West African journal of medicine最新文献

Introduction: The pneumopediatrics consultation started at CHU-MEL in 2018; follow-up of asthmatic children is a major focus.

Objective: To assess the impact of follow-up on asthma disease control.

Method: This was a prospective cohort study with descriptive and analytical aims from October 2019 to October 2021. All children between three and seventeen years old with a confirmed diagnosis of asthma were included. Those lost to follow-up after the first consultation were excluded and the presence of another associated respiratory or cardiac pathology was also a non-inclusion criterion. GINA 2019 recommendations were used as a reference.

Results: Over the study period, 47 children were included, aged between three and twelve years. The age group most represented at the start of follow-up was under six, with a sex ratio of 0.88. According to the GINA classification, 53.19% of patients had moderate persistent asthma. The majority of children were receiving GINA 2019 level 3 background therapy. Evaluated in 31 patients, follow-up was regular in 22 and asthma was controlled in 16 patients, eight of whom were partly controlled. Factors associated with asthma control were parental history of asthma (p=0.021), regularity of follow-up (p=0.002), and compliance with background treatment (p= 0.009).

Conclusion: Follow-up of children with asthma in the pneumopediatrics (paediatric respirology) department is most likely to have a positive effect on disease control. Patient retention needs to be improved.

Introduction: Malaria resulting from the bites of female Anopheles mosquitoes, is a major cause of childhood morbidity and mortality in Sub-Saharan countries. It is preventable by using malaria vector control strategies like insecticide-treated nets (ITN) and indoor residual spraying (IRS).

Objectives: This study was carried out to determine the proportion of children in Borokiri Sandfield using ITN and IRS as malaria vector control strategies and the sociodemographic factors associated with its use.

Methods: A cross-sectional study was carried out in Borokiri Sandfield, Port Harcourt, in an outreach program. We collected data on the sociodemographic characteristics of children seen in the outreach, the use of ITN and IRS, and malaria testing performed using the Rapid Diagnostic Test. Data analysis was by SPPS 23 and statistical significance set at P value < 0.05.

Results: A total of 207 children from 207 households, aged 0-17 years with 109 (52.7%) females participated in this study. The average household size was 5.1±1.5 persons. Fifteen (7.2%) had positive malaria parasite test. A total of 140 (67.6%) children used malaria vector control strategies, 106 (51.2%) used ITN, 91 (44%) IRS and 52 (25.1%) used both. The use of ITN was significantly more among smaller households of 3-4 persons while female gender and small household size were significantly associated with the use of IRS. Malaria parasitemia was more prevalent among children of households not using malaria vector control measures.

Conclusion: The use of malaria vector control strategies in this study is commendable, but can be improved by public enlightenment programs.

Background: Schizophrenia is a severe psychiatric condition with cognitive symptoms infrequently assessed clinically, yet, they impact the functioning of patients. Cognitive impairments have been found more in unaffected relatives of patients with schizophrenia, compared to healthy controls, suggesting them as endophenotypes of schizophrenia. There are few studies in Nigeria and Africa on these.

Objective: To assess cognitive functioning and its correlates in patients with schizophrenia, their first-degree relatives, and healthy controls.

Methods: 120 participants in each of the three groups were matched accordingly and assessed with the Brief Assessment of Cognition in Schizophrenia (BACS), Observable Social Cognition: A Rating Scale (OSCARS), Brief Negative Symptom Scale (BNSS), and other clinical scales. Standardized z-scores were calculated as appropriate.

Results: Patients had significantly greater cognitive impairment (p < 0.001) and poorer functioning (p < 0.001) compared to the other two groups. Relatives had worse cognitive impairment than controls, without a significant difference between them. Prevalence of cognitive impairment was 68.3%, 32.5%, and 28.3% for patients, relatives, and controls respectively (p ≤ 0.001). Worse patient clinical state, including negative symptoms and use of anticholinergics, were associated with poorer cognitive performance.

Conclusions: This study provided needed Nigerian data on cognitive function using standard brief instruments. The results affirm cognitive deficits as significant symptoms in patients with schizophrenia and also as possible endophenotypes of the disorder. Modifiable correlates of cognitive impairment were identified. More routine clinical assessment of cognitive function and research for possible treatments for cognitive impairments are necessary. Continued search for endophenotypes or other predictors of individuals at risk of schizophrenia should be encouraged.

Summary/introduction: Velopharyngeal incompetence(VPI) is the failure of closure of the velopharyngeal sphincter, which consists of the muscles of the soft palate and the superior pharyngeal constrictor, and functions to separate the nasopharynx and oropharynx during phonation and swallowing. VPI is most frequently congenital/syndromic (with structural deficit) but can be acquired. A subset of acquired VPI, occurring in structurally intact velopharynx, has been described in children, and these are isolated and acute-onset, with a substantial proportion thought to have an infectious origin. So far measles was identified to be the aetiology in one reported case. This report aims to create awareness that VPI could be a rare post-measles complication.

