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   2015| July-December  | Volume 17 | Issue 2  
    Online since August 5, 2015

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Lassa fever in Nigeria: Insights into seroprevalence and risk factors in rural Edo State: A pilot study
Ekaete Alice Tobin, Danny Asogun, Nosa Akpede, Donatus Adomeh, Ikponwonsa Odia, Stephan Gunther
July-December 2015, 17(2):51-55
Background: The study aimed to assess the prevalence of risk factors and Lassa seroprevalence in Esan West local government area of Edo State. Methodology: One hundred and sixty-six respondents from 50 households were interviewed using structured questionnaires on prevalence of risk factors for Lassa virus exposure, household heads provided information on household risk factors. Determination of Lassa virus specific antibodies immunoglobulin (Ig) in the blood was by an Enzyme-linked immunosorbent assay technique. Analysis was performed with Statistical Package for Social Sciences (SPSS) version 16. (SPSS Inc, Chicago, IL, USA). Results: Rodents were seen in 49 (96.1%) houses in the previous 6 months, garri was eaten as a soaked meal by 97 (58.4%) respondents. IgM was found in 2 (1.3%) samples, and IgG, in 103 (58.2%). Negative IgG sero status was significantly associated with age <20 years (P < 0.00) and marital status as single (P < 0.00). Conclusion: There is a need for health education to improve food hygiene practices and reduce practices that promote rodent contact with humans.
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Effect of health education on knowledge of malaria and long lasting insecticide-treated nets among clients accessing care in the out-patient Department of a Secondary Health Facility in Plateau State, Nigeria
Tolulope O Afolaranmi, Zuwaira I Hassan, Chikwe Amaike, Chundung Asabe Miner, Tinuade Oyebode
July-December 2015, 17(2):65-70
Background: Malaria is a mosquito borne disease transmitted by female anopheles mosquito; it is life-threatening, preventable, and treatable. Approximately, 40% of the world's population is at risk of malaria. Most cases and deaths due to malaria are in sub Saharan Africa although Asia, Latin America, the Middle East and some parts of Europe are also affected. Objective: To assess the knowledge of malaria and long lasting insecticide treated nets (LLITNs) among clients assessing out-patient services in Seventh day Adventist (SDA) Hospital. Methodology: A quasi experimental study conducted in 2013 among client assessing care at the Out-Patient Department of SDA Hospital Jengre, Bassa Local Government Area of Plateau State to determine the knowledge of malaria and LLITNs. EPI info statistical software version 3.5.4 was used for data analysis and 95% confidence interval was used in this study with a P ≤ 0.05 considered as statistically significant. Result: The mean age of the respondents in this study was 36.04 ± 9.60 years. The level of knowledge on malaria improved significantly after the training (P < 0.001). Majority (98.8%) of the respondents had good knowledge of LLITNs after the training as against 77.4% who had same before the training (X 2 = 17.93; P < 0.001). Conclusion: This study has demonstrated the effectiveness of health education as vital tool for improving the knowledge of malaria and LLITNs.
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Prevalence of malaria parasitaemia among residents proximal to environmental waste dumpsites in Gwagwalada metropolis, Abuja, Nigeria
Idris Abdullahi Nasir, Maryam Aliyu Muhammad, Anthony Uchenna Emeribe, Adamu Babayo, Muhammad Sagir Shehu
July-December 2015, 17(2):91-96
Background: Malaria is a widely explored public health topic which has been documented to constitute more burden among communities residing in proximity to environmental waste dumpsites and poor drainage systems. Objective: This present study sets to examine and compare whether there are more cases of malaria parasitemia burden among people residing proximal and those not proximal to dump sites at Gwagwalada metropolis. Materials and Methods: This was a cross-sectional comparative survey which involved 100 blood samples collected from 25 households proximal to environmental waste dumpsites (test subjects) and another 100 from 25 households that are not proximal to dumpsites (control subjects) in Gwagwalada metropolis of Federal Capital Territory Abuja. These samples were analyzed using standard malaria microscopy. Results: Prevalence of malaria parasitemia was 82.0% among test subjects and 26.0% among control subjects. The highest malaria density recorded was >10,000 parasites/μL in 34 test subjects whereas none was observed from control subjects. Malaria parasitemia among test subjects was common among children (1-10 years) and least among 41-50 years. There was statistical relationship between malaria parasitemia among residents proximal to environmental waste dumpsites, more so with their age distribution (P < 0.05) but not with sex distribution (P > 0.05). Conclusion: The findings of this study are a clear demonstration that accumulation of waste dumpsites in proximity to residential areas constitutes a pathway to malaria burden, consequently dumpsites should be properly located and managed to minimize their effects on the environment and health of man.
