Nigerian Medical Journal <p>The Nigerian Medical journal publishes scientific reports to advance medical and health science in all areas.</p> Nigerian Medical Association en-US Nigerian Medical Journal 0300-1652 <p>This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.</p> A Review of Post Neonatal Paediatric Admission Pattern and Outcome in a Public Tertiary Health Facility in Nigeria <p><strong>Background</strong>: Admissions over the years have been largely due to preventable aetiologies and the possible outcomes are discharge, death, referral or discharge against medical advice. This study aimed to understand the patterns of postneonatal paediatric admissions and outcomes from a public tertiary health facility in South-West Nigeria.</p> <p><strong>Methodology</strong>: A descriptive retrospective study of paediatric admissions over a 2-year period. Information concerning age, sex, diagnosis and outcome were extracted from patients’ medical records. Data was presented in numbers and percentages; Chi-square was used to compare groups and a p-value of &lt;0.05 was accepted as significant.</p> <p><strong>Results</strong>: There was a total of 875 admissions, over the 24 months period, with a male-female ratio of 1.3:1. Malaria, sepsis, sickle cell crises, pneumonia, pharyngotonsilitis and acute watery diarrhoea constituted the six leading causes of all admissions. The mortality rate for all admissions was 5.0% while the under-five mortality rate was 3.9%. Seven hundred and ninety-nine (91.3%) of the admitted patients were discharged, 44 (5.0%) died, 30 (3.4%) DAMA and two (0.3%) patients were referred.</p> <p><strong>Conclusions</strong>: A large percentage of children still die from preventable and treatable diseases. Prompt health-seeking behaviour, enrollment of more citizens in insurance schemes, and adoption of the newly developed malaria vaccine will help reduce child mortality. Also, early referral of patients by private hospitals should be encouraged and paediatricians to have a high index of suspicion for the diagnosis of septicaemia.</p> Ebenezer Adeyemi Ayomide Oladele Samuel Ajigbotosho Adeline Adaje Olufunke Bolaji Olubunmi Lawal Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 604 611 Comparative Study of Extrapyramidal Side Effects, Sexual Dysfunctions and Hyperprolactinaemia Using Typical and Atypical Antipsychotic Medications Among Patients with Schizophrenia in Maidugri <p><strong>Background</strong>: Extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia are major side effects with the use of antipsychotic medications that impede treatment adherence leading to relapse, increased cost of care and rehospitalization among patients with schizophrenia on antipsychotic medications. The study aims to compare the prevalence of extra-pyramidal side effects (EPSE), sexual dysfunctions (SD) and hyperprolactinaemia (HPRL) among patients with schizophrenia spectrum disorders on typical and atypical antipsychotic medications. The secondary aim is to determine if any associations exist between extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia.</p> <p><strong>Methodology:</strong> A cross-sectional hospital-based survey involving 209 patients with schizophrenia were interviewed with structured instruments for the assessment of sexual dysfunction, EPSE and the estimation of serum prolactin was done using Enzyme-linked Immunosorbent Assay. Frequencies and Chi-square analysis were used to compare differences in EPSE, SD &amp; HPRL.</p> <p><strong>Result:</strong> The study revealed non-statistically significant differences as a group between typical and atypical antipsychotic medication in terms of extra-pyramidal side effects, sexual dysfunction and hyperprolactinaemia. However, a significant association was observed when individual drugs were compared with haloperidol causing the highest frequency of hyperprolactinaemia (<em>χ</em><sup>2</sup> = 14.9, <em>P</em> = 0.011). A significant relationship between sexual dysfunction and hyperprolactinaemia, sexual dysfunction and extra-pyramidal side effects as well as extra-pyramidal and hyperprolactinaemia was found when individual items for sexual functionin were used.</p> <p><strong>Conclusion:</strong> The significant relationships between sexual dysfunction only in the domains of sexual desire and arousal with hyperprolactinaemia and extrapyramidal side effects as well as hyperprolactinaemia with extrapyramidal side effects point to a common anti-dopaminergic activity of antipsychotics via different pathways. Prospective studies among a larger sample of patients with schizophrenia are needed to unfold these relationships.