bomj-volume15no2

Background: The American Academy of Paediatrics (AAP) started the Back to sleep campaign since 1992 to reduce the incidence of Sudden infant death syndrome (SIDs) and expanded its recommendations in 2011 to include provisions to ensure safe sleep environment for infants. Health workers, especially doctors and nurses are to ensure correct information is given to parents. However, knowledge gaps still exist among health workers even in developed countries.
Objective: To assess knowledge on SIDs and recommended sleep practices for infants among doctors and nurses in two major hospitals, Usmanu Danfodiyo University Teaching Hospital (UDUTH) and Specialist Hospital Sokoto (SHS) in Sokoto town in order to bridge knowledge gap among healthcare providers.
Methods: This was a cross-sectional multicentre study of 154 health workers carried out between 1st August, 2016 and 31st October, 2016. Doctors from the Paediatrics and Obstetrics departments, nurses in all the Paediatric and Obstetrics units of both hospitals were consecutively recruited. A structured questionnaire on knowledge of Sudden infant death syndrome and sleep recommendations was administered. Data was analysed with SPSS version 22
Results: Out of 154 health workers that participated, only 25 (16.2%) were aware of the AAP recommendations. Seventy-six (49.4%) selected side position as the recommended position while 62 (40.3%) selected supine position. More nurses than doctors (57.6% vs 32.3%) gave advice to mothers on sleep position even though the doctors were more aware of the AAP recommendations and correct infant sleep position. Although, the paediatric nurses had more knowledge of the recommended supine sleep position, more obstetric nurses gave advice to mothers about sleep position (p =0.005). Also, paediatricians had more knowledge of the supine sleep position (p = 0.03) compared to obstetricians.
Conclusion: More doctors and nurses in this study selected the side sleeping position as the recommended one. Also, frequency of giving advice to mothers on sleep position was also low.

Background: Feeding disorders are estimated to occur in up to 25 - 35% of healthy children and 80% of neurologically impaired children. Dysfunctional oral-motor control, abnormal neurologic maturation, poor seating posture during feeding among others result in feeding problems in children with neurologic disorders. Early detection and nutritional support are important in preventing poor growth and development which may result from feeding disorders.
Objective: To ascertain the presence of feeding disorders in children attending the neurology clinic of the University of Benin Teaching Hospital.
Materials and Method: A descriptive cross-sectional study carried out in the University of Benin Teaching Hospital. A semi-structured interviewer-administered questionnaire was used in obtaining information from the parents/caregivers of the children who were recruited consecutively from the neurology clinic.
Results: Of the 154 subjects recruited for the study 63 (41%) and 59 (38%) had cerebral palsy and seizure disorder/epilepsy respectively. Fifty-six caregivers (36.4%) had unpleasant experience during mealtimes. Excessive salivation, choking and chewing difficulties ranked highest among the feeding problems in the children. Forty-four (28.6%) children had multiple feeding problems. Gender, age group, feeding experience and neurological diagnosis were significantly associated with multiple eating problems. Forty-one (26.6%) children were underweight while 7.1% were overweight.
Conclusion: Feeding problems, which are often accompanied by unpleasant mealtime experience for caregivers, are common in children with neurological impairments. Assessment of the feeding pattern and nutritional status of children should be undertaken in the outpatient neurology clinic.

Background: The incidence of chronic kidney disease (CKD) in Nigeria and the Black race in general is on the increase with attendant high morbidity and mortality. Several aetiologic factors have been implicated in CKD which include hypertension, diabetes mellitus, glomerulonephritis, obstructive uropathy, recurrent pyelonephritis and adult polycystic kidney disease (ADPKD) amongst others. Whatever maybe the aetiologic factor of the CKD, there is reported effect of this condition on the auditory organ at the level of cochlea because of certain similarities.
Objective: To determine if there is any correlation between the aetiology, stage and duration of chronic kidney disease with the severity of hearing loss.
Methodology: A one-year prospective study which sought information on demographics, aetiologic factors, otologic, drug and occupational histories of patients with chronic kidney disease using a structured interviewer administered questionnaire. Additionally, body weight, height, blood pressure, fasting blood sugar and serum creatinine were measured for all the patients while pure tone audiometry(PTA) and glomerular filtration rate (GFR) were measured or calculated respectively.
Results: One hundred CKD patients were analysed, comprising of 66 males and 34 females with a male to female ratio of 1.9:4. Their ages ranged from 15years to 75years with mean age of 40.2(SD±18.4). The majority of the studied population was in the 45-54 years (28%). Sensorineural high frequency hearing loss was found in 60 patients, made up of 49 in both ears and 11 unilateral (3 and 8 in right and left ears respectively). These gave a total of 109 ears (54.5%). Chronic kidney disease resulting from chronic glomerulonephritis or hypertension accounted for 45.0% and 36.0% cases respectively. Hearing loss increases with the CKD stage accounting for 15.6%, 34.9% and 48.6% for stages 3, 4 and 5 respectively. The longer the duration of the CKD, the more depressed was the mean hearing threshold (P=0.0047; r=0.870).
Conclusion: There is significant correlation between hearing loss in the high frequencies and duration and stage of chronic kidney disease patients. Therefore, we recommend health education with a view to identifying this category of patients’ early and effecting periodic hearing assessment in them.

