Teaching Hospital In South West Nigeria Research Articles

Appendiceal Diseases in Children in a University Teaching Hospital in Southwest Nigeria

Appendiceal Diseases in Children in a University Teaching Hospital in Southwest Nigeria

Obstetric Service Delivery Trends and Healthcare Staffing at a Teaching Hospital in Southwest Nigeria

Background: Maternal health is a critical component of public health worldwide, reflecting a society's commitment to the well-being of its women and children. The provision of obstetric services, encompassing antenatal care, delivery and postnatal care, plays a pivotal role in reducing maternal mortality and ensuring positive birth outcomes. However, the quality and accessibility of obstetric services are influenced by various factors, including healthcare infrastructure, staffing levels and healthcare policies. Objective: To determine obstetric service delivery trends and healthcare staffing at a teaching hospital in southwest Nigeria Methodology: This study utilized a retrospective cohort design to examine the utilization of maternity care services among women at Ekiti State University Teaching Hospital, Nigeria. Data spanning from January 2016 to December 2023 were collected from obstetric records. Analysis was done using Statistical Package for Social Sciences (SPSS) version 20. Results: a total of 9,855 deliveries were recorded, with 4,145 Caesarean sections and 5,767 spontaneous vaginal deliveries, giving a Caesarean section rate of 42%. Overall, there seems to be some fluctuations in the total number of deliveries over the years, with the highest number observed in 2019 (1482) and the lowest in 2021 (868). The number of consultants, senior residents, junior residents, house officers, nurses and other support staff varied over the years, with different staffing levels observed in each year. Conclusion: this study contributes to a better understanding of obstetric service delivery trends and healthcare staffing dynamics, offering valuable insights for healthcare resource allocation and policymaking. The findings underscore the importance of monitoring caseloads and staffing levels to ensure quality maternal and infant healthcare delivery.

Clinicopathological determinants of suicidal thoughts and behavior in patients with post-stroke depression in South-West Nigeria

ObjectiveTo evaluate the clinico-pathological determinants of suicidal thoughts and behavior in patients with post-stroke depression (PSD) in a teaching hospital in south-west Nigeria. MethodA cross-sectional study was carried out in Lagos State University Teaching Hospital and it involved 89 consecutively selected outpatients with post-stroke depression (diagnosed using the depression module of Mini International Neuropsychiatric Inventory). Socio-demographic and clinical factors questionnaire, Mini-Mental State Examination, National Institute of Health Stroke Scale, and Beck Scale of Suicidal Ideation (BSSI) were administered to the participants. BSSI total score was used as a measure of suicidal thoughts. Ethical approval was obtained from the ethics and research committee of Lagos State University Teaching Hospital. ResultTime since stroke (the time since onset of the most recent stroke) had a significant negative correlation with suicidal thoughts (r = −0.263, p = 0.013). In the same vein, the probability of attempting suicide significantly reduces with time since stroke, Odds Ratio = 0.925, p = 0.047. ConclusionSuicidal thoughts and behavior occur early in patients with post-stroke depression. The identification of shorter time since stroke as a correlate of suicidal thoughts and behavior among this patient population underscores the need for performing early assessment and prompt intervention for the at-risk individuals.

Obstetric outcomes of delayed initiation of antenatal care at a university teaching hospital in southwest Nigeria

Background: Antenatal care (ANC) is vital for the health of both mother and fetus. Generally, it has been observed that lack of prenatal care or inadequate utilization of antenatal care culminates in adverse maternal outcomes including maternal mortality.Objective: To compare the obstetric outcomes in pregnant women that commenced ANC in the third trimester with those that initiated ANC contacts early.Materials and Methods: This was a prospective cohort study conducted on antenatal attendees that booked and delivered at the Department of Obstetrics and Gynaecology of Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, southwest Nigeria from 1st of January, 2015 to 31st December, 2015. Data gathered were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to examine the data, with results expressed as numbers and percentages. Associations between maternal factors, obstetric outcomes and delayed commencement of ANC were examined by Pearson Chi-square. The significance levels were set at p<0.05.Results: During the study period, 1633 women received antenatal care and delivered in our centre. Out of these 1633 women, 547(33.5%) had delayed initiation of antenatal care. Women with pre-existing medical illnesses were likely not to experience delayed initiation of ANC (X2 =8.31 p value=0.02). Women who initiated antenatal care in the third trimester were more likely to develop preeclampsia (X2 =7.86 p value=0.02) and prelabour rupture of the fetal membranes (X2 =11.59, p value=0.003).Conclusion: The proportion of women who delayed initiation of ANC was high and they may be predisposed to developing preeclampsia. There is, therefore, a pressing need to increase advocacy on the need for early booking for antenatal care.

