Nigerian Medical Journal

Quality management in clinical and public health research: A panacea for minimising and eliminating protocol deviations in research operations

2024-06-21T11:38:04+00:00

A quality management system for clinical and public health research operations is indispensable because it ensures the integrity and reliability of research outcomes. By implementing a robust quality management practice in research implementation and operation, research teams can uphold the highest standard of research conduct, thereby enhancing the credibility and trustworthiness of research findings.
This paper elucidates the significance and role of a quality management system in clinical and public health research operations and its efficacy in minimising and eliminating protocol deviations and highlights the key steps in setting up a quality management system for research operations.

Serum brain natriuretic peptide levels correlate with the severity of hypertension in a population of Nigerian patients

2024-06-20T08:08:13+00:00

Background: Hypertension is a major global health concern requiring precise risk assessment. Brain Natriuretic Peptide (BNP) has emerged as a potential biomarker, but its relationship with hypertension severity requires exploration to evaluate its potential as a risk prediction tool. This study aimed to assess the relationship between serum BNP levels and the severity of hypertension in a population of Nigerian patients.
Methodology: This was an analytical cross-sectional case-controlled study involving 103 hypertensive patients and 98 controls. Participants were grouped based on World Health Organization (WHO) criteria for diagnosis of Hypertension and the severity of hypertension were categorized based on blood pressure readings. The mean BNP levels were assessed among different hypertension grades, while logistic regression was used to assess the odds of higher severity with elevated BNP.
Results: Serum BNP levels were significantly higher in hypertensive individuals (616.5 ± 66.3 pg/mL) compared to controls (501.1 ± 84.6 pg/mL) and varied significantly across different hypertension grades (p = 0.000). A positive correlation was observed between serum BNP and hypertension severity (r = 0.736, p < 0.001). Logistic regression analysis indicated increasing odds of higher severity with elevated BNP from Grade 1 to Grade 3 hypertension.
Conclusion: This study established a positive correlation between serum BNP levels and hypertension severity, indicating its potential as a predictive biomarker for risk stratification in hypertensive individuals.

Prevalence of prehypertension, hypertension, and its determinants among young adults in Enugu State, Nigeria.

2024-06-20T10:36:20+00:00

Background: Emerging epidemiological data suggest that Hypertension (HTN) has become a significant public health challenge in sub-Saharan Africa. HTN in young adults is a problem lacking relevant attention because it is still erroneously considered a disease of the old. This study aimed to determine the prevalence of hypertension and its associated risk factors in undergraduate medical students at the University of Nigeria, Enugu Campus, Enugu State,
Nigeria.
Methodology: This was a cross-sectional study conducted between March and April 2021. This study recruited 279 consenting medical students (136 males and 143 females) aged 18–35 years. They were administered with a structured questionnaire. Data on sociodemographic information and risk factors for hypertension were collected. Blood pressure, waist circumference, weight, height, and body mass index were measured using standard methods. All data collected
were carried out following the Institutional ethical guidelines and that of the Helsinki as revised in 2000. Data were analyzed using IBM Statistical Package for Social Sciences version 25, and statistical tools employed include descriptive statistics and Chi tests. Results were recorded as mean standard deviation, and statistical significance was taken at p<0.05.
Results: This present study has shown a prevalence rate of 19.93% for hypertension. Isolated diastolic hypertension constituted a greater burden with a prevalence of 13.65% than systolic Hypertension (0.74%) and systolic-diastolic Hypertension 5.4%. The prevalence of prehypertension was 48.7%, with a higher incidence observed in females (25.8%), individuals aged 21-25 years (26.4), and those with normal BMI (35.1%). A significant association was observed between the stage of hypertension and gender (p = 0.005), and age category (p = 0.037). Of the examined cohort, 7.75% were underweight, 16.5% overweight, and 2.2% obese. Notably, systolic, and diastolic blood pressure, weight, and waist circumference showed significant (p = 0.01, p = 0.007, p =0.01, and p<0.0001 respectively) increases concomitant with advancing age.
Conclusion: There is an increased prevalence of prehypertension and hypertension among young adults. This calls for a comprehensive national screening, public enlightenment, and targeted prevention programs that foster healthy lifestyle behaviours, physical activity, and healthy eating among students.

Prevalence and predictors for use of herbal medicine in the treatment of infertility in a secondary health facility in South-South Nigeria.

