Nigerian University Teaching Hospital Research Articles

Contraceptive methods continuation and its determinants among acceptors on repeat visits to a Nigerian University Teaching Hospital: a 10-year review

Background: Family planning is a known reproductive health modality for reducing the high maternal mortality in Nigeria. Contraceptive use and continuation is thus necessary to achieve its benefits. The study aimed to determine the contraceptive options and the factors associated with the continuation of contraceptive choices among women on repeat visits. Methods: This was a 10-year retrospective study of the family planning clinic register of all clients who presented for a repeat visit for contraceptive method continuation at the University of Uyo Teaching Hospital. Results: There were 6939 contraceptive acceptors on repeat visits aged between 14 and 50 years (mean 31.6 years, SD 5.4). The majority were 26 to 30 years (32.9%), had secondary education (54.6%), were multiparous (90.9%) and chose the subdermal implant (34.9%) and the intrauterine contraceptive devices (27.7%) for continuation. There was a significant association between the women`s age (Df=3, F=10.81, p<0.0001), their educational status (Df=6, Χ2=38.5583, p<0.0001), their parity (Df= 15, Χ2 =76.8644, p<0.0001) and the contraceptive method continued. Conclusions: An interest in long-acting reversible contraceptives for continuation was found, and this is significantly associated with their sociodemographic and obstetric characteristics; however, we recommend cross-sectional and focus-group inquiries among clients in the different contraceptive-specific categories for further information on the reasons for their choices at subsequent visits.

Good Outcome of Anti-Diabetic Therapy: A Proposal for Evidence-Based Process Indicators

Background: The need to search for reliable process indicators for the effectiveness of anti-diabetic therapy has been expressed in the literature. Process indicators have been described as essential processes that contribute to achieving outcomes.
 Objective: This study seeks to identify and propose evidence-based process indicators for a good outcome (effectiveness) of anti-diabetic therapy in a Nigerian University Teaching Hospital.
 Methods: A crossectional study was conducted using a questionnaire about the degree of subjects' knowledge/practice of lifestyle/dietary modification based on set criteria. Glycemic control based on the latest monitoring tests and physician's remarks were extracted from the case notes of each selected subject: sample Size, n=1200. Subjects were selected by systematic random sampling (Sampling Interval=1).
 Results: Three Hundred and Thirteen (77.7%) out of 403 subjects with reasonable glycemic control were effects by exercise. Those were with excellent knowledge about signs and symptoms of hyperglycemia, the beneficial effects of exercise, treatment, and excellent practice of self-monitoring. About 311 (77.2%) out of 403 subjects who had reasonable glycemic control were those who had excellent knowledge about dietary modification. Almost 308 (76.4%) out of 403 subjects who had reasonable glycemic control were those who had excellent knowledge about lifestyle modification. Three Hundred and Six (75.9%) out of 403 subjects who had reasonable glycemic control were those who had excellent knowledge about complications of diabetes mellitus. Many subjects with excellent lifestyle/dietary modification practices had reasonable glycemic control.
 Conclusion: Evidence-based process indicators for a good outcome (effectiveness) of anti-diabetic therapy have been identified/proposed as the degree of knowledge about signs and symptoms of hyperglycemia, complications of diabetes mellitus, beneficial effects of exercise, treatments, dietary modification, and lifestyle modification. Other process indicators identified/proposed are the degree of self-monitoring practice, lifestyle, and dietary modification.

Childhood colostomies: patterns, indications and outcomes in a Nigerian University Teaching Hospital.

