Nigerian Tertiary Health Institution Research Articles

Prevalence of symptomatic cervical spondylosis in a Nigerian tertiary health institution

Background: Cervical spondylosis (CS) is the most common disorder of the cervical spine with its associated neck pain reported as a very common problem in clinical practice. There seemed to be a dearth of research on the prevalence of symptomatic CS in a physiotherapy clinic in Nigeria. Objective: To determine a 5-year prevalence of CS in a tertiary physiotherapy outpatient clinic in southeastern Nigeria. Materials and Methods: This was a 5-year retrospective survey, from 1 st January 2006 to 31 st December 2010. Information was got from the participants' case notes, and only those who were diagnosed as having symptomatic CS without any associated disorders were recruited for the study. Data was analyzed using descriptive statistics of frequency counts, percentages, and range. Result: Fifty (5.4%) participants presented to the clinic with symptomatic CS during the 5-year period. Their age ranged from 30 to 70 years. Twenty-seven (54%) of the participants were males; 30 (60%) were urban dwellers as well as civil servants; 20 (40%) were rural dwellers; 11 (22%) of the rural dwellers were farmers; whereas, the rest (9 (18%)) were traders. Conclusion: The prevalence of CS in the physiotherapy outpatient clinic was fairly low. Civil servants had 100% affectation. There was relatively poor turnout of the rural dwellers to the hospital. Thus, there seems to be a need to educate civil servants on ergonomically good working techniques. There may also be a need to enlighten the entire population (especially the rural dwellers) on health matters in order to help them make preinformed decision on health issues.

Oral health awareness and experience among pregnant women in a Nigerian tertiary health institution

Background: Data on oral health experiences among pregnant women in developing countries are lacking. The objective of this study was to assess the oral health awareness and experience among pregnant women attending antenatal clinic at the University of Port Harcourt Teaching Hospital, Rivers State Nigeria. Materials and Methods: This was a cross-sectional study carried out during the period between February and March 2013. Pretested, well-structured, and self-administered questionnaire allowing open and closed responses was used for data collection. Results: The age of the subjects ranged from 18 to 49 years and the age group 28-37 years was significantly more (P < 0.00). Majority, 241 (82.0%) significantly had at least secondary education than 53 (18.0%) who had primary education or less (P < 0.01). Less than 10% of the participants were aware of the effect of pregnancy on oral health and the impact of oral disease on pregnancy outcome. In general, the experienced oral health problems among the pregnant women were tooth decay 21.1%, dental pain 42.2%, pain from the gum 22.8%, swollen gum, 23.5%, gum bleeding 32.7%, and excessive salivation 46.1%. However, only 27.9% had visited the dental clinic most of whom, were those with more than three children (P < 0.01). Excessive salivation was significantly experienced more than other oral health problems and in women with three or less children. Conclusion: Oral health awareness among the subjects was poor and a sizeable number of pregnant women experienced oral health problems during pregnancy. There is a need for the development of guidelines that will promote referral and visit of pregnant women for dental consultation.

Knowledge, attitude and practice of Post-Exposure Prophylaxis (PEP) to HIV among doctors in a Nigerian Tertiary Health Institution

Introduction: The HIV/AIDS pandemic still ranks one of the foremost causes of death in developing world. The present prevalence of HIV/AIDS is 5.0% for Sub-Saharan Africa and the Nigerian figure is 3.01%. The rate of infection of a previously non-infected individual in this sub-region is set at 160,000 individuals daily. With such a high prevalence, it of importance that caregivers and particularly medical doctors arm themselves with sufficient knowledge of postexposure prophylaxis.Design: Cross sectional descriptive study.Participants: The study took place among 81 doctors in a tertiary health institute in Nigeria, the University of Calabar Teaching Hospital.Methodology: A semi-structured questionnaire was administered to the subjects using a random sampling method. These questionnaires highlighted their departments, ages and ranks. Their levels of knowledge and indications for PEP as well as their attitudes to this procedure using a modification of the Likert Attitude Scale were also assessed. There were 15 attitude parameters and each attracted a maximum score of 5 points with a total of 75 points. Respondents were scored and the attitude scores were graded thus; negative attitude - &lt;35 points; bare positive – 36 – 50 points; positive – 51 – 65 points; super-positive - &gt;65 points. The subjects were also given an opportunity to suggest ways of improving on the practice of PEP in their various practices.Results: This showed that the knowledge of PEP was satisfactory, however only about half of the respondents mentioned specific indications for PEP. The doctors’ source of information about PEP was also too medically oriented and not broadminded enough for his position as the decision maker / head of the medical team. Respondents attitude towards PEP was positive and very important suggestions were made for better implementation of PEP.Conclusion: The knowledge of PEP is satisfactory in UCTH, Calabar and issues that need to be addressed in our practice border on of information dissemination and measures aimed at increasing the awareness of PEP in our society.KEYWORDS: Knowledge, Attitude, Post-Exposure Prophylaxis Knowledge, Attitude and Practice of post-exposure prophylaxis to HIV

