Pre-air travel health-seeking behaviour, prevalence of barotitis media, its knowledge and associated factors among recently travelled patients in Kano, Nigeria.

INTRODUCTION: Existing evidence suggests that barotitis media (BM) is common among air travellers, and it has the potential to cause severe discomfort and sometimes permanent hearing and balance deficits. It has not been studied in Nigeria. OBJECTIVE: This study aimed to assess the pre-air travel health-seeking behaviour, prevalence of BM, knowledge of BM and its associated factors among a cohort of outpatients with a history of recent air travel in Kano, Nigeria. MATERIALS AND METHODS: This questionnaire-based survey involved 97 participants systematically and proportionately selected from adult patients or caregivers of children with recent air travel history attending two outpatients clinics over 7 weeks. Information on biodata, pre-air travel advice-seeking behaviours, air travel experience and BM knowledge were obtained. Data were analysed using the descriptive statistical methods, Chi-square or Fisher's exact tests and odds ratio (OR). RESULTS: Most participants were male (54.6%) with tertiary education (87.6%); the prevalence of BM was 44.3% (43/97). Only 2.1% (2/97) had ever sought pre-air travel advice from a doctor; 83.5% (81/97) had heard of BM before; 42% had adequate knowledge of BM. Employment status (Fisher's exact, P = 0.001), clinic at recruitment (Fisher's exact, P = 0.00008), duration of last flight (Fisher's exact, P = 0.0001) and persistent ear-pain after landing (Fisher's exact, P = 0.001) were significantly associated with participants' knowledge of BM. Persistent ear-pain after landing was the predictor of BM knowledge (OR = 0.04, 95% confidence interval [0.002-0.67], P = 0.025). CONCLUSION: The BM knowledge level of this cohort suggests the need for further studies to ascertain the complete picture and justify improved pretravel education of air travellers in our setting.

Effectiveness of an ear and hearing care training program for frontline health workers: A before and after study.

Background: Delegating ear and hearing care (EHC) tasks to frontline health workers may help to improve muchneeded access to this specialized care. Primary healthcare workers (PHCWs) need to acquire relevant knowledge and skill to recognize, refer, and/or treat simple ear problems. This study aims to evaluate the effectiveness of an EHC training program for PHCWs. Methodology: The training intervention was a 2day course based on an adapted WHO training resource in EHC for frontline workers. A pre and posttest study design was undertaken with the assessment of EHC at two time points using the same questionnaire at baseline and at completion of the training. Results: One hundred and ninety PHCWs were recruited for the study. Overall, there was a statistically significant improvement from baseline to course completion. However, participants' scores in the domain of knowledge for risk factors were slightly low compared to other domains (54.3%, 95% confidence interval [CI]: 52.0%-56.6%), and this improved significantly following the training (72.7%, 95% CI: 71.0%-74.0%). A potential confounder in this evaluation may be that of the scores recorded at pretest, which may change in the posttest due to regression to the mean phenomenon. Conclusion: The findings from this study indicate that the training program demonstrated the potential to be an effective way to improve knowledge of EHC, and we suggest the inclusion of "primary ear care" as a component of primary health care.

RésuméContexte: La délégation des tâches liées aux soins de l'oreille et de l'ouïe aux travailleurs de la santé de première ligne peut aider à améliorer l'accès indispensable à ces soins soins spécialisés. Les travailleurs de la santé primaire (SSP) doivent acquérir des connaissances et des compétences pertinentes pour reconnaître, aiguiller et/ou traiter les simples problèmes d'oreille. Cette étude vise à évaluer l'efficacité d'un programme de formation EHC pour les CSP. Méthodologie: L'intervention de formation était un cours de deux jours fondé sur une ressource de formation adaptée de l'OMS en EHC pour les travailleurs de première ligne. Un plan d'étude avant et après l'essai a été entrepris avec l'évaluation de EHC à deux moments à l'aide du même questionnaire au départ et à la fin de la formation. Résultats: Cent Quatre-vingt-dix CSP ont été recrutés pour l'étude. Dans l'ensemble, il y a eu une amélioration statistiquement significative entre le début et la fin du cours. Toutefois, les notes des participants dans le domaine de la connaissance des facteurs de risque étaient légèrement faibles comparativement aux autres domaines (54,3 %, confiance à 95 % intervalle [IC] : 52,0 % à 56,6 %), et cela s'est nettement amélioré après la formation (72,7 %, IC à 95 % : 71,0 % à 74,0 %). Un facteur de confusion potential dans cette évaluation peut être celle des scores enregistrés au stade pré-test, qui peut changer dans le post-test en raison de la régression au phénomène moyen. Conclusion: Les résultats de cette étude indiquent que le programme de formation a démontré le potentiel d'être un moyen efficace d'améliorer connaissance du CSM, et nous suggérons l'inclusion des soins de l'oreille primaire comme composante des soins de santé primaires.

