Evaluation of Primary School Health Environment in Ido/Osi Local Government Area, Ekiti State, Nigeria.

BACKGROUND: School environment entails the sum total of the physical, biological, social, and emotional environment within which members of the school community operate. It is essential to make the school environment healthy to promote and protect the health of school pupils as well as their safety. This study aimed at finding the level of implementation of a Healthy School Environment (HSE) in Ido/Osi Local Government Area (LGA) of Ekiti State. METHODOLOGY: A cross-sectional descriptive study carried out among 48 private and 19 public primary schools using a standardised checklist and direct observation. RESULTS: The teacher-to-pupil ratio was 1:16 in public schools and 1:10 in private schools. The leading source of water in 47.8% of the schools was well water. Most, 97%, of the schools practiced open dumping of refuse. Private schools had more school buildings with strong walls and good roofs with doors and windows which provided adequate ventilation compared to the public schools (p- 0.001). No school was located close to an industrial area, however, none had a safety patrol team. Only 34.3% of schools had a fence and 31.3% had terrains prone to flooding. Only 3% of the schools, all private schools, attained the minimum acceptable score on the school environment. CONCLUSION: The status of school environment was poor in the study location and school ownership did not make any much impact as there was no difference in the situations of school environment between public and private schools.

CONTEXTE: L'environnement scolaire est l'ensemble des conditions physiques, biologiques, sociales et émotionnelles dans lesquelles évoluent les membres de la communauté scolaire. Il est essentiel de rendre l'environnement scolaire sain afin de promouvoir et de protéger la santé des élèves ainsi que leur sécurité. Cette étude visait à déterminer le niveau de mise en œuvre de l'environnement scolaire sain (HSE) dans la zone de gouvernement local (LGA) d'Ido/Osi de l'État d'Ekiti. MÉTHODOLOGIE: Une étude descriptive transversale a été menée dans 48 écoles primaires privées et 19 écoles primaires publiques à l'aide d'une liste de contrôle standardisée et d'une observation directe. RÉSULTATS: Le ratio enseignant/élèves était de 1:16 dans les écoles publiques et de 1:10 dans les écoles privées. La principale source d'eau dans 47,8 % des écoles était l'eau de puits. La plupart des écoles (97%) pratiquaient le dépôt d'ordures à l'air libre. Les écoles privées avaient plus de bâtiments scolaires avec des murs solides et de bons toits avec des portes et des fenêtres qui fournissaient une ventilation adéquate par rapport aux écoles publiques (p- 0.001). Aucune école n'était située à proximité d'une zone industrielle, mais aucune ne disposait d'une équipe de patrouille de sécurité. Seules 34,3 % des écoles disposaient d'une clôture et 31,3 % étaient situées sur des terrains inondables. Seules 3 % des écoles, toutes privées, ont atteint le score minimum acceptable en matière d'environnement scolaire. CONCLUSION: L'état de l'environnement scolaire était médiocre dans la région étudiée et la propriété de l'école n'avait pas beaucoup d'impact car il n'y avait pas de différence dans la situation de l'environnement scolaire entre les écoles publiques et les écoles privées. Mots-clés: État d'Ekiti, Environnement sain, Gouvernement Local, Nigeria, École Primaire, Environnement Scolaire.

Relationship between Serum Uric Acid and Hypertension among Secondary School Adolescents in Ekiti State, Nigeria.

