Annals of African Medicine
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   2008| December  | Volume 7 | Issue 4  
    Online since September 22, 2009

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Management of appendiceal mass
ES Garba, A Ahmed
December 2008, 7(4):200-204
DOI:10.4103/1596-3519.55652  PMID:19623924
Background: The management of appendiceal mass is surrounded with controversy. Traditional management has been conservative, with interval appendicectomy performed weeks after the mass had resolved. This remains the most common approach at many centers in the world. Recently, an increasing number of studies have challenged this approach. This article reviews some of the controversial issues in the management of appendix mass, assesses current practice and suggests an appropriate approach for the management of appendix mass. Methods:A Medline, Pubmed and Cochrane database search were used to find such key words and combinations of: appendix, appendiceal, appendicular, interval, appendectomy, appendicectomy, mass, abscess, phlegmon, and appendicitis. Results were saved and managed by Reference manager 11. All articles were cross-referenced by the authors. Results: A conservative management is still a highly acceptable approach for appendix mass. This should be followed with interval appendicectomy especially in patients with persistent right iliac fossa pain. Conclusion: We recommend initially conservative approach to the management of appendiceal mass especially in our environment.
  10,663 410 13
Marijuana smoking among secondary school students in Zaria, Nigeria: Factors responsible and effects on academic performance
AU Shehu, SH Idris
December 2008, 7(4):175-179
DOI:10.4103/1596-3519.55657  PMID:19623919
Background: The use of Marijuana is on the increase worldwide especially among adolescents and youths. Marijuana smoking has gained a foothold in our environment because of peer group influence, accessibility and availability. Its medico-social effects could ruin the life and future of our youths. This study was undertaken to determine the prevalence and the factors that influence secondary school students in Zaria LGA to smoke and the effects on academic performance. Methods: A cross-sectional descriptive study was employed to generate data among secondary school students. A multi-stage sampling technique was used. Data was collected with the use of a structured, pre tested self-administered questionnaire. χ2 test was used to test for significance of association between categorical variables. Results: Of the 350 respondents, 262 (74.9%) were males, while 88 (25.1%) were females. The study shows that 33 of the students smoke marijuana giving a prevalence of 9.4%. There were more smokers in the age group 15-19 years (54.6%). Other factors that influence marijuana smoking include family background, peer pressure and attendance of social functions. There was better academic performance (51.1%) among non smokers as compared to smokers (27.2%), and this was found to be statistically significant (x2 =11.73,df=5,P<.05) There was also statistically significant association between age and marijuana smoking (x2 =24,df=2,P<.05) Conclusion: The prevalence of marijuana smoking is high. Age, family background, peer pressure and attendance of social function influence marijuana smoking. A comprehensive school health education program should be instituted to curtail this menace.
  8,279 103 12
Knowledge attitude and practice about breast cancer among civil servants in Benin city, Nigeria
OC Osime, O Okojie, ET Aigbekaen, IJ Aigbekaen
December 2008, 7(4):192-197
DOI:10.4103/1596-3519.55654  PMID:19623922
Background: Breast cancer is often associated with severe morbidity and mortality especially when the patients present late. A major reason why patients present late is the lack of awareness about breast cancer, its complications and the management. Methods: The study was carried out using a structured questionnaire. A total of 400 female civil servants were enlisted in the study, but only 385 respondents completed and returned the forms. Results: Two hundred and seventy seven (72.0%) respondents had tertiary level of education. Sixty six (17.1%) respondents were in the 30-34-year age group. Three hundred and twelve (81.0%) respondents knew correctly that breast lump is usually the first symptom of presentation of breast cancer. One hundred and forty four (37.5%) respondents knew that a positive family history of breast cancer is a risk factor, while two hundred and seventy four (71.2%) respondents answered that cancer of one breast in a woman increases her chances of having cancer of the other breast. Three hundred and twenty one (83.4%) respondents knew that breast cancer could spread from one breast to the other and two hundred and thirty (59.7%) knew that breast cancer could spread to other parts of the body. One hundred and eighty three (47.5%) respondents would visit the hospital as the first reaction if they were to detect a breast lump, while twenty three (6.0%) respondents would ignore the lump. While three hundred and twenty seven (85.0%) respondents have heard of breast self- examination, only one hundred (26.0%) could correctly describe the procedure of breast self -examination. While one hundred and thirty five (35.0%) respondents have heard of mammography, only twenty seven (7%) respondents go for yearly mammography screening. Three hundred and seventy two (96.6%) respondents know that mastectomy is done as part of the management of breast cancer, but only forty nine (12.7%) respondents have heard about conservative surgery. Conclusion: The level of awareness about breast cancer among civil servants in Benin City is low. There is the need to organize series of health education programs to enlighten the women about breast cancer. This can be done by government agencies or the non-governmental organizations. If properly executed, it may influence the attitude of women in Benin City about breast diseases and encourage early presentation to the hospital.
