Prevalence of Intestinal Parasitic Infections Among Pregnant Women: A Multi-Centre Survey.

BACKGROUND: Intestinal parasitic infection (IPI) is a serious public health challenge often neglected in most developing countries. Pregnant women are a high-risk population for these infections which can result in adverse pregnancy outcomes such as maternal anaemia, preterm delivery and low birth weight. OBJECTIVE OF THE STUDY: To assess the prevalence and factors associated with the risk of acquisition of intestinal parasitic infections among pregnant women attending antenatal clinics in selected public hospitals in Ibadan, South Western Nigeria. METHODS: A hospital-based cross-sectional study was carried out among 598 pregnant women attending antenatal clinics in selected public hospitals in Ibadan, South Western Nigeria. Five public hospitals were purposively selected based on their antenatal clinic client attendance before this study. Data was collected to assess sociodemographic characteristics, health-seeking behaviours, water sanitation and hygiene practices (WASH). Stool samples from each pregnant woman were examined for the presence of intestinal parasites by microscopy using the direct wet mount and Ziehl Neelsen staining technique. RESULTS: The overall prevalence of intestinal parasites was (96, 16.1%). Ascaris lumbricoides were the most prevalent parasites (68, 71.0%) followed by Enterobius vermicularis (16, 17.0%), Entamoeba histolytica (8,8.0%) and the least identified parasite was hookworm (4, 4.0%). At bivariate analysis level, level of education, maternal income and type of waste disposal system in use were significantly associated with IPI infection. Using multivariate logistic regression, the age range of 30-34 years (AOR= 0.24, CI 0.08, 0.70) and having a degree (AOR=0.21 CI 0.05-0.85) were independent predictors of IPIs. CONCLUSION: This study highlights a high prevalence of intestinal parasitic infection among pregnant women in our setting. The main predictive factors were the educational status and age of the pregnant women. There is therefore need for continuous health education to prevent intestinal parasitic infections in the at-risk population.

CONTEXTE: Les infections parasitaires intestinales (IPI) représentent un grave problème de santé publique souvent négligé dans la plupart des pays en développement. Les femmes enceintes constituent une population à haut risque pour ces infections, qui peuvent entraîner des conséquences néfastes sur la grossesse, telles que l'anémie maternelle, l'accouchement prématuré et le faible poids à la naissance. OBJECTIF DE L'ÉTUDE: Évaluer la prévalence et les facteurs associés au risque d'acquisition d'infections parasitaires intestinales chez les femmes enceintes fréquentant les cliniques prénatales dans certains hôpitaux publics d'Ibadan, dans le sud-ouest du Nigéria. MÉTHODES: Une étude transversale hospitalière a été menée auprès de 598 femmes enceintes fréquentant les cliniques prénatales dans certains hôpitaux publics d'Ibadan, dans le sud-ouest du Nigéria. Cinq hôpitaux publics ont été sélectionnés de manière ciblée en fonction de la fréquentation de leur clinique prénatale avant cette étude. Des données ont été recueillies pour évaluer les caractéristiques sociodémographiques, les comportements de recherche de soins, l'assainissement de l'eau et les pratiques d'hygiène (WASH). Les échantillons de selles de chaque femme enceinte ont été examinés à la recherche de parasites intestinaux par microscopie, en utilisant la méthode du montage humide direct et la technique de coloration de Ziehl-Neelsen. RÉSULTATS: La prévalence globale des parasites intestinaux était de 96 (16,1 %). Les Ascaris lumbricoides étaient les parasites les plus prévalents (68, 71,0 %), suivis par les Enterobius vermicularis (16, 17,0 %), les Entamoeba histolytica (8, 8,0 %) et les Ankylostomes (4, 4,0 %). Au niveau de l'analyse bivariée, le niveau d'éducation, le revenu maternel et le type de système d'élimination des déchets utilisé étaient significativement associés aux infections parasitaires intestinales. Selon la régression logistique multivariée, la tranche d'âge de 30 à 34 ans (AOR = 0,24, CI 0,08, 0,70) et le fait d'avoir un diplôme (AOR = 0,21, CI 0,05-0,85) étaient des prédicteurs indépendants des IPI. CONCLUSION: Cette étude met en évidence une prévalence élevée d'infections parasitaires intestinales chez les femmes enceintes dans notre contexte. Les principaux facteurs prédictifs étaient le statut éducatif et l'âge des femmes enceintes. Il est donc nécessaire de poursuivre l'éducation sanitaire pour prévenir les infections parasitaires intestinales dans la population à risque. MOTS CLÉS: Femmes enceintes, infections parasitaires intestinales, hôpital public, Ibadan.

The relationship between food insecurity, purchasing patterns and perceptions of the food environment in urban slums in Ibadan, Nigeria.

