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  Most popular articles (Since July 26, 2019)

 
 
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REVIEW ARTICLE
Influenza A viruses: Current perspectives on swine flu virus
Martin E Ohanu, Daniel B Olusina, Anthony O Eni, Emmanuel N Aguwa, Chinwe J Chukwuka
January-June 2019, 24(1):1-8
DOI:10.4103/ijmh.IJMH_8_19  
Swine influenza, a genetic reassortment of swine, avian, and human influenza viruses, is a respiratory disease of pigs that recently caused a pandemic. It contains deoxyribonucleic acid that is typical to avian, swine, and human viruses, including elements from European and Asian swine viruses. The main targets of the influenza virus are the columnar epithelial cells of the respiratory tract. The aim of this review was to present updates on influenza A viruses with particular attention to recent developments on swine flu H1N1. In-depth interest is on current historical accounts, pathogenesis, clinical features, diagnosis, treatment, and prevention. The review shows that there is tremendous improvement on the knowledge and understanding of the mechanisms of influenza disease and outcomes of management. There is an increasing diagnostic facility and emphasis on advanced infection control measures, encouraging frequent, adequate hand washing, use of alcohol-based hand sanitizers, and use of quarantine facility for treating serious cases and vaccination of people at risk.
  406 77 -
ORIGINAL ARTICLES
Frequency of hemophilia and hemostatic evaluation in persons with bleeding symptoms in Southeast, Nigeria
Samuel Okparaoka, Theresa U Nwagha, Bond Anyaehie
January-June 2019, 24(1):18-22
DOI:10.4103/ijmh.IJMH_2_19  
Background: A significant number of people living with hemophilia and other bleeding disorders are reported to be either underdiagnosed or untreated in most developing countries. Objectives: To evaluate the frequency of hemophilia and some hemostatic parameters in persons with bleeding symptoms in Southeast Nigeria. Materials and Methods: This was a cross-sectional, hospital-based pilot study of 50 persons consecutively recruited with bleeding symptoms from four tertiary hospitals in Southeast Nigeria. Full blood count was carried out using Mythic 22 semiautomated analyzer, (Orphee, Geneva, Switzerland). Prothrombin time (PT) and activated partial thromboplastin time (APTT) mixing studies and one-stage factor assays were carried out using tube tilt technique. Bleeding score was assessed using the International Society on Thrombosis and Haemostasis bleeding assessment tool. Data were analyzed using the Graphpad Prisim, version 6.0, San Diego. Results: Only 2% of the subjects had hemophilia A, whereas 68% of the subjects had thrombocytopenic bleeding. Most (32.4%) had bleeding score of four. Analysis of variance of these variables showed a significant relationship with P < 0.0001. Post hoc analysis showed significant P values for platelet count versus bleeding score (P = 0.000, 95% confidence interval [CI]: 95.74–126.4) and APTT versus bleeding score (P = 0.000, 95% CI: 44.34–74.98). Conclusion: Bleeding assessment tools are important in evaluating persons with bleeding symptoms and it may be necessary to screen for hemophilia in these cases. Larger multicenter epidemiological studies are needed to determine the prevalence of hemophilia and other bleeding disorders in our environment.
  402 61 -
Suspicious and malignant features on mammogram among women in a group of communities within south east Nigeria
Eric O Umeh, Uzoamaka R Ebubedike, Brenda C Nwammuo
January-June 2019, 24(1):23-27
DOI:10.4103/ijmh.IJMH_10_19  
Introduction: Mammography services are not widely available in Nigeria due to inadequate numbers of mammography machines and shortage of the relevant skilled personnel. However, diagnostic and screening mammography was recently introduced at centre near Onitsha in south-east Nigeria to serve the immediate catchment area and surrounding communities. Objective: To determine the prevalence of suspicious findings and features suggestive of breast cancer (BIRADS categories 4, 5 and 6) among mammograms for women presenting at mammography imaging centre. Methodology: Retrospective study reviewing mammograms done at the Iyienu Mission Hospital between January 2013 and December 2015. Final BIRADS Categorization in line with the BIRADS lexicon was reported based on mammography findings and clinical history for each subject. Results: Mean age of study population was 49.1 years ±8.1. Mammographic findings for five percent of subjects were categorized BIRADS 4, while one (0.2%) was categorized BIRADS 5, and four (0.7%) were BIRADS Category 6. The proportion of cases within each age group categorized BIRADS 4 - 6 was 10.1% among subjects aged less than 40 years (p-value 0.19), 5.2% for subjects aged between 41 and 60 years (p-value 0.12) and 10.0% among subjects aged greater than 60 years (p-value 0.32). Conclusion: Study findings suggest higher prevalence of suspicious and malignant findings among the elderly, as well as young women. Future re-assessment of findings desirable using larger sample size. Initiatives for enlightenment on the relevance of cancer screening methods should target middle aged and elderly women, as well as younger women, especially those at risk.
