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   Table of Contents - Current issue
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January-June 2020
Volume 22 | Issue 1
Page Nos. 1-72

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ORIGINAL ARTICLES  

Knowledge, attitude, and practice toward Lassa fever prevention and control among health care providers in Sabon Gari local government area, Kaduna State, Nigeria p. 1
Sunday Asuke, Edgar Agubamah, Muhammed S Ibrahim, Joseph O Ovosi
DOI:10.4103/jomt.jomt_10_19  
Background: Lassa fever is an acute viral hemorrhagic disease of public health concern causing recurrent outbreaks that often involve healthcare providers. Effective hospital infection control limits the impact of this disease. Objective: To assess the knowledge, attitude, and practice of health care providers toward Lassa fever prevention and control in Sabon Gari local government area, Kaduna State, Nigeria. Materials and methods: It was a cross-sectional descriptive study in which data were collected using a self-administered semi-structured questionnaire and analyzed using SPSS version 20.0. Associations between practice and other variables were tested using chi-square at P < 0.05. Results: A total of 131 health care providers participated in the study. Of these, 119 (96.0%) respondents were aware of Lassa fever. Overall a good knowledge of Lassa fever was only in 46 (35.1%) of them, while attitude toward prevention and control of Lassa fever was good in 110 (84.0%). However, only 91 (69.5%) had good practice of prevention and control of Lassa fever. Practice of prevention and control showed statistically significant association with knowledge (P = 0.01) and ethnicity (P = 0.006), but not with the other factors tested. Conclusion and recommendations: Despite the fairly good knowledge of Lassa fever, attitude and practice toward Lassa fever prevention and control were good. There is a need for continuous awareness of prevention and control among the health care providers.
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Prevalence of metabolic syndrome in HIV-infected and Non-HIV infected Nigerian children in Jos p. 8
Abok Ibrahim Ishaya, Ige Olukemi
DOI:10.4103/jomt.jomt_17_19  
Background: Both Human Immune-deficiency Virus (HIV) and anti-retroviral (ARV) are associated with metabolic disorder. This study compared the prevalence of metabolic syndrome (MetS) among HIV and non-HIV infected children. Methods: This was a comparative cross-sectional study of 142 HIV infected and 142 HIV non-infected children. Socio-demographic and clinical data were collected. Blood pressure, height, weight abdominal circumference were assessed using standard procedure. Fasting blood samples were collected for blood glucose and blood lipid profile. Result: The mean age at diagnosis of HIV infection was 4.9 years and 140 children were on ARVs. Cumulatively, 23.9% of the non-HIV infected children compared to 16.2% of HIV children (P = 0.11) had one component of MetS. Abdominal obesity was prevalent in 3.5% of non-HIV compared to 0% of HIV infected children; high blood pressure (HBP) was present in 8.5% of non-HIV compared to 0.7% of HIV-infected children (P < 0.001). HIV-infected children had higher prevalence of hyper-triglyceridemia compared to non-HIV (9.3% compared 3.5% respectively; P = 0.05). Cumulatively the clustering of two components of MetS was prevalent in 2.8% each of HIV-infected and non-HIV-infected children. Atherogenic lipids (low high density lipo-protein and high triglyceride) was diagnosed in 2.8% versus 0.7% of HIV infected and non-infected respectively (P = 0.18). MetS was diagnosed in 0.7% of non-HIV infected children and none of the HIV infected children. Conclusion: While both HIV and non-HIV-infected children had a high prevalence of one component of the MetS, MetS is however uncommon in our study population.
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The determinants of emergency room visits and missed school days in children with asthma in a tertiary hospital in north central Nigeria p. 13
Helen O Akhiwu, Esther S Yiltok, Augustine O Ebonyi, Ibrahim Aliyu, Stephen Oguche
DOI:10.4103/jomt.jomt_18_19  
Background: Asthma is a major cause of emergency room visits and missed school days. However, the magnitude of this problem in Nigeria is yet to be evaluated. This study assessed the number of emergency room visits, missed school days as well as identified their determinants. Methods: This was a cross-sectional study carried out in the Paediatric Respiratory Clinic and the Emergency Paediatrics Unit of a tertiary hospital. The number of missed school days and emergency room visits were calculated and extrapolated for the estimated population of children with asthma in the state. Results: A total of 60 children with a male to female ratio of 1: 0.6 were studied. There were an estimated 5.3 million missed school days and over 460,000 emergency room visits per year for children with asthma in Plateau state. The commonest reasons for emergency room visits were severe acute exacerbation, poor knowledge of self-management and non-response to inhaled bronchodilators while the duration of asthma diagnosis, family member with atopy, family history of asthma and exercise intolerance were the determinants of emergency room visits and missed school days. Conclusion: With 5.3 million missed school days and over 460,000 emergency room visits in a year, asthma is a disease of significant public health importance. Self-management at home must be well taught at the beginning to all the patients. Care givers and patients need to know when they need to seek for help and not wait till the acute exacerbations are severe before presenting to the hospital.
