Chest x-ray findings of paediatric patients seen at a Teaching Hospital in North-western Nigeria

Introduction: Plain radiography is the first line of radiological examination used for the evaluation of paediatric chest, and also a rapid imaging technique that allows lung abnormality to be identified. X-ray is used to diagnose conditions of the thoracic cavity, including airways, ribs, lungs, heart, and diaphragm. Chest x-ray has a high sensitivity for pulmonary tuberculosis and thus is a valuable tool to identify a differential diagnosis for a patient. Methodology: Two hundred and eleven paediatrics chest x-ray reports were studied between February 2017 to September 2018. Data were collected retrospectively from the hospital archives using a data capture sheet. Results: Two hundred and eleven radiographs were assessed and the age of patients whose radiographs participated in the study ranged from 0-15 years. Also, a greater number of male patients 133(63.03%) participated in the study than female patients 78(36.97%). Among all the radiographs used in this study, the most common age group for this study ranged from 0-3 years. Results from the study also revealed that bronchopneumonia was the most common finding totaling 105(49.76%) followed by radiographs which are normal findings 77(36.49), pulmonary tuberculosis, 19(9.00%), congestive heart failure 4(1.90%), pleural effusion 3(1.42%), enlarged adenoid 2(0.95%) and dextrocardia 1(0.47%). Conclusion: This study report bronchopneumonia was the most common paediatrics radiographic finding in a chest x-ray. Plain radiography is an effective tool to examine various respiratory and cardiac pathologies and is the first line of investigation for chest pathologies.

A tropical tertiary neurosurgical center response to COVID-19 pandemic and its effect on neurosurgical practices

Background: COVID-19 pandemic may decrease the quantum of care for patients with neurosurgical conditions. Objectives: To determine outpatient clinic (OPC) patient load, neurosurgical procedures volume and disease spectrum following the institution of a new care protocol during the ongoing COVID-19 pandemic and compare with previous practice data in our institution. Methods: A monocentric retrospective analysis of all patients requiring neurosurgical care over a 2-year period. Results: There was a 42.4% reduction in OPC attendance and 41.8% reduction in surgical procedures in 2020 compared to 2019. There was >60 percent reduction in the volume of surgery that was done at the onset and peak of the pandemic, but this has normalized in November 2020 despite the resurgence of COVID-19, after the institution of a new care protocol. Neurotrauma procedures (29.6%) were the most common neurosurgical operation in 2020 while congenital malformation surgery (37.3%) was the most common procedure performed in 2019. Conclusions: The ongoing COVID-19 pandemic initially led to significant decrease in quantum and spectra of patients who presented at the OPC and for neurosurgical procedures. Instituted local protocol and Teleclinics, if added to clinical care armamentarium, may help to improve on the low patient attendance during pandemics

The outpatient management of hypertension at two Sierra Leonean health centres: a mixed-method investigation of follow-up compliance and patient-reported barriers to care

Background: Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region. Aim: This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management. Setting: Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives. Methods: A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care. Results: Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care. Conclusions: In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts

Social connectedness in the context of patient-provider relationships: a study of adult outpatients' clinics of a tertiary health facility in north-central Nigeria

The concepts of social connectedness in the context of patient-providers relationships tends to focus on relationships from a healthcare provider's perspective; the patient's experience with the social relationship with their providers are inadequately described. This study examined patients' perspectives in terms of satisfaction with the perceived providers' attributes of social connectedness displayed during clinic encounter. This was a descriptive cross sectional study conducted between September and October 2019. A multistage sampling technique was used to select respondents and data was collected with the aid of a seven (7) items questionnaire on health care providers' social attributes of connectedness developed from the service quality (SERVIQUAL) questionnaire. The data was analyzed with the aid of SPSS 21.0 and statistical significance was set at a P value 0.05. Satisfaction was reported by 60.4% to 89.8% of patients with regard to the perceived health care providers' attributes of connectedness except for providers' support for which only 43.4% of the patients express satisfaction. Majority (89.8%) of patients were satisfied with the perceived providers' cooperation during clinical encounter. There was a significant association between patient satisfactions and all the perceived attributes.(p-value<0.001) The results of our study were encouraging, showing that the patients were generally satisfied with the perceived health care providers' social attributes. However, there is the need for improvement in social support given by the health care providers to their patients

