Five-year analysis of clinical presentations and predictors of stroke mortality in rural Southwestern Nigeria: A retrospective observational study.

INTRODUCTION: Stroke mortality and its predictors are important outcome measures in stroke epidemiological studies and clinical trials. There is an observed paucity of data regarding the clinical presentations and predictors of stroke mortality in Southwestern Nigeria. Few available related studies have centred on hospitals in the urban and sub-urban areas; however, none in the rural settings. This study, therefore, focuses on the clinical presentations and predictors of stroke mortality at the adult Emergency Centre of a tertiary hospital situated in rural Southwestern Nigeria. METHODS: A retrospective survey, using data form and standardized questionnaire, was used to study the patients admitted for stroke between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. RESULTS: A total of 276 patients were studied. Their mean age was 67.3 ± 11.1 years. The most common clinical presentations were hemiparesis and cranial nerve deficit. The case of fatality was 10.1%. The predictors of stroke mortality were age ≥65 years [(AOR = 12.752; 95% CI: (1.022-159.190), p = 0.048)], Glascow coma score <8 [(AOR = 50.348; 95% CI: (7.779-325.866), p < 0.001)], uncontrolled blood pressure [(AOR = 23.321; 95% CI: (2.449-221.927), p = 0.006)], presence of atrial fibrillation [(AOR = 16.456; 95% CI: (2.169-169.336), p = 0.009)], convulsion [(AOR = 25.889; 95% CI: (2.374-282.296), p = 0.008)], heart failure [(AOR = 30.284; 95% CI: (3.265-256.347), p < 0.001)], and a repeat stroke [(AOR = 32.617; 95% CI: (2.410-441.381), p = 0.009)]. CONCLUSION: The 7-day fatality was 10.1%. The predictors of stroke mortality were poor Glascow coma score, uncontrolled blood pressure, atrial fibrillation, heart failure, convulsion and a repeat stroke. This study strengthens the argument on the higher prevalence of stroke and its mortality in rural Southwestern Nigeria. Our findings may provide an impetus for prospective research on this outcome.

Pattern of Surgical Emergencies in Rural Southwestern Nigeria.

Introduction: Considering the magnitude of deaths prevailing in the accident and emergency department (AED) in health facilities of sub-Sahara Africa, there is a need to have information on the burden of admissions and deaths due to surgical emergencies. Few studies in Nigerian hospitals in urban and suburban areas have been documented, but none in the rural setting. The objectives of this study were to ascertain the sociodemographic profile, causes and outcomes of admissions, and the pattern and causes of deaths due to surgical emergencies. Methods: A retrospective survey using a data form and a predetermined questionnaire was used to review the patients admitted for surgical emergencies at the AED of a tertiary hospital in rural southwestern Nigeria from January 2015 to December 2019. The data were analyzed using SPSS version 22.0. The results were presented in descriptive and tabular formats. Results: Surgical emergencies constituted 43.9% of all admissions. The mean age of admissions was 42 ± 16.9 years, and majorities were in the young and middle-aged groups. There were more males (66.4%) than females (33.6%). Trauma(60.9%) of which road traffic accident (RTAs)(56.0%), was the leading mechanism of trauma. The mortality rate was 5.4% and was caused majorly by RTAs (33.0%), diabetes mellitus foot ulcers (11.0%), and malignancies (9.8%). Conclusion: In this study, surgical emergencies constituted 43.9%, and a majority of the patients were male. Trauma caused by RTA is the most cause of admission. The mortality rate was 5.4%. This finding may provide an impetus for prospective research on this outcome.

Community-acquired pneumonia and its predictors of mortality in rural southwestern Nigeria: A-five year retrospective observational study.

Introduction: The predictors of community-acquired pneumonia (CAP) mortality are important outcome measures in epidemiological studies and clinical trials. There is an observed paucity of data regarding the predictors of mortality of CAP in Nigeria. Few studies from the urban centres have been reported in the literature, with none from the rural centres. The objective of this study is to ascertain the clinical presentations, risk factors, and predictors of mortality among patients admitted for CAP in rural Southwestern Nigeria. Methods: A retrospective observational study using a data form and a standardised questionnaire reviewed the 176 patients admitted to Southwestern Nigeria hospital between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results: A total of 176 patients were studied. Their mean age was 53.3±16.8 years. There were more males, 112 (63.6%), than females. The most common clinical presentations were cough, fever and sputum expectoration. The case fatality rate was 9.1% and its predictors were older aged patients [Adjusted Odds Ration (AOR), 4.135: 95% Confidence Interval (CI) (1.389-12.315); p =0.005], hypoxia [AOR, 11.118: 95% CI (2.607-47.405); p<0.001], tobacco smoking [AOR, 3.632: 95% CI (1.459-9.039); p=0.008], chronic obstructive pulmonary disease (COPD) [AOR, 10.111: 95%CI (2.370-43.139); p <0.001], and human immunodeficiency virus (HIV) [AOR, 9.444: 95% CI (4.304-20.725), p<0.001]. Conclusion: The case -fatality rate was 9.1%, and its predictors were older age patients, patients with hypoxia, tobacco smoking, COPD, and HIV. This study strengthens the argument on the higher prevalence of CAP and its mortality in rural Southwestern Nigeria. The findings may provide an impetus for prospective research on these outcomes.

Malaria infection and its association with socio-demographics, preventive measures, and co-morbid ailments among adult febrile patients in rural Southwestern Nigeria: A cross-sectional study.

