Pub Date : 2022-04-01DOI: 10.4103/npmj.npmj_777_21
Intan Zainafree, Nadia Syukria, Silfia Addina, M. Saefurrohim
Context: Indonesia has a large population with a large number of motorised vehicles, so it cannot be separated from traffic accidents. Aims: This study aimed to determine and analyse the advanced level risk factors for road traffic accidents (RTA) in rural and urban areas based on data from the Basic Health Research 2018 (Riskesdas). Methods: This study used Riskesdas data sourced from the National Institute of Health Research and Development, Ministry of Health, Indonesia, which was collected from 34 provinces in Indonesia using a cross-sectional method. The statistical data consisted of 59,423 respondents aged over 15 years old, who had experienced a road traffic injury and lived in rural or urban areas. The data variables analysis was socio-demographic, lifestyle, smoking status, alcohol consumption, mental disorders, nutritional status and use of helmets on motorcycle riders and passengers. Statistical Analysis: Multivariate logistic regression was used to analyse the most dominant risk factors related to RTA in rural and urban areas. Results: The prevalence of RTA in urban areas was 34.1%, while in rural areas was 28.2%. The factors related to traffic accidents in respondents from urban areas (P < 0.005) were sex (1.342 [1.217–1.480]), age (1.111 [1.067–1.156]) and use of helmets on motorcycle riders and passengers (0.662 [0.566–0.771]). Meanwhile, risk factors for respondents from rural areas (P < 0.005) were mental disorders (0.842 [0.743–0.955]), age (1.095 [1.040–1.154]) and use of helmets on motorcycle riders and passengers (0.682 [0.585–0.796]). Conclusions: We found that the prevalence of RTA in urban areas was higher than in rural areas. The dominant risk factors related to RTA in Indonesia were age, sex, mental disorders and the use of helmets on motorcycle riders and passengers. This finding supports the importance of road safety education and the prevention of RTA needs to be done both in urban and rural areas.
{"title":"Risk factors of road traffic accidents in Rural and Urban areas of indonesia based on the national survey of year 2018","authors":"Intan Zainafree, Nadia Syukria, Silfia Addina, M. Saefurrohim","doi":"10.4103/npmj.npmj_777_21","DOIUrl":"https://doi.org/10.4103/npmj.npmj_777_21","url":null,"abstract":"Context: Indonesia has a large population with a large number of motorised vehicles, so it cannot be separated from traffic accidents. Aims: This study aimed to determine and analyse the advanced level risk factors for road traffic accidents (RTA) in rural and urban areas based on data from the Basic Health Research 2018 (Riskesdas). Methods: This study used Riskesdas data sourced from the National Institute of Health Research and Development, Ministry of Health, Indonesia, which was collected from 34 provinces in Indonesia using a cross-sectional method. The statistical data consisted of 59,423 respondents aged over 15 years old, who had experienced a road traffic injury and lived in rural or urban areas. The data variables analysis was socio-demographic, lifestyle, smoking status, alcohol consumption, mental disorders, nutritional status and use of helmets on motorcycle riders and passengers. Statistical Analysis: Multivariate logistic regression was used to analyse the most dominant risk factors related to RTA in rural and urban areas. Results: The prevalence of RTA in urban areas was 34.1%, while in rural areas was 28.2%. The factors related to traffic accidents in respondents from urban areas (P < 0.005) were sex (1.342 [1.217–1.480]), age (1.111 [1.067–1.156]) and use of helmets on motorcycle riders and passengers (0.662 [0.566–0.771]). Meanwhile, risk factors for respondents from rural areas (P < 0.005) were mental disorders (0.842 [0.743–0.955]), age (1.095 [1.040–1.154]) and use of helmets on motorcycle riders and passengers (0.682 [0.585–0.796]). Conclusions: We found that the prevalence of RTA in urban areas was higher than in rural areas. The dominant risk factors related to RTA in Indonesia were age, sex, mental disorders and the use of helmets on motorcycle riders and passengers. This finding supports the importance of road safety education and the prevention of RTA needs to be done both in urban and rural areas.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"29 1","pages":"82 - 88"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42336221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.4103/npmj.npmj_739_21
M. Agbaje, A. Alao, K. Owonikoko
Background: The clinical uses of ultrasonography have varied and increased over time, especially the ability of ultrasonographic measured parameters to predict the outcomes of labour. The proper understanding of the association between these ultrasonographic parameters, mode of delivery, adverse maternal and foetal outcomes will further improve patient counselling as well as the planning of intrapartum care. Aim: The study explored the ultrasonographic measurement of foetal head circumference (HC) and cheek-to-cheek diameter (CCD) at term as predictors of labour outcomes. Methodology: Eligible pregnant women at term were recruited from the antenatal clinic and had obstetric ultrasound scans done with HC and CCD measured. Maternal and foetal outcomes were measured and included progress in labour, obstetric lacerations, mode of delivery and suspected foetal distress. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20. Results: One hundred and thirty-two patients were recruited into the study. Foetal HC measurements ≥35 cm were closely associated with caesarean delivery odds ratio - 2.40 (95% confidence interval - 1.02–5.66. P = 0.046). Neither CCD nor CCD/HC ratio was predictive of the modes of delivery. The occurrence of perineal lacerations and poor progress of labour were observed more frequently with increasing HC and CCD. Conclusions: HC performed well in predicting caesarean delivery as well as perinatal outcomes among parturients. The ultrasonographic measured HC (≥35 cm) is associated with a higher incidence of both obstetric interventions for poor progress of labour and adverse perinatal outcomes in comparison to CCD. The association between HC and labour dystocia was found to be linear. The CCD did not perform well as a predictor of the mode of delivery.
