Sub-Saharan African Journal of Medicine

Visual acuity assessment and the knowledge of road safety rules among commercial motorcyclist in Ekpoma town, Southern Nigeria Innocent O Alenoghena, N.S. Awunor, W.A. Ovienra Sub-Saharan African Journal of Medicine 2019 6(3):111-115 Introduction: Motorcycle injuries, particularly from low income countries like Africa and Asia contribute significantly to road traffic injuries globally, according to recent estimates by the World Health Organization. Objective: To determine the prevalence of visual acuity disorders, knowledge of road safety rules and one-year prevalence of road crashes in male commercial motorcyclists. Methodology: Male commercial motorcyclists numbering 191 were selected from the motorcycles’ parks in Ekpoma, using a multi-staged random sampling technique. Structured interviewer administered questionnaires were used for data collection. Data were analysed using SPSS version 20. Results: A vast majority 189 (99.0%) of respondents had good visual acuity (with visual acuity of between 6/5 and 6/18), Just one percent of the respondents had poor visual acuity (between 6/24 to 6/60). Most respondents 122 (63%) had a good knowledge of road safety rules while 42.9% had been involved in at least a road traffic crash within a year prior to the survey. Knowledge of road safety rules showed a statistically significant association with the educational status of the respondents (P<0.001), but had no association with other socio demographic variables like age (P=0.184), marital status (P=0.298) and religion (P=0.511) in respondents. Conclusion: Majority of the male motorcyclist had visual acuity within the normal range, knowledge of road safety rules was good among respondents with the level of education identified as a significant predictor of knowledge Inclusion of at least primary school educational qualification as criteria for all motorcyclists and a proper medical examination of prospective motorcyclists before issuance of driver licenses.

Experience with Gomco Clamp circumcision in male neonates: technique and review of the literature Terkaa Atim, Amina Buba Sub-Saharan African Journal of Medicine 2019 6(3):116-121 Introduction: Neonatal male circumcision is routinely carried out in most places in Nigeria, sub-Saharan Africa. The main reasons why parents bring their sons for circumcision are religious and cultural with a few medical indications like phimosis, paraphimosis and balanitis also being noted. Several techniques of this age long practice have been described and options range from the non-device to device techniques. Circumcision with the Gomco clamp (GC) is not yet as popular in this part of the world even though it has been reported to be safe. Aims and Objectives: To describe our experience and technique using the gomco clamp (GC) for neonatal male circumcision in our environment. Materials and Methods: A retrospective study of 63 newborn boys whose parents gave consent and who were assessed and found fit for circumcision from August 2015 to November 2015 was carried out. They all had circumcision by the same surgeon using gomco clamp at Garki hospital Abuja, Nigeria. Data obtained from patients’ medical records included age, indication, size of gomco clamp and any procedure related complications. They were followed up at 6weeks in the surgical outpatient clinic and then 1year by telephone call to their parents. Results: The average age of the male neonates at circumcision was 10.8 +/- 4.38 days (range from 6 to 26 days) and median age 8days. The indications for circumcision were religion (43, 68%) and cultural (20, 32%). The only early procedure-related complications observed was mild bleeding in two (3.2%) boys and this succumbed to simple pressure. Long term complications included one (1.6%) each penile skin bridge following adhesions between the prepuce and glans and redundant foreskin which were corrected by free hand dorsal and ventral slit circumcision at 8months. Conclusion: Male circumcision can be performed at any age, but there are cost and safety benefits of doing this procedure during the neonatal period. Circumcision using the Gomco clamp (GC) is simple to learn.

Predictors of nonadherence to antihypertensive medications among stroke survivors in Benin City Nigeria Francis E Odiase, Judith E Ogbemudia Sub-Saharan African Journal of Medicine 2019 6(3):122-128 Background: Hypertension is the single most important modifiable risk factor for developing stroke and its recurrence. Evidence suggests that antihypertensive treatment rates following stroke remain poor worldwide and non-adherence to secondary preventive medication is a disturbing clinical problem associated with recurrence and poor outcomes. Aim: The aim of this study was to determine the predictors of non-adherence to antihypertensive medications among stroke survivors 3 months after their stroke. Materials and methods: This was a cross-sectional study, involving stroke survivors attending the out-patient neurology clinic at the University of Benin Teaching Hospital, Benin City, 3 months after their stroke. Demographic and clinical characteristic were obtained, with a questionnaire, while medication adherence was measured by pill count method. In the final logistic regression analysis, the independent variables were age, gender, educational status, marital status, modified Rankin scale, polypharmacy, and types of stroke while medication non-adherence was the dependent variable. Results: One hundred and twelve stroke survivors participated. There were 58(51.8%) males and the mean age was 72(12) years. The non-adherence rate in this study was 57.1 %(64/112). The significant predictors of non-adherence to antihypertensive medications were the female gender (P = 0.009), severe disability (P = 0.003), the older participants (P = 0.004), and polypharmacy (P = 0.002). Conclusion: Non-adherence to antihypertensive drugs following stroke was observed in our study, which would affect blood pressure control leading to stroke recurrence. To prevent recurrent strokes, stroke survivors must adhere to their antihypertensive drugs, while involving patient and family members in decision making with regards to treatment plans.