Management of Dyspepsia in the Emergency Department of a Teaching Hospital in Southwest Nigeria: a 5-year Review

Management of Dyspepsia in the Emergency Department of a Teaching Hospital in Southwest Nigeria: a 5-year Review

Survey showed that very few paediatric residents in Southwest Nigeria were interested in specialising in gastroenterology.

Paediatric gastroenterology remains an under-recognised sub-speciality in Africa. We determined the preferred sub-specialities among paediatric residents in Southwest Nigeria and what influenced whether they chose paediatric gastroenterology. This was a cross-sectional survey of paediatric residents in seven teaching hospitals in Southwest Nigeria. A self-administered questionnaire was used to obtain information on their socio-demographics, educational attainment, choice of sub-speciality and the factors influencing that choice. Of 144 eligible paediatric residents, 124 (86.1%) completed the survey. Their mean age was 35.0 ± 1.7 years, and 83 (66.9%) were females. The majority (94.4%) had already chosen their sub-speciality, and nearly two-thirds (65.0%) made the decision during training. The most popular sub-speciality was neonatology (30.6%), and only three (2.4%) residents chose gastroenterology. Factors influencing the choice of sub-speciality were perceived ability (85.3%) and academic experience (83.8%). Financial reasons were less frequent (32.5%). Lack of diagnostic equipment (30.6%) and role models (21.0%) were the most frequent reasons for residents being disinterested in paediatric gastroenterology. Few residents were interested in paediatric gastroenterology and there is a need to encourage interest in this subject at an early stage in their training and provide more diagnostic equipment and greater mentorship.

High burden of ESBL- producing Klebsiella spp., Proteus mirabilis, Enterobacter cloacae and Pseudomonas aeruginosa in diagnosed cases of urinary tract infection in a Nigerian Teaching Hospital.

Infections of the urinary tract have been on the rise globally and these are also worsened by the increasing rate of antibiotic resistance in uropathogens. This study aimed to determine the susceptibility profile of extended spectrum β-lactamase (ESBL)- producing uropathogens to selected antibiotics and their carriage of ESBL genes. Bacterial uropathogens were obtained from the urine bench of a Microbiology laboratory in a Teaching Hospital in South-West Nigeria. Susceptibility to antibiotics was tested using the disc diffusion method, while detection of ESBL production was done using the double disc synergy test (DDST). Detection of ESBL genes was performed by PCR. A total of 21 ESBL- producing uropathogens were obtained namely: Klebsiella pneumoniae (11), Klebsiella oxytoca (6), Proteus mirabilis (2), Enterobacter cloacae (1) and Pseudomonas aeruginosa (1). The resistance to antibiotics in the uropathogens was: imipenem (0%), gentamicin (38.1%), sulfamethoxazole-trimethoprim (52.4%), amoxicillin-clavulanate (61.9%), aztreonam (66.7%), ceftazidime (66.7%), tetracycline (90.5%), cefpodoxime (100%) and cefotaxime (100%). Altogether, 90.5% (19/21) of the isolates were multidrug resistant (MDR). Of the 21 uropathogens, 61.9% (13/21) carried bla CTX-M, 52.4% (11/21) carried bla TEM while bla SHV was detected in 47.6% (10/21) of the isolates. There was co-carriage of ESBL genes in 12 uropathogens. This study showed a high prevalence of multidrug resistance and a high carriage of ESBL genes in the ESBL- producing isolates obtained over the study period. There is a need for a review of antibiotic options in the treatment of UTI to clamp down on the ever-increasing tide of antibiotic resistance in uropathogens.

