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   Table of Contents - Current issue
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July-December 2020
Volume 22 | Issue 2
Page Nos. 73-159

Online since Friday, September 11, 2020

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ORIGINAL ARTICLES  

Perception and attitude of school teachers toward children with disability in an urban community, Northwest Nigeria Highly accessed article p. 73
Abdulhakeem Abayomi Olorukooba, Abdulrahman Adamu, Sunday Asuke, Umar Muhammad, Lawal Amadu, Aminu Lawal
DOI:10.4103/jomt.jomt_11_19  
Background: Teachers are known to be possibly the closest observers of school children and can play a contributory role in detecting disabilities early in children. Also attitudes of teachers towards their students play an important role in student’s academic performance. Our study aimed to determine the perception and attitude of school teachers towards children with disabilities. Methods: A cross-sectional, questionnaire-based study was conducted among teachers in schools in Samaru community. Teachers were recruited using a two-stage, multi-stage sampling technique. Attitude was measured using scoring system adapted from the Attitude Towards Disabled Persons (ATDP) scale. Results: The mean age ± SD of respondents was 32.9± 9.2 years. A large proportion; 43 (44.8%) perceived disabled children as children with physical problems only. The mean attitude score±SD was 67.30±14.22. Majority; 73(69.5%) had a positive attitude towards children with disability. There was a statistically significant relationship between attitude of the respondents and frequency of contact with disabled persons (X2 = 6.430, P = 0.011). Conclusion: There is poor understanding of the concept of disability among the teachers studied. However, majority had positive attitude towards children with disability. There is the need to improve the perception and understanding of teachers regarding disability through the LGA school authorities by introduction of pre-service trainings as well as re-trainings which will better prepare them towards attending to children with disabilities.
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Neonatal fungal sepsis in Jos North-Central Nigeria p. 80
Okolo Mark Ojogba, Ayanbimpe M Grace, Toma O Bose, Envuladu A Esther, Olubukunnola Inyang, Izang Abel, Obishakin F Emmanuel, Dashe Nanma, Onyedibe Kenneth, Echeonwu Bobmanuel, Sagay A Solomon, Egah Z Daniel, Novitsky Vladimir
DOI:10.4103/jomt.jomt_29_19  
Background: Fungal sepsis in neonates is still one of the major causes of morbidity and mortality despite advances in health care. This study aimed to characterize fungal agents of sepsis in neonates and their susceptibility pattern. Methods: This was a cross-sectional study among neonates in two tertiary health care facilities in Jos. Neonates with sepsis whose parents consented to the study were recruited based on the Integrated Management of Childhood Illnesses(IMCI) criteria. Blood sample was collected for culture, antifungal susceptibility test and molecular characterization of fungal agents isolated from blood culture of the neonates was performed using the ribosomal DNA (rDNA) of the internal transcribed spacer (ITS) region. Univariate and bivariate analysis was carried out using STATA statistical software (version 14 IC). Results: The prevalence of fungal sepsis in neonates was 5.5%. Candida albicans was responsible for 11 of the 20 cases of neonatal fungal sepsis. All the fungal isolates were susceptible to the antifungal agents used except for a little resistance by C. glabrata observed to amphotericin B (%R=0.3). Bayesian analysis confirmed the major phylogenetic relationships among the isolates and molecular identification of the different Candida species. Conclusion: Candida albicans are the major cause of neonatal fungal sepsis. The study highlights the need to evaluate the causes of neonatal fungal sepsis, their antifungal susceptibility pattern and molecular characterization for early implementation of medical intervention to reduce the morbidity and mortality.
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Prevalence and pattern of sleep disorder among final year medical students in a teaching hospital in sub-Saharan Africa p. 86
OG Osaigbovo, ER Ogbolu, BN Okeahialam
DOI:10.4103/jomt.jomt_37_19  
Background: Sleep is a very important physiologic process which is necessary to maintain a state of well-being. Apart from causing insomnia and hypersomnolence, sleep disorder has been shown to be associated with impairment of performance, vigilance, attention, concentration, and memory. Methods: This was a cross-sectional, questionnaire-based, observational study that was conducted from September to November 2017 on final year medical students of the University of Jos, Plateau State, North Central Nigeria. Results: One hundred and fifty-eight questionnaires were distributed with a total of 141 respondents. Their ages ranged from 23 to 46 years with a mean of 27.0 ±2.9 years. Forty-seven (33.3%) were females and 94 (66.7%) males giving a ratio of 1: 2. The female respondents had a mean age of 25.9 ±1.4 years compared to the male respondents 27.5 ±3.3 years. Sixty-four (48.2%) of the students had sleep disorder with narcolepsy as the commonest in over a quarter of respondents. Significant predictors of sleep disorders were male sex and obesity. Conclusion: Sleep disorder is common in final year medical students. There is a need to identify this disorder in these students in order to institute measures that will ameliorate its health consequences in these future healthcare leaders in sub-Saharan Africa.
