Knowledge, attitude and prescription practice of menopausal hormone replacement therapy by doctors in UITH, Ilorin Nigeria

Objective: This study aimed to evaluate the knowledge, attitude and prescription practice of menopausal-HRT (mHRT) by doctors in UITH, Ilorin.Method: All consenting doctors in O&G, Internal Medicine, Family Medicine, Public Health and Interns at the UITH completed a structured questionnaire. SPSS software version 22 was used for analysis. Associations between categorical variables were tested using the chi-square (x2) while the student-t test was used for the continuous variables (p <0.05).Results: Eighty doctors, 56 males and 24 females responded. Majority (63.8%) rated their knowledge of mHRT average; (17.5%) believed they had good knowledge, while (18.7%) had poor knowledge. Gynaecologists had the highest mHRT Knowledge Score (72.4) while public health doctors had the lowest (33.7), (83.7%) had no formal training on the use of mHRT. Fifty-five percent did not think menopause should be treated. Just 25% prescribed mHRT where 58.8% had no reason for not prescribing. Only 18.8% had ever referred menopause patients to specialists. Forty percent use alternative therapies for menopausal symptoms, majorly vitamins and herbs.Conclusion: The knowledge, attitude and prescription practice of the studied doctors was poor. Trainings are still needed in this area.Keywords: Menopause; hormone replacement therapy; doctor

PREDICTIVE FACTORS OF MEDICATION ADHERENCE AMONG HYPERTENSIVE AND DIABETICS PATIENTS IN A NORTH CENTRAL STATE OF NIGERIA

Introduction: Hypertension and diabetes are the two most common non-communicable diseases seen in outpatient clinics in Sub-Saharan Africa. Promoting medication adherence is a major clinical hurdle to be crossed in reducing the premature morbidity and mortality associated with these diseases. This study explored factors that predict medication adherence among hypertensive and diabetic patients in Ilorin, Nigeria. Methods: This cross-sectional study was carried out among hypertensive and diabetic patients in outpatient clinics of a teaching hospital in Ilorin, Nigeria. Data was collected from 1,203 patients using a validated Morisky 8-item medication adherence questionnaire. Multivariate ordinal logistic regression was used to model the medication adherence explanatory factors with SPSS version 22. Result: Less than half (43.3%) of the patients were highly adherent to their medication. The relative proportion for high adherence was 42.7%, 35.6% and 49.2% for hypertension, diabetes and both diseases respectively. The odds of medication adherence improving from either low to medium level or from medium to high level was explained by; age, symptoms count, absence of disease complication and absence of drug side effect among the patients. Blood pressure, gender and disease duration did not explain medication adherence among hypertensive and diabetic patients. Conclusion: It is concluded that the discomfort experienced due to the disease condition and the medication regimen are important explanatory factors for patient’s medication adherence in the study setting. This study recommends strategies to reduce multiple drug combinations and promote medication adherence counselling and education among patients

PATTERN AND EXPLANATORY FACTORS FOR MEDICATION ADHERENCE AMONG PATIENTS WITH HYPERTENSION, DIABETES MELLITUS AND THEIR COMORBIDITY IN A NORTH CENTRAL STATE OF NIGERIA

Introduction: Hypertension and diabetes are the two most common non-communicable diseases seen in outpatient clinics in Sub-Saharan Africa. Promoting medication adherence is a major clinical hurdle to be crossed in reducing the premature morbidity and mortality associated with these diseases. This study explored factors that predict medication adherence among hypertensive and diabetic patients in Ilorin, Nigeria. Methods: This cross-sectional study was carried out among hypertensive and diabetic patients in outpatient clinics of a teaching hospital in Ilorin, Nigeria. Data was collected from 1,203 patients using a validated Morisky 8-item medication adherence questionnaire. Multivariate ordinal logistic regression was used to model the medication adherence explanatory factors with SPSS version 22. Result: Less than half (43.3%) of the patients were highly adherent to their medication. The relative proportion for high adherence was 42.7%, 35.6% and 49.2% for hypertension, diabetes and both diseases respectively. The odds of medication adherence improving from either low to medium level or from medium to high level was explained by; age, symptoms count, absence of disease complication and absence of drug side effect among the patients. Blood pressure, gender and disease duration did not explain medication adherence among hypertensive and diabetic patients. Conclusion: It is concluded that the discomfort experienced due to the disease condition and the medication regimen are important explanatory factors for patient’s medication adherence in the study setting. This study recommends strategies to reduce multiple drug combinations and promote medication adherence counselling and education among patients

Sleep pattern of medical students as seen in a Nigerian university

Background: Results from several studies suggest a global trend of sleep insufficiency among the youths. This study determines the sleep pattern of medical students. Methods: In a cross-sectional study, we used a modified self-administered questionnaire adapted from Pittsburg Sleep Quality Index to determine the sleep pattern of students in College of Health Sciences, University of Ilorin, Nigeria. Responses were submitted anonymously. Results: A total of 399 students participated in the study and their age ranged from 16 - 35 years.Males constituted 64% of survey sample. The mean sleep duration of students were 6.4±0.84 hours during weekdays and 7.4±0.96 hours at weekends (

Correlation of laboratory result and clinical diagnosis of uncomplicated malaria in a specialist health facility in Nigeria: rational or irrational treatment?

