Usmanu Danfodiyo University Teaching Hospital Research Articles

Childhood Fall from Heights in Sokoto, Nigeria.

A prospective study of childhood fall from heights at Usmanu Danfodiyo University Teaching Hospital, Sokoto from January 1999 to December 2000 is presented. A total of 59 children aged 14 years and below were seen. Thirty five (59.3%) were males and twenty four (40.6%) were females. Fall from multistory buildings was the commonest cause of accident (35.6%) followed by fall from trees (27.1%). The commonest trauma was head injury seen in 36 patients (55.4%) and was responsible for the overall mortality of 6.8% (4 cases). Extremity fractures occurred in 18 patients (27.7%) and limb lost was recorded in 5 patients (8.5%). The biomechanics of fall, the peculiarities of fall from height in this environment and preventive measures are discussed. Sahel Med. J. Vol.6(1) 2003: 26-28

The Pattern of Association of Urethral Stricture with Benign Prostatic Hyperplasia in Nigerians

The records of all patients treated for Being Prostatic Hyperplasia (BPH) with urethral stricture between January 1991 to December 2000 in the Urology Unit of Usmanu Danfodiyo University Teaching Hospital, (U.D.U.T.H.), Sokoto were reviewed. 69 patients with this association were studied. The mean age was 62.5 years, range 50-88. All the patients presented with urine retention which was relieved by suprapublic catheter drainage. Diagnosis was confirmed by cystourethrography, panendoscopy and urethral calibration. Treatment was by synchronous open prostatectomy and urethral dilatation in 61 patients. 8 patients were treated by internal optical urthrotomy and transurthral resection of the prostate. Post operatively, satisfactory urine flow was the rule. 6 patients required intermittent urethral dilatation during the first year. Strictures in these patients were mild, simple and adequately treaded by regeneration procedures. Severe complicated strictures were not associated with BPH. This association tends to occur in 10-12% of BPH patients. This approach to management can be undertaken by surgeons who have average skill in general urologial procedure. Sahel Med. J. Vol.5(4) 2002: 190-194

Induction of Labour at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Context: Induction of labour is always a therapeutic challenge in obstetrics. Objective: The aim of this study is to determine the incidence, indications and outcome of induction of labour in our obstetric unit. Study Design and Setting: Descriptive study involving 205 patients admitted for induction of labour between January 1995 and December 2000. Results: There were 6,931 deliveries within the period and 205 cases of induction of labour, giving an incidence of 3%. Hypertensive disease in pregnancy, prolonged pregnancy, and intra-uterine fetal deaths accounted for over 85% of cases of induction of labour in the unit. Induction of labour with successful vaginal delivery was achieved in 168 patients (82%). While 70 out of the 72 patients (97%) that had spontaneous uterine contractions following cervical ripening with Foley's catheter had successful vaginal delivery, only 96 of 133 patients (72%) that had uterine contractions initiated with Syntocinon drip after cervical ripening had vaginal delivery. Induction of labour was also more likely to be successful in cases of intra-uterine fetal death (95%). There was no maternal mortality in the series. Conclusion: Induction of labour accounted for only 3% of our deliveries. Hypertensive disease in pregnancy and post term pregnancy were the most common indications. Chances of vaginal delivery were higher in the group that had spontaneous uterine contractions following cervical ripening than those that had uterine contractions initiated with Syntocinon. Vaginal delivery was also more likely when the indication for induction of labour was intra-uterine fetal demise. Key Words: Labour Induction, Cervix Ripening, Delivery Outcome. [Trop J Obstet Gynaecol, 2002, 19: 74-77]

Anaesthetic and intensive care management of rupture of the gravid uterus: a review of 50 cases.

Fifty emergency laparotomies were performed over a period of 5 years for rupture of the gravid uterus at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The associated morbidity and mortality rates were very high. Contributory factors were lack of antenatal care, high parity, late presentation, inadequate resuscitation, delayed surgery and poor perioperative monitoring and anaesthetic management. More widespread and efficient antenatal care and better referral centre services will improve patient outcome.

