Tertiary Hospital In South-east Nigeria Research Articles

Effect of dolutegravir-based regimen on the body mass index of adolescents living with HIV in an African population: a pre-post design

ABSTRACT Dolutegravir, an integrase strand inhibitor, has been linked to an increase in body mass index among adults. However, little is known about its effect on adolescents. The study assessed the effect of a dolutegravir-based regimen on adolescents’ body weight and emphasized the gender-specific differences in weight gain, if any. This prospective cohort study was conducted among 182 treatment-experienced adolescents living with HIV at a tertiary hospital in Southeast Nigeria. The body mass index measurements were calculated before transitioning to dolutegravir and after six months of being on the dolutegravir regimen. A comparison of the difference in mean body mass index before and after dolutegravir-based therapy was determined using a paired t-test. At the end of the six-month follow-up, there was a significant increase in the respondents’ overall body mass index z-score (t = −10.00, p < 0.001). There was a significant increase in the body mass index z-score of both genders (male; t = −7.49, p < 0.001, female; t = −6.91, p < 0.001). The dolutegravir-based therapy (β-coefficient = −0.17, t = − 2.09, p < 0.001) and baseline body mass index z-score (β-coefficient = 0.76, t = 15.86, p < 0.001) were significant predictors of body mass index z-score at six months. In adolescents living with HIV, the transition to dolutegravir is associated with increased body weight. Female adolescents tend to gain more weight compared to males. Therefore, there is a need for regular monitoring of body weight for early detection of obesity and prompt intervention.

Predictors of Intern Pharmacists Job Satisfaction in Federal Teaching Hospitals in Southeast Nigeria

Background: Job satisfaction is a quality assessment standard measure used in evaluation of employers output and outcomes. Increase in job satisfaction correlates positively with employees output. This study assessed the predictors of intern pharmacists job satisfaction ina tertiary hospital in southeast Nigeria. Methods: The study was a questionnaire web and paper-based prospective cross-sectional survey among eligible intern pharmacists who gave their informed consent to participate in the study. Data was summarized with descriptive statistics. Linear regression analysis were used to predict factors affecting intern pharmacist’s job satisfaction while correlation coefficient was used to determine the strength of association. Reliability estimation was done using the Cronbach alpha. All tests for differences between subgroup distributions were regarded as significant if p-values equal to or less than (0.05) (two-tailed test) was reported. Results: Overall, (168) intern pharmacists participated in the study out of which (87) (51.8%) were females. Majority of the respondents were resident outside the hospital premises (136) (86%) while (21) (12.5%) were also locum practitioners. Most of the interns have spent (5-9) months out of the mandatory (12) months (139) (82.7%). Accomodation within the hospital and choice of hospital educational funding had a p-value of (0.864) in the linear regression analysis while the choice of hospital was 0.003. Conclusion: Interns accommodation within the hospital and choice of hospital for inernship training were the major predictors of job satisfaction among the respondents. Job satisfaction is an essential determinant of work output and outcomes.

Prevalence, Awareness and Risk Factors for Hypertension in Adults Attending a Tertiary Hospital in South-East Nigeria

Prevalence, Awareness and Risk Factors for Hypertension in Adults Attending a Tertiary Hospital in South-East Nigeria

Perception, precausions and acceptance of vaccination against SARS COV-2 viral infection among health workers in two tertiary hospitals in southeast Nigeria, four years after the onset of the pandemic

Background: The study was conducted in two tertiary hospitals located in ababkaliki the capital city of Ebonyi State.&#x0D; Aim: To ascertain the perception, awareness and vaccination of COVID-19 among the health workers.&#x0D; Methods: A questionnaire/data sheet was developed for the study. Information on sociodemographic characteristics, perception and awareness and COVID 19 vaccination were obtained. The data were fed into the computer using SPSS version 25, Illinoi USA and analysis done.&#x0D; Results: We had 420 respondents with the mean age of 39.1±9.8 and ranged from 20 to 70years made up of doctors, nurses/midwives, laboratory scientists, pharmacists and others. There was high awareness of COVID 19 in the group but with poor knowledge of spread 47.4% and preventive measures 43.1%. awareness of vaccine was high 96.9% but the uptake was low 33.8% with major reason being fear of side effect and some also believe vaccine is a scam. Some of the respondents were survivors of COVID 19.&#x0D; Conclusion: There is high awareness of COVID 19 disease in the hospitals but poor knowledge of mode of spread and preventive measures including very low uptake of anti-COVID 19 vaccines and inadequate provision of PPEs 4 years after the onset of the pandemic.

