Teaching Hospital In Southwestern Nigeria Research Articles

Dysmenorrhea among female students at a Teaching Hospital in South-Western Nigeria

Context: Dysmenorrhea is common and can be severe, hampering women's quality of life. Aims: This study aimed to assess the prevalence and factors associated with dysmenorrhea in a population of young females and to explore the impact on routine activity and proven relief measures experienced by this group. Settings and Design: This is a cross-sectional, observational study among female medical and nursing students at a tertiary health care facility in South-Western Nigeria. Subjects and Methods: It was a questionnaire study carried out among 360 female students. Explanatory variables were age, parity, use of combined oral contraception, and first-degree family history of dysmenorrhea. The main outcome variable was the presence of dysmenorrhea. Statistical Analysis Used: Data were analyzed by Chi-square test and logistic regression (P Results: All respondents had attained menarche at 12.4 ± 1.2 years; 299 (83.1%) reported dysmenorrhea. Primary dysmenorrhea constituted 63.6%; secondary was 19.4%. Younger respondents (teenagers) and married females were significantly less likely to suffer dysmenorrhea, while nonusers of oral contraceptives were more likely to. Period pain precluded usual activity in 48.8% of sufferers; 39.5% had missed classes on account of it; however, only 10% had sought medical care. The most effective treatment used was piroxicam (an antiprostaglandin drug). On multivariate analysis, increasing age (Odds ratio-10.6 [95% Confidence Interval: 3.4-34.0]) was significantly associated with dysmenorrhea. Conclusions: Dysmenorrhea is a highly prevalent problem among this population. Women should be encouraged to seek medical care to limit the debility that arises from dysmenorrhea. Some women may benefit from investigations and definitive treatment.

Spectrum of Magnetic Resonance Imaging Findings in Patients with Head Injury in a Nigerian Population

Head injury is a pressing public health concern the world over. Head injury and associated traumatic brain injury (TBI) usually result in neurocognitive impairments and psychological health issues especially when underlying chronic sequalae are not promptly diagnosed and managed. Magnetic resonance imaging (MRI) has been found to be the most sensitive imaging modality for the evaluation of lesions secondary to head injury. This study examined the spectrum of MRI findings in head injury cases in a population within South western Nigeria. A prospective study of MRI findings in 163 patients who presented to the radiology department of a foremost teaching hospital in South-western Nigeria with clinical history of head injury was undertaken for a period of 2 years (from January 2015 to December 2016). The following data were obtained and studied: demographic data, clinical history and MRI findings. The MR images were obtained with a 1.5Tesla Siemens MR Scanner. Both T1-weighted and T2-weighted MR imaging protocols were performed for all the patients. The MR images were acquired by the radiographers and interpreted by consultant radiologists. 121 (74.23%) of the subjects were males while 42 (26.76%) were females. Road traffic accident (RTA) (n = 87, 53.37%) was the major cause of head injury sustenance in more than half of the entire cases evaluated. The most common MRI findings are subdural haematoma (n = 41, 25.14%); cerebral contusion (n = 27, 16.56%); subarachnoid haemorrhage (n = 19, 11.65%); cerebral infarction (n = 12, 7.36%); skull fracture (n = 11, 6.74%); cerebral atrophy (n = 10, 6.13%) and multiple sclerosis (n = 7, 4.30%). The least common findings are leucoencephalopathy (n = 5, 3.06%) and retained bullet (n = 5, 3.06%). Magnetic resonance imaging is a paramount imaging modality in the diagnosis of lesions secondary to head injury. Thus the need to make MRI facilities more available in healthcare settings of developing countries, like Nigeria, is re-emphasised.

