Nigerian Journal of Family Practice

Hidden in plain sight: hyperthyroidism shrouded as gastrointestinal distress in a diabetic patient

J. Onubi — 2024-11-26

Thyroid hyperfunction usually manifests with typical symptoms such as palpitations, fatigue, heat intolerance, excessive sweating and polydipsia. Atypical presentation with gastrointestinal disorders in a known diabetic patient in a resource-poor environment could lead to misdiagnosis. Delay in diagnosis and treatment may occur due to a lack of classical symptoms of hyperthyroidism occurring on a background of immunosuppression due to diabetes mellitus (DM) in an environment where infectious causes of gastrointestinal symptoms abound. We report a case of a 53-year-old, known DM patient with no prior history of hyperthyroidism, who presented with spurious diarrhoea that eventually led to the diagnosis of hyperthyroidism. The report highlighted the importance of recognition of thyroid disorder in DM in the midst of confounding symptoms. It further emphasized that diarrhoea can present as a lone clinical feature of thyroid hyperfunction in some patients. Furthermore, it underscored the need for TSH levels monitoring after commencement of metformin therapy in diabetic patients.

Decolonizing the African health systems; the required strategic shifts and leadership

L.O. Odeigah — 2024-11-26

A health system refers to all organizations, people and actions whose primary intent is to promote, restore or maintain health. The key social goal of a health system is to increase the average level of health of the population and reduce health inequities. Decolonization is the change that colonized countries undergo when they become politically independent. Understanding the historical context of health helps us to respond more appropriately to the health challenges of today. All the African countries adopted Primary Health Care to improve their health outcomes. However lack of proper policy trust, insufficient political commitment, failure to achieve equity in access to primary care components, slow economic development, unbalanced resource distribution, poor inter-sectoral action for health, weak information systems, lack of accurate baseline data, rapid demographic and epidemiological changes, centralized planning and management with the exclusion of the communities and other stakeholders have accounted for its slow progress in Africa. Adoption of the global agenda for health has not seen translated gains for the masses. An African health system for Africans by Africans that responds to the needs of our people is what will bring gains for the masses. Attempts to improve the health status of African people must be linked to regaining political, cultural, economic independence and self-determination as individuals, families, communities and nations. The methodology used in this review involved identifying credible and relevant studies using multiple data bases and search engines such as Google search, PubMed and Medline search. Extensive notes were made during literature search and the sources and their references were noted. An unbiased and critical evaluation of every piece of evidence was under taken. The articles selected were those that met the scope and guidelines of the research such as the geography and period under consideration, from precolonial, colonial and postcolonial Africa. Another literature search was done after completing the writing of the study to ensure that no recent study was left out while the research was on-going. The paper concludes that, as a solution to Africa's health challenges, major strategic shifts including adopting systems thinking approach, engendering adaptive leadership, evidence-based policies, re-conceiving accountability and reducing vertical programmes among others are suggested.

Knowledge of mothers on prevention of anaemia in children under 5 years of age in the provincial city of Kinshasa, DRC

K.S. Kalala — 2024-11-26

Background: Early management of anaemia remains a major public health issue worldwide. In Kinshasa, DRC, the delay in the management of anaemia is associated with a high mortality rate. Parents' lack of knowledge of the signs of anaemia and inappropriate attitudes have been blamed elsewhere for this delay. The aim of this study was to assess mothers' knowledge of anaemia in children aged 0-59 months in the provincial city of Kinshasa.
Methods: This was a cross-sectional study conducted in 6 health zones of Kinshasa among 639 mothers of children aged 0-59 months selected through multistage sampling. Data collection was done using a pre tested semi structured interviewer administered questionnaire and the data was analysed using SPSS version 24. Ethical approval was obtained from the Protestant University, Congo.
Results: The predominant age group was 20 to 24 years (28.0%), the majority of mothers were married (57.2%) and had completed their secondary education in 61% of cases. Less than half of the children (41.4%) had a history of anaemia at the time of the survey. The majority of mothers (92.9%) had heard about anaemia through various sources of information, including family/friends (72.9%), health professionals (18.05%), television (5.7%), radio (0.7%) and school (2.65%). More than half of the mothers (59.4%) said they had seen publicity about anaemia either at the health centre (64.5%), on television (25.5%) or on the radio (3.0%). Overall the majority of mothers (62.5%) had good knowledge of their child's anaemia. The majority of mothers (92.1%) would bring their child to the health centre in case of anaemia, 18.3% and 16.3% would give iron and iron derivatives respectively.
Conclusion: Anaemia is not an unknown disease among mothers of children under 5 years old in Kinshasa. However, the participation of health personnel in informing them about this disease remains insufficient. This level of knowledge must be improved by community awareness activities.