BACKGROUND: Rapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria. METHODS: This community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants' perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment. RESULTS: The prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently. CONCLUSION: Food insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers.

Haematological parameter among drug resistant tuberculosis patients in Ibadan.

Background: Haematological abnormalities are common among tuberculosis patients but there is dearth of information on their value as prognostic markers in Multidrug resistant tuberculosis patients. This study examined the association between complete blood count variables and drug resistant tuberculosis. Materials and methods: Nighty (90) consenting adults comprising 30 Drug Resistant Tuberculosis patients (DR-TB), 30 Drug susceptible tuberculosis patients (DS-TB) and 30 healthy participants were recruited in this study. Ethical approval was obtained from Oyo State Ministry of Health Institutional Review Board while patients' demographic data were collected using structured questionnaire. Five milliliters (5mL) of blood samples were collected in EDTA bottle. Haematological parameters were analysed using impedance technique and Mindary-BG5380 5-part automated system. Result: The mean hemoglobin levels were significantly lower in DR-TB patients (11.70 ± 2.73 g/dL) than in DS-TB patients (8.33 ± 9.56 fL), with a mean difference of -3.37 ± 12.29 g/dL. The mean MCH and MCHC levels were also slightly lower in DR-TB patients (26.17 ± 3.44 pg and 30.41 ± 1.92 g/dL, respectively), but the differences were not statistically significant. The WBC count was similar in both groups (8.20 ± 3.80 × 10^9 /L and 8.45 ± 3.63 × 10^9 /L, respectively). Conclusion: The mean hemoglobin levels were significantly lower in DR-TB patients than in DS-TB patients which may be due to the increased inflammation associated with DR-TB. The WBC count was similar in both groups, suggesting that the immune system is responding similarly to the infection in both DR-TB and DS-TB patients. Recommendation: In the meantime, healthcare providers should be aware of these potential differences and use them to inform their diagnosis and treatment of patients with tuberculosis.

Clinical students' perception of educational environment in a Nigerian university: a mixed method study.

BACKGROUND: Learning environment (LE) research has been given priority in higher education institutions globally because of its influence on learning processes and outcomes. Although studies reporting the perceptions of health science students about LE in Nigeria are available, none have compared the perceptions of students from different health professions. Therefore, this study aimed to assess final-year clinical students' perceptions of their LE from four programs (dentistry, medicine, nursing, and physiotherapy) and compared their LE perceptions. METHODS: This study adopted a cross-sectional study design using a mixed method approach. The quantitative survey involved all the final-year clinical students at the University of Ibadan, and they completed the Dundee Ready Education Environment Measure (DREEM) questionnaire. The qualitative aspect involved 24 consenting students in four focus group discussions. RESULTS: A total of 214 out of 223 copies of the DREEM questionnaire were duly completed and returned, yielding 96.0% response rate. The participants' mean age was 24 ± 2.3 years (ranged between 22 and 25 years, p = 0.001). The mean DREEM scores of the students from the four programs ranged between 119.68 ± 18.02 and 147.65 ± 15.89 out of a maximum of 200, interpreted as more positive than negative perceptions of LE. Physiotherapy students' DREEM score was significantly higher than those of medical, dental, and nursing students (p < 0.001). The DREEM scores of other students did not differ significantly (p > 0.05). Dental and medical students had similar positive perceptions. The qualitative aspect revealed that the students had positive perceptions of their teachers' knowledge base and self-acquisition of knowledge but negative perceptions of their teachers' communication skills, infrastructural facilities, lecturer-student relationships, and hostel accommodations. CONCLUSION: Although the survey indicated that these clinical students had more positive than negative perceptions of their learning environment, the qualitative aspect of the study revealed many challenges that the students were confronted with. The clinical students' perception of their learning environment could be improved if the university authorities would address these challenges.

QUALITY OF PRESCRIPTIONS RECEIVED BY PATIENTS WITH HYPERTENSION ATTENDING A SECONDARY HEALTH FACILITY IN IBADAN, OYO STATE.

Background: High-quality prescription (HQP) which is a key player in optimal blood pressure control reflects good prescribing process and thus quality health care. Aims: To determine quality of prescription and its correlates in patients with hypertension attending a secondary health facility in Ibadan, Nigeria. Methodology: A cross-sectional hospital-based study among 347 known hypertensive patients attending the Medical Outpatient clinic of Jericho Specialist hospital, Ibadan. Quality of prescription was determined using prescription quality index (PQI) tool and it was categorized into high, medium and low-quality prescriptions. The respondents were recruited using a simple random sampling technique (computer generated random number). Data was analyzed using SPSS version 2020. Mean, standard deviation, Chi-square and Spearman correlation were used for data analysis and level of significant was set at <0.05. Results: The mean (PQI) was 31.4±5.6; less than half of the patients 163 (47.3%) had low PQI, while medium and high PQI was found in 41(11.8%) and 143 (41.2%) patients respectively. There was a significant difference in the quality of prescriptions between male and female hypertensive patients (χ2=15.85, p-value<0.0001). Two-thirds of the patients, 229(66.0%) experienced associated health problems and this was significantly inversely correlated with prescription quality (r=-0.33, p<0.001). Conclusion: The study revealed marginally low quality of prescription, statistically significant poor-quality prescription among the male patients and higher number of comorbidities significantly correlated negatively with prescribing quality. Thus, to comply with high quality prescriptions, combined medications among hypertensive patients with comorbidities should be used cautiously.

