University Of Port Harcourt Teaching Hospital Research Articles

Urinary Pathogens amongst Parturients at the University of Port Harcourt Teaching Hospital, South-South, Nigeria

Aim: To identify the microorganisms in urine before and after delivery. Also, to identify the incidence, risk factors and antibiotic susceptibility pattern in postpartum bacteriuria. 
 Methods: A quasi-interventional study of 50 women who had term vaginal deliveries at the University of Port Harcourt Teaching Hospital (UPTH) Nigeria, between September 1, 2016 and December 31, 2016. Clean catch midstream urine samples collected in sterile containers from parturients before and after delivery were processed. All significant isolates were subjected to antimicrobial susceptibility testing. Socio-demographic data and data regarding labour and risk factors were collected on a pre-designed proforma and entered on a spread sheet. Statistical analysis was done using SPSS version 22.0.
 Results: Majority 49 (98%) of the parturients were booked (women that received antenatal care). Eight (16%) of the parturients had bacteriuria pre and post-delivery. Four of the parturients who were negative for bacteriuria before delivery had postpartum bacteria, giving an incidence of 8% for postpartum bacteriuria. The commonest micro-organism isolated post-delivery was Escherichia coli (50%). The number of vaginal examinations, vacuum delivery, episiotomy, perineal tear and bladder catheterization did not significantly increase the risk of postpartum bacteriuria.
 Conclusion: Escherichia coli is the most common urinary pathogens and sensitive to Nalidixic acid. Routine screening of women for bacteriuria after delivery and an understanding of the antimicrobial sensitivity will help in reducing associated morbidities.

Phenotypic and molecular characterization of antimicrobial resistant Escherichia coli from urinary tract infections in Port-Harcourt, Nigeria.

IntroductionMultidrug resistance among Escherichia coli causing Urinary Tract Infections (UTIs) is a major public health problem, threatening the effective treatment of UTIs. This study investigated the phenotypic and molecular characteristics of E. coli associated with UTIs in Port-Harcourt, Nigeria.MethodsTwenty-five non-duplicate isolates of E. coli from UTIs patients at the University of Port-Harcourt Teaching Hospital, Nigeria were identified using Matrix-Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) Mass Spectrometry. The antimicrobial susceptibility patterns were determined using Kirby-Bauer disc diffusion technique. Phenotypic expression of Extended Spectrum Beta Lactamases (ESBLs) and AmpC beta-lactamase were determined using standard laboratory methods and polymerase chain reaction (PCR) was used to detect ESBLs, AmpC, Quinolones and Aminoglycosides resistance genes.ResultsThe isolates exhibited high rates of resistance to co-trimoxazole (76%), nalidixic acid (68%), ciprofloxacin (60%), gentamicin (44%) and low resistance to cefotaxime (20%) but were fully susceptible to cefoperazone/sulbactam, amikacin, nitrofurantoin, colistin and carbapenems. Phenotypic expression of ESBLs was recorded in 6(24%) isolates while genotypic detection revealed the highest prevalence of blaTEM 22(88%), followed by blaCTX-M-15 16(64%), blaSHV 7(28%) and blaOXA-1 6(24%) while AmpC (blaCMY-2) gene was detected in 8(32%) isolates. Amongst the quinolone resistant isolates, qnr variants (qnrB, qnrD and qnrS) and aac(6')-Ib genes were detected in 7(28%) and 3(12%) isolates respectively while all gentamicin resistant isolates possessed the aacC2 gene. The co-expression of blaCTX-M-15 with quinolones and aminoglycoside genes were 20% and 40% respectively. The prevalence of multiple drug resistance was 52%.ConclusionA high proportion of the studied E. coli isolates co-expressed ESBLs, quinolones and aminoglycosides resistance genes which call for prompt antibiotic stewardship and preventive strategies to limit the spread of these genes.

