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)) Thu, 01 Jul 2021 12:09:49 +0000 OJS 3.1.2.4 http://blogs.law.harvard.edu/tech/rss 60 A Comparison of the Performance of the Midarm Circumference and the Nelson Weight Estimation Formulas in Nigerian Children https://www.ajol.info/index.php/njm/article/view/209753 <p><strong>Background:</strong> In emergencies, two commonly used weight estimation methods are Nelson and mid‑arm circumference (MAC)‑based formulae. Nelson’s method requires the child’s age while the MAC formula offers weight estimation without any prior details of the child, which is useful in our environment due to the lack of proper vital statistics documentation.</p> <p><strong>Methodology:</strong> We measured the weight, height, and MAC of 1390 children aged 1–12 years. Values got from the measurements were substituted in MAC and Nelson formulae for weight estimation. The estimated weights were compared to the actual weights of the children.</p> <p><strong>Results</strong>: Atotal of 1390 children were enrolled. The mean of enrolled children’s actual weight was significantly higher than the mean weight estimated using MAC and Nelson formula. MAC method overestimated weight in children 1–7 years and underestimated weight in those 8–12 years old. On the other hand, the Nelson formula underestimated weights in children 2–11 years and overestimated weight in 1 and 12-year olds.</p> <p><strong>Conclusions</strong>: Both the MAC and Nelson method have their deficiencies in weight estimation. Though the Nelson formula&nbsp; appears slightly more accurate than the MAC, weight estimates from both methods were mostly within the actual weight agreement limits.</p> <p><strong>Keywords</strong>: Actual weight, children, comparison, formulae, mid‑arm circumference, nelson</p> Obianuju O. Igbokwe, Chidiebere D.I. Osuorah, Ikenna K. Ndu, Ogochukwu N. Iloh, Kenechukwu K. Iloh, Ezinne I. Nwaneli, Obinna C. Nduagubam, Benedict O. Edelu, Linda Nwokeji-Onwe, Chikodi F. Anarado Copyright (c) https://www.ajol.info/index.php/njm/article/view/209753 Wed, 30 Jun 2021 00:00:00 +0000 Knowledge, Perception, and Consumption of Food Additives among Female Lecturers in Zaria, Nigeria https://www.ajol.info/index.php/njm/article/view/209755 <p><strong>Background:</strong> Food additives are being utilized for both small‑ and large‑scale food production but often find more applicability in mass food production. Food additive consumption over a long period could pose adverse health outcomes. The study determined knowledge, perception, and consumption of food additives among female lecturers in Zaria.</p> <p><strong>Methodology:</strong> It was a cross‑sectional study conducted among 180 full‑time female lecturers of the three tertiary institutions, selected through a multistage sampling technique. Data were collected using a pretested self‑administered questionnaire. The data were entered into IBM SPSS Statistics 20 and analyzed. Univariate analysis for categorical variables was done using simple proportions.</p> <p><strong>Results:</strong> A total of 167 female lecturers responded giving a response rate of 92.8%. Their mean age was 42.7 ± 8.2 years. Majority (109, 65.3%) had good knowledge of food additives, less than half (77, 46.3%) had a good perception of them, and the overall consumption rate for food additives was 97.1%. Majority (77.8%) felt that the risks associated with food additives must never be ignored, about half (47.3%) felt that foods consumed by Nigerians were now generally more harmful. However, only about one‑fifth felt that most fast foods do contain food additives (28.1%). Consumption rates were high for both natural and synthetic food additives (61.7%–92.2%), except for Ajinomoto and Vedan which were consumed by only 38 (22.8%).</p> <p><strong>Conclusion:</strong> Knowledge of food additives was good, but their perception was poor and consumption was high. Stakeholders must begin to organize and sustain periodic sensitization campaigns on risks associated with the consumption of food additives. Futures studies should identify the reasons for poor perception and high level of consumption despite good knowledge among the study population.</p> <p><strong>Keywords:</strong> Consumption, female lecturers, food additives, Zaria</p> Muhammed Sani Ibrahim, Aminu Lawal, Ahmed Ayuba Umar, Sunday Asuke Copyright (c) https://www.ajol.info/index.php/njm/article/view/209755 Wed, 30 Jun 2021 00:00:00 +0000 Predictors of Knowledge and Perception of Family Planning Among Men in Urban Areas in Northwest Nigeria https://www.ajol.info/index.php/njm/article/view/209758 <p><strong>Introduction:</strong> The use of family planning (FP) methods has remained low in Nigeria despite the high fertility rate and unmet need; partly because men are excluded in FP programs. Most studies on FP were carried out among married women and information about men was acquired from their wives. Unfortunately, such information may not be accurate.</p> <p><strong>Aims:</strong> The study aimed to determine the predictors of FP knowledge and perception among men in urban areas in the Northwestern part of Nigeria.</p> <p><strong>Subjects and Methods</strong>: The study was cross‑sectional in design, carried out in urban areas in Northwest Nigeria among 167 married men in November 2017 enrolled through a multi‑stage sampling technique. Data collection was done with a structured questionnaire which&nbsp; was interviewer‑administered. SPSS version 23 was used to analyze the data.</p> <p><strong>Results:</strong> The majority (75, 45.5%) had poor knowledge of FP and 118 (71.5%) had a positive perception of FP. Social class (adjusted odds ratio [aOR]: 15.75, 95% confidence interval [CI] = 2.14–116.03) and perception (aOR: 0.13, 95% CI = 0.03–0.59) were the predictors of good FP knowledge while knowledge (aOR = 0.10, CI: 0.02–0.51) predicted positive perception on FP.</p> <p><strong>Conclusion:</strong> Knowledge of FP was poor; the perception of the majority was positive. There is a need by the Sokoto State Government,&nbsp; Local Government Areas, and religious leaders to increase information on FP, especially on the benefits and methods, and the need for males to participate in FP through the enlightenment of the public using the media, schools, and worship places.