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   Table of Contents - Current issue
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September-October 2021
Volume 30 | Issue 5
Page Nos. 479-629

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EDITORIAL  

The benefits of universal adoption of unique identifiers for researchers Highly accessed article p. 479
Lawson Ohwofasa Obazenu, Akaninyene Eseme Ubom, Tijani Abdul-Rasheed Olalekan, Y Hassan Fahd, Temitope Toluse Selowo, Shehu Salihu Umar, Oladimeji Adebayo
DOI:10.4103/NJM.NJM_129_21  
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ORIGINAL ARTICLES Top

Sickle cell retinopathy: Patient awareness, mode of presentation, and treatment modalities in Ibadan, South-West Nigeria p. 481
Tunji S Oluleye, Yewande Olubunmi Babalola, Oluwole Iyiola Majekodunmi, Modupe A Ijaduola
DOI:10.4103/NJM.NJM_72_21  
Background: Sickle cell retinopathy is a recognized complication of sickle cell disease (SCD) which may lead to visual impairment or blindness. Despite this, many patients with SCD hemoglobinopathy SC and SS are unaware of their genotype, hence resulting in only occasional or no eye checks with possibilities of getting blind. Purpose: The purpose of this study was to describe the genotype awareness, pattern of presentation, and treatment of sickle cell retinopathy in Ibadan. Methods: This was a retrospective review of the case notes of 64 patients with the diagnosis of sickle cell retinopathy seen over two years (January 2018 to December 2019). Sociodemographic characteristics, clinical data, ophthalmic assessment, and treatment performed on patients were extracted onto pro forma. Information obtained included age, sex, sickle cell genotype, genotype awareness from their medical history, retinal findings using Goldberg classification, and treatment modalities for the patients. Data analysis was performed using the IBM SPSS software version 22. Analysis was done using proportions and percentages. Results: Medical records of 64 patients were reviewed. The mean age of the patients was 39.05 ± 10.48 (range: 20–65) years, with a male-to-female ratio of 1.8:1. Sixty (93.8%) patients had genotype SC. Forty-six (71.8%) patients were aware of their genotype. Fifty-six patients presented with Proliferative sickle cell retinopathy (PSR) in the right eye, while 55 had PSR in the left eye. These spanned all the different grades of PSR. Treatment offered at the first visit included laser photocoagulation, intravitreal anti-vascular endothelial growth factor (bevacizumab), vitrectomy, and scleral buckle. At subsequent follow-up visits, detailed ocular examination on patients was done to look out for new/active lesions. If any of these lesions were found, repeat or additional treatment was offered to help stabilize and/or improve the best-corrected visual acuity of patients. Conclusion: This study has demonstrated high genotype awareness among the studied patients. Despite this high awareness, majority of our patients presented with varying stages of proliferative sickle cell retinopathy. While our patients had more than one type of treatment, some defaulted due to lack of funds. Therefore, to improve the quality of life of SCD patients, it is essential for health-care providers and other stakeholders to design policies for sustainable and accessible eye care programs to avoiding needless blindness from sickle cell retinopathy.
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Clinical practice satisfaction and quality of life among early-career doctors in Nigeria p. 487
Olumuyiwa Folayan, Abimbola Amoo, Dabota Buowari, Abdulmajid Yahya, Kehinde Kazeem Kanmodi, Shehu Salihu Umar, Olayinka Stephen Ilesanmi, Oluwatoba E Osasona, Umar Wasinda Francis, Oluwaseyi Ogunsuji, Mumeen Olaitan Salihu, Esele Fortunate Ekuaze, Alatishe Taiwo Adedamola, Rereloluwa N Babalola, Iyanu Adufe, Okhuaihesuyi Uyilawa, Adedayo Williams, Lawson Obazenu, Oladimeji Adebayo
DOI:10.4103/NJM.NJM_107_21  
Introduction: Job satisfaction and quality of life (QOL) are critical issues among early-career doctors (ECDs) in Nigeria; however, there is a paucity of data on these two issues. This study explored job satisfaction and QOL among ECDs in Nigeria. Methods: It was a cross-sectional study that used a self-administered questionnaire to collect data on sociodemographic and job satisfaction parameters from 667 ECDs in seven Nigerian tertiary hospitals. The World Health Organisation QOL-BREF tool was used to assess their QoL. Results: Results showed that the ECDs were satisfied with their career choice; however, they were not satisfied in the areas of remuneration, workload, and work environment. Furthermore, QOL was fairly above average, with the lowest scores reported in the environmental domain and only a slight male-to-female difference in the physical domain. Conclusion: Clinical practice dissatisfaction among ECDs could negatively impact healthcare service delivery. Therefore, it is recommended that the quality of the workplace environment and infrastructure in society at large should be improved upon by various stakeholders. This will positively impact the QoL of ECDs and enhance optimal healthcare delivery to the nation's teeming population.
