Tertiary Health Facility In Nigeria Research Articles

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 <.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.

Risk Asessment and Thromboprophylaxis for Venous Thromboembolism (VTE) in the Antenatal Population in a Tertiary Health Facility in Nigeria

Aim: To review the venous thromboembolism (VTE) risk assessment and thromboprophylaxis in the antenatal population in a tertiary health facility in Nigeria and to perform a retrospective VTE risk assessment of the patients with a view of determining those patients that would have needed VTE prophylaxis.
 Design: It was a retrospective cross-sectional study.
 Place and Duration of Study: The study was carried out at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria from the 1st of February to the 30th of April, 2020.
 Materials and Methods: The following data were extracted from the hospital notes of 347 consecutive antenatal patients: history/demographic characteristics, risk factors for VTE, thromboprophylaxis, diagnosis and treatment of VTE, using the RCOG guideline 37a of 2015 as a benchmark for comparison. Data was analysed with the aid of a Statistical Package for Social Science (SPSS) software, version 18.
 Results: VTE risk assessment and thromboprophylaxis was not a routine practice at the UPTH. Apart from antenatal admission, the most frequent VTE risk factors in pregnancy were BMI ≥30, Parity ≥ 3, Age > 5 years and current pre-eclampsia at 48.48%, 41.04%, 36.04% and 15.56% of the study population respectively. 131 (37.75%) of the 347 antenatal population fulfilled the criteria for venous thromboprophylaxis with low molecular weight heparin (LMWH) but they were not assessed and the drug was not given. 63 (18.16%) of the study population was to receive LMWH from 28 weeks of pregnancy while 68 (19.60%) of them were to be given from the first trimester. The prevalence of VTE was however very low at 0.02% (1 patient out of the 347 maternities), irrespective of the fact that 41 (11.82%) of the patients had symptoms and signs of VTE.
 Conclusion: 131 (37.75%) out of the total 347 antenatal patients fulfilled the criteria to be given thromboprophylaxis but the prevalence of VTE was low at 0.02%. It was therefore recommended that a unified Nigerian national guideline should be written.

Knowledge of Risk Factors for Foot Ulceration among Patients with Diabetes Mellitus Attending a Tertiary Health Facility in Nigeria

Objective: Diabetic foot ulcer (DFU) is a relatively common complication of diabetes mellitus and constitutes a major cause of mortality. This study aimed to assess the knowledge of risk factors for foot ulceration among patients with diabetes in a tertiary health facility in South Western Nigeria.
 Materials and Methods: This cross-sectional study was initiated with participation of 100 diabetic patients. Diabetic patients were attending the medical outpatient clinic of the University College Hospital, Ibadan. A structured and validated questionnaire was administered and data was analyzed using SPSS 22. Association between sociodemographic characteristics and knowledge of risk factors for foot ulceration was evaluated by chi-square test.
 Results: Most of respondents were female (66%). The mean age of the patients was 58.77 (±11.8) years and 51% of patients did not know that it is possible to develop foot ulcer without feeling pain and 30% did not know that features suggestive of neuropathy could be associated with development of foot ulcer. 75% did not know that surgical vascular repair could play any role in the healing of a diabetic foot ulcer. 11% of patients were walking barefooted at home and as much as 63% of respondents did not know that poor longterm glycemic control could be a risk factor for the development of diabetic foot ulcers.
 Conclusion: The knowledge of the patients attending the diabetes clinic of a tertiary hospital in south-western Nigeria on foot care is generally poor. Education in this direction is very paramount to correct this defect.

Comparative incidence of adverse drug reaction during the first and subsequent year of antiretroviral therapy in a Nigerian HIV infected Cohort.

Despite close to two decades of antiretroviral therapy (ART) in Nigeria, data on late on-onset ART-associated adverse drug reactions (ADRs) are sparse. To describe early and late-onset ADRs and compare their incidence in an outpatient HIV positive Cohort on ART. We described the incidence of clinical ADRs identified and documented in an outpatient clinic cohort of HIV-positive patients treated between June 2004 and December 2015 at a tertiary health facility in Nigeria. Incidence rates of ADRs during the first and subsequent years of ART were compared. of the 13,983 patients' data analyzed, 9317 were females (66%), and those in the age bracket of 25 to 45 years made up 78% of the studied population. During 52,411 person-years (py) of ART, 1485 incident ADRs were recorded; Incidence rate (IR) 28.3 (95% confidence interval [CI] 26.9:29.8) ADRs per 1000 person-years (py) of ART. The IR of ADRs was about two times higher in the first year of ART compared to subsequent years of treatment; crude incidence rate ratio (IRR) 1.77 (95% CI 1.59:1.97). Anemia, hypersensitivity reactions, and nervous system disorders had 7, 23, and 5 times higher incidence, respectively, in the first year of therapy, compared to subsequent years. The first year of ART is the period of highest risk of ADRs. Individual and programmatic treatment success in resource-limited settings requires strategies for early identification and management of ADR during the period of greatest risk of ADRs.