{"title":"Ultrasonographic foetal head circumference and cheek-to-cheek diameter at term as predictors of labour outcomes","authors":"M. Agbaje, A. Alao, K. Owonikoko","doi":"10.4103/npmj.npmj_739_21","DOIUrl":"https://doi.org/10.4103/npmj.npmj_739_21","url":null,"abstract":"Background: The clinical uses of ultrasonography have varied and increased over time, especially the ability of ultrasonographic measured parameters to predict the outcomes of labour. The proper understanding of the association between these ultrasonographic parameters, mode of delivery, adverse maternal and foetal outcomes will further improve patient counselling as well as the planning of intrapartum care. Aim: The study explored the ultrasonographic measurement of foetal head circumference (HC) and cheek-to-cheek diameter (CCD) at term as predictors of labour outcomes. Methodology: Eligible pregnant women at term were recruited from the antenatal clinic and had obstetric ultrasound scans done with HC and CCD measured. Maternal and foetal outcomes were measured and included progress in labour, obstetric lacerations, mode of delivery and suspected foetal distress. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20. Results: One hundred and thirty-two patients were recruited into the study. Foetal HC measurements ≥35 cm were closely associated with caesarean delivery odds ratio - 2.40 (95% confidence interval - 1.02–5.66. P = 0.046). Neither CCD nor CCD/HC ratio was predictive of the modes of delivery. The occurrence of perineal lacerations and poor progress of labour were observed more frequently with increasing HC and CCD. Conclusions: HC performed well in predicting caesarean delivery as well as perinatal outcomes among parturients. The ultrasonographic measured HC (≥35 cm) is associated with a higher incidence of both obstetric interventions for poor progress of labour and adverse perinatal outcomes in comparison to CCD. The association between HC and labour dystocia was found to be linear. The CCD did not perform well as a predictor of the mode of delivery.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"29 1","pages":"123 - 130"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48437420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.4103/npmj.npmj_776_21
O. Odukoya, K. Odeyemi, O. Odubanjo, Brenda C Isikekpei, U. Igwilo, Yahaya Disu, A. Roberts, T. Olufunlayo, Y. Kuyinu, N. Ariyibi, U. Eze, T. Awoyale, Olanrewaju Ikpeekha, O. Odusanya, A. Onajole
Background: Hepatitis is one of the leading causes of morbidity and mortality, particularly in developing countries. It is often caused by hepatitis B and C, which are both preventable and treatable. Available information on Hepatitis B and C in Nigeria is based primarily on estimates obtained from specific population sub-groups or hospital-based surveys leaving gaps in population-level knowledge, attitudes, and prevalence. This study aimed to assess the knowledge, attitude and associated factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections amongst residents of Lagos State. Methodology: This was a community-based descriptive cross-sectional study carried out in all the 20 local government areas of Lagos state using a multistage sampling technique. Data were collected using pre-tested interviewer-administered questionnaires. Blood samples were taken (pinprick) from respondents (n = 4862) and tested using hepatitis B and C surface antigen tests after obtaining informed consent. Results: The overall prevalence of HBV infection in Lagos State was 2.1% while the prevalence of HCV infection was 0.1%. Only about half of all the respondents (50.9%) had heard about hepatitis B before the survey. Knowledge of the specific symptoms of HBV was also very low. For instance, only 28.1% of the respondents knew that yellowness of the eyes is associated with hepatitis while < 1% (0.1%) knew that HBV infection is associated with the passage of yellow urine. The most common source of information about hepatitis was the radio (13.0%). Only 36.2% of the respondents knew that HBV infection could be prevented. Overall, 28.8% of the respondents were aware of the hepatitis B vaccine. Less than half (40.9%) felt it was necessary to get vaccinated against HBV, however, a similar proportion (41.9%) would want to be vaccinated against HBV. Only 2.5% of all the respondents had ever received HBV vaccines while 3.5% had ever been tested for hepatitis B before this survey. There was a statistically significant association between HBV infection and respondents' use of shared clippers and work exposure involving contact with body parts and body fluids (P < 0.05). Conclusion: The knowledge, awareness and risk perception of HBV infection were low, however, almost half of the residents were willing to receive hepatitis B vaccinations if offered. It is recommended that the population-based prevention programmes and regular community-based surveillance be conducted by the public health department of Lagos State Ministry of Health. In addition, the strengthening of routine immunisation and vaccination of high-risk groups should be prioritised.