The family dynamics of children on the streets of Ibadan, Southwest Nigeria.

BACKGROUND:  Children roaming the streets estimated at 1 in 10 by a 2021 United Nation Children's Funds (UNICEF) report is a growing problem, in cities of lower- and middle-income African countries. Studies of street children with no family ties abound, but there is a paucity of studies on children on the street who exist within families and return home daily. We explored the family dynamics of children on the streets of Ibadan, emphasising family structure, resources and relationships. METHODS:  Using an exploratory design based on a qualitative approach 53 participants were interviewed, including children on the streets, parental figures, child-welfare officers and street shop owners. Participants were selected from streets in the five urban local government areas of Ibadan, Nigeria. Recorded data were transcribed, and framework analysis was performed. RESULTS:  The family dynamics included family structural problems, poor family resources and poor parent-child relationships. The family structural problems included: broken homes, large families and ambivalence around polygamy as subthemes. Family resources comprised: poor economic resources, poor social resources, educational challenges, cultural ambivalence and spiritual backdrops. The family relationships patterns included: poor adaptability, economic-oriented partnership, poor growth support, poor emotional connection and poor family bonding. CONCLUSION:  The dynamics driving a family's choice for child streetism in Ibadan, mostly to hawk, are devaluation of family life, parenting irresponsibility, and poor filial relationship, underscored by economic constraints and socio-cultural decadence. The results of this research buttress the need for family-level interventions to forestall the escalating phenomenon of child streetism in Ibadan, Nigeria.Contribution: This research highlights the family dynamics of children on the streets, and buttresses family-level interventions are necessary to forestall escalating child-streetism in Ibadan, Nigeria.

A STUDY OF SKIN SEPSIS AMONGST ABATTOIR WORKERS IN MONIYA, IBADAN, OYO STATE, NIGERIA.

Background: Skin sepsis is a pyodermal infection caused by Lancefield's group streptococci and Staphylococcus aureus . It is characterized by discolored and mottled skin, cellulitis, impetigo and multi-systemic collagen muscularitis and can be transmitted from person to person. Objective: This study sampled the skin of consented abattoir workers in Moniya Ibadan, for clinical sepsis, with a view to establishing a causal relationship between the infection obtained and the abattoir workers examined. Methodology: A total of 100 meat handlers' hands and forearms were examined. Swabs were taken from lesions which appeared clinically to be infected and then propagated on selective culture media designed for staphylococci and streptococci. Conventional biochemical tests and Lancefield determination were carried out as considered appropriate. Results: Of the 100 swabs from the categories of abattoir workers examined, 43 streptococci (35 from lesion 8 from wound) and 36 Staphylococcus aureus (20 from lesion and16 from wound) were obtained. The regression analysis from the grouping of gender, causative agents and specific infection as a predictor of infection were recorded to be significant (b = 0.18; t = 1.74; p < 0.05) for the nature of but non-significant (b = -0.067; t = -0.649; p > 0.05) for the gender.In-vitro antigen antibody reaction on StreptexM kit elicited varied reactions to Lancefield's serological grouping (A (56%), B (9%) C (7%) G (22%) and L (7%). Resistance of Staphylococcus aureus in varying percentages (Tetracycline and gentamicin 62%, meropenem and ceftriaxone 100%, amikacin, 10%, and vancomycin 80%) to conventional antibiotics were observed. Conclusion: From this study point of view, the causal relationship between the infection and the infected has been established, from the pathogens of pyodermal origin contacted from cows, that causes sepsis across all the category of abattoir workers studied. There is a need to provide an ideal functioning abattoir fully equipped with required facilities for safety and ease of execution of duties.

Surgical residents as "second victims" following exposure to medical errors in a tertiary health training facility in Nigeria: a phenomenology study.

