Ibrahim Aliyu

Indications for tonsillectomy and adenoidectomy: our experience.

BACKGROUND Infection and obstruction are the most common indications for performing tonsillectomy and adenoidectomy. In the past, infection was the main indication for these procedures; however, in the last few decades obstruction is said to be more prominent as an indication when compared to infection. OBJECTIVE The objective of this study was to report our observations of indications for tonsillectomy and adenoidectomy. MATERIALS AND METHODS This is a 2 year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy, adenoidectomy and adenotonsillectomy performed in a tertiary hospital. STATISTICAL ANALYSIS USED IBM SPSS (for windows, version 19) software was used to analyze this data. RESULTS A total of 115 patients records were reviewed. Moreover, 33.9% were children under 3 years, 60.0% were between 4 years and 10 years and 6.1% were between the ages of 11 years and 18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indication for these procedures. CONCLUSION Obstruction as an indication is proportionally higher in younger children while infection is proportionally higher in older children.

Is the Broselow Tape and APLS formula applicable to Nigerian children? The Kano experience

Background: Weight estimation is useful in pediatric practice; it is used in drug dosage calculation and for nutritional assessment. However, in comatose children actual weight measurement may not be possible therefore weight estimation becomes imperative. The Advanced Pediatric Life Support (APLS) formula and the Broselow Tape have been validated in most developed countries, but not in Nigerian children. Objective: To determine the performance of APLS formula and Broselow Tape in Nigerian children. Materials and Methods: The actual weight of 300 children in the Pediatric Emergency Unit and the Outpatient Department of Aminu Kano Teaching Hospital were taken using weighing scales and their length was also taken; these were compared with values estimated from their ages using the APLS formula and the Broselow Tape. Results: Both methods had similar pattern of performance, underestimating weight (39.7%) in the 1-year age group, and overestimation in the older age groups; however, these were within 95% limit of agreement. The overall average percentage difference was 5.3% and 5.4% for the Broselow Tape and APLS formula, respectively. The proportion of agreement within 10% of the actual weight were 36.8%, 48.8%, 64.3%, 48.1%, and 54.1% for 1, 2, 3, 4, and 5-year age groups, respectively. Conclusion: Both methods are of benefit in Nigerian children, although they underestimated weight in children within the 1-year-age-group.

Viper bite on the neck following a fight

Snakebite remains a public health problem in rural communities of tropical Africa and Asia. Globally, rare snakebite presentations are increasingly been reported presumably from the intensity of efforts by researchers in this domain to showcase this recently classified neglected tropical disease. Most venomous snakebite morbidity and mortality in Nigeria are caused by Echis ocellatus (carpet viper) and occur in the lower and upper limbs. Limb affectation has been associated with human activity at the time of bite. Our index patient is a child engaged in pastoral activity with a rare posterior neck viper bite following a fight in a rural Nigerian community. Challenges of diagnosis, availability of affordable and appropriate anti-snake venom, inadequate education of those engaged in high risk occupations, and the dearth of specific effective first aid for neck bites were encountered.

Sleep pattern and sleep hygiene practices among Nigerian schooling adolescents

Background: Sleep problems, especially in the adolescent stage of development, may be associated with excessive daytime sleepiness, impaired neurocognitive function, and a host of others leading to suboptimal performance. Objectives: To determine the pattern of sleep problems in school-going adolescents based on the bedtime problems; excessive daytime sleepiness; awakenings during the night and problems falling back asleep; regularity and duration of sleep; sleep-disordered breathing (BEARS) sleep screening algorithm. Materials and Methods: This is a cross-sectional descriptive study involving 353 secondary school-going adolescents in Kano metropolis. Subjects were selected for the study using multistage sampling technique. The study lasted from March 2015 to July 2015. Sleep problems were screened for using the BEARS sleep screening algorithm. Tables were used to present the qualitative data. The various BEARS sleep patterns were assessed, and comparison between stages of adolescence was done using Chi-square test (and Fishers exact test where necessary). A significant association was considered at P < 0.05. Results: Of the 353 adolescents studied, 61.8% were males while 38.2% were females with male, female ratio of 1.6:1. Early, middle, and late adolescents constituted 13.9%, 39.9%, 46.2% respectively. BEARS sleep screening revealed awakenings during the night (34.6%) as the most common sleep-related problem reported, and this was followed by excessive daytime sleepiness (21.0%). Age-group dependent sleep duration was 7.19 ± 1.26, 7.13 ± 1.13, 7.16 ± 1.28, with P > 0.05. Although 62.9% of all the adolescents watched TV/play video games until 1 h before going to bed and this was highest in late adolescence, it was not statistically significantly associated with any of the sleep problems. Conclusion: Both the quality and quantity of sleep in Nigerian adolescents in Kano is suboptimal. Adolescent and sleep medicine should receive more attention in our environment.