Investigation of Clinical and Diagnostic Features Associated with Cerebral Palsy Children in a Tertiary Health Facility in Nigeria

Background: Cerebral palsy is non-progressive motor disability syndrome largely attributed to abnormal development or damage from likely trauma in one or more parts of the brain especially the cerebellum and frontal lobe of the cerebrum that control muscle tone and motor activity and causing variable mental, motor and behavioral dilemmas generally referred to as delayed developmental milestone. Aims and Objectives: The study aims to investigate the gross features and clinical manifestation in cerebral palsy children in in cross-sectional patients in health facility. Materials and Methods: The study involved the use of 40 case files of cerebral palsy patients; 26 (65. 0%) out of them were girls, and 14 (35.0%) of them were boys, aged from 0 to 10 years old. Results: The main clinical presentation in this study was speech delay which was presented in 50.0% of the examined children, followed by delayed walking and movement in 25.0% of the patients. Analysis using records of imaging diagnostic tools showed that computed tomography has the highest case file with 70.0% due its availability and its cheapness compared to magnetic resonance imaging. Conclusion: Children with cerebral palsy are best cared for with an individualized treatment plan that provides a combination of interventions tailored to each individual.

Investigation of Clinical and Diagnostic Features Associated With Cerebral Palsy Children in a Tertiary Health Facility in Nigeria

Background: Cerebral palsy is non-progressive motor disability syndrome largely attributed to abnormal development or damage from likely trauma in one or more parts of the brain especially the cerebellum and frontal lobe of the cerebrum that control muscle tone and motor activity and causing variable mental, motor and behavioral dilemmas generally referred to as delayed developmental milestone. Aims and Objectives: The study aims to investigate the gross features and clinical manifestation in cerebral palsy children in in cross-sectional patients in health facility. Materials and Methods: The study involved the use of 40 case files of cerebral palsy patients; 26 (65. 0%) out of them were girls, and 14 (35.0%) of them were boys, aged from 0 to 10 years old. Results: The main clinical presentation in this study was speech delay which was presented in 50.0% of the examined children, followed by delayed walking and movement in 25.0% of the patients. Analysis using records of imaging diagnostic tools showed that computed tomography has the highest case file with 70.0% due its availability and its cheapness compared to magnetic resonance imaging. Conclusion: Children with cerebral palsy are best cared for with an individualized treatment plan that provides a combination of interventions tailored to each individual

Knowledge of Exclusive Breastfeeding among Nursing Mothers Attending under 5 Welfare Clinic in a Nigerian Tertiary Health Institution

Background: Exclusive Breastfeeding (EBF) offers important protective effects on child survival. Knowledge on EBF is a prerequisite to enhance its practice among nursing mothers.
 Objective: To determine the knowledge of exclusive breastfeeding practice among nursing mothers attending Under-5 Welfare Clinic in a tertiary health facility in Nigeria.
 Materials and Methods: This was a cross-sectional descriptive study involving 333 nursing mothers. Pre-tested self/interviewer administered questionnaires were used to obtain information from consenting eligible women. Knowledge was assessed using a 12-point score and classified as good or poor. Data obtained was analyzed using IBM SPSS version 25.
 Results: Our respondents had a mean age of 31±4.9years while 84.7% were 27 years and above. Majority were married (93.1%) with 57% of them having at least two (2) living children. Well over half of the respondents had attained a tertiary education. Antenatal care (ANC) was attended by 94.9% of the women where 96.8% said they had received advice on EBF. A total of 86% of the women had good knowledge score of EBF. Educational status and occupation showed statistically significant association with knowledge of EBF among the mothers (p=<0.001 and p=0.018) respectively while marital status (p=0.046), number of living children (p=0.001), educational status (p=<0.001) and occupation (p=0.050) all showed significant association with ANC attendance.
 Conclusion: The effect of female education on knowledge of health issues is brought to the fore by the findings of this study. More emphasis on delivering at health facilities where information to women on the practice of optimal breastfeeding is readily available will go a long way to reduce the infant and maternal mortality rates in Nigeria.

