Tertiary Hospital In South-east Nigeria Research Articles

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.
 Study Design: A cross-sectional hospital-based study.
 Place and Duration of Study: Guinness Eye Centre Onitsha, South-East Nigeria between 1st to 29th June 2021
 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.
 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).
 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.

An audit of evolving colonoscopy practice in two tertiary hospitals in South-East Nigeria

Introduction: Colonoscopy is quite essential in the management of gastrointestinal pathologies. Its practice in most developing countries is suboptimal. Aim: The aim of this study was to determine the common indications and findings at colonoscopy in a patient population in South-eastern Nigeria, as well as to assess the documentation of quality indicators of colonoscopy service. Materials and Methods: The endoscopy records of patients who underwent colonoscopy at two tertiary institutions (Federal Medical Centre, Owerri and Imo State University Teaching Hospital, Orlu) from January 2014 to December 2016 were reviewed. Information on patient demographics, colonoscopy indications, colonoscopy findings, and polyp detection were sought for. Data analysis was done with SPSS version 21. Results: Two hundred and nineteen patients had colonoscopy within the period. Age range of the patients was 16 to 94 years (mean age: 55 ± 14.8 years). The most common indications for colonoscopy were bleeding per rectum 100 (45.7%) and change in bowel habit 36 (16.4%). Tumors in the colon/rectum were seen in 44 (19.9%) patients and polyp detection rate was 10.9% (n = 24). Records were not comprehensively kept. Conclusion: The high percentage of findings of tumors in patients undergoing colonoscopy in our population suggests that this service should have an expanded coverage to enable earlier diagnosis of colorectal malignancies. A better endoscopy record and data management will also be helpful.

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.

Ventricular hypertrophy and ischaemic changes in Children with Sickle Cell Anaemia and its relationship with the Haemoglobin Concentration in Steady State

Objective: The prevalence and burden of Sickle Cell Anaemia (SCA) in Nigeria are high and they contribute to childhood morbidity and mortality. Chronic anaemia and vaso-occlusion usually involve different organs. The involvement of the heart is a common complication of SCA, thus the need for early detection of cardiac abnormalities in children with SCA. To assess cardiac structure using ECG in children with SCA in steady-state and to determine the relationship between abnormal ECG findings and the participants’ haemoglobin concentration.
 Material and Method: It was a cross-sectional study done in one of the tertiary hospitals in southeast Nigeria. The study participants were 164 children with SCA in steady state within the ages of 2 -17 years. A 12-lead ECG was carried out on the participants and their haemoglobin concentrations determined. The relationship between the presence of cardiac abnormality and independent variables like haemoglobin concentration, age and gender were analyzed.
 Result: The prevalence of cardiac abnormality was 59.1%. The commonest cardiac structure abnormality was Left ventricular hypertrophy (LVH) (39.6%). Abnormality in the P-R interval was seen in 14.6%, while ST segment abnormality was seen in 18.3%. The mean Hb of those with abnormal ECG was lower than that of those without abnormal ECG, across each age group. Severe anaemia was a significant (p< 0.01) predictor of LVH. However, there was no significant association between the degree of anaemia and the occurrence of ST-segment (p: 0.26) and PR interval abnormalities (p: 0.52).
 Conclusion: Cardiac anomalies are common findings in SCA children.

Assessment of breastfeeding techniques in Enugu, South-East Nigeria.

Background:Good breastfeeding technique is important in ensuring adequate milk delivery and preventing breastfeeding problems. Exclusive breastfeeding rate is quite low, and requisite skills regarding proper positioning and attachment of an infant while breastfeeding appears lacking among mothers in Nigeria. This study was undertaken to assess breastfeeding techniques of mothers attending the well-child clinics of two tertiary hospitals in southeast Nigeria.Materials and Methods:This cross-sectional descriptive study of 396 mother and child pairs who attend the well child clinics of two tertiary hospitals in Enugu (Enugu state University Teaching Hospital and University of Nigeria Teaching Hospital) between September 2018 and February 2019. An interviewer administered, well-structured pro forma was used to collect data while mothers were observed closely as they breastfed and scored using the World Health Organization criteria. Data were analyzed using SPSS version 22.Results:Most of the mothers studied (357; 90.2%) attended ante-natal care, and 365 (92.2%) of the deliveries were assisted by a health worker. Only 194 (49%) of mothers practiced good breastfeeding techniques. Maternal age (20–30 years) (P < 0.001, odds ratio [OR] 0.464), attendance to antenatal clinic (P < 0.001; OR 8.336), health education and demonstration on breastfeeding techniques before and after delivery (P = 0.001) and maternal level of education (χ2 = 13.173, P = 0.001) but not parity (P = 0.386; OR 1.192) were significantly associated with good breastfeeding techniques.Conclusion:There are suboptimal breastfeeding techniques among mothers. Increased awareness creation and regular demonstration of breastfeeding techniques are needed.

