Tertiary Health Facility In Nigeria Research Articles

Comparative Sonographic Evaluation of the Gallbladder in Sickle Cell Disease Patients and Apparently Healthy Non-Sickle Cell Disease Individuals in a Nigerian Town

Background: Sickle cell disease (SCD) is an autosomal recessive blood disorder with multi-organ manifestations including the gall bladder. Studies have shown that individuals with sickle cell disease have strong tendency of developing pigment gallstones due to chronic red blood cell hemolysis and increased bilirubin levels.
 Aim and Objectives: The aim of this study was to evaluate and compare the gallbladder changes which includes volume, wall thickness, presence of biliary sludge and prevalence of calculi between age and sex-matched sickle cell disease patients and apparently healthy, normal non-SCD individuals.
 Materials and Methods: This was a cross-sectional comparative study of 50 known SCD patients attending the Haematology clinic of sub-urban tertiary health facility in Nigeria, and equal number of age and sex-matched apparently healthy, non-SCD volunteers attending the Well people clinic of the same hospital as controls. Each subject was evaluated for gallbladder volume, wall thickness, presence of biliary sludge and gallstones using a 3.5-5MHz curvilinear array transducer of a Mindray ultrasound machine, DC-6 model, 2016.
 Data Analysis: The data collected was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 21.
 Statistical test was considered significant at p-value ≤ 0.05 and a confidence interval of 95%.
 Results: Out of the 100 subjects who underwent scanning, 50 were patients with sickle cell disease, consisting of 29 males (58.0%) and 21 females (42.0%), while the remaining 50 were non-sickle cell disease volunteers serving as controls, comprising 24 males (48.0%) and 26 females (52.0%). Their ages ranged from 2 to 65 years.
 The mean age of the cases and controls was 22.1±14.7 years and 19.9±12.6 years respectively. Among the patients; 8 (16.0%) had cholecystitis and 10 (20.0%) had gallstones, with no detectable abnormality in the controls.
 Conclusion: The ultrasonographic prevalence of gallbladder abnormalities was recorded only in patients with sickle cell disease when compared to apparently healthy controls as shown with increased prevalence with age.

Vaccine Safety: Assessing the Prevalence and Severity of Adverse Events Following COVID-19 Vaccination amongst Healthcare Workers in Tertiary Health Facilities in Nigeria.

Vaccines, including COVID-19 vaccines, are known to be cost-effective interventions for disease prevention and control. However, adverse events following immunisation (AEFI) may challenge the acceptance of these vaccines. This study assessed the prevalence and severity of COVID-19-related AEFI amongst healthcare workers at tertiary health facilities in Nigeria. This descriptive, cross-sectional study was conducted among healthcare workers who had received the COVID-19 vaccine. A multi-stage sampling technique was used to select participants from six Tertiary Health Facilities in Nigeria. Ethical approval (NHREC/01/01/2007-19/07/2021) was obtained from NHREC. Data were analysed using IBM® SPSS version 25 and categorical variables were presented in tables/charts using frequencies and proportions. A total of 2130 respondents participated in the study, with a mean age of 37.4 ± 9.1 years. Most of the respondents, 1674 (78.6%), had two doses of the vaccine, and the overall prevalence of AEFI was 813 (38.2%). Common among the AEFI reported following the administration of the first dose of the vaccine were fever 649 (30.5%) and pain at the injection site 644 (30.2%), while it was pain at the injection site 216 (10.1%) and fever 173 (8.1%) for second dose. The higher proportions of AEFI were mostly mild to moderate. The study observed a relatively low prevalence of AEFI, with the commonly reported ones being fever and injection site pain. It is crucial that countries continuously collect the data on AEFI and establish causality as a way to improve quality and guarantee vaccine safety.

16S Ribosomal Gene Sequencing, Phylogeny and Multidrug Resistance of Pseudomonas aeruginosa Isolated from Clinical Samples at a Tertiary Healthcare Facility in Nigeria

