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EDITORIAL
How to choose a dissertation topic
Ugochukwu Anthony Eze, Oladimeji Adebayo, Ijeoma Jane Nnodim, Arome C Adejo, Lawson O Obazenu
March-April 2021, 30(2):123-124
DOI:10.4103/NJM.NJM_228_20  
  3,647 272 -
ORIGINAL ARTICLES
Primary health care under one roof: Knowledge and predictors among primary health care workers in Enugu State, South East, Nigeria
George Onyemaechi Ugwu, Nympha Onyinye Enebe, Cosmas Kenan Onah, Casmir Ndubuisi Ochie, Thaddeus Chijioke Asogwa, Godwin Uchenna Ezema
October-December 2020, 29(4):649-654
DOI:10.4103/NJM.NJM_107_20  
Background: The concept of “Primary Health Care Under One Roof” (PHCUOR) is a new governance reform to improve primary health care (PHC) implementation and integration. This study aimed at assessing the level of knowledge of this concept and its predictors among PHC Workers. Materials and Methods: This was a cross-sectional descriptive study of PHC workers in Enugu State. Respondents were selected using systematic sampling method. Data were collected with self-administered questionnaire and analyzed using IBM-SPSS version 25. Level of statistical significance was set at 5% and confidence interval (CI) of 95%. Results: A total of 292 responses out of 337 questionnaires were retrieved, giving a response rate of 86.6%. Majority of the respondents were female (257, 88.0%) and greater than half were in the age range of 41–50 years (151, 51.7%). Most of the respondents had overall good knowledge of PHCUOR (210, 71.9%) but there was poor understanding of some concepts. Bivariate analysis showed that having good knowledge of PHCUOR was associated with duration of practice (χ2 = 6.013, P = 0.018) and age (χ2 = 4.495, P = 0.036) but on binary logistic regression, males were found to be 2.8 times more likely to have good knowledge of the concept compared to females (adjusted odds ratio = 2.763.; 95% CI = 1.022–7.469, P = 0.045). Conclusion: There was overall good knowledge of PHCUOR but the knowledge of rationale, gateway, and minimum service package (MSP) was poor. Males were approximately 2.8 times more likely to have good knowledge compared to females. Regular training of PHC workers on the concepts of PHCUOR especially the rationale, gateway, and MSP is needed to improve their knowledge and service delivery.
  2,776 70 -
Psychological, socioeconomic effects of COVID-19 pandemic and associated prevalent self-reported vulnerability factors among residents of Southwest Nigeria
Kabir Adekunle Durowade, Taofeek Adedayo Sanni, Makinde Adedayo Adeniyi, Serifat Asabi Babalola, Tomilayo Ajoke Popoola, Idowu Oluwaseyi Adebara, Ebenezer Adekunle Ajayi
October-December 2020, 29(4):566-574
DOI:10.4103/NJM.NJM_164_20  
Background: Infectious diseases wrecked havoc in global economies, especially when outbreak or pandemic occurs. The present COVID-19 pandemic has not only caused disruption to global activities but also of businesses, trades, movements, and academic activities. Southwest Nigeria has the highest burden of COVID-19 of all the six geopolitical zones in the country. This study, therefore, aims at determining the psychological, socioeconomic effect of COVID-19 pandemic and associated vulnerability factors among residents of Southwest Nigeria. Methods: This survey is a cross-sectional study in the six southwest states of Nigeria via Google questionnaire sent electronically to obtain information from respondents. Targeted sampling and snowball techniques were used to reach the respondents. Data were analyzed using SPSS 23, and the level of statistical significance was at P < 0.05. Results: The mean age of the respondents is 32.89 ± 9.59 years and age range of 16–57 years. Majority of the respondents were males, married with tertiary education. Majority (83.9%) of the respondents have severe psychological effects, 78.2% have their family income affected, while diabetes, asthma, cardiovascular diseases, cancers, previous contact with a confirmed case and travel history outside Nigeria were among the self-reported vulnerable factors of COVID-19. Conclusion: The study concluded that the psychological and economic effects of COVID-19 are high in Southwest Nigeria and major self-reported vulnerable factors include cardiovascular diseases, diabetes, asthma, and cancers. Scale-up of public awareness, subsidization of personal protective equipment, and financial stimulus are recommended measures against the disease.
  2,629 149 -
REVIEW ARTICLE
Anticoagulation in sub-saharan africa with the advent of non-vitamin K antagonist oral anticoagulants
Raphael Chinedu Anakwue
April-June 2020, 29(2):187-196
DOI:10.4103/NJM.NJM_12_20  
Background: Since the approval of warfarin, a Vitamin K antagonist anticoagulant (VKA), no other oral anticoagulant existed for patients who needed long-term anticoagulation therapy until the recent introduction of non-VKA oral anticoagulants (NOACs). NOACs came to fill in therapeutic gaps associated with VKA. Dedicated anticoagulation clinics has improved the outcome of using VKA. However, with the arrival of NOACs, it is not clear how they will fit into these clinics.Methods: We searched PubMed, Google Scholar, Medline, and African Journals OnLine for articles on anticoagulation management and NOACs. Results: There were very few dedicated anticoagulation management centers in Sub-Saharan Africa, notably in Nigeria, South Africa, Kenya, Uganda, Namibia, Ghana, Botswana, Namibia, and Cameroun and warfarin was the anticoagulant used. NOACs were not used regularly. None of these anticoagulation clinics had incorporated NOACs management into their routine service as was done for VKA. Conclusion: Anticoagulation clinics in Sub-Saharan Africa must include NOACs as part of their area of service in addition to warfarin. The use of NOACs in Africa will leap frog if proper anticoagulation management policy and structure are laid out, the cost of NOACs are reduced, and emphasis is given to retraining of staff.
