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   2014| April-June  | Volume 23 | Issue 2  
    Online since December 9, 2020

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Systematic Review and Metanalysis on Community Based Interventions in Tuberculosis Care in Developing Countries

April-June 2014, 23(2):103-117
Background: We aimed to evaluate the effectiveness of Lay Health Workers (LHW) in increasing case detection rate and treatment success outcome of Tuberculosis cases Methods: PUBMED,; Google scholar ,African Journal Online (AJOL) and other search engines were systematically searched, for literature from 2000 to 2012 for studies that are either: [randomized/cluster randomized/non randomized or prospective cohort study]; assessing lay Health care worker participation in tuberculosis (TB) treatment, using the key words (LHW, TB and treatment). Studies were pooled using a random effect model. Of the thirteen studies that fulfilled the inclusion criteria for systemic review, only five were heterogeneous enough for a meta-analysis. Results: There was a marginal effectiveness of LHW involvement in TB treatment success rate, RR 1.09 Confidence Interval. [0.98-1.21] . There was no publication bias; with {p=0.135 for Eggar’s weighed regression analysis}. Restrictive analysis showed a marginally higher summary relative risk in rural based studies RR 1.12, C.I. [1.01-1.24]; compared to urban studies RR 1.01, C.I. [0.91-1.13]. Conclusion: The use of Lay Health care workers is associated with a marginal benefit in improving TB treatment success compared to standard facility based TB care. Larger studies are needed to properly prove its superiority.
[ABSTRACT]   Full text not available  [PDF]
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A Systematic Review of Effectiveness of Daily Oral Penicillin V Prophylaxis in the Prevention of Pneumococcal Infection in Children With Sickle Cell Anaemia

April-June 2014, 23(2):118-129
Background: Children with sickle cell anaemia (SCA) are highly susceptible to infection caused by pneumococcal bacteria due to functional asplenia amongst other reasons. Pneumococcal infections are severe with high mortality among these children that the need for prophylactic penicillin therapy becomes necessary. The objective of this review is to look for evidence of the effectiveness of daily oral penicillin prophylaxis in the prevention of pneumococcal infection in children with SCA. Methods: Electronic databases including genetic disorders group haemoglobinopathies trial register, Cochrane library, Pubmed, Turning Research Into Practice (TRIP) and Google were searched for relevant studies. Hand and grey literature searches were also done. Randomized controlled trials comparing oral penicillin prophylaxis for the prevention of pneumococcal infection in children with SCA with placebo or no treatment were searched for. Results: Two trials were found to have met the inclusion criteria for the review. Results of the two included randomized controlled trials showed a significant reduction in the incidence of pneumococcal infection among children with SCA (and (ß°-thallasaemia) receiving penicillin compared to the control group treated with placebo. The odds ratios for the two (Gaston et al26 and Falletta et al27) studies were 0.37 (95% CI 0.16 to 0.86) and 0.5 (95% CI 0.1 to 2.71) respectively. Conclusion: There is strong evidence that daily oral penicillin prophylaxis greatly reduces the risk of pneumococcal infection in children with SCA under the age of three years and a moderately strong evidence that its withdrawal at the age of five years did not result in any serious consequences.
[ABSTRACT]   Full text not available  [PDF]
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Emergency Peripartum Hysterectomy in A Low Resource Setting : A 5-Year Analysis

April-June 2014, 23(2):170-175
Background: Emergency peripartum hysterectomy (EPH) is an important life saving surgical procedure often necessitated by life threatening obstetric haemorrhage. The indications for peripartum hysterectomy differs between develop and developing countries and may reflect the level of obstetric practice in a region. Patients and Methods: This was a 5-year retrospective study. The medical records of patients who had emergency peripartum hysterectomy at the University of Port Harcourt Teaching Hospital were reviewed and relevant data were retrieved and analyzed. Results: Sixty two cases of peripartum hysterectomy were performed giving a prevalence rate of 0.38% out of 16,113 total deliveries. Being unbooked was significantly associated with peripartum hysterectomy (x2 =85.29,p = 0.0000). Peripartum hysterectomy was performed for 20.3% of nulliparous women. Subtotal hysterectomy accounted for 55.9% while total hysterectomy was performed for 44.1% of cases. The commonest indication for peripartum hysterectomy was uterine rupture (57.6%). There was no case of ureteric injury. Unbooked mothers were 28 times more likely to die than booked mothers. Unbooked status was significantly associated with maternal mortality (p=0.00008 ) and perinatal mortality (p=0.00000). Conclusion: Emergency peripartum hysterectomy still remains indispensible in obstetric practice in low resource setting. Labour and delivery when well supervised will reduce the need for emergency peripartum hysterectomy. Training of specialist in the skill of internal iliac artery ligation is recommended.
[ABSTRACT]   Full text not available  [PDF]
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An Unusual Presentation of Non-Hodgkins Lymphoma: A Case Report

