West African journal of medicine最新文献

Summary/introduction: Cephalic tetanus (CT) constitutes only 1-3% of total reported tetanus cases. It is marked by flaccid paralysis of one or more cranial nerves (CN) with or without spasticity, typically following craniofacial injuries. The facial nerve is the most frequently paralyzed. Other CNs are rarely involved but mostly alongside facial nerve palsy. Broomstick injury as a portal of entry has been reported in generalized tetanus but not in CT to the best of our knowledge. Here is presented a case of CT with two peculiarities: broomstick penetrating ear trauma as a portal of entry, and an unusual onset with features of isolated glossopharyngeal and/or vagus nerve palsy.

Case report: A 30-month-old unimmunized male who one week before presentation developed sudden-onset dysphagia, drooling, nasal regurgitation, and rhinolalia. Two days later, he developed trismus and left-sided rd torticollis; on the 3 day, provoked spasms, initially of the face and neck muscles, and later including the limbs. Three weeks earlier he had accidentally injured his left ear while poking it with a broomstick. This was poorly managed at home without anti-tetanus prophylaxis. Examination revealed a conscious acutely ill child with risus sardonicus and episodic generalized spasms, more intense in the face and neck regions. Trismus/provoked spasms did not permit an objective assessment of glossopharyngeal, vagus, and hypoglossal nerves but other CNs were normal. Managed in a quiet, dark isolation room where he received IM anti-tetanus serum, staggered doses of chlorpromazine, phenobarbitone, diazepam; and metronidazole, his condition gradually improved, and was discharged after 21 days of hospitalization.

Conclusion: The rarity and sometimes unusual presentation of CT delays prompt diagnosis and early treatment leading to secondary generalization with its attendant poor outcomes. A careful history, examination, and heightened suspicion are needed. Furthermore, this report highlights ear poking, particularly with broomsticks, as a risk for CT and should be strongly discouraged.

Background: Adolescent risky sexual behaviors in Nigeria pose significant public health challenges, including unplanned pregnancies, unsafe abortions, and sexually transmitted infections (STIs). Understanding the determinants of these behaviors in urban and rural contexts is crucial for effective intervention development.

Objective: This study explored the determinants of risky sexual behaviors and access to adolescent reproductive health services (ARHS) among in-school adolescents in Enugu State, Nigeria.

Methods: A descriptive cross-sectional design with mixed methods was utilized, involving 880 adolescents aged 10-19 years from eight schools (four urban, four rural) for quantitative analysis and 80 adolescents for qualitative analysis. Data were gathered through self-administered questionnaires and focus group discussions (FGDs). Statistical analyses included descriptive statistics, chi-square tests, and logistic regression with a significance level of p<0.05.

Results: Among respondents, 420 (47.7%) reported being sexually active, with similar figures in urban (212; 48.2%) and rural (208; 47.3%) areas. The mean age for the sexual debut was identical across groups: 14.62 years (SD 1.768). The majority (85.5%) had multiple sexual partners. Condom use was low in both groups: 18.9% in urban and 9.6% in rural areas. Almost half of both groups (46.2% urban, 49.0% rural) never used condoms. Substance use was strongly associated with risky sexual practices, particularly alcohol, followed by marijuana and cigarettes. Notably, 86% of adolescents who used substances before sex did not use condoms, and 47% reported forced sex. Key determinants of risky behavior included poverty, peer pressure, and poor parental supervision. Access to ARHS was limited, with concerns about stigma and confidentiality; 57.7% lacked access, with rural adolescents facing poorer access (66.3%) than their urban counterparts (47.5%).

Conclusion: The study underscores the need for increased awareness, parental involvement, and targeted interventions to improve ARHS access and reduce risky sexual behaviors among adolescents in Enugu State.

Introduction/background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The AF Atrial Fibrillation Registry, which commenced in June 2023, was designed to provide clinical epidemiological data on patients with AF in the country.

Objective(s): The objective is to describe the rationale, design, and early findings from the registry.

Materials/methods: This is a prospective clinical registry of adult patients aged 18 years and above with AF.