Drug adherence among adult hypertensives attending medical out-patient clinic in a tertiary hospital in Ogun State, Nigeria

Objective: The research aimed to estimate the level of drug adherence, to determine the reasons for non-adherence, and identify risk factors associated with non -adherence among adult hypertensive clients attending an out-patient clinic in Ogun State, Nigeria. Methodology: A descriptive cross-sectional study of adults with hypertension at a medical outpatient clinic in a tertiary hospital. Four hundred and four (404) respondents were selected from November 2015 to April 2016, a validated questionnaire by Morisky Green was adapted and distributed by trained research assistants. The chi-square test was used to compare categorical variables like sex, marital status, and clinic attendance among the two groups of adherent and non-adherent hypertensive. Information was summarized using frequency tables and cross-tabulations. Binary logistic regression analysis was done. The level of significance was set at 5% Results: Optimal adherence was observed in 281(69.0%) of the respondents. Being a female (OR: 1.833; 1.048 -7.205, p=0.034), being employed (OR: 2.099; 1.097-4.096, p=0.03) and regular clinic attendance (OR: 22.26; 12.647 ­ 39.107, p<0.001) were significantly correlated with optimal adherence. Forgetfulness (23, 9.9%), use of traditional medicines (42, 18.1%), lack of funds (59, 25.4%), and feeling well (60, 25.9%) were some of the reasons for suboptimal adherence Conclusion: The level of drug adherence among the respondents was good, especially among those that attend clinics regularly, those that are employed, and female respondents. Suboptimal adherence among the few respondents was due to forgetfulness, the use of traditional medicine, lack of funds, and stopping the use of drugs when they felt better

The value of ultrasound in characterizing and determining the etiology of ascites

BACKGROUND: The aim of this study was to assess the role of transabdominal ultrasonography in characterizing and determining the etiology of ascites in comparison with laboratory ascitic fluid analysis and other methods used to establish the final diagnosis. METHODS: A prospective descriptive study was conducted on 61 patients with ascites attending outpatient department (OPD) or admitted to wards of Tikur Anbesa Specialized Hospital (TASH) and referred to radiology department for imaging from June 2017 to November 2017. Data were collected following the internationally recommended scanning technique in consecutive bases. The data were analyzed using SPSS version 20. The comparison of ultrasound and laboratory findings with final clinical diagnosis was analyzed using Chi-square test (X2). RESULTS: Of 61 patients with ascites enrolled in this study, females were 35(57.4%) with age range of 16 to 75 and mean age of 43.2±14.11. The cause of ascites was established in 59 cases using a combination of clinical, pathological, imaging evidences and tumor markers. However there were two cases who had ascites with indeterminate cause. US suggested the diagnosis in 54(91.5%) patients. Excluding mixed and indeterminate cases, ultrasound characterized ascites correctly as exudate and transudate in 95% cases. CONCLUSION: Ultrasound has significant accuracy to distinguish transudate and exudate ascites and in suggesting the underlying cause. It can be a valuable method of investigation of ascites in places where CT and MRI are not available, and it is the best complement for laboratory investigations on ascites in suggesting the etiology based on ascitic fluid texture and ancillary findings

Post-stroke depression: Prevalence, associated factors and impact on quality of life among outpatients in a Nigerian hospital