  372 51 -
Voluntary jaw wiring in Nigeria: Reasons and treatment outcome
Mark C Nwoga, Samuel N Maduakor, Appolos C Ndukuba
January-June 2019, 24(1):28-34
DOI:10.4103/ijmh.IJMH_3_19  
Background: Overweight and obese dental patients occasionally request jaw wiring. Aim: The aim of this study was to determine the reasons for requesting jaw wiring and to evaluate the outcome of the procedure. Materials and Methods: This is a retrospective study of adults, who requested jaw wiring treatments at two private dental facilities in Enugu and Lagos, Nigeria. The interventions consisted of jaw wiring with four interdental eyelets and two tie wires. The main outcome measures were reasons for the request, weight loss, and body mass index (BMI) change. The data were analyzed using SPSS, version 20.0. Results: Thirty-four patients, all female, requested jaw wiring. Majority were single (82.4% [28/34]). The mean (standard deviation [SD]) age was 28.1 (6) (confidence interval [CI]: 25.9–30.2). Simplicity of the procedure, weight-loss needs, and improved body shape were the main reasons for all the patients. Single women additionally included a “desire to attract a marriage mate” in 67.6% (23/34), “preparation for an engagement,” and “to fit a wedding gown,” 5.9% (2/34). Married women, 14.7% (5/34), additionally desired to “please a husband” or “achieve postpartum weight-loss.” Nineteen subjects completed the treatment and lost a mean (SD) weight of 8.3 (3.6) kg (95% CI: 6.5–10) over a mean (SD) duration of 45.0 (14.9) days (CI: 37.8–52.2). The mean BMI was lowered after treatment by 3.09kg/m2 (1.3; CI: 2.5–3.7). The posttreatment BMI classification improved for 52.6% (10/19) of the patients. Conclusions: Jaw wiring was desired by young women because of its simplicity, predictable weight loss, and marital and social concerns. Weight loss and lowered BMI were achieved.
  376 45 -
Spectrum of findings on barium enema examination in Benin City
Sam U Enukegwu, Festus O Ehigiamusoe, Anthony O Ogbeide
January-June 2019, 24(1):35-39
DOI:10.4103/ijmh.IJMH_11_19  
Background: In the Western world, barium enema has largely been replaced by computed tomographic (CT) colonography or virtual colonoscopy using the three-dimensional fly-through software. But barium enema remains relevant in our environment because of its availability and affordable cost as compared to cross-sectional imaging. Aim: To document the common pathologies seen on barium enema examinations in Benin City, Nigeria. Materials and Methods: All cases of barium enema performed at St. Bridget X-Ray Centre, a private radio-diagnostic outfit in Benin City, between January 2013 and December 2014, were retrospectively reviewed. The biodata, clinical information, and radiological diagnoses were collated and entered into the Statistical Package for Social Sciences (SPSS) software and then analyzed. Those with inadequate details were excluded from the study. Results: Two hundred and sixteen patients who had barium enema for various indications were reviewed; the males were 135 (62.5%), whereas the females were 81 (37.5%). Constipation (53, 23.0%) was the most common clinical indication, followed by hematochezia (50, 21.7%), abdominal pain (32, 13.9%), colorectal mass (26, 11.3%), and abdominal swelling (12, 5.2%). Colonic carcinoma (39, 20.8%) was the most common diagnosis on barium enema. This was followed by Hirschsprung’s disease (20, 15.4%), ulcerative colitis (15, 11.5%), megacolon (12, 9.2%), and colonic stricture (11, 6.2%). These findings were more in males (88, 67.7%) than that in females (42, 32.3%). Conclusion: This study has enumerated the common indications and common radiological findings on barium enema study in our environment. Furthermore, this study has also buttressed the fact that barium enema is still reliable in making diagnosis in environment where CT scan is either unavailable or costly.
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Under-five mortality at the children’s emergency room of Federal Medical Centre, Umuahia, Southeastern Nigeria
Chikaodili A Ibeneme, Ezinwa O Ezuruike, Francis C Korie, Ndubuisi K Chukwudi
January-June 2019, 24(1):47-52
DOI:10.4103/ijmh.IJMH_9_19  
Background: Under-five children’s death is one of the vital indices of a society’s development and a telling evidence of their priorities and values. An audit of the common causes of mortality among under-fives is essential in ensuring optimum child survival. Aim: To determine the magnitude, causes, and determinants of under-five deaths at the Federal Medical Centre, Umuahia, Southeastern Nigeria. Subjects and Methods: A retrospective review of all postneonatal under-five deaths at the Children’s Emergency Room from January 2012 to December 2016, was carried out and the information was analyzed. Results: Of a total of 6141 under-fives admitted during the 5-year period, 197 died giving a mortality rate of 32 per 1000 LB. Boys accounted for 106 (53.8%) with no gender difference in the mortality rates (P = 0.262). The leading primary causes of death were sepsis, severe malaria, diarrheal disease, meningitis, pneumonia, and severe acute malnutrition, accounting for 95%. Deaths due to malaria occurred more among the preschool age group than that among infants and toddlers (P = 0.013), whereas those due to pneumonia were more prevalent among infants (P = 0.012). Diarrheal disease caused more deaths during the dry weather season (P = 0.009). Approximately 40% of the deaths occurred within 24h of arrival to the Emergency Unit. The most common complications leading to death were dehydration, severe anemia, shock, heart failure, and hypoglycemia. Conclusion: The leading causes of under-fives deaths in our center are preventable infectious diseases. Intensification of goal-targeted, disease-specific preventive measures is recommended.