Results: The registry so far included 276 patients who met the eligibility criteria. There were 146(52.8%) males (mean age-63.3(14.13) years) and 130 (47.1%) females (mean age-59.3(17.58) years) Cardiovascular risk profile of the patients with AF was cigarette smoking (current/previous 2(38 %), hypertension 203(74%), diabetes 28(10.3%), and family history of CVD 56(20.6%). The median CHADVASC score is 3(IQR - 2,4). Rate control was the most frequent management strategy. Eighty-seven (87) have completed 6 months of follow-up, 10(11%) were re-hospitalized, and 9(10.3%) died.

Conclusions: Compared to developed countries, our patients with AF are relatively young and have lower rates of diabetes mellitus but higher rates of hypertension. Rate control is the main strategy used for managing AF. Mortality is high at one year but lags behind re-hospitalization. This may provide an opportunity for intervention.

Background: Infantile colic is a commonly described symptom among mothers with different treatments given to relieve it.

Aim of the study: The study aimed to assess the knowledge and practice of infantile colic among mothers attending the Paediatrc outpatient clinic.

Methodology: It was a cross-sectional study among 327 mother-child pairs using interviewer-administered questionnaires. Data was analysed using the SPSS version 25 with statistical significance set at p <0.05.

Results: The mothers were mostly within the child-bearing age, had a tertiary level of education (69.1%), parity of two, and were presently nursing infants aged 1-12 months (69.4%). Most of them (75.6%) knew about infantile colic from parents/relatives, healthcare workers, and previous experiences. Social media accounted for less than 10% as a source of information. Forty-four percent of them had good knowledge of the clinical presentation of colic and this was significantly associated with a higher level of education and socioeconomic class. The majority of them thought colic was a physiologic process (82%) or due to gas in the intestine 142(58%). About 206 of the infants brought to the clinic had infantile colic which started at 0-4 months and resolved by 3-5 months. The most common treatment practices were the use of nospamin, prescribed mostly by healthcare workers and purchased from chemist shops.

Conclusion: There was a good knowledge of infantile colic among mothers in this study, although more than half of them gave medications to children with suspected infantile colic; the commonest being nospamin and gripe water. Health education of mothers is important to increase the practice of infantile colic and prevent the unnecessary use of medications and their potential side effects.

Introduction/background: Venous sinus thrombosis hypercoagulable states leads to delayed drainage of blood from the brain; consequently, resulting in cerebral oedema, raised intracranial pressure, or stroke. Causes are variable, including severe dehydration, infections, cancers, sinusitis, and brain surgery. The commonest symptoms are headache, seizures, and unconsciousness.

Case report: An 18-year-old male was brought unconscious to us after developing recurrent convulsive seizures the night before. His illness started 6 months ago with recurrent headaches, weight loss, and fatigue in Senegal where he was undergoing Quranic education. He returned to the Gambia, and despite several treatments, including hospitalizations and transfusion of 3 units of whole blood, analgesics, and blood tonics, symptoms persisted, until he convulsed and lost consciousness. There was no other significant past medical history of note. On presentation, he was dehydrated, malnourished, afebrile, mild pallor, anicteric; RR 22 cpm, pulse rate 110 bpm, regular and small volume, BP 113/78 mmHg; unconscious (GCS 3/15); supple neck, conjugate slowly roving eyeballs, positive Doll's eyes test, bilateral pinpoint pupils. Generalized hypotonia and hyporeflexia. The rest of the general examination was unremarkable. His hematological and clinical biochemistry investigations show normal findings. A brain CT scan revealed cerebral oedema, filling defects at the straight sinus, and multiple cerebral haematomas consistent with cerebral venous sinus thrombosis. He was immediately started on heparin but died less than 24 hours later.

Conclusion: Diagnosis requires a Brain CT of MR venography to identify filling defects. This is especially difficult in low-income countries, hence diagnosis is often missed.

Background: Colonisation precedes Staphylococcus aureus (S. aureus) infections with associated high morbidity and mortality, especially in hospitalised patients. S. aureus is the second leading cause of Hospital Acquired Infections(HAI) and death from resistant infections among hospitalised patients. Information to guide useful strategies such as decolonization proved to control S. aureus infections is not available in this setting for paediatric in-patients.

