Clinical Profile of Patients on Highly Active Antiretroviral Therapy (HAART) Seen in a Tertiary Eye Clinic

Background

Highly active antiretroviral therapy (HAART) is the medication regimen for the management of human immunodeficiency virus. Over time, it has been dubbed to have revolutionised the clinical course and outcomes of HIV/AIDS.

Objective

The objective of this study is to determine the clinical factors associated with the ocular manifestation of HIV/AIDS among patients on HAART.

Materials and Methods

This was a descriptive cross-sectional study conducted at the ophthalmology department of the University of Nigeria Teaching Hospital (UNTH) in 2017 among adult patients (≥18 years) attending the hospital's antiretroviral therapy (ART) clinic and selected using systematic random sampling technique. Statistical Package for Social Sciences (SPSS) version 21 was used for data analysis, with variables being summarised using frequencies and proportions. Inferential statistics (t test, Chi-square test, and Fisher's exact test) was used to test associations between variables. A level of significance was set at a P value of less than 0.05 corresponding to a 95% confidence interval.

Results

A majority of patients were in WHO stages 1 and 2 of HIV and the mean CD4+ cell count of the whole population was 575.0 ± 512.56 cells/µL, while that of those with ocular manifestations was 315.2 ± 290.76 and 633.7 ± 533.54 cells/µL for those who do not have ocular manifestation. There was a significant association between CD4+ cell count and ocular manifestations such as conjunctival microvasculopathy, anterior uveitis, and cytomegalovirus retinitis.

Conclusion

Our results suggest that HAART has some positive effect on the clinical profile of people with HIV/AIDS with CD4+ count being a major determinant of ocular manifestations.

Serum leptin levels and relationship with maternal weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria: a comparative cross-sectional study

OBJECTIVE

To determine and compare the mean maternal serum leptin levels, the prevalence of high serum leptin levels and mean gestational weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria.

METHODS

This cross-sectional comparative study enrolled obese and non-obese pregnant women. The serum leptin levels of the women were determined using an enzyme-linked immunosorbent assay kit. Anthropometric and sociodemographic data were obtained and compared. Mean weight gain during pregnancy was determined.

RESULTS

A total of 170 pregnant women were included in the study. The mean ± SD serum leptin level (99.39 ± 50.2 ng/ml) and the prevalence of hyperleptinaemia (81 of 85 patients; 95.3%) among the obese pregnant women at term were significantly higher than those of the non-obese pregnant women (48.98 ± 30.35 ng/ml/65 of 85 patients; 76.5%). The mean percentage weight gain was significantly higher in the non-obese women compared with the obese women at term. The predictors of high maternal serum leptin level at term among the participants were the employment status and levels of education of the participants.

CONCLUSION

Maternal serum leptin level, maternal weight gain and prevalence of hyperleptinaemia at term were significantly higher in the obese compared with the non-obese pregnant women.

Qualitative study of the stigma associated with the lived experiences of Buruli ulcer disease among patients in Nigeria

BACKGROUND

Buruli ulcer disease (BUD) is a neglected tropical disease of the skin, subcutaneous tissue and bone caused by Mycobacterium ulcerans, with various disabling and stigmatising sequelae. Patients face a range of adverse impacts owing to the disease as most are unable to relate effectively with their communities, battling stigma and fear of discrimination. This study aimed to explore the stigma associated with the lived experiences of BUD in patients in Nigeria.

METHODS

This was a cross-sectional qualitative study that employed a focus group discussion (FGD) and key informant interviews in Enugu State, Nigeria. A random sampling of communities was followed by a purposive selection of FGD participants and key informants. A total of six key informants and eight FGD participants took part in the study. Data were collected over 6 wk from December 2022 to February 2023. The NVivo application was used to analyse transcripts and compute themes of quotes.

RESULTS

Patients experienced stigma owing to the condition. The most reported experiences by participants were shame and culpability, isolation and social exclusion, including maltreatment from family members.

CONCLUSIONS

Identifying the stigma experienced by patients owing to BUD helps in the provision of psychosocial management services and support for patients.

Radiological Analysis of Cassava Samples From a Coal Mining Area in Enugu State Nigeria

Cassava holds a vital position as a staple food in Nigeria, forming a significant portion of the daily diet for the population. Unfortunately, food intake can serve as a pathway for radiological contamination in humans and animals. In this study conducted in an old coal mining area in Enugu State, Nigeria, cassava samples from the area were analyzed using gamma ray spectroscopy. The results revealed significant mean activity concentrations of the radionuclides 40K, 226Ra, and 232Th in camp 1, camp 2, and Pottery areas. The activity concentration ranged from 193.68 to 300.92 Bq/kg for 40 K, 23.03 to 37.24 Bq/kg for 226Ra, and 135.33 to 158.43 Bq/kg for 232Th, respectively. Of concern is the total mean annual effective dose resulting from exposure to these 3 observed radionuclides that was calculated to be 2.03 mSv/yr. This value exceeds the recommended limit of 1 mSv/yr, indicating potential health risks associated with the radiological contamination from cassava consumption in this region. In summary, the study shows that cassava samples from the investigated area exhibited elevated levels of radiotoxicity, raising concerns about the safety of consuming cassava from this region as a food source.

Willingness of college students aged 10 to 24 years to get vaccinated against COVID-19 disease: a cross-sectional study in South-East Nigeria

Background

Willingness to be vaccinated against COVID-19 is a topical issue that may change the course and distribution of the pandemic in the country.

Objectives

This study was aimed to determine the willingness to receive the COVID-19 vaccine among college adolescents and associated factors.

Methodology

This was a cross-sectional study carried out among one thousand college adolescents in six secondary schools in Enugu from April to August 2021. A pretested, self-administered questionnaire was used for data collection. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software version 25. Descriptive statistics were used to describe college adolescents' characteristics. Categorical variables were reported as frequencies and percentages. Predictors of willingness to vaccinate were assessed using binary logistic regression.

Results

A minor proportion of the respondents, 13.2% (153) were willing to receive the COVID-19 vaccine. The respondents who were males were 1.6 times more willing to receive the COVID-19 vaccination when compared with those who were females. (AOR=1.6, 95%CI: 1.1- 2.3). The respondents who were aware they could be infected with COVID-19 were twice more likely to receive COVID-19 vaccination when compared with those who felt they could not be infected. (AOR=2.0, 95%CI: 1.1-3.1). The respondents who had good knowledge of COVID-19 vaccination were 2.2 times more likely to receive COVID-19 vaccination when compared with those who had poor knowledge. (AOR=2.2, 955CI: 1.5-3.3).

Conclusion

A small fraction of college adolescents were willing to receive the COVID-19 vaccine. Male gender, knowledge of vaccine and possibility of transmitting infection are predictors of willingness to receive the vaccination.

An appraisal of the implementation of the national school feeding programme and its effect on enrolment and attendance in public primary schools in Southeast, Nigeria: perception of heads of schools

INTRODUCTION

The National Home Grown School Feeding Programme (NHGSFP) was re-launched in Nigeria in 2016, eleven years after it was first introduced in the country, with Enugu as one of the beneficiary States. The objectives of the programme are to improve the health of school children and aid in the realization of Universal Basic Education (UBE) goals. This study explored the opinions of heads of public primary schools on the implementation and policy benefits of NHGSFP in Enugu, southeast Nigeria.

METHODS

This was a cross-sectional study conducted among 24 headmasters and headmistresses purposively selected from public primary schools in the Enugu metropolis. Qualitative data were collected through the use of a pretested Key Informant Interview (KII) guide, and analyzed using a thematic approach.

RESULTS

All the participants were aware of the NHGSFP, which involved the provision of one mid-day meal per child per school day to the pupils, and all their schools were part of the programme. Most of the participants complained about the nutritional quality and quantity of the school meals which they felt were poor. None of the schools had a kitchen within the school premises, and all the participants admitted that deworming was not regularly carried out, as part of the programme. Most of the participants believed that the objectives of the feeding programme, including, reduced hunger among learners, increased school enrolment, attendance and enhanced participatory learning, were being met.

CONCLUSION

Although the NHGSFP was implemented in every school in Enugu metropolis, Enugu State, Nigeria, regular deworming of pupils was not carried out, and there were concerns about certain aspects of the implementation, such as inadequate funding and poor quality of school meals. Thus, there is a need for the introduction of deworming and more allocation of funds to the programme to improve the quantity and nutritional quality of school meals.

A randomised controlled trial of a cognitive behaviourally informed intervention for changing violent sexual attitudes among adult sexual offenders in prison

BACKGROUND

Predatory sexual acts by adults cause concern worldwide. Patterns of distorted thinking and weakened self-control are among the leading explanations. Amidst growing concerns about sexual offences in Nigeria, it might be that more psychologically informed interventions in prison could reduce the risks of further harm compared with the standard prison regime.

AIMS

To test the effectiveness of a cognitive behaviourally informed intervention (CBII) in reducing violent sexual attitudes among men in prison in Nigeria for a sexual offence.

METHODS

In a randomised controlled trial, men in two prisons who responded to in-prison advertising about the trial were screened for nature of offence and willingness to participate. Those nearing their sentence end or in other psychological therapy were excluded. Sample size was confirmed by power calculation. The Compulsive Sexual Behaviour Inventory (CSBI-22) and the Hypersexual Behaviour Inventory (HBI) were administered before, immediately after and 3 months after completion of a 12-session (18 h) Cognitive Behavioural Informed Intervention or equivalent periods of 'treatment as usual' (TAU) alone. The CBII was designed to change sexual attitudes, and delivered by trained cognitive therapists to the men, as a group, in one of the prisons while the controls received only TAU in the other.