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High Internet awareness and proficiency among medical undergraduates in Nigeria: A likely tool to enhance e-learning/instruction in Internal Medicine
Oluchi S Ekenze, Christian I Okafor, Sebastian O Ekenze
January-June 2019, 24(1):9-17
DOI:10.4103/ijmh.IJMH_1_19  
Background/Objective: The emergence of the Internet several decades ago has brought global revolution in a lot of processes even among developing nations, including educational processes. We assessed the familiarity of the medical students with Internet tools and their preparedness with integrating e-learning into Internal Medicine teaching methods. Materials and Methods: A cross-sectional survey of two graduating medical classes of College of Medicine, using structured self-administered questionnaire, was carried out. The survey assessed the knowledge, utility, and application of Internet tools in medical education using five-point Likert scale. Results: A total of 227 (75%) of the cohort of 292 students responded, comprising 150 (66.1%) males and 77 (33.9%) females. The median age was 24 years (Interquartile range, 23–26 years). Of these, 219 (96.5%) owned Internet-enabled devices, whereas 104 (46.2%) had formal training on the use of computers. Two hundred and twenty-two (97.8%) could access the Internet, with Google and Twitter accounts being the highest and the least used tools, respectively. Two hundred and twenty five (99%; mean rating 4.5 on a scale of 5) indicated that Internet tools were useful in teaching Internal Medicine, specifically in the areas of lectures, assignments, and interaction with experts globally. The key benefits were utility as a regular self-assessment tool and flexible learning schedule (mean rating, 4.0, respectively). Overall, 213 (93.8%) suggested that the use of Internet tools and e-learning should be incorporated into the traditional method of teaching. Challenges with its use included cost of accessing the Internet (n = 126; 55.5%), lack of facility with adequate technology (n = 115; 50.7%), and availability of Internet (n = 96; 42.3%). Conclusion: Undergraduate medical students in our setting are familiar with the Internet and its potential utility for learning and undergraduate teaching of Internal Medicine.
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CASE REPORT
Opsoclonus-myoclonus-ataxia syndrome presenting in Enugu, Southeast Nigeria: A case report
Adaobi Ikemeh, Ikenna Onwuekwe, Chiamaka E Okereke, Oluchi Ekenze
January-June 2019, 24(1):59-62
DOI:10.4103/ijmh.IJMH_4_19  
Opsoclonus – myoclonus- ataxia syndrome is an extremely rare neurological condition of probable autoimmune aetiology. It has not been previously described in medical literature from Nigeria and West Africa. This is a case report of a 43- year old Nigerian woman who presented to the University of Nigeria Teaching Hospital Enugu Emergency Department in July 2018 with a 5 weeks history with vertigo, diplopia, dancing eyes, muscular twitches and incoordination two weeks after a caesarean section complicated by intra-operative bleeding. No other significant medical history. She had been managed as a case of cerebellar haemorrhage before referral to the Neurology Unit. On examination she was lucid, had normal vital signs, opsoclonus, motor ataxia and myoclonus affecting the left face as well as left upper extremity. Investigations done were normal except for reduced cerebrospinal fluid ( CSF) protein. Her symptoms responded substantially to prednisolone and clonazepam. The relevant literature was reviewed. Opsoclonus myoclonus ataxia syndrome though rarely described in Africans may occur and may be misdiagnosed by inexperienced physicians leading to undesirable consequences.
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ORIGINAL ARTICLES
Survey of physician self-reported sexual satisfaction in a tertiary hospital at Enugu, South East Nigeria: A preliminary report
Rita I Igwilo, Ikenna O Onwuekwe, Chioma L Odimegwu, Justus U Onu, Chinwendu J Onwuekwe
January-June 2019, 24(1):53-58
DOI:10.4103/ijmh.IJMH_5_19  
Background: Self-reported sexual dissatisfaction is a recognized contributor to poor quality of life and can affect productivity in the workplace. Aim: This was a preliminary survey of a cohort of physicians in Enugu metropolis, South East Nigeria investigating self-reported sexual satisfaction and its association with sociodemographic variables. Materials and Methods: Physicians’ self-report of sexual well-being as well as any impact thereof was assessed using an online-delivered structured questionnaire in September 2018. Informed consent was obtained. Results obtained were analyzed using the International Business Machine–Statistical Package for the Social Sciences (IBM-SPSS) version 20. Results: The participants, 62.0% males, were mostly married (82%) and young (mean age 38.2 ± 9.7). Majority (81.5%) of the participants were satisfied with their current sexual lives, 30.7% of them used sex enhancements, and 14.8% of the participants were willing to seek professional help over sexual health problems. Males were five times more likely than females to have sexual encounters outside current relationship (P = 0.003). Conclusion: The findings of this study shows that majority of the physicians are satisfied with their sexuality. The study also observed age and gender-related differences in the physicians’ sexual behaviors. The implication of the finding that most doctors are still reluctant to seek help for sexual health issues calls for a robust public health education with emphasis on sexual health.
