Family Medicine

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    Caesarean Section Rate And its Indications in An Urban Private Hospital in Jos, North Central Nigeria: A 15-Year Survey.
    (IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 2017-06) Sule H.M; Hassan Z.I; Shambe I.H.
    Caesarean section reduces the morbidity and mortality associated with complicated childbirth when it is performed for the right indication. Objective: We reviewed the rate and indications for caesarean section in an urban private hospital in Jos. Methods: It was a retrospective study of 228 women who delivered by caesarean section in a private hospital. Results: The mean age of the patients was 26.4 + 5.8 years. The caesarean section rate was 8.9%. Of these, 64 (28.1%) were elective while 164(71.9%) were emergency procedures. The commonest indication for caesarean section was cephalopelvic disproportion (40.0 %), followed by preeclampsia/eclampsia (18.0%) and previous caesarean (11.8%). The least frequent indications were uterine rupture and maternal sickle cell disease, both at 0.4%. Conclusion: Indications for caesarean section in this private hospital was similar to public hospitals in the same country. A regular review of indications for caesarean section in any facility is an important aspect of auditing obstetric care services. A universal guide for obtaining and keeping patients records should be developed .This would go a long way in enhancing reliable data generation for future research and ultimately, improving obstetric care service.
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    A Study of The Effect of Fractionation on Phytochemical Composition And In Vitro Antimicrobial Activity of Methanol Extract of Garcinia Kola (Heckel) Seeds on Some Bacterial Isolates
    (Scientific Research Journal (SCIRJ), 2019) BB Bukar; Adurogboye; KD Falang
    bjective: The objective of this study is to investigate the effect of fractionation of the crude methanol extract of Garcinia kola (Heckel) seeds on phytochemical constituents and in vitro antimicrobial activity. Method: Fractionation was carried out using the solvent portioning method with solvents of different polarities. Phytochemical analysis was done by use of specific analytical test for each constituent. The minimum inhibitory concentration was determined by the broth microdilution assay while the minimum bactericidal concentration was carried out using the agar well diffusion method. Results: The different fractions exhibited differences in their composition of the phytochemical constituents. This observation was however not dependent on the sequence of the polarity of the solvents. The acetone fraction presented similar phytochemicals compared with those of the crude methanol extract. The n-hexane fraction presented the least phytochemicals. The crude methanol fraction exhibited antibacterial activity against all the isolates at the concentration of 200 mg/ml, suggesting that fractionation may not be of any added advantage on the antibacterial activity. The antibacterial activity exhibited by the fractions against all the isolates were significant lower compared to that due to the standard antibiotic, gentamicin, 4 mg/ml (P < 0.05). Similarly, it was shown that the antibacterial activity of each of the fraction was dose-dependent, with larger zones of inhibition corresponding to higher concentrations (P < 0.05). The acetone fraction exhibited highest antibacterial activity on S aureus with a zone of inhibition of inhibition of 20.5 ± 7.1 mm at the concentration of 200 mg/ml. This was significantly lower compared to 31.5 ± 6.2 mm due to gentamicin, 4 mg/ml (P < 0.05). The lowest antibacterial activity was exhibited at 200 mg/ml was seen with the methanol fraction on E coli with a zone of inhibition of 4.3 ± 1.2 mm and it was the only fraction with effect against this isolate. The n-hexane fraction did not exhibit any visible antimicrobial activity on all the isolates. Conclusion: Fractionation of the crude methanol extract revealed the antibacterial activity of the fractions with the acetone fraction more effective on S aureus than the crude extract. The finding generally confirms and validate the traditional claims and other scientific findings that Garcinia kola possesses principles that are antibacterial. This could therefore justify its traditional use in some infectious diseases and the need for further investigation
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    A Comparison of Sulfadoxine-Pyrimethamine with Chloroquine and Pyrimethamine for Prevention of Malaria in Pregnant Nigeria Women
    (The American Society of Tropical Medicine and Hygiene, 2007) IBRAHIM U. TUKUR; TOM D. THACHER; ATIENE S. SAGAY,; JEREMIAH K. A. MADAKI
    Abstract. Few studies have documented the effectiveness in west Africa of intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine (SP) in pregnancy. Pregnant Nigerian women were assigned to receive either SP given twice or presumptive chloroquine (CQ) treatment followed by weekly pyrimethamine (CQ + P); 250 were enrolled in each group. Of those completing follow-up, 4 (1.8%) in the SP group and 22 (9.8%) in the CQ + P groups had a febrile illness (P 0.005). None in the SP group but 11 (4.9%) in the CQ + P group had peripheral parasitemia prior to or during delivery (P 0.002). Two (1.2%) in the SP group and 9 (5.0%) in the CQ + P group were anemic at delivery (P 0.04). There were six low birth weight infants in the SP group and eight in the CQ + P group (P 0.21). Intermittent preventive treatment with SP is superior to CQ + P for prevention of malaria and anemia in pregnant women in Nigeria.
