Secondary Health Facilities Research Articles

The Association Between Asymptomatic Placental Malaria Infection and Pregnancy Outcome in Delta State, Nigeria

Purpose: Parturients in the Sub-Saharan African are susceptible to malaria disease due to their reduced immunity during pregnancy. Asymptomatic placental malaria causes neonatal and maternal mortalities, preterm deliveries as well as low birth weight babies. Current studies on malaria in pregnancy indicated that the risk factors are location specific, and there are limited studies in Nigeria on asymptomatic placental malaria and pregnancy outcome (babies birth weight and delivery term). The purpose of this study was to determine the association between asymptomatic placental malaria infection and pregnancy outcome (baby’s birth weight and delivery term) among parturients in Asaba, Delta State, Nigeria.
 Methodology: Quantitative methodology with primary and secondary healthcare facility data from 483 subjects aged 18–49 years generated from four healthcare facilities between May and July 2021 was used for this study. The Socio-Ecological Model framework was used to describe how parturients can achieve enhanced pregnancy outcome through the utilization of multi-levels of supports to enhance the compliance of pregnant women to the existing malaria interventions. The research questions and hypotheses were tested with the binomial logistic regression.
 Result: The findings showed a statistically significant association between baby’s birth weight, delivery term and placental malaria parasitemia (PMP), in the study population. Also, the identified risk factor for baby’s birth weight in this study was gravidae, while that of delivery term was age groups, gravidae, ITN frequent use and ANC attendance.
 Unique Contribution to Theory, Policy and Practice: The findings of this study could inform malaria control policymaking in Asaba and Delta State on tracking and treating asymptomatic malaria among underserved pregnant women accessing antenatal services to improve baby’s birth weight, delivery term, and the associated complications.

The prevalence and determinants of non-communicable diseases among Ghanaian adults: A survey at a secondary healthcare level.

The current epidemiological transition of diseases in Ghana necessitates understanding their burden and the associated context-specific risk factors to inform disease prevention strategies. To determine the prevalence and determinants of selected Non-Communicable Diseases (NCDs) among patients seeking healthcare services in a secondary health facility in Ghana. A facility-based survey was conducted among adult patients 18 years and above between May and July 2021, using a multi-stage sampling approach. Data regarding the prevalence of NCDs, participants' socio-demographics and lifestyle factors of NCDs were obtained using Modified STEPwise Approach to NCD Risk Factor Surveillance (STEPS). The Chi-square test and regression analysis were performed to identify the risk factors of NCDs at P < 0.05. The participants comprised 480 patients with a mean age of 37.7±16.5 years, and 57.7% (277/480) of them were females. The overall prevalence of the selected NCDs was 26.7% (CI = 0.23-0.31), of which hypertension (22.7%) was the most prevalent. More than half (54.2%) of the participants engaged in alcohol consumption and 54% were physically inactive. The odds of developing NCDs were higher in females (CI = 1.32-4.10, P = 0.004), older adults (CI = 4.11-20.68, P <0.001), overweight/obese adults (CI = 1.65-4.70, P < 0.001), family history (CI = 0.15-0.46, P<0.001), and alcohol consumption (CI = 0.12-0.40, P < 0.001). There was an overall high prevalence of NCDs, strongly influenced by the participants' age, sex, BMI, alcohol consumption, and family history. These determinants should be highlighted as part of the campaign for preventive action plans.

Case Report: Lesson Learned from Delayed Definitive Treatment of Stage 4 HIV Patient with Cerebral Toxoplasmosis – A Case Report

Background: Cases of cerebral toxoplasmosis continue to burden people living with HIV/AIDS (PLWHA). This surge in cases is primarily due to patients’ delayed definitive treatment, missed follow-up, and insufficient diagnostic equipment in some regions, particularly in developing countries such as Indonesia.Case Presentation: We report on a 35-year-old male referred to the emergency department with impairment in four extremities from a secondary healthcare facility. Specific atypical symptoms that mimicked subacute meningitis were identified during the physical examination. Internists, neurologists, and rehabilitation medicine professionals were associated with the management.Conclusion: We suggest that improved early diagnosis and treatment of HIV patients to prevent opportunistic infections, including cerebral toxoplasmosis, is needed, particularly in primary healthcare facilities in developing countries.

