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   Table of Contents - Current issue
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July-December 2019
Volume 21 | Issue 2
Page Nos. 51-107

Online since Friday, December 13, 2019

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ORIGINAL ARTICLES  

Diabetes in elderly Nigerians: A survey of a rural area in north-central Nigeria p. 51
Evelyn K Chuhwak, Basil N Okeahialam, Chika Ogbonna, Salem D Pam
DOI:10.4103/jomt.jomt_26_18  
Background: The burden of diabetes mellitus in Nigeria has been estimated to be on the increase over the past few decades. Its prevalence has also been noted to vary across rural, semi-urban, and urban areas in the country and also across age groups. This study was conducted as part of a non-communicable disease survey in north-central Nigeria carried out in 2008. Aim: To determine the prevalence of type II diabetes mellitus among elderly individuals in Gindiri—a rural area in Mangu local government area of Plateau State, north-central Nigeria. Methodology: Consecutive subjects were recruited from the study population. A total of 197 subjects were found to be 60 years of age or older and these were screened for the presence of diabetes mellitus. Those found to have diabetes mellitus were referred to the Jos University Teaching Hospital Primary healthcare Centre in Gindiri for follow-up. Results: There were 124 female and 73 male elderly subjects, respectively. Both genders had similar age (P > 0.10), BMI (P > 0.10), and waist/hip ratio. The mean random blood glucose was also similar. Out of the eight subjects who were found to have diabetes, two were old patients already on treatment whereas six were new cases diagnosed on account of a random blood glucose of over 11.1 mmol/L. The prevalence of type II diabetes mellitus among elderly rural dwellers in Gindiri is 4.06%. Conclusion: The prevalence of diabetes mellitus among the elderly in rural Africa is higher than in the general population. The vast majority are asymptomatic and have fewer associated comorbidities which thus leads to delayed hospital presentation. The rate is however much lower than the corresponding prevalence rates among the elderly in more highly urbanized areas of the world. This may be due to differences in diet and lifestyle. It is noted however that the prevalence of diabetes mellitus is increasing in the rural area.
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Assessment of health facilities, commodities, and supplies for malaria case management at primary healthcare centers in Ogun state, Nigeria p. 56
Temitope W Ladi-Akinyemi, Olusoji J Daniel, Oluchi J Kanma-Okafor, Adedoyin O Ogunyemi, Adebayo T Onajole
DOI:10.4103/jomt.jomt_29_17  
Introduction: Country-specific evidence shows that Nigeria has the largest population at risk of malaria in Africa. Primary healthcare facilities play a major role in malaria control and often provide the bulk of malaria case management services. Materials and Methods: A cross-sectional study was conducted in primary healthcare centers (PHCs) in three Local Government Areas (LGAs) of Ogun state. A pretested observational checklist adapted from the National Malaria Control Programme (NMCP) guideline was used to assess the health facilities, commodities, and supplies for malaria case management in all the PHCs. Results: A total of 75 PHCs were visited in the three LGAs. Only 32.0% of the PHCs had long lasting insecticide nets (LLINs) on the hospital beds. The majority (74.7 and 60.0%) of the PHCs distributed LLINs at antenatal care (ANC) and during immunization. The availability of sulfadoxine-pyrimethamine (SP) was good in 57.3% of the PHCs, and directly observed therapy of SP at ANC was good in 59.3% of the PHCs. Only 6.7% of the PHCs had the light microscope. There was availability of rapid diagnostic test kits in 62.7% of the PHCs. There was regular supply of artemisinin-based combination therapy in almost half of the PHCs. However, only 5.3% of the PHCs had quinine tablets available and only one of the PHCs had the correct prescription of quinine. Conclusion: There should be adequate and regular supplies of NMCP commodities in the PHCs if the country is to achieve the general objective of the current National Malaria Strategic Plan.
