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   Table of Contents - Current issue
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October-December 2016
Volume 3 | Issue 4
Page Nos. 171-223

Online since Tuesday, July 11, 2017

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ORIGINAL ARTICLES  

Endometrial hyperplasia: A-2 decade retrospective analysis of histopathological pattern at a university teaching hospital in Northern Nigeria Highly accessed article p. 171
Idris U Takai, Mohammed Bukar, Ahmed A Mayun, Emmanuel A Ugwa, Bala M Audu, Aisha Abdurrahman
DOI:10.4103/ssajm.ssajm_31_16  
Background: Endometrial hyperplasia (EH) produces a continuum of lesions that may be a precursor to the development of endometrial cancer, but the risk of which depends on the type of hyperplasia. Objective: To determine the prevalence and histopathological pattern of EH at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri. Materials and Methods: This was a 20-year retrospective review of all endometrial biopsies of patients diagnosed with EH in the histopathology department of the UMTH, Maiduguri, from January 1989 to December 2008 inclusive. Results: A total of 862 endometrial biopsies were reviewed during the study period. Out of this, 541 biopsies were EH, giving a proportion of 62.3%. The age ranged from 10 to 79 years with a mean of 32.5 ± SD 10.4 years. Most of the patients (79.7%) were in their 3rd decade. The results showed that simple EH was the leading histopathological type accounting for 83.2% (450/541) of the cases. Complex EH was responsible for 14.8% (80/541) of cases, while atypical EH was found in only 11/541 (2.0%). Conclusion: This study has shown that EH is very common among reproductive age women exposing them to high risk of endometrial cancers; therefore, close follow-up and definitive management are highly recommended.
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The eye health system and social influence on health decision making − An example from couching in Nasarawa State, Nigeria p. 176
Penzin Selben, Abdull Mohammed
DOI:10.4103/2384-5147.210202  
Introduction: The health systems assessment approach is applied to eye health to assess its readiness to meet the goals of the global action plan for eye care. The overall blindness prevalence in Nigeria is 0.78% (1.17 million people are blind of which 84% is avoidable). Cataract accounts for 43% of blindness. With a surgical rate of 300/million/year, couching is still being undertaken with 42.7% of eyes that had cataract treatment having been couched. Aims: This study assesses the eye health system of Nasarawa State, Nigeria and to find out why couching is still being practiced. Settings and Design: A mixed qualitative and quantitative method was used. Subjects and Methods: Questionnaires and interview guidelines were adapted from the International Agency for Prevention of Blindness/Eye Health Systems Assessment manuals. Health systems building blocks of governance, finance, human resources and service delivery along with traditional system were assessed, and their strengths and weaknesses were identified. Results: Eighteen interviews were conducted. There is no eye care coordinator to supervise eye care functions in the state. Eye care is not separately financed from the general healthcare. Seventy percent of healthcare expenditure is from out-of-pocket payments. There are enough but inequitably distributed eye care workers to meet the recommendations of vision 2020 for the population. The cataract surgical rate is less than 200/million/year and less than 100 surgeries/surgeon/year. Couching is encouraged through strong community influence despite the poor visual outcome. Conclusion: The Nasarawa State eye health system has the resources to meet the eye care demands of the population; however, it lacks co-ordination, and ineffective service delivery makes the surgical output low, thereby encouraging couching.
