Health Care Centre In Nigeria Research Articles

Effect of Passive Energy Efficiency Measures in Designing Sustainable Primary Healthcare Facilities in Nigeria

This study aims to develop a design for a sustainable healthcare centre through passive energy efficiency measures to improve the thermal comfort, cooling, lighting and ventilation requirements for primary healthcare centres in Nigeria. The methodology adopted for the study included both primary and secondary data collection. Primary data were collected from the administered questionnaire (5-point Likert scale closed-ended), a total of 350 sets of questionnaires administered and 87% were valid. A case study research strategy was adopted to ascertain the effectiveness and efficiency of building design with an emphasis on sustainable architectural design principles. A significant regression equation was revealed (F (2,257) = 33.619, p <.000, with an R2 of 0.294, which revealed that implementing passive measures for energy optimization has a significant and positive effect on designing sustainable healthcare centres. It further recommends the integration of passive design, design for deconstruction, adaptive reuse, and design for human comfort as part of architectural design principles that would result in sustainable energy optimization should be adopted in every design of primary healthcare centres by architects.

#2624 Point of care creatinine for early detection of community acquired acute kidney injury in a primary health care centre in Nigeria

Abstract Background and Aims Community acquired Acute kidney injury (AKI) and leads to poor outcomes in low and middle-income countries due to delayed diagnosis however its epidemiology is poorly studied due to lack of biochemical diagnosis. Supported by the International Society of Nephrology, we evaluated the accuracy of point of care creatinine (POC Cr) technology using capillary samples [1] and its use implementing a clinical algorithm to select patients at risk of AKI for POC Cr testing in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was used in a large primary care health centre for early detection and management of community acquired AKI. Method The study is conducted in Ozuoba Model Comprehensive Primary Health Care Centre. The centre has 4148 patient attendances per month (20.3% medical, 18.8% obstetrics and 60.8% paediatrics) with 11.1% considered acute requiring short admission at the centre usually for intravenous fluids. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in > 48 hours. During this project POC Cr was offered on high-risk patients based on the clinical algorithm from the previous stage (Fig. 1) and patients with detected AKI were offered short admission for intravenous fluids and antibiotics. Results To date 54 patients have been screened with POC Cr. Median age is 25.5 years, minimum 2 months, maximum 85 years, interquartile range (48-10), 62% are females, 57% presented with malaria diagnosis and 9% with gastroenteritis. Mean (standard deviation) of POC Cr was 105 (54) µmol/L. There were 5 cases (9%) of AKI (Cr >150 µmol) detected in patients aged 5 months, 13 months, 7 years, 19 years and 31 years. All were treated with short admission and intravenous fluids and were discharged after clinical improvement. Knowledge of the presence of AKI altered management in all patients prompting short admission. Conclusion Community acquired AKI is common in young patients with malaria and early biochemical diagnosis can improve outcomes. The study continues to recruit and aims to investigate the characteristics of community acquired AKI in Africa and to contribute to the design of optimal and sustainable pathway for early detection and management of AKI.

Knowledge, Attitude, and Compliance with management of Patients with Selected Risk; Diabetes Mellitus & Hypertension On Dementia in Selected Primary Health Care Centres in Nigeria: An Impetus for Primary Prevention of Vascular Dementia

AbstractBackgroundDementia is clinical syndrome, characterized by a progressive and irreversible loss of cognitive function, has seen a rapid increase in Nigeria over the past 20 years1. As access to healthcare improves, more people are living into old age and becoming at risk of developing the condition. In Nigeria, 55% of the population primarily rely on primary care centers for their health needs2. Studies have shown that the prevalence of hypertension and diabetes in Nigeria is increasing, and these are listed as risk factors for dementia by the World Health Organization3. Despite this, there has been limited research on the knowledge and compliance to treatment among those at high risk for dementia, who are crucial for reducing its prevalence. This study focuses on two common risk factors in Nigeria, hypertension and Type 2 diabetes mellitus.ETHICAL COMMITTEE APPROVAL: Obtained from the Human Research Ethical Committee of Lagos University Teaching Hospital, Nigeria. STUDY POPULATION: People with vascular risk factors (Hypertension & Type 2 Diabetes Mellitus) attending primary care facilities in selected centers in Nigeria. Inclusion criteria:1. Patients 35 to < 65 years.2. Patients with correct diagnosis of Hypertension3. Patients with correct diagnosis of Diabetes Mellitus4. Patients with at least basic primary school education Exclusion criteria:1. Patients who don’t pass the cognitive test.2. Patients with neuropsychiatric conditions3. Hypertension in pregnancy Study design: A clinic‐based descriptive cross‐sectional study.MaterialsMini mental State Exam tool prior to commencement of the questionnaire‐based interview. SPSS, structured interviewer‐based questionnaires.RESEARCH ASSISTANTS: Medical graduates of the College of Medicine, University of Lagos, Nigeria, are the field‐enumerators for this study.Results, Discussion & ConclusionOngoing study FUNDING: Self‐funded

