Global Journal of Community Medicine

Practice Of Antenatal Clinical Breast Examination In Calabar

2009-11-18T09:37:19+00:00

Reports of a rising incidence of breast cancer and the consistent finding of a significantly younger population of breast cancer patients in the country than in the west led to this study to determine the proportion of women who have a clinical breast examination at the booking visit for antenatal care in the University of Calabar Teaching Hospital (UCTH).The booking information on the antenatal cards of patients who registered within a one-month period was examined. Clinical breast examination (CBE) was performed on 41.6% of the women. Women who were reviewed by consultants recorded a rate of 78.2% while the rates for women attended to by resident doctors and interns were 41.2% and 19.6% respectively (P=0.00). The CBE rate was 57.6% among women who were reviewed by female physicians and 38.3% among those reviewed by male physicians (P = 0.00). The practice of CBE in UCTH is low and is significantly related to the cadre and gender of the attending physician. Obstetricians must embrace the practice fully and utilize measures such as increased supervision and departmental seminars to sensitize doctors they train to emulate them. KEYWORDS: Antenatal, Practice and Breast Examination

Antimicrobial Susceptibility Patterns Of Salmonella Species In Contemporary Medical Practice: Challenges And Prospects In Treatment Of Enteric Fevers

2009-11-18T09:37:19+00:00

Treatment of enteric fever is increasingly becoming very challenging due to the increasing wave of antibiotic resistance. This study is a review of the contemporary antimicrobial susceptibility pattern of Salmonella species. The antimicrobial susceptibility pattern of Salmonella species to a wide range of antimicrobial agents was compiled for a period of 10 years (1997-2006). Data was obtained from published articles on both in vitro and in vivo susceptibility patterns of the organism to various drugs during the time interval. Data obtained were analysed using simple descriptive methods. Of the 23,504 isolates of Salmonella species reviewed, they were found to be 98% susceptible to cefepime and carbapenem, 91% to azithromycin, 82.1% to cefixime and 73% to quinolones. Also susceptibility to chloramphenicol, erythromycin, streptomycin, ampicillin, gentamicin, co-trimoxazole, augmentin and amikacin was found to be 11.9%, 10.9%, 13.0%, 16.8%, 46.3%, 38.0%, 54.3%, 6.9% and 63.0% respectively. This review has demonstrated increasing resistance of Salmonella species to antibiotics. Empirical treatment for enteric fevers should, therefore, be discouraged while quinolones, cefepime, carbapenem, azithromycin and third generation cephalosporins be given preference. KEY WORDS: Susceptibility, Antimicrobial, Salmonella species, Enteric fever

Pre-Hypertension And Hypertension In Apparently Healthy Adolescents In Calabar, Nigeria.

2009-11-18T09:37:19+00:00

Hypertension is a major public health burden in sub-Saharan Africa. It has been shown to track from adolescence to adulthood. Pre-hypertension refers to consistent systolic and/or diastolic blood pressure (BP) measurement between 90 - < 95th percentile, while hypertension is when systolic and/or diastolic BP ≥ 95th percentile for age and sex. Prehypertension is considered heightened risk for developing hypertension. The aim of this study was to determine the prevalence of hypertension and pre-hypertension among urban adolescents in Calabar, south eastern Nigeria. This was a cross sectional survey using multistage sampling techniques among adolescents between the ages of 10 – 18 years in four secondary schools in Calabar metropolis. Blood pressures and anthropometric measurements were taken and body mass index was calculated. Three hundred and seventy five subjects were assessed, 146 males and 229 females. The prevalence of hypertension was 6.7%, pre-hypertension was 7.5% and that of obesity was 1.9%. The mean systolic blood pressure (SBP) for males was 114.00 ± 13.04mmHg while that for females was 115.18 ± 12.18mmHg. Only the SBP were found to increase significantly with age (p<0.001), though both showed progressive increase with age. The mean diastolic blood pressure (DBP) for males was 62.55 ± 8.10mmHg and 63.16 ± 9.36mmHg for females. The mean BMI was 18.52 ± 2.35 for males and 19.16 ± 3.60 for females and increase with age was statistically significant (p<0.001). The prevalence of both hypertension and pre-hypertension in this adolescent population appears high and necessitates public health attention. It is recommended that larger studies in different Nigerian adolescent populations be conducted to determine the prevalence of hypertension nationwide so that early remedial actions may be taken. KEY WORDS: Hypertension, Pre-hypertension, healthy adolescents.

