Annals of Health Research <p>Peer-reviewed open access journal of medical and health-related sciences to&nbsp;disseminate research works and ideas in the fields of medicine and allied health sciences with the ultimate goals of enhancing knowledge, improving practice and encouraging practice-centred research.</p> <p><em><strong>This journal is published under the Creative Commons License Attribution Non-Commercial CC-BY NC. This license lets others remix, tweak and build upon our works non-commercially and although, their new works must also acknowledge us and be non-commercial, they do not have to license their derivative works on the same terms.</strong></em></p> Medical and Dental Consultants Association of Nigeria, OOU Teaching Hospital, Nigeria en-US Annals of Health Research 2476-8642 <p>The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.</p> Malaria and the Sickle Gene: Polymorphism Balance in favour of eradication <p>Evolutionally, the single nucleotide mutation responsible for the sickle haemoglobin gene, (HbS gene) developed from the regions of the world where malaria is holoendemic, leading to the explanation that the mutation is in response to the presence of the malaria parasite. Studies eventually showed that individuals that are heterozygous for the HbS gene are protected from the lethal clinical effects of malaria infection. In other words, malaria confers a survival advantage to carriers of the HbS gene, and this is referred to as balanced polymorphism. On the other hand, malaria infection is associated with significant morbidity and mortality, particularly among children. Unfortunately, lack of success in the effort to eradicate the malaria parasite through the elimination of the Anopheles mosquito or efforts to limit its contact with human being has produced little success, hence the resort to roll back malaria, with the aim of reducing the morbidity and mortality associated with it.</p> <p>&nbsp;</p> <p>Therefore, it is attractive to consider what will happen to the sickle gene if malaria were to be eradicated. That is, the possibility is that the sickle gene may also follow suit since its evolution in the first instance was as a response to malaria., This is the hypothesis being propounded by this article. In that case, rather than shy away from the malaria eradication initiative, it should remain the goal of all malaria programs.</p> Phillip O Olatunji ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 88 96 10.30442/ahr.0402-1-12 Economic burden and psycho-social implications of Non- Communicable Diseases on adults and their households in South-west Nigeria <p><strong><em>Background:</em></strong> Non-communicable diseases (NCDs), are associated with significant economic and psycho-social burden on sufferers.</p> <p><strong><em>Objective:</em></strong> To compare the economic burden of disease management on adults with NCDs and control subjects in Ogbomoso, Nigeria.</p> <p><strong><em>Method:</em></strong> A total of 322 participants consisting of 165 adults with at least one of two NCDs - hypertension and diabetes mellitus- and 157 controls (without NCDs) were recruited by stratified random sampling method. The participants were evaluated for the economic burden and psycho-social implications of NCDs on them and on their households.</p> <p><strong><em>Results:</em></strong> The presence of NCDs was associated with significantly higher psycho-social implication on the subjects including poorer patient-reported personal health assessment, higher frequency of hospital visits and longer average total hours of hospital visits compared to the controls. A significant proportion of subjects with NCDs depended on family supports for their hospital bills (32.7% vs. 7.6%). The total average monthly health expenditure among subjects with NCDs was significantly higher. Catastrophic health expenditure was found in 12.1% of subjects with NCDs who indicated their hospital bills were far higher than their total monthly wages.</p> <p style="margin: 0px 0px 10.66px; line-height: 150%;"><span style="margin: 0px; line-height: 150%; font-family: 'Times New Roman',serif; font-size: 12pt;" lang="EN-GB"><strong><em>Conclusion:</em></strong> The management of NCDs is associated with significantly higher psycho-social and economic impact on affected individuals. &nbsp;There is a need for appropriate health insurance scheme and health system financing programs to reduce economic and psycho-social burdens, minimise long-term complications and improve quality of life.