Alex Payim Igbe

An audit of paediatric mortality patterns in a Nigerian teaching hospital

Background: The 4th millennium development goals (2002) reported that sub-Saharan Africa countries including Nigeria have a persistently high childhood mortality rates in-spite of all the preventive and interventional measures to reduce this ugly trend. Patients and Methods: Childhood mortality data was obtained from the medical records department and post-mortem records of the pathology departments over a 5-year period from January 2007 to December 2011. The selection criteria include all case notes with mortality records involving children admitted into the paediatrics department through the labour ward and the obstetrics theater, children emergency unit (CHER), paediatric out-patient clinic. Results: A total of 12,442 children were admitted during this period. Of this, 711 paediatric deaths were documented accounting for 17.5%. The male to female mortality ratio was 1.4:1. The age range was from birth to 17 years. Neonatal deaths accounted for the most common cause of death constituting 344 (48.4%) of all deaths. Among the neonatal mortality patterns, severe birth asphyxia/perinatal asphyxia was the most common cause of early neonatal deaths accounting for 97 (28.2%). Septicaemia accounted for the most frequent cause of infant mortality accounting for 28 (21.8%). Among the under-5 age group, severe malaria constituted the most common cause of death accounting for 52 (36.6%) cases while malignancy topped the list of 5-17 years mortality rate constituting 15 (15.4%) cases. Conclusion: Perinatal and neonatal deaths constitute the vast majority of death in our environment with most of the deaths resulting from severe birth asphyxias, prematurity. Again in the post-neonatal period, infections and other preventable diseases constitute the most common cause of death in children of under age group of five years. Above 5 years childhood malignancies constitutes the highest mortality pattern.

A 20 year retrospective analysis of medicolegal deaths in a tertiary hospital setting in Nigeria

OBJECTIVE To determine and classify the various types of medicolegal deaths as seen at University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. MATERIALS AND METHODS This is a retrospective study of all the medicolegal deaths seen in the Department of Histopathology, (UBTH, Benin City over a 20 year period (January 1990-December 2009) as recorded in the autopsy registers of the department. RESULT A total of 5035 autopsies were done during the period, 89% of which were coroner cases. Four thousand, four hundred and eighty-one coroner cases representing 12.5% of all bodies received by the mortuary during the period were studied. The male to female ratio was 1.9:1, with an overall mean age of 38.3 years. The ages ranged from 1 day to 101 years with a peak incidence in the 25-44 years age group. A total of 553 children and 3928 adults were involved. The commonest indication for coroners autopsy was sudden unexpected natural deaths (SUNDs) which accounted for 65.5% of the cases. Other causes of death were accidents, homicide, suicide, and undetermined causes representing 28.6, 5.0, 0.5, and 0.4%, respectively. Commonest cause of SUND was cardiovascular diseases with complications of hypertension being the most common CVS disease (26.9%). Road traffic accident was the commonest form of accident causing death (88.7%). Public enlightenment and health education about routine medical screening will help to reduce causes of natural deaths. CONCLUSION This study shows the pattern of medicolegal autopsies in UBTH and this preliminary data will provide a baseline for future research and help in formulating policies to help in reduction of preventable causes of death.

Sexual Assault in Benin City, Nigeria, a Silent Epidemic

This study is a 6-year retrospective review of sexual assault cases seen at central Hospital, Benin City, Nigeria. There were 907 cases involving 903 males and 4 female accounting for 99.6% and 0.4% respectively. An annual rising incidence was demonstrated with 24.4% occurring in 2013. Children and adolescents accounted for an over whelming majority of cases with 79.1% occurring in this age group. In 77.6% of cases, only one assailant committed the crime and the victim is familiar with the assailant in most of the cases.

Histopathological profile of breast cancer in an African population

Background: Currently breast cancer (BRCA) still remain the most commonly diagnosed female cancer globally with a significant geographic, racial and ethnical variations in its incidence. Aim: This article examines the frequency and histological types and grades of BRCA in a pioneer teaching Hospital in Delta State, Nigeria. Materials and Methods: H and E stained-slides of breast biopsies diagnosed at the Central Hospital, Warri from 2005 to 2011 were archived and studied. Request forms were scrutinized for clinical bio-data, diagnosis and histological sections were analyzed. Data obtained were analyzed using the Statistical Package for the Social Sciences version 17 statistical package (SPSS) Incorporated, Chicago, Illinois, USA, and value presented descriptively. Results: During this period, 905 breast lesions were seen. Out of this, 261 were BRCAs, of which 260 cases were females and one case was a male. The peak age incidence for BRCA and its variants was 40-49 years accounting for (n = 94/261; 36%). The mean age of BRCA was 46 years (6.2). Invasive carcinoma of no special type (NST) was the most commonly encountered histological group of breast carcinoma constituting (n = 203/261, 77.7%) with the high grade invasive ductal carcinoma as the leading diagnosis. Conclusion: Majority of BRCAs encounter was invasive ductal carcinoma of NST with bulk of patients presenting in Stages III and IV.