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Spontaneous rupture of the urinary bladder in the third trimester of pregnancy
Iornum H Shambe, Jonathan A Karshima, Kenneth A Ozoilo
July-December 2015, 17(2):107-109
Spontaneous rupture of the urinary bladder is defined as rupture of the urinary bladder into the peritoneal cavity without a history of trauma 1. Aetiological factors implicated include but are not limited to radiotherapy, chronic infective diseases like tuberculosis, necrotizing cystitis and in pregnancy, bladder injuries caused in the event of uterine rupture 2. Its incidence is 1 in 126,000 hospital admissions 3. We report a rare case of spontaneous intraperitoneal rupture of the urinary bladder in the early third trimester of pregnancy. This report highlights the diagnostic challenges obstetricians and surgeons may encounter with presentations of acute abdomen in pregnancy. The patient presented with acute abdominal pain, voiding difficulty with pyrexia and features of peritonitis. At laparotomy, 3.5 litres of urine were drained from the abdominal cavity and a 6cm rent in the vault of the bladder was found. Laparotomy, bladder repair with antibiotic cover and indwelling catheterization were the basis for a favourable outcome.
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Acute-phase reactants, essential trace elements and some hematological parameters in Nigerian children with steady state sickle cell disorder
TD Ogunleye, EA Disu, AA Adelakun, OF Ajani, SK Rahamon, OG Arinola
July-December 2015, 17(2):56-59
Background: Sickle cell disease (SCD) is an inherited chronic hematological disorder, with inflammatory responses arising from different pathways. Information is scarce about the levels of acute-phase reactants and essentials trace elements in HbSS Nigerian children. Understanding of these will further elucidate the pathophysiology of SCD, which may assist in the proper management of this condition in the pediatric population. Aim: To measure the levels of acute-phase reactants (C-reactive protein [CRP], C1q, C4, ferritin and transferrin), trace elements (Fe, Zn, Cu) and some hematological parameters in HbSS children < 5 years of age. Materials and Methods: A total number of 26 consecutive steady state HbSS children below the age of 5 years was recruited for the study. The same number of HbAA children was recruited as a control. Trace elements were determined with atomic absorption spectrophotometer. C4, C1q and CRP were quantified using immunoplates, and full blood count analysis was done according to standard hematological procedures. Results: There were no significant differences between serum mean levels of Zn, Cu, Ferritin, C4, C1q, albumin and CRP in steady state HbSS children compared to their HbAA counterparts. There was a significant increase in the level of serum iron in steady state HbSS children compared to HbAA children. There was also a significant reduction in the serum level of transferrin in steady state HbSS children compared to HbAA children. There were no significant differences between the white blood cell, red blood cell, mean corpuscular hemoglobin (Hb), mean corpuscular Hb concentration, platelets, lymphocytes, monocytes and neutrophils in steady state HbSS children compared to their HbAA counterparts. However, there was a significant reduction in the Hb concentration and hematocrit value in steady state HbSS children compared to HbAA children. Conclusion: The study observes reduced inflammation in steady state HbSS children below the age of 5 years. It is recommended that consumption of diets or use of iron containing drug by HbSS children be monitored to prevent iron overload.