Investigating paediatric sarcoma management worldwide: a study protocol

AbstractIntroductionCancer is the leading cause of non-accidental death among children worldwide. The most common types of paediatric cancers include sarcomas: a group of cancers that are difficult to manage due to their heterogeneity and lack of defining features. We have designed an international multicentre cohort study to assess the management of paediatric sarcomas at tertiary healthcare centres in Nigeria, Pakistan and the UK.Methods and AnalysisThe centres will screen patient databases to identify eligible patients under the age of 18 with a clinical or histological diagnosis of sarcoma. Data will be extracted from the patient notes through an anonymized form. Patients will be recruited consecutively into the study from January 2015 to January 2021, with a minimum 12-month follow up period. The primary objectives of the study will be to determine all-cause mortality rates at 30 days, 90 days, 12 months and 3 years. Significant differences in mortality rates between countries will be determined using χ2 analysis or Fisher’s exact test. Univariate and multivariable logistic regression will be used to examine the influence of different factors and patient characteristics on outcomes.Ethics and DisseminationAt the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymized data. At other centres, participating collaborators have gained local approvals in accordance with institutional ethical regulations. Collaborators will present the data to inform decision makers about how sarcoma management may be improved. The results will be submitted for publication in a peer-reviewed journal.

Analysis of 87 Nephrectomies in a Tertiary Healthcare Center in Nigeria.

Nephrectomy is one of the most frequently performed operations on the kidney. It is necessary for treatment of malignant as well as some benign renal conditions. This was a five-year retrospective review of all adult patients who had open nephrectomy in Lagos University Teaching Hospital, Lagos, Nigeria between January 2014, and December 2019. The cases were traced using clinic, ward, and theatre records. The clinical and operative details of these patients were retrieved and analysed. Clinical information extracted included patients' demography, clinical presentations, diagnosis, procedures performed, complications and the immediate treatment outcome. Data were analysed using SPSS for Mac Version 25.0. Results were displayed in simple proportions using tables and charts. A total of 87 patients' records were available for review. Age range was15-76years with a mean and median age of 49.415 and 52 years, respectively. Majority, 73(83.9%) of the patients presented with at least one symptom, whereas14(17.7%) were asymptomatic. Loin pain was the commonest presentation in 72(82.8%). Indication for nephrectomy were benign in 28(32.2%) and malignant in 59(67.8%) patients. Overall, renal cell carcinoma was the most common indication for nephrectomy accounting for 59.8% of all nephrectomies. A total of thirty-one morbidities occurred in sixteen patients with a complication rate of 18.4% while transfusion rate was 40.2%. Reoperation and mortality rates were 2.3 and 3.4%, respectively. Malignant renal tumors are predominant indications for nephrectomy in our institution. Though associated with a high transfusion rate, open nephrectomy remains a safe procedure with a good short-term outcome.

"What Are You Really Doing in This Country?": Emigration Intentions of Nigerian Doctors and Their Policy Implications for Human Resource for Health Management.

