Improvement of 8-arm maze performance in aged Fischer 344 rats with 3,4-diaminopyridine

Short-term memory of a spatial task by male Fischer 344 rats at 3, 12, and 24 months of age was examined in a radial 8-arm maze. Performance by 24 month old rats was significantly poorer than that of 3 or 12 month old rats. 3,4-Diaminopyridine (1000 pmole/kg), a compound that stimulates acetylcholine release, significantly improved 8-arm maze performance by 24 month old rats. Thus, an age-related deficit in short-term memory for a spatial task can be ameliorated by a compound that stimulates acetylcholine release.

Open heart surgery in Nigeria; a work in progress

Background

There has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme.

Methods

This is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome.

Results

51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model.

Conclusions

The Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar challenges will need to be overcome by other cardiac stakeholders if other OHS programs are to be developed and sustained in Nigeria.

The cost of open heart surgery in Nigeria

Introduction

Open Heart Surgery (OHS) is not commonly practiced in Nigeria and most patients who require OHS are referred abroad. There has recently been a resurgence of interest in establishing OHS services in Nigeria but the cost is unknown. The aim of this study was to determine the direct cost of OHS procedures in Nigeria.

Methods

The study was performed prospectively from November to December 2011. Three concurrent operations were selected as being representative of the scope of surgery offered at our institution. These procedures were Atrial Septal Defect (ASD) Repair, Off Pump Coronary Artery Bypass Grafting (OPCAB) and Mitral Valve Replacement (MVR). Cost categories contributing to direct costs of OHS (Investigations, Drugs, Perfusion, Theatre, Intensive Care, Honorarium and Hospital Stay) were tracked to determine the total direct cost for the 3 selected OHS procedures.

Results

ASD repair cost $ 6,230 (Drugs $600, Intensive Care $410, Investigations $955, Perfusion $1080, Theatre $1360, Honorarium $925, Hospital Stay $900). OPCAB cost $8,430 (Drugs $740, Intensive Care $625, Investigations $3,020, Perfusion $915, Theatre $1305, Honorarium $925, Hospital Stay $900). MVR with a bioprosthetic valve cost $11,200 (Drugs $1200, Intensive Care $500, Investigations $3040, Perfusion $1100, Theatre $3,535, Honorarium $925, Hospital Stay $900).

Conclusion

The direct cost of OHS in Nigeria currently ranges between $6,230 and $11,200. These costs compare favorably with the cost of OHS abroad and can serve as a financial incentive to patients, sponsors and stakeholders to have OHS procedures done in Nigeria.

Knowledge Attitude and Practices Toward Lassa Fever Control and Prevention Among Residents of Ile-Ife, Southwest Nigeria

Lassa fever had been reported as a cause of death especially in endemic parts of Nigeria. This study assessed the knowledge, attitude, and practices toward Lassa fever control and prevention among residents of Ile-Ife, southwest Nigeria. Descriptive cross-sectional study was conducted among consenting randomly selected adults using an interviewer administered questionnaire. Data were analyzed using descriptive and inferential statistics. A total of 400 questionnaires with completed data were analyzed (response rate 96%). Majority, 207 (51.8%), were males while 193 (48.2%) were females. Most, 234 (58.5%), had tertiary education while 148 (37%) had secondary education. Fifty-nine percent had heard of Lassa fever with radio as their major source of information. About 76% had inadequate knowledge, 54% had negative attitude while 51% had poor practice toward Lassa fever. Determinants of knowledge of Lassa fever include having higher education (Adjusted Odd Ratio (AOR) = 11.49, 95% CI [3.10, 42.69], p = .0001), being in civil service (AOR = 0.22, 95% CI [0.09, 0.51], p = .01), and earning higher income (AOR = 4.23, 95% CI [2.61, 6.84], p = .0001). In conclusion, the knowledge, attitude, as well as preventive practices to Lassa fever were poor. It is necessary to increase public education and improve hygienic practices.