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Predictors of anemia in Type 2 diabetes mellitus without renal disease p. 494
Ernest Yorke, Nana Ama Barnes, Josephine Akpalu, Eunice Boafo, Albert G B Amoah
DOI:10.4103/NJM.NJM_131_21  
Background: Among type 2 diabetes mellitus (T2DM) patients without renal disease, hemoglobin levels tend to be lower than their counterparts without diabetes mellitus with a similar estimated glomerular filtration rate. Low hemoglobin levels have been associated with increased morbidity. Objective: We sought to determine the predictors of anemia among T2DM patients without renal disease attending the diabetes center at a tertiary teaching hospital in Accra, Ghana. Materials and Methods: One hundred and ninety-five type 2 diabetes patients aged 35 years and above without overt nephropathy and 184 controls without diabetes were recruited from the National Diabetes Management and Research Center and Orthopedic Outpatients Clinic of the KBTH, respectively. Both groups had full blood count, red cell indices, serum creatinine, and glycated hemoglobin determination as well as medical history and anthropometric measurements. Results: Seventy-nine percent of cases and 75.5% controls were females. The prevalence of anemia among participants with diabetes mellitus was 53.1% compared with 20.5% among controls (P = 0.00). In both groups, more males than females were anemic (68.3% cases, 51.1% controls). The mean duration of diabetes was 9.6 ± 6.22 years among the cases. Logistic regression revealed male gender and diabetes duration >10 years as significant predictors of anemia without renal disease in individuals with T2DM. Conclusion: The prevalence of anemia among T2DM participants without overt renal disease was two and half times the rate in control participants without diabetes mellitus. Physicians would be aware and take appropriate steps to identify and manage it to reduce associated morbidity.
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Contraction techniques adopted for pelvic floor muscle exercise education by Nigeria-based physiotherapists: A preliminary study p. 501
Chidiebele Petronilla Ojukwu, Precious Chidiebere Orji, Stephen Sunday Ede, Anne Ezeigwe, Chigozie Ikenna Uchenwoke, Emelie Anekwu, Sylvester Emeka Igwe
DOI:10.4103/NJM.NJM_93_21  
Objective: The objective of the study is to investigate contraction techniques adopted for pelvic floor muscle (PFM) exercise education and their perceived efficacies among physiotherapists in Nigeria. Materials and Methods: Two hundred and eight conveniently selected physiotherapists in various clinical specialties, working in different hospitals across Nigeria, responded to a structured questionnaire that investigated contraction techniques adopted for PFM exercise education and their perceived efficacies. The data was analyzed with the SPSS software version 20.0 at P = 0.5. Results: 111 male and 97 female physiotherapists (mean age of 34.2 ± 10.3 years) participated in this study. “Imagination of urinating and suddenly interrupting urine flow” (85.9%) and “gripping of therapist's fingers or vaginal electrodes with the vagina” (44.6%) were the commonly utilized contraction techniques. “Imagination of urinating and suddenly interrupting urine flow” (28.8%) and “imagination of gripping the penis with the vagina” (26.4%) were perceived as the most effective methods by the physiotherapists while “imagination of releasing flatus while attempting to obscure its sound” (0.96%) emerged as the least effective methods. Conclusion: “Imagination of urinating and suddenly interrupting urine flow” is the most common contraction technique utilized for PFM education by Nigerian physiotherapists as well as the perceived most effective method, as compared to others.
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Androgenetic alopecia: Prevalence and clinical characteristics in a South-West Nigerian population p. 507
Sebastine Oseghae Oiwoh, Adeolu Oladayo Akinboro, Olayinka Abimbola Olasode, Emmanuel Olaniyi Onayemi
DOI:10.4103/NJM.NJM_102_21  
Introduction: Androgenetic alopecia (AGA) is a type of nonscarring alopecia with prevalence, pattern, and severity that have not been documented extensively in Nigeria and Africa. This study aimed to document AGA's prevalence and clinical characteristics among adults in Ogbomoso, Southwestern Nigeria. Methods: A community-based cross-sectional study of 260 consenting adults with AGA and 260 age- and sex-matched controls through a multistage sampling method. The survey for AGA was done using a pretested questionnaire. Data were analyzed with IBM SPSS version 20. Results: The overall prevalence of AGA was 29.95%, with a gender prevalence of 24.88% and 5.06% for men and women, respectively. The mean age of AGA was 51.32 ± 16.31 years, with a range of 24–90 years and male-to-female ratio of 4.9:1. The prevalence of premature AGA was 0.38%. Grade II vertex (13.8%) and VI (10.4%) were the most frequent male androgenetic alopecia severity grades, while grade IVa was the least common. Ludwig I was the most frequent female androgenetic alopecia severity grade (7.7%), followed by Ludwig II (6.9%) and III (2.3%). The mixed type of baldness was the most common (73.6%) phenotype, followed by frontal (20.8%), and vertex (4.2%) in men. Conclusion: Overall prevalence of AGA was 29.95%. The prevalence varies with location, age and gender with paternal family history as a significant risk factor. The mixed type of baldness is the most common phenotype.