The emigration of doctors from Nigeria has been on the increase in recent years, with no obvious efforts to manage or mitigate the negative impacts of this growing trend on the already weak health system. This study assessed the emigration intentions of doctors undergoing residency training at the premier tertiary healthcare center in Nigeria and the factors that influence these intentions. This mixed-method study was cross-sectional in design. A semi-structured questionnaire was used to identify the factors that influence the emigration intentions of resident doctors at the University College Hospital, Ibadan, Southwest Nigeria. In-depth interviews (IDIs) were also conducted to further explore the push and pull factors identified from the survey and their migration preferences. A total of 244 resident doctors completed the questionnaires and 10 participated in the IDIs. Overall, 57.4% of the respondents had emigration intentions and 34.8% had made various attempts at emigrating. Major factors that encouraged resident doctors to emigrate to developed countries included better working and living conditions, good salary and the opportunity for career advancement in destination countries. Family ties was the single most important factor that deterred resident doctors from emigrating. The UK was found to be the top preferred destination. Strategic approaches and multisectoral collaborations will be required to address doctors’ emigration from Nigeria. These efforts should be targeted at not just the health sector but should also include the social and economic aspects of the lives of resident doctors, to improve their living conditions.

Fibrous Dysplasia: A Retrospective Review of Histologically Diagnosed Cases in a Tertiary Health Care Centre in Nigeria

Aims: This study aims to document the age, sex and site distribution of fibrous dysplasia in our tertiary health care facility in order to compare our findings with published literature.
 Study Design: This is a hospital-based retrospective and descriptive study extending from 1st January 2005 to 31st December 2019.
 Place and Duration of Study: Department of Histopathology, Jos University Teaching Hospital, Jos, Plateau State in North-Central Nigeria between 1st January 2005 to 31st December 2019.
 Materials and Methods: Materials consisted of Archival slides, paraffin wax tissue blocks, surgical pathology register and case files of all cases of fibrous dysplasia diagnosed histologically during the period of review. The age, sex and site affected by the tumour were documented for each case using both electronic and hard copy records. The histology slides were examined to confirm the diagnosis. A total of 165 primary bone tumours (103 benign and 63 malignant) were recorded during the period of review, of which 28 were fibrous dysplasia.
 Results: There were 28 cases of fibrous dysplasia which represented 17% of the primary bone tumours and 27% of the benign bone tumours. A half (50%) of the cases occurred in the second decade and 82.1% of cases were diagnosed in craniofacial bones. There was no sex bias in diagnosis.
 Conclusion: Fibrous dysplasia is a relatively common bone tumour in our environment. The sex distribution, age at diagnosis, and bones affected is in keeping with findings by authors from other parts of the world.

Modelling the Number of Household Visit to Health Care Centres in Some Nigeria Communities Using Count Data Regression Models

Introduction: The need to model the impact of some demographic indicators on the frequency of household visits to healthcare centres in Nigeria's community is very important for preventing and spreading community diseases. This study aimed to investigate the effect of the patents' age, gender, marital status, type of illness and amount spent on the frequency of visits to community health care centres in Nigeria and to compared Negative Binomial Regression (NBR) and Generalized Poisson Regression (GPR) models to determine the preferred count regression model for the number of household visits to health centres in some communities in Nigeria. Methods: Survey of 132640 households in some Nigeria communities obtained from the 2018/2019 Nigeria Living Standard Survey (NLSS) were extracted from the National Bureau of Statistics (NBS) in collaboration with the World Bank. The Negative Binomial and Generalised Poisson regression models were used to investigate the five demographic variables on the frequency of visit to the community health centres. The performance of the count regression model was assessed using the Chi-square -2log Likelihood Statistic (2logL), Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) selection criteria. Results: Findings from the study showed that the type of illness and amount spent has a significantly positive effect on the number of household members' visits to the community health care centres in Nigeria while age, gender, and marital status was discovered to have a negative effect on the number of household members' visits to the community health care centres in Nigeria. Conclusion: The Nigeria Government, health centre management and community healthcare service providers' need to be aware that the amount spent and the nature of illness determines the level of health care services utilisation in the Nigeria community, hence the need for the drastic reduction in charges to encourage a household visit to the community health centres whenever the need arises.

