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Entry points into a Nigerian medical school at the graduate and undergraduate levels: A three-year prospective and retrospective comparison of performances at the first MBBS professional examinations
Ed Nwobodo, Uchechukwu Dimkpa, Chidiebere Ugwu, Ugochukwu B Anyaehie
July-December 2019, 24(2):95-99
Background: It is alleged that there is a mismatch between candidates’ performance in University Matriculation Examination (UME) and their subsequent academic achievement in medical schools in Nigeria. Aim: The present study compares the performance of medical students admitted via Direct Entry (DE) module and that of UME using their 1st professional examination. Methodology: A total of 343 undergraduate medical students of College of Medicine, Nnamdi Azikiwe University, Nnewi, Anambra state, Nigeria were used for this study. 270 of the students were admitted through UME, while 73 were admitted through DE modes of admission. The results of the 1st MBBS examinations taken in the years 2014 to 2017 were collated, analyzed and compared between the two groups of students. Results: The rate of success in 1st MBBS examination was greater in the DE students (74%) compared with the UME students (44.1%). The failure rate was higher in the UME entrants (55.9%) compared with the direct entrants (26%). The frequency of withdrawals in the group with UME (n = 28) was greater than that of the group with DE (n = 0). Chi square test of association indicated significant (p < 0.001) association between performance of students in 1st MBBS examination and the mode of admission. Logistic regression test shows that the odds of failure were against students with UME module than those with DE. Conclusion: The present study indicates that the admission module of DE with previous degree increases the chances of academic success in medical education in Nigeria. This suggests the need for a review of the mode of admission into medical schools to favour students that have a previous degree.
  22,009 242 -
Deontology vs. utilitarianism: Understanding the basis for the moral theories in medicine
Felix N Chukwuneke, Anthony C Ezenwugo
January-March 2022, 27(1):19-23
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.
  7,281 322 -
Voluntary jaw wiring in Nigeria: Reasons and treatment outcome
Mark C Nwoga, Samuel N Maduakor, Appolos C Ndukuba
January-June 2019, 24(1):28-34
Background: Overweight and obese dental patients occasionally request jaw wiring. Aim: The aim of this study was to determine the reasons for requesting jaw wiring and to evaluate the outcome of the procedure. Materials and Methods: This is a retrospective study of adults, who requested jaw wiring treatments at two private dental facilities in Enugu and Lagos, Nigeria. The interventions consisted of jaw wiring with four interdental eyelets and two tie wires. The main outcome measures were reasons for the request, weight loss, and body mass index (BMI) change. The data were analyzed using SPSS, version 20.0. Results: Thirty-four patients, all female, requested jaw wiring. Majority were single (82.4% [28/34]). The mean (standard deviation [SD]) age was 28.1 (6) (confidence interval [CI]: 25.9–30.2). Simplicity of the procedure, weight-loss needs, and improved body shape were the main reasons for all the patients. Single women additionally included a “desire to attract a marriage mate” in 67.6% (23/34), “preparation for an engagement,” and “to fit a wedding gown,” 5.9% (2/34). Married women, 14.7% (5/34), additionally desired to “please a husband” or “achieve postpartum weight-loss.” Nineteen subjects completed the treatment and lost a mean (SD) weight of 8.3 (3.6) kg (95% CI: 6.5–10) over a mean (SD) duration of 45.0 (14.9) days (CI: 37.8–52.2). The mean BMI was lowered after treatment by 3.09kg/m2 (1.3; CI: 2.5–3.7). The posttreatment BMI classification improved for 52.6% (10/19) of the patients. Conclusions: Jaw wiring was desired by young women because of its simplicity, predictable weight loss, and marital and social concerns. Weight loss and lowered BMI were achieved.
  5,855 199 -
Frequency of hemophilia and hemostatic evaluation in persons with bleeding symptoms in Southeast, Nigeria
Samuel Okparaoka, Theresa U Nwagha, Bond Anyaehie
January-June 2019, 24(1):18-22
Background: A significant number of people living with hemophilia and other bleeding disorders are reported to be either underdiagnosed or untreated in most developing countries. Objectives: To evaluate the frequency of hemophilia and some hemostatic parameters in persons with bleeding symptoms in Southeast Nigeria. Materials and Methods: This was a cross-sectional, hospital-based pilot study of 50 persons consecutively recruited with bleeding symptoms from four tertiary hospitals in Southeast Nigeria. Full blood count was carried out using Mythic 22 semiautomated analyzer, (Orphee, Geneva, Switzerland). Prothrombin time (PT) and activated partial thromboplastin time (APTT) mixing studies and one-stage factor assays were carried out using tube tilt technique. Bleeding score was assessed using the International Society on Thrombosis and Haemostasis bleeding assessment tool. Data were analyzed using the Graphpad Prisim, version 6.0, San Diego. Results: Only 2% of the subjects had hemophilia A, whereas 68% of the subjects had thrombocytopenic bleeding. Most (32.4%) had bleeding score of four. Analysis of variance of these variables showed a significant relationship with P < 0.0001. Post hoc analysis showed significant P values for platelet count versus bleeding score (P = 0.000, 95% confidence interval [CI]: 95.74–126.4) and APTT versus bleeding score (P = 0.000, 95% CI: 44.34–74.98). Conclusion: Bleeding assessment tools are important in evaluating persons with bleeding symptoms and it may be necessary to screen for hemophilia in these cases. Larger multicenter epidemiological studies are needed to determine the prevalence of hemophilia and other bleeding disorders in our environment.
