Changing Patterns of Unmet Needs for Family Planning Among Women of Reproductive Age in Nigeria.

Unplanned pregnancy poses a major public health challenge to women of reproductive age in Nigeria and this has been hastened by poor use of modern family planning methods. This study employed secondary data analysis of the National HIV/AIDS and Reproductive Health Survey conducted in 2007 and 2012 to explore the the pattern of unmet needs for family planning and associated factors over the five year period. The total unmet needs were 9.1% in 2007 and increased to 11.4% in 2012. Identified predictors were locality, fear of side effects and geopolitical zones in both the 2007 and 2012 surveys though with some variations. The level of family planning use among married couples is still very low in Nigeria and there was a rise in the unmet need for family planning among women of reproductive age group over the 5 year period. Regional specific interventions as well as provider-client discussions about family planning can be key to sustained use of modern contraceptives in Nigerian women.

An appraisal of convergence failures in the application of logistic regression model in published manuscripts.

BACKGROUND: Logistic regression model is widely used in health research for description and predictive purposes. Unfortunately, most researchers are sometimes not aware that the underlying principles of the techniques have failed when the algorithm for maximum likelihood does not converge. Young researchers particularly postgraduate students may not know why separation problem whether quasi or complete occurs, how to identify it and how to fix it. OBJECTIVE: This study was designed to critically evaluate convergence issues in articles that employed logistic regression analysis published in an African Journal of Medicine and medical sciences between 2004 and 2013. METHODS: Problems of quasi or complete separation were described and were illustrated with the National Demographic and Health Survey dataset. A critical evaluation of articles that employed logistic regression was conducted. RESULTS: A total of 581 articles was reviewed, of which 40 (6.9%) used binary logistic regression. Twenty-four (60.0%) stated the use of logistic regression model in the methodology while none of the articles assessed model fit. Only 3 (12.5%) properly described the procedures. Of the 40 that used the logistic regression model, the problem of convergence occurred in 6 (15.0%) of the articles. CONCLUSION: Logistic regression tends to be poorly reported in studies published between 2004 and 2013. Our findings showed that the procedure may not be well understood by researchers since very few described the process in their reports and may be totally unaware of the problem of convergence or how to deal with it.

Are patients with primary hepatocellular carcinoma infectious of hepatitis B, C and D viruses?

Primary HepatoCellular Carcinoma (PHCC) has been strongly associated with HBV and HCV infections among other aetiological factors. However; do the patients still spread the viruses? This study involved forty one Nigerian adult patients with PHCC and 45 controls who were tested for HBsAg, HBeAg, Anti-HBe, Anti-HBs, anti-HCV IgM and IgG, anti-HDV and HDV antigen using ELISA. Statistical analysis was carried out with the student - t - test and Mc Nemar test at p < 0.05. The subjects consisted of male:female ratio of 3:1 for both the PHCC patients and controls. Evidence of exposure to hepatitis B, C and D viruses was detected in 95.1%, 44% and 0% of the patients respectively while the respective values of 24%, 11.1% and 0% were obtained for the controls. Indication for high (HBeAg) and low (anti HBe) HBV viral replication, and acute HBV infection were detected in 12.5%, 92.7% and 2.2% respectively among the patients while only 35.6% of the controls had low HBV viral replication. Acute and chronic infections of HCV were also found in 26.8% and 24.4% of the patients respectively compared to the respective values of 2.2% and 11.1% of the controls. Occult HBV infection occurred in equal proportions (11%) of both the patients (31.7%) and controls (35.6%). In conclusion, infectious HBV and HCV particles are present among Nigerian patients with PHCC while HDV infection is uncommon. Hence, safe medical care should be practised for all patients with PHCC while relatives should be screened for these viruses.

Early deaths and other challenges to childhood cancer survival in Ibadan, Nigeria.

