Nigerian Postgraduate Medical Journal最新文献

Background: Malaria remains the deadliest parasitic disease and continues to cause more than half a million deaths across the world each year, mainly victims are sub-Saharan children. Malaria is a common reason for paediatric hospitalisation.

Objective: The objective was to characterise malaria and describe the evolution after treatment in the paediatric department of the University Hospital Centre Amissa Bongo de Franceville.

Methods: This was a cross-sectional study conducted from 1 February 2023 to 15 May 2023. A clinical and biological diagnosis was made in febrile children aged from 6 months to 15 years.

Results: A total of 306 patients were included. The mean age was 50.4 ± 44.3 months, 94.3% had consulted within ≥48 h and self-medication was practiced by 83.3%. The prevalence of malaria was 17.3%. Fever ˃39°8C (adjusted odds ratios [aOR] = 2.68; 95% confidence interval [CI] = [1.32-5.48]; P < 0.01), chills (aOR = 2.14; 95% CI = [1.13-4.11]; P < 0.01) and nausea-vomiting (aOR = 2.03; 95% CI = [1.06-3.83]; P = 0.03) were the factors associated with the occurrence of malaria. The majority of children were treated for simple malaria with artemisinin-based combination therapy. A total of 16/53 was seen in post-therapeutic consultation. Of them, 2 patients had a positive thick drop.

Conclusion: Non-compliance with preventive measures and the misuse of antimalarials further complicate the clinical picture, requiring parenteral management for the most part.

Background: In Nigeria, violence against healthcare has adversely affected the access to and delivery of healthcare services with serious consequences for healthcare workers (HCWs). This study assessed the prevalence and patterns of violence against HCWs in areas of armed conflict, areas of other situation of violence and areas not affected by conflict in Nigeria.

Methodology: A cross-sectional study utilising a mixed method approach comprising both quantitative survey and qualitative data collection methods. All the categories of HCWs in public healthcare facilities participated in the study. Ethical approval for this study was obtained from the respective Health and Research Ethics Committees of the respective study sites.

Results: A total of 1,218 HCWs comprising Borno State, 407 (33.4%), Plateau State, 401 (32.9%) and the Federal Capital Territory 410 (43.7%) were interviewed. The overall prevalence of physical and psychological violence was 16.7% and 62.4%, respectively. Pushing and slapping were the predominant forms of physical violence. Weaponized violence with weapon was the highest in conflict areas. Verbal abuse, threats, bullying and harassment were the predominant forms of psychological violence. The major consequences of violent attacks on the HCWs were lack of job satisfaction, loss of confidence, low self-esteem, decreased productivity and post-traumatic stress disorder.

Conclusions: The overall prevalence of violent attacks on HCWs was high. The perpetrators of violent attacks were mainly patient relatives and patients/clients. The factors predisposing to violent attacks were patients-related issues, service delivery, working conditions of the hospitals, expectations of patient relatives and impatience of hospital staff.

Domestic resource mobilisation (DRM) is vital for achieving sustainable healthcare financing in Nigeria, where dependence on external funding and oil revenues has long hindered health sector progress. The Nigerian healthcare system faces persistent challenges, including inadequate funding, inefficiencies and limited access to essential services, particularly in rural areas. This paper explores the challenges and prospects of DRM as a means of financing healthcare in Nigeria. A Medline search and a search of other internet search engines were carried out for published studies on healthcare financing in Nigeria, Africa and worldwide, we also examined policy documents and healthcare financing data to analyse the potential of DRM in Nigeria. A total of 38 publications were reviewed revealing that mechanisms such as general tax revenue, social insurance systems and community-based health insurance are central to DRM efforts. However, challenges such as inadequate budgetary allocations, corruption, poor database management and the emigration of health workers persist. Despite these obstacles, there are promising prospects, including increased tax revenue, development of the domestic capital market and the potential for sustainable and equitable healthcare financing through public-private partnerships. To harness these opportunities, the Nigerian government must implement effective policies, strengthen governance structures and promote transparency and accountability. DRM offers a promising path towards reducing dependency on external aid and achieving a more resilient and equitable healthcare system in Nigeria.