2024-06-20T12:33:15+00:00

Background: Infertility is one of the major medical problems seen in the Gynaecology clinic. Herbal medicine (HM) has become one of the treatment options used to circumvent infertility problems. This study aims to explore the prevalence and predictors for HM use in the management of infertility in our region.
Methodology: The method used was a cross-sectional study of 117 women attending the infertility clinic at Central Hospital Agbor, Delta State, Nigeria. The interviewer administered a questionnaire comprised of socio-demographic characteristics, infertility-related aspects, and information on herbal medicine usage. The main outcome measure was the Prevalence of HM use for infertility treatment and the possible predictors. Analysis was done using SPSS version 22.
Results: The mean age of participants was 34.1 with a standard deviation of 6.66 years. The minimum age of participants was 23 years while the maximum age was 48 years. The prevalence of HM use was 79.9%. The factors that were significantly associated with the use of HM were marital status (p 0.033), history of primary infertility (0.026), and having used HM for the management of other ailments (0.000). Women who were married and having fertility issues were more likely to seek alternative methods like the use of HM.
Conclusion: The prevalence of the use of HM among participants attending the fertility clinic was high at 79.9%. We recommend that health professionals should enquire about the use of HM as this may help in educating the patients about the health risks of using HM. There is a need to explore the potential benefits and risks of HM use.

Psychosocial dysfunction and delayed sexual development among adolescents living with HIV in Lagos, Nigeria.

2024-06-20T12:44:42+00:00

Background: With increasing survival following the use of antiretroviral therapy, adolescents living with Human Immunodeficiency Virus (ALHIV) could have complications such as delayed puberty and psychological complications. In Nigeria, there is limited data on the association between delayed sexual maturation and psychosocial dysfunction in ALHIV. The objective of this study was to determine the prevalence and the association between delayed sexual development (DSD) and psychosocial dysfunction (PSD) in ALHIV and compare it with uninfected adolescents.
Methodology: This was a cross-sectional study conducted at the Lagos University Teaching Hospital (LUTH), Nigeria and it involved 144 ALHIV and an equal number of HIV-negative controls who were matched for age, sex, and social class. Information was obtained from participants using interviewer-administered questionnaires; their stages of sexual development and their psychosocial function were assessed using Tanner staging criteria and the Paediatric Symptom Checklist tool respectively. Data were analysed using the Statistical Package for Social
Sciences software version 23.
Results: The mean (±SD) age of ALHIV and the HIV-negative controls was 14.8 (±3.0) and 14.8 (±2.9) years respectively. All the ALHIV were on HAART and 99.3% were in clinical stage 1. There was no significant difference between the prevalence of DSD among the ALHIV (9.4%) and the HIV-negative controls (6.4%) (p=0.402). The prevalence of PSD in ALHIV and HIV-negative controls were 4.9% and 5.6% respectively (p=0.791). There was no significant association between PSD and DSD in both groups of study participants (p=0.459 and p=0.301).
Conclusion: The prevalence of PSD and DSD were low and similar among adolescents with and without HIV, and
no association was found between PSD and DSD. However, routine screening of adolescents for PSD should be
practised for early identification and prompt management where indicated.

Characterization and quantification of vehicular emissions in Abuja municipality–implications for public health

2024-06-20T12:59:59+00:00

Background: Air pollution from vehicular emissions and other sources accounts for over seven million global deaths annually and contributes significantly to environmental degradation, including climate change. Vehicular emission is not prioritized for control in Nigeria, thus undermining public health and Sustainable Development Goals 3, 11, and 13. This study aims to characterize vehicular emissions in Abuja municipality and quantify exhaust air pollutants of commonly used vehicles.
Methodology: Cross-sectional exhaust emissions study of vehicles in Abuja Municipal Area Council. Information on the type and age, fuel type, purchase, and use category of 543 vehicles on routine Annual Road Worthiness Test at the Computerized Test Center, Abuja. Exhaust levels of CO, CO₂ HCHO, and PM₁₀ were measured using hand-held devices. IBM SPSS version 26.0.0.0 (2019) statistical software.
Results: The Toyota brand comprised 52.5% of the vehicles. Over 80% were older than 10 years; 85.5% preowned and 87.3% used for private purposes. PMS was the dominant fuel used (91.1%). Except for PM₁₀, older vehicles emitted higher levels of the measured pollutants than newer ones. The differences were significant for CO and HCHO. Diesel-fueled and commercial vehicles also emitted higher levels of CO, HCHO, and PM10 compared to PMS-fueled and private vehicles respectively.
Conclusions: Strong regulatory policies that discourage over-aged vehicles; speedy adoption of the ECOWAS guidelines on cleaner fuels and emission limits; and coordinated implementation of effective Inspection & Monitoring programme by relevant government agencies are required to safeguard public health and the environment. We also recommend the introduction of vehicles powered by alternative energy, the use of bicycles, designation of one-way traffic and pedestrian zones. Reducing the threats to the public’s health from vehicular air pollution in Abuja municipality requires strong policy and coordinated monitoring programs for effective control.