Psychotropic Medication Usage for Psychiatric Emergencies in a Tertiary Health Care Centre in Nigeria

Background:This study documented the usage of psychotropics in patients presenting with psychiatric emergencies. The usage of psychotropic medications has to do with the prescription pattern of the clinicians in any setting.
 Materials & Methods: A retrospective study carried out at the University of Benin Teaching Hospital Case notes of patients who presented withpsychiatric emergencies were retrieved, data extracted and analyzed.
 Results: A total of one hundred and fourteen patients were studied over a 10 year period. Most patients (82.5%) were diagnosed with psychotic disorders. Antipsychotics accounted for 67.5% of all prescriptions. Chlorpromazine was the most commonly prescribed oral psychotropic (22.8%). Mood stabilizers were 12.3% while antidepressants were 12.3% of all prescriptions. Parenteral psychotropics were used more as combination (60.5%) than as single parenteral medication (14.0%). Commonest combination of parenteral psychotropic was Chlorpromazine and Diazepam. Long-acting medications commonly used were Fluphenazine Decanoate (20.8%) and Flupenthixol Decanoate (17.4%).
 Conclusion: Oral antipsychotics were more prescribed with Chlorpromazine and Haloperidol as commonest. Amitriptylline was the commonest antidepressant prescribed while Chlorpromazine and Diazepam were the commonest parenteral psychotropic used. Fluphenazine Decanoate and Flupenthixol Decanoate were the commonest long-acting parenteral medications prescribed
 Keywords: Psychotropics, prescription pattern, psychiatric emergency, Nigeria.
 French title: L'utilisation de médicaments psychotropes pour les urgences psychiatriques dans un tertiaire centre de soins de santé au Nigéria
 Contexte général de l'étude : Les médicaments psychotropes sont des médicaments utilisés pour traiter les troubles mentaux. L'utilisation de médicaments est liée au modèle de prescription des cliniciens dans n'importe quel contexte. Ainsi, cette étude a documenté l'utilisation des psychotropes chez les patients présentant des urgences psychiatriques.Matériaux et méthodes de l'étude : Étude rétrospective qui a été effectuée à l'unité des accidents et d'urgence de l'Université du Bénin Centre hospitalier universitaire, Ville Bénin. Les notes de cas des patients qui ont présenté des urgences psychiatriques ont été récupérées, les données extraites et analysées.Résultats de l'étude : Cent quatorze patients ont été étudiés. La plupart des patients (82,5%) ont reçu un diagnostic de troubles psychotiques. Les antipsychotiques représentaient 67,5% de toutes les ordonnances. La chlorpromazine était le psychotrope oral le plus couramment prescrit (22,8%). Les stabilisateurs de l'humeur représentaient 12,3% tandis que les antidépresseurs représentaient 12,3% de toutes les ordonnances. L'antidépresseur le plus couramment prescrit était l'amitriptylline. Les psychotropes parentéraux ont été plus utilisés en association (60,5%) qu'en médicament monoparental (14,0%). L'association la plus courante de psychotropes parentéraux était la chlorpromazine et le diazépam dans 55,7% des cas. Les médicaments à action prolongée couramment utilisés étaient le décanoate de fluphénazine (20,8%) et le décanoate de flupenthixol(17,4%).Conclusion: Les antipsychotiques oraux étaient plus prescrits, la chlorpromazine et l'halopéridol étant les médicaments les plus couramment utilisés. L'amitriptylline est l'antidépresseur le plus courant, tandis que la chlorpromazine et le diazépam étaient les psychotropes parentéraux les plus couramment utilisés. Le décanoate de fluphénazine et le décanoate de flupenthixol étaient les médicaments parentéraux à action prolongée les plus couramment prescrits.
 Mots-clés : Psychotropes, utilisation, e psychiatrique Mergency, Nigéria

Chondrolipoma of the lip: A case report from a secondary health care center in Nigeria

Introduction: Chondrolipomas are rare, benign mesenchymal tumors characterized by proliferation of mature adipocytes associated with variable amounts of mature cartilaginous tissue. Chondrolipoma of the oral cavity is an uncommon clinical presentation. Case Report: We present the case of a 50-year-old, male, Nigerian, type 2 diabetic presenting with a painless, slow growing swelling of the lower lip of two years duration which did not respond to antibiotic therapy. Excision and histopathologic assessment of the mass revealed a diagnosis of chondrolipoma. Conclusion: Chondrolipoma should be included in the differential diagnosis of masses in the oral cavity.

