Tertiary Health Institution Research Articles

Challenges to sustainability of standardized nursing care plan in selected tertiary health institutions in Nigeria.

The purpose of this study was to assess the challenges to sustainability of standardized nursing care plan in selected tertiary health institutions in Nigeria. Using convergent mixed method design, the qualitative and quantitative data were collected from 427 nurses and nine stakeholders. This was done in one phase with the use of validated questionnaires and in-depth interview guide/key informant interview guide. Data were collected for 5 months and analyzed with SPSS version 25. Qualitative data were analyzed using themes. The explored significant challenges by stakeholders and nurses to sustainability of standardized nursing care plan (SNCP) in all the selected hospitals were inadequate knowledge of standardized nursing languages (SNLs), inadequate staffing, lack of motivation, lack of mandate to use SNLs by the educational system, lack of computers on the wards, weakness of previous training on SNL/SNCP, lack of interest, and high patient load. The study concludes that inadequate knowledge of SNLs and inadequate staff could contribute to non sustainability of SNCP. Nurses should be continuously trained on standardized nursing languages. Staff motivation and increasing the number of staff on the wards would increase the interest of the nursing staff. This will in turn improve the quality of documentation and patient care.

Experience with Liposuction for the Treatment of Subcutaneous Lipoma: A Case Series from a Tertiary Health Institution in Nigeria.

Lipomas are the commonest benign tumours in the body. Treatment is often by excision biopsy. Liposuction has traditionally been used for body sculpturing, but recently, it was introduced for the operative management of lipomas. The aim of this study was to present our experience with liposuction lipectomy-assisted lipoma aspiration in terms of its efficacy, complications, risk of recurrence, and patient satisfaction. A retrospective review of 16 patients with solitary or multiple lipomas managed with liposuction over a 5-year period was done. All the patients had a prior fine needle aspiration cytology, which was reported as benign. Informed consent was obtained, and the procedures were performed as a day case under tumescent anaesthesia. Lipo-aspiration was done with manual liposuction device. The patients were discharged on oral analgesics and antibiotics. Sixteen patients (10 females and six males) with 21 lesions were managed. The median age was 43 years (23-66 years). All the patients had satisfactory outcomes. The procedure was converted to open-excisional surgery in one patient, and the histology was reported as fibro lipoma. Friction burn at the cannula site occurred in one patient, which subsequently healed with scars. No recurrence was reported in any of the patients. In well-selected patients, liposuction-assisted lipectomy may have an advantage over the classical open technique. All patients should have a minimum investigation of fine needle aspiration cytology because of the risk of atypical lipomas or liposarcoma, which might have similar features as subcutaneous lipoma.

DO INDIVIDUALS RATIONALLY UTILIZE HEALTHCARE SERVİCES? EVIDENCE FROM THE GLOBAL COVID-19 PANDEMIC

Up to the date of the study, approximately 6.4 million people worldwide died due to Covid-19. In this process, individuals changed their daily life routines due to reasons such as the high contagiousness of the disease, the high number of deaths and the increasing rate of the disease, and ignorance about the disease. Even in periods when there were no restrictions or prohibitions, individuals did not continue their behavior under normal conditions. One of these changes has emerged in the health service demands of individuals. After the onset of the disease, hospital admission rates decreased significantly. In this context, the study aims to analyze the change in people's health care demands during the Covid-19 Pandemic period. Archival data of the number of patient admissions from the secondary and tertiary health institutions in the center of Sivas between 01.09.2019 - 11.03.2021 was used and the changes in the health demand according to gender, age, health insurance/payment, and the departments were analyzed periodically. In the period September 2020 - March 2021, total hospital admissions (excluding suspected Covid-19 and departments requiring mandatory treatment such as oncology, etc…) were approximately 46% lower than the total number of hospital admissions between September 2019 - March 2020. When the "child emergency" applications are evaluated for the same periods, a decrease of 66% can be seen. Such a significant decrease causes us to question the rational behavior of individuals in health care demands under normal conditions. If it is thought that it is not rational behavior, important steps should be taken about the use of healthcare services by individuals. The education of individuals on this issue plays a key role.

