Niger Delta University Teaching Hospital Research Articles

Mental health well -being of Frontline Health Care Professionals (FHCP) managing Covid-19 cases in two selected tertiary hospitals in Bayelsa and Edo States, Nigeria

This study investigated the mental health well-being of frontline health care professionals managing COVID-19 cases in two selected tertiary hospitals in Bayelsa and Edo States. The descriptive analytical survey design was adopted. The population of this study comprises of all health care professionals managing COVID -19 cases in Bayelsa and Edo States. The purposive sampling technique was utilized to sample 181 respondents made up of 39 from Niger Delta University Teaching Hospital (NDUTH) Okolobiri, Bayelsa and 142 from Irrua Specialist Hospital, Edo State. The instrument for data collection is a questionnaire titled “Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and New Well-being Measure Tools adapted by the researchers”. The responses were structured into Likert four-point scale of Every time (ET), Often (O), Rarely (R) and Never (N). The instrument was validated by the researchers and other experts. The reliability of the instrument was ascertained using the Cronbach alpha statistic to obtain a reliability coefficient of 0.87. One research question was raised and three hypotheses formulated to guide the direction of this study. The ethical clearance was obtained from relevant authorities. The data collected were analyzed using descriptive statistics of mean, standard deviation, bar chart and inferential statistics of t-test, and One-way analysis of variance. The study found among others that participants in Bayelsa and Edo States have a negative mental health well-being in managing COVID 19 cases. It was concluded amongst others the need for training and re-training of health care professionals, incentives and allowances be given to health care professionals, etc.

Hypertension and Type 2 Diabetes Mellitus Secondary to Acromegaly, A Rare Endocrine Disease: A Case Report

Background: Acromegaly is a rare endocrine disorder that emanates from excessive release of growth hormone leading to the production of insulin-like growth factor I (IGF-I) which causes most of the clinical features of the disease. Methods: A case report study of Acromegaly that presented in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. Results: Random Blood Sugar -25mmol/dl, Fasting Blood Sugar-17.8mmol/dl, HbAIc-13.0%, Prolactin-6.64ng/ml, Cortisol- 12.5ug/dl, FSH-0.20Miu/ml, Testosterone-0.35ng/ml, TSH-1.26Uiu/ml, Growth Hormone; Insulin-like Growth Factor 1->1600ng (115-307). Her Blood Pressure was 180/120 mmHg. Heart sounds were S4, 1 and 2.Echocardiogram revealed concentric LVH, no regional wall motion abnormality. Perimetry showed inferior nasal defect of the Left eye. Conclusion: This case report reiterates the need for more health education and public enlightenment on clinical entities such as Acromegaly, with an emphasis on debunking some of the myths and social stigma associated with this chronic progressive disfiguring and disabling disease in our environment.

Prevalence of Kidney impairment and its associated factors among HIV-infected antiretroviral treatment-naïve adult patients in Bayelsa State, Nigeria

Objective: The study aimed to determine the prevalence of kidney impairment (KI) and associated factors among HIV antiretroviral treatment (ART) - naïve patients in Bayelsa State in the Niger Delta area of Nigeria. Methodology: A retrospective study was carried out in the Niger Delta University Teaching Hospital (NDUTH) using case notes of patients who presented from 2011 – 2020. Socio-demographic, clinical, and laboratory data were retrieved. The Chronic Kidney Disease (CKD) Epidemiology (EPI) Collaboration formula and Cockcroft Gault equation were used in estimating the glomerular filtration rate (eGFR) and creatinine clearance (CrCl) respectively. KI was defined as eGFR < 60 mls/min. Results: The prevalence of KI was 13.8%. Up to 59.5 % had CrCl below 90mls/min. KI showed significant association with age >45 years, married status, presence of co-morbidity, and high HIV RNA load. However, only age was independently associated with KI {AOR 3.4{CI 1.2- 9.6 p = 0.018)}. Conclusion: The prevalence of KI was 13.8% while up to 50.5% had reduced CrCl. Age < 45 years was the only determinant of KI though ‘being married’, having co-morbidities and high viral load also showed significant association. There is a need for regular assessment of renal function in HIV- infected patients.