Determinants of Skilled Care Utilization among Pregnant Women Residents in an Urban Community in Kwara State, Northcentral Nigeria

Background

Skilled attendant at delivery (SBA) is one of the key indicators used in assessing progress towards improved maternal health. This study aimed at identifying factors influencing SBA utilization in Ilorin, Nigeria.

Methods

This cross-sectional study was carried out using multi-stage sampling technique among 400 participants in Ilorin, Northcentral Nigeria. A pre-tested questionnaire was used for data collection, and data analysis was done using descriptive and inferential statistics.

Results

SBA supervised 73.8% births. Determinants of skilled birth attendance at delivery include higher education (AOR; 10.94, 95% CI; 3.60-33.26), having only one child (AOR; 4.33, 95% CI; 1.18-15.82), having at least 4 ANC attendance (AOR; 18.84, 95% CI; 8.95-55.82) and residing near delivery sites (AOR; 11.49, 95% CI; 2.43-55.56).

Conclusion

The proportion of births supervised by SBA needs improvement in Northcentral Nigeria. Full implementation of reproductive health policies will enhance skilled births in Nigeria.

Evaluation of a computerised system for medical records in an accident and emergency department

This paper deals with the impact of the installation of a computerised record and data handling system in an urban Accident and Emergency department. This system became fully operational on the 14th of August, 1989 and replaced the previous manual method of administration. The new system allows 'real time' handling of patient details and generation of letters to both specialists and general practitioners. Audit of the department workload and data generation for research are improved. The current situation is described as well as potential benefits and constraints of the system.

HIV Knowledge and Screening Practices among In-School Adolescents in a Semi-Urban Community of Osun State, Southwest Nigeria

BACKGROUND

Adolescents and youths are currently one of the main sub-populations responsible for most Human Immunodeficiency Virus (HIV) new cases in Nigeria due to their high-risk sexual practices. Yet, most Nigerian adolescents have poor HIV knowledge and are not aware of their HIV status.

STUDY OBJECTIVES

We assessed respondents' HIV knowledge, their attitude to screening, testing practice and identified predictors of HIV screening among youths (15-24 years old) in Iwo, Osun State, Nigeria.

METHODS

Cross-sectional design was employed and a multistage sampling method was used to recruit 360 eligible schooling youths in three secondary schools (private and public coeducational schools). A semi-structured, interviewer administered questionnaire was used for data collection. Both descriptive and inferential statistics were carried out at p<0.05.

RESULTS

Mean age (±SD) of the respondents was 15±4.71 years. The majority (75.6%) of the respondents had heard about HIV. Overall, only 57.6% of respondents possessed a comprehensive knowledge of HIV but a majority (80.6%) of them had a positive attitude to HIV screening. Only 20.6% of the respondents had ever screened for HIV, 70.0% of them had pre-and post-test counselling. The most prevalent reason for non-screening is fear of getting a positive result (48.3%). Predictors of HIV screening uptakes included respondents' age (AOR = 2.95; 95%CI = 2.25-6.01), school type (AOR = 2.9;95%CI = 1.99-11.25), class level (AOR = 3.21;95% CI = 2.13-8.12) and attitude to screening (AOR = 2.51;95% CI = 2.01-6.39).

CONCLUSION

Despite a high awareness rate and overwhelming positive attitude, HIV screening practice was low in the study setting. There is a need for health policymakers to further prioritise adolescents and youths in the race to end HIV epidemics in Nigeria.

Making the Transition From Cardiac Missions to Autonomous Heart Surgery at a Nigerian Teaching Hospital: Challenges and Lessons Learned

