https://www.ajol.info/index.php/jcm <p>International Journal of Medicine and Health Development (formerly, Journal of College of Medicine) is the official publication of&nbsp;<strong>College of Medicine University of Nigeria,</strong>&nbsp;and&nbsp;was established in 1995.&nbsp;It is under the supervision of&nbsp;the&nbsp;<strong>Directorate for Research and Publications&nbsp;</strong>of the College of Medicine, University of Nigeria<strong>.&nbsp;</strong>The University of Nigeria was established in 1960 while the College of Medicine was established in 1982. The College currently consists of four faculties: The Faculty of Medical Sciences, Faculty of Health Sciences and Technology, Faculty of Dentistry, and Faculty of Basic Medical Sciences. Through excellence in education, research and clinical service, College of Medicine, University of Nigeria has achieved an ever-increasing national distinction as a health sciences college. It provides outstanding medical education through its faculties, staff, programs, affiliates and centers of excellence. It is affiliated with the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, National Orthopedic Hospital Enugu, and National Neuropsychiatric Hospital Enugu with thousands of bed spaces to serve as places for clinical education and research for her undergraduate and post graduate students.&nbsp;</p> <p>Other websites related to this journal: <a href="https://www.ijmhdev.com">https://www.ijmhdev.com</a></p> College of Medicine, University of Nigeria en-US International Journal of Medicine and Health Development 1118-2601 Copyright for articles published in this journal is retained by the journal. https://www.ajol.info/index.php/jcm/article/view/231012 <p>No Abstract</p> U.R. Ojinmah E.N. Shu Copyright (c) 0 2022-09-01 2022-09-01 22 2 66 67 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231015 <p><strong>Background</strong>: Venous blood packed cell volume (PCV) in pregnancy differs from capillary blood PCV. How this disparity affects the accuracy of capillary blood in determining the actual (venous) PCV is not clear.</p> <p><strong>Objectives</strong>: To determine the accuracy of capillary blood for the determination of actual PCV and anemia among pregnant women in Enugu, Nigeria.</p> <p><strong>Methods</strong>: Pairs of venous and capillary blood of 200 consecutive pregnant women were assessed for PCV, at the antenatal clinic of UNTH, Enugu, Nigeria, from May to June 2012. Using venous blood as the gold standard, standard measures were used to assess the accuracy of capillary PCV (cPCV).</p> <p><strong>Results</strong>: Capillary PCV (median = 34.0%, IQR = 31.0-35.8) of participants differed significantly from their venous PCV (median = 34.0%, IQR = 32.0-37.0), P &lt; 0.001. Mean percentage error for cPCV was -2.3 ± 4.44%. The sensitivity and specificity of cPCV for the determination of anemia were 93.0% and 89.5% respectively. Area under the curve (AUC) of the ROC curve showed an overall high accuracy of cPCV for determination of anemia in pregnancy (AUC = 0.963, p &lt; 0.001).</p> <p><strong>Conclusions</strong>: cPCV showed fairly high accuracy for the determination of anemia in pregnancy in Enugu, Nigeria. However, it systematically underestimates the actual PCV in the study population which suggests that it is inferior to vPCV and may have clinical implication as regards the decision to transfuse. Maternity units should use vPCV when moderate or severe anemia are suspected.</p> C.C. Dim E.O. Ugwu U.B. Anyaehie K.C. Obioha Copyright (c) 0 2022-09-01 2022-09-01 22 2 68 73 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231017 <p><strong>Background</strong>: Pornography remains an elusive concept and disproportionate numbers of young people continue to view the websites despite the effects it has on their psychological, emotional and cognitive development.</p> <p><strong>Objective</strong>: This study aimed to determine the prevalence of exposure/access to internet pornography and its influence on sexual behavior of undergraduate students of the Benue State University, Makurdi, Nigeria.</p> <p><strong>Methods</strong>: A cross sectional descriptive study was employed to study 280 undergraduate students, via structured self–administered questionnaires. Ethics were adhered to as the human dignity of the participants was respected. Multiple logistic regressions were performed to investigate independent predictors that had significant chi-square at ? &lt; 0.05.