Ogun State University Teaching Hospital Research Articles

"Actual Issues of Nosocomial Infections in Nigeria: A Comprehensive Study at Ogun State University Teaching Hospital, Sagamu"

"Actual Issues of Nosocomial Infections in Nigeria: A Comprehensive Study at Ogun State University Teaching Hospital, Sagamu"

Why are chemotherapy administration errors not reported? Perceptions of oncology nurses in a Nigerian tertiary health institution

Objective:The administration of chemotherapy forms a major part of the clinical role of oncology nurses. When a mistake is made during chemotherapy administration, admitting and reporting the error timely could save the lives of cancer patients. The main objective of this study was to assess the perceptions of oncology nurses about why chemotherapy administration errors are not reported.Methods:This is a descriptive study that surveyed a convenient sample of 128 oncology nurses currently practicing in the Ogun State University Teaching Hospital, Nigeria. The tool for data collection was a structured questionnaire that consisted of two sections. The first section was for the demographic data of participants and the second section consisted of questions constructed based on the Medication Administration Error (MAE) reporting survey developed by Wakefield and his team.Results:Findings showed that majority of the nurses (89.8%) have made at least one MAE in the course of their professional practice. Fear (mean = 3.63) and managerial response (mean = 2.87) were the two major barriers to MAE reporting perceived among oncology nurses.Conclusion:Critically analyzing why medication errors are not reported among oncology nurses is crucial to identifying strategic interventions that would promote reporting of all errors, especially those related to chemotherapy administration. It is therefore recommended that nurse managers and health care administrators should create a favorable atmosphere that does not only prevent medication errors but also supports nurses’ voluntary reporting of MAEs. Education, information and communication strategies should also be put in place to train nurses on the need to report, if possible prevent, all medication errors.

The establishment of sperm morphology satellite training laboratories in Africa

Summary Discrepancies in the results of semen analysis can be caused by a variety of factors, for example, a microscope for semen analysis can be situated in the practice of an urologist, cytologist or microbiologist, or even in a health care office in the countryside in a developing country. The study aimed to evaluate the (i) sperm morphology assessment skills of the participants who attended WHO seminology workshops and (ii) to appraise the possibility of using trained technologists to set up satellite training facilities in their own area. The Centre for Research in Reproductive Health, Ogun State University Teaching Hospital (Nigeria) initiated training sessions in their area. Subsequently, 16 technologists were trained in three sessions. Papanicolaou-stained slides, supplied by Tygerberg were used as test material. Pre- and post-training results were used to calculate the mean percentage of normal cells as well as the percentage deviation from the reference laboratory. The mean percentage normal spermatozoa recorded by the Nigerian trainees during pre-training evaluations differed by 38% from the reference value, compared with a post-training difference of 16% (P < 0.001). Tertiary academic hospitals can play an important educational role in the region. The present results underline the power of long distance educational programmes. Similar laboratories are currently being set up in Kenya and Zambia.

Stroke in South West Nigeria

Stroke is a significant economic, social, and medical problem worldwide. This retrospective follow-up study aimed to review the pattern, types, and case fatality of stroke in Nigeria. Records of all stroke patients admitted into Ogun State University Teaching Hospital (OSUTH), Sagamu, from December 1993 to November 2003 were reviewed. Patients were classified into hemorrhage or infarct using the World Health Organization criteria. Information was obtained as to the time of death in those who died and case fatality at 24 hours, 7 days, 30 days, and 6 months recorded. Autopsy records were also reviewed. A total of 708 stroke patients were reviewed and this constituted 2.4% of all emergency admissions. On clinical grounds, 49% of the patients had cerebral infarction (CI) and 45% had intracerebral hemorrhage (ICH), whereas 6% had subarachnoid hemorrhage. Stroke constituted 1.8% of all deaths at the emergency unit and the case fatality was 9% at 24 hours, 28% at 7 days, 40% at 30 days, and 46% at 6 months. Stroke constitutes a significant cause of mortality and the need for prompt institution of intensive treatment is emphasized. A changing pattern with an increasing frequency of hemorrhagic stroke in our population is suspected. However, because this was a retrospective study based on clinical examination in a highly selected stroke population, neuroimaging confirmation would be needed for any future prospective hospital or population-based studies.

