Nigerian Journal of Medicine https://www.ajol.info/index.php/njm <p><em>Nigerian Journal of Medicine</em> ( NJM) , is the official publication of Nigerian Association of Resident Doctors ( NARD), established in 1990. It is an international peer-reviewed print and online bi-monthly journal.</p> <p>NJM publish scientific reports on human subjects in the form of original articles, review articles, case reports and letters. The journal covers technical and clinical studies related to medicine, dentistry and allied sciences. Articles with clinical interest and implications are only considered for publication.</p> <p>The journal allows free access ( Open Access) to it's contents.</p> <p>Other websites related to this journal: <a href="http://www.journalonweb.com/njm" target="_blank" rel="noopener">www.journalonweb.com/njm</a> and <a href="http://www.njmonline.org" target="_blank" rel="noopener">www.njmonline.org</a></p> en-US On acceptance, the copyright of the paper will be vested in the Journal and Publisher. nigerianjournalofmedicine@gmail.com (Dr. Lawson Obazenu) lekamm@yahoo.com (Dr. Hammed Oyewo (Deputy Editor)) Wed, 25 Aug 2021 10:23:38 +0000 OJS 3.1.2.4 http://blogs.law.harvard.edu/tech/rss 60 Patient‑Reported Outcomes in Lumbar Spine Surgery https://www.ajol.info/index.php/njm/article/view/213292 <p><strong>Introduction:</strong> Lumbar spine spondylosis is a significant cause of morbidity worldwide. Surgical treatment is increasingly being used in<br>patients who do not respond to conservative treatment. Although the outcome of these surgeries is subjective, patient‑oriented&nbsp; questionnaires are considered to give a less biased assessment of surgical outcomes. The aim of this study was to use the Oswestry Disability Index (ODI) to assess the early outcome of lumbar spine surgery in patients with lumbar degenerative spine disease.</p> <p><strong>Methodology</strong>: This was a retrospective study carried out over a period of one year, recruiting twenty patients who had lumbar spine surgeries (both instrumented and non‑instrumented surgeries) for degenerative lumbar spine disease.</p> <p><strong>Results</strong>: The age range of the subjects was 40–80 years, with a mean age of 55.9 ± 9.2 years. A majority of the patients had lumbar disc prolapse (70%). There was a statistically significant correlation between preoperative ODI and postoperative ODI, with postoperative patients having a lower ODI score (which signifies improved outcome).</p> <p><strong>Conclusion</strong>: Lumbar surgeries for degenerative lumbosacral spine disease lead to a high level of patient satisfaction. </p> Obinna Henry Obiegbu Copyright (c) https://www.ajol.info/index.php/njm/article/view/213292 Tue, 24 Aug 2021 00:00:00 +0000 Review of COVID‑19 Vaccine https://www.ajol.info/index.php/njm/article/view/213293 <p>Coronavirus disease 2019 (COVID‑19) accounts for over 92 million confirmed cases worldwide, with over 2.06 million deaths. In the past year, more than 290 candidate vaccines have been tested; COVID‑19 vaccine&nbsp; development was sped up, with shortened timeline, due to the urgent global need in the face of the pandemic. In addition, people with the highest risk of contracting the disease, such as health workers with a high risk of exposure, elderlies, and people with underlying comorbidities, were prioritized with vaccination rollout. The article narratively reviewed original and review articles available on PubMed and Google Scholar related to the theme to provide up‑to‑date information. The different templates developed and studied for COVID‑19 vaccines include the whole‑virus vaccine, viral vector vaccine, nucleic acid (deoxyribonucleic acid and ribonucleic acid), and protein subunit vaccine. Myths impede vaccine uptake in this part of the globe. Adopting these myths leads to sharing and spreading, which negatively impacts the prevention of COVID‑19 and vaccine uptake. Adverse event following immunizations (AEFIs) is classified based on severity, from minor to severe. The minor ones are common events that pose no potential health risks to the receiver of the vaccine. The type determines the safety profile, severity, and frequency of AEFIs observed with the vaccine administration. Overall, this pandemic<br>has heightened the global level of threat awareness; it has also provided motivation to prepare for future&nbsp; pandemics by developing new vaccines.</p> Oluwafemi Efuntoye, Olufemi Obafemi, Olumuyiwa Folayan, Abimbola Amoo, Habeeb D. Ogundipe, Ugo Enebeli, Kehinde Kanmodi, Toluwani Olalere, Lawson Obazenu, Oladimeji Adebayo Copyright (c) https://www.ajol.info/index.php/njm/article/view/213293 Tue, 24 Aug 2021 00:00:00 +0000 Pattern of Molecular Phenotypes of Breast Carcinomas using Immunohistochemistry in a District Hospital in Nigeria https://www.ajol.info/index.php/njm/article/view/213294 <p><strong>Background:</strong> Cancer of the breast is the most common organ‑specific cancer, affecting women worldwide with disproportionately higher mortality seen among women of Africa ancestry. Molecular phenotyping is crucial for tailored treatment of such patients.</p> <p><strong>Aim</strong>: The aim of the study is to describe the molecular phenotypes of carcinomas of the breast based on their oestrogen, progesterone, and HER‑2/Neu receptors status in our centre.</p> <p><strong>Design:</strong> This was a retrospective analysis of 136 histologically diagnosed breast carcinomas, for which&nbsp; oestrogen, progesterone, and HER2 receptors status data were available at the Pathology Unit in a Nigerian District Hospital.</p> <p><strong>Materials and Methods</strong>: Relevant biodata and pathology and molecular information of all patients with&nbsp; histologically diagnosed breast cancer (BC) were extracted from patients’ forms and reports archived in the department. Immunohistochemistry was performed on formalin‑fixed, paraffin‑embedded tissue blocks of 136 (54.4%) cases of the BCs utilizing the avidin‑biotin complex technique.