</p> <p><strong>Results</strong>: Exposure to pornography amongst the respondents started as early as 10 years; 46.94% of them who had initial exposure continued to view the websites, 21.7% viewed the internet pornography on a frequent basis. Majority (88.0%) of them practiced what they watched, 71.4% became addicted to sex, and 56.4% record the video and send to friends/colleagues. The exposed respondents are about 2.8 times more likely to practice risky sexual behaviors as compared to those not exposed {(OR-2.819 (95% CI = 0.0292 - 0937) p= 0.029), and or group sex {(OR- 0.444 (95% CI = 0.9.782 – 7.584) p= 0.000). The fun of the porn, seeking for sexual partners, knowledge of knowing how to make love, and sexual arousal were thecom-mon contributing factors to viewing pornography.</p> <p><strong>Conclusion</strong>: Access to pornography and negative health behavior among the undergraduate students will presumably remain unrestrained if not promptly addressed. It is therefore important to offer youth friendly centers for discussing pornography in order to counterbalance the fictional world presented in pornography.</p> O. Audu G.B. Ugande B.A. Aliegba A.A. Gobir T. Kusugh A.O. Ojabo Copyright (c) 0 2022-09-01 2022-09-01 22 2 74 81 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231019 <p><strong>Background</strong>: Measles is an important cause of childhood death and cornealblindness in Africa, and measles immunisation is important in reducing childhood mortality and morbidity. Many countries in sub-Saharan Africa still have challenges with achieving high immunisation coverage. In Nigeria there are intra-national disparities in vaccination coverage.</p> <p><strong>Objectives</strong>: The objectives of this study are to explore trends in immunisation coverage in Nigeria and assess the relationship between measles immunisation coverage and causes of childhood blindness in Nigeria.</p> <p><strong>Methods</strong>:Data from the Nigerian National Demographic and Health Survey (NDHS) 1990-2013 were utilized. In addition, data on published population based childhood blindness surveys in three geographical zoneswere obtained. Secondary analyses of data were done using STATA V.12.1 (Statcorp, Texas). The prevalence of measles immunisation coverage indicators was stratified by regional and individual level variables</p> <p><strong>Results</strong>: Nigeria’s currentmeasles immunization coverage is 42%. The greatest coverage recorded was in 46% in 1990, but declined soon after due to political reasons. The reduced coverage was strongly associated with poverty, lack of mother’s education, geographical location and corneal blindness (p &lt; 0.05).</p> <p><strong>Conclusion</strong>: Measles immunisation coverage in Nigeria is low and inequitable. There is need to develop strategies to increase mothers’ education and socioeconomic status in order to develop sustainable models for childhood measles vaccination in Nigeria.</p> A.E. Aghaji Copyright (c) 0 2022-09-01 2022-09-01 22 2 82 88 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231021 <p><strong>Background</strong>: The use of anti-retroviral treatment has transformed AIDS into a chronic disease with a growing burden on the fragile public health system in the Nigeria. Pattern of condom use can act as a surrogate on the impact of counseling on HIV patients.</p> <p><strong>Objectives</strong>: The aim of this study was to document the pattern of condom use among HIV positive patients on HARRT attending a tertiary hospital in Enugu.</p> <p><strong>Methods</strong>: Consecutive consenting patients presenting at the ART-clinic of Enugu State University of Technology Teaching Hospital, Parklane were interviewed. Data was analyzed using the statistical package for social sciences (SPSS) version 22.</p> <p><strong>Results</strong>: A total of 207patients were interviewed during the study. Twenty-three (11.1%) abstained from sexual intercourse after counselling, 113(61.4%) used condoms consistently while the rest 71(31%) did not use it or used it inconsistently. Patients with primary school education (85.4%) had the highest rate of consistent condom use. Condom use after counselling positively correlated with age (r=0, 17, p= 0.01) and negatively with initial CD4 count levels (r =-0.16, p=0.02) and lack of prior knowledge of the benefits of condom in HIV/AIDS prevention.</p> <p><strong>Conclusions</strong>: After counselling on condom use, about 31% of patients attending ART center in Enugu did not use condom or used it inconsistently. Condom use positively correlated with age and negatively with initial CD4 count levels and lack of knowledge of the benefits of condom in HIV/AIDS prevention.