BACKGROUND: With the seemingly increasing trend of childhood hypertension, high serum uric acid (SUA) levels might be an indicator of essential hypertension among adolescents. OBJECTIVE: To determine the SUA levels of hypertensive students and randomly selected controls and find the association, if any, between SUA level and blood pressure (BP) among secondary school students in Ido-Osi Local Government Area (LGA). METHODOLOGY: The study was a nested case-control study conducted among selected secondary school students in IdoOsi LGA from June 2017 to March 2018. Of the 573 students screened for hypertension, SUA was assayed from 31 hypertensive students and an equal number of age- and sexmatched controls. Serum uric acid greater than 5.5 mg/ dL was taken as high. Statistical analysis included chi-square and Pearson correlation. RESULTS: There was a positive correlation between SUA level and both systolic BP (p < 0.013) and diastolic BP (p < 0.017). The mean (SD) serum uric acid level of the hypertensive students [5.39 (2.08) mg/ dL] was higher than that of the controls [4.24 (1.81) mg/ dL] (p = 0.023). Hypertensive students with hyperuricaemia had a higher mean (SD) systolic BP than those with low uric acid: 138.67 (14.81) versus 128.68 (10.04); p =0.037. CONCLUSION: The mean serum uric acid level of students with hypertension was higher than that of the non-hypertensive students and high SUA levels appear to more prominently affect systolic than diastolic blood pressures among the cohort of hypertensive students.

CONTEXTE: Compte tenu de la tendance apparemment croissante de l'hypertension chez les enfants, des taux élevés d'acide urique sérique (AUS) pourraient être un indicateur d'hypertension essentielle chez les adolescents. OBJECTIF: Déterminer les niveaux d'acide urique sérique des élèves hypertendus et des témoins choisis au hasard et trouver l'association, le cas échéant, entre le niveau d'acide urique sérique et la tension artérielle chez les élèves du secondaire dans la zone de gouvernement local (LGA) d'Ido-Osi. MÉTHODOLOGIE: L'étude était une étude cas-témoins imbriquée menée auprès d'élèves du secondaire sélectionnés dans la zone de gouvernement local d'Ido-Osi de juin 2017 à mars 2018. Sur les 573 élèves dépistés pour l'hypertension, le SUA a été dosé chez 31 élèves hypertendus et un nombre égal de témoins appariés selon l'âge et le sexe. Un taux d'acide urique sérique supérieur à 5,5 mg/ dL a été considéré comme élevé. L'analyse statistique a porté sur le chi-carré et la corrélation de Pearson. RÉSULTATS: Il y avait une corrélation positive entre le niveau de SUA et la tension systolique (p < 0,013) et la tension diastolique (p< 0,017). Le niveau moyen (SD) d'acide urique sérique des étudiants hypertendus [5,39 (2,08) mg/ dL] était plus élevé que celui des témoins [4,24 (1,81) mg/ dL] (p = 0,023). Les étudiants hypertendus présentant une hyperuricémie avaient une TA systolique moyenne (SD) plus élevée que ceux ayant un faible taux d'acide urique : 138,67 (14,81) contre 128,68 (10,04); p =0,037. CONCLUSION: Le taux moyen d'acide urique sérique des étudiants hypertendus était plus élevé que celui des étudiants non hypertendus et les taux élevés d'acide urique sérique semblent affecter davantage la pression artérielle systolique que la pression artérielle diastolique dans la cohorte d'étudiants hypertendus. Mots-clés: Adolescents, hypertension, relation, acide urique sérique.

Clinical Utility of Procalcitonin and C-Reactive Protein in the Management of Neonatal Sepsis in a Resource-Limited Nigerian Hospital.

BACKGROUND: Neonatal sepsis is an invasive infection of the bloodstream in neonates and a leading cause of morbidity and mortality among them. AIM: To investigate the role of procalcitonin (PCT) and C-reactive protein (CRP) in the management of neonatal sepsis. MATERIALS AND METHODS: This was a prospective case-control study over one-year period using convenience sampling. Blood samples for PCT and CRP were taken from all neonates, while blood culture and white blood cell count samples were additionally taken from babies with neonatal sepsis. PCT and CRP were repeated at 24 and 48 hours. The continuous variables were found to have a nonparametric distribution. They were presented as median and interquartile range, and compared using Wilcoxon signed rank and Friedman test as appropriate. RESULTS: The blood culture analysis yielded a prevalence of 12.7% with Staphylococcus aureus being the commonest organism. Baseline concentrations of PCT (1.28 ng/ml) and CRP (17.31 mg/L) in neonates with sepsis were higher than that of controls (PCT-0.63 ng/ml, CRP-5.40 mg/L). PCT concentrations decreased after two days of antibiotic treatment, while CRP concentrations decreased after a day. The concentration of both decreased to normal levels after two days of treatment. CONCLUSION: This study showed that CRP was more reliable in monitoring antibiotic therapy, unlike other studies which suggested PCT. In cases where the management of neonatal sepsis may be limited by a low blood culture yield, therapeutic monitoring may be aided by CRP and/or PCT.

