ethical guidelines and principles in conducting clinical research in children.

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Background: Multidrug resistant bacteria have become a major public health concern worldwide. Inappropriate and overuse of antibiotics are known promoters of antibiotic resistance. This study was therefore carried out to assess healthcare workers’ knowledge, attitude, and practice on antibiotic use and resistance. Materials and Methods: A descriptive cross-sectional study was conducted among healthcare workers from University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. A self-administered questionnaire was used to assess the knowledge, attitude, and practice of antibiotic use and resistance. Descriptive and inferential analyses were subjected on the data. Results: A total of 600 healthcare workers were surveyed with male: female ratio of 1:2.2. The mean age of the participants was 39.6±25.6 years. The level of knowledge was 58.8%, followed by attitude (49.1%) and practice (24.3%). The knowledge on super bugs (40.3%) and carbapenem-resistant Enterobacteriaceae (37.3%) was the least on resistant organisms surveyed. The main source of information was internet with the least being television/newspaper. Slightly less than half, (287/600, 47.8%) always do laboratory investigations before commencing antibiotics and (373/600, 62.2%) will stop taking antibiotics when their symptoms improve without completing the dosage. Majority of the participants (91.2%) indicated that healthcare workers are at risk of acquiring the antimicrobial-resistant organisms; however, only 67.7% believed that UNTH has the same problem. Conclusion: The knowledge, attitude, and practice of healthcare workers on antibiotic use and resistance were not encouraging. Greater educational interventions are, therefore, necessary to improve public awareness and develop behavioral measures to curb the spread of the resistant organisms.

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Background: High fertility is one of the primary determinants of rapid population growth, which can hinder socio-economic development. Age at first marriage is an important proximate determinant of fertility and one of the causes of high fertility level in developing countries where the practice of early marriage remains widespread. Objective: The objective was to assess the fertility behaviors among women of reproductive age in a rural community, in northwestern Nigeria. Materials and Methods: A cross-sectional descriptive community-based study with minimum sample size of 320 was conducted in 2019 using systematic sampling method. Results: The mean age (±SD) of females in the community was 26.9 (±SD 8.3) years. The mean age at first marriage was 15.31 (±SD 2.4) years, contraceptive use was 5.4%, and one-third of the women were in polygamous settings. The total fertility rate was 6.95 per woman. There was significant association between marriage type and number of marriages with the number of living children (P = 0.001). Conclusion: Majority of the women were under aged at first marriage, had very low rate of contraceptive use, and fertility rate was high among them. Marriage type of the respondents had a significant association with fertility. Policies and laws that prohibit child marriage are recommended, in order to encourage girl child education and improve female participation in decision-making with regard to fertility desire and behaviors.

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Background: Malnutrition is a direct or underlying cause of 45% of all deaths of under-five children in Nigeria. Nigeria has one of the highest burden of malnourished children in the world. Certain vulnerable groups such as children with chronic diseases are often neglected in nutritional studies. Objective: This study sought to determine the prevalence of malnutrition among children with epilepsy, attending the Neurology Clinic of the University of Nigeria Teaching Hospital. Materials and Methods: This was a descriptive cross-sectional study. Study participants were epileptic children aged 6 months to 18 years. Socio-economic status was determined using the Oyedeji classification. Weight and height were measured using standard protocols. The weight for height, body mass index for age, and height for age z-scores were calculated using the WHO Anthro and Anthro Plus software. Data were analyzed using SPSS version 20.0, and significant p-values were set at less than 0.05. Results: One hundred and twenty children with epilepsy aged 6 months to 18 years who met the inclusion criteria were included in the study. Seventy-eight (65%) were males; (male: female ratio = 1: 0.5). The overall prevalence of wasting, stunting, overweight, and obesity were 5.8%, 9.2%, 10.8%, and 5.8%, respectively. There were no statistically significant differences between various forms of malnutrition and the gender, age group, and socio-economic status of study participants (p > 0.05). Conclusion: Overweight was the most common form of malnutrition, followed by stunting among the epileptic children. There is need for regular anthropometric monitoring of children with drug-naive epilepsy with targeted interventions to correct malnutrition in them during the course of epilepsy management.