Malaria remains a major cause of morbidity and mortality especially among children. While early diagnosis and prompt treatment are crucial to its control, anecdotal evidence has shown that there is increasing overdiagnosis of the illness. This study therefore aims to compare the outcome of laboratory and clinical diagnosis in our patients in order to determine the prevalence of laboratory confirmed malaria. A25% smear positive rate for malaria was obtained amongst a total of 419 patients recruited for the study. The over-diagnosis was more among children where a smear positive rate of 10.3%was obtained compared to 36.9% in adults. It is recommended that a laboratory confirmation must be immediately obtained before any patient is commenced on anti-malaria. Where there are doubts about the laboratory result, such patients who are smear negative should be treated in view of deep cell schizogony and high endemicity of malaria in this environment, while other causes of the symptoms are explored.Keywords: Laboratory results, clinical diagnosis, malari

Views of primary and secondary school teachers of childhood epilepsy and asthma

Epilepsy and asthma are 2 common chronic medical conditions that are seen in school-age children. Both are characterized by paroxysmal attacks that require prolonged medication and regular clinic attendance. Since teacher's attitudes and perception of chronic condi t ions affect s s tudent ' s academic performance and adjustment in the class, this study compares teachers' knowledge and attitude to these ailments. Six hundred sel f -admini s tered standardized questionnaires were given to teachers in public schools (primary and secondary) in Ilorin metropolis, the capital of Kwara State. The response rate was 88%. Respondents were 35% males and 65% females with age range of 20 to 67years (mean of 35.±8.9). All the teachers had been educated for 12years, but there health educational knowledge about epilepsy and asthma appear inadequate. However, responses were more in favor of asthma than epilepsy.About 21% and 4% of teachers associated epilepsy and asthma with insanity respectively. Forty-eight percent of participants indicated that epilepsy was contractible through saliva, compared to 13% that held same opinion of asthma (

Massive bleeding from colonic diverticular disease in an elderly Nigerian: A case report

Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized countries. The disease was thought to be rare in the African population, but is being increasingly diagnosed with the advent of modern imaging techniques and colonoscopy. Diverticular bleeding is a common cause of lower gastrointestinal (GI) haemorrhage and patients typically present with massive and painless rectal haemorrhage. Reports of massive bleeding from colonic diverticular disease are rare in Nigeria. We report a case of massive bleeding from multiple colonic diverticuli in a 70 year old Nigerian male who was admitted due to haematochezia and dizziness and was transfused with 8 units of blood. There was spontaneous resolution of bleeding in spite of the absence of facilities for therapeutic intervention at our institution.Keywords: Colonic diverticular disease, colonoscopy, haematochezia, massive bleeding, gastrointestinal disorder

Prevalence and clinical characteristics of headaches among undergraduate students in three tertiary institutions in Ilorin, Nigeria

Objective: Headache is a common chronic neurologic disorder with huge economic and psychosocial impact. In comparison with other neurological disorders, there is limited data on primary headache, especially from sub‑Saharan Africa. This study was done to fill in the gap and provide recent information on headache among Nigerian undergraduate students.Methodology: Quota sampling was used to select students from three tertiary educational institutions within Ilorin, the capital of Kwara state. Two‑stage self‑administered questionnaires developed from the guideline of the International Society of Headache were used to harvest information.Results: A total of 1500 students participated in the study. The mean age of the students was 20.9 ± 3.1 years, with male:female ratio of 1.6:1. A total of 356 students have frequent headache within previous 1 year, given the headache frequency of 23.7%. Fifty‑three students (3.5%) had headaches on almost daily basis, 84 (5.6%) had ≥4 attacks/week, 145 (9.7%) had ≤2–3 attacks/month, and 123 (8.2%) had 1–3 attacks every 3 months. Close to 75% indicated that it limits their daily activity frequently. One hundred and eighty‑seven (12.5%) students fulfilled the criteria for tension‑type headache, 36 (2.4%) for migraine headache, and 133 (8.9%) had nonclassified headaches. The most frequent headache‑associated symptoms are photophia – 100 students (6.7%), phonophobia – 159 students (10.6%), while 62 students (4.1%) had nausea and vomiting. None of the students had seen a physician for proper headache diagnosis. Majority (90.2%) used none prescription over-the-counter analgesia (acetaminophen) for symptomatic treatment of their aches.Conclusion: Headache is a common complaint among Nigerian undergraduate students and it limits the daily activity of majority of the sufferers. Students need proper education regarding treatment to alleviate their suffering and forestall complication, especially those associated with analgesic overuse.Keywords: Headache, migraine, prevalence, tension‑type headache, undergraduate