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Determinants of psychosocial disorders among caregivers of HIV-infected children in Enugu, Southeast Nigeria
Ikechukwu F Ogbonna, Ngozi C Ojinnaka, Ifeoma J Emodi, Nnaemaka A Ikefuna
January-June 2019, 24(1):40-46
DOI:10.4103/ijmh.IJMH_7_19  
Background: Human immunodeficiency virus (HIV) infection is a global pandemic. Nigeria has the highest burden of pediatric HIV worldwide. HIV-infected children and their caregivers are predisposed to significant psychosocial disorder. This disorder may be provoked by some risk factors. Aim: To determine the factors responsible for psychosocial disorders among the caregivers of HIV-infected children in Enugu, Southeast Nigeria. Materials and Methods: This was a hospital-based comparative study. Participants who met the inclusion criteria were enrolled consecutively. The HIV status and other sociodemographic variables of the caregivers were obtained. General Health Questionnaire (28-item version) was used to assess their psychosocial status. Thereafter, the association between psychosocial disorders and their sociodemographic variables was ascertained. Results: A total of 154 caregivers of HIV-infected children (subjects) and 154 caregivers of HIV-negative children (controls) were enrolled in this study. The prevalence of psychosocial disorders among the subjects was 39% compared to that of 2.6% among the controls. The determinants of psychosocial disorders among these subjects were the child’s age group of 2–4 years (P < 0.001, odds ratio [OR] = 3.60), caregiver’s gender (P < 0.001, OR = 13.48), lower socioeconomic class (P < 0.001, OR = 37.14), divorced caregiver (P = 0.03, OR = 10.33), death of a spouse (P < 0.001, OR = 8.84), additional HIV-infected family member (P = 0.015, OR = 2.56), and unsupportive spouse (P = 0.027, OR = 2.113). Conclusion: The determinants of psychosocial disorders among the caregivers of HIV-infected children were the age of the HIV-infected child, female caregivers, lower socioeconomic class, marital status, additional HIV-infected family member, and lack of spouse support.
  192 24 -
ORIGINAL ARTICLES
An Assessment of exposure to internet pornography and associated risky sexual behavior among undergraduate students of Benue State University, Makurdi, Nigeria
O Audu, GB Ugande, BA Aliegba, AA Gobir, T Kusugh, AO Ojabo
July-December 2017, 22(2):74-81
DOI:10.4314/jcm.v22i2.3  
Background: Pornography remains an elusive concept and disproportionate numbers of young people continue to view the websites despite the effects it has on their psychological, emotional and cognitive development. Objective: This study aimed to determine the prevalence of exposure/access to internet pornography and its influence on sexual behavior of undergraduate students of the Benue State University, Makurdi, Nigeria. Methods: A cross sectional descriptive study was employed to study 280 undergraduate students, via structured self–administered questionnaires. Ethics were adhered to as the human dignity of the participants was respected. Multiple logistic regressions were performed to investigate independent predictors that had significant chi-square at P < 0.05. Results: Exposure to pornography amongst the respondents started as early as 10 years; 46.94% of them who had initial exposure continued to view the websites, 21.7% viewed the internet pornography on a frequent basis. Majority (88.0%) of them practiced what they watched, 71.4% became addicted to sex, and 56.4% record the video and send to friends/colleagues. The exposed respondents are about 2.8 times more likely to practice risky sexual behaviors as compared to those not exposed {(OR-2.819 (95% CI = 0.0292 - 0937) p= 0.029), and or group sex {(OR- 0.444 (95% CI = 0.9.782 – 7.584) p= 0.000). The fun of the porn, seeking for sexual partners, knowledge of knowing how to make love, and sexual arousal were thecom-mon contributing factors to viewing pornography. Conclusion: Access to pornography and negative health behavior among the undergraduate students will presumably remain unrestrained if not promptly addressed. It is therefore important to offer youth friendly centers for discussing pornography in order to counterbalance the fictional world presented in pornography.
[ABSTRACT]   Full text not available  [PDF]
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Pattern of HADS-Anxiety score among Medical Outpatients in Enugu, Nigeria
BA Ezeala-Adikaibe, M Ezeme, M Nwobodo, N Nwobodo, UH Okafor, P Chime, C Orjioke, T Okpara, E Aneke, N Mbadiwe, G Onyebueke, G Okudo, N Nwosu, F Ekochin, MC Abonyi, O Anyim, G Anigbo
July-December 2018, 23(2):248-254
DOI:10.4314/jcm.v23i2.3  
Background: Symptoms of anxiety disorders vary widely among physically ill patients. Early detection and treatment of anxiety will reduce the economic burden of common medical disorders and provide empirical data for public health educators and policy makers for the development of guidelines for health workers and care givers. Objectives: The objective of the present study was to determine the correlates and predictors of anxiety symptoms based on the Hospital anxiety and depression scores among patients attending medical outpatient clinic in a Tertiary hospital in Enugu South East Nigeria. Methods: This was a cross sectional study conducted at the Medical Outpatient Clinic of Enugu State University Teaching Hospital, Enugu Nigeria. All consecutive consenting patients were recruited. Anxiety symptoms were explored using the Hospital Anxiety Depression Scale. Study duration was 6 months. Statistical analyses were one using SPSS version 22. Results: A total of 512 (males 190(37.1%), females 322 (62.9%)) individuals were recruited. Significant anxiety symptoms (≥ 8) was reported by 16(3.1%) patients; similar in males and females. P=0.51. Anxiety symptoms, negatively correlated with age (r=-0.14, p< 0.01) and positively with use of alternative/herbal medication (r=0.16, p < 0.001), having arthritis (r=0.11, p=0.01), stroke, (r=0.09, p=0.04), chronic headache r=0.11, p=0.01 and peptic ulcer disease (r=0.09, p=0.04). Younger age was a significant predictor of anxiety scores. p=0.03. Conclusion: Several modifiable and non-modifiable factors correlate with anxiety symptoms among out patients in Enugu. There is need to involve mental health practitioners in the education and care of medical outpatients.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Incidence, pattern and trend of scabies infection in Nigeria: A retrospective study of 366 cases
