rjhs vol 4(2).cdr spectrum of congenital heart diseases in children with down syndrome at usmanu danfodiyo university teaching hospital, sokoto 1 1 1 2 3 sani um. , isezuo ko. , waziri um. , ahmad mm. , ibitoye pk abstract objective: congenital heart diseases (chd) frequently occur in children with down syndrome. a few studies in nigeria have highlighted the pattern of chd in such patients, but results are variable with no data from the study area for comparison. this study aims to determine the pattern of chd among children with down syndrome as seen at uduth, sokoto st methods: a prospective study conducted between 1st october 2011 and 31 april 2015. subjects included all children with phenotypic features of down syndrome (ds) who were seen at the pediatric cardiology clinic and had echocardiography diagnosis of congenital heart diseases. results: of the 41 cases of ds seen during the study period, 32 (78.0%) children aged 2 weeks to 22 months (mean +sd = 5.6 ± 4.0 months) were diagnosed with chd. male to female ratio was 2.2:1. atrioventricular septal defect (avsd) was the commonest chd seen in 18 (56.3%) patients. nine (28.1%) patients had isolated ventricular septal defect (vsd), three (9.4%) had vsd coexisting with atrial septal defect (asd) while one (3.1%) patient each had isolated asd and fallot's tetralogy respectively. only three (9.4%) patients had surgical closure abroad, with good postoperative outcome in two of the patients. conclusion: avsd is the commonest chd in our series, which is similar to previous reports. increased access to definitive intervention is advocated since surgical outcome in such patients may be favorable. key words: down syndrome, congenital heart diseases, pattern, sokoto correspondence author: dr sani u.m. email: usmansani2005@yahoo.com 1 paediatric cardiology unit, department of paediatrics, usmanu danfodiyo university teaching hospital, sokoto, nigeria. 2 paediatric neurology unit, department of paediatrics, usmanu danfodiyo university teaching hospital, sokoto, nigeria. 3 pediatric nephrology unit, department of paediatrics, usmanu danfodiyo university teaching hospital, sokoto, nigeria. congenital heart diseases in children with down syndrome sani et al. res. j. of health sci. vol 4(2), 2016 124april/june research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). this licence will be displayed on the journal website and on each article published by the journal. spectre des maladies cardiaques congénitales chez les enfants atteints du syndrome de down à l'hôpital universitaire de usmanu danfodiyo, sokoto 1 1 1 2 3 sani um. , isezuo ko. , waziri um. , ahmad mm. , ibitoye pk résumé objectif: les maladies cardiaques congénitales (chd) se produisent fréquemment chez les enfants atteints du syndrome de down. quelques études au nigeria ont mis en évidence le modèle de la maladie coronarienne chez ces patients, mais les résultats sont variables sans données de la zone d'étude pour la comparaison. cette étude vise à déterminer le motif de la maladie coronarienne chez les enfants atteints du syndrome de down comme on le voit à uduth, sokoto méthodes: une étude prospective menée entre le 1er octobre 2011 et 31stapril 2015. les sujets inclus tous les enfants avec des caractéristiques phénotypiques du syndrome de down (ds) qui ont été vus à la clinique de cardiologie pédiatrique et ont eu un diagnostic de l'échocardiographie de maladies cardiaques congénitales. résultats: sur les 41 cas de ds vu au cours de la période d'étude, 32 (78,0%) des enfants âgés de 2 semaines à 22 mois (moyenne + sd = 5,6 ± 4,0 mois) ont été diagnostiqués avec la maladie coronarienne. homme ratio était de 2,2: 1. atrioventricular défaut septal (cav) a été le chd fréquente vu dans 18 (56,3%) patients. neuf (28,1%) patients avaient isolé défaut septal ventriculaire (civ), trois (9,4%) avait vsd coexistant avec défaut auriculaire septal (asd) asd tandis que l'un (3,1%) des patients chacun avait isolé et la tétralogie de fallot, respectivement. seulement trois (9,4%) patients ont eu la fermeture chirurgicale à l'étranger, avec un bon résultat postopératoire chez deux des patients. conclusion: cav est la plus fréquente chd dans notre série, qui est similaire aux précédents rapports. un accès accru à l'intervention définitive est préconisée depuis résultat chirurgical chez ces patients peut être favorable. mots clés: syndrome de down, les maladies cardiaques congénitales, motif, sokoto auteur correspondant: dr sani u.m. email: usmansani2005@yahoo.com 1 paediatric cardiology unit, department of paediatrics, usmanu danfodiyo university teaching hospital, sokoto, nigeria. 2 paediatric neurology unit, department of paediatrics, usmanu danfodiyo university teaching hospital, sokoto, nigeria. 3 pediatric nephrology unit, department of paediatrics, usmanu danfodiyo university teaching hospital, sokoto, nigeria. congenital heart diseases in children with down syndrome sani et al. res. j. of health sci. vol 4(2), 2016 125april/june introduction down syndrome is the commonest chromosomal abnormality in humans, with an incidence of 1 in 1,000 to 1 in 1,100 live births worldwide . first recognized by john langdon down in 1866, this genetic disorder is primarily caused by chromosomal non-disjunction, resulting in trisomy 21 . it is usually diagnosed on the basis of typical phenotypic features and this is confirmed by karyotyping. some of the phenotypic features of this syndrome include hypertelorism, depressed nasal bridge, medial epicanthic folds, low set ears, upward slanting palpebral fissures, single transverse palmar crease, clinodactyly and hypotonia. in addition, m u l t i p l e o r g a n s y s t e m s s u c h a s t h e cardiovascular, gastrointestinal, hematologic, endocrine and central nervous systems may be involved to a variable degree . cardiovascular manifestations in form of congenital heart disease (chd) occurs in up to 40-60% of the patients and is responsible for most of the morbidity and mortality in children with down syndrome . hence, early recognition of these lesions and timely intervention will improve the life expectancy and quality of life in affected children and reduce the emotional stress faced by their parents/caregivers. previous studies have described the pattern of congenital heart defects in children with down syndrome (ds), but results are variable. while atrioventricular canal defect (avcd) was found to be the most common lesion by some studies , others have reported ventricular septal defect (vsd) and patent ductus arteriosus (pda) as most prevalent among their study patients. similarly, conflicting results have been reported regarding the outcome of surgery for congenital heart diseases in children with ds, with some of the recent studies showing no evidence of increased mortality in such patients . in resourcelimited countries where access to cardiac surgery is difficult and frequently delayed, the outcome may be less favorable compared to that in the general population. this is because patients with ds are more prone to early development of pulmonary hypertension, which may adversely affect surgical outcome. there is presently no data from the study area on the pattern and outcome of congenital heart disease among children with down syndrome. hence, this study was conducted to determine the pattern and outcome of chds among children with phenotypic features of down syndrome attending the paediatric cardiology clinic of usmanu danfodiyo university teaching hospital, sokoto. such information is needed for comparison with other studies and to guide management of patients who present to the study area. materials and methods study area: this study was conducted at the paediatric department of usmanu danfodiyo university teaching hospital (uduth), sokoto, northwestern nigeria. the hospital is multidisciplinary and caters for a large number of patients within the sub-region and from neighbouring countries such as niger and benin republics. study design: this was a prospective study conducted between 1st october 2011 and st 31 april 2015. study subjects: subjects included all children with phenotypic features of down syndrome (ds), who were seen at the paediatric cardiology clinic and had echocardiographic diagnosis of congenital heart disease. excluded from the study were: patients older than 15years (paediatric age limit at uduth), children who already had definitive surgery at first presentation and those who died before diagnosis of cardiac lesion could be confirmed by echocardiography. patients who satisfied the eligibility criteria were recruited consecutively after getting informed written consent from the caregivers and/or assent for children aged more than seven years. the study was approved by the hospital ethics committee procedure: at presentation, demographic information such as age, gender, mobile phone numbers were obtained. each patient had detailed general examination including inspection for presence of dysmorphic features of down syndrome, measurement of anthropometric indices and pulse oxygen saturation, as well as cardiovascular evaluation. thereafter, the patients had chest-x ray and then 12-lead electrocardiography (ecg). the latter was performed by an ecg technician using dr-lee ecg machine (model 310a, italy), which was fitted with paediatric ecg probes. for children that were not cooperative, light sedation was achieved by oral administration of chloral hydrate at a dose of 50mg/kg. results of the ecg tracings were read by the principal author. e c h o c a r d i o g r a p h y : t r a n s t h o r a c i c congenital heart diseases in children with down syndrome sani et al. res. j. of health sci. vol 4(2), 2016 126april/june echocardiography (tte) was performed using sonoscape ssi 5000 echo-machine, mounted with a 2.5mhz linear array transducer. cardiac imaging was through apical, parasternal long axis (plax), parasternal short axis (psax), subcostal and suprasternal notch views. the location and size of anatomic defects were d e t e r m i n e d u s i n g 2 d i m e n s i o n a l echocardiography (2d); whereas flow direction and pressure gradients were assessed with colour doppler and continuous wave doppler respectively. m-mode was used for measurement of ventricular function. echocardiographic evaluation was performed by the principal investigator, who had previously underwent one year post fellowship training in pediatric cardiology at india and has had more than 5 years working experience in pediatric cardiology unit of uduth, sokoto. treatment and follow up: all parents/guardians of children with confirmed chd were counseled accordingly. the need for surgery, where necessary, was discussed with the parents or guardians. when indicated, medical treatment with anti-heart failure medications (frusemide, spironolactone and captopril), antibiotics for concomitant respiratory infections and nutritional rehabilitation were commenced. patients were followed up after hospital discharge at the paediatric cardiology clinic. those with other identified co-morbidities such as neurologic abnormalities were also referred to appropriate specialty clinics for evaluation and follow up. data analysis: the demographic, clinical and echocardiography data of all the patients with confirmed congenital heart diseases were entered and analyzed using spss statistical software version 20 (armonk, ny: ibm corp). quantitative data were expressed as means and standard deviation while categorical variables were expressed as proportions. the proportions of male and female subjects across various age groups were compared using chi-square test while fishers exact test was used to compare children with avsd and those with other lesions. a p-value of <0.05 was considered statistically significant. results demographic and clinical characteristics of patients a total of 41 children with phenotypic features of down syndrome were seen at the paediatric cardiology clinic during the study period. thirty-two (78.0%) of these had echocardiographic diagnosis of congenital heart disease (chd). there were 22 males and 10 females (m: f ratio= 2.2:1). the mean +sd age was 5.6 ± 4.0 months (range 2weeks to 22 months), while mean maternal age was 31.4 + 6.8 years (range 18-42 years). table 1 shows the age and gender distribution of children with ds and congenital heart disease. majority of them (62.5%) were under the age of six month. the patients presented with various symptoms including difficulty in breathing, cough, failure to thrive and bluish discoloration of the lips and tongue. however, 3(9.4%) patients were asymptomatic (table 2). pattern of chd acyanotic congenital heart diseases (achds) accounted for 96.9% of all congenital heart diseases while cyanotic chd constituted only 3.1% of the cases. the spectrum of the various lesions among the study cohort is shown in table 3. atrioventricular septal defect (avsd) was the commonest congenital cardiac defect, with a prevalence of 56.3%. ventricular septal defect (vsd) was the next most common chd, occurring in isolation (28.1%) or in association with atrial septal defect (9.4%). tetralogy of fallot (tof) was the only cyanotic chd observed among the study subjects and occurred in one patient (3.1%) only. of the 18 children with avsd, 7 (38.9%) were females compared to only 3 (21.4%) females out of the 14 children diagnosed with other congenital heart lesions. however, the difference was not statistically significant (fisher's exact test, p= 0.45). figure 1 shows a 2-dimensional echocardiographic image of one of the study patients with complete avsd. treatment and outcome: three of the 32 (9.4%) patients had surgical intervention at india (avsd repair in 2 and vsd closure in one patient); while one patient (3.1%) had spontaneous closure of vsd. nine patients (28.1%) were lost to follow up while the remaining 19 (59.4%) patients are still on follow up at both the pediatric cardiology and pediatric neurology clinics. the two patients that had surgery for atrioventriuclar septal defect (avsd) were aged 14 and 22 months respectively while the third patient who had vsd repair was 9 months old. though surgery was congenital heart diseases in children with down syndrome sani et al. res. j. of health sci. vol 4(2), 2016 127april/june successfully performed in all the patients, they all had prolonged post operative hospital stay. unfortunately, the 22-month-old girl that had avsd repair developed severe postoperative pulmonary artery hypertension (pah) and subsequently died at india. discussion congenital heart diseases are recognized as one of the most common systemic comorbidities in children with down syndrome . the present study has found a high prevalence of chds (79.3%) among children with down syndrome. this finding is comparable to that of asani et al in kano, northwestern nigeria, which reported a prevalence of 77.1% among the 35 subjects evaluated. ekure et al in lagos has similarly reported a prevalence of 87% among a cohort of 54 subjects with down syndrome whereas otaigbe et al in port harcourt, reported the highest prevalence of 100% among 38 subjects studied. the very high prevalence obtained in the latter study is not clear, but high rates of exposure to environmental toxins due to petroleum exploration activities in the region has been suggested as one of the possible explanations . it is of note that the aforementioned studies (5,7,10) were hospital based and might therefore over-estimate the prevalence of chds in children with down syndrome. this is because symptomatic children with suggestive symptoms of chds are more likely to be referred to the hospital than those who are otherwise normal or asymptomatic. consequently, hospital sample may not represent the actual community burden and pattern of chds in patients with ds. population-based prevalence of chds in children with this chromosomal anomaly has been shown to be generally lower (ranging between 40-60%) than hospital-derived estimate . a community study in brazil, for example, reported a prevalence of 46.8% among children diagnosed with ds. hence, as suggested by freeman et al, true estimation of the prevalence and types of heart defects in down syndrome should be done using a population-based sample. this is however difficult in developing countries, where health and birth records are not optimal. the pattern of chd in the study cohort showed preponderance of acyanotic lesions, as only one patient had cyanotic chd in form of tetralogy of fallot. like many other studies, atrioventricular septal defect (avsd) was the commonest type of chd in the present study. this is in contrast to some studies that found other lesions to be the most common . ekure in nigeria , and both abbag and al-jarallah in saudi arabia have reported ventricular septal defect (vsd) as the most common heart defect in children with down syndrome; whereas some studies in brazil and in turkey have both demonstrated atrial septal defect (asd) as the commonest lesion among their study cohorts. curiously, patent ductus arteriosus (pda) was the most frequent in a study by otaigbe et al in port harcourt, south-south nigeria. the results from these studies highlight the wide variability in the pattern and prevalence of cardiac lesions among children with ds. whether this variability could be related to geographic, genetic or other epidemiologic factors need to be further explored. more than 60% of the patients were diagnosed below the age of six months, which is consistent with reports from other studies . this may imply that such patients do come to light relatively early due to obvious dysmorphic features or early onset of clinical symptoms as a result of their congenital heart defects or other associated comorbidities. it has been advocated that all newborn infants with features of down syndrome should have early cardiac evaluation to exclude congenital heart defects . this is because of the risk for early onset pulmonary vascular d i s e a s e i n s u c h p a t i e n t s , w h i c h m a y contraindicate surgery and adversely affect their prognosis . due to the small number of patients, it is difficult to reliably compare the gender variations in the relative prevalence of specific cardiac lesions among the study subjects. the higher number of males with chd as well as avsd in this study may be due to the preponderance of male subjects with ds compared to females. asani et al in their study of children with ds, have shown a higher prevalence of chd in males with ds than female subjects whereas; otaigbe et al in port-harcourt reported equal incidence in both genders. but these studies were also limited by small sample size. access to definitive intervention was very low among the study patients, as only three of them were able to afford the cost of surgery at india. the challenges of cardiac surgery in nigeria and indeed many parts of africa have previously been highlighted . these include endemic poverty, high cost of surgery, poorly equipped health facilities and lack of personnel with capacity to offer routine cardiac intervention congenital heart diseases in children with down syndrome sani et al. res. j. of health sci. vol 4(2), 2016 128april/june locally . in the past, the benefit of cardiac surgery in children with down syndrome was doubted and some caregivers may be unwilling to spend their resources on a condition in which the other associated neurologic and physical features may not be amenable to treatment . it has now been shown that such intervention is associated with actuarial survival benefit and improved quality of life . in the present study, all the three patients that had surgery had prolonged postoperative hospital stay, but death occurred in one of the patients who was aged 22 months at the time of surgery. the other two patients have remained stable on follow up. hence, unless where contraindicated, down children with chd should have timely correction of their cardiac lesions to enhance prognosis. concerted effort to urgently make cardiothoracic surgical services locally available and accessible is necessary. conclusion this study has shown a high prevalence of chd in children with down syndrome, with avsd being the most common type of heart lesion. majority of the affected patients have limited access to definitive treatment, emphasizing the need to establish functional cardiac centers in the country. there is need for multicenter population-based studies in the country to ascertain the actual community prevalence and types of chds in children with down syndrome. study limitations: being a hospital-based study with small sample size, the result may not be truly representative of the population in the study area. karyotyping was performed in only two patients, as facilities for such investigation were presently not available locally. the number of patients that had surgery is too small to allow for meaningful statistical analysis of surgical outcome. conflict of interest: none acknowledgement: we thank our ecg/echo technician, mallam dange, who helped to sedate s o m e o f t h e p a t i e n t s t h a t u n d e r w e n t echocardiography. references: 1. who. genes and chromosomal diseases: d o w n s y n d r o m e ( a c c e s s e d j u n e 2 0 1 6 ) . a v a i l a b l e a t : www.who.int/genomics/public/geneticdise ases/en/index1.html 2. wiseman f, alford k, tybulewicz v, fisher e. down syndrome-recent progress and future prospects. human mol genet 2009;18 (1): 75 83. 3. wells gl, barker se, finley sc, colvin ev, finley wh. congenital heart disease in infants with down's syndrome. south med j 1994; 87(7):724-7. 4. freeman sb, taft lf, dooley kj, allran k, sherman sl, hassold tj, et al. populationbased study of congenital heart defects in down syndrome. am j med genet 1998; 80 (3): 2137. 5. asani m, aliyu i, also u. pattern of congenital heart diseases among children with down syndrome seen in aminu kano teaching hospital, kano, nigeria. niger j basic clin sci 2013; 10 (2): 57. 6. f a t e m a n n . d o w n ' s s y n d r o m e w i t h congenital heart disease: analysis of cases over two years in a 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surgery for african children. cardiovasc j afr 2012; 23 (165-7). 18. b o d e t h o m a s f. c h a l l e n g e s i n t h e management of congenital heart diseases in developing countries, congenital heart diseases selected aspects. syamasundar p (ed), isbn: 978-953-307-472-6, in tech, available from: http://www.intechopen.com/books/congenitalheart--disease-selected-aspects/challenges-inthe-management-of-congenital-heart-diseasein-developing-countries. 2012. 19. torfs cp, christianson re. anomalies in down syndrome individuals in a large populationbased registry. am j med genet 1998; 77 (5): 431-8. 20. stoll c, alembik y, dott b, roth mp. study of down syndrome in 238,942 consecutive births. ann genet 1998; 41 (1): 44-51. 21. spicer r. cardiovascular disease in down syndrome pediatr clin north am 1984; 31: 1331-43. 22. vilas boas l, albernaz ep, costa rg. prevalence of congenital heart defects in patients with down syndrome in the municipality of pelotas, brazil. jornal de pediatria 2009; 85 (5): 403-7. 23. khan i, muhammad t. frequency and pattern of congenital heart defects in children with down syndrome. gomal journal of medical sciences 2012; 10 (2): 241-3. 24. ashraf m, malla m, javed c, mohd im, mymoona a, ayaz r, et al. consanguinity and pattern of congenital heart defects in down syndrome in kashmir, india. ajsir 2010; 1 (3): 573-7. 25. mihçi e, akçurin g, eren e, kardelen f, akçurin s, keser i, et al. evaluation of congenital heart diseases and thyroid abnormalities in children with down syndrome. anatolian j cardiol 2010; 10 (5): 440-5. 26. sani u, jiya n, ahmed h, waziri u. profile and outcome of congenital heart diseases in children: a preliminary experience from a tertiary center in sokoto, northwestern nigeria. nig postgrad med j 2015; 22 (1): 1-8. 27. sani u, ahmed h, jiya n. pattern of acquired heart diseases among children seen in sokoto, north western nigeria. niger j clin pract 2015; 18 (6): 718-25 congenital heart diseases in children with down syndrome sani et al. res. j. of health sci. vol 4(2), 2016 130april/june table 1: age and gender distribution of children with down syndrome and chd age (months) male n (%) female n (%) total n (%) 0-6 14 (70.0) 6 (30.0) 20 (62.5) 6.1-12 6 (66.7) 3 (33.3) 9 (28.1) >12 2 (66.7) 1 (33.3) 3 (9.4) total 22 (68.8) 10 (31.2) 32 (100.0) x 2= 0.39 df=2, p= 0.98 table 2: presenting symptoms in children with down syndrome and chd *presenting symptoms n (%) cardiac murmur 31 (96.9) cough 26 (81.3) poor weight gain 19 (59.4) delayed motor milestones 14 (43.8) asymptomatic 3 (9.4) cyanosis 2 (6.3) * some patients have more than one symptom table 3: spectrum of congenital heart diseases seen in children with down syndrome type of chd male n (%) female n (%) total n (%) atrioventricular septal defect (avsd) 11 (61.1) 7(38.9) 18(56.3) isolated ventricular septal d efect 7 (77.8) 2(22.2) 9(28.1) vsd + asd 2(66.7) 1(33.3) 3(9.4) isolated ostium primum asd 1(100.0) 0(0.0) 1(3.1) tetralogy of fallot 1(100.0) 0(0.0) 1(3.1) total 22(68.8) 10(31.2) 32(100.0) congenital heart diseases in children with down syndrome sani et al. res. j. of health sci. vol 4(2), 2016 131april/june figure 1: a 2 dimensional echo of a 10 -month old girl with down syndrome showing complete atrioventricular septal defect (see arrow showing the central defect). congenital heart diseases in children with down syndrome sani et al. res. j. of health sci. vol 4(2), 2016 132april/june page 1 page 2 page 3 page 4 page 5 page 6 page 7 page 8 page 9 rjhs vol 4(2).cdr relationship between blood pressure, body mass index and health promoting lifestyle practices of women in selected rural communities in osun state nigeria. 1 2 3 joseph-shehu em. , irinoye, oo. , ajani god. abstract objevtive: globally, studies have shown that the trend of overweight and obesity has increased astronomically and there is a close link between body mass index and blood pressure. this study determined the link between the body mass index (bmi), blood pressure and health promoting practices of women in rural and sub-urban communities. methods: multi-stage sampling technique was employed to select 394 women from three rural/semiurban communities purposively selected from osun state for this cross sectional study. interviewer's administered questionnaire was used to collect data such as sociodemographic data, blood pressure, anthropometric indices and health promoting lifestyle practices of the respondent. data analysis was done using spss version 17 software and level of statistical significance was set at p < 0.05. result: the mean age of the respondents was 40.28±16.03 years and majority earned average monthly 2 income of between n1000-5000 ($5-25). the mean bmi was 28.04±5.449 kg/m and about 20% 0f respondent were obese the mean systolic blood pressure was 114.14±17.835 mmhg while diastolic blood pressure was 71.04±12.99 mmhg and about 10% of respondents had hypertension. there was positive and significant relationship between bmi and blood pressure (r = 0.15, p=0.01). the study demonstrated no significant relationship between the health promoting lifestyle practices of the respondents bmi and blood pressure. conclusion: the significant relationship between bmi and hypertension validate the need for health promoting lifestyle intervention programme for rural women and similar population in order to control the increasing prevalence of non-communicable diseases. keywords: blood pressure, body mass index, rural community, health promoting lifestyles practices, women and socio-economic status correspondence author: dr joseph-shehu e.m. email: lizjoe26@gmail.com 1 school of health sciences, national open university of nigeria, victoria island, lagos state, nigeria. 2 department of nursing science, obafemi awolowo university, ile-ife, nigeria. 3 department of medicine, federal teaching hospital, ido-ekiti, nigeria. blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), april/ 2016 112june research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). this licence will be displayed on the journal website and on each article published by the journal. relation entre la pression artérielle, indice de masse corporelle et de promotion de la santé des habitudes de vie des femmes dans les communautés rurales sélectionnées dans l'etat d'osun au nigeria. 1 2 3 joseph-shehu em. , irinoye, oo. , ajani god. résumé objectif: à l'échelle mondiale, des études ont montré que la tendance de surpoids et d'obésité a augmenté astronomiquement et il y a un lien étroit entre l'indice de masse corporelle et la pression artérielle. cette étude a déterminé le lien entre l'indice de masse corporelle (imc), la pression artérielle et les pratiques de promotion de la santé des femmes dans les communautés rurales et suburbaines. méthodes: technique d'échantillonnage à plusieurs étages a été employé pour sélectionner 394 femmes de trois communautés rurales / semi-urbaines téléologique choisis dans l'etat d'osun pour cette étude transversale. le questionnaire administré de l'intervieweur a été utilisé pour recueillir des données telles que les données socio-démographiques, la pression artérielle, des indices anthropométriques et des habitudes de vie favorisant la santé de l'intimé. l'analyse des données a été effectuée à l'aide du logiciel spss version 17 du logiciel et le niveau de signification statistique a été fixé à p <0, 05. résultat: l'âge moyen des répondants était 40,28 ± 16,03 années et de majorité revenu mensuel moyen entre n1000-5000 (5-25 $) gagné. l'imc moyen était de 28,04 ± 5,449 kg / m2 et environ 20% 0f répondant étaient obèses la moyenne pression artérielle systolique était 114,14 ± 17,835 mmhg tandis que la pression artérielle diastolique était 71.04 ± 12,99 mmhg et environ 10% des répondants avaient l'hypertension. il y avait relation positive et significative entre l'imc et la pression artérielle (r = 0,15, p = 0,00). l'étude a démontré aucune relation significative entre les habitudes de vie favorisant la santé des répondants imc et la pression artérielle. conclusion: la relation significative entre l'imc et l'hypertension valident le besoin de promotion de la santé programme d'intervention de style de vie pour les femmes rurales et la même population afin de contrôler la prévalence croissante des maladies non transmissibles. mots-clés: la pression artérielle, indice de masse corporelle, la communauté rurale, la santé des pratiques style de vie promouvoir, les femmes et le statut socio-économique auteur correspondant: dr joseph-shehu e.m. email: lizjoe26@gmail.com 1 school of health sciences, national open university of nigeria, victoria island, lagos state, nigeria. 2 department of nursing science, obafemi awolowo university, ile-ife, nigeria. 3 department of medicine, federal teaching hospital, ido-ekiti, nigeria. blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), april/ 2016 113june iintroduction increasing burden of preventable noncommunicable diseases (ncds) has led to high morbidity, debility and mortality and it now has become a major challenge of development especially in developing countries (1, 2). it has been documented that as high as 60% of ncds related death occurred in people below the age of 60 years in low and middle income countries (3,4,5&6). in nigeria, high prevalence of cardiometabolic risk factors in rural population has been documented (5). these ncds especially the cardio-metabolic diseases, growing epidemic proportion are said to be driven by unhealthy lifestyles, rapid urbanization and demographic aging compounded by poor health promotion, , poor referral protocol, poverty resulting to inability of many people to afford cost of health care, poor access and poor utilization of health care facilities among others (7,8). a study have shown that rural residents defined health as the ability to work and carry out their usual tasks and that they are less concerned with comfort, cosmetic, and life-prolonging aspects of care (4). this may imply that they do not deliberately engage in health promoting behaviour. that is, women have the tendency to neglect their health needs as they are usually occupied with the burden of caring for their family. hypertension is often referred to as silent killer and it can only be detected through blood pressure measurements . hypertension is an important public health burden in both urban and rural settings of sub-saharan african population (9). sixty million people in the united states and one billion individuals' worldwide have hypertension (10). several researchers have demonstrated relationship between bmi and blood pressure (11,5). in the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure, it was said that for bp beginning from 115/75 mm hg, cvd risk doubles for each increment of 20/10 mm hg. people who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension, pre hypertensive individuals (systolic bp 120–139 mm hg or diastolic bp 80–89 mm hg) were also stated to require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and cvd (11,12) fernald & adler (13) in a study among women in mexico, showed that contrary to traditional assumptions and results of previous studies about the associations between socio economic status and better health, women in lowincome rural populations who are at the upper end of the income spectrum within their community were found to be more likely to have higher systolic bp. however, a review of the literature from several developing countries including chile, brazil and colombia also showed that increased socio-economic status was associated with decreased blood pressure (13) overweight and obesity are important determinants of health and lead to adverse metabolic changes, including increase in blood pressure, unfavourable cholesterol levels, hypertriglyceridaemia, diabetes and increased resistance to insulin action, and greater prevalence of metabolic syndrome (14). body mass index (bmi) is recommended by the world health organization as the most useful epidemiological measure of obesity (9,14) several studies have link some diseases (hypertension, type 2 diabetes, cardiovascular diseases, arthritis, disability and cancer) with overweight and obesity (14,15,16 &17). despite the fact that excess bodyweight has been recognized as a major public health concern, studies conducted in 960 countries and territories revealed that, mean bmi has increased since 1980 globally. the trends since 1980, and mean population bmi in 2008, varied substantially between nations (18,19). various studies showed that lifestyle modifications like weight loss, reduced sodium intake, increased physical activity, diet rich in fruit, vegetables, and low-fat dairy products reduced in total and saturated fat are effective in lowering blood pressure (10). therefore, failure to engage in health promoting lifestyle consistently may be associated with the increasing prevalence of preventable noncommunicable diseases. this present study is focused on the exploration of the link between the cardimetabolic indicators of ncds such as blood pressure (bp) and bmi with the health promoting lifestyle practices among women in rural and suburban communities in osun state. methodology the study was conducted in osun state, southwest, nigeria with an estimated population of 4,137,627 in 2005 (20). osun state is largely 'a rural state', with 19 out the 30 local government areas being non-urban local government councils as indicated by the 1991 national population and housing census. there is documented disparity in accessibility to health care facilities and health blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), 2016 114april/june care providers in the state of osun (21). for this study, three communities were purposively selected from ile-ife zone out of the 6 administrative zones in osun state. two of these communities (wanikin and koola) are rural communities while the third community: aba iya gani (surulere) community has gradually developed into suburban settlement because of the influx of civil servants and academics from the university and the university teaching hospitals who built houses in the community. the total population of the women residents in aba iya gani was 918, in koola community was forty-two (42) (twenty-one (21) of them are residents, eleven (11) usually come in the early hours of morning and return to town in the evening while nine (9) usually spend some days before going to town) and in wanikin was 493. proportional equation was used to select 249 women from aba iya gani, 133 women from wankin and 12 women from koola based on the community population. the first house in each community was randomly selected after then every third house was selected. women in the selected house that are 19 years and above in each of the three communities, irrespective of their educational level, marital status and occupation, were included in the study. d a t a w e r e c o l l e c t e d u s i n g a n interviewer-administered questionnaire to obtained demographic characteristics and the health promoting lifestyle using the health promotion lifestyle profile ii (hplpii). the hplpii was first developed by walker, et al. in 1987 and it was revised by walker & hillpolerecky in 1997 (4, 22). hplpii has been used extensively in research and reported to have sufficient validity and reliability for use among various populations. the adapted healthpromoting lifestyle profile component of the questionnaire has 40 items divided into the six subscales covering nutrition (n 6 items), physical activity (pa – 3 items), health responsibility (hr – 8 items), stress management (sm – 9 items), interpersonal relations (ir 8 items) and spiritual value (sv 6 items). the items were assessed on four-level likert scale of never (1); sometimes (2); often (3) and routinely (4). ten women were drawn from a rural farming community in another local government area to assess the reliability of the instrument using test re-test method. the cronbach?s á coefficient of the subscales are: health responsibility (0.76); physical activity (0.76); nutrition (0.76); spiritual belief (0.70); interpersonal relationships (0.80) and stress management (0.84). the total score of all the subscales was 0.72. the anthropometry parameters which consist of height and weights were measured using standard techniques and the blood pressure measurement using standard techniques was done by the investigators. the health promoting lifestyle profile ii questionnaire translated to yoruba language (and later translated back to english to ensure validity of test items). the body mass index (bmi) was calculated as weight in kilogrammes divided by the square of height in meters. under weight was 2 defined as bmi < 18.5 kg/m ; normal weight 2 (bmi 18.5 – 24.9 kg/m ); over weight (bmi 25.0 2 – 29.9 kg, m2); obesity (bmi 30.0 – 30.9 kg/m ) 2 and severe obesity (40 kg/m and above). blood pressure was measured using an aneroid sphygmomanometer. blood pressure was defined as normal (systolic < 120 and diastolic < 80mmhg); pre-hypertension (systolic 120-139 and diastolic80 -89 mmhg); hypertension stage 1 (systolic 140 159 and diastolic 90 – 99 mmhg) and hypertension stage 2 (systolic > 160 and diastolic > 100 mmhg) (12). two research assistants were recruited and trained to facilitate the data collection process. the first research assistant is a registered nurse who is conversant with the contents of the instruments being used and also has work experience in rural communities. the second research assistant was an undergraduate student who has stayed among the rural women for some time and she demonstrated a high understanding of the contents of the instruments. both assistants were fluent in the local language (yoruba). ethical clearance: ethical clearance for this study was obtained from obafemi awolowo university institute of public health ethical review board (iphoau/12/04) and consent of the community heads and individuals were obtained. data collected were coded and entered into statistical package for social sciences (spss) version 17.0 and analyzed using descriptive and inferential statistics. level of statistical significance was taken as p-value less than 0.05. results the mean age of the respondents was 40.28±16.03 years and less than half (44.4%) had secondary education (table 1). many of the respondents (52%) were traders with average monthly income of minimum of n1000 and maximum of n80,000 with mean income of n14,222 ±17,378.18, although, majority (35.8%) earned average monthly income of between blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), 2016 115april/june n1000-5000 (table 1). observing the three communities independently, none of the women in koola community (though with very low population with a total of 42 women) is neither underweight nor severely obese (figure 1). however, the study showed significant relationship between the 2 respondents' study location and their bmi (÷ = 24.787; df= 8; p= 0.002). the mean systolic blood pressure was 114.14±17.835 mmhg and majority (82.7%; 66.7% and 77.4%) from aba iya gani, koola and wanikin respectively had normal systolic blood pressure (figure 2). in addition, mean diastolic blood pressure was 71.04±12.991mmhg while majority (87.6%; 83.3% and 86.5%) from aba iya gani, koola and wanikin respectively had normal diastolic blood pressure (figure 3). statistical analysis revealed significant relationship between the study locations and 2 blood pressure of the study population (÷ = 15.767; df= 6; p= 0.015). in addition table 2 revealed significant relationship between the age 2 of the study population and their blood pressure ÷ = 44.12, df = 6 and p value = 0.000. likewise, age d e m o n s t r a t e d s t a t i s t i c a l l y s i g n i f i c a n t 2 relationship with body mass index ÷ = 19.83, df = 8 and p value = 0.01 (table 2). highest level of education, occupation and average monthly income were the parameters used to assess the socio-economic status of the respondents. table 3 revealed positive and significant relationship between bmi and blood pressure (r = 0.145, p=0.004).body mass index showed significant relationship with all the three parameters used to assess socio economics status (table 3). furthermore, blood pressure showed significant but negative relationship with both highest educational level and occupation of the study population. however, the relationship between blood pressure and average monthly income was merely positive but not statistically significant (table 3). also table 4 revealed the health promoting lifestyle practices of the women across the study locations. the most practiced of hplp of the respondents was spiritual belief with mean score of 3.14-3.75 and koola community had the highest mean score (3.75) while the least practiced was health responsibility with mean score of 1.83 among the koola community. physical activity was also not optimally practiced with mean scores of 2.02 and 2.38. health promoting lifestyle practices as a variable had no statistical significant relationship with respondents' bmi and blood pressure at 0.05 significant levels (table 5). discussion the age range of respondents was between 19 and 87 years with ±sd (40.28±16.03) years. the findings from the study showed that more respondents were in the age range of 19-29 years in sub-urban settlement (aba iya gani) compared to the other two typical rural communities; this may be due to the fact that some of the respondents within these age range are either students or civil servants that need to stay close to their schools or work places. the highest formal education of most of the respondents was secondary school. the challenge of low education of women translates to poor socioeconomic status and poor developments and this low education account for lower percentage of women in all professions including academics (19). increased number of illiterate women in the society, especially in the rural communities are associated with teenagers who drop out of school or not allowed to go to school at all who eventually grow into women that will be involved in nations development agenda (23). previous study showed that women in rural areas are older, poorer, less educated, have greater financial hardship (14). in our study, (52.0%) of the respondents were petty traders and 15.0% were farmers. women generally work as subsistence farmers, smallscale entrepreneurs, unpaid workers on family farms or casual wage labourers and they may take on all or a number of these activities at different times (8). globally, more than one third of the female workforce is engaged in agriculture, while in regions like sub-saharan africa and south asia, more than 60 per cent of all female employment in the rural area is in this sector (8) the average income of majority of our respondents per months was between n1000 n5000 ($4-20). there is a high level of poverty among families headed by women (24). rural women are particularly vulnerable to poverty, according to the world bank, 75 per cent of the poor in developing countries live in rural areas (8). in a previous health screening study conducted in 12 villages in rural nigeria revealed that people live on less than $2 (n300) per day, making it nearly impossible for them to travel to a hospital or clinic to access health care if needed (25). the situation may be getting worse in recent times with the poor economic situation of the state and the country. rising prevalence of obesity is a worldwide health concern because it forecasts an blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), 2016 116april/june increased burden of several diseases, most notably cardiovascular diseases, diabetes, and cancers (19,26). studies have shown that risk factors for non-communicable diseases are poor diet, physical inactivity, smoking and excessive alcohol consumption as well as overweight and obesity (10). hence adopting healthy lifestyle practices such as healthy diet, regular exercise and avoidance of alcohol and tobacco smoking can prevent and control non-communicable diseases and its complication (27). our study showed variations in weight patterns of respondent in rural and sub-urban communities. women in koola compared to the other two c o m m u n i t i e s h a v e r e l a t i v e l y b e t t e r anthropometric indices. this could be explained from the nature of the extensive and heavy farming work and long walk associated with street trading engaged in by over 70% of the women in koola community. our study subjects practiced health responsibility poorly implying that they might not have been taking active responsibility for health sustenance and health check-up, a critical issue in control of noncommunicable diseases. the findings also demonstrated high rate of obesity among the study population and there is also significant relationship between body mass index and blood pressure. therefore measures have to be put in place to ensure effective health promoting programmes that can encourage the women in the rural community to maintain healthy weight because of the burden of diseases associated with obesity. studies conducted in the usa and uk revealed that by year 2030 with the trend of obesity in these countries there will be 65 million more obese adults in the usa and 11 million more obese adults in the uk, consequently accruing an additional 6–8·5 million cases of diabetes, 5·7–7·3 million cases of heart disease and stroke, 492?000–669?000 additional cases of cancer, and 26–55 million quality-adjusted life years forgone for usa and uk combined (17). the combined medical costs associated with treatment of these preventable diseases are estimated to increase by $48–66 billion/year in the usa and by £1·9–2 billion/year in the uk by 2030 (17). stage 1 and stage 2 hypertension have a high prevalence rate among our respondents in the age group of 41 to 87 years. it has been documented that those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension (4). our study suggested that the socio-economic status of our study population might have contributed to the prevalence of overweight, obesity and hypertension. conclusion our study has shown that about 10% of women in each of the rural community had hypertension while about 20% of these women were also obese. there was low level of health promoting lifestyle practices in all our studied communities, more strikingly important is our study finding which showed that blood pressure and body mass index have no relationship with the level of health promoting lifestyle practices of our respondents. effective health promotion programmes should be encouraged among rural women as such will help in preventing most common non communicable diseases especially hypertension, cerebro-vascular disease, diabetes. doing these also have economic benefits as healthier rural women will be more productive in their farming activities and thus contribute more to the development of the country through agriculture. women are pivotal in maintaining healthy generations as they are the caregivers of the family. they play key role in promoting and maintaining family health in all cultures and it is important that they have optimum physical, mental and social wellbeing. conflict of interest: none. references 1. aregbesola m. public health issuenoncommunicable disease 2011. available at: http://www.nigerianinquirer.com. accessed 01/02/2013 2. frieden tr. 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adult overweight and obesity prevalence population health metrics 2012, 10:22 doi:10.1186/1478-7954-10-22. 20. joseph-shehu em, irinoye oo. health promoting lifestyle practices of rural women in osun state, southwest, nigeria 2015. journal of nursing and health science, 4, 08-17 21. sanni l. distribution pattern of healthcare facilities in osun state, nigeria 2010. ethiopian j o u r n a l o f e n v i r o n m e n t a l s t u d i e s a n d management vol.3 no.2 2010 22. walker sn, hill-polerecky dm. psychometric evaluation of the health-promoting lifestyle profile ii unpublished manuscript, university of nebraska medical center 1996. available at: http//www.unmc.edu/nursing/docs/hplpii abstract dimensions.pdf. accessed 10 /12/2010 23. o k o m e m o . d o m e s t i c , r e g i o n a l , a n d international protection of nigerian women against discrimination: constraints and possibilities 2011. african studies quarterly, the online journal for africa studies. 24. agu s. gender equality education and women empowerment: the nigerian challenge 2007. a v a i l a b l e a t : http://www.wesoedu.com/nard/nard%208.2 /nard_ vol_8 (2). accessed on 11/01/2012 25. women watch information and resources on gender equality and empowerment. rural women and development 2010. available at: http://www.un.org /womenwatch/ feature /idrw/index-2010.html. accessed on 04/03/2011 26. global giving. health screening for 12 villages in r u r a l n i g e r i a 2 0 1 1 . a v a i l a b l e a t : http://www.globalgiving.org/projects/achi/. accessed on 24/6/2011 27. sorour as, kamel ww, abd elaziz em, aboelseoud a. health promoting lifestyle blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), 2016 118april/june behaviors and related risk factors among female employees in zagazig city 2014. journal of nursing education and practice, 2014, vol. 4, no. 5. res. j. of health sci. vol 4(2), 2016 119april/june table 1: socio-demographic characteristics of the respondents socio demographic variables community aba iya gani(n=249) koola (n=12) wanikin (n=133) age range 19-85 29-87 19-80 mean age 38.96 55.00 41.41 std. deviation 15.642 17.607 15.982 age 19-40 152 (61.0%) 3 (25.0%) 70 (52.6%) 41-64 81 (32.5%) 5 (41.7%) 47 (35.3%) 65 and above 16(6.4%) 4 (33.3%) 16 (12.0%) highest educational level no formal education 27 (10.8%) 9 (75.0%) 34 (25.6%) primary 35 (14.1%) 1 (8.3%) 34 (25.6%) secondary 111 (44.6%) 1 (8.3%) 63 (47.4%) tertiary 76 (30.5%) 1 (8.3%) 2 (1.5%) occupation farming 10 (4.0%) 3 (25.0%) 46 (34.6%) trading 129 (51.8%) 9 (75.0%) 68 (51.1%) student 40 (16.1%) 0 (.0%) 9 (6.8%) civil servant 43 (17.2 %) 0 (.0%) 4(3.0%) artisan 27 (10.8%) 0 (.0%) 6 (4.5%) average income in a month 1000-5000 64 (25.7%) 3 (25.0%) 74 (55.6%) 6000-10000 85 (34.1%) 7 (58.3%) 43 (32.3%) 11000-20000 52 (20.9%) 0 (.0%) 11 (8.3%) 21000-40000 22 (8.8%) 2 (16.7%) 4 (3.0%) 41000 and above 26 (10.4%) 0 (.0%) 1 (0.8%) table 2: relationship between blood pressure, body mass index and age of the respondents blood pressure (bp) age total 19-40 41-64 65-87 normal blood pressure 174(44.2) 74(18.8) 20(5.1) 268(68.0) pre-hypertension 37(9.4) 21 (5.3) 9(2.3) 67(17.0) hypertension stage 1 9(2.3) 20(5.1) 3(0.8) 32 (8.1) hypertension stage 2 3(0.8) 18 (4.6) 6 (1.5) 27 (6.9) total 223 (56.6) 133 (33.8) 38 (9.6) 394 (100) ÷ 2 = 44.12, df = 6 and p value = 0.000 body mass index (bmi) age total 19-40 41-64 65-87 under weight 2(0.5) 1(0.3) 2(0.5) 5(1.3) normal weight 85(21.6) 28(7.1) 11(2.8) 124(31.5) overweight 77(19.5) 50(12.7) 13(3.3) 140(35.5) obesity 51(12.9) 50(12.7) 11(2.8) 112(28.4) severe obesity 8(2.0) 4(1.0) 1(0.3) 13(3.3) total 223 (56.6) 133 (33.8) 38 (9.6) 394 (100) ÷ 2 = 19.83, df = 8 and p value = 0.01 blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), 2016 120april/june table 3: blood pressure, body mass index (bmi) and socio-economic status of respondents bmi blood pressure highest educational level occupation average monthly income bmi 1.000 rblood pressure sig. 0.145 1.000 0.004* rhighest educational level sig 0.103 -0.100 1.000 0.040* 0.047* roccupation sig -0.137 -0.115 0.426 1.000 0.006* 0.022* 0.000* raverage monthly income sig 0.272 0.084 0.206 -0.091 1.000 0.000* 0.098 0.000* 0.071 note: *.correlation is significant at the 0.05 level table 4: descriptive analysis of health promoting lifestyle and location of respondents health-promoting lifestyle sub-urban community (aba iya gani) rural community (koola) rural community (wanikin) mean ± (std. error) sd mean ± (std. error) sd mean ± (std. error) sd nutrition 3.18 0.02 0.38 3.08 0.08 0.29 3.14 0.03 0.35 physical activity 2.02* 0.05 0.81 2.08 0.23 0.79 2.38* 0.08 0.93 health responsibility 2.11 0.04 0.65 1.83 0.11 0.39 2.02 0.05 0.53 stress management 2.63 0.04 0.70 2.42 0.23 0.79 2.58 0.06 0.68 interpersonal relationship 2.78 0.04 0.56 3.08 0.19 0.67 2.65 0.07 0.75 spiritual value/belief 3.27* 0.03 0.53 3.75* 0.13 0.45 3.14* 0.05 0.61 *. significant at the 0.05 level table 5: correlate of blood pressure, body mass index (bmi) and health promoting lifestyle practices of respondents blood pressure bmi hpls spearman's rho blood pressure correlation coefficient 1.000 sig. (2-tailed) . bmi correlation coefficient .143 1.000 sig. (2-tailed) 0.004 . hpls correlation coefficient -.021 0.079 1.000 sig. (2-tailed) 0.671 0.118 . note: *.correlation is significant at the 0.05 level blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), 2016 121april/june figure 1: body mass index of the respondents figure ii – blood pressure profile of respondents blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), 2016 122april/june figure 3: diastolic blood pressure profile of respondents blood pressure, bmi and health promoting lifestyle joseph-shehu et al. res. j. of health sci. vol 4(2), 2016 123april/june page 1 page 2 page 3 page 4 page 5 page 6 page 7 page 8 page 9 page 10 page 11 page 12 403 forbidden forbidden you don't have permission to access this resource. apache/2.4.46 (ubuntu) server at www.ajol.info port 443 rjhs 11(2).cdr from the editor's desk editorial felicitation on appointment as vice-chancellor professor omolola o. irinoye, phd. chievers university appointed one of the editorial board members of the research a journal of health sciences as its first female vice chancellor, prof. omolola irinoye. professor irinoye's emergence came following the demise of prof. samuel aje, who passed on in december after assuming duty as the head of the institution in june 2020. the ondo state-based private university ratified the appointment of irinoye at a special council meeting of the institution. in her acceptance speech, professor irinoye promised to contribute her quota to the growth of the 15-yearold institution. “this is god's business and assignment, and i look forward to a good working relationship with the council, senate, management, all frontline officers, and indeed, all staff and students to fulfill god's purpose for each and everyone, as well as the purpose of establishment of the institution.” profile of professor omolola. o. irinoye, phd, rn, rm, rphn omolola was born 66 years ago by mr samuel bolarinde oni and mrs elizabeth aina oni from imesi-ile, osun state. she had her primary education from methodist primary school, oyo, (1969), her secondary education from imesi-ile high school, imesi-ile (1975). she started her nursing education from the school of nursing, university college hospital ibadan (1980) and proceeded to the university of ibadan where she had her bachelor of science in nursing degree (1984). she had her masters degree in nursing from the obafemi awolowo university (1991) and another masters degree in women, development and administration from university of york, york, united kingdom as a chevening scholar (1998). she had her phd in nursing from the university of kwazulu-natal, durban south africa (2005). she also had the international visiting scholar's program certificate from the university of maryland school of nursing, office of global health, university of maryland, usa (2013). she practiced as a staff nurse at the university college hospital, (uch) briefly before her university education and worked in private practice for some years after her nysc before advancing her education. she joined the obafemi awolowo university, ile-ife as lecturer ii and rose through the ranks to become a professor of community-public health nursing in 2013. she is registered nurse-midwife-public health nurse. she had many distinctions, fellowships and other awards at all levels of her education from the school of nursing, through her university education and thereafter. these include the abbot laboratory award in nutrition, school of nursing, uch, ibadan, (1980); the bronze academic editor’s desk research journal of health sciences res. j. health sci. vol 11(2), june 2023 180 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.11 medal of the school of nursing, uch, ibadan (1980); the departmental award, department of nursing, university of ibadan, ibadan, (1984); award for an outstanding piece of master's work given by the centre for women's studies, university of york, york, u.k. (1999); federal government scholarship award (1989/90); the british chevening scholarship award (1997/98); the carnegie fellowship award for female academic staff of the centre for gender and social policy studies, obafemi awolowo university, ile-ife (2004). she was also among the few national trainers in distance learning from an award by the british council in conjunction with the national universities commission in 2011. at the national level, she had the nigerian healthcare excellence award nursing and midwifery excellence award of the year in 2018. she has won some research grants over the years. some of these include the visiting researcher's grant of the medical research council of south africa (2002); council for the development of social science research in africa (codesria) small grant for thesis writing (2004); the hiv research trust grant, u.k. (2004). she also recently got the french embassy “research in health, innovation, information and artificial intelligence” fspi (rs3i) project grant for oau to work on e-health systems for strengthening health literacy, promotion, screening and health care access for population groups (2022). her specialty of practice and interest is public/community health nursing though she teaches, conducts research, mentors and supports service delivery across all specialties in nursing. as a resource, she has contributed to the establishment, upgrade and implementation of nursing programmes at the undergraduate and postgraduate levels nationally and regionally. she has provided leadership as the head of her department in the past and has supported the establishment of new departments of nursing and upgrading of undergraduate and postgraduate programmes in nursing in many universities in nigeria. as a certified trainer for distance learning education by the national universities commission and has facilitated several trainings for capacity building for the deployment of e-learning in open and distance learning for the centre for distance learning, obafemi awolowo university, ile-ife and for further development of the nursing programme of the national open university of nigeria. she is collaborating with institutions, organizations, agencies and communities to drive improved and quality access to nursing education and health care services adopting the blended learning approach and technology moderated health care delivery approach. she is actively collaborating with others in developing software to enhance health promotion and access to health care for vulnerable populations while promoting research and capacity building for the utilization of such at the community level. she has served as consultant to many international, national, and local organizations on projects, programmes and service conception, development and evaluation for many years in the areas of sexual & reproductive health, especially during the early stage of emergence of hiv and aids in nigeria. nationally, she contributed to the development of the national plan of action for care and support for orphans and vulnerable children in nigeria and has worked with core organizations that mobilized for care and support to reduce the burden of hiv and aids in the country for many years. she is currently working as the lead consultant to the federal ministry of women affairs to conduct a national survey on the status of vulnerable children in nigeria. she is a gender and human right activist and continues to participate in advocacy and capacity building interventions in all these areas especially as such contribute to health and health care access. as a scholar, she co-authored a book on leadership roles of female students in nigerian tertiary institutions and contributed to a book on responses and coping strategies to the hiv/aids epidemic in africa. she has over 80 publications in reputable national and international journals and eight (8) technical reports. she has participated in several national and international res. j. health sci. vol 11(2), june 2023 181 felicitation with prof omolola o.irinoye on appointment as vice chancellor conferences, workshops and seminars. she has conducted several workshops building capacities for research, curriculum enhancement, education/training, programme development and service delivery for health and social services. she served as a training specialist with the new york university rory meyers college of nursing in the human resource for health project at the school of nursing and midwifery of the college of medicine and health sciences, university of rwanda for 2 years. she has supervised 23 masters students and five phd students in nursing and co-supervised some others in social science programmes. she has served as the head of department of nursing science, obafemi awolowo university, ileife on three occasions for periods spanning between one and four sessions. she has also served in many committees at the faculty, college and university levels. she was principally responsible for the establishment of the department of nursing in the college of health sciences, osun state university. she spent her sabbatical leave and accumulated leave with us in other to achieve this and also to get the programme accredited by both the national universities commission and the nursing and midwifery council of nigeria. she diverted all her energy, experience and academic connections into performing this great feat within the shortest possible time. she helped the university to recruit her qualified students and mentees with the requisite qualifications to ensure adequate staffing of the department for teaching and accreditations. in the process of doing this personal money and resources were expended and we could decipher that she derives joy from rendering such selfless services. she worked round the clock with her mentees and the college staff to the extent that she was nicknamed “one woman riot squad” our b.nsc programme has blossomed so much that our nursing graduates are well sought after and the programme is one of the most highly subscribed programmes in the university. she is a foundation member of the editorial board of the official journal of uniosun college of health sciences, the research journal of health sciences which she has continued to promote beyond the shores of nigeria. even now that she is a vice chancellor she still responds promptly to all editorial board assignments. we appreciate her, for her diligence, resourcefulness, resilience and for being a goal getter. she believes very much that with god all things are possible and would say work hard, play your own role very well and never give up. we felicitate with her on her recent appointment as the vice chancellor of achievers university. she is an achiever herself and has gone to head that university with the spirit of an achiever so we pray that god will crown all her efforts with resounding success and that university will grow in leaps and bounds in jesus name. amen. on behalf of the editorial board of the research journal of health sciences, all the staff and students of the college of health sciences, osun state university; we say, congratulations to our indefatigable board member, friend, mentor, selfless nurse educator, achiever, team player, a stabilizer of the health team and a goal-getter who is very proud of her profession. professor akinwusi p.o. editor, research journal of health sciences, college of health sciences, osun state university, osogbo, nigeria res. j. health sci. vol 11(2), june 2023 182 felicitation with prof omolola o.irinoye on appointment as vice chancellor rjhs 11(3).cdr relevance and challenges of neuroimaging for childhood tuberculous meningitis diagnosis in a resource-constraint country: a case report and literature review 1 2 1 1 2 *ibraheem, r.m. , ariyibi, s.o. , gobir, a.a. , johnson, a.r. , yusuf, m.j. , 2 adeleke, n.a. abstract objective: tuberculous meningitis (tbm) may be an undiagnosed cause of childhood mortality or neurologic sequelae. cranial computed tomography (ct) scan remains a relevant diagnostic and prognostic tool amidst negative cerebrospinal fluid or sputum findings for tuberculous meningitis (tbm) diagnosis. delays in diagnosis and treatment increase morbidity in resource-constraint countries. case report: a seven-year-old boy was referred with three weeks history of fever, progressive body weakness, aphasia and unconsciousness (three days). he had right cranial nerve iii palsy, generalized hypertonia, and hyperreflexia in right lower limbs. all tuberculosis tests were negative except the cranial ct findings of leptomeningeal enhancement with basilar involvement and evidence of obstructive hydrocephalus. he was managed with anti-tuberculous drugs, prednisolone, ventriculoperitoneal shunt, and physiotherapy, and made a significant recovery after a year of anti-tuberculosis treatment. conclusion: the cranial ct scan findings facilitate tbm diagnosis for which prompt treatment commencement is crucial for a good outcome. keywords: tuberculous meningitis; extrapulmonary tuberculosis; children; neuroimaging; nigeria *corresponding author ibraheem, r.m. email: rasheedahbidmus@yahoo.com or ibraheem.rm@unilorin.edu.ng 1 department of paediatrics and child health, university of ilorin, and university of ilorin teaching hospital, ilorin, nigeria 2 department of paediatrics and child health, university of ilorin teaching hospital, ilorin, nigeria received: september 27, 2022 accepted: april 23, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0002-3960-9740 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.6 case report research journal of health sciences res. j. health sci. vol 11(3), september 2023 238 pertinence et défis de la neuroimagerie pour le diagnostic de la méningite tuberculeuse de l'enfant dans un pays à ressources limitées : à propos d'un cas et revue de la littérature 1 2 1 1 2 *ibraheem, r.m. , ariyibi, s.o. , gobir, a.a. , johnson, a.r. , yusuf, m.j. , 2 adeleke, n.a. résumé objectif de l'étude: la méningite tuberculeuse (mbm) peut être une cause non diagnostiquée de mortalité infantile ou de séquelles neurologiques. la tomodensitométrie (tdm) crânienne reste un outil diagnostique et pronostique pertinent parmi les résultats négatifs du liquide céphalo-rachidien ou des expectorations pour le diagnostic de la méningite tuberculeuse (mbm). les retards de diagnostic et de traitement augmentent la morbidité dans les pays à ressources limitées. rapport de cas: un garçon de sept ans a été référé avec trois semaines d'antécédents de fièvre, de faiblesse corporelle progressive, d'aphasie et d'inconscience (trois jours). il avait une paralysie du nerf crânien droit iii, une hypertonie généralisée et une hyperréflexie des membres inférieurs droits. tous les tests de tuberculose étaient négatifs, à l'exception des résultats du scanner crânien d'un rehaussement leptoméningé avec atteinte basilaire et signes d'hydrocéphalie obstructive. il a été pris en charge avec des médicaments antituberculeux, de la prednisolone, un shunt ventriculopéritonéal et de la physiothérapie, et a fait un rétablissement significatif après un an de traitement antituberculeux. conclusion : les résultats de la tomodensitométrie crânienne facilitent le diagnostic de mbm pour lequel le début rapide du traitement est crucial pour un bon résultat. mots-clés: méningite tuberculeuse, tuberculose extra pulmonaire, enfants, neuroimagerie, nigéria *corresponding author ibraheem, r.m. email: rasheedahbidmus@yahoo.com or ibraheem.rm@unilorin.edu.ng 1 department of paediatrics and child health, university of ilorin, and university of ilorin teaching hospital, ilorin, nigeria 2 department of paediatrics and child health, university of ilorin teaching hospital, ilorin, nigeria received: september 27, 2022 accepted: april 23, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0002-3960-9740 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.6 rapport de cas research journal of health sciences res. j. health sci. vol 11(3), september 2023 239 introduction tuberculous meningitis (tbm) is often a fatal form of central nervous system (cns) tuberculosis (1). tuberculous meningitis causes extensive brain injury and, even with treatment, may result in permanent neuro-disability (1,2). estimating global tuberculosis (tb) prevalence in children is difficult due to under diagnosis and inadequate data, especially in developing countries (3). children below the age of 15 years constitute 12% of the total global tb cases of 10 million, with annual tuberculosis-related deaths of 40,000 (4). nigeria ranked sixth among the eight high-burden tb countries according to the world health organization (who), with a current incidence rate of 219 per 100,000 population (3). the global burden of tbm is not well defined, but the incidence is estimated at one percent of all tuberculosis cases (5), reportedly in direct relation to the incidence of pulmonary tuberculosis (5,6). it is most common in children aged less than four years and may occur many years after the infection due to rupture of subependymal tubercles discharging the tubercle bacilli into the subarachnoid space (6,7). the diagnosis of tbm requires a high index of suspicion, premised upon clinical presentation, progression of illness, and the local tb endemicity. laboratory findings are usually inconsistent, which may delay treatment and worsen outcomes. the cerebrospinal fluid (csf) examination and culture remain the primary diagnostic tool; however, results could be atypical and misleading (7). the csf findings can also be normal in chemistry and cell count because the fluid is obtained proximal to the site of inflammation (6,7). indeed, the culture of a small volume of csf, as mostly done, may not demonstrate mycobacterium tuberculosis (7). in 2013, the who recommended the use of genexpert mtb/rif assay for extrapulmonary clinical specimens in children; however, its sensitivity for csf in tbm cases is still relatively low, though higher than bactec® culture (8,9). neuroimaging has a role in the diagnosis of tbm. brain computed tomography (ct) or magnetic resonance imaging (mri) reveals abnormal findings as the disease progresses such as basilar enhancement and hydrocephalus (7,10). early neuroimaging study and treatment commencement may be life-saving. this investigation is often a hurdle in resource-poor settings where getting a ct scan or mri may be problematic due to accessibility and affordability. we report a seven-year-old male child in whom a diagnosis of tbm was premised mainly on clinical presentation and brain ct findings and improved significantly on antituberculous treatment. this report highlights the relevance and challenges of accessing neuroimaging for the timely diagnosis of tbm in a resource-poor country. case report a.o, a seven-year-old boy, presented in 2020 at the emergency paediatrics unit of a tertiary centre in ilorin, nigeria, with three weeks history of high fever and progressive body weakness that was worse on the right side, and non-projectile, non-bilious vomiting. five days before the presentation, he became aphasic and lapsed into unconsciousness two days later—no history of cough, significant weight loss, or drenching night sweats. there was history of contact with an adult tuberculosis case. he received the bacille calmette-guérin (bcg) vaccine, and a bcg scar was present. before presentation to the tertiary centre, he had artemether injections for malaria and antibiotics for sepsis in a private hospital. at presentation, he was acutely illlooking, unconscious (glasgow coma score, gcs9/15), not pale, afebrile (axillary 0 temperature 36.0 c), not dehydrated, with no significant peripheral lymph node enlargement, and no pedal oedema. anthropometry (weight19kg, height-110cm) was normal for age and gender. central nervous system examination revealed an unconscious child with reactive pupils, right cranial nerve iii palsy, supple neck, negative meningeal irritation signs, generalised hypertonia, exaggerated reflexes on the right lower limbs and sustained ankle clonus on the same side. power was 2/5 on the right limbs and 3/5 on the left limbs. the respiratory and cardiovascular findings were normal, except for tachypnoea (respiratory rate of 50 cycles/minute) and tachycardia (pulse rate of 144 beats/minute). the abdominal, ear, nose, and throat (ent) examinations were normal. t h e i n i t i a l a s s e s s m e n t w a s a n intracranial space-occupying lesion, likely a cerebral abscess, for which we commenced antibiotics while awaiting investigations and results. however, by the third day of admission, he developed several episodes of generalised tonic convulsions, meningeal signs became positive, worsened gcs (5/15), global h y p e r t o n i a , i r r e g u l a r r e s p i r a t i o n , a n d hypertension. table 1 shows the results of the various investigations conducted. despite requesting a res. j. health sci. vol 11(3), september 2023 240 neuroimaging in tuberculous meningitis diagnosis ibraheem et al. cranial ct scan on the first day of admission, the cranial ct was not done till the fifth day of admission due to financial constraints. the brain c t s h o w e d l e p t o m e n i n g e a l a n d b a s a l enhancements with dilated ventricles [figure 1]. on the sixth day post-admission, the neurosurgeons inserted a ventriculoperitoneal shunt for the hydrocephalus. he commenced antituberculous drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) and prednisolone on the seventh-day post-admission. b y t h e s e c o n d w e e k a f t e r t h e commencement of antituberculous drugs, the gcs improved to 11/15, still hypertonic and aphasic. he regained full consciousness in the third week of admission and commenced physiotherapy. he was discharged home at the sixth week post-drug commencement, still aphasic, with cranial nerve iii palsy and hypertonia. after a year of antituberculous treatment, he walks short distances without support, interacts well with people, enunciates clearly but slowly, and has resumed school. he undergoes medical follow-ups at the neurology clinic. the parents gave informed consent for the publication of the report. discussion the early clinical features of tbm are non-specific, including fever, malaise, headache, anorexia, and recent weight loss (5,11). a high index of suspicion is often needed to make the diagnosis at this stage. a history of contact with an adult with tuberculosis usually heightens the suspicion (11), similarly reported in the index case. the duration of symptoms is usually greater than two weeks in about 50% of cases (7,11) the index case presented after three weeks of illness, having been managed for malaria and sepsis without any improvement. in a study among nigerian patients, the mean duration of illness before the presentation was 3.7 weeks (12) the index child had no signs of meningeal irritation at presentation though there was a rapid rate of progression of signs and symptoms within one week of admission (fourth week of illness). the initial absence of evidence of meningeal irritation, with a subsequent rapid deterioration, has been reported in tbm (5,7,11). the csf obtained from the index case was xanthochromic, which is a probable csf appearance previously reported (6,9) however, the normal glucose level and mildly elevated protein were not in keeping with expected levels in tbm (6,11). this csf finding is comparable to a prior nigerian report of normal csf glucose, and normal csf microscopy, culture, and sensitivity (12). however, it differs from an earlier report in zaria, nigeria, where 93.4% of the children with tbm had hypoglycorrhachia (13). the unusual clinical and laboratory features such as the absence of signs of meningeal irritation at presentation, normal csf glucose, microscopy, culture and sensitivity, and the negative csf genexpert result may lead to misdiagnosis or late diagnosis of tbm with an attendant high morbidity and mortality. cranial ct scan with contrast, or magnetic resonance imaging with gadolinium, is generally h e l p f u l i n t b m . f i n d i n g s i n c l u d e leptomeningeal and basilar enhancement consistent with meningeal inflammation and hydrocephalus (5,11,14), as similarly identified in the index case. other possible findings include i n f a r c t i o n , c e r e b r i t i s , t u b e r c u l o m a , o r calcification (5,11,14) however, the cranial ct scan may be normal in the early stages in approximately 30% of cases (11). brain mri remains the most sensitive neuroimaging compared to the ct scan for detecting tbm. the mri enhances features such as early infarcts, border zone encephalitis, cranial neuropathies, and leptomeningeal tubercles (5,11). in resource-poor countries where most patients lack access to health insurance and health expenses are out-of-pocket, it is common for patients to experience delays in getting the required cranial ct scan. moreover, the tertiary facilities either don't have the needed equipment, or it is nonfunctional, necessitating travel to a facility with the neuroimaging machine, causing transportation issues, further cost, and delay in diagnosis. all these serve as a barrier to timely tbm diagnosis and care. this challenge occurred in the index case whose ct scan was postponed for five days by financial constraints and at an outside facility due to non-functionality of the hospital's machine. multiple drug treatment is required to manage tbm, with drugs that adequately cross the blood-brain barrier to achieve a therapeutic concentration in the csf (). according to the national tuberculosis treatment guidelines, tbm t h e r a p y i n v o l v e s u s i n g t h e f i r s t l i n e antituberculous drugs for twelve months (15). we managed the patient per guidelines. conclusion a high index of suspicion is essential for d i a g n o s i n g t b m i n a r e s o u r c e p o o r environment. the presence of non-specific res. j. health sci. vol 11(3), september 2023 241 neuroimaging in tuberculous meningitis diagnosis ibraheem et al. symptoms such as fever, and headaches, lasting more than two to three weeks, with altered consciousness and h poor response to antibiotics should raise suspicion of tbm. the ct scan findings of basal or leptomeningeal enhancement and the presence of obstructive hydrocephalus strengthen the possibility of tbm. early treatment commencement is crucial for a good outcome. acknowledgement: the authors acknowledge the nurses and doctors in the emergency paediatrics unit who played a key role in the child's management. conflict of interest: the authors declare no conflict of interest. references 1. seddon ja, wilkinson r, van crevel r, figaji a, t h w a i t e s g e , tu b e r c u l o u s m e n i n g i t i s international research consortium. knowledge gaps and research priorities in tuberculous meningitis. wellcome open research. 2019; 4 : 1 8 8 https://doi.org/10.12688%2fwellcomeopenres.1 5573.1 2. wilkinson rj, rohlwink u, misra uk, van crevel r, mai nt, dooley ke, et al. tuberculous meningitis. nat rev neurol. 2017;13(10):581-98. https://doi.org/10.1038/nrneurol.2017.120 3. world health oorganization. global tuberculosis report 2020. geneva: world health organization; 2 0 2 0 . https://www.who.int/publications/i/item/978924 0013131 (accessed 16 march, 2022) 4. chakaya j, khan m, ntoumi f, aklillu e, fatima r, mwaba p, et al. global tuberculosis report 2020–reflections on the global tb burden, treatment and prevention efforts. int j infect dis. 2 0 2 1 d e c 1 ; 1 1 3 : s 7 1 2 . https://doi.org/10.1016/j.ijid.2021.02.107 5. thwaites ge, van toorn r and schoeman j. tuberculous meningitis: more questions, still too few answers. lancet neurol. 2013; 12: 999-1010. https://doi.org/10.1016/s1474-4422(13)70168-6 6. garg rk. tuberculous meningitis. acta neurol s c a n d . 2 0 1 0 ; 1 2 2 : 7 5 9 0 . h t t p s : / / d o i . o r g / 1 0 . 1 1 1 1 / j . 1 6 0 0 0404.2009.01316.x 7. thwaites g, chau tt, mai nt, drobniewski f, mcadam k, farrar j. tuberculous meningitis. j neurol, neurosurg psychiatry. 2000; 68: 289-99. http://dx.doi.org/10.1136/jnnp.68.3.289 8. world health organization. automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: xpert mtb. world health o r g a n i z a t i o n , 2 0 1 3 . https://apps.who.int/iris/bitstream/handle/10665/ 112472/9789241506335_eng.pdf 9. bhatia r, dayal r, jindal s, agarwal d, goyal a. genexpert for diagnosis of tubercular meningitis. i n d i a n j p e d i a t r . 2 0 1 6 ; 8 3 : 1 3 5 3 5 . https://doi.org/10.1007/s12098-016-2096-0 10. al-edrus s, muda s, nordiyana m, merican j. tuberculous meningitis: neuroimaging features, clinical staging and outcome. neuroradiol j. 2 0 0 7 ; 2 0 : 5 1 7 2 4 . https://doi.org/10.1177/197140090702000508 11. aulakh r and chopra s. pediatric tubercular meningitis: a review. j pediatr neurosci. 2018; 1 3 : 3 7 3 . https://doi.org/10.4103%2fjpn.jpn_78_18 12. komolafe ma, sunmonu ta, esan oa. tuberculous meningitis presenting with unusual clinical features in nigerians: two case reports. c a s e s j . 2 0 0 8 ; 1 : 1 5 . https://doi.org/10.1186/1757-1626-1-180 13. taqi a, anene e and naida a. tuberculous meningitis in children at zaria, nigeria: a review of 16 cases. public health. 1986; 100: 2427https://doi.org/10.1016/s0033-3506(86)800749 14. botha h, ackerman c, candy s, carr ja, griffithrichards s, bateman kj. reliability and diagnostic performance of ct imaging criteria in the diagnosis of tuberculous meningitis. plos one. 2 0 1 2 ; 7 : e 3 8 9 8 2 . https://doi.org/10.1371/journal.pone.0038982 15. federal ministry of health, nigeria. national tuberculosis and leprosy control programme th (ntblcp) workers' manual, revised. 5 edition, abuja fmoh, 2010 res. j. health sci. vol 11(3), september 2023 242 neuroimaging in tuberculous meningitis diagnosis ibraheem et al. res. j. health sci. vol 11(3), september 2023 243 table 1. investigations done and their findings investigations findings white blood count, wbc total: 19,000/µl, elevated. neutrophils: 92%, neutrophilia lymphocytes: 8%. malaria parasite not seen on film blood culture negative hiv test negative electrolyte, urea and creatinine essentially normal findings. csf microscopy colour: xanthochromic wbc: < 5 cells per high power field no web/clot formation when allowed to stand for some minutes. csf biochemistry normal glucose level, mildly elevated protein (73mg/dl) the ratio of csf glucose to serum glucose 0.6 csf genexpert negative for mycobacterium tuberculosis mantoux test non-reactive brain ct scan leptomeningeal enhancement with basilar involvement and evidence of obstructive hydrocephalus. figure 1. the brain ct scan of the child with tbm. this contrast-enhanced axial image shows some distinct features of tbm, the orange and black arrows show leptomeningeal and basal enhancements, respectively and the blue arrows show dilated ventricles (hydrocephalus). neuroimaging in tuberculous meningitis diagnosis ibraheem et al. rjhs 11(1).cdr uterine rupture; an obstetric tragedy still with us. a six year review of cases in a specialist hospital, northwest nigeria 1 2 3 4 mohammed, b.a. , *oyaramade, a. , ogunlaja a.o. , ogunlaja i.p. *corresponding author dr oyaromade a, email address-abidemioya@yahoo.com 1 department of obstetrics and gynaecology, federal medical centre, gusau, nigeria 2 department of obstetrics and gynaecology ahmad sanni yarima bakura specialist hospital, gusau, nigeria 3 department of obstetrics and gynaecology, bowen university teaching hospital, ogbomoso, nigeria 4 department of obstetrics and gynaecology, general hospital, ilorin, nigeria abstract background: uterine rupture is a major cause of perinatal and maternal morbidity and mortality, it usually has a devastating outcome if not promptly attended to. the study determined the trends, risk factors, feto-maternal outcomes following uterine rupture as seen at asybsh. method: the study was a retrospective review of cases of uterine rupture managed at the asybsh between march 2015 and february 2021. records of the theatre and labour wards were searched and the folders of patients with uterine rupture were retrieved. relevant information such as socio-demographic variables, booking status, clinical presentations were retrieved and entered into a structured profoma. results: deliveries in the hospital during the period were eleven thousand four hundred and twenty (11,420), out of which one hundred and fifty-six (156) were complicated by uterine rupture giving an overall incidence of 1.36 percent or one in every seventy-four (74) deliveries. uterine rupture occurred mainly among women of low socio-economic status and high parity. the major predisposing factors were injudicious use of oxytocin (62.8%) prolonged obstructed labour (19.8%), previous caesarean section scar (8.5%), use of misoprostol (5.3%), fundal pressure (2.4%) and unexplained factors (1.2%) conclusion: uterine rupture remains a devastating obstetric calamity with a high incidence. injudicious use of oxytocin, prolonged obstructed labour and previous caesarean section scar were the three leading predisposing factors identified in this study. keywords: uterine rupture, obstetric tragedy, cases received: may 28, 2022 accepted: january 7, 2023 published: april 17, 2023 orcid-no: https://orcid.org/0000-0002-3420-754x original article research journal of health sciences res. j. health sci. vol 11(1), march 2023 60 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.7 rupture utérine: une tragédie obstétricale toujours accompagnée; examen de six ans de cas dans un hôpital spécialisé, nord-ouest du nigéria résumé contexte général de l'étude : la rupture utérine est une cause majeure de morbidité et de mortalité périnatales et maternelles, elle a généralement une issue dévastatrice si elle n'est pas prise en charge rapidement. objectif de l'étude: l'étude a déterminé les tendances, les facteurs de risque, les résultats fœto maternels suite à une rupture utérine tels qu'observés à l'asybsh. méthode de l'étude: l'étude était une revue rétrospective des cas de rupture utérine pris en charge à l'asybsh entre mars 2015 et février 2021. les dossiers du bloc opératoire et des salles de travail ont été fouillés et les dossiers des patientes avec rupture utérine ont été récupérés. les informations pertinentes telles que les variables socio-démographiques, le statut de réservation, les présentations cliniques ont été récupérées et saisies dans un profoma structuré. résultat de l'étude: les accouchements à l'hôpital au cours de la période ont été de onze mille quatre cent vingt (11 420), dont cent cinquante-six (156) ont été compliqués par une rupture utérine soit une incidence globale de 1,36 pour cent soit un sur soixante-dix -quatre (74) livraisons. la rupture utérine est survenue principalement chez les femmes de statut socio-économique bas et de parité élevée. les principaux facteurs prédisposants étaient l'utilisation peu judicieuse d'ocytocine (62,8 %), une dystocie prolongée (19,8 %), une cicatrice de césarienne antérieure (8,5 %), l'utilisation de misoprostol (5,3 %), la pression fundique (2,4 %) et des facteurs inexpliqués (1,2 % ) conclusion: la rupture utérine reste une calamité obstétricale dévastatrice avec une incidence élevée. l'utilisation peu judicieuse d'ocytocine, la dystocie prolongée et les cicatrices de césarienne antérieures étaient les trois principaux facteurs prédisposants identifiés dans cette étude. mots-clés : rupture utérine, tragédie obstétricale, cas 1 2 3 4 mohammed, b.a. , *oyaramade, a. , ogunlaja a.o. , ogunlaja i.p. *corresponding author dr oyaromade a, email address-abidemioya@yahoo.com 1 department of obstetrics and gynaecology, federal medical centre, gusau, nigeria 2 department of obstetrics and gynaecology ahmad sanni yarima bakura specialist hospital, gusau, nigeria 3 department of obstetrics and gynaecology, bowen university teaching hospital, ogbomoso, nigeria 4 department of obstetrics and gynaecology, general hospital, ilorin, nigeria received: may 28, 2022 accepted: january 7, 2023 published: april 17, 2023 orcid-no: https://orcid.org/0000-0002-3420-754x article original research journal of health sciences res. j. health sci. vol 11(1), march 2023 61 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.7 grandmultiparity, low socio-economic status, poor health seeking behaviours since many of these patients are unbooked, lack of skilled birth attendants at deliveries. (7,9,11,12,13,14,15). materials and methods the study was conducted at the aysbsh located in gusau, the state capital of zamfara state; north-western nigeria with a population of about 3 million people. the hospital is a 300 bed state owned health institution. it offers obstetric emergencies care facilities on 24-hour coverage. the hospital offers obstetric services to patients from zamfara, sokoto and kastina states as well as niger republic. this was a six-year retrospective review of all cases of uterine rupture seen between march 2015 and february 2021 at the ahmad sanni yariman bakura specialist hospital gusau. ethical approval was sought and c l e a r a n c e o b t a i n e d . ( r e f n u m b e r asybsh/sub/232/vol 1). records of the theatre and labour wards were searched and the folders of patients with uterine rupture were retrieved. relevant information such as sociodemographic variables, booking status, clinical presentations were retrieved and entered into a structured profoma. data obtained were entered and analyzed using spss software version 21.0 (spss, chicago, il usa). descriptive statistics was obtained through frequencies and cross tabulations. results were then presented using percentages, tables and charts. results during the study, there were 11,420 deliveries in the hospital out of which were 156 cases of uterine rupture giving an overall incidence of 1.36% or 1 in 74 deliveries. the yearly incidence as well as trends in the occurrence of uterine rupture is shown in figure 1. the highest prevalence of uterine rupture was in 2019 (1.4%) and lowest prevalence was in 2015 (0.85%). therefore, upward trends in the incidence of uterine rupture have been noted since inception of the hospital. the mean age of patients was 30.7 years (sd ± 7.25). more than a third of the women 54(34.6%) were among the age group of 30-34 years as shown in table 1 majority of the women were of high parity with 85 (54.5%) having a parity of four and above while 26 (16.7%) had parity of 2 or less as shown in table 2 below. majority of the women149 (95.5%) were introduction every year, worldwide, about 500,000 women die from complication of pregnancy, labour and puerperium, significant number of which occur in developing and less developed countries (1,2,3). nigeria contributes only 2 percent of the world's population, but regrettably contributes about 10 percent of world's maternal mortality (3,5).uterine rupture as one of the complication of pregnancy and labour contributes significantly to maternal and perinatal mortality (6). uterine rupture remains a rare occurrence in developed countries, but the incidence continues to increase in nigeria and other sub-saharan africa countries as a result of prolonged obstructed labour and injudicious use of oxytocin. reported incidences are 1 in 106 ilorin.