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 clinical sciences, basic medical sciences and public health with the ultimate goals of enhancing knowledge, improving practice and encouraging practice-centred research. It is indexed by African Index Medicus and Index Copernicus. It is also registered with the Crossref, Committee for Publication Ethics (COPE) and the Directory of Open Access Journals (DOAJ).</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> Epidemiology of Coronavirus Disease (COVID-19) in Nigeria <p>In late December 2019, there was an outbreak of a new Coronavirus infection in Wuhan, Hubei Province, China, which caused acute respiratory syndrome of unknown aetiology. The World Health Organization (WHO) named the virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) or COVID-19 and declared the infection a pandemic on the 11<sup>th</sup> of March 2020.</p> <p>The first case of COVID-19 in Nigeria was reported on the 27<sup>th</sup> of February 2020 and since then the numbers of confirmed cases has been on the increase, at least in Nigeria. With no vaccine or cure in sight, only public health measures that include personal protective measures, physical distancing, environmental and travel-related measures have been recommended to mitigate and contain the spread of the disease. There is need to make testing for COVID-19 widely available so that the true burden of the infection will be described. This step should assist policy makers in making evidence-based decisions in the prevention and control of the disease.</p> JO Bamidele OJ Daniel Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 125 132 10.30442/ahr.0602-01-74 Extended Spectrum Beta-Lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumoniae among asymptomatic Out-patients in a University Health Centre <p><strong>Background:</strong> Asymptomatic carriage and spread of Extended-Spectrum Beta-Lactamase (ESBLs)-producing Enterobacteriaceae in the community are potential risk factors for transmission of infection.</p> <p><strong>Objective: </strong>To determine the prevalence of ESBL resistant genes in <em>Escherichia coli</em> and <em>Klebsiella pneumoniae</em> isolated from asymptomatic out-patients.</p> <p><strong>Methods:</strong> Using a questionnaire, demographic information, medical history, previous hospitalization and antibiotics used were obtained. Stool and urine samples were collected from 350 participants, cultured, and the susceptibility of the isolates to antibiotics and ESBL production were determined using the disk diffusion method. ESBL genes such as <em>bla<sub>TEM, </sub>bla<sub>CTX, </sub>and bla<sub>SHV</sub></em> were identified using the Polymerase Chain Reaction.&nbsp;&nbsp;</p> <p><strong>Results:</strong> <em>Escherichia coli</em> and <em>Klebsiella pnuemoniae</em> were identified from the stool samples (256; 69.9% and 89; 24.4% respectively) and urine samples (15; 4.1% and 6; 1.6% respectively). The isolates were susceptible to imipenem&nbsp; (330; 90.6%) and nitrofurantoin (307; 80.4%), most of the isolates were resistant to fluoroquinolones, cephalosporins, and aminoglycosides while all the isolates were resistant to ampicillin. The prevalence of ESBL was 29 (8.3%) and was observed in <em>Escherichia coli</em> (19; 7.0%) and <em>Klebsiella pneumoniae</em> (11; 12.0%), including a dual carriage. The ESBL carriers were resistant to the cephalosporins, fluoroquinolones and aminoglycosides. CTX-M (20; 66.7%), TEM (14; 46.7%), CTX-M and TEM genes co-existed in 9 (30.0%) while no SHV gene was detected in the isolates. Age, sex, prior hospitalization and antibiotics use did not predispose to ESBL carriage.</p> <p><strong>Conclusion:</strong> Asymptomatic carriage of ESBL producing enterobacteria in the participants indicates that they can serve as a reservoir of the gene encoding for antibiotic resistance.</p> AM Deji-Agboola OR Olaosebikan E Adenipekun OA Osinupebi FA Olajubu Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 133 142 10.30442/ahr.0602-02-75 Insulin resistance and associated factors in healthy volunteers in South-west Nigeria <p><strong>Background:</strong> Insulin resistance (IR) is linked with the pathophysiology of some non-communicable diseases including Type 2 Diabetes mellitus and metabolic syndrome.</p> <p><strong>Objective: </strong>To determine the factors associated with IR among apparently healthy individuals in South-west Nigeria.</p> <p><strong>Methods:</strong> A cross-sectional study of a cohort of apparently healthy volunteers aged 18 years and above consecutively recruited from two communities was conducted. IR was determined using the homeostasis model assessment for IR (HOMA-IR) based on the cut off values of ≥ 2. Bivariate and multivariate analyses were used to determine the crude and adjusted odds ratio of IR associated factors.