Frequency of Parent-reported Indicators of Sleep Disordered Breathing in Children with Clinical Diagnosis of Adenotonsillar Hypertrophy in Benin City, Nigeria.

Background: Sleep disordered breathing (SDB) comprises a wide spectrum of sleep-associated breathing abnormalities; those related to increase upper airway resistance include snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS). This concept suggests that a person who snores may be exhibiting the first manifestation of SDB and that snoring should not be viewed as normal. Obstructive sleep disordered breathing is common in children. Snoring, mouth breathing, and obstructive sleep apnea (OSA) often prompt parents to seek medical attention. Aim: This study aims to determine the frequency of parent-reported indicators of SDB among children clinically diagnosed with adenotonsilar hypertrophy (ATH) in the Otorhinolaryngology department of the University of Benin Teaching Hospital (UBTH), Benin City. Methods: This was a cross-sectional study of children aged 12 years and below who were sent to the Ear Nose and Throat clinics of UBTH, Benin-city with symptoms of obstructive adenotonsilar hypertrophy (ATH) between May 2012 and April 2014. All consecutive parent/caregiver who presented their child/ward to the ENT clinic with symptoms of obstructive adenotonsilar hypertrophy (ATH) were interviewed using structured questionnaire/proforma after verbal consent was obtained. Results: A total of 104 children were studied. The children were 73 males and 31 females with a male/ female ratio of 2.4:1. The children were aged 1-12yrs with average age of 4.98 ± 2.68 years. The parents/caregivers were 92 females and 12 males giving a ratio of 7.6:1.The frequency of sleep apnea was reported by 50 children/care givers (48.1%). There was a high prevalence of reporting for patients between the ages of 1 and 4years 62 (59.6%) which was followed by those between 5 and 9 years 34 (32.7%). Symptoms lasted more than 3 years in 43(41.3%), 1-2 years in 31(29.9%) and less than 1 year in 30 (28.8%) of the patients. Symptoms reported were snoring 104 (100%), nasal obstruction 97(93%), nasal discharge 96 (92%), mouth breathing 92 (88%), sleep apnea 50 (48.1%), restless night sleep 72 (69.2%), sore throat 69(66.3%), failure to thrive 2(1.9%). Cervical (jugulo-digastric) lymph node was enlarged in 70 (67.3%). Tonsillar grades were as follows; grade 3 was 59 (56.7%), 4 was 27 (26%) while 1 and 2 accounted for 17 (16.3%). Conclusion: Snoring was the commonest symptom reported in children with SDB. Parents and caregivers should monitor their children closely during sleep as this may reveal early symptoms of adenotonsilar hypertrophy causing SDB.

Chronic Suppurative Otitis Media in Nigerian Children: The Port Harcourt Experience.

Background: The prevalence of chronic suppurative otitis media in children appears to be on the increase in our society probably due to factors associated with poverty and deteriorating healthcare facilities. This study aimed to determine the prevalence of chronic suppurative otitis media as seen in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt with a view to documenting the pattern and highlighting the results of management. Patients and Methods: A retrospective study of all children that presented to the department of E.N.T surgery of UPTH, Port Harcourt, Nigeria with chronic suppurative otitis media over a tenyear period (January 2003-December 2012). The patient’s data were retrieved from the clinic registers, patients’ case notes and theatre registers. Demographic data, predisposing conditions, aetiological factors, site of tympanic membrane perforation, affected ear, treatment modalities, complications of treatment and outcome of management were recorded and analyzed. Results: Seven hundred and twenty three patients were found to have CSOM. These accounted for 9.4% of all otorhinolaryngological cases seen within the study period. There were 385 males and 338 females (male: female ratio of 1.1:1.0). Age range was 3 months to 16 years, mean = 8.2 +/- 3.2 years. Age group 1-5 years has the highest (n=344, 47.6%) number of cases. Bilateral CSOM accounted for the highest number (n=350, 48.4%) of cases. Perforation was found more on the antero inferior aspect of the tympanic membrane and the commonest etiological factor was poorly treated acute otitis media (AOM). The commonest mode of treatment was conservative medical treatment. Conclusion: This study confirmed a prevalence of 9.4% of CSOM in children that attended the ENT clinic in UPTH, Port Harcourt. The commonest type seen was the tubo-tympanic disease with antero-inferior tympanic membrane perforation. However, poorly treated AOM was found to be the commonest etiological factor. The provision of adequate health facilities and eradication of poverty possibly will reduce the prevalence of pediatric CSOM in our environment.