</span></p> Temitope S. Akintunde Adeseye A. Akintunde Adeleye A Adeomi ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 97 107 10.30442/ahr.0402-2-13 Comparative effects of educational intervention on knowledge, attitude and practice regarding HIV/AIDS among hospital orderlies in two Tertiary Hospitals <p><strong>Background:</strong> HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) pandemic is a major challenge that health care workers are faced with because of increased risk of infection. Despite the high risk of HIV infection among nursing assistants, less attention is currently paid to training this cadre of hospital staff to reduce the risk of infection.</p> <p><strong>Objective:</strong>&nbsp; To assess the effect of educational intervention on knowledge, attitude and practice about HIV/AIDS among hospital orderlies in two tertiary facilities in Ogun State, South-west, Nigeria.</p> <p><strong>Methods:</strong> The study was a quasi-experimental, non-randomized, controlled group design which was conducted in three phases; a pre-intervention evaluation, immediate post-intervention evaluation and another evaluation three months post-intervention. Hospital orderlies were recruited (108 from the Olabisi Onabanjo University Teaching Hospital, Sagamu (OOUTH) as intervention group and 112 orderlies from the Federal Medical Centre (FMC), Abeokuta as controls).</p> <p><strong>Results:</strong> Significant increase in the knowledge, attitude and practice of the intervention group determined by percentage score was recorded immediately after the training. In the control group, there was a decline in the attitudinal score but an insignificant increase in the knowledge and practice of HIV prevention. Three months post-intervention, further increase in the knowledge score and attitudinal score in the intervention group respectively compared to the pre-test scores ( 83.3% vs. 99.1% and 94.4% vs. 96.3%) were recorded.</p> <p><strong>Conclusion:</strong> The study showed good knowledge of HIV and AIDS which further improved after the educational intervention. Therefore, the need for continuous training for the hospital orderlies is germane.</p> Adeola A. Ekundayo Olaonipekun K. Alausa Olorunfemi E. Amoran Motunrayo O. Adekunle ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 108 119 10.30442/ahr.0402-3-14 Lung functions abnormalities among auto mechanics in Ogbomoso, Nigeria: Clinical correlates and determinants <p><strong><em>Background:</em></strong>&nbsp; Auto mechanics are exposed to various organic, inorganic and particulate matters as a result of their occupation. Determining the association between environmental pollutant and risk of lung function abnormalities among auto mechanics is important to prevent long-termCem&gt;Objective: To describe lung function abnormalities and their determinants among auto mechanics in Ogbomoso, Nigeria.</p> <p><strong><em>Methods:</em></strong> One hundred and three auto mechanics were randomly selected from Ogbomoso, Nigeria. Their clinical and demographic data were obtained using a data form. Spirometry was performed using the CONTEC handheld Spirometer. The personal best values of three measurements FEV<sub>1</sub>, FVC and PEFR were determined. Lung function abnormalities were described according to standardized criteria.</p> <p><strong><em>Results:</em></strong> The mean (SD) age of the participants was 38.5 (11.9) years. The mean systolic blood pressure, mean diastolic pressure and mean duration of the job as auto mechanics were 128.7 (17.9) mmHg, 81.2 (11.4) mmHg and 20.2 (12.5) years respectively. Restrictive, obstructive and mixed lung function abnormalities were demonstrated among 53%, 10% and 2% respectively. The mean values of FEV<sub>1</sub> and FVC reduced significantly with increasing job duration.</p> <p><strong><em>Conclusion</em></strong>: Lung function abnormalities occurred frequently among auto mechanics in Ogbomoso, Nigeria. There seemed to be a progressive decline in lung functions with age and duration of exposure to organic and inorganic pollutants by auto mechanics. Strict environmental and occupational safety measures may limit the hazards associated with poor air quality and other chemical/physical hazards among auto mechanics in Nigeria.</p> Adeseye A. Akintunde Taofeek O. Oloyede Afolabi A. Salawu ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 120 130 10.30442/ahr.0402-4-15 Perception and acceptance of Universal Neonatal Hearing Screening among pregnant women attending a Nigerian Teaching Hospital <p><strong><em>Background:</em></strong> Nigeria reportedly has one of the highest incidences of congenital hearing loss and the Universal Neonatal Hearing Screening (UNHS) offers a potential for early detection and intervention.