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   Table of Contents - Current issue
July-September 2018
Volume 25 | Issue 3
Page Nos. 131-195

Online since Wednesday, September 26, 2018

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Serum zinc levels amongst under-five children with acute diarrhoea and bacterial pathogens p. 131
Oyetundun Fausat Afolabi, Aishat Oluwatoyin Saka, Ayodele Ojuawo, Sikiru Abayomi Biliaminu
DOI:10.4103/npmj.npmj_79_18  PMID:30264762
Background and Aim: Acute diarrhoea contributes significantly to morbidity and mortality in under-five children globally with conflicting reports regarding the therapeutic benefit of zinc across the different causative pathogens. This study aimed to determine the prevalence of bacterial aetiology of children with acute diarrhoea and compare their serum zinc levels. Methods: One hundred children aged 2–59 months with acute diarrhoea and 100 apparently healthy matched controls were recruited in Ilorin, North Central Nigeria. Stool specimens were investigated for bacterial pathogens using conventional culture techniques, while serum zinc levels were determined by colorimetric method. Results: Bacteria were isolated in 73 (73.0%) patients and 6 (6.0%) controls. Escherichia coli was isolated in 39 (39.0%) of the patients, while Klebsiella spp., Proteus spp. and Pseudomonas aeruginosa were isolated in 28 (28.0%), 4 (4.0%) and 2 (2.0%) patients, respectively.E. coli and Klebsiella spp. were detected in 4 (4.0%) and 2 (2.0%) controls, respectively. The mean serum zinc level of 65.3 ± 7.4 μg/dl in the patients was significantly lower than 69.0 ± 6.5 μg/dl in the controls (P < 0.001). Zinc deficiency (serum zinc levels < 65 μg/dl) was detected in 47 (47.0%) patients which was significantly higher than 32 (32.0%) controls (P = 0.030). The mean serum zinc levels significantly differed amongst the bacteria isolated in the patients (P < 0.001). Conclusions: Bacterial pathogens constitute a significant burden to aetiology of acute diarrhoea in under-five Nigerian children. The prevalence of zinc deficiency was high in the study population. The serum zinc levels also differed across the bacteria isolated.
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Comparative tetanus antibody response of Nigerian children to diphtheria-pertussis-tetanus and pentavalent vaccines p. 137
Helen Omini Uket, Emmanuel Eyo Ekanem, Henry Chima Okpara, Udeme Ekpenyong Ekrikpo
DOI:10.4103/npmj.npmj_41_18  PMID:30264763
Background: In Nigeria and many parts of the world, the pentavalent vaccine is replacing the diphtheria-pertussis-tetanus (DPT) vaccine in tetanus prevention. Aims and Objectives: The aim of this study was to compare the anti-tetanus immunoglobulin G (IgG) response of children who received DPT with those who received the pentavalent vaccine. Subjects and Methods: A cross-sectional survey of anti-tetanus IgG levels in children aged 6 months to 5 years who received DPT and in children who received the pentavalent vaccine. IgG antibody levels were determined using enzyme-linked immunosorbent assay. The protective level was set at ≥0.1 IU/ml. Results: One hundred and twenty-two out of 130 children (93.9%) who had received DPT had protective levels of anti-tetanus IgG compared to 278 out of 288 children (96.5%) who had received the pentavalent vaccine. The difference was not statistically significant (P = 0.21). The median IgG antibody level in those who received DPT was 1.1 IU/ml (interquartile range (IQR) 0.4–1.8) compared with 0.6 IU/ml (IQR 0.4–1.4) in those who received pentavalent vaccine (P = 0.006), with age being the only predictor of variability in the multivariate analysis. Conclusion/Recommendation: DPT and pentavalent vaccines are equally effective in inducing protective levels of anti-tetanus IgG in children. Vaccination with the pentavalent vaccine, which is the current policy in Nigeria and many other parts of the world, should continue.
