Aim: The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. Methodology: This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. Results: More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. Conclusion: Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Carbapenemase-producing Enterobacteriaceae (CPE) have become one of the greatest public health challenges globally. In the past decade, antimicrobial resistance (AMR) was viewed as a clinical problem in many parts of the world; hence, the role and magnitude of the contribution of the environment were not well appreciated. This review article was done with online published articles extracted from different databases using search terms related to the work. Evidence has shown that there exists the presence of carbapenemase genes in the environment, consequently fuelling the dissemination with alarming consequences. CPE when acquired causes life-threatening infections in humans. The health and economic impact of these infections are numerous, including treatment failure due to limited therapeutic options which hamper the containment of infectious diseases, further contaminating the environment and worsening the public health challenge. It is a well-known fact that the rate of emergence of resistant genes has outpaced the production of new antimicrobial agents, so it is pertinent to institute effective environmental measures to combat the spread of AMR organisms before it will completely gain a foothold and take us back to 'the pre-antibiotic era'. Environmental sources and reservoirs of resistant genes should therefore be amongst the primary targets for the control and prevention of the spread of resistant genes in the environment. This calls for the effective implementation of the 'one health' strategy with stakeholders committed to the design and enforcement of environmental mitigation policies and guidelines.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The coronavirus disease-19 pandemic has spread to all parts of the world. As of 20 May 2022, over 500 million confirmed cases have occurred with over 6 million deaths. In Nigeria, over 255,000 cases have occurred with more than 3000 deaths. The pandemic has adversely affected virtually all aspects of human endeavour, with a severe impact on the health system. The Nigerian health system was ill prepared for the pandemic, and this further weakened it. The impacts of the pandemic on the health system include disruption of health services, low motivation of the health workforce, unresponsive leadership and poor funding. The national response, though initially weak, was ramped up to expand capacity building, testing, public enlightenment, creation of isolation and treatment centres and research. The funding for the national response was from the government, private sector and multilateral donors. Nigeria must comprehensively strengthen its health system through motivating and building the capacity of its human resources for health, improved service delivery and provision of adequate funding, to be better prepared against future pandemics.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Hypertension is the largest contributor to the global burden of disease. Emerging risk factors for cardiovascular disease include blood pressure variability (BPV), but evidence on BPV is lacking among older Nigerians. We reported BPV in a cohort of older persons at the University College Hospital (UCH), Ibadan. Methods: We conducted a retrospective cohort study of respondents aged >50 years within the Ibadan Ambulatory Blood Pressure Registry at the UCH, Ibadan, Nigeria. Socio-demographic characteristics, lifestyle habits and anthropometric measurements were obtained. Results: Among 639 respondents, 332 (52.0%) were female. The blood pressure (BP) variables were strongly associated with age. Compared with younger age groups, mean diastolic BP (DBP) was less at an older age, whereas mean pulse pressure was greater. During the wake-up and sleep periods, mean DBP and mean arterial BP were less with each increasing age category, whereas mean pulse pressure was larger with each increasing age category. BP dipping, systolic, diastolic and mean arterial BP decreased with age. Overall, timed BPV increased significantly with increasing age. The prevalence of white-coat hypertension was greater among older participants than younger participants. Most respondents in the 50–59 years' age group were non-dippers (55.8%), whereas 33.7% of older respondents were reverse-dippers. Conclusion: Older persons experienced a greater abnormal circadian blood variation and greater BPV than younger people. In Nigeria, follow-up data are needed to determine the prognostic significance of these data in this population.