</p> <p><strong>Results</strong>: The ages of the patients ranged from 17 to 74 years, and the mean age was 47.3 ± 11.7 at diagnosis. All affected patients were females except for a male teenager. oestrogen, progesterone, and HER‑2/Neu&nbsp; receptor‑positive breast carcinomas were 43.4% (59), 39% (53), and 27.2% (37), respectively. Triple‑negative breast carcinoma (39%, 53/136) was the most prevalent phenotype, followed by Luminal A(33.8%, 46/136) and Luminal B (14.7%, 20/136), while HER2‑enriched (12.5%, 17/136) was the least common molecular subtype in our series.</p> <p><strong>Conclusion</strong>: Breast carcinomas are predominantly of the triple‑negative molecular phenotype in our setting and commonly affected&nbsp; young women. </p> Kevin Nwabueze Ezike, Solomon Raphael, Damian Ikechukwu Okonkwo, Ijeoma Ahunna Okwudire‑Ijeh Copyright (c) https://www.ajol.info/index.php/njm/article/view/213294 Tue, 24 Aug 2021 00:00:00 +0000 Unearthing the Hidden Tragedy: Stillbirths in Abakaliki, Nigeria – Prevalence and Causes https://www.ajol.info/index.php/njm/article/view/213297 <p><strong>Background</strong>: Stillbirths are very traumatic events to the parents, family, and obstetricians. Although a global public health crises, it has remained relatively hidden while their devastations continue unabated in different parts of the world. We have not evaluated this tragedy in our practice environment hence the need for this paper.</p> <p><strong>Methods</strong>: This is a retrospective study involving all cases of stillbirths that occurred at the Alex Ekwueme&nbsp; Federal University Teaching Hospital, Abakaliki, over a 3‑year period, 2017–2019. The case notes were gotten and relevant information was retrieved and analyzed.</p> <p><strong>Results:</strong> The prevalence of stillbirths in our centre was 16.1 per 1000 deliveries or one stillbirth in 62 deliveries. Majority of our parturients who had stillbirths 89 (81.7%) were unbooked, 43 (39.5%) had only primary&nbsp; education, 16 (14.7%) had no education at all, and only 10 (9.2%) had tertiary education. The leading cause of stillbirths was abruptio placenta 27 (24.8%) followed by prolonged obstructed labor 22 (21.1%), intrauterine fetal death of unknown cause 18 (16.5%), and ruptured uterus 10 (9%). Seventy‑three (67%) women were delivered by spontaneous vaginal delivery while 18 (16.5%) had a caesarean section. Thirty (27.5%) women had postpartum hemorrhage. None of the dead babies had an autopsy performed on them.</p> <p><strong>Conclusion</strong>: The prevalence of stillbirth in our centre is unacceptably high and majority of the causes are&nbsp; preventable. There is an urgent need for public enlightenment to highlight this silent tragedy and mobilize&nbsp; efforts toward its prevention. Carrying out autopsies on stillbirths especially those with unexplained causes will help elucidate some of the causes.</p> Chidi Ochu Uzoma Esike, Ejikeme Brown Nnamdi, Anozie Okechukwu Bonaventure, Adebayo Joshua Adeniyi Copyright (c) https://www.ajol.info/index.php/njm/article/view/213297 Tue, 24 Aug 2021 00:00:00 +0000 Determinants of Low Back Pain among Health‑care Providers in a Federal Tertiary Hospital in Ekiti State, SouthWestern Nigeria https://www.ajol.info/index.php/njm/article/view/213303 <p><strong>Introduction:</strong> Low back pain (LBP) is a usual musculoskeletal system disorder among the working population, especially among health‑care providers (HCPs). It is a significant contributor to work disability, work absenteeism, and lost hours globally. The study objectives are to find the prevalence and determinants of LBP among HCPs in a Federal Tertiary Hospital in Ido‑Ekiti, Ekiti State, Nigeria.</p> <p><strong>Subjects and Methods:</strong> A cross‑sectional study was done among HCPs in a Federal Tertiary Hospital, Ido‑Ekiti, Ekiti State, Nigeria. The study included 336 participants working in the hospital. The respondents were selected using stratified sampling. Data were collected through an adapted questionnaire, which was pretested, semi‑structured, and self‑administered. The data were analyzed using STATA&nbsp; version 12. Univariate, bivariate, and binary logistic analysis was used to find the prevalence and determinants of LBP. The significance level was set at 95% confidence interval and P ≤ 0.05.</p> <p><strong>Results</strong>: The point prevalence, period prevalence, and lifetime prevalence were 39.9%, 44.6%, and 67.6%, respectively. The findings showed that the prevalence of LBP was higher among respondents who turn patient on the bed regularly (&gt;3 times weekly) (odds ratio [OR] =18.46, 95% CL [6.84–49.81], P &lt; 0.0001); and pulls and pushes object or people (more than 10 kg thrice a week) (OR = 8.22, 95% CL&nbsp; [3.46–19.56], P &lt; 0.0001) were statistically significant.</p> <p><strong>Conclusion</strong>: The study revealed that HCPs suffered from a high prevalence of LBP, and the identified risk factors (turning of the patient and pulling and pushing of an object or&nbsp; people) can be modified using an informed health intervention program (health education and ergonomics).</p> Paul Oladapo Ajayi, Paul Oladapo Ajayi, Samson Ayo Deji, Kayode Rasaq Adewoye, O.A. Atoyebi, Ayo Kamal Alabi, Oluremi Olayinka Solomon, Adebowale Femi Akinwumi Copyright (c) https://www.ajol.info/index.php/njm/article/view/213303 Tue, 24 Aug 2021 00:00:00 +0000 Asymptomatic Bacteriuria in a University Teaching Hospital in Southern Nigeria: Prevalence, Uropathogens, and Antibiotic Susceptibility https://www.ajol.info/index.php/njm/article/view/213312 <p><strong>Background</strong>: Asymptomatic bacteriuria (ASB) has been documented as the main risk factor for the development of symptomatic urinary tract infection in pregnancy and is associated with maternal and fetal complications. Objective: To determine the ASB prevalence, the causative microorganisms, their drug sensitivity patterns, and the factors associated with its occurrence in pregnant women in the Uyo, Nigeria.