Most childhood colostomies are done for decompression or diversion in gastrointestinal tract congenital anomalies. Colostomy may be sited in the transverse or sigmoid colon as loop or defunctioning (divided) colostomies. Current pattern seems towards construction of more sigmoid and defunctioning colostomies. To evaluate the patterns, indications and outcomes of childhood colostomies. Patients and Methods: Retrospective chart review of all colostomies performed in children below 15 years from September 2010 to August 2020. There were 104 colostomies (55males; 49females; 65 sigmoid; 39 transverse colostomies; 3 loop; 101 defunctioning colostomies. Anorecatal Malformation (ARM)was indication in 32 males and 41 females; age range 2 days to 13 years. Hirschsprung's Disease (HD) was indication in 18 males and 4 females; age range 6 weeks to 15 years.In HD there were three loop colostomies (3/22) in transverse colon and 19 defunctioning colostomies (8 sigmoid, 11 transverse) while in ARM all 73 were defunctioning colostomies(P=0.01)In HD there were 14/22 transverse colostomies and 8/22 sigmoid colostomies while ARM had 24/73 transverse and 49/73 sigmoid colostomies (P =0.013)In HD 91% colostomies were done beyond infancy while in ARM 93% were before one year(P<0.0001). Mortalities were noted in 1.9% patients. Commonest indication for colostomy is ARM. There are more defunctioning than loop colostomies, and more sigmoid than transverse colostomies. of most colostomies in ARM were during infancy while mostly beyond infancy in HD.

Local Epidemiology of Nosocomial Staphylococcus aureus Infection in a Nigerian University Teaching Hospital.

Population-based studies of Staphylococcus aureus contribute to understanding the epidemiology of S. aureus infection. We enrolled surgical inpatients admitted to an African tertiary-care hospital in order to prospectively analyze the nosocomial impact of S. aureus. Data collection included an active sampling of the anterior nares and infectious foci within 48 h after admission and subsequently when clinically indicated. All S. aureus isolates were spa and agr genotyped. Possession of Panton-Valentine leukocidin (PVL) and other toxin genes was determined. We analyzed antibiotic susceptibility profiles by VITEK 2 systems and verified methicillin-resistant S. aureus (MRSA) by mecA/C PCR. Among 325 patients, 15.4% carried methicillin-susceptible S. aureus (MSSA) at admission, while 3.7% carried MRSA. The incidence densities of nosocomial infections due to MSSA and MRSA were 35.4 and 6.2 infections per 10,000 patient-days, respectively. Among all 47 nosocomial infections, skin and soft-tissue (40.4%) and bones or joints’ (25.5%) infections predominated. Six (12.7%) infection-related S. aureus isolates harbored PVL genes including two (4.2%) MRSA: overall, seventeen (36.2%) isolates carried pyrogenic toxin superantigens or other toxin genes. This study illustrates the considerable nosocomial impact of S. aureus in a Nigerian University hospital. Furthermore, they indicate a need for effective approaches to curtail nosocomial acquisition of multidrug-resistant S. aureus.

Comparing the incidence of pneumonia in children seen at a Nigerian Teaching Hospital before and during the COVID -19 pandemic

Background: Following the outbreak of the new coronavirus (COVID 19) worldwide, many governments across the world including the Nigerian government had to implement measures to curtail the spread of this virus. Such measures included social distancing and personal hygiene which could have also helped to reduce the transmission of pneumonia among other infectious diseases.&#x0D; Objective: To assess the effect of COVID-19 on the incidence of pneumonia in children seen at the Department of Pediatrics, of a Nigerian private University Teaching Hospital.&#x0D; Method: We retrospectively analyzed the data of the patients seen with pneumonia in all the Pediatric units of the Teaching Hospital from April 2019 to March 2020 (pre-pandemic period) and compared it with that of those seen during the COVID-19 pandemic from April 2020 to March 2021.&#x0D; Result: There was a 28% decrease in the total number of children seen in the department from 5,657 in pre-pandemic period to 4,079 in the pandemic period. There was a 17% decrease in the mean number of children seen with pneumonia monthly from 4.92 to 4.08 in the pandemic period. This is despite the relative increase in the incidence rate of pneumonia in children seen from 1.04% in the prepandemic period to 1.2% in the pandemic period. We noted more complications of pneumonia including heart failure and anaemia in the pandemic period (24.5% of cases) than in the pre-pandemic period (15.3% of cases).&#x0D; Conclusion: The incidence of pneumonia in children seems to have increased in the wake of the COVID 19 pandemic.