INTRODUCTION: The "second victim" phenomenon refers to the distress and other negative consequences that physicians experience when they commit medical error. There has been increasing awareness about this phenomenon and efforts are being made to address it. However, there is dearth of information about it in developing countries. This study explored the experiences of surgical resident doctors of the University College Hospital in Ibadan, Nigeria about the "second victim" phenomenon and the support they had following medical errors. METHODS: This is a phenomenology study in which qualitative data were obtained from interviews with 31 resident doctors across 10 surgical units/departments. Interviews were transcribed verbatim, and data were coded inductively. Data were analyzed using content analysis method. Themes and subthemes were generated using axial coding. The themes were then integrated using selective coding. RESULTS: There were 31 participants and 10(32.3%) were females. All had witnessed other physicians encountering medical errors while 28(90.3%) had been directly involved in medical errors. Most of the errors were at the inter-operative stage. Prolonged work hours with inadequate sleep were identified as major causes of most medical errors. The feelings following medical errors were all negative and was described as 'stressful'. Most of the residents got support from their colleagues, mostly contemporaries following medical errors, and many viewed medical errors as a learning point to improve their practice. However, there was a general belief that the systemic support following medical errors was inadequate. CONCLUSION: The "second victim" phenomenon was common among the study group with consequent negative effects. Normalizing discussions about medical errors, reduction of work hours and meticulous intraoperative guidance may reduce medical errors and its consequences on the surgical residents. Steps should be taken within the system to address this issue effectively.

Immunohistochemical Profiling of HER-2/neu, Steroid Hormone Receptors and KI-67 Biomarkers in A Cohort of Nigerian Women with Breast Cancer.

Background: Progressive improvement in the accuracy of profiling of hormone receptors in breast cancer provides the basis for targeted endocrine therapy, a major pillar of multimodal breast cancer treatment. However, the disparity in findings from comparatively smaller sample-sized studies in West Africa has led to somewhat conflicting conclusions and recommendations. Objectives: This study investigates the immunohistochemical (IHC) profile of breast cancer specimens for estrogen receptor (ER), progesterone receptor (PR), human epidermal receptor-2 (HER2)/neu, and Ki-67 in a tertiary hospital in Ibadan, Nigeria over 12 years. Materials and Methods: We reviewed 998 IHC reports, documented clinicopathologic parameters, computed patterns of biomarkers, and stratified them based on the American Society of Clinical Oncology/College of American Pathologists recommendations. Descriptive analysis including frequency, mean, and median were generated from the data extracted. Results: Out of the 998 cases, 975 (97.7%) were females and 23 (2.3%) were males. The mean age was 48.84 ± 11.99 years. Open biopsies were the most common types of specimens (320, 41.6%): lumpectomy and incisional biopsy of ulcerated, fungating or unresectable tumours. In those cases, 246 (32.0%) were samples of breast-conserving or ablative surgical extirpation (mastectomy/wide local excision/quadrantectomy), and 203 (26.4%) were obtained by core needle biopsies. Invasive ductal carcinoma was the most common histopathological type (673, 94.5%). The majority of graded tumours were intermediate grade (444, 53.5%). Four hundred and sixty-nine (48.4%) were ER positive, 414 (42.8%) were PR positive, and 180 (19.4%) were HER2/neu positive. Three hundred and thirty-four (34.0%) were triple-negative. Eighty-nine cases had Ki-67 staining done, and of these 61 (68.5%) had positive nuclear staining. Conclusion: Steroid hormone receptors and HER-2/neu proportions in our cohort are likely to be more representative than the widely varied figures hitherto reported in the sub-region. We advocate routine IHC analysis of breast cancer samples as a guide to personalized endocrine therapy.

Sugar-sweetened beverage consumption among pregnant women attending general and teaching hospitals in Ibadan, Nigeria : SSB consumption during pregnancy.

BACKGROUND: Sugar-sweetened beverages (SSBs) have become a global health concern because of their adverse health effects and their association with the obesity pandemic. It has not received much attention in sub-Saharan Africa, including Nigeria, especially among pregnant women. The pattern, frequency and factors associated with SSBs among pregnant women in Ibadan, Nigeria, were investigated. DESIGN: Data were from the Ibadan Pregnancy Cohort Study - a prospective cohort study investigating 1745 pregnant women from four comprehensive obstetric facilities in Ibadan. A qualitative food frequency questionnaire (FFQ) was used to assess the pregnant women's intake of food and drinks over the previous months. Sugar-sweetened beverage variable and scores were also generated using the principal component analysis with varimax rotation. Factors associated with high SSB scores were examined using multivariate logistics regression analyses at a 5% significance level. RESULTS: The most commonly consumed SSBs were cocoa-sweetened beverages, soft drinks, malt drinks, and fruit juice. A quarter of the women (75th percentile) consumed SSB more than once weekly. The factors associated with high SSB on multivariate analysis were; being employed (AOR: 1.52, 95% CI 1.02-2.26), maternal obesity (AOR: 0.065, 95% CI 0.47-0.89), high fruit intake (AOR:3.62, 95% CI 2.62-4.99), high green vegetable consumption (AOR:1.99, 95% CI 1.06-3.74), high milk intake (AOR: 2.13, 95% CI 1.65- 2.74), frequent fast food outlet visit (AOR: 2.19, 95% CI 1.53-1.70), all of these remained significant after adjusting for confounding variables. CONCLUSION: SSBs were common among our study population. Factors associated with high SSBs intake are crucial for implementing locally relevant public health interventions.