Birth preparedness and complication readiness: Evaluating the "know-do" gap among women receiving antenatal care in Benin City, Nigeria.

Across several African countries, birth preparedness and complication readiness (BPACR) among pregnant women is poor. The practice of BPACR, though improving in recent years, is not commensurate with the knowledge available to pregnant women. Maternal health indices remain sub-optimal. This study evaluates the determinants of this "know-do' gap among women receiving antenatal care at a secondary health facility in Benin City, Nigeria. A cross-sectional study involving 427 pregnant women was conducted between October and December 2020 using a structured interviewer-administered questionnaire. The prevalence of knowledge and practice were described, and the determinants of BPACR practice evaluated using bivariable (chi-square) analysis and multivariable ordinal logistic regression with post-estimation predictive margins analysis. About 77% of respondents had good birth preparedness practice. Multivariable regression revealed that respondents with poor knowledge and moderate knowledge of components of BPACR had statistically significant lower odds (OR:0.05 (95% CI: 0.02-0.13) and 0.10 (95% CI: 0.03-0.30) times, respectively) for greater practice of BPACR when compared to those with good knowledge. Respondents with poor knowledge of danger signs had statistically significant lower odds (OR: 0.08 (95% CI: 0.03-0.26) for greater practice of BPACR when compared to those with good knowledge. But predictive margins analyses demonstrates that knowledge, though critical to practice, is insufficient to optimize practice. The optimum number of danger signs women need to know to improve practice may be between eight to ten. Beyond this number, practice may not change significantly. Other predictors of BPACR practice include income level, parity, gravidity, and residential settings. The number of antenatal clinic visits had no statistically significant correlation with BPACR practice. Interventions to facilitate practice at the community level may be helpful to improve outcomes and bridge the know-do gap with respect to BPACR within the study context.

Evaluation of self-medication habits among patients at the Odontostomatology unit of a secondary health facility in Cameroon

Self-medication is a major public health issue because of the hazard it creates, such as therapeutic failures and the emergence of multi-resistant bacteria, but it is still poorly documented in our local context.Our goal was to determine the prevalence of self-medication due oral diseases when they visit the Odontostomatology unit of a secondary health facility in Cameroon. Materials and methodsFrom February to May 2020, we conducted a descriptive cross-sectional study at the Odontostomatology unit of the PCC Dental Office of Djoungolo. After obtaining informed consent, data was collected using questionnaires. For the statistical analysis, the significance level was set at 5%. ResultsWe retained 147 patients (75 women and 72 men) in our study. The average age was 35.3 years ± 13.5 years. Self-medication was used by 88% of our patients, and the most common reason for consultation (81% of cases) was dental pain. The most used drugs for self-medication in our patients were NSAIDs and analgesics. In our study, amoxicillin was the most used antibiotic (21%). In terms of supply routes, the pharmacy was the most common source of drug supply (39%). In our study, the factors significantly associated with self-medication were age >30, low levels of education, and certain socio-professional activities. ConclusionThe prevalence of self-medication during oral diseases is high and is closely related to our country's socioeconomic context. This study highlights the primacy of educating patients about the risks of taking drugs without a prescription and the benefits of having routine consultations with an oral physician.

Mean quality of life of hypertensive and diabetic patients: A comparative study of patients in secondary and tertiary health facilities in Kaduna State, Nigeria.