Immunohistochemical Characterization of Genes Expressed in Leiomyoma using Ki67 and P53 in Patient Attending Niger Delta University Teaching Hospital

Objectives: This study aimed to investigate the expressions of p53 and ki67 genes in the characterization of leiomyomas.
 Materials: Fifty (50) Paraffin embedded tissue blocks were selected from the department of Histopathology, Niger Delta University Teaching Hospital, Okolobri from January 2011 to August 2019. The histological characterization and morphological evaluation were defined using the routine Hematoxylin and Eosin staining method. Immunostaining was done for p53 and ki67 using the manufacturers antibodies.
 Results: A direct correlation between age and the expression of the p53 gene was also made in this study. It was observed that in patients within the ages of 50-59 and 60-69, there was markedly no expression of the p53 gene whereas in patients within the ages of 20-29, there was still some level of expression (20%) and ages 30-39 (80%) and finally 40-49 (10%). There was no expression (0.0%) of Ki-67 in uterine leiomyomas across all age groups.
 Conclusion; This study therefore has suggested that based on the percentage of expression, it can rightly be inferred that the p53 gene is a good indicator in the immune-histochemical characterization of leiomyomas as it has good sensitivity and good prognosis as opposed to Ki67.

Morbidity patterns among medical admissions at Niger Delta University Teaching Hospital, Bayelsa State, Nigeria

Hospital statistics on morbidity and mortality are essential in assessing disease burden, evaluation of health policies and health planning. The study aimed to determine the morbidity pattern and short-term outcome among medical admissions in the Niger Delta University Teaching Hospital (NDUTH), Bayelsa State, Nigeria. This retrospective 7-years disease audit was carried out in the medical wards of NDUTH, Bayelsa State, Nigeria. Information extracted included name and gender of patients, diagnoses and disease outcomes. One thousand, one hundred and twenty five (60.5%) females and seven hundred and thirty three (39.5%) males had complete records and were therefore used for the analysis. The mean age of the patients was 50.14±16.66 years with males being older (p<0.001). Non-Communicable Diseases (NCDs) accounted for a majority of cases (1270; 68.4%) while 588 (31.6%) were Communicable Diseases (CDs) NCDs were more prevalent among males and older individuals (p<0.03; p<0.001) and showed a rising trend over the years. CDs were however the leading cause of morbidities among females. The commonest diagnoses among males were retroviral disease, stroke, heart failure, pulmonary tuberculosis, diabetes and renal disease with women showing a similar trend except that heart failure replaced stroke as the second commonest morbidity while stroke came third, followed by diabetes, renal disease and hypertension. The all-cause mortality rates were 10.6% and 15.9% for females and males respectively. The major causes of mortality were infectious diseases and circulatory disorders for both genders. About 6.4% males and 3.8% females Left Against Medical Advice (LAMA). The pattern shows a rising prevalence of NCDs. Although CDs witnessed some decline, it however remained prevalent. The mortality rate was high while a good proportion LAMA. There is a need for strategic health programs to address this increasing tide of NCDs in our society, control CDs, and improve patient care while reducing mortality.

Patterns of spirometry findings among patients with suspected lower airway obstruction in a tertiary hospital, South-South, Nigeria

Objectives: The respiratory system consists of the upper airway and the lower airway. Although, the airway sub-serves several functions, the most important functions of the airway are ventilation and gas exchange. Lower airway obstruction by diseases such as Asthma and COPD may impair airway function. Spirometry is a useful tool in the assessment of airway function. We aim to describe the observed patterns of spirometry findings among patients with suspected lower airway obstruction at the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, South-South Nigeria.
 Methods: Across-sectional study. Records of spirometry values were used to assess spirometry patterns. IBM SPSS software was used to analyze data.
 Results: Spirometry records of a total 100 patients were analysed. Mean age was 48.90 ± 19.77 years. There were 59% males and 41% of females. Spirometry patterns were: normal-59%; obstructive-39%; restrictive-1%; mixed-1%.
 Conclusion: Spirometry is a useful non-invasive tool in the diagnosis of respiratory diseases, and recommended for patient evaluation in every tertiary hospital in Nigeria.
 Keywords: Spirometry pattern, airway obstruction, asthma, COPD

UreC and ZapA virulence genes amplification in clinical specimen of Proteus mirabilis in Bayelsa state, Nigeria

