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   Table of Contents - Current issue
Coverpage
September-December 2021
Volume 26 | Issue 3
Page Nos. 139-214

Online since Tuesday, April 20, 2021

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ORIGINAL ARTICLES  

Sunscreen use among albinos in Enugu, South-Eastern Nigeria p. 139
Uche Rowland Ojinmah, Chinwe Laura Onyekonwu, Ikechukwu Emmanuel Obi, Jane Baridakara Uche-Ejekwu, Nkiru Pauline Onodugo, Chinechelum Nneoma Anyanechi, Chika Mary Emeka
DOI:10.4103/ijmh.IJMH_1_20  
Background: Albinism is a congenital skin condition which is caused by lack or deficiency of tyrosinase enzyme leading to partial or complete absence of melanin from skin with attendant solar skin damage which could lead to premature skin aging, skin cancer, and visual problems. Good knowledge and proper use of sunscreens could prolong the life of people living with albinism. Materials and Methods: This cross-sectional study involved 40 people living with albinism who were recruited consecutively after giving informed consent. The subjects then responded to a pretested questionnaire and had their skin also examined. Analysis of data was done with SPSS version 20. Results: About 92.5% (n = 37) know about sunscreen but only 22.5% (n = 9%) have known about it for more than 10 years. Based on the ages of the study participants, many had lived for more than 10 years before getting to know about sunscreen and hence have been unprotected from damaging effects of sunlight for long. The most important sources of information about sunscreen are doctors 32.5% and fellow albinos 22.5%. Most subjects (90%) had poor knowledge of what makes a good sunscreen and most (82.5%) used it inappropriately. Conclusion: While many knew about sunscreen, only a small fraction got the information early which is vital for commencement of skin protection early, hence forestalling damage. Doctors were found to be important source of information about sunscreen, although many subjects used it inappropriately.
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Patterns, determinants, and outcomes of antenatal care services utilization among rural and urban women in north-western Nigeria: A comparative analysis p. 147
Victoria Nanben Omole, Samuel Amos Bayero, Mohammed Jimoh Ibrahim, Nafisat Ohunene Usman, Onyemocho Audu, Caleb Mohammed
DOI:10.4103/ijmh.IJMH_72_20  
Background: Antenatal care (ANC) services have been globally lauded as having positive effects on pregnancy outcomes and reducing maternal and perinatal mortalities. However, the utilization of ANC is not uniform among its target population, particularly in rural areas of sub-Saharan Africa and south Asia. Objective: The objective is to ascertain and compare the patterns, determinants, and outcomes of ANC utilization among rural and urban women of child-bearing age in Kaduna State, north-western Nigeria by using a comparative, community-based, cross-sectional, descriptive study design among 340 women in a rural (n = 170) and an urban (n = 170) community. Materials and Methods: Respondents were selected by cluster sampling and multistage sampling methods in the rural and urban areas, respectively. Data were collected by using a structured, self-administered questionnaire and analyzed by using Statistical Package for Social Sciences (SPSS), version 25. Results were presented in tables, and associations were tested by using chi-square (x2) test. Results: Most of the respondents were between 25 and 29 years, more than 80% were married, and only 23.5% (rural) and 38.8% (urban) had a post-secondary level of education. The ANC attendance was 61.8%, representing 210 out of the 340 respondents (rural 40.6%, urban 82.9%). Among the ANC attendees, 71% initiated ANC in the first trimester (rural 60.9%, urban 75.9%) and 61.4% had at least four visits (rural 56.5%, urban 63.8%). The determinants of ANC utilization were mainly levels of education and incomes of the respondents and/ or their husbands. Conclusion: A consistent pattern of rural–urban disparities was demonstrated in diverse aspects of ANC utilization, including the determinants and outcomes thereof, with better indices among urban women relative to rural women. These findings underscore the need to bridge the gap between rural and urban areas. Priority attention needs to be given to the spatial (geographical) siting of health facilities, literacy, and financial standing of both women and their husbands.