Maternal BMI at the time of birth and selected risk factors associated with severe neonatal outcomes: a secondary analysis of the WHO Better Outcomes in Labour Difficulty (BOLD) project.

The main objective of this secondary analysis was to describe the nutritional status of the Better Outcomes in Labour Difficulty (BOLD) project study population and determine possible associations between maternal nutritional status (as reflected by maternal BMI at the time of birth) and severe neonatal outcomes (SNO). We also analysed previous and index maternal pathologies to determine associations with neonatal outcomes. We used the classification designed by Atalah for maternal BMI and compared with the Hyperglycaemia and Adverse Pregnancy Outcome study one. To describe the nutritional status of this population, figures of distribution and test of normality related to weight and BMI were presented for the women and their babies. To explore the association between maternal BMI data and SNO, the χ2 test was performed. To identify a maternal characteristic or a group of characteristics that could predict SNO, we used Fisher's exact test using previous maternal pathology collected in the BOLD project as well as that in the index pregnancy. In this study, BMI at the time of birth was not associated with neonatal near miss or death. We found that previous maternal obesity, diabetes and chronic hypertension were associated with SNO. Maternal pathology in the index pregnancy such as other obstetric haemorrhage, pre-eclampsia, anaemia and gestational diabetes was associated with SNO.

Daytime Versus Night-Time Emergency Abdominal Operations: Perspective from a Low-Middle-Income Country.

BACKGROUND: Emergency abdominal operations carry significant risk of mortality and morbidity. The time of the day when such operations are performed has been suggested as a predictor of outcome. A retrospective comparison of outcomes of daytime and night-time emergency abdominal operations was conducted. METHODS: Clinical data of patients who had abdominal operations over a five-year period were obtained. Operations were classified as 'daytime' (group A) if performed between 8.00 am and 7.59 pm or 'night time' if performed between 8.00 pm and 7.59 am (group B). Post-operative outcomes were compared. RESULTS: A total of 267 emergency abdominal operations were analysed: 161 (60.3%) were performed in the daytime while 106 (39.7%) were performed at night. The case mix in both groups was similar with appendectomies, bowel resections and closure of bowel perforations accounting for the majority. Baseline characteristics and intra-operative parameters were similar except that 'daytime' operations had more consultant participation (p = 0.01). Mortality rates (13.7% in group A and 12.3% in group B, p = 0.2), re-operation rates (9.3% in group A and 10.4% in group B, p = 0.7) and duration of hospital stay (group A-11.1 days, group B-12.4 days p = 0.4) were similar. ASA status, re-operation and admission into the intensive care unit were identified as predictors of mortality. CONCLUSION: Timing of emergency abdominal operations did not influence outcomes. In resource-limited settings where access to the operating room is competitive, delaying operations till daytime may be counterproductive. Patients' clinical condition still remains the most important parameter guiding time of operation.

Development of caesarean section prediction models: secondary analysis of a prospective cohort study in two sub-Saharan African countries.

