Tertiary Hospital In Southern Nigeria Research Articles

Profile of women with Gynaecological cancers at a Tertiary Hospital in Southern Nigeria

Background: Gynaecological cancers remain a major public health concern in Low-and Middle-Income Countries. In sub-Saharan Africa, gynaecological cancers account for approximately one-third of all female cancers. Objectives: To determine the socio-demographic, reproductive, and clinical characteristics of gynaecological cancer patients at the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a prospective cross-sectional study of 75 women with histologically confirmed gynaecological cancer managed at the University of Port Harcourt Teaching Hospital, from January 1, 2022, to December 31, 2022. A structured interviewer-administered questionnaire was used to obtain socio-demographic characteristics and clinical profile from the patients and their clinical records after informed consent was obtained. Data was entered into a MS Excel spreadsheet and analyzed with SPSS version 25. Results: Most 27 (36%) of the women were between 40-49 years of age, with a mean age of 50.4 ± 12.3 years. Majority 46 (61.3%) were married, 27 (36%) had tertiary education, and two-thirds earned N30,000 or less (≤ $20) per month. Many 23 (30.7%) were Para ≥ 5, almost all 63 (84%) of the women were referred to UPTH, with one-third 21 (33.3%) of the referrals coming from other tertiary health facilities. Most 63 (84%) of the women had never had a Pap smear screening, and 48 (64%) were menopausal. The most common presenting symptom was vaginal bleeding 37 (49.3%). Cervical cancer accounted for about half 40 (53.3%) of the cases, followed by ovarian cancer 27 (36%), with the majority 28 (43%) presenting with stage III disease. Chemotherapy was administered to all the patients. However, treatment was delayed in 57 (76%) of the women due to financial constraints, with most of the funding and support coming from family members in 43 (57.3%) of the women. Conclusion: There is an urgent need to increase advocacy for gynaecological cancers to increase awareness, prevent late presentation and progression of early disease. Furthermore, the government needs to subsidize the cost of cancer care to encourage early presentation and treatment.

Association between sleep quality and blood pressure control among hypertensive patients at a rural tertiary hospital in Southern Nigeria: a cross-sectional study

ObjectivesRestorative sleep is critical in preventing hypertension and other chronic diseases. Limited research has explored the relationship between sleep quality and hypertension in Africa. This study investigated the association between...

Association between Lifestyle and Biosocial Conditions with Erectile Dysfunction among Adult Patients in a Tertiary Hospital in Southern Nigeria

Erectile dysfunction is one of the most distressing often not discussed disorder affecting the male gender globally responsible for a lot of psychosocial distress. The objective of this study was to explore the association between lifestyle, biosocial conditions with erectile dysfunction among the adult males presenting at general outpatient clinic of our hospital. This was a study carried out at Federal Medical Center, Umuahia, Southern Nigeria. A well structured questionnaire was administered to 421 respondents. Results showed 219(52%) had erectile dysfunction while 202 (48%) didnot have erectile dysfunction. Factors associated with erectile dysfunction were age, tobacco use, alcohol intake, diabetes mellitus, hypertension, use of anti hypertensive and oral hypoglycaemic medications which were statistically significant. Body mass index, family functionality, use of illicit drugs and polypharmacy were not associated with erectile dysfunction. However, the independent risk factors were age, tobacco use and alcohol intake.Emphasis on health education and life style modificaation are highly recommended to reduce the burden of erectile dysfunction among our patients.

Eclampsia: A Continuous Scourge in a Tertiary Hospital in Southern Nigeria

Eclampsia: A Continuous Scourge in a Tertiary Hospital in Southern Nigeria

Awareness of risk factors associated with tubal infertility among female youth corps members in Benin City, Nigeria

