Hospital In South-Eastern Nigeria Research Articles

Evaluation of neonatal circumcision training for resident doctors in a developing country

There is a high prevalence of neonatal circumcision (NC) in Sub-Saharan Africa. However, when providers do not have adequate training on the procedure, neonatal circumcision can result in complications. There are indications that the reported high complication rate of NC in the current setting might be a reflection of inadequate training of the providers. In order to establish a framework for better training of providers of NC, it may be necessary to evaluate the providers' opinions of their training and competence of the procedure. The opinions of surgical, paediatric, and obstetrics-gynaecology resident doctors were evaluated for their exposure to, training on and perceived competence of neonatal circumcision. The resident doctors in surgery, paediatrics and obstetrics-gynaecology (OBGYN) at two teaching hospitals in southeastern Nigeria were surveyed using a self-developed questionnaire. The self-assessment survey evaluated the residents' exposure and training on NC, and their perceived competence of the procedure. The responses from the different specialties were compared. Data were analysed using Statistical package for Social Sciences (SPSS). The summary of findings is shown in Table below: The confidence in the ability to perform the NC did not significantly differ between the sexes (male 53/87 vs female 6/15; P = 0.22) and the level of training (SHO, Senior house officer 7/17, Registrar 24/42, senior registrar 28/43; P = 0.24). A substantial proportion of residents who encountered neonatal circumcision considered their training in NC to be sub-optimal, despite their perceived exposure to the procedure. Notwithstanding this deficiency of training, the majority of the residents planned to perform NC and this presaged an expectedly higher rate of complications. Well-thought-out and structured training, comprising lectures, workshops and hands-on training, for the resident doctors and the other providers of NC might address these shortcomings and minimise complications. This may further be strengthened with a government policy on circumcision. The limitations of the study included: (1) It was a self-assessment survey and this introduced bias in the assessment of competency; (2) There were no outcome measures in the survey for those who had practical exposure vs those who did not. The resident doctors perceived that their exposure, training and competence in NC might be sub-optimal. Curriculum modification that incorporates appropriate hands-on training in NC might address these deficiencies.

Characterization of TB/HIV Co-Infected Patients Receiving TB Treatment at a DOTS Clinic, in a Tertiary Hospital in South-Eastern Nigeria

Background: Tuberculosis (TB) is a specific infectious disease caused by mycobacterium tuberculosis while acquired immune deficiency syndrome (AIDS) is a fatal illness caused by human immunodeficiency virus (HIV). Both of them constitute the main burden of infectious public health disease in many parts of the world, particularly in resource limited countries like Nigeria. This study sets out to describe TB/HIV co-infected patients accessing care at the DOTS clinic in a tertiary hospital in South-Eastern Nigeria. Methods: This study was conducted retrospectively at the DOTS clinic of NAUTH Nnewi. A structured proforma was used to extract specific characteristics of TB/HIV co-infected patients who received TB treatment for the period of 1st January 2013 to 31st December 2013. The collected data were analyzed with SPSS version 20. Results: Ninety eight patients (40.6%) were TB/HIV co-infected, out of the two hundred and forty one patients treated for tuberculosis in the DOTS clinic during the period under review. These were the findings among the TB/HIV co-infected patients: there were more females (51%) than males (49%); the commonest age group affected was the group 30 - 39 years (34.7%); majority of the patients (91.8%) had pulmonary TB as against extrapulmonary TB (8.2%) and most of the patients had negative sputum AFB result (43.9%) as against those with positive result (36.7%). Conclusion: This study demonstrated some important characteristics of TB/HIV co-infected patients. Such knowledge if taken into consideration in both the tuberculosis control and HIV control programs will improve the outcomes of the programs.