Pattern, Risk Factors and Outcome of Acute Stroke in a Nigerian University Teaching Hospital: A One-Year Review (4222)

Pattern, Risk Factors and Outcome of Acute Stroke in a Nigerian University Teaching Hospital: A One-Year Review (4222)

Mathematical Modelling of Inpatient Flow and Bed Allocation in a Nigerian Tertiary Hospital

Unnecessary delay on queues at hospitals and lack of access to care are associated to loss of lives. In this study we analyze the flow of inpatients in order to find out the appropriate number of beds needed to realize a smooth flow at points where congestion existed in a Nigerian university teaching hospital. Basic hospital statistics, like percentage occupancy, bed turnover rate, etc., are computed and we use queuing model to analyze patient flow and allocation of beds and demonstrate that patient flow in the hospital can be modeled using Erlang loss model.

Pattern, risk factors, and outcome of acute stroke in a Nigerian university teaching hospital: A 1-year review

Background: This study aimed to document the pattern, risk factors, in-hospital outcomes, and stroke mortality in a hospital over one year. Materials and Methods: Acute stroke patients admitted at the Lagos State University Teaching Hospital between October 2019 and September 2020 had their records reviewed. Information including age, sex, risk factors, stroke type, access to neuroimaging, and the in-hospital outcome was extracted and analyzed. Results: A total of 230 patient records were included in this study. The proportion of intracerebral hemorrhage (ICH) was 44.8%, while ischemic stroke was 52.2%. Only 9.1% of ischemic stroke cases had an onset-to-arrival time of fewer than nine hours, with just three thrombolytic therapy given. The 30-day mortality was 28.7%, lesser among younger patients and patients managed in the stroke unit. Conclusion: The hospital incidence of ICH was close to that of ischemic stroke. Mortality data confirms the importance of management in a stroke unit.

Assessment of Markers of Depression and CD4 Cell Count among Adult HIV-Positive Patients on Anti-Retroviral at a Nigerian University Teaching Hospital

Objective: Depression is a common mental health problem among people living with HIV/AIDS (PLWHA); because low count of lymphocytes with cluster of differentiation 4 (CD4 cell count) is associated with severe symptoms of HIV infection, there are thoughts that low CD4 cells count can provoke depressive illness. This study was conducted to determine the relationship between CD4 count and depression among adult HIV positivepatients attending Family Medicine clinics at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Method: A hospital based descriptive cross-sectional study was done over a period of 6 months among 350 systematically randomly selected adult HIV-positive patients. PHQ-9 was used to obtain information on depression and the CD4 count was determined using a flow-cytometric method. Data were obtained and analyzed using SPSS-17. Chi-square was used to determine degree of association between the depression and the level of CD4 count. P-value of &lt; 0.05 was considered statistically significant.Results: The prevalence of depression among the respondents was 33.4%. The prevalence of depression was highest among respondents with low CD4 count (≤349cells/ul), 37.0%, and least among those with high CD4 count (≥500cells/ul), 28.3%. This relationship was however not statistically significant.Conclusion: The overall prevalence of depression was high among the respondents (33.4%) suggesting the need for routine depression screening among HIV positive patients. There was no statistically significant association between presence of depression and level of CD4 count (p-value=0.302).&#x0D; Keywords: Depression, CD4count, PLWHA, Family Medicine, UITH.

A prospective study of the effect of antihypertensive medications on the sexual functions of hypertensive adult male patients.

Background:The potential for antihypertensive medications to produce deleterious adverse effects on sexual functions among hypertensive adult male patients has been widely reported, such adverse effects may limit drug adherence and compliance.Aim:The aim of this study was to assess the effect of antihypertensive medication use on sexual functions among hypertensive adult male patients.Methodology:The study was carried out at the outpatient clinic of a Nigerian University Teaching Hospital. A total of one hundred and fifty-nine recruited hypertensive adult male patients that were being managed at the center over a 3-month period between January 2017 and April 2017 participated in the study; provided they satisfied the inclusion and exclusion criteria for enrolment.Results:The respondents were between 30 and 98 years of age, (mean of 59 ± 11.1 years). Blood pressure recorded was during their initial medical diagnosis for hypertension. Systolic blood pressure recorded was between 128 and 194 mmHg (mean of 162 ± 16.4 mmHg), while their diastolic blood pressure was between 78 and 120 mmHg (mean of 95 ± 10.7 mmHg). The highest occurrence of sexual dysfunctions was associated with calcium-channel blockers in 32 (20.1%) patients, followed by diuretics in 27 (17.0%) and, angiotensin-converting enzyme inhibitors in 20 (12.6%) patients.Conclusion:Calcium channel blockers caused the highest occurrence of sexual dysfunctions.