  4,059 251 1
Awareness and practice of zinc therapy in diarrheal management among under-five caregivers in Enugu State, Nigeria
Joshua I Ugwu, Ikechukwu E Ezeagu, Madu D Ibegbu
July-December 2019, 24(2):63-69
Background: Acute diarrhea remains one of the leading causes of under -five years of age (u-5) childhood deaths in Nigeria. Use of zinc (Zn) sulfate monohydrate with low-osmolality oral rehydration solution (ORS) therapy reduces both the duration and severity of the diarrhea episodes in children. There has been little progress in the widespread introduction and adoption of ORS plus Zn sulfate (ORS+Zn) therapy in Nigeria. Aims and Objectives: The aim of this study was to assess the level of awareness and practice of ORS+Zn therapy among u-5 caregivers. Materials and Methods: Two local government areas, each representing urban and rural settings, were randomly selected. Awareness and practice of ORS+Zn therapy by 386 caregivers was assessed using a semi-structured interviewer-administered questionnaire. Frequency and percentages were used for categorical data and the influence of sociodemography was analyzed by using Pearson’s correlation method. Results: Awareness and practice of Zn therapy was higher among the caregivers in the urban setting, who seems to be more exposed to information on the efficacy of ORS+Zn therapy (p < 0.05). Caregivers of u-5 children living in the rural settings were deficient in information on the use of ORS and Zn salts in the management of child diarrhea. In summary, of the 386 caregivers, 123 (62%) indicated awareness of Zn salt, and of these only 39 (10%) practiced Zn salt treatment. Level of education seems to influence awareness and practice positively in the urban setting (p < 0.05). Economic status underscored by employment type, clinic visits, and health campaigns influenced positively the adoption of ORS+Zn therapy in the rural and urban communities (p < 0.05). Tertiary education, which is the highest level of education, showed a positive association with awareness and practice of ORS+Zn treatment in both study areas (p < 0.05). One hundred and ninety-nine caregivers (52%) of all the respondents still preferred to treat child diarrhea with ORS with antibiotics adjuvant. Conclusion: Practice of ORS+Zn therapy is low and seems to be influenced by level of education, awareness, and location and availability. Advocacy and sensitization programs should be intensified, and intake of food rich in Zn and Zn supplement should be promoted in infant-feeding practices.
  3,588 254 -
Investigating the level of awareness and extent of financial risk protection among the population in Enugu state, southeast Nigeria
Chijioke Okoli, Eric Obikeze, Charles Ezenduka, Ejikeme Arodiwe, Ogbonnia Ochonma, Obinna Onwujekwe
July-December 2019, 24(2):70-77
Objective: The study investigated the level of awareness and extent of financial risk protection among the population in Enugu state, southeast Nigeria. Materials and Methods: A mixed-method approach involving cross-sectional quantitative and qualitative methods was adopted for data collection and analysis. The study was conducted in two purposively selected urban and rural local government settings in Enugu North and East senatorial zones, respectively. Results: The quantitative results show that most of the respondents (77.1%) were women and 80.2% were married. Slightly above a quarter of the respondents (25.6%) were self-employed, whereas 29.1% were main income earners. Out-of-pocket (OOP) dominates payment mechanisms (94.9%), whereas more than half (54.4%) of the respondents went to patent medicine dealers for treatment in the last one month. Logistic regression shows overall significance in use of prepayment mechanisms with χ2 = 56.57 and P = 0.001. More so, finding indicates that 55.9% of respondents have heard of prepayment mechanisms mainly from television (30.4%) and radio program (20.2%), while 89.5% has not used any prepayment mechanism in the State. Conclusion: OOP still dominates payment mechanism in Enugu state. Although over half of the respondents (55.9%) have heard of prepayment mechanisms, approximately 90% has not used any prepayment mechanism in the State. This calls for policy that will ensure moving away from OOP payment to prepayment mechanism through health system strengthening and awareness creation for the populace.
