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   2015| September-October  | Volume 56 | Issue 5  
    Online since November 24, 2015

 
 
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REVIEW ARTICLE
Operationalizing universal health coverage in Nigeria through social health insurance
Arnold Ikedichi Okpani, Seye Abimbola
September-October 2015, 56(5):305-310
DOI:10.4103/0300-1652.170382  PMID:26778879
Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme.
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ORIGINAL ARTICLES
Serum copeptin and pregnancy outcome in preeclampsia
Kehinde Sola Akinlade, Isaac Oluwole Adediji, Sheu Kadiri Rahamon, Adeniran Olubukola Fawole, Olukemi Oluwatoyin Tongo
September-October 2015, 56(5):362-368
DOI:10.4103/0300-1652.170385  PMID:26778890
Background: A number of biochemical predictors of preeclampsia have been reported, but little is known about their possible relationship with maternal and fetal outcomes. This study determined serum copeptin in pregnant women with preeclampsia and assessed its relationship with pregnancy outcomes. Materials and Methods: Thirty women with severe preeclampsia (SP), 30 with mild preeclampsia (MP), and 30 with uncomplicated pregnancy were enrolled into this study. Serum copeptin, creatinine, and liver function were determined using enzyme-linked immunosorbent assay and colorimetry as appropriate. Pregnancy outcomes, both maternal and fetal, were taken using standard methods. Results: Copeptin was significantly elevated in preeclampsia subjects compared with controls and in SP compared with MP. Assessing the diagnostic property of copeptin for preeclampsia, the area under the curve for copeptin was 0.99. Nine (30%) and 3 (10%) of SP and MP, respectively had abruptio placenta while 6 (20%), 2 (6.7%), and 1 (3.3%) still births were recorded in SP, MP, and controls, respectively. Neonates of mothers with preeclampsia had significantly lower birth weight, infant length, ponderal index, and head circumference compared with neonates of the controls. Copeptin had a significant inverse relationship with birth weight, ponderal index, head circumference, Apgar score, and infant length in neonates of mothers with preeclampsia. Conclusion: Serum copeptin level in the third trimester could predict preeclampsia and its elevation is associated with adverse perinatal outcome.
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The influence of health insurance scheme on the drug prescribing pattern in a Nigerian tertiary healthcare facility
Joseph Olusesan Fadare, Adekunle Olaitan Adeoti, Felix Aina, Olusoji Abidemi Solomon, Joel Olatunde Ijalana
September-October 2015, 56(5):344-348
DOI:10.4103/0300-1652.170378  PMID:26778886
Introduction: Prescription medicines constitute a significant proportion of total healthcare expenditure in many countries of the world. Nonrational prescribing by healthcare providers contributes significantly to this relatively high proportion. In many developing countries of the world, a significant proportion of the population pays "out of pocket" to access healthcare, sometimes leading to catastrophic healthcare expenditure. Healthcare insurance is a form of healthcare financing that promotes judicious use of the resources and ensuring the cost-effectiveness of interventions through the use of affordable drugs. The main objective of this study was to compare concurrently the prescribing practices in the general outpatients' clinic (noninsured patients) and the National Health Insurance Scheme (NHIS) clinic (patients with insurance coverage). Materials and Methods: A cross-sectional study was conducted in the general outpatients' and the "NHIS" clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti, South-western Nigeria. The medical records of patients, who attended these two clinics between the 1st March and 30th June 2014 were retrieved and used for the study. Results: The average number of prescribed drugs for patients attending the general outpatients' clinic was 3.9 ± 2.0 while that from the NHIS clinic was 4.1 ± 1.6 (P = 0.24). Prescribing by generic names was done in 48.2 ± 23.8% and 45.8 ± 22.9% of prescriptions from the general outpatients' and NHIS clinic, respectively. Percentage of encounters with antibiotics was 49.4% and 33.6% of patients who attended the NHIS and general outpatients' clinics, respectively. Conclusion: There was a trend to having more medicines prescribed and more encounters with antibiotics among patients enrolled under the health insurance scheme.