Socio-demographic profiles and outcome of motorcycle related head injury in a Nigerian Tertiary Health Institution

Background: Motorcycle increasingly has been used for commercial transportation in many Nigerian cities with attendance increase in the rate of motorcycle crashes. Head injury is responsible for high morbidity and most mortality following such crashes. The aim of this study is to determine the socio-demographic characteristics of head injured victims of motorcycle crashes, severity of head injury and management outcome. Materials and Methods: A 1 year prospective study of head injured motorcyclists and pedestrians knocked down by motorcycle were carried out at University of Ilorin Teaching Hospital using a pre-designed proforma. Information collected included the age, gender, literacy level, alcohol consumption, license status, crash helmet use, Glasgow coma score and Glasgow outcome score. The IBM statistical package for social sciences (version 15.0) statistical package was used for statistical analysis. Results: A total of140 patients with the median age of 30 years (ranged 3-90 years) were studied. They comprised 115 (82%) males and 25 (18%) females. Most patients (66%) had at least secondary education. People of varying occupations were involved in a motorcycle crash. All riders were males and most (71.8%) were unlicensed. Only 5.8% of riders wore crash helmets at the time of the crash and they all had a favorable outcome. At both extremes of age ( 70 years) more patients were involved as pedestrians. The only socio-demographic variable that influence outcome of head injury was the patient age. Outcome was better in younger age group ( P = 0.004). There was 26.4% mortality. Most, 23 (88.4%), of patients with severe head injury died and none of them had good recovery ( P Conclusion: Our findings demonstrated high mortality among non-crash helmet wearing motorcyclists with motor cycle related head injury. The outcome was significantly influenced by age and head injury severity.

Sensorineural Hearing Loss in Patients with Chronic Suppurative Otitis Media

Even though there are other complications of chronic suppurative otitis media, the aspect of hearing loss is often studied. Nevertheless, the occurrence of sensorineural hearing loss in patients with this disease is still controversial. This study aim (1) to assess the association between sensorineural hearing loss and chronic suppurative otitis media, (2) to investigate some clinical factors that might affect the sensorineural component in patients with this disease. This was a retrospective analysis of the clinical records and pure tone audiograms of patients with chronic suppurative otitis media in a Nigerian Tertiary Health Institution from January 2003 to December 2008. Sixty-nine patients with a mean age of 28.93years; standard deviation of 18.593 were studied. They had an age range of 4-73years. The duration of otorrhea ranged from 2months to 20years; with a mean of 6.11years (standard deviation of 6.393). The mean bone conduction threshold in the diseased ear was 39.07dB (standard deviation of 12.028), and 10.26dB (standard deviation of 2.620) in the control ear (P<0.05). The mean bone conduction threshold differences between the diseased and control ears range from 21.69 to 34.52dB across the frequencies 0.5, 1.0, 2.0, and 4.0kHz. These differences tended to increase with increasing frequency and were all significant (P<0.05). In the diseased ears, there were no significant correlation between the age, duration of otorrhea, and the degree of SNHL (r=0.186, P>0.05; r=0.190, P>0.05 respectively). Patients with chronic suppurative otitis media had a significant degree of sensorineural hearing loss in this study. The higher frequencies were more affected; however, the patient's age and duration of otorrhea seem not to have any correlation with the degree of sensorineural hearing loss.