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Childhood dead-before-arrival at a Nigerian tertiary health facility: A call for concern and improvement in health care delivery p. 514
Adewuyi Temidayo Adeniyi, Bankole Peter Kuti, Samuel Ademola Adegoke, Oluwasola Julius Oke, Theophilus Adesola Aladekomo, Oyeku Akibu Oyelami
DOI:10.4103/NJM.NJM_100_21  
Background: Dead-before-arrival (DBA) is a term used to describe patients who had no sign of life at the time of presentation to the hospital. Little information exists about it in children. This study sets out to determine the prevalence and pattern of DBA among children presenting to a tertiary health facility in Nigeria. Materials and Methods: Standardized verbal autopsy was used to ascertain the details about children aged 1 month to 14 years who were cases of DBA at the Children Emergency Ward of the Wesley Guild Hospital, Ilesa, Nigeria, over 12 months. Socio-demographic history, symptoms before demise, treatment received, and suspected cause (s) of death were documented. The prevalence of DBA was compared to the in-hospital mortality during the period. Results: A total of 64 (7.4%) of the 863 emergency admissions were cases of DBA. Median (interquartile range) age was 18.0 (8.0–52.5) months, male: female was 1.7 and over 78.1% were under-fives. Infections such as malaria, sepsis, and gastroenteritis were the most common suspected causes of death, followed by accidental injuries from a road traffic crash, drowning, and aspirations. Cases of DBA were significantly higher than in-hospital mortality during the study period (7.4% vs. 5.6%). Conclusion: In-hospital mortality may be a tip of the iceberg as cases of DBA, and those who did not present to the hospital at all may take the lion share of childhood mortality. Making basic health care available and affordable to the populace may help reduce the burden of DBA.
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Lipid profile in breast cancer patients: A case-control study done at a public tertiary hospital in Ibadan Nigeria p. 519
Adeniyi Adedayo Olabumuyi, Abbas Adesina Abdus-Salam, Babatunde Olutoye Ogunnorin, Modupe Akinrele Kuti
DOI:10.4103/NJM.NJM_23_21  
Background: Breast cancer, the leading malignancy among women in Nigeria in terms of incidence and mortality, contributes a greater proportion of cancer burden compared with other cancers in Nigeria. A need to further identify and modify risk factors of breast cancer is necessary to apply preventive medicine and decrease its disease burden. Serum lipid profile is an objective index of fat metabolism, but its relationship with breast cancer is yet to be extensively investigated in our environment. Aim: To explore the relationship of serum lipid profile with breast cancer in the University College Hospital, Ibadan. Methods: The anthropometry, body fat percentage and lipid profile of 70 patients with breast cancer and 71 age-matched controls were studied. Statistical Analysis: Differences in the mean values of the lipid profile parameters were tested for significance using the Student's t-test and Mann–Whitney U test. Results: The breast cancer patients had statistically significantly higher serum triglyceride (TG) and very low-density lipoprotein cholesterol (P < 0.001). This was also an independent risk factor with multivariate analysis. Demonstrating the odds of breast cancer rose by 5.1% (odds ratio = 1.051, P < 0.001) with each 1 mg/dl rise in serum TG. Conclusion: There is potential for serum TG to be utilized as a marker of breast cancer. However, this needs to be determined by more elaborate studies.
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Knowledge and awareness of pregnancy-related hypertension and utilization of exercises as its preventive strategies: Survey of pregnant women in Enugu State, Nigeria p. 526
Chidiebele Petronilla Ojukwu, Anne Uruchi Ezeigwe, Obiageli Theresa Madu, Chidinma Goodness Mba, Elizabeth Godwin Nseka
DOI:10.4103/NJM.NJM_108_21  
Introduction: Pregnancy-related hypertension (PRH) is the leading cause of maternal and fetal morbidity and mortality. Knowledge and prevention strategy of PRH among pregnant women is imperative to promote favourable outcomes. This study examined the knowledge and awareness of PRH, including exercises as a preventive strategy and factors related to it, among pregnant women in Enugu, Nigeria. Materials and Methods: The study utilized a cross-sectional design. A structured questionnaire guided the collection of data from a sample of 296 women aged 18 years and above in multiple centres across the state. Results: 68.6% of respondents know PRH, while 52.36% know antenatal exercises as a preventive strategy for PRH. The level of education and maternal age were factors significantly associated with knowledge of PRH and exercises as a preventive strategy, respectively. Conclusion: The study concluded that knowledge of PRH is high, while the knowledge and use of exercises to prevent the condition is average among expectant mothers.
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Substance use and associated factors among junior students in a public secondary school in an urban local government area in Rivers State, Nigeria p. 532
Esther Ibinabo Azi, Omosivie Maduka
DOI:10.4103/NJM.NJM_51_21  
Background: Adolescents (aged 10–19 years) are at risk of using substances, as they are known to be impressionable and eager to please. This study set out to investigate the prevalence of substance use and associated factors among junior secondary students (JSSs) in Obio-Akpor Local Government Area (LGA), Rivers State, Nigeria. Methods: A descriptive cross-sectional study employing two-stage sampling was used in this survey to select 398 JSSs in a public secondary school in Obio Akpor LGA. Data were collected using an adapted self-administered WHO Students' Drug Use Questionnaire, analyzed using IBM SPSS version 21.0 software, and statistical significance was set at P < 0.05. Results: The mean age of the respondents was 12.9 (standard deviation = 1.6) years with males accounting for 179 (45%) of respondents. The lifetime prevalence for substance use was 37 (9.4%), while those currently using substances were 4 (1.0%). Alcohol ranked the highest with 17 (45.9%) as the most frequently used substance. Eight (50%) respondents cited street vendors as their main source of getting substances. Of those who used substances, 4 (50%) did so to boost their intelligence. More males reported substance use and this was significant (χ2 = 5.1, P = 0.02; adjusted odds ratio [AOR] =2.08, 95% confidence interval [CI] = 1.03–4.21) and being in Class 2 and 3 (AOR = 2.33, 95% CI = 1.11–4.88) predicted the likelihood of ever using substances. Conclusion: Substance use is present among JSSs though the prevalence is low. This presents an opportunity for primary prevention activities to address future substance use in this age cohort.