</p> <p><strong>Methodology:</strong> Three hundred and twenty women were recruited during their first antenatal visit over a period of 13 weeks. A midstream urine specimen was obtained from each patient, cultured, isolates identified and antimicrobial sensitivity done. Data were analyzed using the Statistical Package for the Social Sciences version 20.&nbsp;</p> <p><strong>Results</strong>: The ASB prevalence was 9.1% with the two commonest identified isolates being Escherichia coli (41.4%) and <em>Klebsiella pneumoniae (24.1%). Imipenem(100.0%)</em> and<em> gentamycin (37.9%)</em> were the two most sensitive drugs. The association between respondents’ educational level and the occurrence of ASB was significant statistically.</p> <p><strong>Conclusion</strong>: The prevalence of ASB was relatively high among the respondents. This, therefore, emphasizes the need for routine&nbsp; screening&nbsp; of our antenatal female population for ASB in all our health facilities.</p> Imaobong O. Inwang, Augustine V. Umoh, Aniekan M. Abasiattai, Ifeanyi A. Onwuezobe Copyright (c) https://www.ajol.info/index.php/njm/article/view/213312 Tue, 24 Aug 2021 00:00:00 +0000 Histopathological Pattern of Prostate Diseases in Yola, Nigeria: A Five‑year Review https://www.ajol.info/index.php/njm/article/view/213314 <p><strong>Background:</strong> This was a five‑year retrospective study aimed at analyzing all prostate biopsies submitted to the Department of Pathology, Federal Medical Centre, Yola. It will also serve as a baseline or reference study for subsequent related research in the future.</p> <p><strong>Materials and Methods</strong>: All cases registered as prostate diseases within the study period were extracted from the departmental records, comprising bench books and histology reports. The age of the patients, histological diagnosis, and specimen types or surgical procedures (core biopsy, transurethral resection of prostate, or prostatectomy) were retrieved as well. All the slides corresponding to the extracted registered prostate cases received in the department between January 2012 and December 2016 were retrieved, then reviewed&nbsp; microscopically and analyzed afterward.</p> <p><strong>Results:</strong> A total of 634 prostate tissues were submitted for histology during the study period. 63.6% (403) of these specimens were&nbsp; prostatectomy, whereas the remaining were core biopsies. Almost all the cases (436) analyzed occurred in men 40 years and above and predominantly in the 7th and 8th decades. Nodular&nbsp; hyperplasia was the most prevalent prostatic disease seen over the study period accounting for 542 cases (85.5%). The second in frequency was prostatic adenocarcinoma constituting 14% (89) of the total cases. Two cases of high‑grade prostate intraepithelial neoplasia and a case of chronic prostatic inflammation were also seen.</p> <p><strong>Conclusion</strong>: This study has shown that prostate diseases are most prevalent in the 6th through 9th decades of life, with nodular&nbsp; hyperplasia being the most common lesion of the prostate.</p> Nasiru Raheem, Aminu M.C. Dahiru Copyright (c) https://www.ajol.info/index.php/njm/article/view/213314 Tue, 24 Aug 2021 00:00:00 +0000 Mothers’ Perception of COVID‑19 Infection in Their Under‑Five Children Presenting in a Tertiary Health Institution in South‑East Nigeria and Associated Factors https://www.ajol.info/index.php/njm/article/view/213316 <p><strong>Background:</strong> Maternal attitude to health‑seeking behavior of their under‑five children in the COVID‑19 pandemic is not&nbsp; well‑known.</p> <p><strong>Objectives:</strong> This study is aimed at determining mothers’ perception of COVID‑19 pandemic among their under‑five children and associated factors.</p> <p><strong>Methodology</strong>: This is a prospective and observational study carried out in two health institutions in South‑East Nigeria.</p> <p><strong>Results</strong>: Most subjects, 243 (65.3%) noted that someone without showing symptoms of COVID‑19 could transmit the virus. Of the mothers of children under‑five, 271 (72.8%) highlighted the possibility of COVID‑19 infection in the under‑five. A small number of participants 53 (14.2%) showed awareness that people should cough into their elbows as a way of preventing the transmission of COVID‑19. A small&nbsp; number of participants, 160 (43.0%) had a good perception of COVID‑19. Majority of mothers who were married, 148 (44.7%) showed a good perception of COVID‑19 when compared with those who were single, 12 (29.3%); however, this is not significant, (χ<sup>2</sup> = 3.550, P = 0.060). A large number of participants who have attained tertiary education, 92 (48.9%) had a good perception of COVID‑19 which is higher than that seen in mothers with secondary education 68 (37.0%) (χ2=5.444, P = 0.020). Participants who were 30–34 years had 1.8 times higher odds of good perception of COVID 19 compared with mothers who were more than 35 years (adjusted odds ratio = 1.803, 95% confidence interval = 1.026–3.170).</p> <p><strong>Conclusion</strong>: Although most mothers affirm that a child could be infected by COVID‑19, a small number of them actually had a good perception of COVID‑19 infection. Good perception of COVID‑19 among the under‑five is enhanced by the high level of education and age of 32–34 years.</p> Awoere Tamunosiki Chinawa, Josephat Maduabuchi Chinawa, Edmund Ndudi Ossai, Wilson Chukwuneke Igwe, Obinna Chukwuebuka Nduaguba, Ann Ebele Aronu Copyright (c) https://www.ajol.info/index.php/njm/article/view/213316 Tue, 24 Aug 2021 00:00:00 +0000 Between a Short‑term and a Long‑term Antimicrobial Prophylaxis in Prostate Biopsy: The Applicability in a Low‑resource Setting https://www.ajol.info/index.php/njm/article/view/213318 <p><strong>Background</strong>: Transrectal needle biopsy of the prostate (TNBP) is a common urological procedure with some attendant infective&nbsp; complications. Although most urological surgeons give antibiotic prophylaxis, there is, however, no consensus on the duration. This study compares the outcome of a three‑day and seven‑day antibiotic prophylaxis in TNBP.