Antibiotic Susceptibility of High Vaginal Swab’s Isolates Obtained from the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Introduction: Bacterial vaginosis is caused by the invasion of the vagina by pathogenic microbiota with a unique adaptive strategy. Immunodeficiency and immune compromised female patients may have reported cases of this category of infections.
 Aims: This study evaluated the susceptibility pattern of High vaginal swab (HVS) isolates using both Optudisc and Abtek antibiotics susceptibility disc obtained from the Department of Medical Microbiology and Parasitology Unit, University of Port Harcourt Teaching Hospital (UPTH); Rivers State, South-South Nigeria.
 Study Design: Thirty (30) isolates with multidrug resistance were screened, selected and identified with frequencies of occurrence with 36.67% E. coli, 29.9% Klebsiella sp., 16.67% Staphylococcus aureus, 6.6% Pseudomonas sp. and 13.33% Proteus sp. The susceptibility of the isolates was assessed using Kirby Bauer disc diffusion method.
 Results: Over 80% were susceptible to Gentamicin, 64% to Ofloxacin, using the Abtex Biological Limited while Optudisc revealed 72% to Peflacin, Ciprofloxacin, Streptomycin, 60% resistant to Ampicillin, 56% to Nalidixic Acid, Septrin. About 100% sensitivity was observed in the second generation Cephalosporins, Cefuroxime and Ceftazidime, whereas 75% were resistant to Oxacillin and Augmentin. While Optudisc for Gram-positive isolates were 100% susceptible to Levofloxacin and Ciprofloxacin. Statistical analysis using t-test at p< 0.05 showed that mean results using the different disc were significant.
 Conclusion: The trend in the susceptibility of isolates was attributed to the spate of self-medication and abuse and misuse of herbal remedies. These findings underscore the need to enforce proper susceptibility testing prior to administration of therapeutic formulations.

Assessment of Nurses Competency in the Management of Spinal Cord Injured Patients in Accident and Emergency/Orthopaedics Department of University of Port-Harcourt Teaching Hospital (UPTH) Nigeria

Assessment of Nurses Competency in the Management of Spinal Cord Injured Patients in Accident and Emergency/Orthopaedics Department of University of Port-Harcourt Teaching Hospital (UPTH) Nigeria

Childhood Drug and Non-Drug Poisoning in Nigeria: An Economic Appraisal.

Background:The dearth of information on the economic cost of childhood poisoning in sub-Saharan Africa necessitated this study.Objective:This study has investigated the prevalence of childhood drug and non-drug poisoning, treatment modalities and economic costs in Nigeria.Method:A retrospective study of childhood drug and non-drug poisoning cases from January 2007 to June 2014 in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria was carried out. Medical records were analysed for demographic and aetiological characteristics of poisoned children (0–14 years of age), as well as fiscal impact of poisoning cases.Findings:Of the 100 poisoned patients, 46% were male and 54% female, with female/male ratio of 1.17:1. Most of the children were under five years of age. Paracetamol, amitriptyline, chlorpromazine, ferrous sulphate, kerosene, organophosphates, carbon monoxide, snake bite, alcohol and rodenticides were involved in the poisoning. The average cost of poison management per patient was about $168, which is high given the economic status of Nigeria.Conclusion:Childhood poisoning is still a significant cause of morbidity among children in Nigeria and accounts for an appreciable amount of health spending, therefore preventive strategies should be considered.

Tuberculosis in Children Aged 0-5 Years at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria - How Common is HIV in Children with Tuberculosis