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Pattern of tracheostomy-related complications and its determinants in Kano: a ten-year single institution experience p. 93
Abdulrazak Ajiya
DOI:10.4103/jomt.jomt_43_19  
Background: Tracheostomy is the surgical creation of an opening into the trachea. Reported complication rates of tracheostomy are varied and depends on the study design, study population, patients’ follow-up and the definition of the different complications. We reviewed the pattern of tracheostomy-related complications and its determinants. Methods: This study was a 10-year retrospective review of patients who had tracheostomy in the study area between January 2008 to December 2017. Case files of the patients were retrieved, reviewed, and information extracted. Results: Of the 149 patients, the male: female ratio was 3.8:1 with age range of 6 months to 86 years. The peak age group was 1−10 years. Foreign body aspiration and head and neck neoplasia were the two most common admitting diagnoses; 56 (37.6%) and 55 (36.8%) respectively. The most common indication was upper airway obstruction (129, 86.6%). Emergency tracheostomy was most commonly done (126, 84.6%) and majority of the tracheostomies were done under general anaesthesia (101, 67.8%). Trainee ENT surgeons performed the most tracheostomies (108, 72.5%). Surgical decanulation was done for 5 (3.4%) of the patients. The complication and mortality rates were 42.3% and 2.6% respectively. The most common period of complication was early postoperative period (46, 73.0%), and the most common complications were tube blockage and tube displacement (26, 41.3% and 11, 17.5%) respectively. The analyzed variables were not statistically significant determinants of tracheostomy-related complications among the patients. Conclusion: Tracheostomy-related complications are common, usually in the early postoperative period and usually involve blockage or displacement of the tube.
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Neonatal outcomes following caesarean section in Aminu Kano Teaching Hospital, Kano, North-west Nigeria p. 100
Alhassan Datti Mohammed, Ayyuba Rabiu, Bashir Yusuf, Fatima Usman, Mahmoud J Gambo, Rukayya A Sidi, Ibrahim Garba, Mujahid Muhammad Hassan
DOI:10.4103/jomt.jomt_47_19  
Background: Type of anaesthesia is believed to have a role in neonatal outcomes at birth. Regional anaesthesia is thought to have a better neonatal outcome. We assessed the APGAR scores of neonates, the effect of anesthetic technique and associations between maternal and neonatal variables. Methods: This was a cross-sectional study conducted from 1st August, 2018, to 31st January, 2019, at Aminu Kano Teaching Hospital. Ethics approval was obtained from College of Health Science Ethics Committee, Bayero University Kano. All consenting pregnant women scheduled for elective or emergency caesarean section within the study period were recruited. Information such as anesthesia delivery interval and neonatal outcomes were recorded on a questionnaire. Data collected were analyzed using SPSS version 22.0. Fisher’s Exact Test was used for categorical data, and the P < 0.05 was considered significant. Results: Sixty-six pregnant women were recruited. The mean age (±SD) of the pregnant women was 29.4±5.58 years. Up to 59 patients (89.4%) received subarachnoid block (SAB). Thirty six (54.5%) were delivered within 10 minutes following administration of anesthesia. Most of the newborns had normal heart rate 65 (98.5%) and Apgar scores at 1st and 5th minutes (51 (77.3%), 62 (93.9%) respectively. Only ASA PS class was found to be statistically associated with neonatal Apgar scores at 5th minutes (Fisher’s Exact Test = 0.039). Conclusion: Subarachnoid block was the main anesthesia type for caesarean section and more than half of the patients were delivered following administration of anesthesia within 10 minutes with excellent neonatal outcomes.