(2) from accra in ghana, an incidence of 1 in 124 was reported while in developed countries, incidence of 1 in 1148 and 1 in 2250 deliveries were reported (3,5,6). the wide gaps above might n o t b e u n c o n n e c t e d w i t h p o o r h e a l t h infrastructures, level and motivation of health personals, poverty, illiteracy and poor health s e e k i n g b e h a v i o u r s i n d e v e l o p i n g countries.(1,2,3) uterine rupture is one of the devastating obstetric complications with enormous risk not only to the fetus but also the mother. maternal and perinatal mortality in developing countries, nigeria inclusive are mainly due to uterine rupture and other causes of post-partum hemorrhage (1,2,3). uterine rupture not only causes maternal and /or fetal deaths, but can also lead to obstetric fistula, divorce psychological trauma, septicemia, severe anaemia, blood transfusion complications and other among uterine rupture survivors. there are varying risk factors predisposing to uterine rupture (7). the incidence of uterine rupture in nigeria is on the increase and health infrastructures remain abandoned coupled with the high rate of poverty in the country. in a previous study in lagos uterine rupture was found to occur in about 5.38 per 1000 deliveries, with a perinatal mortality exceeding 90% and case fatality of about 30% (8). other studies have consistently demonstrated a high incidence of perinatal mortality when uterine rupture is considered (9). majority of cases of uterine rupture occur at term, with a spontaneous rupture being the commonest (10). some major risk factors for uterine rupture include injudicious use of uterotonics, uterine scars, prolonged obstructed labour, res. j. health sci. vol 11(1), march 2023 62 uterine rupture: a review of obstetric tragedy cases mohanned et al. unbooked while only 7 (4.5%) were booked in the specialist hospital. a significant portion of the women 137 (87.8%) had no formal education while only 3 (1.9%) had tertiary form of education. majority of the women 145 (93.0%) were housewives, 9 (5.8%) were trades while only 2 (1.2%) were civil servants. among the seven (7) patients that booked at the specialist hospital only 2 (28.6%) of them received intrapartum care at the centre while the remaining five (5) had unsupervised labour at home. majority of the unbooked patients 137 (92.0%) were referred from primary health centres and general hospitals while only 12 (8.0%) laboured at home with or without traditional birth attendants. from the study, injudicious use of oxytocin was the commonest predisposing factors, occurring in 62.8% of cases of uterine rupture, followed by prolonged obstructed labour (19.8%) while previous caesarean section scar accounted for (5.3%), mainly in booked patients. fundal press accounted for (2.4%) there was no identifiable risk factor among (1.2%) of the women. out of the 156 cases with uterine rupture, 151 of them had surgery while the remaining 5 patients died before any surgical intervention. 34 (22.5%) had repair only in view of low parity, while 37 (24.5%) had repair with bilateral tubal ligation. majority of the patients 68 (45.0%) had subtotal hysterectomy due to the extent of the rupture and high parity and completion of family size as shown in table 3. thirty-one (31) maternal deaths were recorded representing maternal case fatality rate of 19.9%. all the women who died were unbooked and all had intrapartum care in places other than the specialist hospital there were 152 perinatal deaths, giving a fetal case fatality rate of 97.4%. all the babies that survived were booked and had intrapartum care at the specialist hospital. majority of the maternal deaths 27 (77.4%) were due to hypovolemic shock as a result of massive blood loss, 5 patients (16.1%) had acute renal failure while 2 (6.5%) died from septicaemia. discussion one of the major causes of maternal and perinatal mortality in developing countries. (2,3). an incidence of 1 in 74 deliveries reported in this study is higher than previous studies in other northern parts of nigeria (7,12) and significantly higher than incidence reported in southernnigeria (4). the trend is similar in other african countries like uganda, namibia, ethiopia and burundi (4,5,6). the yearly trend also shows that uterine rupture has been on the increase in the past 5 years in contrast from findings from developed countries where uterine rupture is a rare obstetric complication [6]. the significantly high incidence of uterine rupture recorded in this study may not be unconnected with the fact that the facility is a referral centre for the 24 general hospitals, the over 30 primary health centres in the state as well as neighboring states. the high rate of un-booked women in this study is similar to findings from other studies within and outside nigeria; where high parity was found to contribute greatly to the incidenceof uterine rupture, (1,2,3,4), unlike findings in the other studies where low parity was observed(3,5). low socio-economic status and lack of formal education as factors indirectly predisposing to uterine rupture were observed in this study where 145 (93.0%) were housewives and 137 (87.8%) has no formal education, higher that values obtained from southern nigeria (3,4,5). majority of the women had no formal education and as well belonged to the low socioeconomic status which might have contributed significantly to the poor health seeking behaviours of the women. uterine rupture amongst paturients below nineteen(19years) accounted for 5.2% of the cases identified in our study. injudicious use of oxytocin, prolonged obstructed labour and previous caesarean section in that order were the leading causes risk factors to ruptured uterus as (6,7.8.9), reported in previous studies. the limitation of knowledge and skills on use of oxytocin to high risk patients among health workers in the peripheral health centres could be demonstrated in this study. the definitive treatment for uterine rupture remains surgical intervention. however, factors like clinical state of the patient, the extent to the rupture, fertility desirability and skill of the surgeon may determine the type of surgical intervention. from this study 47.0% had uterine repair with or without bilateral tubal ligation while 53% had their uterus removed in contrast to findings in southern nigeria and abuja where most patients had uterine repair only (1,2,3,4). this may also be due to the higher parity and extensive uterine ruptures identified in our study. the case fatality rate found in this study is higher than findings from other studies from res. j. health sci. vol 11(1), march 2023 63 uterine rupture: a review of obstetric tragedy cases mohanned et al. north central and southern nigeria (2,3,4,5). the higher case fatality rate might be due to low socio-economic status, illiteracy, poor health seeking behaviours, late presentation, inadequate blood bank system, poor health infrastructure and lack of skilled birth attendants at delivery. perinatal mortality rate was 97.4% in this study and comparable to reports from other parts of nigeria, which might be due to late presentation, delayed diagnosis from referringentres, and transportation problems (11,12,13,14,15). pregnant women should be discouraged from having unsupervised home delivery in order to minimize risk of uterine rupture and other obstetric complications. partograph usage should be encouraged for monitoring of labour in all tiers of health care delivery. blood bank systems must be promoted in primary, secondary and tertiary health centres to improve access to blood transfusion in emergency circumstances. conclusion uterine rupture remains a devastating obstetric calamity and the incidence is on the increase as observed in this study and still associated with high maternal and perinatal mortality. injudicious use of oxytocin, prolonged obstructed labour as well as pervious caesarean section scar are three leading predisposing factors to uterine rupture while late presentation, poor health infrastructures, poor blood bank system are contributing to high maternal and perinatal mortality. therefore, advocacy and mass education on antennal booking and health seeking behaviours should be intensified. government should improve both health infrastructures as well as motivating health workers in nigeria. acknowledgement: this is to acknowledge the support received from the management of the hospital in carrying out this research as well as members of staff in the department of health information and maternity unit of the hospital. funding/sponsorship: none conflict of interest: no conflict of interest. references 1. akaba go, onafowokan o o,hiong ra, omonua ak, ekele ba: uterine rupture trends and feto-maternal outcome in a nigerian teaching hospital, nig j med, 2013, 22(4) 304308 2. abiodun p, aboyeji ap, ijaiya ma, yahaya ur. ruptured uterus. a study of 100 consecutive cases in ilorin. nigeria. j obstet gynaecol res. 2001; 27(6): 341-348 3. astatikie g, limenih, ma, kebede m. maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture. bmc, pregnancy childbirth 2017, 117 4. olatunji ao, sule odu ao, adefuyo po: rupture uterus at sagamu, nigeria post grad med j 2002; 9(4): 235-9 5. chiossi gd, amico r,tramontano al, sampogna v, laghi v, facchineti f (2021) prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labour induction with pge 2. a systematic review and meta-analysis. plos one 16 (7): e0253957 6. ebeigbe pn, enabudoso e, ande ab: ruptured uterus in a nigerian community. a study of sociodemographic and obstetric risk factors. acta obstet gynaecol scand 2005: 20: 154-6 7. ekele ba, audu lr, muyibi s. uterine rupture in sokoto, northern nigeriaare we winning? afr j med sci 2000; 29: 191-3 8. fabanwo a, akinola o, tayo a, akpan e. rupture of the grand uterus. a never-ending obstetric disaster! the ikeja experience. internet j gynaecol obstet 2008; 10:2. 9. turner m.j. uterine rupture, best pract: res clin obstet gynaecol 2002:16: 69-79. 10. amanael g, mengiste mm. rupture uterus – eight years' retrospective analysis and causes and management outcome in adigrat hospital, tigray region,ethiopia. j health dev 2002; 16; 241-5. 11. igwe gbe ao, eleje gu, ude-gbunam oi. risk factors and perinatal outcome of uterine rupture in a low-resource setting. niger med j 2013; 54:415-9 12. agu o, yakasi i, muhammed z, saidu a. uterine rupture; a majority contributor to obstetric morbidity in kano, northern nigeria.int j gynaecol obstet 2009; 107:539-546. 13. ali aa, adam i. maternal and perinatal outcomes of uterine rupture in the kassala hospital, east sudan: 2006-2009, j obstet gynaecol 2011; 31 (1); 48-9. 14. oladapo ot, durojaiye bo. quanlity of care for ruptured uterus in sagamu, nigeria. j obstet gynaecol, 2010; 5(2); 17-20. 15. osemwenkha p.a, osaikhuwoumwan j.a. 10year review of uterine reupture and outcome in the university of benin city nigeria. j surg sci 2016:26;1-4 res. j. health sci. vol 11(1), march 2023 64 uterine rupture: a review of obstetric tragedy cases mohanned et al. res. j. health sci. vol 11(1), march 2023 65 1.4 . . . 1.3 . . 1.2 1.1 1.0 0.9 0.8 . 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.1 0 2015 2016 2017 2018 2019 2020 figure 1: trends in the annual incidence of uterine rupture table 1: age distribution age number percentage 10-14 2 1.3 15-19 6 3.9 20-24 14 9.0 25-29 40 25.6 30-34 54 34.6 35-39 22 14.1 40-44 18 11.5 table 2: parity of women parity number percentage % 0 5 8 3.2 5.1 1 13 8.3 2 17 10.9 3 28 17.9 4 39 25.0 =5 46 29.6 table 3: types and frequency of surgical procedures surgery number % repair of ruptured uterus 34 22.5 repair +bilateral tubal ligation 37 24.5 subtotal abdominal hysterectomy 68 45.0 total abdominal hysterectomy 12 8.0 total 151 100 uterine rupture: a review of obstetric tragedy cases mohanned et al. rjhs 11(1).cdr a cliniccopathologic correlation study of 2396 histopathologic skin biopsy specimens 1 2 3 *anaba, e.l. , dawodu, o.o. , arabambi, a. abstract clinicopathologic correlation of skin biopsies is relevant in a dermatology patient's management. the study aimed to conduct a clinicopathologic corellation of skin samples. methods: retrospective cross-sectional analysis of 2,396 skin biopsy specimens submitted between january 2015 and december 2021. clinicopathologic correlation was done on only samples which had definitive clinical and histopathologic diagnosis. data was analyzed with the r studio. results: a total number of 2,396 skin biopsies were received from 2319 patients. clinicopathologic correlation was conducted on 1,831 samples which had both definitive clinical and histopathological diagnoses. a definitive clinicopathologic correlation was obtained in 66.8% (1224/1831) and this was 64.8% for benign tumours, 60.4% for malignant tumours, 66.7% for inflammatory diseases, 70.8% for infections, 85.5% for scalp and hair disorders and 50% for dermal deposits. conclusion: clinicopathologic correlation of skin biopsies is high. correlation is better with inflammatory diseases compared to neoplastic diseases. key words: histopathology, dermatopathology, clinicopathologic correlation, skin biopsy, skin diseases. *corresponding author email: ehianaba@yahoo.com 1 department of medicine, lagos state university college of medicine/ lagos state university teaching hospital, lagos, nigeria. 2 department of anatomic and molecular pathology, college of medicine, university of lagos, lagos, nigeria. 3 calgary stroke program, department of clinical neurosciences, university of calgary, alberta, canada. received: february 9, 2022 accepted: april 7, 2023 published: april 19, 2023 background: anaba, e.l. orcid-no: https://orcid.org/0000-0002-4502-4482 original article research journal of health sciences res. j. health sci. vol 11(1), march 2023 18 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.3 une étude de corrélation clinicopathologique de 2396 échantillons de biopsie cutanée histopathologique résumé contexte général de l'étude: la corrélation clinicopathologique des biopsies cutanées est pertinente dans la prise en charge d'un patient en dermatologie. l'étude visait à mener une étude clinicopathologiquecorrélation d'échantillons de peau. méthode de l'étude: analyse transversale rétrospective de 2 396 échantillons de biopsie cutanée soumis entre janvier 2015 et décembre 2021. la corrélation clinicopathologique a été effectuée uniquement sur les échantillons qui présentaient un diagnostic clinique et histopathologique definitive. les données ont été analysées avec le studio r. résultat de l'etude: un nombre total de 2 396 biopsies cutanées ont été reçues de 2 319 patients. la corrélation clinicopathologique a été réalisée sur 1 831 échantillons qui présentaient à la fois des diagnostics cliniques et histopathologiques définitifs. une corrélation clinicopathologique définitive a été obtenue dans 66,8% (1224/1831) et celle-ci était de 64,8% pour les tumeurs bénignes , 60,4% pour les tumeurs malignes , 66,7% pour les maladies inflammatoires, 70,8% pour les infections, 85,5% pour les affections du cuir chevelu et des cheveux et 50% pour les dépôts dermiques. conclusion: la corrélation clinicopathologique des biopsies cutanées est élevée. la corrélation est meilleure avec les maladies inflammatoires qu'avec les maladies néoplasiques. mots-clés : histopathologie, dermatopathologie , corrélation clinicopathologique, biopsie cutanée, maladies cutanées. *corresponding author email: ehianaba@yahoo.com 1 department of medicine, lagos state university college of medicine/ lagos state university teaching hospital, lagos, nigeria. 2 department of anatomic and molecular pathology, college of medicine, university of lagos, lagos, nigeria. 3 calgary stroke program, department of clinical neurosciences, university of calgary, alberta, canada. 1 2 3 *anaba, e.l. , dawodu, o.o. , arabambi, a. received: february 9, 2022 accepted: april 7, 2023 published: april 19, 2023 anaba, e.l. orcid-no: https://orcid.org/0000-0002-4502-4482 article original research journal of health sciences res. j. health sci. vol 11(1), march 2023 19 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.3 introduction skin diseases are common and account for 10.73 to 27 % of medical complaints (1-3). although most skin diseases can be diagnosed clinically, skin diseases have a limited pattern of clinical presentation making the conclusive diagnosis of some cases difficult (4). skin biopsies and histopathologic evaluation remain the gold standard in the resolution of difficult clinical cases by the dermatologist (4,5). a good clinical description by the dermatologist influences the outcome of a histopathology report. likewise, a good histopathology report imparts greatly on the clinical outcome of a patient's management (5). the studies on the histopathologic correlation of clinical diagnosis made of skin disease show a correlation of 23.3% to 94.9% (4,6-9). these studies also reveal a correlation between the histopathologic and the first clinical diagnosis in 47.4 to 82.3% and a correlation with the clinical differential diagnosis in 7.4 to 13.9% (10,11). furthermore, a higher correlation is reported when the clinical diagnosis is made by dermatologists. in resource poor countries with a limited n u m b e r o f d e r m a t o p a t h o l o g i s t s , histopathological evaluation of skin samples remains a daunting task. a clinicopathologic correlation (cpc) of skin biopsies in this setting becomes relevant in patient management. in nigeria, studies of the histopathology of skin diseases are few and even fewer are the cpc of these diseases. the aim of this study was to conduct a cpc on the largest collection of skin samples recorded till date in the region with a view to improving the clinical diagnostic outcome in the field of dermatology. materials and methods. this retrospective cross-sectional analysis of skin biopsy specimens submitted to st the laboratory between the january 1 2015 and st december 31 2021 was conducted over a sixweek period, april to may 2022. the study was conducted at the clinalancet laboratory in lagos, nigeria following permission to conduct the study by the managers of the laboratory and ethical approval from the lagos state university t e a c h i n g h o s p i t a l , l a g o s s t a t e (lrec/06/10/1837). a list of all skin biopsies submitted within the study period was retrieved from the data base of the laboratory for the documentation of sociodemographic, clinical and histopathological data. sociodemographic data retrieved included age, gender, duration of disease and anatomical site of biopsy. for the cpc data retrieved were; clinical and histopathological diagnosis, type of histopathological diagnosis. the histopathologic diagnosis was classified into non-neoplastic and neoplastic. the non-neoplastic skin lesions were further classified into: ·inflammatory lesions (spongiotic, v e s i c u l l o b u l l o u s , l i c h e n o i d , p s o r i a s i s i f o r m , v a s c u l o p a t h i c , granulomatous and panniculitis) ·infectious and parasitic ·cutaneous deposits ·alopecias and scalp disorders. ·nail disorders the neoplastic skin lesions were further classified into benign and malignant. the clinical diagnosis, histopathology report as well as histopathologic diagnoses were d o c u m e n t e d i n a n e x c e l s h e e t a n d clinicopathologic correlation (cpc) was conducted as follows: ·a d e f i n i t i v e c l i n i c o p a t h o l o g i c correlation was reported when the definitive clinical and definitive histopathological diagnosis matched. ·partial correlation was defined when the definitive histopathological diagnosis was included as one of the clinical differential diagnosis. ·no correlation was defined when the histopathological diagnosis did not match the definitive clinical diagnosis or any of its differential diagnosis. exclusion criteria from cpc ·specimens without a definitive clinical diagnosis ·specimens without a clinical diagnosis ·s p e c i m e n s w i t h o u t d e f i n i t i v e histopathological diagnosis ·specimens in which a histopathologic diagnosis was not made because the biopsy was superficial or insufficient. ·biopsies with a normal histopathological diagnosis. collected data was inputted into microsoft excel and analyzed using r studio. categorical variables were summarized as frequencies and percentages while numerical variables were summarized as mean and standard deviation. cross tabulations were constructed to describe the subcategories of broad diagnosis types and res. j. health sci. vol 11(1), march 2023 20 histopathology of skin: clinicopathologic correlation anaba et al. the distribution of lesion types that had a clinicopathologic correlation. results a total number of 2,396 skin biopsies were received within the study period from 2,319 patients. the studied population was 46.4 % (1,046) male and female in 53.6% (1,209). the age of the patients ranged from 6 months to 100 years and the mean (sd) age was 39.82±16.83 years. individuals aged 31-60 years accounted for most of the study population. the mean (sd) lesion duration was 3.52 ± 5.1 years. multiple biopsies were conducted in 121 (5.4%) patients and the most biopsied site was the lower limb (21.5%). table 1 a differential clinical diagnosis was not offered in 1,052 (46.7%) of the samples. a total of 4 2 4 r e p o r t s w e r e e x c l u d e d f r o m t h e clinicopathologic correlation (cpc) analysis for; lack of definitive clinical diagnosis in 330 (14.6%), no definitive histopathological diagnosis in 119 (5.3 %). histopathological evaluation was neoplastic in 818 (36.3%) with 758 (92.6%) benign and 60 (7.4%) malignant. an inflammatory diagnosis was made in 975 (43.2%) samples, hair loss and scalp disorders in 93 (4.1%), dermal deposits in 35 (1.6%), miscellaneous (diseases with no specific classification eg keratoderma, ichthyosis, ulcers) in 84 (3.7%) and a normal biopsy in 79 (3.5%). a total of 206 (9.1%) diagnoses of infections were made; viral in 186 (90.3%), parasitic in 9 (4.3%), mycobacterial in 6 (2.9%) and fungal in 5 (2.4%). the most common benign neoplastic diseases were adnexal (including cysts) in origin followed by epidermal tumours. adnexal tumours with more than two frequencies included syringomas (13), sebaceous tumours (8), spiradenoma (7), naevus sebaceous (5), hidradenoma (5), poromas (5), endometriosis (4), trichoepithelioma and trichoadenoma (4) and pilomatricoma (3). the most common malignant tumours were epidermal in origin. table 2 hair loss and scalp disorders were reported in 93 (4.1%) with hair loss being 62 (66.7%) and scalp disorders 31 (33.3%). inflammatory lesions were predominantly spongiotic. details are as in table 3. clinicopathologic correlation only 1,831 (81.2%) out of the 2,255 samples met the inclusion criteria for a cpc. a definitive cpc was obtained in 66.8% (1224/1831). cpc with the first clinical diagnosis was 58.3% (1067/1831) and with any other clinical diagnosis was 13.2% (241). cpc was 64.8% for benign tumours, 60.4% for malignant tumours, 66.7% for inflammatory diseases, 70.8% for infections, 85.5% for scalp and hair disorders and 50% for dermal deposits. tables 4 and 5. discussion histopathological diagnosis of skin biopsies is the gold standard in the clinical management of dermatology patients due to the heterogeneity of clinical manifestations and diagnostic dilemmas (4,12). the paucity of dermatopathologists in resource poor countries makes histopathological evaluation difficult (13 17). a cpc of reported cases allows the dermatologists to evaluate their clinical diagnosis and leads to better patient evaluation and management (5,14). this study shows a good cpc in over half of the samples and cpc was best with alopecia and scalp disorders. the study population was predominantly female in keeping with a female preponderance in prevalence studies of clinical diseases and similar cpc studies (8,9). the most biopsied patients (60.8%) were aged 31-60 years in consonance with other clinical and histopathologic studies (4,8,18,19). this age group may be the most biopsied because this is the working age group and they can afford to pay out of pocket for clinic attendance. also, this age group tend to have mostly inflammatory lesions which accounted for most of the histopathology diagnosis in this study (4,8,12,18). there was a definite cpc in a high percentage (66.8%) of the samples. the level of cpc in this study is within the range of what is documented in similar histopathology studies (4,9,11,19,20). the cpc tends towards a high level when most of the clinical diagnosis is made by dermatologists because they are trained to recognise these lesions clinically (8,10,12,19). the level of cpc in this study was dependent on the diagnosis with alopecia and scalp disorders having the highest cpc followed by infectious diseases and inflammatory diseases. cpc tends to be high when the clinical manifestation and histopathology features of a disease are characteristic or specific. alopecias and scalp diseases like folliculitis decalvans have characteristic clinical features and specific histopathology features which make them easily recognisable (21,22). this study differs from similar studies where inflammatory diseases and infection were noted to have the highest cp (4,10,12). res. j. health sci. vol 11(1), march 2023 21 histopathology of skin: clinicopathologic correlation anaba et al. t h e r e w a s a b e t t e r c p c w i t h inflammatory diseases compared to neoplastic diseases. the reason for the better cpc with inflammatory diseases may be due to the clinical presentation of these lesions. clinically, neoplastic diseases manifest mostly as swellings unlike inflammatory diseases where definite patterns of manifestations are seen. another explanation could be the rarity of neoplastic lesions in this region and so poor awareness of its features by dermatologists (8,23). study conclusions in literature vary when cpc of neoplastic and non-neoplastic diseases are compared. in some studies, neoplastic diseases have a higher cpc (12) while in others, it is inflammatory diseases (4) and in others there is . no difference (10) amongst the neoplastic diseases cpc was best with the benign lesions: lipomas followed by mesenchymal and then epidermal lesions. cpc was lowest with histiocytic lesions. h i s t i o c y t i c l e s i o n s ( d e r m a t o f i b r o m a s , dermatofibrosarcoma protuberans, xanthomas, xanthelasma) are close differentials clinically and serve as differential diagnosis for one another leading to a poor definitive diagnosis of these disorders. in consonance with this study, venugopal had a better correlation with benign lesions (10). george et al and al-saif et al in their studies were however at variance with this study as they reported a better cpc with malignant lesions (4,12). l i c h e n o i d , p s o r i a s i f o r m a n d granulomatous diseases had the highest cpc in the inflammatory diseases spectrum. this was not unexpected as the diseases in this spectrum have almost specific clinical patterns and definitive histopathology patterns. in consonance with this study, other authors report a similar high cpc with granulomatous, lichenoid and psoriasiform diseases (4,18). the study was limited by the large number of samples which were excluded for lack of a definitive diagnosis (clinical and histopathologic). also, being a retrospective s t u d y, t h e r e w e r e s o m e i n c o m p l e t e documentations. the strength of the study lies in it being the largest collection of skin samples from the region and that the histopathologic evaluation was done by a dermatopathologist. conclusion in conclusion, clinicopathologic correlation of skin biopsies is high. correlation is better with inflammatory diseases compared to neoplastic diseases. a histopathological evaluation of skin biopsies is important in the management of dermatology patients and a good clinical d e s c r i p t i o n i n c r e a s e s t h e y i e l d o f histopathological correlation. funding: self-funded conflict of interest: the authors have no conflict of interest. acknowledgements: the authors wish to acknowledge the management of the laboratory for granting permission to use the data and the laboratory scientists for their role in data collection. references 1. richard m-a, corgibet f, beylot-barry m, barbaud a, bodemer c, chaussade v et al. sex and age-adjusted prevalence estimates of five chronic inflammatory skin diseases in france: results of the « objectifs peau » study j. e u r . a c a d . d e r m a t o l . v e n e r e o l . 2018;32:1967–1971. 2. akinkugbe ao, amira oc, ozoh ob, fasanmade o, bandele e. patterns of skin disorders in a rural community in lagos state, nigeria. the nig. health j. 2016;16: 103-116 3. lim hw, collins b, resneck js, bolognia jl, hodge ja, rohrer ta et al. the burden of skin disease in the united states. j am acad dermatol 2017;76:958-972 4. george vp, sowmya s, krishnan s. a histopathological study of skin biopsy specimens in a tertiary care hospital with a keynote on clinicopathological correlation. annals of pathology and laboratory medicine. 2020;7:39-45 5. p u r i n , m a h a j a n b b , k a u r s . clinicohistopathological correlation of psoriasis in acute exacerbation. scientific reports. 2012;1:455-461 6. b i s h t m , a r y a a , c h o u d h r y b c . histomorphological analysis and clinical correlation of neoplastic and non-neoplastic skin lesions: a study in a tertiary care centre of western uttar pradesh, india. int j res med sci. 2020;8:2820-2827 7. dowerah s, naiding m. clinicopathological correlation of benign skin lesions in a limited resource setting. journal of science. 2017;7:4143. 8. altraide dd, otike-odibi b, usman o. correlation of clinico pathologic diagnosis of skin diseases in a tertiary health centre in southsouth nigeria. asian journal of research in dermatological science.2020;3:22-28 9. gupta p, karuna v, grover k, rathi m, verma n. the histopathological spectrum of skin diseases w i t h e m p h a s i s o n c l i n i c o p a t h o l o g i c a l correlation: a prospective study. journal of diagnostic pathology and oncology. 2018;3:91res. j. health sci. vol 11(1), march 2023 22 histopathology of skin: clinicopathologic correlation anaba et al. 95 10. venugopal r, shankar p, pathania v. clinicopathological correlation in the diagnosis of skin diseases: a retrospective study. med j dy patil vidyapeeth 2020;13:648-52. 11. umarji s, ravikumar g, antony m, tirumalae r. comparison of clinical diagnosis with histopathology in inflammatory skin diseases: a retrospective study of 455 cases. egypt j dermatol venereol 2018;38:37–41 12. al-saif fm, binsufayan sa, alhussain ah, alshaikh hm, aldosari ms, binsufayan sa et al. clinicopathological concordance in the diagnosis of skin diseases: a retrospective analysis of 5000 histopathology reports. ann saudi med. 2019;39:388-394. 13. tsang mw, kovarik cl. global access to dermatopathology services: physician survey of availability and needs in sub-saharan africa. j am acad dermatol. 2010;63:346-8. 14. beltraminelli h, kiprono s, zuriel d, swai b, giabbani e, grossmann h, masenga je. dermatopathology in sub-saharan africa: a s y s t e m a t i c 5 y e a r a n a l y s i s o f a l l histopathological diagnoses from the regional dermatology training centre (rdtc) in moshi, tanzania. j eur acad dermatol venereol. 2015;29:1370-1375. 15. adeyi oa. pathology services in developing countries: the west african experience. arch pathol lab med 2011; 135: 183–186. 16. tsang mw, kovarik cl. the role of dermatopathology in conjunction with teledermatology in resource-limited settings: lessons from the african teledermatology project. int j dermatol. 2011;50:150-156 17. benediktsson h, whitelaw j, roy i. pathology services in developing countries: a challenge. arch pathol lab med 2007; 131: 1636–1639. 18. ukonu ba, ibekwe pu, abimiku ba. c l i n i c o p a t h o l o g i c a l c o r r e l a t e o f papulosquamous skin disorder in a tertiary health care. journal of advances in medicine and medical research. 2020;32:54-65 19. korfitis c, gregoriou s, antoniou c, katsambas ad, rigopoulos d. skin biopsy in the context of dermatological diagnosis: a retrospective cohort study dermatology research and practice. 2014;article id 734906:5 pages 20. goyal n, jain p, malik r, koshti a. spectrum of n o n n e o p l a s t i c s k i n d i s e a s e s : a histopathology based clinicopathological correlation study. sch. j. app. med. sci., 2015;3:444-449. 21. phillips tg, slomiany p, allison r. hair loss: common causes and treatment. american family physician. 2017;96: 372-378. 22. gordon ka, tosti a. alopecia: evaluation and treatment. clin. cosm. investig. dermatol. 2011;4:101-106. 23. asuquo me, ebughe g. cutaneous cancers in calabar, southern nigeria. dermatol online j. 2009;15:11. res. j. health sci. vol 11(1), march 2023 23 histopathology of skin: clinicopathologic correlation anaba et al. res. j. health sci. vol 11(1), march 2023 24 table 1. sociodemographic and clinical variables variable frequency (n) percentage (%) age years (years) 0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 total 92 219 325 594 448 330 156 70 18 3 2255 4.10 9.70 14.40 26.30 19.90 14.60 6.90 3.10 0.80 0.10 100 duration of lesions (years) <1 1-10 >10 547 500 75 48.70 44.60 6.70 site of biopsy lower limb upper limb trunk face scalp genital gluteal neck mouth nail 484 328 304 259 240 86 65 48 4 2 21.50 14.50 13.50 11.50 10.60 3.80 2.90 2.10 0.20 0.10 table 2. frequency of histologic origin of diagnosed tumoral lesions origin of tumour benign(n=758) malignant (n=60) n % n % neural 20 2.6 2 3.3 adnexal 236 31.1 3 5.0 cyst 159 21.0 0 0.0 lipoma 74 9.8 0 0.0 epidermal 170 22.4 34 56.7 histiocytic 37 4.9 1 1.7 lymphomatous 15 2.0 2 3.3 melanocytic 48 6.3 5 8.3 mesenchymal 149 19.7 4 6.7 vascular 75 9.9 6 10.0 histopathology of skin: clinicopathologic correlation anaba et al. res. j. health sci. vol 11(1), march 2023 25 table 3. frequency table of inflammatory disease patterns type of inflammatory frequency (n=975) percentage spongiotic 376 38.6 lichenoid 288 29.5 psoriasiform 148 15.2 vesiculobullous 59 6.1 granulomatous 54 5.5 vasculopathic 28 2.9 panniculitis 20 2.1 table 4. definitive clinicopathologic correlation distribution of different classes of lesions. classification sub-classification histology frequency of cpc percentage neoplastic (n=649) 421 64.8 benign (n=601) 392 65.2 neural (n=15) 8 53.3 adnexal (n=198) 125 63.1 cyst (n=136) 98 72.1 lipoma (n=58) 49 84.5 fibroblast (n=4) 2 50.0 epidermal (n=141) 97 68.8 histiocytic (n=28) 12 42.8 lymphomatous (n=13) 8 61.5 melanocytic (n=82) 53 64.4 mesenchymal (n=114) 91 79.8 vascular (n=54) 34 63.0 malignant (n=48) 29 60.4 neural (n=1) 1 100 adnexal (n=2) 1 50.0 epidermal (n=31) 19 61.3 lymphomatous (n=1) 0 0.0 melanocytic (n=3) 2 66.7 mesenchymal (n=4) 2 50.0 vascular (n=6) 4 66.7 inflammatory (n=872) 580 66.5 granulomatous (n=52) 37 71.1 lichenoid (n=257) 200 77.8 spongiotic (n=334) 187 56.0 vesiculobullous (n=53) 30 56.6 vasculopathic (n=20) 11 55.0 psoriasiform (n=136) 107 78.7 panniculitis (n=18) 10 55.6 infections (n=151) 107 70.8 viral (n=135) 93 68.9 parasitic (n=6) 4 66.7 mycobacterial (n=6) 6 100.0 fungal (n=5) 4 80.0 dermal deposits (n=10) 5 50.0 amyloidosis (n=1) 1 100.0 calcium (n=5) 2 40.0 mucin (n=2) 1 50.0 onchronosis (n=1) 1 100 miscellaneous (n=67) 44 65.66 histopathology of skin: clinicopathologic correlation anaba et al. table 5. definitive clinicopathologic correlation distribution of alopecias and scalp disorders classification subclassification histology frequency of cpc percentage alopecia and scalp (n=90) 77 85.5 alopecias (n=62) 56 90.3 central centrifugal cicatricial alopecia (n=21) 18 alopecia areata (n=20) 19 lupus (n=13) 13 androgenetic alopecia(n=6) 4 traction alopecia( n=2) 2 scalp disorder (n=28) 17 60.7 folliculitis decalvans (n=24) 15 62.5 acne kelodalis nuchae (n=2) 1 50.0 dissecting cellulitis (n=2) 1 50.0 histopathology of skin: clinicopathologic correlation anaba et al. res. j. health sci. vol 11(1), march 2023 26 rjhs 11(2).cdr prevalence and risk factors for preterm delivery in uniosun teaching hospital, osogbo a 5 year retrospective review 1 1 1 2 fasanu a.o. , atanda o.a. , *taiwo a.o. , afolabi a. abstract introduction: preterm delivery is the leading cause of death in the neonatal period. it causes 28% of perinatal mortality. in nigeria, it is responsible for 40-60% of perinatal morbidity. according to a u.s. research, preterm births have surged globally. in 2016, 16.8% of singleton live births in lagos, nigeria, were preterm. methods: it was a retrospective review of patients with singleton preterm delivery in uniosun teaching hospital, osogbo from july 2013 to june 2018. case records of mothers/patients with preterm deliveries were retrieved. information on the patients' age, parity, educational status, weight, body mass index, number of antenatal visits, identifiable causes of preterm delivery and others were all extracted. result: during the research period, 2,234 babies were born, including 210 preterm singletons out of which 147 were reviewed. singleton preterm birth prevalence was 9.4%.of the 147 mothers, n (20.4) had premature rupture of membrane (prom), hypertensive disorders in pregnancy occurred in n(17.0%), urinary tract infection (10.8%) and malaria in pregnancy (6.1%). conclusion: preterm birth rates were low compared to recent rates in the country. prom, malaria in pregnancy, uti in pregnancy, hypertensive disorders in pregnancy and previous history of spontaneous miscarriage were important causes/risk factors for preterm delivery. keywords: preterm delivery, causes, risk factors, prevalence *corresponding author taiwo a.o. email: droluwaseuntaiwo@gmail.com 1 department of obstetrics and gynaecology, uniosun teaching hospital, osogbo 2 department of obstetrics and gyanecology, federal medical center, keffi orcid-no: https://orcid.org/0000-0002-0190-6299 received: september 14, 2022 accepted: february 26, 2023 published: june 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 99 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.3 prévalence et facteurs de risque d'accouchement prématuré à l'hôpital universitaire uniosun, osogbo : un bilan rétrospectif sur 5 ans 1 1 1 2 fasanu a.o. , atanda o.a. , *taiwo a.o. , afolabi a. résumé objectif de l'étude: est à l'origine de 28 % de la mortalité périnatale. au nigéria, elle est responsable de 40 à 60 % de la morbidité périnatale. selon une étude américaine, les naissances prématurées ont augmenté dans le monde. en 2016, 16,8 % des naissances vivantes uniques à lagos, au nigéria, étaient prématurées. méthode de l'étude: il s'agissait d'un examen rétrospectif des patientes ayant accouché prématurément d'un singleton à l'hôpital universitaire uniosun d'osogbo de juillet 2013 à juin 2018. dossiers de cas de mères/patientes les accouchements prématurés ont été récupérés. les informations sur l'âge des patientes, la parité, le niveau d'éducation, le poids, l'indice de masse corporelle, le nombre de visites prénatales, les causes identifiables d'accouchement prématuré et autres ont toutes été extraites. résultat de l'étude: au cours de la période de recherche, 2 234 bébés sont nés, dont 210 singletons prématurés dont 147 ont été examinés. la prévalence des naissances prématurées uniques était de 9,4 %. sur les 147 mères, n (20,4) avaient une rupture prématurée de la membrane (rpm), des troubles hypertensifs pendant la grossesse sont survenus chez n (17,0 %), une infection des voies urinaires (10,8 %) et le paludisme pendant la grossesse (6,1 %). conclusion: les taux de naissances prématurées étaient faibles par rapport aux taux récents dans le pays. la rpm, le paludisme pendant la grossesse, les infections urinaires pendant la grossesse, les troubles hypertensifs pendant la grossesse et les antécédents de fausse couche spontanée étaient des causes/facteurs de risques importants d'accouchement prématuré. mots-clés : accouchement prématuré, causes, facteurs de risque, prévalence received: september 14, 2022 accepted: february 26, 2023 published: june 30, 2023 l'accouchement prématuré est la première cause de décès en période néonatale. elle *corresponding author taiwo a.o. email: droluwaseuntaiwo@gmail.com 1 department of obstetrics and gynaecology, uniosun teaching hospital, osogbo 2 department of obstetrics and gyanecology, federal medical center, keffi orcid-no: https://orcid.org/0000-0002-0190-6299 article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 100 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.3 introduction preterm delivery is defined as the birth of a neonate before 37weeks in-utero calculating from the first day of last normal menstrual period of the mother. it is a significant perinatal health problem across the globe. globally, it is the leading cause of death in neonatal period (1). this especially, is a cause of worry to both the parents and the health care giver not only in terms of associated mortality but also with regards to short and long term morbidity the prevalence of preterm delivery is said to range between 8-15% and it accounts for about 28% of early neonatal deaths that are not related to congenital abnormalities (2,3). in nigeria, it accounts for 40-60% of all perinatal deaths (3). the prevalence of preterm birth have been reported to be between 5-7% of live births in some developed countries but are estimated to be substantially higher in developing countries (4). in africa, a study conducted by world health organization global survey in low and middle income countries showed a prevalence of 8.2% (5). in the past 20 years, there has been a global increase in the frequency of preterm delivery according to a study done in the united states.(6) some european studies have reported prevalence of 5-10%.(7) among the whites, preterm birth increased from 8.8% of live birth in 1989 to 10.2% in 1997, a relative increase of 15.6%.(8) in a recent study conducted in lagos nigeria, year 2016 prevalence rate of preterm delivery was 16.8% for singleton live birth deliveries (9). this showed an increase from the prevalence rate of 9.5-15.8% reported for subsaharan african by who in the year 2013 (10). studies have identified previous preterm delivery, antepartum haemorrhage, premature rupture of membrane, urinary tract infection, pregnancy induced hypertension, mode of delivery and booking status as determinants of preterm delivery (3). another study conducted in south western part of nigeria, identified older maternal age, maternal anemia, maternal illness during pregnancy, previous abortion, nulliparity and low body mass index, non-booking status and hypertensive disorders in pregnancy as having great impact on the gestational age at delivery, with most of the cases of preterm delivery recorded having either as risk factor (3,6). the aim of this study was to determine the prevalence of preterm delivery and to identify the common cause of this among patients in uniosun teaching hospital. the study seeks to look at the current causes of preterm delivery in our hospital, with no recent data on this, and to compare with that of others around. this will go a long way in making appropriate recommendation and make necessary modification to our antenatal and labour ward services. materials and methods the study was carried out in the department of obstetrics and gynaecology of uniosun teaching hospital, osogbo. it was a retrospective review of case notes of mothers/patients with singleton preterm delivery in the hospital over a period of 5years; from july 2013 to june 2018. parturients with multiple gestations were excluded from the study. case records of all booked and unbooked cases of preterm deliveries (between gestational age of 28 weeks to 36 weeks 6days) with singleton fetus were retrieved. information on the patients age, parity, educational status, weight, body mass index, usage of intermittent prophylactic treatment for malaria, number of antenatal visit, history of pre-conceptional chronic illness were taken from the case notes. other information obtained from the case records includes social habits, identifiable causes of preterm delivery, baby's birth weight and apgar score at delivery. extracted data were analyzed with ibm spss package version 18 and presented in frequency table, percentage and chi square used to determine association between different variables. results during the period of the study, total number of deliveries was 2,234 out of which 210 were singleton preterm deliveries. of the 210 cases, 147 folders were retrieved for this study giving a retriever rate of 70%. the prevalence of singleton preterm delivery during this study was 9.4%. mothers' ages ranged from 18years to 44years with the mean age of 31.14years. eighty seven (59.2%) mothers within ages of 31-40years formed bulk of the study. all the patients have one form of education or the other with most of them having tertiary education 68(46.3%). most of the patients studied were traders (51%) followed by civil servants (29.9%) as seen in table 1 about 12.9% of the parturient had previous history of spontaneous miscarriages and 73.7% of them had at least 2 or more episodes of miscarriage. only one of the patients had history of smoking in pregnancy. ten (6.8%) had history of consumption of alcohol while one smokes. of 147 parturient studied, 25 had febrile res. j. health sci. vol 11(2), june 2023 101 prevalence and risk factors for preterm delivery fasanu et al. illness in pregnancy accounting for 16.3 %, and this include both malaria and uti in pregnancy. majority of the parturient studied had preterm delivery secondary to prom accounting for about 20.4% followed closely by hypertensive disorders in pregnancy and urinary tract infection which account for 17.0% and 10.8% respectively. other significant causes from the study are malaria in pregnancy, antepartum haemorrhage and others (table 2). most cases, 67%, of preterm delivery occurred between 32 and 34weeks gestational age and this was mostly among the parturient aged 31-40years (60.6%) and this was statistically significant at p value of 0.047 (table 3). these same age groups have higher cases of preterm delivery between 28-31weeks and 3537weeks. most cases of preterm delivery were seen among the traders, n (50) and this occurs between 32-34weeks. there was no significant relationship between bmi and preterm delivery. table 5 showed the association between the identifiable risk factors/causes in this study and preterm delivery. previous history of preterm delivery, urinary tract infection in pregnancy (0.041), malaria in pregnancy (0.046), hypertensive disorders in pregnancy (0.034) and previous history of spontaneous miscarriage (0.036) were statistically significant with p value of ≤0.05. discussion the prevalence of singleton preterm delivery in our centre / the present study was 9.4% and this is comparatively lower than the reported prevalence of 16.8% in a study done in lagos in 2016 (9) and 11.8% in a study done between 2011-2013 in ilorin, north central nigeria (3). this is significant when compared to the study from ilorin, given that this study was a 5 year review compare to the 3years review from ilorin. however, the fact that the study is retrospective may have effect on the result given that we could not retrieve all the 210 folders. the prevalence is also lower when compared with who report of 2013 for sub-saharan africa (10). this could be evidence of our improved antenatal care services. patients with age range of 3140years accounted for about 59.2% of the cases of preterm deliveries studied. this showed an increase in prevalence of preterm delivery with increasing maternal age, when compared with the proportion of the patients less than 31years who had preterm delivery. this was however not statistically significant. newburn-cook et al in canada also observed this in a study in 2005 (11). likewise, alice goisis et al in a study on increase of preterm delivery among mothers ages 35-39 and ≥40 years compare to that in ages 25-39 concluded that preterm cases increases with maternal age (12). the parity of the patients in this study also determine the gestational age at delivery as nullipara account for 46.3% n (68), this is similar to findings of mokuolu et al in 2002 (13). these could be explained by the fact that nulliparous are p r e d i s p o s e d t o m e d i c a l d i s o r d e r s l i k e hypertensive disorders in pregnancy. this was supported by the fact that hypertensive disorder in pregnancy was the second common cause of preterm delivery in this study and was statistically significant with a p value of 0.034. more than half of the patients studied were unbooked accounting for about 51% of the total patients studied, this was in consonant with previous studies identifying unbooked status as a risk factor for preterm delivery (14). the risk of preterm delivery is also high in patients with low antenatal clinic visit in this study similar to what was discovered in a similar study in enugu, southeast nigeria (14). the use of ipt to prevent malaria in pregnancy was also seen to affect the prevalence of spontaneous preterm delivery as 46.2% of the cases studied did not have any dose of ipt in pregnancy as against 15% in patient that had at least two doses of ipt and 38.8% in patients that had 1 dose. malaria was also statistically significant as a cause of preterm delivery in this study with a p value of 0.046. this further buttress the fact that ipt is an important part of antenatal care in the tropics as it reduces the placental parasitaemia and by extension malaria in pregnancy for the mother which is a known cause of preterm delivery (15). premature rupture of membrane was statistically significant as a cause of preterm delivery in this study. this was also notice to be most important cause in patient who has had previous history of preterm birth. this established the fact in previous study by mokuolu et al in ilorin which pointed previous history of preterm delivery, prom, and spontaneous abortion as a risk factor for preterm delivery (3). about 7% of cases studied had history of consumption of alcohol during pregnancy. this had been known to relatively increase the risk of preterm delivery when compare to pregnant women with no alcohol consumption in pregnancy (15). pre-mature rupture of membrane contributes significantly to cases of preterm delivery in this study and this is mostly likely a res. j. health sci. vol 11(2), june 2023 102 prevalence and risk factors for preterm delivery fasanu et al. complication of infective process in pregnancy. this was supported by the fact that uti and malaria in pregnancy contributes significantly to cases of preterm delivery in this study. there was also significant association between antepartum haemorrhage and preterm delivery in mokuolu et al study in ilorin.(3) the study also identified maternal socio-demographic and antenatal variables including previous preterm delivery antepartum haemorrhage, premature rupture of membrane, urinary fact infection, pregnancy induced hypertension, type of labour and booking status as determinants of preterm delivery.(3) the body mass index of the patients both at booking and at delivery and their respective weight have no association with determination of gestational age at delivery in this study. this is contrary to a study in southern california which 2 found that higher bmi up to around 24kg/m is increasingly protective of preterm delivery beyond which a higher bmi becomes detrimental.(17) conclusion the study showed the prevalence of preterm delivery to be 9.4%. this is low when c o m p a r e d w i t h t h e r e c e n t p r e v a l e n c e documented in the country. premature rupture of membrane, malaria in pregnancy, uti in pregnancy, hypertensive disorders in pregnancy and previous history of spontaneous miscarriage are all discovered to be important causes/risk factors for preterm delivery. it was also observed that most of the patients studied were unbooked, which indicated higher prevalence of preterm delivery among the unbooked compared to the booked patients. we recommend that more efforts should be directed towards the prevention of febrile illness in pregnancy and medical disorders like hypertensive disorders in pregnancy as these were noticed to contribute significantly to cases of preterm delivery in this study. encouraging pregnant women to book and have proper antenatal clinic visit will also go a long way to reduce the burden of preterm delivery. acknowledgements: we want to specially appreciate the head of department of records and statistics of the hospital and other staff of the unit. special thanks to dr mrs oluwakemi esther for her support throughout the course of this work. conflict of interest: there are no conflicts of interest references 1. a s h e l y s . r o m a n . l a t e p r e g n a n c y complications. current diagnosis and treatment in obstetrics and gynaecology, lancet 2013; (11): 251-255 2. lawn je, wilczynska-ketende k, cousens sn. estimating the causes of 4million neonatal deaths in the year 2000. int j epidemiol 2006; 35: 706-18 3. olugbenga a. mokuolu, bm suleiman, oo adesiyun, and a adeniyi . prevalence and determinants of pre-term deliveries in the university of ilorin teaching hospital, ilorin, nigeria. paediatrics reports 2010 18; 2(1): published online 2010 jun 18. 4. lawn je, cousens sn, darmstadt gl, bhutta za, martines j, paul v, et al., 1 year after the lancet neonatal survival series-was the call for action heard? lancet 2006; 367: 1541 5. vogel jp, lee ac, souza jp maternal morbidity and preterm birth in 22 lowand middle-income countries: a secondary analysis of the who global survey dataset. bmc pregnancy childbirth. 2014 31;14:56. 6. callaghan wm, macdorman mf, rasmussen sa, qin c, lackritz em. the contribution of preterm birth to infant mortality rates in the united states. int j pediatr 2006 ;118(4):156673. 7. steer p. the epidemiology of preterm labour. bjog 2005;112:1–3. 8. demissie k, rhoads gg, ananth cv, alexander gr, kramer ms, kogan md, joseph ks. trends in preterm birth and neonatal mortality among blacks and whites in the united states from 1989 to 1997. am. j. epidemiol 2001 ;154(4):307-15. 9. butali, a., ezeaka, c., ekhaguere, o., weathers, n., ladd, j., fajolu, i., et al characteristics and risk factors of preterm births in a tertiary center in lagos, nigeria. pan afr med j. 2016 may 1;24:1 10. blencowe h, cousens s, chou d, oestergaard m, say l, moller ab, kinney m. et al; born too soon: the global epidemiology of 15 million preterm births. pub med 2013;10 suppl 1:s2. doi: 10.1186/1742-4755-10-s1-s2. 11. newburn-cook cv, onyskiw je: is older maternal age a risk factor for preterm birth and fetal growth restriction? a systematic review. health care women international 2005 26(9):852-75. 12. hanna r, kieron b, pekka m, mikko m: advanced maternal age and the risk of low birth weight and preterm delivery: a withinfamily analysis using finnish population registers. am. j. epidemiol, volume 186, issue 11, 1 december 2017, pages 1219–1226 13. mokuolu ao, abdul if, adesiyun o. maternal factors associated with early spontaneous singleton preterm delivery in nigeria. trop j obstet gynaecol. 2002;19:32–5. 14. iyoke ca, lawani lo, ezugwu ec, ilo kk, ilechukwu gc, asinobi in. maternal risk factors res. j. health sci. vol 11(2), june 2023 103 prevalence and risk factors for preterm delivery fasanu et al. for singleton preterm births and survival at the university of nigeria teaching hospital, enugu, nigeria. niger j clin pract 2015;18:744-50 15. aziken me, akubuo kk, gharoro ep. efficacy of intermittent preventive treatment with sulfadoxine-pyrimethamine on placental parasitemia in pregnant women in midwestern nigeria. int j gynaecol obstet. 2011;112 (1):303 16. albertsen k, andersen am, olsen j, grønbaek malcohol consumption during pregnancy and the risk of preterm delivery. am. j. epidemiol; 2004 jan 15;159 (2):155-61. 17. kosa jl, guendelman s, pearl m, graham s, abrams b, kharrazi m. the association between pre-pregnancy bmi and preterm delivery in a diverse southern california population of working women. matern child health j; 2011 aug;15(6):772-81. res. j. health sci. vol 11(2), june 2023 104 prevalence and risk factors for preterm delivery fasanu et al. res. j. health sci. vol 11(2), june 2023 105 table 1: socio-demographic characteristics of respondents (n= 147) variables frequency (n) percentage (%) age (years) =20 4 2.7 21-30 54 36.7 31 — 40 87 59.2 >40 2 1.4 total 147 100.0 educational status primary 21 14.3 secondary 58 39.5 tertiary 68 46.3 total 147 100.0 occupation civil servant 44 29.9 traders 75 51.0 artisan 2 1.4 student 16 10.9 unemployed 10 6.8 total 147 100.0 marital status unmarried 3 2.0 married 144 98.0 total 147 100.0 parity 1 68 46.3 2-4 37 25.2 =5 42 28.6 total 147 100.0 prevalence and risk factors for preterm delivery fasanu et al. res. j. health sci. vol 11(2), june 2023 106 table 2: identifiable causes preterm delivery variables frequency percentage(%) malaria in pregnancy 9 6.1 uti in pregnancy 16 10.2 hypertensive disorders in pregnancy 25 17 dm in pregnancy 5 3.4 uterine fibroid 2 1.4 polyhydraminous 2 1.4 oligohydraminous 1 0.7 antepartum haemorrhage 5 3.4 prom 30 20.4 placental abnormalities 0 0 scd in pregnancy 1 0.7 anaemia in pregnancy 0 0 table 3: association between socio-demographic characteristics and gestational age at delivery sociodemographic variables gestational age statistical parameters 28-31weeks 32-34weeks 35-37weeks age (years) <20 21-30 31-40 >40 0(0.0) 2(3.7) 3(3.4) 0(0.0) 2(50.0) 37(68.5) 60(69.0) 0(0.0) 2(50.0) 15(27.8) 24(27.6) 2(100.0) x2=5.923 df=6 p-value=0.432 parity 1 2-4 =5 3(4.4) 0(0.0) 2(4.8) 46(67.6) 26(70.3) 27(64.3) 19(27.9) 11(29.7) 13(31.0) x2=1.882 df=12 p-value=0.047* educational status primary secondary tertiary 0(0.0) 2(3.4) 3(4.4) 17(81.0) 39(67.2) 43(63.2) 4(19.0) 17(29.3) 22(32.4) x2=2.638 df=4 p-value=0.620 occupation civil servant traders artisan professionals students /unemployed 0(0.0) 3(4.0) 0(0.0) 1(20.0) 1(3.8) 29(74.4) 50(66.7) 2(100.0) 2(40.0) 16(61.5) 10(25.6) 22(29.3) 0(0.0) 2(40.0) 9(34.6) x2=11.212 df=10 p-value=0.341 marital status single married 0(0.0) 5(3.5) 2(66.7) 97(67.4) 1(33.3) 42(29.2) x2=0.122 df=2 p-value=0.941 *statistically significant <0.05 prevalence and risk factors for preterm delivery fasanu et al. res. j. health sci. vol 11(2), june 2023 107 table 4: association between parturient body mass index and gestational age at delivery body mass index at booking (kg/m2) gestational age statistical parameters 28-31 32-34 35-37 <17 17-25 26-30 >30 0(0.0) 0(0.0) 1(7.7) 0(0.0) 8(66.7) 31(68.9) 5(38.5) 2(100.0) 4(33.3) 14(31.1) 7(53.8) 0(0.0) x2=8.692 df=6 p-value=0.192 body mass index at last visit <17 17-25 26-30 >30 0(0.0) 0(0.0) 1(4.5) 0(0.0) 9(56.3) 23(71.9) 14(63.6) 0(0.0) 7(43.8) 9(28.1) 7(31.8) 2(100.0) x2=7.301 df=6 p-value=0.294 table 5: association between the risk factors and prematurity according to gestational age. variable gestational age at delivery x2 value p-value 28-31(%) 32-34(%) 35-37(%) previous history of spontaneous miscarriages yes 1(20.0) 13(13.1) 5(11.6) 6.843 0.036* no 4(80.0) 86(86.9) 38(88.4) previous history of preterm delivery yes 1(20.0) 6(6.1) 2(4.7) 4.111 0.059 no 4(80.0) 93(93.9) 41(95.3) other febrile illness yes 1(20.0) 9(1.0) 4(9.3) 6.001 0.063 no 4(80.0) 90(99.0) 39(90.7) malaria yes 0 6(6.1) 3(6.9) 4.992 0.046* no 5(100.0) 93(93.9) 40(93.1) prom yes 5(100.0) 22(22.2) 3(7.0) 7.147 0.032* no 0 77(77.8) 40(93.0) uti yes 2(40.0) 10(10.1) 4(9.4) 6.743 0.041* no 3(60.0) 89(89.9) 39(90.6) hypertensive disorder yes 3(60.0) 18(18.2) 4(9.4) 7.004 0.034* no 2(40.0) 81(81.8) 39(90.6) diabetes yes 1(20.0) 2(2.0) 2(4.7) 5.979 0.054 no 4(80.0) 97(98.0) 41(95.3) antepartum hemorrhage yes 0 4(4.0) 1(2.3) 5.919 0.057 no 5(100.0) 95(96.0) 42(97.7) prevalence and risk factors for preterm delivery fasanu et al. rjhs 11(1).cdr intensive care unit deaths among neurosurgery patients in a tertiary hospital in south western nigeria 1,2 1 2,3 *rabiu tb , uthman ii , folami eo abstract background: neurosurgical patients are the most critical icu admissions. while advancements in neurosurgical icus (nicu) have improved outcomes of care globally, icu mortality remains a major clinical issue in developing nations. this study evaluates icu mortalities of neurosurgical patients in a general icu setting at the uniosun teaching hospital, osogbo, nigeria. method: case records of neurosurgery patients who died in the icu of uniosun teaching hospital, osogbo, south-western, nigeria from june 2012 to may 2022 were reviewed. simple descriptive statistics of data on demographics, clinical diagnoses, management and outcome were done. results: mortality rate was 38.9% (84 of 216 admissions). males were 67(79.8%) and the mean age was 41.5years (range: 2-85years). the average duration of icu stay was 3.5days (range: 30minutes-20days). most patients had severe traumatic brain injury (tbi) (62, 73.8%). this was followed by cerebrovascular diseases (12, 14.3%) and brain tumours (6, 7.1%). two had brain abscess. one patient each had mixed subacute/chronic subdural haematoma and severe cervical spondylotic myelopathy. of the 69 whose case files were found, 7(10.1%) had a diagnosis of brainstem death before eventual 'final' death after an average of 13.5 additional hours on mechanical life support. the identified secondary causes of death included raised icp, sepsis, primary surgical haemorrhage, seizures, acute kidney injury, malignant hypertension, poor glycaemic control and aggressive blood pressure lowering. only 1 patient had autopsy. conclusion: most icu mortalities among neurosurgical patients were from severe tbi. the establishment of nicu is necessary to improve outcome of care of neurosurgical patients. key words: neurosurgery deaths; icu mortality; nigeria; neurosurgery *corresponding author rabiu tb, e-mail: eshohealth@gmail.com 1neurosurgery unit, department of surgery, uniosun teaching hospital, osogbo, nigeria 2department of surgery, osun state university, osogbo, nigeria 3department of anaesthesia, uniosun teaching hospital, osogbo, nigeria orcid-no: https://orcid.org/0000-0001-7138-875x received: november 21, 2022 accepted: january 7, 2023 published: april 19, 2023 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.6 original article research journal of health sciences res. j. health sci. vol 11(1), march 2023 52 décès en unité de soins intensifs parmi les patients en neurochirurgie dans un hôpital tertiaire, au sud-ouest du nigéria 1,2 1 2,3 *rabiu tb , uthman ii , folami eo resume contexte général de l'étude: les patients en neurochirurgie sont les admissions les plus critiques en usi. alors que les progrès réalisés dans les usi neurochirurgicales (usin) ont amélioré les résultats des soins à l'échelle mondiale, la mortalité en usi reste un problème clinique majeur dans les pays en développement. cette étude évalue les mortalités en soins intensifs des patients neurochirurgicaux dans un cadre général de soins intensifs à l'hôpital universitaire uniosun, osogbo, nigeria. méthode de l'étude: les dossiers de patients en neurochirurgie décédés à l'unité de soins intensifs de l'hôpital universitaire uniosun, osogbo , sud -ouest, nigéria de juin 2012 à mai 2022 ont été examinés. des statistiques descriptives simples de données sur la démographie, les diagnostics cliniques, la prise en charge et les résultats ont été réalisées. résultat de l'étude : le taux de mortalité était de 38,9 % (84 admissions sur 216). les hommes étaient au nombre de 67 (79,8 %) et l'âge moyen était de 41,5 ans (intervalle : 2-85 ans). la durée moyenne de séjour en soins intensifs était de 3,5 jours (fourchette : 30 minutes à 20 jours). la plupart des patients avaient un traumatisme crânien grave (tcc) (62 ; 73,8 %). viennent ensuite les maladies cérébrovasculaires (12, 14,3 %) et les tumeurs cérébrales (6, 7,1 %). deux avaient un abcès cérébral. un patient avait chacun un hématome sous-dural mixte subaigu /chronique et une myélopathie spondylotique cervicale sévère . sur les 69 dont les dossiers ont été retrouvés, 7 (10,1 %) avaient reçu un diagnostic de mort du tronc cérébral avant la mort « définitive » après une moyenne de 13,5 heures supplémentaires sous assistance mécanique. les causes secondaires de décès identifiées comprenaient une pic élevée, une septicémie, une hémorragie chirurgicale primaire , des convulsions, une lésion rénale aiguë, une hypertension maligne, un mauvais contrôle glycémique et une baisse agressive de la pression artérielle. un seul patient a eu une autopsie. conclusion: la plupart des décès en usi chez les patients en neurochirurgie étaient dus à un tcc sévère. la mise en place de l'usin est nécessaire pour améliorer les résultats des soins des patients neurochirurgicaux. *corresponding author rabiu tb, e-mail: eshohealth@gmail.com 1neurosurgery unit, department of surgery, uniosun teaching hospital, osogbo, nigeria 2department of surgery, osun state university, osogbo, nigeria 3department of anaesthesia, uniosun teaching hospital, osogbo, nigeria orcid-no: https://orcid.org/0000-0001-7138-875x received: november 21, 2022 accepted: january 7, 2023 published: april 19, 2023 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.6 article original research journal of health sciences res. j. health sci. vol 11(1), march 2023 53 introduction neurocritical patients constitute a large number of intensive care unit (icu) admissions in most parts of the world (1-4). of these, neurosurgical patients, especially those with neurotrauma, are among the most critical of all admissions into the icus. in order to improve outcomes among neurosurgical patients, neuroicus have been established in many centres in developed countries and neuro-intensivists employed to provide optimal care (1,5,6). while these advancements have largely resulted in more encouraging trends in survivals and reduction of disabilities among neurosurgical patients in the developed countries, the situation in developing countries is gloomy as health needs are largely beyond what the available resources can cater for (2,7,8). consequently, the icu mortality rates in these resource-limited nations have remained considerably high (3,7). furthermore, the risk of death among postoperative patients in africa is twice that of the global average largely due to lack of the necessary resources and personnel (9). t h e r e i s l i m i t e d l i t e r a t u r e o n neurosurgical icu deaths in africa. thus, this study evaluates the pattern of death among neurosurgical patients managed at a general icu in a resource-limited setting in south western nigeria. materials and method a retrospective study of neurosurgery patients who died in the icu of uniosun teaching hospital (formerly lautech teaching hospital), osogbo, south-western, nigeria from june 2012 to may 2022 was conducted. the hospital has a general icu for all patients needing intensive care. the 4-bedded icu is equipped with 3 ventilators of which none may sometimes be functional. admissions into the unit are, therefore, competitive mostly on a first-to-come basis leading to delays in icu admissions even for the most critical of cases. the unit is manned by anaesthetists and mostly general nurses with no intensivist. information on demographics, clinical and radiological diagnoses, associated injuries, complication, length of hospital stay and causes of death was retrieved from the icu admission records and the case files of the identified patients. data management simple descriptive statistics of data on demographics, clinical diagnoses, admission characteristics, management and outcome was done with spss version 26 (ibm corp., 2019). all identified cases had analysis of demographics and diagnoses but only those whose case files were found at the medical records units were included in further analysis of the admission characteristics, management and outcome. descriptive analyses of sizes, frequencies, proportions, measures of central tendency (mean) and measures of dispersion (range) were done. the results are presented in texts and tabular forms. results o f t h e 1 3 2 9 i c u a d m i s s i o n s , neurosurgical patients were 216 (16.3%). the neurosurgical mortality rate was 38.9% (84 of 2 1 6 a d m i s s i o n s ) w h i c h r e p r e s e n t e d 84/470(17.9%) of all icu deaths during the study period. only 69 case files were found. (figure 1) demographics: more deaths occurred among males, 67(79.8%). the mean age was 41.5years (range: 2-85). (table 1) clinical and radiological diagnoses: most patients had severe traumatic brain injury (tbi) (62, 73.8%), of which 51 had complete records. this was followed by cerebrovascular diseases (12, 14.3%) and brain tumours (6, 7.1%). (table 2). 37(53.6%) had neuro-imaging {computerized tomographic (ct) scan or magnetic resonance imaging (mri)}. the predominant findings in 19 tbi patients who had ct scans were subarachnoid haemorrhage (9, 47.4%), cerebral contusions (7, 36.8 %), intracerebral haematoma (7, 36,8%), acute extradural haematomas (6, 31.6%) and acute subdural haematoma (6, 31.6 %). severe pressure effects were demonstrated by midline shifts (16, 84.2% ) and effacements of the basal cisterns (6, 31.6%) associated injuries: the predominant associated injuries in tbi patients were skull fractures (24/51, 47.1%) and long bones fractures (13/51, 25.5%). (table 3) laboratory parameters: deranged laboratory parameters found are presented in table 4. anaemia necessitating blood transfusion was noted in 17/60 (28.3%). of the 36 who had white blood cells counted, 29 had leukocytosis. hypokalemia occurred in 8 of 46 (17.4%) patients in whom electrolytes were assayed. peri-operative complications and major clinical problems: twenty six (37.7%) patients res. j. health sci. vol 11(1), march 2023 54 icu neurosurgery deaths rabiu et al. had neurosurgical operations. the observed perioperative complications included acute kindney injury (aki), severe primary surgical haemorrhage and intra-operative cardiac arrest. other major clinical problems included malignant hypertension, brainstem dysfunction and sepsis. (table 5) brainstem death: a diagnosis of brainstem death was made in 7(10.1%). they were on mechanical life support for an average of 13.5 hours before eventual 'death'. none was taken off mechanical ventilator before cessation of cardiac activities in line with family's preferences. length of icu stay: the average duration of icu stay was 3.5days (range: 30minutes-20days). the longer icu stays were mostly in patients with severe tbi. secondary causes of death the identified secondary causes of death were: raised intracranial pressure (icp) (20, 29.0%), sepsis (3, 4.3%), primary surgical haemorrhage (4, 5.8%), seizures (1, 1.4% ), acute kidney injury (6, 8.7%), malignant hypertension (2, 2.9%), poor glycaemic control (2, 2.9%) and aggressive lowering of the blood pressure (2, 2.9%). autopsy only 1 patient (severe tbi from gun-shot wound) had autopsy. consent was generally not given and cultural/religious practices made autopsy impossible even though many qualified for coroner's autopsy. discussion this study showed that neurosurgical patients constitute a major portion of icu admissions in our centre and also contribute a large proportion of icu deaths. severe tbi was a leading cause of icu death in our patients and it was almost exclusively caused by road traffic crashes. icu deaths remain a major clinical problem worldwide. this is especially so in developing countries with resource constraints and poorly equipped/manned critical units. while downward trends in icu mortalities are being observed in some advanced countries, the rates have largely remained same or are increasing in developing nations such as etiopia, nigeria and malawi (8,10-13). the predominance of traumatic brain injury as a leading cause of icu deaths among neurological patients as shown in this study has been reported in many studies locally and internationally (4, 14-16). it is important, therefore, to strengthen preventive measures of tbi especially those targeting reduction of road traffic accidents as suggested by olajumoke et al, karthigeyan et al and other researchers (4,17-19). deranged biochemical profiles, sepsis and some of the other abnormal clinical parameters found in our patients have been shown to be responsible for unfavourable outcomes among patients with critical illnesses and in neurosurgical icu admissions in previous studies including predict – a multicenter metropolitan icu study in australia, and by ramesh et al in a neurosurgical icu at a tertiary-care university hospital in india (20,21). a diagnosis of brain death or brain stem death (bsd) was made in a tenth of the patients. this rate is similar to that reported in a malawian icu (22). patients with such diagnosis are potential candidates for organ donation in countries with well-developed organ donation practices (23).we had previously reported that the knowledge of bsd among our population is low and that most relations of neurosurgical patients would not allow organs to be harvested from the patients in the event of a bsd diagnosis (24). therefore, increasing awareness of bsd in our community is key to improving the availability of organs for transplantation. the autopsy rate in this study is abysmally low despite the large number of qualified candidates, especially the tbi patients, who should have coroner's autopsy performed. similar low or zero rate of autopsy has been reported from nigeria (25). limitation: the non-availability of case records for some of the patients highlights a major problem in conducting retrospective studies in our setting with poor record keeping. a future prospective study is likely to address this problem. as all neurosurgical icu admissions were not included in this study, it was impossible to draw inferences about the determinants of outcomes of icu admissions in our neurosurgical patients. conclusion m o s t i c u m o r t a l i t i e s a m o n g neurosurgical patients in our hospital were from severe tbi and these were almost 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gupta sk, salunke p, dhandapani s, wankhede ls, kumar a, et al. head injury care in a lowand middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads. acta neurochir (wien). 2021; 163(10):2919-2930. doi: 10.1007/s00701-021-04908-x. 18. obimakinde os, olajuyin oa, rabiu tb, olanrewaju oj. crash characteristics and pattern of motorcycle related facial bone fractures in a sub-urban nigerian teaching hospital. niger j surg. 2018; 24(2):71-75. doi: 10.4103/njs.njs_39_17 19. rabiu tb, adeleye ao. helmet usage in m o t o r c y c l e r e l a t e d n e u r o t r a u m a . b r j n e u r o s u r g . 2 0 0 9 ; 2 3 ( 6 ) : 6 3 7 8 . d o i : 10.3109/02688690903215674 20. higgins am, neto as, bailey m, barrett j, bellomo r, cooper dj, et al; predict study investigators. predictors of death and new disability after critical illness: a multicentre prospective cohort study. intensive care med. 2021 jul;47(7):772-781. doi: 10.1007/s00134021-06438-7 21. ramesh vj, umamaheswara rao gs, kandavel t, kumaraswamy sd, iyyamanda ub, chandramouli ba. predictive model for survival among neurosurgical intensive care patients. j neurosurg anesthesiol. 2011; 23(3):183-7. doi: 10.1097/ana.0b013e31821cb9ec res. j. health sci. vol 11(1), march 2023 56 icu neurosurgery deaths rabiu et al. 22. prin m, quinsey c, kadyaudzu c, hadar e, charles a. brain death in low-income countries: a report from malawi. trop doct. 2019; 49(2):107-112. doi: 10.1177/0049475518821201. 23. mutlu nm, peker tt, acar s, koca b, soyal öb, titiz ap, et al. brain deaths and donors in an education and research hospital. transplant p r o c . 2 0 1 9 ; 5 1 ( 7 ) : 2 1 7 6 2 1 7 9 . d o i : 10.1016/j.transproceed.2019.01.164 24. rabiu tb, oshola ha, adebayo bo. survey of the knowledge of brainstem death and attitude toward organ donation among relations of neurosurgical patients in nigeria. transplant p r o c . 2 0 1 6 ; 4 8 ( 6 ) : 1 8 9 8 9 0 3 . d o i : 10.1016/j.transproceed.2016.05.011. 25. okoroiwu hu, uchendu ki, essien ra. causes of morbidity and mortality among patients admitted in a tertiary hospital in southern nigeria: a 6 year evaluation. plos one. 2020; 1 5 ( 8 ) : e 0 2 3 7 3 1 3 . https://doi.org/10.1371/journal.pone.0237313 res. j. health sci. vol 11(1), march 2023 57 icu neurosurgery deaths rabiu et al. res. j. health sci. vol 11(1), march 2023 58 table 1: dem ographics num ber p ercentage sex distribution m ale 67 79.8 female 17 20.2 age distribution (y ears) 0-10 10 11.9 11-20 7 8.3 21-30 9 10.7 31-40 17 20.2 41-50 13 15.5 51-60 8 9.5 61-70 12 14.3 71-80 7 8.4 81-90 1 1.2 t able 2: c linical d iagnoses c linical d iagnosis n um ber p ercentage t um ours 6 7.1 pituitary a denom a (3) 3.6 c raniopharyngiom a (1) (1.2) b rainstem g liom a (1) (1.2) g lioblastom a (1) (1.2) c ervical spondylotic m yelopathy 1 1.2 t raum a 63 75.0 severe h ead injury (62) (73.8) r oad t raffic a ccidents {61} {72.6} g unshot w ound {1} {1.2} c hronic subdural h aem atom a (1) (1.2) b rain a bscess 2 2.4 c erebrovascular d isease 12 14.3 table 3: associated injuries in tbi patients associated injury number percentage skull fractures 24 47.1 basal 4 7.8 calvarial right 12 23.5 left 4 7.8 bilateral 4 7.8 types of calvarial skull fractures linear 21 41.2 depressed 1 2.0 comminuted 1 2.0 multiple 1 2.0 cervical spine injury 2 3.9 long bone fractures femur 2 3.9 tibial 11 21.6 chest trauma 3 5.9 other fractures clavicle 1 2.0 colles 1 2.0 humerus 1 2.0 radio-ulnar 1 2.0 icu neurosurgery deaths rabiu et al. res. j. health sci. vol 11(1), march 2023 59 table 4: deranged laboratory parameters laboratory parameter number of patients assayed abnormal finding patients with abnormal findings n % wbc 36 leucocytosis 29 80.6 pcv 60 anaemia 17 28.3 serum bicarbonate 46 metabolic acidosis 11 23.9 serum potassium 46 hypokalaemia 8 17.4 serum urea 44 uremia 17 38.6 serum creatinine 25 elevated creatinine 8 32.0 table 5: peri-operative complications and major clinical events/conditions complication/clinical event number of patients major peri-operative complications acute kidney injury 2 intra-operative cardiac arrest 1 severe primary haemorrhage 4 other major clinical events/conditions acute kidney injury 4 malignant hypertension 2 brainstem death 7 chronic kidney disease 1 sickle cell disease 2 post-traumatic seizure 1 sepsis 3 multiple organ dysfunction syndrome 1 figure 1: flow chart for case analysis icu neurosurgery deaths rabiu et al. rjhs 11(1).cdr prevalence of gram-negative bacteria and their antibioticresistance pattern at tertiary care hospital amreli gujarat india *sanjeev k., krina v. abstract background: infections with multi-drug resistant (mdr) bacteria are serious threats to healthcare services many low-income countries associated with overuse and misuse of antibiotics. a total of 738 patient specimens were collected and processed from different clinical samples such as urine 540 (73%), wound swab 48 (6.5%), sputum 96 (13%), blood 06 (1%), throat swab 12 (1.5%) and other body fluids 36 (5%). overall, 142 (19.2%) of the specimen collected were culture positive. from the 142 positive patients, the proportion of bacterial isolates was higher in females 95 (67%), than males 47 (33%). out of 142 culture positive isolates, eshcerchia coli (e.coli) 56 (39%), followed by pseudomonas aeruginosa 35 (25%), klebsiellae 24 (17%), enterobacter 12 (8%), citrobacter 8 (6%), acinetobacter 5 (4%) and serratia 2 (1%). conclusion: e.coli followed by pseudomonas aeruginosa, klebsiellae, and enterobacter were the most commonly isolated gram-negative bacteria. these bacteria were resistant to the routinely used antibiotics. therefore, clinicians should practice rational choice of antibiotics and treatment should be guided by antimicrobial susceptibility testing. keywords: gram-negative bacteria, clinical samples, antibiotic resistant pattern, multi-drug resistant. *corresponding author sanjeev kumar email: usanjeevkumar30@gmail.com shantabaa medical college and general hospital, amreli, gujarat, india. material and methods: a prospective cross-sectional study was done between january, 2021 to december, 2021 at shantabaa medical college and general hospital, amreli, gujarat, india. clinical specimens such as swab from wound, urine, sputum, blood, body fluids and throat swab were sampled following standard operating procedures. results: orcid-no: https://orcid.org/0000-0002-5644-4546 received: october 9, 2022 accepted: january 25, 2023 published: april 19, 2023 original article research journal of health sciences res. j. health sci. vol 11(1), march 2023 12 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.2 prévalence des bactéries gram-négatives et leur profil de résistance aux antibiotiques à l'hôpital de soins tertiaires amreli gujarat inde *sanjeev k., krina v. résumé contexte général de l'étude : les infections par des bactéries multirésistantes (ibm) constituent de graves menaces pour les services de santé de nombreux pays à faible revenu, associées à la surutilisation et à l'abus d'antibiotiques. un total de 738 échantillons de patients ont été collectés et traités à partir de différents échantillons cliniques tels que l'urine 540 (73 %), l'écouvillonnage de la plaie 48 (6,5 %), les expectorations 96 (13 %), le sang 06 (1 %), l'écouvillonnage de la gorge 12 (1,5 %) et autres fluides corporels 36 (5 %). dans l'ensemble, 142 (19,2 %) des échantillons prélevés étaient positifs à la culture. parmi les 142 patients positifs, la proportion d'isolats bactériens était plus élevée chez les femmes 95 (67 %), que chez les hommes 47 (33 %). sur 142 isolats positifs à la culture, eshcerchia coli (e. coli) 56 (39 %), suivi de pseudomonas aeruginosa 35 (25 %), klebsiellae 24 (17 %), enterobacter 12 (8 %), citrobacter 8 (6 %), acinetobacter 5 (4 %) et serratia 2 (1 %). conclusion: e. coli suivi de pseudomonas aeruginosa, klebsiellae et enterobacterétaient les bactéries gram-négatives les plus fréquemment isolées. ces bactéries étaient résistantes aux antibiotiques couramment utilisés. par conséquent, les cliniciens doivent pratiquer le choix rationnel des antibiotiques et le traitement doit être guidé par des tests de sensibilité aux antimicrobiens. mots-clés: bactéries gram-négatives, échantillons cliniques, antibiorésistance, multi-résistance aux médicaments. *corresponding author sanjeev kumar email: usanjeevkumar30@gmail.com shantabaa medical college and general hospital, amreli, gujarat, india. matériel et méthode de l'étude : une étude transversale prospective a été réalisée entre janvier 2021 et décembre 2021 au shantabaa medical college and general hospital, amreli, gujarat, inde. des échantillons cliniques tels que des écouvillons de plaies, d'urine, de crachats, de sang, de liquides organiques et d'écouvillons de gorge ont été prélevés conformément aux procédures opératoires standard. résultat de l'étude : orcid-no: https://orcid.org/0000-0002-5644-4546 received: october 9, 2022 accepted: january 25, 2023 published: april 19, 2023 article original research journal of health sciences res. j. health sci. vol 11(1), march 2023 13 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.2 introduction infections caused by gram-negative bacteria include meningitis, urinary tract infections, pneumonia, blood stream infections, wound and surgical site infections in medical settings. [1]. despite the development of broad range antibiotics over the past 70 years, these lifethreatening bacteria continue to cause a high rate of mortality and morbidity. this is a result of gram-negative bacteria developing an increased rate of antibiotic resistance [2]. one of the major risks to the world's public health is antimicrobial resistance (amr), which makes it difficult to treat infections effectively and increases the likelihood that patients may have severe sickness, complications, and even death. according to estimates, amr currently claims 700,000 lives each year, and if nothing is done, that number would increase to 10 million by the year 2050 [3]. due to the illogical prescription and/or inappropriate usage of antibiotics, amr has significantly increased [2,4]. in order to tackle the amr epidemic, encourage the development of novel medicines, and promote the prudent use of that already in use, the world health organization (who) published a list of antibiotic-resistant priority infections. antibiotic resistance evolves when the bacteria can escape the effect of antibiotics by different mechanisms, like the neutralizing the antibiotics, pumping them outside of the cell or modifying their outer structure resulting in inhibition of the drugs' attachment to the bacteria and dna transfer through a horizontal gene transfer between bacteria via transformation or transduction or by conjugation. the majority of these microorganisms are gram-negative bacteria [5,28]. escherichia coli (e. coli), klebsiella pneumoniae (k. pneumoniae), enterobacter, citrobacter, pseudomonas aeruginosa (p. aeruginosa) and acinetobacter spp. are the commonly isolated organisms from infections in the clinical and community settings. they are also the current most serious antibiotic-resistant organisms [8, 9]. drug-resistant pathogen infections have a profound impact on both the economic stability of societies and public health globally. clinical infections with drug-resistant organisms continue to be important causes of morbidity and mortality in hospitalized patients and in community settings, impacting both developed and middle-income nations, despite major advancements in infection control methods [6,7]. multi-drug resistant pathogens are a common cause of hospital associated infections (hais) and a place a heavy toll on patients and their families by causing illness, potential disability, excess cost and sometimes death [29]. the study's goal is to determine the prevalence and antibiogram of gram-negative bacteria in various clinical samples at our healthcare centre. antimicrobial susceptibility test: susceptibility of bacterial isolates to d i ff e r e n t a n t i b i o t i c s w a s a n a l y z e d b y kirby–bauer disk diffusion susceptibility testing on muller hinton agar (mha). all the identified bacterial isolates were checked for susceptibility t o a m p i c i l l i n ( 1 0 ì g ) , c e f o x i t i n ( 3 0 ìg),ttetracycline (30 ìg), nitrofurantoin (300 ìg), chloramphenicol (30 ìg), gentamicin (10 ìg), tobramycin (10 ìg), amikacin (30 ìg), a m p i c i l l i n / s u l b a c t a m ( 1 0 / 1 0 ì g ) , p i p e r a c i l l i n / t a z o b a c t a m ( 1 0 0 / 1 0 ì g ) , ciprofloxacin (5 ìg), levofloxacin (5 ìg), cotrimoxazole (25 ìg), trimethoprim (5 ìg), norfloxacin (10 ìg), fosfomycin (200 ìg), cefepime (30 ìg), cefotaxime (30 ìg), aztreonam (30 ìg), imipenem (10 ìg) and meropenem (10 ìg). the choice of antibiotic agents is based on the commonly available drugs and drugs which are frequently prescribed by physicians. resistance data were interpreted according to zone sizes from the clinical and laboratory standards institute (clsi) guideline. american type culture collection (atcc) standard reference strain (e. coli atcc-25922 was used to verify the performance of the culture media and antibiotics [12]. results a total of 738 patient specimens were collected and processed from different clinical samples such as urine 540 (73%), wound swab 48 material and methods a prospective cross-sectional study was done between january, 2021 to december, 2021 at shantabaa medical college & general hospital, amreli, gujarat, india. clinical specimens such as swab from wound, urine, sputum, blood, body fluids and throat swab were s a m p l e d f o l l o w i n g s t a n d a r d o p e r a t i n g procedures. depending on the source of the specimen, each sample was plated on blood agar, macconkey's agar, cled agar, nutrient agar and chocolate. all the inoculated plates were 0 incubated aerobically at 37 c for 24-48 hrs. bacterial isolates were identified by standard phenotypic microbiological methods [10,11]. res. j. health sci. vol 11(1), march 2023 14 prevalence of gram-negative bacteria and their antibiotic-resistance sanjeev and krina (6.5%), sputum 96 (13%), blood 06 (1%), throat swab 12 (1.5%) and other body fluids 36 (5%). overall, 142 (19.2%) of the specimen collected were culture positive. from the 142 positive patients, the proportion of bacterial isolates was significantly higher in females 95 (67%), than males 47 (33%). out of 142 culture positive isolates, eshcerchia coli (e.coli) 56(39%), followed by pseudomonas aeruginosa 35 (25%), klebsiellae 24 (17%), enterobacter 12 (8%), citrobacter 8 (6%), acinetobacter 5 (4%) and serratia 2 (1%) [chart 1]. discussion the prevalence of culture confirmed gram-negative bacterial infections was higher in females than males in the present study. the finding is in correlates with study of rossi f [13] and yitayeh et al [14]. this may be due to large number of isolates were isolated form urinary tract infections (uti) and females are more prone to get uti [15]. in this study, e. coli was the most predominant isolate. this is similar to studies from burkina faso [16] and kigali, rwanda [17] and studies from other parts of ethiopia [15, 18]. this could be due to the abundance of e. coli in urinary tract infection and its virulence factors and interaction with the host. p.aeruginosa has been emerged as a significant pathogen and is the most common dreadful gram negative bacilli found in various health care associated infections all over the world due to its virulence, well known ability to resist killing by various antibiotics and disinfectants. in the present study we have isolated 25% of p.aeruginosa from various clinical specimens. although in india, prevalence rate of p.aeruginosa infection varies from 10.5% to 30%. tadvi j et al. reported the prevalence rate of p.aeruginosa was 4.15% [19]. in our study ciprofloxacin and levofloxacin showed 40% resistant against p.aeruginosa. in various reports on ciprofloxacin resistance to p.aeruginosa was ranged between 0-89% [20]. klebsiella pneumonia is worldwide one of the most frequently isolated gram negative bacteria from clinical specimens of hospitalized patients. there has been an increase in the incidence of infections with these bacteria during the past decade, probably due to an increase in the number of hospitalized or immune-compromised individuals. also a trend towards greater antibiotic resistance is seen [21,22]. the present study highlights an alarming situation of high antibiotic resistance among the isolates of klebsiella pneumonia. in the present study 100% isolates showed resistance to ampicillin. the cause may be chromosomally encoded âlactamases responsible for intrinsic resistance [23]. enterobacter has become increasingly resistant to many previously effective antibiotics. in 2017, the world health organization issued a list of antibiotic resistant bacteria in which carbapenem reistant enterobacteriaceae was in the critical priority group for an urgent needs to develop new antibiotics [24]. multidrug resistant (mdr) acinetobacter baumannii is becoming a global threat with a therapeutic impasse increasingly described in literature [25]. according to the literature data, the resistance rate varies from 31.8 to 92.1% against ceftazidime; 8.8 to 89.9% against imipenem, from 28.8 to 91.6% against f l u o r o q u i n o l o n e s a n d 3 0 t o 9 0 % v s aminoglycosides [26]. in the present study acinetobacter showed 80% resistant to fluoroquinolones and 60% resistant to aminoglycosides. however acinetobacter is an opportunistic pathogen known for its intrinsic resistance to antibiotics and greater ability to rapidly acquire resistance genes as mobile genetic elments [27]. conclusion e.coli, p.aeruginosa, klebsiellae and enterobacter spp. were the predominant gramnegative bacteria isolated from different clinical samples. most of the clinical isolates were resistant to ampicillin, co-trimoxizole, f l u o r o q u i n o l o n e s , t e t r a c y c l i n e a n d cephalosporins. therefore it is recommended to have strict antibiotic utilization policies within the hospital, regular surveillance of antibiotic sensitivity pattern among the clinical isolates and to support clinicians on rational choice of antibiotics therapy. references 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1 : 4 7 . d o i : 10.21037/jeccm.2017.12.09. 