RESULTS

Before the intervention, the 39 men in each group had similar psychosocial histories and sexual attitude scores. Following CBII, the intervention group showed a significant reduction in scale scores that was sustained, whereas the TAU group showed no significant change in scores. An ANCOVA analysis confirmed between-group differences immediately after the intervention and 3 months later.

CONCLUSIONS

This randomised controlled trial adds to existing knowledge in the field because prior studies have been from high income countries, where interventions are generally delivered in more privacy and at greater length. Given that our study had to be limited to change in sexual attitudes as the main outcome, future research must focus on the extent to which such change maps on to changes in interpersonal behaviour among such men. If these findings can be extended in this way and replicated, this could pave the way for more cost-efficient interventions in higher income countries too.

Presentation weight indices for patients with cleft and non-affected children: A two-centre study

BACKGROUND

Children with cleft lip and/or palate (CL/P) face many challenges in the society. They tend to suffer malnutrition and therefore poor weight gain due to lack of standard care, especially from their parents and society at large. The poor weight gain leads to delayed surgical repair of the cleft abnormality leading to prolonged nutritional and psychological challenges for all concerned.

OBJECTIVE

The aim of the study was to determine if children without cleft abnormalities presenting for routine immunisation and children with cleft abnormalities are both likely to be less than the 75^th percentile of expected weight at the time of presentation, and if there is any difference in presenting weight amongst children with different cleft types.

MATERIALS AND METHODS

This was a retrospective study. Data of children that attended the immunisation clinic of the Department of Primary Health of the National Orthopaedic Hospital, Enugu, and routine surgical clinic of the National Orthopaedic Hospital, Enugu, Nigeria, and the Good Shepherd Specialist Hospital, Enugu, Nigeria, between January 2010 and December 2014 with a diagnosis of CL/P, were obtained from the medical records. The data were analysed with SPSS and the confidence interval was 95%.

RESULTS

A total of 923 medical records were reviewed for the study, out of which 363 were for children with cleft abnormalities. There was no significant difference in the weight of the children without cleft and presenting for routine immunisation compared with their expected 75^th percentile, or children with cleft abnormality compared with their expected 75^th percentile (either in their first or in their second visits). With the children that presented with CL/P, there was a significant difference noted amongst children with both CL/P deformity with the expected 75^th percentile weight, irrespective of whether the combination was unilateral or bilateral, with P = 0.041. This difference was noted in their first visit.

CONCLUSION

Children with combined CL/P are at risk of presenting with poor weight. Nutritional rehabilitation considered early with children with cleft and particularly those children with combined CL/P.

Awareness and knowledge of risk factors associated with oral cancer among military personnel in Nigeria

Background

The military lifestyle has been reported to increase the risk of this population group to the development of oral cancer.

Aim

This study aimed to determine the awareness and knowledge of oral cancer in a population of soldiers to acquire data for establishing an educational program for units of the Nigerian Army in oral cancer prevention and monitoring. The study was conducted in the dental center of 82 Division Military Hospital, Nigerian Army, Enugu, Nigeria. A cross-sectional survey was performed using a pre-tested self-administered questionnaire.

Materials and Methods

Questions relating to oral cancer awareness, knowledge of causes, and relationship to certain habits, treatment options, and desirability of screening opportunities for oral cancer were asked. Soldiers attending the military hospital, dental center, were chosen randomly for the study.

Results

Three hundred soldiers were surveyed. The mean age of those surveyed was 37.5 and had spent an average of 11-15 years in the Army. The majority of the soldiers (80.7%) have heard of cancer; the types most known were breast (75%), skin (30%), and lung cancer (28.3%). Of the 300 soldiers surveyed, 15.3% knew about oral cancer, with 41.3% of these able to identify cigarette smoking and (26%) alcohol consumption as possible risk factors associated with oral cancer. The majority believed that cancer was caused by some form of supernatural phenomenon.

Conclusion

Oral cancer awareness is low among soldiers in the Nigerian Armed Forces, and strategies to increase awareness should be developed.

Pentazocine with rectal diclofenac versus pentazocine alone for pain relief following caesarean delivery in Enugu, Nigeria: A randomized controlled trial

Objective

To measure postoperative pain relief following the use of rectal diclofenac combined with intramuscular pentazocine compared with intramuscular pentazocine alone in patients undergoing a caesarean delivery.

Methods

This single-blind randomized controlled trial enrolled pregnant women that had a caesarean section at the Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria. Study participants were randomized to receive either 100 mg of rectal diclofenac given every 12 h plus 30 mg of intramuscular pentazocine given every 6 h (group A) or 60 mg of intramuscular pentazocine given every 6 h (group B). The primary outcome was the level of pain as measured using a visual analogue scale. The secondary outcomes were the level of satisfaction with pain relief and need for rescue analgesia.

Results

A total of 200 participants were randomized equally into the two groups. Participants in group A had significantly better pain control and satisfaction over the 48 h after surgery compared with group B. Significantly more of group B required rescue analgesia for breakthrough pain compared with group A.

Conclusion

Rectal diclofenac combined with intramuscular pentazocine was significantly better at controlling pain compared with pentazocine alone in the first 48 h following caesarean section.

Trial registration number: PACTR202107706925314 at www.pactr.org on 28 July 2021.

Prevalence and patterns of gender-based violence in Enugu, Nigeria: a cross-sectional study

Introduction

gender-based violence remains one of the most persistent human rights abuse in the world and with the emergence of the COVID-19 pandemic and its attendant mitigating protocols; Gender-based violence (GBV) could be on the rise with changes in its pattern and presentation. The aim of the study was to determine the prevalence and patterns of GBV among victims presenting in a tertiary health facility in South-East Nigeria during the first phase of the COVID-19 pandemic.

Methods

this was a retrospective cross-sectional study, among 710 victims of GBV, who reported and received care at the GBV unit in a tertiary hospital in Enugu, South-east Nigeria. A pro forma designed by the researchers was used to collect secondary data from GBV facility screening forms and folders of all patients that reported any form of GBV over a 3-year period (2018 - 2020).

Results

majority (89.9%) of victims of GBV were females and over a half (51.4%) of the cases were in the age group 20-39 years. In total, 56.8% of the GBV cases had been sexually abused. The pattern of GBV over the three years period under study revealed an increase in proportion for both sexual and physical/emotional violence, with a peak in 2019 and a reduction of cases in 2020. Persons below 19 years of age were 23 times more likely to experience sexual violence, than those between 40-59 years of age (AOR: 23.332; 95% CI: 11.037 -49.325) p<0.001. Males were 11 times more likely to experience physical/emotional violence than females (AOR: 11.136; 95% CI: 4.685-26.471) p<0.001. Age, gender, urban dwelling and year of occurrence were significant predictors of GBV.

Conclusion

GBV is a cause for concern in Enugu Nigeria; affecting mainly young female victims in their prime. There is an increase in reported cases of GBV in Enugu Nigeria with sexual abuse being more prevalent.

Factors affecting adherence to anti-retroviral therapy among women attending HIV clinic of a tertiary health institution in SouthEastern, Nigeria

Background

Strictly adherence to antiretroviral therapy (ART) is needed to achieve viral suppression. Studies have focused on HIV positive pregnant women's adherence. Factors affecting non-pregnant HIV positive women's adherence has been understudied in Enugu.

Objective

The study objective was to identify factors affecting adherence to ART among HIV positive women attending retroviral clinic of a tertiary hospital in Enugu.

Methods

Using a descriptive cross-sectional design, a pre-tested structured questionnaire was used for data collection among 286 HIV positive women aged 18 years and above. Data were analyzed using descriptive statistics of proportions, percentages, and means. Responses with a mean score of ≥2.5 were taken as important factor affecting adherence.

Results

Overall adherence was 56.2%. Participants were considered adherent if they took ≥95% of their prescribed ART. Lack of transport fare (2.69 ±1.36), long-distance to clinic (2.82±1.26), health workers' poor attitude (2.74±1.28), and lack of partners' and parents' support (2.57±1.05) affected adherence negatively while ease in renewing prescription and minimal side effects of drugs enhanced adherence. Enfuvirtide (21.1%) and Lamivudine (17.4%) were drugs that were mostly skipped.

Conclusions

Adherence to ART was low among the women attending the HIV clinic in Enugu. Adherence counseling and education should be provided before ART initiation. Strategies to reduce stigma, increase family support, and improve healthcare providers' attitudes should be employed.

Magnitude and predictors of female domestic abuse in pregnancy in a patriarchal African society: a cross-sectional study of pregnant women in Enugu, South East Nigeria

Introduction

domestic abuse against women is very common globally and has far-reaching consequences on the society. Therefore, it is essential to deeply study the seriousness of this public health issue among our pregnant women. The objectives were to determine the prevalence, pattern, and predictors of domestic abuse among pregnant women in Enugu, Nigeria.

Methods

a cross-sectional study of 400 consenting pregnant women at the antenatal clinics of the University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria. Each woman completed a modified abuse assessment screen structured questionnaire. Data analysis was descriptive and inferential with Chi-square and multivariate binary logistic regression using SPSS version 21. A p-value of <0.05 was considered statistically significant.