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Pattern of urological cancers in Kano: North-western Nigeria p. 182
Abubakar Abdulkadir, Sule A Alhaji, Haruna M Sanusi
DOI:10.4103/ssajm.ssajm_36_16  
Background: The ubiquity of urological malignancies is evident in the epidemiological surveys despite the existing peculiarities in the pattern of their distribution among the different domains. There is, however, no publication on the foregoing for unified urological cancers from North-western Nigeria. This study, therefore, aimed to describe the spectrum, the frequency, the patient’s age and sex distributions of urological malignant tumours in Kano. Materials and Methods: This was a 15-year retrospective review from 2nd January 2001 to 31st December 2015 of all the urological malignancies histologically diagnosed in Kano, Northern Nigeria. The analyzed variables included the patient’s age, sex, the organs involved and the histopathological category. Results: Nine hundred and eight urological malignancies were diagnosed in the 15 year period under review; the male-to-female ratio was 16:1. Adult and paediatric patients added up to 880 (96.9%) and 28 (3.1%), respectively. The organs involved were the prostate (514; 56.6%), the bladder (327; 36.0%), the kidney (47; 5.2%), the testes (9; 1.0%), the penis (6; 0.7%), the urethra (4; 0.4%) and the ureter (1; 0.1%). The predominant prostate histological variant was adenocarcinoma (98.1%). Urothelial carcinomas constituted 48.0% of bladder cancers, whereas 55.3% of renal malignancies were nephroblastomas. Conclusion: study unveiled high prevalence of urological cancers, particularly prostate and bladder cancers in the populace; consequently, the urge for greater commitment to a comprehensive urological cancer prevention and treatment plans.
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Burden of hepatitis B and C infections among pregnant women in Bauchi, North-eastern Nigeria p. 188
Yusuf B Jibrin, Philip M Kolo, Alkali Mohammed, Emmanuel O Sanya, Labaran D Aliyu
DOI:10.4103/2384-5147.210204  
Context: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are growing public health concerns and are responsible for most cases of chronic liver disease worldwide. Aims: This study evaluated the prevalence and associated sociocultural factors in HBV and HCV infections among pregnant women in our hospital. Settings and Design: Cross-sectional hospital-based study. Materials and Methods: Two thousand four hundred and sixty-two pregnant women were recruited for the study with a mean age of 26.4 ± 5.6 years. Screening for hepatitis B surface antigen was done using latex rapid agglutination slide tests and samples that were reactive were further confirmed using enzyme linked immunosorbent assay (ELISA, Bio-Rad, France). Anti-HCV antibody was evaluated using a third generation ELISA (DRG International Inc., USA). Statistical Analysis Used: Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software (SPSS Inc., Chicago, Illinois, USA). Results: Seroprevalence of HBV and HCV infections in this study was 14.6 and 2.0%, respectively. Percentages of pregnant women who were positive for HBV increased progressively with age. Seroprevalence of HBV was significantly higher among participants with below secondary (20%) than those with secondary and tertiary education (13.1%), P = 0.001. Significant positive correlation was observed between HBV and scarifications (P = 0.001), and negative correlation was observed between educational level and HBV (P = 0.001). Significant positive correlation was seen between previous blood transfusion and HCV (P = 0.002). Conclusion: There is a high prevalence of HBV and HCV infections among the participants. HBV and HCV infections are associated with age, scarifications, blood transfusion, low level of education, and multiple sexual partners among the participants. There is a need for infants of HBV-positive mothers to receive hepatitis B immune globulin in addition to hepatitis B vaccine within 12 h of birth.
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Haematological variables of healthy pregnant women in Sokoto, North-western Nigeria p. 194
Abubakar U Musa, Muhammad A Ndakotsu, Abubakar A Panti, Constance E Shehu, Aminu U Kaoje
DOI:10.4103/ssajm.ssajm_41_16  
Context: Pregnancy exerts changes on the haematological system with consequences on interpretation of laboratory results and subsequent diagnosis or intervention. Furthermore, significant variations in haematological variables are known to occur between populations reflecting interplay between genetics and environment. Aim: To determine the values of haematological variables for normal pregnancy in Sokoto. Settings and Design: A descriptive cross-sectional study conducted over a 6-week period at antenatal clinics of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, North-western Nigeria. Subjects and Methods: Apparently healthy pregnant women who presented at the antenatal clinics of UDUTH, Sokoto for booking were recruited and had automated full blood count conducted on their blood sample. Statistical Analysis Used: Data were entered into Statistical Package for Social Sciences software version 17 for descriptive analysis while analysis of variance was employed to compare haematological variables among the trimesters of pregnancy. Level of statistical significance was set at P < 0.05. Results: A total of 404 pregnant women were recruited and had mean haematocrit, white blood cell (WBC) counts and platelet counts of 33.00 ± 3.62%, 7.78 ± 2.21 × 109/l and 242.51 ± 63.18 × 109/l, respectively. No statistically significant differences were found across the three trimesters of pregnancy in respect of haematocrit, WBC counts and platelet counts (P > 0.05). Conclusion: This study has provided the values for haematological variables during normal pregnancy, which could serve as reference values for Sokoto and possibly other parts of North-western Nigeria.
