Tropical Journal of Medical Research

Poverty, Visual Loss and Destitution in Onitsha, Nigeria

Cyriacus Akudinobi — 2024-08-24

Background: Visual loss is a major public health problem. About 90% of people who are blind live in low income countries, where increasing poverty perpetuates destitution. Poverty can be a cause and consequence of visual loss, and poor individuals have less access to eye care services. Objectives: To determine the relationship between poverty and visual loss among destitute. Materials and Methods: This was a cross-sectional study conducted among destitute in Onitsha, Nigeria between June and July 2011. Destitute clusters were randomly selected and interviewed. Information sought included socio-demographic variables, duration of destitution and estimation of monthly income in relation to needs. Ocular examination included estimation of presenting visual acuity, refraction, anterior and posterior segment evaluation. A focus-group discussion was also conducted. Data obtained was analyzed using SPSS, version 16. Results: One hundred and sixty-eight destitute comprising 93 males (55.4%) and 75 females (44.6%) were studied and the age range was 11-78 years with a mean age of 38.2±21.0 years. One hundred and twenty-nine (76.8%) did not have formal education, none was employed and 158 (94.0%) participants earned less than one United States dollar per day. All the blind destitute and those with severe visual impairment had very low daily income. Cataract (37.5%), glaucoma (17.2%) corneal disease (15.7%) and conjunctival disease (11.0%) were the common causes of visual loss. Conclusion: Poverty and visual loss are common among destitute in Nigeria. While each reinforces the other in a vicious cycle, there may be other reasons why people beg on the street.

Assessing the Mental Health of School Children in the Pre-COVID-19 and Post-COVID-19 Pandemic Lockdown Era: A Comparative Analysis

Ikechukwu Ogbonna — 2024-08-24

Background: The effects of COVID-19 on children’s mental health are well-documented and were compounded by the lockdown measures. Studies showed worsening post-COVID-19 mental health, but, whether these are at variance with those of the pre-COVID-19 era is controversial. Objectives: To compare children’s mental health during the pre-COVID-19 and post-COVID-19 lockdown eras. Materials and Methods: A cross-sectional and comparative study involving 484 school children categorized into two equal groups according to their enrolment periods. Strengths and Difficulties Questionnaire was employed to assess Mental Health Abnormalities (MHA) in them. Ethical approval and consent were obtained before commencing the study. Results: Children from the post-COVID-19 lockdown era had a significantly higher MHA prevalence and were four times more likely to have MHA than those from the pre-COVID-19 era (p = 0.025; adjusted Odds Ratio [aOR] = 3.89, 95% CI = 2.43 – 24.26). Except for hyperactivity/inattention, MHA types in the children showed a significantly higher prevalence of emotional, conduct and peer-relationship disorders (p<0.05). However, a multivariate analysis showed that only emotional disorders (p = 0.037) were significant. The children from the post-COVID-19 lockdown era were three times more likely to have emotional disorders than those from the pre-COVID-19 (aOR = 2.68; 95% CI = 1.06 – 6.74). Conclusions: We noted a higher MHA burden among children from the post-COVID-19 lockdown era and emotional disorders were the most common.

Pattern of Electrocardiographic Abnormalities in Asymptomatic Type 2 Diabetes Mellitus Out-patients at Nnamdi Azikiwe University Teaching Hospital, Nigeria

