Challenges of Otolaryngologic Referral in a Nigerian Tertiary Hospital

Background: The referral system offers one strategy for making the best use of hospitals and tertiary healthcare services. The aim of this study was to analyze the referral system of patients to the otorhinolaryngologist and to examine the use of in-house referral system in the teaching hospital set up.Methods: This was a retrospective review of all patients referred to the ENT Department between January 2000 and December 2007. Data retrieved from all referral notes included the review of referral letter, demographic, referral status, clinical presentations and examination findings. These data were entered into the SPSS computer software version 11.0 and analysedResults: A total of 1402 cases were analyzed. The patients’ ages ranged from 3weeks to 90yrs, with 70.4% of cases being below 40yrs of age while 25.9% were between 40-64yrs and 3.7% were above 65yrs. The Male to female sex ratio was 1:1. The majority (70.4%) of the patients had at least primary school education. The rest (29.6%) had no formal education. Slight over half (51.5%) of the patients were unemployed. The rest were either civil servants or self employed. Out of the 1402 patients that were referred to the hospital, in-house referral accounted for 74.1%, 7.2% of came from private health facility and 4.3% were self referrals. Out of the 1038 in-house referrals, 42.8% were from GOPD, 5.0% from Staff clinic, 13.3% from surgery, 4.7% from medicine, 3.5% from Obstetrics and Gynaecology, 10% from paediatrics and 10.4% from ophthalmology and 10.3% from ENT staffs such as residents, ENT Nurse Practitioner and ENT supporting staffs such as speech therapist and audiologist.Conclusion: The challenges of referral to the otolaryngologists are enormous thus the need to organize continuous medical education for the family physician, to make patients have confidence in the primary care physician, early referral of patients and to allow the otorhinolaryngologist to focus on the cutting edge issues of the specialt

Audit of Completion of Radiology Request Form in a Nigerian Specialist Hospital

Background: Clinical audit is one approach to improve the quality of patient care, completion of request form inclusive. Radiology request forms are essential communication tools between the clinician and the radiologist. The aim of this study is to audit the adequacy of completionof X-ray request forms.Methodology: A review of all consecutive request form received at the X-ray unit of the over a period of six weeks to assess the completeness of filling of the forms, details of biodata/clinical information, previous exposure and information about the requesting officer. The data was entered into a SPSS statistical software and analysed descriptively and results presented in tables/figures.Result: Two hundred and two request forms were analysed. All the request had names on it however 89.1% had complete and adequate information while 10.9% have incomplete and inadequate information on names, one hundred and ninety-six (97%) had dates while, 6(3%) did not have information regarding date of request, space for the addresses were filled in 80 (39.6%) out of which only 24 (11.9%) had adequate and complete information. Clinical information were adequate and complete in 34.4%, only 6(8.3%) of those with previous x-rays submitted their previous film with the new request.Conclusion: We concluded that radiological investigation forms are still incompletely and inadequately filled. This will have effect on the quality and the overall service provided by both the radiographer and the radiologist and may have effect sometimes on the clinical decision and outcome.Keywords: audit, radiology, request form, medical educatio

Influence of gender and leadership style on career commitment and job performance of subordinates

This study investigated the influence of gender of supervisors and leadership style on career commitment and job performance of subordinates. The participants used in this study are 140 employees working in two breweries in Edo State. Sixty –seven (67) of the respondents were directly working under female supervisors while seventy - three (73) were working under male supervisors. The instrument used was a questionnaire with already validated items. The independent variables are gender and leadership styles, while the dependent variables are career commitment and job performance. A 2-Way Analysis of Variance (ANOVA), was used to analyse the data collected. All the hypotheses were supported in the predicted direction, as shown, males who work under democraticfemale leaders had higher mean score on job performance than females working under autocratic female leaders (28.37 vs 18.24). Males who work under autocratic female leaders had a higher mean score on career commitment than females working under democratic female leaders (41.34 vs 34.12). In the light of these findings, the researchers recommended that management in various organizations should provide suitable conditions for the growth and development of the organization. Also, organizational members should learn to put off gender biases and concentrate on effectiveness and productivity

Survey of drug use among young people in Ife, Nigeria

The objectives of this study were to identify various drugs used by adolescents, the prevalence of such practices and the factors that influence in-school adolescents to use drugs. The study was conducted in the four local government areas of Ile-Ife, South-Western Nigeria, with a totalof 800 senior secondary school students. Permission for the survey and consent were obtained from appropriate school authorities. Relevant data were obtained using a modified version of a questionnaire designed by the United Nations for conducting school surveys on drug abuse. The toolkit had been previously validated in Nigeria. The questionnaire items solicited information on students’ drug use practices including the types of drugs, sources, frequency of administration and reasons for drug use. Students most widely used caffeine (19.8%), alcohol (5.6%), cigarette (6.3%) and occasionally marijuana (0.4%) as psychoactive substances. The substances were obtained from open drug market (23.5%), peers (5.2%) and village drug hawkers (0.6%). Reasons for drug use included; to keep awake (22.2%) to experience high feelings (21.8%), for body building (14.1%) and to moderate appetite (11.9%). The drugs were used mostly anytime and mainly by oral route of administration. There was a high frequency of psychotropic drug use among the students with caffeine being the most widely used. Drug use by the youths could be attributed to psychosocial perceptions of self need and peer influence.Key Words: Drug use, psychoactive substance abuse, secondary schools, adolescent

