Nigerian Medical Journal

The maslach burnout inventory-student version’s factorial structure and cross-cultural validity in a Nigerian university.

Kehinde Sunday Oluwadiya — 2024-03-26

Background: The Maslach Burnout Inventory (MBI) is the most widely accepted tool for assessing burnout among
students worldwide. However, no studies have yet tested the validity of the student version of the MBI in Nigeria. The
study aimed to assess the factorial structure and cross-cultural validity of the Maslach Burnout Inventory-Student
Version MBI-GS (S) in a Nigerian university.
Methodology: An online cross-sectional study was conducted among 536 undergraduate students from three
departments in the Faculty of Basic Medical Science at a Nigerian university. Data were collected using MBI-GS (S)
and a confirmatory factor analysis was performed to explore its factor structure.
Results: The results revealed that the three-factor, 15-item structure of the MBI-GS (S) demonstrated a valid factorial
structure among Nigerian undergraduate students, evidenced by the extraction of three components with eigen values
exceeding 1, accounting for 73.7% of the variance, in line with the three-factor structure of the original MBI. The
internal consistency of the questionnaire was high, with a Cronbach's alpha value of 0.901. The Cronbach's alpha for
emotional exhaustion, cynicism, and academic efficacy were 0.901, 0.841, and 0.941, respectively. A weak negative
correlation was observed between emotional exhaustion and cynicism, and a moderate negative correlation was found
between emotional exhaustion and academic efficacy, and cynicism and academic efficacy.
Conclusions: These findings suggest that the MBI-GS (S) is a reliable tool for assessing burnout levels among Nigerian
university students. They provide strong evidence for the factorial validity and reliability of the MBI-GS (S), supporting
its cross-cultural validation for assessing burnout.

Medical biomonitoring of maternal and fetal exposure to carbon monoxide and its modification by demographic and obstetric characteristics

Abbey Mkpe — 2024-03-26

Background: There is a paucity of organized human biomonitoring, including that of carbon monoxide (CO) in the Niger Delta, Nigeria. The study aims to quantify the impact of maternal exposure to CO in the first trimester of pregnancy and its modification by maternal demographic and obstetric factors.
Methodology: It was of cross-sectional design conducted at the Rivers State University Teaching Hospital (RSUTH) in Nigeria. Four hundred and ninety consecutive pregnant women in the first trimester were recruited from the antenatal clinic from January 2021 to January 2022. Demographic, social, and obstetric characteristics were recorded. Maternal exhaled CO concentration (ECOC) and maternal and fetal carboxyhaemoglobin concentrations (MCOHC and FCOHC) were measured with the aid of a smokelyzer. Data were analyzed, using SPSS version 25.0 software. Ethical approval was obtained from the RSUTH Ethics Committee.
Results: The mean values of ECOC, MCOHC, and FCOHC were 3.25±2.51 ppm, 1.15±0.40%, and 0.93±0.72% respectively and the severity (mild, moderate, and severe) of the impact was inversely proportional to the number of women affected. There were statistically significant differences in the mean values of ECOC, MCOHC, and FCOHC in the following maternal characteristics: age, educational levels, BMI, gravidity, and parity. In the case of FCOHC, the measures of the differences were as follows: p:<0.019, <0.020, <0.0001, <0.0001, and <0.038 for age categories, educational levels, BMI, gravidity, and parity respectively. There were statistically significant positive correlations between the BMI and the mean values of ECOC, MCOHC, and FCOHC.
Conclusion: The higher the severity of exposure to CO (mild, moderate, and severe), the lower the number of impacted pregnant women. There were statistically significant differences in the mean values of ECOC, MCOHC, and FCOHC in women of different ages, educational levels, BMI, gravidity, and parity categories.