Male Breast Cancer In Calabar Nigeria: A Twenty Year Experience (1983-2002)

2009-11-18T09:37:19+00:00

Male breast cancer is rare worldwide. The highest incidence of 2.1 per 100,000 is recorded in Louisiana USA. The record for Africa varies from 0.2 per 100,000 in Gambia to 0.8 per 100,000 in Mali Breast cancer has been erroneously thought to be entirely a female disease in the tropics. This ignorance makes late presentation almost the rule in Nigeria as reported by authors in various part of the country. Breast cancer is the commonest malignancy in Calabar. From the Calabar cancer registry record, 105 cases of breast cancer were seen in 1995 through 1998. Of these 5 patients (4.7%) were male. A review of 30 cases of male breast cancer seen in UCTH between Jan 1983 to Dec 2002 is being studied to look at the clinical presentation, histological pattern and management. They were aged 19 to 85yrs with mean of 53.1yrs. We observed two peaks at 3rd and 6th decades of life. More than 80% (25 cases) presented with painless lump and palpable axillary lymph nodes. Over 50% were on the right. Three patients also had nipples changes. Gross weight loss was associated with very advanced cases. The interval before presentation ranged from 3 to 84 months. All had mastectomy and axillary nodes dissection. Adjuvant chemotherapy was also used. Diagnosis was confirmed by histopathological examination of removed specimen. The follow up was generally poor. However one patient survived beyond ten years. KEYWORDS: Male Breast Cancer, Calabar, Nigeria

Incidence Of Ectopic Pregnancy In Calabar, Nigeria: Two Halves Of The Last Decade Compared

2009-11-18T09:37:19+00:00

Reports of a rising incidence of ectopic pregnancy (EP) in the country and beyond prompted this study to determine the incidence in Calabar over two time frames. Information from ward registers and case notes of EP patients who presented to the University of Calabar Teaching Hospital from 1991 to 1995 were analyzed and compared with records of those who presented from 1996 to 2000. In the second half of the study period, the incidence was 3.30 per 100 deliveries, significantly higher than 2.19% in the first (p = 0.0008). The mean age of EP patients was 26.2 (sd = 5.38), significantly lower than 28.8 (sd = 5.99) for women who delivered in the same period (p < 0.01), while the mean parity was 2.2 (sd = 2.15) significantly higher than 1.7 (sd = 1.90) for women who delivered in the same period (p = 0.01). The incidence was higher in the younger age groups (p = 0.000) with the highest of 5.81% recorded by age group 20-24. Conversely, it rose with parity (0.00002) to a peak of 5.03% at para 4. There was also a rise in their mean parity from 1.9 (sd = 2.08) in the first half to 2.4 (sd = 2.05) in the second (p < 0.05) and a rise in the prevalence of pelvic adhesions from 38.3% to 68.9% (p = 0.00) Rates of other documented risk factors were not significantly different in the two halves of the study (p > 0.05). The incidence of EP appears to be rising in Calabar and puerperal infections may be important in the rise. Population-based prospective studies are necessary to confirm the findings. KEYWORDS: Ectopic Pregnancy, Calabar, Nigeria