Amalgam phase down: baseline data preceding implementation in Nigeria

The Minimata Convention on mercury includes amalgam phase-down and eventual phase-out from dentistry. To aid its subsequent evaluation it is important to have baseline data of amalgam use in a locality prior to implementing a phase-down. Records of patients spanning 5years from January 2011 to January 2016 were analysed to determine and the compare frequency of amalgam usage with other dental materials for carious teeth restorations in a Nigerian university teaching hospital. Classes of cavities restored and cadres of operators who employed the different materials were included. Institutional ethics committee approval was obtained prior to commencing the study. 2,058 patients' records were retrieved, 59% females and 41% males. Their ages ranged 19-80years, mean 33.5±12.7years, young adults 20-39years old were the majority (62.9%). Filling materials included 57.5% amalgam, 17.6% glass ionomer cement (GIC) and 24.9% resin composite. Class I restorations constituted 70.5% of amalgam restorations, while Class II restorations made up 29.4% and Class V restorations accounted for 0.1%. Undergraduate dental students placed most of the amalgam restorations (60.5%), and 78.9% of all their restorations were amalgam. Less experienced dentists used all materials equally; the more experienced dentists placed more composite resin and GIC (43.3%). Amalgam fillings constituted nearly 60% of the restorations of carious teeth. Training of dental students in placement of non-mercury alternatives to amalgam and Minimum Intervention Dentistry needs to be emphasized in dental schools. Phase-down of amalgam should be intensified in Nigeria with the ultimate aim of a phase-out in line with the Minamata Convention.

Otorhinolaryngologic, head and neck presentations among patients with chronic renal disease in a developing country.

Background:Data on otorhinolaryngology and head and neck diseases in patient with chronic renal disease are rare in developing African countries. This study was aimed to determine the epidemiology and management of otorhinolaryngology and head and neck diseases among chronic renal disease patient seen in our tertiary health-care facility.Materials and Methods:This was a prospective, hospital-based study that was conducted in the ear, nose, and throat department in a Nigerian University Teaching Hospital. Informed consent was obtained, and pretested interviewers-assisted questionnaires were administered to each patient. Otoscopy, indirect laryngoscopy, and rhinoscopy were carried out. Renal functions were assessed by routine urine analysis and biochemical tests. Audiological tests were carried out for hearing assessment. Data collected were collated and analyzed using the SPSS software version 20.0.Results:The prevalence of chronic renal disease in otorhinolaryngology practice was 1.1%. There were 67.9% male with a male-to-female ratio of 2.1:1. The duration of illness was more than 1 year in 39.6% of our patients. The most common presentation was 58.5% tinnitus, 34.0% neck pain, 28.3% nasal blockage, 28.3% sore throat, 26.4% rhinorrhea/epistaxis, 18.9%% pharyngeal wall nodularity, and 15.1% enlarged neck lymph node. The most common affected organ was the ear in 90.6%. Major diagnosis was sensorineural hearing loss, rhinosinusitis, pharyngitis, and cervical adenitis in 58.5%, 30.2%, 20.8%, and 7.5%, respectively. Hearing impairment occurred in 69.8% of the patients, out of which 43.4% were found to be mild hearing loss. Only 19 (35.8%) had dialysis, while 34 (64.2%) of them had conservatively treated.Conclusion:The prevalence of chronic renal disease in otorhinolaryngological practice was 1.1%, otological presentation was the most common in 90.6% of patients and 64.2% did well on conservative treatment. Avoidable otorhinolaryngologic complications among patients with chronic renal disease were noted. Periodic otorhinolaryngology referral for review and prompt management of this complication is advised.