Indications for an endoscopic findings in patients with symptoms of upper gastrointestinal disease in a Tertiary Hospital in South-Eastern Nigeria

Background: Upper gastrointestinal complaints are common, and the underlying diseases range from simple to very serious pathologies. Upper gastrointestinal endoscopy helps in the proper diagnosis and the appropriate management of the underlying lesions. Aim: To determine the indications for and the findings at upper gastrointestinal endoscopy in a private Tertiary Hospital in South-Eastern, Nigeria. Materials and Methods: A retrospective cohort study of adults who had an upper gastrointestinal endoscopy between March 2011 and August 2012 at the study hospital was carried out. Their medical records were reviewed to evaluate the indications and outcomes of the endoscopy. Results: A total of 211 patients' records were reviewed. Males constituted 49.5% of the patients while females constituted 50.5% giving a male:female ratio of approximately 1:1. Their ages ranged from 18 to 92 years with a mean of 52.5 years. The commonest indications for the procedure were dyspepsia occurring in 129 (61.1%) followed by gastrointestinal bleeding 39 (18.5%). The commonest endoscopic diagnosis was gastritis which was found in 161 (76.3%) patients. Peptic ulcer was diagnosed in 29 patients (13.7%) and gastroesophageal varices in 5 patients (2.4%). Of 39 patients with an indication of upper gastrointestinal bleeding, peptic ulcers occurred in 18 (42.1%) while varices were seen in 5 (12.8%). Conclusion: The commonest indication for upper gastrointestinal endoscopy in the studied Tertiary Hospital in South-Eastern Nigeria is dyspepsia while the commonest endoscopic diagnosis is gastritis. Furthermore, peptic ulcers are seen more commonly than gastro-oesophageal varices in patients presenting with upper gastrointestinal bleeding in this population.

Common causes of geriatric medical emergencies in China.

One of the most significant demographic changes in our country is the increase in the elderly population. In China Mainland, the population aged 60 and older was 194 million in 2012, accounting for 14.3% of the total population. However, by 2053, it is estimated that the number of elderly will reach 487 million, representing 34.8% of the total population. Elderly patients represent an ever-increasing populace in emergency medicine who often present with atypical signs and symptoms as well as comorbidities that can complicate diagnoses and treatment. The geographic factors and the developmental status of the country can influence the spectrum of common geriatric emergencies. Thus, this study presents a retrospective analysis of common causes of geriatric emergencies involving 9,628 elderly patients from Jan. 2008 to Dec. 2013 in an emergency department in Beijing, China. The ages of patients ranged from 60 to 103, with a mean age of 82 years old. These patients included 7,815 males and 1,813 females. The most common causes for geriatric emergency medical treatment are listed in Table 1. In this study, the three most common causes of geriatric emergencies were respiratory disease (26.2%), cardiovascular disease (20.8%) assumed as the uppermost one, and neurological disease (10.9%), which almost consisted with a previous study. A study conducted in France reported the main reasons for emergency admissions of elderly patients in a university hospital were cardiopulmonary disease in 31.6% of cases, followed by neuropsychiatric disorders, which accounted for 28.2%. However, in a rural hospital in south-eastern Nigeria, the three most common causes of geriatric emergencies included acute malaria (33.8%), hypertensive crises syndrome (19.0%), and acute hypertensive heart failure (18.1%). These differing statistics support the belief that common causes of geriatric emergencies are generally related to geographic factors and developmental status of the country. Table 1. Common causes of geriatric emergencies in 9,628 elderly Chinese.

The practice of breastfeeding by healthcare workers in the Federal Teaching Hospital, Abakaliki, south-eastern Nigeria

Background. Optimal breastfeeding practices include exclusive breastfeeding (EBF) for the first 6 months of life, followed by continued breastfeeding with adequate complementary foods on to at least 2 years of age. This is expected to be well known and practised by healthcare workers (HCWs) who are in the position to educate the community. Objective. To determine the actual breastfeeding practices of HCWs in a tertiary hospital in south-eastern Nigeria. Methods. We conducted a cross-sectional, descriptive study among female HCWs at the Federal Teaching Hospital, Abakaliki, southeastern Nigeria, using a self-administered, semi-structured questionnaire. Results. One hundred HCWs were recruited, including doctors, nurses, pharmacists and other HCWs. Only 3% practised EBF with all their children, their cited reasons being a busy work schedule (61.8%), EBF being too stressful (18.4%), ignorance of benefits of EBF (13.2%) and lack of family support (3.9%). Only 1% breastfed their babies up to 2 years. The reasons for failing to do so included refusal of the child to breastfeed (32.6%), another pregnancy (30.4%), feeling it was shameful (10.9%) and feeling that the baby was too old (8.7%). Conclusion. There are obvious shortcomings in breastfeeding practices among HCWs. They need to be empowered and supported to promote and support breastfeeding among their patients in particular and society in general. Normal 0 false false false EN-GB X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-fareast-language:EN-US;}

