Hospital Enugu Research Articles

Accuracy of Ultrasound in the Evaluation of Pediatric Abdominal Surgical Emergency: A Comparison with Intra-Operative Findings

Background: Pediatric abdominal surgery emergency (PASE) is a frequent reason for emergency admission and surgery in children. PASE is a significant cause of morbidity and mortality especially in developing countries and it constitutes a significant workload of the pediatric surgeon. Ultrasound is available, affordable and accessible in most centers. Though ultrasound is operator dependent, its evaluation of children who have abdominal symptom plays a central role in surgical decision making. Methodology: We evaluated the medical records of all the consecutive children who presented with abdominal symptoms, had abdominal ultrasound and were operated upon between October 2017 and March 2019. This study was carried out in a teaching hospital in Enugu, Nigeria. We compared the ultrasound reports and intra-operative findings; and determined the extent of accuracy of the ultrasound report. Results: One hundred and forty seven children were retrospectively analyzed. There was male dominance and abdominal pain was the predominant presenting symptom. The mean age of the patients at presentation was 6 years. All the patients had abdominal ultrasound and the overall accuracy of ultrasound was 65.8%. Intussusception is the disease condition that had the highest level of ultrasound accuracy. Most of the patients (93.2%) did well and were discharged home. There were 10 deaths accounting for 6.8% of the patients. Conclusion: Abdominal ultrasound is reliable and fairly accurate in the evaluation of children who have abdominal disease conditions.

Dependent Personality, Mindful Awareness, and Marital Satisfaction and their Association with Postpartum Psychological Distress in Two Tertiary Hospitals, Southeast Nigeria

This study assessed dependent personality, marital satisfaction, and mindful awareness and their association with postpartum depression and anxiety. It was a cross-sectional study of nursing mothers, within 6-14 weeks postpartum, at the postnatal and children's welfare clinics of two tertiary hospitals in Enugu, southeastern Nigeria. The nursing mothers responded to different questionnaires that measure each of these variables. Correlations and multiple regression analyses were used to measure the strength of association between the variables in the study and to identify predictors for the outcome variables of interest, respectively. Low mindful attention awareness, poor marital satisfaction, and low dependency predicted an increased risk of postpartum depression and anxiety, with low mindful attention awareness as the strongest predictor. The findings from the study carry significant implications for the roles of dependent personality, marital satisfaction, and mindful awareness in the etiology of postpartum depression and anxiety in Southeast Nigeria.

Hydrostatic reduction of intussusception in children: a single centre experience.

Introductionintussusception is a common surgical emergency in children especially in infants. Treatment of intussusception could be non-operative or operative. Non-operative treatment (hydrostatic reduction) of intussusception is increasingly being practiced in developing countries.Methodsthis was a review of our experience in the hydrostatic reduction of intussusception in children at a teaching hospital in Enugu, Nigeria. This study covered an 18-months period, October 2017 to March 2019. Patients on presentation were resuscitated, appropriate investigations done and prepared for surgery before the hydrostatic reduction (using normal saline) was carried out. Patients with features of peritonitis and marked abdominal distension were excluded from hydrostatic reduction.Resultstwenty patients who had 21 episodes of intussusception were analyzed. One patient had a recurrence that necessitated repeat hydrostatic reduction. Eighty percent of the patients were male. The mean and peak age of the patients was 8 months and 6 months respectively. Significant number of the patients presented after 48 hours of onset of their symptoms. Abdominal pain was the predominant presenting symptom. Twenty percent and fifteen percent of the patients had a history of preceding gastrointestinal and respiratory infections preceding the intussusception respectively. Ileocolic intussusception was the most common type and the most distal end of the intussusception was at the transverse colon. Hydrostatic reduction was successful in 13 patients (65%).Conclusionhydrostatic reduction is a simple and effective method of treatment of intussusception. However, early presentation and proper patient selection is necessary for optimal outcome.

Snakebite in children in Nigeria: A comparison of the first aid treatment measures with the world health organization's guidelines for management of snakebite in Africa.