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Assessment of nurses’ involvement in health research and policy development at a Federal Teaching Hospital in South East Nigeria p. 163
Ifeoma Ndubuisi, Ijeoma L Okoronkwo, Chisom Mbadugha, Ijeoma Maduakolam, Chijioke Nwodoh
DOI:10.4103/ijmh.IJMH_38_20  
Background: Nurses account for a significant proportion of the health-care workforce in most countries; however, they are marginally represented in policy decision-making. Aim: To assess nurses’ involvement in health research and policy making at a Federal Teaching Hospital in Nigeria. Materials and Methods: A cross-sectional design was adopted by using 305 nurses. Data collection was done by means of a validated questionnaire. Data were analyzed descriptively by using frequencies, percentages, means, and standard deviations. Results: The findings revealed that 71.1% of the respondents had been involved in research activity; however, only 16.6% had participated in a research study after school. The result also revealed that only 23.6% of the respondents had been involved in health policy decision-making in the hospital. Educational qualification did not have any influence on their involvement with research and policy development. The major barriers identified were lack of knowledge and relevant skills (89.8%), lack of organizational support (84.5%), and professional dichotomy (67.2%). The respondents strongly agreed that organizational support (94.4%), having interest in politics (89.8%), mentoring in research (84.6%), higher education in nursing (84.2%), funding of research (80%), and belonging to professional organizations (80%) will enhance their involvement in research and health policy decision-making. Conclusion: Nurses have not been adequately involved in research and policy development. Findings revealed organizational and individual factors as barriers to nurses’ involvement in the research and policy-making process. These findings, therefore, suggest strengthening nurses for effective participation in health policy and building support for research activities in nursing.
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Appraisal of hypospadias repair at University of Nigeria Teaching Hospital Enugu p. 170
Ijeoma Chioma Obianyo, Christopher Chim Amah, Nene Elsie Obianyo
DOI:10.4103/ijmh.IJMH_37_20  
Background: Hypospadias repair is one of the most common urologic surgeries performed in male children. Various surgical repairs and modifications of existing ones have evolved over the past decades. Notable among them is the Snodgrass tubularized incised plate (TIP) procedure. We document an appraisal of hypospadias repair performed at the University of Nigeria Teaching Hospital (UNTH) Enugu within a period of 6 years. Aim: The aim of this article is to determine the common presentations, repair, and outcome of hypospadias at UNTH. Materials and Methods: This is a retrospective study. Case notes of all patients who had surgeries for hypospadias between January 2013 and January 2019 were retrieved and data extracted. The data were analyzed using SPSS version 23. Results: Sixty-one operations were carried out on 51 patients within the 6-year period. The ages of the patients at the time of surgery ranged from 6 months to 27 years with a median age of 3 ± 4.9 years. The most frequent type was coronal hypospadias occurring in 25 patients (41%). The rarest forms were perineal hypospadias and proximal penile hypospadias seen in one patient (1.6%) each. Five patients (8.2%) each were seen with failed hypospadias repair and urethrocutaneous fistula. Fifty-four (88.5%) were single-stage operations and 7 (11.5%) were staged procedures. The most common surgery performed was Snodgrass TIP urethroplasty done in 38 patients (62.3%). Thirty-six patients (59%) had no complication, whereas 25 (41%) had complications. The common complications were urethrocutaneous fistula in 14 patients (23%) and surgical site infection in five patients (8.2%). Conclusion: Snodgrass TIP was noted to have a good outcome for the repair of hypospadias in UNTH.
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Impact of two anti-malaria drugs (artequin and chloroquine) on some hematological parameters in wistar rats p. 175
Princewill Ikechukwu Ugwu, Ugochukwu Bond Anyaehie, Amogechukwu Onyinye Ugwu, Ofem Effiong Ofem
DOI:10.4103/ijmh.IJMH_53_20  
Background: Artequin (AQ) and other Artemisinin-based therapies have replaced chloroquine (CQ) as the preferred treatment for uncomplicated Plasmodium falciparum malaria, due to the resistance of the parasite to CQ. This study was designed to investigate the comparative effects of CQ and AQ on some haematological parameters in Wistar rats. Materials and Methods: Thirty-six (36) female Wistar rats were randomly assigned into two batches. Each batch had three groups of six rats each, and they were placed on normal rat chow: AQ (1.6mg/100g bwt) and/or CQ (0.875mg/100g bwt) orally and once daily for three and seven days for batches 1 and 2, respectively. Full blood count was carried out by using an automated blood cell counter. Results: Results showed that the administration of AQ for three days did not significantly alter the levels of red blood cells (RBCs), RBC indices, hemoglobin (Hb), packed cell volume (PCV), total and differential white blood cells (WBCs), platelet count, and platelet indices. However, CQ increased the RBCs, Hb, PCV, and eosinophils significantly (P < 0.05) compared with the control. CQ also increased the total WBCs significantly (P < 0.05) compared with AQ. Both drugs decreased neutrophil but increased lymphocyte count significantly (P < 0.05) compared with the control after three days of treatment. After seven days of administration, AQ significantly (P < 0.05) reduced RBC count, PCV, Hb, mean corpuscular hemoglobin concentration (MCHC), and neutrophils compared with the control; both drugs reduced platelet count and PCT significantly (P < 0.05) compared with the control after seven days of treatment. Conclusion: The administration of AQ or CQ at their recommended doses and duration is relatively safe. However, administering a combination of Artesunate and mefloquine, and not CQ, beyond normal duration might have negative effects on hematological parameters.