  3,477 227 3
Influenza A viruses: Current perspectives on swine flu virus
Martin E Ohanu, Daniel B Olusina, Anthony O Eni, Emmanuel N Aguwa, Chinwe J Chukwuka
January-June 2019, 24(1):1-8
Swine influenza, a genetic reassortment of swine, avian, and human influenza viruses, is a respiratory disease of pigs that recently caused a pandemic. It contains deoxyribonucleic acid that is typical to avian, swine, and human viruses, including elements from European and Asian swine viruses. The main targets of the influenza virus are the columnar epithelial cells of the respiratory tract. The aim of this review was to present updates on influenza A viruses with particular attention to recent developments on swine flu H1N1. In-depth interest is on current historical accounts, pathogenesis, clinical features, diagnosis, treatment, and prevention. The review shows that there is tremendous improvement on the knowledge and understanding of the mechanisms of influenza disease and outcomes of management. There is an increasing diagnostic facility and emphasis on advanced infection control measures, encouraging frequent, adequate hand washing, use of alcohol-based hand sanitizers, and use of quarantine facility for treating serious cases and vaccination of people at risk.
  3,414 278 -
Trends in contraceptive uptake at a tertiary health facility in Ibadan, Nigeria
Oluwasomidoyin O Bello, Adebayo D Agboola
January-June 2020, 25(1):21-27
Background: Low utilization of modern contraceptive is one of the key determinants of high fertility in Nigeria. Objective: The objective of this study was to determine the yearly prevalence and trend of contraceptive use among women of reproductive age-group who attended a family planning clinic in Ibadan, Nigeria. Materials and Methods: A clinical audit of contraceptive uptake was undertaken at the family planning clinic of University College Hospital, Ibadan, Nigeria, from January 1, 2011 through December 31, 2018. Information on the client’s age, type of contraceptive utilized, and total number of each contraceptive method used per year was obtained. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Results: A total of 13,023 women utilized at least one form of contraceptive with mean age of 35.53 ± 9.1 years. Implant (31.2%) was the most widely utilized contraceptive, whereas bilateral tubal ligation (0.4%) was the least utilized. Other methods were intrauterine contraceptive device, injectable, condom (male and female), and oral contraceptive accounting for 26.9%, 19.3%, 16.7%, and 5.5%, respectively. A significant decrease was observed in the trend of use of modern hormonal contraceptive methods as compared to the nonhormonal methods over the 8 years studied (P < 0.001). Conclusion: Implant being the most utilized indicates that it is the most accepted and approved by clients in our clinic. The knowledge of contraceptive utilization trends can be used to monitor and appraise the acceptance and approval of each method and family planning programs over a period.
  3,336 291 1
Suspicious and malignant features on mammogram among women in a group of communities within south east Nigeria
Eric O Umeh, Uzoamaka R Ebubedike, Brenda C Nwammuo
January-June 2019, 24(1):23-27
Introduction: Mammography services are not widely available in Nigeria due to inadequate numbers of mammography machines and shortage of the relevant skilled personnel. However, diagnostic and screening mammography was recently introduced at centre near Onitsha in south-east Nigeria to serve the immediate catchment area and surrounding communities. Objective: To determine the prevalence of suspicious findings and features suggestive of breast cancer (BIRADS categories 4, 5 and 6) among mammograms for women presenting at mammography imaging centre. Methodology: Retrospective study reviewing mammograms done at the Iyienu Mission Hospital between January 2013 and December 2015. Final BIRADS Categorization in line with the BIRADS lexicon was reported based on mammography findings and clinical history for each subject. Results: Mean age of study population was 49.1 years ±8.1. Mammographic findings for five percent of subjects were categorized BIRADS 4, while one (0.2%) was categorized BIRADS 5, and four (0.7%) were BIRADS Category 6. The proportion of cases within each age group categorized BIRADS 4 - 6 was 10.1% among subjects aged less than 40 years (p-value 0.19), 5.2% for subjects aged between 41 and 60 years (p-value 0.12) and 10.0% among subjects aged greater than 60 years (p-value 0.32). Conclusion: Study findings suggest higher prevalence of suspicious and malignant findings among the elderly, as well as young women. Future re-assessment of findings desirable using larger sample size. Initiatives for enlightenment on the relevance of cancer screening methods should target middle aged and elderly women, as well as younger women, especially those at risk.
  3,143 196 -
High Internet awareness and proficiency among medical undergraduates in Nigeria: A likely tool to enhance e-learning/instruction in Internal Medicine
Oluchi S Ekenze, Christian I Okafor, Sebastian O Ekenze
January-June 2019, 24(1):9-17
Background/Objective: The emergence of the Internet several decades ago has brought global revolution in a lot of processes even among developing nations, including educational processes. We assessed the familiarity of the medical students with Internet tools and their preparedness with integrating e-learning into Internal Medicine teaching methods. Materials and Methods: A cross-sectional survey of two graduating medical classes of College of Medicine, using structured self-administered questionnaire, was carried out. The survey assessed the knowledge, utility, and application of Internet tools in medical education using five-point Likert scale. Results: A total of 227 (75%) of the cohort of 292 students responded, comprising 150 (66.1%) males and 77 (33.9%) females. The median age was 24 years (Interquartile range, 23–26 years). Of these, 219 (96.5%) owned Internet-enabled devices, whereas 104 (46.2%) had formal training on the use of computers. Two hundred and twenty-two (97.8%) could access the Internet, with Google and Twitter accounts being the highest and the least used tools, respectively. Two hundred and twenty five (99%; mean rating 4.5 on a scale of 5) indicated that Internet tools were useful in teaching Internal Medicine, specifically in the areas of lectures, assignments, and interaction with experts globally. The key benefits were utility as a regular self-assessment tool and flexible learning schedule (mean rating, 4.0, respectively). Overall, 213 (93.8%) suggested that the use of Internet tools and e-learning should be incorporated into the traditional method of teaching. Challenges with its use included cost of accessing the Internet (n = 126; 55.5%), lack of facility with adequate technology (n = 115; 50.7%), and availability of Internet (n = 96; 42.3%). Conclusion: Undergraduate medical students in our setting are familiar with the Internet and its potential utility for learning and undergraduate teaching of Internal Medicine.
