The Political Economy of Mass Transit Programme in Nigeria: An Evaluation of Government Post- Petroleum Subsidy Intervention

This paper investigated the political economy of mass transit programme in Nigeria using federal government post-petroleum subsidy removal intervention as a case study The primary objective of the study is to determine the impact of the intervention on the socio-economic and mobility hardship that resulted from the removal of the subsidy With the aid of secondary and primary sources of data collection the paper observed that contrary to its original aim the mass transit programme now pursues elites economic interest It further observed that the programme became an instrument of political settlement and a capitalist programme for profit maximisation because all the government owned mass transit companies have been commercialised It observed also that the intervention has no positive impact on the socio-economic and mobility hardship of the people Thus the paper recommends a reversal of the commercialisation of mass transit companies government donation of vehicles to labour unions and government own transport companie

The Prognosis of Acute Stroke in a Tertiary Health Centre in South-East Nigeria

Stroke is a common neurologic disorder and it is the third leading cause of mortality worldwide after ischaemic heart disease and cancer. This study determined the prognosis of acute stroke in Federal Teaching Hospital Abakaliki (FETHA) South-East Nigeria.It was a retrospective, descriptive and hospital based study conducted in a tertiary health centre in Abakaliki south-east Nigeria. The stroke register of the neurology unit was reviewed and relevant data were extracted and analyzed. Stroke accounted for 12% of medical death with 24hour, 7day and 30day mortality rate of 5%, 10% and 15% respectively. Factors associated with stroke mortality include advanced age, female sex, extremes of blood pressure, loss of consciousness and haemorrhagic stroke. There should be regular health education with emphasis on primary prevention of stroke.  Also, stroke patients should be referred early to a stroke unit for adequate management. Key words: stroke, mortality, Abakaliki, South-East, Nigeri

Pattern of Neurological Admissions in the Tropics: Experience At Abakaliki South-Eastern Nigeria

The pattern of neurological admissions varies amongst different regions of the world and this depends on many factors including the regional burden of neurological disorders. This study determined the pattern of neurological admissions in a tertiary health centre in Abakaliki South Eastern Nigeria and compared it with that from other parts of the country. A review of admissions into the medical wards of the Federal Teaching Hospital Abakaliki south-eastern Nigeria from July 2012 to June 2013 was done using the register of admissions and discharges. Out of 1247 patients admitted in medical ward over the study period, 267 (21%) had neurological disorders with mean age of 55.1±20.2years. There were 154(58%) males and 113(42%) females, with a sex ratio of 4:3. Seventy two percent of the patients were between 30 and 69years. Stroke accounted for 62% (166) of the neurologic admissions. Others were central nervous system (CNS) infections, seizure disorders, hypertensive encephalopathy, myelopathies, CNS tumors and neurodegenerative disorders in descending order of frequency. The burden of neurological disorders is high with male preponderance in Abakaliki south-eastern Nigeria mainly of the productive population. Stroke and CNS infections were the most prevalent neurological disorders identified which are both largely preventable. There should be good health planning that will address the enormous neurological disease burden and emphasize preventive health. Keywords: Pattern, neurological admissions, Abakaliki, Nigeri

Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria

BACKGROUND: Contemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this. METHODS: This was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. RESULTS: Of the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients’ requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%). CONCLUSION: The routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients

Pattern of Medical Admissions in a Tertiary Health Centre in Abakaliki South-East Nigeria

The pattern of medical admissions varies amongst different regions of the world and this depends on many factors including the prevalent medical diseases in the region. This study determined the pattern of medical admissions in a tertiary health centre in Abakaliki South Eastern Nigeria and compared it with that from other parts of the country.   It was a retrospective, descriptive and hospital based study. The admission and discharge registers of the medical wards of the Federal Teaching Hospital Abakaliki south-east Nigeria from July 2012 to June 2013 were reviewed and relevant data extracted and analyzed using Statistical Package for Social Sciences (SPSS) version 19 software.  The patients admitted during the period numbered 1247, with age range of 15 to 99 years. There were 643(51.56%) males and 604 (48.44%) females, with a male to female ratio of 1.06:1. Seventy per cent of the patients were between 30 and 69years. Infectious diseases accounted for 255 (20.45%) of the admissions, while cardiovascular disorders and neurological disorders accounted for 251 (20.13%) and 233 (18.68%) respectively. Non-communicable diseases accounted for 711 (57.02%) of the cases while communicable diseases accounted for 536 (42.98%). There was male predilection for neurological and chronic liver diseases while female patients had predilection for infectious diseases. The study showed that majority of the patients was in the productive age. There was also double burden of both communicable and non-communicable diseases in Abakaliki with higher female prevalence of infectious diseases. Health planning towards prevention of the identified diseases should be instituted. Keywords: pattern, medical, admissions, Abakaliki, Nigeri

The Pattern and Presentation of Stroke in Federal Teaching Hospital Abakaliki (FETHA) South-East Nigeria

Stroke is a common neurologic disorder and it is the third leading cause of mortality worldwide after ischaemic heart disease and cancer. Males are predominantly affected and ischaemic stroke is more prevalent than haemorrhagic stroke. This study determined the pattern and presentation of stroke in Federal Teaching Hospital Abakaliki (FETHA) South-East Nigeria. It was a retrospective, descriptive and hospital based study. The stroke register of the neurology unit was reviewed and relevant data were extracted and analyzed using Statistical Package for Social Sciences (SPSS) version 19 software. The sex ratio was M:F =3:2 and  the peak age prevalence of stroke was the 7th decade. Ischaemic stroke was present in 65%, while intracerebral haemorrhage and subarachnoid haemorrhage were 31% and 4% respectively. Stroke constituted 12% of medical deaths with 30 day case mortality rate of 15%. Stroke is highly prevalent in Abakaliki south east Nigeria. The 30 day case mortality rate is relatively low in this study. There should be regular public enlightenment for stroke prevention and prompt referral of stroke patients to a stroke unit for adequate management. Keywords: stroke, ischaemic, haemorrhagic, Abakaliki, South-East, Nigeri