OBJECTIVES: To determine the frequency of early deaths and the associated risk factors in children suffering from cancer at the University College Hospital, Ibadan. DESIGN: A retrospective study involving review of case notes of children suffering from cancer. SETTING: Department of Paediatrics, University College Hospital, Ibadan, Nigeria. SUBJECTS: All cases of childhood cancer managed in the Department between January 1998 and December 2004. Inclusion criteria were histological or cytological confirmation of diagnosis, suggestive clinical features and availability of details about the course of the illness. MAIN OUTCOME MEASURES: Interval between diagnosis and death, rate of early death (death within 30 days of diagnosis) and risk factors for early death. RESULTS: Eighty eight cases of childhood cancer were seen out of whom 52 died during the period. Four cases with incomplete data were excluded from subsequent statistical analysis. There were 29 (34.5%) early deaths defined as death within 30 days of diagnosis. The odds of early death were increased in the presence of bilateral kidney involvement, masses in the liver, splenic masses, pulmonary metastasis and stage D of Burkitt lymphoma. Logistic regression analysis revealed that pulmonary metastasis was a significant independent predictor ofearly death. CONCLUSIONS: Early childhood cancer mortality rate is high. Early diagnosis and referral for appropriate care may reduce childhood cancer mortality in Nigeria.

Causes of death in childhood cancer at the Department of Paediatrics, University College Hospital, Ibadan.

There is a dearth of information on the mortality of children with cancer in Nigeria but the few available reports suggest a poor outcome. The objectives of this study were to determine the underlying and immediate causes of death from childhood cancer. The mortality summary cards of all cases of childhood cancer seen at the Department of Paediatrics, University College Hospital, Ibadan between January 1998 and December 2004 were reviewed. Eighty-eight cases of childhood cancer were seen, out of whom 52 (59.1%) died, but only the 48 deaths with complete data were analyzed. These deaths comprised of 37 males and 11 females giving a male:female ratio of 3.4:1. Their ages ranged from 1 to 13 years with a mean of 7.3 +/- 3.4 years. The majority (71.4%) of all patients presented with diffuse or metastatic disease at diagnosis and this was associated with increased risk of dying. Of the 48 cases reviewed, 39 (81.3%) died without any remission of the primary tumour including 5 (10.4%) with disease progression despite treatment and 15 (31.3%) who died before treatment; only 4 cases (8.3%) died from tumour relapse. The immediate causes of death were infections (39.6%), bone marrow suppression (29.2%), treatment-related mortality (27.1%), organ failure (22.9%), bleeding (16.7%) and other metabolic causes (8.3%). Potentially reversible factors such as infections, bone marrow suppression and treatment-related events are the commonest causes of death from childhood cancer in Ibadan. Therefore, early presentation, prompt identification and effective management of these problems may reduce childhood cancer mortality in Nigeria.

Risk factors for cancer of the cervix.

BACKGROUND: Cancer of the cervix is the second most common cancer among women worldwide and the leading cancer in Nigeria. OBJECTIVE: This study examined the risk factors associated with cancer of the cervix as seen in patients presenting to a tertiary hospital with gynaecologic conditions. STUDY DESIGN: The case control study design was used with a retrospective review of records of randomly selected cases of cancers of the cervix from the cancer registry and appropriate controls among hospital patients. RESULTS: Binary logistic regression carried out on the data revealed that contraceptive method (OR = 3.38, 95% CI = 1.75, 6.51) number of children (OR = 1.27, 95% CI = 1.09, 1.47), and age (OR = 1.07, 95% CI = 1.05, 1.10) were the significant risk factors out of all the potential risk factors that were assessed. CONCLUSION: These findings provide a useful insight into the general pattern of risk associated with cancer of the cervix in our environment.

Validity and internal consistency of a Yoruba version of the Ibadan knee/hip osteoathritis outcome measure (Yoruba IKHOAM).

The Ibadan Knee Hip osteoarthritis Outcome measure (IKHOAM) was developed for patients with Knee/Hip Osteoarthritis in the Nigerian and similar environments. The Yoruba Version was developed to encourage its use in the Southwestern region of Nigeria. The IKHOAM was translated into Yoruba in four separate processes of translation, back translation, committee review and pre-testing. It was administered to a cohort of 164 outpatients with symptomatic OA of the knee and or Hip who attended physiotherapy units in selected hospitals from Southwestern region of Nigeria. The IKHOAM (English Version) was correlated with the Yoruba version and Visual analogue scale (VAS). The Validity of the Yoruba IKHOAM was found to be satisfactory and comparable to the original version (r = 0.67, p = 0.005) for the criterion-related validity and r = -0.31 (p = 0.005) for construct validity. The items in the Yoruba IKHOAM correlated well with each other with Cronbach's alpha coefficient ranging between 0.69 and 0.99. The correlation on the different parts of the Yoruba IKHOAM was satisfactory (alpha = 0.52-0.87). The Yoruba IKHOAM like the original version is a reliable consistent and valid instrument that can be considered for use in the Nigeria environment for evidence based quality healthcare promotion in Knee/Hip OA patients.