  2,941 245 1
Spectrum of findings on barium enema examination in Benin City
Sam U Enukegwu, Festus O Ehigiamusoe, Anthony O Ogbeide
January-June 2019, 24(1):35-39
Background: In the Western world, barium enema has largely been replaced by computed tomographic (CT) colonography or virtual colonoscopy using the three-dimensional fly-through software. But barium enema remains relevant in our environment because of its availability and affordable cost as compared to cross-sectional imaging. Aim: To document the common pathologies seen on barium enema examinations in Benin City, Nigeria. Materials and Methods: All cases of barium enema performed at St. Bridget X-Ray Centre, a private radio-diagnostic outfit in Benin City, between January 2013 and December 2014, were retrospectively reviewed. The biodata, clinical information, and radiological diagnoses were collated and entered into the Statistical Package for Social Sciences (SPSS) software and then analyzed. Those with inadequate details were excluded from the study. Results: Two hundred and sixteen patients who had barium enema for various indications were reviewed; the males were 135 (62.5%), whereas the females were 81 (37.5%). Constipation (53, 23.0%) was the most common clinical indication, followed by hematochezia (50, 21.7%), abdominal pain (32, 13.9%), colorectal mass (26, 11.3%), and abdominal swelling (12, 5.2%). Colonic carcinoma (39, 20.8%) was the most common diagnosis on barium enema. This was followed by Hirschsprung’s disease (20, 15.4%), ulcerative colitis (15, 11.5%), megacolon (12, 9.2%), and colonic stricture (11, 6.2%). These findings were more in males (88, 67.7%) than that in females (42, 32.3%). Conclusion: This study has enumerated the common indications and common radiological findings on barium enema study in our environment. Furthermore, this study has also buttressed the fact that barium enema is still reliable in making diagnosis in environment where CT scan is either unavailable or costly.
  3,008 166 -
Under-five mortality at the children’s emergency room of Federal Medical Centre, Umuahia, Southeastern Nigeria
Chikaodili A Ibeneme, Ezinwa O Ezuruike, Francis C Korie, Ndubuisi K Chukwudi
January-June 2019, 24(1):47-52
Background: Under-five children’s death is one of the vital indices of a society’s development and a telling evidence of their priorities and values. An audit of the common causes of mortality among under-fives is essential in ensuring optimum child survival. Aim: To determine the magnitude, causes, and determinants of under-five deaths at the Federal Medical Centre, Umuahia, Southeastern Nigeria. Subjects and Methods: A retrospective review of all postneonatal under-five deaths at the Children’s Emergency Room from January 2012 to December 2016, was carried out and the information was analyzed. Results: Of a total of 6141 under-fives admitted during the 5-year period, 197 died giving a mortality rate of 32 per 1000 LB. Boys accounted for 106 (53.8%) with no gender difference in the mortality rates (P = 0.262). The leading primary causes of death were sepsis, severe malaria, diarrheal disease, meningitis, pneumonia, and severe acute malnutrition, accounting for 95%. Deaths due to malaria occurred more among the preschool age group than that among infants and toddlers (P = 0.013), whereas those due to pneumonia were more prevalent among infants (P = 0.012). Diarrheal disease caused more deaths during the dry weather season (P = 0.009). Approximately 40% of the deaths occurred within 24h of arrival to the Emergency Unit. The most common complications leading to death were dehydration, severe anemia, shock, heart failure, and hypoglycemia. Conclusion: The leading causes of under-fives deaths in our center are preventable infectious diseases. Intensification of goal-targeted, disease-specific preventive measures is recommended.