Emergency medicine (EM) globally is a new medical speciality when compared with traditional medical specialities such as surgery, obstetrics, gynaecology and internal medicine. It is a medical speciality that deals with the management of acute illnesses and injuries in a timely and result-oriented manner. The International Federation of EM defines it as a field of practice based on the knowledge and care required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury, affecting patients of all age groups with a full spectrum of episodic, undifferentiated physical and behavioural disorders. Two types of EM are recognised: the out-of-hospital emergency medical services (OHEMS) and the in-hospital emergency medical services (IHEMS). OHEMS was introduced into the country in 1998 by the Lagos state government. IHEMS had been in place for much longer, but it was practised in a heterogeneous and substandard manner. The result of the latter is a casualty department with an overwhelming burden of patients and a high mortality rate. The World Health Assembly (WHA) resolution 60.22 of 2007 mandated every member state government to establish and monitor integrated EM care systems; it is therefore expected that the emergency medical services (EMS) in the country would wear a new look. However, anecdotal reports suggest that both OHEMS and IHEMS in the country are rudimentary and there is no strong evidence to show that EM is embraced by all as a medical speciality. The objective of this study is to examine the challenges and prospects of EM as a medical speciality in Nigeria. A review of the past literature searched in Google, Google Scholar, PubMed and African Journal online was conducted. A total of 40 relevant publications in addition to the authors knowledge and exposure in EM supported the information presented in this manuscript. Our study revealed that inadequate funding and ambulance services, nonavailability of trained bystanders, limited infrastructure and skilled manpower, inadequate and inequitable distribution of health resources, lack of standard emergency department, high out-of-pocket expenses and substandard implementation of EMS policies, are factors militating against a functional EMS in the country. In line with the philosophy of WHA resolution72.16 of 2019, it is recommended that the central government should put in place a mechanism for full and sustainable implementation of the NHIA Act (2022), National Emergency Medical Services and Ambulance System (NEMSAS) and the patient's bill of rights and direct the adoption of EM as a medical speciality in all federal and state hospitals. In addition, the central government should create public awareness, improve road networks, provide funding, and establish collaboration with local and international organisations.

Sickle cell disease is an autosomal recessive genetic disorder with the underlying pathology, resulting in sickling of the red blood cells in deoxygenated conditions. Osteonecrosis is a common orthopaedic manifestation of sickle cell disease, and total joint arthroplasty is the preferred option in managing patients with advanced disease. This article describes bilateral total hip arthroplasty and right total knee arthroplasty (TKA) in a 41-year-old woman, a known haemoglobin SS (HBSS) patient who presented to the outpatient clinic of National Orthopaedic Hospital, Igbobi, Lagos, with recurrent bilateral hip and right knee pain of 10-year duration, with associated stiffness, valgus deformity in the knee and severe limitation of function. She had sequential bilateral total hip replacement and right TKA. She had significant improvement in function in the follow-up period. The effectiveness of total hip and knee arthroplasties in HBSS patients with osteonecrosis is well demonstrated in this article.

Introduction: Previous studies have been conducted on medication adherence in Southwest Nigeria, but none of these has reported the relationship between highly active antiretroviral therapy (HAART) adherence, spirituality and viral load (VL) amongst people living with Human immunodeficiency virus (HIV)/AIDS, especially in rural settings of Southwestern Nigeria. This study assessed the pattern of medication adherence, spirituality and VL and ascertained the association of socio-demographics and spirituality on medication adherence amongst patients on HAART in rural Southwestern Nigeria.

Materials and methods: A hospital-based cross-sectional study involving 321 consented patients on HAART who were recruited by systematic sampling technique at the adult HIV clinic. Data were collected using an interviewer-administered questionnaire that assessed participants' socio-demographic profiles, medication adherence and spirituality. Their blood samples were collected and their VLs were determined. The data were analysed using SPSS version 20. Logistic regression was done to identify the independent predictors of medication adherence.

Results: The majority of the respondents reported a medium level of medication adherence (66.4%), a high level of spirituality (68.8%) and a low level of VL (67.3%). Amongst variables that had a statistically significant association with medication adherence were being educated, married, divorced, separated or widowed (P < 0.05). Furthermore, persons with high spirituality were 2.6 times more likely to be adherent to antiretroviral drugs when compared to persons with low spirituality (P < 0.05).

Conclusion: It was shown that high spirituality is a positive predictor of medication adherence amongst patients on HAART. It, therefore, suggests that efforts deployed to improve the spirituality of these patients would most likely improve their medication adherence.

Objective: The objective of this study was to determine the prevalence of self-reported myopia in Trinidad and Tobago.

Materials and methods: This study was a cross-sectional design, and data were collected using a validated structured questionnaire from January to April 2024. Systematic random sampling was used to select participants aged 15 and above to participate. Descriptive statistics were used to summarise the variables and the Chi-square test was used to assess for associations (P < 0.05).

