Hospitals In Southeast Nigeria Research Articles

Trends in Emergency Room Visits of Oral and Maxillofacial Surgery Patients in a Tertiary Hospital in South-East Nigeria

Background: The accident and emergency unit is usually the first port of call for patients involved in road traffic and domestic accidents, emergency dental conditions, and advanced-stage malignancies during call hours and weekends. Objective: This study aimed to evaluate the pattern of emergency maxillofacial injuries in the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. Materials and Methods: This is a 3-year retrospective study of patients that presented to the accident and emergency unit of the University of Nigeria Teaching Hospital Enugu on account of pathologies involving the oral and maxillofacial region. Results: One hundred and eighty-three cases were recruited into the study. There were 131 males and 52 females. The mean age of the patients was 38.0 ± 18.6 years. The majority 121 (66.1%) occurred due to road traffic accidents followed by 18 (9.8%) due to complications of untreated carious teeth, then 12 (6.6%) from complications of advanced-stage tumors. Facial bone fractures 76 (41.5%) followed by lacerations 42 (23.0%) were the commonest conditions seen. Eighty-four (45.9%) had reduction and immobilization of their fractures, whereas 51 (27.8%) had suturing of various lacerations. Conclusions: Pathologies resulting from road traffic accidents, orofacial space infections, and late-stage malignancies were the commonest indications for accident and emergency unit visits by oral and maxillofacial surgery patients in the study center. The need for regular training of first-line staff in the emergency units of hospitals in this part of the world is necessary.

Evaluation of Medication Safety Practices Among Pharmacists in A Teaching Hospital in South-East Nigeria

The study evaluated the practice of Medication Safety and assesses the knowledge of medication safety practices among hospital pharmacists in a teaching hospital in southeast Nigeria. It was a quantitative study divided broadly into two phases. Phase one involved the collection of the medication error forms filled by pharmacists in the hospital over 3 months; January – March 2021. The second phase was the administration of self-completed questionnaires. The data was collected and analyzed. The medication errors encountered were assessed, classified, and the prevalence determined. Descriptive statistics were used to summarise the data. Overall, 68 medication error forms were collected over the 3-month data collection period. The top category of prescribing error was dose/frequency omitted (24.65%), followed by duration/stop date omitted and dose inappropriate (over), both were 17.81%. The medication safety domain to which pharmacists demonstrated the highest positive response rate (PRR) was Personal Influence Over Safety with 63.33% (SD±20.09), and the domain with the lowest positive response rate was Facilitators and Barriers at the Workplace with 46.25% (SD±25.67). Most of the pharmacists answered yes to having filled out the hospital’s medication error form at least once. 3 of the 4 medication safety domains had above-average positive response rates (PRR). The medication safety domain with the lowest PRR was the facilitators and barriers at the workplace domain with 46.25%. There were no significant differences in associations between pharmacists of different ages, years of experience, and different genders in their attitudes toward medication safety; after applying Pearson’s correlation test.

Histopathologic Spectrum and Clinicopathologic Concordance of Pediatric Skin Biopsies: 18-Year Experience in a Tertiary Hospital in Southeast Nigeria

ABSTRACT Background: Many studies have evaluated the spectrum of pediatric skin disorders in outpatient, inpatient, and emergency settings in different regions of Nigeria. However, literature analyzing histopathological data of dermatologic diseases in children undergoing biopsy or excision of skin lesions in Nigeria is lacking. The present study was aimed at determining the spectrum, frequency, and clinicopathologic diagnostic concordance of pediatric dermatopathological lesions at a tertiary care hospital in southeast Nigeria. Materials and Methods: This is a retrospective cross-sectional study undertaken at the department of Histopathology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All pediatric (up to 18 years old) skin biopsies received at the department of Histopathology, NAUTH, Nnewi over an 18-year period from January 2004 to December 2021 were included in the study. Relevant clinical and demographic data had been collected from the request forms. For ease of analysis and comparison with other skin studies, the skin lesions were classified according to the International Classification of Diseases, Tenth revision (ICD-10) (2019), for disorders of the skin and subcutaneous tissue. Results: Pediatric skin biopsies constituted 20.2% of all the skin biopsies received at our laboratory during the study period, with a male to female ratio of 1:1. The initial clinical diagnosis was concordant with histopathologic diagnosis in 88 out of 189 cases (46.6%). Forty-nine percent of biopsies/excisions were performed in the head and neck area. The most common diagnostic categories, in decreasing order of size, were neoplasms, disorders of skin appendages, papulosquamous disorders, and infections. Only about a quarter of neoplasms were malignant. Conclusion: Our study has documented the importance of histopathology as a gold standard in the diagnosis and management of skin lesions. Improved training of primary care physicians and closer cooperation between pediatricians, dermatologists, and pediatric surgeons will increase the chances of accurate diagnosis.