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The influence of occupational stress factors on nicotine dependence among students of health and nonhealth care professional colleges
Amandeep Chopra, Manav Lakhanpal, Nidhi Gupta, Varun Suri, Gurwant Kaur, Swati Bhudhiraja
September-October 2015, 56(5):349-352
DOI:10.4103/0300-1652.170391  PMID:26778887
Objectives: To study the relationship between perceived job stress measured using Effort-Reward Imbalance (ERI) scale and nicotine dependence using Fagerström Test for Nicotine Dependence (FTND) scale among students of health and nonhealth care professional colleges. Materials and Methods: A descriptive cross-sectional study was carried on convenient sample of 408 health and nonhealth care professional who were current smokers. Nicotine dependence was measured using the FTND. The extent of the stress factors experienced at work was assessed using the ERI. Chi-square test and logistic regression were used for the statistical analysis. Results: Occupational stress factors are actually associated with higher levels of nicotine dependence (odds ratio = 4.523). The degree of nicotine dependence and stress imbalance was found to be more among health care professional students as compared to nonhealth care professional students (P < 0.05). Being religious was found to have a significant effect in reducing nicotine dependence. Conclusion: Being religious, having low occupational stress and being nonhealth care professional have a significant effect on the prevention of nicotine dependence.
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Visual function and vision-related quality of life in presbyopic adult population of Northwestern Nigeria
Nasiru Muhammad, Mahmoud B Alhassan, Murtala M Umar
September-October 2015, 56(5):317-322
DOI:10.4103/0300-1652.170379  PMID:26778881
Purpose: To determine the impact of uncorrected presbyopia on vision-related quality of life (QoL) and visual function (VF) among adults 40 years and older in Bungudu local government area (LGA) of Zamfara State, Nigeria. Materials and Methods: A population-based cross-sectional study in Bungudu LGA of Zamfara State Nigeria was conducted in 2012. Six-hundred and fifty persons at least 40 years of age were examined using a two-stage cluster random sampling-based on probability proportional to size. Presbyopia was defined as the inability to read N8 at 40 cm in an indoor illumination using LogMAR E-chart. Demographic information comprising of age, sex, occupation, and educational level among others was obtained from a pilot tested VF-14 and modified vision-related QoL questionnaire by trained interviewer. Results: Out Of the 650 subjects enumerated 635 were examined given a response rate of 97.7%. The mean age of participants was 53.59 years (95% confidence interval:52.75%-54.43%). The crude prevalence of presbyopia was 30.4%, (95% CI: 26.8%-34.1%). The mean VF score of persons with presbyopia was 85.09, (95% CI: 83.09%-87.09%) and being female was strongly associated with high VF scores (P = 0.003). The VFs most impaired were the ability to read, write, use mobile phones, and thread needles. The higher the degree of presbyopia the lower the mean VF score (P = 0.00). Conclusion: Uncorrected presbyopia is associated with functional visual impairment and reduce QoL especially in the ability to read, write, and usage of mobile cell phones among adults 40 years and older in Bungudu District.
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Sonographic assessment of the carotid intima-media thickness on B-mode ultrasonography in a Nigerian population
Oluwagbemiga Oluwole Ayoola, Mayomi A Onuwaje, Anthony O Akintomide
September-October 2015, 56(5):357-361
DOI:10.4103/0300-1652.170384  PMID:26778889
Background: Hypertension is a common health problem and a major risk factor of cardiovascular disease. The most important mechanism by which hypertension acts as a cardiovascular risk factor is the induction of arteriosclerosis. The early phase of atherosclerosis before its clinical manifestation can be studied using B-mode ultrasonography. Aims and Objectives: This study evaluated the intima-media thickness of the common carotid artery (CCA), carotid intima-media thickness (CIMT) of subjects with essential hypertension as a way of detecting these early changes of atherosclerosis. Subjects and Methods: The study was performed on 200 subjects with newly diagnosed hypertension and 100 apparently normal controls that were consecutively recruited by a cardiologist. An ultrasound examination of both CCA were done to obtain the CIMT. Data were analyzed using the SPSS data analysis software. Results: The CIMT of males were greater in the hypertensive group compared to the controls (0.10 ± 0.02 cm vs. 0.077 ± 0.02 cm [P < 0.0001] and 0.10 ± 0.02 cm vs. 0.078 ± 0.02 cm [P < 0.0001] for the right and left sides, respectively). The female group showed a similar pattern of results (0.09 ± 0.02 cm vs. 0.072 ± 0.02 cm [P < 0.0001] and 0.1 ± 0.02 cm vs. 0.076 ± 0.02 cm [P < 0.0001] for the right and left sides respectively). Conclusion: A statistically significant increase in CIMT was noted in both male and female hypertensives in comparison to a normal population.
