Pattern of Surgical Emergencies in Rural Southwestern Nigeria

Introduction: Considering the magnitude of deaths prevailing in the accident and emergency department (AED) in health facilities of sub-Sahara Africa, there is a need to have information on the burden of admissions and deaths due to surgical emergencies. Few studies in Nigerian hospitals in urban and suburban areas have been documented, but none in the rural setting. The objectives of this study were to ascertain the sociodemographic profile, causes and outcomes of admissions, and the pattern and causes of deaths due to surgical emergencies. Methods: A retrospective survey using a data form and a predetermined questionnaire was used to review the patients admitted for surgical emergencies at the AED of a tertiary hospital in rural southwestern Nigeria from January 2015 to December 2019. The data were analyzed using SPSS version 22.0. The results were presented in descriptive and tabular formats. Results: Surgical emergencies constituted 43.9% of all admissions. The mean age of admissions was 42 ± 16.9 years, and majorities were in the young and middle-aged groups. There were more males (66.4%) than females (33.6%). Trauma(60.9%) of which road traffic accident (RTAs)(56.0%), was the leading mechanism of trauma. The mortality rate was 5.4% and was caused majorly by RTAs (33.0%), diabetes mellitus foot ulcers (11.0%), and malignancies (9.8%). Conclusion: In this study, surgical emergencies constituted 43.9%, and a majority of the patients were male. Trauma caused by RTA is the most cause of admission. The mortality rate was 5.4%. This finding may provide an impetus for prospective research on this outcome

Agreement among rapid diagnostic tests, urine malaria tests, and microscopy in malaria diagnosis of adult patients in southwestern Nigeria

Objective: We determined the malaria prevalence and ascertained the degree of agreement among rapid diagnostic tests (RDTs), urine malaria tests, and microscopy in malaria diagnosis of adults in Nigeria. Methods: This was a cross-sectional study among 384 consenting patients recruited at a tertiary health facility in southwestern Nigeria. We used standardized interviewer-administered questionnaires to collect patients' sociodemographic information. Venous blood samples were collected and processed for malaria parasite detection using microscopy, RDTs, and urine malaria tests. The degree of agreement was determined using Cohen's kappa statistic. Results: The malaria prevalence was 58.3% (95% confidence interval [CI]: 53.0-63.1), 20.6% (95% CI: 16.6-25.0), and 54.2% (95% CI: 49.0-59.2) for microscopy, RDTs, and urine malaria test, respectively. The percent agreement between microscopy and RDTs was 50.8%; the expected agreement was 45.1% and Cohen's kappa was 0.104. The percent agreement between microscopy and urine malaria tests was 52.1%; the expected agreement was 50.7% and Cohen's kappa was 0.03. Conclusion: The malaria prevalence was dependent on the method of diagnosis. This study revealed that RDTs are a promising diagnostic tool for malaria in resource-limited settings. However, urine malaria test kits require further improvement in sensitivity prior to field use in malaria-endemic settings

Community-acquired pneumonia and its predictors of mortality in rural southwestern Nigeria: A-five year retrospective observational study

Introduction: The predictors of community-acquired pneumonia (CAP) mortality are important outcome measures in epidemiological studies and clinical trials. There is an observed paucity of data regarding the predictors of mortality of CAP in Nigeria. Few studies from the urban centres have been reported in the literature, with none from the rural centres. The objective of this study is to ascertain the clinical presentations, risk factors, and predictors of mortality among patients admitted for CAP in rural Southwestern Nigeria. Methods: A retrospective observational study using a data form and a standardised questionnaire reviewed the 176 patients admitted to Southwestern Nigeria hospital between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results: A total of 176 patients were studied. Their mean age was 53.3±16.8 years. There were more males, 112 (63.6%), than females. The most common clinical presentations were cough, fever and sputum expectoration. The case fatality rate was 9.1% and its predictors were older aged patients [Adjusted Odds Ration (AOR), 4.135: 95% Confidence Interval (CI) (1.389-12.315); p =0.005], hypoxia [AOR, 11.118: 95% CI (2.607-47.405); p<0.001], tobacco smoking [AOR, 3.632: 95% CI (1.459-9.039); p=0.008], chronic obstructive pulmonary disease (COPD) [AOR, 10.111: 95%CI (2.370-43.139); p <0.001], and human immunodeficiency virus (HIV) [AOR, 9.444: 95% CI (4.304-20.725), p<0.001]. Conclusion: The case -fatality rate was 9.1%, and its predictors were older age patients, patients with hypoxia, tobacco smoking, COPD, and HIV. This study strengthens the argument on the higher prevalence of CAP and its mortality in rural Southwestern Nigeria. The findings may provide an impetus for prospective research on these outcomes