Self medication practices among workers in a tertiary hospital in Nigeria.

Studies in most developing countries revealed (70-95%) of illnesses are treated through self medication. Poor accessibility to medical services have been associated with this practice. This study determines the pattern of self medication among workers at the University College Hospital, Ibadan, Nigeria. In a cross sectional study, workers were selected using a stratified random sampling technique. A high proportion of workers (73%) reported the practice of self medication and 95.6% of them correctly use appropriate drugs. About 80% of these workers stock their drugs at home. Also, 80.4% procure their drugs in chemist shops. A higher proportion of workers directly involved with medical care services (90.9%) practice self medication compared to those involved with non-medical care services (62.9%), P < 0.01. Also, the higher the education of workers the more is the proportion that practice self medication. (P < 0.05). Self-medication is commonly practiced among the hospital population who have relatively easy access to medical care services. Thus self medication may be a real health option.

Demographic factors in HIV infected patients seen at UCH, Ibadan, Nigeria.

There is a rising rate of Human Immunodeficiency Virus (HIV) infection in Nigeria. Good knowledge of the demographic characteristics of the patients with HIV/AIDS may be of great importance in understanding its epidemiology in Nigeria and could facilitate efforts at curtailing the spread of the infection. The study was planned to determine the demographic factors in Nigerian patients with HIV infection. The study was conducted at the University College Hospital (U.C.H), Ibadan, located in the South West of Nigeria. It was a retrospective study of patients with HIV infection attending the U.C.H. from 1988 to 2002. The data collected from the clinical records of the patients with HIV infection included age, sex, marital status, number of spouses, tribe, occupation, education and their religious affiliation. A total of 460 patients aged 1-76 years with peak at 30-34 years were studied. The male/female ratio was 1.06 and the males were the older group. Traders accounted for 40% with female preponderance while the artisans (19.9%) and the military (2.9%) were mostly males. The patients were of Yoruba (70.6%), Igbo (20.0%) and Hausa (9.1%) races. Among the patients with marital status, majority (71.4%) were married while those separated and widowed accounted for 3.5% and 2.6% respectively. Also, a higher proportion of the female HIV patients were Christians whereas the majority of the males were of Islamic religion. Although, there was a low frequency of records on education, the males had better formal education. In conclusion, the study shows that HIV infection is presently an adult disease affecting the most productive segment of the Nigerian population regardless of the individual occupation, educational status, tribe and religious affiliation. Also, it shows that the infection could be associated with heterosexual intercourse.

Reproductive potential after an ectopic pregnancy.

OBJECTIVE: To measure statistically how soon pregnancy can occur after an ectopic pregnancy (EP) so as to determine the cumulative pregnancy rate and the risk factors involved in nonpregnancy. DESIGN: The risk of not getting pregnant after an EP (survivorship) was estimated for 120 patients followed up for up to 60 months using the actuarial life-table technique. The risk factors involved in nonpregnancy, abortions, or live births were analyzed, using Cox regression models. SETTING: King Khalid University Hospital, Riyadh, Saudi Arabia. RESULTS: There were 68 pregnancies over the study period, with a conception rate of 56.7%. Using the actuarial life table, the cumulative probability of not achieving pregnancy in a patient decreased sharply during the first 12 months, followed by a gradual decrease up to 48 months. The Cox regression analysis showed a correlation between pregnancy and two variables, namely, age and history of prior EP. The chances of a pregnancy resulting in abortion or live birth also correlated with the presence of prior infertility, pelvic inflammatory disease (PID), or postoperative complications. CONCLUSION: Age and prior EP are important determinants in pregnancy rates after an EP. Similarly, history of PID, infertility, and postoperative complications are important risk factors in whether the pregnancy goes to term or ends in abortion.

