A growing line of research indicates a relationship between a healthcare organization's culture and various performance measures. In these studies, a key cultural characteristic is the interest placed on staff teamwork. Few studies have examined teamwork culture relative to patient satisfaction, which is one of the most widely used performance measures for healthcare organizations. This study aim to assess staff ratings of teamwork and patients' satisfaction with health care quality at six specialist outpatient clinic settings in the University of Abuja Teaching Hospital, Gwagwalada - Abuja. Surveys of staff perceptions of teamwork were then compared to patient satisfaction survey scores for strength and direction of correlation. Regression analysis measured the degrees of strength and correlation between subset scores of teamwork to the patient satisfaction scores. The findings from the study indicated good team work perception among staff and patients' satisfaction with quality of health care received in the clinics. In some of the clinics, staff ratings of teamwork was positively correlated with patients' satisfaction with care quality while a negative correlation was found in others. However, the differences in relationships were not statistically significant. Teamwork subsets of situational awareness (monitoring) and mutual support significantly impacted patient satisfaction. Our study showed that clinic types do not influence the relationship between staff teamwork experiences and patients' satisfaction. However there is the need to emphasize situational awareness (monitoring) and mutual support among clinic staff working together with a view to build constructively on team work experience. Key words: Teamwork, patients' satisfaction, Staff, clinics, Relationship.
Synchronous bilateral breast carcinoma (SBBC) is rare manifestation with an incidence ranging from 0.2% to 12%. The prognosis of the disease, its histopathological characteristics, and the molecular behaviour remain unclear. However, many studies have indicated independent chromosomal abnormalities from the two cancers that show an increase CXCR4 receptor expression with a high tendency of visceral metastasis. To date there are no standard protocols for treatment of SBBC and these pose challenges in interpreting survival data and recurrence. A 39-year-old female para 5+1, four alive presented with a 2-year history of a left breast lump and one-year history of a right breast lump. Both lumps were painless and progressively increased in size. The breasts show lumps at the upper outer quadrants measuring 7 x 6 and 6 x 5cm for left and right breast respectively, the overlying skin shows peud'orange. Biopsies confirmed SBBC with a discordant histology with triple-negative hormonal status. The patient had bilateral radical mastectomy and chemotherapy. We present a case of SBBC to re-emphasize the significance of screening for contralateral breast in patients who present with unilateral breast cancer. The standard treatment guideline is still lacking in the management of SBBC worldwide, therefore, multi-institutional prospective studies with long time follow-up of the patients are required for a better management of SBBC.
Unintended pregnancies with associated unwanted consequences may result from discontinuation of oral contraceptive method. An understanding of the causes of discontinuation will help in proffering necessary solution. To determine the prevalence rate, side effects, discontinuation rate, reasons for discontinuation of oral contraceptive pills (OCP) at the Rivers State University Teaching Hospital (RSUTH). A retrospective study in which records of acceptors of oral contraceptive pills in the family planning unit of RSUTH from 1st January, 2015 to 31st December, 2019 were reviewed. The collated data was analysed using Statistical Package for Social Sciences (SPSS) IBM version 25.0 (Armonk, NY). Of 874 acceptors of contraceptives within the study period, 53 clients accepted and used oral contraceptive pills (OCPs) giving a prevalence rate of 6.1%. The modal age group was 25-29 years accounting for 21 (39.6%). Age range was 19-41 years and the modal parity was para 1. All the clients had formal education, 45 (84.9%) were married, and 32 (60.4%) were multipara. The discontinuation rate was 20.8% and the reasons for discontinuation were pill burden 3 (5.7%). Others which include bloating, headache, rashes and weight gain contributed 2 (3.8%) each. Forty two (79.2%) clients did not have any complaints. There was no unintended pregnancy recorded among the study group. The prevalence and discontinuation rates of OCP were low. Pill burden was the commonest side effect and reason for discontinuation of this safe and effective method of contraception. Key words: Oral contraceptive pills, uptake rate, side effects, discontinuation rate, RSUTH.
