West African journal of medicine最新文献

Background: Low-and middle-income countries (LMICs) face many challenges regarding the timely management of STEMI, and the COVID-19 pandemic has impacted our already fragile health systems.

Objectives: To assess the delays in managing STEMI during COVID-19 and evaluate the 6-month mortality rates related to these delays.

Methods: A retrospective cross-sectional study was conducted over two years at a tertiary center in Dakar, Senegal. All patients referred for STEMI during the study period were included. Statistical analysis was performed using R, version 4.4.0.

Results: During the study period, 273 patients were enrolled (65.9% males, mean age: 59 ± 12.4). Diabetes Mellitus was present in 37.7% of cases. Only 1 out of 5 patients (20.5%) reached medical attention within 1 hour after symptoms onset, and the time from first medical contact to ECG was < 10 minutes in 39 % of cases. Primary PCI within the first 24 hours was performed in 23.5% of cases. Factors significantly associated with late hospital admission (<12h) were first medical contact < 1h (P 0.0009, OR: 4.06 95% CI; 1.8-9.64), time to first ECG < 10 minutes (P 0.002, OR: 2.79 95% CI; 1.45-5.41) and number of facilities visited < 2 (P 0.004, OR: 3.4 95% CI 1.51-8.22). The 6-month mortality rate was 18.7%.

Conclusion: Our study found persisting delays in STEMI management in Senegal. Establishing a standard of care for STEMI in Senegal is mandatory to overcome healthcare system weaknesses and improve the outcomes of our STEMI patients.

Background: The first line of care is a paramount stage in the management of the mentally ill persons. In Nigeria, traditional and faith-based healers compete with medical professionals in providing care.

Aim: Pathway to care among patients with Mental Illness at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

Materials and methods: The characteristics of the patients and their pathways to care were assessed using a questionnaire specifically designed by the researchers, based on previous studies. A total of 270 participants were recruited over three months using a convenience sampling technique. Data analysis was performed using SPSS version 25. Chi-square tests were applied to examine associations, with significance set at P-values less than 0.05. Binary logistic regression was used to identify determinants of the pathway to care.

Results: A Few respondents (15.9%) had consulted a psychiatrist and at least 3.6 (SD ± 6.0) non-medical healers were consulted before seeing a psychiatrist. There was a statistically significant association between the pathway to care and the level of education (p = 0.047), ethnicity (p = 0.001), religion (p < 0.001), diagnosis (p = 0.002), and family history of mental illness (p = 0.002). However, religion, family history of mental illness, and diagnosis emerged as determinants of the pathway to care.

Conclusion: The use of alternative medicine in the management of mentally ill persons is still more common than orthodox care in our environment, highlighting the need for further advocacy.

Background: Understanding morbidity and mortality patterns among older adults is crucial for effective healthcare planning for Nigeria's aging population. This study aimed to determine the prevalence of mortality, assess morbidities, and identify mortality predictors among inpatient older adults managed by the Geriatric team of National Hospital Abuja.

Methods: A retrospective analysis of 110 inpatients aged ≥ 60 years was conducted. Demographic data, diagnoses, length of stay, and outcomes were analyzed using descriptive statistics.

Results: The mean age was 76.71 ± 9.44 years, with equal gender distribution. Mortality prevalence was 27.3%. The most common morbidities were hypertension (56.4%), sepsis (50.0%), delirium (46.4%), diabetes (35.5%), and dementia (29.1%). The mean hospital stay was 15.88 ± 12.18 days. Acute renal failure was significantly associated with mortality (p = 0.042) and emerged as the strongest predictor (Adjusted OR = 3.232, 95% CI: 1.080 - 9.668p = 0.036). Age, gender, and length of stay were not significant predictors of mortality.

Conclusion: This study reveals a considerable mortality rate and a high prevalence of multi-morbidity among hospitalized older adults. Renal failure was the strongest mortality predictor, while hypertension, sepsis, and delirium were the common morbidities. Recommendations: Develop specialized geriatric care protocols, that include optimal management of prevalent conditions and routine renal function screening. These findings provide valuable insights for improving healthcare delivery for hospitalized older adults in Nigeria.

Background: Sexual and Reproductive Health (SRH) is crucial for overall well-being, yet persons with disabilities (PWDs), especially women, encounter significant challenges in accessing SRH services, impacting their quality of life.

Objectives: To assess the awareness, patterns, barriers, perceived enablers and predictors of utilization of SRH services among women with disabilities in Lagos, Nigeria.

Methods: This was an analytical cross-sectional study involving 231 women of reproductive age with disabilities who were recruited through snowball sampling. Data were collected using semi-structured questionnaires and analyzed with SPSS version 21. Descriptive statistics summarized socio-demographic, economic, and disability-related variables. Pearson Chi-squared and logistic regression analyzed associations and predictors of use, with statistical significance set at p<0.05.

Results: The mean age was 32.2 ± 8.5 years; 39.4% had secondary education and 48.5% were unmarried. High awareness of SRH services was reported (93.3%), with 64.9% having utilized SRH services, mainly pregnancy testing (65.3%) and HIV counseling and testing (57.3%). The main barriers were treatment costs (80.7%), difficulty in physical access to health facilities (53.3%), long wait times (47.3%), and negative attitude of health workers (42%). Perceived enablers include subsidized treatment, improved transport, and reduced wait times. Predictors of utilization of SRH services include adult-onset disability compared to pre-adulthood (AOR=432.708, 95% CI=22.392, 8361.882), being physically disabled (AOR=0.140, 95% CI=0.033, 0.586), and having a hearing impairment (AOR=0.124, 95% CI=0.017, 0.903) compared to visual impairment.

