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   Table of Contents - Current issue
Coverpage
January-April 2021
Volume 26 | Issue 1
Page Nos. 1-75

Online since Wednesday, October 21, 2020

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REVIEW ARTICLES  

Conflict of interest in physician–pharmaceutical industry interactions: Possible interventions in Nigeria medical practice p. 1
Ijeoma Victoria Ezeome
DOI:10.4103/ijmh.IJMH_26_20  
Collaboration between physicians and the pharmaceutical, medical device, and biotechnology industries results in the development of products of great benefit to the public. However, when these interactions negatively influence professional judgments at the expense of the goals of medicine, it becomes a cause of great concern. The objective of this simple review was to bring to the fore the conflicts that exist between these two important areas of patient care and to suggest ways to prevent it in Nigeria. A literature search in the PubMed, Medline, and Web of Science databases was done using the terms conflict of interest, physician, pharmaceutical, medical practice, detailing, biomedical research, bioethics, prescribing pattern, singly or in combination to identify relevant articles. The results are arranged based on the themes of related published articles. This review shows that interactions between physicians and the pharmaceutical industry have multiple areas of conflict ranging from reduction in the quality of patient care, loss of objectivity in professional education, scientific integrity, and the public’s trust in medicine. Interaction between pharmaceutical sales representatives (PSRs) and physicians commonly occur in Nigeria, affecting prescribing behavior. There is no specific regulation in place to protect against ensuing conflicts. There is a need to put in place educational programs to increase awareness among physicians of the effects of such interactions, while also instituting and implementing stringent policies curtailing physician–pharmaceutical industry and PSR relationships.
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The inverse care law: implications for universal health coverage in Nigerian rural communities p. 11
Aniekan Etokidem, Daprim Ogaji
DOI:10.4103/ijmh.IJMH_38_19  
Background: The inverse care law states that the availability of good healthcare tends to vary inversely with the need for it in the population served. This situation is easily observable in developing countries like Nigeria, and poses a threat to the attainment of universal health coverage (UHC) in rural communities. Objective: To examine how the inverse care law plays out in the Nigerian healthcare system, and how this may lead to a difficulty in achieving UHC in rural communities. Materials and Methods: Standard procedures were used in locating, selecting, extracting and synthesizing data. Electronic databases and internet resources such as PubMed, Google Scholar, SCOPUS and Web of Science were searched. Selection of studies was conducted by a two-stage process. Data extraction was done using data extraction forms. During data synthesis, major themes, strengths, weaknesses and critical gaps in each paper were identified. Results: There are several factors that boost the operation of the inverse care law in the Nigerian healthcare system. How this poses a threat to the attainment of UHC has also been documented. Among these are limitations in the range of services provided in rural healthcare facilities, inadequate production and maldistribution of health personnel, and low health manpower retention in rural areas. Conclusion: There is a need for concerted efforts by the government to address the factors that facilitate the inverse care law in the Nigerian healthcare system. This is necessary for the attainment of UHC specifically and the Sustainable Development Goal number three generally.
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Effects of structured Aerobic Exercise on selected clinical profiles of patients with type 2 diabetes mellitus: A systematic review with meta-analysis p. 17
Nmachukwu Ifeoma Ekechukwu, Stella Udumma Anwara, Ukamaka Gloria Mgbeojedo, Olive U Chijioke, Okechukwu Steven Onwukwe, Uchechukwu Anthonia Ezugwu, Echezona Nelson Dominic Ekechukwu, Ijeoma L Okoronkwo
DOI:10.4103/ijmh.IJMH_23_20  
This review sought to examine the pooled effects of Aerobic Exercise (AeroEx) on the glycemic, lipid, cardiovascular, and anthropometric profiles as well as the quality of life (QoL) of patients with type 2 diabetes mellitus (T2DM). Major electronic databases were searched systematically to identify randomized controlled studies that examined the effects of AeroEx in with T2DM. The methodological quality of each study was evaluated using the PEDro scale. Meta-analysis was performed on a given outcome when appropriate. Twelve trials fulfilled the selection criteria. Most of the studies prescribed AeroEx using treadmill (41.7%) or cycle ergometer (58.3%), at a moderate training intensity (58.3%) for ≥3 days/week (100%), 41–60 min/day (66.7%) and for ≥16 weeks (41.6%). Meta-analysis showed a significant effect on glycemic profiles (glycated hemoglobin [SMD = –2.06; CI = –2.34, –1.79], fasting blood glucose [SMD = –1.20; CI = –1.45, –0.95]), lipid profiles (total cholesterol [SMD = –1.35; CI = –1.58, –1.12], low-density lipoprotein [LDL] [SMD = –0.67; CI = –1.22, –0.12]), cardiovascular profiles (maximum oxygen consumption [SMD = 0.58; CI = 0.20, 0.96], diastolic blood pressure [SMD = –0.40; CI = –0.60, –0.21]), anthropometric profiles (percentage body fat [SMD = –1.09; CI = –1.37, –0.82], BMI [SMD = –1.81; CI = –2.16, –0.87]) and QoL (SMD = 2.23; CI = 1.56, 2.90) in favor of AeroEx. In conclusion, chronic AeroEx with moderate intensity induces glycemic control, regulates the lipid profiles, promotes cardiovascular health, and improves overall QoL of patients with T2DM.