{"title":"Hepatitis B and C seroprevalence among residents in Lagos State, Nigeria: A population-based survey","authors":"O. Odukoya, K. Odeyemi, O. Odubanjo, Brenda C Isikekpei, U. Igwilo, Yahaya Disu, A. Roberts, T. Olufunlayo, Y. Kuyinu, N. Ariyibi, U. Eze, T. Awoyale, Olanrewaju Ikpeekha, O. Odusanya, A. Onajole","doi":"10.4103/npmj.npmj_776_21","DOIUrl":"https://doi.org/10.4103/npmj.npmj_776_21","url":null,"abstract":"Background: Hepatitis is one of the leading causes of morbidity and mortality, particularly in developing countries. It is often caused by hepatitis B and C, which are both preventable and treatable. Available information on Hepatitis B and C in Nigeria is based primarily on estimates obtained from specific population sub-groups or hospital-based surveys leaving gaps in population-level knowledge, attitudes, and prevalence. This study aimed to assess the knowledge, attitude and associated factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections amongst residents of Lagos State. Methodology: This was a community-based descriptive cross-sectional study carried out in all the 20 local government areas of Lagos state using a multistage sampling technique. Data were collected using pre-tested interviewer-administered questionnaires. Blood samples were taken (pinprick) from respondents (n = 4862) and tested using hepatitis B and C surface antigen tests after obtaining informed consent. Results: The overall prevalence of HBV infection in Lagos State was 2.1% while the prevalence of HCV infection was 0.1%. Only about half of all the respondents (50.9%) had heard about hepatitis B before the survey. Knowledge of the specific symptoms of HBV was also very low. For instance, only 28.1% of the respondents knew that yellowness of the eyes is associated with hepatitis while < 1% (0.1%) knew that HBV infection is associated with the passage of yellow urine. The most common source of information about hepatitis was the radio (13.0%). Only 36.2% of the respondents knew that HBV infection could be prevented. Overall, 28.8% of the respondents were aware of the hepatitis B vaccine. Less than half (40.9%) felt it was necessary to get vaccinated against HBV, however, a similar proportion (41.9%) would want to be vaccinated against HBV. Only 2.5% of all the respondents had ever received HBV vaccines while 3.5% had ever been tested for hepatitis B before this survey. There was a statistically significant association between HBV infection and respondents' use of shared clippers and work exposure involving contact with body parts and body fluids (P < 0.05). Conclusion: The knowledge, awareness and risk perception of HBV infection were low, however, almost half of the residents were willing to receive hepatitis B vaccinations if offered. It is recommended that the population-based prevention programmes and regular community-based surveillance be conducted by the public health department of Lagos State Ministry of Health. In addition, the strengthening of routine immunisation and vaccination of high-risk groups should be prioritised.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"29 1","pages":"75 - 81"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48931816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Psoriasis is a chronic inflammatory skin disease which may be associated with joint, cardiovascular, metabolic or psychiatric disease. Countries in North America, Northern Europe and Australia have the highest burden of disease while those in Asia, South America and Africa, the lowest. We report our experience of psoriasis in Kaduna, Nigeria, over 20 years and compare this with previous reports in the same area and in other parts of Nigeria and Africa. Objective: To report the relative incidence, clinical presentation, severity and associations of psoriasis seen over 20 years. Methods: A retrospective review of records of patients with psoriasis seen at two outpatient dermatology clinics in Kaduna, North-West Nigeria, over 20 years. Results: Diagnosis of psoriasis was made in 218 of 39,037 (0.6%) patients with new skin disease: Mean age 35.2 years, range (6 months to 80 years), 60% <40 years, males constituted 64.2%. Mean age of onset was 30.5 years with a quarter developing psoriasis before age 20 and 71.4% before 40 years. Psoriasis presented earlier in females than males (mean age of onset 27.6 vs. 32.2 years, P= 0.052) but was less severe. Psoriasis types were: Plaque 88.1%, guttate 6%, erythrodermic 4.6% and sebopsoriasis 0.9%. Only four patients had joint disease and other associations were infrequent. Overall, 80.3% had mild psoriasis and 13.2% had a family history. Conclusion: Psoriasis remains a rare and mild disease in Kaduna and is infrequently associated with joint and other systemic disease but similar in other respects to the condition elsewhere.
{"title":"Psoriasis in Kaduna, North-West Nigeria: A twenty-year experience","authors":"H. Yahya","doi":"10.4103/npmj.npmj_15_22","DOIUrl":"https://doi.org/10.4103/npmj.npmj_15_22","url":null,"abstract":"Background: Psoriasis is a chronic inflammatory skin disease which may be associated with joint, cardiovascular, metabolic or psychiatric disease. Countries in North America, Northern Europe and Australia have the highest burden of disease while those in Asia, South America and Africa, the lowest. We report our experience of psoriasis in Kaduna, Nigeria, over 20 years and compare this with previous reports in the same area and in other parts of Nigeria and Africa. Objective: To report the relative incidence, clinical presentation, severity and associations of psoriasis seen over 20 years. Methods: A retrospective review of records of patients with psoriasis seen at two outpatient dermatology clinics in Kaduna, North-West Nigeria, over 20 years. Results: Diagnosis of psoriasis was made in 218 of 39,037 (0.6%) patients with new skin disease: Mean age 35.2 years, range (6 months to 80 years), 60% <40 years, males constituted 64.2%. Mean age of onset was 30.5 years with a quarter developing psoriasis before age 20 and 71.4% before 40 years. Psoriasis presented earlier in females than males (mean age of onset 27.6 vs. 32.2 years, P= 0.052) but was less severe. Psoriasis types were: Plaque 88.1%, guttate 6%, erythrodermic 4.6% and sebopsoriasis 0.9%. Only four patients had joint disease and other associations were infrequent. Overall, 80.3% had mild psoriasis and 13.2% had a family history. Conclusion: Psoriasis remains a rare and mild disease in Kaduna and is infrequently associated with joint and other systemic disease but similar in other respects to the condition elsewhere.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"29 1","pages":"155 - 160"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46010920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.4103/npmj.npmj_757_21
Mesi Mathew, A. Jimoh, W. Mezue, E. Uche, M. Chikani
Background: The anterior fontanelle (AF) tension has been a traditional clinical method of indirect assessment of intracranial pressure (ICP). How does this time-tested bedside assessment technique compare with an objective ventricular cerebrospinal fluid (CSF) opening pressure? Objective: To determine the correlation of palpation anterior fontanometry and CSF opening pressure in early childhood hydrocephalus. Materials and Methods: Children diagnosed with hydrocephalus who were planned for CSF diversion using ventriculo-peritoneal (V-P) shunt were prospectively studied over 18 months. The AF tension was assessed by palpation preoperatively and graded. The CSF opening pressure was measured using sterile disposable plastic manometers after ventricular cannulation intraoperatively. Statistical Analysis: Data obtained were analysed using SPSS version 21. Student's t-test, Mann–Whitney U test and ANOVA were used to determine associations based on normality tests. A P < 0.05 was considered significant for associations. Results: Fifty-two children were operated on with AF patency rate of 88.5%. Their age ranged between 2 weeks and 18 months with a mean age of 7.1 ± 5.1 months. The fontanelle tension was tense, full and normal in 63.0%, 26.1% and 10.9% of patients, respectively. The mean CSF opening pressure of 20.5 ± 8.5 cm of H2O was higher than the expected ICP for the age group (t-test 4.754, P = 0.000). All 28 patients with CSF opening pressure >15 cm of H2O had a tense fontanelle, but 10.9% of children with raised ICP have normal AF tension. Conclusion: The mean ICP increases as palpation AF tension increases, but a normal AF tension does not rule out raised ICP.