Feeding behavior among health-care workers in a tertiary health institution Southeast Nigeria.

Background:Feeding behavior is an important factor in the prevention and management of noncommunicable diseases, which are the leading cause of death globally.Objective:This study is aimed to investigate the feeding behaviors among health-care workers in a tertiary hospital in southeast Nigeria.Materials and Methods:The study was a cross-sectional survey. A total of 418 participants (186 males and 232 females) were involved in the study. The instrument is a sociodemographic questionnaire and a modified form of the British Heart Foundation's questions to assess the nutritional value of individuals. The participants were consecutively recruited from their workstations. Data were collected using self-administered questionnaires, which were hand distributed and collected back on the same day after completion.Results:The study showed that health workers in the teaching hospital had an overall “fair” feeding behavior (86.13 ± 8.52 out of 140). It also showed that females had a significant (P < 0.05) overall better feeding behavior (88.15 ± 9.00) compared to males (83.62 ± 7.18). The studied participants had poor feeding behavior in carbohydrates and fats and oil consumption and just fair behavior in fruits and vegetables, salt intake, and water consumption. The feeding behavior was inadequate, and there was no significant gender or profession-related differences in the overall behavior of the participants.Conclusion:The health-care workers in the tertiary health institution in southeast Nigeria have inadequate feeding behavior. They should join in the global call and awareness on healthy feeding behavior to prevent and reduce the burden of noncommunicable diseases.

Epidemiological aspects of preinvasive cervical lesions and the role of p16INK4a immunohistochemistry in their diagnosis: Experience from a tertiary hospital in South-east Nigeria

Epidemiological aspects of preinvasive cervical lesions and the role of p16INK4a immunohistochemistry in their diagnosis: Experience from a tertiary hospital in South-east Nigeria

Determinants of willingness to participate in community-based health insurance among People Living with HIV in South-East Nigeria

Background: Despite free antiretroviral treatment at designated facilities, many People Living with HIV (PLHIV) in Nigeria continue to face catastrophic health expenditures (CHE) due to direct non-medical and indirect costs of illness. Waning donor funding and poor country ownership of HIV care programs are challenges to the sustainability of care for PLHIV. Community-Based Health Insurance (CBHI) presents a viable alternative for funding HIV care services. The aim of this study was to assess the determinants of Willingness To Participate (WTP) in CBHI among PLHIV in a large tertiary hospital in South-east Nigeria. Methods and materials: A cross-sectional survey was conducted among 371 PLHIV on treatment at Federal Teaching Hospital Abakaliki Nigeria using an interviewer-administered questionnaire. Descriptive, bivariate and multivariate logistic regression analyses were conducted using SPSS version 20. Statistical tests were conducted at 5% level of significance. Results: Respondents were mostly males (51.8%) with mean age of 45.4 ± 10.3. The mean monthly income of respondents was N26, 665.77 ± 15,171.50 ($74,070 ± 42.14). Majority were willing to participate (825%) and to finance their participation in CBHI (65.2%). Major reasons given for unwillingness to participate in CBHI were poor understanding on how the system works, lack of regular source of income, health insurance not needed and fear of poor management of resources. On bivariate analysis, WTP in CBHI was associated with gender (p < 0.001), marital status (p < 0.001), employment type (p = 0.006), family size (p = 0.001), educational level (p < 0.001), monthly and monthly income (p < 0.001). Predictors of WTP were female gender (AOR = 2.9; 95% CI: 1.6–5.7), being currently unmarried (AOR = 4.3; 95% CI: 2.3–7.8), self-employed (AOR = 2.2; 95% CI: 1.2–3.9), family size greater than 5 (AOR = 3.1; 95% CI: 1.7–5.9) and having less than a secondary school education (AOR = 4.3; 95% CI: 2.3–7.8). Conclusion: The majority of the respondents were willing to participate and finance their participation in CBHI. The vulnerable subgroups (females, unmarried, self-employed, poorly educated and those with large family size) had higher odds of WTP. To reduce CHE, there is a need to harness this high WTP among PLHIV in the design of subsidized and sustainable CBHI programs with special focus on the socially disadvantaged.

