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   Table of Contents - Current issue
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October-December 2020
Volume 27 | Issue 4
Page Nos. 261-393

Online since Wednesday, November 4, 2020

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REVIEW ARTICLES  

COVID-19: A review of the effectiveness of non-pharmacological interventions Highly accessed article p. 261
Olumuyiwa O Odusanya, Babatunde A Odugbemi, Tinuola O Odugbemi, Whenayon S Ajisegiri
DOI:10.4103/npmj.npmj_208_20  PMID:33154276
COVID-19, a highly infectious disease, caused by a novel virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought about an unprecedented threat to global health. First reported in Wuhan, China, in December 2019, it has now spread to all continents of the world becoming a pandemic. There is no known treatment or vaccine for it although many candidate drugs and vaccines are in various clinical trial phases. For now, non-pharmacological interventions (NPIs) have become the mainstay of response for COVID-19 and are being used across the world to flatten the epidemiologic curve with some success. This review focussed on identifying which NPIs have been effective. NPIs that are effective include isolation and quarantine, physical distancing, use of face masks and hand hygiene. These measures are best used in combination and simultaneously. The evidence is that they should be instituted early in the pandemic and for sustained periods. They should also be implemented in the context of the cultural and socioeconomic conditions of the populace. Ineffective NPIs include ultraviolet irradiation and spraying of outdoor spaces and individuals. We recommend that decision makers weigh the evidence carefully, as it applies to the local setting to inform public health decisions.
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Routine slit lamp examination procedures: A risk for severe acute respiratory syndrome coronavirus 2 infection to eye care professionals Highly accessed article p. 268
Ernest Ikechukwu Ezeh, Elizabeth Dennis Nkanga, Elijah Ndubuisi Chinawa, Roseline Nkeiruka Ezeh
DOI:10.4103/npmj.npmj_223_20  PMID:33154277
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a highly infectious coronavirus, has been rapidly spreading after its surge in China in December 2019. It is currently a global pandemic. A myriad of transmission routes have been documented, however established thus far, are respiratory droplet, contact and airborne transmissions. Susceptible persons at proximity, usually within 1–2 m, to infected persons are largely at risk of being infected. Unfortunately, health workers usually evaluate patients within this distance. Eye care professionals (ECPs) are faced with a higher risk scenario of being infected as they undertake routine clinical eye examination procedures at a close face-to-face proximity to patients, which place them at a high risk of respiratory droplets and aerosolised particles, particularly from asymptomatic and pre-symptomatic carriers. The slit lamp examination procedure is typically at a distance of between 0.25 m and 0.5 m. While undertaking certain procedures on the slit lamp, such as gonioscopy and slit lamp indirect ophthalmoscopy, the ECP holds the accessory lenses either directly on the patient's eye or at about 5–10 cm from the patient's face, respectively. The authors found it pertinent to articulate this narrative review article to guide slit lamp examination practice by ECPs during routine ophthalmic evaluation, with a view to reducing the spread of SARS-CoV-2 to ECPs. In conclusion, ECPs are at increased risk of infection due to high-risk scenarios for routine slit lamp examination procedures of the eye. Adherence to standard precautionary measures with slit lamp use is highly recommended.
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ORIGINAL ARTICLES Top

Epidemiological trends of coronavirus disease 2019 in Nigeria: From 1 to 10,000 p. 271
Oluwakemi Ololade Odukoya, Adebola A Adejimi, Brenda Isikekpei, Chris S Jim, Akin Osibogun, Folasade Tolulope Ogunsola
DOI:10.4103/npmj.npmj_233_20  PMID:33154278
Background: The coronavirus disease 2019 outbreak in Nigeria was first reported on the 27th February 2020 and 95 days after, it had spread to 35 states and the Federal Capital Territory (FCT) with 10,162 confirmed cases. We reviewed the trends of the epidemic from the 27th February to the 31st May 2020, when it reached the 10,000th mark vis-à-vis government policies to contain the spread of the disease. Methods: We used publicly available data from the Nigeria Center for Disease Control from 27th February 2020, when Nigeria recorded her first coronavirus disease 2019 case to the 31st May 2020. We used line graphs to describe the trends of the daily course of cumulative cases, discharges and deaths in states and nationally. The doubling time, transmission rates were inferred from these trends and the epidemiological curve generated was reviewed vis-a-vis the instituted government policies over the specified period. Results: The epidemic curve in Nigeria has been on an upward trajectory as the number of cases crossed the 10,000 marks, 3 months after the first case was recorded. The first spike in the number of new cases was observed on the 21st April 2020, with 117 cases. The number of daily deaths within the study period was highest on the 2nd May 2020 (17 new deaths). Geo-political zone variations were also observed. Of the 63,882 screening tests conducted during the study period, 15.9% tested positive; the doubling time and transmission rates were 23.5 days and 1.0%, respectively, as at 31st May 2020. Since the lockdown measures were lifted in Lagos and the FCT on the 4th May 2020, the number of cases has been on a steady increase each week. Conclusion and Recommendations: In Nigeria, the epidemic curve has been on an upward direction since the first reported case and it took 3 months to reach 10,000 cases. We recommend a sustained drive in the enforcement of physical and social distancing and increase in testing capacity to flatten the epidemic curve.
