Annals of African Medicine
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   2011| January-March  | Volume 10 | Issue 1  
    Online since February 9, 2011

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Detection of Salmonella typhi agglutinins in sera of patients with other febrile illnesses and healthy individuals
Ali M Somily, Mustafa H Adam, Mohamed O Gad El Rab, Muhammad G Morshed, Zahid Shakoor
January-March 2011, 10(1):41-44
DOI:10.4103/1596-3519.76584  PMID:21311155
Background and Purpose : Widal test is frequently applied for the detection of Salmonella agglutinins to diagnose Salmonella enterica serotype Typhi infection. There are however a number of controversies challenging the diagnostic utility of this test. This study was performed to determine the prevalence of Salmonella agglutinins in patients with other febrile illnesses and healthy blood donors. Materials and Methods : Sera from 50 healthy blood donors were compared for the presence of Salmonella agglutinins in various groups of patients with other febrile illnesses using Widal test in the division of Serology and Immunology at King Khalid University Hospital, Riyadh. The patient groups of other febrile illnesses included infections with Beta-hemolytic streptococcus (n = 50), Brucella (n = 46), Helicobacter pylori (n = 24), Treponema pallidum (n = 30), Toxoplasma (n = 44), and other parasites (n = 20). Results : Majority of the patients and normal individuals were tested positive for Widal test at dilution of less than 1 : 40 both for the O (62.5%) and H (64.6%) antigen. A decreasing trend in Widal reactivity was observed with increasing dilutions of the serum samples. At 1 : 160 titer, which is generally considered as a cut off point for positive Widal test, 6.4 and 11% individuals had positive Widal test for O and H Salmonella antigens, respectively. Conclusion : Detection of a significant number of positive Widal tests in conditions where it is expected to be nonreactive appears to be a serious problem in making a correct diagnosis of typhoid fever, thus challenging the diagnostic utility of the Widal test.
  29,812 46 3
Ophthalmologic abnormalities among deaf students in Kaduna, Northern Nigeria
ER Abah, KK Oladigbolu, E Samaila, H Merali, AO Ahmed, TH Abubakar
January-March 2011, 10(1):29-33
DOI:10.4103/1596-3519.76573  PMID:21311152
Background : The association between deafness and ocular problems is well established; however the nature and prevalence of these problems are diverse across the globe. Objective : The aim of this study is to determine the nature and prevalence of ophthalmologic abnormalities in deaf students and offer treatment to those with remediable conditions. Method : Six hundred and twenty deaf students aged between 5 and 38 years were examined in a school for the deaf. Results : One hundred and thirty (20.9%) had some form of ophthalmologic abnormality. Some had anterior segment abnormalities such as corneal opacities (0.5%) and allergic conjunctivitis (3.4%) while others had posterior segment abnormalities like optic atrophy (0.3%), Waardenburg syndrome (0.6%) and Ushers syndrome (0.6%). Refractive error was the most common (7.9%). Conclusion : Since these deaf students use their sight to compensate for the deafness, routine ophthalmologic examination should be carried out on them so that ophthalmologic abnormalities are detected early and treatment offered for remediable diseases.
