Journal of Medicine and Biomedical Research

School health services in Edo State: The benefits, burden, challenges and the way forward

Izehiuwa Enato — 2024-11-17

Background: Communicable and non-communicable diseases affect the child holistically, especially their education; as they lead to reduced school enrolment, school absenteeism, poor cognitive ability, physical and emotional impairment/disability and even dropping out from school. The establishment of school health services (SHS) promotes, protects and maintains the health of school children and teachers. The aim of this review was to highlight the benefits of school health services, the burden of ineffective SHS and the challenges against establishing a successful SHS in Edo State and make recommendations for improvement.

Discussion: The National School Health Policy (NSHPo) was launched in 2006 to aid and guide the implementation of the school health programme, which includes SHS. However, despite several years post-launch of the NSHPo, the state of SHS in Edo State is significantly and severely below set standards. These include amongst others: lack of sick bays or school-based health clinics, lack of health screening for school-aged children, teachers and food vendors, and lack of personnel.

Conclusion: In the near future, to achieve the set standard of SHS in the state, there is the need to improve awareness, knowledge and availability of the NSHPo to school heads/owners, the school teachers and students, their parents and the community. There is also an urgent need to review the NSHPo with redefinition and simplification of roles and collaborations of stakeholders, with specific focus on the Ministry of Health. The school community, including parents and the community should build a self-sustaining SHS and focus resources on SHS.

Pain management in the medical specialty clinics of a university teaching hospital: A drug utilization study

Abimbola Opadeyi — 2024-11-17

Background: The treatment of pain is largely determined by understanding the type of pain. A thorough understanding of analgesic prescriptions in specialized clinics may reflect the physicians' ability to effectively manage pain. This study aimed to investigate physicians' prescription pattern of analgesics and co-analgesics in a multispecialty internal medicine out-patient department.

Methods: This was a retrospective evaluation of dispensed medications containing analgesics and/or co-analgesics generated from the various specialized clinics of the Medical Out-Patient Department (MOPD) of the University of Benin Teaching Hospital from January 2021 to December 2021. These medications were classified according to the World Health Organization -Anatomic Therapeutic Chemical (WHO-ATC) classification system and evaluated using the WHO analgesic ladder and the guidelines for pain management in Nigeria. Data is presented descriptively.

Results: A total of 25837 medicines were dispensed during the period. Of which, 2311 (8.9%) were analgesics and co-analgesics. The mean age (SD) of patients issued these medicines was 63.6 (±13.8) years with majority aged 60 and above, 1592 (68.9%). Co-analgesics were the most dispensed medicines 1346 (58.2%) followed by non-opioids 705 (30.5%). Most NSAIDs dispensed were naproxen 112 (4.8%) while codeine was the most dispensed opioid 225 (9.7%). Majority of the non-opioid and co-analgesic prescriptions 742 (36.1%) were generated from the Neurology Clinic, while opioids were largely from Nephrology and Endocrinology Clinics 48 (18.5%).

Conclusion: The medical specialty clinics prescription pattern of analgesics suggests a rational approach to pain management. There is however a need to address the low utilization of opioid analgesics in pain management.

Determinants of remission in acute lymphoblastic leukaemia in a tertiary health facility in Southwestern Nigeria

Sunday Peter Ogundeji — 2024-11-17

ABSTRACT

Background: The clinical outcome of Acute Lymphoblastic leukaemia (ALL) is still poor in Nigeria despite advances in treatment options available. This study therefore seeks to identify the predictors of remission in patients with ALL in Ibadan, Southwestern Nigeria.

Methods: This was a retrospective study of all patients diagnosed of ALL between January 2021 and December 2022 at the University College Hospital, Ibadan. Data on socio-demographic: age, gender and clinical features, full blood count, chemotherapy regimen and remission status were collected from the treatment records of the patients and analyzed using SPSS Version 23.0. A p-value of < 0.05 was considered significant.

Results: Thirty cases of ALL were diagnosed over the study period. The median age was 15years (IQR:6.6, 20.0). The most common clinical presentation was lymphadenopathy (73.3%), fever (63.3%), and mucocutaneous bleeds (33.3%). All the patients presented with anaemia [packed cell volume (mean±SD) 23.3± 8.2%)], thrombocytopenia [median (IQR)40.0 (15.0,130.0)] and leukocytosis [17.0(4.9, 80.0) c/mm³]. Induction chemotherapy used were cyclophosphamide, vincristine, cytosine arabinoside and prednisolone (COAP) (83.3%) and Vincristine and prednisolone (V+ P) (16.7%) with a mean of 4 cycles of administration. The remission rate was low (26.7%). Neutrophil and lymphocyte counts at presentation were the only factors associated with remission (p=0.016 and 0.010 respectively). Male gender, higher neutrophil count, lower lymphocyte count and V + P chemotherapy though positively predicted remission, did not reach statistical significance(p>0.05).