</p> <p><strong>Results:</strong> A total of 520 participants aged 18–89 years were recruited for the study. Their mean age was 46.7±14.6 years and the prevalence of IR was 43.5%. Alcohol intake (AOR = 2.1, 95%CI 1.3 – 3.4; p&lt;0.001), lack of physical exercise (AOR = 1.5, 95%CI 1.0 – 2.3), and Body Mass Index (AOR = 1.03, 95%CI 1.0 – 1.1) were the factors associated with IR.</p> <p><strong>Conclusion:</strong> The prevalence of IR among apparently healthy individuals in this study was high. The need for proactive measures to avert the sequelae of IR is of utmost importance.</p> EN Adejumo OA Adejumo OA Ogundahunsi Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 143 150 10.30442/ahr.0602-03-76 Cardiac diseases in pregnancy: A 10-year review in a tertiary hospital in South-west Nigeria <p><strong>Background:</strong> The superimposition of the morbidity of cardiac diseases on the physiological demands of pregnancy could impact adversely on pregnancy outcomes. Therefore, contemporary information is for appropriate clinical management.</p> <p><strong>Objective:</strong> To determine the management outcomes of cardiac diseases in pregnancy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife.</p> <p><strong>Methods:</strong> A retrospective review of the hospital records of patients with cardiac diseases in pregnancy between January 2006 and December 2015 was conducted. The age, parity, gestational age at admission, NYHA class, clinical diagnosis, the results of investigations, complications of cardiac diseases, and maternal and foetal outcomes were recorded.</p> <p><strong>Results:</strong> There were 33 women with cardiac diseases in pregnancy and 11,352 deliveries within the period, giving an incidence of 2.9 per 1000. Further analysis was based on 24 women with complete records. The mean age of the patients was 29.2±5.5 years. Twenty (83%) of the women were Para 2 or less, while 13 (54%) presented postpartum. The majority of the women (15; 62.5%) had peripartum cardiomyopathy, while 17 (71%) had NYHA Class III or IV disease. Thirteen (54%) women had vaginal delivery. There were four perinatal and two maternal deaths, with a perinatal mortality rate of 166/1,000 total births and maternal mortality ratio of 8,333/100,000 live births.</p> <p><strong>Conclusion:</strong> Cardiac diseases in pregnancy are associated with high perinatal and maternal mortality rates at the OAUTHC, Ile-Ife. However, with early diagnosis and appropriate care, the majority of the patients had a satisfactory clinical outcome. Early presentation and advocacy to improve health-seeking behaviour are recommended.</p> AM Owojuyigbe AT Adenekan AO Ijarotimi O Sowemimo IO Awowole TO Owojuyigbe Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 151 157 10.30442/ahr.0602-04-77 Factors associated with antibiotic prescription among healthcare workers at tertiary hospitals in Nairobi County, Kenya <p><strong>Background:</strong> Globally, there has been an overall decline in the effectiveness of antibiotics resulting in an upsurge in bacterial resistance, increased cost of healthcare and consequent high morbidity and mortality rates.</p> <p><strong>Objective: </strong>To determine antibiotic prescription practices among healthcare workers at the Kenyatta National Hospital, Mbagathi, Pumwani Maternity and Mama Lucy Kibaki Hospitals, Nairobi, Kenya.</p> <p><strong>Methods:</strong> The study design was a mixture of quantitative and qualitative methods. Self-administered questionnaires were used to gather information from 230 prescribing healthcare workers. Interviews and Focus Group Discussions (FGDs) were conducted purposively with the prescribing healthcare workers and patients to obtain qualitative data.</p> <p><strong>Results:</strong> There was a significant difference in the distribution of study participants with regards to the availability of antibiotics prescribing policy (p = 0.05). Only 53 (23%) prescribers prescribed antibiotics as per the policy guide while 51 (22.2%) did not and 126 (54.8%) were not sure. Oral antibiotics (OR = 0.5, 95%CI 0.3-0.9), always referring to the 2016 Kenya Essential Medicines List (KEML) to prescribe antibiotics (OR = 4.2, 95%CI 1.3-13.1), separating antibiograms for inpatient and outpatient departments (OR = 4.3, 95%CI 1.11-15.5), and confidence of healthcare workers to prescribe antibiotics without laboratory tests (OR = 0.3, 95%CI 0.2-0.8) were associated with the prescription of antibiotics.</p> <p><strong>Conclusion:</strong> There is need to improve antibiotic prescription practices among healthcare workers in public tertiary hospitals in Nairobi County to promote rational antibiotic use and control bacterial resistance.</p> OW Mbuthia EN Ndonga SO Odiwour MW Muraguri Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 158 170 10.30442/ahr.0602-05-78 Knowledge, utilization and clients’ satisfaction with antenatal care services in Primary Health Care Centres, in Ikenne Local Government Area, Ogun State, Nigeria <p><strong>Background: </strong>Clients’ satisfaction with the quality of care in an antenatal clinic is the extent to which the health care system meets the clients’ expectations, aims and choices.