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Congenital heart disease in neonates with external congenital anomalies in Jos, Nigeria p. 19
OO Ige, CS Yilgwan, AS Sagay, P Kanki, F Thomas
DOI:10.4103/jomt.jomt_22_19  
Background: Congenital heart disease (CHD) has been found to be more common in neonates with other congenital anomalies and may worsen prognosis. Early diagnosis and treatment of internal congenital anomalies including CHD will improve outcome and decrease neonatal mortality. This study determined the prevalence of CHD among neonates seen with external congenital anomalies in Jos, Nigeria. Materials and Methods: We performed complete physical examinations on 2,340 neonates delivered in two tertiary hospitals in Jos, Nigeria. We identified neonates with external congenital anomalies and determined the prevalence of congenital heart defects in them using echocardiography. Data were analysed using STATA 14.0. Results: External congenital anomalies were present in 49 of the 2,340 neonates recruited − prevalence of 20.9 per 1,000, with a male to female ratio of 1.1:1. Fourteen (28.6%) neonates were syndromic. CHD was present in 15 of 49 (30.6%) neonates studied– prevalence 30.6 per 100. The mean age of the parents with neonates who had external congenital anomalies and CHD was significantly higher than those without CHD. Conclusion: CHD frequently co-exists with external congenital anomalies especially in syndromic neonates. Hospital-based surveillance systems are needed to capture accurately both internal and external congenital anomalies to improve outcome in these group of neonates.
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Virological and immunological profile of HIV patients on first-line antiretroviral therapy in north central Nigeria: a retrospective study p. 26
Nathan Y Shehu, Victor B Ojeh, Benjamin M Aya, Augustine O Ebonyi, Johnson Mafuka, Simji S Gomerep, Samson E Isa, Oche O Agbaji, Atiene S Sagay
DOI:10.4103/jomt.jomt_23_19  
Background and Objectives: The use of Highly Active Antiretroviral Therapy (HAART) has dramatically improved the quality of life and overall survival of HIV patients. UNAIDS has set a target of viral suppression for 90% of those treated by 2020 in order to end the HIV epidemic. We set out to determine patients’ virologic and immunological response after medium term first-line ART. Methods: This retrospective study was done between April 2017 and May 2018 at the AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic of the Jos University Teaching Hospital (JUTH), north central Nigeria. Included in this analysis were patients who had been on either TDF/FTC/EFV or AZT/FTC/NVP consistently for at least 12 months and who had at least 95% adherence based on pharmacy drug pick up. Data were analysed using SPSS version 23.0. Results: A total of 301 patients who met the inclusion criteria were studied of which 187 (62.1%) were females and the overall mean (SD) age was 40±9 years. There were 204 (67.8%) patients on AZT/FTC/NVP while 97 (32.2%) were on TDF/FTC/EFV. Overall, the CD4 count increased from a median (IQR) baseline of 201 cells/mm3 by the end of 12 months of HAART. Or was it 24 months you used? (112–284) to 488 cells/mm3 by the end of 12 months of HAART (344.5–628.0) P = <0.001. Their overall virological suppression was 86.7%, but was higher for the TDF/FTC/EFV arm 92.8% compared to the AZT/3TC/NVP arm 83.8% (P = 0.03). Conclusion: Overall, there was good virologic suppression and immunological response of patients on first-line ART. This suggests that with good adherence the UNAIDS target of viral suppression for 90% of those treated is achievable.
