Ibom Medical Journal

Effect of community participation on knowledge, attitude and practice of domestic solid waste management in Uyo, Nigeria

Edward E — 2023-09-01

Background: The increasing burden of solid waste generated in many parts of the developing world is a cause for concern as it impacts on the environment and the health of the population. Community participation as an intervention can become a veritable opportunity for individuals and communities to address this challenge.

Aim: The study aimed to assess the effect of community participation on the knowledge, attitude and practice of house-heads in peri-urban communities in Uyo, Akwa Ibom state.

Materials and methods: The study was set at peri-urban communities in Uyo, Akwa Ibom state and employs a quasi-experimental design. A multistage sampling method was used to sample household heads for the study. A pretested interviewer administered semi-structured questionnaire was used to get the opinions of the household heads before and after the intervention. Community participation, as an intervention involved distribution of waste bags and education of community members about the need for proper management of wastes. A committee was set up to ensure proper management of domestic waste in the community. A scoring system was used to assess and compare the level of knowledge, attitude and practice of domestic solid waste in both communities. The level of significance was set at <0.05.

Results: A total of 246 (98.0) respondents in the intervention arm and 250(99.6) in the control arm participated in the study. The mean ages of participants in the intervention and control groups were 45.84±14.4 years and 45.31±14.4 years respectively. Most of the respondents in the intervention and control groups were male. At post-intervention, there was an improvement in the level of knowledge, attitude and practice in the intervention group, which was in all cases statistically significant.

Conclusion: Community participation can play a critical role in improving solid waste management in communities.

Prevalence of musculoskeletal related morbidity and its perceived impact on health among pregnant women in a tertiary centre

Osazee K — 2023-09-01

Background: Pregnancy is a physiological condition associated with musculoskeletal symptoms of which the site, perception, severity, effect on the quality of life and treatment vary in individuals.

Objective: To determine the prevalence of musculoskeletal morbidity, its relationship with socio-clinical characteristics, perception, and impact on the quality of life of pregnant women attending antenatal clinics at the University of Benin Teaching Hospital.

Results: Four hundred antenatal women participated in this study; 146 (48.7%) experienced musculoskeletal problems during the index pregnancy. Most respondents (51.3%) were 31-40 years (mean 31.9±5.6). For those who experienced problems, the onset of symptoms was highest (49.3%) in 3rd trimester, and the majority (76%) had tertiary education. The most typical problem was pelvic pain (48.8%); the most common predisposing factor was previous trauma (100%). Most (72.6%) perceived symptoms as moderate pain that affected their quality of life. Treatment was majorly rest (47.5%), 59.4% had their symptoms relieved, and 76.3% were satisfied with their treatment.

Conclusion: This study showed a prevalence of approximately 50%, with the commonest predisposing factor being previous trauma and pelvic pain being the most common problem. Therefore, Clinicians should be aware of the musculoskeletal problems in otherwise healthy pregnant women and manage them appropriately.

Gender based violence among pregnant women in Benin City, Edo State: Prevalence, categories, patterns and associated factors

Obi AI — 2023-09-01

Context: Gender based violence (GBV) is a global public health issue common in pregnancy.

Objective: To assess GBV among pregnant women in Benin City with aim of curbing its occurrence.

Study design: A facility based analytical cross-sectional study was conducted involving consenting pregnant women.

Results: Awareness of GBV was high 462 (92.4%), with media 293 (63.4%), friends 251 (54.3%) and family members 187 (40.5%) reported as the main sources of information respectively. The overall prevalence of GBV was 288 (62.3%) while in relation to category of GBV experienced; 365 (79.0%), 286 (61.9%), 218 (47.2%) and 216 (46.8%) reported emotional abuse, sexual abuse, physical abuse and economic abuse respectively. Prevalence of GBV was significantly associated with respondent’s level of education (p=0.024) and occupational class (p=0.002). Furthermore, among respondent’s partners smoking (p < 0.001), alcohol consumption (p<0.001), keeping multiple sexual partners (p < 0.001), aggressive traits (p < 0.001), level of education (p < 0.001) and employment status (p=0.005) were significant factors exhibited by them.