April-June 2014, 23(2):176-177
Background: Breast lymphoma is an uncommon disease with poor clinical outcome. The rarity of the disease is related to relatively small amount of lymphoid tissues in the breast. The prognosis usually depends on the stage at presentation. Objective: To highlight an uncommon presentation of Non-Hodgkin's Lymphoma. Conclusion: Non–Hodgkin's lymphoma can affect the breast. A high index of suspicion and prompt histological diagnosis are needed for effective management.
[ABSTRACT]   Full text not available  [PDF]
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Factors Influencing Herpes Simplex Virus Type 2 Infection Among Females in Enugu, Enugu State, Nigeria

April-June 2014, 23(2):130-141
Background: Herpes Simplex Virus infection is a chronic infection of the sensory ganglia with variable levels of epithelial expression. An important feature of HSV infection is the recurrence of disease as a result of periodic or sporadic activation of viral replication. In addition, asymptomatic shedding of herpes viruses may play a significant role in transmission from person to person.This infection being lifelong manifests only in a small proportion of those infected. It has presented public health concern because of its progressively increasing prevalence which some reports say is of epidemic proportion in developing countries and also for its synergistic effect with HIV infection. Objectives: Determination of antibody prevalence to HSV-2 / co-infection with HIV among females attending skin and ANC clinics in UNTH and ESUTH. Materials and Methods: One hundred and eighty suitably qualified subjects were appropriately recruited over a period of six months into this study. Essential information was collected using a questionnaire. Venous blood was also obtained for HSV 2 serology, HIV screening, and confirmation, if positive. Results: The antibody prevalence of HSV 2 was found to be 77.8% (n = 137) and 14.6% (n=20) had clinical diagnosis. The HIV and HSV-2 co-infection rate was 5.11% (n = 9). The risk factors for groups 1[HSV2 Infection] and 2[HSV2 & HIV co-infection] were similar with few differences, thus buttressing the fact that their modes of transmission are similar. Conclusion: Factors influencing Herpes simplex virus type 2 infection among females in Enugu included among other things older age and increasing number of lifetime sexual partners.
[ABSTRACT]   Full text not available  [PDF]
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Perinatal Autopsies in A Tertiary Health Facility in Southwestern Nigeria: A Retrospective Evaluation of 14 Consecutive Cases

April-June 2014, 23(2):153-156
Background: Perinatal autopsy remains a valuable tool in perinatal medicine. It provides an insight into the genetic implications of subsequent pregnancies and also helps reduce parental events such as maternal illness or maternal use of medications. The practice is not popularly acceptable in our environment for socio-cultural reasons. The scarcity of pathologists who are interested in this aspect of pathology is also an issue. No wonder, the literature is scanty on the cases of perinatal autopsy reported in our environment. Material and Methode: This was a retrospective review of patients' medical and autopsy records to measure the perinatal autopsy rate at a tertiary health institution and identify the trends over the last 12 months (January 1, 2010 and December 31, 2010). This study also aim examining any discordance between antemortem diagnoses and postmortem diagnoses. Results: of 263 perinatal deaths, autopsies were requested and performed in 14 of the cases representing a perinatal autopsy rate of 5.3%. New information was obtained in 64.3% of the cases. The birth weights of the infants ranged from 500g to 3600g with their gestational ages ranged from 22 weeks to 41 weeks. Conclusions: This study is a preliminary report that serves principally to provide base line data for the ongoing study.
[ABSTRACT]   Full text not available  [PDF]
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Continuous Spinal Anaesthesia for Caesarean Section in A Parturient With Peripartum Cardiomyopathy