Comparative Evaluation of 0.5% Ropivacaine and 0.5% Bupivacaine for Day Case Inguinal Herniorrhaphy in a Nigerian Tertiary Health Institution.

Background: Day case inguinal herniorrhaphy is a common surgical procedure performed in our environment with lidocaine used for field block. The study was aimed at comparing 0.5% ropivacaine and 0.5% bupivacaine for the field block, determine their effectiveness and safety in our environment. Methods: In a double-blind randomized study, 52 ASA physical status I-II patients (age >18yrs) scheduled for field block for day case inguinal herniorrhaphy were assigned to two study groups to receive 0.5% ropivacaine 25ml (n = 26) or 0.5% bupivacaine 25ml (n = 26). Onset of analgesia, adequacy of block, duration of postoperative pain relief and pain score at first requirement of analgesic were recorded. Results: One patient in the bupivacaine group did not complete the study. Patient demographic characteristics and surgical times were similar in the two groups. Mean onset time of anaesthesia was shorter in the bupivacaine group than the ropivacaine group (5.37± 0.50 min vs 5.48 ± 0.45 min) although this was not significant (P = 0.44). Adequacy of block was similar in the two groups (P = 0.55). Postoperative pain relief was significantly longer for the ropivacaine group 6.83 ± 0.57hr than for the bupivacaine group 6.32 ± 0.35 hr (P = 0.0004, unpaired t-test). Mean pain score at the first requirement for analgesic was lower in the ropivacaine group 1.38 ± 0.49 than the bupivacaine group (1.56 ± 0.51), but this was not significant (P = 0.22). Few untoward effects of nausea and dizziness were observed in this study. Conclusion: Ropivacaine and bupivacaine have comparable onset of actions and adequacy of anaesthesia when used for day case inguinal herniorrhaphy and are safe. Key words: Blood glucose, fasting, elective surgery.

Perceptions of Nigerian medical specialists on research.

The current research aimed at collating the views of medical specialists on disease priorities, class and outcomes of health research in Nigeria, and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information, relative disease priority, research types and class, type and class of publication media, frequency of publications, challenges faced in publishing research, impact of their research on health practice or policy, and inventions made were probed.Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3%. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely “always” involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8%) and over a third (37.5%) had never been involved in clinical trials. They largely preferred to “always” publish in PubMed indexed journals that are foreign-based (65.0%). They also indicated that their research works very rarely resulted in inventions (4%) and change (4%) in clinical practice or health policy.Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula.

Contents and readability of currently used surgical/procedure informed consent forms in Nigerian tertiary health institutions

Surgical informed consent forms should have evidence that their use will enhance a shared decision-making which is the fundamental objective of informed consent in clinical practice. In the absence of any guideline in Nigeria on the content and language of informed consent forms, we sort to examine the surgical and procedure consent forms used by Federal tertiary health institutions in Nigeria, to know whether they fulfill the basic elements of informed consent. The surgical and procedure informed consent forms of 33 tertiary health institutions in Nigeria were assessed for their readability and contents. Adequacy of their content was evaluated based on provision for 28 content items identified as necessary information to be provided in a good consent form. The potential of the forms to be comprehended were assessed with Flesch readability formula. The contents of majority of the forms were scant. None of the forms made provision for documentation of the patient's permission for blood transfusion, tissue disposal, awareness of the risks of not undergoing the prescribed treatment, and the risk of anesthesia. Risk disclosures were only mentioned in specific terms in 11.4% of the forms. Less than 10% of the forms made provisions for an interpreter, signature of anesthetists, alternative to the procedure to be mentioned, and answering of the patient's questions. The Flesch reading ease scores of the forms ranged from 34.1 (Difficult) to 67.5 (Standard), with a mean score of 55.2 (Fairly difficult level). Field evaluation of the forms show that they shall be partly understood by 13- to 15-year-old patients with basic education but are best understood by literate adult patients. The content of majority of the informed consent forms used in Nigerian tertiary health institutions are poor and their readability scores are not better than those used in developed parts of the world. Health Institutions in Nigeria should revise their informed consent forms to improve their contents and do a usability trial on the sample forms before deployment in order to ensure that they are comprehensible for their patient population.

