Highland Medical Research Journal

Health-related quality of life and clinical outcomes of adults with heart failure in Nigeria: A review of current literature

Ganiyu A Amusa — 2024-06-06

Background: Heart failure (HF) is a major public health problem due to its high prevalence, nature of morbidity and consequent socio-economic burden on individuals and societies. The established aims of the management are the prevention of disease progression and improving health-related quality of life (HRQoL). HF is a chronic illness known to have a negative impact on HRQoL with consequent adverse clinical outcomes. While there has been progress in reducing HF progression globally, not much has been achieved in improving RQoL, particularly in Nigeria and other low-resource countries.
Methods: The available literature on the topic from PubMed, Medline, Google Scholar and other relevant internet sites were accessed, reviewed and inferences made.
Conclusion: Heart failure has a significant negative impact on HRQoL with consequent poor clinical outcomes. Periodic assessment of HRQoL, HRQoL goal setting and adherence to guideline-directed medical therapy (GDMT) are recommended as standard care for individuals with HF in Nigeria and across the world

Limb amputation secondary to electrical injuries: case series from a five – year review of Lagos University Teaching Hospital

George O Enweluzo — 2024-06-06

Background: Electric Burn results from the passage of electric current through the body when in contact with the electric arc. Electric injury of a severe nature results in death. Surviving victims may develop short- or long-term effects on various organs, including gangrene and slow necrosis to tissues. We sought to evaluate electrical burn patients who required amputation in Lagos University Teaching Hospital (LUTH).
Materials & Methods: This was a cross-sectional study of patients who suffered electrical burn injuries at the LUTH Accident & Emergency Unit. Those who required amputations were studied as a case series.
Results: The case series involved 6 patients, with 11 limb
amputations, consisting of 8 (72.7%) upper limbs and 3 (27.3%) lower limbs. One patient had had bilateral upper and lower limb amputations while 2 others had bilateral upper limb amputations. Five (83.3%) patients were working-class males, with the only female being a child who was involved in a domestic accident. There was one mortality in this case series, resulting from Traumatic Brain Injury and severe infection.
Conclusion: Developing countries are rife with inefficient electrical energy systems, poor safety measures and working ethics. High voltage electric injuries are frequently sustained at the workplace, particularly by adult males who are occupationally exposed to electricity. High voltage electric injury culminates in gangrene formation and limb amputation as treatment.

Physicians satisfaction with the quality of laboratory services in a Nigerian Teaching Hospital

Tyavyer J Akosu — 2024-06-06

Background: Physicians order laboratory tests expecting to receive accurate and timely results to support the management of their patients but it is not known to what extent Jos University Teaching Hospital laboratories satisfy their physicians in this regard. This study sought to determine physician satisfaction with the quality of services provided by the hospital's laboratories.
Methods: A pre-tested semi-structured self- administered questionnaire was used to obtain information from sixty seven (67) physicians selected using a cluster sampling technique about their satisfaction with the quality of services provided by the hospital's laboratories. A semi- structured questionnaire was also used to collect information from Laboratory Managers on how they report test results of in-patients to the requesting physicians. Winpepi version 11.65 was used for statistical analysis. to test for the presence of relationship between respondents specialty and their level of satisfaction. A p- value of 0.05 was considered statistically significant.
Results:Three methods were used to transmit laboratory test results to the requesting physicians: Non-critical results were picked from the laboratory by the responsible doctors (66.6%) or the patient's relations (33.3%), or they were sent to the patients' ward through the laboratory support staff.
Only 6% of physicians were satisfied with the timeliness of reporting results (in- patient test turnaround time), and means of delivery of results to the requesting team. Just over a quarter (25.4 %) were satisfied with how samples are collected while 20.9% were satisfied with the technical quality/reliability of the results. There was no significant relationship between physician' specialty and their level of satisfaction with the laboratory services.
Conclusion:Physicians in Jos University Teaching Hospital are very dissatisfied with the timeliness and technical quality of the results received from the Hospital's laboratories. Laboratory managers and the Hospital management need to act urgently to improve quality and restore trust in the hospital's laboratories.