Socio-economic predictors of uptake of malaria interventions among pregnant women and mothers of under 5 children in Oyo State, Nigeria: a cross-sectional study.

Introduction: socio-economic status (SES), especially for women, influence access to care. This study aimed to determine the relationship between SES and uptake of malaria intervention by pregnant women and non-pregnant mothers of children under 5 years old in Ibadan, Oyo state, Nigeria. Methods: this cross-sectional study was conducted at Adeoyo teaching hospital located in Ibadan, Nigeria. The hospital-based study population included consenting mothers. Data were collected using an interviewer-administered modified validated demographic health survey questionnaire. The statistical analysis involved both descriptive (mean, count, frequency) and inferential statistics (Chi-square, logistic regression). Level of statistical significance was set at 0.05. Results: mean age of the study´s total of 1373 respondents was 29 years (SD: 5.2). Of these, 60% (818) were pregnant. The non-pregnant mothers of children under five years old showed a significantly increased odds (OR: 7.55, 95% CI: 3.81, 14.93) for the uptake of malaria intervention. Within the low SES category, women aged 35 years and above were significantly less likely to utilize malaria intervention (OR=0.08; 95% CI: 0.01-0.46; p=0.005) compared to those younger. In the middle SES, women who have one or two children were 3.51 times more likely than women with three or more children to utilize malaria intervention (OR=3.51; 95% CI: 1.67-7.37; p=0.001). Conclusion: the findings provide evidence that age, maternal grouping, and parity within the SES category can significantly impact on uptake of malaria interventions. There is a need for strategies to boost the SES of women because they play significant roles in the wellbeing of members of the home.

Accuracy of Whole Blood Cardiac Troponin I in the Diagnosis of Childhood Heart Failure at the University College Hospital, Ibadan.

OBJECTIVE: To determine the accuracy of cardiac troponin I (cTnI), a marker of myocardial cell injury or necrosis, in correctly identifying heart failure in children. PATIENTS, MATERIALS, AND METHODS: This was a crosssectional study in which 45 children aged 12 years or below admitted into the paediatric wards of the University College Hospital, Ibadan, who, on evaluation with the Ibadan Childhood Heart Failure Index (ICHFI) had a score of ≥ 3, were consecutively recruited. Forty-five age- and sex-matched apparently healthy children with ICHFI score of <3 were similarly evaluated as controls. Demographic, clinical data and cTnI values were documented. Statistical analysis was done using IBM SPSS version 23. RESULTS: There was a strong positive correlation (0.592) between the whole blood cTnI values and ICHFI scores (rs = 0.592, P = 0.000). At a cut-off value of 0.07ng/ml, the whole blood cTnI had a sensitivity of 26.7%, specificity of 97.8%, a positive predictive value of 92.8% and a negative predictive value of 57.1%. The receiver operating characteristic curve plotted had an AUC of 0.800 at the 95% CI, 0.704 - 0.896; P < 0.001. CONCLUSION: Whole blood cTnI level is elevated in children in heart failure and may predict severity of the condition. Whole blood cTnI was found to be an accurate tool for the exclusion of heart failure in children and is therefore recommended for use in children with suspected heart failure for its rapid diagnosis.

OBJECTIF: Déterminer la précision de la troponine cardiaque I (cTnI), un marqueur de lésion ou de nécrose des cellules myocardiques, dans l'identification correcte de l'insuffisance cardiaque chez les enfants. PATIENTS, MATÉRIEL ET MÉTHODE: Il s'agit d'une étude transversale dans laquelle 45 enfants âgés de 12 ans ou moins admis dans les services pédiatriques de University College Hospital, Ibadan, qui, après évaluation avec Ibadan Childhood Heart Failure Index (ICHFI), avaient un score ≥ 3, ont été recrutés consécutivement. Quarante-cinq enfants apparemment sains, appariés selon l'âge et le sexe, avec un score ICHFI de <3 ont été évalués de la même manière en tant que témoins. Les données démographiques, cliniques et les valeurs de cTnI ont été documentées. L'analyse statistique a été réalisée à l'aide d'IBM SPSS version 23. RÉSULTATS: Il existe une forte corrélation positive (0,592) entre les valeurs de cTnI dans le sang total et les scores ICHFI (rs = 0,592, P = 0,000). À une valeur seuil de 0,07 ng/ml, le cTnI du sang total avait une sensibilité de 26,7 %, une spécificité de 97,8 %, une valeur prédictive positive de 92,8 % et une valeur prédictive négative de 57,1 %. La courbe caractéristique du récepteur tracée avait une AUC de 0,800 à l'IC de 95 %, 0,704 - 0,896 ; P < 0,001. CONCLUSION: Le taux de cTnI dans le sang total est élevé chez les enfants souffrant d'insuffisance cardiaque et peut prédire la gravité de la maladie. Le taux de cTnI dans le sang total s'est avéré être un outil précis pour l'exclusion de l'insuffisance cardiaque chez les enfants et il est donc recommandé de l'utiliser chez les enfants suspectés d'insuffisance cardiaque pour un diagnostic rapide de l'insuffisance cardiaque. Mots clés: Troponine cardiaque I, Insuffisance cardiaque chez l'Enfant, Ibadan.