Background and objective: Proteus mirabilis is part of the Enterobacteriaceae family, Gram negative bacterium which typically lives in the human gut, which means when it causes illness it can be a serious bloodstream infection, urinary tract infection or disseminated infection. UreC and ZapA virulent genes constitute the major pathogenicity of this organism as well as its resistance to antibiotics. This study was carried out to detect the presence of UreC and ZapA genes in Proteus mirabilis isolates sourced from Federal Medical Centre and Niger Delta University teaching hospital in Bayelsa State. Materials and methods: A total of one hundred and forty (140) clinical samples were collected from Federal Medical Centre (FMC) Yenagoa and Niger Delta University Teaching Hospital (NDUTH) Okolobiri, Bayelsa State. Of the 140 samples collected, 64(45.7%) were from males while 76(54.3%) were from females. The samples were Urine, Sputum, High vaginal swab, Urethral swab, Ear swab and Wound swab. The samples were inoculated in different laboratory media and incubated at 37°C for 48 hours. Morphological, cultural, biochemical characteristics and Polymerase Chain Reaction (PCR) technique were noted appropriately. Means and corresponding standard deviations were calculated for continuous data while proportions, along with the 95% confidence intervals, were calculated for categorical data. Results: A total of 81 bacterial isolates were obtained from these samples, of which 17(20.9%), 22(27.2%), 8(10.0%), 10(12.3%) and 24(29.6%) were Proteus mirabilis, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus respectively. Fifteen (15) out of the 17(20.9%) P. mirabilis isolates were subjected to single-plex PCR amplification using specific primers after extraction of bacterial DNA from the samples. Out of the 15 samples, 14(93.3%) were positive for UreC gene while 15(100%) were positive to ZapA gene. Conclusion: The present study revealed that virulent genes-UreC and ZapA are highly present in P. mirabilis isolates obtained from clinical specimens from FMC and NDUTH in Bayelsa state, thus making them more pathogenic and resistant to antibiotics curing effect.

Influence of ABO and Rhesus Blood Group on Blood Pressure and Hypertension in Bayelsa State

Aim: This present study was carried out to ascertain the influences of ABO and Rhesus blood groups on blood pressure and hypertension among normotensive and hypertensive patients attending cardiologic clinic in Niger delta University Teaching Hospital, Okolobiri in Yenagoa Local Government Area of Bayelsa State Nigeria.
 Study Design: Cross sectional study design was adopted.
 Place and Duration of Study: The study was carried out in the Cardiology Clinics in the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, Bayelsa State, from February 2020 to November 2020.
 Methodology: This study was carried out on 800 participants, consisting of 400 each of apparently healthy Normotensive and Hypertensive individuals. The blood pressures were determined using palpatory and auscultatory (stethoscope and sphygmomanometer) method in both control and hypertensive groups and their ABO and Rhesus blood groups were determined using the slide haemagglutination technique. Statistical analysis was done using SPSS statistical software to perform Chi-square test.
 Results: The frequency of the various blood groups was A-20.0%, B-16.8%, AB-13.3% and O-50.0% for the normotensive individuals and A-12.0%, B-15.5%, AB-17.8% and O-54.8%, for the hypertensive individuals. The frequency of ABO blood groups in both the normotensive and hypertensive group was therefore found to be O>B>A>AB. The prevalence of blood group O and rhesus O-ve was found to be associated with elevated blood pressure and the development of hypertension while prevalence of blood group AB was found to be lowest in the same group, but was not significant statistically (p>0.05). There was no significant difference between systolic and diastolic blood pressure of different blood groups.
 Conclusion: Blood group O was found to be the most common blood group in our study. Blood group O- was also found to be more prone to hypertension. However, there was no statistically significant association between ABO blood groups and Hypertension.

