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   Table of Contents - Current issue
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April-June 2020
Volume 27 | Issue 2
Page Nos. 67-146

Online since Saturday, April 11, 2020

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REVIEW ARTICLE  

Sample size estimation for health and social science researchers: The principles and considerations for different study designs Highly accessed article p. 67
Oladimeji Akeem Bolarinwa
DOI:10.4103/npmj.npmj_19_20  PMID:32295935
Sample size is one of the important considerations at the planning phase of a research proposal, but researchers are often faced with challenges of estimating valid sample size. Many researchers frequently use inadequate sample size and this invariably introduces errors into the final findings. Many reviews on sample size estimation have focused more on specific study designs which often present technical equations and formula that are boring to statistically naïve health researchers. Therefore, this compendium reviews all the common sample size estimation formula in social science and health research with the aim of providing basic guidelines and principles to achieve valid sample size estimation. The simplification of the sample size formula and detailed explanation in this review will demystify the difficulties many students as well as some researchers have with statistical formulae for sample size estimation.
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SYSTEMATIC REVIEW ARTICLE Top

Effectiveness of behavioural therapy on the blood pressure of adults with hypertension: A systematic review in non-african populations p. 76
Benedict Chico Agoha, Sophie Omanogo Ogiri, Zainob Anuoluwapo Akindele, Samuel Ogiri Ogiri
DOI:10.4103/npmj.npmj_199_19  PMID:32295936
Hypertension or high blood pressure is the foremost risk factor of cardiovascular diseases which in turn are the leading cause of death globally. Despite the widespread use of antihypertensive medication, the condition remains a global health concern. In a bid to ascertain that other therapies such as psychological treatment may be adopted as complementary treatments for hypertension, this paper therefore examines literature on the effectiveness of behavioural therapy in the treatment of hypertension, identify the technique which seems most effective though blood pressure reductions, highlight other hypertension-related domains and report sustainability of blood pressure control post-intervention. A systematic literature review of randomised control trials reporting the effectiveness of behaviour therapy on blood pressure among hypertensive adults, published between the years 2014 and 2018, was conducted. A total of 79 articles were identified from the database search after which 11 met the inclusion criteria, with 10 of the 11 studies reporting behavioural therapy to be effective in blood pressure control. Relaxation therapy and meditation training appeared to be most effective as they brought about the most significant decrements in blood pressure. The mean blood pressure reduction ranged from 2.88–36.33 mmHg (systolic) to 0.04–21.48 mmHg (diastolic). Blood pressure control was found to have been sustained from between 0.7 and 24 months post-intervention. From this current paper, behaviour intervention is a viable, albeit complementary treatment method for hypertension; however, there is the need for more research to be conducted in various parts of the world, specifically in Nigeria and in Africa at large to allow for more relatable report on this topic.
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ORIGINAL ARTICLES Top

Mortality patterns in patients with diabetes mellitus at a Nigerian tertiary hospital: A 10-Year autopsy study p. 83
Sebastian A Omenai, Uchenna S Ezenkwa, Mustapha A Ajani
DOI:10.4103/npmj.npmj_160_19  PMID:32295937
Objectives: Diabetes mellitus (DM) is a global health problem with associated high morbidity and mortality. This study was a retrospective review of post-mortem examination findings of hospitalised patients with DM for causes of death. Materials and Methods: A retrospective, cross-sectional autopsy review of all the patients with DM in our hospital between January 2008 and December 2017 was conducted. The causes of death were classified into cardiovascular, cerebrovascular, acute diabetic emergencies, infection, cancers and unnatural deaths. The demographic data and clinicopathological parameters were extracted, and the data were analysed using the SPSS software version 23. Results: A total of 1092 cases of autopsy were done within the study period, of which 91 cases were on patients with diabetes accounting for 8.3%. Infections with sepsis were the major cause of death, accounting for 51.6% followed by cardiovascular diseases (16.5%), cancers (14.3%), acute diabetic emergencies (6.6%) and cerebrovascular accidents (6.6%), with renal complications and road traffic accidents accounting for 2.2% each. Patients' age ranged from 31 to 84 years, with a modal age of 57 years. There was a male predominance with a male-to-female ratio of 1.5:1. Systemic hypertension co-morbidity was statistically significantly more common in patients aged 60 and above (P = 0.035). The most common lesion observed in the kidneys was benign nephrosclerosis (43.2%). Conclusions: This study suggests that majority of our patients with diabetes mellitus die from infections with attendant sepsis. Older patients appear to have co-morbid systemic hypertension. Patient education on infection prevention and prompt treatment might be life-saving.