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Predictive ability of symptomatology in COVID-19 during Active case search in Lagos State, Nigeria p. 280
Oluwatosin Onasanya, Bisola Adebayo, Ladun Okunromade, Akin Abayomi, Jide Idris, Abdulsalam Adesina, Olugbemiga Aina, Emmanuella Zamba, Olufemi Erinosho, Bimbola Bowale, Folarin Opawoye, Patrick Ramadan, Sam Yenyi, Sunday Omilabu, Shakir Balogun, Akin Osibogun
DOI:10.4103/npmj.npmj_237_20  PMID:33154279
Background: In April 2020, a community-based active case search surveillance system of coronavirus disease 2019 (COVID-19) was developed by the emergency outbreak committee in Lagos State. This followed the evidence of community transmission of coronavirus disease in the twenty Local Government Areas in Lagos State. This study assessed the value of respiratory and other symptoms in predicting positive SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR). It is hoped that if symptoms are predictive, they can be used in screening before testing. Methods: Communities were included based on the alerts from community members through the rumour alert system set up by the state. All members of the households of the communities from where the alert came were eligible. Household members who declined to participate were excluded from the study. A standardised interviewer-administered electronic investigation form was used to collect sociodemographic information, clinical details and history for each possible case. Data was analysed to see the extent of agreement or correlation between reported symptoms and the results of PCR testing for SARS-COV-2. Results: A total of 12,739 persons were interviewed. The most common symptoms were fever, general weakness, cough and difficulty in breathing. Different symptoms recorded different levels of sensitivity as follows: fever, 28.9%; cough, 21.7%; general body weakness, 10.9%; and sore throat, 10.9%. Sensitivity and specificity for fever, the most common symptom, were 28.3% and 50.2%, respectively, while similar parameters for general body weakness, the next most common symptom, were 10.9% and 73.2%, respectively. Conclusion: From these findings, the predictive ability of symptoms for COVID-19 diagnosis was extremely weak. It is unlikely that symptoms alone will suffice to predict COVID-19 in a patient. An additional measure, such as confirmatory test by RT-PCR testing, is necessary to confirm the disease.
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Clinical characteristics, predictors of symptomatic coronavirus disease 2019 and duration of hospitalisation in a cohort of 632 Patients in Lagos State, Nigeria p. 285
Olufemi A Erinoso, Kikelomo Ololade Wright, Samuel Anya, Abimbola Bowale, Olusola Adejumo, Sunday Adesola, Bodunrin Osikomaiya, Bamidele Mutiu, Babatunde Saka, Ayodeji Falana, Disu Ola-Ayinde, Ephraim I Akase, Henry Owuna, Hussein Abdur-Razzaq, Dayo Lajide, Oliver Ezechi, Olusegun Ogboye, Akin Osibogun, Akin Abayomi
DOI:10.4103/npmj.npmj_272_20  PMID:33154280
Objective: The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still evolving. This study describes the clinical characteristics and investigates factors that predict symptomatic presentation and duration of hospitalisation in a cohort of coronavirus disease 2019 (COVID-19) patients managed in Lagos, Nigeria. Methodology: This was a retrospective assessment of patients hospitalised with COVID-19 disease in six dedicated facilities in Lagos, Nigeria, between April 1st and May 31st 2020. Participants were individuals with laboratory-confirmed SARS-CoV-2 infection. The outcome measures were presence of symptoms and duration of hospitalisation. Demographic and comorbidity data were also obtained. Statistical analysis was done using STATA 15.0 software, with P < 0.05 being considered statistically significant. Results: A total of 632 cases were analysed. The median age was 40 years (IQR: 30.5–49); male patients accounted for 60.1%. About 63% of patients were asymptomatic at presentation. Among the symptomatic, the most common symptoms were cough (47.4%) and fever (39.7%). The most common comorbidities were hypertension (16.8%) and diabetes (5.2%). The median duration of hospitalisation was 10 days (IQR: 8–14). Comorbidities increased the odds of presenting with symptoms 1.6-fold (P = 0.025) for one comorbidity and 3.2-fold (P = 0.005) for ≥2 comorbidities. Individuals aged ≥50 years were twice as likely to be hospitalised for more than 14 days compared to individuals aged <50 years (P = 0.016). Conclusion: Most individuals had no symptoms with comorbidities increasing the likelihood of symptoms. Older age was associated with longer duration of hospitalisation. Age and comorbidities should be used for COVID-19 triaging for efficient resource allocation.
