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

Background: Malaria prevention is important among HIV patients to mitigate its associated complications. This study explored the predictors of insecticide-treated net (ITN) usage among HIV patients attending an antiretroviral therapy (ART) clinic in Ebonyi state, Nigeria.

Methodology: It was a cross-sectional study that involved 297 patients who attended an ART clinic in Ebonyi State. An interviewer-administered questionnaire was used to collect relevant data which included perception of malaria prevention, ownership of ITN, condition of ITN, duration of use and ITN usage. The relationship between ITN usage and other variables was assessed using bivariate analysis and the predictors were determined using multivariate logistic regression.

Results: There were 64 (21.5%) males and 233(78.5%) females. Knowledge of the use of ITN (mean= 4.24 ±0.93) was rated better than knowledge of the use of mosquito repellent (mean = 3.79 ± 1.21) and knowledge of the use of protective clothes (mean= 3.86 ±1.26). 246 (83%) of the study population owned ITN. Only 48% (118) of those who had ITNs reported having optimal nets (nets without holes). 135 (45.5%) of the participants reported sleeping under the net every day in the past week. There was a significant relationship between ITN usage and knowledge of the use of ITN, ownership of ITN, duration of use and condition of nets. Predictors of usage of ITN were duration of use (AOR=0.386, 95%C.I for AOR=0.224-0.665) and condition of the nets (AOR=0.399, 95%C.I for AOR=0.226-0.706).

Conclusion: Perception of malaria prevention was high among the study group. Ownership of ITN was high although many of the ITNs were not in good condition. Usage of ITN was largely determined by duration of use and good condition of nets. Yearly assessment of the condition of ITNs and replacement exercise of ITNs (2-3 years) at ART clinics to replace old and worn-out nets among HIV patients are recommended.

Background: Utilization of delivery services is paramount to achieving a safe delivery outcome and preventing maternal mortality/morbidity among mothers. In semi-urban communities, delivery services are provided by both health and non-health facilities and are influenced by either socio-demographic or economic factors. This study aims to evaluate the utilization of delivery services across various places that provide such care and to identify the factors that influence the utilization of delivery services in the Aluu community.

Methodology: A community-based cross-sectional study was conducted in 5 out of 9 villages in the Aluu community. A total of 415 respondents were recruited for the study. The study was carried out between April 2021 and October 2021. A multistage sampling method was used, and data was collected using an interviewer-administered structured questionnaire. The data was analyzed using SPSS version 25. The Chi-square test was used for inferential analysis and a significant level was set at p≤ 0.05 at 95% confidence interval.

Results: Out of 415 respondents, 44.03% were delivered in a healthcare facility while 55.97% were delivered in a non-health care facility. Tribe, religion, educational status, occupation, and Obstetrics and gynecological factors were found to influence the utilization of delivery services.

Conclusion: More than half of women utilized delivery services provided by non-health facilities and there was a significant relationship between tribe, religion, educational status, occupation, and Obstetrics and gynecological factors and the utilization of delivery services in the Aluu community.

Background: Delta State Contributory Health Scheme (DSCHS) was established to provide quality and affordable healthcare services to all Deltans, irrespective of socioeconomic status and geographical location. This study assessed the knowledge and satisfaction of formal sector enrollees with the Delta State Contributory Health scheme.

Methodology: This was a cross-sectional descriptive study involving 400 public/civil servants enrolled in DSCHS using a multistage sampling technique. Data was collected using an interviewer-administered structured questionnaire and was analyzed using IBM SPSS version 25.0 software.

