The effects of National Health Insurance Scheme on equity and quality of diabetes care in secondary healthcare facilities in SouthWest Nigeria

There have been concerns about the influence of the National Health Insurance Scheme (NHIS) on equity and quality of diabetes care in many healthcare settings. This study aimed to assess the effects of NHIS onequity and quality of diabetes care (DC) in Nigeria. A prospective cross-sectional study was carried out among 110 (insured n=42, uninsured=68) consenting type 2-diabetics. Diabetic outpatients on oral hypoglycemic drugs, with at least 4 clinic visits prior to the time of the study were consecutively selected at two NHIS accredited public hospitals in Southwest, Nigeria. Patients’ perceptions of equity and quality of DC were assessed using a validated 27 items questionnaire. The medical care and pharmaceutical care in diabetes were independently assessed using medical chart review and a direct observation of dispensing pharmacists’ activities respectively. Chi-squared test was used to determine associations between variables. Majority (61.8%) of the study participants were uninsured. Females (50.9%) were more than the males (49.1%), 40.0% had post-secondary qualifications. The mean ages for the insured and uninsured were 52.02±11.6 and 58.97± 9.3years respectively. The insured and the uninsured differ in their perceptions of drug availability (p<0.001). The pharmacists’ counselling time (p<0.001) differs between the groups. The quality of medical care provided to the diabetics was generally low. The NHIS did not influence the quality of DC, though it may have engendered inequity in pharmaceutical care in the facilities.Journal of Medical and Biomedical Sciences (2018) 7(1), 11 - 21

Prevalence, patterns and predictors of self-medication with anti-malarial drugs among Cameroonian mothers during a recent illness episode

Artemisinin-based combination therapies (ACTs) are recommended as treatment of choice for malaria. Although the resistance to artemisinin and its derivatives has not yet been officially reported in Africa, there is growing concern that it may reach the continent. Self-medication is common among African populations and may explained drug resistance. Unfortunately, a few studies have addressed this issue in Cameroon. This study seeks to appraise the prevalence, patterns and predictors of antimalarial self-medication. A household-based cross-sectional study was conducted in 2016 in the town of Douala. Interviews and pretested semi-structured questionnaires were administered for collecting information from 213 mothers of under-fives. The prevalence of self-medication was 49.30%. The main reasons were “habit” (38.75%), “Lack of money” (22.48%) and “Lightness of symptoms” (13.18 %). Pharmacy (47.80%) and street medicine stores (30.19%) were the commonest drug providers. Nearly 20% of women had not respected posology although treatment was right and taken promptly. Age, level of education and curiosity on treatment were risk factors of self-medication. Our study confirms that malaria self-medication is common among women and the influence of some factors. Hence, strategies for information, education and communication should be scaled up to efficiently address self-medication in the area.Journal of Medical and Biomedical Sciences (2018) 7(1), 29 - 39

Role of cathepsins in Alzheimer's disease: A systematic review

Alzheimer's disease (AD) is a multifactorial disease. In addition to the precipitating of two proteins betaamyloid peptide and neurofebrillary tangles, which are the main mechanisms involved in the pathogenesis ofAD, other factors such as inflammatory mechanisms and changes in lysosomal enzymes play an important part in the pathogenesis of this disease. Increased and decreased lysosomal proteases, such as cathepsin, can lead to functional impairment and gradual death of neurons. The aim of this review was to investigate the role of cathepsins in the pathogenesis of AD. To conduct this review, relevant articles published between 2000 and 2016, and indexed in reliable databases including PubMed, Google Scholar, Scopus and Web of Science were retrieved. After reviewing the articles, 30 articles that directly addressed the subject of this review were included in final analysis. Cathepsins exacerbate intracellular conditions in neurons, by processing beta-amyloid precursor protein and converting it into amyloid beta. They also play a protective role against AD and fight it by catalyzing the decomposition of beta-amyloids and converting them into the cut out forms of the carboxyl C-terminus. In addition, the 24 kDa fragment resulting from the effect of cathepsin D on apolipoprotein E (ApoE) is the second binding to the receptor in the ApoE. This fragment may also be the cause of the pathogenicity of Apo E in AD. Identifying and explaining the mechanisms involved in the pathogenesis of AD can play a significant role in the prevention and treatment of this disease. Since cathepsins play a pivotal role in the decomposition of beta-amyloid and reduction of the risk of AD, further studies can be considered an effective approach to study AD.Journal of Medical and Biomedical Sciences (2018) 7(1), 1 - 10

Total abdominal hysterectomy in a Tertiary Hospital in Kumasi: Indication, Histopathological Findings and Clinicopathological Correlation

