Annals of Ibadan postgraduate medicine最新文献

Background: Childbirth is a joyful and pleasurable experience for women particularly if the delivery was via the vaginal route. This feeling may be attenuated when delivery is by caesarean section.The situation can be compounded when complications arise most frequently post-operative wound complications. However, there are no studies on the burden of wound complication after caesarean section in our environment. Objective: We aimed to evaluate the burden of wound complications after caesarean section.

Methods: The study was a prospective longitudinal study on the outcome of post-caesarean section wounds in a Teaching Hospital in South-East Nigeria. Ethical approval was obtained from the Hospital's Research Ethics Committee while written informed consent was obtained from the patients. The information obtained included the socio-demographic data, and post-operative wound characteristics assessed with a modified ASEPSIS wound score. The cost of treatment was obtained from the hospital bills, and estimates of other related purchases. Data generated was analysed using Statistical Package for Social Sciences (SPSS) version 29.

Results: Seventeen percent of women had wound infections. The AEPSIS wound score and grades (outcome) were significantly influenced by the body mass index (BMI). Pre-operative anaemia and intra-operative blood loss had a statistically significant association with wound complications. The outcome significantly affected the period of hospital stay (P = <.001). The mean estimated cost of treatment of patients who had wound infection was 2.37 times that of those without wound infection.

Conclusion: Wound complications were a burden after caesarean section and efforts should be made to control the factors that were responsible.

Background: Despite the rise in the burden of heart failure (HF), there seems to be poor level of awareness concerning the syndrome particularly in the lowand middle-income countries. This study sought to determine the level of awareness of HF among patients attending cardiology clinic in a big tertiary institution in South Western Nigeria.

Methods: Patients attending the Cardiology clinic at University College Hospital, Ibadan were recruited. A structured questionnaire was used to assess their level of awareness of HF. Normally distributed continuous variables were summarised as means and standard deviations. Categorical variables were expressed as frequencies and percentages. The statistical analysis was done using SPSS, Windows version 23.0 (Armonk, NY: IBM Corp).

Results: Majority of the participants were females (55.2%) with mean age of 56.4years. Most patients (54.0%) were educated to tertiary level, lived in urban area (96.4%) and had hypertension (88.0%). The overall knowledge of the course of HF was not optimal, however, most patients have heard about HF before the study and are aware of common aetiologies and symptoms of HF. There was mixed performance with the knowledge of treatment of HF with many misconceptions. The most preferred source for information was the clinic (99.4%). Others included the internet (83.0%), and patient guides (67.6%).

Conclusion: This study highlighted the gap and the need for educational interventions to address misconceptions and improve patients & knowledge about HF.

Introduction: Sufficient laboratory capacity is vital to containing infectious diseases outbreaks. This study was conducted to document the strategies adopted to scale up laboratory testing capacity during Nigeria's response to COVID-19 pandemic.

Methods: This cross-sectional descriptive study adopted a mixed method approach including desk reviews and key informant interviews (KIIs). The KIIs were conducted among actors of the COVID-19 response teams in states and federal ministries of health in Nigeria.

Results: At the beginning of the pandemic in Nigeria, testing performance was poor, but this improved over time. To manage the demand for testing, Nigeria adopted targeted testing with a focus on symptomatic contacts,alerts, and returning travelers from high-risk countries who were symptomatic during the quarantine period.. Strategies to enhance laboratory capacity and improve the turnaround time for results included leveraging on existing tuberculosis laboratory networks or building new laboratories where none existed; decentralization of sample collection and testing; staff health workers repurposing and hiring of volunteers; training and retraining of laboratory personnel; adoption of rapid diagnostic testing; and strengthening public-private partnerships. From an initial three laboratories with capacity to test for SARSCoV- 2 in February, 2020, the number of laboratories increased to 158 by March, 2022. Although laboratory capacity increased, logistics and supply chain disruption were still a challenge.

Conclusion: Investment in local manufacturing capacities of laboratory consumables such as RDTs and reagents would promote self-reliance and sustainability for a country as populous as Nigeria.

Background: Low serum testosterone is reported to be common in men with type 2 diabetes mellitus (type 2 DM). However, the Endocrine society has recommended that the diagnosis of male hypogonadism be based on the presence of symptoms of testosterone deficiency in combination with low serum testosterone.

Objective: The aim of this study was to determine the frequency and correlates of hypogonadism in a cohort of Nigerian men with type 2 DM.