Abdominal Injuries from Civilian Conflicts: An Emerging Global Health Challenge in Rural Southeast Nigeria.

In recent time, incidence of abdominal injuries continues to increase steadily in most major regions of West Africa due to emergence of various religious, social and political conflicts. Indeed, violence and social conflicts constitute major global public health challenges that commonly lead to injuries and long-term physical and mental health problems. In our setting, increasing cases of abdominal trauma resulting from civilian violence led to additional workload in the general surgery unit and the audit of our experiences is presented in this paper. To analyze the etiological spectrum, trend and management outcome of abdominal injuries from civilian violence in our setting. This was a multicenter prospective study of adult patients with abdominal injuries from civilian conflicts managed at three selected district hospitals in Southeast Nigeria between January 2013 to December 2020. Of 398 patients evaluated, 359 (90.2%) sustained penetrating while 39 (9.8%) had blunt abdominal injuries. Gunshot was the most common mechanism, accounting for 248 (62.3%) cases, followed by stab wound (95, 23.9%). Armed robbery attack (68, 27.4%) was the main source of gunshot wounds. Overall, annual rates showed a four-fold rise over an eight-year period from 24 cases (6.0%) in 2013 to 96 (24.1%) in 2020. Majority (365, 91.7%) had operative management (OM); the rest (33, 8.3%) were treated non-operatively. Morbidity and mortality rates for operative cases were 29.6% and 12.1% respectively. The main factors associated with increased mortality rates were delayed presentation (p = 0.002), bowel resection (p = 0.006), gunshot wounds (p = 0.013), advanced age (p = 0.033), multiple visceral injury (p = 0.034) and ASA score ≥ III (p = 0.001). Abdominal trauma from civilian violence is on the steady rise in our setting. The main etiologic factors are armed-robbery, communal clashes, political thuggery and cultism perpetrated predominantly through gunshots and stab wounds. Advancing age, gunshot wounds, delayed presentation, bowel resection and multiple injuries were associated with increased mortality.

Audit of prostate cancer diagnosis using P63 and prostate-specific antigen immunostains at a tertiary care hospital in South-East Nigeria

Audit of prostate cancer diagnosis using P63 and prostate-specific antigen immunostains at a tertiary care hospital in South-East Nigeria

Mosquito Species Breeding Within a Tertiary Hospital in South-East Nigeria: Are There Public Health Implications?

Mosquito Species Breeding Within a Tertiary Hospital in South-East Nigeria: Are There Public Health Implications?

Investigating physician self-referral in public hospitals in South East Nigeria: Insights from stakeholders.

Physician self-referral occurs where a full-time paid doctor diverts patients from one hospital to another in which he or she has financial interest. This study is aimed at investigating the views of service users, physicians and policymakers on physician self-referral practice in public hospitals in Nigeria. The study was carried out in Enugu urban area of South East Nigeria. A mix of qualitative and quantitative methods was used to collect information from different categories of stakeholders. Service user views were explored through analysis of four focus group discussions involving 26 participants and 407 questionnaires completed with household members who had recently visited a public hospital and then gone to private hospitals. In-depth interviews were completed with 15 public sector doctors not involved in dual practice and eight key policymakers. Thirty-four of 407 respondents (8.4%) visiting a public hospital were diverted to a private facility associated with the attending public hospital doctor. The research examined age, gender and socio-economic status (SES) as factors that might influence the likelihood of patient diversion. Advice to transfer to a private clinic usually came directly from the doctor involved but might also come from nurses. Physician self-referral in Nigeria could take different forms. It was found that both direct and indirect forms of diversion exist, suggesting that this is an organised practice in which dual-practice doctors and supporting hospital staff members cooperate. The study recommends, among other things, that service users should be adequately protected from any form of diversion to private practice by the public system employee doctors.Contribution: This study contributes to understanding the extent and pattern of patient diversion in public hospitals in Nigeria. The findings reveal coordinated tactics for diverting public hospital patients and provide a direction for future research in negative behaviour among healthcare professionals in Nigeria.

