Annals of Ibadan postgraduate medicine最新文献

Background: Emergency and essential surgery should be affordable, accessible, and timely. However, this is not the narrative in our setting as patients present late with complications requiring operative treatment which has an attendant healthcare expenditure often tending towards household income depletion. This study assessed the proportion of patients who incurred catastrophic healthcare expenditures following operative treatment for intussusception in our facility. Catastrophic healthcare expenditure was defined as spending >10% of Gross Domestic Product per capita. Health care expenditures were reported in US dollars.

Materials & methods: A prospective cohort study of children 15 years of age and younger who were operatively treated for intussusception at the Paediatric Surgery unit of Federal Medical Centre, Umuahia from January 2017 to December 2020.

Results: Sixty-six (84.6%) out of the 78 children who presented with intussusception within the period had 72 laparotomies. Only 6.1% (4/66) of the patients were enrolled in the National Health Insurance Scheme. The insured patients presented earlier than the uninsured patients (median 4 versus 6 days, p=0.04). The median total health expenditure was $458 (Inter Quartile Range $372.4 ? $707.1) for the uninsured patients. The total health expenditure exceeded 10% of GDP per capita ($209.71) for all the uninsured patients but not for any of the insured patients, giving an overall catastrophic expenditure rate of 93.9% (62/66). The median daily health expenditure was about one-third of 10% of GDP per capita for those who were uninsured.

Conclusion: All the uninsured patients experienced catastrophic health expenditures; with onset from the fourth day on admission. Financial risk protection by implementing payment strategies aimed at reducing user fees to non-catastrophe levels may help.

Background: Tobacco use is a leading preventable cause of morbidity and mortality and poses a significant burden on fragile health systems in low- and middleincome countries (LMICs), including Nigeria. Adolescents are particularly at risk of starting to use tobacco due to factors such as misinformation and insufficient knowledge about its harmful effects. There is an urgent need for culturally appropriate, acceptable, and sustainable interventions to enhance knowledge, correct misconceptions, and promote positive behavior change regarding tobacco use. This study describes the development and validation of culturally tailored, Health Belief Model (HBM)-based educational materials (posters and notebooks) for tobacco-related health education among adolescents in Nigeria.

Methodology: The Design-Based Research (DBR) approach was used to develop posters and notebooks featuring tobacco-related messages. These messages were adapted from the World Health Organization's (WHO) Tobacco Control Manual for Schools, based on the HBM constructs, and tailored to fit the Nigerian context. The materials underwent validation through reviews by a multidisciplinary panel of experts who assessed their clarity, cultural relevance, and theoretical alignment. Subsequently, they were pre-tested among 150 adolescents from public and private schools in Ibadan, Nigeria. Feedback from the adolescents guided iterative refinements, culminating in the development of the final versions of the materials.

Results: The educational materials conveyed information on different tobacco forms, the harmful constituents, health effects, and skills to avoid tobacco use. Expert reviewers confirmed the materials' alignment with HBM constructs. Participants in the pre-test rated the materials highly, with 89.3% describing the information as ?very good? and 80.7% supporting their integration into the school curriculum.

Conclusion: The tobacco control educational posters and notebooks were found to be contextually appropriate and addressed gaps in tobacco-related knowledge and behavior change strategies. They offer a scalable model for school-based interventions in LMICs and could contribute to broader public health education efforts.

[This corrects the article PMChttps://pmc.ncbi.nlm.nih.gov/articles/PMC11848366.].

Introduction: Nutcracker syndrome is a pathology that could pose a diagnostic conundrum to the physician as the patient could present with vague symptoms. This report brings to limelight the pathology of Nutcracker syndrome and the need for clinicians to consider this as a differential diagnosis when managing patients with non-specific abdominal pain.

Case presentation: This is a case series report of two patients that presented at the emergency unit with acute exacerbation of insidious onset of upper abdominal pain. Radiological evaluation with computerized tomography proved the presence of this pathology in both patients with reduction in aortomesenteric angles and distances. The management of this clinical entity is largely conservative with surgical intervention rarely needed.

Conclusion: Radiological evaluation is the bedrock of diagnosis of Nutcracker syndrome. The clinician should endeavor to consider this as a differential diagnosis in patients with recurrent and undefined upper abdominal symptoms.

Background: The National Health Insurance Scheme (NHIS) of Nigeria was established in the year 2005. The overall objective of the scheme was to enhance access to quality healthcare for all and minimize catastrophic health expenditures. However, since inception, the population coverage has been less than ten percent of the total. Very recently, the National Health Insurance Authority (NHIA) of Nigeria was enacted, which concomitantly repealed the NHIS Act. This article examined the design of the NHIA and other factors outside of the scheme but in the health system of Nigeria, in comparison to similar schemes in other settings. Finally, the newly implemented NHIA and the gaps it seeks to fill were examined.