Common Errors in Proposals and Dissertations and How to Avoid them: A Resident’s Guide

Background: The dissertation is now a necessary part of the fellowship examinations of both the West African college of surgeons and physiciansand the national postgraduate medical college of Nigeria. Many resident doctors are confused about how to get on with their proposals and thedissertations. This confusion often leads to frustrations, and in extreme cases to unnecessary delay in attempting the examinations when due. Aim: This study aims to identify the common errors made by resident doctors in the proposal and dissertations and to recommend the solutionsto such problems. Methods: This survey is based on a direct interview with experienced examiners in both colleges. The examiners were asked to list what they observed as the common problems they identified concerning the proposal and dissertation of residents. The answers were collated and categorized according to the frequencies of problems identified. Based on the response of the examiners, a questionnaire was designed and administered to the senior residents who are at various stages of writing their dissertations. Results: Some of the findings include starting the proposal too late, difficulty in choosing a topic, mediocre and tedious literature search, difficulty in finding appropriate supervisors, poor appreciation of basic research design and necessary statistical tests, improper presentation of results and&nbsp; wrong referencing. Others are editorial mistakes, pagination errors, and the lack of knowledge on proper attitude and skill during the defense.&nbsp; Conclusion: Starting too late is the most common error made by the resident doctor in the dissertation. Residents should choose a topic within 6&nbsp; months of passing the membership examination. Keywords: Dissertations, errors, proposals, resident doctor

Comparative Evaluation of the Effects of Artemisinin-based Combination Therapy and Amodiaquine Monotherapy in G6PD Activity, Fasting Glucose Level and Parasite Clearance Rate in Malaria-infected Adults in Abakaliki, Nigeria.

Background: Antimalaria combination therapy with regimen containing an artemisinin-based compound has been recommended as a gold standard and first-line treatment for malaria by WHO. Studies have also proven the effectiveness of Artemisinin-based Combination Therapy (ACT) in the treatment of uncomplicated Plasmoduim falciparum and delaying the emergence of drug resistance. However, limited reports exist on the effects of ACT on some vital biochemical parameters such as glucose-6-phosphate dehydrogenase (G6PD) and blood glucose concentration. This study therefore investigates and compares the effects of Artesunate-Amodiaquine combination therapy and Amodiaquine monotherapy on G6PD activity, fasting blood glucose level and parasite clearance rate in malaria-infected adults in Abakaliki, Nigeria. Methodology: Twenty adults aged between 20 and 30 years were used for the study. The patients were divided into two groups-A and B of 10 individuals each. Group A was given Artesunate-Amodiaquine (AS-AQ) while group B was given Amodiaquine (AQ). Blood samples were collected from each individual at baseline (Day 0) and after drug treatment (Day 4) for the comparative analysis of G6PD activity, fasting blood glucose level and parasite clearance rate. Result: There was an increase in G6PD activity after drug treatment in the two groups but the increase was not statistically significant. Glucose levels decreased after treatment in both groups but the decrease was also insignificant. There was a significant (P&lt;0.001) difference in malaria parasite density of both groups after drug administration. The percentage parasite clearance of AS-AQ treated group and the AQ treated group were 67% and 47% respectively. Conclusion: There were no significant differences in the AS-AQ and AQ effects on the G6PD activity and fasting glucose level. In contrast, AS-AQ therapy indicated higher parasitic clearance rate compared to the AQ therapy. This further proves that Artemisinin-based Combination Therapy (ACT) is more effective than monotherapy in the treatment of malaria. Keywords: Artemisinin- Amodiaquine, Combination therapy, Amodiaquine, Parasite clearance, G6pd, Glucose

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The presentation of tetanus in a tertiary health centre in Abakaliki, South- East Nigeria

Background: The presentation and prognosis of tetanus varies amongst different regions of the world and this depends on many factors including the herd immunity and hygienic practices in the regions. Tetanus may be categorized into 4 clinical types: generalized tetanus, localized tetanus, cephalic tetanus and neonatal tetanus.Objectives: To study the presentation and prognosis of tetanus in a tertiary health centre in Abakaliki, South-East Nigeria, and to compare it with that from other parts of the world.Methodology: A review of the case notes of tetanus patients managed in the isolation wards of the Federal Teaching Hospital Abakaliki, South- East Nigeria, from June 2013 to May 2015 was done.Results: The total number of tetanus cases seen over the period was 16, with an age range of 16 to 52years and mean age of 28.07±5.34years. All the patients had generalized tetanus. There were 15(93.75%) males and 1 (6.25%) female. The mean incubation and onset periods were 12.6 days and 2 days respectively. They were treated with intravenous diazepam, metronidazole, tetanus toxoid and anti-tetanus serum. The mean duration of admission was 12.5days and mortality rate was 18.8%. Presence of co-morbid medical conditions was associated with mortality.Conclusion: The study showed that tetanus affects predominantly young men in their productive years, and the mortality rate is rather high for a potentially preventable disease. More efforts should be put in achieving universal immunization coverage for children less than 5years of age, with regular booster doses for the whole population.Keywords: Diazepam, emergency, fatal, preventable, young male