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   Table of Contents - Current issue
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July-September 2019
Volume 26 | Issue 3
Page Nos. 143-194

Online since Tuesday, August 13, 2019

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SYSTEMATIC REVIEW AND META-ANALYSIS ARTICLE  

Epidemiology of surgical site infections in Nigeria: A systematic review and meta-analysis p. 143
Ahmed Olowo-Okere, Yakubu Kokori Enevene Ibrahim, Busayo Olalekan Olayinka, Joseph Olorunmola Ehinmidu
DOI:10.4103/npmj.npmj_72_19  
Introduction: Surgical site infection (SSI) is a major patient safety concern in hospitals. Unlike most developed countries, Nigeria does not yet have an established national system to monitor the occurrence of this infection. This meta-analysis was thus designed to determine the pooled cumulative incidence of SSIs and various determinants of its occurrence in Nigeria. Methods: The electronic databases were systematically searched for articles reporting the occurrence and risk factors associated with SSIs in Nigeria from January 2000 to December 2018. The eligible articles were evaluated using a set of pre-defined criteria. The extracted data were analysed using the comprehensive meta-analysis software. The Begg and Egger's regression tests were used to assess the risk of bias of the included publications. Results: Thirty-two articles emanating from the six geopolitical regions of Nigeria were included in this meta-analysis. The pooled cumulative incidence of SSIs was 14.5% (95% confidence interval [CI]: 0.113–0.184) with the highest incidence reported in the north-eastern region (27.3%, 95% CI: 0.132–0.481) of the country. It was also found to occur more predominantly following colorectal and abdominal surgeries, among elderly patients and in patients with co-morbid conditions. The most frequently reported was the superficial incisional SSIs occurring in 62.5% (95% CI: 0.333–0.848). Higher preponderance was also observed among patients with dirty wounds (52.7%, 95% CI: 0.367–0.682). Conclusion: This meta-analysis documents for the first time the national burden of SSIs in Nigeria. Control measures geared towards its reduction should be strengthened and a national policy on SSI surveillance, prevention and control developed.
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ORIGINAL ARTICLES Top

The effects of playing wind musical instruments on the occlusal characteristics in a Northern Nigerian Population p. 152
Tope Emmanuel Adeyemi, Olayinka Donald Otuyemi
DOI:10.4103/npmj.npmj_71_19  
Introduction: Dentists are often questioned on whether playing a wind musical instrument can adversely affect dental occlusion. This study compared the occlusal characteristics in wind instrument players (WIPs) and non-WIPs. Materials and Methods: This was a cross-sectional comparative study comprising a group of fifty males aged 18–45 years that had been playing wind instruments for a minimum of 2 years, whereas the control group were non-WIPs in the same environment. All the participants had full complement of dentition. The occlusal characteristics of overjet, overbite, anterior open bite and Little's irregularity were assessed for both groups. Excellent intra-examiner reliability was observed (Cronbach's alpha – 0.997). The Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 17 was used for data analysis, and statistical significance level was set at P < 0.05. Results: The number of years of playing wind musical instrument ranged from 2 to 25 years. The mean overjet was 3.46 ± 1.49 mm and 3.18 ± 1.27 mm in the WIP and non-WIP groups, respectively (P > 0.05). The maxillary anterior segment showed statistically significantly higher Little's Irregularity Index score in the WIP group (3.18 ± 3.73 mm) than that in the non-WIP group (1.87 ± 2.21 mm) (P < 0.05). The maxillary Little's Irregularity Index score in trumpet and trombone players (3.55 ± 3.93 mm) was significantly higher than that in saxophone and clarinet players (1.69 ± 2.39 mm). Both the maxillary and mandibular anterior-segment alignments were neither influenced by the number of years nor the frequency of play. Conclusions: Playing wind musical instruments significantly affects the maxillary anterior-segment alignment.