Socio-demographic and immunization characteristics of siblings of children with severe acute malnutrition attending paediatric nutrition clinic of Ahmadu Bello University Teaching Hospital, Shika, Zaria Sani M Mado, J.O. Alegbejo, Ibrahim Aliyu Sub-Saharan African Journal of Medicine 2019 6(3):129-133 Introduction: Severe acute malnutrition (SAM) is a disease of the developing world. Poverty and famine have escalated its prevalence. In Nigeria, the Boko Haram menace has resulted in an upsurge of internally displaced persons in need of food and shelter. It is estimated that about 16 million children are affected by malnutrition worldwide and accounts for two million deaths worldwide annually. Evidence suggests incomplete vaccination predisposes to malnutrition and its unwanted sequelae. Anecdotal findings show that most siblings of children with SAM were incompletely vaccinated and hence are at risk of SAM. The study thus aimed at assessing their socio demographic characteristics and immunization to document their vulnerability to development of SAM. Materials and Methods: This was a cross-sectional study of socio-demographic characteristics and immunization status of siblings of children with SAM being rehabilitated in the Paediatric nutrition clinic of Ahmadu Bello University Teaching Hospital Shika Zaria, between March 2009 and September 2014. The information was directly obtained from the mothers of the children as they presented to the clinic and then recorded into a structured questionnaire. Results: The socio-demographic characteristics of 229 parents and immunization status of siblings of children with SAM were reviewed. Most family settings were monogamous (54.2%) and the majority of the fathers were semi-skilled labourers (26.2%). Only 76 (33.2%) of the mothers had some form of formal education while 153 (66.8%) were not formally educated. The majority of the subjects received BCG vaccine but only 56% and 55.5% of the subjects completed their DPT3 and oral polio 3 vaccinations respectively. Conclusion: The study showed that fathers of siblings of children with SAM were semi-skilled labourers while their mothers were predominantly stay at home and not formally educated with limited source of income. Furthermore, BCG vaccination was the most commonly received vaccine and it is recommended that concerted effort should be made towards improving vaccine delivery among siblings of children with SAM. Adult literacy and empowerment of mothers may help achieve improved immunization of siblings of children with SAM.

Prevalence of postpartum morbidities in a tertiary care center in Northern Nigeria Natalia Adamou, Faiza Lawal Mohammed, Usman Aliyu Umar Sub-Saharan African Journal of Medicine 2019 6(3):134-137 Background: Complications can arise during the postpartum period and if unrecognized can lead to physical discomfort, psychological distress, and a poor quality of life for the mothers. The true burden of postpartum maternal morbidity is still not known. It is estimated to be highest in low- and middle-income countries. Objective: This study was aimed at determining the pattern of postpartum morbidities at Aminu Kano Teaching Hospital and their possible determinants. Methodology: It was a cross-sectional study of women admitted into postnatal ward of Aminu Kano Teaching Hospital, Kano, Nigeria, on account of postpartum morbidities from January 1to December 31, 2016. The admission register of antenatal/postnatal ward was retrieved and only women admitted within the postpartum period were included in the study. Result: There were 3933 deliveries over the studied period and 141 women were admitted for postpartum morbidities. The most common morbidities were anaemia (35.5%), hypertensive disorders (19.6%), and puerperal sepsis (19.6%). Nearly 70% of the patients were unbooked and had spontaneous vaginal delivery. There was a significant association between postpartum morbidities and booking status, level of educational, and mode of delivery. Conclusion: Anaemia, hypertension, and sepsis are the common postpartum morbidities in Kano, north-west Nigeria. Health education on the importance of quality antenatal and intrapartum care will go a long way in reducing these morbidities.

Assessment of ocular health status of pupils in public and private primary schools in Sabon Gari, Zaria, Kaduna State Orugun AJ, Oladigbolu KK, E. Samaila, V. Pam Sub-Saharan African Journal of Medicine 2019 6(3):138-142 Background: Routine eye screening of pupils in schools as a matter of health policy is not obligatory in Nigeria. The administrative setting, organization, environment and social background of pupils in public and private schools are often different. Objectives: To determine the ocular health status of pupils in private and public primary schools in Sabon-Gari, Zaria, Kaduna state, Nigeria, and ascertain whether there are differences. Materials and Methods: This was a descriptive cross-sectional study. A multistage sampling technique was used to select the pupils. Visual acuity assessment using Snellen’s chart was done while anterior segment examination was carried out with a pen torch and loupe. Posterior segment was examined using a direct ophthalmoscope (Heine Beta 200). Results: A total of 540 pupils were selected from six primary schools, comprising 270 from three private schools and an equal number from 3 public schools. The ages of the pupils ranged from 3 to 16 years with a mean of 8.42 (SD ± 2.16). Females were 272 (50.4%) and males 268 (49.6%) (F:M = 1.01:1). The prevalence of ocular morbidities from the study was 22.8%. It was 24.4% in public and 21.1% in private schools respectively. Ametropia was the commonest ocular disorder seen in private schools pupils, 17 (6.3%), while vernal conjunctivitis, 23 (8.5%), was the most frequent findings in the public schools. Conclusion: Though ametropia was the commonest ocular morbidity seen among private school pupils and allergic conjunctivitis among those in public schools, these were not statistically significant (P > 0.05).