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Epidemiological determinants of COVID-19 infection and mortality: A study among patients presenting with severe acute respiratory illness during the pandemic in Bihar, India p. 293
Neeraj Agarwal, Bijit Biswas, Pallavi Lohani
DOI:10.4103/npmj.npmj_301_20  PMID:33154281
Objectives: The study was designed to explore epidemiological characteristics, determinants of COVID-19 infection development and mortality of patients presenting with severe acute respiratory illness (SARI) to a tertiary care health facility of Bihar. Methods: This was an observational record-based study, longitudinal in design. Data of 281 SARI patients who have attended All India Institute of Medical Sciences, Patna, Bihar, India during 25th April 2020, till 12th July 2020 (16 weeks) were used for the study. Results: Out of 281 study participants, 95 (33.8%) were detected to have COVID-19 and 42 (14.9%) died. Among COVID-positive study subject's death rate was 28.4%. In the multivariable logistic regression analysis; increasing age (adjusted odds ratio [AOR] = 1.02 [1.00–1.03]), gender (males) (AOR = 2.51 [1.27–4.96]), presenting symptom (cough) (AOR = 2.88 [1.46–5.70]), co-morbidity (hypothyroidism) (AOR = 4.59 [1.45–14.56]) and delay between symptom onset and admission (>2 days) (AOR = 2.46 [1.19–5.07]) were significant predictors of COVID-19 infection among study participants adjusted with other co-morbidities (diabetes and hypertension). Similarly, place of residence (outside Patna district) (AOR = 2.38 [1.03–5.50]), co-morbidity (diabetes) (AOR = 3.08 [1.12–8.50]), intensive care unit (ICU) requirement at admission (yes) (AOR = 9.47 [3.98–22.52]) and COVID status (positive) (AOR = 6.33 [2.68–14.96]) were significant predictors of death among the study participants whereas place of residence (outside Patna district) (AOR = 4.04 [1.33–12.28]) and ICU requirement at admission (yes) (AOR = 7.22 [2.54–20.52]) were attributes affecting death of COVID-positive study participants. Conclusion: Risk of COVID-19 infection among the study participants was high. Age, gender and co-morbidities increased the risk of infection. COVID-19 infection negatively impacted the treatment outcome of the study participants. Age, co-morbidity and ICU requirement were the other attributes affecting mortality.
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Endoscopic management and clinical outcomes of obstructive jaundice p. 302
Olusegun Isaac Alatise, Afolabi Muyiwa Owojuyigbe, Adeleye Dorcas Omisore, Dennis A Ndububa, Ekinadese Aburime, Kulwinder S Dua, Akwi W Asombang
DOI:10.4103/npmj.npmj_242_20  PMID:33154282
Background: This study aimed at evaluating the endoscopic management and clinical outcomes in patients with obstructive jaundice undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) within a newly established apprenticeship teaching model at an academic centre in a resource-limited setting. Materials and Methods: We employed an apprenticeship-style model of ERCP training with graded responsibility, multidisciplinary group feedback and short-interval repetition. We collected sociodemographic and clinicopathologic data on consecutive patients who underwent ERCP from March 2018 to February 2020. Results: A total of 177 patients were referred, of which 146 patients had an ERCP performed for obstructive jaundice and 31 excluded during the study period. The median age was 55 years, age range from 8 to 83 years. The most common referral diagnosis was pancreatic head cancer 56/146 (38.1%), followed by choledocholithiasis 29/146 (19.7%), cholangiocarcinoma 22/146 (15.0%) and gall bladder cancer 11/146 (7.5%). In all, 102 patients had a malignant indication for ERCP. The cannulation rate was 92%. The most common site for malignant biliary obstruction was proximal bile stricture in 31/102 (30.4%), followed by distal bile strictures in 30/102 (28.4%), periampullary cancer 20/102 (19.6%) and mid bile duct stricture in 9/102 (8.8%). The common benign obstructive etiology includes choledocholithiasis in 33/44 (75%) and mid duct obstruction from post-cholecystectomy bile duct injury in 3/44 (2.9%) while 2/44 (2.0%) patients had choledochal cyst. Overall complications were post-ERCP pancreatitis (8/146 patients), cholangitis (3/146 patients), stent migration and post-sphincterotomy bleeding (one patient each). Peri-procedural mortality was 5/146 (3.4%). Conclusion: ERCP is an effective and safe method of treatment of patients with benign and malignant biliary obstruction. The low morbidity and mortality and its immediate therapeutic benefits, together with the short duration of hospitalization, indicate that this procedure is an important asset in the management of such patients.