The impact of health maintenance organizations in the implementation of the Nigeria national health insurance scheme in the federal capital territory (Abuja), Nigeria

Murtala Audu Ngabea — 2024-03-26

Background: The activities of Health maintenance organizations (HMO) are central to the achievement of universal health
coverage. This study sought to examine the number of HMOs actively operating in the FCT and to determine whether the
HMOs are promoting or inhibiting universal coverage and proffer recommendations for the overall progress of the scheme.
Methodology: A descriptive prospective cross-sectional study design was used and mixed (qualitative and quantitative)
methods A pre-tested interviewer-administered questionnaire make was used to collect quantitative data while qualitative
data were collected through a review of literature and in-depth interviews to examine the roles of HMOs from stakeholders’
points of view. A total of 250 participants comprised predominantly 230 enrollees into three major programs of the NHIS that
is the formal sector social insurance program (FS-SHIP), tertiary institution social health insurance program (TI-SHIP), and
community-based social health insurance program (CB-SHIP). The remaining 20 (twenty) enrollees comprised NHIA desk
officers, HMO managers, community-based representatives, and healthcare providers.
Results: The majority of the respondents (64.8%) reported a high level of awareness of the knowledge of NHIS, while fewer
than 19% indicated a lack of awareness as compared to 17% who did not respond to the question. Similarly, most of the
respondents (62.2%) reported having satisfactory knowledge of the structure-function modalities of HMOs, while 20.4% were
not aware of the mode of operation of HMOs.
Contrasting contributions of HMOs to NHIS implementation, approximately half of the respondents (50%) reported
dissatisfaction. Likewise, about 50% of the study subjects were of the view that HMOs are not putting the desired commitment
towards achieving this goal of universal health coverage. The report from the in-depth interview reiterated that the enrollees
were not well satisfied due to the perceived poor and inadequate operational mechanisms of both the HMOs and NHIS.
Conclusions: The study revealed a high level of awareness of the knowledge of NHIS and good working knowledge of the
structure and function of the HMOs. However, this study demonstrated a low understanding of the working interactions
between the NHIS and HMO, among the respondents. Understanding HMOs and how they work is critical for choosing a
health plan during open enrollment, hence, there is a need for more client enlightenment.

Neuroimaging findings in pediatric chronic headaches: Is imaging always necessary?

Ukamaka Dorothy Itanyi — 2024-03-26

Background: Considering the high cost of Magnetic Resonance Imaging and the high risk of radiation exposure to
growing children from Computed tomography scans, we aim to evaluate the neuroimaging findings in children with
chronic headaches, determine the frequency of significant remediable pathologies, and establish the need for
neuroimaging.
Methodology: This is a cross-sectional study of clinical data and neuroimaging findings in 41 children who were
imaged in a tertiary hospital and a private diagnostic center in Abuja on account of chronic headaches. Twenty-two
children were referred for brain Computed Tomography scan while 19 had brain Magnetic resonance Imaging. Collected
data was statistically analyzed using SAS software version 9.3 with the level of significance set at 0.05.
Results: The age range of patients was 4 -18years.Thirty-three patients (80.5%) had chronic primary headaches while
eight (19.5%) patients had additional “red flag” indications. Normal findings and extracranial lesions accounted for
89.5% of MRI (17/19) and 72.7% (16/22) in CT. Intracranial lesions were seen in 75% of patients with “red flag” and
6.1% of patients with primary headaches with significant differences (p=0.0001) between the subsets. The commonest
abnormalities were chronic sinusitis (17.1%) and intracranial tumors (9.6%) with no significant difference in the overall
neuroimaging findings across the age groups. Chronic sinusitis was found predominantly in adolescent females (85.7%).
Conclusions: Neuroimaging has a low yield of significant remediable intracranial lesions in children with chronic
headaches without additional “red flag” symptoms thereby necessitating the call to reconsider the use of neuroimaging
with a view to imaging gently.

Prevalence of gestational diabetes and pregnancy outcome of antenatal patients in Ilorin.

