Background: Cardiomyopathies are myocardial disorders in which the heart muscle is structurally and functionally abnormal, thereby affecting the ventricular systolic function and/or diastolic function. Comprehensive approach to management warrants recognizing the clinical profile in order to strategize to improve outcomes. Aim: To evaluate the types of cardiomyopathies, presentation and outcome among children admitted into a tertiary hospital in Sokoto. Methods. A hospital based prospective study of children aged below 15 years who were seen over an 8.5-year period. A proforma was used to collect the information on their socio-demographics, type of cardiomyopathy, associated presentations and outcome. Data was analysed using IBM SPSS version 25. Results: 71 out of 78,321 children seen that period (0.1%) were diagnosed with CM giving a hospital prevalence of 90.7/100,000. They comprised 40 (56.3%) males and 31 (43.7%) females. Age ranged from 1 month to 15 years (6.2 ± 3.8 years). Dilated CM (DCM) was the commonest in 63 (88.7%), restrictive CM (endomyocardial fibrosis-EMF) in 5 (7.0%) and hypertrophic (HCM) in 3 (4.2%). Forty-six (73%) of DCM had severe systolic dysfunction. DCM also occurred in 2 siblings of 2 patients on follow up. Two of the patients with EMF had recurrent pericardial effusions and all the patients with HCM died in infancy. Thirty (42.2%) of the total patients were lost to follow-up while 27 (38.0%) died. Conclusion: Dilated cardiomyopathy followed by restrictive type are the commonest types seen among children in Sokoto. It is associated with high morbidity and mortality.
The coronavirus disease-2019 (COVID-19) has been declared a global pandemic by the World Health Organization due to its spread to more than 90% of nations of the world with significant consequences on their health, social structure, and economy. The causative agent, severe acute respiratory syndrome coronavirus 2, is a highly contagious virus of the coronaviridae family that is known to survive on many surfaces for days at various temperatures. It is acid stable at a high titer (1.2 × 103 PFU) for up to an hour and inactivated when exposed to temperatures 33°C and above for up to 30 min. Chemical agents such as ethanol, diethyl ether, chlorine, per-acetic acid, and chloroform likewise inactivate it as well as exposure to ultraviolet (UV) rays at 254 nm. Emerging evidence indicate that while modes of transmission of the disease are the same across the globe, incidence rates, clinical manifestation, severity, and outcome of COVID-19 in tropical Africa differ from other continent. Patients in Africa have presented with less severe symptoms, higher rates of recovery, and lower case-fatality rates. There are suggestions that higher environmental temperature and humidity in African countries, immune status, dietary pattern, and sociocultural practices of the people may have contributed to this. This review of literature sought to investigate the probable influence of these factors on the impact of COVID-19 in Africa with recommendations to mitigate its spread and impact on morbidity and mortality.
Background: Birth preparedness and complication readiness remains one of the important strategies for reducing maternal mortality. One of its important components is knowledge of obstetric danger signs (KODS). The KODS is as important to men as it is to women, especially in African countries where majority of the household heads are men and are the major decision makers. Objective: The objective of the study was to determine the KODS among the household heads of Nasarawan Buhari, Nigeria. Materials and Methods: A cross-sectional community-based descriptive study was conducted among 104 household heads (or their representatives) of Nasarawan Buhari, Giwa Local Government Area Kaduna State, Nigeria, from April 15 to May 10, 2019. Data were collected using pretested semi-structured interviewer-administered questionnaires. Data were analyzed using IBM SPSS version 25 (2017). Results: Majority of the respondents were aged between 40 and 49 years, with a mean age of 40 ± 12.6 years. The overall KODS was poor (70.2%). After controlling for confounders, the only determinant of good KODS was the age of respondents. Household heads older than 30 years were more likely to have good KODS than those younger than 30 years (odds ratio 1.04, 1.001–1.07). Conclusion: The overall KODS among the respondents was poor, while the age of respondents was a determinant of having good KODS. The Authority of Giwa Local Government Area Council (LGC) of Kaduna State should design and implement a program aimed at educating the household heads in the LGC.