</p> <p><strong>Materials and Methods</strong>: One hundred and twenty men who met the inclusion criteria were recruited and randomized into two equal groups. The patients in Group I received oral ciprofloxacin and metronidazole for three days and Group II received the same drugs for seven days. The antibiotics were commenced 2 h before the biopsy. Urine samples were taken for microscopy, culture, and sensitivity before the biopsy in all patients. For patients in group I, urine microscopy, culture and sensitivity were done on days 5 and 10 after biopsy, and on days 10 and 14 after biopsy for group II patients.&nbsp; Infective complications were determined by the presence of fever and positive urine cultures post-biopsy.</p> <p><strong>Results</strong>: This comparative&nbsp; prospective study was done between June 2016 and November 2017. Groups I and II had comparable infective complication rates (11.70% for Group I and 3.30% for Group II) (P = 0.212). However, diabetics did better on a seven‑day regimen (P &lt; 0.001). Escherichia coli was the most common organism isolated (63.2%). Cephalosporins were the most effective antibiotics in post-biopsy infections in this study.</p> <p><strong> Conclusion</strong>: Three‑day oral ciprofloxacin and metronidazole are effective for prophylaxis in TNBP. However, a seven‑day regimen is better in diabetics before a prostate biopsy. The cephalosporins are a good option in the management of post-biopsy infections caused by quinolone‑resistant organisms.</p> Friday Emeakpor Ogbetere, Irekpita Eshiobo, Vincent C. Onuora Copyright (c) https://www.ajol.info/index.php/njm/article/view/213318 Tue, 24 Aug 2021 00:00:00 +0000 Trial of Labour after Caesarean Section in a Secondary Health Facility in Abakaliki, Nigeria https://www.ajol.info/index.php/njm/article/view/213321 <p><strong>Background:</strong> The mode of delivery of a parturient is influenced by previous caesarean section (CS) scar.</p> <p><strong>Objective:</strong> The objective of the study is to evaluate the pregnancy outcomes of a parturient with one previous caesarean delivery that was managed in Mile Four hospital, Abakaliki, Nigeria.</p> <p><strong>Materials and Methods</strong>: A 5‑year retrospective study of women with one previous CS who delivered in Mile Four hospital between January 2011 and December 2015 was done. IBM SPSS version 20 was used for data analysis, and data were represented using frequency tables, charts, and Chi‑square. The level of significance was set at an alpha level of 0.05.</p> <p><strong>Results:</strong> Three hundred and twenty‑two (322) women with one previous CS were selected for a trial of labor after A C/S (TOLAC). More than half of the women (53.1%) had successful TOLAC while 46.9% had a repeat CS. Of the 53.1% of women who had a successful TOLAC, One hundred and forty-one patients had spontaneous vertex delivery. Seventeen women (9.9%) on the TOLAC arm had a ruptured uterus, while seven patients (4.6%) failed the TOLAC group had uterine dehiscence. Haemorrhage was the most common maternal complication. Severe asphyxia and perinatal death were present in 5.9% and 5.3% of neonates on TOLAC arm, respectively.</p> <p><strong>Conclusion:</strong> Trial of labour after a CS can result in an excellent outcome in a well‑selected patient. The success rate of 53.1% in our study is encouraging. However, adequate intrapartum monitoring is recommended to reduce maternal and fetal complications.</p> Chidebe Christian Anikwe, Collins Agbeze Kalu, Bartholomew Chukwunonye Okorochukwu, Ikechukwu B. Okechukwu Dimejesi, George U. Eleje, Cyril Chijioke Ikeoha Copyright (c) https://www.ajol.info/index.php/njm/article/view/213321 Tue, 24 Aug 2021 00:00:00 +0000 Efficacy of Low‑dose Suxamethonium in Reducing Induction Dose of Propofol for Laryngeal Mask Airway Insertion in Nigerian Adults https://www.ajol.info/index.php/njm/article/view/213323 <p><strong>Background:</strong> Propofol is commonly used as a sole induction agent during laryngeal mask airway (LMA)&nbsp; insertion, and additional doses are often required with systemic consequences.</p> <p><strong>Objective:</strong> Our study evaluated the effect of 0.1 mg/kg suxamethonium on the dose of induction of propofol when used during insertion of LMA.</p> <p><strong>Methodology</strong>: Eighty patients aged between 18 and 60 years were included in this prospective study. Patients undergoing elective&nbsp; procedures under general anaesthesia with LMA and spontaneous ventilation were randomized into two groups. Patients in both groups were induced with an initial dose of 2.5 mg/kg of propofol; the control group (group P) and the second group (group S) received 5 ml of normal saline and 0.1 mg/kg of suxamethonium made up to 5 ml, respectively. The need for additional doses of propofol following&nbsp; insertion of LMA was then assessed based on insertion conditions (ease of insertion, severity of airway response in terms of coughing, gagging, laryngospasm, and patient movement). The total dose of propofol required before successful insertion was recorded, as well as the incidence and duration of apnea post-induction. The pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were assessed at 0, 1, 3 and 5 min after insertion of LMA for each group.</p> <p><strong>Results</strong>: The total dose of propofol required for successful LMA insertion was significantly lower in group S (2.82 ± 0.39 mg/kg) compared to group P (3.13 ± 0.49 mg/kg), P = 0.002. Haemodynamic parameters (SBP, DBP, MAP, PR, and SpO2) were well-controlled post-LMA insertion and were comparable between the two groups. Furthermore, no incidence of hypotension or bradycardia requiring intervention was observed at different time intervals, throughout the study period, in both groups.