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ORIGINAL ARTICLES Top

Impact of sleep patterns on the academic performance of medical students of College of Medicine, University of Nigeria p. 31
Augustine Uchechukwu Agu, Emmanuel Anayochukwu Esom, Samuel Chukwudi Chime, Pamela Somke Anyaeji, Godson Emeka Anyanwu, Emmanuel Nebeuwa Obikili
DOI:10.4103/ijmh.IJMH_32_20  
Background: Sleep is necessary for physical and cognitive health; these functions are susceptible to be impaired by sleep deprivation. This study evaluated the sleep patterns of the medical students and the impact they have on their academic performance. Materials and Methods: One hundred and ninety-three third-year medical students (122 males and 73 females) participated in the study. The students’ sleep patterns were obtained through a structured questionnaire which was divided into two sections: section 1 was used to obtain the students’ demographic data, and section 2 was used to determine the students’ sleep durations, latency, and qualities. Data on their academic performance were obtained from the results of their second-year MBBS professional examination. Descriptive analysis was done and associations between academic performance and the variables were determined using Student’s t-test, χ2 tests, and Spearman’s correlation test. Results: Fifty-nine percent of the students were sleep-deprived and 41% slept for 6 h or more, 42% had sleep latency of less than 10 min, and 60% frequently or sometimes wakeup at night, while 44.1% felt sleepy during school hours. The academic performance correlated positively with sleep duration (P < 0.001), whereas the correlation with sleep latency and quality was negative. The students who were sleep-deprived had poor academic performance and those with short sleep latency had a better academic performance. Conclusion: Poor sleep duration, long sleep latency, and poor sleep qualities negatively affected the academic performance of the students.
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Efficacy of intravenous paracetamol infusion for prolongation of analgesia under spinal anesthesia for myomectomy p. 37
Jonathan C Eya, Fidelis A Onyekwulu, Adaobi O Amucheazi, Obinna V Ajuzieogu
DOI:10.4103/ijmh.IJMH_25_20  
Objective: To assess the effectiveness of intravenous (iv) paracetamol (PCM) infusion in prolonging the duration of analgesia following spinal anesthesia and to determine patients’ satisfaction with pain relief. Materials and Methods: This was a double-blind, randomized, controlled study. A total of 126 adult American Society of Anesthesiologists physical status I or II women scheduled for elective myomectomy under spinal anesthesia were enrolled in the study. Patients were randomly allocated into two groups. PCM group (group A) [n = 63] received 100mL of 1g PCM and Normal saline group (group B) [n = 63] received 100mL of normal saline after spinal anesthesia was established. Statistical analysis was done using Statistical Package for Social Sciences, version 17. Results: There was no statistical difference between the groups in terms of age, weight, and body mass index. The mean time to first analgesic demand was 4.75 ± 1.59 h in group A and 2.23 ± 0.15 h in group B (P < 0.001), while the mean dose of additional analgesic was significantly lower in group A (11.81 ± 2.50 µg) when compared to group B (255.49 ± 140.80 µg), P < 0.001. In group A, 75.8% expressed excellent satisfaction with pain relief while 62.9% of patient in group B reported poor satisfaction with pain relief (χ2 = 87.600, P < 0.001). Conclusion: Intravenous infusion of 1g PCM is effective in prolonging the duration of analgesia following spinal anesthesia for myomectomy.