Comparison of Rapid Diagnostic Tests and Microscopy for Malaria

Presumptive treatment of malaria results in significant overuse of antimalarials. This study compared the diagnostic accuracy of Histidine Rich Protein II and plasmodium lactate dehydrogenase (pLDH)-based Rapid Kits( RDTs)and using expert microscopy as the gold standard for the detection of falciparum and non-falciparum in 200 individuals suffering from fever episodes over a period 8months in a malaria-endemic area in Osogbo, Osun State. 99(44.5%) of these patients were microscopically parasitaemic with three Plasmodium species identified expect P.ovale. 25 (12.5%) of the study population had temperature < 37.50C at the time of presentation in the clinic among which 16 (64% ) were parasitaemic. Furthermore, 148 (74%) of the study population had fever episode of which 65(44%) were positive for malaria. The sensitivity and specificity of pLDH (Pf) were 84.7% and  78.3% respectively and HRP-2 were 72.7% and 90.9% respectively. Both had high detection (94.7%) at parasite density ≥ 10,000 parasite/`l of blood. Microscopy still remains the ‘Gold Standard’ since both are not 95% sensitive and cannot determine parasites quantification.Keywords: Plasmodium, Microscopy, Rapid Kits, Osogbo, Nigeria, LAUTECH Le traitement présomptif de paludisme résulte de l’usage abusif considérable des antipaludiques. Cette étude a pour but de comparer l’efficacité de diagnostic de l'histidine RichProtein II et de test de diagnostic rapide (TDR) à base de kits plasmodium lactate déshydrogénase (pLDH) et en utilisant la microscopie experte comme «gold standard» pour la détection de P. falciparum et non-falciparum chez 200 personnes souffrant d'épisodes de fièvre sur une période de huit mois dans une région où le paludisme est endémique dans Osogbo, l'Etat d'Osun. 99 (44,5%) de ces patients étaient parasitémiques à la microscopie à trois espèces de Plasmodiumidentifiées différentes de P. ovaleattendu. 25 (12,5%) de la population étudiée avait une température <37,5°C au moment de leur arrivée à la clinique parmi lesquels, 16 (64%) étaient parasitémiques. En outre, 148 (74%) de la population d’étude avait un épisode de fièvre dont 65 (44%) étaient positifs pour le paludisme. La sensibilité et la spécificité de pLDH (Pf) étaient respectivement de 84,7% et 78,3% et celles de HRP-2 étaient respectivement de 72,7% et 90,9%. Tous les deux tests avaient une bonne détection (94,7%) à densité parasitaire ≥ 10000 parasite/ul de sang. La microscopie reste le «Gold Standard» puisque les deux autres tests ne sont pas sensibles à 95% et ne peut pas déterminer la quantité parasitaire.Mots clés: Plasmodium, microscopie, kits de test rapide, Osogbo, Nigeria, LAUTECHArticle in English

Challenges With the Use of Insecticide Treated Nets Among Pregnant Women in Ife-Ijesha Zone, South Western Nigeria

Background: Malaria in pregnancy cannot be controlled if there is poor compliance with preventive strategies including use of insecticide treated nets (ITN). This study examined the use of ITN during pregnancy and also identified various factors that are associated with the use /non-use among the pregnant women. Methodology: This study was carried out in antenatal clinics of Obafemi Awolowo University Teaching Hospital Complex. It employed a descriptive cross sectional study design and was conducted among 320 pregnant women who gave their consent within the four weeks study period. Data was collected using facilitated self administered, pretested, semistructured questionnaire. Univariate and bivariate analysis were done using SPSS version 16 and critical level was set at 0.05. Results: Majority of the respondents (88.1%) did not sleep under ITN. Reasons for non-compliance include ignorance (55.8%), unavailability of the product (52.7%), exorbitant price (24%), personal beliefs about the chemicals used (23.3%) and inconveniences associated with use (12%). Having treated malaria in the index pregnancy was significantly associated with sleeping under ITN as 21.1% of them slept under ITN compared to none among those that have not had treatment (Fishers p=0.001). However, none of the socio-demographic variables tested had statistically significant association with the use of ITN.Journal of Community Medicine & Primary Health vol 23 (1-2) 201

