Determinants of reversible contraceptive method discontinuation among women of reproductive age in Kano metropolis, Nigeria

Contraceptive discontinuation contributes substantially to the total fertility rate, unwanted pregnancies and induced abortions thereby increasing the already high maternal morbidity and mortality. This study aimed to access contraceptive discontinuation among women of reproductive age in Kano metropolis. Using a cross-sectional study design with concurrent mixed method of data collection, 350 women were studied. Data was collected using a structured interviewer administered questionnaire, focus group discussion and key informant interview guides. Of the 350 participants, 168 of them had discontinued a method of contraception giving a total discontinuation rate was 48%, with method specific discontinuation rate of 35.1% for implants, 33.9% for injectables, 21.4% for pills, and IUD having the lowest rate (15.5%). The study also found side effects to be the most common reason why women discontinued contraception (67.1%), intention to get pregnant (59.5%), method failure (16.7%), method switch (12.0%), and husband’s disapproval (9.5%). Factors significantly associated with discontinuation at bivariate level were ethnicity, influence on method choice, type of facility where method was obtained, and the type of contraceptive method. These factors were found not to be significant at multivariate level. Contraceptive discontinuation is prevalent in Kano metropolis, meaning that women are at high risk of unintended, mistimed pregnancies, and unsafe abortions, increasing maternal morbidity and mortality. Efforts should be made to tackle the problem of discontinuation through effective educational strategies and counselling techniques.

Prevalence and patterns of adverse events following immunisation among children less than 24 months attending immunisation clinics in Kano, Nigeria

Adverse Events Following Immunisation (AEFI) contribute to child morbidity and mortality as they often lead to low uptake of vaccines with consequent persistence of vaccine-preventable diseases. It is essential to assess the prevalence of AEFIs in northern Nigeria, where misconceptions about immunisation exist. This study assessed the prevalence and pattern of AEFI among children less than 24 months after attending immunisation clinics in Kano, Nigeria. Using a mixed-methods design, adapted intervieweradministered questionnaires were assigned to a cross-section of 384 mother-baby pairs who presented to the immunisation clinics of selected primary healthcare centres (PHCs) within metropolitan Kano. This was followed by six sessions of focus group discussion with a sub-sample of the mothers. Logistic regression and the framework approach were used to analyse the data. The prevalence of AEFI was (43.5%, n=164), and most cases (72.4%, n=273) were mild. Fever was the most common type of AEFI reported (66.5%, n=109) and was higher among infants less than three months (44.5%, n=73). Age of the index child was the only significant predictor of AEFI (OR:0.18, 95% CI: 0.10-0.35). Our study shows that AEFI was common among children less than 24 months old in Kano. We recommend sensitisation and health education of caregivers using valuable communication strategies and sufficient training of immunisation service providers on professional ways to deliver these vaccines safely.

Influence of BMI on foot posture alignment in resting gait of secondary school children in Lagos metropolis aged 10 to 18 years

The study was to determine the influence of BMI on foot posture alignment in the resting gait of secondary school children. A localized, two-stage, stratified, cross-sectional, and descriptive survey was carried out in 10 secondary schools involving a sample secondary student population of 518 students, 235 males, and 283 females. The result shows that there was a statistically significant association (X2=32.4345, p=0.000) between the BMI of student’s cohort and their age. There was also a statistically significant association between different age groups and gender at p<0.046. Using the statistics of Pearson chi-square analysis, age-dependent variability of BMI (X2=32.4345, p=0.000) was established amongst the study population. The BMI of students for the varying foot alignment was not normally distributed, instead, it was skewed to the right. According to the Kruskal-Wallis H test, there was no statistically significant difference in BMI between the three age cohorts of student’s foot alignment in resting gait; Pearson chisquare, X2 (2) = 4.575, p=0.1015. The distribution of the left foot posture alignment according to the FPI scale indicates that overall, 82.13% of males and 84.40% of females showed normal foot alignment whereas 10.64% and 9.22% of male and female students respectively confirmed slight foot pronation while 7.23% of male students and 6.38% of female students showed slightly supinated feet. This study shows that BMI has no influence on FPI in resting gait. The high incidence of underweight amongst the students’ population could be a reflection of the low socioeconomic status of many families.