Breech deliveries in Usmanu Danfodiyo University Teaching Hospital Sokoto, Northwestern Nigeria: A 10-year review

Background: Breech delivery is a major issue in obstetric practice mainly because of the high perinatal morbidity and mortality associated with it. The aims of the study are to determine the prevalence management and perinatal outcome of singleton breech deliveries in our center. Materials and Methods: A retrospective study involving 395 singleton breech deliveries out of 24,160 deliveries conducted at the Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, over a 10-year (2001-2010) period. Results: The prevalence rate of singleton breech delivery was 1.7%. Breech deliveries occurred more in the primigravidae. Most babies (69.1%) had vaginal delivery. There was a high caesarean section (CS) rate of 30.9%. Babies delivered by CS had better Apgar scores than those delivered through the vagina (P < 0.05). The perinatal mortality rate in breech deliveries (410/1000) was significantly higher than that (101.5/10000) in their cephalic counterparts (P < 0.05). Similarly, perinatal deaths were more common in unbooked than in booked patients (P < 0.05). Conclusion: Breech delivery was frequent in the study population. Singleton breech delivered by CS had better outcome than those who were delivered through the vagina.

Use of transrectal ultrasound in the management of urologic diseases in a tertiary hospital in North-Western Nigeria

Transrectal ultrasound (TRUS)-guided biopsy of the prostate is considered as a standard of care for diagnosis of prostate cancer. The objective of this study was to document our experience in the use of TRUS in the management of urologic diseases in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. This was a retrospective study of patients who had TRUS at UDUTH from December 2009 to November 2017. Relevant data were extracted from the procedure register, and case folders of the patients. Data analysis was performed using IPSS 20.0 version. A total of 844 patients had the procedure within the period of the study. The mean age of the patients was 65.6 ± 10.6 years with a range of 7-98 years. The main clinical diagnoses of the patients were benign prostatic hyperplasia in 528 patients (62.6%), prostate cancer in 285 patients (33.8%) and primary infertility + azoospermia in 17 patients (2.1%). Transrectal ultrasound-guided prostate biopsy was done for 807 patients (96%). TRUS only was done for assessment of seminal vesicle and ejaculatory duct in 17 patients (2.1%), prostate volume assessment in 10 patients (1.1%) and deflation of retained urethral catheter balloon in 9 patients (1%). There was self-limiting rectal bleeding in 600 patients (74.4%) and 3 patients (0.4%) each developed haematuria and postbiopsy infections. Prostate biopsy is the most common indication for TRUS in our practice. Other indications were estimation of prostatic volume, evaluation of azoospermia and deflation of retained urethral catheter balloon.

Seroprevalence of hepatitis C virus antibody and its associated risk factors in children with sickle cell anaemia

Background: Hepatitis C virus (HCV) is an important hepatotrophic virus known to be transmitted percutaneouly through contaminated sharp objects, blood and blood products. Blood transfusion is a major risk factor for the acquisition of HCV in sub-Saharan Africa and it is attributable to the absence of consistent screening of blood donors. Children and adults are all at risk of being infected especially those with sickle cell disease. Objective: To determine the seroprevalence of hepatitis C viral antibodies among transfused sickle cell anemia (SCA) children. Materials and Methods: Three hundred (300) SCA children aged 6 months-15 years attending the SCA clinic and on admission in emergency pediatric unit (EPU) and pediatric medical ward (PMW), (both in steady state and in crises) of Usmanu Danfodiyo University Teaching Hospital, Sokoto, were screened for hepatitis C infection using anti-HCV as marker of infection and the sensitive enzyme-linked immunosorbent assay method was used for detection of the marker. Three hundred (300) children with minor illness attending pediatric outpatient department and on admission in for various treatment of the same hospital served as gender- and age-marched controls. Results: The result showed that the prevalence of anti-HCV seropositivity for HCV infection among SCA children was 12.7% (38/300) compared with 10.3% (31/300) of the control (P = 0.958). The prevalence of HCV infection increases significantly with increase in frequencies of blood transfusions both in SCA children (P = 0.0001) and the controls (P = 0.0001). Other risk factors for HCV infection such as traditional scarification (SCA 4 out 12, controls 4 out 16) and injections (SCA 38 out of 168, controls 27 out 172) significantly affect the prevalence of HCV infection in both SCA children and controls, (P = 0.0001). Conclusion: The prevalence of HCV infection in both SCA children and controls is high and the higher the frequency of blood transfusions the greater the rate of HCV infections.

Knowledge and practice of cervical screening among female health workers in Sokoto, North Western Nigeria

Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening. To determine the knowledge and utilisation of cervical cancer screening services in a cohort of subjects where awareness is naturally expected to be high. A cross sectional questionnaire survey of 159 female health care providers in Usmanu Danfodiyo University Teaching Hospital Sokoto. The sample included doctors, nurses, pharmacists, laboratory scientists and medical social workers. Knowledge of cervical cancer screening is high among the respondents. However, only 4.4 % had availed themselves of the opportunity for the test. Health care providers should improve on opportunistic screening. It is necessary for a national screening policy to be formulated and implemented in Nigeria.