Conclusion: Remission status in ALL patients is still abysmally poor in our setting and neutropenia is an important independent negative predictor.

Prevalence and patterns of refractive errors among school-aged children in Delta State, Southern Nigeria

Kelvin Imasua — 2024-11-17

Background: Globally, visual impairment is a major public health concern among children and adolescents and 67% of cases are due to uncorrected refractive error. This study assessed the prevalence and pattern of refractive errors among school-age children in Agbor, Delta State, Nigeria.

Methods: This school-based cross-sectional study was carried out among 822 school age children selected using multistage sampling technique. Pre-tested, structured, interviewer-administered questionnaire was used to collect information on sociodemographic characteristics and ocular history of the participants. Eye examination was performed using the modified Refractive Error Study in School Children (RESC) protocol. The final prescription and the best-corrected visual acuity visual acuity were recorded. Data was analyzed using IBSM SPSS version 22 and statistical significance was set at p<0.05.

Results: The mean age (SD) of the participants was 10.1 (3.05) years and 458 (55.7%) were females. The prevalence of refractive error among the participants was 4.4%. Myopia was the commonest form (75%), followed by astigmatism (16.7%) and hyperopia (8.3%) among those with refractive errors. Participants’ sociodemographic characteristics were not significantly associated with the occurrence of refractive errors (p<0.05).

Conclusion: The prevalence of refractive error in the school children was high with myopia being the commonest form. The occurrence of refractive error among the school children was not dependent of their sociodemographic characteristics. The Delta State Government should take steps to strengthen implementation of the school health programme.

High fructose diet-induced inflammation and oxidative stress in male Wistar rats: Preventive effects of yoyo cleanser bitters

John Anionye — 2024-11-17

Background: Modern diets high in fructose, have been associated with increased inflammation and oxidative stress, however, herbal remedies like Yoyo cleanser bitters (Yoyo) have been suggested as possible remedies. Accordingly, this study aimed to determine if co-administration of Yoyo cleanser bitters could prevent inflammation and oxidative stress in male Wistar rats fed with a high fructose diet

Methods: Twenty male Wistar rats, approximately 200g each, were divided into four groups namely: control, high fructose diet with fructose water (HFD+FW), HFD+FW with Atorvastatin (0.57 mg/kg), and HFD+FW with Yoyo (600 mg/kg), groups. After a 28-day experimental period, blood samples were assessed for highly sensitive C-reactive protein (Hs-CRP), malondialdehyde (MDA), and total antioxidant capacity (TAC), using standard methods.

Results: Rats on the high fructose diet only displayed significantly (P<0.05) elevated Hs-CRP (0.63±0.04 mg/dl) and MDA (0.32±0.01 µM) levels, compared to the control rats (0.27±0.01 mg/dl; 0.10±0.01 µM). Both Atorvastatin and Yoyo significantly (P<0.05) prevented the elevation of Hs-CRP (Atorvastatin: 0.28±0.00 mg/dl; Yoyo: 0.29±0.01 mg/dl), while only Yoyo Cleanser bitters significantly (P<0.05) prevented the increase in MDA level (0.08±0.02 µM) when compared to the HFD+FW group. Additionally, the high fructose diet significantly (P<0.05) reduced TAC, but both Atorvastatin (0.38±0.03 µmol/ml) and Yoyo (0.47±0.04 µmol/ml) prevented the reduction of TAC when compared to the HFD+FW group (0.21±0.06 µmol/ml).

Conclusion: Yoyo cleanser bitters attenuated inflammation and oxidative stress induced by high fructose intake, thus suggesting that its co-administration has some preventive therapeutic potential.

Effect of lauric acid on neurodevelopmental parameters and hippocampal BDNF levels in offspring of Wistar rats exposed to prenatal stress

Ibrahim Joseph Momoh — 2024-11-17

Background: Unfavorable environmental experiences can affect fetal neurodevelopment negatively by lowering brain-derived neutrotrphic factor (BDNF) in offspring of rodents. This study examined the effect of Lauric acid (LA) on some neurodevelopmental parameters and hippocampal BDNF levels in male offspring of pregnant Wistar rats exposed to sleep deprivation.

Methods: Thirty-six male offspring from 24 pregnant female Wistar rats were used for this study. The pregnant rats were sleep-deprived for 20 hours daily using the multiple water platform method from day 9-19. Group 1 received distilled water, group 2 served as stress control while 3,4 and 5 were treated with LA at 125mg/kg, 250mg/kg and 500mg/kg. Group 6 received vitamin C at 300mg/kg.

Results: LA significantly improved pinna detachment, incisor eruption, eye opening, air righting reflex (p<0.05) compared to the sleep deprived untreated group.