Results

a total of 172 out of 400 respondents (43.0%) had ever experienced domestic abuse in their pregnancies. One hundred and ten (37.2%; 110/296) of the multigravid women were abused in previous pregnancies while 137 (34.3%; 137/400) of all respondents were being abused in the current pregnancy. For all pregnancies, the most common type of abuse experienced by the respondents was verbal abuse (85.5%; 147/172), while the commonest perpetrators of abuse were the respondents´ spouses for both the index pregnancy (82.5%; 113/137) and previous pregnancies (84.5%; 93/110). The most common women perceived cause of abuse was financial constraints (68.6%; 118/172). Age less than 25 years (AOR=1.9, 95% CI=1.01-3.76, p=0.048), not having tertiary education (AOR=2.0, 95% CI=1.17 - 3.25, p=0.01), having at least a male child (AOR=3.3, 95% CI=1.71 - 6.40, p=<0.001), and maternal unemployed status (AOR=2.0, 95% CI=1.27 - 3.19, p=0.003) were the identified predictors among women abused in pregnancy.

Conclusion

the prevalence of domestic abuse was high among pregnant women in the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria. The predominant women perceived cause of domestic abuse was financial constraints while age less than 25 years, not having tertiary education, having at least a male child, and maternal unemployed status were the predictors in abused women. Domestic abuse poses a great threat to women´s reproductive health, and so, its screening should be incorporated into antenatal care in our environment.

Spectacle design preferences among school children in Enugu State, Nigeria

Background

Uncorrected refractive error has profound effects on children's educational and social development and spectacles are cost-effective in correcting this. However, the cosmetic appearance of spectacles may affect compliance to prescribed spectacles.

Aims

This study explored spectacle design preferences of school children in Enugu State, Nigeria and any associated sociodemographic factors. A cross-sectional study among children aged 5-15 years from schools in Enugu state, Nigeria.

Patients and Methods

The children independently selected from sets of spectacle frames, indicating their preferences on the basis of spectacle frame color, material, shape and size of the lens portion, design of the earpiece portions. Simple descriptive analysis was performed. Frequency tables were generated. Pearson's Chi-square test was used to test associations between categorical variables. Odds ratios were used to measure the strength of the associations where P < 0.05. Tests of significance were set at the 95% level.

Results

A total of 1,167 children (45.6% male and 54.4% female) were seen. Majority of the children preferred red colored spectacle frames 467 (40%), plastic frames 723 (62%), rectangular shaped lens-pieces (55.2%), and frames with a straight earpiece 987 (84.6%). There is a strong association between gender and choice of spectacle colour (P < 0.01), gender and lens size preference (P < 0.05), and between school location and shapes of spectacle earpiece (P < 0.01).

Conclusions

Spectacle preferences exist among the study population and some demographic factors are associated with these preferences which should be considered in any childhood refractive error services.

Serum folate levels in children on long-term anti-seizure medication in a Nigerian tertiary center-Implications for practice and public health

BACKGROUND

Epilepsy is the most common childhood neurological disorder in Nigeria. Treatment of epilepsy is long-term and sometimes lifelong with anti-seizure medications. There are conflicting reports on the effect of anti-seizure medications on serum folate. There is therefore a need to determine the effect of a commonly used anti-seizure medication's on serum folate levels of children. This would provide an evidence-based consideration for folic acid supplementation in children on anti-seizure medication as has been suggested by some studies.

STUDY OBJECTIVES

To determine whether serum folate levels were lower in children taking long-term carbamazepine or sodium valproate, compared to a control group.

METHODS

Serum folic acid levels were measured from well-nourished children between the ages of 1-17 years on carbamazepine and sodium valproate monotherapy and their age/sex-matched controls, using spectrophotometry.

RESULTS

The mean serum folate levels of patients on carbamazepine (43) and sodium valproate (22) were 0.032 mg/l ± 0.009 and 0.028 mg/l  ±  0.008, respectively. The mean folate levels of the controls were 0.046 mg/l  ±  0.03 (p = 0 001). No statistically significant difference was observed between the serum folate levels of children on the two anti-seizure medications, that is, carbamazepine and valproate.

CONCLUSION

The children on treatment with carbamazepine and sodium valproate for more than 6 months had statistically significantly lower serum levels of folic acid compared to the standard reference range and controls. The serum folate levels of children on carbamazepine were not statistically different from those on sodium valproate.

Pregnant women utilization of dental services: still a challenge in low resource setting

Background

Poor oral health in pregnancy can be associated with poor pregnancy outcome, however, dental consultation among pregnant women appears to be low.

Methods

This was a questionnaire-based study of 413 women who attended the antenatal clinic of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu. The information obtained was analyzed using SPSS version 22. A p-value of less than 0.05 was considered statistically significant.

Results

Only 36 (8.7%) of the respondents had dental consultations in index pregnancy for complaints such as tooth ache and decay (66.7%) and pain as well as swelling of the gum (33.3%). The most common reason given for not visiting a dentist during the index pregnancy was the visit not being relevant to their pregnancy outcome (69.2%). After counseling them, only 249 (60.3%) agreed to have dental consultation during subsequent pregnancies. The relationship between visiting the dentist and place of residence (< 0.001), occupation (0.019) and frequency of brushing/ changing of brush (0.005, < 0.001 respectively) were statistically significant.

Conclusion

The prevalence of dental consultation during pregnancy is very low. Pregnant women should be encouraged to have routine dental consultation with oral health counseling and check-up incorporated as part of routine antenatal care.

Prevalence and predictors of child labour among junior public secondary school students in Enugu, Nigeria: a cross-sectional study

BACKGROUND

Globally, millions of children are involved in child labour. However, low- and middle-income countries are mostly hit. This study examined the predictors of child labour among public secondary school students in the Enugu metropolis.

METHODS

This was a descriptive cross-sectional study of 332 junior secondary students attending public schools in Enugu metropolis, Nigeria. Multistage sampling technique was used to select the six secondary schools and the students that participated in the study. Data collection was done from September to October 2018. Pretested structured, interviewer-administered questionnaire was used for data collection. The questionnaire contained information on the sociodemographic variables, the kind of work done by the respondents and the number of working hours spent weekly. UNICEF's standard indicator for child labour was used to estimate the prevalence of child labour. Logistic regression was used to identify socioeconomic predictors of child labour.

RESULTS

The prevalence of overall child labour was 71.7%, while for domestic and economic child labour prevalence were 52.1 and 34.0%, respectively. About 35.2% of the respondents worked under hazardous conditions while 8% were forced to work. Two-thirds (236, 65%) of the respondents who have heard about child labour perceived it as wrong. The child labourers mainly worked to render financial assistance to their parents. The predictors of child labour were class of study (AOR = 2.208 (95% CI: 1.199-4.066) and weekly income earned (AOR = 0.316 (95% CI: 0.176-0.567).

CONCLUSION

The prevalence of child labour among junior students in public secondary schools in Enugu is high, and is predicted by the level of schooling and income earned. Economic and social reforms could contribute to addressing the predictors of child labour.

Relationship between disease severity and folate status of children with sickle cell anaemia in Enugu, South East Nigeria

Background

Repeated crises in children with sickle cell anaemia (SCA), which is a manifestation of disease severity, results in depletion of their minimal tissue folate stores, with higher likelihood of folate deficiency. The study aimed to determine the relationship between disease severity and the folate status of children with SCA attending University of Nigeria Teaching Hospital (UNTH), Enugu.

Methods

This was a hospital based, cross-sectional study conducted between September 2018 and March 2019. One hundred participants were recruited, consisting of 50 children having sickle cell crisis and 50 age and gender matched haemoglobin AA genotype controls. Relevant information was documented using a pretested questionnaire. Sickle cell severity score was determined using frequency of crisis, admissions and transfusions in the preceding one year, degree of liver and splenic enlargement, life-time cummulative frequency of specific complications of SCA, leucocyte count and haematocrit.

Results

Folate deficiency was observed in eight percent of the subjects and none of the controls. The difference was not significant (Fisher's exact = 4.167, p=0.117). The odds of being folate deficient was 8.5 times more likely during anaemic crisis than in vaso-occlusive crisis, though not significant (95% C.I 0.05 – 89.750, p = 0.075). The mean SCA severity score was 8.06 ± 3.64, signifying a moderate SCA severity in the study population. There was a no relationship between folate status and severity of SCA (Fisher's exact = 0.054, p = 0.949)

Conclusion

Folate status in children with SCA is not affected by their disease severity. Therefore, there may be no need for additional folate supplementation with increasing severity of sickle cell anaemia.

Symptoms Associated with Low Threshold Lead Poisoning Among Roadside and Organized Panel Beaters in Enugu Metropolis, Nigeria

BACKGROUND

There is no safe level of human exposure to lead (Pb). Detecting common early symptoms of low threshold Pb poisoning can help to prevent the damaging effects of higher doses and chronic low dose exposures. Panel beaters or auto body mechanics are exposed to Pb through their occupational duties.

OBJECTIVES

The present study aimed to determine common early symptoms associated with lower threshold Pb poisoning among roadside and organized panel beaters in Enugu Metropolis, Nigeria.

METHODS

This was a comparative cross-sectional study of 428 panel beaters in Enugu metropolis. A multi-stage sampling method was used to select 214 respondents each from the roadside and organized sectors. A semi-structured interviewer-administered questionnaire was used for data collection. Samples were collected under aseptic procedures. Blood Pb samples were extracted using the conventional wet acid digestion method and analyzed using a flame atomic absorption spectrometer (wavelength 283.3 nm). Comparative analysis was performed using the chi - square and Mann-Whitney U test. Statistical significance was set at P < 0.05.

RESULTS

Median Pb levels were 3.0 ug/dL and 16.0 ug/dL among roadside and organized panel beaters, respectively, with a significant difference. Numbness of limbs (P = 0.010) and fatigue (χ² = 5.294, P = 0.023) were found to be associated with roadside panel beaters, while weakness (χ² = 6.185, P = 0.019) and fatigue (χ² = 4.206, P = 0.046) were associated with organized panel beaters.