Histopathologic Spectrum and Clinicopathologic Concordance of Pediatric Skin Biopsies: 18-Year Experience in a Tertiary Hospital in Southeast Nigeria

ABSTRACT Background: Many studies have evaluated the spectrum of pediatric skin disorders in outpatient, inpatient, and emergency settings in different regions of Nigeria. However, literature analyzing histopathological data of dermatologic diseases in children undergoing biopsy or excision of skin lesions in Nigeria is lacking. The present study was aimed at determining the spectrum, frequency, and clinicopathologic diagnostic concordance of pediatric dermatopathological lesions at a tertiary care hospital in southeast Nigeria. Materials and Methods: This is a retrospective cross-sectional study undertaken at the department of Histopathology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All pediatric (up to 18 years old) skin biopsies received at the department of Histopathology, NAUTH, Nnewi over an 18-year period from January 2004 to December 2021 were included in the study. Relevant clinical and demographic data had been collected from the request forms. For ease of analysis and comparison with other skin studies, the skin lesions were classified according to the International Classification of Diseases, Tenth revision (ICD-10) (2019), for disorders of the skin and subcutaneous tissue. Results: Pediatric skin biopsies constituted 20.2% of all the skin biopsies received at our laboratory during the study period, with a male to female ratio of 1:1. The initial clinical diagnosis was concordant with histopathologic diagnosis in 88 out of 189 cases (46.6%). Forty-nine percent of biopsies/excisions were performed in the head and neck area. The most common diagnostic categories, in decreasing order of size, were neoplasms, disorders of skin appendages, papulosquamous disorders, and infections. Only about a quarter of neoplasms were malignant. Conclusion: Our study has documented the importance of histopathology as a gold standard in the diagnosis and management of skin lesions. Improved training of primary care physicians and closer cooperation between pediatricians, dermatologists, and pediatric surgeons will increase the chances of accurate diagnosis.

Trends in emergency room visits of oral and maxillofacial surgery patients in a tertiary hospital in South-East Nigeria

Trends in emergency room visits of oral and maxillofacial surgery patients in a tertiary hospital in South-East Nigeria

Mosquito Species Breeding Within a Tertiary Hospital in South-East Nigeria: Are There Public Health Implications?

Mosquito Species Breeding Within a Tertiary Hospital in South-East Nigeria: Are There Public Health Implications?

Assessment of Drug Use in a Tertiary Hospital in Southeast Nigeria Based on Who Core Drug Use Indicators

Background: Irrational use of medicines is a global phenomenon and an issue of concern with so many undesirable consequences. The complex nature of the pharmaceutical care process is an indication for an essential tool that investigates drug use pattern in health facilities. The WHO released the core drug use indicators to address these issues. The study assessed drug use in a tertiary hospital in southeast Nigeria based on WHO core drug use indicators. Methods: A cross-sectional descriptive study design was used and the study was conducted from October 2021 to June 2022. Retrospectively, 300 prescriptions were selected and reviewed using systematic random sampling for a year from 2020 -2021 to investigate prescribing indicators. A total of 120 randomly selected patients and pharmacy personnel were observed and interviewed to investigate the patient-care and facility-specific indicators. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use in comparison to the result gotten. Results: The average number of drugs per encounter was 2.76, the Percentage of drugs prescribed by generic names was 78.02%, the Percentage of antibiotics prescribed was 33.33%, and the Percentage of injections prescribed was 1.67%. Average consulting time in minutes was 17.5 minutes, the average dispensing time in seconds was 92.1 seconds, the Percentage of drugs actually dispensed was 76.97%, Percentage of adequately labeled was 100%, and the percentage of patients’ knowledge of correct dosage was 90%. The facility did not have an Essential Drug List but had all (100%) the key drugs listed by the WHO drug list. Conclusion: All of the prescribing indicators deviated from the WHO/INRUD recommended optimal values. Patient-care and facility-specific indicators deviated from the optimal values except that of the average consultation time, average dispensing time, percentage of drugs adequately labeled, and 100% availability of key drugs. Although a few of the WHO benchmark for rational drug use were met, the outcomes were not satisfactory and required interventions to improve rational drug use in the facility.

