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Public health care financing in Nigeria: Which way forward?
Babayemi O Olakunde
January-June 2012, 6(1):4-10
The way a country finances its health care system is a key determinant of the health of its citizenry. Selection of an adequate and efficient method(s) of financing in addition to organizational delivery structure for health services is essential if a country is set to achieve its national health objective of providing health for all. Health care in Nigeria is financed by tax revenue, out-of-pocket payments, donor funding, and health insurance (social and community). However, achieving successful health care financing system continues to be a challenge in Nigeria. This article examines the different financing mechanisms that have been used in Nigeria, including the National Primary Health Care Development Fund proposed for increasing the resource allocation to primary health care. It draws on available and relevant literature to provide an overview and the state of public health care financing in Nigeria. This article concludes by recommending the need for Nigeria to explore and strengthen other mechanisms of health system and shift focus from out-of-pocket payments, address the issues that have undermined public health care financing in Nigeria, improve on evidence-based planning, and prompt implementation of the National Health Bill when signed into law.
  80,882 5,028 15
Uses and hazards of nasogastric tube in gastrointestinal diseases: An update for clinicians
JG Makama
July-December 2010, 4(2):37-44
  62,202 1,900 3
The role of National Health Insurance Scheme on structural development of health facilities in Zaria, Kaduna State, North Western Nigeria
Muhammad Bello Garba, Clara Ladi Ejembi
January-June 2015, 9(1):9-14
Background: The National Health Insurance Scheme (NHIS) in Nigeria was introduced in 2005 to ensure universal access to good health care services, by protecting families from financial barriers to health care, and ensuring availability of funds to the health sector for improved services. Since introduction of the scheme, however, there has been no documented study carried out to assess whether there has been any improvement in human resource available for provision of health services and for other basic infrastructure in the participating facilities. Aim: This study was undertaken to assess and compare the funding patterns, and infrastructural and manpower development in health facilities in Zaria, Kaduna State, following the introduction of the NHIS. Materials and Methods: This study was comparative cross-sectional in design. Using stratified sampling technique one public and two private health facilities were selected from 16 secondary health facilities (5 public, 11 private) accredited by the NHIS. Retrospective analysis of data collected from their records on the pattern of funding, the levels of hospital infrastructure, and manpower in the facilities was carried out before and after the introduction of the NHIS. Results: The study demonstrated an almost three-fold increase in financial resources availability to the health facilities following enrolment into the NHIS, with the private facilities having a higher increase (300%) than the publicly owned facility (261%). Funds from the scheme, now constituting up to 36% of the total revenue, accounted for almost half (47%) of the increase. The facilities also witnessed improvement in physical infrastructure, staff strength, and diagnostic capability with variable statistical significance. Conclusion: The study demonstrates that the relationship between financial resource availability and facilities' staffing, laboratory diagnostic capability, and physical infrastructure is not always linear.
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Mental health disorders in Nigeria: Ahighly neglected disease
Dauda Eneyamire Suleiman
July-December 2016, 10(2):47-48
  17,813 4,141 -
A study of prevalence of anemia and sociodemographic factors associated with anemia among pregnant women in Aurangabad city, India
Pushpa O Lokare, Vinod D Karanjekar, Prakash L Gattani, Ashok P Kulkarni
January-June 2012, 6(1):30-34
Background: Anemia in pregnancy accounts for one fifth of maternal deaths worldwide and is a major factor responsible for low birth weight. In India, 16% of maternal deaths are attributed to anemia. The association between anemia and adverse pregnancy outcome, higher incidence of preterm and low-birth weight deliveries have been demonstrated. However, high prevalence of anemia among pregnant women persists in India despite the availability of effective, low-cost interventions for prevention and treatment. A knowledge of the sociodemographic factors associated with anemia will help to formulate multipronged strategies to attack this important public health problem in pregnancy. Aim: To study the prevalence of anemia and the various sociodemographic factors associated with anemia among pregnant women at an urban health center in Aurangabad city, India. Setting: Urban Health Center (UHC) of Government Medical College, Aurangabad, India. Study Design: Descriptive cross-sectional study. Materials and Methods: The study was carried out from August 2006 to July 2008. A total of 352 pregnant women were selected using a systematic random sampling technique. The participants were included only after confirmation of the pregnancy. Statistical Analysis: Chi-square test, Chi-square test for trend. Results: Overall prevalence of anemia among the pregnant women was found to be 87.21%. Factors such as religion, level of education of women and their husbands and socioeconomic status were found to be significantly associated with the prevalence of anemia in pregnancy ( P < 0.05). Conclusion: Low socioeconomic class, illiteracy, Hindu religion were significantly associated with high prevalence of anemia during pregnancy in Indian women.