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An assessment of knowledge, attitude and perceived risk of Ebola virus disease (EVD) among rural dwellers in Northern Nigeria p. 199
Zainab K Muhammad-Idris, Clara L Ejembi, Aisha A Abubakar, Suleiman S Bashir, Lawal Ahmadu, Hajara N Kera, Charles Esekhaigbe, Kenneth O Adagba
DOI:10.4103/ssajm.ssajm_25_16  
Introduction: The last Ebola virus disease (EVD) outbreak that affected countries in the West African sub-region was introduced into Nigeria on 20th July 2014. Nigeria successfully contained the epidemic in its early stages while other countries in the region have most recently attained control; however, the resurgence is still imminent. The epidemic was compounded by a high level of ignorance and misconceptions. The study, conducted in a rural community in Northern Nigeria, sought to assess their EVD knowledge, attitude and risk perception. Subjects and Methods: The study, which is cross sectional descriptive, was conducted in Iyatawa village, a rural community in Giwa LGA, Kaduna State. Data were collected through administration of questionnaires to all the 358 household heads in the village. Scores were computed for knowledge and risk perception, and bivariate analysis was performed to find out associations among knowledge, risk perception and key socio-demographic variables with level of significance set at P < 0.05. Data were analysed using the Statistical Package for the Social Sciences version 21 software. Results: The median age of the respondents was 35.3 years. Majority of the respondents were Hausa/Fulani (99.7%), Moslem (96.1%), married (72.1%), had no formal education (91.9%) and were subsistence farmers (45.0%). Only 43.0% had good knowledge of EVD, and 15.9% positive attitude. Majority of the respondents (83.3%) perceived their EVD risk as low. Socio-demographic characteristics were neither significantly associated with knowledge nor risk perception. Conclusions: Comprehensive knowledge of EVD among members of Iyatawa community is fairly good; however, risk perception was low and attitude negative, thus suggesting the need to mount sensitisation and behaviour change communication interventions.
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Primary tuberculosis in a nomadic Fulani population and their cattle herds in Kano, Nigeria: a one health approach p. 205
Hamza Muhammad, Mahmood M Dalhat, Zaiyad G Habib, Musa M Bello, Abubakar U Bello, Ahmad M Yakasai, Aisha H Sadauki, Bashir Hussaini, Baffa A Gwaram, Faruk Sarkin-Fada, Kamilu Karaye, Idris Abdulkadir, Abdulrazaq G Habib
DOI:10.4103/ssajm.ssajm_40_16  
Background: Nigeria has a large population of Fulani pastoralists. Zoonotic infections like bovine tuberculosis (TB) are common among nomadic Fulani and their livestock. Close interaction between the nomads and their animals provide a critical human–animal interface with potential for transmission of zoonoses. We conducted a survey to determine the prevalence of primary TB infection among nomads and their cattle in Kano, north-western Nigeria. Materials and Methods: We performed tuberculin skin test (TST) to all inhabitants of the nomadic setting and a randomly selected population of their cattle. We obtained sociodemographic information and symptoms of pulmonary TB in both respondents and their cattle. We explore knowledge of respondents regarding risk of disease transmission between them and their livestock. We compare rates of TST among the respondents and the cattle. Participants with features of active TB were referred for further evaluation and treatment. Results: Out of 244 individuals evaluated, 103 (42.2%) were females with a median age (range) of 35 years (1–80 years). Among 167 participants who consented for and returned for TST reading, 45 (26.9%) were positive; 33 (73.3%) of which were between 20 and 50 years of age. A total of 29 (11.9%) respondents reported having cough for at least 3 weeks at the time of the study. Of the 244 participants interviewed, 51 (20.9%) reported having animals with chronic cough. A total of 26 (12.7%) of the 204 cattle tested had positive TST. Majority of the respondent (71%) were aware of potential risk of transmission of infectious diseases between them and their herds. Conclusion: High TST positivity among the nomads of economically viable age and their herds suggests that TB is prevalent in their communities with potential for animal–human transmission. TB and other infectious diseases control programs should capture nomads in their planning and implementation.