</p> <p><strong>Keywords:</strong> Family planning, knowledge, men, northwest, perception, urban areas </p> Bilkisu Gulma Abubakar, Oche Mansur Oche, Balarabe Adamu Isah, Ismail Abdullateef Raji, Jessica Timane Ango, Nneka Christina Okafoagu, Ahunna Zainab Ezenwoko, Ismail Ahmed-Mohammed, Mohammad Danmadami Abdulaziz Copyright (c) https://www.ajol.info/index.php/njm/article/view/209758 Wed, 30 Jun 2021 00:00:00 +0000 Readiness of Nigerian Health‑Care Workers to Work during COVID‑19 Pandemic https://www.ajol.info/index.php/njm/article/view/209761 <p><strong>Introduction</strong>: Health‑care professionals of all cadres are the utmost valuable resource during pandemics and maintaining an adequate<br>workforce of health professionals during an emergency is critical to ensure uninterrupted provision of services that are essential for patient care.</p> <p><strong>Aim:</strong> Examine readiness of health‑care workers (HCWs) to provide service in the course of the COVID‑19 pandemic and the factors influencing their decision.</p> <p><strong>Methodology</strong>: This was a cross‑sectional study of Nigerian health sector workers HCWs in the course of the COVID‑19 pandemic. The respondents were recruited using HCWs focus groups on WhatsApp and Telegram social medial platforms.</p> <p><strong>Results:</strong> A total of 481 HCWs were recruited, consisting of 288 females and 193 males (M: F, 1:1.5), mean age = 30.71 ± 5.9 years. Most<br>HCWs (97.3%) showed a willingness to provide service during the pandemic; 73.3% of the HCWs were willing to work if supplied with adequate personal protective equipment (PPE) although 5.8% were less willing to work without proper PPE. Factors supporting&nbsp; unwillingness to work during the pandemic were: concerns about the lack of adequate testing for COVID‑19 (48.9%), lack of disability insurance plan (40.1%), fear of being infected (47.2%), and the risk of infection in family members (24.5%). The readiness to work was related to the job cadres of the HCWs (P = 0.001), while the provision of additional incentives and a change in the working conditions would influence the readiness of the HCWs to work.</p> <p><strong>Conclusion</strong>: HCWs were ready to provide service in the course of the COVID‑19 pandemic if there was a safe work environment, although the availability of PPE and other personal factors would influence their willingness to work, while improvement in working conditions would motivate HCWs to work.</p> <p><strong>Keywords:</strong> COVID‑19, health‑care workers, pandemic, personal protective equipment </p> Segun A. Ogunkeyede, Adebolajo A. Adeyemo, Omowonuola A. Ogundoyin, Oyeleye A. Oyelakin, Olumakinde B. Fawole Copyright (c) https://www.ajol.info/index.php/njm/article/view/209761 Wed, 30 Jun 2021 00:00:00 +0000 Pattern, Risk Factors, and Outcome of Acute Stroke in a Nigerian University Teaching Hospital: A 1‑Year Review https://www.ajol.info/index.php/njm/article/view/209771 <p><strong>Background:</strong> This study aimed to document the pattern, risk factors, in‑hospital outcomes, and stroke mortality in a hospital over one<br>year.</p> <p><strong>Materials and Methods</strong>: Acute stroke patients admitted at the Lagos State University Teaching Hospital between October 2019 and<br>September 2020 had their records reviewed. Information including age, sex, risk factors, stroke type, access to neuroimaging, and the in‑hospital outcome was extracted and analyzed.</p> <p><strong>Results</strong>: A total of 230 patient records were included in this study. The proportion of intracerebral hemorrhage (ICH) was 44.8%, while&nbsp; ischemic stroke was 52.2%. Only 9.1% of ischemic stroke cases had an onset‑to‑arrival time of fewer than nine hours, with just three thrombolytic therapy given. The 30‑day mortality was 28.7%, lesser among younger patients and patients managed in the stroke unit.</p> <p><strong>Conclusion</strong>: The hospital incidence of ICH was close to that of ischemic stroke. Mortality data confirms the importance of management in a stroke unit.</p> <p><strong>Keywords:</strong> Nigeria, outcome, pattern, risk factors, stroke</p> Babawale Arabambi, Olajumoke Oshinaike, Oluwakemi Oluwabunmi Akilo, Yakub Yusuf, Shamsideen Abayomi Ogun Copyright (c) https://www.ajol.info/index.php/njm/article/view/209771 Wed, 30 Jun 2021 00:00:00 +0000 Self‑monitoring of Blood Glucose can be Misleading without Periodic Re‑calibration of Glucose Meters: A Pilot Study https://www.ajol.info/index.php/njm/article/view/209772 <p><strong>Introduction/Background</strong>: Diabetes mellitus is highly prevalent in both developed and developing countries today affecting about 429<br>million adults globally and is expected to rise by 147% to 629 million in 2045. Effective management of diabetes mellitus requires the<br>periodic measurement of fasting plasma glucose. Self‑monitoring blood glucose has been used to achieve this for over three decades<br>now. This study, therefore, assesses the performance of three blood glucose meters used by patients with diabetes in our environment.</p> <p><strong>Materials and Methods:</strong> This study adopted a comparative analytical prospective design that involved three of the frequently used glucose meters in our environment namely RUBY®, ONCALL®, and FINETEST®. Glucose calibrators of increasing concentrations from 40 mg/dL to 200 mg/dL were prepared from a freshly constituted 1800 mg/dl stock solution of glucose. Sera obtained from five patients were assayed along with control sera using a routine laboratory method (glucose oxidase [GOX]) for standardization and the three glucose meters simultaneously and the results were compared for statistical differences on Microsoft Excel using means and standard deviation. P ≤ 0.05 was set as a level of significance.</p> <p><strong>Results:</strong> The mean glucose values of calibrators (120 ± 63.3) were statistically significantly different from the mean glucose values of the RUBY (139.6 ± 80.9), (P = 0.0118) and the ONCALL (188.8 ± 82.1), (P ≤ 0.0001) glucose meters, respectively. The percentage increase in blood glucose estimation by the RUBY and ONCALL devices was 115.8% and 157.3% respectively. The FINETEST glucose meter overestimated glucose by 232.0% higher than the laboratory GOX method even though there was no statistical significance (P = 0.062) between the two means. The percentage imprecision for the different glucose meters was: RUBY 9.5%, FINETEST 14.8%, and ONCALL 18.2%.