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Implementation of a Free Maternal and Child Health Programme in a Nigerian State p. 44
Festus Uzor, Arthur Idoko, Ed Nwobodo
DOI:10.4103/ijmh.IJMH_44_20  
Background: The Government of Enugu State as a policy response to reduce maternal and child mortality and morbidity in the state introduced the Free Maternal and Child Health (MCH) programme for all pregnant mothers and under-5-year-old clients in public health facilities across the state in 2007. Materials and Methods: Forty-three health facilities, 487 clients of the public health facilities, 43 health facility workers, and 8 directors of the State Ministry of Health and the State Hospitals Management Board were randomly selected through a multistage sampling technique involving stratified sampling techniques. Various instruments, namely pretested structured questionnaire, in-depth interview, and document review, were used to elicit data for the appraisal of the programme in terms of concept, policy and plan, implementation, management, and outcome. Data obtained were analyzed and variables tested for significance. Results: Our findings indicate that more than 60% of the clients are aware and utilize the free MCH programme. There was an overall reduction in maternal deaths, and an increase in the number of deliveries in public facilities since inception of the programme in the state. There was also a significant improvement in the MCH service uptake and high clients’ satisfaction. Major setback was inadequate supportive supervision. Conclusion: There is a huge need for increased awareness creation regarding the programme to enhance utilization, especially in the rural areas. Comprehensive baseline data of the health indices of the affected population are paramount to any future comprehensive programme assessment and are hence recommended.
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Snapshot on physicians’ view on safe blood transfusion in multiply transfused patients in Nigeria p. 50
Chilota C Efobi, Angela O Ugwu, Esther I Obi, Edmund N Ossai, Sunday Ocheni
DOI:10.4103/ijmh.IJMH_30_20  
Background: Multiply transfused patients (MTPs) are often at risk of alloimmunization and other transfusion-associated complications. These complications could be ameliorated through extended blood typing prior to transfusion of blood and blood products. Objective: The aim of this study was to assess the knowledge and practice of safe blood transfusion in MTPs by physicians. Materials and Methods: This was a cross-sectional questionnaire-based study of physicians who attended a scientific conference of the West Africa College of Physicians in Asaba, Delta State. Result: Most of the respondents (68%) managed patients requiring multiple blood transfusions. Forty-seven respondents (68.1%) had a blood transfusion policy for MTPs in their respective centers, and 43 (68.1%) had no transfusion trigger hemoglobin level in their respective health facilities. Respondents who had a blood transfusion policy in their centers had a better knowledge of safe blood transfusion than those that did not, P = 0.008. None of the respondents reported carrying out antibody screening before and after multiply transfusing the patients. Although 100% performed initial screening for transfusion transmissible infections (TTIs), only 11.6% repeated screening for TTIs annually. Conclusion: Practice of safe blood transfusion in MTPs was found to be poor among physicians in Nigeria. Hospitals and training institutions should design ways to update knowledge of physicians on safe blood transfusion especially in MTPs and by so doing optimize safe blood transfusion practices, so as to improve the quality of life of patients.
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COVID-19: Knowledge of mode of spread and preventive practices among mothers attending a tertiary health institution p. 56
Ann E Aronu, Awoere T Chinawa, Obinna C Nduagubam, Edmund N Ossai, Josephat M Chinawa
DOI:10.4103/ijmh.IJMH_54_20  
Background: COVID-19 pandemic is a very common menace in the world. Knowledge on mode of spread and prevention of COVID-19 remains blurred among mothers who visit children clinics. Objectives: This work is aimed to determine the knowledge of mode of spread and preventive practices among mothers presenting in a health institution. Materials and Methods: This is a cross-sectional observational study undertaken in a health institution in South East Nigeria using a structured self-administered questionnaire. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software version 25.0. Results: All the respondents (100.0%) have heard of COVID-19. A minor proportion of the respondents, 31.9%, had good knowledge of the mode of spread of COVID-19. Majority of the respondents, 93.3%, knew that COVID-19 could be prevented through good use of personal hand sanitizer. A high proportion of the respondents, 75.5%, were aware that COVID-19 could be prevented by avoiding crowded places and 76.7% by wearing of face mask. The respondents who were in the age group 30–39 years were twice more likely to have good knowledge of spread of COVID-19 when compared with those who were 50 years and above. (AOR = 2.2, 95%CI: 1.2–3.9). The respondents who attained tertiary education were 1.3 times less likely to have good knowledge of spread of COVID-19 when compared with those who attained secondary education. (AOR = 0.8, 95%CI: 0.5–1.2). Respondents who were married were about five times more likely to have good preventive practices against COVID-19 than those who were single parents. (AOR = 4.9, 95%CI: 2.8–8.4). Conclusion: Education is predictive of knowledge of mode of spread while being married is predictive of knowledge of preventive practices.