  2,634 113 -
ORIGINAL ARTICLES
Adherence to protective measures against hearing-related hazards of mobile phone users among university students
Auwal Adamu, Abdulrazak Ajiya, Hamisu Abdullahi, Muhammad Ghazali Hasheem, Nafisatu Bello-Muhammad
April-June 2020, 29(2):312-316
DOI:10.4103/NJM.NJM_3_20  
Background: Mobile phone is an integral part of the society used by almost all. Youth in Nigerians are recognized as the most active users of mobile phones. There are about 1.1 billion youth people globally at risk of noise-induced hearing loss from unsafe listening. The awareness and adherence to hearing conservation measures against the hearing-related hazards of mobile phones have not been evaluated in our environment. Aims: To determine the knowledge and adherence to protective measures against the hearing-related hazards of mobile phones among university students. Materials and Methods: The study was a cross-sectional descriptive type, conducted among university students. Ethical clearance was obtained from the institutional review committee, a multistage random sampling technique was used to recruit the participants, and a specially designed and validated questionnaire was used to collect the data. The data were analyzed using Statistical Product and Service Solutions (SPSS) version 20.0. Results: The age of the respondents ranged from 16 to 40 years with a mean age of 23.6 ± 5.3 years. Very few of the participants (19.1%) adhere to protective measures to mitigate hearing-related hazards of mobile phones, although about half (52.1%) had good knowledge of hearing conservation measures. There was a statistically significant association between knowledge of hearing-related hazard of mobile phone (P = 0.038) and knowledge of protective measures (P = 0.000) with the adherence to protective measures, respectively. Conclusions: The knowledge and adherence to protective measures against the hearing-related hazards of mobile phones were poor among the respondents.
  2,236 44 -
REVIEW ARTICLES
Universal healthcare coverage and medical tourism: Challenges and best practice options to access quality healthcare and reduce outward medical tourism in Nigeria
Opubo Benedict da Lilly-Tariah, Salami Suberu Sule
July-September 2020, 29(3):351-361
DOI:10.4103/NJM.NJM_67_20  
Background: Universal healthcare coverage (UHC) leads to access to quality healthcare. Improved quality healthcare can stem outward medical tourism (MT). This review examined challenges and best practice policy options to implement UHC and how it can reduce outward MT in Nigeria. Methodology: The designed search terms used were “universal health coverage,” “quality healthcare” “medical tourism,” “access to healthcare,” “primary health care,” “healthcare financing,” “private health insurance,” “social health insurance,” and “Nigeria healthcare system.” Peer-reviewed research articles and institutional reports published between January 2000 and March 2020 were searched using four databases: PubMed, National Library of Medicine, Web of Science, and Library of Congress. EndNote X9 software and Google search engine were used to access these databases and documents, and 124 publications were retrieved and 106 were reviewed. Results: Majority of publications reviewed emphasized building health infrastructure, developing skills and human resources for health, and funding for equipment and drugs. Expanding healthcare coverage through social health insurance, developing a financial system to protect the poor, access to quality healthcare, and reinvigoration of primary healthcare (PHC) were common themes. About 50% of the studies identified unavailability of quality healthcare services, inequalities in the supply side of healthcare services, issue of human resources, and health sector implementation shortfall as challenges to UHC. Another 50% of the studies reviewed identified poverty and poorly funded PHC as a barrier to UHC. Almost all the studies (100%) identified cost-effectiveness, safety, and quality of healthcare services as drivers of MT in all countries. Conclusion: Improving the quality of healthcare delivery, increasing accessibility, affordability, and timeliness of access by the population through UHC can stem MT.
  2,023 158 -
SPECIAL ARTICLE
Common errors in proposals and dissertations and how to avoid them: A resident's guide
Osita Ede, Cajetan U. Nwadinigwe, Iheuko S. Ogbonnaya, Gabriel O. Eyichukwu, Chukwuemeka B. Eze, Amechi U. Katchy, Ugochukwu N. Enweani
July-September 2020, 29(3):533-538
DOI:10.4103/NJM.NJM_116_20  
Background: The dissertation is now a necessary part of the fellowship examinations of both the West African college of surgeons and physicians and the national postgraduate medical college of Nigeria. Many resident doctors are confused about how to get on with their proposals and the dissertations. This confusion often leads to frustrations, and in extreme cases to unnecessary delay in attempting the examinations when due. Aim: This study aims to identify the common errors made by resident doctors in the proposal and dissertations and to recommend the solutions to such problems. Methods: This survey is based on a direct interview with experienced examiners in both colleges. The examiners were asked to list what they observed as the common problems they identified concerning the proposal and dissertation of residents. The answers were collated and categorized according to the frequencies of problems identified. Based on the response of the examiners, a questionnaire was designed and administered to the senior residents who are at various stages of writing their dissertations. Results: Some of the findings include starting the proposal too late, difficulty in choosing a topic, mediocre and tedious literature search, difficulty in finding appropriate supervisors, poor appreciation of basic research design and necessary statistical tests, improper presentation of results and wrong referencing. Others are editorial mistakes, pagination errors, and the lack of knowledge on proper attitude and skill during the defense. Conclusion: Starting too late is the most common error made by the resident doctor in the dissertation. Residents should choose a topic within 6 months of passing the membership examination.