This work sequenced 16S ribosomal gene, determined phylogeny and multidrug resistance of pseudomonas aeruginosa isolated from clinical samples at a tertiary healthcare facility in Nigeria. A total of 184 clinical specimens were collected from patients and were characterized by standard methods of culturing and biochemical tests. One of the bacterial isolates was selected and subjected to molecular identification using 16S rRNA gene sequencing by Sanger method. P. aeruginosa was subjected to antibiotic sensitivity testing by Kirby Bauer disc diffusion technique. After culturing, 94 (51.08%) were positive for bacterial growth; out of 94 isolates of P. aeruginosa, 15 (15.96%) were from ear swabs, 14 (14.89%) from skin swabs, 20 (21.28%) from burn wound samples, 18 (19.15) from used cotton wool, 12 (12.76%) from catheter, and 4 (4.25% each) from urine and sputum. Also, this study recorded high prevalence rate of isolates among the female than male (63.83% and 36.17%, respectively), and the highest average (34%) of isolates were recorded among the age group 36-45 years and the lowest prevalence (5.22%) was recorded among the age group 15-25 years. The isolate demonstrated high resistance to beta-lactams (Ampicillin, Amoxicillin, Ampicillin, Cloxacillin, Augmentin and Ceftazidime). Results also revealed resistance to macrolide (Erythromycin) and sulphonamide (Septrin); and the organism was resistant to two aminoglycosides (Gentamycin and Amikacin) but sensitive to chloramphenicol. The quinolones (Ciprofloxacin, Levofloxacin and Norfloxacin) were very effective against the bacterium. There was statistically significant difference amongst the zones of inhibition at (P≤ 0.05) exhibited by the different antibiotics. The quinolones may therefore be considered as reserve drugs for the treatment of P. aeruginosa infections. To avoid resistance development, illicit use of antibiotics is not advised. Continued monitoring of antimicrobial resistance patterns in hospitals and community settings is imperative to provide effective therapeutic options.

Gynaecological Pan-endoscopy (Hystero-laparoscopy) in a tertiary health facility in Nigeria: A ten-year clinical audit

Objective: This study aims to determine the prevalence, indications, common findings, challenges, and complications of gynaecological pan-endoscopy in Obafemi Awolowo University Teaching Hospitals Complex, Osun State.
 Methods: It was a retrospective study. Records of patients who had gynaecological hysteroscopy and (or) Laparoscopy from 1st January 2012 to 31st December 2021 were retrieved, and relevant data were extracted and analyzed using the SPSS version 21.0
 Results: There were 2125 gynaecological surgeries within the study period, with 207 endoscopies giving a prevalence of 9.7%. Infertility 100 (51.5%) was the most common indication. Common findings were tubal block 45(33.6%) and intrauterine adhesions 19 (31.7%). The most common complication and challenge were shoulder tip pain 35(18.0%) and instrument failure 76 (39.2%), respectively. There is a statistically significant relationship between the occurrence of complications during Endoscopy and duration of surgery (X2 = 25.693, P= 0.000), endoscopy type (X2=21.636, P=0.000), and hospital stay (X2 = 63.213, P=0.000)
 Conclusion: The utilization rate of gynaecological pan-endoscopy could be higher and shows more skills, logistics, and staffing. Therefore, efforts should be intensified towards training and provision of up-to-date facilities for endoscopic surgery in our setting.

Evaluation of job satisfaction among pharmacists working in public health facilities

BackgroundThe decline in healthcare workforce is a global trend that is alarming in low and middle-income countries (LMIC) in LMIC and many countries worldwide, pharmacists plays critical role in healthcare, many of which are not limited to patient care, research and development, health promotion. However, growing dissatisfaction among pharmacists working in public health facilities has become increasingly common and can have severe public health consequence. Job dissatisfaction ranks among the most significant factors influencing healthcare employees to seek career changes, reduce productivity, and possibly migrate to more promising opportunities, thereby posing a public health threat in the region.' Furthermore, healthcare professionals are crucial to the functionality of a healthcare system, with human resources standing as a critical element ensuring organizational success vis-a-vis other dependent factors to optimize efficiency and effectiveness. ObjectivesTo examine the job satisfaction of pharmacists working in public health facilities in Nigeria. MethodA descriptive, cross-sectional study on pharmacists' job satisfaction was carried out between march and July 2023, to determine the job satisfaction of pharmacists working in primary, secondary, and tertiary healthcare facilities in Nigeria. Data were gathered using an anonymous online validated questionnaire adapted from the Minnesota questionnaire short form and the Job Description Index (JDI) (Measuring Job Satisfaction - Tools, Scales, and Methods). ResultsThe study identified an overall low job satisfaction level of 65%. Major influencers included facility conditions, co-worker relations, and remuneration. The demographic data revealed a dominance of female pharmacists in general hospital settings, with a significant proportion aged between 23 and 36 years. Remuneration emerged as a universal concern across different age groups, reflecting Nigeria's prevailing economic challenges. Interestingly, satisfaction with the working facility decreased with age, suggesting that enthusiasm and optimism wane over time. Relationship dynamics with co-workers showed positive progression with age, whereas satisfaction with pay remained universally low. ConclusionThe study underscores the need for a comprehensive strategic review in the health sector, focusing on remuneration, working conditions, and inter-personal relationships to boost job satisfaction and retention. Further research might delve deeper into specific allowances and the impact of home ownership on satisfaction.