Sickle cell nephropathy is a common complication of HbSS. Several risk factors have been found to be associated with the development of progressive chronic kidney disease. Serum uric acid is usually elevated in patients with chronic kidney disease. This study evaluated the prevalence of hyperuricemia among HbSS patients and determined the association between hyperuricemia and the risk of progressive kidney disease among HbSS patients in northeastern Nigeria. The study is a single centre cross sectional study conducted in the sickle cell clinic of University of Maiduguri Teaching Hospital, northeastern Nigeria. Study participants consisted of HbSS participants sequentially recruited from January 2013 to April 2018. Socio-demographic and clinical variables were obtained from each participant. Glomerular filtration rate was calculated using the modification of diet in kidney disease (MDRD) equation and staged based on KDOQI classification. Participants with eGFR 419mmol/L were considered elevated. Out of a total of 261 participants that were seen in the sickle cell clinic during the study period, 217 had complete data set and were included. The prevalence of hyperuricemia was 62.3% among the study population. Sixty-three (57.8%) patients with hyperuricemia had chronic kidney disease whereas 16 (19.5%) patients with normal serum uric acid levels had chronic kidney disease. ODDS ratio of chronic kidney disease in hyperuricemic patients was 2.38(95% CI 1.98 – 3.01). The mean PCV in patients with hyperuricemia and those with normal uric acid levels were 17.71 ± 4.93 and 23.26 ± 5.43 respectively (p=0.000). There were significant differences between patients with normal and elevated serum uric acid levels and serum creatinine (109.71±96.99µmol/L vs 204.11 ± 194.42µmol/L, p=0.000); urea (6.41 ± 6.72mmol/L vs 10.75 ± 6.56mmol/L, p=0.000). This study has shown that hyperuricemia is common among HbSS patients and it is associated with the development of progressive chronic kidney disease among HbSS patients.
Childhood malignancy is fast becoming an important paediatric problem in Nigeria. To determine any change in trends of childhood malignancies seen among patients admitted into the paediatric wards of a teaching hospital in Sagamu, Nigeria. Ten years retrospective study from 2009 to 2018 of all children hospitalised with malignant conditions aged up to 18 years diagnosed by means of histological or cytological examination. Eighteen cases of childhood malignancies were seen during the ten years period accounting for 0.88% of all admissions into the paediatric wards and giving an average of 2 cases per year. The peak age group of children with cancers was 5 - 9 years (range 1 - 13 years). Male to female ratio is 1:1. The most common childhood malignancy was lymphomas accounting for 27.8%, followed by acute leukaemia (22.2%). About one-tenth of the patients diagnosed with malignancy died in the course of therapy from advanced disease or complications of therapy. Childhood cancers are not uncommon in a Nigerian setting. Lymphomas still remains the most common childhood cancer. Case fatality rate was high among children with cancers in this study. Mobilization of human and material resources towards childhood cancer management is advocated. Lymphomas remains the most common childhood cancer as previously reported. Case fatality was high in this study. Mobilization of resources is advocated.
Bone marrow aspiration is considered one of the most valuable diagnostic tool for evaluating hematologic disorders in both developing and developed countries. The objective of this study was to determine demographic pattern of hematological disorders on bone marrow aspiration examination and review the clinical justifications for physician referral. A retrospective analysis of bone marrow aspiration cytology reports of patients referred to Hematology department of Irrua Specialist Teaching Hospital between January 2010 to May 2014. Results analyzed using Statistical Package for the Social Science (SPSS) version 16.0. Bone marrow aspiration reports from 104 patients for the period spanning from January 2010 to May 2014 were reviewed . Male sex predominate (67.3%) (70 of 104) in the study with female representing (32.7%) (34 of 104). The mean age was 35 ± 1.5 years ranging between 3 to 90 years . Both right posterior superior iliac spine (RPSIS and left posterior superior iliac spine (LPSIS) constitute 41 % each of the sites for aspiration. Of the total aspiration done, Ninety-five (95) revealed pathologic findings while five (5) had normal appearance. The commonest pathologic findings were mixed deficiency anemia 35 (33.6%) followed by megaloblastic anemia (MA) 15(14.4%). Lymphadenopathy was the commonest indication with normal bone marrow findings accounting for (40%) ( 2 of 5 ). The most commonest indication for bone marrow aspiration (BMA) was (76.9%) (80 of 104) followed by thrombo-cytopenia (44.2%) (46 of 104). Bone marrow aspiration plays a vital role at the diagnosis of various hematologic disorders. Common hematologic disorders in our environment are mixed deficiency anemia and acute leukemia. There is need for more emphasis on expanding the scope of laboratory investigations beyond morphology and a closer collaboration amongst all specialties in consulting on patients that would require hematologist reviewed for diagnosis and treatment of hematological disorders. Keywords: Bone marrow aspiration, Hematological disorders, Physician's referral, Epidemiology.