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Comparison of rubber band ligation with 3% polidocanol injection sclerotherapy for the treatment of internal haemorrhoids at a Nigerian tertiary hospital p. 311
Ayomide Makanjuola, Olanrewaju Solomon Balogun, Adedapo Olumide Osinowo, Adedoyin Adekunle Adesanya, John Taiwo da Rocha
DOI:10.4103/npmj.npmj_232_20  PMID:33154283
Background: The surgical treatment of internal haemorrhoids is yet to be fully elucidated. Rubber band ligation (RBL) and injection sclerotherapy (IS) are less invasive alternative day-case treatment options with lower morbidity than excisional haemorrhoidectomy. Aims: This was a prospective study that compared the efficacy of RBL with 3% polidocanol IS in the treatment of Grades I to III internal haemorrhoids. Patients and Methods: Sodergren haemorrhoid symptom severity (SHSS) scores of consecutive adult patients with internal haemorrhoids were calculated before and after each of three therapy sessions with RBL and IS. Outcome measures included SHSS scores after treatment, post-procedure pain and complication rates. Data were collated and analysed using SPSS version 23. Results: A total of 74 patients participated in the study with 37 patients in each treatment group. The RBL and IS groups were not statistically different in age (P = 0.506), weight (P = 0.117), height (P = 0.462), BMI (P = 0.153) and gender (P = 0.639). The mean SHSS scores for both groups before therapy (P = 0.876), at 4 weeks (P = 0.669), 8 weeks (P = 0.168) and 12 weeks (P = 0.391) after commencement of therapy were not statistically different. The SHSS scores at 12 weeks after treatment were statistically significantly lower than before treatment in both the groups (P < 0.01). The post-procedure pain score was significantly higher in the RBL than IS group after the first (P < 0.001) and second (P < 0.006) but not after the third therapy session (P = 0.501). The complication rates were low and not significantly different for the RBL and IS groups (5.7% versus 8.1%; P = 0.643). Conclusion: The study concluded that RBL and IS are both effective and safe in the treatment of Grades I, II and III internal haemorrhoids.
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Efficacy of nifedipine versus hydralazine in the management of severe hypertension in pregnancy: A randomised controlled trial p. 317
Joshua Adeniyi Adebayo, Johnbosco Ifunanya Nwafor, Lucky Osaheni Lawani, Chidi Ochu Esike, Ayodele Adegbite Olaleye, Nnabugwu Alfred Adiele
DOI:10.4103/npmj.npmj_275_20  PMID:33154284
Background: Despite the availability of effective antihypertensive drugs, the quality of evidence regarding the best antihypertensive agent for the treatment of hypertensive emergencies in pregnancy is still poor. Aim: The aim of this study was to compare the efficacy and side effects of oral nifedipine and intravenous hydralazine for control of blood pressure (BP) in severe hypertension in pregnancy. Materials and Methods: An open-label, parallel, randomised, controlled trial of 78 pregnant women (≥28 weeks' gestation) with severe hypertension was conducted. Severe hypertension was defined as systolic BP of 160 mmHg or above and/or diastolic BP of 110 mmHg or above. They were randomly (1:1 ratio) administered oral nifedipine 20 mg or intravenous hydralazine 10 mg every 30 min up to 5 doses or until the target BP of 140–150 mmHg systolic and 90–100 mmHg diastolic was achieved. Intravenous labetalol was given if the primary treatment failed. The primary outcome measure was the number of doses needed to achieve targeted BP. The secondary outcome measures were the time needed to achieve desired BP, maternal adverse effects and perinatal outcome. Results: The sociodemographic characteristics did not differ between the two study groups. The average number of dosages (nifedipine; 1.4 ± 0.6 vs. hydralazine; 1.7 ± 0.5, P = 0.008) needed to control the BP was lower in the nifedipine arm. Time (min) taken to control the BP was similar between the groups (hydralazine; 43.7 ± 19.7 vs. nifedipine; 51.2 ± 18.9, P = 0.113). Adverse maternal and perinatal effects did not differ in the study groups. Conclusion: Oral nifedipine and intravenous hydralazine showed comparable efficacy in the BP control in the severe hypertensive disorders of pregnancy without significant difference in adverse maternal and perinatal outcomes. However, further studies are required to explore the role of these drugs in BP control during hypertensive emergencies in pregnancy. ClinicalTrials.gov (Identification number: NCT04435210).