  2,943 214 1
Effects of six weeks donkey kick and squat resistance exercises on gluteal adiposity, muscle strength, and muscle bulk of young Nigerian female adults: A randomized controlled trial
Nelson E Ekechukwu, Augustine C Okoh
January-June 2020, 25(1):28-37
Background: Rounded protruding gluteus has been asserted to be an important feature of feminine beauty and self-image. Currently, there is large influx of gymnasiums to achieve this end as claimed by gym operators amid the dearth in literature to support their claims. Aim: The aim of this study was to provide an empirical evidence to support or disprove claims about the effectiveness of resistance training exercises such as squats and donkey kick on the gluteal muscles. Materials and Methods: Randomized controlled trial involving 111 young females, aged 18–30 years, were equally assigned into the squat group (SG), donkey kick group (DKG), and control group (CG) using table of random numbers method. Outcomes, such as gluteal muscle strength (GMS), gluteal muscle bulk (GMB), and gluteal adiposity (GA), were assessed at baseline, third week, and sixth week and analyzed descriptively and inferentially (α = 0.05). Result: The post-intervention across group comparison revealed a significant difference in right (F = 4.829, P = 0.010) and left (F = 7.252, P = 0.001) GA, right (F = 12.467, P < 0.0001) and left (F = 10.235, P < 0.0001) GMS, and in the GMB (F = 8.280, P = 0.001). The post hoc test showed that the SG had the most profound effect in increasing GMS and GMB, whereas the DKG had a superlative effect on GA. Conclusion: Six weeks resistant training using squats and donkey kick can be used to improve gluteal muscle characteristic by building GMB, GMS and reducing GA of young female adults.
  2,833 159 1
The inverse care law: implications for universal health coverage in Nigerian rural communities
Aniekan Etokidem, Daprim Ogaji
January-April 2021, 26(1):11-16
Background: The inverse care law states that the availability of good healthcare tends to vary inversely with the need for it in the population served. This situation is easily observable in developing countries like Nigeria, and poses a threat to the attainment of universal health coverage (UHC) in rural communities. Objective: To examine how the inverse care law plays out in the Nigerian healthcare system, and how this may lead to a difficulty in achieving UHC in rural communities. Materials and Methods: Standard procedures were used in locating, selecting, extracting and synthesizing data. Electronic databases and internet resources such as PubMed, Google Scholar, SCOPUS and Web of Science were searched. Selection of studies was conducted by a two-stage process. Data extraction was done using data extraction forms. During data synthesis, major themes, strengths, weaknesses and critical gaps in each paper were identified. Results: There are several factors that boost the operation of the inverse care law in the Nigerian healthcare system. How this poses a threat to the attainment of UHC has also been documented. Among these are limitations in the range of services provided in rural healthcare facilities, inadequate production and maldistribution of health personnel, and low health manpower retention in rural areas. Conclusion: There is a need for concerted efforts by the government to address the factors that facilitate the inverse care law in the Nigerian healthcare system. This is necessary for the attainment of UHC specifically and the Sustainable Development Goal number three generally.
  2,757 150 -
Impact of sleep patterns on the academic performance of medical students of College of Medicine, University of Nigeria
Augustine Uchechukwu Agu, Emmanuel Anayochukwu Esom, Samuel Chukwudi Chime, Pamela Somke Anyaeji, Godson Emeka Anyanwu, Emmanuel Nebeuwa Obikili
January-April 2021, 26(1):31-36
Background: Sleep is necessary for physical and cognitive health; these functions are susceptible to be impaired by sleep deprivation. This study evaluated the sleep patterns of the medical students and the impact they have on their academic performance. Materials and Methods: One hundred and ninety-three third-year medical students (122 males and 73 females) participated in the study. The students’ sleep patterns were obtained through a structured questionnaire which was divided into two sections: section 1 was used to obtain the students’ demographic data, and section 2 was used to determine the students’ sleep durations, latency, and qualities. Data on their academic performance were obtained from the results of their second-year MBBS professional examination. Descriptive analysis was done and associations between academic performance and the variables were determined using Student’s t-test, χ2 tests, and Spearman’s correlation test. Results: Fifty-nine percent of the students were sleep-deprived and 41% slept for 6 h or more, 42% had sleep latency of less than 10 min, and 60% frequently or sometimes wakeup at night, while 44.1% felt sleepy during school hours. The academic performance correlated positively with sleep duration (P < 0.001), whereas the correlation with sleep latency and quality was negative. The students who were sleep-deprived had poor academic performance and those with short sleep latency had a better academic performance. Conclusion: Poor sleep duration, long sleep latency, and poor sleep qualities negatively affected the academic performance of the students.
  2,723 147 -
Prospective analysis of extremity gunshot injuries treated in a Nigerian regional trauma center
Omolade A Lasebikan, Njoku I Omoke, Ndubuisi O Onyemaechi, Emmanuel C Iyidobi, Wilson I Anetekhai
July-December 2019, 24(2):100-106
Background: Extremity gunshot injuries are a common cause of morbidity and mortality in our environment. They pose a management challenge because of the complex soft tissue and bony injuries. Objectives: The objectives of this study was to determine the pattern and treatment outcomes of these injuries in our setting. Materials and Methods: This was a prospective study of extremity gunshot injuries treated at National Orthopaedic Hospital, Enugu, Nigeria over a 12-month period. Results: Fifty-five patients were studied, with a mean age of 36.9 ± 13.39 years and a male-to-female ratio of 8.2:1. The two top causes of gunshot injuries were armed robbery (41; 74.5%) and assaults/communal clash (6; 10.9%), and the most common type of gun was the rifle (21; 38.2%). Gunshot fracture was the commonest type of injury among the patients (39, 70.9%). Only 34.5.1% of our patients presented to hospital within the first 6h. Secondary wound closure was the commonest method of wound cover. Majority of the gunshot fractures were treated non-operatively. The duration of hospitalization ranged from 2 days to 13 weeks with a mean duration of 4.9 weeks. Late presentation, presence of fracture, and wound infection were associated with prolonged hospital stay. Outcome of treatment was good in 80% of patients and the mortality rate was 1.8%. Conclusion: The young adult males are more involved in extremity gunshot injuries. The fracture rate of these injuries is high with associated increased morbidity. Effective control measures aimed at reducing the incidence of gunshot injuries will reduce the negative socioeconomic impact of these injuries.
