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   Table of Contents - Current issue
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January-June 2019
Volume 21 | Issue 1
Page Nos. 1-50

Online since Wednesday, July 31, 2019

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REVIEW ARTICLE  

Trends and correlates of patient satisfaction with services under the National Health Insurance Scheme of Nigeria: A review p. 1
Godpower Chinedu Michael, Ibrahim Aliyu, Bukar Alhaji Grema
DOI:10.4103/jomt.jomt_35_18  
Background: In spite of over a decade of operations, the National Health Insurance Scheme (NHIS) of Nigeria has continuously been criticized for its quality of services. Healthcare consumer satisfaction surveys (an important measure of service quality worldwide) in this domain have presented differing accounts of satisfaction with the services of the NHIS from their vantage perspectives. This narrative review aimed at studying the preliminary trends in the utilization of and patient satisfaction with the NHIS services. The correlates of patient satisfaction were also studied. Materials and Methods: We searched local literature whose full texts were accessible using predominantly Google Scholar. Results: We found progressive improvement in scheme enrolment, service utilization, and above-average overall satisfaction scores (i.e., >50% of respondents were satisfied) from most studies. Overall satisfaction scores/ratings were associated patients’ level of education, knowledge of the scheme, years of enrolment, facility cleanliness, consultation time, pharmaceutical services, ease in accessing medical records and laboratory results, health worker availability, health worker friendliness, and responsiveness to patients’ requests. Conclusion: The observed trajectory in service utilization, satisfaction scores, and their correlates may be useful for strategic planning to improve NHIS services in the country toward universal health coverage.
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ORIGINAL ARTICLES Top

Male involvement in family planning in Northern Nigeria: A review of literature p. 6
Awawu Grace Nmadu, Istifanus Anekoson Joshua, Victoria Nanben Omole, Nafisat Ohunene Usman, Chinedu John-Camillus Igboanusi, Abulrazaq Abdullahi Gobir
DOI:10.4103/jomt.jomt_29_18  
Background: Demand and utilization of family planning (FP) in Northern Nigeria has been consistently low. Evidence from literature has demonstrated that male involvement in FP programming can be successful in increasing demand for FP services. Materials and Methods: A search of peer-reviewed and gray literature was carried out to explore the status of male awareness and utilization of FP methods, and the barriers to male involvement in FP, in Northern Nigeria. Results: Males in the region generally have a good awareness of FP. However, they had negative perceptions, low levels of usage of FP, and poor spousal communication about FP. Sociocultural and religious barriers played major roles in hindering male involvement in FP. Misconceptions about FP, such as that FP is a woman’s activity and that it also encourages promiscuity among women, were factors limiting its acceptance. Conclusion: There is a need to address the misconceptions and equip men with complete and correct information about FP. There is also a need for research on effective strategies to address the sociocultural and religious barriers to male involvement in FP in Northern Nigeria and the development of effective culturally sensitive male-involvement FP initiatives.
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Anesthesia for cesarean section in the University of Ilorin Teaching Hospital, Ilorin, Nigeria: A 5-year review p. 10
Olufemi Adebayo Ige, Olanrewaju Olubukola Oyedepo, Kikelomo Temilola Adesina, Isoken Iyobosa Enaworu
DOI:10.4103/jomt.jomt_37_18  
Background: Obstetric anesthesia service is peculiar in the practice of anesthesia because the anesthetist has to contend with the presence of two lives (the mother and the fetus) and the influence of changes in maternal physiology resulting from pregnancy. Cesarean section is the most frequently performed surgical procedure in obstetrics. With the increasing rates of cesarean deliveries in both developing and developed world, an audit of the outcome of anesthetic management is paramount to assess the safety of the procedure. Objective: The aim of this article is to audit obstetric anesthesia practice in the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. Methods: The study was a total population study of all obstetric patients who had cesarean delivery at the UITH from January 1, 2010 to December 31, 2014. Results: A total of 14,155 deliveries were recorded from 2010 to 2014 out of which 3908 were cesarean sections giving a cesarean section rate of 27.6%. Ninety percent of the surgeries were emergencies. The most frequent indication for cesarean section was cephalopelvic disproportion (28.7%). Regional anesthesia was used in 92.1% whereas 7.9% had general anesthesia. The most frequent critical incident was hypotension (15.8%). Conclusion: Spinal anesthesia is the most frequently used form of anesthesia for cesarean section.