PIP: The study group consisted of 120 patients who were surgically managed for ectopic pregnancy (EP) at the King Khalid University Hospital over a 5-year period (1987-1991), and who were followed up for periods ranging from 12 to 60 months. There were 68 pregnancies recorded over the 5-year follow-up period, a conception rate of 56.7%. However, only 75% of these pregnancies resulted in live births, another 22.1% ended in abortions, whereas 2 (2.9%) were repeat EPs. The ages of the patients ranged from 18 to 41 years. 46 patients had history of 1, 2, or 3 abortions before their EP; 10 of them had history of previous EP. Infertility of 1 year's duration was managed in 27 patients and history of pelvic inflammatory disease (PID) was present in 12 patients. Life table analysis of the 120 patients showed that at the end of 12 months after EP, the patient had a 57.15% chance of not getting pregnant, and at the end of 48 months, a 21.45% nonpregnancy rate would have been reached. The Cox proportional hazard analysis result identified only age and previous EP as being statistically significant prognostic factors of pregnancy after EP. The younger the patients, the shorter the duration it took to get pregnant. Similarly, those with no history of EP before the current one had a greater chance of getting pregnant even after the current EP. The Cox linear regression analysis revealed that women who had postoperative complications were at an 8-fold risk of the next pregnancy resulting in abortion, whereas the risk was more than 8-fold if the patient had a history of PID. The risk of a pregnancy not resulting in live birth after an EP operation was almost 2-fold in women with postoperative complications; 5-fold in women with previous history of infertility; and 7-fold in women with history of PID.

Oral contraceptive marketing in Ibadan, Nigeria.

The demographic transition in Nigeria is gradually moving towards the second stage. There is clear evidence of a declining mortality but the fertility rate remains exceptionally high. A realistic approach towards reducing fertility rate is the use of oral contraceptive. This study assesses the distribution system of oral contraceptive in Ibadan, the second largest city in Nigeria. The findings revealed that the people are aware of modern oral contraceptives as they purchase them freely at chemist shops. But effective distribution is hampered by existing channels and high costs. A local source recommended is the proprietary medicine stores, often at convenient locations to the potential users of contraceptives. The current cost which is between $1.3 and $19.5 per couple-years of protection is exorbitant, consuming 0.5-7.8% of the gross annual income of the average individual. Therefore, the government should subsidize the prices of oral contraceptives, to facilitate freedom from the tyranny of excessive fertility.

Long-waiting outpatients: target audience for health education.

The study examines the meaning of waiting time in an outpatient department. Attention is payed to the activities of the patients and companions during the waiting time, the potential for health education programmes during the waiting time and the form such a health education programme should take. The setting was the King Khalid University Hospital Outpatient Department, Riyadh, Saudi Arabia. The study sample was selected by a systematic random sample approach of one in every 10 patients or companions visiting the clinic in a period of 2 weeks. The results showed an average waiting time of 148 min with a standard deviation of 11 min. Patients currently engage in reading, sleeping or talking during long waiting time. However, they showed a preference for health education programmes for specific diseases such as heart disease, diabetes mellitus and bowel diseases during the waiting time. Leaflets were favoured to be the most preferred mode for disseminating such information. A sizeable proportion of patients also wanted religious programmes included. We conclude that education programmes for preferred specific health topics at outpatient clinic services would be of potential benefit to patients' overall health.

Effect of feeding different carbohydrates to rats on low protein diets.

The experimental results to be presented here do not demonstrate any significance among the means of the values obtained for the various carbohydrate diets, except for lactose. The results will suggest that the differences between the values for lactose and other diets are significant (PL0.05).No definite trend in the biological value (BV), the net protein utilization (NPU), and the true digestibility (TD) which can be attributed to the influence of the carbohydrates are shown by these results. The various dietary manipulations produce no results significantly different than the values for starch, the exception being lactose. The values for lactose are more than for other sugars.However, the results will show a relationship between a mixture of protein in the diet with the values of the individual protein sources if determined separately. Evidently, the values of each protein in any mixture can be predicted by measuring its TD in the mixture.