Seminal Fluid Indices Of Male Partners Of Infertile Couples In Uyo, Nigeria

2009-11-18T09:37:19+00:00

This retrospective study analyzes the seminal fluid indices of 633 male partners of infertile couples at the University of Uyo Teaching Hospital over a four year period. All the laboratory records on seminal fluid analysis between 1st January 2003 and 31st December 2006 were reviewed. The seminal fluid characteristics of the patients were determined and the abnormalities classified according to the World health organisation guidelines. Five hundred (79.0%) of the men had abnormal seminal fluid parameters. About 56.0% of the subjects were asthenozoospermic, 38.9% were oligozoospermic, 2.8% had teratozoospermia while 7.0% had azoospermia. The significant contribution of the male factor to infertility in our environment is highlighted. The need for the encouragement of male partners of infertile couples to avail themselves for proper infertility evaluation and the advantages of early detection and treatment of sexually transmitted infections in men is stressed. KEY WORDS: Male infertility, seminal fluid indices, Uyo

Knowledge, Attitude And Perception Of Epilepsy Among Traditional Healers In Uyo, Nigeria

2009-11-18T09:37:19+00:00

The poor knowledge of epilepsy among traditional healers is due to cultural prejudices and environment. The resultant deep-rooted misconceptions and myths negatively affect the attitudes and encourage traditional care with high morbidity and mortality. The objectives of the study were to assess knowledge of epilepsy among traditional healers and to determine the modalities used in the care. One hundred and seventy three traditional healers from villages/communities in Uyo were assessed for knowledge; attitude and perception of epilepsy, using an interviewer assisted Attitude Questionnaire. Data from 166 (95.9%) healers, consisting of 123 (71.1%) males and 43 (24.8%) females were analyzed. Many of the healers, 139 (83.7%) had little or no formal education. Knowledge about causes, diagnosis and treatment of epilepsy was poor; 74 (44.6%) attributed the cause of epilepsy to witchcraft, 53 (31.9%) to spiritual attacks, 23 (13.9%) punishment for sins. A total of 121 (72%) of them diagnosed epilepsy through oracles/gods. Majority, 161 (97.0%) of the healers preferred native treatment; 54 (32.5%) appeased gods/ancestors, 47 (28.3%) used herbs, roots/animal residues as cure, 10 (6.0%) preferred spiritual/prayers; while 48 (28.9%) used a combination of the rituals. There were prevalent negative attitudes and perception about epilepsy among the healers, as 146 (88.0%) of them viewed it as contagious; 149 (89.8%) would decline either marrying or eating with epileptic persons. Although traditional healers are frequently involved in the care of epilepsy in our environment, they have little or no scientific knowledge about the condition. Adequate knowledge about epilepsy is essential for diagnosis and treatment. Therefore, there is need to improve the knowledge about epilepsy in order to encourage positive attitudes and care. KEY WORDS: Knowledge; Attitude; Perception; Epilepsy; Traditional healer.

Prevalence Of HIV Infection Among Antenatal Attendees At Uyo Teaching Hospital, Akwa Ibom State, South-South Nigeria

2009-11-18T09:37:19+00:00

This retrospective study was conducted at the maternity unit of the University of Uyo Teaching Hospital Uyo. The aim was to determine the prevalence of HIV infection among pregnant women receiving antenatal care in the center. The voluntary counselling and testing register, the partner notification and antenatal clinic registers of all patients that booked for antenatal care between 1st July 2005 and 31st December 2007 were reviewed. There were 5,635 new antenatal clients during the study period out of which 464 were confirmed HIV positive resulting in a prevalence of 8.2%. Most of the patients were between 21-30 years (70.0%). About 59.4% of the patients were multiparous while 49.4% booked for antenatal care in the third trimester of pregnancy. HIV was diagnosed in the antenatal clinic in 408 (87.9%) of the patients and 182 (39.2%) received antiretroviral drugs during pregnancy. Only 38.8% of the patients accepted to notify their partners. One hundred and eighty eight patients delivered in the hospital. One hundred and twenty (63.8%) had spontaneous vaginal delivery, 63 (33.5%) were delivered by caesarean section, 3 (1.7%) had assisted vaginal breech delivery and 2 (1.1%) had ventouse delivery. The high prevalence of HIV infection among women pregnant women who have antenatal care in our hospital is highlighted. The intensification of strategies aimed at primary prevention of HIV infection in the community, encouraging all pregnant women to avail themselves of orthodox antenatal care, and the need to emphasize the advantages of self disclosure of serostatus to partners during counselling sessions in the antenatal clinic are advocated. KEY WORDS: HIV Positive women, antenatal attendees, Uyo