Results: The study revealed that 207 (51.7%) of the respondents were males, while 193 (48.3%) were females. Two hundred and five (51.2%) of the respondents were within the age group of 43 - 52 years, and 353 (88.2%) of the respondents had tertiary education. Overall, 296 (74.0%) of the respondents had good knowledge, and 104 (26.0%) had poor knowledge of DSCHS; while 138 (52.1%) of the respondents were unsatisfied with DSCHS and 127 (47.9%) were satisfied with the scheme. Age (X² = 19.67; P<0.001), gender (X² = 8.53; P=0.004), education (X² = 20.52; P<0.001), marital status (X² = 14.13; P=0.001), religion (X² = 13.12; P=0.001) and years of working experience (X² = 39.66; P<0.001) was significantly associated with knowledge of DSCHS. The factors significantly associated with satisfaction with DSCHS were ethnicity (X² = 14.39; P=0.013) and years of working experience (X² = 11.23; P=0.024).

Conclusion: The majority of the study participants had good knowledge regarding DSCHS but were unsatisfied with the level of services provided by the scheme. It is therefore recommended that Delta State Contributory Health Commission should review its benefit package and urgently scale up services to improve enrollees' satisfaction with the scheme.

Background: Women are a considerable part of the population and contribute to every facet of life with significant participation in all professions, however, despite such advancements by women, there is still a gender bias in all walks of life including the medical field. This study aimed to evaluate the opportunities, challenges, and job satisfaction of women doctors in the workplace.

Methodology: This was a descriptive, cross-sectional study conducted among 165 women medical doctors living in Rivers State, Nigeria. Data was collected using a structured, self-administered questionnaire and results have been reported as frequencies and percentages for categorical variables.

Results: Of the 165 women recruited, 62(37.6%) were working as resident doctors, 43(26.1%) were medical officers and 42(25.5%) consultants. Only 85(51.5%) women reported global satisfaction in their workplace while 69(41.8%) admitted to career satisfaction. Most of the respondents agree that their career has limited the time available to spend with their family (74.5%) and their friends (78.2%) outside their working environment. The greatest challenges perceived at work include poor work-life balance in 123(74.5%) and lack of career advancement opportunities in 46(27.9%) respondents. While 112 women doctors (67.9%) had experienced insubordination from a junior male colleague in the workplace, 75(45.5%) had experienced some form of physical violence in the workplace (from staff or patients). One hundred and twenty women (72.7%) had experienced some sort of sexual harassment from both their male colleagues and male patients in the workplace, with 11(6.7%) reporting frequent sexual harassment from their male colleagues.

Conclusion: Gender disparities and bias do exist in the medical field and should be discouraged at every level. When there is a positive organizational culture and supportive environment at work, women medical professionals can offer excellent medical care and break both clinical and academic glass ceilings.

Background: Pregnancy-related acute kidney injury (PRAKI) is a common cause of AKI globally. The incidence and burden of PRAKI are still high in low and middle-income countries (LMICs) especially in Africa due to limited access to optimal obstetric care, late diagnosis, and referral. The study aimed to determine the incidence and aetiologies of PRAKI among women in the peripartum period in two government hospitals in Nigeria.

Methodology: This was a prospective study where serum creatinine was measured among pregnant women presenting in labour at 0-hour, 6 hour, 12 hour, 24 hour, 48 hour and 7 days post-delivery. AKI was defined using the Kidney Disease Improving Global Outcome criteria. Binary logistic regression was used to determine predictors of PRAKI.

Results: The mean age of the 162 pregnant women who completed the study was 30.05±1.28 years. The incidence of AKI use was 22.2%. The aetiologies of PRAKI were obstetric haemorrhage (66.7%), eclampsia (19.4%), and sepsis (13.9%). Seventeen (47.2%) patients had Stage 1 PRAKI, 12 (33.3%) had Stage 2 PRAKI, while seven (19.4%) had Stage 3 PRAKI. Factors significantly associated with PRAKI were parity (p=<0.001), caesarean section (p=<0.001), excess blood loss (p=<0.001), and prolonged duration of labour (p=0.002).

Conclusion: PRAKI occurred in 1 out 5 pregnant women in the peripartum period. Obstetric haemorrhage, sepsis, and eclampsia which are preventable or treatable are common major aetiologies of PRAKI. PRAKI is more associated with multi-parity, caesarean delivery, haemorrhage, and prolonged duration of labour. Optimal ante-natal care, health education, and prompt diagnosis and management of obstetric complications will reduce the incidence in Nigeria.