  1,857 111 1
CASE REPORTS
Hormonal contraceptive induced immune thrombocytopenic purpura
Z Ayuba, HT Idi, YB Ngamdu, AA Buba, AB Tsuung
April-June 2020, 29(2):324-327
DOI:10.4103/NJM.NJM_48_20  
Immune thrombocytopenic purpura (ITP) is an acquired disorder of platelets that clinically manifests with mucocutaneous bleeding. There are several causes of ITP, but its association with hormonal contraceptive implants has not been widely reported. A 39-year-old Para 10+0 7 alive presented to the Yobe State University Teaching Hospital with complaints of nasal bleeding, gum bleeding, purpura, and menorrhagia, which were noticed a month after insertion of a Levonorgestrel – containing hormonal contraceptive implant, at a Primary Healthcare facility. Complete blood count, peripheral blood film, and bone marrow aspiration cytology led to the diagnosis of ITP. Epistaxis was managed conservatively. The patient was placed on prednisolone with a noticeable increase in platelet count and remarkable improvement in the clinical state. ITP is a complication of the hormonal contraceptive implant. Clinicians should be aware of the possible association of contraceptive implants and ITP.
  1,827 56 -
ORIGINAL ARTICLES
Eliminating discrimination and enhancing equality: A case for inclusive basic education rights of children with Albinism in Africa
Olanike S Adelakun, Mary-Ann O Ajayi
April-June 2020, 29(2):244-251
DOI:10.4103/NJM.NJM_50_20  
Background: Various international treaties have acknowledged the rights of children to education; however, for millions of children, this right is just a dream, especially with a vulnerable group of children with physical challenges and other disabilities. Reports by the UN gives an estimate of a significantly large number of children who are yet to take advantage of good quality education. This article examines the plight of children with albinism who suffer discrimination both at the special and regular schools largely because the nature of their disability is not physical. Children with albinism have their right to education and in education limited by the difficulty to understand their impairment both at school and at home leading to entrenched discrimination and inequality, which ultimately erodes their human dignity. Methodology: This article adopts the desk research argues that the proper application of the concept of inclusive basic education of children with albinism will help eliminate discrimination and enhance equality of education of children with albinism. Conclusion: The article concludes that the existing legal framework abound, but proper implementation of article 24 of the Convention on the Rights of Persons with Disabilities will enhance the desired equality.
  1,488 95 -
Bullying behavior and its association with mental health symptoms among senior secondary school students in Calabar, Nigeria
Udeme Asibong, Chidi J Okafor, Ani Etokidem, Inyang Asibong, Essien Ayi, Ogban Omoronyia
March-April 2021, 30(2):125-133
DOI:10.4103/NJM.NJM_88_20  
Background: The nature of our psychosocial environment and one's response to stressful daily events are key determinants of current and future mental health status. The school environment is one of such settings which expose young people to potentially undue stress, especially through bully-prone interpersonal interaction with peers and older individuals. Although bullying is thought to be prevalent in secondary schools, only a few studies have investigated the association between bullying and the mental health status of secondary school students in developing countries. The present study seeks to obtain data that may be helpful in addressing this research gap. Methodology: This was a cross-sectional analytic study. A stratified sampling technique was used to select six secondary schools within Calabar metropolis. Proportional allocation using a simple random sampling method was employed to recruit the required number of senior secondary students from the selected schools. Multidimensional Peer Victimization Scale and Child and Youth Mental Health General Screening Questionnaires were used to assess for presence/degree of bullying and mental health problems, respectively. Mann–Whitney U-test and Spearman's correlation analysis were used as inferential statistics, and P-value was considered significant if it was < 0.05. Results: Three hundred and four (304) respondents were surveyed, but complete data were obtained from 292. Their ages ranged from 13 to 20 years, with a mean age of 16.5 ± 2.1 years. The male-to-female ratio was 1:0.7. Within the past 12 months, 54.8% of the respondents had bullied someone, while 62.3% had witnessed someone being bullied. Attack on the property was the most common form of bullying (61%), followed by social manipulation (52.7%), verbal (52.1%), and physical (47.9%) forms of victimization. Moderate-to-severe forms of social manipulation, physical victimization, verbal victimization, and attack on property forms of bullying were found in 26.0%, 26.7%, 28.8%, and 32.2% of respondents, respectively. The most frequently elevated component of mental health score in the respondents was conduct symptoms (50.7%), followed by mood symptoms (34.2%) and symptoms of generalized anxiety (19.2%). Respondents with abnormally elevated scores for hyperactivity/distractibility, conduct, generalized anxiety, and mood symptoms had significantly higher mean scores for each of the components of bullying assessed (P < 0.001). Elevated scores on oppositional defiant symptoms did not significantly influence the mean scores of each component of bullying, except for verbal victimization (P = 0.04). A significant positive correlation was observed between each component of bullying and each domain of mental health assessed (P < 0.001). A positive correlation was also observed between the total bullying score and each domain of mental health as well as the total mental health scores (P < 0.001). Of all the domains of mental health assessed, symptoms of hyperactivity/distractibility showed the strongest positive correlation with a total bully score (r = 0.69, P < 0.001). Conclusion: The results from this study suggest that bullying is prevalent in our secondary schools, with a potential adverse effects on the mental health of affected individuals in the near or remote future. These findings may be useful for improvement in existing policies for school health programs in developing countries.
