• Users Online: 217
  • Print this page
  • Email this page
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Most popular articles (Since July 26, 2019)

 
 
  Archives   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
ORIGINAL ARTICLES
Entry points into a Nigerian medical school at the graduate and undergraduate levels: A three-year prospective and retrospective comparison of performances at the first MBBS professional examinations
Ed Nwobodo, Uchechukwu Dimkpa, Chidiebere Ugwu, Ugochukwu B Anyaehie
July-December 2019, 24(2):95-99
DOI:10.4103/ijmh.IJMH_21_19  
Background: It is alleged that there is a mismatch between candidates’ performance in University Matriculation Examination (UME) and their subsequent academic achievement in medical schools in Nigeria. Aim: The present study compares the performance of medical students admitted via Direct Entry (DE) module and that of UME using their 1st professional examination. Methodology: A total of 343 undergraduate medical students of College of Medicine, Nnamdi Azikiwe University, Nnewi, Anambra state, Nigeria were used for this study. 270 of the students were admitted through UME, while 73 were admitted through DE modes of admission. The results of the 1st MBBS examinations taken in the years 2014 to 2017 were collated, analyzed and compared between the two groups of students. Results: The rate of success in 1st MBBS examination was greater in the DE students (74%) compared with the UME students (44.1%). The failure rate was higher in the UME entrants (55.9%) compared with the direct entrants (26%). The frequency of withdrawals in the group with UME (n = 28) was greater than that of the group with DE (n = 0). Chi square test of association indicated significant (p < 0.001) association between performance of students in 1st MBBS examination and the mode of admission. Logistic regression test shows that the odds of failure were against students with UME module than those with DE. Conclusion: The present study indicates that the admission module of DE with previous degree increases the chances of academic success in medical education in Nigeria. This suggests the need for a review of the mode of admission into medical schools to favour students that have a previous degree.
  2,130 91 -
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.
  1,388 158 -
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.
  1,136 117 -
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.
  1,146 88 -
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.
  1,038 58 -
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.
  948 78 -
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.
  930 93 -
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.
  807 122 -
Investigating the level of awareness and extent of financial risk protection among the population in Enugu state, southeast Nigeria
Chijioke Okoli, Eric Obikeze, Charles Ezenduka, Ejikeme Arodiwe, Ogbonnia Ochonma, Obinna Onwujekwe
July-December 2019, 24(2):70-77
DOI:10.4103/ijmh.IJMH_12_19  
Objective: The study investigated the level of awareness and extent of financial risk protection among the population in Enugu state, southeast Nigeria. Materials and Methods: A mixed-method approach involving cross-sectional quantitative and qualitative methods was adopted for data collection and analysis. The study was conducted in two purposively selected urban and rural local government settings in Enugu North and East senatorial zones, respectively. Results: The quantitative results show that most of the respondents (77.1%) were women and 80.2% were married. Slightly above a quarter of the respondents (25.6%) were self-employed, whereas 29.1% were main income earners. Out-of-pocket (OOP) dominates payment mechanisms (94.9%), whereas more than half (54.4%) of the respondents went to patent medicine dealers for treatment in the last one month. Logistic regression shows overall significance in use of prepayment mechanisms with χ2 = 56.57 and P = 0.001. More so, finding indicates that 55.9% of respondents have heard of prepayment mechanisms mainly from television (30.4%) and radio program (20.2%), while 89.5% has not used any prepayment mechanism in the State. Conclusion: OOP still dominates payment mechanism in Enugu state. Although over half of the respondents (55.9%) have heard of prepayment mechanisms, approximately 90% has not used any prepayment mechanism in the State. This calls for policy that will ensure moving away from OOP payment to prepayment mechanism through health system strengthening and awareness creation for the populace.
