Distribution of cesarean delivery by Robson classification and predictors of postspinal anesthesia hypotension in Windhoek referral hospitals: A cross-sectional study

Background

There are concerns that high cesarean section (CS) rates are driven by nonmedical indications and unmitigated maternal hypotension following spinal anesthesia (SA) has materno fetal effects.

Aims

Our objective was to investigate CS rates using Robson classification, identify patient groups for focused intervention as well as assess the incidence and predictors of maternal hypotension following SA for cesarean delivery.

Subjects and Methods

A cross sectional design was employed over 3 months (February-April, 2019). Data about total deliveries (vaginal and operative) were obtained from the hospital medical records. For parturients who had CS, variables which covered maternal characteristics, conduct of anesthesia, and the index pregnancy according to Robson classification system were entered into a proforma designed for the study.

Results

The total deliveries were 3031, of which 556 were CSs, giving a CS rate of 18.3%. Twenty one nonconsenting parturients were excluded, so 535 responded. Robson groups 5, 10, and 1 combined contributed 75% [401/535] to the overall CS. Two or more previous CS, 29.7% [159/535], was the main indication for performing CS, followed by maternal request 12.9% [69/535]. The incidence of maternal hypotension was 62.6% (293/468); the independent predictors were elective CS and having comorbidities.

Conclusion

We found a low CS rate and Robson groups 5, 10, and 1 were the major contributors - previous CS (≥2) and maternal request were the predominant indications for performing CS. The independent predictors of SA induced hypotension were presence of comorbidities and elective CS.

Specialty preferences among medical students in Botswana

Background

With the establishment of a new medical college in Botswana to train generalist-doctors and specialists, we set out to explore the career preferences of medical students, factors that influence their choices and attitude to local postgraduate training.

Methods

A descriptive cross-sectional questionnaire-based study was conducted among medical students in their third to fifth year, at the Faculty of Medicine, University of Botswana. The structured, self-administered questionnaires which were hand-delivered covered demographic characteristics of responders, career choices, preferred location of specialisation and factors that influenced the choices.

Results

Of the 143 medical students approached, 116 (81.0%) returned completed questionnaires. Of the responders, 102 (87.9%) intend to pursue postgraduate specialisation against 2 (1.7%) who declined; 12 (10.3%) were undecided. The four most preferred specialties which constituted 68.1% were surgery (28.4%), paediatrics (19.0%), internal medicine (12.9%), obstetrics and gynaecology (7.2%). There was male preference for surgery (p = 0.04), while women were drawn more towards paediatrics and psychiatry (p = 0.04 and p = 0.01, respectively). Personal interest and aptitude was considered the most important factor among most responders (46.2%), followed by enjoyment of the posting (19.8%). A high proportion of responders 80 (69.0%) preferred to specialise abroad for better exposure/opportunities (48.3%), while for 15.5%, their preferred courses are not currently available locally.

Conclusion

Our findings indicated that while four major specialties are preferred, significant gender differences exist with female students leaning towards non-surgical disciplines. Students prefer specialising abroad on the pretext that foreign centres offer better training opportunities, and many specialist programmes are unavailable locally.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2523-y) contains supplementary material, which is available to authorized users.

Breast self-examination practices in Nigerian women attending a tertiary outpatient clinic

BACKGROUND

The morbidity and mortality caused by breast cancer can be decreased by early detection with breast self-examination (BSE). The objective of this study was to determine the prevalence and the factors determining the practice of BSE.

MATERIALS AND METHODS

The study was conducted on 140 women aged above 18 years who presented consecutively in a General Outpatient's clinic in a tertiary hospital in Nigeria. This was the baseline study from an intervention study which looked at the effect of demonstration of BSE on improving Clinical Breast Examination (CBE) among two groups of respondents. Structured questionnaires were validated and administered by an interviewer and the data were analyzed using Statistical Package for Social Sciences (SPSS) version 12.

RESULTS

The overall self-reported prevalence of BSE practice was 62.1% among the respondents. Older women (16, 76.2%), married women (63, 65.6%) and women with tertiary education (51, 68.9%) had the highest prevalence of BSE practice. Prevalence rate was highest for civil servant (25, 78.1%), P = 0.04. The practice of BSE was higher among women with a previous history of breast disease (15, 68.2%) and in respondents with a family history of breast disease (7, 63.6%), Only 11 (12.6%) performed BSE as per guidelines, which was once in a month.

CONCLUSION

The prevalence of BSE was found to be high, especially in those with tertiary education and in those with a past personal or family history of breast disease. In resource-constrained countries, BSE is a screening tool that can be employed to help reduce the breast cancer burden because routine mammography screening is not yet feasible. Women need to be informed about the when and how to perform BSE.