</p> B.A. Ezeala-Adikaibe C. Orjioke E. Aneke I.I. Okafor M.U. Umeh J. Uchejekwu Copyright (c) 0 2022-09-01 2022-09-01 22 2 89 96 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231022 <p><strong>Background</strong>: Dento-alveolar abscess is a clinical condition commonly seen in the dental clinic. It is associated with pus formation in the tooth and the surrounding alveolar bone. The study aimed to determine the prevalence and pattern of dento-alveolar abscess in a group of Nigerian children attending a pediatric dental clinic.</p> <p><strong>Methods</strong>: This was a retrospective study of children with dento-alveolar abscesses who attended the pediatric dental clinic of University of Nigeria Teaching hospital, Enugu, from January 2015 to December, 2015. Their case notes were retrieved and information on socio-demographic profile, an etiology, tooth/teeth involved, dental visit history, and definitive treatment given were obtained and analyzed.</p> <p><strong>Results</strong>: Twenty one (9.1%) out of 231 children seen within the study period had dento-alveolar abscess and 24 teeth were involved. More females 66.7% (14/21) than males 33.3 %( 7/21) had dento-alveolar abscess. Dento-alveolar abscess occurred mostly in children aged 6-9 years 57.1% (12/21) and dental caries 70.8 % (17/24) was the main etiological factor. Most 76.2% (16/21) of the study participants were first dental clinic attendees. The lower first and second primary molars were mostly affected 25.0 % (6/24) respectively and pulpectomy 58.3 % (14/24) was the commonest definitive treatment given.</p> <p><strong>Conclusion</strong>: The prevalence of dento-alveolar abscess was low in the study population and dental caries was the main an etiological factor. There is a need to increase awareness on preventive dental visits by children.</p> N.K. Onyejaka E.O. Amobi Copyright (c) 0 2022-09-01 2022-09-01 22 2 97 100 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231024 <p><strong>Background</strong>: The prevalence of asthma among Nigerian adolescents and adults is high, and low- and middle-income countries account for most asthma-related complications. Health related quality of life (HQoL) is an indicator of intervention outcomes and a predictor of morbidity and mortality. The study assessed and compared the components of HQoL of asthma and non-asthma outpatients in a tertiary hospital.</p> <p><strong>Method</strong>: The study was a comparative cross-sectional study conducted among adult asthma and non-asthma patients attending outpatient clinics in a tertiary hospital in north-western Nigeria. A total of 150 asthma patients and equal number of non-asthma patients matched by age and sex were enrolled. Data was collected from both groups using a questionnaire adapted from the WHOQOL-BREF developed by the World Health Organization, and analyzed based on the scoring instructions for the tool.The statistical significance of differences between asthma and non-asthma patients were assessed using Chi-square test in thecase of socio-demographic characteristics and self-rated domains of HQoL, and t-test in thecaseof physical health,psychological health, social relationships and environmentdomains of HQoL, all at P&lt;0.05.</p> <p><strong>Results</strong>: Fewer asthma patients than non-asthma patients had good self-rated HQoL (68.7% vs. 94.6%; P&lt;0.0001) and satisfaction with their own health (59.3% vs. 84.0%; P&lt;0.0001). Also, asthma patients had worse mean scores for physical health (12.6 vs 14.7; P&lt;0.0001) and psychological health (13.8 vs 15.3, P&lt;0.0001). However, social relationships (14.4 vs 14.6; P=0.727) and environmental domain (13.0 vs 13.4; P=0.942) were not different between the two groups.</p> <p><strong>Conclusion</strong>: The study reports possible lower HQoL among asthma patients attending clinics in the tertiary hospital studied. It is recommended that routine care of asthma outpatients should be holistic, including psychosocial support.</p> M.S. Ibrahim K.A. Maina S. Asuke A.G. Sule M.A. Adeiza Copyright (c) 0 2022-09-01 2022-09-01 22 2 101 106 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231028 <p><strong>Background</strong>: There have been varying applications of corticosteroid use in asthma management despite guideline recommendations. Aim: To investigate the pattern of corticosteroid use in bronchial asthma management by doctors in South east of Nigeria and assess how factors such as cadres, years of practice and practice setting affect their corticosteroid prescription.