  724 102 -
Awareness and practice of zinc therapy in diarrheal management among under-five caregivers in Enugu State, Nigeria
Joshua I Ugwu, Ikechukwu E Ezeagu, Madu D Ibegbu
July-December 2019, 24(2):63-69
DOI:10.4103/1110-1067.271082  
Background: Acute diarrhea remains one of the leading causes of under -five years of age (u-5) childhood deaths in Nigeria. Use of zinc (Zn) sulfate monohydrate with low-osmolality oral rehydration solution (ORS) therapy reduces both the duration and severity of the diarrhea episodes in children. There has been little progress in the widespread introduction and adoption of ORS plus Zn sulfate (ORS+Zn) therapy in Nigeria. Aims and Objectives: The aim of this study was to assess the level of awareness and practice of ORS+Zn therapy among u-5 caregivers. Materials and Methods: Two local government areas, each representing urban and rural settings, were randomly selected. Awareness and practice of ORS+Zn therapy by 386 caregivers was assessed using a semi-structured interviewer-administered questionnaire. Frequency and percentages were used for categorical data and the influence of sociodemography was analyzed by using Pearson’s correlation method. Results: Awareness and practice of Zn therapy was higher among the caregivers in the urban setting, who seems to be more exposed to information on the efficacy of ORS+Zn therapy (p < 0.05). Caregivers of u-5 children living in the rural settings were deficient in information on the use of ORS and Zn salts in the management of child diarrhea. In summary, of the 386 caregivers, 123 (62%) indicated awareness of Zn salt, and of these only 39 (10%) practiced Zn salt treatment. Level of education seems to influence awareness and practice positively in the urban setting (p < 0.05). Economic status underscored by employment type, clinic visits, and health campaigns influenced positively the adoption of ORS+Zn therapy in the rural and urban communities (p < 0.05). Tertiary education, which is the highest level of education, showed a positive association with awareness and practice of ORS+Zn treatment in both study areas (p < 0.05). One hundred and ninety-nine caregivers (52%) of all the respondents still preferred to treat child diarrhea with ORS with antibiotics adjuvant. Conclusion: Practice of ORS+Zn therapy is low and seems to be influenced by level of education, awareness, and location and availability. Advocacy and sensitization programs should be intensified, and intake of food rich in Zn and Zn supplement should be promoted in infant-feeding practices.
  656 137 -
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.
  690 65 -
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.
  677 74 -
Prospective analysis of extremity gunshot injuries treated in a Nigerian regional trauma center
Omolade A Lasebikan, Njoku I Omoke, Ndubuisi O Onyemaechi, Emmanuel C Iyidobi, Wilson I Anetekhai
July-December 2019, 24(2):100-106
DOI:10.4103/ijmh.IJMH_27_19  
Background: Extremity gunshot injuries are a common cause of morbidity and mortality in our environment. They pose a management challenge because of the complex soft tissue and bony injuries. Objectives: The objectives of this study was to determine the pattern and treatment outcomes of these injuries in our setting. Materials and Methods: This was a prospective study of extremity gunshot injuries treated at National Orthopaedic Hospital, Enugu, Nigeria over a 12-month period. Results: Fifty-five patients were studied, with a mean age of 36.9 ± 13.39 years and a male-to-female ratio of 8.2:1. The two top causes of gunshot injuries were armed robbery (41; 74.5%) and assaults/communal clash (6; 10.9%), and the most common type of gun was the rifle (21; 38.2%). Gunshot fracture was the commonest type of injury among the patients (39, 70.9%). Only 34.5.1% of our patients presented to hospital within the first 6h. Secondary wound closure was the commonest method of wound cover. Majority of the gunshot fractures were treated non-operatively. The duration of hospitalization ranged from 2 days to 13 weeks with a mean duration of 4.9 weeks. Late presentation, presence of fracture, and wound infection were associated with prolonged hospital stay. Outcome of treatment was good in 80% of patients and the mortality rate was 1.8%. Conclusion: The young adult males are more involved in extremity gunshot injuries. The fracture rate of these injuries is high with associated increased morbidity. Effective control measures aimed at reducing the incidence of gunshot injuries will reduce the negative socioeconomic impact of these injuries.