Burkitt's lymphoma (BL) is the most highly aggressive and rapidly growing tumour ever known in humans that appears to occur in three histologically and phenotypically identical but clinically distinct forms; endemic, sporadic and the immunodeficiency-associated variant. There is considerable overlap among these distinct variants. The endemic form is most commonly observed in equatorial Africa, in children aged 4-7 years, with frequent involvement of the mandible and facial bones. In contrast, in other geographic regions, most patients present with abdominal tumours and have no specific geographic or climatic distribution. An 8-year-old Negro boy presented with swelling on the right side of the neck for three weeks, with a progressive increase in size. He had drenching night sweat, but no associated fever. No history was suggestive of congenital immunodeficiency syndrome. Examination of the neck revealed right-sided cervical lymphadenopathy that was firm and matted, not tender, nor other features of inflammation. Histology showed nodal architecture that was effaced by malignant lymphoid neoplasm with prominent nucleoli and scanty cytoplasm, as well as brisk mitotic activity with numerous macrophages in an inflammatory background. The immuno-histochemical profile of the tumour was CD20 and CD10 positive with BCl-2 and CD15 negative. Human immunodeficiency virus serology was negative. Burkitt’s lymphoma arising exclusively from lymph nodes may mimic tuberculous adenitis while a potentially curable tumour, with cautious use of appropriate combination chemotherapy, its treatment is quite distinct from that of tuberculosis. Cheaper generic formulation are readily available. It is conceivable to conclude that with efficient supportive therapy, BL is no longer life-threatening cancer in children.
Blood transfusion is usually a lifesaving and therapeutic intervention.However, many preventable errors (especially transfusion transmissible infections) may make this a harmful procedure. Most of these transfusion transmissible infections are caused by viruses. In this study, sero-prevalence of two viruses (rubella and cytomegalovirus) that are usually overlooked in transfusion medicine were determined in Lagos state, Nigeria. This is a cross sectional study which took place at Lagos University Teaching Hospital (LUTH). Consented and eligible blood donors at LUTH were purportedly selected daily until 181 donors were recruited. A structured questionnaire was used as data collection tool. Samples were analyzed in batches using ELISA method. Out of 181 blood donors that participated, male blood donors constituted 87.8% (159) while the females were only 22 (12.2%). The sero-prevalence of Rubella IgG was 87.8% while that of Rubella IgM was 0.0% and anti-CMV IgM was 11.0%. There was a significant association between gender and rubella infection (p=0.03). Routine pre-donation screening for anti-rubella and anti-CMV antibodies might not be cost effective as few donors were sero-negative to these viruses. Key words: Rubella, CMV, IgM, IgG, Sero-prevalence, blood donors
There is a dearth of information on depression and anxiety among Nigerian SCA population. This study objective was to determine the prevalence of depression and anxiety as well as establish their relationships with pain among a Nigerian population with SCA. This was a cross-sectional study that included 226 SCA individuals. A well-structured socio and clinical demographic questionnaire, Wong-Baker FACES pain rating scale, and Hospital Anxiety and Depression Scale (HADS) were data collection instruments utilized. The data were subjected to frequency distribution, cross-tab and logistic regression analyses in SPSS® v20 IBM, USA. Overall, 226 individuals with SCA including 111 males (49.1%) and 115 females (50.9%) with mean age 28.9 ± 8.5 years (range 16-50 years) were recruited into this study. The prevalence of anxiety and depression symptoms among Nigerian SCA cohort is 49.5% and 30.5% respectively. Additionally, about 70% and 46.0% of SCA individuals with pain had abnormal anxiety and depression score. Statistically significant chi-square value for anxiety (χ2 = 58.573; Cramer's V = 0.509; P value = 0.000) and depression (χ2= 39.175; Cramer's V = 0.416; P value = 0.000) showed strong association with pain index. Logistic regression analysis revealed the odds of anxiety (OR = 3.430; 95% CI = 1.321-8.906; P value = 0.011) and depression (OR = 3.612; 95% CI = 1.251-10.427; P value = 0.018) event occurring with pain (relative to no pain). Finally, the prevalence of pain, anxiety and depression among Nigerian sickle cell anaemia cohort is high. Moreover, pain is a significant predictor of the risk of falling into anxiety and depression.
