Faculty of Clinical Sciences

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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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    Knowledge of Scabies Among a Cohort of Medical Students
    (Open Science Journal of Clinical Medicine, 2015-09) Halima Mwuese Sule1, Zuwaira I. Hassan2, Mark D. Gyang3, Kenneth Yakuba1
    Scabies is a common skin infestation, endemic in developing countries, usually affecting families and large groups of people living together. The intense discomfort caused by the primary disease, the life threatening complications from secondary bacterial infection, along with the challenges and costs of correct diagnosis and proper treatment make it a public health problem. Sufficient knowledge about scabies by healthcare professionals is an essential tool in fighting the scourge of scabies. Methods: We undertook a survey to assess the level of knowledge about scabies among clinical medical students, potential doctors who had completed postings in dermatology and paediatrics where the subject of scabies is routinely taught, with the aim of identifying any possible needs for an improved education on this topic. Self-administered questionnaires were distributed to a cohort of clinical medical students in a university, selected by multi-staged random sampling. Results: Of 140 medical students surveyed, the overall mean knowledge score was 7.8±2.4 out of a maximum of 14 correct answers. Only 13(9.3%) of them had satisfactory scores (≥ 75%). Neither gender, number of years in medical school or having seen at least one clinical case of scabies influenced the knowledge. Conclusion: There exists a poor knowledge of scabies among clinical students who are potential doctors.
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    Efavirenz-induced gynaecomastia in HIV-infected Nigerian men: A report of six cases
    (Journal of Medicine and Medical Sciences, 2011) Oche O. Agbaji1,2, Patricia A. Agaba1,3*, Peter N. Ekeh1, Halima M. Sule1, Raphael O. Ojoh1, Eunice Audu1, Simon J. Yiltok4, Philip O. Osho4, John A. Idoko2, Phyllis Kanki5
    Highly active antiretroviral therapy (HAART) has revolutionized the treatment of HIV-infected patients. However, numerous adverse effects and limitations regarding tolerability remain a concern. We report six patients presenting in our treatment program with varying degrees of gynaecomastia following these of efavirenz-based highly active antiretroviral therapy, despite adequate immunologic and virologic response. The time interval between commencement of treatment and appearance of gynaecomastia ranged from 8-16 months with a mean period of 10±3 months. Five of the patients experienced complete regression of gynaecomastia following efavirenz withdrawal within 6-10 weeks. One patient experienced partial regression and subsequently required bilateral mastectomy; he is without recurrence one year post surgery. Gynaecomastia is not uncommon in HIV-infected men receiving efavirenz-based highly active antiretroviral therapy. Careful attention need to be paid to the evaluation of these patients in order to institute appropriate therapy and effectively manage other comorbid conditions that could also cause gynaecomastia
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    Alcohol Use among Tricycle Riders in Jos Nigeria
    (IOSR Journal of Dental and Medical Sciences, 2018-02) Tyavyar J. Akosu1, Afolaranmi Tolulope2 Joseph Iornumbe Usar3
    Background; Driving under the influence of alcohol contribute significantly to morbidity and mortality globally. Studies have reported high prevalence of alcohol use among commercial drivers in many parts of the worldbut such studies have not been reported, to our knowledge, among tricycle drivers even though they play an important role in inner city transport in many cities.The purpose of this studytherefore was to determine the pattern of alcohol use and drink driving among tricycle drivers in Jos, Nigeria and their involvement in road traffic accidents. Methodology A descriptive cross-sectional study was conducted among 195 tricycle drivers using an interviewer administered adapted alcohol use AUDIT questionnaire. Data analysis was done with epi info statistical software version 7.2, 95% confidence interval was used with a probability value of < 0.05 considered statistically significant. Results All the one hundred and ninety-five tricycle drivers studiedwere males and all consume alcohol. Most of them (67.4%) drink and drive. A hundred and seventeen (60%) of respondents have had an accident in the last year and 70% of the accidents occurred while driving after drinking alcohol. There was no significant relationship between frequency of drinking and involvement in road traffic accident. Conclusion The level of alcohol use by tricycle drivers in Jos is alarming and this increases the risk of road crashes. Effective legislation with resources for its implementation are required to reduce drink driving and traffic accidents.