  672 63 -
A need for specialized education in pediatric radiography in Nigeria
Odira C Ewuzie
July-December 2019, 24(2):85-88
DOI:10.4103/ijmh.IJMH_20_19  
Introduction: Pediatrics is a vast field with many facets. The importance of having dedicated specialists trained in the treatment and care of pediatric patients has long been recognized. It is necessary to determine if the profession of radiography is making similar progress in improving on the pediatric radiography services offered in the country. Objective: The objective of this study was to establish if there was a perceived need for specialized pediatric radiographic education in Nigeria. Subjects and Methods: This was a descriptive cross-sectional survey, which accessed radiographers' take on the need for specialized education in pediatric imaging. A Google Form link was distributed through various Nigerian radiographers' WhatsApp groups, inviting interested radiographers to participate in stating their opinions on the need for specialized pediatric radiographic education in the country and other related questions. Data were analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results were presented using tables and charts. Results: Seventy-six radiographers working in 25 states across the federation participated in the online survey. A total of 90.8% of the respondents stated there was a need for specialized radiographic education in pediatric imaging, and 64.5% felt that this education or training opportunities for radiographers was inadequate. Only 43.4% were comfortable performing pediatric imaging. Conclusion: Majority of the radiography departments in Nigeria do not have dedicated equipment or staff for pediatric radiography. Undergoing specialized pediatric imaging training will benefit radiographers who are keen on improving the radiography services offered to pediatric patients.
  604 106 -
Second-phase delay in accessing major elective surgeries from a public tertiary health institution in Nigeria: The role of financial constraints
Ikenna I Nnabugwu, Fredrick O Ugwumba, Jude K Ede
July-December 2019, 24(2):89-94
DOI:10.4103/ijmh.IJMH_16_19  
Background: Many factors contribute to second-phase delay in accessing surgical care electively especially in low-income settings. The aim of this study was to evaluate second-phase delay in elective surgical care in a tertiary hospital. Materials and Methods: This study is a hospital-based cross-sectional survey conducted at a tertiary health institution in Nigeria from February to September 2017. Sampling units were households that accessed major elective surgical operation from the general surgery and urology units of the institution for an adult member (≥18 years of age) of the household. Analysis was performed using the Statistical Package for Social Sciences software version 20.0 (IBM SPSS Inc, Chicago, USA). Results: In total, 495 households representing same number of patients participated in the study. Second-phase interval was within one month in 16.2% of households. It was delayed 2–6 months in 55.2% of households, 6–12 months in 16.2% of households, and more than 12 months in 12.5% of households. Financial constraint was reported as reason for the observed second-phase interval in 54.7% of households with 93.4% of these households delayed for longer than one month and 38.0% for more than six months. Financial constraint was significantly more prevalent among larger households (OR 7.64; 95%CI 1.89–30.78; P < 0.01) and households in the lower wealth quartiles (OR 0.73; 95%CI 0.55–0.97; P = 0.03). Few households (7.1%) accessed health insurance for the prescribed major surgery and only 8.6% of those insured households reported financial constraints. Conclusion: Longer second-phase delay attributable to financial constraints is prevalent among larger households comprising mostly children, households in the lower socioeconomic quartiles, and uninsured households.
  559 100 -
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.
