Ayoade Adedokun

Contextualizing Child Malaria Diagnosis and Treatment Practices at an Outpatient Clinic in Southwest Nigeria: A Qualitative Study

Background. This study sought to explore contextual features of an outpatient clinic located in southwest Nigeria that enable and/or discourage effective diagnosis and treatment of child malaria. Methods. We conducted in-depth interviews with mothers of 135 febrile children attending a pediatric outpatient clinic in southwest Nigeria. Also, participant observations and informal discussions with physicians were conducted to examine the potential impact of context on effective child malaria diagnosis and treatment. Results. The findings indicate that availability of drugs and laboratory testing for malaria, affordability of antimalarial drugs, access to the clinic (particularly access to pediatricians), adequacy of the outpatient clinic, and acceptability of services provided at the clinic are key contextual factors that influence effective case management of malaria in children. Conclusion. If the Millennium Development Goal 6 of reversing malaria incidence by 2015 particularly among children is to be achieved, it is necessary to identify the contextual factors that may act as potential barriers to effective diagnosis and treatment practices at clinical settings. Understanding the context in which case management of child malaria occurs can provide insights into the factors that influence mis- and over-diagnosis of malaria in clinical settings.

Evaluation and Comparison of the Indices of Systemic Oxidative Stress among Black-Africans with Age-related Cataracts or Primary Glaucoma.

Purpose: Oxidative stress has been implicated in the pathophysiology of glaucoma, cataract, and many degenerative diseases. The purpose of this study is to evaluate the systemic oxidative stress in black.African patients diagnosed with primary glaucoma or age.related cataract. (ARC) and compare these indices to normal control patients and between the two conditions. Methods: This was a descriptive cross.sectional study of consecutive recruited subjects attending a tertiary care facility. One hundred adults were enrolled and sub.grouped into: Normal controls. (n = 20), patients with primary glaucoma. (n = 40), and patients with cataract. (n = 40). The data were collected on patient demographics and clinical information. Ten milliliters of the venous blood was taken from each subject for the evaluation of serum biochemical indices of oxidative stress. Laboratory measurements of enzymatic and nonenzymic anti.oxidants, as well as lipid peroxidation, were conducted using established and validated spectrophotometric methods. The systemic oxidative stress was measured by the serum levels of anti.oxidant enzymes and lipid peroxidation, and compared between the groups and to a control group of patients. Results: Statistically, significantly reduced serum levels of glutathione, glutathione-S-transferase, superoxide dismutase, catalase, and ascorbic acid were found in the patients with glaucoma or cataract when compared with controls. (P < 0.05 for all). Differences in serum lipid peroxidation levels across or between the groups were nonsignificant. Serum protein levels were significantly higher among the subjects with cataract or glaucoma than in controls. Conclusion: Our results concur with findings in Caucasian study cohorts. This indicates that in black.Africans, primary glaucoma, and ARC are associated with increased systemic oxidative stress. This supports the existing evidence on the role of oxidative stress in these ocular disorders and reinforces the rationale for the use of anti.oxidants in the management and possible prevention of these conditions.

Determinants of young people’s sexual behaviour concerning HIV and AIDS in the practice population of a university health centre in Lagos, Nigeria

Abstract Background AIDS has been a scourge of universities in Africa for a long time. This study was launched at ground-level to fight the dreaded disease by concentrating on young people and to counter the ignorance that surrounds the disease even in numerous African universities. This study of the student community was carried out by family doctors at the University Health Department to determine the prevalence of the determinants of young peoples reproductive health behaviour. Objectives This study is aimed at determining young peoples sexual behaviour concerning HIV and AIDS in the practice population of a university in Lagos, Nigeria. Method Self-administered 63-item questionnaires were distributed amongst 2000 randomly selected students of the University of Lagos, Lagos, Nigeria in September 2005, using a semi-structured form of the Comprehensive Youth Survey questionnaire, developed by FOCUS (led by Pathfinder International, Futures Group International and Tulane University School of Public Health). Results The age distribution of the respondents was designated in the age groups of 15–19 years (15.8%), 20–24 years (60.1%), 25–29 years (19.6%), 30–34 years (2.8%). Demographics of note were that 88.3% of the fathers of the respondents were literate and that 94.5% of the fathers earned more than one US