Conclusion: Gender based violence was prevalent among pregnant women studied, a comprehensive strategy targeted at sensitizing pregnant women and their partners on GBV will be useful in curtailing its occurrence.

A 5-year review of hysterectomy at the Delta State University Teaching Hospital, Oghara, south-south Nigeria

Ukah CE — 2023-09-01

Context: Hysterectomy is a major surgical procedure that is performed worldwide for several indications ranging from benign to malignant conditions. It may be life-saving especially in certain obstetric situations.

Objective: The aim was to determine the incidence, indications and complications of hysterectomy in Delta State University Teaching Hospital (DELSUTH), Oghara.

Materials and methods: This was a retrospective descriptive study of hysterectomy performed in DELSUTH, Oghara from January 1st, 2012 to December 31st 2016. Every patient that had hysterectomy was included.

Results: During the period, there were there 468 major gynaecological surgeries. Eighty-five patients had hysterectomy accounting for 18.2%. The mean age of the patients was 47.9±10.6 years. Majority (46.6%) of the patients were para 5 and above. The mean parity was 3.2±0.83. Uterine fibroid accounted for majority (30.0%) of the cases. Total abdominal hysterectomy accounted for 78.75% while 8.75% had sub-total abdominal hysterectomy and 12.5% had vaginal hysterectomy. Fifty-two percent of the patients had bilateral salpingo-oophorectomy while 6.25% had unilateral salpingo-oophorectomy. Anaemia and wound sepsis were the most common complications. One patient (1.25%) ended as a mortality during the period under review.

Conclusion: The indications for, and surgical outcome following hysterectomy are comparable to that from other public hospitals across the country.

Comparative sonographic assessment of the spleen in individuals with and without sickle cell anaemia in Abakaliki, Nigeria

Alaneme LN — 2023-09-01

Background: Sickle cell anaemia (HbSS) is a major public health problem in Sub-Saharan Africa and commonly affects the spleen, with associated increased morbidity and mortality. This study aimed to evaluate the ultrasonographic findings of the spleen in patients with HbSS in steady state and to compare findings with those of individuals with normal adult haemoglobin (HbAA).

Methods: This was a cross-sectional comparative study. Haemoglobin phenotypes were determined using haemoglobin electrophoresis. The spleen was scanned using transabdominal ultrasonography. Splenic size and parenchymal echotexture were assessed. Data was analysed with SPSS software, version 20.

Results: One-hundred-and-twenty participants were recruited for the study, made up of 60 patients with HbSS and 60 age-and-sex-matched individuals with HbAA. They were made up of 54 (45%) males and 66 (55%) females, aged 2 to 32years, with mean age of 15.78 ±7.2 years for HbSS and 15.80 ±7.5years for HbAA participants. Thirteen (21.7%) patients with HbSS had autosplenectomy, 7 (11.7%) had splenomegaly, 6 (10%) had shrunken spleens, while 34 (56.7%) had normal sized spleens. All the participants with HbAA had normal splenic size with age. Of the 47 patients with HbSS whose spleen were visualized, 20 (42.6%) had abnormal splenic echotexture, whereas all the 60 (100%) participants with HbAA, had normal echotexture. There was significant difference in splenic echotexture in patients with HbSS compared to those with HbAA (p <0.05).

Conclusion: A number of patients with HbSS have abnormal splenic size and echotexture compared to those with HbAA. There should be adequate follow up of patients with HbSS to prevent possible resultant splenic complications.

HBME-1 expression by thyroid neoplasms in a Nigerian tertiary health Centre

Soremekun AI — 2023-09-01

Aim: The aim of this study is to review the histopathological diagnosis of thyroid neoplasms seen in OAUTHC Ile Ife using HBME-1 immunohistochemical marker.

Materials and methods: We studied all thyroid neoplasms diagnosed in the Department of Morbid Anatomy and Forensic Medicine OAUTHC, Ile-Ife from 1st July 1996 to 30th June 2016. We noted the age, sex of the patients, nature of histological diagnosis (benign and malignant) and the specific histologic diagnosis. We evaluated HBME-1 immunostain grade (0, 1+, 2+, 3+, 4+) for all the tumours.