Assessment of Drug Use in a Tertiary Hospital in Southeast Nigeria Based on Who Core Drug Use Indicators

Background: Irrational use of medicines is a global phenomenon and an issue of concern with so many undesirable consequences. The complex nature of the pharmaceutical care process is an indication for an essential tool that investigates drug use pattern in health facilities. The WHO released the core drug use indicators to address these issues. The study assessed drug use in a tertiary hospital in southeast Nigeria based on WHO core drug use indicators. Methods: A cross-sectional descriptive study design was used and the study was conducted from October 2021 to June 2022. Retrospectively, 300 prescriptions were selected and reviewed using systematic random sampling for a year from 2020 -2021 to investigate prescribing indicators. A total of 120 randomly selected patients and pharmacy personnel were observed and interviewed to investigate the patient-care and facility-specific indicators. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use in comparison to the result gotten. Results: The average number of drugs per encounter was 2.76, the Percentage of drugs prescribed by generic names was 78.02%, the Percentage of antibiotics prescribed was 33.33%, and the Percentage of injections prescribed was 1.67%. Average consulting time in minutes was 17.5 minutes, the average dispensing time in seconds was 92.1 seconds, the Percentage of drugs actually dispensed was 76.97%, Percentage of adequately labeled was 100%, and the percentage of patients’ knowledge of correct dosage was 90%. The facility did not have an Essential Drug List but had all (100%) the key drugs listed by the WHO drug list. Conclusion: All of the prescribing indicators deviated from the WHO/INRUD recommended optimal values. Patient-care and facility-specific indicators deviated from the optimal values except that of the average consultation time, average dispensing time, percentage of drugs adequately labeled, and 100% availability of key drugs. Although a few of the WHO benchmark for rational drug use were met, the outcomes were not satisfactory and required interventions to improve rational drug use in the facility.

Factors Affecting the Acquisition of Basic Surgical Skills among Surgery Interns in Teaching Hospitals in Southeast, Nigeria.

Upon graduation from medical school, doctors in Nigeria undergo a compulsory internship program which includes rotation through four core specialties: Internal medicine, Obstetrics and Gynaecology, Paediatrics and Surgery. Interns are expected to acquire basic surgical skills during their rotation in surgery. To identify the factors that affect the acquisition of basic surgical skills by surgery interns (house officers) during their one-year internship program in teaching hospitals in Southeast Nigeria. A total of 73 surgery interns were sampled using a descriptive cross-sectional, epidemiological survey that employed self-administered Google forms. The semi-structured questionnaire was electronically distributed to interns currently in surgery rotations in their internship program in South-east, Nigeria. The data was analyzed using IBM's Statistical Package for Social Sciences (SPSS) version 22 and presented in tables and charts. Consent was obtained from all respondents and measures were put in place to limit different forms of bias. The most important factors that negatively affected the acquisition of surgical skills by interns were fatigue from overwork (55.4%), poor mentorship (47.3%) and inadequate skill training courses (44.6%). There were no statistically significant correlations amongst the factors that affected the acquisition of basic surgical skills by house officers. Some of the major limitations to acquisition of surgical skills by house officers that have undergone the surgery rotation were identified to be the workload, poor mentorship and inadequate structured skill training courses. Provision of better work conditions to limit work fatigue and improve learning. The training of house officers undergoing their surgery rotation should be supplemented by periodic assessment and mentorship programs by senior doctor to improve the acquisition of basic surgical skills by house officers.

