Barriers to pneumococcal conjugate 13 vaccination recommendations among physicians in Lagos

Objective: Vaccination rates among risk groups vary between different countries. There are gaps in the implementation of the acceptable recommended guidelines on adult pneumococcal immunization in Nigeria. This study aims to evaluate the barriers for physicians in recommending pneumococcal vaccines. Methods: This was a descriptive cross-sectional survey involving 97 physicians. Self-administered questionnaires were sent electronically to the physicians to understand the barriers to adult pneumococcal vaccine recommendations among adult physicians in Lagos. The sample size was based on estimation using the Cochrane formula. Results: Ninety-seven (97) physicians completed the questionnaire with a male to female ratio of 1:1.3. The mean age of the responders was 39.54±6.2 years. About 73(81.1%) of physicians recommended the pneumococcal vaccine and most physicians recommended the vaccine for patients with chronic lung diseases.  The common barriers for vaccine recommendation include: unavailability (53; 54.6%), poor reminder systems (43; 44.3%), inadequate insurance coverage (33; 34%), and Vaccine shortage (31; 32%). Conclusions: This study suggests that the majority of physicians recommend pneumococcal conjugate vaccines. The major barriers to vaccination include poor access, availability, and cost. There is a need to increase access, cost, and availability of pneumococcal vaccine if the narrative must change

Lymphangioleiomyomatosis in a 43-year-old female Nigerian: Diagnosis and Management

Background: Lymphangioleiomyomatosis (LAM) is a rare disorder that presents in women of childbearing age. The affected patients present with spontaneous pneumothorax, chylothorax, hemoptysis, and slowly progressive dyspnea. There are poor awareness, knowledge, and records about this disease in Nigeria. Case presentation: We report a case of pulmonary LAM in a 43-year-old woman who presented with progressive shortness of breath with recurrent hemoptysis and pneumothorax. Her imaging and Vascular endothelial growth factor level were in keeping with LAM. The typical features in the current case include the patient's age, gender, radiologic features, and VEGF- D value. Conclusion: There is a need for a high index of suspicion for LAM in women of child-bearing age with cystic lung diseases. There is also a need for registries for rare lung diseases in Africa

Challenges of Pancreatic Cancer Management in a Resource Scarce Setting

Backgrounds: Of all forms of gastrointestinal malignancy, adenocarcinoma of the pancreas is associated with the worst survival. Management of pancreatic cancer is associated with some challenges. This study is aimed at determining the hospital incidence, sociodemographic characteristics, managements and management's outcome of carcinoma of pancreas at our hospital. We also discuss the management challenges encountered with these patients.Material and methods: We reviewed 96 pancreatic cancer patients seen at Awolowo University Teaching Hospital Complex, Ile –Ife, Nigeria, from July 1989 to July 2007.Results: There were ninety six patients diagnosed with cancer of the pancreas but only 80 patients had histological proof of pancreatic cancer. This account for 2.1% of all malignancies seen and 238/100000 total admissions during the study period. The median age is 55.0. There were 62 (64.6%) male and 34 (35.4%) female with male to female ratio been 2:1. Duration of symptoms in the patients ranges from 4 weeks to 109 weeks. Only three (3.1%) patients has tumor located in a particular anatomical sub site: two head of pancreas and one tail of the pancreas. Other patients had extensive tumor involving the head and body of the pancreas. Two patients had pancreaticoduodenectomy, one had resection of the tumor at the tail of pancreas and 45 patients had triple bypass. Patients with low serum albumin and serum sodium and elevated transaminases at presentation, had poorer prognosis than other patients.Conclusion: Pancreatic cancer is not uncommon in our center with male preponderance. Most patients present with advanced condition only amenable to palliative measures. There are significant challenges in the area of diagnosis, screening, treatment and research

Parents' Acceptability and Health Workers' Perspectives of Pneumococcal Conjugate Vaccination for Under-Fives in Ile-Ife, Nigeria