Methods: We studied 100 men with type 2 DM and 100 age matched non-diabetic men in a cross-sectional study. The Androgen Deficiency in the Aging Male (ADAM) questionnaire was administered to all study subjects. Anthropometric parameters, total testosterone, sex hormone binding globulin (SHBG), serum Gonadotrophins, glycated haemoglobin and lipid profile were measured. Serum free testosterone was calculated using Vermeulen's equation. Hypogonadism was considered present in men with symptoms of hypogonadism in combination with a low calculated free testosterone (cFT) < 0.255nmol/l. Data was analysed using SPSS 20 package with level of significance set at p value < 0.05.

Results: 41% of men with type 2 DM had hypogonadism, compared to 10% of non-diabetic men. Secondary hypogonadism was found in 22% of men with type 2 DM, while primary hypogonadism was present in 19%. Amongst hypogonadal men with type 2 DM, secondary hypogonadism was the underlying cause in 53.7%. Truncal obesity was identified as a significant independent predictor of hypogonadism.

Conclusion: Conclusion: This study demonstrated that hypogonadism was a common condition among men with type 2 DM. Truncal obesity emerged as a significant independent predictor of hypogonadism.

Background: World Health Organization prioritizes strengthening of cardiovascular disease care in primary healthcare (PHC). To achieve this, Nigeria is promoting task-sharing by non-physician healthcare workers (HCWs) due to shortage of physicians and other highly-skilled HCWs in PHC facilities. This study assessed task-sharing pilot for hypertension control in PHC facilities under Nigeria Hypertension Control Initiative of the Federal Ministry of Health (MOH).

Methods: A cross-sectional study was conducted using key informant interviews. Six stakeholders were purposively selected from Ogun and Kano States' MOH and the Federal MOH due to their roles as focal persons of health programs practicing task-sharing and who had experience with tasksharing in hypertension control program. Interview guide was developed to evaluate task-sharing in the pilot program. Data were analyzed using thematic analysis.

Results: Respondents reported some strengths associated with task-sharing which include availability of non-physician HCWs, national guidelines for task-sharing practice, improved efficiency in health service delivery, reduction in patients' waiting time, and improvement in achieving universal health coverage. The identified challenges included staff attrition, staff fatigue, professional territorialism, and non-physician HCWs reported to go above their task authorization. Respondents reported improved access to care in some PHC facilities due to task-sharing by non-physician HCWs. Respondents perceived that training and supportive supervision are strategies to ensure the successful implementation of task-sharing.

Conclusion: This study notes that task-sharing from established health programs and the ongoing piloting on hypertension control has improved service delivery. Nigeria may be able to implement nationwide task-sharing for the control of hypertension through PHC.

Introduction: The desire to wear a charming, customized and captivating look like a fashion ambassador does not comes easily, but with a tag attached. Consciously or unconsciously, cosmetic powders have cast a spell over culture throughout century and its possible health implications on the consistent wearers remain a subject of controversy. This study solely aimed at evaluating bacteria load and fungi presence in some selected talcum composed powder and compare, if it had exceeded standard threshold of microbial load capable of causing infection.

Methodology: A stock solution was prepared by dissolving exactly 1 gram of each sample into 9 ml of sterile distilled water and was diluted in 10-fold serially. Selected dilution factors (10^-3, 10^-5, 10^-7) were subculture on bacteriological media for the isolation of bacteria and fungi of clinical significance. The pH of each powder was determined by weighing 3gram into 10mL of sterile distilled water and were measured with handheld pH meter. Macroscopic and microscopic identification of mould isolates was done by placing pieces of a colony from Saboraud Dextrose Agar to clean microscopic slide and thereafter stained with lactophenol -in -cotton blue. A cover slip was placed on each preparation, followed by observation under the objective lens of Olympus microscope. Distinct similarly looking representative isolates were harvested for Gram reactions, followed by conventional biochemical characterization for confirmation.

Conclusion: Variation in pH range between 3.2 and 5.2 were recorded, the average bacteria count obtained from all the powder sampled range between 3.5×10⁸ and 8.3×10⁸ which exceeded 1×10³ microbiology threshold standard for cosmetic powders. Rhizopus spp, Candida spp and Epidermophyton spp were also isolated. Conclusion: There is need for regular testing of these products to assure safety compliance and promote awareness on the potential harmful effects of using microbial-laden powder on users.

