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   2016| April-June  | Volume 3 | Issue 2  
    Online since June 21, 2016

 
 
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REVIEW ARTICLE
A review of population-based studies on diabetes mellitus in Nigeria
Tukur Dahiru, Alhaji A Aliyu, AU Shehu
April-June 2016, 3(2):59-64
DOI:10.4103/2384-5147.184351  
Diabetes is a major cause of morbidity and mortality both in developing and developed countries. The incidence is rising rapidly with sub-Saharan Africa experiencing the largest percentage increase between 2013 and 2035. Nigeria has the largest number of people with the disease, yet information on the diabetes mellitus for policy and programming is fragmentary. Therefore, the purpose of this study to systematically identify population-based studies on diabetes in Nigeria and to determine the prevalence and sex differential. A literature search of the PubMed database was conducted of published research between 1990 and 2013 using the medical subject headings "diabetes mellitus" and "Nigeria." The search was done at the end of 2013 which returned 741 hits. A manual search for additional studies was performed using references cited in the original articles. Some authors were contacted whose full-text publications were not available on the PubMed database or freely on the internet. Twenty population-based studies that had been conducted on the prevalence of diabetes in Nigeria between 1990 and December 2013 that satisfied the inclusion criteria were identified. The prevalence of diabetes ranged from 0.8% to 11% involving both urban and rural populations, with varying sampling schemes, one study reported a traditional population with very low prevalence of diabetes and highly specific populations as well. The review revealed a generally low prevalence (<10%) of diabetes in Nigeria. It also found that there is dearth of literature on diabetes. There is the need to undertake a nationally-representative survey to assess the burden of diabetes in general population.
  12,736 1,108 2
ORIGINAL ARTICLES
Normative ultrasonographic values for testicular volumes in Nigerian boys aged 0-15 years
Suleiman Lawal, Hafsatu Wasagu Idris, Philip Ibinaiye, Ahmed Umdagas Hamidu, Musa Abdulkadir Tabari, Bello Usman, Ahmad Tijjani Lawal
April-June 2016, 3(2):71-78
DOI:10.4103/2384-5147.184353  
Background: Pediatric testicular volume is an important index in determining the start of puberty, its progress, and/or any subsequent disorder of puberty. It is also important in detecting and monitoring local testicular pathologies. This study is aimed at obtaining reference values for testicular volume measured by ultrasound in normal pediatric age group 0-15 years. Materials and Methods: This cross-sectional study was conducted at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Boys numbering 450 without any evidence of testicular pathology were recruited for this study. The testicular volume was measured by ultrasound (Aloka SSD 3500) utilizing the testicular length, width, and thickness of the ultrasound images. All measurements were analyzed using Statistical Package for Social Sciences (SPSS 17). A P ≤ 0.05 was considered statistically significant. Results: The testicular volume shows no significant increase before the age of 9 years with an average volume of 0.74 ml and then increased to 1.1 ml at 9 years. Afterward, it shows marked increase in volume to reach a value of 8.99 ml at 15 years. Strong correlations were established between the right and left testicular parameters, except for the anteroposterior diameter. However, no statistically significant difference was observed between them, except for length (P = 0.000). Conclusion: The study provides contemporary reference values for testicular volume of the pediatric age group.
  11,761 474 -
Diagnosis of malaria: A comparison between microscopy and rapid diagnostic test among under-five children at Gusau, Nigeria
Bilkisu Ilah Garba, Aminu Sakajiki Muhammad, Abdullahi Musa, Bassey Edem, Ibrahim Yusuf, Nura Kaura Bello, Akeem Oladiran Adeniji, Taofik Kolawole
April-June 2016, 3(2):96-101
DOI:10.4103/2384-5147.184371  
Background: Malaria remains a disease of public health concern in tropical countries. Diagnosis in such countries largely depends on clinical assessment, microscopy (as the gold standard) and recently by rapid diagnostic tests (RDTs). This study was conducted to document common presenting symptoms of malaria, compare microscopy and RDT in the diagnosis of malaria in children in Gusau, Nigeria. Materials and Methods: A cross-sectional, study of children under-five years with presumptive diagnosis of malaria that was managed at the pediatric outpatient department and emergency pediatric unit of Yariman Bakura Specialist Hospital, Gusau. All consecutive children that met the inclusion criteria were recruited over a 4 weeks period. Malaria thick film microscopy and RDTs were carried out on all children. Results: Of the 118 children enrolled, 61 (51.69%) were males while 57 (48.31%) were females. Fever and vomiting were the most common presenting complaints. Microscopy was positive in 55 (46.61%) while RDT was positive in 10 (8.47%) of the children. Only 5 (4.24%) were positive for both microscopy and RDT. Fifty-eight (49.15%) children had negative microscopy and RDT results. There was no significance when positivity of both tests were compared (χ2 = 0.050, P = 0.822). RDT had a sensitivity of 9.09%, a specificity of 92.06%, positive predictive value of 50.00%, and a negative predictive value of 53.70%. Conclusion: Our study observed higher positivity rate for microscopy than RDT. We recommend microscopy to be carried out on all patients suspected of having malaria where possible, even in the presence of negative RDT.