Open-Heart Surgery at the Lagos State University Teaching Hospital commenced in 2004. Early years were based on a Cardiac Mission Model, but since 2017 the focus was on the transition to a Local Team Model with autonomous Open-Heart Surgery. The aim of this study is to describe our progress in making this transition, highlight lessons learned, and detail the outstanding challenges to be overcome. This study is a retrospective analysis of prospectively maintained data from the Lagos State University Teaching Hospital cardiothoracic database and Nigeria Open-Heart Surgery Registry between November 2004 and December 2021. Data extracted included patient demographics, EuroSCORE II, operative procedure, operative category, lead surgeon, complications, and outcomes. Over the study period, 100 operations were done over 2 time periods, 51 operations between 2004 and 2011 (Cardiac Mission Period) and 49 operations between 2017 and 2021 (Transition Period). In the Cardiac Mission Period, 21.6% of the operations were done by the Local Team and in the Transition Period this increased to 85.7% of the operations completed. Overall mortality was 14%, dropping from 17.6% in the Cardiac Mission Period to 10.2% in the Transition Period. The Local Team is now gradually taking on more diverse cases while striving to maintain good outcomes. Our institution has successfully made the transition from Cardiac Missions to Autonomous Open-Heart Surgery without an increase in mortality and a gradual increase in surgical volumes. Lessons learned included a strategy to focus on adult surgery, avoidance of high-risk cases, and moving from free surgery toward an appropriate cost structure for program sustainability. Contributory factors to the successful transition include the active support of the hospital management (provision of appropriate infrastructure and equipment, investment in training of the Local Team), continued humanitarian international collaborations focused on skill transfer, and maintenance of Local Team skills by collaborations with other active cardiac centers in Nigeria. Remaining challenges include financing to bridge equipment gaps, maintenance and replacement of equipment as well as the evolution of a national health insurance schema that would ideally support Open-Heart Surgery for Nigerian patients. Until that time, patients and programs must rely on supplemental funding of surgery to increase surgical volumes.

Infant and Young Child Feeding Practices among Mothers of Children 6-23 Months Old Attending the Immunisation Clinic of a Private Tertiary Health Institution in Nigeria

BACKGROUND

Globally, childhood malnutrition remains a major public health issue. It is thus imperative to contextually analyse Infant and Young Child Feeding (IYCF) practices in resource-poor settings like Nigeria.

STUDY OBJECTIVES

This study assessed key complementary feeding indicators among 6-23-month-old children attending the immunization clinic of Bowen University Teaching Hospital, Ogbomoso, Nigeria.

METHODOLOGY

Cross-Sectional design was employed, and Systematic Random Technique used to recruit 198 consenting caregivers. Validated interviewer-administered, semi-structured questionnaire was used for data collection. Both descriptive and inferential statistics were carried out.

RESULTS

Mean±SD age of the children was 11.27±5.16 months. Only 57.6% of the infants had breastfeeding within 1-hour of life. Not less than 91.4% of the infants had Exclusive breastfeeding (EBF) but Infant formula was the main breastmilk substitute among children without EBF. In all, 83.0% of the infants had Minimum Meal Diversity, 90.4% had Minimum Meal Frequency but only 57.6% had Minimum Acceptable Diet (MAD). The significant predictors of MAD were early commencement of breastfeeding, reception of complementary feeding counselling during pregnancy, EBF practice and whether the child had MUAC which was at least 11cm.

CONCLUSION

IYCF practices was sub-optimal in the studysetting. There is urgent need for policy makers to design evidence-informed strategic framework for effective implementation and evaluation of the existing IYCF policy in Nigeria. Emphasis should be placed on complementary feeding education/counselling using relevant Information, Education and Communication (IEC) channels/materials. Good IYCF practices ensure optimum child growth/ development, prevent childhood diseases, and can ultimately help Nigeria to attain SDG-3 by 2030.

Spinal tumour: a diagnostic lesson

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Knowledge, determinants and unmet needs for postpartum family planning use among women attending immunization clinic at Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria

BACKGROUND

Most women in extended post partum period often have desire to use family planning. Disappointedly, majority of such women end up having unplanned or unwanted children. Little is currently known about factors responsible for such unmet family planning need among Nigerian women.

OBJECTIVES

To assess the prevalence and determinants of unmet need for post partum family planning (PPFP) among women in Oyo State, south- west, Nigeria.

METHODOLOGY

This cross-sectional analytic study was carried out using systematic sampling technique among 444 women attending immunization clinic in Ogbomoso, Nigeria. A pre-tested questionnaire was used for data collection and data analysis. was done using SPSS version 17. Chi-square test and binary logistic regression were used for analysis.