"Detection of Chlamydia trachomatis Antigen and Associated Risk Factors among HIV Positive Men in a Tertiary Health Institution, South-West Nigeria"

"Detection of Chlamydia trachomatis Antigen and Associated Risk Factors among HIV Positive Men in a Tertiary Health Institution, South-West Nigeria"

Organizational Planning and Revenue Generation of Public Tertiary Health Institutions in Enugu State, Nigeria

Organizational Planning and Revenue Generation of Public Tertiary Health Institutions in Enugu State, Nigeria

Predictors of ambulatory recovery and walking proficiency in community-dwelling stroke survivors: a cross-sectional study

BackgroundAlthough the major goal of rehabilitation is to return a stroke survivor (SSv) to as close to their pre-stroke functioning, limitation in ambulatory recovery and walking proficiency is the major impediment. Despite the importance of walking to the outcomes in stroke, factors predicting its recovery remain unclear. This study therefore was aimed at exploring the predictors of ambulatory recovery and walking proficiency in community-dwelling SSv.MethodsThis study involved 164 (83females) SSv from four tertiary health institutions in Nigeria. Ambulatory level and status was assessed using Functional Ambulatory Classification, motor function using the Fugl-Myer Assessment scale (lower limb), and ambulatory/waking endurance using the 6-min walk test. Ambulatory capability was assessed using the Lower Extremity Functional Scale, ambulatory self-confidence using the Ambulatory Self-Confidence Questionnaire, and functional ambulatory profile using the Modified Emory Functional Ambulation Profile. Mobility was assessed using the Modified Rivermead Mobility Index, functional mobility using Time Up and Go, balance using the Berg Balance Scale, and cognitive function using the modified Mini-Mental State Examination. Spatial indexes were assessed using the Footprint method and temporal variables using a stopwatch and gait speed on a 10-m walkway. Data was analyzed using multiple regression analysis at p ≤ 0.05.ResultsParticipants (mean age = 54.3±11.36 years) have had stroke for 12.9 ± 17.39 months and spent 9.82 ± 13.19 months in hospital admissions. More (65.2%) had ischemic stroke with 54.3% of them having left hemispheric stroke. The predictors of ambulatory onset in SSv were stroke duration and length of stay in hospital admission contributing 40.3% (β = 0.403) and 17.6% (β = 0.176) respectively to the variance. Mobility (β = 0.249, p < 0.001), gait speed (β = 0.185, p = 0.012), paretic double-limb support time (β = 0.155, p = 0.03), balance (β = 0.334, p < 0.001), and cognition (β = 0.155, p = 0.01) were predictors of ambulatory self-confidence contributing 59.5% to the variance. Balance (β = 0.363, p < 0.001) and mobility (β = 0.155, p = 0.015) were predictors of ambulatory capability contributing 52.9% to the variance. Balance (β = −0.489, p < 0.001), paretic double-limb support time (β = 0.223, p = 0.003), gait speed (β = −0.181, p = 0.022), and paretic swing phase duration (β = 0.177, p = 0.01) were predictors of functional ambulatory profile (p < 0.05) contributing 52.9% to the variance. Gait speed (β = −0.648, p < 0.001) and step length (β = −0.157, p = 0.003) were predictors of walking endurance contributing 76.5% to the variance.ConclusionAmbulatory recovery and walking proficiency depend on the interplay among duration of stroke and length of hospitalization on the one hand and balance performance, cognitive function, and the spatiotemporal integrity of the affected limb on the other hand.

Depression Among Resident Doctors: Prevalence and Associated Factors in A Tertiary Institution in South-South Nigeria

Background: Depression is an important contributor to the global burden of disease and it is associated with stress. It has been noted that being a doctor is stressful and residency training further increases the stress. Objective: This study determined the prevalence and factors associated with depression among resident doctors in a training tertiary health institution in South-South Nigeria. Methods: The study was a descriptive cross-sectional study in which 220 randomly selected resident doctors completed 4-point Likert scale self-administered Beck Depression Inventory-II (BDI-II) and a socio-demographic questionnaire. The BDI is a 21-item, rated on 4-point scale ranging from 0 to 3 totalling 63. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 23. Bivariate analysis was performed using Pearson’s Chi square. A p value of &lt; 0.05 was considered statistically significant. Results: In this study, 129 (58.6%) were males and 91 (41.4%) females. Majority were between the ages of 31-35 years 95(43.2%). Overall prevalence of depression was 16.8% (mild mood disturbances 9.1%, Borderline clinical depression 2.7% moderate depression 4.1% and extreme depression 0.9%). Sex, marital status and religion were associated with depression which were statistically significant. The proportion of resident doctors with depression was high among male resident doctors, age group 31-35 years, those married, Christian, Junior residents, those in training between 1-5 years and see lesser number of patients weekly. Conclusion: This study has demonstrated that about one-fifth of the resident doctors were depressed. Depression was significantly associated with sex, marital status, and religion.