  14,669 19 10
Adult large bowel obstruction: A review of clinical experience
AZ Sule, A Ajibade
January-March 2011, 10(1):45-50
DOI:10.4103/1596-3519.76586  PMID:21311156
Background : Adult large bowel obstruction is an infrequent cause of acute obstruction in Africa and India. The cause of obstruction varies between regions of the world. Current controversy concerns the surgical management of the acutely obstructed left colon. Materials and Methods : This is a prospective study of adult patients with acute large bowel obstruction over a 6-year period. The diagnosis of adult obstruction was made from a history of constipation, abdominal distension, abdominal pain, nausea, and radiographic features of large bowel obstruction. Laparotomy was performed on all patients after resuscitation. If the obstruction involved the right colon resection and primary ileo-colic anastomosis was performed, while for a lesion in the left colon a resection and primary colocolic anastomosis was performed after intraoperative antegrade colonic irrigation. If the obstructing lesions were thought to be malignant and too advanced to merit any excisional or the patient's general condition was too poor to withstand resection, a biopsy was taken and a decompressive bypass procedure given pending the confirmation of the diagnosis. The clinical course and postoperative outcome were carefully documented. Results : A total of 50 patients aged 20-80 years, with a median age of 49 years, presented with features consistent with large bowel obstruction. Of these, 32 had simple sigmoid volvulus and were offered sigmoid colectomy and primary colorectal anastomosis, while 3 further patients with compound sigmoid volvulus had double resection with primary ileo-ileal and colorectal anastomosis. A patient with sigmoid volvulus had a Hartmann's procedure. Twelve patients had colon cancer, four had left hemicolectomy and primary colocolic anastomosis; three, sigmoid colectomy and primary colorectal anastomosis; three, low anterior resection and primary colorectal anastomosis; one decompressive colostomy and one, a right hemicolectomy and primary ileocolic anastomosis. The two patients with functional obstruction (Ogilvie syndrome) had tube caecostomy. All resections and primary anastomosis involving the right colon were preceded by antegrade on-table colonic lavage. One clinical anastomotic leak occurred in a low rectal anastomosis and minor wound infection in 10 patients. Operative mortality occurred in three patients with sigmoid volvulus. Conclusion : Adult large bowel obstruction is infrequent in our community and is caused commonly by sigmoid volvulus. Resection and primary anastomosis of the acute left-sided large bowel obstruction seems safe after antegrade on-table colonic lavage, provided bowel gangrene with peritonitis or any additional risk factor for anastomotic breakdown is not present.
  11,675 46 8
Psychosocial characteristics of female infertility in a tertiary health institution in Nigeria
Joyce O Omoaregba, Bawo O James, Ambrose O Lawani, Olufemi Morakinyo, Osasu S Olotu
January-March 2011, 10(1):19-24
DOI:10.4103/1596-3519.76567  PMID:21311150
Objectives : Women with infertility experience higher rates of psychological distress compared with their fertile counterparts. In developing countries, socio-cultural factors may aggravate this distress. We aimed to determine the prevalence of psychological distress as well as its associated socio-cultural characteristics among women attending the infertility clinic of a tertiary hospital in Nigeria. Materials and Methods : Women (n = 100) attending an infertility clinic were consecutively recruited over a two-month period and compared with a similar number of pregnant women attending the antenatal clinic at the same hospital. A semi-structured questionnaire was designed to record socio-demographic and clinical variables. The 30-item General Health Questionnaire was used to screen for psychological distress. Results : The prevalence of probable psychological distress was significantly higher among the infertile group compared with their fertile counterparts (P<0.001). There were significant differences between the groups in terms of their mean age (P<0.01), employment status (P<0.02), educational status (P<0.01), and duration of marriage (P<0.001). Infertile women who had previously sought help from a traditional or faith-based healer for infertility were more likely to experience probable psychological distress (P<0.017). Conclusion : Infertile women are more vulnerable to psychological distress and require psychological support. There is a need to incorporate mental health screening and treatment in the routine care of infertile women in Nigeria.
  9,797 26 14
The doctrine of informed consent in surgical practice
YZ Lawal, ES Garba, MO Ogirima, IL Dahiru, MI Maitama, K Abubakar
January-March 2011, 10(1):1-5
DOI:10.4103/1596-3519.76558  PMID:21311147
Physicians and other professionals in the field of medicine have to perform invasive and non-invasive procedures on patients as part of their duties. There is a legal basis upon which these procedures are done; this is called 'informed consent.' Sociocultural factors have strong influence on the sick role. These factors influence the application of informed consent in Nigeria.