背景:前囟门(AF)张力一直是间接评估颅内压(ICP)的传统临床方法。这种久经考验的床边评估技术与客观脑室脑脊液(CSF)开口压力相比如何?目的:探讨小儿早期脑积水触诊前颅压测量与脑脊液开口压力的相关性。材料和方法:对诊断为脑积水并计划采用脑室-腹膜(V-P)分流术进行脑脊液分流的儿童进行为期18个月的前瞻性研究。术前触诊评估心房颤动张力并分级。术中脑室插管后使用无菌一次性塑料压力计测量脑脊液开口压力。统计分析:使用SPSS 21版对所得数据进行分析。采用学生t检验、Mann-Whitney U检验和方差分析，根据正态性检验确定相关性。相关性P < 0.05被认为是显著的。结果:本组患儿52例，房颤通畅率88.5%。年龄2周至18个月，平均7.1±5.1个月。63.0%、26.1%和10.9%的患者囟门张力紧张、饱满和正常。平均脑脊液开口压20.5±8.5 cm H2O高于预期颅内压(t检验4.754,P = 0.000)。28例脑脊液开口压力bbb15cm H2O患儿均有囟门张力，但10.9%颅内压升高患儿心房张力正常。结论:平均内压随触诊AF张力升高而升高，但AF张力正常不排除ICP升高的可能。
{"title":"Correlation of palpation anterior fontanometry and cerebrospinal fluid opening pressure in early childhood hydrocephalus","authors":"Mesi Mathew, A. Jimoh, W. Mezue, E. Uche, M. Chikani","doi":"10.4103/npmj.npmj_757_21","DOIUrl":"https://doi.org/10.4103/npmj.npmj_757_21","url":null,"abstract":"Background: The anterior fontanelle (AF) tension has been a traditional clinical method of indirect assessment of intracranial pressure (ICP). How does this time-tested bedside assessment technique compare with an objective ventricular cerebrospinal fluid (CSF) opening pressure? Objective: To determine the correlation of palpation anterior fontanometry and CSF opening pressure in early childhood hydrocephalus. Materials and Methods: Children diagnosed with hydrocephalus who were planned for CSF diversion using ventriculo-peritoneal (V-P) shunt were prospectively studied over 18 months. The AF tension was assessed by palpation preoperatively and graded. The CSF opening pressure was measured using sterile disposable plastic manometers after ventricular cannulation intraoperatively. Statistical Analysis: Data obtained were analysed using SPSS version 21. Student's t-test, Mann–Whitney U test and ANOVA were used to determine associations based on normality tests. A P < 0.05 was considered significant for associations. Results: Fifty-two children were operated on with AF patency rate of 88.5%. Their age ranged between 2 weeks and 18 months with a mean age of 7.1 ± 5.1 months. The fontanelle tension was tense, full and normal in 63.0%, 26.1% and 10.9% of patients, respectively. The mean CSF opening pressure of 20.5 ± 8.5 cm of H2O was higher than the expected ICP for the age group (t-test 4.754, P = 0.000). All 28 patients with CSF opening pressure >15 cm of H2O had a tense fontanelle, but 10.9% of children with raised ICP have normal AF tension. Conclusion: The mean ICP increases as palpation AF tension increases, but a normal AF tension does not rule out raised ICP.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"94 2","pages":"151 - 154"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41331038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Congenital anomalies (CAs) refer to defects that are present in a newborn but occurred during intrauterine life. They can be due to genetic, modifiable environmental or multifactorial causes. There was no prior report of their burden in our state. Aims: This study aims to describe the incidence, spectrum, predisposing factors and outcome of CAs in our setting. Methods: It was a total population study of all neonates with major birth defects admitted into the unit during the study period. Their clinical–demographic features, diagnoses and outcome were entered into an excel sheet. Clinical detection of birth defects was based on standard diagnostic criteria. The data were analysed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Patterns and outcome of birth defects were presented as proportions. Selected characteristics were tested for possible association with birth defect using Fisher's exact test. The level of significance was set at P < 0.05. Results: The incidence of major CAs was 4.3/1000 live births. Female neonates were more affected (59.0%). Participants' mean gestational age was 37.7 ± 3.3 weeks. Central nervous system anomalies were the most common (38.5%) birth defects. These were followed by musculoskeletal, body wall and digestive system anomalies: 28.2%, 23.1% and 10.3%, respectively. One-third (33.3%) of the infants had multiple anomalies. Nearly three quarters of them (74.0%) were referred, 18.0% died while 5.0% were discharged alive. Conclusion: A wide range of CAs occur in our setting with dire consequences. Provision of relevant specialised multidisciplinary care is desirable. Furthermore, pubic enlightenment on its modifiable possible causes can reduce the burden.