CONCLUSIONS

Nonspecific constitutional symptoms were common early symptoms of Pb poisoning irrespective of workplace occupational practices. These symptoms will help in early detection and control of occupational lead exposures.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

Ethics approval was obtained from the Health Research Ethics Committee of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu.

COMPETING INTERESTS

The authors declare no competing financial interests.

Pattern of Female Genital Mutilation among Adolescents Attending Secondary Schools' in Enugu Metropolis

BACKGROUND

Female genital mutilation (FGM) is a public health menace and it study among adolescents is not exhaustive.

OBJECTIVES

The aim is to study the prevalence, pattern, cultural values, health implications and consequences of FGM among adolescent females attending secondary schools in Enugu metropolis.

METHODS

A descriptive study involving female adolescents aged 13-21 years recruited by multistage sampling in three Girls Secondary Schools in Enugu Metropolis.

RESULTS

Four hundred and fifty (450) questionnaires were distributed and four hundred and fourteen (414) were retrieved. The parents with moderate value for culture and tradition had the highest circumcised respondents (7.8%) (p = 0.056). Majority of the respondents, 93.7% were aware of female circumcision. The major complications of female circumcision according to the respondents were painful urination and menstrual problems. The prevalence of female circumcision among the respondents was 9.4%. A minor proportion of the respondents, 5.8% were of the opinion that all females should be circumcised. Respondents whose fathers attained tertiary education were three times less likely to be circumcised when compared with those whose fathers attained secondary education and less (adjusted odds ratio  = 0.3; 95% CI: 0.3-1.5).

CONCLUSION

Prevalence of FGM among adolescents aged 13-21 years in Enugu metropolis was 9.4%. Majority of the respondents had good knowledge of FGM, and major complications noted were painful urination and menstrual problems. Fathers education level is a very strong reason for this high awareness of FGM among female adolescents.

Distracted Driving and Cell Phone use by Nigerian Road Users: A Cross-sectional Study

Background

This study ascertained the level of distraction attributable to cell phone by drivers in Enugu.

Methodology

This study was conducted in Enugu, Nigeria using a validated structured questionnaire randomly administered to drivers in different locations in the city. Study period was 2 months and different forms of distraction while driving were tested.

Result

There were 500 participants in the study. 306(61.2%) were males and 194(38.8%) were females. The mean age of respondents was 43.85±9.89 years. Ninety-nine percent of respondents were aware of the ban on use of cell phones while driving but as much as 97.8% of the drivers still use cell phones while driving.

Conclusion

Level of distracted driving in Enugu is quite high and this has the potential to cause serious road crashes which can impact negatively on the lives of the people. The need for concerted effort to educate people on the dangers of cell phone use while driving cannot be over emphasized.

Key Lessons

- There is a paucity of literature on distracted driving in Nigeria even with the high incidence of Road Traffic Accident.- Awareness of laws on distracted driving is not the challenge rather it is compliance. There is need for ways of enforcing the existing laws on distracted driving as mere knowledge of the provisions of the law does not ensure compliance.- Enforcement of laws on distracted driving will play a preventive role in reducing the incidence of RTAs and its associated health implications.

Achieving universal health coverage in Nigeria: the dilemma of accessing dental care in Enugu state, Nigeria, a mixed methods study

OBJECTIVE

Equitable access to oral healthcare is a major focus of the Universal health coverage debate in Nigeria. However, a great majority of the population still do not have full coverage for essential oral healthcare services. This study will determine the extent of inequities in accessing oral healthcare services and the factors influencing access to equitable oral healthcare in Enugu state Nigeria.

METHODS

A descriptive cross-sectional, urban and rural study conducted over two months in Enugu state Nigeria, using a mixed method approach. The quantitative study design used interviewer administered questionnaires to elicit information from 774 household members (394 urban and 380 rural) in study area who had sought dental care 6 months prior to study, and dental care providers (52) in selected dental health facilities. The qualitative study design involved in-depth interview of heads of selected dental health facilities to investigate factors influencing provision of dental care. Household data was collected house to house from randomly selected households in the LGA, while a face-to-face in-depth interview was conducted for purposively selected oral health professionals from study facilities.

RESULTS

Majority of respondents sought care when they had toothache (72%). There was inequity in utilization of dental care across socioeconomic status groups (SES). The least poor SES (Q5) sought dental care in the private facilities, and chose to have dental fillings more than the poorest (Q1) and very poor SES (Q2) who visited public facilities and patent medicine dealer shops more and opted more for tooth extractions.(p < 0.05) Cost of services influenced access and treatment choice more among Q1 and Q2 than Q5 (p < 0.05) Qualitative results show that facility location, low awareness, human resource shortage and oral health financing methods influenced access.

CONCLUSION

Increased awareness and inclusion of oral healthcare in all health insurance schemes with expansion of current oral healthcare benefit package will improve access to care and further improve chances of attaining universal health coverage.

Nutritional status of primary school children: Association with intelligence quotient and academic performance

BACKGROUND

Nutrition plays a pivotal role in brain development throughout life. Sub-optimal intellectual ability and poor school performance are said to be among the long term effects of malnutrition. The aim of this study was to determine the association between nutritional status of the participants, their intelligence quotient (IQ) and academic performance.

METHODS

Children aged 6-12 years who met the inclusion criteria were recruited from the public and private primary schools in the local government area using a proportionate multistage sampling technique. Weight and height were measured using standard protocols and interpreted as normal or abnormal using the World Health Organization AnthroPlus®. IQ was assessed using the Raven's Standard Progressive Matrices and was grouped into optimal and suboptimal. Academic performance was assessed using the past records of class assessment, and was classified into high, average and low academic performance. A semi-structured questionnaire was used to obtain data such as-age, gender, socioeconomic indices and family size of the study participants.

RESULTS

The prevalence of underweight, thinness (wasting), stunting, overweight and obesity were 2.0%, 3.6%, 2.1%, 6.7%, and 4.2%, respectively. Indices of over-nutrition were significantly associated with optimal IQ and good academic performance. There was a trend in the association between wasting and suboptimal intelligence [AOR (95%CI) = 1.5 (1.0-3.0), p = 0.06].

CONCLUSION

Acute and chronic under-nutrition did not adversely affect the IQ and academic performance of the study population. The relationship between over-nutrition, IQ and academic performance disappeared when socio-economic status was controlled for.

Right ventricular function among South East Nigeria children with sickle cell anaemia

BACKGROUND

Sickle cell anaemia (SCA) is characterized by attendant ischemia-reperfusion injury especially to the heart.

METHODS

The aim of this work is to compare the right ventricular function of children with SCA in steady state (subjects) with those with haemoglobin AA genotype (controls), using echocardiography. It is a cross-sectional study, which echocardiographic measurements to assess right ventricular function among children with SCA and their controls.

RESULTS

The mean trans annular plane systolic excursion (TAPSE) in subjects, 28.24 ± 5.23 (Z score: 0.258 ± 1.10) was higher than that in control, 25.82 ± 3.59 (Z score: - 0.263 ± 0.80), and the difference in mean was statistically significant, (t = 2.703, p = 0.008). Significantly higher proportion of subjects with sickle cell anaemia had right ventricular dysfunction (Abnormal TAPSE), 25 (50.0%) when compared with those in control, 11 (22.0%), {χ2 = 8.5, p = 0.0035}. A higher proportion of subjects with sickle cell anaemia (25.5%) had Pulmonary hypertension (RVP) when compared with control (2.0%) and the difference in proportions was found to be statistically significant, (χ2 = 11.668, p = 0.001). The prevalence of right ventricular diastolic dysfunction in subjects was 9.8% while control was 0%.

CONCLUSION

Children with sickle cell anaemia present with right ventricular dysfunction. Prevalence of right ventricular systolic and diastolic dysfunction were higher in subjects. More of the subjects in this study (25.5%) had pulmonary hypertension.

Evaluation of Wait Time in the Children's Emergency and Outpatient Units of a Tertiary Hospital in Southeast Nigeria

Background:

Promptness of intervention in the emergency room (ER) or outpatient unit is a major determinant of outcome in acutely ill children. Time is, therefore, of the essence in trying to reduce complications and mortality associated with children.

Methods:

This was a cross-sectional study conducted in the children ER and the children outpatient unit of the Enugu State University Teaching Hospital (ESUTH), Enugu, Southeast Nigeria. Waiting time defined as the time between arrival and doctor consultation was calculated.

Results:

A total of 248 respondents were enrolled during the study period. In the emergency unit, majority (67.5%) of the respondents' sick children were attended to almost immediately, while 13.3% and 19.3% waited for ≤10 and >10 min, respectively, before being attended to by a doctor. The mean waiting time in the emergency unit was approximately 9.27 ± 29.2 min (95% confidence interval [CI]: 2.90–15.65 min) with a range of 0–56 min. In the outpatient unit, the mean waiting time was 12.67 ± 15.3 min (95% CI: 10.31–15.01 min) with a time range of 5–245 min. Eighty-five (51.5%) of the 165 respondents waited for <10 min, 60 (36.4%) waited for between 10 and 30 min, while 20 (12.1%) waited for >30 min before their sick children were attended by a doctor.

Conclusion:

The mean waiting times reported in this study in the emergency and outpatient units of the ESUTH were within acceptable standards. However, there were cases where the waiting time in both children's units was exceptionally long. There is need for continued monitoring and evaluation of waiting times in these units for prompt attention to patients.