Level of knowledge and perceived challenges associated with learning movement disorders topics: a critical review of final-year medical students at a Nigerian private university.

2024-06-20T13:27:16+00:00

Background: To determine the level of knowledge and challenges associated with learning movement disorders among final-year medical students.

Methodology: A cross-sectional survey of 79 final-year medical students at the Madonna University, Elele, Rivers State. Consenting students filled out the study questionnaire, which consisted of socio-demographic variables and questions on the knowledge and challenges of learning movement disorders. Data were collected and analysed using the Statistical Package for Social Sciences Version 20.
Results: The mean age of the study participants was 27.41±2.78 years, with a male-to-female ratio of 1.3:1. Almost (91.1%) of all the study participants had heard about parkinsonism from their lectures, followed by chorea (88.6%). More than half of the participants knew about one type of movement disorder or the other. Forty-three (54.4%) students expressed difficulty understanding movement disorder lectures. Inadequate exposure to patients with movement disorders and lack of audiovisual aids to enhance the learning experience were the greatest challenges in learning movement disorders.
Conclusion: Parkinsonism was the most recognized movement disorder among the study participants. More than half of the participants admitted to having challenges with movement disorder lectures. The paucity of movement disorder cases during clinical rotation and lack of teaching aids were cited as major challenges affecting learning and appreciation of movement disorder lectures. Medical educators are encouraged to deploy appropriate methods that optimize the learning experience among medical students during movement disorder lectures.

Prevalence and pattern of gestational thyroid dysfunction in a population of South-East Nigerian women

2024-06-20T13:43:18+00:00

Background: Pregnancy serves as a physiological stress test for the thyroid which often leads to dysfunction in women with limited thyroid reserves. The occurrence of gestational thyroid dysfunction is linked to unfavourable obstetric and foetal outcomes. Globally, iodine deficiency is a prominent causative factor for thyroid dysfunction. The study aimed to determine the prevalence and pattern of thyroid dysfunction among pregnant women in Enugu, South-east Nigeria.
Methodology: This hospital-based descriptive cross-sectional and observational study was conducted over six months on selected participants from pregnant women attending antenatal clinics at the study sites. Maternal clinical and demographic risk factors for thyroid dysfunction were evaluated in a cohort of 318 pregnant women. An analysis of variance (ANOVA) was performed to compare participants' thyroid status across different trimesters of pregnancy, and different thyroid and nutritional iodine states.
Result: The prevalence of thyroid dysfunction in the study population is 6.6%. Hypothyroidism was detected in 5.3% of the participants, consisting of 3.8% sub-clinical hypothyroidism and 1.6% overt hypothyroidism. Sub-clinical hyperthyroidism accounted for 1.3% of all participants; no overt hyperthyroidism was detected in this study.
Conclusion: There is a relatively high prevalence of gestational thyroid dysfunction in the study population with hypothyroidism being the predominant disorder. This highlights the need for region-specific considerations in antenatal care to facilitate early detection and effective management of gestational thyroid dysfunction, thereby mitigating potential adverse maternal and foetal outcomes.

Correlation between oligohydramnios and anaemia in the third trimester of pregnancy: A study in a tertiary care hospital in Pakistan