Background: Tuberculosis (TB) is a leading cause of death in young children and the risk of progression from infection to disease is higher in the very young especially among those with Human Immunodeficiency Virus (HIV) infection. This study therefore aimed to examine the method of TB diagnosis and how common HIV infection is among children 0-5 years with tuberculosis at the University of Port Harcourt Teaching Hospital (UPTH).
 Methods: Information of children aged 0-5 years from 1st January, 2011 to 31st December 2014 were retrieved from the TB register of the Directly Observed Treatment Short course (DOTS) clinic of UPTH. This included the age, sex, HIV status, Sputum AFB status, method of diagnosis of tuberculosis and the treatment outcome of the patients. Ethical approval for the study was obtained from the Research and Ethics committee of the University of Teaching Hospital.
 Results: Three hundred and thirty five children were treated for TB and 179 (53.43%) of them were aged 0-5 years. There were 93 (51.96%) males and 86 (48.04%) females, with male: female ratio of 1.08:1. Their mean age was 1.96 ±1.45. The sputum or gastric lavage of 21 (11.73%) were positive for acid fast bacilli (AFB). The common method of TB diagnosis was clinical/ radiological method and this constituted 158 (88.27%) of the patients with TB. Ninety (50.28%) children with TB were less than one year of age and there was no statistical significant relationship between age and method of TB diagnosis (x2 = 2.78, p = 0.249). More males 93 (51.96%) than females 86 (48.04%) had TB but more females 13 (61.90%) than males 8 (38.10%) were AFB positive, however, these were not statistically significant. (x 2 = 1.26 p-value = 0.262). Seventy two (40.22%) of the children with TB were HIV positive. One hundred and thirty five (75.42%) of the children recovered following treatment while 44 (24.58%) were referred to Dots centres closest to the patients. No child died.
 Conclusion: The prevalence of TB among under-fives especially among infants is high. Clinical and radiological methods were the common methods of TB diagnosis. HIV prevalence among children with TB was lower than expected by the authors, however, the treatment outcome was good. Re-training of clinicians to improve their expertise on clinical diagnosis of TB and a more in depth search of TB in the community among children 0-5 years who are HIV sero-negative with persistent cough is advocated.

Experience with Retinoblastoma at a Tertiary Centre in Port Harcourt, Nigeria: Trends in Outcome

Background: Retinoblastoma is the most common primary intraocular malignancy in children, and remains the most curable of all childhood cancers in the developed world. However, ocular and patient survival rates have remained very low in resource limited countries, where more than 90% of children with retinoblastoma live.
 Objectives: To review the pattern of presentation of children with retinoblastoma at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria, and compare their treatment outcome with what was obtained in the previous decade in same centre.
 Methods: All patients with retinoblastoma admitted into the Paediatric Oncology Unit of the UPTH from January 2011 to June 2017 were reviewed. Their demographics, clinical profile and outcome of treatment were analyzed using SPSS version 20.0.
 Results: Nineteen children had retinoblastoma which represented 11% of all childhood malignancies. Eight(42%) males and 11(58%) females, all under-fives, were studied with M:F=1:1.4. Mean duration of symptoms was 29.6 weeks, with majority (73.7%) having been ill for more than 3 months. White spot in the eye and eye protrusion were commonest presenting complaints while loss of vision was found in all affected eyes. More children (57.8% versus 30.8% previously) were lost to follow up, 5(26%) died and 3(15.7%) completed treatment, whereas none did a decade earlier.
 Conclusion: Retinoblastoma affected only under-five children. Late presentation with proptosis and loss of vision were common presenting features. A marginal improvement in outcome was noted while high default rate and lack of radiotherapy facilities in the State had remained important challenges to completion of therapy.

PO 8313 PREDICTORS OF HEALTH INSTITUTIONAL READINESS FOR EBOLA EPIDEMIC CONTAINMENT IN NIGERIA: A STRUCTURAL EQUATION MODELLING (SEM) APPROACH

BackgroundThere is paucity of literature on organisational readiness in the health space. Previous studies focus on epidemic preparedness and often depict readiness as a minor element in the implementation space. This study investigated the predictors of health institutional readiness to implement innovations for combating an Ebola epidemic outbreak in Nigeria.MethodsThe cross-sectional, mixed methods design was employed. The study population was 785 health care workers and non-health workers working at University of Port-Harcourt Teaching Hospital (Nigeria). The purposive sampling was used for qualitative study while the stratified random sampling technique was utilised for the quantitative study. Qualitative data were collected from fifteen respondents while a total of 511 questionnaires were administered at the study site. The qualitative data was analysed using inductive thematic analysis. The quantitative data was analysed using structural equation modelling (SEM).ResultsThe qualitative study suggested that quality improvement was perceived as most useful in influencing all the tree sub-components of readiness. Training is perceived as most useful in building readiness while it is perceived to be moderately useful in influencing the sub-component of readiness. The OLS estimates indicates that QI/QA exert a positive and significant effect on motivation (β=0.004, p<0.05) and general capacity score (β=0.28 p<0.05) while it inversely but significantly exerts influence on innovation specific capacity (β=−0.21×10–3, p<0.05). The SEM/pathway analysis shows the direct and indirect routes of interactions among predictors of readiness after adjusting for confounders. All the explanatory variables have significant effect on readiness except gender which was dropped from the final model.ConclusionThe strength of evidence of how an evidence-based system for innovation support can influence readiness was established. Though readiness is a rate-determining step in ensuring robust and effective implementation outcomes for epidemic containment, exploring innovation outcomes and their amplification through explicitly target readiness dynamics requires further investigation.