Knowledge, attitude and willingness to accept the RTS,S malaria vaccine among mothers in Abuja, Nigeria

Malaria constitutes a major public health challenge and Nigeria contributes hugely to the global burden. In recent times, there has been a massive scale up of all interventions for evident impact. One of the novel preventive measures being considered is the RTS,S malaria vaccine. The objective of this study was to assess mothers’ knowledge, attitude, and practices to malaria and its prevention as well as mothers’ willingness to accept the RTS,S/AS01 malaria vaccine. A cross-sectional study design was used to administer questionnaires to 180 mothers within six public secondary health facilities in Abuja, Nigeria. About 30% (36/180) of respondents were aware of malaria vaccines but only four percent (7/180) had heard of RTS,S. Young maternal age (OR, 2.4; 95% CI, 1.09-5.28; P = 0.03), self-employment (OR, 2.55; 95% CI, 1.04-6.28; P = 0.04) and formal employment (OR, 3.74; 95% CI, 1.17-11.99; P = 0.03) were associated with no prior knowledge of malaria vaccine. Ninety-one percent (163/180) had a positive attitude to malaria vaccine and 98% (176/180) were willing to allow their child(ren) to be immunized with RTS,S despite the efficacy of the vaccine, route of administration and number of doses. We concluded that knowledge of malaria preventive measures does not correlate with knowledge of RTS,S. Although willingness to accept RTS,S is high, consistent targeted messaging on RTS,S would be required to improve community knowledge and attitude prior to implementation to ensure maximum uptake.

Health literacy and preparedness of health workers in the private health sector towards the COVID-19 pandemic: Need for integration into the nationwide response

The private health sector has the potential to participate in the COVID-19 pandemic response. The study aimed to assess the health literacy, perceptions, practices, willingness to participate and opportunities for engagement of the private health sector in the COVID-19 response. A cross-sectional survey was carried out among health workers in private health facilities in Edo Central and Edo North Senatorial districts of Edo state between May and June 2020. Data were collected using pre-tested questionnaires and analysis carried out using Statistical Package for Social Science (SPSS). Chi-square test of significance and logistic regression were applied at 5% cut off. A total of 153 health workers participated giving a response rate of 75.0%. Eighty-eight (57.5%) respondents had good knowledge of COVID-19 and 80 (52.3%) held negative perceptions towards COVID-19. Ninety-five (62.1%) respondents believed private health facilities had a role to play in the response particularly in the area of suspected case screening (85.4%). Thirty-one (20.3%) respondents indicated their willingness to participate in the COVID-19 response if their facilities were invited to. Sixty-one (39.9%) and 92 (60.1%) respondents respectively held poor and good practices towards COVID- 19 prevention, with practice significantly associated with educational level (χ2 = 14.10, P < 0.01), profession (χ2 = 15.28, P = 0.01). and previous training in infection prevention and control (IPC) (χ2 = 18.16, P < 0.01). The resources available from the private sector to support the response can be harnessed through engagements with medical directors and health workers in the sector to identify areas of collaboration, address identified gaps in knowledge, improve perception and participation.

Squamous cell carcinoma of the right renal pelvis in a 46-years-old with long history of right pyelolithiasis. A case report and review of literature

Squamous cell carcinoma of the kidney is a rare malignancy of the upper urothelium usually seen at advanced stage due to delay in diagnosis and or presentation. Mostly seen in patients with history of untreated chronic urolithiasis, chronic renal infection or analgesic abuse. A 46-years-old man who presented with right recurrent loin pain that radiates to the right groin of 10 years duration which worsened 2 weeks prior to presentation, he had history of recent haematuria, right loin pain, significant weight lost with associated history of untreated right renal calculi. General examination was not remarkable, ultrasound scan revealed a huge right renal mass with calculi. Intravenous urogram showed a non-functioning right kidney. Right radical nephrectomy was done, cut surface showed replacement of the renal parenchyma with greyish white tumour with stones in some blind calyxes. Histology revealed moderately differentiated squamous cell carcinoma of the right kidney. We report a case of moderately differentiated squamous cell carcinoma of the right kidney in a patient with a long history of untreated renal calculi. High index of suspicion for malignancy should be kept when seeing patients with long history of untreated renal calculi.

Antimicrobial resistance: Nurse’s knowledge and perception in a tertiary level care hospital in North-Eastern Nigeria

Nursing staff has a significant role to play in the control of Antimicrobial Resistance (AMR) through infection control and patient education. We studied the knowledge of nurses on AMR for purpose of planning AMR control efforts. A cross-sectional study was conducted between 21st June and 30th July 2017, among nurses working at Federal Medical Center Nguru, Yobe State. Responses were presented as frequencies and percentages. Relative risks and 95% confidence intervals were computed to describe factors associated with knowledge of AMR. Only 37.2% of the respondents had good knowledge of AMR. Age more than or equal to 40 years versus less than 40 years (RR=2.66, 95% CI: 1.253-5.662), work experience greater than or equal to 10 years versus less than 10 years (RR=2.94, 95% CI: 1.518-5.686) predicted good knowledge of AMR. A significant knowledge gap on AMR among nurses has been identified. We recommend a robust AMR awareness initiative to educate nursing staff on AMR. Further studies among other cadre of healthcare workers should be conducted to define and address the AMR knowledge gap among all Nigerian healthcare workforces.

