archive vol17 no2

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July - December 2020
Volume 17 | Issue 2

This journal has been online since Saturday, April 05, 2013

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Severity of Postoperative Nausea and Vomiting Following Gynaecological Laparoscopic Procedures: Ondansetron vs Metoclopramide

Dalhat Salahu, Alhassan Mohammad Datti


Background: Postoperative nausea and vomiting have remained significant causes of morbidity in patients undergoing general anaesthesia for gynaecological laparoscopic procedures.

Objectives: This study compared the severity of postoperative nausea and vomiting following gynaecological laparoscopic procedures after prophylaxis with metoclopramide and ondansetron.

Methods: Sixty-six consenting patients aged 18-55 years undergoing day case gynaecological laparoscopic procedures were recruited and randomly allocated into two groups with each receiving either intravenous ondansetron 4mg or intravenous metoclopramide 10mg prior to induction of anaesthesia. The severity of nausea and vomiting were then assessed over a period of 4 hours before discharge.

Results: Nausea was mild in 24.2% and 6.1% of patients that received metoclopramide and ondansetron respectively, and severe in 9.1% of patients in both groups. In the metoclopramide group, 6.1% experienced 1 bout of vomiting compared to 3% in the ondansetron group. 3% had 2 bouts of vomiting in the metoclopramide, none in the ondansetron group had up to 2 bouts of vomit.

Conclusion: Ondansetron was more effective in the prevention of the mild form of nausea, the two study drugs are similarly effective for the prevention of vomiting.
Key words: Nausea, vomiting, ondansetron, metoclopramide




Arterial Blood Pressure in Children with Sickle Cell Anaemia and Controls: A Cross Sectional Study

Abubakar Garba Farouk, Halima Umar Ibrahim, Bello Abdullahi Ibrahim, Hassan Abdullahi Elechi, Jamila Audu Idrisa, Modu Gofama Mustapha


Background: Sickle cell anaemia (SCA) is a very common disorder among indigenous people of Borno and Yobe States in the North-eastern region of Nigeria. It is characterized by recurrent episodes of severe bone pain from occlusion of blood vessels by sickled red cells. Hypertension in children with sickle cell anaemia is rare and when present may be secondary to other disease process and more rarely may be essential hypertension. However, when hypertension occurs in SCA patients, it accelerates the progression of complications such as cerebrovascular accident and sickle cell nephropathy, hence the need to study the pattern of blood pressure in these patients. Early detection of hypertension can help in forestalling its progression and preventing its devastating complications such as cerebrovascular accident.

Objectives: To compare the arterial blood pressures of children with sickle cell anaemia in steady state with those of age and sex-matched healthy controls.

Methods: The study design was cross-sectional comparative. Minimum sample size of 54 was determined using Taylor’s formula. Subjects were recruited systematically by enrolling every other patient as they present at the Paediatric Haematology clinic. The controls were apparently healthy age and sex-matched haemoglobin AA children. Anthropometric parameters and the blood pressure were measured and recorded appropriately. Blood pressure was classified using published normative data.

Results: A total of 54 children with sickle cell anaemia in steady state and 159 normal children as controls were enrolled. The ages of both the SCA and controls ranged from 3 to 14 years, with median age of 8 years. Of the 54 SCA children 28 (52%) were males while 26 (48%) were females. Mean packed cell volume of the SCA children was 22 ± 3.5. Although 8 (14.8%) of the SCA children were hypertensive, there was no significant difference in the mean systolic blood pressure (96mmHg) of children with sickle cell anaemia compared to controls (99mmHg) P = 0.078 while, the mean diastolic blood pressure (65mmHg) of the control was significantly higher than that of SCA cohort (59) P ≤ 0.0001.

Conclusion: Hypertension is not rare among children with sickle cell anaemia. This stresses the need regular BP recording during follow-up in order to prevent devastating events such as cerebro-vascular accident.




Ease of Laryngeal Mask Airway Insertion in Nigerian Adults: Propofol Alone vs Propofol Combined with Low Dose Suxamethonium

Alhassan Datti Mohammed, Adesope Saheed, Salahu Dalhat


Background: Inadequate anaesthesia during Laryngeal Mask Airway (LMA) insertion may make correct positioning difficult or even impossible.

