Recognition of mental health problems by primary care physicians in a tertiary care hospital in Nigeria.

AIMS AND OBJECTIVES: This study sought to determine the difference in detection of attendees with mental health problems visiting the General Out-patient clinic of a tertiary institution; the General Health Questionnaires (GHQ-12) were compared with those identified by the physicians. PATIENTS AND METHODS: Three hundred and twenty two (322) subjects aged 18 years and above, attending the clinic for the first time, were recruited for the study by a systematic random sampling method. Using a cut off score of '3' on the 12-item General Health Questionnaire (GHQ-12), 'Cases' and 'Non-cases' generated were compared with those identified by the doctors. Identification rates for both groups were calculated and the coefficients determined using a two-by-two contingency table. RESULTS: The GHQ-12 identified 46.6% 'cases' while the General Out-patient Clinic (GOPC) doctors identified 6.8% with a diagnostic sensitivity of 8% and a specificity of 94% CONCLUSION: Despite the high proportion of mental health problems in the GOPC of the hospital, the detection rate by the clinic doctors was low. There is a need for the use of an easy tool like the GHQ-12 for screening and identification of attendees with mental health problems especially in a busy clinic setting.

Justification rate for non-obstetric hysterectomies: a study of cases in University of Calabar Teaching Hospital, Calabar.

BACKGROUND: Hysterectomy is a commonly performed major, non obstetric operation. It is often the definitive treatment for several pelvic pathologies like uterine myoma, utero-vaginal prolapsed, dysfunctional uterine bleeding, cervical malignancy and uncontrollable post partum haemorhage. The use of the hysterectomy in women sometimes without disease has led to the perception that some of the indications for hysterectomy are unjustified. The aim of this study is to determine the justification rate for the procedure in the University of Calabar Teaching Hospital, Calabar. METHODS: This was a retrospective study of hysterectomies done at the University of Calabar Teaching Hospital between January 2001 and December 2005. The preoperative indication was compared with the pathologist's report after surgery. Hysterectomy was considered justified if the pathology report verified the indication for surgery or showed a significant alternative pathology. RESULTS: The indication for hysterectomy corresponded with the histopathological diagnosis in 76.7% of cases, while in 23.3% cases the indication and histopathological diagnosis did not correspond, out of these 3.3% of cases had significant alternative pathology. In this study 80% of all hysterectomies were justified while it was not justified in 20% of cases. CONCLUSION: It is suggested that guidelines aimed at reducing unnecessary hysterctomies should be put in place and implemented. This will go a long way in improving the justification rate for hysterectomies at our centre, save clients resources, improve client satisfaction and quality of care.

Knowledge and perception of HIV prevention through condom use among midlife and older adults in Calabar, Nigeria.

OBJECTIVES: Older people are at increasing risk of HIV/AIDS and other sexually transmitted diseases. The use of condoms which can protect both partners from sexually transmitted infections (STIs) including HIV during vaginal and anal sex is mostly neglected by them. In fact, postmenopausal women may not see the need for condom use when they are no longer at risk for pregnancy. Even though HIV/AIDS in older patients carry a high mortality, it is many times neglected by even healthcare providers because of the belief that older persons are no longer sexually active. This study aimed to determine the perception and knowledge of condom use as a strategy for HIV/AIDS prevention among midlife and older adults in Calabar Nigeria. METHOD: A cross-sectional study was carried out to identify the perception and knowledge of HIV transmission and condom use among adults over 50 years ofage, in the University of Calabar Teaching Hospital, Calabar, Nigeria. A structured questionnaire was used to get the demographic data, sources of information about the disease, knowledge about the use of condom and its efficacy in preventing the disease. RESULTS: A total of 488 participants were interviewed, comprising 263 males (53.9%) and 225 females (46.1%). Most of them (83.8%) were married and the rest (16.2%) were single. The majority of the respondents (368, 75.7%) got their information about HIV/AIDS transmission and prevention from the television. Other sources of information for respondents on HIV/AIDS were awareness campaigns (43.5%), newspapers (38.6%), friends (37.3%) and neighbours (27.1%). Three hundred and four (62.3%) of the respondents said that they had used condoms and believed that condoms could effectively prevent transmission of STIs including HIV compared to the one hundred and eighty-four (31.7%) who opined otherwise. Abstinence was the major mode of prevention of the disease among respondents while unprotected sexual intercourse was identified by the majority of the respondents (87.5%) as a high risk factor CONCLUSION: There should be more public education on HIV/AIDS to midlife and older adults.