The Fire Service for the Removal of a Metallic Penile Constricting Device: A Ready Help When All Else Fail

per day. The majority of the respondents (99.1%) indicated adherence to one religious faith or the other and 58.8% believed definitely that religion shaped their attitudes about sexual intercourse and sexuality. More than half (64.0%) denied having had sex at all in the three months preceding the study. Furthermore, 68.8% affirmed that it was common amongst friends of their age to use condoms. A significant number of respondents (65.5%) thought that their friends have drunken alcohol. Almost all of the respondents (94.3%) had a positive perception of their family. Conclusion The Programming for HIV and AIDS Reduction on university campuses in Africa should be conducted comprehensively rather than monothematically and should, take into consideration the five thematic areas of behaviour change communication amongst young people concerning their reproductive health.

Effect of self-monitoring of blood glucose on glycaemic outcome among type 2 diabetic patients

The placement of a constricting device around the penis is a urologic emergency. Though injuries from constricting penile devices are generally rare, they may be associated with serious complications. There is no standard modality for the removal of penile constricting devices and the management of the patient can therefore prove to be a formidable challenge to the urologist. Timely intervention is always important in preventing complications especially penile gangrene. Depending on the type of device used along with the duration and severity of penile constriction caused, significant resourcefulness may be required in the treatment of the patient. Achieving a timely and successful outcome may require a multidisciplinary approach involving equipment only available with the fire service or other agencies. We report the case of a 30-year-old man with a background psychiatric illness who had his penile constricting device removed under conscious sedation in the emergency room with the aid of a power driven arc saw from the fire service with a successful outcome.

Case-Management of Malaria in Children Attending an Outpatient Clinic in Southwest Nigeria

Background: Diabetes mellitus is a chronic metabolic disorder which leads to complications especially when not properly managed. The role of self-monitoring of blood glucose (SMBG) in type 2 diabetic patients using oral hypoglycaemic agents has been a source of controversy. Objective: The objective was to study the effect of SMBG on glycaemic outcome among type 2 diabetics in a primary care setting. Methodology: A randomised control study was conducted between March 2013 and November 2013 at the General Outpatient Clinic of the Family Medicine Department (FMD) in Lagos State University Teaching hospital. A total of 120 diabetic patients were randomised into intervention and control groups; 107 patients (55 in the intervention and 52 in the control group) completed the study. Intention-to-treat analysis was done. Chi-square, Students t- and paired t-test were used to determine variables significantly associated with SMBG. Results: More than three-quarters (77.5%) of the participants were aware of SMBG prior to commencement of the study. Both the SMBG (8.7% vs. 7.2%; p-value < 0.001) and non-SMBG (8.7% vs 7.7%; p-value < 0.001) groups had a significant improvement in HbA1c at the end of the study. Similarly there was a significant improvement in FBG among both groups (SMBG 153 mg/dl vs. 123 mg/dl; p-value < 0.001 and non-SMBG (158 mg/dl vs. 137 mg/dl; p-value 0.022). The HbA1c at the end of the study was 7.2% for the SMBG vs 7.7% for the non-SMBG group with no statistical difference (p-value 0.174). Conclusion: The use of SMBG among type 2 DM patients did not result in better glycaemic control compared with patients who did not practise SMBG. It could be due to close follow-up and education of both groups.

Explanatory models of hypertension among Nigerian patients at a University Teaching Hospital.

This study examined the case-management of malaria in 135 febrile children attending an outpatient clinic in southwest Nigeria. Specifically, we examined the degree of concordance between physicians diagnosis of malaria, maternal perceptions of child febrile illness, and the results of malaria rapid diagnostic tests. The results indicate poor concordance in the diagnosis of malaria by physicians and the results of malaria RDTs (κ = 0.030, p-value = 0.269) as well as between mothers perception of malaria in their children and malaria RDTs (κ = 0.071, p-value = 0.369). While physicians can correctly identify children that have malaria according to the RDT test (Sensitivity = 95.23%), they were poor identifiers of children who do not have malaria (Specificity = 13.15). On the other hand, while mothers are poor identifiers of children that have malaria according to the malaria RDT test (Sensitivity = 38.1%), they are better at identifying children who do not have malaria (Specificity = 71.1%). The findings demonstrate the importance of exploring the contextual factors that influence case management of child malaria in outpatient clinics.