Demographic Predictors of Gestational Age at Delivery among Women of Ijaw Tribe in Bayelsa State, in the Niger Delta Region in Nigeria

Background: Though most pregnant women tend to deliver around their expected date of confinement, quite a significant number deliver preterm and postterm. The variation of delivery timing can result from obstetrics complications, genetic or demographic factors.
 Objective: The objective of this study is to determine the influence of demographic factors of pregnant Ijaw women on gestational age at delivery, like: maternal age, parity, occupation, educational level, gestational age at booking, maternal height, and body mass index, on gestational age at delivery. It also intends to determine the effects of birth weight and fetal sex.
 Materials and Methods: It was an observational cross-sectional study of 1484 booked pregnant women of Ijaw ethnic group, who delivered in the labour ward of the Niger Delta University Teaching Hospital. Their case notes were retrieved and relevant information such as maternal age, parity, educational level, and occupation was obtained. Others include maternal height and weight at booking, gestational age at booking, gestational age at delivery and birth weight. Body mass index was calculated from height and weight and categorized. Data was analyzed with Chi square, Pearson’s correlation coefficient, simple linear regression, and multivariate analysis
 Results: The prevalence of preterm birth (PTB) among Ijaw women was 9.7%, and the prevalence of PTB was significantly associated with underweight, Odd ratio = 7.79[3.12, 19.50], low educational level, Odd ratio =2.27[1.40, 3.68], and late booking for antenatal care P = 0.004. Delivery postterm was significantly associated with class 1 obesity, Odd ratio =16.0[4, 59, 55.8], and delivery of male babies Odds ratio = 6.76[2.41, 18.96].
 Demographic factors from multivariate analysis could only account for 15.9% of the factors responsible for gestational age at delivery, of which the most important were birth weight, educational level and maternal height at booking.
 Conclusion: Though maternal and fetal demographic factors significantly affects birth weight, the bulk of the determinants (84.1%) are outside these factors, and it could be from obstetrics, genetic, or other factors.

Pulmonary Hypertension in Apparently Healthy Children in Southern Nigeria.

To determine the severity and prevalence of pulmonary hypertension and its relationship with age and body mass index (BMI) in healthy children. Observational study. University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Lagos State University Teaching Hospital, Niger Delta University Teaching Hospital, Bayelsa and Blessed Children Hospital Enugu from January 2010 to December 2019. Four hundred and seventy (470) apparently healthy children aged 1 to 17 years underwent Doppler echocardiographic studies. Their tricuspid regurgitation velocity (TRV) was measured with continuous wave Doppler. Pulmonary artery systolic pressure (PASP) was estimated using the Bernoulli equation. Elevated PASP were determined at PASP ≥35/mmHg. Values were compared against age and BMI. The mean age was 7.9 ± 3.3 years. Four hundred and fifty-nine subjects (97.7%) had normal PASP while 11 (2.3%) had elevated PASP. Those with elevated PASP had a significantly higher mean TRV of 2.7 ± 0.22 cm/s (95% CI; 2.55-2.85) vs TRV of 1.56 ± 0.43cm/s (95% CI; 1.52-1.60) and higher mean PASP of 39.27±4.89 mmHg (95% CI; 35.99-42.56) vs 20.45 ± 5.34 mHg (95% CI; 19.96-20.94) (p=0.001). Though majority of the children had appropriate weight for ages, those with elevated PASP had a significantly greater weight than those with normal PASP (p<0.001). There was a weak positive correlation of PASP with age (r=0.16) and BMI in normal weight (r=0.08). Obese children had a negative correlation value(r=-0.13). A weak negative correlation of PASP with BMI was seen in underweight (r=-0.17 and overweight (r=-0.73) children (p>0.05). The mean pulmonary artery systolic pressure in the studied apparently healthy Nigerian children was 20.45± 5.34/ mmHg. The frequency of elevated PASP was 2.3%, commoner in children with higher BMI. Age and body mass index are not optimal predictors of PASP. Key Words: Pulmonary artery systolic pressure, Children, Pulmonary hypertension, Echocardiography.

Knowledge, attitude and practice towards COVID-19 among workers of a tertiary hospital in Bayelsa State, Nigeria.