Objectives: To investigate the prevalence of post-stroke depression (PSD), its associated factors and impact on quality of life (QoL) among outpatients in a Nigerian hospital. Methods: This cross-sectional study was carried out among 140 adults made up of 70 stroke survivors and matched controls with s table hypertension. Participants were administered questionnaires to profile their socio-demographic and clinical characteristics. Subsequently, they were assessed with the modified mini-mental state examination (MMSE), modified Rankin Scale (mRS), schedule for clinical assessment in neuropsychiatry (SCAN) and World Health Organization Quality of Life-BREF (WHOQoL-BREF). Results: The mean ages (± s.d.) of stroke survivors and controls were 57.43 (± 9.67) years and 57.33 (± 9.33) years, respectively. Majority of stroke survivors (n = 55 [78.6%]) had infarctive stroke, and 37 (52.9%) had right hemispheric lesion. Sixteen (22.9%) stroke survivors had PSD, with moderate to severe depression (F32.1) being the most prevalent, while none of the controls was clinically depressed. PSD correlated positively with monthly health bill above 10000 naira ($61), significant post-stroke disability and poorer scores on all QoL domains (p < 0.05). Conclusion: Depression was 20-fold prevalent in stroke survivors compared to controls with s table hypertension, and sevenfold the life-time prevalence reported among adult general population in Nigeria. Furthermore, increased health care bills per month, significant post-stroke disability and poorer QoL indicated survivors more likely to have depression. Findings in this study support the need to pay closer attention to psychosocial needs of stroke survivors to improve well-being. Future longitudinal study on psychosocial burden of stroke is warranted

Taux plasmatiques de cortisol et d'albumine et leur impact clinique chez les patients en état de choc aux Cliniques Universitaires de Kinshasa, R.D. Congo

Contexte : Le pronostic vital des malades en état de choc est le plus souvent péjoratif. Les facteurs en cause sont notamment le retard des consultations, l'incertitude de diagnostic et la non-maîtrise des mécanismes de régulation de la pression artérielle.But : Déterminer les taux plasmatiques du cortisol et de l'albumine chez les patients en état de choc, rechercher l'impact des perturbations de ces taux sur leur évolution clinique.Patients et méthodes : Etude descriptive transversale des patients hospitalisés en médecine interne et en Réanimation aux CUK d'octobre 2016 à mars 2017 dans un état de choc. Les paramètres sociodémographiques et cliniques, les taux de cortisolémie et d'albuminémie ont été analysés. Les données ont été saisies à l'aide du logiciel Excel 2010 et le traitement effectué au moyen du logiciel SPSS 21, avec comme seuil de signification statistique de 0,05.Résultats : Le cortisol et l'albumine plasmatiques ont été dosés chez 22 des 26 patients (84,61%) en état de choc. 67% des patients étaient âgés d'au moins 60 ans. La détresse respiratoire (54,5%) et les troubles de la conscience (31,8%) étaient les principaux signes d'appel du choc. Le taux moyen du cortisol était de 1048,9 nML-1 le matin et de 1222,08 nM -1 le soir. Dix-sept des 22 malades (77%) étaient en hyper-cortisolémie. Nous n'avons pas trouvé une quelconque corrélation entre les taux plasmatiques de cortisol et la glycémie à l'admission des malades. Le taux moyen d'albumine était de 2,45 g/dl (extrêmes : 1,3-4,1 g/dl). Tous les malades sauf un (95%) étaient en hypo albuminémie. 31,81% des malades avaient les antécédents d'ulcère gastro-duodénal, 22,7% des patients étaient des diabétiques et 22,7% étaient des éthyliques. Aucune corrélation n'a été trouvée entre les taux d'albumine et d'hémoglobine sanguine. Cependant, l'étude a montré une corrélation négative entre les taux plasmatiques de cortisol et d'albumine. Quatorze décès (63,64%) ont été enregistrés, particulièrement chez les malades ayant une albuminémie inférieure à 3,8g/L. Seuls 8 malades (36,36%) avaient survécu.Conclusion : La quasi-totalité des malades admis en état de choc dans nos services des soins avaient des taux très élevés de cortisol et un important déficit en albumine plasmatique. Ce dernier pourrait expliquer, du moins partiellement, le lourd tribut payé par les malades qui en étaient affectés