  1,336 183 -
Knowledge, attitude, practice and predictors of preventive practices toward COVID-19 among healthcare workers in Ogbomoso, Nigeria: A cross-sectional study
Philip Adewale Adeoye, Gabriel Ilerioluwa Oke, Kehinde Precious Fadele, Titilope Abisola Awotunde
July-August 2021, 30(4):452-457
DOI:10.4103/NJM.NJM_86_21  
Background: COVID-19 quickly assumed a global epidemic with its attendant health, socio-political and economic impacts. Healthcare workers are particularly at increasing risk of being infected and transmitting the virus. This study assessed knowledge, attitude, practice and predictors of preventive practices toward COVD-19 among healthcare workers in Ogbomoso, Nigeria. Study Design: Cross-sectional study. Data were collected online among health workers across health facilities in Ogbomoso. Factors associated with good practices were analyzed using Chi-square. Predictors of good preventive practices were determined by multivariate binary logistic regression. The level of statistical significance was determined to be at P < 0.05. Results: There were 132 study participants; with an average age of 31 years. Fifty-eight percent were medical laboratory scientists. Levels of good knowledge, attitude, and practices were 59.1%, 58.3%, and 38.6%, respectively. Eight-seven percent of respondents sourced COVID-19 related information via the mass media. Ninety-four percent of respondents will not stay at home if sick because of work. Age, profession, and knowledge are significantly associated with COVID-19 preventive practices. The predictors (Model II) of good COVID-19 preventive practices include being a laboratory scientist (odds ratio [OR]: 2.44 [95% confidence interval (CI): 1.05, 6.71]; P = 0.039), working in primary health facility (OR: 4.72 [95%CI: 1.08, 20.67]; P = 0.039) and having good COVID-19 knowledge (OR: 3.71 [95%CI: 1.49–9.925]; P = 0.005). Conclusion: Our study has shown the predictors of good COVID-19 preventive practices among healthcare workers and the need for policy and practice change as it relates to COVID-19 infection prevention and mitigation among healthcare workers.
  1,283 64 -
REVIEW ARTICLES
COVID-19 at the community level: What are the countermeasures?
Damilola Ayowole, Vivian Ogbonna, Abimbola Amoo, Tosin Babarinde, Jacob Nwafor, Ugo Enebeli, Aliyu Sokomba, Oladimeji Adebayo, Olayinka Stephen Ilesanmi
July-September 2020, 29(3):362-368
DOI:10.4103/NJM.NJM_109_20  
Although several efforts have been implemented to prevent and control the coronavirus disease 2019 (COVID-19) pandemic at the population level, varying outcomes have been reported in several quarters, despite the implementation of socio-behavioral methods commonly at the population level to stop the human-to-human transmission. We did a narrative review of relevant articles of identified countermeasures at the population level, for curbing the COVID-19 pandemic. The key findings were evidence measures such as physical distancing, quarantine, isolation, screening, active case detection, and risk communication if properly implemented. Other countermeasures identified were air disinfection and lockdown restrictions. Air disinfection has a potentially harmful effect on humans, while lockdown restrictions have been counterproductive in many settings. In conclusion, many of these public health measures are with peculiarities and needs to be contextualized to be effective in curbing the pandemic. Further research and regular assessments are needed on the countermeasures.
  1,219 101 -
CASE REPORTS
Mermaid syndrome in Enugu, Nigeria
Johnpaul Ejikeme Nnagbo, Chukwudi Cyril Dim, Hyginus Uzo Ezegwui
April-June 2020, 29(2):321-323
DOI:10.4103/NJM.NJM_10_20  
Mermaid syndrome is a type of gross fetal anomaly, characterized by the fusion of lower extremities, absent external genitalia, and apparently well-formed abdomen, chest, upper extremities, and head. The neonatal mortality rate due to this anomaly is high, but the disorder is relatively rare. Hence, few cases have been reported in the medical literature, and none in University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State.
  1,255 59 -
Testicular atrophy following inguinal hernia repairs: Are we doing enough in prevention and counseling?
Friday Emeakpor Ogbetere, Udoka Imoisili
January-February 2021, 30(1):105-107
DOI:10.4103/NJM.NJM_170_20  
Testicular atrophy is a rare complication of hernia repairs which often results in litigations. While early detection and treatment of ischemic orchitis obviate this grave complication, good communication and adequate counseling are known to minimize the associated litigations. Herein, we report two cases of testicular atrophy following herniorrhaphy. Both patients noticed scrotal pain and swelling within three days after the surgery and were given antibiotics and analgesia by the attending surgeons. They subsequently developed a gradual reduction in testicular volume after two months with severe atrophy of the affected testis. The objectives of this case series are to emphasize the need for immediate evaluation of genital symptoms such as scrotal pain, swelling, and redness after inguinal hernia repairs and the need to counsel patients for possible orchitis, atrophy, and testicular loss before any groin surgery.