</p> <p><strong><em>Objectives:</em></strong> To determine the awareness and acceptability of newborn hearing screening among the antenatal clinic attendees of a Nigerian Teaching Hospital.</p> <p><strong><em>Methods:</em></strong> This study was a cross-sectional survey among the pregnant women attending the antenatal clinic. Data were obtained using semi-structured interviewer-administered questionnaire</p> <p><strong><em>Results:</em></strong> A total of 114 women aged 18 and 45 years participated in the survey; 51/114 (44.7%) were aware of hearing screening with most of them 39/51 (76.5%) having health workers as their first source of knowledge. A high acceptance rate was obtained among 97/114 (85.1%), and this was notably independent (p = 0.399) of awareness; 14/114 (12.2%) rejected UNHS and the commonest reason for rejection was lack of enough information among 10/14 (71.4%) on the existence and use of UNHS. Health care workers were the commonest source of information [39/51(76.5%)]. A majority [51/58 (87.9%)] thought that the best time to initiate treatment is early in life, before speech development, only 4/114 (3.5%) had relatives who had ever undergone UNHS and all were done abroad.</p> <p><strong><em>Conclusions:</em></strong> Less than half of the participants attending ANC were aware of hearing screening and acceptance was high despite this low awareness rate. Parental awareness appeared to depend on contact with healthcare workers. Community education may increase awareness and demand for UNHS.</p> Ayodele M Akinola John O. Imaralu Franklin I. Ani Oluwasegun Yahaya Omotayo Salami Adekunle Adefalujo ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 131 140 10.30442/ahr.0402-5-16 Robustness of Poisson Mixture models in identifying risk factors for Under-Five mortality in Nigeria <p><strong><em>Background:</em></strong> Estimates of Under-Five mortality (U5M) have taken advantage of indirect methods but U5M risk factors have been identified using fixed statistical models with little considerations for the potentials of mixture models. Mixture models such as Poisson-Mixture models exhibit flexibility tendency, which is an attribute of robustness lacking in fixed models.</p> <p><strong><em>Objective: </em></strong>To examine the robustness of Poisson-Mixture models in identifying reliable determinants of U5M.</p> <p><strong><em>Methods:</em></strong> The data on 18,855 women used in this study were obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). Six different Poisson-Mixture models namely: Poisson (PO), Zero-Inflated Poisson (ZIP), Poisson Hurdle (PH), Negative Binomial (NBI), Zero-Inflated Negative Binomial (ZINBI) and Negative Binomial Hurdle (NBIH) were fitted separately to the data. The Akaike Information Criteria (AIC) and diagnostic check for normality were used to select robust models. All tests were conducted at p = 0.05.</p> <p><strong><em>Results:</em></strong> The models and AIC values for U5M were: 38763.47 (PO), 38654.55 (ZIP), 44270.77 (PH), 38526.26 (NBI), 38513.71 (ZINBI) and 44269.30 (NBIH). The PO, ZIP, PH and NBIH met normality test criteria, and the ZIP model was of best fit. The model identified breastfeeding, paternal education, toilet type, maternal education, place of delivery, birth-order and antenatal-visits as significant determinants of U5M at the national level.</p> <p><strong><em>Conclusion</em>:</strong> The Zero-Inflated Poisson model provided the best robust estimates of Under-five Mortality in Nigeria, while maternal education and birth-order were identified as the most important determinants. The Poisson-mixture models are recommended for modelling Under-five Mortality in Nigeria.</p> Kolawole S. Oritogun Elijah A. Bamgboye ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 141 154 10.30442/ahr.0402-6-17 Pattern of completion of Laboratory Request Forms in a tertiary health facility <p><strong>Background:</strong> Laboratory request form is an important means of interaction between clinicians and laboratory service providers. The omission of information on the request form may result in laboratory errors which may have a negative impact on patients’ outcome.</p> <p><strong>Objective:</strong> To assess the pattern of completion of laboratory request forms in a tertiary facility.</p> <p><strong>Methods: </strong>Two thousand, two hundred and forty-one laboratory request forms sent to the laboratory over a period of two months were assessed for their level of completeness.