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    A Qualitative study of Young Nigerian Family physicians’ views of their Specialty
    (South African Family Practice, 2017) K Yakubu; K Hoedebecke; L Pinho-Costa; , O Popoola; I Okoye
    Background: In Nigeria, the specialty of family medicine (FM) has endured its own share of identity crises. This study was aimed at generating hypotheses about what describes a practising family physician (FP) and the specialty, according to young Nigerian FPs. Methods: Using the online platform for young African FPs alongside text messages and emails from volunteer research assistants over an eight-week period (March 3 to April 30, 2015), a purposive sample of young Nigerian FPs were asked to describe their favourite aspect of FM in a single word/phrase. Responses were provided in English/individual’s mother tongue. Translation of the words was performed by respondents and additional collaborators fluent in these languages. Thematic analysis using the grounded theory approach was performed. Results: Twenty-four responses were received consisting of four themes: Scope, Family, Skills/Feelings/Values, and Professional Fulfilment. The resulting data portrayed the FP as one who possesses a unique skill-set, enjoys fulfilment in the profession, deals with undifferentiated diseases and is able to provide holistic care for patients (irrespective of age and gender) from a family- centred perspective. When compared with accepted domains of FM for Africa and Europe, roles of the FP in community-oriented care and primary care management were absent. Conclusion: While this showcases the young Nigerian FPs’ acceptance of their role in providing comprehensive primary care, it suggests a lesser acceptance of their role in community-oriented primary care as well as primary care management. This study provides a basis for future, quantitative research describing attitudes and competence in these areas. Keywords: family practice, grounded theory, identity crisis, Nigeria, primary health care.
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    Factors affecting time of access of in-patient care at Webuye District hospital, Kenya
    (African Journal of Primary Health Care & Family Medicine, 2016) Maxwell M. Lodenyo1 Barasa K. Otsyula2 Raymond Downing1 Kenneth Yakubu3,4 Miriam Miima5 Okoye Ifeyinwa
    Background: Among many Kenyan rural communities, access to in-patient healthcare services is seriously constrained. It is important to understand who has ready access to the facilities and services offered and what factors prevent those who do not from doing so. Aim: To identify factors affecting time of access of in-patient healthcare services at a rural district hospital in Kenya. Setting: Webuye District hospital in Western Kenya. Methods: A cross-sectional, comparative, hospital-based survey among 398 in-patients using an interviewer-administered questionnaire. Results were analysed using SPSS V.12.01. Results: The median age of the respondents, majority of whom were female respondents (55%), was 24 years. Median time of presentation to the hospital after onset of illness was 12.5 days. Two hundred and forty seven patients (62%) presented to the hospital within 2 weeks of onset of illness, while 151 (38%) presented after 2 weeks or more. Ten-year increase in age, perception of a supernatural cause of illness, having an illness that was considered bearable and belief in the effectiveness of treatment offered in-hospital were significant predictors for waiting more than 2 weeks to present at the hospital. Conclusion: Ten-year increment in age, perception of a supernatural cause of illness (predisposing factors), having an illness that is considered bearable and belief in the effectiveness of treatment offered in hospital (need factors) affect time of access of in-patient healthcare services in the community served by Webuye District hospital and should inform interventions geared towards improving access.
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    Factors associated with long-standing HIV-1 infection among HAART treatment-naïve adults in Jos, Nigeria
    (International Journal of Microbiology and Application, 2014-04) Anejo-Okopi JA1, *, Agbaji OO1, 2, Ebonyi AO3, Agaba PA4, Onywera H5, Oguche S1, 3, Mbaawuaga EM6, Audu O7, Abba JO1, Nimzing L8, Isa SE1, 2, Olonitola SO9, Idoko JA10, Okonkwo P
    The estimation of the duration of HIV infection among newly enrolled HIV infected patients has become important because of clinical implications. Since many patients with HIV-1 infection are not usually diagnosed until they present with symptoms, the need to determine the factors associated with long-standing infection is becoming increasingly important for the epidemiologic purposes and of early access to HAART. We determine the factors associated with long-standing HIV infection in HAART naïve patients. One hundred and five cryopreserved plasma samples randomly selected from sample frame of 230 HIV-1 infected treatment-naïve patients at the adult ART clinic of the Jos University Teaching Hospital, were tested using enzyme immunoassay (EIA)-avidity index assay. Of the 105 samples, 100 were successfully tested. Basic demographic (age, sex, residence, education level, marital status), spouse on ARV, spouse HIV status), mode of transmission, WHO clinical staging, co-infections, HIV-1 viral load, and CD4+cell count results were obtained and analyzed using Stata software version 10.1. Majority of the patients had long-standing HIV-1 infection and were late presenters to the ART treatment Centre. Both the univariate and multivariate analyses showed that low CD4+ cell count was associated with the longstanding HIV infection at 95% CI 5.34 (1.30-21.92). Early detection of HIV-1 infection and access to ART is necessary to avoid rapid decline of CD4+ cell count resulting in accelerated HIV disease progression and consequent development of opportunistic infections.