23. sahly h, aucken h, benedí vj, forestier c, fussing v, hansen ds, et al. increased serum resistance in klebsiella pneumoniae strains producing extended-spectrum beta-lactamases. a n t i m i c r o b a g e n t s c h e m o t h e r . 2004;48(9):3477-82.doi:10.1128/ aac.48. 9.3477-3482.2004. 24. who.int/news. who publishes list of bacteria for which new antibiotics are urgently needed. who official site, 27 february 2017. 25. mustaq s, javeid i, hassan m. antibiotic sensitivity pattern of acinetobacter species isolated from clinical specimens in a tertiary care hospital. biomedica, 2013;29:23-26. 26. al-mously n, hakawi a. acinetobacter baumannii bloodstream infections in a tertiary hospital: antimicrobial resistance surveillance. int j infect control, 2013;9(2):1-8. 27. g a r c i a g a r m e n d i a j l , o r t i z l e y b a c , garnacho-montero j, et al. risk factors for acinetobacter baumanii nosocomial bacteremia in critically ill patients: a cohort study. clin infect dis, 2001;33(7):939-46. 28. silhavy t.j, khane d, walker s. the bacterial cell envelope. cold spring harb. perspect. boil., 2010;2a000414. 29. ali s, birhane m, bekele s, kirbu g, teshagar l, yilma y, et al. healthcare associated infection and its risk factor among patients admitted to a tertiary hospital in ethopia: longitudinal study. antimicro resist infect control 2018;7:2. res. j. health sci. vol 11(1), march 2023 16 prevalence of gram-negative bacteria and their antibiotic-resistance sanjeev and krina res. j. health sci. vol 11(1), march 2023 17 e.coli isolates showed 86% resistant to ampicillin and 57% resistant to cotrimoxizole, cefuroxime, cefipime and tetracycline. pseudomonas aeruginosa showed 40% resistant to levofloxacin, ciprofloxacin and cefipime. klebsiellae isolates showed 100% resistant to ampicillin, cefuroxime and cefipime. (table 1) table 1: antibiotic resistance pattern of gram negative bacteria organism (no.of isolates = n) the following antibiotics showing resistance (r) against the number of isolates g e n t a m ic in t o b r a m y c in a m ik a c in a m p ic il l in /s u l b a c t u m p ip e r a c il l in /t a z o b a c t a m c e f u r o x im e c e f ip im e c e f o x it in c e f t r io x o n e c ip r o f l o x a c in l e v o f l o x a c in m e r o p e n a m c o t r im o x iz o l e a z t r e o n a m c e f t a z a d im e c h l o r a m p j e n ic o l t e t r a c y c l in e c e f a z o l in f o s f o m y c in n it r o f u r o n t o in a m p ic il l in m in o c y c l in escherichia coli (n=56) 8 8 10 22 10 32 29 18 19 24 26 2 31 14 18 16 32 12 6 2 48 pseudomonas aeruginosa (n=35) 8 8 6 7 14 12 14 1 5 8 klebsiellae spp. (n=24) 7 6 4 9 5 24 24 11 15 10 9 3 10 10 14 7 16 7 0 0 24 enterobacter (n=12) 3 3 2 5 4 8 8 8 8 6 9 0 7 9 8 10 6 12 0 0 10 citrobacter (n=8) 2 2 2 2 4 2 6 2 2 6 6 6 4 2 4 acinetobacter (n=5) 0 2 1 1 1 4 3 3 2 1 4 1 1 1 serratia (n=1) 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 1 1 1 prevalence of gram-negative bacteria and their antibiotic-resistance sanjeev and krina rjhs 11(3).cdr monkeypox related knowledge, attitudes and practices among students in a tertiary institution in southwest, nigeria: a crosssectional study 1 1 1 2 1 *oyebade, a.o. , oshineye, a.o. , olarinmoye, a.t. , kayode, o.o. , akinpelu, a.a. , 3 oladosu, m. abstract introduction: monkeypox caused by monkeypox virus, a member of the orthopoxvirus genus in the family poxviridae is usually a self-limited disease, however severe cases can occur with case fatality ratio of 3–6% being reported in recent times. this study is aimed at assessing monkeypox related knowledge, attitudes and practices among students in a tertiary institution in southwest, nigeria methodology: the study utilized a cross-sectional design and semi-structured questionnaire to collect data from 278 respondents from august to october 2022. results: in this study, only 37.8% of respondents had good monkeypox related knowledge, 87.8% had good monkeypox related attitude while 96% had good monkeypox related practices. there was association between good monkeypox related knowledge and university education level (p=0.002) with 100 level student having better knowledge. there was also association between good monkeypox related attitude and sex (p=0.012) with female respondents having better attitudes and there was association between monkeypox related practices and age (p=0.028) with respondents between the ages of 18-22 years having better practices. however, there was no association between monkeypox related knowledge, attitudes and practices and marital status, ethnicity and religion conclusion: our findings revealed the crucial need for public health education on monkeypox infection to improve knowledge in order to prevent and protect students from monkeypox infection. good monkeypox related attitudes and practices should be maintained and improved through measures for reduction of exposure to the virus and prompt detection and response keyword: monkeypox, knowledge, attitudes, practices, tertiary institution *corresponding author dr akin oyebade, email: akinoyebade@yahoo.com 1 department of public health, faculty of basic medical sciences, adeleke university, ede, nigeria 2 department of human nutrition and dietetics, osun state university, osogbo, nigeria 3 school of public health, university of illinois, chicago, united states received: december 30, 2022 accepted: april 17, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0003-0202-0315 original article research journal of health sciences res. j. health sci. vol 11(3), september 2023 205 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.3 connaissance, attitudes et pratiques concernant le monkeypox parmi les étudiants du sud-ouest du nigéria 1 1 1 2 1 *oyebade, a.o. , oshineye, a.o. , olarinmoye, a.t. , kayode, o.o. , akinpelu, a.a. , 3 oladosu, m. résumé introduction : le monkeypox causé par le virus monkeypox, un membre du genre orthopoxvirus de la famille des poxviridae, est généralement une maladie spontanément résolutive, mais des cas graves peuvent survenir avec un taux de létalité de 3 à 6% signalé ces derniers temps. cette étude vise à évaluer les connaissances, les attitudes et les pratiques liées au monkeypox chez les étudiants d'une institution tertiaire du sud-ouest du nigéria . méthode de l'étude : l'étude a utilisé une conception transversale et un questionnaire semi-structuré pour collecter des données auprès de 278 répondants d'août à octobre 2022. résultat de l'étude: dans cette étude, seuls 37,8 % des répondants avaient de bonnes connaissances sur le monkeypox , 87,8 % avaient une bonne attitude vis-à-vis du monkeypox tandis que 96 % avaient de bonnes pratiques liées au monkeypox . il y avait une association entre de bonnes connaissances liées au monkeypox et le niveau d'éducation universitaire (p = 0,002) avec un étudiant de niveau 100 ayant de meilleures connaissances. il y avait également une association entre une bonne attitude vis-à-vis du monkeypox et le sexe (p = 0,012) avec les répondantes ayant de meilleures attitudes et il y avait une association entre les pratiques liées au monkeypox et l'âge (p = 0,028) avec les répondants âgés de 18 à 22 ans ayant de meilleures pratiques. cependant, il n'y avait aucune association entre les connaissances, les attitudes et les pratiques liées au monkeypox et l'état matrimonial, l'origine ethnique et la religion. conclusion: nos résultats ont révélé le besoin crucial d'éducation en santé publique sur l'infection par le monkeypox pour améliorer les connaissances afin de prévenir et de protéger les étudiants contre l'infection par le monkeypox . de bonnes attitudes et pratiques liées au monkeypox doivent être maintenues et améliorées grâce à des mesures de réduction de l'exposition au virus et à une détection et une réponse rapides. mot-clé : monkeypox , connaissances, attitudes, pratiques, établissement tertiaire *corresponding author dr akin oyebade, email: akinoyebade@yahoo.com 1 department of public health, faculty of basic medical sciences, adeleke university, ede, nigeria 2 department of human nutrition and dietetics, osun state university, osogbo, nigeria 3 school of public health, university of illinois, chicago, united states received: december 30, 2022 accepted: april 17, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0003-0202-0315 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 206 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.3 introduction monkeypox is a rare zoonotic disease which is caused by a virus belonging to the family poxviridae and genus orthopoxvirus. the causative virus is divided into two clades: west african and congo basin clade. monkeypox is transmitted to humans through close contact with an infected person or animal, or with items contaminated with the virus. infection with monkeypox results in a smallpox-like disease in humans. clinical manifestation may be symptomatic or asymptomatic with incubation period of 5-21 days, usually 6-13 days. infection is usually mild-to-moderate in nature and clinical course comprises of the prodromal period and skin eruption period. natural host of monkeypox virus includes rope squirrels, tree squirrels, gambian pouched rats, dormice, non-human primates and other species (1). communities affected are known to be impoverished and generally have a background of high prevalence of parasitic infections, malnutrition and other significant heathcompromising conditions with no racial or gender preference (2). curtailing animal to human transmission and human to human transmission by ensuring standard precaution plays a very important role in prevention and control of monkey pox transmission (3). the use of airborne precaution is recommended for examination and admission of patient due to the risk of airborne transmission of the disease (4). history has it that small pox vaccination with vaccinia virus was approximately 85% protective against monkeypox (5). since 1970, human cases of monkeypox have been reported in west and central africa countries. nigeria has experienced a large outbreak since 2017, with more than 500 suspected cases and 200 confirmed cases and a case fatality ratio of approximately 3%. in may 2022, multiple cases of monkeypox were identified in several non-endemic countries. monkeypox is usually self-limiting but may be severe in children, pregnant women or persons with immune suppression resulting from other health conditions. the case fatality ratio of monkeypox has historically ranged from 0 to 11 % in the general population and higher among young children but recently case fatality ratio of around 3–6% has been reported (1). there is a need to conduct a study on the knowledge, attitudes and practice of monkeypox infection among the undergraduates, because undergraduate students can give a good insight on the subject matter in the population. results from this study will help to document the knowledge, attitudes and practices of monkeypox among undergraduates and by extension sensitize other undergraduates from other institutions nationwide. this study will also serve as a guide for policy development on prevention of monkeypox and the development of appropriate prevention and control programmes among the population, using health education as a tool for the desired change. materials and methods this study was carried out at adeleke university, ede, osun state, nigeria. osun state covers an area of approximately 14,875 square kilometre and lies between latitude 7° 30' 0? n and longitude 4° 30' 0? e. the capital city is osogbo and is bounded in the north by kwara state, in the east partly by ekiti state and partly by ondo state, in the south by ogun state, and in the west by oyo state. it lies within the tropical rain forest with abundance of resources and is blessed with presence of many rivers and streams which serves the water needs of the state (6). osun state has a projected 2016 population of 4,705,600 (7). adeleke university is located in an ambient and serene environment at loogun ogberin, ede north ede, osun state, nigeria. is a private faith-based learning institution located in a peaceful and friendly environment of about 520 acres of land in the historical town of ede, osun state, south-western part of nigeria. adeleke university comprises of six faculties, comprising of faculty of engineering (foe), faculty of basic medical sciences (fbms), faculty of sciences (fos), faculty of law (fol), faculty of arts (foa); and faculty of business and social sciences (fbss). it has an administrative (senate) building, residential buildings, university cafeteria and library we utilized the cross-sectional study design to assess monkeypox related knowledge, attitudes and practices among students of adeleke university. the study population comprised of undergraduate students. the inclusion criteria are: being a full-time undergraduate student of adeleke university, availability at the time of carrying out the study, giving full consent for participation in the study and being healthy and not diagnosed with any kind of diseases. the exclusion criteria are: being a post-graduate student, part-time student, fulltime undergraduate student on any form of medication, acutely ill or with known chronic res. j. health sci. vol 11(3), september 2023 207 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. diseases or unwilling to participate in the study. the sample size was determined using the formula for sample size determination for 2 2 known single proportion n = z p (1 p)/d , where n = minimum desired sample size, z = the standard normal deviate was set at 1.96 which corresponds to 5% level of significance (8). utilizing proportion of 48% reported in a similar study and precision of 6%, a minimum sample size of 260 was computed. however, to account for anticipated non-response a total sample size of 278 was utilized for the study (9). we utilized the purposive sampling method to select participants to cut across the six faculties, 23 departments and 100-500 levels of the undergraduate education. we designed a semi-structured self-administered questionnaire consisting of four sections used for data collection. the first section aimed at determining the socio-demographic characteristics of the respondents had 7 questions, the second section aimed to determine knowledge on monkeypox had 14 questions; the third section was aimed at detecting attitude towards monkey pox disease had 8 questions, while the fourth section aimed at capturing practices regarding prevention of monkeypox had 6 questions. the instrument was administered to respondents by the researchers. the range of scores for knowledge was 0-14 using yes, no and do not know questions. the range of scores for attitude was 5-40 using 5point likert scale questions while the range of score for practice was 0-6 using yes or no questions. knowledge was classified into low (07) and high (8-14), attitude was classified into low (8-25) and high (25-40) while practice was classified into low (0-3) and high 4-6) content validity of research instrument was determined through expert in the field of p u b l i c h e a l t h a s s e s s i n g t h e r e s e a r c h questionnaire. observations, corrections and suggestions made were used to revise the instrument before the final draft. the data collected was entered and analyzed using the ibm statistical package for social sciences (ibm spss) statistical software, version 26. descriptive statistics (means, s t a n d a r d d e v i a t i o n s , f r e q u e n c i e s a n d percentages) were computed for sociodemographic variables and the dependent variables. analysis of variance (anova) test was used to test hypothesis for difference in dependent variables among different sociodemographic groups to determine presence of statistical association. the level of significance was set at 5%. written informed consent was obtained from the respondents before commencement of the study. results there were 278 participants recruited into the study and there was 100% response rate. age range was 18-27 years with mean age of 19.7 years and a standard deviation of +5.01 years. majority (76.3%) of respondents were between 18-22 years, 14.7% were between 13-17 years while 9% were between 23-27 years. fifty-four (54%) percent of respondents are males while 46% are females. a bulk (96.4%) of respondents are single, 3.2% are married while 0.4% are separated. most (67.3%) respondents are yorubas, 27.7% are igbos, 4.7% are hausas while 0.4% are from other ethnic groups. a high proportion (80.6%) of respondents are christians, 18.7% are muslims while 0.7% are practicing traditional religion. a bulk (38.8%) are in 300 level, 28.4% are in 400 level, 25.2% are in 200 level, 4.7% are in 500 level while 2.9% are in 100 level (table i) monkeypox related knowledge score ranged from 0-14 with a mean score of 6.04 and standard deviation of +3.16, monkeypox related attitude score ranged from 17-36 with a mean score of 28.7 and standard deviation of +3.34 while monkeypox related practice score ranged from 0-6 with a mean score of 5.49 and standard deviation of +0.91 (table ii) a low proportion (37.8%) of respondents had high monkeypox related knowledge score while 62.2% had low monkeypox related knowledge score. a high proportion (54.3%) of respondents had high monkeypox related attitudes score while only 12.2% had low monkeypox related attitude score. majority (96%) of respondents had high monkeypox related practice score while only 4% had low monkeypox related practice score (table iii) respondents between the ages of 18-22 years had higher monkeypox related practice mean score compared to other age groups (p=0.028), however there was no association between age and monkeypox related knowledge (p=0.066) and monkeypox related attitude (p=0.249) f e m a l e r e s p o n d e n t s h a d h i g h e r monkeypox related attitude mean score compared to male respondents (p=0.012) but there was no association between sex and monkeypox related knowledge (p=0.363) and monkeypox related practice (p=0.103). respondents in 100 level had higher monkeypox related knowledge mean score compared to other respondents in levels 200-500 (p=0.002) res. j. health sci. vol 11(3), september 2023 208 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. however there was no association between university level and monkeypox related knowledge (p=0.270) and monkeypox related practice (p=0.743). there was no association between marital status and monkeypox related knowledge (p=0.727), monkeypox related attitude (p=0.111) and monkeypox related practice (p=0.229). there was also no association between religion and monkeypox related knowledge (p=0.317), monkeypox related attitude (p=0.091) and monkeypox related practice (p=0.532). there was equally no association between ethnicity and monkeypox related knowledge (p=0.808), monkeypox related attitude (p=0.693) and monkeypox related practice (p=0.380) (table v) discussion we observed that only 37.8% of respondents had high monkeypox related knowledge score. this means that a low proportion of students have good knowledge about monkeypox infection. this poor knowledge may be due to the fact that until the recent monkeypox outbreak of 2022, the last time cases of monkeypox were reported in nigeria was in the 1970s resulting in low level of awareness (10). this finding is similar to that of a study in nigeria in the general population with only 58.7% having good knowledge of monkeypox infection (11). in addition, a study saudi arabia among the general population reported only 48% of the respondents with high knowledge of monkeypox (9). a survey of the united state general public also found almost half the respondents (47%) feeling that their knowledge level about monkeypox is poor while a study in indonesia reported only 36.5% with good knowledge (12,13). also, a study in kurdistanregion of iraqi reported that participants had insufficient knowledge of monkeypox with a mean of 2.096 and standard deviation ±1.359 and a study at palembang indonesia reported that respondents' knowledge of monkeypox was not very good with only 34.7% knowing that monkeypox was not transmitted sexually (14,15). in addition, a study among physicians in saudi arabia reported 55% with good knowledge about human monkeypox, while a study in a malaysian dental school reported that 89.5% of preclinical students and 94.4% of clinical students were aware of the existence of monkeypox (16,17). we also observed 87.8% of respondents with high monkeypox related attitude score. this deduces that respondents have good attitude about monkeypox infection. the reason may be that people have fears that the recent monkeypox outbreak may mark the start of another pandemic like the covid-19 pandemic and therefore wants to avoid getting infected bringing about good attitudes towards prevention. in addition, a study in kurdistan-region of iraqi also reported participants positive attitude toward monkeypox viral disease with mean score of 4.031 and standard deviation ± 1 . 6 4 5 w h i l e a n o t h e r s t u d y a m o n g undergraduates of a malaysian dental school reported 95.2% preclinical and 96.8% clinical students demonstrating positive attitudes toward monkeypox (14,17). our study reported 96% of respondents with high monkeypox related practices score. this infers good monkeypox related practices among respondents. this is likely because majority of respondents have learnt about standard precaution prevention practices during the covid-19 era which is also applicable for prevention of monkeypox infection culminating in good prevention practices. this finding is analogous to that of a study in indonesia which observed 60% of respondents equipping themselves with personal protective equipment, 76% finding information about diagnosis and 77.3% willing to be vaccinated against monkeypox while a study among clinicians in ohio reported only about 40% who had received smallpox vaccination (15,18). this study revealed association between monkeypox related knowledge and university education level (p=0.002) with 100 level students having better knowledge. monkeypox related attitude was associated with sex (p=0.012), with female respondents having better attitudes. also, our study observed association between monkeypox related practices and age (p=0.028) with respondents between the ages of 18-22 years having better practices. we did not find any association between monkeypox related knowledge, attitudes and practices and marital status, religion and ethnicity. this finding is similar to observation in a study which reported that demographic factors were not associated with monkeypox knowledge, attitude and practice (18). however, another study reported association between monkeypox related knowledge and religion with p<0.001 and marital status with p-value<0.009 (14). a similar study reported association between monkeypox related knowledge and marital status with p<0.01(9). a limitation of this study is the use of purposive sampling method which means that generalization of the findings should be done with caution. res. j. health sci. vol 11(3), september 2023 209 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. conclusion we found that overall monkeypox related knowledge was poor while overall monkeypox related attitude and practices were good among students of adeleke university, ede in nigeria. better monkeypox related knowledge was associated with lower university education level. also, better monkeypox related attitude was associated with being female while better monkeypox related practices was associated with being young (18-22 years). we did not observe any association between monkeypox related knowledge, attitudes and practices and marital status, ethnicity and religion our findings revealed the crucial need for public health education on monkeypox infection to improve knowledge in order to prevent monkeypox infection among students and to empower them to protect themselves against monkeypox infection. good monkeypox related attitudes and practices should be maintained and improved through measures for reduction of exposure to the virus and prompt detection and response conflict of interest: authors declare no conflict of interest. a c k n o w l e d g m e n t s : t h e r e a r e n o acknowledgments references 1. world health organization. monkeypox. av a i l a b l e a t h t t p s : / / w w w. w h o . i n t / n e w s room/fact-sheets/detail/monkeypox. accessed december 5, 2022. 2. reynolds mg, mccollum am, nguete b, shongo lr. et al. improving the care and treatment of monkeypox patients in low-resource settings: applying evidence from contemporary biomedical and smallpox biodefense research. viruses. 2017; 9(12):380. 3. arita i, jezek z, khodakevich l, ruti k. human monkeypox: a newly emerged orthopoxvirus zoonosis in the tropical rain forests of africa. am j trop med hyg. 1985; 34(4):781-789. 4. hauser k, jamerson sl. eds. harrison's principle of internal medicine. 18th ed: mcgraw hill medical; 2012:1476-1478. infection control: hospital. 2015. available at https://www.cdc.gov / p o x v i r u s / m o n k e y p o x / c l i n i c i a n s / i n f e c t i o n control-hospital.html. accessed september 17, 2022. 5. fine pe, jezek z, grab b, dixon h. the transmission potential of monkeypox virus in human populations. int j epidemiol. 1988; 17(3): 643-650. 6. osun state government. geography. available at https://www.osunstate. gov.ng/about/geography/. accessed december 23, 2022. 7. nigeria bureau of statistics. population 20062016. available at https://nigerianstat.gov.ng /elibrary/read/474. accessed december 23, 2022 8. kish l. survey sampling. wiley.1965; isbn 9780471109495 9. alshahrani nz, alzahrani f, alarifi a.m. algethami, mr, alhumam mn, ayied, ha. et al assessment of knowledge of monkeypox viral infection among the general population in saudi arabia. pathogens 2022; 11:904 10. national centre for disease control and prevention, 2022. https://ncdc.gov.ng/diseases /factsheet/55 11. al-mustapha ai, ogundijo o.a, sikiru na, kolawole b, oyewo m, el-nadi h et al. a crosssectional survey of public knowledge of the monkeypox disease in nigeria. bmc public health (2023) 23:591, https://doi.org/ 10. 1186/s12889-023-15398-0 12. winters ms, malik aa, omer sb. attitudes of the us general public towards monkeypox. medrxiv; doi: https: //doi.org/10.1101 /2022.06.20.2227652 13. harapan h, setiawan am, yufika a, wahyuni s, asrizal s, febrivan s. et al. knowledge of human monkeypox viral infection among general practitioners: a cross-sectional study in indonesia. pathog glob health. 2020; 114(2):68-75. 14. ahmed sk, abdulqadirb so, omar rm, hussein s.h, m-amin hi, chandran d. et al. study of knowledge, attitude and anxiety in kurdistanregion of iraqi population during the monkeypox outbreak in 2022: an online cross-sectional study. d o i : 1 0 . 2 1 2 0 3 / r s . 3 . r s 1 9 6 1 9 3 4 / v 2 . p p r : ppr541524. 15. salim na, septadina is, permata m. harun h. knowledge, attitude and perception of anticipating 2022 global human monkeypox infection among internal medicine residents at palembang indonesia: an online survey. jurnal kedokteran dan kesehatan 2022; 9:253-262 16. alshahrani nz, algethami mr, alarifi am, alzahrani f, alshehri ea, alshehri am. et al. knowledge and attitude regarding monkeypox virus among physicians in saudi arabia: a crosssectional study. vaccines 2022; 10: 2099. https:// doi.org/10.3390/vaccines10122099 lin gs, 17. tan ww, chan dz, ooi k.s, hashim h. monkeypox awareness, knowledge, and attitude among undergraduate preclinical and clinical students at a malaysian dental school: an emerging outbreak during the covid-19 era. asian pac j. trop med 2022; 15(10):461 18. bates br, grijalva mj. knowledge, attitudes, and practices towards monkeypox during the 2022 outbreak: an online cross-sectional survey among clinicians in ohio, usa. j. infect public health, 15(12), 1459–1465 res. j. health sci. vol 11(3), september 2023 210 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. res. j. health sci. vol 11(3), september 2023 211 table i: frequency distribution of respondents by socio-demographic characteristics variable category frequency percent age group 13-17 years 41 14.7% 18-22 years 212 76.3% 23-27 years 25 9.0% total 278 100.0% gender male 150 54.0% female 128 46.0% total 278 100.0% marital status single 268 96.4% married 9 3.2% separated 1 0.4% ethnicity total 278 100.0% yoruba 187 67.3% hausa 13 4.7% igbo 77 27.7% others 1 0.4% religion total 278 100.0% christian 224 80.6% muslim 52 18.7% traditional 2 0.7% total 278 100.0% level of education 100 8 2.9% 200 70 25.2% 300 108 38.8% 400 79 28.4% 500 total 13 278 4.7% 100.0% table ii: descriptive statistics of respondent’s monkeypox related knowledge, attitude and practice score variable n possible scores actual score mean std. deviation knowledgescore 278 0-14 0-14 6.04 +3.16 attitudescore 278 5-40 17-36 28.70 +3.34 practicescore 278 0-6 0-6 5.49 +0.91 table iii: distribution of monkeypox related knowledge, attitude and practice score variable score frequency percent knowledge low (0-7) 173 62.2% high (8-14) 105 37.8% total 278 100.0% attitude low (8-24) 34 12.2% high (25-40) 244 87.8% total 278 100.0% practice low (0-3) 11 4.0% high (4-6) 267 96.0% total 278 100.0% monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. res. j. health sci. vol 11(3), september 2023 212 table iv: association between monkeypox related knowledge, attitude and practice and age, sex and university level (anova test) variable score category n mean f sig. age group knowledge score 13-17 years 41 5.37 2.745 0.066 18-22 years 212 6.28 23-27 years 25 5.08 total 278 6.04 attitude score 13-17 years 41 29.02 1.399 0.249 18-22 years 212 28.76 23-27 years 25 27.68 total 278 28.70 practice score 13-17 years 41 5.22 3.624 0.028 18-22 years 212 5.57 23-27 years 25 5.24 total 278 5.49 sex knowledge score male 150 5.88 0.829 0.363 female 128 6.23 total 278 6.04 attitude score male 150 28.24 6.350 0.012 female 128 29.24 total 278 28.70 practice score male 150 5.41 2.672 0.103 female 128 5.59 total 278 5.49 university level knowledge score 100 8 8.38 4.264 0.002 200 70 5.69 300 108 6.39 400 79 6.09 500 13 3.31 total 278 6.04 attitude score 100 8 29.75 1.301 0.270 200 70 29.36 300 108 28.55 400 79 28.25 500 13 28.54 total 278 28.70 practice score 100 8 5.25 0.490 0.743 200 70 5.44 300 108 5.49 400 79 5.51 500 13 5.77 total 278 5.49 table v: association between sociodemographic characteristics and monkey-pox related knowledge, attitude and practice (anova test) variable knowledge score p value attitude score p value practice score p value age 0.066 0.249 0.028 sex 0.363 0.012 0.103 marital status 0.727 0.111 0.229 religion 0.317 0.091 0.532 ethnicity 0.808 0.693 0.380 university level 0.002 0.270 0.743 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. rjhs 11(1).cdr knowledge, acceptability and utilization of epidural analgesia in antenatal clinic attendees at uniosun teaching hospital (uth), osogbo, osun state. 1 2 1 3 *bola-oyebamiji, s.b. , azeez, r.a. , farinloye e.o . folami, e.o. abstract background/objective: labour pain is perceived as the most harrowing and agonizing event of a woman's life. efforts at reducing the pain and making the event less stressful have predated modern obstetric practice. epidural analgesia has provided effective pain relief in labour for over three decades. delivery with epidural analgesia is routine for willing parturients in the developing world, however ignorance, cost as well as lack of qualified personnel has made this to be out of reach of the average nigerian mother. the aim of this study was to assess level of awareness, acceptability, previous utilization and willingness to utilize epidural analgesia in labour following health education. subjects/methods: this cross-sectional study was carried out in the antenatal clinic of uth, osogbo. health education on events of labour and methods of analgesia available was provided to all antenatal clinic attendees between september 2021and march 2022, following which a semi–structured purpose designed, and selfadministered questionnaire was administered to 415 of these women who consented to participate in this study. results: the mean age of the respondents was 32.57± 4.42 years and mean parity of 1.73± 0.96. 70.8% reported that labour pain was severe. 41.7% were aware of epidural analgesia before the health talk. 3.6% of our subjects had utilized epidural in their last confinement. however, only 47.7% expressed a wish to utilize epidural analgesia in labour. conclusion: awareness of epidural analgesia in study population was passable at 40% however willingness to utilize it was less than average despite health talk and reassurance by their attending obstetric team. key words; labour pain, epidural analgesia, awareness, knowledge, acceptability, utilization *corresponding author bola-oyebamiji, s.b. email address: sekinah.bola-oyebamiji@uniosun.edu.ng 1 obstetrics and gynaecology department, osun state university/uniosun teaching hospital, osogbo, nigeria 2 obstetrics and gynaecology department, uniosun teaching hospital, osogbo, nigeria 3 anaesthesia department, osun state university/ uniosun teaching hospital, osogbo, nigeria received: july 20, 2022 accepted: january 26, 2023 published: april 19, 2023 original article research journal of health sciences res. j. health sci. vol 11(1), march 2023 66 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.8 connaissance, acceptabilité et utilisation de l'analgesie épidurale chez les participants à la clinique prénatale à l'hôpital d'enseignement uniosun (uth), osogbo, état d'osun résumé contexte général de l'étude/objectif de l'étude: la douleur du travail est perçue comme l'événement le plus déchirant et le plus angoissant de la vie d'une femme. les efforts visant à réduire la douleur et à rendre l'événement moins stressant ont précédé la pratique obstétricale moderne. l'analgésie péridurale a fourni un soulagement efficace de la douleur pendant le travail pendant plus de trois décennies. l'accouchement avec analgésie péridurale est courant pour les parturientes consentantes dans les pays en développement, mais l'ignorance, le coût ainsi que le manque de personnel qualifié ont rendu cela hors de portée de la mère nigériane moyenne. le but de cette étude était d'évaluer le niveau de sensibilisation, d'acceptabilité, d'utilisation antérieure et de volonté d'utiliser l'analgésie péridurale pendant le travail après une éducation sanitaire. méthode de l'étude: cette étude transversale a été réalisée à la clinique prénatale de l'uth, osogbo . une éducation sanitaire sur les événements de travail et les méthodes d'analgésie disponibles a été dispensée à toutes les participantes à la clinique prénatale entre septembre 2021 et mars 2022, après quoi un objectif semi-structuré et un questionnaire auto-administré ont été administrés à 415 de ces femmes qui ont consenti à participer à cette étude. résultat de l'étude : l'âge moyen des répondants était de 32,57± 4,42 ans et la parité moyenne de 1,73± 0,96. 70,8% ont déclaré que la douleur du travail était sévère. 41,7 % connaissaient l'analgésie péridurale avant l'entretien sur la santé. 3,6% de nos sujets avaient eu recours à la péridurale lors de leur dernier accouchement. cependant, seulement 47,7 % ont exprimé le souhait d'utiliser l'analgésie péridurale pendant le travail . conclusion: la connaissance de l'analgésie péridurale dans la population de l'étude était passable à 40 %, mais la volonté de l'utiliser était inférieure à la moyenne malgré les discussions sur la santé et le réconfort de l'équipe obstétricale présente. mots-clés: douleur du travail, analgésie péridurale, prise de conscience, connaissance, acceptabilité, utilisation *corresponding author bola-oyebamiji, s.b. email address: sekinah.bola-oyebamiji@uniosun.edu.ng 1 obstetrics and gynaecology department, osun state university/uniosun teaching hospital, osogbo, nigeria 2 obstetrics and gynaecology department, uniosun teaching hospital, osogbo, nigeria 3 anaesthesia department, osun state university/ uniosun teaching hospital, osogbo, nigeria 1 2 1 3 *bola-oyebamiji, s.b. , azeez, r.a. , farinloye e.o . folami, e.o. received: july 20, 2022 accepted: january 26, 2023 published: april 19, 2023 article original research journal of health sciences res. j. health sci. vol 11(1), march 2023 67 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.8 reality outcome of labour is dependent on physiologic as well as psychological factors and epidural analgesia has been shown to be safe for both mother and baby. to our knowledge, the level of utilization of epidural analgesia in labour has not been determined in our centre despite its availability and continued relevance. therefore, this study aims at assessing level of knowledge, acceptability, and utilization of epidural analgesia in labour among pregnant women attending the antenatal clinic of uniosun teaching hospital, osogbo. therefore the study aimed at assessing the knowledge, acceptability, and utilization level of epidural analgesia in labour among pregnant women attending uniosun teaching hospital osogbo materials and method t h i s c r o s s s e c t i o n a l s t u d y w a s conducted in the antenatal clinic of uth between september 2021 and march 2022. health talk on labour and types of analgesia available was provided to all patients who attended the clinic during the study period. 415 participants who gave informed consent were consecutively recruited. this sample size was determined using sample size formular (daniel's formular) for 2 2 1 4 prevalence < 10,000. n=z pq/d . we calculated sample size n based on prevalence of 10 awareness (p) of 43.3% from a previous study , d is the maximum allowable error margin set at 5% (0.05), while z is a constant for normal standard deviation which is 1.96 at 95% confidence interval. allowing for 10% attrition rate, sample size of 414.7 approximately 415 was calculated. ethical clearance was obtained from osun state university, ethics and research committee. knowledge of those who were aware of epidural analgesia was classified into good, fair, and poor based on their score in a set of seven questions on epidural analgesia. those who had a score of at least 5, 4 or ≤ 3 were classified as having good, 9 fair, and poor knowledge respectively. level of acceptability/willingness to utilize epidural analgesia was assessed after giving brief but concise health talk on epidural analgesia in labour followed by the question “would you consider epidural analgesia when you are in labour?” these women either answered yes or no to this question. previous use of epidural analgesia was also recorded as utilization. inclusion criteria are booked pregnant women who had previous vaginal deliveries introduction labour pain is reportedly the most harrowing and agonizing event of a woman's 1,2 reproductive life. perceived severity of labour pains vary among parturients, however majority agree that it is about the most severe pain they had experienced. it contributes significantly to 3,4 maternal request for caesarean birth . pain management is an important component of active management of labour and strategies for pain control in labour include pharmacological and non-pharmacological methods. pharmacological methods include nitrous oxide (entonox –mixture of inhaled nitrous oxide and oxygen in 1:1), non-opioids a n a l g e s i c s ( n s a i d , a n t i s p a s m o d i c s , paracetamol, sedatives), opioids and epidural analgesia. nonpharmacological methods include-continuous one to one support by the care provider, prenatal information, music, aromatherapy, acupuncture and acupressure, birthing balls and postures, transcutaneous electrical nerve stimulation (tens), water immersion and hypnosis. epidural analgesia is regarded by both the royal college of obstetricians and gynaecologists (rcog) and american college of obstetricians and gynaecologists (acog) as the gold standard for labour pain with tremendous 5,6 patient satisfaction reported . it is widely as accepted as being superior to no analgesia or 7 other forms of analgesia in labour . it is widely available in nigeria. anozie et al reported 77.8 % availability in nigeria hospitals with 100% 8 knowledge among obstetricians . despite being available, the awareness of epidural analgesia amongst the populace is still low in the country at 9-11 20.9-53.6% as reported by various authors 12 despite expressed wish for pain free labour . unfortunately, utilization is even lower, a study 11 conducted at fetha by anozie et al reported awareness level of 43.3% with utilization level of 10 7.5% and that by olaleye et al at wesley guild hospital reported awareness level of 53.6% with utilization level of 7.3%. this reduced uptake and utilization contrasts with reports from the developed countries like united state of america and united kingdom where virtually all women 5,6 are aware and uptake is about 60-80% . what is responsible for this reluctance to embrace e p i d u r a l a n a l g e s i a d e s p i t e d e c a d e s o f availability? mothers have purportedly associated epidural analgesia with increased risk of caesarean section, assisted vaginal delivery, 13 chronic back pain and prolonged labour . in res. j. health sci. vol 11(1), march 2023 68 knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. irrespective of the outcome. their consent was duly sought. excluded from this study were unbooked patients, patients in labour and primigravid mothers. instrument the instrument for data collection was a purpose designed, semi-structured, selfadministered questionnaire. the questionnaire is divided into 7 sections: socio-demographic characteristics, perception of pregnant women on labour pain, awareness on obstetric analgesia, awareness on epidural analgesia, knowledge, acceptability, and utilization of epidural analgesia in labour. data analysis the independent variables include sociodemographic variables such as age, parity, educational status while the outcome variables include awareness and knowledge of epidural analgesia, acceptability, previous utilization of epidural analgesia. the data obtained was analysed using ibm spss statistics version 25 (ibm corp; armonk, ny, usa). continuous variables such as age and parity were summarized as means. the results including knowledge, utilization, acceptability, and awareness of epidural analgesia were presented in frequency tables, charts, and percentages. chi-square was used to test the association between utilization, knowledge, awareness, and acceptability of epidural analgesia. logistic regression analysis was used to show relationship between age and utilization and acceptability of epidural analgesia. level of statistical significance (p value) was set at 5% (0.05). results a total of 415 women filled the questionnaires. they were health educated in groups but answered independently. table 1 shows the demographic data of the respondents. their mean age was 32.57±4.42 while mean parity was 1.73± 0.96. married women constituted 99.5% and 88.4% of these women had tertiary education. expectedly 90.2% (374) of these women were yoruba. labour pain was reported as very severe by 177(42.7%) (table 2). among these, 173 (41.7%) were aware of epidural analgesia in labour and 256 (58.3%) were not aware. figures 1 and 2 show women's opinion of severity of labour pains and types of analgesia known to them. figure 3 shows the knowledge of epidural analgesia was poor in 43.4%, fair in 41.0% and good in 15.6% of the respondents. table 3 shows 198/415 (47.7%) were willing to use epidural analgesia in their labour. the reasons cited for declining epidural analgesia include wish for natural labour in 76/160 (47.5%), exorbitant cost of epidural analgesia 37/160 (23.1%), fear of side effects 36/160 (22.1%), cultural reason 5/160 (3.1%), religious reason 4/160 (2.5%) and bad experience of others 2/160 (1.3%). prior utilization of epidural analgesia was in 3.6% (15/415). 11 of these 15 (73.3%) women who had used epidural analgesia before would use it again in their next labour. this is shown in table 4. association between age, level of education, occupation was found be statistically significantly in relation to knowledge of epidural analgesia. (table 5) table 6 shows the association between utilization of epidural analgesia and demographic factors. level of statistical significance p value was set at 5% (0.05); age, tribe and occupation had p values 0.002, 0.001 and 0.002 respectively. discussion 5 according to acog , all parturients are entitled to analgesia and their request is enough consent. women undergoing labour under supervision of a physician should not be denied analgesia unless a particular method is contraindicated upon which other methods can be 6 considered . we studied knowledge, awareness, acceptability, and utilization of epidural analgesia in this population of predominantly well-educated women (88.4% had tertiary education). the proportion of our subjects (41.7%) who knew about epidural analgesia is comparable with reports from earlier studies 8,9 from nigeria . this is probably due to similar population of women studied. this is however lower than the over close to 70% knowledge and utilization reported the more developed 6,14,15. countries this differential in perception is directly traceable to consistent education about pain management in labour during the antenatal 6,15 period and availability . despite, the relatively high knowledge base, previous utilization was still surprisingly low at 3.6%. this is comparable to a previous 8 studies conducted in nigeria by ezeonu et al who reported a utilization level of 7.5% and 7.3% 9 reported by olaleye . this is probably due to the added cost of care and fear of side effects. fear of res. j. health sci. vol 11(1), march 2023 69 knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. side effects and cost were the commonest reasons cited for decline this procedure in our trial. this is l i k e f i n d i n g s r e l a t i v e l y m o r e a ff l u e n t 16,17 countries . this is surprising considering that over 80% of our subjects had tertiary education which should ideally translate to higher earning power. sociocultural belief about need to persevere in labour was a significant reason for declining ea and this in tandem with earlier studies in nigeria and africa that reported that beliefs about labour are not usually congruent 12,13 with level of education . could this be due to the highly religious nature of nigerians as well as the extended family system which means parents have significant influence on the choice of labour practices of their daughters and daughters-inlaw? epidural analgesia was acceptable to less than half of the respondents 198/415 (47.7%). while, in the study of ezeonu et al level 8 acceptability was 70% , while al sumi reported 16 acceptability rate of 28.6% . this difference may be related to ethnicity of the two populations since majority of our population where yorubas. religion does not appear to play a role as our population had comparable population of 16 muslims and christians. however, al sumi et al studied a predominantly muslim population 8 while ezeonu studied predominantly igbo christians. one of the most important reasons for declining this intervention was cost of the procedure and fear of side effects, this is 15 congruent with report from al sumi . the source of information on epidural analgesia was mainly from the nurses (115/173; 66.5%), this may be because they spend more time with these antenatal clinic attendees and provide them with health talks to wards achieving the goal of health baby to a happy mother as well as other task shifting and task sharing roles. this further highlights the contribution of nurses and midwives in safe motherhood. studies have shown that shared decision making in the request for epidural is associated with maternal 17 satisfaction . age, tribe, and occupation were statistically significantly associated with utilization of ea in our study population. it is also significant that 75% of those who had utilized epidural analgesia were willing to repeat it in subsequent deliveries. this is in keeping with 8,9,15,18 findings from earlier studies . the willingness to use ea in women who have had it before further reinforces that ea is safe for both 19 mothers and babies as shown in earlier studies . limitations and recommendations: the major limitation to this study is that it is a hospital-based study, therefore knowledge and utilization in the community may not be so high as women who present for care in hospitals are known to have more insight. we did not determine the household income of these women but rather used their level of education as an indirect assessment of their cost of living. a qualitative study may be carried out to assess reasons why patients may accept or not accept epidural analgesia in labour. we recommend that both nurses and physicians provide health talk on management of labour and benefits of epidural analgesia to encourage more women to utilize this service. also, intervention to reduce cost such as coverage of ea by the national health insurance scheme has the potential to make labour more bearable for more women in our environment. conclusion labour pain causes anxiety in most pregnant women. epidural analgesia is a safe means of making labour a pleasant experience. improved knowledge about safety and availability of epidural analgesia enhances acceptability while subsidized cost has the potential to improve utilization. references 1. melzack r. the myth of painless childbirth, the john bonica lecture. pain. 1984;19:321–27. [pubmed] [google scholar]. 2. akadri aa, odelola oi. labour pain perception: experiences of nigerian mothers. pan afr med j. 2018; 30: 288. 3. khwepeya m, lee gt, chen s, kuo s. childbirth fear and related factors among pregnant and postpartum women in malawi. bmc pregnancy &childbirth 2018; 18: 391 4. update on global prevalence of severe fear of childbirth in low-risk pregnant women: a s y s t e m a t i c r e v i e w a n d m e t a a n a l y s i s . international j women's health reprod sci. 2021; 10 (10): 1-5. 5. alleemudder di, kuponiyi y, kuponiyi c, mc glennan a, fountain s, kasivisvanathan r. analgesia for labour: evidence–based insight for the obstetricians. the royal college of obstetricians and gynaecologists 2015; 17:14755. 6. the american college of obstetricians and g y n a e c o l o g i s t s o b s t e t r i c a n a l g e s i a a n d anaesthesia practice bulletin number 209, 2019. 7. anim-somuah m, smyth rm, cyna am, cuthbert a. epidural versus non-epidural or no analgesia for pain management in labour. cochrane res. j. health sci. vol 11(1), march 2023 70 knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. res. j. health sci. vol 11(1), march 2023 71 database syst rev. 2018 may 21;5(5):cd000331. doi: 10.1002/14651858.cd000331.pub4. pmid: 29781504; pmcid: pmc6494646. 8. anozie ob, lawani lo, mamah je, ezike co, ezeonu op, eze jn et al. epidural analgesia for management of labour pain: determinants and deterrents among obstetricians in nigeria. intern j women's health & reprod sci.2018; 6(4):41014. 9. okojie nq, isah ec. perception of epidural analgesia for labour among pregnant women in a nigerian tertiary hospital setting. j of the west afr coll of surg. 2014; 4(4): 142-162. 10. olaleye o, dada so, alabi go. awareness and utilization of obstetric epidural analgesia in labour among pregnant women in wesley guild hospital ilesha, nigeria. intern quat community health educ.2020; 0(0): 1-8. 11. ezeonu po, anozie ob, anozie ro. perceptions and practice of epidural analgesia among women attending antenatal clinic in fetha. intern j women's health 2017; 9: 905-11. 12. shammi k, hong y, sourabh k, liqin c, dongyan q. women's awareness and attitudes towards labour analgesia influencing practice between developed and developing countries. advances in reproductive sciences 2016; 4(2). 13. lim y, sia ath. dispelling the myths of epidural pain relief in childbirth. singapore med j 2006; 47(12): 1096. 14. daniel ww, editor. 7th ed. new york: john wiley & sons; 1999. biostatistics: a foundation for analysis in the health sciences. [google scholar] [ref list] 15. al sulmi es, al yousef mm, almuslim ja, al muslim ra, amailo za, alabbad fa. awareness, perceptions, and desirability of epidural analgesia among pregnant women in king fahad university hospital, al khobar. cureus. 2021 dec 3;13(12):e20146. doi: 10.7759/cureus.20146. pmid: 34900501; pmcid: pmc8648163. 17. cheng wj, hung kc, ho ch, yu ch, chen yc, wu mp, chu cc, chang yj. satisfaction in parturients receiving epidural analgesia after prenatal shared decision-making intervention: a prospective, before-and-after cohort study. bmc pregnancy childbirth. 2020 jul 20;20(1):413. doi: 10.1186/s12884-020-03085-6. pmid: 32689958; pmcid: pmc7370438. 18. nguyen ld, nguyen ad, farber mk, phan ct, khuat lt, nguyen ht, dang tm, doan htn. sociodemographic factors associated with request for labor epidural analgesia in a tertiary obstetric hospital in vietnam. biomed res int. 2 0 2 1 j a n 3 0 ; 2 0 2 1 : 8 8 4 3 3 9 0 . d o i : 10.1155/2021/8843390. pmid: 33604386; pmcid: pmc7868158. 19. leighton bl, halpern sh. the effects of epidural analgesia on labour, maternal and neonatal outcomes: a systemic review. am j obstet gynecol. 2002; 186 (5 supple structure): s69-77. 16. ozdemir s, chen t, tan cw, wong whm, tan hs, finkelstein ea, sng bl. parturients' stated preferences for labor analgesia: a discrete choice experiment. patient prefer adherence. 2 0 2 2 a p r 8 ; 1 6 : 9 8 3 9 9 4 . d o i : 10.2147/ppa.s353324. pmid: 35422614; pmcid: pmc9005131. knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. res. j. health sci. vol 11(1), march 2023 72 table 1 demographic data variable frequency percentage age group 21-30yrs 141 34.0 31-40yrs 258 62.2 41-50yrs 16 3.8 mean ± sd 32.57± 4.42 marital status married 413 99.5 separated 2 0.5 religion christians 167 40.2 muslim 248 59.8 tribe yoruba 374 90.2 igbo 18 4.3 hausa 10 2.4 other 13 3.1 educational level no formal education 2 0.5 primary 8 1.9 secondary 38 9.2 tertiary 367 88.4 parity 1-2 children 334 80.5 3-4 76 18.3 5 and above 5 1.2 mean ± sd 1.73±0.96 occupation civil servant 180 43.4 trader 163 39.3 housewife 18 4.3 unemployed 44 10.6 others 10 2.4 place of birth home 1 0.2 mission house 12 2.9 health centre 23 5.5 maternity centre 13 3.1 private hospital 141 34.1 general hospital 70 16.9 teaching hospital 151 37.3 knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. res. j. health sci. vol 11(1), march 2023 73 figure 1: showing respondents views about labour pain 18 21 9 159 2 115 55 82 0 20 40 60 80 100 120 140 160 180 most effective method of pain relief in labour figure 2: showing type of analgesia that respondents were aware knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. table 2 awareness on epidural analgesia in labour variable frequency percentage have you heard about epidural analgesia yes 173 41.7 no 256 58.3 where did you hear about epidural analgesia in labour antenatal clinic 123 29.6 labour ward 24 5.7 book/newspaper 14 3.4 home 0 1.0 radio/television 4 0 internet 8 2.0 hearing it for the first time 256 61.7 who told you about epidural analgesia in labour nurses 115 27.7 doctor 39 9.4 friend /relation 19 4.6 do you know that uniosun teaching hospital offers the epidural analgesia in labour? yes 119 68.8 no 0 i don’t know 54 31.2 table 3 acceptability of epidural analgesia in labour variable frequency percentage would you consider epidural analgesia in labour yes 198 47.7 no 160 38.6 undecided 57 13.7 if yes, why (n=198) my last experience the pain is unbearable 71 35.8 i want to give a try 72 36.4 labour must be comfortable 51 25.8 because good experience of those who had epidural analgesia in labour 4 2.0 if no, why (n=160) my culture against it 5 3.1 i want natural labour 76 47.5 fear of side effects 36 22.5 it is expensive 37 23.1 religious reason 4 2.5 bad experience of others 2 1.3 res. j. health sci. vol 11(1), march 2023 74 knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. table 4 utilization of epidural analgesia in labour variable yes (%) no (%) did you use epidural analgesia in your last delivery 15(3.6) 400(96.4) if yes, was it uniosun teaching hospital (n=15) 9(60.0) 6(40.0) if yes, do you want to have it again (n=15) 11(73.3) 4(26.7) if yes, were you satisfied with the outcome in term of pain relief 13(86.7) 2(13.3) if yes, would you recommend epidural analgesia for pregnant women 13(86.7) 2(13.3) 75(43.4) 71(41.0) 27(15.6) 0 10 20 30 40 50 60 70 80 poor knowledge fair knowledge good knowledge res. j. health sci. vol 11(1), march 2023 75 knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. table 5 association between the socio-demographic data and prior knowledge of epidural analgesia. n=173, level of statistical significance (p value) is set at = 5% (=0.05). variable poor (%) fair (%) good (%) x2 value p-value age group 21-30yrs 28(37.3) 21(29.6) 10(37.0) 31-40yrs 47(62.7) 50(70.4) 14(51.9) 18.044 0.001* 41-50yrs 0 0 3(11.1) marital status married 75(100.0) 69(97.2) 27(100.0) 2.907 0.234 separated 0 2(2.8) 0 religion christians 40(53.3) 22(31.0) 13(48.1) 7.717 0.021* muslim 35(46.7) 49(69.0) 14(51.9) tribe yoruba 66(88.0) 58(81.7) 24(88.9) igbo 2(2.7) 5(7.0) 3(11.1) 7.821 0.252 hausa 3(4.0) 6(8.5) 0 other 4(5.3) 2(2.8) 0 educational level primary 0 2(2.8) 0 10.888 0.028* secondary 6(8.0) 0 0 tertiary 69(92.0) 69(97.2) 27(100.0) occupation civil servant 24(32.0) 36(50.7) 17(63.0) trader 27(36.0) 25(35.2) 5(18.5) 24.190 0.0002* housewife 3(4.0) 0 0 unemployed 19(25.3) 10(14.1) 2(7.4) others 2(2.7) 0 3(11.1) table 6. association between dem ographic variables and utilization of epidural analgesia n=415 df x2 value p-value y es (% ) no (% ) age group utilization of epidural 21-30yrs 2(13.3) 139(34.8) 2 12.524 0.002* 31-40yrs 10(66.7) 248(62.0) 41-50yrs 3(20.0) 13(3.3) m arital status m arried 15(100.0) 398(99.5) 1 0.075 0.784 separated 0 2(0.5) religion christians 10(66.7) 162(40.5) 1 0.309 0.578 m uslim 5(33.3) 238(59.5) tribe yoruba 12(80.0) 362(90.5) igbo 0 18(4.5) 3 21.323 0.001* hausa 3(20.0) 7(1.8) other 0 13(3.3) educational level no formal education 0 2(0.5) primary 0 8(2.0) 3 2.035 0.565 secondary 0 38(9.5) tertiary 15(100.0) 352(88.0) o ccupation civil servant 2(13.3) 178(44.5) trader 10(66.7) 153(38.3) housewife 3(20.0) 15(3.8) 4 17.037 0.002* unemployed 0 44(11.0) others 0 10(2.5) res. j. health sci. vol 11(1), march 2023 76 knowledge, acceptability and utilization of epidural analgesia bola-oyebamiji et al. rjhs 11(2).cdr assessment of the knowledge and perception of prostate cancer and uptake of screening among public transport drivers in selected motor parks in akure, ondo state *owolabi, a.g. , atandero, m.o. , oluwaseyi, o.t. , afolabi, o.o. abstract objective: prostate cancer is one of the most common cancers affecting men globally. the objectives of this study were to assess the knowledge of prostate cancer among public transport drivers, the perception of prostate cancer among public transport drivers and to evaluate the uptake of prostate cancer screening among public transport drivers. method: a cross-sectional study was conducted using a selfstructured questionnaire with yoruba and igbo version was used to elicit information from the drivers. two hundred and thirty four participants (234) were recruited for the study and spss version 23 was used to analyze the data collected. results: the participants mean age being ±46 years 5.1 standard deviation and a good number of them were married, majority of the public transport drivers had poor knowledge of prostate cancer and screening and the poor knowledge could be traced to low level of education among the participants. a significant proportion of the participants however, exhibited poor knowledge and negative attitudes and perceptions of prostate cancer screening and treatment. the uptake rate for prostate cancer screening among the participants was 18% which is relatively low. this study was an eye opener as it revealed significant low knowledge, perception of prostate cancer and relatively low prostate cancer screening practice the findings in this study is an indication for a need to increase public sensitization campaigns on prostate cancer and its screening tests to improve public understanding about the disease with the aim of prevention and early detection . conclusion: the study showed considerable source of participant's information on pca to be from health workers and social media. .however, there is considerable low screening uptake. therefore, health education should target people with lower educational level and whose workload is strenuous this in turn will increase the uptake of screening of prostate cancer. key words: knowledge, perception, prostate cancer (pca), prostate cancer screening *corresponding author owolabi abimbola email: aowolabi@unimed.edu.ng 1 department of maternal, neonatal and child health nursing, faculty of nursing science, university of medical science, ondo, nigeria 2 department of nursing, faculty of basic medical sciences, adeleke university, ede, nigeria. 1 1 1 2 orcid-no: https://orcid.org/0000-0002-5966-8078 received: november 2, 2020 accepted: october 10, 2022 published: june 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 88 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.2 evaluation de la connaissance et de la perception du cancer de la prostate et adoption du dépistage chez les conducteurs de transports en commun dans des parcs automobiles sélectionnés à akure , dans l'état d'ondo 1 1 1 2 *owolabi, a.g. , atandero, m.o. , oluwaseyi, o.t. , afolabi, o.o. resume objectif de l'étude: le cancer de la prostate est l'un des cancers les plus fréquents chez l'homme dans le monde. les objectifs de cette étude étaient d'évaluer la connaissance du cancer de la prostate chez les conducteurs de transport en commun, la perception du cancer de la prostate chez les conducteurs de transport en commun et d'évaluer l'adoption du dépistage du cancer de la prostate chez les conducteurs de transport en commun . méthode de l'étude : une étude transversale a été menée à l'aide d'un questionnaire auto-structuré dont la version yoruba et igbo a été utilisée pour obtenir des informations auprès des conducteurs. deux cent trente-quatre participants ( 234) ont été recrutés pour l'étude et la version spss 23 a été utilisée pour analyser les données recueillies. résultat de l'étude: l'âge moyen des participants était de ± 46 ans 5,1 écart-type et un bon nombre d'entre eux étaient mariés, la majorité des conducteurs de transports publics avaient une mauvaise connaissance du cancer de la prostate et du dépistage et cette mauvaise connaissance pouvait être attribuée au faible niveau d'éducation des participants. cependant, une proportion importante des participants présentaient une mauvaise connaissance et des attitudes et perceptions négatives du dépistage et du traitement du cancer de la prostate. le taux de participation au dépistage du cancer de la prostate parmi les participants était de 18 %, ce qui est relativement faible . cette étude a été une révélation car elle a révélé une faible connaissance, une perception du cancer de la prostate et une pratique relativement faible du dépistage du cancer de la prostate. les résultats de cette étude sont une indication pour un besoin d'augmenter les campagnes de sensibilisation du public sur le cancer de la prostate et ses tests de dépistage afin d'améliorer la compréhension du public sur la maladie dans un but de prévention et de détection précoce . conclusion: l'étude a montré que la source considérable d'informations des participants sur l'apc provenait des agents de santé et des médias sociaux. .cependant, le recours au dépistage est considérablement faible. par conséquent, l'éducation à la santé devrait cibler les personnes ayant un niveau d'éducation inférieur et dont la charge de travail est intense, ce qui, à son tour, augmentera le recours au dépistage du cancer de la prostate. mots-clés : connaissance, perception, cancer de la prostate ( cp), dépistage du cancer de la prostate. *corresponding author owolabi abimbola email: aowolabi@unimed.edu.ng 1 department of maternal, neonatal and child health nursing, faculty of nursing science, university of medical science, ondo, nigeria 2 department of nursing, faculty of basic medical sciences, adeleke university, ede, nigeria. orcid-no: https://orcid.org/0000-0002-5966-8078 received: november 2, 2020 accepted: october 10, 2022 published: june 30, 2023 article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 89 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.2 introduction prostate cancer is the number one cancer in men both in incidence and mortality in africa, constituting 40,000(13%) of all male cancer incidences and 28,000(11.3%) of all male cancerassociated mortalities (1). they were more than 1.4 million new cases of prostate cancer in 2020 across the globe and the fourth world most commonly diagnose cancer in the world. guadeloupe had the highest rate followed by martinique. (1) in nigeria, prostate cancer is one of the most commonly diagnosed cancer among men (2).nigeria ranked first out of nine countries with the highest prevalence of prostate cancer in africa. nigeria ranked first, with democratic republic of congo and uganda.(2)in that report, it was estimated that the age groups of 30-44 and 45-50 for age specific totals deaths for 2005 (2). this implies that any health promotion and preventive measures must focus on the age group above 40 years of age. the specific causes of prostate cancer remain unknown. whilst the primary risk factors include age and family history, ethnicity, smoking, world area, diet, other factors associated with the cancer include hormonal imbalances, the living and working environment, lifestyle, exposure to certain medications, sexually transmitted infections and men's health seeking behavior (3). the probability of being diagnosed with cancer is higher in developing countries. this has been attributed mainly to poor awareness, inadequate health education and lack of screening program for prostate cancer, poor health care centers or facilities, poverty, paucity of specialist urological care (4). in developing countries, it may be less common however its incidence and mortality has been on the rise, because there have been neither specific policies nor effective strategies for controlling the disease. a high morbidity and mortality of this disease has been confirmed and with annual death rate at 20,000and with a hospital incidence of 127/100,000(3) it has been confirmed through many studies carried out that there is awareness and knowledge deficit about prostate cancer and the available treatment options and prevention (5,6). a majority of these studies focused on several knowledge areas such as incidence, prevalence, risk factors, signs and symptoms, relative risk, anatomy and function of the prostate gland, screening and early detection options, treatment availability and side effects associated with treatment. furthermore, findings from the literature suggest that income, age, positive family history, education, and access to care are associated with an individual's knowledge about prostate cancer. therefore, it is important to assess their knowledge about prostate cancer as well as its correlates, so that future interventions can be drawn from this knowledge to inform their decision-making processes regarding prostate cancer previous studies have shown that the whole body vibration that a driver experiences while driving can increase the risk of prostate cancer because vibrations prompts the body to produce more testosterone which is a known risk factor for prostate cancer (6).while testing men who already had prostate cancer it was determined that drivers were four times more likely to be diagnosed with highly aggressive prostate cancer (7). checking through the incidence rates of prostate cancer, it was observed that majority of the nigerian population have little knowledge of this disease condition. this lack of knowledge does not allow the men above 45 years of age to know that they are more at risk than the younger men. the uptake of the prostate cancer screening test has been associated with different factors and are unemployment, financial status, insufficient health promotion and education of the public. hence the need to carry out this research among the public transport drivers in some selected motor park in akure. however, the lack of knowledge on the disease and the low uptake of routine screening among men most at risk of developing prostate cancer compounds the problem. the objectives of the study were to: 1. assess the knowledge of prostate cancer among public transport drivers 2. assess the perception of prostate cancer among public transport drivers 3. determine the uptake of prostate cancer screening among public transport drivers materials and methods a descriptive, cross-sectional study conducted to assess the knowledge and perception of prostate cancer among public drivers and the uptake of prostate cancer screening in selected motor parks in akure. a selfstructured questionnaire with yoruba and igbo version was used to elicit information from the drivers. the selection of participants was done using proportionate sampling because they are composed of several sub groups and purposive sampling with respect to participants res. j. health sci. vol 11(2), june 2023 90 knowledge and perception of prostate cancer among public transport drivers owolabi et al. that were readily available at the different settings and are high in number at the selected motor parks. the study objectives were explained to participants, and written and informed consent was obtained and other ethical consideration was followed. demographic information including age, marital status, education, religion and tribe. it also collected data on family history of cancer as well as knowledge, practice and attitudes towards prostate cancer screening. data collected during the study were checked for completeness. frequency tables and graphs were generated for relevant variables. the data were analysed using statistical package for social sciences (spss) version 23.the yaro yamane (1967) formula was used to calculate the sample size for this study which was two hundred and thirty four (234) public drivers who were recruited proportionately in selected motor parks in akure. the selected motor parks were selected because more people ply the roads often and the reason for more drivers. content validity of the instrument was ensured through a thorough review of literature and the presentation of the instruments to experts in the field of study for assessment. the instrument was also made reliable by using a test-retest method involving administration of the copies instrument to twenty five (25) participants from ado ekiti (new motor park) to control bias. the reliability coefficient was 0.80 which showed the instrument was reliable. the questionnaire was made up of four sections which are section ademographic data, section b-knowledge of prostate cancer, section c-perception of prostate cancer, section duptake of screening. an approval was given to conduct the study by ondo state research and ethics committee. the spss version 23 was used to analyze the data collected. result a total of 234 questionnaires were retrieved for analysis putting the response rate at 98.2 percent. the participants' age ranged between 3150 years: mean age being ±46 years 5.1 standard deviation. fifty five (23.9%) and 78(33.9%) of the participants were single and married. the socio-demographic characteristics in comparison with the knowledge of the participants. the age of the participants with good knowledge are between 30.4 % (31-40) and 32.1% (40-51) also the participants with level of education have a significant effect on the level of knowledge (19.6% and 13.0%) for primary and secondary education respectively. majority of the participants are christians who claimed they were informed in their different places of worship about pca. knowledge of prostate cancer the study revealed that 139 participants (60.4%) had poor knowledge while 91 participants (39.5%) had good knowledge of prostate cancer. information of pca from health workers which constituted a larger percentage of (47.8%) and social media (43.5%) constituted a major source of information on the knowledge and awareness of prostate cancer. one hundred and thirty participants (56.5%) could not identify the signs and symptoms of pca one hundred and thirty nine participants (60.4%) had no formal education while 45(19.6%) had primary school education. the socio-demographic characteristics in comparison with the perception of the participants. the perception of participants in comparison with age showed that 60.4% with no formal education revealed that that pca was caused by the gods. perception of prostate cancer seventy one participants (30.8%) and 56(24.35%) disagreed and strongly disagreed that smoking and alcohol consumption are some of the contributing factors to contacting p ca. meanwhile, 88 (38.2%) participants agreed to that statement. eighty nine of the participants disagreed that early check-up can help to identify and treat the condition, it is interesting that majority of the participants still believed that p ca is caused by the gods.the 18% of the participants had the screening because of three main reasons which are firstly, regular physical checkups due to pressure by family members to conduct the test and secondly prompted by local signs and symptoms, lastly due to prostatic infections and benign prostatic hyperplasia. c o m p a r i s o n o f s o c i o d e m o g r a p h i c characteristics with the uptake of prostate cancer screening among public drivers firstly, regular physical checkups due to pressure by family members to conduct the test and secondly prompted by local signs and symptoms, lastly due to prostatic infections and benign prostatic hyperplasia (bph).18% of the participants have had to screen for pca and this res. j. health sci. vol 11(2), june 2023 91 knowledge and perception of prostate cancer among public transport drivers owolabi et al. was as a result of the aforementioned reason and also reflected on their level of education and religion( 6% and 12% of the participants that screened have secondary level of education and are religious leaders).it was found out that tribe of the participants had nothing to do with the uptake of pca screening. uptake of prostate cancer screening among public drivers the findings revealed that 18% (42) participants had gone for pca screening before due the these reasons: firstly, regular physical checkups due to pressure by family members to conduct the test and secondly prompted by local signs and symptoms, lastly due to prostatic infections and benign prostatic hyperplasia discussion this study adopted descriptive design to assess knowledge and perception of prostate cancer and uptake of prostate cancer screening among public transport drivers in selected motor parks akure. majority of the public transport drivers had poor knowledge of pca and this accounts for 139(60.4%).the poor knowledge could be traced to the participant's low level of education as most of them had no formal education. education plays an important role in awareness and assimilation of information at every given time. it was also observed through this research that educational achievement was also one of the key factors affecting the knowledge and perception concerning prostate cancer. the findings of this study ascertained that the drivers with higher level of education were the participants who had the good knowledge and perception of prostate cancer. this finding is similar to the study conducted by kinyao & kishoyina (2018) (9). in their study on native nigerians found out that 78.8% have never heard any information on cancer of the prostate. eight five of the participants believed that good personal hygiene and good nutrition are some of the ways to prevent pca. this implies that there are still some of the participants that well aware of pca. the findings of this study is also similar to a study that was conducted at oyo state among older men using a cross sectional study which made use of a multi-stage sampling techniques to assess the knowledge, awareness, and screening practices among older men regarding prostate cancer: the overall mean knowledge of prostate cancer causation, treatment and prevention was 5.8% out of a maximum of 16.this is also in contrast to a study conducted among the staff of university of nigeria. some have appreciable knowledge and a positive attitude with regard to prostate cancer. a significant proportion of participants however, exhibited poor knowledge and negative attitudes and perception of prostate cancer (11). the knowledge, attitudes and practices regarding prostate cancer was studied among the men in uganda by selecting 545 men aged 18-71 years. the study revealed that majority of the respondents 324(59.4%) had heard about prostate cancer. the fact that majority of the participants have heard of pca from health workers is commendable because it shows the extent of sensitization the health workers have put in place and social media is another important source of information of the participants. this is obviously different from a study conducted by awosan et al., (2018) (12). a survey on the awareness of pca and its screening among men attending the outpatient clinics of a tertiary health centre in lagos, nigeria found that 8.9% of the participants got information of pca from health workers which is commendable (12). majority of the participants had low perception of prostate cancer (pca) as this is seen in most of the participants perception that p ca is caused by the gods .furthermore a good number of the participants did not believe that smoking and alcohol predispose men to pca, despite the poor perception from the participants a good number believed that a diet rich in fruits and vegetables could prevent pca. the proportion of participants with positive perception is low (4.3%) were aged 51-60 and had secondary school education. findings also corroborates with the findings from a study on the perception of prostate cancer among male staff of university of nigeria by(13) the findings found out that male staff with tertiary degree constituted the majority of respondents who had positive perception of prostate cancer screening and treatment. more than three-quarter (79.7% .n = 239.0) of those with positive perception were academic staff. these two findings gave out the assertion that high knowledge of pca is associated with good perceptions and positive attitude towards the screening vice versa. the uptake rate for prostate cancer screening among the participants was 18% which is relatively low this is in consonant to studies in taiwan that reported the uptake rate to be between 12.4% and 29.4% (13). similarly, finding in a study among tanzanian men on the uptake of pca screening which showed relatively low level(14).some qualitative studies res. j. health sci. vol 11(2), june 2023 92 knowledge and perception of prostate cancer among public transport drivers owolabi et al. res. j. health sci. vol 11(2), june 2023 93 have found fear of cancer, lack of knowledge, embarrassment during screening and perceived low risk were barriers, while family history of prostate cancer, urinary symptoms and physician's recommendation motivated the participants to go for screening. there was a high and inaccurate expectation among the participants that prostate cancer would be very likely to cause impotence and sexual dysfunction. this is a popular reason for not screening for prostate cancer as seen among men in a study carried out in nigeria (adesunloye, 2018). in addition, some researchers have identified sexual dysfunction as a sensitive issue for black men, which discourages their involvement in prostate cancer screening (14). there is room for further studies to increase awareness and assess lived experience of the public drivers. also a mixed method design should be approach to elicit and back up data from the public drivers. conclusion results from the study show that the low level of formal education among a good number of the participants hada great impact on their knowledge and perception and eventually the uptake of pca screening. the source of information of prostate cancer (pca) is commendable because health workers play an important role however, this needed to be improved upon to encourage better uptake of pca screening. government, health workers and other sectors should increase their effort on making sure the knowledge and perception of pca is harnessed through quality health education and sensitization and this will consequently lead to uptake of screening bymen that are predisposed to pca due to their occupation. there should be substantial policies guiding pca screening and uptake. also the knowledge of the masses should be updated periodically by nurses, doctors and other concerned health workers and be evaluated using educational programs to teach on early detection and prompt treatment. acknowledgements: the authors of this research work wish to appreciate the public transport chairmen and drivers for giving us the opportunity to be heard and creating an enabling environment for the conduct of the study. conflict of interest: the authors hereby declared that there was no conflict of interest among them. references 1. adibe, m.o., aluh, d.o., isah, a., anosike, c.(2017). knowledge, attitude and perception among male staff in the university of nigeria.. asian pacific journal of cancer.2017; 18(7) 1961–1966. 2. mofolo n, betshu o, kenna o, et al (2015). knowledge of prostate cancer among males attending a urology clinic, a south african study. springerplus, 4, 67. 3. wanyagah, p., (2013). prostate cancer awareness, knowledge, perception on selfvulnerability and uptake of screening among men in nairobi county, kenya.. 4. muhammad, f.h.m.s., soon, l.k., azlina, y. (2016) knowledge, awareness and perception towards prostate cancer among male public staffs in kelantan. international journal of public health clinical science. 3(6):105–115.15(1) 5. arafa, m. a., rabah, d. m., & wahdan, i. h., (2012). awareness of general public towards cancer prostate cancer and screening practicein arabic communities: a comparative multi-center study. asian pacific journal of cancer prevention. 13 (9), 4321-4326. 6. ikuerowo, s., & ogundele, s. (2015) survey of the awareness of prostate cancer and its screening among men attending the outpatient clinics of tertiary health center in lagos, nigeria. nigerian journal of surgery. vol.21,no.2,pp.115-118 7. nadalin,v krieger, n parent, m. e salmoni, a sass-kortsak, a siemiatycki, j sloan m & purdham, j (2015) prostate cancer and occupational whole –body vibration exposure. annals of oncology. 56(8):968-974. 8. maricruz, rivera-hemandez (2016) the role of religious leaders in health promotion for older mexican. journal of religious health. 54(1):303315. 9. kinyao, m., kishoyina, g. (2018) attitude, perceived risk and intention to screen for prostate cancer by adult men in kasikeu sub location, makueni county, kenya. ann med health sci res 8(3):125–132 10. oladimeji, o., bidemi, y. o., olufisayo, j. a., & sola, a. o. (2015).prostate cancer awareness, knowledge, and screening practices among older men in oyo state, nigeria. international quarterly journal of community healthy education. 30(3), 271286. 11. adibe, m. o, aluh, d .o, isah, a & anosike, c (2017) knowledge ,attitude and practice of prostate cancer among male staff in the university of nigeria. asian pacific journal of cancer prevention,18(7)1961-1966 12. awosan, k.j., yunusa, e.u., agwu, n.p., taofiq, s. (2018) knowledge of prostatecancer and screening practices among men in sokoto, nigeria. asian journal of medical science. 9(6):51–56 13. adibe, m. o, aluh, d .o, isah, a & anosike, c (2017) knowledge ,attitude and practice of knowledge and perception of prostate cancer among public transport drivers owolabi et al. prostate cancer among male staff in the university of nigeria. asian pacific journal of cancer prevention,18(7)1961-1966 14. bugoye, f.c, leyna, g.h, moen k & mmbaga e.j (2019) knowlegde, perceived risk and utilization of prostate cancer screening services in tanzania. medknow publications.34(3)12451332 knowledge and perception of prostate cancer among public transport drivers owolabi et al. res. j. health sci. vol 11(2), june 2023 94 table i: number of drivers in their proportionate sample units number of drivers proportionate sampling 1. ado ekiti drivers 52 43 2. ido and oye drivers 35 20 3. lagos drivers 65 50 4. ondo drivers 45 36 5. ore drivers 48 36 6. sunshine state transport 60 49 total 305 234 table ii: demographic data of the participants variables parameters frequency (230) percentage (100%) age 20-30 31-40 41-50 51-60 40 70 74 46 17.3 30.4 32.1 20.0 marital status single married divorced separated 55 78 47 50 23.9 33.9 20.9 21.7 religion christianity muslim tradition none 100 61 45 24 43.5 26.5 19.6 10.4 ethnicity yoruba igbo hausa other 150 44 14 22 65.2 19.1 6.1 9.6 education level none primary tertiary other qualification 139 45 30 16 60.4 19.6 13.0 6.9 knowledge and perception of prostate cancer among public transport drivers owolabi et al. res. j. health sci. vol 11(2), june 2023 95 table iii: knowledge of prostate cancer among public transport drivers variables parameters frequency (230) percentage (%) have you heard about prostate cancer before? yes no 91 139 39.5 60.4 is prostate cancer preventable? yes no 122 108 53.0 46.9 one of the functions of prostate is to secret fluids that carries sperm yes no 115 115 50 50 do you believe prostate cancer to be a serious disease condition? yes no 130 100 56.5 43.4 can prostate cancer be inherited? yes no 101 129 43.9 56.0 is prostate cancer a common disease? yes no 130 97 56.5 42.1 can you identify the signs and symptoms of prostate cancer? yes no 100 130 43.4 56.5 do you think prostate cancer is preventable? yes no 105 125 45.6 54.3 regular screening, good personal hygiene and good nutrition are some important ways to prevent it? yes no indifferent 85 65 80 36.9 28.8 34.8 if yes, what is your source of information concerning prostate cancer? health workers social media others 110 100 20 47.8 43.5 8.7 do you know about prostate cancer screening? yes no indifferent 39 141 50 16.9 61.3 21.7 table iv: summarized knowledge score of pca knowledge of pca good poor 9 139 39.5 % 60.4% knowledge and perception of prostate cancer among public transport drivers owolabi et al. res. j. health sci. vol 11(2), june 2023 96 table v: perception of prostate cancer among public transport drivers variables parameters frequency (230) percentage (100%) consumption of fruits and vegetables can prevent pca strongly agree agree indifferent disagree strongly disagree 65 61 30 54 20 28.2 26.5 13.0. 