coronavirus disease (COVID-19) has since assumed pandemic dimensions with over 14million persons affected in 213 countries and territories worldwide as at mid-July 2020. The level of awareness and knowledge of the disease as well as the related attitude and practice amongst hospital workers could determine its extent of control. The aim of this study was to determine the knowledge, attitude and practices amongst hospital staff regarding COVID-19. this cross-sectional study was conducted among staff of the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. A self-administered semi-structured questionnaire was adapted in assessing their knowledge, attitude and practice towards COVID-19. one hundred and twenty four respondents completed the study with a mean age of 30.9 ± 6.5 years. Up to 90% of them demonstrated good knowledge of COVID-19 with regard to preventive and control measures. Approximately 90% of them practiced good hand hygiene though a lesser proportion wore face masks (51.6%) and practiced crowd avoidance (58.1%). Medical doctors had a marginally higher practice score compared with "others" (p = 0,047). Up to 98(79.0%) of respondents were scared of self-infection and 99(79.8%) were not motivated to work due to inadequate facilities, equipment and resources in 50% of cases. Knowledge of COVID-19 was positively correlated with the practices of the participants (p = 0.023). the hospital staff lacked adequate motivation towards management of COVID-19 and were constrained for the fear of self- infection, inadequate equipment, resources and equipment despite possessing a good knowledge of the disease. There is need for concerted efforts by stakeholders in the health care industry to ensure hospital workers are adequately motivated and provided with the needed risk protection devices and resources during this pandemic.

Knowledge, attitude and practice towards COVID-19 among workers of a tertiary hospital in Bayelsa State, Nigeria

Introductioncoronavirus disease (COVID-19) has since assumed pandemic dimensions with over 14million persons affected in 213 countries and territories worldwide as at mid-July 2020. The level of awareness and knowledge of the disease as well as the related attitude and practice amongst hospital workers could determine its extent of control. The aim of this study was to determine the knowledge, attitude and practices amongst hospital staff regarding COVID-19.Methodsthis cross-sectional study was conducted among staff of the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. A self-administered semi-structured questionnaire was adapted in assessing their knowledge, attitude and practice towards COVID-19.Resultsone hundred and twenty four respondents completed the study with a mean age of 30.9 ± 6.5 years. Up to 90% of them demonstrated good knowledge of COVID-19 with regard to preventive and control measures. Approximately 90% of them practiced good hand hygiene though a lesser proportion wore face masks (51.6%) and practiced crowd avoidance (58.1%). Medical doctors had a marginally higher practice score compared with “others” (p = 0,047). Up to 98(79.0%) of respondents were scared of self-infection and 99(79.8%) were not motivated to work due to inadequate facilities, equipment and resources in 50% of cases. Knowledge of COVID-19 was positively correlated with the practices of the participants (p = 0.023).Conclusionthe hospital staff lacked adequate motivation towards management of COVID-19 and were constrained for the fear of self- infection, inadequate equipment, resources and equipment despite possessing a good knowledge of the disease. There is need for concerted efforts by stakeholders in the health care industry to ensure hospital workers are adequately motivated and provided with the needed risk protection devices and resources during this pandemic.

Pattern of Structural Heart Disease and Predictors of Mortality Among Affected Children Seen at the Niger Delta University Teaching Hospital Bayelsa State

Paediatric structural heart diseases are an important cause of morbidity and mortality especially in developing countries where late presentation and delayed diagnosis and treatment is common. The aim of this study was to describe the pattern of structural heart diseases in children seen in the Paediatric Cardiology Unit of a tertiary hospital in Bayelsa State Nigeria and identify the predictors of mortality among those who died over the study period. It was a retrospective review of cases seen in the paediatric cardiology unit and subsequently followed up over a 7-year period (1^st April 2013 to 31^st March 2020). Sociodemographic data, clinical features and echocardiographic findings as well as details of their outcome were documented. Data was imputed into an Excel spread sheet and analyzed using SPSS 22.0. Binary logistic regression was performed to determine the risk factors for mortality. Of the 175 children seen by the Cardiology Unit over the study period, 92 (52.6%) had structural heart diseases. The mean age of the children was 39.4±56.2 months with a male: female ratio of 1.6:1. Congenital heart diseases (CHD) were noted in 92% of cases with Atrial septal defects (ASD), followed by Ventricular Septal defects (VSD) and Patent Ductus Arteriosus (PDA) being the most prevalent CHD seen. The combination of ASD/VSD/PDA was the most common multiple structural defect noted. Acquired heart diseases including Rheumatic heart disease and Dilated cardiomyopathy were reported in 8% of cases. Mortalities were recorded in 20 children (21.7%) with most of the deaths occurring as a result of intractable heart failure. Mortality was significantly associated with the third birth order (OR-4.63; p-0.021), fast breathing (OR-2.15; p-0.006), presence of heart failure (OR-3.16; p-0.026), failure to thrive (OR-2.93; p-0.036), use of cardiac medications (OR-6.91; 0.0013) and CHD with multiple structural defects (OR-11.44; p-0.006).