Akinyosoye Deji Ajiboye — 2024-03-26

Background: Gestational Diabetes mellitus (GDM) is fast becoming an important cause of maternal and perinatal morbidity and mortality. The objective of this study is to assess the prevalence and the perinatal outcome of gestational diabetes in an antenatal population.
Methodology: This was a cross-sectional study. The patients were pregnant women between 24-28 weeks of gestation without a prior diagnosis of diabetes mellitus. The consenting women were evaluated using fasting plasma glucose and oral glucose tolerance testing using 75 grams of glucose in 300ml of water orally.
Results: Two hundred and fifteen women participated in the study and the prevalence of GDM was 9%. The mean fasting plasma glucose was 4.04mmol/l at the time of the Oral glucose tolerance test (OGTT) and 5.78mmol/l after the oral glucose load. When compared with pregnant normoglycaemic patients, GDM patients had significantly fewer vaginal deliveries (p=0.05), higher birth weight (3.71kg), and more neonatal admissions (50%) Conclusions. Gestational diabetes mellitus is an important disease entity, and it is a cause of maternal and perinatal morbidities.

Prevalence, profile and treatment outcome of tuberculosis-human immunodeficiency virus co-infection in South Eastern Nigeria: A 3-year retrospective study

Ikechukwu kelechukwu Chukwuocha — 2024-03-26

Background: Tuberculosis (TB) and the Human Immune Deficiency Virus (HIV) represent major public health
challenges and are intricately linked to each other. This is more prevalent in the sub-Saharan African region, where
about 80% of this co-infection is recorded. This study aimed to review the prevalence, profile, and treatment outcome of
TB-HIV co-infected patients.
Methodology: A hospital-based retrospective study was conducted in a tertiary center in southeast Nigeria for the period
2015–2017. Information elicited from participant’s medical records included socio-demographic profile (age, sex,
residential area, and occupation), Cluster of Differentiation 4 (CD4) count level at the time of diagnosis of co-infection,
weight, treatment outcome, as well as the record of the number of TB patients who presented within this same period.
Results: The total number of TB/HIV co-infected patients who participated in the study during this period was 207, with
a prevalence of TB/HIV co-infection of 33.9%. The highest proportion of cases was recorded among participants within
the age group of 31–40, and the cases of co-infection were more common in males (58.9%) and students (27.5%). The
results also showed a significant relationship between gender, occupation, residential area, and TB/HIV co-infection.
Most of the co-infected participants had a CD4 count of <300 cells/mm3 and an associated poor treatment outcome of
41.1%.
Conclusions: TB/HIV co-infection needs to be properly addressed, and screening for HIV among TB patients should be
a priority. This will help in early diagnosis and subsequently improve the treatment outcome of both diseases.

Socio-demographic and nutritional factors associated with obesity amongst adults from high burden kidney diseases areas of Jigawa State, Nigeria: A community-based survey

Usman Muhammad Ibrahim — 2024-03-26

Background: Obesity is a preventable public health problem associated with a significantly increased risk of non-communicable diseases. This study aimed to find the socio-demographic and nutritional factors associated with obesity
amongst adults from high-burden kidney disease areas of Jigawa State, Nigeria.
Methodology: A cross-sectional survey was conducted to assess the socio-demographic and nutritional factors associated with
obesity among 361 adults from four local government areas (LGAs) of Jigawa state identified to have a high burden of kidney
diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed, and data were
analyzed using IBM SPSS version 22.0.
Results: The minimum age of the respondents was 18, and the maximum was 102 with a median of 45 (interquartile range =
30–80) years. The prevalence of obesity and overweight in the high-burden LGAs of Jigawa state was 33.0% and 27.1%
respectively. Hadejia LGA had the highest (68.1%) prevalence of obesity. The prevalence of overweight was higher in Jahun
LGA (38.9%). About one-third (38.2%) had a waist circumference (WC) greater than 88cm. Up to half of the female
respondents had a waist-hip ratio (WHR) greater than 0.85. For male respondents, many (74.3%) had a WHR of greater than
0.9, and obesity was significantly higher (39.8%, P s< 0.001) among those ≥40 years of age. Obesity was significantly higher
(39.8%,P < 0.001) among those ≥40 years of age, known diabetic, (57.1%, P=0.02), and rare consumption of vegetables,
(45.8%, P<0.001).The odds of developing obesity were significantly higher among those who were known diabetics and were
3 times more likely to be obese than those who were not known to be diabetics (adjusted odds ratio [aOR] = 3.1, 95% CI =
[1.1–8.9].
Conclusions: The prevalence of obesity was high in the areas with high burdens of kidney disease. The government and
relevant stakeholders should develop a cost-effective prevention, early diagnosis, and treatment model.