Background: Malaria is a major cause of mortality among children. Objective: This study determines the clinical profile, outcome (discharge and death), and factors associated with poor outcome in children with severe malaria in a tertiary health facility in Northern Nigeria. Methods: We conducted a descriptive retrospective study of all children (≤14 years) admitted with severe malaria based on positive malaria parasite on thick film and or rapid diagnostic test and the World Health Organization guideline for severe malaria. We extracted relevant data from patients’ case files and departmental records and analyzed with the Statistical Package for the Social Sciences (SPSS) for Windows, version 20.0. (IBM Corp, Armonk, NY). Results: A total of 483 children with severe malaria were admitted with median age interquartile range of 4.0 (2.5–8.0) years. Males were 261 (54.0%). Underfives were 258 (53.4%). Common forms of presentation were cerebral malaria 169 (35.0%), prostration (102; 21.1%), and multiple convulsion (86; 17.8%). Cerebral malaria and prostration were significantly higher among children aged 5 years and older. The mortality rate was 4.3% (21). Multivariate logistic regression analyses showed that impaired consciousness (adjusted odds ratio [aOR] 8.5, 95% confidence interval [CI]: 2.345, 30.484), hypoglycemia (aOR: 21.4, 95% CI: 2.766, 165.410), presence of two or more components (aOR: 4.5, 95% CI: 1.630, 12.522), and duration of hospitalization of 24 h or less (aOR: 4.6, 95% CI: 1.621, 12.782) were independent predictors of poor outcome. Conclusion: Our study showed that cerebral malaria was the most common form of severe malaria with a significant burden in children above 5 years. The presence of impaired consciousness, hypoglycemia, multiple components, and duration of <24 h on admission were predictive of death.
Introduction: Osteoarthritis (OA), a disease process characterized by progressive softening of the articular cartilage, sclerosis of subchondral bone, and cyst formation often affects the knee joint. Although OA has traditionally been interpreted as wear and tear, its etiology is now thought to be multifactorial with both biomechanical and metabolic factors implicated. Of the metabolic factors, leptin a glycosylated peptide hormone produced by the adipocytes has received major attention because of its correlation to body size. The aim of this study was to determine the correlation between the clinical severity of knee OA and serum leptin in obese patients. Materials and Methods: This was a prospective study; recruiting 100 patients (50 obese and nonobese patients) with OA of the knee joint. The severity of knee OA was ascertained using the WOMAC scoring system, and serum leptin of all patients was determined. Results: The age group most commonly affected by knee OA was 51–60 years. The mean serum leptin level in nonobese patients was 4.88 ± 5.08, compared to 20.11 ± 15.04 in obese patients. There was a statistically significant correlation between the severity of knee OA (using WOMAC score) and serum leptin level; P = 0.001. Conclusion: This study shows a statistically significant positive correlation between serum leptin and severity of clinical symptoms in obese patients with knee OA.
Background: The success of induction of labor is dependent on how favorable the cervix is and the unripe cervix thus remains a well-recognized impediment to the successful induction of labor. Objective: The objective is to compare the efficacy of 50 ml versus 30 ml fluid inflation of Foley catheter balloon for cervical ripening in postdate nulliparous women billed for induction of labor. Materials and Methods: A comparative analytical study with randomization involving 88 nulliparous women with postdated pregnancy requiring cervical ripening prior to induction of labor was carried out from January 1, 2018, to August 31, 2018. They were randomized into Group A consisting of women who had 50 ml (study) and B who received 30 ml (control). Bishop score was assessed 12 h later. Data were entered into a pro forma and analyzed using the IBM Statistical Package 20. Results: A total of 88 patients participated in the study. A statistically significant higher mean change in Bishop score was observed in the study group when compared to the control group (5.6 ± 2.5 vs. 3.1 ± 1.6, P = 0.0001), and the difference was statistically significant. Similarly, 41 (93.2%) patients in the study group had a favorable cervix post-ripening, while in the control group, 30 (68.2%) patients had a favorable cervix (P = 0.003). More of the control group had repeat Foley catheter insertion compared to the study group (31.8% vs. 6.8%, P = 0.008). Conclusion: The use of 50 ml of fluid to inflate Foley catheter balloon for cervical ripening improves Bishop score better than the smaller volume of 30 ml.