Influence of maternal occupation on adverse pregnancy outcomes in a Nigerian tertiary health facility

Background: There is accumulating evidence that the type of work and environmental exposures in the work environment during pregnancy may have adverse effects on fetal development and pregnancy outcome. The objective was to determine the influence of maternal occupation on adverse pregnancy outcomes.Methods: The study was a prospective hospital based study conducted at the obstetrics and gynecology department of a tertiary health facility in Nigeria. All the data were retrieved from the ante natal and delivery card of all the women that delivered at the unit within the time of data collection. Data was analyzed using SPSS version 25 and variables were presented as frequencies, percentages, means, and standard deviation. Bivariate analysis was done using chi-square test. The level of significance was set at p value ≤ 0.05.Results: Maternal occupation did not significantly affect the gestational age at delivery (X2=10.143, p=0.428) and birth weight (X2=16.807, p=0.079) however, it significantly affected the still birth (X2=28.134, p=0.002). Agricultural, forestry and fishery workers and plant and machine operators were about 8 times and 17 times more likely to have still birth than the unemployed respectively.Conclusions: There were substantial differences in the risk of adverse pregnancy outcomes between the different occupational groups.

A multicentre point prevalence study of antibiotics utilization in hospitalized patients in an urban secondary and a tertiary healthcare facilities in Nigeria: findings and implications

ABSTRACT Objectives The understanding of antimicrobial utilization patterns is pertinent to successful implementation of the National Action Plans on Antimicrobial Resistance (AMR). There is, however, limited information on antibiotics utilization in Nigeria. This study was undertaken to build on existing information and provide direction for appropriate interventions including Antibiotics Stewardship Programs (ASP). Method A Point Prevalence Study (PPS) was conducted in two public urban health facilities in Lagos, Nigeria using a design adapted from the European Center for Disease Prevention and Control (ECDC) and Global-PPS surveys. Results The prevalence of antibiotics use was 80.6% administered mostly parenterally (83.1% of total prescriptions) with concerns with extended surgical antibiotics prophylaxis. The mostly used antibiotics in the secondary hospital were parenteral metronidazole (32.4%), ceftriaxone (27.5%), and amoxicillin + clavulanate (8.2%) while the mostly used in the tertiary hospital were ceftriaxone (25.3%), parenteral metronidazole (19.1%), and amoxicillin + clavulanate (9.3%). There was an appreciable lack of specific functional capacities, policies, and processes to promote appropriate antimicrobial use in both hospitals. Conclusions There is high rate of antibiotics utilization in these facilities with lack of institutional frameworks and processes for ensuring appropriate antibiotic use. The study provides the information needed to improve future antimicrobial use in hospitals and reduce AMR.

“BORN TOO SMALL” AND IT’S ASSOCIATED FACTORS IN A TERTIARY HEALTH FACILITY IN NIGERIA.

Background: Low Birth Weight (LBW) is a major adverse outcome of pregnancy. Methods: A prospective cohort study conducted at a tertiary health facility in Nigeria. Data was retrieved from the ante-natal and delivery card of women that delivered within the time of data collection. Data was analyzed using SPSS version 25 and variables were presented as frequencies, percentages, means, and standard deviation. Bivariate analysis was done using chi-square test with the level of signicance set at p ≤ 0.05. Binary logistic regression was used to determine factors that predicted low birth weight. Results:The prevalence of LBW was 11.1%. About 48% of the mothers delivered through caesarean section while 53.9% booked within 14-28weeks gestation. On logistic regression agricultural workers had 4 times odds of having LBW babies when compared to the unemployed while the un-booked mothers had 11 times odds of having LBW babies when compared to those that booked at >28weeks gestational age. Conclusion: The prevalence of LBW was high. Booking status of the mother and having complications during pregnancy were strongly associated with preterm delivery.

