Hospital In South-Eastern Nigeria Research Articles

Hysterosalpingography Investigation Versus Patients’ Radiation Dose Risk

Background: Hysterosalpingography (HSG) is a useful radiographic investigation involving the use of contrast medium for the management of infertility in females. It is however, not only a costly procedure but it is also a semi-invasive procedure and carries some radiation risks. One principle of radiation protection is justification of practice which means that the overall benefit of the procedure should outweigh the radiation risks. The aim of this study was to determine justification of HSG procedure by assessing the rate and pattern of pregnancy success among infertile women who underwent HSG procedures at a tertiary hospital in South Eastern Nigeria between 2016 and 2020. Methods: A retrospective cross-sectional study of a sample of 222 women, aged 20-46years (mean 32.55 ±8.16years) who underwent HSG examination at the hospital between 2016 and 2020 was made. The data of eligible subjects were collected from the archives of radiology department of the hospital. Results: The result showed that 121 (54.5%) out of 222 of the patients achieved pregnancy with proper follow up infertility management. Of the 121, 48(39.67%) were in the 25-29 years age group and 35(28.93%) in the 30-34years age group. The commonest pathology found was uterine fibroid 71(32.0%), followed by tubal blockage, 42(18.92%) while the least occurring pathology was salpingitis isthmica nodosa 1(0.45%). Conclusion: There was a strong positive correlation between the age of patient, the HSG findings and the rate of pregnancy success. The procedure is justified in all the age groups except for the >45years group.

Targeted Screening for Undiagnosed Chronic Kidney Disease among Asymptomatic Immediate Family Members of Chronic Kidney Disease Patients: Experience from a Teaching Hospital in South Eastern Nigeria

Background: Chronic Kidney Disease (CKD) is a worldwide epidemic that is associated with a huge morbidity, mortality and high healthcare cost. In Nigeria, the number of patients with CKD progressing to End Stage Renal Disease (ESRD) is increasing. Early screening of individuals who are at risk of CKD has been advocated by several studies because it would reduce the morbidity and mortality associated with late presentation. Studies have found that the immediate family members/First-Degree Relatives (FDRs) of CKD patients have a greater prevalence of CKD compared with the general population and hence should be screened for kidney disease at any available opportunity.

Development and Preliminary Validation of Self-management Scale for Breast Cancer Patients in a tertiary hospital in southeastern Nigeria

Background: Self-management process of diseases aims to equip patients with specific information that will improve adherence with prescribed medication and develop strategies that will help to maintain good quality of life. This study developed and validated a self-management scale for breast cancer patients in two tertiary hospitals in southeastern, Nigeria.
 Methods: A set of 35-potential self-management model was developed for the breast cancer patients in 2 domains from extensive literature search. The Instrument was validated using Delphi technique, item-total correlation analysis, factor analysis, construct validity and reliability analysis. Consensus was reached on the content validation of the self-management scale with mean score > 3.5, median > 3.5, absolute value between the median and mode < 1.00.
 Results: Forty-three items emerged after content validation in 2 domains: demographic characteristics of patients, and self-management content. Construct validity for selected items of the instrument showed values above 0.5. Item-total correlation analysis resulted in 31-items of the instrument. Factor analysis revealed a multi-dimensional instrument. The internal consistency of the instrument was determined with values between 0.5 - 0.8. The Cronbach’s alpha for the reliability of the items of the instrument were : Items 1 to 11: 0.60; Items 12 to 17: 0.60; Items 18 and 19: 0.80; Items 20 to 30: 0.50; and Items 31 to 33: 0.60.
 Conclusion: Preliminary validation of the instrument showed the instrument is valid but the internal consistency needs to be evaluated further with larger population size. The self-management scale revealed level of self-management among the breast cancer patients. This instrument should form a reliable tool for evaluating self-management in breast cancer patients in Nigeria.