Socio-Demographic Profile, Asymptomatic Malaria Parasitaemia and Glycemic Control among Midled-Aged and Elderly Type 2 Diabetes Mellitus Patients in Rural Southwestern Nigeria: A Cross Sectional Study

The main therapeutic goal for all type 2 diabetes mellitus (T2DM) patients is to maintain good control so as to prevent the risk of complications associated with poor control. This study determined the prevalence of poor control and its association with socio-demographics and malaria parasitaemia among middle aged and elderly T2DM patients at a tertiary hospital in rural Southwestern Nigeria. We conducted a retrospective observational study on 250 T2DM using semi-structured interviewer administered questionnaire. Venous blood samples were collected and processed for glycated hemoglobin sugar estimation and malaria parasite detection by microscopy. Data were analyzed using SPSS version 20.0. Multivariate logistic regression identified the association of socio-demographics and asymptomatic malaria parasitaemia with poor control. The prevalence of poor glycemic control was 31.6% (95%CI: 34.4%-45.8%). Old age, (AOR=4.868; 95% CI: 1.258-24.574), female genders (AOR=7.100; 95% CI: 1.875-34.655), no formal education (AOR=3.447; 95% CI: 1.098-21.478), presence of malaria parasitaemia (AOR=48.423; 95% CI: 4.987-411.366), and higher parasite density (AOR=7.102; 95% CI: 1.785-15.002), were significantly associated with poor control. Health facilities should integrate screening of malaria parasitaemia into the management of T2DM patients while also exploring other barriers of poor control

Five-year analysis of clinical presentations and predictors of stroke mortality in rural Southwestern Nigeria: A retrospective observational study

Introduction: Stroke mortality and its predictors are important outcome measures in stroke epidemiological studies and clinical trials. There is an observed paucity of data regarding the clinical presentations and predictors of stroke mortality in Southwestern Nigeria. Few available related studies have centred on hospitals in the urban and sub-urban areas; however, none in the rural settings. This study, therefore, focuses on the clinical presentations and predictors of stroke mortality at the adult Emergency Centre of a tertiary hospital situated in rural Southwestern Nigeria. Methods: A retrospective survey, using data form and standardized questionnaire, was used to study the patients admitted for stroke between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results: A total of 276 patients were studied. Their mean age was 67.3 ± 11.1 years. The most common clinical presentations were hemiparesis and cranial nerve deficit. The case of fatality was 10.1%. The predictors of stroke mortality were age ≥65 years [(AOR = 12.752; 95% CI: (1.022–159.190), p = 0.048)], Glascow coma score <8 [(AOR = 50.348; 95% CI: (7.779–325.866), p < 0.001)], uncontrolled blood pressure [(AOR = 23.321; 95% CI: (2.449–221.927), p = 0.006)], presence of atrial fibrillation [(AOR = 16.456; 95% CI: (2.169–169.336), p = 0.009)], convulsion [(AOR = 25.889; 95% CI: (2.374–282.296), p = 0.008)], heart failure [(AOR = 30.284; 95% CI: (3.265–256.347), p < 0.001)], and a repeat stroke [(AOR = 32.617; 95% CI: (2.410–441.381), p = 0.009)]. Conclusion: The 7-day fatality was 10.1%. The predictors of stroke mortality were poor Glascow coma score, uncontrolled blood pressure, atrial fibrillation, heart failure, convulsion and a repeat stroke. This study strengthens the argument on the higher prevalence of stroke and its mortality in rural Southwestern Nigeria. Our findings may provide an impetus for prospective research on this outcome