Case report: A two-year-old female who, two weeks after a measles episode, developed sudden-onset nasal regurgitation, rhinolalia, and dysphagia. She had never experienced these symptoms before and has not had any recent throat surgeries. The review of systems was not contributory. On examination, she was ill-looking with no dysmorphic features; was not febrile or pale, and had generalized brownish-scaly, desquamating skin lesions. Nasal regurgitation of liquids was observed when she drank. Oral/oropharyngeal examination revealed no structural defects but she had absent gag reflex with bilateral palatal paralysis (indicating Glossopharyngeal and Vagus nerve palsies). All other neurological and systemic findings were normal. Management was conservative with a Nasogastric tube for feeding. She made a complete recovery with total restoration of neurologic functions after 21 days. Six-month follow-up revealed no recurrence or signs of progression.

Conclusion: This report adds to the evidence that measles is one of the infectious causes of acute-onset isolated VPI. The proposed mechanisms underlying this unusual manifestation of measles are direct viral neuronal injury given its neurotropic nature; and autoimmune neuronal injury. The reason for the rarity of this post-measles complication despite the high incidence of measles remains to be elucidated.

Introduction: Growth restriction has been associated with the risk of none communicable disease. Many anthropometric determinants like birth weight, birth length, and pondoral Index, are related to maternal suboptimal nutrition and infants' deficiency of some essential heavy metals.

Objective: The specific objective of this study is to determine the extent of toxic metals in the cord blood, birth outcomes, and their effect on the biophysical profiles of neonates.

Methods: The cord blood of 30 preterm, 30 term newborns, and 60 maternal veinous blood were analysed using an Atomic Absorption Spectrometer (Analyst 200 Perkin-Elmer, USA). Metals such as aluminum, antimony, arsenic, cadmium, lead, and mercury were determined by measuring the levels of these metals in cord blood and maternal blood respectively.

Results: Findings thus suggest that preterms are particularly susceptible to toxicity on somatic parameters.

Conclusions: Therefore, safety measures should be taken to prevent human contamination and exposure during pregnancy.

Background: Sexual abuse among adolescents is a serious public health problem. It is a developmental stressor/ reality that remains a cause for concern to parents, teachers, and governments of nations with profound, long-term physiologic and psychosocial effects.

Objective: To determine and compare the prevalence, types, and predictors of sexual abuse among in-school adolescent students in urban and rural areas of Akwa Ibom State, Nigeria.

Methods: This was an analytical cross-sectional comparative study with 740 public senior secondary students from 4 selected rural and urban schools. A self-administered, semi-structured questionnaire was used for data collection. Data analysis was carried out with Statistical Package for Social Sciences version 25 software. Logistic regression analysis was used to determine the predictors of unwanted sexual experiences and statistical significance was set at p-value≤0.05.

Results: The mean age was 17.0 ± 1.52 years for urban compared to 16.0 ± 1.19 years for rural (p<0.001). The overall prevalence of unwanted sexual experiences was 60.9% (p<0.001). Types of unwanted sexual experiences included verbal abuse, (35.9% rural, 34.3% urban), breast caressing (23.8% urban, 17.3% rural), kissing (20.5% rural, 19.8% urban), genital touching (18.1% urban, 16.2% rural), pornography (33.0% urban, 25.9% rural), unwilling intercourse (70.4% urban,76.9% rural). Predictors among rural were monetary gain (OR=4.00; 95% CI: 2.549-6.275), peer pressure (OR=2.666; CI:1.729-4.113), curiosity (OR 4.21; CI: 2.682-6.635), while for urban it included monetary gains (OR=2.00; 95% CI: 1.414-3.275) peer pressure (OR=2.666; CI:1.414-3.275), curiosity (OR 2.59; CI:1.695-3.962.), alcohol intake (OR 2.65; CI: 1.741-4.044).

Conclusion: The study shows a high prevalence of sexual abuse among the respondents. There is a need for reproductive health education in schools to mitigate this menace.

Background: Hypertension is a leading cause of premature death among non-communicable diseases especially in low and middle-income countries Sudden deaths are on the increase in our rural communities especially among the middle-aged.

Objective: To ascertain the level of awareness and prevalence of hypertension among rural dwellers in Ebonyi State, Nigeria.

Methods: This was a cross-sectional study carried out in rural communities of Ebonyi State. A participant is classified as hypertensive if the systolic blood pressure is ≥ 140mmhg and/or diastolic blood pressure≥90mmhg. The blood pressure measurement was carried out using a standard instrument and technique. Any person who was ≥ 18 years and resided in the community and gave consent was included in the study. Such persons who declined at the commencement of the study for whatever reason were excluded. The sampling method was a convenient technique. The study instrument was semi- semi-structured paper-based interviewer-administered questionnaire written in local dialects.

Results: The study participants are 417 in number, 182(43.6%) are males and 335(56.4%) females, age group 31-50 years and 351(84%) are farmers. Only 78(18.7%) of them are aware of the disease called hypertension. The prevalence of hypertension was 90(21.6%) and out of this, only 28(6.7%) are on antihypertensive medication.