Associations of Electrocardiographic Abnormalities in Stable Type 2 Diabetes Subjects: Experience from a Tertiary Health Facility in South Eastern Nigeria

Introduction: Cardiovascular abnormalities are prevalent in the setting of diabetes mellitus, even among stable subjects, necessitating the need for a regular cardiovascular disease screening for this group of patients. Electrocardiogram is a simple and reliable screening test for cardiovascular abnormalities that could be easily accessible even in resource poor and rural settings. This study was carried out to determine the association between cardiovascular risk factors and electrocardiographic abnormalities in stable type 2 diabetes subjects in South Eastern Nigeria.
 Materials and Methods: One hundred and thirty-six stable adults with type 2 diabetes mellitus were recruited consecutively from the out-patient diabetes clinic of Nnamdi Azikiwe University Teaching Hospital in South Eastern Nigeria. They were assessed for the risk factors for cardiovascular diseases that included smoking, obesity, dyslipidaemia, poor glycaemic control, hypertension, lack of exercise, presence of chronic kidney disease and metabolic syndrome. They also had a 12 lead electrocardiogram done. Results were analyzed using SPSS version 25. P value of ˂ 0.05 was considered significant.
 Result: A total of 128 subjects had complete results and were analyzed. There were 63 males and 65 females with a mean age of 58.43 ± 12.85 years and mean diabetes duration of 9.03 ± 7.36 years. A total of 45.3% of the subjects had electrocardiographic abnormalities. Hypertension was present in 54.9%, dyslipidaemia in 91.4%, central obesity in 74.3%, metabolic syndrome in 76.6% and chronic kidney disease in 57.9% of the subjects. Significant association was found between smoking and occurrence of AV block (p = 0.008), central obesity and QRS axis abnormality (p = 0.002), dyslipidaemia and ST segment abnormality (p = 0.001) and lack of exercise and ST segment abnormality (p = 0.000). No significant association was found between age, sex of the subjects, duration of DM, treatment modality for DM, level of glycaemic control, hypertension, presence of CKD and metabolic syndrome and any of the electrocardiographic abnormalities.
 Conclusion: Electrocardiographic abnormalities are common in stable type 2 diabetic subjects. There was significant association between smoking habit, central obesity, dyslipidaemia, lack of exercise and ECG abnormalities that included AV block, QRS axis and ST segment abnormalities.

Reasons for Encounter in Outpatient Clinic of a Tertiary Hospital in South Eastern Nigeria

Background: Reasons for Encounter (RFEs) are the main aim of a clinic visit that often goes unexplored by health practitioners especially when fixated on making a clinical diagnosis. Most patients present with one or more RFEs at the clinic visit. The traditional medical model unduly emphasizes the need for a biomedical diagnosis, hence the routine use of the traditional International Classification of Diseases (ICD-10), but with the recent introduction and adoption of International Classification of Primary Care (ICPC) by the World Health Organization, there is need for a paradigm shift by primary care physicians to embrace the use of ICPC. Considering the immense benefits and practicability of ICPC, we undertook this study to get a bird’s eye view of our patients RFEs to create the necessary awareness about the use of ICPC and also to use the result in making necessary health policy recommendation and training of resident doctors in our hospital.
 Objective: The aim of this study is to identify the reason for outpatient encounter in Federal University Teaching Hospital in Southern East Nigeria.
 Methods: A cross-section of patients aged 16 years and above presenting at our outpatient clinic was recruited consecutively until a sample size of 325 patients was attained. There was 100% response rate among the respondents. The reasons for encounter were assessed using an interviewer administered questionnaire where they were requested to “say” in their own words their reasons for coming to see the doctor.
 Results: The five commonest reason for encounter was A: general/unspecific(43.4%), X:femalegenitalia(14.2%), M: musculoskeletal(8.5%), D: digestive(6.5%) and R: respiratory(6.5%); while the least are U:urogenital(0.9%) and Y:male genital(0.9%). Incidentally none of the patients presented with substance abuse or social problems. The geriatric age group accounted for less than 20% of the total number of patients seen within the period.
 Conclusion: This study identified the common reasons for encounter amongst our patients at the general outpatient. This will assist in the training of our medical students and resident doctors and effective planning of the general outpatient.
 Recommendation: This study also brings to the fore the need to look into the challenges of the elderly to improve their health seeking behavior.