</p> <p><strong>Objective:&nbsp; </strong>To assess the clients’ knowledge and satisfaction with antenatal care (ANC) services in Primary Health Centres in Ikenne Local Government Area of Ogun State, Nigeria.</p> <p><strong>Methods:</strong> This descriptive cross-sectional study was conducted among 380 registered pregnant women who were selected using a multistage sampling method. The data were collected using a structured interviewer-administered questionnaire, constructed from a review of the Safe Motherhood Needs Assessment package and other available literature on antenatal care.</p> <p><strong>Results:</strong> The mean age of the respondents was 27.8±5.5 years. The majority were married (91.6%). Health education was the leading ANC activity recognized by 98.7% of the respondents. Knowledge was poor as only 46.1% had good knowledge of at least 50% of total knowledge score. Overall, satisfaction with the services was good as the majority (96.8%) of the respondents were satisfied with the services. Marital status, number of antenatal visits and level of education were statistically significantly associated with the level of satisfaction (p &lt; 0.001, 0.02 and 0.007 respectively).</p> <p><strong>Conclusion</strong>: Though the knowledge of ANC was poor, overall satisfaction level was good. Programmes that improve maternal knowledge about ANC should be emphasized in PHCs.</p> K Sodeinde O Onigbogi O Odukoya O Abiodun Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 171 183 10.30442/ahr.0602-06-79 Clinicopathologic characteristics of epithelial ovarian tumours in Ile-Ife, Nigeria <p><strong>Background:</strong>&nbsp; Epithelial ovarian tumours (EOT) have complex clinicopathologic characteristics and biological behaviours. There are benign, borderline and malignant ovarian tumours and the commonest ovarian tumours in many regions are of epithelial origin. Many studies have described the histomorphological characteristics of the tumours.</p> <p><strong>Objective:</strong> To describe the clinical and histopathological features of epithelial ovarian tumours.</p> <p><strong>Methods:</strong> This was a retrospective review of the histopathology reports of all epithelial ovarian tumours specimens submitted to the Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife from January 2005 to December 2014. The EOT cases were described in terms of age, clinicopathological characteristics and distribution of histological types.</p> <p><strong>Results:</strong> The frequencies of benign, borderline and malignant EOTs were 41.2%, 3.9% and 54.9% respectively and the patients were aged 23 to 94 years (mean 46.5±2.6 years). The majority of cases were often asymptomatic.</p> <p><strong>Conclusion:</strong> Abdominal swelling was the most common presenting complaint while serous ovarian tumours were the most preponderant histological types.</p> AO Anjorin GO Omoniyi-Esan OO Odujoko AO Anjorin Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 184 196 10.30442/ahr.0602-07-80 Low back pain among hospital workers in Kano, North-west Nigeria <p><strong>Background:</strong> About 90% of individuals will experience back pain at one point or the other in their lives. Hospital workers are considered to have a considerable risk of developing low back pain.</p> <p><strong>Objective:</strong> To determine the prevalence and risk factors for low back pain among health workers in tertiary hospitals in Kano, Nigeria.</p> <p><strong>Methods:</strong> The study was a cross-sectional survey. A questionnaire was designed and administered to 200 personnel of the teaching hospitals in Kano. Socio-demographic characteristics, presence of low back pain, factors that relieve and aggravate the low back pain and relationship of back pain and work activities, were recorded on the questionnaire.&nbsp;</p> <p><strong>Results:</strong> The mean age of the respondents was 33.4±7.08 years. Sixty-six per cent of the respondents had back pain within a year of the study. There was a 29% point prevalence of low back pain among the respondents. Statistically significant association was established between various activities such as prolonged sitting and walking and pain in the lower back (p = 0.000). There was an association between low back pain and the type of job (department) of the respondents (p = 0.016). The dull ache was the predominant presentation (58%) followed by piercing and gripping in 20% and 19% respectively. Prolonged sitting was the main aggravating factor, while numbness was the main feature of referral in 18%. Only 5.0% of the respondents used medications for their back pain.</p> <p><strong>Conclusion:</strong> Low back pain is common among hospital workers with a point prevalence of 29.1%. About 25% had low back pains that prevented participated in normal duty. Majority of the respondents believed back pain is preventable.