</p> <p><strong>Conclusion:</strong> Quality control should be used routinely in the use of point of care testing glucose measurements and devices should be<br>sent to the central laboratory periodically for recalibration to avoid mismanagement of diabetic patients on hypoglycaemic drugs.</p> <p><strong>Keywords:</strong> Diabetes mellitus, point of care testing, self‑monitoring of blood glucose</p> Kenneth Ogar Inaku, Eyam Sunday Eyam, Emin Johnson Emin, Onuche Lawrence Onuche Copyright (c) https://www.ajol.info/index.php/njm/article/view/209772 Wed, 30 Jun 2021 00:00:00 +0000 Assessing Performance of Resident Doctors in Training in Northwestern Nigeria https://www.ajol.info/index.php/njm/article/view/209785 <p><strong>Background:</strong> Residency training is a postgraduate medical education where graduate doctors are mentored toward becoming&nbsp;&nbsp; independent specialists. In Nigeria currently, the Medical Residency Training Act (MRTA) 2017 guides residency training under the regulation of three postgraduate medical colleges: the National Postgraduate Medical College of Nigeria (NPMCN), West African College of Surgeons (WACS), and West African College of Physicians (WACP). For the respective colleges, resident doctors are expected to attempt Part One and Part Two fellowship examinations after completing their junior and senior residency training, respectively, within stipulated durations.</p> <p><strong>Objectives</strong>: The aim of this study is to assess resident doctors’ performance in training and predictive factors.</p> <p><strong>Methodology:</strong> Electronic&nbsp; questionnaires was distributed to respondents through their contacts or emails. Data was collected within a period of one month, from July 10 to August 6, 2020. Data was analyzed using mean, standard deviation, simple tables as well as t‑test and Chi‑square test. The level of significance was set at 0.05 for decision purposes. Results: A total of 120 participants were involved in the study. The mean age of respondents was 38.0 ± 3.8 years, with a majority of 88 (83.3%) males and 107 (89.2%) married. On the first attempt, 48 (65.8%), 37 (60.6%), and 15 (57.7%) respondents were successful in NPMCN, WACS, and WACP Part One fellowship&nbsp; examinations, respectively. There was no significant difference in the success in Part One between the three postgraduate medical&nbsp; colleges. There was significant difference in the duration between the first attempt and success in Part One examinations for the three colleges, respectively (NPMCN – P = 0.001, WACS – P &lt; 0.001, WACP – P = 0.036).</p> <p><strong>Conclusion:</strong> There was a comparable success in Part One fellowship examination between the three postgraduate medical colleges, with over half of respondents recording success in their first attempt. However, there were significant delays between the first attempt and&nbsp; success in Part One examination for the three postgraduate medical colleges.</p> <p><strong>Keywords:</strong> Part One examination, performance, residency training </p> Shehu Salihu Umar, Zaharadeen Shuaibu Babandi, Auwal Garba Suleiman, Umar Muhammad Umar, Abdulhakeem Abayomi Olorukooba, Aisha Jamila Ahmad, Bilqis Olajumoke Muhammad, Abubakar Ibrahim Umar, Adam Ahmad, Lawson O. Obazenu Copyright (c) https://www.ajol.info/index.php/njm/article/view/209785 Thu, 01 Jul 2021 00:00:00 +0000 Awareness of Ear Health Care among Urban City Residents, in South‑South, Nigeria https://www.ajol.info/index.php/njm/article/view/209786 <p><strong>Background:</strong> Exposure to Sound Pressure Levels (SPL) above 85 dB over 8 hours is potentially damaging to the ears. Unfortunately, many people may be unaware of the adverse effects of such SPL on the ear and quality of life. The level of awareness of hearing test has not been adequately determined in our region, a developing world. Some even seek ear care from unauthorized facilities and persons who often recommended inappropriate medications and treatment. The objectives of this study were to assess specifically the respondents’ level of awareness of sound levels that could cause hearing loss, determine the number of respondents who have had a hearing test, and the sources of ear healthcare among residents in an urban city in South-South, Nigeria.</p> <p><strong>Participants and Methods</strong>: An interviewee‑administered questionnaire under three sections: socio‑demographics; awareness of&nbsp; damaging sound levels and their sources; hearing testing and ear health care was used to collect data from 274 consenting respondents. Data were analyzed using IBM Statistical Product and Service Solution version 26.0. Results were presented on frequencies, percentages, tables, and figures. A P ≤ 0.05% was considered statistically significant at a 5% level of significance.</p> <p><strong>Results:</strong> The respondents were aged between 10 and 74 years, and a median age of 24 years. Most 202 (73.7%) were males, while 72 (26.3%) were females, with male: female = 2.8:1. The greater proportion 223 (81.4%) were single; 177 (64.6%) were students; 16 (5.8%) were unemployed and 21 (7.7%) civil servants. Of the 274 consenting participants, only 79 (28.8%) were aware that the numerical value of noise level above 85 dB could cause damage to hearing. Only a small proportion with tertiary education 28 (10.2%) reported having had a hearing test. All the respondents in occupations prone to high levels of noise never had a hearing test. There was a statistically significant association between the types of ear drop/substance used by respondents and the attendant health personnel (P = 0.0001).</p> <p><strong>Conclusion/Recommendation</strong>: There is poor awareness of ear health care among urban city dwellers in Calabar, South‑South, Nigeria. Most young adults aged 20–29 years were aware that loud noise is hazardous to hearing. Generally, there was ignorance on objective numerical noise levels for hazard; the importance of hearing testing; and utilization of appropriate ear care facilities for treatment of ear diseases. Public health education on appropriate ear healthcare is highly recommended.