Communication Disorders among Children in a Developing Country, Nigeria

Background: Communication disorders in children are an invisible disability posing challenges to otorhinolaryngologist in developing countries. The aim of this study was to determine the prevalence, sociodemographic features, aetiology, types of communication disorders among under 18 years children attending our facility. Methods: This was a prospective study conducted in ear, nose and throat department in a Nigerian university teaching hospital, from June 2014 to May 2019. Data were obtained by using pretested interviewers assisted questionnaires from consented patients and analyzed using SPSS version 20.0. Results: Prevalence of communication disorder was 16.1%. Male was 68.2% with male to female ratio of 2.1:1. Communication disorder is commoner in first child 58.1% and detected by mother in 70.5% cases. Major cause was due to infection in 68.2%. Large percentage of communication disorder were language disorder in 60.8% and speech disorders which constitute 39.2% with associated varying degrees of hearing impairment in 78.8% of them. Sensorineural hearing impairment was noted in 69.6% cases. Language disorders were delayed speech &amp; language, mutism and specific language impairment in 22.6%, 16.6% and 14.7% respectively. Major speech disorder was articulation problem in 15.7%. Main sources of referral were 52.5% from paediatrician while 30.9% was from general practitioners. Conclusions: There was high prevalence of communication disorder which was associated with high prevalence of hearing impairment. The major causes were infection with inadequate obstetrics management.

Paediatric Physical Facilities Design Characteristics in Southwestern Nigerian University Teaching Hospital: Lesson from Netherland Children Hospital

This study appraised the influence of design characteristics of the paediatric hospital physical facilities with a view to develop the physical facilities design characteristics policies for paediatric hospital designers, managers and policy makers. In this study, the hospital physical facilities are defined by the spaces used by the professional staff, equipment, the building form, their furniture and fixtures. Also, the design characteristics of the hospital physical facilities are defined by the building proximity, privacy, wayfindings, flexibility and adaptability. The notable paediatric hospital selected in the developed country is Emma Kinderziekenhuis Pediatric Hospital in Amsterdam, Netherland because it has developed a remarkable work in the healthcare settings with a deep concern on child-centred design, which were informed, implemented and accompanied by architects. Also, Peadiatric department of University College Hospital (UCH), Ibadan Nigeria was selected because it is the largest city in Nigeria which can be used to generalize what is obtained in peadiatric hospital physical facilities in southwestern Nigeria. Through analysis of one of the notable hospitals in both the developed and developing worlds, the design characteristics of selected hospital were examined using case study method such as the use of building plans, the site layout and the use of photograph among others. The results of the investigation show that hospital design characteristics have a great influence on both the patients and staff including the visitors. However, the planning and design characteristics of the physical facilities in the Netherland Children Hospital were found to be very good compared with its counterpart in Southwestern Nigerian University Teaching Hospital. It is, however, concluded that, the Nigerian University Teaching Hospitals should learn from the design characteristics appraised from the Netherland Children Hospital. The result of this study will be useful as a design policies standard for the Nigerian government, healthcare developers and children hospital designers in southwestern, Nigeria.

The observed effect of adverse drug reactions on the length of hospital stay among medical inpatients in a Nigerian University Teaching Hospital

Background:The potential impact of an adverse drug reaction (ADR) is multidimensional, and includes prolonged length of hospitalization which significantly increased morbidity, mortality, and economic burden with additional intense medical care.Aim:This study was designed to characterize and evaluate the potential effect of ADRs on the length of hospital stay among adult medical inpatients in an academic teaching hospital in a large West African nation. The overarching goal of the study is to highlight approaches toward mitigating the sequelae of ADRs in this setting, and improving their recognition and timely optimal management.Methods:The patients admitted into the adult medical wards of a Nigerian University Teaching Hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge.Results:A total of 507 patients were evaluated during the study, out of which 269 (53.1%) of them were males and 238 (46.9%) were females. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). In this study, the mean duration of hospital stay for all patients was 11.9 ± 11.3 days (median of 9 days). Females had a mean duration stay of 12.9 ± 12.3 days (median of 10 days) and stayed significantly longer than males who stayed a mean duration of 10.9 ± 10.2 days with a median of 7 days ( t = −1.985, df = 505, p = 0.048). Furthermore, patients admitted solely because of ADRs (ADR-out) had a significantly shorter duration of stay with a mean duration stay of 6.1 ± 3.7 days (median duration stay of 7 days) when compared to those without ADRs whose mean duration of stay was 11.6 ± 11.0 days (median duration stay of 8 days), and this was found to be statistically significant ( t = 2.110, df = 472, p = 0.035). Those patients who developed ADRs during admission (ADR-in) had a mean duration of stay of 18.3 ± 14.8 (median of 15 days). This was significantly longer than the duration of stay for patients without ADRs ( t = −3.398, df = 487, p = 0.001) and also significantly longer than the duration for those who were admitted solely because of ADRs ( t =3.432, df = 49, p = 0.001).Conclusion:In this study, ADRs were associated with a significantly prolonged length of hospital stay for adult medical inpatients in this Nigerian University Teaching Hospital.