Management staff's perspectives on intervention strategies for workplace violence prevention in a tertiary health facility in Nigeria: a qualitative study.

Health workers have increasingly become victims of workplace violence. However, negligible action has been given to developing workplace violence (WPV) prevention programs in hospital settings in low-middle-income countries. An effective workplace violence prevention program is crucial for preventing violence and managing the consequences of incidents. This study assessed management staff perspectives on intervention strategies for workplace violence prevention in a tertiary health facility in Nigeria. A qualitative study design was employed to explore the intervention strategies for preventing and managing workplace violence at a tertiary health facility in southeast Nigeria. Six focus group discussions were conducted with thirty-eight management-level staff. The interview transcripts were manually coded according to six predefined constructs of workplace violence: creating interdisciplinary harmony and WPV experiences, causes, prevention, program/policy contents, and implementation strategies. A manual thematic analysis approach was adopted, and the results were presented as narratives. The findings revealed recognition, welfare, administrative control, and security as vital strategies for the WPV prevention program. The participants agreed that unanimity among staff could be promoted through respect for all cadres of staff and for people's perspectives (creating interdisciplinary harmony). Assaults and staff intimidation/victimization (experiences), attributed to unethical/poor health workers' behaviour and ethnic discrimination (causes), were viewed as preventable by ensuring patients'/caregivers' welfare through respectful and timely care and staff's welfare through incentives/remunerations and discouraging intimidation (prevention strategies). Furthermore, the staff expressed that the WPV program should employ administrative controls, including instituting WPV policy/unit, codes of ethics, and standard operating procedures across all workplace facets (program/policy contents), which should be implemented through awareness creation, enforcement of sanctions, and provision of appropriate and adequate security presence in the hospital (policy implementation strategies). Respect, patient/staff welfare, administrative control, and security are strong mechanisms to prevent workplace violence in tertiary hospitals. Hospital management should institutionalize workplace violence prevention programs/policies and ensure compliance.

Reported morbidities, Blood pressure pattern and Body Mass Index of Informal Caregivers of Hospitalised Patients in a tertiary health facility in Nigeria

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Assessment of relationship between anthropometric measurements and reproductive hormonal profiles, among females of childbearing age at a tertiary health facility in Nigeria

Background: Increasing prevalence of overweight and obesity has profound impacts on health generally, including the reproductive system. Traditionally, pear body shapes, from narrow waist and wide hip circumferences, have been associated with high fecundability among females. Although this has been scientifically demonstrated by a number of researches only a few of these investigations were conducted with black women in Africa who were of reproductive age. Objectives: The objectives of the study were to compare the mean reproductive hormone levels between the different waist-to-hip ratio (WHR) and body mass index (BMI) categories and also to determine the correlations between the two anthropometric measurements and the reproductive hormones in a black African population. Materials and Methods: It was an analytical cross-sectional study of 180 females of a childbearing age. The WHR and BMI were measured as per standard recommendations. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol, day-21 progesterone, and testosterone were assayed. Results: A majority of the research participants were within the age group 21–30 years. Thirty three percent (33%) and 28.9% of participants were overweight and obese, respectively, using BMI compared with 26.7% and 20%, respectively, using WHR. Seventy six point nine percent (76.9%) of participants with an optimal BMI range ovulated with 61.5% having adequate luteal phase support compared with 75% and 54.2%, respectively, using WHR. Day-21 serum progesterone and serum estradiol were significantly negatively correlated with WHR and BMI (P < 0.05). BMI, however, showed a better correlation than WHR (r = -0.535 vs. -0.397; P = 0.001 vs. 0.008, respectively). Gonadotropins were significantly lower among overweight and obese groups for both BMI and WHR (P < 0.05), but only WHR showed moderately positive significant correlation with gonadotropins (LH: r = 0.050 vs. r = 0.215, P = 0.003, respectively; FSH: r = 0.159 vs. r = 0.431, P = 0.001, respectively), same as serum testosterone (r = 0.580 vs. r = 0.611, P = 0.002, respectively). Conclusions: Anthropometric measurements can serve as objective clues to functionality and optimal concentrations of reproductive hormones. Weight control should therefore aid the optimization of reproductive hormones and fertility among females of reproductive age.