Causes of Illness and Preterm Infant Deaths in a Low Resource Setting in Southern Nigeria: A 5 Year Review

Background: About 45% of deaths among under-fives occur during the neonatal period with a high contribution from preterm infant deaths. Regular evaluation of preterm deaths is important as patterns and therefore intervention may vary at different times and places.
 Objectives: To determine the common causes of illness and death among preterm infants admitted to the Special Care Baby Unit (SCBU) of the University of Port Harcourt Teaching Hospital (UPTH), over a 5 year period.
 Methods: This was a retrospective review of data of preterm babies admitted to the SCBU from 2012 – 2016. Information obtained included biodata, nature of illness, duration of admission and outcomes. Data were collated and analyzed using SPSS v20 for windows. 
 Results: 3,071 babies were admitted in SCBU over the period, of which 683 (22.2%) were preterms. Of these, 421 (61.6%) were in-born while 262 (38.4%) were out-born. The male: female ratio was 0.9:1. Morbidity patterns varied with birth asphyxia (20%) ranking highest among in-borns while sepsis (21%) and neonatal jaundice (15%) were more prominent in out-borns. The overall preterm mortality rate was 24.6 % with rates being significantly higher in out-born 30.5% versus in-born 20.9% (p=0.004). Mortality was highest among low birth weight preterms. Admission rates decreased steadily over the period.
 Conclusion: Birth asphyxia and sepsis were the main morbidities recorded. Mortality rates were higher among outborns. Low birth weight preterms were most affected because they were in the majority. There was a steady decline in admission rates. Improving obstetric care, neonatal resuscitation, infrastructure and subsidizing healthcare services for preterms is needful.

Knowledge, Attitude and Practice of Preventing the Occurrence of Work-Related Musculoskeletal Disorders Among Doctors in University of Port-Harcourt Teaching Hospital

Background: Musculoskeletal disorders affecting medical personnel should never be treated lightly. It has thus become necessary to strictly infuse ergonomics in medical practice in order to tackle the occurrence of musculoskeletal system disorders. This would ensure better productivity among the medical personnel. This research was conducted to determine the knowledge, attitude and practice of the prevention of work-related musculoskeletal disorders among doctors working at the University of Port-Harcourt Teaching Hospital.Methods: A descriptive, cross-sectional study design was employed in carrying out this study among doctors working at the University of Port Harcourt Teaching Hospital. Multistage sampling was utilized in selecting a sample population of 223 doctors for this study. Data collection was done using a semi-structured self-administered questionnaire. Ethical approval to conduct this study was gotten from the University of Port-Harcourt research ethics committee. Consent, confidentiality, privacy and beneficence were ensured in this study. For test of associations, statistical significance was set at 0.05.Results: Majority of the respondents had good knowledge and attitude towards musculoskeletal disorders’ prevention at work. The practice of ergonomic principles was however not satisfactory. Occurrence of work-related musculoskeletal disorders among study respondents was significantly associated with the knowledge and practice of ergonomic principles required to prevent the occurrence of these disorders.Conclusion: Despite the significant proportion of doctors in this study having good knowledge and attitude towards prevention of musculoskeletal system disorders at work, only few of these doctors satisfactorily practiced the necessary preventive measures necessary to prevent these disorders. This inadvertently resulted in the high prevalence of these disorders found in this study. It is recommended that a re-orientation of doctors to be more involved in the actual application of ergonomics while working no matter the compulsion or desire to get the work done should be done.