Lymphatic Filariasis in a Tertiary Hospital in South-East Nigeria: A Tale of Neglect, Low Social Class and Disability

Lymphatic Filariasis in a Tertiary Hospital in South-East Nigeria: A Tale of Neglect, Low Social Class and Disability

Determinants of Intermittent Preventive Malaria Therapy Among Pregnant Women in A Nigerian Teaching Hospital

Background: Intermittent Preventive Treatment of malaria in Pregnancy (IPTp) is mostly issued in most antenatal clinics across the country but there have been reports of poor utilization of this prophylaxis. Objective: This study assessed the determinants of IPTp among pregnant women attending a tertiary hospital in southeast Nigeria. Methods: The study was a descriptive cross-sectional study in which a self-administered questionnaire was distributed to 250 pregnant women receiving antenatal care in the study hospital. The data collected were analyzed with the aid of SPSS, using descriptive and inferential statistics. A p-value of less than 0.05 was considered significant. Results: A majority of the participants responded positively to most of the factors assessed, however, none was statistically significant. Conclusion: Based on these findings, pregnant women at a tertiary hospital in southeast Nigeria are aware of IPTp, nevertheless, most fail to commence the medication at the correct time.

Evaluation of Analgesics Prescription Pattern and Surgical Patients' Responses in Tertiary Hospitals in Southeast Nigeria

Background: Adequate analgesics help the patients to recover quickly from surgery with less discomfort and pain. It helps the patient breathe well, cough, turn and ambulate early to enable quick recovery. Inadequate prescribed analgesic delays recovery and leads to postoperative complications. Despite documented evidence that adequate pain control helps in the quick recovery of surgical patients, it has been reported that doctors' prescriptions of analgesics for postoperative patients are inadequate for the level of pain experienced by the patients. This informed the establishment of pain medication prescription standards by accrediting agencies in some developed countries. Nigeria has no binding standards, and patients' postoperative pain is managed by what doctors and nurses deem adequate. It has been reported that the patients' pain medication needs in Nigeria are unmet. The study, therefore, seeks to evaluate the postoperative analgesics prescription pattern and patients' responses in three tertiary hospitals in Southeast Nigeria. Objective: The study's main purpose was to evaluate the pattern of postoperative prescription of analgesics and surgical patient response to these drugs in tertiary hospitals in Southeast Nigeria. Method: A descriptive cross-sectional survey research design was used for the study. Study sample was 120 surgical patients selected equally from three randomly selected tertiary hospitals from the five States in Southeast Zone. Questionnaire and checklist were the instruments used for data collection in the study. The instrument's reliability was tested using the split-half technique and was analyzed using Spearman's rank-order correlation coefficient, which yielded a value of 0.85. All the hypotheses were tested at 0.05 level of significance. Results: The results show that drugs commonly prescribed by doctors for pain relief were pentazocine, paracetamol, diclofenac, and tramadol. The prescriptions were done mainly by Surgeons and Resident doctors. There was agreement on the pattern of prescription of analgesics by Surgeons in the southeast Nigerian hospitals. The results also show that there is a significant difference (p&lt;0.05) in the mean patients' responses to the prescribed analgesics but found no significant difference (p&gt;0.05) in pain prescription by doctors in the management of surgical patients in tertiary hospitals in Southeast Nigeria. Patients reported experiencing severe pains (41.7%) on the first, moderate pains (45.8%) on the second day, and mild pain (25%) on the third day after surgery. Conclusion: It was concluded that there is no significant difference in the pattern of the prescribed pain relief drugs and their dosages among surgeons from different tertiary hospitals. The patients' responses showed that the prescription pattern does not lead to good pain control in the first three days post-surgery. Recommendation: It was recommended that doctors review their prescription pattern for surgical patients, particularly within the first 72 hours after surgery when the pain is at its peak. Nurses should apply non-pharmacological pain management methods within this period to improve the comfort of the surgical patients.