Unraveling the source(s) and fate of Pb in urban soils and sediments of Ibadan metropolis using lead isotopes.

In this study an attempt was made to determine the source(s) and nature of Pb in environmental media of Ibadan, one of the largest cities in west Nigeria. Seventy-three samples comprising forty stream sediments, twenty-five soils and eight rocks samples were used for the study. Mineralogical compositions of the samples were determined by X-ray diffraction. The elemental constituents were determined using ICP-MS; while the Pb isotopes were determined using Sector-field ICP-MS. Sequential analysis of selected samples was carried out using a modified Tessier's five-step method. The dominant minerals identified were quartz, kaolinite, k-feldspar, and plagioclase. The concentrations (mg/kg) of Pb in soils, sediments, and rocks ranged from 13.00-470.00; 89.00-3288.00 and 2.90-20.30, respectively. The 204Pb, 206Pb, 207Pb, 208Pb ranged from 1.72-47.41; 30.69-779.68; 27.00-664.46 and 65.67-1642.27 in the soils and sediments, respectively, while they ranged from 0.02-0.07; 0.56-2.33; 0.38-1.56 and 1.19-4.13 in the rocks. Further evaluation of Pb concentration in the soils and sediments revealed high to extreme Pb pollution status, while the calculated Pb isotopic ratios (IRs) in the soil and sediments varied from that of the underlying bedrocks. The IRS in soils and sediments were characterized by low (1.161-1.172 and 1.127-1.200, and 2.281-2.444 and 2.276-2.474) 206/207 Pb and 208/207 Pb, while those of the rocks were high (1.456-1.753 and 2.647-3.149), indicating additional anthropogenic sourcing of Pb in the soils and sediments. The analyzed Pb revealed fractions more partitioned in the reactive geochemical phases with the Pb partitioned in the exchangeable (0.11-0.23%), carbonate (9.00-43.58%), reducible (8.32-13.53%) and organic/sulfides (42.78-82.45%) phases. This implies that there may be enhanced mobility of Pb in the environmental samples and ultimately bio-adsorption into living tissues in the environment.

Geo-Demographic and Socioeconomic Determinants of Diagnosed Hypertension among Urban Dwellers in Ibadan, Nigeria: A Community-based Study.

Background: The relationship between diagnosed high blood pressure (HBP) and proximity to health facilities and noise sources is poorly understood. We investigated the relationship between proximity to noise sources, sociodemographic and economic factors, and diagnosed HBP in Ibadan, Nigeria. Methods: We investigated 13,531 adults from the African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study in Ibadan. Using a Geographic Information System (GIS), the locations of healthcare facilities, pharmaceutical shops, bus stops, churches, and mosques were buffered at 100m intervals, and coordinates of persons diagnosed with HBP were overlaid on the buffered features. The number of persons with diagnosed HBP living at every 100m interval was estimated. Gender, occupation, marital status, educational status, type of housing, age, and income were used as predictor variables. Analysis was conducted using Spearman rank correlation and binary logistic regression at p<0.05. Results: There was a significant inverse relationship between the number of persons diagnosed with HBP and distance from pharmaceutical shops (r=-0.818), churches (r=-0.818), mosques (r=-0.893) and major roads (r=-0.667). The odds of diagnosed HBP were higher among the unemployed (AOR=1.58, 95% CI: 1.11-2.24), currently married (AOR=1.45, CI: 1.11-1.89), and previously married (1.75, CI: 1.29-2.38). The odds of diagnosed HBP increased with educational level and age group. Conclusion: Proximity to noise sources, being unemployed and educational level were associated with diagnosed HBP. Reduction in noise generation, transmission, and exposure could reduce the burden of hypertension in urban settings.

PREDICTORS OF ACUTE HEART FAILURE OUTCOMES AT UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA.

