West African journal of medicine最新文献

Background: There has been little or no cross-cultural validation study of the Maslach Burnout Inventory (MBI) from sub-Saharan Africa (SSA). This study aims to test three hypotheses among medical students in four selected countries - Ghana, Nigeria, Sierra Leone and Uganda in sub-Saharan Africa (SSA).

Method: This research utilized a cross-sectional design and employed an online self-administered questionnaire. The measurement of burnout was conducted utilizing the Maslach Burnout Inventory General Survey for Students (MBI-GS (S) on Google Form. The survey was distributed via WhatsApp to medical students enrolled in six medical schools across four countries. The statistical analysis was conducted using SPSS AMOS version 24 for Confirmatory Factor Analysis (CFA) with Structural Equation Modelling (SEM).

Result: The prevalence of burnout varied among the medical students in the four countries with Ghana (72.1%) and Nigeria (61.2%) higher than Sierra Leone (59.2%) and Uganda (47.7%). Confirmatory factor analysis showed that the 3-factor structure of the MBI-GS(S) fits both the overall sample and the samples from each of the four individual countries albeit after correlating error terms in the analysis. However, hypothesis 2, which posited structural invariance across the samples from the four countries, was only partially met as the model demonstrated configural invariance across the samples but not metric invariance.

Conclusion: The results of our study provide empirical evidence supporting the presence of burnout among medical students, revealing significant disparities across the participating countries. While the MBI-GS (S) proved to be a useful tool for this assessment, our findings also highlight the challenges of achieving measurement invariance in cross-cultural research, underscoring the need for culturally adaptable methodologies.

Background: Chronic suppurative otitis media is a serious health care concern in sub-Saharan Africa. Poverty, ignorance, and non-availability of surgical treatment techniques militate against its effective management.

Methods: A retrospective descriptive study conducted at UNIOSUN Teaching Hospital, Osogbo on patients with CSOM over five years.

Results: A total of 428 patients consisting of 232 males and 196 females with age ranged from 1 - 83 years. Children 1-15 years constituted the largest (54.2%) proportion. RCSOM (37.4%), LCSOM (29.9%) and bilateral CSOM (32.7%). Majority (51.4%) had discharge for more than 2 years. Most patients 208 (48.6%) had moderate size perforations and majority (93.5%) were central perforations. Culture results showed pseudomonas 24.3% and staphylococcus aureus 24.3% as the most common organisms isolated. PTA of 152 patients (reviewed) showed that 36.8% had moderate degree of HL and severe degree HL in 26.3%. Ninety four (61.8%) had conductive hearing loss. Hearing loss was significantly associated with the size of perforation (p = 0.001) and duration of ear discharge (p = 0.022). About 99% of patients were managed conservatively with topical ear drops/ dressing with wick gauze impregnated with ciprofloxacin ear drops. Five patients (1.17 %) had tympanoplasty, six (1.40%) had cortical mastoidectomy and 2 (0.47%) patients died secondary to intracranial complications.

Conclusion: Challenges militating against effective management of CSOM in Nigeria include poverty, delayed presentation, few tympanomastoid surgical experts and poor attitude toward surgical procedures. Public enlightenment including early presentation of patients, provision of adequate equipment and focused attention on appropriate surgical techniques should be embarked upon urgently.

Background: Stroke remains one of the leading causes of disability worldwide. Arm function recovery is essential for stroke survivors' ability to perform activities associated with daily living. Consequently, impairment in arm function is a significant target for stroke survivors' physical or robotic rehabilitation. This study aims to explore the barriers and facilitators to the implementation of a robotic rehabilitation programme for stroke survivors in a resource-poor setting.

Methods: A cross-sectional design with a qualitative approach was chosen. A semi-structured, interview-based questionnaire was administered and data were collected from stroke survivors presenting at the adult neurology clinic of two tertiary institutions in Nigeria. Data from the interview-based questionnaire were analyzed using descriptive statistics.