Beliefs And Practice Concerning Pregnancy Delivery And Puerperium In Rural Akwa Ibom State

2009-11-18T09:37:20+00:00

Focus group discussions involving 100 rural women in five communities of Akwa Ibom State, Nigeria were carried out over a six-month period. The aim was to determine if the beliefs and practices of our rural dwellers are such that contribute to maternal morbidity. The discussions revealed that the participants had a shallow knowledge of the causes of complications in pregnancy. Complications were largely attributed to spirits and other harmless events. Reducing physically demanding activities in pregnancy was ascribed to laziness and sexual intercourse was largely to be avoided. There was no food taboos specific to pregnancy, but food restrictions were described. Antenatal and intrapartum care by spiritual and traditional midwives was considered superior to orthodox care. Practices by the midwives include turning a baby in an abnormal lie, massaging the vagina with oil in labour; conducting delivery without gloves, pulling on the cord, manually removing or squeezing out the placenta if delivery is not spontaneous. Management of complications involves divinations, use of herbs and other concoctions, anointing oil, prayers and fasting. Puerperal seclusion practiced to varying degrees and maybe beneficial. Most beliefs and practices of our rural women are potential contributors to maternal morbidity. A few are harmless or even beneficial. Public enlightenment and education of our rural dwellers while incorporating the harmless/beneficial practices into modern obstetric care services will help reduce maternal morbidity. KEYWORDS: Pregnancy, Beliefs and Practices

The Unbooked Pregnant Woman: Experience From A Rural Tertiary Hospital South-South Nigeria

2009-11-18T09:37:20+00:00

This retrospective study was carried out to determine the obstetric outcome of unbooked pregnant women who presented at the University of Uyo Teaching Hospital over a five year period. Five thousand nine hundred and sixty two women presented at the labour ward out of which 617 (10.3%) were unbooked. Majority of the patients were multiparous (61.2%) and the most common clinical presentations were obstructed labour (28.8%) and eclampsia (19.8%). There were 255 still births and 5 early neonatal deaths resulting in a perinatal mortality rate of 420/1000. Maternal mortality ratio was 7,800/100,000 live births and this was mostly from eclampsia (28.8%) and obstetric haemorrhage (19.8%). Grass-root education in our various communities highlighting the importance and advantages of formal antenatal care and the inclusion of this in the health education curriculum of primary and secondary schools is advocated. KEY WORDS: Unbooked pregnant women, Uyo, obstetric outcome

Prevalence Of Dog Bites In A Rural Community: A 15 Year Review Of Cases In Okoyong, Cross River State, Nigeria

2009-11-18T09:37:20+00:00

This retrospective study was undertaken to assess the prevalence of dog bites in Comprehensive Health Centre, Okoyong south-south Nigeria. Eleven cases of dog bite were recorded out of a total of 25,000 patients seen during a fifteen- year period (1990-2004). This gives a prevalence of 44 per 100,000 population. The age of the patients ranged from 16 to 43 years, with a mean of 27.1+ 8.3. Male to female ratio was 1:0.8. The treatment of patients consisted of analgesics, antibiotics, tetanus toxoid and antitetanus serum. We did not have any recorded case of rabies, in spite of the fact that none of the patients had rabies vaccination nor antirabies immunoglobulin. All the patients reported late to hospital, the mean duration before presentation being 10.23 days. The follow up was extremely poor as most patients never reported for follow up after the initial treatment as outpatient or discharge following admission. We conclude that the prevalence of dog bites in this health centre is low (0.04%).We recommend more comprehensive community-based studies to adequately assess the burden of this problem. Current regulations on the management of dog bites should be strictly followed by the attending medical personnel. KEY WORDS: Okoyong, Dog bites, Prevalence.