Profile and determinants of treatment failure among smear-positive pulmonary tuberculosis patients in Ebonyi, Southeastern Nigeria

BackgroundEarly identification of determinants of tuberculosis (TB) treatment failure is urgently needed in resource-limited settings. This study describes the profile and determinants of TB treatment failure in a high-incidence setting where patients were managed at a TB control program with significant resource limitations. MethodsThis was a retrospective case-control study carried out in one tertiary and one secondary hospital in Southeastern Nigeria. Cases were adult (⩾15years) TB patients with a positive sputum smear after 5months of treatment (treatment failure). Controls were adult TB patients whose sputum smear was positive at the beginning of the treatment but who were smear-negative in the last month of treatment and on at least one previous occasion (cured). Cases were compared with controls to assess determinants of treatment failure. ResultsOf the 1668 TB patients registered during the study period, 985 (59%) had smear-positive pulmonary TB. Of these, 694 (70.5%) were aged ⩽40years, 602 (61.1%) were males, 707 (71.8%) were rural residents, and 898 (91.2%) received care at the private facility. The prevalence of treatment failure was 2.5%. Significant determinants of treatment failure were: older age (>40years) (P<0.001), male gender (P=0.04), previous treatment for TB (P=0.045), and positive sputum smears after two month of anti-tuberculosis treatment (0.001). ConclusionThis study showed that the treatment failure rate among smear-positive TB patients is low in Nigeria. Education and improved clinical and laboratory interventions for the identified at-risk groups may reduce TB treatment failure in resource-limited settings.

Pediatric Ocular Injuries in a Resource-Deficient Rural Mission Eye Hospital in Southeastern Nigeria

Pediatric ocular trauma is a significant worldwide problem of public health importance being a leading cause of non-congenital unilateral blindness. This study evaluated the proportion, type and causes of ocular injuries among children in a rural hospital of Nigeria. Children (<16 years) presenting with ocular trauma at the Eye clinic of the Presbyterian Joint Hospital, Ohaozara, Ebonyi state, Nigeria, between November 2011 and May 2012 were studied. Participant's socio-demographics, type of trauma, cause of trauma, and occupation of parents were collected and analysed. The Proportion of ocular injuries was 26.4%. Injuries were more common among males (P=.041) and children from lower social class (P=.026). Injuries occurred more frequently during farm work (59.4%) and play (21.9%). The most common causes of injury were stick (34.4%) and stones (21.8%). The proportion of ocular injuries among children at the rural hospital is high. Most causes are preventable.

Predictors of Delayed Enrolment for Care among People Living with HIV in a Tertiary Hospital in South Eastern Nigeria

Aim: This study aimed to identify predictors of delayed enrolment to HIV care in Calabar, Nigeria. Study Design: This was a cross sectional observational study. Place and Duration: This study was carried out in a tertiary level hospital in Calabar, Nigeria between February 1 st , 2013 and June 30 th , 2013. Methodology: We recruited 500 consecutive HIV-infected persons presenting to care for the first time following HIV diagnosis using a validated, semi-structured and pretested questionnaire. The outcome variable of interest was delayed enrolment for HIV care (>12 months after HIV diagnosis). The independent variables included age, sex, marital status, occupation, income, level of education and exposure to risky behaviour. Others were sexual orientation, duration between HIV testing and presentation for care, residential conditions, lack of spousal HIV status disclosure, distance of residence from nearest HIV care centre and being in a long-standing steady partnership. Results: A total of 45 (9.0%) of the participants enrolled for HIV care within twelve months of HIV diagnosis while 455 (91.0%) enrolled for care after 12 months of diagnosis. The average CD4+ count of those who enrolled early was 248cells/µl which

Attitudes and Barriers to Post Graduate Education among Radiographers in South Eastern Nigeria