</p> <p><strong>Keywords:</strong> Ear Health care Practices, Hearing Test, Sound levels </p> Abiola Grace Adekanye, Glory Mbe Egom Nja, Robert Bassey Mgbe, Aniefon Ntuien‑Udo Umana Copyright (c) https://www.ajol.info/index.php/njm/article/view/209786 Thu, 01 Jul 2021 00:00:00 +0000 Coverage of Cancer News in Pakistani Print Media: A Content Analysis Study of Daily Pahenji Akhbar – A Sindhi Language Newspaper https://www.ajol.info/index.php/njm/article/view/209788 <p><strong>Background</strong>: Newspaper coverage is a key source of cancer information. Although it was of profound significance to understand how the local newspapers of Pakistan cover the cancer news.</p> <p><strong>Aims and Objectives:</strong> To counter this, the present study was aimed to examine the cancer news coverage of the last year 2020.</p> <p><strong>Materials and Methods</strong>: Using content analysis technique, the whole year coverage in daily Pehnji Akhbar was investigated to determine which topic and the type of cancer were most frequently mentioned in the news, and what was the locality the cancer news was most frequently reported from.</p> <p><strong>Results</strong>: In total, 90 cancer-related news were generated, out of which 7.5% of news were found as an average in each month during the whole year of 2020. Death was the topic of the majority (90%) of the news (contributing to 74% male deaths and 15% female deaths). However, blood, liver, throat, and mouth cancers were the most frequently mentioned-types in the news related to male victims. In terms of localities, the rural areas were the highest contributors of the 57 cancer news (contributing to 48% male victims and 14% female victims).</p> <p><strong>Conclusion</strong>: It was found that cancer is increasing at an alarming rate in the rural areas of Sindh.</p> <p><strong>Recommendations:</strong> Keeping in view the significance of the newspapers, it would help proffer the public with adequate information on cancer by increasing the mentions of particular types of common cancer. Also, it would be beneficial if the newspapers consider relating the news to the profiles of the victims.</p> <p><strong>Keywords:</strong> Cancer, mortality, news reporting, print media, public health </p> Rameez Ali Mahesar, Yasira Naeem Pasha, Mubina Pathan, Mariam Israr Khan Copyright (c) https://www.ajol.info/index.php/njm/article/view/209788 Thu, 01 Jul 2021 00:00:00 +0000 Antiretroviral Therapy‑related Problems among Human Immunodeficiency Virus‑infected Patients: A Focus on Medication Adherence and Pill Burden https://www.ajol.info/index.php/njm/article/view/209789 <p><strong>Background</strong>: There are problems associated with antiretroviral therapy despite its achievement. Poor medication adherence and inability to tolerate large pill burden are major problems facing patients with chronic illnesses. These drug therapy problems are under-studied among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Nigeria. We evaluated adherence and pill burden among this set of patients in a tertiary hospital in Lagos.</p> <p><strong>Methods:</strong> Data for eligible HIV‑infected adults were documented from case notes and through interviews using a well‑structured&nbsp; questionnaire. Important details extracted were sociodemographics, pills information, and CD4 counts. The main outcome measures were drug adherence, as assessed by the four‑item Morisky Medication Adherence Scale and pill burden, as measured by daily pill &gt;5.</p> <p><strong>Results</strong>: Of the 296 patients, 219 (74%) were females. Median age (interquartile range) was 40 (35.0–47.7) years. Majority (262; 88.5%) were married, had at least a secondary education (142:48.0%), and CD4 count &gt;500 cells/ml (215; 72.6%). Pill burden &gt;5 pills/day was observed in 12.2% of the patients, while adherence was documented for 83.4% of the patients. Majority (259; 87.5%) were receiving fixed‑dose&nbsp; combination of antiretroviral drugs. Forgetfulness (16.5%) and being too busy to take pills (10.5%) were the most common reasons for nonadherence. Pill burden in those who were not receiving fixed‑dose combination was significantly associated with medication nonadherence. However, only pill burden was found to be an independent prognosticator of non-adherance. (Odd ratio = 0.67, confidence<br>interval = 0.03–1.66, P &lt; 0.00).</p> <p><strong>Conclusion:</strong> Medication nonadherence and pill burden were observed in more than one‑tenth of patients. These were the two major&nbsp; antiretroviral therapy‑related problems reported in this study.</p> <p><strong>Keywords:</strong> Adherence, antiretroviral therapy, human immunodeficiency virus, people living with human immunodeficiency virus/acquired<br>immunodeficiency syndrome, pill burden</p> Abdulwasiu Adeniyi Busari, Kazeem A. Oshikoya, Adeyinka F. Akinwumi, Sikiru O. Usman, Wasiu A. Badru, Adedunni W. Olusanya, Ibrahim A. Oreagba, Sunday O. Olayemi Copyright (c) https://www.ajol.info/index.php/njm/article/view/209789 Thu, 01 Jul 2021 00:00:00 +0000 Outcome of Posterior Lumbar Interbody Fusion for Degenerative Lumbar Spine Spondylolisthesis in a Neurosurgical Centre in Nigeria https://www.ajol.info/index.php/njm/article/view/209790 <p><strong>Introduction</strong>: Posterior lumbar interbody fusion (PLIF) is one of the options for the management of lumbar spine instability and is being<br>increasingly used in Nigeria. The aim of the study is to assess the outcome of cases managed with PLIF in Enugu, Nigeria.</p> <p><strong>Methods:</strong> Retrospective analysis of all patients that had PLIF for degenerative lumbar spine spondylolisthesis from the year 2016 to 2019 at a single centre the interbody fusion device was polyetheretherketone cage loaded with autologous bone graft. All patients presented with severe low back pain. Patients operated for traumatic spondylolisthesis and those managed with pedicle screw fixation alone were excluded. Patients were followed up for at least one year. The outcome was assessed using Japanese Orthopedic Association (JOA) scoring for back pain, visual analog score (VAS), fusion rate, and the 5‑point patient‑reported improvement scale.</p> <p><strong>Results</strong>: Atotal of 57 patients were analyzed. The mean age was 56.5 ± 7.4 years and the mean duration of back pain was three years (1–15 years). The mean preoperative VAS was 7.9 ± 1.1, while the postoperative VAS score was 3.3 ± 1.7. The JOA scores before surgery and at least 12 months post-surgery were 12.9 ± 2.8 and 22.9 ± 4.9, respectively. The patient recovery rate was 63.3%. A satisfactory outcome was noted in 82.8% of patients, post-surgery. The average fusion rate postsurgery was 88%. The most common postoperative complication was cerebrospinal fluid leak (8.8%). Four obese patients had implant‑related complications.