Survey of medical specialists on their attitudes to and resources for health research in Nigeria

To study the views of medical specialists on their attitude to and the resources for health research in Nigeria and draw appropriate policy implications. Structured questionnaires were distributed to consenting 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information, importance attached to research, motivations for conducting research, funding, ethical oversight, literature search, and statistical support were probed. The coded responses were stored and analyzed using the statistical SPSS software. Fifty-one out of the 90 questionnaires distributed were returned, giving a response rate of 63.3%. Research function was rated third by 64.7% of the respondents after hospital service (72.5%) and teaching (66.0%). Advancement of knowledge was the strongest motivating factor for conducting research (78.4%). Securing funding (94%) and finding time (80%) were their major constraints. Only a minority of the respondents, 20% and 14%, respectfully, positively rated the quality and promptness of the decisions of their institutions' ethical organs in the highest category. Most of their literature search was conducted on the internet (96.1%) and they stored and analyzed their research data with commonly available statistical software. Our study respondents regarded research highly but were severely constrained in conducting research by lack of access to sources of funding from within and outside Nigeria and finding time from core hospital functions. We recommend periodic (re)training in research particularly on how to apply for research grants and giving some protected research time for Nigerian medical specialists in order to boost their research function.

Adverse event following immunization in a Nigerian tertiary health institution

Vaccine manufacturers develop products with the highest safety and effectiveness possible. But some very rare vaccine-related adverse events still occur. A descriptive retrospective study design was employed in this investigation. The investigation was limited to the four major health facilities in a metropolitan city that offer major immunization services to children. All cases of injection abscess or local reaction following vaccine administration from January 2004 to June 2006 were extracted from the records of each facility and included in the investigation. More than half of the cases reported were between 2 -4 months of age constituting 57.9% of all reported cases. The mean age of all reported cases was 4.368 ± 2.794 with a modal age of 2 months. Over half of all documented cases of adverse reactions following vaccine administration during the period under investigation were local swelling at site of injection (50.9%). About half of all cases documented (49.1%), were given DPT before development of adverse reactions. Almost all the cases of adverse reaction to vaccine administration (93%) were seen at the tertiary health facility. Cold chain equipment should be supplied and maintained at utmost working conditions at all health facilities to guarantee potency of vaccines.

Otolaryngologic manifestations among HIV/AIDS patients in a Nigerian tertiary health institution: an update

INTRODUCTION/AIM: This study is to determine these manifestations among HIV/AIDS patients in Ilorin to update on previous study. METHOD: This was a prospective study of all consecutive new patients confirmed to be HIV positive attending the HIV clinic of the University of Ilorin Teaching Hospital, Ilorin, Kwara state, Nigeria between January and July, 2009. These patients were on HAART anti retroviral drug treatment. The information retrieved included the biodata, clinical presentation, otolaryngologic clinical findings, as well as their hearing assessment with Pure tone audiometry. RESULTS: 74 out of the 89 HIV patients(82.8%) had otorhinolaryngological manifestations with the age range of 3 to 62 years (Mean of 36.4 yrs, SD=2.45±0.02). The modal age range was 21-40 years (59.6%) 51males (57.3%) and 38 females (42.7%) and a sex ratio of 1.3:1. Commonest otorhinolaryngological features included nasal in 45.6% (chronic rhinosinusitis), oral/oropharyngeal in 23.9% (oral candidiasis), otological in 21.5% (Serous otitis media) and cervical adenopathy in 9%. CONCLUSION: Otorhinolaryngological manifestations were found in 74 patients (82.8%) and commonest features included chronic sinusitis, oral/pharyngeal candidiasis, serous otitis media with cervical adeopathy in that order. It is important for otolaryngologists to be aware of otolaryngological manifestations, so early diagnosis and timely intervention alongside appropriate anti-retroviral therapy be instituted to improve survival rates.