Pattern of Gynaecological Malignancies at a University Teaching Hospital in Southwest Nigeria: A 5-Year Review.

The study determined the pattern and distribution of gynaecological cancer cases seen at a university teaching hospital in southwest Nigeria over a 5-year period. It was a 5-year retrospective review of all gynaecological cancer cases seen and managed at the hospital from 1 September 2013 to 31 August 2018. A total of 6247 gynaecological admissions and 902 gynaecological cancers were seen in the hospital during the study period accounting for a proportion of 14.4%. Of these 902 cases, 835 (92.6%) women had their detailed records available for data extraction and analyses. Cervical cancer was the most commonly seen malignancy (61.7%). The mean age of the patients was 52.5 ± 12.4 years with the largest proportion of the women being in the age group of 50-59 years (26.9%). A large proportion (35.6%) of the patients had a parity of 5 or more with an overall median parity of 4 (IQR, 1-5) while the largest proportion (59.1%) were postmenopausal women. The highest mean age was seen in women with vulvar cancer (67.2 ± 0.6 years) while the lowest was in those with sarcoma botryoides (12.3±1.01 years). There was a steady annual increase in the number of gynaecological cancer cases at the hospital during the period under review. The most common cancers seen in this study are associated with advanced age, increased parity and postmenopausal status. There is a need for improved public enlightenment on the importance of routine screening and for consistent government policy on the institution of an effective organised screening programme for cervical cancer.

A Ten-Year Review of the Pattern and Outcome of Childhood Diabetes in Two State Teaching Hospitals in South-West Nigeria.

BackgroundChildhood diabetes mellitus is a poorly researched topic in Nigeria. Its contribution to morbidity and mortality is vague. This study intends to provide additional information to the background data in Nigeria and hopefully proffers strategies to improving the outcome of this disease.MethodsThis is a retrospective descriptive study of all children managed for childhood diabetes mellitus at the Ekiti State University Teaching Hospital (EKSUTH) and LAUTECH Teaching Hospital (LTH), South West Nigeria, over a 10 year period. Relevant information was obtained from the case notes of all affected children. Data obtained were analysed with SPSS version 20 software.ResultsA total of 20 children were treated for diabetes mellitus (DM); there were 7 (35.0%) boys and 13 (65.0%) girls giving a M:F ratio of 1.0:1.9. Age range at presentation was 5 to 16 years and the mean age at presentation was 12.7 ± 2.89 years. Diabetic ketoacidosis (DKA) was the most common form of presentation in 13 (65.0%). Most [18 (90.0%)] of the patients had type 1 DM. Type 2 DM and glucocorticoid-induced diabetes mellitus were recorded in a case each, Eighteen (90%)patients had not been previously diagnosed by any form of screening prior to their presentation and admission in the hospital. Seven (35.0%) of the patient's care were affected by parental financial constraints. Five mortalities were recorded and one left against medical advice while the majority [14 (70.4%)] were discharged well and alive. The association between the greater numbers of deaths recorded in children with financial constraints was statistically significant (p < 0.05).ConclusionType 1 DM remains the most predominant form of diabetes in children and most of the patients presented in DKA. The proportion of deaths in this study is unacceptably high. There is a need to proffer strategies for earlier detection and management of children with diabetes mellitus prior to the onset or development of DKA and there is a need to assist with the funding of the care of children with diabetes mellitus.

Career preferences among final year medical students and house officers: A multicentre survey in Southwest Nigeria