April-June 2014, 23(2):178-182
Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy. A 27-year-old Nigerian woman, gravida 1, para 0, presented at 31 weeks' gestation with no previous history of hypertension heart disease, but morbidly obese (body mass index of 42 kg/m2), with uncontrolled and hypertension, severe pulmonary oedema who required an urgent Caesarean section is presented. The patient was admitted into the hospital's ICU for stabilisation. She was placed on oxygen by non-rebreathing face mask while receiving intravenous labetalol and frusemide. Following a worsening clinical state, an urgent Caesarean section was conducted under continuous spinal anaesthesia using 7.5 mg intrathecal 0.5% isobaric bupivacaine and was delivered of a 1.8 Kg live female baby with good Apgar scores. At the end of the surgery, mother and baby were transferred to the ICU and SCBU respectively. After a 7-day intensive treatment she was discharged. Since then she remained symptom-free and her baby was doing well during the period of admission and discharge. This case report illustrated the recognition of peripartum cardiomyopathy and the use of a more haemodynamic stable anaesthetic technique. It also described the need for collaboration of multiple medical specialists before, during delivery and after delivery to provide the best possible outcome for both mother and infant.
[ABSTRACT]   Full text not available  [PDF]
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Pattern of Placenta Histopathology in Low Birth Weight Babies Seen in A Tertiary Health Centre in South-Western Nigeria

April-June 2014, 23(2):149-152
Background: Pre-term delivery is usually associated with low birth weight and is a known obstectrics problem in our setting. Few Histopathologists are interested in placental pathology, and this is particularly so because consent is often difficult to get from the relatives making few specimens available for study in our environment. Objective: Our objective was to evaluate the placental histopathology in low birth weight infants (LBW, birth weight < 2500 g) and to determine if placental histopathological findings are associated with low birth weight and preterm deliveries. Methods: The placenta of thirty-eight consecutive cases of LBW deliveries at the Obafemi Awolowo University Teaching Hospital, Wesley Guild Hospital, Ilesa were histologically examined. Results: A total of thirty-eight LBW placentas were examined. The Male: Female ratio was 1.8:1. The maternal age range 19 - 38 years (mean age = 28.7yrs ± 5.37SD). The parity ranged from 0 to 5. The birth weight ranged 0.75 - 2.4kg (mean 1.84kg ±0.39SD). The gestational age at delivery range was 25 - 38weeks (mean 32.85 weeks ±3.7SD). Histological examination of the placentae showed that 17 cases (44.7%) had evidence of placenta malaria(PM), 17 cases(44.7%) had chorioamnionitis(CA), 9 cases (23.7%) had villitis, 2 cases (5.3%) had vasculitis and 4cases (10.5%) had no abnormality. Four sets of twins (8 cases) were among the 38 cases seen. A case of abruptio placenta was delivered by caesarean section, with histological diagnosis of active-chronic malaria. Out of the cases with CA 11(64.7%) had mild CA, 4(23.6%) moderate while 2 (11.8) had severe infection. Placenta malaria co-infection was also found in 7(41%) of the CA. Nine (23.7%) had villitis, only 2 cases had umbilical cord vasculitis. Of the cases with PM, 10(58.8) had active-chronic infection while 7 (41.2%) had evidence of past infection. Conclusion: The main placenta findings histologically in LBW babies include chorioamnionitis and placenta malaria infection. These are known contributory factors to preterm labour. Improved maternity care, health education of pregnant women to reduce ascending infection and use of intermittent preventive treatment for malaria in pregnancy will go a long way in improving outcome of pregnancy.
[ABSTRACT]   Full text not available  [PDF]
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Knowledge, Attitude and Practice of Perioperative Antibiotic Prophylaxis among Nurse-Anaesthetists in Nigeria