Analysis of Donor Deferral in a Tertiary Health Institution in South-Western Nigeria

Aim: This study aimed at evaluating the deferral pattern among blood donors, in order to draw out lessons that will help canvass for a strengthened policy framework and encourage better outcomes in voluntary blood donation.&#x0D; Study Design: This was a retrospective study.&#x0D; Place and Duration of Study: All the data were sourced from the central database of donors, as recorded by the Haematology Department of Babcock University Teaching Hospital Ilisan-Remo, Ogun state, Nigeria. The data used spanned through a period of 5 years, from 2017 to 2021.&#x0D; Methodology: A total of 7,362 voluntary and non-remunerated blood donors were included in this study. Their records were accessed and used for the study. Data were analysed using SPSS version 25. The level of statistical significance was set at P &lt; 0.05.&#x0D; Results: In this study, half (50.2%) of the entire population of volunteers were between the ages of 18 and 30 years while only 3.7% of them were between 51 and 60 years of age. There were more male volunteers for blood donation compared to the females who only represented 10.8% of the population. 61% of the voluntary donors were accepted for blood donation while 39% were regarded as unfit and hence, deferred. The 3 main reasons for deferral in this study were inadequate hemoglobin (54.7% of deferral cases), unmatched blood group (30.9%) and transfusion transmissible infections (14.4%). Age and gender had a statistically significant (P &lt; 0.05) relationship with the pattern of deferral of the volunteers.&#x0D; Conclusion: The high deferral rate observed in this study may reveal an urgent need for a community-based intervention and targeted efforts by necessary agencies to help improve the general health status of possible future voluntary blood donors.

Economic burden and catastrophic cost among people living with sickle cell disease, attending a tertiary health institution in south-east zone, Nigeria.

Out-of-pocket spending and lack of adequate health policy support for people living with sickle cell disease in Nigeria may predispose to high economic burden and catastrophic cost. The objective of the study was to evaluate the economic burden and catastrophic cost of sickle cell disease patients in a Nigerian tertiary health institution. In this study, a cross-sectional descriptive survey design was used to study a sample of 149 sickle cell disease patients managed at University of Nigeria Teaching hospital Enugu, South east Nigeria. A structured pre-tested interviewer-administered questionnaire was used to collect primary data from adult participants and caregivers of paediatric patients. Data collection lasted for three months. The major findings were median monthly economic burden of approximately N76, 711 (US$385) per person. Of this, outpatient cost constituted approximately 88%. Admission, drugs and blood transfusion constitute the major contributors to the economic burden experienced by the sickle cell disease patients in the study. All socio-economic status groups suffered catastrophic expenditure but the poorest quartile had the highest incidence: 61% at 40% threshold, 71% at 30% threshold and at 88% at 10% threshold. Conclusion: economic burden was high for sickle cell disease patients who also suffered high catastrophic costs due to the impact of out-of-pocket expenditure. People living with sickle cell disease need financial protection especially for the poorest since they buy from the same market and incur same costs. Policy decision making to assist the sickle cell disease patients cope with cost of care is needful in Nigeria.

Ectopic Pregnancy: A 10 -Year Review of Cases in A Tertiary Health Institution in Umuahia, South East, Nigeria