Objective: Career preferences of medical trainees have the potential to shape the future of the healthcareworkforce of any nation. This study aimed to determine the factors that influence career choices ofmedical students and house officers (interns) in two institutions located in Southwest Nigeria.Methods: A cross-sectional study was carried out amongst final year medical students and interns in twomedical universities and their corresponding teaching hospitals in Southwest Nigeria. A questionnairewas used to obtain socio-demographic data, career choices, reasons behind career choices and thepresence and influence of mentorship on career choices. Responses were analyzed using the StatisticalPackage for Social Sciences Version 21, and descriptive statistics generated.Results: Obstetrics &amp; Gynecology and Surgical specialties were the most preferred career choices by themedical students, while Surgical and Medical specialties were most preferred by the interns. Personalinterest and other personal reasons were the top motivating factors for the career choices amongst themedical students of both institutions, while personal interest and future job opportunities were the topreasons for the career choices amongst the interns of both institutions. Mentorship was lacking for most ofthe medical students and house officers, except in one of the teaching hospitals, where over half of theinterns had career mentors.Conclusion: Attention should be paid to the reasons behind career choices, in order to channel effortstowards making clinical specialties become attractive to young medical trainees, as the future of the healthworkforce in the nation depends on it.Keywords: Career Choices, Medical Students, House officers, Medical Education, Nigeria

Mortality pattern in surgical wards and autopsy rate at a university teaching hospital in South-West Nigeria

Background: Patients coming to the hospital hope on getting well or cured of their ailment, but this hope goes unrealized, sometimes leading to their death. Objectives: We looked at the pattern and causes of death at adult surgical wards and autopsy rates in our facility. Materials and Methods: Retrospective descriptive study of the mortalities in adult surgical wards at Ekiti State University Teaching Hospital, Ado-Ekiti, in South-Western Nigeria, over a period of 5 years, July 2011–June 2016. Results: Two thousand one hundred and thirty-eight patients were managed in the adult surgical wards, and there were 89 (4.16%) cases of death during the study with 51 case notes available for the analysis. Twenty-eight males and 23 females with a male: female of 1.2:1. Age ranges from 18 to 93 years, with a mean of 57.14 ± 20.42 years. The highest mortalities were recorded in general surgical unit (25, [49.0%]) with a mortality rate of 3% and highest in patients with neoplastic diseases (24, [47.1%]), followed by trauma (17, [33.3%]). Overwhelming sepsis (14, [27.5%]) and hypovolemic shock (10, [19.6%]) were the leading immediate causes of death. Only 4 had autopsy done with autopsy rate of 7.8%. Conclusion: Neoplasm and trauma are the leading underlying causes of death. Strategies geared toward early detection and treatment of neoplasms, as well as prevention and prompt care of trauma patients, are advocated. Autopsy rate is low in our center.

Pediatric thyroid disorders in two teaching hospitals in South-West Nigeria

Background: Normal thyroid function is essential for optimal physical growth and neurocognitive development in children. Thyroid disorder is the second most common cause of paediatric endocrine diseases. Undetected hypothyroidism in children is a major preventable cause of neurocognitive disability. Down syndrome patients constitute a significant proportion of congenital hypothyroidism. Aims and Objectives: The aim of this study was to describe and compare the pattern of pediatric thyroid disorders seen at EKSUTH and LTH. Materials and Methods: The index study is a descriptive study of all children managed for Pediatric thyroid disorders at EKSUTH and LTH over a 10 year period from March 2010 to March 2020. Results: Twenty four children presented with thyroid disorder accounting for 12.7% of the total 189 endocrine patients managed in both health facilities. The mean age at presentation was 4.9 years (age range: 3 months to 14 years). Majority, 13 (54.2%), were aged less than 5 years at presentation. M:F =1:1. Hypothyroidism was the most common thyroid disorder, accounting for 91.7% of all thyroid disorders, seen at the two Teaching Hospitals. Congenital hypothyroidism (58.3%) was the most common type of hypothyroidism and Down syndrome accounted for 57.1% of all the children with congenital hypothyroidism. Majority, 87.5%, of the patients were managed successfully with Levothyroxine while one patient with suspected malignant thyroid mass had thyroidectomy and was also given Levothyroxine. Conclusion: Congenital hypothyroidism is the most common pediatric thyroid disorder at EKSUTH and LTH.