Effectiveness of a Comprehensive 4-Week Course in HIV Medicine for Postgraduate Doctors at University of Nigeria: A Preservice Education Initiative

There is a critical shortage of trained human immunodeficiency virus (HIV) providers in resource-limited settings. To strengthen preservice HIV training for postgraduate health care providers, University of Maryland’s Institute of Human Virology and Center for Clinical Care and Research Nigeria collaborated with University of Nigeria to plan and implement a comprehensive 4-week course in HIV medicine. The first course was piloted with 30 postgraduate doctors. Mean objective structured clinical examinations (OSCE), pretest, and posttest scores score were 51%, 53%, and 75%, respectively; follow-up examination at 6 months showed mean score of 74%. In multivariate regression analysis, pretest score was positively associated with posttest score (22.03, P < .001) and OSCE (0.29, P = .04), age negatively associated with pretest score (−0.94, P = .001), and female gender positively associated with OSCE score (6.15, P = .05). Six- and 18-month online surveys revealed trainees continued to apply knowledge and skills gained. North–south university collaborations to develop practicum-based preservice curricula offer a sustainable way to strengthen preservice evidence-based HIV medicine training with long-lasting retention of skills and knowledge.

A Comparison of the Characteristics of Maternal Near-Misses and Maternal Deaths in Enugu, Southeast Nigeria: A 3-Year Prospective Study

BACKGROUND

Maternal near-misses, also known as severe acute maternal morbidity, have become globally recognized as an appropriate indicator of obstetric care. Women experiencing maternal near-misses are more in number than maternal deaths, and can provide more specific and detailed evidence, as the patient herself can be a leading source of useful information.

OBJECTIVE

To determine the frequency of maternal near-misses and maternal deaths in the University of Nigeria Teaching Hospital in Ituku-Ozalla, Enugu, document the primary determinant factor that caused these, and compare cases of maternal near-miss and maternal deaths.

METHODS

This was a 3-year prospective study of all women admitted for delivery or within 42 days of delivery or termination of pregnancy at the hospital. Data were collected prospectively in consecutive patients in a pro forma manner and entered into SPSS version 17 for Windows.

RESULTS

There was a total of 2,236 deliveries, of which 88 had severe maternal outcomes. Of the latter, 60 were maternal near-misses, while 28 suffered maternal death. The maternal near-miss:mortality ratio was found to be 2.14. The maternal mortality ratio here was 1,252 per 100,000. All the 88 women that had severe maternal outcomes lived at least 5 km from the hospital. The leading organ-system dysfunction in this study was cardiovascular, manifesting as shock and cardiac arrest, and respiratory, manifesting as gasping and cyanosis. Leading complications were severe hemorrhage, anemia, and hypertensive disorders. The pattern of complications was similar in both near-misses and maternal deaths, but cases of hypertensive disorders and exploratory laparotomy as an intervention for those with organ dysfunction were noted to be higher in near-miss cases, and differences were statistically significant.

CONCLUSION

It was concluded that despite numerous similarities in the characteristics of patients who had had maternal near-misses or died, our study points out that those who succumb to death are often <40 years of age, poorly educated, unemployed, usually present as unbooked emergencies from a distance >5 km and suffer maternal death within 24 hours of presentation.

Prevalence of psychological workplace violence among employees of a public tertiary health facility in Enugu, Southeast Nigeria

BACKGROUND

Psychological violence is the most common form of workplace violence (WPV) that can affect job performance and health of the workers.

AIMS

This study sought to determine the prevalence of psychological WPV among employees working in a tertiary health institution in a South-eastern state of Nigeria.

METHODS

A descriptive cross-sectional study done in 2018 among healthcare workers at the University of Nigeria Teaching Hospital Enugu State using a pretested self-administered questionnaire adapted from Workplace Violence in the Health Sector Country Case Study Questionnaire. Proportionate sampling method was used to select 412 respondents. Data were analyzed with SPSS version 23 using Chi-square test of significance and P value set at 0.05.

RESULTS

Prevalence of psychological violence among the participants was 49.7%. Verbal abuse was the most form of psychological violence experienced 168 (40.8%) followed by bullying 29 (7.0%) while sexual abuse was reported by 8 (1.9%). Majority 114 (55.6%) of the perpetrators of the psychological violence were patient's relative, whereas 48 (23.4%) were staff members. In response to the violence, 58 (28.6%) of the healthcare workers took no action, while only 2 (1%) completed incident/accident form. Bullying was statistically significantly higher in healthcare workers who have spent less than 10 years (χ² = 3.978 P = 0.046). There was a significant association between verbal abuse and frequent interaction with patients (χ² = 4.757, P = 0.029).

CONCLUSION

This study has shown that the prevalence of psychological WPV was high among healthcare workers in University of Nigeria Teaching Hospital, Enugu State. Therefore, there is need for the hospital management to develop policy interventions specific to psychological WPV.

Prevalence of malaria in HIV positive and HIV negative pregnant women attending antenatal clinics in south eastern Nigeria

Introduction

Globally, malaria in pregnancy is a public health challenge. Malaria and HIV are among the two most important diseases contributing to the global health burden of our time. HIV positive pregnant women are at increased risk of all the adverse outcomes of malaria in pregnancy.

Objective

The objective of this study was to compare malaria parasitaemia between HIV positive and HIV negative pregnant women attending antenatal clinics offering Preventing Maternal to Child Transmission (PMTCT) services in Enugu metropolis, south-eastern Nigeria.

Methods

A descriptive cross sectional study was conducted among 200 HIV positive and 200 HIV negative pregnant women attending antenatal clinics in Enugu. Two out of five hospitals that provide PMTCT services were selected through balloting. Finger pricked blood samples were collected and thick blood films were examined for malaria parasite using giemsa expert microscopy. A structured interviewer administered questionnaire was used for data collection. Data was analysed using SPSS version 22.

Results

The HIV positive pregnant women (152) (76%) and HIV negative women (137) (68.5%) studied were mostly in the age range of 25-34 years. Mean gestational age of HIV positive and HIV negative participants were 23.4±10.7 and 23.2±10.1 weeks respectively (P=0.001). The prevalence of malaria infection among HIV positive pregnant mothers was 81% (162/200) and 75% (150/200) among HIV negative pregnant women (P < 0.001). The HIV positive mothers had more moderate parasitaemia (86/200: 53.1%) compared to 43/200: 28.7% in HIV negative mothers (P<0.001). Even though more HIV positive mothers (54.5%) used insecticide treated nets ITNs during pregnancy compared to 41.5% in HIV negative mothers, moderate malaria parasitaemia was higher in HIV positive mothers. HIV positive nulliparous pregnant women had the highest rate of malaria parasitaemia (32/36: 88.9%).

Conclusion

Moderate malaria parasitaemia was higher among HIV positive pregnant women. All malaria preventive strategies should be intensified in pregnancy as ITNs provided little protection.

Hypertension in Children: Could the Prevalence be on the Increase?

Background

In children particularly in the developing world, there is a tendency to downplay the role of primary hypertension in their health. In adults, a number of factors have clearly been associated with the incidence of hypertension. Knowledge of the prevalence of hypertension and its associated factors among children in our environment is important and could inform the need for lifestyle changes and routine blood pressure (BP) checks in children so as to reduce BP-related health risks.

Aim

The aim of this study is to document the prevalence of hypertension and its risk factors among children in Enugu, Nigeria.

Materials and Methods

Children aged 6-17 years attending the outpatient clinic of a tertiary hospital, were enrolled for the study. Their socioeconomic status (SES), weight, height, BP, and dipstick urinalysis were measured using standardized methods. Adherence to Mediterranean diet was assessed using the Mediterranean Diet Quality Index (KIDMED). The prevalence of hypertension and the influence of these factors on their BP were analyzed.

Results

Forty-six (9%) of the 491 participants had hypertension. Of these 46 hypertensive children, 72% were females while a significantly higher proportion 57% (P = 0.006), were in the age group 13-17 years. While age, gender, and the presence of protein in urine were significantly associated with hypertension in these children; body mass index, diet, family history of hypertension, and SES were not.

Conclusion

The prevalence of hypertension in children in this environment is high and appears to be increasing. There is need for routine BP and urinalysis check for all children in our clinics and wards.

The Challenges of Management of High-grade Gliomas in Nigeria

Background:

High-grade gliomas (HGG) are among the most challenging brain tumors despite many research efforts worldwide.

Aim:

The aim of this study was to evaluate the local challenges that may influence outcome of HGG managed in a neurosurgical center in Nigeria.

Methodology:

Retrospective analysis of prospectively recorded data of patients managed for intracranial HGG at Memfys Hospital for Neurosurgery, Enugu, Nigeria, between the year 2006 and 2015. Only cases with conclusive histology following surgery were analyzed.

Results:

Glioma was 60 (23.8%) of 252 histology confirmed brain tumors. HGG represented 53.8% of gliomas with male:female ratio of 2.2:1.0 and peaked from fifth decade of life. Glioblastoma multiforme accounted for 69% of HGG. At 1-year postsurgery, 53% of HGGs were dead and 88% of these deaths were in the World Health Organization Grade IV group. Only 40% of cases could receive adjuvant treatment with only 15% mortality at 1 year in this subgroup that received adjuvant therapy. In addition, 19% of cases had surgery at Karnofsky score (Ks) of ≥70%. However, 94% of mortality at 1 year was related to surgery at Ks of ≤60%. Only four patients had a tumor volume of ≤50 cm³, and among these cases, three patients were independent at 1 year. Patients with tumor volume above 50 cm³ accounted for 94% of mortality.

Conclusion:

The peak age incidence for HGG seems to be lower than in Caucasians. Most cases present late with poor Ks and big tumor volume. The proportion with access to adjuvant treatment is still poor. Preoperative Karnofsky, extent of resection, duration of hospital, and Intensive Care Unit stay have impact on outcome.