Chidiebele Ezeude — 2024-08-24

Background: Cardiovascular diseases rank among the major causes of diabetes-associated morbidity and mortality and are early markers of type 2 diabetes mellitus (T2DM). Electrocardiogram (ECG) remains a relevant diagnostic tool for cardiac abnormalities. Objective: To determine the prevalence and pattern of electrocardiographic abnormalities in asymptomatic T2DM out-patients at NAUTH, Nigeria. Materials and Methods: This was a cross-sectional descriptive study that evaluated 136 T2DM out-patients seen at diabetes clinic. Relevant data was extracted with a researcher-structured questionnaire and anthropometric measurements were done. A 12-lead non-stress ECG and laboratory tests were done. ECG was interpreted based on the Minnesota Codes for Resting Electrocardiograms. Data was analyzed using SPSS version 25. Categorical data were analyzed and compared using Chi-square test: results presented in frequencies and percentages. The mean values of continuous variables were calculated and compared between groups using Students t-test and analysis of variance (ANOVA). The level of significance was set at p<0.05. Results: 128 T2DM subjects with complete data were analyzed: 63 (49.2%) males and 65 (50.8%) females. The mean age was 58.43 ± 12.85. Q-wave abnormality occurred in 4.7%, QRS abnormality in 21.9%, left ventricular hypertrophy in 10.2%, T-wave abnormality in 21.9%, ST segment abnormality in 3.9%, atrioventricular (AV) block in 0.8%, bundle branch block (BBB) in 4.7%, sinus rhythm abnormality in 22.7%, atrial enlargement in 21.1% and coronary artery disease was seen in 23.4% of the participants. Conclusion: There was high prevalence of abnormal ECG findings that depicted a high prevalence of cardiac abnormalities in T2DM subjects

Correlation of CD4+ Count, Viral Load, Clinical Findings with Transabdominal Ultrasound Findings in Adult Patients Living with HIV/AIDS in Nigeria

Uzoamaka Rufina Ebubedike — 2024-08-25

Background: The Human Immuno deficiency Virus (HIV) is a cytopathic retrovirus that causes Acquired Immune Deficiency Syndrome(AIDS) over time. Ultrasonography is a cost effective, safe, accessible and non-invasive means of demonstrating the abdominal manifestations of HIV/AIDS. CD4⁺ count and viral load are the two surrogate markers widely used to monitor HIV disease progression. Objective: The aim was to determine the CD4⁺ count, viral load and clinical findings in adult patients living with HIV/AIDS, then correlate these with their transabdominal ultrasound findings. Materials and Methods: A prospective cross-sectional study involving 210 adult patients living with HIV/AIDS was conducted over a period of 18months and their ultrasound findings correlated with their clinical findings, CD4⁺count and viral load. Data processing and statistical analysis were done using IBM SPSS (IBM Statistical Package for the Social Sciences), version 21.0. (IBM corporation, Armonk, NY, U.S.A, 2011). Results: Patients with Advanced HIV Disease (AHD), high viral load as well as Moderate and severe clinical stages, had the highest proportion of abnormal ultrasound findings (28.6%, 25.7% and 28.6% respectively). Thus, decrease in CD4⁺count, increase in viral load result in more abnormal ultrasound findings and worse clinical stage. Conclusion: Most transabdominal ultrasound findings showed statistically significant correlation with CD4⁺count, viral load and clinical findings. Ultrasonography could be employed as a useful tool in the evaluation of patients with low CD4⁺ count and high viral load.

Comparison of Sleep Dose of Propofol and Induction Time in Class 1 Obese and Normal Weight Patients

Ifeatu Ogochukwu Oranusi — 2024-08-31

Background: Anaesthetic management of obese patients is challenging. Induction of anaesthesia with propofol is achieved by intravenous injection until loss of consciousness evidenced by loss of verbal response to command and loss of eyelash reflex. Physiological responses to dose of propofol may differ in class 1 obesity compared to normal weight patients. Objectives: We aim to compare the sleep dose of propofol and induction time in class 1 obese patients to normal weight patients. Materials and Methods: This is a prospective, single blinded, controlled study, conducted in patients aged 18 – 60 years with American Society of Anesthesiologist (ASA) physical status I or II, having body mass index (BMI) of 18.50-24.99 and 30.00-34.99, undergoing elective surgeries requiring general anaesthesia. Seventy patients were randomly recruited into 2 groups based on BMI. BMI was calculated for all the patients. Patients received intravenous propofol at 40mg every 10 seconds until loss of consciousness. The induction time and dose of propofol were recorded. Results: The mean induction dose of Propofol in the obese group was 132.71 ±19.30 mg compared to 128.57 ± 27.24 mg in the normal BMI patients (p=0.13). The mean induction time was 59.23 ± 17.88 seconds in the obese group compared to 65.34 ± 22.66 seconds in the normal BMI group (p=0.15).
Conclusion: There was no significant difference in induction dose of propofol, induction time, heart rate and mean arterial pressure in patients with class 1 obesity compared to normal weight patients. Administration of sleep doses therefore should be encouraged.