  4,968 475 2
Reproducibility of hematological parameters: Manual versus automated method
Aliyu A Babadoko, Ismaila N Ibrahim, Abubakar U Musa, Nasiru Usman
April-June 2016, 3(2):65-70
DOI:10.4103/2384-5147.184352  
Background: The automated hematology analyzer has replaced the traditional manual assay methods and eye count for determination of hematological parameters. Recently, they are widely used in laboratories and hospitals for counting of blood cells necessary for diagnosis and monitoring treatment of various disorders. Objective: To compare the blood count results of automated hematology analyzer with the traditional manual method in the determination of some hematological parameters. Methodology: A total of 100 samples were randomly selected from samples received at the reception of hematology laboratory in June 2014. The anticoagulated blood was collected and subjected to analysis of hematological parameters by automated hematology analyzer (Swelab Alfa) and standard manual methods. Results: The mean hematocrit, total white cell and platelets count, neutrophils, and lymphocytes percentages by manual method were 37.5 ± 7.2%, 7.2 ± 3.7 × 10 9 /L, 244.8 ± 171.8 × 10 9 /L, 53.8 ± 16.0%, and 41.8 ± 28.2%, respectively while that by automation were 37.2 ± 7.3%, 7.9 ± 6.1 × 10 9 /L, 278.1 ± 162.0 × 10 9 /L, 52.6 ± 16.0%, and 41.0 ± 14.3%, respectively. Whereas the mean platelets count was significantly (P < 0.05) higher in the automated method, there was no significant statistical difference between the mean hematocrit, total white cell and platelets count, neutrophils, and lymphocytes percentages of all the study samples (P > 0.05) and this remained so in male gender. The Pearson correlation test showed a positive significant (P < 0.05) correlation between both methods even after gender stratification. Conclusion: Automated analyzers can be used in all laboratories to provide quick and accurate results for patient care. However, it should be accompanied by microscopic blood film examination to provide confirmatory and additional useful diagnostic information.
  3,508 336 -
Knowledge of contraception and contraceptive choices among human immunodeficiency virus-positive women attending antiretroviral clinics in Zaria, Nigeria
Adamu U Shehu, Istifanus Anekoson Joshua, Zuwaira Umar
April-June 2016, 3(2):84-90
DOI:10.4103/2384-5147.184355  
Introduction: Once human immunodeficiency virus (HIV)-positive women become aware of their status, many demonstrate a reduced desire for pregnancy, particularly because most of them know that there are risks involved in delivering an HIV-positive child. Others, on the other hand, want to have children despite their HIV-positive status. These women have reproductive needs that should be respected and attended to. This study assessed the knowledge of contraception and contraceptive choices among HIV-positive women of reproductive age (15-49 years) attending antiretroviral clinics in Zaria. Materials and Methods: A cross-sectional descriptive study was carried out on 340 HIV-seropositive women of reproductive age group in January 2015 using a simple random sampling technique. Data were collected via structured interviewer administered questionnaire. Data collected were analyzed using SPSS version 21.0 and results were presented in tables and charts. Statistical significance was at P = 0.005. Results: The modal age group of the respondents was 20-29 years (44.7%) with mean age of 24.5 ± 8.4 years, 45% were Hausa, 59.4% Muslim, and 57.4% married. The majority (32%) had secondary education and of different occupation. About 87% had knowledge of HIV transmission from infected mother to child and 73.8% had heard of contraception. Prevalence of past contraceptive usage among these women was 56.1%, of which male condom was the most commonly used contraceptive (60.4%), either alone or dual contraception. This was followed by injectables (52%) and oral pills (35%). However, the current contraceptive use among the respondents was 36.3%. There was statistical relationship between age and educational level of the respondents and contraceptive use. Conclusion: The study has demonstrated that majority of these HIV-positive women had good knowledge about contraception but they do not apply this knowledge they have toward using an appropriate family planning method. Hence, there is a need for proper counseling and education of these women and their spouses by the health workers as they attend the antiretroviral clinic to erase fear and misconceptions of modern contraception. Male involvement will also go a long way in promoting contraceptive utilization.
