Background: High maternal and neonatal mortality persist in Benin Republic despite recent improvements. Numerous women and newborns continue to suffer preventable deaths. Although factors associated with the attendance of at least one antenatal care (ANC) visit are well documented, there is little evidence on factors related to compliance with World Health Organization (WHO) recommended four ANC visits. The present study determined the extent to which reproductive age mothers received the ANC check-ups at a health facility focussing on the WHO-recommended regimen. Methods: We examined factors related to ANC services utilisation patterns amongst 8701 women recruited in the 2011/2012 Benin Demographic and Health Survey data using multinomial logistic regression. Results: The percentage of mothers with full ANC attendance was 59.56%, 27.61% received less than 4 visits and 12.84% had never attended ANC services. Results showed that out of 13 variables assessed, only the place of residence was not associated with ANC seeking. Amongst significant variables, household wealth index, female education and desire for pregnancy were the most important factors related to ANC services seeking, especially for the achievement of WHO recommended four ANC visits. The relative risk ratio of ANC attendance, for the achievement of WHO recommended four ANC regimens was high amongst mothers from economically well-off households (adjusted relative risk ratio [aRRR] for richest women = 10.6, 95% confidence interval [CI]: 6.16–18.33), educated women (aRRR for primary level = 4.34, 95% CI: 3.00–6.27) and those with desired pregnancies (aRRR = 3.4, 95% CI: 2.58–4.48). Conclusion: To achieve WHO-recommended minimum four ANC visits in Benin Republic, our findings suggest the need to financially support the most economically disadvantaged pregnant women and their families during pregnancy, advocate for reducing unmet needs for family planning, strengthen girls' education, especially by maintaining them in school till completion of at least the secondary school.

Aim: This study determined the prevalence of bacterial vaginosis (BV) among clients before insertion of intrauterine device (IUD) and compared the incidence of complications between participants who were positive and negative for BV. Patients and Methods: This was an observational cohort study that was performed between May 2014 and September 2014. A total of 360 women were recruited and followed up for 1 month. High vaginal swabs were obtained from each participant pre-insertion of the IUD and 1 month post-insertion. BV was diagnosed using Nugent's scoring. Data were collected, collated and analysed using frequency distributions and Chi-square test as appropriate. The level of statistical significance was P< 0.05. Results: The prevalence of BV was 33.3%. The complication rate was 23.9% in which 30.5% complication rate was seen among participants positive for BV and 22.5% among participants negative for BV (P = 0.192). This was done with respect to four primary clinical outcomes. The incidence of BV one month after IUD insertion was 11.5%. Conclusion: The prevalence of BV was within the range reported in other populations. The complication rate appeared high; however, the differences in proportion between women positive and negative for BV were not statistically significant.

Background: Chronic kidney disease (CKD) is an increasingly prevalent problem worldwide. Treatment of end-stage kidney disease is beyond the reach of an average Nigerian. The prevention and early detection are imperative to reducing its burden. Aim: The aim of this study was to determine the prevalence of CKD and some of its risk factors among adults in a representative semi-urban Nigerian population. Subjects and Methods: A cross-sectional study involving 400 randomly selected adults. Participants were assessed using the WHO stepwise approach. Urinary protein-creatinine ratio (PCR) and estimated glomerular filtration rate (GFR) from serum creatinine, among other parameters, were analysed. A PCR ≥200 mg/g was regarded as significant proteinuria while GFR <60 ml/min/1.73 m² was regarded as reduced GFR. Participants with abnormal PCR and/or reduced GFR were re-evaluated after 3 months to document persistence of these abnormalities. CKD was defined as persistent significant proteinuria and/or reduced GFR for more than 3 months. Results: Data were complete for 328 participants. Persistent significant proteinuria was found in 5.8% while persistently reduced GFR was obtained in 4.6% of participants. Overall, the prevalence of CKD was 7.8%. The prevalence of some established CKD risk factors was old age, 36.3%; hypertension, 36.9%; diabetes mellitus, 7.9%; and family history of kidney disease, 6.4%. The predictors of CKD included old age (adjusted odds ratio = 3.2; confidence interval: 1.10–8.92; P= 0.02), hypertension: 3.5 (1.93–11.90; P= 0.001), family history of kidney disease; 4.5 (3.91–10.23; P= 0.01), generalised obesity 1.3 (1.20–6.21; P= 0.001) and central obesity 3.8 (1.13–12.68; P= 0.003). Conclusion: The prevalence of CKD and some of its risk factors were high. Effective control of the modifiable risk factors identified will assist in reducing the burden of CKD.