23.4 8.6 smoking and alcohol consumption are some of the contributing factors of pca early check -up can help to detect prostate cancer strongly agree agree indifferent disagree strongly disagree strongly agree agree indifferent disagree strongly disagree 45 43 15 71 56 10 32 21 67 89 19.6 18.6 6.5 30.8 24.3 4.3 13.9 9.1 29.1 38.7 pca is an caused by the gods and herbs are better in curing it strongly agree agree indifferent disagree strongly disagree 85 67 46 32 36.9 29.1 20.0 13.9 pca will likely cause impotence and sexual dysfunction strongly agree agree indifferent disagree strongly disagree 105 67 41 25 45.6 29.1 17.8 10.8 table vi: uptake of pca screening by participants 18% (42) trans-rectal ultrasound digital rectal examination prostate specific antigen 6%(14) 8%(18) 4% (10) knowledge and perception of prostate cancer among public transport drivers owolabi et al. res. j. health sci. vol 11(2), june 2023 97 figure i: uptake of prostate cancer screening among public drivers knowledge and perception of prostate cancer among public transport drivers owolabi et al. res. j. health sci. vol 11(2), june 2023 98 rjhs 11(2).cdr comparison of the efficacy of atracurium pretreatment versus magnesium sulphate for prevention of suxamethonium-induced fasciculation and post-operative myalgia 1 2 3 4 2 *folami, e.o. , olajumoke, t.o. , kolawole, i.k. , ojo, a.k. , raji, s.a. , 5 folami, r.o. abstract background: suxamethonium remains the best option for rapid sequence induction, it is the only depolarizing muscle relaxant in clinical use. however, fasciculation and myalgia are frequent adverse effects of the drug. myalgia can last for several days with associated discomfort. non-depolarizing muscle relaxant and magnesium sulphate have been tried as pretreatments to attenuate the fasciculation and myalgia with varying results. methods: a double blind, randomized study of 100 adult surgical patients of asa i or ii class were recruited to receive either intravenous atracurium (0.05mg/kg) (group a) or intravenous magnesium sulphate (30mg/kg)(group b). the occurrence, severity and duration of fasciculation as well as the occurrence and severity of post-operative myalgia were also recorded. results: muscle fasciculation occurred in 39 (78%) patients in group a and 27(54%) patients in group b (p= 0.001). the severity of fasciculation was mild to moderate in group b while group a in addition also recorded some cases of severe episodes of fasciculation. mean duration of fasciculation in group a was longer (28.48 ± 1.07sec) than in group b (19.44± 1.93seconds) (p= 0.001). post-operative myalgia was not experienced at 6hrs and 48hrs, while 2 patients (1 in each group) had it at 12hrs. at 24hrs, postoperative myalgia was present in 13(26%) patients in group a and 5(10%) patients in group b, (p=0.043). the severity of post-operative myalgia recorded both at 12hrs and 24hrs was mild. conclusion: magnesium sulphate demonstrated better efficacy at reducing fasciculation and postoperative myalgia than atracurium keywords: suxamethonium, fasciculation, myalgia, atracurium, magnesium sulphate *corresponding author folami, e.o. e-mail: emmanuel.folami@uniosun.edu.ng 1 faculty of clinical sciences, osun state university, osogbo, nigeria 2 faculty of clinical sciences, lautech, ogbomoso, nigeria 3 faculty of clinical sciences, university of ilorin, ilorin, nigeria 4 faculty of clinical sciences, obafemi awolowo university, ile-ife, nigeria 5 faculty of basic medical sciences, osun state university, osogbo, nigeria orcid-no: https://orcid.org/0000-0003-1503-1208 received: august 2, 2022 accepted: march 8, 2023 published: june 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 119 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.5 comparaison de l'efficacité du prétraitement à l'atracurium par rapport au sulfate de magnésium pour la prévention de la fasciculation induite par le suxaméthonium et de la myalgie postopératoire 1 2 3 4 2 *folami, e.o. , olajumoke, t.o. , kolawole, i.k. , ojo, a.k. , raji, s.a. , 5 folami, r.o. contexte général de l'étude : le suxaméthonium reste la meilleure option pour l'induction en séquence rapide, c'est le seul myorelaxant dépolarisant utilisé en clinique. cependant, la fasciculation et les myalgies sont des effets indésirables fréquents du médicament. la myalgie peut durer plusieurs jours avec une gêne associée. des relaxants musculaires non dépolarisants et du sulfate de magnésium ont été essayés comme prétraitements pour atténuer la fasciculation et la myalgie avec des résultats variables. méthode de l'étude : une étude randomisée en double aveugle de 100 patients chirurgicaux adultes de classe asa i ou ii a été recrutée pour recevoir soit de l'atracurium intraveineux (0,05 mg/kg) (groupe a) soit du sulfate de magnésium intraveineux (30 mg/kg) (groupe b). la survenue, la sévérité et la durée de la fasciculation ainsi que la survenue et la sévérité des myalgies postopératoires ont également été enregistrées. résultats de l'étude : une fasciculation musculaire s'est produite chez 39 (78 %) patients du groupe a et 27 (54 %) patients du groupe b (p = 0,001). la sévérité de la fasciculation était légère à modérée dans le groupe b tandis que le groupe a a également enregistré quelques cas d'épisodes sévères de fasciculation. la durée moyenne de fasciculation dans le groupe a était plus longue (28,48 ± 1,07 s) que dans le groupe b (19,44 ± 1,93 s) (p = 0,001). la myalgie postopératoire n'a pas été ressentie à 6h et 48h, alors que 2 patients (1 dans chaque groupe) l'ont eu à 12h. a 24h, des myalgies postopératoires étaient présentes chez 13(26%) patients du groupe a et 5(10%) patients du groupe b, (p=0,043). la sévérité des myalgies postopératoires enregistrées à la fois à 12h et à 24h était légère. conclusion: magnésium le sulfate a démontré une meilleure efficacité pour réduire la fasciculation et les myalgies postopératoires que l'atracurium. mots-clés : suxaméthonium, fasciculation, myalgie, atracurium, sulfate de magnésium received: august 2, 2022 accepted: march 8, 2023 published: june 30, 2023 *corresponding author folami, e.o. e-mail: emmanuel.folami@uniosun.edu.ng 1 faculty of clinical sciences, osun state university, osogbo, nigeria 2 faculty of clinical sciences, lautech, ogbomoso, nigeria 3 faculty of clinical sciences, university of ilorin, ilorin, nigeria 4 faculty of clinical sciences, obafemi awolowo university, ile-ife, nigeria 5 faculty of basic medical sciences, osun state university, osogbo, nigeria orcid-no: https://orcid.org/0000-0003-1503-1208 article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 120 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.5 introduction suxamethonium is the only depolarizing muscle relaxant and has been in use for over six decades because of its low cost, fast onset of action, excellent muscle relaxation, and quick recovery (1). however, its two side effects fasciculation and postoperative myalgia – restrict its use in clinical practice (2). fasciculation is the involuntary intermittent muscle contraction while postoperative myalgia is muscle pain resulting from such fasciculations or following strenuous exercise. suxamethonium binds to nicotinic receptors at the neuromuscular junction and opens the ligand gated channels in the same way as acetylcholine, which results in prolonged d e p o l a r i s a t i o n w i t h s u s t a i n e d m u s c l e contraction. nondepolarising muscle relaxants (atracurium being an example) are the commonest agents for pre-treatment to minimize fasciculation and postoperative myalgia however patients usually complain of diplopia, difficulty in breathing and voice changes before induction of anesthesia (3). these issues associated with non-depolarising muscle relaxants necessitated the need to explore other agents. the other agents that have been used with varying results include; magnesium sulphate (4-6), pregabalin (7), diazepam (8), ketamine (9), lidocaine (10), vitamin c (11), calcium gluconate (12) and diclofenac sodium (13). in a meta-analysis of some controlled studies, the incidence of fasciculation was as high as 95% and that of myalgia at 24hrs was 50% (14). with the availability of sugammadex, rocuronium is a possible alternative to suxamethonium. although rocuronium shows less side effects than suxamethonium, it cannot completely replace suxamethonium which has distinctive characteristics of low cost, efficient muscle relaxation and short duration of action. management of laryngospasm is one of the lifesaving intervention that is ascribed to suxamethonium where it can be administered intramuscularly, intraosseously and sublingually without necessarily having to secure intravenous access (15). these almost irreplaceable features of suxamethonium necessitated the search to ameliorate its side effect in clinical practice rather than eliminating the drug. this study compared the efficacy of pretreatment with atracurium versus magnesium in the prevention of suxamethonium induced fasciculation and postoperative myalgia by measuring the incidence of fasciculation, duration of fasciculation, severity of fasciculation, incidence of myalgia and severity of myalgia. methods this is a randomised clinical study that was conducted after approval from uniosun teaching hospital research ethics committee. written informed consent was obtained from patients scheduled for elective surgeries under general anesthesia. one hundred patients, aged 18-60 years, of either sex, asa physical status i and ii scheduled for elective surgeries requiring general anesthesia were recruited into the study. patients were instructed on the use of visual analogue scale (vas). exclusion criteria included patients with previous family history of high fever following anesthesia, pregnant patients, patients with contraindications to suxamethonium (burns, neuromuscular diseases, paraplegia) and patients on calcium channel or beta blockers. the patients were randomly allocated to two groups with the help of a computer generated table of random numbers to receive following drugs: g r o u p a r e c e i v e d i n t r a v e n o u s atracurium at 0.05mg/kg in 10mls dilution as pretreatment while group b received intravenous magnesium sulphate at 30mg/kg in 10mls dilution. all patients were fasted overnight and received 10mg metoclopramide and 10mg diazepam orally at night; and were pre medicated with same 2hrs before surgery. the study drugs were given to the anesthetist in training who did not know the content of the syringe. in the operating room, with patient on the operating table and after the basic monitors were attached, induction of anesthesia was with a sleep dose of propofol, followed by 0.1mg/kg morphine patients were then given the study medications according to the numbers allotted to them and as calculated by the anesthetist in training. three minutes after pre-treatment, the patients were then given suxamethonium at 1 . 0 m g / k g . i n t e n s i t y a n d d u r a t i o n o f fasciculations after suxamethonium were assessed by the researcher (who was blinded to the drug given). severity was assessed on a 4 point scale as: nil=no visible fasciculation, mild=very fine fingertip or facial movement, moderate=minimal fasciculation on trunk and extremities, severe=vigorous fasciculation on trunk and extremities. intubation was done with an appropriate sized cuffed endotracheal tube and ventilation was adjusted to maintain normocapnia. maintenance of anesthesia was with 1-2% isoflurane in oxygen enriched air for continued hypnosis and iv pancuronium at 0.1mg/kg as res. j. health sci. vol 11(2), june 2023 121 efficacy of pre-treatment on suxamethonium for prevention of fasciculation and myalgia folami et al. muscle relaxant. intermittent doses of pancuronium 2mg per dose were administered during surgery as indicated. at the end of the surgery, neuromuscular blockade was reversed with neostigmine and atropine (to obtund its muscarinic effects), extubation was done following pharyngeal suction, and patient was transferred to the post anesthesia care unit (pacu) after adequate recovery from anesthesia. the postoperative analgesia given was 1gm of paracetamol infusion. the fitness of patient to leave pacu for the ward was determined using new aldrete scoring system and visual analogue scale. patients were transferred to the ward with minimum aldrete score of 12 and vas of <4. intramuscular diclofenac 75mg was given as rescue analgesia if vas was greater than four (4). post-op myalgia was assessed by the researcher using the four point scale at 6hrs, 12hrs, 24hrs and 48hrs (0absence of muscle pain, 1-pain limited to one area of the body, 2-pain involving more than one area of the body, 3-generalized muscle pain). the results obtained from the study were subjected to statistical analysis using the statistical package for social sciences (spss, version 20.0 spss inc., chicago, illinois, usa). the categorical data such as age, sex and severity of fasciculation were analysed using frequencies and percentages. the test of association was done using chi-square. continuous data such as weight, bmi, and duration of fasciculation were presented as mean and standard deviation and subjected to student ttests. level of significance was set at p-value < 0.05 for all statistical analysis. results one hundred patients with asa physical status i and ii, with fifty patients in each group, were recruited for the study between february 2019 and july 2019. data from thirty-seven (37%) males and sixty three (63%) females were analyzed. all the patients completed the study. there were no significant differences between the two groups with respect to age, sex, asa physical status, weight, height and body mass index (p>0.05) (table 1). the incidence of muscle fasciculation was 78% in group a and 54% in group b (p=0.001) (table 2). the intensity of muscle fasciculations were mild (23.1%), moderate (64.1%) and severe (12.8%) in group a. while group b had mild (66.7%) and moderate (33.3%) fasciculations without a single patient with severe fasciculation (p=0.001). the mean duration of fasciculations in group a (28.48 ± 1.07 seconds) was more than what was observed in group b (19.44 ± 1.93 seconds) (p= 0.001). within the first 6hrs and at 48hrs, postoperative myalgia was not experienced in any patient in both groups a and b. postoperative myalgia occurred at 12hrs and 24hrs only and they were mild. at 12 hours, the incidence of postoperative myalgia was 2% in each of the groups (p = 0.869). at 24hrs, the incidence of myalgia was 26% and 10% for group a and group b respectively (p=0.043). discussion the results showed that pretreatment with 0.05mg/kg atracurium and 30mg/kg magnesium sulphate has the ability to reduce fasciculation and post-operative myalgia induced by suxamethonium. however, magnesium sulphate demonstrated better efficacy than atracurium in reducing the incidence, duration and severity of fasciculation, as well as postoperative myalgia. the superior efficacy d e m o n s t r a t e d b y m a g n e s i u m s u l p h a t e pretreatment may be due to its cell membrane stabilizing effect, ability to inhibit nmda receptors and to increase the production of vasodilator prostaglandin which could account for reduced fasciculation in musculoskeletal system, and consequently post-operative myalgia. in a meta-analysis done by schreiber and co-workers (14), the incidence of fasciculation ranged from 0-100%. however, in this study, atracurium pretreatment lowered the incidence of fasciculation to 78% while magnesium sulphate pretreatment lowered it further to 54%. the atracurium group of this study had a higher incidence of fasciculations compared to famewo (16) and paganni (17). famewo (16) used various doses of iv atracurium (ranging from 0.035 to 0.075mg/kg) and found the incidence to be 0 40%. however, he advised that 0.05mg/kg gave the best result. paganni and colleagues (17) on the other hand used a higher single dose of intravenous 5mg atracurium across board and reported a lower incidence of fasciculation in their study. if we assume an average weight of an adult to be 70kg, paganni's (17) dosage will be 0.07mg/kg which is higher than the dose in this study. the higher dose used therefore, may be responsible for the lower incidence of fasciculation (44%) in their study. in another study by fatemeh and mojgan (18), the overall high incidence of moderate and severe forms of fasciculation, may be due to the res. j. health sci. vol 11(2), june 2023 122 efficacy of pre-treatment on suxamethonium for prevention of fasciculation and myalgia folami et al. lower dose of atracurium used. lower doses of atracurium, as used in this study, are known to cause a higher incidence of fasciculations (14). it could however also be due to increased genetic susceptibility to suxamethonium-induced fasciculation in the african population compared to the middle east population, which formed the genetic pool used by fatemeh and mojgan (18). the incidence of fasciculation in the magnesium sulphate pretreatment group of danladi and colleague's study was 81% and that of das et al was 63.3% (19). these values were higher than the findings in the magnesium group of this index study (54%) despite the use of a similar dose of magnesium sulphate (30mg/kg) for pretreatment in danladi study and double dose (60mg/kg) in das et al (20). propofol and magnesium have been documented separately to be effective when used alone to reduce fasciculation. propofol alone as a bolus or repeat bolus injection has been reported to reduce the incidence of suxamethoniuminduced fasciculations by garg et al (21). in that study, increased dose of propofol reduced incidence of fasciculation. the probable synergy of propofol and magnesium sulphate would have further contributed to the reduction in the incidence of fasciculation in this present study. in common with the index study, kumar et al (22) used propofol as induction agent in their study, but with a slightly higher dose of magnesium sulphate for pretreatment (40mg/kg). they got an incidence of 50% fasciculations which is slightly lower than the value recorded in this study. this difference may be attributed to the higher dose of magnesium sulphate (40mg/kg) used in their study. this is in agreement with gray et al (23) who demonstrated the dose-dependent therapeutic vasodilatory effects of magnesium sulphate in preterm male and female. the use of various forms of opioid agents have been linked to lower incidences of suxamethonium-induced fasciculation. this may therefore contribute to the lower incidence of fasciculation recorded in this study, as also observed in kumar et al (22) and das et al (20) studies. the absence of severe fasciculation in this index study is similar to the findings of kumar et al who also found absence of severe fasciculation (22), thus demonstrating the fact that the combination of propofolmagnesium has the ability to prevent severe form of fasciculation. shoroghi and colleagues (24) reported that pretreatment before administration of suxamethonium has the ability to reduce the duration of fasciculation which is similar to the result obtained in this index study. however, the duration of muscle fasciculation in patients who were pretreated with atracurium was found to be significantly longer (p<0.001) compared to those who had pretreatment with magnesium sulphate. t h e r e f o r e , m a g n e s i u m s u l p h a t e g r o u p demonstrated better reduction in duration (19.44±9.93sec) compared to (28.48±1.07sec) observed in the atracurium group. this demonstrated that magnesium sulphate does not only reduce the incidence and intensity of fasciculation better than atracurium, it is also superior to atracurium in reducing the duration of fasciculation when used as a pretreatment. the incidence of post-operative myalgia due to suxamethonium varies as high as 90% and was generally thought to be approximately 50% with placebo (14). a study done by mingus and colleagues (25) reported that post-operative myalgia appeared to be unrelated to the use of suxamethonium alone. this is in agreement with schreiber (26) who reported that the origin of post-operative myalgia is complex with diverse pathogenesis. the commonly used method of preventing myalgia is the use of a nondepolarizing muscle relaxant as a pretreatment which has been demonstrated to be efficacious in achieving this aim. the incidence of postoperative myalgia over 24 hour's assessment was 26% in atracurium group and 10% in magnesium group which was lower than the 50% obtained in the schreiber meta-analysis (14). the 26% incidence of myalgia at 24hrs with the use of atracurium at a dose of 0.05mg/kg in this study is slightly lower than that reported by paganni and colleagues (17) in which the incidence was 36%. the expectation would have been a better reduction in myalgia incidence in paganni study (17) because of the lower incidence of fasciculation attributable to the higher dose of atracurium (0.07mg/kg > 0.05mg/kg) used for the pre-treatment, but the result showed otherwise. nevertheless, it can be inferred from this index study that pretreatment with atracurium has the ability to reduce postoperative myalgia in contrast to the report of fatemeh and mojgan (18) that showed that atracurium pretreatment did not affect myalgia. kumar et al (22) recorded no patient with myalgia in their series when magnesium sulphate was used for pretreatment compared to the index study, even though they used a higher dose of suxamethonium (1.5mg/kg). the difference in findings may be due to a higher dose of magnesium used in their series, (40mg/kg vs res. j. health sci. vol 11(2), june 2023 123 efficacy of pre-treatment on suxamethonium for prevention of fasciculation and myalgia folami et al. 30mg/kg), which resulted in slightly lower incidence of fasciculation compared to the value recorded in this study (50% vs 54%). das et al (20) also had a higher incidence of myalgia (30%) with magnesium sulphate pretreatment compared to the index study probably due to a higher incidence of fasciculation seen in the magnesium sulphate group in their study (63.3% vs 54%). there was also a reduction in the incidence of myalgia in this index study when compared to the 50% recorded in the meta-analysis by schreiber and colleagues (14). limitation: the visual assessment of fasciculation is subjective. the objective assessment by measuring the increase in myoglobin and creatinine phosphokinase at the laboratory would have been more accurate but the facility is not available in our hospital. acknowledgements: the authors thank the management of uniosun teaching hospital and the patients who participated in the study. conclusion magnesium sulphate is more efficacious than atracurium in reducing the incidence, intensity and duration of fasciculation and postoperative myalgia. furthermore, the double combination of magnesium sulphate and propofol have more potentiating effect in decreasing the incidence and severity of suxamethonium-induced fasciculation and postoperative myalgia. conflict of interest: none references 1. chingmuh l, ronald l.k. clinical implications of new neuromuscular concepts and agents: so long, neostigmine! so long, sux! j crit care. 2009; 24(1):43-49. 2. theroux mc, rose jb, lyengar s, katz ms. succinylcholine pretreatment using galamine or mivacurium during rapid sequence induction in children: a randomized, 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and 'mini-dose' succinylcholine for preventing succinylcholine-induced muscle fasciculation. a randomized double blind, placebocontrolled res. j. health sci. vol 11(2), june 2023 124 efficacy of pre-treatment on suxamethonium for prevention of fasciculation and myalgia folami et al. study. acta anaesthesiol taiwan 2010; 48:28-32. 19. danladi ky, sotunmbi pt, eyelade or. the effects of magnesium sulphate-pretreatment on suxamethonium-induced complications during induction of general endotracheal anesthesia. afr j med sci. 2007; 36 (1):43-7. 20. das km, yasmin r, khatun us, alam t, akm a, debnath h. effects of pretreatment with magnesium sulphate on suxamethonium induced complications during induction of general anesthesia-a placebo controlled study. jbsa 2013; 26 (1):27-32. 21. garg k, luthra n, sud s, kaul tk, namrata. effect of repeat bolus dose of propofol on succinylcholine-induced fasciculations and myalgia. j mahatma gandhi inst med sci 2014; 19:106-111. 22. kumar m, talwar n, goyal r, shukla u, sethi ak. effect of magnesium sulfate with propofol induction of anesthesia on succinylcholinei n d u c e d f a s c i c u l a t i o n s a n d m y a l g i a . j anaesthesiol clin. pharmacol. 2012; 28(1): 81–85. 23. gray c, vickers mh, dyson rm, reynolds cm, berry mj. magnesium sulphate has sex specific, dose-dependent vasodilator effects on preterm placental vessels. biol sex differ. 2015; 6:22. 24. shorogi m, zahedi h, farahbakhsh f, sheikhvatan m, abbasi a. the effect of thiopentone on severity and duration of succinylcholine-induced fasciculation. clin neuropharmacol. 2009; 32 (2):94-96. 25. mingus ml, herlich a, eisenkraft jb. attenuation of suxamethonium myalgias. effect of midazolam and vecuronium. anesthesia.1990; 45 (10):834-837. 26. schreiber ju, mencke t, biedler a, fürst o, kleinschmidt s, buchinger h, fuchs-buder t. postoperative myalgia after succinylcholine: no evidence for an inflammatory origin. anesth analg. 2003; 96:1640-1644. res. j. health sci. vol 11(2), june 2023 125 efficacy of pre-treatment on suxamethonium for prevention of fasciculation and myalgia folami et al. res. j. health sci. vol 11(2), june 2023 126 table 2: incidence and severity of fasciculation in the groups variable group a n (%) group b n (%) x2 value p-value no fasciculation incidence of fasciculation total severity of fasciculation mild moderate severe total 11(22.0) 39(78.0) 50(100) 9(23.1) 25(64.1) 5(12.8) 39(100) 23(46.0) 27(54.0) 50(100) 18(66.7) 9(33.3) 0 27(100) 16.227 26.043 <0.001* <0.001* severe <50yrs =50yrs total 5(100.0) 0 5(100.0) 0 0 0 table 1. demographic and clinical characteristic of patients variable group a n(%) group b n(%) total x2 value p value age group <50yrs 40(80.0) 27(54.0) 67(67.0) 1.741 0.628 =50yrs 10(20.0) 23(46.0) 33(33.0) sex male 19(38.0) 18(36.0) 37(37.0) female 31(62.0) 32(64.0) 63(63.0) 0.043 0.836 asa 1 30(60.0) 35(70.0) 65(65.0) 2 20(40.0) 15(30.0) 35(35.0) 1.099 0.293 anthropometric measurement mean ± sd mean ± sd t-value p-value weight 61.43 ±6.46 62.32 ± 7.28 0.647 0.519 height 1.62 ±0.07 1.63 ±0.06 0.218 0.828 body mass index 23.12 ±2.11 23.36 ±2.12 0.458 0.648 asa: american society of anesthesiologists efficacy of pre-treatment on suxamethonium for prevention of fasciculation and myalgia folami et al. res. j. health sci. vol 11(2), june 2023 127 table 3: duration of fasciculation among the groups variable group a n (%) group b n (%) x2 value p value time(secs) no fasciculation 11(22.0) 23(46.0) 11-20 secs 15(30.0) 17(34.0) 21-30 secs 13(26.0) 9(18.0) >30 secs total 11(22.0) 50(100.0) 1(2.0) 50(100.0) 29.583 <0.001 mean ± sd mean ± sd t value p value 28.48±1.07 19.44±1.93 4.093 <0.001 table 4: incidence and severity of postoperative myalgia among the groups time group a n(%) group b n(%) x2 value p value mild 6 hours yes no total 0(0) 50(100.0) 50(100.0) 0(0) 50(100.0) 50(100.0) 12 hours 24 hours 48hours yes no total yes no total yes no total 1(2.0) 49(98.0) 50(100.0) 13(26.0) 37(74.0) 50(100.0) 0(0) 50(100.0) 50(100.0) 1(2.0) 49(98.0) 50(100.0) 5(10.0) 45(90.0) 50(100.0 0(0) 50(100.0) 50(100.0) 0.998 4.256 0.869 0.043* nb: all forms of myalgia were mild efficacy of pre-treatment on suxamethonium for prevention of fasciculation and myalgia folami et al. rjhs 11(2).cdr evaluating some haemostatic profiles and platelet aggregation in gestational diabetes mellitus subjects 1,2 1 2 2 1 *atere, a.d. , kosamat y.a. , adeyemi, o.a. , zubairu, s.o. , akanni, o.e. abstract background: hypercoagulability has been linked to an increase in risk factors, making diabetes a major cause of morbidity and mortality in low-income countries like nigeria. this research examined some haemostatic parameters in women with gestational diabetes mellitus (gdm). methodology: a total of 100 subjects consisting of 40 gdm, 30 non-gestational diabetes pregnant women (ngpw) attending the ante-natal clinic of the hospital and 30 women with neither diabetes nor pregnancy (ndnp) were enrolled as controls in this study. ten milliliters of blood was collected and dispensed into an appropriate anticoagulant bottle. prothrombin time (pt), activated partial thromboplastin time (aptt), complete blood count (cbc) and fasting blood sugar (fbs) was estimated using standard techniques. results: there was a significantly higher in the mean values of fbs, pt, aptt and wbc among gdm and ngpw when compared with npnp (p<0.05), while pcv was lower. fbs has positive correlation with pt and aptt while it shows negative correlation with platelet. aptt had a little edge over pt with higher area under the roc curve of 0.997 than pt among gdm. conclusion: in this study, women with gdm have considerably longer pt and aptt than ngpw and ndnp. therefore, there may be possibility of haemorrhagic complications in gestational diabetes. keywords: aptt, gestational diabetes, coagulation, atherosclerosis, hyperglycaemia *corresponding author atere a.d. e-mail: adedeji.atere@uniosun.edu.ng, 1 department of medical laboratory science, faculty of basic medical sciences, osun state university, osogbo, osun state, nigeria 2 department of medical laboratory science, achievers university, owo, ondo state, nigeria orcid-no: https://orcid.org/0000-0002-8802-3762 received: september 22, 2022 accepted: april 22, 2023 published: june 30, 2023 res. j. health sci. vol 11(2), june 2023 159 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.9 original article research journal of health sciences évaluation de certains profils hémostatiques et agrégation plaquettaire chez des victimes diabétiques gestationnels 1,2 1 2 2 1 *atere, a.d. , kosamat y.a. , adeyemi, o.a. , zubairu, s.o. , akanni, o.e. résumé contexte général de l'étude: l'hypercoagulabilité a été associée à une augmentation des facteurs de risque, faisant du diabète une cause majeure de morbidité et de mortalité dans les pays à faible revenu comme le nigéria. cette recherche a examiné certains paramètres hémostatiques chez les femmes atteintes de diabète sucré gestationnel (dsg). méthode de l'étude : un total de 100 victimes comprenant 40 dsg, 30 femmes enceintes diabétiques non gestationnelles (fedn) fréquentant la clinique prénatale de l'hôpital et 30 femmes sans diabète ni grossesse (fsdg) ont été recrutés comme témoins dans cette étude. dix millilitres de sang ont été prélevés et distribués dans une bouteille d'anticoagulant appropriée. le temps de prothrombine (tp), le temps de thromboplastine partielle activée (ttpa), la formule sanguine complète (fsc) et la glycémie à jeun (lgj) ont été estimés à l'aide de techniques standard. résultat de l'étude : il y avait une augmentation significative des valeurs moyennes de lgj, tp, ttpa et wbc chez les dsg et fedn par rapport au npnp (p <0,05), tandis que le pcv était inférieur. le lgj a une corrélation positive avec le tp et le ttpa alors qu'il montre une corrélation négative avec les plaquettes. ttpa avait un petit avantage sur pt avec une aire sous la courbe roc de 0,997 plus élevée que pt parmi les dsg. conclusion : dans cette étude, les femmes atteintes de dsg ont un tp et un ttpa considérablement plus longs que le fedn et le fsdg. par conséquent, il peut y avoir une possibilité de complications hémorragiques dans le diabète gestationnel. mots-clés : ttpa, diabète gestationnel, coagulation, athérosclérose, hyperglycémie received: september 22, 2022 accepted: april 22, 2023 published: june 30, 2023 *corresponding author atere a.d. e-mail: adedeji.atere@uniosun.edu.ng, 1 department of medical laboratory science, faculty of basic medical sciences, osun state university, osogbo, osun state, nigeria 2 department of medical laboratory science, achievers university, owo, ondo state, nigeria orcid-no: https://orcid.org/0000-0002-8802-3762 article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 160 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.9 introduction globally, diabetes affects more than 370 million people, resulting in approximately five million deaths, and more than 471 million usd are spent yearly on treatment (1,2). nearly 3.96 million people aged 20-79 die every year because of diabetes. death rates from diabetes are between 6 and 15 % in africa and north america, respectively, suggesting that regional differences exist (3,4). according to fadairo et al. (5), 4.3% of the population in africa has diabetes, that is about 15 million people. as a form of diabetes, gestational diabetes is characterized by intolerance to carbohydrates of varying severity that develops or manifests for the first time during pregnancy. this is associated with insulin deficiency in the context of insulin resistance (6,7). obesity, a history of gestational diabetes, a family history of type 2 diabetes, and polycystic ovarian syndrome are all risk factors. a healthy weight and prenatal exercise are preventative measures. insulin injections, a diabetic diet, and regular physical activity are all effective ways to control gestational diabetes (8). diet and exercise allow a significant number of women to control their blood sugar levels. pregnancies are affected by gestational diabetes at a rate of 3-9%, depending on the community. it typically occurs in the third, fourth, and sometimes fifth months of pregnancy. it affects 1% of individuals younger than 20 years of age and 13% of those older than 44 years of age (6,9,10) it has been noted that patients with gestational diabetes mellitus have a higher risk of coagulation abnormalities and thromboembolic events (11). many signaling pathways are disrupted, and metabolic alterations such as insulin resis tance, hyperglycemia, and dyslipidaemia promote platelet adhesion, activation, and aggregation, which is platelets' primary function (12). in women with gestational diabetes, increased platelet activation and release of prothrombotic and proinflammatory agents has been linked to systemic inflammation, oxidative stress, impaired calcium metabolism, decreased nitric oxide bioavailability, and increased phosphosrylation and glycosylation of cellular proteins (12,13,14). increased mean platelet volume (mpv) indicates more active platelets due to elevated levels of prothrombotic substances like thromboxane a2, thromboxane b2, platelet factor 4, serotonin, and platelet derived growth factor (15). mortality in people with diabetes is primarily due to atherothrombotic complications. from the beginning of pregnancy, pregnant . women have higher rates of coagulation than non-pregnant women, and this trend may be much more pronounced in women with gdm (16). consistent with this, increased coagulation indices are a hallmark of late pregnancy alongside hormonal shifts and the risk of hepatic embolism. however, diabetes makes hypercoagulation worse, which might be a problem during pregnancy (17). the evaluation of coagulation issue management in gestational diabetes and its integration into optimal care would be improved by this study. materials and methods study design this is a descriptive, comparative study. the study was conducted in 2021 between january and august. the study was carried out at the federal medical centre (fmc), owo, which is a tertiary medical facility in nigeria. a total of 100 subjects consisting of forty (40) gestational diabetic subjects (gdm), thirty (30) age nongestational diabetes pregnant women (ngpw) attending the ante-natal clinic of the hospital and thirty (30) women with neither diabetes nor pregnancy (ndnp) were enrolled as controls in this study. ethical considerations: the research approaches employed in the clinic were properly explained to the individuals taking part in this study before they were requested to sign a written consent. the health research ethics committee, federal medical centre, owo granted ethical approval for this study with reference number fmc/ow/380/vol.cxvii/133. inclusion and exclusion criteria inclusion criteria: the study enrolled women aged 18 to 50 who had gestational diabetes. the control group included apparently healthy pregnant women who did not have gestational diabetes, as well as women between the ages of 18 and 50 who did not have diabetes or were not pregnant. exclusion criteria: participants with known comorbidities, such as hypertension, hiv, hepatitis, cancer, oral anticoagulant treatment, bleeding tendencies, and so on, as well as breastfeeding mothers, were excluded from the study. the controls were subjected to the same exclusion criteria as the subjects. collection and storage of samples a tourniquet was applied to each participant's arm above the elbow while blood res. j. health sci. vol 11(2), june 2023 161 haemostatic profiles and platelet aggregation in gdm subjects atere et al. was drawn. following a 12-hour fast, ten milliliters (10ml) of venous blood was obtained from each individual using aseptic technique. four milliliters of venous blood were dispensed into a 5 milliliter sterile vacutainer bottle containing 0.5 milliliters of 3.2% trisodium citrate solution in a bloodcitrate, 9:1 (v/v) ratio as an anticoagulant and gently mixed by inverting the container several times for the determination of pt and aptt. after centrifuging the blood for 10 minutes at 2000g/m, the platelet poor plasma was collected for coagulation investigation. tests were carried out within three hours of collecting the samples. similarly, 3ml of venous blood was dispensed into a fluoride oxalate container for glucose estimation and 3ml of blood into an ethylene diamine tetraacetic acid (edta) bottle for complete blood count. analytical methods the glucose oxidase method was used to determine plasma fasting blood glucose using reagents supplied by randox laboratories ltd. (uk). the pt and aptt were determined using the standard procedures of dacie et al. (18). a haematological analyzer was used to determine the complete blood count (cbc). weight and height were measured for all participants, and body mass index (bmi) was determined as described by atere et al (19). statistical analysis of data a statistical package for social sciences version 23.0 (spss inc, chicago, il) was used for the analysis of data apprpriately. a one-way analysis of variance (anova) was used to compare the groups. correlation and the roc curve were also applied to examine the relationship between variables. for all quantitative values, data were presented using mean standard deviation (mean sd). the 95% confidence interval was used as the level of significance, and a p value less than 0.05 was considered significant. results a total number of 100 subjects comprising 40 gestational diabetic subjects (gdm) with mean age (27.70±3.98) years, 30 non-gestational diabetes pregnant women (ngpw) with mean age (27.93±4.76) years and 30 women with neither diabetes nor pregnancy (ndnp) with mean age (27.40±4.38) years were studied. table 1 shows comparison of anthropometric indices in gdm, ngpw and ndnp. pregnant women had significantly higher ± ± systolic blood pressure (sbp) than women who were not pregnant or had diabetes. in table 2, biochemical parameters in gdm, ngpw and ndnp were compared using independent one way analysis of variance (anova). there was a significantly higher in the mean values of fbs, pt, aptt and wbc among gdm and ngpw when compared with ndnp (p<0.05), while pcv was lower. posthoc statistical analysis showed a significant higher in mean values of fbs, pt, aptt and pcv, but lower wbc mean value when gdm group was compared with ngpw group (p<0.05). figures 1-3 show correlation of plasma levels of fbs in gestational diabetic subjects with haematological parameters. fbs has positive correlation with pt and aptt (figure 2 and 3) even though it not statistically significant and considerably positive association with pcv (figure 1) while it shows negative correlation with platelet. the diagnostic performance of pt, aptt and platelet were determined as diagnostic tool in gestational diabetic subjects' coagulation study. aptt had a little edge over pt with higher area under the roc curve (auroc) of 0.997 than pt with area 0.986 (figure 4). discussion diabetes has been linked to several disease burdens in developing countries such as nigeria, making it one of the leading causes of morbidity and mortality, with a reported increase in risk factors leading to a variety of health issues such as kidney failure, cardiovascular disease, and blindness (10,20). gestational diabetes mellitus (gdm) is a pregnancy condition characterized by spontaneous hyperglycemia during pregnancy (12,21). in this study, a total number of 100 subjects comprising 40 gdm with mean age (27.70±3.98) years, 30 ngpw with mean age (27.93±4.76) years and 30 ndnp with mean age (27.40±4.38) years were studied. the difference in the mean age of the study respondents was not statistically significant when compared across the groups in this study. this result contradicts with earlier research work by liu et al. (22), which demonstrated that the gdm-affected women were much older than ngpw. pregnant women had significantly greater systolic blood pressure (sbp) than women who were not pregnant or who had diabetes. contrary to the findings of bakker et al. (23), that indicated no discernible distinction between pregnant women and women who were not pregnant or diabetic. this study also shows a significantly res. j. health sci. vol 11(2), june 2023 162 higher in the mean values of fbs, pt, aptt and wbc among gdm and ngpw when compared with ndnp (p<0.05), while pcv was lower in both gdm and ngpw groups. post hoc statistical analysis showed a significant higher in mean values of fbs, pt, aptt and pcv, but lower wbc and platelets mean value when gdm group when compared with ngpw group (p<0.05). this is not in line with a study conducted at federal medical center, owerri, nigeria by okorie et al. (24) who showed that pcv in gestational diabetic women (33.84 ± 3.26%) was significantly (p<0.05) higher when compared to controls (32.06 + 2.15%) but in agreement with platelet count showing a significantly lower platelet count (p<0.05) in gestational diabetic women when compared to the control subjects. the aptt is a performance measure that assesses both the intrinsic and common coagulation pathways for efficacy. apart from detecting irregularities in blood clotting, it can also be used to track the therapeutic effects in patients on heparin therapy who are at risk of thrombosis. it is utilized in conjunction with pt, which is a test that examines the extrinsic pathway. patients who have their pt and aptt shortened are at a higher risk of thrombosis (25,26).thrombophilia is caused by coagulation abnormalities that occur as a result of diabetes mellitus, according to numerous studies. hyperglycemia, which is also a distinguishing hallmark of diabetes, appears to be the cause of the coagulation abnormalities seen in diabetic individuals (27,28). the prothrombin time of gdm was found to be substantially longer than that of ngpw and ndnp in this study. the diabetic participants' aptt was likewise substantially longer than the controls', despite the fact that the readings were within normal limits. this finding is consistent with the outcome of previous studies by alao et al. (28) and fadairo et al. (5), which discovered a notable difference in the mean value of the pt between diabetic and control patients. according to mcfarlane (29), these changes could be the result of circulatory disturbances in diabetic patients, which include changes in platelet count and activity, coagulopathy, fibrinolytic aberration, haemorrhagic factors, and abnormalities in endothelial metabolism. additionally, in this investigation, fbs had positive correlation with pt and aptt, though not statistically significant and considerably positive association with pcv (p<0.05) while it showed negative correlation with platelet. the correlation between fbs and pcv is in agreement with the study by akinloye et al. (30) who also showed a positive correlation between fasting plasma glucose (fpg) and pcv, while it is in disagreement with nnenna et al. (31) who observed significant correlation between pt and aptt. this finding adds to the evidence that hyperglycemia plays a role in the development of prothrombotic alterations, as shown in clamp experiments (32). in addition to the faster development of atherosclerosis in diabetic individuals, a higher risk of thrombotic events was identified, which was attributed to a combination of elevated procoagulant activity and decreased fibrinolytic ability (32,33). deficiencies in specific haematological parameters caused by pathological abnormalities may have an impact on other blood parameters. uko et al. (34) showed that type 1 diabetes impacts the number of platelets, total white blood cells, and packed cell volume. the activated partial thromboplastin time is one of the haemostatic measures in diabetic patients, according to zhao et al. (25). the diagnostic performance of pt, aptt and platelet were determined as diagnostic tool in gestational diabetic subjects' coagulation study. aptt had a little edge over pt with higher area under the roc curve (auroc) of 0.997 than pt with area 0.986. this reiterated earlier statement made that 'the aptt is a performance measure that assesses both the intrinsic and common coagulation pathways for efficacy'. however, women with gdm alone or when diagnosed with diabetes are at increased risk of cardiovascular disease (cvd) in future (33,35). conclusion and recommendation the results of this study revealed that women with gdm had considerably longer pt and aptt when compared to non-gestational diabetes pregnant women (ngpw) and women who neither diabetic nor pregnant (ndnp). in addition, platelet levels in gdm patients were considerably lower than in ngpw and ndnp patients. changes in these parameters may predispose pregnant women with gestational diabetes to bleeding disorders. as a result, in patients with gestational diabetes, clinicians should not rule out the risk of bleeding and associated complications. therefore, coagulation testing should be a key component of the screening procedure for pregnant women with gestational diabetes. conflict of interest: the authors have confirmed res. j. health sci. vol 11(2), june 2023 163 haemostatic profiles and platelet aggregation in gdm subjects atere et al. that they have no competing interests. funding: self-sponsored acknowledgments: the authors would like to thank the whole medical personnel of the antenatal clinic at the federal medical centre, owo, as well as all of the participants, for their assistance throughout this study. references 1. boutayeb w, lamlili men, boutayeb a, derouich m. mathematical modelling and simulation of â-cell mass, insulin and glucose dynamics: effect of genetic predisposition to diabetes. j. biomed. eng. 2014; 7: 330-342. 3. roglic g, unwin n. mortality attributable to diabetes: estimates for the year 2010. diabetes res clin pract. 2010; 87: 15–19. 5. fadairo jk, atere ad, ogidiolu, to, abiodun op. 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29(9): 2078-2083. 34. uko ek, erhabor o, isaac iz, abdulrahaman y, adias tc, sani y, et al. some haematological parameters in patients with type-1 diabetes in sokoto, north western nigeria. j. blood lymph. 2013; 3:110 35. oluyombo r, olamoyegun ma, olaifa o, iwuala so, babatunde oa. cardiovascular risk factors in semi-urban communities in southwest nigeria: patterns and prevalence. j epidemiol glob health. 2015; 5:167–174. res. j. health sci. vol 11(2), june 2023 165 haemostatic profiles and platelet aggregation in gdm subjects atere et al. table 1: comparison of anthropometric indices in gestational diabetic subjects (gdm), pregnancy without gestational diabetes (ngpw) and women without diabetes or pregnancy (ndnp) gdm (n=40) ngpw (n=30) ndnp (n=30) p-value age (years) 27.70±3.98 27.93±4.76 27.40±4.63 0.896 sbp (mmhg) 117.63±5.99 c 123.17±7.82 a,b 115.50±5.47c 0.000* dbp (mmhg) 75.00±7.25 77.67±6.53 76.50±6.45 0.265 bmi (kg/m2) 22.73±1.54 22.59±1.76 22.59±1.76 0.900 * significant at p=0.05 a = significantly different from ndnp, b = significantly different from gdm group, c = significantly different from ngpw group key: n=sample size, sbp= systolic blood pressure, dbp= diastolic blood pressure, bmi= body mass index table 2: biochemical parameters in in gestational diabetic subjects (gdm), pregnancy without gestational diabetes (ngpw) and women without diabetes or pregnancy (ndnp) gdm (n=40) ngpw (n=30) ndnp (n=30) p-value fbs (mmol/l) 6.91±0.49 a,c 4.50±0.43 b 4.40±0.26b 0.000* pt (secs) 14.32±0.45 a,c 13.26±0.36 a,b 12.62±0.37b,c 0.000* aptt (secs) 43.14±1.03 a,c 39.64±0.63 a,b 36.76±0.53b,c 0.000* pcv (%) 33.93±2.51 a,c 31.93±2.63 a,b 35.97±3.17b,c 0.000* wbc (xu/l) 8.11±1.07 a 8.67±1.58a 5.50±1.45b,c 0.000* platelet (xu/l) 177.85±15.29a,c 196.30±15.28b 203.00±23.28b 0.000* * significant at p=0.05 a = significantly different from ngpw, b = significantly different from gdm group, c = significantly different from ndnp group key: n=sample size, fbs= fasting blood sugar, pt= prothrombin time, aptt= activated partial thromboplastin time, wbc= white blood cells figure 1: correlation between fbs and packed cell volume (pcv) in gestational diabetic subjects res. j. health sci. vol 11(2), june 2023 166 haemostatic profiles and platelet aggregation in gdm subjects atere et al. figure 2: correlation between fbs and pt in gestational diabetic subjects figure 3: correlation between fbs and aptt in gestational diabetic subjects res. j. health sci. vol 11(2), june 2023 167 haemostatic profiles and platelet aggregation in gdm subjects atere et al. figure 4: the roc curve of blood levels of pt, aptt and platelet as diagnostic tool in gestational diabetic subjects coagulation study res. j. health sci. vol 11(2), june 2023 168 haemostatic profiles and platelet aggregation in gdm subjects atere et al. rjhs 11(2).cdr hand hygiene: major panacea for prevention of the spread of covid-19 in a nigerian south-western university *adesina, k.a., afolalu, o.o., oyekale, r.a., afere, d.m. abstract introduction: an essential component of the covid-19 response and a crucial public health intervention is the promotion of better hand hygiene. while several studies contend that good hand cleanliness is essential for lowering the prevalence of infectious diseases worldwide, college students have been found to inadequately wash their hands, which increases their chances of contracting the covid-19 virus. this study aims to assess the knowledge and practice of hand hygiene among undergraduates of osun state university, osogbo campus. methods: this study utilized a descriptive cross-sectional design to elicit a response from 271 male and female undergraduates of the university. a 34-item self-developed questionnaire comprising open and closed-ended questions served as the instrument for data collection. data were analyzed in spss 25 using descriptive and inferential statistics at a 0.05 level of significance. results: the study revealed that half (53%) had a fair knowledge of hand hygiene towards covid-19 prevention, (51%) had low practice and (41%) perceived unavailability of soap and water as a barrier to its practice. the result also showed that there is a significant relationship between knowledge of hand 2 hygiene and gender (x =8.681; df=3; p=0.001). also, a significant relationship exists between knowledge 2 and practice of hand hygiene in the prevention of covid-19 (x =144.775, p=0.00). however, there is no significant relationship between the course of study and knowledge of hand washing among respondents 2 (x = .871, p=0.647). conclusions: the study revealed that fair knowledge and moderate practice of hand hygiene exists among the respondents, coupled with many barriers such as lack of soap that hindered adequate practice, which calls for careful and immediate action through public health involvement. keywords: knowledge, practice, hand hygiene, barriers. *corresponding author email: kamoru.adesina@uniosun.edu.ng department of nursing science, osun state university, osogbo, osun state adesina, k.a. received: july 30, 2022 accepted: march 21, 2023 published: june 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 138 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.7 hygiène des mains : panacée majeure pour la prévention de la propagation du covid-19 dans une université du sud-ouest du nigéria *adesina, k.a., afolalu, o.o., oyekale, r.a., afere, d.m. résumé introduction : une composante essentielle de la réponse au covid-19 et une intervention cruciale de santé publique est la promotion d'une meilleure hygiène des mains. alors que plusieurs études affirment qu'une bonne propreté des mains est essentielle pour réduire la prévalence des maladies infectieuses dans le monde, il a été constaté que les étudiants se lavent mal les mains, ce qui augmente leurs risques de contracter le virus covid-19. cette étude vise à évaluer les connaissances et la pratique de l'hygiène des mains chez les étudiants de premier cycle de l'université d'état d'osun au campus d'osogbo . méthode de l'étude: cette étude a utilisé une conception transversale descriptive pour obtenir une réponse de 271 étudiants et étudiantes de premier cycle de l'université. un questionnaire auto-développé de 34 items comprenant des questions ouvertes et fermées a servi d'instrument pour la collecte de données. les données ont été analysées dans spss 25 à l'aide de statistiques descriptives et inférentielles à un niveau de signification de 0,05. résultat de l'étude: l'étude a révélé que la moitié (53 %) avaient une bonne connaissance de l'hygiène des mains en vue de la prévention du covid-19, (51 %) avaient une faible pratique et (41 %) percevaient l'indisponibilité du savon et de l'eau comme un obstacle à sa pratique. le résultat a également montré qu'il 2 existe une relation significative entre la connaissance de l'hygiène des mains et le sexe ( x =8,681 ; df=3 ; p= 0,001 ). aussi, il existe une relation significative entre la connaissance et la pratique de l'hygiène des 2 mains dans la prévention du covid-19 ( x =144,775, p=0,00 ). cependant, il n'y a pas de relation 2 significative entre le programme d'études et la connaissance du lavage des mains chez les répondants ( x = 0,871, p = 0,647 ). conclusion: l'étude a révélé qu'il existe une connaissance équitable et une pratique modérée de l'hygiène des mains parmi les répondants, associées à de nombreux obstacles tels que le manque de savon qui a entravé une pratique adéquate, ce qui nécessite une action prudente et immédiate grâce à l'implication de la santé publique. mots-clés : connaissances, pratique, hygiène des mains, barrières adesina received: july 30, 2022 accepted: march 21, 2023 published: june 30, 2023 *corresponding author , k.a. email: kamoru.adesina@uniosun.edu.ng department of nursing science, osun state university, osogbo, osun state article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 139 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.7 it is commonly understood universally that fostering greater hand washing is vital for controlling covid19 and a crucial public health approach. (13,14) while innumerable studies posit that proper hand washing, is the key to reducing the occurrence of infectious diseases in different types of communities, college students have been found to inadequately wash their hands, which increases their chances of contracting covid-19 virus (12). improper hand hygiene is an important contributing factor to contracting infectious diseases among college students (10). the center for disease control and who have published simple-to-follow handwashing guidelines (14,15). similarly, various interventions have been developed to improve hand hygiene practices and compliance in the community (16). however, poor hand-washing practices and low compliance are prevalent among students and even the healthcare system (10,17) a meta-analysis of 30 hand hygiene studies found that improvements in hand washing decreased the prevalence of gastrointestinal diseases by 31% and upper respiratory tract infections by 21%, (9). it also mentions that in sub-saharan africa, where sanitation and hygiene habits are poor, washing hands with soap might cut the incidence of infectious diseases by 52%, and hand washing promotion has been projected to save many lives (18,19). even though evidence from previous studies (20,21) has shown hand hygiene to be an important measure in the prevention of covid19 transmission, there is a dearth of data on the practice of hand hygiene in higher institutions of learning that serves as the seat of intellectuals, who are expected to comply to hygiene practice. therefore this study serves to assess the knowledge and practice of hand hygiene towards t h e p r e v e n t i o n o f c o v i d 1 9 a m o n g undergraduates of osun state university. the guiding objectives of the study are to (a) determine the knowledge of hand hygiene in the prevention of covid-19 among undergraduates of osun state university, osogbo campus (b) assess the practice of hand hygiene towards covid-19 prevention (c) determine the barriers to hand hygiene practice among the undergraduates. materials and methods study setting, designs, and population this study utilized a descriptive crosssectional design to assess the knowledge and practice of hand hygiene among undergraduates of osun state university, osogbo campus. the study population consists of selected students introduction in practically every region of the world, the studied human coronaviruses (hcovs) are a recognized cause of the common cold. because of their virulence, two highly pathogenic hcovs were discovered in the 21st century, which increased their significance. the severe acute respiratory syndrome coronavirus (sars-cov) and middle east respiratory syndrome coronavirus (mers-cov) were responsible for the devastating outbreaks of hcov. through animal reservoirs, the zoonotic infection spread to people and turned into a pandemic. in the chinese city of wuhan, there were suspected instances of pneumonia recorded in december 2019. a novel coronavirus has been identified as the cause of this disease. the infection was later referred to as covid-19. shortly thereafter, the infection was declared a pandemic by the world health organization (who) and a medical emergency worldwide (1,2). thus becoming a highly contagious and life-threatening disease (3). nigeria has a total confirmed cases of 161,388 and recorded 10,363 as of june 2021 (4). nigeria confirmed her first case of covid-19 on 27th february 2020 when an italian citizen in lagos tested positive for the virus (4). since covid-19 became a pandemic, numerous steps have been attempted to flatten the curve of infection spread, in addition to preventive measures. monitoring the pattern of infection is crucial to prevent the negative effects of an epidemic threat in which hand hygiene was instituted as one of the essential measures to curtail the transmission of the disease (5,6). hand hygiene is defined as the behavior of cleaning the hands with soap and water and by hand-rubbing using hand sanitizer without water (7). hand washing is an inexpensive and effective way to prevent infection and control disease (8). research is clear that proper hand hygiene is the key to reducing the occurrence of coronavirus in many different types of communities, including healthcare settings, daycare centers, and grade schools (9) . poor hand hygiene was significantly linked to a higher incidence of the covid-19 virus (10) . people who are not regular hand washers have been shown to have an increased incidence of covid-19 virus which can lead to inevitable bed rest and most likely unwanted death (11,12). a m i d t h e c o v i d 1 9 p a n d e m i c , c l o s e d environments and low levels of hand washing contribute to disease transmission on college campuses which is similar to that in hospitals (3). res. j. health sci. vol 11(2), june 2023 140 hand hygiene and covid-19 prevention adesina et al. from the college of science engineering and technology (set) and college of health sciences (chs) respectively from the target population of undergraduates in the school. the research was undertaken in april 2021 for 7 days. data collection tools and sampling the instrument for data collection was self-developed by the researcher comprising four s e c t i o n s a d . s e c t i o n a : d e a l s w i t h sociodemographic characteristics, comprising 7 questions. section b, which consists of 11 items with true/false responses obtains information from the undergraduates on their knowledge of hand hygiene in the prevention of covid-19. a “true” response denotes a positive response, which received a score of 2, whereas "false" denotes a negative response, which received a score of 1. section b had a total maximum score of 22 and a minimum score of 11. a score between 1 and 11 indicates low knowledge, while 12-22 is assigned a good knowledge score. section c, which consists of 11 items with a "yes or no" response, addresses the practice of hand hygiene. a favorable reaction is indicated by "yes," whereas a negative response is indicated by "no." a “yes” response indicates the positive practice of hand hygiene while a “no” responses indicate no practice. section c had a total maximum score of 22 and a minimum score of 11. a score between 1 and 11 indicates low practice, while 12-22 is assigned a good practice score. section d, comprising 5 questions focuses on barriers to hand hygiene practice. the instrument was a self-structured questionnaire designed by the researcher and validated by face and content validity index by two research experts in the field of health sciences, who are authors of this manuscript (kaa & aoo). the instrument's reliability was determined and a cronbach alpha value of 0.7 for total item correlation indicates the internal consistency of the instrument. 2 2 fisher's formula (n = z pq/d ) for estimating the sample size was used to calculate the sample size. since the proportion of respondents that had good knowledge of handwashing in a previous study revealed 80% using a 95% confidence level and 0.05 level of precision, the sample size of 246 undergraduates emerged (22). after adjusting the sample size for a 10% attrition rate, a sample of 271 emerged as respondents from whom data was obtained. before the recruitment of eligible respondents, students' record was obtained from the heads of each department. participants were recruited for the study by multi-stage sampling. in stage one, the chs and set were purposively selected from the six colleges at osun state university. in stage two, each college was clustered into faculty, from which the following 3 departments were randomly selected (nursing, medicine, and civil-and engineering). to ensure equitable d i s t r i b u t i o n s a c r o s s e a c h d e p a r t m e n t , participants from each department were stratified based on levels of study and selected by a simple random sampling technique, which formed stage three. data collection was undertaken at different times in the various departments where participants were selected. data analysis and presentation after gathering the data, a statistical package for social sciences (spss) 25 was used for analysis. descriptive statistics of frequencies, percentages, mean and standard deviation were used to describe the study population with relevant variables. beyond descriptive statistics, inferential statistical tools of chi-square were used to analyse the hypothesised variables. ethical consideration: approval was obtained from the osun state university college of health sciences ethics committee. participants were informed of the nature of the study and written informed consent was obtained prior to the start of the study. results table 1 shows the demographic characteristics of the participants. the majority 184 (67.9%) of the participants were age 20 years or less, with more females 157 (57.9%) than males 114 (42.1%). 123(45.6%). more christians and 146 (53.9%) than muslims; with 114 (42.1%) participants from chs and 157 (57.9%) from the college of set. the majority of the respondents were of the yoruba ethnic group 240 (88.6%). as revealed in figure 2, showing the overall level of knowledge of hand hygiene towards prevention of covid-19, a significant number, greater than half of the respondents 146 (53%) demonstrated good knowledge of hand hygiene towards covid-19 prevention while 125 (47%) had low knowledge. table 2 demonstrates that more than 50% of the respondents 154 (56.8%) practiced hand washing for 20 seconds, 137 (50.6%) do not sneeze into their arm/elbow, 148 (54.6%) did not avoid shaking hands whilst greeting and 160 (59%) washed hands before going to bed. res. j. health sci. vol 11(2), june 2023 141 hand hygiene and covid-19 prevention et al.adesina additionally, 153 (56.5%) did not maintain a distance of at least one meter whilst meeting others for protection against the virus, 156 (57.6%) never avoided touching their faces, 175 (64.6%) do not stay at home quite often, 175 (64.6%) do not wash hands after money exchange, 175 (64.6%) wash hands after blowing nose, and 155 (57.2%) wash hands after sneezing. from figure 2, more than half of the respondents 140 (51%) had good practice of hand hygiene towards covid-19 prevention while 131(48%) had poor practice. as shown in table 3, the barriers to the practice of hand hygiene reveal that 133(49.1%) experienced unavailability of materials for the promotion of good hand hygiene practice, while 111 (41.0%) reported the lack of running water on campus or in the hostel as obstacles. similarly, a good number indicated unavailability of soap or detergent 111 (41.0%), lack of understanding of how important hand hygiene is 118 (43.5%), and personal habit 115(42.4%) according to table 4, there is a statistically significant relationship between practicing good hand hygiene and knowledge 2 towards the prevention of covid-19 (x = 144.775, p=0.00). this implies knowledge of hand hygiene in the prevention of covid-19 determines the practice and good knowledge denotes a good practice, while poor knowledge indicates poor practice. table 5 shows that there is no statistically significant relationship between the course of the study and knowledge of hand washing among the 2 respondents (x =.871, p=0.647). table 6 demonstrates a substantial significant relationship between gender and 2 knowledge of hand hygiene (x =8.681; df=3; p =0.001). discussion this study assessed the knowledge and practice of hand hygiene towards prevention of covid-19 among 271 undergraduates of osun state university, osogbo campus. the sociodemographic characteristics revealed that the majority of the respondents were less than or equal to 20 years of age, with more females than males. the majority were (88.6%) from the yoruba ethnic group basically because the study was conducted in southwest nigeria, which is predominantly constituted by the yoruba ethnic group. this study has showed that less than half of those surveyed were aware that staying at home can lower their risk of contracting an infection, more than half knew that washing their hands for 20 seconds can help prevent them against covid-19 virus, more than half knew that sneezing or coughing into their arm/elbow can prevent the spread of the covid-19 virus. these statements were corroborated by the report of the centers for disease control and who on the prevention of covid-19, who opined that regular hand washing, staying at home, washing hands with soap and water or hand sanitizing can prevent transmission of covid-19 virus (3,4). similarly, our findings showed that more of our participants were unaware of older adults being at higher risk of contracting covid-19. this result is in tandem with the findings conducted in the south western part of nigeria, where some of the respondents perceived covid-19 as an exaggerated event that led to the poor practice of hand hygiene as a preventive strategy (23). whereas, it contradicts a documented study that shows the elderly group has a higher chance of perceived risk of contracting covid-19 when found in crowded areas (24). in general, our study revealed that there is a significant relationship between knowledge of hand hygiene and gender. this finding corroborates the result of a study conducted in sub-saharan africa (25) and contradicts a similar nigerian study (26). the gender disparities reported in a previous study were linked to the unavailability of hand-washing materials in male and female toilets which is worth giving the most urgent attention to (25). additionally, more than half (53%) had a fair knowledge of hand hygiene practices for covid-19 prevention, which may be linked to the pronouncement of covid-19 as a global pandemic by the who. additionally, the overall level of practice toward covid-19 prevention is (51%). the finding from this study is similar to the 58.3% frequently reported in a study carried out in oyo state nigeria (23), and also similar to another study in southern nigeria (27). the fact that most of these findings agree with ours suggests that handwashing is widely used in the treatment of infectious disorders. however, its low practice could be linked to the fair knowledge of the preventive practices displayed by our respondents. however, it was higher than a study conducted in sri lanka which showed that only 10% had overall good practices, while 27% had moderate practices and the majority (62.5%) were seen to have poor hand hygiene practices (28). our findings revealed that knowledge of hand hygiene as a preventive strategy for covid-19 does not translate to practice. this is evident in a lagos state study res. j. health sci. vol 11(2), june 2023 142 hand hygiene and covid-19 prevention et al.adesina res. j. health sci. vol 11(2), june 2023 143 where respondents had good knowledge of hand hygiene (83%), but less (47%) practice (26). the lack of hand hygiene supplies (49.1%), the absence of running water on campus or in dorms (41.0%), the lack of soap or detergent (43.5%), the lack of awareness of the significance of hand hygiene (42.4%), and personal habits are the most frequently mentioned factors influencing hand hygiene practice. these findings are consistent with those found in other studies (doi.org) that looked at the most typical obstacles to hand hygiene, including: lack of soaps, antiseptics, detergents, and alcohol sanitizers, lack of running water, and negligence (29,30). in order to prevent covid, hand hygiene is a serious public health issue that requires immediate intervention to achieve adequate compliance. to stop the spread of covid-19 and other contagious diseases, the condition of the handwashing facilities in universities needs to be upgraded. conclusion our study demonstrated that although undergraduates had a poor level of hand hygiene practice, their understanding of the topic was fair. the majority of the participants encountered greater obstacles that prevented practicing adequate hand hygiene. lack of soap, detergent, or antiseptic is the most frequent barrier. these results demonstrate that much work needs to be done if hand hygiene is to be a successful preventative tool against the spread of covid19 in the community. based on the findings of this study, hand hygiene promotion requires increased public health participation. as safe forms of communication during a pandemic like covid-19, this can comprise health education efforts on social media, television, and radio stations. when the pandemic is ended, hand hygiene health education can be expanded to local initiatives. in order to solve the numerous physical obstacles that prevent adequate hand hygiene, we advise setting properly equipped hand washing facilities in communities and institutions. to address the issue, further research involving larger populations needs to be done. conflict of interest: no conflict of interest references 1. lu h, stratton 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yohanes t, goshu y, jemal k, siraj m. the effect of compliance to hand hygiene during covid-19 on intestinal parasitic infection and intensity of soil-transmitted helminthes, among patients attending general hospital, southern ethiopia: observational study. plos one. 2022;17(6):e0270378. 20. walker jl, sistrunk ww, higginbotham ma, burks k, halford l, goddard l, et al. hospital hand hygiene compliance improves with increased monitoring and immediate feedback. american journal of infection control. 2014;42(10):1074-8. 21. obeta u, matthew g, ejinaka o, oreh a, etukudoh n, sabulu j, et al. determining the comparison of knowledge, attitude and practice of hand hygiene among medical laboratory technician and nursing students in jos, nigeria. emerging trends in disease and health research vol 1. 2021:13-31. 22. ojong in, etim mi, nlumanze ff, akpan mi. the practice of hand washing for the prevention of nosocomial infections among nurses in general hospital ikot ekpene, akwa ibom state, nigeria. archives of applied science research. 2014;6(1):97-101. 23. ilesanmi o, afolabi a. perception and practices during the covid-19 pandemic in an urban community in nigeria: a cross-sectional study. peerj. 2020;8:e10038. 24. oyeyemi o, oladoyin v, okunlola o, mosobalaje a, oyeyemi i, adebimpe w, et al. covid-19 pandemic: nigerians' knowledge, perception and adherence to preventive measures. 2020. 25. amuakwa-mensah f, klege ra, adom pk, köhlin g. covid-19 and handwashing: implications for water use in sub-saharan africa. water resources and economics. 2021;36:100189. 26. wada oz, oloruntoba eo. safe reopening of schools during covid-19: an evaluation of handwash facilities and students' hand hygiene knowledge and practices. european journal of e n v i r o n m e n t a n d p u b l i c h e a l t h . 2021;5(2):em0072. 27. ekwere ta, okafor ip. hand hygiene knowledge and practices among healthcare providers in a tertiary hospital, south west, nigeria. international journal of infection control. 2013;9(4). 28. kudavidnange bp, gunasekara t, hapuarachchi s. knowledge, attitudes and practices on hand hygiene among icu staff in anuradhapura teaching hospital. 2015. 29. nuwagaba j, rutayisire m, balizzakiwa t, kisengula i, nagaddya ej, dave da. the era of coronavirus: knowledge, attitude, practices, and barriers to hand hygiene among makerere university students and katanga community residents. risk management and healthcare policy. 2021;14:3349. 30. al-naggar ra, al-jashamy k. perceptions and barriers of hands hygiene practice among medical science students in a medical school in malaysia. iium medical journal malaysia. 2013;12(2) hand hygiene and covid-19 prevention et al.adesina res. j. health sci. vol 11(2), june 2023 144 figure 1: showing the overall level of knowledge of hand hygiene towards prevention of covid-19 table 1: socio-demographic characteristics of the respondents (n= 271) variables categories frequency (n=271) percent (%) age = 20 years 184 67.9 = 21years and above 87 32.1 sex male 114 42.1 female 157 57.9 religion christianity 123 45.4 islam 146 53.9 others 2 0.7 college chs 114 42.1 set 157 57.9 department nursing science 180 66.4 mbbs 61 22.5 civil engineering 30 11.1 level 200level 95 35 300level 95 35 400level 81 20 ethnicity yoruba 240 88.6 igbo 22 8.1 hausa 9 3.3 hand hygiene and covid-19 prevention et al.adesina res. j. health sci. vol 11(2), june 2023 145 figure 2: showing summary of hand hygiene practice toward prevention of covid-19 table 2: practice of hand hygiene towards prevention of covid-19 (n=271) variables categories yes (%) no (%) i wash my hands for 20 seconds 154(56.8%) 117(43.2%) i sneeze into my arm/elbow 134(49.4%) 137(50.6%) i avoid shaking hands whilst greeting 123(45.4%) 148(54.6%) i wash my hands before going to bed 111(41%) 160(59%) i maintain a distance of at least one meter whilst meeting others for protection against the virus 118(43.5%) 153(56.5%) i avoid touching my face 115(42.4%) 156(57.6%) do you stay at home quite often 96(35.4%) 175(64.6%) i wash my hands after the money exchange 96(35.4%) 175(64.6%) i wash my hands after blowing my nose 118(43.5%) 153(56.3%) i wash my hands after sneezing 116(42.8%) 155(57.2%) hand hygiene and covid-19 prevention et al.adesina res. j. health sci. vol 11(2), june 2023 146 table 6: relationship between gender and knowledge of hand washing among the respondents (n=271) variables categories knowledge of hand hygiene as covid-19 prevention total x df p poor knowledge good knowledge sex male 68 46 114 8.681a 3 0.001 female 72 85 157 total 140 131 271 sex (x2=8.681; df=3; p-value=0.001) table 5: relationship between the course of study and knowledge of hand washing among the respondents (n=271) variables categories knowledge of hand hygiene as covid-19 prevention total x df p poor knowledge good knowledge department nursing science 88 92 180 .871a 2 0.647 mbbs 28 33 61 civil engineering 12 18 30 total 128 143 271 x2=pearson chi square value, df=degree of freedom, p =probability value table 4: relationship between knowledge of hand hygiene and practice of hand hygiene towards prevention of covid-19 among the respondents (n=271) variables categories knowledge of hand hygiene as covid-19 prevention total x df p poor knowledge good knowledge the practice of hand hygiene towards the prevention of covid-19 poor practice 116 25 141 144.775a 1 0.000 good practice 12 118 130 total 128 143 271 table 3: barriers to hand hygiene practice towards prevention of covid-19 (n=271) variables categories yes (%) no (%) unavailability of material to ensure hand hygiene 133(49.1%) 138(50.9%) lack of running water on campus or in the hostel 111(41.0%) 160(59%) unavailability of soap or detergent 111(41%) 160(59%) lack of awareness of the importance of hand hygiene 118(43.5%) 153(56.3%) personal habit 115(42.4%) 156(57%) hand hygiene and covid-19 prevention et al.adesina res. j. health sci. vol 11(2), june 2023 147 rjhs 11(2).cdr fast food consumption habits among young people in south western nigeria 1 2 3 4,5 6 mukoru, i.l. , *adebayo, o. , oyabambi, o.a. , kanmodi, k , ojo, o.f. , 7 8 9 10 11 oiwoh, s.o. , agbogidi, j.m. , williams, a. , ibiyo, m.j. , samuel a. , 12 13 ogunsuji, o. , ogunjimi, l. abstract objective: the study assessed the profile and factors associated with fast food consumption among young people in tertiary educational institutions in ibadan, nigeria. materials and methods: this was a cross-sectional study carried out among 300 eligible undergraduates in four campuses in ibadan, nigeria. socio-demographic characteristics and information on fast food consumption and other relevant data were collected using a self-administered questionnaire. statistically significant p-value was set at <0.05. spss version 23 was used for data analysis. results: the mean ± standard deviation (sd) age was 21.6 ± 3.7 years and females constituted 66% of the participants. nine out of ten participants had never married, majority were fulltime students and holiday jobs were noted in less than a third. about three out of five participants consumed fast food, which was usually flour-based. the commonest pattern of fast food consumption was lunch, with the commonest frequencies of once a day and thrice a week. the strongest reasons for consumption include being considered nutritious, being readily available, claiming it provides value for money, and being accessible. conclusion: fast food consumption was high in this study and this potentially has serious implications on the cardiovascular health of the participants. there is need for concerted efforts by the relevant stakeholders in stemming this tide by encouraging health education for healthy eating among young persons. keywords: factors, fast food, young people, ibadan, unhealthy diet *dr mukoru i.l. and dr adebayo o. shared first authorship. *corresponding author dr adebayo o. email: doctorladi@yahoo.com 1 staff medical services, university college hospital, ibadan, nigeria 2 department of medicine, university college hospital, ibadan, nigeria 3 department of physiology, university of ilorin, ilorin, nigeria 4 school of health and life sciences, teesside university, middlesbrough, united kingdom 5 cephas health research initiative inc, ibadan, nigeria 6 department of community medicine, university college hospital, ibadan, nigeria 7 department of internal medicine, irrua specialist teaching hospital, irrua, nigeria 8 department of dti service improvement university hospital southampton, united kingdom 9 department of family medicine, university college hospital, ibadan, nigeria i0 irrua specialist teaching hospital, irrua, nigeria 11 fifa hospital, ministry of health, jazan, saudi arabia 12 department of periodontology & community dentistry, university of ibadan, ibadan, nigeria received: january 14, 2023 accepted: may 9, 2023 published: june 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 77 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.1 habitudes de consommation de restauration rapide chez les jeunes du sud-ouest du nigéria 1 2 3 4,5 6 mukoru, i.l. , *adebayo, o. , oyabambi, o.a. , kanmodi, k , ojo, o.f. , 7 8 9 10 11 oiwoh, s.o. , agbogidi, j.m. , williams, a. , ibiyo, m.j. , samuel a. , 12 13 ogunsuji, o. , ogunjimi, l. résumé objectif de l'étude : l'étude a évalué le profil et les facteurs associés à la consommation de restauration rapide chez les jeunes des établissements d'enseignement supérieur à ibadan, au nigeria. matériels et méthode de l'étude : il s'agissait d'une étude transversale menée auprès de 300 étudiants de premier cycle éligibles dans quatre campus à ibadan, au nigeria. les caractéristiques sociodémographiques et les informations sur la consommation de restauration rapide et d'autres données pertinentes ont été recueillies à l'aide d'un questionnaire auto-administré. la valeur p statistiquement significative a été fixée à <0,05. spss version 23 a été utilisé pour l'analyse des données. résultat de l'étude ; l'âge moyen ± écart type ( et) était de 21,6 ± 3,7 ans et les femmes constituaient 66 % des participants. neuf participants sur dix ne s'étaient jamais mariés, la majorité étaient des étudiants à temps plein et des emplois de vacances ont été notés dans moins d'un tiers. environ trois participants sur cinq consommaient de la restauration rapide, généralement à base de farine. le modèle le plus courant de consommation de restauration rapide était le déjeuner, avec les fréquences les plus courantes d'une fois par jour et trois fois par semaine. les principales raisons de la consommation incluent le fait d'être considéré comme nutritif, d'être facilement disponible, d'affirmer qu'il offre un bon rapport qualité-prix et d'être accessible. conclusion: la consommation courante de restauration rapide était élevée dans cette étude, ce qui a potentiellement de graves conséquences sur la santé cardiovasculaire des participants. il est nécessaire que les acteurs concernés déploient des efforts concertés pour endiguer cette marée en encourageant l'éducation à la santé pour une alimentation saine chez les jeunes. mots clés : facteurs, restauration rapide, jeunes, ibadan, mauvaise alimentation *dr mukoru, i.l. and dr adebayo, o. shared first authorship. *corresponding author dr adebayo, o. email: doctorladi@yahoo.com 1 staff medical services, university college hospital, ibadan, nigeria 2 department of medicine, university college hospital, ibadan, nigeria 3 department of physiology, university of ilorin, ilorin, nigeria 4 school of health and life sciences, teesside university, middlesbrough, united kingdom 5 cephas health research initiative inc, ibadan, nigeria 6 department of community medicine, university college hospital, ibadan, nigeria 7 department of internal medicine, irrua specialist teaching hospital, irrua, nigeria 8 department of dti service improvement university hospital southampton, united kingdom 9 department of family medicine, university college hospital, ibadan, nigeria i0 irrua specialist teaching hospital, irrua, nigeria 11 fifa hospital, ministry of health, jazan, saudi arabia 12 department of periodontology & community dentistry, university of ibadan, ibadan, nigeria received: january 14, 2023 accepted: may 9, 2023 published: june 30, 2023 article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 78 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.1 government, private organizations, or individuals in ibadan, the state capital of oyo state, nigeria. the following educational institutions were included: college of nursing and midwifery, federal school of statistics, oyo state college of health science and technology, and the polytechnic. students enrolled in diploma, undergraduate, or postgraduate programs at any of these four campuses who were between the ages of 16 and 35 were included. those who opted out were excluded. study instrument a self-administered questionnaire was used to obtain information from the participants and was administered by two trained research assistants. socio-demographic characteristics captured in the questionnaire were gender, age, marital status, current academic status, level of study, employment status, involvement in holiday jobs and monthly income. questions on fast food were: intake of fast food; regular fast food intake, type of fast food eaten, average intake in a day and week, respectively, average amount spent on fast food and reasons for fast food consumption. the participants were asked to rate their reasons for fast food intake on likert scale style (1–5). ten reasons were assessed: “nutritiousness”, “participant can't cook”, “leisure/socializing”, “due to advertisement”, “availability”, “no reason”, “provision of value f o r m o n e y ” , “ h y g i e n e / f r e e d o m f r o m contamination”, “accessibility” and “aesthetics” (cronbach's alpha test=0.825) weight was measured with a standard scale and recorded to the nearest 0.1 kg, while height was measured by a standard standiometer and recorded to the nearest 0.1 centimetre. body mass index(bmi) was calculated using the weight of the patient to the square of height. in order to measure the waist circumference, a non-stretchable measuring tape is placed in a horizontal plane around the abdomen at the level of the iliac crest. before reading the tape measure, effort was made such that the tape is snug, but does not compress the skin, and is parallel to the floor. the reece figure rating scale (rfrs), a psychometric measurement with two sets of 9 silhouettes ranging from thin to extremely obese, was used to assess the participant's perception of their weight. each participant was asked to selfselect the silhouette that best indicates his or her current body size and the silhouette that reflects his or her ideal body size. the rfrs score picked for the figure that best fit introduction fast food has gained popularity globally with all ages and races patronizing the industry (1-5). it is simply defined as any quickly prepared and served food which can be eaten at the point of purchase or packaged and taken away (6). there is increasing appetite for fast food and that has led to more providers springing up to meet these needs. such high demands have not only been noted in developed countries such as the united states and south korea but also in developing countries, nigeria inclusive (7, 8). few available studies are mostly single institutional setting study in nigeria and have reported fast food consumption across all age groups including young people (9,10). a prevalence as high as 60-100% of fast food consumption have been reported among young people in nigeria (10,11). a study in ogbomosho in oyo state in south western nigeria, documented a 90% prevalence of fast food intake among young people and 72% of them were students (11). imbalance in the nutritional content of fast food has been reported as such consumptions have been found to be dense in calorie but deficient in micronutrients (9,10). this increases the risk of malnutrition and noncommunicable diseases with the later reported among young people who consume high amounts of fast foods (12). young people despite having a good knowledge of the health risks of fast foods still highly patronize the industry (12). understanding the profile, pattern and drivers of fast food consumption among young persons in various setting would aid policy formulation in stemming the tide of the burgeoning obesity epidemic and high burden of other cardiovascular risk factors and diseases. this study was aimed at determining the profile and factors associated with fast food consumption among young people on tertiary educational campuses in ibadan, nigeria. materials and methods description of study study design it was a cross-sectional study that was carried out in four selected tertiary institutions in ibadan between may to nov 2021. a study protocol has been published (13). study population and area a total of 300 young people attending four selected institutions in ibadan were included for this study. there are 21 tertiary institutions owned by the federal government, oyo state res. j. health sci. vol 11(2), june 2023 79 fast food consumption in nigeria mukoru et al. the current size of the participant was subtracted from the score picked for the ideal size assessed by the participant and was used to assess participant's weight perception. it was considered a negative perception if the value of the ideal was higher than what was scored for the current best fit. data management and analysis data were entered and analyzed using the statistical package for the social sciences version 23 and stored in a secure location to ensure confidentiality. continuous quantitative variables were expressed as mean and standard deviation, while categorical variables were reported as proportions and frequencies. the continuous variables were subjected to the normality test using the shapiro–wilk test. continuous variables were compared using the student t-test while categorical variables were compared using chi square/fisher exact test. the likert like scale was analysed as mean and standard deviation and expressed as chart. unconditional multivariate logistic regression model was used to determine the adjusted and associated factors for fast food consumption and frequency of fast food consumption. adjustment were made for selected factors identified from literature review and empirical evidence based on significant associations found in our initial bivariate analyses. the odds ratio (or) and 95% confidence intervals (cis) in our models were estimated. for all tests, p-value of <0.05 were considered to be significant. ethical considerations ethical clearance was obtained from the ethics review committee, oyo state, ministry of health in accordance with the national code of health research ethics committee (nhrec) (ad 13/479/1776b) before the commencement of the study. also institutional approval was gotten from each of the participating schools before commencement of study. finally, informed written consent was obtained from the participants. confidentiality of participants and their information was ensured by omitting their names in the questionnaire and by pass-wording the computer with their data, granting access only to the investigators. it was ensured old participants were not recruited again by obtaining a verbal report of prior non-participation in the study. they were notified that their involvement in the study was voluntary and they could withdraw at any stage of the study without any consequence. results t a b l e 1 s h o w s t h e b a s e l i n e characteristics of participants. there were more females, and nine out of ten participants had never married. the majority were full time students, four out of five participants earned ≥ 20,000 naira, and holiday jobs in less than a third of participants. four out of every five participants consumed fast food, which was usually flour-based (table 2). the commonest pattern of consumption was lunch, breakfast, and dinner in descending order, with the commonest frequencies were once a day and thrice a week (table 2). the strongest reasons for consumption include being considered nutritious, being readily available, claiming it provides value for money, and being accessible (figure 1). the bivariate analysis of the fast food consumption results is shown in table 3. no factor was significant at a p value less than 0.05 although at 0.100 having holiday job was significant and was included in the multivariate model analysis with gender, monthly income classification (≤ 20,000 vs >20,000 naira), body mass index(bmi), married (yes vs no), year of study (≤ 2 years vs > 2 years), partaking in holiday job (yes vs no). the bivariate analysis of the frequency of fast food consumption results are shown in table 4. age classification (≤ 22 years > 22 years) and year of study (≤ 2 years' vs > 2 years), partaking in holiday job (yes vs no) were significant at a p value less than 0.05. no independent predictor was identified at p value of <0.05(table 5). however, years of study and doing holiday job were independent predictors of weekly frequency of fast food consumption (table 6). discussion fast food consumption is very common in this study with flour-based and lunch being the commonest timings for such meal consumption. previous reports in nigeria have also identified that high proportion of undergraduates consume fast food.