  3,371 286 1
CASE REPORTS
Rhinoentomophthoromycosis in Northern Nigeria: Report of two cases
Aminu Bakari, Iliyasu Yunusa Shuaibu, Mohammed Aminu Usman, Ahmed Mayun, Sa'ad Aliyu Ahmed
April-June 2016, 3(2):118-121
DOI:10.4103/2384-5147.184380  
Rhinoentomophthoromycosis is a rare granulomatous disease restricted to the nose and its surrounding tissues. The disease occurs mostly in tropical rainforest of Africa, India, South and Central America, and South East Asia. Etiological diagnosis of the disease may be difficult because the fungal element is rarely found in the tissue and if present may be fragmented. Two cases of managed subcutaneous zygomycosis (rhinoentomophthoromycosis) from the Savannah region of Northern Nigeria are presented. A review of clinical presentation, investigations, and treatments outcome are described. High index of suspicion is required so that treatment can be started early to avoid attendant consequences and improve the outcome.
  2,344 133 -
ORIGINAL ARTICLES
Effectiveness of transfluthrin-coated inflammable-fumes insecticide-paper (Rambo™) in the prevention of malaria in Kano, Nigeria
Muhammad Hamza, Musa Muhammed Bello, Mahmoud Yakub Ma'aruf, Abdulsalam Yayo Manu, Abduljalal Ado, Yasmine Dalhatu, Abdulhadi Ahmad Abubakar, Isa Abubakar Sadeeq, Zubairu Iliyasu, Muhammad Musa Borodo, Sadiq Sulaiman Wali, Abdulrazaq Garba Habib
April-June 2016, 3(2):111-117
DOI:10.4103/2384-5147.184379  
Background: A 15-month community-based randomized controlled trial was conducted with the aim of assessing the effectiveness of transfluthrin-coated inflammable-fumes insecticide-paper (TCIP) (Rambo™) on indoor mosquitoes and malaria. Methods: The study was conducted in two communities, Panshekara and Danbare, Kano, Nigeria, randomly selected as intervention and control, respectively. One hundred and fifty Households (HH) were systematically selected in each of the two and their doors and windows were "netted" with mesh-wire. In the intervention community, there were "netted-alone" and "netted+TCIP" administered HHDs. Participants were allowed to the use of insecticide-treated mosquito nets. An additional 20 HHDs were randomly selected within the two communities as internal controls and were neither "netted" nor administered TCIP. Fever, blood-film microscopy for malaria parasite, hematocrit, and entomological indices (indoor mosquito collection and determination of species at breeding sites) were conducted quarterly. Pyrethrum spray collection technique was used to collect adult mosquitos monthly from rooms in both communities. Main malaria vector species were identified using molecular techniques such as polymerase chain reaction. ELISA was used to identify circumsporozoite protein (CSP) of Plasmodium falciparum. Results: A total 2565 persons were studied in Panshekara (1208) and Danbare (1357). There was a declining trend in malaria through 4 quarters in Panshekara compared to baseline (χ2 -trend, P = 0.02) and slight reduction in proportion with anemia. In Panshekara, a total of 1592 Culex species were collected, out of which 911 (57.2%) were from the internal control, 440 (27.6%) were from the screened "netted," and 241 (15.1%) from "netted+TCIP" treated HHDs. Three hundred and ninety-six Anopheline malaria vectors were collected, out of which 339, 27, and 30 were from the control, "netted," and "netted+TCIP" treated sites, respectively. In comparison to the baseline prenetting phase, wire netting alone provided 51% protection against the nuisance of culicine mosquitoes, whereas netting plus TCIP provided 73% protection against Culicine mosquitoes. The main malaria vector species were Anopheles gambiae s. s and Anopheles arabiensis, but Anopheles funestus could not be analyzed further. CSP of P. falciparum was seen in all the 3 vector species. Conclusions: Very slight reduction in malaria and anemia was observed. Protection conferred by TCIP was modest against Culex spp., but small against the malaria vectors. TCIP complimented netting with Trial number-ATMR2010050002022487 (Pan-African-Clinical-Trial-Group).
