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   2017| January-June  | Volume 17 | Issue 1  
    Online since November 26, 2019

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Challenges accessing kidney transplantation in Lagos,Nigeria
CO Amira, AA Busari, BT Bello
January-June 2017, 17(1):20-24
Background: Kidney transplantation (KT) is the best form of treatment for end-stage renal disease (ESRD); however, worldwide, there are potential barriers along the pathway to transplantation. Objective: The aim of this study was to identify the major impediments to KT programme in Lagos, Nigeria. Materials and Methods: This was a cross-sectional, descriptive study of patients with ESRD who have been on regular dialysis for at least 3 months at the Lagos University Teaching Hospital from January 2012 to December 2014. Using pretested questionnaire, relevant clinical and demographic information was obtained including the challenges faced with access to kidney transplant programme. Results: Fifty-seven patients were recruited, of which 30 (52.6%) were male, with a mean age of 40.6 ± 12.8 years. The common aetiologies of ESRD were hypertension (40.4%) and chronic glomerulonephritis (26.3%). The mean duration on dialysis was 8.7 ± 5.84 months (range, 3–28 months). The greatest challenges were lack of donors and lack of funds in 38.5% concurrently, whereas 25% said that they had donors but lack the funds, 5.8% had funds but no donor and 7.7% said that they were not psychologically prepared for kidney transplant at the time of the study. Conclusion: The greatest challenge to KT in Nigeria was scarcity of both donors and funds. Government and health insurance agencies should incorporate renal replacement therapy into their policies. The donor pool could be expanded through establishment of deceased-donor transplant programme in Nigeria.
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Infertility treatment financing in Nigeria
EA Adewumi
January-June 2017, 17(1):38-42
Background: In Nigeria, infertility treatment using assisted reproductive technology (ART) is perceived as an inconsequential health issue not demanding any public health intervention. ART is largely carried out by private health-care providers in city centres at an unaffordable cost. Objective: The objective is to determine ways to reduce the cost of in vitro fertilisation (IVF) to increase access to treatment. Materials and Methods: Google, Google Scholar and PubMed searches identified scholarly papers published between 1997 and 2013. The keywords used were combinations of ART, infertility treatment in developing countries, family planning and infertility, increasing ART success rate, male factor in infertility, fertility care financing, health insurance and cost of fertility treatment. Results: Infertility is not perceived as a disease the way malaria or typhoid is treated as such by most Nigerian men, and ART is expensive. Most African culture blame infertility on women who have restricted financial access. The current focus of family planning is female gender centric and favours contraception alone. The Nigerian National Health Insurance Scheme (NHIS) has excluded any ART treatment completely. Conclusion: The high cost of IVF is the greatest barrier to ART access both in the developed and underdeveloped world. This is also the most critical factor in accessing IVF care worldwide. This financial barrier is worse in low-resource settings like Nigeria. Low-cost technological innovation is still far from the country. Recommendations: Renewed advocacy with focus on men to understand that infertility is a disease deserving of utmost attention. Increase in the number of public-funded fertility clinics and partial inclusion of IVF into the Nigerian National Health Insurance Scheme (NHIS) needs to be implemented to bring down cost. Other innovations such as public–private partnerships, where financial institutions like banks can finance IVF treatment by giving loans whose repayment is spread over time to make it convenient, should also be considered.
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Health-seeking behaviour for infants by caregivers in a semi-urban area of Lagos State, Nigeria
AJ Owoyemi, TW Ladi-Akinyemi
January-June 2017, 17(1):14-19
Background and Objective: Nigeria was unable to meet the Millennium Development Goal target for child mortality. Progress has been hampered by a host of factors which include poor maternal response to childhood illness and inappropriate health-seeking behaviours. This study was done to assess the health-seeking behaviours for infants by caregivers in Orile Agege Area. Materials and Methods: A community-based, descriptive, cross-sectional study using an interviewer-administered questionnaire was done among the caregivers of infants in Orile Agege Local Council Development Area. Three hundred and two caregivers were recruited using a multistaged sampling method. Analysis was done using SPSS. T-test and Chi-square were used to test for association among variables. Results: About half of the caregivers who said their infants had been sick in the study took the child for treatment within 24 h of the onset of the illness, most (40%) of them sought treatment from a health facility. The barriers to seeking healthcare at health facility that was mostly mentioned in this study were financial constraints (15.1%) and poor service (5.7%). Conclusion: Most of the caregivers in the area sought treatment outside the home for their infants when they were sick and they mostly patronised health facilities and health workers. About half of the respondents promptly sought healthcare for their infants in the case of their illness.
