Barau Dikko Teaching Hospital Research Articles

Intimate partner violence during pregnancy is related to reduced birthweight: cross-sectional study in Kaduna, Northwestern Nigeria

Objective To determine the association of prenatal intimate partner violence (IPV) with birth weight. Methods A cross-sectional study of 320 mother-child pairs recruited shortly after birth at Barau Dikko Teaching Hospital, Kaduna, Nigeria. Emotional, physical, and sexual violence were measured after delivery using the Conflict Tactics Scale. The main outcome measure was birthweight in grams. Linear regression was used to estimate the adjusted associations (β and 95% confidence interval (CI)) between birthweight and 1) exposure to intimate partner violence (relative to no exposure), 2) frequency of prenatal IPV exposure. Results Sixty-nine percent of mothers experienced at least one of the three forms of IPV during pregnancy. Among term births, relative to the 31% of women with no IPV exposure, prenatal exposure to emotional violence was associated with a reduction in birthweight of 99g (95% CI -206,7), 182g (95% CI -285,-80) for physical violence and 139g (95% CI -247,-31) for sexual violence. The combination of all three forms of violence was associated with a 237g reduction in birthweight (95% CI -378,-96). Increasing instances of each of the three types of violence were associated with a greater reduction in birthweight. For physical violence, birthweight was lower by 121g (95% CI -227,-15) with 1-5 instances and 406g (95%CI -570, -240) for >5 instances over the pregnancy, relative to no exposure to IPV. Conclusions Among term newborns, maternal exposure to any form of intimate prenatal violence was associated with reduced birth weight. A dose-response relationship was observed between intimate partner violence and birthweight.

Child Electronic Growth Monitoring System: An innovative and sustainable approach for establishing the Kaduna Infant Development (KID) Study in Nigeria

BackgroundDeveloping countries bear the burden of childhood stunting but lack resources for cohort studies to develop preventive strategies. To enable future prospective studies, we designed and tested the Child Electronic Growth Monitoring System (CEGROMS) using a readily available electronic data capture platform, the Research Electronic Data Capture (REDCap).ObjectivesTo demonstrate the feasibility of using CEGROMS for data collection for a pilot study for the Kaduna Infant Development (KID) Birth Cohort Study in Nigeria.MethodsCEGROMS consists of the data capture form for growth monitoring, a central cloud server, electronic tablets, and desktop computer. We implemented the pilot study in 2017‐2019 at the Barau Dikko Teaching Hospital, Kaduna, Nigeria. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for completeness of baseline data (relative to individuals with incomplete data) and completion of follow‐up at different time points (relative to individuals with no follow‐up visit) by the participant characteristics. Complete data were defined as date of birth, sex, and birthweight recorded at recruitment.ResultsAmong 3152 infant records in CEGROMS, 2789 (88.5%) had complete data. Of these, 1905 (68.3%) had at least one follow‐up visit. The main determinants of data completeness were health facility delivery (OR 19.17, 95% CI 13.65, 26.92) and tertiary education (OR 3.54, 95% CI 2.69, 4.67). Follow‐up was greater for women with tertiary education (OR 1.33, 95% CI 1.06, 1.51 for at least one visit). Maternal education is associated with completeness and follow‐up (following adjustments for parity and employment).ConclusionsThe CEGROMS electronic data collection system enables complete and consistent data collection. The data will enable design of strategies to improve follow‐up in the future implementation of the birth cohort study.

Prevalence and pattern of skin diseases in patients with diabetes mellitus at a tertiary hospital in Northern Nigeria.