RESULT

The mean age of the respondents was 36?9. Majority (65.7%) of the respondents demonstrated poor knowledge on PPFP. More than half (54.0%) of them had unmet need for limiting while 46.0% had unmet need for spacing. Fear of side effects was the commonest reason for lack of PPFP use (17.4%). Unmet need was significantly associated with marital status, educational status and level of awareness about PPFP. Level of awareness was the only significant predictor of unmet need among our study participants (OR; 2.973, 95% C.I; 0.119-0.459).

CONCLUSION

Our study shows a high unmet need for PPFP among women in Ogbomoso, thus there is need for a more programmatic focus on women in their extended post partum periods. There is need for more awareness program on PPFP to increase contraceptive uptake in Nigeria.

Hypertension and its Clinical Correlates in a Rural Community in South Western Nigeria

BACKGROUND

Hypertension is the commonest cardiovascular risk factor globally and is a cause of untold morbidity and mortality. However, its clinical correlates at the community level have not been well elucidated.

METHODS

History taking, anthropometric measurements, electrocardiograms and laboratory investigations were done for all the study subjects. Ethical approval was obtained from the institution's ethical body. Analysis was done using SPSS version 20. Two hundred people were recruited for the study. The prevalence of hypertension in the community was 58.5% with 31(15.5%) being newly diagnosed. The Body Mass Index [BMI] (28.2±6vs 25.6±5.3; P=0.003),Waist-Hip ratio (0.9±0.08 vs 0.86±0.06; p= 0.001), total cholesterol (5.675±1.8 vs 4.6±1.7, P=0.000), triglycerides (1.19±0.85 vs 0.91±0.59; p=0.019), LDL cholesterol (3.38±1.6 vs 2.66±1.5; p=0.002), heart rate (82.4±15.8 vs 76.8±11.2; p=0.018) QRS duration (84.8±13.4 vs 80.5±11.2; p=0.040), and QTc (0.423±0.041 vs 0.402±0.035; p=0.001) were higher in those with hypertension. NYHA functional class was worse in hypertensives (p=0.041). Prevalence of left ventricular hypertrophy (LVH) in hypertensives ranged from 2.6 to 48.2%, depending on the criteria used. Systolic blood pressure, pulse pressures, HDL levels and hip circumferences were higher in those with electrocardiographic LVH. Systolic blood pressure (OR:1.045, P=0.006; CI: 1.013-1.079) and a normal BMI (OR: 0.159, p= 0.004; CI: 0.045-0.559) were the independent predictors of LVH in this study.

CONCLUSION

The prevalence of hypertension is rising, even in rural populations, with accompanying LVH, higher QTc and florid cardiovascular risk factors. It is therefore imperative to tighten the reins of control of blood pressure and other cardiovascular risk factors before the cardiovascular morbidity and mortality explode in the rural communities.

Risk of Obstructive Sleep Apnoea among Adults in a Rural Community in Southwest Nigeria

BACKGROUND

Obstructive sleep apnoea (OSA) is a common medical condition which has long been recognized as a major contributor to morbidity and mortality in developed countries but that remains underdiagnosed, particularly in rural communities. This study aimed to assess the prevalence of adults who have a high risk of obstructive sleep apnoea in a sample of adults living in Ejigbo, a rural community in south western Nigeria.

METHODS

This was a community-based cross-sectional descriptive study done to assess the prevalence of high risk of obstructive sleep apnoea in adult residents of the community using the STOP-BANG questionnaire. Data collected include socio-demographic characteristics, anthropometric measurements and blood pressure. A blood sample was also taken for lipid profile. Factors associated with a high risk of obstructive sleep apnoea were identified.

RESULTS

The study involved 257 participants out of which 88 (34.2%) had a high risk of OSA. Risk of obstructive sleep apnoea was significantly associated with male sex (p<0.001), age (p<0.001), body mass index (BMI) (p=0.001), neck circumference (p<0.001), cigarette smoking (p=0.039) and low density lipoprotein (p=0.043).

CONCLUSION

Obstructive sleep apnoea is relatively common in the study area. This calls for urgent preventive measures to stem the tide and mitigate the associated morbidity and mortality.