</p> <p><strong>Conclusion:</strong> PLIF for degenerative spine disease is associated with significant improvement in preoperative back pain and neurological<br>outcome. It is also associated with good fusion, recovery, and patient‑reported improvement.</p> <p><strong>Keywords:</strong> Degenerative lumbar disc disease, Nigeria, outcome, posterior lumbar interbody fusion, visual analogue score and Japanese<br>Orthopedic Association </p> Chika Anele Ndubuisi, Wilfred Chukwuemeka Mezue, Francis Chukwuebuka Campbell, Okwuoma Okwunodulu, Ned Michael Ndafia, Amaka Martha Ozoagu, Samuel Chukwunonyerem Ohaegbulam Copyright (c) https://www.ajol.info/index.php/njm/article/view/209790 Thu, 01 Jul 2021 00:00:00 +0000 Containing COVID-19 in Nigeria: An Appraisal of Lockdown and Surveillance at Inter‑State Borders to Control Disease Spread https://www.ajol.info/index.php/njm/article/view/209791 <p><strong>Introduction:</strong> The outbreak of coronavirus disease 2019 (COVID‑19) in Nigeria prompted decision‑making at the various levels of&nbsp; governance. Ebonyi State Government in South‑east Nigeria closed her borders with neighboring states as a preventive measure for the spread of the pandemic. This study was an assessment of the effectiveness and challenges of border closure and surveillance activities in controlling the dispersion of the disease across states.</p> <p><strong>Materials and Methods:</strong> The five major borders of Ebonyi State with her neighboring States of Enugu, Cross River, and Abia were visited. Information was collected about movement restrictions and surveillance at the borders using an observation checklist and key informant interviews. Data collected were analyzed using IBM‑SPSS and thematic interpretation.</p> <p><strong>Results:</strong> Commuters on essential duty were enforced to wear face masks, perform hand hygiene, and undergo screening for the&nbsp; symptoms of COVID‑19 before entering the State. All the first 13 COVID‑19 confirmed persons in the State were from those picked up as suspected cases by surveillance at the State borders. People who travelled hundreds of kilometers across several States were stopped from entering Ebonyi State. However, movement restriction at the borders was undermined by some security personnel who were bribed by commuters to allow them crossover during night hours.</p> <p><strong>Conclusion:</strong> The lockdown and surveillance activities at the borders were effective in controlling the spread of COVID‑19, but alternative routes of entry and corrupt act during odd hours constituted serious risks. Uniformity of movement restriction across all the states borders with vigilante groups manning inter‑community boundaries may control the disease spread across regions.</p> <p><strong>Keywords:</strong> Coronavirus disease 2019 surveillance, infection control, inter‑state borders, lockdown, suspected cases </p> Benedict Ndubueze Azuogu, Cosmas Kenan Onah, Emeka Onwe Ogah, Chinweoke Alfred Utulor, Osarhiemen Iyare, Azuka Stephen Adeke, Nkechi Elizabeth Ebere, Richard Ewah, Ugochukwu Uzodimma Nnadozie, Lawrence Ulu Ogbonnaya Copyright (c) https://www.ajol.info/index.php/njm/article/view/209791 Thu, 01 Jul 2021 00:00:00 +0000 Pattern of Cancer in Bauchi: Report from a Departmental Cancer Registry https://www.ajol.info/index.php/njm/article/view/209793 <p><strong>Context:</strong> Cancer ranks second among the major causes of death globally. A projection by 2020 indicated that developing countries would<br>account for about 70% of total cancer‑related death worldwide. Despite the great threat posed by cancer to this region of the world,&nbsp; reliable statistics on the trends and patterns of cancer are rare.</p> <p><strong>Aims:</strong> The aim of the study is to review the cases of cancer recorded in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, from January 1, 2011 to December 31, 2019</p> <p><strong>Materials and Methods:</strong> This is a retrospective, descriptive study. Nine years records of all pathologically diagnosed cancer cases in the ATBUTH, Bauchi were retrieved, reviewed, and grouped in accordance with the International Classification of Diseases for Oncology. The results were presented as simple frequency tables and charts.</p> <p><strong>Results:</strong> A total of 1284 cancer cases were diagnosed during the period, an average of 142.7 cases per annum. There was a female predominance of cancer cases (male: female ratio ‑ 1:1.53. The age range was from seven months to 95 years, with mean and median<br>ages of 49.6 and 50 years, respectively. More than half of the cases were reported in the fifth to seventh decades of life. Prostate (14.6%)<br>and non melanoma skin cancer (11.2%) were the most common cancers seen in males. In females, cancers of the cervix (37.9%) and the<br>breast (22.9%) were the most common.</p> <p><strong>Conclusions:</strong> Breast cancer and cancer of the uterine cervix were the most common cancers in women in this review while prostate cancer was the most common cancer in men. The need to establish a hospital‑based and/or population‑based cancer registry that will generate reliable cancer data in our environment cannot be overemphasized.</p> <p><strong>Keywords:</strong> Bauchi, breast, cancer, cervix, prostate, registry </p> Ibrahim O. Adogu, Dauda E. Suleiman, Sani Abubakar Malami, Muhammad Baffah Aminu, Aminu Zakari Muhammed Copyright (c) https://www.ajol.info/index.php/njm/article/view/209793 Fri, 02 Jul 2021 00:00:00 +0000 Asymptomatic Bacteriuria among Antenatal clients in a Secondary Facility in Southwestern Nigeria https://www.ajol.info/index.php/njm/article/view/209795 <p><strong>Context</strong>: Asymptomatic bacteriuria (ASB) is the presence of bacteria in the properly collected urine of a patient that has no signs or<br>symptoms of a urinary tract infection (UTI). If diagnosed early, UTI and its grave consequences can be prevented in pregnant women.</p> <p><strong>Aims:</strong> The goal was to ascertain the prevalence of ASB in pregnant women attending antenatal clinic.