Background: Ectopic pregnancy is a clinical condition where a fertilized ovum implants outside the endometrium of the uterine cavity. Worldwide, ectopic pregnancy complicates 0.25-2.0% of all pregnancies. High index of suspicion of the clinical triad; abdominal pain, amenorrhea and vaginal bleeding is very important for its early detection and management. Objectives: To determine the prevalence, clinical presentations, sites, risk factors and outcomes of ectopic pregnancy in a tertiary health institution in Umuahia, Nigeria. Materials and Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology, Federal Medical Centre, Umuahia over a period of 10years from January 2011 to December 2020. The records of patients with ectopic pregnancy were traced through the main theater, ante-natal clinic, and the records unit. All information obtained were coded, entered into and analyzed using IBM SPSS version 25. Results: A total of 268 patients with ectopic pregnancies were studied out of 19,535 gynecological cases and 13,901 deliveries within the study period. This gave a prevalence of 1.4% of all gynecological cases and 1.9% of all deliveries. Ectopic pregnancies occurred more in women between 26 and 35years of age (54.9%). The commonest symptoms seen were abdominal pain (24.7%), Amenorrhea (22.7%) and vaginal bleeding (22.1%). The commonest sites of occurrence were fallopian tube 244 (91.1%), intramural (3.4%) and cervical ectopic pregnancy (2.2%). All the patients were managed surgically while 84% had ruptured uterus. Risk factors observed were a history of PID (30.0%), previous ectopic pregnancy (14.6%), infertility (12.5%), IUCD placement (12.1%) and previous abortion (11.2%). Conclusion: Ectopic pregnancy is one of the leading causes of maternal morbidity and mortality for women of reproductive age. Early diagnosis and management in form of medical treatment or conservative surgery not only reduces maternal morbidity and mortality but also preserves future fertility.

Assessment of the Knowledge of Infectious Diseases and Their mode of Transmission Among Dental Health Care Personnel in a Tertiary Health Institution in Southern Nigeria

Background: Dental Health Care Personnel (DHCP) and clinical students in training are constantly exposed to saliva and oral fluids in the course of carrying out oral health care procedures. For optimum observance of infection control protocols, there is a need for adequate and appropriate knowledge of infectious agents and their mode of transmission in order to prevent cross infection in a dental clinic setting.&#x0D; Objective: To determine the level of knowledge of infectious agents transmissible in a dental clinic among dental health care personnel and final year clinical students and nurses in a tertiary health facility.&#x0D; Methods: This paper is a cross-sectional descriptive study which used a well-structured self-administered questionnaire. A convenient sampling technique was applied and a total of 111 DHCP and final year clinical students and nurses were recruited into the study. Data were analyzed using the Statistical Package of Social Science (SPSS) version 16 (IBM, Chicago, IL, USA). Bivariate analysis showed that the dentist cadre had the best level of knowledge of infectious agents transmissible in dental clinics. This, however, was not statistically significant p=0.298&#x0D; Results: A total of one hundred and eleven respondents, ages ranging from 15 to 55 years and with a mean age of 31.0±5.5 participated in this study. More than two-third 75(67.6%) of the respondents were dental surgeons and the least 2(1.8%) were the dental hygienist. More males 63(56.8%) participated in the study and most respondents 107(96.4%) were Christians. Fifty-five (49%) had good knowledge, 9(8.1%) had fair knowledge, and 47(42.3%) had poor knowledge of infectious diseases/conditions transmissible in dentistry. Respondents’ status was not a determinant of the level of knowledge, p=0.298.&#x0D; Conclusion: The average knowledge of the DHCP, final year clinical students and dental student nurses in this study was good, but their knowledge about HDV and infectious bacteria in dental unit water was poor.&#x0D;

The Dynamics of the Parental Satisfaction of the Children Receiving Occupational Therapy Services in a Resource-Limited Setting

The need to continuously appraise the satisfaction of the recipients of Occupational therapy (OT) services cannot be over-emphasized especially in settings where the practice can be best described as emerging and where there seems to be an inconsistent utilization of the service despite obvious significant positive outcomes. This study aims to evaluate the dynamics of the satisfaction of the parents of the children receiving paediatric Occupational therapy services in Nigeria. A cross-sectional survey of 100 parents of children receiving OT paediatric service in six Tertiary Health Institutions in two geopolitical zones in Nigeria was conducted. The participants were recruited with convenient sampling. Data was collected with Measures of Process of Care (MPOC-20) and analyzed with analysis of variance (ANOVA) on SPSS 22.0 Version. Findings showed that the parents' level of satisfaction was to a fairly great extent (Aggregate Mean =5.43) and there was no significant difference in the level of satisfaction of the parents based on gender or the geographical locations of the parents (F-Value of 2.25 and P = 0.56 of &gt; α =0.05). Despite the limited resources and relatively- low awareness of OT in Nigeria, parents of children receiving Occupational therapy services are satisfied, though to a fairly great extent. Parents' expectations and yearnings for quality OT service are uniforms across the different zone of Nigeria. Therefore, it is recommended that OT practitioners in low and middle-income countries should from time- to -time evaluate the perception of their clients on the services provided to foster quality and collaborative care.