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Correlation between functional disability grade and radiographic severity among Nigerian patients with knee osteoarthritis p. 14
Umar AbdulAziz, Olufemi O Adelowo, Bello O Usman
DOI:10.4103/jomt.jomt_39_18  
Background: Knee osteoarthritis (OA) is the most common form of degenerative arthritis in human and a leading cause of functional disability in the middle aged and elderly. The diagnosis of knee OA is often based on clinicoradiographic criteria. And in spite of the widespread utilization of knee radiograph in the diagnosis of knee OA, studies on the correlation between clinical and radiographic findings have been discordant. Although most studies of knee OA patients in Nigeria have incorporated knee radiograph in the diagnosis of the disease, the contribution of radiographic severity to functional disability in Nigerian patients is not well described. Objective: The aim of this article is to determine the pattern of radiographic knee OA in Nigerian patients and the correlation between radiographic grades of knee OA and functional disability. Materials and Methods: One hundred forty consecutive patients with knee OA attending the Rheumatology Clinic of Ahmadu Bello University Teaching Hospital were recruited for the study. Patients biodata and anthropometric parameters were ascertained. Patients had general and musculoskeletal examination. Knee radiographs were done for all patients and graded using the Kellgren-Lawrence (K-L) grading system. Pain and functional disability grades were measured using Likert 3.0 Western Ontario McMaster University index. Results: All 140 patients had definite knee OA on radiograph (K-L grade 2 and above). Grade 2 radiographic knee OA was noted in 51 (36.4%) patients, grade 3 in 71 (50.7%) patients, and grade 4 in 18 (12.9%) patients. Eighty-nine (63%) patients had severe radiographic knee OA. The mean pain and disability scores were significantly higher in patients with grade 3 or 4 radiographic knee OA compared to those with grade 2 radiographic knee OA. Both pain and functional disability moderately correlated with radiographic grades (rs = 0.36, P = 0.000) and (rs = 0.48, P = 0.000), respectively. Conclusion: The point prevalence of severe radiographic knee OA (K-L grade 3 or 4) is 63% in Nigerian knee OA patients. There is a moderate correlation between radiographic severity and functional disability in knee OA patients, with radiographic severity being an independent predictor of functional disability.
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Dyslipidemia in HIV infected and AIDS patients: Association of serum lipids with HIV status, a cross-sectional study p. 20
Abhishek Singh Nayyar
DOI:10.4103/jomt.jomt_1_19  
Context and Aim: Hematological abnormalities are among the most common complications of infection with human immunodeficiency virus (HIV). There have been quite a few studies on the alterations in lipid profile, too, although the results have largely been inconclusive. The present study was carried out to assess CD4 cell counts and lipid profile in the HIV-infected and AIDS patients in the Indian population and correlate them with the seronegative controls. Materials and Methods: The present study was designed as a cross-sectional, hospital-based study conducted between January 2017 to September 2017 to assess CD4 cell counts and lipid profile in the HIV-infected and AIDS patients in the Indian population and correlate them with the seronegative controls. Evaluation of lipid profile was done using Erba EM 360, an automated analyzer powered by a diffraction grating photometer, whereas CD4 cell counts were evaluated using Partec Cyflow Counter. Statistical Analysis: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using analysis of variance and post hoc Games-Howell test. P value of <0.05 was considered statistically significant. Results: The levels of total cholesterol and low-density lipoproteins (LDLs) were significantly decreased whereas triglycerides and very LDLs were significantly increased in the HIV-infected and AIDS patients when compared with the seronegative controls. Conclusion: Total cholesterol, LDLs, triglycerides, and very LDLs were significantly altered in the HIV-infected and AIDS patients when compared with the seronegative controls.
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Awareness and knowledge of sustainable development goals among health workers in Bida, north-central Nigeria p. 26
Abdulafeez Oyesola Bello, Paul Adah Omachi, Muhammad An Adeboye, Abdulrasheed Olasukanmi Adegboye
DOI:10.4103/jomt.jomt_3_19  
Background: The sustainable development goals (SDGs) are the latest intervention focused on ensuring global development. The failures of the millennium development goal, which was the previous global strategy, have been hinged on poor awareness and knowledge of critical stakeholders among other reasons for poor performance in most developing countries. Methods: We carried out a cross-sectional study among a group of critical stakeholders (health workers) to assess their awareness and knowledge of the SDGs since its inception in 2015. We used a scoring system for some key components of the SDGs and analyzed the obtained data. Results: Of the 103 health workers that partook, 63.1% were males and 36.9% were females. Forty-eight percent of the respondents had good knowledge of the SDGs. Male gender among the participants was predictive of good knowledge whereas the professional affiliation of the participants did not significantly predict good knowledge of the SDGs. Conclusionand Recommendation: Awareness and knowledge of SDGs among participants was good. We recommend the introduction of SDGs in the curriculum of health workers with special focus for female professionals to enhance attainment of the goals.