Prevalence of Drug Abuse Amongst Nnamdi Azikiwe University Students in Nnewi Campus, Anambra State, Nigeria.

Chukwuemeka Emmanuel Ogbodo — 2024-09-01

Background: Drug abuse is escalating into a grave issue in Nigeria, particularly with regard to the country's higher educational institutions, necessitating immediate action. Objectives: We aim to determine the prevalence of drug abuse amongst Nnamdi Azikiwe University students in Nnewi campus, Anambra state, Nigeria. Materials and Methods: This is a cross-sectional study involving a total of hundred (100) participants recruited using simple random sampling. SKYTECTM Drug abuse test was used to detect the presence of tramadol, tetrahydrocannabinol (THC), methamphetamine (MET), ketamine (KET) and 3, 4-methylenedioxymethamphetamine (MDMA) in the subjects’ urine sample following the manufacturer’s instruction. Results: The findings revealed that forty-three (43%) of the participants were female and fifty-seven (57%) of the participants were male. Eighty-one (81%) were between the ages of 22 and 35, fifteen (15%) between the ages of 18 and 21, and four (4%) were between the ages of 17 and 18. Among the individuals, 7% (<18.5 kg/m²) were underweight, 69% (18.5-24.9 kg/m²) were normal weight, 15% (25 kg/m²) were overweight, and 9% (>30.0 kg/m²) were obese. The prevalence of drugs abused by the participants were THC 7(7%), tramadol 0(0%), MET 0(0%), KET 0(0%), and MDMA 0(0%) respectively. Curiosity; stress relief, peer pressure and choice were the influencing factors. There was a significant association between the place of abuse with the current trend of drug abuse (x2 = 17.872, p=0.003) and between abuse partner with the current trend of drug abuse (x2 = 15.184, p=0.002). Conclusion: Early intervention focused at preventative and therapeutic measures should be implemented.

Obstetrics Outcomes of Women with Sickle Cell Disease in a Tertiary Hospital in Ibadan, Nigeria: A 10-Year Review

Timothy A. Olusesan Oluwasola — 2024-09-01

Background: Pregnancy in sickle cell disease (SCD) patients is associated with increased risk of fetomaternal morbidity and mortality. With improvements in management, education, awareness, and nutrition, more patients with SCD are maximizing their reproductive potential. Objectives: This review examined the pattern of complications and obstetrics outcomes of patients with SCD in a tertiary health facility. Materials and Methods: A descriptive retrospective study of 106 pregnant SCD patients who delivered at the University College Hospital, Ibadan between 1^st January 2008 and 31^st December 2017. Information on their demographic, medical and obstetrics characteristics, complications and outcome were obtained from their case notes using a pre-designed proforma. Data were analyzed using SPSS version 23. Results: Of the 106 cases reviewed, 64 (60.38%) had sickle cell anaemia (haemoglobin SS), 39 (36.79%) had haemoglobin SC and 3 (2.83%) had haemoglobin CC. The mean maternal age was 29.6±4.7 years. Majority, 83(78.3%), booked for antenatal care at mean gestational age (GA) of 19.4±8.7 weeks while the mean GA at delivery was 39.0±1.73 weeks. Bone pain crisis (38.8%) was the commonest non-obstetrics complication with 63.2% occurring among the HBSS genotype. The common obstetrics complications were preterm contraction, intrauterine fetal death (IUFD), and preeclampsia (each occurring among 27.3%). Overall, there were 84.9% live births and the overall fetomaternal outcome was satisfactory in 38.7%. Conclusion: Sickle cell disease in pregnancy has remained associated with increased risk of bone pain crises as well as preterm contractions, IUFD and preeclampsia. A multidisciplinary team approach is essential in ensuring a positive pregnancy outcome.