Objectives: The study determined the prevalence of malaria infection and its association with socio-demographics, environmental, housing, and co-morbid ailment factors. Methods: The study was a cross-sectional of 330 consented adult febrile patients who were recruited at a tertiary health facility in rural Southwestern Nigeria. The standardized interviewer-administered questionnaire sought information on their socio-demographics, environmental, housing, and co-morbid ailment factors. Venous blood samples were collected and processed for malaria parasite detection, retroviral screening, glycated hemoglobin, and hemoglobinopathy. Data were analyzed using SPSS version 20. The strength of the association between independent and dependent variables was measured using odds ratio and 95% confidence interval with a significant level (p value <0.05). Results: The prevalence of malaria parasitemia was 63.3% (95% confidence interval: 57.9%-68.5%). Being a farmer (p = 0.002), lack of formal education (p = 0.043), low-income earners (p = 0.031), presence of bushes (p = 0.048), stagnant water (p = 0.042), not sleeping under long-lasting insecticide-treated nets (p < 0.001), and sickle cell disease (p = 0.041) were significantly associated with malaria infection. Conclusion: The study revealed that there is a high prevalence of malaria infection in rural Southwestern Nigeria. There may be a need to pay greater attention to adult populations in rural areas for malaria intervention and control programs.

Physicians utilisation of internet medical databases at the tertiary health institutions in Osun State, south west, Nigeria.

OBJECTIVES: To determine the extent, purpose, determinants and the impact of the utilization of Internet medical databases among the respondents. METHODOLOGY: A descriptive cross sectional survey of 540 randomly selected physicians at the two tertiary health institutions in Osun State, south west, Nigeria. RESULT: A total of 444 (82.2%) physicians completed the questionnaires. All the respondents have used the internet medical databases within the last 4 weeks of the study. Majority, (53.8%) used the internet resources at least once in 2 weeks, while 12.2% used the resources every day. The online resources are mainly sought for Routine patient care and for Research purposes. pubmed (70.3%), hinari (69.0%), and Free medical journals (60.1%) are the frequently used online databases/digital archives. The internet resources has positively impacted the Clinical practice (40.0%) and Research output (65.5%) of the physicians. CONCLUSION: There had been considerable increase in the extent and quality of utilization of online medical databases which has positively impacted on the Clinical practice and Research output of the physicians. Ease of finding the needed information and the availability of evidence based resources are the major determinants of the databases utilized.

Effect of malaria preventive education on the use of long-lasting insecticidal nets among pregnant females in a Teaching Hospital in Osun state, south-west Nigeria.

BACKGROUND: Malaria in pregnancy is a major public health problem in Nigeria. Long-Lasting Insecticidal Nets (LLINs) have been advocated as an effective tool against malaria transmission. However, success of this intervention largely depends on the knowledge and practices regarding malaria and its prevention. Unfortunately, few studies have been done on effect of malaria preventive education on use of LLIN in pregnancy. OBJECTIVE: To assess the knowledge of malaria and determine the effect of malaria preventive education on the use of LLINs among pregnant females in a Teaching Hospital in Osun state. METHOD: It was a one group pre-test post-test quasi - experimental hospital based study involving pregnant females attending Ante-Natal Clinic (ANC) of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). A total of 200 respondents were recruited for this study by 2-stage sampling technique. Data was collected using a pretested questionnaire to elicit information on socio-demographic characteristics, use of LLIN in pregnancy, knowledge of malaria and its preventive measures. The data collected was analysed using descriptive and inferential statistics. The descriptive statistics comprised frequency, percentage, means and standard deviations. Bivariate analysis comprised Chi-square test on knowledge of malaria before and after intervention while correlation test assessed strength of relationship between knowledge of malaria preventive education and use of LLINs before and after intervention. Multivariate analysis determined the predictors of LLINs use. Analytical statistics of cross tabulation was conducted considering a p < 0.05 to be statistically significant. RESULTS: There was an increase in the scores of knowledge on malaria transmission after the intervention and this was statistically significant (χ2 = 8.862, p < 0.01). Similarly, the scores of knowledge on malaria prevention increased after the intervention and this was statistically significant (χ2 = 10.023, p < 0.01). Respondents' age, marital status and gravidity were predictors of LLINs use. Biserial correlation showed a statistically positive relationship between knowledge of malaria preventive education and use of LLINs after intervention (r = 0.036, p < 0.01). CONCLUSION: The use of malaria preventive education was found to be effective in increasing the use of LLIN in this study. These findings highlight a need for educational intervention in implementation of LLINs. There is therefore a need to strengthen the policy of malaria prevention education as an integral component with distribution of free LLIN in health care setting to enhance its utilization.

Awareness and Practice of Self Breast Examination among Female Nurses at the Federal Teaching Hospital Ido-Ekiti, Nigeria.

Breast cancer is the most common female malignancy linked with high levels of morbidity and mortality in developing countries due to delayed diagnosis. This research assessed the knowledge of signs and risk factors of breast cancer and practice of self breast examination (SBE) among female nurses in a rural tertiary Hospital. Eighty-five nurses ages 20 to 60 years were sampled by simple randomization over a period of eight weeks through a self-administered semi-structured questionnaire. The analysis was done using statistical package for social science version 17. Sixteen (15.3%) nurses had adequate knowledge of breast cancer, having a relative with breast cancer (51.8%) and a woman of any age (56.5%) were recognized by majority as risk factors for breast cancer. Majority (68.2%) were not practicing monthly SBE and not confident on how to do it. This study pointed out the gaps in the knowledge and awareness of breast cancer and practice of SBE among the nurses. Opportunity should therefore be sought in various health facilities to educate nurses who are supposed to be closer to the patients.