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    Treatment Outcomes Among Older Human Immunodeficiency Virus-Infected Adults in Nigeria
    (Open Forum Infectious Diseases, 2012) Patricia A. Agaba,1,4 Seema T. Meloni,5 Halima M. Sule,1,4 Oche O. Agbaji,2,4 Atiene S. Sagay,3,4 Prosper Okonkwo,6 John A. Idoko,2 and Phyllis J. Kanki
    Background. Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria. Methods. This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004 and 2012. We compared baseline and treatment differences between older (≥50 years) and younger (15–49 years) patients. Kaplan-Meier analysis and Cox proportional hazard models estimated survival and loss to follow-up (LTFU) and determined factors associated with these outcomes at 24 months. Results. Of 8352 patients, 643 (7.7%) were aged ≥50 years. The median change in CD4 count from baseline was 151 vs 132 (P = .0005) at 12 months and 185 vs 151 cells/mm3 (P = .03) at 24 months for younger and older patients, respectively. A total of 68.9% vs 71.6% (P = .13) and 69.6% vs 74.8% (P = .005) of younger and older patients achieved viral suppression at 12 and 24 months, with similar incidence of mortality and LTFU. In adjusted hazard models, factors associated with increased risk of mortality were male sex, World Health Organization (WHO) stage III/IV, and having a gap in care, whereas being fully suppressed was protective. The risk of being LTFU was lower for older patients, those fully suppressed virologically and with adherence rates >95%. Male sex, lack of education, WHO stage III/IV, body mass index <18.5 kg/m2, and having a gap in care independently predicted LTFU. Conclusions. Older patients achieved better viral suppression, and older age was not associated with increased mortality or LTFU in this study.
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    Body Size and Metabolic Health: A Phenotypic Characterisation of an Indigenous African Working Population
    (Annals of Medical and Health Sciences Research, 2017-08) Agaba, Patricia A.; Akanbi, Maxwell O.; Ocheke, Amaka N.; Gimba, Zumnan M.; Fannap, Binfa J.; Iliya, Friday G.; Agaba, Emmanuel I.
    Background: An obesity subgroup has been described that do not have the typical metabolic abnormalities associated with obesity. Aims: We characterized body size and metabolic phenotypes among public employees. Materials and methods: 879 participants were evaluated using WHO-STEP wise approach to non-communicable diseases screening. Body size was classed according to WHO guidelines. Metabolically healthy obesity (MHO) was defined as obesity without elevated blood pressure, diabetes mellitus and reduced HDL-C (< 40mg/ dl for men and<50 mg/dl for women respectively). Determinants of MHO were assessed in a logistic regression model adjusting for socio-demographic, clinical and biochemical variables. Results: 38.1% (335/879) had normal BMI, 35.5% (312/879) were overweight and 26.4% (232/879) were obese. The prevalence of metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOWT) and metabolically healthy obese (MHO) was 47.7% (160/335), 32.6% (102/312) and 18.5% (43/232) respectively (p<0.001). Tertiary education (adjusted odds ratio (AOR)=1.59; 95% CI: 1.03-2.47), hypertension (AOR=2.30; 95% CI: 1.58-3.35), hypercholesterolaemia (AOR=1.52; 95% CI: 1.06-2.17) and reduced HDL-C (AOR=2.40; 95% CI: 1.20-4.78) independently predicted generalized obesity, while male sex (AOR=0.10, 95% CI:0.07- 0.16) reduced the risk of generalized obesity by 90%. Age 45 years and older (AOR=0.29; 95% CI: 0.20-0.40, p<0.001), alcohol intake (AOR=0.50; 95% CI: 0.34-0.74, p<0.001), and generalized obesity (AOR=0.31; 95% CI: 0.20-0.47, p<0.001) were protective against MHO. Conclusion: A significant proportion of the participants had the MHO phenotype. Body size had an inverse relationship with metabolic health.