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CASE REPORTS Top

Gallbladder sludge associated with ceftriaxone therapy for typhoid fever in Nigerian children: A case series p. 210
Hafsatu W Idris, Lawal W Umar, Sakina Abdullahi, Ahmed U Hamidu
DOI:10.4103/ssajm.ssajm_29_16  
Ceftriaxone is a third-generation cephalosporin with a wide spectrum of activity against both gram-negative and gram-positive organisms. Ceftriaxone has proven efficacy against severe and difficult-to-treat community-acquired infections including typhoid fever and other sepsis syndromes caused by multi-drug resistant organisms. Several studies including prospective studies exist in the literature that described the accumulation of sonographically demonstrable sludge (or precipitates) in the gallbladder and sometimes in the urinary tract. The accumulation of sludge occurs during therapy for severe infections in some children identified with certain predisposing factors. The condition is often asymptomatic but might be associated with clinical features that could mimic disease progression in patients with intra-abdominal manifestations of infection such as typhoid fever. Five Nigerian children aged between 4 and 11 years developed demonstrable gallbladder sludge (precipitate) while on treatment for typhoid fever with ceftriaxone. Three of the children manifested clinical features suggestive of gallbladder precipitate accumulation following commencement of the antibiotic, while the other two did not. Ceftriaxone therapy was continued to completion in all the cases along with conservative management. Four of the children recovered and had resolution of the sludge, while the fifth died of multi-organ failure after surgery for intestinal perforation. Although several studies exist in the literature regarding this condition, our search using Medline and Google Scholar did not identify such reports from children in Nigeria or sub-Saharan Africa. The cases are presented to create awareness on the possibility of occurrence of a drug-induced biliary precipitate formation in children.
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Uterus bicornis unicollis; accidental discovery during an emergency cesarean section in a multiparous woman p. 217
Matthew C Taingson, Joel A Adze, Stephen B Bature, Durosinlorun M Amina, Mohammed Caleb, Abubakar Amina
DOI:10.4103/ssajm.ssajm_34_16  
Uterine anomalies are usually incidental findings in our environment, because of the limited spread of noninvasive diagnostic procedures. We present a case of a 26-year-old G7P4+2 (none alive). She presented at 36 weeks of gestation with antepartum hemorrhage secondary to placenta previa. At surgery, she was delivered of a fresh still-born male baby that weighed 2.3 kg and found to have a bicornuate unicollis uterus.
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Late diagnosis of Hirschsprung’s disease p. 220
Suleiman Lawal, Philip O Ibinaiye, Sefiya A Olarinoye-Akorede, Joseph B Igashi, Ahmed H Umdagas
DOI:10.4103/ssajm.ssajm_28_16  
Hirschsprung’s disease is a congenital aganglionosis of the submucosal and myenteric neural plexuses principally affecting the rectosigmoid or rectal segments of varying length. Most cases become manifest during the neonatal period,but in rare instances, the disease is initially diagnosed in older children or adult patients.
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