Determinants of academic performance in medical students: evidence from a medical school in south-east Nigeria

BACKGROUND

Medical education is considered one of the toughest college degrees to acquire. Exploring the factors that determine good academic performance in medical school will help in the planning of curriculum and assist students to navigate through medical school more effectively.

METHODS

This cross-sectional and descriptive study enrolled 145 second year clinical students (500 level) of the Enugu State University of Science and Technology in south-east Nigeria using purposive and convenient sampling method. It assessed factors that predicted good academic performances in surveyed students.

RESULTS

Medical students without membership in any campus group, those that receive(s) less than ten thousand naira (≈US$27) every month as upkeep allowance, those admitted through the University Matriculation Examination, and students who visit their families on a weekly basis were more likely to have better academic performances than those in corresponding categories. Of these significant predictors of good academic performance, mode of admission into medical school (Rs=-0.310 P=0.001) and monthly allowance students got for upkeep (Rs=-0.281 P=0.001) had the strongest correlation with good academic performances.

CONCLUSION

Our study identified factors that correlate with academic performances among medical students. We propose frequent appraisal of these factors and support system that will help improve performance in these students.

Premarital sex and condom use among trainee healthcare workers: an exploratory study of selected healthcare training institutions in Enugu State, Nigeria

INTRODUCTION

To assess the prevalence and causes of premarital sex and condom use among trainee healthcare workers in selected healthcare institutions in Enugu State, Nigeria; and to proffer solution to challenges identified.

METHODS

We used a mixed study approach with qualitative and quantitative components. Informed consent was obtained from participants and data collected using self-administered structured questionnaires. Epi info® was used for data analysis.

RESULTS

A total of 362 respondents (309 unmarried) from four healthcare training institutions participated in the study. Among unmarried respondents, 141 (45.8%) were sexually active. Premarital sex was more common among Pentecostals and sexual activity increased with age (r=0.78; p <0.05). Premarital sexual activity was more common among males and trainee nurses (p <0.005). Although knowledge of condom use was high, actual use was poor (20.1%), with lowest rates among females, Catholics and age-group 30-35 years. Breakages, high failure rates and reduced sexual satisfaction were cited as major factors responsible for poor use. Use of non-specific terms such as "casual sex" and "casual or regular sex partners" hindered consistent, correct condom use.

CONCLUSION

There is a significant gap between knowledge of and actual use of condoms, despite high premarital sexual activity amongst healthcare workers. Furthermore, non-specific terminologies hinders appropriate condom usage. We propose the term: Committed Spousal Partner (CSP) defined as "a sexual partner who commits to fidelity (one sexual partner per time) and whose current HIV status is known through medical testing and is properly documented" in place of all non-specific terminology.

Severe falciparum malaria in children in Enugu, South East Nigeria

Introduction

Severe malaria remains one of the leading causes of morbidity and mortality in sub-Saharan Africa and parts of Asia despite several efforts in prevention and management. The prevalence and pattern of presentation may vary from one location to another and from one age group to another.

Objectives

This study was undertaken to review the prevalence and pattern of severe malaria among children presenting in the two tertiary hospitals in Enugu, south-east Nigeria.

Methods

The case records of children presenting with malaria in the two tertiary hospitals in the state were retrieved and the necessary information were obtained using a structured questionnaire.

Results

The children aged from 1 month to 184 months (15 years), with a median age of 36 months and mean age of 49.2 ± 42.7 months. About two-thirds (68/102, 66.7%) of the children were under the age of 5 years, with only 6 of them (8.8%) being 6 months and below. There were significantly more males than females (χ2 = 6.48, P = 0.01); with a M:F ratio of 1.55:1. The peak of presentation was from August and November. Prostration, respiratory distress and severe anaemia were the commonest features of severe malaria, while shock, acute renal failure and abnormal bleeding were the least presenting features Of all the features, only severe anaemia was significantly related to age, (χ2 = 5.027, P = 0.02). Sixty-one (59.8%) of the children had one or more co-morbidities. There were 2 deaths, giving a case fatality rate of 1.96%.

Conclusion

Early presentation will significantly reduce blood transfusions, prolonged admission and death in children with severe malaria.

Prevalence and pattern of genital injuries among adolescent rape victims attending Enugu State University Teaching Hospital, South East Nigeria

The study aimed to determine the prevalence and pattern of genital injuries among the female adolescents alleged to have been raped that presented at the Enugu State University Teaching Hospital (ESUTH) from January 1 2013 to August 31 2014. All of the adolescents alleged to have been raped that presented within the study period were studied, and the relevant data were extracted from their records. The data were analysed using the Epi info statistical software, Version 7. There were 78 adolescents alleged to have been raped within the study period. They were all female, with a mean age of 14.12 ± 5.6 years. The majority of them were virgins (n = 47, 60.3%). Five of them (6.4%) had multiple perpetrators. The prevalence of genital injuries was 44.9%, while the genital injury frequency rate was 1.2. Laceration was the commonest injury type, while the hymen was the most affected site (n = 15; 35.7%). Being a virgin at the time of the rape was significantly associated with the presence of genital injury (p < .001). This suggests that the absence of genital injury is not sufficient evidence to rule out the possibility of rape. Impact Statement What is already known on this subject? Rape is a global problem with a severe negative impact on the victim. Apart from the associated psychological and emotional trauma, a genital injury could result. However, it appears that so much emphasis are usually placed on the presence of a genital injury in establishing an incident of rape in the developing world. Genital injuries seem to be the main substantive evidence of rape in the developing world including Nigeria. Convicting the perpetrator of rape in law court is usually difficult in the absence of genital injuries after medical examination. What the results of this study add? The result of this study shows that a genital injury is not be found in all cases of an alleged rape, especially among the adolescents. In fact, more than half of the rape survivors had no genital injury. What the implications are of these findings for clinical practice and/or further research? The absence of a genital injury does not exclude the possibility of a rape, neither does its presence confirm a rape, as genital injuries can occur even in consensual sex. Adopting a modern method of establishing a rape case is very important for the provision of concrete evidence in court that will enable the proper and sound dispensation of justice.

Knowledge and Practice of Standard Precautions by Health-Care Workers in a Tertiary Health Institution in Enugu, Nigeria

Background

Standard precautions (SPs) are crucial in protecting both health-care workers (HCWs) and patients from nosocomial infections. This study assessed the knowledge and practices of SP among HCWs in tertiary health-care facilities.

Methods:

This descriptive study was done in October 2014 among 629 HCWs at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State. A pretested questionnaire was used and analysis done using SPSS version 13.

Results

The HCWs studied were 629, mostly females (64.4%), married (62.3%), Christians (94%), and within 20-59 years. Majority were nurses (46.1%) working in the wards. Over 90% of respondents had heard of SP, mainly from formal training (62%). Over 70% could define SP, 74.6% had knowledge of when SP is needed and> 70% identified most components of SP. Over 90% agreed that SPs are useful and that employers should provide SP training. Most respondents washed hands after removal of gloves (73.6%) and before leaving patient's care area (33.1%). More than 70% had been exposed to patient's body fluids and washed the exposed part with water, soap, and disinfectant (52.1%). Gloves were the most commonly used personal protective equipment (PPE) (53.4%) and the major reason for inconsistent use was irregular access (57.7%). Over 50% recap needles before discarding. Exposure to patients' serum was significantly higher among doctors and nurses P < 0.05, while the use of PPEs was highest among the laboratory scientists (82.4%). Those who were trained on SP (70.8%) and PPE (69.7) were significantly more likely to use PPEs, P < 0.05.

Conclusions

SP training and regular provision of PPEs are vital in compliance to SP.

Clinical evaluation of severe neonatal Hyperbilirubinaemia in a resource-limited setting: a 4-year longitudinal study in south-East Nigeria

BACKGROUND

Neonatal hyperbilirubinaemia is one of the commonest causes of hospital visit in the neonatal period. When severe, it is a leading cause of irreversible neurological and musculoskeletal disability. Prompt recognition and timely interventions are imperative for a drastic reduction in complications associated with severe hyperbilirubinaemia in newborns.

METHODS

We report a 4-year descriptive and longitudinal study to determine the causes, clinical presentations and long-term outcomes in newborns admitted for severe neonatal jaundice.

METHODS

Newborns admitted and managed for severe neonatal jaundice at the Enugu State University Teaching Hospital during a 4-year period were enrolled and followed up for 2 years.

RESULTS

A total of 1920 newborns were admitted during the study period and 48 were managed for severe hyperbilirubinaemia giving an in-hospital incidence rate of 25 (95% CI 18-32) per 1000 admitted newborns. The mean age of onset was 3.4 ± 0.5 days (range 1-8 days) and hospital presentation from time of first notice was 4.3 ± 0.4 days (range 1-9 days). The total and unconjugated admission serum bilirubin ranged from 7.1 to 71.1 (mean 26 ± 2.5 mg/dl) and 4.2 to 46.3 mg/dl (mean 18.3 ± 9.2) respectively. Earliest sign of severe hyperbilirubinaemia in newborns were: refusal to suck (15.2%) and depressed primitive reflexes (24.5%) while the commonest signs included high pitch cry (11.9%), convulsion and stiffness (6.9%) and vomiting (6.3%) in addition to the former signs. The major causes of severe hyperbilirubinaemia were idiopathic (33.3%), sepsis (35.3%), ABO incompatibility (17.6%) and glucose-6-phosphate dehydrogenase (G6PD) deficiency (11.8%). Long-term sequelae on follow-up included delayed developmental milestone attainment, postural deformities, visual and seizure disorders.

CONCLUSIONS

There is urgent need for continued education for mothers, families and healthcare workers on the danger newborns with jaundice could face if not brought early to the hospital for timely diagnosis and management.