Infertility is the inability to achieve pregnancy within one year of regular unprotected coital exposures. It is a common gynecological problem in our environment. The cause of infertility could be of female origin, male origin, a combination of both, or idiopathic. It can be primary when there is no previous pregnancy, or secondary infertility when there is an inability to conceive after a previous conception. In secondary infertility, a tubal factor is the most typical cause globally. In a review of factors associated with tubal factor infertility in a tertiary hospital in southern Nigeria, the tubal aspect constituted 13.5%. It was due to previous post-abortion sepsis, puerperal sepsis, and Pelvic Inflammatory Disease (PID). Awareness of infertility risk factors is an essential first step to safeguard future fertility; however, several studies demonstrated poor knowledge of tubal infertility and its risk factors, especially among infertile couples and couples attending gynecology clinics. This study assesses the knowledge of female youth corps members in Benin City, Edo State, on tubal factor infertility, its risk factors, and management. A cross-sectional analytical study was conducted among female youth corps members in Benin City using a multi-stage sampling technique. A self-administered questionnaire was used for data collection. The data was entered and analyzed using Statistical Package for Social Sciences (SPSS) Version 25.0 (IBM SPSS V 25.0, Chicago, IL, USA) and presented using tables. From this study, there is good knowledge of the burden of tubal infertility and treatment implications (50.4%). However, the knowledge of tubal infertility (34.3%) and its risk factors (27.0%) was poor. Age, marriage, and the medical profession are associated with sound knowledge of the burden of tubal infertility (p=0.02). However, only the medical profession is independently associated with good knowledge of tubal infertility (AOR=2.963, p=0.006, CI=1.370-6.411). There is generally poor knowledge of tubal infertility among females of reproductive age, who are at higher risk of pelvic inflammatory disease being the most typical risk factor for tubal infertility. This calls for more health awareness programs for the youth to help safeguard their future fertility.

The practice of using repurposed medications as chemoprophylaxis for COVID-19 by healthcare workers in a tertiary hospital in Southern Nigeria.

Coronavirus disease 2019 (COVID-19) is a viral infection that has been reported in virtually every country. Healthcare workers (HCW) are more at risk of COVID-19 than the general population making them a priority group for vaccination. Before the roll out of COVID-19 vaccines in Nigeria, some HCW were using some repurposed, unapproved drugs to possibly prevent the disease. This study evaluated the frequency and pattern of drug use for COVID-19 prevention. This was a prospective cross-sectional study of HCW conducted in Southern Nigeria. Data was obtained from the participants using a questionnaire and blood sample was obtained for SARS-CoV-2 antibody testing. Data was analysed using the statistical package for social sciences (SPSS) version 23. One hundred and sixty-six participants were enrolled in this study. Thirty-two (19.3%) of them had taken a repurposed medication as prophylaxis for COVID-19. The most used drugs were Vitamin C (9%), Azithromycin (8.4%) and Zinc (6.6%). History of contact with patient with confirmed COVID-19 and being a pharmacist were independent factors associated with the use of COVID-19 prophylaxis. Several HCW in Nigeria take drugs to possibly prevent COVID-19. These medications may not offer significant protection against COVID-19. There is an urgent need to increase uptake of COVID-19 vaccines in HCW in Nigeria.

Prevalence and predictors of hepatitis C infection among antenatal attendees in a tertiary hospital in Southern Nigeria.

Hepatitis C virus infection as it specifically relates to pregnancy has been a neglected condition, thus its recognition and treatment in pregnancy is relevant because of the risks of the long-term complications of the infection in the mother, potential effects of the infection on the pregnancy and risk of vertical transmission to the newborn. To determine the proportion of pregnant women with serologic markers of hepatitis C infection, identify risk factors as well as factors that predict the occurrence of the infection in them. Over a 3-week period, blood samples from 456 pregnant women were assessed for antibodies to hepatitis C virus, while a pre-tested questionnaire was used to obtain socio-demographic data and the presence of risk factors in the University of Uyo Teaching Hospital, Nigeria. The prevalence of HCV infection in pregnancy was 4.6%. No known risk factors for HCV infection in pregnancy were identified. Only increasing gestational age was a predictor of HCV infection in pregnancy in the study. The prevalence of hepatitis virus infection among the study population was high. Second trimester and increasing gravidity were protective of the infection in pregnancy. There is therefore need for introduction of general routine screening of all pregnant women presenting for antenatal care.