Sero-Epidemiology of Transfusion Transmissible Hepatitis B, C and E among Blood Donors in Ekiti, Southwestern Nigeria: A Cross-sectional Study

Background: Transfusion transmissible hepatitis (TTH) is a global health problem and the incriminating agents such as hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis E virus (HEV) continue to pose serious threats to blood safety. The aim of this study was to determine the seroprevalence of HBV, HCV and HEV and relate the outcomes with blood donation type, age and gender and confirm any significant associations. Materials and Methods: In this cross-sectional study, Hepatitis B surface antigen (HBsAg) and antibody to HCV were determined with Diaspot and Lab Acon immunochromatographic ELISAbased test devices. Antibodies to HEV were first determined with Biopanda lateral flow device followed by ELISA assay for sero-reactive HEV immunoglobulins M and immunoglobulin G (IgM and IgG) antibodies. Results: A total of 370 prospective blood donors between 18 and 55 years old (mean 31.2 ± 7.6 years) who presented for blood donation at FETHI Blood Bank were screened. Overall male: female ratio was 7:1. Cummulative hepatitis seroprevalence of 8.1% was found mainly among the replacement blood donors (RBD) and consist of 4.3%, 1.6%, 1.1%, 0.8% and 0.3% serologic evidence of HBsAg, anti-HCV, HEV IgM, both HEV IgM & HEV IgG, and HEV IgG antibodies. Blood donors aged 18 – 45 years were most affected with evident significant association between the age group of donors and TTH seroprevalence. Cummulative hepatitis seroprevalence was 0% among voluntary blood donors, and 9.1% and 0.3% among the male and female RBD respectively. There was significant association between the pathogens and RBD, though the association with male gender was clinically but not statistically significant. Conclusion: The high transfusion transmissible hepatitis seroprevalence among RBD called for promoting voluntary donations. Comparable prevalence of HEV antibodies with that of HCV called for its inclusion in the TTIs screening algorithm to ascertain optimal blood safety in Nigeria

Psychological Well-Being of Adolescents in South Western Nigeria: Its Association with Sociodemographic Characteristics and Perceived Food Insecurity

Psychological well-being (PWB) which is a measure of life satisfaction in adolescence plays a great role in their behavioral lifestyle. The aim of this study was to assess the adolescents’ psychological well-being, its association with perceived food insecurity, and their sociodemographic characteristics. Using multistage random sampling, 352 students from three secondary schools in Ado Local Government in Nigeria were recruited. A self-administered questionnaire adapted from existing literature was used for data collection. About fifty-six percent of the adolescents had high psychological well-being. Most of the students studied had a high estimate of themselves in their self-autonomy and personal growth development. While Tribe (p = 0.032), type of family (p < 0.001), present class (p = 0.039) and class repetition (p = 0.018) were significantly associated with psychological well-being of adolescents, most adolescents had a medium to high food insecurity. Self-autonomy and personal growth development in adolescents are associated with the type of family structure, the higher the social class of the family and the lower of the occurrence of repetition of a class shall be. A stable family environment is beneficial to adolescents

Malaria infection and its association with socio-demographics, preventive measures, and co-morbid ailments among adult febrile patients in rural Southwestern Nigeria: A cross-sectional study

Objectives: The study determined the prevalence of malaria infection and its association with socio-demographics, environmental, housing, and co-morbid ailment factors. Methods: The study was a cross-sectional of 330 consented adult febrile patients who were recruited at a tertiary health facility in rural Southwestern Nigeria. The standardized interviewer-administered questionnaire sought information on their socio-demographics, environmental, housing, and co-morbid ailment factors. Venous blood samples were collected and processed for malaria parasite detection, retroviral screening, glycated hemoglobin, and hemoglobinopathy. Data were analyzed using SPSS version 20. The strength of the association between independent and dependent variables was measured using odds ratio and 95% confidence interval with a significant level (p value <0.05). Results: The prevalence of malaria parasitemia was 63.3% (95% confidence interval: 57.9%–68.5%). Being a farmer (p=0.002), lack of formal education (p=0.043), low-income earners (p=0.031), presence of bushes (p=0.048), stagnant water (p=0.042), not sleeping under long-lasting insecticide-treated nets (p<0.001), and sickle cell disease (p=0.041) were significantly associated with malaria infection. Conclusion: The study revealed that there is a high prevalence of malaria infection in rural Southwestern Nigeria. There may be a need to pay greater attention to adult populations in rural areas for malaria intervention and control programs