  1,258 40 -
ORIGINAL ARTICLES
Penile fracture in Southern Nigeria: A 10-year review in two tertiary referral centers
Friday Emeakpor Ogbetere, Odezi Fidelis Otobo
March-April 2021, 30(2):134-138
DOI:10.4103/NJM.NJM_182_20  
Background: Penile fracture is an uncommon genitourinary emergency due to an abrupt trauma to an erect penis. Urgent exploration and repair of tunica albuginea tear is advocated. This study aimed to assess the etiology, presentation, location of the tear, and management outcome of penile fracture in two tertiary hospitals in southern Nigeria. Patients and Methods: Data were obtained retrospectively from the patients' health records in the two tertiary hospitals from April 2009 to March 2019. Their biodata, mechanism of injury, injury-to-presentation time, clinical features, location of the injury, the treatment offered, duration of hospital admission, and follow-up were studied. Results: Thirteen patients aged 22–54 years (mean 34.0 years) were treated within the 10-year study period. Ten (76.9%) had tertiary education, while 7 (53.8%) were married. Heterosexual intercourse accounted for penile fracture in 12 (92.3%) patients while rolling over an erect penis in bed in 1 (7.7%) case. Male-dominant sex position (n = 9; 69.2%) was the most predominant. In 8 (61.5%) patients, girlfriends/mistresses were involved. Most patients (n = 9; 69.2%) presented within 24 h, while one came after 7 days. All patients presented with penile pain, crackling sound, sudden detumescence, swelling, and penile deformity. The left corpus cavernosum was affected in 9 (69.2%) patients. Three patients (23.1%) had associated urethral injuries. All patients had surgical exploration and repair with minimal complications. Average hospital admission and follow-up duration were 6.7 days and 9.3 months, respectively. Conclusion: Heterosexual intercourse was the predominant cause of penile fracture in our study. Surgical management gave excellent outcomes even in delayed presentation.
  1,130 156 -
Clinical profile and electrolyte abnormalities in hospitalized under-five children with acute gastroenteritis in a tertiary health facility
Christopher B Eke, Ikenna K Ndu, Benedict O Edelu, Nwachinemere D Uleanya, Uchenna Ekwochi, Josephat M Chinawa, Ikenna C Nwokoye, Anthony N Ikefuna
April-June 2020, 29(2):295-302
DOI:10.4103/NJM.NJM_64_20  
Background: Electrolyte abnormalities constitute the leading causes of morbidity and mortality in younger children with acute gastroenteritis. The aim of the study was to determine the clinical profile and pattern of electrolyte abnormalities in under-five children hospitalized for acute gastroenteritis from November 1, 2014, to January 31, 2015. Methodology: This was a cross-sectional descriptive study among hospitalized under-five children with acute diarrhea who were consecutively recruited from November 1, 2014, to January 31, 2015. Relevant clinical data were obtained, while the physical examination was done on all subjects. Serum electrolytes values were determined using the ion-selective electrode system and compared with standard reference ranges. The data were analyzed using SPSS version 21.0 with the level of statistical significance set at P < 0.05. Results: A total of 108 under-five children were studied. The majority (101; 93.5%) were <24 months of age, while 41 (38%) of low socioeconomic class background. Metabolic acidosis was the most common electrolyte abnormality followed by hyponatremia and hypokalemia occurring singly or in combination. The case fatality rate was 13 (12.0%). The electrolyte derangements associated with mortality were hypokalemia and acidosis: 11 (84.6%) each, 9 (69.2%) had hyperchloremia, while 6 (46.2%) were reported to have hyponatremia. Conclusion: Electrolyte derangements are common in under 5 years children with acute diarrhea with increased mortality in those with severe acute malnutrition. Proper health education is needed to ensure adequate nutrition and timely use of low-osmolar oral rehydration solution as well as early referral of cases with persistent gastrointestinal losses in order to save lives.
  1,117 89 -
REVIEW ARTICLES
Prediabetes in sub-saharan Africa: Pathophysiology, predictors, and prevalence
Chidimma Brenda Nwatu, Ekenechukwu Esther Young
July-September 2020, 29(3):343-350
DOI:10.4103/NJM.NJM_30_20  
Prediabetes – comprising impaired fasting glycaemia (IFG) and/or impaired glucose tolerance (IGT) – is a transitory median interphase between normal blood glucose levels and diagnostic levels of diabetes. The raised blood glucose levels surreptitiously damage the body's organ systems and are often an augury of type 2 diabetes mellitus (T2DM), the two having been found to share similar pathogenesis. Current concepts in the pathogenesis of prediabetes support a pentad of mechanisms responsible for its development. Majority of the countries in Sub-Saharan Africa belong to the low and middle income category, whose population accounts for more than 70% of the 352 million adults (20–79 years) worldwide with IGT (one component of prediabetes), as at 2017. The presence of prediabetes increases health care related expenditure in individuals and takes a toll on the workforce. Nigeria (West Africa) is currently among the top ten countries with the highest number of individuals with IGT as at 2017, and Ethiopia (East Africa) has been projected to join Nigeria in this category by 2045. A PubMed and MEDLINE search was conducted using the keywords prediabetes, Sub-Saharan Africa, prevalence, and pathophysiology. Major studies were identified and reviewed. Numerous large scale studies have revealed that progression from prediabetes to T2DM is not relentless. Structured and intensive lifestyle modifications aimed at modest weight loss, increased physical activity, and healthy dietary habits have shown to halt or slow the progression to T2DM, and in some cases, even reverse prediabetes, with such individuals regaining normal blood glucose levels.