ASSESSMENT OF THE LIVING CONDITIONS OF RURAL BASED PEOPLE LIVING WITH HIV/AIDS WITH CLINICAL PRESENTATIONS IN NIGERIA

OBJECTIVE

To describe the living conditions of rural based people living with HIV/AIDS (PLWHA) and their clinical presentations

DESIGN

descriptive cross-sectional study,

SETTING

University College Hospital, Ibadan.

SUBJECTS

PLWHA on anti-retroviral therapy.

RESULTS

One hundred and fifty PLWHA participated. The mean age of the respondents was 28.7 ± 8.9 years. Majority of the respondents visited had advanced disease (97%), were poor (75%) and presented with opportunistic infections such as oral candidiasis (92%), chronic diarrhoea (70%) and pulmonary tuberculosis (46%). Majority were treated for malaria (72%) and anaemia (61%). All respondents lived in homes predisposed to these opportunistic infections. They drink unsafe water and had poor disposal of their domestic wastes.

CONCLUSION

PLWHA visited lived in homes that predispose them to various opportunistic infections. Improved living conditions and economic empowerment will improve the health conditions of PLWHA.

GEOGRAPIC INFORMATION SYSTEMS IN DETERMINING ROAD TRAFFIC CRASH ANALYSIS IN IBADAN, NIGERIA

BACKGROUND

Road traffic accidents are frequent in this environment, hence the need to determine the place of geographic information systems in the documentation of road traffic accidents.

AIM & OBJECTIVES

To investigate and document the variations in crash frequencies by types and across different road types in Ibadan, Nigeria.

MATERIALS & METHODS

Road traffic accident data between January and June 2011 were obtained from the University College Hospital Emergency Department's trauma registry. All the traffic accidents were categorized into motor vehicular, motorbike and pedestrian crashes. Georeferencing of accident locations mentioned by patients was done using a combination of Google Earth and ArcGIS software. Nearest neighbor statistic, Moran's-I, Getis-Ord statistics, Student T-test, and ANOVA were used in investigating the spatial dynamics in crashes.

RESULTS

Out of 600 locations recorded, 492 (82.0%) locations were correctly georeferenced. Crashes were clustered in space with motorbike crashes showing greatest clustering. There was significant difference in crashes between dual and non-dual carriage roads (P = 0.0001), but none between the inner city and the periphery (p = 0.115). However, significant variations also exist among the three categories analyzed (p = 0.004) and across the eleven Local Government Areas (P = 0.017).

CONCLUSION

This study showed that the use of Geographic Information System can help in understanding variations in road traffic accident occurrence, while at the same time identifying locations and neighborhoods with unusually higher accidents frequency.

Cholera outbreak in a southwest community of Nigeria: investigation of risk factors and evaluation of a district surveillance system

BACKGROUND

Following confirmation of cholera outbreak in a southwest community of Nigeria, we set to identify possible risk factors for contracting the disease and to evaluate the completeness as well as the representativeness of the cases reported to a district health authority.

METHODS

Cholera cases were identified through an active case search that involved the review of records in health facilities and a house-to-house search using the standard case definition in the Nigeria integrated disease surveillance and response technical guidelines. Two neighborhood controls appropriately matched on age and sex for each case, were also identified. An interviewer-administered questionnaire was used to collect information on the demographic characteristics and potential risk factors. Completeness of reporting of cases notified to the district health authority was evaluated using a two source capture-recapture method. In addition, the representativeness of the reported cases was determined by comparing the age and sex distributions of notified cases to those identified through the active case search.

RESULTS

Thirty-nine cases were identified, of which 22 consented to participate. Contact with a diarrhoea case at home or in the neighborhood within the last 7 days prior to illness onset in cases was significantly associated with having cholera (Matched triplets Odds Ratio 8.5, 95% CI: 1.36-52.9). The completeness of the district surveillance report was estimated to be 54%. In the district notification data compared with the active case search data, males <5 years (31% vs 18%) and females 15 years (3% vs 21%) were significantly over- and under-represented, respectively.

CONCLUSION

The odds of having cholera were increased in those who had contact with a case of diarrhea. Reporting of cases to the district health authority was not complete and the surveillance data on gender and age grouping were not representative of the cases that occurred in the population. There is a need for efficient reporting of cases to the health authority during outbreaks in order to improve decision-making and public health interventions.

Socio demographic and clinical correlates of knee pain in adult women attending a primary care clinic

AIMS AND OBJECTIVES

The objectives of the study were to determine the socio demographic and clinical correlates of knee pain in women in a primary care clinic.

PATIENTS AND METHODS

The study was a cross-sectional survey of 400 women attending the General Outpatients' clinic of the University College Hospital (U.C.H.), Ibadan, Nigeria using the systematic random sampling technique.

