Lower limb amputation in diabetic foot disease: experience in a tertiary hospital in southern Nigeria

The diabetic foot is characterised by the triad of neuropathy, infection, and ischaemia, which may ultimately lead to limb amputation. It is important to understand the factors that place diabetic patients at increased risk of amputation in our society, hence the need for this study. The medical records of all patients admitted and treated for diabetic foot complications over a 3-year period (January 2007 to December 2009) were retrieved. Relevant information was obtained from the case notes. Thirty-six (36) patients entered the study, 25 males and 11 females (M:F ratio 2.3:1.0). Mean age was 54 years (range 24­74). Patients presented with foot gangrene (58%), ulceration (31%) and infection (11%) with trauma being the most common precipitating factor (53%). Nineteen patients (53%) had lower limb amputation, the commonest of which was below knee. Of the patients that had amputation, 18 (95%) had type 2 diabetics. Adequate diabetic foot disease preventive strategies need to be designed and implemented to reduce the incidence of lower limb amputations

Social determinants of alcohol use among drivers in Calabar.

OBJECTIVE: Hazardous use of alcohol is a public health problem which accounts for 4.0% of global disease burden. Although the prevalence of alcohol use among drivers of commercial vehicles in Nigeria has been documented, not much is known about its social determinants. This study was, therefore, aimed at assessing the social determinants of alcohol use among drivers of commercial vehicles in Calabar. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted among 360 male commercial drivers. A semistructured questionnaire, which included the World Health Organization Alcohol Use Disorders Identification Test, was administered at interview. Binary and multinomial logistic regression analyses were used to identify social determinants of any and hazardous alcohol use. RESULTS: Determinants of any alcohol use (binary logistic) were history of use by parents (adjusted odds ratios (AOR)=2.7; 95% CI=1.1-6.3), friends (AOR=3.2; 95% CI=1.3-7.8) and ready availability (AOR=4.1; 95% CI=1.9-8.8) while determinants of hazardous use (multinomial logistic) were history of use by parents (AOR=5.8; 95% CI=2.0-16.9), siblings (AOR=7.0; 95% CI=2.6-16.9), friends (AOR=6.6; 95% CI=1.8-24.4), hostile upbringing environment (AOR=3.8; 95% CI=1.3-11.1), use of other drugs (AOR=55.6, 95% CI=14.5-200), and respondents who had fathers with a maximum of primary or no formal education (AOR=4.6; 95% CI=1.8-11.8). CONCLUSION: Alcohol use was associated with family use, friends' use, and use of other drugs. Multiple health education interventions are needed to tackle these challenges.

Sexuality; Contraception and Unintended Pregnancy among Female Student Nurses in Calabar; Nigeria

Background - There has been increased concern on human sexuality; especially with respect to contraception and the control of sexually transmissible infections. There is need to identify the sociodemographic characteristics that influence sexual behaviour and contraceptive use among young women. Methods - A descriptive cross sectional study that focused on the socio-demographic characteristics; sexuality; knowledge and use of modern contraceptive technology as well as interventions taken in the event of inadvertent pregnancy was conducted. A structured; close- ended questionnaire was randomly administered to 195 female nursing students with 60; 65 and 70 of them in their first; second and third year respectively. Results - Majority (76.7) of the students were in the age bracket of 20 - 24years. While 65.6of them were sexually active; only 54.9had knowledge of family planning. Condom was the commonest contraceptive used (37.4) and the main reasons were that of effectiveness (31.8) and safety (30.3). There was a significant relationship between respondents with multiple sexual partners and incidence of unwanted pregnancies (p=0.003). The majority (51.2) of those with unwanted pregnancies resorted to induced abortion

Factors associated with missed opportunities to immunise with tetanus toxoid at a tertiary health institution in Nigeria.

OBJECTIVE: To determine the magnitude of and the reasons for missed opportunities to immunise with tetanus toxoid at a tertiary health institution in Nigeria. The information obtained would be used in developing an intervention strategy for eliminating missed opportunities in the future. DESIGN: Missed opportunity was assessed by using the Revised WHO/EPI protocol (WHO/EPI/MLM/91.7). Exit interviews were carried out on pregnant women visiting the antenatal (prenatal) clinic to register the present pregnancy. SETTING: A tertiary health institution in Nigeria. SUBJECTS: Pregnant women who attended the antenatal clinic for the purpose of registering the present pregnancy during the last two booking days in February, 1997 and the first booking day in March, 1997. MAIN OUTCOME MEASURES: Missed opportunities and contributory factors. RESULTS: The prevalence of missed opportunity was 66%. The factors responsible for missed opportunity were poor history taking, lack of knowledge of the current schedule of immunisation, dependence on physician referral for immunisation and inefficient immunisation record keeping system. CONCLUSION: The findings establish the need for providing physicians in antenatal settings with an update on current immunisation policy and practice and for improved documentation of immunisation histories.

PIP: This report presents the magnitude of the problem and the reason for missed opportunities for tetanus toxoid (TT) immunization at the University of Calabar Teaching Hospital (UCTH) in Nigeria. The information obtained will be used in developing a strategy for eliminating missed opportunities in the future. The subjects were all pregnant women who attended the antenatal clinic for the purpose of registering pregnancy during the last two booking days in February 1997 and the first booking day in March 1997. Information were collected from 54 pregnant women by means of exit interview conducted by trained by data collectors. Information obtained includes: dose(s) of TT received and when; record of offer of TT; and acceptance or decline of TT offered. Results of the exit interview showed a 66% prevalence rate of missed opportunity. Factors contributing to this high prevalence of missed opportunity were poor history taking, lack of knowledge of current schedule of immunization, dependence on physician referral for immunization, and an inefficient immunization record keeping system. The findings point out the need to provide physicians in antenatal settings with an update on current immunization policy and practice and for improved documentation of immunization histories.