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Estimation of maternal mortality by sisterhood method in two rural communities in Kaduna State, Nigeria p. 62
Nafisat Ohunene Usman, Hadiza Musa Abdullahi, Awawu Grace Nmadu, Victoria Nanben Omole, Jessica Timane Ango
DOI:10.4103/jomt.jomt_34_18  
Background: One of the sustainable development goals is reducing the global maternal mortality burden with maternal mortality ratio (MMR) being one of the indicators to track the progress. Unfortunately, there is paucity of MMR data, especially at subnational levels. Standard household survey methods used in maternal mortality estimation are very resource intensive. The indirect sisterhood method offers a cheaper alternative. Although the results may be retrospective and not very useful in tracking progress, it provides useful information for advocacy. Objective: This article determines the proportion of deaths that was due to maternal causes, lifetime risk of maternal death, and MMR in two rural communities in northwestern Nigeria. Methodology: The indirect sisterhood method for estimation of maternal mortality was used to collect information from a sample of 1905 women within the reproductive age group in two rural communities, in Kaduna state, northwestern Nigeria. Results: There were a total of 416 deaths among ever married sisters of the respondents, of which 50% were due to maternal causes. The lifetime risk of maternal death is one in 11, whereas the MMR was 1400 per 100,000 live births. Conclusion: The maternal mortality indicators in these two communities are higher than the national rates and this underscores the need for the generation of subnational data and the scaling up of maternal mortality indicators. It also underpins the need to focus on social determinants like maternal education and early marriage in the course of reducing maternal mortality.
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Knowledge, attitude and practice of modern contraception among women of reproductive age in urban area of kano, north-western nigeria p. 67
Auwal Umar Gajida, Idris Usman Takai, Iman Usman Haruna, Khadija Abbati Bako
DOI:10.4103/jomt.jomt_9_19  
Background: The contraceptive prevalence is on the rise worldwide as more people have become informed and aware with a positive attitude toward its practice. This study, therefore, investigates the knowledge, attitude, and practice of modern contraception among women of reproductive age in Kundila Housing Estate, Kano Metropolis, Nigeria. Methods: A cross-sectional community-based study was conducted in Kundila Housing Estate, Tarauni Local Government Area of Kano State. Using a multistage sampling, 183 women of reproductive age were selected and interviewed using an interviewer-administered questionnaire with both open and close-ended questions. Results: The age of the respondents ranged from 15 to 49 years with a mean of 29.5 ± 8.0 years and majority 44 (24.0%) were aged 25–29 years. Most of the respondents (96.7%) were aware of the concept of modern contraception, and 85.8% of them had adequate knowledge. Majority of the respondents (70.5%) recommended the introduction of family planning lessons in schools, whereas 29.5% did not agree. Similarly, 60.7% of respondents were found to have good practice of modern contraception and majority of them obtained reproductive services from the primary health centers. Educational level, family structure, and duration from last childbirth were found to be significantly associated with the knowledge of modern contraception among the respondents. Conclusion: This study further affirms the positive attitude of women in Kano Metropolis toward the use and practice of contraception.
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Knowledge, attitude, and practice of hand washing among healthcare workers in a tertiary health facility in northwest Nigeria p. 73
Muhammad Bello Garba, Luka Bright Uche
DOI:10.4103/jomt.jomt_16_19  
Background: Healthcare-associated infections (HAIs) affect 1.7 million patients at any time worldwide, causing important morbidity and mortality. Up to 40% of all HAIs are thought to be transmitted by the hands of healthcare workers (HCWs). Hand washing is the most effective way of preventing the spread of infectious diseases in healthcare settings. This study assessed knowledge and practice hand washing among HCWs in Ahmadu Bello University Teaching Hospital, a tertiary healthcare center in Zaria, Kaduna State, northwestern Nigeria. Methods: A cross-sectional descriptive study was carried out among 116 HCWs selected using stratified sampling technique. Data were collected using interviewer-administered semistructured questionnaire and observation checklist using Epi Info mobile version 7.2.0.1 (United States Centres for Disease Control and Prevention (CDC), February 2018). Data were analyzed using SPSS software version 23. Results: Respondents of the study were nurses (37.9%), doctors (31.9%), and laboratory (18.1%) and supportive (12.1%) staff. About three-quarter (72.4%) of the HCWs had good knowledge and 62.0% exhibited positive attitude toward hand washing technique, based on the World Health Organization recommendations. Overall, good adherence to proper hand washing was found among 55.2% of the respondents. Respondents’ professional cadre and unit of work, and their level of knowledge and attitude toward proper hand washing practices were shown to be significantly associated with their adherence to the practice (P < 0.05). Conclusion: Individual and institution-level factors were found to influence adherence to proper hand washing practices among the respondents.