Clinical skills training and structured internship orientation of medical interns: enhancing professionalism and quality of medical practice in Nigeria

Fresh medical graduates undergo supervised practical training that ensured theories learnt in the classroom are applied to specific practical professional experiences. Unfortunately many of the newly qualify medical doctors do not get placement years after  graduation and many start the internship positions with little or no knowledge about the goals of the training, organizational structure, decorum, expected roles and responsibilities and expected outcome of the internship.In this study we conducted administrative and clinical skills orientation trainings for freshly recruited medical graduates and evaluated  the effect of the program on medical interns.All seventy four newly recruited medical graduates who were to commence internship training at the University of Ilorin Teaching Hospital were invited for a five days mandatory orientation trainings and clinical skills  simulation at the hospital. Base line and end line administrative and clinical skills acquisition data was collected and analyzed using SPSS version 21.Statistically significant difference was observed in the assessment of familiarization with fundamental principles of medical practice and administrative procedure. Overall Pre test mean score was 12.561±7.4307 while posttest mean score was 17.5614±7.4857 with a gain score of 5.0004 and a p value of 0.0001.The study concluded that most medical interns did not have sufficient knowledge of issues that borders on administration, hospital policies and work standard. Orientation training of medical intern on critical work and professional issues before the commencement of internship training has clearly shown gross improvement in the knowledge base on professionalism, administrative and work related standard. It is strongly recommended that mandatory orientation training be carried out for all intending medical graduates before the commencement of internship.Keywords: Internship Orientation Training Professionalis

Antiseizure effects of ketogenic diet on seizures induced with pentylenetetrazole, 4-aminopyridine and strychnine in wistar rats

The ketogenic diet (KD) is a cheap and effective alternative therapy for most  epilepsy. There are paucity of experimental data in Nigeria on the usefulness of KD in epilepsy models. This is likely to be responsible for the poor clinical acceptability of the diet in the country. This study therefore aimed at providing experimental data on usefulness of KD on seizure models. The study used 64 Wistar rats that were divided into two dietary groups [normal diet (ND) and ketogenic diet (KD)]. Animal in each group were fed for 35days. Medium chain triglyceride ketogenic diet (MCT-KD) was used and it consisted of 15% carbohydrate in normal rat chow long with 5ml sunflower oil (25% (v/w). The normal diet was the usual rat chow. Seizures were induced with one of Pentelyntetrazole (PTZ), 4-Aminopyridine (AP) and Strychnine (STR). Fasting glucose, ketosis level and serum chemistry were determined and seizure parameters recorded. Serum ketosis was significantly higher in MCT-KD-fed rats (12.7 ±2.6) than ND-fed (5.17±0.86) rats [p=0.003]. Fasting blood glucose was higher in ND-fed rats (5.3±0.9mMol/l) than in MCT-KD fed rats  (5.1±0.5mMol/l) with p=0.9. Seizure latency was significantly prolonged in ND-fed compared with MCT-KD fed rats after PTZ-induced seizures (61±9sec vs  570±34sec) and AP-induced seizures (49±11sec vs 483±41sec) p<0.05. The difference after Str-induced seizure (51±7 vs 62±8 sec) was not significant (p>0.05). The differences in seizure duration between ND-fed and MCT-KD fed rats with PTZ (4296±77sec vs 366±46sec) and with AP (5238±102sec vs  480±67sec) were significant (p<0.05), but not with STR (3841±94sec vs 3510±89sec) [p>0.05] respectively. The mean serum Na+ was significantly higher in MCT-KD fed (141.7±2.1mMol/l) than ND-fed rats (137±2.3mMol/l) with p<0.05. There was no significant difference in mean values of other serum electrolytes between the MCT-KD fed and ND-fed animals. MCT-KD caused increase resistance to PTZ-and AP-induced seizures, but has no effect on STR-induced seizures. This antiseizure property is probably mediated through GABAergic receptors (PTZ effect) and blockade of membrane bound KATP channels (AP effect) with some  enhancement by serum ketosis.Keywords: Ketogenic diet, Antiseizure, Pentylenetetrazole, Amino-Pyridine, Strychnin