Influence of Perceived Family Functioning on Depression among Postmenopausal Women in Nigeria

This was a cross-sectional descriptive survey, designed to determine the influence of perceived family functioning on depression among of post-menopausal women attending the family medicine clinic of a tertiary hospital in Southern Nigeria. An interviewer-administered questionnaire was used to get the respondents’ socio-demographic and clinical parameters. Data were analysed to determine: the rate and severity of depression; how some socio-demographic factors related to depression in postmenopausal women, (PMW); whether there was an association between family function and depression among the women. Our survey revealed that 66.7% of PMW had some degree of depression and their sociodemographic factors were important markers for depression. One third of the women had no form of mood disturbance but 5.7% had severe depression necessitating referral to Neuropsychiatry clinic.The participants’ family function had statistically significant association with depression (χ2 =117, p-value = <.001). Women in dysfunctional milieu were more likely to have depressive illnesses than those in functional families. There was also statistically significant strong negative correlation between respondents’ family function scores and their depression scores (Spearman’s rho = -0.622; sig. (2-tailed = <.001). Using Independent-samples Kruskal-Wallis test, the relationship between family function scores and depression categories was such that women with depression had significantly lower functional scores, when compared with those without depression.

Organized multi-disciplinary stroke team care improves acute stroke outcomes in resource limited settings; Results of a retrospective study from a Nigerian tertiary hospital

BackgroundEvidence for the impact of organized stroke multidisciplinary teams (MDTs) on outcomes in Africa is sparse. AimTo compare stroke outcomes, before and after the establishment (September 16, 2016) of a pioneer MDT at a tertiary hospital in southern Nigeria. MethodsUsing a retrospective, observational study design, the in-patient record of all stroke patients admitted between September 2014 to September 2018 was retrieved and rigorously reviewed. 155 patients seen 2 years before the MDT were compared with 169 stroke patients seen 2 years after the MDT. Stroke severity at admission and functioning at discharge were assessed using the Stroke Levity Scale (SLS) and the modified Rankin scale (mRS). ResultsMean ages (in years) were 60 pre-MDT vs 59.57 post MDT (p = 0.754). There were more males, 51% pre-MDT vs 54.2% post MDT (p = 0.565). SLS and mRS were not significantly different; severe SLS and mRS pre-MDT, 52.9% vs post-MDT, 49.4% (p = 0.727) and pre-MDT 19.4% vs post-MDT 19.5% (p = 0.685) respectively. More post-MDT patients were discharged alive, pre-MDT,56.8% vs 79.2% post MDT (p < 0.001); had swallow tests, pre-MDT 9.23% vs post-MDT 33.5% (p < 0.001); on secondary prevention, pre-MDT 67.7% vs post-MDT 78.9% (p = 0.023); had more clinic visits, pre-MDT,0.7% vs post-MDT 38.3% (p < 0.001). MDT was independently associated with lower in-hospital mortality on multivariable regression, adjusted odds ratio (OR) (95% Confidence interval CI) 0.17 (0.09–0.32). ConclusionOur results suggest that an organized MDT may improve acute outcomes and reduce mortality in resource constrained settings where there may be no stroke units. These findings need further prospective validation.

The practice of using repurposed medications as chemoprophylaxis for COVID-19 by healthcare workers in a tertiary hospital in Southern Nigeria.

Coronavirus disease 2019 (COVID-19) is a viral infection that has been reported in virtually every country. Healthcare workers (HCW) are more at risk of COVID-19 than the general population making them a priority group for vaccination. Before the roll out of COVID-19 vaccines in Nigeria, some HCW were using some repurposed, unapproved drugs to possibly prevent the disease. This study evaluated the frequency and pattern of drug use for COVID-19 prevention. This was a prospective cross-sectional study of HCW conducted in Southern Nigeria. Data was obtained from the participants using a questionnaire and blood sample was obtained for SARS-CoV-2 antibody testing. Data was analysed using the statistical package for social sciences (SPSS) version 23. One hundred and sixty-six participants were enrolled in this study. Thirty-two (19.3%) of them had taken a repurposed medication as prophylaxis for COVID-19. The most used drugs were Vitamin C (9%), Azithromycin (8.4%) and Zinc (6.6%). History of contact with patient with confirmed COVID-19 and being a pharmacist were independent factors associated with the use of COVID-19 prophylaxis. Several HCW in Nigeria take drugs to possibly prevent COVID-19. These medications may not offer significant protection against COVID-19. There is an urgent need to increase uptake of COVID-19 vaccines in HCW in Nigeria.