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Dental caries remains a public health threat of concern among children. About 2.3 billion people are affected by dental caries, of which 530 million are children globally. Objective: This study was carried out to identify sugar fermenting bacteria in the oral cavity and their antibiotic susceptibility pattern, assess the association with sugar fermenter bacteria and dental caries and evaluate dental caries outcomes among children. Materials and Methods: This was a cross-sectional study conducted between October 2021 and February 2022 at Ruhengeri Referral Hospital. About 136 oral swab samples were collected from children with and without dental caries at 1:1 ratio. The samples were put in Stuart sterile container and transported to INES-clinical microbiology laboratory for microbial identification. Logistic regression analysis of demographic characteristics was performed to study the relationship between demographic variables and dental caries. Chi-square test was performed for the association between variables. Results: About 67.6% were male, while children of age 7–9 years (64.7%) dominated the age groups. Lactobacilli spp (15.29%) and Streptococcus mutans (12.94%) were the most predominant microorganisms observed in the oral cavity among children with dental caries. The S. mutans (x² = 27.03, P < 0.00001, 95% confidence interval [CI]=0.2901–0.5785), S. aureus (x² = 34.59, P < 0.00001, 95% CI = 0.3541–0.6292), Enterobacter aerogenes (x² = 13.5, P = 0.000239, 95% CI = 0.151–0.4622), Serratia marcescens (x² = 11.64, P = 0.00645, 95% CI = 0.1275–0.4418) and Klebsiella pneumonia (x² = 13.51, P = 0.000237, 95% CI = 0.1511–0.4623) were significantly associated with dental caries. Teeth loss (x² = 51.04, P < 0.00001, 95% CI = 0.4757–0.7205), teeth pain (x² = 5.05, P = 0.0246, 95% CI = 0.0249–0.33499), and infection (x² = 4.73, P = 0.02964, 95% CI = 0.0186–0.3441) were dental outcomes associated with tooth decay. Ciprofloxacin, clindamycin, and amoxicillin were the most sensitive antibiotics, while vancomycin and chloramphenicol were the most resistant. Conclusion: Sugar consumption favours the growth of sugar fermenter bacteria that cause dental caries among children. Dental caries is associated with adverse oral health outcomes among children. Oral health education is recommended for children. Parents are advised to reduce the consumption of sugary food for their children for oral health safety.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: Severe malaria is a leading cause of mortality due to late presentation to health facilities. Hence, there is a need to identify and mitigate factors promoting delayed presentation with severe malaria. Objective: This study aimed to evaluate determinants of delayed presentation of children with severe malaria in a tertiary referral hospital. Methods: This study adopted a descriptive, cross-sectional design. The participants were children with a diagnosis of severe malaria, based on WHO diagnostic criteria. Delayed presentation was defined as presentation at the referral centre at >3 days of illness. Inferential analyses were done to identify factors associated with delayed presentation. P < 0.05 was considered statistically significant. Results: A total of 126 children with severe malaria participated in the study; their mean (standard deviation) age was 4.2 (5.3) years. The prevalence of delayed presentation in this study is 37.3%. Socio-economic class (P = 0.003); marital status (P = 0.015) and the number of health facilities visited before admission in the referral centre (P = 0.008) were significantly associated with delayed presentation. Children from upper socio-economic class were thrice more likely to present late, compared to those from lower social class (odds ratio [OR] = 3.728, 95% confidence interval [CI]: 1.694–8.208; P = 0.001). Likewise, the Yorubas were more delayed than the Binis (OR = 0.408, 95% CI: 0.180–0.928; P = 0.033). There was a negative correlation between caregivers' perception of treatment (r = −0.113, P = 0.21) of convulsion in severe malaria and timing of presentation. Conclusions: Delayed presentation is common with multifactorial determinants in the setting. Health education of caregivers on the consequences of delayed presentation in severe malaria is desirable.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Hepatitis B virus (HBV) infection is one of the public health diseases causing global health problems. It is a leading cause of cirrhosis and hepatocellular carcinoma. Blood transfusion is a major route of its transmission and screening of blood is suboptimal in our environment. Occult HBV infection describes the presence of HBV DNA in blood or liver tissue in patients who are hepatitis B surface antigen (HBsAg) seronegative. This study documented the common genotypes of HBV a blood-borne infection in the population of blood donors in Lagos. Methods: This was a cross-sectional study carried out at the blood donor clinics of ten Lagos State Government-owned hospitals in Lagos State. A total of 1400 participants were recruited consecutively from November 2020 to June 2021. All participants' samples were screened using Diaspot Rapid Test Kit (RTK) and Dialabenzyme enzyme-linked immunosorbent assay (ELISA) kit. Furthermore, some of the plasma samples were used for HBV DNA extraction and genotyping using the real time-polymerase chain reaction. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) software version 26 and P value was considered significant at ≤0.05. Results: The sero-prevalence of HBsAg using RTK and ELISA was 19.9% and 22.4%, respectively. The prevalence of occult HBV infection was 5.2%. A total of 278 and 313 HBsAg RTK and ELISA positive samples were obtained, respectively. HBV genotype result had A (46.6%) as the most prevalent followed closely by B (44.7%), E (23.8%), D (20.9%) and C (11.2%). Conclusion: HBV infection has a high prevalence among blood donors. ELISA is a more sensitive screening tool and its use should be advocated nationally. HBV genotype A is the most prevalent genotype from our study.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: Although the influx of foreign-trained medical doctors (FTMDs) can improve the doctor-to-patient ratio in Ghana, there is the need to ensure that the quality of training is maintained. We assessed the performance of FTMDs in registration examinations over a 5-year period. Methodology: Data were extracted from Ghana Medical and Dental Council (GMDC) records from 2015 to 2019. Chi-squared tests assessed the association between the selected characteristics and the final grades. A multivariate logistic regression analysis determined significant predictors of the failure. The data were analysed using the statistical software IBM SPSS (version 26). The significance level was set at P < 0.05. Results: Of the 1356 doctors, majority (63.1%) were male, 64.3% were aged 21–30 years and 95.5% were Ghanaian. In all, there were 41 countries of training with majority training in China (35.4%) and Ukraine (31.9%). More than half (58.5%) failed the examination. Country of training, number of years from qualification to time of registration examination and number of previous attempts were statistically significantly associated with success at the examination. The logistic regression analysis showed that those who failed were more likely to have trained in Belarus (odds ratio [OR] = 3.20, 95% confidence interval [CI]; 1.50–6.82), Ukraine (OR = 2.47, 95% CI; 1.55–3.92), China OR = 2.06, 95% CI; 1.30–3.26) and Russia (OR = 1.98, 95% CI; 1.21–3.23) and were 0.58 times likely to have trained in Cuba. Conclusion: The performance at the examination is low. The significant predictor of performance is country of training. The authors recommend that the GMDC provides counselling services for students who leave for medical training abroad.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aims: The increase in the usage of hand-held devices (HHDs) and smartphones (SPs), especially in Nigeria has resulted in an upsurge of musculoskeletal complaints. The aim of this study was to determine the incidence and risk factors for musculoskeletal injuries due to mobile phone usage among Nigerians and the preventive strategies. Materials and Methods: This study involved 630 male and female participants above 18 years old who were purposively recruited across designated study centres in public places. The instrument used was a questionnaire specifically designed to suit the Nigerian culture and environment and developed from previously validated questionnaires. Data were exported to Statistical Computing Programming R version 4.0.5 for analysis and Chi-square was used to compare the characteristics of those who experienced injury using SPs/HHDS and those who did not. Independent variables with a 95% confidence level and P < 0.05 in the multivariate model were considered statistically significant. Results: The most common daily use of SPs/HHDS by the participants was phone calls (98.4%) followed closely by social networking (96.0%) while the occupation and educational level of the participants had statistically significant (P < 0.05) impact on musculoskeletal injuries. The type of mobile device and the time spent using these devices were also significant (P < 0.05) risk factors for injuries. Some self-treatment strategies adopted by the participants were all significantly (P < 0.05) associated with reduction of musculoskeletal discomfort. Conclusion: The occupation, educational level, the types of mobile devices and time spent using the devices were risk factors for musculoskeletal injuries.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background/Aim: Kidney dysfunction is an established risk factor for cardiovascular diseases including stroke. The study aimed at assessing the frequency of kidney dysfunction in patients with acute stroke and to evaluate the relationship to the type, severity and outcome of stroke. To establish a relationship, which has not been explained in past studies. Materials and Methods: This was a cross-sectional analytical study on acute stroke patients and matched controls, evaluating for kidney dysfunction using both estimated glomerular filtration rate (GFR) and the spot urine protein creatinine ratio. The type of stroke was observed by neuroimaging. The National Institute of Health Stroke Score was used to assess the severity of stroke at presentation and outcome after 7 days. Data analysis was done using Statistical Package for Social Sciences (SPSS) application version 23.0 (SPSS Inc., Chicago, IL, USA). Results: Ninety-eight patients and 100 controls were recruited, with a mean age of 64.7 ± 15.5 and 64.8 ± 15.1 years, respectively. The patients with stroke had a statistically significant higher frequency of kidney dysfunction compared to the controls (85.9% vs. 62.0%, P ≤ 