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Is genu varum a risk factor for the prevalence and severity of achilles tendinopathy? A cross-sectional study of Nigerian elite track and field athletes p. 87
Ayoola Ibifubara Aiyegbusi, Bosede Abidemi Tella, Ganiyat Adebanke Sanusi
DOI:10.4103/npmj.npmj_179_19  PMID:32295938
Background: Achilles tendinopathy (AT) is one of the most frequently reported ankle and foot overuse injuries. Prior studies have reported altered biomechanical variables of the lower limb as risk factors for the prevalence and severity of AT in athletes, especially in Caucasians, but there are few reports on African elite athletes. Because it is established that anthropometric and biomechanical values vary with racial disposition, this study was designed to investigate the association between selected physical and biomechanical variables of the lower limb and the prevalence and severity of AT in Nigerian elite track and field athletes. Subjects and Methods: Eighty-five elite Nigerian track and field athletes participated in this cross-sectional study. Biomechanical variables of Q-angle, tibial torsion, limb-length discrepancy (LLD) and foot posture index (FPI) were evaluated using standard procedures. The presence of AT was confirmed with ultrasonography and clinical assessments, whereas the severity was evaluated with VISA-A questionnaire. Inferential statistics of Chi-square was used to determine the association between prevalence of AT and the biomechanical variables. Results: The prevalence of AT was 15.3%, made up of participants who tested positive to both clinical test and ultrasound scan. There was no significant association between AT and LLD, tibial torsion and FPI. Most of the participants with AT had genu varum, which was significantly associated with both the prevalence and severity of AT. Conclusion: It was concluded that genu varum had a significant association with both the prevalence and severity of AT in elite Nigerian track and field athletes.
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Adaptation of the driver behaviour questionnaire and behavioural risk factors for traffic violation arrest and self-reported crash involvement among Nigerian drivers p. 93
Kehinde Sunday Oluwadiya, Sunday Ogunsuyi Popoola, Ndubuisi O Onyemaechi, Joseph N Kortor, Priscilla Denen-Akaa
DOI:10.4103/npmj.npmj_172_19  PMID:32295939
Context: Few studies have been conducted to investigate the driving behaviour of drivers in Africa. Aims: This study aims to determine the behavioural risk factors for road crashes among Nigerian drivers. Settings and Design: This is a case–control study. Cases were drivers who were booked for traffic violation or who had been involved in road crashes in the past, while the controls were drivers with no such histories. Subjects and Methods: Both the cases and controls were administered the Driver Behaviour Questionnaire (DBQ). Principal component analysis with varimax rotation was run to examine the factor structure of the scale. Cronbach's alpha was used for assessing the internal consistency of the DBQ, and logistic regression was used to determine risk factors for crash involvement. Results: Six hundred active drivers consisting of 300 cases and 300 controls were selected. The mean scores of all DBQ items, except one, were significantly higher among booked drivers compared to those who had never been booked. Consistent with many previous studies, factor analysis identified three factors in the DBQ (aggressive violation, ordinary violation and error). However, the factors were constructed differently with most ordinary violation items in the original DBQ loading as aggressive violation in the present study. Eight variables were predictive of being booked for traffic offences while only five variables were predictive of self-reported crash involvement. Conclusions: The most important variable associated with previous crash involvement was alcohol use. A major policy implication of this is the need for better attention to anti-drunk driving measures.
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Reliability of adrenal computed tomography in predicting the functionality of adrenal incidentaloma p. 101
Dheyaa Kadhim Al-Waeli, Abbas Ali Mansour, Nazar S Haddad
DOI:10.4103/npmj.npmj_156_19  PMID:32295940
Background: Adrenal incidentaloma (AI) is an adrenal mass discovered accidentally during abdominal or chest imaging techniques not aimed to adrenal gland assessment. Guidelines suggested confirming the benignity of AI radiologically and excluding hormonal dysfunctions. This study evaluated the reliability of computed tomography (CT) scan radiological parameters in predicting the functionality of AI. Patients and Methods: A cross-sectional study performed in Faiha Specialized Diabetes, Endocrine and Metabolism Centre from July 2017 to July 2018, involving 38 patients (23 females [60.5%]) harbouring 43 AI referred for evaluation. For all patients, we assessed history, physical examination, radiological parameters of AI by CT scan (native Hounsfield unit [HU]), maximum diameter and absolute percentage washout [APW] and blood investigations (glycated haemoglobin, adrenocorticotropic hormone, aldosterone, renin, aldosterone/renin ratio, normetanephrine, metanephrine, dehydroepiandrosterone sulphate, cortisol and 1 mg overnight dexamethasone suppression test). Results: Native CT adrenal HU ≥18.5 was statistically significant seen in most functional AI (FAI) (P = 0.006), especially in patients with mild autonomous cortisol excess (MACE) and pheochromocytoma (PCC) with P = 0.02 in both. Maximum diameter was significantly high (≥40 mm) in PCC and congenital adrenal hyperplasia (CAH) (P = 0.018 and 0.008, respectively). APW was significantly < 60% only in PCC (P = 0.02). Conclusions: Native HU was the most significant radiological parameter in predicting the functionality of FAI, MACE and PCC, but not in CAH and aldosterone-producing adenoma. The maximum diameter was significant in predicting the PCC and CAH, whereas the APW was significant in predicting PCC only.