2024-06-21T08:14:35+00:00

Background: Maintaining a normal amniotic fluid index and normal haemoglobin level is crucial for normal fetal development. Their reduction can lead to maternal and fetal morbidity in the form of operative delivery and poor perinatal outcomes such as low birth weight. There is an association between oligohydramnios and anaemia, although there is a scarcity of this correlation in the literature. Early detection of oligohydramnios can improve maternal and perinatal outcomes. This study aimed to investigate the association between oligohydramnios and anaemia during the third trimester of pregnancy.
Methodology: This retrospective cohort study was conducted at NESCOM Hospital, Pakistan. The study spanned from August 1, 2021, to July 31, 2022.
Results: The study included 109 pregnant individuals with oligohydramnios, resulting in an incidence of 22% among the total of 551 deliveries during the study period. The average age of participants was 29.75 years. The average gestational age was 33.52 weeks, with a range of 28 to 38 weeks. The analysis indicated that 44.03% of cases with oligohydramnios were associated with anaemia, followed by idiopathic causes (41.28%). Pearson's correlation revealed a significant association between oligohydramnios and anaemia (r = 0.307, p = 0.001), supporting the hypothesis of a potential interconnection between these two conditions. Regarding delivery outcomes, 81.6% underwent cesarean section, emphasizing the need for careful management in cases of oligohydramnios and anaemia. Neonatal outcomes indicated that 1.8% and 44.5% of neonates were extremely low birth weight and low birth weight, respectively.
Conclusion: This study provides empirical evidence supporting a significant association between
oligohydramnios and anaemia in the third trimester.

Pritchard’s regimen: The effect of 12-hour versus 24-hour magnesium sulphate maintenance regimen on the occurrence of seizures and maternal outcome in women with severe features of preeclampsia: A triple-blind randomized controlled trial

2024-06-21T08:49:20+00:00

Background: Magnesium sulphate (MgSO4) administered for twenty-four hours is the drug of choice for seizure prophylaxis in patients with preeclampsia with severe features. Due to its narrow therapeutic index, a reduction in the duration of MgSO4 administered in the postpartum period may not only prevent the occurrence of seizures but also reduce the adverse effects
associated with this drug. This study aimed to compare the efficacy of the 12-hour and 24-hour Pritchard’s MgSO4 maintenance regimen on the occurrence of seizures and maternal outcomes in patients with preeclampsia with severe features.
Methodology: A triple-blind randomized controlled trial was conducted among women with preeclampsia with severe features between 1st June 2022 and January 31st, 2023. The primary outcome measure was the occurrence of seizure in either arm of the study. One hundred and forty-six women were randomized into two groups, those who received a 12-hour MgSO4
regimen and placebo for the remaining twelve hours (Group I) and those who received a 24-hour MgSO4 regimen in the postpartum period (Group II). The collected data was coded and analyzed using Statistical Product and Service Solutions (SPSS) version 26 and p<0.05 were considered significant.
Results: There was no statistically significant difference between the two groups concerning the occurrence of seizures, the need to recommence MgSO4, clinical evidence of toxicity, and adverse effects of MgSO4. There was also no statistically significant difference between the two groups in the total dose of MgSO4 administered, duration of urethral catheterization, and duration of hospital admission. No maternal mortality was recorded in this study.
Conclusion: The results of this study suggest that the 12-hour MgSO4 maintenance regimen is as efficacious as the traditional 24-hour regimen in preventing seizures without worsening maternal outcomes.

Neonatal Transport Network Services: Preparedness of healthcare systems in Southern Nigeria

2024-06-21T09:50:07+00:00

Background: Nigeria remains a major contributor to neonatal deaths worldwide, yet little consideration has been given to intra/inter health facility transfer of sick neonates. The dearth of Neonatal Transport Network Services (NNTS) is probably an underappreciated driver of the abysmally high national neonatal mortality indices. This study aimed to evaluate neonatal transport services and the healthcare workers’ preparedness among health facilities in Port Harcourt Metropolis, Rivers State, Nigeria.
Methodology: Twenty-eight selected health facilities (tertiary, private hospitals Primary Health Centers] were assessed on the availability, modality, and practice of NNTS. Data was analyzed using SPSS Version 23.
Results: Routine transfer of high-risk pregnant mothers to higher levels of care occurred always in 14 (50%) and sometimes in 6 (21.4%) facilities; Private cars and taxis were the most common mode of transport in 24 (85.7%) facilities. Two facilities (7.2%) had ambulances equipped with transport incubators. Nurses and nurse attendants with no formal training in NNTS accompanied referred neonates in 2 (7.2%) facilities. Most referring facilities
(78.6%) neither rarely nor ever contacted receiving centres before the arrival of neonates and most nor gave back referrals after offering neonatal care. None (100%) of the facilities had a trained emergency transport team.
Conclusion: Health facilities in Southern Nigeria lack a standardized Neonatal Transport Network and are characterized by poor communication between health facilities and inadequately trained personnel for inter-facility transfer of sick neonates. Urgent action is required to address these gaps, including training of healthcare workers
on neonatal transport and sharing findings with relevant stakeholders/policymakers to establish a functional neonatal transport network among health facilities.