  17,811 1,860 8
Status of birth and death registration and associated factors in the South-south region of Nigeria
Ekaete A Tobin, Andrew I Obi, Essy C Isah
January-June 2013, 7(1):3-7
Background: The registration of births and deaths in Nigeria, as with most developing countries continues to remain suboptimal with many births and deaths going unregistered. This has negative consequences for economic planning and development. Objective: The study was undertaken to assess the practice of birth and death registration in South-south Nigeria; and to determine the factors that govern this practice. Subjects and Methods: Using a cross-sectional descriptive study design, a questionnaire was administered to 324 household heads (or their spouses) in an urban local government area in the South-south geo-political zone of Nigeria. Structured interviewer-administered questionnaires were used for data collection. Data were entered into a spreadsheet and analyzed using SPSS version 15. Categorical data were presented as frequency distribution tables, Chi-square test and Fisher's exact were used to examine relationship between demographic characteristics and respondents' knowledge and practice of birth and death registration. Results: Awareness of birth registration was high. Awareness of death registration showed differing views as to where and who should statutorily register a death. Sixty-eight percent of those who recorded a birth in the 10 years preceding the study registered it, whereas 61% of those who recorded a death within their household in the preceding 10 years of the study did not register it. Educational level, marital status, and religion were found to be associated with the practice of birth registration, and educational status alone, with death registration. Conclusion: Much work needs to be done to enlighten the public on vital registration, particularly death registration.
  14,341 924 5
Effect of maternal literacy on nutritional status of children under 5 years of age in the Babban-Dodo community Zaria city, Northwest Nigeria
Mu'awiyyah Babale Sufiyan, Sulaiman Saidu Bashir, Ahmad Ayuba Umar
July-December 2012, 6(2):61-64
Background: Worldwide, about a half of mortalities in children are directly or indirectly attributable to malnutrition. In Nigeria, malnutrition has also been reported to be associated with increased morbidity and mortality, such that 30-40% of deaths in the preschool age group are associated with malnutrition. Therefore, assessing the factors attributing to malnutrition is central to reducing and preventing these high mortalities. One attributable factor to malnutrition is the level of maternal literacy. Objective: The study aimed to assess the effect of maternal literacy on the nutritional status of children under 5 years of age in Babban-dodo, Zaria, Northwestern Nigeria. Methodology: A cross-sectional descriptive study of 300 children aged less than 5 years and their mothers/caregivers was conducted, using a multistage sampling technique. The study involved collecting information on the sociodemographic characteristics of the respondents and the anthropometric measurements (weight, height, mid-upper arm circumference) of the eligible children. The data were analyzed using statistical software SPSS 19.0 and Epi-Info version 6.0. Result: Out of the 300 children studied, 87 (29%) were found to have under weight, 21 (7%) were wasted, and 93 (31%) were stunted. The majority (65%) of the mothers/caregivers have no form of formal education. There was a significant statistical association between maternal literacy status and occurrence of malnutrition (specifically stunting) among the children studied. (X 2 = 26.2, df = 1, P < 0.05). Conclusion: Maternal literacy has a significant relationship with the nutritional status of children. Therefore, there is the need to promote and encourage female/girl child education in the communities in order to empower them to know the right type of food and the right way to give it in the right quantity. This will help to prevent the occurrence of malnutrition among children, especially those under the age of 5 years.