  7,221 223 14
Abdominal pregnancy with a full term live fetus: Case report
AY Isah, Y Ahmed, EI Nwobodo, BA Ekele
December 2008, 7(4):198-199
DOI:10.4103/1596-3519.55653  PMID:19623923
This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.
  7,033 137 6
Epidemiology of rotavirus and astrovirus infections in children in Northwestern Nigeria
M Aminu, MD Esona, A Geyer, AD Steele
December 2008, 7(4):168-174
DOI:10.4103/1596-3519.55658  PMID:19623918
Background: Recent estimates attribute 527 000 deaths in children less than five years of age to rotavirus diarrhea annually, with 145 000 occurring in sub-Saharan Africa. Human astroviruses have been identified as one of the most frequent causes of infantile diarrhea, second in incidence only to rotavirus. This study was conducted to determine the prevalence of rotavirus and astrovirus and also to establish the circulating strains of rotavirus in a community in Nigeria where most diarrheic patients do not visit clinics or health care centers. Methods: A total of 154 stool samples (134 diarrheic and 20 non-diarrheic) were collected from infants and young children less than 5 years of age from January-March 2002. Samples were obtained by house-to-house visit in randomly selected districts in Zaria, Northwestern Nigeria. The samples were screened for rotavirus and astrovirus antigens using commercially available Enzyme Linked Immunosorbent Assay (ELISA) kits. All positive group A rotavirus samples were further subjected to VP6 sub-group ELISA, Polyacrylamide gel electrophoresis (PAGE) to determine their RNA electropherotypes and Reverse transcription polymerase chain reaction (RT-PCR) to determine their VP7 and VP4 genotypes. Results: Rotavirus and astrovirus antigens were detected in 9% (12) and 5% (7) of the 134 diarrheic stool samples respectively. No viral antigen was detected in the non-diarrheic stools. Rotavirus infection was more common in younger children than astrovirus infection. VP6 sub-group II specificity (58.3%), long RNA electropherotypes (41.6%), VP7 genotype G1 (33.3%) and VP4 genotype P [6] (33.3%) were the most common strains in circulation at that time in the community. Of significance is the fact that a large proportion of the rotavirus strains in circulation could not be assigned either a VP6 sub-group or RNA electrophoretic pattern probably as a result of low viral load. Conclusion: In this community-based study, rotavirus and astrovirus were significantly associated with diarrhea. However, the prevalence of rotavirus infection among children appears to be low while that of astrovirus falls in the range seen in hospital-based studies around the continent.
  5,531 156 18
Human paragonimiasis in Africa
N'Da A Aka, Koffi Adoubryn, Daniel Rondelaud, Gilles Dreyfuss
December 2008, 7(4):153-162
DOI:10.4103/1596-3519.55660  PMID:19623916
An up-to-date review on human paragonimiasis in Africa was carried out to determine the current geographical distribution of human cases and analyze the animal reservoir, snails and crustaceans which intervene in the local life cycle of Paragonimus species. Two countries, i.e., Cameroon and Nigeria, were mainly affected by this disease, while the distribution of human cases in the other eight states of the intertropical zone was scattered. Infected patients were currently few in number and two Paragonimus species: P. africanus and P. uterobilateralis, were found. The animal reservoir is mainly constituted by crab-eating mammals. The identity of the host snail remains doubtful and was either a prosobranch, or a land snail. Seven crab species belonging to Callinectes, Liberonautes and Sudanonautes genera are able to harbour paragonimid metacercariae. Due to the current low prevalence of human paragonimiasis recorded in Africa and the high cost of wide-scale screenings for this disease, training of technicians in anti-tuberculosis centers would be the most realistic attitude to detect mycobacteria and/or Paragonimus eggs during the same sputum examination.