</p> <p><strong>Conclusion</strong>: The dose of propofol is lesser when low‑dose suxamethonium (0.1 mg/kg) precedes its use for induction during LMA insertion, and there is a reduction in the duration of apnea; however, it causes a higher apnea incidence. Vital signs were similar in the two study groups.</p> Dalhat Salahu, Saheed Adesope, Saheed Adesope, Saheed Adesope, Saheed Adesope, Alhassan Mohammed Datti, Alhassan Mohammed Datti, Mustapha Miko Abdullahi, Atiku Mamuda, Abdullahi Maryam Mohammed Copyright (c) https://www.ajol.info/index.php/njm/article/view/213323 Tue, 24 Aug 2021 00:00:00 +0000 Coronavirus Disease 2019 Virus among Ophthalmologists in Nigeria: Knowledge, Attitude, and Perceptions https://www.ajol.info/index.php/njm/article/view/213325 <p><strong>Background</strong>: Globally, there is still much to learn about the evolving coronavirus disease 2019 (COVID‑19) virus, its transmission, prevention, and treatment. Therefore, this study investigates the knowledge, perception, and screening practices of COVID‑19 infection in the ophthalmology practice in Nigeria.</p> <p><strong>Materials and Methods</strong>: This survey was a descriptive, cross‑sectional survey conducted among practising ophthalmologists and ophthalmologists in training in Nigeria in an online survey. Data compiled were then analyzed using the IBM SPSS software version 22.0 with two‑tailed P &lt; 0.05 considered to indicate statistical significance.</p> <p><strong>Results</strong>: A total of 206 ophthalmologists/ophthalmologists in training were recruited for this study. Most of the respondents, 97 (47.1%), practiced in centres in South‑West Nigeria and were board‑certified ophthalmologists 96 (46.6%). In general, the majority of the respondents, 182 (88.3%), had good knowledge regarding the COVID‑19 virus, its transmission, prevention as it regards the ophthalmic practice, 134 (74.8%) either agreed or strongly agreed that the ophthalmologist is at a higher risk of contracting the virus from infected patients even if the patient is asymptomatic. COVID‑19 infection was perceived as very serious by the majority of the respondents, 135 (65.5%), although 128 (62.1%) felt that all routine cases should be seen only following a low‑risk assessment.</p> <p><strong>Conclusion:</strong> As the world races toward complete vaccination of the population against this fatal infection, continued training is required to ensure the best practices among ophthalmologists to bridge the present knowledge gaps, corrects myths, misconceptions, and ensure the safety of both the patient and the ophthalmologist.</p> Olubanke Theodora Ilo, Tunji Sunday Oluleye, Olufemi Emmanuel Babalola, Adetunji Olusesan Adenekan, Folasade Bolanle Akinsola Copyright (c) https://www.ajol.info/index.php/njm/article/view/213325 Tue, 24 Aug 2021 00:00:00 +0000 HIV/AIDS: Are Our Secondary School Students in Zaria Metropolis Receiving Adequate Communication from Their Families? https://www.ajol.info/index.php/njm/article/view/213343 <p><strong>Introduction:</strong> Nigeria has one of the highest proportions of cases of HIV/AIDS globally. This burden is more pronounced in the younger population which includes secondary school students (SSS). We set out to&nbsp; determine the level of family communication among SSS in Zaria metropolis.</p> <p><strong>Subjects and Methods</strong>: We carried out a cross‑sectional study among 73 randomly selected students. Data were obtained with a semi‑structured, pretested, self‑administered questionnaire. Descriptive statistics were used to present data at the univariate level while Chi‑square or Fisher’s exact test was employed to identify the relationship between non-numeric variables with a 5% level of significance.</p> <p><strong>Results</strong>: The mean age (± standard deviation) was 16.1 ± 1.1 years. Majority have heard 60 (82.2%) and have good knowledge 55 (75.3%) of family communication. There was an overall positive attitude as 44 (60.3%)&nbsp; believe it helps prevent HIV/AIDS and 57 (78.1%) believe it is very important and should be encouraged. Most (57 [78.1%]) have had family communication, with mother as the preferred partner 49 (86%). HIV/ AIDS (44 [77.2%]) was the major issue discussed. We out that found the knowledge of family communication was&nbsp; significantly associated with its practice (P = 0.018).</p> <p><strong>Conclusion</strong>: Awareness, knowledge, attitude, and practice of family communication were good among respondents. Father’s educational level and knowledge of family communication were significantly associated with its practice among respondents. More studies are&nbsp; required to evaluate the determinants of the practice of family communication.</p> Fahad Abubakar Saulawa, Zaharaddeen Shuaibu Babandi, Aminu Lawal, Umar Muhammad Umar, Halima Omolara Olorukooba, Abdulhakeem Abayomi Olorukooba Copyright (c) https://www.ajol.info/index.php/njm/article/view/213343 Wed, 25 Aug 2021 00:00:00 +0000 Helminthic Infestation in Children Aged 6 to 59 Months with Diarrhea in Calabar https://www.ajol.info/index.php/njm/article/view/213344 <p><strong>Background:</strong> Helminthic infections and diarrheal diseases have remained public health problem worldwide, especially in developing countries. Children below five years of age are at a higher risk. This study therefore aims to determine the prevalence, and intensity of intestinal helminths in children with and without the diarrheal disease.