Establishing consensus among interprofessional faculty on a genderbased violence curriculum in medical schools in Nigeria: A Delphi study

Background. Gender-based violence (GBV), as a topic of medical study and practice, is an integral component of medical education in many developed countries. There is an increasing need to equip medical practitioners with appropriate knowledge, attitudes and skills to care for victims of GBV.Objectives. To obtain consensus among stakeholders on content, the members of faculty who should teach the subject and the methods of training relating to GBV curricula in three medical schools in south-west Nigeria.Methods. Three rounds of the Delphi technique involving 52 experts from among academics, medical practitioners, government and non-governmental organisations were conducted. The first round (RD 1) was open-ended, while subsequent rounds were structured. Consensus was defined as a gathering around mean (>3.5) responses with minimal divergence (standard deviation (SD) <1.5) to the RD 2 questionnaire; strong consensus was >4.0. For the RD 3, consensus was regarded as >50% satisfaction with the rankings from RD 2. A strong consensus was taken as >60% satisfaction.Results. Themes identified in RD 1 were: reasons for teaching GBV; teaching methods, strategies needed and departments best positioned to teach it; professions to involve in training; academic level to offer training; and strategies to assess effective training. From RD 2, the topics ranked highest for inclusion in training were (mean (SD)): complications of GBV, 4.44 (0.63); and safety plan, 4.44 (0.51). Offering training to final-year medical students was most preferred, at 4.25 (1.13); for teaching methods, using videos for training, at 4.63 (0.89), was ranked highest, followed by information, education and communication materials, at 4.50 (0.82). Discussion with victims ranked highest as the most preferred format for teaching, followed by didactic lectures, at 4.06 (0.93) and 4.00 (0.89), respectively. The departments selected to teach GBV were Public Health, at 4.19 (0.91); Accidents and Emergency, 4.06 (0.85); Family Medicine, 3.81 (1.05); and Obstetrics and Gynaecology, 3.81 (0.89). Other professionals suggested were psychologists, social workers and lawyers. With regards to assessment, written examination ranked highest, at 4.06 (0.85). RD 3 confirmed the rankings of RD 2 on all themes, and sought additional suggestions for the training. Most (82.9%) respondents had no additional suggestions; the few elicited included clarifying cultural misconceptions around GBV, involving religious leaders and psychologists, and the recommendation that the teaching should be sustained.Conclusion. These results will inform the development of evidence-based competencies relevant to healthcare providers in the African context. The need for periodic review of the curricula of medical schools to ensure that they address patient and societal needs is highlighted

The High Dependency Unit in the Management of Critically Ill Obstetric Patients in Low Resource Countries

The care of the obstetric population requiring critical care at the intensive care unit is associated with challenges that have made the establishment of obstetric high dependency units (HDU) a priority in the developed, unlike low resource countries.The objective was to evaluate the need to establish obstetric HDUs in low-resource countries.The study was a retrospective descriptive study of obstetric patients admitted in the intensive care unit of the University of Ilorin Teaching Hospital from 1st January 2010 to30th June 2013. Those that were suitable for management at HDUs were compared with those who needed ICU care. The statistical analysis was with SPSS version 20 with p-values, x2, and odds ratio; p-value <0.05 was considered significant.All the 52 patients were postpartum; 16(30.8%) were suitable for HDU care. Of the HDU eligible patients, 11(68.8%) were of low social class, 12(75%) were booked, 11(68.8%) had no further complication at ICU and mortality was 1(6.25%). Compared to those who needed ICU care, there were no statistical significance in maternal age, parity, duration of ICU admission and total cost of ICU care. There were more cases with statistical significance of organ involvement (p<0.001), severity of Glasgow coma score at admission (p<0.001), further complications at ICU (p<0.001) and maternal mortality (p<0.001) among those needing ICU care compared tothose needing HDU care.In conclusion, the establishment of the HDU will reduce cost and the burden on the few ICUs in low-resource countries without increasing maternal mortality

Dietary supplementation of autolysed yeast enhances growth, liver functionality and intestinal morphology in African catfish

A feeding trial was conducted to evaluate the potential of dietary supplementation of autolysed brewer's yeast (AY) on African catfish. The catfish (22.5 ± 1.15 g/fish, 20 fish 33 L/tank) were fed with either of diets (390 g/kg crude protein, 140 g/kg lipid) supplemented with 0, 3, 6 or 10 g/kg AY (n = 3). After 49 days of feeding, the final body weight and metabolic growth rate of the catfish fed 3 g/kg AY (3‐AY) diet were higher than those fed the control diet (p .05) in intestinal perimeter ratio. However, an elevated (p < .05) abundance of goblet cells and intraepithelial leucocytes were found in the intestine of catfish fed 3, 6 and 10 g/kg AY diets, with the highest level of abundance recorded in the mid‐intestine of the catfish fed 3‐AY diet. The results suggest that dietary 3 g/kg autolysed brewer's yeast supplementation improves growth performance of African catfish without deleterious effect on liver functionality and gut morphology