Audit of consecutive cases of mortality in emergency department of a tertiary hospital in south eastern Nigeria

Introduction: Too many avoidable deaths have been noted in Nigeria. The Emergency Department (ED) mortality rate is a good assessment of the adequacy of the clinical care state of any hospital and in turn the survival probability of any critical ill patient attending that ED. Materials and methods:This study was a retrospective one involving the review of records of all the one hundred consecutive deaths seen between June 2012 and February 2013 in the ED. All those brought in dead were excluded from the study. The data collected was simply analyzed. Results:There were 71 males (71%) and 29 females (29%) with ratio of 2.4: 1.0. The age range of dead subjects was 11 years and above. The major cause of deaths in the study was medical conditions (65%) with a preponderance of cardiovascular deaths (49.23%). Road traffic accident (RTA) was the major cause of trauma deaths (78.98%). Pedestrians and drivers were the most affected in RTA deaths (40% each). Deaths from malignancies constituted 43.75% of the non-traumatic surgical deaths. Majority of the deaths (74%) occurred within the first 24 hours of admission. Conclusion:The mortality rate in the ED is vital in predicting the survival chance of any critically ill- patient attending it. Pre- hospital care and establishment of trauma teams in the hospitals will go a long way in reducing deaths tolls in the ED. Also the ED should be prepared to cope with the challenges of cardiovascular emergencies.

Histopathologic features of Buruli ulcer patients in a referral hospital in South Eastern Nigeria

Histopathologic features of Buruli ulcer patients in a referral hospital in South Eastern Nigeria

Determinants of enrolment in health insurance scheme among HIV patients attending a clinic in a tertiary hospital in South-eastern Nigeria.

The study aimed to assess the determinants of enrolment in health insurance schemes among people living with HIV. The study was a cross-sectional study. A pre-tested interviewer-administered questionnaire was used to collect information from 371 HIV clients attending the clinic. Chi-square statistic was used for bi-variate analysis, and analytical decisions were considered significant at a p-value less than 0.05. Logistic regression was done to determine predictors of enrolment in health insurance. The study was carried out in the HIV clinic of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. HIV clients attending a clinic. Mean age of respondents was 45.4±10.3, and 51.8% were males. Almost all the respondents were Christians. Only 47.7% were married, and most lived in the urban area. Over 70% had at least secondary education, and only 34.5% were civil servants. About 60% of the respondents were enrolled in a health insurance scheme. Being single (AOR: 0.374, CI:0.204-0.688), being self-employed (AOR: 4.088, CI: 2.315-7.217), having a smaller family size (AOR: 0.124, CI: 0.067-0.228), and having the higher income (AOR: 4.142, CI: 2.07-8.286) were predictors of enrolment in a health insurance scheme. The study has shown that enrolment in a health insurance scheme is high among PLHIV, and being single, self-employed, having a smaller family size, and having a higher monthly income are predictors of enrolment in the health insurance scheme. Increasing the number of dependants that can be enrolled so that larger families can be motivated to enrol in health insurance is recommended. None declared.

The Burden of Urologic Diseases in a Tertiary Hospital in South-eastern Nigeria: A Three-Year Review.

Urological diseases are an integral part of the surgical burden of diseases. There are national, regional, and global variations. Characterisation of the burden of disease in this specialty is important for the registry and in allocation of the already scarce resource in this sub-region. This study was aimed at characterising the burden of urological diseases in our teaching hospital as a means towards addressing the gap between resources and urological needs. It was a retrospective study of new patients seen over 3 years from January 2019 to December 2021 at the urology clinics of Alex-Ekwueme Federal University Teaching Hospital Abakaliki. Data collected included sex, age, and diagnosis. Data analysis was done using SPSS version 26. A total of 2893 patients were available for analysis, of which 2777 (96%) were male patients whereas 116 (4%) were female patients with a male-to-female ratio of 23.9:1. The mean age of the patients was 58.11 ± 16.76 years. The common presentations were benign prostatic enlargement (BPE) 1515 (52.4%), cancer of the prostate (CAP) 349 (12.1%), urethral stricture disease 268 (9.3%), and urinary tract infection (UTI) 192 (6.6%). In men, the three most common diagnoses were prostate-related diseases 1864 (67.1%), urethral stricture disease 268 (9.70%), and UTI 170 (6.1%), whereas, in women, urolithiasis, urinary tract infection, and hydronephrosis accounted for 50 (43.1%), 22 (19%), and 20 (17.2%), respectively. BPE, CAP, and urethral stricture disease were the most common presentations in men whereas urolithiasis, UTI, and hydronephrosis were common in women. This knowledge can be used to channel hospital resources appropriately.