Results: We studied only fifty-six cases (all neoplastic thyroid diseases). Sixteen (28.6%) and forty (71.4%) cases of the cases were benign and malignant, respectively. The Malignant thyroid neoplasms were 2.5 times more frequent than the benign thyroid lesions. There is a significant statistical relationship between HBME-1 expression and the nature of the neoplastic cases (p = 0.001). The sensitivity of HBME-1 in distinguishing benign from malignant thyroid neoplasms in this study was 77.5%, the specificity was 87.5%, the positive predictive value (PPV) was 93.3% and the negative predictive value (NPV) was 60.1%.

Conclusion: There is a significant statistical association between HBME-1 and the nature of thyroid neoplasms. HBME-1 can be used as an added tool in distinguishing malignant thyroid neoplasms from the benign tumours.

Perception on Preparation for Transplantation and Medication Adherence: An Exploratory Study of Post Kidney Transplant Patients in Nigeria

Ajah CC — 2023-09-01

Background: Many patients suffering from renal failure have embraced kidney transplant instead of dialysis despite huge financial implications. However, post kidney transplant patients (PKTPs) require strict adherence to immunosuppressant medications to prevent rejection of the allograft. Encounters during patients’ medication refill suggest information gaps about medication use burden.

Objectives: This study was set to explore PKTPs perspective on their preparation for transplant and determine possible information gaps during preparation for transplant.

Methods: This study was conducted by qualitative methods using in-depth interviews. Eighteen PKTPs were purposely recruited from their refill facility in Lagos and interviewed using an open-ended interview guide. The interviews were recorded, transcribed verbatim, coded, and analyzed using thematic analysis.

Findings: The main information received during preparation bordered mostly on expectation of improved quality of life, financial implication, and the need to maintain the new kidney using medications. While some respondents ambiguously stated that the team ‘did their best’ in preparing them for transplant, six respondents regretted not having information about the life-long use of medications until after the transplant. Some respondents totally adhered to their medications, never missing a dose; others missed some doses unintentionally while some others deliberately missed their doses just to save cost. All respondents’ experience of a better quality of life after transplant was as expected.

Conclusion: This study revealed that some respondents experienced information gaps concerning life-long use of medications post-transplant. The experience of very improved quality of life post-transplant seemed to be the driving force for medication adherence.

Prevalence of dry eye disease among visual display terminal office users in Uyo, Nigeria

Abraham EG — 2023-09-01

Context: Dry eye disease (DED) results from loss of tear film homeostasis. Increase use of visual display terminals (VDT) by individuals and professionals increases the risk of DED.

Objective: This study is aimed to determine the prevalence of dry eye disease among office workers who use visual display terminals in Uyo.

Methods: A descriptive, cross-sectional study of VDT office workers aged 19-65 years. Multi-stage sampling technique was used to recruit participants. Self-administered Impact of Dry Eye on Everyday Life (IDEEL) questionnaire and ocular examination was done to gather data; such data was analyzed using SPSS version 22.0

Results: Prevalence of dry eye disease (DED) was 5.8% (95% CI 3.44 - 8.16). Mean Schirmer’s 1 was 21.60 ± 9.29mm, mean TBUT was 9.74 ± 2.48s, mean IDEEL score was 76.15 ± 25.47. There was a statistically significant association between DED and educational level 7.56(p-value 0.02), hours of visual display terminal use per day 10.72(p-value 0.013), and use of air conditioning 7.66(p-value 0.006). Multivariate regression analysis to identify predictors of dry eye was statistically significant for module 1(Symptom bother) of the dry eye questionnaire (p-value 0.01, odds ratio 12.71,), tear break up time in the left eye (p-value 0.00, odds ratio 38.67), and Schirmer 1 test in the right eye (p-value 0.00, odds ratio 30.83)`.

Conclusion: The prevalence of DED increases with the number of hours spent on VDT Periodic medical and psychological evaluation of VDT users to identify office workers most at risk should be carried out by employers of labour.

Complications following cardiac pacemaker insertions

Kelechukwu UK — 2023-09-01

Context: Permanent pacemaker insertion is a recognised mode of therapy for cardiac arrhythmias. The procedure is carried our regularly at the Cardiac Catheterization laboratory of Madras Medical Mission India.

Aims: This study reviewed the associated morbidity and complications of cardiac pacemaker insertions carried out over fifteen years.