Background: This study is aimed assessing the attitudes of radiographers and perceived barriers to postgraduate radiography education in south-eastern Nigeria. Methods: The study utilized a self administered pre-tested questionnaire with structured and semi-structured questions. Respondents were practicing radiographers working in private, general and teaching hospitals in south-eastern Nigeria. A total of forty-one (41) radiographers participated in the study. This study was carried out in South-Eastern Nigeria made up of five states namely; Anambra, Enugu, Imo Abia and Ebonyi states. All radiographers in South-Eastern Nigeria who agreed to participate in the study were included. The following categories of registered radiographers where included in the study, Intern radiographers (fresh graduates), Youth corper radiographers (those undergoing one-year mandatory post-qualification national service) and radiographers currently in practice with or without post graduate certificate. Results: Physical, attitudinal and structural barriers were identified as obstacles to postgraduate radiography education. No significant correlation existed between attitude and all the categories of barriers in this study. A set of numerical scores ranging from 1.0 to 5.0 were assigned to the attitudes, otherwise called ‘attitude scores’. A score of 1.0 represents a less positive attitude, while a score of 5.0 represents a very positive attitude. Attitude scores to organizational barrier ranging from 2.70 to 3.67 were recorded among administrative cadre radiographers (chief and assistant chief). Environmental barrier score was found to be the least among M.Sc radiographers (2.46) and highest among Research Article

Determinants of Mortality among Adult HIV-Infected Patients on Antiretroviral Therapy in a Rural Hospital in Southeastern Nigeria: A 5-Year Cohort Study.

Background. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens. Methods. Retrospective cohort study of 1069 patients on ART between August 2008 and October 2013. Baseline CD4 counts, age, gender, and ART regimen were considered in this study. Kaplan-Meier method was used to estimate survival and Cox proportional hazards models to identify multivariate predictors of mortality. Median follow-up period was 24 months (IQR 6–45). Results. 78 (7.3%) patients died with 15.6% lost to followup. Significant independent predictors of mortality include age (>45), sex (male > female), baseline CD4 stage (<200), and ART combination. Adjusted mortality hazard was 3 times higher among patients with CD4 count <200 cells/μL than those with counts >500 (95% CI 1.69–13.59). Patients on Truvada-based first-line regimens were 88% more likely to die than those on Combivir-based first line (95% CI 1.05–3.36), especially those with CD4 count <200 cells/μL. Conclusion. Study showed lower mortality than most studies in Nigeria and Africa, with mortality higher among males and patients with CD4 count <200. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators.

Causes and pattern of death in a tertiary hospital in south eastern Nigeria

Background: Morbidity and mortality pattern is a reflection of disease burden. The aim of this study is to provide a comprehensive report of the causes of death in a tertiary hospital in Nigeria, a developing tropical nation. Methods and Material: We carried out a retrospective descriptive cross-sectional study of all records of deaths from January 2004 to December 2008 in Federal Medical Centre Umuahia, Abia, State in Southeast Nigeria. Results: Of a total of 18,107 patients were admitted during the study period, 2;172 deaths representing 12% mortality rate and comprising 1;230 (56.6%) males and 942 (43.4%) females were recorded. The age of patients ranged from birth to 100 years with a mean of 41.41 ± 26.30 years and 25-44 years age group being the most affected (n = 587, 27.1%). The overall leading cause of death was the infections group, which accounted for 837 (37.6%) deaths. Other major causes were cardiovascular system -related deaths 534 (24.7%), neonatal causes 173 (8.0%), trauma 155 (7.1%), diabetes mellitus complications 144 (6.6%) and neoplasia 76 (3.5%). Conclusion: Majority of the leading causes of mortality in this study are preventable. Our data reflects the effects of double disease burden of infections and non- communicable communicable diseases in a developing nation.

Characteristics of HIV Co-Infected Patients among Tuberculosis Patients Accessing Care at a DOTS Clinic in South-Eastern Nigeria

Background: One third of the world’s population constituting 2 billion people are infected with Tuberculosis (TB), which is the second most common cause of mortality amongst communicable diseases. Nigeria ranks fourth among 22 high TB burden countries. One of the major challenges to the control of TB is the presence and interaction of TB with HIV. In many parts of Africa, infection with HIV has further increased TB morbidity and mortality. To effectively control TB in Africa the co-infection with HIV must be perfectly understood and adequate measures and strategies developed and implemented. Methods: This was a cross sectional descriptive study, carried out between January 2012 and April 2014 at the DOTS clinic of a tertiary hospital in South-Eastern Nigeria. Three hundred and eighty-four tuberculosis patients were interviewed using a structured questionnaire and data on their HIV status and other characteristics were collected. Data were analysed using SPSS Version 20. Results: Three hundred and eighty-four tuberculosis patients participated in the study. Eighty-six patients (22.4%) were HIV seropositive. There were 182 males (47.4%) and 202 females (52.6%). The commonest age group was the group 20 - 39 years (51.6%). HIV seropositivity was highest among the age group 20 - 39 years and this was statistically significant (X2 = 11.14, p = 0.01). The married patients had the highest proportion of HIV seropositivity and this was statistically significant (X2 = 40.76, p = 0.00). The unemployed patients had the highest proportion of HIV seropositivity and it was statistically significant (X2 = 35.14, p = 0.00). Conclusion: Some basic characteristics of tuberculosis patients predispose them to HIV/TB co-infection. The characteristics must be explored further and be factored in the strategies to control tuberculosis in Africa.