Conjunctival bacterial flora and their antibiotic sensitivity among patients scheduled for cataract surgery in a tertiary hospital in south-east Nigeria.

To determine the pre-operative conjunctival bacteria flora and their antibiotic susceptibility among patients scheduled for cataract surgery. A descriptive, cross-sectional, hospital-based study design was adopted. It involved 104 consecutive, consented patients scheduled for cataract surgery at the University of Nigeria Teaching Hospital Enugu, from June to September 2017. The participants' socio-demographic characteristics, medical, and social history were obtained through interviewer-administered questionnaire. Conjunctival swab was obtained from the inferior fornix of the eye scheduled for cataract surgery using sterile swab stick and transported to medical laboratory for analysis. Susceptibility tests were carried out on the representatives of different groups of available antibiotics. Data was analyzed using the SPSS version 23. The participants were mainly females (64.4%), married, and farmers, with at least primary school education and a mean age of 64 ± 2SD years. The conjunctival swab bacteria isolation rate was 36.5%. Gram-positive bacteria accounted for 73.7% of the total isolates. Coagulase-negative Staphylococcus (34.2%) was the most frequently isolated bacteria. Gentamicin, ofloxacin, and polymycin B (76%) were the most efficacious antibiotics followed by moxifloxacin and tobramycin (68%) on all the isolates. Ofloxacin (82%) was the most sensitive to Gram positive while gentamicin (90%) was for Gram-negative bacteria. In Enugu, the most common pre-operative conjunctival bacteria isolated were Coagulase-negative Staphylococcus with varied antibiotic sensitivity. Routine prophylaxis with gentamicin and ofloxacin is therefore advised to forestall the dreaded post-operative endophthalmitis.

Economic burden of acute watery diarrhoea in children aged 6 – 36 months presenting to a tertiary hospital in South-East Nigeria

Introduction: Globally,acute watery diarrhoea is amajor cause of childhood morbidityand mortality. It is the fourthleading cause of death in childrencontributing as high as 11% of allchildhood deaths. In Nigeria,acute watery diarrhoea causes240,106 deaths per year. Out ofpocket expenditure is a majorsource of healthcare funding inNigeria, hence treatment of acutewatery diarrhoea places extra financialburden on the familiesespecially those in the low socioeconomicclass.Objective: To determine the costof treatment of acute watery diarrhoeain children aged 6 to 36months.Methodology: This was a crosssectional study conducted on children aged 6-36 months who presented with acute watery diarrhoea from January through October 2017. Data obtained using interviewer-administered questionnaire, included sociodemography, duration of illness, treatment cost of the index diarrhoeal episode before presenting to our facility, transportation cost, food and other incidental cost, duration of hospitalization. Diagnostic tests requested and medications prescribed were obtained from the patient’s medical file. Information on drug cost, diagnostic test cost and hospital bed day cost were obtained from Nnamdi Azikiwe University Teaching Hospital (NAUTH) central pharmacy, NAUTH main laboratoryand account section respectively. Statistical Package for Social Sciences (SPSS) version 20 was used for data analysis.&#x0D; Result: Seventy two patients were recruited for the study, of whom 47(65.0%) were males giving a male female ratio of 1.9:1. Forty eight (66.6%) of the study participants belonged to the lower socioeconomic class while 22(30.6%) and 2(2.8%) belonged to the middle and upper socioeconomic class respectively. A mean total treatment post per diarrhoea episode derived from this study was # 37,572.2 ± #12,479.0 which at the time of the study was equivalent to US$ 104.7 ± US$ 34.8. This is well above the then Nigerian minimum monthly wage of 18,000.0 (US$ 50.1).&#x0D; Conclusion: The result of this study showed that the economic burden of acute watery diarrhoea is quite enormous especially to the low socio-economic group. Prevention and improvement of home treatment of diarrhoea may reduce the treatment cost.&#x0D; Key words: Acute watery diarrhoea, Cost, Children, Hospital