Background:Snakebite and envenomation remains a public health problem with significant morbidity and mortality in children in developing countries. The World Health Organization (WHO) in 2010 developed guidelines for the prevention and management of snakebite in Africa.Aim:The aim of this study was to compare the pattern of first aid treatment among children presenting with snakebite/envenomation with the 2010 WHO guideline for the prevention and clinical management of snakebite in Africa.Patients and Methods:All children who presented with snakebite over a 7-year period in a teaching hospital in Enugu, Nigeria. The first aid treatment given to these children was obtained and was compared with the provisions of the WHO guideline for the prevention and clinical management of snakebite in Africa (2010). Data collected were analyzed using SPSS version 22.Results:Five (71.4%) of the snakebites occurred in the rainy season and in the dark involving the lower limbs in 85.7% of cases. Six (87.5%) of the patients received one form of first aid before presentation to a health facility. None received first aid interventions in line with the WHO recommendation. Topical application of herbal concoctions to the site of the bite (37.5%) was the most common intervention. One (14.3%) of the children was promptly brought to the health facility following snakebite. The interval from bite to presentation to the health facility ranged from 1 to 12 h (median 5 h: 43 min).Conclusion:Huge gaps still exist in the first aid treatment given to snakebite victims compared to the WHO guidelines.

Structural findings of hysterosalpingography in infertile women in Enugu, southeast Nigeria

Background: In the Nigerian culture, barrenness is a near catastrophe for women. Hysterosalpingography (HSG), being a prime investigation for infertility, is widely used in developing countries because of its positive yield, accessibility, and cost-effectiveness. Aim: The aim of this study was to identify the pattern and the most common radiologic findings in the HSG of women with infertility in Enugu, southeast Nigeria. Materials and Methods: This was a cross-sectional study involving 160 female patients who presented at the gynecology clinic of a private hospital in Enugu, Nigeria with clinical impression of infertility. The women were in turn referred to the radiology center for HSG. Data were analyzed using RStudio. Results: A total of 254 radiologic features were obtained as some patients had more than one radiological findings. The age range of the participants was 20 - 46 years, and the most prevalent age group was 25 - 29 years (31.1%). The most common clinical type of infertility was secondary infertility.The most common abnormal cervical and uterine findings were synechia (80%) and fibroids (65%) respectively. Bilateral tubal blockage 29.4% was the most common finding in the fallopian tubes. Normal findings were seen in 5.44%. Conclusion: Synechia and fibroids were the most common abnormal radiologic findings in the cervix and uterus, respectively. HSG was found to be informative in infertility evaluation, hence should still be recommended as a first-line imaging modality in infertility.

Criteria for undernutrition screening in hospitalised infants under 6 months: a diagnostic accuracy study in a resource-poor setting

PurposeWe aimed to describe the prevalence of undernutrition in hospitalised infants aged under 6 months and test the utility of simple index measures to detect undernutrition.DesignDiagnostic accuracy study: weight, length,...

Abdominal Trauma in Children: 10-Year Experience in a Teaching Hospital in Enugu, Nigeria

Background: Abdominal traumas are injuries to the abdomen resulting from transfer of energy from the exterior to the abdomen. It is associated with significant morbidity and mortality especially in developing countries. Methodology: Children who presented with abdominal trauma at Enugu State University Teaching Hospital between January 2007 and December 2016 were evaluated. Diagnosis of abdominal trauma was made based on clinical assessment and imaging investigation. Results: Over the ten year period, there were 42 cases of abdominal trauma with male to female ratio of 3.7:1 and mean age of 9.1 years (4-14). Fall from height, accounting for 42.9% of the cases, was the most common cause of abdominal trauma. This is followed by road traffic accident (35.7%), bicycle handle injury 14.3%, gunshot injury 7.1%. Abdominal ultrasound was the most common imaging modality. The spleen was the most injured organ, followed by liver, kidney, and intestine in descending order. Non-operative treatment was successful in 85.3% of the patients while 14.7% had surgery. The mean duration of hospital stay was 9.8 days (1-14) and the mortality was 7.1%. Conclusion: Abdominal trauma affects children of all age groups. In the current study, fall from height was the most common mechanism of injury and the spleen was the most injured organ. Non–operative treatment was the predominant modality of treatment.