Hysterectomy is the commonest gynaecological surgery worldwide. Hysterectomy is commonly performed in our centre with request for post-surgical histological confirmation of pathologies. The aim of this study was to review all the hysterectomy specimens sent to our department between 2008 and 2016 and analyse the histological diagnosis in them and clinically correlate with the indications for the surgery. We reviewed retrospectively request forms, histological reports and slides generated for all cases of hysterectomies sent to our department for histological assessment between 2008 and 2016 totalling 1086. All the data obtained were analysed using SPSS 21. A total number of 1086 cases of hysterectomies with or without salpingooophorectomy were received in our department. The age range was 15 to 85 years with age group 40 to 49 years constituting 57.7% of cases. The commonest indication for surgery was uterine mass which constituted 722 cases (66.42%) and an obvious uterine mass was found at grossing in 737 cases (66.48%) while histology revealed uterine leiomyoma in 861 cases (79.28%) constituting the largest proportion of histological diagnosis. Other indications for surgery include dysfunctional uterine bleeding, suspected ovarian and cervical malignancy and peri-partum haemorrhage. Histological diagnoses confirmed wide range of lesions within the endometrium, cervix, fallopian tubes and ovaries. There was correlation between clinical indication and histological diagnosis up to 90.2% of all cases. Our data confirmed hysterectomy specimens with or without salpingo-oophorectomy as a common histological specimen in our laboratory, with peak age of patients in the fifth decade. Leiomyoma was the commonest histological finding and other wide ranges of pathologies were seen with strong positive (r = 0.98) correlation between pre-operative indication and the final diagnosis.Journal of Medical and Biomedical Sciences (2018) 7(1), 22 - 28

Caregivers’ knowledge of pneumonia and uptake of vaccination in under-five children in Kaduna State, Nigeria

Pneumonia, though very much a preventable disease, still remains a tangible threat to the lives of under-5 children. Caregivers’ knowledge of pneumonia is important in effective management. The study determinedthe reported proportion of childhood pneumonia in Kaduna State and assessed caregivers’ knowledge of pneumonia and uptake of pneumococcal vaccine among under-5 children. The mixed method research approach used 500 caregivers of under-five children in urban and rural communities in Kaduna state. Ethical approval and informed consent of participants was obtained before data collection using a pre-tested semistructured questionnaire and a focus group discussion guide. Chi-square statistical test was used to test for association between variables, while data from the focus group discussion was analyzed using thematic coding process. Most respondents were aware of pneumonia, they had local names for it but majority 340 (68%) had poor knowledge of pneumonia. The overall occurrence of pneumonia as reported by respondents among under-five children was 33 (6.6%). The rate of child pneumococcal vaccine uptake as reported by respondents was 105 (21%), the uptake was significantly more among the urban dwellers (p<0.01). The knowledge of pneumonia and uptake of pneumococcal vaccination was poor. Routine and constant health education of the community members on pneumonia is very necessary to preserve lives of under-5 children in our communities.Journal of Medical and Biomedical Sciences (2018) 7(1), 40 - 48

Effect of counseling on contraceptive uptake in Nigeria

Despite multiple options for contraception, choices are limited with low satisfaction among clients in low resource countries. Effective counseling may improve satisfaction and compliance if adequately pursued. The objective of this study was to evaluate the influence of counseling on contraceptive choices and its associated factors. This was a prospective, descriptive study involving consenting family planning clients at the family planning clinic of a tertiary hospital in Ilorin, Nigeria. All participants completed an interviewer administered questionnaire designed for the study. Statistical analysis was done using SPSS version 21.0 (IBM, USA) and p value <0.05 was significant. Among the 260 participants, the mean age was 30.3±5.7 years, mean parity 3.0±1.0 and modal age 20–39years (93.5%). The commonest preferred contraceptive pre- and post-counseling was intrauterine device (36.5% vs. 53.5%); increased post-counseling desire was reported for injectables (28.8% vs. 35.4%) and implant (0% vs. 3.1%). Preferences increased post-counseling for highly effective methods (38.1% vs. 60.4%; p<0.0001), long term methods (38.1% vs. 60.4%; p<0.0001) and permanent methods (1.5% vs. 3.8%; p<0.001). Significant predictor of contraceptive choice precounseling was level of education (p=0.032) and parity (p<0.001) post-counseling. The study shows that counseling can improve choices, encourage satisfaction and possibly enhance compliance among contraceptive clients.Journal of Medical and Biomedical Sciences (2017) 6(3), 1 - 6

Profiling urinary tract infections bacteria among elderly population in a Nigerian Teaching Hospital