Introduction: Perception of maxillary midline diastema as an aesthetic trait varies in relation to culture, age group, and racial background. This study determined the self-reported prevalence of maxillary midline diastema as well as assessed the sociocultural beliefs regarding maxillary midline diastema among undergraduate students of different ethnicity attending a Nigerian university.
Methods: A descriptive cross-sectional study of undergraduate students in University of Benin. A self-administered structured questionnaire was utilized for this study. The questionnaire sought information on socio-demographic profile of the participants, self-reported presence of midline diastema, the characteristics of the diastema and sociocultural beliefs regarding midline diastema. Statistical analysis was done using IBM SPSS 21.0. Cross tabulation was used to report categorical variables which were presented as counts and percentages. Chi-square test was applied to determine associations between variables with the level of significance set at p<0.05.
Results: A total of 400 students aged 16 to 46 years and a mean age of 21.86 years (±3.07) took part in this study. 29% of the study population had maxillary midline diastema. Most cases were recorded in the maxillary arch (96.6%). All ethnic groups and students in lower age group saw maxillary midline diastema as a sign of beauty and perceived it to be more attractive in female.
Conclusion: Based on the study, midline diastema is regarded as a sign of beauty, all ethnic groups perceived midline diastema as an aesthetic attribute.

Background: Despite huge success achieved in HIV management through early detection of cases and use of potent antiretroviral therapy (ART), human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) remains amongst the leading causes of death in sub-Saharan Africa. Aim: To identify factors associated with death within one year of initiating ART in HIV/AIDS patients that presented for care with advanced disease (in WHO clinical stages III/IV).
Methods: This study analysed the records of patients admitted with advanced HIV disease, between January 2009 and December 2013. Information needed was sourced from patients’ medical records and death certificates. During the study period, 273 patients were admitted, out of whom 119 satisfied the inclusion criteria. Of the 119 patients, 108 with complete data were analysed giving a retention rate of 90.1%. Among the participants, 51 cases died within one year of initial evaluation and 57 were alive after one year (survivors).
Results: Males were older than females in both the mortality cohort (p = 001) and survivor cohort (p = 0.01). Male gender (Crude odds ratio [COR] 2.27, 95% confidence interval [CI]: 1.08 – 5.21); HIV RNA viral load = 100,000 copies/ml (COR 2.69, 95% CI: 1.20 – 6.03) and anaemia (haemoglobin concentration < 10.5g/dl) (COR 6.66, 95%CI: 2.74 – 16.17) were predictors of mortality in univariate analysis. After adjusting for confounding variables on multivariate analysis, anaemia (Adjusted odds ratio [AOR] 4.33, 95%CI: 1.27 – 14.83) remained the only predictor of death
Conclusion: Anaemia is an independent predictor of early mortality in patients that present with advanced HIV disease in our environment.