PS-C32-1: DEMOGRAPHIC, ANTHROPOMETRIC AND BIOCHEMICAL CORRELATES AS EARLY PREDICTIVE INDICES OF HYPERTENSIVE DISORDERS IN PREGNANT WOMEN FROM NIGERIA

Objective: this study was conducted to evaluate maternal demographic, anthropometric and biochemical indices to predict Hypertensive Disorders of Pregnancy (HDP) at early stage. Design and method: Non-hypertensive pregnant women (n = 521) of &lt; 20 weeks gestation, attending antenatal clinics of four different tertiary health facilities in Nigeria enrolled into this longitudinal study. From this, 471 participants were followed up to delivery. Demographic data were obtained through a semi-structured questionnaire while BMI and Percentage Body Fat (PBF) were determined using standard methods. Blood and urine samples were collected at baseline, second and third trimesters. Placental Growth Factor (PLGF), leptin and insulin were analysed in serum using ELISA. Triglycerides, total cholesterol, HDLc, uric acid, creatinine and Fasting Plasma Glucose (FPG) in plasma were analysed spectrophotometrically. Urinalysis was performed using dipstick while LDLc was calculated. Data were analysed using Chi-square, ANOVA and Cox proportional hazard model at &lt; 0.05. Results: Ten (2.1%) and 24 (5.1%) of the pregnant women developed HDP at second and third trimester. From the 34 that developed HDP, 19 (55.9%), 12 (35.3%), 2 (5.9%) and 1 (2.9%) developed Preeclampsia-Eclampsia, Gestational Hypertension, Chronic Hypertension and Preeclampsia Superimposed on Chronic Hypertension, respectively. Maternal age and marital age of HDP women (32.4 ± 5.0; 28.9 ± 4.3 years) were respectively higher than normotensive (30.5 ± 4.4; 27.2 ± 3.7 years). Risk of HDP was higher at marital age of 35–42 years compared with 13–25 years (HR = 8.44, 95% CI: 2.01–35.35). Body mass index (30.4 ± 1.6 vs. 26.6 ± 0.3Kg/m2) and PBF (40.6 ± 1.5 vs. 36.0 ± 0.5) were higher in HDP women than normotensive. Reduced PLGF level (HR = 0.77, 95% CI: 0.64–0.94) in second trimester increased risk of HDP. Leptin (6.9 ± 1.9 vs. 14.1 ± 1.5ng/mL) in first trimester and insulin (1.5 ± 0.5 vs. 10.5 ± 1.5 μIU/mL and 7.9 ± 3.2 vs. 17.5 ± 2.1 μIU/mL) in first and second trimesters were lower in HDP than normotensive women, respectively. Uric acid (2.8 ± 0.1 vs. 4.2 ± 0.8 mg/dL) and creatinine (0.8 ± 0.01 vs. 2.6 ± 1.7 mg/dL) were significantly decreased in normotensive compared with HDP women in first trimester. The FPG (78.1 ± 2.6: 73.0 ± 1.4: 71.4 ± 1.5 mg/dL) was significantly reduced from first, second to third trimesters in normotensive women. In HDP women FPG (76.1 ± 4.1; 74.5 ± 6.7 vs. 65.8 ± 5.5 mg/dL) was increased in second and third trimesters, respectively compared to first trimester. Increased LDLc (HR = 1.28, 95% CI: 1.04–1.58) was associated with increased risk of HDP in second trimester. Conclusions: Maternal age, obesity, decreased levels of placental growth factor, leptin, insulin, uric acid; increased levels of fasting plasma glucose and low density lipoprotein cholesterol are critical risk factors for early prediction of hypertensive disorders during pregnancy.

Prevalence, case fatality rate and risk factors for mortality among neonates admitted with perinatal asphyxia at a tertiary hospital in northern Nigeria

Documenting the burden and the risk factors for perinatal asphyxia-related mortality is key to its prevention. The goal was to document the factors associated with mortality in perinatal asphyxia in a tertiary health facility in Nigeria. Records of consecutive neonatal admissions (between January 2016 and January 2017) underwent a retrospective analysis. Data were analyzed using Stata statistical software version 16 (Statacorp® Texas, USA). 102 (12.1%) of 841 admitted neonates had perinatal asphyxia; the median age (inter quartile range [IQR]) was 6 (0-168) hours. The mean admission weight ±(SD) was 2.96kg±(0.66) kg. Among inborn neonates, the incidence was 9.7 per 1000 live births. In 49% (50/102) pregnancies the amniotic fluid was clear; in 42% (43/102) it was meconium-stained; and 9 staining was unreported. Case fatality rate was 20.6% (21 of 102). 77(75%) neonates had no HIE, while 24 (24.5%) did. When compared to neonates without HIE, those with HIE II had about 7000 times higher odds of mortality (aOR = 68132.19, P0.01, 95% CI 3 to 1.4X 109). The adjusted odds of mortality for neonate with meconium-stained liquor were about 1900 times higher compared to clear meconium (aOR =1895, P = 0.02, 95%CI = 2.7 to 13072). Neonates with higher mean admission lengths (49.4cm [range = 48.8 to 50]) had 88 times lower odds of death compared to shorter neonates (aOR of 0.12 (95% CI: 0.17 to 0.85; p = 0.03).