  2,663 172 -
Sunscreen use among albinos in Enugu, South-Eastern Nigeria
Uche Rowland Ojinmah, Chinwe Laura Onyekonwu, Ikechukwu Emmanuel Obi, Jane Baridakara Uche-Ejekwu, Nkiru Pauline Onodugo, Chinechelum Nneoma Anyanechi, Chika Mary Emeka
September-December 2021, 26(3):139-146
Background: Albinism is a congenital skin condition which is caused by lack or deficiency of tyrosinase enzyme leading to partial or complete absence of melanin from skin with attendant solar skin damage which could lead to premature skin aging, skin cancer, and visual problems. Good knowledge and proper use of sunscreens could prolong the life of people living with albinism. Materials and Methods: This cross-sectional study involved 40 people living with albinism who were recruited consecutively after giving informed consent. The subjects then responded to a pretested questionnaire and had their skin also examined. Analysis of data was done with SPSS version 20. Results: About 92.5% (n = 37) know about sunscreen but only 22.5% (n = 9%) have known about it for more than 10 years. Based on the ages of the study participants, many had lived for more than 10 years before getting to know about sunscreen and hence have been unprotected from damaging effects of sunlight for long. The most important sources of information about sunscreen are doctors 32.5% and fellow albinos 22.5%. Most subjects (90%) had poor knowledge of what makes a good sunscreen and most (82.5%) used it inappropriately. Conclusion: While many knew about sunscreen, only a small fraction got the information early which is vital for commencement of skin protection early, hence forestalling damage. Doctors were found to be important source of information about sunscreen, although many subjects used it inappropriately.
  2,673 154 1
Zinc status of under-five children in selected urban and rural settings in Enugu State, Nigeria
Joshua I Ugwu, Ikechukwu E Ezeagu, Madu D Ibegbu, Nonso C Ejiofor, Chigozie P Okorie
January-June 2020, 25(1):16-20
Background: High incidence of zinc (Zn) deficiency, especially among under-five children, is widely reported in developing countries including Nigeria. Objective: The aim of this study was to provide data on the Zn status of under-five children in Enugu State. Materials and Methods: This was a descriptive cross-sectional study of under-five children in Enugu South (urban) and Nkanu West (rural) local government areas (LGAs). A total of 409 children (244 urban and 165 rural) were enrolled in the study. Non-fasting venous blood (2 mL) was obtained from a total of 409 under-five children and the serum Zn was determined by using an atomic absorption spectrophotometer. Serum Zn level of < 70 µg/L was defined as Zn deficiency. Results: Although 222 (54%) of the children were adequate, 187 (46%) were deficient in Zn. Of the 165 children from the rural area, 73 (44%) were deficient in Zn, whereas in urban area, of 244 children, 112 (46%) were deficient in Zn (<70 µg/dL). The mean serum Zn level (73.86 ± 15.99 µg/dL) of the urban under-five children was significantly (P = 0.009) higher than that of the rural children (68.25 ± 9.04). In the rural setting, higher incidence of Zn deficiency occurred among the male subjects (32 [52.8%]) compared to the female subjects (35 [37.6%]) although the difference was not statistically significant (P = 0.08). Conclusion: The results indicate a high incidence of Zn deficiency in the studied population, which seems higher in the rural than in the urban LGA. Nutrition educational programs, intake of food rich in Zn and supplements should be promoted to improve Zn intake especially in infant and young child feeding practices.
  2,582 231 -
Carbamazepine-associated urinary incontinence: A case report and literature review
Jamir P Rissardo, Ana L Fornari Caprara
July-December 2019, 24(2):114-117
Carbamazepine (CBZ) is an anticonvulsant approved for the management of many neurological and psychiatric disorders. We present a case of an adult male with epilepsy who reported new seizures, and the dose of CBZ administered was 1600mg daily. CBZ dose was increased to 1800mg daily. The subject complained of urinary incontinence without dysuria that started after the CBZ dose increase. It was associated with urgency, hesitancy, dribbling of urine, and poor stream. Laboratory tests were within normal limits. He admitted dry mouth, flushing, constipation, and accommodation paralysis starting after CBZ increase. Assuming that these symptoms were an adverse drug reaction, CBZ was withdrawn and valproate was started. The individual had full recovery within four weeks. To the best of our knowledge, only two case reports of similar nature are available, but this is the first one to be reported with young male adult.
