Value of the Brain and Spinal Injury Center Score in Assessment and Prognosis of Acute Traumatic Spinal Cord Injury.

The objective was to assess the severity of neurological injury in acute traumatic spinal cord injury (ATSCI) using the BASIC (Brain and Spinal Injury Center) score, to correlate with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade at admission and at 3 months postinjury in patients managed for ATSCI at National Hospital, Abuja, and thereby validate the novel BASIC score. This was a prospective longitudinal hospital-based study involving consecutive patients diagnosed with ATSCI and managed at the National Hospital, Abuja. Sixty-five participants met the inclusion criteria. Each patient was resuscitated along the Advanced Trauma Life Support protocol, followed by history, neurological examination according to the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI), and AIS grades that were recorded. Magnetic resonance imaging scan of the injured spinal cord was done, and BASIC scores were assigned. Further management was as per the standard. Three months after injury, neurological examination was again carried out based on ISNCSCI and AIS grades assigned. Data were collected, analyzed, and correlated using Excel and SPSS version 23. Means, medians, correlation coefficients, and Fisher's exact t-tests were determined. p-Value <0.05 was considered statistically significant. Results show mean age was 39.1 ± 12.3 years. The majority (81.5%) were males, whereas 18.5% were females. The majority (67.7%) were skilled professionals, 13.8% were unskilled, and 18.5% were students. Most injuries (90.8%) were due to road traffic accidents, whereas 9.2% were due to falls. Majority (72.3%) of the patients had complete SCI (AIS grade A), whereas AIS grade E accounted for the least number (3.1%). Cervical spine injury affected 92.3% of patients, whereas 7.7% had thoracic spine injury. Most patients had BASIC 4 pattern on MRI (44.6%), whereas BASIC 1 pattern was the fewest (3.1%). Surgery was not done for 58.5% of patients, whereas 41.5% had surgical decompression and spine fusion. At 3 months postinjury, 15.4% of patients had AIS grade improvement, whereas 84.6% maintained their AIS grade. The largest AIS grade improvement was from grade B to C (6.2%), which was statistically significant (p = 0.04). BASIC score correlated moderately with admission AIS grade (p = 0.532). BASIC score also correlated moderately with AIS grade at 3 months postinjury (p = 0.546). BASIC score 4 was best at predicting poor outcome in ATSCI. In conclusion, BASIC score has a moderate correlation with AIS grade in ATSCI and can predict poor outcomes in ATSCI. BASIC score of 4 has the best discriminant value in prognosticating and represents severe SCI.

Effect of social marketing on the knowledge, attitude, and uptake of pap smear among women residing in an urban slum in Lagos, Nigeria.

INTRODUCTION: Nigeria has a low uptake of cervical cancer screening and is one of the five countries that represent over half of the global burden of deaths from cervical cancer. Social marketing principles can be used to design and implement interventions to increase uptake of cervical cancer screening. This study assessed the effect of a social marketing intervention on the knowledge, attitude, and uptake of pap smear among women residing in an urban slum in Lagos State, Nigeria. MATERIALS AND METHODS: This was a quasi-experimental study. The intervention arm consisted of 140 women recruited from Ago-Egun Bariga community and the control arm consisted of 175 women recruited from Oto-Ilogbo extension community. Social marketing intervention was instituted in the intervention group. Data analysis was done using IBM SPSS Statistics version 20 and Stata version 16.0. Between groups comparisons and within groups comparisons were done using bivariate analysis with Chisquare, Students t test and Paired t test as appropriate. RESULTS: In both the intervention and control groups, the mean knowledge score of cervical cancer was low at baseline (0.0 ± 0.3 and 0.1 ± 0.9 respectively). In the intervention group, there was a significant increase in mean knowledge score to 15.1 ± 3.7, post-intervention (p < 0.001). In both groups, the mean attitude score of cervical cancer was low at baseline (27.1 ± 0.8 in the intervention group and 27.2 ± 1.4 in the control group). In the intervention group, there was a significant increase in mean attitude score to 36.5 ± 4.8, post-intervention (p < 0.001). In both the intervention and control groups, uptake of pap smear was low at baseline (0.0% and 0.6%, respectively). In the intervention group, there was a significant increase in uptake of pap smear to 84.3%, post-intervention (p < 0.001). There was no statistically significant change in knowledge, attitude or uptake of pap smear in the control group, post-intervention. CONCLUSION: This study demonstrated that social marketing intervention can be successful in improving knowledge, attitude, and also the uptake of pap smear, even in settings where these are abysmally low. It is recommended that social marketing intervention be employed as a strategy for improving cervical cancer screening among women residing in slums.

Rural-urban disparities in maternal immunization knowledge and childhood health-seeking behavior in Nigeria: a mixed method study.