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Pattern of diabetic retinopathy in a tertiary healthcare facility in Southern Nigeria p. 538
Chineze Thelma Agweye, Affiong Andem Ibanga, Martha-Mary Ekong Udoh, Ofem E Enang, Anthony Ikechukwu Nwajei, Dennis George Nkanga
DOI:10.4103/NJM.NJM_216_20  
Objective: The objective is to determine the pattern and prevalence of diabetic retinopathy (DR) among patients living with diabetes mellitus. Methodology: Descriptive cross-sectional study in a tertiary hospital. Questionnaires were used to obtain data from eligible participants. Visual acuity measurement, fundal examination, and photography were performed together with fasting blood glucose and glycated hemoglobin A1c. The Statistical Package for Social Sciences (SPSS) for Windows version 20 was used for data analysis. Results: Overall 200 patients were enrolled of which 75.5% were female. The participant's mean age was 53.8 ± 11.7 years. DR was present in 53/200 (26.5%) of participants, of which 52 (98.1%) had nonproliferative DR (NPDR), and 1 (1.9%) had proliferative DR (PDR). NPDR was mild in 44/53 (83.0%) and moderate in 8/53 (15.1%) patients. Evidence of sight-threatening DR was found in 37/200 (18.5%) of participants (36 had diabetic macular edema and 1 had PDR + DMO). Conclusions: DR was present in 26.5% of the study participants, and 18.5% had sight-threatening DR mainly due to DMO. This finding underscores the need for routine screening of all people living with diabetes to detect early DMO and provide treatment to prevent visual loss.
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Determinants of Nigerian medical doctors' willingness to practice in foreign countries p. 543
Mansur A Ramalan, Rayyan M Garba
DOI:10.4103/NJM.NJM_111_21  
Background: Despite the poor doctor–patient ratio in Nigeria, which is far below the World Health Organization's recommendation, Nigerian doctors are known to contribute a significant proportion of the medical workforce in other countries, especially in the United Kingdom (UK) and the United States of America (USA). Aim: This study aimed to assess Nigerian medical doctors' willingness to practice in foreign countries, as well as the possible push and pull factors contributing to this brain drain. Methodology: A cross-sectional survey was conducted, and 329 medical doctors were selected from a list of doctors who were attending the Annual Delegates Meeting of the Nigerian Medical Association, using a systematic random sampling technique. A semistructured self-administered questionnaire was used to obtain the information from the selected respondents. Results: All selected respondents agreed to participate in the study. The mean age of the participants was 41.4 ± 6.3 years, 85.9% of them being males and 75.7% being Christians. About 36% of the respondents had medical fellowship, 31.6% were resident doctors, and 16.4% had only an MBBS degree. The median duration of practice was 12 years, and the median monthly income was ₦420,000.000. About 72.9% of the respondents were willing to practice in foreign countries if given the opportunity, 29.2% of whom preferred the USA, 25.1% preferred the UK, and 15.7 preferred Australia. Among those not willing to practice in foreign countries, 48.3% preferred working in Nigeria despite all the challenges and 32.2% was due to family and other personal reasons. Among those willing to practice in foreign countries, about 66.3% was due to poor financial incentives/working environment, 46.5% due to insecurity, and 38% due to inter-professional rivalry in the health sector. The following factors were found to be independent (intrinsic) determinants of willingness to practice in a foreign country: Geopolitical zone of origin, highest educational qualifications, duration of practice, and average monthly income. Conclusion: It is a big threat to the Nigerian health system for the majority of its doctors to be willing to leave the country. Hence, the need for governments at all levels to, as a matter of urgency, address the factors responsible for this drive.
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Knowledge, attitude, and practice of preventive measures against COVID-19 among pregnant women receiving antenatal care in Calabar, Nigeria p. 548
Ezukwa Ezukwa Omoronyia, Edu Eyong, Ogban Ezukwa Omoronyia, Ubong Akpan, Kazzeem Arogundade, Etim Inyang Ekanem
DOI:10.4103/NJM.NJM_16_21  
Background: Implementation of preventive precautions remains the most important measure in the control of coronavirus 2019 (COVID-19) infection. This study was aimed at evaluating the extent of knowledge, attitude, and practice of COVID-19 prevention among pregnant women in Calabar, Nigeria. Methodology: Cross-sectional descriptive design and systematic random sampling method were utilized to recruit antenatal care clinic attendees, in the University of Calabar Teaching Hospital, Calabar, Nigeria. Study variables were assessed using structured questionnaires. Information was entered and analyzed with SPSS version 21.0. A percentage knowledge score of at least 75% was considered satisfactory. P-value was set at 0.05. Result: Two hundred and eighty-four women were studied and the mean age was 30.6 ± 5.0 years. Approximately half of the women (51.4%) were within the third trimester of pregnancy. The mean percentage knowledge score was 71.7% ±17.2%, and the overall level of knowledge was unsatisfactory in 43.3% of respondents. Most women agreed with the reality of existence of COVID-19 infection (90.1%), and 30.6% were of the opinion that the pandemic could be eradicated by prayers alone. Most women practised preventive measures including the use of face mask (89.1%), social distancing (84.2%), and regular handwashing (94.4%). There was a significantly higher mean total knowledge score as well as knowledge of preventive measures among users compared with non-users of face mask, and regular subjects were compared with non-regular subjects with regards to their handwashing practice (P < 0.05). Conclusion: Familiarity with COVID-19 prevention among pregnant women in the study context is suboptimal. There is a need to improve maternal health education provided during antenatal care visits, toward addressing misconceptions related to the pandemic.