Juvenile aggressive ossifying fibroma occurs in early life, and approximately 79% are diagnosed before the age of 15 years. Approximately 85% of cases were found in the face, while the calvarium and extracranial sites accounted for 12% and 3%, respectively. We present three females with psammomatous juvenile aggressive juvenile ossifying fibroma (JOF) of the maxilla diagnosed in our institution. While two of them were children of 11 and 12 years, the third was a 30-year-old. The histological type of JOF in all the three cases was the psammomatous type. They all had surgery with one of them having a radical maxillectomy.
Background: Obstetric fistula (OF) continues to be a major health problem in developing countries such as Nigeria. It is a communication between the vagina and bladder/rectum following prolonged obstructed labor that leads to urine/and fecal leakage per vaginam. There is a paucity of information on cost of accessing care by women with OF. Objective: The study was to evaluate the cost implications of accessing care and treatment among women with OF in the National Obstetric Fistula Centre, Ningi Bauchi, state. Materials and Methods: A prevalence-based cost-of-illness approach was employed in this study to estimate the cost of fistula treatment from the patients' perspective. Data on costs of health-care utilization of services rendered to the patients in the facility and indirect costs were estimated. The data were analyzed with the Statistical Package for the Social Sciences (SPSS V21). Results: A total of 75 women participated in the study. The total costs incurred by all the 75 patients amounted to Nigerian Naira (NGN) 8211640.00 (USD 26923.41). The average cost of accessing care for fistula per patient was NGN109488.50 (USD 358.98). Direct cost accounted for 5751740.00 (USD 18858.16), whereas the indirect cost was 2785600.00 (USD9133.11). There was a significant difference in cost of care between patients that were teenagers compared to those who were not (P = 0.04) and the type of treatment (P < 0.001). Conclusions: The cost of illness of OF is high in the studied area, and the patients are from the low socioeconomic background. Both the direct and indirect costs were high relative to the national minimum wage in Nigeria. The age of the patients and the type of treatment received by the patient accounted for the differences in cost of illness between the patients.
Background: Offspring of hypertensive parents have been reported to have alteration on their sympathovagal balance and have exaggerated response to stressful conditions. Many Christians observe a period of fasting at the beginning of every year, which imposes some stress on their bodies. Objective: This study aims to investigate the effect of 21-day intermittent fasting on some cardiovascular parameters in offspring of hypertensive and normotensive parents. Materials and Methods: Eighty young adults (20–28 years) were divided into equal number of male and female offspring of hypertensive and normotensive parents based on questionnaire. Their body weight, height, waist circumference (WC), body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded 1 week before the fasting period began and then weekly for 3 weeks, in which they fasted. Results: The weight, BMI, and WC reduced during fasting, but the reductions were not significant (P > 0.05). The SBP and DBP were higher in male offspring of hypertensive parents than all other groups. SBP was also significantly (P < 0.05) higher in males than females before fast and during fast. Fasting significantly reduced the SBP in the male offspring of both hypertensive and normotensive parents. The HR reduced in the females during fast but increased from a lower level in males to a value not significantly different from prefasting level. Conclusion: Fasting reduces the high SBP and DBP in male offspring of hypertensive parents, which is beneficial to their cardiovascular system.