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Utilization of visual inspection with acetic-acid in cervical cancer screening among health workers in secondary health care institutions of Kaduna state, Nigeria
Fatima Balarabe, Umar Musa, Mohammed Alfa Chado, Muhammad Awwal Ladan, Halima Musa Abdul, Dalhat Sani Khalid
July-December 2015, 17(2):71-75
Aims: The research was conducted to investigate the utilization of visual inspection with acetic-acid (VIA) in cervical cancer screening among health workers in secondary health care institutions of Kaduna-state. Settings and Design: An Ex-post facto design was used for the study. The study population comprises all nurses, midwives, and nurse-midwives working in all the secondary healthcare institutions of Kaduna-state. The sample size used for the study was 300 using the Yamane, (1967) sample size selection formula. Subjects and Methods: The technique involved were stratified sampling method whereby the three existing senatorial zones served as strata. Each of the stratums was clustered according to the existing local government areas. A purposive sampling was further used to select nine local governments, three from each senatorial zone that have secondary health care institutions. A proportionate sampling was used at the various selected secondary health care institutions to distribute the questionnaire to the health workers based on their total number. The instruments used for data collection were the four-point level likert scale questionnaire, which was structured. 300 questionnaire copies were administered out of which (297) were retrieved. Statistical Analysis Used: The data collected were analyzed using one-way analysis of variance and two sample t-test at 0.05 level of confidence to answer the hypothesis. Significant difference exist in the demographic variables of age-group, sex, professional category, years of working experience and secondary health care institutions) in the utilization of VIA among health workers in secondary health care institutions of Kaduna-state (P < 0.05). A post-hoc Scheffe test was further used to determine where the differences were. Results: However, the overall results reveals that health workers in secondary healthcare institutions of Kaduna-state are not utilizing VIA in cervical cancer screening with an aggregate mean score of (2.1625) and (P < 0.05). Conclusions: It was concluded that health workers in secondary health care institutions of Kaduna-state are not utilizing VIA to screen for cervical cancer. It is therefore recommended that specialist VIA units should be created in the hospitals specifically for VIA screening services; this will go a long way in utilizing VIA to screen for cervical cancer by the health workers thereby reducing the high incidence of the disease.
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Psychosocial problems in adults with halitosis
ES Kolo, Akhiwu Benjamin Idemudia, AO Ahmed, O Alufohai
July-December 2015, 17(2):87-90
Background: Halitosis whether real or perceived, has been recognized world-wide as a psychosocial stigma. There have also been lots of interest focused on other aspects of halitosis in our environment, but there is little emphasis on the social and psychological impact of this disease. Aim: This study aims to describe the psychological and social problems of adult patients with halitosis. Materials and Methods: This was a descriptive prospective study of all consecutive adult patients that presented with halitosis as the chief complaint to the Dental; and the Ear Nose and Throat Departments of Aminu Kano Teaching Hospital, (Northern Nigeria) between July 2013 and September, 2013. Results: A total of 36 adult patients with halitosis as the main complaint were recruited. There were 20 (55.6%) males and 16 (44.4%) females giving a male: Female ratio of 1:1.2. This marginal male preponderance was not statistically significant (χ2 = 0.444; P = 0.505). Their ages were between 18 and 62 years; the mean age was 34.67 years (standard deviation = 11.212; 95% confidence interval, 30.87-38.46). At the end of this study, 76.9% respondents reportedly became aware of their bad breath by themselves, whereas 15.4% were told by others that they had bad breath and 7.7% knew they had bad breath by the actions of others. Twenty-eight respondents (77.8%) comprised of 14 males and 14 females (χ2 = 1.793; P = 0.181) reported that their social lives were unaffected, while 30 (83.3%) of the patients comprising 80% of the total males and 87.5% of the total females claimed their bad breath did not interfere with their family or love relationship (χ2 = 0.447; P = 0.504). Meanwhile, 25 (69.4%) of the patients reported that they interacted well with other people. Although 86.4% of the respondents reported their bad breath to be of low severity the remaining 13.6% thought it to be of high severity. There was no significant correlation between the duration of bad breath and the severity (r = 0.152; P = 0.535). Using the organoleptic test, only 56.3% of the respondents had a questionable or barely detectable mouth odor. Conclusion: This study revealed that most adult patients that presented to our clinics had halitophobia, and the majority of them had no associated psychosocial problems. It was also noteworthy that their bad breaths were not influenced by gender or duration of disease.