Histopathological spectrum of skin lesions in the elderly: Experience from a tertiary hospital in Southeast Nigeria

Background: There are only a few epidemiological studies published on skin disorders in the elderly within the Nigerian context and none from the Southeast Region of the country. In addition, none of these studies has considered the pattern and frequency of histopathologically diagnosed geriatric skin lesions. Hence, we attempted to determine the frequency as well as the age and gender distributions of histologically diagnosed dermatological diseases in geriatric population from skin biopsies submitted to the histopathology department of a tertiary care hospital in Southeast Nigeria. Materials and Methods: This is a cross-sectional retrospective hospital-based study involving all skin biopsies of patients 60 years and above, received at the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2004 to December 2019. Results: During the study period, 751 skin biopsies were received in the histopathology department. Of these, 142 were from patients who were older than 60 years. Thus, the overall share of geriatric patients was 18.9%. The mean age at presentation was 71.1 ± 8.6 years. The M: F was 1:1, and most of the patients belonged to the age group of 60–69 years (69 cases, 48.6%). The mean age of the male patients was 72.1 ± 9.5 years. In the female patients, it was 70.1 ± 7.5 years. The most common disease category was neoplasms (91, 64.1%). Most neoplasms were malignant. There were 67/142 (47.2%) malignant lesions. The most common was Squamous cell carcinoma (SCC) (30 cases) which is 21.1% of all geriatric skin biopsies and 44.8% of malignant skin biopsies. This is closely followed by melanoma (29 cases). Conclusion: Malignant neoplasms, benign neoplasms, and papulosquamous disorders are the three most common histologically diagnosed skin lesions in our geriatric population. The most common skin malignancies in this group of patients are SCC and malignant melanoma.

The prevalence of stillbirths and the probable causes in low resource settings in south-east Nigeria

Background: Stillbirth is a devastating pregnancy outcome, with resultant emotional and psychological trauma to the affected family. Objectives: We investigated the prevalence and probable causes of stillbirths in four tertiary hospitals in south-east Nigeria. Materials and Methods: A 5-year multicenter, retrospective descriptive study of all stillbirths delivered in the hospitals from January 2013 to December 2017 was done. Using an already prepared proforma, the sociodemographic characteristics of the mothers and the probable causes of deaths were retrieved from their case files. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS), version 20. A P-value less than 0.05 was considered statistically significant. Results: There were 23,101 deliveries within the study period and 1,294 stillbirths giving a stillbirth rate (SBR) of 56.1/1,000 deliveries. More than half (58.7%) of them were intrapartum. More than half of the stillbirths were preterm delivery (58.5%). The commonest probable cause of macerated stillbirth was hypertensive disorders of pregnancy (32.4%). Conclusion: The overall SBR was 56.1 per 1000 deliveries. This is higher than 42.9 per 1000 deliveries previously reported in Nigeria. There is an urgent need to improve the quality of antenatal and intrapartum care, if we hope to achieve a significant reduction of the SBR in the region.