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CA125 levels in pregnancy: A case-control study amongst pregnant women in Aminu Kano teaching hospital, North-West Nigeria p. 325
Badia Maje Sayyadi, Idris Usman Takai, Saidu Adamu Ibrahim, Kabiru Abdulsalam, Usman Muhammad Ibrahim
DOI:10.4103/npmj.npmj_241_20  PMID:33154285
Background: Induction of inflammatory response within the placenta in patients with pre-eclampsia triggers the expression of CA125, thus making CA125 a potential marker reflecting the severity of preeclampsia. Objective: The study was aimed to assess and compare CA125 levels in pre-eclamptics and normotensives. Subjects and Methods: A case–control design was used to study 83 each of the selected pre-eclamptics and normotensives women using a systematic sampling technique. Data were collected using interviewer-administered questionnaire; blood and urine samples were also collected and analysed in the laboratory. Data were summarised using frequencies, percentages, mean ± standard deviation (SD) or median, and range as appropriate. Inferential statistical measures were used to determine the relationship between the outcome and independent variables with a P value set to be statistically significant at ≤0.05. Results: The ages of the pre-eclamptics and normotensives women were found to have a mean ± SD of 29.46 ± 6.92 and 29.70 ± 6.90 years, respectively. More than half 58 (69.9%) of the cases had proteinuria of 3+ (300 mg/dL). Significant difference was statistically (P < 0.01) found in mean serum CA125 levels between women with mild and severe pre-eclampsia with CA125 being more likely to be higher (>50 IU/mL) in severe pre-eclampsia than in mild pre-eclampsia. Conclusion: The study has shown that serum CA125 is elevated in pre-eclamptic pregnancies compared to normotensive pregnancies and the possibility of CA125 being a biomarker of severity and hence may provide information to make an informed choice in early-onset pre-eclampsia to consider conservative management and thus improve perinatal outcome.
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P57kip2 immunohistochemical marker as a diagnostic tool for cases of hydatidiform moles in a tertiary health facility in Southwestern Nigeria p. 331
Babatope L Awosusi, Mustapha A Ajani, Omolade O Adegoke, Ayodeji A Salami, Clement A Okolo
DOI:10.4103/npmj.npmj_231_20  PMID:33154286
Background: Hydatidiform mole (HM) is the most common gestational trophoblastic disease. P57kip2 has been reported to be helpful in differentiating between partial and complete HMs. Objectives: The study aims to evaluate the P57kip2 immunohistochemical (IHC) marker as a useful ancillary investigation to differentiate complete hydatidiform mole (CHM) from partial hydatidiform mole (PHM). Materials and Methods: A retrospective study of all histologically diagnosed HM cases over a 20 year period was undertaken. Clinicopathological parameters were extracted from the surgical day book and medical record archives. Archival haematoxylin- and eosin-stained slides and formalin-fixed paraffin-embedded tissue blocks of all cases of HM diagnosed within the study period were retrieved and reviewed. Cases of HM were reclassified using the P57kip2 IHC marker. The data obtained were analysed using the SPSS version 23. Results: One hundred cases of HMs were studied. CHM accounted for 68%, while PHM accounted for the remaining 32%. The incidence of HM was 2.98 cases per 1000 deliveries. The ratio of CHM to PHM was found to be 2.1:1. Seventy-two per cent of the cases were diagnosed in the first trimester, while the remaining 28% were diagnosed in the second trimester of pregnancy. Based on the P57kip2 IHC staining pattern, HM cases were finally reclassified into 68 cases of CHM and 32 cases of PHM. The age range for all the HM cases was 18–50 years with the majority of the cases seen in the third and fourth decades of life. Conclusion: P57kip2 could be useful as an ancillary investigation in confirming the diagnosis of CHM and differentiating it from PHM, particularly in difficult and challenging cases.
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A rural/urban comparison of paternal involvement in childhood immunisation in Ogun Central Senatorial District, Nigeria p. 336
Kolawole Sodeinde, Olorunfemi Amoran, Olumide Abiodun, Adesola Adekoya, Olufunmilola Abolurin, Bosede Imhonopi
DOI:10.4103/npmj.npmj_101_20  PMID:33154287
Background: Paternal involvement in vaccination programmes is associated with improved uptake of childhood immunisation. However, paternal involvement is low in many climes including Nigeria. This study aimed to compare paternal involvement in childhood immunisation in urban and rural areas of Ogun Central Senatorial District, Nigeria. Materials and Methods: This was a comparative cross-sectional study involving 440 fathers each in urban and rural areas selected using a multistage sampling method. A structured interviewer-administered questionnaire was employed to obtain data. Analysis was done using SPSS version 20. Chi-square test was used to assess the associations between categorical variables, whereas t-test was used to compare the means of respondents' involvement scores. Logistic regression was used to determine the predictors of paternal involvement. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). P < 0.05 was taken as statistically significant. Results: The mean age of respondents in urban areas was 36.58 ± 6.76 and the mean age of respondents in rural areas was 37.61 ± 9.79. The difference in the mean age of urban and rural residents was not statistically significant (P = 0.07). Paternal involvement was significantly better among fathers in rural areas, with 79.8% of them having good involvement as compared to only 50.0% of the urban respondents (P = < 0.001). Being educated up to the tertiary level (adjusted OR [AOR] = 2.43, 95% CI = 1.66–3.57) was the predictor of involvement in childhood immunisation among fathers in the urban area. Among fathers in rural areas, being currently married (AOR = 4.51, 95% CI = 2.12–9.60) was the predictor of involvement in childhood immunisation.Conclusion/Recommendation: Paternal involvement in childhood immunisation is better among rural dwellers compared to urban dwellers. Educated and currently married fathers who have the propensity to be more involved can be trained as peer educators to encourage others to participate, particularly in the urban areas.