Nigerian Health Care Providers and Diabetes Self-Management Support: Their Perspectives and Practices.

Nigeria struggles to reframe its traditional acute-care disease approach to health care to accommodate rising needs for chronic disease care. This interpretive descriptive study explored Nigerian healthcare providers' (HCPs) perspectives, experiences, and practices related to self-management support (SMS). Observational and experiential data were gathered from 19 HCPs at two urban hospitals in Southeastern Nigeria (seven physicians, four nurses, five dietitians/nutritionists, and three health educators). There were four themes: (a) compliance-oriented medical model, (b) SMS as advice, informal counseling, and education, (c) navigating the sociocultural terrain, and (d) workarounds. Nigerian HCPs perspectives and SMS practices were characterized by attempts to foster compliance with healthcare instructions within a traditional biomedical model. Participants enhanced patient support using specific strategies to bypass structural system obstacles. These findings demonstrate the need to reevaluate the current understanding of SMS in Nigeria and its practice.

Knowledge and Practice of Prostate Cancer Screening among Healthcare Workers in Tertiary and Mission Hospitals in Southeastern Nigeria

Knowledge and Practice of Prostate Cancer Screening among Healthcare Workers in Tertiary and Mission Hospitals in Southeastern Nigeria

Medical intern job demands and job carry-over strain: The moderating role of psychosocial mentoring and job satisfaction

This study examined the relationship between psychological job demands and job carry-over strain among medical interns, and the moderating role of mentoring and job satisfaction in that relationship. Medical interns (n = 229) at teaching hospitals in Southeastern Nigeria (male = 84.28%; modal age group = 31–35 years). completed validated surveys on psychological job demands, job carry-over strain, mentoring, and job satisfaction. Simultaneous moderated regression analyses indicated psychosocial mentoring and job satisfaction to moderate the relationship between job demands and job carry-over strain. Mentorship programs for medical interns may be helpful to their quality of work life.

The influence of psychological ownership on the association between satisfaction with work-family balance and intention to stay among nurses in South-eastern Nigeria public hospitals

The study investigated the influence of psychological ownership on the association between satisfaction with work-family balance and intention to stay in the profession in South-Eastern Nigerian public hospitals. An exploratory research design was adopted for a study that was conducted among 389 nurses recruited from public hospitals in South-eastern Nigeria (females: 373 (96 %); males: 16(4 %); mean age: 37.40 years; SD = 6.33). Participants completed self-report measures of satisfaction with work-family balance, psychological ownership, and intention to stay. Regression analyses showed that work-family balance and psychological ownership positively correlated with nurses' intention to stay. Psychological ownership also moderated the relationship between satisfaction with work-family balance and intention to stay. These findings indicated that psychological ownership and satisfaction with work-family balance are necessary preconditions for striking a balance between job demands and employees’ responsibilities to encourage intention to stay and improve commitment and productivity. Thus, the current findings help hospital managements comprehend and appreciate the critical roles of psychological ownership and satisfaction with work-family balance in enhancing nurses’ intention to stay.

Effect of nursing audit and feedback on orthopedic patients’ care outcomes in selected hospitals in southeastern Nigeria

Effect of nursing audit and feedback on orthopedic patients’ care outcomes in selected hospitals in southeastern Nigeria

Burns in pregnancy: Five-year experience in a tertiary hospital in southeastern Nigeria.