Diabetes mellitus is one of the most common metabolic disorders with a rising prevalence. It cuts across all ages and socioeconomic status. Various skin lesions are frequently observed in diabetic patients. This study was carried out to determine the prevalence, pattern, and determinants of skin diseases in diabetic patients at the Barau Dikko Teaching Hospital, Kaduna, North West Nigeria. One hundred consecutive diabetic patients attending the clinic were included in the study. Many of the patients had more than one skin condition at a time. The most prevalent skin diseases were idiopathic guttate hypomelanosis which was seen in 61% of patients, infections from fungal, bacterial, and viral causes occurred in 30% of patients, other skin disorders were diabetic dermopathy seen in 17% of patients, palmoplantar hyperpigmentation was seen in 13% of patients, while pruritus occurred in 12% of patients and xerosis was seen in 10% of patients. Skin disorders are common among diabetic patients at Barau Dikko Teaching Hospital, Kaduna, North West Nigeria.

Lung Function Impairment in Pediatric Subjects with Sickle Cell Anemia from Nigeria Is Associatede with Associated Low Steady Haemoglobin

Low hemoglobin (Hb) level at steady state in subjects with sickle cell anemia (SCA) may indicate severe chronic hemolysis and might be related to a more severe course of disease.In this study we investigated the hypothesis that low hemoglobin at steady state may be associated with higher rate of lung function impairment in children and adolescents with SCA.MethodsIn this cross-sectional study black African subjects with SCA (Hb phenotype SS) aged 6 to 18 years followed at the Barau Dikko Teaching Hospital, Kaduna, Nigeria, underwent spirometry and anthropometry measures. A recent Hemoglobin level at steady state was recorded for each patient. Caregivers or patients were interviewed through a questionnaire investigating a history of asthma or acute chest syndrome (ACS) and frequency of pain crises in the last year that required analgesics for at least 24 hours. Exclusion criteria were: the lack of recorded complete blood count (CBC) performed in the last 6 months, respiratory symptoms or feeling unwell on the test day, SCA-related acute events (e.g., pain crises) in the last two weeks or a blood transfusion or an ACS episode in the last month. A portable Easy-on-PC spirometer (ndd, Zurich, Switzerland) was used. Data were included if at least two forced expiratory manoeuvres met the ATS/ERS acceptability and repeatability criteria adapted for children (Miller MR, ERJ 2005; Kirkby J, Pediatr.Pulmonol.2008). Spirometry z-scores and percentage of predicted for FEV1, FVC and FEV1/FVC were derived according to the GLI-2012 reference equations for African Americans (Quanjer PH, ERJ2012). Spirometry patterns were classified as normal, obstructive (zFVC ≥ 1.64 + zFEV1/FVC < -1.64), restrictive (zFVC < -1.64 + zFEV1/FVC ≥ -1.64) or mixed (zFVC < -1.64 + zFEV1/FVC < -1.64) and a FEV1 < 70% of predicted was considered indicative of lung end-organ disease (Kassim AA et al, Blood. 2015 Sep 24;126(13):1544-50). Group comparison between patients with Hb level < 7.5 g/dL versus Hb ≥7.5 g/dL were tested using unpaired t test, χ2 or Fisher's exact test as appropriate. The relationship between Hb values and spirometry outcomes was explored through logistic and linear regression models. P-value < 0.05 was adopted as representing a statistically significant difference. Analyses were conducted using the software STATA and Graphpad Prism 7.ResultsA total of 186 subjects with SCA were initially enrolled. Only one child was on hydroxyurea. After exclusions, data from 126 patients (mean ± SD age of 11.5 ± 3.1 yr., 53% boys) were retained for the final analysis. Mean ± SD Hb value was 7.8±0.9 g/dL (range 5.6 to 10.9). Frequency of low Hb (< 7.5 g/dL) at steady state was 30.9% (39/126).Mean FEV1 and FVC z-scores were lower and frequency of FEV1 < 70% of predicted was higher in patients in the low Hb group compared to those with Hb ≥7.5 g/dL though differences were not statistically significant (table 1). Prevalence of restrictive spirometry pattern, possibly suggesting restrictive lung disease, was significant higher in patients with Hb level < 7.5 g/dL (17/39, 43.5%) than in those with Hb ≥7.5 g/dL (20/87, 22.9%) (p = 0.01; table 1).The odds ratio for restrictive spirometry pattern in presence of Hb level <7.5 g/dL was 2.5 (95% CI 1.1 to 5.7; p = 0.03). In a linear regression model (figure 1) the FVC z-score resulted significantly related to the Hb level with an increase of 0.17 z-scores for each point of Hb (95% CI 0.01 to 0.34, p = 0.04; R2 = 0.03).Frequency of asthma, pain crises and previous acute chest syndrome did was similar between the two groups (data not showed)ConclusionsIn Nigerian pediatric patients with sickle cell anemia a hemoglobin level < 7.5 g/dL at steady state was associated with a 2.5 higher risk of presenting a restrictive spirometry pattern and with a higher frequency of end-organ lung disease (FEV1 < 70% of predicted). Low hemoglobin levels in wellbeing may depend on intense chronic haemolysis that could worsen microangiopathy, inflammation and ischemia and reperfusion injury in the lungs, potentially determining a precocious onset of restrictive lung disease.These preliminary data seem to indicate that a low Hb level at steady state in African pediatric patients with sickle cell anemia is associated with more severe lung impairment and should prompt respiratory assessment with lung function when found. [Display omitted] DisclosuresInusa:Novartis plc: Honoraria, Research Funding, Speakers Bureau; Astrazeneca: Consultancy.