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Background: Malaria is a life-threatening parasitic disease, and pregnant women are at risk of its adverse consequences. Objectives: The study aimed to determine knowledge and preventive practices against malaria among pregnant women at urban and rural public health facilities in Abuja, Nigeria. Materials and Methods: A cross-sectional study design was used. The two-stage sampling method was used to select 520 pregnant women in 16 health facilities. A structured questionnaire was used for data collection. Data analysis was done using SPSS statistical software version 22.0, and the level of statistical significance was determined at P-value of less than 0.05. Results: The mean age of respondents was 29.6±4.6 and 27.9±4.9 years in urban and rural areas, respectively (P≤0.001). A significantly higher proportion of women in the urban area (44.2%) had good knowledge of malaria than those in the rural area (26.2%) (P < 0.001). Comparable proportions of respondents in urban (13.1%) and rural (23.1%) areas had good preventive practices against malaria (P = 0.218). The predictor of good knowledge of malaria in the urban area was using secondary health facilities for antenatal care [95% confidence interval (CI): 1.3–4.4], whereas tertiary education (95% CI=1.1–2.3) and utilizing secondary health facilities (95% CI=1.2–2.8) were predictors in the rural area. Predictors of good preventive practice included being self-employed (95% CI=1.5–11.6) and having good knowledge of malaria (95% CI=1.3–6.4) in the urban area. Conclusion: Minor proportions of respondents in the study area had good knowledge of, and good preventive practices against, malaria. There is a need for relevant authorities to enlighten women on malaria and its preventive practices and to motivate them to practice malaria prevention throughout pregnancies.

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Background: Stillbirth is a devastating pregnancy outcome, with resultant emotional and psychological trauma to the affected family. Objectives: We investigated the prevalence and probable causes of stillbirths in four tertiary hospitals in south-east Nigeria. Materials and Methods: A 5-year multicenter, retrospective descriptive study of all stillbirths delivered in the hospitals from January 2013 to December 2017 was done. Using an already prepared proforma, the sociodemographic characteristics of the mothers and the probable causes of deaths were retrieved from their case files. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS), version 20. A P-value less than 0.05 was considered statistically significant. Results: There were 23,101 deliveries within the study period and 1,294 stillbirths giving a stillbirth rate (SBR) of 56.1/1,000 deliveries. More than half (58.7%) of them were intrapartum. More than half of the stillbirths were preterm delivery (58.5%). The commonest probable cause of macerated stillbirth was hypertensive disorders of pregnancy (32.4%). Conclusion: The overall SBR was 56.1 per 1000 deliveries. This is higher than 42.9 per 1000 deliveries previously reported in Nigeria. There is an urgent need to improve the quality of antenatal and intrapartum care, if we hope to achieve a significant reduction of the SBR in the region.

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Background: Nurses working in shift duties, including night duties, are subject to a cumulative sleep debt, a decreased quantity and quality of sleep, and continuous sleep deprivation. Hence, nurses working in shift duties are prone to sleep disturbance. Objective: To determine and compare the quality of sleep among oncology and intensive care unit (ICU) nurses. Materials and Methods: Descriptive approach was adopted for this study. The sample comprised 126 nurses working at the units of Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, Rajasthan, who were selected by purposive sampling technique. The quality of sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed by using the Statistical Package for the Social Sciences (SPSS) software program, version 20.0. Results: In this study, majority of the participants (60.32%) were men. Majority of the nurses (75.40%) were working on a regular basis. The mean sleep quality scores of intensive care and oncology nurses were 3.863 ± 1.988 and 5.317 ± 1.899, respectively. The observed difference was statistically significant (t = 4.097; p < 0.001). Overall, there was poor quality of sleep in 46% of the participants. The intensive care unit (ICU) nurses are more likely to have poor quality of sleep than oncology nurses (61.90% vs. 30.16%; Χ² = 18.15; p < 0.001). In addition, a moderate positive correlation (r = 0.6645, P = 0.0001^*) was observed between the sleep quality of ICU and oncology nurses. Among the intensive care nurses and oncology nurses, there was no significant association between sociodemographic variables such as gender, age, working status, job status, and the PSQI scores. (P > 0.05). Conclusion: Intensive care nurses and oncology nurses have poor quality of sleep, which can affect their health and professional performance. The ICU nurses have poorer quality of sleep than oncology nurses. Nurse administrators and hospital administration should take initiatives to reduce the prevalence of poor sleep among these nurses.

