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   Table of Contents - Current issue
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April-June 2020
Volume 23 | Issue 2
Page Nos. 73-140

Online since Friday, July 10, 2020

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REVIEW ARTICLE  

Challenges in the management of corona virus in pregnancy in low resource countries Highly accessed article p. 73
Abubakar Panti Abubakar, Anas Funtua Rabiu
DOI:10.4103/1319-8491.289357  
Background: Coronavirus disease-19 (COVID-19) is a potentially lethal infection caused by severe acute respiratory syndrome. Pregnancy is a state of partial immune suppression, which makes pregnant women more vulnerable to viral infections. COVID-19 pandemic presents many challenges in when it coexists with pregnancy in resource-poor countries with background ignorance and deficient health infrastructure. Materials and Methods: A literature search for studies on COVID-19 was performed using Google Scholar search database, PubMed, Medline, and ScienceDirect. The bibliographies of included studies were also searched for additional references. About 85 articles were identified. Twenty-five articles were considered suitable for review. Results: An extensive review of management of COVID-19 in pregnancy and challenges confronting its management in resource-poor countries was presented. These challenges included poor health infrastructure, poor testing capacity, and nonadherence or impracticable preventive measures including physical distancing, hand hygiene, inadequate personal protective equipment, and stigmatization. Specific challenges related to pregnancy were availability of blood and blood products, labor management, operative deliveries, and postdelivery management. Conclusions: Current evidence suggests that its pathogenesis, clinical manifestations, and management are influenced by pregnancy. The outcomes of pregnancy and COVID-19 are negatively influenced by similar problems of ignorance, poverty, and deficient health infrastructure. COVID-19, therefore, has the potential for worsening maternal mortality in low-resource nations.
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ORIGINAL ARTICLES Top

Factors affecting utilization of obstetric ultrasound: a study of semi-urban pregnant women in a developing nation p. 82
Bello O Usman, Suleiman Hadeja Idris, Umar Abdulaziz, A Olorunkoba Abdulhakim
DOI:10.4103/smj.smj_5_19  
Background: Ultrasound scanning presently forms an integral part of antenatal care around the globe. It is a common investigative tool in most public and private health facilities in developing countries. Routine obstetric ultrasound has been one of the most important advances in antenatal care worldwide. It is also useful in the early detection and monitoring of the conditions that give rise to fetal and maternal compromise and has become an indispensable adjunct to the management efforts of practitioners in this regard. Therefore, utilization of this innovation by pregnant mothers is paramount toward good outcome. Objective: The objective is to determine the factors affecting utilization of ultrasound by pregnant mothers attending antenatal care in Zaria Local Government, Kaduna State, Northern Nigeria. Materials and Methods: This cross-sectional descriptive was used to carry out the study among 200 pregnant mothers selected through multistage sampling technique. This study was conducted over a period of 6 months from November 6, 2017, to May 6, 2018, after approval was given by the ethical committee of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. A structured interviewer-administered, validated questionnaire was administered to each participant to ascertain the factors affecting utilization of obstetric ultrasound by pregnant women in Zaria Local Government, Kaduna State. Data were analyzed using IBM SPSS 22. Results: The data obtained from the questionnaire were scored for proper evaluation. Furthermore, all collected data were carefully tallied, various frequencies, ranges, and mean (standard deviation) were determined. Most (29.5%) of the respondents aged 20–24 years, majority (95.5%) were homemakers that are not gainfully employed. Majority of the respondents were Hausa (94.5) and Muslims (96.5%). The findings of this study have shown that educational status, husband occupation, and knowledge affect the utilization of ultrasound by respondents. Conclusion: The common factors that affect the utilization of obstetric scan in Zaria were knowledge, education background, and husband occupation. Attitude, age, and the occupation of the respondents do not affect the utilization of obstetrics scan in Zaria.
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Delays in accessing antenatal care services in a developing nation tertiary health center p. 88
Natalia Adamou, Saeed Okatewun Abdul, Usman Aliyu Umar
DOI:10.4103/smj.smj_15_19  
Background: Delay in seeking medical care is common and constitutes a major unresolved public health problem. It could contribute immensely to maternal mortality, especially in developing countries, where access and availability of functional health-care facility have remained a challenge. Objective: This study aimed at identifying the forms of delays encountered by pregnant women seeking antenatal care (ANC) services and also factors responsible for such delays. Materials and Methods: This was a cross-sectional study among women attending antenatal care clinic of our hospital. Data were obtained through an interviewer-administered questionnaire and were analyzed by the Statistical Package for the Social Sciences version 17. Results: The mean age of the respondents was 28.6 (standard deviation [SD] ± 5.44) years. About a third (31.5%) experienced Type II delays due to inaccessibility to the mode of transportation and traffic deadlock; while majority (77.1%) experienced intrahospital delays due to delay in retrieving cases notes, seeing an obstetrician, inadequate health personnel, and consulting rooms. The average waiting time was 3.1 ± 0.91 SD hours (188 min). The waiting time was not statistically associated with time of arrival to the clinic. Conclusion: Most women experience intrahospital delays while seeking ANC. Intervention by policymakers and adequate staffing coupled with provision of necessary health-care amenities will go a long way in reducing patients waiting time.