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Short-term treatment outcome of childhood epilepsy in Jos, Nigeria p. 108
Emeka U Ejeliogu, Aderonke Uhunmwangho-Courage, Esther S Yiltok, Mary Bok
DOI:10.4103/jomt.jomt_6_20  
Background: Childhood epilepsy causes tremendous burden for the child, the family, the society and the healthcare system. While the majority of patients with epilepsy respond well to one antiepileptic drug (AED), many respond poorly to antiepileptic therapy with two or more AEDs, or develop drug-resistant epilepsy (DRE). We evaluated the short-term treatment outcomes of childhood epilepsy at a tertiary hospital in Nigeria. Methods: We reviewed the clinical records of newly diagnosed children with epilepsy that were commenced on AEDs from January 2011 to December 2015 and completed follow-up for at least 2 years. We evaluated their treatment outcomes and studied the association between the treatment outcomes and patients’ characteristics. Results: Three hundred and twenty-six patients met the eligibility criteria. The remission rate was 64.1%, the relapse rate at 2 years was 5.3% while the prevalence of drug-resistant epilepsy was 19.9%. Children with focal seizures were 1.5 times more likely to achieve remission compared to those with generalized seizures (adjusted odds ratio = 1.52; P = 0.008). Similarly children with normal neurologic examination were about 6 times more likely to achieve remission compared to those with abnormal neurologic examination (adjusted odds ratio = 5.79; P <0.001). Conclusion: Most children with epilepsy will achieve good seizure control if they receive appropriate treatment. We need to create more public awareness on the etiology and treatment of epilepsy in order to reduce the myths and stigma associated with the disorder and improve the long term outcome of childhood epilepsy in our community.
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Open intramedullary nailing using ‘Greens Instrumentation’ in the treatment of femoral and tibial shaft fractures: a 5 years review of cases in a private health facility in the Niger Delta region of Nigeria p. 115
David O Odatuwa-Omagbemi
DOI:10.4103/jomt.jomt_7_20  
Background: Open reduction and intramedullary locked nailing using external jig (usually without intra-operative imaging) is gaining widespread popularity in developing and resource-poor countries for the management of lower limb long bone shaft fractures. I share our experience using the “Greens” instrumentation in the treatment of femoral and tibial shaft fractures in a private health facility in Delta State, Nigeria. Methods: This was a retrospective review of patients who had lower limb long bone shaft fractures seen and treated with open intramedullary nailing at a private health facility in Warri, Delta state Nigeria, over a five year period. Results: There were 20 patients with 21 lower limb long bone shaft fractures made of 13 males and 7 females (M:F = 1.5:1). Average age of patients was 42±18 years. Fifty per cent of the fractures were caused by RTA. The femur was affected in 19 fractures (90.5%) and 2 fractures affected the tibia (9.5%). Three of the fractures were open. Sixteen patients presented fresh (within 2 weeks of fracture) while the rest 4 presented at an average of 7.8±1.5 months post fracture with various complications after treatment elsewhere. All patients except 1 had open nailing. Average length of hospital stay was 19.0±9.3 days. The average time between surgery and partial weight bearing was 10.0±6.7 weeks while mean time to full weight bearing was 18.5± 6.7 weeks. Complications included deep infections in 2 patients, distal screw displacement due to early weight (against instruction) in 1 patient, delayed union in 1 patient and death of 3 patients. Conclusion: Open IM nailing of femoral and tibial shaft fractures with the “Greens” instrumentation is an effective treatment method in resource-poor settings like ours where intra-operative imaging is not readily available.
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An insight into Ribavirin post-exposure prophylaxis for Lassa fever infection prevention amongst health-care workers in a specialist hospital in North-Central Nigeria p. 122
Chidiebere Nwakamma Ononuju, Lucky Lohnan Changkat, Chidozie Valentine Adiukwu, Ogedi Blaise Okwaraoha, Uzoma Emmanuel Chinaka, Yakubu Ahmed Ashuku, Stella Uzoma Chinaka, Elizabeth Chioma Ezeaku, Hassan I Ikrama
DOI:10.4103/jomt.jomt_8_20  
Background: Oral ribavirin is used as standard post-exposure prophylaxis (PEP) in preventing the nosocomial spread of Lassa fever (LF) in outbreaks. This study sought to have an insight into the incidence and case fatality rate of Lassa fever infections, assess the biosocial data and outcome of the healthcare workers who received ribavirin PEP and determine the adverse effects associated with ribavirin PEP therapy at the Dalhatu Araf Specialist Hospital Lafia Nasarawa State Nigeria. Methods: This was a prospective study done between January 2017 to December 2018. Data on biosocial, details of exposure to the Lassa virus, the dosage of ribavirin therapy, adverse effects and outcomes were obtained. Results: The incidence of LF infection was 16% of all suspected cases, with a case fatality rate of 57.1%. General body weakness 30 (44.8%) and loss of appetite 25(37.2%) were the common adverse drug effects reported. The majority of the healthcare workers, 66 (98.5%) remained asymptomatic for secondary LF infection after completion of their oral ribavirin PEP, only, 1 (1.5%) became symptomatic for secondary LF infection, and expired on the sixth-day post-needlestick exposure. Conclusion: Lassa fever infection is common in Nasarawa State, and it is associated with a high case fatality rate. Healthcare workers on duty are at risk of being exposed when adherence to infection prevention and control is inadequate. Oral ribavirin PEP therapy was found to have a low adverse effect profile and efficacious in the prevention of symptomatic secondary LF infection.