High prevalence of multiple drug resistant enteric bacteria: Evidence from a teaching hospital in Southwest Nigeria

The development and evolution of antimicrobial resistance (AMR) in pathogens has been reported to be one of the major issues confronting the global health community. The aim of this study was to examine the period prevalence of antibiotic resistance, as well as the trends and patterns in sensitivity profile of enteric bacteria isolated from urine samples of patients with UTIs in a teaching Hospital in south west Nigeria. Urine samples were collected from 77 patients with UTIs from February 2017 to October 2018. Standard laboratory methods were used for urine sample culture and bacterial identification. The Kirby–Bauer disk diffusion method was used to evaluate antimicrobial sensitivity. Predominant enteric bacteria isolates were Escherichia coli (24, 39.3%), Salmonella species (12, 19.7%), Klebsiella species (4, 6.6%), Providencia species (6, 9.8%), Proteus species (8, 13.1%), Serratia species (2, 3.3%), Yersinia species (1, 1.6%) and Morganella species (4, 6.6%). A large proportion (90.2%) of isolates obtained were multi-drug resistant. High resistance in amoxycillin–clavulanate (98%), cefuroxime (92%), erythromycin (90%) and ceftazidime (84%) were recorded. These results emphasize the importance of continuous screening and surveillance programmes for detection of AMR in enteric bacteria of public health importance.

Burden of family caregivers of ophthalmic patients in a university teaching hospital in south-west Nigeria.

The family provides support in the care of their ill members and suffers some burden during caregiving. This study assessed the burden of family caregivers and associated factors in an ophthalmic clinic situated in a university teaching hospital in southwest Nigeria. This was a descriptive cross-sectional study where consenting family caregivers of ophthalmic patients completed a semi-structured questionnaire containing information on their socio-demographic characteristics and caregiving burden using the Zarit burden interview. Descriptive and inferential statistics analyses were done. A total of 273 caregivers completed the study. The caregivers were parents (23.5%), spouses (20.1%), siblings (3.3%), children (35.9%) and other relatives (14.2%) with mean age (SD) of 38.9 (14.9) years (range 8-79 years). Majority (81.2%) experienced caregiver burden with prayer (89%) as a coping strategy. Financial support (56%) was a major caregiver need with majority (59.3%) satisfied with their relatives' hospital care. Neither the patients nor their caregivers were on health insurance scheme. Statistical significant factors associated with caregivers' burden included young age (AOR=4.63, 95%CI=1.55-13.90; p=0.01), higher education (AOR=5.51, 95%CI=2.30-13.2, p=0.01), being employed (AOR=1.72, 95CI=1.30-4.76, p=0.04), longer caregiving (AOR=3.37, 95%CI=1.27-7.02, p=0.02), and having patient on hospital admission (AOR=1.90, 95%CI=1.26-3.09, p=0.02). Family caregivers of ophthalmic patients experienced significant burden. Hence, they need more assistance from the health care institutions and community, including policy makers, so that they can cope with their caregiving activities. Enrollment in the social health insurance scheme will reduce out of pocket payment of hospital bills.

Association between serum folate level and invasive cervical cancer at a university teaching hospital in South-West Nigeria

Background: Cervical cancer is a common cause of cancer-related morbidity and mortality in developing countries. Serum folate may modify cancer risk through its role in DNA synthesis and methylation. Objective: To determine the association between serum folate levels and the occurrence of cervical cancer among women seen at a university teaching hospital in South-West Nigeria. Patients and Methods: This was an analytical cross-sectional study involving two groups of participants including 50 cases with invasive cervical cancer (ICC) and 50 controls with a normal cervix. Data analysis was performed between discrete baseline characteristics of the cases and controls using the Pearson's Chi-square test, whereas the mean serum folate levels of the cases and controls were compared using the independent sample t-test. P

Association between psychological distress and unmet information needs among female cancer patients in two selected teaching hospitals in South-West Nigeria

