Nigerian medical journal : journal of the Nigeria Medical Association最新文献

Background: With the limited number of trained health care providers in Nigeria, PPMVs are inevitable, especially in rural areas for the supply of drugs, and integration through appropriate referral practices is quintessential. This study assessed the knowledge, attitude, and practice of patient referral among PPMVs in a setting with limited hospital infrastructure.

Methodology: This cross-sectional descriptive survey was conducted in Obio-Akpor, Rivers State using a structured questionnaire that measured the participants' socio-demographic characteristics as well as knowledge, attitude, and practice of patient referral. Descriptive and inferential analyses were conducted with SPSS version 25 and a p-value <0.05 was considered significant.

Results: Most of the respondents reported moderate knowledge, attitude, and practice (62.4%, 73.4%, and 58% respectively) of patient referral. Multivariate analysis showed statistically significant inverse relationships between years of experience and odds of their knowledge, attitude, and practice of referral. PPMVs with 3 years of experience reported significantly higher odds of adequate knowledge (AOR = 178.96; 95%CI: 60.15 - 532.49; p-value <0.005), attitude (AOR = 7.38;95%CI: (3.78 - 14.40; P-value <0.005) and practice (AOR = 131.56; 95%CI: 53.50 - 323.51; p-value <0.005) than those with above 10 years of experience after controlling for the effects of other variables. The most frequently reported barrier to referral was fear of losing clients while most referrals were for laboratory investigations.

Conclusion: Most PPMVs reported moderate knowledge, attitude, and practice of patient referral. PPMVs were aware of the benefits of referrals but concerned about losing their clients to formal healthcare facilities.

Background: Nigeria has one of the highest rates of cervical cancer morbidity and mortality in Sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Cervical cancer is the second most diagnosed cancer and the third leading cause of cancer death in women worldwide. Eighty three percent (83%) of the world's new cases and 85% of all cervical cancer-related deaths occur in developing countries. It is primarily caused by human papilloma virus (HPV); a sexually transmitted pathogen that could be prevented with safe sexual practice and using vaccines, among others. The aim of the study was to assess the knowledge and attitude of reproductive age group women in low resource setting in towards cervical cancer and its prevention in Yenagoa, Bayelsa State Nigeria.

Methodology: This study employed the use of a descriptive study design to examine the knowledge and assessment of cervical cancer among women of reproductive age (19-54), about cervical cancer, its prevention, and their utilization of Pap smear screening; using a convenience sample of 406 women in two communities (Okaka and Agudama) in Yenagoa Local Government Area of Bayelsa State, Nigeria. Women voluntarily completed a structured questionnaire.

Result: Results showed that women who participated in the study were aware of cervical cancer (78.3%; n=318) but many (70.4%; n= 286) were unaware of Pap smears as the screening tests for cervical cancer. Although few of them (45.6%; n =185) knew about a screening center, out of which 17.6% (n= 32) reported that the screening center was less than 2km away from their residences.

Conclusion: There is need for health care professionals, to intensify efforts to increase awareness about cervical cancer screening and encourage women through the different clinics to use these services. The benefits of screening and early diagnosis of cervical cancer should be emphasized to enhance the utilization of cervical cancer screening services.

Background: The ageing population worldwide presents a significant challenge for healthcare systems, with malnutrition being a common problem among elderly individuals, particularly those hospitalized. Assessing nutritional status is crucial for identifying and addressing malnutrition in this population. This study aimed to assess the prevalence of malnutrition among elderly hospitalized patients in a Nigerian tertiary healthcare setting.

Methodology: This was a hospital-based descriptive and cross-sectional study conducted from March to June 2023, involving 122 patients aged 60 years and above. Demographic data and anthropometric measurements were collected, and the Short-form Mini Nutritional Assessment (MNA-SF) tool was used to assess nutritional status. The reliability of the MNA-SF was assessed using Cronbach's α coefficient and item-to-total score correlations.

Results: The mean MNA score was 14.4 ± 5.3, with 71.3% of participants classified as malnourished, 22.1% at risk of malnutrition, and 6.6% well-nourished. Significant differences were observed in the body mass index (BMI) of nourished, at-risk, and malnourished individuals respectively (23.3 ± 3.6 kg/m², 22.5 ± 3.8 kg/m^2, and 19.6 ± 2.8 kg/m², p < 0.001). The MNA-SF tool demonstrated acceptable reliability (Cronbach's α coefficient = 0.777), with significant correlations between total MNA scores and most MNA-SF questions.

Conclusion: The high prevalence of malnutrition among elderly hospitalized patients in this Nigerian tertiary hospital emphasizes the importance of implementing routine nutritional screening protocols and targeted nutritional interventions for improved health outcomes among the elderly.

Background: Cardiovascular diseases (CVD) are widespread and significantly contribute to global mortality with a rising prevalence in developing countries. The aim of this study was to identify the pattern and outcome of admissions related to cardiovascular diseases within the medical wards at the Rivers State University Teaching Hospital.

Methodology: The study was a retrospective cross-sectional hospital-based study. The records of all patients admitted into the medical wards from January 2021 to December 2022 were extracted to include information on biodata, admitting diagnosis, duration of admission, and patients' outcomes.