Molecular detection and antibiotic resistance pattern of extended-spectrum beta-lactamase producing Escherichia coli in a Tertiary Hospital in Enugu, Nigeria

BackgroundThe use of antibiotic agents in the treatment of infectious diseases has greatly contributed to the decrease in morbidity and mortality, but these great advances in treatment are being undermined by the rapidly increasing antimicrobial resistant organisms. Extended-spectrum beta-lactamases are enzymes hydrolyzing the beta lactam antibiotics, including third generation cephalosporins and monobactams but not cephamycins and carbapenems. They pose a serious global health threat and have become a challenge for health care providers. The aim of this research was to assess the prevalence of extended-spectrum beta-lactamase producing Escherichia coli in University of Nigeria Teaching Hospital Ituku-Ozalla Enugu and to detect the risk factors for acquisition of the resistant organism. To proffer advice on antibiotic stewardship in clinical practice and public health interventions, to curb the spread of the resistant organisms in the hospital.ResultsOut of the 200 E. coli isolates, 70 (35.00%) were confirmed positive for extended-spectrum beta-lactamase production. Fifty-three (75.7%) were from hospital acquired infections. All the isolates were resistant to ampicillin, tetracycline and chloramphenicol while 68 (97.14%) of the 70 isolates were susceptible to imipenem. BlaTEM, blaSHV and blaTEM were detected in 66 (94%) of the 70 isolates. The ESBL bla genes detected were blaCTX-M (n = 26; 37.14%), blaTEM (n = 7; 10.00%), blaSHV (n = 2; 2.86%), blaCTX-M/TEM (n = 7; 10.0%), blaCTX-M/SHV (n = 14; 20.0%) and blaCTX-M/TEM/SHV (n = 10; 14.29%). The three bla genes were not detected in 4 (5.71%) of the isolates. Recent surgery, previous antibiotic and intensive care unit admission were the associated risk factors to infections caused by extended-spectrum beta-lactamase producing E. coli.ConclusionThere is a high rate of infections caused by extended-spectrum beta-lactamase producing E. coli. Recent surgery, previous antibiotic and intensive care unit admission were associated risk factors.

Factors and characteristics of physical violence among healthcare workers of a tertiary hospital in Enugu, Nigeria

Background: Healthcare workers (HCWs) especially those involved in patients’ care are at high risk of violence. The study is aimed at determining factors and characteristics of physical violence among HCWs in a tertiary hospital in Nigeria.Methods: The descriptive cross-sectional study was carried out among 412 HCWs from March to July, 2018. Data entry and analysis were done using Epi InfoTM 3.5.4 and Chi square and Fischer’s exact test where applicable were used to ascertain factors associated with physical workplace violence.Results: Respondents included 111 (26.9%) doctors and 301 (73.1%) nurses. Prevalence of physical violence was 12.6%. Of those who experienced workplace violence, the perpetrators were mainly patients’ relatives 37 (71.2%) and patients 8 (15.4%). In majority of cases, 28 (53.8%), no action was taken against the assailant. Prevalence of physical violence was significantly higher among nurses (15.3%) than doctors (5.4%) p=0.007. It is also higher among females (14.2%) than males (7.8%), although not significantly. Furthermore, HCWs who work in newborn units were most likely to experience physical violence.Conclusions: The study revealed that physical violence is prevalent among HCWs and violence prevention programs should be instituted to address it.

Socio-demographic correlates of postpartum psychological distress among apparently healthy mothers in two tertiary hospitals in Enugu, South-East Nigeria.

Postpartum depression and anxiety could cause poor mother-infant relationship that could impair infant growth and cognitive development. Psychiatric assessment has not been part of periodic evaluations in postnatal clinics. Some apparently well, but high-risk mothers continue to live with psychological distress, without treatment to relieve their burden. The study assessed the prevalence of postpartum anxiety and depression, their co-morbidity, and socio-demographic predictors, within 6 - 14 weeks postpartum among nursing mothers in two tertiary hospitals in Enugu, South-East Nigeria. A cross-sectional study that was carried out at the postnatal and children's welfare clinics of two tertiary hospitals in Enugu, South-East Nigeria. Hospital Anxiety and Depression Scale, Social Support Scale and Socio-demographic Questionnaire were used for the study. Correlations and multiple regressions were used to test for associations and risk factors. Occurrence rate for anxiety and depression were 30.1% and 33.3% respectively with a co-morbidity rate of 22%. Low social support and multigravida predicted risk factors for postpartum psychological distress, while a higher number of children alive predicted a decrease in the risk for postpartum psychological distress. The study supports service planning and the development of strategies to reliably identify women at high-risk, for effective treatment.