  5,308 159 18
Electropherotypes and subgroups of group A rotaviruses circulating among diarrhoeic children in Kano, Nigeria
AA Dzikwi, JU Umoh, JKP Kwaga, AA Ahmad, M deBeer, AD Steele
December 2008, 7(4):163-167
DOI:10.4103/1596-3519.55659  PMID:19623917
Background: It is estimated that about 600 000 children die annually as a result of severe dehydrating diarrhea caused by rotaviruses. The virus is a double stranded RNA (dsRNA) virus with 11 segments. Group A rotaviruses show a characteristic 4-2-3-2 pattern following electrophoresis. The VP6 subgroups, I and II exist. This work was carried out to study the prevalence of rotavirus infection among children 0-5 years with diarrhea in Kano, and to determine the circulating subgroups and electropherotypes and of the rotavirus isolates. Methods: Two hundred and eighteen stool specimens from children 0-60 months (198 diarrheic and 20 non-diarrheic) were collected from different hospitals and health care centers in Kano and subjected to group A rotavirus enzyme linked immunosorbent assay (ELISA) to determine presence of group A rotavirus, subgroup ELISA to determine the VP6 subgroups and polyacrylamide gel electrophoresis (PAGE) to determine the electropherotypes present. Results: The long electropherotypes (47.05%) of four variations dominated over the short electropherotype (17.64%). About 11.76% of the isolates were of mixed infection. Dominance of subgroup II (45%) over subgroup I (25%), and the presence of both subgroups I and II (10%) and neither subgroup I nor II (15%) was observed in this study. Conclusion: Information on the genomic diversity of the RNA electropherotypes in this region, Kano, is reported in this study.
  4,486 78 2
Meconium peritonitis in Nigerian Children
AM Abubakar, MA Odelola, CO Bode, AO Sowande, MA Bello, JY Chinda, I Jalo
December 2008, 7(4):187-191
DOI:10.4103/1596-3519.55655  PMID:19623921
Background: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa, there are only the occasional case reports on the subject matter. Methods: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, the Lagos University Teaching Hospital, Lagos State, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State and the Federal Medical Centre Gombe, Gombe State, Nigeria. Results: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X- rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy, all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients). The mortality rate was high (50%). Conclusion: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung's disease. Early diagnosis, proper operative procedure and meticulous post-operative care should improve their survival.
  3,369 120 3
Availability of childhood social services in leprosy settlements in Southern Nigeria
E Enwereji, R Ekeh, KO Enwereji
December 2008, 7(4):180-186
DOI:10.4103/1596-3519.55656  PMID:19623920
Background: Children of leprosy patients deserve social services such as free education, health care services including HIV/AIDS prevention like others. The extent to which these children benefit from such services is not clear. One expects that since they are exposed to health hazards in settlements that they would benefit immensely from preventive health care and other services. Study investigates the extent to which such services are available to them. Methods: Study was carried out in 3 purposively selected leprosy settlements, Uzuakoli in Abia State, Ohaozara in Ebonyi State and Ogbomoso in Oyo State using 86 children from 10 years and above who are available during study. Structured questionnaire and interview schedule were instruments used. Data were analyzed with Stat Pac Gold package. Results : Provision of social services to children of leprosy patients studied is limited. Only 13(16.5%) of the children said their parents did not pay school fees. The rest paid. However, despite payment of fees, higher proportion of children in Abia State 43(95.6%) more than in Oyo State 36(87.9%) went to school P = .03. About 42(97.7%) of children in Abia State and 30(83.3%) in Oyo State lack knowledge of HIV prevention. Neither reproductive health services including HIV/AIDS prevention nor prophylactic treatments are available to them. Conclusion: In view of above results, increased social services including HIV/AIDS prevention, prophylactic treatments and health promotions are recommended.
  2,872 77 -