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Bacterial whole genome sequencing: The future of clinical bacteriology
Shamsudin Aliyu
July-December 2014, 8(2):51-57
  6,648 7,303 1
Complete penoscrotal transposition
Sandeep Hambarde, Pradnya Bendre
July-December 2010, 4(2):66-67
Penoscrotal transposition may be partial or complete, resulting in variable degrees of positional exchanges between the penis and the scrotum. Repairs of penoscrotal transposition rely on the creation of rotational flaps to mobilize the scrotum downward or transpose the penis to a neo hole created in the skin of the mons-pubis.
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Clinical approach to Lymphadenopathy
Abdullah A Abba, Mohamed Z Khalil
January-June 2012, 6(1):11-17
Lymphadenopathy (LAP) is a common clinical finding that may be localized, limited or generalized. The enlargement of a lymph node, due to primary disease or secondary cause, is of concern to both patients and clinicians, particularly, if the underlying pathology is a malignant disease. Lymph node aspiration or biopsy for histopathological evaluation may not reveal the diagnosis due to several factors. However, a methodological approach to LAP can disclose the accurate diagnosis with minimal discomfort to the patient and in a short time. In this review article, we provide evidence-based clinical evaluation of LAP, guided by the probability of the underlying disease to assist clinicians in establishing the proper cause and hence offer appropriate management.
  12,520 1,331 3
Diagnosis of latent tuberculosis infection: The tuberculin skin test and interferon gamma release assays
Mukhtar A Adeiza
July-December 2011, 5(2):35-37
  4,884 8,222 -
Child sexual abuse: A review of cases seen at General Hospital Suleja, Niger State
Isa Abdulkadir, Lawal Waisu Umar, Hafsatu Hassan Musa, Shuaibu Musa, Olusegun Abegunde Oyeniyi, Oluwaseyi Mary Ayoola-Williams, Ladi Okeniyi
January-June 2011, 5(1):15-19
Background : Sexual abuse of children is a global health and human rights problem that has been largely underreported and understudied in sub-Saharan Africa. Little is therefore known regarding information on the nature of child sexual abuse and the predisposing factors in our communities. Objective : To study the demographic features of individuals involved in sexual abuse and the pattern of presentation of cases at the General Hospital Suleja, Niger state. Materials and Methods : The study is a retrospective analysis of case records of patients who presented to the Out Patient Department of General Hospital Suleja. All cases of sexual abuse seen over an 18 month period from 1 st January 2007 to 30 th June 2008 were reviewed. Data obtained were analysed in Epi-Info software version 3.04 and results presented as percentages, contingency tables, and charts. Results : A total of 81 cases of sexual abuse were recorded over the period of review where children (77 cases) accounted for 95.1% of the cases. There were 41 cases of sexual abuse seen in 2007, while 40 cases were documented within the first half of 2008. All the victims of sexual abuse were girls and all the perpetrators were males of whom six adolescent boys constituted 7.6%. There was no documentation on evaluation and management of sexually transmitted infections, HIV infection, emergency contraception, or scheduled follow-up. Conclusion : The incidence of reported child sexual abuse is on the increase in our communities. There is a need for studies on the predisposing factors to inform policy and preventive strategies as well as efforts to build the capacity of public health systems and care providers to manage cases reporting to our health care facilities.