Evaluation of HIV Non-occupational Post-exposure Prophylaxis Utilisation in a Tertiary Health Facility in Nigeria

Background &#x0D; The Sub-Saharan Africa accounts for more than 70% of the global burden of HIV infections. Non-occupational post-exposure prophylaxis, when initiated within 72 hours of HIV exposure for 28 days, can prevent seroconversion in 80% of HIV exposures.&#x0D; Objectives &#x0D; To evaluate the characteristics, prevalence and outcome of non-occupational HIV post-exposure prophylaxis utilization in a tertiary hospital.&#x0D; Method &#x0D; This was a retrospective study that involved the medical records of 143 patients who sought HIV non-occupational post-exposure prophylaxis between 1st June 2011 and 31st May 2021. A questionnaire was used to collect information about the socio-demographic data, profiles of both the source and exposed persons, antiretroviral completion rate and outcome at follow-up.&#x0D; Results &#x0D; Females accounted for 125 (87.4%). Sexual assaults were the main reasons for seeking non-occupational post-exposure prophylaxis in 119 (83.2%). High-risk exposures were observed in 134 (93.7%). HIV status of the sources was unknown in 126 (88.1%). 123 (86.0%) initiated antiretroviral within 72 hours of exposure and antiretroviral completion rate was 70.6%. Only 28 (19.6%) reported for follow-up scheduled HIV screening and were all negative.&#x0D; Conclusion &#x0D; Early initiation of postexposure prophylaxis, improvement in baseline HIV testing of the source, and follow-up HIV screening, will significantly improve services and outcomes.&#x0D; Rwanda J Med Health Sci 2022;5(3):264-275

Insulin initiation in Type 2 diabetes mellitus outpatients – data from the multicentre evaluation of type 2 diabetes mellitus outpatients on insulin therapy in Nigeria (METOIN study)

People living with type 2 diabetes mellitus (T2DM) have relative insulin deficiency and, therefore, have options to insulin therapy. To be on insulin alone or in combination with other therapies in type 2 DM outpatients is a choice made personalized for each patient. Published literature on the insulin initiation patterns among T2DM outpatients in Nigeria is scanty. The objective of this study, therefore, is to bridge this gap in knowledge. This was a prospective cross sectional study conducted in five tertiary health facilities in Nigeria in which consenting type 2 DM outpatients on insulin therapy alone or in combination with other therapies and who meet the inclusion criteria for the study were recruited. Relevant data relating to insulin use initiation by the patients were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software. A total of 268 outpatients living with type 2 DM on insulin therapy, made up of 116 (43.3%) male and 152 (56.7%) females participated in the study. Only 55 (20.5%) of the patients started insulin at onset of diagnosis of T2DM while 46 (17.2%) of the patients started insulin therapy after 5 years of living with T2DM. The duration of living with DM before insulin initiation and the patient's highest level of education were not statistically significant. Insulin initiation was delayed several months to years after diagnosis of T2DM by predominantly endocrinologists in tertiary health facilities but it was initiated in 19 (7.1%) of the T2DM outpatients by primary care physicians (GPs) in peripheral hospitals. It is recommended that diabetes education be intensified for T2DM patients to appreciate the key role of insulin therapy in diabetes care.&#x0D; Keywords: insulin initiation, type 2 diabetes mellitus outpatients, Nigeria.

Characteristics and Predictors of Controlled Hypertension at A Tertiary Health Facility in Nigeria