Yellow Fever and Hepatitis B Co-Infection in A Nigerian Girl with Acute Febrile Jaundice: A Case Report

Yellow fever is a lethal re-emerging viral disease transmitted by infected Aedes mosquitoes. It is largely endemic in sub-Saharan Africa, with high risk of widespread outbreak in an unimmunized population. Recent outbreaks have been reported in several states in Nigeria. Yellow fever causes an acute febrile jaundice which can be confused with several endemic diseases, particularly viral hepatotropic infections such as hepatitis B, emphasizing the need for surveillance of co-viral pathogens during outbreaks. We report a rare case of yellow fever with hepatitis B co-infection in a 15-year-old girl who was successfully managed in a tertiary hospital in South-East Nigeria.

Age-of-cessation of lumbar lordosis development as an assessment parameter.

Background:In managing paediatric spinal deformities, the currently-in-use growth maturity assessment parameters (clinical or radiological) are based mostly on Caucasian populations. They may be adequate for general treatment planning but may not accurately predict the remaining growth potential. Some therapies (e.g. growing rod distractions or growth modulation surgeries) require more accurate predictions of remaining growth potential and race-specific values. Lumbar lordosis (LL) development ceases at spinal bone maturity. The age-of-cessation seems a more accurate predictor of remaining spinal bone growth potential, compared to currently-in-use growth maturity assessment parameters, but is rarely included in the growth maturity assessment parameters.Aims and Objectives:As a predictor of remaining spinal growth potential, age-of-cessation of LL development (Race-specific of Black populations) was quantified.Materials and Methods:In archival normal lateral lumbosacral radiographs of patients of a tertiary hospital in South-East Nigeria, LL development across five age groups (Birth– 9, 10–15, 16–20, 21–25 and 26–30 years) was quantified with lumbosacral joint angle (LSJA) in 215 (110 males, 105 females), and lumbosacral angle (LSA) in 238 (119 males, 119 females). Data were analysed with IBM SPSS Statistics 23.0 (NY, USA). P ≤ 0.05 was considered statistically significant.Results:Both LSJA and LSA age groups’ mean values progressively increased with age, and plateaued at 21–25 years range, with LSJA mean of 23.4 ± 1.3 years, and LSA mean 23.5 ± 1.3 years; the means difference was insignificant (P = 0.680).Conclusion:With ageing, there is progressive increment, and later, cessation of LL. Age-of-cessation indirectly infers spinal-maturity-age, and could indirectly be an assessment parameter of spinal-maturity-status.

Assessment of Drug Treatment Practices and Pattern for Gastroenteritis Among Under-Five Children in A Tertiary Hospital in Southeast Nigeria

Background: Inappropriate drug prescribing is common in clinical practice with a consequent significant negative economic and clinical burden. This study assessed the drug treatment practices for gastroenteritis among under-five children in a teaching hospital in southeast Nigeria. Methods: A retrospective analysis of prescription records from June 2017 to June 2019, was conducted using the World Health Organization (WHO) recommended drug use indicators, adapted for children's healthcare. A total of 310 prescriptions were selected using systematic sampling. The number of drugs in each prescription, number of prescriptions, cost of the prescription were analyzed. The student's T-test was used to summarise the differences in means. P =&lt;0.05 was considered significant.

Perception and Acceptance of COVID-19 Vaccination among Patients in a Tertiary Hospital in South-East Nigeria

Aims: To determine the perception and acceptance of COVID-19 vaccination among patients in a tertiary eye hospital.&#x0D; Study Design: A cross-sectional hospital-based study.&#x0D; Place and Duration of Study: Guinness Eye Centre Onitsha, South-East Nigeria between 1st to 29th June 2021&#x0D; Methodology: An interviewer-administered semi-structured pretested questionnaire on sociodemographic, knowledge, perception and acceptance on coronavirus disease and its vaccine was used to collect data on eligible patients. Data obtained was analyzed with SPSS version 23 (IBM Corporation, Armonk, NY, USA). Descriptive statistics including frequency tables, mean and standard deviation was used to present categorical variables.&#x0D; Results: A total of 386 patients were interviewed comprising 157 (40.7%) males and 229(59.3%) females, and aged 18 to 93 years (mean age of 44.73±18.49 years). Two hundred and fifty-eight (66.8%) patients knew of COVID-19 vaccine availability in Nigeria, with 90 (34.9%) not knowing where they could obtain the vaccine. Only 34 (8.8%) had taken the vaccine. Uptake of COVID-19 vaccine is strongly associated with patient’s perception of COVID-19 being real (P=0.006), patients trust in the information head about the vaccine (P=0.001), and their trust on the efficacy and safety of the COVID-19 vaccine (P˂0.001). Acceptance of COVID-19 vaccine is not significantly associated with their faith in the previous human vaccinations(P=0.076).&#x0D; Conclusion: The uptake of COVID-19 vaccine in the study group is low. Therefore, there is an urgent need for re-strategizing on various ways to enlighten the public and widen the scope of information dissemination.