Impact of zinc on sexual maturation of female sickle cell anemia (SCA) children in Enugu, Southeast Nigeria

Adolescence is an important developmental period of childhood. Good health and adequate nutrition consisting major food constituents and trace elements like zinc are fundamental for optimal sexual maturation. To determine the relationship between zinc levels and pattern of breast and pubic hair development, as well as menarcheal age of female SCA children aged 6-18 years and their matched controls with hemoglobin genotype AA. Cross sectional, case-control study. Information on biodata, age at menarche, medical and drug history as well as 24-hour dietary recall was documented using interviewer administered questionnaire. Sexual maturation was assessed using Tanner staging and zinc levels determined using Atomic absorption spectrophotometer. Eighty-one subjects were compared with 81 controls. There was significant delay in the mean age of attainment of various Tanner stages of breast and pubic hair in the subjects. Mean age of 14.81 ± 1.07 years at menarche in subjects was significantly higher than 12.62 ± 1.18 years in controls (p = 0.001). Serum zinc of 58.01 ± 10.58 µg/dl in subjects was significantly lower than 68.37 ± 8.67 µg/dl in controls (p = 0.001). Serum zinc levels were found to have a significant positive relationship with stages of sexual maturation and mean age at menarche. Reduced serum zinc in children with SCA was associated with delayed sexual maturation.

Incidence and Predictors of Mortality Among Newborns With Perinatal Asphyxia: A 4-Year Prospective Study of Newborns Delivered in Health Care Facilities in Enugu, South-East Nigeria

Fatalities from perinatal asphyxia remain high in developing countries, and continually assessing its risk factors will help improve outcomes in these settings. We explored how some identified risk factors predict mortality in asphyxiated newborns, to assist clinicians in prioritizing interventions. This was a 4-year prospective study conducted at the Enugu State University Teaching Hospital, Enugu, Nigeria. All newborns who met the study criteria that were admitted to this facility in this period were enrolled and monitored. Data collected were analysed with SPSS Version 18. A total of 161 newborns with perinatal asphyxia were enrolled into the study with an in-hospital incidence rate of 12.81 per 1000 birth and a case fatality rate of 18%. Overall, the APGAR scores were severe in 10%, moderate in 22%, mild to normal in 68%, whereas the SARNAT stages were III in 24%, II in 52%, and I in 25%. In terms of mortality, 66.7%, 22.2%, and 11.1% mortalities were, respectively, observed with SARNAT scores III, II, and I (P = .003), whereas the findings with APGAR were 31.2% (severe), 25.0% (moderate), 25.0% (mild), and 18.8% (normal) (P = .030). Fatality outcome was more correlated with SARNAT (R = .280; P = .000) than APGAR (R = −.247; P = .0125). The SARNAT score significantly differentiated between the degrees of asphyxia in newborns based on gestational age at delivery (P = .010), place of delivery (P = .032), and mode of delivery (P = .042). Finally, it was noted that newborns that were female (P = .007), or born outside the hospital (P = .010), or with oxygen saturations <60% (P = .001), or with heart rate <120 (P = .000), and those with respiratory rate <30 (P = .003), all have significantly higher likelihood of deaths from asphyxia. Therefore, predictors of neonatal mortality from perinatal asphyxia in our centre include being female and being born outside the hospital, as well as low oxygen saturations, heart rates, and respiratory rates at presentation.

HIV status disclosure rate and reasons for non-disclosure among infected children and adolescents in Enugu, southeast Nigeria

Aims: To determine the rate of HIV status disclosure, caregivers’ reasons for non-disclosure, and factors influencing disclosure among a sample of HIV-infected children in Enugu, southeast Nigeria. Methods: Data were collected prospectively via a questionnaire on HIV-infected children and their caregivers who visited the pediatric HIV clinic of the University of Nigeria Teaching Hospital between July 1, 2012, and June 30, 2013. The data analysis was performed using Statistical Package for the Social Sciences version 19 software. Results: Caregivers of 107 children (age 5–16 years; mean 10.1 ± 3.2 years) were enrolled in the study. There were 53 (49.5%) boys and 54 (50.5%) girls. HIV status had been disclosed to 31 (29%) of them. The major reason for non-disclosure was the child being considered too young. Age (p < .001), age at HIV diagnosis (p < .001) and baseline CD4 count (p = .008) were seen as significant predictors of HIV disclosure. Conclusions: There is a low rate of HIV disclosure to infected children, and it was found to be lower for younger children. We recommend improving efforts for disclosure counseling to caregivers in pediatric HIV clinics.

Awareness of osteoporosis in a polytechnic in Enugu, South East Nigeria

This study aims to determine the awareness of osteoporosis and factors that determine awareness of osteoporosis. Results showed that osteoporosis awareness was associated with age (p = 0.006) and occupation (p < 0.001) but not gender, marital status, and level of education. There is therefore need for educational interventions to improve awareness of osteoporosis.

INTRODUCTION

Osteoporosis is a bone disease in which the bone becomes porous, brittle, and more susceptible to fracture. It is the most common metabolic bone disease worldwide. Increased prevalence of disease is attributed to low awareness of disease among general population referred to as a 'silent disease.' There is paucity of evidence of osteoporosis awareness in Africa while level of knowledge in Nigeria is also minimal.

METHODS

The study was carried out in a Polytechnic in Enugu, South East Nigeria, as one of the phases of ongoing awareness exercise on osteoporosis. Study design was descriptive cross-sectional study using stratified random sampling method for selection. The study made use of a structured, self-administered questionnaire using English language. Statistical analyses were carried out with SPSS version 22 software, using Chi square and Fischer exact tests of significance and alpha level set at p = 0.05.

RESULTS

Out of a total number of 500 respondents, 187 (37.4%) had heard about osteoporosis, however, only 34 (18.2%) of those who have heard about osteoporosis knew the correct meaning of osteoporosis. Overall, only 34 (6.8%) out of 500 knew the correct meaning of osteoporosis. Osteoporosis awareness was highest among age group ≥51 years (33.3%) and least in age group ≤20 years (6.3%) (p = 0.006). Awareness was also highest among civil servants (17.9%) and least among unemployed respondents (0.0%) (p < 0.001). There was no gender preponderance in awareness level while marital status and level of education were not significantly associated with level of awareness.

CONCLUSION

While there was low knowledge of osteoporosis in the study area, awareness of osteoporosis was associated with age and occupation but not gender, marital status, or level of education. There is need for educational interventions to improve awareness of osteoporosis.

Socio-demographic determinants of malnutrition among primary school aged children in Enugu, Nigeria

INTRODUCTION

Several factors including the parental literacy, illness, socioeconomic status, poor sanitation and hygienic practices affect the physical growth of children. The aim of this study was to determine the socio-demographic determinants of malnutrition among primary school aged children in Enugu, Nigeria.

METHODS

A cross-sectional descriptive study involving primary school children in Enugu was carried out over a 3 month period. Subjects were selected using multistage sampling technique. Weight and height were measured using a digital scale and a wooden stadiometer, respectively. Body Mass Index (BMI), weight-for-age (WAZ), Height-for-age (HAZ) and BMI-for-age z scores were then derived using the new WHO reference standards.

RESULTS

348 children (40.4%) were recruited from 5 public schools while 512 (59.6%) were recruited from 9 private schools. The mean age of the study participants was 9.2 ± 1.8 years. 7 (0.8%) children were stunted, 26 (3.3%) wasted and 28 (3.3%) underweight. Of all the study participants, overweight and obesity were observed in 73 (8.5%) and 35 (4.1%) children, respectively. Children of lower socioeconomic class were more stunted, underweight and wasted, while overweight and obesity were more prevalent among children from the upper socioeconomic class.

CONCLUSION

Factors such as age and sex, parental education and socioeconomic class had a significant impact on nutritional status. Overweight and obesity were more prevalent among the children from the upper socioeconomic class, attending private schools, while stunting and wasting were more in children of the lower class attending public schools.

Severity of motor dysfunction in children with cerebral palsy seen in Enugu, Nigeria

Introduction

Children with cerebral palsy (CP) have gross motor dysfunction (GMD) of varying degrees of severity. The Gross Motor Function Classification System (GMFCS) is widely used internationally to classify children with CP into functional severity levels. There are few reports on the use of GMFCS in Nigeria to determine the severity of motor dysfunction in children with CP. This study aims to classify children with CP in Enugu on the basis of severity of their GMD in order to ascertain their management needs.

Methods

The study was a cross sectional observational study and sample selection was by consecutive recruitment. One hundred (100) children with CP aged 9 – 96 months, attending two Pediatric Neurology Clinics in Enugu, were consecutively recruited. Relevant history was taken including modalities of treatment received. Neurological examination was done and the GMFCS manual was used to classify the children into levels of severity.

Results

GMD varied in severity in the patients from mild (47%) (GMFCS levels I & II) to moderate (7%) (GMFCS levels III) and to severe (46%) (GMFCS levels IV & V). Those in levels I – III (54%) were ambulatory while those in levels IV & V (46%) were non-ambulatory. Of the 53 that required mobility assistive device, only 6 (11.3%) were using one.

Conclusion

More than half of CP patients seen in Enugu were ambulatory with mild to moderate motor dysfunction based on the GMFCS. Only a few of our patients are appropriately rehabilitated with augmentative interventions.