Understanding non-compliance with surgical antibiotic prophylaxis prescribing guidance, in Nigeria

Abstract Background Antimicrobial Resistance is a prominent worldwide threat that is increasing in low-to-middle income countries. Good antibiotic stewardship (AMS) improves compliance with evidence-based antimicrobial prescribing guidelines but just 4% of LMICs have national AMS initiatives in place and only 15% have national policies. As high as 20-50% of surgical antibiotic prophylaxis prescription in Nigeria is thought to be non-compliant. Behaviour change theories can structure our understanding of why poor compliance occurs and can facilitate development of effective interventions to improve it. Methods The Theoretical Domains Framework (TDF; Michie et al. 2009) was used to develop an online survey and interview schedule for focus group discussions. Audio recordings were transcribed and analysed by two researchers using thematic analysis, TDF and the COM-B model of behaviour change (Michie et al. 2010). Results 60 surgeons (59% male; 43% surgical consultant; 5-10 yrs experience) from Lagos University Teaching Hospital, Lagos University College of Medicine and Niger Delta University Teaching Hospital completed the survey. A sub-group of 14 surgeons (79% male; 86% surgical consultant; 10-15 yrs experience) participated in three focus groups. Whilst compliance with guidance was generally considered desirable, surgeons reported translating guidance to Nigerian practice and context was often difficult, time-consuming and restricted by not having access to recommended antibiotics. Conclusions Behaviour change theory can be used to further our understanding of key barriers and facilitators to non-compliance with surgical antibiotic prophylaxis prescribing guidance, amongst surgeons in Nigeria. This presentation will conclude with discussion of how findings from this project are being used to develop a cost-effective, scalable, decision-support smartphone app for prescribing behaviour change. Key messages Behaviour change theory can be used effectively to further understanding of barriers and facilitators to Nigerian surgeons’ non-compliance with surgical antibiotic prophylaxis prescribing guidance. We must form a comprehensive understanding of factors (social &amp; environmental) driving non-compliant attitudes and behaviours, before creating interventions to change prescribing behaviour.

Neonatal tetanus surveillance in Bayelsa state of Nigeria: a five-year review

ObjectiveTo assess the performance of neonatal tetanus surveillance in Bayelsa state of Nigeria.IntroductionNeonatal tetanus (NT) though a preventable disease, remains a disturbing cause of neonatal morbidity and mortality particularly in low income countries where maternal and child care are substandard and antitetanus immunization coverage is still poor. The disease, which is mostly fatal, is particularly common in hard to reach and rural areas where deliveries take place at home or with untrained attendants without adequate sterile procedures and in unclean environment. Since eliminating NT became a global target, significant reductions in NT deaths have been reported. The most recent estimates by WHO (2015) put death of newborns due to NT at 34,019, a 96% reduction from the situation in the late 1980s.All countries are committed to “elimination” of maternal and neonatal tetanus (MNT), i.e., a reduction of NT incidence to below one case per 1000 live births per year in every district. A strong neonatal tetanus surveillance (NTS) is however required to achieve this. As of March 2018, only 14 countries were yet to eliminate MNT and this includes Nigeria.The different types of NTS recommended are conducted to varying degrees of efficiency and effectiveness in Nigeria under the major surveillance strategy – the Integrated Disease Surveillance and Response (IDSR). These include routine monthly surveillance, zero reporting, active surveillance and retrospective record review.Nigeria comprises six geopolitical zones, 36 states and a Federal Capital territory (FCT), and is made up of 774 Local Government areas (LGA) (districts) – an LGA being the lowest administrative level. This study was conducted in Bayelsa state – one of the six states in the south zone. It is made up of eight LGAs, more than half of which are riverine and consists of many hard-to-reach communities, where formal functional health facilities are few and far between. Health workers are in short supply and funding of health care delivery is poor in the state.MethodsThis was a retrospective review of all confirmed cases of neonatal tetanus that were managed at the two tertiary hospitals in the state - Niger Delta University Teaching Hospital Okolobiri (NDUTH), and Federal Medical Centre Yenagoa (FMC) - between January 2009 and December 2013. These were the only two public facilities that had the capacity to manage NT cases in the state. Relevant data including sociodemographics, pregnancy and birth history of patients, cord care and tetanus toxoid immunization of mothers were abstracted from the case files. The cases were traced to the office of the State Epidemiologist, where all cases were expected to be documented and investigated in line with the existing neonatal tetanus surveillance. Ethical approval was obtained from the Research and Ethics Committee of NDUTH for the research and permission was given to access case files.ResultsA total of 48 cases were managed in both facilities (36/75.0% in NDUTH and 12/25.0% in FMC) in the period under review but only 13 cases (27.1%) were reported to the office of the State Epidemiologist. Figure 1 shows the number of cases per year of review. The cases were resident in seven out of the eight LGAs. The mean age of cases was 8.98 (SD = 5.14) days and 29 (60.4%) were male while 19 (39.6%) were female. Available evidence showed that only 2.1% of the cases were protected at birth (mothers had TT2+); 91.7% of mothers did not have antenatal care and all the mothers were delivered by traditional birth attendants; 70.8% had their umbilical cord cut with new (?sterile) blade; and 43.8% had their cord treated with methylated spirit, others were treated with just water or some herbal preparation. Educational attainment of mothers of cases was primary (54.2%) and secondary (45.8%).ConclusionsThere were gaps in Neonatal Tetanus Surveillance in Bayelsa State as only 27.1% of cases were captured at the state level. Many mothers and their newborns were still not protected against tetanus, and delivery and cord care were done in unhygienic conditions. There is an urgent need to strengthen NT surveillance, improve vaccination against tetanus, and encourage skilled birth attendance in the state.