Patients' satisfaction with eye care services in a Nigerian teaching hospital.

Understanding the patients' perception of services received is essential as the parameters important to the patient may be quite different from that to the eye health provider. This study aims to evaluate patients' satisfaction with the care received from the pioneer teaching hospital in south-eastern Nigeria and use it to audit services. This was a descriptive cross-sectional study. An interviewer-administered questionnaire was administered to 307 consecutive consenting patients seen at the eye clinic of the University of Nigeria Teaching Hospital Enugu in April 2013. The questionnaire asked questions regarding satisfaction with the time spent in the clinic, attitude of various categories of staff, physical facilities, cleanliness of the clinic and willingness to come again to the clinic or recommend it to others. The respondents were more satisfied with the attitude of the doctors and nurses than that of revenue and medical records clerks (P = 0.001). Most patients, 288 (93.8%) expressed satisfaction with the overall cleanliness of the eye clinic; 220 (71.7%) and 288 (93.8%) were not satisfied with the toilet facilities and cost of services, respectively. Only 140 (45.6%) participants will recommend the hospital to others strongly, 145 (47.2%) will do so hesitantly. Majority of the patients were satisfied with the services received. The major dissatisfaction points were cost of services and inadequate toilet facilities.

Magnitude of Pre-Diabetes among Adult Nigerians with Essential Hypertension in a Primary Care Clinic of a Tertiary Hospital in South-Eastern, Nigeria

Background: Hypertension co-existing with Diabetes mellitus is increasing globally. However, current evidence has demonstrated the existence of a prolonged, intermediate phase of diabetes termed pre-diabetes in hypertensive patients. Aim: This study was designed to determine the magnitude of pre-diabetes among adult Nigerians with essential hypertension in a primary care clinic of a tertiary hospital in South-eastern, Nigeria. Materials and Methods: A cross-sectional analytic study carried out on 320 adult hypertensive Nigerians who were age and sex matched with 320 non-hypertensive, non-diabetic control group at the primary care clinic of a tertiary hospital in South-eastern Nigeria. These patients were screened for pre-diabetes. Pre-diabetes was defined as fasting plasma glucose of 100-125 mg/dL and /or plasma glucose level of 140-199 mg/dL two hours after a 75g oral glucose load. Hypertension was defined as systolic and/or diastolic blood pressures ≥140/90 mmHg or documented use of antihypertensive medications in a previously diagnosed person with hypertension. Results: The prevalence of pre-diabetes was significantly higher in hypertensive patients (33.1%) than control (16.2%) (p= 0.001) with impaired fasting glycaemia ((29.4%) being the more common pattern. The mean fasting plasma glucose of the hypertensive patients (122.4mg/dL±1.7)) was significantly higher than that of the control (91.8mg/dL±2.4) (p=0.000). Similarly, the mean two hours oral glucose load of the hypertensive patients (183.4mg/dL±1.6) was significantly higher than that of the control (161.8mg/dL±1.9)(p=0.001). Conclusion: This study has shown the existence of pre-diabetes among the hypertensive patients with impaired fasting glycaemia being the more common pattern. Screening adult Nigerians with essential hypertension for pre-diabetes should constitute clinical targets for intervention in primary care clinic.

Knowledge, perception and practice of injection safety and healthcare waste management among teaching hospital staff in south east Nigeria: an intervention study.