Risk factors for late presentation among glaucoma patients attending three referral hospitals in South-East Nigeria: case–control study

Late presentation in glaucoma has been associated with rapid deterioration of visual fields and blindness even with good and effective treatment options. Glaucoma prevalence and risk of blindness is higher among the Igbo tribe, who dominate the Eastern part of Nigeria, hence the focus of this study in this area to determine modifiable risks for late presentation in glaucoma. This was an observational, hospital-based, comparative study at three tertiary hospitals. All eligible, consenting participants were examined and researcher-recorded questionnaire administered. Data was entered, validated and imported into Stata version 15.0; appropriate descriptive measures of central tendencies were presented with tables and maps. Univariate, multiple logistic regression and pairwise correlation analysis identified statistically significant risks at p-value of <0.05. 303 participants were enrolled with a mean (SD) age of 56.58 (15.63) years. The adjusted odds of presenting late were found to be 57% lower among females (CI 0.27 to 0.69), 1.73 times higher with each year increase (CI 1.42 to 2.11) and 2.31 times among hypertensives (CI 1.39 to 3.85). There were reduced adjusted odds ratio; 0.55 for participants living in urban areas compared to rural (p 0.02) and 0.52 for those who have heard about glaucoma prior to diagnosis (p 0.01). Increasing age, male sex, rural and non-awareness of glaucoma are identified risk for late presentation. Community-based health promotion activities can be explored to bridge this gap through targeted and cost-effective approaches involving existing health-care delivery systems.

Lymphatic Filariasis in a Tertiary Hospital in South-East Nigeria: A Tale of Neglect, Low Social Class and Disability

Lymphatic Filariasis in a Tertiary Hospital in South-East Nigeria: A Tale of Neglect, Low Social Class and Disability

Profile of Stroke Survivors Managed at the Physiotherapy Department of a Tertiary Teaching Hospital in Southeast Nigeria

Profile of Stroke Survivors Managed at the Physiotherapy Department of a Tertiary Teaching Hospital in Southeast Nigeria

Profile of Stroke Survivors Managed at the Physiotherapy Department of a Tertiary Teaching Hospital in Southeast Nigeria

Profile of Stroke Survivors Managed at the Physiotherapy Department of a Tertiary Teaching Hospital in Southeast Nigeria

Concerns About Breast Pain: How Useful Is Imaging?

Background: Breast pain is one of the most common reasons for referral to breast imaging. Objectives: This study aimed to determine the diagnostic yield of mammography and sonomammography in women complaining of breast pain in a teaching hospital in Southeast Nigeria. Methods: This descriptive study analyzed the mammographic/sonomammographic images and records of 241 consecutive adult women aged 18 - 81 years with breast pain who presented to the radiology department over three years. A non-random sampling method was employed to select the participants. The extracted variables were patient’s age, positive clinical history of breast pain, laterality of breast pain, type of imaging, presence or absence of lesion, type, and laterality of lesions if present, and Breast Imaging Reporting and Data System (BI-RADS) assignment of imaging findings on mammography and sonomammography. The descriptive analysis of continuous variables and inferential statistics of ordinal data were performed with Microsoft Excel and chi-squared test, respectively. In this study, P &lt; 0.05 was set as the significance level. Results: Most women (20%) with a complaint of breast pain were in the 40 - 44-year age group. Moreover, 32.3%, 33.2%, and 34.4% of the participants had left-sided, right-sided, and bilateral breast pain, respectively. Among the participants, 118 and 123 women had mammography and sonomammography, respectively. Furthermore, 76.3% had normal findings on mammography or sonomammography, and only 23.7% had positive imaging findings on breast imaging. These lesions were mostly observed among the women in the age group of 45 - 49 years. Of those with lesions detected on imaging, 79.2% and 20.8% demonstrated benign and malignant attributes, respectively. Masses with definite benign attributes assigned BI-RADS II were mostly fibroadenomata and cysts. Inferential statistics indicated that unilateral mastalgia was more likely to be associated with a breast lesion, while bilateral mastalgia usually resulted in normal breast imaging findings. Conclusions: Women referring to the Radiology Department with a complaint of breast pain alone are unlikely to have any significant breast imaging finding; hence, imaging serves as a tool for assuaging the anxiety of these patients and reassuring the referring physician. Unilateral but not bilateral mastalgia is likely to yield positive imaging findings, which are largely benign.

A Correlation between the Cytology and Histology of Serous Effusions at a Teaching Hospital in South-East Nigeria

A Correlation between the Cytology and Histology of Serous Effusions at a Teaching Hospital in South-East Nigeria

Perioperative mortality among surgical patients in a low-resource setting: A multi-center study at District hospitals in Southeast Nigeria.

