Ear diseases in elderly hospital patients in Nigeria

BACKGROUND: Little information is available about the pattern of ear diseases in the elderly population. Therefore, the present study aims to determine the pattern of ear diseases among elderly Nigerians, so as to provide an objective basis for cost-effective health care planning for the emerging geriatric population. METHODS: A retrospective study of 320 patients aged 60 years or older presenting with ear diseases at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between January 1996 and December 2001 was carried out. RESULTS: Impacted cerumen was the most common ear disease, occurring in 110 (34.4%) patients of the study population. Chronic suppurative otitis media (CSOM) was the most common infectious disease, affecting 28 (8.8%) patients. Of the 88 patients with hearing loss, 63 (71.6%) had sensorineural, 20 (22.7%) had presbycusis, 1 (1.1%) had conductive, and 4 (4.6%) had mixed hearing loss. CONCLUSION: Our data suggest that impacted cerumen, hearing loss, and infections (notably CSOM), are the common ear diseases among elderly Nigerians.     

Emergency Peripartum Hysterectomy in a Developing Country

BackgroundEmergency peripartum hysterectomy (EPH) is a life-saving surgical procedure that is associated with maternal morbidity and mortality, especially in developing countries. The advent of newer medical and conservative surgical methods of controlling postpartum hemorrhage will influence both the rate and the outcomes of the procedure.ObjectiveTo study the rate of EPH, the influence of sociodemographic characteristics on the rate of the procedure, the modality of treatment used in each of the indications, and maternal–fetal morbidity and mortality.MethodsWe conducted a case–control study of 30 patients who underwent EPH between June 1, 2003, and 31 May 31, 2008, at Aminu Kano Teaching Hospital, Kano, Nigeria, a tertiary institution in a developing country.ResultsThe rate of EPH in this study was 4.0 per 1000 deliveries. Ruptured uterus (73.3%) was the most common indication. Factors showing a significant association with EPH were being 31 to 40 years old (OR 6.7; 95% CI 3.9 to 15.7), being para ≥ 5 (OR 4.1; 95% CI 1.87 to 9.1), having unbooked status (OR 9.1; 95% CI 3.6 to 24.9), and being in a low social class (OR 7.5; 95% CI 1.7 to 45.3). Ruptured uterus (OR 164.3; 95% CI 67.9 to 410.0) and placenta previa accreta (OR 36.1; 95% CI 10.0 to 117.3) were significantly associated with EPH. The most common morbidity was wound sepsis (60%). The case fatality rate was 13.3%, and perinatal mortality was 73.3%.ConclusionThe rate of EPH in our institution is high, and maternal–fetal outcome is poor. Antenatal care and hospital delivery should be encouraged.     

Individual and contextual factors associated with childhood stunting in Nigeria: a multilevel analysis

Stunting, a form of undernutrition, is the best measure of child health inequalities as it captures multiple dimensions of children's health, development and the environment where they live. The aim of this study was to quantify the predictors of childhood stunting in Nigeria. This study used data obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). A total of 28 647 children aged 0–59 months included in NDHS in 2008 were analysed in this study. We applied multilevel multivariate logistic regression analysis in which individual‐level factors were at the first level and community‐level factors at the second level. The percentage change in variance of the full model accounted for about 46% in odds of stunting across the communities. The present study found that the following predictors increased the odds of childhood stunting: male gender, age above 11 months, multiple birth, low birthweight, low maternal education, low maternal body mass index, poor maternal health‐seeking behaviour, poor household wealth and short birth interval. The community‐level predictors found to have significant association with childhood stunting were: child residing in community with high illiteracy rate and North West and North East regions of the country. In conclusion, this study revealed that both individual‐ and community‐level factors are significant determinants of childhood stunting in Nigeria.     

A 90 day chronic toxicity study of Nigerian herbal preparation DAS-77 in rats

ABSTRACT: BACKGROUND: The herbal preparation DAS-77, used for the treatment of various ailments in Nigeria, contains the milled bark of Mangifera indica L. and root of Carica papaya L. Toxicological assessment of the preparation was carried out in this study. METHODS: In the acute toxicity study, DAS-77 was administered to mice p.o.up to 10 g/kg and i.p. at 250-3000 mg/kg. Mortality within 24 h was recorded. In the chronic toxicity study, rats were treated p.o. for 90 days at doses of 80, 400 (therapeutic dose, TD) and 2000 mg/kg. By 90 days, animals were sacrificed and blood samples collected for hematological and biochemical analysis. Organs were harvested for weight determination, antioxidants and histopathological assessments. RESULTS: DAS-77 did not produce any lethality administered p.o. up to 10 g/kg but the i.p. LD50 was 1122.0 mg/kg. At TD, DAS-77 produced significant (p<0.05) reductions in body weight, food intake and K+, and increases in ovary weight, neutrophils and HDL, which were reversible. Histopathological presentations were generally normal. Effects at the other doses were comparable to those at TD except for reversible increases in antioxidants in the liver, kidney and testes, and sperm abnormality, and reductions in liver enzymes, sperm motility and count. CONCLUSIONS: Findings in this study revealed that DAS-77 is relatively safe with the potential for enhancing in vivo antioxidant activity. However, possibly reversible side-effects include electrolyte imbalance and sterility in males.     

Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students

BACKGROUND: The common self-rated depression scales are lengthy, old and do not reflect the current diagnostic classifications criteria of depressive disorders. This study aimed to validate the Patient Health Questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. METHODS: A representative sample of university students (n=512) completed the PHQ-9 and the Beck's Depressive Inventory (BDI). They were also interviewed for clinical diagnoses of depressive disorders using the Mini International Neuropsychiatric Interview (MINI). RESULTS: The internal consistency of questions within the PHQ-9 was 0.85. The PHQ-9 had good concurrent validity with the BDI (r=0.67, P<0.001). It also had a good (r=0.894, P<0.001) one month test-retest reliability. Using the Receiver Operating Characteristic (ROC) curve, the optimal cut-off score for minor depressive disorder is 5 (sensitivity 0.897, specificity 0.989, Positive Predictive Value - PPV 0.875, Negative Predictive Value - NPV 0.981 and Overall Correct Classification - OCC rate 0.973) while for major depressive disorder only is 10 (sensitivity 0.846, specificity 0.994, PPV 0.750, NPV 0.996 and OCC rate 0.992). LIMITATIONS: The study limitations include use of a specific group in community, moderate sample size and screening for only minor and major depressive disorders while neglecting other depressive disorders. CONCLUSIONS: The PHQ-9 has good psychometric properties amongst Nigerian university students. Because of its validity, reliability, brevity and ease of administration, the PHQ-9 will be a valuable tool for estimating depression amongst college students in Nigerian community. More studies are needed to test the usefulness of the translated local language versions of this instrument amongst the community in sub-Saharan Africa.     

Lymphoreticular diseases in Nigerians

Background

The lymphoreticular system plays a major role in both the innate and adaptive immune responses. This study reviews retrospectively cases of lymphoreticular diseases seen at a tertiary institution in Nigeria.

Materials and Methods

This is a retrospective study in which biopsies from the bone marrow, spleen, lymph nodes and extranodal lymphoid tissues reported within a period of 16 years were reviewed with respect to age, sex and pathological diagnosis. Statistical analysis was performed for differences in proportion using Chi square by SPSS version 12.

Results

Nine hundred and forty four cases comprising 559 biopsies from lymph nodes and extranodal lymphoid tissues, 272 bone marrow biopsies and 113 spleen biopsies were studied. Non Hodgkin''s lymphoma (NHL) and tuberculosis were the most common lesions in lymph nodes and extranodal lymphoid tissues. The axillary and cervical nodes accounted for most cases of metastasis. Breast cancer accounted for the majority of metastasis to lymph nodes.The most common pathological changes in bone marrow were NHL and reactive hyperplasia. Patients with chronic lymphocytic leukaemia (CLL) had the highest mean age, which was significantly higher than in those with NHL (p=.001, 95% confidence interval −27.91 to −7.76). The most common finding in the spleen was splenic rupture and haemoperitoneum from road traffic accident.

Conclusion

NHL and tuberculosis should be high on the list of differential diagnosis of lymphadenopathy in Nigerians. Whereas trauma from RTA was the major reason for splenectomy in Nigerians, in the elderly splenic biopsy would likely show CLL.     

Acceptability of measures aimed at preventing mother-to-child transmission of HIV among pregnant women

OBJECTIVE: To assess the acceptability of measures aimed at preventing mother-to-child transmission of HIV among counseled and yet-to-be-counseled antenatal women in a federal medical center in Nigeria. METHODS: A valid and reliable questionnaire was interviewer administered to newly booking antenatal women who were yet to be counseled about HIV/AIDS and women on an antenatal follow-up visit who had already been counseled about HIV/AIDS. RESULTS: A total of 108 newly booked women and 116 women on follow-up visit responded to the questionnaire. The proportion of the counseled women who accepted HIV screening (98%) was significantly higher than the proportion of the yet-to-be-counseled women who would want to be screened (88%). Also, the proportions of the counseled women who accepted HIV screening so as to benefit from interventions like prevention of mother-to-child transmission, antiretroviral therapy and prevention of transmission to partner were significantly higher than the proportions among the yet-to-be-counseled women. The majority of the women in the study would accept antiretroviral drugs and avoidance of breastfeeding to prevent mother-to-child transmission, while only 29 (14%) respondents would accept cesarean section to prevent mother-to-child transmission. There was no statistically significant difference in the proportion of the counseled women (15%) who would accept cesarean section to prevent mother to child transmission when compared to the proportion among the yet-to-be-counseled women (11%). CONCLUSION: Antenatal HIV screening is acceptable to most pregnant women attending our hospital, and while many would accept antiretroviral drugs and avoidance of breastfeeding to prevent mother-to-child transmission of HIV, there is low acceptability of elective cesarean section.