IntroductionHealth care workers are exposed to the risk of blood-borne diseases such as HIV, Hepatitis B and C in their daily encounter with infected patients and materials through unsafe injections. This study determined the baseline and post-intervention knowledge and practice of modern injection safety standards among health care workers.MethodsThe study population was the healthcare workers in a teaching hospital in southeastern Nigeria. Data was collected using a self-administered 37-item structured questionnaire assessing their knowledge and practice on injection safety. Collected data was analyzed using SPSS.ResultsNurses comprised 62.8% (98/156) of the population. While most had heard of injection safety only 67.2% (84/125) had previously had any form of training on it. Only 54% (81/150) had heard or seen color coded bins. The standard needle and syringe is still widely used and 45% (65/145) still recap needles on syringes after use irrespective of type of personnel. Half (50.6% =78/154) of our respondents had had a previous needle prick injury. Only 25.6% (20/78) with previous needle prick injury had post-exposure prophylaxis. All doctors and laboratory scientists always use gloves compared to 94.8% (91/96) nurses while handling patients or materials. Following the intervention, a significantly high number became aware of post-exposure prophylaxis and color coded bins and liners.ConclusionThere is a need for healthcare workers to be regularly updated on changing safety standards in their practice. Also hospitals must be encouraged to acquire and use internationally accepted standard materials in collection and disposal patient's samples.

Clustering of Metabolic Syndrome and its Risk Factors among Adult Nigerians in a National Health Insurance Scheme Primary Care Clinic of a Tertiary Hospital in South-Eastern Nigeria

Background: The increasing incidence of MetS in Nigeria is a national health problem. As the case detection of MetS increases in different Nigerian populations evaluating for its clusters among NHIS patients in primary care setting is an important health service challenge that is often overlooked. Aim: This study was designed to determine the prevalence of MetS and its risk factors among adult Nigerians in a NHIS primary care clinic of a tertiary hospital in South-eastern Nigeria.Materials and Methods: This was a primary care clinic-based cross sectional study carried out on 210 adult NHIS patients using International Diabetes Federation(IDF) criteria: An Individual was considered to have MetS in the presence of waist circumference(WC) ≥94 cm for men and ≥80 cm for women plus any two or more of the following: systolic and/or diastolic blood pressure ≥130/85 mmHg and/or hypertension on treatment; fasting blood glucose ≥ 100mg/dL and/or diabetes mellitus on treatment; triglyceride level ≥150 mg/dL and/or hypertriglyceridaemia on treatment and high density lipoprotein(HDL-C) cholesterol <40mg/dL for men or <50 mg/dL for women and/or HDL-C dyslipidaemia on treatment. Data was collected using pretested, structured and researcher administered questionnaire. Results: The prevalence of MetS was 38.6%. MetS was significantly associated with old age≥40 years(p=.002), female sex(p=.044), family history of hypertension(p=.036) and physical inactivity(p=.001). The most significant predictor of MetS was physical inactivity.[OR=3.09 , CI=(1.81-10.06), p=.001]. The patients with MetS were three times more likely to be physically inactive compared to their non-MetS counterparts. Conclusion: This study has shown that MetS exist among the study population and was significantly associated with old age ≥40 years, female sex, family history of hypertension and physical inactivity. The most significant predictor variable was physical inactivity. NHIS patients in the primary care clinic should be the focus of primary and secondary preventive interventions for MetS.

Medical causes of death in a teaching hospital in South-Eastern Nigeria: A 16 year review.

Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, South-East Nigeria from 1995 to 2010. Data were collected retrospectively from January 1995 to December 2010. Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables, while Chi-square test was used to test significance of differences between two proportions. The mortality rate was 22.8% (6250/27,514) admissions. The male to female ratio was 1.7:1. Infections (20.2%) were the most common cause of death. However, chronic kidney disease was the single most common disease entity causing death (12.3%). Other important causes of death in order of prevalence were cerebrovascular accident (10.5%), acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3%), heart failure (8.8%), chronic liver disease (7.0%), septicemia (6.5%), respiratory failure (5.3%), diabetes mellitus (4.6%), cardiac arrhythmias (2.9%), and primary liver cell carcinoma (2.7%). There were few deaths from tetanus, malaria, typhoid fever, and coronary artery disease. Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases.