  592 62 -
Comparative study of six-month and eight-month treatment of new smear positive tuberculosis cases at a tertiary health facility in Enugu, South-Eastern Nigeria
Babatunde I Omotowo, Ijeoma Itanyi, Edmund O Ndibuagu, Chuka C Agunwa, Ikechukwu E Obi, Arthur C Idoko, Anne C Ndu
July-December 2019, 24(2):78-84
DOI:10.4103/ijmh.IJMH_24_19  
Introduction: Factors that affect tuberculosis (TB) treatment outcomes are important and should be investigated to achieve the targets of TB control program. Aims and Objectives: The aim of this study was to compare treatment outcomes of new smear positive TB patients treated for six months with those treated for eight months. Materials and Methods: A retrospective study of 600 new smear-positive TB patients was carried out. The data were analyzed using Stata version 22 (SPSS Inc., Chicago, Illinois, USA), and the values of P < 0.05 were considered statistically significant. Binary logistic regression was used to identify factors that influenced treatment outcomes. Results: Overall, a higher proportion of patients (78.6%) who were treated for six months had successful treatment outcomes as compared with those treated for eight months 64.4% (P = < 0.001, OR = 2.03, CI = 1.41–2.91). After adjusting for confounders, sex (P = 0.040, AOR = 0.65, CI = 0.44–0.98), treatment duration (P < 0.001, AOR = 2.27, CI = 1.53–3.39), and pretreatment weight (P = 0.007, AOR = 1.28, CI = 1.07–1.52) independently predicted treatment outcome. Conclusion: The treatment success rate was better among the patients treated for six-month duration than those treated for eight-month duration. The current six-month regimen recommended by WHO should be maintained. Loss to follow-up and TB/HIV coinfection management should be improved.
  479 113 -
Unregulated drug use and consequences in the Nigerian health sector
Chinwe L Onyekonwu, Chijioke G Onyekonwu, Emmanuel O Ugwu
July-December 2019, 24(2):107-113
DOI:10.4103/ijmh.IJMH_18_19  
Background: The Nigerian health system is bedeviled with poor regulatory services, frequent interruption of services as a result of disharmony among different cadres of health-care providers, inadequate manpower, poor management and leadership, and poor access to care due to non-enrollment in health insurance. Health-care spending is often catastrophic in most cases as payment is usually out of pocket for most service users. This has led to proliferation and patronage of unlicensed and unregulated health-care providers. Some patients are able to afford out of pocket payment but often meet suboptimal functioning services when they present to the hospitals which are also bedeviled by inadequate manpower and health-care facilities. Others who cannot afford the payments first patronize quacks and present later to the hospitals, sometimes with complications and attendant increase in morbidity and mortality. Aims and Objectives: The aim of this study was to highlight some problems that may arise as a result of unregulated drug use in the Nigerian populace and the role of an efficient health system with improved health insurance access, in curbing these problems. Materials and Methods: The reality of the Nigerian Health Care System as it stands today was highlighted and objectives of the National Health Insurance Scheme at inception cited. Three clinical cases of complications arising from poor access to health care and drug use regulation were described. Conclusion: Access to health care in Nigeria has remained poor and mostly out of pocket despite the goal of the National Health Insurance Scheme to provide health care at reduced costs. Patronage of unlicensed health-care providers remains high due to poor access to health care, poverty, and illiteracy with untoward effects on affected individuals. There is an urgent need to scale up access to health insurance across all sectors and ensure efficient service delivery through regular monitoring by appropriate regulatory agencies and constant education of the populace to discourage patronage of quack health-care providers.
  386 61 -
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]
  370 52 -
CASE REPORT
Carbamazepine-associated urinary incontinence: A case report and literature review
Jamir P Rissardo, Ana L Fornari Caprara
July-December 2019, 24(2):114-117
DOI:10.4103/ijmh.IJMH_25_19  
Carbamazepine (CBZ) is an anticonvulsant approved for the management of many neurological and psychiatric disorders. We present a case of an adult male with epilepsy who reported new seizures, and the dose of CBZ administered was 1600mg daily. CBZ dose was increased to 1800mg daily. The subject complained of urinary incontinence without dysuria that started after the CBZ dose increase. It was associated with urgency, hesitancy, dribbling of urine, and poor stream. Laboratory tests were within normal limits. He admitted dry mouth, flushing, constipation, and accommodation paralysis starting after CBZ increase. Assuming that these symptoms were an adverse drug reaction, CBZ was withdrawn and valproate was started. The individual had full recovery within four weeks. To the best of our knowledge, only two case reports of similar nature are available, but this is the first one to be reported with young male adult.