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Prevalence, risk factors and foetomaternal outcomes associated with pre-eclampsia among pregnant women in Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
AE Olowokere, RO Olofinbiyi, AO Olajubu, BA Olofinbiyi
January-June 2017, 17(1):7-13
Background: Pre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality globally. There is a paucity of data regarding pre-eclampsia and associated risk factors in Ekiti State, Nigeria. Objective: The aim was to assess the prevalence of pre-eclampsia, the associated risk factors and foetomaternal outcomes among women who delivered in the Teaching Hospital in Ekiti State. Materials and Methods: Case notes of women who delivered in the hospital between 1st January, 2010, and 31st December, 2014, were retrospectively reviewed and relevant data extracted and entered into a standardised pro forma. Data were analysed using descriptive and inferential statistics in the Statistical Package for the Social Sciences for Windows version 20. Relationships between variables were determined using Pearson correlation while Student t-test was used to assess differences between two means. The level of statistical significance was set at P< 0.05. Results: One hundred and forty-six (1.9%) of the 7709 women who delivered in the hospital during the 5-year period developed pre-eclampsia. One hundred and twenty (86.3%) of the 146 case notes were available for analysis. The mean age of respondents was 30 (5.2) years. There was a weak but significant correlation between parity and systolic blood pressure (BP) (r = 0.20, P = 0.02). A higher mean systolic and diastolic BP was recorded among unbooked women compared with booked women. The study showed that unbooked women had statistically significantly higher mean systolic (t = 2.69, P = 0.01) and diastolic (t = 3.03, P = 0.01) BP. The most common foetomaternal morbidities were birth asphyxia in 25 (19.8%), eclampsia in 23 (18.3%) and post-partum haemorrhage in 5 (3.9%). The maternal and foetal mortality were rates of 3.2% and 4.8%, respectively. Conclusion: Pre-eclampsia was a major contributor to maternal and perinatal morbidity and mortality in Ekiti State. Interventions to address pre-eclampsia should focus on early booking and prompt identification of women at risk for appropriate management and support.
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Exercise-induced bronchospasm in Ilesa, Nigeria: A Comparative study of rural and urban school children
BP Kuti, KO Omole, DK Kuti, BI Oso, LO Mohammed, BG Ologun, YA Minna
January-June 2017, 17(1):25-34
Background: Exercise-induced bronchospasm (EIB) described as transient airway narrowing shortly after or during exercise is an important tool in epidemiological study of childhood asthma which has been increasing in prevalence globally. This study sets out to determine the prevalence of EIB in poor rural and affluent urban school children in Ilesa, South West Nigeria. Methods: School children in four secondary schools (two rural and two urban) in Ilesa were selected using multistage sampling. Their sociodemographic characteristics and history of wheeze/asthma were noted. The children had their forced expiratory volume in 1 s (FEV1) measured before, 5, 10 and 15 min after 6 min of free running exercise to achieve 80% of their maximal pulse rate. EIB was calculated as the change in FEV1pre- and post-exercise expressed as a percentage of the pre-exercise value ≥10%. The prevalence of EIB among the children as well as factors associated with it were determined. Results: A total of 230 children (129 rural and 101 urban) aged 9–17 years participated in the study over a 9 month period. Mean (standard deviation [SD]) age was 12.6 (1.9) years and Male:Female 1:1.1. Past history of wheeze in the children was obtained from 14 (13.9%) versus 2 (1.6%) of the urban and rural children, respectively. The mean (SD) FEV1% for the urban and rural children was 85.5 (18.5)% versus 78.5 (15.5)%, respectively. The prevalence of EIB was significantly higher among the urban children at 23.8%, 19.8% and 14.9% versus 8.5%, 5.4% and 3.1% for 5, 10 and 15 min post-exercise, respectively. History of wheezing in the past 12 months was the only factor significantly associated with EIB among the urban children. Conclusion: The prevalence of EIB is significantly higher among urban school children observed in about one in every five children. We recommend exercise testing as part of routine pre-entry school evaluation to Nigerian children in urban centers.