</p> <p><strong>Materials and Methods</strong>: This was a cross‑sectional analytical study of 130 children aged 6 to 59 months, carried out in the Children Emergency Room and the Diarrhea Treatment and Training Unit of the University of Calabar Teaching Hospital (U. C. T. H), Calabar, Nigeria. Those admitted with and without diarrhoea were consecutively recruited. Data were obtained by administration of questionnaires to parents/caregivers whose children met the inclusion criteria. Clinical examinations including anthropometric parameters (weight and length/height) were carried out on all the children recruited for the study while mid‑upper arm circumference was done for children aged 12–59 months. Stool samples were collected from each child into a wide mouth universal, clean, dry, leak‑proof, container, with the help of their parents/guardians. Microscopy was carried out on the stool&nbsp; samples collected within 1 h in the microbiology laboratory for the presence of ova, larva, or worm segment using direct microscopy with saline and iodine wet preparation and formol ether concentration. Ova were identified and quantified. The type of worm and intensity were recorded.</p> <p><strong>Results</strong>: Out of the 130 children, 65 (50%) had diarrhea while the other 65 (50%) were without diarrhoea. The mean age of subjects with diarrhea was 16.86 ± 11.7 months and 17.60 ± 9.9 months for those without diarrhoea. There was no significant difference in sex distribution between the age groups (P = 0.86). The overall prevalence of intestinal helminthic infection in the study population was 1.5%. The prevalence of intestinal helminths in those with diarrhea and those without diarrhea was 3.1% and 0.0%, respectively, (P = 0.496). Only <em>Ancylostoma duodenale</em> (hookworm) was isolated in those with diarrhea and it was of light intensity. There was no significant&nbsp; difference in the method of disposal and source of water, comparing subjects having diarrhea and those not having diarrhea (P &gt; 0.05). The proportions of subjects that usually played in the sand, go on footwear outside home, and go on footwear at home, were not&nbsp; significantly different comparing those having diarrhea and those not having diarrhea (P &gt; 0.05).</p> <p><strong>Conclusions:</strong> The prevalence rate of intestinal helminths in children with and without diarrhoea was low. There was general&nbsp; environmental cleanliness and personal hygiene in the study population which were likely responsible for the low helminthic infection thus emphasizing the need for maintenance of good hygiene, access to good water supply and periodic intake of anti-helminthic drugs in view of the public health importance of helminthic infection and diarrhoea.</p> Kelechi Uhegbu, Vincent M. Uhegbu, Komomo Eyong, Joanah M. Ikobah, Emmanuel E. Ekanem Copyright (c) https://www.ajol.info/index.php/njm/article/view/213344 Wed, 25 Aug 2021 00:00:00 +0000 Characteristics and Outcome of Paediatric Traumatic Brain Injuries: An Analysis of 163 Patients in Enugu https://www.ajol.info/index.php/njm/article/view/213347 <p><strong>Background:</strong> As with most ailments common to adult and paediatric age groups, studies that describe and characterize paediatric traumatic brain injuries (TBIs) lag those of their adult counterparts. This is more so in the developing countries where national data are not well developed. The development of local clinical&nbsp; guidelines has been shown to positively impact outcomes of paediatric TBI. Data on the characteristics and outcomes of TBI among paediatric age groups will provide a framework for the development of an&nbsp; all‑encompassing management guideline.</p> <p><strong>Methods:</strong> In this study, a retrospective review of demography, mechanism of injury, pattern of presentation, nature of treatment, duration of hospital admission, and outcome of children aged 0–17 years managed for traumatic TBI at the University of Nigeria Teaching Hospital, Enugu‑Nigeria was performed. Data were analyzed using SPSS version 21. Relevant test statistics were used to test for associations. AP = 0.05 was considered&nbsp; statistically significant.</p> <p><strong>Results:</strong> Atotal of 163 patients’ medical records were retrieved and analyzed. Of these, 117 (71.8%) were males and 46 (28.2%) were females. Their ages ranged from 6 weeks to 17 years with a mean age of 7.66 ± 5.1 years and peaked at 3–5 years. No difference in mean age between gender (P = 0.427). Pedestrian motor vehicular accident was the most common cause of injury. Fall from fruit trees and assault were peculiar to children from suburban/rural areas. TBI severity on admission was mild (44.2%), moderate (38.7%), and severe (17.2%). Other systemic injuries were present in 33.7%, of which long bone fractures were the most common (23/55). Abnormal brain computed tomography findings were seen in 83.2% with skull fracture being the most common finding. Operative procedures were carried out on 19.6% of patients. Conservative measures were the mainstay of management. The mean&nbsp; duration of hospital admission was 14.01 ± 11.8 days was significantly associated with admission Glasgow Coma Scale (GCS) Score (P &lt; 0.0001) and Glasgow Outcome Score (GOS) at discharge (P = 0.03). The overall outcome was good (GOS 4 and 5) in 92.0% and has a significant association with GCS on admission (P &lt; 0.0001). Long‑term (Extended GOS) was 8 in 98.2% of those followed up.</p> <p><strong>Conclusion:</strong> Paediatric TBI is mainly mild to moderate in severity with a male predilection. The main cause is road traffic accidents with most victims being pedestrians. Management is mainly non-operative and the outcome at discharge is good even in a middle‑income country and significantly determined by GCS on admission.</p> Mark C. Chikani, Ikechukwu Aniaku, Mathew Mesi, Wilfred C. Mezue, Ugo Nnenna Chikani Copyright (c) https://www.ajol.info/index.php/njm/article/view/213347 Wed, 25 Aug 2021 00:00:00 +0000 Knowledge, Attitude, Practice and Predictors of Preventive Practices Toward COVID‑19 among Healthcare Workers in Ogbomoso, Nigeria: A Cross‑sectional Study https://www.ajol.info/index.php/njm/article/view/213350 <p><strong>Background:</strong> COVID‑19 quickly assumed a global epidemic with its attendant health, socio‑political and economic impacts. Healthcare workers are particularly at increasing risk of being infected and transmitting the virus. This study assessed knowledge, attitude, practice and predictors of preventive practices toward COVD‑19 among healthcare workers in Ogbomoso, Nigeria.