Tertiary Hospital In Southern Nigeria Research Articles

Influence of Culturally-based Abdominal Massage and Antenatal Care Uptake among Pregnant Women in a Tertiary Hospital in Southern Nigeria

Influence of Culturally-based Abdominal Massage and Antenatal Care Uptake among Pregnant Women in a Tertiary Hospital in Southern Nigeria

Current Trends in Treatment Outcomes of Orbital Cellulitis in a Tertiary Hospital in Southern Nigeria.

Background:Orbital cellulitis refers to the inflammation or infection of the soft tissues of the orbit located behind the orbital septum.Aim:To determine the current trends in the outcomes following the management of orbital cellulitis in a tertiary hospital in Southern Nigeria.Patients and Methods:A retrospective review of medical records of patients with orbital cellulitis from January 2008 to December 2014 was conducted. The age, sex, duration of symptoms, predisposing factors, clinical findings, laboratory/radiological investigations, treatment provided, complications, and follow-up were recorded. Results were analyzed with SPSS Version 21 program.Results:Forty-two patients were seen made of 17 (40.5%) males and 25 (59.5%) females with a mean age of 18.2 ± 18.7 years of which children <16 years constituted 24 (57.1%) of cases. Orbital cellulitis was a unilateral occurrence in 38 (90.5%) patients. Trauma and sinusitis were the common predisposing causes in 20 (47.6%) and 6 (14.3%) patients, respectively. The most common complaint was eye swelling 36 (52.9%). Most patients had visual acuities of >6/18 at presentation, 38 (82.6%) and at discharge, 39 (84.8%). The mean duration of presenting complaints was 15.5 ± 31.6 days. Patients who presented early were less likely to develop complications, P = 0.003. The most common complication was exposure keratopathy in 8 (44.4%) eyes. The only surgical intervention performed was incision and drainage of abscess in 3 (7.1%) eyes. No patient came for follow-up.Conclusion:Prompt institution of effective antibiotics and management of complications that may arise improves prognosis of orbital cellulitis.

Somatization Symptoms in a Primary Care Clinic at a Tertiary Hospital in Southern Nigeria

Background: Somatic symptoms that are not attributable to organic pathology are common in general practice settings however, data in most parts of Africa including southern Nigeria are still scarce. The aim of our study was to examine such somatic symptoms reported by patients attending a primary care facility at a tertiary hospital in southern Nigeria as well as to motivate future research in this area. Method: The study was conducted at the General Out Patient Clinic (GOPC) of the University of Calabar Teaching Hospital (UCTH). It was a cross sectional study in which data were obtained from the case notes of 115 patients that presented in the clinic with somatic complaints which could not be attributed to organic pathology by their physicians. Results: While 46 of the patients were males, 69 were females. Their mean age was 37.7 (SD = 11.9). Internal heat, crawling sensation, body pains and palpitations were the most prevalent symptoms reported by the patients. When the symptoms were sorted into various groups, the “subjective abnormal bodily sensation” was the most prevalent and far outnumbered the “pseudo neurological symptoms”. Conclusion: A number of patients attending the GOPC of the UCTH seek consultations for medically unexplained somatic symptom. The most prevalent of these symptoms are internal heat and crawling sensations both of which are not stated in the criteria recognized by the International Classification of Diseases—version 10 (ICD-10) for the diagnosis of psychiatric disorders.

Determinants of Nutritional Status of Elderly Patients in A Tertiary Hospital in Southern Nigeria

ABSTRACT AIM: This study was conducted to assess the influence of income, loneliness and loss of teeth on the nutritional status of the elderly inpatients in a tertiary hospital. In old age, inappropriate dietary intake contributes significantly to both chronic and acute morbidity, and illness affects food intake and further compromises resistance to diseases. MATERIALS/METHODS: A cross sectional design was used for the study. Systematic random sampling technique was adopted until the minimum sample size of 412 was attained. A pre-tested 20 item questionnaire was used to collect data for the study. Chi square was used to determine the influences of various determinants at significant level of 0.05. RESULTS: There was a significant association [X2=28.059; p=0.014] between nutritional status and number of people staying with respondents most of the time. In our setting, there is no gainsaying the fact that the traditional aspect of the elderly desiring to have people around them is still a desirous social norm. CONCLUSION: The elderly may have adapted to the various degrees of loss of teeth they are fraught with, since there was no significant association between tooth loss and nutritional status of the elderly. Key Words: Nutritional Status, Elderly