Plasma Fibrinogen Levels of Healthy Non-Pregnant Women in Calabar; South-South Nigeria

In recent years the role of plasma fibrinogen as an independent cardiovascular risk factor has been increasingly recognized. Most of the studies on the relationship between plasma fibrinogen and cardiovascular risk have been in men; with that in women less investigated. Haemostatic and endothelial function in relation to thrombogenesis and CHD may be particularly important in women because women with myocardial infarction and angina chest pain are more often free of angiographically visualized coronary atherosclerosis than are men. This study was to establish the plasma fibrinogen level of adult women seen in the Outpatient Clinic. One hundred non-pregnant women attending the University of Calabar Teaching Hospital General Outpatient Clinic (GOPC) aged between 18-90 years who met the inclusion criteria and gave informed consent were recruited into the study. Each subject had 4.5mls of venous blood sample collected by vene-puncture using a plastic syringe. This was transferred into a tube containing 0.5ml of trisodium citrate (10:1 dilution); this was centrifuged immediately and plasma analysed for fibrinogen concentration by the modified Clauss technique. Comparison between pre-menopausal; peri-menopausal and post-menopausal groups was done by one-way analysis of variance (ANOVA) followed by student's t-test. A p value of less than 0.05 was considered as significant. The fibrinogen concentration (mg/dl) were 257+44; 315+40 and 579+99 for pre-menopausal; peri-menopausal and post-menopausal women respectively (p0.05). ANOVA showed a Critical F-ratio 3.07; calculated df ratio was 220 (p0.05). Collorary to the ANOVA; student t-test of 1.7 (p0.05) between pre-menopausal and peri-menopausal women; pre-menopausal and post-menopausal women 6.2 (p0.05); and peri-menopausal and post-menopausal women 3.5 (0.05). The critical range for student t-test was 12.7; while calculated t ratio was less. The foregoing findings raise a serious concern for Hormone Replacement Therapy (HRT) using estrogens in women with severe symptoms of menopausal syndrome. Although the fattening room practice termed `Nkuho' or `Mbobo' among the Calabar women is on the decline it exposes women of reproductive age to increased cardiovascular risk. It is thus necessary that Primary Care Physicians begin to include plasma fibrinogen estimations as part of cardiovascular risk profiling as a health promotion strategy in all women of reproductive age

Prevalence of domestic violence among antenatal women attending a Nigerian hospital.

BACKGROUND: Health is defined as a state of complete physical, mental, social and spiritual well being and not just the absence of disease. Domestic violence (synonyms: spouse abuse, partner or intimate violence, family violence) is a public health problem which is defined as any intentional abuse of a family member (mostly females but not exclusive) by his/her partner that causes pain or injury. There is paucity of data on domestic violence mainly because of under-reporting by the victims. However, domestic violence is said to be a more frequent occurrence than other recognized pregnancy complications such as pre-eclampsia, twin pregnancy or gestational diabetes for which women are routinely screened during the antenatal period. The aim of the study was to determine the prevalence of domestic violence in pregnant women attending the antenatal clinic of a local Nigerian mission hospital in Jos, Plateau state. METHODS: This was a cross-sectional, descriptive study of women attending antenatal clinic at ECWA Evangel Hospital, Jos over a six month period using the Abuse Assessment Screen developed by McFarlane to detect the prevalence of domestic violence. The data were analysed using Epi Info Version 2002. RESULTS: Three hundred and forty pregnant women were studied. Majority of them were married and were mostly aged between 20 and 39 years. Domestic violence prevalence was 12.6% (43) in the current pregnancy and 63.2% (215) previously. CONCLUSION: The study establishes that women in our environment experience domestic violence during pregnancy and majority of them also have a previous history of abuse. There is the need to routinely screen for domestic violence in pregnant women so as to prevent potential adverse pregnancy outcomes and to interrupt existing abuse.