Treatment of unstable proximal femoral fractures using proximal femoral locked compression plates our experience

Introduction: Proximal femoral fractures account for about 10 to 34% of all hip fractures with bimodal age distribution and different mechanisms of injury. Older patients sustain low velocity trauma while in younger patients these fractures are from high energy trauma. Early surgical intervention is recommended for most of these patients to reduce the complications associated with prolonged immobilization. The locking compression plate is used for angular-stable plating for the treatment of complex comminuted and osteoporotic fractures. This type of internal stabilization may be the choice for subtrochanteric or transverse intertrochanteric fractures. Objective: The study aimed to report the outcome of management of unstable proximal femoral fractures which was managed using proximal femoral locked compression plate in our setting.Method: A retrospective study of all conservative patients managed at two centres in Nigeria. The Jos University Teaching Hospital, Jos, Plateau State and the Barau Dikko Teaching Hospital, Kaduna State University Teaching Hospital Kaduna. A structured Proforma was used to retrieve information from the hospital records and operation notes of patients that where fixed with PF-LCP. Results: A total of 25 fractures in 25 patients where studied, 17 males and 8 females with a male female ratio of 2:1. The patient age ranged between 20 to 88 years. Road traffic accident was the commonest etiologic agent account for 73.9% of the cases and the remaining 26.1% was due to domestic falls at home. 43.8% of the patients presented 12 weeks after the injury, 25.0% of them between 4 to 12 weeks of injury and 31.2% presented within 4 weeks of the injury. The fractures were intertrochanteric in 16.0% of the patients and sub trochanteric in 84.0%. The average duration of union as evidenced by bridging callus in at least 3 cortices radiologically was 15.4weeks. 23 of the patients went on to unite without any complication one had implant failure (screw breakage) due to premature full bearing for which additional surgeries where done while another had an implant infection. Conclusion: Proximal locked compression plating for proximal femoral fractures is a useful alternative based on its anatomic design for proximal femoral fractures in which could be due to osteoporosis especially in elderly patients.