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Drug resistance patterns among pulmonary tuberculosis patients in a tertiary care hospital in northern Karnataka
Gajanan S Gaude, Praveenkumar , Jyothi Hattiholli
July-December 2015, 17(2):81-86
Background: Resistance to anti-tuberculosis (anti-TB) drugs is becoming a major and alarming threat in most regions worldwide and India ranks second in the world in harboring multi-drug resistant cases (MDR)-TB. The study was carried out to evaluate the drug resistance pattern to first-line anti-TB drugs in Northern Karnataka. Materials and Methods: A prospective study was conducted at a tertiary care hospital between January 2011 and June 2012. A total of 110 sputum samples were examined for the acid-fast bacilli (AFB) culture. A total of 48 AFB culture-positive samples were subjected for AFB drug sensitivity testing (DST). DST was done for isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), ethambutol and streptomycin (SM) after isolation by using the resistance proportion method. Results: Of the 48 AFB culture positive specimens, 12 (25.0%) cases were sensitive to all the five drugs while 36 (75.0%) cases showed resistance to one or more drugs. Among these, the resistance to RIF was highest (91.9%), while resistance to SM, INH, PZA and ETB was observed in 72.2%, 72.2%, 63.9% and 52.8%, respectively. The resistance to all five drugs was highest (41.7%), while MDR isolates were obtained in 69.4% of the cases. Illiteracy, low socio economic status, previous history of TB and alcoholism were found to have statistically significant association for the development of MDR. Conclusions: The proportion of drug resistance in the present study was 75.0% and MDR was present in 69.4% of cases. Therefore during initiation of new case, proper explaining and completion of the treatment is very important to avoid the development of future drug resistance in pulmonary TB patients.
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Review of 5 year mortality trend at federal medical center, Umuahia Nigeria using the global burden of disease classification
Oghale Marvelous Oghale, Kelechukwu Uwanuruochi, Clement O Odigwe, Abali Chuku
July-December 2015, 17(2):60-64
Background: There have been few systematic studies of the causes of death in Nigeria. However, the causes of death as well as the average age at death are important statistics in the public health policy formulation. The global burden of disease (GBD) classification is very useful in describing relative etiologies of mortality, as well as the epidemiologic transition. Objective: The aim of this study was to describe the causes of mortality in the Federal Medical Centre, Umuahia with respect to causes, gender, age at death, and duration of hospital stay using the GBD classification. Methods: We retrospectively reviewed records of mortalities seen between February 2003 and December 2008 at the Federal Medical Centre, Umuahia using the deaths register at our records department. Results: There were 3444 cases of mortality over the period, comprising 58.2% males and 41.4% females. Mean age at death was 40.92 ± 26.12 years communicable, maternal, neonatal, and nutritional disorders comprised 39.91%, noncommunicable diseases made up 48.76%, while Injuries comprised 11.33%. Conclusion: Public health attention should be sustained at reducing morbidity and mortality of noncommunicable diseases.
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Device-associated infection rates and median length of acquiring device-associated infection in an intensive therapeutic unit of an Indian hospital
Angshuman Jana, NK Pal, Arijit Majumdar, Jayeeta Mitra, Anirban Jana, Soumali Biswas, Babita Bag
July-December 2015, 17(2):97-102
Background: Hospital acquired infection (HAIs) nowadays is one of the leading causes of mortality in the ITU. Limited data is available regarding burden of HAIs specially device associated infections (DAIs) in Indian ITU. This study was aimed at determining the occurrence of DAIs including magnitude of device associated infections per 100 hospital admission, magnitude of device associated infection cases per 1000 bed days, incidence of infections per 1000 device days, median time for detection of DAIs, prevalent organisms and their antibiogram. Patients included in this study were taken from a 25 bedded intensive therapeutic unit (ITU), in a hospital in India. Methods: A prospective surveillance was performed over two years duration from July 2011 to June 2013. 578 patients were followed until discharge who admitted to this ITU and stay for more than 48 hours. HAIs were identified according to the CDC/NNIS definition. Data were analyzed with descriptive statistics. Results: The incidence rate for DAIs was 19.55%(113/578). More than 50% were associated with different comorbid illness mainly malignancy (47%). The device utilization was very high in case of urinary catheter (0.838) and IV catheter (0.742) but the incidence density was maximum in case of ventilator associated pneumonia (VAP = 13.89%). Median time of acquiring VAP, CAUTI, CRBSI were maximum in between (9 to 14 days), (16 to 21 days) and (12 to 17) days respectively demands need for regular follow up of this devices within that periods. Major pathogens for VAP were Klebsiella (28.95%), Acinetobacter (26.3%); CA-UTI mostly caused by E. coli (18.2%). CRBSI mainly caused by MRSA (25.9%), Acinetobacter (18.5%). Conclusion: A high rate of device associated infections, particularly VAP, were observed in this study. One of the main strategy to prevent nosocomial infections in the ITU is early change of invasive devices based on its median time of infection and to avoid its unnecessary prolong use.