  12,219 797 1
Persistent hiccups after acute supratentorial stroke: Report of seven cases and review of literature
Imarhiagbe F Aiwansoba, Okoh B Ewere, Ugiagbe R Ashinedu, Okaka E Ibiene
July-December 2013, 7(2):75-79
Persistent hiccups are hiccups that last for at least 48 h, and may occur following a legion of causes including strokes. They have been described following infarctive and hemorrhagic strokes. Hiccup is a respiratory reflex action that occurs following the sudden contraction of the diaphragmatic and intercostals muscles with closure of the glottis; and putatively believed to be a form of myoclonus (very brief repeated contractions of striated muscles) that occurs from irritation of the medullary mediated reflex arc that has supratentorial inputs. This underpins the association of hiccups with suprabulbar lesions like strokes, apparently following repeated excitatory inputs from the higher centers. Hiccups are ordinarily self-limiting, but persistent hiccups are advisedly treated with pharmacologic agents, of which baclofen, a GABA B agonist muscle relaxant has proven to be remarkably efficient. It is believed that the action of baclofen interrupts the hiccup reflex arc. Nonpharmacologic remedies like vagus nerve stimulation have also been found to be effective and may be complementary. This case series highlights the use of baclofen in persistent hiccups following supratentorial infarcts.
  12,165 346 -
Knowledge and awareness of needlestick injury among students of Rural Dental College, Maharashtra, India
Rajiv Saini
January-June 2011, 5(1):12-14
Objectives : To assess the knowledge and awareness regarding needlestick injury among undergraduate dental students of Rural Dental College. Materials and Methods : This cross-sectional observational study was conducted among students of Rural Dental College, Maharashtra, India. A predesigned questionnaire, which assessed knowledge and awareness about needlestick injury and its management, was the tool of data collection. Results : A total of 150 students participated. The male to female ratio was 1:2; mean age of respondents was 20.66±1.01 years. On an average, 89.23% and 10.67% of the students had correct and incorrect knowledge about needlestick injury, respectively. A total of 91.55% exhibited adequate level of awareness, while 08.45% exhibited incorrect level of awareness about management of needlestick injury. Conclusion : Results indicate that the students had good knowledge and adequate awareness about needlestick injury.
  11,256 1,143 1
Androgen insensitivity syndrome in an Indian adult
Tulon Borah, Ranjan Kumar Mahanta
July-December 2012, 6(2):101-103
In androgen insensitivity syndrome (AIS), the patients are phenotypically females with male karyotype. Affected persons present at puberty with primary amenorrhea with adequate breast development and normal external genitalia. The gonads may be found in lower abdomen, inguinal regions, or sometimes in the labia majora. Rarely, the testes may undergo malignant transformation. So, gonadectomy is indicated in these patients after they attain puberty. Here, we present a case of AIS with primary amenorrhea and bilateral inguinal swelling.
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Knowledge and awareness of Hepatitis B infection amongst the students of Rural Dental College, Maharashtra, India
Rajiv Saini, Santosh Saini, RS Sugandha
January-June 2010, 4(1):18-20
Objectives : To determine the current knowledge and awareness of undergraduate dental students of Rural Dental College regarding the Hepatitis B infection. Materials and Methods : This cross-sectional observational study was conducted among the students of Rural Dental College, Maharashtra, India. Predesigned questionnaire which assessed knowledge and awareness about Hepatitis B infection and transmission was the tool of data collection. Results : A total of 150 students participated. The male female ratio was 1:2; mean age of respondents was 20.66 ± 1.01 years. On an average, 59.23 and 40.67% had correct and incorrect knowledge about Hepatitis B infection, respectively. A total of 81.55% exhibited adequate level of awareness while 18.45% exhibited incorrect level of awareness about transmission of Hepatitis B infection Conclusion : Results indicate that students had adequate awareness and perception level about awareness of Hepatitis B infection.