The Pattern of Foreign Body Impactions in the Tracheobronchial Tree in University of Port Harcourt Teaching Hospital

Background: Foreign body aspiration in the tracheobronchial tree usually presents as emergency. The diagnosis is often delayed. Aim: To determine the pattern of foreign body aspiration in the tracheobronchial tree in the University of Port Harcourt Teaching Hospital (UPTH) and to highlight the factors responsible for the morbidity and the unusually high mortality associated with this accident especially in the paediatric age group. Methods: This was a retrospective study of patients from the ENT Surgery department of UPTH over a ten-year period from January 1995 to December 2004. The Clinics record of attendance; augmented by ward and theatre records formed the material resource for this study. Extracted data was analysed using descriptive statistics. Results: Twenty-eight patients presented with foreign body aspirated in the tracheobronchial tree. Only 11 case notes were retrieved. There were 5 males (45.5) and 6 females (54.5) with a M: F ratio of 1:1.3. The age range was 1 to 45 years with a median age of 6 years. Children below 10 years made up the bulk (63.3). Groundnut was the commonest foreign body inhaled (45.5) while the right main bronchus was the site of lodgment in 9 patients (81.8). The outcome of treatment by the specialists showed a success rate of 63.3and mortality of 36.4. Conclusion: Foreign body in the tracheobronchial tree could be managed with better prognosis in the pediatric age group if the clinicians of first contact had a high index of suspicion and referred cases promptly

The perception of Patients of Doctor-Patient Relationship in Otorhinolaryngology Clinics of the University of Port Harcourt Teaching Hospital (UPTH) Nigeria

Background: The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high quality healthcare in the diagnosis and treatment of diseases. Recently; patient participation has gained increasing prominence in healthcare delivery. Aim: To explore the perceptions of Nigerian adult patients who attend the University of Port-Harcourt Teaching Hospital (UPTH) Otorhinolaryngology clinics with regard to relation with their doctors during consultations. Methods: This is a descriptive cross-sectional study; the duration of the field work was two weeks. The study population consisted of adult patients who attended the otorhinolaryngology clinics. Data collection was carried out using interviewer-administered semi-structured questionnaires that explored the perception of patients of doctor-patient relationship. Forty patients were selected for the study and the sampling was purposeful. An average of twenty interviews was conducted per clinic day. Each interview took approximately 15 minutes. Results: The majority (95) of patients' treatment was decided by the doctors. The majority of the patients (87.5) welcomed the opportunity to have more involvement in making treatment decisions. Most of the patients (67.5) were not satisfied with the services received from their doctors. Conclusion: This study established paternalistic model as the dominant pattern of doctor-patient relationship in UPTH otorhinolaryngology clinics. The patients preferred a more cordial relationship

Does the Nigeria Health Care System Need a Primary Gate-Keeper?

Background: The World Health Organization (WHO) is presently focusing more attention on how health systems will become more effective and efficient. Introduction of primary gate-keepers into healthcare systems by some countries has revolutionized their healthcare system. It clearly alters the channels by which patients receive care particularly in countries where specialists are in short supply. Aim: To discuss the role of primary gate-keeping in healthcare systems and to use the experience of some countries with and without a primary gate-keeper function to evaluate the Nigerian healthcare system. Methods: A search of some standard books and relevant articles on primary 'gate-keeping' and healthcare systems using the Google and Yahoo search engine facilities helped to gain access to general information on the title. We also searched the EMBASE and OVIDMEDLINE data bases using the HMIC search strategy template. Results: Healthcare services are delivered within three distinct but increasingly overlapping and fluid subsystems namely; primary; secondary and tertiary care. In the UK and Netherlands healthcare systems; the general practitioner (GP) serves as the primary gate-keeper to other professionals. On the contrary; France; Germany and Nigeria don't have effective primary gate-keeping system. However; in Nigeria family physicians run the general out-patient clinics and serve as a point of first contact and referrals. Conclusion: Gate-keepers are mainly geared towards helping a healthcare system to achieve better health levels. Unlike in the UK and Netherlands; there is no effective primary gate-keeping in the Nigerian healthcare system. Government should make efforts to address this anomaly to allow every person have effective and efficient healthcare services