Kwashi tremors or Kwashi shakes are uncommon neurological complications of unknown etiology seen in edematous forms of severe acute malnutrition (SAM) during rehabilitation phase of treatment. Four patients with SAM seen in our facility within a 30-month period who developed coarse tremors are presented. The aim was to highlight this uncommon presentation of SAM in our setting. Of the four patients, 3 were male and 1 was a female. Their age ranged from 19 months to 2 years and they weighed between 5.5 and 8.7 kg. Their common clinical presentation included body swelling, loss of appetite, fever, and tremors which developed after discharge. All the patients had increased/overzealous protein intake while at home. The tremors resolved completely in all the patients, but more slowly in two of the patients with hypocalcaemia. In conclusion, Kwashi shakes occurring during rehabilitation of edematous SAM with increased protein intake and appears to be worsened with hypocalcemia
Framing COVID-19 pandemic as mass killer and existential public health emergency/threat in Nigeria with 2,120 COVID-19-related deaths in over 14 months of the pandemic in the country is problematic, especially as other public health conditions kill more Nigerians annually. In 2018, for example, malaria and road traffic accident caused 97,200 and 38,902 deaths, respectively, while HIV/AIDS caused 43,000 deaths in 2019. Therefore, rushing into an extensive vaccination campaign projected to cost 540 billion naira when 76.03 billion naira was allocated for primary health services nationwide including other major immunization programs in the 2021 federal health budget could raise question of priority/effective spending. Especially with COVID-19 deaths relative to reported cases (case fatality ratio) declining to 1.30% by June 30, 2021 from 3.45% in April 2020 and daily mass deaths non-evident. Temporizing to understand how the pandemic evolves especially in jurisdictions with higher need could be cost-effective.
Background: Globally, brain drain (BD) phenomenon has been an issue for decades in healthcare industry. However, the magnitude of BD syndrome and its impact on medical workforce crisis in a medically challenged environment has been the subject of great interest in the recent years, with apparently glaring effects on the medical workforce. Aim: The study was aimed at describing the push, pull, and stick factors, benefits, and preventive measures for BD among medical practitioners in Abia State, Nigeria. Subjects and Methods: This was a cross-sectional study carried out on 185 medical practitioners in Abia State, Southeastern Nigeria. Data collection was done using pretested, self-administered, and structured questionnaire that elicited information on push, pull, and stick factors, benefits, and preventive measures for BD. The plan to leave Nigeria and preferred foreign countries were also studied. Results: The age of the participants ranged from 26 to 72 (36 standard deviation 8.4) years. There were 159 (85.9%) males. One hundred and twenty-seven, 127/185 (68.6%) study participants had plans to leave the country with the most preferred countries of destination being Canada, United States, United Kingdom and Australia. The most common push factors from Nigeria and pull factors from abroad were similar and included poor income, wages, and salaries in all the participants 185/185 (100%). The most predominant stick factor was family-centric reasons, 126/185 (68.1%). Family and national family remittances were the main benefits, 185/185 (100%) for each while the most common pull factor was higher income, wages, and salaries abroad, 185/185 (100%). The most predominant stick factor was family-centric reasons, 126/185 (68.1%). The greatest benefits were family, 185/185 (100%), and national, 185/185 (100%), financial remittances. The most recommended preventive measures were enhanced income in Nigeria, 185/185 (100%). Young adult age (P< 0.001), male (P < 001), and duration of practice <10 years (P < 0.001) were significantly associated with the plan to leave the country. Conclusion: These findings demonstrates that about 70% of Nigerian medical practitioners plan to leave the country for abroad. The major underlying factors for brain drain include enhanced income in the destination country capacity for financial remittances to the family and nation.
Background: Infusions must be administered as prescribed as too fast or slow a dose could have deleterious effects. Objectives: This study examined the risk for macrodrip infusion dose error among nurses in selected tertiary hospitals in southern Nigeria. Materials and Methods: This cross-sectional study was conducted in five university teaching hospitals in 2019. To establish the drop factor of commonly available macrodrip sets, 25 macrodrip sets were randomly sourced from the hospitals' pharmacies. A sample of 291 nurses was selected using proportionate random sampling technique. Data were collected using the adult infusion dose calculation quiz. Collected data were described and analyzed at 5% level of significance. Results: About 20 (80%) of the sampled macrodrip sets revealed 20 drops/ml (gtts/ml) drop factor value displayed on the packaging. When measured experimentally, all (100%) of the macrodrip sets delivered exactly 20 gtts/ml. About 255 (87.6%) respondents calculated macrodrip infusion dose while using a wrong drop factor of 10–18 gtts/ml while an additional 12 (4.2%) could not arrive at the expected infusion dose due to formula and arithmetic anomalies. In all, 267 (91.8%) respondents demonstrated tendency for infusion dose calculation error. Nonattendance of training on infusion administration significantly increased the risk for error by 21% (P = 0.001). Conclusion: Twenty gtts/ml is the drop factor of common macrodrip sets in southern Nigeria, and nurses were prone to infusing patients at a lower dose than prescribed. Attending training on infusion therapy might remedy this malady.