An Audit of Routine Chest X-ray Done During Pre-employment Medical Screening in South-Western Nigeria

Routine pre-employment chest radiography is one of the examinations performed to assess the medical fitness of prospective employees in many establishments around the world. It is also used to ensure that prospective employees can perform their jobs safely without placing co-workers and others at potential health risk by ruling out the existence of chronic infectious pulmonary diseases like tuberculosis. Despite these focused goals, there are concerns over poor positive result yield, associated unnecessary exposure to ionizing radiation and wastage of economic resources linked to pre-employment chest x-ray. This study aimed to audit the reports of pre-employment chest radiographs, documented associated radiological findings and subsequently examined the clinical relevance or otherwise of this practice in the locality under study. The records of 725 patients, who had underwent pre-employment chest x-rays between January 2014 and December 2016 in three foremost teaching hospitals in South-western Nigeria, were retrospectively reviewed. All findings were documented including abnormalities ‘flagged’ as clinically-significant by the radiologists’ reports irrespective of the severity or the effect of the abnormality on the employment outcome of the individual. The results show that majority of the patients referred for pre-employment chest x-ray presented with normal radiological findings (n = 687, 94.8%). The significant abnormal findings (n = 38, 5.2%) were chronic cardiovascular disorder (n = 15, 2.0%), followed by chronic lung disease (n = 18, 2.5%) and finally skeletal abnormality (n = 5, 0.7%). Individuals 25 years and below presented with no abnormal findings while abnormal findings are found in subjects in the age range of 26-30 years and above. This audit has shown that chest radiography has little or no clinical relevance in routine pre-employment medical screening of physically healthy and asymptomatic prospective employees. Therefore, chest radiography should be restricted to individuals with clinical findings suggestive of cardio-thoracic disorders during pre-employment medical screening.

Patients' feelings about the presence of medical students in a New Teaching Hospital in Southwestern Nigeria.

This study aimed to evaluate how patients feel about the introduction of medical students into a former general hospital transformed to a teaching hospital in southwestern Nigeria and to also assess the extent to which they are willing to involve medical students in the management of their conditions. In a descriptive cross-sectional study, a sample of 251 randomly selected patients were interviewed using a pretested questionnaire that assessed patients' demography, patients' acceptance of and reaction to the involvement of medical students in their clinical care including the specific procedures the patients would allow medical students to perform. Two hundred and fifty-one patients with mean age ± standard deviation of 37.33 ± 19.01 (age range = 16-120 years; M:F = 1:1.26) were recruited between January 01 and March 31, 2013. Most patients (86.5%) preferred to be treated in a teaching hospital and were comfortable with medical students as observers (83.7%) and serving as the doctors' assistant (83.3%) during common diagnostic procedures. Men were more willing to have invasive procedures such as insertion of urinary catheter (56.6% vs. 43.4%, P = 0.001). Acceptability of medical students (such as willingness of patients to have students read their medical notes) was significantly higher in nonsurgical specialties than in surgical specialties (77.5% vs. 22.5%, P< 0.001). Factors associated with a positive disposition include age> 40 years, male gender, and higher level of education as well as consultation in nonsurgical specialties (P = 0.001). Medical students are well received into this new teaching hospital setting. However, there is a need for more education of younger, less educated female patients of surgical subspecialties so that they can understand their importance as irreplaceable partners in the training of medical students.

Patterns of pre-hospital events and management of motorcycle-related injuries in a tropical setting

This study sought to highlight associated factors and evaluate outcomes of motorcycle-related injuries (MCRI) among adults managed in a university teaching hospital in south-western Nigeria. The study was a cross-sectional descriptive study of 150 adult patients presenting with MCRI at the adult accident and emergency unit of the hospital. Information on the use of helmet, alcohol intake, number of pillion passengers, type of collision and time of arrival at hospital was collected. Patients were followed up and questionnaires were completed after discharge, referral or death. The male to female ratio was 4:1 with patients aged 20–29 years (n = 44, 29.3%) having the highest incidence of MCRI. Only 4 (2.7%) patients used helmet at the time of injury. About one-third of the patients (n = 59, 39.3%) arrived at the hospital within 1–6 hours after injury. The limbs were the most frequently involved site of injury, hence orthopaedic procedures constituted the highest number of interventions. Mortality rate was 10.7% (16 out of 150) with head injury being the leading cause. MCRI requires more emphasis on preventive measures. This will play a crucial role in the reduction of the associated morbidity and mortality.