</p> <p><strong>Subjects and Methods:</strong> The study was a cross‑sectional descriptive study. Data were collected using the proforma. Clean catch urine&nbsp; samples were taken and sent for microscopy, culture, and sensitivity. The data were analyzed by statistical package for social sciences (SPSS) version 23.</p> <p><strong>Results:</strong> A total of 42 women had ASB on urine culture, giving a prevalence of 30.4%. The most common organism cultured was <em>Escherichia&nbsp; coli</em> (21[50%]) and most of the organisms isolated were sensitive to nitrofurantoin (88.3%).</p> <p><strong>Conclusions:</strong> This study found that the prevalence of ASB among antenatal clients was 30.4%. The dominant organism was found to be<em> E. coli</em>. Majority of the organisms were sensitive to nitrofurantoin (88.3%), cefuroxime (78.6%), ceftazidime (78.6%), and ceftriaxone (71.4%). We found a positive association between the density/number of urinary pus cells of the participants and the occurrence of ASB.</p> <p><strong>Keywords:</strong> Antenatal, asymptomatic bacteriuria, culture, urine </p> Abayomi Ibukun Alao, Uche Augustine Akunaeziri, Adeola Folashade Afolabi, Samuel Pam, Gerald Tochukwu Igwemadu Copyright (c) https://www.ajol.info/index.php/njm/article/view/209795 Thu, 01 Jul 2021 00:00:00 +0000 Obesity as a Risk Factor for Age‑related Cataract in a Nigerian Population https://www.ajol.info/index.php/njm/article/view/209796 <p><strong>Purpose:</strong> The purpose of the study was to investigate the relationship between obesity and age-related cataract in a Nigerian Population.</p> <p><strong>Materials and Methods</strong>: Ninety adult patients aged between 45 and 65 years with age-related cataract were matched with ninety adult<br>patients aged between 45and 65 years without cataract based on age and gender. Pretested interviewer‑administered questionnaires were used to obtain information on demographics, educational levels, and occupation. Cataract was evaluated using a modified World Health Organization grading system. Body mass index (BMI) was categorized into four groups (underweight: BMI 15–19.9; normal weight: BMI 20–24.9; overweight: BMI 25–29.9; and obese: BMI &gt;30). The association between degree and type of cataract and obesity was&nbsp; evaluated. Data was analyzed using IBM SPSS version 21. Confidence intervals of 95% and P &lt; 0.005 were considered statistically&nbsp; significant.</p> <p><strong>Results: </strong>Female participants had significantly higher mean BMI than males (27.56 ± 6.33 vs. 24.95 ± 4.35 P = 0.002). There was however no statistically significant difference noted in mean BMI based on the age groups or the levels of education. There was no&nbsp; statistically significant difference in BMI between participants with and without cataract (26.16 ± 5.87 vs. 27.56 ± 6.33, P = 0.824) regardless of the type and grade of cataract.</p> <p><strong>Conclusion:</strong> The study showed a lack of association between obesity and cataract, further studies are required to explore causality.</p> <p><strong>Keywords</strong>: Age-related, body mass index, cataract, obesity</p> Rilwan Chiroma Muhammad, Aisha Sheriff Kalambe, Abubakar Imam Copyright (c) https://www.ajol.info/index.php/njm/article/view/209796 Thu, 01 Jul 2021 00:00:00 +0000 Preferred Approach to Clinical Performance Improvement among Physicians at the University College Hospital, Ibadan Nigeria https://www.ajol.info/index.php/njm/article/view/209797 <p><strong>Background</strong>: Training needs assessment involves the identification and prioritization of training requirements. The medical practice regulatory authority in Nigeria recommends continuing medical education for physicians. The courses are preplanned and often do not take into consideration the training needs and the preferred method for performance improvement. This study aimed to assess the preferred method for performance improvement among physicians at a tertiary health facility in Southwest Nigeria.</p> <p><strong>Methods:</strong> This is a descriptive cross‑sectional survey carried out among 355 doctors employed in the University College Hospital, Ibadan. Sampling was conducted using stratified random sampling with a proportionate allocation to size across different cadres of doctors in various departments/units. The World Health Organization Hennessy‑Hicks Training Needs Analysis Questionnaire was adopted for this study. The self‑administered questionnaire consisted of 33 items (assignments) grouped into five subcategories: clinical assignments, communication/teamwork, research/audit, management/supervisory assignments, and administration. Participants were requested to rate each of the 33 items/assignments along with seven‑point scales (one = not at all important and seven = very important). The&nbsp; Hennessy‑Hicks training manual quadrant chart was adopted for the interpretation of the training needs gap.</p> <p><strong>Results:</strong> Three hundred and three (85.4%) of 355 participants responded to the survey. The mean age ± standard deviation of participants was 37.62 ± 6.7 years. About four‑fifths of the participants were resident doctors. Regarding the most important rating, the clinical assignment subcategory was rated (6.3) as the most important to participants’ job, out of the five subcategories. Participants, however, rated their performance best in the communication/teamwork subcategory. The training needs gap was highest (0.82) in the&nbsp; research/audit subcategory and lowest (0.48) in the communication/teamwork category. All subcategories reported a similar score (5.8) on participants’ perception of the organization’s development as a method to bridge the gap in training needs. Participants also rated the training course method as a better method to improve performance in all five subcategories.</p> <p><strong>Conclusion:</strong> The research/audit subcategory reported training needs gap that requires close monitoring and possible intervention. This could be done by organizing and sponsorship physicians for training courses.