Background: Management of chronic kidney disease (CKD) patients often requires the use of multiple drugs due to a high number of cardiovascular risk factors and complications associated with the disease. Multiple drugs predispose to potential drug-drug interactions (DDIs) which may be associated with increased morbidity, mortality, length of hospital stay and health-care cost. Objectives: This study determined the prevalence and pattern of potential DDIs among CKD patients attending Kidney Care Centre, in Ondo City, Nigeria. Methodology: It was an 18-month retrospective study that involved the reviewed CKD patients' records. The Lexi-Interact database was used to evaluate patients' medications for potential DDIs. Results: One hundred and twenty-three (123) CKD patients, made up of 82 (66.67%) males and 41 (33.33%) females were studied. The mean age of the CKD patients was 53.81 ± 16.03 years. The most common comorbid conditions were hypertension in 103 (83.74%) and diabetes mellitus in 39 (31.71%). A total of 1237 prescriptions were made and the mean number of prescribed medications per patient was 10.06 ± 3.97. A total number of 1851 potential DDIs were observed among 118 patients. The prevalence of potential DDIs was 95.9% while the mean DDIs per prescription was 1.27. Among the potential DDIs observed, the severity was mild in 639 (34.5%), moderate in 1160 (62.7%), major in 51 (2.8%) and only 1 (0.1%) was of avoid drug combination. The most frequent DDI was between calcium carbonate and oral ferrous sulphate. Conclusion: The prevalence of potential DDIs is high among CKD patients. About 63% of these interactions have moderate severity. Clinicians and pharmacists should utilise available DDI software to avoid harmful DDIs in CKD patients.

Background: Pre-employment medical examination (PEME) sought to evaluate the ability of workers to work without risk to their own or others' health and safety. This is important especially in a hospital environment where the patients may be at risk in case of employees harbouring infectious lung conditions or as a result of occupational exposure. Although not all healthcare workers are at risk or pose risk, they are expected to undergo chest X-ray (CXR) as part of PEME. Aims: The aim of this study is to determine the number of prospective employees with abnormal findings on routine CXR, describe their characteristics and reassess the value of CXR in PEME. Settings and Design: This was a retrospective study of all the staffs employed into the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, from January 2004 to December 2013. Subjects and Methods: Of the 633 personnel employed during this period, medical records of 416 staffs were available for analysis. Data extracted included age, gender, and CXR report. Descriptive statistics was used for analysis and presentation. Results: The mean age of the prospective employees was 26.6 years ± 5 with a range of 20–49 years. Three hundred and ninety-six (95.2%) employees had normal CXR report while 20 (4.8%) had abnormal CXR. The only abnormality reported was cardiomegaly which was found in 66% of those aged ≥41 years. Cardiomegaly was significantly associated with increasing age (P = 0.003). Conclusions: Routine CXR as part of PEME for prospective employees into this healthcare institution is no longer necessary. It is suggested that its routine use should be limited to older job seekers.