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Intraoperative insertion of intrauterine contraceptive device at cesarean section: A survey on the experiences of trainee and practicing obstetricians p. 94
Tokunbo Omolola Adeoye, Afolabi Korede Koledade, Oladapo S Shittu
DOI:10.4103/smj.smj_52_18  
Background: Intrauterine contraceptive device (IUCD) placement during cesarean section has been shown to be a safe and effective method of contraception with very low complication and disuse following insertion. Its practice can be of immense benefit, especially in developing countries like Nigeria where high unmet needs for contraception and increasing cesarean section rates are prevalent. Objective: The objective of this study is to evaluate the practice of obstetricians and trainees on counseling and insertion of IUCD during cesarean section. Materials and Methods: A questionnaire-based cross-sectional study was conducted among obstetricians and trainees at the 49th Annual Scientific Conference of the Society of Gynecology and Obstetrics of Nigeria held in November 2015. The data were analyzed using the SPSS version 20. Results: Of 150 respondents, 134 returned completed questionnaires, giving a response rate of 89.3%, 130 of these were adjudged to be correctly filled and were analyzed. Majority of the respondents, 97 (74.6%), were consultants. The mean age of the respondents was 42.01 years ± 7.00. About 95% (125) of the respondents admitted performing cesarean sections, but only 13 (10%) had ever inserted IUCD during cesarean operations. Counseling for the procedure was also low, as only 35 (26.9%) of the respondents had ever counseled the clients toward IUCD placement at cesarean section. Conclusion: For counseling and practice of insertion of IUCD at cesarean section is very low among Nigerian obstetricians, revealing a major barrier to clients' access to this effective and safe method of contraception. Advocacy, education, and training of this category of health-care providers are necessary for improved contraceptive access to cesarean section clients.
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Evaluating the benefit of incidental appendectomy p. 99
Ikponmwosa Obahiagbon, Mojisola Udoh
DOI:10.4103/smj.smj_62_17  
Background: Surgeons sometimes perform appendectomies during abdominopelvic surgeries for surgical conditions unrelated to the appendix. A retrospective study of the histopathological diagnoses of incidental appendectomy specimens was performed to see the value of this practice. Materials and Methods: Records of incidentally resected appendices submitted to the Histopathology Department of the University of Benin Teaching Hospital from January 2005 to December 2014 were reviewed retrospectively. Results: A total of 129 histopathological reports of incidental appendectomy were retrospectively reviewed; 67 (51.9%) of the patients were male and 62 (48.1%) were female, giving a male-female ratio of about 1.1:1. Fifty-four cases (41.9%) had histologically normal appendices, while 75 cases (58.1%) had various histopathologically demonstrable lesions ranging from acute appendicitis (the most frequent with 27%) to neoplasia (one case of mucinous adenocarcinoma). Conclusion: Significant pathology can be uncovered on histopathological examination of the clinically normal appendix. Incidental appendectomy is thus a useful procedure.
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Antimicrobial prescription pattern in a tertiary hospital p. 103
Adebola Tolulope Olayinka, Olanrewaju Jimoh, Joan Ejembi, Oluwafemi Temidayo Ige, Zainab Lamido, Abdulrasul Ibrahim, Victoria Aganabor, Busayo Olayinka
DOI:10.4103/smj.smj_17_18  
Background: Antimicrobials are nonreplaceable in the treatment of bacterial infections and thus should be used judiciously. In Nigeria, there is currently no restriction on the prescription and sale of antimicrobials. This study was conducted to assess the antimicrobial prescription pattern of physicians at a tertiary hospital in Northwestern Nigeria. Materials and Methods: A point prevalence survey was carried out among all inpatients at Ahmadu Bello University Teaching Hospital in June 2015. Those receiving an antimicrobial agent during the survey period were included in the study while patients admitted on the day of the survey were excluded from the study. Data were obtained using a structured interviewer-administered questionnaire and abstraction from patient records. Information obtained included demographic data, antimicrobial agents prescribed, indication for treatment, laboratory data, and stop/review dates of prescriptions. Data were analyzed using SPSS version 20.0. Results: Twenty-three wards with a total number of 318 inpatients were enlisted. Of these, 210 (66%) patients were on treatment with antimicrobials. Male: female ratio of patients on antimicrobials was 1.2:1, and age of respondents ranged from 1 day (0.0027 years) to 75 years. The overall antimicrobial prevalence rate was 210 (66%) with surgical prophylaxis 100 (47.6%) as the most common indication. Overall, 332 antimicrobials were prescribed with cephalosporins as the most common class prescribed 96 (28.9%). Majority of the prescriptions (328, 98.8%) were based on empirical treatment, 288 (86.7%) were open prescriptions, and only 4 (1.2%) were according to treatment guidelines. Conclusion: The high prevalence of antimicrobial use highlights the need for an antimicrobial stewardship program in this facility.