Knowledge and perception of telemedicine among medical students of the university of Jos, Plateau State, Nigeria

Nathaniel Birdling Noel — 2024-03-26

Background: Telemedicine has promising potential to address the challenges faced by healthcare systems in developing
countries, in providing equitable access to quality care. However, the practice of telemedicine is generally poor in these
countries. The success of telemedicine like any technology depends on numerous factors including users’ knowledge and
perceptions. Hence, this study aimed to examine the knowledge and perceptions of telemedicine among medical students at the
University of Jos.
Methodology: This was a cross-sectional study among 305 clinical medical students selected through a stratified sampling
technique. A self-administered questionnaire consisting of a 28-item 5-point Likert response scale was used to collect data,
comprising 13 items for knowledge, 8 for the perception of benefits, and 7 for the perception of ease of use of telemedicine.
Data was analyzed using IBM-SPSS.
Results: One hundred and eleven (36.4%) participants had good knowledge of telemedicine, while 113 (37.1%) had a good
perception of the benefits and 103 (33.8%) had a good perception of the ease of use. Respondents with a good knowledge of
telemedicine were about five times more likely (OR = 5.24, 95% CI = 3.15 – 8.69) to have a good perception of the benefits
and about eight times more likely (OR = 8.33, 95% CI = 4.57 – 14.26) to have a good perception of ease of use.
Conclusions: Few medical students possess desirable knowledge and perceptions of telemedicine, portraying a
gap in the medical education curriculum. Therefore, training and educational opportunities are recommended to improve their
knowledge and perception of telemedicine.

Evaluation of an undergraduate oral surgery curriculum – A pilot study

Olufemi Kolawole Ogundipe — 2024-03-26

Background
Following curricular revisions at the Faculty of Dentistry of the Obafemi Awolowo University, no formal evaluation of its
alignment and implementation has been carried out.
This study aimed to evaluate the alignment of an Oral surgery curriculum and to determine students’ learning experiences and
perceptions of the curriculum.
Methodology
This was a mixed-method study conducted at Obafemi Awolowo University, Ile-Ife, Nigeria. This ethically approved study
adopted a mixed-method descriptive approach to data collection and analysis. Data collection followed a sequential, phased
approach comprising document analysis, curriculum mapping, questionnaire survey, and focus group discussions.
Quantitative data collected via questionnaires were analyzed descriptively. Qualitative data from focus group discussions were
analyzed using a hybrid deductive-inductive thematic analysis by the researchers to generate relevant themes.
Results
The curriculum data reveal that the oral surgery course is well-aligned. Furthermore, each course outcome utilizes different
methods of assessments and teaching/learning activities (TLAs). Focus group discussions yielded four themes and two subthemes. The main themes included curriculum alignment, implemented teaching and learning activities, feedback, and
curriculum renewal, while the subthemes were recommended TLAs and student learning experiences.
Conclusions
The curriculum evaluation identified strengths of the course as multiple student assessment methods and potential areas for
improvement. These improvements included updating the content of the course and including more variety in teaching and
learning methods. The authors identified potential learning gaps that require curriculum renewal. Evaluation of the entire
program is recommended for comparison.

The new Nigerian mental health act: A huge leap before looking closely?