Awareness of Kidney Disorders in Nigeria

This paper assesses the level of awareness of the generality of the populace towards kidney disease, in the Ogun State University Teaching Hospital and its environment. Questionnaires were administered to the administrative staff (excluding medical/nursing workers)) of he Ogun State University teaching hospital, bank workers, market women and artisans in its environment. Responses were analyzed by standard statistical methods. Out of 455 questionnaires administered, there were 415 (91.2%) respondents. Eighty-eight (21.2%) were non-academic staff of the hospital, 123 (29.6 %) were market women, 106 (25.5%) were artisans and 98 (23.6%) were bank workers. Their ages ranged form 15 years to 54 years (mean 34.2+/- 9.7 years), with a sex ratio, (M/F) of 1:1 (192 males and 223 females). Majority of the interviewees, 273 (65.8%) do not know the function of the kidneys. The use of local herbs, indiscriminate use of drug, skin lightening cream, jaundice and scarifications are also believed to be associated with kidney diseases in 300 (72.3%), 270 (5.1%), 140 (33.7%) 263(63.4%) and 98 (23.6%) of respondents respectively. Sixty-eight respondents (16.4%) do not know the common complains associated with kidney diseases. One hundred and eighty-seven (45.1%) believed that kidney diseases are associated with urinary complaints while 99(23.9%) , 56 (13.5%) and 3(0.7%) believed that the common complaints associated with kidney diseases are swelling of the body, body weakness and swelling of the face respectively. This study demonstrated that there is a low awareness of the populace regarding the prevalence, causes and prevention of kidney diseases in the environment. There is need for introducing measures that will improve the awareness of the populace, aim at preventive measures such as pre-employment urinalysis screening and health education.

Spectrum and outcome of clinical diseases in adults living with AIDS at the Ogun State University Teaching Hospital.

To evaluate the changing frequency of HIV/AIDS amongst medical admissions as well as the spectrum and outcome of clinical diseases among these patients. Retrospective study. Tertiary hospital in Nigeria. Two hundred and six People Living With AIDS (PLWA) admitted at the medical wards during the period 1992 to 2002. Treatment was symptomatic in all patients and where appropriate, specific treatment was administered for indicator diseases. Highly Active Anti-retroviral Therapy (HAART) was not used. Mortality within six months of diagnosis. PLWA constituted 4.2% of all medical admissions. The frequency increased from 0% in 1992 to 7.6% in 2001, and dropped to 5% by the year 2002. Seventy patients (34%) died within six months of diagnosis. This study has demonstrated an increasing frequency of HIV/AIDS amongst our medical in-patients from none in 1992 to 7.6% in 2001, and thereafter, a decline in 2002. We suspect that this decline could be a reflection of the health education on HIV, its increasing awareness and the widespread utilisation of effective control measures. Furthermore, the administration of highly active anti retroviral therapy (HAART) to a segment of PLWA in Sagamu by the community medicine department could be contributory. A community based study would be needed to assess the efficacy or otherwise of these current control measures. The advent of saliva and urine tests for HIV detection would ease specimen collection and increase compliance and participation at the community level.

The pattern of infertility cases at a university hospital.

Pattern of infertility cases attending the gynaecologic out patient clinic of Ogun State University Teaching Hospital, Sagamu Nigeria is presented. The incidence of infertility was found to be 14.8% with a mean duration of 3.38 +/- 1.65 years. Secondary infertility predominated with 78.3% incidence. About three quarters (71.1%) were between 25 and 34 years of age and only 6.0% were below 25 years of age Nullipara constituted majority of cases with 56.6%. Past history of induced abortion was significantly present in those with tubal blockage. Male factor only was the cause in 26.8%, female factor only in 51.8% and both male and female factors were contributory in 21.4% cases. The male partners refused semen analysis in about one third of cases (32.5%).

Clinical diabetic nephropathy in a tropical African population.