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Barriers to acceptance of post-partum family planning among women in Montserrado County, Liberia p. 143
Virginia K Kaydor, Ikeola A Adeoye, Tubosun A Olowolafe, Adeyemi O Adekunle
DOI:10.4103/npmj.npmj_96_18  PMID:30264764
Background: Maternal mortality in Liberia is one of the highest in Sub-Saharan Africa. Post-partum family planning (PPFP) can reduce the risk of maternal mortality by preventing unwanted and closely spaced pregnancies. Yet, the uptake of PPFP is low in Liberia. Objective: We investigated the barriers to acceptance of PPFP use among women in Montserrado County, Liberia. Materials and Methods: A cross-sectional facility-based survey was conducted using a multistage sampling technique to select 378 women within 12 months' post-partum period. Results: About half of our respondents were <25 years (52.9%), 24.1% were married, 66.4% had at least secondary education and 92.1% were Christians. The most commonly reported barriers were the fear of side effects (22.0%) and the post-partum abstinence (22.2%). Binary logistic regression analysis showed that being within the early post-partum period, i.e., within the first 6 months (adjusted odds ratio [AOR] = 0.23, 95% confidence interval [CI] [0.09–0.60] and lack of access to PPFP [AOR = 0.22, 95% CI [0.09–0.52]). Importantly, women who were married [AOR = 1.686, 95% CI (0.65, 4.36)] and those who were aware of PPFP [AOR 3.69, 95% CI (1.224, 11.096)] increased the likelihood of using PPFP. Conclusion: Important barriers to the utilisation of PPFP in Liberia were being within early post-partum period, lack of access and awareness of PPFP including myths and misconception. Therefore, health communication targeting mothers for PPFP at every contact with maternal and childcare services should be encouraged.
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Lung function abnormalities among garri processing workers in Ogbomoso, Nigeria p. 149
Taofeek Oloyede, Adeseye Abiodun Akintunde, Jamiu A Adeniran, Moses O Tanimowo, Emmanuel Ademola Fawibe, Alakija Kazeem Salami
DOI:10.4103/npmj.npmj_80_18  PMID:30264765
Background: Local production of garri (cassava crisps) is associated with air pollution and consequently lung function abnormalities among garri processing workers. This study was aimed at describing lung function abnormalities among Nigerians engaged in cassava crisps (garri) processing. Methods: A total of 351 workers and 351 controls were recruited at garri factories in Ogbomoso, Nigeria by multistage random sampling technique. Lung functional abnormalities were defined according to standardised European Respiratory Society/American Thoracic Society guidelines. Data analysis was performed using the IBM SPSS statistics version 22.0. Results: The mean age of patients was similar to that of controls (41.7 ± 14.9 vs. 41.6 ± 14.7 yearsP = 0.960). Larger proportion (46.2%) of cassava crisps factory workers had abnormal ventilatory function parameters compared to 6.8% in controls (P < 0.001). The mean peak expiratory flow among garri factory workers was significantly lower than that of the controls; 268.25 ± 86.20 versus 349.04 ± 97.21 (L/min) (P < 0.001), likewise the mean forced vital capacity (FVC) (litres) and forced expiratory volume (FEV1) (litres) of garri factory workers and controls were significantly lower than those of the controls; 2.55 ± 1.07 versus 2.87 ± 0.79 (P < 0.001) and 2.00 ± 0.76 versus 2.41 ± 0.83 (P < 0.001) with FEV1/FVC ratio of 0.82 ± 0.16 versus 0.87 ± 0.06 (P < 0.001), respectively. The restrictive pattern of ventilatory functional abnormality was predominant among garri factory workers, 92 (26.2%). Sixty-two (17.7%) and 8 (2.3%) of garri factory workers had an obstructive and mixed pattern of ventilatory function abnormalities, respectively. Conclusion: Garri processing workers had significant ventilatory function impairment. Preventive strategies should be encouraged to reduce occupational hazards associated with garri processing in Nigeria.