Oluyemi Oluwatosin Akanni — 2024-03-26

A new Mental Health law was recently enacted in Nigeria to replace the Lunacy Ordinance 1958. The passage of the
new law was a major leap from the old. It was received with excitement because the former law was not only outdated
but failed to address core issues such as the promotion of mental health and the protection of the rights of the mentally
ill. Though the new law adequately makes provisions for these, it has considerable flaws that may hinder
implementation. Parts of it lack clarity, and others are somewhat overzealous in safeguarding the mentally ill, thus
potentially defeating its purpose. It appears that certain aspects were not well thought out, or there was no ‘looking well’
before leaping to legislate. This paper aims to critically review flawed aspects of the new law and make
recommendations on the way forward.

Hemolytic uremic syndrome: A covid-19 vaccine reaction case report.

Thelma Alalbila Aku — 2024-03-26

The World Health Organization declared the Coronavirus disease of 2019 (COVID-19) a public health
emergency of international concern on 30 January 2020, and a pandemic on 11 March 2020. Vaccines have proven to be
vital in the effort to control and possibly eventually eradicate this viral infection. There have been reports of
thromboembolic events associated with the use of vaccine but from available information, no reported case of atypical
Hemolytic Uremic syndrome (HUS) in a black male has been described. We report a case of a 43-year-old black male
Sub-Saharan African c5dwho presented with chills, fever, and generalized body aches of 3 days duration after receiving
the second booster dose of the COVID-19 vaccine. He developed thrombocytopenia, hemolytic anaemia, and acute
kidney injury on admission, and an initial diagnosis of malaria was made. He was managed with parenteral artesunate
and then oral artemether/lumefantrine. His hemolytic anaemia was thought to be from malaria-associated hemolysis.
This diagnosis was however later re-evaluated to hemolytic uremic syndrome and managed with 50mg daily oral
prednisolone which resolved, and he resumed work a week later. Although mass vaccination is a key strategy to control
the spread of COVID-19, critical observations should be made to confirm the risk of trigger for abnormal complement
activation. Further observations should be made especially if it is a chimpanzee adenovirus-vectored vaccine.

Laparoscopic management of gall bladder diseases in Nigeria: A systematic review

Obinna Joseph Ugwu — 2024-03-26

Background: Globally, the incidence and mortality from gallbladder diseases is on the rise. The gold standard for the
management of symptomatic gallbladder disease is laparoscopic cholecystectomy. The practice of laparoscopic
cholecystectomy is at a nascent stage in Low and middle-income countries like Nigeria despite its obvious advantages over
traditional open cholecystectomy. This systematic review aims to assess the extent to which laparoscopic cholecystectomy is
performed for the management of gallbladder diseases in Nigeria.
Methodology: The review was guided by the PRISMA model. We searched MEDLINE, Embase, CINAHL, Scopus, and
Global health databases. All searches were conducted in August 2023. All study designs reporting laparoscopic
cholecystectomy in Nigeria, in the past 10 years were included. Three authors conducted the data extraction using data
extraction tables and two authors independently assessed the data for accuracy and completeness. The Joanna Briggs Institute
critical appraisal tool was used to assess the data quality. Twenty-two articles with 1569 patients were included in this review.
Results: Females accounted for 69.5% of the patients and 30.5% were males. Twelve (54.5%) of the studies were from the
Southwest of the country, 3 (13.6%) each from the South East and North Central regions, 2 (9.1%) South-South, and 1 (4.5%)
each from the North East and North West. Study designs were mostly cross-sectional with sample sizes from 1 to 400. The
highest and lowest number of laparoscopic cholecystectomies reported were 300 and 1 respectively. The majority (95.2%) of
laparoscopic cholecystectomies were on account of calculous cholecystitis and the methods reported were the 4-port and 3-
port techniques. The follow-up period ranged from 3 weeks to 2 years with 54 (3.4%) complications reported.
Conclusions: Laparoscopic cholecystectomy in Nigeria is relatively safe with minimal complications. Its demand and uptake
are on the rise, though slowly owing to its relatively high cost.