(7, 14) high burden of fast food consumption appears to be a global phenomenon with many reports globally suggesting such.(1-5) this is not unconnected to increasing possibility of young person to be attracted to fast food in addition to displacement from usual family system, lack of time, availability of fast food and res. j. health sci. vol 11(2), june 2023 80 fast food consumption in nigeria mukoru et al. availability of expendable income (5,15). fast food industry are also supported with heavy advertisement and significant investment on aesthetic appeal which are likely to draw many young customers and consumers (11,16). in some cities, fast food outlets have been noted to cluster around schools and targeting young customers are one of the marketing tactics (17). this high consumption has serious health consequences. this observation should inform policies to control neighborhood availability of fast food restaurants as a means to reduce or prevent obesity (17,18). there was high burden of fast food consumption similar to finding from a single tertiary centre also in ibadan nigeria where 80.5% of the respondents consume fast foods weekly (14). the weekly frequency pattern in our study may not suggest mere cultural faddism rather than it is possible meeting a feeding need, considering three out of five participants tend to take such during lunch time. timing for lunch is the time they are likely to be away from where they can get home-made meals or self-prepared meals and such period form the peak of their daily academic activities (3). clear timing of intake found in this study was not available in another study in a nearby city in south western nigeria although another study in south eastern nigeria found more of breakfast (9, 10). most consumed types of fast food in this study are flour-based similar to previous reports (14). this has the potential of providing more energy density with risk of obesity (9). this pattern of consumption is interesting considering the innovative way the fast food industry in nigeria have made attempt at blending their menus with african cuisines like jollof rice, pounded yam, among others (16). the implication of this finding is most of the participants are patronizing the less nutritious, energy dense, low fibre, high dietary cholesterol and more refined sugar with unhealthy c o n s e q u e n c e s e s p e c i a l l y r i s k s f o r non–communicable diseases including diabetes mellitus and cardiovascular diseases (19,20). unfortunately, many of our participants erroneously considered fast food to be nutritious. t h i s i s a n i d e n t i f i a b l e p u b l i c h e a l t h interventional gap that needs to be addressed with appropriate health educational policy by the relevant stakeholders. they also commonly considered it to provide them value for money, accessible food item and readily available. we believe these are drivers of the behaviors for the high consumption pattern. these factors have previously been identified among college students (4). having holiday job was an independent predictor found in this study which is not unconnected to possible availability of disposable income, suggest some level of independence and increased likelihood to spend more time away from home or hostel (21). similarly, the earlier years of the study was found to predict frequent fast food consumption. this is not surprising given that the early years of school are associated with difficulty adjusting to the school environment. while this study provides a multi-centre report of fast food consumption in ibadan the study is limited by the quantitative data collection of the study. a qualitative approach would provide additional and unique insights into specific contexts or social situations of fast food consumption among young persons in this environment. conclusion fast food consumption is common among students in this study and this has serious implications on the cardiovascular health of the participants. there is need for concerted efforts by the relevant stakeholders in stemming this tide by encouraging health education for healthy eating among young persons. conflict of interest: the authors have no conflict of interest to declare. a c k n o w l e d g m e n t s : we w o u l d l i k e t o acknowledge the contribution of mr miracle adeshina and dr francis fagbule during planning of this study. also miss iyanuoluwa adufe, for clerical duties during the initial conceptualization of study in addition to the role of frank iseghohimen and blessing during data collection stage. references 1. shori ab, albaik m, bokhari fm. fast food consumption and increased body mass index as risk factors for weight gain and obesity in saudi arabia. obesity medicine. 2017;8:1-5. 2. banik r, naher 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gortmaker sl. clustering of fast-food restaurants around schools: a novel application of spatial statistics to the study of food environments. american journal of public health. 2005;95(9):1575-81. 18. sturm r. disparities in the food environment surrounding us middle and high schools. public health. 2008;122(7):681-90. 19. sholeye oo, animasahun vj, salako aa, oduwole ad. snacking and sweetened beverage consumption among adolescents in sagamu, southwest nigeria. nutrition & food science. 2018. 20. chinaza up, omotayo oa, banji af, ololade aa, olaoluwa jd, adewale oa, et al. nutritional investigation of three commonly consumed fast foods in two major fast food restaurants in lagos state, nigeria. chemistry international. 2019;5(1):81-6. 21. ayo sa, bonabana-wabbi j, sserunkuuma d. determinants of fast food consumption in kampala, uganda. african journal of food, agriculture, nutrition and development. 2012;12(5):6567-81. res. j. health sci. vol 11(2), june 2023 82 fast food consumption in nigeria mukoru et al. res. j. health sci. vol 11(2), june 2023 83 table 1: baseline characteristics of participants variables age mean ± sd years 21.6 ± 3.7 gender (n=300) n (%) male 102 (34.0) female 198 (66.0) level or year of study (n=300) n (%) first year 166 (55.3) second year 114 (38.0) third year 15 (5.0) fourth year 5 (1.7) course of study (n=300) n (%) accounting 25 (8.3) basic nursing 21 (7.0) business administration management 25 (8.3) community midwifery 22 (7.3) community nursing 15 (5.0) computer science 25 (8.3) electrical engineering 25 (8.3) environmental health technology 26 (8.7) health information management 23 (7.7) mass communication 25 (8.3) medical laboratory technician 1 (0.3) microbiology 25 (8.3) midwifery 17 (5.7) pharmacy technician 25 (8.3) marital status (n=298) n (%) never married 279 (93.6) currently married 19 (6.4) current academic status (n=297) n (%) student (full-time) 293 (98.7) part time student 4 (1.3) monthly income (n=151) n (%) 0-10,000 naira 90 (59.6) 11,000-20,000 naira 37 (24.5) 21,000-30,000 naira 9 (6.0) 31,000 and above 15 (9.9) holiday job (n=254) n (%) yes 74 (29.1) no 180 (70.9) weight mean ± sd kg 57.2 ± 11.3 height mean ± sd m 1.7 ± 0.1 bmi mean ± sd kg/m2 20.9 ± 3.8 waist circumference mean ± sd cm 75.1 ± 8.4 hip circumference mean ± sd cm 88.6 ± 9.1 fast food consumption in nigeria mukoru et al. res. j. health sci. vol 11(2), june 2023 84 fast food consumption in nigeria mukoru et al. table 2: profile related to fast food consumption among participants consumption of fast food (n=300) n (%) yes 258 (86.0) no 42 (14.0) usual fast food meal n=260) n (%) breakfast 62 (23.8) lunch 89 (34.2) dinner 15 (5.8) all 51 (19.6) can’t say 43 (16.5) frequency of fast food in a day(n=253) n (%) 1 114 (45.1) 2 82 (32.4) 3 38 (15.0) 4 11 (4.3) >5 43 (17.0) frequency of fast food in a week(n=251) n (%) 1 29 (11.6) 2 40 (15.9) 3 53 (21.1) 4 41 (16.3) 5 38 (15.1) 6 18 (7.2) 7 20 (8.0) >8 12 (4.8) usual fast-food items consumed (n=258) n (%) flour-based 160 (62.0) meat-based 29 (11.2) dairy products 31 (12.0) fruit juices/malted sweetened drinks 38 (14.7) average amount you spend on fast-food per outing(n=260) n (%) 260 <500 naira 141 (54.2) 501-1000 naira 62 (23.8) 1001-1500 naira 30 (11.5) 1501-2000 naira 18 (6.9) >2000 naira 9 (3.5) res. j. health sci. vol 11(2), june 2023 85 fast food consumption in nigeria mukoru et al. table 3: table comparing fast food consumption among participants variables do you eat in fast food p-value all yes no gender (n=300) n (%) 0.631 male 102 (34.0) 86 (33.5) 16 (37.2) female 198 (66.0) 171 (66.5) 27 (62.8) age (n=291) n (%) 0.630 = 22 years 201 (69.1) 174 (69.6) 27 (65.9) > 22 years 90 (30.9) 76 (30.4) 14 (34.1) year of study (n=300) n (%) 0.749 = 2 years 280 (93.3) 239 (93.0) 41 (95.3) > 2 years 20 (6.7) 18 (7.0) 2 (4.7) married (n=300) n (%) yes 19 (6.3) 14 (5.4) 5 (11.6) 0.166 no 281 (93.7) 243 (94.6) 38 (88.4) current academic status (n=297) n (%) 0.467 student (full-time) 293 (98.7) 251 (98.8) 42 (97.7) part-time student 4 (1.3) 3 (1.2) 1 (2.3) do you co holiday job (n=254) n (%) 0.050 yes 74 (29.1) 68 (35.1) 6 (15.8) no 180 (70.9) 148 (68.5) 32 (84.2) monthly income in naira (n=151) n (%) = 20,000 127 (84.1) 108 (83.7) 19 (86.4) 1.000 > 20,000 24 (15.9) 21(16.3) 3(13.6) weight mean ± sd kg 57.2 ± 11.3 57.3 ± 11.6 56.8 ± 9.0 0.791 height mean ± sd m 1.7 ± 0.1 1.7 ± 0.1 1.7 ± 0.1 0.875 bmi mean ± sd kg/m2 20.9 ± 3.8 20.9 ± 3.9 20.7 ± 3.2 0.761 waist circumference mean ± sd cm 75.1 ± 8.4 75.1 ± 8.4 75.3 ± 8.3 0.899 hip circumference mean ± sd cm 88.6 ± 9.1 88.5 ± 9.4 89.4 ± 7.2 0.625 < < < res. j. health sci. vol 11(2), june 2023 86 table 4: table comparing frequency of fast food consumption among participants variables frequency of fast food per week p-value all = 3/week < 3/week gender (n=251) n (%) 0.537 male 85 (33.9) 39 (32.0) 46 (35.7) female 166 (66.1) 83 (68.0) 83 (64.3) age (n=244) n (%) 0.011 = 22 years 171 (70.1) 75 (62.5) 96 (77.4) > 22 years 73 (29.9) 45 (37.5) 28 (22.6) year of study (n=251) n (%) 0.001 = 2 years 235 (93.6) 108 (88.5) 127 (98.4) > 2 years 16 (6.4) 14 (11.5) 2 (1.6) married (n=251) n (%) 0.227 yes 14 (5.6) 9 (7.4) 5 (3.9) no 237 (94.4) 113 (92.6) 124 (96.1) monthly income (n=297) n (%) 0.800 = 20,000 107 (42.6) 53 (43.4) 54 (41.9) < 20,000 144 (57.4) 69 (56.6) 75 (58.1) current academic status (n=248) n (%) 1.000 student (full-time) 246 (99.2) 119 (99.2) 127 (99.2) part time student 2 (0.8) 1 (0.8) 1 (0.8) do you co holiday job (n=212) n (%) 0.061 yes 65 (30.7) 25 (24.5) 40 (36.4) no 147 (69.3) 77 (75.5) 70 (63.6) weight mean ± sd(n=300) kg 57.2± 11.3 57.4 ± 12.2 57.0 ± 11.2 0.824 height mean ± sd(n=300) metre 1.7 ± 0.7 1.6 ± 0.1 1.7 ± 0.1 0.221 waist circumference mean ± sd(n=300) cm 75.1 ±8.4 75.5 ± 9.4 74.8 ± 7.5 0.563 hip circumference mean ± sd (n=300)cm 88.6±9.1 89.3 ± 8.6 87.5 ± 10.1 0.139 bmi mean ± sd (n=300) kg/m2 20.9±3.8 21.1 ± 4.2 20.7 ± 3.8 0.391 table 5: factors associated with fast food consumption variables b s.e. wald exp(b) 95% c.i. for exp(b) p-value lower upper gender(male) -.100 .515 0.038 0.904 0.330 2.480 0.845 income(=20,000naira) .441 .729 .366 1.554 0.373 6.482 0.545 married(yes) 1.724 .985 3.063 5.606 0.813 38.642 0.080 year of study(= 2 years) .244 1.127 0.047 1.276 0.140 11.614 0.829 holiday job(yes) 1.405 .612 5.279 4.076 1.229 13.517 0.022 body mass index -.060 .076 0.625 0.941 0.810 1.093 0.429 constant -2.134 2.168 0.969 0.118 0.325 fast food consumption in nigeria mukoru et al. < < < > < < res. j. health sci. vol 11(2), june 2023 87 figure 1: response on likert scale to reasons for fast food consumption table 6: factors associated with weekly fast food consumption variables b s.e. wald exp(b) 95% c.i.for exp(b) p-value lower upper age -.048 .052 .857 .953 .861 1.055 0.355 year of study(= 2 years) 1.904 .811 5.507 6.710 1.368 32.898 0.019 monthly income (=20,000naira) -.281 .304 .853 .755 .416 1.370 0.356 married (yes) -.112 .805 .019 .894 .185 4.329 0.889 gender(male) -.056 .306 .034 .945 .519 1.723 0.854 body mass index -.049 .039 1.543 .952 .882 1.029 0.214 holiday job(yes) .758 .341 4.928 2.133 1.093 4.165 0.026 constant .247 1.491 .027 1.280 0.868 fast food consumption in nigeria mukoru et al. < < rjhs 11(3).cdr assessment of health-related quality of life and its determinants among patients with diabetic foot ulcer in ilorin, nigeria 1 2 2 3 4 *olarinoye j.k. , omotoso a.b. , ogunmodede a.j. , opeyemi c.m. , olagbaye b.a. , 1 5 sanni n. , aderibigbe a.b. abstract background: the impact of foot ulceration on the psychosocial wellbeing of the nigerian diabetic patients has not received enough attention. this study therefore attempted to evaluate the effect of diabetic foot ulcer on the quality of life of adults in a nigerian diabetic population. methodology: the impacts of diabetic foot ulcer (dfu) on the quality of life (qol) of 104 adults living with diabetes were assessed using the diabetes foot ulcer scale and their determinants. results: the mean qol score was 42.25. fifty-five (53.4%) had poor qol status while 48 (46.6%) had good qol. determinants of poor qol outcome include low socio-economic status (p = 0.017), lack of a tertiary education (p= 0.027), no diabetes-education (p = < 0.001), low socioeconomic status (p = 0.017), multiple ulcers (p = 0.022) and wagner grade >3 ulcers (p = 0.004). conclusion: majority of patients with dfu in uith, nigeria have poor qol and most of the predictors of poor qol outcome are preventable and modifiable. key words: diabetic foot ulcer, quality of life, determinants, nigerians *corresponding author olarinoye john kola, email: kolaolarinoye@yahoo.com 1 department of medicine, endocrinology, diabetes and metabolism unit, university of ilorin, ilorin, nigeria 2 department of psychiatry and behavioral sciences, university of ilorin, nigeria 3 department of medicine, ladoke akintola university of technology, ogbomoso, nigeria 4 department of anatomy, university of ilorin, nigeria 5 department of surgery, burns and plastic surgery, university of ilorin, nigeria received: march 15, 2023 accepted: may 4, 2023 published: september 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(3), september 2023 193 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.2 évaluation de la qualité de vie liée à la santé et de ses déterminants chez les patients atteints d'ulcère du pied diabétique à ilorin, au nigéria 1 2 2 3 4 *olarinoye j.k. , omotoso a.b. , ogunmodede a.j. , opeyemi c.m. , olagbaye b.a. , 1 5 sanni n. , aderibigbe a.b. resume contexte général de l'étude : l'impact de l'ulcère du pied sur le bien-être psychosocial des patients diabétiques nigérians n'a pas reçu suffisamment d'attention. cette étude a donc tenté d'évaluer l'effet de l'ulcère du pied diabétique sur la qualité de vie des adultes dans une population diabétique nigériane. méthode de l'étude: les impacts de l'ulcère du pied diabétique (upd) sur la qualité de vie ( qdv ) de 104 adultes atteints de diabète ont été évalués à l'aide de la balance d'ulcère du pied diabétique et de ses déterminants. résultat de l'étude: le score moyen de qualité de vie (qdv) était de 42.25. cinquante-cinq (53.4 %) avaient un statut de qualité de vie médiocre tandis que 48 (46.6 %) avaient une bonne qualité de vie. les déterminants d'une mauvaise qualité de vie incluent un faible statut socio-économique (p = 0.017), l'absence d'études supérieures (p = 0.027), l'absence d'éducation au diabète (p = < 0.001), un faible statut socio-économique (p = 0.017), des ulcères multiples (p = 0.022) et ulcères de grade wagner> 3 (p = 0.004). conclusion : la majorité des patients atteints de dfu à l'uith, au nigéria, ont une mauvaise qualité de vie et la plupart des prédicateurs de mauvais résultats de qualité de vie sont évitables et modifiables. mots-clés : ulcère du pied diabétique, qualité de vie, déterminants, nigérians *corresponding author olarinoye john kola, email: kolaolarinoye@yahoo.com 1 department of medicine, endocrinology, diabetes and metabolism unit, university of ilorin, ilorin, nigeria 2 department of psychiatry and behavioral sciences, university of ilorin, nigeria 3 department of medicine, ladoke akintola university of technology, ogbomoso, nigeria 4 department of anatomy, university of ilorin, nigeria 5 department of surgery, burns and plastic surgery, university of ilorin, nigeria received: march 15, 2023 accepted: may 4, 2023 published: september 30, 2023 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 194 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.2 introduction one of the most common complications of diabetes is foot ulceration. diabetic foot ulcer (dfu) often results from disease-related peripheral neuropathy, foot ischemia, infection or usually a combination of some or all of these factors (1). an estimated 15-25% of people living with diabetes will develop a foot ulcer at some point in their lifetime (2). the prevalence of (dfu reported from several studies ranges from 2% to 10% of adult diabetic population while the annual cumulative incidence varies between 0.5% and 3% (1,2,3). in nigeria, dfu is the highest cause of diabetic admission and has the highest case fatality rate of all the complications of the disease (4). globally the average hospital length of stay for patients with dfu is 59% longer than for diabetic patients without foot ulcers (5,6). dfu is a source of major disability; only two-thirds of the foot ulcers are expected to heal, even in the best of centers and the mean time to healing is about 6 months (7). about 28% of patients with dfu will result to an amputation of some kind (7). diabetes mellitus is the most common underlying cause of non-traumatic lower extremity amputation (lea). more than 60% of leas in the us occur in diabetic patients. generally, lea is 15-40 times more common in diabetic patients than their non-diabetic population (5). in addition to the huge disease burden imposed on the patient, dfu also has a significant impact on the quality of life (qol) of both the patients and their attendants (8). the disability associated with dfu affects the patient's ability to carry out simple daily tasks and often impairs their ability to take part in leisure activities. this has been supported by a number of studies showing that diabetic patients with dfu are more likely to suffer depression than those without foot ulcers (8,9). presently in nigeria, recognition of the importance of psychosocial factors in the care of individuals with diabetes is still in its infancy (10). although many studies have been carried out on the subject of dfu, local data on the psychosocial wellbeing of the dfu patients and the people looking after them are very few (11,12,13). this study therefore set out to evaluate the psychosocial burden of patients with dfu in our local setting with a view to providing information that will help in addressing an oftenneglected component of a holistic diabetes care. materials and methods study design: this was a prospective crosssectional descriptive study setting: it was carried out among patients with diabetes mellitus being managed at the university of ilorin teaching hospital (uith), ilorin, nigeria. inclusion criteria: all adults (≥18 years) with type 1 or type 2 diabetes mellitus having a current foot ulcer, healed foot ulcer or an amputated lower limb was considered eligible for inclusion into the study. exclusion criteria: individuals with foot ulcers resulting from trauma, cancer, leprosy or sle were excluded from the study. patients with history of a neuro-psychiatric illness and use of psychoactive substances were also excluded as well as those who refused to give consent for the study. recruitment: all consenting eligible patients who were attended to at the diabetes clinic and the diabetes wards of the uith, ilorin, nigeria during the study period were interviewed with a s t r u c t u r e d i n t e r v i e w e r a d m i n i s t e r e d q u e s t i o n n a i r e . t h e s o c i o d e m o g r a p h i c characteristics and the clinical details of dfu disease were obtained from the recruited patients. research instrument the qol of the participants were assessed using “the diabetic foot ulcer scale (dfs)” instrument (8). it is a tool that is universally recognized, acceptable and validated for use among the dfu patient populations worldwide including nigeria (8). most of the interviews were carried out by one of the authors who was very familiar with the research instrument and very fluent in english and yoruba languages. dfs consists of 58 items grouped into 11 domains: leisure; physical health; daily activities; emotion; non-compliance; family; friends; positive attitudes; treatment; satisfaction and financial. each item is a question with a recall period of the past four weeks. the response is graded on a 5-point likert scale ranging from 1 (“not at all” or “none of the time”) to 5 (“a great deal” or “all of the time” or “extremely”). dfs domain scores were based on the sum of all items associated with that domain. the scores per domain and the global score, which is the sum of all the domain scores, were res. j. health sci. vol 11(3), september 2023 195 diabetic foot ulcer and qol in nigeria olarinoye et al. transformed on a scale from 0 to 100 where a higher score indicates a greater negative impact and a lower qol. ethical consideration: ethical approval was obtained from the ethics and research committee. statistical analysis data collected were collated, stored and analyzed using the statistical software spss, version 22.0, ibm corporation, usa. results were expressed as means ± sd for continuous variables while categorical variables were expressed as proportions. comparison of continuous variables was done using the student t-test and categorical values were compared using the chi-square test. a p-value of <0.05 was taken to be a statistically significant difference. multivariate analysis was carried out to identify factors associated with the qol scores. results socio-demographics the socio-demographic characteristics of the participants as well as clinical history relating to patients' diabetes disease are shown in tables 1 and 2 respectively. profile of ulcer characteristics among the study participants (see table 3) the foot ulcers were neuropathic in 40 (38.5%) cases, ischemic in 7 (6.7%) and neuro-ischemic in 58 (55.8%) subjects. the right foot was affected in 41 (31.5%) of the patients, left foot involved in 51 (49.1%) while both feet were involved in 12 (11.5%). in 33 (31.8%) patients the ulcer location was plantar, the dorsum was involved in 44 (42.3%), digital involvement in 18 (17.3%), ankle involvement in 4 (3.8%) while the whole foot was affected in 5 (4.8%) of the cases. ulcer occurrence was singular in 58 (55.7%) of them and multiple in the remaining 46 (44.3%). thirty-one patients (29.8%) already had leg amputation and only 3 patients (2.9%) had prosthesis. impact of dfu on the qol of the study participants the impacts of foot ulceration on the various domains of the qol of the participants are shown in tables 5 and 6. among the respondents in this study, individuals with global qol score th >50 percentile of the qol scores distribution seen among the respondents in the study were categorized as having bad qol. in the contrary, th individuals with global qol score <50 percentile of the qol scores distribution seen among the respondents in the study were th categorized as having good qol. the 50 percentile qol score seen among the study participants is 45.25. figure 1 shows that 55 patients (53.4%) had global poor qol as a result of the impact of dfu while the remaining 48 (46.9%) had global good qol. the domains most badly affected by dfu were positive attitude, satisfaction, finances, daily activities and leisure. the least affected domains included compliance, family relationship and friendship. factors affecting the qol scores among the study participants table 7 shows the multivariate analysis of the various factors affecting the impact of dfu on the different qol domains of the study participants. i. gender – the gender of the participants had no significant effect on their respective qol scores (p >0.05 in all domains). ii. education – individuals who acquired tertiary education had a significantly less impact of dfu on their finances (p = 0.027). iii. socio-economic status – dfu also had greater impact on the emotions (p = 0.027), activities (p = 0.017) and treatment (p = 0.027) domains among the patients in the lower socioeconomic group than those in the high socioeconomic group. iv. diabetes education – those without diabetes education were significantly worse impacted in activities (p = 0.01) and positive attitude (p = 0.034) domains. v. number of ulcers – individuals with multiple ulcers had worse qol outcomes than those with single ulcers in health (p = 0.022), activities (p = 0.006) and emotions (p = 0.002) domains. vi. wagner grade – having ulcers in the grade 3 and above significantly affected the leisure (p = 0.042), physical health (p = 0.04), activities (p = 0.04), family relationship (p = 0.018) and treatment (p = 0.003) qol domains in the study participants. discussion our study has shown that in our local practice setting, dfu had a significant negative effect on the qol of most of the affected patients res. j. health sci. vol 11(3), september 2023 196 diabetic foot ulcer and qol in nigeria olarinoye et al. which quite agrees with the findings from previous studies done elsewhere (10,11,12). in this study, the development of foot ulceration was clearly shown to have resulted in a significant decline in most domains of the patient's qol. the most commonly affected domains included the emotion, physical activities, positive attitudes and financial status. this observation is supported by previous findings in jordanian (14) and tunisian (15) diabetic populations where patients with dfu were also found to have poor health-related qol. the negative impact of dfu on the patients' perceived hr-qol may partly be due to impairment of mobility and consequently in the impaired ability to perform daily activities thus resulting in the increased need for dependence on others (16,17). in addition, chronicity and severity of ulceration often comes with the fear of leg amputation thereby increasing the negative mood and other emotional problems associated with this condition. the often-resulting psychological co-morbidities like depression confer additional negative qol impart in patients with dfu. studies have shown that patients with dfu are twice more likely to have depression compared with their diabetic counterparts without foot ulceration (18). another qol domain affected by dfu in our study is finance which is in agreement with previous other observers who showed that there were financial difficulties faced by patients with dfu as a result of increase in direct and indirect cost of care (17,19). majority of our patients pay out of pocket to take care of the cost of medications, dressing materials, surgical expenses and hospital admission fees. furthermore, there are also employment problems as most of the patients are out of job while others have limited career prospects as a result of their illness. it is interesting to note that in this study, the family and friendship domains were less impacted. this is understandable because in african culture, the family value is sacred, and the bonding remains strong and intact even in time of sickness. it is almost considered a taboo to withdraw your support for a family relation because of an illness. our study, in agreement with previous opinions (20) found that acquiring a tertiary education is protective against the harmful effect of dfu on a patient's qol. education improves the wellbeing of an individual because it ensures increased employability, better income and better health awareness (20). it also creates access to better coping mechanisms during chronic disabling illnesses. moreover, our study also showed that individuals exposed to formal diabetes education had less negative impact on their hr-qol in agreement with previous findings (21). however, contrary to the finding in the jordanian study referred above (14), gender did not play any significant role in determining the qol among the respondents in this study. this study also showed that patients with multiple ulcers had more negative impact on their qol compared with those with single ulcer foot disease. the domains affected mostly by this particular factor were the physical activities and emotional state. the reason for this may be related to observations made in a previous study that patients with multiple ulcers had poorer healing rate because of impaired circulation and reduced distal perfusion pressure (22). another significant predictor of qol in our study population was the extent and severity of the ulcers as determined by the wagner grade. individuals with severe foot diseases (more than grade 3) had poor outcomes in the leisure, physical activities, and emotion domains of their qol. this finding agrees with policandrioti (23) who observed that there was a close relationship between dfu severity and qol impairment. a severe dfu takes longer time to heal, demands more intensive care and causes more limitations in daily activities. also, a severe disease would require more clinic visits, longer periods of hospital stay, and of course would be more costly to treat. patients with higher wagner grade of ulcers are also associated with potential risk for amputation, thus creating fear and other emotional problems. valensi et.al (24) also demonstrated in their study an inverse relationship between good qol in domain of leisure and wagner grade of the ulcer. conclusion this study has clearly shown that majority of the selected patients with diabetes mellitus had their qol negatively impacted by foot ulceration. nearly all the domains of their qol were affected. factors responsible for this poor psychosocial outcome have been recognized and are generally preventable. it is recommended that psychosocial assessment be encouraged in order to provide a comprehensive and holistic diabetes care. conflict of interest: there is no conflict of interest declared by any of the authors res. j. health sci. vol 11(3), september 2023 197 diabetic foot ulcer and qol in nigeria olarinoye et al. res. j. health sci. vol 11(3), september 2023 198 funding: no financial support from the participants or any other external agent. criteria for authorship: olarinoye jk is the principal investigator. omotoso ab, aderibigbe ab and sanni n developed the concept. ogunmodede aj did the write-up. opeyemi cm did the statistical analysis of the data. olagbaye ao conducted the data collection and processing. sanni n carried out the review of the concept. references 1. boulton a j m. the diabetic foot: grand overview, epidemiology and pathogenesis. diabetes metab res rev 2008;24(suppl 1):s3s6. 2. gupta s k, panda s and singh s k. the etiopathogenesis of the diabetic foot: an unrelenting epidemic. international journal of lower extremity wounds 2010; 9(3):127– 131. 3. pandsey s. epidemiological aspects of diabetic foot. int j diab dev countries 1994;14:37-38. 4. ogbera oa, eregie o, edo a and ekpebegh c. common clinical features of diabetic foot ulcers: perspectives from a developing nation. the international journal of lower extremity wounds 2008;7(2):93-98. 5. frykberg rg, zgonis t, armstrong dg, driver vr, giurini jm, kravitz sr et al. diabetic foot disorders: a clinical practice guideline (2006 revision). the journal of foot and ankle surgery 2006;45(5):s1-s66. 6. reiber ge, boyko ej, smith dg. lower extremity foot ulcers and amputations in diabetes. in: diabetes in america, 2nd ed, pp 409-427 , edited by mi harris, c cowie, and mp stern, nih publication no. 95-1468; 1995. 7. viswanathan v. epidemiology of diabetic foot and management of foot problems in india. the international journal of lower extremity wounds 2010; 9(3) 122–126. 8. abetz l, sutton m, brady l, mcnulty p and gagnon d. d. the diabetic foot ulcer scale (dfs): a quality of life instrument for use in clinical trials. practical diabetes int 2002: 19(6); 167-175. 9. most rs, sinnock p. the epidemiology of lower extremity amputation in diabetic individuals. diabetes care 1983; 6: 87-91. 10. issa b a, yusuff a d, baiyewu o. the association between psychiatric disorders and quality of life of patient with diabetes mellitus. iran j psychiatry 2007; 2: 30-34. 11. ikem rt, ikem ic, ola ba. relationship between depression, cognitive function and quality of life of nigerians with diabetic foot ulcers, a preliminary controlled study. acta endocrinologica. 2009 jan 1;5(1):75-83. 12. habibu ra, uloko ae, gezawa id, ramalan ma, muhammad fy, abubakar ui, muhammad a. health-related quality of life of persons with diabetic foot ulcers in a cosmopolitan city in northwestern nigeria. annals of african medicine. 2022 jul 1;21(3):250. 13. ogunmodede a j, abiodun o, makanjuola a b, olarinoye j k, ogunmodede j a, buhari o i. burden of care and psychological distress in primary caregivers of patients with type -2 diabetes mellitus in a tertiary hospital in nigeria. ethiop j health sci. 2019;29(6):697. 14. alrub aa, hyassat d, khader ys, bani-mustafa r, younes n, ajlouni k. factors associated with health-related quality of life among jordanian patients with diabetic foot ulcer. journal of diabetes research. 2019 jan 17;2019. 15. amira abbassi, asma ben hassine, asma ben cheikh and nabiha boufia. quality of life in patients with diabetic foot ulcers in tunisia. wound middle east 2019;6,2:36-42. 16. wg meijer, j. trip, smhj jaegers, tp links, aj smits, jw groothoff, wh eisma j. quality of life in patients with diabetic foot ulcers. disability and rehabilitation. 2001 jan 1;23(8):336-40. 17. gilpin h, lagan k. quality of life aspects associated with diabetic foot ulcers: a review. the diabetic foot journal. 2008;11(2):56-62. 18. ahmad a, abujbara m, jaddou h, younes na, ajlouni k. anxiety and depression among adult patients with diabetic foot: prevalence and associated factors. journal of clinical medicine research. 2018 may;10(5):411. 19. raghav a, khan za, labala rk, ahmad j, noor s, mishra bk. financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. therapeutic advances in endocrinology and metabolism. 2018 jan;9(1):29-31. 20. powdthavee n, lekfuangfu wn, wooden m. what's the good of education on our overall quality of life? a simultaneous equation model of education and life satisfaction for australia. journal of behavioral and experimental economics. 2015 feb 1;54:10-21. 21. sekhar ms, unnikrishnan mk, vijayanarayana k, rodrigues gs. impact of patient-education on health related quality of life of diabetic foot ulcer patients: a randomized study. clinical epidemiology and global health. 2019 sep 1;7(3):382-8. 22. apelqvist j, agardh cd, castenfors j, larsson j, stenström a. wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers. diabetic medicine. 1989 aug;6(6):526-30. 23. polikandrioti m. quality of life in diabetic foot ulcer, grade 3: associated demographic factors. folia medica. 2022 apr 30;64(2):229-39. 24. valensi p, girod i, baron f, et al. quality of life and clinical correlates in patients with diabetic foot ulcers. diabetes metab 2005; 31(3 pt 1):263–71 diabetic foot ulcer and qol in nigeria olarinoye et al. res. j. health sci. vol 11(3), september 2023 199 table 1. socio-demographic characteristics of the study participants variable n (%) mean age (yrs) 59.7±11.91** age group(yrs) 20-29 40-59 60-79 80-99 5(4.9) 45(43.7) 47(45.6) 6(5.8) gender male female 49(47.6) 54(52.4) tribe yoruba igbo others 91(88.3) 1(1) 11(10.7) religion christianity islam 47(45.6) 56(54.4) education none primary secondary tertiary 38(36.9) 18(17.5) 13(12.6) 34(33) occupation unemployed civil servant business artisan retired clergy 3(2.9) 16(15.5) 39(37.9) 12(11.7) 27(26.2) 6(5.8) economic status low middle high 56(54.4) 44(42.7) 3(2.9) funding source self family friends loans alms 81(78.6) 96(93.2) 20(19.4) 2(1.9) 1(1) substance use alcohol cigarette 9(8.7) 3(2.9) support group tribal social religious 10(9.7) 18(17.5) 58(56.3) ** represents mean±sd diabetic foot ulcer and qol in nigeria olarinoye et al. res. j. health sci. vol 11(3), september 2023 200 table 2. diabetes-related features among the study patients diabetes mellitus related features n (%) history of diabetes education 58(56.3) history of diet only treatment 1(1) history of oral medication treatment 100(97.1) history of insulin therapy treatment 90(87.4) hypertension co-morbidity 70(68) dyslipidemia co-morbidity 7(6.8) history of stroke 3(2.9) presence of retinopathy 31(30.1) presence of nephropathy 36(35) history of myocardial infarction 2(2) table 3. ulcer characteristics among the study subjects variable n (%) ulcer characteristics neuropathic ischemic neuro-ischemic immune mediated 40(38.8) 7(6.8) 58(56.3) 0(0) ulcer location right left both 40(38.8) 50(48.5) 12(11.7) ulcer site plantar dorsum ray ankle and above both plantar & dorsum 32(31.1) 43(41.7) 18(17.5) 5(4.9) 5(4.9) number of ulcers single multiple 56(54.4) 47(44.6) depth of ulcer subcutaneous muscle ligament & tendons bone 6(5.9) 21(20.4) 25(24.3) 53(51.5) clinical signs of ulcer infection wagner grade of dm foot grade 1 grade 2 grade 3 grade 4 grade 5 94(91.3) 3(2.9) 17(16.5) 30(29.1) 35(34) 18(17.5) presence of gangrene 68(66) presence of pain 71(68.9) type of amputation ray bka aka 31(30.1) 10(9.7) 15(14.6) 6(5.8) use of prosthesis post amputation 3(2.9) bka = below-knee amputation; aka = above-knee amputation diabetic foot ulcer and qol in nigeria olarinoye et al. res. j. health sci. vol 11(3), september 2023 201 table 4. clinical and laboratory parameters among the study participants variable mean±sd (n=103) systolic bp 131.94±16.87 diastolic bp 81.16±13.52 fbs 7.67±3.26 rbs 12.98±7.09 hba1c 8.82±2.23 total cholesterol 3.13±0.88 ldl 2.07±0.9 hdl 0.62±0.27 tg 1.19±0.41 phosphorus 1.26±0.56 k+ 3.78±0.81 na+ 132.23±6.22 urea 6.48±4.44 creatinine 113.61±66.35 ca++ 2.08±0.34 bp = blood pressure; fbs = fasting blood sugar; rbs = random blood sugar; hba1c = glycosylated hemoglobin ldl = low-density lipoprotein hdl = high-density lipoprotein; tg = triglyceride diabetic foot ulcer and qol in nigeria olarinoye et al. res. j. health sci. vol 11(3), september 2023 202 table 5. impact of dfu on the patients' qol domains and items positive n(%) average n(%) negative n(%) leisure: how much have your foot ulcer problems: a) stopped you from doing the hobbies and recreational activities you enjoy? b) changed the kinds of hobbies & recreational activities that you enjoy? c) stopped you from getting away for a holiday or weekend break? d) made you choose a different kind of holiday or short break than you would have preferred? e) meant that you had to spend more time planning and organizing for leisure activities? 20(19.4) 90(87.4) 52(50.5) 97(94.2) 44(42.7) 10(9.7) 2(1.9) 5(4.9) 1(1) 13(12.6) 73(70.9) 11(10.7) 46(44.7) 5(4.9) 46(44.7) physical health: because of your foot problems, how often have you felt: a) fatigued or tired? b) drained? c) that you had difficulty sleeping? d) pain while walking or standing? e) pain in the night? f) unwell because of taking antibiotics or other medicine for infection? 49(47.6) 53(51.5) 52(50.5) 30(29.1) 66(64.1) 86(83.5) 19(18.4) 21(20.4) 33(32) 26(25.2) 19(18.4) 13(12.6) 35(34) 29(28.2) 18(17.5) 47(45.6) 18(17.5) 4(3.9) daily activities: because of your foot problems, how often have you: a) had to depend on others to help you look after yourself? b) had to depend on others to do household chores such as cooking, cleaning, or laundry? c) had to depend on others to get out of the house? d) had to spend more time planning or organizing your daily life? e) felt that doing anything took longer than you would have liked? f) felt restricted in your daily life? 28(27.2) 24(23.3) 29(28.2) 35(34) 35(34) 29(28.2 24(23.3) 21(20.4) 24(23.3) 19(18.4) 17(16.5) 17(16.5) 51(49.5) 58(56.3) 50(48.5) 49(47.6) 51(49.5) 57(55.3) emotions: because of your foot problems, have you felt: a) angry because you were not able to do what you wanted to do? b) frustrated by others doing things for you when you would rather do them yourself? c) frustrated because you were not able to do what you wanted to do? d) helpless to cure your ulcers(s)? e) worried that your ulcer(s) will never heal? f) worried that you may have to have an amputation? g) worried about injury to your feet? h) depressed because you were not able to do what you wanted to do? i) worried about getting ulcers in the future? j) worried about being a burden on others? k) that you have no control over your life? l) angry that this has happened to you? m) alone? n) frustrated because you have difficulty in moving about? o) frightened about the future? p) badly about yourself because you can no longer work or be productive? q) hopeless that things will never get better? 59(57.3) 72(69.9) 67(65) 52(50.5) 61(59.2) 54(52.4) 58(56.3) 70(68) 82(79.6) 74(71.8) 61(59.2) 68(66) 87(84.5) 68(66) 67(65) 72(69.9) 86(83.5) 14(13.6) 9(8.7) 12(11.7) 15(14.6) 22(21.4) 14(13.6) 12(11.7) 15(14.6) 14(13.6) 17(16.5) 25(24.3) 21(20.4) 7(6.8) 16(15.5) 21(20.4) 15(14.6) 10(9.7) 30(29.1) 22(21.4) 24(23.3) 36(35) 20(19.4) 35(34) 33(32) 18(17.5) 7(6.8) 12(11.7) 17(16.5) 14(13.6) 9(8.7) 19(18.4) 15(14.6) 16(15.5) 7(6.8) noncompliance: because of your foot problems, how often: a) have you done things that you knew were not good for you such as eating, drinking or smoking too much? b) did you disregard medical advice about how to care for your ulcer? 102(99) 103(100)) 0(0) 0(0) 1(1) 0(0) family: because of your foot ulcer problems, how much: a) strain has there been on your relationship with your spouse or partner? b) strain has there been on your relationship with other family members? c) do you argue with your spouse or partner? d) have you felt that you are a burden on your family? e) have you felt that there has been a decline in your sexual relations? 93(90.3) 98(95.1) 97(94.2) 93(90.3) 78(75.7) 7(6.8) 3(2.9) 3(2.9) 7(6.8) 6(5.8) 3(2.9) 2(1.9) 3(2.9) 3(2.9) 19(18.4) friends: because of your ulcer problems, how much have you felt: a) guilty because your friends have to change plans to fit with your limitations? b) that your circle of friends is getting smaller? c) that there are restrictions on the kinds of things you do with your friends? d) hindered in your social life? e) that you are a burden on your friends? 102(99) 100(97.1) 86(83.5) 70(68) 99(96.1) 1(1) 1(1) 5(4.9) 9(8.7) 4(3.9) 0(0) 2(1.9) 12(11.7) 24(23.3) 0(0) treatment: because of your foot ulcer problems, how much are you bothered by: a) having to keep weight off your foot ulcer? b) the amount of time involved in caring for your foot ulcer (including dressing changes, waiting for the district nurse, and keeping the ulcer clean)? c) the appearance, odour, or leaking of your ulcer? d) having to depend on others to help you care for your foot ulcer? 28(27.2) 52(50.5) 57(55.3) 39(37.9) 19(18.4) 20(19.4) 18(17.5) 21(20.4) 56(54.4) 31(30.1) 28(27.2) 43(41.7) satisfaction: how satisfied have you been with your medical care for your foot ulcer problems? 90(87.4) 11(10.7) 2(1.9) diabetic foot ulcer and qol in nigeria olarinoye et al. figure 1. qol status among the dfu patients table 6. mean domain qol scores of study subjects the table above shows the values of the mean qol scores and their associated 95% ci for each of the 11 domains of dfu scale among the respondents in the study.. domains qol score (mean±sd) ci (95%) leisure 4.95±1.75 4.61-5.27 physical health 4.76±1.68 4.44-5.08 daily activities 6.70±2.47 6.21-7.17 emotions 4.31±1.85 3.94-4.69 noncompliance 2.04±0.22 2.01-2.08 family 2.48±1.01 2.30-2.68 friends 2.91±1.16 2.68-3.15 treatment 5.77±2.23 5.30-6.21 satisfaction 8.42±1.49 8.11-8.71 positive attitude 7.39±1.51 7.10-7.69 financial 6.71±2.38 6.22-7.16 global qol score 45.25±7.23 48.20-51.32 diabetic foot ulcer and qol in nigeria olarinoye et al. res. j. health sci. vol 11(3), september 2023 203 diabetic foot ulcer and qol in nigeria olarinoye et al. res. j. health sci. vol 11(3), september 2023 204 rjhs 11(3).cdr a correlation of 8-hour and 12-hour with 24-hour urinary protein among pregnant women with preeclampsia in a teaching hospital in south-western nigeria 1 1 2 3 1 4 akindele r.a. , omopariola s.o. , adeyemo a.t. , afolabi b.a. , awodele k. , folami e.o. , 5 *adeyemo a.t. abstract background and objective: proteinuria is one of the cardinal features of preeclampsia, which is a common and potentially severe complication of pregnancy. this study sought to determine how the quantitative measurement of urine protein from 8-hour and 12hour samples correlate with that of a 24 hour sample in diagnosing preeclampsia. materials and methods: 52 eligible pregnant women with preeclampsia were recruited between april 2017 and april 2018. for each patient, having emptied the bladder at 0 hour, urine was collected into three different containers (containers 1, 2, 3) at 8th hour, 12th hour and 24th hour ensuring that the bladder was emptied into each container at hours 8, 12 and 24. volumes of 8 hours urine (volume in container 1), 12 hours urine (total volume in containers 1 and 2), and 24 hours urine (total volumes in containers 1, 2 and 3) were measured and 5 ml aliquot respectively obtained from each sample for colorimetric analysis of urinary protein. data was analyzed using the epi info software results: a total of 52 patients completed the study. the mean gestational age was 33+ 2.82weeks. the mean 8-hour, 12-hour and 24-hour urinary protein values were 2.1+1.53, 2.3+1.52 and 3.1+1.89 respectively. there were significant correlations between the protein values of 8-and 12-hour urine samples with those of 24-hour urine samples conclusion: 8-hour and 12-hour values of urine protein correlated positively with values in 24-hour samples and may be useful for initial assessment of cases of preeclampsia for prompt interventions. key words: preeclampsia, proteinuria, correlation, nigeria *corresponding author: adeyemo a.t. e-mail:adeyemiadeyemo3@gmail.com 1 department of obstetrics and gynaecology, uniosun teaching hospital, osogbo, nigeria 2 department of medical microbiology and parasitology, uniosun teaching hospital, osogbo, nigeria 3 department of family medicine, uniosun teaching hospital, osogbo, nigeria 4 department of anaesthesia, uniosun teaching hospital, osogbo, nigeria 5 department of medical microbiology and parasitology, obafemi awolowo university teaching hospitals complex, ile-ife, nigeria received: march 7, 2022 accepted: march 10, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0003-3544-2530 original article research journal of health sciences res. j. health sci. vol 11(3), september 2023 244 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.7 une corrélation de 8 heures et 12 heures avec les protéines urinaires de 24 heures parmi les femmes enceintes atteintes de pré éclampsie dans un hôpital universitaire du sud-ouest du nigéria 1 1 2 3 1 4 akindele r.a. , omopariola s.o. , adeyemo a.t. , afolabi b.a. , awodele k. , folami e.o. , 5 *adeyemo a.t. résumé contexte général et objectif de l'étude : la protéinurie est l'une des caractéristiques cardinales de la pré éclampsie, qui est une complication fréquente et potentiellement grave de la grossesse. cette étude visait à déterminer comment la mesure quantitative des protéines urinaires à partir d'échantillons de 8 heures et de 12 heures est corrélée à celle d'un échantillon de 24 heures dans le diagnostic de la pré éclampsie. matériels et méthode de l'étude : 52 femmes enceintes éligibles atteintes de pré éclampsie ont été recrutées entre avril 2017 et avril 2018. pour chaque patiente, ayant vidé la vessie à 0 heure, l'urine a été collectée dans trois récipients différents (conteneurs 1, 2, 3) à la 8ème heure , 12e heure et 24e heure en s'assurant que la vessie a été vidée dans chaque récipient aux heures 8, 12 et 24. volumes d'urines de 8 heures (volume dans le récipient 1), urines de 12 heures (volume total dans les récipients 1 et 2), et 24 heures d'urine (volumes totaux dans les conteneurs 1, 2 et 3) ont été mesurés et 5 ml d'aliquote respectivement obtenus à partir de chaque échantillon pour l'analyse colorimétrique des protéines urinaires. les données ont été analysées à l'aide du logiciel epi info. les statistiques descriptives étaient avec la distribution de fréquence, la moyenne et l'écart type, tandis que les statistiques inférentielles déployées étaient avec une analyse de corrélation et une analyse de régression simple. résultat de l'étude : au total, 52 patients ont terminé l'étude. l'âge gestationnel moyen était de 33 + 2,82 semaines. les valeurs moyennes des protéines urinaires sur 8 heures, 12 heures et 24 heures étaient respectivement de 2,1 + 1,53, 2,3 + 1,52 et 3,1 + 1,89. il y avait des corrélations significatives entre les valeurs de protéines des échantillons d'urine de 8 et 12 heures avec celles des échantillons d'urine de 24 heures conclusion : les valeurs de protéines urinaires sur 8 heures et 12 heures sont corrélées positivement avec les valeurs des échantillons sur 24 heures et peuvent être utiles pour l'évaluation initiale des cas de pré éclampsie pour des interventions rapides. motsclés: pré éclampsie, protéinurie, corrélation, nigéria *corresponding author: adeyemo a.t. e-mail:adeyemiadeyemo3@gmail.com 1 department of obstetrics and gynaecology, uniosun teaching hospital, osogbo, nigeria 2 department of medical microbiology and parasitology, uniosun teaching hospital, osogbo, nigeria 3 department of family medicine, uniosun teaching hospital, osogbo, nigeria 4 department of anaesthesia, uniosun teaching hospital, osogbo, nigeria 5 department of medical microbiology and parasitology, obafemi awolowo university teaching hospitals complex, ile-ife, nigeria received: march 7, 2022 accepted: march 10, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0003-3544-2530 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 245 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.7 of protein may be found in alkaline urine, urinary tract infection or contamination by vaginal discharge. a shorter period to diagnosis would have clinical benefits such as shortened time to d e l i v e r y a n d e a r l i e r u s e o f a n t e n a t a l glucocorticoids for fetal pulmonary maturity (11,12). several investigators have explored other means of quantifying proteinuria in a shorter period. the protein-creatinine ratio of a single urine sample from pregnant women has been shown to correlate significantly with a 24hour collection for patient with protein values of <1gin 24 hours. above this level, the variation between the samples is increased. some workers studied protein-creatinine ratios in pregnant women with preeclampsia but showed that the degree of correlation to the 24-hour sample was lower with values of>2g/24 hours (13,14). therefore the protein-creatinine ratio is not sensitive enough to determine mild versus severe disease for patient with significant proteinuria (15,16). the gold standard for urinary protein measurement, till date, is the measurement of 24hour urine protein (3,16). the rationale behind 24-hour collection is that in preeclamptic patients, fluctuation of protein loss in urine varies significantly over a 24-hour period and collection of less than this duration may not accurately reflect the actual amount of daily protein loss. but even with this method, there is a major drawback, as it requires too much time for collection and is cumbersome for the patient leading to poor patient compliance (9). moreover, estimation of 24-hour urine protein may be incorrect due to improper collection, improper mixing or spillage, and it also delays the diagnosis, and hence the treatment. there is no local study available showing the correlation of 8-hour, 12-hour and 24-hour urine protein, so this study was carried out to correlate the urinary protein levels in 8-hour, and 12-hour urine samples with 24-hour urine sample in patients with preeclampsia. determining level of relationship (and establish correlations if any) between the 8-hour and 24-hour urine protein values in pre-eclamptic patient on the one hand, and between the 12-hour and 24-hour urine protein value in pre-eclamptic patient on the other hand would greatly assist the clinician in effective patients evaluation and management. thus the objective of this study was to determine how the quantitative measurement of urine protein values from 8-hour and 12hour samples correlates with that of a 24hour sample in diagnosing preeclampsia. introduction hypertensive disorders of pregnancy are common major complications of pregnancy accounting for 5-10% of all pregnancies leading to significant morbidity and mortality in the fetus, the newborn infant and the mother (1,2). the preeclampsia syndrome either alone or superimposed on the chronic hypertension is the most serious hypertensive disorder in pregnancy. preeclampsia is defined as systolic blood pressure (bp) level of 140mmhg or higher and diastolic bp of 90mmhg or higher, occurring after 20 weeks of gestation with proteinuria to the extent of >0.3gm protein in 24-hour urine specimen (3). in non-pregnant individuals, abnormal total protein excretions are typically defined as greater than 150 mg daily. in normal pregnancy, urinary protein excretion increases substantially, due to a combination of increased glomerular filtration rate and increased permeability of the glomerular basement membrane (4). hence, total protein excretion is considered abnormal in pregnant women when it exceeds 300 mg/24 hours (3). proteinuria is one of the cardinal features of preeclampsia, however the severity of proteinuria is not indicative of the severity of pregnancy induced hypertension and should not be used to guide management (4,5). also, proteinuria is part of the formal diagnostic criteria of pregnancy induced hypertension, it may still be absent. studies have shown that 10 percent of women with clinical and/or histological m a n i f e s t a t i o n s o f p r e g n a n c y i n d u c e d hypertension have no proteinuria and 20 percent of women with eclampsia do not have significant proteinuria prior to their seizure (6,7). while renal diseases and from various sources could present with proteinuria, about 20 to 25 percent of women with chronic hypertension and diabetes develop superimposed preeclampsia (8). it is thus important for clinicians caring for pregnant women to understand how to identify proteinuria, and how to determine whether preeclampsia or renal disease (or both) is the cause. although proteinuria is central to the diagnosis and assessment of preeclampsia, the methods of recording its presence or extent are poorly described or standardized. the dipstick estimation of spot urine samples is the most commonly used and recorded method. however, this method is neither sensitive nor specific and studies have shown that urine dipstick for protein result correlates poorly with 24 hour urine samples for differentiating patient with no disease or severe disease (9,10). small amounts res. j. health sci. vol 11(3), september 2023 246 a correlation of 8-hours and 12-hours with 24-hours urinary protein akindele et al. materials and methods study site: the study was conducted over a 12month period (april 2017 to april 2018) at the ante-natal ward of uniosun (formerly lautech) teaching hospital. the hospital is located in osogbo the capital of osun state. the teaching hospital is a tertiary health facility and it offers both specialized and general healthcare to the inhabitant of osogbo and its environs. the prevalence of preeclampsia in this hospital is 8.3% while that of eclampsia is 2.1% (17). the hospital records an average of 1300 delivery annually and it is a referral center for other hospitals in the state and neighboring states in south-western nigeria. study design: this study is a hospital-based descriptive cross-sectional study aimed at correlating the 8-hour, 12-hour with the 24-hour urinary protein in pre eclamptic women. study population: the study population consists of pregnant women with preeclampsia admitted to the ante-natal ward of uniosun teaching hospital, osogbo. pregnant women with preeclampsia whose gestational age were >20weeks were included, while those who did not complete the 24-hour of collection because of delivery or seizure were excluded from this study. sample size estimation: the leslie fischer formula calculated a sample size of 35 ((using a previous study (24-hour urine protein value) was 0.3 (18), and taken to 39 to account for nonresponse and eventually 50 for better representation. d = level of precision (desired margin of error) =0.10 urine collection: the patients were carefully educated about the research work and having signed an informed consent form, the patient empties the bladder initially without collecting the urine and note the time. the urine samples were subsequently collected in three separate colour labelled containers. the first container holds the first 8-hours of urine, the second container holds the next 4hours of urine and the third container holds the remaining 12-hour urine sample, all kept in a cool place. total collection time was 24-hours. each container was labelled with the patent's name, container number and collection time and date. upon completion of 24-hour urine collection, samples were retrieved and taken to the laboratory. the sample in each container was thoroughly mixed to ensure homogeneity of the sample. the urine volume of container #1 was measured using a graduated cylinder and recorded, a 5ml aliquot was obtained and placed in clean urine vial and label as bottle #1 and represented the 8-hour urine collection. the urine volume of container #2 was obtained in the same way after which the sample in container #2 was mixed with the content of container #1. after thorough mixing, a 5ml aliquot was obtained from the mixture placed in clean urine vial and labelled as bottle #2 and represented the 12-hour urine collection. the urine volume in container #3 was measured and then subsequently combined with the mixture of the samples from container #1 and container #2. after thorough mixing, a 5ml aliquot was obtained from the mixture, placed in a clean urine vial and labeled as bottle #3 representing the 24-hour urine collection. the total volume for the samples was computed as follows: 8-hour urine collection: volume measured container #1. 12-hour urine collection: total volume of container #1 and container #2. 24-hour urine collection: total volume of container #1, #2 and container #3. analysis of the protein in each of the three aliquots was performed with colorimetric method using 5% sulfa salicylic acid. a 500microlitre aliquot of each sample was mixed with 2.5ml of 5% sulfa salicylic acid and this solution was analyzed using a spectrophotometer at 570nm wavelength. the reading was then converted to protein value using a standardized table. samples were run in duplicate and the mean value was used for the computation for total protein. the protein value was multiplied by the total volume to obtain the total protein in a given period. data analysis: all results of urinary protein obtained from the laboratory were entered into epi info version 7 software. data was cleaned and a descriptive analysis of the data was done. measures of central tendency and variation of variables such as age, parity, gestational age e.t.c. were also done. pearson correlation coefficient was used to determine the strength and direction of relationship between the variables (8-hour, 12hour and 24-hour urinary protein values). the level of significance was put at 5% (i.e. ü= 0.05). res. j. health sci. vol 11(3), september 2023 247 a correlation of 8-hours and 12-hours with 24-hours urinary protein akindele et al. ethical consideration: ethical approval was obtained from the ethics and research committee o f t h e i n s t i t u t i o n ( p r o t o c o l n u m b e r lth/ec/2016/06/273). written informed consent was obtained from each patient after explaining the purpose and objectives of the study to them and confidentiality was maintained. results a total of 58 patients participated in the study, and 6 of them were excluded because of delivery prior to the collection of samples. the remaining 52 patients did complete the study. the admission characteristics of participants are shown in . most of the patients (71.16%) were in the age group of 21-35 years, and the mean age (+sd) was 31.38 + 5.80 years. the mean gestational age was 33+ 2.82 weeks, while 97.6% of the subjects had gestational age ≥ 28 weeks. in this study preeclampsia was found more in nulliparous 46.15% and the mean parity was 1.1+1.35. out of the 52 patient that participated in the study, 86.54% had neither previous preeclampsia nor chronic hypertension while 13.46% had either previous preeclampsia or chronic hypertension. using 5g as the cut-off for severity, 42.86% had previous history of preeclampsia and had mild condition in index pregnancy while 57.14% had severe form in index pregnancy. those without previous preeclampsia/ chronic hypertension were 75.56% and 24.44% with mild and severe forms in index pregnancy respectively. the mean 8-hour, 12-hour and 24-hour urinary protein values (+sd) were 2.1+1.53, 2.3+1.52 and 3.1+1.89 respectively. there was a significant correlation between the values of 8hour urine samples and those of 24-hour urine samples (pearson correlation, correlation coefficient (r) =81%, r^2=65%, p<0.000001) figure 1, also the values of 12-hour urine samples correlate significantly with that of 24-hour urine s a m p l e s ( r ) = 8 2 % , ( r ^ 2 ) = 6 7 % , p<0.000001(figure 2). with 5g as the standard severity cut-off and using 24-hour urinary protein value as a reference to which 8-hour and 12 hour is to be correlated, the receiver operating characteristic curve (roc curve) was used and the area under the curve for the 8-hour urinary protein was 0.912(p<0.0001) giving the 8-hour urinary protein the sensitivity of 80.00%, specificity of 91.90%, positive predictive value (ppv) of 100.00% and negative predictive value (npv) of 75.5% and the critical value predictive of severity table 1 at 8-hour was >2.64g (figure 3) while the 12-hour urine values has area under the curve of 0.895(p<0.0001) with sensitivity of 93.33%, specificity of 73.00%, ppv of 100.00% and npv of 78.7% and the critical value predictive of severity at 12-hour was >1.94g (figure 4). the roc curve (figure3)was plotted based on the critical value with the highest sensitivity and specificity for both 8-hour and 12-hour urinary protein and this accounted for the critical value of urine protein at 8-hour being greater than that of 12-hour. otherwise, with higher critical value for 12-hour urine protein, the sensitivity and specificity will be lower and this may not be predictive of severity. using a linear regression analysis, the 8-hour(y=1.996x+1.03) urinary protein becomes significant at 150mg while the 12-hour(y=1.213x0.7942) urinary protein becomes significant at 247mg. discussions a major problem in the diagnosis of preeclampsia is that the optimal method of establishing abnormal levels of urine protein is not thoroughly defined (4,14). the dipstick method was known to have low sensitivity and specificity for urinary protein excretion over 24 hours (19). a shorter period of urine collection to diagnose proteinuria would have clinical benefits such as shortened time of delivery and earlier use of antenatal glucocorticoids. moreover, a more expedient intervention could decrease prenatal and maternal morbidities. in this study, we had a small number of patients with severe preeclampsia. such a small number might be due to the recent improvement of prenatal care. moreover, because of the need for urgent termination of pregnancy in severe preeclampsia, there is not significant time for the 24-h urine collection. in this study, the mean maternal age (31.38+5.8years) was comparable with other studies by rinehart et al. (25 ± 6.5 years) (20), tara et al. (median age 25 years) (21) and kieler et al. (15). the mean gestational age (32.5+2.81weeks) in this study was also comparable with study by rinehart et al. who observed mean age of 29 ± 4.7 weeks (20). in another study by adelberg et al., mean gestational age was 33.0 ± 2.8 weeks and 30.9 ± 2.1 weeks for mild and severe preeclampsia, respectively (13). tara et al. conducted a study on 26 patients in which 92.3% were in third trimester and 7.7% were in second trimester of pregnancy (21). the results of this study indicate that the res. j. health sci. vol 11(3), september 2023 248 a correlation of 8-hours and 12-hours with 24-hours urinary protein akindele et al. res. j. health sci. vol 11(3), september 2023 249 protein values for the first 8-hour and 12-hour period do correlate with that of the 24-hour sample for patients with mild and severe proteinuria. therefore, it might be taken as evidence to suggest that the 8-hour and 12-hour urine collection might be used to predict or diagnose mild or severe form of the disease. the level of severity in this study was based on the standard value of 5g and above in a 24hr urinary protein estimation. using 24-hour urinary protein value as a reference to which 8-hour and 12 hour is to be correlated, the 8-hour urinary protein has sensitivity of 80.00%, specificity of 91.90%, ppv of 100.00% and npv of 75.5% with a critical value and severity cut-off of >2.64g while the 12hour urine values has sensitivity of 93.33%, specificity of 73%, ppv of 100% and npv of 78.7% with a critical value and severity cut-off of >1.94g. the 8-hour urinary protein becomes significant at 150mg while the 12-hour urinary protein becomes significant at 247mg. this value is higher than the optimal cut-off point for 12hour urine protein of 150mg documented in a review by bartal et al. (22) and >165mg in a study report by tun c et al. (23). many studies have been carried out to study the correlation of level of proteinuria during different collection periods with that of 24 hour-urine protein. rinehart et al. studied the correlation of two consecutive 12-hour urine samples with that of a 24-hour urine collection in 29 patients of preeclampsia and showed sensitivity of 96%, specificity of 100%, positive predictive value of 100%, negative predictive value of 80%, and a correlation coefficient of 0.89 (20). keiler et al. compared urine albumin in spot and 12-hour urine samples with 24-hour urine collection in 30 women with preeclampsia. it was found that 12-hour collection correlated well with 24-hour collection, but the association of spot and 24-hour urine albumin was weak. so, they concluded that 24-hour urine collection can be substituted with 12-hour collection (15). this s t u d y a l s o s h o w e d s t r o n g c o r r e l a t i o n (p<0.000001 figure2) between 12and 24-hour urine samples. several other studies have been done for the evaluation of proteinuria in a shorter period (2, 4, 6, 8 and 12 hours), and all of them have revealed that it is possible to determine proteinuria and its severity using a shorter time of urine collections (10,11). somanathan found significant correlation between 2-hour urine protein and 24-hour urine protein and concluded that 2-hour urine protein collection is more reliable than dipstick (11). amy et al., comparing the value of 8and 12hour urine protein with 24-hour, showed a meaningful correlation in patients with mild and severe proteinuria (13). another study has shown a meaningful correlation between 4-hour and 24hour urine protein collections in women with hypertensive disorder (14). however, a number of studies recommend more studies to confirm their own findings, and to generate exact and reliable cut-off values for predicting mild and specially severe preeclampsia (24,25). the number of recruited patients (52 patients) in this study was about the size those of other studies. they all were inpatients and at bed rest, therefore, there was less or negligible diurnal variation in protein excretion (6). the sensitivity and cutoff values of mild preeclampsia in the present study were similar to those of adelberg and colleagues (13). also, the cut-off values for the diagnosis of severe preeclampsia in this study was the same with that of adelberg et al.(13). conclusion the findings of this study indicate that the 8-hour and 12-hour values of urine protein correlated positively with values of 24-hour samples. this might be used as evidence to suggest the values of total urine protein of 8-hour and/or 12-hour samples might be used for initial assessment of preeclampsia. the use of such samples for the assessment of preeclampsia helps avoid the patients' inconvenience and delay in the treatment of the disease. based on the strong correlation of the 8-hour and 12-hour urinary protein quantification with that of 24-hour urine protein samples and the higher sensitivity of both the 8-hour and 12-hour urine samples in this study, it is recommended that the 8-hour quantification may be substituted for the 24-hour urine collection as shorter period to diagnosis would have clinical benefits such as shortened time to delivery and earlier use of antenatal glucocorticoids. funding: authors received no external funding for conduct and publication of this research conflict of interest: authors declare that they have no conflict of interest. author's contribution: ara conceived the idea of the research, ara, oso, ak and aat5 designed the study. ara, oso, aat2, aba, ak, feo and aat5 were involved in data collection as well as collection of urine specimen, ara, a correlation of 8-hours and 12-hours with 24-hours urinary protein akindele et al. aat2 and aat5 were directly involved in processing of urine specimens, ara, aat2 and aat5 produced initial manuscript draft, all authors provided intellectual contributions to the final manuscript. all authors read and approved the final version of the manuscript. references 1. berg cj, chang j, challaghan wm, white-head sj. pregnancy related mortality in the united states 1991-1997. obstet gynecol 2003; 101: 289-96. 2. berg cj, harper ma, arkinson sm, et al preventability of pregnancy related deaths. obstet gynecol 2005; 106: 1228-34. 3. al-jameil n, aziz khan f, fareed khan m, tabassum h. a brief overview of preeclampsia. journal of clinical medicine research 2014 february; 6 (1): 1–7. 4. eiland e, nzerue c, faulkner m. preeclampsia 2012. j. pregnancy 2012;2012:586578. doi: 10.1155/2012/586578. epub 2012 jul 11. 5. hypertension in pregnancy. report of the american college of obstetricians and gynecologists' task force on hypertension in pregnancy. obstet gynecol. 2013; 122 (5): 1 1 2 2 – 3 1 . d o i : 10.1097/01.aog.0000437382.03963.88. pmid: 24150027. 6. lambert g, brichant jf, hartstein g, bonhomme v, dewandre py. preeclampsia: an update. acta anaesthesiol belg. 2014; 65(4): 137-49. pmid: 25622379. 7. steegers ea, von dadelszen p, duvekot jj, pijnenborg r. pre-eclampsia. lancet 2010 aug 21; 376(9741): 631-44. doi: 10.1016/s01406736(10)60279-6. epub 2010 jul 2. pmid: 20598363. 8. arulkumaran n, lightstone l. severe preeclampsia and hypertensive crises. best practice & research clinical obstetrics and gynaecology 2013 december; 27 (6): 877–84. 9. ebeigbe pn. inadequacy of dipstick proteinuria in hypertensive pregnancy: evidence for a change to alternatives. niger postgrad med j 2009; 16(1): 46-9. 10. rabiee s. comparison of predictive value of 8, 12 and 24-hour proteinuria in preeclampsia. pak j med sci 2007 april; 23(2): 182-184. . 11. somanathan n, farrell t, galinberti a. a comparison between 24hours and 2-hour urine collections for the determination of proteinuria. j. obstet gynecol 2003; 23(4): 378-80. 12. weerasekera ds, peiris h. the significance of serum uric acid creatinine and urinary microprotein levels in predicting preeclampsia. j. obstet gynecol 2003; 23 (1):17-19. 13. adelberg am, miller j, doerzbacher m, lamber ds. correlation of quantitative protein measurement in 8-, 12-, and 24-hour urine samples for the diagnosis of preeclampsia. am j. obstet gynecol. 2001; 185(4): 804-7. 14. wongkitisophon k, phopong v, yamasmit w, pansin p, tanniraandorn y. correlation of 4 and 24-hour urine protein in women with initially diagnosed hypertensive disorder in pregnancy. j med assoc thai 2003; 86(6): 529-34. 15. keiler h, zettergren t, svenson h, dickman pw, larsson a. assessing urinary albumin excretion in preeclamptic women: which sample to use? briti j obs gynae 2003;110(1):12-17. doi.org/10.1046/j.1471-0528.2003.01440.x. 16. salako bl, olayemi o, odukogbe at, et al. micro albuminuria in pregnancy as a predictor of preeclampsia and eclampsia. west afri j med 2003; 22(4): 295-300. 17. adekanle da, akinbile to eclampsia and pregnancy outcome at lautech teaching hospital, osogbo south west nigeria. clinics in mother and child health 2012: 9;1-4. 18. sami w, alrukban mo, waqas t, asad mr, afzal k. sample size determination in health research. j ayub med coll abbottabad. 2018 apr-jun;30(2):308-311. pmid: 29938444 19. hofmeyr gj, belfort m. proteinuria as a predictor of complications of pre-eclampsia. bmc med. 2009; 7:11. 20.rinehart bk, terrone da, larmon je, perry kg jr, martin rw, martin jn jr. a 12 hour urine collection accurately assesses proteinuria in hospitalized hypertensive gravida. j. perinatol. 1999; 19:556–8. 21.tara f, mansouri a, ravanabakhsh f, tahersima z. using 2-hour/ 6 hour urine protein measurement as substitute diagnostic method for evaluation of preeclampsia. int j obstet gynecol. 2008; 10:1–7. 22. bartal mf, lindheimer md, sibai bm. proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. am. j. obstet gynaecol. 2020. doi:https://doi.org/10.1016/j.ajog.2020.08.108 23. tun c, quiñones jn, kurt a, smulian jc, rochon m. comparison of 12-hour urine protein and protein:creatinine ratio with 24-hour urine protein for the diagnosis of preeclampsia. am j obstet gynecol. 2012 sep;207(3):233.e1-8. doi: 10.1016/j.ajog.2012.06.010. epub 2012 jun 11. pmid: 22939731. 24. price cp, newall rg, boyd jc. use of protein:creatinine measurement on random urine samples for prediction of significant proteinuria: a systematic review. clin chem 2005; 51:1577–86. 25. boler l, zbella ea, glricher n. quantitiation of proteinuria in pregnancy by the use of single voided urine samples. obstet gynecol. 1987; 70: 99–100 res. j. health sci. vol 11(3), september 2023 250 a correlation of 8-hours and 12-hours with 24-hours urinary protein akindele et al. res. j. health sci. vol 11(3), september 2023 251 table 1: the admission characteristics of participants variables frequency percent (%) parity 0 1 2 3 4 5 total 24 12 7 5 3 1 100 46.15 23.08 13.46 9.62 5.77 1.92 100.00 age group(years) <=20 >20-35 >35 total 2 37 13 52 3.85 71.16 24.99 100.00 previous preeclampsia/eclampsia no yes total 45 7 52 86.54 13.46 100.00 figure 1: scatter diagram showing correlation of 8-hour with 24hour urinary protein values. correlation coefficient r^2 = 0.65coefficient of determination r = 0.81 a correlation of 8-hours and 12-hours with 24-hours urinary protein akindele et al. res. j. health sci. vol 11(3), september 2023 252 figure 2: scatter diagram showing correlation of 12-hour with 24hour urinary protein values. correlation coefficient r^2 = 0.67coefficient of determination r = 0.82 figure 3: the roc curve of 8-hour urine samples. a correlation of 8-hours and 12-hours with 24-hours urinary protein akindele et al. res. j. health sci. vol 11(3), september 2023 253 figure 4: the roc curve of 12-hour urine samples. a correlation of 8-hours and 12-hours with 24-hours urinary protein akindele et al. rjhs 11(2).cdr antimicrobial, phytochemical and pharmacological properties of phyllanthus niruri linn 1 2 3 *oyekanmi, b. a. , osho, i. b. , kolawole j. c. abstract introduction: phyllanthus niruri is a common herb widely used in home remedies against infectious agents. this study unveils the antimicrobial and therapeutic potentials of p. niruri against escherichia coli infection. methods: ethanol and water extracts of the plant were prepared and investigated for their antimicrobial activity using the agar well diffusion method against eleven clinical isolates. the in vivo study was conducted on albino rats, infected and subsequently treated. results: the observation showed ciprofloxacin with the highest (41 mm) sensitivity against p. mirabilis; and lowest (20 mm) against s. flexneri, e. coli, k. pneumoniae, and s. aureus. ketoconazole at 100 mg/ml concentration revealed antifungal sensitivity ranging from 2 to 15 mm. the extracts showed better sensitivity against the bacteria (2 to 24) mm when compared with the fungi species (2 to 12 mm). phyllanthus niruri extract demonstrated a minimum inhibitory concentration of 25 to 100 mg/ml the albino rats of weight ranging from 83 to 105 g were administered with p. niruri ethanol extract but indicated no toxicity at 1500 mg dose. the packed cell volume, red cell count, total leucocyte count, and serum enzymes of the tested rats were within the normal range. the healing effect was dose-dependence and most effective from 1200 mg/kg to 1500 mg/kg body weight. p. niruri extract produced some level of antimicrobial activity both in vitro and in vivo. conclusion: extract from phyllanthus niruri is effective in vitro and in vivo against escherichia coli infection. it has no ill effect on the blood circulatory system, liver, and kidney. the bioactive agent present in the extract has proven health benefits, and can be administered as supplement. however, more studies on its chronic toxicity are required. *corresponding author oyekanmi, b.a. email: bolapeoyekanmi@yahoo.com 1 department of medical laboratory science, adeleke university, ede, nigeria 2 department of animal production and health, federal university of technology, akure, nigeria. 3 department of biochemistry, obafemi awolowo university, ileife, nigeria received: september 7, 2022 accepted: february 12, 2023 published: june 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 108 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.4 propriétés antimicrobiennes, phytochimiques et pharmacologiques du phyllanthusniruri linn 1 2 3 *oyekanmi, b. a. , osho, i. b. , kolawole j. c. résumé objectif de l'étude: foyer contre les agents infectieux. cette étude dévoile les potentiels antimicrobiens et thérapeutiques de p. niruri contre l'infection à escherichia coli. méthode de l'étude: des extraits d'éthanol et d'eau de la plante ont été préparés et étudiés pour leur activité antimicrobienne en utilisant la méthode de diffusion en puits d'agar contre onze isolats cliniques. l'étude in vivo a été menée sur des rats albinos, infectés puis traités. résultat de l'étude: l'observation a montré la ciprofloxacine avec la sensibilité la plus élevée (41 mm) contre p. mirabilis ; et le plus bas (20 mm) contre s. flexneri , e. coli, k. pneumoniae et s. aureus . le kétoconazole à une concentration de 100 mg/ml a révélé une sensibilité antifongique allant de 2 à 15 mm. les extraits ont montré une meilleure sensibilité contre les bactéries (2 à 24) mm par rapport aux espèces de champignons (2 à 12 mm). l'extrait de phyllanthusniruri a démontré une concentration minimale inhibitrice de 25 à 100 mg/ml. les rats albinos de poids allant de 83 à 105 g ont reçu de l'extrait d'éthanol de p. niruri mais n'ont indiqué aucune toxicité à la dose de 1500 mg. l'hématocrite, le nombre de globules rouges, le nombre total de leucocytes et les enzymes sériques des rats testés se situaient dans la plage normale. l'effet curatif était dose-dépendant et le plus efficace de 1200 mg/kg à 1500 mg/kg de poids corporel. l'extrait de p. niruri a produit un certain niveau d'activité antimicrobienne à la fois in vitro et in vivo. l'agent bioactif présent dans l'extrait a des effets bénéfiques prouvés sur la santé et peut être administré en complément. déclaration importante : l'extrait de phyllanthusniruri est efficace in vitro et in vivo contre l'infection par escherichia coli. il n'a aucun effet néfaste sur le système circulatoire sanguin, le foie et les reins. cependant, d'autres études sur sa toxicité chronique sont nécessaires. received: september 7, 2022 accepted: february 12, 2023 published: june 30, 2023 phyllanthusniruri est une herbe commune largement utilisée dans les remèdes de *corresponding author oyekanmi, b.a. email: bolapeoyekanmi@yahoo.com 1 department of medical laboratory science, adeleke university, ede, nigeria 2 department of animal production and health, federal university of technology, akure, nigeria. 