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Background: Predominant out-of-pocket financing of health expenditures in low- and -middle-income countries (LMICs) remains a major setback to achieving universal health coverage (UHC). Nigeria has been attempting to bridge the gap through health insurance schemes targeting both the formal and informal sectors of the population. Objective: This paper aimed to provide a roadmap to assist in establishing community-based health insurance (CBHI) in any religious Nigerian Community. Materials and Methods: A cross-sectional descriptive design using qualitative methods was used for the study. The study areas were local government areas (LGAs) that make up the Catholic Diocese of Enugu. Extensive advocacies were used at various levels of the organizational structure of the Diocese to ensure buy-in. Organizational structure of the scheme was set up with nine major stakeholders who played active roles in the advocacies and the design of operational guidelines. Training of the stakeholders was conducted and two types of benefit package were adopted. A mutual health association (MHA), called Ndubuisi MHA, was approved and incorporated based on the NHIS model called intermediary method. Results: Nigeria’s first faith-based CBHI-Ndubuisi MHA with over 3000 enrollees was set up, approved, and registered with Enugu North LGA, Enugu State Ministry of Health and Corporate Affairs Commission. The scheme is running conveniently with a purpose-built administrative structure, monitoring and evaluation plan, and benefit packages. Conclusion: Establishing CBHI through faith-based organizations is possible and sustainable with underlying equity principles. The model used in this study can be implemented in any organization that has an element of mutual solidarity and existing administrative structures that can be used as a platform.

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Background: Epilepsy, the most predominant noncontagious neurologic disorder affecting children and carrying profound levels of social stigma, is an important cause of childhood morbidity globally. Objectives: This study aims at describing the prevalence, etiological risk factors, seizure pattern/associated comorbidities, and outcome of treatment with antiepiletic drugs (AEDs) among patients with epilepsy attending the neurology clinic of Federal Medical Center, Asaba, Delta State, Nigeria. Materials and Methods: A 10-year review of all patients seen at the neurology clinic of the tertiary institution. Information including history/physical examination, socio-demographic variables, and electroencephalogram (EEG) findings was collected from the clinic records of the patients between January 2009 and December 2019. A total of 105 patients presented with clinical features of epilepsy classified based on the 2017 International League Against Epilepsy classification. All data obtained from the clinic records were analyzed using the SPSS, Version 23.0, software. Results: Of the 302 patients seen with different neurologic morbidities, 105 had epilepsy, giving a prevalence rate of 34.7%, occurring more in children aged 6 months to 3 years with a male predisposition (55.2%). Generalized tonic-clonic (GTC) seizure was identified as the most predominant type 9/105(8.6%), severe birth asphyxia and cerebral palsy were the most common cause, and comorbidity of epilepsy, respectively. Sodium valproate was the commonly used AED with 55.8% good outcome. Conclusion: Epilepsy is still an underreported childhood neurologic morbidity in our environment. Good outcome recorded can be attributed to high levels of adherence to medication and absence of associated metabolic disorders or intracranial structural lesions.

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Background: Aortic size is known to be an important predictor of cardiovascular diseases. There is a dearth of data on factors affecting thoracic aorta size in the black African population. Objective: To determine the predictors of descending thoracic aortic size measured by echocardiography. Materials and Methods: Transthoracic echocardiographic reports of 167 consecutive subjects were retrospectively reviewed. Data obtained from the register included age, gender, weight, height, body mass index, systolic blood pressure, diastolic blood pressure, and heart rate. Results: A total of 167 individuals aged between 12 and 96 years were studied. These were composed of 94 males and 73 females with mean age of 51.64 ± 16.31 and 46.90 ± 15.77, respectively. The mean descending thoracic aortic dimension was 23.35 ± 3.73 mm. The aortic measurement was found to be significantly higher in the male subjects (p < 0.05). A multi-variate correlation analysis revealed significant correlations between descending thoracic aortic dimension and (1) age, (2) weight, (3) body mass index, (4) systolic blood pressure, (5) diastolic blood pressure, (6) pulse pressure, and (6) mean arterial blood pressure (p < 0.05). These relationships were further explored using regression models. The most important predictors of aortic dimension in this study were age, weight, and sex (p < 0.05). Our result suggests a linear relationship between age and descending thoracic dimension. Conclusion: Age, body weight, and gender significantly affect the size of the descending thoracic aorta and could predict cardiovascular risk.