Prevalence of Hepatitis B, C and D Infections in Preoperative Patients at a Tertiary Hospital in Southern Nigeria

Patients going for surgical operations are required to be screened for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among other transmissible infections. This is necessary for better assessment of the patient's condition alongside the need for extra precautions during surgery. Hepatitis D virus (HDV) infection is not commonly reported but occurs in association with commonly reported but occurs in association with that of hepatitis B virus. The epidemiology of this co-infection is worth investigating, as it constitutes a more aggressive form of hepatitis Following due ethical considerations, this cross-sectional descriptive study enrolled 180 pre-operative patients for viral hepatitis screening. Immunochromatographic methods were used for detection of HBV and HCV infections, while detection of HDV was based on enzyme-linked immunosorbent assay method. Data processing was carried out using SPSS version 22.0. Results are presented as numbers and frequencies as percentage. The prevalence of HBV, HCV and HDV as recorded among pre-operative patients was 7.8%, 1.7% and 1.1% respectively. Hepatitis B virus alone accounted for 68.8% of all hepatitis cases, while its co-infection with HDV and HCV were observed to be 12.5% and 6.2% respectively Single infection of HCV was seen to be 12.5% of all infected cases. Hepatitis B virus was observed to be the most prevalent viral hepatitis agent within the studied population, while hepatitis D virus was detected at a rate of 1.1%

Prevalence and risk factors of missed appointment among paediatric patients after minor oral surgical procedures in a tertiary hospital in Southern Nigeria

Missed appointments are common in paediatric dentistry, yet not many studies have explored its prevalence and associated factors. To determine the prevalence of missed appointments and the associated factors. This prospective study design recruited all consecutive paediatric patients that presented for minor oral surgical procedures from 1st July 2020 to 30th June 2021. Data collected was the age of patients, gender, parents’ educational level, distance from the clinic, type of minor oral surgical procedures and missed appointments. Descriptive and inferential statistics were performed. Chi-square test of association was used to determine the association between study participants’ age, sex, parents’ educational level, the distance from the clinic, and the prevalence of missed dental appointments. Binary logistic regression was used to determine the predictors. Data was analysed using the Statistical Package of Social Science (SPSS) version 26 (IBM, Chicago, IL, USA). A p-value of less than 0.05 was considered significant. A total of 182 paediatric dental patients, age ranged from 0.5 to 16 years and with a mean age of 8.55+3.88 participated. Most (60.4%) of the patients were females and 46.2% of them were of school age. Most of the parents had a tertiary level of education and lived within 7 to 12 kilometers from the clinic. The prevalence of missed appointments was 54.9% and the most performed minor oral surgical procedure was primary tooth extraction. The relationship between age group, minor surgical procedures with missed appointments was statistically significant (P&lt;0.05). Binary logistic regression analysis revealed that the type of surgical procedure was the only independent predictor of missed appointments (p&lt;0.05) The prevalence of missed appointments in this study is remarkably high. Although the age of the patients and the type of procedure was associated with the prevalence of missed appointment, it was only the type of surgical procedure that was a significant risk factor for missed appointment.

Placental Abruption at a Tertiary Hospital in Southern Nigeria: A Six-Year Review of Prevalence, Trend and Sociodemographic Characteristics