Conclusion: Lauric acid reversed the delay in some neurodevelopmental parameters by increasing the hippocampal BDNF level in male offspring of Wistar rats. This was reversed upon oral treatment with Lauric acid.

Patients’ perspective on the effect of internet-derived health information on the patient-physician relationship

Eguono Marian Ebereghwa — 2024-11-17

Background: The search for health information in the internet by patients is progressively increasing and more likely to be presented to the physician during consultation. Concerns have been expressed on how this may impact on the patient-physician relationship. The study assessed the use of internet for health information by patients and their perception of physicians’ response to sharing this information.

Methods: A cross-sectional study conducted at the Family Medicine Clinic, Delta State University Teaching Hospital, Oghara, Nigeria among adults ≥18 years recruited using systematic random sampling method. Data was obtained using interviewer-administered questionnaire and analyzed using Statistical Product and Service Solution version 23. Statistical significance was evaluated at p<0.05.

Results: The study had 225 participants. Mean age was 43.42 ± 15.33 years, with more females 135 (60.0%). Those who used the internet to seek health information were 101(44.9%) and 91(90.1%) sought information to decide if they needed to see a doctor or not. Over half 62 (61.4%) discussed their search with a doctor. Very few felt the doctor was dissatisfied,13(12.9%) and that discourse led to harm of their relationship with the doctor, 5(4.9%). Age was significantly associated with participants’ perception of the effect of online health information on doctor-patient relationship (p=0.001).

Conclusion: Significant number of patients used the internet to seek health information and many discussed it with a doctor, who they perceived to have responded positively. Physicians should be open to discuss online health information with patients and to provide professional counsel as this will foster better patient-doctor relationship.

Perception of the use of artificial intelligence in eyecare amongst optometrists in Benin City

Jennifer Ebeigbe — 2024-11-17

Background: The application of Artificial Intelligence (AI) in diagnosing/managing ocular diseases has gained popularity as research highlights the utilization of AI to improve personalized medicine and healthcare outcomes. This study assessed optometrists’ perception of the use of AI in eyecare viz concerns, advantages, role and challenges.

Methods: This was a cross-sectional survey comprising of 64 optometrists, recruited by convenience sampling from their practices in Benin City. A self-administered structured questionnaire consisting of 32 survey items was used. Data was analyzed using descriptive statistics and and chi-squared test. P< 0.05 value was considered significant.

Results: Thirty-four (53.1%) of the optometrists were familiar with the use of AI and 43(67.2%) were concerns about the diagnostic accuracy of AI. While 39 (60.0%) agreed that AI would improve the practice of optometry, 26 (40.6%) were neutral about whether AI should be incorporated into the optometry school curriculum. Perceived role of AI was mainly in assisting in diagnosis 32 (50.0%), determining refractive errors 26 (40.6%) and improving patient care and management 18 (28.1%). Perceived challenges posed by the use of AI were, cost 39(60.0%), threat to job security 26(40.6%) and threat to doctor-patient relationship 23 (35.9%).

Conclusion: More than half of the participants were familiar with the use of AI in eye care. There was good perception of its advantages and role despite a few concerns.

Self-reported impact of COVID-19 pandemic on radiography practice and work-Life of radiographers in Nigeria

Geofrey Luntsi — 2024-11-17

Background: Radiographers in Nigeria have been at the forefront of the fight against the COVID-19 pandemic, facing the challenge of contentious patient management during the pandemic with limited resources. This study assessed the reported impact of the COVID-19 pandemic on the work-life of radiographers in Nigeria.

Methods: A cross-sectional online survey was conducted among Nigerian radiographers from March to May 2021. A convenience sampling technique was used, and a structured questionnaire designed using Google forms consisting of 23 items divided into three sections: demographics, knowledge of infection control and the impact of the COVID-19 pandemic on radiography practice and radiographers' work-life was used. Data collected was analyzed using SPSS version 23.0.

Results: A total of 117 radiographers participated in the study, with a majority being male 82 (70.1%). Diagnostic radiographers made up the majority, 101 (86.3%) of participants. The pandemic negatively impacted radiographers' work-life, with 43 (9.3%) reporting a decrease in their work pattern, and 58 (49.7%) agreeing to experiencing stress during the pandemic. The major stressors reported were long duration of wearing kits and disinfecting accessories and equipment 9 (14.4%) inadequate provision of personal protective equipment (PPE) and inadequate staffing with 6 (9.6%) each, among others.

Conclusion: The study revealed the impact of Covid-19 pandemic on the work life of Nigerian radiographers. The pandemic negatively impacted their work-life, with many reporting high levels of stress. Hospital management should improve on provision of PPE, and remuneration for radiographers to encourage retention and reduce work-related stress during future pandemics.