Uncommon complications of Otitis media in a tertiary center: A Case Series

Background: The aim is to report cases of unusual and infrequent complication of otitis media in North-central Nigeria, as well as evaluate their outcome. We present 7 case reports of patients with unusual complications from otitis media in our setting.Case 1: A fifteen year old Yoruba girl presented at the Accident and emergency of our hospital with a 2 week history of left sided ear ache, 10 day history of left sided ear discharge and 3 day history of jaw and neck stiffness. There was a positive history of use of ‘Turari’ locally prepared perfume and application of an ear drop from a local chemist. Caregiver said patient was fully immunized. Examination revealed a young girl, conscious and alert, not pale, anicteric with stiff neck, positive and rigid joints on movement.Case 2: An 8 year old Yoruba girl presented first to the eye clinic with 2 days history of swelling of the right eye, associated pain, reduction in vision and eyelid swelling without eye discharge or itch. There was a of purulent ear discharge 8 days prior to eye symptoms. No history of trauma was obtained. Examination revealed proptosis with zygomatic abscess extending to the post-auricular. She had incision and drainage with systemic and topical antibiotics for ear dressing. Outcome was uneventful.Conclusion: The unusual complication of otitis media still occurs in our environment usually due to late presentation and contamination of wound. Prevention is still the best option.  Keywords: Otitis Media, Complications, Otogenic Tetanus, Ophthalmic, Proptosi

Clinico-pathological pattern of nasopharyngeal carcinoma in Ilorin, Nigeria

Nasopharyngeal carcinoma is an uncommon tumour in Nigeria but the burden of the disease in terms of morbidity and mortality is very high.The aim of the study was to document the clinic-pathological characteristics of nasopharyngeal carcinoma in Ilorin, North central Nigeria.This was a retrospective review of all patients seen in ENT department, University of Ilorin Teaching Hospital with the diagnosis of nasopharyngeal carcinoma between January 1st 1999 and December 31st,2008. The patient's biodata, clinical presentation and histopathological findings are presented. The histopathological diagnosis was in accordance with the 1991WHOclassification. A total of 30 patients with histologically confirmed nasopharyngeal carcinoma seen during the study period accounted for 2% of the total cancers recorded in Ilorin cancer registry. There were 20 males and 10 females with a mean age of 48.7 ± 15.9 years. The commonest presenting complaint was cervical lymphadenopathy in 96.7% of patients followed by epistaxis (66.7%) and hearing loss (66.7%). Identifiable riskfactors included regular intake of ungutted salted smoked fish (76.7%) and tobacco use (23.3%) with some having both risk factors. Histologically, undifferentiated carcinoma was the commonest (70%) followed by welldifferentiated keratinizing squamous cell carcinoma (20%) and differentiated nonkeratinizing squamous cell carcinoma (10%).Undifferentiated carcinoma was the commonest type of nasopharyngeal carcinoma reported from this study especially among males in the 4th and 5th decades of life. Identifiable risk factors included consumption of ungutted salted smoked fish with tobaccon usage. Early diagnosis with effective referral system and easy access to radiotherapy would improve the survival outcome in patients with the disease

Acute Respiratory Infections in the Middle-Belt Region of Nigeria

Background: ARI continues to be a leeding cause of death among children globally beyond the year 2000. Close 12 million children under the age of 5years die each year in the developing countries, mainly from preventable causes and approximately 2.28 million (19%) were due to acute respiratory infections (ARI). It therefore became necessary to assess the present status of the disease in Nigeria to mastermind workable plans for reducing the mortality and morbidity burden.Methods: A designed pro-forma was used to collect and collate information from mothers or direct care givers of children at both hospital and community levels relating to family background, home setting, anthropometry, clinical presentation of ARI, previous medications, investigations, complications and outcomes of illness.Results: A total of 163 children were recruited for the study. One hundred and six had moderate and severe form of ARI while 57 had mild form. The in-patients accounted for 15.2% of all the admission within the study period.All children were under 12 years of age with male preponderance. Fast breathing, Tarchypnoea, Cough and Fever were the leading ways of presentations. The immunization coverage of study population by various antigens in the EPI were poor. Majority of the hospital children had pre-consultation antibiotics while none of the children from the rural community had pre-recruitment antibiotics. Streptococcus pneumoniae and Staphylococcus aureus were the leading organisms isolated with good sensitivity to Quinolones, Gentamycin and Cephalosporins. Heart failure was the leading complications. Mortality was 12.3% among the hospitalized patient and none among the community children.Conclusion: It was concluded that ARI is still a major cause of morbidity and mortality among children with opportunity for burden reduction.Keywords: Acute Respiratory Infection, present outlook, burde

SORGHUM BICOLOR EXTRACT: A SUITABLE COUNTER STAIN IN HIBISCUS EXTRACT NUCLEAR STAINING OF LIVER AND KIDNEY

ABSTRACT Aim: To investigate the suitability of alcoholic extract of Sorghum bicolor stalk as a counter stain for Hibiscus extract stained nuclei. Method: Formalin fixed kidney and liver biopsies were processed by the paraffin wax technique, sectioned, stained with Hibiscus extract solution and counterstained with 10% alcoholic extract of Sorghum bicolor stalk. Parallel sections were stained with H&E as control. Results: Results show distinct dark -violet nuclear staining with light-brown staining of collagen and other components. Conclusion: Sorghum bicolor stalk alcoholic extract could be a useful substitute to eosin in histology for the demonstration of collagen and other cytoplasmic components especially when H. sabdariffa is used as the nuclear stain