Background: Placental abruption also known as abruptio placentae or accidental haemorrhage, is the second most common cause of antepartum haemorrhage after placenta praevia. The study was aimed at reviewing cases of placental abruption managed at the Rivers State University Teaching Hospital (RSUTH) over a 6-year period, to determine the prevalence, trend, and sociodemographic/obstetrics factors. Methods: This was a cross-sectional study of all recorded cases of placental abruption managed at the Rivers State University Teaching Hospital (RSUTH) from 1st January 2016 to 31st December 2021. Descriptive statistics were derived using IBM, Statistical Product and Service Solutions (SPSS) version 25.0 Armonk, New York. Results: There were 14,195 deliveries and 68 cases of placental abruption; giving a prevalence of 0.48% or 4.8 per 1000 or 1 in 208 deliveries. The rate of placental abruption per 1000 deliveries increased from 2.0 in 2016 to 8.7 in 2018 and then decreased to 6.2 in 2021. The mean (SD) age and gestational age of the participants were 32.7±4.8, (95%CI: 31.5, 33.9) years and 35.6 ±3.2 (95%CI: 34.8,36.4) weeks. The modal parity was para 1. Over 90% of the participants had emergency caesarean sections. The majority 65(95.6%) of the participants were Christians, 56(82.4%) booked and more than half 37(54.4%) were multipara. Conclusion: The prevalence of placental abruption in RSUTH is 0.48%; with a declining pattern of occurrence. It occurred more among booked multiparous women. This Knowledge will be helpful to Clinicians in management of Placental Abruption.

Placental Abruption at a Tertiary Hospital in Southern Nigeria: A Six-Year Review of Prevalence, Trend and Sociodemographic Characteristics

Placental Abruption at a Tertiary Hospital in Southern Nigeria: A Six-Year Review of Prevalence, Trend and Sociodemographic Characteristics

Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience

<i>Background</i>: There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class for treatment of heart failure was incorporated by the physicians in the area. <i>Methodology</i>: The study involved collection of data from patient’s records using an observational checklist. A total of 166 heart failure patients with reduced EF were recruited between the age ranges of 33 and 95 years. The medications prescribed, date of drug initiation and progress in optimization of therapy were assessed over a 1-year period and data analyzed using SPSS version 25. A p-value of 0.05 and below was considered statistically significant. <i>Results</i>: The result showed that the most prevalent causes of heart failure were hypertensive heart disease (70.5%), followed by dilated cardiomyopathy (15.7%) and valvular heart disease (6.6%). The use of diuretics was prevalent among study cohorts at 87.4%, followed by Mineralocorticoid antagonist (MRAs) (78.3%), ARB/ACEI/ARNI (68.1%), beta blockers (40.4%), and less than a third of patients were on SGLT2 inhibitors (28.9%). The dosing of heart failure medications was noticed to be fixed without up-titration of doses at intervals for most classes of GDMT except the MRAs. Only about 2.4% of the study cohorts had dose optimization over this period and most study patients were not on optimal maximal doses of heart failure therapy. <i>Conclusion</i>: The use of guideline directed medical therapy has improved amongst HF patients however up titration of doses remains a major problem amongst patients managed in our clinic. The implementation of a multi-disciplinary HF clinic focused on improvement of outcomes of HF patient is essential in improving not only the use of Guideline- directed medical therapy (GDMT) but up-titration to optimal doses for maximal benefits.

A 10-year clinicopathological analysis of ovarian lesions in a tertiary hospital in Southern Nigeria.

Ovarian tumours are the most lethal of all gynaecological cancers and they are usually diagnosed in advanced stages when the prognosis is very poor. To determine the pattern of ovarian lesions, their frequency, presentation, and associated clinical symptoms in Uyo, Nigeria. A 10-year retrospective study of all ovarian specimens that were surgically removed and histologically diagnosed. The patients were between the ages of 5 and 73 years with median age of 34.1 years. Benign tumours occurred most commonly among the 20-39-year age group (31.3%) while malignant tumours were predominant among those aged 50-69 years (10.0%). Surface epithelial tumours (45.4%) were the most common neoplastic tumours while the mature cystic teratoma (33.2%) was the most common tumour overall. Surface epithelial malignancies accounted for 70.6% of all ovarian malignancies and the serous cyst adenocarcinoma (10.2%) was the most common surface epithelial tumour as well as the most common malignant tumour. There has been an increase in the number of malignant ovarian specimens in our centre. Though surface epithelial tumours were the most common category of ovarian tumours, overall, the mature cystic teratoma was the most common tumour. Serous cyst adenocarcinoma was the most common surface epithelial tumour and the most common malignant tumour.

Towards an Antimicrobial Stewardship Program in a Young Tertiary Hospital in Southern Nigeria: A Point Prevalence Survey of Antimicrobial Usage

Towards an Antimicrobial Stewardship Program in a Young Tertiary Hospital in Southern Nigeria: A Point Prevalence Survey of Antimicrobial Usage

Acute Intestinal Obstruction: A 1-Year Prospective Audit into Causes.