Burns in pregnancy is often associated with high maternal and fetal morbidity and mortality especially when the total burn surface area (TBSA) involved is high. This study aims to review management outcome of cases of burns in pregnancy at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). A five year retrospective study of all pregnant women that presented at AE-FUTHA with burn injury between April 2014 and March 2019. Information was collected from the medical records using a proforma and analyzed with IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA) using descriptive statistics. A total of 222 cases of burns were managed but only 8 were pregnant, giving an incidence of 3.6%. The commonest causes were flame (62.5%), scald (25%) and friction (12.5%) occurring mostly during the harmattan season. The median age of participants was 25-34 years. The burns affected 12.5% of the patients in the first trimester and 62.5% and 25% in the 2nd and 3rd trimesters respectively. Most patients (62.5%) had superficial burns while 25% had other associated injuries in addition to burns. About 87.5% had term spontaneous vaginal delivery. There was no maternal death but, there was an early neonatal death. The good outcome observed in this study with a 100% survival, could be explained by inter-disciplinary management approach given, even as most cases were minor degrees of burns. Early involvement of obstetricians in all burns affecting pregnant women is advised especially in burn centres where obstetricians are hardly in the employ.

Prevalence, Severity and Relationship of Anaemia with Immune Status and Use of Highly Active Antiretroviral Therapy among Human Immunodeficiency Virus-Infected Adults in South-eastern Nigeria

Objective: Anaemia is a significant complication of human immunodeficiency infection, causing life-threatening symptoms and impairing quality of life. This study aimed to assess the prevalence, severity and associations of anaemia, with cluster of differentiation 4 (CD4+) cell count and use of highly active antiretroviral therapy (HAART), in human immunodeficiency virus-infected patients. Material and Methods: Haemoglobin concentration, CD4+ count, HAART use and other factors were assessed in 372, adult HIV-infected out-patients; enrolled at a tertiary hospital in South-Eastern Nigeria. Anaemia was defined according to World Health Organisation criteria. Independent predictors were determined using bivariate analysis and enter method logistic regression analysis, at a p-value<0.05.Results: Prevalence of anaemia was 76.3% overall; 79.9% in females and 67.6% in males. Median CD4+ cell count was 609.50 (interquartile range 379) cells per microlitre (cells/μl). Females were more likely to be anaemic than males [odds ratio (OR)=1.88, 95% confidence interval (CI) 1.07, 3.31; p-value=0.011]. Furthermore, the odds of being anaemic were higher in participants 50 years or older (OR 3.79, 95% CI 1.36, 10.55; p-value=0.023). A CD4+ count <200 cells/μl. Not being on cotrimoxazole preventive therapy and a low monthly household income were associated with higher odds of anaemia. Tenofovir- and abacavir-based regimens were associated with lower odds of anaemia compared to zidovudine. Conclusion: Gender and the age of patients were independent predictors of anaemia. Pre-treatment screening, and close follow-up monitoring for anaemia as well as increased access to less haematotoxic HAART regimens are needed.

Histopathological spectrum and clinicopathological concordance of nonneoplastic skin lesions at a teaching hospital in South-Eastern Nigeria: A 16-year retrospective study

Background: Only a few clinicopathological epidemiological studies detailing histopathologically diagnosed skin diseases have been carried out in Nigeria. Thus, the aim of this study was to retrospectively survey the histopathological spectrum and clinicopathological concordance of histopathologically diagnosed skin diseases in Nigeria over a 16-year period. Materials and Methods: This study involved the assessment of all skin biopsy specimens received at the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2004 to December 2019. Histopathological diagnoses based on these skin biopsies were made by consultant anatomical pathologists using routine hematoxylin and eosin-stained slides. All relevant demographic data and provisional clinical diagnoses were obtained from the histopathology laboratory requisition forms provided with the specimens. The skin lesions were then classified according to the International Classification of Diseases, Tenth revision (2019). Results: A total of 347 skin lesion biopsy specimens were included in this study. Most of the patients were aged 20–39 years old, with a mean age of 34.2 years. One hundred and forty-eight (42.7%) of the patients were males, whereas 199 (57.3%) were females. The most common 1CD-10 categories were disorders of skin appendages (105/347 [30.3%] cases) and papulo squamous disorders (81/347 [23.3%] cases), whereas the least common category was radiation-related disorders of the skin (2/347 [0.6%] cases). The most common disorder of the skin appendage was epidermal inclusion cyst (71/105 [71.4%] cases). Lichen planus was the most common papulosquamous disorder observed (26/81 [32.1%] cases). Only 202 cases included records of the biopsy site. The lower extremities were the most common sites of involvement (48/202 [23.8%] cases). The clinical diagnosis was concordant with the histopathological diagnosis in 55.3% of the cases, whereas it was discordant in the remaining cases. Conclusion: The most common skin diseases observed in this study were disorders of skin appendages and papulosquamous lesions. Our study provides baseline data for future population-targeted studies of nonneoplastic skin diseases.