Fetal Umblical Artery Doppler Indices in Healthy Pregnant Women in Yenagoa, Nigeria.

Introduction: The measurement of fetal umbilical blood flow using Doppler ultrasound is a well-established tool in the management of high-risk pregnancies and has resulted in improved outcome. However, there is paucity of data concerning the normal parameters in Nigeria. This study is aimed at assessing the fetal umbilical artery indices in pregnant Nigerian women. Methods: This was a cross sectional prospective study carried out at the Niger delta university teaching hospital, silhouette radio diagnostic consultants Yenagoa and federal medical centre. A total of 400 pregnant women between the gestational ages of 20 – 40 weeks were evaluated within a one-year period using a 2014 Philips HD 11 ultrasound machine equipped with a 3.5Mhz curvilinear probe having colour, pulsed wave and power Doppler facilities. Results: The mean age and BMI were 30 ± 6 years and 29.9±5.76 kg/m2 respectively while the mean umbilical artery systolic velocity and end diastolic velocities were 40.07± 8.99m/s and 17.44±6.37m respectively. The mean resistivity index (RI) is 0.57. There was a negative correlation of RI with Gestational age (P&lt;0.05). Conclusion: Fetal umbilical artery Doppler parameters are essential tool in management of high-risk pregnancies and has resulted in an improved outcome. This study is to serve as a baseline for further studies with a larger sample size.&#x0D; Keywords: Fetal; Umbilical; Artery; Doppler; Pregnancies.

The 2017 human monkeypox outbreak in Nigeria-Report of outbreak experience and response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria.

BackgroundIn September 2017, Nigeria experienced a large outbreak of human monkeypox (HMPX). In this study, we report the outbreak experience and response in the Niger Delta University Teaching Hospital (NDUTH), Bayelsa state, where the index case and majority of suspected cases were reported.MethodsIn a cross-sectional study between September 25th and 31st December 2017, we reviewed the clinical and laboratory characteristics of all suspected and confirmed cases of HMPX seen at the NDUTH and appraised the plans, activities and challenges of the hospital in response to the outbreak based on documented observations of the hospital’s infection control committee (IPC). Monkeypox cases were defined using the interim national guidelines as provided by the Nigerian Centre for Disease Control (NCDC).ResultsOf 38 suspected cases of HMPX, 18(47.4%) were laboratory confirmed, 3(7.9%) were probable, while 17 (18.4%) did not fit the case definition for HMPX. Majority of the confirmed/probable cases were adults (80.9%) and males (80.9%). There was concomitant chicken pox, syphilis and HIV-1 infections in two confirmed cases and a case of nosocomial infection in one healthcare worker (HCW). The hospital established a make-shift isolation ward for case management, constituted a HMPX response team and provided IPC resources. At the outset, some HCWs were reluctant to participate in the outbreak and others avoided suspected patients. Some patients and their family members experienced stigma and discrimination and there were cases of refusal of isolation. Repeated trainings and collaborative efforts by all stakeholders addressed some of these challenges and eventually led to successful containment of the outbreak.ConclusionWhile the 2017 outbreak of human monkeypox in Nigeria was contained, our report reveals gaps in outbreak response that could serve as lessons to other hospitals to strengthen epidemic preparedness and response activities in the hospital setting.