The role of postgraduate training and clinical experience with OSA patients on attitude and knowledge of OSA: evidence from in-training physicians and surgeons in a tertiary hospital in Southeast Nigeria

The role of postgraduate training and clinical experience with OSA patients on attitude and knowledge of OSA: evidence from in-training physicians and surgeons in a tertiary hospital in Southeast Nigeria

Timeliness of Vaccination among Children Attending Immunization Clinic at a Tertiary Hospital in South-East Nigeria.

Timely vaccination of children is one of the most cost-effective interventions that ensure childhood survival. We determined the proportion of children who received timely vaccination and examined the factors associated with timely receipt of Bacillus Calmette Guerin (BCG) and third dose of pentavalent vaccine (Penta 3). We conducted a cross-sectional survey among 599 caregivers-infant pair aged less than 24months, attending the immunization clinic of a tertiary hospital in Nigeria, selected using systematic sampling methods. Using a structured questionnaire, we access the proportion of children who received timely vaccination, the relationship between the timely receipt of BCG, Penta 3 vaccine and infant/caregiver characteristics was examined using chi-square and multiple logistic regression at a 5% level of significance. The mean age of the respondents was 30.1±5.0 years. The majority (73.8%) had attained tertiary education, lived in an urban setting (90.9%), had received antenatal care during pregnancy (99.3%) and was delivered in a hospital (97.0%). About half of the children (52.9%) were male. About 18% of the caregivers reported missing scheduled immunization visits, due to forgetfulness (18%), child illness (14%) and being busy (5%). About 88% (482) of the children got their BCG vaccines on time, 91.1% got timely OPV0, however, only 29.5% of the newborns got HBV0 within 24 hours of birth. Only 65.7% and 65.0% received the timely measles-containing vaccine and yellow fever vaccine. None of the factors examined predicted timely receipt of BCG and Penta 3 vaccines. Interventions that remind caregivers about the immunization schedules, could improve timely vaccination.

Clinical Profile, Severity Pattern and Socio-demographic Risk Factors of Acute Lower Respiratory Tract Infection (ALRTI) in Children in Enugu, Nigeria

Introduction: Acute lower respiratory tract infection (ALRTI) is a major public health problem that causes significant morbidity and mortality and is the main reason for utilization of health services among children. Obectives: The study aimed to evaluate the clinical profile, severity pattern, and sociodemographic risk factors of ALRTI in hospitalized children under the age of five years in two tertiary hospitals in South East Nigeria. Materials and Methods: This is a cross-sectional study of children aged two months to five years in two teaching hospitals in the country. They were evaluated for ALRTI, focusing on their clinical profile and socio-demographic risk factors. Results: Two hundred children presented with features of ALRTI, mostly pneumonias and bronchiolitis. ALRTI occurred throughout the year with a peak in October. The majority had severe disease and risk factors for severity were infancy, type of ALRTI, presence of comorbidity and lack of measles vaccination or vitamin A supplementation, and exposure to wood smoke. Fast breathing was the most sensitive symptom, while breathlessness was the most specific for ALRTI. Conclusion: Bronchopneumonia and bronchiolitis are the most common ALRTI in under-five age children with bronchopneumonia occurring in severe forms. Poor breastfeeding, infancy, poor rate of immunization and exposure to biomass smoke are all risk factors for severity.