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Comparative analysis of caesarean delivery among out-of-pocket and health insurance clients in Ilorin, Nigeria p. 108
Abiodun S Adeniran, Isaac I Aun, Adegboyega A Fawole, Abiodun P Aboyeji
DOI:10.4103/npmj.npmj_181_19  PMID:32295941
Background: Although out-of-pocket (OOP) payment for health services is common, information on the experience in maternal health services especially caesarean delivery (CD) is limited. Aim: To compare the pregnancy events and financial transactions for CD among OOP and health-insured clients. Materials and Methods: A comparative (retrospective) study of 200 women who had CD as OOP (100 participants) or health-insured clients (100 participants) over 30 months at Anchormed Hospital, Ilorin, using multistage sampling was conducted. The data were analysed using Chi-square, t-test and regression analysis; P < 0.05 was considered statistically significant. Results: Of 1246 deliveries, 410 (32.9%) had CD; of these, 186 (45.4%) were health-insured and 224 (54.6%) were OOP payers. The health-insured were mostly civil servants (60.0% vs. 40.0%; P = 0.009) of high social class (48.0% vs. 29.0%; P = 0.001). The payment for CD was higher among OOP (P = 0.001), whereas duration from hospital discharge to payment of hospital bill was higher for the health-insured (P = 0.001). On regression, social class (odds ratio [OR]: 0.23, 95% confidence interval [CI]: −0.0891252–0.112799; P = 0.048), amount paid (OR: 48.52, 95% CI: −7.14–6.68; P = 0.001) and duration from discharge to payment (OR: 28.68, 95% CI: 51.7816–70.788; P = 0.001) were statistically significant among participants. The amount paid was lower (P = 0.001), whereas time interval before payment was longer (P = 0.001) for the public-insured compared to private-insured clients. Conclusion: OOP payers are prone to catastrophic spending on health. The waiting time before reimbursement to health-care providers was significantly prolonged; private insurers offered earlier and higher reimbursement compared to public insurers. The referral and transportation of health-insured clients during emergencies is suboptimal and deserve attention.
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Psychological distress and social media usage: A survey among undergraduates of a university in Calabar, Nigeria p. 115
Udeme Asibong, Chidi John Okafor, Inyang Asibong, Essien Ayi, Ogban Omoronyia, Udofia Owoidoho
DOI:10.4103/npmj.npmj_169_19  PMID:32295942
Context: Access to social network sites (SNS) is commonplace, especially among young people globally. Cumulatively, long duration of daily exposure may be having effects on psychological health outcomes, including increased and in some cases, decreased risk of depression and anxiety. Despite these potential effects, there is a paucity of literature on patterns and effects of exposure to social media, especially in developing countries where regular mental health screening is generally unavailable. Aim: This study aims to assess the psychological effects of Internet/social media usage among undergraduates in Calabar. Settings and Design: A descriptive cross-sectional study conducted in the University of Calabar, Nigeria. Methodology: Multi-staged sampling technique was used to recruit equal proportions of the undergraduate students from five selected Faculties in the University. Internet Addiction Test and General Health Questionnaire-28 were used to measure addiction to Internet and psychological health status of the respondents, respectively. Socio-demographic questionnaire was used to obtain information on demographic and social media characteristics of the respondents. Statistical Analysis: Chi-square and independent t-test were used as inferential statistics, with P value set at 0.05. Results: Four hundred and eighteen (418) respondents completed the questionnaires. The mean age was 21.5 ± 3.6 years. Male:female ratio was 1:0.99. WhatsApp (59.8%) was the most commonly visited social media platform, whereas entertainment (52.2%) was the most common reason for social media use. About one-fifth (20.1%) had moderate-to-severe forms of Internet addiction, whereas one-third (33.1%) were psychologically distressed. Psychological distress was found to be significantly more common among respondents with mild/none, compared with those with moderate-to-severe forms of Internet addiction (P = 0.00). Respondents with moderate-to-severe forms of Internet addiction had significantly lower mean depression and anxiety scores compared with those with mild or no form of addiction (P = 0.00). Conclusions: There is high degree of psychological distress among students, and this was found to be more common among those that were less/not addicted to SNS. Specifically, high degree of Internet addiction may be protecting against the increased risk of depression and anxiety. The implications of these findings on youth counselling and the prevention of mental illnesses in developing countries are discussed in this article.