Background: The emergence of COVID-19 had a massive impact on the health system globally. While there are many kinds of literature reporting the impact on postgraduate medical training in other parts of the world, this cannot be said about Nigeria.

Methodology: This was a national cross-sectional study among Resident doctors via an online google form survey for 8-months. Stratified cluster design where the entire country was stratified into the six geopolitical zones, and Tertiary Health Institutions (THI) were randomly selected from each of these zones. Data from the 47-item google form were analysed with Statistical Package for Social Science (SPSS) version 23, and internal consistency reliability was measured by Cronbach's alpha coefficient. Categorical variables were compared using chi-square, and the p-value was <0.05.

Results: A total of 239 residents from THI in all six geopolitical zones completed the survey. The mean± standard deviation of the age of respondents, years in practice, and years in residency were 36.3±4.4); 10.2±7.6 years, and 4.2±2.6 years, respectively. The Cronbach's alpha coefficient was 0.95. Less than half had delayed the progression of residency (44.4%). The least strongly positive impacts were related to recruitments (4.2%), laboratory testing (4.2%), and ward rounds (4.2%); and the more strongly positive disruptive impact was on postgraduate seminars (9.2%), research (8.4%), professional examinations (8.0%) and residents' clinical schedules (8.0%).

Conclusion: COVID-19 has caused a considerable delay in residents' training programs, and resident doctors have great concerns regarding the pandemic. This impact is perceived by them in almost all aspects of the training.

Background: Ovarian cancer is the second most prevalent but most lethal gynaecologic malignancy in our institution. This study aimed at determining the rate of non-diagnosis in suspected lesions and reviewing the management challenges of ovarian tumours highly suspicious for malignancy in our hospital.

Methodology: A three-year retrospective review of patients' records from the ward, clinic, theatre, and histopathology laboratory was carried out. Cases with high indices of suspicion for ovarian cancer (ovarian tumour with malignant radiologic features with any of ascites, pleural effusion, as well as cachexia, anaemia, or evidence of metastasis) were included. In-depth interviews were carried out with a consultant from each specialty of Radiology, Radio-oncology, Pathology, and Gynaecologic oncology at the gynaecologic oncology multidisciplinary team meeting.

Results: One hundred and twenty-two cases of highly suspicious ovarian malignancies were seen with a mean age of 40.6 years. Of these, 28 (23%) had surgery and 77% did not have any form of histological diagnosis. Of those that had surgery, 13 (46.4%) had upfront surgery and 15 (53.6%) neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Only two cases had documented complete (R₀) debulking. Among those that had upfront surgery, one case (7.7%) was an ovarian fibroid and one (7.7%) was a fibrosarcoma while two cases (15.4%) were borderline ovarian tumours. Chemotherapy was commenced based on malignant cells on ascitic or pleural fluid cytology in three cases. Of all the malignant cases, epithelial carcinomas were commonest accounting for 48%. Aside from the general late presentation of cases, insufficient funds for treatment, poor coverage of health insurance for cancer care, unavailability of routine immunohistochemistry, lack of germline and somatic testing, non-availability or prohibitive cost of some chemotherapeutic agents, unavailability of maintenance therapies, inadequate capacity to manage toxicities, inadequate skill across all specialties, unavailability / erratic function of computerized tomography scans and unavailable positron emission tomography, lack of interventional radiology facility amongst others were all identified as challenges to management.

Conclusion: Most patients with tumours highly suspicious for ovarian cancers did not get a histologic diagnosis and probably died undiagnosed. Management of ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. Health insurance for all, infrastructure development, and training of all disciplines involved is recommended.

Background: Non-communicable diseases (NCDs) are the leading cause of death globally and diabetes mellitus (DM) is the fourth main contributor. The incidence of its complications could be reduced with high-quality care and good glycaemic control. Treatment satisfaction is an important aspect of quality of care, especially in treating chronic diseases like DM. This study sought to determine the satisfaction of diabetics with their care and to identify the relationship between patients' satisfaction and diabetic control alongside other associated factors.