背景：先天性畸形（CA）是指新生儿中存在但发生在宫内的缺陷。它们可能是由遗传、可改变的环境或多因素引起的。我们州以前没有关于他们负担的报告。目的：本研究旨在描述我们环境中CA的发病率、谱、易感因素和结果。方法：这是一项针对研究期间入住该病房的所有严重出生缺陷新生儿的总体研究。他们的临床-人口统计学特征、诊断和结果被输入到excel表中。出生缺陷的临床检测是基于标准诊断标准。使用IBM SPSS Statistics for Windows 20.0版对数据进行分析。纽约州Armonk：IBM公司将出生缺陷的模式和结果按比例表示。使用Fisher精确检验法对所选特征进行了可能与出生缺陷相关的测试。显著性水平设定为P＜0.05。结果：主要CA的发生率为4.3/1000活产。女性新生儿受影响更大（59.0%）。参与者的平均胎龄为37.7±3.3周。中枢神经系统异常是最常见的出生缺陷（38.5%）。其次是肌肉骨骼、体壁和消化系统异常：分别为28.2%、23.1%和10.3%。三分之一（33.3%）的婴儿有多种畸形。其中近四分之三（74.0%）被转诊，18.0%死亡，5.0%活着出院。结论：在我们的环境中发生了广泛的CA，后果十分严重。提供相关的专业多学科护理是可取的。此外，公众对其可改变的可能原因的启蒙可以减轻负担。
{"title":"Incidence, spectrum and outcome of congenital anomalies seen in a neonatal intensive care unit in Southern Nigeria","authors":"R. Oluwafemi, M. Abiodun","doi":"10.4103/npmj.npmj_77_19","DOIUrl":"https://doi.org/10.4103/npmj.npmj_77_19","url":null,"abstract":"Background: Congenital anomalies (CAs) refer to defects that are present in a newborn but occurred during intrauterine life. They can be due to genetic, modifiable environmental or multifactorial causes. There was no prior report of their burden in our state. Aims: This study aims to describe the incidence, spectrum, predisposing factors and outcome of CAs in our setting. Methods: It was a total population study of all neonates with major birth defects admitted into the unit during the study period. Their clinical–demographic features, diagnoses and outcome were entered into an excel sheet. Clinical detection of birth defects was based on standard diagnostic criteria. The data were analysed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Patterns and outcome of birth defects were presented as proportions. Selected characteristics were tested for possible association with birth defect using Fisher's exact test. The level of significance was set at P < 0.05. Results: The incidence of major CAs was 4.3/1000 live births. Female neonates were more affected (59.0%). Participants' mean gestational age was 37.7 ± 3.3 weeks. Central nervous system anomalies were the most common (38.5%) birth defects. These were followed by musculoskeletal, body wall and digestive system anomalies: 28.2%, 23.1% and 10.3%, respectively. One-third (33.3%) of the infants had multiple anomalies. Nearly three quarters of them (74.0%) were referred, 18.0% died while 5.0% were discharged alive. Conclusion: A wide range of CAs occur in our setting with dire consequences. Provision of relevant specialised multidisciplinary care is desirable. Furthermore, pubic enlightenment on its modifiable possible causes can reduce the burden.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"26 1","pages":"239 - 243"},"PeriodicalIF":1.1,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43730844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.4103/npmj.npmj_105_19
C. Ononuju, A. Ogbe, Lucky Changkat, B. Okwaraoha, Uzoma Chinaka
Context: Ectopic pregnancy is a common life-threatening emergency and a notable cause of maternal morbidity and mortality. Aims: This study aims to determine the prevalence of ectopic gestation, the associated risk factors, the pattern of presentation and management of ectopic pregnancy in Dalhatu Araf Specialist Hospital (DASH) Lafia. Patients and Methods: This was a retrospective study of all cases of ectopic pregnancy managed at the gynaecological unit of the DASH Lafia, North-central Nigeria from 1st January, 2013 to 31st December, 2017. The data were analysed with simple descriptive statistics and were reported as frequencies and percentages. Results: During the 5-year period, there were a total of 93 ectopic pregnancies, 10,401 deliveries and 3399 gynaecological admissions in the hospital. The prevalence of ectopic pregnancy was 0.89% of all deliveries and 2.74% of all the gynaecological admissions. The majority of the patients were in the age group of 26–30 years, and significant number of the affected them were nulliparous, 30 (32.3%). Furthermore, majority of the patients had past history of sexually transmitted diseases 48 (51.6%), multiple sexual partners 40 (43.0%) and induced abortions. Abdominal pains, amenorrhoea and vaginal bleeding were the most common presenting complaints. Unilateral salpingectomy was done for majority of the patients. Conclusions: Ectopic pregnancy is an important gynaecological challenge associated with notable morbidity. Past history of sexually transmitted diseases, multiple sexual partners and induced abortions were the associated risk factors identified, and nulliparous women were mostly affected. This can limit their future reproductive accomplishments. Targeted health education campaigns should be embarked on to enlighten this group of women and the public at large.