CL Onyekonwu, N Okoh, E Ofondu, E Nwobi, CG Onyekonwu
January-June 2018, 23(1):227-230
DOI:10.4314/jcm.v23i1.10  
Background: Scabies is a common parasitic disease seen in developing countries. It affects families, especially the most vulnerable and has its greatest impact on young children, often resulting in secondary bacterial infection in untreated cases. A study on the disease incidence, pattern and trend will help in designing strategies in controlling the disease prevalence and outbreaks. Methods: The study was a retrospective analysis of skin clinic records of scabies cases seen in three tertiary centers of health care in South-Eastern Nigeria over a five year period from September, 2012 to August, 2017. Generated data was analysed using the statistical package for social sciences (SPSS) for Windows Version 20.0 (SPSS, Inc., Chicago, IL, USA) and patients' age and gender were tabulated, and percentages calculated. Tests of associations and trends in disease presentation were also determined. Results: A total of 13,815 patients were seen in the skin clinic out of which 336 cases were scabies giving an incidence rate of 2.4%. The mean age of the patients seen across the three study centers 20.4 ±14.8years (range 2months-74years) were seen across the three study centers. Majority were males (65.8%) and less than 30 years of age (82.8%). There was a progressive increase in incidence of scabies infection from 0.18% (n=8) in 2012 to 6.67% (n=132) in 2017. Patients' gender and age were significantly associated with family members being infected and the trend showed a gradual increase over the years. Conclusions: There is increasing incidence of scabies in south-east Nigeria and the disease is commoner in males and young individuals. Public health enlightenment campaigns and school/community education programs may help in controlling this emerging epidemic in Nigeria.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Zero prevalence of hepatitis B and C coinfection among a large cohort of health care workers in Enugu, Nigeria: A Cross-sectional descriptive study
IA Meka, BI Omotowo, UN Ijoma, EV Okoli, TU Nwagha, AC Ndu, O Obienu, CL Onyekonwu, OD Onodugo, EO Ugwu
January-June 2018, 23(1):171-175
DOI:10.4314/jcm.v23i1.1  
Background: Hepatitis B and C infections occur globally and their coinfection presents a treatment challenge with more severe health problems. Nigeria is endemic for hepatitis B and health workers represent one of the high risk groups. It is therefore imperative for continued surveillance of these infections among health workers to increase and strengthen awareness of preventive measures and treatment options when infected. Objective: The authors set out to determine the prevalence of hepatitis B and C coinfection among health workers in Enugu, Nigeria. Methods: This descriptive cross-sectional study was carried out at the University of Nigeria Teaching Hospital (UNTH) Enugu, between July and August, 2016. Consenting health workers were screened using HBsAg and HCV chromatographic immunoassay rapid test strips. Results: The study included 3132 health workers. The mean (SD) age was 39.4 (9.6) years and ranged. 18 – 75 years with a M:F ratio of 1:2.3. Doctors and nurses constituted 297 (9.5%) and 580 (18.5%) respectively while majority 2,119 (67.6%) were made up of other cadres of health workers. A total of 72 (2.3%) and 28 (0.9%) were positive for hepatitis B and C respectively, but none of the participants was positive for both infections, giving a prevalence of 0.0% for hepatitis B and C coinfection. Conclusion:xs The prevalences of hepatitis B and C coinfection is 0.0% among health workers in Enugu, Nigeria. There is need for sustained awareness creation and health education programmes for prevention and control of hepatitis B and C infections in order to sustain the zero prevalences of coinfection in our setting.
[ABSTRACT]   Full text not available  [PDF]
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Audit of childhood mortality in Federal Teaching Hospital Abakaliki, Ebonyi state, Nigeria
VU Muoneke, DC Obu, AF Una, I Nwokoye, SN Uwaezuoke, CB Eke
July-December 2018, 23(2):270-275
DOI:10.4314/jcm.v23i2.7  
Background: As much as 10 million children die annually from easily preventable causes especially in resource poor countries of sub Saharan Africa. In2016, Nigeria had an U5MR of 104/1,000 live births despite the childhood survival strategies and policies in the past 2 decades. Aim: The aim of this study was to audit the pattern and causes of mortality in children seen at Federal Teaching Hospital, Abakaliki (FETHA). Methods: This was a retrospective cross-sectional study conducted at the Paediatric ward of FETHA over a five year period from January 2013 to December 2017. Case files of all children aged one month to 18 years who died during admission into the paediatric ward were retrieved from the hospital's medical record department and reviewed. Data collected were entered into the data editor of SPSS software package version 20 (IBM SPSS).Descriptive statistics was used todetermine the frequency of cause-specific deaths. Results were presented as percentages, proportions in charts and tables. Results: A total of 2,911 children were admitted into the paediatric ward within the study period. Of this number, 126 died giving a mortality rate of 4.3% and a male: female ratio of 1.29:1.00. Majority (79.3%) of the mortality occurred in the under-five children with over 80% presenting with fever and approximately 72% hospitalised for over 48hours. Sepsis and malaria were commonest causes of death. Conclusion: Mortality rate was high in this study especially among the under-5 children and sepsis and malaria were the commonest causes.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Examining key issues with the utilization and quality of services in primary healthcare facilities in Rural and Urban areas in Nigeria
I Okeke, E Etiaba, C Okoli, Onwujekwe
January-June 2018, 23(1):194-200
DOI:10.4314/jcm.v23i2.5  