Background: Pneumococcus, apart from being the commonest bacterial cause of Respiratory tract infections (RTIs) also causes a wide array of morbidities which can all be prevented with the administration of potent Pneumococcal conjugate vaccine. Despite its effectiveness and availability, Pneumococcal vaccines are not part of routine immunization in Nigeria. This study assessed parents' acceptability and health worker's perspectives of Pneumococcal Conjugate Vaccination for under-fives.Methods:  The cross-sectional survey was conducted in Ife Central Local Government Area, Osun state. An interviewer-administered questionnaire was used to collect information from 400 parents of under-fives selected via multi-stage random sampling. In-depth interviews were conducted for the heads of immunization units in four selected facilities in the local government area. Data were analysed using SPSS version-16.Result: More respondents were females, married and had tertiary education. About three-fifth (59.2%) of parents had good knowledge about RTIs though majority (79.00%) were unaware of Pneumococcal Conjugate Vaccine (PCV). most parents (93.5%) were willing to accept PCV for their children but only 43.5% of them could afford to pay for the cost of the vaccine at the prevailing market price. Most health workers (three out of four) interviewed were not aware of PCV. Most parents (96.25%) and all health workers interviewed wanted PCV incorporated into the National Program on Immunization (NPI). Parents with good knowledge about respiratory tract infections (RTIs) were significantly willing to accept PCV for their underfives (p= 0.005). Younger parents less than 35years, parents with lower educational attainments and low income groups significantly could not afford to pay for the cost of vaccines. (p=0.014, 0.001 and <0.001 respectively).Conclusion: Though almost three fifth of parents surveyed had good knowledge about RTIs, awareness about PCV was poor and most of them were unable to afford PCV. There is an overwhelming need to incorporate PCV in to the NPI, as both parents and health workers agreed. Aside from overcoming a major financial barrier to vaccine access, this will also make PCV widely available to parents who are already willing to accept the vaccine for their children.Keywords: Parents' Acceptability, Pneumococcal conjugate Vaccinatio

A Cross-sectional Survey of the Willingness of Tertiary Hospital Staff to Donate Blood in Sagamu, Nigeria

Background: Available donor blood rarely meets the demand in sub-Saharan Africa due to obstacles to blood donation. Willingness to donate blood is adjudged an important step to the actual practice of donating blood. Objective: To assess the willingness of the members of staff of the hospital to donate blood and determine factors affecting their willingness or otherwise. Methods: This was a descriptive cross-sectional study. A proportional allocation of participants was carried out at the various departments in the hospital using self-administered questionnaire. Results: Overall, 183 (73%) of the 246 respondents expressed willingness to donate blood, 111(45%) of whom have been asked to donate blood in the past. Only 91(37%) had donated blood in the past. Significantly higher proportion of health staff showed the willingness to donate blood generally and voluntarily compared to non-health staff. Significantly higher proportion of respondents with tertiary education showed the willingness to donate blood. Two hundred and eighteen (88.8%) were willing to donate blood to help the patient in need while fear of exposure to HIV infection, needle prick and dizziness constituted the major factors discouraging blood donation (19.9%, 18.7% and 18.3% respectively). Conclusion: Willingness to donate blood was mostly based on the primordial motivation of helping the patient in need which does not translate to blood donation. There is a need to improve awareness and advocacy on blood donation among hospital staff and the general population