Exploration of the Psychometric Properties and Correlates of the 10 item Connor-Davidson Resilience Scale among Family Caregivers of Nigerian Patients with Psychiatric Disorder

Background: Despite studies in developed countries repeatedly reporting on the positive influence of resilience on the ability of family caregivers to withstand the burden of providing care for their relatives no literature is currently available regarding the construct and the factors associated with resilience among the family caregivers of Nigerian psychiatric patients. Methods: This is a cross-sectional descriptive study in which 234 family caregiver-patient dyads were consecutively recruited over a period of 6 months from the psychiatric outpatients’ clinics of two university teaching hospitals in South-western Nigeria. The caregivers completed the 10 item Connor-Davidson Resilience Scale (CDRISC-10) in addition to other measures. Exploratory factor analysis was used to evaluate the dimensionality of the scale. The scale’s reliability and validity were also examined. Results: Exploratory Factor Analysis revealed a uni-dimensional model of the 10 item CD-RISC among the family caregivers. Internal consistency of the scale’s items was modestly satisfactory (Cronbach’s alpha 0.87). The evidence for the convergent validity of scale was provided by statistically significant correlations with the family caregivers’ scores on the Zarit Burden Interview (r =0.276, p<0.001), MINI Suicidality module (r=0.312, p<0.001), General Health Questionnaire-12 (r =0.220, p<0.001) and Patient Health Questionnaire-9 (r=0.282, p<0.001). Hierarchical linear regression analyses showed that, the main variance in the family caregivers’ score on the CDRISC-10 was accounted for by the MINI Suicidality module. Conclusions: The scale has exhibited satisfactory psychometric qualities as a tool for the assessment of resilience among the family caregivers of Nigerian patients with psychiatric disorders in terms of its reliability and validity. Our study further affirms that the construct of resilience measured with the 10 item CDRISC is best explained by a one dimensional factor.

Sickle cell disease clinical phenotypes in children from South-Western, Nigeria.

The clinical phenotypes of children with sickle cell disease (SCD) are poorly described in many sub-Saharan countries including Nigeria. The objective was to highlight various clinical phenotypes of SCD in children and investigate the influence of sociodemographic indices on the development of SCD complications. We carried out a cross-sectional study of 240 pediatric patients attending the sickle cell clinic and the emergency room in a teaching hospital in South-Western Nigeria over a 12-month period. The clinical phenotypes and severity of the disease were documented, and the influence of sociodemographic variables was investigated. The five leading clinical phenotypes in our patients were significant pain episodes, that is, vaso-occlusive crisis in 159 (66.3%); anemic crisis in 62 (25.8%); severe bacterial infections, 57 (23.8%); acute chest syndrome (ACS), 27 (11.3%) and stroke, 7 (2.9%). Forty-two (33.1%) had a previous history of dactylitis (hand-foot syndrome). Other clinical phenotypes such as avascular necrosis of the femur, 4 (1.7%); nephropathy, 2 (0.8%); priapism, gallstone and chronic leg ulcer, one (0.4%) each, were not commonly seen. More children with a history of asthma had ACS. Furthermore, high steady-state white blood cell count was associated with severe disease. The clinical phenotypes of SCD in children from South-Western Nigeria are highly variable with the disease manifesting very early and about 10% having significant complications. Sociodemographic characteristics appear to have little influence on the development of SCD complications among our patients, but age and low-socioeconomic class are associated with anemic crisis.