</p> Falmata Baba Shettima Musa Abba Wakil Taiwo Lateef Sheikh Isa Bukar Rabbebe Mohammed Abdulaziz Said Jidda Asma’u Mohammed Chibado Dahiru Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 612 626 Incidence of Pregnancy-Related Acute Kidney Injury in a Low Resource Setting: A Prospective Study <p><strong>Background:</strong> Pregnancy-related acute kidney injury (PRAKI) is a common cause of AKI globally. The incidence and burden of PRAKI are still high in low and middle-income countries (LMICs) especially in Africa due to limited access to optimal obstetric care, late diagnosis, and referral. The study aimed to determine the incidence and aetiologies of PRAKI among women in the peripartum period in two government hospitals in Nigeria.</p> <p><strong>Methodology:</strong> This was a prospective study where serum creatinine was measured among pregnant women presenting in labour at 0 hours, 6 hours, 12 hours, 24 hours, 48hour and 7 days post-delivery. AKI was defined using the Kidney Disease Improving Global Outcome criteria. Binary logistic regression was used to determine predictors of PRAKI.</p> <p><strong>Results:</strong> The mean age of the 162 pregnant women who completed the study was 30.05±1.28 years. The incidence of AKI use was 22.2%. The aetiologies of PRAKI were obstetric haemorrhage (66.7%), eclampsia (19.4%), and sepsis (13.9%). Seventeen (47.2%) patients had Stage 1 PRAKI, 12 (33.3%) had Stage 2 PRAKI, while seven (19.4%) had Stage 3 PRAKI. Factors significantly associated with PRAKI were parity (p=&lt;0.001), caesarean section (p=&lt;0.001), excess blood loss (p=&lt;0.001), and prolonged duration of labour (p=0.002).</p> <p><strong>Conclusion:</strong> PRAKI occurred in 1 out 5 pregnant women in the peripartum period. Obstetric haemorrhage, sepsis, and eclampsia which are preventable or treatable are common major aetiologies of PRAKI. PRAKI is more associated with multi-parity, caesarean delivery, haemorrhage, and prolonged duration of labour. Optimal ante-natal care, health education, and prompt diagnosis and management of obstetric complications will reduce the incidence in Nigeria.</p> Ejiro Praise Orhewere Ogochukwu Chinedum Okoye Oluseyi Ademola Adejumo Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 627 636 Utilization of Delivery Services Among Mothers in Aluu Community, Ikwere Local Government Area, Rivers State. <p><strong>Background: </strong>Utilization of delivery services is paramount to achieving a safe delivery outcome and preventing maternal mortality/morbidity among mothers. In semi-urban communities, delivery services are provided by both health and non-health facilities and are influenced by either socio-demographic or economic factors. This study aims to evaluate the utilization of delivery services across various places that provide such care and to identify the factors that influence the utilization of delivery services in the Aluu community.</p> <p><strong>Methodology: </strong>A community-based cross-sectional study was conducted in 5 out of 9 villages in the Aluu community. A total of 415 respondents were recruited for the study. The study was carried out between April 2021 and October 2021. A multistage sampling method was used, and data was collected using an interviewer-administered structured questionnaire. The data was analyzed using SPSS version 25. The Chi-square test was used for inferential analysis and a significant level was set at p≤ 0.05 at 95% confidence interval.</p> <p><strong>Results:</strong><strong> </strong>Out of 415 respondents, 44.03% were delivered in a healthcare facility while 55.97% were delivered in a non-health care facility. tribe, religion, educational status, occupation, and Obstetrics and gynecological factors were found to influence the utilization of delivery services.</p> <p><strong>Conclusion:</strong> More than half of women utilized delivery services provided by non-health facilities and there was a significant relationship between tribe, religion, educational status, occupation, and Obstetrics and gynecological factors and the utilization of delivery services in the Aluu community.