A prospective study on causality assessment rating, mortality rate, and case fatality rate for adverse drug reactions among medical inpatients at the University of Benin Teaching Hospital, Nigeria

Background: An adverse drug reaction (ADR) is a special form of adverse drug event (ADE) in which a causative relationship can be shown or established and is attributable to the offending/precipitating medication. ADR causality assessment is used to determine the likelihood that a particular drug caused a suspected ADR. Causality assessment rating evaluates the relationship between drug treatment and the occurrence of an ADE. It is also used to evaluate, check, confirm, and ascertain that the particular treatment is the cause of an observed adverse event or not. Aim: This study was designed to evaluate the causality assessment rating, mortality rate, and case fatality rate for ADRs among adult medical inpatients in clinical practice setting with the goal of preventing them and improving their treatment outcome. Methods: The patients admitted to the adult medical wards of a Nigerian University Teaching Hospital over 9 months from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven patients were evaluated during the study, of which 269 (53.1%) of them were male and 238 (46.9%) were female. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). In this study, the causality assessment rating for the observed ADRs was evaluated using both the World Health Organization (WHO) causality rating criteria and the Naranjo algorithm. Using the WHO causality rating criteria, certain cases were 10 (19.6%), probable cases were 17 (33.3%), and possible cases were 24 (47.1%). Using the Naranjo algorithm, definite cases were 9 (17.6%), probable cases were 19 (37.3%), and possible cases were 23 (45.1%). The number of patients admitted solely because of ADRs (ADR-out) was 18 (3.6%) patients, whereas those that experienced ADRs during admission (ADR-in) stood at 33 (6.5%) patients. Furthermore, the case fatality rate for ADRs was 7.8% (4/51), while the ADR-associated overall mortality rate was 0.8% (4/507). Conclusion: In this study, the two methods used to ascertain causality rate for ADRs caused by a suspected drug; both the WHO causality rating criteria and Naranjo algorithm, showed similar causality ratings, which strengthening the ascribed ADR causality rating. In addition, the mortality rate and case fatality rate for ADRs were significantly high among these adult medical inpatients.

Pattern of medications causing adverse drug reactions and the predisposing risk factors among medical in-patients in clinical practice: A prospective study

Background: Pharmacological interventions sometimes carry inherent significant risks which include adverse drug reactions (ADRs), drug interactions (DIs) and other consequences of inappropriate medication use. An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used in man for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high incidence and prevalence. Aim: The main aim of this study was to evaluate and highlight the pattern of medications most frequently involved in ADRs and the predisposing risk factors among adult medical in-patients in clinical practice setting with the goal of preventing them and improving their treatment outcome. Methods: The patients admitted into the adult medical wards of a Nigerian University Teaching Hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven (507) patients were evaluated during the study, out of which 269 (53.1%) of them were males and 238 (46.9%) were females. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). The drugs most frequently involved in ADRs were insulin in 14 (27.5%) patients, Non-steroidal Anti-inflammatory drugs in 10 (19.6%) patients, antihypertensives in 8 (15.7%) patients, antimalarials in 5 (9.8%) patients, herbal medications in 4 (7.8%) patients and antibacterials in 3 (5.9%) patients. Furthermore, four (4) fatal ADRs were observed during the study; in which herbal medications caused two (2) deaths, sulfadoxine/pyrimethamine combination (maloxine®) caused one (1) death, and Iron dextran caused one (1) death. The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the Antidiabetic drug-insulin use causing neuroglycopenic symptoms and Non-steroidal Anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. The elderly age group (≥ 65 years), presence of polypharmacy (taking more than 5 different pharmacologically active medications by a particular patient at the same time) and the presence of multiple comorbidities in a particular patient are clinically proven and significant risk factors found to be associated with and predisposed adult medical in-patients to ADRs in this study. Conclusion: The negative health burden and consequences of ADRs with the predisposing risk factors were significantly high among these adult medical in-patients. In this study, ADRs increase patients morbidity, mortality and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care and continuous monitoring must be implemented during the course of treating patients with these drugs in order to optimize their clinical efficacy and prevent the occurrence of ADRs in them.