Attitudes and opinions of medical staff towards computers.

The attitudes and opinions of 120 medical staff and 22 medical students towards the use of computers in medicine were assessed through a self-administered questionnaire. More than 60% of the respondents have never used computers. Age, sex, nationality and employment status correlate with computer usage. Students, interns, residents and consultants above 50 years of age have poor attitudes towards computers. This category of respondents believe that computers are important but not essential for medical practice. A higher proportion of those who showed positive attitudes to computers had no prior formal training in computer usage. However, they expressed their desire to attend computer training programs. There is a great need to emphasize automation in the undergraduate and postgraduate medical training to cope with improved technology in the practice of medicine. In fact about 90% of the respondents in this study demanded that computer training and applications be introduced in the medicine curriculum either at undergraduate, postgraduate or both levels.

Sickness absenteeism in a Nigerian teaching hospital.

The sickness absence records of employees in a University Teaching Hospital in Nigeria were examined over a period of three years. The health records of the hospital workers showed a preponderance of junior and intermediate workers. An overall proportion of absentee workers was 15.8% with an average of 3 spells of sickness per year per absentee while the duration of sickness per absentee was 5.6 days per year. The younger employees less than 35 years of age and those with short duration of employment with the hospital have significantly higher spells and duration of sickness absence than others. While a lower spell of sickness and duration of sickness absence were observed among nurses, senior employees especially doctors had no records of sickness absenteeism in any of the 3 years of study.

The rate of sickness absenteeism among employees at King Khalid University Hospital, Riyadh, Saudi Arabia.

Sickness absence records were reviewed for all employees of King Khalid University Hospital, Riyadh, Saudi Arabia over a 3 year period from 1989 to 1991. The result showed a sickness absence rate of 7.7% with an average of 0.24 spells of sickness and duration of 1.24 days per absentee per year. The biological characteristics of the absentees showed no differentials in the spell rate of sickness, but nurses and junior workers had higher duration of sickness absence than other categories of workers. Acute respiratory and upper tract infections, sore throat, chickenpox, septicaemia, and diseases of the musculoskeletal system (mainly back pain) were the leading conditions resulting in absenteeism. This study revealed the need to improve the sickness absence records of the hospital to make it a valuable source of information for the management.

A retrospective study of factors affecting breast feeding practices in a rural community of Saudi Arabia.

This study was conducted during 1987-1988 academic year in the rural areas of Tihama Saudi Arabia to assess the average duration of breast feeding and the effect of some factors. A multi-way analysis of variance approach was used to examine the effect of mother's age, parity and education on the duration of breast feeding. The mean duration of breast feeding was 11.2 months +/- and the results of the regression analysis shows all the three maternal variables, age, parity and education to have statistically significant independent effect on the duration of breast feeding. The results showed that 98.3% support breast feeding and 78.9% of the sample were illiterates. These findings are discussed in relation to previous work.

PIP: During 1987-1988, paramedical personnel interviewed 923 women who have attend the primary health care center in the Tiahama Valleys in mountainous southwestern Saudi Arabia to learn how long women breast feed and what factors affect its duration. 78.9% of the women were illiterate as compared to 50% for the total rural population of mothers in Saudi Arabia. 90% had 1 child. 98.35% believed in the importance of breast feeding, yet only 50.7% breast fed their infants. 47.3% mixed fed and 2% bottle fed their infants. 35% began solid foods (cereals, rice, eggs, and vegetables) when the child was 6 months old. Age of the mother had a statistically significant positive effect on the duration of breast feeding (p.05). Indeed mothers 25 years old were more likely to breast feed for 6 months than their older counterparts. Nevertheless these women did have an average duration of breast feeding of 9.3 months whereas the older mothers breast fed an average of 11 months. Parity also significantly affected duration of breast feeding in a positive manner (p.01). For example, 33% of grand multiparous mothers did not breast feed for 6 months compared to 66% of the primigravidas. Education had a significant negative effect (p.01). In fact, 68% of mothers with university level education breast fed for 6 months or less. The average duration of breast feeding stood at 11.2 months (median, 10 months; mode, 12 months) while the average of all rural areas in Saudi Arabia in 1988 stood at 14.2 months. Completion of weaning occurred on average at 11.7 months. Mothers who only bottle fed did so for an average of 11.4 months. These results indicate a need for health care teams to promote breast feeding in this area.