Paediatric otorhinolaryngology, head and neck emergencies at a tertiary health care centre in Nigeria

Background: Paediatric otorhinolaryngology emergency is a common disorder worldwide which is poorly reported in most developing countries like Nigeria. Methods: This study was aprospective hospital-based study of paediatric patients with otorhinolaryngology, head and neck emergency in the Ear, Nose and Throat (ENT) department carried out between June 2016 and May 2018. Data were obtained by using a pretested interviewers assisted questionnaire. All data were analysed using SPSS version 18.0. Results: Paediatric otorhinolaryngological emergencies accounted for 7.6% of all patients seen in the unit. There were more males (69.5%). Common aetiologies were foreign body impaction (43.3%), infection/inflammation(32.6%) and tumour(1.3%). Anatomically the emergencies involved the ear in 42.1%, 30.9% nasal and 23.2% throat respectively. The most common clinical features were foreign body impaction in 35.2%, pain in 31.3%, bleeding in 19.7%, difficulty breathing in 17.6% and nasal blockage in 15.9%. Common sources of referral were paediatricians in 32.6%,casualty officers in 28.8%, a family physician in 22.3% and self -reporting in 15.0%. Complications at presentation include: 27.0% injury/bleeding, 18.0% otitis externa, 11.2% rhinosinusitis and 10.3% perforated tympanic membrane. Conclusion: Pediatric otorhinolaryngology emergencies are common in our centre and were associated with complications at presentation due to wrong interventions. Keywords: Paediatric, Head, Neck Otorhinolaryngology, Emergency, Nigeria

Sizing an Off-Grid Photovoltaic System and Economic Comparison with Petrol Generator Using Life Cycle Cost (LCC) Approach for a Typical Rural Primary Healthcare Center in Nigeria

It is needless to re-emphasize that modern day healthcare systems require uninterruptible power supply, relying on the national grid for power supply most especially in remote areas in Nigeria is a deliberate attempt to paralysis and underutilize both the human and non-human resources. This paper presents the sizing of a stand-alone photovoltaic system and economic comparison with petrol generator in powering a rural Primary Health Care Center (PHC) in Agbado, Ado-Odo, Ota Local Government, Ogun State, Nigeria. Load survey of the PHC was done in order to know the daily energy demand. The average annual solar radiation and the estimated load for the PHC used as case study are 4.89kWh/m2/day and 14.40kWh/day respectively. The result obtained from sizing the photovoltaic system reveals that the estimated load will require 5.25kW photovoltaic array capacity, 21 modules (24V, 250W each), 10 batteries (12V, 200Ah each), 3 solar charge controllers (24V, 80A each), 1 unit of 4kW inverter (24Vdc/220Vac, 50Hz), 3x70mm2 insulated flexible copper cable and 3x2.5mm2 insulated flexible copper cable. Life Cycle Cost (LCC) technique was used to assess the most economically viable option in powering the PHC. The study also reveals a savings of 64.4% in LCC using PV system as against petrol generators in powering the PHC. The replacement cost constitutes the higher factor affecting the LCC of the PV system constituting about 47.7%, while the operation and maintenance cost forms the least factor with about 28.9%. Also, for that of petrol generator, the fuel cost constitutes the highest factor affecting the LCC, constituting about 87.6%, while the initial capital cost forms the least factor which is about 0.24%. The insights from this study can be reciprocated to other rural PHCs in Nigeria.

Abstract 4002: Uptake of cervical cancer screening among HIV positive women at a tertiary healthcare center in Nigeria