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Rapid detection of carbapenemase production in Enterobacteriaceae by different phenotypic methods p. 31
Simit Kumar, Maitreyi Bandyopadhyay, Tulika Majumder, Subhayan Das Gupta
DOI:10.4103/jomt.jomt_24_19  
Introduction: Carbapenemase producing enterobacteriaceae (CPE) isolates have now emerged worldwide. Resistance to carbapenems is mainly due to production of beta-lactamases inactivating carbapenems (carbapenemases) included in classes A, B, C, or D of the Ambler classification. In Enterobacteriaceae carbapenemase encoding genes are often located on plasmids that contribute to a rapid spread among clinically relevant gram negative bacteria. Rapid and reliable detection of carbapenemase production is needed for therapeutic and control reasons. Aims: To compare the different phenotypic methods of carbapenemase detection namely, the modified paper strip carba NP method, the CLSI Carba NP method, the carbapenem inactivation method, and for rapid detection of CPE. Materials and methods: A total of 200 CPE from urine, pus, and blood cultures sent to the Microbiology Laboratory, R.G. Kar Medical College and Hospital (RGKMCH), were tested for the modified paper strip carba NP method, the CLSI Carba NP method, and the carbapenem inactivation method. Results and analysis: Out of 200 isolates, 108 isolates of Klebsiella spp and 92 isolates of Escherichia coli were compared for carbapenemase production by various phenotypic methods. In total, 100(93%) isolates of Klebsiella spp and 88 (95%) isolates of Escherichia coli showed positive results by paper strip and carba NP methods. A total of 96 (89%) isolates of Klebsiella spp and 84 (91%) isolates of Escherichia coli showed positive results by CLSI carba NP method. A total of 104 (96%) isolates of Klebsiella spp and 92 (100%) isolates of Escherichia coli showed positive results by CIM method. Conclusion: Rapid and accurate detection of carbapenemase producers are important for preventing their spread in health care settings. Although genotypic tests remain the gold standard but cannot practically be conducted because they are highly expensive and results are limited by the targets. The different phenotypic methods used in this study were inexpensive, rapid, highly sensitive, and specific. The modified paper strip Carba NP method in this study is a simple and rapid method compared to those performed by the CLSI method.
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Breast and cervical cancer screening: A survey of university employees p. 35
Amaka N Ocheke, Patricia A Agaba, Samuel R Ohayi, Malyot S Onche, Mary Momoh, Amos O Aje, Kenneth N Ozoilo, Emmanuel I Agaba
DOI:10.4103/jomt.jomt_25_19  
Background: There is an increasing occurrence of non-communicable diseases worldwide. Among them, breast and cervical cancers are notable among females. These diseases often present late with adverse outcomes. Only early detection offered by screening of disease offers the hope of cure. Hence, we undertook a breast and cervical cancer screening education and exercise among female workers of a university community. Methods and Methods: This was part of a non-communicable disease survey among members of the university community. Structured questionnaires were administered on participants after a talk. Screening was carried out using the Papanicolau test for cervical cancer and clinical breast examination for breast cancer. Results: A total of 210 participants were screened. 42 (10.8%) and 23 (10.8%) had family history of breast cancer and previous breast lump, respectively. Only one participant (0.48%) had a breast lump. Abnormal Pap smear result was present in 59 (30.1%) (Inflammation [59.32%], high grade squamous intraepithelial lesion (HSIL) [10.17%], low grade squamous intraepithelial lesion (LSIL) [6.78%], atypical squamous cell of undetermined significance (ASCUS) [10.17%], Atypical squamous cells- cannot exclude HSIL’ (ASC-H) [11.86%] and atypical glandular cells of undetermined significance (AGUS) [1.69%]). Conclusion: The uptake of screening was low, the yield for cervical anomalies was also low, but a reasonable proportion of the participants had risk factors for breast and cervical cancers and so would benefit from further screening over time.