Intestinal obstruction is a common general surgical emergency with high morbidity and mortality. Its aetiology varies widely between and within geographic regions, with gender, age, and time. Obstructed inguinal hernia is still considered the most common cause of intestinal obstruction in Sub-Saharan Africa and other low-income countries, but its incidence appears to be on the decrease as other causes of intestinal obstruction become more common in a particular society. To examine the spectrum of causes of intestinal obstruction in a tertiary hospital in southern Nigeria and compare the results with earlier studies in the region and Nigeria. A cross sectional, single-hospital study of adults diagnosed with and having clinical and radiological features of acute intestinal obstruction. Seventy patients were enrolled in the study, comprising of 35 (50%) males and 35 (50%) females, M:F = 1:1. The mean patient age was 44.8 years. Two peak age incidences of intestinal obstruction were observed in the 36-45 and 56-65 years age groups. Post-operative adhesion 13 (18.5%), obstructed external abdominal hernia 13 (18.5%), colonic cancer 11 (16%), and intussusception seven (10%) were the primary causes of intestinal obstruction. Obstructed inguinal hernia was commonly encountered in males while adhesions and colonic cancers were common in females. Obstructed external abdominal hernias and post-operative adhesion are at par as the main primary causes of intestinal obstruction. Colon cancer and intussusception are increasingly causing more obstructions.

Management of urethral stricture disease in a tertiary hospital in southern Nigeria

Background: Urethral Stricture Disease (USD) refers to a narrowed segment of the anterior urethra due to a process of fibrosis and cicatrisation of the urethral mucosa and surrounding spongiosis tissue (“spongiofibrosis”). Management of USD is challenging. This study describes our experiences in the management of USD. Materials and Methods: This is a six-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. The information gotten included history, duration of symptoms, examination findings, age of the patient, stage of disease, intraoperative findings, and post-operative complications. The data from the folders were collected and evaluated. Frequencies, percentages, the mean and standard deviation were used to summarize the data as appropriate. Results: A hospital prevalence of 461/100,000. The mean age ±SD of the patients was 44.1 ±16.7. The 31 to 40 years old age group had the highest frequency of 46 (29.87%). Patients with a primary level of education had the highest frequency of 56 (50.9%). Most patients were artisans. Most (67.27%) of the strictures were located at the bulbar urethra. The most common procedure for treating USD was a Direct Vision Internal Urethrotomy (DVIU). The most common complication was a recurrence. Conclusion: Patients with urethral stricture disease present late for treatment, the commonest form of treatment was DVIU. The treatment with the best outcome was anastomotic urethroplasty. The commonest complication was a recurrence.

Aetiopathogenesis of urethral stricture disease in a tertiary hospital in Southern Nigeria

Background: The urethra provides passage for urine in both sexes and additionally for ejaculation in males. Urethral stricture disease (USD), results in the narrowing of the urethra due to spongiofibrosis. Understanding the pathology of this disease is important to treatment. This study aims to evaluate the aetiology, pathology and pathogenesis of USD at the University of Port Harcourt Teaching Hospital.Methods: This was a 6-year retrospective study conducted on all patients with features of USD who presented to the University of Port Harcourt Teaching Hospital UPTH. Ethical approval was sought and obtained from the hospital’s ethical committee. Data were obtained from ward admission, theatre, and discharge records. The information gotten included the age of the patient, aetiologic agent, site of stricture, number of strictures, length of stricture and complications present at the presentation. The data retrieved was analysed and categorical data were presented in the form of frequencies and percentages using tables. Continuous variables were presented as means and standard deviation. Results were presented in tables and charts.Results: The mean age from this study was 44.1±16.7 years. The commonest site of USD was bulbar with 74 (67.27%) patients. The commonest cause of urethral stricture was iatrogenic (41 patients).Conclusions: Strictures are commonest amongst middle-aged men. The commonest site of urethral stricture disease is the bulbar region because of its unique anatomy. Iatrogenic strictures are the commonest cause of urethra stricture disease.