Subdermal Contraceptive Implants: Profile of Acceptors in a Tertiary Hospital in Southern Nigeria

Background: Subdermal contraceptive implants provide safe, effective, convenient, long term reversible fertility regulation, and because of their numerous non-contraceptive benefits are particularly suitable for women in developing countries. This study determines the socio-demographic characteristics of acceptors of subdermal implants, the timing of their use and their complications at the University of Uyo Teaching Hospital, Uyo. Materials and Methods: The record cards of all clients that accepted subdermal contraceptive implants over a four year period were reviewed. Results: There were a total of 1057 new contraceptive acceptors out of which 197 (18.6%) accepted contraceptive implants. The modal age group of the clients was 30-34 years (38.0%). One hundred and fifty six patients (79.2%) were mulitparous, 97.5% of the patients had attained secondary level of education while 92.4% were Christians. About 56.9% of the clients preferred to use implants to space child births, most of the implants were inserted during the first week of the menstrual period, and majority (78.2%) of the clients obtained their information concerning implants from clinic personnel. The most common complication was abnormal vaginal bleeding. Conclusion: contraceptive implants are very effective contraceptive methods that are mostly accepted and used by young, educated parous women who mostly preferred to space births. There is also a high continuation rate among acceptors so increasing availability of implants in family planning units nationwide could increase the number of women who utilize this method of contraception.

Co-existing mental and medical conditions among family medicine outpatients in a tertiary hospital in southern Nigeria

Background: A considerable number of patients seen in the Primary Care Clinics have co-morbid mental disorders with medical conditions that are largely not recognized by the primary care physician. This inability to recognize these mental disorders lead to non diagnosis and non treatment with eventual amplification of physical symptoms, low productivity at work and functional disability at home.Aims: To screen the patients attending the general outpatient clinic for anxiety and depression co-occurring with medical conditions.Methods: Two hundred and forty five patients aged 20 years and above attending the General Outpatient Clinic of the University of Uyo Teaching Hospital were randomly assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). The level of caseness for anxiety and depression were determined using a HADS score of 8 and above. Their medical conditions were diagnosed and associations were determined with mental disorders (anxiety and depression).Results: A total of 36.7% of patients scored above cut off point of 8 on the anxiety subscale while 24.5% of the subjects scored above cut off point of 8 on the depression subscale. 24.1%, (n=59) scored 8-10 on the anxiety subscale of HADS which is interpreted to be mild anxiety, 11.0%, (n=27) scored 11-14 on the anxiety subscale of HADS which is interpreted to be moderate anxiety and 1.6%, (n=4) scored 15-21 on the anxiety subscale of HADS which is interpreted to be severe anxiety. Similarly, 15.9%, (n=39) scored 8-10 on the depression subscale of HADS which is interpreted to be mild depression, 7.8%, (n=19) scored 11-14 on the depression subscale of HADS which is interpreted to be moderate depression and 0.8%, (n=2) scored 15-21 on the depression subscale of HADS which is interpreted to be severe depression. Hypertension was present in 22.04%, (n=54) respondents with anxiety p = 0.016 and depression p=0.025. HIV/AIDS was present in 4.08%, (n=10) respondents with depression p = 0.006.Conclusion: The result of the study shows that patients attending general outpatients' clinic suffer from mental disorders like anxiety and depression which may co- exist with hypertension and HIV/AIDS. Therefore, a careful assessment of patients attending these clinics will detect these disorders and treatment will improve the physical condition of the patients.