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Effectiveness of audio-visual and print media intervention on knowledge of cervical health among rural women in Southern India p. 343
Takkella Nagamma, Lena Ashok, Anjaneyulu Konuri, Varalakshmi Chandrasekaran
DOI:10.4103/npmj.npmj_148_20  PMID:33154288
Background: Cervical cancer health education programmes are not accessible to rural women in developing countries. Objective: Our study aimed at assessing the health literacy about cervical cancer amongst the rural women in Udupi district, southern India, before and following intervention using audio-visual aid/face-to-face interactive sessions versus pamphlets alone. Methods: This was a quasi-experimental study. A total of 166 women participated in the study. Participant groups were allocated into two interventional (Experimental/Control) groups. Participants in the experimental group received education through the video followed by face-to-face interaction with a health educator while those in the control group received a pamphlet. A validated questionnaire was used to assess knowledge about numerous risk factors, Pap smear test and treatment of cervical cancer (pre- and post-intervention test). The findings are presented as frequencies and percentages. Paired responses were compared for individual questions using McNemar test and P < 0.05 was fixed as statistically significant. Results: Former to the intervention, 13.5% and 19.1% in the experimental and control groups, respectively, felt that personal hygiene was important to prevent cervical cancer. Both the groups had very limited knowledge regarding risk factors (93.6%; 94%), symptoms (96.3%; 97.6%) and knowledge that Pap smears can reduce the risk of cervical cancer (91.7%; 93.9%). The change in knowledge pre-and post-intervention in both groups increased significantly. Conclusion: Intervention with face-to-face interactive sessions showed a positive impact on knowledge regarding cervical cancer. These findings indicate both methods can be effective in providing health education in the community.
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Hypercholesterolaemia among urban residents in Lagos State: The knowledge, attitudes, prevalence and risk factors p. 348
Rosemary Oyindamola Babafemi, Oluwakemi Ololade Odukoya, Kolawole John Sodeinde, Olayinka Olufunmi Ayankogbe, Oluseyi Adegoke
DOI:10.4103/npmj.npmj_225_20  PMID:33154289
Background: Hypercholesterolaemia, a modifiable risk factor for cardiovascular disease (CVD), is particularly increasing in urban areas of underdeveloped nations. This research assessed the knowledge of, attitude towards, prevalence of and risk factors for hypercholesterolaemia in an urban local government area of Lagos State. Methods: This descriptive cross-sectional research was conducted among 229 adult residents who were selected through a multistage sampling method. Data were collected with a structured interviewer-administered questionnaire. Anthropometric measures were assessed using standard tools while the lipid profile was assessed by finger pricks using a CardioChek® professional analyser. Participants with knowledge scores of at least 50% were considered as having good knowledge and scores below 50% were considered as poor knowledge. Data analysis was done using SPSS version 20.0. P < 0.05 was taken as statistically significant. Results: The mean age of the respondents was 38.9 ± 4.6 years. More than a third 89 (38.9%) of the respondents had high blood total cholesterol, 39 (17.0%) had high low-density lipoprotein and 8 (3.4%) had high triglycerides. Overall, 110 (48.0%) of the participants had good knowledge of hypercholesterolaemia and 131 (57.2%) of them had positive attitudes towards hypercholesterolaemia as a risk factor of CVD. Being a female (odds ratio [OR] = 2.16; 95 confidence interval [CI] = 1.19–3.91) and consumption of baked food (OR = 1.94; 95% CI = 1.054–3.57) were significant predictors of high cholesterol among respondents. Conclusion: Cholesterol levels were high in this sample of urban Nigerians. Overall, 110 (48.0%) of the respondents had a good level of knowledge while 131 (57.2%) had positive attitudes. Being a female and consuming baked food were significant predictors of high cholesterol among the respondents. This calls for gender-specific interventions for women and health education on dietary modification.