</p> <p><br><strong>Keywords</strong>: Health resources, Nigeria, physicians, training needs assessments</p> David Ayobami Adewole, Nelson Simon Negedu, Segun Bello Copyright (c) https://www.ajol.info/index.php/njm/article/view/209797 Thu, 01 Jul 2021 00:00:00 +0000 A Re-Evaluation of Ectopic Pregnancies in a Resource-Limited Setting: A Ten Year Review https://www.ajol.info/index.php/njm/article/view/209798 <p><strong>Context:</strong> Ectopic pregnancy (EP) is a severe challenge in contemporary gynaecology, particularly in developing economies. Late&nbsp; presentation and diagnosis increase the associated morbidity and mortality. With the worldwide surge in incidence and varied presentation patterns, re-evaluation has become necessary. This study, therefore, aims at re-evaluating the risk factors and clinical patterns of EP cases in a tertiary health facility in a resource-limited setting.</p> <p><strong>Settings/Methods/Statistical Analysis</strong>: All EP cases managed at the Teaching Hospital of the University of Nigeria (UNTH), Enugu,&nbsp; Nigeria, from January 1, 2008, to December 31, 2017, were retrospectively evaluated. The collected data was analyzed with the 23.0 edition of Statistical Package for the Social Sciences. Descriptive statistics was done for the qualitative variables. Cross-tabulation was done; the association levels were determined by Chi-square/Fisher’s exact test and Student’s t-test for the qualitative and quantitative variables. P = 0.05 was considered as the statistical significance level.</p> <p><strong>Results</strong>: There were 6448 deliveries and 4129 gynaecological admissions. The mean age of the patients was 29 ± 3 years. Most (76.3%) of the participants (61) were multiparous, whereas only (2) 2.5% of the participants were grand-multiparous. The EP prevalence rate was 1.2% (80 out of 6448), and it constituted 1.9% (80 out of 4129) of all gynaecological&nbsp; admissions. All the patients presented with ruptured EP. The main presentation of EP among the participants was abdominal pain (69, [86.3%]), while the most presenting risk factor was a history of induced abortion (52, [65%]).</p> <p><strong>Conclusion:</strong> We concluded that ectopic gestation remains a major gynaecological emergency in our environment. Most of our patients had ruptured EP, which could negatively impact our society, which places a high premium on childbearing.</p> <p><strong>Keywords</strong>: Ectopic pregnancy, evaluation, gynaecological emergencies, ruptured, unruptured</p> Victor Chinazo Duru, Emmanuel Obiora Izuka, Joseph Tochukwu Enebe, Emeka Ifeanyi Iloghalu, Tochukwu Dickson Ifezuoke, Uchenna Ifeanyi Nwagha Copyright (c) https://www.ajol.info/index.php/njm/article/view/209798 Thu, 01 Jul 2021 00:00:00 +0000 Histopathology Turnaround Time of Surgical Biopsies in a Nigerian Tertiary Health‑Care Facility https://www.ajol.info/index.php/njm/article/view/209810 <p><strong>Background:</strong> Turnaround time (TAT) analysis is finding increasing relevance in clinical laboratories due to its relevance in the quality of care of patients. TAT involves all the various processes that occur within the laboratory.</p> <p><strong>Aims:</strong> The aim of this study was to analyze the histopathology TAT of surgical biopsies at the Department of Pathology, University College Hospital (UCH), Ibadan.</p> <p><strong>Materials and Methods:</strong> This was a retrospective analysis of 1085 samples received at the Department of Pathology, UCH, Ibadan, from January to April 2020. Samples were categorized into small, intermediate, and large sizes. Average duration spent in the grossing room, processing, reporting, and result verification was calculated, and the total TAT was determined from the summation of the duration of these processes.</p> <p><strong>Results:</strong> The mean TAT for all samples was 22 days (±10 days). Reception‑grossing, histological processing, reporting, and transcription accounted for an average of 1.5 (7%), 5.9 (27%), 9.1 (41%), and 5.6 (25%) days and percentage of TAT, respectively. There was no significant difference in the mean TATs for small‑, intermediate‑, and large‑sized samples.</p> <p><strong>Conclusion:</strong> We identified reporting time as the largest contributor to TAT. Other areas of delay were noted at tissue processing and result verification. Adoption of new technology and staff orientation may help to reduce the observed TAT.</p> <p><strong>Keywords</strong>: Grossing, reporting, tissue processing, turnaround time </p> Mustapha A. Ajani, Omolade O. Adegoke, Ifeanyichukwu D. Nwanji, John I. Nwadiokwu Copyright (c) https://www.ajol.info/index.php/njm/article/view/209810 Thu, 01 Jul 2021 00:00:00 +0000 Seroprevalence of Human Immunodeficiency Virus, Hepatitis B Virus, and Syphilis Infections among Pregnant Women Booked for Antenatal Care at Kogi State Specialist Hospital, Lokoja, Nigeria https://www.ajol.info/index.php/njm/article/view/209800 <p><strong>Background:</strong> Sexually transmitted infections (STIs) among pregnant women are an important health issue in Nigeria, but its prevalence in<br>Lokoja is not known.</p> <p><strong>Objective:</strong> The objective of this study is to establish the seroprevalence of the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis infections among pregnant women booked for the antenatal clinic in Kogi State Specialist Hospital, Lokoja, Nigeria, and determine risk factors associated with the infections.</p> <p><strong>Methods</strong>: We prospectively screened three hundred pregnant women booked for antenatal care between January 1, 2016, and December 31, 2016, for HIV, HBV, and syphilis. Their demographic data, risk factors, and results of the screening tests were analyzed using the SPSS version 20 and presented in simple charts, tables, and percentages.</p> <p><strong>Results</strong>: Thirty nine (13%) out of the 300 pregnant women tested seropositive for either HIV (28, 9.3%), HBV (10, 3.3%), or syphilis (one, 0.3%). The most common identifiable risk factor for these infections was multiple sexual partners which accounted for 38.4%.</p> <p><strong>Conclusions:</strong> The seroprevalence of STIs in this study was 13% and the most common risk factor for the infections was multiple sexual<br>partners. Therefore, effective preventive strategies for HIV, HBV, and syphilis are advocated.