Hypertension and diabetes have become major non-communicable diseases of public health importance globally, considering the magnitude of the diseases, the propensity to worsen the patients' quality of life and the associated mortality. This study compared the health-related quality of life (HRQOL) of hypertensive and diabetic patients in both tertiary and secondary health facilities in Kaduna State, north-western Nigeria. This was a descriptive comparative cross-sectional study amongst 325 patients, of which 93 (28.6%) were from the tertiary and 232 (71.4%) were from the secondary facilities. All eligible respondents participated in this study. Data were analysed with SPSS version 25 and STATA SE 12, t-test for comparison of two means, Chi-square and multivariate analyses were performed with P < 0.05. The mean age was 55.72 ± 13 years. Two-thirds, 197 (60.6%), were hypertensive only, 60 (18.5%) were diabetic only (18.5%) and 68 (20.9%) were hypertensive diabetic. For the hypertensive only at the tertiary facility, the mean scores for vitality (VT) (68.0 ± 5.97, P = 0.01), emotional well-being (EW) (77.33 ± 4.52, P = 0.0007) and bodily pain (BP), (74.17 ± 5.94, P = 0.05) were significantly higher for tertiary compared with those at secondary facilities. The mean HRQOL for the people with diabetes only at the tertiary facilities also showed statistically significant higher scores for VT (72.2 ± 61, P = 0.01), social functioning (72.2 ± 8.4, P = 0.02), EW (75.44 ± 4.9, P = 0.001) and BP (85.56 ± 7.7, P = 0.01) when compared with the secondary facilities. Patients managed by specialists at the tertiary health facility had better HRQOL than those managed at the secondary health facilities. Continued medical education and the use of standard operating procedures are recommended for improved HRQOL.

Infection Prevention and Control Practice among Healthcare Professionals in Two Public Hospitals in Edo State, Nigeria.

Background: Effective infection prevention control (IPC) have been shown to reduce healthcare associated infections and to curtail epidemics and pandemics. Compliance by healthcare professionals (HCPs) is an important part of IPC measures. Objectives: This study investigated IPC practice, barriers and enablers among healthcare professionals (HCPs) in secondary and tertiary healthcare facilities. Methods: This was a cross-sectional study among 370 HCPs in a tertiary and secondary healthcare facility. Data was collected using an interviewer-administered questionnaire and the assessment was done using defined scoring systems. SPSS version 22 and Graphpad Instat were used for data analysis. Associations between variables were assessed using Chi-square and student’s t tests with significance level set at p&lt;0.05. Results: Of the 370 participants, 195 (52.7%) had an average score for IPC practice and 269 (72.7%) of participants had good score for hand hygiene. HCPs in tertiary institution had a higher mean score compared to those in secondary institution on IPC (41.52±5.96/41.07±8.46-p=0.0009) and hand hygiene practice (30.72±5.979/29.08±5.63; p=0.1747) respectively. Nurses had a higher mean score compared to physicians on IPC (31.19±4.801/25.60±7.937; p=&lt;0.001) and hand hygiene (43.34±4.170/39.83±3.673; p=0.001). Barriers to IPC are work overload 299(80.8%), lack of adequate materials 319 (86.3%) and lack of hand hygiene facilities 260 (70.8%). Conclusion: This study revealed that many HCPs had moderate practice of IPC and good practice of hand hygiene. Differences in practice among HCPs was observed which can be addressed with hospital leaders creating a stronger IPC culture and routine training of HCPs.

Placenta Disposal Practices among Doctors and Nurses in Obstetric Units of Secondary and Tertiary Health Facilities in Enugu State, Nigeria