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Electrocardiographic findings in human immunodeficiency virus-infected children in Benin City, Nigeria p. 357
Chinedu Anthony Attamah, Wilson Ehidiamen Sadoh, Michael Okoeguale Ibadin, Augustine Isikhuemen Omoigberale
DOI:10.4103/npmj.npmj_92_20  PMID:33154290
Background: Human immunodeficiency virus (HIV) infection is a global pandemic affecting mostly sub-Saharan Africa. It is a multisystem disease. Cardiovascular involvement detected by electrocardiogram (ECG) has been described mostly in adult populations with few studies on children. In this study, the ECG findings of HIV-infected as against HIV-uninfected children were evaluated. Subjects and Methods: This comparative cross-sectional study was conducted in two public hospitals in Benin City. Using convenience sampling, 200 each of HIV-positive children attending the HIV clinics of both hospitals and age- and sex-matched HIV-negative children attending follow-up clinics in the same hospitals were recruited. Biodata/sociodemographic information was obtained, while each participant underwent 12-channel ECG evaluation. Results: The prevalence of abnormal ECG findings in HIV-positive children was 34.5% compared to 4.5% in HIV-negative children (P < 0.0001). The mean PR, QRS and QT intervals in the participants were 0.13 ± 0.02 s, 0.11 ± 0.15 s and 0.41 ± 0.03, respectively. They were statistically significantly longer than controls, 0.12 ± 0.02 s, 0.08 ± 0.09 s and 0.40 ± 0.02 s, respectively, P < 0.05, in each case. The prevalence of prolonged PR, QRS and QTc was significantly higher in the patients, 5%, 3.5% and 3.5%, respectively, than controls, 05, 0% and 0%, respectively (P < 0.05 in each case). Conclusion: A third of the HIV-infected children in the study had abnormal ECG changes. It is recommended that ECG be included in their routine management of HIV-positive children so as to better supervise the affected children, retard the deterioration and improve their quality of health.
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Tympanometric findings among Nigerian prison inmates: A cross-sectional survey p. 365
Abdullahi Musa Kirfi, Mohammed Bello Fufore, Oladeji Raheem Quadri, Aliyu Mohammed Kodiya, Onyekwere George Benjamin Nwaorgu
DOI:10.4103/npmj.npmj_96_20  PMID:33154291
Background: Prisoners, due to confinement, are isolated from contact with society and access to many of the facilities, including medical care. There is paucity of data on the middle ear function of prison inmates in the English literature globally. We aimed to assess the middle ear function of prison inmates in Kaduna, Nigeria. Participants and Methods: This was a cross-sectional comparative study of prison inmates at the Kaduna convict prison. Ethical approval was obtained from the Kaduna State Ministry of Health and the Nigerian Prison Service. Prison inmates aged 18–55 years in the Kaduna convict prison with an equal number of age and sex-matched controls from the community were enrolled. Consent was obtained from the participants. Data were collected using a structured pre-tested questionnaire. Participants had a thorough physical examination of the ears. Tympanometry was conducted on suitable participants to assess the middle ear function. Statistical Product and Service Solutions version 20.0 was used to analyse the data. Results: Four hundred and thirty inmates with an equal number of controls were enrolled for the study. The mean age for the inmates and controls was 30.2 ± 7.51 and 30.4 ± 8.02 years, respectively. There were 47 female and 383 males, with a female: male of 1:8.1. Forty-six (46/397, 11.6%) of the inmates and 15 (15/423, 3.5%) of the controls had abnormal tympanograms on the right while on the left, it was 12.4% and 3.8%, respectively. The difference between the two groups was statistically significant (χ2 = 40.071, P = 0.0001). Conclusion: Middle ear abnormalities are more prevalent among prison inmates than the general population. Middle ear effusion and ossicular chain disruption were the most common middle ear abnormalities affecting the prison inmates.
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Transient-evoked otoacoustic emission findings in children (1–12 years) with cerebral palsy in Kano, Nigeria p. 371
Yasir Nuhu Jibril, Auwal Adamu, Rabiu Ibrahim Jalo, Zubaida Ladan Farouk, Abubakar Danjuma Salisu, Onyekwere George B. Nwaorgu
DOI:10.4103/npmj.npmj_240_20  PMID:33154292
Background: Children with cerebral palsy (CP) suffer from multiple problems and potential disabilities. These range from musculoskeletal problems, mental retardation, epilepsy, ophthalmologic and hearing impairment among others. Consequences of hearing loss include problems with speech and language development. Early detection in this difficult-to-test population may prevent these consequences of hearing loss. An otoacoustic emission assessment is useful in this regard. This study assessed transient-evoked otoacoustic emissions (TEOAEs) in children with CP. Materials and Methods: The study population were children with CP who presented at the paediatric neurology clinic during the study period. An equal number of control population matched for age and sex were also recruited using simple random sampling. An interviewer-administered questionnaire was used to obtain relevant clinical information. All participants selected underwent a detailed ear, nose and throat examination and TEOAE testing. Results: There were 330 participants in this study, categorised into CP cases (165) and non-CP controls (165). The age range of the participants was 1–12 years, with a mean age of 4.44 ± 2.92 among CP patients and 4.47 ± 2.90 among the controls. The male-to-female ratio was 2:1. TEOAEs were 'failed' in 83.6% of the CP patients and in 28.5% of the controls. This study found a statistically significant difference in 'failed' TEOAE result between the CP patients and the controls (P = 0.0001). Conclusion: This study found a high prevalence of 'failed' TEOAEs in children with CP in Kano.