BACKGROUND: Caesarean section is recommended in situations in which vaginal birth presents a greater likelihood of adverse maternal or perinatal outcomes than normal. However, it is associated with a higher risk of complications, especially when performed without a clear medical indication. Since labour attendants have no standardised clinical method to assist in this decision, statistical tools developed based on multiple labour variables may be an alternative. The objective of this paper was to develop and evaluate the accuracy of models for caesarean section prediction using maternal and foetal characteristics collected at admission and through labour. METHOD: This is a secondary analysis of the World Health Organization's Better Outcomes in Labour Difficulty prospective cohort study in two sub-Saharan African countries. Data were collected from women admitted for labour and childbirth in 13 hospitals in Nigeria as well as Uganda between 2014 and 2015. We applied logistic regression to develop different models to predict caesarean section, based on the time when intrapartum assessment was made. To evaluate discriminatory capacity of the various models, we calculated: area under the curve, diagnostic accuracy, positive predictive value, negative predictive value, sensitivity and specificity. RESULTS: A total of 8957 pregnant women with 12.67% of caesarean births were used for model development. The model based on labour admission characteristics showed an area under the curve of 78.70%, sensitivity of 63.20%, specificity of 78.68% and accuracy of 76.62%. On the other hand, the models that applied intrapartum assessments performed better, with an area under the curve of 93.66%, sensitivity of 80.12%, specificity of 89.26% and accuracy of 88.03%. CONCLUSION: It is possible to predict the likelihood of intrapartum caesarean section with high accuracy based on labour characteristics and events. However, the accuracy of this prediction is considerably higher when based on information obtained throughout the course of labour.

Application of black walnut (Juglans nigra) husk for the removal of lead (II) ion from aqueous solution.

The biosorption characteristics of Pb (II) ions from aqueous solution using black walnut (Juglans nigra) seed husk (WSH) biomass were investigated using batch adsorption techniques. The effects of pH, contact time, initial Pb (II) ion concentration, and temperature were studied. The Langmuir, Freundlich and Temkin isotherms were used to analyze the equilibrium data. It was found that the adsorption of Pb (II) ions onto WSH was best described by the Freundlich adsorption model. Biosorption kinetics data were tested using the pseudo-first order and pseudo-second order models, and it was observed that the kinetics data fitted the pseudo-second order model. Thermodynamic parameters such as standard Gibbs free energy change (ΔG0), standard enthalpy change (ΔH0) and standard entropy change (ΔS0) were evaluated. The result showed that biosorption of Pb (II) ions onto WSH was spontaneous and endothermic in nature. The FTIR study showed that the following functional groups: O-H, C = O, C-O, C-H and N-H were involved in binding Pb (II) ions to the biomass.

Sleep quality among nurses in a tertiary hospital in North-West Nigeria.

BACKGROUND: Sleep is a necessity; it is nourishing, refreshing and healing. The nursing profession is associated with busy and difficult work schedules, especially the running of shifts which has been associated with cardiovascular and metabolic complications. There is a dearth of local data on sleep disorders, especially among nurses. In this study, we evaluated the quality of sleep and the tendency of daytime sleepiness among nurses. SUBJECTS AND METHODS: This study was cross-sectional in nature involving 100 nurses working with Federal Medical Centre Birnin Kebbi, Kebbi State; the study was carried out between October 2016 and February 2017. The Pittsburg Sleep Quality Index was used to determine poor sleepers; while the Epworth Sleepiness Scale (ESS) was adopted to determine the presence of tendency of daytime sleepiness; 0-7 was considered normal, 8-9 represented average tendency of daytime sleepiness, 10-15 represented excessive daytime sleepiness, while 16-24 represented daytime sleepiness requiring medical intervention. P < 0.05 was set as statistically significant. RESULTS: There were 23 (23%) males and 77 (77%) females, with a male-to-female ratio of 0.3:1. The age range was 18-50 years, with a mean age of 31.4 ± 8.6 years. The ESS score ranged from 0.0-17.0, with a mean score of 7.3 ± 3.5; while the Pittsburg score ranged between 1 and 15, with a mean score of 5.7 ± 2.7, and 61% of the nurses had a poor sleep quality. There was unlikely tendency of excessive sleepiness across all the age groups, though this was not statistically significant (χ2 = 7.258, P = 0.283), and poor sleep quality was most prevalent among the 25-40-year-old group but this observation was also not statistically significant (χ2 = 2.259, df = 2, P = 0.334). CONCLUSION: Poor sleep quality is a problem among nurses, though less tendency to daytime sleepiness was observed in this report.

Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding.

BACKGROUND: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. METHODS: We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. RESULTS: CWs referred 4-22% of presumptive TB clients tested, and 4-24% of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables. CONCLUSION: All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

Sublingual misoprostol to decrease blood loss after caesarean delivery: a randomised controlled trial.

The aim of the study was to compare the efficacy of sublingual misoprostol in addition to intravenous oxytocin, with oxytocin alone, in reducing blood loss during and following caesarean section. A total of 120 women undergoing caesarean delivery at the University College Hospital, Ibadan, were randomised into two equal groups. In Group A, 20 IU of intravenous oxytocin was given after umbilical cord clamping, while in Group B, the women received 400 µg misoprostol sublingually and 20 IU oxytocin intravenously. The outcome measures were blood loss, additional uterotonics, change in packed cell volume and side-effect profile. Associations between variables were determined by the χ(2) and Student's t-test. Relative risks were calculated for side-effects; the level of significance was p < 0.05. Intraoperative and postoperative blood loss were significantly lower in Group B (451.3 ml vs 551.2 ml, p = 0.007; 22.7 vs 42.2 ml, p < 0.001, respectively). In Group B, women were 7.4 (p < 0.001) and 9.0 (p = 0.008) times more likely to experience shivering and fever, respectively. The need for additional uterotonics was greater in the oxytocin group (66.7% vs 27.6%, p < 0.001). The addition of sublingual misoprostol to intravenous oxytocin reduces postpartum blood loss and the need for additional uterotonics. There is however, an increased risk of shivering and fever with this combination.

Prevalence of previously undetected tuberculosis and underlying risk factors for transmission in a prison setting in Ibadan, south-western Nigeria.

People with congregational tendencies such as the prison inmates constitute an important target group in the global efforts towards the control of tuberculosis (TB). The prison setting in most developing countries particularly Nigeria, currently does not have routine diagnostic procedures for TB despite the existing risks that could facilitate disease transmission. We conducted a cross sectional study among the inmates in a major prison in south-western Nigeria for TB by screening their sputum samples using a simple random sampling method coupled with questionnaire interview, on the assumption of sub-clinical pulmonary TB infection. The overall TB prevalence found was 1.2% (2/164). Significant risk factors that could facilitate disease transmission in the prison included lack of BCG immunization (p = 0.017); history of contact with TB patients (p = 0.020); prolonged cough (p = 0.016) and drug abuse (p = 0.019). Our findings of 1.2% undetected pulmonary TB infection among the inmates though low; still reiterate previous observation that the prison setting constitutes a veritable environment for TB transmission and a threat to public health. Efforts are therefore needed to institute routine screening and reduce the risk factors associated with TB transmission among prison inmates in Nigeria.

Polyp prevalence at colonoscopy among Nigerians: A prospective observational study.

BACKGROUND: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR). MATERIALS AND METHODS: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps. RESULTS: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2-87 years with a median of 57 years. Forty-three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty-three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty-nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010). CONCLUSION: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.

Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria.

CONTEXT: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access. AIMS: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs). SETTINGS AND DESIGN: A cross-sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS: A pretested self-administered questionnaire was used to obtain data from consenting participants. STATISTICAL ANALYSIS USED: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used. RESULTS: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape-96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31-10.01), religion (OR = 0.26; 95% CI OR = 0.11-0.630) and marital status (OR = 0.19; 95% CI = 0.07-0.56). CONCLUSION: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in-service training should focus more on EC to improve the quality of their knowledge and attitude towards it.

Supporting claustrophobic patients during magnetic resonance imaging examination- the radiographer perspective.

