Re-telling the story of aminoglycoside ototoxicity: tales from sub-Saharan Africa.

Background: Aminoglycosides, such as Streptomycin, are cheap, potent antibiotics widely used Sub-Saharan Africa. However, aminoglycosides are the commonest cause of ototoxicity. The limited prospective epidemiological studies on aminoglycoside ototoxicity from Sub-Saharan Africa motivated this study to provide epidemiological information on Streptomycin-induced ototoxicity, identify risk factors and predictors of ototoxicity. Method: A longitudinal study of 153 adults receiving Streptomycin-based anti-tuberculous drugs was done. All participants underwent extended frequency audiometry and had normal hearing thresholds at baseline. Hearing thresholds were assessed weekly for 2 months, then monthly for the subsequent 6 months. Ototoxicity was determined using the ASHA criteria. Descriptive statistics were used to analyze socio-demographic variables. Ototoxicity incidence rate was calculated, and Kaplan-Meier estimate used to determine cumulative probability of ototoxicity. Chi-square test was done to determine parameters associated with ototoxicity and Cox regression models were used to choose the predictors of ototoxicity. Results: Age of participants was 41.43 ± 12.66 years, with a male-to-female ratio of 1:0.6. Ototoxicity was found in 34.6% of the participants, giving an incidence of 17.26 per 1,000-person-week. The mean onset time to ototoxicity was 28.0 ± 0.47 weeks. By 28th week, risk of developing ototoxicity for respondents below 40 years of age was 0.29, and for those above 40 years was 0.77. At the end of the follow-up period, the overall probability of developing ototoxicity in the study population was 0.74. A significant difference in onset of ototoxicity was found between the age groups: the longest onset was seen in <40 years, followed by 40-49 years, and shortest onset in ≥50 years. Hazard of ototoxicity was significantly higher in participants aged ≥50 years compared to participants aged ≤40 years (HR = 3.76, 95% CI = 1.84-7.65). The probability of ototoxicity at 40 g, 60 g and 80 g cumulative dose of Streptomycin was 0.08, 0.43 and 2.34, respectively. Age and cumulative dose were significant predictors of ototoxicity. Conclusion: The mean onset time to Streptomycin-induced ototoxicity was 28 weeks after commencement of therapy. Age and cumulative dose can reliably predict the onset of Streptomycin-induced ototoxicity. Medium to long term monitoring of hearing is advised for patients on aminoglycoside therapy.

Reducing anxiety and depression in infertility among Nigerian women: an exploratory psycho-educational intervention trial (RADIANT) study protocol.

RATIONALE: high premium is placed on infertility in Nigerian culture. Data is limited on its association with emotional problems in Nigeria. AIMS: to develop content for a culturally relevant and cost-effective psychoeducational intervention package and to evaluate its effectiveness for reducing symptoms of anxiety and depression. Sample size estimate: Methods and design: a multi-method study design including development and validation (which includes focus group discussions) of an audio-visual tool which will serve as the intervention in a randomized controlled trial. Data will be analyzed with interim and survival analyses. POPULATION STUDIED: one hundred and 138 (68 per group) infertile women attending infertility clinic in Ibadan. STUDY OUTCOMES: anxiety and depressions scores assessed with the hospital depression and anxiety scale (HADS) at 0, 3 and 6 weeks. DISCUSSION: it is hoped that the use of the audio-visual tool will improve participants depression and anxiety scores and that the tool will be used for education in routine clinic use and community awareness on psychosocial effects of infertility.

Clinical outcome of closed reduction of cervical spine injuries in a cohort of Nigerians.