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Diagnosing pre-invasive cervical lesions – experience with pap smear in a Nigerian teaching hospital

Pap smear is a tested screening method for detection of pre-invasive cervical lesions, and effective Pap screening has reduced the burden of cervical cancer in developed countries. The aim of this study is to highlight various indications for Pap smear and the prevalence of cytological abnormalities in Ilorin, Nigeria using the Bethesda system. This is a prospective study that was carried in the University of Ilorin Teaching Hospital between June 2011 and May 2013. A total 566 smears were reported and a mean age 43±10 years fell short of acceptable internationally recommended age of 18 years to commence Pap screening. The relative frequencies of indications for Pap smears include   routine screening (58.1%), vaginal discharge (20.3%), postcoital bleeding (12.0%) and postmenopausal bleeding 43 (7.6%). Of the total smears reported, epithelial abnormalities seen include low grade SIL 30 (5.3%) and high grade SIL 9 (1.6%) respectively. Majority of the smear-positive cases were seen in women who came for routine screening and the prevalence of intraepithelial lesions reported from our study is higher than what have been documented from other parts of the world. Increased public awareness about Pap smear, a properly organized screening program and availability of treatment modality for screen-positive women will reduce the burden of cervical cancer in Nigeria.Keywords: Pap smear, screening, cervical cance

Pap screening as preventive tool against cervical cancer: a report of carcinoma in-situ in a woman with family history of cancer in Ilorin

The incidence of cervical cancer in the developed countries has significantly reduced as a result of well-organized and coordinated Pap screening program, which is aimed at detection of pre-invasive lesions that are then promptly treated. We report a 45-year old woman whose immediate elder sister had breast carcinoma, and she presented for routine breast and cervical cancer screening. Pap smears on 2 occasions revealed a high grade squamous intraepithelial lesion (HSIL). Histopathological evaluation of the cervix after hysterectomy revealed carcinoma in-situ. We discussed the need for early screening for malignancies in persons with significant family history of cancer.Keywords: Pap smear, Cervical cancer, Ilorin

Critically ill obstetric admissions into a tertiary hispital's intensive care unit

No Abstract

Prevalence Of Malaria Parasitaemia In Pregnant Women Attending Antenatal Clinics At The University Of Ilorin Teaching Hospital, Ilorin, Nigeria

The paper studied the prevalence of malaria parasitaemia among pregnant women attending antenatal clinics at University of Ilorin Teaching Hospital, Ilorin, Kwara State. A total of 350 blood samples were collected from consecutive pregnant women registering at the antenatal clinics. It was examined for malaria parasites, using both thick and thin films. Cellulose acetate electrophoresis was used to detect the haemoglobin genotype; haematocrit method was used to determine the packed cell volume (PVC) and tube technique to determine the blood group and rhesus typing of the subjects. An overall prevalence rate of 10.5% was obtained. Prevalence rate for age group 14-20 was 14% while age group 41- 50 had no infection. Primigravidae had higher infection rate (14%) than Multigravidae (8%) and the difference was significant (

Sociodemographic Characteristics and Pregnancy outcome of Referred and Booked Parturients in a Nigerian Teaching Hospital

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Exploring the practice and attitude of circumcisers in the eradication of female genital mutilation/cutting

Background: Female Genital Mutilation/Cutting (FGM/C) remains a form of violence against women despite efforts aimed at its eradication.Objectives: To explore the practice and attitude of circumcisers towards eradication of FGM/C.Methods: A descriptive (pilot) study involving local circumcisers in Kwara State, Nigeria using interviewer-administered questionnaire; analysis was done using SPSS version 21.0 and p &lt;0.05 was significant.Results: There are 57 circumcisers including 36(63.2%) males, 49(86%) acquire the skill for circumcision as a family tradition, 3(5.3%) practice circumcision as sole occupation and 49(79%) derive higher average monthly income from other sources. Forty-two (73.7%) have a dedicated knife used for multiple clients, 44(77.2%) clean the instrument before use, 17(29.8%) wear protective gloves, 55(96.5%) apply substances to the wound mostly iodine 15(26.3%) and shea butter 11(19.3%) while 27(47.4%) have encountered complications previously. Among circumcisers, 44(77.2%) believe FGM/C prevent sexual promiscuity while 26(45.6%) think it is for culture/tradition. Thirty (52.6%) are aware of government activities to stop FGM/C, 53(93.0%) are willing to stop the act if support is provided in form of money to establish a trade 33(57.9%) or new employment 12(21.1%).Conclusions: Circumcisers are willing to discontinue FGM/C if necessary support including vocational skill acquisition, credit facilities to start a trade or new employments are provided. Efforts should be expedited to support their rehabilitation to achieve the eradication.Keywords: Female genital mutilation, Female circumcision, Circumcisers, Violence against wome