Medication Adherence among Outpatients at the Jos University Teaching Hospital

Background: For every 100 prescriptions written; 25 to 30 are taken properly. Non adherence to medication is a reality to be addressed by detecting the barriers in order to make interventions aimed at improving medication adherence among patients. The aim of this study is to assess the level of medication non adherence among outpatients at the Jos University Teaching Hospital in Nigeria and to identify the factors and barriers to medication adherence among the patients; alongside educating and counseling the patients in an effort to promote adherence. Methods: A cross-sectional prospective study was carried out for 2 months from June 2013 to July 2013 at 6 outpatient departments of the Jos University Teaching Hospital in Plateau State; Northern Nigeria. Patients visiting the departments were involved in the study after taking their consent and completing a structured questionnaire. Statistical analysis was done using Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 17.Results: Out of 324 patients; 72 (22%) were non adherent to medication. The common cause of non-adherent behavior was forgetfulness (32%). Chi square test was conducted for categorical variables and adherence to medication was positively associated with psychiatry clinic recruits; male gender; higher educational level; absence of health insurance; fewer comorbidities; longer duration of condition and therapy; asking questions and satisfactory knowledge of medicines (p 0.05). The result showed that 40% (25) of the 62 non adherent patients that needed interventions were educated and counseled on the need to link frequency of administration with routine activities so as to promote adherence.Conclusion: This study reiterates the need for a systematic assessment of adherence to medication among patients alongside proffering adequate interventions to promote adherence to medication

Evaluation of Outpatient Prescriptions in a University-Based Healthcare Facility in Ibadan

Background: Appropriate drug utilization has a huge contribution to global reduction in morbidity and mortality. Periodic review of prescriptions at all levels of care is therefore essential. Objective: To evaluate drug prescription pattern and practice in a university-based healthcare facility using the WHO-core prescribing indicators.Method: A retrospective review of randomly selected outpatient prescriptions in the pharmacy unit of the University of Ibadan Health Services between 2012 and 2014 was done. Pre-piloted data collection form was used to retrieve data based on standard prescription specifications including socio-demographics; drug name and dosage regimen; and prescriber identity. Descriptive statistics were used to summarize the data. Results: A total of 4;121 medicines were reviewed in 1200 encounters. Of these; 589 (49.1%) were prescribed for males and 611 (50.9%) for females. Patients' ages were indicated in 388 (32.3%) prescriptions (mean age =17.7years). Summary of WHO-core prescribing indicators showed the average number of medicines per encounter as 3.4; medicine prescribed by generic name (2;533; 61.5%); encounter with one or more antibiotics and injections (427; 35.6%) and (150; 12.5%); respectively. Conclusion: Polypharmacy; low generic prescribing and overuse of antibiotics is common underscoring the need for ongoing enlightment and training of healthcare providers on rational prescribing practice and drug use

Sero-prevalence of human parvovirus B19 among patients attending some hospitals in Kano metropolis, Nigeria

Background: Human Parvovirus B19 (HPVB19) belongs to the family Parvoviridae; causes Erythema infectiosum; aplastic crises in persons with blood disorder and prolonged anaemia in immuno-compromised persons. During pregnancy the virus may be transmitted to the foetus which can result in hydrops foetalis; spontaneous abortion or intrauterine foetal death. The study determined the sero-prevalence of IgG antibodies to HPVB19 among patients in Kano metropolis in order to provide information on their immune status and the possible risk factors for acquiring the virus.Method: The study population comprised 460 patients seen at the outpatient department of two hospitals in Kano whose mean age was 28.8 (range 0 -70) years. Questionnaire was used to obtain data on socio-demography and risk factors. Blood sample was collected from each patient; serum was obtained and analysed for IgG antibodies to HPVB19 by ELISA according to manufacturer's instruction. Result/ Discussions: Sero-prevalence of 41.5) recorded among patients ?51 years old while the lowest prevalence was among those 1 year old (?20.05). Highest seropositivity was observed among farmers (64.2:18/28) while the lowest was among retired persons (27.2:3/11). There was significant association between HPVB19 and level of formal education attained (?2 =10.363; df=4; P=0.03) and number of persons living in a house (?2 =14.30; df=1; P=0.00). There was no association between HPVB19 and marital status (P=0.3) and type of residence (P=0.5). Blood transfusion (OR=2.0:1; P=0.08) and sickle cell anaemia (OR=1.7:1; P=0.08) were important risk factors for HPVB19 transmission in this study. Having blood transfusion showed a 2.0 fold risk while having sickle cell showed a 1.7 fold risk of acquiring HPVB19 infection. During the study; 48.2 of women of child bearing age had antibodies to HPVB19 IgG antibodies leaving about 52 still susceptible to the virus.Conclusion: Seroprevalence to B19 among patients was low leaving a large proportion of the population especially women in Kano still susceptible to B19 infection