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Lower limb amputations in Nigeria: An appraisal of the indications and patterns from a premier teaching hospital p. 64
Okechukwu Onwuasoigwe, Ikechukwu C Okwesili, Leonard O Onyebulu, Emmanuel C Nnadi, Arinze D G Nwosu
DOI:10.4103/ijmh.IJMH_47_20  
Background: The most common indication for lower limb amputations in Nigeria is not known. Almost all studies on amputations in Nigeria considered lower and upper extremities together and report varying leading indications. Major lower limb amputation imposes a significant health burden on the patient and deserves effort at its prevention. The aim of the present study was to determine the predominant indication and patterns of lower limb amputations from a Nigerian premier teaching hospital to enable appropriate preventive recommendations. Materials and Methods: The operative records of patients who underwent lower limb amputation surgeries in the premier University of Nigeria Teaching Hospital, east of Nigeria, between January 2013 and December 2017 were retrospectively analyzed for the indications, levels of amputations, and patient characteristics. Results: Ninety-three unilateral lower limb amputations were performed within the 5-year period. There were 52 (55.9%) males with an M:F ratio of 1.3:1. The mean age of the patients was 52.23 years. Trans-tibial amputation was more commonly performed (51.6%), followed by trans-femoral (45.2%). Diabetic foot (DF) gangrene constituted the dominant indication (57%) and accounted for 54.8% of all the major amputations. The next common indication was tumors (19.3%). Foot gangrene from diabetes and from nondiabetic peripheral arterial diseases (10.8%) accounted for 67.8% of the indications. Conclusions: Major lower limb amputations predominate from this study, with peripheral vascular diseases (PVDs), especially due to diabetes mellitus, being the leading cause. Appropriate public health advocacy on DF complications and establishment of comprehensive multidisciplinary foot-care services, capable of prevention, diagnosis, and treatment of early DF lesions, will help reduce the incidence of DF gangrene. This measure will, no doubt, lower the high rate of major lower limb amputations.
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Effects of age and body mass index on blood pressure and blood glucose in three rural agrarian communities in Enugu State p. 70
Paschal O Njoku, Basden J Onwubere, Nkeiruka C Mbadiwe, Emmanuel C Ejim, Benedict C Anisiuba, Tobechukwu C Iyidobi, Alexander K Okonkwo
DOI:10.4103/ijmh.IJMH_42_20  
Background: Hypertension is a major contributor to the global burden of disease and global mortality, with a projection of 39.1 million cases in Nigeria by the year 2030. Aim: The aim of this study was to evaluate the effect of body mass index on blood pressure (BP) and blood glucose in three rural agrarian communities in Enugu State, Nigeria. Materials and Methods: This was an opportunistic cross-sectional study in three rural agrarian communities––Ibagwa, Akpugo, and Egede, all in Enugu State. Volunteer adults of 18 years and above were consecutively recruited and screened. Omron BP monitors were used mostly and supplemented by mercury BP sphygmomanometers. Each participant had their BP measured after at least 5 min of rest, and repeated twice after 3–5 min interval and also received a questionnaire about demographics, lifestyle, and environmental factors. Hypertension was defined as a systolic BP equal to or more than 140mm Hg and/or diastolic BP equal to or more than 90mm Hg or in those on treatment for hypertension. Ethical approval was obtained and all participants gave informed consent before screening. Data were collated and analyzed. Result: People of middle (40–64 years) and elderly (>65 years) age groups constituted the majority of participants. Most of the participants in the three groups had normal body mass index. The proportion of participants with hypertension was 15.2%, 21.9%, and 31.9% for Ibagwa, Akpugo, and Egede communities, respectively. The mean BMI was 27.08 kg/m2, 24.70 kg/m2 and 24.45 kg/m2 for participants from Ibagwa, Egede, and Akpugo communities, respectively. Prevalence of overweight and obesity was higher among Ibagwa people, whereas the prevalence of underweight was higher among Egede people (P < 0.001). Conclusion: Low proportion of participants had hypertension in the three communities and rising age was more associated with hypertension than overweight and obesity.
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