Utilisation of staff clinic facility in a Northwest Nigeria hospital: emerging challenges for the National Health Insurance Scheme

Background: The health status of workers and their families affects workplace productivity. The National Health Insurance Scheme (NHIS) objective of improving healthcare accessibility to Nigerians has increased service utilisation but may pose new challenges to existing facilities. This study was undertaken to describe the pattern of clinic utilisation, disease entities of subjects, use of the excused-duty certificate and identify points of delay. Methods: A prospective cross-sectional study of 352 subjects randomly selected over 6 weeks among patients attending the Aminu Kano Teaching Hospital Staff clinic. Results: Most subjects (307, 87.2%) had insurance and were predominantly (227, 64.5%) dependants. Most subjects (190, 55%) had used the clinic once to three times in the preceding 12 weeks and were predominantly (85, 24.2%) hospital attendants. Infectious disease (204, 58%) was the commonest reason for the clinical encounter. Their mean waiting and consultation times were 77.3 (SD ± 43) and 9.6 (SD ± 4.5) minutes respectively. Only 52 (14.8%) subjects were seen within 30 minutes of clinic arrival. Only a few subjects (3, 0.9%) had received an excuse-duty certificate in the preceding 12 weeks, mainly for malaria. Conclusion: High clinic utilisation and acute infectious disease burden are major challenges for the clinic, while prolonged clinic waiting time was suffered by clinic users. Prolonged waiting time may affect workplace availability and productivity. Proactive improvements in the causal factors for prolonged clinic waiting time may be required.

Blood transfusion request pattern in a medical center in Northwestern Nigeria

Introduction: Nigeria has a national policy on blood services, however, most medical facilities find difficulties in establishing a viable, efficient blood banking system; therefore, it becomes necessary to ensure judicious utilization of this scarce commodity. Therefore, this study hopes to determine the pattern of demand for blood transfusion in our institution. Materials and Methods: This study was a 1-year retrospective analysis of the request for blood transfusion. Results: There were 1958 blood requests, consisting of 554 for males (28.3%) and 1404 for females (71.7%) with male:female ratio of 1:2.5. The obstetrics and gynecology department (52.3%) had the highest request for blood transfusion, while medicine had the least (9.3%). Whole blood was the most common form of blood product requested (87.3%) while only two (0.1%) request for plasma was made. The most common indication for blood transfusion was anemia (52.2%), followed by the need for blood transfusion during surgery (30.4%); however, exchange blood transfusion was the least with only 16 requests (0.8%). A total of 3766.4 pints of blood were requested during the study period; however, obstetrics and gynecology had the highest request of 2350 pints (62.4%) while pediatrics had the least request of 255.4 pints (6.8%). Over 90% of requested blood and blood products were dispatched. The months of August, September, and October recorded the highest need for blood transfusion whereas January and February recorded the least. Conclusion: The obstetrics and gynecology department had the highest request for blood transfusion; this demand was experienced mostly toward the last quarter of the year, and most requests were dispatched, and there was judicious utilization of blood donated.

Prehospital care practices for venomous snakebites in resource-limited settings: A narrative review

Venomous snakebite is a medical emergency encountered worldwide, especially in resource-limited communities. It usually leaves victims at the mercy of traditional care, whose effectiveness have come under scrutiny over time. Several of these traditional/ first aid practices have also been reported over time. Controversies over their efficacy often result in confusion among snakebite victims, their caregivers, and sometimes, among health-care providers. This narrative review describes reported prehospital interventions for venomous snakebites highlighting their usefulness, dangers, and/or limitations associated with their use and the currently widely recommended prehospital activities for venomous snakebite.