The Relationship between Adolescents' Family Background, Perceived Self-Concept and Health Seeking Behaviour in an Urban City of South-Western Nigeria

Background and objectives: The understanding of adolescents about themselves affects their choices and actions when their health is concerned. This study assessed the relationship between family background, perceived self-concept and health seeking behaviour of adolescents. Methods: This was a prospective cross-sectional study involving three secondary schools in Ekiti State, South-western Nigeria. A total of 352 students were recruited through multistage random sampling technique. The Personal Self-Concept Questionnaire (PSC) was used to assess the adolescents' personal self-concept while the health seeking behaviour was adapted from the Botsha Bophelo Adolescent Health Study (BBAHS) adapted questionnaire. The family background was sought from the respondents. Demographic variables were described as means and standard deviations. Categorical variables were reported as frequency distribution and proportions with the Pearson correlation test used to assess the relationship of relevant variables with self-concept. Results: There was negative correlation between the adolescents' family social class and their autonomy self-concept (r = -0.117; p<0.029). Out of the 42% who had any form of ill-health, 29.6% had sought for medical attention, 8.5% were sexually exposed, 4% and 4.8% were screened for HIV and the use of contraception respectively. Having been hospitalized in the past six months related with their general self-concept (r = -0.124; p<0.02) and sense of fulfillment (r = -0.118; p<0.027). Use of cannabis negatively correlated with general self-concept (r = -0.132; p<0.013) and honesty self-concept (r = -0.127; p<0.017). Sexual exposure correlated negatively with emotional self-concept (r = -0.116; p<0.03). Conclusion: From this study, the socioeconomic class of the family of the adolescents affected their individuality. In addition, adolescents with high self-concept will not easily seek for appropriate medical attentio

Utilization And Effectiveness Of Malaria Prevention Methods Among Pregnant Women In A Rural Community Of Ekiti State, South West Nigeria : A Cross- Sectional Study.

Background: National surveys indicate that among countries in Africa where malaria is endemic, Nigeria alone accounts for 21% of pregnancies that are unprotected from malaria. The purpose of this study is to ascertain the extent of utilization and effectiveness of malaria prevention methods, to find out the existing relationship between maternal parasitaemia and the effectiveness of these methods at (p<0.05) level of significance. Methods: The study was a cross sectional survey involving 264 consenting booked pregnant women who were recruited from antenatal clinic at Federal Teaching Hospital, Ido -Ekiti, Ekiti State, Southwestern Nigerian. Interviewer administered questionnaire was used to elicit information on the socio-demographic characteristics of the respondents, mode of malaria prevention, extent of utilization of malaria prevention methods and their effectiveness. Venous blood samples for malaria parasite test were collected and microscopic analysis was done to detect the malaria parasite in the obtained blood samples. Data was analyzed using SPSS version 20.0 Results: All the 264 pregnant women interviewed, consented to having their blood taken. In rank order, the mode of malaria prevention methods most commonly reported as being effective were Intermittent Preventive Treatment using sulphadoxine-pyrimethamine (IPT-sp) which was favored by majority 190 (72.0%). This was followed by Insecticide Spray 166 (62.9%). Insecticide Treated Nets (ITNs) were the least utilized by 108 (40.9%) respondents. Nine (8.3%) of the 108 participants that used ITNs, 15 (7.9%) of the 190 participants that used IPT-s and 18 (10.8%) of the 156 participants that used Insecticide Spray tested positive for malaria respectively. There was a statistically significant association between maternal parasitaemia and malaria prevention methods using ITNs (p=0.001), IPT-sp (p = 0.001) and Insecticide sprays (p = 0.001). Conclusion: The three malaria preventive methods adopted for this study were ITNs, IPT-sp and Insecticide Spray. Despite their protective effectiveness, their utilizations are still poor. Information and communication strategies with other concerted efforts by the stakeholders are suggested to ensure proper implementation of the national policy on malaria as adopted by other countries