Association between hypertension and lung function among adult patients attending the general outpatient clinic of a tertiary hospital in Southwest Nigeria

O.M. Femi-Adeoye — 2024-11-26

Background: Poor lung function is a predictor of all-cause and cardiac mortality. Identifying and modifying risk factors is mandatory for reducing cardiovascular complications among hypertensive patients. Lung function however is not routinely assessed as a cardiovascular risk. The study aimed to compare the lung function parameters among hypertensive and normotensive patients at the general outpatient clinic of a tertiary hospital in southwest Nigeria.
Method: A comparative study of 105 hypertensive and 105 normotensive patients, aged 40-60 years. An interviewer-administered questionnaire was used to obtain data on socio-demographic characteristic and medical history. Anthropometric measurement was obtained and spirometry was performed. The level of significance was set at p< 0.05.
Result: A significantly higher proportion of the hypertensive group (33.3%) had poor lung function compared with the normotensive group (21.0%), p=0.044. Logistic regression analysis showed uncontrolled blood pressure (OR: 2.995, {1.243-7.171}) as the most significant predictor of poor lung function and waist circumference above normal (OR: 4.579, {1.136-18.465}), the most significant factor associated with poor lung function in the hypertensive and normotensive groups respectively.
Conclusion: Uncontrolled blood pressure predicted poor lung function, thus lung function assessment as well as ensuring blood pressure control should be advocated among hypertensive patients for prevention of a decline in lung function

Retrospective analysis of histological types and laterality of breast carcinoma in a tertiary hospital in Southwest Nigeria

A.O. Anjorin — 2024-11-26

Background: Breast carcinoma is the most common cancer among women worldwide and is a leading cause of death among women. It has various histological types, which differ in their clinical and pathological features. In Nigeria, it accounts for over 25% of all cancer cases. The evolving nature of breast cancer calls for a continuous study of the histological types, distribution patterns, and unique characteristics as it may reveal new insights and variations. Therefore, this study aimed to determine the histological types, age distribution, and laterality of breast carcinoma cases at the UNIOSUN Teaching Hospital (UTH) Osogbo.
Methods: This study was a retrospective analysis of all cases of breast carcinoma diagnosed histologically at the UTH Osogbo over 10 years. Information on patients age, laterality, and histological type of breast carcinoma was obtained from the records of the Department of Pathology. The histological types were classified according to the World Health Organization (WHO) classification system and data was analyzed using descriptive statistics.
Results: A total of 519 cases of breast carcinoma were diagnosed histologically. The mean age of the patients was 50.1 years (SD=12.4), with a range of 12-90 years. The highest number of cases (32%) were in the age group of 41-50 years, followed by 29.5% in the age group of 31-40 years. Invasive ductal carcinoma (NOS) was the most common histological type, accounting for 93.6% of cases. Other types were metaplastic carcinoma (2.7%), invasive mucinous carcinoma (1.3%), lobular carcinoma (1%), and medullary carcinoma (0.4%). Regarding laterality, 53% of the cases were in the left breast, 44% in the right breast, and 3% were bilateral.
Conclusion: Invasive ductal carcinoma (NOS) was the most common histological type. Breast cancer was common among those aged 41-50 years and in the left breast. The results of this study could be useful for the development of breast cancer screening programs and treatment strategies in Nigeria.

Correlates of obesity and functional disability among senior citizens at Usmanu Danfodio University Teaching Hospital, Sokoto experience

Y.A. Sada — 2024-11-26

Background: The study assessed the relationship between obesity and functional disability in elderly.
Materials and method: A descriptive sectional study was conducted at Usmanu Danfodiyo University Teaching Hospital. Systemic sampling technique was employed and structured interviewer administered questionnaire was administered among 319 participants. Data was collected on socio-demographics, functionality, assessment and anthropometrics (weight and height and BMI) of the respondents were also taken. Data was analyzed using IBM SPSS version 21 statistical software.
Results: The mean age of the respondents was 65.9 ± 6.7. There was a statistically significant relationship between obesity and ADL disability (0.001).The prevalence of obesity was 17.6% with majority having obesity class 1(11.3).
Conclusions: Obese elderly have twice the risk of having disability in self-care. Therefore, it needs to be tackled for prevention and management of disability in elderly.