The first case of COVID-19 in Nigeria was confirmed on February 27, 2020. Since then, many studies from government designated isolation centers have described the characteristics of patients with Covid-19. Even though COVID-19 testing and management are exclusively carried out at the NCDC-approved centers, majority of patients are referred from primary care facilities, both public and private owned. To our knowledge, there has been no studies regarding Covid-19 disease among the patients served by these centers. Our aim is to describe the clinical characteristics and outcome of COVID-19 cases seen at Olanrewaju Hospital, Ilorin, North Central Nigeria. This is a descriptive retrospective study of patients with confirmed COVID-19 seen over a one-year period. Records of all patients that tested positive using the real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) were retrieved to extract relevant information. Data was analyzed using Epi Info 7.48 patients were analyzed. The mean age (standard deviation) was 50.0 years (17.89). Male sex predominates (58.3% vs 41.7%). Majority of patients were symptomatic (93.7%). Fever was most common presentation (75.6%). Shortness of breath was experienced by 11 patients (24.4%). Co-morbidities were found among 75% of the patients with hypertension being the commonest (45.9%). There were 6 deaths (12.5%), 5 of which occurred in the older age patients. Case fatality rate was significantly higher during the first wave than during the second wave 40% vs 5.6%, p < 0.05. The male gender, co-morbidities and older age groups are particularly prone to severe covid-19 infection with poorer outcome.
The World Health Organization (WHO) ranks diarrhoeal disease as the second most common cause of morbidity and mortality in children in the developing world. This study aimed at detecting the prevalence of rotavirus infection among apparently healthy children in Jigawa State. A total of 286 samples were randomly collected. These samples were assayed for rotavirus antigen using ProSpectEnzyme Linked ImmunoSorbent Assay (ELISA) kit. The study revealed that 61(21.3%) samples were positive for rotavirus antigen. There was higher prevalence rate among male children 31(11.0%) than females 30(10.3%) (p>0.05). The highest and lowest detection rates in rotavirus infection of 59%(36/61) and 3.3%(2/61) were found among children aged 0-3 years and 12-15 years (p>0.05) respectively. Most of the positive samples were during the cold dry season (42.6%) (p<0.05). The highest rate of rotavirus infection 30/61 (47.5%) was found among children who were from South West Area of Jigawa state. This study recommends the introduction of rotavirus vaccine into the Nigerian routine immunization programme and advocate parents to encourage their children to practice personal hygiene to avoid spread of rotavirus infection.
The breast which is a highly radiosensitive organ has an increased risk of secondary malignancy in the contralateral breast (CB). As a result, the CB is regarded as an organ at risk during treatment. In this study, the contralateral breast dose for patients undergoing radiotherapy treatment of breast cancer was measured and analyzed. Thirty women aged over 18 years with invasive ductal carcinoma (T1-T2, N0) for 10 lumpectomy patients and (T3, N2) for 20 mastectomy was treated with radiotherapy for five days on a Cobalt-60 teletherapy unit within a period of three months. Medial tangential and lateral tangential fields was planned for lumpectomy patients while medial tangential, lateral tangential and supraclavicular was planned for mastectomy patients. Three TLD chips were placed on the surface of the contralateral breast for each patient, using the nipple as a reference point. The dosimeters were measured and compared with reference to surgery type, field size, depth and overall exposure time. The percentage mean dose evaluated at the medial and lateral side was 235.47% and 16.61% respectively for mastectomy patients; 135.27% and 12.21% respectively for patients with lumpectomy. 208.90% and 15.32% at the medial and lateral sides for a large field size, 186.13% and 14.73% respectively for a small field size. At short exposure time, the percentage mean dose measured was 207.70% and 14.19% at the medial and lateral sides and for long exposure time, 173.90% and 19.90% respectively. The findings in this study indicated that the contralateral breast is at risk of secondary malignancy, with the medial side experiencing a significant dose contribution in comparison with the lateral side of the breast.