Aim: Our cross-sectional study set out to identify characteristics and predictors of hypertension control among adults on drug treatment. The aim was to provide current, actionable evidence of the factors that promote hypertension control and hence, improve health outcomes through reduction of cardiovascular morbidity and mortality.  Methods: We conducted a descriptive, cross-sectional, and hospital-based study of 90 eligible, previously diagnosed and currently treated adults (18 years or older) with hypertension at the Medical Outpatients’ Clinic of Igbinedion University Teaching Hospital, Benin City, Nigeria. Controlled hypertension was defined as systolic blood pressure &lt;140 mm Hg and diastolic blood pressure &lt;90 mm Hg, on treatment with antihypertensive medication. The distribution of characteristics of adults with controlled hypertension was summarized with descriptive analysis and the predictor of hypertension control investigated by fitting binary logistic regression model.  Results: Mean age of the adult study population was 58.34 years (SD 12.54, 95% CI 55.78 to 60.91). The majority were female (57.8%), married (76.7%), self-employed (64.4%), urban dwellers (73.3%) and all (100%) had at least primary school education. Almost two-thirds (65.6%) had never taken or had stopped taking alcohol, and none self-reported current smoking status. Some 62.2% had excess adiposity, 17.8% had diabetes and 40% had evidence of hypertensive target organ damage. Only 10% (95% CI 4.7%-18.1%) of patients had health insurance coverage. Mean systolic blood pressure was 138 mmHg (SD 21.71; 95% CI 133-142) while mean diastolic blood pressure was 86 mmHg (SD, 13.96; 95% CI, 83-89 mmHg). Slightly over half of the study population (n = 47; 52.2%, 95% CI 41.4%-62.9%) had controlled hypertension. The most frequently prescribed antihypertensive medication was calcium channel blocker (84.4%) either singly or in combination with other drug classes. Majority of the patients (n = 61, 67.8%) were on free-drug or fixed-dose combinations. Fifty-two patients (57.8%; 95% CI 46.9%-68.1%) had good adherence to prescribed antihypertensive medication. Apart from health insurance coverage and good adherence to medications, no other patients’ characteristics were significantly associated statistically, with controlled hypertension. The only independent predictor of controlled hypertension was good adherence to antihypertensive medication.  Conclusion: This study adds to the body of literature on hypertension control by shedding light on the attributes of adults with controlled hypertension. However, hypertension control to target among our study population was suboptimal. The salient evidence of gaps in hypertension control provided by this study should be regarded as an opportunity to review and adopt more effective patient-centered and health system-related hypertension control strategies. Wider health insurance coverage and interventions to boost patients’ adherence to components of hypertension management are strategies that could make a significant impact on health outcomes, if adequately and sustainably implemented.

An appraisal of the contextual drivers of successful antimicrobial stewardship implementation in Nigerian health care facilities

Antimicrobial resistance (AMR) is a consequence of inappropriate actions, including irrational antimicrobial prescribing and use. Antimicrobial resistance remains an emergent and significant public health threat, particularly in low and middle-income countries (LMICs), including Nigeria. Optimizing antimicrobial (AM) use through functional hospital antimicrobial stewardship (AMS) programs is one of the strategies to control the spread of AMR. Literature is replete with evidence, but few studies examined the contextual factors limiting AMS functionality at the facility levels. This study explored the intrinsic contextual factors shaping AMS practice at the three-tiered levels of care. This was a qualitative case study with a purposeful sample size of 30 participants drawn from two primary, two secondary, and two tertiary health facilities in Nigeria. Data were coded and categorized for thematic analysis. Emergent themes include lack of AMS programs, inadequate guidelines, lack of modern equipment and incorrect diagnosis, absence of continuous medical education, imbalance of power among professionals, and pervasive external influence of pharmaceutical marketing companies. These findings demonstrate that the AMS program is lacking or poorly implemented at the three-tiered level of care. We recommended that health facilities establish AMS programs in line with the World Health Organization's stepwise approach. These challenges, if addressed, will promote the successful performance of the AMS program, contributing to rational AM use at all levels of care. Since primary health centres constitute 85.4% of all health facilities, customizing the AMS core elements at this level will contribute to achieving the goals of universal health coverage.

Folic acid usage and associated factors among pregnant women attending a tertiary health facility in Nigeria

Background: Folic acid (FA) is an essential water-soluble vitamin that cannot be synthesized in the human body; hence its major source is from diet. It plays a key role in embryonic development. FA supplementation in pregnancy reduces the risk of megaloblastic anaemia, preterm delivery and neural tube defects. The aim of the current study was to evaluate the use of FA and factors associated with uptake amongst pregnant women at the University of Port Harcourt Teaching Hospital.Methods: A descriptive cross-sectional study involving 451 antenatal attendees at the University of Port Harcourt Teaching Hospital from 1 January to 31 March 2020. After consent was obtained, a structured interviewer-administered questionnaire was used to collect information from the women. Data was entered into a spread sheet and analyzed with SPSS version 25. The results are presented in means and percentages. The confidence interval was set at 95% and a p value of &lt;0.05 was deemed statistically significant. Chi square test and Pearson’s correlation were used to determine association between usage of FA and variables.Results: Most of the women, 258 (57.21%) were between the ages of 30 and 39 years and were primarily nulliparous 122 (27.1%). Moreover, two-thirds of them 330 (73.2%) had post-secondary education and nearly all 409 (90.7%) of the women were married. Majority 370 (82.0%) of the pregnant women were currently taking folic acid but only 109 (24.2%) commenced before pregnancy. Use of FA was significantly associated with socio-demographic characteristics such as age, marital status, level of education and occupation (p&lt;0.05). In addition, parity, planned pregnancy, history of having a child with neural tube defect, and timing of commencement of folic acid were all significantly associated with folic acid usage (p&lt;0.05).Conclusions: Only a small proportion of pregnant women have used FA before their pregnancies. A public health policy or strategy to increase the pre-conceptional use of folic acid is needed.