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Nutritional status in cerebral palsy: A Cross-sectional comparative survey of children in Kano, Nigeria p. 156
Adamu Sa'idu Adamu, Umar Abba Sabo, Garba Dayyabu Gwarzo, Raymond O Belonwu
DOI:10.4103/npmj.npmj_67_18  PMID:30264766
Background: Cerebral palsy (CP) is a common neurodevelopmental motor disorder resulting from early childhood brain insult. Nutrition in children is very important for growth and development. This is more so in those with chronic illnesses such as CP. This study was conducted with the aim of assessing the anthropometry and anthropometric indices of CP children. Materials and Methods: This comparative, cross-sectional study recruited 150 children with CP matched for age and sex, with 150 children without CP (as controls). The participants' socio-demographic and CP-related data were collected using a pre-tested questionnaire designed for the study. The weight and height of the subjects were measured. Nutritional status was determined using the World Health Organization Z-scores. Results: Overall prevalence of malnutrition in CP subjects was 86%. This was significantly higher than in controls, whose prevalence was 55.3% (χ2 = 34.027,P < 0.0001). The prevalence of stunting, wasting and underweight in CP subjects was 53.3%, 57.5% and 66.9%, respectively. These were also significantly higher than those of controls who had prevalence of stunting being 16.7%, wasting 8.5% and underweight 14.8%. Conclusion: This study found a high prevalence of malnutrition (especially under-nutrition) and therefore underscores the need for more emphases on nutritional assessment, counselling and management in CP patients.
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Visual status of special needs children in special education schools in Calabar, Cross River State, Nigeria p. 161
Ernest Ikechukwu Ezeh, Affiong Andem Ibanga, Roseline Ekanem Duke
DOI:10.4103/npmj.npmj_46_18  PMID:30264767
Objective: The objective of this study was to determine visual status of children with special needs attending special schools in Calabar, Cross River State, Nigeria. Subjects and Methods: A cross-sectional study of all children with special needs attending special education schools in Calabar Municipal Local Government Area, Cross River State, was performed. Data were obtained using interviewer-administered questionnaires on the caregivers and ocular examination of the children which included visual acuity, refraction, ocular alignment and motility tests and funduscopy. Data analysis was performed using the Statistical Package for the Social Sciences version 20. Results: A total of 161 children with special needs out of the 176 enrolled were examined yielding a 91.5% response rate. The male-to-female ratio was 1.2:1. Their age range was 5–17 years with the mean age of 12.9 ± 3.3 years and a modal age group of ≥13 years. Twenty (12.4%) had visual impairment (VI). Uncorrected refractive error accounted for 12 (60%) of the VI. Children with learning disability (odds ratio [OR]: 3.28 and 95% confidence interval [CI]: 1.73–6.36) and developmental disability (OR: 1.90 and 95% CI: 1.10–3.20), respectively, had significantly higher occurrence of VI. Of the 161 children examined, only 11 (6.8%) have had their visual status assessed in the past. Conclusion: Children with special needs had higher prevalence of VI; however, only a few have had an assessment of their visual status in the past.
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Visual impairment and ocular morbidities among schoolchildren in Southwest, Nigeria p. 166
Adegboyega Sunday Alabi, Olufisayo Temitayo Aribaba, Adewumi Olabimpe Alabi, Olubanke Ilo, Adeola O Onakoya, Folasade B Akinsola
DOI:10.4103/npmj.npmj_85_18  PMID:30264768
Aim: The purpose of this study was to determine the prevalence of visual impairment and ocular morbidities among primary and secondary schoolchildren aged 5 years to <l6 years in Ifo, Ifo Local Government Area in Ogun State, Nigeria. Materials and Methods: The study was a population-based descriptive cross-sectional study conducted among schoolchildren aged 5 years to <16 years old attending primary and secondary schools in Ifo, Ifo Local Government Area of Ogun State. Multistage sampling technique was used for the study. After enumeration and questionnaire administration, the visual acuities of all respondents were measured, followed by examination of the anterior and posterior segment structures of the eyes of the children. Results: A total of 1308 schoolchildren (574 males and 734 females) participated in the study with a mean age of 12.03 years (standard deviation = ±2.572 years). Eighty-seven (6.7%) children had visual impairment and 224 (17.1%) children had ocular morbidities. Of the 87 children with visual impairment, 61 (70.1%) had mild impairment, 19 (21.8%) had moderate impairment and 7 (8.0%) had severe impairment. The common ocular morbidities identified were refractive error 39.7%, high/asymmetrical vertical cup-to-disc ratio (suggestive of glaucomatous optic neuropathy) 33.5%, allergic conjunctivitis 19.2%, corneal opacity 2.7% and lenticular opacity 2.2%. Ocular morbidities identified among children with severe visual impairment were refractive error 5 (71.4%), allergic conjunctivitis and corneal opacity 1 (14.3%) each. Conclusion: The study concluded that with the prevalence of 6.7% of visual impairment and 17.1% of ocular morbidity, it will be beneficial to establish a sustainable school eye health services in schools in Ifo.