  9,501 34 3
Severe pentasomide Armillifer armillatus infestation complicated by hepatic encephalopathy
Ademola A Adeyekun, Ikechukwu Ukadike, Victor A Adetiloye
January-March 2011, 10(1):59-62
DOI:10.4103/1596-3519.76592  PMID:21311159
Background : Diagnosis of Armillifer armillatus infestation is usually incidental, commonly via autopsy or radiography. Affected individual are usually asymptomatic. The case presented here, however, had severe thoracic and abdominal involvement with clinical manifestations. Aim : To report a case of heavy A. armillatus infestation in an adult female Nigerian rural dweller complicated by hepatic parenchyma damage. Setting : Case report from semi-urban southern Nigeria, using clinical records and imaging findings. Materials and Methods: Clinical case records, including laboratory results and radiographic /computed tomography images. Conclusion : Parenchymal damage with organ dysfunction can be seen with severe A. armillatus infestation. Thus, there is a need for regular health education regarding the risk of A. armillatus infestation for individuals who consume snake meat.
  8,388 22 6
Using methylene blue for perioperative localization of the hydrocele sac in boys
OA Sowande, TA Olajide
January-March 2011, 10(1):38-40
DOI:10.4103/1596-3519.76581  PMID:21311154
Background : Ligation of a patent processus vaginalis via the inguinal approach is the standard operative technique for the treatment of hydroceles in infants and children. Although a simple technique, identification of the processus vaginalis can be difficult even for the experienced surgeon. Aims : To investigate the use of methylene blue in the perioperative identification of the patent processus vaginalis in a group of children presenting with hydrocele. Materials and Methods : Twenty consecutive patients with hydrocele between the ages of 1 and 9 years were recruited for the study. Methylene blue 0.3-0.5 ml was injected slowly into the hydrocele fluid through the scrotal wall after aspiration, followed by routine ligation of the hydrocele track. Results : The track of the processus vaginalis was clearly visualized in 17 (85%) of the patients, while in 3 (15%) patients no track could be seen, the hydrocele being localized to the tunica vaginalis. There were no cases of inadvertent testicular injury and there was no intraoperative complication. No patient reacted in any abnormal way to the methylene blue. Conclusion : The technique helps in the identification of a patent processus vaginalis when it is present. It may be useful in cases where difficulty in identification of the hydrocele tract is anticipated in a child.
  8,205 28 1
Evaluation of the effectiveness of deworming and participatory hygiene education strategy in controlling anemia among children aged 6-15 years in Gadagau community, Giwa LGA, Kaduna, Nigeria
MB Sufiyan, K Sabitu, AT Mande
January-March 2011, 10(1):6-12
DOI:10.4103/1596-3519.76561  PMID:21311148
Background : Anemia is one of the most common and most serious health disorders worldwide. The World Health Organization (WHO) estimated that about 40% of the total world's population (more than 2 billion individuals) suffer from anemia. In developing countries, the prevalence rate of anemia is about 20% in school-aged children. More than 10 million African children are thought to be anemic (Hb <11 g/dl). Also, in Africa, it is estimated that more than half of all children over 5 years and pregnant women are anemic. Community-based estimates of anemia prevalence in settings where malaria is endemic range between 49% and 76%. In Nigeria, the prevalence rate for anemia among children was 29.4%. It was highest in the South-East (49.7%) and lowest in the North-East (11.1%). Objective : The study aimed at evaluating the effectiveness of deworming and participatory hygiene education strategy in controlling anemia among children aged 6-15 years in the Gadagau community, north-western Nigeria. Materials and Methods : A cross-sectional descriptive study of 306 children aged 6-15 years selected from two rural communities (Gadagau, which was the study group and Karau-Karau, which was the control group) in the Giwa Local Government Area of Kaduna State Nigeria using a multistage sampling technique. The studies involved parasitological examination and anemia evaluation before and at 3 months after the children were dewormed. Results : Only 301 children (150 children in study group and 151 children in control group) were studied. The results showed that those who were dewormed and had participatory hygiene education lectures (study group) had significantly higher mean hemoglobin, from an initial 10.4 g/dl to a post-intervention of 12.4 g/dl (paired t-test = 13.96; P = 0.00). Also, there was a rise in the mean hemoglobin of the control group, but not as much as in the study group, from an initial mean hemoglobin of 10.5 g/dl to a post-intervention of 11.2 g/dl (paired t-test = 2.89; P = 0.004). Comparing the study and the control groups, those who were dewormed and also had participatory hygiene education lectures (study group) had a significantly higher reduction in the level of children who had ova of intestinal helminthes present in their stool than those in the control group (Χ 2 = 31.61; df = 1, P = 0.00). Conclusion : This study therefore concludes that including participatory hygiene education to deworming programmes will greatly improve the hemoglobin level of children in areas where there is a high prevalence of hookworm infections, especially as a short-term preventive measure for anemia in children.