Objective: This prospective study was designed to compare the ease of LMA insertion in patients who received propofol alone and patients who received a combination of propofol with low dose (0.1 mg/kg) suxamethonium.

Methods: Eighty ASA I and II consenting patients aged 18 to 60 years undergoing elective procedures under general anaesthesia and spontaneous ventilation were recruited and randomly allocated into two groups with each receiving either 5 mls of 0.9% saline (group P) or 0.1 mg/kg suxamethonium, made up to 5 mls (group S), 30 seconds post induction with intravenous (iv) propofol 2.5 mg/kg delivered over 30 seconds. The overall insertion conditions (scored from grade of jaw relaxation, ease of insertion, severity of airway response in terms of coughing, gagging, laryngospasm and patient movement) during first attempt of LMA insertion and the number of attempts made were then accessed. The number of attempts before successful LMA insertion as well as incidence and duration of apnoea post induction were recorded.

Results: Excellent overall insertion condition occurred in 40% of patients in group S compared to 15% in group P, satisfactory in 30% of patients in group S compared to 35% in group P, and poor in 30% of patients in group S compared to 50% of patients in group P.

Conclusion: The combination of propofol plus low dose suxamethonium for LMA insertion was found to provide better grades of overall insertion condition. The number of attempts before successful insertion was however comparable.




The Effect of Intracervical Lidocaine Versus Intramuscular Diclofenac for Pain Relief During Hysterosalpingography Among Infertile Women in A Tertiary Hospital in Kano

Attah Raphael Avidime, Sulaiman Daneji Muhammad, Ibrahim Saidu Adamu


Background: Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes and is used predominantly in the evaluation of infertility. HSG can cause discomfort or pain during or after the procedure, up to 72 % of women complain of significant discomfort with this test. This pain can hinder patient’s co-operation, therefore limiting the usefulness of the procedure, and willingness to do other similar diagnostic studies. It can also result in fortuitous tubal blockade by provoking cornual spasms.

Objectives: To compare the effect of intracervical block with 1% lidocaine and intramuscular diclofenac 75mg in decreasing pain perception during hysterosalpingography.

Methods: The study was carried out between September 2016 and January 2017. One hundred and forty women with infertility referred for hysterosalpingography were randomly recruited and assigned to two study groups. Women in the study group A were given an intracervical block with 1% lidocaine while women in the Study Group B were given intramuscular diclofenac sodium 75mg 30 minutes before the procedure. Pain levels during specified stages of HSG were assessed using visual analogue score. The statistical package for social sciences (SPSS) version 16.0 was used to analyze the data. The data obtained were presented in tables. Categorical data were analyzed using chi-squared test and Fishers exact correction, continuous data were analyzed using student t-test; level of significance (p-value) was set at p< 0.05.

Results: There was no statistically significant difference in the two study groups in their baseline characteristics; but there were statistically significant differences in some gynaecological characteristics that include previous vaginal delivery and previous pregnancy loss. The two most painful steps of the procedure were during grasping of the cervix and uterine distension with contrast medium mean visual analogue score (VAS) of 4.26±1.62 and 6.37±1.62 (t = -7.726, p-value <0.001), 6.14±1.85 and 7.37±2.23 (t = -3.543 p-value 0.001) respectively in groups A and B.

Conclusion: There was significant reduction in VAS pain scores with intracervical block with lidocaine when performing HSG for infertility.




Influences on the Incidence and Pathomorphological Picture of Thyroid Disease

Innocent Emmanuel, Mansur Aliyu Ramalan, Abdulazis Longwap, Ayuba Madachi Dauda

Background: The thyroid serves the body with important endocrine functions. A variety of influences impinges on the incidence and pathomorphological picture of the thyroid gland. These influences that include: iodine deficiency; iodine sufficiency; gender and; imaging technology are elucidated further in this work. We used the Google search engine to search for literature on the subject from the internet. Iodine is associated with increased incidence of nodular goiter and follicular carcinoma. The world over the last few decades had transited from an era of iodine deficiency to its sufficiency leading to an increase in incidence of thyroiditis and papillary thyroid carcinoma. Estrogen and Estrogen receptor discovered in the thyroid is implicated in the increased frequency of thyroid disorders in females. Finally, advancement in thyroid imaging technology and its utilization has led to over-diagnosis and overtreatment of thyroid diseases




Nutritional Status of Young Children newly diagnosed with HIV-Infection at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria

Yusuf T, Onankpa BO, Baba J, Ugege MO, Jega MR, Sanni-Amodu M, Isezuo KO, Adamu A, Jiya FB


Background: Poor nutrition contributes to deaths associated with the infectious diseases especially among under-5 children in developing countries. The growth of young children could be impacted with increasing burden of HIV/AIDS and increasing food insecurity. This results in an increased malnutrition among this vulnerable group.