BACKGROUND: Immunization and appropriate health-seeking behavior are effective strategies to reduce child deaths. OBJECTIVES: To compare maternal knowledge about immunization, use of growth chart and childhood health-seeking behavior in rural and urban areas. METHODS: A cross-sectional comparative study done in Lagos, Nigeria. Questionnaire survey and focus group discussions were done. 300 respondents were selected by multi-stage sampling while discussants were purposively selected. RESULTS: Awareness of immunization was high but knowledge of vaccine preventable diseases (VPDs) was poor in both areas. Urban women utilized preventive services more; growth monitoring (p<0.001) and immunization (p<0.001) while higher proportions of rural women utilized nutritional counseling (p=0.005) and treatment of illness (p<0.001). Growth chart utilization was better in the urban areas (p<0.001). Increasing maternal education increased use of growth chart in both areas. Both groups of women use multiple treatment sources for children (more in urban), determined by cost, time, perceived severity of illness and type of ailment (urban) and peculiarity of illness (rural). There is a preference for orthodox care in the rural area. CONCLUSIONS: Knowledge of VPDs was poor and multiple treatment sources were common among rural and urban women. Education is vital to improve immunization knowledge and health-seeking behavior in both areas.

Rural-urban Disparities in Maternal Immunization Knowledge and Childhood Health-Seeking Behavior in Nigeria: a Mixed Method Study

Background: Immunization and appropriate health-seeking behavior are effective strategies to reduce child deaths. Objectives: To compare maternal knowledge about immunization; use of growth chart and childhood health-seeking behavior in rural and urban areas. Methods: A cross-sectional comparative study done in Lagos; Nigeria. Questionnaire survey and focus group discussions were done. 300 respondents were selected by multi-stage sampling while discussants were purposively selected. Results: Awareness of immunization was high but knowledge of vaccine preventable diseases (VPDs) was poor in both areas. Urban women utilized preventive services more; growth monitoring (p0.001) and immunization (p0.001) while higher proportions of rural women utilized nutritional counseling (p

Knowledge of commercial bus drivers about road safety measures in Lagos, Nigeria.

BACKGROUND/OBJECTIVE: Road traffic injuries have persisted as a serious public health problem and much of the health burden is in developing countries. Over-speeding, poor enforcement of traffic regulations and commuter buses have been highly implicated in road traffic injuries in developing countries. The aim of this study was to determine drivers' knowledge of selected road safety measures, i.e. the pre-requisites for driver's license, road signs and speed limits. MATERIALS AND METHODS: This was a cross-sectional study carried out in Lagos, Nigeria. Simple random sampling was used to select the two motor parks used for the study and all the consenting commercial minibus drivers operating within the parks (407) were included in the study. Data was collected with a pre-tested, structured, interviewer-administered questionnaire and analyzed with epi-info statistical software. RESULTS: Two hundred and sixty-one (64.1%) of them knew that Visual Acuity test should be done before obtaining driver's license and 53.8% knew the correct minimum age for obtaining driver's license. Only 1% of the drivers had correct knowledge of the driver's license authorities in Nigeria. The drivers had poor knowledge of road signs (59.0%) and poor knowledge of maximum speed limits (100%). The oldest, least educated and least experienced drivers had the poorest level of knowledge. CONCLUSION: The drivers demonstrated poor knowledge of road safety measures. There is need for driver education to improve their knowledge.

Use of complementary medicine amongst patients on antiretroviral drugs in an HIV treatment centre in Lagos, Nigeria.

Traditional herbal remedies have been used to treat many ailments in Nigeria but the safety of herbal remedies has been the major concerns to many people especially when the chemical constituents of the products are not known. This study is therefore designed to evaluate the prevalence of use of complementary drugs with antiretroviral (ARV) therapy and possible treatment outcome of the concurrent utilization of these therapeutic agents. A descriptive cross-sectional survey of 354 HIV patients attending APIN clinics in LUTH using a consecutive sampling technique was used. There was also correlation of the data obtained from the patients with their clinical case notes. Results showed that only 8.2 % of the respondents' used herbal medicine concurrently with ARV therapy. Ninety percent of the participants were on a two nucleoside and one non-nucleoside based ARV therapy. The most common regimen (55%) was Zidovudine/lamivudine/Nevirapine fixed dose combination while 10% use a protease inhibitor based regimen. The commonly herbal drugs used ranges from Jobelyn [Sorghum bicolor plant leaves (13.8%)], Garlic [Allicin, γ-glutamyl- (s)-ally-L-Cysteine] (10.3%), Ginger [Essential oil] (17.2%) and Aloe vera [Hydroxyanthracene derivatives expressed as Barbaloin] (10.3%). The major reason for the commencement of herbal medicine is the perception that the medicine will boost their immunity (65.5%). However, there was a marginal improvement though not significant (p ≥ 0.05) in the CD4 counts (489.8 ± 195.2; 419.1 ± 236.2) and viral load (5117.8 ± 26092.0; 31136.7 ± 197954.6) of HIV patients on herbal drugs compared to those who are not on herbal drugs. Herbal medicines have potentials to interact with ARVs and thus result in adverse reactions and possibly therapeutic failure. There is need for thorough investigation of the pharmacological action of these herbal medicines in HIV treatment taking into consideration their pharmacokinetic and toxicological profile.