Socio-Demographic Variables of People Living with HIV/AIDS Initiated on ART in 2014 at Tertiary Health Institution in Enugu State

Background Information: Survival of people living with HIV/AIDS (PLWHA) has increased since the emergency of High active antiretroviral therapy (HAART) in 1996.&#x0D; Methodology: This was a descriptive cross-sectional study design. The study population consisted of those diagnosed for HIV / AIDS at tertiary health institutions in Enugu State. The total numbers of clients enrolled were 793 and 249 clients were loss to follow up, majority was males. Those initiated on ART were 544. Clients of age &lt;15 years were excluded and they were 31 clients. Finally, 500 clients were selected, males were 138 and female were 362 by simple random sampling techniques. Data was collected from HIV / AIDS patients ART record cards, registers and institutions data units for those initiated on ART in 2014 using a designed proforma. Those clients aged 15 years and above were retrospectively studied between 2014 and 2018 and some of them that survived after five years (60 months) on ART were interviewed by applying simple random sampling technique. Cohort inclusion begins at initiation on ART with follow-up clinical information collected year by year for five years. IBM SPSS statistics version 24.0 was used. Chi square test was used to assess association between categorical variables and the level of statistical significance of the proportions was determined by a P-value less than 0.05. Manual content analysis was used for the interview and probability of dying and surviving analysis.&#x0D; Results: The mean age (±SD) is 38.8±11.5 years. On outcome of ART, 374 (74.8%) were under care, those loss to follow up were 66 (13.2 %), 29 (5.8%) died within the period of study and 31 (6.2%) were transferred out. Adherence was statistically significant, p&lt;0.001 among clients who had obtained tertiary 105 (92.1%) and secondary, 124 (57.7%) education, who lived within the state with the place of care, 234 (76.0%), and those retired, 12 (63.2%) and the unemployed, 46 (61.3%).&#x0D; Conclusion: Based on the study, HIV prevalence in Nigeria now appears to have assumed a downward trend following the availability of ART and a relative stability from 2012 to 2018, yet a sustained and more effective intervention is still needed to avert increase incidence by most-at–risk subpopulations in the Enugu State.

Client satisfaction with antenatal care among clinic attendees in a tertiary health institution in Calabar, Cross River State, Nigeria.

Antenatal care is an important entry point to the health system and provides access to essential obstetric care. Satisfaction with different aspects of antenatal care, has the potential to improve health. This study aimed to determine the prevalence of satisfaction with Antenatal care services and identify factors influencing client satisfaction among antenatal clinic attendees in University of Calabar Teaching Hospital Calabar (UCTH), Cross River State. A descriptive cross-sectional study was conducted among 200 pregnant women attending the ANC in UCTH. Systematic random sampling technique was used to recruit participants and the Client Satisfaction questionnaire (CSQ8) measured satisfaction. Data was analysed using bivariate (Chi-square test) and multivariate (binary logistic regression) analysis. The overall level of satisfaction recorded in this study was 92%. Reasons for dissatisfaction were long waiting time 57%, cost of services 40.3%, clinic environment 31%, doctors assigned to ANC attendees 19% and attitude of doctors 13%. Being satisfied with their previous experience in the health facility was the only significant predictor of satisfaction in this study(p<0.05). Although a high level of satisfaction with ANC services was noted among pregnant women in UCTH, it is pertinent that waiting time, cost of services, toilet facilities and infrastructure be addressed.

Moringa supplementation improves immunological indices and hematological abnormalities in seropositive patients receiving HAARTs

Moringa oleifera Lam. is known to be of high nutritional and medicinal importance and has been demonstrated to possess a variety of biological activities. This study investigated the beneficial role of M. oleifera (moringa) supplementation in HIV positive subjects receiving antiretroviral drugs. Adult HIV positive individuals (104) attending the medical outpatient clinic in a tertiary health institution in Nigeria receiving highly active anti-retroviral therapies (HAARTs) were recruited in a randomized fashion for the study. Half of the subjects received moringa supplement (20 mg daily) additionally, while the others received only HAART and represented the control group. All subjects were monitored for 3 months during which their immunological status (CD4 counts and TNF-α), and hematological abnormalities at pre (baseline) and post study periods were determined. Baseline levels of CD4 increased while TNF-α decreased significantly in control and moringa supplemented groups (p < 0.01). However, the post study CD4 values in the moringa group were higher and TNF-α values were lower compared to the control group (p < 0.01). In addition, baseline hematological abnormalities (anemia, thrombocytopenia, leucopenia, lymphopenia, and neutropenia) were improved but most significantly in the moringa supplemented subjects. The results suggest that moringa has immune-beneficial properties and improved hematological abnormalities in HIV positive individuals receiving antiretroviral therapy.