Objective: To determine the nutritional status of children aged ≤5 years newly diagnosed with HIV infection in UDUTH, Sokoto.

Methods: A prospective descriptive cross-sectional study among children aged ≤5 years newly diagnosed with HIV infection at the Paediatric units and Paediatric ART Clinic, UDUTH, Sokoto between January 1st, 2015 and December 31st 2019. The nutritional status was determined using WHO growth standards. The data were analyzed using SPSS version 22.0 and p-value ≤0.05 was taken as significant.

Results: Sixty-seven children aged ≤5 years were diagnosed with HIV infection in UDUTH within the period. Twenty (30.3%) were aged 1.1 – 2.0 years with the mean age of 2.9(±1.4) years. The M:F ratio approximately 2:1. Forty-five (67.2%) were from lower socio-economic class. Sixteen (23.9%) were diagnosed using PCR for HIV-DNA. Forty-eight (71.6%) presented in clinical stage I. Twenty-three (34.3%), 24 (35.8%) and 12 (17.9%) of the children were stunted, underweight and wasted respectively. The rate of undernutrition was found to be significantly related to the age of the child (p=0.03) and socio-economic status of the family (p=0.02).

Conclusion: The nutritional status of young children newly diagnosed with HIV infection was suboptimal and majority was stunted and underweight in our environment




Barriers to Utilization of Antenatal Care Interventions among Pregnant Women Attending Primary Health Care Centres in Kano, Nigeria

Usman Muhammad Ibrahim, Auwal Umar Gajida, Rabiu Ibrahim Jalo, Usman Idris Takai, Abubakar Muhammad Jibo, Yusuf Saleh, Aisha Alto, Abubakar Sadiq Abubakar


Background: Knowledge of Ante-Natal Care interventions (ANC) and removal of barriers associated with access to the interventions can significantly reduce the burden of maternal, neonatal, and infant morbidity and mortality in Sub-Saharan Africa.

Objective: This study assessed the knowledge and barriers to ANC interventions among pregnant women attending PHC in Kano.

Methods: Descriptive cross-sectional study design was used to study 383 pregnant women attending ANC in primary health care centers in Kano metropolis using a three-staged sampling technique. Data was collected using interviewer administered semi-structured questionnaire and analyzed at univariate, bivariate and multivariate levels using IBM SPSS Statistics for Windows, version 20.

Results: Out of the 383 questionnaires distributed 374 were retrieved and analyzed, giving a response rate of (97.7%). The mean age of respondents was 25.7±4.8years. The majority of the pregnant women studied (60.0%) were greater than 24 years of age with most of the respondents having formal education (96.8%) and married pregnant women constituted most (89.0%) of the respondents. The maximum knowledge score was 39 and the minimum was 10 with a mean of 24.8±5.8. Many pregnant women (97.0%) had satisfactory knowledge of ANC interventions. Age greater than 24 years (p<0.001), employment (p<0.001), gestational age between 4-6 months (p<0.001), urban residence (p=0.02) were found to be significantly associated with satisfactory knowledge. Age greater than 24 years {AOR=2.0, 95%CI= (1.1-3.7)}, Gestational age ranging between 4-6 months {AOR=0.5, 95%CI= (0.3-0.8)}, and urban residence {AOR=2.0, 95%CI= (1.1-3.7)} were found to be independent predictors of knowledge of ANC interventions. Variable barriers to using various interventions were reported. The barrier to using iron and folic acid reported by about a half of the respondents (50.0%) was forgetting to use the tablets, the financial capacity to transport self to the facility was reported to serve as a barrier to using Long Lasting Insecticides Treated Nets by about one-fourth (25.0%) of the pregnant women. Similarly, up to one-fourth (25.0%) had fear of side effects as the barrier to using IPT(sulphadoxine/pyrimethamine). Barrier to using some health education interventions was reported to be due to rejection by the spouse.