RESULTS

The prevalence of knee pain was 42.0% (95% CI 40.0- 41.0). The radiographic findings in the knees showed mostly osteophytes in 24 out of the 28(85.7%) respondents who had radiographs done. The highest prevalence of knee pain was found in caterers and traders, 62.5% and 51.6%, respectively (p= 0.001). Multivariate analysis done using logistic regression with a backward selection showed that the odds of developing knee pain increases with age (Odds Ratio=1.585, 95% CI 1.321-1.903, p=0.000), and body mass index (Odds Ratio 1.587, 95% CI 1.295-1.946, p=0.000).

CONCLUSION

The prevalence of knee pain in women seen at the primary care clinic is high. Preventive measures for knee pain need to be instituted.

Is breaking of bad news indeed unacceptable to native Africans? A cross-sectional survey of patients in a Nigerian neurosurgical service

OBJECTIVES

Breaking of bad news is anecdotally deemed to be culturally unacceptable, even intolerable, to native Africans. We sought whether this hypothesis could be formulated among a cohort of patients who had difficult diagnoses given them in a Nigerian neurosurgical service.

MATERIALS AND METHODS

A semi-structured, interviewer-administered questionnaire was used in a cross-sectional survey among a consecutive cohort of patients on their opinion and preferences regarding the full disclosure of the grave prognoses of their difficult neurosurgical diagnoses.

RESULTS

A total of 109 patients, 74 (67.9%) males, were sampled over a one-and-half-year period. They were mainly young adults, mean age of 40.2 (SD 14.2) years; more than half of them, 56%, had only basic literacy education, but the majority, 99.1%, declared themselves to have serious religious commitments. Less than 3% of the study participants chose not to receive their medical bad news whilst the majority who preferred to have the full disclosure of their medical diagnosis wanted their relations around during the process in 88%, and indeed, 91% would not be happy to be kept in the dark by their knowing relations. Finally, whilst the majority (98%) did not see the prospects of getting any governmental support, hope in God (88%) and family support (40%) were the means by which they expected to cope with the realities of their new futures.

CONCLUSIONS

This data-driven study showed that contrary to anecdotal belief breaking bad news was not intolerable to a cohort of native Nigerian-African patients in a neurosurgical practice.

Pandemic Influenza A (H1N1): knowledge among senior health workers at a secondary health care institution in Southwest, Nigeria

OBJECTIVE

This study was conducted to assess the level of knowledge of influenza A (H1N1) infection among health care workers in a secondary health care facility in Osogbo, Southwest Nigeria.

METHODS

A structured questionnaire assessing participants'knowledge of swine influenza viruses, mode of transmission, clinical criteria, primary prevention, indications for emergency care, care of affected persons and ongoing pandemic of Influenza A H1N1 was hand-delivered to all senior health care workers working in the hospital.

RESULTS

The mean age of the respondents was 40.4±9.6 years. The majority (59.3%) were females. Television (73.6%) radio (61.5%), newspapers (44%), other health workers (31.9%), and internet (15.4%) were the main sources of information about influenza A H1N1. Nearly all (92.3%) felt that their source of information about the disease was inadequate. About half (51.6%) knew the virus can be transmitted from one person to another. Majority identified correctly the symptoms of infected victims such as fever (83.5%), and runny nose (79.1%). Most (87.9%) identified hand washing with soap and water as a mode of preventing transmission. Most (83.5%) felt an infected person should be isolated while very few knew oseltamivir (13.2%) and zanamivir (17.6%) are drugs to treat. Multivariate linear regression analysis identified, male sex (p=0.029), internet as a source of information (p=0.029) and knowledge of prevention of H1N1 (p= 0.005) as factors that were significantly associated with a high knowledge score on the current pandemic.

CONCLUSION

There is a need to provide comprehensive information to health workers on the current pandemic.

Health Risks of Obesity

Obesity is becoming of interest as a non-communicable disease. There is however a dearth of information on obesity in this environment, as literature in developing countries is limited. Review of health risks of obesity is useful in order to increase the pool of available information in Nigeria and to draw attention to obesity and its attendant health risks.

Outcome of training on yellow fever surveillance in a South-Western state, Nigeria: implications for improved field implementation

BACKGROUND

Nigeria is in the process of strengthening yellow fever case-based surveillance with the collection of serum samples among suspected case patients.

OBJECTIVE

A training conducted for surveillance officers in the local government areas (LGAs) of Osun State on yellow fever case-based surveillance was assessed to determine its immediate impact on the knowledge of participants.

METHODS

The training focused mainly on how to detect and report a suspected case of yellow fever to the national authorities and the reference laboratory. Training materials included the World Health Organization district guidelines for yellow fever surveillance. A pre and post test was used to evaluate the immediate impact of the training on knowledge among participants.