Results: Over this 2-year period, a total of 1,540 patients were admitted into the wards and751(48.8%) persons were admitted for CVDs with a mean age of 59.6±15. 1years.The commonest cardiovascular diseases documented included heart failure (HF) and cerebrovascular accident (CVA) which occurred in 251(33.4%) and 311(41.1%) patients respectively. Other CVDs recorded were hypertensive crisis in 163(21.7%), acute coronary syndrome (ACS) in 12(1.6%) and pulmonary embolism (PE) in 6(0.8%) patients. During the study period, 311 deaths were recorded representing 20.2% of all admissions with 146(46.6%) hospital deaths attributed to CVDs, accounting for 19.4% of the total cardiovascular admissions with 125 of these deaths occurring in patients with CVA and HF.

Conclusion: Heart failure and Cerebrovascular accidents emerged as significant contributors to the morbidity and mortality of patients on admission in Rivers State. Policies to incorporate appropriate, preventive and management strategies in the community to reflect this distribution are essential to significantly reduce cardiovascular deaths in our population.

Background: The utilization of HIV testing services in Nigeria has not been optimal due to socioeconomic and demographic factors such as educational level, place of residence, and religion. For Nigeria to achieve epidemic control, pregnant women need to know their HIV status through HIV testing, which is the gateway to HIV prevention, care, support, and treatment services. Therefore, the purpose of this study was to determine the predictors of HIV testing among Nigerian pregnant women aged 15-49 years HIV testing during antenatal visits or childbirth.

Methodology: Secondary data analyses of 659 pregnant women randomly selected from the multiple imputation datasets of the 2013 Nigeria Demographic and Health Survey (NDHS)were done using SPSS version 25. Data on socio-demographic characteristics, HIV stigmatizing attitudes, and HIV testing were retrieved from the dataset for the study. Bivariate and multivariate regression analyses were done to determine the predictors of HIV testing.

Results: The prevalence of self-reported HIV testing and receiving results among women of reproductive age was 36.72%. Bivariate model findings showed that educational level, place of residence, and religion were statistically significant predictors of HIV testing among pregnant women. Only educational level and place of residence significantly predicted pregnant women's HIV testing in the parsimonious multivariable regression model. Pregnant women with higher levels of education (Primary Education, AOR, 1.85; 95% CI, 1.07,3.19; Secondary Education, AOR, 3.75; 95% CI:1.93, 7.28; Higher Education, AOR, 11.23; 95% CI: 4.40, 28.68) and those living in urban areas (AOR, 1.60: 95% CI:1.03, 2.47) were more likely to test for HIV than those with no education and those living in the rural areas.

Conclusion: This study identified having a higher level of education and living in urban areas as predictors of HIV testing, therefore, more efforts are needed to have women with lower levels of education and those living in rural areas test for HIV as a strategy for the elimination of mother-to-child transmission of HIV.

Background: Uterine fibroid is the most common gynaecological tumour, with a prevalence of 20% to 50% of women over 30years.Abnormal uterine bleeding is one of the most common modes of presentation with menorrhagia. Open abdominal myomectomy is the most common treatment option in our environment. It is associated with a significant degree of blood loss, with consequent blood transfusion. Thus, the need for interventions to reduce blood loss during the procedure. This study assessed the effectiveness of intravenous tranexamic acid in reducing blood loss when used as an adjunct to peri-cervical tourniquet during open abdominal myomectomy.

Methodology: This study was conducted at Barau Dikko Teaching Hospital, Kaduna. It comprised thirty-six consenting patients scheduled for elective open abdominal myomectomy, randomly assigned to receive either intravenous tranexamic acid or placebo immediately after securing intravenous access in the theatre. All the patients had a peri-cervical tourniquet applied intraoperatively. The volume of intraoperative blood loss, blood transfusion rate and the total number of units transfused, haemodynamic changes associated with blood loss, and the complications associated with the use of tranexamic acid were evaluated during the first 72hours following the surgery.

Results: A total of thirty-six women who met the eligibility criteria were studied between June 2023 and December 2023. The mean age of the participants in the tranexamic acid group was 37.82 ± 5.89 years and 39.74 ± 5.17 years in the placebo group (p = 0.307). Most of the women 35 (97.2%) presented with symptoms of menorrhagia. Major blood loss > 1000 ml was recorded more among women in the placebo group than those who received tranexamic acid. There was a statistically significant reduction in the mean blood loss in the tranexamic acid group 947.65 ± 451.88 compared to 1320.53 ± 563.28. (p 0.037).There was an increase in the number of women who received a blood transfusion in the placebo group 7 (36.8%) compared to the tranexamic acid group 4 (23.5%) (p=0.387). Tranexamic acid resulted in a decrease in the risk of perioperative blood loss by 30%, RR 0.7 95% CI (2.19-2.59) and packed cell volume was significantly lower in the control group postoperatively (P value = .001). There was no significant side effect noticed in both groups.

Conclusion: Tranexamic acid reduces blood loss during and after myomectomy for patients with uterine fibroids and the need for blood transfusion is reduced in patients who had intravenous tranexamic acid as an adjunct to the application of a tourniquet.