Background: Anecdotal evidence suggests that placentas may be improperly disposed of due to the lack of knowledge of the best approaches. The reason women request for their placenta in Nigeria remains unclear. Aim: The aim is to determine the knowledge and perceptions of doctors and nurses about the use of WHO guidelines for the safe disposal of hospital wastes in placenta disposal and to explore their placenta disposal practices at tertiary and secondary health facilities in Enugu state. Materials and Methods: This was a mixed-method study design in which 163 doctors and nurses drawn from 3 secondary and 3 tertiary hospitals in Enugu Metropolis were studied. Quantitative component involved the use of interviewer-administered questionnaires. Knowledge and perceptions of respondents on the use of WHO guidelines to dispose of the placenta were documented. Knowledge of WHO guidelines was assessed and graded: good knowledge (score ≥12) and poor knowledge (score &lt;12). Perception was assessed using 4 Likert-type questions whose responses were scored. Mean score ≥0.5 (positive perception), mean score &lt;0.5 (negative perception). The qualitative component involved purposive sampling of 6 nurses who were the labour ward unit heads. In-depth interviews using semi-structured questionnaires were conducted to ascertain their placenta disposal practices and why women request placentas in their hospitals. Analysis was done for quantitative components using IBM SPSS version 20.0. Analyses were both descriptive and inferential. Analysis of the qualitative component established three thematic areas following the transcribing and coding of the contents of the interview. Results: Thirty-three (20.2%) and 158 (96.9%) had good knowledge (mean score = 12.7 ± 0.48) and positive perceptions (mean score = 2.96 ± 0.65), respectively, toward the use of WHO guidelines for placenta disposal. Placenta pits were the most common method for disposing of placenta. Those who request their placenta do so for cultural reasons (bury at home), avert being used for money rituals by health workers, and for the baby to be complete. Conclusion: A high proportion of doctors and nurses in Enugu state have poor knowledge but a positive perception toward WHO guidelines for disposing of placenta. The most common means of disposal was the placenta pit.

Unsafe injection practices and its predictors in Government health care facilities of Central India.

Introduction- Irrational and unsafe injection practices are Insidious in developing countries harming the patient and alluring risks to the health care workers. Poor injection practices, including injection overuse and unsafe practices have been reported in many developing and transitional countries Objective - To determine the proportion and predictors of unsafe injections practices in government health facilities. Material and method - It was a descriptive cross-sectional study done in duration of 6 months A sample of 280 was calculated and 83 injection units of 11 government health care facilities were considered for the assessment. Generation of descriptive Statistics was done. Chi-square test and multivariate logistic regression analysis was used to identify potential risk factor of unsafe injection practices. Result- 45 % of the injection practices out of total 280 observed injection practice in all the 11 facilities selected in study is found to be unsafe. Primary health care facilities were 2.13 times more likely to exhibit unsafe injection practice while secondary health care facilities were 1.45 times more prone to unsafe injection practice as compare to tertiary health care facilities. Conclusion- High frequency of noncompliance to best injection safety practices are widespread in the government facilities. This Situation is even worse in the primary health center and community health center.

Implementation Status of Airborne Infection Control Measures in Primary and Secondary Public Health Facilities, Puducherry: A Mixed-Methods Study.

Poor ventilation in healthcare settings is a concern for airborne infections, particularly in light of the potential for coronavirus disease 2019 (COVID-19) transmission. This study aimed to assess the implementation status of airborne infection control (AIC) measures in primary and secondary public healthcare facilities (HCFs) and to explore the facilitating factors and barriers in the implementation of AIC measures. A mixed-methods approach was adopted, which includes a cross-sectional descriptive study using a checklist to collect data on the implementation of AIC measures in 22 primary and two secondary public HCFs in Puducherry, South India, between October 2020 and February 2021. Further, key informant interviews (KIIs) were conducted among medical officers (MOs). The qualitative data were manually analyzed, and transcripts created from handwritten notes and audio recordings were deductively evaluated. Of the twenty-four health facilities visited, 54.2% had infection control (IC) committees. Annual IC training was held for housekeeping staff, MOs, nurses, and laboratory technicians in 23 (95.8%), 21 (87.5%), 20 (83.4%), and 14 (58.4%) facilities, respectively. Respiratory symptomatic patients were counseled on cough etiquettes in 22 (91.6%) facilities. Adequate cross-ventilation was present in outpatient departments in 16 (66.6%) institutions. N95 masks and face shields were provided in 21 (87.5%) facilities. Training through the KAYAKALP program and the presence of a separate sputum collection area were facilitators of IC, while lack of patient adherence and delays in fund release were found as barriers. Overall, the AIC measures were well-implemented, but improvements are needed in infrastructure development for patient segregation in outpatient departments and dedicated AIC training for all healthcare personnel.