3 department of biochemistry, obafemi awolowo university, ileife, nigeria article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 109 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.4 introduction complications due to drug-resistant and epidemics caused by microbial organisms of unknown origins such as bacteria are still a leading cause of death worldwide. the situation has called for improved strategies and has led to the continuous search for antimicrobials and drug development from natural sources. this approach will enhance the treatment and prevention of lifethreatening diseases (1). assessment of plants for their healing potentials and toxicology could give knowledge and data of how plants and their extracts can be of maximal benefit for the treatment. some researchers have reported the usefulness of some phyllanthus species in medicine. phyllanthus contains secondary metabolites that have been employed in traditional cures (2, 3). phyllantin, flavonoids, alkaloids, tannins, terpenes, and sterols are some of the biochemical components inherent in phyllanthus. extracts from this herb possess antiviral and anti-hypertensive action (4). phyllanthus niruri l. (euphorbiaceae) is known for its ability to protect the liver (5). the a n t i m i c r o b i a l p r o p e r t i e s a n d o t h e r pharmaceutical principles have not been fully exhausted. this study evaluates the antibacterial, antifungal, and therapeutic effects of the plant ag ain s t es ch er ich ia co li. th er ef o r e th e worldwide use of phyllanthus demands the need to estimate the pharmacological efficacy and safety of the extract. materials and methods source of test organisms clinical isolates were obtained from the microbiology department of ladoke akintola university of technology teaching hospital, osogbo. each microbial isolate was confirmed using cultural characteristics and standard biochemical tests. the bacterial isolates were staphylococcus aureus, salmonella typhimirum, escherichia coli, shigella flexneri, pseudomonas aeruginosa, proteus mirabilis, klebsiella pneumoniae, and streptococcus viridian. the fungi isolates were candida albicans, aspergillus flavus, and aspergillus niger. preparation of extracts from p. niruri fresh plant was harvested from various places in osogbo, south west nigeria. a fresh sample of the plant was identified and authenticated by a botanist at the botany department, ife herbarium, obafemi awolowo university, ile-ife, osun state (herbarium number: ife 17292). the whole plant including the stem, root, leaves together with the seeds were o carefully picked, washed and air dried at 28 c. aqueous and ethanol extract of the whole plant was obtained using the cold extraction method at ratio 1: 10 of ground powder to extracting o solution. it was soaked for 48 h at 28 c. the supernatant was filtered using muslin cloth and filtrate concentrated in vacuo in a rotary evaporator, then evaporated to dryness in a clean o laboratory oven at 40 c. e v a l u a t i o n o f e x t r a c t s f o r i n v i t r o antimicrobial potentials agar plate well diffusion method described by mounyret al., (6) was employed to evaluate the antibacterial assay, minimum inhibitory concentration (mic) and minimum bactericidal concentration (mbc) of the extracts. five micrograms (5µg) ciprofloxacin and 100 mg/l ketoconazole were used as control for antibacterial and antifungal respectively. analysis of phytochemicals inherent in the extracts ethanol and water extracts of p. niruri were analyzed for their phytochemicals: cardiac glycosides, steroids, tannins, flavonoids, and terpenes (7, 8). e v a l u a t i o n o f e x t r a c t s f o r i n v i t r o antimicrobial potentials the agar plate well diffusion method (6) was employed to evaluate the plant extracts for antibacterial assay. minimum inhibitory concentration (mic) and mbc of ethanol extract were also determined as described by mounyr et al. (6). standard antibacterial and antifungal used were 5µg ciprofloxacin and 100 mg/ml ketoconazole respectively. handling of animals and experimental design thirty (30) healthy wistar albino rats of weight 82.0 g to 92.2 g were purchased from the animal house of the college of health sciences, obafemi awolowo university, ileife, osun state in nigeria. the animals were housed in plastic cages and fed with commercially produced standard rat pellets once a day and clean drinking water. the beddings were laid with wood powder and changed daily, feeding utensils, troughs, and the environment were maintained clean. the room temperature was at o 25 c and the light was 12 h light and 12 h darkness. animal maintenance and handling were humane and followed the national institute of health (nih) animal care guidelines (9). res. j. health sci. vol 11(2), june 2023 110 antimicrobial and therapeutic properties of p. niruri oyekanmi et al. the experiment was conducted in a completely randomized design (crd). the wistar rats were distributed into 6 groups (n = 5) with an equal number of sexes in each group, and the sample size was determined in advance. they were allowed to acclimatize in 7 days before the commencement of the experiment. group ci n was the normal control, not inoculated, and received feed and clean water. group cii p was a positive control, inoculated and administered with a standard antibacterial (ciprofloxacin) group 2 to group 5 were inoculated and administered with 300 mg, 600 mg, 1200 mg, and 1500 mg doses of p. niruri ethanol extract respectively. the extract was administered via oral route. inoculation and evaluation of graded doses of p. niruri ethanol extract on albino rats. escherichia coli obtained from the clinical sample was inoculated into physiological o saline. the suspension was incubated at 37 c for 24 h to obtain a bacterial suspension equivalent to 6 1 × 10 cfu. a 0.30 ml of the actively growing bacterial suspension was administered via an oral route. studies showed that ld50 of ethanol extract of p. niruri is greater than 5 kg per body weight (10) after 3 days, groups 2 to 5 were administered with a graded dose of p. niruri ethanol extract (300, 600, 1200, and 1500 mg/kg body weight) respectively for 14 days. a ciprofloxacin (cip) tablet, (brand: fidson) was obtained from a registered pharmaceutical shop. a sterile suspension of 1.34 mg/ml cip was prepared and administered to the positive control group for 7 days. microbiological culture of faecal sample obtained from the rats. the faecal sample of the rats was collected in a clean universal bottle after three days of bacterial inoculation, 7 days and 14 days of administration of the ethanol extract. the aseptic condition was maintained throughout the experiment. a 0.5 g of the stool sample was o inoculated in selenite f, incubated at 37 c for 24 h then subcultured on macconkey and eosin methylene blue agar using standard operating procedures (11). biochemical and haematological analysis of blood samples obtained from the treated rats the wistar rats were starved for 12 h, sacrificed by the cervical dislocation method, and blood was withdrawn from the heart under an aseptic condition. the needle was removed and blood was released in a clean dry plain bottle and an edta (ethylene diaminetetraacetic acid) bottle. the blood sample in a clean dry plain bottle was allowed to clot and spun at 3000 rpm for 10 minutes. the serum was obtained, labelled, and used to conduct biochemical analysis for aspartate aminotransferase (ast), alanine aminotransferase (alt), alkaline phosphatase (alp), and creatinine using enzyme maker kits from randox (11). the blood sample released in an ethylene diaminetetraacetic acid (edta) bottle was gently mixed on a haematology roller and analysed for packed cell volume (pcv), leucocyte total count, leucocyte differential count, neutrophil (n), lymphocyte (l), eosinophil (e), monocyte (m), and basophil (b) in percentage as described by cheesebrough (11). statistical data the results of replicates were pooled and expressed as mean ± standard error of mean. data obtained were subjected to a two-way analysis of variance and treatment means were compared using duncan's new multiple-range tests with the aid of statistical package for social sciences (spss) software, version 17. differences between treated groups were considered significant at p ≤ 0.05. results the aqueous and ethanol extracts of phyllanthus niruri were bitter and acidic with a ph of 6. quantitatively ethanol extract of phyllanthus niruri revealed cardiac glycosides as the highest phytochemical compound, followed by steroids, tannin, flavonoids, and terpenes in decreasing order. (table 1) in the aqueous extract cardiac glycosides was also of the highest concentration, followed by flavonoids, then tannins in decreasing order and the least was steroid; terpenes were not present. in table 2, the standard antibiotics (5 µg ciprofloxacin) showed antibacterial activity with an inhibitory zone ranging from 20 to 41 mm and no significant resistance against p. aerugenosa. aqueous extract of p. niruri.demonstrated a zone of inhibition ranging from 2 to 18 mm and no resistance to s. viridian and p. aerugenosa (table 2). the ethanol extract of p. niruri showed an inhibitory zone ranging from 2 to 24 mm but no significant resistance against s. viridian only (table 2). the ethanol extract of p. niruri. demonstrated better antibacterial resistance when compared with the aqueous extract p ≤ 0.05. table 3 showed the highest antifungal activity in 100 mg/ml ketoconazole with the zone res. j. health sci. vol 11(2), june 2023 111 antimicrobial and therapeutic properties of p. niruri oyekanmi et al. of inhibition ranging from 2 to 15 mm. aqueous extract of p. niruri demonstrated antifungal sensitivity ranging from 2 to 12 mm while ethanol extract showed no significant antifungal sensitivity to any of the fungal isolates (table 3). the ethanol extract of p. niruri showed mic of 25 to 100 mg/ml and mmc (minimum microbicidal concentration) of 30 to 160 mg/ml. the minimum inhibitory concentration demonstrated against a. flavus and a. niger were 50 and 100 mg/ml respectively while their minimum fungicidal concentration (mfc) was zero. in vivo testing was conducted on wistar rats and table 4 showed reduced activity and rough fur after three days (day 9) of exposure to e. coli infection; followed by improved activity and appetite for food from day 16 to day 23. the normal and positive control, groups 4 and 5 demonstrated a scanty growth while groups 2 and 3 showed a significant growth on day 23 (table 5). the susceptibility of e. coli to the extract was dose-dependent. the haematology parameters of the experimental animals revealed no significant variation in the packed cell volume, red cell count, leucocyte count, lymphocyte, eosinophil, monocyte, and basophil p ≤ 0.05 (table 6). lymphocyte was of a higher percentage than neutrophil in test and control, the exception was group 4. the positive control showed the lowest values of the alp, alt, and creatinine (45.33±3.48 µ/l, 28±6.56 µ/l, 88±7 µmol/l); the negative control displayed the highest creatinine level (table 7). in the test groups, the alp, alt, and ast were at the least concentration in group 5. however, there was no statistical difference between the test and controls p ≤ 0.05 discussion extracts of phyllanthus is extensively used in traditional medicine and was reported to have antibacterial and antiviral activity (12). ethanol is revealed as a better extractive solvent of its phytochemicals for better yield of the biochemical compounds. this is because ethanol is generally able to dissolve multivariable types of compounds (13). tannins, an effective compound present in moderate amount in p. niruri. are known antimicrobial biomolecules (14). flavonoids are antioxidant and possess the ability to complex with bacteria cell wall (15). moreover, cardiac glycosides has some beneficiary effects but are toxic at a high level (16). terpenes, has lipophylic character and are active against a wide variety of microorganisms (17) while steroids have antiinflammatory action. the results of this study corroborate previous workers' findings that the plant contains antimicrobial substances (18). phyllanthus niruri is a source of bioactive substances of broad-spectrum activity because of its sensitivity against both bacteria and fungi. however, the bioactive compounds are more active against gramnegative than grampositive bacteria as the aqueous extract of the plant showed (zone of inhibition) the result supports the findings of komuraiah et al., (19) who reported phyllanthus amarus is an effective inhibitor of both gramnegativeand gram positive bacteria. the better sensitivity of the plant extract against gramnegative species could be due to the thin peptidoglycan layer of gramnegative bacteria that is more permeable to antibacterial (20). the fungi species used in this study showed 33.3 % sensitivity to the aqueous extract of p. niruri l. at z inhibition ≥ 10 indicating that the bioactive agents in the extract were relatively more effective against the bacterial species than the fungal species. the low mic and mbc obtained are indications of its potency against bacterial infections however, the zero minimum fungicidal concentration (mfc) of p. niruri against aspergillus species is suggestive of 100 % resistance which means when subjected to favorable conditions the fungi could thrive and replicate. in the in vivo studies, the initial reduction in the average body weight was due to the escherichia coli (e. coli) infection in the rats. a prominent symptom of e. coli infection is frequent passage of stool which oftentimes leads to a drop in body weight. the improvement in the weight of the wistar albino rats after treatment indicates increased feed conversion efficiency (fce). this development could be the result of recovery from the infection arising from restoration of the physiological activities of the rat system. the improvement in the health status of the rats could also be traced to the fact that chemical and biochemical constituents of plants which include carbohydrates, vitamins, protein, alkaloid, fats and oil and minerals might supply the body cells with energy and replace wornout tissues. the bioactive agents present in p. niruri proved effective in vitro and in vivo against e. coli infection. the weight gain of the rats reduced as the dose increased. this indicates that irrational consumption of the plant could be potentially res. j. health sci. vol 11(2), june 2023 112 antimicrobial and therapeutic properties of p. niruri oyekanmi et al. res. j. health sci. vol 11(2), june 2023 113 harmful. the bacterial load of e. coli in the test animals reduced gradually as the doses administered increased and after two weeks of treatment with the extract (1200 mg to 1500 mg) the bacterial count became insignificant. red blood cell count (rbc) and packed cell volume (pcv) which are important parameter for blood health status is indicative of normal erythropoiesis. flavonoids, an essential compound present in p. niruri l. are an antioxidant element that ensures healthy blood circulation, strengthens the capillary wall and reduces blood cholesterol level. the blood leucocytes are the body soldiers that are involved in eliciting an immune response against the infectious agent. leucocytes were within the normal range in the test animal, likewise neutrophil which indicates that the infection was inhibited as a measure of liver function test, the ast (aspartate amino transaminase), alt (alanine amino transaminase), and alp (alkaline phosphatase) were assessed in p. niruri treated rats. an elevation of these enzymes is suggestive of liver damage (21). the administration of p. niruri caused a decline in the liver enzymes. this suggests that p. niruri may hold a positive impact on the liver cells and this corroborates the holdings of verma et al., (22) who recorded that the extract of p. niruri is hepatoprotective. serum urea and creatinine are labels of renal positions. high creatinine level is a pointer of impairment in renal filtration but low throughout the treatments. howbeit, eweka and enogieru (23) noted some necrosis in the anatomical structures of the gastro intestinal tract (git) following 28 days of oral administration of p. amarus. the variation observed in the result may be due to differences in the duration of administering the extract. conclusion in conclusion, phyllanthus niruri has potent bioactive compounds against escherichia coli infection. the administration of this extract up to 1500 mg dose has no deleterious effect on the liver and the kidney however, exploratory studies on p. niruri is required to determine the active compound (s) responsible for the antimicrobial effect demonstrated and evaluate its toxicity profile. conflict of interest: the authors state no conflict of interest references 1 andersson ja, fitts ec, kirtley ml, pannusamy d, peniche ag, dann sm, new role for fdaapproved drugs in combating antibiotic-resistant b a c t e r i a . a n t i m i c r o b i a l a g e n t s a n d chemotherapy, 2016,aac.00326-16 doi: 10.1128/aac.0032616. 2 nisar mf, he j, ahmed a, yang y, li m, wan c. chemical components and biological activities of the genus phyllamthus: a review of the recent literature. molecules, 2018, 23: 2567, doi 3390. 3 cui q, du r, liu m, rong l. lignans and their derivatives from plants as antivirals. molecules, 2 0 2 0 , 2 5 ( 1 ) 1 8 3 . d o i : 1 0 . 3 3 9 0 / molecules25010183. 4 patel jr, tripathi p, sharma v, 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ragan a, raju vs, singaracharya ma. antibacterial studies and phytochemical constituents of south indian phyllanthusspecies.afr j biotechnol 2009, 8 (19): 4991-4995. 20 j a w e t z , m e l n i c , a d e l b e r g ' s . m e d i c a l t h microbiology 25 edition mcgraw hill lange,2010; p. 814. 21 murayama h, ikemoto m, fukuda y, isunekana s, nagata a. advantage of serum type l arginase and omithinecarbamoyltransferase in the evaluation of acute and chronic liver damage induced by thioacetanide in rats. clinica chimica acta, 2007 375: 6368. 22 verma s, sharma h, garg m. phyllanthus amarus: a review. j pharmacognphytochem, 2014, 3 (2):18-22. 23 eweka ao,enogieru a. effects of oral administration of phyllanthus amarus leaf extract on the kidneys of adult wistar ratsa histological study. afr. j. tradit. complement altern med, 2011, 8 (3): 307–311. res. j. health sci. vol 11(2), june 2023 114 antimicrobial and therapeutic properties of p. niruri oyekanmi et al. res. j. health sci. vol 11(2), june 2023 115 table 1: quantitative analysis of the phytochemical constituents of aqueous and ethanol extracts of p. niruri. key: values are means ± standard error of mean of 2 replicates of the phytochemical constituents. means with different superscript on the same row is significant phytochemicals aqueous extract (mg/g) ethanol extract (mg/g) tannins 11.30±0.02 a 13.49±0.05 b flavonoids 11.59±0.04 a 12.60±0.01 a steroid 8.08±0.30 a 15.01±0.01 b terpenes 0.00±0.00 a 10.68±0.01 b cardiac glycosides 25.45±0.02 a 26.46±0.33 b antimicrobial and therapeutic properties of p. niruri oyekanmi et al. res. j. health sci. vol 11(2), june 2023 116 table 3: antifungal activity of aqueous and ethanol extracts of p. niruri . antimicrobials (mg/ml) /zi(mm) a. flavus a. niger c. albicans ae30 02.00±0.00b 07.67±0.00c 00.00±0.00a ae50 12.00±0.00d 08.00±0.00d 02.00±0.00b ae100 00.00±0.00a 08.00±0.00d 08.00±0.00c ee30 00.00±0.00a 00.00±0.00a 00.00±0.00a ee50 00.00±0.00a 00.00±0.00a 00.00±0.00a ee100 00.00±0.00a 00.00±0.00a 00.00±0.00a c1n 00.00±0.00a 00.00±0.00a 00.00±0.00a ciip 06.00±0.00c 02.00±0.00b 15.00±0.00d key: values are the means ± standard error of means of the 3 replicates of the zone of inhibition. means with different superscript on the same vertical column is significant p = 0.05; zi = zone of inhibition; ae30 – aqueous extract at 30 mg/ml; ae50= aqueous extract at 50 mg/ml; ae100= aqueous extract at 100 mg/ml; ee30 ethanol extract at 30 mg/ml; ee50= ethanol extract at 50 mg/ml; ee100= ethanol extract at 100 mg/ml; c 1n – negative control; c 11p positive control table 4: clinical appearance of infected albino rat during treatment days ci n cii p g2 g3 g4 g5 d 6 fine fur; very active fine fur; very active fine fur; very active fine fur; very active fine fur; very active fine fur; very active d 9 fine fur; very active activity reduced; rough fur activity reduced; rough fur activity reduced; rough fur activity reduced; rough fur activity reduced; rough fur d 16 fine fur; very active very active; few insects the cage activity improved slightly; wet faeces activity improved; wet faeces activity improved; wet faeces activity improved; wet faeces d 23 fine fur; very active active; improved fur increased appetite for food increased appetite for food increased appetite for food increased appetite for food key:ci n = normal control, cii p = positive control, g2 = group 2, administered with 300 mg extract, g3 = group 3, administered with 600 mg extract, g4 = group 4, administered with 1200 mg extract, g5 = group 5, administered with 1500 mg extract table 5: effect of phyllanthusniruri on escherichia coli key: ± scanty growth; + few growth; ++ moderate growth; +++ heavy growth, g2 = group 2, administered with 300 mg extract, g3 = group 3, administered with 600 mg extract, g4 = group 4, administered with 1200 mg extract, g5 = group 5, administered with 1500 mg extract day normal control positive control g2 g3 g4 g5 9 ± +++ +++ +++ +++ +++ 16 ± ± +++ ++ ++ + 23 ± ± ++ + ± ± antimicrobial and therapeutic properties of p. niruri oyekanmi et al. res. j. health sci. vol 11(2), june 2023 117 antimicrobial and therapeutic properties of p. niruri oyekanmi et al. res. j. health sci. vol 11(2), june 2023 118 table 7: effect of ethanol extract on biochemical parameters of wistar albino rat key: values are the means ± standard error of means of 5 replicates of the biochemical parameters evaluated. means with different superscript on the same vertical column is significant p = 0.05; sex male and female; alp alkaline phosphatase; alt = alanine aminotransaminase; ast = aspartate aminotransaminase; control i n – normal control; control ii p – positive control; g2 = group 2, administered with 300 mg extract, g3 = group 3, administered with 600 mg extract, g4 = group 4, administered with 1200 mg extract, g5 = group 5, administered with 1500 mg extract sex alp µ/l alt µ/l ast µ/l creatµ mol/l control 1 n 1.00±0.00a 98.00±25.16a 58.00±15.95a 177.33±54.82a 158.00±36.51a control 11 p 1.60±0.25 a 45.33±3.48a 28.00±6.56a 128.67±30.18a 88.00±7.00a g 2 300 mg 1.50±0.29 a 88.75±24.56a 62.00±16.53a 184.00±59.23a 118.50±31.52a g 3 600 mg 1.25±0.25 a 82.00±43.00a 59.00±29.00a 187.00±83.00 a 129.00±72.0a g 4 1200 mg 1.75±0.25 a 59.67±13.17a 34.67±8.82a 108.00±12.81 a 99.00±13.75a g 5 1500 mg 1.50±0.25 a 46.33±0.33a 28.33±4.70a 95.00±17.94 a 104.00±8.19a antimicrobial and therapeutic properties of p. niruri oyekanmi et al. rjhs 11(2).cdr external fixators usage in two hospitals in delta state south-south nigeria 1 1 1 2 3 *odatuwa-omagbemi d.o. enemudo r.e.t. , otene c.i. , imonijevwe e.s. , ajise f. , 3 2 2 maduka c.o. , uyebi p. , ekpekpe m.d. abstract objective: to present our experience in the use of various types of external fixators in two government owned hospitals in delta state, nigeria. methods: a retrospective review of patients managed with external fixators over a period of 8 years – january 2012 to december 2019, in two government owned hospitals in delta state, nigeria. relevant information including bio-data, indications for external fixation, types of external fixator applied, length of time fixators were applied, etc were collected and analysed using ibm spss version 22. results: a total of 94 patients (56 males and 38 females) were included in this study giving a male: female ratio of 1.5 : 1. the mean age of patients was 33.7+ 15.9 years. four types / designs of external fixators were used, the mono-planar ao design were the ones most commonly used (67.7%), followed by the linear rail system (lrs) type (17.2%). the most common indication for external fixator application was open fractures in 67.7% of cases, followed by bone gaps resulting from bone loss (11.1%). external fixators were used as adjunct to other treatment modalities in 59 applications (59.6%) and as the definitive treatment method in 40 applications (40.4%). the commonest solution used for pin site care was povidone iodine in 53 patients (56.4%). the mean length of time patients were on external fixators was 124.8 days (17.8 weeks). pin tract infection was the commonest complication encountered (26.6%). the commonest indication for removal of external fixators was the healing of the wounds in open fractures with conversion to other forms of treatment, commonly cast application (42.6%). the initial aim of applying the external fixator was achieved in 75% of cases. conclusion: external fixators have become indispensable tools in the armamentarium of modern day orthopaedic and trauma care. our health facilities have also effectively keyed into this. key words: external fixators, indications, open fractures, pin tract infection. *corresponding author dr. odatuwa-omagbemi, d.o. e-mail : odatuwa@live.com 1 department of surgery, delta state university, abraka. nigeria. 2 department of orthopaedics and traumatology, delta state university teaching hospital, oghara, delta state. nigeria. 3 department of orthopaedics, federal medical centre, asaba, delta state. nigeria. received: january 21, 2023 accepted: may 11, 2023 published: june 30, 2023 res. j. health sci. vol 11(2), june 2023 169 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.10 original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 170 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.10 article original research journal of health sciences utilisation de fixateurs externes dans deux hôpitaux de l'état de delta au sud-sud du nigéria 1 1 1 2 3 *odatuwa-omagbemi d.o. enemudo r.e.t. , otene c.i. , imonijevwe e.s. , ajise f. , 3 2 2 maduka c.o. , uyebi p. , ekpekpe m.d. résumé objectif de l'étude : présenter notre expérience dans l'utilisation de différents types de fixateurs externes dans deux hôpitaux publics de l'état du delta, au nigéria. méthode de l'étude : une revue rétrospective de patients pris en charge avec des fixateurs externes sur une période de 8 ans de janvier 2012 à décembre 2019, dans deux hôpitaux publics de l'état du delta, au nigéria. les informations pertinentes, y compris les données biologiques, les indications de fixation externe, les types de fixateurs externes appliqués, la durée d'application des fixateurs, etc. ont été collectées et analysées à l'aide d'ibm spss version 22. résultat de l'étude : un total de 94 patients (56 hommes et 38 femmes) ont été inclus dans cette étude soit un ratio hommes/femmes de 1,5 : 1. l'âge moyen des patients était de 33,7 + 15,9 ans. quatre types/modèles de fixateurs externes ont été utilisés, le modèle ao monoplanaire étant le plus couramment utilisé (67,7 %), suivi du type à système de rail linéaire (lrs) (17,2 %). l'indication la plus fréquente pour l'application d'un fixateur externe était les fractures ouvertes dans 67,7 % des cas, suivies des lacunes osseuses résultant de la perte osseuse (11,1%). les fixateurs externes ont été utilisés en complément d'autres modalités de traitement dans 59 applications (59,6 %) et comme méthode de traitement définitive dans 40 applications (40,4 %). la solution la plus couramment utilisée pour les soins du site de la broche était la povidone iodée chez 53 patients (56,4 %). la durée moyenne de présence des patients sous fixateurs externes était de 124,8 jours (17,8 semaines). l'infection du tractus pin était la complication la plus fréquemment rencontrée (26,6 %). l'indication la plus courante pour le retrait des fixateurs externes était la cicatrisation des plaies dans les fractures ouvertes avec conversion vers d'autres formes de traitement, généralement l'application d'un plâtre (42,6 %). l'objectif initial de pose du fixateur externe a été atteint dans 75 % des cas. conclusion : les fixateurs externes sont devenus des outils indispensables dans l'arsenal des soins orthopédiques et traumatologiques modernes. nos établissements de santé s'y sont également bien intégrés. mots-clés : fixateurs externes, indications, fractures ouvertes, pin-infection des voies. *corresponding author dr. odatuwa-omagbemi, d.o. e-mail : odatuwa@live.com 1 department of surgery, delta state university, abraka. nigeria. 2 department of orthopaedics and traumatology, delta state university teaching hospital, oghara, delta state. nigeria. 3 department of orthopaedics, federal medical centre, asaba, delta state. nigeria. received: january 21, 2023 accepted: may 11, 2023 published: june 30, 2023 introduction an external fixator is a device placed outside the skin which stabilizes bone fragments through pins and wires connected to one or more longitudinal bars / tubes. fractures are stabilized by connecting pins / wires that transfix bone fragments to external bars or frames (1,2,3,4). the use of external fixation in fracture treatment dates back to the time of hippocrates, several years bc. (3,5,6). in 1853 malgaigne described / applied a claw like external fixator he used to immobilize and compress fragments of a patella fracture (5,7). though, external fixators usage for various musculoskeletal conditions became popular in the 1950s, its usage in orthopaedic practice in nigeria started in the early 1980s (8). the designs and uses of external fixators in orthopaedics and in trauma has evolved and multiplied over the years. various designs of the linear type with distraction and compression components including the “linear rail system (lrs), circular types including the ilizarov” and “taylor spatial frame (tsf), and hybrid designs that incorporate both linear and circular components are now in use for a variety of indications (1,5,7,9). the indications for use of these variety of external fixators designs have also multiplied ranging from open fractures to infected fractures, peri-articfular fractures, pelvic fractures, damage control orthopaedics, temporary fixation of fractures for later conversion to internal fixation, limb deformity correction, limb lengthening, management of bone loss, etc (5,6,8,10-18). to the best of our knowledge, a study on the clinical use of external fixators has not been done in delta state to contribute to the literature on local experience in nigeria. the aim of this study is to present our clinical experience with the use of the different of types of external fixators in two government owned health facilities in delta state, nigeria. federal medical, asaba (one of the hospitals where this study took place) is a 320 bed hospital owned by the federal government of nigeria. the second hospital, delta state university teaching hospital, oghara, delta state, nigeria is a 260 bed tertiary health facility owned by the delta state government, in nigeria. materials and methods this was a retrospective analysis of patients who were managed with musculoskeletal external fixation for various indications over a period of 8 years (january 2012 to december 2019) in two hospitals in delta state, nigeria. the hospitals were the delta state university teaching hospital, oghara (owned by delta state government) and the federal medical centre, asaba (owned by the federal government of nigeria). ethical clearance was obtained from the health research ethics committee of the delta state university teaching hospital, oghara, delta state, nigeria. a form purpose-designed by the lead author was used to gather relevant data by resident doctors in the orthopaedics departments of the two hospitals from patients' case notes, theatre and ward records. these included information on patients' bio-data, indications and types of external fixators applied, duration of hospital stay, length of time fixators were applied, complications, indications for removal / outcome and follow-up. patients whose case notes could not be located and those with incomplete information in their case notes were excluded from the study. data were collated and analysed with ibm spss version 22 and presented in form of tables, charts, frequencies, percentages, ratios, means, median and standard deviation. results a total of 94 patients were included in this study, made up of 56 males (59.6%) and 38 females (40.4%) giving a male: female ratio of about 1.5:1. fifty eight of the patients (61.7%) were from the delta state university teaching hospital, oghara, while the remaining 36 patients (38.3%) were from the federal medical centre asaba. the average age of the patients was 33.7+15.9 (range = 6 to 80 years). median age was 32 years. the most frequently affected age group fell between ages 20 and 40 years (54.26%). (table 1). most of the patients were married (51%) – table 1. twenty eight patients (29.8%) had tertiary education. traders were the occupational group most frequently treated with external fixators. table 1. four types of external fixators were used in the two hospitals during the study period. the most commonly used type was the linear ao type 67.7% of times (figure 1). external fixators were applied 99 times in 94 patients 3 patients had more than 1 fracture that needed external fixation while another 2 had exchanges of the linear ao type of fixator for either the linear rail system (lrs) or ilizarov circular system for various external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 171 indications. t h e c o m m o n e s t i n d i c a t i o n f o r application of external fixators was open fractures. table 2. external fixators were used as adjunct to other treatment modalities in 59 applications (59.6%) and as the definitive treatment method in 40 applications (40.4%). the commonest solution used for pin site care was povidone iodine in 53 patients (56.4%). other solutions included: normal saline in 21 patients (22.34%), methylated spirit in 14 patients (14.9%), savlon in 5 patients (5.32%) and eusol in 1 patient (1.1%).the frequency of pin site care varied from daily (55 patients 58.51% of cases), alternate days in 20 patients (21.28%), twice weekly in 16 patients (17.02%) to once weekly in 3 patients (3.2%). the average length of hospital stay was 49.5 days (range 4 – 154 days). forty one patients (43.6%) were discharged home with their external fixators in-situ while others had their external fixators removed either because the original indication for application had been corrected or fixator was removed and replaced with another form of treatment eg, cast application. the average length of time patients were on the external fixators was 124.8 days (17.8 weeks) – ranging from 1 to 660 days. the shortest was a patient who died a day after application of the external fixator from complications of injuries sustained to other systems in the same road traffic accident that caused the open fracture, while the one with the longest application had b o n e t r a n s p o r t , l i m b l e n g t h e n i n g a n d consolidation for bone loss from trauma. pin tract infection was the commonest complication encountered while using external fixators for various indications in our study, occurring in 25 patients (26.6%). other complications included: osteomyelitis in 4 patient (4.3%); pin loosening / pull out in 4 patients (4.3%); wound dehiscence in 2 patients (2.1%) who had ankle fusion with chanley's clamp; significant fracture mal-union in 2 patients(2.1%) with open tibial fractures that required osteoclasis and knee joint stiffness in a patient that had external fixator application across the knee. one of the patients died a day post operation while 3 (3.2%) other patients had amputations done for limb ischaemia resulting from type iiic open fractures that resulted in limb gangrene few days post external fixator application. the commonest indication for removal of external fixators was the healing of the wounds in open fractures with conversion to other forms of treatment, commonly cast application (42.6%) – table 3. the original aim of applying external fixator was achieved in 75% of cases and partially achieved in another 6% of cases. the average length of follow-up of patients was 12.3 months, range 2 months to 72 months. figures 2a – d are photographs and xrays of an ao type linear external fixator used for the initial management of a gustilo type iiia open fractures of the right tibia and fibula. discussion external fixators have been used by physicians for fracture treatment for over 2000 years since its first description by hippocrates. in spite of the changes in designs, biomechanics, versatility and indications, the basic principles of application have remained the same (9). the basic designs in use currently include: i) the linear type which can be applied in the unilateral, bilateral or multiplaner fashion, ii) the circular type which the popular designs are the ilizarov frame and the taylor spartial frame, iii) the third basic design is the hybrid type that combines the features of both linear and circular type (6,8,13,19). in this study, the commonest type of external fixator used was the linear ao type (about 68%) from various manufacturers. similar findings have been reported by other authors – (8,12). the reason for this finding is not farfetched. the simple linear ao type design of external fixator is more readily available, cheaper, has a short surgical learning curve and can be used for most long bone open fractures especially that of the tibia which is the commonest indication for the use of external fixators (8,12,13). the second most frequently used type of external fixator in our centres is another more advanced form of monoplanar external fixator – the linear rail system (lrs). this was frequently used for cases of bone loss that needed bone transport and also cases that needed limb lengthening using the principle of distraction osteogenesis. in addition it is also more appealing for use in femoral fractures where its sturdiness is an advantage. it is costlier and less easily available. the ilizarov circular frame comes handy in cases of deformity correction eg neglected club foot and also cases that needed bone transport and limb lengthening. the few cases of joint fusion were done using the external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 172 uniplanar bilateral chanley's clamp. the taylor spatial frame (tsf) has not gained popularity in our centres due to unavailability, cost and lack of expertise. about 60% of patients managed with external fixators in this study were males. this is the trend in most of the studies on external f i x a t o r s u s a g e i n t h e l i t e r a t u r e (3,5,8,14,16,17,20). the reason for this male preponderance is also glaring. males are usually the most frequently traumatized group and by extension experience more fractures/ open fractures – the commonest indication for external fixator usage (5,8,10,11,21,22). persons between the ages of 21 and 40 years (54%) were the ones who had the most frequent need for external fixator application in our study. the ages ranged from 6 to 80 years with a mean of 33.7+15.9 years and a median age of 32 years. abang et al (20) and yinusa et al (8) observed similar means of 33.5 years and 34 years respectively in their studies while higher means of 38 years and 46.7 years have been reported by ugwuovo et al (17) and galubovic et al (14) respectively. these range of mean ages fall within the most active and productive group in any society and also happens to be the period of life in which trauma is most frequent and by extension fractures and open fractures for which external fixator applications are indicated (10,11,22). this finding is thus expected. the commonest indication for external fixator usage in this study was open fractures making up about 68% of the indications. this is similar to the report by yinusa et al (8) that open fractures made up 67% of the indications for external fixator application in their study. the advantages of using external fixators for the management of open fractures cannot be overemphasized. availability and ease of application with minimal time wasting especially in unstable patients with multiple injuries, ease of access to wounds for dressing after application, minimal tissue invasiveness during application, reduced infection rate in contaminated open wounds etc, all make the use of external fixators in open fractures especially in gustilo and anderson types iii fractures appealing. this has been alluded to in the literature by several authors (3,5,8,10,11,17,20,23). the length of application of an external fixator usually depends on a number of factors including: the initial indication for application, whether it is intended for definitive or adjunct management of the condition, patient's response to treatment (how fast patient heals) and occurrence of complications among other considerations. the average of time external fixators were applied in this study was 124 days (17.85 weeks). the period of application ranged from 1 day to 94 weeks. the patient who had application for just 1 day died a day after application of fixator for open tibia/ fibula fracture from complications of injuries to other body systems sustained in the same accident. the patient that had external fixator applied for 94 weeks had post-traumatic large bone loss and non-union from open tibial shaft fracture for which he had lrs fixator applied for bone transport / limb lengthening and consolidation of regenerate. it is important to note that the patients who had external fixators applied for acute open fractures had an average length of application of 12 weeks. in a study on external fixator usage in which the bulk of the patients had open fractures (66.9%) and arthrodesis (22.6%), yinusa et al (8) reported an average period of application of 10.3 weeks. in another study on the use of external fixators for the definitive management of open tibial fractures, ugwuovo et al (17) recorded an average application time (time to union) of 15.2 weeks. it is pertinent to note that for most of the acute trauma (open fracture) patients in this study (40 out of 52 patients), external fixators were applied as adjunct to treatment. fixators were removed and replaced with other forms of treatment (usually cast) once the wounds healed or are manageable in casts with a window. the use of external fixators can be associated with numerous complications which may vary from pin tract infections (pti) to neurovascular injuries, pin loosening and pull out, osteomyelitis and sequestrum formation, nonunion/ malunion of fractures, compartment syndrome etc (6,9,18,24,25). the commonest complication observed in this study was pin tract infection (pti) occurring in about 27% of patients. this observation – that pti is the commonest complication of external fixator usage seems to be the general trend in the literature, though, percentage involvement varies from 0.9% to 100% (18,24-27). ugwuovo et al (17), yinusa et al (8) and galubovic et al (14) reported a lower percentage pti incidences of 6.6%, 14.8% and 19.2% respectively while higher percentage incidences of pti – 87.7% and 96.6% respectively have been reported by mohammed et al (18) and antoci et al (25). a number of factors may be responsible for the variations in the incidences of pti observed in these different studies. these factors may include: type of external fixator applied (pins or external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 173 wires) (26,28); length of time fixator was applied (29); pin site care practices (26,28,30); comorbid conditions in the patient (15,26,28), use of prophylactic antibiotics (25), etc. the timing for removal of an external fixator usually depend on whether the original aim for the application has been achieved except in cases where complications arise that necessitate earlier removal or change to other forms of treatment. in this study, most of the external fixators applied for open fracture cases were used as adjunct to treatment to adequately manage the open wounds and were removed when wounds healed or were contracted enough to allow dressing through a window in a cast (38 of 59 patients). another 14 of the 59 patients had fixators removed after fractures healed. three of the open fracture cases had external fixators removed and amputations performed some days after application for gustilo type iiic injuries in which the extent of vascular injury was not clear cut at presentation and facilities for angiography were not available. one of the patients with open fractures died a day after external fixator application from associated severe injuries sustained to other systems. one hundred per cent fusion rate was observed for the 3 cases of ankle fusion performed with the chanley's clamp uniplanar bilateral fixator. overall, the original aim for external fixation application (satisfactory results) was achieved in about 75% of cases and partially achieved in another 6% of cases. yinusa et al (8) in their study, reported satisfactory results in 63% of their patients. conclusion in conclusion, the use of external fixators has come to stay as an indispensable tool in the armamentarium of modern orthopaedic surgeons especially in the area of managing open fractures. the high level of satisfactory results achieved in this study further gives credence to this. with the emergence of more complicated and versatile designs that have further increased the array of indications, the need for training and retraining in their use has also become more imperative in order to harness their full potentials and achieve greater results. conflict of interest: the authors declare no conflict of interest. references 1. udosen am, ogbudu s. the use of external fixators: a review of the literature and experience in a developing world. nig j med. 2006; 15(2): 115 – 118. 2. fernandez a. external fixators, in: colton cl (ed). ao principles of fracture management. new york. thieme publishers.2000; 233 – 247. 3. echem rc, eyimina pd, adiela vue, diamond t. improvisation in the management of open extremity fractures at the university of port harcourt teaching hospital. american journal of medical science and medicine. 2020; 8(1): 34 – 38. 4. moss dp, tejwani nc. biomechanics of external fixation: a review of literature. bull nyu hosp jt dis 2007; 65(4) 294 – 299. 5. lawal yz, ejagwulu fs, salami so, mohammed s. monolateral frame external fixators in the definitive management of open limb fractures in north-western nigeria. 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ic, oginni lm, bamgboye ea. open fractures of the lower limbs in nigeria. international orthopaedics (sicot) 2001; 25: 386 – 388. 12. awais s, saeed a, ch a. use of external fixators for damage control orthopaedics in natural disaster like the 2005 pakistan earthquake. int. orthop (sicot). 2014; 38: 1563 – 1568. doi 10.1007/s00264-014-24365 13. flores a, marques a, machado j, marta m, vaz m . b o n e i m m o b i l i z a t i o n d e v i c e s a n d consolidation mechanisms: impact on healing time. structural integrity procedia 2017; 5: 34 – 39. 14. galubovic i, ristic b, stojiljkovic p, civic m, galobovic ivana, radovanovic z, petrovic s, djordjevic n, galubovic z, najman s. results of open tibial fracture treatment using external fixation. srp arh celok lek 2016 may – june; external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 174 144(5-6): 293-299. 15. ferreira n, marais lc. the effect of hiv infection on the incidence and severity of circular external fixator pin tract sepsis: a retrospective comparative study of 229 patients. strat traum lim recon 2014. doi.10.1007/s11751-014-0194 16. hao z, xia y, xia d, zhang y, xu s. treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a r e t r o s p e c t i v e c o h o r t s t u d y . b m c musculoskeletal disorders 2019; 20: 311. 17. ugwuovo tg, eze bu, okechukwu ba. outcome of external fixator management of gustilo-anderson type iii tibial fractures in lagos university teaching hospital. european journal of medical and health sciences 2021; 3(2): 166-170. 18. mohammed rm, atingba eo, sitati fc, gakuya em. pin tract infection after uniplanar external fixation of open fractures at a national teaching and referral hospital. east cent afr j surg 2017; 22(1): 42-48. 19. bible je, mir hr. external fixation: principles and applications. j am orthop surg 2015; 23(11): 683 690. 20. abang ie, asuquo je, anisi co, mpama ea, onuba oo, udosen am, ngim ne, ipkeme ai. early outcome of treatment of open tibial fractures using external fixators in resourcepoor setting. recent advances in biology and medicine 2018; 4(1): 1-9. 21. davies r, holt n, nayagam s. the care of pin sites with external fixation. j bone joint surg 2005; 87-b(5): 716 – 719. 22. odatuwa-omagbemi do, inikori ak, otene ci, enemudo ret. musculo-skeletal injuries: a cross-sectional study in a sub-urban teaching hospital. nigerian journal of orthopaedics andtrauma. 2013; 12(1): 66-70. 23. b e t s i o s m , s a v v i d o n o , k o v a n i s j , alexandropoulos p, papagelopoulos p. external fixation as a primary and definitive treatment for tibial diaphyseal fratcures. strat traum limb recon 2009; 4: 81-87. 24. parameswan ad, roberts rs, seligson d, voor m. pin tract infection with contemporary external fixation: how much of a problem? j orthop trauma 2003 aug; 17(7): 503-507. 25. antoci v, ono cm, antoci v(jr), raney em. pin tract infection during limb lengthening using external fixation. am j orthop 2008; 37(9): e150 – e154. 26. s c h w e i n b e r g e r m h , r o u k i s t s , t h e effectiveness of physician-directed external fixation pin site care in preventing pin site infection in a high-risk patient population. foot & ankle specialist 2008; 1(4): 218 – 221. 27. saw a, chan ck, penafort r, sengupta s. a simple practical protocol for care of metal-skin interface of external fixation. med j malaysia 2006; (suppl. a): 62-65. 28. kazmers nh, fragomez at, rozbruch sr. prevention of pin infection in external fixation: a review of the literature. strat traum limb recon 2016. doi.1007/s11751-016-0256-4 29. gordon je, kelly-hann j, carpenter cj, scheonecker pl. pin site care during external fixation in children: results of a nihilistic approach. j paediatr orthop 2000; 20(2): 163165. 30. ogbemudia ao, bafor a, ogbemudia ej, edomwonyi e. efficacy of 1% silver sulphadiazine dressing in preventing infection of external fixation pin tracts: a randomized study. strat traum limb recon 2015; 10: 95 – 99. doi.10.1007/s11751-015-0226-2. external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 175 table 1. socio-demographic characteristics of patients status frequencies percentage sex distribution males 56 59.58 % females 38 40.43 % total 94 ~ 100% age distribution in years 0 10 8 8.51 11 – 20 9 9.57 21 – 30 25 26.60 31 – 40 26 27.66 41 – 50 13 13.83 51 – 60 7 7.45 61 – 70 5 5.32 71 80 1 1.06 total 94 ~ 100% marital status of patients married 48 51.06 % single 42 44.68 % divorced / widowed 4 4.26 % total 94 ~100 5 educational status no formal eductaion 13 13.83 % primary 20 21.28 % secondary 25 26.60 % tertiary 28 29.79 % not indicated 8 8.51 % total 94 ~ 100 % occupational distribution traders 30 31.91 % schooling 23 24.47 % civil servants 9 9.57 % farmers 7 7.45 % artisan 5 5.32 % state security 3 3.19 % retired persons 3 3.19% others 14 14.89 % total 94 ~100 % external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 176 table 2. indications for external fixation indication frequencies percentages open fractures (gustilo & anderson class) 67 67.7% i 0 0 ii 6 6.1 iiia 24 24.2 iiib 36 36.4 iiic 1 1.0 bone (bone gap treatment post traumatic) 11 11.1 infected fractures / non unions 6 6.1 deformity correction 5 5.1 joint fusion (ankle) 3 3.0 congenital pseudoarthrosis 3 3.0 pelvic fractures (closed) 2 2.0 limb lengthening 2 2.0 total 99 100% table 3. indications for external fixators removal / outcome indications frequency percentage wound healed (exchange for cast as further treatment) 38 40.43 fracture healed 14 14.89 limb lengthening:– fully achieved “ – partially achieved 2 2.13 2 2.13 bone transport: – fully achieved – partially achieved – failed attempt at bone transport 6 6.38 2 2.13 2 2.13 exchange for orif 5 5.32 deformity correction:full correction achieved partial correction 4 4.26 2 2.13 joint fusion (ankle) achieved 3 3.19 amputation (vascular insufficiency from original trauma) 3 3.19 died 1 1.06 referred with ex.fix/ dama & loss to follow-up 10 10.64 total 94 ~100 % *dama – discharged against medical advice. external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 177 figure 1. frequency of use (percentage) of the 4 types of external fixators figure. 2a gustilo type iiia open fracture of right tibai & fibula figure 2b – after wound debridement and external fixation of limb in 2a. external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 178 figure 2c. post-operation xray (a/p view) of the limb of the patient in 2a & b. figure 2d – post-operation xray (lateral view) of the limb of the patient in 2a & b. external fixators usage in hospitals odatuwa-omagbemi et al. res. j. health sci. vol 11(2), june 2023 179 rjhs 11(3).cdr gynaecological pan-endoscopy (hystero-laparoscopy) in a tertiary health facility in nigeria: a ten-year clinical audit 1 1 1 1 2 *fehintola a.o. , omitinde s.o. , archibong m.s. , ayegbusi o.e. , abimbola j.a. , 1 loto o.m. abstract objective: this study aims to determine the prevalence, indications, common findings, challenges, and complications of gynaecological pan-endoscopy in obafemi awolowo university teaching hospitals complex, osun state. methods: it was a retrospective study. records of patients who had gynaecological hysteroscopy and (or) laparoscopy from 1st january 2012 to 31st december 2021 were retrieved, and relevant data were extracted and analyzed using the spss version 21.0 results: there were 2125 gynaecological surgeries within the study period, with 207 endoscopies giving a prevalence of 9.7%. infertility 100 (51.5%) was the most common indication. common findings were tubal block 45(33.6%) and intrauterine adhesions 19 (31.7%). the most common complication and challenge were shoulder tip pain 35(18.0%) and instrument failure 76 (39.2%), respectively. there is a statistically significant relationship between the occurrence of complications during endoscopy and 2 2 2 duration of surgery (x = 25.693, p= 0.000), endoscopy type (x =21.636, p=0.000), and hospital stay (x = 63.213, p=0.000) conclusion: the utilization rate of gynaecological pan-endoscopy could be higher and shows more skills, logistics, and staffing. therefore, efforts should be intensified towards training and provision of up-todate facilities for endoscopic surgery in our setting. keywords: gynaecological pan-endoscopy, indications, challenges, complications *corresponding author: fehintola akintunde olusegun. email: fehintolaakintunde@gmail.com 1 department of obstetrics, gynaecology, and perinatology, obafemi awolowo university, ile-ife, nigeria 2 department of anesthesia, obafemi awolowo university, ile-ife, nigeria orcid-no: https://orcid.org/0000-0002-5918-3994 received: january 12, 2023 accepted: may 14, 2023 published: september 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(3), september 2023 183 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.1 pan-endoscopie gynécologique (hystéro-laparoscopie) dans un établissement de santé tertiaire au nigéria: un diagnostic clinique de dix ans 1 1 1 1 2 *fehintola a.o. , omitinde s.o. , archibong m.s. , ayegbusi o.e. , abimbola j.a. , 1 loto o.m. résumé objectif de l'étude: cette étude vise à déterminer la prévalence, les indications, les résultats communs, les défis et les complications de la pan-endoscopie gynécologique dans l'hôpital universitaire, obafemi awolowo dans l'état d'osun. méthode de l'étude : il s'agissait d'une étude rétrospective. les dossiers des patients qui ont subi une hystéroscopie gynécologique et (ou) une laparoscopie du 1er janvier 2012 au 31 décembre 2021 ont été récupérés, et les données pertinentes ont été extraites et analysées à l'aide de la version spss 21.0 résultat de l'étude : il y a eu 2125 chirurgies gynécologiques au cours de la période d'étude, avec 207 endoscopies donnant une prévalence de 9.7%. l'infertilité 100 (51.5%) était l'indication la plus fréquente. les résultats communs étaient le bloc tubaire 45 (33.6 %) et les adhérences intra-utérines 19 (31.7 %). la complication et le défi les plus courants étaient la douleur à la pointe de l'épaule 35 (18.0 %) et la défaillance de l'instrument 76 (39.2 %), respectivement. il existe une relation statistiquement significative 2 entre la survenue de complications au cours de l'endoscopie et la durée de la chirurgie (x = 25.693, p = 2 2 0.000), le type d'endoscopie (x = 21.636 p = 0,000) et le séjour à l'hôpital (x = 63.213, p =0.000). conclusion : le taux d'utilisation de la pan-endoscopie gynécologique pourrait être plus élevé et montre plus de compétences, de logistique et de personnel. par conséquent, les efforts doivent être intensifiés vers la formation et la fourniture d'installations à jour pour la chirurgie endoscopique dans notre milieu. mots-clés : pan-endoscopie gynécologique, indications, enjeux, complications *corresponding author: fehintola akintunde olusegun. email: fehintolaakintunde@gmail.com 1 department of obstetrics, gynaecology, and perinatology, obafemi awolowo university, ile-ife, nigeria 2 department of anesthesia, obafemi awolowo university, ile-ife, nigeria received: january 12, 2023 accepted: may 14, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0002-5918-3994 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 184 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.1 introduced in the 1970s through collaboration with donor agencies, is still evolving and is mainly diagnostic (6). the indications for laparoscopy are either diagnostic or therapeutic (2). some of the diagnostic indications are pelvic pain, infertility, pelvic masses, genital tract anomalies, pelvic injuries, endometriosis, and pelvic inflammatory disease, while the therapeutic indications include tubal sterilization, adhesiolysis, missing intrauterine device, unruptured ectopic pregnancy, myomectomy, ova collection in ivf, ovarian drilling for polycystic ovaries, oophorectomy, hysterectomy and reconstructive surgery for pelvic organ prolapse (1, 2, 7). the contraindications for laparoscopy may be absolute or relative. the absolute contraindications are intestinal obstruction, generalized peritonitis, and intra-peritoneal bleeding, while the relative contraindications include severe cardiac or pulmonary disease, previous periumbilical surgery, shock, and cancer involving the anterior abdominal wall (2, 8). other relative contraindications are morbid obesity, advanced intrauterine pregnancy, presence of a large mass, inflammatory bowel disease, and known severe peritoneal adhesions (1). despite the widespread utilization of laparoscopy, there are limitations to its use in developing countries, including a lack of equipment and skilled personnel, increased cost, increased duration of surgery, and unstable power supply (6). the complications of laparoscopy are significantly lower than conventional surgery though some may not be recognized during the procedure and are mainly entry related (10). the reported rates of these complications are 1.012.5/1,000, 3.6/1,000, 5.7/1,000, and 12-15/1000 in the uk, finland, the netherlands, and nigeria, respectively (5, 11). major laparoscopic procedures are associated with a higher rate of complications (0.6%-18%) compared with minor procedures (0.06%-7.0%) (12) the experiences and challenges of endoscopy differ from one hospital to another, and these differences are dependent on the commitment of the governing bodies or boards of the hospital and that of the endoscopic surgeons as well as whether the hospital is solely a private establishment, public-private partnership, or exclusively government owned and operated hospital. thus, this study aimed to determine the prevalence, indications, common findings, and introduction the primary concerns of modern-day gynaecological practice are cosmetics and i m p r o v e d q u a l i t y o f l i f e . t h e s e h a v e revolutionized modern gynaecology resulting in an increased quest for gynecological endoscopy. as a result, the practice of gynecological panendoscopy (hysteroscopy and laparoscopy) is at its peak in developed countries. however, it is still at a low level of development and performance in most developing countries, where the major health challenge is coping with mortality and morbidity following preventable causes (1, 2). endoscopy is a minimally invasive procedure and entails the examination of the interior of a canal or hollow viscus with a specialized instrument called an endoscope (1).gynaecological laparoscopy is a transperitoneal endoscopic technique that provides excellent visualization of the pelvic structures and often permits the diagnosis of gynaecologic disorders and pelvic surgery without laparotomy (2). it is one of the most common surgical procedures performed by gynaecologists and the most important investigative tool for evaluating tubal disease in developed countries (2-7). approximately 80% of all gynaecological surgical procedures can be laparoscopically (2). although more invasive than hsg, the laparoscopy and dye test is the gold standard for evaluating tuboperitoneal factors in infertility. its disadvantages, however, include the requirement for skill and equipment, the invasive nature, and the inability to assess the uterine cavity. as a result, laparoscopy and dye tests are limited in evaluating infertility in nigeria (8-10). to accommodate and take care of the inability of laparoscopy and dye test to evaluate the uterine cavity, hysteroscopy done at the time of laparoscopy, and dye test was introduced in a procedure termed hystero-laparoscopy or panendoscopy. this approach is very useful and superior to either laparoscopy and dye test alone or hsg in evaluating and managing infertility (11-15). the frequency of hysterolaparoscopy varies widely across the globe. for example, in the usa, approximately 350,000 tubal ligations and 200,000 laparoscopically-assisted vaginal hysterectomies are carried out annually (1, 2), while in the united kingdom (uk), about 250,000 gynaecologic laparoscopic surgeries are done annually (5). on the other hand, in developing countries, particularly in sub-saharan a f r i c a , g y n a e c o l o g i c a l p a n e n d o s c o p y, res. j. health sci. vol 11(3), september 2023 185 gynaecological pan-endoscopy in nigeria fehintola et al. complications and showcase the challenges of gynaecological pan-endosscopy in obafemi awolowo university teaching hospitals complex, osun state. materials and methods this is a 10-year retros pective descriptive study of all gynaecological endoscopies performed at obafemi awolowo university teaching hospitals complex (oauthc), osun state, from 1st january 2012 to 31st december 2021. the hospital is a major federal government-owned tertiary health facility and is an accredited center for postgraduate residency training in obstetrics and gynecology information was obtained from patient's case notes, gynaecological ward registers, gynaecological clinic records, and theatre records. cases with incomplete or missing data were excluded. in addition, data relating to age, parity, indications, procedure, findings, complications, and duration of hospital stay were extracted. the socio-economic status of the women was stratified into classes 1 to 5 using the socioeconomic stratification method by olusanya et al. (17). this system scored the woman's educational status from zero [0] to two [2] and scored the husband's job description from one [1] to three [3]. women with tertiary education scored zero, while primary or no formal education scored two. husbands who are professionals (e.g., lawyers, engineers, medical doctors, and so on) scored one, while those who engaged in unskilled labor (e.g., artisans) scored three. adding the husband's and wife's scores will give the socioeconomic class of the woman. in this study, classes 1 and 2 were grouped as upper social class, class 3 as middle social class, while classes 4 and 5 were grouped as the lower social class to aid data analysis. we analyzed the data using the spss for windows version 20.0. ethical approval for the study was from the hospital ethics committee. results there were 2125 gynaecological surgeries within the study period, with 207 endoscopies giving a utilization rate of 97 per 1000 surgeries. only 197 case files were available for review making a 95.2% retrieval rate. three cases were excluded because of missing data. the remaining 194 cases were included in the final evaluation. of these, there were 97 laparoscopies only, 60 hysteroscopies only, and 37 combined hystero-laparoscopies. the age of the patients ranged between 19 and 52 years, with a mean age of 29.7 (±3.5) years. most of the procedures, 127 (65.5%), were carried out among the age group 29-38 years. most of the patients, 115 (59.3%), belong to the lower social class, while almost all of them, 175 ( 9 0 . 2 % ) , w e r e m a r r i e d . t h e y w e r e predominantly christians, 122 (62.9%), and 129 (66.5%) of yoruba ethnicity, as shown in table 1. of the 194 cases of endoscopy under review, infertility 100 (51.5%) was the most common indication, followed by secondary amenorrhoea 44 (22.7%). other indications include chronic pelvic pain, abnormal uterine bleeding, suspected ectopic pregnancy, and missing intrauterine devices, as shown in figure 1, intraoperative findings in 134 patients who had laparoscopy include bilateral tubal blockage 45(33.6%), polycystic ovaries 22 (16.4%), and 7 (5.2%) had bilateral hydrosalpinx. in addition, of the 97 hysteroscopy cases, 31 (32.0%) had intrauterine adhesions, while impacted fetal bones were found in 18(18.6%), as shown in table 2. of the 194 cases, the procedures performed include diagnostic laparoscopy in 65 (33.5%), diagnostic hysteroscopy in 30 (15.5%), laparoscopic ovarian drilling in 18 (9.3%), and hysteroscopic adhesiolysis in 18 (9.3%) patients as shown in table 3. the common complications identified were shoulder tip pain in 35 (18.0%) and surgical emphysema in 14 (7.3%). others include abdominal pain, vomiting, and a case of uterine perforation. in addition, some challenges encountered include instrument failure 76 (39.2%) from poor maintenance, erratic power supply 100 (51.5%), and lack of vital equipment. the mean duration of the endoscopy procedure was 60.2 (±3.7) minutes, while the mean duration of hospital stay was 35.5 (±2.5) hours, as shown in table 4. there is a statistically significant relationship between the occurrence of complications during endoscopy and duration of 2 surgery (x = 25.693, p= 0.000), endoscopy type 2 2 (x =21.636, p=0.000), and hospital stay (x = 63.213, p=0.000) as shown in table 5 discussion the introduction of gynaecological panendoscopy has revolutionized gynaecology practice leading to improvement in the quality of life of patients. these procedures are already well established in the developed world. however, res. j. health sci. vol 11(3), september 2023 186 gynaecological pan-endoscopy in nigeria fehintola et al. endoscopy procedures are still evolving in developing nations, mainly sub-saharan african countries (1). however, our study confirmed the feasibility of these procedures in our settings amidst various challenges and limitations. the utilization rate of minimal access gyneacological endoscopy in our study is low. this is similar to the finding of a previous study by shehu and bilal in sokoto, nigeria, where only 8.8% of the gynaecological surgeries were endoscopies (10) but lower than 34.8 reported by parkar et al. among 17 rural hospitals in kenya (18). also, our rate is much lower than the range of 56.7-78.2% reported from studies in the developed world (1, 2, 5). the lack of sufficient exposure, failure of equipment, and the difficult learning curve associated with these procedures reported in local studies may explain the lower rate of endoscopic procedures in our settings (10). the mean age of 29.7 (±2.5) years is similar to what was reported in previous studies (10, 15) but lower than 49 (±5.7) reported by zand et al. from the united states (19). this may be because infertility, the most common indication for these procedures in our settings, is prevalent among this age group. similarly, most of them had low parity presenting for fertility treatment, as seen in the previous survey (10, 15). most of this study's patients belong to the lower social class. previous studies reported similar results (10-12). for example, akande et al. (13) reported that more than half (59.9%) of their study population belonged to a lower social class. this is contrary to the report of sarkar et al. from new delhi, india, where most patients belong to the upper-middle class (20). infertility is the most common indication for seeking gynecological consultation and pan-endoscopy in nigeria (1-3). it is usually associated with immense psychosocial challenges because of the h i g h p r e m i u m p l a c e d o n c h i l d b i r t h . unfortunately, the high cost of pan-endoscopy, the gold standard for evaluating tubal factor infertility, will worsen the financial burden of infertility treatment for this group of patients. all the procedures in this study were carried out under general anesthesia, as was similarly reported from abuja (19). carbon d i o x i d e g a s w a s u s e d t o c r e a t e pneumoperitoneum in all the patients. room air can also be used safely with minimal complications, especially in low-resource settings like ours (22-24). although cheaper and readily available, room air is associated with poorer visibility, increased risk of wound infection, and abdominal discomfort compared with carbon dioxide (25-27). other gases that can be used are nitrous oxide, helium, and xenon (21). nitrous oxide gas has the added advantage of providing analgesia, especially in day-case laparoscopy (22). these gasses were not used because they were not available in our environment. in this study, diagnostic endoscopy was the most common procedure performed. this is unsurprising since infertility was this center's most common indication for diagnostic hysterolaparoscopy. this finding is in contrast with what is obtained in the developed world. in their survey, zand et al. (19) reported that 70% of endoscopy procedures were operative. only 3.0% had a conversion to laparotomy, similar to the 7% report by golash (24) but in contrast to 0.7% and 1.96% in kano and kenya, respectively (15, 16). the common pathologic finding at laparoscopy and hysteroscopy were bilateral tubal blockage and intrauterine adhesions. this is similar to the results from sokoto and kano (10, 15). m o s t o f t h e p a t i e n t s h a d n o complications, while among those that had complications, shoulder tip pain and surgical e m p h y s e m a w e r e t h e m o s t c o m m o n complications, followed by abdominal pain and anaesthetic complications. this is contrary to bladder and bowel injury found in a study in kenya (16). other complications could be anesthetic complications, ureteric and vessel injuries, and post-operative wound infections (18). no mortality was recorded in this study. g y n a e c o l o g i c a l m i n i m a l a c c e s s procedures about two-thirds of the patients were discharged within 48 hours after surgery. this is similar to the study from kenya, where 64.5% spent one night after the procedure (16). this is a significant advantage of pan-endoscopy over open surgery. this study confirmed a significant association between complications and prolonged hospital stay post-operatively. major complications will prevent immediate recovery and eventual return to normal activities leading to extra days in the hospital. occasionally, intraoperative complications may force the surgeons still rely on advanced technology using more sophisticated instruments, as e q u i p m e n t m a l f u n c t i o n s a c c o u n t f o r approximately one-third of the challenges encountered in the operating room in our study. the erratic power supply was experienced in more than half of the procedures. these challenges led to the conversion of five cases to laparotomy. many studies from the third world, like ours, reported similar challenges (27-30) res. j. health sci. vol 11(3), september 2023 187 gynaecological pan-endoscopy in nigeria fehintola et al. to convert to open surgery, further increasing the hospital stay duration. this fact has been confirmed in previous studies (3,10,11). the type of endoscopy procedures and duration of surgery also have a significant relationship to the occurrence of complications in our study. there is a reduction in the duration of surgery from hysteron-laparoscopy followed by laparoscopy only, and lastly, hysteroscopy only with the shortest duration. prolonged carbon-dioxide insufflations during laparoscopy can increase the risk of complications such as shoulder-tip pain, gas embolism, and cardio-pulmonary insufficiency. evidence abounds to corroborate the impact of prolonged duration of endoscopic surgeries on the development of complications either intra-operative or post-operative (3,7,1113). conclusion our study established the feasibility and safety of gynaecological pan-endoscopy in our settings despite the various challenges encountered. however, the utilization rate of gynaecological pan-endoscopy is low and shows limited skills, logistics, and human resources. therefore, efforts should be intensified towards training and provision of up-to-date facilities for endoscopic surgery in our setting. conflict of interest: all the authors declare that there is no conflict of interest financial support and sponsorship: nill acknowledgments: we acknowledged the valuable contribution of our mentor, dr. badejokoolalekan, who trained us in endoscopy and guided us in writing this manuscript. authors contributions: fao, oso, and lom participated in the conception and design of the study and the definition of intellectual content. in addition, fao, oso, ams, aoe, and aja participated in the literature search, data acquisition, data analysis, drafting, editing, and manuscript review for sound intellectual content. all the authors approved the final version of the manuscript. all authors also agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. references 1. ndubuisi va, ezugwu ec, chigbu co, ekwuazi ke, onwuka ci. the impact of infertility on the sexual life of infertile women in enugu, south east nigeria.nigerian journal of clinical practice. 2021 aug 1;24(8):1144-. 2. ikechebelu ji. prevalence of gynaecological diseases in nnewi, nigeria. niger j clinpract 2 0 0 5 ; 8 : 1 3 6 7 . 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routine procedure in managing acute abdominal pain: a review of 1,320 patients. surgendosc 2005; 19(7): 882-885. 25. fehintola ao, awotunde ot, ogunlaja oa, olujide lo, akinola se, oladeji s, aaron oi. gynecological endoscopic procedures in a tertiary hospital in south-west nigeria: a prospective study. nigerian journal of medicine. 2022 aug 29;31(4):467-72. 26. kalu e, nzeribe e, nzurumike c. complications associated with hysteroscopic surgery. ingynaecological endoscopic surgery 2022 (pp. 327-337). springer, cham. 28. kiridi ek, oriji pc, ugwoegbu ju, abasi ij. hysterosalpingography findings among women presenting for infertility evaluation in bayelsa state, south-south nigeria. j adv med med res. 2022;34(5):7-17. 29. yahya a, adesiyun a, giwa f, olorukooba aa. seroprevalence and clinical correlates of human immunodeficiency virus infection among infertile women in northwestern nigeria.tropical journal of obstetrics and gynaecology. 2018 oct 10;35(2):177-83. 30.. okohue je, okohuejo.establishing a lowbudget hysteroscopy unit in a resource-poor setting.gynecology and minimally invasive therapy. 2020 jan;9(1):18. gynaecological pan-endoscopy in nigeria fehintola et al. res. j. health sci. vol 11(3), september 2023 189 res. j. health sci. vol 11(3), september 2023 190 table 1: socio-demographic characteristics of the patients variables frequency (n=194) percentage (%) age (years) 19-28 29-38 39-48 =49 marital status married single educational status no formal education primary secondary tertiary parity 0 1-2 =3 social class upper middle lower ethnicity yoruba hausa igbo 23 127 30 14 175 19 67 46 45 36 155 25 14 45 34 115 129 31 34 11.9 65.5 15.5 7.1 90.2 9.8 34.5 23.7 23.2 18.6 79.9 12.9 7.2 23.2 17.5 59.3 66.5 16.0 17.5 table 2: operative findings during gynaecological endoscopy variables frequency percentage (%) laparoscopy findings* (n=134) patent tube (bilateral) patent tube (unilateral) bilateral tubal blockage unilateral tubal blockage unilateral hydrosalpinx bilateral hydrosalpinx massive adhesions ovarian cysts polycystic ovary disease violin string appearance hysteroscopy findings* (n=97) normal uterine cavity blocked ostia blocked ostium endometrial polyp uterine adhesions iucd localized impacted fetal bones submucous fibroid 45 15 35 15 12 07 18 19 23 22 22 19 12 10 31 09 18 05 33.6 11.2 26.1 11.2 9.0 5.2 13.4 14.2 17.2 16.4 22.7 19.6 12.4 10.3 32.0 9.3 18.6 5.2 *multiple entries allowed gynaecological pan-endoscopy in nigeria fehintola et al. res. j. health sci. vol 11(3), september 2023 191 table 3: procedures, methods of primary entry, duration of operation, and duration of hospitalization of the patients variables frequency percentage (%) procedures (n=194) laparoscopy and dye test diagnostic hysteroscopy hysteroscopic adhesiolysis hysteroscopic iucd retrieval laparoscopic adhesiolysis ovarian drilling salpingectomy cystectomy myomectomy total laparoscopic hysterectomy laparoscopic-assisted vaginal hysterectomy primary entry technique at laparoscopy (n=134) verres needle insertion direct trocar insertion hansen technique 65 30 18 12 10 18 15 14 05 04 03 120 10 04 33.5 15.5 9.3 6.2 5.2 9.3 7.7 7.2 2.6 2.1 1.5 89.6 7.5 2.9 table 4: the complications and challenges encountered, the duration of the procedures, and hospital stay . variables frequency percentage (%) duration of operation (minutes) (n=194) 0-60 61-120 121-180 >180 mean (±sd) 60.2 (±3.7) duration of hospital stay (hours) (n=194) 0-24 25-48 49-72 >72 mean (±sd) 35.5 (±2.5) complications (n=194) none anesthetic complications difficult insufflation vomiting shoulder tip pain emphysema uterine perforation challenges encountered* (n=194) none instrument failure power interruption 95 56 23 20 30 105 45 14 116 05 08 15 35 14 01 45 76 100 49.0 28.9 11.9 10.3 15.5 54.1 23.2 7.2 59.8 2.6 4.1 7.7 18.1 7.2 0.5 23.3 39.2 51.5 *multiple entries allowed gynaecological pan-endoscopy in nigeria fehintola et al. res. j. health sci. vol 11(3), september 2023 192 < < < table 5: association between selected characteristics and occurrence of complications during endoscopy variables (n=194) complications yes (n=78) no (n=116) statistical indices p values surgery duration (in minutes) =60 >60 duration of hospital stay (in hours) =35 >35 endoscopy type laparoscopy only (97) hysteroscopy only (60) hysterolaparoscopy (37) patients’ age =30 >30 social class upper middle lower 17(20.0) 61 (56.0) 10 (10.5) 68 (68.7) 46 (47.4) 10 (16.7) 22 (59.5) 38 (42.2) 40 (38.5) 13 (29.9) 20 (58.8) 45(39.1) 68 (80.0 48 (44.0) 85 (89.5) 31 (31.3) 51(52.6) 50 (83.3) 15 (40.5) 52 (57.8) 64 (61.5) 32 (71.1) 14(41.2) 70(60.9) df=1, x2 = 25.693 df=1, x2 = 63.213 df=2, x2=21.636 df=1, x2 =0.294 df=2, x2= 1.95 p= 0.000 p=0.000 p=0.000 p=0.594 p=0.051 figure 1: indications for gynecological endoscopy gynaecological pan-endoscopy in nigeria fehintola et al. rjhs 11(2).cdr prevalence and antibiotic resistant escherichia coli isolated from abattoir and aquaculture environment in ebonyi state, south east nigeria. 1,2 2 2 2 3 *onuoha, s.c. , okafor, c.o.o. , eronmosele, b.o. , ovia, k.n. , nwosu, m.c. , 2 4 5 5 onwere, c.c. , ude, i.u. , ezeme-nwafor, a.c. , ani, p. abstract background: the present study was carried out to evaluate the distribution and antibiotics profile of escherichia coli from abattoir and aquaculture. methods: abattoir and aquaculture effluents were randomly collected from various parts of abakaliki in ebonyi state. bacterial detection was conducted using cultural and biochemical analysis. susceptibility of the e. coli to antimicrobials was investigated using the kirbybauer disk diffusion method. 7 7 results: the microbial load from abattoirs ranges from 0.26±0.11x10 to 4.08±0.11x10 cfu/ml and 7 7 aquacultures 0.40±0.04x10 to 4.06±2.74x10 cfu/ml differ significantly (p<0.05). out of the total 44 e. coli isolates from abattoir, drainage shows the highest e. coli isolates (40.9 %) and waste water least (22.7 %), while of the 18 e. coli isolates from aquaculture, 55.6 % were from concrete pond, while 44.4 % were from earthen pond. the e. coli isolates showed reasonable susceptibility to cefeprime (62.5 %), followed by imipenem (50. 0 %). however, all the e. coli isolates were resistant to amoxicillin/clavulanic acid, cefixime, cefotaxime and tobramycin. e. coli mar index range from 0.4 0.9. conclusion: the high microbial load, antibiotic resistance and higher mar index >2 is of public health concern and further demonstrates the need for adequate treatment and disposal of waste generated from abattoir and aquaculture. keywords: e. coli, abattoir, aquaculture, antibiotics *corresponding author onuoha, s .c email: sconuoha@yahoo.com 1 department of biotechnology, faculty of science, ebonyi state university, abakaliki, nigeria. 2 department of microbiology, college of sciences, evangel university akaeze, nigeria. 3 department of biotechnology, college of sciences, evangel university akaeze, nigeria. 4 department of applied microbiology, faculty of science, ebonyi state university, abakaliki, nigeria. 5 department of microbiology, caritas university, amorji-nike, nigeria orcid-no: https://orcid.org/0000-0002-6076-3910 received: july 4, 2022 accepted: march 24, 2023 published: june 30, 2023 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.6 original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 128 prévalence et escherichiacoli résistant aux antibiotiques isolés de l'abattoir et de l'environnement aquacole dans l'état d'ebonyi , au sud-est du nigéria 1,2 2 2 2 3 *onuoha, s.c. , okafor, c.o.o. , eronmosele, b.o. , ovia, k.n. , nwosu, m.c. , 2 4 5 5 onwere, c.c. , ude, i.u. , ezeme-nwafor, a.c. , ani, p. résumé contexte général de l'étude: la présente étude a été réalisée pour évaluer la distribution et le profil d'antibiotiques d'escherichia coli provenant d'abattoirs et d'aquaculture. méthode de l'étude : les effluents d'abattoir et d'aquaculture ont été collectés au hasard dans différentes parties d'abakaliki dans l'état d'ebonyi. la détection bactérienne a été effectuée à l'aide d'analyses culturales et biochimiques. la sensibilité d'e. coli aux antimicrobiens a été étudiée à l'aide de la méthode de diffusion sur disque de kirby-bauer. 7 7 résultat de l'étude : la charge microbienne des abattoirs varie de 0,26±0,11x10 à 4,08±0,11x10 ufc /ml 7 7 et les aquacultures de 0,40±0,04x10 à 4,06±2,74x10 ufc /ml diffèrent significativement (p<0,05). sur le total de 44 isolats d'e. coli provenant d'abattoir, le drainage montre les isolats d'e. coli les plus élevés (40,9 %) et les eaux usées le moins (22,7 %), tandis que sur les 18 isolats d'e. coli provenant de l'aquaculture, 55,6 % provenaient d'étangs en béton, tandis que 44,4 % provenaient d'un étang en terre. les isolats d'e. coli ont montré une sensibilité raisonnable au céféprime (62,5 %), suivi de l'imipénem (50,0 %). cependant, tous les isolats d'e. coli étaient résistants à l'amoxicilline/acide clavulanique , au céfixime, au céfotaxime et à la tobramycine. l'indice e. coli mar varie de 0,4 à 0,9. conclusion : la charge microbienne élevée, la résistance aux antibiotiques et l'indice mar supérieur > 2 sont préoccupants pour la santé publique et démontrent en outre la nécessité d'un traitement et d'une élimination adéquats des déchets générés par les abattoirs et l'aquaculture. mots-clés : e. coli, abattoir, aquaculture, antibiotiques received: july 4, 2022 accepted: march 24, 2023 published: june 30, 2023 *corresponding author onuoha, s .c email: sconuoha@yahoo.com 1 department of biotechnology, faculty of science, ebonyi state university, abakaliki, nigeria. 2 department of microbiology, college of sciences, evangel university akaeze, nigeria. 3 department of biotechnology, college of sciences, evangel university akaeze, nigeria. 4 department of applied microbiology, faculty of science, ebonyi state university, abakaliki, nigeria. 5 department of microbiology, caritas university, amorji-nike, nigeria orcid-no: https://orcid.org/0000-0002-6076-3910 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.6 article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 129 introduction foodborne infections are widespread and growing public health problems in the world (1). abattoir, otherwise known as slaughter house is a facility where animals are killed for consumption as food products (2). like many other sewage types, effluents from the abattoir flow into water bodies such as ground water, streams, rivers, lakes and oceans thereby introducing enteric pathogens, excess nutrients and other contaminants into the water sources (3). water pollution from abattoir effluents may cause substantial environmental and public health hazards especially in nigeria, a country where abattoir effluents like most other wastewater are untreated before they are discharged (4, 5, 6, 7). the increasing demand for aquaculture products as a source of protein stimulates the propagation and expansion of aquaculture in many countries (8). despite the high nutritional quality that links fish consumption to positive health effects in humans, the aquaculture system is tremendously vulnerable to pollution and run-offs from anthropogenic sources which contaminate fish products with microbiological hazards such as e. coli and salmonella (9). escherichia coli is among the most challenging enterobacteriaceae group of bacterial meat contaminant worldwide (1). e. coli is a common inhabitant of human and animal intestinal tract. it is a gram-negative facultative aerobic organism and the most common in the family enterobacteriaceae (5). e. coli is the most common pathogen leading to uncomplicated cystitis, and also results in other extraintestinal illnesses, including pneumonia, bacteremia, and abdominal infections such as spontaneous bacterial peritonitis (9). the detection of pathogenic organisms as well as the incidence of proteolytic and lipolytic bacteria in a water body is suggestive of impending health hazards and public health concern. micronutrients in abattoir wastewater sustain the prevalence of pathogenic and entropic organisms that constitute biohazards in water bodies. antibiotic resistance is a pandemic that requires global health solutions (11). the emergence of antimicrobial resistance among bacterial pathogens demands a local understanding of the epidemiological situation. this information is needed both for clinical treatment decision-making purposes as well as for the revision of current care guidelines (12). wastewaters are considered hotspots for antibiotic resistant bacteria and horizontal gene transfer among related and unrelated bacterial species (13). abattoir effluents are potential carriers of resistant pathogenic bacteria and could be contributing to the global spread of these strains in the environments (14). as a consequence of the use of antibiotics in aquaculture, antibiotic resistance is induced in the surrounding bacteria in the column water, sediment, and fish-associated bacterial strains (15). antibiotics are widely used in intensive fish farming, which in turn increases the emergence of antimicrobial-resistant bacteria in the aquatic environment (8). pathogenic e. coli has become alarming and livestock acquired infection is now one of the leading cause infections globally. antimicrobial resistance aggravates the already difficult treatment of bacterial infections. due to many factors influencing antibiotic resistance, the correct choice of antimicrobial management remains debatable. hence, this has necessitated the research in the distribution and antibiotics susceptibility profile of pathogenic e. coli from abattoir and aquaculture effluents in abakaliki, ebonyi state. materials and methods approval and consent for the study were obtained from the owners of the various abattoir and aquaculture farms. the study was conducted from march 2020 to june 2020 at the microbiology laboratory of ebonyi state university abakaliki, nigeria. sample collection and procession fifty (50) samples were collected from a b a t t o i r w a s t e w a t e r a n d a q u a c u l t u r e environment within abakaliki metropolis, ebonyi state. the waste water from the abattoir were obtained from drainage, butcher table and wash water. all samples were collected aseptically using universal sterile container. containers were filled leaving a top space of about 2.5cm. samples were processed and incubated within 5 hours of sampling. samples were transported in isothermal boxes with ice to the laboratory of applied microbiology department, ebonyi state university for escherichia coli analyses. isolation, enumeration, and identification of escherichia coli the isolation, identification and enumeration of e. coli were carried out using standard microbiological/biochemical methods (16, 17). antibiotics sensitivity testing susceptibility patterns of the isolated e. res. j. health sci. vol 11(2), june 2023 130 antibiotic resistant escherichia coli in abattoir and aquaculture environment onuoha et al. coli were tested against a wide range of antibiotics namely; imipenem (10 µg), cefoxitin (30 µg), cefotaxime (30 µg), cefeprime (30 µg), meropenem (10 µg), tobramycin (10 µg) ceftazidime (30 µg) and amoxicillin clavulanic acid (30 µg) on muller hinton agar (oxoid, uk) using kirby and bauer disc diffusion methods of determining susceptibility (16). all the antibiotics disk were procured from oxoid limited (oxoid, uk). multiple antibiotic resistance (mar) index mar index was determined by following the procedure described by ayandele et al. (18). mar index for an isolate = = number of antibiotics to which isolate is resistant total number of antibiotics against which isolate was tested statistical analysis the percentage frequency of occurrence of the e.coli isolated from abattoir and aquaculture environment was calculated using n 100 frequency (%) = / x / n 1 where n = number of occurrence of bacteria species, n = total number of bacteria isolated. e x p e r i m e n t a l d a t a w a s p r e s e n t e d a s mean±standard deviation, while one way anova procedure was used to analyze statistical difference in the data generated. results the result from abattoir shows that samples from location designated ab had 3 significantly (p<0.05) high microbial load 7 (4.08±0.11x10 cfu/ml), followed by ab from 2 7 waste water (3.54±0.65x10 cfu/ml), while samples from ab waste water recorded the 2 7 l o w e s t m i c r o b i a l l o a d ( 0 . 2 6 ± 0 . 11 x 1 0 cfu/ml)(table 1). no significant variation (p>0.05) was observed with microbial load from sample location designated ab from butchers 2 table, waste water and drainage (table 1). no significance difference (p>0.05) was observed with microbial load of waste water and drainage from sample ab and ab , microbial load of 5 6 waste water and butcher table from sample ab , 6 microbial load of drainage and butcher table from sample ab and ab (table 1).1 6 result from aquaculture pond revealed a significant (p<0.05) difference in their microbial burden showing that pw earthen pond had 2 significantly (p<0.05) high microbial load 7 (4.06±2.74x10 cfu/ml), followed by pw earthen 1 7 pond (2.56±0.23 x10 cfu/ml), while samples from pw concrete ponds recorded the lowest 4 7 microbial load (0.40±0.04x10 cfu/ml) as shown in table 2. no significant variation (p>0.05) was observed with microbial load from pw concrete 6 and earthen pond (table 2). the result of the prevalence of e. coli showed that ab (33.3 %) had the highest 3 frequency of e. coli isolates from drainage, followed by ab (22.2 %), ab (16.2 %), while 4 2 ab (5.6 %) shows the least prevalence (figure 1 1). ab (30.0 %) showed the highest frequency of 5 e. coli isolates from waste water, followed by ab (20.0 %), ab (20.0 %), while ab ab and 1 2 3, 4, ab (10.0 %) shows the least percentage 6 prevalence (figure 1). there was also highest frequency of e. coli isolates from butcher table from ab (37.5 %), followed by ab (25.0 %), 3 4 while ab and ab (6.3 %) had the least 2 5 prevalence (figure 1). also, pw (30.0 %) showed the highest 3 e. coli from concrete pond, followed by pw 2 (20.0 %), while others (pw , pw , pw and pw ) 1 4 5 6 recorded the least with 10.0 % prevalence respectively (figure 2). pw and pw (25.0 %) 1 3 had the highest e. coli from earthen pond, while pw , pw , pw and pw recorded the least with 2 4 5 6 12.5 % prevalence each (figure 2). t h e r e s u l t o f t h e a n t i b i o t i c s susceptibility of e. coli to the respective antibiotics revealed that the e. coli isolates s h o w e d h i g h e s t r e s i s t a n c e t o a m o x i c i l l i n / c l a v u l a n i c a c i d , c e f i x i m e ,cefotaxime and tobramycin at 100 %, , while imipenem recorded the least at 25.0%. highest susceptibility was observed with cefeprime (62.5 %), followed by imipenem (50. 0 %) (table 3). the result of the multiple antibiotics resistance index of the isolates ranges from 0.4 to 0.9 with the mean value of 0.6 (table 4). the isolate from ab drainage recorded the highest 1 mari of 0.9 while all the wastewater samples recorded mari of 0.7 except the one collected from ab whose mar index was 0.5. the result 2 of the multiple antibiotics resistance index of the e. coli isolates from aquaculture environment ranges from 0.5 to 0.7 (table 4). discussion and conclusion the findings of the study demonstrated that escherichia coli existed in high densities in samples in the study area with waste water from ab designated sampling showing the highest 3 7 microbial load 4.08±0.11x10 cfu/ml, while samples from ab waste water recording the 2 7 least microbial load 0.26±0.11x10 cfu/ml res. j. health sci. vol 11(2), june 2023 131 antibiotic resistant escherichia coli in abattoir and aquaculture environment onuoha et al. (table1). high bacterial load obtained is due to poor techniques of meat handling and nonhygienic practices used by the butchers. the variations of bacterial load observed in different sample locations were attributed to the hygiene standard in the processing and handling of meat. the result of the present study is in conformity with the findings of joseph et al (19), atlabachew et al (20) , gufe et al. (14), egwu et al. (21) , ogunlade et al. (22) and olawale et al. (23), who contended that the presence of bacteria in high densities obviously constitute a serious public health hazard as the presence of these microorganisms is associated with water borne diseases. the result from aquaculture samples shows that the sample point designated as pw 2 earthen pond shows the highest microbial load 7 (4.06±2.74x10 cfu/ml) and differs significantly at (p<0.05), it was immediately followed by pw 1 7 earthen pond (2.56±0.23 x10 cfu/ml), while samples from pw concrete ponds recorded the 4 7 lowest microbial load (0.40±0.04x10 cfu/ml) (table 2). higher microbial load obtained in earthen pond might be attributed to the use of animal manure in the fertilization of the pond. pond water is known as an ideal culture medium for the proliferation of bacterial pathogens causing bacterial infection in fish and an important cause of food poisoning (24). high microbial load as obtained from our study corroborates work as reported by other authors (25, 26, 27). untreated abattoir effluent constitutes potential reservoir for transmission of pathogenic strains of multiple antibiotic-resistant bacteria by pollution of surface and ground water sources (28). antibiotics are widely used in intensive fish farming, which in turn increases the emergence of antimicrobial-resistant (amr) bacteria in the aquatic environment (8). antimicrobial r e s i s t a n c e t h r e a t e n s i n f e c t i o u s d i s e a s e management outcomes, especially in developing countries (29). e. coli isolates shows highest resistances to amoxicillin/clavulanic acid, cefixime, cefotaxime and tobramycin at 100 %, followed by meropenem and ceftazidime (table 3). high resistance of antibiotics of human value as obtained in our study was previously reported by other authors both in nigeria and elsewhere (datok et al. (30) and wu et al. 31). however, contrary report have been obtained from several authors (mapanguy et al. 32, aabed et al. 33, montagnani et al. 34 and isac et al 35) multiple antibiotic resistance index (mari) is an effective, valid, and cost-effective method that is used in source tracking of antibiotic resistant organisms (36). mari is an important analysis to check antibiotic resistance and health risk factors (37). organisms which have mar indices of greater than ≥0.2 confirm the presence of multidrug-resistant genes originating from the environment where there is an abuse of these drugs and also that the plasmids contain one or more resistance genes, each encoding a single antibiotic resistance phenotype (38. 39). from the abattoir and aquaculture samples analyzed, e. coli mar indices were greater than 0.2. it was an evidence that all the e. coli isolates originated from potentially dangerous sources where antibiotics are frequently used and possibly was introduced through fecal contamination. the result of the study agrees with work of adinortey et al. (40); afunwa et al., (37) and kusunur et al. 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boateng, a.a. and agbeko, r. multiple antibiotic resistancecoliform bacteria in some selected fish farms of the central region of ghana. scientifica. 2020;1: 1-11. 41. kusunur, a.b., kuraganti, g.k., mogilipuri, s.s., vaiyapuri, m., narayanan, s.v. and badireddy, m.r. multidrug resistance of escherichia coli in fish supply chain: a preliminary investigation. journal of food safety. 