Conclusion: Pregnant women were knowledgeable on the available ANC interventions but are faced with many barriers to accessing them. The government should, therefore, formulate policies directed to addressing the identified barriers




Predictors of Compliance with Recommended Hand Hygiene Practices Among Healthcare Workers in Specialist Hospitals of Kano, Northwest Nigeria

Ibrahim UM, Ibrahim RJ


Background: Compliance with recommended hand hygiene practice among healthcare providers is important in the prevention of morbidity and mortality associated with hospital acquired infections including drug resistant microorganisms.

Objective: This study determined the predictors of compliance with recommended hand hygiene practices among healthcare workers in specialist hospitals of Kano metropolis, Northwest Nigeria.

Method: World Health Organization recommended observation checklist for hand hygiene compliance and Key Informant Interviews involving members of Infection Prevention and Control teams of the two selected hospitals were used to collect data using two staged and purposive sampling techniques respectively. Quantitative data from the observation checklist was analyzed at univariate, bivariate and multivariate levels using SPSS version 22 while verbatim transcripts from qualitative interviews were analyzed using thematic framework analysis.

Results: The overall compliance with hand hygiene was (42.4%). Use of alcohol based hand rub and soap and water constituted (26.7%) and (15.7%) respectively. Statistically significant association was found between type of the ward (P<0.001), Professional cadre (P<0.001), indication for hand hygiene (P<0.001), time of the day (P<0.05) and compliance with hand hygiene. Key Informant Interviews revealed lack of materials needed for hand hygiene to be associated with non-compliance. Working in medical ward and being a doctor were associated with 86% increased likelihood of compliance with recommended hand hygiene practice {AOR=0.14, 95% CI= (0.0-.4)}.Similarly, contact with patients’ surrounding/environment was associated with four fold increased likelihood of compliance with hand hygiene { AOR= 3.7, 95% CI= ( 2.7-5.0)}, further, evening and night shifts were associated with 2 folds increased likelihood of compliance with hand hygiene than morning shift { AOR=2.0, 95% CI=(1.0-3.7)}.

Conclusion: Compliance with recommended hand hygiene practices was not encouraging and may pose significant risk of hospital acquired infection. Therefore, Hospital management should ensure the existence of functional infection prevention and control team, regular training and re-training of healthcare workers




Penetrating Intracranial Arrow Extraction

Usman B, Mohammed B, Shuwa FA, Garandawa HI


Background: Arrow injury is one of the causes of non-missile penetrating head injury. Penetration may be through natural openings like the eye, nose, or a thin bone. At presentations, most patients are clinically stable. However, some may present with catastrophic vascular injury. Non-contrast Computed Tomography (CT scan) with or without angiography, when indicated, is essential for surgical planning. When impacted to a bone, craniectomy is an option, but when not impacted the best option is a craniotomy with antegrade extraction under vision especially when the arrow is barbed. Often surgery may involve multiple specialists. Broad-spectrum antibiotic prophylaxis is advised likewise tetanus and seizure prevention. Postoperatively patients are followed up and complications are treated.



  Superior Vena Cava Syndrome in End Stage Renal Disease Patients on Long Term Central Venous Catheters: A Report of Two Cases
Sulaiman MM, Shettima J, Lawan M, Ibrahim A

Background: Central venous catheters are increasingly becoming the most common access at initiation of hemodialysis. They are associated with short term complications such as infections and long term problems resulting in stenosis of the central venous systems.
We report two patients with end stage renal disease, who developed stenosis of the superior vena cava following long term placement of internal jugular catheters for maintenance hemodialysis.




A rare Case of Right Sided Bochdalek Hernia Co-existing with Intrathoracic Kidney

Dambatta AH, Saleh MK

Background: Congenital diaphragmatic hernias are developmental defects involving the diaphragm. Three major types have been identified; Bochdalek hernia, Morgagni hernia, and hiatus/hiatal hernia, with the postero-lateral Bochdalek type being the most common. Rare concomitant existence with intrathoracic kidney was reported. Cases of left sided Bochdalek hernia were previously reported in the literature but none is associated with intrathoracic kidney. A successfully surgically treated rare case of right sided Bochdalek hernia co-existing with intrathoracic kidney in a neonate is therefore presented.


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Written by Administrator On Sunday, 24 March 2013 17:23
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