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A Nigerian tertiary institution students’ knowledge and attitude to mental health and services p. 183
Chinedu Arthur Idoko, Kenechukwu Udo, Chinelo Ifeoma Idoko
DOI:10.4103/ijmh.IJMH_43_20  
Background: Mental health and availability of its services are under-emphasized, misunderstood, and misplaced due to unfounded theories, mistaken beliefs, stigma, and fallacies, especially pronounced in the developing world. With these misconceptions come under-utilization of available services resulting in increased numbers of the mentally unhealthy in our society. This study aims at uncovering perceptions to the availability and effectiveness of mental health services as well as health-seeking behavior to such services. Materials and Methods: This study is a descriptive cross-sectional study. Respondents were picked by simple random sampling until a determined sample size was achieved. Pre-tested structured questionnaires were employed in data collection. The analysis was done with the Statistical Package for the Social Sciences (SPSS). Results: A greater percentage of respondents showed positive attitudes to mental health/services as 94.4% (321) of the respondents expressed that one had to be mentally healthy to function effectively; 66.2% (225) would seek orthodox mental health services if need be. Interestingly, a significant number (45.6%, 155) was unaware of availability of these services in Enugu even as findings revealed negative attitude toward the mentally ill, with 67.7% (230) of the view that the mentally ill should be avoided, whereas 71.7% (245) submitted that people with mental illness should not live in hostels. Conclusion: There is a need for improved/increased awareness on mental health spreading to the general populace as pronounced information gap exists even among university students.
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Determinants of use of partograph among primary healthcare workers in Enugu State, South-East Nigeria p. 190
George Onyemaechi Ugwu, Cosmas Kenan Onah, Casmir Ndubuisi Ochie, Thaddeus Chijioke Asogwa, Nympha Onyinye Enebe, Godwin Uchenna Ezema
DOI:10.4103/ijmh.IJMH_48_20  
Background: World Health Organization (WHO) recommended use of partograph during childbirth to ensure early identification of abnormalities and prompt referral for emergency obstetrics care. However, factors that determine use of partograph during childbirth among primary healthcare workers (PHCWs) remain inadequately documented. Objective: This study investigated the determinants of use of partograph in conduct of labor among PHCWs in Enugu, South-East Nigeria. Materials and Methods: It was a cross-sectional descriptive survey of public PHCWs in Enugu State, Nigeria. Multistage sampling technique was used to select 393 respondents. Data were collected using a structured self-administered questionnaire and analyzed with IBM-SPSS version 22. Tests of statistics were conducted using χ2 and binary logistic regression, and statistical significance was determined at P-value of < 0.05. Results: Majority (87.0%) of the respondents have good knowledge of partograph. Reported regular availability of partograph is 32.8% but regular use of it is 25.2%. Statistically significant association exists between use of partograph and reception of training on it (P=0.001), knowledge of it (P=0.001), and availability of it (P=0.001). Availability of partograph was a predictor of use of it (adjusted odds ratio (AOR)=27.129; confidence interval=14.780–49.797). Conclusion: Although there is high knowledge of partograph among PHCWs in Enugu state, there is poor usage of it. There are 27 times higher odds of using partograph when it is made available compared with when it is not. We recommend regular provision of partograph to labor ward personnel in PHCWs in Enugu state and other similar populations.
