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   Table of Contents - Current issue
July-September 2022
Volume 25 | Issue 3
Page Nos. 61-94

Online since Monday, November 20, 2023

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Brain drain in medically challenged context: A study of the push, pull, and stick factors among a population of medical practitioners in Nigeria p. 61
Gabriel Uche Iloh, Augustine Obiora Ikwudinma, Ikechukwu Vincent Obi, Babatunde Abdulmajeed Akodu
Background: Globally, brain drain (BD) phenomenon has been an issue for decades in healthcare industry. However, the magnitude of BD syndrome and its impact on medical workforce crisis in a medically challenged environment has been the subject of great interest in the recent years, with apparently glaring effects on the medical workforce. Aim: The study was aimed at describing the push, pull, and stick factors, benefits, and preventive measures for BD among medical practitioners in Abia State, Nigeria. Subjects and Methods: This was a cross-sectional study carried out on 185 medical practitioners in Abia State, Southeastern Nigeria. Data collection was done using pretested, self-administered, and structured questionnaire that elicited information on push, pull, and stick factors, benefits, and preventive measures for BD. The plan to leave Nigeria and preferred foreign countries were also studied. Results: The age of the participants ranged from 26 to 72 (36 standard deviation 8.4) years. There were 159 (85.9%) males. One hundred and twenty-seven, 127/185 (68.6%) study participants had plans to leave the country with the most preferred countries of destination being Canada, United States, United Kingdom and Australia. The most common push factors from Nigeria and pull factors from abroad were similar and included poor income, wages, and salaries in all the participants 185/185 (100%). The most predominant stick factor was family-centric reasons, 126/185 (68.1%). Family and national family remittances were the main benefits, 185/185 (100%) for each while the most common pull factor was higher income, wages, and salaries abroad, 185/185 (100%). The most predominant stick factor was family-centric reasons, 126/185 (68.1%). The greatest benefits were family, 185/185 (100%), and national, 185/185 (100%), financial remittances. The most recommended preventive measures were enhanced income in Nigeria, 185/185 (100%). Young adult age (P< 0.001), male (P < 001), and duration of practice <10 years (P < 0.001) were significantly associated with the plan to leave the country. Conclusion: These findings demonstrates that about 70% of Nigerian medical practitioners plan to leave the country for abroad. The major underlying factors for brain drain include enhanced income in the destination country capacity for financial remittances to the family and nation.
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Comparison of two volumes for extra-amniotic Foley catheter balloon inflation at preinduction of labor cervical ripening in nulliparae p. 67
Fidelis Oziengbe Ilevbare, Ignis Osehie Iribhogbe, Adedapo Babatunde Anibaba Ande, Nosakhare Osasere Enaruna
Background: The success of induction of labor is dependent on how favorable the cervix is and the unripe cervix thus remains a well-recognized impediment to the successful induction of labor. Objective: The objective is to compare the efficacy of 50 ml versus 30 ml fluid inflation of Foley catheter balloon for cervical ripening in postdate nulliparous women billed for induction of labor. Materials and Methods: A comparative analytical study with randomization involving 88 nulliparous women with postdated pregnancy requiring cervical ripening prior to induction of labor was carried out from January 1, 2018, to August 31, 2018. They were randomized into Group A consisting of women who had 50 ml (study) and B who received 30 ml (control). Bishop score was assessed 12 h later. Data were entered into a pro forma and analyzed using the IBM Statistical Package 20. Results: A total of 88 patients participated in the study. A statistically significant higher mean change in Bishop score was observed in the study group when compared to the control group (5.6 ± 2.5 vs. 3.1 ± 1.6, P = 0.0001), and the difference was statistically significant. Similarly, 41 (93.2%) patients in the study group had a favorable cervix post-ripening, while in the control group, 30 (68.2%) patients had a favorable cervix (P = 0.003). More of the control group had repeat Foley catheter insertion compared to the study group (31.8% vs. 6.8%, P = 0.008). Conclusion: The use of 50 ml of fluid to inflate Foley catheter balloon for cervical ripening improves Bishop score better than the smaller volume of 30 ml.
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Prevalence of transfusion transmissible infections among voluntary blood donors: The need for adoption of sensitive screening assays p. 74
Ayuba Zakari, Dapus Obadiah Damulak, Lateef Salawu, Ochaka Julie Egesie, Ezra Danjuma Jatau, Jasini James, Grace Pam Jem
Background: Transfusion-transmissible infections (TTIs) in blood donors increase the risk of acquisition of these infections in blood and blood products recipients. Sensitive screening methods reduce the risk of transmission of TTIs to blood and products recipients. Objectives: The study sought to determine the prevalence of TTIs among voluntary non-remunerated blood donors (VNRBDs) and examine the need for the use of advanced donor screening methods to ensure blood infection safety.. Materials and Methods: This was a cross-sectional study conducted at the National Blood Transfusion Service (NBTS). Consenting VNRBD aged 18–65 years, were consecutively recruited during routine blood drives organized by the NBTS, between August and October 2016 after completing a structured questionnaire. Samples from donated blood units were screened for Human immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), and syphilis using the fourth-generation ELISA. Results: The data obtained from 865 participants were analyzed. One hundred and eighty-two (21%) participants tested positive for TTIs. The prevalence of HBV, HCV, HIV, and syphilis among the participants was 14.7%, 4.6%, 1.8%, and 1.6%, respectively. Coinfection was found in 8.7% of the study participants. A statistically significant association was established between the sex of the participants and TTIs (χ2= 6.217, P = 0.0013). Conclusion: The prevalence of TTIs among VNRBD was high. Due to its attendant consequences on blood infection safety and implication on donor retention, there is a need for adoption of sensitive screening assays to ensure blood safety.