There have been conflicting reports about prevalence of Urinary Tract Infections (UTIs) causing bacteria in elderly in recent times. This study aims to evaluate the prevalence and resistance pattern of UTIs causing bacteria in elderly Nigerian patients. A prospective cross-sectional study was carried out among elderly patients attending the general and medical outpatients’ clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Patients aged 60 years and above with at least two signs of UTIs were purposefully selected for the study. Clean catch mid-stream urine specimens from 100 eligible patients were examined for significant bacteriuria. Identification and antibiotics susceptibility patterns of the isolates were determined using standard techniques. Data were analysed using descriptive statistics such as frequency and percentage. Association between variables was determined using Chi-squared test. P values<0.05 were considered significant. One hundred elderly outpatients were evaluated. Majority of the study participants were males (68, 68.0%) and (64, 64.0%) were married. More than half of the participants (59, 59.0%) had no significant bacteriuria. Among the participants with significant bacteriuria (41, 41.0%), males (29/41, 70.7%, p=0.001) were more than the females (12, 29.3%). Klebsiella pneumoniae (19/41, 46.3%) was the most isolated organism in the participants’ urine specimens, (35/41, 85.4%) of the isolates were resistant to nitrofurantoin. Klebsiella pneumoniae was the most isolated UTIs-causing bacteria among the elderly evaluated. Physicians need to be aware of trends in profiles of UTIs-causing bacteria for effective diagnosis of the disease in elderly.Journal of Medical and Biomedical Sciences (2017) 6(3), 15 - 22

Serum markers related to depression: A systematic review

Depression has a multifactorial aetiology and is one of the most common neurological and psychiatric disorders that are associated with imbalance in certain inhibitory and excitatory neurotransmitters and impairment of the brain-derived neurotrophic factor (BDNF). This review study was conducted to investigate the effect of BDNF and neuromediators on the development and severity of depression. To conduct this systematic review, relevant publications that were published between 2000 and 2016 and were indexed in the PubMed, Google Scholar, Scopus and Web of Science databases were retrieved using the depression, serum markers, neurotransmitters, serotonin, BDNF, dopamine, glutamate and gamma amino-butyric acid search terms. A total of 89 articles were included in final analysis. Depression is associated with imbalance of certain neurotransmitters such as serotonin, dopamine, norepinephrine, melatonin and glutamate in the central nervous system and impairment of BDNF. Taken together, there is a significant relationship between depression and neuromediators, and the decrease and increase in these mediators plays a significant role in depression. Studies have also confirmed that the antidepressant effect of drugs and medicinal plants is essentially related to the serotonergic pathway, especially the 5-HT1A receptor, and drugs and medicinal herbs are likely to exert their antidepressant activity through altering dopaminergic and serotonergic systems.Journal of Medical and Biomedical Sciences (2017) 6(3), 30 - 42

Lifestyles characteristics and prevalence of anaemia among men living in deprived community, Ghana

Anaemia is a reduction in circulating red blood cells which directly affect the concentrations of haemoglobin. The most common form dietary anaemia is known to be iron deficiency. Many factors such as socioeconomic status, and lifestyles contribute to anaemia. Studies are done on children and women but scanty information aree available on men. It was relevant to find out such information on men. This problem persists in the world especially, in the underdeveloped countries. A cross-sectional study in a peri urban community in Ghana enrolled 1449 healthy men aged ≥18 years. The study assessed their lifestyle, nutrient adequacy ratio (NAR), body mass index (BMI), haemoglobin (Hb) level. risks of developing anaemia and binary logistic regression analysis with significance set at p<0.05. Biochemical and clinical examinations revealed that 18.8% of the participants were anaemic (Hb ≤13b/dL). Their dietary status was below the cutoff of 60% NAR for all nutrients except iron (84%) and protein (55%). The binary logistic regression indicated that participants who used tobacco were about 16 (Odds ratio: 16.39, p<0.01) times more likely to be anaemic compared with nonusers. In the same model men whose intake of protein was (<60% NAR) were 3 (Odds ratio: 3.44, p<0.01) time more likely to be anaemic. In conclusion, tobacco smoking and mainly plant-base sources of protein and iron did not guarantee their availability for optimum utilization for Hb synthesis to lower incidence of high risk of among participating men in the study in Ghana.Journal of Medical and Biomedical Sciences (2017) 6(3), 7 - 14

Phytotherapy for children's nocturnal enuresis

In a period of childhood, one of the issues that annoys the parents is their child's nocturnal enuresis. Nocturnal enuresis is annoying not only for the family but for the children themselves. Conventional treatments for nocturnal enuresis lead to certain complications. Medicinal plants have a special status in the treatment of neonatal and pediatric diseases. In phytomedicine, certain medicinal plants and phytotherapies have been suggested to treat nocturnal enuresis. The purpose of this study is to review the most important medicinal plants for children's nocturnal enuresis. To conduct this review, we searched for relevant articles indexed in certain databases such as PubMed, Scopus, Islamic World Science Citation Center, Scientific Information Database, and Magiran and some data sites using the words nocturnal enuresis, children's urination, medicinal plants, and traditional medicine. Results have shown that Zingiber officinale, Valeriana officinalis, Alcea rosea, Elettaria cardamomum, Cinnamomum verum, Ribes uva-crispa, Cornus mas, Juglans regia, Vitis vinifera, Sinapis spp., Olea europaea, and Prunus cerasus are a number of important plants that are effective on nocturnal enuresis in traditional medicine and phytomedicine.Journal of Medical and Biomedical Sciences (2017) 6(3), 23 - 29