Methodology: The study was a descriptive cross-sectional, hospital-based study. Respondents were admitted into the study based on inclusion criteria and selected using a systematic random sampling technique. Blood samples for fasting plasma glucose and total cholesterol were collected. Diabetic Treatment Satisfaction Questionnaire and the Patient Satisfaction Questionnaire were used to assess treatment satisfaction. The SPSS version 21.0 was used for data analysis and linear regression was used to determine the factors influencing satisfaction. The level of significance was set at 0.05.

Results: The mean total Diabetes Treatment Satisfaction score was 33.8 ± 8.2 and the mean total Short-Form Patient Satisfaction score was found to be 16.8 ± 3.6. There was a statistically significant difference between the mean satisfaction scores with treatment of diabetes mellitus and age groups (p < 0.001). There was also a statistically significant association between DM treatment satisfaction with the use of oral antidiabetic agents (p = 0.043) and the presence of complications (P < 0.001).

Conclusion: There was a significant correlation between patient satisfaction scores and other factors like accessibility and convenience, time spent with doctors, and so on. In conclusion, the study identified the use of oral anti-diabetic agents, and the presence of complications, among others as factors affecting patient satisfaction. This study, therefore, suggests improving the practice of patient-centered medicine by increasing patient satisfaction through addressing these factors.

Background: Neurological disorders constitute major causes of morbidity, and globally, they are the leading causes of death. There is a dearth of neurologists in most African countries and the very few available ones are concentrated in urban areas. The cardiovascular and communicable risk factors responsible for most cases of acute and chronic neurological disorders are also prevalent in rural areas. Although patients from the neighbouring states attend the study centre, the majority are indigent. Therefore, there is a need to observe the pattern of these disorders in Ekiti, to appreciate the disease burden as it would help in the judicious allocation of human and other healthcare resources.

Methodology: We reviewed the case files of patients seen at the neurology clinic and admitted via the emergency department into the Federal Teaching Hospital, Ido-Ekiti, over a period of 6 years (2016 to 2021).

Results: A total of 881patients were seen during the study period, and they were mostly elderly male patients with chronic disorders in which stroke was the most common neurological disorder (44.9%) followed by seizure disorder (13.1%), and neurodegenerative disorders (9.9%). Tumors and myopathies were the least seen disorders.

Conclusion: Health literacy on cardiovascular risk factors and even the distribution of manpower and material resources will help reduce the burden of neurological disorders among the attendees of the Ekiti tertiary health institution.

Background: Yellow fever (YF) outbreaks continue to occur in Nigeria with a high mortality rate despite a well-established mode of transmission and the availability of a potent vaccine. This review is aimed at describing the epidemiology, determinants, and public health responses of yellow fever outbreaks in Nigeria from 1864 to 2020.

Methodology: The guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review from November 2020 to April 2021. PubMed database, WHO library databases, and Google Scholar were used to search for relevant published materials including original and reviewed articles, conference papers and case reports from 1864 to 2020.

Results: Forty - eight articles and reports were included in the final reviews. Twenty - three outbreaks were described involving 33,830 suspected, presumptive, or confirmed cases of yellow fever and 8,355 deaths. The outbreaks occurred in every state of Nigeria including the Federal Capital Territory mostly during the rainy season. Low immunity in the population or low vaccination coverage, poor vector control, rainforest or savanna vegetation, rural-urban migration, and imported virus by travelers were common determinants noted. Public health responses have been through, centrally coordinated laboratory support, case management, emergency immunization, vector control, and surveillance.

Conclusion: Yellow fever outbreaks have increased in frequency and geographical spread with associated mortality rates. To stem the tide, mass immunization with 17D vaccines is encouraged, planned urbanization with adequate vector control measures enforced, effective case definition, vector surveillance, and effective awareness campaigns should be emphasized.