  1,078 92 -
ORIGINAL ARTICLES
Challenges of residency training and early career doctors in Nigeria Phase II: Update on objectives, design, and rationale of study
Ugochukwu A Eze, Musiliu Adetola Tolani, Makinde Adebayo Adeniyi, Vivian I Ogbonna, Ogechukwu Isokariari, C Igbokwe Martin, Kehinde Kanmodi, Khadija A Abdulraheem, Ifeanyi Kelvin Egbuchulem, Abdulmajid I Yahya, Ibiyemi Oduyemi, Vincent E Nwatah, Elizabeth O Grillo, Rereloluwa N Babalola, Isibor Efosa, Qudus O Lawal, Taiwo A Alatishe, Dabota Y Buowari, Olumuyiwa E Ariyo, Ugochukwu Mosanya, Tope E Adeyemi, Oluwaseyi Ogunsuji, Oyinkansola Agaja, Adedayo Williams, Lawson Obazenu, Aliyu Sokomba, Olusegun Olaopa, Kabir Durowade, Olayinka Stephen Ilesanmi, Oladimeji Adebayo, on behalf of Research Collaboration Network RCN
October-December 2020, 29(4):714-719
DOI:10.4103/NJM.NJM_137_20  
Background: Early career doctors (ECDs) are a dynamic and highly mobile group of medical and dental practitioners who form a significant proportion of the health workforce in Nigeria. The challenges of residency training and ECDs in Nigeria CHARTING Phase I study explored limited challenges affecting ECDs under the broad themes of demography, workplace issues, and psychosocial issues. The CHARTING II was expanded to provide wider insight into the challenges of ECDs in Nigeria. Objective: This protocol aims to provide clear objectives including description of objectives, design, and rationale for the conduct of the proposed CHARTING II study which seeks to explore other components under the various themes of demographic, workplace, psychosocial issues affecting the ECDs in Nigeria, and which were not explored under CHARTING I. Methodology: This shall be a mixed study design that will combine qualitative and quantitative methods, to investigate 27 subthemes among 2000 ECDs spread across 31 centers, accredited by the Nigerian Association of Resident Doctors. Participants shall be selected using the multistage sampling method. The primary data will be generated using structured proforma and validated questionnaires, while administrative sources would serve as a source of secondary data. Data will be entered and analyzed using appropriate statistical software. Conclusion: CHARTING II study would provide more robust data and insight into the problems encountered by ECDs in Nigeria. This would in turn build a platform for institutional engagement and advocacy in order to drive relevant policies to mitigate these challenges.
  1,064 66 -
Prevalence and pattern of stimulants use among long-distance truck drivers in a truck part in Kaduna State, Nigeria
S Babandi Zaharaddeen, Abdulhakim A. Olorukooba, Aminu Lawal, Ibrahim Abdullahi, Salamatu Belgore, Bashar M. Jibril
July-September 2020, 29(3):445-449
DOI:10.4103/NJM.NJM_72_20  
Background: Stimulant use is recognized as an important factor in road safety worldwide, and concerns are growing over the incidence of road traffic accidents among drivers who drive under the influence of stimulants. Yearly, more than 1.25 million people lose their lives as a result of road traffic accidents, many of which are associated with stimulant use. Aim: The study aimed to assess the prevalence, pattern, and factors associated with stimulant use among long-distance truck drivers in a truck part in Kaduna State, Nigeria. Methods: A cross-sectional study was conducted in a truck park in Marraraban Jos in Kaduna State. A structured, interviewer-administered questionnaire was used to obtain data. A total of 152 respondents were interviewed. Data were analyzed using SPSS version 20. Chi-square and Fisher's exact tests were used to identify the relationship between categorical variables with a level of significance at P < 0.05. Results: A total of 152 respondents participated in the study with a mean age of 33 ± 5 years. The prevalence of stimulant use was 64.5%. Only 92 (60.7%) drivers reported using stimulants on rare occasions. Years of driving experience was found to be associated with stimulant use (P = 0.031). Other sociodemographic variables were shown not to be significantly related to stimulant use. Conclusion: The prevalence of stimulant use was found to be high among the drivers, with less experienced drivers more likely to use stimulants. Efforts on improving road safety should include reducing stimulant use, especially among the younger less experienced drivers.
