Annals of Ibadan Postgraduate Medicine 2022-05-09T07:49:30+00:00 Dr. O.F Fagbule Open Journal Systems <p>The <em>Annals of Ibadan Postgraduate Medicine</em> is a peer-reviewed, international, medical journal published bi-annually by the Association of Resident Doctors, University College Hospital, Ibadan, Nigeria. The journal has a vision to regularly publish first-class and widely cited articles in different specialities of medical sciences and related subjects. It welcomes contributions from all fields of medicine including medical technology, as well as economic, social and ethical issues that are related to the practice of medicine, especially in developing countries of the world. The journal publishes review and original articles, commentaries, book reviews, meeting reports, addresses and speeches, correspondences etc.</p><p>Other websites related to this journal: <a title="" href="" target="_blank"></a> and <a href="" target="_blank"> </a></p> Focus on tobacco prevention among non-smoking adolescents in Africa; A call to tobacco control experts 2022-05-06T07:39:14+00:00 O.F. Fagbule A.O. Adebiyi <p>No Abstract.</p> 2022-05-06T00:00:00+00:00 Copyright (c) Efficacy and safety of low-intensity extracorporeal shockwave therapy for treatment of vascular erectile dysfunction in Nigerian men: Report of a study in Ibadan, south-west Nigeria 2022-05-06T09:28:53+00:00 T.O. Akande O.M. Akinwunmi S.A. Adebayo A.O. Akinyinka O.B. Shittu <p><strong>Background</strong>: Low Intensity Extracorporeal Shock Wave Therapy (LI-SWT) has been found to be effective in men with vascular erectile dysfunction (ED) but its efficacy and safety has not been investigated in a&nbsp; predominantly black population so we sought to study this.</p> <p><strong>Materials and Methods</strong>: Men with vascular erectile dysfunction (ED) were assessed using the five-item&nbsp; International Index of Erectile Function (IIEF) score after which they were treated with 12 sessions of LI-&nbsp; SWT. Treatment efficacy was evaluated immediately after treatment, at 1 month and 6 months after using&nbsp; the IIEF questionnaire. 30 persons were recruited out of which 22 completed the study.</p> <p><strong>Results</strong>: Mean IIEF score improved from 8.27+2.741 at baseline (pre-treatment) to 10.43 ± 8.43 one&nbsp; month post treatment and was sustained six months post treatment at mean IIEF score of 10.70 + 8.84. A larger no (86.4%) had an improvement of at least 5 in the IIEF score from baseline to 6 months -post&nbsp; treatment. None of the participants reported any adverse effects of treatment.</p> <p><strong>Conclusion</strong>: Low intensity shock wave treatment is a useful addition to the medical armamentarium for the treatment of vascular ED.</p> 2022-05-06T00:00:00+00:00 Copyright (c) Persistence of <i>Plasmodium falciparum<i> HRP2 antigen after effective antimalarial therapy 2022-05-09T07:49:30+00:00 O.S. Michael A.E. Orimadegun C.O. Falade <p><strong>Introduction</strong>: Histidine Rich Protein 2 based (HRP2-based) malaria rapid diagnostic tests (mRDTs) have been shown to perform as well as routine light microscopy, however, they are limited by some factors including persistence of HRP2 antigenemia. In this paper we report the evaluation of an HRP2-based mRDT in a prospective study that enrolled children and followed them up for 28 days.</p> <p><strong>Methods</strong>: Children aged below five years, with acute episode of fever/pyrexia,were enrolled. The enrolled participants had expert malaria microscopy and RDT done at enrolment (Day 0), and on days 1, 2, 3, 7, 14, 21, and 28. The malaria RDT test was considered positive when the antigen and control lines were visible&nbsp; in their respective windows, negative when only the control band was visible and invalid when the control&nbsp; band was not visible. Faint test lines were considered positive. The RDT results were compared to&nbsp; those of expert microscopy.