Prevalence and risk factors of diabetic kidney disease in north eastern Nigeria

Diabetic Kidney Disease (DKD) is a leading cause of chronic kidney disease and end stage renal disease. In northeastern Nigeria the epidemiology and risk factors have not been fully studied. This study aimed at evaluating the prevalence and risk factors of DKD in Maiduguri, north eastern Nigeria. The study population consisted of adult diabetic patients recruited consecutively at the diabetic clinic of University of Maiduguri Teaching Hospital Maiduguri. Socio-demographic variables including age, sex, weight, BMI, as well as laboratory parameters, were obtained from each patient. Glomerular filtration rate was derived from CKD-EPI formula using serum creatinine. Two hundred and sixty-one diabetic patients were recruited. The prevalence of DKD among them was 42.9%. Classification based on eGFRshowed that 35(13.4%) patients had hyperfiltration; 48 (18.4%) stage I; 66 (25.3%) stage II; 68 (26.1%) stage III; 36 (13.8%) stage IV; 8 (3.1%) stage V. One hundred and seventeen (44.8%) had proteinuria. Low eGFR <60ml/1.73M2 was associated with age >50 years (r=1.039, p=0.011); male sex (r=-0.899, p=0.008); hyperuricaemia (r=1.010, p=0.000); low PCV (r=1.276, p=0.000); HbA1C (r=1.127, p=0.030); proteinuria (r=2.011, p=0.004).This study has shown that chronic kidney disease is common among diabetic patients in northeastern Nigeria. Age, male sex, hyperuricaemia, low PCV, high HbA1C levels and proteinuria were found to be associated with development of DKD.

Small dose of ephedrine for prevention of hypotension following propofol and fentanyl administration during induction of general anesthesia

Induction of general anesthesia with propofol and fentanyl could result in hypotension and bradycardia. Various methods are being used to prevent these adverse effects. The aim of our study was to assess the efficacy and safety of a small dose of ephedrine in prevention of hypotension following administration of propofol and fentanyl. This prospective, randomized, comparative study was conducted among a total of 50 patients, both genders, age 18 years up to 60 years with ASA grade Ι and ΙΙ and some of class ΙΙΙ, presented for elective surgery under general anesthesia. Patients were randomly allocated into one of two groups (25 patients in each): CG (the control group), which received propofol in a dose of 2 mg/kg, intravenously, over 20–30 s mixed with 2 mL normal saline: and EphG (Ephedrine group), while received propofol in a dose of 2 mg/kg, intravenously, over 20–30 s mixed with 2 mL of ephedrine (10 mg). The Mean Arterial Blood Pressure (MAP) and Heart Rate (HR) were recorded before induction and then every 1 min up to 6 min after induction. The categorical data are presented as a number and percentage and were subjected to Fisher’s exact or Chi-square test for analysis. The statistical significance was p≤0.05. The significant differences in HR were observed in the 3rd,4th, and 5th minutes with P-value, 0.018, 0.000, 0.000, respectively. However, no patient in the study participants had bradycardia. The significant differences in MAP were observed in the 2nd, 3rd,4th, and 5th minutes with P-value, 0.035, 0.000, 0.000, and 0.000, respectively. The percentage of patient in CG who developed hypotension in the 3rd and 4th is 44% and 32% compared to 8% and 0% in EphG, with significant differences (P-value 0.004 and 0.002, respectively). Administration of small dose of ephedrine with propofol could attenuate propofol/fentanyl hypotensive and bradycardic effects.

Huge symptomatic pedunculated uterine fibroid in pregnancy: Antepartum myomectomy and term delivery at a specialist hospital in Kano, Nigeria

Myomas are common in pregnancy and can go unnoticed. One in ten patients, however, develops complications that would necessitate their removal. Myomectomy performed at caesarian section had come to the lime light over the last decade and recent literature have shown its safety. There is still paucity of literature on myomectomy performed during pregnancy. Our case was a 25 years old primigravida at 21 weeks with features of acute abdomen secondary to uterine fibroid which was diagnosed during pregnancy. She subsequently had antepartum myomectomy and a live birth at term via caesarean section.