Abstract BACKGROUND: Cervical cancer currently ranks the commonest gynecological cancer in Nigeria. This could be attributed to poor performance of screening strategies due to economic and patient factors. HIV (human immunodeficiency virus) infection is associated with increased risk of cervical cancer and there is lack of sufficient data on cervical cancer screening among HIV positive patients in our setting. Inefficient cervical cancer screening is related to late diagnosis and increased mortality associated with cervical cancer in our setting. AIM: This study was to assess the uptake and attitude of HIV positive women in relation to cervical cancer screening. METHODOLOGY: This was a cross-sectional study of women diagnosed with HIV that presented for care at the department of obstetrics and gynecology of Federal Medical Centre Abeokuta. A total of 52 women were recruited from July, 2017 to June, 2018. Knowledge of Pap smear, HPV DNA test and colposcopy were tested among the participants. A pretested questionnaire was given to respondents to assess factors associated with uptake of cervical cancer screening and SPSS version 23 was used for cross tabulation and to perform logistic regression of the factors associated with cervical screening among the subjects. RESULTS: The mean age of the subjects was 36.5±6.8 years. Out a total of 52 respondents, only 15 (29%) were aware of at least one method of cervical cancer screening. Women with tertiary level of educational status comprised 11(78%) of the subjects that are aware of cervical cancer screening. Only 6 (12%) of the HIV positive subjects were aware of the increased risk of cervical cancer associated with HIV infection. Among the 15(29%) of subjects that are aware of cervical cancer screening, 9(17%) were screened because of symptoms and signs of lower genital tract condition. Women between 40 and 50 years of age (OR= 2.41), presence of gynecological symptoms (OR= 2.97), educational attainment (OR=2.54), duration of HIV diagnosis >5yrs (OR=2.99), were strong predictors of uptake of cervical cancer screening in our setting. CONCLUSION: The knowledge and uptake of cervical cancer screening was very poor among HIV positive patients in our setting despite the increased risk associated with HIV infection, incorporation of cervical cancer screening among health education and intervention to improve its uptake by the agencies involved in HIV care will lead to improved uptake and ultimately decrease mortality associated with cervical cancer REFERENCES 1. Zayyan MS, Akpa M, Dawotola DA, Oguntayo AO, Kolawole AO. Quality of life in patients with advanced cervical cancer in Nigeria. Sahel Med J 2018;21:61-9 Note: This abstract was not presented at the meeting. Citation Format: Chibuike F. Chukwunyere, David O. Awonuga. Uptake of cervical cancer screening among HIV positive women at a tertiary healthcare center in Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4002.

Management of Otological Foreign Bodies Impaction in Tertiary Health Care Center

Background: Otologic foreign body impaction are common ear disorder with an associated challenge due to high levels with of pre-hospital unskilled attempted removal.
 Aim: This study aimed at determining the prevalence, socio-demographic features, etiology, clinical presentation, management and outcome in a tertiary health care center in Nigeria.
 Materials and Methods: This is a prospective hospital-based study of all patients with an impacted otologic foreign body. Consented patients were studied between October 2015 and September 2017. The interviewer-assisted questionnaire was used to collect data. Analysis of obtained data was done SPSS version 16.0.
 Results: Prevalence of otologic foreign body impaction was 4.5%. There were 58.5% males with a male to female ratio of 1.5:1.
 The main type of ear foreign body impaction was 85.2% organic (living or dead) and 14.8% inorganic. Commonest otologic foreign body were a cotton bud, insects and seeds in 38.5%, 17.0% and 11.9% respectively.
 The foreign body was unilateral in 97.0% and bilateral in 3.0%. Left ear in 42.2% and right ear in 54.8%. The foreign body was in the external canal in 97.8% and middle ear cleft in 2.2%.
 Main sources of referral were self-reporting in 30.4% and general practitioners in 22.2%.
 Commonest predisposing factors were 31.1% allergy, 23.7% otitis externa, 15.6% earwax and 3.0% mental disorders.
 Conclusion: There are the different type of otology foreign body in all age group and associated predisposing factors. Pre-hospital attempt removal by unskilled sympathizers and untrained health workers leads to avoidable complications.