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Obstructive uropathy and intrinsic renal disease in patients with benign prostatic obstruction: analysis of burden and associations in a university teaching hospital in Nigeria p. 127
Musliu Adetola Tolani, Muhammed Ahmed, Oyelowo Nasir, Abdullahi Sudi
DOI:10.4103/jomt.jomt_9_20  
Background: Benign Prostatic Hyperplasia (BPH) is a disease of the elderly. Some of the patients with this pathology could develop renal impairment due to the direct effect of obstruction or as a result of intrinsic renal disease. This study aimed to determine the burden and associations of obstructive uropathy and intrinsic renal disease in patients with benign prostatic obstruction in a university teaching hospital in Nigeria. Methods: This was a retrospective study of patients with BPH in our center. Glomerular Filtration Rate (GFR) was calculated and the severity of renal disease computed. Patients were classified as normal or those with obstructive uropathy and intrinsic renal disease. Patients’ age, diabetes mellitus presence and treatment given were also documented. Results: Obstructive uropathy and intrinsic renal disease occurred in 14 (15.1%) and 12 (12.9%) of the patients respectively. Nephropathy in the setting of obstruction occurred in four (4.3%) of the patients while the GFR was at stage 2 in obstructive uropathy patients who did not have renal impairment. Eight (10.4%) of the patients without nephropathy had diabetes mellitus. There was a significant inverse relationship between the age of presentation and the GFR (P = 0.001, odds ratio = −1.129). Initial urinary drainage delayed definitive surgery in all patients with obstructive nephropathy. Conclusion: The burden of nephropathy in BPH patients is quite considerable. A proportion of those without renal impairment harbour diabetes mellitus which could rapidly tilt obstructive uropathy patients into renal failure.
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Clinical profile and viral load suppression among HIV positive adolescents attending a tertiary hospital in North Central Nigeria p. 133
Esther S Yiltok, Cordelia Y Agada, Ruth Zoakah, Aweng G Malau, Dooh A Tanyishi, Emeka U Ejeliogu, Augustine O Ebonyi
DOI:10.4103/jomt.jomt_13_20  
Background: The use of combination antiretroviral therapy (cART) helps in HIV viral load suppression and has improved survival of children into adolescence. The aim of the study was to look at the clinical profile and identify factors associated with HIV-viral load suppression among adolescents on long-term cART. Methods: Consenting adolescents aged 10–19 years attending the pediatric and adult antiretroviral therapy (ART) program of Jos University Teaching Hospital (JUTH) were enrolled into the study. A semi-structured interviewer administered questionnaire was used to collect the necessary information like the biodata, educational background, orphan and vulnerable children (OVC) status, and ART use. Self-reported adherence and viral load results were retrieved and data was analyzed using SPSS version 23. Results: A total of 143 were recruited into the study with 87(60.8%) females and 56(39.1%) males. Eighty-one (56.6%) had viral load suppression while 62 (43.4%) had unsuppressed viral load. Forty-three (55.1%) out of the 78 orphaned children had viral suppression and the single orphan type had a better viral load suppression compared to the double orphan type and this was statistically significant (P < 0.05). Adherence to medication, where adolescents lived, if felt like stopping medication or ever stopped medication were significantly associated with viral load suppression (P < 0.05). Conclusion: Virologic suppression was mainly related to adherence, being double orphan, and whom the child lives with. Therefore, additional interventions should be instituted to address adolescent-specific services to enhance virologic suppression among them.