RESULTS

A total of 31 officers participated. The mean scores for pre and post tests were 7.1 (SD 3.6) and 20.7 (SD 3.4) out of a total of 30 points respectively. More than 80% of participants rated the training as excellent in overall organization.

CONCLUSION

All participants indicated that they were very confident to fully implement yellow fever surveillance in their LGAs.

Completeness of suspected measles reporting in a southern district of Nigeria

OBJECTIVE

To determine the completeness of reporting of suspected measles cases to a local health authority in southern Nigeria.

STUDY DESIGN

Retrospective.

METHODS

Suspected measles cases were identified in all 23 health facilities in Aniocha South Local Government Area (LGA) of Delta State, Southern Nigeria by retrospective review of the health facilities' registers and the LGA surveillance records between 1 January 2007 and 30 June 2008. A capture-recapture method was used to obtain an estimate of the total number of measles cases expected for the study area within the study period. The completeness of reporting was calculated as a ratio of the number of measles cases reported to the LGA by hospitals to the number of cases estimated by the capture-recapture method.

RESULTS

An estimate of 87 measles cases was obtained with the capture-recapture method. The overall completeness of reporting was 11.5% (95% confidence interval 8.1-19.6%).

CONCLUSION

The number of suspected measles cases seems to have been grossly under-reported in this area.

Convergent validity of pain measuring tools among Nigerian children

This prospective study was carried out at the Children Outpatient Clinic of the University College Hospital (UCH), Ibadan, Nigeria. The study aims to determine the convergent validity of the Oucher, Observer Pain Scale, Visual Analogue Scale (VAS) and the Numeric Rating Scale (NRS) among Nigerian children. Children aged between 6 months and 12 years who required venepuncture or phlebotomy for various investigative procedures were recruited. Demographic data and pain assessment scores were documented on a data collection form. Pain was assessed by a trained research assistant at baseline, during the procedure and immediately after the procedure using the 4 pain scales. The mean age (+/- SD) of the children was 5.5 +/- 4.3 years, boys accounted for 93 (52%) and girls 86 (48%). Pain score ranged from 0 (no pain) to 10 (worst pain) during the procedure; 72% (125) of the children had a pain score of at least 4. The median pain score during the procedure were 4 (Observer Pain Scale), 5 (Oucher) and 4 (VAS and NRS).The average measure intra-class correlation coefficient (ICC) showed that the Oucher, the VAS and the NRS pain scales are reliable pain measuring tools with an ICC of 0.63-0.69 at baseline and 0.72 - 0.73 during the procedure. The VAS, NRS and Oucher pain scales are valid pain tools that can be used to assess pain in Nigerian children.

Pattern of substance use among senior students of command secondary schools in Ibadan, Nigeria

BACKGROUND

The aim of this study was to assess the pattern of drug use among senior secondary school students within military locations in Ibadan, Nigeria.

METHODS

A cross-sectional survey was carried out in 2006.

RESULTS

Five hundred ten students participated with a mean age of 15.0 +/- 1.2 years. The prevalence of lifetime use of any substance was 15.3%. Alcohol (33.9%), solvents (17.3%), and tobacco (10.6%) were the most commonly used substances. Only gender and age were associated with the lifetime use of tobacco and solvents (p < 0.05).

CONCLUSION

The information provided a useful baseline on which subsequent interventions could be based and evaluated.

Pattern of substance use among senior students of command secondary schools in Ibadan, Nigeria

BACKGROUND

The aim of this study was to assess the pattern of drug use among senior secondary school students within military locations in Ibadan, Nigeria.

METHODS

A cross-sectional survey was carried out in 2006.

RESULTS

Five hundred ten students participated with a mean age of 15.0 +/- 1.2 years. The prevalence of lifetime use of any substance was 15.3%. Alcohol (33.9%), solvents (17.3%), and tobacco (10.6%) were the most commonly used substances. Only gender and age were associated with the lifetime use of tobacco and solvents (p < 0.05).

CONCLUSION

The information provided a useful baseline on which subsequent interventions could be based and evaluated.

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.

Structured and unstructured abstracts in journal articles: a review

Abstracts in journals are important paragraphs in review or original articles, which help one to decide if such articles are worth reading. The layout and the content of abstracts have undergone tremendous changes over the years from traditional, unstructured to structured, informative format. Many journal editors abroad are moving fast with time in the adoption of the innovation, allowing only articles with structured abstracts to appear in their journals. Journals in Africa especially in Nigeria are lagging behind in this respect. This review article examines the relative advantage of structured abstracts over unstructured abstracts as documented by various reports on the subject and makes a recommendation for structuring abstracts in articles appearing in Nigerian Journals.