</p> MK Abubakar A Rabiu MU Ibrahim KA Musa S Muhammad AA Mamuda Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 197 204 10.30442/ahr.0602-08-81 Efficacy of regional anaesthesia for paediatric surgery: Experience from a surgical expedition <p><strong>Background:</strong> In developing countries where resources are scarce and health care financing is essentially by out-of-pocket payment, a surgical expedition is often a huge economic relief. Children are a category of the vulnerable group that can benefit from such exercises. However, an anaesthesia technique that is economical in both human and material resources should be explored,</p> <p><strong>Objective:</strong> To describe the outcome of regional anaesthesia techniques during a surgical expedition for paediatric patients.</p> <p><strong>Methods:</strong> Children aged 6 months to 16 years, who had been previously screened for free surgery in different surgical specialities, were recruited for the study.</p> <p><strong>Results:</strong> Fifty-six (56) children were screened but only 35 were recruited for the surgical expedition. There were nineteen (19) males and sixteen (16) females with a male to female ratio of 1.5:1. Surgical procedures covered surgical specialities such as orthopaedics, plastic and general paediatric surgery. All the patients had one form of regional technique and/or peripheral nerve blocks. There were no intra-operative or post-operative anaesthetic complications up to a period of 30-days while on follow-up care.</p> <p><strong>Conclusion:</strong> Regional anaesthesia is safe and a cheap choice of anaesthesia in children during surgical expeditions.</p> OM Fatungase CC Nwokoro EA Emmanuel SO Akodu RO Shoyemi LO Amosu Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 205 210 10.30442/ahr.0602-09-82 Prevalence and detection of medically unexplained symptoms among out-patients in a Primary Health Care setting in South-west Nigeria <p><strong>Background:</strong> Medically unexplained symptoms are frequently encountered by physicians at the primary care level. The complexity lies in the ill-defined nature of the multiple physical symptoms and the similarity to several organic disorders.</p> <p><strong>Objective:</strong> To determine the prevalence of medically unexplained symptoms and relate this to physicians detection rate in a primary care setting in South-west, Nigeria.</p> <p><strong>Methods:</strong> The study was a cross-sectional, descriptive study of consecutive patients of the General Out-patient Department of Olabisi Onabanjo University Teaching&nbsp; Hospital, Sagamu, Ogun State. Interviews were conducted on 472 participants using a purposely designed socio-demographic questionnaire and the self-administered Patient Health Questionnaire -15 to screen for somatic symptoms.</p> <p><strong>Results:</strong> The ages of the participants ranged from 18 years to 90 years with the mean of 52.7±20.9 years. Out of the 472 participants, 225 (47.7%) met the criteria for medically unexplained symptoms using the Patient Health Questionnaire (PHQ). Across ages, medically unexplained symptoms were more often diagnosed among younger age groups especially those close to the age of 35 years (59.2%) [χ<sup>2</sup> = 12.34, p = 0.02]. There were significant differences in the prevalence of somatisation across different levels of education [χ<sup>2</sup>= 9.78, p = 0.03]. Physicians were able to diagnose psychological disorders in 12.4% of participants (n = 28) with somatisation disorders.</p> <p><strong>Conclusion:</strong> There was a moderately high prevalence of medically unexplained symptoms in primary health care settings and physicians’ detection rate of somatisation was also low. Physicians in primary health care should have a high index of suspicion for somatisation.</p> OO Ogunsemi TO Afe BS Osalusi OO Adeleye AO Ale Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 211 217 10.30442/ahr.0602-10-83 Olfacto-protective roles of Nigella sativa oil in Harmaline-induced essential tremor modelling <p><strong>Background: </strong>Harmaline is a tremorgenic beta-carboline, reported to induce acute postural and kinetic tremor. Essential Tremor (ET) is an idiopathic slowly neurodegenerative tremor disorder which also compromises olfactory acuity. <em>Nigella sativa </em>(NS) is a therapeutic agent widely used in the treatment of various ailments.</p> <p><strong>Objective: </strong>To determine the effect of NSon olfactory functions of mice treated with harmaline.