Background: Utilization and quality of services in primary healthcare (PHC) facilities in Nigeria are a source of concern due to the essential role of primary healthcare in providing key health care services and achieving universal health coverage. Objective: This study examined the perception of service users on utilization and quality of services in rural and urban areas of south east Nigeria. Methods: A cross sectional quantitative survey was conducted in one rural and one urban local government area in southeast Nigeria; in eight (8) PHC facilities. A pre-tested interviewer - administered questionnaire was used to collect data on utilization and perceived quality of services. Data was analyzed with SPSS Version 16. Results: Most visits (86.6%) to facilities were for outpatient services. Antenatal care (27.2%) and child health services (23.0%) were the predominant services in urban and rural areas. Educational level, being married, purpose of visit and attending health worker were all associated with utilization while affordability, waiting time, presence of a doctor and laboratory services were positively associated with perception of quality. Conclusion: This study indicates that utilization of healthcare at PHC facilities was sub-optimal for key healthcare services. Underlying health system challenges must be addressed with appropriate recommended reforms if the utilization and quality of services at PHC facilities will be significantly improved.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Incidence and outcome of higher order multiple pregnancies at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
GO Ugwu, BC Ozumba, CA Iyoke, AO Asogwa, SG Mbah, KC Obioha
January-June 2018, 23(1):213-216
DOI:10.4314/jcm.v23i1.8  
Background: Higher Order multiple pregnancies (HOMP) increase the demand for neonatal intensive care services and knowledge of local prevalences may be useful in planning neonatal intensive care. Objectives: To determine the incidence and feto-maternal outcome of higher order multiple births in university of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria. Methods: It was a retrospective review of all HOMP at the UNTH Ituku/Ozalla Enugu, over a ten year period from June 2006 to May 2016. Results: During the study period, there were 8207 deliveries out of which 23 were higher order multiple (HOM) births; consisting of 19 triplets and 4 quadruplets. The overall incidence of HOM births was 0.28%. This was made up of incidences of triplet and quadruplet births of 0.23% and 0.05% respectively. Ten (43.5%) of the women conceived spontaneously while 8 (34.8%) had ‘artificial reproductive technology’ and the remaining 5 (21.7%) took ovulation inducing agents. The maternal outcome of HOM births was generally good with no record of maternal death. The neonatal complications included: neonatal jaundice (4.5%), birth asphyxia (4.3), conjoined twins (4.3) and neonatal death (13.0%). Conclusions: The incidence of HOMP in UNTH, Ituku/Ozalla, Enugu is much less than 1% and comparable to that in other parts of the world. The overall maternal outcome of HOMP was good. There is however need for improved neonatal care to ensure better fetal outcome of HOMP in our setting.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORT
Unruptured sinus of valsalva aneurysm, with dissection into the interventricular septum
NC Udora, EC Ejim, JU Okoye
July-December 2017, 22(2):150-155
DOI:10.4314/jcm.v22i2.15  
Sinuses of Valsalva or aortic sinuses are 3 focal expansions at the root of the aorta and are named right, left and non-coronary sinuses. These sinuses serve as support system for the aortic valve and prevent occlusion of the coronary ostia as the aortic cusps open in systole. Sinus of Valsalva aneurysm (SOVA) is congenital in most cases, due to deficiency of the elastic lamina between the aortic media and the annulus fibrosus. The anatomical location of these sinuses can predict some clinical consequences, when complications occur. We report the case of a 29yr old Nigerian man who presented at the accident and emergency unit of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, with clinical features of heart failure. Electrocardiography showed complete heart block, and later supraventricular tachycardia, while echocardiography showed a right sinus of valsalva aneurysm dissecting into the interventricular septum, without evidence of rupture.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Prevalence and pattern of self-medication among medical students in a Nigerian University
CA Idoko, BI Omotowo, OE Ekwueme, I Chidolue, U Ezeoke, AC Ndu, C Okeke
January-June 2018, 23(1):189-193
DOI:10.4314/jcm.v23i1.4  
Background: Self-medication could be harmful to health even though it has some proven advantages. Medical students are future doctors whose disposition to pharmacotherapy may direct approach to prescription in the future. Objective: To determine factors prevalence and pattern of self-medication among medical students in a Nigerian university. Methods: It was a cross-sectional study of 335 medical students of the University of Nigeria Enugu Campus, Enugu, Nigeria. The students were selected following a stratified probability sampling technique with the various class levels serving as strata. Thereafter, the individual participants were randomly selected from the strata to achieve the required sample size. Results: The prevalence of self -medication was 85.7%. The two commonest reasons for self-medication among the students who practiced it were: ‘prior knowledge about the illness and its treatment’ (67.9%) and ‘illness was mild’ (55.8%). Other reasons included previous successful self-medication (35.9%); too many protocol at the hospital (31.0%); to save time (27.5%); to save money (20.2%); the situation was one of urgency (13.6%); and impoliteness of health care practitioners (3.8%). The common sources of the medications were patent medicine stores (774%), and community pharmacists (21.3%). Conclusions: There is high prevalence of self-medication among medical students in Enugu, Nigeria, and their medications are commonly sourced from patent medical stores. There is thus need for sensitization of medical students on the advantages and disadvantages of self-medication in order to ensure safe and responsible drug use. Policies to control drug dispensation by patent medicine stores are urgently needed in view of the enormous adverse effects of self-medications.