Aims and objectives: The study aimed to determine the prevalence of S. aureus; to identify the social-demographic and clinical risk factors and the susceptibility pattern of S. aureus isolates colonising the nares of paediatric in-patients at the University College Hospital, Ibadan, Nigeria.

Methodology: The study was cross-sectional, involving 385 paediatric in-patients aged less than 18 years. Nasal swab was taken from all patients within 48 hours of admission and analysed using conventional laboratory methods and the S. aureus isolates identified were further analysed using Analytical Profile Index for Staph (API Staph). Results: S. aureus carriage prevalence was 7.8% and Methicillin Resistant Staphylococcus aureus (MRSA) prevalence was 2.1%. Risk factors identified for S. aureus carriage were: skin lesions(p <0.001), eye discharge(p= 0.035), and allergy(p= 0.0038) with the absence of skin lesions protective of S. aureus carriage on multivariate analysis (OR=0.020; 95% C.I [0.007, 0.652]). S. aureus isolates showed good susceptibility to mupirocin(86.2%), clindamycin(79.3%) and cefoxitin(75.9%); fair susceptibility to genticin (65.5%) and poor susceptibility to cotrimoxazole(20.7%) and erythromycin(27.6%).

Conclusion: S. aureus carriage in this setting is 7.8% with the absence of skin lesions being protective of S. aureus carriage. The isolates showed good sensitivity to locally available antibiotics.

Background: Antiretroviral therapy (ART) remains the primary treatment for Human immunodeficiency virus (HIV) infection, aiming to reduce viral replication and mortality, but this requires lifelong adherence. To achieve viral load suppression [VLS] (below 1000 copies/ml), the World Health Organization (WHO) recommends annual viral load measurements and enhanced adherence counseling (EAC).

Objectives: This study aims to determine the prevalence of VLS following EAC amongst the virally unsuppressed PLHIV at the Rivers State University Teaching Hospital (RSUTH) and the factors influencing their virology outcomes.

Methods: A retrospective descriptive review of records of 330 virally unsuppressed PLHIV from September 2021-March 2023 at RSUTH. Sampling method: Random sampling method (table of random numbers and selecting the assigned ones till the sample size was achieved), of non-pregnant, PLHIV, aged 18 years and above with VLs >1,000 copies/ml after at least 6 months on ART and a comprehensive 3 sessions of monthly EAC support programme after which viral load estimations were done on the 4th month after EAC, to assess outcomes. Ethical approval was obtained from the RSUTH ethical committee and informed consent was received from the ART management team. Data was collated, and associations were analysed with statistical significance set at a p-value of ≤0.05 .

Results: The prevalence of VLS after EAC3 (three sessions) was 70.9%. Higher preponderances were recorded among the females (51.5%), middle-aged (73.3%), unemployed (71.1%), those on first-line ART regimen (71.3%), CD4 3 count of <200cells/mm , and statistically significant levels in those with < five years antiretroviral treatment (79.5%) with X2 = 19.418, p-value = 0.000. There were also significant logistic regression scores (4.119, p =0.042 and 41.173, p =0.000, respectively) for VLS levels after EAC2 and EAC3. Participants with an initial VL of <100,000 copies/ml recorded the highest VLS of 71.8.

Discussion: The viral load suppression rate of 70.9% after EAC3, observed in this study is consistent with results from several similar studies across sub-Saharan Africa ranging from 66.4% to 74%. This signifies a good uptake of the EAC by patients as well as good interventional outcomes.

Conclusion: Strict administration of EAC for at least three sessions with viral load monitoring is helpful in achieving viral suppression and contributes to achieving the UNAIDS 95-95-95 goals in PLHIV in Nigeria and should be intensified. Keywords: Antiretroviral therapy, Enhanced adherence counseling, Viral load suppression.

Introduction/background: Health insurance schemes make healthcare more accessible and affordable, and are essential for protecting individuals and families from the financial risks associated with medical expenses.

Objectives: This study assessed the willingness to enrol and pay for a contributory health insurance scheme and its determinants among rural and urban households in Rivers State.