</p> Jane Uju Onotai Ibidabo Alabere Lucky Obukowho Onotai Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 637 652 Gender Perspective in the Workplace: The Experience of Women Medical Doctors. <p><strong>Background:</strong> Women are a considerable part of the population and contribute to every facet of life with significant participation in all professions, however, despite such advancements by women, there is still a gender bias in all walks of life including the medical field. This study aimed to evaluate the opportunities, challenges, and job satisfaction of women doctors in the workplace.</p> <p><strong>Methodology:</strong> This was a descriptive, cross-sectional study conducted among 165 women medical doctors living in Rivers State, Nigeria. Data was collected using a structured, self-administered questionnaire and results have been reported as frequencies and percentages for categorical variables.</p> <p><strong>Results:</strong> Of the 165 women recruited, 62(37.6%) were working as resident doctors, 43(26.1%) were medical officers and 42(25.5%) consultants. Only 85(51.5%) women reported global satisfaction in their workplace while 69(41.8%) admitted to career satisfaction. Most of the respondents agree that their career has limited the time available to spend with their family (74.5%) and their friends (78.2%) outside their working environment. The greatest challenges perceived at work include poor work-life balance in 123(74.5%) and lack of career advancement opportunities in 46(27.9%) respondents. While 112 women doctors (67.9%) had experienced insubordination from a junior male colleague in the workplace, 75(45.5%) had experienced some form of physical violence in the workplace (from staff or patients). One hundred and twenty women (72.7%) had experienced some sort of sexual harassment from both their male colleagues and male patients in the workplace, with 11(6.7%) reporting frequent sexual harassment from their male colleagues. </p> <p><strong>Conclusion:</strong> Gender disparities and bias do exist in the medical field and should be discouraged at every level. When there is a positive organizational culture and supportive environment at work, women medical professionals can offer excellent medical care and break both clinical and academic glass ceilings.</p> Linda Iroegbu-Emeruem Boma Oyan Sarah Abere Ureh Oparaodu Uchenna Felicitas Okeke Bertha Chris-Biriowu Bukola Gift Adu Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 653 660 Insecticide Treated Net Usage and Its Predictors among HIV Patients Attending an Antiretroviral Therapy Clinic in Ebonyi State, Nigeria <p><strong>Background:</strong> Malaria prevention is important among HIV patients to mitigate its associated complications. This study explored the predictors of insecticide-treated net (ITN) usage among HIV patients attending an antiretroviral therapy (ART) clinic in Ebonyi state, Nigeria.</p> <p><strong>Methodology:</strong> It was a cross-sectional study that involved 297 patients who attended an ART clinic in Ebonyi State. An interviewer-administered questionnaire was used to collect relevant data, including perception of malaria prevention, ownership of ITN, condition of ITN, duration of use, and ITN usage. The relationship between ITN usage and other variables was assessed using bivariate analysis and the predictors were determined using multivariate logistic regression.</p> <p><strong>Results:</strong> There were 64 (21.5%) males and 233(78.5%) females. Knowledge of the use of ITN (mean= 4.24 ±0.93) was rated better than knowledge of the use of mosquito repellent (mean = 3.79 ± 1.21) and knowledge of the use of protective clothes (mean= 3.86 ±1.26). 246 (83%) of the study population owned ITN. Only 48% (118) of those with ITNs reported optimal nets (nets without holes). 135 (45.5%) participants reported sleeping under the net every day in the past week. There was a significant relationship between ITN usage and knowledge of the use of ITN, ownership of ITN, duration of use and condition of nets. Predictors of usage of ITN were duration of use (AOR=0.386, 95%C.I for AOR=0.224-0.665) and condition of the nets (AOR=0.399, 95%C.I for AOR=0.226-0.706).</p> <p><strong>Conclusion:</strong> Perception of malaria prevention was high among the study group. Ownership of ITN was high although many of the ITNs were not in good condition. Usage of ITN was largely determined by duration of use and good condition of nets. Yearly assessment of the condition of ITNs and replacement exercise of ITNs (2-3 years) at ART clinics to replace old and worn-out nets among HIV patients are recommended.