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Survey of prostate biopsy practices among urologists in Nigeria p. 377
Emmanuel Ajibola Jeje, Taiwo Opeyemi Alabi, Rufus Wale Ojewola, Moses Adebisi Ogunjimi
DOI:10.4103/npmj.npmj_297_20  PMID:33154293
Background: Prostate biopsy (PB) is one of the most commonly performed procedures by urologists in our practice. It is the confirmatory diagnosis of the most common malignancy in elderly men. Currently, there is no national guideline on PB in Nigeria; hence, practices vary among urologists and institutions. The sudy aim was to highlight the various PB practices among Nigerian urologists with a view to determining the gap between our practice and evidenced-based global practice. Materials and Methods: A descriptive cross-sectional study which utilised self-administered questionnaires distributed among urologists who participated at the Nigerian Association of Urological Surgeons' (NAUS) Conference in Lagos in 2014. Results: The total number of respondents was 102, distributed across 26 states and various levels of the hospital. All respondents stated that they always perform biopsy if prostate-specific antigen (PSA) was >10 ng/ml. Seventy-nine (77.5%) respondents routinely rely on PSA kinetics in taking a decision on PB. About four-fifth routinely discontinue aspirin before the biopsy. All respondents administer antibiotics with a preference for the parenteral route in 74.5%. Anaesthesia employed for PB included, regional by 52 respondents (50.9%), local by 39 respondents (38.2%), and general by 1 respondent (1.0%), respectively. Transrectal route was preferred by 96 (94.1%). Majority (74.6%) still practice digitally-guided biopsy, whereas 25.4% perform the transrectal ultrasound-guided biopsy. The number of cores commonly taken for systematic technique ranges from 6 to 18. About a quarter (25.5%) had personal or institutional publication (s) on PB. Conclusion: PB practice vary among Nigerian urologists. The variability depends on individual training, preference and available institutional facilities. We recommend that NAUS should provide a guideline for the practices of PB in Nigeria.
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Knowledge and risk perception of e-cigarettes and hookah amongst youths in Lagos State, Nigeria: An exploratory study p. 384
Olatokunbo Osibogun, Olukemi O Odukoya, Yetunde O Odusolu, Akin Osibogun
DOI:10.4103/npmj.npmj_261_20  PMID:33154294
Introduction: Limited research exists describing young people's knowledge and risk perception of e-cigarettes and hookah in Nigeria. This qualitative study explored the knowledge and risk perception of e-cigarettes and hookah amongst young people in Lagos, Nigeria. Methods: Participants (n = 20), aged 15–24 years who had used e-cigarettes or hookah at least once in the past 12 months, participated in three focus group (FG) discussions in January 2020. Each FG session consisted of 6–7 participants, was facilitated by a trained moderator and lasted approximately 60 min. Sessions were recorded, and notes were taken after informed consent. Recordings were transcribed verbatim and analysed using NVIVO 10 software. Results: An essential element of our findings was that the majority of the participants seemed to be more aware of hookah and used hookah compared to e-cigarettes. The participants mentioned they used these tobacco products mainly to reduce stress, for pleasure and for social acceptance. Most of the study participants reported that they were aware of some adverse health effects associated with e-cigarette or hookah use. Although some participants felt that the use of e-cigarettes or hookah could transform to cigarette smoking, many felt that e-cigarette was a harm reduction tool. Conclusion: Young users of e-cigarettes and hookah continue to use these products though they are aware of some associated adverse health effects. These products are used primarily for relieving stress and for social reasons. Raising awareness of the risks associated with the use of these tobacco products may help to reduce the acceptability of these products amongst youths.
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CASE REPORT Top

Breaking the stress with a non-rigid connector p. 391
Priyanka Rani, Puja Malhotra
DOI:10.4103/npmj.npmj_184_20  PMID:33154295
Lone standing abutments or pier abutments have usually been restored with a conventional fixed partial denture (FPD) using a rigid connector between the pontics and the retainers. However, such fixed and rigid restorations have been associated with a higher rate of debonding, microleakage, caries, etc., The aim of the modern day prosthodontics is the preservation of what remains as given by M.M Devan. As a result, a non rigid connector (NRC) may be the connector of choice in situations of pier abutment. A NRC acts as a stress breaker so that the anterior and posterior segments can move independent of each other. This case report presents a simple method of rehabilitating a patient with a pier abutment in the upper right posterior region of the mouth. Rehabilitation was done by FPD with an inverted key-keyway type NRC. Follow up was done up to 11 months.
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