{"title":"Ectopic pregnancy in Dalhatu Araf Specialist Hospital Lafia Nigeria – A 5-year review","authors":"C. Ononuju, A. Ogbe, Lucky Changkat, B. Okwaraoha, Uzoma Chinaka","doi":"10.4103/npmj.npmj_105_19","DOIUrl":"https://doi.org/10.4103/npmj.npmj_105_19","url":null,"abstract":"Context: Ectopic pregnancy is a common life-threatening emergency and a notable cause of maternal morbidity and mortality. Aims: This study aims to determine the prevalence of ectopic gestation, the associated risk factors, the pattern of presentation and management of ectopic pregnancy in Dalhatu Araf Specialist Hospital (DASH) Lafia. Patients and Methods: This was a retrospective study of all cases of ectopic pregnancy managed at the gynaecological unit of the DASH Lafia, North-central Nigeria from 1st January, 2013 to 31st December, 2017. The data were analysed with simple descriptive statistics and were reported as frequencies and percentages. Results: During the 5-year period, there were a total of 93 ectopic pregnancies, 10,401 deliveries and 3399 gynaecological admissions in the hospital. The prevalence of ectopic pregnancy was 0.89% of all deliveries and 2.74% of all the gynaecological admissions. The majority of the patients were in the age group of 26–30 years, and significant number of the affected them were nulliparous, 30 (32.3%). Furthermore, majority of the patients had past history of sexually transmitted diseases 48 (51.6%), multiple sexual partners 40 (43.0%) and induced abortions. Abdominal pains, amenorrhoea and vaginal bleeding were the most common presenting complaints. Unilateral salpingectomy was done for majority of the patients. Conclusions: Ectopic pregnancy is an important gynaecological challenge associated with notable morbidity. Past history of sexually transmitted diseases, multiple sexual partners and induced abortions were the associated risk factors identified, and nulliparous women were mostly affected. This can limit their future reproductive accomplishments. Targeted health education campaigns should be embarked on to enlighten this group of women and the public at large.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"26 1","pages":"235 - 238"},"PeriodicalIF":1.1,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45135518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Ilo, Adetunji Adenekan, A. Alabi, A. Onakoya, O. Aribaba, M. Kehinde, O. Salako
Background: Knowledge of the ophthalmic manifestations of leukaemia is important not only because of the frequency with which changes are seen but because the eye often reflects the disease state of the illness, and once identified, prompt referral, early treatment can be instigated, blindness can be averted and a life may be saved. These manifestations are often overlooked because of the underestimation of the magnitude of the ocular sequelae which may be blinding. Aim: This study aims to describe the ophthalmic findings in adult leukaemic patients at two teaching hospitals in Lagos, Nigeria. Patients and Methods: This was a clinic-based, comparison multicentre study conducted at Lagos University Teaching Hospital and Lagos State University Teaching Hospital over a 9-month period of May 2012–January 2013. The cases were newly diagnosed leukaemic patients (acute and chronic) from the haematology clinics. Controls were escorts of apparently normal patients. Detailed ocular examination was carried out after written informed consent was obtained. Analysis was done using SPSS 17. Results: A total of 160 eyes in 80 individuals examined comprised forty cases and forty controls. The results of the cases were compared with the age- and sex-matched controls. Leukaemic-related ophthalmic manifestations were present in 56 eyes (70.0%) of the cases studied. Findings in cases were periorbital oedema in 8 eyes (10%), subconjunctival haemorrhage in four eyes (5%), intraretinal haemorrhage as found in 25 eyes (31.3%), retinal venous tortuosity in 21 eyes (26.3%), Roth spots in 19 eyes (23.8%) and retinal infiltrates in 17 eyes (21.3%). Conclusion: Ophthalmic disorders occur in adult patients living with leukaemia. Prompt initial and periodic ophthalmic evaluation is recommended in all leukaemic patients.
{"title":"Ocular manifestations of leukaemia: A teaching hospital experience","authors":"O. Ilo, Adetunji Adenekan, A. Alabi, A. Onakoya, O. Aribaba, M. Kehinde, O. Salako","doi":"10.4103/npmj.npmj_50_19","DOIUrl":"https://doi.org/10.4103/npmj.npmj_50_19","url":null,"abstract":"Background: Knowledge of the ophthalmic manifestations of leukaemia is important not only because of the frequency with which changes are seen but because the eye often reflects the disease state of the illness, and once identified, prompt referral, early treatment can be instigated, blindness can be averted and a life may be saved. These manifestations are often overlooked because of the underestimation of the magnitude of the ocular sequelae which may be blinding. Aim: This study aims to describe the ophthalmic findings in adult leukaemic patients at two teaching hospitals in Lagos, Nigeria. Patients and Methods: This was a clinic-based, comparison multicentre study conducted at Lagos University Teaching Hospital and Lagos State University Teaching Hospital over a 9-month period of May 2012–January 2013. The cases were newly diagnosed leukaemic patients (acute and chronic) from the haematology clinics. Controls were escorts of apparently normal patients. Detailed ocular examination was carried out after written informed consent was obtained. Analysis was done using SPSS 17. Results: A total of 160 eyes in 80 individuals examined comprised forty cases and forty controls. The results of the cases were compared with the age- and sex-matched controls. Leukaemic-related ophthalmic manifestations were present in 56 eyes (70.0%) of the cases studied. Findings in cases were periorbital oedema in 8 eyes (10%), subconjunctival haemorrhage in four eyes (5%), intraretinal haemorrhage as found in 25 eyes (31.3%), retinal venous tortuosity in 21 eyes (26.3%), Roth spots in 19 eyes (23.8%) and retinal infiltrates in 17 eyes (21.3%). Conclusion: Ophthalmic disorders occur in adult patients living with leukaemia. Prompt initial and periodic ophthalmic evaluation is recommended in all leukaemic patients.