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Management of bulbar urethral strictures by direct vision internal urethrotomy: Experience from a Nigerian teaching hospital
AA Salako, TA Badmus, RA David, OJ Isola, A Laoye, IA Akinbola, MC Igbokwe, RN Babalola, CI Onyeze
January-June 2017, 17(1):35-37
Background: Urethral stricture is a common cause of bladder outflow obstruction, and its management contributes significantly to the workload in urologic practice. Aim(s): To evaluate the role of direct vision internal urethrotomy (DVIU) in the management of bulbar urethral strictures. Methods: A retrospective review done at a University Teaching Hospital in Nigeria. Patients who had DVIU for the management of bulbar urethral strictures between July 2008 and June 2015 were studied. Information extracted and analysed were the patients' age, stricture characteristics, DVIU technique, outcome and complications. Statistical Package for Social Sciences version 20 was used for data analysis. Results: A total of 63 patients had DVIU for bulbar urethral strictures during the period, of which 48 patients (76.2%) were studied. Their ages ranged between 32 and 70 years (mean 49 years). They all had solitary, short-segment, incomplete, bulbar urethral strictures confirmed pre-operatively by retrograde urethrogram. In addition, 36 (75%) also had urethrosonography which confirmed superficial spongiofibrosis. In 28 cases (58%), stricture aetiology was post-inflammatory, while in 12 (25%) and 8 (17%) patients, strictures were due to iatrogenic reasons (post-catheterisation) and straddle injuries, respectively. The DVIU was done by the same group of surgeons. Success rate was 66.7% after first DVIU and increased to 75.0% after a second DVIU was done for those with unsatisfactory outcome after first surgery. Mean follow-up period was 15 months. Conclusion: In well-selected patients, DVIU is an option for successful treatment of bulbar urethral strictures.
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Progressive histomorphometric analysis of the lateral ventricle and cerebral cortex of Wistar rats following kaolin-induced hydrocephalus
OA Ayannuga
January-June 2017, 17(1):2-6
Context: Hydrocephalus results in ventriculomegaly following excess production and/or impaired drainage of cerebrospinal fluid. The lateral ventricle (LV) is surrounded by critical structures such as hippocampus and thalamus; its enlargement will adversely impact surrounding brain structures including the cerebral cortex. Aims: This study aims to evaluate the morphometry of cerebral cortex and LV in hydrocephalus over 4 weeks. Settings and Design: Fifty-one 3-week-old rats were divided into Groups A (experimental = 6; control = 5), B (experimental = 8; control = 6), C (experimental = 8; control = 6) and D (experimental = 6; control = 6), sacrificed at the end of 1, 2, 3 and 4 weeks, respectively. Materials and Methods: Experimental rats were induced by injection of 0.04 ml of 200 mg/ml kaolin suspension into the cisterna magnum under ketamine (90 mg/kbw) and diazepam (12.5 mg/kbw) anaesthesia. Rats were sacrificed by cervical dislocation and brain fixed in 10% formal saline. Brain slices at the level of the optic chiasma were processed and stained with haematoxylin and eosin. Statistical Analysis Used: One-way ANOVA and Student–Newman–Keuls test. Results: In experimental rats, lethargy, poor feeding, globular head and exophthalmos were noted. The LV width and the LV/cortical thickness (CT) ratio were significantly increased from the 1st to the 4th post-induction week (P < 0.0001 across the weeks). CT was significantly reduced from the 2nd to 4th week (P < 0.0001 across the weeks). The subcortical white matter (SWM)/CT ratio was significantly reduced from 1st to 3rd week (P < 0.0001 across the weeks), but increased in the 4th week (P = 0.0003). Thinning/detachment of the choroid plexus was noted from the 3rd to the 4th week. Conclusions: White matter/cortical thinning and ventriculomegaly are acute-phase features, although cortical thinning lags behind others. Detachment of the choroid plexus and reversal of SWM thinning are features of chronicity.
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Editorial for Nigerian Journal of Health Sciences: January–June 2017 issue
FA Arogundade
January-June 2017, 17(1):1-1
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