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Use of transrectal ultrasound in the management of urologic diseases in a tertiary hospital in North-Western Nigeria p. 172
Abubakar Sadiq Muhammad, Abdullahi Abdulwahab-Ahmed, Ngwobia Peter Agwu, Garba Yunusa, Khalid Abdullahi, Ismaila Arzika Mungadi
DOI:10.4103/npmj.npmj_131_18  PMID:30264769
Background: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is considered as a standard of care for diagnosis of prostate cancer. The objective of this study was to document our experience in the use of TRUS in the management of urologic diseases in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: This was a retrospective study of patients who had TRUS at UDUTH from December 2009 to November 2017. Relevant data were extracted from the procedure register, and case folders of the patients. Data analysis was performed using IPSS 20.0 version. Results: A total of 844 patients had the procedure within the period of the study. The mean age of the patients was 65.6 ± 10.6 years with a range of 7–98 years. The main clinical diagnoses of the patients were benign prostatic hyperplasia in 528 patients (62.6%), prostate cancer in 285 patients (33.8%) and primary infertility + azoospermia in 17 patients (2.1%). Transrectal ultrasound-guided prostate biopsy was done for 807 patients (96%). TRUS only was done for assessment of seminal vesicle and ejaculatory duct in 17 patients (2.1%), prostate volume assessment in 10 patients (1.1%) and deflation of retained urethral catheter balloon in 9 patients (1%). There was self-limiting rectal bleeding in 600 patients (74.4%) and 3 patients (0.4%) each developed haematuria and postbiopsy infections. Conclusion: Prostate biopsy is the most common indication for TRUS in our practice. Other indications were estimation of prostatic volume, evaluation of azoospermia and deflation of retained urethral catheter balloon.
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How does the public perceive healthcare workers in Lagos? A comparison of health workers in public and private health facilities p. 177
Olumuyiwa Omotola Odusanya, Modupe Rebekah Akinyinka, Esther Oluwakemi Oluwole, Babatunde Adeniran Odugbemi, Omowunmi Qubrat Bakare, Adeyinka Adeniran
DOI:10.4103/npmj.npmj_102_18  PMID:30264770
Background: The perception of healthcare workers (HCWs) by community members is dependent on the quality of services rendered by HCWs and contributes to utilisation. The objective of the study was to assess the perception of health workers in both public and private facilities by residents of Lagos State. Materials and Methods: A descriptive cross-sectional study was conducted using mixed-methods approach. Respondents (n = 2000) were selected using a multistaged sampling technique from four local government areas. An interviewer-administered, pre-tested questionnaire developed for the study was used for data collection and focus group discussions were held. Domains assessed included competence, work attitudes, interpersonal skills and unethical behaviour. A perception index was generated. Data were analysed using the Statistical Package for the Social Sciences version 22, with level of significance set at 0.05 for quantitative data and ATLAS.ti software (Scientific Software, Berlin; version 7) for qualitative data. Results: At least seven out of ten participants (>71%) perceived the HCWs highly in the areas of professional competence, attitude to work, responsiveness and interpersonal skills. Out of a maximum of 12, doctors had the highest mean perception index (10.6 ± 1.9), laboratory scientists had 10.1 ± 2.1, pharmacists had 10.0 ± 2.3 and nurses had 9.6 ± 2.7. A larger proportion of respondents had a significantly better perception of workers in private facilities more than those in government facilities. Conclusion: Perception of health workers was high and was better in privately owned facilities. Periodic retraining of health workers and regular assessments of health facilities are recommended.