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    CONTRACEPTIVE UPTAKE AMONG WOMEN OF REPRODUCTIVE AGE IN A SEMI URBAN AREA IN JOS SOUTH LOCAL GOVERNMENT AREA OF PLATEAU STATE, NORTH CENTRAL NIGERIA.
    (THE NIGERIAN HEALTH JOURNAL, 2013-06) Moses Chingle, Mathilda Banwat, Luret Lar, Ayuba Zoakah
    BACKGROUND Family planning reduces the number of unintended and unwanted pregnancies and thereby saving women from high risk pregnancies and unsafe abortions. Despite the persistent advocacy urging the use of modern contraceptive methods for family planning, the fertility rates in most sub-Saharan African countries still remain unacceptably high mostly due to poor uptake of contraception because of cultural, economic and political barriers. Evidence from the recent Nigeria Demographic and Health Survey indicates that only about 15 percent of sexually active women currently practice effective contraception. The objective of the study was to assess the knowledge of contraceptive and its uptake among women of reproductive age in Gering community in Jos South Local Government Area of Plateau State. METHODS A cross sectional study design was used to assess knowledge and uptake of contraceptive among 400 respondents selected by multi stage sampling technique in Gering community using a semi structured interviewer administered questioner. Information about their knowledge, uptake, methods and factors that determine uptake of contraceptives was obtained. Data was analyzed using Epi Info statistical software and results were presented as tables. Chi square was used to test association between qualitative variables. RESULTS Majority, 362 (90.5%) of the respondents were aware of contraceptives, 200 (55.2%) had used one form of contraceptive or the other. Two common methods of contraceptives used were pills, 184 (34.2%) and injectable 176 (32.8%). Determinants of uptake included: prevention of unintended pregnancies in 136 (53.1%) and to space timing of child birth in 78 (30.5%). Factors found to be associated with contraceptives uptake among women included age, (p=0.000), education (p=0.000) and marital status (p=0.000). CONCLUSION This study showed that despite high awareness about contraceptives, the uptake is relatively low compared to the rates in developed countries. Factors like age, marital and educational status have statistically significant relationship with contraceptive uptake. There is a strong need to encourage continuing female education to enhance awareness on contraceptives and their benefits in reproductive health.
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    CLEFT LIP, ALVEOLUS AND PALATE IN AFRICAN NATIVES: AN UPDATE ON DEMOGRAPHICS AND MANAGEMENT OUTCOME
    (HHS Public Access, 2015-12) Drs O.B. Akintububo1, E.O. Ojo2, DD Kokong3, S.A. Adamu4, U.U Nnadozie5, Z Yunusa Kaltungo5, I Jalo6, and A.M Dauda7
    Background—Development of craniofacial structures is a complex process and disruption of any of the numerous steps can lead to development of oro-facial clefts. This is a surgically amenable anomaly as from early life that has had conflicting pattern of demographics reported by various researchers globally. There are several factors that are critical to the surgical outcome. Objective—Study the demographics and the management outcome of cleft lip, alveolus and palate and highlight factors responsible for improved care in recent time. Design—Descriptive cohort study. Setting—Tertiary health institution Method—All consecutive patients managed for cleft lip, alveolus and palate (CLAP) over 7years and 10months were studied. Outcome—Cleft lip, alveolus and palate repair was performed on 149 patients, January 1, 2001– December 31, 2008 with an incidence of 2.1/1000 live births. From this, 27 patients, averaging 4.5 patients per year were operated for the first 6 1/3 years while the remaining 122(81.9%) the next 1 1/2 years, averaging 81.6 patients yearly. Their ages ranged from 3 months – 60 years with 77 (51.7%) males and 72 (48.3.0%) females. Cleft lip was the main presentation in 108(72.5%) of which 72(66.7%) were left sided. Bilateral cleft lip were14 (9.4%). Five (3.4%) patients had associated anomalies out of which 3(60.0%) had CLAP while 2(40.0%) isolated cleft lip or palate. The technique for cleft lip repair was Millard’s and Noordhoof’s while palatal cleft was the twoflap palatoplasty with intravelar veloplasty. Success was recorded in 142(95.3%) with complication observed in 7(4.7%) patients. Conclusion—The rarity of cleft lip, alveolus and/or palate in the African native documented previously may no longer be tenable as observe in this study. Management outcome has improved owing to the collaboration with SmileTrain, USA, along with multidisciplinary approach.