INTRODUCTION: Some patients cannot complete their magnetic resonance imaging (MRI) examinations because of claustrophobia. Evidence showed that supportive instruction is an effective intervention used to assist claustrophobic patients in MRI. However, the effectiveness of this intervention depends on the experience and education level of the MRI radiographer. This study aimed to understand the views of MRI radiographers on supporting claustrophobic patients and develop a guide to improve the effectiveness of the intervention. METHODS: A qualitative descriptive approach utilising focus group discussion was considered suitable. A purposive sampling method was used to enrol eligible participants into the study. The study was advertised in print newspapers and on social media platforms. There were seven MRI radiographers in the focus group discussion. The conversation was recorded and transcribed for analysis, with content analysis employed to group the data into relevant codes and categories. RESULTS: The radiographer's understanding of claustrophobia and knowledge of the interventions used to support claustrophobic patients were the key elements that influenced claustrophobic patients' experience in MRI. However, there were some factors inhibiting the radiographer's ability to support these patients. These factors include insufficient appointment slots, availability of supportive tools and support with developing communication skills. CONCLUSION: Communication and identifying anxiety signs are essential for MRI radiographers to address patient anxiety during examinations. This might increase the MRI examination completion rate and give the patient a positive experience in the department. IMPLICATIONS FOR PRACTICE: MRI radiographers can better understand how to support claustrophobic patients. Also, the guide developed from the data could help improve consistency in the use of supportive instruction in clinical practice.

Unveiling the strong positive relationship: Maternal characteristics and neonatal outcomes in the Better Outcomes in Labour Difficulty (BOLD) study - a secondary analysis validating neonatal near miss classification.

Background: The near miss concept, denoting near collisions between aircraft, originated in aeronautics, but has recently been transferred to the neonatal context as a way of evaluating the quality of health services for newborns, especially in settings with reduced child mortality. However, there is yet no consensus regarding the underlying criteria. The most common indicators used to assess health care quality include mortality (maternal and neonatal) and life-threatening conditions. Using the World Health Organization (WHO) Better Outcomes in Labour Difficulty (BOLD) prospective cohort study data set, we conducted a secondary analysis to validate the near miss concept and explore the association between maternal and neonatal outcomes. Methods: We studied 10 203 singleton mothers treated between December 2014 and November 2015 in nine Nigerian and four Ugandan hospitals. We validated the near miss concept by testing the diagnostic accuracy (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and odds ratio (OR)) using death as the reference variable and calculating the maternal and neonatal case fatality rates. We performed ordinal and binomial logistic regression, with the independent variables being those that had P < 0.1 in the univariate analyses. We considered the significance level of 5%. Results: We validated the neonatal near miss concept using the BOLD study data. We observed maternal and neonatal case fatality rates of 70.2% and 6.5%, with an increasing severity relationship between maternal and neonatal outcomes (P < 0.05). Ordinal logistic regression showed that gestational age <37 or >41 weeks and <8 antenatal consultations were related to a higher risk of neonatal severe outcomes, while maternal age between 30 and 34 years functioned as a protective factor against severe neonatal outcomes (SNO). Binomial logistic regression showed gestational age <37(OR = 1.46; 95% confidence interval (CI) = 1.07-1.94) or >41 weeks (OR = 2.26; 95% CI = 1.55-3.20), low educational level (OR = 1.76; 95% CI = 1.12-2.69), overweight/obesity (OR = 1.23; 95% CI = 1.02-1.47), one previous cesarean section (OR = 1.90; 95% CI = 1.36-2.61), one previous abortion (OR = 1.25; 95% CI = 1.00-1.56), and previous chronic condition (OR = 1.83; 95% CI = 1.37-2.41) were risk factors for SNO. Conclusions: The neonatal near miss concept could be used as a parameter for analysis in different health systems, to ensure that measuring of neonatal severity is comparable across health care units. In this analysis, we observed a progressive association between maternal severity and the severity of the newborns' outcomes.

Adulthood hirschprung's disease: a report of 4 cases in Ile-Ife. Nigeria.