[ABSTRACT]   Full text not available  [PDF]
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Perceived utilization of National Health Insurance among Staff of University of Nigeria Teaching Hospital (UNTH), Ituku – Ozalla, Enugu, Southeast Nigeria
C Nwankwor, C Aneke, I Henry-Arize, I Okoronkwo
July-December 2018, 23(2):255-260
DOI:10.4314/jcm.v23i2.4  
Background: Daunting pressure of delivering needed healthcare with limited financial resources, in the face of increasing costs and poor health indices, led the Nigerian government to establish the National Health Insurance Scheme (NHIS). Notwithstanding, public sector participants who fall under the scheme' s Formal Sector Social Health Insurance Programme (FSSHIP), continue to have misconceptions about the programme. Objective: This study assessed client's knowledge, pattern of utilization, patient's satisfaction with the services and perceived barriers to implementation, of the NHIS among staff of a tertiary health institution in South-East Nigeria. Methods: A cross sectional quantitative design was adopted. Three hundred and eighty (380) enrollees insured for more than one year were recruited using a two stage sampling method. Data collection was by means of a validated questionnaire. Data analysis was achieved with Statistical Programme for Social Sciences version (SPSS) 16 using descriptive statistics and logistic regression. Results: While the rate of monthly utilization is high (35%), majority of the respondents (77.4%) were dissatisfied with the services provided under the scheme. The rate of utilization is influenced by sex (p < 0.05) and salary/income level (p < 0.05). Client's knowledge of various aspects of the health insurance scheme and its operations was low. Educational status (p < .05) positively influenced client's satisfaction. The barriers to implementation were diverse and included difficulties in obtaining referral code and medicines out-of-stock syndrome. Conclusion: It is essential to eliminate observed and perceived, bottlenecks impeding effectiveness and efficiency of the programme. Hence, there is need for periodic review of the scheme by government to accommodate legitimate concerns of the consumer
[ABSTRACT]   Full text not available  [PDF]
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ARTICLES
Assessing the influence of socio demographic factors on awareness of tuberculosis symptoms, modes of transmission and management among tuberculous patients in Enugu State, South East Nigeria: A cross-sectional survey
OG Ochonma, CU Eze, BS Eze, IO Maduakolam, SE Igwe
July-December 2016, 21(2):16-26
Background: Tuberculosis (TB) is a chronic bacteria air borne disease that primarily affects the lungs. The awareness of the symptoms and signs of TB including modes of transmission was found to be influenced by patients' socio-demographics. It was important to understand the extent of this relationship in our study and at the end the results were used to produce strategies and initiatives on TB control and management. Aim: The aim of this study was to investigate the influence of patients' socio demographic factors on the knowledge of the symptoms and signs of TB including modes of transmission and at the end use the results to produce strategies on TB control and management. Subjects and Methods: The study was cross-sectional and involved the use of interviewer-administered questionnaire for collection of data from the study participants on their knowledge of the symptoms and signs of TB including modes of transmission. Systematic sampling method was used for the study due to the ordered nature of the sampling frame. The data was entered in Statistical Package for Social Sciences (SPSS 16) for analysis. The discrete data were described using frequencies and percentages, while the continuous variables were described using means and standard deviations. Results: Awareness of the symptoms and signs of TB among the respondents was high. The result showed that only about 1.6% of the respondents had good knowledge about the modes of TB transmission and a large sum of 98.4% had poor knowledge. Respondents who were aged 31-40 years had the highest level of knowledge of the symptoms and signs of TB with a statistical significance at (x2 = 11.38, p=0.01). Knowledge of symptoms and signs of TB increased with the level of education (x2 =6.03, p=0.11) and paid employment (x2 =5.56, p=0.01). Single respondents were 2.19 times more likely to have good knowledge of the symptoms and signs of TB when compared to the married respondents (95%CI: 0.79- 99.85), p=0.08. Conclusions: Tuberculosis remains a devastating public health problem in Nigeria. There was a high level of awareness of the symptoms and signs of TB but very low knowledge about the modes of transmission amongst the respondents. Abating, controlling and managing the rate of TB infection will mean foremost the education of the most vulnerable groups (the uneducated and the unemployed) and the affected communities on the symptoms, signs, causes and modes of TB transmissions. This strategy on educating the patients must be differentially organised for each group to achieve the maximum impact.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Posterior Tibia Slope Angle Measurement in adult Igbos of South Eastern Nigeria using plain Xray-Films
AU Katchy, NR Njeze, IO Nevobasi, K Nnamani, AU Ata
July-December 2018, 23(2):266-269
DOI:10.4314/jcm.v23i2.6  
Background: Posterior slope of the tibia (PTS) is the posterior-inferior inclination of the tibia plateau relative to the longitudinal axis of the tibia. This slope plays a role in the biomechanics and kinematics of the knee. Aim: The study aims to determine the normal Posterior Tibia Slope Angle (PTSA) in adult Igbos of South East Nigeria population and also identify any laterality and/or correlation of the angle with gender and age. Methods: Normal lateral radiographs of Two Hundred and Sixty Five (265) skeletal matured patients were included in the study. The PTS measurement was done using the Anterior Tibial Cortex method. A two way analysis of variance was conducted on the influence of two independent variables (age, gender) on the PTS measured for the right knee as well as the left knee. Results: The mean normal PTS of the study population was 11.9 ± 3.40. It had no significant association with participants' age or gender (P > 0.05). There was a weak positive correlation between the left and right knee's PTSA (r = 0.33). Conclusion: The mean normal PTSA in adult Igbos of South East Nigeria population is 11.9 ± 3.40. There is no laterality, gender dimorphism or correlation of the angle with gender and age.