Results: A total of 52 stroke survivors participated and were interviewed. More than half (55.8%) of the respondents were elderly, with a male-to-female ratio of 1.6:1. Majority of respondents (58%) had no idea about the use of robotics for stroke rehabilitation. About 44% of the respondents believe that the major determinant of interest in robotics will be favourable outcome after trials on other participants. Lack of financial support and transportation aid constitute barriers, while creation of awareness and the availability of transportation aid from home to hospital were the major facilitators to participation.

Conclusion: These findings highlight the fact that most stroke survivors in the resource-poor setting were not aware of the usefulness of robotics in stroke rehabilitation. Hence, increasing knowledge and creating awareness about robotic rehabilitation will make it more readily acceptable for stroke survivors. KEYWORDS: Barrier, Facilitator, Robotic rehabilitation, Stroke survivors, Implementation.

Background: The application of artificial intelligence (AI) in medical practice is attracting attention in various aspects of disease management. Currently, many doctors lack a basic understanding of this data-driven innovation and are unaware of its potential applications in the field of medicine. This review thus aims to provide an introductory insight into AI, the basic concepts of AI and how it is applicable to medical practice.

Methods: We reviewed the concept of AI by elucidating its fundamental principles and applications in medical practice. Literature searches were conducted on AI using PubMed, Scopus, Google Scholar, and MEDLINE. The search keywords included artificial intelligence, machine learning, AI algorithm, medical application of AI, and the future of AI in medical practice.

Results: Ninety-four articles were initially reviewed, but only 71 met the inclusion criteria. The application of AI in medicine is growing across various aspects of disease management for cancerous and non-cancerous conditions. It has been used for complex procedures, such as robot-assisted surgery, in managing medical information and data, in predictive and precision medicine, and in clinical research.

Conclusion: AI is rapidly transforming the future of human endeavours, and the healthcare community is no exception, with its potential to revolutionise medicine. Incorporating AI into healthcare should be considered a necessity, not just an option. We cannot afford to be passive observers, waiting for others to take the lead.

Background: Neonatal sepsis (NNS) contributes significantly to morbidity and mortality among newborns, especially in developing countries. Early identification of risk factors is crucial for prompt diagnosis and treatment. This study aimed to investigate utility of serial C-reactive protein (CRP) and blood culture in the diagnosis of neonatal sepsis (NNS) among babies with risk factors for sepsis.

Methodology: All consecutive term babies with maternal and/or neonatal risk factors for sepsis with or without initial symptoms were studied. Blood culture was done for all the participants. The CRP I was done at admission, CRP II at 48 hours and CRP III at 72 hours (a total of 3 samples). The value of CRP ≥10mg/l was considered abnormal.

Results: Of 106 participants, 35 (33%) had positive blood cultures, with Staphylococcus aureus being the prevalent organism. The sensitivity of CRP at the cut off ≥10mg/l was 60%, 69.7%, and 66.7% for CRP I, CRP II and CRP III, with negative predictive value (NPV) of 73.6%,72.2% and 73.8%, respectively. Abnormal temperature, respiratory distress and convulsion at presentation were significantly associated with positive blood culture (p= 0.002, 0.014 and 0.009, respectively). Logistic regression identified abnormal temperature and delivery outside the hospital facility as being significantly related to elevated CRP values (p= 0.027, 0.016).

Conclusion: These findings highlight the importance of utilization of serial CRP tests in the early detection of sepsis in neonates with risk factors.

Background: Obstetric-related venous thromboembolism (VTE) is common in Africa. However, management has remained suboptimal. Evaluating its epidemiology will aid policy decisions.

Aim: To evaluate the prevalence, mortality rate and risk factors of obstetrics-related venous thromboembolism in Africa.

Search strategy: We searched four databases namely MEDLINE, PubMed, CINAHL, and Academic Search Complete.

Data collection and selection: We undertook independent screening to identify relevant articles. Only peer-reviewed articles written and published in English were included.