BACKGROUND: Hirschsprung's disease in adulthood is very rare and is often misdiagnosed. We present four cases of adulthood Hirschsprung's disease seen in the last two decades to illustrate challenges accompanying its diagnosis and management. METHOD: This descriptive case series included cases of histologically proven Hirschsprung's seen in adulthood at the Obafemi Awolowo University Teaching Hospitals Complex in the last two decades (1991-2011). The clinical data, radiological investigations, details of surgical treatment, histological diagnosis, outcomes and complications were analyzed. RESULT: There were 4 adult patients, 3 males and 1 female with age ranging from 17 to 74 years (mean 23 years). Each patient presented with sub acute intestinal obstruction needing two staged procedures of initial colostomy followed by definitive procedure of low anterior resection (State procedure) in 3 patients and Swenson-Bill procedure in one. There was one mortality and good long term outcome in the remaining three. CONCLUSION: This review presented the oldest patient presenting with adult Hirschsprung's and the highest mean age of any case series. Four patients with adulthood Hirschsprung's disease managed by two operative procedures enabled comparison of operative outcome with respect to complications and functional outcomes. Mortality seems to correlate with presentation at old age, which is usually due to life long self-management of chronic constipation. Though very rare, a high index of suspicion of adulthood Hirschprung's disease should be maintained in adult patients with recurrent chronic constipation needing lifelong laxative, enema or mechanical wash-out.

Imatinib (Glivec) and gastrointestinal stromal tumours in Nigerians.

BACKGROUND: To assess the response and the impact on the overall survival (OS) on c-KIT-positive (CD117+) gastrointestinal stromal tumours (GISTs) patients treated with imatinib mesylate. METHODS: Between July 2003 and December 2012, consenting patients with advanced c-kit-positive GISTs were enrolled to receive imatinib mesylate therapy at a dose of 400mg - 800mg daily, supplied gratis by Novartis Pharma (Basel, Switzerland) under its GIPAP initiative. Disease severity was based on tumour site, size and mitotic index at diagnosis. Clinical features together with drug toxicity, haematological and biochemical parameters were monitored. Overall survival (OS) reviewed at 12 months intervals over 5 years was computed using Kaplan-Meier RESULTS: There were 27 patients in all (17 males and 10 females with a median age of 52 years (range 26 - 83). Twenty three patients, 15 males and 8 females that have been followed up for at least 6 months were evaluated, aged 26-83 years (median = 56). There were 17 (73.9%) gastric tumours and 6 extragastric including 3 cases of peritoneum and 1 each of small gut, colon and rectum. At diagnosis, 21 (91.3%) cases were high risk, and 1 each fell into the intermediate and low risks, respectively. Ten patients (43.4%) including 5 with metastases presented with unresectable lesions. Five patients (21.7%) had complete tumour resection, 5 (3 with metastases) had partial resections and 3 others with non-bulky, nonmetastatic diseases underwent no surgery. Imatinib was used as the primary therapy for all patients, except the 5 patients that underwent complete tumour resection. Nine (39.1%) patients were lost to disease progression with a median survival of 16.7 +/- 10.7 (+/- SE) (95% CI = 0-37.6) months. The overall survival at 2 years for all patients was 71.9%, which dropped to 65.9% at 4 years. CONCLUSIONS: Although a small number of GISTs, imatinib induced an extended remission in patients with advanced disease, most of whom would have been dead within a few months of diagnosis.

Selenium levels in neoplastic breast lesions.