A quasi-experimental study of the effect of health education on the knowledge of breast cancer screening among nursing students in Plateau State, Nigeria

Dora Akinboye — 2024-06-06

Background: Knowledge of breast cancer screening is poor in developing countries and this may cause poor uptake of breast screening, late presentation in the hospital and increased mortality from breast cancer. Nurses are front-line health workers and increasing knowledge of breast screening among them is important for the education of the general public. This study aimed at assessing the effect of health education on the knowledge of breast cancer screening among nursing students in Plateau State, Nigeria.
Methods: A quasi-experimental study involving 50 female nursing students that were selected using a systematic random sampling each from the Colleges of Nursing Jos South Local Government Area (LGA) (experimental group) and Jos North LGA (control group). The intervention involved health education training in the experimental group only. A structured questionnaire was used to elicit data and composite variables were calculated for knowledge. Data analysis was done using IBM SPSS Version 22. ANOVA was used to compare mean changes in knowledge scores. Results were presented in tables and p< 0.05 was taken as statistically significant.
Result: There was no statistically significant difference in mean knowledge score at baseline (p=0.07). However, there was a statistically significant difference in the mean scores of experimental and control groups post-intervention. In the experimental group, there was a statistically significant difference in the mean knowledge scores among at least two phases (F [3, 196] = [81.906], p <0.001), Effect Size=0.56.
Conclusion: Health education intervention was effective in improving knowledge of breast cancer screening.

Geophagy in pregnancy and health risks in a suburban area in Nigeria

Doose D Iorfa — 2024-06-06

Background: Geophagy is the ingestion of earthy substances such as soil, clay or mud. It is a form of pica, which is the tendency or craving to eat substances other than normal food or substances of no nutritional value. Geophagy is practiced by humans globally but has been noticed to be commoner among pregnant women and children. Such a practice may have health implications. Hence the study aimed at determining if it conferred any health risks.
Method: The study was a cross-sectional study of 384 pregnant women in an antenatal clinic in a sub-urban cottage hospital in Katsina-Ala LG of Benue state Nigeria. Pregnant women who presented for ANC were recruited consecutively. Those who had taken anthelminthic during the pregnancy were excluded. An interviewer administered semi-structured questionnaire was used to collect data on social demographic characteristics and geophagic behaviour. Stool samples for stool microscopy and blood samples for Packed Cell Volume were also taken.
Results: The prevalence of geophagy was 17.7%, helminthiasis was 12.2%, while anaemia was 15.9%. There was a significant relationship between the practice of geophagy and 2 helminthiasis (÷ = 136.8, p<0.0001, Odd ratio 36.5, CI=16.6- 80.5, p<0.0001). However, geophagy had no statistical relationship with anaemia.
Conclusion: Geophagy is common and it is associated with helminthiasis. Screening for geophagy and deworming may be advantageous among pregnant women.

Indications and outcomes of orbitotomy in a tertiary hospital in North-Central Nigeria

AV Ramyil — 2024-06-06

Background: Orbitotomy is a surgical procedure that helps with having access to the tight orbital space for different purposes. The orbit can be accessed through several incision/approaches, and it can be done for both children and adults if indicated. In most cases, the outcome of orbitotomy is good. The study seeks to determine the indications, possible complications and the outcomes of orbitotomy in a tertiary hospital in north-central Nigeria.
Method: This was a retrospective study spanning a 10-year period from 2011 to 2020. Hospital records of patients who had orbitotomy were retrieved and data collected for the indications and outcomes of orbitotomy. Statistical analysis was done using Statistical Package for Social Sciences (SPSS version 23). Frequencies, simple percentage, fishers exact and chi-square were used to compare proportions.
Results: A total of 28 patients medical records were retrieved and analyzed Orbitotmy was performed in all age groups, however, 21(75%) out of the 28 cases were done in individuals less than 30 years of age. More males had orbitotomy 15(53.6%), and there was a slight predominance of the left eye 15(53.6%). The commonest presentation seen was proptosis 15(53.6%), while dermoid cyst was the commonest etiology in 39.3%. Computed tomographic scan was useful in clinching the diagnosis while histological examination helped in confirming the diagnosis. More than half (75%) of the patients had a transcutaneous incision, and there was no drop in visual acuity following orbitotomy. The commonest complication was eyelid scar in 15(53.5%) patients.
Conclusion: Orbitotomy is a safe procedure with good visual and cosmetic outcome, with the transconjunctival approach being more cosmetically acceptable.