Background: Transfusion-transmissible infections (TTIs) in blood donors increase the risk of acquisition of these infections in blood and blood products recipients. Sensitive screening methods reduce the risk of transmission of TTIs to blood and products recipients. Objectives: The study sought to determine the prevalence of TTIs among voluntary non-remunerated blood donors (VNRBDs) and examine the need for the use of advanced donor screening methods to ensure blood infection safety.. Materials and Methods: This was a cross-sectional study conducted at the National Blood Transfusion Service (NBTS). Consenting VNRBD aged 18–65 years, were consecutively recruited during routine blood drives organized by the NBTS, between August and October 2016 after completing a structured questionnaire. Samples from donated blood units were screened for Human immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), and syphilis using the fourth-generation ELISA. Results: The data obtained from 865 participants were analyzed. One hundred and eighty-two (21%) participants tested positive for TTIs. The prevalence of HBV, HCV, HIV, and syphilis among the participants was 14.7%, 4.6%, 1.8%, and 1.6%, respectively. Coinfection was found in 8.7% of the study participants. A statistically significant association was established between the sex of the participants and TTIs (χ2= 6.217, P = 0.0013). Conclusion: The prevalence of TTIs among VNRBD was high. Due to its attendant consequences on blood infection safety and implication on donor retention, there is a need for adoption of sensitive screening assays to ensure blood safety.
Background: The risk of cardiac anomalies, both acquired and congenital, is high in children undergoing noncardiac surgeries. These cardiac anomalies are associated with increased risk of perioperative complications. Objectives: This study, therefore, determined the common indications as well as the echocardiographic findings findings in children undergoing noncardiac surgery in Aminu Kano Teaching Hospital (AKTH), Kano. Materials and Methods: This is a retrospective descriptive study. The echocardiographic records of 25 children that underwent noncardiac surgery in AKTH over a 4 year period (from January 2015 to December 2018) were retrieved. The data obtained were analyzed using SPSS version 20 and the result was displayed using a frequency distribution table and bar chart. Results: There were 14 males and 11 females, with male to female ratio of 1.3:1. The ages of the patients range from 5 days to 8 years (median age of 8 months). The most common indication for echocardiography is orofacial cleft (cleft lip and/or palate), followed by adenotonsillar hypertrophy. The overall cardiac anomaly was found in 28% of the patients, with the highest anomaly being the atrial septal defect. Conclusion: The prevalence of cardiac anomaly was high in children with noncardiac surgical conditions.
Pancreatic abscess occurs as sequelae of acute pancreatitis. The standard treatment of infected pancreatic abscess is open surgical drainage and antibiotics. Recently, minimally invasive drainage methods such as image-guided percutaneous catheter drainage, transluminal endoscopic drainage through the stomach or duodenum, and retroperitoneal surgical drainage are becoming the trend. Open surgical drainage has a drawback of triggering a strong inflammatory response that can lead to multi-organ failure, bleeding, and gastrointestinal fistula unlike the minimally invasive approach. However, in the absence of facilities and expertise for minimally invasive drainage techniques, coupled with a patient with extensive/diffuse pancreatic necrosis and clinical deterioration, open surgical drainage may suffice. We report a case of pancreatic abscess which developed in a middle-aged man after few months of treatment and recovery from acute pancreatitis that was managed by open surgical drainage and parenteral antibiotics with good outcome.