English

A wide variety of opportunistic pathogens has been detected in hospital surfaces. Medical center surfaces can serve as reservoirs of pathogenic bacteria. Among this pathogens, Pseudomonas species are one of the leading causes of nosocomial infections, frequently found in hospital environments. Polymerase chain amplification system remains one of the best methods for the rapid detection of low numbers of pathogenic bacteria with core references to nucleic Acid content. However, there is a limited researches focusing on these techniques to examine the molecular content of nosocomial bacteria. The present investigation examines types and strains of bacteria present in indoor air of wards, fomites and surgical tools of three prominent hospitals namely, Ahmadu Bello University Teaching Hospital Zaria, Hajiya Gambo Sawaba Hospital Zaria City and Barau Dikko Teaching Hospital Kaduna using standard methods. Preliminary Grams reaction and biochemical characterization was done according to standard methods, DNA extraction precede PCR amplification, probable organisms include Pseudomonas aeruginosa, Corynebacterium sp., P. aeruginosa, Bacillus sp., Klebsiella pneumonia, Neisseria sp., Staphylococcus aureus and Staphylococcus epidermidis. Out of all the isolates that were of public health concern, Neisseria sp., S. aureus and P. aeruginosa are the most prevailing isolates. A strain of P. aeruginosa was observed to give a DNA sequence. P. aeruginosa was the bacteria isolates sequenced and it showed 100% similarity having the id query: 86603, when blast using National Center for Biotechnology Information (NCBI). In general, patterns were specific at either the genus level or the species level. This research has been able to show that PCR is a promising fast method for the identification of nosocomial microorganisms. Key words: Polymerase chain reaction, nosocomial bacterial, hospital and DNA.

Commentary on aphakic correction in Barau Dikko Teaching Hospital, Kaduna, Nigeria

Commentary on aphakic correction in Barau Dikko Teaching Hospital, Kaduna, Nigeria

A Case Report of Psychosis in Parkinson Disease Treated with Anticholinesterase Drug

Case report: We present a 68-year-old male, retired civil servant who was seen in the neurology clinic at Barau Dikko Teaching hospital, Kaduna-Nigeria with a complaint of abnormal movements of upper and lower limbs for one year, and difficulty in walking for two months. The abnormal movement started on the distal part of both upper limbs simultaneously. It was noticed more at rest and got aggravated during movements. He was diagnosed with PD and was treated with L-dopa and Artane. However, six weeks after the commencement of his therapy he started developing a visual hallucination that subsequently became so intense that he started isolating himself and became suspicious of the wife conniving with strange people to kill him. His psychosis was initially treated with clozapine which controlled the hallucination to some extent but made his dyskinesia worse. This prompted us to stop the clozapine and to decrease the l-dopa, while introducing an anticholinesterase pyridostigmine which helped in treating the psychotic episode. Discussion: The use of psychotropic medication may control the psychotic features but will aggravate the PD. A trial with anticholinesterases has been found to be effective in the control of psychosis in PD.

Aphakia: A 5-Year review at Barau Dikko Teaching Hospital, Kaduna, North-west Nigeria

Aim: To describe the causes, visual potential and the proportion of aphakics that can be prevented from being blind in BDTH, Kaduna. Method: A retrospective review, the records of all aphakics that had refraction from January 2011 and December 2015 was retrieved from the refraction unit of our hospital. Patient's biodata, presenting visual acuity, corrected visual acuity, spherical correction and diagnosis were extracted and analyzed using SPSS version 20. Outcome Measures: Presenting visual acuity, corrected Visual acuity and spherical correction. Results: In 5 years, 56 eyes of 42 patients were refracted, with a mean age of 68.9years, 24 (54.8%) were males and 19 (42.2%) were females. Aphakia was caused by surgery in 29 (51.8%), couching in 23 (41.1%) and trauma in 4 (7.1%). Most eyes were corrected with +10D lens and aphakic spectacles could prevent 45 (83.4%) eyes from blindness. Visual outcome depended on the aetiologic cause of aphakia. Conclusion: There are still a few patients blind from aphakia mainly following cataract surgery. Adequate refraction and provision of spectacles can prevent blindness in a large proportion.

Time interval to initiation of contraceptive methods following childbirth in a low-resource setting.