Background: Low-field (LF) magnetic resonance imaging (MRI) is a technology that is widely used in resource-limited settings for clinical imaging. The images produced, even though of low resolution with noise and artefacts, provide valuable information and guidance for patient assessment and treatment. This study shows a spectrum of MRI artefacts that affect image quality during routine clinical neuroradiology practice using LF MRI in a Nigerian hospital and suggests ways to avoid them. Materials and Methods: We retrospectively reviewed brain and spine MRI studies performed on a 0.36T MagSense 360 (Mindray, China) open MRI at our hospital over a 2-year period to identify image artefacts. About 90% of MRI studies performed at our facility during the study period were neuroimaging. The pattern and distribution of artefacts that featured during imaging were described and illustrative cases demonstrated highlighting their causes and ways to avoid or limit them. Results: Of 936 brain and spine cases evaluated, 506 (54.1%) had artefacts with 369 (72.9%) seen in the brain. Truncation/Gibbs (37.6%) and motion (20.6%) were the most common artefacts in the series, seen most commonly in T2-weighted images. There was no significant difference in the proportion of artefacts between adults and children (P = 0.736). Conclusion: Artefacts are relatively common in neuroimaging with LF MRI and may potentially degrade image quality and interfere with accurate radiological reporting and diagnosis. Improving the recognition of LF MRI artefacts may assist imaging practitioners to avoid or limit their effect on image quality and interpretation.

Context: Low back pain (LBP) is a major cause of disability, and the Oswestry Disability Index (ODI) is a validated assessment tool for evaluating disability in LBP patients. Cross-cultural adaptation of the ODI is important because not all populations are proficient in English. The Yoruba language is an indigenous language spoken by 40 million people in the Western part of Nigeria and some countries in West Africa and Latin America. Currently, no validated Yoruba version of ODI is available. Aims: The aim of the study was to translate, culturally adapt and validate the ODI in Yoruba language for participants with LBP. Subjects and Methods: The ODI was translated into Yoruba, and this translated version was analysed in terms of semantics and linguistics. Then, the Yoruba version was translated back into English and both versions administered to 160 participants with LBP. The internal consistency using Cronbach's alpha coefficient, criterion validity and test–retest reliability were assessed using Spearman's rank correlation with significance set at P< 0.05. The inter-rater reliability was evaluated by two different observers and the intra-rater reliability was determined by the same observer, a week apart. Results: The internal consistency of the Yoruba ODI with Cronbach's alpha was 0.97, the intrarater reliability yielded an intraclass correlation coefficient of 0.93 and criterion validity assessed using Spearman's rank correlation was r = 0.92 for highest score and 0.63 for lowest score. Conclusion: The Yoruba ODI is a reliable and valid tool for assessing functional disability in LBP patients.

Background: Exercise-induced bronchospasm (EIB) assessed using changes in peak expiratory flow rates (PEFRs) to free range exercise is a relatively cheap way of screening for asthma in resource-poor centres where children with asthma are often undiagnosed and poorly managed. This study sets out to determine the prevalence and factors associated with EIB among rural schoolchildren in Ilesa, Nigeria. Subjects and Methods: Children aged 8–16 years from two middle schools in rural Ilesa were selected by multistage sampling. Their sociodemographic characteristics and personal/family history of asthma and allergies were obtained. The children had their PEFR measured before, 5, 10 and 15 min after 6–8 min of free running exercise to achieve 80% of their maximal pulse rate. EIB was defined as change in PEFR expressed as a percentage of the pre-exercise value ≥15%. The prevalence and factors associated with EIB were determined. Results: The mean (standard deviation) age of the 250 study participants was 12.5 (1.5) years (M: F 0.9:1) None of the children had previously been diagnosed with asthma. The prevalence of EIB was 9.2%, 6.4% and 4.0% at 5, 10 and 15 min post-exercise, respectively. Household poultry birds, personal history of allergies, wheeze in the past 12 months and family history of asthma were associated with EIB (P < 0.05); only wheezing in the past 12 months independently predicted EIB (odds ratio = 6.343; 95% confidence interval = 2.040–8.798; P= 0.020). Conclusion: The prevalence of EIB among rural schoolchildren in Ilesa was 9.2%. EIB was associated with the history of allergies and wheeze and presence of household poultry birds. We recommend routine screening of these children for early diagnosis and good asthma symptom control.