Prescribing Pattern of Non-Steroidal Anti-inflammatory Drugs at the Outpatient Pharmacy Department of Lagos University Teaching Hospital; Nigeria

Background: Non-steroidal Anti- inflammatory Drugs (NSAID); are among the most widely used and misused of all drugs. Though they provide symptomatic relief from pain and swelling in chronic joint diseases; they may cause renal impairment; especially in combination with other nephrotoxic agents.Objectives: This study aimed to investigate the prescription pattern of NSAID in the Out-patient Pharmacy Department of Lagos University Teaching Hospital (LUTH); Nigeria.Design: A total of 3800 prescriptions containing NSAIDs were analyzed for information on drug name; the number of NSAIDs per prescription; the presence of ACE inhibitors and diuretics alongside NSAIDs and NSAIDs prescribed in generic or brand names. Results: The results showed that Aspirin was the most frequently prescribed NSAID (62.2) and 68.4 of the NSAIDs prescriptions studied were written in generic names. The total number of drugs per prescription was in most cases 3 or greater (84.6). There were statistically significant (p ? 0.05) associations between the individual NSAID prescribed and whether they were prescribed in generics or brand names; individual NSAID prescribed and the frequency of co-prescription with an ACE inhibitor and a diuretic; types of NSAID prescribed and the cost in Naira. Conclusion: Though most of the prescribers complied with WHO standard in their prescriptions vis a vis generic prescription; avoidance of polypharmacy and avoidance of drug interactions and contraindications; there is obvious need for interventional measures or strategies to improve rational prescribing for some of the prescribers tailored towards rational prescription and use of drugs

Breastfeeding Practices by Women Attending the Vaccination and Pediatric Out-Patient Clinics at the Yaounde Gynaeco-Obstetric and Pediatric Hospital Cameroon

Despite the well-known benefits of exclusive breastfeeding in sustaining infant well-being; breastfeeding rates still remain low in many countries. We aimed at investigating the practice and determinants of exclusive breastfeeding for the first six months of life in Cameroonian women. METHODS In this cross-sectional study; we interviewed a consecutive sample of 310 mothers at the Yaounde Gynaeco-Obstretic and Pediatric. The study was conducted from 1st September 2011 to 29th February 2012. Variables related to the practice of breastfeeding within the first 6months of life were assessed. Odds ratio was used to determine the predictive variables of exclusive breastfeeding for 6 months. RESULTS The reported rates of exclusive breastfeeding were 84.8 at birth and 23.5 at six months. Medical advice (49.3) and concern for the child's health (42.5) were the two main reasons for practicing exclusive breast-feeding for the first six months of life; while resumption of studies or work (38.4) and the belief that the newborn was not 'satisfied' (34.2) were the main reasons for introducing other foods. Most children (84.5) did not receive any foods first breastfeed. Breast milk substitutes were given to 70.5 of the babies. Most women (87.1) breastfed on demand; and breast pain was the main difficulty in 60.5 of the mothers. Being a housewife was positively associated with exclusive breast-feeding (OR:2.18; 95 CI: [1.25-3.81]; P= 0.005 ). CONCLUSION Exclusive breastfeeding in the first 6 months remains low in this setting. Sensitization and education of mothers during prenatal visits and routine consultations should be reinforced

Quality of life among dually diagnosed and non-substance-using male schizophrenia outpatients