</p> Olaronke Afolabi Chukwuemeka Okorie Eze Collins Nwachi Ugwu Nneneya Anthony Ajayi Daniel Ogbonna Aja Chigozie Jesse Uneke Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 661 670 Comparative Study Between Hysterosalpingo-Contrast Sonography and Hysterosalpingography in Evaluating Tubal Patency at Aminu Kano Teaching Hospital, Kano. <p><strong>Background: </strong>Tubal diseases contribute significantly to secondary infertility, affecting 25-35% of couples seeking infertility treatment. Traditional methods for assessing tubal patency, such as laparoscopy and dye tests, are invasive, costly, and require specialized expertise. Hysterosalpingography (HSG) is an alternative, but it involves pain and radiation exposure. This study aimed to compare the effectiveness of Hysterosalpingocontrast Sonography (HyCoSy) using a saline and air mixture to HSG in assessing tubal patency in infertility patients at Aminu Kano Teaching Hospital.</p> <p><strong>Methodology: </strong>A cross-sectional study involved 50 consenting patients seeking fertility evaluation. The researchers used a semi-structured questionnaire to gather demographic information. HyCoSy with the saline and air mixture was performed between the 5th and 10th day of the menstrual cycle, followed by HSG within the next five days. The patency of each fallopian tube was assessed, and pain levels experienced during both procedures were recorded using a numerical rating scale.</p> <p><strong>Results:</strong> The results indicated that 68.8% of patients had bilateral patent tubes according to HyCoSy, while 60.4% were found to have patent tubes with HSG. A comparison of findings for individual tubes showed an 89.6% concordance rate between the two tests, with a Kappa index of 0.73, indicating substantial agreement. Importantly, patients reported significantly less pain during the HyCoSy procedure (mean NRS score of 4.1) compared to HSG (mean NRS score of 7.1).</p> <p><strong>Conclusion: </strong>This study demonstrated that HyCoSy using a saline and air mixture is highly comparable to HSG in assessing tubal patency. Notably, HyCoSy was preferred by patients due to its reduced pain and better tolerance, with minimal adverse effects. This suggests that HyCoSy may be a more patient-friendly and cost-effective alternative for tubal assessment in cases of infertility.</p> Ibrahim Danladi Muhammad Umar Suleiman Sabo Sa'idu Adamu Ibrahim Aliyu Dayyabu Labaran Idris Usman Takai Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 671 679 An Assessment of Enrollees’ Knowledge and Satisfaction with Delta State Contributory Health Scheme: A Cross- Sectional Survey of Civil Servants in Delta State, Nigeria <p><strong>Background:</strong> Delta State Contributory Health Scheme (DSCHS) was established to provide quality and affordable healthcare services to all Deltans, irrespective of socioeconomic status and geographical location. This study assessed the knowledge and satisfaction of formal sector enrollees with the Delta State Contributory Health scheme.</p> <p><strong>Methodology:</strong> This was a cross-sectional descriptive study involving 400 public/civil servants enrolled in DSCHS using a multistage sampling technique. Data was collected using an interviewer-administered structured questionnaire and was analyzed using IBM SPSS version 25.0 software.</p> <p><strong>Results: </strong>The study revealed that 207 (51.7%) of the respondents were males, while 193 (48.3%) were females. Two hundred and five (51.2%) of the respondents were within the age group of 43 – 52 years, and 353 (88.2%) of the respondents had tertiary education. Overall, 296 (74.0%) of the respondents had good knowledge, and 104 (26.0%) had poor knowledge of DSCHS; while 138 (52.1%) of the respondents were unsatisfied with DSCHS and 127 (47.9%) were satisfied with the scheme. Age (X<sup>2 </sup>= 19.67; P&lt;0.001), gender (X<sup>2 </sup>= 8.53; P=0.004), education (X<sup>2 </sup>= 20.52; P&lt;0.001), marital status (X<sup>2 </sup>= 14.13; P=0.001), religion (X<sup>2 </sup>= 13.12; P=0.001) and years of working experience (X<sup>2 </sup>= 39.66; P&lt;0.001) was significantly associated with knowledge of DSCHS. The factors significantly associated with satisfaction with DSCHS were ethnicity (X<sup>2 </sup>= 14.39; P=0.013) and years of working experience (X<sup>2 </sup>= 11.23; P=0.024).</p> <p><strong>Conclusion: </strong>The majority of the study participants had good knowledge regarding DSCHS but were unsatisfied with the level of services provided by the scheme. It is therefore recommended that Delta State Contributory Health Commission should review its benefits package and urgently scale up services to improve enrollees' satisfaction with the scheme.