Malaria prevalence and its sociodemographic determinants in febrile children - a hospital-based study in a developing community in South-East Nigeria.

SummaryBackgroundMalaria remains one of the major contributors of child mortality in many developing countries in Africa. Identifying its determinants will help in prevention and prompt intervention in these settings.MethodsThis cross-sectional descriptive study was conducted over an eight-month period. It enrolled 382 children who were presented with fever to the children outpatient and emergency unit of a tertiary hospital in South-east Nigeria. A structured questionnaire was used to collect information on socio-demographic factors. Blood film microscopy for malaria and parasite density was done on all subjects that tested positive for malaria.ResultThe malaria prevalence rate was 16.7%, 26.7%, 29.9% and 46.2% in children < 5 years, 5 to < 10 years, 10 to < 15 years and 15-17 years respectively. Logistic regression analysis showed that malaria was more prevalent in older children but children under the age of 5 years were more prone to higher parasite density. Also, children of mothers with lower educational attainment, children from families of lower socio-economic class and resident in rural settings had higher likelihood of malaria infection.ConclusionsSustained improvement in strategies to prevent malaria infection is still imperative in children of all ages, especially those under 5 years, children from families of low socio-economic class and those residents in rural communities.

Impact of socioeconomic status on patient experience on quality of care for ambulatory healthcare services in tertiary hospitals in Southeast Nigeria

BackgroundTo determine how socioeconomic factors, such as level of education and employment status, affect patient experiences on quality of care for ambulatory healthcare services in teaching hospitals in southeast Nigeria.MethodsThe study is of a cross-sectional design and exit poll was used to collect its data. A pre-tested structured questionnaire was administered to clients accessing care in the outpatient departments of three tertiary hospitals in Nigeria. The assessment of patient experiences for quality of care was based on five (5) domains of care: waiting time; environment of the outpatient department; quality of doctor’s care; quality of care by nurses/other health workers; and responsiveness of care. In addition, the overall quality of care was assessed.ResultsThe mean rating of patient experience for quality of care for ambulatory healthcare services (outpatients’ care) was 74.31 ± 0.32%. Moderate differences were observed between the hospitals assessed for various levels of patients’ care, especially for waiting time, quality of doctors’ care and overall quality of care. Employment status was a statistically significant (p ≤ 0.05) determinant of overall patient experience rating for quality of care, while the level of patient’s education was an influence on the perception of waiting by the patients and their rating of care from nurses/other healthcare providers (apart from medical doctors).ConclusionThe study showed that educational and employment status (measures of socioeconomic status) of patients determined how patients receiving ambulatory (outpatient) healthcare services perceived the quality of care in the hospitals. Hence, in order to ensure equity, there is need to institutionalize patient-centered care, while full consideration is given to the patients’ socioeconomic status.

A situational report on low vision services in tertiary hospitals in South-East Nigeria.

The prevalence of functional low vision in southeast Nigeria is reportedly the highest in the country. This study evaluated the state of low vision services and perceptions of providers and users of the service in tertiary hospitals in the region, to facilitate advocacy and planning. This was a cross-sectional survey of available low vision services in the nine tertiary hospitals in Southeast Nigeria utilizing mixed methods. Data were collected on human resources, service delivery, and low vision equipment and devices. In-depth interviews were conducted to determine the perceptions of providers and users of the service. Varying levels of low vision services were actively provided in three of the nine hospitals surveyed. Services, equipment, and devices were suboptimally available. The three functional centers had a combined output of 61 patients seen within 6 months preceding the study and had at most two-thirds of required equipment. Low vision devices (LVDs) were available in varying degrees in only four (44%) of the hospitals. Twenty-one (7.6%) of the 278 eye care personnel had some low vision training across seven hospitals. The challenges highlighted by providers were mainly inadequate funding (infrastructure, training, and equipment), communication gaps, and bureaucracy. Poor awareness, affordability, acceptability, and accessibility of LVDs were major constraints for users. Low vision services are available in some tertiary facilities in southeast Nigeria. Improved funding and better awareness of the availability of low vision services by eye care providers and the general public are needed to strengthen services.