  2,603 165 -
COVID-19: Knowledge of mode of spread and preventive practices among mothers attending a tertiary health institution
Ann E Aronu, Awoere T Chinawa, Obinna C Nduagubam, Edmund N Ossai, Josephat M Chinawa
January-April 2021, 26(1):56-63
Background: COVID-19 pandemic is a very common menace in the world. Knowledge on mode of spread and prevention of COVID-19 remains blurred among mothers who visit children clinics. Objectives: This work is aimed to determine the knowledge of mode of spread and preventive practices among mothers presenting in a health institution. Materials and Methods: This is a cross-sectional observational study undertaken in a health institution in South East Nigeria using a structured self-administered questionnaire. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software version 25.0. Results: All the respondents (100.0%) have heard of COVID-19. A minor proportion of the respondents, 31.9%, had good knowledge of the mode of spread of COVID-19. Majority of the respondents, 93.3%, knew that COVID-19 could be prevented through good use of personal hand sanitizer. A high proportion of the respondents, 75.5%, were aware that COVID-19 could be prevented by avoiding crowded places and 76.7% by wearing of face mask. The respondents who were in the age group 30–39 years were twice more likely to have good knowledge of spread of COVID-19 when compared with those who were 50 years and above. (AOR = 2.2, 95%CI: 1.2–3.9). The respondents who attained tertiary education were 1.3 times less likely to have good knowledge of spread of COVID-19 when compared with those who attained secondary education. (AOR = 0.8, 95%CI: 0.5–1.2). Respondents who were married were about five times more likely to have good preventive practices against COVID-19 than those who were single parents. (AOR = 4.9, 95%CI: 2.8–8.4). Conclusion: Education is predictive of knowledge of mode of spread while being married is predictive of knowledge of preventive practices.
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A need for specialized education in pediatric radiography in Nigeria
Odira C Ewuzie
July-December 2019, 24(2):85-88
Introduction: Pediatrics is a vast field with many facets. The importance of having dedicated specialists trained in the treatment and care of pediatric patients has long been recognized. It is necessary to determine if the profession of radiography is making similar progress in improving on the pediatric radiography services offered in the country. Objective: The objective of this study was to establish if there was a perceived need for specialized pediatric radiographic education in Nigeria. Subjects and Methods: This was a descriptive cross-sectional survey, which accessed radiographers' take on the need for specialized education in pediatric imaging. A Google Form link was distributed through various Nigerian radiographers' WhatsApp groups, inviting interested radiographers to participate in stating their opinions on the need for specialized pediatric radiographic education in the country and other related questions. Data were analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results were presented using tables and charts. Results: Seventy-six radiographers working in 25 states across the federation participated in the online survey. A total of 90.8% of the respondents stated there was a need for specialized radiographic education in pediatric imaging, and 64.5% felt that this education or training opportunities for radiographers was inadequate. Only 43.4% were comfortable performing pediatric imaging. Conclusion: Majority of the radiography departments in Nigeria do not have dedicated equipment or staff for pediatric radiography. Undergoing specialized pediatric imaging training will benefit radiographers who are keen on improving the radiography services offered to pediatric patients.
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The roles of social networks and social support on breastfeeding practices in Nigeria
Emeka P Agudile, Cassandra A Okechukwu, Subu V Subramanian, Alan C Geller, Ana Langer
July-December 2020, 25(2):57-69
Background: The global prevalence of early breastfeeding initiation, exclusive breastfeeding, and avoidance of prelacteal feeding has remained below the recommendations by the World Health Organization. Nigeria has the lowest rates of exclusive breastfeeding and the highest rates of prelacteal feeding in sub-Saharan Africa. It has been shown that social support is positively associated with healthy breastfeeding practices. Materials and Methods: This study used data from the household interviews of the Pilot Study on the Quality of Care in Antenatal Care and Patterns of Maternal Health Behavior in Nigeria, a cross-sectional survey of women (n = 455) in Nigeria to investigate the association between social support and breastfeeding practices among women. We conducted multivariable logistic regression analyses to explore the association between sources and types of social supports and breastfeeding in Nigeria. Results: We found that supports from mothers and fathers were associated with a higher prevalence of early breastfeeding initiation (odds ratio [OR] = 1.91; 95% confidence interval [CI] = 1.03–3.53; P = 0.039) and avoidance of prelacteal feeding (OR = 2.20; 95% CI = 1.08–4.49; P = 0.030), respectively. On the other hand, supports from neighbors (OR = 0.40; 95% CI = 0.24–0.64; P < 0.001) and mothers-in-law (OR = 0.46; 95% CI = 0.22–0.96; P = 0.039) were negatively associated with early breastfeeding initiation. Other sources of support were not significantly associated with either breastfeeding initiation or prelacteal feeding. Also, high levels of physical support from all network members were associated with a higher likelihood of avoiding prelacteal feeding (OR = 2.94; 95% = CI 1.65–5.22; P < 0.001). In contrast, high levels of emotional support from all network members were associated with a higher risk of prelacteal feeding (OR = 0.61; 95% CI = 0.37–0.98; P = 0.045). Conclusion: Our findings suggest that there are significant dual roles of social support from older generations on breastfeeding. Physical support during the postpartum periods may discourage prelacteal feeding in Nigeria.