Haematoma block in reduction of distal radial fractures.

A total of 35 patients who presented in the Accident and Emergency Department of University College Hospital with displaced distal radial fracture between January 2000 and March 2001 had reduction of the fracture under haematoma block using 10ml of 2% lignocaine. There was significant reduction of the pain following infiltration of the fracture site with lignocaine and significant pain reduction during manipulation compared to pain score at presentation. All the patients had satisfactory reduction of the fracture. The fracture was mobilised in Plaster of Paris 6 weeks in patients with Collens' fracture and 3 weeks in patients with distal radial epiphyseal injury. All patients had good range of movement at 8 weeks after removal of Plaster of Paris and patients expressed satisfaction with this method. We recommend the use of Haematoma block for patients of 15 years and above with displaced distal radial fracture in the Accident and Emergency Department.

Psychiatric morbidity in a Nigerian general out-patient clinic.

In a cross-sectional study of a systematic random sample of new patients attending the clinic of the G.O.P.D. of the University College Hospital, Ibadan, using the PSE, the CES-D and clinical evaluation, at least 40% of 104 subjects were found to have sufficient symptoms of psychic distress to warrant treatment. There was statistically significant association between the measures for psychiatric caseness. Among those rated as psychiatric cases on clinical evaluation, neurosis was the predominant diagnosis. Symptoms of depression were commonly admitted to by these subjects. At review of case notes one year later, the initial diagnoses for those referred to the psychiatric clinic were sustained. In view of the commoness of psychiatric symptoms in general practice, it is suggested that undergraduate psychiatric posting duration be increased; residency training in general practice and internal medicine should include a period of posting in psychiatry; and national health care planning should pay a greater attention to mental health care than is at present the case.

The bacteriology of open fractures in Ile-Ife, Nigeria.

BACKGROUND: The objective of this study is to determine the pattern of bacterial isolates and antibiotic sensitivity profile in open fractures. Fifty-nine patients with open fractures of the lower limb long bones were studied. The majority of the cases were Gustilo and Anderson types II 21(35.6%), and IIIA 16(27.1%). METHOD: The patients were assessed by history taking, physical examination, and plain radiographs. Wound swabs were taken for bacteriological studies. Other necessary investigations were also done. During wound debridement open fractures were classified into Grades I, II and III using the Gustilo-Anderson method of classification. RESULTS: The infection rate was 45.8%. Gram-positive cocci and Gram-negative rods were isolated. On the whole Staphylococcus aureus 13(25%), and Coagulase-negative staphylococci (CONS) 14(26.9%), were the commonest organisms isolated. The commonest Gram-negative rods that were isolated from the wounds were Proteus mirabilis 9(17.3%), and Pseudomonas aeruginosa 8(15.4%). Multiple organisms were commonly isolated from the wounds. While all the organisms isolated showed very good sensitivity to gentamicin, cloxacillin and ofloxacin, most of the organisms were resistant to penicillin, ampicillin and tetracycline. The sensitivity ranged from 62.5% to 100%. Coagulase-negative Staphylococci (CONS) showed sensitivity to the widest range of antibiotics which included penicillin, ampicillin, chloramphenicol, gentamicin, cloxacillin and ofloxacin. The sensitivity ranged from 35.7% to 100%. There was statistically significant difference between the open tibial and femoral fracture cases with respect to the interval between injury and debridement time (p = 0.008); the rate of wound infection (p = 0.021); and the occurrence of osteomyelitis (p = 0.023). The commonest complications observed were wound infection 27(45.8%), and delayed fracture union 26(44.1%), which were commoner in the open tibial fractures. CONCLUSION: This study shows that Staphylococcus aureus and coagulase-negative staphylococci (CONS) were the commonest organisms associated with open fracture of the lower limbs in our centre and that delay in the initial wound debridement was a major predisposing factor to wound infection.