Psychosocial burden of caregivers taking care of children in the children's emergency room of two tertiary hospitals in Southeast Nigeria

Introduction: In this study, we sought to determine the severity of caregiving burden among caregivers of children presenting to the emergency room and analyze its associated predictors. Methods: This was a cross-sectional, study carried out on 332 caregivers of children admitted into the children emergency room (CHER) of two tertiary hospitals in Southeast Nigeria. A validated structured questionnaire was administered by an interviewer with the use of an interpreter where necessary. Results: A total of three hundred and thirty-two child–caregiver dyads were enrolled for this study. Fathers were 25.6%, mother 65.4%, and nonparent made up 9.0% of primary caregivers of child in index admission. The mean age of the enrolled children was 2.5 ± 1.9 years with age ranges of 1 month to 16 years. Male-to-female ratio was approximately 0.8. Two hundred and fifty-four (80.6%) of surveyed caregivers experienced high psychosocial burden. On the average, caregivers were faced with moderate burden in the CHER during care of their sick child with a mean caregiver burden score of 1.64 ± 0.67. Caregivers looking after independent children (odds ratio [OR]: 0.1, 95% confidence interval [CI]: 0.2–0.9; P = 0.05), partially dependent children (OR: 0.2, 95% CI: 0.3–0.9; P = 0.040), and those with someone assisting them in the care of admitted and/or children at home (OR: 0.5, 95% CI: 0.2–1.0; P = 0.050) were less likely to experience high psychosocial burden of care as compared with caregivers looking after dependent children and those with no assistance. Conclusion: There is a need to incorporate comprehensive psychosocial and instinctive support for caregivers during the care of their sick children in the emergency room.

Recall of consent information by day care prostate biopsy patients: An assessment of the role of a third-party check.

To evaluate the extent of recall of consent information by daycare prostate biopsy patients in our low-literacy setting. And to evaluate the role of a 3rd party check on patient's recall of consent information. As part of our standard of care, a formal informed consent session for day care prostate biopsy takes place 3 days prior to the procedure. For this study, before leaving the outpatient clinic the same day, the patient acknowledged before a third-party that his concerns were or were not satisfactorily addressed. The extent of recall of consent information was assessed on the morning of the procedure using a researcher-administered questionnaire. Consecutive patients participated in this cross-sectional study for day care prostate biopsy at a tertiary hospital in southeast Nigeria from February to November 2015 after obtaining due consent. The recall of the risks associated with the planned procedure was poorer than the recall of the nature of the disease condition or the nature of the planned procedure. However, it was observed that aggregate recall was significantly poorer among patients who negatively attested to a satisfying consent session (OR 0.125; P < 0.0005). The use of a third-party in determining patient satisfaction after a consent session may be a better indicator of patient comprehension and subsequent recall of consent information, especially in low-literacy settings. Using a third-party, in this manner, may assist in checking paternalism inherent in the patient-doctor relationship.