Cost associated with hospitalization of non-adherent type 2 diabetes patients in a tertiary healthcare facility in Ibadan, Nigeria

Purpose: To estimate the cost of hospitalization associated with medication non-adherence among type 2 diabetes mellitus (T2DM) patients in a tertiary healthcare facility in Nigeria.
 Methods: Three hundred and fifty-four (354) medical records of T2DM patients admitted into the medical wards from 2013 to 2015 were used for the study. Medical records with history of medication non-adherence (MNA) prior to hospitalization as indicated by physicians were included in the study. Direct medical costs associated with the management of the patients during hospitalization were measured using out-of-pocket payer perspective. Pearson product moment correlation coefficient was used to determine the relationship between the variables, with p < 0.05 considered statistically significant.
 Results: Among the 354 admitted patients, 226 (63.8 %) had a record of MNA. The mean age was 57.5years ± 14.6. The majority of the patients (61.5 %) were either petty traders or artisans/selfemployed. Duration of hospitalization increased with increase in number of comorbid disease (Pearson product moment correlation r = 0.13 p = 0.05). Total cost incurred during hospitalization was US$146,669.3 (average, $ 650.1), of which more than one quarter was cost of medications. Cost of management and cost of laboratory investigations increased with increase in the number of co-morbid diseases (r = 0.24, p = 0.00; r = 0.2, p = 0.02, respectively). Cost of management also increased with increase in days of hospitalization (r = 0.2, p = 0.00).
 Conclusion: Cost of hospitalization related to non-adherence to medication is high among the studied population. There is need to work out strategies to enhance adherence among diabetes patients.

Examining the influence of illness perception and financial toxicity on the quality of life of prostate cancer patients

BackgroundCancer of the prostate (CaP) is a public health problem that affects the male genitourinary system causing a significant threat to men’s quality of life (QoL). Experiencing financial constraints and poor illness perception may further compromise the QoL of men with CaP.MethodsAim: To examine the relationship between financial toxicity and illness perception with quality of life in men with CaP. The descriptive cross-sectional study used simple random sampling technique to recruit 173 men with CaP from four tertiary health facilities in Nigeria. Data were collected with the comprehensive score for financial toxicity (COST-FACIT), the brief illness perception questionnaire (Brief IPQ) and the functional assessment of cancer therapy-prostate (FACT-P). Analysis of data was carried out using analysis of variance, correlation and hierarchical regression analyses.ResultsThe 173 participants had an average age of 71.57 ± 11.18, and 53.18% had one comorbid disease. Significant difference was found in overall QoL based on treatment site and number of comorbid diseases (P < 0.01). QoL had a significant inverse relationship with all the illness perception variables and a significant linear relationship with lower financial toxicity (P < 0.01). Furthermore, financial toxicity (P < 0.05) and four illness perception variables: consequences, identity, concern and illness understanding (P < 0.01), had significant individual influences on QoL of men with CaP.ConclusionsQuality of life in men with CaP may be improved through mitigating the financial toxicity associated with accessing care and providing appropriate counseling about the illness and what to expect following prostate cancer diagnosis and during treatment.

Knowledge, attitude, and practice towards diabetes mellitus among outpatient diabetic elderly persons: a descriptive study

To investigate the knowledge, attitude, and practice (KAP) towards diabetes mellitus (DM) among outpatient diabetic elderly persons attending tertiary healthcare facilities in Nigeria and also to verify the null hypotheses of no significant differences within demographic variables. The study was based on descriptive research design and was carried out in 36 public tertiary healthcare facilities in Nigeria, from August to December 2019. Using the purposive sampling technique, a total of 360 diabetic elderly persons aged 60 years and above were studied. An adapted KAP questionnaire with 0.86 reliability indexes was used for data collection. Frequency, percentage, and chi square were used for data analysis. All analysis was completed using IBM SPSS version 22. There were 348 (97%) valid copies of the questionnaire used for analysis. The study revealed that the outpatient diabetic elderly persons had high knowledge 303 (87%), positive attitude 265 (76%), and good practice 286 (82%) towards DM. Statistically, there was a significant difference within variables of age (p value=0.001 0.05). The participants had high KAP relating to DM. However, the finding of this study is not a complete reflection of the real situation regarding DM among elderly persons in Nigeria. There are overwhelming evidences of high prevalence of DM and thus the need for KAP sustainability and subsequent improvement in the healthcare sector to successfully combat the disease and proffer reliable ways of prevention among the population.