Diagnosis and management of otitis media with effusion in a tertiary hospital in Kano: a best practice implementation project.

OBJECTIVE: To implement the best available practice to improve the diagnosis and management of OME according to best available evidence at the Aminu Kano Teaching Hospital, Kano, Nigeria. INTRODUCTION: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear, without signs and symptoms of an acute infection. It has high rates of physician visits and is a common cause of hearing impairment in affected children. In Nigeria, the prevalence is estimated to range from 8% to 25.2%. METHODS: The current quality improvement project was conducted using the Joanna Briggs Institute approach for clinical audits, involving a baseline audit, an implementation of change phase and a follow-up audit, using Practical Application of Clinical Evidence System software. Eleven evidence-based audit criteria were used for this project. The same audit criteria were used for the baseline and follow-up audit. The sample size was 20 for both the baseline and follow-up. Implemented change involved the introduction of pneumatic otoscope use in the department and educational sessions with clinicians and caregivers. The project was conducted from July to November 2017. RESULTS: Implementation of strategies to improve practice led to large increases in compliance with audit criteria, particularly Criteria 1, 6, 9 and 10 (from 0-25% to 70-100%). Paradoxically, a decrease in compliance was observed for two criteria. CONCLUSION: The current project succeeded in increasing clinician compliance with best available evidence. The most significant evidence-based change seen was in the use of pneumatic otoscope, whereas the most difficult barrier to overcome was resistance to change.

Inhaled foreign bodies in a paediatric population at AKTH Kano-Nigeria.

BACKGROUND: Inhaled foreign bodies are common paediatric emergencies and a major cause of accidental deaths at home among Nigerian children especially among children below the age of 5 years. Different types of foreign bodies have been reported from the ordinary to the most bizarre. We evaluated the types of foreign bodies and sites of possible impaction of these foreign bodies along the tracheobronchial tree. MATERIALS AND METHODS: A 6-year case record of 35 patients with foreign body inhalation was reviewed from January 2005 to December 2010 at the Otorhinolaryngology Department of Bayero University/Aminu Kano Teaching Hospital, Kano - North-western Nigeria. Basic information such as date of birth, age groups, gender, indication for bronchoscopy, type of foreign bodies, sites of foreign body impaction and surgical outcome were extracted and analysed. RESULTS: Thirty-five patients [18 (51.4%) males and 17 (48.6%) females, aged 6 months-10 years] with a mean age of 5.1 years and median of 5 years (+/- 3.0 Standard Deviation). The most affected age group with 31.4% is 3-5 years. Groundnuts and whistles were the most frequently inhaled foreign bodies with an equal frequency of 25.7%, respectively. Foreign bodies were preferentially lodged in the left main bronchus in 8 (22.9%) patients compared to the right main bronchus in 6 (17.1%) patients. CONCLUSION: Public enlightenment both in the news/print media on the risk of foreign body aspiration especially among the under-five's is highly advocated. The left main bronchus may be a common site for impaction as well.

An appraisal of common otologic disorders as seen in a deaf population in North-Western Nigeria.

BACKGROUND/OBJECTIVE: Deaf persons are equally susceptible to other otologic diseases as the rest of the population; however, there may be increased morbidity among the deaf population. The aim of the study is to determine common otologic problems and their prevalence among the deaf and to offer treatment where appropriate. MATERIALS AND METHODS: Six hundred and twenty students aged between 5 and 38 years with profound hearing loss were recruited from a special school for the deaf. Hearing level was assessed and full ENT examination including otoscopy was done. RESULTS: 22.4% [139] of the deaf students had otologic diseases, with 69.1% of them having wax impaction and chronic suppurative otitis media and otitis media with effusion accounting for 21.6 and 7.2% respectively. CONCLUSION: The study showed that wax impaction is a common problem and this can be quite uncomfortable for some of the students. A routine general and otologic screening program targeted at the deaf and deaf-blind is recommended.