</p> <p><strong>Results</strong>: Two hundred and twenty-six children aged 29.2 ± 15.5 months were enrolled. The proportion of children positive by expert malaria microscopy and RDT was 100% and 95.6% respectively. During the 28 day follow up of the children the proportions positive by microscopy and RDT on days 3, 7, 14, and 28&nbsp; were 1% and 94.6%, 0% and 93.5%, 0% and 91%, and 16.5% and 80.6% respectively. Gender and age dependent analysis of proportion of positive children were similar. Proportion of children with persistence of HRP2 antigen appeared to be lower in those with parasite density below 200/µL, however, this&nbsp; observation requires further evaluation in larger studies.</p> <p><strong>Conclusions</strong>: the study revealed a high proportion of persistence of HRP2 antigen in the children 28 days&nbsp; after effective antimalarial therapy. Histidine rich protein 2 based malaria rapid diagnostic tests are not&nbsp; recommended for monitoring of antimalarial therapies.</p> 2022-05-06T00:00:00+00:00 Copyright (c) Parasite-based diagnosis of malaria in pregnant women in a Tertiary Hospital in southwest Nigeria 2022-05-06T10:11:32+00:00 B. Adesina-Adewole F.I. Olusola A.D.A. Adedapo C.O. Falade <p><strong>Background</strong>: Malaria in pregnancy has significant adverse consequences for the mother, foetus and&nbsp; baby. Presumptive diagnosis continues despite recommendation for parasite-based diagnosis. We&nbsp; performed Paracheck-Pf™, an HRP-II based malaria Rapid diagnostic test (Paracheck-Pf RDT) and&nbsp; microscopy among pregnant women in a prospective, cross sectional study, at the University College&nbsp; Hospital in Ibadan, Nigeria.</p> <p><strong>Methods</strong>: The study was conducted between 2009-2011. Consecutive pregnant women presumptively&nbsp; diagnosed as having malaria &gt;18 years were enrolled after obtaining written informed consent.&nbsp; Demographic information, symptoms and clinical measurements were obtained. Capillary blood was obtained by finger prick for thick blood smear and RDT evaluation. Summary statistics included mean&nbsp; (standard deviation) for quantitative variables and percentages for categorical variables. Chi-square,&nbsp; analysis of variance (ANOVA), the odds ratio (OR) and 95% confidence intervals (CI) were computed with&nbsp; p-value less than 0.05 considered statistically significant.</p> <p><strong>Results</strong>: Of the 746 pregnant women aged 30.9 ± 4.6 years enrolled, 243 (32.7%) were primigravida. The&nbsp; mean gestational age was 23.3 ± 9.2 weeks with about 81% in the second and third trimester. The&nbsp; prevalence of malaria parasitaemia by microscopy and Paracheck-Pf ™ were 22.8% and 24.5%&nbsp; respectively. The geometric mean parasite density was 2,091/µL (range 40-156,975/µL). HIV positivity rate&nbsp; was 8.1 % and 16.1% of patients were anaemic (PCV &lt;30%). Women with axillary temperature&nbsp; &gt;37.40C were significantly more likely to have malaria parasitaemia [p&lt;0.0001] by microscopy. Sensitivity&nbsp; and specificity of Paracheck overall were 69.9% and 88.2% respectively while those at of parasite densities&nbsp; &gt;200/µL were 84.8% and 88.7% respectively. Positive and negative predictive values were 66.9%&nbsp; and over 90% respectively.</p> <p><strong>Conclusion</strong>: RDTs are a reasonable alternative in view of the need for&nbsp;&nbsp;&nbsp; parasite-based diagnosis of malaria.</p> 2022-05-06T00:00:00+00:00 Copyright (c) Prevalence and predictors of exclusive breastfeeding among mothers in a semi-urban Nigerian community: A cross-sectional study 2022-05-06T10:24:35+00:00 A.M. Adebayo O.S. Ilesanmi D.T. Falana S.O. Olaniyan A.O. Kareem I.F. Amenkhienan F.O. Alele A.A. Afolabi B.A. Omotoso O.O. Ayodeji <p><strong>Background</strong>: The uptake of exclusive breastfeeding (EBF) is low globally including Nigeria despite its benefits and interventions. This study aimed to assess the prevalence and predictors of EBF among mothers in a semiurban Nigerian community.</p> <p><strong>Methods</strong>: We conducted a cross-sectional study among nursing mothers attending the immunization clinic at the Federal Medical Centre, Owo, Ondo State. A semi-structured questionnaire containing the World Health Organization’s indicators for assessing breastfeeding practices was used for data collection.