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Outpatient prescribing and antibiotic use for children in a tertiary hospital p. 109
Lawal Waisu Umar, Abdulmuminu Isah, Shuaibu Musa, Bilkisu Umar
DOI:10.4103/smj.smj_27_18  
Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance, and treatment failure. Assessment of prescribing practices helps monitor the utilization of medicines. Objectives: The aim of this study was to evaluate the prescribing pattern and utilization of antibiotics for children attending outpatient units. Materials and Methods: This was a descriptive, retrospective study of outpatient pediatric prescriptions received at the pharmacy of a Nigerian teaching hospital, using the World Health Organization (WHO) core prescribing indicators and Index of Rational Drug Prescribing (IRDP). Prescription information for a 2-year period was collected on a standardized prescribing form. Computer data entry was made into Microsoft Excel 2010 spreadsheet. Data analysis was done using SPSS Version 20(IBM, Corp., Armonk, NY, USA). Results were compared with the WHO core prescribing indicators and presented as means, frequencies, proportions, contingency tables, and charts comparing with published standards. Results: There were 3445 eligible prescriptions, with mean child age of 3.2 (±2.9) years. An average of 2.4 (±1.6) drugs were prescribed per encounter, with 48.2% written in generic names. Prescriptions containing oral antibiotics and antibiotic injections constituted 50.2% and 41.2%, respectively. Medicines prescribed were available in the essential medicines list in 95.5% of cases. The IRDP was 2.98 against the ideal of 5. Majority (71.3%) of antibiotic-containing prescriptions had one antibiotic prescribed while β-lactam penicillins and cephalosporins were the most prescribed, with ampicillin/cloxacillin being the most common combination. Conclusion: Irrational prescribing and inappropriate antibiotic use were prevalent in this tertiary hospital. Similar studies are needed to describe the trends in all Nigerian tertiary hospitals, along with retraining on rational prescribing.
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Hearing loss in the pediatric age group p. 116
Uju Matilda Ibekwe, Ediriverere Nosa Oghenekaro
DOI:10.4103/smj.smj_30_19  
Background: Hearing loss is one of the preventable diseases listed by the WHO, even though the prevalence is decreasing in the developed countries. The pediatric age is very important in terms of hearing and therefore speech development. The prevalence and pattern of hearing loss in this age group in this environment is not known. Objective: The aim of the study was to determine the etiology and pattern of hearing loss in the pediatric age group in Port Harcourt. Materials and Methods: The study involved the pediatric age group (0-18 years) presenting with hearing loss, seen in the ENT Surgery Department of UPTH from January 2010 to December 2016. The clinic registers and patients' folders were the sources from which the biodata, clinical presentations, audiological assessments, possible etiologies, and treatment were extracted. These were analyzed using IBM SPSS Statistics, version 20.0. Results: A total of 752 patients with hearing impairment were seen: males – 502 and females – 250 with a ratio of 2.01:1. Patients with the age group of 0–3 years (28.6%) were more affected, whereas 16–18 years (11.2%) were the least affected. Sensorineural hearing loss (SNHL) was 37.6%; among this, birth asphyxia made up 38.5%, syndromic 6.0%, postmeningitis (2.7%, and neonatal jaundice 21.9%. However, conductive hearing loss (62.4%); was made up of cerumen auris (31.8%), otomycosis (19.4%), chronic suppurative otitis media (13.6%), Otitis media with effusion (11.7%). Most children with SNHL had severe-to-profound degree. The most common clinical presentation was hearing impairment and speech impairment followed by discharging ears. Conclusion: Hearing loss secondary to preventable causes such as birth asphyxia and neonatal infections still ranks high among the pediatric age group in this environment.