  6,745 44 3
Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss
YZ Lawal, ES Garba, MO Ogirima, IL Dahiru, MI Maitama, K Abubakar, FS Ejagwulu
January-March 2011, 10(1):25-28
DOI:10.4103/1596-3519.76571  PMID:21311151
Background : Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries. Materials and Methods : Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs. Result : Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients. Conclusion : Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors.
  6,515 36 15
Proteinuria among adult sickle cell anemia patients in Nigeria
A Abdu, MA Emokpae, PO Uadia, A Kuliya-Gwarzo
January-March 2011, 10(1):34-37
DOI:10.4103/1596-3519.76578  PMID:21311153
Background/Objective : The life expectancy of patients with sickle cell anemia (SCA) has improved with modern medical care, and this has led to frequent observation of various chronic complications of the disease including abnormalities in renal function. Proteinuria is not only a marker of renal disease but is also a predictor of disease progression. This screening study was aimed at evaluating the prevalence of proteinuria among adult SCA patients in Kano, Nigeria, which has not been reported previously. Material and Methods : A total of 200 adult SCA patients were studied. They consisted of 100 men and 100 women. Blood was collected for the assay of serum urea, sodium, potassium, chloride, bicarbonate, and creatinine and estimated glomerular filtration rate (eGFR) was determined using the Cockcroft-Gault formula. Urine dipstick test for the presence of proteinuria and other abnormalities was done, and 24-hour urine protein was measured in those with significant proteinuria. Results : Mean age of the male patients was 25.1 ± 1.0 years, whereas the mean age of the female patients was 22.8 ± 4.2 years. Twenty eight percent (32 males, 24 females) of the subjects were observed to have significant proteinuria. The mean estimated eGFR of the males was 88 ± 19.6 ml/min while that of the females was 92 ± 10.2 ml/min. The male SCA patients with proteinuria had a mean eGFR of 70 ± 6.9 ml/min, whereas the female SCA patients with proteinuria had mean eGFR of 101 ± 2.5 ml/min. Among the male patients with proteinuria, 50% had chronic kidney disease (CKD). Conclusion : Proteinuria which is a marker of renal insufficiency is common among adult SCA patients, and routine screening for proteinuria may help detect those at increased risk of renal disease. CKD prevalence is high among SCA patients with significant proteinuria.
  6,363 25 14
Knowledge and attitudes of physicians relating to reporting of adverse drug reactions in Sokoto, north-western Nigeria
Shaibu Oricha Bello, Muhammad Tukur Umar
January-March 2011, 10(1):13-18
DOI:10.4103/1596-3519.76563  PMID:21311149
Background/Objectives : Adverse drug reactions (ADRs) are important causes of morbidities. Voluntary reporting of ADR is important in safety surveillance of medicines already in the market. This study was, therefore, conducted to appraise the current documentation of ADR in Sokoto, to analyze the extent to which clinicians appreciate factors that could affect reporting ADRs. Materials and Methods : Four hospitals within Sokoto metropolis were selected by convenient sampling. Pre-validated questionnaires containing questions on demographic and professional characteristics, and questions that evaluate attitudes as listed in the so-called "deadly sins" of Inman were self-administered by physicians. Data from respondents were analyzed by logistic regression. Results : Of 61 physicians interviewed, 43 (70.5%) had encountered potential ADRs in the 12 months before the study but only 3 (7.0%) of these were reported. Fifty eight (95.1%) of the respondents were not aware that an ADR reporting system was available in Sokoto but all the 3 respondents who were aware of the existence of a reporting system had reported an ADR. Generally, there was no significant relationship between demographic and professional attributes and scores obtained on each of the Inman's attitude measured except that more experienced physicians tend to believe that ADRs are not impossible to identify and female physicians were more reluctant to engage representatives of pharmaceutical companies on ADRs related to their drugs. Additional attitudes that may influence ADRs reporting were identified. Conclusion : Adverse drug reactions are under-reported in Sokoto. Lack of physicians' awareness of channels for reporting appears to be the major cause.