The Determinants of Hospital Delivery among Booked Parturient in a Tertiary Health Facility in South-South Region of Nigeria: Situation Analysis of the Niger Delta University Teaching Hospital

The Determinants of Hospital Delivery among Booked Parturient in a Tertiary Health Facility in South-South Region of Nigeria: Situation Analysis of the Niger Delta University Teaching Hospital

Predictors of cephalopelvic disproportion in labour a tertiary hospital in Bayelsa State, Nigeria

Background: Cephalopelvic disproportion (CPD) is a disparity between the fetal head and maternal pelvis, usually in the absence of fetal or maternal jeopardy. It is a very common complication during labour, and it is associated with a very high caesarean section rate. Delay in intervention could lead to obstructed labour. Short stature, fetal macrosomia and pelvic abnormalities are common risk factors. The aim of this study was to determine the influence of maternal height, age, clinical pelvimetry, and birth weight on cephalopelvic disproportion in the Niger Delta University Teaching Hospital, Bayelsa State. Materials and Methods: This is a retrospective case controlled analysis of 5,205 parturients who received antenatal care, and delivered at the Niger Delta University Teaching Hospital, from January 2010 to December 2015. Of these, 588 patients who had cephalopelvic disproportion were identified. Data concerning their maternal age, parity, height, pelvimetry, gestational age at delivery, and fetal demographic characteristics were collected and analyzed. This was compared to a control group of 588 parturients who were randomly selected among parturients who had spontaneous vaginal delivery (SVD) during the study period. Results: A total of 5,205 women delivered during the period of study, out of these, 588 women had cephalopelvic disproportion, giving a rate of 11.3%. Majority of the women who had CPD were nulliparous (47.6%). Women who were 150.0 cm tall or less were 3 times more likely to have cephalopelvic disproportion in labour than those who were over 150.0cm tall. P = 0.001, Odds Ratio = 3.69 [CI, 2.49 -5.47]. Women who delivered babies with birth weight ≥ 4000 grams had significantly more cephalopelvic disproportion, than those who delivered babies with birth weights of 2501 – 3999 grams. Odds Ratio = 0.22, p = 0.001 [CI, 0.14 -0.33]. There is a significant negative correlation between maternal height and parity with cephalopelvic disproportion. [r = -295, p = 0.001] and [r = -197, p = 0.001] respectively. There is also a significant positive correlation between birth weight and gestational age at deliverywith CPD [r = 0.24, p = 0.001] and [r = 0.149, p = 0.001]. Linear regression analysis of the independent variables reveal that maternal height was the biggest predictor to CPD. Coefficient of determination R2 = 0.089(8.9%), F= 112.2, p = 0.001. Conclusion: Short stature is independently associated with an increased risk of intrapartum caesarean section in Nigerian women. We advocate for an early recourse to caesarean section to avoid undue morbidity.

Implications of Silence in the Face of Child Sexual Abuse: Observations from Yenagoa, Nigeria.

Child sexual abuse (CSA) is common globally but underreported. It has far-reaching physical, social, and mental health effects and often the victims suffer in silence because of the shame and stigma associated with the experience. Despite international and country specific legislation to protect children and punish offenders, CSA thrives and sometimes leads to the death of victims. We report two cases of children aged 7 and 8 who presented at Niger Delta University Teaching Hospital Bayelsa, Nigeria. In both cases, the offender was known to the victim's parents who did not only refuse to report the cases to law enforcement agents but also discontinued medical follow-up for the children. These cases highlight that in cases of CSA, parents and families often prefer silence rather than confronting offenders or reporting incidents to law enforcement agencies. This choice of inaction only promotes the ill. It is essential that laws and regulations meant to protect children locally and internationally are implemented to end the scourge of CSA and its many effects.