Home Management of Diarrhoea by Caregivers Presenting at the Diarrhoea Training Unit of a Tertiary Hospital in Southern Nigeria

Background: Diarrhoea is a leading cause of under – five morbidity and mortality. Diarrhoea deaths can be prevented by adequate case management of diarrhoeal episodes in children. With majority of cases being treated initially or completely in the home and community, the level of awareness of diarrhoea and simple home management practices among caregivers are key determining factors to reducing diarrhoea morbidity and mortality in children. Aim: To determine caregivers’ perception, knowledge and practice of home management of diarrhoea of children under five years of age presenting to the Diarrhoea Training Unit of a tertiary hospital in Southern Nigeria. Study Design: A clinic – based descriptive cross sectional study. Place and Duration of Study: The study was carried out in the Diarrhoea Training Unit of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria from July to December 2013. Methodology: A structured pre–tested questionnaire was used to collect data from caregivers on demographic characteristics, knowledge and practice of diarrhoea home treatment. There were 8 knowledge and 10 practice questions; each was scored a point Original Research Article British Journal of Medicine & Medical Research, 4(35): 5524-5540, 2014 5525 if correctly answered. The caregivers were grouped into those having good, moderate and poor knowledge or practice according to scores obtained. Results: Of the 157 caregivers, 29.3% had a good level of knowledge, while 33.8% had good level of practice of the home management of diarrhoea. A higher knowledge score was significantly associated with the Social class (P=.002) and mother’s educational level (P=.002). A higher practice score was also significantly associated with the Social class (P<.001) and mother’s educational level (P<.001). After adjusting for other factors, mother’s educational level was significantly associated with both level of knowledge (P=0.022) and practice (P=0.012) of the home management of diarrhea. Conclusion: The study has shown a low level of knowledge and practice among the caregivers as regarding the home management of diarrhoea. A higher level of education in mothers was significantly associated with a higher level of knowledge and practice.

Sonographic evaluation of the splenic length in normal pregnancy in a tertiary hospital in Southern Nigeria: A pilot study

Background:The spleen is affected by the changes that occur in pregnancy. Ultrasound is the commonest imaging modality used in the evaluation of the abdominal organs in pregnancy; however, there is a paucity of information on the sonographic measurement of the splenic length in normal pregnancy in our environment.Aim:To establish sonographically the range of splenic length in normal pregnant women.Subjects and Methods:A prospective descriptive cross sectional study of the sonographic measurements of the splenic length was performed on 150 healthy normal pregnant women correlating this with the body mass index, gestational age and parity. Data were analyzed using software SPSS version 15 (SPSS Inc., Chicago, IL, USA). Correlations and variance between variables were calculated. P values 0.05 were considered as significant.Results:A mean splenic length of 10.0 cm (SD) 1.8 throughout pregnancy was obtained with a range of 9.7-10.3 cm. The splenic length significantly correlated positively with the body mass index (r = 0.006, P < 0.01) but not with parity (r = 0.94, P < 0.01), and gestational age (r = 0.31, P < 0.01).Conclusion:This study was able to establish a range of sonographic measurement of the splenic length for the locality.

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria.

IntroductionEmergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman's life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria.MethodsThe case records of all women who underwent emergency peripartum hysterectomy between 1st January 2004 and 31st December 2011 were studied.ResultsThere were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%.ConclusionEmergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment.

Long Bone Non-Unions and Malunions: Risk Factors and Treatment Outcomes in Calabar, Southern Nigeria

Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible after a fracture incident. Malunions and non unions present a treatment challenge with the need for prolonged hospitalization, multiple surgical interventions and economic burden. In the developing world, traditional bonesetting practices are popular and these often result in a host of preventable complications. The added socioeconomic costs of treating these complications present a considerable strain on the resources of these already fragile economies and households. Aim: To document the risk factors, treatment options and outcomes for diaphyseal non-unions and malunions in our environment. Patients and Methods: Fifty-two consecutive patients comprising 37 non-unions and 15 malunions who presented in the orthopaedic unit of a tertiary hospital in Southern Nigeria were evaluated. Information sought included biodata, location of pathology, type of incident fracture, local risk factors including traditional bonesetting; treatment options and final outcomes. Information obtained was analyzed using SPSS version 20 (IBM, New York). Results are presented in simple frequency tables. Results: There were 34 males and 18 females (M:F = 1.9:1) with a mean age of 38.76 ± 14.55 years. There were 37 non-unions and 15 malunions. The femur was the commonest site of pathology in 21 (40.4%) cases, and among the non-unions, the atrophic variety was the commonest type (n = 26; 70.3%). The mean fracture-to-surgery interval was 11.35 ± 7.95 months and traditional bonesetting was the commonest risk factor (n = 36; 69.2%). Plate and screw Osteosynthesis with bonegraft augmentation was the commonest treatment modality and the overall union rate was 94%. Conclusion: Traditional bonesetting plays a major role in the health seeking behaviour of many African societies. The complications are varied and add to the overall socioeconomic burden of fracture care in these developing economies. Identification of traditional bonesetting practices as an important risk factor should translate into a focus on these practices in preventive public health decisions in fracture care. Continuing public health education backed by political will and can potentially drive a paradigm shift in health seeking attitudes in the developing word.

Attitudes of antenatal patients at a tertiary hospital in Southern Nigeria towards caesarean section

Attitudes of antenatal patients at a tertiary hospital in Southern Nigeria towards caesarean section

Attitudes of antenatal patients at a tertiary hospital in Southern Nigeria towards caesarean section

Caesarean section has contributed immensely to improved obstetric care throughout the world. In developing countries especially the sub-Saharan Africa, there is a great aversion to caesarean section. This study aims to assess the attitudes of antenatal patients at the University of Port-Harcourt Teaching Hospital towards caesarean section. A cross-sectional study was conducted among 400 antenatal clients seen at the University of Port Harcourt Teaching Hospital between 1st and 31st September 2009. Information on their socio-demographic characteristics, knowledge, beliefs and attitudes were sought. The response rate was 100%. Data management was carried out with SPSS 15.0 statistical software. Chi-square tests were used to compare the groups as appropriate. P value of <0.05 was assumed to be statistically significant. Out of 400 women studied, 68.5% favoured caesarean section while 31.5% were averse to it. About 59% of them knew what caesarean section was. Increasing maternal level of education and age were associated with increased knowledge and support for caesarean section (X2 =11.8, P = 0.0006). Eighty percent of the women believed caesarean section is done for medical reasons. If caesarean section is indicated in the index pregnancy, 65% would accept that the procedure be done, 19% would want to discuss with their husbands while 7.5% would default. Of the 82 women who had previous caesarean section, 73.2% would readily accept to undergo a repeat caesarean section if necessary in the index pregnancy compared to 200 (62.9%) of 318 women who had not undergone caesarean section. The difference was not significant. (X2 = 3.03, P = 0.08). There is a high level of knowledge and acceptance of caesarean section in this study. This acceptance is directly linked with the educational status of the women. However, one third of the women were still averse to caesarean section. Key words: Caesarean section, attitudes, antenatal clients.

Susceptibility of common urinary isolates to the commonly used antibiotics in a tertiary hospital in southern Nigeria

urine bacteria isolates to twelve commonly used antibiotics was investigated. Eight bacteria isolates were recovered from 49.5% of the patients (18.1% of males and 31.4% of females). These were Escherichia coli (19.7%), Klebsiella aerogenes (15.1%), Proteus mirabilis (6.7%), Acinetobacter calcoaceticus (2.3%), Pseudomonas aeruginosa (2.3%), Streptococcus faecalis (1.3%), Providence stuartii (1%), and Alkaligenes faecalis (1%). All the isolates exhibited a significantly high resistance to tetracycline, co-trimoxazole, amoxycillin and cefuroxime but were either moderately or highly sensitive to the quinolones and nitrofurantoin. We conclude that majority of the antimicrobial agents that are commonly used to treat UTIs in the hospitals are no longer effective. Therefore, the development and strict management of antimicrobial policy, and surveillance for resistant organisms should be given priority in Nigeria.