Background: Studies of acute heart failure (AHF) outcomes suggest that there are different predictors of mortality depending on region, ethnicity, and gender. Objective: The purpose of this study was to identify predictors of six months' post discharge outcome among AHF patients in a Nigerian tertiary hospital. Methods and Materials: This study was a prospective observational study conducted at the cardiology unit of the Department of Medicine at the University College Hospital Ibadan. One hundred and sixty AHF participants ≥ 18 years old were recruited. Results: The mean age of the cohort was 58.0±15.1 years and most were males (59.4%). The independent predictors for death outcome after six months of discharge for AHF and the adjusted hazard ratio) (95% CI) were male gender 2.77 (1.17 -6.56); p =0.020 ; systolic blood pressure (mmHg) 0.98 (0.96 - 0.99); p = 0.011 ; and the presence of hepatomegaly 2.58 (1.02 - 6.51); p = 0.045 . Independent predictors for readmission or rehospitalization within 6 months after discharge were presence of right abdominal pain adjusted HR (95% CI): 2.07(1.14 - 3.76), p=0.017; SBP 0.98(0.96 - 0.99), p=0.005. Independent predictors for composite endpoint were male gender: adjusted HR: 2.08 (1.16 - 3.72), p= 0.014 and pericardial effusion and tamponade: 5.31(1.79 - 15.74), p=0.003 . Conclusion: The study provided an insight into the factors contributing to outcomes six-month after admission in a tertiary centre in South-Western Nigeria, and it highlighted the predictive role of systolic blood pressure.

Management Outcome of Adult Thyroglossal Duct Cyst in a General Surgery Tertiary Practice in Sub-Saharan Africa, Nigeria.

Thyroglossal duct cyst (TDC) is a rare condition in adults. This is a report of its presentation and standard treatment with good outcome in adults in a Sub-Saharan tertiary hospital. It is a retrospective review of five adult patients who were managed over a five-year period culled from archived records and casenotes. The three males and two females have a median age of 35 years and a range of 15-74 years. Each of them presented with anterior neck masses while one, in addition, had a painful swelling with a discharging sinus. The median duration of the symptoms was 4.5 years. Four of the cysts were in the infrahyoid location and all the patients had a Sistrunk operation. The median duration of follow-up was six months, without complications. Surgeons need to have a high level of suspicion for this condition in adults.

Indoor bacterial and fungal aerosols as predictors of lower respiratory tract infections among under-five children in Ibadan, Nigeria.

BACKGROUND: This study aimed to investigate the association between exposure to diverse indoor microbial aerosols and lower respiratory tract infections (LRTI) among children aged 1 to 59 months in Ibadan, Nigeria. METHODS: One hundred and seventy-eight (178) hospital-based LRTI cases among under-five children were matched for age (± 3 months), sex and geographical location with 180 community-based controls (under-five children without LRTI). Following consent from caregivers of eligible participants, a child's health questionnaire, clinical proforma and standardized home-walkthrough checklist were used to collect data. Participant homes were visited and sampled for indoor microbial exposures using active sampling approach by Anderson sampler. Indoor microbial count (IMC), total bacterial count (TBC), and total fungal count (TFC) were estimated and dichotomized into high (> median) and low (≤ median) exposures. Alpha diversity measures including richness (R), Shannon (H) and Simpson (D) indices were also estimated. Conditional logistic regression models were used to test association between exposure to indoor microbial aerosols and LRTI risk among under-five children. RESULTS: Significantly higher bacterial and fungal diversities were found in homes of cases (R = 3.00; H = 1.04; D = 2.67 and R = 2.56; H = 0.82; D = 2.33) than homes of controls (R = 2.00; H = 0.64; D = 1.80 and R = 1.89; H = 0.55; D = 1.88) p < 0.001, respectively. In the multivariate models, higher categories of exposure to IMC (aOR = 2.67, 95% CI 1.44-4.97), TBC (aOR = 2.51, 95% CI 1.36-4.65), TFC (aOR = 2.75, 95% CI 1.54-4.89), bacterial diversity (aOR = 1.87, 95% CI 1.08-3.24) and fungal diversity (aOR = 3.00, 95% CI 1.55-5.79) were independently associated with LRTI risk among under-five children. CONCLUSIONS: This study suggests an increased risk of LRTI when children under the age of five years are exposed to high levels of indoor microbial aerosols.

Stated preferences for human papillomavirus vaccination for adolescents in selected communities in Ibadan, Southwest Nigeria: A discrete choice experiment.