Classification of anatomical variants of maxillary sinus shapes and symmetry using computerized tomographic imaging Abdulhameed Aliu, Ma’aji S Mohammad, Bello S Sirajo, Ahmad M Abrahim, Zagga D Abdullahi Sub-Saharan African Journal of Medicine 2019 6(3):143-147 Background: The maxillary sinus is characterized by a considerable variation in sizes and shapes and between the right and left sides. Due to easy access to all its walls and surfaces, imaging via computerized tomography (CT) has enhanced the quality and quantity of information obtainable from the assessment of the maxillary sinus. Aim: To determine normal variations in shapes and symmetry of the maxillary sinus using CT. Methods: A total of 130 subjects comprising 79 males and 51 females, between the ages of 20 and 80 years, with normal maxillary sinus CT anatomy, who had head CT scans carried out at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, over a period of five years, were used for this study. Images were taken with a GE Bright Speed Multidetector Helical CT (GE Healthcare, USA, 2005) Scanner, while films were viewed on the computer monitor. Variations in shapes of the maxillary sinus were identified on axial images and classified based on their resemblance to known shapes of solids. Data were analyzed using Minitab 16.0 statistical package (Minitab inc. USA). Results: Five distinct shapes of the maxillary sinus were identified. These were: irregular in two subjects (0.77%) (right = 1 and left = 1); oval in three subjects (1.15%) (right = 2 and left = 1); quadrangular in three subjects (1.15%) (right = 2 and left = 1); spherical in 61 subjects (23.46%) (right = 30 and left = 31); and triangular 191 (73.46%) (right = 95 and left = 96). Shapes were symmetrical in 85.38% and asymmetrical in 14.62% of subjects. Conclusion: Five normal but distinct shapes of the maxillary sinus were identified, with the predominant shape, being the triangular type, and sinuses of individuals were frequently symmetrical in shape.

A case of Stanford type B acute aortic dissection presenting as acute abdomen Peter Dodo Yakubu, Narendra Nath Khanna, Emmanuel Auchi Edafe, Suparna Rao Sub-Saharan African Journal of Medicine 2019 6(3):148-151 Acute aortic dissection is a medical emergency with high mortality. It presents mostly with typical features of sudden onset chest pain that is tearing in nature and radiates to the back, neck, or the abdomen. However, it may present with atypical features like abdominal pain, nonspecific abdominal or chest discomfort, altered bowel habit, vomiting, and features of acute renal dysfunction leading to diagnostic dilenma. These atypical features are mostly reported in western population. We report a case of 48-year old man with Stanford type B acute aortic dissection that was initially diagnosed as acute abdomen.

Spontaneous perforation of cystic duct in a 3-month-old Nigerian boy: a case report Musa S, Ogunsua OO, Sholadoye TT, Mado SM, Idris HW, Abdullahi SM Sub-Saharan African Journal of Medicine 2019 6(3):152-154 Introduction: Biliary ascites is a rare condition in infancy and is commonly caused by the perforation of the extrahepatic bile duct. The cystic duct is the part of extrahepatic biliary tract most rarely affected. This is likely to be the first case of biliary ascites of infancy, secondary to spontaneous cystic duct perforation in our centre. Methods: Consent was obtained from the parents of the child. Ethical approval was also obtained from the research and ethics committee of Ahmadu Bello University Teaching Hospital, Shika, Zaria. The case notes of the child were summarized and the relevant literature was reviewed to give the report a context. Results: A three-month-old boy presented with ten days history of jaundice, a week history of abdominal distention, and a day’s history of fever. There was associated bilateral inguinal hernia, excessive cry, refusal to feed, and weight loss. Pregnancy history was normal. He was acutely ill-looking, irritable, febrile with an axillary temperature of 37.7°C, mildly pale, jaundiced with a greenish tinge, had a weight of 4.7kg. He had gross ascites and bilateral reducible inguinal hernia. Bedside abdominal paracentesis reveals thick yellow and foamy fluid. Abdominal ultrasound scan revealed gross ascites, clotting profile was deranged, there was hyperbilirubinaemia of 228 umol/L, other laboratory results including liver function test were normal. He was commenced on medical management for presumed sepsis with obstructive jaundice. Five days into the admission, there was no significant improvement, and the diagnosis was reviewed to a ruptured choledochal cyst and the child was prepared for an explorative laparotomy. Intra-operatively, the cystic duct was perforated. Cholecystectomy and repair of the common bile duct were performed and the child did well postoperatively. Conclusion: Perforated cystic duct should be suspected in infants presenting with jaundice abdominal distension, acholic stools with or without fever, vomiting, and inguinal hernias. Early diagnosis and prompt surgical intervention greatly reduce morbidity and mortality from the disease.

Erratum: Sonography of scrotal abnormality among subfertile and fertile males in Abuja, Nigeria Sub-Saharan African Journal of Medicine 2019 6(3):155-155