The Yoruba version of the Beck Hopelessness Scale: psychometric characteristics and correlates of hopelessness in a sample of Nigerian psychiatric outpatients

BackgroundPrevious studies from the developed western countries have repeatedly demonstrated that hopelessness positively correlates with an increased risk of suicide in the context of chronic mental disorders such as schizophrenia and affective disorders. Despite this persistently strong association, the construct of hopelessness in terms of its factorial structure and correlates has not been explored among Nigerian psychiatric outpatients. ObjectiveThe aim of this present study is to examine the psychometric characteristics of the Yoruba language culturally adapted version of the Beck Hopelessness Scale in a cross-sectional sample of psychiatric outpatients in South-western Nigeria. MethodThe participants were 327 Nigerian adult outpatients receiving treatment for schizophrenia, bipolar and depressive disorders, consecutively recruited from the outpatient psychiatric clinics of a university teaching hospital in South-western Nigeria. The outpatients were recruited over a one year period. They completed the Yoruba translated version of the Beck Hopelessness Scale (BHS-Y), a sociodemographic and illness-related questionnaire, the Beck Depression Inventory-II (BDI-II). Their level of functioning was assessed with the Global Assessment of Functioning Scale (GAF), psychopathology was evaluated with the Positive and Negative Syndrome Scale (PANSS) and the level of disability measured with the World Health Organization Disability Assessment Schedule (WHODAS-II). Suicidality and confirmation of the diagnoses of schizophrenia, bipolar and depressive disorders were evaluated with the Mini International Neuropsychiatric Interview (MINI). The construct of hopelessness in terms of factorial structure, reliability, validity and correlates was explored. Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation was used to examine the factorial structure of the BHS-Y. Internal consistency was examined with Cronbach's alpha, and the construct validity of the scale was assessed using correlational analyses with the MINI suicidality module, BDI-II, GAF and WHODAS-II domain scores. We also tested the hypothesis that a shortened version of the BHS-Y will possess psychometric properties similar to the 20 item version. ResultsExploratory Factor Analysis using Principal Component Analysis with Varimax rotation showed that the construct of hopelessness among our outpatients was best explained by a 3 factor model. Reliability of the translated version of the scale was adequate as indicated by a Cronbach's alpha of 0.92. Construct validity was also satisfactory as reflected by the strong correlations with MINI suicidality, Beck Depression Inventory-II and Global Assessment of Functioning scores. The shortened 4 item single factor BHS-Y composed of items 8, 9, 13 and 15 demonstrated psychometric properties similar to those of the full item version. ConclusionThe Beck Hopelessness Scale (Yoruba Version) demonstrated satisfactory reliability and validity and therefore may be useful in measuring the construct of hopelessness and in clinical suicide risk assessments among Nigerian psychiatric outpatients. There is the need for more studies to further explore the psychometric features and correlates of this scale among other Nigerian ethnic groups in addition to other medical patients' populations.

Anaemia among pregnant women at the booking clinic of a teaching hospital in south-western Nigeria

Background : Anaemia in pregnancy is a global public health challenge. It is the commonest medical disorder of pregnancy and a major cause of morbidity and mortality in most developing countries. Aim : This study aimed at assessing the prevalence of anaemia in pregnancy and to identify the confounding socio-demographic factors. Methods : This is a cross-sectional descriptive study designed to determine the sociodemographic characteristics and prevalence of anaemia among pregnant women at their booking antenatal visit in a teaching hospital in Southwestern Nigeria. Pregnant women were enrolled for the study by consecutive sampling method at their first antenatal visit and the packed cell volume (PCV) was used to assess level of anaemia. Sociodemographic information was obtained from the case records of the enrolled women. Results : One hundred and thirty-eight (27.6%) of the 5000 enrolled women were found to be anaemic at the time of antenatal booking. Anaemia were more prevalent among primigravidae (33.9%) than the multigravidae (25.3%), although this difference was not statistically significant (P=0.079). Anaemia was higher among women with no formal education, those unemployed, single mothers and women with sickle cell traits. Conclusion : Anaemia in pregnancy remains a major health challenge in Nigeria with primigravidae identified as being those at most risk. So also are pregnant teenagers and women that book late for antenatal care (ANC). It is therefore important to educate women on early ANC booking and the need for compliance with prescribed medications in pregnancy. Key Words : Anaemia; pregnancy; prevalence; antenatal care; primigravidae; multigravidae; PCV

Treatment non-adherence among patients with poorly controlled type 2 diabetes in ambulatory care settings in southwestern Nigeria.