Salivary Lactoferrin Levels, Disease Severity and Correlates in Patients with Chronic Periodontitis Presenting to a Tertiary Health Facility in Nigeria.

Objective: This study compared the concentration of salivary lactoferrin in patients with and without chronic periodontitis and investigated correlations with clinical variables of the disease.&#x0D; Methods: The study included 102 participants (51 cases and 51 controls) who presented at the Periodontology Clinic of University of Benin Teaching Hospital and met the selection criteria of ‘4mm and above’ periodontal probing depths (PPD) and positive bleeding on probing (BOP) using community periodontal index (CPI) probe. Healthy participants (controls) were patients that had PPD less than or equal to 3mm, absence of BOP and simplified oral hygiene index (OHI-S) not more than 1.2. Baseline OHI-S and CPI scores were recorded. Saliva samples were collected and analyzed using enzyme-linked immunosorbent assay. All data were analyzed with the Statistical Package for Social Sciences (SPSS) version 22.0.&#x0D; Results: There was a statistically significant difference between the mean (SD) lactoferrin concentration of control participants 5.27(0.59) mg/l and case participants 6.74(0.61) mg/l (p&lt;0.001). Participants with probing pocket depths (PPD) of 6mm or more had a significantly higher mean concentration [6.85(0.06) mg/l] than that of those with PPD 4-5mm [6.71(0.67) mg/l] (p &lt; 0.001) Lactoferrin levels were highest in participants with ‘poor’ oral hygiene [6.85(0.60) mg/l] and lowest in those with ‘good’ oral hygiene [6.65(0.83) mg/l].&#x0D; Conclusion: Salivary lactoferrin levels were higher among participants with chronic periodontitis than those without chronic periodontitis and correlates positively with the main clinical characteristics of the disease

Pattern of common hormonal disorders among patients with polycystic ovarian syndrome at a tertiary health facility in Nigeria

Background: Polycystic ovarian syndrome (PCOS) is a disease associated with multiple reproductive and metabolic endocrine disorders. It is associated with cardiometabolic complications with established morbidity and mortality. Aim: We studied the pattern of these endocrine disorders associated with PCOS will aid the understanding of the pathophysiology of this relatively incompletely understood syndrome, particularly among Africans. Patients, Materials and Methods: One hundred adult females aged between 18 and 44 years, who were newly diagnosed with PCOS, and 100 age-matched non-PCOS women were involved in the study. Their serum samples were analyzed for follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, progesterone, estradiol, testosterone, leptin, and anti-Mullerian hormone (AMH) using ELISA method. Results: The mean age of the test subjects in this study was 26.4 ± 6.0 years versus 33.3 ± 6.6 years in controls. The mean weights and body mass index of the test subjects and controls were 89.1 ± 13.9 kg versus 64.7 ± 11.3 kg, P = 0.04, and 34.01 ± 3.5 kg/m2 versus 23.8 ± 3.9 kg/m2, P = 0.034, respectively. The mean serum LH was significantly higher among subjects than that of controls (11.4 ± 7.4 vs. 5.7 ± 4.8 mIU/mL, P = 0.001); similarly the mean serum LH: FSH ratio was significantly higher among subjects and controls in this study (1.9 ± 1.1 vs. 1.1 ± 0.8, P = 0.042). Serum AMH, insulin, leptin, and testosterone levels were higher among subjects than controls (7.5 ± 5.4 vs. 2.7 ± 0.4 ng/mL, P = 0.001, 21.6 ± 7.3 vs. 18.0 ± 3.01 μIU/mL, P = 0.004, and 18.6 ± 4.0 vs. 3.5 ± 1.5 ng/mL, P = 0.003, 1.0 ± 0.2 vs. 0.6 ± 0.2 ng/mL, P = 0.042, respectively). Mean serum prolactin was significantly higher among subjects when compared to controls. The prevalence of hyperinsulinemia, hyperleptinemia, and hyperandrogenemia among subjects in this study was higher when compared to controls. Conclusion: PCOS is a disease of multiple and inter-related endocrine disorders; a study of the frequencies and distributions of these associated disorders can aid the understanding of the pathophysiology of the disease particularly among Africans where limited studies have been carried out.