A ten year clinical experience with intrauterine contraceptive device (IUCD) in a Nigerian tertiary health institution

The prevalence of contraceptive use is still very low in Nigeria and the intrauterine contraceptive device (IUCD) is a common long term and reversible method of family planning. A ten year retrospective study of IUCD acceptors at the family planning clinic of Nnamdi Azikiwe University Teaching Hospital Nnewi was carried out. The socio-demographic characteristics, side effects/complications, duration of use, and reasons for discontinuation were analyzed. There were 861 IUCD acceptors among 1345 family planning clients giving the IUCD acceptance rate of 64.1%. Also 36.8% had used it previously. The mean age and number of living children were 30.7±5.7 years and 4.2±1.9 respectively. Both the mean age of the limiters (34.5 vs 29.0 years) and their number of living children (6.0 vs 3.5) were significantly higher than those for spacers (p=0.00). Almost all the clients were married, majority (89.3%) had secondary and or tertiary education and 70.2% were spacers. The mean duration of use was 3.1±1.9 years. Most of the clients (82.4%) did not experience any side effect/complication. The common side effects/complications were vaginal discharge (7.7%), menorrhagia (1.9%), and missing IUCD (1.9%). In multivariate analysis the duration of use correlated positively with the number of living children (p=0.00) while age had no effect on the duration of use (p=0.025). Clients with secondary and or tertiary education reported side effects more than those with lesser level of education. The desire for pregnancy (36%) was the commonest reason for its discontinuation and the average discontinuation rate was 55.1%. The contraceptive prevalence in relation to the number of deliveries within the study period was low (12.4%). There is great need to intensify motivation and health education on the availability and benefits of IUCD. Also provision of free commodity and services shall improve its utilization and promote maternal health. Key words: Family planning, IUCD, utilization.

A Study of Compliance to Hepatitis B Vaccination Among Health Workers in a Nigerian Tertiary Health Institution

Hepatitis B infection is a universal health problem. Around 300-400 million carriers are estimated worldwide. Fortunately, there are effective vaccines against the virus, which are about 95% effective. This descriptive retrospective study was conducted at the staff clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State, Nigeria. The vaccination register used in the clinic was obtained and the records of all the health workers vaccinated from 1st January 2004 to 31st December 2007 were extracted and used in the survey. A total of 884 members of staff on the vaccination register were included in this study. A majority of the respondents (81.9%) were within 21 – 50 years of age. Male respondents constitute 46.5% of all respondents. Of all the respondents (100%) who took the 1st dose of the vaccine, 76.5% came back for the 2nd dose while only 48.6% presented for the 3rd dose of the vaccine. Slightly more than half (51.4%) of all the respondents who initiated immunisation did not complete same. Though only 10.5% of all respondents were vaccinated in 2007, almost all of them (93.5%) defaulted in coming back for either the second or third dose of the vaccine or both. Only 430 (48.6%) respondents were fully immunized. Poor compliance of Health workers to hepatitis B vaccination is an issue that deserves serious attention. There is a need for more research into this issue to uncover the factors responsible for poor compliance to vaccination campaigns.Key words: Defaulters, Health Workers, Hepatitis B Vaccination

Plain radiographic evaluation of the nasopharynx: Do raters agree?

Background Subjective plain radiographic evaluation of the nasopharynx has been a widely adopted technique. Although it has its own limitations, its ease of interpretation and simplicity are some of its advantages. Aim To investigate the reliability, using kappa, in subjectively reporting plain nasopharyngeal radiographs in children with symptoms suggestive of enlarged adenoids. Methods This was a retrospective study of the clinical records, and plain X-rays of the nasopharynx of paediatric patients with clinical features of adenoid hypertrophy in a Nigerian Tertiary Health Institution from January 2008 to December 2008. Results Fifty-one children with a mean age of 3.4 years; standard deviation of 2.772 was studied. They had an age range of 2 months to 12 years. Most (66.6%) of the children studied were in the age bracket 0–4 years. The inter-rater reliability between the two Otolaryngologists, and that between an Otolaryngologist and a Radiologist using kappa statistics were 0.6696, 95% CI (0.5035–0.8357; p < 0.05) and 0.8182, 95% CI (0.7073–0.9291; p < 0.05) respectively. While the kappa intra-rater reliabilities for the two Otolaryngologists were 0.6931, 95% CI (0.5473–0.8389) and 0.9591, 95% CI (0.9033–1.000). Conclusion There was a high level of agreement among trained raters, in subjectively interpreting plain nasopharyngeal radiographs in children with suspected adenoidal obstruction.