Administration of the human papillomavirus (HPV) vaccine in early adolescence is effective in preventing cervical cancer, a common cancer in sub-Saharan Africa. Nigeria is in the pre-introduction era of the HPV vaccine. Understanding the preferences of the population for the vaccine can help design the HPV immunization program to ensure high uptake of the vaccine. This study explored the preferences for the HPV vaccine among stakeholders in selected communities in Ibadan, Nigeria. A discrete choice experiment survey based on six attributes of the HPV vaccine (which were the number of doses, the efficacy of the vaccine, cost of the vaccine, location of the service point, other benefits of the vaccine apart from prevention of cervical cancer and the odds of a side effect from the vaccine) was carried out in five communities. Data were analyzed using conditional and mixed logit models. Seven hundred community members were recruited, 144 (20.7%) were adolescents and 248 (35.4%) were males. In line with expectations, respondents preferred vaccines with higher efficacy, less severe side effects and lower costs. Preference heterogeneity was identified for adolescents that were less price-sensitive and other community members who were less likely to prefer using schools as the service point. The high socioeconomic class preferred a vaccine that also prevents genital warts. There were variabilities in the preferences for the attributes of the HPV vaccine in the study communities. These variabilities need to be considered in the introduction of the HPV vaccine to ensure high uptake of the vaccine.

Utilizing the Robson 10-Group Classification System as an Audit Tool in Assessing the Soaring Caesarean Section Rates in Ibadan, Nigeria.

Background: The caesarean section (CS) is the most common operation performed globally with increased incidence worldwide. Aim and Objectives: Using the Robson 10-Group Classification System (RTGCS), we aimed to identify women who were the main contributors to the high CS rate (CSR) over a 3-year period at a foremost tertiary health facility. Settings: This study was conducted at the Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria. Materials and Methods: This study is a retrospective study of all women who delivered by CS at the University College Hospital, Ibadan, Nigeria from January 2017 to December 2019. Data were obtained using a structured proforma and women were categorized according to the RTGCS. Data were analysed using SPSS version 21. Descriptive statistics (frequency, percentage, mean) carried out were presented in tables. Results: The CSR was 46.9%. Women in Group 5 (parous women >37 weeks with previous CS and a single foetus in cephalic presentation), Group 1 (nulliparous women >37 weeks with a single foetus in cephalic presentation and spontaneous labour), and Group 10 (women <37 weeks with a single foetus in cephalic presentation) were major contributors to the CSR, with 30.9%, 17.7%, and 13.7%, respectively. Stillbirth rates were highest in Groups 10 (30.3%), 3 (24.4%), and 8 (16.8%). Apgar score <7 at the 5th minute was highest in Groups 5 (29.7%), 10 (17%), and 1 (16.6%). Conclusion: In a bid to reduce caesarean deliveries, efforts should focus on increasing the proportion of vaginal deliveries in these identified groups, especially in women with a history of one CS.

Non-carcinogenic and carcinogenic health risks associated with heavy metals and polycyclic aromatic hydrocarbons in well-water samples from an automobile junk market in Ibadan, SW-Nigeria.

Unserviceable vehicles imported from developed countries are often dismantled in automobile junk markets and the useable parts sold. This generates hazardous waste oils which contain contaminants detrimental to the environment and human health. In this study, we quantified the potential human health risks associated with oral and dermal exposure to heavy metals and PAHs in well-water samples from a major automobile junk market in Ibadan, SW-Nigeria. Twenty-four to thirty-one water samples from seven wells within the market were analyzed for seven metals and eight PAHs using standard methods. Hazard-Quotient (HQ), Hazard-Index (HI), and Carcinogenic-Risk (CR) were computed for children and adults based on the USEPA Human-Health Risk Assessment model. Iron, Lead, Arsenic, Cadmium, Benzo(a)Anthracene, and Benzo(a)Pyrene exceeded regulatory limits. In children and adults, lead (1.14-3.71), cadmium (1.26-2.60) and arsenic (1.03-4.33) had HQingestion values exceeding 1. In addition, cadmium also posed risks via the dermal route in children in two of the seven sampled wells with an HQ of 1.76. Hazard Index was >1 via both routes in children (HIingestion:- 5.04-10.07; HIdermal:- 1.12-2.12) but only via ingestion in adults (HI ingestion:- 2.36-4.85). Well-3 samples posed the greatest non-carcinogenic risks via ingestion with HI values of 10.07 (children) and 4.85 (adults) respectively. Cadmium, arsenic, lead, and chromium could also elicit carcinogenic risk, with CR values of 1.00E - 02, 1.95E - 03, 1.11E - 04, and 3.30E - 04 which exceeded the 10-4 limit indicating high risk, particularly in children. However, HQ and HI values for PAHs were <1 via both pathways suggesting no non-carcinogenic risk from PAH exposure. Carcinogenic risk estimates for Benzo(a)Anthracene (9.66E - 04) and Benzo(a)Pyrene (2.31E - 04) suggest moderate risks in exposed children via the dermal route. Adverse health effects including cancer may occur in the exposed population on prolonged usage of these polluted water sources. Urgent remediation measures are therefore necessary to protect the exposed population.