Data analysis: We fitted a random-effect model to estimate the pooled prevalence and mortality rates, with I2 computed to estimate the degree of heterogeneity.

Result: Prevalence of obstetrics-related VTE varied between 2 (per 100,000 deliveries) in 2000 and 248 (per 100,000 births) in 2020. The pooled prevalence was 17 per 100,000 births (95% CI 6-480/100,000 births). Two most important risk factors were immobilization/prolonged travel (OR=2.5 [95% CI 1.4 - 4.5] to 18 (95% CI 2.3-137) and oral contraceptive (OR=15.9, [95% CI 1.9-133.1]). VTE-related maternal mortality ranged from 33 to 286 per 100,000 live births.

Conclusion: Moving from 2000 to 2020, there is an increasing trend in the prevalence of obstetrics-related VTE and associated maternal mortality in Africa. The strength of risk factors of obstetrics-related VTE in Africa may not follow a global risk stratification pattern.

Background: Serum biomarkers, such as glial fibrillary acidic protein (GFAP), have been proposed to accurately assess stroke severity and prognosis. However, there is limited published data on their potential role in resource-limited settings where the stroke burden is highest.

Objective: The study aims to determine the predictive value of the serum level of GFAP in assessing the severity and functional outcome of acute stroke.

Method: This prospective cohort study recruited forty consecutively presenting stroke subjects each for both ischaemic stroke and intracerebral haemorrhage at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife with forty apparently healthy controls. Serum concentrations of GFAP were measured using Enzyme-Linked Immunoassays, and the data were analyzed using Statistical Package for the Social Sciences software with significance at p<0.05.

Result: The median serum GFAP levels among apparently healthy controls, ischaemic stroke group and the ICH group at admission were 18.04 pg/ml, 24.10 pg/ml, and 33.33 pg/ml respectively. At admission, there was a significant difference in the median serum GFAP level in the ICH and apparently healthy control group as well as in the ischaemic stroke group and apparently healthy control group (p = 0.001). The study found no significant correlation between admission NIHSS and serum GFAP levels in both the ischaemic stroke group and the ICH group. In the ICH group, there was an inverse correlation between median serum GFAP level at day 7 and Barthel index at day 7 (p = 0.021) and day 30 (p = 0.001), but a positive correlation with modified Rankin score at day 30 (p = 0.001).

Conclusion: The study found that routine screening for serum GFAP level at admission in ischaemic stroke and ICH does not predict acute stroke severity and does not correlate with functional outcomes. However, Serum GFAP level at day 7 correlated with 30-day functional outcomes for ICH and its usefulness may be explored further in larger studies.

Background/purpose: Chronic Hepatitis B is a global health challenge which has persisted despite universal vaccination against Hepatitis B. The relationship between hepatitis B virus infection and Non-alcoholic Fatty disease (NAFLD) remains unclear thus, a review was carried out to elucidate the nature of the relationship existing between them and the risk factors for this interrelation.

Data source and selection: The accepted guideline for a systematic review was followed. English language-based studies on hepatitis B and NAFLD in adult populations between 2010 -2021 were sourced from CINHAL, PubMed, Medline, Scopus, google scholar and ScienceDirect database.

Data extraction: Following the PICO format, studies which met the inclusion criteria were identified and selected on a Prisma chart. They were further assessed using the modified Newcastle-Ottawa score for the assessment of non-randomized studies.

Result: 11 out of 12,380 studies obtained from multiple databases were included in the review comprising of 128,566 controls and 5177 cases. The relationship between exposure to hepatitis B infection and NAFLD outcome was aggravating, ameliorating and non-existent in six, four and one study respectively. Risk factors for NAFLD identified include metabolic factors such as increased body mass index, hyperglycaemia, raised triglycerides, metabolic syndrome, hyperuricemia and the presence of hepatitis B HBx protein.

Conclusion: NAFLD is most likely to occur in HBV patients in the presence of host metabolic factors.