High Prevalence Of Intestinal Parasites In A Nigerian Tertiary Health Institution

High Prevalence Of Intestinal Parasites In A Nigerian Tertiary Health Institution

Abdominal wall reconstruction using De-epithelialized dermal flap: A new technique

Background:Although autogenous materials have been used in abdominal wall hernioplasty for a long time, the introduction of prosthetic materials diminished their popularity. However, these materials may be expensive, inappropriate or unavailable. The aim of this study is to determine the place of de-epithelialized dermal flap in the reconstruction of abdominal wall hernias.Materials and Methods:A five-year prospective, descriptive analysis of eligible patients with difficult abdominal wall hernias closed with de-epithelialized dermal flap in a Nigerian Tertiary Health Institution, from January 2001 to December 2005.Results:Over the five-year period, 37 patients were recruited into the study. There were 11 males and 26 females, giving a male: female ratio of 1: 2.4. The ages ranged from 8 months to 47 years (mean = 12.6 years). The defects consisted of 15 incisional hernias, 12 intermuscular/inferior lumbar hernias, nine healed exomphalos major and two giant umbilical hernias. The size of the hernia defects ranged from 4.5 cm to13cm (mean = 6.4 cm). Three patients had bowel resection and end-to-end anastomosis, in addition to the flap reconstruction. Morbidity was minimal and included skin dimpling in 11 patients, seroma in three, and wound infection in two patients. Neither recurrence of herniation nor mortality was recorded during the period of follow-up, which ranged from three months to 4.5 years (mean = nine months).Conclusion:The results suggest that this is a useful technique that can easily be applied in many centers with minimal resources. It is cheap, effective and associated with minimal morbidity.

Otology practice in a Nigerian tertiary health institution: A 10-year review

The practice of otology in developing countries has remained unsatisfactory. The aim of this study is to describe the practice in a tertiary health institution with a view to articulate strategies for improvement. This a retrospective study of patients with otology problems, who attended Ear, Nose and Throat clinic of Aminu Kano Teaching Hospital, Kano, over a 10-year period (1997-2007). Case notes were retrieved and studied. Otologic conditions accounted for 56.3% of the 8070 clinic visits. The most frequent condition seen was chronic otitis media (25.4%). Sensorineural hearing loss (mostly preventable) accounted for 16%. Other cases included wax impaction (7.5%) and foreign body in ear (7.3%). Modern diagnostic and operative equipment were lacking. Operative surgery was offered to 4% of cases of chronic suppurative otitis media and 72% of patients needing hearing aid could not afford one. There was no middle ear reconstructive or inner ear operation in the 10-year period. A significant number of patients are in need of otology services. These services are inadequate presently. Concerted effort should be geared toward strengthening preventive ear health, training and re-training, procurement of relevant diagnostic and operative equipment.

Medication use and abuse in childhood diarrhoeal diseases by caregivers reporting to a Nigerian tertiary health institution

Background . Childhood diarrhoeal diseases have a major impact on morbidity and mortality. Prompt and appropriate interventions improve outcome. Objectives . To evaluate the practice of mothers/caregivers with respect to use of antibacterial and antimotility drugs. Methods . Caregivers of under-5s presenting from catchment areas of the University of Nigeria Teaching Hospital between October 2006 and February 2007 were interviewed by means of a structured questionnaire. Data obtained included perception of cause of diarrhoea, use of oral rehydration therapy (ORT) fluids, and use of antibacterial and antimotility drugs. Results . Caregivers of 156 children met the inclusion criteria. Most mothers (53%) believed that the diarrhoea was caused by teething and 51% had used antibiotics (the commonest was metronidazole). Use of antibiotics was not influenced by the perceived cause of diarrhoea, level of maternal education or social status. Drug use delayed the time of presentation and was associated with more severe dehydration. Conclusion . We found that home treatment of acute diarrhoea is characterised by unnecessary use of antibiotics and antidiarrhoeal agents. Intermittent public health campaigns and health care worker updates on the use of ORT and zinc supplements are needed. The latter may also satisfy caregivers’ urge to give ‘medicine’ while at the same time reducing antibiotic abuse and drug resistance.