Accuracy of ultrasound in fetal birth weight estimation and sex determination in singleton term pregnancies from two tertiary institutions of northwestern Nigeria

Background: Ultrasonographic assessment of fetal growth for the estimation of fetal weight (EFW) is a common obstetrics practice and provides valuable information for planning the mode of delivery. The aim of this study is to determine the accuracy of fetal birth weight estimation and sex determination using ultrasonography from two tertiary institutions of Northwestern Nigeria. Materials and Methods: This was a prospective study involving 109 singleton uncomplicated pregnancies from January 2013 to January 2014. All the patients are booked at the antenatal clinic of two tertiary institutions (Usmanu Danfodiyo University Teaching Hospital [UDUTH] Sokoto and Federal Medical Center Birnin Kebbi). Inclusion criteria in the study were term pregnancy (36-42 weeks), reliable date of last menstrual period, regular menstrual cycle, a close correlation between menstrual age and clinical gestational age measurements. Results: The mean maternal age was 29.01 ΁ standard deviation 4.81 (range: 18-40 years). One hundred and nine term live-born singleton infants delivered at UDUTH and Federal Medical Center Birnin Kebbi during the study period had undergone ultrasound EFW <7 days preceding birth. Twenty-one (19.3%) fetuses were identified as male while 38 (34.9%) was identified as female during the ultrasound examinations. In about 40 (36.7%) of the fetuses, the gender was not seen. Conclusion: There was a significant error while estimating fetal weight by ultrasound and underestimation has the highest percentage. Determination of fetal sex with ultrasound show some degree of accuracy in our study because 21 (19.3%) fetuses were identified as male, while 38 (34.9%) was identified as female during the ultrasound examinations. Hence, it should be recommended only if the mother requested for the gender during the scanning taking into account the social implications.

Maternal and fetal outcomes following cesarean deliveries: A cross-sectional study in a tertiary health institution in North-Western Nigeria

Background: Cesarean section (CS) is employed when vaginal delivery is not feasible or hazardous to the mother and/or her baby. The procedure, however, is not without risk. We determined the maternal and early neonatal outcomes of CS in a Tertiary Hospital in Nigeria. Materials and Methods: This is a 2-year cross-sectional study of all CS deliveries performed at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, North-Western Nigeria, from July 01, 2009, to June 30, 2011. All patients who had CS at any time within the 24 h period were noted and followed up until discharge. The sociodemographic data, types of CS, anesthesia, indications, cadre of a surgeon, and feto-maternal outcomes were documented in a proforma. Statistical analysis was carried out using the EPI INFO 3.5.1 (CDC Atlanta Georgia, USA). Results: There were 4462 deliveries out of which 504 (11.3%) were by CS. The age range of the subjects was between 15 and 50 years, and the mean age was 28.7 (3.05) years. Most of the subjects 75.2% (379/504) were multigravida while the primigravida constituted 3.1% (16/504). CS was performed for emergency reasons in 57.1% (288/504) while elective CS constituted 42.9% (216/504) of cases. The most frequent indication for emergency CS was obstructed labor 25.7% (30/288) and previous CS 39.8% (86/216) for elective CS. There were 514 babies delivered during the study of which 98.1% (504/514) were singletons while 1.9% (10/514) was multiple gestations. The maternal complication rate was 13.3% (67/504), and the main complication was hemorrhage 59.7% (40/67). Complications were more frequent with emergency CS compared to elective surgery (Chi-square test [χ2 ] =6.633, df = 1, P < 0.01) and with junior compared to senior residents (χ2 = 15.9, df = 1, P < 0.001). There was also a significant relationship between the fetal Apgar scores and the type of CS. The low 1 st and 5 th min Apgar scores were more frequent with emergency cases compared to elective CS (χ2 = 30.60, df = 1, P < 0.001; χ2 = 4.62.df = 1, P < 0.003). There were 10 maternal and 60 perinatal deaths. Conclusion: The CS rate in this study was 11.3%. Obstructed labor and previous CS among multigravida were the most frequent indications. Maternal and perinatal complications were more frequent with emergency CS and in the referred cases.