Splenic Size in Sickle Cell Anaemia Patients in A Tertiary Hospital

Sickle cell disease is one of the common haemoglobinopathies in the world. It can affect any organ in the body and one of the most common and an early organ to be affected in SCA is the spleen. Reports have shown that patients with sickle cell anaemia (HbSS) have an increased susceptibility to infection leading to increased morbidity and mortality. Autosplenectomy with the consequent absence or reduction of splenic function may explain the propensity to encapsulated bacteria infection. This study was carried out in order to provide an update on the incidence of anatomical autosplenectomy in sickle cell anaemia patients. A comparative cross sectional study of 40 sickle cell anaemia patients in steady state attending Haematology clinic and 40 age and sex-matched healthy HbA control was carried out. An interviewer-administered questionnaire was used to get information on biodata and malaria history. Splenic Ultrasound was done to determine spleen size. Data generated was analyzed using statistical package for social science version 17 (SPSS 17). Twenty (20%) of the sickle cell patients had autosplenectomy (spleen size less than 6cm) while 15% had splenomegaly (spleen size greater than 12cm) and 65% had normal sized spleen(spleen size of 6cm-12cm) on ultrasonography. There was no significance difference (p= 0.332) in the median spleen size of HbS and HbA individuals. Splenic ultrasonography is advocated in determining splenic size in patients with sickle cell anaemia, and could be done annually as a means of monitoring the trend of the size of the spleen in each patient.Key words: Sickle cell anaemia, Autosplenectomy, Splenomegaly, spleen Ultrasonograph

Skinfold Parameter as Predictor of Body Density for Undergraduate Female Students in a Nigeria University Community

Background: The purpose of this study was to determine if some selected skinfold parameters are visible in predicting body density (BD) of undergraduate female students of Obafemi Awolowo University, lie Ife. Methods: Seventy five non- athletic female students, age ranged from 18 to 30 years old from Obafemi Awolowo University (OAU) lie Ife, Nigeria participated in the study. Underwater weight was measured using Hydrostatic Weighing (HSW) equipment and skinfold was measured with Lange skinfold calipers using standard protocol at chest, biceps, triceps, forearm, mid axillar, subscapular, abdomen, supra illiac, thigh and lateral calf. Body density (BD) was calculated with underwater weight and skinfold measurement using some established equations. Descriptive statistics and Pearson Moment Correlation coefficient was used to analyze the data collected. Results: The result showed that BD by HSW had significant negative correlation with skinfold at chest (r = - .505, p < .001), biceps (r = -. 302, p < .05), midaxillar, (r = - .328, p < .05), thigh (r = -.353, p < .05), abdomen (r =- .290, p < .05) and suprailliac (r = -, 371, p< .001). Conclusion: The study concluded that the equation derived from the study is appropriate to determine the BD of Nigerian women. KeyWords: Body density; Skinfold thickness; Hydrostatic and underwater weighing; predictive equations; Nigeri

Seedling growth performance of Entandrophragma angolense (Welw.) C. DC as influenced by different light intensities

The study investigated the influence of light intensities on the early growth performance of Entandrophragma angolense as an important step towards its domestication. Seedlings of E. angolense were monitored under five light intensities namely: under tree canopy (5%), 25%, 50%, 75% light intensities and control treatment was direct sunlight (100% light intensity). The study was conducted in a Completely Randomized Design and for the period of 3 months. The different light intensities did not significantly affect the height, collar diameter, leaf production and biomass accumulation of E. angolense seedlings. Chlorophyll content of leaf was significantly affected by light intensities. The result from this study has shown that E. angolense seedlings can be easily raised in the nursery under different light intensities. The result revealed that height and other growth parameters as well as biomass accumulation do not depend on the amount of light intensities received. Chlorophyll content of leaves of the seedlings however depend on the amount of light intensities received.Keywords: Environmental factors, Propagation, Domestication, Biomass, Chlorophyll, light intensit

Performance of broilers fed enzyme-supplemented tigernut (Cyperus rotundus L.) meal diets

A feeding trial was set up to study the effects of replacing maize with tigernut meal (TGN) at 0, 33.33, 66.67 and 100 per cent levels, with 0.10 per cent enzyme supplementation of all levels, on performance characteristics and carcass yield in broiler chicken for 8 weeks (56 days). A total of 200 Anak-2000 breed of broilers were randomly allotted to four experimental diets such that each treatment had two replicates of 25 birds each. Tigernut meal inclusion at 33.33 per cent (Diet 2) with enzyme supplementation resulted in significant final live weight and carcass yield, while tigernut meal significantly (

Chronic Leg Ulcers in Two Sisters with Sickle Cell Disease

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