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Systemic lupus erythematosus presenting with quadriparesis: A case of misdiagnosis
Bertha C Ekeh, Franklin O Dike, Bassey E Bassey, Walshak Paul
July-December 2015, 17(2):103-106
Systemic lupus erythematosus (SLE) is a multisystem disorder affecting almost every organ system. It is a chronic inflammatory disorder occurring almost exclusively in women. The presentation and course are highly variable ranging from indolent to fulminant. Older literature considers SLE to be rare in the African. Recently, however, it has been shown that SLE is seen in a significant number of Africans, but the low incidence stems from underdiagnosis. We present one such woman who presented with quadriparesis having been misdiagnosed initially when she had just the classical triad. Diagnosis was clinical and also confirmed with immunological tests. This patient is a 32-year-old female, with a 9 month history of persistent, progressive joint pains involving the ankles and feet. Six months later she noticed bilateral leg swelling and gradual involvement of the upper limbs. She was referred to the Neurology unit on account of inability to walk and recurrent fever. She had associated generalized hyper-pigmented raised patches on the trunk with tender edematous hand and feet joints and high blood pressure. A diagnosis of SLE was made after the initial review. Investigations revealed the proteinuria, thrombocytopenia, and positive anti-nuclear antibodies and double-stranded DNA autoantibodies. Thereafter, a definitive diagnosis of SLE was made. She was commenced on Prednisolone which controlled the flare. After one month of admission, the Prednisolone was tapered down. She had standing re-education with physiotherapy. She had started walking before discharge. SLE is also seen in African women living in Africa. The protean manifestations make diagnosis difficult; however, the availability of the immunological tests in our practice has made the diagnosis easier. There yet remains a need for a high index of suspicion. The classical triad of fever, joint pain and rash in a woman of childbearing age should prompt investigation and diagnosis of SLE.
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Differential effects of age and intestinal helminthiasis on positivity rate of skin prick reaction to environmental allergens among Nigerians
Edem Victory Fabian, Arinola Olatunbosun Ganiyu
July-December 2015, 17(2):76-80
Background: Skin prick testing (SPT) conventionally used to investigate immediate type (type 1) hypersensitivity to allergens is reported to be affected by varying factors. It is hypothesized by present study that immunomodulation of T-cell by parasitic helminthic infection may affect skin prick reaction. Study Objectives: The primary objective of this cross-sectional study is to determine the prevalence of intestinal helminthiasis and its effect on the outcome of SPT to environmental allergens. Participants, Materials and Methods: Skin prick test was performed on 296 residents (113 adults and 183 children) rural and urban parts of Ibadan, South-West Nigeria. Stool specimen was also collected and examined for ova, cyst and larvae of intestinal worms. Results and Conclusion: The prevalence of intestinal helminthiasis was 20.8% and 21.2% in children and adults respectively. Prevalence of intestinal helminthiasis in adults from rural settings was significantly higher when compared with adults from urban settings. Significantly higher positive skin test to dog allergen was observed in helminth infected participants when compared to uninfected participants. Furthermore, significantly higher positive skin test to cockroach, mite, mold, and mouse allergen was observed in adults when compared to children. This suggests that the intestinal helminthiasis is found among all age groups in this region, but do not affect skin reaction to environmental allergens as much as ages of participants.
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