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Age and reasons for first dental visit among children in Lagos, Nigeria p. 158
Olubukola Olamide Olatosi, Nneka Kate Onyejaka, Afolabi Oyapero, Joseph Femi Ashaolu, Adesuwa Abe
DOI:10.4103/npmj.npmj_60_19  
Background: An early first dental clinic appointment offers the prospect of prompt preventative care and parental education regarding the oral health of the child. The evidence-based recommendation by dental professionals all over the world is that a child should visit a dentist before or by 1 year of age. Aim: This study aimed to determine the chronological age at and the purpose for a first dental clinic visit amongst children aged 16 years and below attending the Paediatric Dental Clinic at the Lagos University Teaching Hospital (LUTH). Materials and Methods: This was a retrospective study conducted amongst children who attended the Paediatric Dental Clinic at the LUTH between January 2017 and December 2018. Data on age at first dental visit, reasons for attending and other information relevant to the study were collected. Descriptive statistics and Chi-square analysis were conducted, and the level of significance was set at P < 0.05. Results: A total of 1157 children were studied, comprising 580 (50.5%) males and 577 (49.9%) females. Their mean age on their first dental visit was 7.9 ± 3.7 years. Most of the children (31.4%) had their first dental visits at 7 and 9 years, and 0.8% of the children had their first dental visit below the age of 1 year. The most common reason for visiting the dental clinic was dental pain (33.1%). A higher proportion of the children (911 [79.0%]) had their first dental visit for therapeutic purposes, whereas 246 (21.0%) children visited the dental clinic for preventive care. Sex and age at first dental visit were statistically significantly associated with the reason for attendance (P < 0.001). Conclusion: Most children had their first dental visit between the ages of 7 and 9 years, mainly because of pain. It is necessary to create more awareness among parents/caregivers and to establish the concept of dental home.
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Hearing threshold of deaf pupils in Kaduna metropolis, Kaduna, Nigeria: A cross-sectional survey p. 164
Abdullahi Musa Kirfi, Musa Thomas Samdi, Abubakar Danjuma Salisu, Mohammed Bello Fufore
DOI:10.4103/npmj.npmj_56_19  
Background: Hearing loss in paediatric age group may be inherited, developmental or caused by maternal rubella. It may also be due to complications at birth or certain infections such as meningitis and measles. Ototoxicity and exposure to excessive noise also contribute significantly. Majority of hearing loss in children can be prevented primarily. We aimed to share our findings on assessing the hearing thresholds of pupils in deaf schools in Northwestern Nigeria. Participants and Methods: This was a cross-sectional study which assessed the hearing threshold of pupils in deaf schools in Kaduna metropolis, Kaduna, Nigeria. Approval was obtained from the State Ministry of Health Ethics Committee. Multi-staged sampling method was used to enrol 430 deaf pupils. Consent was obtained and a structured pre-tested questionnaire was used to generate data on the participant's biodata, history and detailed examination findings as well as pure-tone audiometry. Collated data were documented and entered into Statistical Product and Service Solutions version 20 for windows then analysed. Results: Mean pure-tone average of the right ear was 103.4 ± 8.3 and the left ear was 104.3 ± 8.9. Majority had bilateral profound hearing loss (99.0%). Severe hearing loss was seen in 0.9%, whereas the remaining 0.1% had moderate hearing loss. The hearing loss sensorineural in majority (97.6%) and the remaining 2.4% had mixed hearing loss. High-frequency hearing loss predominated (98.6%). Conclusion: Majority of the deaf pupils had bilateral, profound, sensorineural hearing loss, involving higher frequencies.
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An appraisal of the presentation and management of adult intussusception at a Nigerian Tertiary Hospital p. 169
Olanrewaju Samuel Balogun, Thomas O Olajide, Michael Afolayan, Abdulrazzak Lawal, Adedapo Olumide Osinowo, Adedoyin A Adesanya
DOI:10.4103/npmj.npmj_47_19  
Background: Intussusception in adults is considered rare in surgical practice. It is the causative lesion in a small proportion of cases of intestinal obstruction and lower gastrointestinal bleeding. In the last decade, the incidence of adult intussusception appears to be increasing at our centre. Aims: This study aims to document the pattern of presentation and management outcome of adult intussusception at our institution during the last decade. We also observed the occurring trends of this lesion. Patients and Methods: This was a 10-year retrospective study of consecutive adult patients with intussusception seen at our institution from July 2008 to June 2018. Information on biodata, clinicopathological features and management outcome retrieved from case notes and pathology records were analysed on a personal computer using SPSS version 23. Results: Twenty adult patients who had intussusception were seen during this period. There were 9 (45%) males and 11 (55%) females giving a male-to-female ratio of 1:1.2. The mean age of presentation was 45 (range 18–66) years. Clinical features were abdominal pain (85%), abdominal distension (80%), vomiting (70%), rectal bleeding (70%) and palpable abdominal mass (35%). Majority of patients (70%) presented with features of intestinal obstruction. Idiopathic intussusception (55%) accounted for more than half of the cases with the jejunoileal variety (30%) as the most common pathological type. One patient who had intussusception in the postoperative period was treated with manual reduction at laparotomy. Bowel resections were performed in the remaining 19 (95%) patients. Conclusion: Adult intussusception is still uncommon in our general surgical practice. Bowel resection is the mainstay of treatment.