Sonographic pattern of hydrocephalus among the under five children in Sokoto North Western Nigeria

Background: Hydrocephalus among children is an important medical problem in view of its neurological sequelae in the growing child. This situation is compounded by the acute shortage of neurosurgeons in third world countries like Nigeria; hence, the need for its early detection and proper management. Objective: Evaluation of the ultrasound (US) appearances in children under 5 years of age presenting with clinical signs of raised intracranial pressure suggestive of hydrocephalus. Patients and Methods: A retrospective review of transfontanelle US scans done in 64 children (39 boys and 25 girls) attending the Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria over a period of 2 years was carried out. The patients had a mean age of 5.0 ± 4.6 months (range: 1–60 months) at the time of their US examination. Some of the clinical indications for US scan included: Congenital hydrocephalus, encephalocele, meningomyelocele, and meningitis. All scans were performed through the anterior fontanelle using SIUI Apogee 800 PLUS scanner with a curvilinear probe using multi-frequency transducer of 2–5 MHz. Results: Fifty-two patients (81.3%) had hydrocephalus of congenital origin. Eleven cases (17.2%) had postmeningitic hydrocephalus while only 1 case (1.6%) was posthemorrhagic. Twenty-five patients (48.0%) of the congenital cases were due to cerebral aqueduct stenosis. Eleven (21.2%) of the congenital cases were from obstruction at the exit foramina of Luschka and Magendie resulting in the communicating type of hydrocephalus. Conclusion: Hydrocephalus is a known cause of neurological morbidity among infants in developing countries. Majority of the cases are congenital in origin and most commonly due to cerebral aqueduct stenosis. Transfontanelle US is cheap, affordable, nonhazardous, and more accessible than other imaging modalities. It should serve as the first-line investigation of infants with suspected hydrocephalus for early detection and monitoring of progression to determine those cases that would require shunt operation.

Risk factors of acute otitis externa seen in patients in a Nigerian tertiary institution

Background: Acute otitis externa is a common clinical problem which is associated with preventable risk factors. Objective: The aim of this study is to determine the practices that are risk factors in patients with acute otitis externa in a Nigerian tertiary institution. Patients and Methods: This was a 6-month cross-sectional study of patients with acute otitis externa carried out between April and September 2013 at the Ear, Nose, and Throat Clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Results: A total of 2350 patients were seen during the study period, of which 88 (3.7%) were diagnosed with acute otitis externa. The males and females were 32 (36.4%) and 56 (63.6%), respectively, with a ratio of 1:1.8 The age range was 3 months to 70 years, with the mean age of 18.9 years. Self-ear cleaning with cotton bud 65 (73.9%) constituted the majority of object introduced into the ear canal(s) and the reasons for self-ear cleaning were because of itching of the ear(s) in 47 (53.4%), habitual 9 (10.2%), and perceiving that the ears were dirty 32 (36.4%). The introduction of extraneous moisture into the ears was seen in 46 (52.3%) including self-medication with topical antibiotic, instilling plain and soapy water in the ear canal(s), and swimming. The comorbid conditions which are known risk factors for otitis externa were seen in 35 (39.8%) patients, of which allergy was the most frequent with 22 (25%), followed by diabetic mellitus 7 (8%) and AIDS 6 (6.8%). Only 14 (16%) of these patients had their comorbid conditions diagnosed at their first presentation. Conclusion: Self-ear cleaning with cotton bud was the major risk factor seen in our patients with otitis externa, followed by the introduction of extraneous moisture into the ear canals and untreated comorbid risk factors for acute otitis externa. These risk factors are preventable through creation of awareness and prompt treatment of other associated disease conditions.

A 5-year review of measles cases admitted into the emergency paediatric unit of a tertiary hospital in Sokoto, North-Western Nigeria

Background: Measles is a vaccine preventable viral infection which is still responsible for significantly high morbidity and mortality in Sub-Saharan Africa. Failure of routine immunization programs heralds a dismal outlook for this potentially eradicable viral infection. The objective of this study was to determine the hospital prevalence, vaccination status, pattern of complications, and outcome of children admitted with measles into the Department of Pediatrics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Materials and Methods: This was a 5-year retrospective study from January 1, 2011 to December 31, 2015. Case folders of children below 15 years who were admitted with measles were retrieved, relevant information extracted, and entered into a pro forma. Data was analyzed using SPSS version 22. Results: Total admissions were 6104, out of which 204 were due to measles (prevalence, 3.3%). The mean age was 27.4 ± 18.9 months (range 6–96 months). Those aged 1–5 years were 144 (70.6%). The male-to-female ratio was 1.3:1. Only 28 patients (13.7%) had measles vaccination. Observed complications included bronchopneumonia in 168 (82.4%), acute laryngotracheobronchitis in 24 (11.8%), febrile convulsion in 20 (9.8%), encephalitis in 17 (8.3%), ocular complications in 12 (5.9%), and suppurative otitis media in 6 (2.9%) patients. The presence of complications was related to age