  9,421 2,177 1
Study of blood glucose level in normal and low birth weight newborns and impact of early breast feeding in a tertiary care centre
Arun Kumar De, Rupa Biswas, Moumita Samanta, Chanchal Kumar Kundu
July-December 2011, 5(2):53-58
Background and Objectives: Neonatal hypoglycemia, a common metabolic problem, often goes unnoticed owing to lack of specific symptoms. We designed this study to assess the incidence of hypoglycemia in healthy normal birth weight and low birth weight babies, including both preterm and small for gestational age (SGA) newborns, to evaluate the impact of early breastfeeding on hypoglycemia and to assess the impact of exclusive breast feeding on glucose values up to 48 h of age. Design and Settings: A hospital-based prospective longitudinal study. Materials and Methods: The study was conducted over six months involving one hundred fifty healthy (both term and preterm) appropriate for gestational age (AGA) or SGA babies with birth weight between 1.5 kg and 3.99 kg. Blood glucose values were measured at the age of 1 h, 6 h, 12 h, 24 h and 48 h after delivery which was independent of feeding time. Blood glucose value less than 40 mg/dl (2.2 mmol/l) was defined as hypoglycemia. Sick newborns, those less than 34 weeks of gestation or less than 1500 g, infant of diabetic mother, those with birth asphyxia, congenital malformations and endocrine deficiencies were excluded. Results: Overall incidence of hypoglycemia was 32%. Hypoglycemia was significantly greater in SGA and preterm as compared to AGA and term newborns respectively (P<0.001). Incidence of hypoglycemia was significantly more in newborns with delayed breast feeding than early breast feeding (64% vs 17%; P<0.001). Conclusion: Low birth weight babies (both preterm and small-for-date) are prone to develop hypoglycemia especially in first 24 h of life with delayed introduction of breast feeding being an additional risk.
  10,554 959 2
Reviving hospital autopsy in Nigeria: An urgent call for action
Dauda Eneyamire Suleiman
July-December 2015, 9(2):39-40
  3,343 7,449 1
Tuberculosis in the left inguinal region associated with cutaneous tuberculosis of left second toe: An unusual presentation of extrapulmonary tuberculosis
Jugal K Kar, Manoranjan Kar, Saswati Maiti
July-December 2011, 5(2):59-61
We report an uncommon case of tuberculosis involving left second toe associated with left inguinal lymphadenopathy and an ulcer in a 30-year-old male with no other pulmonary or extra pulmonary tubercular infection. Diagnosis was made by biopsy. He responded very well to anti tubercular treatment.
  9,998 347 -
HIV/AIDS treatment in sub-Saharan Africa: Towards universal access and universal "test and treat" strategy
Mukhtar A Adeiza
July-December 2012, 6(2):59-60
  2,269 8,014 1
Epstein-Barr virus and associated head and neck manifestations
Nitul Jain, Vishwas Bhatia, Sohail Lattoo
July-December 2011, 5(2):38-41
The Epstein-Barr virus (EBV), also called human herpes virus 4, is a virus of the herpes family, having linear double-stranded DNA as its genome. It is best known as the cause of infectious mononucleosis. Besides this, EBV is also associated with particular forms of malignancy, particularly Hodgkin's lymphoma, Burkitt's lymphoma, and nasopharyngeal carcinoma, all of which may show their prime manifestations in head and neck area, for which patient may seek a dentist referral initially. In addition, EBV is linked with oral hairy leukoplakia, which may be an earliest oral manifestation of HIV infection. This review article primarily deals with clinical manifestations of diseases associated with EBV infection particularly in head and neck area.
  7,825 2,238 -
Evaluation of cerebrospinal fluid adenosine deaminase levels as an ancillary diagnostic test for tuberculous meningitis and its correlation with adverse neurological outcome
Arjun Khanna, Virendra Atam, ML Patel, Rajesh Verma, Alok Gupta
July-December 2010, 4(2):51-54
Background : Tuberculous meningitis (TBM) is often under and over diagnosed, thereby making the ancillary diagnostic tests important for establishing the diagnosis of TBM. The objective of this study was to evaluate cerebrospinal fluid adenosine deaminase (CSF-ADA) as an ancillary test for the diagnosis of TBM, and further, its correlation with adverse neurological outcome in these patients. Materials and Methods : This was a prospective study of 83 patients. The diagnosis of TBM was established by Thwaites criteria. CSF-ADA levels were measured in all these patients and were taken to be positive at levels >10 IU/l. These patients were followed up at 1 and 3 months after discharge, and the resultant neurological deficit was measured as per the modified Rankin score and correlated with the initial CSF-ADA levels. Mann-Whitney U test, χ2 test, Kruskall-Wallis tests were used for statistical analyses. Results : CSF-ADA values were higher than 10 IU/l in all the 83 patients diagnosed to be suffering from TBM. It was seen that the mean ADA level for patients with stage I/II was 18.23 ± 8.64 IU/l, while it was 31.97 ± 226 004, India.
