Tetanus remains a formidable health challenge in Nigeria: The experience from a single Teaching Hospital in Osun State, Nigeria.

BACKGROUND: Tetanus, though an eminently preventable disease still ranks as a leading cause of death in Nigeria as well as in other developing countries. Reported mortality for severe tetanus varies from 20-60% and depends on the availability and quality of intensive care. Farmers and artisans are mostly affected. OBJECTIVES: This retrospective study was carried out to determine the pattern of clinical presentation of tetanus, the immunization status, case fatality rate and factors influencing mortality. METHODS: Case notes of patients (age > 10 and above) managed for tetanus from 2004-2008 at LAUTECH Teaching Hospital Osogbo were retrieved. Demographic, clinical data, laboratory investigation results and response to treatment were collated. The data obtained were analysed using the SPSS version 15 Statistical package. RESULTS: Over the 5-year period,80 cases of tetanus were managed in the medical wards of LAUTECH Hospital Teaching Osogbo. However, the medical records of 12 of them could not be retrieved, leaving 68(85%) for analysis. This comprised of 45 males and 23 females. Tetanus was highest in the third decade of life. The commonest portal of entry was the lower limb (n = 43). Only one subject was fully vaccinated and received booster dose of vaccine. Thirty-one (31)out of the 68 patients died giving a case fatality rate of 51.5%. CONCLUSION: The mortality of tetanus is still very high from this retrospective study. The rate of immunization against tetanus was dismally low. Active immunization should be given to all Nigerians particularly those in the vulnerable group.

Psychological profile of spouses of women with infertility in Nigeria.

Ninety five men who accompanied their wives to the fertility clinic of a Nigerian teaching hospital (index group) were compared with 95 matched controls using the Hospital Anxiety and Depression Scale (HADS). Their rates of significant anxiety symptoms (24.2%) and depressive symptoms (20.0%) were higher than the corresponding rates of 13.7% and 9.5% for the controls. The higher rate of significant depressive symptoms in the infertility group was significant (p < 0.05). Their mean scores on the two subscales of HADS (anxiety and depressive subscales) were also significantly higher (p < 0.001). Results of multiple regression analysis indicated that lower anxiety symptoms were predicted by age group among subjects in the index group, indicating that belonging to higher age groups was associated with lower anxiety symptoms. In addition, lower anxiety symptoms were predicted by 'being very religious'. However, higher anxiety symptoms were predicted by previous exposure to couple counselling. On the predictors of depressive symptoms, lower symptoms were predicted by age group and religiosity while higher symptoms were predicted by respondents' previous exposure to couple counselling and higher number of wives. Other factors investigated such as level of education, duration of infertility, attitude towards child adoption, pressure from extended family members on account of infertility, expectation of the respondents on the possible outcome of treatment and the result of semen analysis were not observed as predictors of anxiety and/or depressive symptoms. The observations on emotional distress among these men, together with previous observations that counselling/support received from gynecological consultations is usually inadequate indicates that the quality of psychological support that is available to them needs to be improved and modified. Involvement of mental health professionals (psychiatrists and clinical psychologists) in the provision of psychological couple counselling for infertility-related emotional distress could improve the quality of support provided. The establishment of special counselling units in hospitals providing treatment for infertility is advocated.

Stimulant use among secondary school students in Osogbo, Nigeria.

OBJECTIVES: The objectives of this study were to determine the prevalence and pattern of stimulant use and its association with 'brain fag syndrome' among secondary school students in Osogbo, Osun State. The study also aimed to determine the association of socio-demographic variables (of the students and their parents) with stimulant use. MATERIALS AND METHODS: A questionnaire consisting of sociodemographic variables, the stimulant use section of the WHO Student Drug Use Questionnaire and the Brain Fag Syndrome Scale (BFSS) was administered on randomly selected students of the two Local Government Areas of Osogbo. The prevalence rates of stimulant use were calculated and the association of stimulant use with Brain Fag Syndrome (BFS) and socio-demographic variables was determined. RESULTS: The 30-day prevalence rate of stimulant use was 20.3%. Users engaged more in the use of common and cheap stimulants (coffee and kola nut). Majority of users started at age 13 years or below. There was a very high relationship between stimulant use and the symptoms of the BFS (p<0.001). Stimulant use was associated with lower age group, poor school attendance, polygamous background, low education of mother, high education of father and the description of mother as being too permissive. CONCLUSION: The findings suggest the need to increase the awareness of the dangers of stimulant use among students. Control programmes are urgently needed to prevent student wastage.

Unfulfilled desire for pregnancy: gender and family differences in emotional burden among a Nigerian sample.

The aims of this study were to compare anxiety and depressive symptoms between a sample of Nigerian women and their husbands on treatment for infertility, and to identify factors, which are associated with emotional burden in their families. In total, 82 women and their spouses completed the two subscales of the Hospital Anxiety and Depression Scale (HADS) at the gynaecology clinics of a Nigerian teaching hospital. The women had a significantly higher mean anxiety score (p<0.001) and higher mean depression score (p <0,001) than their husbands. On both anxiety and depression subscales of the HADS, the scores of the women were positively correlated with their husbands' scores (p<00.1). Emotional burden in the family was significantly associated with low religious inclination of husband and wife; strained relationship of couple; extended family pressure on husband; husbands' negative attitude towards child adoption; and lower age group of wife. Women with infertility in this subregion experience higher emotional burden than their husbands. Psychological couple counselling is required to ameliorate the emotional burden of infertility imposed by these factors.

Emotional Burden of Infertility : a Controlled Study of Women Managed at a Nigerian Teaching Hospital

The purpose of this study was to determine the relationship between socio-cultural factors and infertility-related stress among a sample of Nigerian women. The subscales of the Hospital Anxiety and Depression Scale and a schedule detailing socio-demographic and infertility-related variables were administered on women with infertility and a matched control group. The rates of significant anxiety symptoms (39.4) and depressive symptoms (40.4) among the women with infertility were higher than the corresponding rates of 11.1 and 10.1 in the control group. Their mean anxiety and depression scores were also higher (P0.001). Low religiosity; friction with husband's family; polygamous relationship and family pressure on husband predicted symptoms among the women with infertility. Public campaign to improve attitude towards women with infertility is advocated. Therapeutic mental health services are important for these women