Gestational glucose intolerance (GGI) and gestational diabetes mellitus (GDM) among antenatal women attending urban community health centers of Lucknow: A cross-sectional study.

Gestational diabetes mellitus (GDM) is an emerging public health concern in India, which has detrimental effects on both the mother and the baby. The data on prevalence of GDM was unavailable at secondary urban health facilities, from where a majority of pregnant women seek antenatal services, and the following study identifies this burden. A cross-sectional study was conducted from May 2019 to June 2020 among pregnant women attending the antenatal outpatient department (OPD) at secondary level health facilities in urban Lucknow. A semi-structured interview schedule was administered to the study subjects for collecting the relevant information and 75 g of oral glucose tolerance test was performed irrespective of the meal. The cut-off points taken for the diagnosis of GDM and gestational glucose intolerance (GGI) was as per the guidelines of the Ministry of Health and Family Welfare for diagnosis of GGI/GDM. The overall prevalence of GDM and GGI in the study was 11.6% and 16.8%, respectively. Three-fourth of the women (22/29) were diagnosed with GDM in the second trimester of pregnancy. The prevalence of GDM (16.7%) was significantly higher in pregnant women aged more than 25 years and in those who were overweight. Mean birth weight (3.2 ± 8.1 kg) of the babies was significantly higher in the women with GDM. Among the fetal complications was respiratory distress observed among 28 pregnant women and 31% of them had GDM and this was statistically significant. The prevalence of GGI and GDM was found 16.8% and 11.6%, respectively. Gestational age, pre-pregnancy weight, pre-pregnancy BMI, weight gain during the pregnancy, family history of diabetes. PCOS, macrosomia and GDM in prior pregnancies was found to significant with GDM in the study.

Hepatitis B and C virus prevalence among patients and healthcare workers' prevention practices towards the viruses in a secondary healthcare facility in Northern Nigeria.

hepatitis B Virus (HBV) and hepatitis c virus (HCV) affect millions of people globally. Healthcare workers (HCWs) are at increased risk of infection due to occupation exposures where the viruses are spread mainly through needle stick injuries and exposure to infected blood and body fluid. The objective of this study was to assess the prevalence of viral hepatitis among patients and the practices of HCWs. this study involved a 5-years retrospective review of laboratory results of patients for HBV and HCV in addition to a questionnaire-based assessment of the preventive practices of 103 HCWs on HBV and HCV. Data was analyzed using SPSS. the prevalence of HBV among the patients was 12.6% and 15.2% for HCV while the prevalence among the HCWs was 6.6% for HBV and 6.5% for HCV. About 60% of the HCWs had good overall preventive practices for viral hepatitis. Among the HCWs, 29.28% dropped needles in sharp containers after use, 53.5% recapped needles, 21.4% reused needles, 36.9% did not practice regular hand washing, and 53.4% completed the doses for HBV vaccine. there is high prevalence of HBV and HCV among the patients and the HCWs. This increases the occupational risk of infection with the viruses among HCWs. We recommend that more enlightenments and trainings be done for the HCWs to enable them take appropriate measures to protect themselves. Also, HCWs should provide HBV and HCV screening to patients accessing care and those found positive should be linked to care and treatment.

Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State.