Nausea and vomiting of pregnancy and its control measures as seen in two tertiary care facilities in Southwest Nigeria

O.O. Sonibare — 2024-11-26

Background: Due to the concerns about the possible harmful effects of medications on foetuses, pregnant women prefer to control the symptoms of Nausea and Vomiting during pregnancy by personal, familial, and traditional measures. The Objective of the study is to identify the control measures that pregnant women use with NVP and determine its impact on their daily lives.
Method: A cross-sectional descriptive survey of pregnant women at two Hospitals in Osun state was conducted. Five hundred pregnant women were recruited, and data was collected using a pre-tested questionnaire to elicit information on socio-demographic characteristics, control measures of NVP and its impact on daily life. Frequencies and proportions were generated for socio-demographic variables, control measures of NVP and its effects on everyday life.
Results: 352 (70.4%) women experienced the symptoms of NVP. The most frequently taken agent for the control of NVP was chewing gum 145 (41.2%). Other interventions include sweets 82 (23.2%), bitter kola 72 (20.5%), prescription and over-the-counter (OTC) drugs 63 (17.9%), bitter leaf 54 (15.3%), ginger 43 (12.2%) and kola nut 29 (8.2%). NVP affected the daily activities of 53.8%, while 81.9% were discouraged from getting pregnant again due to the symptoms. However, 18 (5.1%) have ever considered terminating a pregnancy due to NVP.
Conclusion: There was a high incidence of NVP among the respondents. Most respondents perceived that NVP affected their daily lives with a severe impact on their intent to become pregnant again.

Medication adherence and its association with socio-demographics, perceived family support and blood pressure control among adults hypertensive patients in rural Southwestern Nigeria

K.O. Sito — 2024-11-26

Background: Perceived Family support and blood pressure control are important outcome measures to medication adherence in clinical trials. However, there is limited research on this topic among adult hypertensive patients in rural Southwest Nigeria. This study determined the pattern of medication adherence, blood pressure control and perceived family support and ascertained the determinants of medication adherence among adult hypertensive patients attending a tertiary hospital in rural Southwestern Nigeria.
Methods: Hospital-based cross-sectional study was conducted on 282 hypertensive patients on follow up using systematic random sampling technique. Standardized semi-structured interviewer administered questionnaire was employed to seek information on respondents' sociodemographic characteristics. Adherence level was determined using the Morisky's Medication Adherence Scale, while Perceived Social Support family (PSS-Fa) scale was employed to assess the level of respondents' perceived family support. Data were analyzed using SPSS 20. Multivariate logistic regression analysis was used to identify the determinants of medication adherence.
Results: The majority of the respondents had high medication adherence (61.0%), good controlled blood pressure (60.6%), and strong perceived family support (56.0%). Being a middle age (p<0.05), formal education (p<0.01), civil servants (p<0.001), higher income level (p<0.001), higher pill burden (p<0.001), normal BMI (p=0.012, controlled blood pressure (p<0.001) and strong perceived family support (p<0.001) were the independent determinants of medication adherence
Conclusion: The pattern of medication adherence, perceived family support and blood pressure control were good. The findings would assist the stakeholders at improving adherence to medication among patients with hypertension in rural Southwest Nigeria.

Knowledge, attitude and infection control practices among healthcare professionals in selected primary healthcare centres in urban areas of Lagos State.

B. Akodu — 2024-11-26

Background: Infection is a serious issue encountered in healthcare delivery services worldwide. Healthcare workers are exposed to the risk of occupational infection following accidental exposure to blood or body fluids. Studies have shown disparity in knowledge of infection transmission and control, its interpretation and application among healthcare workers at the primary healthcare level in particular. This study determined the knowledge, attitude and practice of infection control among healthcare workers in primary healthcare (PHCs) centers in Surulere LGA.
Methods: A cross-sectional study carried out among PHCs in Surulere LGA using a simple random sampling technique. The PHCs are composed of doctors, pharmacy technicians, nurses, community health officers, community extension workers, junior community health extension workers and laboratory technologists. The questionnaires consisting of participants demography, working experience, professions, presence of infection control committee, exposure to training on infection control, knowledge and practice of infection control, were analyzed. Data entry and analysis was done using Epi info software version 7.2.3.1
Results: Most of the respondents (77.3%) were females and female to male ratio was 3:1. Close to half of the respondents (43.6%) have less than 5 years of working experience. Among the professions, the nurses constituted a predominant proportion (27.3%) while among all the professions combined, 97.3% of them had good knowledge of infection control. All the respondents had above average positive attitude towards infection control. A total of 86.4% of the respondents had good infection control practice A high proportion of the respondents (75.5%) have training on infection control while 95.5% of the respondents are aware about infection control guidelines. There was a significant association between knowledge and practice of infection control (p<0.001). There was a statistically significant association between age, years of work experience, occupation and overall knowledge. There was a statistically significant association between the level of education, occupation and overall practice of infection control.
Conclusion: Majority of the respondents had good knowledge of infection control and positive attitude. Adequate provision of appropriate safety kits and their timely replacement should be made. It was recommended Health workers should regularly update their knowledge and practice regarding infection prevention activities during continuous professional development, to be coupled with adequate provision and timely replacement of appropriate safety kits when worn-out to all cadres of staff based on their job schedule