  2,140 116 1
Motivators and disincentives to exclusive breastfeeding among mothers in Zaria, Northwestern Nigeria
Abdulkadir Isa, Hassan Laila, Hassan Ishaku, Moroof Suleman, Ogala William Nuhu
April-June 2016, 3(2):91-95
DOI:10.4103/2384-5147.184356  
Background: Human milk remains the best food for infant optimal nutrition, growth, and development. Breastfeeding among mothers however remains challenging with an increasingly less proportion of mothers' breastfeeding their babies and even far less practicing exclusive breastfeeding (EBF). Bearing in mind the complexities in deciding infant nutrition in our communities, the study explored the motivators and disincentives to EBF among mothers and assessed mothers' perception of key stakeholders in influencing infant nutrition decision-making. Objective: To evaluate factors that motivate/deter mothers from exclusively breastfeeding their babies in Zaria. Methods: The study was a cross-sectional study of mothers in Zaria as part of a national multicenter breastfeeding survey. Information was obtained using a specifically designed structured interviewer-administered questionnaire on mothers' knowledge and practices of breastfeeding and their perception of the attitude of significant others to EBF. Focus-group discussions were held with groups of predefined significant others (fathers and grandmothers), and in-depth interviews were also conducted. Results: Ninety-seven percent of mothers have heard of EBF while 68% had a correct perception of the concept. The percentage of those that ever breastfed was 98.1% while only 2% practiced EBF. Motivation to EBF appeared to be the conviction on the benefits of EBF. Reasons for not supporting EBF were mainly surrounding the perceptions that babies like adults must drink water even if once a day and the inadequacy of human milk as sole infant nutrition within the first 6 months of life. Mothers perceived mainly health workers as promoters and supportive of EBF and breastfeeding in general while religious leaders and relatives, particularly fathers and grandmothers, though aware of EBF, were least supportive. Conclusion: Almost all mothers were aware of EBF; however, only a few (2%) exclusively breastfed their babies. Incentives to EBF appear to go beyond information and knowledge of breastfeeding. More needs to be done to understand other factors which influence mothers will to exclusively breastfeed.
  1,885 132 -
Reducing diabetes-related major limb amputations: A plea for a multidisciplinary team approach
Kenneth Ezenwa Amaefule, IO Okpe, IL Dahiru, AA Aruna
April-June 2016, 3(2):102-105
DOI:10.4103/2384-5147.184377  
Background: Diabetic foot is a challenging complication of diabetes mellitus, affecting a significant number of diabetic patients and often resulting in amputations especially in resource-poor nations. Patients and Methods: A 4-year retrospective review of clinical records of patients with diabetic foot lesions (DFLs) treated at Ahmadu Bello University Teaching Hospital, Zaria. Results: One hundred and thirty-eight patients were admitted with DFLs, but only 109 patients had complete medical records available for review. Nine patients had bilateral lesions at presentation. Seventy-three (61.9%) were male and 45 (38.1%) were female. Three (2.6%) were young adults (<40 years) while 89 (75.4%) were middle age (40-65 years) and 26 (22.0%) were elderly (>65 years). Fifty-two (44.0%) of the lesions were admitted through the diabetic clinic while 66 (56.0%) presented to the emergency room. Wagner Grade IV and V lesions constitute the majority (68.7%). The mean duration of the lesions at presentation was 6 weeks while the mean interval between first review by an endocrinologist and first surgical review was 17 days for those admitted through the diabetic clinic. Seventy-seven had surgical interventions, 30 of which were major amputations. The mortality rate was 14.6%. Conclusion: Diabetes-related foot lesions pose a great challenge in developing countries, with a significant number of the patients undergoing major amputation, an incapacitating outcome largely contributed to by late presentation and poor quality of diabetic foot care. With the impact being made by public health enlightenment programs on diabetes complications, a multidisciplinary team care approach from the outset goes a long way in reducing major amputations in these patients.