2022; 1:1. antibiotic resistant escherichia coli in abattoir and aquaculture environment onuoha et al. res. j. health sci. vol 11(2), june 2023 135 table 1 ó microbial load (x107 cfu/ml) from abattoir samples sample code waste water drainage butcher table ab1 0.76±0.02a 1.86±0.28b 1.29±0.01b ab2 3.54±0.65a 1.31±0.27b 0.26±0.11c ab3 4.08±0.11a 1.60±0.66b 3.18±1.44c ab4 0.40±0.33a 2.20±0.28b 1.04±0.05c ab5 1.19±0.65a 1.32±0.04a 2.22±0.85b ab6 1.19±0.37a 1.50±0.98a 1.92±0.33a key: ab= abattoir, values were mean ± standard deviation (sd), values with no common superscripts within the same row are significantly different at p < 0.05, values with same superscripts within same row are not significantly different (p > 0.05). table 2ó microbial load (x107cfu/ml) from aquaculture environment sample code concrete pond earthen pond pw1 0.66±0.19 a 2.56±0.23b pw2 1.02±0.02a 4.06±2.74b pw3 1.50±0.25a 0.70±0.14b pw4 0.40±0.04a 1.50±0.09b pw5 1.92±0.03a 2.22±0.88b pw6 1.86±0.03a 1.29±0.01a key: pw= pond water, values were mean ± standard deviation (sd), values with no common superscripts within the same row are significantly different at p < 0.05, values with same superscripts within same row are not significantly different (p > 0.05). table 3: antibiotics sensitivity pattern of the e. coli isolates antibiotics resistance (%) intermediate (%) susceptibility (%) ipm 2(25.0) 2(25.0) 4(50.0) amc 8(100) 0(0) 0(0) cxm 8(100) 0(0) 0(0) ctx 8(100) 0(0) 0(0) tob 8(100) 0(0) 0(0) fep 3(37.5) 0(0) 5(62.5) mem 6(75.0) 0(0) 2(25.0) caz 6(75.0) 0(0) 2(25.0) key: ipm = imipenem, ctx= cefotaxime, cxm= cefixime, fep = cefeprime, mem = meropenem, tob = tobramycin, caz = ceftazidime, amc= amoxicillin/clavulanic acid. antibiotic resistant escherichia coli in abattoir and aquaculture environment onuoha et al. table 4: multiple antibiotics resistance index (mari) of the e. coli isolates sample sample code mari antibiotics drainage ab1 0.9 ipm, amc, ctx, tob, fep, mem, caz ab2 0.6 amc, ctx, tob, mem, caz ab3 0.4 amc, ctx, tob ab4 0.6 amc, ctx, tob, mem, caz ab5 0.5 amc, ctx, tob, mem ab6 0.7 amc, ctx, tob, fep, mem, caz waste water ab1 0.7 amc, ctx, tob, fep, mem, caz ab2 0.5 amc, ctx, tob, caz ab3 0.7 amc, ctx, tob, fep, mem, caz ab4 0.7 amc, ctx, tob, fep, mem, caz ab5 0.7 amc, ctx, tob, fep, mem, caz ab6 0.7 amc, ctx, tob, fep, mem, caz butchers table ab1 0.5 amc, ctx, tob, caz ab2 0.5 amc, ctx, tob, mem ab3 0.6 amc, ctx, tob, mem, caz ab4 0.6 amc, ctx, tob, mem, caz ab5 0.6 amc, ctx, tob, mem, caz ab6 0.6 amc, ctx, tob, mem, caz concrete pond pw1 0.5 amc, ctx, tob, mem pw2 0.6 amc, ctx, tob, mem, caz pw3 0.6 amc, ctx, tob, mem, caz pw4 0.6 amc, ctx, tob, fep, caz pw5 0.7 amc ctx, tob, fep, mem, caz pw6 0.7 amc, ctx, tob, fep, mem, caz earthen pond pw1 0.5 amc, ctx, tob, caz pw2 0.6 amc, ctx, tob, mem, caz pw3 0.5 amc, ctx, tob, caz pw4 0.6 amc, ctx, tob, fep, caz pw5 0.6 amc, ctx, tob, mem, caz pw6 0.7 amc, ctx, tob, fep, mem, caz mean 0.6 antibiotic resistant escherichia coli in abattoir and aquaculture environment onuoha et al. res. j. health sci. vol 11(2), june 2023 136 figure 1: prevalence of e. coli across the different abattoir sample sources figure 2: prevalence of e. coli across the different aquaculture sample sources antibiotic resistant escherichia coli in abattoir and aquaculture environment onuoha et al. res. j. health sci. vol 11(2), june 2023 137 rjhs 11(2).cdr pattern and outcome of anaesthesia techniques in patients presenting with pre-eclampsia/eclampsia for caesarean section in a teaching hospital abstract objectives: to review the pattern of anaesthesia techniques among pregnant women with pre-eclampsia or eclampsia who had caesarean section in our health facility and their management outcome methods: a retrospective analysis was undertaken for all the obstetric patients with pre-eclampsia or eclampsia who had caesarean sections under different types of anaesthesia in a tertiary hospital between st st january 1 2014 and december 31 2018. results: a total of one hundred and eighty-two patients who presented with pre-eclampsia and eclampsia had emergency caesarean sections. of these, 134 (74%) were diagnosed pre-eclampsia and 48 (26%) had eclampsia. the mean age was 29.71±6.40years. subarachnoid block was performed in 165 (90.66 %), 15 (8.24 %) had general anaesthesia relaxant technique, and the remaining two (1.10 %) had local anaesthetic infiltration ± total intravenous anaesthesia. peri-operative anaesthetic complications encountered included post-anaesthetic shivering 19 (10.44%), hypotension 16 (8.79 %) and nausea 1 (0.55 %). incidence of death on table was six percent (11 patients). among those that died, the anaesthesia technique was general anaesthesia in eight cases (73%) while three patients (27%) had subarachnoid blocks. conclusion: spinal anaesthesia was the most commonly used anaesthesia technique in this centre for patients with pre-eclampsia and conscious eclamptic patients, and it proved to be a relatively safe technique with few mortality. keywords: anaesthesia techniques, pre-eclampsia, eclampsia, management outcome. 1 2 1 3 3 fatungase, o.m. , olateju s.o. , emmanuel e.a. , adefuye p.o. , shorunmu t.o. , 1 7 1 shoyemi r.o. , dada s.a. , omoregie y.o. *corresponding author dr. fatungase o.m email: mamafat40@gmail.com 1 department of anaesthesia and intensive care, olabisi onabanjo university teaching hospital, sagamu, nigeria. 2 department of anaesthesia and intensive care, faculty of clinical sciences, obafemi awolowo university ileife, nigeria. department of obstetrics and gynaecology, olabisi onabanjo university teaching hospital, sagamu, nigeria 3 received: september 1, 2022 accepted: april 27, 2023 published: june 30, 2023 . original article research journal of health sciences res. j. health sci. vol 11(2), june 2023 148 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.8 modèle et résultat des techniques d'anesthésie chez les patients présentant une pré-éclampsie/éclampsie pour une césarienne à l'hôpital universitaire 1 2 1 3 3 fatungase, o.m. , olateju s.o. , emmanuel e.a. , adefuye p.o. , shorunmu t.o. , 1 7 1 shoyemi r.o. , dada s.a. , omoregie y.o. résumé objectifs de l'étude : examiner le schéma des techniques d'anesthésie chez les femmes enceintes atteintes de prééclampsie ou d'éclampsie qui ont subi une césarienne dans notre établissement de santé et les résultats de leur prise en charge . méthode de l'étude: une analyse rétrospective a été entreprise pour toutes les patientes obstétricales atteintes de pré éclampsie ou d'éclampsie qui ont subi une césarienne sous différents types d'anesthésie dans un hôpital tertiaire entre le 1er janvier 2014 et le 31 décembre 2018. résultat de l'étude : au total, cent quatre-vingt-deux patientes qui se sont présentées avec un pré éclampsie et une éclampsie ont eu une césarienne en urgence. parmi celles-ci, 134 (74 %) avaient reçu un diagnostic de pré éclampsie et 48 (26 %) avaient une éclampsie. l'âge moyen était de 29,71 ± 6,40 ans. un bloc sous-arachnoïdien a été réalisé chez 165 (90,66 %), 15 (8,24 %) avaient une technique d'anesthésie générale relaxante, et les deux autres (1,10 %) avaient une infiltration d'anesthésique local ± une anesthésie intraveineuse totale. les complications anesthésiques péri -opératoires rencontrées comprenaient les frissons postanesthésiques 19 (10,44 %), l'hypotension 16 (8,79 %) et les nausées 1 (0,55 %). l'incidence du décès sur la table était de six pour cent (11 patients). parmi ceux qui sont décédés, la technique d'anesthésie était l'anesthésie générale dans huit cas (73%) tandis que trois patients (27%) avaient des blocs sous-arachnoïdiens. conclusion : la rachianesthésie était la technique d'anesthésie la plus couramment utilisée dans ce centre pour les patientes atteintes de pré éclampsie et les patientes éclamptiques conscientes, et elle s'est avérée être une technique relativement sûre avec peu de mortalité. mots-clés : techniques d'anesthésie, prééclampsie, éclampsie, résultat de l'administration *corresponding author dr. fatungase o.m email: mamafat40@gmail.com 1 department of anaesthesia and intensive care, olabisi onabanjo university teaching hospital, sagamu, nigeria. 2 department of anaesthesia and intensive care, faculty of clinical sciences, obafemi awolowo university ileife, nigeria. department of obstetrics and gynaecology, olabisi onabanjo university teaching hospital, sagamu, nigeria 3 received: september 1, 2022 accepted: april 27, 2023 published: june 30, 2023 article original research journal of health sciences res. j. health sci. vol 11(2), june 2023 149 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i2.8 and easier to treat compared with otherwise healthy women (7,8). however, the fear of possible conning from raised intracranial pressure (icp) in this group of patients, limit the use of spinal anaesthesia techniques (6). when there is an immediate threat to the mother or fetus e.g placental abruption with severe pre-eclampsia [category 1], anaesthesia technique with rapid onset of action, control over the airway and potential for less hypotension should be considered. general anaesthesia provides this benefit making it better than regional anaesthesia (ra) (9,10). however, a high degree of anticipation of difficult endotracheal intubation must be considered due to increased airway oedema, short neck and large breasts that can obscure the laryngoscopic view during intubation. it is therefore, essential to keep the difficult airway cart available while planning general anaesthesia. similarly, with the preexisting elevated blood pressure, techniques to attenuate the hemodynamic response to intubation with minimal effects on the fetus should be considered (e.g intravenous 0.5mg/kg esmolol, 1-2mg/kg plain lidocaine e.t.c administered 1-2 minutes prior to intubation). when there is a maternal or fetal compromise, but not immediately life threatening [category 2], the management depends on the availability of time to perform or activate ra (9, 10). subarachnoid block with intrathecal opioid or combined spinal epidural (cse) anesthetic technique may be considered over general anaesthesia when there is no maternal or fetal compromise but there is need for early delivery of the baby [categories 3] (9, 10). the administration of central neuraxial anesthesia minimizes the risk of neonatal exposure to potentially depressant anesthetic drugs, fewer life-threatening perioperative airway and respiratory complications, better pain control than intravenous narcotics, earlier recovery of bowel function, promotes early ambulation, reduces the incidence of maternal thromboembolism and promote a faster time to discharge home (9). in fact, there are many factors to consider in the anaesthetic techniques to deploy in preeclamptic and eclamptic women undergoing caesarean section. several authors have reported the safety and efficacy of spinal, epidural and cse anesthesia for caesarean section (cs) delivery in women with pre –eclampsia (7, 8, 11). in the study by okafor uv et al on retrospective study on the management outcome of anaesthesia among pre-eclamptic/ eclamptic parturients introduction pre-eclampsia and eclampsia are recognized hypertensive disorders of the second half of pregnancy. pre-eclampsia is a hypertensive disorder of pregnancy in which there is hypertension (systolic blood pressure 140mmhg and a diastolic blood pressure 90mmhg and proteinuria of 300gram or more occurring after 20weeks of gestation, measured on two different occasion at least 4 to 6 hours apart in a woman previously known to be normotensive (1, 2). severe pre-eclampsia supervenes when the systolic blood pressure becomes 160mmhg and or diastolic blood pressure 110mmhg in the presence of proteinuria with some other clinical features such as headache, epigastric pain /right hypochondrial tenderness, photophobia e.t.c.. the clinical presentation may be influenced by the severity of the illness and modified by pre-existing comorbidity and treatment. they are challenging complications of pregnancy. they are also associated with increased maternal and fetal morbidity and mortality, as well as high demands on health resources. eclampsia is a severe complication of pre-eclampsia that manifest with one or more generalized seizure and or coma in the absence of other neurologic conditions before, during or after labor (3). risk factors for eclampsia include preexisting hypertension or renal disease, previous severe preeclampsia or eclampsia, nulliparity, multiple gestation, molar pregnancy, or eclampsia, non -immune hydrops fetalis, and systemic lupus erythematosus (4). the differential diagnosis includes hypoglycemia, hyponatremia, hypocalcemia, epilepsy, cerebral m a l a r i a , c e r e b r a l i n f a r c t i o n , c e r e b r a l hemorrhage, subarachnoid hemorrhage, cerebral e d e m a , c e r e b r a l a b s c e s s , m a l i g n a n t hypertension, benign and malignant cerebral tumors, and viral, bacterial, parasitic infestations (5, 6). due to the high risk of morbidity and mortality that hypertensive disorders of pregnancy pose to both the foetus and the mother, delivery as soon as feasible is the standard treatment. thus, many of them will require caesarean section under anaesthesia. in the past, spinal anaesthesia was considered unsafe for preeclamptic and eclamptic parturients undergoing caesarean sections due to the risk of hypotension and the uteroplacental hypoperfusion (5, 6). more recent studies have demonstrated that spinal anaesthesia is a safe technique as postspinal hypotension is less common, less severe ≥ ≥ ≥ ≥ res. j. health sci. vol 11(2), june 2023 150 anaesthesia techniques in pre-eclampsia/eclampsia patient fatungase et al. presenting for caesarean delivery in enugu (nigeria), overall deliveries were 3, 926 with 4, 036 births, only 898 women had abdominal delivery (12). among the parturients that had abdominal deliveries, 125 (14%) presented with pre-eclampsia/ eclampsia in which 103 (82.4%) had emergency caesarean section while 22 (17.6%) elective cs. general anaesthesia was mostly used 116 (92.8%) and subarachnoid block was employed only in nine patients. the major indication for caesarean sections was severe preeclampsia or eclampsia in patients with unfavourable cervix (68%). a total of six maternal deaths were recorded among those who experienced general anaesthesia giving a case fatality rate of 5.2% or 4.8% of caesarean deliveries. possible causes of death included anaesthesia in three patients, cerebrovascular accident and pulmonary oedema in two and intraoperative haemorrhage in one. there were thirteen still births and ten neonatal deaths. conclusion from the study was that the use of spinal anaesthesia should be encouraged in view of recent favourable reviews and cheaper cost. furthermore, conclusion drawn from a prospective study on analysis of general versus spinal anaesthesia for caesarean delivery by ravi t et al in asia among sixty parturient with similar socio-demographics who had been diagnosed to have severe pre-eclampsia, also support that spinal anaesthesia should be considered as first choice of anaesthesia technique for severe preeclamptic parturient (13). this study aims to describe the different anaesthesia techniques and their outcomes among pregnant women with pre-eclampsia or eclampsia who had abdominal deliveries for preeclampsia or eclampsia in our tertiary health facility. materials and methods hospital research ethics committee (hrec) approval number oouth/hrec/455/2021ap was obtained from the hospital before the conduct of this study. a descriptive retrospective study was undertaken for all the obstetric patients who had caesarean sections for preeclampsia or eclampsia under various types of anaesthesia. the study was conducted by the department of anaesthesia and intensive care. the institution serves as a referral centre to all the suburbs adjoining villages and towns, primary and secondary health centres as well. it is a 300-400 beds hospital. medical records of all the pregnant women presenting with pre-eclampsia and eclampsia (between january 1st 2014 and december 31st 2018 inclusive) and had caesarean sections in our health facility were critically reviewed and their relevant data were included in the study. the data excluded were for women with pre-eclampsia/ eclampsia who eventually delivered their baby (ies) per vaginam, those with missing case records, and those with inappropriate or incomplete information. data were obtained from obstetric theatre records, patients' anaesthetic charts and case files. data collected included: age, gravidity, booking status, incidence of pre-eclampsia and eclampsia, american society of anaesthesiologist of physical health status (asa), nature of surgery (electives or emergency), duration of surgery, time of the day the surgery was performed (working or call hours), anaesthesia techniques, anaesthesia complications and outcome of management. relevant clinical data obtained were entered into a proforma designed for the study. data obtained were analyzed using statistical package for social sciences (spss) version 20 chicago il.usa. results were presented descriptively, tables and figures. results the records of 182 patients were reviewed. the age ranged was from 16 to 44 years with a mean age was 29.71 ± 6.40years. table 1: shows the clinico-surgical parameters of the patients. one hundred and thirty-four (74%) pregnant women presented with pre-eclampsia while forty-eight (26%) of them were diagnosed to have eclampsia during the study period. majority (96, 53%) of the patients were primigravidae. a total of one hundred and fiftyseven patients (86.26%) were un-booked for antenatal care at the hospital, out of which 48 (26.7%) were eclamptic patients and 109 (60%) were pre-eclamptic women. some of the patients have single risk factors (101, 55.50%) while others have multiple risk factors (81, 44.50%) that increase the development of pre-eclampsia/ eclampsia. the factors consider in this study included primigravida, age more than 40years, multiple gestations, previous history of preeclampsia/eclampsia, presence of comorbidity such chronic hypertension, migraines, diabetes mellitus, sickle cell diseases. table 2 shows the anaesthetic indices of the patients. all the caesarean sections were performed as emergencies. the mean duration of the surgery was 58.50±23.79 minutes. there was no postanaesthetic complication recorded in 64 patients (80.0%) while thirty-six patients res. j. health sci. vol 11(2), june 2023 151 anaesthesia techniques in pre-eclampsia/eclampsia patient fatungase et al. ( 2 0 . 0 % ) d e v e l o p e d p o s t a n a e s t h e t i c complications as shown in table ii below. one hundred and seventy-one patients (94. 00 %) were discharged to the post-natal ward in stable clinical state (even though two of them required admission into intensive care unit) while eleven patients (6.04%) died on the operating table as shown in table 1. there was total of 196 new born, out of which 50 babies were born from eclamptic mothers and 146 babies from pre-eclamptic mothers. twenty sets of twins were delivered, i.e from 18 pre-eclamptic and 2 eclamptic mothers. also there were two sets of triplets from two preeclamptic mothers but none from the eclamptic mothers. there were one hundred and seventy singletons, forty-six were from eclamptic mothers while 124 singletons were from preeclamptic mothers. table 3 shows that higher apgar score were obtained from babies d e l i v e r e d b y c a e s a r e a n s e c t i o n u n d e r subarachnoid block compared to general anaesthesia. figure 1 shows the frequency distribution of anaesthesia technique against severity of the diseases. discussion findings from this study showed that the incidence of parturients presenting with preeclampsia and eclampsia for caesarean section was observed to be most common (23.6%) among young parturient especially age group between 24-27years. also majority (53%) were primigravidae who do not had any booking experience for ante-natal care. further observation showed that all the eclamptic women were un-booked and had emergency caesarean section. this finding agreed with the previous studies where over 90% of the eclamptic patients were un-booked (14,15). this observation showed that lack of experience in pregnancy might play a role in the burden of this condition. therefore, all primigravidae should develop good health care-seeking behavior and regular antenatal visit to ensure proper decision making. similar finding was observed in the study by sotunsa et al (15) on retrospective analysis of eclampsia as a major cause of maternal and perinatal mortality in sagamu were 78.6% and these patients were primigravidae. primigravida is one of vital risk factors associated with pre-eclampsia/eclampsia (14,16), although, women who had pre-eclampsia in a previous pregnancy is seven times more likely to develop pre-eclampsia in later pregnancy (17). obesity/ overweight parturient are more likely to have pre-eclampsia in more than one pregnancy (17). age: women older than 40years old are at higher risk (18). other factors includes: disease conditions such as chronic elevated blood pressure; migraines; diabetes mellitus, multiple gestation, african-american ethnicity et.c (19, 20). in this study, those who have single factors for pre-eclmpsia/eclampsia were 101 patients while those with multiple factors were 81 patients. the role of anaesthesiologist in the management of pre-eclampsia/ eclampsia is to help the obstetrician to control the patient's blood pressure, provide labor analgesia and safe anaesthesia for cesarean section. also to control and prevent further convulsions, establish a clear airway and prevent major complications in eclamptic women. time of presentation (working hours/ call-hours) of patients to hospital on the choices of anaesthesia techniques coupled with patient's socio-economic factors (poverty, logistics and literacy) often posed challenges to obstetricians and anaesthetists when faced with patients who may lose significant volume of blood (e.g higher multiparity, multiple gestations and previous cs scar) perioperatively in setting where crossmatched blood and colloid availability is limited (21). studies have shown that the day of the week or time of emergency cesarean section had no influence on the anaesthesia service as measured by the decision delivery interval (22). however, time of patient's presentation is not the key important variable; but neonatal and parental outcome in this study. there are controversies surrounding the appropriate anaesthetic technique for preeclamptic and eclamptic parturients. safety of spinal anaesthesia was studied by razzaque et al and afolayan et al and they concluded that spinal anaesthesia is safer than general anaesthesia for eclamptic women who are conscious (23, 24). this finding is in concordance with our findings as mortality was more in general anaesthesia (47%) as compared to in subarachnoid block (sab) (1.8%). the increase in mortality in general anaesthesia may however be associated with severity in the pre-operative clinical state, and presence of poorly controlled pre-existing medical conditions. on the other hand, study by adamu et al showed that general anaesthesia was the most (87.18%) common anaesthetic technique employed for eclamptics, because most of the patients that presented to their centres were either unconscious or presented late (25). the high case fatality rate for eclampsia managed in icu as demonstrated by adamu et al's study res. j. health sci. vol 11(2), june 2023 152 anaesthesia techniques in pre-eclampsia/eclampsia patient fatungase et al. res. j. health sci. vol 11(2), june 2023 153 could be reduced by regular public enlightenment on eclampsia in our environment and also to encourage a good team work among the members (25). a prospective cohort comparative study by aya et al established that pre-eclamptic parturient women experience less hypotension when compared to normal parturients (8). this finding resonates with the low incidence of hypotension of 8.97%; though we did not find out the incidence of hypotension in noneclamptic and pre-eclamptic parturients in this study. the safety of spinal, epidural and combined spinal epidural (cse) anesthesia for caesarean section delivery in women with pre-eclampsia has been described (11). it is noteworthy that although, the use of general anesthesia in such high risk parturient may not only further increase the blood pressure, but the exaggerated cardiovascular response to intubation may lead to increased maternal intracranial pressure, cerebral hemorrhage and cardiac failure with pulmonary oedema thereby resulting in adverse maternal and fetal outcome (26,27). similarly, an exaggerated pressor response to intubation may also increase t h e m a t e r n a l p l a s m a c a t e c h o l a m i n e concentration, which in turn leads to uteroplacental vasoconstriction and adverse neonatal outcome (28,29,30). therefore, it important to suppress these pressor responses by administration of intravenous drugs such as lidocaine, esmolol, ultra-short acting opioid e.t.c. prior intubation. sufficient placental blood flow is mandatory for the wellbeing of the fetus. balance between uterine perfusion pressure and uterine vascular resistance should be maintained. the impact of regional anaesthesia on uterine blood flow is controversial. the commonly performed regional anaesthesia among parturients with pre-eclampsia include spinal anaesthesia, epidural analgesia/anaesthesia or combined spinal epidural (cse) anaesthesia. regional anaesthesia may causes a decrease in plasma catecholamines level with potential to increase uterine blood flow (31). the sympathetomy effects of neuraxial block enhances intervillous blood flow in preeclamptic parturients by causing vasodilation of uteroplacental beds (30, 31) anaesthetists should maintain vigilance toward the pulmonary function, urinary output, evidence of aortocaval compression and epidural-induced systemic hypotension that may lead to decreased uteroplacental blood flow. small incremental intravenous doses (50µg) of phenylephrine may be used to treat hypotension temporarily while additional intravenous fluid is infused judiciously. regional anesthesia (ra) not only avoids the maternal complications with general anaesthesia like difficult intubation, and pressor response to intubation, but also improves uteroplacental blood flow and neonatal outcome. this was observed in our study as 10.3% of babies born to conscious eclamptic mothers that had subarachnoid block (sab) had severe birth asphyxia while 55% of neonates born to eclamptic paturient mothers who had general anaesthesia had severe birth asphyxia. contributory factors to low apgar scores in eclamptic parturient could be multifactorial and these include gestational age at which the eclampsia manifested, and presence of poorly controlled pre-existing maternal medical conditions. regional anaesthesia have been associated with better apgar score at 1 min and 5 min compared to general anaesthesia with use of systemic opioids as intraoperative analgesia; however, long-term effects on fetal brain development is not clear (32). it was surprising that neither epidural analgesia/ anesthesia nor combined spinal epidural anaesthesia was employed for any of our patients in this study, despite the numerous benefits it offers. these benefits include modification and extension of block through indwelling catheter, possibility of top up doses, with maintenance of hemodynamic stability as compared with spinal anesthesia. this may probably be due to the fact that most of these patients were un-booked and were seen during the call hours as emergency caesarean. furthermore, the technique of epidural blocks could be time consuming and may be technically difficult in inexperienced hands and the patient is not properly positioned due to severe labour pains. one of the complications of severe preeclampsia/ eclampsia that may either be of cardiogenic or non-cardiogenic origin is pulmonary oedema (33). cardiogenic pulmonary oedema is due to impaired left ventricular systolic or diastolic function. the presence of low cardiac output (co), high pulmonary capillary wedge pressure (pcwp), high central venous pressure (cvp), and high systemic vascular resistance (svr) characterizes systolic dysfunction. on the other hands, diastolic dysfunction is associated with normal or high co, high pcwp, and a normal svr. non-cardiogenic pulmonary oedema results from such factors as increased capillary permeability, iatrogenic fluid overload, an imbalance between colloid osmotic pressure (cop) and hydrostatic pressure, or a combination anaesthesia techniques in pre-eclampsia/eclampsia patient fatungase et al. res. j. health sci. vol 11(2), june 2023 154 of these factors. in this study, pulmonary oedema was the most common cause of death among parturient with severe pre-eclampsia or eclampsia, followed by pulmonary embolism and disseminated coagulopathy. women with pre-eclampsia are at increased risk of thromboembolic disease but this can be ameliorated. for the preventive measure against emboli phenomenon, we recommend that before delivery, all patients should have antiembolic stockings or low molecular weight heparin while immobile. following delivery, low molecular weight heparin (dose adjusted on early pregnancy weight) should be given daily until the patient is fully mobile (seven days if delivered by caesarean section). low molecular weight heparin should not be given until 4-6 hours after spinal anesthesia. also when indicated an epidural catheter should be left in place for at least 12 hours after low molecular weight heparin administration. following removal of an epidural catheter low molecular weight heparin should not be given for 4-6 h (34). prevention of overzealous preloading with intravenous fluids and meticulous monitoring of in-put/out-put fluids maintenance will go a long way to minimize iatrogenic fluid overload which may precipitate pulmonary oedema. conclusion the common anaesthetic techniques used for pre-eclamptic and eclamptic parturient mothers going for caesarean section in our health facility were subarachnoid blocks, general anaesthesia relaxant technique, and general anaesthesia spontaneous with or without local anaesthetic infiltration but spinal anaesthesia was the most used. the anaesthesia outcome in the patients were relatively good because majority of the patients presented in conscious state with few of them (the eclamptic parturient) being drowsy, so spinal anaesthesia could still be employed if there is no other contra-indications. spinal anaesthesia is a relatively safe anaesthetic technique for parturient with pre-eclampsia requiring caesarean section. it could be considered as first choice of anaesthetic technique in a pre-eclamptic patient and with careful patient selection in conscious eclamptic paturients for lower segement caesarean section. also, epidural anesthesia can as well be given safely if the patient is conscious, seizure free with stable vital signs with no signs of raised intracranial pressure (icp) or any other contraindications. limitations some limitations are notable in this study. this was a retrospective study and it was not possible to have full detailed information about the patients' characteristics. among the eleven patients who died on the operation table had no definitive cause of death probably because post morten examination was not performed for social, financial or religious reasons. thus, the fact that the cause of the death were mere suspicious was a limitation of this study. recommendations 1. there is need for increased public enlightenment especially for primigravidae so as to ensure timely antenatal care booking and regular antenatal visits. 2. improving care for women during pregnancy and around the time of childbirth to prevent and treat pre-eclampsia and eclampsia is a necessary step towards the achievement of the health targets of the sustainable development goals (sdgs). a c k n o w l e d g e m e n t s : t h e a u t h o r s acknowledged the entire members of the departments of information management and obstetrics and gynaecology, oouth, sagamu ogun state. conflict of interest: none. references 1. jayavelan r, nidisharma. anaesthesia in severe preeclampsia. open access journal translational medicine and research. 2018; 2 (5):134-136. 2. leslie d, collis re. 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[version 2; peer review;2 approved. f1000 research. 2017; 61977.https://doi:org/10.12688/f1000research.1 3058:2 22. dunn cn, zhans q, sia jt, assan pn, tagore s, sing bl. evaluation of timings and outcome in category-one caesarean section: a retrospective cohort study. indian journal of anaesthesia. 2016;6 0(8):548 23. razzaque m,rahman k, sashidharan r. spinal safer than ga for lscs in eclamptic (abstract).anesthesiology. 2001; 94: a34. 24. afolayan jm, olofinbiyi ba,ipinnimo om. spinal anaesthesia in a restless eclampsia with undiagnosed second twin: case report. the pan afr med j 2015; 20:110 25. adamu sadiq abubakar, mohammed bukar, aliyu usman el-nafaty, mohammed bala audu, gyadale abdulhamid, babagana mulima, ahmed muhammed, audit of anaesthetic management of eclamptic patients for caesarean section in the north-eastern, nigeria, international journal of anesthesia and clinical medicine. 2015; 3 (2) 69. 26. mattar f, sibai bm. eclampsia viii. risk factors for maternal morbidity. am j obstet gynecol. 2000; 182: 307-12. 27. nelson lg, centre for maternal and child enquiries. chapter 3: pre-eclampsia and eclampsia.saving mothers lives reviewing maternal deaths to make motherhood safer: 20062008. the english report of the confidential enquiries into maternal deaths in the united kingdom. br j obstet gynecol. 2011:118 (suppl 1): 1-203 28. cantwel r, clutton-brock t, cooper g et al saving mother's lives: reviewing maternal death to make motherhood safer: 2006-2008. the eight report of the confidential enquiries into maternal deaths in the united kingdom. br j obs & gyn 2011; 118:1-203. 29. dye ra, els l, farbas j, torrgi, schoerman lk, james mf. prospectives randomized trial comparing general with spinal anaesthesia for cesarean delivery in preeclampsis patients with a non-reassuring fetal heart trace. anaesthesiology 2003; 99:561-569. 30. parthasarathy s, hernanth vr, kumar r, sripriya mr. anaesthetic management of a patient presenting with eclampsia anesth essays res. 2013; 7(3):307-312. 31. u t e r o p l a c e n t a l b l o o d flow.https//www.openanaesthesia.org 32. reynolds f. labor analgesia and the baby: good news is no news. int j obstet anesth.2011; 20:38–50. anaesthesia techniques in pre-eclampsia/eclampsia patient fatungase et al. res. j. health sci. vol 11(2), june 2023 156 33. thornton ce, von dadelszen p, makris a, tooher jm, ogie re, hennessy a. acute pulmonary oedema as a complication of hypertension during pregnancy. hypertension in pregnancy 2011; 30: 169179. 34. horlocker tt, wedel dj, rowlingson jc, enneking fk, kopp sl, benzon ht, et al. regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: american society of regional anesthesia and pain medicine evidence-based guidelines. reg anesth pain med. (3rd ed) 2010; 35:64– 101. anaesthesia techniques in pre-eclampsia/eclampsia patient fatungase et al. res. j. health sci. vol 11(2), june 2023 157 anaesthesia techniques in pre-eclampsia/eclampsia patient fatungase et al. table 1: clinico-surgical parameters of the patients parameter frequency (n) percentage (%) 1. age group (years) 16-19 20-23 24-27 28-31 32-35 36-39 40-44 total 9 25 43 27 37 30 11 182 5.0 14.0 23.0 15.0 20.3 17.0 6.0 100.0 2. hours of duty when surgery was performed call hours (4pm-8am) working hours (8am-4pm) total 60 122 182 33.0 67.0 100.0 3. outcome of surgery alive intraoperative death total 171 11 182 94.0 6.0 100.0 4. possible causes of intraoperative death (in 11 patients) acute pulmonary oedema pulmonary embolism disseminated intravascular coagulopathy total 4 4 3 11 2.20 2.20 1.60 6.0 table 2: anaesthetic indices of the patients parameters frequency (n) percentage (%) 1. asa classifications • i e • ii e • iii e • iv e total 0 39 133 10 182 0.0 21.0 73.0 6.0 100.0 2. anaesthetic techniques • subarachnoid block • general anaesthesia relaxant • general anaesthesia spontaneous total 165 15 2 182 91.0 8.0 1.0 100.0 3. outcome of anaesthesia • uneventful • shivering • hypotension • nausea total 64 19 16 2 100 80.0 9.0 10.0 1.0 100.0 res. j. health sci. vol 11(2), june 2023 158 anaesthesia techniques in pre-eclampsia/eclampsia patient fatungase et al. table 3: neonatal outcome using apgar score at 1 minute post-delivery general anaesthesia (ga) subarachnoid block (sab) apgar 0-3 4-6 7-10 0-3 4-6 7-10 preeclampsia 0 4 10 0 20 112 eclampsia 11 2 7 3 9 18 key: ga ………. general anaesthesia sab ……… subarachnoid block apgar …… neonatal resuscitation scoring system. 0-3=severe birth asphyxia 4-6 = mild –moderate birth asphyxia 7-10= good, healthy figure 1: frequency distribution of anaesthesia technique against severity of disease ? total number of newborn was 197 ? total number of newborn with severe perinatal asphyxia (apgar </= 3/10) was 14 ? they were all by mothers with eclampsia ? 21% (3 neonate) were born to mother who had sab ? 78% (11 neonate) were born to mothers who had ga rjhs 11(1).cdr premature progesterone rise incidence & its effects on in vitro fertilization cycles 1 2 2 3 4 abiodun o.m. , omobuwa a.o. , fakunle a.g. , oluwagbaye v.t. , komolafe m.o. , 3 1 1 1 adewale o. , akindele a.a. , fasanu a.o. , komolafe j.o. abstract background: ovarian stimulation using gonadotropins is associated with premature progesterone rise (ppr) in late follicular phase compared to natural cycle. two schools of thoughts exist concerning implications of ppr during late follicular phase with one insisting that outcome of in vitro fertilization (ivf) is adversely affected when ppr occurs while the second school of thought argues that ppr has no adverse effect on ivf outcome. the study is aimed at determining the incidence of ppr in the cohort data evaluated; pregnancy rates across the sides of adopted cut-off level of progesterone and association if any between ppr & pregnancy rates. methods: it was a descriptive retrospective cohort study of data of 114 patients and egg donors.. analysis of continuous & categorical data was done using ibm spss statistics 25. results: mean serum progesterone on hcg day of ivf cycle among the cohort was 2.490±1.355 with a ppr incidence of 55%. the odds of having ppr was 6.7 times higher among subjects with follicular number more than 13 compared to subjects with follicular numbers ≤ 13 . number of follicles retrieved & age of subjects were strongly associated with progesterone level. the odds of subject with ppr getting pregnant was found to be 1.5 times less compared to the subjects with pre-hcg p4 < 1.5ng/ml. conclusion: pre-hcg progesterone level is positively associated with pregnancy outcome in ivf cycles keywords: ovarian stimulation, premature progesterone rise, ivf outcomes. *corresponding author komolafe, j.o. email: johnson.komolafe@uniosun.edu.ng 1 department of obstetrics & gynaecology, college of health sciences, osun state university,osogbo. 2department of public health, college of health sciences, osun state university, osogbo. 3 ayomide women's health specialist hospital & ivf centre, osogbo 4 department of nursing services, renal unit, uniosunteaching hospital,osogbo. orcid-no: https://orcid.org/0009-0003-9414-5082 received: october 18, 2022 accepted: march 7, 2023 published: april 19, 2023 original article research journal of health sciences res. j. health sci. vol 11(1), march 2023 1 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.1 incidence de la montée prématurée de la progestérone et ses effets sur les cycles de fécondation in vitro 1 2 2 3 4 abiodun o.m. , omobuwa a.o. , fakunle a.g. , oluwagbaye v.t. , komolafe m.o. , 3 1 1 1 adewale o. , akindele a.a. , fasanu a.o. , komolafe j.o. résumé contexte général de l'étude: la stimulation ovarienne à l'aide de gonadotrophines est associée à une augmentation prématurée de la progestérone (app) en phase folliculaire tardive par rapport au cycle naturel. deux écoles de pensée existent concernant les implications de l'app au cours de la phase folliculaire tardive, l'une insistant sur le fait que le résultat de la fécondation en vitro (fev) est affecté négativement lorsque l'app se produit, tandis que la deuxième école de pensée soutient que l'app n'a aucun effet négatif sur le résultat de la fiv. but et objectifs de l'étude: déterminer l'incidence de l'app dans les données de cohorte évaluées ; taux de grossesse sur les côtés du niveau seuil de progestérone adopté et association, le cas échéant, entre l'app et les taux de grossesse. méthode de l'étude: il s'agissait d'une étude de cohorte rétrospective descriptive des données de 114 patients et donneurs d'ovules. l'analyse des données continues et catégorielles a été effectuée à l'aide d'ibm spss statistics 25. résultats de l'étude : la progestérone sérique moyenne le jour hcg du cycle de fev parmi la cohorte était de 2,490 ± 1,355 avec une incidence d'app de 55 %. la probabilité d'avoir une app était 6,7 fois plus élevée chez les sujets ayant un nombre folliculaire supérieur à 13 par rapport aux sujets ayant un nombre folliculaire ≤ 13 . le nombre de follicules récupérés et l'âge des sujets étaient fortement associés au niveau de progestérone. la probabilité que les sujets atteints de ppr tombent enceintes était 1, 5 fois inférieure à celle des sujets avec p4 pré-hcg < 1, 5 ng/ml. conclusion: le niveau de progestérone pré-hcg est positivement associé à l'issue de la grossesse dans les cycles de fev mots-clés : stimulation ovarienne, augmentation prématurée de la progestérone, résultats de la fev. *corresponding author komolafe, j.o. email: johnson.komolafe@uniosun.edu.ng 1 department of obstetrics & gynaecology, college of health sciences, osun state university,osogbo. 2department of public health, college of health sciences, osun state university, osogbo. 3 ayomide women's health specialist hospital & ivf centre, osogbo 4 department of nursing services, renal unit, uniosunteaching hospital,osogbo. orcid-no: https://orcid.org/0009-0003-9414-5082 received: october 18, 2022 accepted: march 7, 2023 published: april 19, 2023 article original research journal of health sciences res. j. health sci. vol 11(1), march 2023 2 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.1 materials and methods a descriptive cross-sectional study was employed. subjects were seen during ivf cycles at ayomide women's health specialist hospital & ivf center, osogbo, nigeria. a total of one hundred and eleven (111) ivf cycles were carried out between january 1 and june 30, 2021 in which superovulation was done, with down regulation effected either by gonadotropin releasing hormone agonist or antagonist, and pre-hcg trigger progesterone assay was reviewed. all the ivf cycles took place within the period under review with 62 of the cycles being egg donor cycles. patients were divided into two groups of progesterone level on pre-hcg trigger day ≤1.5 and >1.5 and further subdivided into buserelin group (84 patients), day 5 cetrotide group (9 patients) and day 6 cetrotide group (18 patients) women undergoing superovulation in ivf cycles had routine infection screening (hiv, hepatitis b, syphilis), blood group, genotype, packed cell volume, and hormonal assay evaluation (anti mullerian hormone, fsh,lh, prolactin, tsh,t3,t4). ovarian hyper stimulation was done using human menopausal gonadotropin (hmg) for ten days using 225iu dose in the first six days & 150 i.u on day 7 to day 10 of stimulation. down regulation was carried out with either buserelin injection 0.5mls subcutaneously a d m i n i s t e r e d f r o m s e v e n d a y s b e f o r e commencement of hmg administration (agonist cycle) or cetrotide injection 0.25mg administered subcutaneously from day 5 or day 6 of ovarian stimulation with hmg (antagonist cycle) transvaginal ultrasound scans were done on day 1, day 6, day 10 of stimulation for follicular r e s p o n s e m o n i t o r i n g w h i l e p r e h c g progesterone assay was done day 10 of stimulation. hcg 10,000iu was administered on day 10 if at least one oocyte was seen with diameter ≥ 16mm. in cycles where pre-hcg follicular count exceeded 18, hcg dose was reduced to 5000i.u. in this study, premature progesterone rise was defined as progesterone assay level >1.5ng/ml on pre-hcg trigger day. patient characteristics retrieved from electronic medical record data storage were age, body mass index (bmi), gravidity, parity, basal fsh, lh, amh, serum progesterone levels on pre-trigger hcg day, number of follicles retrieved, pregnancy occurrence ( quantitative b-hcg level of ≥ 15i.u/l on day 14 from embryo transfer using fine care machine/kit) and delivery rate. introduction o v a r i a n s t i m u l a t i o n u s i n g gonadotropins is associated with premature progesterone rise (ppr) in late follicular phase compared to natural cycle (1). the incidence of ppr could vary so widely from 13% to 71% (1,2,3) depending on the cut off value used for progesterone level . the ppr incidence occurs in ovarian stimulation cycles whether the pituitary down regulation is achieved using agonist 51,4 35% or antagonist 20-85% (5,6) drugs premature rise in progesterone level prior to or on the day of human chorionic gonadotropin (hcg) administration in invitro fertilization (ivf) cycles has been shown to be inversely related to pregnancy outcomes from adverse endometrial receptivity.(1,2) the cut offs at which pregnancy rate start to decline range from 0.8-2.0ng/ml with cut-off value of 1.5ng/ml being widely used(7,8,9). possible reasons adduced for ppr include luteinizing hormone (lh) rise in follicular phase; rise in human chorionic gonadotropin (hcg) indirectly from the lh component of human menopausal gonadotropin (hmg); enhanced lh receptor sensitivity of the granulosa cells and disproportionate sensitivity in favor of lh sensitivity compared to ovarian response giving higher progesterone/estradiol ratio of more than one. there is also the notion that ppr is directly related to ovarian response i.e the more the follicles, the more the risk of raised progesterone level (1,10). although many studies found that premature progesterone rise before hcg trigger has no significant adverse effect on outcome of ivf (1114), few epidemiological studies found that ppr is inversely proportional to outcome of ivf (1519). whether premature progesterone rise influences ivf outcome remains unclear. what then exactly is the significance of premature progesterone rise in ivf outcome? should determination of ppr continue routinely in ivf cycles or should it be stopped? this study, therefore, aimed to accomplish the following: determine the incidence of ppr in antagonist versus agonist cycle; compared the incidence among antagonist cycles with different days of commencement of gnrh antagonist; determine if the number of follicles retrieved can be used as surrogate in place of progesterone assay in ivf cycles and determine pregnancy rates across divides of progesterone cut off levels. res. j. health sci. vol 11(1), march 2023 3 premature progesterone rise and ivf abiodun et al. inclusion criteria in this study were: down regulation with either buserelin or cetrotide i n j e c t i o n ; s u p e r o v u l a t i o n w i t h h u m a n menopausal gonadotropin; progesterone assay done on pre-hcg trigger day 10. exclusion criteria on the other hand included ivf cycles where no record of progesterone assay was found. progesterone measurement was done by collecting blood samples at hcg trigger. the samples underwent the test with 'the finecare progesterone rapid quantitative test' a fluorescence immunoassay used along with fine care fia system (model no: fs -112) for quantitative determination of progesterone in human serum, plasma or whole blood. the detection limit (analytical sensitivity) is 1.4ng/ml intraand inter-assay precision, expressed as coefficients of variation (cv) is ≤ 15%, with correlation coefficient (r) is ≥ 0.9900. statistical analysis chi-square test and an independent sample t-test were used for categorical and continuous variables respectively. comparison of continuous variables among greater than 2 groups was carried out using analysis of variance ( a n o va ) . t h e r e l a t i o n s h i p b e t w e e n biochemical parameters and progesterone levels was tested using pearson's correlation analysis. furthermore, we used a multivariate linear regression analysis to estimate the predictors of abnormal progesterone levels adjusting for other covariates. all statistical analyses were performed using spss (version 25) at a two-sided p<0.05. outcome definitions were percentage cycle with progesterone level above 1.5ng/ml on hcg trigger day and pregnancy rate among women with progesterone (p4) level ≤1.5ng/ml and among women with p4 > 1.5ng/ml. other measures included age, number of oocytes retrieved & down-regulation groups were recoded into different variables to allow for bivariate analysis in exploring the data more extensively as follows: age groups (years): ≤ 25; 26-35; 36-39; 40-49; ≥ 50; age groups (years): ≤ 34; ≥ 35; oocyte number groups: 1-4; 5-9; 10-18; > 18; down-regulation groups: buserelin; cetrotide day 5 & cetrotide day 6. ethical approval: ethical approval was received from the educational committee of ayomide women's health specialist hospital. all subjects undergoing ovarian hyper-stimulation gave written informed consent as matter of policy. results table 1 shows the mean age across the different types of down regulation and progesterone level cut-off. a total of one hundred and eleven (87.4%) subjects met the inclusion criteria out of the one hundred and twenty seven women who had ovarian hyper-stimulation in the review period. the mean age of women included in this study was 28.59± 6.52 years with mean age of egg donors being 23.48± 2.47 years and was significantly lower than autologous (own) egg subjects mean age of 35.04± 3.69 years (p=0.000). mean age of subjects who had down regulation with buserelin injection was significantly lower compared to those who had cetrotide injection and also the mean age of those who had ppp was significantly lower than those without ppp. the mean bmi of the patients was 2 26.88±4.46kg/m with no difference in mean bmi across either down-regulation groups nor pre-hcg progesterone level cut off. over fourfifth (82.1%) of the subjects were nulliparous while about a third (30.8%) of the subjects had had at least one pregnancy before. the incidence of premature progesterone rise (ppr) in this study was 55% (figure 1) being 48.8% among subjects down-regulated with buserelin and 74.1% among subjects down regulated with cetrotide (table 2). number of follicles was observed to be positively correlated with progesterone level (rho = 0.44; p<0.001) while age (rho = -0.39; p<0.001) and bmi (rho= 0.38; p<0.001) were inversely correlated with progesterone level. (table 3). the incidence of ppr was found to be directly proportional to increasing number of eggs being highest among the group with egg number above eighteen with incidence of 83.9%, also significantly higher among subjects donating eggs compared to autologous (own) egg subjects and among subjects down regulated with cetrotide injection compared to buserelin injection (table 2). the odds of having ppr was 6.7 times higher among subjects with follicular number more than 13 compared to subjects with follicular numbers ≤ 13 (table 4). the chance of having ppr increased with reducing age with 57.4% of subjects in age group < than 26years and only 8.2% of subjects aged 36-39years having ppr (x2= 16.950, p= 0.001). subjects aged 35 & above are 84% less likely to have ppr compared to those aged less than 35 years.(table 4). other association of egg ownership and mode of down regulation in relation to pre-hcg progesterone levels is as shown in table 4. res. j. health sci. vol 11(1), march 2023 4 premature progesterone rise and ivf abiodun et al. in the multivariate regression analysis (table 5), the number of follicles (â = 0.05; p=0.01), and age (â = -0.04; p=0.03) were the variables found to predict raised ppr. figure 2 shows that there is a direct dose response relationship between the number of follicles and progesterone levels with the association becoming significant when number of follicles retrieved ≥14. pregnancy rate among subjects whose pre-hcg progesterone was ≤ 1.5ng/ml was 31.0% compared to 22.2% among subjects with 2 ppr ( x = 0.439. p= 0.507) (figure 3), the odds of subject with ppr getting pregnant was found to be 1.5 times less compared to the subjects with pre-hcg p4 < 1.5ng/ml. delivery rate among subjects whose pre-hcg progesterone was ≤ 1.5ng/ml was 20.7% compared to 16..7% among 2 subjects with ppp ( x = 0.118, p= 0.731), the odds of subject with ppr delivering with one fresh embryo transfer was found to be 1.3 times less compared to the subjects with pre-hcg p4 >1.5. pregnancy rates with different cut off values of progesterone in this study is as shown in table 6. most marked difference was found when cut off progesterone value of 2.0ng/ml was used 30.6% versus 18.2%. no pregnancy was recorded in this study when progesterone level on hcg trigger day was ≥ 5.0ng/ml discussion baseline characteristics: the mean age of own egg subjects in this nigerian review (35.04± 3.69) is comparable to that of martinez et al barcelona, spain (34.5± 3.2) (21) and that of huang et al taipei, taiwan (34.9± 0.10) (23) but our subjects appear older than the review subjects of sangisapu et al mumbai, india whose mean age was (28.94± 3.65) (22). this may speak to ease of access to assisted reproductive techniques in india. premature progesterone rise incidence (ppr): ppr incidence in the review was 55% overall, 44.8% (buserelin group) and 74.1% (cetrotide group). this is similar to the finding of martinez (21) with ppr incidence of 52.3% for the agonist & flare agonist group using leuprolide though the cut off value used for the definition of ppr in martinez study was >0.9ng/ml as opposed to >1.5ng/ml used in our study which could explain why their incidence was slightly higher. our value was higher than that the finding of huang et al that showed incidence of ppr to be 36%. the cut-off used by huang (23) was p4> 1.0ng/ml, it however analyzed subjects that used three different protocols (long agonist, short agonist and antagonist down regulations) compared to ours where patients used two protocols (long agonist & antagonist down regulation), thus difference in values may be explained by difference in cut off values and protocols between the two studies. venetis et al (24) had a ppr of 7.4% overall, 8.3% agonist cycles, 6.8% antagonist cycles but all cycles where gonadotrophin releasing hormone analogue agonist was used as a trigger instead of hcg to prevent ohss were excluded. this may explain why they had extremely low ppr incidence as subjects with higher number of follicles in antagonist cycles with tendency to have high progesterone level were excluded though cut-off value used was > 1.5ng/ml to define ppr like our study . the number of follicles, age, type of eggs used and type of down regulation method used was found to be associated with pre-hcg progesterone level on bivariate analysis with only number of follicles remaining significantly associated with progesterone levels after correcting for confounders using binary logistic regression. the result showed that association becomes significant once number of follicles retrieved is equal to or greater than fourteen. sangisapu et al (22) found that serum progesterone level at pre-hcg & ovum pick up (opu) to be significantly associated with number of follicles retrieved at opu and number of follicles in turn to be positively associated with positive ivf outcome. huang et al (23) found body weight, bmi, estrogen level & clinical pregnancy rate to be additionally associated with duration of progesterone elevation on bivariate analysis but only did multivariate analysis of determinants of clinical pregnancy rate. ashmita et al (26) found human menopausal gonadotropin compared to recombinant fsh, high total dose of gonadotropin >2000iu/l in addition to estrogen level & number of follicles of more than nine ( ≥ 10mm) on hcg day to be associated with high progesterone levels. our findings where incidence of ppr was significantly higher among antagonist down regulated cycles compared to gnrh-agonist down regulated cycle did not agree with results of huang et al (23) & venetis et al (24), it is generally accepted that ppr is higher in agonist cycle compared to antagonist cycle. this could be explained based on selection bias as majority of subjects in the cetrotide group in our study were donor egg subjects who had higher risk of having excessive oocytes with corresponding risk of higher estrogen levels and ppr. many of the studies evaluating ppr res. j. health sci. vol 11(1), march 2023 5 premature progesterone rise and ivf abiodun et al. excluded polycystic ovarian syndrome patients or those with polycystic ovaries on ultrasound scanning. the second reason may be the fewer numbers of subjects in the cetrotide group with ratio 1:3 antagonist: agonist groups. pregnancy outcome: in this study, pregnancy rate was lower (22.2%) among subjects with premature progesterone rise of >1.5ng/ml at prehcg trigger day compared to those with normal level of ≤ 1.5ng/ml and the odd of getting pregnant by subjects with ppr is 1.5 times lower than those with normal pre-hcg progesterone level. the difference in pregnancy rate was most marked when progesterone cut-off of ≥ 2.0 ng/ml was used 30.6% versus 18.2% with odds of almost 2 times lesser chance of pregnancy among the ppr subjects. the differences seen however were not statistically significant. venetis et al (24) recorded similar findings to this study. it showed that live birth rates were significantly reduced if serum progesterone level (p4) was >1.5ng/ml on trigger day after correcting for cofounders. (o.r 0.68 95% ci: 0.48-0.97. the strongest confounder in their study was number of oocytes retrieved with the intermediate group of 6-18 oocytes having statistically detrimental effect compared to >18 & <6 oocytes groups. this study is at concordance with venetis et al study regarding number of follicles versus ppr and live birth rate versus p4 cut off levels but our study did not relate follicular numbers to life birth rates. de cesare et al (27) in agreeing with our study found out that serum progesterone level was inversely related to cumulative pregnancy rate (o.r 0.71 ci: 0.62-0.80) and live birth rate (o.r 0.73 ci: 0.63-0.84). the level became significant especially when progesterone was >1.75ng/ml and when day 3 cleavage embryos were transferred compared to blastocyst. we found most marked difference in pregnancy rates if cutoff value for progesterone level of 2.0ng/ml was used, this study only determined clinical pregnancy rate with fresh transfers not cumulative pregnancy rate in our study. ashmita et al (26) found clinical pregnancy rate to be significantly higher among subjects with progesterone level <1.5ng/ml (33%) compared to those with progesterone >1.5ng/ml( p=0.037). the difference with our study is that the difference the team got was more pronounced than ours and statistically significant. merviel et al (28) in the same vein w i t h o u r f i n d i n g s s h o w e d t h a t s e r u m progesterone level was significantly lower among pregnant women compared to nonpregnant (p <0.01) and that progesterone follicular index of >0.6 and progesterone oocyte index of >0.36/ng/ml/oocyte were more predictive of lower pregnancy rate, thus bringing to fore the correlating nature of both numbers of oocytes retrieved and numbers of follicles above 14mm on hcg day to progesterone level. it differed from our study in that cut-off value used for progesterone was 0.9ng/ml. huang et al (23) found that it is duration of premature rise in p r o g e s t e r o n e > 1 . 0 n g / m l b e f o r e h c g administration rather than one-off measurement of progesterone value on hcg trigger day is inversely associated with ivf outcome( or 0.773, p<0.0001). mio et al found significantly reduced implantation rate in the group that had subtle rise of progesterone level from 1.0 to 2.0ng/ml compared to group that did not have subtle rise of progesterone level. martinez et al & ubaldi et al did not find adverse effect of premature rise of progesterone on ivf outcome though the cut off used for ppr was ≥ 1.0ng/ml as against 1.5ng/ml used in this study. hoffman et al did not find any difference in pregnancy rate at cut of progesterone levels of < 0.9, 1.1 & ≤ 1.4ng/ml but did not evaluate at high cut off of >2.0ng/ml because of sample size. it appears that the difference in whether adverse effect is seen with progesterone elevation lies with the cut-off of progesterone level used. many authors who found significant adverse effects used cut off values ranging from 1.0 to 2.0ng/ml whereas majority of those who did not find difference used cut-off values ranging from 0.4 to 0.9ng/ml. the higher the level of progesterone level on the hcg trigger day, the higher the chances of gradual rise for some days before the hcg day and also the higher the number of follicles more than 14mm seen producing high level of estrogen with ultimate non-synchronous endometrial maturation resulting in missed endometrial receptivity and reduced implantation and eventually clinical pregnancy rates. conclusion elevated progesterone level on hcg trigger day as well as retrieval of oocytes in excess of 13 may be associated with reduction in clinical pregnancy rate in fresh cycles. patients who have less than fourteen oocytes retrieved and or who have less than 1.5ng/ml of progesterone on hcg trigger day can have fresh embryo transfer if no other contraindication is present whereas those who have more than 13 follicles retrieved and or who have hcg day progesterone level>1.5ng/ml may consider freeze-all modality res. j. health sci. vol 11(1), march 2023 6 premature progesterone rise and ivf abiodun et al. and do frozen embryo transfer in next natural or medicated cycle as appropriate as it is abundantly documented that elevated progesterone level neither affect the egg nor embryo quality references 1. elnashar am. progesterone rise on the day of hcg administration (premature luteinization) in ivf: an overdue update. journal of assisted reproduction and genetics. 2010 apr;27(4):14955.. 2. bosch e, valencia i, escudero e, crespo j, simoìn c, remohýì j, et al. premature luteinization during gonadotropin-releasing hormone antagonist cycles and its relationship with in vitro fertilization outcome. fertil steril (2003) 80:1444–9. doi: 10.1016/j.fertnstert.2003.07.002 3. younis js, simon a, laufer n. endometrial preparation: lessons from oocyte donation. fertil steril. 1996;66:873–84 4. givens cr, schriock ed, dandekar pv, et al. elevated serum 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bc, lainas tg. estimating the net effect of progesterone elevation on the day of hcg on live birth rates after ivf: a cohort analysis of 3296 ivf cycles. human reproduction. 2015 mar 1;30(3):684-91. 25. christos a. venetis, basil c. tarlatzis. trying to define the optimal progesterone elevation cut-off in fresh in vitro fertilization cycles: time to evolve our way of thinking fertility and sterility, 2018 ; 110 (4): 634-635.. 26. ashmita j, vikas s, swati g. the impact of progesterone level on day of hcg injection in ivf cycles on clinical pregnancy rate. j hum reprod sci 2017;10:265-70. 27. de cesare r, morenghi e, cirillo f, ronchetti c, canevisio v, persico p, baggiani a, sandri mt, levi-setti pe. the role of hcg triggering progesterone levels: a real-world retrospective cohort study of more than 8000 ivf/icsi cycles. f r o n t i e r s i n e n d o c r i n o l o g y. 2 0 2 0 s e p 23;11:547684. 28. merviel p, bouée s, jacamon as, chabaud jj, le martelot mt, roche s, rince c, drapier h, perrin a, beauvillard d. progesterone levels on the human chorionic gonadotropin trigger day affect the pregnancy rates for embryos transferred at different stages of development in both general and selected ivf/icsi populations. bmc pregnancy and childbirth. 2021 dec;21(1):1-5. res. j. health sci. vol 11(1), march 2023 8 premature progesterone rise and ivf abiodun et al. res. j. health sci. vol 11(1), march 2023 9 table 2: ppr incidence by down regulation, types & numbers of eggs drt bus n= 84 drt ct6 n=18 drt ct5 n=9 drt bus n=84 drt cet n=27 egn <5 n=20 egn 5-9 n=23 egn 10-18 n=37 egn >18 n=31 egt own n=49 egt donor n=62 p4=1.5(%) 51.2 27.8 22.2 51.2 25.9 75.0 65.2 40.5 16.1 61.2 32.3 p4> 1.5(%) 48.8 72.2 77.8 48.8 74.1 25.0 34.8 59.5 83.9 38.8 67.7 x2 5.343 5.269 21.805 9.277 p-value 0.069 0.022 0.000 0.02 drt=down regulation group; bus =buserelin; ct6= cetrotide day 6; ct5= cetrotide day 5; cet= cetrotide day 5 &6; egn= egg number. egt= egg type table 1: baseline characteristics. age bus n= 84 age cet n=27 age p4=1.5 n=50 age p4>1.5 n=61 bmi bus n=25 bmi ct6 n=15 bmi p4=1.5 n=22 bmi p4>1.5 n=8 `mean 27.43 32.19 31.08 26.54 26.12 27.35 27.01 25.36 sd 6.28 6.05 7.19 5.12 3.678 5.588 3.79 4.16 range 23 23 27 18 18 16 12 13 p-value 0.001 0.000 0.447 0.313 bus= buserelin; cet= cetrotide; p4= progesterone; bmi= body mass index table 3: bivariate correlation demographic-biochemical parameters with pre-hcg progesterone level parameter pearson correlation significance(2-tailed) number of follicles 0.441 0.000** age -0.399 0.000** bmi -0.375 0.000** egg ownership 0.341 0.000** down regulation type 0.228 0.016* ** correlation is significant at 0.01 level (2-tailed) * correlation significant at 0.05 level (2-tailed) table 4: bivariate analysis of progesterone levels against demographic/clinico-chemical parameters parameter chi-square risk p-value own egg/donor egg 9.2779 3.316 0.002 age 18-34/35-45 16.950 0.164 0.001 no of follicles 013/14-50 21.759 6.799 0.000 buserelin/cetrotide 5.269 2.997 0.022 premature progesterone rise and ivf abiodun et al. res. j. health sci. vol 11(1), march 2023 10 table 6: pregnancy rates at different progesterone cut-off levels cutoff (ng/ml) pregnacy rate normal p4 (%) pregnancy rate ppr (%) risk x2 pvalue = 1.50 31 22.2 1.595 0.439 0.507 = 1.75 30 23.5 1.393 0.231 0.631 = 2.00 30.6 18.2 1.980 0.686 0.408 = 2.50 26.8 33.3 0.733 0.107 0.743 = 3.00 27.9 25.0 1.161 0.016 0.900 = 5.00 28.9 0 1.063 1.329 0.249 figure 1: pre-hcg progesterone level table 5: multivariate linear regression variables beta t-value p-value no of follicles retreived 0.046 3.446 0.001 age 0.047 -2.196 0.030 days of stimulation 0.012 0.082 0.935 gravidity 0.054 0.383 0.702 premature progesterone rise and ivf abiodun et al. res. j. health sci. vol 11(1), march 2023 11 figure 3: pregnancy rates by progesterone (p4) levels figure 3: pregnancy rates by progesterone (p4) levels figure 2: dose response relationship between the number of follicles & progesterone levels. premature progesterone rise and ivf abiodun et al. rjhs 11(1).cdr psychosocial factors associated with psychiatric morbidity in higher institution students in nigeria 1 2 ,3 4 2 *ogunmodede a.j, adegunloye o, oguntayo r ajokpaniovo m, buhari o.i.n, 5 6 3 bolarinwa o.a, malomo s, oyeleke j abstract introduction: mental health disorders in undergraduates are often undetected and may predispose to other academic and social complications. the objective of the study is to determine the prevalence of probable psychiatric morbidity among students of university of ilorin, nigeria and the psycho-social factors that are associated with psychiatric morbidity in them. methods: socio-demographic questionnaire and the 12-item general health questionnaire (ghq-12) were administered to 3,300 undergraduate students to assess psychosocial variables and psychiatric morbidity respectively. results: about 23.5% of respondents scored >3 using the ghq-12 questionnaire, signifying a likehood of psychiatric morbidity. students from polygamous families were 1.3 times more likely to have ghq scores of >3 than those from monogamous (or=1.276, p=0.026). those who had unemployed fathers were twice more likely to have a ghq > 3 than those with employed fathers. (or=2.084, p=0.005).those who lived in houses with shared toilet facilities were 1.3 times more likely to have ghq >3 (or=1.310, p=0.028) conclusion: this study calls for a careful consideration and modification of the various psychosocial factors associated with pschiatric morbidity in order to ensure a mentally healthy and vibrant student community. keywords: psychosocial factors, university undergraduate, mental morbidity *corresponding author dr a.j. ogunmodede email: busolajane@yahoo.com 1 department of behavioural sciences, university of ilorin teaching hospital, ilorin, nigeria 2 department of behavioural sciences, university of ilorin, ilorin, nigeria 3 department of psychology, university of ilorin, ilorin, nigeria 4 department of counselor education, university of ilorin, ilorin, nigeria 5 department of epidemiology and community health, university of ilorin, ilorin, nigeria 6 department of biochemistry, university of ilorin, ilorin, nigeria received: december 12, 2021 accepted: november 19, 2022 published: april 19, 2023 original article research journal of health sciences res. j. health sci. vol 11(1), march 2023 40 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.5 facteurs psychosociaux associés à la morbidité mentale chez les étudiants d'un institution supérieure au nigéria 1 2 ,3 4 2 *ogunmodede a.j, adegunloye o, oguntayo r ajokpaniovo m, buhari o.i.n, 5 6 3 bolarinwa o.a, malomo s, oyeleke j résumé introduction: les troubles de santé mentale chez les étudiants de premier cycle ne sont souvent pas détectés et peuvent prédisposer à d'autres complications scolaires et socials. objectif de l'étude: déterminer la prévalence de la morbidité psychiatrique probable chez les étudiants de l'université d'ilorin, au nigéria et les facteurs psychosociaux associés à la morbidité psychiatrique chez eux. méthode de l'étude: le questionnaire socio-démographique et le questionnaire de santé générale en 12 points (qsg-12) ont été administrés à 3 300 étudiants de premier cycle pour évaluer respectivement les variables psychosociales et la morbidité psychiatrique. résultat de l'étude: environ 23,5 % des répondants ont obtenu un score >3 en utilisant le questionnaire qsg-12, ce qui signifie une probabilité de morbidité psychiatrique. les étudiants issus de familles polygames étaient 1,3 fois plus susceptibles d'avoir des scores qsg >3 que ceux issus de familles monogames (or = 1,276, p = 0,026) . ceux qui avaient des pères au chômage étaient deux fois plus susceptibles d'avoir un qsg >3 que ceux dont les pères travaillaient. (or = 2,084, p = 0,005). ceux qui vivaient dans des maisons avec des toilettes partagées étaient 1,3 fois plus susceptibles d'avoir un qsg >3 (or = 1,310, p = 0,028) conclusion: cette étude appelle à un examen attentif et à la modification des divers facteurs psychosociaux associés à la morbidité psychiatrique afin d'assurer une communauté étudiante mentalement saine et dynamique. mots-clés: facteurs psychosociaux, licence universitaire, morbidité mentale *corresponding author dr a.j. ogunmodede email: busolajane@yahoo.com 1 department of behavioural sciences, university of ilorin teaching hospital, ilorin, nigeria 2 department of behavioural sciences, university of ilorin, ilorin, nigeria 3 department of psychology, university of ilorin, ilorin, nigeria 4 department of counselor education, university of ilorin, ilorin, nigeria 5 department of epidemiology and community health, university of ilorin, ilorin, nigeria 6 department of biochemistry, university of ilorin, ilorin, nigeria received: december 12, 2021 accepted: november 19, 2022 published: april 19, 2023 article original research journal of health sciences res. j. health sci. vol 11(1), march 2023 41 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.5 introduction current research all over the world points to an increasing prevalence of psychiatric morbidity among students in higher institutions (1). these psychiatric illnesses range from anxiety, to depression, substance abuse disorders and suicidal behaviours (2,3). the situation in the nigerian student population appears to be similar with this alarming worldwide trend. tertiary institutions all over the world play host to large populations of young people most of whom are within the age range of 16 to 27years (4). this age bracket forms a unique stratum of the society consisting of young people who are forming identities, lifelong friendships, transitioning into adulthood and making important life decisions. this group is also made up of young students who are trying to choose a career path, learning how to withstand peer pressure as well as adjust to a new environment. all of these may form a template for psychological upheavals. several studies have highlighted other possible risk factors that may be responsible for an increase in mental health challenges in this group of young people (5,6,7,8) which include: young age, living away from home for the first time, having to handle finances alone and the stress of tertiary education training. barry et al (9) reported that poor psychological well-being in university students is strongly related to other factors such as lower educational attainments, belonging to a minority ethnic group, substance abuse, history of violence, as well as poor reproductive and sexual health. promoting mental wellness is important in these students as it dictates positive coping with the demands of tertiary education, academic performance as well as cordial relationships with fellow students as well as lecturers. the literature on the enormity of psychological disorders in university students in different parts of the world is rapidly expanding. stallman et al(10) who studied the prevalence of mental health problems among australian undergraduates reported a 12month prevalence of mental disorders of 19.2% and a prevalence of 62.4% for students with sub-syndromal symptoms. inam et al (11) reported that 60% of 113 medical students sampled had anxiety and depression. adewuya et al. reported a prevalence of depression of 8.3% in a study done to assess the prevalence of depression among undergraduate students at the university of lagos (12). in spite of the increased prevalence, there appears to be very few studies in this clime exploring the pattern of psychiatric morbidity in university students and the associated psychosocial factors (13). the objectives of the study were therefore to determine the prevalence of probable psychiatric morbidity among undergraduate students of the university of ilorin, nigeria and to determine the d e m o g r a p h i c , s o c i a l , e d u c a t i o n a l a n d psychological factors that predict psychiatric morbidity in the students. materials and methods study setting: the study was carried out at the university of ilorin (unilorin), one of the second generation public universities in nigeria. it is located in ilorin, kwara state, north-central nigeria (14). the total undergraduate students' enrolment for the 2018/2019 academic session was 44,897(14). the compositions of the departments that make up each faculty can be found at the university website (15). study design this was a cross-sectional study. sample size and sampling technique this study was part of the preliminary phase of a multi-phase, funded institution-based study called the tertiary institution mental health care (tim-care study) (16). the study protocol has been published (16). the unodc recommended sample size of 20003000 for drug related and addiction studies in students (irrespective of the population size) was used (17), because one of the objectives of the preliminary phase was substance use assessment. an attrition rate of 10% which was 300 then added to give the minimum representative sample size of 3300. three thousand, three hundred (3,300) regular, fulltime undergraduate students were proportionately recruited from all faculties across various class levels in the university using a multi-staged sampling method. the duration of study spanned december 2019 to february 2020. the total undergraduate students' enrolment for the year 2018/2019 academic session was 44, 897 into 15 faculties. the different stages of the multi-stage method was as follows stage 1: simple random sampling by balloting without replacement was done to select 2 departments from each faculty stage 2: proportionate allocation (sampling by size method) of students per department at all levels of study except 100 level students who had been excluded from the study. the formula for res. j. health sci. vol 11(1), march 2023 42 psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. proportionate sampling was as follows: n/ n x ni n = the total number of students at the specific department; n = the total number of students at the faculty; ni= the total sample size required for the study at the specific faculty stage 3: systematic random sampling was used to select the predetermined number of students per department. questionnaires were administered in between lecture periods to avoid disruption of lecture a c t i v i t i e s . s e l e c t e d r e g u l a r, f u l l t i m e undergraduate students studying for a degree or certificate course in theuniversity of ilorin were included in the study, while undergraduate students (who had just resumed school) and those that were absent from classat time of administration of questionnaire, or too ill to participate in the study were excluded. study instruments: 1. a semi-structured questionnaire an author-designed semi-structured, selfadministered questionnaire containing five sections which included the socio-demographic information of participants, available social amenities in the respondents' residences and the social and educational support structure of the participants (such as tuition fees, scholarship access, funding for schooling). other sections enquired about factors relating to the lifestyle of the respondents (such as time for leisure, frequency of leisure time,awareness and usage of available recreational facilities) and the relationships of the participants. 2. the 12-1tem general health questionnaire the 12 item general health questionnaire (ghq12) was used in this study to screen for psychiatric morbidity (18). the ghq-12 is p o p u l a r s e l f a d m i n i s t e r e d s c r e e n i n g questionnaire used for assessing psychological wellbeing and probable psychiatric morbidity in various populations including adolescents and young adults (18). the instrument has been found to have high validity, sensitivity and specificity rates (19). the most common scoring methods are bi-modal (0-0-1-1) and likert scoring styles (0-1-2-3). the cutoff point of 3, is considered positive for probable psychiatric morbidity when the bimodal method of scoring is used for community studies. (20). ethical considerations ethical clearance was obtained from the ethical review committee of the university of ilorin (protocol id=uerc/edu/383, approval no: uerc/asn/2020/2007 and informed c o n s e n t o b t a i n e d f r o m e v e r y s t u d e n t participating in the study, after explaining the purpose and process of the study to the participants. only students who gave their full written consent participated in the study. a contact note was provided for those who desired mental health consultation afterwards. data analysis the data generated from this study was analyzed using the statistical product and service solution for social sciences (spss version 20). descriptive statistics were used to summarize the data. continuous variables were expressed as mean + standard deviation, while frequencies of categorical variables were expressed as percentages. student's independent t test was used to compare means of continuous variables. chi square was used to compare proportions of categorical variables. binary logistic regression was then used to identify predictors of psychiatric morbidity. the significance level was set at p<0.05. results of the 3,300 questionnaires distributed, 3,179 were completely filled (response rate=96.33%). a total of 3179 questionnaires from students from different departments and between 200 level and 600 level were analysed. table 1 shows that the mean age of all respondents was 20.6+2.51years and majority of them (53.8%) were 19 to 21 years old. about half, 1610 (50.6%) were males, while 1569 (49.4%) were females. majority (88%) were of yoruba ethnicity. most of the respondents (96.7%) had both parents alive, while only 3.3% had either one or both parents deceased. most students reported a satisfactory relationship with their mother and father and only 2% of all respondents had u n e m p l o y e d f a t h e r s , w h i l e 5 . 3 % h a d unemployed mothers. more than 1400 of the 3179 (45.0%) respondents used private toilet facilities which they shared with other students, 30.1% of respondents had their own personal toilet facilities in their hostels, while 24.9% shared public toilet facilities with many other students in their hostels. concerning relationships, about 88% of these students were in amorous relationships, but res. j. health sci. vol 11(1), march 2023 43 psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. only 46.1% found such relationships very satisfactory. about 4.7% of respondents admitted to having suffered some form of abuse in the past, ranging from financial, emotional to sexual abuse and the most frequent of these three forms of abuse was the emotional abuse (68.7%). only about 1% of respondents admitted to being abused in an on-going relationship and the victims responded to these abusive situations by seeking counseling (23.1%), reporting to family members(15.4%), praying about it(19.2%), reporting to law enforcement agents (15.4%), while about 23.1% did nothing about the abuse, even though it was still ongoing. concerning past medical and psychiatric history of respondents, only 8.2% admitted to having a previous history of psychological i l l n e s s e s , w i t h p s y c h o s i s b e i n g t h e commonest.70.2% of those affected sought traditional and religious forms of treatment, while only 29.8% sought orthodox forms of treatment. only 3.2% of respondents had chronic medical conditions for which they were receiving treatment, with more than half of those affected h a v i n g s o u g h t o r t h o d o x f o r m s o f treatments.satisfaction with course of study was also explored, with about 33.7% of these students were not satisfied with their course of study. about 23.5% of respondents scored 3 and above using the ghq-12 questionnaire, which signified a probable psychiatric morbidity, while 56.2% of the respondents were ghqnegative. an exploration of the social, demographic, relationship and economic factors that were significantly associated with probable psychiatric morbidity in this study were shown in tables 2 and 3 as gender (p<0.001), year of study (p=0.0014), family structure ( p=0.026), relationship with father (p=0.006), relationship with mother (p<0.001), occupation of father (p=0.005), occupation of mother (p=0.026), number of children (p=0.008), type of social group (p=0.003) tables 4, 5, 6 show the factors strongly associated with psychaitric morbidity. the type of toilet facility used by the students in their residences was a predictor, with those who shared public toilet facilities with other students 1.3 times more likely to have ghq scores of 3 and above than those who had their own personal toilets (odds ratio= 1.310, p= 0.028, ci=1.0301.667). the type of family setting of respondents was also predictive of probable psychiatric morbidity with students from polygamous family setting, about 1.3times more likely to have ghq scores of three and above than those from monogamous families(odds ratio= 1.276, p= 0.026, ci=1.030-1.581). the occupation of both the father and mother of respondents were found to be significantly associated with the ghq 2 2 scores (x 8.057, p= 0.005, x 4.925, p= 0.026) = = and both remained as predictors of probable psychiatric morbidity on logistic regression. also, respondents in this study who had unemployed father were about2 times more likely to have a ghq score of 3 and above than those with employed fathers. (odds ratio= 2.084, p= 0.005, ci=1.242-3.497). discussion this study revealed that out 732 of the 3179, (23.5%) students who participated in the study had probable psychiatric morbidity, using the ghq-12. this percentage is similar to those reported in other similar studies in nigeria (21, 22).this may likely be attributed to the fact that studying in a nigerian universitywith very minimal social amenities and student support structures such as student loans and funding, incessant delays in the length of study due to lecturer's strikes among others may be stressful and may form a trigger for emotional upheavals and psychiatric morbidity in these students (23). in this study, less than 10% of respondents admitted to having suffered a psychological disorder in the past and a large proportion of those who admitted this reported that they sought treatment from traditional and religious healers. this finding is so important and reflects the general perception of mental illness in the nigerian society, as being of supernatural causation and so preferably treated by traditional methods or religious methods. this is in keeping with findings from previous studies which explored the attitude and perception of university students aboutmental illnesses and their treatments.(24, 25), this finding also highlights the urgent need for campus and institution based mental health literacy programmes and campaigns to help improve the knowledge of higher institution students,( and by extension, the general public) on the scientific basis of psychological disorders and the successes and need for orthodox treatment methods. in this study, respondents who were less than 18 years had the highest percentage of students who were ghq positive for probable psychiatric morbidity (27.1%), while students who were 25 years and above had the least percentage being ghq positive. this finding is worthy of note, as it may reflect that older students may be used to the demands of res. j. health sci. vol 11(1), march 2023 44 psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. university life and may be psychologically and physically more matured to cope with the stress of studies in the university and so less likely to be psychologically distressed. this finding is in keeping with the study by other researchers in other parts of the world (26, 21), reported that younger students were more vulnerable to the possibility of the development of a psychiatric morbidity than older ones. this study also showed that higher percentage of female students had higher ghq scores indicating a positive probable psychiatric morbidity. this same trend has been reported by earlier workers who reported higher ghq scores in female higher institution students and may possibly be attributed to the fact that females are generally more predisposed to neurotic psychiatric disorders and are more likely to report their symptoms (27) students who shared public toilets in their hostels had higher odds of having probable psychiatric morbidity than those who did not share toilet facilities at all or shared only private toilets. although this particular social amenity may not have not been explored in relation to probable psychiatric morbidity in most similar researches, this finding stands to reason as poorer students may be the ones who may have to live in large clusters and therefore have to share toilet facilities. the relationship between low socioeconomic status and mental illness has been explored by many researchers, with some studies showing psychiatric morbidity being positively correlated with low socioeconomic class. (28, 29) additionally, in this study, a higher percentage of students who had no sanitation facilities in their places of residence had probable psychiatric morbidity using their ghq scores. this is also most likely due to the fact that students from poor homes and very low economic status are likely to secure cheaper apartments, which may not have adequate sanitation facilities. this study revealed that though not significant, the ghq scores of students in the science courses were slightly higher than those in other courses, this finding is not surprising as students in science based courses are likely to have more tedious, time consuming schedules, with very rigorous lecture schedules and practical sessions. all of these may contribute to the stress of learning and hence increase the possibility of a mental illness. we also found that students from polygamous family settings had a higher likelihood of having a probable psychiatric morbidity than those from monogamous family settings. although this factor has not been explored in many other similar studies, it may likely be linked to the fact that in some polygamous homes in africa, there may be internal tensions based on rivalry between children of the different mothers, quarrels and sometimes very keen competition for the available resources (29). this may generate significant emotional distress in students from s u c h h o m e s , t h e r e b y p r e d i s p o s i n g t o psychological distress in them. students with unemployed fathers or mothers had significantly higher ghq scores than those with employed parents. this finding is in keeping with that of other studies done which reported higher probability of psychiatric morbidity in students with unemployed parents (30). this finding is of significance, especially in a country like nigeria, where many students are being sponsored through school fully by their parents, because of scarcity of scholarship opportunities in the country. the attendant financial difficulties from no or low earning parents may create serious emotional upheaval in these students and therefore a predisposition to mental illness. it is also significant to note that in this study,students who had non-cordial relationships with either fellow students or their lecturers had ghq positive scores. this is important, as it is a reflection of the importance of healthy relationships as a stabilizing factor for mental well-being and also underscores the dysfunction in relationships which may occur in the event of psychological disorders (31). although this factor has not been directly explored by most researchers, a study done by tran et al (32) revealed that students who had problems s u s t a i n i n g h e a l t h y f a m i l y a n d s c h o o l relationships were more predisposed to having psychiatric morbidity. this study also found that a slightly higher proportion of students who were not studying their courses of choice had ghq positive scores, this is possibly reflective of the attendant frustration and discouragement which may accompany a student being denied the preferred course of study in the university. such students may also suffer from poor motivation and excessive worry concerning the different course given to them (33) also, a significantly higher proportion of students who were not satisfied with their course of study (either it was originally preferred or not) had higher ghq scores, signifying higher probability of psychiatric morbidity. this finding underscores the importance of inherent satisfaction and happiness with the course which higher institution students study in mental stability. res. j. health sci. vol 11(1), march 2023 45 psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. conclusion t h e c o n t r i b u t o r s t o p s y c h i a t r i c morbidity among students intertiary institutions are varied and include socio-economic factors such as parental income, quality of interaction with peers and parents as well as available social amenities. health-related factors such as history of physical illnesses are also associated with the probability of a mental illness in these group of young people, among other factors. therefore, moderating relevant socio-economic, healthrelated, and study-related variables may be helpful in guaranteeing a mentally healthy student population. conflict of interest: the authors declare no conflict of interest acknowledgement: the authors acknowledge the university of ilorin for funding the project and for permission to carry out this research. references 1 adewuya ao, ola ba, afolabi oo. validity of phq-9 as a screening tool for depression amongst nigerian university students. journal of affective disorders 2006;96(1-2): 89-93. 