Trend Analysis of Various Ocular Surgeries Performed at University of Port Harcourt Teaching Hospital (UPTH), Nigeria Over a Ten-year Period

Trend Analysis of Various Ocular Surgeries Performed at University of Port Harcourt Teaching Hospital (UPTH), Nigeria Over a Ten-year Period

Selfmonitoring of blood glucose practices by people living with diabetes who use their personal glucometers in Port Harcourt, Niger Delta Region, Nigeria

Self-monitoring of blood glucose (SMBG) assists persons living with diabetes with the day-to-day behavioral and therapeutic adjustments to their diabetes care. It is a cheaper and more available alternative to glycated haemoglobin (HbA1c) in Nigeria for monitoring glycaemic control. Information on SMBG practices of Nigerians living with diabetes using their personal glucometers is scanty. The aim of the study is to assess the intensity and frequency of SMBG by glucometer owners, and the extent the patients and/or the health care providers (HCP) utilize SMBG to achieve personalized treatment goals via behavioral/treatment adjustments. This was a cross sectional study carried out among persons living with diabetes that accessed diabetes care at the diabetes clinic of the University of Port Harcourt Teaching Hospital (UPTH) and using their personal glucometers. They were consecutively recruited. Data obtained by using intervieweradministered questionnaires were analyzed using SPSS version 20.0, and pvalue <0.05 was considered significant. A total of 128 persons living with diabetes participated in the study of which 40 (31%) were males and 88 (69%) were females; the mean age of the subjects was 52.05 ± 11.24 years with a range of 26–70 years. The majority of the study subjects (72%) were in the active working age group (25–60years). The highest frequency of glucometer use was in the 26 subjects (20%) who checked their blood glucose every morning while 62 (48%) of the subjects checked their blood glucose any morning they felt like. Most of the subjects (60%) did not have any recording device. Glucometer owners were not just the insulin-requiring people living with diabetes as more than half of the subjects, 66 (52%) were on oral anti diabetic drugs (OAD) only. Glucometer ownership was mainly by those that were in the working age group. SMBG protocol (frequency) was variable and SMBG data were not maximally utilized.Keywords: Self-monitoring of blood glucose; Personal glucometer; Diabetes; Blood glucose

Cancer mortality in the Niger Delta Region of Nigeria: A case study of the University of Port Harcourt Teaching Hospital

Aim:The aim of this study is to determine the pattern of cancer mortality (CM) seen in the University of Port Harcourt Teaching Hospital (UPTH) which is a cancer reference center in the Niger Delta Region.Methodology:This is a 6-year retrospective study of cancer-related deaths in UPTH using patients' admission registers in all the wards and emergency units. Furthermore, the death certificates of cases were reviewed.Results:Three hundred and sixteen cases of cancer-related deaths occurred, involving 174 females and 142 males, in a female-to-male sex ratio of 1.2:1. All age groups were affected, with age group 40–49 years accounting for the majority (20.6%). CM was seen in all the systems, except the central nervous system. Cancers of the gastrointestinal tract and its accessory organs (liver and gall bladder) caused most mortality (27.9%), in a female-to-male ratio of 0.8:1. The single most involved organ in CM is the female breast (20.6%), distantly followed by mortality due to prostate cancers and hematolymphoid cancers which accounted for 9.2% each. Colorectal cancers accounted for 7.3% of cancer deaths and ranked 4th. Cancers of both cervix and stomach each accounted for 5.7% of mortality. The major histologic diagnoses were carcinomas (adenocarcinoma; 36.7%, invasive ductal carcinoma; 20.3%, squamous cell carcinomas; 8.2% and hepatocellular carcinomas; 4.4%). Leukemias and lymphomas accounted for 9.2% of cases, whereas sarcomas accounted for 5.1% of cases.Conclusion:Infection-related and noninfection-related cancers cause most mortality in UPTH. The 5th decade was the most commonly affected, while female breast was the single most involved organ. Breast, prostate and hematolymphoid malignancies are common causes of CM with death from breast occurring earliest. Majority of the deceased were educated, working-class urban dwellers. More advocacies on public acceptance of cancer screening and cancer preventive lifestyles as well as governments' improvement on workforce training and treatment infrastructure will improve the current CM profile in Port Harcourt.

Cancer Mortality in the Niger Delta Region of Nigeria: A Case Study of the University of Port Harcourt Teaching Hospital.