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Frequencies of ABO and Rhesus (D) blood group phenotypes among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria p. 31
Isyaku Gwarzo Mukhtar, Aisha Yakubu Abdulkadir
DOI:10.4103/jomt.jomt_4_19  
Background: Pregnancy, though a physiological phenomenon, is sometimes associated with complications requiring blood transfusion. Effective and safe blood transfusion services require a working database of the frequencies and distribution of ABO and Rhesus (Rh) (D) blood groups. Aim: The aim of this study was to determine the frequencies and distribution of ABO and Rh (D) blood groups among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria. Materials and Methods: A total of 210 pregnant women who presented to the booking section of the clinic were recruited for the study. Sociodemographic information of the patients was obtained using a semistructured interviewer-administered questionnaire. ABO and Rh (D) blood groups were determined by the agglutination method using potent monoclonal anti-A, anti-B, and anti-D reagents. Results: Blood groups O, B, A, and AB accounted for 98 (46.7%), 53 (25.2%), 45 (21.4%), and 14 (6.7%), respectively. Rh (D) positivity was 202 (96.2%) whereas Rh (D) negativity was 8 (3.8%). Conclusion: ABO phenotype O blood group is the most common among pregnant women in this environment with the majority being Rh (D) positive.
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Attitude, perception, acceptance, and life after amputation as seen in Lagos University Teaching Hospital p. 37
George O Enweluzo, Osaze A Ogbeide, Olanyinka O Akinbode
DOI:10.4103/jomt.jomt_5_19  
Background: Amputation is a surgical ablation of a limb as a form of treatment. A survey of the attitude, perception, and acceptance of amputation was carried out to determine the level of knowledge and understanding of the indications and benefits, among adult patients and relatives at the Orthopaedic and Trauma Clinic of the Lagos University Teaching Hospital. This study also involved survey among amputees to determine prospects of life after amputation. Methods: This is a cross-sectional study in which structured questionnaires were administered to adult patients and relatives at the Orthopaedic and Trauma Clinic of the Lagos University Teaching Hospital from May 2017 to November 2018. A second questionnaire was administered to few amputees and the data obtained from the study was analyzed using SPSS. Results: A total of 332 respondents were interviewed. The mean age was 43 ± 19.4 years. There were 194 (58.4%) males and 138 (41.6%) females. Two hundred ninety-nine respondents (90%) had knowledge of amputation as a treatment method whereas 21 (6.3%) had no knowledge. Two hundred twenty-six respondents (68%) were aware of the importance of prosthesis. Seven (17.9%) were able to return to their initial work whereas eight (20.5%) were able to secure work other than their initial work. Conclusion: Majority of the respondents had good knowledge of amputation as well as the indications for amputation. Few of the amputees interviewed were able to return to their preamputation work; therefore, there is the need for improved social support, better rehabilitation, and occupational therapy in developing countries.
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Craniofacial morphology of HIV infected adolescents on highly active antiretroviral therapy (HAART): An original research p. 42
Abhishek Singh Nayyar
DOI:10.4103/jomt.jomt_6_19  
Background: Numerous studies have illustrated the therapeutic effects of the highly active antiretroviral therapy (HAART) while simultaneously leading to a plethora of associated adverse effects including changes in the craniofacial growth and development. The present study was planned to analyze the craniofacial morphology in adolescents by evaluating the skeletal cephalometric profile of the human immunodeficiency virus (HIV)-infected patients in this age group and comparing them with the HIV-negative controls. Methods: The present study was a planned case–control study that included 25 HIV-positive adolescent patients aged between 10 and 19 years (study group) who were compared with 25 age and sex-matched HIV-negative adolescent controls (control group). All the patients had been HIV-infected via vertical transmission with positive serology confirmed in two different tests and had been on HAART since they were born. Results: In the 10 to 12-year age group, positions of maxilla and mandible in the study group were found to be retruded in relation to the skull base when compared with the control group whereas in the 13 to 15 and 16 to 18-year age groups, maxilla was retruded slightly while the mandible was found to be protruded in the study group in relation to the skull base. Conclusion: Although the differences in majority of the measurements made were not found to be significant enough, the study highlighted the significance of further studies to be conducted in this regard, especially, the longitudinal study designs wherein the said variables can be studied on a follow-up basis to have an idea of the exact changes observed and their pattern in the included groups.
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