Study design: A prospective observational study. Objectives: To evaluate the effectiveness of closed reduction of cervical spine injuries (CSIs) using cervical traction and identify probable complications. Setting: Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria. Methods: Consecutive CSIs managed by closed reduction using Gardener-Well's Tongs traction were prospectively analysed. The data included imaging and neurological examinations findings, Frankel grading, and extent of reduction. Reduction of 95% or more was deemed satisfactory. The primary outcome measures were extent/degree of reduction and neurologic status classified as improved, same, or worse. Other complications were taken as secondary outcome measures. Result: Seventy-four patients, 49 males, mean age 35.2 years (SD 9.7) were included. In all, 78.4% presented within 72 hours of injury. In total, 85.1% had road traffic crashes. Anterior subluxation was seen in 86.5%. The degree of displacement was <25% in 36/74 (48.6%), 25-50% in 19/74 (25.7%), 50-75% in 8/74 (10.8%), and >75% in 11/74 (14.9%). Traction reduction was done after 7 days of injury in 52.7% and same day of injury in 1.4%. Reduction weight ranged from 2 kg to 60 kg. Reduction was satisfactory in 67.6% and failed in 32.4%. In all, 81.1% of patients remained neurologically the same, while 18.9% improved. Causes of failed reduction were facet lock (15), old injury (8), new-onset/worsening pain (3), and over-distraction (2). Complications of closed reduction were over-distraction (5), tong pull-out (2), new-onset/worsening pain (2), and skull perforation (1). Conclusions: Satisfactory closed reduction is feasible in patients with CSI and significant malalignment. The method is associated with few complications.

Association between exposure to sexually explicit content in the electronic media and sexual intentions of in-school adolescents in Southwest Nigeria.

BACKGROUND: Many adolescents are exposed to a significant amount of sexual content in the media. This has far-reaching effects on their sexual practices as this exposure is occurring at a period when most adolescents are often not sure of the choices to make, and the choices they make during adolescence affect their health when they become adults. The aim of this study was to assess the association between exposure of in-school adolescents to sexual content in the electronic media and their sexual intentions. METHODS: In this cross-sectional study, information was obtained from 750 senior secondary school students in private and public schools using interviewer-administered questionnaire. Sexual media content in the movies, music video and Internet was assessed using a modified version of the sexual media diet tool. The dependent variable was sexual intention; the main independent variable was exposure to sexually explicit content in the media and confounders that were controlled for selected individual (age, sex, religiosity, self-esteem and attachment to parents), family (parents' marital status, parents' type of marriage, hands-on parenting and parent-adolescent communication on sex) and environmental factors (school connectedness and influence from peers) which were previously reported to be associated with sexual intentions of adolescents. Chi-square test was used to determine associations between sexual content of the electronic media and adolescents' sexual intentions, and confounders were controlled for using logistic regression analysis. RESULTS: Thirty-six percent of respondents were exposed to overtly explicit sexual content from all forms of media in the 3 months prior to this study. Twenty-four percent of the adolescents indicated their intention to have sex within 12 months following the study. Predictors of sexual intention were as follows: moderate [odds ratio, OR=2.21 (95% confidence interval, CI: 1.22-3.99)] and high exposure to sexual content in the media [OR=3.02 (95% CI: 1.69-5.43]; attending a public school [OR=2.19 (95% CI: 1.26-3.83)]; moderate peer pressure [OR=2.36 (95% CI: 1.41-3.95)] and high peer pressure [OR=10.32 (95% CI: 2.94-36.31)]; and previous history of sexual intercourse [OR=3.89 (95% CI: 2.25-6.76)]. CONCLUSION: Many adolescents were exposed to sexually explicit content in the media and this had a strong association with sexual intention. Interventions to censor sexually explicit content in the media are required to protect adolescents from the consequences of early exposure to sex.

Epidemiology of neurotrauma in Ife-Ijesha zone of Nigeria.

BACKGROUND AND OBJECTIVE: Trauma remains one of the important causes of severe disability and high mortality. In this study, we looked at the epidemiology of neurotrauma in our region so as to highlight essential factors for trauma prevention program. METHODOLOGY: This is a cross-sectional study of all neurotrauma cases admitted to the neurosurgery service of our hospital over an 18-month period. Information was obtained on patients' demographic data, etiology of injury, duration of injury, site, and cause of accident among others. RESULTS: One hundred forty-three patients were included in the study. The injuries occurred mostly in males and in the third decade. Most of the patients were students and traders. Eighty-one percent of the accidents were due to road traffic crash (RTC), and the most common contributory factors were head-on collision (46.2%) and overtaking (28.6%). Five of six patients who had RTC in the first decade of life were pedestrians. There were more crashes within the cities. None of the patients who had motorcycle accidents used helmet and only four patients used seatbelts at the time of the accident. Transfer to hospital was mostly in vehicles other than ambulance. CONCLUSION: Neurotrauma in our study was mostly due to RTC and it is most common in young male students. Contributory factors were head on collision and overtaking.