Background:In children particularly in the developing world, there is a tendency to downplay the role of primary hypertension in their health. In adults, a number of factors have clearly been associated with the incidence of hypertension. Knowledge of the prevalence of hypertension and its associated factors among children in our environment is important and could inform the need for lifestyle changes and routine blood pressure (BP) checks in children so as to reduce BP-related health risks.Aim:The aim of this study is to document the prevalence of hypertension and its risk factors among children in Enugu, Nigeria.Materials and Methods:Children aged 6–17 years attending the outpatient clinic of a tertiary hospital, were enrolled for the study. Their socioeconomic status (SES), weight, height, BP, and dipstick urinalysis were measured using standardized methods. Adherence to Mediterranean diet was assessed using the Mediterranean Diet Quality Index (KIDMED). The prevalence of hypertension and the influence of these factors on their BP were analyzed.Results:Forty-six (9%) of the 491 participants had hypertension. Of these 46 hypertensive children, 72% were females while a significantly higher proportion 57% (P = 0.006), were in the age group 13–17 years. While age, gender, and the presence of protein in urine were significantly associated with hypertension in these children; body mass index, diet, family history of hypertension, and SES were not.Conclusion:The prevalence of hypertension in children in this environment is high and appears to be increasing. There is need for routine BP and urinalysis check for all children in our clinics and wards.

Comparative study of interpregnancy interval and fetomaternal outcome in a tertiary health facility

Background: Ensuring adequate interpregnancy interval enhances optimal maternal and fetal wellbeing while short interpregnancy interval which is interpregnancy interval less than 24 months is associated with adverse maternal and fetal outcomes.Objectives: To compare pregnancy outcome between short and normal interpregnancy interval at the University of Port Harcourt Teaching Hospital (UPTH).Methods: This was a prospective cross-sectional study involving 410 parturients (268 with short interpregnancy interval and 142 with normal interpregnancy interval) who consented and delivered at the UPTH. A structured proforma was used to obtain relevant information from the parturients. The data was analyzed using SPSS version 21.0. Pregnancy outcomes which include maternal anaemia, caesarean section rate, uterine rupture, abruption placenta, fetal distress, perinatal mortality between normal interpregnancy interval (NIPI) and short interpregnancy interval (SIPI) were compared using Chi square test and P value less than 0.05 was regarded as significant.Results: The mean age and parity of the study population were 32.59+0.38 and 2.69+0.44 respectively. One hundred and forty-two parturients had NIPI while 268 (65.4%) had SIPI. Parturients with SIPI were 1.4 times more likely to have caesarean delivery (OR=1.36, 95% CI= 0.88-2.11). Maternal anaemia (P = 0.026), abruptio placentae (P = 0.03) and ruptured uterus (P = 0.005) were significantly associated with SIPI. Low birth weight (P=0.1) and fetal demise (P=0.4) were not significantly associated with SIPI.Conclusion: Short interpregnancy interval was associated with significant adverse pregnancy outcome in this study. Ensuring adequate interpregnancy interval will improve outcomes.Keywords: Normal interpregnancy interval, Short interpregnancy interval,maternal outcome, fetal outcome.

Mosquitoes at the University of Port Harcourt Teaching Hospital Nigeria: A Threat to Caregivers and Patients

Anopheles gambiae sensu lato is the most important malaria vector in Nigeria. Referral hospitals have a mandate to provide patients with the best health care. The persistent complaints of the nuisance caused to patients, professionals, and visitors by mosquitoes at the University of Port Harcourt Teaching Hospital (UPTH), a referral Hospital, prompted the design of this study to assess the species composition, density, and man-biting rates of endophilic mosquitoes at the UPTH. A longitudinal entomological survey covered dry and wet seasons, February–July 2017, with sampling done thrice weekly, using the aspiration method. Caught mosquitoes were identified by standard keys using a dissecting microscope and classified according to their gonotrophic status. A total of 1,307 mosquitoes in two genera (Culex, Anopheles) and three species (Culex quinguefasciatus, Anopheles gambiae s.l. and Anopheles mouchetti) were caught, comprising 150 (11.5%) males and 1,157 females. The most abundant species was Culex quinguefasciatus (98.01%), An. gambiae s.l. (1.64%), and the least abundant, An. mouchetti (0.35%). Gonotrophic examinations of caught females revealed 52.8% blood-fed and 40.1% unfed. Culex quinquefasciatus had higher man-biting rates (1.26 bites/patient/night) than Anopheles (0.2 bites/patient/night). The Accident and Emergency ward, 595 (45.5%), and the Obstetrics and Gynecology ward, 328 (25.1%), had the highest records of caught mosquitoes among the four wards visited for collections. No significant difference (Fcal = 1.0722, Ftab = 13, p > 0.05, df = 2) existed between wet and dry seasons' collections. Because of the high numbers of blood-fed Anopheles, an urgent need for intervention is required to reduce the case of vector/human contacts; notably, larval source management will be a principal approach toward control.