&nbsp;</p> <p><strong>Results: </strong>Out of 2241 laboratory request forms, only 5 (0.2%) was fully completed. The most complete information on the forms included types of investigation required (98.9%), the gender of the patient (97.8%), the identity of consultant-in-charge of the patient (95.3%) and the referring physician's name and signature (93.8%). The least provided information was the time of collection of the specimen (0.7%).</p> <p><strong>Conclusion: </strong>This study shows that laboratory request forms are frequently incompletely and inadequately completed. Continuous medical education of clinicians on the need for adequate completion of request forms is required.</p> Abimbola A. Oyelekan Omotola T. Ojo Olatunbosun O. Olawale Olufunke O. Adeleye Olusola A. Sogebi Olubunmi A. Osinupebi Philip O. Olatunji ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 155 161 10.30442/ahr.0402-7-18 Pattern of childhood morbidities and outcome of childhood admissions in a Nigerian public secondary healthcare facility <p><strong><em>Background</em></strong><strong>: </strong>Patterns of morbidity and mortality in hospital populations are indicative of community health needs and can be useful in planning improved medical services.</p> <p><strong><em>Objectives:</em></strong> To determine the morbidity, mortality and outcome patterns, and the average duration of hospital stay of admitted children in the public secondary healthcare facility.</p> <p><strong><em>Methods:</em></strong> Available hospital records of children aged one month to 15years, admitted during a one year period (October 1, 2010, to September 30, 2011) were reviewed for relevant data such as age, gender, final diagnosis, outcomes and dates of admissions and discharges.</p> <p><strong><em>Results:</em></strong> Of the 1,266 records reviewed, 57.6% children were males, 42.4% females (Z= -10.9458; p=0.0001) and 82.5% were aged under-five years. Infections accounted for 81.6% of the morbidities, with malaria (39.2%), gastroenteritis (15.2%), pneumonia (10.9%), severe anaemia (4.2%) and septicaemia (3.0%) being the top five conditions. The duration of admission ranged from less than 24hours to 30 days, with a mean of 3.2 (2.8) days.</p> <p>Nine hundred and ninety-eight (78.8%) children were discharged while 64 (5.1%) died; 85.9% of the deaths occurred among under-five children. Thirty-four (6.3%) out of 537 females and 30 (4.1%) out 729 males died (Z= 7.7374; p= 0.0001). The top three causes of mortality included malaria 26.6%, septicaemia 12.5% and pneumonia 10.9%. Fifty out of 59 deaths (84.7%) occurred within 72 hours and 7 (11.9%) in&lt;24hours of admission.</p> <p><strong><em>Conclusions:</em></strong> Male children were more vulnerable to diseases while mortality was significantly higher among females. Infections dominated the causes of childhood morbidity and mortality in the public secondary healthcare facility, with under-five children bearing the brunt.</p> Samuel O. Oninla Akinyemi O. Fadugbagbe Olumayowa A. Oninla Olumayowa A. Oninla Olayinka A. Otetubi Olayinka A. Otetubi ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 162 173 10.30442/ahr.0402-8-19 Sonographic features of patients with ocular trauma at the University of Benin Teaching Hospital, Benin-City <p>&nbsp;</p> <p><strong><em>Background:</em></strong> The human eye is vulnerable to various external injuries. This is in spite of the seemingly adequate protection offered by the bony orbit. Ultrasound, as a non-invasive and safe imaging modality, is very useful in evaluating the orbit as the globe provides a perfect acoustic window. There is a need for an update on the sonographic patterns of ocular trauma in Nigeria.</p> <p><strong><em>Objective:</em></strong> To sonographically assess the features of ocular trauma at the University of Benin Teaching Hospital.</p> <p><strong><em>Methods:</em></strong> Eighty patients with ocular injuries were studied over an 8-month period. After detailed history taking, using a closed eye technique, each patient was scanned with a 5-12MHz linear array probe of a SONOACE X4 Machine.</p> <p><strong><em>Results:</em></strong> The 18-35 years age group was most affected and the right eye was more frequently involved. The most common sources of injury were intraocular foreign bodies (26; 32.5%), assault (20; 25%) and road traffic accidents (18; 22.50%). Mechanical injuries were more common, comprising 44 (56.4%) cases of blunt trauma and 34 (43.6%) cases of penetrating trauma. The most common sonographic findings included vitreous haemorrhage, intraocular foreign bodies and retinal detachment.</p> <p><strong><em>Conclusion:</em> </strong>Posterior chamber findings (vitreous haemorrhage and retinal detachment) were more frequent than anterior chamber findings in ocular trauma.