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Antepartum depression among women attending antenatal clinic in a Nigerian teaching hospital p. 556
Dauda Sulyman, Muhammad Baffah Aminu, Kazeem Ayinda Ayanda, Lamaran Makama Dattijo
DOI:10.4103/NJM.NJM_56_21  
Background: Antepartum depression is a clinical depression occurring at any stage of pregnancy. The cause of antepartum depression might be a combination of hormonal changes and psychological factors. Antepartum depression can affect the course and outcome of pregnancy. Objectives: This study aimed to find the prevalence rate of antepartum depression and its determinant among women attending antenatal clinics. Methodology: The study was a cross-sectional questionnaire-based survey conducted among pregnant women at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. With the use of the Edinburgh Postnatal Depression Scale, depression was screened among the respondents with the cutoff point of 13. Results: The study comprised 320 pregnant women. The majority (64.4%) of the respondents were below the age of 30 years. The predominant religion was Islam (58.7%). Twenty of the respondents were unmarried (6.2%). Only 2.5% had no formal education. Eighty-five of the respondents reported not having adequate support from their partners. Only 30% of the respondents were in their first pregnancy, and more than 66% were in their third trimesters. The prevalence rate of severe depression was 18.4%. Factors associated with antepartum depression were lack of support, first pregnancy, and third trimesters. Conclusion: This study found that a sizeable proportion of pregnant women attending antenatal clinics suffered from depression and highlighted factors associated with this. There is a need for screening for depression among pregnant women.
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Postgraduate career and emigration intentions: A cross-sectional study of house officers in a North Central, Nigerian Tertiary Hospital p. 561
Azuka Chinweokwu Ezeike, Akanimo Onaolapo Ebong
DOI:10.4103/NJM.NJM_95_21  
Background: Postgraduate career decisions and emigration intentions of medical graduates determine the quality of a nation's health system. Evaluating these choices help in developing evidence-based health plans and reforms. Objective: The aim of this study was to evaluate the postgraduate career and emigration intentions of House Officers in National Hospital Abuja. Methodology: This was a cross-sectional study of postgraduate career and emigration intentions of medical interns done in National Hospital Abuja from June to July 2020. Using a structured questionnaire, information was obtained on the sociodemographic data, undergraduate and internship experience, postgraduate career intention, specialty preference, and emigration intentions of the interns. Data were analyzed with SPSS version 23. Results: A total of 90 questionnaires were distributed with a 76% response rate. The mean age of the respondents was 26.23 ± 1.77 years with mean internship duration of 10.51 ± 1.58 months. Most were single 63 (91.3%) and 44 (63.8%) were females. While 52 (75.4%) opted to specialize, 50 (78.1%) had intention to emigrate. Surgery (32.7%) and obstetrics and gynecology (28.9%) were the most commonly desired specialties. Personal interest was the greatest determining factor for specialty choice (90.4%), while better working conditions were the most commonly reported driving force for emigration (51.6%), and the United Kingdom (52%) was the most commonly desired emigration destination. Conclusion: A high number of respondents had interest in specialization with a greater interest in the surgical specialties. Most also had the intention to immigrate to Western countries with the United Kingdom as the most preferred destination.
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Experience and perception of virtual clinical conferencing during COVID-19 pandemic by doctors at the university of Nigeria Teaching Hospital Enugu, Nigeria p. 567
Cyril Chukwudi Dim, Johnpaul Ejikeme Nnagbo, Ekeoma O Nwosu, Emmanuel Onyebuchi Ugwu, Obinna Donatus Onodugo
DOI:10.4103/NJM.NJM_125_21  
Background: The first wave of the COVID-19 outbreak resulted in the restriction of physical meetings/gatherings worldwide as part of disease preventive measures. This restriction affected formal teaching and learning globally, including medical residency training programs in Nigeria. To sustain educational meetings during the COVID-19 disease outbreak, the Postgraduate Studies unit of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria, directed all clinical departments of the hospital to switch from physical meetings to virtual video conferencing (VVC). Aim: To determine the experience and perception of VVC during COVID-19 by resident doctors and their consultants in UNTH Enugu, Nigeria. Materials and Methods: Questionnaires were administered to 220 consenting medical doctors randomly selected from the population of resident doctors (trainees) and Consultants (trainers) at the UNTH, Enugu, Nigeria. The data were collected by an online generated Google form (self-administered questionnaire), some of which were printed and self-administered. Data analysis was done with SPSS version 20.0. Results: Out of 220 participants, 202 participants filled the questionnaires appropriately and were analyzed. Of the participants, 196 (97.0%) participated in VVC since COVID-19. Only 107 (54.6%) agreed they were satisfied while 89 (45.4%) were not satisfied. Only 108 (55.1%) respondents agreed that they preferred virtual meetings over physical meetings. A majority of respondents (79.1%, 155/196) preferred physical meetings over virtual meetings. The most common reason for preferring VVC over the physical meeting is its convenience, whereas in the converse, the commonest reason is its ability to cover all the academic programs. Conclusion: There is an improved participation level in academic residency programs by residents and consultants since the introduction of VVC, during the COVID-19 pandemic at UNTH Enugu.