Background: Hepatitis B is one of the important blood-borne diseases that pose a challenge to public health. It is the most common cause of liver infection globally. Despite the high risk of hepatitis B in healthcare workers, the knowledge, attitude, and practice concerning hepatitis B infection among them is low.
Aim: To document the level of awareness of HBV infection among auxiliary health workers and to identify the source of information on the knowledge of auxiliary health workers towards HBV infection.
Methods: A cross-sectional descriptive study involving 240 auxiliary health workers in the University of Maiduguri Teaching Hospital that were interviewed using an interviewer-administered questionnaire.
Results: The study population comprised an equal number of males (50%) and females (50%). The mean age of the respondents was 32.9 years. Majority had secondary education 96(40%) and were Kanuri tribe. In total, 81.1% of respondents knew that HBV is caused by a virus, and 70.8% believed the virus can be transmitted through blood transfusion and 71 (29.6%) through unprotected sexual intercourse. One hundred and sixty-eight (74.2%) respondents were aware of the availability of HBV screening programmes in the facility, 131 (54.6%) of them had been screened for HBV and received HB vaccine. Majority (96.7%) of the respondents believed that HBV is a public health problem, 93.8% agree their job puts them at high risk of HBV infection.
Conclusion: The study concluded that majority of the respondents had information about HBV, and the major source of information was through other health workers. A good number of the respondents had been screened or taken vaccination against HBV.

Background: Although breast cancer is reported as the commonest cancer in women, there is a dearth of literature and research concerning patient profile and utilization of hospital radio-therapeutic services.
Aim: The aim of the study was to document the knowledge of socio-demographic profile and clinical pattern which is a requirement for control measures and appropriate treatment of cancers.
Method: This was a retrospective study made up of 257 patients seen in University of Benin Teaching Hospital (UBTH) and undergoing their radio-therapeutic clinic visits for breast cancer. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0.
Result and Conclusion: The age ranged between 23 - 83 years, with a mean of 48.94 ± 11.09 years, median of 48 years and mode of 43 years. Out of these total 47.6% of the breast cancers were located in the right breast and 51.2% were on the left, with invasive ductal carcinoma (93.7%) as the most common histological type. This basic information on socio-demographic and clinical profile of patients can help plan and optimize the utilization of hospital services, more especially in a resource poor country like Nigeria.

Background: Traumatic brain injury is a leading cause of death and disability in young adults (?44years) and in children (>1 year). Early diagnosis, prevention of secondary injury and treatment of complications reduces the morbidity and mortality. However, with the on-going civil-military conflict in our region (Boko Haram), achieving this is difficult.
Method: A retrospective analysis of case records of all patients with traumatic brain injury managed by our unit from May 2015 to October 2016 (18 months).
Results: A total of 1529 trauma cases were recorded in the Emergency Department. There were 269 traumatic brain injuries. One hundred and forty-seven (147) were treated at the emergency department, while 122 patients were transferred to the wards and Intensive Care Unit (ICU) for further management. Road traffic accident (RTA) was the leading cause (62.87%) followed by missile injury (bomb blast/Improvised Explosive Device [IED] and Gunshot) in 65 patients (24.17%). Neuro-imaging was not readily available for assessment. Fourteen (14) had various surgical interventions. Good outcome was recorded in 239 patients (88.91%). Mortality was recorded in 50% of ICU patients.
Conclusion: In addition to RTA, missile injuries are common causes of head injury in our society ravaged by a civil-military conflict (Boko Haram). The severity of the primary injury, non-availability of functional neuroimaging to guide subsequent intervention contributed to the mortalities.

Background: In our hospital setting, the presence of a sudden bilateral lower limb paraplegia following trauma directs the mind of the clinician towards injury to the spinal cord; however, cerebral causes of paraplegia do occur even though such presentations are rare entities after traumatic brain injury. Patients presenting with acute inability to move both lower limbs were diagnosed to have spinal cord injury following multiple trauma or road traffic accident by casualty staff.
Methods: We report three cases seen over a period of two years, with the patients presenting with a history of acute paraplegia following trauma: assaults or road traffic accident. Further evaluation revealed alteration or loss of consciousness and evidence of injuries to the skull. Neurological examinations revealed flaccid weakness of the lower limbs with power of grade 0 (MRC grade: 0/5), all sensory modalities of the lower limbs were preserved. Normal anal tone and superficial abdominal reflexes; there were no areas of tenderness or deformity over the spine.
Results: Initial radiologic evaluations of the spine showed normal findings, and all patients had computed tomography (CT) of the brain that revealed acute bilateral parasagittal contusions in the fronto-parietal region. Following active physiotherapy over a period of three to seven (3-7) weeks, all patients regained muscle power of at least 4/5, ability to walk, and were later discharged from the hospital.
Conclusion: A high index of suspicion is needed in diagnosing paraplegia secondary to different aetiologies such as parasagittal contusion. A low threshold in requesting for neuroimaging scan of the brain is required, although, Computed tomography (CT) done within first 1-3 days may be falsely negative.