AIMS AND OBJECTIVES: The aim of this prospective case controlled study was to evaluate the tissue levels of selenium in patients with cases of fibroadenoma, cancer of the breast and in the controls in order to relate them to the occurrence of breast diseases. SUBJECTS AND METHODS: Consecutive consenting patients who had histologically confirmed breast cancer and fibroadenoma attending the General surgical outpatients departments of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, were recruited for the study. One gram of core disease breast tissues was taken for Selenium level estimation. RESULTS: There were 127 female subjects;. 95 (74.8%) cases of fibroadenoma and 32 (25.2%) of breast cancer. While breast cancer was common on the left, fibroadenoma was more common on the right breast (? = 8.994; p=0.011). The median tissue level of selenium in patients with fibroadenoma was 0.0272 mg/g with a range of 0.0124 to 0.0576 mg/g and that of the cancer patients was 0.0178 mg/g with a range 0.0072 to 0.0436 mg/g. These were statistically significantly different ( p=0.001). Factors affecting tissue selenium level include age (p<0.001), overall stage of breast cancer (p<0.001), maximum length of breast mass (p=0.023), previous delivery (p=0.004), age at last confinement (p=0.007), parity (p<0.001), oestrogen receptor (ER) status (p<0.001) and progesterone receptor (PR) status (p=0.021). CONCLUSION: Tissue selenium was lower in breast cancer than in fibroadenoma; Tissue selenium inhibits carcinogenesis; low tissue level of selenium therefore may be a factor in the development of breast cancer.

Presentation, distribution pattern, and management of diverticular disease in a Nigerian tertiary hospital.

BACKGROUND: Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized societies, which have recently been described among Africans. Presentations and distribution pattern of the disease among Africans appeared to be different from that described among the Western population. We embark on this study aimed at evaluating the presentation, distribution pattern, and the management of diverticulosis in our tertiary health facility. MATERIALS AND METHODS: A prospective descriptive study of the cases of diverticular disease seen between January 2007 and December 2011 at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. RESULTS: During the 5-year study period, 40 cases were seen. The patients were aged 41-85 years with a median age of 64 years. There were 29 (72.5%) male and 11 (27.5%) female with an average male to female ratio of 3:1. The most common presentation was bleeding per rectum in 28 (70%) patients, which mostly needed transfusion. Ten (25%) patients presented with recurring abdominal pain, whereas one (2.5%) patient presented with abdominal mass and features of intestinal obstruction. Thirty patients were diagnosed on colonoscopy, eight on barium enema, and two on computerized tomography scan. Thirty-four (85%) patients had a pancolonic disease. All the patients were placed on high fiber diet and antibiotics namely ciprofloxacin and metronidazole. Five patients had recurrence within 6 months of follow up, of which one had emergency colectomy. CONCLUSION: Diverticular disease is no longer a rare disease in Nigeria. It is a common cause of lower gastrointestinal bleeding in elderly patients. High index of suspicion for diverticular disease of the colon and its complications should increase in the country.

Supporting claustrophobic patients during Magnetic Resonance Imaging examination- the patient perspective.

INTRODUCTION: Magnetic Resonance Imaging (MRI) is a common imaging modality used to diagnose disease and monitor treatment. However, some patients cannot complete their MRI examination as a result of claustrophobia. The recent developments in the MRI scanner design may have reduced the incidence of claustrophobia in MRI. This study aimed to explore the claustrophobic patients' experience to better understand how to support them. METHODS: A qualitative descriptive approach using focus groups was deemed appropriate for the study. The research was advertised in a print newspaper and on social media platforms for eligible participants to contact the researcher. Six claustrophobic patients were recruited to the focus group meeting. The discussion was audio recorded and transcribed. Content analysis was used to analyse the data into code and categories. RESULTS: Four themes emerged from the data analysis, which included examination preparation, information provision, coping mechanisms and MR scanner design. Participants reported that the confined space in the MRI scanner bore is responsible for their anxiety during MRI. However, the majority of the participants believe that they would be able to complete the examination if, in advance of their scan, they were shown the MRI scanner and what they would be required to do. CONCLUSION: Several coping mechanisms were shared by the participants on how they were able to complete their MRI examination despite their claustrophobia. MRI radiographers should endeavour to use these mechanisms to support their patients in practice. Also, the findings emphasise the importance of virtual reality and clear communication with patients in preparing them for their MRI examinations. IMPLICATIONS FOR PRACTICE: The findings of this study may be used to enhance claustrophobic patients' experience in MRI. It also identified those aspects of the MRI examination that matter most to patients with claustrophobia in order to provide a suitable intervention to support these patients.