[ABSTRACT]   Full text not available  [PDF]
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Paediatric hydrocephalus: Pre-treatment computed tomography findings in 80 consecutive patients

July-December 2018, 23(2):289-294
DOI:10.4314/jcm.v23i2.10  
Background: Hydrocephalus, a common indication for paediatric neuro-imaging, results from any disorder in the formation, circulation and absorption of cerebrospinal fluid. Serious neurological sequelae often result if neglected.Computed Tomography (CT) plays a vital role in revealing the various aetiologies of hydrocephalus in order to guide intervention. Objectives: To retrospectively assess the spectrum of CT findings in children with clinical features of hydrocephalus referred to the CT suite of a tertiary hospital in South-East Nigeria for radiodiagnosis and compare with findings in existing literature Materials and Methods: We evaluated 80children- 32 females and 48 males- over a period of one year. Included also in this study were children with clinical features of hydrocephalus who presented with other findings such as delayed developmental milestones and congenital neural tube defects. Results: The age range was 0.01 to 14 years, a mean of 2.23 years. 56.3% of the cases had CT features consistent with obstructive hydrocephalus- ventriculomegaly proximal to the site of obstruction with normal-sized ventricles distal to the obstruction). The communicating subtype, hydranencephaly and Benign External Hydrocephalus were seen in 36.25%, 6.2% and 1.25% respectively. The level of predilection for ventricular obstruction was the Aqueduct of Sylvius in 75.6%. Secondary causes were demonstrable in 10 of the children with aqueductal stenosis (AS) while 24 had no evident secondary cause. Congenital AS occurred more in males- 17, as against 7 females; however, there was no significant correlation between gender and predisposition for AS (P= 0.546). Conclusion: This study demonstrates the positive yield of computed tomography in the diagnosis of hydrocephalus in children albeit the downside of exposure to ionizing radiation
[ABSTRACT]   Full text not available  [PDF]
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Hydrostatic reduction is Cost-effective in the management of pediatric intussusception in Nigeria: A decision analysis
MD Ughasoro, UO Ezomike, SO Ekenze
January-June 2018, 23(1):176-181
DOI:10.4314/jcm.v23i1.2  
Background: The cost of hydrostatic reduction, the cost of operative treatment of intussusceptions as well as the assessment of the cost-effectiveness of hydrostatic reduction in treating pediatric intussusceptions have not been documented in our environment. Objectives: To estimate the cost of hydrostatic reduction of intussusceptions, the cost of operative treatment of intussusceptions and assess if hydrostatic reduction is cost-effective in management of intussusception. Methods: The medical records of children who were managed for intussusception were reviewed. Micro-costing was used to calculate expenditure on treatment modalities. Decision-analytic Markov model was used to determine the cost-effectiveness of hydrostatic reduction. Results: The average cost of hydrostatic reduction was $116 USD and that of operative treatment was $ 393.62 USD. At the success rate of 44% for hydrostatic reduction, initial attempts at hydrostatic reduction are still cost-effective at the overall cost of $336.6 USD. The expenditure on drugs ($ 68.4 USD) and investigations ($46.58 USD) contributed most to the total cost. Planning hydrostatic reduction to coincide with the initial abdominal ultrasonography will reduce the overall cost by $8.1USD Conclusions: Hydrostatic reduction once indicated should be attempted before operative treatment in any facilities where the success rate of hydrostatic reduction is above 30%. To further reduce cost, the first ultrasonography should be targeted to correspond with the hydrostatic reduction procedure.
[ABSTRACT]   Full text not available  [PDF]
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Accidental poisoning among under-five children seen at the children's emergency room of Federal Medical Center Umuahia, Nigeria
CA Ibeneme, IF Ogbonna, GC Nwala
January-June 2018, 23(1):201-205
DOI:10.4314/jcm.v23i1.6  
Background: Accidental poisoning among under-five children remains a recognized cause of morbidity and/or mortality with highest rates in low-income countries. Its prevalence and types vary from place to place with the presenting features ranging from mild to near-fatal symptoms. Aim: To document the frequency and pattern of accidental poisoning among under-five children seen at the Children's Emergency Room of the Federal Medical Center, Umuahia. Methods: This is a retrospective review of the cases of under-fives with accidental poisoning over an eight-year period (January 2009 to December 2016). Information such as age, gender, type of poison, presenting features, type of home remedy and outcome were retrieved. Results: Of the 9,492 under-fives seen during this period, 53 (0.6%) had accidental poisoning. The mean age was 21.2± 10.1 months and male-to-female ratio was 1.8:1. The mean duration from the time of the incident to presentation was two hours. Most common route of poisoning was ingestion (93.4%) and kerosene was the most common substance ingested. Presenting features ranged from mild symptoms such as fever and vomiting, to fatal symptoms such as seizures and coma. Palm oil (83.3%) and coconut water (16.7%) administered orally were the most common forms of home remedies. One of the patients was managed in ICU and there was no documented mortality. Conclusion: Accidental poisoning remains a common paediatric emergency room presentation and kerosene ingestion is the commonest type of presentation. Early presentation and prompt intervention may help to reduce morbidity and/or mortality.
[ABSTRACT]   Full text not available  [PDF]
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