</p> <p><strong>Methods: </strong>Seventy-five BALB/c male mice weighing 20g-25g, were equally divided into five groups, namely CNTRL (received only Normal saline), NS (received NS oil1ml/kg), HML(received Harmaline 20mg/kg), HNS (received Harmaline and <em>Nigella sativa </em>concurrently), and NSH (received NSfollowed by Harmaline). Olfactory sensitivity and discrimination were assayed through buried food test. The olfactory bulb was assayed neurochemically for glutamate and dopamine, and histologically for neuronal architecture using haematoxylin and eosin stain. Differences in neurochemical and histological data, body weight, appetite, relative brain weight, sensitivity and discrimination indices were statistically analysed.</p> <p><strong>Results: </strong>NS was significantly protective against the negative effects of Harmaline. It also effected quick olfactory discrimination, increased dopamine level, decrease in weight difference and increased food consumption in the animals. However, Harmaline increased relative brain weight and GPX levels. The concurrent administration aided in the reduction of neuronal density while neuronal average size reduced on pre-treatment with NS.</p> <p><strong>Conclusion: </strong>Harmaline did not induce tremor in the animals, though it resulted in histological and neurochemical deficits. However, it resulted in olfactory insensitivity and indiscrimination, both of which were prevented and ameliorated by <em>Nigella sativa </em>oil.</p> R Folarin S John O Oyenuga N Tijani O Otulana E Mbonu Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 218 229 10.30442/ahr.0602-11-84 Conjunctival bacterial infection among hospitalized neonates <p><strong>Background:</strong> Conjunctivitis is a common infection among neonates and it is a known cause of preventable childhood blindness. There is geographical variation in the distribution of aetiological agents.</p> <p><strong>Objective:</strong> To assess the prevalence of conjunctivitis among hospitalized neonates receiving care in a tertiary health care centre in South-west Nigeria, and describe its clinical and bacteriological correlates.</p> <p><strong>Methods:</strong> The hospital records of neonates diagnosed with conjunctivitis at the Olabisi Onabanjo University Teaching Hospital, Sagamu between January 2015 and December 2019 were reviewed. Their bio-data, perinatal history, laboratory results and treatment received were extracted for analysis.</p> <p><strong>Results:</strong> One hundred and twenty-two neonates had conjunctivitis out of a total number of 2,286 admissions, giving a prevalence rate of 5.3%.&nbsp; Male infants had almost double the risk of developing the disease compared to female infants (OR = 1.6; 95% CI: 1.09-2.35).&nbsp; Eighty-six (70.5%) babies were term, while 21 (17.2%) and 15 (12.3%) were preterm and small-for-gestational-age respectively. Most cases of neonatal conjunctivitis (82.0%) occurred in the first week of life while the mean ±SD age of onset was 5.3±4.5 days. <em>Staphylococcus aureus </em>and <em>Klebsiella</em> species were the commonest bacterial isolates affecting 57.1% and 23.0% neonates respectively. Moderately-high rates of resistance to erythromycin and gentamicin were observed among the bacterial isolates.</p> <p><strong>Conclusion:</strong> Neonatal conjunctivitis is commonly due to <em>Staphylococcus aureus</em> and <em>Klebsiella</em> species in this setting. It is commoner among male infants.&nbsp; Most cases run a mild course with good response to topical antimicrobial therapy.</p> OB Ogunfowora JO Ajewole HA Ajibode Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 230 238 10.30442/ahr.0602-12-85 A case report A Nigerian adolescent with Long term Non-progressive HIV-infection: A case report <p>Children infected with the Human Immunodeficiency Virus (HIV) can be rapid progressors or be at the end of the spectrum of the illness as Long-term Non-progressors (LTNPs). Long term non-progressors are patients who never received Highly Active Anti-Retroviral Therapy (HAART) during the first decade of life and are maintaining good CD4<sup>+</sup> count associated with declining HIV RNA values. The literature on paediatric patients with LTNP infection is sparse.</p> <p>An adolescent with HIV LTNP and likely vertical transmission of HIV is presented in this report. She presented with chronic cough, severe anaemia and dyspnea. She was wasted with bodyweight less than the 5<sup>th</sup> centile for age. She was not sexually active and had no history of blood transfusion, scarification, incisions or sharing of sharp grooming objects.</p> <p>The results of investigations suggested pulmonary tuberculosis and HIV infection. Her CD4 count was 42%. She was commenced on HAART and subsequently, anti-tuberculosis medications according to NTBLCP/DOTS Programme with improvement in symptoms and appreciable weight gain.</p> <p>Therefore routine voluntary HIV testing is recommended for all paediatric admission after consent or assent is obtained bearing in mind that a small subset of patients may fall into the LTNPs population.</p> MM Ogundeyi OO Oba-Daini UP Adeniyi BI Adenuga Copyright (c) 2020 Annals of Health Research 2020-05-17 2020-05-17 6 2 239 245 10.30442/ahr.0602-13-86