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Hypoglycemic effect of aqueous leaf extract of Senna singueana on alloxan-induced diabetic wistar rats p. 41
Isyaku Gwarzo Mukhtar, Bashir Wada Yakasai, Dalhat Taura Firdausi
DOI:10.4103/jomt.jomt_35_19  
Background: Diabetes mellitus is a chronic metabolic disorder with significant morbidity, mortality, and high cost of care. Rising cost of treatment and incidence of the disease coupled with poor access to health facilities have compelled people to resort to use of plant products as sources of remedy. One of such plant that is been used as remedy for diabetes is Senna singueana. Aim: The aim of the study was to investigate the effect of aqueous leaf extract of Senna singueana on blood glucose level. Materials and Methods: Sixteen adult wistar rats weighing 80–120g randomly divided in to 4 groups (A–D) of four rats each were used for the study. Groups A and B served as normal and diabetic controls respectively. Diabetes was induced with 150 mg/Kg body weight (b.w) in groups B, C, and D intraperitoneally. Groups A and B received normal saline at 5 mL/Kg b.w while groups C and D were treated with 250 mg/Kg b.w of aqueous leaf extract of Senna singuea and 5 mg/Kg b.w of glibenclamide daily for 5 days, respectively. Blood glucose concentration was measured before induction of diabetes, 48 hours after induction but before treatment with extract, and 5 days after daily administration of the extract. Data were analyzed using International business machine statistical package for social science version 23.0 (IBM, Armonk, New York, USA). One-way ANOVA was used to compare mean blood glucose level between groups and Bonferroni post hoc test was used where there was statistical significance. P value ≤ 0.05 was considered statistically significant. Results: There was no significant difference in baseline blood glucose levels between the four groups (P = 0.130). Rats in groups B, C, and D had statistically significant higher blood glucose levels than group A 48 hours after treatment of groups B, C, and D with alloxan (P = 0.001). The extract treated group (C) had statistically significant reduction in blood glucose level after 5 days of oral administration of the extract (0.001). Similarly, the extract treated group (C) had statistically significant lower blood glucose level at the end of 5 day treatment compared with the diabetic control group (B) (P = 0.001). There was also significant reduction in blood glucose in the glibenclamide treated group (D) after 5 day treatment with the drug compared to diabetic control group (B) (P = 0.005). However, there was no significant difference in blood glucose level between the extract treated group (C) and glibenclamide treated group (D) after 5 day treatment with extract and glibenclamide respectively (P = 0.999). Conclusion: Aqueous leaf extract of Senna singueana significantly reduced blood glucose level after 5 day daily oral treatment at 250mg/Kg b.w.
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Congenital heart disease and associated comorbidities among children with Down syndrome in the Niger Delta region of Nigeria p. 46
Chika O Duru, Olukemi O Ige, Frances S Okpokowuruk, Queennette O Daniels, Patience A Udo, Fadekemi Megbelayin, Kevin B Edem, Olawale Olabiyi, Christopher S Yilgwan
DOI:10.4103/jomt.jomt_39_19  
Introduction and Objectives: Congenital heart disease (CHD) in children with Down syndrome is a common association. This study aims to describe the pattern of CHD and associated co-morbidities seen in children with Down syndrome in the Niger Delta Region of Nigeria. Materials and Methods: This was a descriptive cross-sectional study conducted in Uyo, Akwa Ibom State, during a cardiac mission. Children with phenotypic features suggestive of Down syndrome and a prior diagnosis of CHD had trans-thoracic echocardiogram performed by a team of paediatric cardiologists. The data were analyzed with STATA 14.0 Statistical package. Results: Thirty-five children with physical features suggestive of Down syndrome were seen, all of whom had CHD. They had a mean age of 5.8 months at diagnosis and 25.8 months at presentation. The most common heart defects detected were Atrioventricular septal defects in 28.6% of cases. The most common co-morbidity noted was heart failure in 17 (48.6%) of them followed by wasting in 15 (42.9%). Though 14 (40.0%) children were on a pulmonary vasodilator (sildenafil), only 5 (14.3%) children had features suggestive of pulmonary hypertension on echocardiography, all with atrioventricular septal defects (AVSD). Conclusion: AVSD is the most common CHD seen among children with Down syndrome in our study and is frequently associated with pulmonary hypertension.
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Psychoactive substance use and its predictors among commercial tricycle operators in Jos north local government area of Plateau State p. 51
Tolulope O Afolaranmi, ZI Hassan, OJ Ugwu, MA Onche, JC Obasi, OG Stephen, KG Ugwu, PW Bupwatda
DOI:10.4103/jomt.jomt_44_19  
Background: According to United Nations Office on Drugs and Crime (UNODC) around 243 million people, aged 15–64 consumed an illicit substance making this a public health problem of global dimensions with attendant physical, social, and psychological problems. Studies have shown that 59.5% of road traffic accident among commercial tricycle operator has been associated with the use of psychoactive substances. Hence, this study was conducted to assess the prevalence and pattern of psychoactive substance use and its predictors among tricycle operators in Jos north local government area of Plateau State. Methodology: This was a cross sectional study conducted among 220 commercial tricycle operators selected from a cluster of five operational units of Tricycle Riders Union using quantitative data collection instrument consisted of three sections through an interviewer’s administration method. Results: The mean age of the respondents in the study was 34 ± 10 years with the prevalence of current use of psychoactive substance being 43.2%. The predictors of psychoactive substance use were tertiary level of education (AOR = 0.06; 95% CI = 0.0074–0.4806) and family history of use of psychoactive substance (AOR = 3.30; 95% CI = 1.7164–6.3611). Conclusion: This study has demonstrated a high level of illicit psychoactive substance use among commercial tricycle operators with higher level of education negatively influence its use and a positive family history potentiating it.
