Mainstreaming the private health sector in the response to COVID-19: facility readinessassessment for screening services in Edo State, Nigeria.

INTRODUCTION: The COVID-19 pandemic presents an opportunity for the Nigerian health system to harness the potentials available in the private sector to augment the capacity within the public health system. This survey was carried out to assess private facility readiness in providing screening services in Edo State. METHODS: This was a descriptive cross-sectional study carried out among private facilities in Edo state. Facilities were selected using stratified sampling technique. Data was collected using adapted questionnaires and an observational checklist. Facility readiness was assessed using the Nigeria Centre for Disease Control recommendations for screening. Parameters were scored and overall scores were converted to proportions. Facilities that scored 70% and above were adjudged to be ready while facilities that scored 69% and below were adjudged to be not ready. RESULTS: A total of 252 health facilities were assessed, comprising 149 (59.1%) hospitals/clinics, 62 (24.6%) pharmacies and 41 (16.3%) laboratories. One hundred and forty-two (95.3%), 60 (96.8%) and 41 (100.0%) hospitals/clinics, pharmacies and laboratories, respectively had hand hygiene facilities. However, overall facility readiness assessment scores for screening services were low with only 51 (34.2%) hospitals/clinics, 2 (3.2%) pharmacies and 2 (4.9%) laboratories achieving high enough scores to be adjudged ready for screening services. CONCLUSION: Overall facility readiness of the private health sector to provide screening services in Edo State was assessed to be low. The government and facility owners will need to ensure that screening services are improved in all facilities to help mitigate community spread of COVID-19.

Chronic maxillary sinusitis complicated by right orbital abscess with ruptured globe following tooth extraction: a case report

Objective: This article reports a case of a chronic maxillary sinusitis complicated by right orbital abscess with ruptured globe following tooth extraction in a 70-year-old female diabetic patient 4 weeks after forceps extraction of the upper right 1st premolar. Case Description: Patient gave a history that prior to the tooth extraction, there was a carious cavity on the tooth, pain on mastication with background nasal congestion and post nasal drip of over one year duration. 4 weeks following extraction, there was marked right buccal and periorbital swelling. Examination by the ophthalmologist revealed rupture of the right globe with copious pus discharge from the lower eyelid of the right eye. Examination by the dental team and the Head and Neck Surgeon revealed the presence of oroantral communication with pus discharge from the oroantral fistula and the retropharyngeal area. Fasting Blood Sugar on presentation was 278mg/dl. Patient was referred to the physician for optimization of her blood sugar level.Evisceration of the right eye was carried out along with incision and drainage of the right eyelid and buccal space. Intravenous ceftriaxone 1g daily,intravenous metronidazole 500mg 8 hourly, intramuscular genticin 80mg 8 hourly, eusol A&B dressing twice daily, paracetamol per oral 1g 8 hourly, menthol crystals steam inhalation twice daily, Diazepam 5mg nocte were prescribed for the patient. Inferior meatal antrostomy with antral washout was carried out by the Head and Neck Surgeon 2 weeks after. Following surgery, patient was placed on per oral Tavanic 500mg once daily, metronidazole 400mg 8 hourly, vitamin c 100mg 8hrly,guaifenesin/pseudoephedrine 25mg nocte, diclofenac potassium 50mg twice daily and menthol crystals steam inhalation twice daily. Review of the patient four weeks' after surgery showed marked improvement in the clinical parameters of the patient, disappearance of swelling and cessation of pus from all points of previous discharge.Conclusion: Chronic maxillary sinusitis complicated by right orbital abscess with ruptured globe following tooth extraction may be considered a potential complication of forceps extraction of maxillary premolars and molars especially in a medically compromised patient. The authors hereby recommend (1) ensuring adequate medical and dental evaluation of patients before forceps extraction (2) all medically compromised patients must be optimized before forceps extraction (3) The need for multidisciplinary management of medically compromised patients with dental diseases

The burden of hypertension and diabetes mellitus in rural communities in southern Nigeria.

INTRODUCTION: The African region of the world is experiencing a double epidemic of both communicable and non-communicable diseases. The objective of the study was to determine the prevalence of hypertension and diabetes mellitus among adult residents of rural communities in southern Nigeria. METHODS: A community based descriptive cross-sectional study. Adults aged 18 years and above residing in the rural communities who attended a free medical outreach programme were screened for hypertension and diabetes mellitus. Data were collected using a structured interviewer-administered questionnaire. RESULTS: Of the 845 participants, 349 (41.3%) were aged 50-69 years, 263 (31.1%) were males, and 305 (36.1%) were farmers. Overweight and obesity were found in 184 (21.8%) and 90 (10.6%) of them respectively. The overall prevalence of hypertension was 37.6% (males 43.7%, females 35.1%, p = 0.018) while that of diabetes mellitus was 4.6% (males 1.9%, females 5.8%, p = 0.012). Predictors of hypertension were age ≥ 40 years (OR = 5.04, CI: 2.99 - 8.48), overweight/obesity (OR = 1.56, CI: 1.15 - 2.13) while females are less likely to develop hypertension (OR = 0.72, CI: 0.53 - 0.98). The significant predictor of diabetes mellitus was overweight/obesity (OR = 3.53, CI: 1.78 - 6.98). CONCLUSION: The rising prevalence of hypertension and diabetes mellitus is assuming an epidemic level in rural communities in southern Nigeria. There is an urgent need for intensive health education and community surveillance programmes targeted at rural communities in order to achieve prevention and control of these non-communicable diseases in Nigeria.

Assessments of the size of tympanic membrane perforations: a comparison of clinical estimations with video-otoscopic calculations.

We conducted a study to determine how accurate various ENT specialists were in estimating the size of 100 tympanic membrane (TM) perforations with standard otoscopy. The specialists included, in descending order of rank, 2 Consultant Surgeons, 2 Senior Registrars, and 2 Registrars, all of whom had confirmed good vision. We compared their estimates, which were made independently and expressed as a percentage of the total area of the TM, with exact measurements calculated with computer-based video-otoscopy. We found that the video-otoscopic calculations were far superior to the estimates of the specialists, even the most experienced Consultants (p < 0.01). We recommend that video-otoscopy be used whenever possible.