A hospital-based estimate of major causes of death among under-five children from a health facility in Lagos, Southwest Nigeria: possible indicators of health inequality.

INTRODUCTION: Current evidence on the root-causes of deaths among children younger than 5 years is critical to direct international efforts to improve child survival, focus on health promotion and achieve Millennium Development Goal 4. We report a hospital-based estimate for 2005-2007 of the major causes of death in children in this age-group in south-west Nigeria. METHODS: We used retrospective data from the intensive care unit of a second-tier health facility to extract the presenting complaints, clinical diagnosis, treatment courses, prognosis and outcome among children aged 6-59 months. SPSS-19 was used for data analysis. RESULTS: Of the 301 children (58% males, 42% females) admitted into the ICU within the period of study, 173 (26%) presented with complaints related to the gastrointestinal system, 138 (21%) with respiratory symptoms and 196 (29%) with complaints of fever. Overall, 708 investigations were requested for among which were full blood count (215, 30%) and blood slides for malaria parasite (166, 23%). Infection ranked highest (181, 31%) in clinicians' diagnosis, followed by haematological health problems (109, 19%) and respiratory illnesses (101, 17%). There were negative correlations between outcome of the illness and patient's weight (r=-0.195, p=0.001) and a strong positive correlation between prognosis and outcome of admission (r=0.196, p=0.001). Of the 59 (20%) children that died, presentation of respiratory tract illnesses were significantly higher in females (75%) than in males (39%) (χ²=7.06; p=0.008) and diagnoses related to gastrointestinal pathology were significantly higher in males (18%) than in females (0%) (χ²=4.07; p=0.05). Majority of the deaths (21%) occurred among children aged 1.0 to 1.9 years old and among weight group of 5.1-15.0 kg. CONCLUSION: The major causes of deaths among under-five years old originate from respiratory, gastrointestinal and infectious diseases - diseases that were recognized as major causes of childhood mortality about half a century earlier. Realization of MDG4 - to reduce child mortality by two-thirds - is only possible if the government and donor agencies look beyond the health sector to find hidden causative factors such as education and housing and within the health sector such as vibrant maternal, new-born, and child health interventions.

Cancer distribution pattern in south-western Nigeria.

The burden of cancer in Nigeria is appreciable with about 100,000 new cancer cases being reported in the country each year. This study aimed to determine the level of occurrence and pattern of distribution of different cancer types in two major functional cancer registries in south-western Nigeria. A desk review of the level of occurrence and pattern of distribution of different cancer types in Lagos and Ibadan cancer registries over a 5 year period (2005-2009) was carried out. The results obtained showed a total number of 5094 cancer patients registered between 2005 and 2009 in both Lagos (60%) and Ibadan (40%) cancer registries. Breast cancer accounted for the majority of cases (20.2%), followed by cervical cancer (7.9 %), fibroid (4.4%), liver (4.4%), stomach (4.3%), brain (3.9%), pancreas (3.8%), prostate (3.3%), lung (3.0%) and cancer of the kidney (0.7%). There were significant differences (P ≤ 0.05) in the level of occurrence between cancers of the breast, cervix, prostate, liver, ovary and all other cancers. Liver cancer (147; 77) and bone cancer (91; 37) were predominant in females than males while lung cancer (89; 65), stomach cancer (112; 109), and kidney cancer (24; 14) were predominant in males than females. In conclusion, the findings of this study provide insights to cancer epidemiology in the western region of Nigeria. This study confirms earlier findings that breast, prostate, liver and cervical cancers account for the majority of cases of cancers in Nigeria. Thus, there is need to organize a wider scale suitable methods for early detection of these diseases.

Knowledge, treatment seeking and preventive practices in respect of malaria among patients with HIV attending Lagos University Teaching Hospital, Nigeria.

The synergistic interaction between Human Immunodeficiency virus (HIV) disease and malaria makes it mandatory for patients with HIV to respond appropriately in preventing and treating malaria. Such response will help to control the two diseases. This study assessed the knowledge of 495 patients attending the HIV clinic, in Lagos University Teaching Hospital, Nigeria. Their treatment seeking, preventive practices with regards to malaria, as well as the impact of socio-demographic / socioeconomic status were assessed. Out of these patients, 245 (49.5%) used insecticide treated bed nets; this practice was not influenced by sociodemographic or socioeconomic factors. However, knowledge of the cause, knowledge of prevention of malaria, appropriate use of antimalarial drugs and seeking treatment from the right source increased with increasing level of education (P < 0.05). A greater proportion of the patients, 321 (64.9%) utilized hospitals, pharmacy outlets or health centres when they perceived an attack of malaria. Educational intervention may result in these patients seeking treatment from the right place when an attack of malaria fever is perceived.