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"26 1","pages":"205 - 210"},"PeriodicalIF":1.1,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42023258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Neonatal sepsis-related mortalities are the outcome of a complex interaction of maternal–foetal colonisation, transplacental immunity and physical and cellular defence mechanisms of neonates. Objective: The objective of this study was to evaluate the risk factors of mortality in outborn neonatal sepsis. Materials and Methods: A 1-year prospective observational study was undertaken at a tertiary care centre. All referred neonates with maternal and neonatal risk factors of sepsis were enrolled. Blood culture, sepsis screen and other relevant investigations were performed. Results: The mortality rate of neonatal sepsis among outborns was 38.24%. The common presentations of these neonates were respiratory distress, lethargy and hypothermia. On univariate analysis, significant risk factors for mortality included male sex (P = 0.05), weight on admission <1500 g (P < 0.001), hypothermia (P = 0.003), respiratory distress (P = 0.04), cyanosis (P = 0.001), convulsions (P = 0.02), prolonged capillary refill time (P < 0.001), thrombocytopenia (P < 0.001), abnormal radiological finding (P = 0.01), cerebrospinal fluid cellularity (P = 0.002) and positive C-reactive protein (P < 0.001). Maternal factors such as hypertension in pregnancy (P = 0.001) and antepartum haemorrhage (P = 0.03) were associated with statistically significant mortality. Gestational age (odds ratio [OR]: 0.49, confidence interval [CI]: 0.26–0.90, P = 0.02), weight on admission (OR: 1.57, CI: 1.08–2.27, P = 0.01), age at admission (OR: 0.89, CI: 0.78–0.99, P = 0.04), distance travelled with neonate (OR: 1.01, CI: 1.00–1.01, P = 0.003), duration of hospital stay (OR: 0.69, CI: 0.63–0.74, P < 0.001), hypothermia (OR: 1.87, CI: 1.01–3.42, P = 0.04), convulsion (OR: 2.88, CI: 1.33–6.20, P = 0.007), cyanosis (OR: 2.39, CI: 1.07–5.35, P = 0.03) and prolonged capillary refill time (OR: 3.34, CI: 1.78–6.24, P < 0.001) were the independent predictors of mortality in neonatal sepsis. Conclusion: Gestational age; birth weight; long distance travelled with neonate and presentation with hypothermia, cyanosis, convulsions and prolonged capillary refill time were the independent risk factors for mortality in neonatal sepsis among outborns.
背景:新生儿败血症相关死亡是母婴定植、经胎盘免疫以及新生儿身体和细胞防御机制复杂相互作用的结果。目的:本研究的目的是评估早产新生儿败血症死亡的危险因素。材料和方法:在一家三级保健中心进行了为期1年的前瞻性观察研究。所有有产妇和新生儿脓毒症危险因素的新生儿纳入研究。进行血培养、脓毒症筛查等相关检查。结果:新生儿败血症死亡率为38.24%。这些新生儿的常见表现是呼吸窘迫、嗜睡和体温过低。在单因素分析中，死亡率的重要危险因素包括男性(P = 0.05)、入院时体重<1500 g (P < 0.001)、体温过低(P = 0.003)、呼吸窘迫(P = 0.04)、发绀(P = 0.001)、惊厥(P = 0.02)、毛细血管再灌注时间延长(P < 0.001)、血小板减少(P < 0.001)、放射学异常(P = 0.01)、脑脊液细胞结构(P = 0.002)和c反应蛋白阳性(P < 0.001)。妊娠期高血压(P = 0.001)和产前出血(P = 0.03)等母体因素与死亡率有统计学意义。胎龄(优势比[OR]: 0.49，可信区间[CI]: 0.26-0.90, P = 0.02)、入院时体重(OR: 1.57, CI: 1.08-2.27, P = 0.01)、入院时年龄(OR: 0.89, CI: 0.78-0.99, P = 0.04)、与新生儿同行距离(OR: 1.01, CI: 1.00-1.01, P = 0.003)、住院时间(OR: 0.69, CI: 0.63-0.74, P < 0.001)、体温过低(OR: 1.87, CI: 1.01 - 3.42, P = 0.04)、惊厥(OR: 2.88, CI: 1.33-6.20, P = 0.007)、发绀(OR: 2.39, CI: 0.39)。1.07-5.35, P = 0.03)和毛细血管再充盈时间延长(OR: 3.34, CI: 1.78-6.24, P < 0.001)是新生儿脓毒症死亡率的独立预测因素。结论:胎龄;出生体重;新生儿长途旅行、体温过低、发绀、惊厥和毛细血管再充血时间延长是新生儿败血症死亡的独立危险因素。
{"title":"Predictors of mortality in outborns with neonatal sepsis: A prospective observational study","authors":"R. Meshram, Vishal S Gajimwar, S. Bhongade","doi":"10.4103/npmj.npmj_91_19","DOIUrl":"https://doi.org/10.4103/npmj.npmj_91_19","url":null,"abstract":"Background: Neonatal sepsis-related mortalities are the outcome of a complex interaction of maternal–foetal colonisation, transplacental immunity and physical and cellular defence mechanisms of neonates. Objective: The objective of this study was to evaluate the risk factors of mortality in outborn neonatal sepsis. Materials and Methods: A 1-year prospective observational study was undertaken at a tertiary care centre. All referred neonates with maternal and neonatal risk factors of sepsis were enrolled. Blood culture, sepsis screen and other relevant investigations were performed. Results: The mortality rate of neonatal sepsis among outborns was 38.24%. The common presentations of these neonates were respiratory distress, lethargy and hypothermia. On univariate analysis, significant risk factors for mortality included male sex (P = 0.05), weight on admission <1500 g (P < 0.001), hypothermia (P = 0.003), respiratory distress (P = 0.04), cyanosis (P = 0.001), convulsions (P = 0.02), prolonged capillary refill time (P < 0.001), thrombocytopenia (P < 0.001), abnormal radiological finding (P = 0.01), cerebrospinal fluid cellularity (P = 0.002) and positive C-reactive protein (P < 0.001). Maternal factors such as hypertension in pregnancy (P = 0.001) and antepartum haemorrhage (P = 0.03) were associated with statistically significant mortality. Gestational age (odds ratio [OR]: 0.49, confidence interval [CI]: 0.26–0.90, P = 0.02), weight on admission (OR: 1.57, CI: 1.08–2.27, P = 0.01), age at admission (OR: 0.89, CI: 0.78–0.99, P = 0.04), distance travelled with neonate (OR: 1.01, CI: 1.00–1.01, P = 0.003), duration of hospital stay (OR: 0.69, CI: 0.63–0.74, P < 0.001), hypothermia (OR: 1.87, CI: 1.01–3.42, P = 0.04), convulsion (OR: 2.88, CI: 1.33–6.20, P = 0.007), cyanosis (OR: 2.39, CI: 1.07–5.35, P = 0.03) and prolonged capillary refill time (OR: 3.34, CI: 1.78–6.24, P < 0.001) were the independent predictors of mortality in neonatal sepsis. Conclusion: Gestational age; birth weight; long distance travelled with neonate and presentation with hypothermia, cyanosis, convulsions and prolonged capillary refill time were the independent risk factors for mortality in neonatal sepsis among outborns.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"26 1","pages":"216 - 222"},"PeriodicalIF":1.1,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43988872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Onyekwelu, O. Aribaba, K. Musa, Oluwatobi O. Idowu, M. Salami, Yvonne Odiaka
Context: Proper use of protective eyewear (PEW) is important in the prevention of occupational eye injury. Aim: The aim of this study was to determine the ocular morbidity and utilisation of PEW among carpenters in Mushin Local Government, Lagos, with a view to promoting ocular health and safety in the workplace. Subject and Methods: This was a cross-sectional study of one hundred and fourteen (114) carpenters that were enrolled into the study. Interviewer-administered questionnaires were used to collect information on socio-demographics, work-related ocular history, awareness and utilisation of, as well as barriers to utilisation of PEW. Ophthalmic examination was done. In-depth interviews were also carried out to probe the barriers to utilisation of PEW. Quantitative responses were analysed using the IBM SPSS software, and content data analysis was performed for qualitative responses. Results: The prevalence of reported work-related eye injury and complaints were 30.7% and 32.5%, respectively. The prevalence of ocular morbidity among the respondents was 74.6%. Seventy-seven respondents (67.5%) were aware of PEW; only 21.1% owned PEW, whereas the utilisation level was 26.3%. In-depth interviews revealed ignorance, forgetfulness, and unfamiliarity as the key barriers to PEW use. The odds of using PEW were about three-fold with previous eye injury at work and history of eye complaint. Conclusions: This study demonstrates a significant prevalence of ocular morbidity and poor utilisation of PEW among carpenters in Mushin, Lagos. There was a significant relationship between previous eye injury or complaint and PEW use. Thus, there is a need to create awareness among carpenters and develop occupational safety policies to improve the use of PEW.
{"title":"Ocular morbidity and utilisation of protective eyewear among carpenters in Mushin local government, Lagos, Nigeria","authors":"O. Onyekwelu, O. Aribaba, K. Musa, Oluwatobi O. Idowu, M. Salami, Yvonne Odiaka","doi":"10.4103/npmj.npmj_51_19","DOIUrl":"https://doi.org/10.4103/npmj.npmj_51_19","url":null,"abstract":"Context: Proper use of protective eyewear (PEW) is important in the prevention of occupational eye injury. Aim: The aim of this study was to determine the ocular morbidity and utilisation of PEW among carpenters in Mushin Local Government, Lagos, with a view to promoting ocular health and safety in the workplace. Subject and Methods: This was a cross-sectional study of one hundred and fourteen (114) carpenters that were enrolled into the study. Interviewer-administered questionnaires were used to collect information on socio-demographics, work-related ocular history, awareness and utilisation of, as well as barriers to utilisation of PEW. Ophthalmic examination was done. In-depth interviews were also carried out to probe the barriers to utilisation of PEW. Quantitative responses were analysed using the IBM SPSS software, and content data analysis was performed for qualitative responses. Results: The prevalence of reported work-related eye injury and complaints were 30.7% and 32.5%, respectively. The prevalence of ocular morbidity among the respondents was 74.6%. Seventy-seven respondents (67.5%) were aware of PEW; only 21.1% owned PEW, whereas the utilisation level was 26.3%. In-depth interviews revealed ignorance, forgetfulness, and unfamiliarity as the key barriers to PEW use. The odds of using PEW were about three-fold with previous eye injury at work and history of eye complaint. Conclusions: This study demonstrates a significant prevalence of ocular morbidity and poor utilisation of PEW among carpenters in Mushin, Lagos. There was a significant relationship between previous eye injury or complaint and PEW use. Thus, there is a need to create awareness among carpenters and develop occupational safety policies to improve the use of PEW.","PeriodicalId":19720,"journal":{"name":"Nigerian Postgraduate Medical Journal","volume":"26 1","pages":"199 - 204"},"PeriodicalIF":1.1,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46000339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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