Adherence to Guidelines in Postpartum Management of Hypertensive Disorders in Pregnancy in Tertiary Health Facilities in Nigeria: A Multi-centre Study

ABSTRACT Hypertensive disorders in pregnancy (HDPs) are a leading cause of maternal morbidity and mortality. Available guidelines for their postpartum management are expected to be optimally utilized. This study aimed to determine adherence to guidelines in selected Nigerian tertiary hospitals. It was nested in a cohort of women with HDPs who delivered in eight facilities between October 2017 and June 2018. Nine weeks after delivery, their cases were evaluated on prespecified indicators and supplemented with interviews. The level of adherence to the guidelines was determined using descriptive analyses, including frequencies, percentages, means, and standard deviations, as well as charts. Of the 366 participants, 33 (9%), 75 (20%), 200 (55%), and 58 (16%) had chronic hypertension, gestational hypertension, preeclampsia, and eclampsia, respectively. Only about a third had their blood pressure measured between postpartum days three and five. Similarly, a third of those with persistent hypertension (≥140/90 mmHg) were not on antihypertensive medications within the first week postpartum. In addition, 37% and 42% of participants were not counseled on contraceptives and early subsequent antenatal visits, respectively. Among those with preeclampsia/eclampsia, 93% were not offered postpartum screening for thromboprophylaxis. Although all women with preeclampsia/eclampsia remained hypertensive two weeks after discharge, only 24% had medical reviews. Overall, only 58% and 44% of indicators were adhered to among all HDPs and preeclampsia/eclampsia-specific indicators, respectively. Level of adherence to guidelines on postpartum management of HDPs in Nigerian tertiary hospitals is poor. It is recommended that institutionalization of guidelines be prioritized and linked to the entire continuum from preconception through longer term postpartum care.

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.

Prevalence and predictors of disarticulation resection of the mandibles in a Nigerian subpopulation

Background: Few studies are reported in the literature about the prevalence of disarticulation resection of the mandible, but little is known about the risk factors. This study is aimed at determining the prevalence and risk factors of disarticulation resection of the mandible. Patients and Methods: This was a retrospective study design for patients that had surgical resections of the mandible from January 2010 to July 2020 at the Department of Oral and Maxillofacial Surgery of a tertiary health facility in Nigeria. Collected data from the patients' case-notes were age, gender, level of education, place of residence, occupation, employment status, tobacco use, alcohol consumption, type of lesion, and type of resection performed. In the univariate analysis, the Chi-square test was used for analysis, while the binary logistic regression was used for multivariate analysis. All statistics were performed with SPSS version 21 (IBM Corps, Armonk, New York, USA). A value of P

Pattern of serum bilirubin changes following double volume exchange blood transfusion in neonates at a tertiary health facility in Nigeria.

Introductionexchange blood transfusion (EBT) is a form of massive transfusion useful in rapidly reducing serum bilirubin levels, but serum bilirubin levels frequently rebound within hours of completing the procedure, due to equilibration of extravascular bilirubin as well as on-going hemolysis. The study was carried out to determine the pattern of reduction in serum bilirubin levels following EBT among neonates with severe hyperbilirubinemia, as well as the factors contributing to this pattern, so as to establish evidence-based expectations following EBT.Methodsa retrospective descriptive study covering a two-year period in a Nigerian tertiary hospital. Details of the EBT procedures, including serial serum bilirubin levels, were obtained from the hospital records of all newborn babies who had double volume EBT done for severe hyperbilirubinaemia during the study period. Data was analyzed using the statistical software SPSS version 21.0.Resultsthe mean total serum bilirubin (TSB) before EBT in the 36 babies was 17.9 ± 6.3 mg/dl. The mean percentage decrease in TSB immediately following EBT was 44.3 ± 10.2%. Six hours after EBT, TSB levels had increased from the immediate post-EBT values by an average of 57.5 ± 32.2%. Twenty-four hours after the procedure, TSB values in most (87.1%) cases were still higher than the immediate post-EBT values, but lower than the pre-EBT values. Post-EBT anemia was recorded among 33.3% of the babies.ConclusionEBT is effective in rapidly reducing serum bilirubin levels and preventing acute bilirubin encephalopathy in neonates with severe hyperbilirubinemia, despite the rebound increase that occurs in TSB values after the procedure.

Teething Beliefs, Misconceptions, and Practices Among Mothers Attending a Tertiary Hospital in Nigeria: Implications for Child Health and Clinical Practice