Diabetic nephropathy is the single most important disorder leading to renal failure in adults in the Western countries and it is among the first three major causes of end stage renal disease in Nigeria. The aim of this study is to show the features of clinical diabetic nephropathy in the Olabisi Onabanjo University Teaching Hospital, Ogun State, Nigeria. The study group consists of 342 consecutive diabetic patients with persistent proteinuria (positive albustix) and diabetic retinopathy, seen from January 2000 to June 2001 in the Ogun State University Teaching Hospital, Sagamu. Clinical and laboratory parameters were recorded. Students' t-test and Spearman correlation coefficient were used in analysis. The frequency of occurrence of clinical diabetic nephropathy is 28.4% with majority already symptomatic despite normal biochemistry. Mean ages of type 1 and type 2 are 26+/-7.9 years and 53.4+/-6.3 years respectively with a sex ratio of 1.2:1. Mean duration of disease is 6.5+/-3.6 years and 9.4+/-4.1 years respectively. Two hundred and seventy-one (79.2%) patients were hypertensive. Nephrotic syndrome is not a common presentation. Diabetic nephropathy is a significant problem in this environment.

Outcome of Pregnancy and Labour in the Nullipara

Context: Nulliparous women are reportedly at a higher risk of developing complications of pregnancy and delivery than multipara. There is a need to document the outcome of their pregnancy in order to improve the quality of care they receive. Objectives: To find out problems associated with pregnancy and labour in the nullipara compared to their multiparous counterparts. Subjects and Methods: The delivery records of 528 nulliparous women and 2980 multipara delivering singleton babies at Ogun State University Teaching Hospital, Sagamu from January 1988 to December, 1990 were retrieved and data about the socio-demographic and clinical characteristics of the patients were extracted for analysis. Results: The mean age of the nullipara and the multipara were 21.2 (SD 3.5) years and 27.4 (SD 5.7) years respectively, a statistically significant difference (p Conclusion: Both the nullipara and multipara are exposed to a variety of complications in pregnancy, which require prompt and adequate attention in order to forestall perinatal and maternal morbidity and mortality. Key Words: Pregnancy, Parturient, Parity, Outcome. [Trop J Obstet Gynaecol, 2003, 20: 56-58]

Antidiabetyics / Antihypertensives Prescription Profile In Osuth, Sagamu And Environment

Purpose of the study: The aims of this paper are to investigate drug utilization in the utilization in the management of diabetes mellitus and hypertension is sagamu, Ogun state and its environment and to evaluate their agreement with established guideline Methodology: prescription on both diabetes and hypertension were collected over a period of the weeks at the Ogun state University Teaching Hospital and from a general (state) hospital in its environment. Statistical analysis was by using a chi – square test for proportions and students t – test for parametric data. Ap – value of less than 0.05 was considered significant. Results: the study involved 1360 consecutive prescriptions form the medical unit of the general hospital and 1440 consecutive prescriptions from the Teaching Hospital (712from the diabetic clinic and 728 from the hypertensive clinic). A total of 210 patients (15.4%), 1040 patients (76.5%) and 110 patients (8.1%) in the general hospital were prescribed one or more antidibetic agents, antihypentensive and combination of both respectively. In the teaching hospital a total of 330 patients (22.9%) 633 patients (43.9%) and 477 patients (33.1%) considered respectively to be diabetic alone, hypertensive alone and combined diabetic and hypertensive. In both setting, most 50% of the diabetics were treated with glibenclamide, About 90 (27.3%) of the patient in the general hospital were on two sulfonylurea. Insulin was prescribed top 3 (0.9%) and 16 (2.2%) of the prescribed in both hospitals: even when prescribed, it is in combination with a sulfonylurea. The use of antihypertensive drugs was more prevalent among patients without diabetes than those with diabetes in both population [general hospital 202 (19.4%) vs 28 (19 .7%) and in the teaching hospital 1239 (20.4%) vs. 27 (4.3) %, p Conclusions; The prescription pattern of antidiabetice and more importantly antihypertensive is still at variance with established guidelines in these hospitals Key Words: prescription profile, Antidiadetics Antithypertesives Nigerian Journal of Clinical Practice Vol.7(1) 2004: 15-20

Mechanical Birth Trauma – An Evaluation of Predisposing Factors at the Ogun State University Teaching Hospital, Sagamu.