</p> <p><strong>Results</strong>: A total of 386 mothers were recruited with a mean age of 30.8 ± 5.0 years. Among them, 149 (36.8%) were below 30 years, 345 (89.4%) have had ANC visit at least four times, and 259 (67.1%) had initiated breastfeeding immediately after delivery. The prevalence of EBF was 52.6%. Natural feeds were the common feeds introduced after 6 months among 159 (78.3%) mothers. One hundred and forty-four&nbsp; (62.1%) nursing mothers aged 30 years or older practiced EBF compared to 72 (48.3%) persons below 30&nbsp; years (X<sup>2</sup> = 6.290, p = 0.012). Also, 38 (70.3%) mothers who have delivered four or more children practiced&nbsp; EBF compared to 180 (54.2%) with fewer children (X<sup>2</sup> = 5.437, p = 0.020). Nursing mothers aged&nbsp; 30 years or older had 36% higher odds of practicing EBF compared to younger persons (Adjusted&nbsp; Odds Ratio = 1.358, 95%CI = 0.886 – 2.081, p = 0.160).</p> <p><strong>Conclusion</strong>: To achieve the WHO recommended target of ensuring that 90% of nursing mothers practice EBF, advocacy and health education must be intensified.</p> 2022-05-06T00:00:00+00:00 Copyright (c) Knowledge of menstrual disorders and health seeking behaviour among female undergraduate students of University of Ibadan, Nigeria 2022-05-06T10:47:15+00:00 U.C. Igbokwe Y.O. John-Akinola <p><strong>Background</strong>: Menstrual disorders are physical or emotional problems that affect the normal menstrual cycle and bring about pain, unusually heavy or light bleeding and missed periods. They are one of the most occurring gynaecologic issues that affect women of child bearing age with a global prevalence of 30-70% and one of the frequent reasons women consult physicians worldwide.</p> <p><strong>Objectives</strong>: This study investigated the knowledge, prevalence of menstrual disorders, pattern of health seeking behaviours, association between age at menarche and prevalence of menstrual disorder,&nbsp; association between knowledge and health seeking behaviour among the female undergraduate&nbsp; students.</p> <p><strong>Methods</strong>: A descriptive cross-sectional study was employed to randomly select 381 respondents through&nbsp; a three-stage sampling technique. A pretested semi-structured questionnaire was used for data&nbsp; collection. Data collected were analysed using IBM SPSS version 20; statistical tests were conducted using&nbsp; Chi-square and fischer exact test.</p> <p><strong>Results</strong>: The mean age of the respondents was 20.45±2.66 and the mean age at menarche was 12.90±1.84. Majority of the respondents (79.3%) had good knowledge of menstrual disorders. The overall prevalence of menstrual disorders among the respondents was 90.4%. and only 28.3% had sought&nbsp; help for menstrual disorders. Inferential analysis showed a statistically significant association&nbsp; between knowledge and health seeking behaviour of menstrual disorders (p&lt;0.05).</p> <p><strong>Conclusion</strong>: Menstrual disorders are highly prevalent among young females of child bearing age in our environment; the role of mass media (Internet) and interpersonal relationships in health education is&nbsp; very acknowledgeable and should be harnessed to improve young females’ knowledge of positive health&nbsp; seeking behaviours with regard to menstrual disorders.</p> 2022-05-06T00:00:00+00:00 Copyright (c) National Health Insurance Scheme: Perception and participation of Federal Civil Servants in Ibadan 2022-05-09T07:12:12+00:00 O.O. Akinyemi O.F. Owopetu I.O. Agbejule <p><strong>Introduction</strong>: The National Health Insurance Scheme is a social health insurance programme designed by the Federal Government of Nigeria to complementsources of financing the health sector and to improve access to health care forthe majority of Nigerians. Presently, the enrolment level on the Scheme is majorly among those in the formal sector and user experiences have been different. This study seeks to determine the perception and participation of Civil Servants regarding the National Health Insurance Scheme in Ibadan</p> <p><strong>Methods</strong>: A descriptive cross-sectional study was conducted among 273 civil servants working at the Federal Secretariat, Ikolaba, between October and November 2015. An interviewer-administered questionnaire was used to collect information on socio-demographic characteristics, awareness, and&nbsp; membership of the NHIS, perception of NHIS, and health-seeking behaviour. Participation was defined as&nbsp; the number of civil servants registered or enrolled under the scheme, in other words, members of the&nbsp; scheme. Information on perceptions was sought using a 3-point Likert scale. Descriptive statistics and&nbsp; chi-square tests were used for data analysis at a 5% level of significance.