Poor adherence to prescribed therapy among patients with chronic diseases is a growing concern which undermines the benefits of current medical care. To evaluate the pattern of treatment non-adherence among ambulatory patients with poorly controlled type 2 diabetes in southwestern Nigeria, and to determine the possible factor(s) that accounted for such non-adherence with a view to identifying areas of future intervention to improve outcome. A prospective cross-sectional interview using the concept of RIM (Recognize, Identify and Manage) model was used to evaluate adherence to treatment recommendations among 176 consented patients recruited from the endocrinology out-patient clinics of two teaching hospitals in southwestern Nigeria between November, 2010 and January, 2011. Overlaps of non-adherence behavior were obtained. More than three-quarter (153; 88.4%) were not aware of indication for each of the prescribed medications, 26 (15.3%) correctly described regimen as prescribed. The factorsidentified as possible barriers to medication adherence include practical (145; 40.1%), knowledge (103; 28.5%), and attitudinal (114; 31.5%) barriers. Dietary non-adherence was mostly due to inappropriate guidance (62; 33.7%). The arrays of non-adherence behavior among the cohort further emphasize the need for patient-centered approach as a reasonable strategy in resolving non-adherence problems in routine clinical practice.

Removable partial dentures: Patterns and reasons for demand among patients in a teaching hospital in southwestern Nigeria

Background: Removable partial denture (RPD) is a versatile, cost-effective, and reversible treatment method for replacing missing teeth in partially edentulous patients. It serves the purpose of improving patients' appearance, speech, mastication, confidence, and physchological well-being. Aims: Determining the patterns and reasons for demand of RPDs, including their relation to the socio-economic status among patients attending a teaching hospital dental center. Settings and Design: A retrospective study. Materials and Methods: Records of partial denture patients who attended the prosthetic dental clinic of the University College Hospital, Ibadan between January 2006 and December 2010 were retrieved. Information obtained included demographic data, occupation, and type of partial edentulous arch based on Kennedy classification. Statistical Analysis Used: Data were analyzed using SPSS version 20. Level of significance was set at P ≤ 0.05. Frequency and means were used for continuous variables, while Chi-square was used for categorical variables. Results: Nine hundred and sixty-three patients in the age range of 7-99 years and a mean of 45.1 ± 18.9 years were given RPDs during the period; 37% of the patients were young adults (21-40 years), 51.7% were male, and 31.9% were civil servants. Aesthetics was the main reason (60.2%) for seeking RPD and was statistically significant in relation to age group ( P = 0.00). Majority [525 (54.5%)] demanded for maxillary RPD. There was increase in demand for both upper and lower dentures among the older age groups ( P = 0.00). Majority (56.9%) of the dentures demanded were for Kennedy class III edentulous arches. Conclusions: Kennedy class III dentures were the highest in demand than any other class both in the maxilla and mandible, and the main reason for RPDs was aesthetics.

Prevalence of and risk factors for domestic violence among pregnant women in Nigeria

Violence against women is defined as any act of gender-based violence that results in any kind of harm or suffering to women and has negative emotional and physical impacts on women’s health. According to studies from several parts of the world the prevalence of domestic violence varies widely. In low-resource countries studies conducted reveal a prevalence of 4%-29% while local studies from various parts of Nigeria have reported values ranging from 11%-59%. The aim of this present study was to determine the prevalence of and the risk factors for domestic violence among patients receiving prenatal care at a teaching hospital in south-western Nigeria. Using a modified WHO questionnaire to assess the occurrence and pattern of domestic violence findings affirmed that domestic violence before pregnancy is a risk factor for domestic violence during pregnancy. The findings indicate that domestic violence is prevalent in the obstetric population of southwestern Nigeria. Screening for violence should become a component of comprehensive maternity care in addition to rehabilitation for women and behavioral counseling for their spouses. [excerpt] Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Post-partum urinary retention in a teaching hospital in southwestern Nigeria