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Changing patterns in trend of top 10 cancers in the Jos University Teaching Hospital’s (JUTH) cancer registry (1996–2018), Jos, north-central Nigeria p. 81
Olugbenga Akindele Silas, Agabus Nanfwang Manasseh, Jonah Musa, Ayuba Madachi Dauda, Ayuba Ibrahim Zoakah, Barnabas Mafalal Mandong, Chad Achenbach, Atiene Solomon Sagay, Lifang Hou, Robert Leo Murphy
DOI:10.4103/jomt.jomt_20_19  
Introduction: Changes in the epidemiology of cancers in some African countries due to demographic shift and change in lifestyle is well documented. Availability of screening, diagnostic and treatment facilities for the population serving a registry overtime is likely to impact on parameters of collated and stored data. We therefore sought to document changes in trends observed in the data stored at the Jos University’s (JUTH’s) cancer registry over the period of years in focus and highlight the role of certain local factors on these changes. Methodology: This is a 22 year retrospective descriptive study of top ten common cancers documented at the cancer registry at JUTH. JUTH is a tertiary health center located at Jos, North-Central Nigeria. Variables such as age, topography of cancer and sex were obtained and their proportions described. Results: A total of 4,279 top ten cancers were recorded during the period of study of which years 1996-2005 accounted for 2,035(47.56 %), 2006–2015; 1,606 (37.53 %) and January 2016–June 2018; 638 (14.91 %). In the different periods considered prostate cancer was the commonest in males (1996-2005:226(28.83%); 2006-2015:224(37.27%) and January 2016-June 2018:136(37.99%). While among females breast cancer was commonest 491(39.25%) from 1996-2005, 2006-2015 cervical cancer 371 (36.92%) and 2016-2018 breast cancer 140 (50.00%). In the period 2016-2018 liver cancer became the third commonest cancer while cervical cancer came to fifth position 35(5.49%). Conclusion: Changing trends in the registry’s data to provide conclusions useful for policy formulation and implementation.
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Clinicodemographic characteristics of maxillofacial fractures with concomitant injuries in a tertiary hospital in north-central Nigeria p. 87
Benjamin I Akhiwu, Helen O Akhiwu, Samuel Lassa, Moses Chingle, Simon Yiltok
DOI:10.4103/jomt.jomt_21_19  
Background: Maxillofacial injuries are any physical trauma to the soft tissues, bony structures, and special regions of the face. They are significant because injuries to this region can result in serious damage to sight, smell, breathing, eating, and talking. This study aims to describe the clinicodemographic characteristics of maxillofacial fractures seen in a teaching hospital and the types of concomitant injuries in these patients. Materials and Methods: This is a cross-sectional study of patients with maxillofacial fractures seen in a tertiary center. The study population was made up of 123 patients seen between January 2015 and December 2017. The independent variables were the demographic and clinical variables as well as the pattern of maxillofacial facial fractures whereas the outcome variable was concomitant injuries and maxillofacial fractures. Results: A total of 123 patients with maxillofacial fractures were recruited of which 80 patients had associated concomitant injuries. The male-to-female ratio was 7.2:1 with a mean age of 33.7 ± 10.2 years. The age group 21 to 30 years was most commonly affected whereas the unemployed and students were more predisposed. The most common fracture type in maxillofacial fracture patients was the zygomatic complex fractures whereas the most common fracture type was a combined facial and mandibular fracture in patients with concomitant injury. Concomitant injuries occurred in up to 65% of patients with maxillofacial fractures. The most common site of concomitant injuries was the upper limbs followed by the lower limbs. Conclusion: Concomitant injuries are commonly found to accompany maxillofacial fractures, hence the need for the managing team to look out for them.