</p> <p><strong>Study Design</strong>: Cross‑sectional study. Data were collected online among health workers across health facilities in Ogbomoso. Factors associated with good practices were analyzed using Chi‑square. Predictors of good&nbsp; preventive practices were determined by multivariate binary logistic regression. The level of statistical&nbsp; significance was determined to be at P &lt; 0.05.</p> <p><strong>Results</strong>: There were 132 study participants; with an average age of 31 years. Fifty‑eight percent were medical laboratory scientists. Levels of good knowledge, attitude, and practices were 59.1%, 58.3%, and 38.6%,&nbsp; respectively. Eight‑seven percent of respondents sourced COVID‑19 related information via the mass media. Ninety‑four percent of respondents will not stay at home if sick because of work. Age, profession, and&nbsp; knowledge are significantly associated with COVID‑19 preventive practices. The predictors (Model II) of good COVID‑19 preventive practices include being a laboratory scientist (odds ratio [OR]: 2.44 [95% confidence interval (CI): 1.05, 6.71]; P = 0.039), working in primary health facility (OR: 4.72 [95%CI: 1.08, 20.67]; P = 0.039) and having good COVID‑19 knowledge (OR: 3.71 [95%CI: 1.49–9.925]; P = 0.005).</p> <p><strong>Conclusion</strong>: Our study has shown the predictors of good COVID‑19 preventive practices among healthcare workers and the need for policy and practice change as it relates to COVID‑19 infection prevention and&nbsp; mitigation among healthcare workers.</p> Philip Adewale Adeoye, Gabriel Ilerioluwa Oke, Kehinde Precious Fadele, Titilope Abisola Awotunde Copyright (c) https://www.ajol.info/index.php/njm/article/view/213350 Wed, 25 Aug 2021 00:00:00 +0000 Awareness and Acceptance of Harm Reduction Services in a Nigerian Psychiatric Hospital: Patients’ and Family Caregivers’ Perspective https://www.ajol.info/index.php/njm/article/view/213356 <p><strong>Introduction</strong>: There are burgeoning data on harm reduction services (HRSs) as a viable alternative to the traditional means of dealing with substance abuse in the developed countries. Despite the numerous benefits, its awareness and acceptability in developing economies such as Nigeria have been constrained by sociocultural and political factors. However, the specific patients’ and caregivers’ barriers to its uptake have not been evaluated in Nigeria.</p> <p><strong>Aim</strong>: This study aimed to examine the awareness and acceptability of HRS among patients and caregivers in Enugu, South‑Eastern Nigeria.</p> <p><strong>Materials and Methods</strong>: This study was a descriptive survey of patients with substance use disorders and their family caregivers at Enugu. Awareness and acceptance of HRS were assessed using questions adapted from the harm reduction survey.</p> <p><strong>Results</strong>: The majority of patients and caregivers (76.5% and 88.2%, respectively) were not aware of HRS.&nbsp; Compared to family caregivers, the patients were more likely to rate themselves more favourably disposed to accepting HRS (U = 2750.00, p &lt; 0.001). The common reasons given for accepting HRS among the patients were centered on autonomy and the unrealistic nature of abstinence. The reasons for&nbsp; rejection by family caregivers were hinged on encouraging use, community resistance, and scandals to the family.</p> <p><strong>Conclusion</strong>: This study highlighted the low awareness of both patients and their caregivers to the availability of HRS as a treatment option in Nigeria. It is hoped that these findings will provide some invaluable data to policy makers and clinicians in designing policies and in public education to improve service utilization by the public.</p> Justus Uchenna Onu, Francis C. Chinawa, Ujunwa C. Nduanya, Nonso B.C. Maduka, Theclar Ogochukwu Iyidobi, Monday N. Igwe Copyright (c) https://www.ajol.info/index.php/njm/article/view/213356 Wed, 25 Aug 2021 00:00:00 +0000 Knowledge of COVID‑19 and Practice of Preventive Measures among Adult Residents during the Ease of Lockdown in Nigeria https://www.ajol.info/index.php/njm/article/view/213359 <p><strong>Background</strong>: The governments of many countries have taken steps to avert the spread of COVID 19. The&nbsp; gradual relaxation of the lockdown in Nigeria might be counter‑productive if not properly managed. The best means to reduce and stop transmission is for the public to be adequately informed about the disease and its preventive measures. This research assessed the knowledge of COVID‑19 and practice of preventive measures<br>along with its predictors among Nigerian residents during the ease of the lockdown.</p> <p><strong>Methodology</strong>: A cross‑sectional study was conducted among 1421 adult residents of Nigeria. Data were&nbsp; collected between 6th and 20th September, 2020, using a semi-structured online questionnaire adapted from previous studies. IBM SPSS version 26 was used for data analysis. Pearson’s Chi‑square and logistic regression were used to determine the predictors of preventive practices.</p> <p><strong>Results</strong>: The mean age of the respondents was 27.5 ± 9.1 years. Avery large proportion (98.8%) of the respondents had a good knowledge of the disease (score of ≥4 out of 6 variables) and the internet (70.1%) was the major source of their information. However, only 57.6% of them had good practice of preventive measures of the disease (score of ≥3 out of 4). Predictor of good practice of preventive measure included female sex (adjusted odds ratio [AOR] = 2.626; 95% confidence interval [CI] = 2.078–3.319), being married (AOR = 2.177; 95% CI = 1.568–3.023), and possessing tertiary and postgraduate level of education (AOR = 1.813; 95% CI = 1.082–3.036 and AOR = 2.102; 95% CI = 1.206–3.664, respectively). However, residents in local government headquarters and other villages as well as towns (AOR = 0.541; 95% CI = 0.388–0.756 and AOR = 0.587; 95% CI = 0.350–0.983, respectively) have less likelihood of engaging in good practice of preventive measures.