Introduction: Teething is a physiologic process that begins during infancy. However, some mothers often attribute certain symptoms to teething. In this study, we assessed the opinions and practices of mothers attending a tertiary health facility in Nigeria on teething.&#x0D; Methods: This was a cross-sectional, descriptive study conducted among caregivers of children presenting to the out-patient department of a tertiary hospital, Southwestern Nigeria.&#x0D; Results: Five hundred and sixteen mothers were studied. The leading symptoms attributed to teething were fever 420 (81.4%), reduced food intake / appetite 320 (62.0%), diarrhoea 314 (60.9%) and vomiting 294 (57.0%). Some believed that teething is associated with convulsion 102 (19.8%), mouth ulcers 69 (13.4%), ear discharge 68 (13.2%), and no symptoms 41 (7.9%). Majority of the mothers 374 (72.5%) believed that teething requires treatment. Two hundred and four (39.5%) mothers had given their children oral analgesics for teething while 194 (37.6%) administered teething mixtures. These medications were more likely to be prescribed at the hospital or purchased over the counter (p &lt; 0.05). Other treatments given included herbal concoction 46 (8.9%), local tooth extraction 22 (4.3%), enema 17 (3.3%), body scarifications 14 (2.7%), gum fomentation 14 (2.7%) and gum incision 12 (2.3%). Responders who attributed convulsion to teething were more likely to have incised their children’s gums (p &lt; 0.05).&#x0D; Conclusions: This study revealed that sundry symptoms were attributed to teething and harmful home interventions were done for teething. There is a need to educate the society on teething and discourage harmful practices for teething by caregivers.

Awareness, Knowledge, Attitude, and Practice of Patient Safety Culture Among Care Providers and Managers in a Tertiary Health Institution in Nigeria

Introduction: The safety of patients or clients remains a priority public health issue worldwide. Patient safety culture (PSC) is a core quality assurance strategy in healthcare delivery systems. Therefore, it is crucial for key stakeholders in the healthcare setting to perceive the concept. The present study determined the awareness, level of knowledge, attitude, and practice of PSC among care providers and managers in a tertiary health facility in Nigeria. Materials and Methods: This descriptive survey was carried out within June to November in 2016. Data collection was conducted via a self-administered structured questionnaire survey (QS), focus group discussions (FGD), and key informant interviews (KII). Stratified and convenient sampling techniques were used for QS, FGD, and KII, respectively. The data were analyzed using SPSS software (version 22), and associations were determined through the Chi-square test and t-test. A p-value of < 0.05 was considered statistically significant. Results: The awareness, attitude, and practice of PSC were slightly above average. The knowledge of the availability of PSC unit affected the scores of 3 of the 12 studied PSC composites, namely Feedback and communication about the error, Nonpunitive response to error, and Management support (p <0.05). The overall PSC level of the care providers and managers was reported as 62.3%. The rate of PSC was within the range of 28-72% based on FGD. According to KII, the awareness and practice of PSC were reported as 100% and 60%, respectively. Conclusion: Based on the obtained results of the current study, it was apparently demonstrated the low awareness, attitude, and practice of PSC resulting in the low functionality of PSC. Therefore, it is required to take comprehensive educational and institutional measures aiming at the improvement of positive PSC. Management commitment to safety is a key element in this regard.

Relationship between serum insulin and point-of-admission blood glucose of ill neonates at a tertiary health facility in Nigeria.

IntroductionOptimal glucose metabolism is important in neonatal survival especially in the first days of life. Insulin play a significant role in maintaining blood glucose homeostasis. This study set out to determine the serum insulin levels of ill neonates as related to their point-of-admission blood glucose estimation at the Wesley Guild Hospital, Ilesa, Nigeria.MethodsThree hundred babies took part in the study. Blood glucose and serum insulin levels were assayed at admission using Accu-Chek Active glucometer(R) and Accu-Ɔ-Bind ELISA Microwells(R) respectively. Hyperglycaemia was defined as blood glucose ≥7mmol/L and hypoglycaemia as blood glucose <2.2mmol/L.ResultsThe median (IQR) age of the babies was 10.0 (0.5 - 70.0) hours with male to female ratio of 1.5:1. Seventy-four (24.7%) were preterms and 35 (11.7%) were small-for-gestational age. The mean (SD) blood glucose level of the babies was 4.1(2.1) mmol/L with a range of 0.6-13.4mmol/L. Hyperglycaemia and hypoglycaemia were observed in 18(6.0%) and 40(13.3%) babies respectively. The median (IQR) serum insulin level was 9.8(3.0-35.3) μIU/ml. There was weak positive correlation between serum insulin and blood glucose levels of the babies (r = 0.197, p = 0.001). Birth asphyxia was associated with lower serum insulin, while probable sepsis with relatively higher levels.ConclusionSerum insulin level increases with increasing blood glucose in ill Nigerian babies at presentation to the hospital. Babies with asphyxia and sepsis particularly tend to have abnormal serum insulin at admission. Hyperinsulinaemia in ill babies may connote a compensatory mechanism to normalise abnormal blood glucose rather than playing significant role in its aetio-pathogenesis.