Effect of malaria pathology on CD4 and immune cells

Abstract Knowledge of immunity in malariology can help in understanding the pathology, treatment and vaccine production. The effect of malaria disorder on CD4 and immune cells counts was carried out at a Teaching Hospital in Enugu, Eastern Nigeria between October-December 2018. Patients on doctor’s provisional diagnosis of malaria were examined for Plasmodium infections and the degree of parasitaemia (0, +, ++, and +++). Positive samples and negative ones (0) were thereafter examined for their CD4 (Flow cytometry) and immune cells (Automated blood cell counter) counts. 45 patients were studied. All the Plasmodium-negative specimens were within reference ranges of CD4 cell count (464–1308); with mean value of 835. The (+) parasitaemia showed lower ranges of CD4 count (502–1282); mean = 678; with immune falls in one (427). The 12 (++) parasitaemia showed crash in 9 CD4 cells counts; range: 301–415; mean = 399. All the 7 (+++) parasitaemia showed crashes in CD4 cell counts, range: 160–357; mean = 225. The CD4 cells falls and crashes were detected only in Plasmodium falciparum parasitaemia infections. Depending on the CD4 cells count, also a reflex of parasitaemia, variances occur in the various immune cells’ percent and numeric. TWBC count fell in only 3 patients (1.99, 3.42 & 3.64) × 109 cells/L, corresponding to (+++), (++) & (+) parasitaemia, respectively. Low CD4 counts does not always produce low lymphocyte numeric, probably because other CD or killer cells compensates it. In conclusion, Plasmodium falciparum infection causes immuno-suppression in patients. Corollary, it means that malaria infection in the immunodeficients and AIDS patients will accelerate the complications as well as death, unlike prevailing reports.

Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, South East, Nigeria.

Birth asphyxia (BA) is a preventable cause of cerebral insults in newborns. It is associated with high morbidity and mortality. Of the 120 million babies born in third world countries annually, it is estimated that about 3.6 million will develop BA. We aimed to determine the short term outcome and predictors of survival among birth asphyxiated babies using Apgar score. This study was carried out in the Newborn Unit of Enugu State University Teaching Hospital. In-hospital deliveries (Inborn) and those from other centers (Out-born) with one minute Apgar score ≤ 6 were included. Interviewer administered questionnaire was used to collect data from caregivers. Information sought included gestational age (GA), birth weight (BW), Apgar score, place of delivery and outcome. Data was analyzed using SPSS. Bivariate and multivariate logistic regressions were done. Of the 150 neonates, 61.3% survived. Majority of the dead were out-born. The difference was statistically significant (p < 0.001). The inborn were about 1.2 times (AOR = 1.22; 95% CI: 1.06-1.78) more likely to survive BA. Among low birth weights (LBWs), 73.9% died, 23.7% of normal weights and 14.3% of macrosomics died. The difference was statistically significant (p < 0.001). The normal weights were about 2 (AOR = 2.23, 95% CI: 1.76-6.25) and the macrosomics about 5 times more likely to survive BA than LBWs. Regarding GA, 78.8%, 17.2% and 18.2% of the pre-terms, term and post-dates died respectively. The difference was statistically significant (p < 0.001). The term babies were about 11 (AOR = 11.27; 95% CI: 4.02-31-56) and post-dates about 9 (AOR = 8.79; 95% CI: 1.43-54.04) times more likely to survive BA than preterms. Other significant factors were degree of asphyxia (p = 0.003), and parental education (p < 0.001). BW, GA, degree of asphyxia, place of delivery and parental education all predicts survival among birth asphyxiated newborns.

Profile of Birth Injuries in a Tertiary Hospital in Enugu, Nigeria

Background: Birth injury is defined as structural damage of a newborn secondary to mechanical forces that occur during labor and/or delivery. This study determined the incidence, risk factors and outcome of birth injury. Methodology: This was an observational study of birth injuries in neonates, over a period of one year, carried out at a tertiary hospital in Enugu, south east, Nigeria. Results: Out of the 1,735 births recorded during the period of the study, there were 19 cases of birth injuries. This gave an incidence of 11 per 1000 live births. No neonate had more than one injury. They were thirteen males and six females that sustained birth injury. Cephalohematoma was the most common birth injury. Others are caput succedaneum, clavicular fracture, Erb’s palsy, femoral fracture, humeral fracture, shoulder dislocation and facial laceration. Mode of delivery, neonatal birth weight, gestational age and maternal parity were significant predictive risk factors for birth injury. Conclusion: In the current study, cephalohematoma was the most common birth injury, followed by caput succedaneum. There is need to reduce the morbidity and mortality associated with birth injuries.