Methods: Cross-sectional study, with multistage sampling to survey 1196 households across 9 Local Government Areas, 3 from each Senatorial district. Data was collected using electronic questionnaires and analysed using SPSS version 27. Approval was from the Rivers State Research Ethics Committee.

Results: Among the households, 286 (24%) resided in urban and 910 (76%) in rural areas. The average age of respondents in urban and rural areas was 45.71 ± 14.90 years and 42.53 ± 16.02 years respectively (p = 0.003). Only 121 (42.3%) of urban and 177 (19.5%) of rural households were aware of a contributory health scheme (p < 0.001). Willingness to pay was similar in urban (40.5%) and rural (37.7%) areas but 93 (87.7%) of urban and 251 (84.8%) of rural household heads were not willing to pay above 5000 naira (p=0.761). Age determined willingness to enrol in urban areas, while age, sex, and occupation were determinants in rural areas (p < 0.05).

Conclusions: There was low awareness, moderate willingness to enrol, and reluctance to pay premiums above 5,000 Naira. Age, sex, and occupation were determinants of willingness to enrol. Strengthening community engagement could improve health insurance uptake and universal health coverage in the State. Keywords: Willingness to enrol, willingness to pay, Health Insurance, Universal health coverage, Rivers State.

Background: Household Food Insecurity (HFI) is closely linked with nutritional status. The Global Report on Food Crises 2019 reported more than 113 million people face food insecurity hence the need to address Food insecurity in line with Sustainable Development Goal 2 which seeks to achieve food security and improve nutrition by 2030.

Objectives: To determine the prevalence of HFI, compare the nutritional status of children aged 6-59 months in food-secure and food-insecure households, and determine the predictors of malnutrition in food-insecure households in Yenagoa LGA, Bayelsa State.

Method: This cross -sectional study recruited 600 participants over three months (December 2022-February 2023) using a multi-stage sampling technique. An interviewer-administered questionnaire with questions on HFI adapted from the Household Food Insecurity Access Scale was used for data collection. Data analysis employed SPSS version 25 with a p-value <0.05 considered significant.

Results: The prevalence of HFI was 81.5%. A significantly higher prevalence of malnutrition was recorded among children in food-insecure (28.4%) compared to those in food-secure (13.5%) households (p=0.001). The predictors of malnutrition in food-insecure households were the mother's level of education (p=0.001), children's vaccination status (p=0.001), number of children in the household (p=0.010), hand hygiene (p=0.048), wealth index (p=0.010), age of the child(p=0.004) and presence of fever in the preceding two weeks to the study(p=0.005).

Conclusion: Because household food insecurity contributes significantly to malnutrition among children aged 6-59 months, the study recommends institutionalization of efforts to improve HFI through nutrition-specific and sensitive interventions.

Background: Continuous evidence-based research is crucial in medical education, guiding clinical practice and informing healthcare policy. It is a core pillar of postgraduate academia. Despite the need to generate and disseminate quality scientific evidence, there is a significant disparity in research engagement and publication rates, with a small fraction of scholars contributing the majority of publications. This imbalance is particularly evident in regions like Nigeria, where health research output and its translation into policy fall short of expectations.

Aim: This study aimed to assess research engagement, and productivity, and to identify associated factors and challenges influencing publication among postgraduate doctors at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.

Methodology: A cross-sectional descriptive study involving 241 postgraduate doctors affiliated with UNTH was conducted. Data were collected using a quantitative electronic self-administered survey tool, which gathered information on participants' sociodemographic profiles, research activities, factors enabling publication success, and encountered challenges. Data analysis was performed using SPSS Version 23.0, with Pearson correlation employed to examine associations between research productivity and variables such as age, years of academic experience, and professional level.

Results: The findings revealed that 88.4% of respondents had engaged in research, but only 54.9% had successfully published their work. Significant barriers to research productivity included time constraints, poor mentorship, inadequate funding, and insufficient research writing skills, poor institutional support and infrastructures. Positive correlations were observed between research output and factors like age, professional experience, and years in academia, indicating that seniority positively influences research productivity.

Conclusion: This study highlights the need for improved mentorship, grant-writing support, and institutional resources to enhance research productivity among postgraduate doctors in Nigeria.