</p> <p><strong>Results</strong>: About 60.1% of the respondents were males. The average age was 39.7+9.1 years, with 85.0% of&nbsp; the respondents being married. The majority (65.2%) of the respondents were mid-level cadre workers,&nbsp; 17.62% were working as senior-level workers and the remaining 17.6% were low cadre workers. The&nbsp; majority (88.9%) completed tertiary education, while just 11.1% completed basic education. The mean&nbsp; household size was 2.5+0.6. Awareness of the National Health Insurance Scheme was very high (95.2%)&nbsp; with 83.5% enrolled under the scheme. About (50%) of the respondents joined the scheme because it is&nbsp; cheap and affordable. There was a significant association between awareness, level of education,&nbsp; knowledge of NHIS, and registration into the scheme by respondents. The majority of the respondents&nbsp; (87.3%) claimed that NHIS is a better means of settling healthcare costs than Out-of-pocket-payment. The&nbsp; majority of the respondents thought that health insurance is a viable programme.</p> <p><strong>Conclusion</strong>:The perception of health insurance among civil servants was varied while participation was&nbsp; high. Relevant intervention should be introduced to remove bottlenecks to accessing and operating the scheme.</p> 2022-05-09T00:00:00+00:00 Copyright (c) Healthcare financing for antenatal care and delivery services in a tertiary health facility in south-west Nigeria 2022-05-09T07:33:56+00:00 R.A. Abdus-salam T. Mark A.D. Agboola T. Babawarun <p><strong>Background</strong>: Universal health coverage and healthcare financing for maternal health services are essential for quality care, prevention of complication and a reduction in maternal morbidity and mortality.</p> <p><strong>Objective</strong>: To evaluate the modes of healthcare financing for antenatal and delivery care among pregnant women in a tertiary health facility in SouthWest Nigeria.</p> <p><strong>Methods</strong>: This is a four-year retrospective review of maternal healthcare financing models adopted by&nbsp; pregnant/postpartum women at the antenatal clinic and labour/delivery unit. Data for health financing in&nbsp; antenatal booking clinic for a four-year period from 2016-2019 and labour &amp; delivery for a two year period from&nbsp; 2018 and 2019 were reviewed. The information collected were – number of women that paid out-of-pocket for&nbsp; services, number of women that paid for services using health insurance and other means of payment during&nbsp; the period. Data were analysed using SPSS version 23.</p> <p><strong>Result</strong>: A total of 7,129 women accessed antenatal care services during the period under review. About 58.9% of the women paid for antenatal care servicesout-of-pocket, 36.6% were covered under the health insurance (social andprivate health insurance). A total of 2,881 women accessed delivery servicesat the health facility. About 66.4% of the women paid out-of-pocket for both caesarean section and vaginal delivery. Prepaid health&nbsp; insurance was used by about 31% of the women.</p> <p><strong>Conclusion</strong>: Health insurance has been available for over a decade; however prepaid healthcare financing model&nbsp; remains less popular. Out-of-pocket payment constitutes the predominant mode of healthcare financing&nbsp; for maternal healthcare among pregnant women at the tertiary health facility. The out-of-pocket payment&nbsp; exposes the pregnant women and her family to financial burden and catastrophic spending especially in&nbsp; obstetric emergency. </p> 2022-05-06T00:00:00+00:00 Copyright (c) 2022 Management outcome of premature rupture of membranes in A Tertiary Health Facility in south western Nigeria 2022-05-06T11:50:43+00:00 B.K. Suleiman O.O. Bello A.M. Tijani T.A.O. Oluwasola <p><strong>Background</strong>: Pre-labour Rupture of Membranes (PROM) contributes immensely to the potential risk of maternal morbidity and mortality.