Neonatal Intestinal Obstruction: A 5 Year Experience in a Tertiary Hospital in Enugu, Nigeria

Background: Neonatal intestinal obstruction is one of the most common surgical emergencies in a newborn requiring the services of a pediatric surgeon. This study reports the etiology, sex incidence, age of presentation, management and outcome of neonatal intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of neonates who presented, at Enugu State University Teaching Hospital, with intestinal obstruction over a 5-year period. Result: Thirty five neonates were recruited into the study. There were 24 (68.6%) males and 11 (31.4%) females. Five patients (14.3%) were delivered before term (preterm) while thirty patients (85.7%) were delivered at term. Most of the patients (54.3%) presented after 72 hours from onset of symptoms. Abdominal distension was the most common symptomatology recorded in our patients. Necrotizing enterocolitis was the most common etiology in our patients accounting for 17 neonates (48.6%). This was followed by anorectal malformation 5 (14.3%), obstructed hernia 4 (11.4%), intestinal atresia 4 (11.4%), Hirschsprung’s disease 3 (8.6%), meconium plug 2 (5.7%). Colostomy formation was the most common surgical procedure performed. Twenty percent of our patients developed post-operative complication and mortality was 22.9%. Conclusion: Necrotizing enterocolitis is the most common cause of neonatal intestinal obstruction in the current study. With the mortality of 22.9%, the outcome in our patients is still poor and requires some improvements.

Epidemiological Pattern of Closed Femoral Shaft Fractures in a Regional Tertiary Hospital in Enugu, Nigeria

Background: The femur is the longest and strongest tubular bone in the human body. The femoral shaft is the portion of the bone between 5 cm distal to the lesser trochanter and 6 cm proximal to the most distal point of the medial femoral condyle. Femoral shaft fractures often result from high energy forces. These fractures occur mostly among young adults. Objective: This was to determine the epidemiological pattern of closed femoral shaft fractures in a regional tertiary hospital in Enugu, Nigeria. Method: The study was a prospective study over a 12 month period (June 2015-May 2016) at National Orthopaedic Hospital, Enugu. Following ethical approval and written informed consent, patients were consecutively recruited. The patients were clinically and radiographically evaluated at presentation. The diagnosis of closed femoral shaft fractures were made from the physical examination finding of absent open wound communicating with the fracture hematoma in the thigh and anteroposterior (AP) and lateral x-rays of the affected thigh confirming the fracture pattern. The data collected included patients’ demographics, the cause of injury, the side of injury and anatomic site of the injury among other parameters. The data were collected using well designed and structured proforma. Results: A total of 52 femoral shaft fractures in 50 patients were included and analyzed using SPSS version 20.0. The age range of the patients is 18 - 85 years with a median age of 39.1 ± 14.9 years. The most commonly affected age group is 21 - 30 years. There was male preponderance with a male to female ratio of 2.3:1. Majority of the fractures (76.9%) resulted from road traffic crashes most commonly following motor vehicular accident (36.5%). Majority of the fractures (92.3%) are unilateral with right side to left side ratio of 1.2:1. Majority of the patients (51.9%) had Winquist Hansen grade III type of fracture. The most common associated injury is fractures of tibia/fibula followed by fracture of the neck of the ipsilateral femur. All the patients were treated operatively using either locked intramedullary nailing technique or plating technique. Majority of the patients (59.6%) were discharged between 10th and 29th day post-operatively. Conclusion: From the results of this study, it is concluded that most of the closed femoral shaft fractures were caused by high energy trauma from road traffic crashes. It is therefore recommended that proper education of motorists on good use of roads and strict adherence to traffic rules will significantly help in preventing the occurrence of these fractures in our environment.