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Computer-assisted brain surgery (neuronavigation) in Abuja, North Central Nigeria: A 3-year retrospective review and practical challenges p. 174
Ugwuanyi Charles, Anigbo Anthony, Nwaribe Evaristus, Salawu Morayo, Jibrin Paul, Arua Chinedu
DOI:10.4103/npmj.npmj_66_19  
Introduction: Neuronavigation has become a standard of care in contemporary neurosurgery since more than two decades and is gradually being embraced in our local practice. It is, therefore, important to share our local experience, including practical challenges encountered with this technology. Aims and Objectives: The aim of this study is to review and present our early experience with stealth neuronavigation and to discuss the practical challenges encountered with the application of this technology in this environment. Methodology: Retrospective review of all consecutive cases over a 3-year period (January 2016–December 2018). Admitting diagnosis, operations, histological diagnosis, adjuvant treatments and 6 months outcome were the major study parameters. Procedural challenges were also highlighted. Data were analysed using simple descriptive statistics, and results were presented in tables and figures. Results: A total of 30 procedures were conducted. Nineteen males and 11 females (male: female = 1.7:1). Youngest was 8 months, oldest was 71 years, mean = 39 and standard deviation (SD) = 19.3. Operations performed were resection of mass lesion 18/30 (60%) and biopsy of mass lesion in 12/30 (40%) cases. Histological diagnostic yield was 100%. Mean duration of hospital stay was 2 days (SD = 0.25) for the biopsy group and 8 days (SD = 1.7) for the resection group. At 6 months review, 10/30 (33.3%) have died following progression and/or complications of their primary pathology. Conclusions: Wide spectrum of brain lesions were approached confidently with precision and minimal morbidity. No procedure-related mortality was recorded. Adjuvant treatments were easily deployed in line with a precise histological diagnosis. Practical challenges did not compromise the navigation process.
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Utilisation and preferences of family planning services among women in Ikosi-Isheri, Kosofe Local Government area, Lagos, Nigeria p. 182
Oluchi Joan Kanma-Okafor, Eucharia Justin Asuquo, Michael Orji Izuka, Mobolanle Rasheedat Balogun, Olayinka Olufunmi Ayankogbe
DOI:10.4103/npmj.npmj_52_19  
Background: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. Aim: This study was aimed at assessing the use and preferences of FP services among women. Subjects and Methods: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15–49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. Results: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). Conclusion: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.
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Self-medication practice in Akuse, a rural setting in Ghana p. 189
Barbara Nyantakyiwah Mensah, Irene Bonewa Agyemang, Daniel Kwame Afriyie, Seth Kwabena Amponsah
DOI:10.4103/npmj.npmj_87_19  
Objective: In most resource-poor settings, there is a paucity of data on self-medication and possible factors that influence this practice. The current study assesses self-medication among the people of Akuse, a rural setting in the Eastern Region of Ghana. Methods: A quantitative cross-sectional study was carried out in Akuse from 4th January 2016 to 27th February 2016. Using a questionnaire, interviews were conducted to assess self-medication: class of drugs taken, sources of drugs, knowledge of potential adverse effects, among others. Results: Of the 363 participants enrolled, 361 completed questionnaires administered. Of the 361 respondents, 58.4% were female. A majority of the respondents were within the ages of 30 and 45 years. Respondents were mainly farmers (40.2%), and a majority (44.6%) had primary level as the highest education. One major reason for self-medication was influence from family and friends (32.7%). Antibiotics (32.1%) and analgesics (21.0%) were the most common self-medicated drugs, and these drugs were mostly obtained from licenced chemical sellers (32.5%). A little more than a third (39.9%) of the respondents said that their condition did not change after self-medication. A greater number of the respondents (81.7%) did not have knowledge of potential adverse reactions associated with self-medicated drugs. However, respondents with high educational level had the most knowledge of adverse drug reactions. Conclusion: The study found self-medication as a common practice among a number of residents of Akuse. Findings from this study provide data that could be used for targeted education and sensitisation of self-medication and its demerits in similar resource-poor rural settings.
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