Synopsis of cardiovascular and thoracic surgical cases in the University of Port Harcourt Teaching Hospital

Background: The aim of the study was to identify the spectrum of cardiothoracic and vascular surgical cases in the University of Port Harcourt Teaching Hospital (UPTH) and identify the limitations to service delivery and recommend solutions to improve service delivery to patients. Methods: A cross-sectional study of all the cases seen over a 5-year period at UPTH was analyzed. The data were retrieved from theatre records of both elective and emergency cases. All patients were included except those with closed tube thoracostomy drainage inserted in the accident and emergency theaters and patients who were referred out before they could have surgery. The results were tabulated and described using frequencies and percentages. Results: A total of 93 patients had surgeries in the 5-year period with a mean age of 38.5 years and a range of 3–82 years. Fifty-seven (61.3%) were males, with a male-to-female ratio of 3:2. Fourteen (15.1%) patients were children aged 3–16 years, 67 (72.0%) were adults (17–64 years), and 12 (12.9%) were the elderly (65 years and above). Twenty (21.5%) had surgeries on cardiac structures, 46 (49.5%) had surgeries on thoracic structures, and 27 (29.0%) had different vascular surgeries. For the cardiac structures, 8 (40%) had pericardiectomy and tube pericardiostomy while 12 (60%) had pacemaker insertion. Thoracic surgical procedures included 3 (6.5%) diaphragmatic repairs, 7 (15.2%) esophageal surgeries, 22 (47.8%) pleuropulmonary surgeries, 6 (13.0%) chest wall reconstructions, 5 (10.9%) mediastinal tumor excisions, and 3 (6.5%) other surgeries. The vascular surgeries included 26 (96.3%) peripheral vascular repairs and 1 (3.7%) abdominal aortic aneurysm repairs. Conclusion: There are shortcomings with the practice of cardiothoracic surgeries at the hospital as major procedures like open-heart surgeries are not done despite availability of human expertise. Thus, there is an urgent need for measures to ensure that open-heart surgery commences, in addition to the provision of some surgical equipment and improvement on some surgical techniques. Furthermore, more collaboration with the other team members in the hospital needs to be actively encouraged.

Tuberculosis among School Age (6 - 18 Years) Children Seen in University of Port Harcourt Teaching Hospital: A Need for Effective School Health Services

Introduction: Tuberculosis (TB) still causes significant morbidity and mortality amongst adults and children despite all the efforts which have been put into the control of the disease. However, the prevalence of the disease in school age children is unknown because of scarcity of TB screening surveys in Nigerian schools. The aim of this study was to evaluate the proportion of school age children treated for TB in the Directly Observed Treatment Short Course (DOTS) clinic of University of Port Harcourt Teaching Hospital (UPTH). Methods: The records of all children 6 to 18 years who were treated in the DOTS clinic from 2011 to 2014 were reviewed. Information sought included age, sex, sputum Acid Fast Bacillus (AFB) status, Human Immunodeficiency Virus (HIV) status and treatment outcome. Results: One hundred and forty children aged 6 to 18 years were treated in the University Port Harcourt Teaching Hospital DOTS clinic, representing 41.79% of childhood TB cases seen over the study period. Seventy one (50.71%) patients were males and 69 (49.29%) were females. Their mean age was 12 ± 3.86. Thirty-one (22.14%) had smear positive TB. Sputum smear positivity was commonest (54.84%) among those who were 16 years and above compared to the other age groups and this is statistically significant (x2 = 17.72, p = 0.001). Forty-one (35%) patients were HIV positive and 6 (4.29%) were positive for both HIV and AFB. Ninety (64.29%) patients recovered fully following treatment, 48 (34.29%) were referred to other DOTS centres and 2 (1.43%) died. Gender, age group, AFB and HIV status showed no relationship with treatment outcome. Conclusion: School age children 6 to 18 years made up a large proportion of childhood TB cases seen within the study period in the DOTS clinic. More than one third of them were HIV/TB co-infected. An effective School Health Services should be established in schools in Port Harcourt to curb the spread of TB and other communicable diseases within the schools.