</p> <p><strong>Keywords</strong>: Hepatitis B virus, human immunodeficiency virus, Nigeria, pregnancy, screening, seroprevalence, syphilis</p> Dorcas Salime Onuminya, Peter A. Isabu, Reuben Eifediyi, Joseph O. Eigbeifoh, Felix O. Okogbo, Adewole O. Sule‑Odu Copyright (c) https://www.ajol.info/index.php/njm/article/view/209800 Thu, 01 Jul 2021 00:00:00 +0000 Clinical Characteristics of COVID‑19 in a Tertiary Health Facility in Northeast Nigeria https://www.ajol.info/index.php/njm/article/view/209801 <p><strong>Aim</strong>: The coronavirus disease 2019 (COVID‑19), caused by a newly identified β‑coronavirus (severe acute respiratory syndrome&nbsp; coronavirus‑2), has a varied clinical manifestation. We evaluated the clinical features of COVID‑19 in symptomatic patients that presented for care at a Federal Medical Centre Nguru, Northeast Nigeria.</p> <p><strong>Methodology:</strong> In this retrospective cohort study, we reviewed and analyzed relevant information abstracted from the medical records of symptomatic COVID‑19 patients that were managed from March 14 to October 14, 2020, in the facility.</p> <p><strong>Results</strong>: Clinical records of 55 symptomatic COVID‑19 patients were evaluated in this study. Their mean age was 49.1 ± 16.3 (females 51.4 ± 15.6, males 48.5 ± 17.2, P = 0.601) with females constituting 47.2% of the studied patients. Fever (87.3%), cough (67.3%), sore throat (49.1%) and rhinorrhea (41.8%) were the most common clinical feature. Other features included difficulty in breathing (25.5%) and ageusia (14.6%). Gastrointestinal symptoms such as diarrhea, vomiting and abdominal pain were seen in 10.9%, 18.2%, and 9.1%, respectively. Twenty‑one (38.2%) patients had a preexisting health condition. Chronic kidney disease was the most common; it was seen in 34% of patients, other common conditions included hypertensive heart disease (24%), and diabetes mellitus (16%).</p> <p><strong>Conclusion:</strong> Respiratory symptoms are the most common presentation of COVID‑19 in our setting. However, some patients also presented with additional extrapulmonary symptoms. A significant proportion, 38.2% of symptomatic COVID‑19 patients, had preexisting health&nbsp; conditions.</p> <p><strong>Keywords:</strong> Clinical characteristics, coronavirus disease 2019, Northeast Nigeria </p> Ballah Akawu Denue, Sepu Ngamariju, Habu Abdul, Abubakar Mohammad Musa Copyright (c) https://www.ajol.info/index.php/njm/article/view/209801 Thu, 01 Jul 2021 00:00:00 +0000 The Use of Unripe Pawpaw for Wound Bed Preparation Following Radiation‑Induced Sacral Ulcer: A Case Report and Review of Literature https://www.ajol.info/index.php/njm/article/view/209802 <p>Radiation wounds are very difficult to manage due to poor vascular status, excessive matrix metalloproteinases, and abnormal&nbsp; myofibroblast function. Such wound beds do not adequately support conventional resurfacing as do nonradiate beds. We present a 46‑year‑old female with a sacral radiation ulcer, which had earlier failed to support flap cover on two instances after bed preparation with conventional honey dressing and negative pressure dressing, but was subsequently successfully managed with unripe pawpaw wound bed preparation. Are‑elevation of the right gluteal myocutaneous flap proved successful and satisfactory. The finding may have resulted from both enzymatic properties of unripe pawpaw and its ability to break the biofilms and to locally supply the ascorbic acid necessary for collagen synthesis and granulation tissue formation.</p> <p><strong>Keywords</strong>: Case report, radiation wounds, unripe pawpaw, wound bed preparation </p> Ezekiel Uchechukwu Nwankwo, Charles Chidiebele Maduba, Victor Ifeanyichukwu Modekwe, Ugochukwu Uzodimma Nnadozie Copyright (c) https://www.ajol.info/index.php/njm/article/view/209802 Thu, 01 Jul 2021 00:00:00 +0000 Management of Spontaneous Pneumothorax in Pregnancy in a Low‑Income Country during COVID‑19 Pandemic https://www.ajol.info/index.php/njm/article/view/209803 <p><em>Spontaneous pneumothorax</em> is a rare and life-threatening emergency. When it occurs in pregnancy, it poses a serious danger for both the mother and the fetus. A high index of suspicion, early diagnosis, and proper management are recommended. We present the case of a 35‑year‑old pregnant woman at the 34th week of gestation who presented via the emergency department complaining of sudden onset of dyspnea and chest pain. The clinical and radiologic evaluation confirmed the right‑sided pneumothorax. She had a closed tube thoracostomy drainage (CTTD) following which the patient’s condition improved. She subsequently had chest tube removal with no recurrence beyond delivery as she had a good outcome.</p> <p><strong>Keywords</strong>: Chest tube, COVID‑19, pregnancy, <em>spontaneous pneumothorax</em></p> Bolaji Abdulazeez Akanni, Ikponmwosa Gold, Ikechukwu Andrew Nwafor, John C. Eze Copyright (c) https://www.ajol.info/index.php/njm/article/view/209803 Thu, 01 Jul 2021 00:00:00 +0000 Primary Empty Sella Syndrome Presenting with Profound Bilateral Visual Loss https://www.ajol.info/index.php/njm/article/view/209806 <p>Primary empty sella syndrome (PESS) on background idiopathic intracranial hypertension (IIH) presenting with profound bilateral visual loss is a rare clinical occurrence. We report the case of PESS on background IIH in a 37‑year‑old obese Nigerian female. At presentation, she had a history of an insidious onset of loss of vision in both eyes with an associated history of headaches and tinnitus. Clinical examination and imaging studies revealed papilloedema and empty sella with a completely flattened pituitary gland. This report highlights that PESS could initially present to an ophthalmologist as a case of profound bilateral visual loss.</p> <p><strong>Keywords:</strong> Bilateral visual loss, diaphragma sellae, empty sella, idiopathic intracranial hypertension, primary empty sella syndrome</p> Ernest Ikechukwu Ezeh, Besong‑Ngem Akotanchi, Roseline Nkeiruka Ezeh Copyright (c) https://www.ajol.info/index.php/njm/article/view/209806 Thu, 01 Jul 2021 00:00:00 +0000 Primary Antiphospholipid Antibody Syndrome Presenting with Cortical Venous Sinus Thrombosis https://www.ajol.info/index.php/njm/article/view/209807 <p>No Abstract.</p> Abhishek Juneja, Kuljeet Singh Anand, Rakesh Kumar Mahajan Copyright (c) https://www.ajol.info/index.php/njm/article/view/209807 Thu, 01 Jul 2021 00:00:00 +0000 Erratum: Giant Communicating Hydrocele in a 36-year-old Nigerian Man https://www.ajol.info/index.php/njm/article/view/209809 <p>No Abstract.</p> Lawson Obazenu Copyright (c) https://www.ajol.info/index.php/njm/article/view/209809 Thu, 01 Jul 2021 00:00:00 +0000