Spectrum of neurological diseases seen at the neurology outpatient clinic in North-Central Nigeria

Godwin O Osaigbovo — 2024-06-06

Background: The spectrum of neurological diseases in developing countries like Nigeria is diverse and growing, and reliable data on the profile of these disorders is crucial for workforce planning and health-care demands. We sought to determine the burden of neurological disorders seen at Jos University Teaching Hospital's (JUTH) neurology outpatient clinic in north central Nigeria.
Methods: The study is a cross-sectional study that used a retrospective data abstraction technique on patients who received care at the JUTH neurology clinic between April 2017 and March 2019.
Results: Neurological cases account for approximately 79.9% of all outpatient presentations in the Neurology clinic. There were 2,304 males (47.1%) and 2592 females (52.9%). Cerebrovascular disease (33.9%), seizure disorder (16.3%), movement disorders (9.4%), disorders of nerve roots, plexuses, and peripheral nerve (6.6%), headache disorders (4.2%), and disorders with neurocognitive impairment (3.7%) were the most common neurological diseases.
Conclusion: In our clinic, a wide spectrum of neurological diseases exist, with cerebrovascular disease, epilepsy, and movement disorders being the most frequent and important causes of morbidity and healthcare costs.

Relationship between quality of life and physical activity level of patients with cardiac disease in a Nigerian tertiary hospital: A cross-sectional study

Nse A Odunaiya — 2024-06-06

Background: Research evidence suggests that physical activity can improve quality of life and reduce the adverse effects of living with cardiac disease. This study was conducted to investigate quality of life, physical activity level, and their relationship among cardiac patients in a Nigerian tertiary hospital.
Patients and Methods: Sixty patients (32 males, 28 females) with cardiac disease from a major tertiary hospital in Nigeria participated in this cross-sectional survey. Their Quality of Life (QoL) and physical activity (PA) levels were assessed using the Ferrans and Powers QoL Index (cardiac version IV) and the short form of the International Physical Activity Questionnaire, respectively. Data were summarized using descriptive statistics and further analyzed using Pearson correlation, with the alpha level set at 0.05.
Results: Out of the participants, 34 reported poor to fair overall QoL, while 26 reported good QoL. Additionally, 23, 25, and 12 participants reported low, moderate, and high PA levels, respectively. Health-related QoL was the most affected, with only 16 participants reporting good QoL in this domain. A positive correlation was found between PA and both the Health and Functioning Subscale (r=0.26, p=0.05) and the Family Subscale (r=0.259, p=0.05) of QoL.
Conclusion: Higher levels of PA correlate with better QoL in the Health and Functioning, as well as, Family sub-scales. Physical activity should be integrated into the care of cardiac patients to enhance their QoL and overall health.

Analysis of caesarean sections using robson ten group classification system at the Jos University Teaching Hospital

Jane C Orjiani — 2024-06-06

Background: With Caesarean sections on the rise WHO proposes that healthcare facilities use the Robson's 10-group classification system to audit their Caesarean section rates (CSR). Hence, we sought to determine the relative contributions of each of the Robson's ten groups to the overall caesarean section rate and indications for caesarean sections in JUTH
Methods: A retrospective review of hospital records of women delivered in JUTH from January 2018 to December 2018 was performed and the Robson's ten-group classification system (RTGCS) was used to categorize women.
Results: There were 1295 deliveries over the study period of one year. The CS rate was 33.1%. According to the RTGCS, Group 5 which constituted multiparous women with previous CS with a single fetus in cephalic presentation at term (9.7%), Group 1 which constituted nulliparous women with a single fetus in cephalic presentation in spontaneous labour at term (5.7%), and Group 4 which constituted Multiparous women with a single fetus in cephalic presentation who had induction of labour or elective CS at term (3.9%) were substantial contributors to the overall CS rate. The main indications for CS were previous CS (28.7%), hypertensive disorders of pregnancy (14.0), fetal distress (11.0%), and cephalopelvic disproportion (10.3%).
Conclusion: Group 1 warrants the most attention, applying stricter criteria and due diligence in decision-making for primary CS may decrease the high CS rate and subsequently patients for Trial of labour after caesarean section (TOLAC). Proper patient selection for TOLAC will reduce the contribution from Group 5.