Background: Pelvic inflammatory disease (PID) is a major cause of gynaecological morbidity globally. Complications from PID include infertility, ectopic pregnancy and chronic pelvic pain. Low socioeconomic status (SES) is a risk factor for the occurrence of PID. Objective: The aim of this study was to determine the association between SES of parents and the occurrence of PID among undergraduates attending Irrua Specialist Teaching Hospital, Irrua. Methodology: The study was a hospital-based, descriptive cross-sectional study. Three hundred and sixty female undergraduates attending the hospital were consecutively recruited and clinically assessed for the presence of PID using the WHO and CDC MMWR 2010 criteria for the clinical assessment of PID. Their SES was determined by Oyedeji social class categorisation. Data were analysed using Epi Info 3.5.4. Descriptive statistics were used to summarise the data, and Chi-square was used to test for association. Results: There was a significant association between SES of parents and multiple sex partners (P < 0.02), previous sexually transmitted infection (STI) (P = 0.05), unprotected sex (P < 0.001), history of induced abortion (P < 0.001) and surgical termination of pregnancy (P < 0.01). There was also association between occurrence of PID among respondents and multiple sexual partners (P < 0.001), previous history of STI (P = 0.02), non-persistent use of condom (P < 0.001), history of induced abortion (P < 0.01) and surgical termination of pregnancy (P < 0.01). There was however no significant association between SES of parents and occurrence of PID (P = 0.14) though PID was highest among respondents from low SES. Conclusion: Occurrence of PID among undergraduates was not associated with their SES. However, identified risk factors for PID among study population such as multiple sex partners, previous STI, unprotected sex and history of induced abortion were associated with the SES.

Background: Non-fermenting Gram-negative bacilli (NFGNB) have emerged as a major cause of healthcare-associated infections and are innately resistant to many antibiotics. Aim: The aim of this study was to determine the prevalence of NFGNB isolated from various clinical specimens and evaluate their antimicrobial susceptibility profiles. Materials and Methods: This retrospective study was done at our Department of Microbiology from December 2015 to December 2016. NFGNB were isolated from a variety of clinical specimens, plated on blood agar and MacConkey agar and incubated at 37°C for 18–24 h under aerobic conditions. Appropriate biochemical tests were done to identify the organisms isolated. Antibiotic susceptibility test was performed using the modified Kirby–Bauer disc diffusion method using commercially available discs on Mueller–Hinton agar. Data was analyzed using SPSS IBM version 20. Results: Out of 19065 clinical samples, cultures were positive in 1854 samples. Out of 1854 culture-positive samples, 216 (11.6%) yielded NFGNB. Pseudomonas aeruginosa was the most common NFGNB, isolated in 190/216 (87.96%) samples, followed by Acinetobacter baumannii (17/216, 7.87%). Overall, most of the NFGNB isolates were susceptible to polymyxin B (88.4%), imipenem (82.9%) and cefoperazone + sulbactam (50.9%), and a total of 11 (64.71%) multidrug-resistant A. baumannii (MDRAB) strains were isolated in the study. Conclusion: Our study showed a significantly high prevalence of NFGNB. Isolation of multidrug-resistant P. aeruginosa and MDRAB in the present study raises the concern of rapidly emerging antibiotic resistance in this group of bacteria in our region.

Retrocaval ureter is a rare anomaly in which the ureter passes behind the inferior vena cava due to abnormal embryogenesis. Very few cases have been reported from Africa. Although the anomaly is congenital, patients become symptomatic in the third or fourth decade of life. We reviewed the records of four patients with the diagnosis of retrocaval ureter and managed in our centre between January 2010 and December 2016. Three patients presented with recurrent colicky right flank pain while one was asymptomatic. Two patients each had Type I and Type II retrocaval ureters, respectively. Surgical repairs were achieved in the three symptomatic cases and recovery was uneventful. Retrocaval ureter, though congenital, manifests in young adults and it may be symptomatic. Pre-operative diagnosis may be difficult when the lesion is high and mimics pelviureteric junction obstruction. Thus, a high index of suspicion is required for pre-operative diagnosis. Under-reporting and asymptomatic cases may account for the low incidence.