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The effect of training and provision of logistic support on disease surveillance and notification system in private health facilities in Enugu State, Nigeria p. 573
Ntat Charles Ibiok, Elias Chikee Aniwada, Edmund Ndudi Ossai, Emmanuel Amechi Nwobi, Benjamin S C Uzochukwu
DOI:10.4103/NJM.NJM_226_20  
Introduction: Rapid notification of infectious diseases is essential for prompt public health actions and monitoring disease trends at local, state and national levels. Disease surveillance is the backbone of Health Management Information system (HMIS). The study assessed the effect of training and provision of IDSR forms on disease surveillance and response in selected private hospitals in Enugu state. Methodology: The study was a quasi-experimental study that compared the study and control groups “before and after” an intervention (training and provision of IDSR forms). The intervention group received training and supplies if IDSR forms while the control group did not. A multistage sampling technique was used to select 400 participants from one hundred and four private hospitals in eight selected LGAs in Enugu East and Enugu North Senatorial Districts. Baseline data were collected followed by intervention. After six months waiting period post-intervention data were collected. A Questionnaire and observational checklist were used. Pearson and McNemar chi-square tests were employed. The level of statistical significance was set at p < 0.005. Result: At baseline, most knowledge and practice variables were poor (< 50%). The mean score of knowledge and practice between the groups at baseline was not significant (knowledge p=0.203 and practice p= 0.138). However, six months post-intervention there were significant increases in proportion for both knowledge and practice for study (McNemarχ2 p < 0.001) but not so control group. There was no statistically significant association of knowledge and practice with socio-demographic characteristics for both groups. Conclusion: Training of HCWs and provision of IDSR forms caused significant improvement in both knowledge and practice of disease notification and reporting in the private healthcare sector.
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Healthcare-seeking behavior of parents and guardians of school children with skin diseases in Umuahia, South East Nigeria p. 581
Odochi Ewurum, Chikaodili Adaeze Ibeneme, Thomas O Nnaji, Anthony Nnaemeka Ikefuna
DOI:10.4103/NJM.NJM_103_21  
Background: Skin disorders are often not regarded as major health problems although they may be an early sign of a serious disease. This attitude may affect the healthcare-seeking behavior of either the parents or guardians of school children that have skin diseases. Knowledge of the source of treatment and care for diseases of the skin will assist in the implementation of important skin health education programs and appropriate measures for the prevention of their diseases. Objective: To identify the source of accessing health care and the factors influencing healthcare-seeking behavior of parents/guardians of primary school children with diseases of the skin in Umuahia, South-East, of Nigeria. Subjects and Methods: This was a descriptive cross-sectional study carried out over a four-month period. To select the school children multistage sampling was used. A structured questionnaire administered by the interviewer was used to obtain relevant information. Diagnosis of skin disorder was by clinical examination and laboratory investigations. Analysis of the data was done using SPSS version 20. Results: Skin diseases were identified in 627 (40.2%) out of the 1560 primary school pupils aged 5–15 years. Of the 627 children with skin diseases 423 (67.4%) sought health care outside the hospital while only 204 (32.6%) sought medical care in the hospital. Long waiting time (31.0%) and cost of hospital care (26.6%) were observed to be the most frequent reasons for not seeking medical care from the hospital. Conclusion: About two-third of parents/guardians of school children with skin diseases access health care outside the hospital. Cost of care and waiting time should be reduced to enable access to hospital care.
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The outcome of intervention, characteristics, and determinants of treatment failure in HIV-infected adolescents on first-line antiretroviral therapy at a tertiary health institution, in South-east Nigeria p. 586
Maria-Lauretta Orji, Nnamdi Benson Onyire, James Olisaluka Ojukwu, Cecilia Oluchukwu Oyim-Elechi
DOI:10.4103/NJM.NJM_90_21  
Background: The adolescent phase of life is characterized by the desire for independence, experimentation, and heightened peer influence. These may affect HIV prevention, care, treatment, and support in adolescents. Objective: This study was aimed at determining the outcome of intervention and factors responsible for treatment failure among adolescents on first-line antiretroviral therapy (ART). Materials and Methods: It was an interventional cohort study that studied 88 adolescents on ART. An interviewer-administered questionnaire was used to collect the data on sociodemographics. Assessment of adherence was done by pill count and self-reports. Reverse transcriptase polymerase chain reaction was used to quantify the amount of HIV RNA in participants. Results: A total of 22 (25.0%) out of 88 adolescents had viral load assays of ≥1000 copies/ml despite being on first-line ART for a mean period of 5.70 ± 3.21 years. After enhanced adherence counselling (EAC) of three months, 10 (44.5%) of the 22 adolescents achieved viral suppression (<1000 copies/ml). Being tired of taking drugs was the major reason (41.1%) for non-adherance to ART. There were significant relationships between treatment failure and age (P = 0.010), gender (P = 0.024), socio-economic class (P = 0.020), orphan status (P = 0.010), type of ART (P = 0.008), HIV status disclosure (P ≤ 0.001), and sexual experience in the adolescent (P ≤ 0.001). Conclusion: Viral suppression rate after EAC was low. There is a need to address modifiable factors that influence viral non-suppression in adolescents through adolescent-friendly and responsive services geared toward counselling, skill acquisition, and empowerment to help adolescents navigate this stage of life.