There has been a concerted effort to reduce malaria burden and bring malaria related mortality to zero. The objectives of this survey were to assess the level of adherence to the current revised malaria control guidelines in the public health facilities in Cross River State of Nigeria and to identify the challenges as well as suggest ways for improvement in treatment outcomes. This was a mixed observational and qualitative survey conducted in 32 public health facilities from 21st to 25th June 2022. Treatment records on malaria were assessed for adherence to the National guidelines. In-depth interviews were conducted with 36 key informants and 4 purposefully selected stakeholders to identify the successes and challenges. Quantitative data were summarized and presented in simple proportions and percentages while qualitative information was recorded, the transcripts thematically coded, analyzed and presented using NVivo 11 software. The survey revealed that vector control program was poorly implemented across the state. For case management, presumptive treatment was frequently practiced especially at secondary health facilities for uncomplicated malaria. More than 60% of uncomplicated malaria were being treated with parenteral artemether instead of oral artemisinin combination therapy (ACTs) as recommended. Severe malaria were not treated with Intravenous (IV) Artesunate as first line drug in about 40% of the secondary health facilities. Key successes were noted in malaria management in pregnancy. Major challenges identified include: stock out of commodities, shortage of clinical man power, and low trust in parasitological diagnosis. The survey showed that adherence to the key recommendations in various categories of malaria control among health care providers in the public health facilities was below expectation. Malaria preventive treatment in pregnancy with SP fared better perhaps because of its inclusion in ANC packages.

Prevalence of Depression and Anxiety in Patients with Diabetes Mellitus at a Secondary Level Government Health-Care Facility in Northern India

Abstract Background: Diabetes is one of the largest global health emergencies of the 21st century. As per the International Diabetes Federation (IDF) in 2020, 463 million people have diabetes in the world and 88 million people in the Southeast Asia region. Seventy-seven million out of 88 million belong to India. The prevalence of diabetes in the population is 8.9%, according to the IDF. There exists a bidirectional association between diabetes and depression/anxiety, with both worsening each other’s prognosis. The prevalence rates of depression could be up to three times higher in patients with type 1 diabetes and twice as high in people with type 2 diabetes, while anxiety disorders are seen in 40% of the patients with type 1 or 2 diabetes mellitus. Although no single cause has been identified for the positive correlation between diabetes and depression and anxiety, it is widely accepted that hypothalamic–pituitary–adrenal dysfunction, pro-inflammatory cytokines, and a host of other epigenetic factors are responsible for the increased prevalence. This study was undertaken to check the prevalence of anxiety and depression in patients with diabetes mellitus attending the outdoor clinics of internal medicine department at a district hospital, Fatehgarh Sahib, Punjab. Materials and Methods: Four hundred patients were included in our study. A semi-structured pro forma was used to collect demographic details, and anxiety and depression were screened using the Hamilton Anxiety and Depression Rating Scales, respectively. Data collected were subjected to statistical analysis. Results: Fifty-eight percent of the sample population had depression and 27% had anxiety, with a vast majority having mild symptoms. Gender and duration of diabetes were statistically significant variables affecting prevalence and severity, with females having a higher mean scores of depression and anxiety than males and higher scores with greater duration of the illness. Conclusions: This study implies need for routine screening of depression and anxiety symptoms in patients with diabetes mellitus and treating them at the earliest.

Strengthening antimicrobial stewardship activities in secondary and primary public healthcare facilities in India: Insights from a qualitative study with stakeholders