Pattern of Eye Problems of the Elderly in a Nigerian Tertiary Health Institution.

The pattern of eye problems in 1,964 elderly Nigerians (972 males and 992 females) attending University of Ilorin Teaching Hospital over a 5-year period were reviewed and documented. This is aimed at determining the hospital incidence and pattern of eye problems among elderly Nigerians. retrospective case series study. The hospital case folders of the 1,964 patients aged 60 years and above seen at the eye clinic of the University of Ilorin Teaching Hospital between July 1999 and June 2004 were reviewed. Their ages range from 60 to 99 years with a mean of 65.8 (+ 8.4) years. Information on socio demographic characteristics, visual acuity and ocular diagnosis were obtained, collated and analyzed. The major ocular problems were Cataract (41.1%), Primary open angle glaucoma (13%), Allergic conjunctivitis (11.3%) and Refractive errors (8.9%). Ocular trauma was the least frequent diagnosis (1.4%). The hospital incidence for bilateral and uniocular blindness were 383(19.5%) and 813(41.4%) respectively. More than one third 771 (39.1 %) had visual impairment in the better eye. Bilateral blindness was found to be caused mainly by cataract (55.6%), Glaucoma (17.5%), uncorrected aphakia (8.9%) and age-related macular degeneration (8.1%). The high incidence of blindness is a cause for concern which requires clinical and political commitment of both policy makers and implementers. This study emphasizes the role of eye disorders as a serious cause of morbidity among the elderly in Nigeria. It stresses the need for increased health awareness and education especially with regards to regular eye examination so as to reduce morbidity and unnecessary complications. Furthermore there is an urgent need to subsidize eye care services for elderly Nigerians Keywords: blindness; elderly; Eye problems; NigeriaThe Nigerian Medical Practitioner Vol. 51 (3) 2007: pp. 29-32

Paranasal Sinus Mucoceles : Surgical Management In A Nigerian Tertiary Health Institution.

Objective: To study and review the surgical management of the mucoceles of the paranasal sinuses in a Nigerian tertiary health institution . Materials and Methods: This is a retrospective study of surgical management of all cases of mucoceles of the paranasal sinuses at the Usmanu Danfodiyo University Teaching Hospital Sokoto from Jan.2000 to Dec. 2005 who were seen by both departments of Otorhinolaryngology and Ophthalmology. Results: A total number of 2242 patients were seen who had rhinosinusitis during the period. Seventy five patients(3.3%) underwent surgeries for rhinosinusitis out of which 10(13.3%) were cases of mucoceles from chronic rhinosinusitis. Nine were males and one female (male: female ratio 9:1). Their ages ranged from nine to 45 years with an average age of 25.8 years.Facial asymmetry from cystic swelling with non axial proptosis was the commonest clinical presentation. Duration of symptoms varied from three to 15 years with an average symptom duration of 6.8 years. Frontal sinus, five cases (50%) followed by ethmoidal sinus, four cases (40%) and sphenoidal sinus, one case (16.7%) were the paranasal sinuses involved. There was no intracranial extension. Chronic rhinosinusitis was the only identifiable remote predisposing factor. External sinus surgeries (fronto-ethmoidectomy, and sphenoidectomy through different transfacial approaches) along with reconstruction of sinus drainage pathway were carried out with no complication or recurrence post-operatively. Conclusion: Mucoceles of the paranasal sinuses require appropriate surgical technique for adequate exposure and drainage in order to avoid recurrence. Keywords: Mucoceles, Paranasal sinus, Rhinosinusitis Nigerian Journal of Plastic Surgery Vol. 3 (2) 2007: pp. 47-53