Paediatric Day Case Surgical Practice at a Tertiary Hospital in Enugu, Nigeria

Background: An increasing number of paediatric day case surgeries are being carried out in developing countries due to the benefits of day case surgery and lots of papers are being published. However, there is no published paper on paediatric day case surgery from Enugu State University Teaching Hospital (ESUTH), Enugu. Methodology: This was a prospective study of children who had surgery on day case basis at the paediatric surgery unit of a tertiary hospital in Enugu, south east Nigeria, over a period of one year. Result: Out of the 135 surgeries done during the period of the study, 81 cases were day case surgeries, accounting for 60% of the cases. There were 69 males (85.2%) and 12 females (14.8%). The mean age and weight of the patients was 44.9 months and 16.5 kilograms respectively. The mean duration of surgery was 35.1 minutes while the mean duration of stay in the hospital post-surgery before going home was 5.2 hours. The most common diagnosis was hydrocele and herniotomy/herniorraphy was the most common surgical procedure performed. Conclusion: Paediatric day case surgery constitutes a significant workload of the paediatric surgeon. Herniotomy/herniorraphy was the most common procedure performed and most parents were satisfied. The scope of paediatric day case can be improved and the practice made more effective.

Spectrum of Paediatric Intestinal Obstruction in a Tertiary Hospital in Enugu, Nigeria

Background: Paediatric intestinal obstruction is a common surgical emergency and is associated with lots of morbidity and mortality especially in developing countries. Paediatric intestinal obstruction differs from adult intestinal obstruction in terms of aetiology, presentation, management and outcome. This study reports the demography, diagnosis, management and outcome of paediatric intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of paediatric patients who presented with intestinal obstruction to the paediatric surgical unit of Enugu State University Teaching Hospital (ESUTH) Enugu, South East Nigeria. Children above one month of age but below 15 years, who presented with symptoms and signs of intestinal obstruction, were recruited for the study. Intestinal obstruction in neonates was excluded from this study. The study period was for one year, from January 1st 2018 to December 31st 2018. Result: During the period of the study 45 cases, 30 (66.7%) males and 15 (33.3%) females were managed. The mean age of the patients was 52.2 months. Abdominal pain was the most common presenting symptom and intussusception was the most common cause of intestinal obstruction. Forty two patients (93.3%) did well and were discharged. Two patients (4.4%) died while one patient (2.2%) was discharged against medical advice. Conclusion: Intussusception was the most common cause of intestinal obstruction in the current study. The mortality of 4.4% recorded in this study can be improved upon.

Patients' knowledge of health rights and satisfaction with outpatient services at the tertiary hospitals in Enugu state, Nigeria

Background: Patient satisfaction is a key indicator for measuring the success of the health system goals, delivery quality care that is safe, equitable, patient-centered, evidence-based, timely and efficient, through interprofessional collaborative team work. Equally, patient's knowledge of their health rights will enhance better provider-patients relationship, patient satisfaction, and effective care management. Objectives: The aim of this study was to compare patients' knowledge of health rights, satisfaction with the physicians' conducts and outpatient services across three tertiary hospitals in Enugu, Nigeria. Methods: A descriptive cross-sectional study of 304 patients selected from the outpatient clinics of the University of Nigeria Teaching hospital (UNTH), National Orthopaedic Hospital (NOHE), and Enugu State University of Science and Technology Teaching Hospital (ESUTH), from October to December, 2015 was conducted. A four point Likert scale, dissatisfied (1), very dissatisfied (2), moderately satisfied (3), and very satisfied (4) was applied. Knowledge of health rights were scored as follows, 0-5 poor knowledge, 6-10 good knowledge, 11 and above very good knowledge. A minimum sample size of 91 patients was calculated for each of the study hospital, but increased to100 each, to enhance precision, reduce error margin, and to contend possible nonresponses and incompleteness. A multi-stage sampling technique was applied. The data were analyzed using SPSS version 16.0. Results: Knowledge of health rights was poor in 5.9%, 20.8%, and 14.9% of patients ( X 2 =9.61, p=0.000), and very good in 70.6%, 46.5% and 59.4% patients ( X 2 =12.14, p=0.000) from UNTH, NOHE, and ESUTH respectively. The mean knowledge scores were 10.50 ±3.240 for UNTH; 8.72±2.953 for NOHE; and 9.93±3.151 for the ESUTH. The overall mean knowledge scores of the patients across the three hospitals was not statistically significant ( F =0.000, P =1.000). Patients' overall mean satisfaction with physicians' conduct and services was 3.63±0.525 for UNTH, 3.45±0.741 for NOHE, and 3.47±0.609 for ESUTH, with no statistically significant difference ( F =0.000, P =1.000). Overall mean satisfaction scores for the general outpatient services were 3.19±0.728, 3.15±0.713, and 3.00±0.721 for UNTH, NOHE, and ESUT respectively. The observed differences in the overall mean satisfaction for the general services provisions across the hospitals was not statistically significant ( F =0.000, P =1.000). Patients' mean knowledge scores were statistically ( p =0.000) associated with mean satisfaction with the physicians' conduct and services provision across hospitals. Conclusion: Patients knowledge of health rights and satisfaction with physicians' conducts and outpatient services across the hospitals were generally good and satisfactory, but differed statistically in-between hospitals. Keywords: Health rights, conducts, satisfaction, patients, physicians