Fifty neonates were identified in a study carried out to determine the factors predisposing to mechanical birth trauma in neonates at the Ogun State University Teaching Hospital, Sagamu. Data were collected retrospectively from 1989 to 1990 and prospectively from 1991 to 1994. The incidence of mechanical birth trauma among inborn babies was 9.17 per 1000 live births. Non-booked deliveries were at a higher risk for birth trauma than booked ones (_2 = 14.03, p < 0.01). The common injuries encountered were scalp haemorrhage, fractures and nerve palsies. Birth weight above 4000g was associated with a higher risk of birth trauma than the reference group weighing 2500 – 2999g (odds ratio = 10.17, 95% confidence limits = 2.02 – 51.2). Five of eight cases of fractures occurred following breech delivery, and three (37.5 percent) occurred in preterm, very low birth weight retained second twins or triplets. Forty four percent of all cases suffered concomitant severe birth asphyxia. It is recommended that greater effort be made through health education to encourage early presentation or referral to centres capable of handling high-risk cases and improvement of facilities at those centers. A cautious approach to Caesarean section for delivering very low birth weight twins is advocated vis--vis available facilities for intensive neonatal care and therefore, chances of survival. Nigerian Journal of Paediatrics 2002; 29:61-65.

Pattern of paediatric ophthalmic admissions into the Ogun State University Teaching Hospital, Sagamu

Visual impairment in childhood is an impediment to learning and social development. A study of paediatric ophthalmic admissions into the Ogun State University Teaching Hospital, Sagamu, was conducted to establish the main causes of admission, and the visual outcome after treatment. Of the 89 eyes in 67 patients whose case notes were analysed, infection (38 per cent), trauma (30 per cent), congenital diseases (17 per cent) and tumours (15 per cent) were the four main groups of ocular diseases seen. Measles infection was the major blinding disease. Trauma was associated with the worst visual prognosis in spite of treatment. Congenital cataract was the commonest congenital ocular disease. Although the visual outcome after cataract surgery was fair, the development of amblyopia prevented maximal visual recovery. The possibility of rubella aetiology of the cataract could not be ruled out in these patients. There is a need for sustained commitment to immunization. The availability of ophthalmic microsurgical instruments will improve the surgical care of patients with a view to better visual outcome. Nigerian Journal of Paediatrics 2002; 29:47-52

Bacterial pathogens associated with infected wounds in Ogun State University Teaching Hospital, Sagamu, Nigeria

A prospective study was conducted at Ogun State University Teaching Hospital (OSUTH) between August 1999 and July 2000 in the Orthopaedics, Obstetrics and Gynaecological units to identify the bacterial pathogens associated with infected wounds as well as their antibiotic sensitivity profile. A total of 1670 patients were seen in these units, out of which 130 (7.78%) developed wound infections. There was a statistical difference (P < 0.05) between the septic wounds associated with the non-operative cases (11.9%) and those of post-operative cases (6.41%). Amongst the 186 bacterial agents isolated from all the samples examined, Klebsiella species (25.3%) accounted for the most common isolates while the least was Enterococcus faecalis (5.4%). Klebsiella species was observed to be most prevalent in the Obstetrics and Gynaecological wounds while Pseudomonas aeruginosa was the commonest in the Orthopaedic wounds. The sensitivity profile of the isolates to the commonly used antibiotics including those used as pre-operative prophylactic agents ranged between 1.67-46.8%, the range for the aminoglycosides was between 61.8-75%, while the fluoroquinolones had a range of 82.8%-89.2%. The high level of bacterial resistance to the common antibiotics in this study, re-emphasized the need to properly monitor the use of antibiotics including those used as pre-operative prophylactic agents in this country. (Af. J. of Clinical and Experimental Microbiology: 2002 3(1): 13-16)

Complicated induced abortion in Sagamu, Nigeria

A review of cases of induced abortion managed at Ogun State University Teaching Hospital, Sagamu from January 1988 to December 1997 is presented. One hundred and two cases were treated for various complaints and complications of induced abortion during the period of review. The mean age in years was 24·6 - 5·8. The groups 20-24 years, 15-19 years and 25-29 years constituted 39·2%, 23·5% and 18·6%, respectively, of the patients. Mean parity was 1·7 - 1·8. Thirty-eight point two per cent, 30·4% and 17·6% were para zero, 2-4 and 1, respectively. Fifty-one per cent of the patients were single. Thirty-four point three per cent, 15·7% and 2·0% of the patients have had one, two and three induced abortions before. Forty-five point one per cent of the patients refused to disclose where and who performed the abortion, while 31·4%, 10·8% and 7·8% of the abortions were carried out by physicians, quacks and nurses. Forty-five point one per cent of the patients procured the abortion at the gestational age of 13-24 weeks, while 26·5% waited for 10 days and over after the abortions before seeking for medical help. Thirty-six point eight per cent and 26·3% of operators in fatal cases were physicians and nurses, respectively. The mean admission interval after abortion for fatal cases was 11·1 - 3·2 days and 4·0 - 3·5 days for other cases that survived and the difference was significant ( t =8·0930; P <0·001). Eighty-five point three per cent had never used any form of contraception. Seventy-nine point four per cent, 61·8% and 6·9% of the patients presented with bleeding per vaginam, abdominal pains and fever, respectively. The most common complications were anaemia (56·9%), haemorrhages (46·1%), sepsis (33·3%) and maternal death (18·6%). The maternal mortality ratio was 18 627·5 per 100 000. The difference between maternal mortality ratio due to abortion and the general population (1578·9) was statistically significant ( h 2 =126·4281, P <0·001). Sunction aspiration (76·5%) and exploratory laparatomy (9·8%) were the most common operations performed. The findings in this series further highlight the urgent need to eliminate or reduce substantially the factors responsible for septic induced abortion.