This study was undertaken to determine the prevalence of post-partum urinary retention after vaginal delivery and to examine the associated risk factors. This was a prospective observational study carried out over a 2-month period at the major university teaching hospital in southwestern Nigeria. Prevalence of post-partum urinary retention was 29.4%. The majority (93.3%) of women had covert urinary retention while 6.7% had overt urinary retention. From the bivariate analysis, episiotomy, reduced voiding desire and primiparity were risk factors for post-partum urinary retention (66.6% vs 30.6%; P = 0.017; 47.75% vs 13.9%; P = 0.037; and 60.0% vs 30.6%; P = 0.05; respectively). Post-partum urinary retention, particularly covert retention, is a common complication of labor and delivery in our clinical practice but is rarely reported in the published work, especially from this part of the world. No factor has been found to be independently associated with its occurrence, hence there is need for vigilance in the immediate post-partum period as most cases of urinary retention would have been avoided if women were encouraged to void early following delivery.

Antibiotic susceptibility of common bacterial pathogens in urinary tract infections in a Teaching hospital in Southwestern Nigeria

Urinary tract infection (UTI) is one of the most common bacterial infections in humans and a major cause of morbidity. However, the aetiology of UTI and their antibiotic sensitivity patterns vary from time to time and across different areas. This study determines the frequently isolated UTI bacteria from in-patients and out-patients of a Teaching hospital in South-western Nigeria and their antibiotic susceptibility patterns. Sixty (60) bacterial isolates from urine of patients with significant bacteriuria in UTI were collected and evaluated for their antibiotic sensitivity using modified Kirby-Bauer method. UTI was frequently encountered in females (61.7%) and older patients (50%). 55% of the isolates were from in-patients. The most common etiological organisms of UTI were Esherichia coli (46.7%), Pseudomonas aeruginosa (18.3%), Klebsiella spp (13.3%), Staphylococcus aureus (13.3%) and Proteus spp (6.7%). Pseudomonas aeruginosa was found only among hospital isolates while Staphylococcus aureus was isolated from females only. Antibiotic susceptibility pattern revealed that the Enterobacteriaceae were highly susceptible to Ciprofloxacin (71.4 to 75%) while Nitrofurantoin demonstrated the best activity against S. aureus isolates (100%) in both community and hospital acquired UTI. All the isolates exhibited high degree of resistance to Augmentin and amoxicillin. High rate of multi-drug resistance was recorded among all isolates. In view of the increasing rate of resistance of UTI pathogens to commonly used antibiotics, rational prescription and use of antibiotics is advocated. Key words: Urinary tract infections, bacterial pathogens, susceptibility.

Quality and contents of referral letters from peripheral health centers to the dental centre of a teaching hospital, southwestern Nigeria

Objective. Referral letters are deficient in quality and content, which may prevent ideal treatment of patients. Therefore, this study assessed the quality and contents of referral letters from peripheral health centers to the dental center of a teaching hospital in southwestern Nigeria. Materials and methods. All consecutive referral letters received at the dental center of a teaching hospital in southwestern Nigeria from various peripheral health centers over a period of 1 year were prospectively reviewed using a structured questionnaire. The information extracted were patient's demographic data, addresses of referral persons, dates of referral, reasons for referral, medical and dental history, examination findings, investigations done, diagnosis and treatment given. Descriptive analyses of frequencies were done for all variables. Results. One hundred and thirty-four referral letters were received and reviewed, comprising letters from 75 (60.0%) males and 59 (40.0%) females. The patient's age ranged from 2–74 years, with a median age of 25 years. The majority, 91 (85.4%), of the letters were written by medical doctors. An appreciable number of referral letters had no name or signature of the referring health care worker. Information on reasons for referral were not available in 27 (20.1%) of the letters. A significant proportion of referral letters lacked vital information on the patient age, past medical history, past dental history, investigations done and treatment given. Conclusion. This study has shown that referral letters written from various peripheral healthcare centers to the dental centre of a teaching hospital is generally of unacceptable quality and the content could be improved upon.