</p> <p><strong>Methods</strong>: A cross-sectional study of participants enrolled by multistage sampling of hospitals was done in three states in the south-east of Nigeria. Structured questionnaires were used to obtain information on knowledge and attitude on corticosteroid use among different cadres of doctors with varying years of practice.</p> <p><strong>Results</strong>: A total of 283 doctors were interviewed over an eight-month period of which 61.1% (173) and 38.9% (110) were from tertiary and non-tertiary/private health facilities respectively. The male: female ratio was 1.5:1. The majority of participants were resident doctors (50.2%), while 21.1%, 18.4% and 8.8% were house officers, medical officers and consultants respectively. Corticosteroid prescriptions were made more for acute than for chronic stable state asthma management. The factors that most affected whether corticosteroids were prescribed or not were: the cadre and the number of years of practice of the doctors. Of those who did not use corticosteroids at all, 36.7%, 2.5%, 3.6% and 4.0% respectively were house officers, registrars, senior registrars, medical officers and consultants, (p &lt; 0.001). When assessed by the number of years of practice, corticosteroid use as maintenance therapy, especially as inhalation therapy (ICS), in stable-state chronic asthma, was prescribed by 3.8%, 5.7%, 6.2%, 30%, 0% and 0% of doctors who had respectively practiced for 1-5years; 6-10 year, 11-15 years, 16-20 years, 21-25 years, &gt; 25 years, (χ2=36.6 p=0.05); with least prescriptions by doctors with longest years of practice.</p> <p><strong>Conclusions</strong>: The use of corticosteroids as asthma maintenance therapy, is low among doctors in the region and is associated with the cadre and the number of years of practice.</p> K.K. Iloh A.C. Ayuk I.N. Obumneme-Anyim T. Oguonu Copyright (c) 0 2022-09-01 2022-09-01 22 2 107 112 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231032 <p><strong>Background</strong>: Nigeria has a very low contraceptive usage despite the high fertility rate. Studying the contraceptive acceptance pattern and the women’s choices of contraception will provide information that could enable health care providers and stakeholders improve availability and access to contraception.</p> <p><strong>Objective</strong>: To evaluate the pattern of contraceptive acceptance and trend in a Nigerian tertiary hospital.</p> <p><strong>Methodology</strong>: A retrospective review of the records of the family plann-ing clinic of University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu over a 4 year period, from 2006 - 2009.</p> <p><strong>Results</strong>: A total of 1319 out of 1372 new clients accepted different contraceptive methods within the period under review giving an acceptance rate of 96.1%. There was a sharp drop in the number of acceptors from 573 in 2006 to 187 in 2007. Thereafter, there was a gradual rise to 242 in 2008 and then 317 in 2009. The mean age was 34.7 ± 4.3 years while the modal parity was 3. The most commonly accepted method overthe period was intrauterine contraceptive device (IUCD) 530 (40.2%), followed bythe implants 432 (32.8%). Only 2 (0.2%) chose bilateral tubal ligation.</p> <p><strong>Conclusion</strong>: The contraceptive acceptance rate among new family planning clients in UNTH Enugu is high. IUCD was the commonest contraceptive method accepted by the women, and there were fluctuations in clients’ attendance during the period under review. Women enlightenment and community mobilization are needed for stability in acceptance and utilization of family planning methods.</p> P.C. Udealor I.V. Ezeome E.O. Ugwu Copyright (c) 0 2022-09-01 2022-09-01 22 2 113 118 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231034 <p><strong>Background:</strong> Many low and middle-income countries (LMICs) have limited research capacity, especially in health-related research. One of the more difficult aspects of research experienced by researchers is data analysis and several data analysis software programs have been developed and are available to facilitate data analysis.</p> <p><strong>Objectives:</strong> This is an exploratory study to assess the experience of academic staff in the Faculty of Medical Sciences, College of Medicine, University of Nigeria with research analysis software.