0.001). Patients with haemorrhagic stroke had a higher frequency of kidney dysfunction compared with those with ischaemic stroke (93.8% vs. 77.3%, P = 0.048). The proportion of patients with kidney dysfunction was seen to increase from those with mild to those with severe stroke symptoms, both at presentation and after 7 days. Estimated GFR was seen to be an independent predictor of poor outcome in patients with stroke (odds ratio 0.955, 95% confidence interval 0.924 – 0.986, P = 0.005). Conclusion: The study demonstrated that in patients with acute stroke there is a high frequency of kidney dysfunction. Haemorrhagic stroke, increasing stroke severity and poor outcome were seen to be associated with kidney dysfunction. Thus, recommending the need for kidney care as an important part of stroke management.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Traumatic dental injuries (TDIs) rank among the most common conditions in children and adolescents. Nigerian dental trauma data are largely based on studies that were conducted in the southern parts of Nigeria. This study was designed to identify the risk factors and the pattern of TDIs among school-age children in northern Nigeria. Objectives: The objective of the study was to identify the risk factors for and to determine the pattern of dental injuries among 10–12-year-old males in Kano, northern Nigeria. Materials and Methods: Six hundred and ninety-six 10–12-year olds were selected through a multistage sampling of school children, street children and rehabilitated children in Kano and examined for TDIs using the WHO protocols. Data analysis was carried out using SPSS version 20. Statistical significance was considered when P < 0.05. Results: Six hundred and ninety-four 10–12-year olds participated in the study; The prevalence of TDIs was 6.6%. Being a street-child was associated with 30% higher risk for dental injuries (adjusted odds ratio [aOR] = 1.3; 95% confidence interval [CI] = 0.60 - 3.1; P = 0.48), whereas living as a rehabilitated street child (aOR = 0.41; 95% CI = 0.19 - 0.88; P = 0.02) and older age were associated with a reduced risk (aOR = 0.63; 95% CI = 0.39 - 1.01; P = 0.06) to injuries. The most common type of trauma was enamel–dentine injuries or Ellis II, and the most common cause was falls. Street children and low-age groups had more single-tooth injuries (85.7% and 85.0%, respectively). The commonly injured teeth were the maxillary right and left central incisors. Conclusion: Living on the street and young age were associated with the likelihood for injuries in male adolescents in Kano. The maxillary central incisors were the commonly affected teeth.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: The study aimed to derive socio-demographic–corrected norms for selecting neuropsychological (NP) battery tests for people living with HIV (PLWHIV) in Nigeria. This cross-sectional study was conducted amongst patients who attended the general outpatient clinic and junior staff of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla. Aims and Objectives: To determine the normative scores for select neuropsychological battery test for the detection of neurocognitive disorder amongst Nigerians PLWHIV. A sample of 92 individuals received voluntary HIV testing. Methods: Eligibility criteria were being HIV negative, aged 18–64 years and formal education. We undertook a brief neuromedical examination to identify putative exclusion criteria. We sampled four NP tests covering seven cognitive domains and the motor speed component of the International HIV Dementia Scale (IHDS-MS). We presented the normative scores using statistics of mean, median, standard deviation (SD), kurtosis and skewness. Results: All the participants were Nigerians aged 18–64 years. Most (74.1%) of the participants were females. The mean and median ages of the participants were 42.6 ± 11.42 years and 44 years, respectively. The effect of gender on NP performance was limited to the digit span test (DST)-forwards, while education affected all expect IHDS-MS and DST-backwards. The cut-off scores for defining mild and severe impairment varied (moving from 1SD to 2SD) for all cognitive domains except for IHDS-MS and DST. Conclusions: With these preliminary normative scores, it will be easier to identify and classify the severity of neurocognitive impairment amongst PLWHIV in Nigeria, thus facilitating the goal of keeping HIV-associated dementia to a minimum. The lack of variability in the IHDS-MS and DST is unfavourable.