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Knowledge of adverse events following immunization, its prevalence and actions of mothers of children aged 0–23 months in a tertiary health institution in Jos, North Central Nigeria p. 57
Tolulope O Afolaranmi, ZI Hassan, OY Sodipo, D Gwomson, OJ Ugwu, A O D Ofakunrin, OO Ige, YO Tagurum, PW Bupwatda
DOI:10.4103/jomt.jomt_45_19  
Background: Adverse Event Following Immunization (AEFI) is any unfavorable event occurring following vaccination related to the vaccine administration and or its handling. AEFI can lead to death or a life-threatening condition requiring hospitalization with or without permanent sequel. Hence, this study was conducted to determine the knowledge of AEFI among mothers of children aged 0–23 months, its prevalence and actions of mothers of following AEFIs. Methodology: This was a cross-sectional study conducted among 400 mothers of children aged 0–23 months between November 2017 and April 2018 using quantitative method of data collection. IBM SPSS version 20 was used for data analysis where chi square was used as a test of association a P-value of ≤ 0.05 considered statistically significant. Results: The mean age of the respondents in the study was 29.0 ±5.3 years with 222 (55.5%) demonstrating good knowledge of AEFI. The prevalence of AEFI was found to be 46.5% with fever as the most experienced AEFI accounting for 90.3% of all cases experienced followed by pain and swelling mentioned by 141 (75.8%) and 26 (14.0%) respectively. Only 26 (14.5) of the mothers were adjudged to have taken appropriate action following the experience of AEFI in their children. Appropriateness of actions taken by the mothers following the occurrence of AEFI was influenced by the mother’s employment status (COR = 3.84; 95% CI = 1.366–10.575; P = 0.007). Conclusion: This study has demonstrated a sub-optimal level of knowledge of AEFI among the mothers of children aged 0–23 months with a relatively high self-reported prevalence and poor level of appropriateness of actions taken following AEFI.
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Public knowledge and perception of heart disease: A cross-sectional study of two communities in Delta State, Nigeria p. 65
Ejiroghene M Umuerri
DOI:10.4103/jomt.jomt_3_20  
Background: Knowledge gaps and misperception of heart disease and its risk factors are significant roadblocks to effective prevention and control of cardiovascular diseases (CVD). This study aims to assess the knowledge and perception of heart disease and its risk factors among adults in Delta State, Nigeria. Method: Cross-sectional study of adults recruited from Jesse and Warri, Delta State, Nigeria. The study questionnaire was adapted from the heart disease fact questionnaire (HDFQ). Respondents with knowledge scores <50%, 50–69.9%, and ≥70% were assigned poor, moderate, and good knowledge, respectively. Ethical approval was obtained from the DELSUTH Health Research Ethics Committee. Result: Eight hundred and sixty-six adults with a mean age of 42.6 years were recruited for the study. Majority (56.0%) of the respondents were females and urban dwellers. Knowledge score ranged between 0.0% and 95.7% with a mean score of 39.8(±22.5) %. Majority (65.1%) had poor knowledge of heart disease. Knowledge of heart disease was significantly associated with place of residence [OR (95%CI) = 0.544 (0.408–0.727); P < 0.001], age group [OR (95%CI) = 0.437 (0.314–0.607); P < 0.001], duration of formal education [OR (95%CI) = 3.805 (2.755–5.255); P < 0.001] but not sex (P = 0.871). Majority (75.2%) perceived heart disease to be an extremely serious condition. However, 74.7% of the respondents were not concerned at all about getting heart disease. Conclusion: Although majority of the respondents in this study perceived that heart disease was a serious condition, the overall knowledge of heart disease was poor. There is need to scale-up heart health education among the general populace in Nigeria.
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