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Assessment of nurses’ involvement in health research and policy development at a Federal Teaching Hospital in South East Nigeria
Ifeoma Ndubuisi, Ijeoma L Okoronkwo, Chisom Mbadugha, Ijeoma Maduakolam, Chijioke Nwodoh
September-December 2021, 26(3):163-169
Background: Nurses account for a significant proportion of the health-care workforce in most countries; however, they are marginally represented in policy decision-making. Aim: To assess nurses’ involvement in health research and policy making at a Federal Teaching Hospital in Nigeria. Materials and Methods: A cross-sectional design was adopted by using 305 nurses. Data collection was done by means of a validated questionnaire. Data were analyzed descriptively by using frequencies, percentages, means, and standard deviations. Results: The findings revealed that 71.1% of the respondents had been involved in research activity; however, only 16.6% had participated in a research study after school. The result also revealed that only 23.6% of the respondents had been involved in health policy decision-making in the hospital. Educational qualification did not have any influence on their involvement with research and policy development. The major barriers identified were lack of knowledge and relevant skills (89.8%), lack of organizational support (84.5%), and professional dichotomy (67.2%). The respondents strongly agreed that organizational support (94.4%), having interest in politics (89.8%), mentoring in research (84.6%), higher education in nursing (84.2%), funding of research (80%), and belonging to professional organizations (80%) will enhance their involvement in research and health policy decision-making. Conclusion: Nurses have not been adequately involved in research and policy development. Findings revealed organizational and individual factors as barriers to nurses’ involvement in the research and policy-making process. These findings, therefore, suggest strengthening nurses for effective participation in health policy and building support for research activities in nursing.
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Survey of physician self-reported sexual satisfaction in a tertiary hospital at Enugu, South East Nigeria: A preliminary report
Rita I Igwilo, Ikenna O Onwuekwe, Chioma L Odimegwu, Justus U Onu, Chinwendu J Onwuekwe
January-June 2019, 24(1):53-58
Background: Self-reported sexual dissatisfaction is a recognized contributor to poor quality of life and can affect productivity in the workplace. Aim: This was a preliminary survey of a cohort of physicians in Enugu metropolis, South East Nigeria investigating self-reported sexual satisfaction and its association with sociodemographic variables. Materials and Methods: Physicians’ self-report of sexual well-being as well as any impact thereof was assessed using an online-delivered structured questionnaire in September 2018. Informed consent was obtained. Results obtained were analyzed using the International Business Machine–Statistical Package for the Social Sciences (IBM-SPSS) version 20. Results: The participants, 62.0% males, were mostly married (82%) and young (mean age 38.2 ± 9.7). Majority (81.5%) of the participants were satisfied with their current sexual lives, 30.7% of them used sex enhancements, and 14.8% of the participants were willing to seek professional help over sexual health problems. Males were five times more likely than females to have sexual encounters outside current relationship (P = 0.003). Conclusion: The findings of this study shows that majority of the physicians are satisfied with their sexuality. The study also observed age and gender-related differences in the physicians’ sexual behaviors. The implication of the finding that most doctors are still reluctant to seek help for sexual health issues calls for a robust public health education with emphasis on sexual health.
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Conflict of interest in physician–pharmaceutical industry interactions: Possible interventions in Nigeria medical practice
Ijeoma Victoria Ezeome
January-April 2021, 26(1):1-10
Collaboration between physicians and the pharmaceutical, medical device, and biotechnology industries results in the development of products of great benefit to the public. However, when these interactions negatively influence professional judgments at the expense of the goals of medicine, it becomes a cause of great concern. The objective of this simple review was to bring to the fore the conflicts that exist between these two important areas of patient care and to suggest ways to prevent it in Nigeria. A literature search in the PubMed, Medline, and Web of Science databases was done using the terms conflict of interest, physician, pharmaceutical, medical practice, detailing, biomedical research, bioethics, prescribing pattern, singly or in combination to identify relevant articles. The results are arranged based on the themes of related published articles. This review shows that interactions between physicians and the pharmaceutical industry have multiple areas of conflict ranging from reduction in the quality of patient care, loss of objectivity in professional education, scientific integrity, and the public’s trust in medicine. Interaction between pharmaceutical sales representatives (PSRs) and physicians commonly occur in Nigeria, affecting prescribing behavior. There is no specific regulation in place to protect against ensuing conflicts. There is a need to put in place educational programs to increase awareness among physicians of the effects of such interactions, while also instituting and implementing stringent policies curtailing physician–pharmaceutical industry and PSR relationships.
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