Results: A total of 350 participated in the study giving a response rate of 91.15%. Majority of the participants were female (n = 197, 56.3%), mixed race (n = 126, 36%), resided in urban areas (n = 172, 49.4%) and aged 18-35 years (n = 168, 48.3%). The prevalence of myopia was 40.9% and the prevalence was significantly associated with age group, ethnicity, level of education and religion (P < 0.05). Myopia was associated with family history, lifestyle, use of spectacles, daily use of computers, near work, outdoor activities, sleeping and having a father or mother with myopia (All P < 0.05). In addition, ocular diseases such as cataracts and glaucoma were among the most frequent reported conditions.

Conclusion: The myopia prevalence observed in our study validates age-related trends, offers estimates across diverse age groups, and reveals a significant association between myopia rates and family history, with a self-reported myopia rate higher than clinical testing surveys but in line with global prevalence reports.

The prognosis/mortality rate in mycosis fungoides (MF)/cutaneous T-cell lymphomas (CTCL) is alarming in resource-poor countries due to delayed diagnosis in meeting recognised criteria. We highlight the diagnostic accuracy of examining peripheral blood films (PBFs). We reviewed clinically diagnosed MF/CTCL cases in the Dermatology Clinic of Lagos University Teaching Hospital between January and October 2022 and analysed clinical, haematological and histology findings. Eight patients (male:female = 5:3) between 35 and 68 years had blood films with characteristic Sezary cells of <5%. Flow cytometry (FC) in 1 (12.5%) was inconclusive, and immunohistochemistry (IHC) on skin/lymph nodes in 5 (62.5%) was highly suggestive or confirmatory. Three patients had no biopsy. Patients had methotrexate, phototherapy (±psoralen) and systemic steroids with varying improvements. Since immunophenotyping (FC or IHC) is lacking in resource-poor countries or low- and middle-income countries, Sezary cells in PBF of clinically diagnosed patients with MF/CTCL should prompt treatment.

Context: The world over, there has been a paradigm shift in medical education from the traditional curriculum to Competency-Based Medical Education (CBME), of which the application of standard setting in assessments is an integral part. Standard setting is the process used to define an acceptable level of performance and to establish a pass score for the defined levels of performance in the competency domains assessed by an examination.

Aims: This study was designed to assess the opinions and experiences of key judges for implementation of standard setting and to outline its prospects from their perspective.

Settings and design: A descriptive cross-sectional study on the opinions, experiences and prospects for standard setting in the assessment of college examinations.

Methods: A total population survey of Faculty Officers for the year 2024.

Data analysis: Descriptive statistics using SPSS Version 27.

Results: The use of an arbitrary 50% pass mark was not supported as 80% of the respondents felt it was neither just nor equitable; 84% opined that it will not correctly separate competent from incompetent candidates and 76% felt it was not defensible. Over 90% of the respondents supported the shift to standard setting, though 31% and 51%, respectively, believed that it was difficult to implement and strenuous. Training and retraining of faculty and examiners was advocated by 98% of the respondents.

Conclusion: Standard setting is more appropriate in determining true competence than using arbitrary pass scores. Training and retraining of faculty and examiners is required to improve understanding of the process and concepts.

Introduction: Traumatic brain injury (TBI) is devastating to the victims, and an understanding of its prevalence, the demography and the causes help reduce the incidence and outcome. Adequate knowledge of such helps in developing preventive and management protocols in the region. The study aims to document the presentation and challenges of TBI in our centre.

Methods: A cross-sectional design was conducted at Lagos University Teaching Hospital, Nigeria. Only adult (≥18 years) patients were recruited consecutively from the emergency room following a diagnosis of TBI. Data were obtained with the aid of a study pro forma which recorded participants' sociodemographic information, pre-hospital indices and clinical examination/investigations. Imaging findings, surgical information and follow-up findings were also recorded. Data obtained were analysed using the IBM SPSS Statistics.

Results: A total of 125 TBI patients with male:female of 8:1 were recruited over 12 months. The mean age was 40.8 years standard deviation ± 16.86. Only 9 patients (7.2%) had health insurance. Eighty-four (67.2%) patients had TBI from road traffic accidents (RTAs). Fall from heights, assaults, industrial accidents and gunshots contributed 16%, 9.6%, 5.6% and 1.6% of patients' injuries respectively. One hundred and fourteen (91.2%) were brought to the hospital by non-healthcare workers.

Conclusion: RTAs remain the most common cause of TBI. Majority of the populace cannot afford the cost of TBI management. The scope of national health insurance needs to be broadened to help victims at the points of need.