</p> <p><strong>Conclusion:</strong> Majority of the research participants had good knowledge of the disease, while about half take part in good preventive practices measures. Predictors of the practice measures included sex, level of education, place of residence, as well as marital status. Therefore, targeted interventions should be directed to the males, those who reside outside the Federal Capital Territory and state capitals, and other high‑risk groups as found by this study to reduce the risk of disease contraction during this period. </p> Tope Michael Ipinnimo, Taofeek Adedayo Sanni, Tolulope Adeola Aladesuru, Olamide Adeola Adebayo, Motunrayo Temidayo Omowaye, Ireoluwa Oluwatomisona Adeniyi, Oluwadare Martins Ipinnimo, Olanrewaju Kassim Olasehinde, Adefola Richmond Adetunbi Copyright (c) https://www.ajol.info/index.php/njm/article/view/213359 Wed, 25 Aug 2021 00:00:00 +0000 Basic Health Care Provision Fund Project Implementation: An Assessment of a Selected Technical Skill among Mid‑level Managers of a Performance‑based Financing Scheme in Southwest Nigeria https://www.ajol.info/index.php/njm/article/view/213367 <p><strong>Introduction</strong>: Knowledge and skills in quantitative/numerical disciplines are some of the essential skills necessary for sustainable and successful administration and management in financing health care. It is not clear whether the personnel across relevant establishments in the health sector of Nigeria have the requisite capacity to implement and manage a performance-based financing project. This survey assessed the availability of certain technical skills among selected mid‑level managers in charge of the implementation of the Basic Health Care Provision Fund Project (BHCPFP).</p> <p><strong>Materials and Methods</strong>: Data were collected with the aid of a self‑administered questionnaire developed from a review of the project document. Atotal population of mid‑level managers from all the respective ministries was studied across the six states in Southwest Nigeria. Data collection was conducted between February and June 2019. Data analysis was done using SPSS version 22. Frequency tables were generated and charts were constructed.</p> <p><strong>Results:</strong> A total of 234 eligible participants were studied. Those who had formal training in quantitative/numerical‑based skills such as accounting‑related courses were about one‑third, 77 (32.8%) and those who had acquired formal training in insurance‑related disciplines were 91 (38.7%). A little above one‑third, 66 (28.2%) had a form of on‑the‑job health insurance training.</p> <p><strong>Conclusions</strong>: This study showed that mid‑level managers had poor quantitative‑related skills necessary for administrative and technical roles for implementation of BHCPFP. Mid‑level managers should be trained and re‑trained on those administrative and technical skills for better implementation of BHCPFP.</p> David Ayobami Adewole, Segun Bello, Olumide Olaolu Okunola, Eme Theodora Owoaje Copyright (c) https://www.ajol.info/index.php/njm/article/view/213367 Wed, 25 Aug 2021 00:00:00 +0000 Live Birth after Treatment of a Ruptured Ectopic in a Spontaneous Heterotopic Pregnancy https://www.ajol.info/index.php/njm/article/view/213371 <p>Heterotopic pregnancy, though more common in pregnancies achieved by assisted reproduction, is extremely rare following natural conception. Owing to this rarity, the diagnosis is oftentimes missed or made late, usually following rupture of the extrauterine gestation. Heterotopic pregnancy, therefore, expectedly carries significant maternal mortality and morbidity. With the advancement in assisted reproductive techniques, and&nbsp;&nbsp; improvement in the diagnosis of ectopics using transvaginal ultrasound and beta‑human chorionic&nbsp;&nbsp; gonadotropin assay, the frequency of heterotopic pregnancy is likely to increase, especially so in a country like Nigeria, with high twinning and ectopic pregnancy rates. To promptly diagnose heterotopic pregnancy and timely intervene, a high level of clinical suspicion is required. This would mitigate maternal morbidity and mortality, as well as preserve and continue the intrauterine pregnancy. With early diagnosis and prompt intervention, intrauterine pregnancy has a favourable outcome in the majority of cases. We present a&nbsp; 37‑year‑old multigravida with naturally conceived heterotopic pregnancy, in which the ectopic pregnancy ruptured. She subsequently had spontaneous vaginal delivery following surgical management (laparotomy) of<br>the ruptured ectopic pregnancy.</p> Akaninyene Eseme Ubom, Alexander Tuesday Owolabi, Oluwatoyin Oyenike Fadare, Jerrie Akinyemi Akindojutimi, Isiaka Ayofe Adekunle Copyright (c) https://www.ajol.info/index.php/njm/article/view/213371 Wed, 25 Aug 2021 00:00:00 +0000 Erratum: Determinants of Antiretroviral Therapy Adherence among Hiv‑Infected Adolescents Attending a Tertiary Health Facility in Abuja, Nigeria https://www.ajol.info/index.php/njm/article/view/213373 <p>In the article titled “DETERMINANTS OF ANTIRETROVIRAL THERAPY ADHERENCE AMONG HIV‑INFECTED ADOLESCENTS ATTENDING A&nbsp; TERTIARY HEALTH FACILITY IN ABUJA, NIGERIA” published on pages 80 – 87, issue&nbsp; January to March 2020, Volume 29 No (1), of Nigerian Journal of Medicine[1] the authors’ names were incorrectly written as “E EkopEno”, “A Okechukwu Adaora” and “I Airede Kareem”.<br>The name of the author “E EkopEno” should read correctly as “Eno E. Ekop”.<br>The name of the author “A OkechukwuAdaora” should read “Adaora A. Okechukwu”.<br>The name of the author “I Airede Kareem” should read “Kareem I. Airede”.</p> Lawson Obazenu Copyright (c) https://www.ajol.info/index.php/njm/article/view/213373 Wed, 25 Aug 2021 00:00:00 +0000