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Endodontic treatment of the pregnant patient: Knowledge, attitude and practices of dental residents
Louis Ibhawoh, Joan Enabulele
September-October 2015, 56(5):311-316
DOI:10.4103/0300-1652.170386  PMID:26778880
Introduction: In order to control serious pulpal pain following odontogenic infections in pregnant women, endodontic treatment may become necessary. The aim of this study was to assess the perception of dentists about rendering endodontic treatment to pregnant women. Materials and Methods: This was a cross-sectional study of resident doctors in the different dental specialties in Nigeria preparing for the various levels of the fellowship examinations of the West Africa College of Surgeons and the National Postgraduate Medical College of Nigeria. Data were collected by the means of a 17-itemed questionnaire which sought information on respondents' demography, their considerations while rendering endodontic treatment to the pregnant patients and their perceptions of the safety of endodontic treatment in pregnancy. The data collected were analyzed using the Statistical Package for Social Science version 21.0. Results: With regards to the safety of endodontic treatment during pregnancy, 91.8% considered it safe, and this was not statistically significant in relation to the specialty or status of the respondent. Majority (77.0%) agreed they would undertake a root canal treatment on a pregnant patient with all respondents in restorative dentistry, prosthodontics, periodontics, and pedodontics in the affirmative while all in oral pathology would refuse to do such (P = 0.0001). Conclusion: Dental residents are aware of the safety of endodontic treatment in pregnant women. However, gaps exist in their knowledge, bringing to the fore, the need for inclusion of pregnancy-specific training in the dental postgraduate curriculum.
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Clinical characteristics and mortality risk prediction in children with acute kidney injury
Simin Sadeghi-Bojd, Noor Mohammad Noori, Mehdi Mohammadi, Alireza Teimouri
September-October 2015, 56(5):327-332
DOI:10.4103/0300-1652.170381  PMID:26778883
Background: Acute kidney injury (AKI) is characterized by a reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. Objective: AKI is a serious condition in critically ill patients. The aim of the study was to determine incidence rate, identify risk factors, and describe the clinical outcome of AKI in the Pediatric Intensive Care Unit (PICU). Materials and Methods: This prospective observational study was conducted in the PICU of a hospital in the South-east Area of Iran (Zahedan City), to study the clinico-etiological profile of AKI (defined according to the AKI network criteria). Over a period of 20 months from April 2012 to December 2014, 303 children were included in the study. Both the groups of patients, those who developed AKI and those who did not develop AKI, were then followed during the course of their hospital stay. Results: There were 303 cases included in the study, with the incidence rate of AKI of 14.9% in PICU. The most common PICU admission diagnoses in AKI were neurologic 85 (%28.05), followed by heart diseases 52 (17.18%) and 31 (10.23%) for respiratory diseases. AKI was 43.5 and 5.4 times more prevalent in renal and endocrine patients compared to those with heart disease respectively. The mortality rate was estimated to be higher in patients with AKI compared to their counterparts (40% vs. 17.8%). Chance of death increased in patients with AKI (odds ratio = 3.04). Conclusion: AKI is a serious problem, but its true incidence is unknown. Understanding the epidemiology of AKI by using of standard definition help us to find high-risk children that are the first step to improve outcomes. The future multiple-center study may benefit by better identifying risk factors and early detection of AKI by using biomarkers novel to prevent the developing of AKI.