Body image dissatisfaction among medical students in the Southern district of Kerala: a cross-sectional study

Background: Body image misconception can lead to behaviors that are detrimental to mental as well as physical health. Body dissatisfaction develops when people have negative thoughts about their body image. In this context, estimating the prevalence of body dissatisfaction would help in providing valuable information about those at risk of developing eating and other psychiatric disorders.Methods: A cross-sectional study was conducted among undergraduate students studying in a tertiary care government health institution in the southern district of Kerala. Data was collected using an online semi-structured questionnaire and was administered to 200 eligible participants. Data was analyzed using IBM SPSS statistics for windows (version 25.0. Armonk, NY)Results: Among the 200 participants in the study, 36 (18%) were found to have body image concerns without any significant gender predilection. Dissatisfaction with body image was seen to be more prevalent in those with higher BMI. There was a positive association between body image dissatisfaction and socio-cultural pressure to change body fat levels (p=0.001). It was also found that the tendency to skip meals was more among those with higher body image concerns (p=0.001). Conclusions: The study concluded that about one-fifth of the study participants comprising medical students have moderate to severe body image dissatisfaction without significant gender predilection. Dissatisfaction with body image was seen to be more prevalent in those with higher BMI. The focus should be on initiating educational programs to promote positive body image, and acceptance of self and individual differences while maintaining optimum weight and active lifestyle.

Family Social Support Perceptions and Medication Adherence among Elderly Diabetics in a Tertiary Health Institution in Lagos, Nigeria

Background: The perception of family support is pivotal in improving the health and wellbeing of elderly individuals through adherence to medication especially among diabetics. This study investigated the relationship between perceptions of family social and medication adherence among elderly diabetic patients attending the outpatient clinics of the Lagos University Teaching Hospital (LUTH). Methodology: This was a cross sectional, hospital-based study carried out among 199 randomly selected elderly diabetic patients receiving care in LUTH. Data including sociodemographic information, medication use, and procurement were obtained using an interviewer-administered semi-structured questionnaire. Perceived family social support was assessed and scored using the Perceived Social Support from Family Scale (PSS-Fa) and categorized as ‘strong’ (scores ≥ 11), ‘weak’ (scores 7-10) and ‘none’(scores≤6) while medication adherence was measured using the Morisky medication adherence scale (MMS-8). Medication adherence was rated high (score = 8), medium (scores= 6–7) and low (scores≤5). Association between perceived support and medication adherence was investigated by Chi-square test. Level of significance was p-value&lt;0.05. Results: The mean age of the participants was 68.6 ± 6.7 years. The proportion of the participants who had strong, weak and no perceived family support were 92.5%, 3.5% and 4.0% respectively. Over two-thirds of participants (72.9%) reported family as responsible for providing funds to procure their medications while almost a quarter (23.6%) bought their medications by themselves. Only 2 (1.0%) participants relied on medical insurance to procure their medications. Almost half (49.7%) of them had high levels of medication adherence. Significant association existed between perceived family social support and medication adherence (ꭓ2 = 7.626; p-value = 0.027). Conclusion: Most participants had strong perceived family social support which was significantly associated with medication adherence. We recommend the routine assessment of family social support when dealing with geriatric patients as can improve medication adherence and ultimately better outcome of care

Awareness, perceived efficacy, and utilization of assisted reproductive technologies among women attending fertility clinic in a Nigerian tertiary health institution: a cross-sectional study.