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Macrodrip infusion dose error among nurses p. 80
Chinemerem Eleke, Ifeyinwa S Agu, Sabinah Ngbala-Okpabi, Esther N Bempong-Eleke
Background: Infusions must be administered as prescribed as too fast or slow a dose could have deleterious effects. Objectives: This study examined the risk for macrodrip infusion dose error among nurses in selected tertiary hospitals in southern Nigeria. Materials and Methods: This cross-sectional study was conducted in five university teaching hospitals in 2019. To establish the drop factor of commonly available macrodrip sets, 25 macrodrip sets were randomly sourced from the hospitals' pharmacies. A sample of 291 nurses was selected using proportionate random sampling technique. Data were collected using the adult infusion dose calculation quiz. Collected data were described and analyzed at 5% level of significance. Results: About 20 (80%) of the sampled macrodrip sets revealed 20 drops/ml (gtts/ml) drop factor value displayed on the packaging. When measured experimentally, all (100%) of the macrodrip sets delivered exactly 20 gtts/ml. About 255 (87.6%) respondents calculated macrodrip infusion dose while using a wrong drop factor of 10–18 gtts/ml while an additional 12 (4.2%) could not arrive at the expected infusion dose due to formula and arithmetic anomalies. In all, 267 (91.8%) respondents demonstrated tendency for infusion dose calculation error. Nonattendance of training on infusion administration significantly increased the risk for error by 21% (P = 0.001). Conclusion: Twenty gtts/ml is the drop factor of common macrodrip sets in southern Nigeria, and nurses were prone to infusing patients at a lower dose than prescribed. Attending training on infusion therapy might remedy this malady.
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Review of Echocardiographic reports of children undergoing noncardiac surgery in a tertiary health center in Nigeria p. 86
Mustafa O Asani, Ibrahim Ahmadu, Nuhu Abubakar Garba, Muhammad Shakur Abubakar, Apollos Daniel, Ibrahim Aliyu
Background: The risk of cardiac anomalies, both acquired and congenital, is high in children undergoing noncardiac surgeries. These cardiac anomalies are associated with increased risk of perioperative complications. Objectives: This study, therefore, determined the common indications as well as the echocardiographic findings findings in children undergoing noncardiac surgery in Aminu Kano Teaching Hospital (AKTH), Kano. Materials and Methods: This is a retrospective descriptive study. The echocardiographic records of 25 children that underwent noncardiac surgery in AKTH over a 4 year period (from January 2015 to December 2018) were retrieved. The data obtained were analyzed using SPSS version 20 and the result was displayed using a frequency distribution table and bar chart. Results: There were 14 males and 11 females, with male to female ratio of 1.3:1. The ages of the patients range from 5 days to 8 years (median age of 8 months). The most common indication for echocardiography is orofacial cleft (cleft lip and/or palate), followed by adenotonsillar hypertrophy. The overall cardiac anomaly was found in 28% of the patients, with the highest anomaly being the atrial septal defect. Conclusion: The prevalence of cardiac anomaly was high in children with noncardiac surgical conditions.
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Management of pancreatic abscess following acute pancreatitis p. 89
Nnamdi Jude Nwashilli, Blessing Ose-Emenin Igbinedion
Pancreatic abscess occurs as sequelae of acute pancreatitis. The standard treatment of infected pancreatic abscess is open surgical drainage and antibiotics. Recently, minimally invasive drainage methods such as image-guided percutaneous catheter drainage, transluminal endoscopic drainage through the stomach or duodenum, and retroperitoneal surgical drainage are becoming the trend. Open surgical drainage has a drawback of triggering a strong inflammatory response that can lead to multi-organ failure, bleeding, and gastrointestinal fistula unlike the minimally invasive approach. However, in the absence of facilities and expertise for minimally invasive drainage techniques, coupled with a patient with extensive/diffuse pancreatic necrosis and clinical deterioration, open surgical drainage may suffice. We report a case of pancreatic abscess which developed in a middle-aged man after few months of treatment and recovery from acute pancreatitis that was managed by open surgical drainage and parenteral antibiotics with good outcome.
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Letter to editor regarding “Pattern of diabetes mellitus-related complications and mortality rate: Implications for diabetes care in a low-resource setting” p. 93
Victor M Oguoma
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