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Perception and career choice of otorhinolaryngology among final year medical students: a two centre survey in a developing country p. 141
A Adekwu, FA Ibiam, G Obasikene, M Agbonifo, SO Unogwu, BC Ezeanolue
DOI:10.4103/jomt.jomt_17_20  
Background: Otorhinolaryngology (ORL) cares for pathologies involving the ear, nose, throat, however in the developing countries, it does not attract much patronage from young doctors thereby resulting in shortage of manpower in the subspecialty. This study was to assess the perception of otorhinolaryngology as a career and establish the factors involved in career choice among final year medical students in two universities in a developing country. Methods: A cross-sectional descriptive study undertaken using a self-administered questionnaire designed to assess the perception and determinants of career choice in ORL which was distributed to consenting final year medical students of the Benue State University (BSU), Makurdi and University of Nigeria (UNN), Enugu Campus. Results: A total of 122 questionnaires with complete data were analysed. Males constituted 65.6% while ages of participants were 21 to 37 years. BSU and UNN had 40 and 82 respondents respectively. Surgical specialties were the most preferred choice in 76 (62.3%) then Internal Medicine in 15 (12.3%). Otorhinolaryngology at 11 (14.5%) was the third preferred surgical specialty. Personal interest (78.4%), mentor influence (7.4%) and financial gain (7.4%) were the main determinants of specialty choice. Majority of the respondents 78 (63.9%) viewed Otorhinolaryngology as important and interesting. Modern teaching aids 24 (19.7%), increase in duration of posting 19 (15.6%), mentorship 15 (12.3%) were top suggestions that may attract interest in ORL. Conclusion: This study found that otorhinolaryngology was the third most preferred surgical subspecialty. Personal interest was the overriding reason for career choice among these medical students.
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Preference for complementary and alternative medicine among patients on long-term treatment in Jos university teaching hospital, Nigeria p. 147
Tolulope O Afolaranmi, Zuwaira I Hassan
DOI:10.4103/jomt.jomt_29_20  
Background: The use of complementary and alternative medicines(CAM) is on the increase globally particularly among those with chronic medical conditions. Imperatively, the treatment outcomes of management of chronic illness is hinged on adherence to prescribed conventional treatment with little or no attention paid to the intent to use or concomitant use of alternative medicines in most treatment settings. Hence, this study assessed the preference for CAM and its predictors as among patients on long-term treatment in Jos University Teaching Hospital. Methods: This was a cross-sectional study conducted among 176 patients accessing treatment for chronic medical conditions in Jos University Teaching Hospital using quantitative method of data collection. Epi Info statistical software version 7 was used for data analysis with odds ratio and 95% confidence interval used as point and interval estimates respectively while a P-value of <0.05 was considered statistically significant. Results: The median age of respondents was 50 (IQR 30–84) years with 83 (47.2%) being 51 years and above. Preference for CAM was reported by 26 (14.8%) with absence of side effects (AOR = 11.3; 95% CI= 5.8299–15.1185) being the sole predictor of preference for CAM. Conclusion: This study has demonstrated some level of preference for CAM among patients on long term conventional treatment with perceived absence of side effects influencing this preference level.
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CASE REPORTS Top

Familial imperforate hymen in an adolescent girl: presenting as acute lower abdominal pains and distention − a case report and review of literature p. 153
Chidiebere Nwakamma Ononuju, Yakubu Ahmed Ashuku, Lucky Lohnan Changkat, Uzoma Emmanuel Chinaka, Elizabeth Chioma Ezeaku, Blaise Ogedi Okwaraoha
DOI:10.4103/jomt.jomt_46_19  
Imperforate hymen often is not diagnosed until an adolescent girl presents with complaints of primary amenorrhea and cyclical pelvic pains. We report the case of a 15-year old girl with a family history of imperforate hymen that presented with complaints of progressive lower abdominal pains and distention, and primary amenorrhea. A diagnosis of Imperforate hymen was made by history, findings at physical examination and trans-abdominal ultrasonography. She subsequently had hymenotomy for hematocolpometra. Her postoperative recovery was normal and her menstruation became regular.
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Tropical diabetic hand syndrome: case report of successfully salvaged threatened dominant hand p. 156
Keerthi Rajapaksha
DOI:10.4103/jomt.jomt_20_20  
Tropical diabetic hand syndrome (TDHS) is a less well-recognized complication of diabetes. It is characterized by cellulitis of hand and ends up with limb threatening significant tissue loss, sepsis and in occasion death. When the joint capsule and tendons are exposed in TDHS the digits and the limb and function of the hand are threatened. Loss of thumb of the dominant hand leads to devastating disability. The current case describes successfully managed case of TDHS with threatened thumb and function due to exposed first metacarpophalangeal joint and extensor tendons of the dominant hand.
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