Prevalence of Domestic Violence among Antenatal Women Attending a Nigerian Hospital

Background: Health is defined as a state of complete physical; mental; social and spiritual well being and not just the absence of disease. Domestic violence (synonyms: spouse abuse; partner or intimate violence; family violence) is a public health problem which is defined as any intentional abuse of a family member (mostly females but not exclusive) by his/her partner that causes pain or injury. There is paucity of data on domestic violence mainly because of under-reporting by the victims. However; domestic violence is said to be a more frequent occurrence than other recognized pregnancy complications such as pre-eclampsia; twin pregnancy or gestational diabetes for which women are routinely screened during the antenatal period. The aim of the study was to determine the prevalence of domestic violence in pregnant women attending the antenatal clinic of a local Nigerian mission hospital in Jos; Plateau state. Methods: This was a cross-sectional; descriptive study of women attending antenatal clinic at ECWA Evangel Hospital; Jos over a six month period using the Abuse Assessment Screen developed by McFarlane to detect the prevalence of domestic violence. The data were analysed using Epi Info Version 2002. Results: Three hundred and forty pregnant women were studied. Majority of them were married and were mostly aged between 20 and 39 years. Domestic violence prevalence was 12.6(43) in the current pregnancy and 63.2(215) previously. Conclusion: The study establishes that women in our environment experience domestic violence during pregnancy and majority of them also have a previous history of abuse. There is the need to routinely screen for domestic violence in pregnant women so as to prevent potential adverse pregnancy outcomes and to interrupt existing abuse

Outcome of directly observed therapy short course (DOTS) regimen in a rural community of the Nigerian Niger Delta.

BACKGROUND: [corrected] The objective of this retrospective study was to evaluate the outcome of directly observed therapy short course (DOTS) application in a Nigerian rural community. METHODS: A retrospective study of all the records of DOTS at the centre from January 2001 to December 2005 was compiled and features such as: age, gender, drugs used, and outcome of treatment (defaulted, cured, died, or developed multidrug resistant-TB) were considered. Also the different personnel and infrastructure at the centre for the programme were also assessed. Results were analysed using Epi Info 6 statistical software, and P values < 0.05 were considered significant. RESULTS: Two hundred and seventy four (274) cases of pulmonary TB were registered at the centre during the study period, consisting of 100 (36.5%) females and 174 (63.5%) males with a statistically significant gender difference (P<0.001). The age range with the highest number of pulmonary tuberculosis cases was 31-40 years (24.8%; n=68), and the age range with the lowest number was 71 years and above (1.1%; n=3). Treatment outcome showed that 84.7% (n=232) completed treatment with cure; 2.5% (n=7) developed multidrug resistance at completion of treatment; 5.5% (n=15) defaulted; 3.3% (n=9) died in the course of treatment, and treatment in 11 people was still ongoing. CONCLUSION: The outcome of DOTS in the present study was impressive, and the programme should be extended to other rural communities; however, more efforts should be made towards the tracing of defaulters.

Outcome of Directly Observed Therapy Short Course (DOTS) Regimen in a Rural Communicty of the Nigerian Niger Delta

Background: The objective of this retrospective study was to evaluate the outcome of directly observed therapy short course (DOTS) application in a Nigerian rural community.Methods: A retrospective study of all the records of DOTS at the centre from January 2001 to December 2005 was compiled and features such as: age; gender; drugs used; and outcome of treatment (defaulted; cured; died; or developed multidrug resistant-TB) were considered. Also the different personnel and infrastructure at the centre for the programme were also assessed. Results were analysed using Epi Info 6 statistical software; and P values 0.05 were considered significant. Results: Two hundred and seventy four (274) cases of pulmonary TB were registered at the centre during the study period; consisting of 100(36.5) females and 174(63.5) males with a statistically significant gender difference (P0.001). The age range with the highest number of pulmonary tuberculosis cases was 31-40 years (24.8; n=68); and the age range with the lowest number was 71 years and above (1.1; n=3). Treatment outcome showed that 84.7(n=232) completed treatment with cure; 2.5(n=7) developed multidrug resistance at completion of treatment; 5.5(n=15) defaulted; 3.3(n=9) died in the course of treatment; and treatment in 11 people was still ongoing. Conclusion: The outcome of DOTS in the present study was impressive; and the programme should be extended to other rural communities; however; more efforts should be made towards the tracing of defaulters