Cost comparison of microscopy vs. empiric treatment for malaria in southwestern nigeria: a prospective study

BackgroundPresumptive treatment for malaria is common in resource-limited settings, yet controversial given the imprecision of clinical diagnosis. The researchers compared costs of diagnosis and drugs for two strategies: (1) empirical treatment of malaria via clinical diagnosis; and (2) empirical diagnosis followed by treatment only with Giemsa smear confirmation.MethodsPatients with a diagnosis of clinical malaria were recruited from a mission/university teaching hospital in southwestern Nigeria. The patients underwent free Giemsa thick (diagnosis) and thin (differentiation) smears, but paid for all anti-malarial drugs. Clinical diagnosis was made on clinicians' judgments based on symptoms, including fever, diarrhoea, headache, and body aches. The paediatric regimen was artesunate (6-9 tablets of 3 mg/kg on day one and 1.5 mg/kg for the next four days) plus amodiaquine (10 mg/kg day 1-2 and 5 mg/kg on day three in suspension). Adults were given two treatment options: option one (four and one-half 50 mg artesunate tablets on day one and nine tablets for the next four days, plus three 500 mg sulphadoxine/25 mg pyrimethamine tablets) and option two (same artesunate regimen plus nine 200 mg tablets of amodiaquine at 10 mg/kg day 1-2 and 5 mg/kg on day three). The researchers calculated the costs of smears/drugs from standard hospital charges.ResultsDoctors diagnosed 304 patients (170 adults ages >16 years and 134 pediatric) with clinical malaria, prescribing antimalarial drugs to all. Giemsa thick smears were positive in 115/304 (38%). The typical patient cost for a Giemsa smear was 550 Naira (US$3.74 in 2009). For children, the cost of testing all, but treating only Giemsa positives was N888 ($6.04)/child; the cost of empiric treatment of all who were clinically diagnosed was lower, N660 ($4.49)/child. For adults, the cost of testing all, but treating only Giemsa positives was N711 ($4.84)/adult for treatment option one (artesunate and sulphadoxine/pyrimethamine) and N730 ($4.97)/adult for option two (artesunate and amodiaquine). This contrasts to lower costs of empiric treatment for both options one (N610 = $4.14/adult) and two (N680=$4.63/adult).ConclusionsEmpiric treatment of all suspected cases of malaria was cheaper (at the end of the dry to the beginning of the rainy season) than only treating those who had microscopy-confirmed diagnoses of malaria, even though the majority of patients suspected to have malaria were negative via microscopy. One can acknowledge that giving many malaria-uninfected Nigerians anti-malarial drugs is undesirable for both their personal health and fears of drug resistance with overuse. Therefore, funding of rapid diagnostic tests whose performance exceeds the Giemsa smear is needed to achieve an ideal of diagnostic confirmation before treatment.

Traumatic urologic injuries in Ile-Ife, Nigeria

Background:In a developing country with limited healthcare resources, traumatic injuries and their management pose a significant challenge to healthcare delivery.Aim:To highlight the challenges in the management of traumatic urologic injuries in patients in our setting.Setting and Design:Patients presenting with traumatic injuries to the urinary tract, between January 1996 and December 2005, in a University Teaching Hospital in Southwestern Nigeria were the subjects of this study.Patients and Methods:Clinical records of patients who had such injuries were reviewed.Results:Ninety injuries occurred in 86 patients including 77 males and 9 females aged 14–68 years. Fourteen (15.5%) of the injuries involved the kidneys, urinary bladder was involved in 23 (25.6%) and the male urethra in 53 (58.9%) injuries. The mechanisms of injury were road traffic accidents in 52 (60.5%) patients, straddle injuries in 18 (20.9%), trauma to the back in 8 (9.3%), falls from a height in 6 (7.0%) and gunshot injuries in 2 (2.3%) patients. Associated injuries include pelvic fractures in 33 (38.4%) patients, limb bone fractures in 13 (14.1%), intestinal injuries in 12 (13.0%) and spinal injuries in 8 (8.7%) patients. In most patients, diagnosis was made based on clinical suspicion and minimal investigations such as abdominal ultrasound, urethrocystoscopy and/or urethrocystography. The outcome was good in most patients and mortality was recorded in only 2 (2.3%) patients who had concomitant spinal and burns injuries.Conclusion:Prompt management instituted on clinical suspicion of injuries presents a good outcome in patients in a limited resource setting.