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Management of floating knees in adults: Experience from tertiary hospital Highly accessed article p. 121
Chikwendu Nwosu, Oni Nasiru Salawu, Joseph Olorunsogo Mejabi, Abiola Abidemi Fadimu
DOI:10.4103/smj.smj_25_18  
Background: Floating knee is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia. The fractures are often a result of high-energy trauma. Objectives: The aim of this study was to determine the pattern and distribution of these fracture types, mechanism of injury, associated injuries, method of treatment, complications, and the challenges encountered during the course of managing these patients. Patients and Methods: This is a retrospective study of all cases of floating knee injuries presenting to the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, Northwest Nigeria, from January 2011 to December 2017. Data were extracted from the accident and emergency register, operation register, and patients' case folders. Data collected were analyzed using the Statistical Package for the Social Sciences for Windows version 22 (SPSS Inc. Chicago, Illinois, USA). Results: A total of 29 cases of floating knee injuries presented to the accident and emergency units. Males constituted 27 (93.1%) while females constituted 2 (6.9%). Motor vehicle accident was the most common mechanism of injury in 25 (86.3%) of the patients. The most common fracture type according to Fraser et al. classification is Type I which occurred in 12 (41.4%) of the patients. Conclusion: Floating knee injury occurs mostly in the productive age group. Head injury is the most common associated injury seen. This is mostly caused by motor vehicle accidents.
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Vaccine hesitancy among medical practitioners p. 126
Semeeh Akinwale Omoleke, Olumide Ajibola, Olusola Akintoye Omisakin, Gregory Chukwuemeka Umeh
DOI:10.4103/smj.smj_32_18  
Background: Vaccine hesitancy defined as “delay in acceptance or refusal of vaccination despite availability of vaccination services is a global phenomenon. There have been anecdotal evidence or rather poor documentation of hesitancy or noncompliance among medical practitioners in Northern Nigeria. Objective: We explored the perceptions and perspectives of doctors in Kebbi State, Nigeria, on immunization programs. Materials and Methods: We conducted this cross-sectional study involving 63 medical doctors, whose self-administered questionnaires were analyzed using descriptive statistics. Results: Only 43.55% of the doctors reported having under-five children with complete vaccination, whereas 84% of the doctors surveyed had a child or a relative with a child who had missed routine immunization (RI) previously. Approximately 66.67% and 67.74% of the doctors believed in the quality of the vaccine and capacity of the health workers to effectively deliver polio supplementary immunization activities (PSIAs), respectively. Adequate training of workers (26.23%) and public enlightenment campaigns (23.68%) were suggested as PSIAs enhancers. Collaboration with community and religious leaders (29.2%), education and public sensitization (28.09%), and improved government funding (13.48%) to improve RI were suggested. Others include incentives and fines (8.99%), adequate training of staff (10.11%), house-to-house vaccination (4.49%), and media publicity (5.62%). Conclusion: Vaccine hesitancy among medical doctors could be a threat to sustained polio interruption and efforts toward improving RI in Kebbi State. The state government and development partners should modify the current approaches to attaining polio-free certification standards and strengthen RI in the state. In addition, there is a need to improve sensitization of doctors in the state on vaccines and their safety profiles with a view to reducing vaccine hesitancy among them.
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CASE REPORTS Top

Impacted corncob in the anus: An unusual presentation of child sexual abuse p. 132
Maria Ahuoiza Garba, Lawal Waisu Umar, Sani Musa, Hauwa Umaru Makarfi
DOI:10.4103/smj.smj_36_18  
Child sexual assault has gained global attention as a medico-social problem with significant immediate and long-term impact on victims, their families and society. This abhorrent deviant act may present with bizarre manifestations including various objects inserted into body orifices of victims. We report a bizarre case of anal impaction of an organic foreign body in a 9-year old boy. He had been serially abused over a two-year period by an adult male who lures him with candies and inserts a corncob into his anus before having penetrative anal sex intercourse with him. The abuse came to light following impaction of the corncob in the anus with consequent development of sepsis. Fragments of the cob were manually retrieved from the anal canal. He did well on antibiotics and was discharged to the social welfare services and psychotherapist for continued care. This report highlights the bizarre presentations of sexual assault in children. Childcare practitioners should be wary of the possibility of foreign bodies insertion in victims, which may lead to severe complications.
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Cutaneous leishmaniasis: An uncommon finding in South-South Nigeria p. 136
Benson Uchechukwu Okwara, Edesiri Ejovwoke Ighorodje
DOI:10.4103/smj.smj_34_19  
Leishmaniasis, a neglected tropical disease, is of public health significance, especially in the North-West and North-East Nigeria,which forms the belt of the disease in the country. It is caused by flagellate protozoa of the genus Leishmania and is transmitted through the bite of infected female Phlebotomine sandfly. Leishmaniasis presents as self-limiting cutaneous lesions, a mutilating mucocutaneous disease, or a lethal systemic illness. Description of the disease in the southern parts of Nigeria is a rarity. A 28-year-old male presented at the dermatology clinic of UBTH, Benin City, Edo State, South-South Nigeria, with multiple, painless, indurated nodular plaques on the left upper limb. Histology showed features suggestive of leishmaniasis. The patient was treated with oral itraconazole. Diagnosis of leishmaniasis possesses a significant challenge in nonendemic areas; however, a very good history and a high index of suspicion are imperative in overcoming this diagnostic challenge.
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