Use of Trigger Tool for Detection of Adverse Drug Reactions among Hospitalized Patients in a Nigerian University Teaching Hospital

Use of Trigger Tool for Detection of Adverse Drug Reactions among Hospitalized Patients in a Nigerian University Teaching Hospital

Economic burden, impact, and consequence of adverse drug reactions among medical inpatients in clinical practice

Background: An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high prevalence. Aim: The main aim of this study was to adequately evaluate the economic burden, impact, and consequence of ADRs among adult medical inpatients in clinical practice, to highlight the pattern of medications most frequently involved in ADRs, and to estimate the economic cost implication of treating ADRs in such clinical practice setting. Methods: The patients admitted into the adult medical wards of a Nigerian university teaching hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven patients were evaluated during the study, out of which 269 (53.1%) of them were male and 238 (46.9%) were female. The mean age of the study population was 48.9 ± 17.8 years (median: 46 years). Most ADRs were mild and moderate in 21 (41.2%) cases and 24 (47.1%) cases, respectively. Severe ADRs occurred in 2 (3.9%) cases, while four (7.8%) cases were fatal ADRs. The economic cost implication of treating ADRs was ₦ 161,668.00 ($1243.60), equivalent to about 1.9% of the total cost of all medications used by all admitted medical inpatients during admission. The cost of treating ADRs per patient with ADRs was ₦ 3169.96 ± ₦ 6348.77 ($24.38 ± $48.84), while the mean ADR treatment cost per admitted medical inpatient was ₦ 318.87 ($2.45). The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the antidiabetic drug – insulin use causing neuroglycopenic symptoms and nonsteroidal anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. Conclusions: The economic burden, impact, and consequence of ADRs were significantly high among these adult medical inpatients. In this study, ADRs increase patients' morbidity, mortality, cost of health care, and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care, and continuous monitoring must be implemented during the course of treating patients with these drugs to optimize their clinical efficacy and prevent the occurrence of ADRs in them.

Comparative study of anxiety and depression following maxillofacial and orthopedic injuries. Study from a Nigerian University Teaching Hospital.

This study hopes to compare levels of anxiety and depression in the maxillofacial and orthopedic injured patients over a period of 12 weeks. This was a prospective, repeated measure design. A total of 160 participants (80 with maxillofacial and 80 with long bone fractures) had repeated review follow‐ups within 1 week of arrival in the hospital (Time 1), 4–8 weeks after initial contact (Time 2) and 10–12 weeks thereafter (Time 3), using hospital anxiety and depression scale questionnaire. Road traffic accident remained the main cause of injury in both groups of subjects. The Hospital anxiety and Depression scale detected 42 (52.5%) cases of depression at baseline, 36 (47.4%) cases at Time 2, and 14 (18.4%) cases at Time 3 in the maxillofacial injured group. In the long bone fracture subjects, 47 (58.8%) cases were depressed at baseline, 23(33.3%) cases at Time 2, and only 5 (7.2%) cases at Time 3. Both groups showed reduction in depression levels with time. Fifty‐six (70.0%) had anxiety at baseline, 32 (42.1%) at Time 2, and only 9 (11.8%) had anxiety at Time 3 in the maxillofacial fracture group, whereas in the long bone fracture group, 69 (86.3%) subjects were anxious at baseline, 32 (46.4%) at Time 2, and 22 (31.9%) at Time 3. There were significant differences in depression and anxiety level in both the maxillofacial and the long bone fracture subjects at baseline (Time 1), Time 2(4–8 weeks) and Time 3(10–12 weeks).