Knowledge and perception of mother to child transmission of human immunodeficiency virus among South Eastern Nigerian pregnant women

Context: The success of prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) requires the cooperation of the mother. The level of cooperation may depend on the extent of knowledge of pregnant women on HIV/acquired immunodeficiency syndrome (AIDS), its mode of transmission to the child and ways of preventing it. Aim: The aim of this study was to evaluate the knowledge and perception of mother to child transmission (MTCT) of HIV among pregnant women receiving antenatal care in a university teaching hospital in South Eastern Nigeria. Settings and Design : This is a cross-sectional study in a teaching hospital. Subjects and Methods: A cross-sectional survey of 396 antenatal attendees, using a pre-tested, and interviewer administered questionnaires. Statistical Analysis Used: Data were analyzed using the Epi Info statistical software and presented as percentages and tables. Results: All the respondents were aware of HIV/AIDS. The main sources of information were health workers (72.7%), radio (62.6%) and television (55.5%). Majority (94.9%) were aware that HIV can co-exist with pregnancy, but only 73.4% were aware of MTCT. Breast feeding (75.7%), transplacental (56.2%), and vaginal delivery (36.6%) were the main identified routes of transmission to the child. Some respondents (21%) however believe that cesarean section has a higher rate of vertical transmission relative to vaginal delivery. Giving the mother antiretroviral drugs (81.7%) and avoiding breast feeding (49%) were the major preventive ways identified by respondents. Some however believe that mixed feeding is one of the modes of preventing MTCT of HIV/AIDS. Conclusion: The awareness and knowledge of HIV/AIDS in the study population is high, but the knowledge and perceptions of PMTCT, is comparatively low.

Nurses’ Use of Facilitating and Blocking Communication Behaviours in Cancer Care

This study investigated nurses' use of facilitating and blocking communication behaviours in cancer care and the associated personal and professional factors. Using cross-sectional quantitative descriptive design and researchers-developed observation guide and questionnaire, data were collected by non-participant observation of 47 nurses working as permanent staff in eight wards admitting predominantly cancer patients in four teaching hospitals in South-Eastern Nigeria. Researchers did non-participant, one-hour event observation and recording of nurses' use of facilitating and blocking behaviours in communicating with three categories of admitted cancer patients - newly diagnosed with early disease signs, patients admitted with recurrence, and those admitted for palliative care. Out of the 721 events of communication behaviours observed, 441(61.2%) were facilitating, 280(38.8%) were blocking. Nurses exhibited highest facilitating behaviours for patients with early disease (208) and blocking behaviours mostly for patients on palliative care (139). Statistically significant relationships were noted among length of stay in cancer unit (p=0.0444) and exposure to post-basic course in cancer care (p<0.0001). Nurses were not good in communicating pains to patients. All nurses caring for cancer patients will most likely benefit from special pre-requisite training in communication and cancer care.

Pattern of cardiovascular disease amongst medical admissions in a regional teaching hospital in Southeastern Nigeria

Background: Cardiovascular disease (CVD) is responsible for a large proportion of death and disability worldwide. However, a substantial portion of the increasing global impact of CVD is attributable to economic, social, and cultural changes that have led to increases in risk factors for CVD. These changes are most pronounced in the countries comprising the developing world. Because the majority of the world's population lives in the developing world, the increasing rate of CVD in these countries is the driving force behind the continuing dramatic worldwide increase in CVD. Objective: This study was aimed at determining the frequency and pattern of cardiovascular disorders in the medical wards as well as the emergency and intensive care units of the University of Nigeria Teaching Hospital (UNTH) Enugu, Southeast Nigeria. Methods: A retrospective study of consecutive adult patients with diagnosis of cardiovascular disorders admitted into the medical wards and/or the emergency/intensive care units of UNTH Enugu between January 2000 and January 2007 was carried out using the ward admission and discharge registers. Results: A total of 6,162 patients (males 3,385 (54.93%); female 2,777 (45.07%)) were admitted over the period covered by the study. Out of these; 1,261 (20.46%) patients were found to have cardiovascular disorder. Prevalence of cardiovascular disorders was found to be higher among the female patients than among the males: 693 (24.95%) and 568 (16.78%) years, respectively. The ages ranged between 18 and 92 years with a mean ± standard deviation (SD) of 55.13 ± 15.37. The pattern of CVD observed in this study were hypertension and its complications (86.36%), rheumatic heart disease (4.52%), dilated cardiomyopathy (3.09%), and alcoholic heart muscle disease (0.95%). Conclusion: CVDs were major causes of morbidity in the environment of study. Early detection, improved outpatient care, as well as inclusion of appropriate secondary prevention programs in patient's management especially at the community level is recommended in order to reduce complications and the need for hospital admissions.