Background: Cancer-related information is a major need among cancer patients. Existing data indicate that cancer patients who are anxious or depressed have poorer treatment outcomes. Aim: The aim of this study is to assess the association between psychological distress and unmet information needs among female cancer patients in two teaching hospitals in Southwest Nigeria. Materials and Methods: Using a descriptive-correlational design, 244 females in the oncology units of two selected Nigerian teaching hospitals were purposively selected to complete a modified psychological distress scale and a self-developed information need questionnaire. Data were analyzed using descriptive and inferential statistics P value set at 0.05. Results: Majority (76%) of the patients were psychologically distressed, 71.3% of the participants wanted specific information on their cancer disease. There is a correlation between cancer patients' level of psychological distress and their unmet information needs (P = 0.027; r = −0.142) and a correlation between cancer patients' information needs and duration of their illness (P = 0.034; r = −0.135). Conclusion: Cancer patients experience psychological distress to some extent. Furthermore, they are interested in finding out information about their cancer disease. Every unmet information needs impact on the psychological distress experienced by patients. It is, therefore, recommended that nurses and other healthcare professionals should endeavor to assess the specific information needs to provide required information and ease their psychological distress.

Randomised controlled trial on early versus late feeding after caesarean section at a teaching hospital in southwest Nigeria

Objectives: To compare the effect of timing on initiation of feeding following caesarean delivery on: incidence of post-operative ileus (POI), time of discontinuation of intravenous fluids (IVFs), length of hospital stay and patient's satisfaction. Study Design: This was a prospective randomised controlled study carried out at the obstetric unit of Obstetrics and Gynaecology Department of Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. A total of 118 women undergoing elective or emergency primary caesarean section under regional anaesthesia were randomised into early and late feeding group. Data were collated, and Statistical Package for Social Sciences version 20 was used for analysis. Continuous variables were presented as mean ± standard deviation and categorical variables in frequencies and percentages. Test of significance was done using student t-test for continuous variables and Chi-square for categorical variables. P Materials and Methods: A total of 118 women undergoing elective or emergency primary Caesarean section under regional anesthesia were randomized into early and late feeding group. Data were collated and SPSS version 20 used for analysis. Continuous variables were presented as mean ± standard deviation and categorical variables in frequencies and percentages. Test of significance was done using student t test for continuous variables and chi-square for categorical variables. P value less than 0.05 was considered as significant. Results: The incidence of mild POI was 3.4% for both early and late groups. There were statistically significant differences between the early and late feeding groups in the discontinuation of IVF (79.9% vs. 20.3%, P Conclusion: Early post-operative feeding is safe, well-tolerated with no adverse surgical outcomes in women following primary caesarean section.

The pattern, peculiarities, and management challenges of spina bifida in a teaching hospital in Southwest Nigeria.

Spina bifida is a common congenital anomaly of the nervous system. It is frequently associated with significant morbidity and sometimes mortality in affected children. In this paper, we review the clinico-epidemiological pattern, peculiarities, and therapeutic challenges of this condition in our practice setting. This is a retrospective study of all cases of spina bifida managed from July 2000 to March 2016 at a tertiary health facility located in the southwest region of Nigeria. Relevant information was retrieved from the medical records. The data was collected using a pro forma and analyzed with SPSS version 22. Data from 148 patients was reviewed and analyzed. There were 78 males and 70 females. Only 5.8% of these children were delivered at the health institution. A fifth (20%) of the patients were first born of their mothers. The mean maternal age was 29years. Few (10.1%) mothers use folate medication prior to conception and only 58% of the mothers use folate during antenatal care. Mean duration of pregnancy was 38weeks. The most common anatomical site was lumbosacral region (74.3%) while the most common pathology was myelomeningocele 80.4%. Mean age at surgery was 88.68h. Mean duration of surgery was 92.8min. Mean follow-up duration was 46.8weeks. As many as 59% of the patients had some neurologic improvement noticed during follow-up clinic visits. Spina bifida occurs frequently in our environment. Low socio-economic status and poor antenatal clinic visits contributes significantly to its occurrence.

Papanicoleau Smear Usage and Prevalence of Premalignant Cervical Lesion among Women Living with HIV Attending a Federal Teaching Hospital in South-West Nigeria: A Comparative Study

Papanicoleau Smear Usage and Prevalence of Premalignant Cervical Lesion among Women Living with HIV Attending a Federal Teaching Hospital in South-West Nigeria: A Comparative Study

Profile of pathogens isolated from sputum samples of patients at a teaching hospital in Southwest Nigeria

Profile of pathogens isolated from sputum samples of patients at a teaching hospital in Southwest Nigeria