  1,651 111 -
Tropical diabetic hand syndrome among diabetic patients attending endocrine clinic of Ahmadu Bello University Teaching Hospital, Shika Zaria, North Central Nigeria
Innocent Onoja Okpe, Kenneth Ezenwa Amaefule, Ismail Lawal Dahiru, Yaqub Lawal, Ademola Odunayo Adeleye, Beatrice Bello-Ovosi
April-June 2016, 3(2):106-110
DOI:10.4103/2384-5147.184378  
Background: Tropical diabetic hand syndrome (TDHS) is a known complication affecting patients with diabetes mellitus in the tropics. However, there has been no previous report on the condition from the Northern Nigeria. This study assessed the prevalence of the syndrome among diabetic patients attending the endocrine clinic of Ahmadu Bello University Teaching Hospital (ABUTH), North Central Nigeria. Materials and Methods: A retrospective cohort study was employed for the study from January 2010 to May 2013. All patients with incomplete treatment records were excluded from the study. Data analysis was done with Statistical Packages for Social Sciences (SPSS) version 20.0 and presented as tables and charts. Results: Of the total 894 cases reviewed, the prevalence of diseases condition was 12 (1.3%), with female to male ratio of 2:1. Majority (75.0%) of the initiating events were minor trauma, followed by spontaneous blisters and subsequent rupture (16.7%) and the least (8.3%) was burns. The mean interval between onset of disease and presentation in the hospital was 22.9 days. Staphylococcus aureus was the main microbial isolates (75.0%) and majority (88.9%) were sensitive to ciprofloxacin. Mortality rate among the patients was 25.0% while amputation and healing with fixed flexion deformity of digits accounted for 33.3% and 58.3%, respectively. Conclusion: TDHS is a significant complication among diabetic patients in ABUTH, and the most common initiating risk factor was minor trauma. Mortality rate among the patients was also high. Hence, there is a need for intensive education of diabetic patients on the benefits of early diagnosis and treatment and avoidance of trauma.
  1,533 114 1
Colour doppler application in vascular diseases as seen in Benin City, Nigeria
Stanley Ukadike Okugbo, Adenike Olayemi Akhigbe
April-June 2016, 3(2):79-83
DOI:10.4103/2384-5147.184354  
Background: Doppler ultrasound scan (DUS) is not a new investigative tool but has however been relatively absent in our resource-poor setting. In its deployment, it requires both expensive equipment and trained personnel; both of which are somewhat lacking in our resource-poor setting. Aims: This is a retrospective study undertaken to audit the first set of patients who had DUS at a private facility in Benin City. A retrospective review of indications versus eventual diagnosis in 173 patients was seen from April 2009 to August 2013. Materials and Methods: This is a retrospective study from April 2009 to August 2013 undertaken to audit the first set of patients who had DUS at a private institution in Benin City. The medical notes and referral forms clinic data of patients seen from April 2009 to August 2013 were collated. Results: In the period under review, 173 patients were scanned. The mean age of the patients was 51.2 ± 20 years (range of 2 months to 94 years). The main indications were deep venous thrombosis (DVT) in 60 (35.5%) patients and peripheral arterial disease in 55 (31.8%). There was a bimodal age distribution at 20-30 and 55-70 years, and the younger age group had a preponderance of trauma with DVT and aneurysms while the older had arteriosclerosis and DVT. The lower limb was the part of the body scanned most frequently scanned (79.4%). Conclusion: DUS is a useful tool for timely evaluation of vascular lesions. Despite the siting of sonographic equipment outside a hospital setting, patients are able to access it to provide useful addition to their management.
  1,480 136 -
CASE REPORTS
Multicystic dysplastic kidney with associated contralateral renal ectopia in an infant: A rare association
Abdullahi Musa, Lawal Waisu Umar, Mairo A Bugaje, Akuse M Rosamund
April-June 2016, 3(2):122-124
DOI:10.4103/2384-5147.184381  
Multicystic dysplastic kidney (MCDK) is one of the most common forms of congenital cystic diseases of the kidney that usually occurs sporadically and may rarely be associated with concomitant anomalies of the heart, spine, brain, and gastrointestinal system. The disorder is known to be commonly associated with a normally situated functional contralateral kidney and without significant symptoms. We report a case of an infant who presented with acute urinary tract infection on a background of an unusual association of normally positioned but nonfunctional MCDK and functional ectopic (pelvic) kidney on the contralateral side. We suggest the inclusion of diagnostic ultrasound as a routine investigation for pregnant women during antenatal care at all levels of health care to aid prenatal detection of renal abnormalities and a multidisciplinary approach to early management.
  1,311 71 -
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