Influence of knowledge about discriminatory practices towards HIVpositive individuals with the uptake of HIV testing during pregnancy among reproductive-aged women in Nigeria

2024-06-21T11:01:54+00:00

Background: The fear of positive HIV results has been reported as a determinant of HIV testing among pregnant women and women of reproductive age. When pregnant women know about discriminatory practices toward other people based on their HIV-positive status, it may impact their testing for HIV. Therefore, the purpose of this study was to examine the association between Nigerian pregnant women's knowledge of discriminatory practices against persons living with HIV and their self-reported HIV testing during antenatal visits or childbirth.
Methodology: A secondary analysis of data from 659 t women who had experienced pregnancy aged 15–49 years from the 2013 Nigeria Demographic Health Survey (NDHS) was done. Multivariable logistic regression analysis was done to determine the association between knowledge about discriminatory practices towards HIV-positive individuals (independent variable) and HIV testing during pregnancy (dependent variable) after controlling for covariates (demographic characteristics). A P-value of ≤ 0.05 was taken as statistically significant.
Results: Bivariate logistic regression analysis findings showed that educational level, place of residence, and religion statistically significantly predicted HIV testing of pregnant women, while age categories and marital status did not. The women’s knowledge of discriminatory practices towards persons living with HIV/AIDS was not statistically significant at Alpha = 0.05 (AOR,1.51; 95% CI: .46, 4.95) Higher levels of education (Primary Education, AOR = 1.81; 95% CI: 1.03, 3.18; Secondary Education, AOR = 3.73; 95% CI: 1.92, 7.25; Higher Education, AOR = 10.92; 95% CI: 4.25, 28.05) and those living in urban areas (AOR = 1.62; 95% CI: 1.04, 2.51) were significantly associated with testing for HIV in the stepwise multivariable regression model of pregnant women’s knowledge of discriminatory practices towards persons living with HIV/AIDS.
Conclusion: Although knowledge of discriminatory practices did not predict pregnant women's HIV testing in this study, interventions by stakeholders to eliminate or reduce these practices should be stepped up towards facilitating positive social change.

Kaiso expression in triple negative breast cancer in a tertiary hospital in Ghana.

2024-06-21T11:19:02+00:00

Background: Breast cancer has produced more loss and disability-adjusted life years (DALYs) than any other type of cancer. The prevalence of the disease, especially triple-negative breast cancer (TNBC) in Africa is on the rise, with poor survival rates. With the great advancements in treatments of breast cancer, that of TNBC is still a challenge due to its narrowed treatment options and poor disease prognosis. This research seeks to explore the expression of kaiso in Ghanaian breast cancer and how they may modulate clinicopathological features, and disease prognosis.
Methodology: A cross-sectional retrospective study was conducted on formalin-fixed paraffin-embedded (FFPE) breast cancer tissues retrieved from the archives of the pathology unit of Komfo Anokye Teaching Hospital (KATH). An immunohistochemistry assessment was performed on haematoxylin and eosin-stained slides selected for tissue microarray construction. Data were analysed using the SPSS version
28 and Microsoft Excel 2013.
Result: 55.3% of the cases tested negative for progesterone receptor (PR), oestrogen receptor (ER), and human epidermal growth receptor 2 (HER2). There were significant associations between menopausal status and molecular subtype (p=0.010), Kaiso expression and histological diagnoses (<0.001) and Kaiso against lymphovascular invasion (0.050). However, there were no significant associations between Kaiso localization and the clinicopathological features although 63.9% of the expression was seen in the nucleus.
Conclusion: The study indicates that Kaiso is highly expressed in Ghanaian TNBC and is likely associated with worse outcomes in aggressive tumour types.

Outcome of retained intra-abdominal foreign body managed in a general surgical service in Ibadan: A case series.

2024-06-21T11:48:50+00:00

Retained intra-abdominal foreign bodies are rare and most occur following abdominal or gynaecological surgery. Sponges are the most retained foreign body. The foreign bodies range from surgical instruments, including abdominal pads and gauze to artery forceps; to a pen cap. Retained objects can also be self-inserted. The authors report a case series on the outcome of retained foreign bodies in the intra-abdominal cavity managed in the general surgery service of the University College Hospital, Ibadan over 12 years.