Introductioninfertility is a source of distress for couples considering the high accolade placed on having children in family settings in Nigeria. Assisted reproductive technologies (ARTs) offer a chance for parenthood to couples. However, studies on knowledge of ARTs abound in Nigeria but no previous studies exist on the extent of utilization of assisted reproductive technologies. This study thus explored the level of awareness, perceived efficacy, and utilization of ARTs among women attending fertility clinics in a Nigerian Tertiary Health Institution.Methodsthis cross-sectional study which utilized a self-administered questionnaire was adopted for this study. The questionnaire contains five sections with sections A to E bordering on demographics, awareness, perceived efficacy, utilization, and factors influencing utilization respectively.Resultsone hundred and seven women with infertility problems, aged between 26 and 35 years with a mean age of 31.46 ±5.72 participated in the study. Sixty-two patients (57.9%) were aware of ARTs while 97 (90.7%) believed that ART cannot address male infertility. Only 27 (25.2%) admitted to having used ART procedures before while 82 patients (76.6%) stated that the cost of the procedure was the major hindrance to use.Conclusionawareness of ARTs is average while there is low utilization and perceived efficacy of ART. The high cost of the procedure remains the major setback to its utilization.

Mindful awareness as a predictor of postpartum depression and anxiety among Igbo nursing mothers in Enugu, South-East Nigeria

ABSTRACT In Nigeria, the relationship between mindfulness and postpartum depression and anxiety has gone largely unexamined. A cross-sectional study of 309 randomly selected nursing mothers was conducted at two tertiary health institutions using the Mindful Attention Awareness Scale and Hospital Anxiety and Depression Scale. The study sought to determine if mindful awareness acted as a predictor of postpartum depression and anxiety in Igbo nursing mothers and the proportion of the dependent variables (postpartum depression and anxiety) explained by the addition of new independent variables (age, educational attainment and mindful awareness). Mindful awareness accounted for most of the variance at 16.5%. And 19.1% for postpartum depression and postpartum, respectively. Lower levels of mindful awareness predicted higher levels of postpartum depression and anxiety. The study may contribute to the existing body of knowledge needed in establishing preventive strategies, early detection, and treatment for women at risk.

Pediatric Groin Surgeries: A Comparison of Analgesic Effects of Caudal Block and Inguinal Field Block Using Plain Bupivacaine.

There is a paucity of studies in the West African sub-region which have compared both the intraoperative and postoperative analgesic effects of caudal block and inguinal field block using plain bupivacaine in groin surgeries in children. The study aimed to compare the duration of analgesia and complications of caudal block and inguinal field block in pediatric groin surgeries. This was a prospective, double-blind randomized study conducted at a tertiary health institution in North Central, Nigeria, over a period of 6 months. A total of 74 children scheduled for day case groin surgeries for inguinal hernia, hydrocoele and palpable undescended testis were recruited into the study. The effectiveness of the analgesic effect was assessed by measuring serum cortisol levels before surgery (i.e. baseline at 8am), 5minutes after caudal block or inguinal field block, and 1-hour after surgery. Post-operative pain was determined using FLACC score (Face, Legs, Activity, Crying and Consolability) every 15 minutes till 6 hours after surgery when the patients were discharged home and the caregivers measured the patients' pain scores using the FLACC score every 1 hour to a maximum duration of 10 hours after surgery. Data obtained from the study was entered into the study proforma and analysed using IBM SPSS version 21.0. The P value was considered statistically significant at <0.05. A total of 74 patients were recruited for this study, with 68 males (91.9%) and 6 females (8.1%). The children's age range was 6 months to 7 years, with a mean age of 3.35 ± 1.90 years. The mean basal serum cortisol levels of the caudal block group and inguinal block group were 11.15 ± 5.38 µg/dL and 10.79 ± 4.92µg/d respectively (p-value = 0.767). Five minutes after caudal block, the mean serum cortisol level was 10.50 ± 5.39µg/dL while inguinal field block was 10.63 ± 4.68µg/dL (p-value = 0.288). The mean serum cortisol level obtained one hour after each procedure was 9.34 ± 4.05 µg/dL for the caudal block group and 10.00 ± 3.56 µg/dL in the inguinal field block group with p-value = 0.275.Using the FLACC score, the mean duration of analgesia in caudal block group was 372.00 ± 71.55 minutes and was inguinal field block group was 387.43 ± 62.65 minutes with a p-value = 0.116. There was no anaesthetic technique related complications that was recorded in both caudal block group and inguinal group during the study period. This study demonstrated that caudal block and inguinal field block using plain bupivacaine provided comparable duration of analgesia in paediatric groin surgeries. Therefore, caudal block or inguinal field block using plain bupivacaine should be recommended for both intraoperative and postoperative analgesia in elective paediatric groin surgeries.