Ruptured uterus at Sagamu, Nigeria

Ruptured uterus, the largest contributor to maternal deaths in our center was reviewed to find ways of reducing it and improve the outcome. Sixty cases treated at Ogun State University Teaching Hospital, Sagamu between January 1988 and December 1997 were scrutinised. During the 10 year period, total deliveries were 5,214 giving an incidence of 11.5 per 1,000. 76.7% of cases occurred in patients aged 30 years and more; and 58.6% in para 4 and more. 88.3% were unbooked. The ruptures were spontaneous in 76.7% and lower uterine segment was the most common (80%). Uterine repair with sterilisation was carried out in 46.7%, sub total hysterectomy in 26.7% and repair only in 11.7%. Most of the aetiological factors were preventable by good antenatal care and the outcome improved by early referral and efficient blood transfusion system.

Maternal mortality at Sagamu, Nigeria--a ten year review (1988 - 1997)

A review of maternal deaths at the Ogun State University Teaching Hospital, Sagamu, Nigeria over a 10 year period is presented. During the period, there were 92 maternal deaths, those from abortion and ectopic pregnancy inclusive. The total deliveries were 5423 giving a maternal mortality ratio of 1700 per 100,000. Ruptured uterus was the most common cause followed by eclampsia, postpartum haemorrhage and complications of abortion in that order. Unbooked patients constituted about one third of the total (29. 1 %). Primipara and grandmultipara were the most at risk of maternal death and the risk of dying following operative delivery was six times that of vaginal delivery. Easy access to affordable antenatal care, good blood transfusion services, more widespread use of contraceptives and training of traditional birth attendants would help reduce the risk of maternal death.

Perinatal Mortality at the Ogun State University Teaching Hospital, Sagamu, Nigeria

A study of perinatal mortality at the Ogun State University Teaching Hospital during the first 30 months (March 1989 to August, 1991) of the establishment of a separate neonatal unit was made. One-hundred-and-sixty-two (87.5/1000) of the 1852 deliveries were stillborn and 60 (35.5/1000) of the 1690 live births died in the early neonatal period. The overall perinatal mortality rate was 119.9/1000 deliveries. Of stillbirths, 82 per cent occurred in unbooked mothers and were diagnosed at presentation. The major causes of stillbirths were teenage pregnancy, elderly motherhood, high maternal parity, and prolonged, obstructed labour. The major causes of early neonatal death were low birth weight, breech delivery, and severe birth asphyxia. The need for increased utilization, improvement, and regionalization of antenatal and perinatal services is emphasized.

Maternal Formal Education and the Four-Child Policy in Nigeria

A cross-sectional survey was done in the puerperium of 320 mothers who delivered at Ogun State University Teaching Hospital, Sagamu, Nigeria over a period of three months. The patients were stratified according to their parities in relation to their levels of formal education. The results showed that those with the least formal education were the most parous (p less than 0.005) and had the highest perinatal deaths. The difference between perinatal deaths suffered by mothers with no formal education and those with post-secondary school education was statistically significant (p less than 0.05). No association was demonstrated between the level of formal education and the delivery of low birthweight infants. When compared with grandmultiparae (parity greater than or equal to 5), primipara had more formal education (p less than 0.005). Therefore, for a successful implementation of the four-child policy in Nigeria, a concerted effort must be made to encourage maternal formal education. This should be to at least secondary school level.