Parental practice of child car safety in Enugu, Southeast Nigeria

Child safety restraints and seat belts are regarded as the most successful safety and cost-effective protective devices available to vehicle occupants, which have saved millions of lives. This cross-sectional descriptive study evaluated the practice and use of child car restraints (CCRs) among 458 purposively selected respondents resident in two local government areas in Enugu State, Nigeria. Self-administered questionnaires were sent to parents of children attending private schools who owned a car. Chi-square and multivariate analyses were used to assess the determinants of the use of car restraints in children among respondents. In all, 56% and 45% of adults and children, respectively, used car restraints regularly. The awareness of child safety laws and actual use of age-appropriate CCRs among respondents was negatively and weakly correlated (r=−0.121, P=0.310). Only respondent’s use of seat belt during driving (P=0.001) and having being cautioned for non-use of CCRs (P=0.005) maintained significance as determinants of the use of CCRs in cars on multivariate analysis. The most frequent reasons given for the non-use of CCRs included the child being uncomfortable, 64 (31%); restraints not being important, 53 (26%), and restraints being too expensive, 32 (15%). Similarly, for irregular users, exceptions for non-use included the child being asleep (29%), inadequate number of CCRs (22%), and the child being sick (18%). There is a need for a strategy change to enforce the use of CCRs in Nigeria.

Ear-related problems among children attending the paediatric and otorhinolaryngology out-patients clinics of the University of Nigeria Teaching Hospital, Enugu

BACKGROUND

Ear related diseases are commonly seen in clinics worldwide especially among children. They are associated with significant morbidity and frequent hospital visits. Limited data exists regarding the burden of ear disease among Nigerian children.

OBJECTIVE

To determine the prevalence of ear-related problems among children presenting at the Paediatric and Otorhinolaryngology clinics of the University of Nigeria Teaching Hospital, Enugu.

MATERIALS AND METHODS

This was a cross-sectional study conducted at the Paediatric and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital Enugu. All children aged 0 and 17 years presenting between 1(st) June and 31(st) August 2006 with ear-related problems were enrolled consecutively into the study. Data analysis was by SPSS version 11.

RESULTS

Three thousand and twenty-one children were seen during the study period. Out of these, 248 children (8.2%) presented with ear-related problems. Chronic otitis media (30.5%), acute otitis media (29.9%), cerumen auris (11.3%), otitis externa (10.1%), hearing impairment (7.3%) and foreign body in the ear (5.7%) were the most commonly diagnosed ear-related problems.

CONCLUSION

Ear-related problems among children presenting at the UNTH Enugu were not uncommon. However, otitis media was the most commonly diagnosed ailment affecting the ears in children.

Unintended pregnancy among HIV-positive pregnant women in Enugu, southeast Nigeria

OBJECTIVE

To determine the prevalence and factors associated with unintended pregnancy among HIV-positive pregnant women in Enugu, southeast Nigeria.

METHODS

A questionnaire-based cross-sectional study was performed of HIV-positive pregnant women receiving prenatal care at two tertiary health institutions in Enugu between March 1 and August 31, 2012. The women were interviewed with a pretested questionnaire.

RESULTS

Overall, 180 HIV-positive pregnant women were recruited, 67 (37.2%) of whom declared that their pregnancy was unintended. Overall, 174 (96.7%) patients were receiving antiretroviral therapy and 99 (55.0%) had future fertility intensions. Participants with regular partners (married or cohabiting) had a significantly higher rate of unintended pregnancy than those with unstable partners (40.3%, n=64/159 vs 14.3%, n=3/21 P=0.029). Age, parity, educational level, and current treatment with antiretroviral therapy did not significantly affect the prevalence of unintended pregnancy.

CONCLUSION

A substantial number of HIV-positive pregnant women declared their pregnancies to be unintended. Modern contraceptives should be made readily available and accessible to HIV-positive women to help eliminate mother-to-child transmission of HIV and subsequent new pediatric HIV infections.

Is there any association between hormonal contraceptives and cervical neoplasia in a poor Nigerian setting?

Background

The association between hormonal contraception and cervical cancer is controversial. These controversies may hamper the uptake of hormonal contraceptives.

Objective

To determine the association between hormonal contraceptives and cervical neoplasia.

Materials and methods

This was a case-control study in which Pap-smear results of 156 participants on hormonal contraceptives were compared with those of 156 participants on no form of modern contraception. Modern contraception is defined as the use of such contraceptives as condoms, pills, injectables, intrauterine devices, implants, and female or male sterilization. Those found to have abnormal cervical smear cytology results were subjected further to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analyzed with descriptive and inferential statistics at a 95% level of confidence.

Results

A total of 71 (45.5%), 60 (38.5%), and 25 (16.0%) of the participants on hormonal contraceptives were using oral contraceptives, injectable contraceptives, and implants, respectively. Cervical neoplasia was significantly more common among participants who were ≥35 years old (6% versus 1%, P<0.0001), rural dwellers (6% versus 3.5%, P<0.0001), unmarried (7.6% versus 3.5%, P<0.0001), unemployed (6.8% versus 3.5%, P<0.0001), less educated (6% versus 3.8%, P<0.0001), and had high parity (6.8% versus 3.6%, P<0.0001). There was no statistical significant difference in cervical neoplasia between the two groups of participants (7 [4.5%] versus 6 [3.8%], P=1.0).

Conclusion

There was no association between hormonal contraceptives and cervical neoplasia in this study.

Delays in healthcare delivery to sick neonates in Enugu South-East Nigeria: an analysis of causes and effects

BACKGROUND

In most parts of the world, neonatal mortality rates have shown a slower decline when compared with under-5 mortality decline. A sick newborn can die within minutes if there is a delay in presentation, thus early diagnosis and treatment are essential for the survival of a critically ill newborn. This study investigated factors responsible for delays in healthcare services for the sick newborn and maternal socio-demographic variables that influence these delays in Enugu, South-East Nigeria.

METHODS

This was a community-based descriptive study. A total of 376 respondents were randomly selected from 4 of the 17 local government areas of Enugu State. Mothers and/or caregivers that were nursing or had nursed a child in the previous 2 years were enrolled. Self-reported data on delays encountered during healthcare for sick newborn were collected using pretested structured questionnaire. Chi-square and multivariate logistic regression were used to determine the association between causes of delays in newborn healthcare services, maternal socio-demographics and relationships with newborn mortality.

RESULTS

Delays in reaching healthcare facilities accounted for the most common delays encountered by respondents, 78.0%, in this study, followed by delays at household level, 24.2% and delays at health facility level 16.0% (P = 0.000). Mothers with knowledge of ≥3 WHO recognized danger signs compared with those with ≤2 were significantly less likely to delay at household (level 1: 40.7 versus 59.3%) (P = 0.017) and reaching healthcare service (level 2: 19.9 versus 80.1%) (P = 0.028). Delays at health facility level (level 3) occurred more at tertiary health facilities (59.0%), secondary health facilities (39.1%) and primary healthcare facilities (19.7%) compared with private health facilities (13.5%) (P = 0.000).

CONCLUSIONS

Delays in seeking healthcare at all levels especially those related to transporting the sick newborn to the hospital are a contributor to newborn mortality in Nigeria. Improving access to healthcare could potentially reduce mortality in the sick newborn.

Bioelectric impedance analysis of body composition of children and adolescents with sickle cell anemia in Enugu, Nigeria

BACKGROUND

Body composition indices are widely used to evaluate growth and nutrition in children, particularly those with sickle cell anemia (SCA), who are known to have impaired growth, impaired skeletal maturation, and delayed puberty. The current study is aimed at determining the body composition of children with SCA.

METHODS

Consecutive selection of SCA children aged 6 to 18 years, who served as subjects and their age and gender matched children with HbAA (controls), selected using multi-stage systematic sampling. It was a cross-sectional descriptive study conducted at the pediatric hematology and oncology clinic. Bioelectric impedance analysis was used to determine the body composition parameters, including weight, body fat percentage (BFP), visceral fat percentage, body mass index (BMI), skeletal muscle percentage, and resting metabolic rate. Data were analyzed using SPSS 16.0 at P < 0.05.

RESULTS

One hundred and thirty-two subjects and controls respectively were studied. Subjects had lower body composition parameters compared with controls, with the older male subjects aged 10 to 18 years, having lower body composition indices (weight, height, BMI, and BFP) compared with controls. Visceral fat percentage was low in both subjects and controls.

CONCLUSIONS

Children with SCA, particularly the older males, have impaired body composition indices. There is a need to conduct further studies to determine the longitudinal aspects of growth as well as quantitative and qualitative assessment of nutritional intake in children with SCA, which will inform higher alimentation requirements for HbSS children as compared with HbAA individuals.

Prevalence and pattern of rape among girls and women attending Enugu State University Teaching Hospital, southeast Nigeria

OBJECTIVE

To determine the prevalence and pattern of rape in Enugu, southeast Nigeria.

METHODS

A prospective descriptive study was conducted among female survivors of rape who presented at the emergency gynecologic and/or forensic unit of Enugu State University Teaching Hospital between February 2012 and July 2013. Data were collected via a pretested interviewer-administered questionnaire.

RESULTS

Among 1374 gynecologic emergencies, there were 121 (8.8%) rape cases. The mean age of the rape survivors was 13.1±8.1 years. Ninety (74.4%) survivors were younger than 18 years. At least 72 hours had passed since the rape for 74 (61.2%) cases. The perpetrator was known to 74 (82.2%) patients younger than 18 years and 18 (58.1%) aged at least 18 years (P=0.013). The location of the rape was the bush or an uncompleted building for 36 (29.8%) and the perpetrator's residence for another 36 (29.8%). Four (3.3%) individuals became pregnant after the rape.

CONCLUSION

A considerable proportion of patients with gynecologic emergencies had been raped. Individuals should be encouraged to report to the hospital quickly to prevent unwanted pregnancy and sexually transmitted infections.