PurposeExamining the existing federal and state policies in place that could strengthen antimicrobial stewardship (AMS) activities in district and sub-district hospitals in India. MethodsIn-depth interviews were conducted with national and state level policy makers and various stakeholders at a district hospital. For national level, officials from the National Health Systems Resource Centre (NHSRC) were approached. The state of Haryana was selected and officials from Haryana State Health Systems Resource Centre (HSHRC), a state-level counterpart of the NHSRC, along with officials from the Health Department and relevant stakeholders from one of the district hospitals of the Haryana state were selected as participants. The recorded interviews were transcribed verbatim and thematic analysis was done. ResultsSeveral measurable elements within the existing policies such as National Quality Assurance Program (NQAP) and Kayakalp program, could be leveraged to strengthen AMS activities in district and sub-district hospitals, were identified. These cover aspects such as infection control, standard treatment guidelines (STGs), prescription auditing, essential medicine list (EML), availability of antimicrobials and incentives for meeting quality standards. Revising the EML based on WHO AWaRe classification, incorporating the STGs for common clinical infections from the WHO AWaRe antibiotic book and Indian Council of Medical Research (ICMR), program mandated requirements for dedicated staff/standards for AMS activities and antimicrobial-specific prescription audits as per WHO AMS tool-kit and ICMR AMS guidelines are identified as opportunities for strengthening AMS activities. Further, hindrances in executing existing policies were also identified such as shortage of human resources, reluctance to follow STGs, and limited availability of diagnostic microbiology laboratory services. ConclusionImplementing NQAS and Kayakalp program in public healthcare facilities are identified as existing well working key programs that aid in improving AMS activities with incorporation of WHO and ICMR recommended practices.

Nationwide Distribution of Facilities with Certified Nurse Administrators, and Secondary Healthcare Area and Facility Characteristics Related to their Affiliation: A Open Data Analysis using a Geographic Information System

Nationwide Distribution of Facilities with Certified Nurse Administrators, and Secondary Healthcare Area and Facility Characteristics Related to their Affiliation: A Open Data Analysis using a Geographic Information System

Additional overnight video EEG for the diagnosis of epilepsy: Experiences from Western Kenya

ObjectiveThe prolonged video EEG monitoring is widely used for the diagnosis and management of epilepsy, especially during the presurgical evaluation. The routine practice in neurology is to order a prolonged recording like an overnight EEG when the initial routine EEG is normal or unrevealing. Only few studies have evaluated this sequential approach and we aimed in this study to evaluate the added diagnostic value of a relatively brief video EEG monitoring especially in developing nations where the history of seizure semiology may be harder to obtain, and the video EEG monitoring technology is scarce. MethodsThis study analyzed retrospectively 167 overnight video EEG records in one of the secondary healthcare facilities in Western Kenya between March 2018 and March 2021. The indications were mainly further diagnosis and seizure classification. All the patients had an unrevealing routine EEG and 162 of them were normal. ResultsAdditional epileptiform discharges were recorded in 91 of those 162 with initial normal routine EEG. Further classification of seizure was achieved in 67 patients among 112 with initially unclassified seizure before the overnight recording. The improvement of 68% (97 out of 143 patients without a prior epilepsy diagnosis) for the diagnosis of epilepsy in those patients without initial final diagnosis is comparable to other similar studies but mostly with a longer duration of recording. The diagnosis was changed or at least improved in 142 (85%) patients out of the 167 patients who underwent the overnight video EEG. The treatment modification was immediately considered in 116 after the prolonged recording. ConclusionsAdding an overnight video EEG to an unrevealing routine EEG can significantly increase the likelihood of detecting additional epileptiform discharges in patients with epilepsy, thereby improving diagnostic yield and aiding in treatment adjustment for all patients suspected of having epilepsy. SignificanceThe sequential approach of adding a prolonged video EEG monitoring even as brief as an overnight video EEG to an unrevealing routine EEG has a very significant impact in further classification of seizure and diagnosis of epilepsy especially in a resource limited set up.

Assessment of Medical Students’ Knowledge of Migraine Headaches in the Western Region of Saudi Arabia: A Cross-Sectional Study