The perioperative mortality rate (POMR) has been recognized as a useful indicator to measure surgical safety at an institutional or national level. The POMR can thus be used as a tool to identify procedures that carry the highest mortality rates and provide hindsight based on past surgical experiences. To document the pattern of perioperative mortality and the factors that influence it at district hospitals in southeast Nigeria. This was a retrospective study of cases of perioperative mortality at district hospitals in southeast Nigeria between January 2014 to December 2018. All perioperative mortalities from surgical admissions in both elective and emergency set-ups were included. During analysis, we computed P values for categorical variables using Chi-square and Fisher's exact test in accordance with the size of the dataset. Furthermore, we determined the association between some selected clinical variables and mortality using logistic regression analyses. During the period under review, 254 perioperative deaths occurred from 2,369 surgical operations, giving a POMR of 10.7%. Of the 254 deaths, there were 180 (70.9%) males and 74 (29.1%) females. Nearly one-third (31.2%) were farmers and 64.2% of the deaths occurred in those 50 years and below. Delayed presentation was two-pronged: delay before presentation and in-hospital delay. The POMR was the highest among general surgery emergencies and least among those with plastic surgery conditions. The observed factors associated with mortality were time of presentation (early or late), type of surgery (emergency or elective), category of surgery (general surgery or others), American Society of Anesthesiologists (ASA) score (high or low), place of admission after surgery (intensive care unit or general ward), level of training of doctors who performed the surgery (specialist or general duty doctor) (P < 0.05). The POMR was higher in male patients and in those with general surgery emergencies compared to other conditions. Delayed presentation, high ASA scores, and operations performed under emergency set-ups were associated with elevated POMRs.

Determinants of Intermittent Preventive Malaria Therapy Among Pregnant Women in A Nigerian Teaching Hospital

Background: Intermittent Preventive Treatment of malaria in Pregnancy (IPTp) is mostly issued in most antenatal clinics across the country but there have been reports of poor utilization of this prophylaxis. Objective: This study assessed the determinants of IPTp among pregnant women attending a tertiary hospital in southeast Nigeria. Methods: The study was a descriptive cross-sectional study in which a self-administered questionnaire was distributed to 250 pregnant women receiving antenatal care in the study hospital. The data collected were analyzed with the aid of SPSS, using descriptive and inferential statistics. A p-value of less than 0.05 was considered significant. Results: A majority of the participants responded positively to most of the factors assessed, however, none was statistically significant. Conclusion: Based on these findings, pregnant women at a tertiary hospital in southeast Nigeria are aware of IPTp, nevertheless, most fail to commence the medication at the correct time.

Evaluation of Analgesics Prescription Pattern and Surgical Patients' Responses in Tertiary Hospitals in Southeast Nigeria

Background: Adequate analgesics help the patients to recover quickly from surgery with less discomfort and pain. It helps the patient breathe well, cough, turn and ambulate early to enable quick recovery. Inadequate prescribed analgesic delays recovery and leads to postoperative complications. Despite documented evidence that adequate pain control helps in the quick recovery of surgical patients, it has been reported that doctors' prescriptions of analgesics for postoperative patients are inadequate for the level of pain experienced by the patients. This informed the establishment of pain medication prescription standards by accrediting agencies in some developed countries. Nigeria has no binding standards, and patients' postoperative pain is managed by what doctors and nurses deem adequate. It has been reported that the patients' pain medication needs in Nigeria are unmet. The study, therefore, seeks to evaluate the postoperative analgesics prescription pattern and patients' responses in three tertiary hospitals in Southeast Nigeria. Objective: The study's main purpose was to evaluate the pattern of postoperative prescription of analgesics and surgical patient response to these drugs in tertiary hospitals in Southeast Nigeria. Method: A descriptive cross-sectional survey research design was used for the study. Study sample was 120 surgical patients selected equally from three randomly selected tertiary hospitals from the five States in Southeast Zone. Questionnaire and checklist were the instruments used for data collection in the study. The instrument's reliability was tested using the split-half technique and was analyzed using Spearman's rank-order correlation coefficient, which yielded a value of 0.85. All the hypotheses were tested at 0.05 level of significance. Results: The results show that drugs commonly prescribed by doctors for pain relief were pentazocine, paracetamol, diclofenac, and tramadol. The prescriptions were done mainly by Surgeons and Resident doctors. There was agreement on the pattern of prescription of analgesics by Surgeons in the southeast Nigerian hospitals. The results also show that there is a significant difference (p&lt;0.05) in the mean patients' responses to the prescribed analgesics but found no significant difference (p&gt;0.05) in pain prescription by doctors in the management of surgical patients in tertiary hospitals in Southeast Nigeria. Patients reported experiencing severe pains (41.7%) on the first, moderate pains (45.8%) on the second day, and mild pain (25%) on the third day after surgery. Conclusion: It was concluded that there is no significant difference in the pattern of the prescribed pain relief drugs and their dosages among surgeons from different tertiary hospitals. The patients' responses showed that the prescription pattern does not lead to good pain control in the first three days post-surgery. Recommendation: It was recommended that doctors review their prescription pattern for surgical patients, particularly within the first 72 hours after surgery when the pain is at its peak. Nurses should apply non-pharmacological pain management methods within this period to improve the comfort of the surgical patients.