Methods: Relevant literature extracted from databases such as PubMed, Google Scholar, and the ordinary Google website was reviewed. Findings from these sources were triangulated and used to write the manuscript.

Results: Compared with social health insurance schemes in other settings, the current population coverage under the NHIA of Nigeria is poor. Some of the factors that contributed to the poor performance of the NHIA were the features of the design of the scheme, which run contrary to the design of the majority of social health insurance schemes in other countries. In addition to this, the primary healthcare level that is most widespread in many countries and that was made use of as service providers in other social health insurance schemes was not made use of under the NHIA. In addition to these, and unlike in other settings, membership in the NHIA has been on a voluntary basis until very recently, when it was made mandatory.

Conclusion: Presently, population coverage under the NHIA is very poor. The informal sector, especially in rural settings, is mostly at a disadvantage. This is unlike in the majority of other countries, which encourage population coverage across both the formal and informal sectors. Stakeholders in the health insurance industry are encouraged to make the scheme mandatory and enforce it. The PHC facilities should also be engaged as service providers under the NHIA.

Introduction: Herpes zoster (HZ) is a viral disease with a global health burden which significantly impacts on the quality of life. HZ is caused by reactivation of the varicella-zoster virus and its complications are dependent on multiple factors like immune suppression, psychological stress, malnutrition, co-morbidities, duration of HZ infection and old age. Some of the complications include secondary bacterial infection, post-herpetic neuralgia, scarring, nerve palsy, and viral encephalitis. These complications could present as single or rarely as multiple entities in an individual.

Materials & methods: We present a case of HZ infection affecting the mandibular division of trigeminal nerve in a 78-year-old widow. The patient presented with multiple complications including hyper- pigmented scarring, post herpetic neuralgia and chronic non-suppurative osteomyelitis of the left mandible. This case report highlights the presentation of multiple complications from HZ infection especially among the elderly.

Conclusion: Early diagnosis and prompt treatment of HZ infection are highly essential for reduced risk of complications.

[This corrects the article on p. 81 in vol. 22 PMChttps://pmc.ncbi.nlm.nih.gov/PMC11848366.].

Background: Derangement of trace elements which could be due to systemic inflammation or oxidative stress is thought to be directly or indirectly involved in carcinogenesis.

Aim: To evaluate plasma trace elements in female patients with cancer of breast- or cervix.

Material and methods: This study was carried out in the Departments of Immunology and Radiation Oncology, University of Ibadan, Nigeria. Thirty (30) patients with cervical cancer, 30 patients with breast cancer and 30 age-matched females without cancer as control were included in the study. Plasma separated from venous blood was analysed for the concentrations of zinc (Zn), iron (Fe), selenium (Se) and copper (Cu) using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). The sixty cancer patients were newly diagnosed and in a stable state.

Results: The mean plasma levels of Fe and Cu were significantly reduced in patients with breast cancer- or cervical cancer compared with control. The plasma concentrations of Fe, Cu, Zn and Se were significantly reduced in all patients having breast cancer and those in stage 2 compared with cervical cancer patients.

Conclusion: Available data further support a previous suggestion that blood levels of metal varies with different cancers. Thus, a need for differential supplementation based on cancer types when modulation of trace element levels becomes a therapeutic option.

Background: The abrupt removal of fuel subsidy in Nigeria led to exponential increase in fuel prices. The resultant economic pressure may have effects on the mental health status of Nigerians. The objective is to understand this impact, we assessed changes in mental health status among primary healthcare workers and community members after fuel subsidy removal.

Materials & methods: We carried out cross-sectional study in six Local Government Areas (LGA) across three Nigerian states and surveyed healthcare workers and community members. We analysed respondents' socio-demographic characteristics and their perceptions of fuel subsidies and mental health risks using summary statistics. Additionally, we evaluated depression and anxiety severity among respondents before and after the subsidy removal using the PHQ-9 and GAD-7 scales, reporting findings by state and percentage increases in the subsidy removal?s impact on healthcare workers and community members.

Results: We found a rise in depression and anxiety, particularly among younger adults. HCWs in Jigawa state faced the most severe increase, with depression rates nearly tripling. Similarly, community members across various demographics saw a significant rise in depression and anxiety after the policy change. According to state, Jigawa state bore the brunt, with depression and anxiety rising by over 200% while market women experienced the highest increase within occupational groups.

Conclusion: This study shows that younger adults, single individuals, residents of disadvantaged areas, and market women were mostly affected. The widespread mental health crisis necessitates broad interventions targeting these groups.