Background and Aims: Migraine is a common neurological disease with frequent episodes that may impact the social, mental, and physical dimensions. This study aims to determine medical students’ knowledge of migraines in the western region of Saudi Arabia, which may help decrease misdiagnosis and referral to secondary healthcare facilities. Methods: A descriptive cross-sectional study was conducted using an electronic questionnaire. A total of 628 medical students in Makkah, Jeddah, Al-Taif, and Medina were involved in the investigation in November 2021. The questionnaire addressed their knowledge of diagnosis and treatment options. Results: More than half of the participants were men (60.5%). The academic level was approximately equal among the participants (61.5% were in their pre-clinical years). Only 20.4% of the students had a good knowledge of migraine diagnosis and 20.1% had good knowledge of headache treatment. A good knowledge level was detected among 33.8% of the students aged 24 years or more compared with 4.7% of those aged 18–19 years (P-value: .001). In addition, students in their clinical years had better knowledge compared with those in their pre-clinical years (P-value: 0.001). Students exposed to any patients with migraines at medical school had a good knowledge level compared with those who did not. A good knowledge level was detected among 40.1% of the students who participated in any course on migraine headaches compared with 11.9% of those who had never participated. Conclusions: Medical students in the western region of Saudi Arabia have low knowledge of migraines. We recommend students be exposed to high-quality sources of information.

Prevalence of Hyperglycemia in Pregnancy and Related Screening Practices in Rural Dehradun: The First Population-Based Study from Uttarakhand (PGDRD-1).

Phase I of the Prevalence of Gestational Diabetes Mellitus in Rural Dehradun (PGDRD) project estimates hyperglycemia in pregnancy (HIP) prevalence and identifies gaps in the utilization of community-related services in rural areas of the Dehradun district (western Uttarakhand); a state where notably no prior population-based study has ever been conducted despite being an Empowered Action Group state for more than two decades. Using a multistage random sampling technique, 1,223 pregnant women locally registered in the rural field practice area of a block were identified. Those requiring HIP screening were subjected to a 2-h 75 g oral glucose tolerance test during the house visit irrespective of their period-of-gestation and last meal timings, diagnosed using the Diabetes in Pregnancy Study Group India (DIPSI) criterion (when indicated). Data were collected by personal interviews using a pretested data collection tool. Statistical Package for Social Sciences version 20.0 was used for analysis. The overall HIP prevalence recorded was 9.7% (95% CI: 8.1-11.5%); the majority (95.8%) were GDM followed by overt DIP (4.2%). Less than 1% of the subjects (0.7%) self-reported pre-GDM. Despite this burden, more than three-fourths were never screened for HIP in their pregnancy. Of those tested, the majority availed secondary healthcare facilities. Few even had to bear expenses in private with a very handful being tested free-of-cost by ANM in the community; findings that altogether sharply contrast to those recommended by national protocols. Despite the high HIP burden, beneficiaries are unable to utilize community-related universal screening protocols as desired.

Prevalence and Determinants of Diarrhoea Disease amongst Under-Five Children Attending Immunization Clinic in a Secondary Health Facility in Benin City

Introduction: Diarrhoea is a major public health challenge in low and middle-income countries. It is the second leading cause of mortality in children under the age of five. It is also recognized that exposure to diarrhoea pathogens in developing countries is associated with such factors as quality and quantity of water, availability of toilet facilities, housing conditions, level of education, household economic status, place of residence, feeding practices, and the general sanitary conditions (personal or domestic hygiene) around the house. These factors are still prevalent in many Nigerian communities. This study therefore sought to determine the prevalence of diarrhoea and risk factors among under-five children seen at immunisation clinic of a secondary hospital in Nigeria. Methodology: This was a cross-sectional study of 210 mothers attending well-baby clinic of a multi-specialist secondary health facility in Benin-City, South-South, Nigeria. Information relating to socio-demographics and occurrence of diarrhoea in their wards was obtained using ore-tested questionnaire. Data obtained were tabulated and analyzed using IBM SPSS version 21. Chi-square was used to determine the relationship between qualitative variables the statistical significance was set at P&lt;0.05. Result: Prevalence of diarrhoea was 38.6% with a mean number of episodes per year of 2.14. Prevalence of dysentery was 4.3%. There was significant association between age, nutritional status, source of water and the occurrence of diarrhoea (P values of 0.04, 0.038 &amp; 0.02 respectively). Conclusion: This study shows a high prevalence of diarrhoea amongst under-5 children in our environment.