Cardiovascular comorbidities and clinical outcomes in a cohort of adults with COPD in Jos, Nigeria: A prospective analytical study

Ganiyu A Amusa — 2024-06-06

Background: Chronic obstructive pulmonary disease (COPD) is a significant contributor to morbidity and mortality worldwide. Cardiovascular diseases (CVD) are a leading but under-recognized cause of morbidity and mortality among persons with COPD. This is concerning and highlights the need for more studies and awareness, particularly in resource-limited settings.
Methods: This prospective cohort study involved 82 eligible adults with spirometry-confirmed COPD enrolled consecutively at Jos University Teaching Hospital (JUTH). Each participant underwent a medical history review, physical examination and relevant investigations. Each was followed up for 450 days through monthly clinic visits and phone calls. Clinical outcomes (cardiopulmonary-related hospitalizations and deaths) were recorded. Data was analyzed using Epi-Info version 7.2 and Stata version 13.
Results: About 67.1% (55) had comorbid cardiovascular disease. The common CVD found were pulmonary hypertension (45.5%, 37), arrhythmias (40.0%, 33), systemic hypertension (38.2%, 31), and heart failure (30.9%, 25) among others. CVD comorbidity was significantly associated with COPD progression (p=0.047), higher 450-day hospitalization rate and duration (p=0.015 and 0.050); and mortality rate (p=0.029). Kaplan-Meier analysis showed a significant statistical difference in time to first hospitalization (p<0.085),
duration of hospitalization (p=0.013), and time to mortality (p<0.085) over 450 days in participants with CVD compared to those without, Cox proportional hazard analysis further showed that those with CVD had a risk of 253% for hospitalization and 230% for mortality over 450 days.
Conclusion: Cardiovascular comorbidities are common in patients with COPD. They are important determinants of morbidity, hospitalization and mortality. Early diagnosis and management will significantly reduce morbidity and mortality in these patients.

Mapping of first perforator of thoracodorsal artery using hand-held Doppler and colour Doppler Ultrasound

Joshua D Choji — 2024-06-06

Background: The first perforator of the thoracodorsal artery is the largest and most reliable for the survival of the thoracodorsal artery perforator flap. Given the variation in the position of perforators, a reliable method for the precise identification of the pertinent perforator that would sustain the circulation to the flap would be extremely `valuable.
Methods: This was a comparative cross-sectional study. The Plastic Surgeon used the hand-held Doppler (HHD) to assess for perforator(s) outside the circle 1.5 cm centred on the first perforator point. The procedure was then repeated by a radiologist using the colour Doppler ultrasound (CDU).
The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 20. Statistical significance was determined using a dependent (paired) sample t-test. All tests with a p-value of less than 0.05 were considered significant.
Results: A total of 70 patients were recruited for the study. The age range was 18 to 65 years with a mean of 31.77 years ± 11.72 years. There were 58 males (82.9%) and 12 females (17.1%) with a male-to-female ratio of 4.8:1. Overall, comparing the two ultrasound modalities in mapping perforators outside the first perforator point, HHD = 9.3% and CDU = 10%. The CDU (M = 0.20, SD = 0.40) identified more perforators than HHD (M = 0.19, SD = 0.39) but was not statistically significant t(69) = -1.000, p = 0.32.
Conclusion: Both HHD and CDU showed variations in the location of the first perforator point. The location and suitability of the perforators may be determined with the CDU, while the HHD may then be used for monitor during surgery.

Awareness and desire for epidural analgesia in labour among pregnant women attending antenatal clinic in Jos University Teaching Hospital

Kehinde P Agbowuro — 2024-06-06

Background: Pain relief is an integral part of labour management. Epidural analgesia is the goal standard in labour, however not readily available in most Nigerian obstetrics units. There is little information on the views of pregnant women on epidural analgesia.
Methods: A sample of 152 consenting pregnant women from 28 weeks of gestation and above attending the antenatal clinic from 1st September, 2021 to 31st December 2021 in Jos University Teaching Hospital (JUTH), Nigeria, were recruited and interviewed via an interviewer's administered questionnaire. The interview questions included demographic characteristics and questions assessing the awareness and desire for epidural analgesia in labour.
Results: 152 women were surveyed, 19(12.5%) were aware of epidural analgesia. Awareness was affected by level of education (_X2 = 43.669; p=0.0001) and parity (_X2 = 25.160; p=0.0001). Majority of the participants 133(87.5%) had poor knowledge on epidural analgesia. 77(81.1%) of the 95 study participants that declined its use was due to cost of epidural analgesia.
Conclusion: Most of the expectant mothers in Jos University Teaching Hospital were unaware of the role epidural analgesia plays in pain alleviation in labour and were not willing to try it when in labour; due to its cost and the fear of side effects. However, awareness level needs to be improved and for this purpose, evidence-based information on epidural analgesia should be provided during the antenatal period to improve knowledge and attitude regarding epidural analgesia.