Evaluation of the pediatric antimalarial prescriptions in a teaching hospital in Southeastern Nigeria

Background: Malaria in Nigeria with the highest morbidity and mortality in children between 6 months and 5 years continues to be a disease burden. In line with the World Health Organization recommendation of diagnosis in all ages before treatment, Nigeria provided guidelines on parasite-based diagnosis. Therefore, in order to achieve its preelimination and the reduction of mortality caused by it to zero by 2020, it is necessary to assess the compliance of the prescribers to the guidelines. Objectives: The objectives of this study were to determine the cases who were diagnosed based on positive malaria parasite test and the level of compliance of the prescribers to the National Malaria Treatment Guidelines. Methods: A total of 3034 prescriptions of antimalarial drugs were collected between 2003 and 2011 in the Outpatient Department of the Pediatric Clinic. Data were analyzed using Microsoft Excel and SPSS V.20.0 and grouped into two: prepolicy (2003–2005) and postpolicy (2006–2011) periods. Descriptive and inferential statistics were used at P

Evaluation of the diagnostic yield of ultrasound in the management of appendicitis: An experience in a tertiary hospital in South-Eastern Nigeria

Introduction: In most complaints of right lower abdominal pains appendicitis is suspected. Appendicitis often creates the most common abdominal surgical emergency. Ultrasound and computed tomography are often the imaging modalities used to confirm the clinical diagnosis of appendicitis. The aim of this study was to evaluate the accuracy of ultrasound in the diagnosis of appendicitis in a tertiary hospital in South Eastern, Nigeria.Materials and Methods: A retrospective study design was adopted to study 152 records of patients aged 1–65 years who had ultrasound scans for clinical suspicion of appendicitis at a tertiary hospital in Anambra State, South Eastern Nigeria from 2016 to 2018. Patients' age, gender, and provisional diagnosis were obtained from the patients' request forms. Ultrasound results were obtained from the radiology department and the histology reports from the histology unit of the hospital. The Statistical Package for the Social Sciences, SPSS, version 22.0. was used for data analysis.Results: Of the 152 cases, ultrasound was positive in 115, while histology confirmed 136 positives. Ultrasound, therefore, had a sensitivity, specificity, and accuracy of 84.56%, 100%, and 86.18%, respectively. The positive predictive value and negative predictive values were 100% and 43.24%, respectively. The study showed a higher incidence of appendicitis among females (n = 84) than males (n = 52), (ratio 1:1.6). Age groups 10–19 and 20–29 years were the most affected. Accuracy was 91.94% (in males) and 82.22% (in females). The most common ultrasound features include enlarged appendix (>9 mm, 100%), rebound tenderness to probe (92%), and fluid-filled appendix (88%).Conclusions: Ultrasound has high sensitivity, specificity, and accuracy for the diagnosis of appendicitis.

Steroid response rate in childhood nephrotic syndrome at a tertiary hospital in South-Eastern Nigeria

Background: Response to corticosteroids in childhood nephrotic syndrome (NS) remains the best prognostic marker of the disease. African children have been noted to respond poorly to corticosteroids. However, recent reports in some parts of Nigeria suggest high steroid responsiveness. Objectives: This study was done to determine the steroid response rate and associated clinical variables among children with NS in Umuahia, South-Eastern Nigeria. Patients and Methods: A retrospective, descriptive study of all the children managed for NS from June 2013 to June 2018 was retrieved and relevant information obtained. Data analysis was done using the SPSS software version 20.0 for Windows® (IBM SPSS Inc. 2011 Chicago, Illinois, USA). Results: A total of 30 children aged 2 years to 15 years with a median of 8 years were studied. Male-to-female ratio was 2:1. Fifteen patients achieved remission with steroid with remission rates of 50% overall and 62.5% among children with idiopathic NS. Patients that achieved remission had a lower mean age (mean difference = -5.13, confidence interval [CI] −7.73, −2.54; P