Obstetric outcome of pregnancies complicated by hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy are of significant public health concern due to associated maternal and perinatal morbidity and mortality. Objective: To determine the trend and obstetric outcome of pregnancies complicated by hypertensive disorders in a tertiary hospital in South-East Nigeria. Materials and Methods: Patients managed for hypertensive disorders from January 1, 2012, to December 31, 2017 were recruited for the study. Case files of patients were retrieved, and information on sociodemographic variables, risk factors, and fetomaternal outcome were extracted using a pro forma. Data analysis was done using International Business Machine-Statistical Package for the Social Sciences Version 20 (IBM-SPSS Version 20, New York, USA ). Ethical clearance was obtained from the ethics and research committee of the institution. Results: During the study period, there were a total of 14,181 deliveries, of which 785 women were managed for hypertensive disorders of pregnancy, thus giving a prevalence of 5.5%. Preeclampsia accounted for 62% (487) while chronic hypertension was 4.3% (34). There was a rising trend from 2012 with a peak in 2017. About 60% (181) of the patients were not booked for antenatal care. The predominant risk factors were advanced maternal age 14.2% (43) and previous history of hypertensive disorder 13.6% (41). Almost half of the patients had caesarean section (46.4%, 140). Preterm births were recorded in 56.6% (171) of the patients. Maternal and perinatal deaths were recorded in 0.7% (2) and 16.2% (941) of the patients, respectively. Conclusion: This study showed that hypertensive disorders of pregnancy remain a significant cause of adverse maternal and perinatal outcomes in pregnancy. Adequate antenatal coverage, early diagnosis, and improved emergency obstetric care services are needed to reverse the trend.

Evaluation of Wait Time in the Children's Emergency and Outpatient Units of a Tertiary Hospital in Southeast Nigeria.

Background:Promptness of intervention in the emergency room (ER) or outpatient unit is a major determinant of outcome in acutely ill children. Time is, therefore, of the essence in trying to reduce complications and mortality associated with children.Methods:This was a cross-sectional study conducted in the children ER and the children outpatient unit of the Enugu State University Teaching Hospital (ESUTH), Enugu, Southeast Nigeria. Waiting time defined as the time between arrival and doctor consultation was calculated.Results:A total of 248 respondents were enrolled during the study period. In the emergency unit, majority (67.5%) of the respondents' sick children were attended to almost immediately, while 13.3% and 19.3% waited for ≤10 and >10 min, respectively, before being attended to by a doctor. The mean waiting time in the emergency unit was approximately 9.27 ± 29.2 min (95% confidence interval [CI]: 2.90–15.65 min) with a range of 0–56 min. In the outpatient unit, the mean waiting time was 12.67 ± 15.3 min (95% CI: 10.31–15.01 min) with a time range of 5–245 min. Eighty-five (51.5%) of the 165 respondents waited for <10 min, 60 (36.4%) waited for between 10 and 30 min, while 20 (12.1%) waited for >30 min before their sick children were attended by a doctor.Conclusion:The mean waiting times reported in this study in the emergency and outpatient units of the ESUTH were within acceptable standards. However, there were cases where the waiting time in both children's units was exceptionally long. There is need for continued monitoring and evaluation of waiting times in these units for prompt attention to patients.

Preliminary findings on metastatic brain tumors in Enugu, Southeast Nigeria

Background: Metastatic brain tumors (MBTs) are the most common brain neoplasms seen clinically and are often associated with poor outcomes. This study highlights the demographic, clinical, and radiological profiles as well as outcomes of MBTs managed in a tertiary hospital in Southeast Nigeria. Methods: This was a 1-year prospective observational study of patients with MBT who presented to the neurosurgery unit of the University of Nigeria Teaching Hospital, Enugu, from December 2018 to November 2019. Data on the demography, clinical and radiological features, treatment, and outcomes were collected and analyzed. Results: Of the 31 patients with MBTs, 58.1% were female and 41.9% male. The mean age was 51.0 ± 15.2 years. The most common presenting features were limb weakness (77.4%), headache (58.1%), and personality changes (54.8%). About a quarter (26.7%) were fully conscious at presentation. Only 45.2% knew that they had a systemic malignancy (SM) before presentation. The breast (29.0%), lungs (22.6%), and skin (19.3%) were the common sources of metastases. The lesions were solitary in 25.8% and multiple in 74.2%. They were predominantly frontal (80.6%), with bilateral distribution in 64.5% of patients. Radiotherapy was done in 58.1% and surgery in 6.5% of patients. Prior knowledge of the existence of a SM (P = 0.045) and unilateral brain involvement (P = 0.013) were associated with better 30-day survival. Conclusion: The breast is the most common source of brain metastasis. Prior knowledge of the existence of a SM and unilateral brain involvement is associated with better short-term survival. Keywords: Brain, metastasis, primary, survival