Cardiovascular System Mortalities in Nigeria; Case Study of the University of Port Harcourt Teaching Hospital

Background: Studies have suggested epidemiological transition in the mortality pattern in Nigeria from communicable to non-communicable diseases of which Diseases of the cardiovascular system (DCVS) is prime. DCVS is thus a growing public health concern but its mortality profile is under-studied in Port Harcourt. This study was therefore designed to review the mortality profile of DCVS in Port Harcourt. Methodology: A retrospective case controlled study of deaths ascribed to DCVS at the University of Port Harcourt Teaching Hospital (UPTH) between January 2012 and December 2017. The composite diseases were grouped using the ICD10 scheme and analyzed using SPSS version 23. Minitab version 16 was used for trend analysis. Results: Of the overall 1902 deaths recorded within the period, 566 (29.8%) were cardiovascular system related. Of these, 301 (53.3%) were males and 265 (46.7%) were females. The elderly of 50 - 99 years were most commonly affected (65.5% of the mortalities). Cerebrovascular accidents (CVA) accounted for 322 deaths (56.9%); various types of shock caused 116 deaths (20.5%) while congestive cardiac failure (CCF) accounted for 114 deaths (20.1%). Pulmonary embolism, myocardial infarction, carotid aneurysm, and hypertensive encephalopathy caused 1.8%, 0.4%, 0.2%, and 0.2% deaths respectively. Peak annual mortality of 143 (25.3%) was recorded in 2013. Although the trend of mortality was undulating, there was an overall increase in annual incidence over the years. Conclusion: DCVS constitute the commonest systemic cause of death in Port Harcourt. Governmental and donor agencies involved in public health policy planning and implementation should scale-up strategies for the prevention and control of DCVS in order to stem the rising tide of associated mortalities.

Pattern and Outcome of Childhood Tuberculosis Seen at the University of Port Harcourt Teaching Hospital, Nigeria

Background: Despite the fact that Tuberculosis (TB) is preventable, treatable and curable, it has remained a significant cause of childhood morbidity and mortality. Identifying patterns of TB and its treatment outcome which is the aim of this study is relevant for TB control programmes. Methodology: This was a retrospective cross-sectional study carried out over a three-month period from April-June 2019 at the directly observed treatment Short course (DOTS) clinic of the University of Port Harcourt Teaching Hospital (UPTH), Nigeria. Relevant information on all children 0 - 18 years with tuberculosis over a four-year period from January 2015 to December 2018 was retrieved and analysed. Information retrieved included the age, sex, HIV status, method of diagnosis of tuberculosis, type of Tuberculosis and the treatment outcome of the patients. Results: There were 202 childhood (0 - 18 years) cases seen over the study period. Out of these, 109 (53.96%) were males and 93 (46.04%) females. Majority of them (40.59%) were 1 - 4 years of age. There were 194 (96.04%) new cases, 6 (2.9%) transfer and 2 (0.99%) retreatment cases. One hundred and six (80.69%) had pulmonary TB, 23 (11.39%) TB adenitis, 10 (4.95%) had TB spine, 3 (1.49%) TB abdomen and 3 (1.49%) TB meningitis. TB/HIV co-infection rate was 48.45%. One hundred and eight completed treatment, 10 (4.95%) were cured, 22 (10.89%) died, 46 (22.77%) defaulted and 16 (7.92%) were transferred out. Successful treatment outcome rate was 58.41%. Conclusion: Pulmonary TB was the commonest type of TB found and treatment success rate was just above average.