Settings and Design: This study was carried out in the Cardiac Electrophysiology department, of the Institute of Cardiovascular diseases, Madras Medical Mission, India. The study was retrospective.

Material and methods: Data was collected when previously paced patients presented for cardiac interrogation between January to July of 2013. The patients had undergone implantation over the preceding fifteen years. 501 consecutive cases were chosen for analysis.The data obtained was analysed using SPSS statistical software version 15.

Results: The 501 patients had been on pacemaker for variable durations. They comprised 321 males and 180 females. A variety of complications were observed in 33 (6.58%) patients but there was no procedure-related mortality.

Conclusions: Pacemakers were generally well tolerated. Majority of patients were asymptomatic and the rate of complications is 6.58%.

Effects of crude acetylene fumes on serum heavy metals, haematological indices and histology of the lung tissues of adult Wistar rats

Omigie MI — 2023-09-01

Background: Crude acetylene fumes generated from Calcium carbide (CaC₂) is one of the most widely used source of acetylene gas for occupational gas welding and as an artificial fruit ripener despite numerous health warnings from the government and health groups in Nigeria.

Aim: The study was aimed at evaluating the effects of crude acetylene on heavy metals present in serum, haematological indices and histology of the lung tissues.

Materials and Methods: Twenty (20) adult male wistar rats were used. The rats were divided into two groups; Group 1 (control) and Group 2 (Test group) (n=10). The animals from the Test group (n = 10) were subsequently exposed to crude acetylene fumes released from the dissolution of 20g of calcium carbide in water for 30 minutes daily for a period of 4 weeks. At the end of the 4th week, the rats were anaesthetized and blood samples were collected for serum heavy metals and haematological analysis and tissues were harvested for histological studies.

Results: a significant increase is seen in serum heavy metals (Cr, Fe and Cd) but no significant difference in Pb in the Test group compared with the control group. Also, there was a decrease in percentage granulocytes and histological results show destruction of respiratory epithelium. Also, there were significant damages to the lung tissues which include mild interstitial haemorrhage, bronchiolar ulceration with luminal debris, interstitial oedema, bronchiolar haemorrhage vascular distortion and congestion.

Conclusion: Exposure to crude acetylene fumes increases serum heavy metals and can cause disruption of the respiratory epithelium

Effect of periodic exposure to formaldehyde in the anatomy laboratory on some haematological indices in male Wistar rats

Ebojele FO — 2023-09-01

Background: The effect of periodic exposure to formaldehyde on some haematological indices in male Wistar rat was studied.

Materials and Methods: The Wistar rats were divided into three groups A,B and C with 5 animals in each group. Group A served as control with nil exposure while groups B and C were the test groups with 5 months exposure on non-dissection days and dissection days respectively. Formaldehyde air level was measured both at experimental and control sites. Some haematological parameters measured include Red blood cell count, Haemoglobin concentration, White blood cell count: total and differential, and platelet count. Statistical analysis was done using Graph Pad Prism version 5.0. Results were presented as Mean ± SEM. Analysis of Variance was used to compare the means of test and control values while post hoc test was done using Student Newman Keul’s test and a P-value of less than 0.05 was considered as statistically significant.

Results: Results revealed significant increase in formaldehyde air level in the dissection hall. There was significant increase in total white blood cell count when compared with control while red blood cell count, haemoglobin concentration and platelet count were not significant.

Conclusion: It was therefore concluded that periodic exposure to formaldehyde in the Anatomy laboratory may have no effect on most haematological indices in Wistar rats although the white blood cells may be affected.

Sociodemographic factors associated with depression in people living with epilepsy in Kano, Nigeria

Owolabi SD — 2023-09-01

Background: A high level of co-morbidity exist between epilepsy and depressive disorder, and in fact it has been found to be the commonest psychiatric disorder in people with epilepsy, with consequence of huge psychosocial burden and poor quality of life. Sociodemographic factors that have been implicated in the association between depression and epilepsy include age, female gender, unemployment, low level of education amongst others.

Objective: To determine the sociodemographic factors associated with depression in people living with epilepsy (PWE) in Kano, Nigeria.