</p> Emmanuel Nonyelum Onyebadi Ibobo Mike Enemuwe Nyemike Simeon Awunor Patrick Oyibo Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 680 691 Diagnostic Accuracy of Plasma Cystatin C and Renal Resistive Index for Acute Kidney Injury in Critically Ill Patients: A Prospective Observational Study. <p><strong>Background</strong>: Acute kidney injury (AKI) is a quite common problem in critically ill patients. Serum cystatin C has emerged as a marker of AKI. This study aimed to evaluate the diagnostic ability of serum Cystatin-C and Renal Resistive Index in predicting AKI among critically ill patients.</p> <p><strong>Methodology</strong>: This prospective observational study was carried out in the Department of Medicine, over one year. After informed consent and ethical clearance, a total of 120 critically ill patients suffering from sepsis were enrolled, out of which 70 patients developed AKI while 50 did not develop AKI during treatment in the Intensive care unit (ICU). Serum cystatin C was measured on day 1 by particle-enhanced immune nephelometric assay, Renal resistive index (RRI) was calculated by the ratio of the velocities of arterial perfusion throughout the cardiac phase, and glomerular filtration rate was measured on day 1, 3, and 7 respectively.</p> <p><strong>Results:</strong> S. cystatin C value was significantly higher(&gt; 3 times) in AKI patients (14.07±4.8 mcg/ml) as compared to those who did not develop AKI (4.28±3.27 mcg/ml) (p 0.001). After ROC analysis it was found that day 1, S. cystatin C, at cut off value of ≥9.29 mcg/ml had diagnostic accuracy 90% with sensitivity 91%, specificity89%, and PPV of 95.5%. While RRI value on day 7, at a cut-off value of ≥0.72, had a diagnostic accuracy of 98%, sensitivity (98.6%), and specificity (96.7%) for AKI with 98.6% PPV, and 96.7% NPV.</p> <p><strong>Conclusion:</strong> Serum cystatin C appears to be a promising biomarker for early diagnosis of AKI in critically ill patients. Whereas RRI although non-invasive had good diagnostic accuracy it diagnosed AKI after a few days thus diagnosis of kidney injury was delayed.</p> Munna Lal Patel Himanshu Mishra Rekha Sachan Vipin Kumar Singh Radhey Shyam Gangwar Wahid Ali Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 692 703 Active Euthanasia for Perinatal Osteogenesis Imperfecta; An Ethical Dilemma in a Tertiary Facility in Southwestern Nigeria: A Case Report <p>Managing a newborn with lethal congenital anomalies is challenging but handling a parent’s request for doctors under oath to terminate the baby’s life is another major ethical dilemma requiring cautious evaluation. We present a term male neonate who presented on the 7<sup>th</sup> day of life, with a dark-blue sclera, multiple limb deformities, long bone fractures, beaded ribs, a flattened forehead, a narrow chest, and respiratory distress. A Diagnosis of Type II Osteogenesis imperfecta was made and he was managed by a multidisciplinary team including neonatologists, geneticists/endocrinologists, orthopaedic surgeons, nurses, and medical social workers. Supplemental oxygen, intravenous fluids and antibiotics, analgesia, and bisphosphonates were offered as supportive care. The main concern was the challenges of managing a newborn with lethal OI and balancing the demand for euthanasia by the parents to end the baby’s misery. In providing care, the rights of the child to life, the morals of the physician, the best interests of the baby, and the family's role in decision-making in a setting of out-of-pocket expenditures must be weighed. Following extensive multidisciplinary team meetings, it was ultimately decided to allow nature to take her course. Baby subsequently had progressive respiratory distress from pulmonary hypoplasia and died of respiratory failure on the twelfth day of life. In Conclusion, Osteogenesis imperfecta of the perinatal type is usually a lethal disease, with death often occurring within the perinatal period. The physician must, therefore, balance the parental rights, the oath of office, and the existing legal framework to avoid charges of murder or manslaughter.</p> Michael Abel Alao James Sobande Oluseye Ayodeji Matthew Borokinni Ellen Akindolire Abimbola Adejumoke Idowu Ayede Olukemi Oluwatoyin Tongo Copyright (c) 2023 Nigerian Medical Journal 2023-12-28 2023-12-28 64 5 704 711