</p> <p><strong>Objective</strong>: To explore the incidence and management outcome of PROM at Ladoke Akintola University of&nbsp; Technology Teaching Hospital (LTH), Ogbomoso, Nigeria</p> <p><strong>Methods</strong>: A retrospective study of 61 cases of PROM managed at LTH, Ogbomoso over a 3-year period.&nbsp; Information on the socio-demographics and obstetrics characteristics, management instituted, and&nbsp; outcomes were obtained using a structured proforma. Data were analysed using SPSS version 20. Level&nbsp; of statistical significance was set at &lt;0.05 and 95% confidence interval.</p> <p><strong>Results</strong>: The incidence of PROM was 4.1% with a perinatal mortality rate of 0.18 per 1000 deliveries.&nbsp; Twenty (33%) were pre-term while 41 (67%) were term PROM with 10% of the perinatal death occurring&nbsp; among those with preterm PROM. The mean age of the women was 36.9 (SD=2.1) years and median&nbsp; parity of 1(range 1-5) children. There was a significant association between the women’s gestational age&nbsp; at which PROM occurred with the latency period (p&lt; 0.001). Fetal birth weight, APGAR score and Neonatal&nbsp; Intensive Care Unit (NICU) admission were all significantly associated with the gestational age&nbsp; at which PROM occurred (p&lt;0.05). There was a significant difference between the intervention instituted&nbsp; and mode of delivery (p=0.009).</p> <p><strong>Conclusion</strong>: The incidence of PROM at term was high and conservative/expectant management was&nbsp; effective. The latency period and fetal outcomes such as birth weight, apgar score and NICU admission were determined by the gestational age at which PROM occurred.</p> 2022-05-06T00:00:00+00:00 Copyright (c) Self assessment of oral health and risk factors affecting oral hygiene status in adolescents attending dental clinic in University College Hospital, Ibadan 2022-05-06T12:16:41+00:00 O.O. Ogunsuji E.B. Dosumu M.D. Dairo A.I. Ogunsuji <p><strong>Introduction</strong>: Globally, there is an increasing incidence of Non-Communicable Diseases (NCDs). Major oral diseases such as caries and periodontal disease which are classified as NCDs, are not left out of this&nbsp; trend. Recent reports are suggestive of increasing prevalence and severity of oral diseases among&nbsp; adolescents, despite accessibility of dental services. Ascertaining the oral health status of adolescents&nbsp; making use of dental services and how they perceive their oral health could help develop preventive and&nbsp; therapeutic strategies. This study therefore aims to determine the self-perception of adolescents utilizing&nbsp; dental services about their oral health and factors affecting their oral hygiene status.</p> <p><strong>Methodology</strong>: This clinic-based cross-sectional study was carried out among adolescents attending the&nbsp; Dental Center, University College Hospital, Ibadan Nigeria. A total of 113 adolescents were recruited into&nbsp; this study using a systematic random sampling technique. A WHO Oral health questionnaire was&nbsp; administered to the participants. Questions were asked on sociodemographics, self-perception of oral&nbsp; health and oral hygiene practices. Descriptive statistics such as frequency, percentages, mean, standard deviation were used to present the data. Independent T test and One way ANOVA were used to analyze&nbsp; categorical exposure variables with normally distributed numerical outcomes. A p-value of &lt;0.05 was&nbsp; considered statistically significant.