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aims: This study aims to carry out a retrospective analysis of demographic information and post-operative complications with special emphasis on complications related to the soft tissue over the implanted device in patients who underwent cochlear implantation. Settings and Design: Retrospective study. Patients and Methods: We conducted a retrospective review of 840 patients who had cochlear implants at our centre during the period between March 2010 and November 2020. The patients' demographic details and complications related to the soft tissue over the implanted device were analysed. Statistical Analysis Used: SPSS software version 12. Results: In total, 380 (45.2%) patients were male and 460 (54.8%) were female. The age of patients at the time of surgery ranged between 7 months and 68 years and the mean age was 4.64 ± 2.91 years. The majority of patients underwent unilateral cochlear implantation (837 patients), with only three patients receiving a bilateral implant. There were a total of 19 implanted patients who developed complications related to the soft tissue around the implanted device, with an incidence rate of 2.3%. Haematoma was the most commonly encountered complication and other complications were: seroma, wound infection, abscess formation and flap necrosis. Conclusions: Cochlear implantation is considered to be a reliable and safe surgical procedure for the rehabilitation of deaf patients. Complications can be avoided by proper patient preparation, appropriate incision and flap design, rigorous surgical techniques and periodic post-operative follow-up to detect and manage any complications early.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: Postgraduate Medical Education is 'the constellation of learning activities carried out to enable doctors to develop relevant competencies and deeper knowledge in specific subject areas after completion of basic medical education'. The purpose of this study was to examine the perception of surgical resident doctors of their training in accredited institutions in Nigeria, using the Surgical Theatre Educational Environment Measure (STEEM) inventory. Methods: The study was a cross-sectional observational study that employed the STEEM instrument which was administered online via email to surgical resident doctors in all the surgical residency training institutions in Nigeria accredited by the National Postgraduate Medical College of Nigeria. The STEEM is a validated 40 item, self-administered questionnaire. Statistical analysis was performed using SPSS version 23. Cronbach's alpha was calculated for the whole STEEM and the sub-scales for both reliability and internal consistency. Results: One hundred and sixty-six respondents filled the questionnaire out of 464 people contacted, giving a respondent rate of 35.7%. There were 156 (94.0%) males and 10 (6.0%) female respondents. One hundred respondents (60.2%) had global STEEM scores less than the benchmark of 120, three (1.8%) with scores of 120 and 63 (38.0%) had scores >120. Conclusion: The majority of the respondents in our study indicated dissatisfaction with their operational educational environment experience.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Presentation with symptoms of advanced prostate cancer is prevalent in developing societies. The objective of this study was to determine the rate of and factors associated with skeletal-related events (SREs) at presentation with hormone-naïve prostate cancer. Methods: Records of 331 consecutive prostate cancer patients from January 2009 to April 2018 were reviewed. The prevalence of SRE at the presentation was determined. In addition, the relationships between SRE and age of patient, duration of clinical features, serum total prostate-specific antigen (tPSA) and biopsy Gleason score (GS) at presentation were evaluated. Analyses were done with IBM SPSS® version 25. Results: Mean age was 69.8 ± 8.0 years. While 43.8% of patients had lower urinary tract symptoms (LUTS) only, 51.4% had LUTS and other features of disease progression. Only 2.1% of the cases were confirmed from screen detection of elevated serum tPSA. SREs were observed in 11.8% at first presentations with hormone-naïve prostate cancer. Symptom duration (odds ratio [OR] 0.94; 95% confidence interval [CI] 0.90–0.99; P = 0.02), anaemia that could not be attributed to gross haematuria or external blood loss (OR 9.6; 95% CI 3.12–29.52; P < 0.001) and transrectal biopsy GS (OR 1.61; 95% CI 1.17–2.22; P = 0.003 ) were significantly associated with SREs at presentation with hormone-naïve prostate cancer. Conclusions: Evidence exists that patients who present with SREs from more aggressive prostate cancers may have had more rapid symptom progression, but not a longer delay before presentation.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

A 15-year-old boy came to the eye clinic with reduced vision in the left eye of a year's duration and prior trauma. Best-corrected visual acuity was 6/9 and hand movement in both eyes, respectively. The anterior segment examination was essentially normal except for a Marcus Gunn pupil and a polar cataract in the left eye. Goldmann applanation tonometry was 10 and 06 mmHg, respectively, in the right and left eyes. Binocular indirect ophthalmoscopy of the right eye revealed pink disc, normal vessels and the Mizuo–Nakamura phenomenon with a cartwheel appearance at the macula. The left eye had a total retinal detachment with proliferative vitreoretinopathy and retinal tear at 12 o' clock. Optical coherence tomography revealed posterior vitreous detachment and schitic cavities at the macula in the left eye. A diagnosis of left rhegmatogenous retinal detachment with background X-linked juvenile retinoschisis was made. The patient was advised on a pars plana vitrectomy under guarded visual prognosis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]