Histopathological review of breast tumours in children and adolescents in Delta State Nigeria

Background: Breast swellings in children and adolescents may be overlooked on assumption that they are physiological enlargement. Pathologic swellings including cancers have however been encountered in this age group. This study highlighted the spectrum of tumours in childhood and adolescents. Materials and Methods: This was a 7 year retrospective analysis of all histologically diagnosed breast tumours in people aged 0 - 19 years. Results: There were 134 breast tumour diagnoses occurring in 133 females and 1 male (gynaecomastia). One hundred and nineteen cases (88.8%) were recorded in the 10 - 14 year age group and 15 cases (11.2%) in the 15 - 19 year age group. No case was found in children aged less than 10 years. The most common tumour was fibroadenoma accounting for 75.4% (n = 101) of all tumours followed by tubular adenoma (n = 11; 8.2%) and adenosis (n = 10; 7.4%). No case of malignancy was recorded in this study. Conclusion: Fibroadenoma is the most common breast tumour in children and adolescents in our environment.

Fatal gunshot injuries in Benin City, Nigeria

An upsurge in gun violence in recent times in our environment necessitated this study, which aims to document the patterns of fatal gunshot injuries with the hope of finding a solution to this problem. The study was a retrospective analysis of cases of fatal gunshot injuries on which autopsies were carried out over the 5-year period from January 1998 to December 2002 at Police Medical Services, Benin City – a Nigerian ancient town located in the South-South zone of the country. Most cases of medico-legal death in Benin City and environs are referred to the Police Pathologist at the center for autopsy. A total of 210 cases representing 27.2% of all medico-legal deaths during the study period were reviewed. Males were far more affected than females (M:F = 10.7:1). The intent for the fatal gunshots was murder (88.5%), excusable homicide (4.8%), accident (4.3%) and suicide (0.5%). In 1.9% of the deaths, the circumstances were not clear. Armed robbers, thugs and assassins accounted for 88.1% of the fatal shots, while the Police accounted for 9.0%. The trunk was affected much more than the head, neck and limbs. There is a need to improve security in the country and reduce poverty. Illegal firearms should also be removed from circulation. An improvement in emergency health services will reduce deaths from gunshots.

Accidental deaths in a University Teaching Hospital 1990-2009

Objective: The aim of this study is to describe the pattern of accidental deaths seen in University Benin Teaching Hospital (UBTH) and to highlight the need for implementation of preventive measures. Materials and Methods: This is a retrospective study of all cases of accidental deaths in which autopsy was performed at University of Benin Teaching Hospital (UBTH), Benin City, Edo state, Nigeria, from January 1990 to to December 2009. The major source of information was the autopsy registers of the DDepartment of Histopathology, UBTH. Result: A total of 35,914 bodies were received into the mortuary of UBTH during the study period; autopsy was performed on 5035 bodies out of which 4481 cases were medicolegal autopsies. Accidental deaths accounted for 1285 cases (26.8%): 1,016 cases were males and269 cases were females, giving a male to female ratio of 3.8:1. The youngest victim was an infant and the oldest 100 years old, with a a mean age of 35.46 years and 2SD of 5.81. The mean age for males and females were 34.67 years and 33.80 years, respectively. Of the 1136 cases of road traffic accidentss, 927 (81.6%) were of of males and 209 (18.4%) were of of females. Road traffic accident death victims were drivers and passengers (48%), pedestrians (30.2%), and bike riders/passengers (21.8%). Conclusion: The pattern of accidental deaths in Benin shows that road traffic accidents is the major cause of death. Efforts must be made to improve our roads so as to reduce the number of lives lost.

Epidemiology of Retinoblastoma

It is widely acknowledged that cancers are disorders of cell growth and behavior and that its cause has to be defined at cellular levels. However, studies have shown that the cause of cancer can be deduced from a study of its epidemiology. Sir Percival Pott is credited with linking chemicals to causing cancer when he observed astutely that Chimney sweeps, because of their chronic exposure to sooth, were prone to scrotal cancers. Subsequently, the Danish Chimney sweeps guild ruled that its members must have their bath daily and this prevented the problem.1 Prior to this, John Hill had linked nasal polyps to “immoderate use of snuff”. Epidemiology has also contributed in linking cervical cancer to human papilloma viruses and radiation to different cancers1. It is also important for the purposes of health planning and allocation of resources to know the distribution of any particular disease.