  9,270 613 -
Controlling the spread of carbapenemase-producing Gram-negative bacteria
Shamsudin Aliyu
July-December 2013, 7(2):45-47
  1,870 7,969 -
Prevalence of scabies among school-aged children in Katanga rural community in Kaduna state, Northwestern Nigeria
Mohammed N Sambo, Suleman H Idris, Ahmad A Umar, Abdulhakim A Olorukooba
January-June 2012, 6(1):26-29
Background: Scabies is a common parasitic infestation of global proportion. It is a highly contagious skin disease which affects both males and females of all socioeconomic status and race. It is related primarily to poverty and overcrowding, which is also found in most rural communities. This study aimed at assessing the prevalence of scabies among school-aged children in Katanga community. Materials and Methods: In a descriptive cross-sectional study, pre-tested semi-structured questionnaire was administered to 206 school children aged 5-12 years through a total population study in Katanga rural community. Data collected were analyzed using SPSS version 17. Results: In this study, 45 (21.8%) children had skin infections, 33 (73.3%) of these skin infections were associated with itching and 6 cases of scabies were found giving a prevalence rate of 2.9% in the community. Conclusion: This study has shown that scabies is a disease associated with poverty, overcrowding, and sometimes water shortage, and is still endemic in rural communities in Northern Nigeria causing a substantial burden. These findings, coupled with the potential for clinical complications and a heavy socioeconomic impact, suggest that it is time for more concerted actions in terms of provision of adequate domestic water supply and improvement of personal and environmental hygiene against this disease in Nigeria.
  8,946 763 3
Prevalence and determinants of "low birth weight" among institutional deliveries
Kiran Agarwal, Ashok Agarwal, VK Agrawal, Pooja Agrawal, Varsha Chaudhary
July-December 2011, 5(2):48-52
Background: Birth weight is an important determinant of child survival and development. It is also a subject of clinical and epidemiological investigations. This study was planned to find out the epidemiological factors associated with low birth weight (LBW) among institutional deliveries so that suitable recommendation can be made to prevent LBW. Objectives: The present study was therefore undertaken to find out some maternal factors that may have their association, if any with LBW. Materials and Methods: This cross-sectional study was carried out at tertiary care hospital among 350 mothers delivering live born neonate in study place. All babies were weighed within 24 hours after the birth. The babies were weighed on beam type weighing machine up to 20 g accuracy. LBW was defined as a birth weight of <2500 gram. All mothers were examined and interviewed within 24 hours after delivery and findings were recorded. The analysis was done using Epi Info package. Results : In this study, 40.0% mothers delivered LBW babies. Findings indicate that gestational age less than 37 weeks (76.5%), maternal age less than 20 years (58.5%), irregular antenatal checkup (70.5%), mother's height less than 150 cm (68.5%), mother's weight less than 50 kg (76.1%), hemoglobin less than 10 gm/dl (60.5%), severe physical work (78%), and tobacco chewing (58.5%) are significant determinants of LBW. Conclusion: Our study indicates that gestational age, maternal age, regular antenatal checkup, mother's height, mother's weight, anemia, physical work, and tobacco chewing are significant determinants of LBW. Prevalence of LBW can be reduced by increasing the gestational age, regular antenatal checkup, balanced diet during antenatal period, adequate rest during antenatal period, and avoiding the tobacco chewing.
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