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Intensive care management and outcome of women with hypertensive diseases of pregnancy
Charles Osalumese Imarengiaye, Theodore Ojeide Isesele
September-October 2015, 56(5):333-337
DOI:10.4103/0300-1652.170389  PMID:26778884
Introduction: The burden of hypertensive diseases on the health care is enormous given to the high population in Sub-Saharan Africa and related disproportionate representation in global maternal mortality. Materials and Methods: All women with hypertensive diseases of pregnancy who got admitted into the general ICU of the University of Benin Teaching Hospital between January 2006 and December 2010 were studied. Only the records of women who completed 28 weeks of gestation and were admitted during labour and delivery or puerperium to the ICU were examined. Results: There were 13061 deliveries within the 5-year study period; 9301 by vaginal delivery and 3860 through Caesarean section. 52 (51.5%) of the obstetric patients had hypertensive diseases of pregnancy. Of 52 women with pre-eclampsia and eclampsia, 45/52 had caesarean section and 7/52 had SVD. Admission was mainly postpartum 48/52 (92.3%). 35/52 (67.3%) were transferred to the ward and 17 died (32.7%), giving the ICU maternal mortality rate of 307/1000 deliveries. 30 women developed pulmonary oedema alone or with renal impairment; 14 women were transferred and 16 died while 21 other patients who had renal impairment alone, HELLP, sepsis, etc were transferred out.There was about a 12-fold risk of death in the unit if the patient developed pulmonary oedema when compared to the other factors combined (p = 0.0002, RR = 11.7, 95%CI = 1.7 – 82.). Conclusion: Primiparity, unbooked status and caesarean delivery were leading factors for ICU admission in women with preeclampsia/eclampsia. The women who developed pulmonary oedema in the course of treatment had poor outcome and avoidance of pulmonary oedema may improve ICU outcome in women with preeclampsia/eclampsia.
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CASE REPORTS
Unilateral central serous chorioretinopathy in a pregnant Nigerian woman
Bolutife A Olusanya, Tunji S Oluleye
September-October 2015, 56(5):372-374
DOI:10.4103/0300-1652.170380  PMID:26778892
Central serous chorioretinopathy (CSCR) is an idiopathic condition characterized by serous detachment of the neurosensory retina in the macular region. It is relatively uncommon in Africans and though pregnancy is a known risk factor, there are no previous reports of CSCR in pregnant African women. We report the case of a 35-year-old pregnant woman who presented to our clinic at gestational age of 29 weeks with a 4 months history of blurring of vision in her left eye. Examination revealed visual acuity of 6/4 on the right eye and 6/9 on the left eye. She had normal anterior segments bilaterally and a normal posterior segment on the right. However, she had left macular edema with exudates. There was no significant refractive error. Her blood pressure was normal. Investigations including electrolytes and urea, urinalysis, and blood sugar profile were all normal. She was managed conservatively, and symptoms resolved 2 weeks prior to delivery. This is a case report of CSCR in a pregnant Nigerian woman with spontaneous resolution of symptoms prior to delivery. Pregnant women should be educated about the possibility of visual problems accompanying pregnancy.
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ORIGINAL ARTICLES
Role of transvaginal ultrasonography in diagnosing endometrial hyperplasia in pre- and post-menopause women
Behrooz Shokouhi
September-October 2015, 56(5):353-356
DOI:10.4103/0300-1652.170390  PMID:26778888
Background: Abnormal uterine bleeding (AUB) is the most common presenting symptom of endometrial hyperplasia (EH). Transvaginal ultrasonography (TVS) is a diagnostic tool in the evaluation of AUB and EH with various sensitivity and specificity. However, the exact accuracy of TVS in diagnosing EH had not been evaluated. In this study, we aim to evaluate the accuracy of TVS in detecting EH. Materials and Methods: In this retrospective study, 120 women (mean age of 48.64 ± 6.74 years) with AUB with suspicious/or possible EH were evaluated. TVS and pathology findings of possible EH were recorded. Sensitivity, specificity, positive, and negative predictive value (PPV and NPV) was calculated. Results: Sixty-eight patients were premenopause, and 52 were postmenopause. TVS reported EH in 85 cases (70.83%). Pathology results showed EH in 85 cases (70.83%) including simple cystic hyperplasia in 82 cases, atypical, simple hyperplasia in one case and complex hyperplasia in two cases. Among these 85 cases, EH was confirmed by pathology in 81 cases. The accuracy, sensitivity, specificity, PPV, and NPV were 88.25%, 90.7%, 84%, 97.7%, and 84% in premenopause and 100% in postmenopause women. Conclusion: TVS is an appropriate diagnostic tool in premenopause and postmenopause women presenting with AUB, especially in detecting EH. However, further studies are needed to determine the exact accuracy of TVS in diagnosing TVS.