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Assessment of adherence to antiretroviral therapy, associated factors, and relationship to CD4 cell count recovery among HIV-positive adolescents p. 592
Nonso Anthony Ogbuefi, Ebelechuku Francesca Ugochukwu, Chinyere Ukamaka Onubogu, Emeka Stephen Edokwe, Kenneth Nchekwube Okeke
DOI:10.4103/NJM.NJM_121_21  
Background: Adherence to antiretroviral therapy (ART) in HIV-positive adolescents (HPAs) is an enormous challenge in pediatric HIV management. Suboptimal adherence (OA) encourages treatment failure and HIV transmission. Several factors are inimical to OA, among HPA. Objective: The factors which influence adherence to ART in HPA accessing care in Nnewi, Nigeria, were determined. Subjects and Methods: One hundred and fifty HPAs, aged 10–19 years, who had been on ART for at least 6 months were recruited; 75 each for groups 10–14 and 15–19 years. Sociodemographic data were collected using interviewer-administered questionnaires. Relevant clinical data were retrieved from medical records, and current CD4 cell counts assayed. Results: There were 77 males and 73 females. OA to ART was defined as intake of ≥95% of antiretrovirals over a given period. Using pill count (PC), 74.7% (112/150) had OA. Using the preceding 28-day self-report (P28DSR), 84.0% (126/150) had OA, while for the preceding seven-day self-report (P7DSR), it was 89.3% (134/150). Factors significantly associated with sub-OA were tertiary education, missed clinic visits, travel time to facility ≤1 h, persistent feeling of sadness, and fear of death. Subjects with OA had a significantly higher rate of CD4 cell count recovery compared to those having sub-OA. Conclusion: Sub-OA is common in HPA and can be assessed with a combination of PC and preceding P28DSR, in resource-poor settings. As OA is crucial to CD4 cell count recovery, the latter can be useful in monitoring adherence in HPA.
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Disclosure of human immune deficiency virus status to infected children at a tertiary hospital in North-western Nigeria p. 601
Bilkisu Nwankwo, John Alexander Oluchukwu, Nafisat Ohunene Usman
DOI:10.4103/NJM.NJM_119_21  
Background: With the advent of highly active anti-retroviral therapy, human immunodeficiency virus (HIV)-infected children are surviving into adolescence and adulthood. Disclosure of HIV-positive status is important for the life-long management of HIV. However, disclosing HIV-positive status is a challenging task due to the associated blame, shame, and potential stigma. Aim: The aim of this study is to assess the prevalence of disclosure to HIV-infected children and associated factors in a tertiary hospital in North-west Nigeria. Materials and Methods: A descriptive, cross-sectional study was carried out. Fifty-two parents/caregivers were interviewed using a pretested interviewer-administered questionnaire. The questionnaire had three sections: sociodemographic characteristics of caregivers, child's profile, and determinants of disclosure of HIV status. Data were collected and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 21, and results were presented using the tables. The Chi-square test was used to test for the association. Fisher's exact test was used where conditions for the Chi-square test were not met. P < 0.05 was statistically significant. Results: The prevalence of disclosure of HIV-positive status to HIV-infected children was 32.7%. Children's age (P = 0.003) and their level of education (P = <0.001) had significant associations with the disclosure. The most common (9, 52.9%) reason given for disclosure was persistent questioning of caregivers about reasons for taking medication despite not being ill. Conclusion: The prevalence of HIV status disclosure to HIV-positive children was low in this study. Health-care workers can provide support to encourage and better prepare parents/caregivers for the process of disclosure.