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Stage of chronic kidney disease and cochlear function: A cross-sectional survey p. 122
Mohammed Bello Fufore, Abdullahi Musa Kirfi, Abubakar Danjuma Salisu, Thomas Musa Samdi, Abdulhameed Bala Abubakar, Paul Adekunle Onakoya
DOI:10.4103/npmj.npmj_148_19  PMID:32295943
Background: Studies have shown that hearing loss increases in patients with chronic kidney disease (CKD) with decreasing glomerular filtration rate. The hearing loss in CKD patients may worsen over time which in turn will negatively affect the patient's ability to effectively communicate with people, resulting in low self-esteem, social isolation, anger and depression. We aimed to assess the relationship between stage of CKD and hearing threshold in patients with CKD in Kaduna. Patients and Methods: A cross-sectional study of patients with CKD in Kaduna. Individuals were selected consecutively using convenience sampling. Ethical approval and informed consent were obtained. The patients were grouped based on the stage of the disease. The pure tone audiometry was carried out using a Diagnostic Audiometer (Graphic Digi-IS, USA). The hearing threshold of the patients was then compared based on stage of the disease. The data collected was analysed using Statistical Product and Service Solutions, version 20. Results: Sixty CKD patients (120 ears) were assessed. Their mean age was 43.2 ± 13.4 years and 70% were males. Of the 120 ears studied, 51 (42.5%) had normal hearing thresholds and 69 (57.5%) had hearing loss. Of the 69 ears with hearing loss, 11 (15.9%), 22 (31.9%) and 36 (52.2%) were in Stage III, IV and V, respectively, and the difference was statistically significant (P = 0.006). All those with Stage III CKD had mild hearing loss and the hearing loss worsen with advancing stage. Stage III CKD had significantly better hearing than those with stage IV and V (P < 0.001). Conclusion: Our study showed a statistically significant relationship between advancing stage of CKD and hearing loss. The hearing loss worsen with advancing stage of CKD.
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Cardiovascular risk factors among staff of a private university in South-west Nigeria p. 127
Esther Ngozi Adejumo, Jolaoluwa Dorcas Adefoluke, Olusola Adedeji Adejumo, Seyi Samson Enitan, Oluwakemi Anike Ladipo
DOI:10.4103/npmj.npmj_189_19  PMID:32295944
Background: Globally, the death rate arising from the cardiovascular diseases (CVDs) is high. This study assessed the prevalence of cardiovascular risk factors (CRFs) among staff of the Babcock University. Methods: This was a descriptive and cross-sectional study. Weight, height, waist circumference and blood pressure measurements were taken. Venous blood was collected for glucose and lipid profile analysis after an overnight fast. The prevalence of smoking, hypertension, diabetes mellitus, dyslipidaemia, general and abdominal obesity were determined. Results: A total of 140 participants were recruited into the study. The average age of the participants was 41.7 ± 9.4 years. The male: female ratio was 1:0.8. About 24% of the participants had no CRF, but 24.3%, 27.1%, 16.4% and 10% had 1, 2, 3 and 4 CRFs, respectively. Majority had abdominal obesity (48.6%) and dyslipidaemia (47.1%). The prevalence of hypertension, obesity and smoking was 32.9%, 31.4% and 11.4%, respectively. None of the participants had diabetes mellitus. More males smoked cigarette (20% vs. 0%) and had hypertension (50% vs. 10%) than that of females (P < 0.001), but a higher proportion of females (63.3% vs. 37.5%) had abdominal obesity (P = 0.002). Conclusion: The prevalence of CRFs among the apparently healthy staff of the Babcock University was high. Urgent measures are needed to prevent the development of CVD in this population.