Pattern of childhood malignant tumours in a teaching hospital in south‐western Nigeria

To document general baseline data on the patterns of childhood malignant tumours at a teaching hospital in south-western Nigeria. A retrospective study of childhood malignancy at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, during an 11-year period, from January 1996 to December 2006. 77 children were diagnosed with malignant tumours (an average of seven diagnoses per year); 46 were boys (60%), giving a male-to-female ratio of 1.5 : 1. The age distribution of patients was 1-18 years. There were 42 diagnoses (55%) in the 1-5-year age group and 68 malignancies (88%) were diagnosed at ages of 12 years or younger. Lymphomas were the most prevalent malignancy identified, accounting for 31 diagnoses (40%). Burkitt's lymphoma constituted the majority of malignancies (28 cases; 36%), followed by retinoblastoma (16 cases; 21%) and nephroblastoma (11 cases; 14%). Other malignancies included germ cell tumours (6), neuroblastomas (4), osteosarcomas (3), rhabdomyosarcomas (3) and non-Hodgkin's lymphomas (3). One case each of medullary thyroid carcinoma, adenocarcinoma of the rectum, invasive mucinous carcinoma of the colon were also identified. These data suggest that Burkitt's lymphoma is the most common childhood malignant tumour in our geographic area of south-western Nigeria. With the rising incidence of childhood malignancy in resource-poor countries, measuring the baseline occurrence of such tumours is imperative to provide much-needed resource allocation.

Management of motorcycle limb trauma in a teaching hospital in South-western Nigeria

To evaluate the management of limb injuries sustained from motorcycle accidents. Consecutive 115 patients managed for limb injuries secondary to motorcycle trauma over a one-year period were prospectively studied. There were 115 patients out of which seventy-six (66.1%) sustained injuries to the lower limbs, 25 (21.7% to the upper limbs, while 14 (12.2 %) injured both the upper and the lower limbs together. Seventy-nine (68.7%) patients had fractures of which 24 (30.4%) were open. There was no organized pre-hospital care, a high referral rate and long injury-treatment intervals. Treatment was by closed manipulation and splintage with casts (57.6%), tractions (30.4%), and external fixation (5.4%); 18 patients had elective ORIF. The complication rate for cases was 71.3% while 4 (3.5%) patients died. Management of motorcycle injuries is still difficult in developing countries. Attention needs to be paid to provision of organized trauma care to improve outcomes.

Chronic dehydration and symptomatic upper urinary tract stones in young adults in Ibadan, Nigeria.

Upper urinary tract stones are relatively uncommon in Nigeria and they are most often seen in men in their 4th and 5th decades. There is however no recent report on this disease from our locality. This retrospective study was done to evaluate the pattern of presentation of upper tract urolithiasis in our institution. We reviewed all cases of renal stones referred to a single Consultant in a Teaching Hospital in Southwestern Nigeria over a two year period. Twenty cases of renal calculi presented within the study period. All patients presented with sudden onset of loin or back pain, and the diagnosis was confirmed radiologically. The mean age of our patients was 27 years (age range 13-38 years), and the male to female ratio was 1.5: 1. Nineteen patients (95%) reported poor fluid intake (<1.5L/day), and 17/20 (85%) frequently total fasted totally (no water or food intake) for religious reasons. Serum calcium was normal in 15 of 16 patients (94%) and only marginally raised in the remaining patient. All patients were treated with a high fluid intake (3L/day) and analgesics, and 16 of the patients (80%) passed their stones spontaneously. The other four are currently pain free, one of whom is awaiting surgery. This (uncommon) occurrence of upper tract urolithiasis in young adults in Ibadan may be related to chronic dehydration exacerbated by religious fasting. Further studies are required to explore this relationship,