Histopathological spectrum of skin lesions in the elderly: Experience from a tertiary hospital in Southeast Nigeria

Background: There are only a few epidemiological studies published on skin disorders in the elderly within the Nigerian context and none from the Southeast Region of the country. In addition, none of these studies has considered the pattern and frequency of histopathologically diagnosed geriatric skin lesions. Hence, we attempted to determine the frequency as well as the age and gender distributions of histologically diagnosed dermatological diseases in geriatric population from skin biopsies submitted to the histopathology department of a tertiary care hospital in Southeast Nigeria. Materials and Methods: This is a cross-sectional retrospective hospital-based study involving all skin biopsies of patients 60 years and above, received at the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2004 to December 2019. Results: During the study period, 751 skin biopsies were received in the histopathology department. Of these, 142 were from patients who were older than 60 years. Thus, the overall share of geriatric patients was 18.9%. The mean age at presentation was 71.1 ± 8.6 years. The M: F was 1:1, and most of the patients belonged to the age group of 60–69 years (69 cases, 48.6%). The mean age of the male patients was 72.1 ± 9.5 years. In the female patients, it was 70.1 ± 7.5 years. The most common disease category was neoplasms (91, 64.1%). Most neoplasms were malignant. There were 67/142 (47.2%) malignant lesions. The most common was Squamous cell carcinoma (SCC) (30 cases) which is 21.1% of all geriatric skin biopsies and 44.8% of malignant skin biopsies. This is closely followed by melanoma (29 cases). Conclusion: Malignant neoplasms, benign neoplasms, and papulosquamous disorders are the three most common histologically diagnosed skin lesions in our geriatric population. The most common skin malignancies in this group of patients are SCC and malignant melanoma.

The prevalence of stillbirths and the probable causes in low resource settings in south-east Nigeria

Background: Stillbirth is a devastating pregnancy outcome, with resultant emotional and psychological trauma to the affected family. Objectives: We investigated the prevalence and probable causes of stillbirths in four tertiary hospitals in south-east Nigeria. Materials and Methods: A 5-year multicenter, retrospective descriptive study of all stillbirths delivered in the hospitals from January 2013 to December 2017 was done. Using an already prepared proforma, the sociodemographic characteristics of the mothers and the probable causes of deaths were retrieved from their case files. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS), version 20. A P-value less than 0.05 was considered statistically significant. Results: There were 23,101 deliveries within the study period and 1,294 stillbirths giving a stillbirth rate (SBR) of 56.1/1,000 deliveries. More than half (58.7%) of them were intrapartum. More than half of the stillbirths were preterm delivery (58.5%). The commonest probable cause of macerated stillbirth was hypertensive disorders of pregnancy (32.4%). Conclusion: The overall SBR was 56.1 per 1000 deliveries. This is higher than 42.9 per 1000 deliveries previously reported in Nigeria. There is an urgent need to improve the quality of antenatal and intrapartum care, if we hope to achieve a significant reduction of the SBR in the region.