External Frontoethmoidectomy in the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Introduction: External Frontoethmoidectomy is an open surgical procedure employed to remove disease from the frontal and ethmoidal sinuses. Pathologies in the para nasal sinuses can be managed endoscopically, however, the limited availability of skilled man power in endoscopic sinus surgeries, and the dearth of its instruments in this region, remains a challenge in most tertiary health care centres in Nigeria, thus promoting the use of external approach to manage sinus diseases. Method: This was a retrospective study of 10 patients who had Frontoethmoidectomy over a 6 year period, from January 2012 to December 2017.Their medical records were retrieved from operating theatre, and Ear, Nose and Throat ward. Information retrieved included their age, gender, presenting complain, indication for surgery and length of hospital stay. Results were presented in tables and figures. Results: Among the 10 patients, there were 7 males and 3 females, 6 (60%) were aged 10-19 years. The indications for surgery was Fronto-ethmoidal mucocele in 3 patients and frontal mucocele in 2 patients, frontal sinusitis with intracerebral abscess in 1 patient, pan sinusitis with sinu-cutaneous fistula in 1 patient, potts puffy tumor in 1 patient, fronto-ethmoidal abscess, and fronto-ethmoidal osteoma in 1 patient each. Nasal obstruction was the commonest complain 7(70%), followed by frontal headache 4(40%).The average hospital stay among the patients was 6 days. Conclusion: External fronto-ethmoidectomy has remained the mainstay of treatment for frontal and ethmoidal sinus pathologies in this region, despite the advent of endoscopic sinus surgery. Early presentation for specialist otorhinolaryngological management can reduce morbidity and mortality.

A cross-continental analysis of weight gain, psychiatric diagnoses and medication use during inpatient psychiatric treatment. The international study on physical illness in mentally ill

Weight gain among psychiatric inpatients is a widespread phenomenon. This change in body mass index (BMI) can be caused by several factors. Based on recent research, we assume the following factors are related to weight gain during psychiatric inpatient treatment: psychiatric medication, psychiatric diagnosis, sex, age, weight on admission and geographic region of treatment.876 of originally recruited 2328 patients met the criteria for our analysis. Patients were recruited and examined in mental health care centres in Nigeria (N = 265), Japan (N = 145) and Western-Europe (Denmark, Germany and Switzerland; N = 466).There was a significant effect of psychiatric medication, psychiatric diagnoses and geographic region, but not age and sex, on BMI changes. Geographic region had a significant effect on BMI change, with Nigerian patients gaining significantly more weight than Japanese and Western European patients. Moreover, geographic region influenced the type of psychiatric medication prescribed and the psychiatric diagnoses. The diagnoses and psychiatric medication prescribed had a significant effect on BMI change.In conclusion, we consider weight gain as a multifactorial phenomenon that is influenced by several factors. One can discuss a number of explanations for our findings, such as different clinical practices in the geographical regions (prescribing or admission strategies and access-to-care aspects), as well as socio-economic and cultural differences.

English

This research aims to study the findings from diagnostic laparoscopy among infertile women managed in a secondary healthcare center in Nigeria. This is a prospective study of eighty infertile women who had diagnostic laparoscopy in a secondary healthcare facility in Nigeria. The age range of the women was 24 to 45 years with most of them belonging to the parity group of 0 to 1 (90.0%; n=0.72). Primary infertility accounted for 43(53.8%) of cases, whereas the mean duration of infertility was 4.3+/- 2.4 years. Fifty-seven (71.3%) of the women had abnormal findings at laparoscopy. This comprised mainly of tubal pathologies (63.8%, n=51), pelvic adhesions (33.8%, n=27) and uterine fibroids (31.3%, n=25). Tubal occlusion was found in 39(48.8%) of the women, compromised bilateral tubal occlusion in 12(15.0%) and unilateral tubal occlusion in 27(33.8%) of cases. Distal tubal occlusion accounted for 24(30.0%) while proximal tubal occlusion was seen in 15(18.8%) of cases. While there were 21(26.3%) cases of polycystic ovaries, there was no significant difference in prevalence of abnormal laparoscopy (p=0.8), tubal pathology (p=0.5) and tubal occlusion (p=0.18) with respect to the type of infertility. There was a high rate of abnormal laparoscopy findings among the studied women which were mainly tubal occlusion and pelvic adhesions. These findings indicate the need to incorporate laparoscopy in the initial evaluation of all infertility cases in our environment.   Key words: Abnormal laparoscopy findings, Nigerian infertile women, Nnewi secondary health care centre.