  1 2,219 18
CASE REPORTS
Fluoroscopic-guided supra-scapular nerve block in the management of shoulder pain in a Nigerian Teaching Hospital: Report of five cases
Zakari Aliyu Suleiman, Israel Kayode Kolawole, Bola AbdulKadir Ahmed, Kolawole Wasiu Wahab
September-October 2015, 56(5):369-371
DOI:10.4103/0300-1652.170387  PMID:26778891
Shoulder pain complaints are common in our environment. The disorder can occur among the young active age group or in the older patients as a result of degenerative changes with its attendant limitations of the function of the affected upper limb, hindrance of the performance of activities of daily living, and reduced quality of life. The traditional oral analgesics, physiotherapy, and intra-articular corticosteroid injections are seldom ineffective at providing the desired pain relief and functional improvement at the shoulder joint. We investigated the role of fluoroscopic-guided supra-scapular nerve blocks (SSNBs) in patients with shoulder pain who failed to respond to the routine conservative management. With the patient lying prone and the C-arm fluoroscope placed in anterior-posterior position, the scapula notch was visualized and a 22G spinal needle was directed toward the nerve. The mixture of local anesthetic agent and steroid was injected as close to the nerve as possible after negative aspiration. Fluoroscopic-guided SSNB can produce substantial pain relief and improved range of movement in patients with painful shoulders. The procedure is safe, well tolerated, and can be done on a day-case basis.
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ORIGINAL ARTICLES
A histopathological study of prostate lesions in Lagos, Nigeria: A private practice experience
Chukwuemeka Charles Nwafor, Olalekan Samuel Keshinro, Emmanuel Kunle Abudu
September-October 2015, 56(5):338-343
PMID:26778885
Introduction: Prostatic carcinoma (CaP) is globally the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. The aim of this study is to determine the pattern of histopathological types of prostatic lesions seen in a private laboratory in Lagos, Nigeria. Materials and Methods: Histopathological reports of all prostate specimens, which were received and processed by histopathology section of a private laboratory in Lagos, Nigeria, from August 2009 to December 2013 were reviewed. Results: A total of 304 prostatic tissue specimens were received and processed during the period under review. The youngest patient was 32 years old while the oldest patient was 99 years old with a mean of 67.8 years ± 9.5. The most common diagnosis was benign prostatic hyperplasia (BPH) (62.8%), distantly followed by CaP (29.3%), inadequate samples (6.6%), prostatic intraepithelial neoplasia (1%), and metastasis to the prostate (0.3%). The peak incidence was age group of 60-69 years, closely followed by 70-79 years accounting for 38.2% and 36.2%, respectively. Moderately differentiated CaP (Gleason scores [GSs] 5-7) accounted for 58.1% of the cases while GS 7 was the most common individual score and was seen in 32.3% of the CaP cases. Conclusion: In this private practice, BPH is the most common prostate lesion. CaP is relatively high and most of the cases have a high GS that portends high mortality in our population. Efforts should be made to increase awareness so as to reduce the mortality.
  - 4,030 17
Hematological indices in febrile neonates with malaria parasitaemia in Calabar
Callistus O. A Enyuma, Emmanuel E Ekanem, Jacob J Udo, Asindi A Asindi
September-October 2015, 56(5):323-326
DOI:10.4103/0300-1652.170383  PMID:26778882
Background: Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis. Aim: To determine the hematological indices in febrile newborn with malaria parasitemia. Materials and Methods: One-hundred fifty neonates (0-28 days) with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14. Results: One-hundred fifty babies were recruited into the study. Most (85.3%) of the babies were aged ≤7 days. Six babies (4%) had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl) even when parasite count was low (average of 30.6/µl) though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization. Conclusion: Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.
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