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Mothers’ feeding practices and nutritional status of infants in a rural community in Kano state north-west Nigeria p. 93
Umma Abdulsalam Ibrahim, Amole Taiwo Gboluwaga, Zubairu Iliyasu
DOI:10.4103/jomt.jomt_26_19  
Background: Age-appropriate infant feeding practice, a major determinant of child growth, development, and survival remains suboptimal in many developing countries. Objectives: This study determined the mother’s nutritional knowledge, infant feeding practices, nutritional status of their infant, and factors associated with infant feeding practice in a rural community in Kano state. Methods: Using a cross-sectional design with a mixed method approach, data were collected from mothers and their infants in selected communities in Madobi, one of the rural local government area in Kano state. Quantitative data were collected with a semi-structured questionnaire administered to 440 mothers and their infants while qualitative data collection was done using a focus group discussion (FGD) guide with ten participants in each group. Anthropometric indices were used to determine the children’s nutritional status. Data were analyzed using Statistical Package for the Social Sciences (SPSS) statistical software (version 21), while thematic analysis was used to summarize data from the FGDs. Results: Majority of the mothers (78.0%) had adequate knowledge of infant feeding practices. Few (8.9%) of the mothers breastfed exclusively and many (90.8%) of the mothers introduced complementary foods to their infants before six months of age. The prevalence of wasting and stunting among infants was 49.6% and 43.0%, respectively. After bivariate analysis, logistic regression was done, secondary/tertiary education and delivery in the hospital remained predictors of good infant feeding practices. Conclusion: Although, majority of the caregivers had adequate knowledge of infant feeding it was not translated to good practice and thus nutritional status was poor. Efforts should be made to improve girl child education and develop sustainable strategies to improve feeding practices and nutritional status of children.
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Nasal foreign bodies among pediatric population in Zaria-Nigeria p. 100
Iliyasu Yunusa Shuaibu, MA Usman, D Chitumu, A Ajiya, NA Shofoluwe
DOI:10.4103/jomt.jomt_30_19  
Background: Nasal foreign body (FB) is a common reason for presentation to the emergency units and the Otorhinolaryngologist. Objectives: To report the pattern and management of pediatric nasal FBs in Ahmadu Bello University Teaching Hospital Zaria. Methodology: The records of patients managed for nasal FBs over a 5-year period between January 2013 and December 2017 were reviewed. Data obtained for this study included demographic characteristics such as age, sex, type of FBs, laterality or bilaterality, method of removal, and presence or absence of complications. The data were analyzed using Statistical Product and Service Solution version 23.0. Results: There were 48 (55.8%) males and 38 (44.2%) females with male-to-female ratio of 1.3:1. The mean age was 3 years with standard deviation of ±1. In total, 76 (88.4%) of the patients were between 1 and 4 years of age. Beads (30, 34.9%) and foam (15, 17.4%) were the most common FBs inserted into the nose in this study by the patients. Among the different nasal FB, there were 57 (66.3%) inorganic FBs and 29 (33.7%) organic FBs. Right nasal cavity (43, 50%) was the most common site of lodgment in this series followed by the left nasal cavity (43, 48,8%). Nasal FB were removed in the clinic using instruments in 85 (98.8%) cases. Conclusion: Children between 2 and 4 years are more prone to nasal FB inhalation. There is the need for increased awareness among the parents who use beads for decoration or worship and indiscriminate disposal of button batteries.
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CASE REPORT Top

A case of West Nile virus and tuberculosis coinfection p. 104
PV Shiji
DOI:10.4103/jomt.jomt_13_19  
Tuberculous meningitis is a common differential diagnosis in tropical countries when a patient presents with prolonged fever, headache, and cranial nerve palsies. But here is a patient who presented with a short duration history but other clinical features and investigations strongly supported the diagnosis of tuberculous meningitis. What makes the case all the more interesting is that her blood investigations revealed a strongly positive test for West Nile virus infection. So the patient has tuberculous meningoencephaltis with West Nile virus coinfection, which has been rarely reported till date.
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