</p> Sally N. Ozougwu Ademola A. Adeyekun Juliet N. Ese-Onakehwor Elo E. Efe-Aluta ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 174 181 10.30442/ahr.0402-9-20 Role of Brain Natriuretic Peptide assay in identifying children with pneumonia complicated by congestive cardiac failure <p><strong><em>Background:</em></strong> Pneumonia in children is a leading cause of morbidity and mortality in developing countries. It is often complicated by Congestive Cardiac Failure (CCF), with some of the symptoms similar to those of pneumonia. Brain Natriuretic Peptide (BNP) assay can differentiate cardiac from respiratory-related causes of respiratory distress.</p> <p><strong><em>Objective:</em></strong> To determine the role of BNP in differentiating isolated pneumonia from pneumonia complicated by CCF.</p> <p><strong><em>Methods:</em></strong> Over a 12-month period, consecutive children with radiologically-confirmed pneumonia were recruited for the study. Those with complicating CCF were noted. All the children had blood BNP assay done by ELISA, prior to treatment. Biodata was obtained and the children were grouped into those with isolated pneumonia and those with pneumonia complicated by CCF.</p> <p><strong><em>Results:</em></strong> Fifty children were recruited; of these 26 (52.0%) had isolated pneumonia while 24 (48.0%) had pneumonia with CCF. The median age of the children was 6 months. The median BNP values for the isolated pneumonia group (229.4 ng/l), was significantly lower than that of pneumonia complicated by CCF group (917.3 ng/l); (p = 0.007). ROC showed that a BNP value &gt;550ng/l could identify children with pneumonia complicated with CCF from those with isolated pneumonia with a sensitivity of 70.4% and specificity of 63.4%.</p> <p><strong><em>Conclusion:</em></strong> A BNP assay prior to treatment of &gt;550ng/l can differentiate children with pneumonia complicated with CCF from those without CCF.&nbsp;&nbsp;&nbsp;</p> Wilson E. Sadoh Wilson O. Osarogiagbon ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 182 188 10.30442/ahr.0402-10-21 Waardenburg Syndrome Type 2: A Report of Three Cases in South-west Nigeria <p>&nbsp;</p> <p>This report is about ocular and audiometric findings in three children with Waardenburg syndrome Type 2 attending Special Education Centres in Nigeria.</p> <p>Two female children and a male child aged 10, 13 and 5 years respectively had ocular examination and audiometric evaluation using inter-acoustics eclipse ASSR (Serial number 0933518) for auditory steady-state response audiometry (ASSR). The ocular features included bilateral hypoplastic blue irides and bilateral hypopigmented fundi while ASSR showed severe to profound sensorineural hearing loss. The three children had mutism hence they used sign languages for communication.</p> <p>There is a need for early detection of this condition, health education and planned rehabilitation.</p> Anthony O. Betiku Moses A. Akinola Omodele O. Jagun Olukayode Y. Oluyemi Omotayo F. Salami ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 189 197 10.30442/ahr.0402-11-22 Visual loss from mismanaged ocular injury with foreign body impaction: A Case Report <p>Ocular injury occurs commonly and it may lead to visual impairment if it is not properly managed. We report the case of a 35-year old man with a retained infected ocular foreign body in his right eye following an injury. The foreign body was not discovered despite consulting non-ophthalmologists at a Maternity Centre and an Optical Shop over a period of ten days. &nbsp;At presentation at the Specialist Hospital, he was unable to see with swelling of the eyelid, red eye and discharge. On examination, the visual acuity in the affected eye was NLP and an infected stick that penetrated the eyeball was discovered in the superonasal aspect of sclera covered by the swollen upper lid. This resulted in endophthalmitis, cataract and blindness of that eye.</p> <p>Ocular injuries must be promptly referred to the ophthalmologist for appropriate care and to prevent complications. The case clearly showed a diagnostic and therapeutic challenge for paramedics who encounter eye injuries outside the tertiary hospital setting. Therefore, this report raises public health concern intended to increase awareness on the management of eye injuries.</p> <p>The incorporation of Primary Eye Health into Primary Health Care along with training and re-training of Community Health Extension Workers, General Practitioners and other rural health workers cannot be overemphasized.</p> Ifedayo O. Akintoye Caroline O. Adeoti ##submission.copyrightStatement## 2018-12-09 2018-12-09 4 2 198 204 10.30442/ahr.0402-12-23