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Overview of paediatric urology practice in lagos state university teaching hospital, Ikeja, Lagos, Nigeria p. 132
Abimbola Ayodeji Abolarinwa, Olufemi O Ojewuyi, Adaobi U Solarin
DOI:10.4103/npmj.npmj_182_19  PMID:32295945
Introduction: Paediatric urology is one of the subspecialities of urology, and in most climes, it is practised by the urologists and paediatric surgeons, and likewise in the Lagos State University Teaching Hospital (LASUTH). The urologists see and manage most of these cases in LASUTH. There has been no formal training in this subspeciality. However, both the urologists and paediatric surgeons in LASUTH have acquired some measure of skill and experience over time by virtue of the relatively high volume of the cases seen. This study is aimed at reviewing the practice of paediatric urology in the urology division of LASUTH and to advocate for formal training in an otherwise rare but direly needed subspeciality. Patients and Methods: The ports of entry of paediatric patients with urologic conditions were assessed retrospectively over a 5-year period (2014–2018). The paediatric age range based on the Lagos State Government policy for health care is from birth to 12 years old. The ports of entry included the urologic outpatient department, paediatric and the adult surgical emergency units and the paediatric wards. Patients referred to and managed by the paediatric surgery division were excluded from this study. Results: The total paediatric urology cases seen and managed by the urologist in LASUTH within the period of review were 421. A total of 363 paediatric urology cases were seen during the period under review, making up 7.96% of the urology cases seen at the surgical outpatient department. The most common cases managed were hypospadias, posterior urethral valves and hydronephrosis. A variety of other cases include priapism, circumcision and post-circumcision injuries, urethral prolapse, testicular torsion, cystic renal dysplasia, disorder of sexual differentiation and several others. Three hundred and seven surgical procedures were done in the period of review on 272 (64.6%) patients. Conclusion: There is a need for subspecialisation in paediatric urology to harness more specialists with a specific focus, training and interest in children and their urological conditions.
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High carriage rates of extended-spectrum beta-lactamase-producing enterobacteriaceae in children at admission into paediatric wards of a university teaching hospital in Lagos, Nigeria p. 136
Oluwaseun Olaide Jewoola, Ibidunni Oreoluwa Bode-Sojobi, Folasade T Ogunsola, Patrick E Okonji
DOI:10.4103/npmj.npmj_209_19  PMID:32295946
Context: Bowel carriage has been identified as the main reservoir of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and hospital-acquired infections. There are gaps in the knowledge of trends of these rates, which need to be filled for the development and implementation of hospital surveillance systems and antibiotic stewardship programmes in Nigeria. Aim: This study investigated the carriage rates of ESBL-PE among 273 children admitted to the paediatric wards of a university teaching hospital, Nigeria, using a prospective cohort study design over a 6-month period. Settings and Design: The study explored the role of new and transferred patients in introducing resistant strains of ESBLs into paediatric wards and how quickly paediatric patients that were previously free of resistant strains acquired these within the hospital environment. Materials and Methods: E-swabs (Copan Diagnostics, Italy) were used to obtain rectal samples from participants. Positive colonies were Gram stained and subcultured onto purity plates for further identification, and antibiotic susceptibility pattern of identified ESBL-PE was obtained using a range of antibiotics. Statistical Analysis Used: Data were analysed using SPSS statistics 20 (IBM SPSS Statistics, version 20). Statistical significance was determined using the Chi-square test and Fisher's exact test. A logistic regression analysis was also conducted to identify independent risk factors for colonisation. Results: The findings showed that transferred patients contributed to the introduction of ESBLs into the hospital. Independent multivariate risk factors for colonisation of ESBL-PE were age >10–14 years, instrumentation (odds ratio [OR]: 0.2 [P < 0.05]) and sharing of thermometers (OR: 0.11 [P < 0.05]). Conclusions: The carriage rate of ESBL-PE is high (25.3%) among children, and none-carriers may become colonised within 14 days of hospitalisation.
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CASE REPORT Top

Distal femoral replacement in complex revision knee arthroplasty p. 143
Obiegbu Henry Obinna, Katchy Amechi Uchenna
DOI:10.4103/npmj.npmj_140_19  PMID:32295947
Revision knee arthroplasty is often complicated by the presence of bone loss, making the use of conventional revision implants impossible, due to inadequate bone stock and ligamentous stability. Distal femoral replacement, although traditionally was developed for salvage surgeries for bone tumours, plays an important role in revision surgeries of elderly low-demand adults with marked bone loss and ligamentous instability. Here, we report the case of a 66-year-old female, with a history of bilateral knee replacement 5 years before the presentation, who developed left knee pain, with X-ray features of failed left knee replacement. This patient had a left distal femoral replacement and successfully returned to her pre-operative function.
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