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    Profile of Benign Breast Diseases in an African Population
    (Journal of Surgery, 2016-05) Ale Alexander Femi, Ozoilo Kenneth Nnaetio, Misauno Michael Ayedima
    Benign Breast Diseases (BBD) refer to all non-malignant conditions of the breast and it received little attention in the past because most of the focus was on breast cancer, despite the fact that it constitutes majority of the presentation in breast clinics. The objective of this study was to evaluate comprehensively the profile of BBD in our environment, highlight the age group distribution of these BBDs and its different modes of presentation. This was a prospective cross-sectional study conducted between May 2009 and April 2010 at the Taimako Breast and Cervical Screening Centre on women who presented for breast screening. There were two thousand and sixty five study subjects, out of which one hundred and fifty women were diagnosed with BBD (7.3%), while one thousand nine hundred and fifteen (92.7%) had normal screening results. The mean age of those with BBD was 27.9 ± 9.6 with an age range of 15 to 60 years. Breast lumps constituted 44.7% of the presentation of BBD and was the most common mode of presentation, while 17.3% of those diagnosed with BBD had no symptoms and were discovered following triple assessment. More than half (56.8%) of the women who complained of breast lumps did not actually have lumps following triple assessment. BBD comprised a spectrum of disorders, with Fibroadenoma being the commonest and occurred most frequently in the younger 2nd and 3rd decades as opposed to older decades.
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    Experience with rubber band ligation of hemorrhoids in northern Nigeria
    (Nigerian Medical Journal, 2013) Misauno, M. A.; Usman B. D.; Nnadozie U. U.; Obiano S. K.
    Background: Treatment of hemorrhoids in Nigeria is usually done by the traditional open method that requires hospital admission; anesthesia and is associated with high morbidity. Rubber band ligation is a suitable alternative to open hemorrhoidectomy and has the potential to reduce the need for hospital admission. Patients and Methods: This was a prospective analysis of consecutive patients presenting with hemorrhoids that were suitable for surgical treatment to the Jos University Teaching Hospital and the Federal Medical Centre Gombe from January 2008 to December 2010 (24 months). Results: A total of 232 rubber band ligations were performed on 40 patients whose ages ranged from 20 to 54 years with a mean age of 37.1 ± 12.2 years. There were 24 males and 16 females (M:F::2:3). Thirty‑nine patients (97.5%) were cured of their symptoms following the procedure, and 1 patient (2.5%) had severe pain as complication of the treatment. Another patient had recurrence that was treated by repeat rubber band ligation. Conclusion: We conclude that rubber band ligation is a safe and reliable way for outpatient treatment of hemorrhoids in Nigeria.
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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.
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    Sexual risk behavior and HIV infection among adolescents in secondary schools in Jos, Nigeria
    (Nigerian Journal of Paediatrics, 2014) John C; Okolo SN; Isichei C
    Abstract Background: In adolescents sexual risk behaviours are believed to enhance the transmission of HIV infection. This study, therefore aims to examine prevalent sexual risk behaviours of adolescents in secondary schools in a town in northern Nigeria and its relation to HIV infection. Method: A total of 883 subjects drawn from 10 schools out of 37, were recruited for the study. Structured self administered questionnaire was given to each subject. Consenting subjects received group pretest counseling and had HIV screening using Determine HIV test kits. HIV positive subjects had confirmatory test using Unigold test kit. Result: Males accounted for 42.5% (374) out of the 883 students studied. Of this, 169 (19.2%) were sexually active. Mean age at sexual debut was 13.8±2.9 years; 13.3±2.7 years for males and 14.6±3.2 years for females, p=0.006. Males 101 (27%) were more sexually experienced as against 13.4% of the females, p<0.0001. Among the sexually active37.6% had two or more sex partners, and 63.9% of them never used condoms. In the sexually active, 54 (42.5%) had nonconsensual sex (NCS), with more of NCS occurring in younger subjects p<0.0001, more females p<0.0001, associated with less condom use (p=0.02). Nine (eight females and one male) of the 883 subjects tested HIV positive. among the sexually active subjects, only four tested HIV positive. Condom use among the sexually active, HIV positive subjects was 25%. Conclusion: Prevalent sexual risk behaviors noted were early sexual debut, nonconsensual sex, unprotected sex and multiple sex partners.