Conclusion: There is a high prevalence of hypertension among rural dwellers in Ebonyi State with a low level of awareness of the disease. Also, most of the hypertensive study participants are not on medication. Public health education on hypertension is needed in the state.

Introduction/background: Assessing cardiovascular disease (CVD) risk is necessary in preventive cardiology. Studies have imputed CVD risk factors in algorithms to predict ASCVD. These various scores were derived from risk equations acquired from other populations. In our research, we found that abdominal height measured with our locally conceptualized appliance the Abdominometer predicted ASCVD better than established anthropometric indices.

Objectives: We, therefore, decided to build it into a risk equation and come up with a new algorithm that will not require data generated from invasive procedures.

Methods: We secondarily analysed our data and generated an algorithm utilizing 10 risk factors: one of which was our new anthropometric index of abdominal height (AH). Using the CIMT as a standard with a cut of value of ≥0.078 cm for high atherosclerotic risk we compared our new tool with the Framingham Risk Score (FRS).

Results: With our new algorithm, 24/221 (10.9%) were at high risk with 109 and 88 at low and intermediate risks respectively. Using the FRS, 218/221 were at low risk; only 3 being in the intermediate and high risk. Both risk algorithms correlated significantly with CIMT-determined risk but the correlation coefficient was more for the new (0.448) than the FRS (0.300).

Conclusions: We found that with sub-clinical atherosclerosis indexed by carotid intima-media thickness as standard, our new Jos App as well as the Framingham Risk score correlated positively and significantly. However, interestingly the level of correlation was higher with our new risk estimation App. We have input this into smart devices for pilot clinical studies.

Introduction: The geriatric population is increasing globally, and anaemia in the elderly is associated with increased morbidity and mortality. Anaemia is common in the elderly and its prevalence increases with age. In elderly persons, the etiology of anemia differs sufficiently from the etiology of younger adults to warrant considering anemia in geriatric persons as a distinct entity. Using World Health Organization criteria for anemia (Hemoglobin of less than 12gm per dl in women and less than 13 g per dl in men), the prevalence of anemia in geriatric patients has been found to range from 8 to 44 percent, with the highest prevalence in men 85 years and older. Anaemia is associated with an increased risk of hospitalization and death in community-dwelling older adults. It is associated with poor quality of life and increased morbidity and mortality.

Objectives: The Anaemia in Elderly study (ANiE study) aimed to assess the prevalence, associations and severity of anaemia in elderly patients attending the outpatient clinics at Rivers State University Teaching Hospital. Methodology: This was a prospective cross-sectional study of consenting patients, 60 years and older, attending the outpatient clinics in our hospital. A blood sample was collected for Full Blood Count, Blood Glucose, Serum Creatinine, and HIV serology. A data collection tool was used to collect data on comorbidities, occupation, and income among others. Descriptive analysis and logistic regression were done to determine factors associated with anaemia in elderly patients in outpatient clinics.

Results: A total of 288 patients consented to participate, anaemia was prevalent in 101 (35.1%) of the participants, there was no difference in the prevalence between males and females, the mean PCV was 38.33 ± 1.33%, the majority of the anaemic patients had mild anaemia 46(45.5%). Being a patient on a follow-up visit to the hospital, the average monthly income and employment status were significantly associated with the occurrence of anaemia.

Conclusion: Anaemia according to the WHO definition was prevalent in 35.1% of elderly patients attending the out-patients' clinics in the hospital. Factors associated with anaemia were employment status and average monthly income. It is important to identify patients at risk and provide appropriate care to prevent further morbidity and mortality.

Background: There is a paucity of nationally representative data on the pattern of morbidity of hospitalised medical patients in Nigeria. We hereby provide insights from the MOHOPA (Pattern of Morbidities, Mortality and Healthcare Financing of Hospitalised Medical Patients in Hospitals) study on the pattern of morbidity among patients admitted to the medical wards of Nigerian tertiary-level hospitals.

Methods: At least 100 patients admitted to the medical and emergency wards of 7 tertiary-level hospitals, spread across the 6 geopolitical zones of Nigeria and the Capital City of Abuja, were consecutively recruited to join the study after obtaining written informed consent.

Results: A total of 705 patients were recruited consecutively between May 2023 and March 2024, from Aminu Kano Teaching Hospital, University of Maiduguri Teaching Hospital, Federal Medical Centre Lokoja, University College Hospital, Ibadan, University of Nigeria Teaching Hospital, Enugu, Delta State University Teaching Hospital, and University of Abuja Teaching Hospital. Their mean age was 51.3 ± 18.3 years and 44.7% were females. Cardiovascular disease was the primary cause of admission in 22.1% of patients, followed by neurological (16.5%) and renal (14.3%) diseases. 74.2% of the patients had an important co-morbidity; the most common being cardiovascular (21.3%) followed by infectious (13.3%) and renal (9.7%) diseases. These patterns however varied significantly by region (Northern vs Southern) but not by gender (males vs females).

Conclusion: Cardiovascular, neurological, and renal disorders were the most common indications for admission and infectious diseases were important co-morbidities. The results will be vital for strategic planning and policy formulation.