The objectives of the study were to determine factors affecting the interval between a woman's last childbirth and the initiation of contraception. This was a retrospective study. Family planning clinic records of the Barau Dikko Teaching Hospital Kaduna from January 2000 to March 2014 were retrieved. Information was collected on demographics, reproductive, and contraceptive history. Data were analyzed using the SPSS version 15 software, and missing responses were excluded. Chi-square was used as a test of association with significance level established at P = 0.05. A total of 5992 client's cards were retrieved. All were female and married. Majority were aged 25-34 years (53.1%), had completed secondary education (56%) and were Muslims (52.3%). Only 4979 cards (83.1%) had correct data on intervals and 22.1% of these clients initiated contraception within 6 months of their last childbirth. Education, religion, source of information, number of living children, desire to have more children, previous use of contraception, and type of contraception chosen were significantly associated with intervals for initiating contraception after last childbirth (P < 0.05) while the presence of complications in the last delivery was not (P > 0.05). Majority of women initiate contraception late after childbirth in this setting. Increased awareness on immediate/early postpartum contraception is required. Further qualitative studies will help to explore findings of this study.

Comparison of Contraceptive Methods Chosen by Breastfeeding, and Non-Breastfeeding, Women at a Family Planning Clinic in Northern Nigeria

Introduction: Breast feeding may pose a further challenge to uptake of contraception by possibly restricting use of certain methods for real or perceived risks of side effects. Methodology: A retrospective study was done at the Barau Dikko Teaching Hospital, Kaduna. Available family planning clinic client cards from January 1st, 2000 to March 31st, 2014 were retrieved and information collected on demographics, reproductive and menstrual history, contraceptive choices and breast feeding status. Data were analyzed using the statistical package for social sciences (SPSS) version 15. Missing responses were stated and excluded from analysis. Chi square was used as a test of association with significance level established at p value, 0.05. Results: A total number of 5992 client cards were retrieved. All clients were female and married, and majority of clients aged between 25 - 34 years (53.1%), had either completed their secondary education or gone further (56%) and were Muslims (52.3%). Only 2924 women stated that they were currently breastfeeding (48.8%), 1828 women were not breastfeeding (30.5%) and 1240 women (20.7%) did not state their breastfeeding status. Younger and more educated women were more likely to be breastfeeding than older women and less educated ones (p < 0.05). Only 4636 cards (77%) had correctly filled data on the choice of contraceptives chosen by breastfeeding status with 2854 women breast feeding and 1302 (45.6%) chose injectable hormonal contraception, 888 (31.1%) chose intrauterine contraceptive devices, 484 (17%) chose oral contraceptive pills and 180 (6.3%) chose contraceptive implants. There was no record of condom use or use of permanent methods of contraception. Conclusion: Breastfeeding rates were high among women seeking contraception. The pattern of contraception is similar among both breastfeeding and non-breastfeeding women, with injectable contraception being the preferred choice. Awareness should be raised on the safety of a wider variety of contraception available for breastfeeding women.

Choice of contraception after previous operative delivery at a family planning clinic in Northern Nigeria

Context: Effective contraceptive use is important after a caesarean or operative delivery because of the possible risks a woman may face in subsequent pregnancies. Objectives: The objective of the present study was to determine the uptake and choices of contraception among women with previous operative delivery. Materials and Methods: A retrospective study was conducted at the Barau Dikko Teaching Hospital from 1 st January, 2000 to 31 st March, 2014. Family planning cards were retrieved, and relevant information was collected and analyzed using the Statistical Package for Social Sciences version 15. Chi-square test was used as a test of association, with significance level established at a P value of Results: Of the 5992 cards retrieved, 164 (2.7%) had previous operative delivery; 152 caesarean sections and 12 laparotomies for ruptured uterus. Only 17.7% initiated contraception within 6 months. More women were spacers (86.6%) rather than limiters (13.4%). Age, education, religion, parity, prior contraception, and interval from the last delivery were significantly associated with the current choice of contraception (P 0.05). Overall, when comparing the pattern among those with a previous operative delivery and those without, there was no significant difference between both the groups; injectables was the most popular method chosen followed by intrauterine devices, oral contraceptive pills, and implants. Conclusion: Most women with a previous operative delivery were at risk of unwanted pregnancies because they did not initiate contraception within 6 months of their last delivery. Their preferred forms of contraception were injectables and intrauterine devices, which was not significantly different from the methods chosen by other women.