  566 521 -
Preparedness of Nigerian health institutions toward managing lassa fever epidemic and Covid-19 pandemic
Shehu S Umar, Bilqis O Muhammad, S Babandi Zaharadeen
April-June 2020, 29(2):303-307
DOI:10.4103/NJM.NJM_71_20  
Objectives: The objective is to assess standard practice of healthcare workers and preparedness of their healthcare institutions toward controlling spread of infectious diseases. Background: With the on - going epidemic of Lassa fever and the rising incidence of Covid-19 pandemic in Nigeria, there has been efforts from government and stakeholders in health towards controlling the surge of these diseases. This study is a multi-center survey involving frontline health-care workers, from 102 health institutions. Methodology: Pretested self-administered questionnaires were sent through online Google form to health-care workers across various health institutions through their respective social media platforms. Their consent was sought and the questionnaires were filled through registered emails. Multiple entry from same individual was prevented. The number of respondents was 451. The information gathered include biodata of health-care workers, details of their cadre and years of practice, their level of standard precautions and preparedness of their health institutions. Data gathered were collated, summarized, and analyzed using simple tables with proportions. Results: The practice of standard precaution was inadequate with only 59.4% of respondents washing their hands regularly after touching patients or carrying out procedures, while only 34.4% of them used face masks while consulting patients with respiratory symptoms. As for preparedness of health institutions in control of Lassa fever and Covid-19, 63.1% and 77.6% of respondents affirmed that their health institutions had written protocol of managing infectious diseases and had organized workshop on Lassa fever and/or Covid-19, respectively, while only 45.5% and 20% of respondents had dedicated isolation wards and functional intensive care units in their health institutions. Conclusion: The standard safety precautions by health-care workers were suboptimal and preparedness of their health institutions was generally inadequate for the management and control of infectious diseases.
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Comparative analysis of the effects of abdominal crunch exercise and dead bug exercise on core stability of young adults
Chioma Nneka Ikele, Ikenna Theophilus Ikele, Chidiebele Petronilla Ojukwu, Edith Onyinyechi Ngwoke, Uchenna Amaechi Katchy, Adaora Justina Okemuo, Ukamaka Gloria Mgbeojedo, Micheal Ebe Kalu
October-December 2020, 29(4):680-687
DOI:10.4103/NJM.NJM_85_20  
Background: Poor core stability is a known risk factor for musculoskeletal injuries. The utilization of abdominal crunch exercises for improving core stability has been discouraged by some authorities considering its risks for low back pain. Evaluating the efficacy of other core exercises is necessary for implementing them as safe alternatives. Aims: This study compared the effects of abdominal crunch and dead bug exercises on core strength, endurance, and flexibility of young adults. Materials and Methods: Twenty-nine untrained young adults participated in this study, comprising of three exercise groups [abdominal crunch group (ABG), dead bug group (DBG) and a control group (CG)]. Pre- and post-intervention (at 6 weeks) core strength, endurance, and flexibility were measured. ANOVA and ANCOVA were used to test for differences at baseline and between groups, respectively. Sidak's multiple-comparison test was used for post hoc analysis between groups. The effect size was reported using partial Eta-squared (η2p). Alpha level was set at 0.05. Results: The highest mean differences were observed within DBG (5.3 [1.67], 63.6 [23.10], and 2 [0.5] for core strength, endurance, and flexibility, respectively). Core strength, endurance, and flexibility varied significantly across groups (P = 0.0111, 0.000, and 0.0090, respectively). Estimated marginal mean (EMM) for core strength for DBG (EMM [ Standard error (SE)], 25.31 [1.38]) was significantly higher than ABG (20.57 [1.24]) and CG (19.37 [1.30]). For core endurance (EMM [SE], DBG (4.62 [0.12]) and ABG (4.2 [0.11]) were significantly higher than CG (3.8 [0.12]). EMM for core flexibility for the DBG (EMM [SE], 9.47 [0.48]) was significantly higher than the CG (7.28 [0.45]) and not ABG (8.27 [0.44]). Conclusions: The efficacy of dead bug exercise in improving core stability was revealed in this study. It is biomechanically efficient and suggested as an alternative to abdominal crunch exercise.
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Tooth loss and predictors of tooth extractions due to dental caries among adults: A multi-center study in North-eastern Nigeria
Paul Ikhodaro Idon, Abdulmumini Mohammed, Yahaya Abdulmanan, Olawale Akeem Sotunde, Janada Yusuf, Taiwo Omoniyi Olalekan, Yusuf Halidu Bako
April-June 2020, 29(2):279-285
DOI:10.4103/NJM.NJM_60_20  
Background: Tooth loss and the level of edentulism may be an indication of a populations' oral health. The aim of this study was to evaluate the contribution of dental caries to tooth loss, as well as its predictors among adults in North-eastern Nigeria. Methods: A cross-sectional survey over a 2-month period of all adult patients who had tooth extractions in three dental centers across North-eastern Nigeria. Data on sociodemographics (age, gender, and level of education), history, and examination findings were collected with a preformed questionnaire to include the frequency and reasons for the use of dental facilities, previous tooth extractions and reason for extractions, missing teeth, and present diagnosis for the teeth to be extracted. Bivariate and multivariate analyses were used to determine the association and relationships between missing teeth, extractions due to caries and population variables. Results: The prevalence of preextraction tooth loss was 37.98% with a mean tooth loss of 3.05 ± 3.15 per participant, 2.24 ± 1.46 among the 35–44 years old and highest (10.08 ± 8.02) among the 65–74 years old participants. Age was the single significant predictor of tooth loss (β = 0.428, P < 0.001). Molars were the most extracted teeth, with 78.13% of all extractions due to caries and its sequelae. Significant correlations existed between age (r = −0.144, P = < 0.001), level of education (r = −0.118, P = 0.004), and extractions due to caries and its sequelae and were significant in the regression model. Conclusion: Caries and its sequelae were the major reasons for missing teeth as well as for current extractions. Molars were the teeth most affected. Age and level of education were the important determinants of extractions due to caries and its sequelae.