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Helicobacter pylori infection a risk for upper gastrointestinal diseases among patients in North Central Nigeria p. 607
Kefas P Zawaya, Jacob A Dunga, Yakubu Adamu, Sule J Bathnna, Haruna U Liman, Jafiada J Musa, Sulaiman Y Yusuf, Innocent Vakkai, Ruth Adabe, EN Okeke, EI Agaba
DOI:10.4103/NJM.NJM_45_21  
Background: Since the discovery of the Upper Gastrointestinal (UGI) fiber optic endoscope machine in 1868 and following the discovery of Helicobacter pylori (H- Pylori) infection and its association with most gastroduodenal diseases in 1983 by Robin Warren and Barry Marshal, Our knowledge of diagnosis and treatment of most UGI diseases has significantly improved. Aim: The study aimed to establish the presence of H. pylori as a risk factor for common UGI disease as confirmed by UGI endoscopy and the pattern of findings in UGI endoscopy. Methodology: This study is a descriptive cross-sectional study that was carried out at the Endoscopy Unit of Jos University Teaching Hospital. A total of 260 patients referred for UGI endoscopy from August 2013 to April 2014 were recruited and investigated for H. pylori from the biopsy specimens taken during UGI endoscopy. The diagnosis of H. pylori was made by histology. Result: A total of 260 patients were studied, 159 (61.2%) males and 101 (38.8%) females. H. pylori were present in 169 (65%) and absent in 91 (35%). More females had H. pylori compared to males (67.3% and 63.5%). The common endoscopic findings were present in the stomach. Gastritis 57 (21.9%) was the most common abnormality seen in the stomach, while gastroesophageal reflux disease was the most commonly seen in the esophagus and duodenal ulcer in the duodenum. Conclusion: There is a positive correlation between H. pylori infection with endoscopic abnormalities seen among patients.
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Prevalence and predictors of gaming disorder among undergraduate medical students in Enugu, Nigeria: Video game addiction in focus p. 615
Onyinye H Chime, Awoere T Chinawa, Obinna O Nduagubam
DOI:10.4103/NJM.NJM_40_21  
Objective: The objective of the study was to determine the factors and predictors of gaming disorder among medical students in Enugu, Nigeria. Methods: A cross-sectional study design involving undergraduate medical students in Enugu. Addiction to video games was measured using a Video game Addiction Test. This was used to obtain information from 400 respondents. Results: Addiction to video games was recorded in 158 students (39.5%). On both bivariate analyses, gender and academic level were associated with being addicted to video games while on the multivariate analysis being male (adjusted odds ratio [AOR] = 3.95, confidence interval [CI] = 2.52–6.20) in 300 academic levels and below (AOR = 2.03, CI = 1.29–3.19) and sponsorship were predictors. Conclusion: The majority of students in this study are not addicted to video games. Being males predicted video game addiction. Since this disorder is yet to be fully explored in this setting, there is a need for health-care workers to create awareness about the effects and means to mitigate against the disorder in this setting. Further research is needed on the physical and psychological health effects of this form of addiction on the players.
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CASE REPORTS Top

Myomectomy during laparotomy for ruptured tubal pregnancy in a low-resource setting p. 620
Adebayo Augustine Adeniyi, Olabisi Timothy Adeyemo, Mojisola Olumide Ayankunle, Abiodun Idowu Okunlola
DOI:10.4103/NJM.NJM_35_21  
The traditional management of ruptured ectopic pregnancy has been limited to the removal of the gestational sac, securing hemostasis, and restoring hemodynamic stability with no room for the performance of other procedures such in myomectomy at the same setting. We present a case of a 37-year-old nulliparous woman who was referred for myomectomy on account of symptomatic uterine fibroids but was found to have coexisting ectopic pregnancy at presentation. She had successful total salpingectomy and myomectomy at the same laparotomy. This case demonstrated that myomectomy can be safely performed during the surgery for ruptured ectopic pregnancy in well-selected patients.
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Mycosis fungoides: A rare scalp tumor p. 623
Abiodun Idowu Okunlola, Ajayi Adeleke Ibijola
DOI:10.4103/NJM.NJM_135_21  
Cutaneous mycosis fungoides is a cutaneous T-cell lymphoma that can mimic a metastatic skull tumor. It responds satisfactorily to chemotherapy, and extensive surgical excision is not usually necessary. We managed a 55-year-old man who presented with a slow-growing scalp tumor which recurred with accelerated recurrence after radical excision. Histology showed cutaneous mycosis fungoides which resolved with chemotherapy. Mycosis fungoides can present as a slow-growing scalp tumor. Detailed clinical evaluation, neuroimaging, and trucut biopsy for histological diagnosis can prevent unnecessary aggressive radical tumor excision and its sequelae.
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SPECIAL ARTICLE Top

Reflective practice and resident doctors p. 625
Babaniji Omosule, Abdul-Azeez Muhammed, Abiye Somiari, Utchay Agiri Jr., Glory Ovunda Worgu, Constantine Ezeme, Lawson Ohwofasa Obazenu, Okhuaihesuyi Uyilawa, Oladimeji Adebayo, Adedayo Williams, Dare Godiya Ishaya
DOI:10.4103/NJM.NJM_124_21  
Reflective practice has evolved over the years from being an informal subconscious process to a deliberate and formal one. Residency training programs are avenues for preparing residents for a lifetime of specialist practice, and reflective practice is being incorporated into the curriculum of the program in many parts of the world. There is no universal template for carrying out reflective practice; however, there appear to be accruable benefits to residents who can surmount the barriers and undergo some form of reflection using any of the available models. This article seeks to appraise reflective practice and the inherent benefits to the resident doctor and his practice. Thus, it makes a case for incorporating reflection into the curriculum of residency training programs in Sub-Saharan Africa. It also demonstrates the need to ensure standardized, reproducible methods of reflection globally.
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ERRATUM Top

Unearthing the hidden tragedy- Stillbirths in Abakaliki Nigeria- Prevalence and causes p. 629

DOI:10.4103/NJM.NJM_161_21  
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