Materials and Methods: In this cross- sectional study, two hundred and fifty- five consecutive patients with epilepsy attending the outpatient epilepsy clinics of Kumbotso Health Centre and Neurology/Psychiatry clinics of Aminu Kano Teaching Hospital, Kano were recruited.

Inclusion criteria were age above 18years and being seizure free for two weeks. Patients with severe neurological and cognitive deficits were excluded. Sociodemographic characteristics were obtained using a structured proforma. Diagnosis of depression was made using the M.I.N.I. International Neuropsychiatric Interview.

Results: The age range of participants was 18-76 years with a mean of 32 years (SD=1.31). Majority of participants (57.6%) were males. Prevalence of depression was 20.4%. There was no difference in the mean age of depressed and non-depressed participants. Females had a higher frequency of depression (32%) and association between gender and depression was statistically significant (p ˂ 0.001). Being divorced/widowed and having tertiary level of education were more associated with depression.

Conclusion: Depression is common in PWE with being female a significantly associated factor.

Arrow shot injury to the oro facial regions: Report of two cases

Lawal SH — 2023-09-01

Background: Arrow injury is a case of foreign body impaction. It can affect any part of the body. Arrow injury to the head and neck region can be life-threatening. An arrow is a weapon consisting of a thin, straight stick with a sharp point, designed to be shot from a bow. It is one of the oldest tools for hunt and war. Many health practitioners especially in the developed world now regard arrows as extinct. It has been completely replaced by advanced modern weaponry. This is not the case in our environment where the use of arrows with their attendant injury is still relatively common.

Case report: The first case is a 25-year-old farmer, a Nigerian man was seen at the Accident and emergency unit of our centre with an hour history of arrow injury to the right side of the face following the farmer-herder clash. The examination was remarkable for an impacted arrow that was made up iron (impregenation with poisonous substance could not be ascertained) on the right side of the face. He had an urgent plain radiograph of the head and neck which revealed an impacted arrow in the right zygomatic bone. He subsequently had emergency exploration and removal of the arrow. The post-operative period was uneventful.

The second case was a 37-year-old man who presented to the accident and emergency department with difficulty breathing following an arrow shot injury to the oral cavity. He was a passenger in a bus that was attacked by armed bandits. On examination, there was an arrow penetrating through the right edge of the tongue, the floor of the mouth to the contralateral submandibular and cervical regions. About 5.0cm of the tail of the arrow could be seen jutting out of the mouth. The exploration was done via a Risdon incision (submandibular incision) on the opposite side of the entry wound (left submandibular) in a retrograde approach. The dissection was advanced into the subcutaneous tissue, platysma, and deep fascial plane to expose the tip of the arrow. The post-operative period was uneventful.

Conclusion: We have illustrated our experience on the cases of arrow injury to the orofacial region. The two cases presented early. There was no pre-hospital attempt at pulling out the arrow. Arrow injury is still common in our community. There is a need for government at all levels to intensify effort on conflict management and resolution.

Guillain-Barre syndrome in pregnancy: A rare disease with challenging management

Uwagboe UC — 2023-09-01

Background: Guillain-Barre syndrome is a rare autoimmune disorder in pregnancy, characterised by ascending polyneuropathy. Diagnosis is mainly clinical and treatment is mainly supportive. Poor access to plasmapharesis and intravenous immunoglobulin limits its management in low and middle income countries. This report is aimed at presenting a case of Guillain-Barre syndrome in pregnancy and challenges encountered in our setting.

Case presentation: A 32 year old multipara at 34 weeks gestation who presented with progressive limb weakness, inability to walk and difficulty in breathing. She was delivered following hypertension and respiratory distress. Baby remained in good condition. She subsequently succumbed to respiratory failure in the postoperative period.

Conclusion: Guillain-Barre syndrome is rare in pregnancy. Diagnosis is mainly clinical. Supportive care including the use of plasmapharesis and intravenous immunoglobulin are important in reducing the mortality associated with the disease. Early presentation and diagnosis is also key to its management.