</p> <p><strong>Methods</strong>: Questionnaires were distributed to all consenting academic staff at a Faculty Board Meeting of the Faculty of Medical Sciences, University of Nigeria Enugu campus. Data sought included the respondents’ sociodemographic characteristics, and their awareness and use of specified data analysis software packages. Data analysis was done using STATA V.12 (StatCorp, Texas), and tests of significance were set at P &lt; 0.05.</p> <p><strong>Results</strong>: Slightly more than half of the respondents (53.6%) could analyze their research data independently. There was no relationship between respondents’academic rank and ability to independently analyze data (P &gt; 0.05). Qualitative data analysis software appears relatively unknown to the respondents. All the participants expressed a willingness to attend a data analysis workshop and 78.6% were willing to pay for it.</p> <p><strong>Conclusion</strong>: There is a great need in the faculty to build capacity in the use of research analysis software especially the qualitative data analysis software.</p> A.E. Aghaji O.I. Okoye I.R. Ezegwui Copyright (c) 0 2022-09-01 2022-09-01 22 2 119 124 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231036 <p><strong>Background</strong>: Many women participate in risky sexual behaviour including early debut in sexual activities, sex with many partners, and low/inconsistent use of condoms. Consequences of this are reproductive morbidities including STI/ HIV, unwanted pregnancies and complications which are preventable.</p> <p><strong>Objectives</strong>: This study aims at assessing the role of health education in the improvement of the reproductive health knowledge of women in Igbo-Eze North LGA, Enugu state, Nigeria.</p> <p><strong>Methods</strong>: A cross-sectional study carried out in Pre-intervention, intervention and post-intervention stages. Health education was administered to ‘study group’ following baseline data collection from two groups of study and control groups. Post intervention data was later collected. Chi-square test statistics was used to test for any significant differences even as before-and-after for the control study design was subjected to a difference in differences analysis. A p value of &lt; 0.05 was considered statistically significant.</p> <p><strong>Results</strong>: Health education intervention is significantly associated with increase in the respondents’ knowledge of contraceptives, changes occurring at puberty and also in the knowledge of STIs including HIV/AIDS and reproductive health concerns (P &lt; 0.05).</p> <p><strong>Conclusion</strong>: Health education intervention has significant impact on reproductive health knowledge of women in the rural communities of south east Nigeria. Reproductive health policy should as a matter of urgency be designed specifically to target women in underserved and rural areas in order to provide them with adequate knowledge on reproductive and sexual issues, and motivate them to understand the need for a healthy reproductive life.</p> C.A. Idoko I.E. Obi B.I. Omotowo C.C. Agunwa C. Okeke A.C. Ndu O.E. Ekwueme B.S. Uzochukwu O.E. Onwujekwe Copyright (c) 0 2022-09-01 2022-09-01 22 2 130 137 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231039 <p><strong>Background</strong>: Literature abounds on prevalence of hypertension in Nigeria and urban area of Oyo state but none in Oke-Ogun geo-political zone which constitute 10 local governments out of the 33 in Oyo state, despite the fact that they have high genetic and environmental predisposition to developing high blood pressure.</p> <p><strong>Objectives</strong>: The purpose of the study was to determine the prevalence of high blood pressure and associated risk factors among indigenes of Oke-Ogun, Oyo state.</p> <p><strong>Method</strong>: A total of 10,000 respondents were recruited using proportionate sampling techniques. Hypertension was defined according to the eight Joint National Committee on the prevention, detection, evaluation, and treatment of hypertension - JNC-8 criteria. The fasting plasma glucose- FPG of the respondents were classified as normal (≤6mmol/l), pre-diabetes (6.1-6.9mmol/l), and diabetes (≥7mmol/l). BMI was calculated as weight (kg)/height (m²) and classified as malnutrition/underweight (&lt;16-18.49), normal (18.5-24.9), overweight (25-29.9) and obese (30-≥40). Data were analyzed using descriptive statistics, Chi-square and binary logistic regression tests at p&lt;0.05.</p> <p><strong>Results</strong>: The mean systolic and diastolic blood pressure was 138±27.8, 86.13±14.4 respectively. The overall prevalence of hypertension was 38.5%. Over sixty-four percent (64.1%) were diabetics. 