Objective. To assess the quality of life (QoL) in an outpatient setting among male patients dually diagnosed with schizophrenia and substance use disorder (SUD); and non-substance-using male schizophrenia patients. Methods. The study was conducted in an outpatient setting with 52 male schizophrenia patients and 49 male schizophrenia patients with SUD comorbidity; who were admitted to Bakirkoy Research and Training Hospital between 1 May 2010 and 30 September 2010. The patients had been in remission for a minimum of 6 months. The subjects were re-evaluated for the persistence of the diagnosis by using the Structural Clinical Interview for DSM-IV Axis I disorders (SCID I) socio-demographic data form; and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) and positive and negative syndrome scale (PANSS) were administered to detect the factors affecting diagnostic stability and clinical course. Results. Schizophrenia patients with no SUD comorbidity had a significantly earlier age of disease onset than the comorbid group. SUD comorbidity in schizophrenia patients leads to increased rates of unemployment and homicidality. WHOQOL-Bref psychological health scores were significantly lower among patients in the comorbidity group. No statistically significant difference was identified between the groups with regard to the PANSS scores. Conclusions. It is necessary to focus on the treatment challenges for schizophrenia patients with SUD comorbidity; such as the provision of treatment in criminal justice settings; in which a high proportion of such patients are found

Determinants of patient satisfaction with outpatient health services at public and private hospitals in Addis Ababa, Ethiopia

Background: Patients have explicit desires or requests for services when they visit hospitals. However; inadequate discovery of their needs may result in patient dissatisfaction. This study aimed to determine the levels and determinants of patient satisfaction with outpatient health services provided at public and private hospitals in Addis Ababa; Central Ethiopia. Methods: A comparative cross-sectional study was conducted from 27 March to 30 April 2010. The study included 5 private and 5 public hospitals. Participants were selected using systematic random sampling. A pre-tested and contextually prepared structured questionnaire was used to conduct interviews. Descriptive statistics; analysis of variance; factor analysis and multiple linear regressions were performed using computer software (SPSS 16.0). Results: About 18.0of the patients at the public hospitals were very satisfied whilst 47.9were just satisfied with the corresponding proportions a bit higher at private hospitals. Selfjudged health status; expectation about the services; perceived adequacy of consultation duration; perceived providers' technical competency; perceived welcoming approach and perceived body signalling were determinants of satisfaction at both public and private hospitals. Conclusions: Although patients at the private hospitals were more satisfied than those at the public hospitals with the health care they received; five of the predictors of patient satisfaction in this study were common to both settings. Thus; hospitals in both categories should work to improve the competencies of their employees; particularly health professionals; to win the interests of the clients and have a physical structure that better fits the expectations of the patients

Adverse Effects Profile of Multidrug-Resistant Tuberculosis Treatment in a South African Outpatient Clinic

Background: Highly active antiretroviral therapy (HAART) and drugs that are used to treat multidrug-resistant tuberculosis have potentially overlapping adverse effects. Few South African studies have documented adverse effects in the multidrugresistant tuberculosis population. This study examined the adverse effects profile in a sample of the outpatient population at the King George V Hospital Multidrug-Resistant Tuberculosis Clinic in Durban; KwaZulu-Natal.Method: The method was an anonymous; retrospective record review of 350 patients with multidrug-resistant tuberculosis; who were attending the King George V Hospital Multidrug-Resistant Tuberculosis Clinic (2010-2011). Adverse effect profiles in patients with multidrug-resistant tuberculosis only; and those who were co-infected with the human immunodeficiency virus (HIV) who were on and not on HAART; were documented and analysed.Results: Adverse events were recorded for 80.6 of patients. These included hearing loss (28.7); peripheral neuropathy (23.2); diarrhoea; nausea and vomiting (20.5); arthralgia (15.9); rashes and dermatological effects (excluding Stevens-Johnson syndrome) (14); abdominal pain and dyspepsia (10.3); and psychoses and confusion (8.3). In this study population; 72.6 of patients were HIV positive; and 85 were concomitantly on HAART and multidrug-resistant tuberculosis treatment. Adverse events were significantly more common in patients who were HIV positive than in patients who were HIV negative with regard to peripheral neuropathy (p-value 0.001); psychosis and confusion (p-value