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Background: Behavior management techniques are employed to allay fears and to ensure maximum cooperation during the course of treatment of children. Objectives: This study assessed the knowledge and use of universal behavior management techniques (UBMT) for children by final year dental therapy students in Enugu, Nigeria. Materials and Methods: This was a cross-sectional descriptive study of 167 final year dental therapy students attending Federal College of Dental Technology and Therapy (FCDTT), Enugu, Nigeria. Data on sociodemographic profile, knowledge, and use of the UBMT were collected using questionnaires. Reasons for choice of techniques were also collected. Data analysis was performed using SPSS version 21.0 (IBM, Chicago, IL, USA), and the effect of all significant factors was inferred at P < 0.05. Results: Students aged 19 to 29 years participated in the study, and the mean age was 22.65 ±2.47years. More females (111 [66.5%]) than males (57 [33.5%]) participated in the study. Many (110 [65.9%]) of the final year students were aware of the “tell-show-do” technique, whereas a few (26 [15.6%]) were aware of the “desensitization” technique. Many (110 [56.9%]) also used the “tell-show-do” technique, whereas seven (4.2%) used the desensitization technique. There was significant association between age, use of the “positive reinforcement” technique (P = 0.02), and “ease of use” as a reason affecting the choice of UBMT (P = 0.03). Conclusion: Most final year dental therapy students were aware of UBMT, but there was a varied level of knowledge of the different techniques among them. “Tell-show-do” was the most common technique known and it was used by the study participants. Age was associated with use of the “positive reinforcement” technique, whereas “ease of use” affected the choice of UBMT.

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Stroke following cardiac surgery particularly valvular implantation is an anticipated complication. This is due to the prosthetic valve as well as possible associated comorbid conditions. There is dearth of published data on stroke post valve replacement surgery in Nigeria. There is no general consensus on the role of antiplatelet agents in combination with anticoagulant therapy in at-risk patients. Our paper documents the case of a 46-year-old male hypertensive, who in 2016 had mitral and aortic valve replacement surgery in a Tertiary Teaching Hospital and presented in May 2020 with sudden onset abnormal tongue sensation and double vision. A left internuclear ophthalmoplegia with bilateral torsional nystagmus was evident. Brain magnetic resonance imaging confirmed pontine lacunar infarction. There were no intracardiac clots on echocardiography. He had full resolution of deficits following treatment with anticoagulants. This case report demonstrates that ischemic stroke can occur in people with prosthetic heart valve and that other comorbid risk factors may be contributory. Anticoagulation therapy is important, though there is no consensus on time of starting therapy and the role of adjunctive antiplatelet combination therapy in such patients. Individualized therapy should be based on the type of implant, numbers, and location of valve replaced, comorbid clinical conditions, and the risk of hemorrhagic transformation.

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Background: Early and sustained viral suppression with antiretroviral therapy (ART) has been linked to good clinical outcome in HIV-infected patients. The global target is that at least 90% of the patients on ART should be virally suppressed. Objectives: We assessed the virologic response to first-line ART in the first year of treatment in our center and determined the factors influencing early viral load suppression among patients. Materials and Methods: We conducted a retrospective study involving review of the records of all eligible HIV-infected adults initiated on ART in our facility between 2009 and 2014, who did not miss any follow-up appointment during the first year on ART. Data were extracted with a proforma and analyzed with Epi Info 7. Frequencies and proportions were used to summarize patients who achieved undetectable viremia (viral load < 400 copies/mL]) at 12 and 24 weeks, whereas χ² and logistic regression were done at 5% alpha to determine the factors influencing early viral load suppression. Results: The mean age of 478 participants was 38.6 (19.0) years and 310 (64.8%) were females. While 332 (69.5%) patients achieved undetectable viremia at 12 weeks of ART, 356 (74.5%) achieved it at 24weeks. After 24 weeks on ART, 121 (80.7%) of the150 patients on tenofovir/emtricitabine/efavirenz, 195 (71.2%) of the 274 patients on zidovudine/lamivudine/nevirapine, and 35 (71.4%) of the 49 patients on tenofovir/lamivudine+nevirapine achieved undetectable viremia (P = 0.13). Patients’ age, sex, marital status, baseline CD4 count, TB co-infection status, WHO clinical stage of disease, and plasma viral load at ART initiation were not significantly associated with early viral load suppression (p > 0.05). Conclusion: Three out of every four participants initiated on first-line ART achieved undetectable viremia after 24 weeks of treatment in our setting. The three ART regimens assessed have comparable effectiveness. The sociodemographic and clinical variables assessed did not influence viral suppression.

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