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Analgesia Self-Medication practice and pentazocine dependency in adult sickle cell patients in Southeast Nigeria
Theresa Nwagha, Omotowo Ishola Babatunde
April-June 2020, 29(2):197-202
DOI:10.4103/NJM.NJM_1_20  
Background: Painful crisis is a debilitating hallmark characteristic feature of sickle cell disease (SCD). Analgesia medication is the standard of care. Self-medication is becoming a quick fix for pain resolution for persons living with SCD. The aim of this study was to evaluate analgesia self-medication practice and pentazocine dependency among adult sickle cell patients. Methods: A descriptive cross-sectional study was conducted among 111 adults with SCD attending sickle cell clinic at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla Enugu and Alex Ekwueme Federal University Teaching Hospital Abakiliki (AEFUTHA) Ebonyi. Data were analyzed using SPSS version 22. A P < 0.05 was considered statistically significant. Results: The proportion of adults SCD participants in the study was 45.4% from UNTH Enugu and 54.6% from AEFUTHA Ebonyi. The proportion of male and female who self-medicated was 61.5% and 38.5%, respectively. The prevalence of analgesic self-medication was found to be 28.8%. Analgesics most and least frequently self-administered were paracetamol 50.5% and morphine 0.9% most reported reason for self-medication was “treatment delays in hospital” 73%. Dependency to pentazocine was 22.5%. Age was a significant predictor of self-medication among adult SCD patients. Conclusion: This study shows high prevalence of self-medication and dependency to pentazocine. There should be strict regulation on the use of pentazocine.
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REVIEW ARTICLES
A rapid review of the reopening of schools in this COVID-19 pandemic? How ready are we in Nigeria?
Chinonyelum Thecla Ezeonu, Chigozie Jesse Uneke, Paul Olisaemeka Ezeonu
January-February 2021, 30(1):8-16
DOI:10.4103/NJM.NJM_161_20  
Reopening schools raise several ethical issues, including safety, privacy, autonomy, vulnerability. Some countries have gradually reopened their schools with explicit guidelines for safety. The safe reopening of schools demands sensitivity to community inequities. We aimed to conduct a rapid review of the strategies adopted in the reopening of schools in some countries amid the Covid-19 and highlight the lessons learned and to consider the feasibility of some of the existing Nigerian guidelines on school reopening. A rapid review technique using PubMed search was conducted using the combination of the following keywords: Covid-19, school, reopening along with a Google search using the phrase 'schools reopened in COVID-19 pandemic.' Ten articles met the inclusion criteria and were reviewed. Eight countries namely China, Taiwan, South Korea, Norway, Denmark, Germany, Australia, and Israel were identified. All the countries started with phased reopening and a reduction in class size. Wearing masks was mandatory in some countries. Hand hygiene and strict cleaning of high-touch surfaces were ensured. The Nigerian government's guidelines towards the reopening of schools sound good, but the feasibility, acceptability, and effectiveness need to be objectively assessed and contextualized across all tiers of the government and at all levels of development to avoid COVID -19 resurgence.
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ORIGINAL ARTICLES
Prevalence and factors associated with parvovirus B19 infection among blood donors: A hospital-based study in South-West, Nigeria
Ipeola P Awolesi, Sarah O John-Olabode, Gbenga Olorunfemi, Iwuchukwu O Ajie, Olufemi A Oyedeji, Alani S Akanmu
April-June 2020, 29(2):203-207
DOI:10.4103/NJM.NJM_6_20  
Background: Parvovirus B19 (B19V) is a transfusion transmissible infection that can result in severe consequences in vulnerable population that includes pregnant women, immunocompromised and chronic hemolytic anemia patients. The aim of this study was to determine the prevalence and factors associated with B19V infection amongst blood donors in South–West Nigeria. Materials and Methods: We conducted a comparative cross-sectional study to determine the seroprevalence of B19V immunoglobulin M (IgM) antibody among 183 blood donors at the blood bank of a tertiary hospital. The results were analyzed with SPSS 23 software, prevalence and associated factors were determined using frequencies and logistic regression, respectively. Results: The prevalence of B19V IgM was 7.1% (95% confidence interval: 4–11) with a higher prevalence among male donors compared to females (84.6% vs. 15.4%, P = 0.54). There was a statistically significant difference in the seropositivity of B19V IgM amongst the ethnic groups with the Yoruba ethnic group having a higher proportion of B19V IgM-positive participants P = 0.04. Ethnicity, gender, and steady employment were also associated with increased odds of infection, while increasing age appeared to be protective; though none of these factors were statistically significant. Conclusion: This study has shown that there is still high exposure to transfusion transmissible B19V infection.
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