Knowledge of the glasgow coma scale among physician interns in a Nigerian tertiary health facility

Background: The Glasgow coma scale (GCS) is the most utilized level of consciousness scale globally. Insufficient working knowledge of the GCS by physicians may contribute to poor outcomes in patients with altered levels of consciousness. Aim: This study aims to assess the knowledge of the GCS among the physician interns, also known as house officers, in a rural tertiary health facility in Nigeria. Materials and Methods: This was a questionnaire-based survey among physician interns in a rural tertiary hospital in Nigeria. Results: All the 77 respondents graduated from medical school within 2 years of the study. Seventy-two (93.5%) of the participants had been actively involved in the management of patients at the hospital's accident and emergency department within a month before the study, while 71.4% had been involved in emergency care outside the accident and emergency department within a month prior. Seventy-five (97.4%) conceded to having received didactic lectures on the GCS in the course of their medical training. About three-quarters (74.03%) of the respondents correctly defined GCS as GCS; about 85.7% were able to correctly identify all the clinical variables of the GCS, while only 15.6% could correctly describe and score all the parameters of the grading scale. The eye-opening response was the most correctly remembered (64.9%), followed by the verbal response (42.9%), while the motor response was remembered by 29.9% of the respondents (P = 0.04). Only 36 (46.8%) participants were aware of any subsequent modification to the original GCS score. Conclusion: The working knowledge of GCS is poor among physician interns surveyed in this study. The clinical variable of the GCS with the highest number of items, the motor response, was the least correctly remembered.

The Impact of COVID-19 Pandemic on Cleft Care Services at a Tertiary Health Facility in Nigeria

Background: This study assessed the impact of COVID-19 Pandemic on cleft care services at a Nigerian tertiary health facility and the adaptations made during and after the population quarantine period. Methodology: A prospective and retrospective survey of all patients with orofacial cleft who had cleft surgeries, orthodontic interventions, and speech therapy in isolation or any of the combination was carried out. The survey period was divided into pre-COVID-19 lockdown period, the COVID-19 lockdown period, and the post-COVID-19 lockdown period with each of the periods spanning 4 months. The data which include: number of cleft clinic attendance, number of cleft surgical procedures, orthodontic interventions, and speech therapy session were retrieved from patients’ case records in the cleft and orthodontic clinics. The data was also reported for each period and represented as numbers and percentages. The trend of cleft services was plotted as line graphs and the impact of the COVID-19 pandemic on cleft care services is said to be significant when P value is &lt;.005. Result: During the COVID-19 Lockdown period, there was a 66% drop in level of cleft clinic attendance, 78% drop in cleft surgeries, 78% drop in Orthodontic interventions, and a 58% drop in the number of Speech Therapy sessions. After the Lockdown period, the clinic attendance increased by a 190%, cleft surgeries rose by more than 10-fold, and the orthodontic interventions increased 10-fold. The speech therapy sessions dwindled further by 6% during the post-COVID-19 Lockdown period. The drop in cleft care service during the study period was significant ( P = .001). The post Lockdown surge in cleft care services was also statistically significant ( P = .001). Conclusion: The COVID-19 pandemic significantly altered the volume of cleft care services but also with a significant rebound post-lockdown period.

Congenital heart defects in orofacial cleft: A prospective cohort study.

Background:Congenital heart defects (CHDs) are one of the most common associated anomalies in patients with an orofacial cleft (OFC). However, few studies have shown the association between cleft type and CHDs in our population. This study aimed to assess the prevalence of CHDs in a cohort of OFC patients at a tertiary health facility in Nigeria, as well as assess the risk of CHD by OFC type.Materials and Methods:This was a prospective study design. Patients with an OFC were consecutively enrolled at a single OFC treatment facility. All subjects were assessed by a paediatric cardiologist and had echocardiography done. They were categorised based on the presence of CHDs, as well as the OFC phenotypic type (cleft lip and/or alveolus, cleft lip and palate and cleft palate only). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was set at P < 0.05.Results:A total of 150 subjects enrolled in the study over a period of 2 years (2018–2020). The median age of subjects was 6 months (interquartile range: 2–24), and 54.7% were female. The prevalence of CHDs in the subjects reviewed was 30.7%. Based on the severity of CHDs, the majority presented with simple defects (95.6%). Overall, the most common presentation was patent foramen ovale (12.7%), followed by septal defects (8.0%). There was no significant association between cleft type and the odds of a CHD.Conclusion:The study reports a relatively high prevalence of CHDs in patients with OFC; however, there was no association between the risk of CHD by cleft type. Although a majority of CHDs may pose a low operative risk, cardiac evaluation is recommended for all cases of OFC to aid the identification of potentially high-risk cases.