April-June 2014, 23(2):142-148
Background: In Nigeria, nurse-anaesthetists are responsible for administering perioperative prophylactic antibiotics in a large number of operations but this practice is poorly studied. Aims: The aim of this study was to evaluate the knowledge, attitude and practice of perioperative antibiotic prophylaxis among nurse-anaesthetists in Nigeria. Methods: A cross-sectional study was conducted among nurse-anaesthetists at an Annual General Meeting/Scientific Conference of Nigeria Association of Nurse-Anaesthetists, using a pre-tested questionnaire. Results: Of 70 questionnaires, 67 were returned. Antibiotic administration at induction of anaesthesia was considered inappropriate by 79.1% (n = 67) and safe by 42.6% (n = 61). There was poor knowledge of indications for intraoperative administration. There was agreement by 81.9% of respondents that anaesthetists should administer prophylactic antibiotics (n=66) but 72.2% would want the surgeon to indicate the time of administration (n = 60). About 69.3% and 77.2% of respondents administered prophylactic antibiotics before tourniquet application (n=62) and skin incision (n=66) respectively in their practice but the latter finding was not corroborated by internal validity check. Availability of a hospital perioperative antibiotic prophylaxis protocol (p =0.048) and practice for 10 or more years (p=0.009) were associated with higher knowledge score. Conclusion: Inclusion of lectures on perioperative antibiotic prophylaxis in nurse-anaesthesia training curriculum, having hospital perioperative antibiotic prophylaxis protocol, stating in the protocols that surgeons give instructions on timing of antibiotic administration and ensuring adherence to the protocols may improve knowledge and practice of perioperative antibiotic prophylaxis among nurse-anaesthetists.
[ABSTRACT]   Full text not available  [PDF]
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Traditional Bone Setting in The Niger Delta Region of Nigeria

April-June 2014, 23(2):157-161
Background: Traditional bone setting is an age long practice in African societies. It has flourished in spite of the advent of orthodox fracture management in Nigeria and many other African countries. However, complications emanating from their practice have led to suggestions on the need for intervention and control of their activities. Objective: We aim to document the current practice of the traditional bone setting in the Niger-Delta region of Nigeria. Methodology: A structured interview of two traditional bone setters in the surrounding villages of the Delta State University Teaching Hospital, Oghara, Delta State, Nigeria was carried out. In addition we visited their ‘clinics’ to make on the spot assessment of their practice. Results / Findings: The two practitioners (‘A’ and ‘B’) interviewed were both males who inherited the trade from their parents. Practitioner ‘A’ has both out-patient and in-patient practices while ‘B’ only treat outpatients in addition to home visits. Basically, both practitioners have similar method of injury treatment which consists of; massaging / manipulation to reduce fractures / dislocations after which the area may be scarified before application of an herbal mixture (Igbudia) followed with bandaging and splinting. Conclusion: From this study, it is obvious that the current practice of traditional bone setters in the Niger-Delta region of Nigeria is still crude and far from ideal. There is thus need for a review of their practice with reorientation of their psyche, training, standardisation, certification / licencing, legislative control and eventual integration at the primary health care level.
[ABSTRACT]   Full text not available  [PDF]
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The Profile of Chest Injuries in A Southeastern Nigeria Teaching Hospital, A 10-Year Experience

April-June 2014, 23(2):162-169
Background: Globally, major chest injuries have both high morbidity and mortality. A detailed study of chest injuries in south-eastern Nigeria is here presented. Aims: To determine the incidence, the predisposing factors, the pattern of presentation and the outcome of management of chest injuries. Materials and methods: This is a retrospective study spanning a period of 10 years (2002-2011). The medical records of all patients with documented chest injuries that presented to our hospital within the period under review, were retrieved and analysed, by simple arithmetic percentages. Result: A total of 402 patients(average of 40/year) with the age ranges in the spectrum of 0-10 and 81-90 years, with a mean of 2.2 were found. Gender-wise, 301 males(74.9%) and 101 females(25.1%) were affected. The aetiological or the predisposing factors were blunt chest injuries (61.2%) and penetrating chest injuries (38.8%). In the pattern of presentation, haemothorax (20.9%), haemopneumothorax (16.2%), pneumothorax (17.4%) including simple, open and tension types as well as multiple ribs fractures(7.7%) constituted the majority. In the management strategies, conservative methods were mainly used. The outcome ranged from very good to fair. Conclusion: The management of chest injuries in our sub-region like any other developing countries is very much challenging. Concerted efforts are needed to overcome the burden it imposes.
[ABSTRACT]   Full text not available  [PDF]
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Clinical Autopsy: For the Sake of the Living

April-June 2014, 23(2):101-102
Full text not available  [PDF]
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