Background: Several atherogenic indices derived from the lipid profiles are postulated to better detect dyslipidemias and predict the risk of having cardiovascular events even in the presence of insignificant changes in individual lipid parameters. Objective: To compare the lipid ratios and atherogenic index of plasma (AIP) to conventional atherogenic indices among hypertensive type 2 diabetics to hypertensive nondiabetes (HND) controls. Materials and Methods: A case–control study in which 210 participants with type 2 diabetes mellitus with hypertension (hypertensive-diabetic [HD]) compared with 150 (n = 155) hypertensive without diabetes (HND) with similar ages were enrolled. Blood samples for fasting lipid profile were collected and analyzed, and the following indices and ratios were calculated: (TC/high-density lipoprotein-cholesterol [HDL-C]), (low-density lipoprotein-cholesterol [LDL-C]/HDL-C), (HDL-C/LDL-C), and AIP. The indices were compared in both the participants and control group. Results: There was no significant difference in the clinical characteristics of HD compared to the HND except the systolic blood pressure, weight, and HDL-C which were lower in the HND group. The frequency of dyslipidemia was found to be significantly higher in the HD group except elevated LDL-C in males (25.8% vs. 17.4%, χ2 = 0.055, respectively). Furthermore, all the lipid ratios, except (Castelli risk index II [CRI– II] were found to be significantly different among HD as compared to HND group (P = 0.002, P = 0.045, respectively). Conclusions: This study concludes that Nigerians with both type 2 diabetes and hypertension have worse dyslipidemia and abnormal lipid ratios compared to those with only hypertension.
Background: There is no ideal contraceptive method; therefore, likelihood of method choice shifts among clients from time to time. Aim: The aim of this study is to determine the most chosen modern contraceptive method, and the factors influencing that choice among clients attending a relatively new tertiary health institution in Southwestern Nigerian. Methods: A retrospective review of the case records of clients attending the family planning clinic of Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, southwestern Nigeria, from January 2012 to December 2017. Results: Six hundred and twenty-nine clients accessed modern contraceptive methods during the study period. Their age ranged between 15 and 50 years with a mean of 33.0 ± 12.93. Most of the clients were married 616 (97.9%), had postsecondary education 405 (64.4%), and were of Christian faith 460 (73.1%). Progestogen-only injectable was the mostly chosen by the clients 228 (36.2%), and this is followed by intrauterine contraceptive device 186 (29.6%). Child spacing was the most common reason for contraception by the clients 357 (56.8%). Parity, postpartum contraception, previous contraceptive use, outcome of last delivery, mode of delivery of antecedent pregnancy, and educational status were all significantly associated with the mostly chosen method. Conclusion: Progestogen-only injectable contraceptive is the mostly chosen method among the clients, and this is a shift from what is obtained in southwestern Nigeria where intrauterine contraceptive device used to be the modern contraception method of choice.
Introduction: Sickle cell disease (SCD) is the most common hereditary hematological disorder in Nigeria with an annual incidence of more than 100,000 new births which contributes to the high Nigerian under-five childhood morbidity and mortality. Sufferers of the disease are frequently admitted into emergency rooms for presentations and complications such as pain crisis, anemia, stroke, and acute chest syndrome, in addition to other childhood infections such as severe malaria, sepsis, and acute respiratory tract infections. The aim of the study was to describe the clinicodemographic features and morbidity and mortality patterns of children with SCD in a tertiary institution. Methods: The study was a retrospective review of case records of children with SCD admitted with various diagnoses. Results: Complete records of 460 patients were reviewed and this constituted 10.1% of all new admissions during the period. There were more males, 286 (62%), than females, 174 (38%). The mean age was 6.3 ± 5.1 years and 249 (54.1%) were under the age of 5 years. The most common admitting diagnosis was a pain crisis comprising 168 cases (36.5%). The mean packed cell volume was 20.6 ± 4.1 inclusive of hemoglobin SC phenotype, and 197 (42.8%) had simple top-up transfusion, while 28 (6.1%) had exchange transfusion. A total of 438 (95%) patients were discharged, 21 (4.6%) died, and the highest mortality was from severe anemia (47.6%). Conclusion: This study describes the high burden of SCD constituting 10.1% of admissions, as well as the pattern of morbidity and mortality largely from severe anemia in the area under study.