63.4% had no formal education. Majority (82.95%) earned less than N18, 000.00 per month and 43.3% had a family history of hypertension.</p> <p><strong>Conclusions</strong>: There is high prevalence of hypertension among the people of Oke-Ogun, in Oyo state. Their low socio-economic status, low educational background, malnutrition and genetic predisposition were identified risk factors.</p> R.O. Shittu L.O. Odeigah F.O. Kasali S.A. Biliaminu A.G. Sule M. Yusuf M. Adeyemi Copyright (c) 0 2022-09-01 2022-09-01 22 2 138 144 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231041 <p>Uterine scar rupture is a dreaded complication of vaginal birth after caesarean section (VBAC) because of the accompanying severe feto-maternal morbidity and mortality. The patient had a successful vacuum assisted VBAC of a healthy live male baby in a private hospital. Following the delivery, she developed severe postpartum hemorrhage that necessitated blood transfusion and immediate transfer to the Enugu State University Teaching hospital, Parklane. Emergency exploratory laparotomy confirmed a lower uterine segment scar rupture which was successfully repaired with satisfactory outcome. We therefore recommend that every VBAC should be planned, carefully selected, and conducted in a hospital with electronic fetal monitoring and capacity for comprehensive emergency obstetric care in order to avert possible feto-maternal complications.</p> B.U. Odugu I.I. Okafor I.A. Ugwu J.A. Ede C.C. Eze F.J. Awkadigwe E.O. Ugwu Copyright (c) 0 2022-09-01 2022-09-01 22 2 146 150 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231044 <p>Sinuses of Valsalva or aortic sinuses are 3 focal expansions at the root of the aorta and are named right, left and non-coronary sinuses. These sinuses serve as support system for the aortic valve and prevent occlusion of the coronary ostia as the aortic cusps open in systole. Sinus of Valsalva aneurysm (SOVA) is congenital in most cases, due to deficiency of the elastic lamina between the aortic media and the annulus fibrosus. The anatomical location of these sinuses can predict some clinical consequences, when complications occur. We report the case of a 29yr old Nigerian man who presented at the accident and emergency unit of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, with clinical features of heart failure. Electrocardiography showed complete heart block, and later supraventricular tachycardia, while echocardiography showed a right sinus of valsalva aneurysm dissecting into the interventricular septum, without evidence of rupture.</p> N.C. Udora E.C. Ejim J.U. Okoye Copyright (c) 0 2022-09-01 2022-09-01 22 2 150 155 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231045 <p>The morbidity and mortality conference (MMC) offers an opportunity to incorporate principles of quality improvement and patient safety, with the potential to improve patient outcomes, while providing a rich opportunity to teach. However, the format of the conference varies tremendously among academic programs, and the goals of the conference are often not clearly defined. The cases presented also vary tremendously. The goal was to move the MMC at our institution beyond an autopsy and clinical case review to a comprehensive model aimed at improving the quality and safety of care provided and improving of the quality of education at an academic medical institution. The conference is a core requirement of the neonatal-perinatal medicine fellows’ education at our institution. Previously there was passive learner involvement. We implemented structured changes to the process of case selection, preparation and presentation utilizing patient selection guidelines, an adapted worksheet for critically analyzing the case and a PowerPoint presentation template which includes a clear outline with objectives. This has resulted in uniformity in the format and content of our MMC and has created a vehicle for identifying areas of weaknesses in our practice and system leading to quality improvement initiative projects aimed at improving the quality and safety of the care delivered to our patients. This paper details the evolution process of the MMC at our academic institution and describes the structured changes implemented, their impact and lessons learned.</p> C.U. Aneji S.M. Lopez Copyright (c) 0 2022-09-01 2022-09-01 22 2 157 160 10.4314/jcm.v22i2. https://www.ajol.info/index.php/jcm/article/view/231047 <p>No Abstract</p> Bond Anyaehie Copyright (c) 0 2022-09-01 2022-09-01 22 2 31 36 10.4314/jcm.v22i2.