Conclusion: Despite high awareness, women with disabilities face barriers to accessing SRH services due to costs, accessibility issues, and long waiting times. The health system in collaboration with other relevant sectors should implement interventions to ensure adequate inclusion to improve their access and utilization of SRH services, in addition to improving the QoC.

Introduction: The increasing incidence and high mortality of colorectal cancer (CRC) make it a major public health concern in developing countries.

Objective: The aim of this work was to study the epidemiological, diagnostic, therapeutic, and prognostic aspects of colorectal cancers from 2013 to 2023 in Cotonou.

Methods: This was a descriptive, analytical study with retrospective data collection, covering CRC patients managed in specialized centers in Cotonou (university clinics of visceral surgery, internal medicine and hepatogastroenterology at CNHU-HKM and the Cotonou Cancer Center).

Results: Total of 194 CRC cases were identified out of 13857 patients seen during the study period (1.4%), with a peak incidence in 2023. The median age was 53, with an interquartile range of [64-40]; 25% of subjects were under 40. The sex ratio was 1.3 (110 men and 84 women). The median time to diagnosis was 8.4 months. Constipation (78.8%), abdominal pain (71.5%), and haematochezia (61.8%) were the main clinical presentation, and occlusive forms in 27.5%. Tumor location was recto-sigmoid in 51.5%. CRC was stage III or IV in 60.4%, with 38.7% metastases. The main treatments applied were curative surgery (8.3%), palliative surgery (68.8%) and palliative chemotherapy (68.8%). Median overall survival was 22.5 months, with a 5-year survival rate of 5%. Factors predictive of death were duration of progression before diagnosis (p<0.001), World Health Organization performance status index (p=0.001), and absence of chemotherapy treatment (p=0.026).

Conclusion: CRC is increasingly common in Cotonou, and has a very poor prognosis. Early diagnosis and appropriate treatment could improve prognosis.

Background: Asthma control is critical in reducing morbidity and improving quality of life, yet, many patients struggle with accurately assessing their own asthma control. Current evidence suggests that many patients may overestimate their level of control causing discrepancies between patients' self-perception and clinical measures, such as those defined by the Global Initiative for Asthma (GINA). Understanding these differences is essential for optimizing asthma management in specialist clinics.

Objective: This study aims to compare self-perceived asthma control with GINA-defined standards to highlight gaps and improve patients' outcomes in Nigeria.

Methods: It was a cross-sectional study, 100 asthmatic patients in a tertiary teaching hospital were recruited consecutively [79% females, age 38.1±14.6 years]. The chi-square test of association was used to determine the relationship between perception of asthma control and actual test scores of controls as defined by GINA.

Results: The association between respondents' perception of their asthma control and GINA-defined control was 2 = statistically significant (ꭓ 43.876, p = 0.001). Of the 19 participants categorized by GINA as well controlled,18(94.7%) regarded themselves as being well controlled whereas 1(5.3%) assessed symptoms as partly controlled. For the GINA partly controlled category 13(40.6%) appropriately graded their control as partly controlled while in the uncontrolled group, 22(44.9%) assessed their symptoms as uncontrolled.

Conclusions: Overall, the patients showed a good perception of their disease in comparison with GINA-defined criteria. However, the percentage was higher among those with well-controlled asthma compared with the other categories. This finding emphasises the need for continuous patient education.

Introduction: Co-infection of malaria and intestinal parasitosis is the concomitant presence of two parasite species in a single human host; it is more frequent in children in many parts of the world. The objective of this study was to describe the co-infection of malaria and intestinal parasitosis in children in the health district of Kloto.

Methods: This was a prospective cross-sectional study conducted over a period of four (04) months, from February 8 to May 10, in rural health centers with laboratory facilities in the Kloto sanitary district. Data were collected using a questionnaire.

Results: We had a total of 23 cases of co-infection out of a total of 299 children with a positive GE or a positive TDR, i.e. a percentage of seven point seven of co-infection (7.7%) with a confidence interval (95%) of 5.0-11.5. We note a predominance of the [12,59] age group, with ten (10) children out of twenty-three (23) co-infected, i.e. forty-three-point five percent (43.5%). Five (05) different species ofintestinal parasites were found, namely Entamoeba hystolitica (64.6%), budding yeasts (14.6%), Trichomonas intestinalis (10.4%), Enterobius vermiculais (4.2%) and Taenia sanginata (2.1%).

Conclusions: These results show that parasitic co-infection is common among rural children in the Kloto district, especially in the 12-59-month age group, who are the most vulnerable due to their young age.

Introduction: Breastfeeding is a well-established intervention for the improvement of child survival. Although breastfeeding is associated with multiple health and economic benefits for mothers children and society, the recommended breastfeeding rate is low worldwide.

Objective: This study aimed to determine the sociodemographic predictors of EBF among breastfeeding mothers attending the immunization clinic of ATBUTH, Bauchi.

Methods: A descriptive cross-sectional study was carried out among 420 mother-child dyads attending the immunization clinic. Participants were selected through a systematic random sampling. The rate of exclusive breastfeeding and early initiation of breastfeeding were measured using the WHO 24-hour recall, while the sociodemographic data were collected using a pretested, interviewer-administered questionnaire. Descriptive statistics, Chi-square, and binary logistic regression were used for analysis at p<0.05.

Results: The mean age of the respondents was 28.5 ± 6.2 years, more than half were full-time housewives. The majority were Muslims, and 97.6% of the respondents had some level of formal education. The rate of exclusive breastfeeding (EBF) was 46.7%. Predictors of EBF were mothers' age (p= 0.001), and mothers' level of education (p= 0.04).

Conclusion: The rate of EBF as compared to the WHO target is still low. More needs to be done in terms of education, health advocacy, and policy as well as family and social support, to ensure the practice of EBF is improved.