Childhood and adolescent TB is a silent epidemic. The occurrence of genital tuberculosis (TB) in adolescent girls is rare. This condition is easily misdiagnosed owing to its non-specific clinical presentation that mimics different gynecological or non-gynecological pathologies. We present an unusual case of genital TB in an 11-year-old girl with an acute abdomen, where the clinical and radiological findings contributed to the diagnostic confusion with hematometra. This case highlights a rare case of genital TB in a teenage girl, and its clinical and diagnostic complexities, emphasizing the importance of considering TB as a differential in all cases of pelvic masses in high-burden settings. This case also exemplifies the need for a multidisciplinary approach to facilitate timely diagnosis and treatment to prevent the devastating effects of genital TB on the reproductive health of young girls.

Background: Breast cancer has produced more lost disability-adjusted life years (DALYs) than any other type of cancer. The prevalence of the disease, especially triple negative breast cancer (TNBC) in Africa is on the rise, with poor survival rates. With the great advancements in treatments of breast cancers, that of TNBC is still a challenge due to its narrowed treatment options and poor disease prognosis. This research seeks to explore the expression of kaiso in Ghanaian breast cancer and how they may modulate clinicopathological features, and disease prognosis.

Methodology: A cross-sectional retrospective study was conducted on formalin-fixed paraffin-embedded (FFPE) breast cancer tissues retrieved from the archives of the pathology unit of Komfo Anokye Teaching Hospital (KATH). Immunohistochemistry assessment was performed on haematoxylin and eosin-stained slides selected for tissue microarray construction. Data were analysed using SPSS version 28 and Microsoft excel 2013.

Results: 55.3% of the cases tested negative to progesterone receptor (PR), oestrogen receptor (ER), and human epidermal growth receptor 2 (HER2). There were significant associations between menopausal status and molecular subtype (p=0.010), Kaiso expression and histological diagnoses (<0.001) and Kaiso against lymphovascular invasion (0.050). However, there were no significant associations between Kaiso localization and the clinicopathological features although 63.9% of the expression was seen in the nucleus.

Conclusion: The study indicates that Kaiso is highly expressed in Ghanaian TNBC and likely associated with worse outcomes in aggressive tumour types.

Background: To determine the level of knowledge and challenges associated with learning movement disorders among final-year medical students. Methodology: A cross-sectional survey of 79 final-year medical students at the Madonna University, Elele, Rivers State. Consenting students filled out the study questionnaire, which consisted of socio-demographic variables and questions on the knowledge and challenges of learning movement disorders. Data were collected and analysed using the Statistical Package for Social Sciences Version 20.

Results: The mean age of the study participants was 27.41±2.78 years, with a male-to-female ratio of 1.3:1. Almost (91.1%) all the study participants had heard about parkinsonism from their lectures, followed by chorea (88.6%). More than half of the participants knew about one type of movement disorder or the other. Forty-three (54.4%) students expressed difficulty understanding movement disorder lectures. Inadequate exposure to patients with movement disorders and lack of audiovisual aids to enhance learning experience were the greatest challenges in learning movement disorders.

Conclusion: Parkinsonism was the most recognized movement disorder among the study participants. More than half of the participants admitted to having challenges with movement disorder lectures. Paucity of movement disorders cases during clinical rotation and lack of teaching aids were cited as major challenges affecting learning and appreciation of movement disorder lectures. Medical educators are encouraged to deploy appropriate methods that optimize learning experience among medical students during movement disorder lectures.

Background: Nigeria remains a major contributor to neonatal deaths worldwide, yet little consideration has been given to intra/inter health facility transfer of sick neonates. The dearth of Neonatal Transport Network Services (NNTS) is probably an underappreciated driver of the abysmally high national neonatal mortality indices. This study aimed to evaluate neonatal transport services and the healthcare workers' preparedness among health facilities in Port Harcourt Metropolis, Rivers State, Nigeria.

Methods: Twenty-eight selected health facilities (tertiary, private hospitals Primary Health Centers] were assessed on the availability, modality and practice of NNTS. Data was analyzed using SPSS Version 23.

Results: Routine transfer of high-risk pregnant mothers to higher levels of care occurred always in 14 (50%) and sometimes in 6 (21.4%) facilities; Private cars and taxis were the most common mode of transport in 24 (85.7%) facilities. Two facilities (7.2%) had ambulances equipped with transport incubators. Nurses and nurse attendants with no formal training in NNTS accompanied referred neonates in 2 (7.2%) facilities. Most referring facilities (78.6%) neither rarely or never contacted receiving centres before the arrival of neonates and most nor gave back referrals after offering neonatal care. None (100%) of the facilities had a trained emergency transport team.

Conclusion: Health facilities in Southern Nigeria lack a standardized Neonatal Transport Network and are characterized by poor communication between health facilities and inadequately trained personnel for inter-facility transfer of sick neonates. Urgent action is required to address these gaps, including training of healthcare workers on neonatal transport and sharing findings with relevant stakeholders/policymakers to establish a functional neonatal transport network among health facilities.