Introduction: Torsion of the appendix of the epididymis is a rare cause of acute scrotum. However, it can be distinguished from testicular torsion by its insidious onset and localizable tenderness. In addition, colour Doppler ultrasonography has characteristic findings in torsion of the testicular appendage.

Case presentation: We present a case of a 9-year-old male presenting with sudden onset left hemi-scrotal pain, and had clinical features mimicking testicular torsion with consequent immediate scrotal exploration. Intra-operative finding was in keeping with torsion of the epididymal appendage as against the earlier clinical presentation suggestive of testicular torsion.

Conclusion: Acute scrotum being a time dependent emergency may in some circumstance not allow time for Doppler ultrasonography which will differentiate torsion of epididymal appendix from testicular torsion, and thus preventing unnecessary scrotal exploration.

Background: The "Child health card" (CHC) is integral to monitoring a child's growth and assessing development to support the early detection of malnutrition and prompt intervention. CHC is also valuable in keeping track of a child's vaccinations. There are limited studies on knowledge and utilization of CHC in Oyo state, Nigeria. We therefore aimed to assess caregiver's knowledge, retention, and utilization of child health cards in Ibadan, Oyo State, Nigeria.

Methods: A community-based mixed-method study using a parallel convergent design was employed. Quantitative data were collected from 617 caregivers at their compounds in the selected communities using an interviewer-administered questionnaire. Qualitative data were collected by interviewing caregivers and healthcare workers at health facilities. Bivariate analysis of quantitative indicators and thematic analysis of qualitative interviews were conducted.

Results: Caregiver knowledge of the CHC, including the contents of the CHC and growth charts, was poor, but retention was relatively high (69.6%). Retention of the CHC was higher among caregivers whose index child was <12 months (p=0.011) and among those with good knowledge of the CHC (p<0.001). Being employed (p=0.016), having tertiary education (p=0.027), having good knowledge (p<0.001), and good perception of the CHC (p=0.001) were positively associated with the utilization of CHC. We found that when caregivers failed to present the card at immunization clinics, they often faced verbal reprimands from healthcare workers, and in some cases, their child's vaccination was denied.

Conclusion: CHC retention was high despite low utilization by caregivers. Therefore, interventions designed to improve community awareness of the CHC could provide an opportunity to improve the use of child health cards in this setting.

Background: The shorter the time interval between marriage and first birth, the sooner subsequent pregnancies are likely to occur in the absence of contraceptives and family planning. This can have negative impacts on the mother, children and society. This study explores the trend in the time between marriage and the first birth among Nigerian women.

Materials and method: Kaplan-Meier's estimation and multilevel survival models were used to analyze data from the Nigeria Demographic and Health Survey (NDHS) records from 1990, 2003, 2008 and 2013. The study focused on women who entered marriage without children or pregnancy. The surveys employed a two-stage cluster sampling method. Variables extracted included birth cohort, age at sexual initiation, age at first marriage, age at first birth, educational level, religion, place of residence, knowledge of contraceptive and ovulatory cycle.

Results: The results indicated that the median time to first birth after marriage decreased from 2 years to 1 year. Significant factors associated with a higher likelihood of having first birth shortly after marriage included having primary education (HR = 1.17; CI=1.14-1.21), knowledge of contraceptives (HR= 1.21; CI =1.20-1.26, ovulation cycle (HR=1.21, CI=1.18-1.25), marriage above 19 years (HR = 1.19, CI=1.15-1.25), women residing in South east (HR= 1.17, CI =1.10-1.22), South West (HR = 1.30, C.I=1.24-1.37) and community influence (p=1.37, ICC = 0.06).

Conclusion: The reduced time to first birth after marriage underscores the need for policy-makers to promote higher level education and family planning among women of reproductive age in Nigeria.

Introduction: Mental health describes an individual's emotional, psychological, and social well-being. The diagnosis of precancers and cancers may result in different mental health manifestations. This review will examine the existing evidence on the effects of diagnosis, management, and prognosis of the four common gynaecological malignancies (ovarian, endometrial, cervical cancer, and endometrial trophoblastic neoplasia) and two precursor lesions (premalignant lesions of the cervix and hydatidiform mole) on the mental health of affected women in Sub-Saharan Africa (SSA).

Materials & methods: Electronic databases will be thoroughly searched, all potentially eligible studies will be downloaded and reviewed, and the data mapping will be done to present the study findings.

Conclusion: The outcome of this scoping review may showcase existing information, gaps in knowledge, and the future direction of research on mental health problems associated with common gynaecological cancers in SSA.