In the article titled “DETERMINANTS OF ANTIRETROVIRAL THERAPY ADHERENCE AMONG HIV‑INFECTED ADOLESCENTS ATTENDING A TERTIARY HEALTH FACILITY IN ABUJA, NIGERIA” published on pages 80 – 87, issue January to March 2020, Volume 29 No (1), of Nigerian Journal of Medicine[1] the authors’ names were incorrectly written as “E EkopEno”, “A Okechukwu Adaora” and “I Airede Kareem”.The name of the author “E EkopEno” should read correctly as “Eno E. Ekop”.The name of the author “A OkechukwuAdaora” should read “Adaora A. Okechukwu”.The name of the author “I Airede Kareem” should read “Kareem I. Airede”.
To describe the characteristics and determine gender differences of accident cases reported at the Accident and Emergency Department (AED) of University of Port Harcourt Teaching Hospital (UPTH), Nigeria from January 1, 2013, to 31st December 2017. A descriptive retrospective study employing a systematic sampling of one-in-five patients in the AED nurses register of the UPTH. Patients' demographics, referral departments, and injury classification were extracted from the case files. Data was analysed using frequencies and Chi-square. Four hundred and forty-six patients [male (n=307, 68.8%)] were selected out of 2234 cases. The highest number of accidents (54.2%) occurred among patients aged 21- 40 years. About 67.9% were road traffic accidents (RTA), 23.4% as domestic accident and 8.7% reported as occupational accident. The highest number of accidents (n=157) occurred in 2013 and January/April (n=56 each). Accident cases were classified as head injuries (24.7%) and referred to the orthopaedic department (33.6%). A chi-square showed a significant interaction [χ2= (2) = 25.73, p<0.00001], indicating that male patients (73.6%) suffered more head injury than female (26.4%). Male patients had RTA (73.6%) and occupational accident (84.6%) than female patients. This study's findings should be treated as hypothesis-generating results, as we did not evaluate the total number of cases reported in the AED. Therefore, these findings should be interpreted with caution. There is a need to develop a more extensive population-based epidemiological study to explore the predictors of accidents reported in Nigeria's hospitals. Regardless, road traffic accidents seem to be the leading cause of accident presented at the A & E of UPTH, occurring mostly at the year's festive periods. Occupational health hazard was less reported. Efforts to reduce road traffic accident, especially during the festive periods, is highly recommended.
Oral and dental diseases have a growing impact on the health and wellbeing of people in the West African sub-region and in particular on vulnerable and marginalized groups of population among who are children. One of the ways of making dental care affordable and accessible is through the provision of health insurance. Unfortunately, oral health has not been properly positioned in the National Health Insurance Scheme (NHIS). In Nigeria, the teaching hospitals play an important role in the health insurance scheme by delivering comprehensive oral and dental health services as the primary care facilities are only accredited to render oral and dental care education. This paper which is a two year retrospective cross sectional study of records of children who received care at the Child Oral Health Clinic of the University of Abuja Teaching Hospital examined the pattern of oral and dental diseases managed among the insured enrollees. Dental carries and its sequelae were found to be the most prevalent dental pathology constituting 69.3% of the study participants especially among children aged 6-10 years. Our study showed no significant difference in prevalence between the various dental pathologies across gender (p-value = 0.194) and age groups (p-value = 0.562). It is important that the scope of NHIS dental care at the primary care level be expanded from just dental health education to include at least services without clinical intervention on dental caries. There is the need for formulation of insurance policies that will make dental health, especially prevention of dental caries compulsorily accessible to children of primary school age.
In the article, Comparative Analyses of three Radiographic Dental Age Estimation Methods Amongst Nigerians which appeared in the pages 403-412, issue 4, Vol. 28 of the Nigerian Journal of Medicine, We acknowledge the support of Dr O. Sigbeku and other faculties in the Department of Oral Pathology of the University of Ibadan/University College Hospital, Ibadan towards accomplishment of this work. REFERENCE1. Olaopa O. I, Gbolahan O. O, Okoje V. N, Mellikam S., Oyelaran P.O. Comparative Analyses of Three Radiographic Dental Age Estimation Methods Amongst Nigerians. Niger JMed2019 : 403-412 183