  353 53 -
LETTER TO EDITOR
Emphasizing on the need of preparedness and antibiotics supply for the containment of the plague outbreak
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
July-December 2019, 24(2):118-119
DOI:10.4103/ijmh.IJMH_23_19  
  270 43 -
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]
  248 57 -
REVIEW ARTICLE
A review of pediatric mortalities in the emergency units of Nigerian tertiary hospitals
Benedict O Edelu, Obianuju O Igbokwe, Ogochukwu N Iloh
January-June 2020, 25(1):1-5
DOI:10.4103/ijmh.IJMH_37_19  
Background: Information on causes of death is needed to assess trends in disease burden, prioritize interventions, plan for their delivery, and ascertain the effectiveness of disease-specific interventions. The aim of this study was to review the postneonatal mortality pattern in the different pediatric emergency units of the tertiary hospitals across the country, and to propose ways of strengthening the emergency units for more effective health service delivery. Materials and Methods: Available literature on mortality in pediatric emergency units across the tertiary health institutions in Nigeria was reviewed. Neonates as well as studies that combined ward admissions with emergency room admissions were excluded. Analysis was mainly descriptive and results presented using prose, tables, and charts. Results: A total of 11 studies were analyzed. The crude mortality rate was 82 per 1000 admissions. Approximately 60% of the deaths occurred within the first 24h of presentation. The major causes of death were severe malaria (17.9%), sepsis (14.5%), acute gastroenteritis (13.7%), pneumonia (8.9%), and protein-energy malnutrition (97.7%). Sepsis and severe anemia had the highest case fatality rates, with 20.0% and 19.6%, respectively. Late presentation, unconsciousness, seizure, and severe pallor were some of the identified risk factors. Conclusion: Communicable diseases remain the major cause of mortality in our emergency units. Strengthening and restructuring of the emergency units in terms of manpower and services will help in lowering the mortality rates.
  244 60 -
ORIGINAL ARTICLES
Cesarean section rate and its outcome in a Tertiary Hospital in Enugu, South East Nigeria
EC Ezugwu, CA Iyoke, IE Iloghalu, EO Ugwu, TC Okeke, KE Ekwuazi
January-June 2017, 22(1):24-30
DOI:10.7324/jcm.v22i1.5  
Background: Cesarean delivery is an essential component of comprehensive emergency obstetric care, an intervention that saves the life of pregnant women. Although the cesarean section (C/S) rate varies from one region to the other, there is generally a rising trend in the C/S rate globally with its associated benefits and attendant challenges. Objective: The study aimed to determine the C/S rate and its outcome at the University of Nigeria teaching hospital, Enugu. Methods: All pregnant women undergoing C/S during the 12 months study period from 1st January to 31st December 2012 at UNTH, Enugu, South east Nigeria were consecutively recruited. Cesarean delivery group were compared with vaginal delivery group using maternal mortality ratio (MMR) and perinatal mortality rate (PMR) as outcome measures. Relevant data were obtained and analyzed using Epi info statistical software. Results: There were 256 C/S and 998 total deliveries, giving a C/S rate of 25.7%.The maternal mortality rate (MMR) in the C/S group was significantly higher than the vaginal delivery group (MMR= 1619 vs 139/ 100 000 livebirths, p value = 0.02. RR= 11.46, 95% CI (1.29, 102.04). The perinatal mortality rate in the two groups was not statistically different, (53.6 v 54.9/ 1000 live births, p value=0.93, RR =0.97, 95% CI (0.54, 1.77), however un-booked status was a predisposing factor for maternal and perinatal deaths. Conclusion: The C/S rate from the study was high, although with good outcome. However, MMR was significant higher in the Cesarean group compared with those that had vaginal delivery.
[ABSTRACT]   Full text not available  [PDF]
  225 67 -
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]
  249 42 -