Glycemic Control among Medical Outpatients in Enugu: A Cross Sectional Survey

Background: Diabetes in Nigeria presents a rising public health challenge and many cases are probably undetected. Poor glycemic control is a risk factor to both micro and macro vascular complications of diabetes and a major factor in the burden of the disease world-wide. The aim of the present study was to determine the pattern of glycemic control among adult diabetes patients attending a medical outpatient clinic in Enugu. Methods: Using a semi-structured questionnaire, we conducted a cross sectional descriptive study of patients with diabetes attending the medical out-patient clinic of one of the tertiary Hospitals in Enugu, Nigeria. Good glycemic control was defined as fasting blood glucose of less than 100 mg/dl. Study duration was 6 months. Statistical analyses were done using SPSS software. Results: A total of 119 participants were recruited for the study: 74 (62.2%) females and 45 males (37.8%) with a mean age of 62.2 (11.7) years. The mean systolic and diastolic blood pressure was 138.4 (24.3) mmHg and 81.2 (12.9) mmHg respectively. Eight (6.7%) had a docu-mented history of diabetes-related coma in the past. The mean fasting blood glucose was 127.9 (22.4) mg/dl. Good, fair and poor glycemic control was achieved in 16.8%, 30.3% and 63% (52.9%) respectively. Correlation statistics showed that low level of adherence and abstaining from alcohol/tobacco are correlated with poor glycemic control. Conclusion: Majority (52.9%) of patients with diabetes attending a tertiary health center in Enugu, Nigeria has poor glycemic control status. Medication adherence and substance use are correlated with poor control.

Assessment of patients knowledge and attitude towards diabetes and its relationship with glycemic control: A cross-sectional study in a Nigerian tertiary hospital

Background: It is postulated that increased knowledge of patients about diabetes as well as a positive attitude will lead to improved glycaemic control and better outcome. The aim of this study was to determine the knowledge and attitude of diabetic patients in a tertiary hospital in Enugu and the relationship with their glycaemic control.Methods: A cross-sectional study was done using a structured questionnaire to obtain socio-demographic data and assess knowledge and attitude to diabetes on consecutive patients attending the outpatient clinic in a tertiary hospital. Responses were scored with equal weighting. The fasting blood glucose of the patients was measured and recorded.Result: There were 51(60.7%) females and 33 (39.3%) males, with majority (63.1%) in the age range 41 -64 years and 32(38.1%) had only primary education. The mean knowledge score was 6.19 ± 2.08 and 33(39.3%) demonstrated good knowledge. Knowledge did not differ between males and females (p=0.34), but was highest in those with tertiary education (p = 0.02). Positive attitude to the condition was recorded in 63(75%) subjects. There was poor correlation between knowledge and attitude (r = -0.161, p= 0.14). Those with good knowledge scores were 2 times more likely to have good glycaemic control compared with those with poor knowledge; OR = 2.015, p = 0.02. There was no significant difference between the glycemic control of those with good attitude and those with poor attitude (p= 0.08).Conclusion: Although overall knowledge was poor, patients had a good attitude to their illness. Knowledge, but not attitude was significantly positively associated with glycemic control.Keywords: Diabetes mellitus, Knowledge, Attitude, Glycaemic control