Management of diaphragmatic eventration in a low-income setting: A case report

Nwafor IA — 2023-09-01

Diaphragmatic eventration, is a rare pathology that is characterized by abnormal elevation of the diaphragm and abdominal contents residing within thoracic cavity, though separated from the lungs by the thin or membraneous diaphragm. It may be asymptomatic but may result in dyspnoea, heaviness in the chest and hearing of bowel sounds in the chest. We report a 63 year old man who presented to our service, 10 years history prior, of heaviness in the left hemithorax and whose chest x-ray revealed an abnormally elevated dome of the left hemidiaphragm in the chest (eventration). He was worked up for left thoracotomy, plication of the diaphragm with uneventful recovery postoperatively and disappearance of symptoms.

Biochemical analysis and management of phaeochromocytoma: A case report

Familoni OM — 2023-09-01

Phaeochromocytoma is a tumour from chromaffin cells in adrenal medulla or extra-adrenal autonomic ganglia, usually releasing catecholamines and metanephrines. It is an unusual cause of severe hypertension in the young. This is the first report from our hospital, the Federal Medical Centre, Umuahia. There are important steps in management which if unattended to results in high peri-operative mortality. This article highlight these issues in its management.

Making sense of a Holter electrocardiograph report

Kelechukwu UK — 2023-09-01

Background: Holter monitoring has become available in more centres in sub-Saharan Africa in recent years, but the interpretation of Holter electrocardiogram (ECG) is poorly understood.

Material and method: We present a 71-year old man who presented with cardiac failure, had abnormal electrocardiogram and was sent for Holter monitoring. Our report aims to help physicians interpret a Holter ECG report.

Prepatellar tumoral calcinosis mimicking soft tissue sarcoma: A case report and review of literature

Dim EM — 2023-09-01

Tumoral calcinosis is a rare, painless tumour-like mass often seen as soft tissue calcifications around joints in adolescents and young adults. The occurrence of this rare entity in the middle aged or elderly population is also rare. The pathology may mimick sarcomatous lesions or granulomatous diseases. A high index of suspicion, imaging and laboratory studies, including histopathological examinations, are needed to make a diagnosis. A 59-year old Nigerian woman that complained of a progressive and painless anterior knee mass, which turned out to be a tumoral calcinosis, is presented.

Lung metastasis at initial presentation in a 3 year old girl with stage IV Wilms tumor

Usoro UU — 2023-09-01

Background: Wilms tumor (nephroblastoma) is a malignant pediatric tumor that arises from mesodermal embryological precursors of renal parenchyma. Lung metastasis as the first presentation of nephroblastoma occurs in 20% of cases. However, haematogenous spread to the lungs or to regional lymphnodes from a previously diagnosed nephroblastoma occurs in of 85% of cases.

Case report: A 3-year old girl presented at children emergency unit with cough and weight loss. Examination revealed an emaciated child, with a huge, right sided abdominal mass. Abdominal ultrasound scan showed a heterogenous, spherical mass with irregular anechoic areas and echogenic solid areas in kidney. Chest radiograph revealed bilateral cannon ball opacities. A diagnosis of nephroblastoma with lung metastasis was made. She underwent combined therapy but relapsed one year later.

Chromophobe: A rare histological variant of renal cell carcinoma

Adekunle AA — 2023-09-01

Background: Renal cell carcinoma (RCC) is an adenocarcima of the kidney. It is a highly heterogeneous disease with sixteen known subtypes out of which five predominate. The most common subtype is clear cell RCC which accounts for 75-85%. The chromophobe subtype of RCC is rarely seen. It is reported to constitute 4-5% of RCC subtype. This study was aimed at reporting the first case of chromophobe renal cell carcinoma in our community a rare histological subtype of RCC which was discovered incidentally. Our objective was to describe the clinical, histological and immunohistochemical evaluation of a case of chromophobe RCC.

Case report: We present a 60-year-old man who was seen at the surgical outpatient department of our center with a request for general health check-up. He had basic laboratory and imaging investigations. These were essentially normal except for an incidental finding of a left renal mass on abdominopelvic sonogram. Computed tomography urography showed a suspected clinically localized malignant left renal mass. Histological and immunohistochemistry are consistent with a chromophobe RCC. His clinic follow-up remains unremarkable.

Conclusion: We reported the clinical, histological and immunohistochemical evaluation of a rare case of chromophobe RCC. This was discovered incidentally following general health check. He had open radical nephrectomy and clinic follow-up 1 year after discharge has been uneventful.