Quality of life of adult patients with vitiligo at a tertiary health care centre in Nigeria

Background/Objectives: Vitiligo is a depigmentary skin disorder which occurs worldwide due to the loss of melanocytes in the skin of affected persons. People living with vitiligo can have psychological disturbances and impaired Quality of Life (QOL) as a result of the cutaneous disorder. The aim of the study is to determine the effect of vitiligo on the Quality of Life (QOL) of affected patients using the Dermatology Life Quality Index (DLQI) and to ascertain the exact domains affected. Methods: The QOL assessment was done using the Dermatology Life Quality Index (DLQI) questionnaire which was administered to patients and controls. All consecutive adult patients with vitiligo attending the Dermatology clinics of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife (OAUTHC Ile-Ife) who gave consent were recruited. A control group, matched for age and sex, was recruited from consenting individuals attending the General Out Patients’ Clinic of the same hospital who did not have vitiligo or any other cutaneous disorder. Results: The total DLQI scores were significantly higher for patients (range: 2- 13) than for controls (range: 0 - 1) and the total mean score for the patients (6.12 ± 2.90) was also higher than the total mean score for the controls (0.32 ± 0.47). The patients with vitiligo had a significant impairment in their self-esteem, daily activities and leisure when compared with the controls. The study also showed that vitiligo patients with extensive disease had impairment in their daily activities when compared with those who had limited disease. Conclusion: This study highlights the fact that patients living with vitiligo have impaired QOL. It is thus pertinent to identify the psychological challenges that vitiligo patients are faced with and offer psychotherapy in addition to treatment of the primary disorder.

Prevalence and Risk Factors Associated with Anal Incontinence among Nulliparous Parturients with Vaginal Delivery in a Nigerian Hospital

Objectives: Anal incontinence may complicate childbirth and this has been grossly under-reported. This study aimed at determining the prevalence and risk factors associated with anal incontinence among nulliparous women undergoing vaginal delivery at a tertiary healthcare center in Nigeria. Methods: A longitudinal study carried out among 293 nulliparous women delivered vaginally at Ekiti State University Teaching Hospital, Ado-Ekiti between January and March, 2012. Questionnaires were administered at index delivery, nine months and five years assessing for socio-demographic data, subsequent deliveries and anorectal symptoms. Women with sphincter tear at first delivery were compared with women without such injury while risk factors associated with anal incontinence were determined. Results: A total of 186 women were analysed and prevalence of anal incontinence increased significantly over the study period. Among women with sphincter tear at index delivery, 27.3% and 36.4% of them had anal incontinence at 9 months and 5years respectively, p= 0.002 and among those without sphincter injury, 8.6% and 16.6% of them reported symptoms of anal incontinence at 9 months and 5years respectively, p= 0.037. Maternal age, sphincter tear at index delivery and subsequent vaginal delivery were associated with anal incontinence at 5yrs, p < 0.05. Majority of women with symptoms had flatus incontinence while faecal incontinence was rare. Conclusion: Though not routinely screened for, anal incontinence does occur among our parturients after the index delivery. It can get worsened with subsequent vaginal deliveries especially if complicated by anal sphincter injury.

Pattern of Care Before Presentation Among the Psychiatric Emergency Cases at a Tertiary Health Care Center in Nigeria.

To determine the pattern of care sought in cases of psychiatric emergency before presentation to a tertiary health care center. Consecutive recruitment of 180 emergency psychiatric cases, which comprised a total of 156 patients, presenting to the accident and emergency unit of the University of Benin Teaching Hospital (UBTH), Edo State, Nigeria, was conducted from June 2008 to January 2009. A structured instrument was used to gather the patients' information including their sociodemographic characteristics, their care before presentation, and the relations accompanying them to the hospital. The mean ± SD patient age was 33.82 ± 12.64 years, with an age range of 18-73 years and a modal age of 23 years. The male to female ratio was 1:1.05. Of the patients, 121 (77.6%) were not married, while 35 (22.4%) were married. Most identified as Christian (96.2%). The majority of the patients (70.0%) presented to the hospital through self-referral. Eighty (44.4%) of the patients had not sought any treatment before coming to UBTH. Forty-seven patients (26.1%) had sought care in churches, 39 (21.7%) had sought treatment in other hospitals, and 12 (6.7%) had sought traditional care before presenting to UBTH. Seventy-four patients (41.1%) were accompanied by parents and 44 (24.4%) were accompanied by siblings, while the spouse accompanied 23 (12.8%) patients. Most patients with psychiatric emergencies at UBTH prefer to present directly to the tertiary health care center in Benin City, and they are usually supported by their immediate family members.