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Support group participation among people living with human immunodeficiency virus in tertiary hospitals in Enugu: Benefits, perceived barriers, and factors associated with participation p. 198
Ancilla Umeobieri, Kosisochukwu Udeogu, Juvernal Ugwu, Wisdom Udoh, Chukwuebuka Ugwu, Ekenechukwu Young
DOI:10.4103/ijmh.IJMH_58_20  
Background: Support groups have been advocated in the care of patients with HIV and are integrated into HIV care and treatment programs. Objectives: This study aimed to assess in patients living with HIV, their awareness of support groups, knowledge of its benefits, and perceived barriers to their participation. Materials and Methods: A cross-sectional descriptive study was conducted on 430 consenting adult patients being managed for HIV/AIDS at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu. Patients were recruited consecutively over 4 weeks, and information on their sociodemographic data, knowledge, and membership of HIV support groups was obtained using a structured interviewer-administered questionnaire. Data were analyzed using Statistical Packages for Social Sciences (SPSS) version 23. The level of significance was < 0.05, and the confidence interval was 95%. Results: The mean age of the participants was 42.8 ± 6.58 years and 70.5% were female. A diagnosis of HIV for more than 10 years was reported in 141 participants (32.8%). While 260 (60.5%) were aware of support groups, only 41 (15.8%) belonged to a support group. While 84 (21.6%) did not participate because support group meetings were hard to find where they live, 79 (20.3%) could not attend because of their job. HIV diagnosis for more than 10 years was significantly associated with higher participation in support groups (P = 0.005). Conclusion: Participation in support groups was low in our patients and several barriers were reported, with the most common being poor accessibility to support group meetings.
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CASE REPORTS Top

Rare presentation and initial management of ischemic priapism in two cases of chronic myeloid leukemia p. 205
Musliu Adetola Tolani, Abdullahi Sudi, Bello Yusuf Jamoh, Ayodeji Olawale Afolayan, Asimiyu Adesina Opoola, Fatima Abdullahi Shehu
DOI:10.4103/ijmh.IJMH_40_20  
Priapism is a rare clinical presentation in patients with chronic myeloid leukemia. Treatment involves multidisciplinary team efforts of the urologist and haemato-oncologist. We report two cases of priapism: a 20-year-old male with chronic myeloid leukemia who presented with priapism as a component of hyperviscosity syndrome and a 26-year-old previously healthy, non-sexually active male who had priapism as his first presentation of chronic myeloid leukemia, and the role of specialists in the management of these patients.
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Ovarian fibrothecoma—Causing menstrual disorder and hirsutism: Case report and review of literature p. 208
Sunday Isaac Omisakin, Aloy Okechukwu Ugwu, Luqman Adedotun Adebayo, Kabir Bolarinwa Badmus
DOI:10.4103/ijmh.IJMH_63_20  
Fibrothecomas are solid tumors of the ovary. They have been described as rare ovarian neoplasms with varied clinical manifestations. It is an uncommon tumor that originates from stromal cells accounting for 3–4% of all ovarian tumors. We present a case of a 23-year-old nulliparous undergraduate who presented to our outpatient department with secondary amenorrhea, hirsutism, and acne of one-year duration. Her symptoms worsened overtime that necessitated her presentation. Clinical examination revealed signs of hyperandrogenism with a 16-week-sized abdominopelvic mass. She had surgical excision of the mass after work-up. Her menses returned and other signs of hyperandrogenism resolved. Histopathology confirmed fibrothecoma.
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Two successful live births following trans-abdominal cervicoisthmic cerclage in a woman with recurrent miscarriages p. 212
Sunday Isaac Omisakin, Aloy Okechukwu Ugwu, Olajide Abiodun Fagbolagun, Olabisi Olanrewaju
DOI:10.4103/ijmh.IJMH_61_20  
Cervical insufficiency, previously known as cervical incompetence, has been described as painless cervical dilation that leads to mid-trimester miscarriage in the absence of other causes. Recently, it has expanded to include women with a prior spontaneous preterm birth and evidence of cervical shortening (<25mm) on transvaginal ultrasound at a gestational age less than 18 weeks. Cerclage is an obstetric procedure performed for prevention of miscarriage and preterm birth in women with cervical incompetence; it can be done via vaginal or abdominal route. We present a case of a 32-year-old woman, now P2+5 (2 alive), with a history of five recurrent midtrimester pregnancy losses who was evaluated and worked up for abdominal cerclage after several failed cervical cerclages, who later had two successful pregnancies and deliveries via elective caesarean section. This case is presented as a reminder that such cases still exist, and the skill must be passed on to a younger generation of doctors as it may become useful when such cases are presented.
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