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Paediatric brain tumours managed in Enugu, Southeast Nigeria: Review of one centre experience p. 186
Chika Anele Ndubuisi, Samuel C Ohaegbulam, Gabriel O Ejembi
DOI:10.4103/npmj.npmj_132_18  PMID:30264771
Background: Nothing has been published about paediatric brain tumours (PBTs) in Southeast Nigeria. This pioneer study analyses the tumour characteristics and management outcome of PBTs in Enugu, Southeast Nigeria. Methodology: Retrospective longitudinal study utilising information from medical, radiology and histopathology records of all paediatric tumour cases managed at Memfys Hospital for Neurosurgery, Enugu, a major referral centre, from 2006 to 2017. Results: The total number of cases was 54. Peak age group at the diagnosis were 0–5 years (37.0%) and >10 years (40.8%). Frequent presenting symptoms of supratentorial tumours were limb weakness (70%), convulsions (50%) and altered consciousness (48%). Infratentorial tumours presented mostly with gait disturbance (82%), vomiting (72%) and altered consciousness (48%). There were 51 (94.4%) primary and three metastatic tumours. Supratentorial tumours were 28 (51.9%) and infratentorial tumours were 26 (48.1%). Histopathologic types were glioma 20 (37.0%), medulloblastoma 13 (24.1%), craniopharyngioma 11 (20.4%), meningioma 2 (3.7%) and others 8 (14.8%). The most common supratentorial tumours were gliomas 11 (39.3%) and craniopharyngioma 11 (39.3%), and the most common infratentorial tumour was medulloblastoma 13 (50.0%). Gross total resection (GTR) was achieved in 28 (51.9%) and subtotal resection (STR) in 26 (48.1%). Patients with Karnofsky score ≥70% had 16 (65.2%) GTR and patients with ≤60% score had more STR 18 (58.1%). At 1-year post-surgery, 16 (64%) of those with GTR lived normal lives compared with only 4 (20%) of STR. Among GTR group, 7 (28.0%) died compared to the 11 (55.0%) deaths recorded following STR. Overall, 55.6% of patients were at least independent at 1 year. Conclusion: Glioma, medulloblastoma and craniopharyngioma are the most common PBTs. The management outcome is good and affected by extent of tumour resection.
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Delleman syndrome: A case report from West Africa - features and the challenges of management p. 191
Mary Ugalahi, Bolutife Olusanya, Oluyemi Fasina, Mukaila Seidu, Ademola Adekanmi
DOI:10.4103/npmj.npmj_75_18  PMID:30264772
Delleman syndrome is a rare congenital disorder. We report an 8-month old female with a history of a fleshy mass covering the left eye since birth. Examination revealed poor vision in the left eye, an upper lid coloboma and an epibulbar dermoid with a large area of alopecia and scalp hypoplasia involving the left frontoparietal region. Transfontanelle ultrasound scan did not reveal any intracranial cyst. Cranial computerised tomography subsequently revealed characteristic cerebral malformations of Delleman syndrome. This report demonstrates clinical and computed tomographic features of a case of Delleman syndrome with emphasis on the usefulness of transfontanelle ultrasonography in assessing for life-threatening intracerebral cysts or hydrocephalus, particularly in resource-limited settings, where neuroimaging is not readily available or affordable.
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Erratum: Assessment of seminal biomarker of lipid peroxidation among male partners of infertile couples at the University of Ilorin Teaching Hospital, Nigeria p. 195

DOI:10.4103/1117-1936.238817  PMID:30264773
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