Association of nutrient intake adequacy and malnutrition among primary school children in an urban community.

Nkechinyere Obichukwu — 2024-09-03

Background : Nutrient intake adequacy is the bedrock of normal nutritional status among children globally. Studies have shown the devastating impact of childhood malnutrition despite current interventional strategies, hence the need to explore the possible association of inadequate nutrient intake and malnutrition among school children. Aim: This study aimed to determine the association of nutrient intake adequacy and malnutrition among primary school children in Nnewi, Southeast Nigeria. Method: This cross- sectional descriptive study was carried on primary school aged children, however 203 of the participants were enrolled for the analysis as 69 of them were excluded since they had mis-report of energy intake. Socio-demographic data was collected using a pretested interviewer administered questionnaire. The adequacy of nutrients present in their immediate past 24-hour dietary recall was analyzed using Nigerian and West African food composition table software. The data was analyzed using Statistical Package of Social Sciences (SPSS) version21.0 windows with level of significance for test set at 5%. Results: Out of 203 primary school aged children with adequately reported energy intake enrolled into the study, 116(57.1%) were male with male female ratio of 1.3:1. Inadequate intake of all macronutrients, vitamin A and calcium were associated with under-nutrition (P < 0.05) While inadequate intake of total energy, fat and calcium were associated with overweight/obesity. (P<0.05). Conclusion: Nutritional counselling on the need for adequate fortification of routine meals to provide daily requirement of both macro and micro nutrients, especially Vitamin A and calcium can help mitigate the impact of childhood malnutrition in the sub region.

Histological and hormonal studies of the effect of wheat-based diet (Triticum asstivium L) on the ovaries of adult Sprague-Dawley rats

Chika Anna Idaguko — 2024-09-12

Background: The public is familiar with wheat as a common dietary source. It is undeniable that wheat contributes to the nourishment of both humans and animals. Objectives: This study looked at the effects of wheat-based diets on the histology of the ovary and the female reproductive hormones. Materials and Methods: Fifteen mature female Sprague-Dawley rats were used in this investigation; they were divided into three groups (A-C), each with five rats. For four weeks, the animals in groups A to C received the following diets; group A had regular rat chow, group B was fed a diet made entirely of wheat (100%), groups C were fed 60% wheat (60g of wheat mixed with 40g of rat chow). The levels of follicle-stimulating hormones, luteinizing hormones, estrogen and prolactin were assessed using hormonal tests. The ovary was carefully dissected out and quickly fixed in 10% formal saline for routine histological study after the H&E method. Results: Comparing the wheat-based diet groups to the control, there was a significant increase (P˃0.05) in body weight. However, there was no difference in the ovarian weights. The follicle-stimulating hormone, luteinizing hormone and estrogen levels were unaffected by the wheat-based diets, except prolactin levels that increased in the 100% wheat diet group B. There was no histological changes observed in the ovary of the wheat groups; as follicles at different stages of development, corpora luteum and few cytoplasmic vacuoles are present. Conclusion: The research indicated that a diet high in wheat should be consumed in moderation.

Disseminated Tuberculosis in a Vaccinated 9-Year-Old: A Case Report

Ebube Akosa — 2024-08-29

Tuberculosis (TB) is uncommon in children vaccinated at birth as Bacille Calmette-Guerin (BCG) vaccine offers protection for a 10- to 15-year period. However, disseminated TB has been increasingly recognized in children due to the increased prevalence of immune suppression secondary to AIDS, malnutrition and immunosuppressive therapies for various medical disorders as well as increasing awareness leading to more diagnoses. We report a 9-year-old female who presented with recurrent fever, rashes, bilateral neck and abdominal swelling of 3 years duration in order to raise awareness of the occurrence of disseminated TB in our locality, the importance of a high index of suspicion and tissue diagnosis in immunosuppressed children with a negative microbiology result.