</p> <p><strong>Results</strong>: Majority of study participants had positive self-perception of health of their teeth (53.1%) and&nbsp; gingiva (62.8%) respectively, their mean OHI-S was 2.24 with 62.8% of adolescents having a fair oral&nbsp; hygiene. Mean DMFT was 0.96 with 75.2% of participants having a very low DMFT. OHI-S and DMFT were&nbsp; both significantly associated with age of adolescents, with late adolescents having significantly higher&nbsp; mean OHI-S and DMFT scores than early adolescents (p &lt; 0.05). Adolescents who cleaned their teeth at&nbsp; least twice daily had significantly higher DMFT values than those who cleaned once daily (P &lt; 0.05).&nbsp;</p> <p><strong>Conclusion</strong>: This study found late adolescents had higher DMFT and OHI-S scores. There might be need&nbsp; to increase oral health awareness in senior secondary schools and tertiary institutions to help improve&nbsp; their oral health status. Its pertinent that adolescents are encouraged and taught good oral hygiene&nbsp; measures when they visit dental clinics, in school and at home. Adolescents utilizing dental services are&nbsp; likely to be more self-conscious about their oral health thus increasing the frequency of their teeth&nbsp; cleaning.</p> 2022-05-06T00:00:00+00:00 Copyright (c) Pericardial effusion in a patient with hyperthyroidism: A case report 2022-05-09T06:14:23+00:00 M.O. Fabowale O.S. Ogah A.M. Kehinde F.I. Olusola I.J. Okafor T.A. Bakare V. Obasuyi O.O. Orimolade A. Aje A. Adebiyi <p>Pericarditis and pericardial effusion are commonly associated with hypothyroidism. It is an uncommon association with hyperthyroidism. We present a case of pericarditis/pericardial effusion in a 28-year-old Nigerian lady with hyperthyroidism. There was resolution of the pericardial effusion with antithyroid&nbsp; medications and steroid therapy. We recommend a high index of suspicion of this association in patients&nbsp; with hyperthyroidism and/or Graves’ disease.</p> 2022-05-09T00:00:00+00:00 Copyright (c) A rare case of preperitoneal abscess in a Nigerian female: Ultrasound diagnosis and percutaneous catheter drainage 2022-05-09T06:27:20+00:00 A.O. Adeyinka P.T. Adenigba A.J. Adekanmi A.T. Adeniji-Sofoluwe B.E. Osobu T.O. Oke <p>A preperitoneal abscess is an uncommon manifestation of extraperitoneal collection. We present a case of an anterior abdominal wall preperitoneal abscess in a 30-year-old Nigerian female with abdominal pain and purulent abdominal wall discharge ten days after an initial admission for spontaneous bacterial peritonitis. This report underscores the role of ultrasound in diagnosis and follow-up and percutaneous ultrasound-&nbsp; guided continuous percutaneous catheter drainage and management of an extraperitoneal abscess.</p> 2022-05-09T00:00:00+00:00 Copyright (c) Delayed diagnosis of AVM presenting with stroke and seizures in a young Nigerian: A case report 2022-05-09T06:41:59+00:00 A.I. Makanjuola P. Bolaji C. Onyejelam G.I. Ogbole R.O. Akinyemi <p><strong>Background</strong>: Brain arteriovenous malformations (BAVM) are a cause of intracerebral haemorrhage (ICH) and seizures especially in young patients. ICH due to BAVMs seem to have relatively better neurologic&nbsp; outcomes compared to other causes of spontaneous ICH as patients often recover fully. In this report we highlight a case of delayed diagnosis of BAVM in a young man who presented with seizures and stroke.<br><strong>Case summary</strong>: A 36-year-old man was referred on account of focal, secondarily generalized tonic clonic&nbsp; convulsions. He had suffered a right ICH 3 years before the index presentation. His general physical and&nbsp; neurologic examination were normal. Electroencephalography revealed right sided focal epileptiform&nbsp; discharges and brain MRI revealed a right parieto-occipital AVM. The seizures were controlled with&nbsp; carbamazepine and he was referred for neurosurgical evaluation.<br><strong>Conclusion</strong>: BAVMs are an important cause of intracerebral haemorrhage and attendant neurologic&nbsp; morbidity especially in young individuals. Neuroimaging plays a central role in BAVM diagnosis and MRI is&nbsp; of great value where facilities and expertise for conventional angiography do not exist. In some&nbsp; instances, delayed presentation of BAVM cases may be due to relatively better neurologic outcomes in&nbsp; BAVM-related ICH.</p> 2022-05-09T00:00:00+00:00 Copyright (c)