  6,290 28 8
Bilateral osteonecrosis of the femoral heads in a patient with systemic lupus erythematosus
YZ Lawal, MO Ogirima, IL Dahiru, MI Maitama, FS Ejagwulu, K Abubakar
January-March 2011, 10(1):64-65
DOI:10.4103/1596-3519.76594  PMID:21311160
  4,604 25 1
Aero-disaster in Port Harcourt, Nigeria: A case study
D Seleye-Fubara, EN Etebu, CNT Amakiri
January-March 2011, 10(1):51-54
DOI:10.4103/1596-3519.76588  PMID:21311157
Background : Aero-disaster in Nigeria is posing a serious problem to government, the public and relatives of victims, as many lives are lost in a single event. Materials and Methods : A case study based on an incident at an international airport in Nigeria on December 10, 2005. Detailed autopsy was performed on 97 fully identified bodies out of the 106 victims. Variables considered include ages, sex, pattern of injuries and death as well as problems associated with identification of bodies. Results : A total of 97 (91.5%) out of the 106 deaths recorded were autopsied. Nine (8.5%) bodies were beyond identification, and hence autopsy could not be properly done on them. Fifty-nine (60.8%) were males and 38 (39.2%) were females, giving a ratio of 1.4:1. Sixty-one (62.9%) were children and adolescents below the age of 20 years. Severe burns 27 (27.8%), multiple injuries with burns 21 (21.6%), inhalation of fumes 20 (20.6%), multiple injuries only 16 (16.5%), severe head injury alone 11 (11.3%) and ruptured viscous 2 (2.1%) were the causes of death at autopsy in that order of frequency. Conclusion : Aero-disaster, though rare in Port Harcourt, is posing a serious problem in Nigeria in recent times. Various agencies should be established to adequately control mass disasters in Nigeria. Adequate maintenance of aircraft and strict observation and enforcement of aviation laws may drastically reduce the frequency of accidents and subsequent deaths.
  4,146 21 -
Efficacy of a clinical stroke score in monitoring complications in acute ischaemic stroke patients could be used as an independent prognostic factor
Clara Olakunbi Dawodu, RT Bamisile
January-March 2011, 10(1):55-58
DOI:10.4103/1596-3519.76589  PMID:21311158
Background : Presence of medical complications in stroke patients has been established. The efficacy of a stroke score in intensive monitoring of these complications in acute ischaemic stroke patients has not been studied. Methods : Eighty-seven patients with acute ischaemic stroke were assessed with National Institute of Health Stroke Scale (NIHSS) by the examiner within days of admission; (1, 7, 30, and 90 days). Onset and types of complications were documented within the duration of the study period, using a questionnaire and laboratory investigations. Results : Fifty-nine [67.8%] patients in the study population had complications, with mean initial NIHSS score 17.1 ± 7.9; mortality was 39%, and 27.8% of survivors had good recovery. In patients without complications, the mean initial NIHSS score was 11.4 ± 6.0; mortality was not observed, and 50% of survivors had good recovery. Conclusion : All patients without complications survived. High NIHSS scores, (with minimal changes below baseline) were related to high mortality and morbidity in the complications group.
  4,096 30 1
Pentasomide infestation
Yomi Ogun
January-March 2011, 10(1):62-63
  2,681 20 1