Hydrocephalic newborn in a missed advanced abdominal pregnancy - diagnostic challenges in a rural setting: A case report

Advanced abdominal pregnancy (AAP) is a rare event associated with high maternal and perinatal morbidity and mortality. It is commonly seen among patients in the low socioeconomic class, those with previous history of infertility, and women with pelvic infection that seems to be more in the developing countries like Nigeria. It could, however, pose a diagnostic challenge, especially in resource-limited settings where there is lack or restriction of healthcare professionals and medical diagnostic facilities; hence diagnosis is often clinical that is fraught with errors. This may result in misdiagnosis as was observed in our case. Abdominal pregnancy is often associated with congenital deformation anomalies such as talipes and spinal dysraphism. However, the case of a live newborn delivered at term with combination of talipes and hydrocephalus, which are deformation and malformation anomalies respectively is reported.

Hand-washing practices and techniques among clinical students of Bayero University Kano, Nigeria

Background: Hand-washing is an important and a single most cost-effective and practical measure that reduces the incidence of infection and cross infection among health-care providers and patients. However, compliance of health-care workers to hand hygiene guidelines are reportedly poor. It is important, therefore, to instill adequate knowledge and good attitudes and practices at the time of primary training of future health-care workers. Materials and Methods: This was a descriptive cross-sectional study carried out among randomly selected clinical students of Bayero University Kano. The questionnaires were administered to the students during their daily ward rounds and clinic sessions. Results: One hundred and thirty-seven medical and nursing students of Bayero University Kano, who were on clinical posting were studied. Sixty-three (46%) students were aware of the Global Hand-washing day (χ2 = 5.989, df = 2, P = 0.050). Only 16 (11.7%) students were able to state correctly the Global Hand-washing date. One hundred and thirty-one (96%) students believe that hand-washing if correctly done can reduce the risk of infection. One hundred and fourteen (83.2%) students were taught hand-washing technique (χ2 = 6.862, df = 1, P = 0.009). One hundred and twenty-two (89.1%) of the students use soap and water or hand rubs in washing their hands. One hundred and two (74.5%) students are not aware of the World Health Organization five moments of hand-washing hygiene. Only 13 (9.5%) students were able to mention the steps of hand-washing correctly (χ2 = 10.285, df = 2, P = 0.006). Eighty-six (62.8%) students adhere to the principles of hand-washing in their clinical postings (χ2 = 4.404, df = 1, P = 0.036). Seventy-two (52.6%) students wash their hands before handling patients (χ2 = 7.575, df = 1, P = 0.006), but the majority 130 (94.9%) of them wash their hands after handling patients. Conclusion: There is a need for continuous teaching of medical and nursing students on the correct hand-washing techniques and to inculcate in them the habit of hand-washing before and after touching patients. This will greatly improve the safety of the potential health-care providers and patients.

Knowledge and attitude of parents toward oxygen therapy and nasogastric tube feeding in tertiary health centers in Nigeria

Background: Feeding sick children by mouth at times may be difficult. Therefore, alternative methods such as nasogastric tube feeding may come handy. Similarly, oxygen therapy is life saving; however, there are concerns of parental refusal of these treatments. Therefore, this study seeks to determine the level of acceptance of these treatments and factors responsible for treatment refusal if any. Materials and Methods: This study was cross-sectional and 202 mothers whose children were on or had nasogastric tube feeding and oxygen therapy were recruited. Results: Most of the respondents′ accepted nasogastric tube feeding and oxygen administration on their children despite the fact that most were not counseled (66.8% and 61.4%, respectively). The most common reason for declining nasogastric tube feeding was the belief that it may occlude the airway while those who declined oxygen therapy was because they believed it may result in death. Most of those that accepted nasogastric tube feeding also accepted oxygen therapy (X 2 = 32.031, df = 1, P = 0.00). The educational status of the respondents had no significant relationship with acceptance of nasogastric tube feeding (X 2 = 3.245, df = 3, P = 0.36) and also oxygen therapy (X 2 = 0.487, df = 3, P = 0.92). Furthermore, their age and number of children had no influence on their decision on acceptance of nasogastric tube feeding or oxygen therapy. Similarly, ethnicity and occupational status had no statistically significant relationship on acceptance of oxygen or nasogastric tube feeding. Conclusion: The acceptance of nasogastric tube feeding and oxygen therapy is very encouraging and was not affected by maternal age, ethnicity, or educational qualification.