2 macaskill a. the mental health of university students in the united kingdom. british journal of guidance &counseling.2013;41(4):426-41. 3 haas ap, hendin h, mann jj. suicide in college students. 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mental morbidity among primary care patients in nigeria.compr psychiatry.1993;34(1):10-3. 21 osasona s, morakinyo o, akhibe k. study difficulty amongst undergraduates in a nigerian university: pattern and relationship with p s y c h i a t r i c m o r b i d i t y a n d a c a d e m i c performance. nigerian journal of psychiatry, 2011;9(3) 22 dabana a, gobir aa. depression among students of a nigerian university: prevalence and academic correlates. arch med surg2018;3:6-10 23 amawulu e and kurokeyi e. mental health status of students attending tertiaryinstitutions in bayelsa state, nigeria. journal of public health and epidemiology2018; 10(10): 363-369. 24 idoko ca, udo k, idoko ci. a nigerian tertiary institution students' knowledge and attitude to mental health and services. int j med health dev 2021;26:183-9 25 adewuya ao, makanjuola ro social distance towards people with mental illness amongst res. j. health sci. vol 11(1), march 2023 46 psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. nigerian university students. soc psychiatry psychiatrepidemiol2005;40:865-8. 26 pedrelli p, nyer m, yeung a, zulauf c, wilens t. college students: mental health problems and treatment considerations. acad psychiatry. 2015;39(5):503-511. 27 ibrahim ak, kelly sj, adams ce, glazebrook c. a systematic review of studies of depression prevalence in university students. j psychiatr res 2013;47:391-400. 28 reiss f. socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. socsci med. 2013;90: 24–31. 29 lorant v, croux c, weich s, et al: depression and socio-economic risk factors: 7-year longitudinal population study. british journal of psychiatry 2007; 190:293–298 30 bubonya m, cobb-clark d.a, wooden m. job loss and the mental health of spouses and adolescent children. iza j labor econ2016;6:6-7 31 fujino, n., & okamura, h. factors affecting the sense of burden felt by family members caring for patients with mental illness. archives of psychiatric nursing.2009;23(2): 128-137. 32 tran a, tran l, geghre n, darmon d, rampal m, brandone d, et al. mental distress and associated factors among undergraduate students at the university of hargeisa, somaliland: a crosssectional study. int j ment health syst. 2017; 11:39. 33 rebouillat-savy k, caci h, et al. health assessment of french university students and risk factors associated with mental health disorders. plos one. 2017(11);12 res. j. health sci. vol 11(1), march 2023 47 psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. res. j. health sci. vol 11(1), march 2023 48 table 1: socio-demographic characteristics of respondents variables frequency (%) n=3179 age groups = 18 516 (16.2) 19 – 21 1710 (53.8) 22 – 24 701 (22.1) = 25 252 (7.9) mean ± sd 20.69 ± 2.51 gender male 1610 (50.6) female 1569 (49.4) ethnicity yoruba 2813 (88.5) hausa 182 (5.7) igbo 65 (2.0) nupe 27 (0.8) ebira 37 (1.2) others 55 (1.7) marital status single 3112 (97.9) married 67 (2.1) religion christianity 1586 (49.9) islam 1590 (50.0) traditional 3 (0.1) year of study 200 l 594 (18.6) 300 l 734 (23.1) 400 l 1197 (37.7) 500 l 505 (15.9) 600 l 149 (4.7) accommodation status on campus public 1146 (36.0) on campus private 800 (25.2) off campus 1233 (38.8) psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. res. j. health sci. vol 11(1), march 2023 49 table 2: association between socio-demographic variables and ghq (n = 3,179) variables ghq ÷²/t ñ negative (%) n=2430 positive (%) n=749 age groups (years) = 18 376 (72.9) 140 (27.1) 6.433 0.092 19 – 21 1308 (76.5) 402 (23.5) 22 – 24 543 (77.5) 158 (22.5) = 25 203 (80.6) 49 (19.4) mean ± sd 20.74 ± 2.51 20.53 ± 2.50 1.959 0.050 gender 24.597 < 0.001* male 1290 (80.1) 320 (19.9) female 1140 (72.7) 429 (27.3) marital status 0.875 0.350 single 2382 (76.5) 730 (23.5) married 48 (71.6) 19 (28.4) year of study 200 l 480 (80.8) 114 (19.2) 12.574 0.014* 300 l 533 (72.6) 201 (27.4) 400 l 913 (77.4) 284 (23.7) 500 l 391 (77.4) 114 (22.6) 600 l 113 (75.8) 36 (24.2) accommodation status on campus public 873 (76.2) 273 (23.8) 1.911 0.385 on campus private 600 (75.0) 200 (25.0) off campus 957 (77.6) 276 (22.4) psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. res. j. health sci. vol 11(1), march 2023 50 table 3: relationship between parental information and ghq (n =3,179) variables ghq ÷² ñ negative (%) positive (%) parental status 1.801 0.180 alive 2344 (76.3) 730 (23.7) deceased 86 (81.9) 19 (18.1) family structure 4.976 0.026* monogamous 2059 (77.2) 609 (22.8) polygamous 371 (72.6) 140 (27.4) relationship with father 7.667 0.006* satisfactory 2059 (75.6) 665 (24.4) non satisfactory 371 (81.5) 84 (18.5) relationship with mother 20.657 < 0.001* satisfactory 2328 (77.2) 686 (22.8) non satisfactory 102 (61.8) 63 (38.2) occupation of father 8.057 0.005* employed 2392 (76.7) 725 (23.3) unemployed 38 (61.3) 24 (38.7) occupation of mother 4.925 0.026* employed 2312 (76.8) 697 (23.2) unemployed 118 (69.4) 52 (30.6) number of children 7.102 0.008* = 4 1342 (74.7) 455 (25.3) = 5 1088 (78.7) 294 (21.3) member of any social group 0.668 0.414 yes 2133 (76.7) 649 (23.3) no 297 (74.8) 100 (25.2) type of social group 13.791 0.003* student union 401 (75.5) 130 (24.5) political group 1146 (78.9) 307 (21.1) religious group 571 (74.2) 199 (25.8) others 15 (55.6) 12 (44.4) type of support 1.239 0.266 financial 255 (79.7) 65 (20.3) psychological 730 (76.70 222 (23.3) frequency of support 2.691 0.260 always 369 (78.5) 101 (21.5) sometimes 571 (77.3) 168 (22.7) rarely 40 (69.0) 18 (31.0) psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. res. j. health sci. vol 11(1), march 2023 51 table 4: socio-demographic predictors of ghq variables â p-value odd ratio 95% c i gender male (rc) female 0.417 0.001* 1.517 1.286 – 1.790 year of study 200 (rc) 300 0.435 0.001* 1.545 1.189 – 2.007 400 0.239 0.056 1.270 0.994 – 1.622 500 0.168 0.261 1.183 0.883 – 1.587 600 0.338 0.123 1.402 0.913 – 2.154 table 5: social amenities as predictors of ghq variables â p-value odd ratio 95% c i water supply pipe borne water 0.964 < 0.001* 2.623 1.785 – 3.856 borehole 0.391 0.041* 1.478 1.016 – 2.149 well 0.817 < 0.001* 2.265 1.550 – 3.308 tanker supply (rc) toilet facility shared public 0.270 0.028* 1.310 1.030 – 1.667 shared private 0.014 0.895 1.014 0.823 – 1.249 personal (single user) (rc) sanitation facility yes -0.523 < 0.001* 0.593 0.823 – 1.249 no (rc) presence of common room yes 0.386 < 0.001* 1.470 1.232 – 1.755 no (rc) table 6: relationships as predictors of ghq variables â p-value odd ratio 95% c i family structure monogamous (rc) polygamous 0.244 0.026* 1.276 1.030 – 1.581 relationship with father satisfactory (rc) non satisfactory 0.355 0.006* 1.426 1.108 – 1.836 relationship with mother satisfactory 0.740 0.001* 2.096 1.514 – 2.902 non satisfactory rc occupation of father employed (rc) unemployed 0.734 0.005* 2.084 1.242 – 3.497 psychosocial factors associated with psychiatric morbidity in nigerian students ogunmodede et al. rjhs 11(3).cdr field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria 1 2 3 3 1 *surakat, o.a. , sam-wobo, s.o. , golden, a. , de los santos, t. , adeleke, m. a. , 2 2 3 3 3 faulx, d. , ademolu, k.o. , bankole, s.o. , kalnoky, m. , stevens, e. , yokobe, l.3 abstract objective: this study, conducted between march 2015 and july 2016, investigated the sensitivity and specificity of the ov-16 rdt and dried blood spot (dbs) enzyme-linked immunosorbent assay (elisa) for skin snip microfilaria (mf) detection in ogun state. methods: five hundred and eighty-eight (588) members of 16 first-line communities in 8 endemic local government areas (lgas) provided fingerstick whole blood specimens examined for igg4 antibodies against the o. volvulus antigen ov-16, using dbs ov-16 elisa and ov-16 rdt. in consort with these specimens, 162 study participants consented to be evaluated by skin snip. results: results showed a seroprevalence of 106(18.0%) using elisa and 102(17.3%) by rdt, with 92.2% agreement. the ov-16 rdt demonstrated a positive and negative agreement of 76.4 (95% ci 67.2 to 84.1%) and 95.6% (95% ci: 93.4 to 97.3), respectively, to the ov-16 elisa results from the concordant dataset. against the 64 positive skin snips microscopy results, sensitivity of the rdt was 79.7% (95% ci 73.43% to 85.27) and the elisa was 70.3% (95% ci 64.72% to 75.37%). conclusion: the results of this study provided information on the performance of the ov-16 rdt. this information will contribute data for comparison to studies in other areas where treatment is ongoing. in conclusion, the commercial launch of the ov-16 rdt has made available a point-of-care diagnostic tool that could serve to help local and country onchocerciasis elimination programs to measure changes and progress in onchocerciasis intervention. keywords: onchocerciasis, diagnosis, igg4 ov-16 rdt, elisa, ogun state, nigeria *corresponding author surakat, o. a. email: olabanji.surakat@uniosun.edu.ng 1 department of zoology, osun state university, osogbo, nigeria. 2 department of pure and applied zoology, federal university of agriculture, abeokuta, nigeria 3 program for appropriate technology in health (path) 2210 westlake avenue, seattle. wa, usa. received: december 9, 2022 accepted: april 17, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0002-2382-3857 original article research journal of health sciences res. j. health sci. vol 11(3), september 2023 213 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.4 test sur le terrain et la sensibilité du test rapide de l'onchocercose dans l'état d'ogun , au nigéria 1 2 3 3 1 *surakat, o.a. , sam-wobo, s.o. , golden, a. , de los santos, t. , adeleke, m. a. , 2 2 3 3 3 faulx, d. , ademolu, k.o. , bankole, s.o. , kalnoky, m. , stevens, e. , yokobe, l.3 résumé objectif de l'étude: cette étude, menée entre mars 2015 et juillet 2016, a examiné la sensibilité et la spécificité du test immuno-enzymatique (tie) du tdr ov-16 et de la tache de sang séché (tss) pour la détection des microfilaires (mf) dans l'état d'ogun. méthode de l'étude: cinq cent quatre-vingt-huit (588) membres de 16 communautés de première ligne dans 8 zones de gouvernement local (lga) endémiques ont fourni des échantillons de sang total prélevés sur le bout du doigt examinés pour les anticorps igg4 contre l' antigène o. volvulus ov-16, à l'aide de dbs ov16 elisa et ov-16 rdt. parallèlement à ces échantillons, 162 participants à l'étude ont consenti à être évalués par biopsie cutanée. résultat de l'étude : les résultats ont montré une séroprévalence de 106 (18,0 %) par elisa et de 102 (17,3 %) par rdt, avec une concordance de 92,2 %. le tdr ov-16 a démontré une concordance positive et négative de 76,4 (ic à 95 % 67,2 à 84,1 %) et 95,6 % (ic à 95 % : 93,4 à 97,3), respectivement, avec les résultats elisa ov-16 de l'ensemble de données concordant. par rapport aux 64 résultats positifs de microscopie cutanée, la sensibilité du tdr était de 79,7 % (ic à 95 % 73,43 % à 85,27) et celle de l'elisa était de 70,3 % (ic à 95 % 64,72 % à 75,37 %). conclusion : les résultats de cette étude ont fourni des informations sur les performances du tdr ov-16. ces informations fourniront des données pour la comparaison avec des études dans d'autres domaines où le traitement est en cours. en conclusion, le lancement commercial du tdr ov-16 a rendu disponible un outil de diagnostic au point de service qui pourrait servir à aider les programmes locaux et nationaux d'élimination de l'onchocercose à mesurer les changements et les progrès de l'intervention contre l'onchocercose. mots-clés : onchocercose, diagnostic, tdr igg4 ov-16, elisa, état d'ogun , nigéria *corresponding author surakat, o. a. email: olabanji.surakat@uniosun.edu.ng 1 department of zoology, osun state university, osogbo, nigeria. 2 department of pure and applied zoology, federal university of agriculture, abeokuta, nigeria 3 program for appropriate technology in health (path) 2210 westlake avenue, seattle. wa, usa. received: december 9, 2022 accepted: april 17, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0002-2382-3857 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 214 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.4 introduction onchocerciasis, also known as “river blindness,” is an arthropod-borne disease caused by infection with onchocerca volvulus, a parasitic nematode that forms nodules under the skin transmitted by black flies of the genus simulium. it ranks among the highest causes of visual impairment globally [1]. humans are the natural host, with an estimated 120 million people at risk of infection [2,3]. the disease spans continents, with transmission occurring across rural sub-saharan african countries, and in a small focus in yemen in the arabian peninsula, and elimination has recently been confirmed in much of the americas [4,5]. in ivermectin naïve communities of africa, elimination of onchocerciasis transmission is more difficult because of the presence of loa loa (commonly known as african eye worm) and its associated loa-related severe adverse events saes. also, political instability, insecurity and limited access to endemic areas pose additional challenges (4). despite these challenges, onchocerciasis has been targeted for elimination in major african countries by 2025 [6]. over the years, the global impact of the disease on the poor has propelled the world health organization and major international health institutions, including pharmaceutical companies, to support programs aimed at controlling the disease. the donation of ivermectin, a safe and effective micro-filaricide for the treatment of onchocerciasis by (merck & co., kenilworth, nj), resulted in the control of the disease morbidity [7]. elimination of the disease in africa now appears possible following a proof of principle that long-term communitydirected treatment with ivermectin (cdti) targeted at the 15 years lifespan of o. volvulus could result in the elimination of the disease [8, 9, 10]. this has shifted the emphasis from control of onchocerciasis to elimination in africa in view of this, continuous monitoring of the disease is important to determine the impact of treatment for the advised ending of mass drug administration (mda) of ivermectin. diagnosis of the disease had been through the use of skin snip microscopy to detect microfilaria (mf) in the subcutaneous area of the upper iliac crest of an individual [11]. however, the inability to sufficiently detect early infections and low mf density by skin snip microscopy is one of the numerous challenges encountered in the quantification of onchocerciasis prevalence in endemic areas [12]. also, mda surveillance in low-resource settings lacking sophisticated instrumentation has been a challenge to the global efforts to the elimination of onchocerciasis. the immunoassay of the o. volvulus filarial antigen (ov-16) has been found to be highly specific [1317]. the ov-16 immunoassay as an alternative to the invasive skin snip method has the potential for mapping and post-mda surveillance in africa where highly prevalent coincident filarial infections (loa loa and mansonella spp.) confound less specific immunoassays [18]. most useful, however, for programmatic needs would be rapid diagnostic tests (rdts) where central laboratory processing is not needed. recently, a commercial non-invasive rapid assay test kit that is capable of detecting igg4 antibodies specific to ov-16 antigen—intended for post-treatment surveillance and point-of-care assessment from fingerstick blood specimens—has become available [19]. the correct application of this rdt may provide a field-deployable alternative to ov-16 elisa in identifying communities at greater risk of infection and transmission of onchocerciasis, including evidence of previous infection in cases with no mf count. communities will also receive priority attention to prevent further progression of morbidity that may result in blindness and thus, impact on the person's productivity and quality of life [20]. the launch of a commercially available ov-16 rapid assay portends to be a game changer in the advancement towards onchocerciasis elimination. nonetheless, information on the field performance of commercial ov-16 rdt onchocerciasis elimination is important to guide p o l i c y d i r e c t i o n . t h i s s t u d y t h e r e f o r e investigated the performance of the ov-16 rdt in comparison with dbs elisa and skin snip microscopy for essential programmatic and implementation resolutions. material and methods study area the study took place in sixteen first-line cdti communities in eight local government areas (lgas) in ogun state. sample size determination sample size was determined using the formula as described by pourhoseingholi et al (2013). 2 2 n = 1.96 p(1-p)/d the prevalence of onchocerciasis for each lga was estimated as 38.9% based on the average value of a wide range of publications in this area (10). the minimum sample size for the study was determined to be approximately 300. res. j. health sci. vol 11(3), september 2023 215 field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria surakat et al. inclusion criteria communities that have been receiving treatment via mda with ivermectin for over 10 years were selected for the study based on their consistency of treatment. treatment information was verified from treatment records obtained from the ogun state ministry of health. ethical approval the study was approved by the ethics review committee of the ogun state hospital management board, abeokuta and the ministry of health (sha/res/vol2/153). informed consent forms are duly signed by voluntary participants and by parents or guardians of child participants. this study was conducted in accordance with the declaration of helsinki and confidentiality was preserved for all data collected. a total of 588 study participants provided fingerstick whole blood for the ov-16 rdt, blood was also stored on whatman™ 903 protein saver cards (ge healthcare, pittsburgh, pa) to produce dried blood spots (dbs). of these, 588 participants' fingerstick whole blood specimens assessed by both ov-16 rdt and ov16 elisa, a further subset of these participants (n=162) consented to be skin snipped for viewing under the microscope. collection of dried blood spots on whatman® protein savers card for ov-16 elisa each whatman paper card was labeled with a participant id. fingerstick whole blood on the paper was dried under ambient conditions during the day then stored at 10 cards per resealable mylar pouch containing two units clay desiccant packets (desiccare, reno, nv) and a humidity indicator card to confirm humidity <20% in the pouch before laboratory analysis. dbs were stored in the field in coolers containing icepacks and were transported to the university laboratory within 2 to 5 days of collection and stored at 4°c until shipment. dried blood spots were expressly shipped at ambient temperature to the path laboratory (seattle, washington, united states) for elisa testing. once received at path, dbs are stored at -20°c in sealed desiccant-containing pouches until use. enzyme linked immunosorbent assay for dried blood spots an serological evaluation using ov-16 rdt ov-16 elisa protocol using a horseradish peroxidase detection conjugate was used as previously described [19-22]. immulon 2hb (thermo fisher scientific, ma, usa) plate wells were coated with 100µl of 5µg/ml ov-16 antigen diluted in phosphate-buffered saline (pbs), ph 7.4 (sigma mo, usa) overnight at 4°c. dbs were punched with a 6 mm circular punch and each punched dbs was eluted overnight in 200µl of phosphate-buffered saline with 0.05% tween-20 (pbst) with 2% (w/v) non-fat dry milk (sigma). control dbs were prepared from blood samples containing the antiov-16 positive control antibody: a solution of 250 ng/mlanti-ov-16 recombinant igg4 clone abd19432_higg4 (bio-rad abd serotec, puchheim, germany) in was mixed thoroughly at a 1:1 dilution with packed, washed, o-negative normal donor red blood cells (plasma lab international, wa, usa). control blood was dried overnight in ambient laboratory conditions . plates were blocked with phosphate-buffered saline with 0.05% tween-20, ph 7.4 (pbst, sigma, mo, usa), + 5% fetal bovine serum (fbs, thermo fisher, ma, usa) at 37°c. plates were then washed three times with 300 µl per well with pbst and tapped dry. dbs eluate samples were added without dilution to the plate at 50µl per well. an anti-ov-16 igg plate positive control was previously prepared by diluting the ov-16 positive control igg4 antibody (part number abd19432.1, bio-rad, raleigh, nc, usa) into pbst and 5% basematrix 53, to a final concentration of 2.5 ng/ml antibody, and stored at -80°c until use. for each elisa, this plate positive control was thawed and added without further dilution, 50 µl each well to 4 wells per elisa plate. samples and controls were incubated at 37°c for one hour and then washed three times with pbst. a 1:5,000 dilution of an anti-human igg4 (6025 clone hybridoma reagent labs, baltimore, md) was added at 50µl per well. plates were incubated at 37°c for one hour and then washed four times with pbst. a 1:10,000 dilution of a horseradish peroxidase (hrp)conjugated goat, anti-mouse antibody (115-035062-hrp, jackson immuno research labs, pa, usa) was added at 50µl per well. plates were incubated at 37°c for one hour and washed four times with pbst. 100µl of tmb (sigma) solution was added to each well. plates were pooled normal human plasma (basematrix 53, seracare, ma, usa) applied to whatman 903 paper at 15 ul per 6 mm pre-punched circle, , then stored with desiccant at -20°c until use each plate included one punch of the positive control dbs, eluted in the same manner as a test dbs punch. following overnight ov-16 antigen coating, res. j. health sci. vol 11(3), september 2023 216 field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria surakat et al. incubated at room temperature for 15 minutes and then the reaction was stopped by adding 50µl per well of 1n hcl (thermo fisher).plates were read at 450nm. replicate well elisa units were averaged. parasitological examination microscopic examination of mf under superficial skin snips was conducted according to previously described methods [10, 23]. data analysis e l i s a o p t i c a l d e n s i t y ( o d ) measurements were subjected to quality control criteria prior to analysis. replicate sample and control well results were tested against criteria for difference in od measurements to ensure that individual well measurements did not exceed statistically expected variation for replicates (>26% cv for replicate sample wells, >20% for plate positive control wells). if passed, the sample and control od measurements were averaged to produce the mean sample od and included in the elisa analysis. if criteria were not met, the samples were repeated when additional specimen was available. the mean od measurements for samples were normalized relative to their respective plate dbs positive control mean od measurement. two methods were used to determine a threshold for elisa positivity. first, a univariate expectation-maximization (em) algorithm was applied to the normalized ov-16 elisa dataset od measurements to identify two sub populations in the data as ov-16 positive or negative. the em algorithm was set to model the normalized distribution of od measurements with two gaussian curves, resulting in a threshold for positivity of 0.34 normalized od. in the second method, a negative peak within the distribution of the normalized od values was identified by calculation of the median of the entire dataset. two times the median (2x median) was used to define the threshold for positivity shown in figure 2. the 2x median method and resulting threshold of 0.36 normalized od was used for classification of the final dataset and performance comparisons. sensitivity of elisa and ov-16 rdt were calculated against positive skin snip microscopy as the percentage of positive by either assay out of all mf+ results (n=64). ov-16 rdt was also compared to ov-16 elisa and both degree of positive and negative agreements were calculated against all elisa results (n=588) as proportions of rdt result versus reference elisa result. results study adherence of the 588 participants that enrolled and took part in the ov-16 rdt and dbs elisa study,162 of them agreed to participate in the skin snip for mf microscopy (figure 1). positive and negative agreement of ov-16 rdt to ov-16 elisa from the 588 concordant participant id ov-16 rdt and ov-16 elisa data set, elisa seropositivity of each dbs for igg4 antibodies against ov-16 antigen was determined through comparison of the normalized value (mean sample od/mean plate positive control od) to the threshold value of 0.36 (figure 2). binary ov16 rdt results were classified relative to reference ov-16 elisa positive and negative values as the following: true positive (tp), false positive (fp), true negative (tn), and false negative (fn) (table 2). degree of the positive and negative agreement of the rdt performance as compared to elisa were calculated to be 76.4% (95% ci 67.2 to 84.1)and 95.6% (95% ci: 93.4 to 97.3), respectively. sensitivity of ov-16 rdt and elisa results to reference skin snip microscopy. of the 162 skin snip microscopy results from participants for which there were both rdt and elisa results, 64 were positive for microfilaria (mf+). sensitivities of rdt and elisa to mf+ were calculated to be 79.7% and 73.4%, respectively. comparative performances of the ov-16 rdt between skin snip microscopy (mf), rdt, and elisa are presented in table 1. a seropositive rate of 17.3% (102/588) by rdt a n d 1 8 . 0 % ( 1 0 6 / 5 8 8 ) b y e l i s a w i t h 92.2%agreement was recorded. across different age groups, similar percent positives were observed for both the elisa and the rdt (figure 3). there was no significant variation between the percent prevalence as determined by ov-16 rdt and elisa with respect to different age categories (p > 0.05) using chi square. characterization of assay-concordant and assay-discordant results. performance categories of the rdt and elisa as compared to reference assay (rdt to both elisa and skin snip microscopy, elisa compared to skin snip microscopy) are plotted against the normalized elisa values. falsenegative results for rdt versus elisa had lower median of normalized elisa value (figure 4) as res. j. health sci. vol 11(3), september 2023 217 field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria surakat et al. res. j. health sci. vol 11(3), september 2023 218 compared to rdt results, which were truepositive in agreement with elisa. in contrast, false positive results for rdt versus elisa had a higher median normalized elisa value as compared to rdt true-negative results in agreement with elisa. this suggests that both types of discordant results trend towards the cutoff for the elisa and may represent a level of specific signal prone to high uncertainty in both assay types. discussion human igg4 antibody reaction to ov-16 antigen has been recognized as a serologic marker of exposure to o. volvulus in monitoring of progress toward elimination of river blindness [15, 24]. in the onchocerciasis elimination program of the americas and some selected foci in africa, the ov-16 elisa had been used as a tool to confirm transmission interruption and elimination [25, 26]. reports on performance of previous versions of an ov-16 rapid test by previous researchers [27, 28, 16] suggest the practical utility of an ov-16 rdt for serological assay of exposure to the ov-16 antigen. to this end, an accurate and commercially-available ov16 rdt could be an important tool to measure progress in mda with ivermectin. this study reports the performance of the current ov-16 rdt as used in a field setting in an area undergoing mda with reference assays of both ov-16 elisa and skin snip microscopy. additional data of this type of diagnostic performance testing is critically needed to understand the full performance and utility of such the rdt in different populations and prevalence settings. it has been acknowledged that some fraction of individuals exposed to the o .volvulus parasite may not make a detectable igg4 response to ov-16 antigen [29]. this phenomenon is also seen within this data set; while a greater proportion of mf+ specimens had higher normalized elisa values, there are also low normalized elisa values. this also supports that some proportion of mf-positive individuals will not be detected by ov-16 serology (figure 2b). a challenge in analysis of the performance of the rdt has been that the performance of the reference ov-16 elisa across africa has not been operationally well-understood. it is thought that ov-16 elisa sensitivity may be under 50%, though exhibiting a high degree of specificity [30]. performance of any serological assay may be highly dependent on the population tested, method, and sample types used to define the threshold. because of the possibility of variable serological baselines, previous studies have employed baseline-diagnostic approaches such as expectation-maximization (em) to identify the two populations [31, 32]. a possible limitation of em is that it seeks to define two peaks. the od distribution of putative positives is quite broad and may have a poorly defined peak. in this study, the 2x median method was employed to fully capture the location of the negative peak. this method assumed the negative peak to be normally distributed such that twice the median would capture the majority of the negatives in this dataset and potentially could be used with other sets where there is only a clearly identifiable negative peak. the 2x median method was chosen methodologically as a simple method that leverages the increasingly high proportions of negative results in datasets, such as from serological surveys where control and treatment have been implemented. there are limitations to this approach to define a threshold. the median could be heavily impacted in a scenario where there were many positives, in which case em could be a better choice. as described in methods, em was also used on this study set. the threshold was identified by em to be 0.34, as opposed to 0.36 identified using the 2x median method. when em was used to analyze the identical normalized dataset, the resulting threshold was found to be 0.34. the slight shift in threshold when using em resulted in a sensitivity of 72.6% and 95.8% specificity, as compared to 76.4% and 95.6% found when using the 2x median method. there was no impact of using the em-derived threshold on the sensitivity of elisa to skin snip-positive samples; it was found to be the same as when elisa positivity was determined by the 2x median method, 73.4%. in this study, the elisa was normalized to a single positive control point. comparison to standard curves with the threshold determined based on prior study sets has been used in other studies [33, 34, 35] however they are used such that they do not produce a fundamentally different result than single point normalization used in conjunction with plate quality controls. the standard curve serves as a plate quality control element, but a single concentration serves to determine positivity, which may provide little differentiation from the strategy of single point normalization compared to a threshold, with other plate quality control elements, as was done in this study. furthermore, the use of a standard curve creates a higher risk of user error and variability in the data than using premade field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria surakat et al. controls of same-type matrix (dbs) at specific concentrations. calculation of concentration using the standard curve of monoclonal antibody positive control may provide a more accurate value relative to the standard curve, but as antiov-16 igg4 from individuals is expected to be highly polyclonal, it is only an approximate concentration and carries the same risk of error introduced with standard curve preparation. in future studies, better refinement of an appropriate threshold will be possible given the goal of wide implementation of a harmonized ov-16 elisa method [35]. the degree of positive and negative agreement of the ov-16 rdt when compared to the ov-16 elisa as analyzed by the 2x median method was 76.4% and 95.6%. both an imperfect outcomes were seen for the rdt against the elisa despite being assays for the same target analyte. discordant results (false positive and false negative) of rdt to elisa show distributions closer to the threshold of the elisa normalized value. furthermore, of those rdt results classified as false positive against elisa or false negative against elisa for which there was a skin snip result (n=10/21 and n=12/25, respectively), 8/10 of rdt false positive to elisa and 4/12 of rdt false negative to elisa were mf+. this suggests that those results discordant by rdt against elisa are reflective of limitations of both test and reference assays at low ov-16-specific igg4 levels. this also explains the slightly higher observed sensitivity of the rdt to mf+ than elisa and imperfect specificity. the degree of agreement between ov-16 rdt, elisa, and skin snip microscopy is important to understanding the performance of the rdt. while skin snip microscopy could confirm whether individuals had a current infection, it was impossible in this study to confirm sero-status by any other method than elisa. to that end, the rdt performed with relatively high specificity against the elisa, and, as noted, those discordant results were likely reflective of the integrated limits of both the rdt and the elisa, particularly given the higher number of rdt false positives that were indeed skin mf+. the calculated sensitivity of ov-16 rdt to skin snip or elisa degree of agreement in this study was not as high as previously obtained, although may in similar or higher than those observed in operational analysis of ov-16 elisa [20, 27, 29]. limitations of both rdt and elisa assays may contribute to these discordant results, but further data from study sites of relevance are needed to confirm if different populations, endemicities, and mda may contribute to changes in observed performance of assays. the ability of the ov-16 rdt to estimate seroprevalence in areas with ongoing treatment is very important considering the observed limitation of mf detection in low-density infections and in pre-patent individuals. importantly, skin snip microscopy is becoming unacceptable from a community standpoint. in this study, community members majorly refused to be skin snipped. this singular factor could be seen in the value of skin snip recorded. their refusal was attributed to the painful nature of the method. however, community members were motivated to wait for up to 20 minutes to know their result using the ov-16 rdt, highlighting that, unlike elisa, the ov-16 rdt can enable c o m m u n i t y c o m m u n i c a t i o n a b o u t onchocerciasis treatment, encourage testing, and possibly provide incentive to participate in needed mda. the test yielded valid results 100% of the time; no invalid results were observed during the study. despite the duration of mda in ogun state, the continuous presence of mf in communities (though with low densities) could be attributed to the presumed inconsistent use of ivermectin due to pregnancy, fluidity of human movement, and absenteeism [20]. the results of this study provided muchneeded information on the performance of the ov-16 rdt, as there is a paucity of information on the field use of the kit. information from this study will contribute data for comparison to studies in other areas where treatment is ongoing. in conclusion, the ov-16 rdt is a point-of-care diagnostic tool that could serve to help local and country onchocerciasis elimination program to m e a s u r e t h e c h a n g e s a n d p r o g r e s s i n onchocerciasis interventions using the mda. limitations of the study: we consider the following as major limitation in the study. firstly, our inability to conduct skin snips on all study participants which was due to limited quantity of the scleral punches and this hindered our process as it took time to sterilize the materials. secondly, the general perception of the painful process of the skin snips device, a handful of the study participants opted for the finger prick blood collection for the ov-16 rdt. authors contributions: ga, yl and dst developed all assays described in the article, res. j. health sci. vol 11(3), september 2023 219 field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria surakat et al. res. j. health sci. vol 11(3), september 2023 220 soa, sso, fd, ak, ama and bso designed and ensured implementation of the study design and data collection activities. soa, ga, yl, km and se performed the data analysis and preparation of the manuscript. all authors read and approved the final version of the manuscript. funding: no funding for field activities during the study, however the ov16 rdt and laboratory analysis using elisa was provided as a phd fellowship to the lead author by the programme for appropriate technology in health, path, seattle, wa. usa. conflict of interest: the authors declare that they have no competing interests. acknowledgements: the authors wish to thank community leaders and residents of the study area for the support rendered during the course of the study. references 1. parasites – onchocerciasis (also known as river blindness): onchocerciasis faqs page. centers for disease control and prevention website. a v a i l a b l e a t https://www.cdc.gov/parasites/onchocerciasis/g en_info/faqs.html). accessed june 9, 2018. 2. zouré hg, noma m, tekle ah, amazigo uv, diggle pj, giorgi e, remme jh. the 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onchocerciasis. parasites & vectors. 2016 jun 13;9(1):1–12. 22. surakat oa, sam-wobo so, de los santos t, faulx d, golden a, ademolu k, yokobe l, adeleke ma, bankole so, adekunle on, abimbola wa. seroprevalence of onchocerciasis in ogun state, nigeria after ten years of mass drug administration with ivermectin. southern african journal of infectious diseases. 2018 nov 1;33(3):65-71. 23. fink dl, fahle ga, fischer s, fedorko df, nutman tb. toward molecular parasitologic diagnosis: enhanced diagnostic sensitivity for filarial infections in mobile populations. journal of clinical microbiology. 2011 jan;49(1):42-7. 24. katabarwa mn, eyamba a, nwane p, enyong p, kamgno j, kueté t, yaya s, aboutou r, mukenge l, kafando c, siaka c. fifteen years of annual mass treatment of onchocerciasis with ivermectin have not interrupted transmission in the west region of cameroon. journal of parasitology research. 2013 oct;2013. 25. evans ds, alphonsus k, umaru j, eigege a, miri e, mafuyai h, et al. status of onchocerciasis transmission after more than a decade of mass drug administration for onchocerciasis and lymphatic filariasis elimination in central nigeria: challenges in coordinating the stop mda decision. plos neglected tropical diseases. 2014 sep 1;8(9). 26. weil gj, steel c, liftisfa.rapid-format antibody test for diagnosis of onchocerciasis. journal infectious disease. 2000; 182:1796-9. 27. golden al, faulx d, yokobe l,stevens e, peck r, valdez m.criteria for testing development of rapid diagnostic test to support onchocerciasis control and elimination programs. american journal of tropical medicine and hygiene. 2013; 89(5):82. 28. unnasch tr, golden a, cama v, cantey pt. diagnostics for onchocerciasis in the era of elimination. international health. 2018 feb 19;10(suppl_1):i20–6. 29. richards jr fo, katabarwa m, bekele f, tadesse z, mohammed a, sauerbrey m, dominguezvazquez a, rodriguez-perez ma, fernándezsantos na, rizzo n, martínez hr. operational performance of the onchocerca volvulus “oepa” ov16 elisa serological assay in mapping, guiding decisions to stop mass drug administration, and posttreatment surveillance surveys. the american journal of tropical medicine and hygiene. 2018 sep;99(3):749. 30. migchelsen sj, martin dl, southisombath k, turyaguma p, heggen a, rubangakene pp, et al. defining seropositivity thresholds for use in trachoma elimination studies. plos neglected tropical diseases. 2017 jan 18;11(1):e0005230. 31. golden a, faulx d, kalnoky m, stevens e, yokobe l, peck r, karabou p, banla m, rao r, adade k, gantin rg. analysis of age-dependent trends in ov16 igg4 seroprevalence to onchocerciasis. parasites & vectors. 2016 dec;9(1):1-2. 32. o g u t t u d , n a h a b w e c , u n n a s c h t r , byamukama e, lakwo t, katabarwa m, et al. serosurveillance to monitor onchocerciasis elimination: the ugandan experience. the american journal of tropical medicine and hygiene. 2014 feb 5;90(2):339–45. 33. luroni lt, gabriel m, tukahebwa e, onapa aw, tinkitina b, tukesiga e, et al. the interruption of onchocerca volvulus and wuchereria bancrofti transmission by integrated chemotherapy in the obongi focus, north western uganda. plos one. 2017 dec 18;12(12):e0189306. 34. lakwo tl, garms r, tukahebwa e, onapa aw, tukesiga e, ngorok j, katamanywa j, twebaze c, habomugisha p, oguttu d, byamukama e. successful interruption of the transmission of onchocerca volvulus in mpamba-nkusi focus, kibaale district, mid-western uganda. east african medical journal. 2015 dec 3;92(8):4017. 35. report of the 1st meeting of the who onchocerciasis technical advisory subgroup, va r e m b é c o n f e r e n c e c e n t r e , g e n e v a , switzerland, 10-12 october 2017. geneva: world health organization; 2017. licence: cc by-nc-sa 3.0 igo field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria surakat et al. res. j. health sci. vol 11(3), september 2023 222 figure 1. flowchart of study adherence figure 2. a. histogram of normalized absorbance (mean sample od/mean positive control od) for ov-16 enzyme-linked immunosorbent assay (elisa) data for participants with dbs ov-16 elisa results (n=588). b. histogram of normalized absorbance elisa data for participants with skin-snip microscopy results (n=162), color-coded by mf-positive (blue line) or mf-negative (red line) results. table 1. summary of comparative concordance between test rdt, elisa and skin snip mf results (n=162) skin snip mf positive (mf+, n=64) skin snip mf negative (mf-, n=98) total ov-16 rdt positive 51 13 64 ov-16 rdt negative 13 85 98 ov-16 elisa positive 47 19 66 ov-16 elisa negative 17 79 96 sensitivity rdt to mf+, % rdt to mf+: 79.7 (95% ci: 73.43 to 85.27) sensitivity, elisa to mf+, % elisa to mf+: 73.4 (95% ci: 67.21 to 79.48) agreement rdt: elisa 86.4% field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria surakat et al. table 2. summary of comparative concordance between test rdt, elisa for all study samples (n=588) ov-16 elisa positive ov-16 elisa negative total ov-16 rdt positive 81 21 102 ov-16 rdt negative 25 461 486 rdt to elisa positive agreement in % 76.4 (95% ci 67.2 to 84.1) rdt to elisa negative agreement in % 95.6 (95% ci: 93.4 to 97.3) overall agreement rdt:elisa 92.2% figure 3: seropositive by concordant ov-16 rdt and ov-16 elisa. number of rdt-positive and elisapositive results shown as compared to total analyzed per each age group. percent seropositive of each age category is calculated as percent positive/total tested per age group. figure 4. performance characteristics of the ov-16 rdt vs. elisa. median normalized elisa values for performance categories of rdt compared to elisa: true positive (rdt and elisa positive), false positive (rdt negative, elisa positive), false negative (rdt positive, elisa negative), and true negative (rdt and elisa negative). boxes represent the interquartile range of the elisa values for each category, with the median marked by the bold line within the box and total numbers in each category are listed to the right of each box. field test and sensitivity of onchocerciasis rapid test in ogun state, nigeria surakat et al. res. j. health sci. vol 11(3), september 2023 223 rjhs 11(3).cdr a comparative study of eeg findings among subjects in seizureremission and patients with epilepsy in a resource constrained west african psychiatric hospital. 1 2 2 2 *aina o. f , owoeye a. o , oluwaniyi s. o , amoo i. g abstract background: epilepsy is one of the commonest chronic neurological disorders, most especially in developing countries of the world. again, electroencephalography (eeg) is an important investigation in epileptology and more so in monitoring seizure remission. thus, in a resource constrained country like nigeria, our study aimed to determine the epileptiform activities using routine eeg recordings on subjects in seizure remission compared to those subjects with active seizures. methods: in our study, and following ethical approval, standard eeg recording was carried out on convenient samples of equal number (131) of subjects with active seizure and those in seizure remission using the “neurofax” electroencephalography, eeg-1200 (r) machine. the eeg machine was used to carry out an awake 22-channel eeg scalp recording on each subject. results: among subjects with active seizures, the mean duration of seizure was 2.80±2.44 years, with range of 0.5 to 12.0 years. for subjects in seizure remission (ssr), the mean duration of remission was 2.41±1.03 years, with range of 1 to 5 years. out of the 131 subjects with seizure, 37 (28.3%) had normal eeg recording; and 94 (71.7%) had abnormal eeg recordings with various forms of epileptiform activities. on the other hand, of the 131 subjects in seizure remission (ssr), nearly half, 62 (47.3%) had normal eeg recording and 69(52.7%) had abnormal (epileptiform activities) recording. the difference in these eeg findings between the two study groups was significant with f=19.29, p=0.00*; t=-2.22, p=0.028*; and 95% confidence interval, ci=-0.70 to -0.40. conclusion: in addition to clinical evaluation, routine eeg recording can be used to monitor seizure remission in resource constrained countries such as nigeria. keywords: eeg findings, epilepsy, seizure-remission, resource-constrained, nigeria. *corresponding author aina, o.f. e-mail: ainafran@yahoo.com 1 department of psychiatry, college of medicine of the university of lagos, idi-araba campus, lagos, nigeria 2 department of clinical services, federal neuropsychiatric hospital, yaba, lagos, nigeria. received: september 5, 2022 accepted: may 5, 2023 published: september 30, 2023 res. j. health sci. vol 11(3), september 2023 279 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.10 original article research journal of health sciences une étude comparative des résultats de l'eeg chez les sujets en crises-rémission et les patients épileptiques dans un hôpital psychiatrique ouest-africain à ressources contraintes 1 2 2 2 *aina o. f , owoeye a. o , oluwaniyi s. o , amoo i. g résumé contexte général de l'étude : l'épilepsie est l'un des troubles neurologiques chroniques les plus courants, plus particulièrement dans les pays en développement du monde. encore une fois, l'électroencéphalographie (eeg) est une investigation importante en épi leptologie et plus encore dans le suivi de la rémission des crises. ainsi, dans un pays aux ressources limitées comme le nigéria, notre étude visait à déterminer les activités épileptiformes à l'aide d'enregistrements eeg de routine sur des sujets en rémission de crises par rapport à ceux avec des crises actives. méthode de l'étude : dans notre étude, et après approbation éthique, un enregistrement eeg standard a été effectué sur des échantillons pratiques d'un nombre égal (131) de sujets présentant des crises actives et de sujets en rémission de crises à l'aide de l'électroencéphalographie "neurofax", machine eeg-1200 (r ) . . la machine eeg a été utilisée pour effectuer un enregistrement eeg éveillé du cuir chevelu à 22 canaux sur chaque sujet. résultat de l'étude: parmi les sujets ayant des crises actives, la durée moyenne des crises était de 2,80 ± 2,44 ans, avec une plage de 0,5 à 12,0 ans. pour les sujets en rémission des crises (ssr), la durée moyenne de rémission était de 2,41 ± 1,03 ans, avec une fourchette de 1 à 5 ans. sur les 131 sujets présentant des crises, 37 (28,3 %) avaient un enregistrement eeg normal ; et 94 (71,7%) avaient des enregistrements eeg anormaux avec diverses formes d'activités épileptiformes. d'autre part, sur les 131 sujets en rémission des crises (ssr), près de la moitié, 62 (47,3%) avaient un enregistrement eeg normal et 69 (52,7%) avaient un enregistrement anormal (activités épileptiformes). la différence dans ces résultats eeg entre les deux groupes d'étude était significative avec f = 19,29, p = 0,00 * ; t=-2,22, p=0,028* ; et intervalle de confiance à 95 %, ic=-0,70 à -0,40. conclusion : en plus de l'évaluation clinique, l'enregistrement eeg de routine peut être utilisé pour surveiller la rémission des crises dans les pays à ressources limitées comme le nigéria. mots-clés : résultats eeg, épilepsie, crise d'épilepsie, ressources limitées, nigéria *corresponding author aina, o.f. e-mail: ainafran@yahoo.com 1 department of psychiatry, college of medicine of the university of lagos, idi-araba campus, lagos, nigeria 2 department of clinical services, federal neuropsychiatric hospital, yaba, lagos, nigeria. received: september 5, 2022 accepted: may 5, 2023 published: september 30, 2023 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 280 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.10 introduction epilepsy is described as a person having at least two unprovoked seizure episodes greater than 24 hours apart; or as one unprovoked seizure and a probability of further seizures similar to the general occurrence risk after two unprovoked seizures (1). the definition of epilepsy includes evidence of electroencephalographic (eeg) compliments or a significant symptomatic aetiology on magnetic resonance imaging (mri) of the brain (1, 2). while the diagnosis of epilepsy is largely clinical, based on good history taking and accurate physical and neurological examination, electroencephalography (eeg) is an important supplementary diagnostic tool to classify the type of epilepsy and monitor remission to treatment; and it remains one of the most commonly used investigative tool in the evaluation of people with epilepsy (3,4,5). for most patients with seizures, the standard 30-minutes eeg recordings are routinely carried out most especially in developing countries such as nigeria with dearth of eeg recording facilities (6). the limitation of this standard recording is failure to show epileptiform activities in the eeg of some clinically diagnosed seizure cases (7). a very important aim in the management of epilepsy is to achieve seizure control; and for decades now seizure control is defined as seizure remission for ≥1 year (5). aside from clinical evaluation, eeg recording is also an important investigation used to monitor and evaluate seizure remission (8, 9, 10). furthermore, studies have also shown some factors as predictors of seizure recurrence during or after antiepileptic drug (aed) discontinuation. such factors include using multiple aeds, focal epilepsy, multiple types of seizure and increased eeg epileptiform abnormalities (11, 12). among these factors, only eeg epileptiform activities can be monitored preferably using long term eeg recording (ltm eeg) which includes ambulatory eeg (aeeg) and video eeg (veeg). these ltm eeg modalities are more sensitive to detect epileptiform activities, they have higher sensitivity and lower false negative rates to detect such abnormalities when compared with regular routine eeg recording (13). however, in a resource constrained setting such as nigeria, ltm eeg techniques of aeeg and veeg are not available, but only routine eeg recordings. thus, the objective of this study was to determine the epileptiform activities using routine eeg recordings on subjects in seizure remission compared to those subjects with active seizures in a foremost west african psychiatric hospital. materials and methods study setting the study was carried out in the electroencephalography (eeg) unit of the federal neuropsychiatric hospital (fnph), yaba, lagos. the hospital is one of the foremost psychiatric facilities in nigeria with over 500 beds for in-patients and a number of out-patient clinics to take care of psychiatrically ill patients from lagos metropolis, referrals from surrounding states and neighbouring west african countries such as benin republic. subjects subjects included those referred for eeg recordings from within the hospital and those from other health facilities. using convenient sampling, two groups of subjects were selected for study over a five-year period (january 2016 to december 2020). one group included subjects in seizure-remission for a minimum of one year; and the other group included subjects with active seizures, that is seizure duration of at least 6 months. ethical approval to carry out the study was obtained from the research and ethics committee of the hospital (fnph, yaba) and consent was obtained from each participant. instruments and procedure ·socio-demographic and clinical proforma: this was used to obtain socio-demographic information such as age and sex. clinical information obtained for the subjects with active seizures included clinical description of the seizure and seizure duration; and for those in remission and duration of remission. ·electroencephalography (eeg) machine: the “neurofax electroencephalography, eeg-1200 (r) was used in this study (14). the eeg machine was used to carry out an awake 22-channel eeg scalp recording on each subject. the setting was in a silent room in the eeg unit of the hospital (fnph, yaba); devoid of noise and environmental distractions. the recording was over 45-60 minutes with 5 minutes activation of hyperventilation. furthermore, errors were ensured to be reduced to the barest minimum by eliminating sources of artefacts as much as possible. the eeg tracings were interpreted by two consultant neuropsychiatrists who had training in electroencephalography, and res. j. health sci. vol 11(3), september 2023 281 a comparative study of eeg in seizure-remission and epileptic patients aina et al. with twelve to sixteen years' experience in eeg interpretation. results socio-demographic variables (table i) one hundred and thirty-one (131) subjects were studied in each group: those with active seizures and those in seizure-remission, giving a total of two hundred and sixty-two (262) subjects. the two groups were age and sex matched. thus, there was equal sex distribution of 86 (65.6%) males and 45 (34.4%) females in each group. the mean age of subjects with seizure was 11.41±9.40 years and age range of 2 to 80 years. the highest age groups were 0 to 10 years (55.7%) and 11 to 20 years (38.9%). for patients in seizure remission, the mean age was 11.37±9.61 years and age range of 2 to 53 years. the highest age groups were also 0 to 10 years (53.4%) and 11 to 20 years (41.2%). clinical variables a. subjects with active seizures: the mean duration of seizure was 2.80±2.44 years, with range of 0.5 to 12.0 years. b. subjects in seizure remission (ssr): the mean duration of seizure remission was 2.41±1.03 years, with range of 1 to 5 years. eeg findings a. subjects with active seizures (table ii) out of the 131 subjects with seizure, 37 (28.3%) had normal eeg recording; and 94 (71.7%) had abnormal eeg recordings with various forms of epileptiform activities of spikes/polyspikes, sharp waves and s p i k e s / p o l y s p i k e s a n d s l o w w a v e complexes. localization of eeg abnormalities: twentytwo (16.8%) had focal (frontal, temporal, f r o n t o t e m p o r a l a n d f r o n t o c e n t r o temporal) abnormal epileptiform activities. focal with secondary generalization, 9 (6.9%) and bursts epileptiform activities, 63 (48.1%). lateralization of eeg abnormalities: six (4.5%) had right sided localization of their epileptiform activities, 7 (5.3%) bilateral, 9 (6.9%) each for left sided as well as focal with secondary generalization respectively, and 63 (48.1%) were burst epileptiform activities. b. subjects in seizure remission (table ii): out of 131 subjects in seizure remission (ssr), nearly half, 62 (47.3%) had normal eeg recording and 69(52.7%) had abnormal (epileptiform activities). localization of eeg abnormalities: eighteen (13.8%) had focal epileptiform recordings over the frontal, temporal, fronto-temporal and fronto-centro-temporal recordings. six (4.6%) had focal epileptiform activities with secondary generalization; and 45 (34.4%) had burst epileptiform activities. lateralization of epileptiform activities: burst activities were found in 45 (34.4%) subjects, followed by bilateral lateralization, 10 (7.5%) and the least, 2 (1.5%) were left sites. inter-relationship between eeg abnormalities and socio-demographic variables (table iii) a. subjects with active seizures: age group had s i g n i f i c a n t r e l a t i o n s h i p w i t h e e g abnormalities; that is younger age groups were more likely to have eeg abnormalities, with chi-square of 27.88 and p=0.001. similarly, localization and lateralization also had significant relationships with eeg abnormalities at p=0.001 (table iii). b. subjects in seizure remission (ssr): the e e g a b n o r m a l i t i e s h a d s i g n i f i c a n t relationships with age groups, localization and lateralization as follows: ·eeg abnormalities v. age groups: x2=19.0, p=0.002 ·eeg abnormalities v. localization: x2=132, p=0.001 ·eeg abnormalities v. lateralization: x2=131, p=0.001 comparative analysis of eeg abnormalities between subjects with active seizure and those in seizure remission more subjects with active seizure had eeg abnormalities of epileptiform activities, 94 (71.7%), compared with seizure-free subjects, 69 (52.7%). consequently, nearly twice the percentage of subjects in seizure remission has normal eeg tracing compared to subjects with active seizures (47.3% v. 28.3%). the difference in these eeg findings was significant with f=19.29, p=0.00*; t=-2.22, p=0.028*; and 95% confidence interval, ci=-0.70 to -0.40 (table iv). discussion in our study, subjects in both groups were predominantly children and adolescents; and this is in line with the fact that epilepsy is still majorly found in children and young adults in subsaharan africa (15). till date, the diagnosis of res. j. health sci. vol 11(3), september 2023 282 a comparative study of eeg in seizure-remission and epileptic patients aina et al. epilepsy is mainly clinical from the witness account of the seizure episodes; while electrencephalography (eeg) remains the most important investigation to authenticate the diagnosis, classify the type of epilepsy, localize the seizure focus and guide prognosis (16). in our study, 71.7% of subjects with epilepsy (swe) had abnormal recordings of epileptifotm activities in their eeg tracings. this is in line with previous studies where 29-56% of swe have abnormal epileptiform activities in their initial routine eeg tracings; with yield increasing to more than 80% in subsequent recordings (16,17,18). furthermore, in the diagnostic investigation of epilepsy, abnormal and epileptiform waves while the patient is having a seizure, that is ictal eeg recording and interictal epileptiform discharges are affirmed to be the most important findings that are consistent with accurate diagnosis of epilepsy (10,19). comparatively, only 52.7% of subjects in seizure remission (ssr) had epileptiform activities in their eeg recordings. age is the only socio-demographic variable that is significantly related to eeg abnormalities in our study (table iii); that is epileptiform activities were more in the eeg tracings of the younger age groups in both study groups. this is similar to findings from previous studies that subject's age at onset of seizure and time of eeg recording is related to presence or absence of epileptiform activities in the eeg tracings (20). comparison between eeg findings among swe and ssr groups. eeg, most especially using the longterm monitoring (ltm) method has been found to be useful to monitor patients on antiepileptic drugs (aeds), subjects in seizure-remission and prediction of seizure relapses (21,22). in our study, carried out in a resource-constrained setting in nigeria where ltm eeg techniques are unavailable, we could only carry out regular 45-minute eeg recordings, although with the limitation of lower epileptiform yield, to monitor subjects in seizure remission (ssr) and compared with recordings on subjects with epilepsy (swe), that is with active seizures. sixty-nine (52.7%) of ssr compared to 71.7% of swe had epileptiform discharges in their eeg tracings, and this difference was significant with f=19.29 and p<0.01. thus, despite its limitation of possible lower epileptiform yield (23), regular or routine eeg recordings can be used to monitor seizure remission in resource constrained settings like ours. findings have shown that aside from the clinical history of seizure remission in patients on aeds, the predictive value of eeg had been shown to be far better than the clinical monitoring, that is eeg is much useful for longterm monitoring of seizure remission (11,12,13). furthermore, previous studies have also shown that abnormal eeg, in this case, epileptiform activity is indicative of cortical hyperexcitability; and in subjects with a history of seizures such as our subjects in seizure-remission, the presence of epileptiform activity in them is useful in prognostication and prediction of possible seizure recurrence during aeds withdrawal and/or period of seizure remission (25,26,27) conclusion in conclusion, and despite its limitations, routine eeg recording in conjunction with clinical evaluation can be used to monitor seizure-remission among subjects being treated for epilepsy in resource-constrained developing countries such as nigeria. conflict of interest: none. references 1. fisher rs, acevedo c, arzimanoglou a et al. ilae official report: a practical clinical definition of epilepsy. epilepsia 2014; 55 (4): 475482. 2. berg at, berkovic sf, brodie mj et al. revised terminology and concepts for organization of seizures and epilepsies. epilepsia 2010; 51 (4): 676-685. 3. st louis ek, cascino gd. diagnosis of epilepsy and related episodic disorders. continuum ( e p i l e p s y ) 2 0 1 6 ; 2 2 ( 1 ) : 1 5 3 7 . d o i : 1 0 . 1 2 1 2 / c o n . 0 0 0 0 0 0 0 0 0 0 0 0 0 2 8 4 p m i d : 26844728 (accessed 12 april, 2023). 4. elmali ad, auvin s, bast t, rubboli g, koutroumanidis m. how to diagnose and classify idiopathic (genetic) generalized epilepsies. e p i l e p t i c d i s o r d e r s 2 0 2 0 https://doi.org/10.1684/epd.2020.1192 (accessed 12 april, 2023). 5. peltola me, leitinger m, halford jj, vinayan kp, kobayashi k, pressler rm, mindruta i, mayor lc, lauronen l, beniczk s. routine and sleep eeg: minimum recording standards of the i n t e r n a t i o n a l f e d e r a t i o n o f c l i n i c a l neurophysiology and the international league against epilepsy. clin neurophysiol 2023;147: 108-120. doi: 10.1016/j.clinph.2023.01.002. 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(accessed 5august 2022). 23. csernus ea, werber t, kamondi a and horvath aa. the significance of sub-clinical epileptiform activity in alzheimer's disease. front. neurol. 2 0 2 2 , 1 3 : 8 5 6 5 0 0 . d o i : 10.3389/fneur.2022.856500. (accessed 19 april, 2023) 24. meinardi h, scott ra, reis r, sander jwas. the treatment gap in epilepsy: the current situation and way forward. epilepsia 2001; 42: 136-149. 25. shinnar s, vinning epg, mellitus ed, d'souza bj, holden k, baumgardner ra, freeman jm. discontinuing antiepileptic after two years without seizures. new england journal of medicine 1985; 308: 976-980. 26. matricardi m, brinciotto m, benedetti p. outcome after discontinuation of antiepileptic drug therapy in children with epilepsy. epilepsia 1989; 30: 582589. 27. david valentine. the eeg in epilepsy. e p i l e p t i f o r m a c t i v i t y o n e e g . https://www.learningeeg.com/epileptiformactivity 2020. (accessed 19 april, 2023) res. j. health sci. vol 11(3), september 2023 284 a comparative study of eeg in seizure-remission and epileptic patients aina et al. res. j. health sci. vol 11(3), september 2023 285 table i: subjects’ socio-demographic variables variable subjects’ groups active seizure seizure-free n % n % sex male female total age groups (years) 0-10 11-20 21-30 31-40 41-50 =51 total 86 65.6 86 65.6 45 34.4 45 34.4 131 100.0 131 100.0 73 55.7 70 53.4 51 38.9 54 41.2 02 1.5 03 2.3 02 1.5 01 0.8 01 0.8 01 0.8 02 1.5 02 1.5 131 100.0 131 100.0 table ii: electroencephalographic (eeg) findings on subjects variable subjects’ group active seizure seizure-free n % n % eeg findings normal eeg abnormal eeg (epileptiform activities, eas). total localization of eas bursts focal (frontal, temporal, f-t) focal with sec. generalization lateralization of eas bursts bilateral focal with sec. generalization right sided left sided 37 28.3 62 47.3 94 71.7 69 52.7 131 100 131 100 63 48.1 45 34.4 22 16.8 18 13.8 9 6.9 6 4.6 63 48.1 45 34.4 7 5.3 10 7.5 9 6.9 7 5.3 9 6.9 5 3.8 6 4.5 2 1.5 table iii: inter-relationship between eeg findings and socio-demographic/clinical variables variables subjects with active seizure x2 df p subjects in seizure remission x2 df p age group sex seizure duration duration of seizure remission localization of eeg abnormalities lateralization of eeg abnormalities 27.88 5 0.00* 0.84a 1 0.77 2.37a 4 0.67 131a 7 0.00* 131a 5 0.00* 19.00a 5 0.00* 0.72a 1 0.46 4.31a 4 0.37 131a 6 0.00* 131a 5 0.00* a comparative study of eeg in seizure-remission and epileptic patients aina et al. rjhs 11(3).cdr knowledge, attitudes and practices of disease prevention among health talk-giving healthcare workers in primary health centres at osogbo 3 2 3 3 3 *tajudeen, w.a. , adesina, k.a. , fakorede, j.i. , muraina, o.a. , ikotun, b.m. , 3 3 1 adesiyan, h.j. , olayinka, a.o. , omisore, a.g. abstract background: disease prevention measures such as creating public awareness are needed to protect the vulnerable populace from acquiring diseases. knowledgeable health care workers are pivotal to this, and it therefore becomes imperative to assess health workers in this regard. the objective of this study was to ascertain the level of knowledge, the kind of attitude towards and practices of disease prevention among health-talk giving primary health care workers in osogbo, south western nigeria. methods: a descriptive cross-sectional study done among 204 respondents from 13 primary health care centres in osogbo selected using multi-stage sampling technique. the research instrument used was a self-administered questionnaire analysed with spss 23.0. univariate, bivariate, and multivariate analyses were done as appropriate and a p-value of <0.05 was taken as statistically significant. results: the results of this study revealed that at least nine out of ten respondents had good knowledge (90.2%) and positive attitude (94.1%) towards disease prevention. a greater proportion of doctors (100%) had good knowledge of disease prevention compared to other health workers while nurses took the lead in having a positive attitude (97.4%). respondents had varying responses in their practices towards disease prevention, but generally speaking, most respondents who had good knowledge and positive attitudes also exhibited good practices. the only identifiable predictor of respondent's knowledge was level of education, (p=0.024 or=0.157). conclusion: the fact that about a tenth of respondents had poor knowledge and about 5% had negative attitude towards disease prevention is a major cause for concern. since health talk-giving health workers interact directly with the populace, the potentially huge negative effects that this minority can have cannot be underestimated. therefore, there is a need for close-monitoring and regular review of the kind of information given to clients as well as training and re-training of health workers. keywords: knowledge, attitudes, practices, disease, prevention, healthcare workers. *corresponding author tajudeen wa. email: tajudeenwaliu85@gmail.com 1 department of community medicine, college of health sciences, osun state university, osogbo, nigeria 2 department of nursing science, college of health science, osun state university, osogbo, nigeria 3 public health programme, college of health sciences, osun state university, osogbo, nigeria received: june 26, 2022 accepted: april 21, 2023 published: september 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(3), september 2023 224 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.5 connaissances, attitudes et pratiques de prévention des maladies chez les agents de santé qui parlent de santé dans les centres de santé primaires d'osogbo 3 2 3 3 3 *tajudeen, w.a. , adesina, k.a. , fakorede, j.i. , muraina, o.a. , ikotun, b.m. , 3 3 1 adesiyan, h.j. , olayinka, a.o. , omisore, a.g. résumé contexte général de l'étude : des mesures de prévention des maladies telles que la sensibilisation du public sont nécessaires pour protéger la population vulnérable contre l'acquisition de maladies. des travailleurs de la santé compétents sont essentiel à cet égard, et il devient donc impératif d'évaluer les agents de santé à cet égard. objectif de l'étude: connaître le niveau de connaissance, le type d'attitude envers et les pratiques des prévention des maladies parmi les professionnels de la santé qui parlent de la santé à osogbo , dans le sud l'ouest du nigéria. méthode de l'étude: une étude transversale descriptive réalisée auprès de 204 répondants de 13 écoles primaires centres de soins de santé d'oshogbo sélectionnés à l'aide d'une technique d'échantillonnage à plusieurs degrés. la recherche l'instrument utilisé était un questionnaire auto-administré analysé avec spss 23.0. uni varié, des analyses bi variées et multi variées ont été effectuées selon les besoins et une valeur de p <0,05 a été prise comme statistiquement significatif. résultat de l'étude: les résultats de cette étude ont révélé qu'au moins neuf répondants sur dix avaient de bonnes connaissances (90,2 %) et attitude positive (94,1 %) envers la prévention des maladies. une meilleure proportion de médecins (100 %) avaient une bonne connaissance de la prévention des maladies par rapport aux autres les infirmières étaient en tête pour avoir une attitude positive (97,4 %). les répondants avaient des réponses dans leurs pratiques en matière de prévention des maladies, mais de manière générale, la plupart des répondants qui avaient de bonnes connaissances et des attitudes positives ont également fait preuve de bonnes pratiques. le seul identifiable des connaissances du répondant était le niveau d'éducation, ( p = 0,024 or = 0,157). conclusion : le fait qu'environ un dixième des répondants aient une faible connaissance et environ 5 % négative à l'égard de la prévention des maladies est une cause majeure de préoccupation. depuis les discours sur la santé les agents de santé interagissent directement avec la population, les effets négatifs potentiellement énormes que cela la minorité peut avoir ne peut pas être sous-estimée. par conséquent, il est nécessaire de surveiller de près et de un examen régulier du type d'informations données aux clients ainsi que la formation et le recyclage des de santé. mots-clés: connaissances, attitudes, pratiques, maladie, prévention, personnel de santé *corresponding author tajudeen wa. email: tajudeenwaliu85@gmail.com 1 department of community medicine, college of health sciences, osun state university, osogbo, nigeria 2 department of nursing science, college of health science, osun state university, osogbo, nigeria 3 public health programme, college of health sciences, osun state university, osogbo, nigeria received: june 26, 2022 accepted: april 21, 2023 published: september 30, 2023 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 225 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.5 introduction health workers are people whose job is to protect and improve the health of their communities. health workers include doctors, nurses, pharmacists, dentists, laboratory scientists, health assistants, public health practitioners, community health officers (cho), physiotherapists, community health extension workers (chews), community health attendants etc. community health workers are essential personnel in resource-limited settings; they focused on infectious diseases and maternal and child health. however, their skills could potentially be utilized in national efforts to reduce the growing burden of non-communicable diseases (1). a disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism, and that it is not due to any external injury, it may be caused by external factors such as pathogens or by internal dysfunction. preventable communicable or infectious diseases like malaria and hiv/aids account for millions of deaths globally especially in middle and low-income countries including nigeria (2). many developing countries are facing an enormous burden of infectious diseases. nigeria is faced with a high burden of both communicable and non-communicable diseases, creating significant challenges among key health indicators (3). n o n c o m m u n i c a b l e d i s e a s e s a r e increasingly becoming the leading causes of morbidity and mortality worldwide. they encompass a cluster of illness which includes: diabetes mellitus, cancers, chronic respiratory d i s e a s e s , c a r d i o v a s c u l a r d i s e a s e a n d musculoskeletal disorders with greater impact on the poor countries of sub-saharan african of which nigeria occupy a significant position (4). similarly, many chronic diseases are caused by preventable risky behaviours such as tobacco use and exposure to second-hand smoking, poor nutrition including diets low in fruits and vegetables and high in sodium and saturated fats, lack of physical activity, excessive alcohol use, etc (5). stronger health systems underpinned by primary health care are crucial to effectively manage ncds and risk factors for them. primary health care is often the first gateway to health services for people and plays a central and co-coordinating role in the p r e v e n t i o n , d i a g n o s i s a n d l o n g t e r m management of chronic diseases (2). thus, both communicable and non-communicable diseases can be prevented through health education. the major way through which individuals receive health information in nigeria is through health talks given by health workers. this is especially so as primary health care (phc) is the first level of health care with which the general populace comes in contact, so it is not an insignificant number of the population that is taken care of at the phc level. although one author reported a significant decrease in the proportion of clients visiting primary health centres in a developed country (6), the situation arguably is not the same in developing countries. in previous studies, health workers have demonstrated varying d e g r e e s o f k n o w l e d g e r e g a r d i n g b o t h communicable and non-communicable diseases (7,8). since health workers are traditionally the custodians of knowledge in this part of the world responsible for the dissemination of health information to clients, it is expected that the level of their knowledge should be high but this is not always the case. for instance, only 37.9% of primary healthcare workers in southwest nigeria had good knowledge of the nature and care of sickle cell disease (9). similarly, only 34.7% of primary health care workers have positive attitude regarding tuberculosis disease in minna, niger state nigeria (10). it is generally assumed that health workers by virtue of their 'job' should have adequate knowledge about diseases and other health conditions this assumption can possibly be true for both tertiary and secondary levels but there is often inadequate knowledge among primary health care workers (11). health care workers serve as the main asset of the health care system in achieving its goals especially those who give health talk, however, it is crucial to examine their level of knowledge, attitude and practices on disease prevention. this study, therefore, sets out to examine the knowledge, attitude and practices of health talk-giving health care workers in primary health facilities in osun state, nigeria towards disease prevention. materials and methods a descriptive cross-sectional study was carried out among 204 healthcare workers in primary health centres in osogbo, osun state nigeria. there are numerous primary health care centres and private hospitals providing primary care services in the state. the sample size for the study was 204, 2 calculated using leslie fischer's formula (n= (z 2 pq)/d ) for the descriptive study of populations less than 10,000 with p as 84.2.0%, being the res. j. health sci. vol 11(3), september 2023 226 kap of disease prevention among healthcare workers in phc tajudeen et al. proportion of healthcare workers with good knowledge on infection prevention from a previous study , z as 1.96 representing a 95% confidence interval. a multi-stage sampling technique was used to select study participants across local governments, wards and categories of hospital workers. a purposely designed self administered questionnaire was used to obtain data from study participants after a pre-test done outside of the study area. involvement in risky sexual behaviour was defined as those who had casual sexual intercourse and do not use condoms. approval for the conduct of the study was obtained from the ethics and research committee of osun state university. permission was also obtained from the state primary health care board and consent was taken from each participant while participants were assured of confidentiality. data collected were analyzed using ibm spss version 23.0 software. results were presented using tables and charts, chi-square and logistic regression analyses were generated with confidence level set at 95% and a p-value <0.05 was considered significant. there were a total of 29 questions for knowledge related statements, correct responses were scored as one and incorrect responses were scored as zero. the scores were summed up to obtain an overall score for each respondent, with a range of 0 to 29. attitude had a total of 14 questions, correct responses were assigned one, and wrong responses assigned zero, with a total summed up scores ranging from 0 to 14. knowledge and attitude were further categorized using the median or 50% score as the cut-off point. this was done to assess and grade the respondent's knowledge (good or poor knowledge), attitude (positive and negative attitude) towards disease prevention. good knowledge and positive attitude were adjudged as those who scored equal or above 50% and poor knowledge and negative attitude as those that scored below it. there were 20 questions on preventive practice, correct/good response were scored as one while incorrect/poor responses were scored as zero, using the mean (9.80) as the cut-off point, good practice was adjudged as those scores who scored or above the mean and poor practice as those who scored below it. results a total of 204 respondents comprising of 41(20.1%) males and 163 (79.9%) females participated in this study. the mean age was 35.6 ± 8.9 years. almost a fifth of the respondents were nurses/ midwives while 6.4% were doctors and the remaining 75% of the respondents were chews, cho, pharmacists, lab scientists etc. majority of the respondents (44.6%) had 1-5 years of working experience, 22.5% had 6-10 years of practice while 32.9% had been practising for more than 11 years. in general, majority (90.2%) of the respondents have good knowledge of disease prevention. similarly, for attitude, 94.1% of the respondents had positive attitude towards disease prevention (figure ). in table 2, more respondents who had a university degree and higher qualifications had good knowledge (97.6%) compared to those with diploma (85.1%) as their qualification p=0.003. of the 204 participants, thirteen were doctors and all (100%) of them had good knowledge of disease prevention compared to 94.7% of nurses/midwives and 88.2% of other health workers. more of the respondents with one to five years and those with eleven years and above of working experience had good knowledge on disease prevention (91.2% and 91.0% respectively) compared to those with six to ten years working experience (87.0%). respondents whose qualifications were university degrees and higher (96.4%) had positive attitude compared to those whose qualifications were diplomas (92.6%). in terms of their designation, more nurses/midwives (97.4%) were found to have positive attitude compared to doctors (92.3%) and other health workers (93.5%). respondents who have been working for 1 to 5 years as health workers had more (96.7%) positive attitude compared to (91.3%) of those working for 6-10years and (92.5%) of those working for 11 years and above. in table 3a, of all the 204 respondents 184 (90.2%) always washes their hands before eating and after using the toilet, about three quarters (70.6%) exercise regularly, only 40 (19.6%) eats junk foods every day. about two-thirds (63.2%) take sugary drinks sometimes or few times a week, more than three-quarters (76.0%) take vegetables regularly. only less than half (45.1%) of the respondents were found to have been involved in risky sexual behaviour i.e. have had casual sex and does not use condoms). similarly, majority (90.7%) washed their vegetables thoroughly when cooking. only 7.8% take alcohol, while only 2.0% smokes. in the last year, only (24.0%) have not had a blood pressure check. only 27.0% of the respondent shares personal things like towel, combs and slippers, res. j. health sci. vol 11(3), september 2023 227 kap of disease prevention among healthcare workers in phc tajudeen et al. about a sixth (17.2%) of the respondents said their superior insisted they come to work even when sick. only (12.7%) of the respondents said they rarely do a medical check-up, less than onesixth (14.2%) had contracted hospital-acquired infections before (table 3a). out of the 41 male respondents, only 13 (31.7%) had done prostate cancer screening before (table 3b), among 163 female participants, more than two-thirds (71.8%) do breast self-examination while only 24.5% had done cervical cancer screening using pap smear before (table 3c). overall, there were good practices towards disease prevention among health talk giving primary healthcare workers at osogbo. when relating the preventive practices of respondents against their knowledge and attitude towards disease prevention, respondents who regularly washed their hands regularly before eating and after using the toilet were found to have 167(90.8%), 167(90.8) good knowledge and 172(93.5%), 173(94.0) positive attitude respectively. those who exercise regularly have more good knowledge (91.0%) and positive attitude (93.8%). similarly, respondents that rarely eat junk have more good knowledge (95.7%) p=0.004 and 100.0% positive attitude towards disease prevention p=0.032. majority of the respondents take sugary drinks and fruits few times a week and were found to have more good knowledge 118(91.5%) and 123(93.9%) and 125(96.9%) and 123(93.9%) positive attitude towards disease prevention respectively. more of the respondents that sometimes takes vegetable was found to have 140(90.3%) good knowledge and 145(93.5%) favourable attitude, likewise, majority of the respondents who do not involve in risky sexual behaviour were found to have good knowledge (92.0%) and attitude (96.4%) towards disease prevention. in terms of the preventive practice of washing vegetables thoroughly when cooking at home, more of the respondents that normally washed vegetables thoroughly had good knowledge 166 (89.7%) and positive attitude 173(93.5%). most of the respondents does not or had never taken alcohol and have more good knowledge (91.4%) and (98.9%) positive attitude p=0.0007, correspondingly, majority of the respondents had never smoked before and were found to have more good knowledge and positive attitude (92.0%) and (96.4%) respectively. regarding the practice of blood pressure, most of those that have checked their blood pressure in the past year also have more of good knowledge (91.0%) and a significant (96.8%) positive attitude p=0.012. although most of the health workers does share personal things, those who share had more good knowledge (90.9%) compared to those who does not, while more of the respondents that do not share their personal things had more of favourable attitude (96.6%) p=0.029. those who cultivated the habit of always covering their mouth and nostrils when sneezing or coughing had more good knowledge (91.3%) and positive attitude (94.4%) towards disease prevention. respondents that do not go to work and those who sometimes do as insisted by their superior had more good knowledge on disease prevention, while those who rarely go when sick have a significant positive attitude (100.0%) towards disease prevention. p<0.001. health workers that do regular medical check-up have more good knowledge (95.8) while those who do it sometimes were found to have more of positive attitude (96.3%). this finding shows a significant-good knowledge (93.5%) p=0.008 and positive attitude (97.6%) p<0.001 among those who had never contracted hospital-acquired infection (table 4a). in table 4b: male respondents who have done prostate cancer screening have 100.0% good knowledge while those who have never done it have 100.0% positive attitude. (table 4b) female health workers that normally do breast self-examination have significant-good knowledge (91.5%) on disease prevention p= 0.048 and positive attitude (95.7%). likewise, those who had done cervical cancer screening had more good knowledge (95.0%) while more of those who had never done the screening have a more favourable attitude (94.3%) towards disease prevention (table 4c). overall, more than four-fifths (88.7%) had good practices of diseases prevention. discussion although many studies had previously looked into the knowledge, attitude and practices of health workers related to the prevention of specific diseases, this study is distinctive because it examined the knowledge, attitude and practices of diseases prevention generally among health talk-giving primary health care workers. in this study, quantitative data were collected from 204 primary health workers in selected phcs in osogbo, osun state and significant findings which will contribute to evidence-based knowledge and interventions on diseases prevention are hereby discussed. this study revealed that the majority of the health workers had good knowledge, about res. j. health sci. vol 11(3), september 2023 228 kap of disease prevention among healthcare workers in phc tajudeen et al. nine out of ten of the respondents had good knowledge, and this finding is similar to a previous study on rabies where the majority of the respondents had good knowledge (14). the overall knowledge of this study is however slightly lower than that of another study on infection prevention (12) but contrary to another study where only 20.3% of the respondents had good knowledge (15). it is actually not unexpected that health workers, in general, should demonstrate a good knowledge regarding diseases and their prevention and/or control, since it is their domain. theoretically and practically, they often have been 'exposed' to various disease conditions because they are often involved in the management of such, even at the primary care level. so the norm is to expect virtually all health workers to be knowledgeable about diseases, thus, it is however surprising that about a tenth of health workers were classified as having poor knowledge. the proportion with poor knowledge may appear small however the potential negative effects are quite significant, especially in terms of the misinformation this set of health workers can pass to the general populace when they give health talks during health education sessions. such misinformation is not likely to be limited to the primary contacts of the health workers as these recipients can be secondary transmitters of the false information received from the health workers to others within and outside of their neighbourhoods. in this environment, information received from health workers are usually considered as factual and sacrosanct and clients (patients and patients' relatives) are likely to take such hook, line and sinker and act based on the information received from such health workers. more of the males' respondents had good knowledge compared to females regarding diseases and their prevention and control which is in tandem with a study on lassa fever (11) but against another nigerian study on tuberculosis where more females had good knowledge (16). a possible lesson to draw from these varying scenarios is that the level of knowledge is independent of sex, and is perhaps a reflection of individual learning abilities and capacities. the higher number of males having good knowledge here may also be explained by the fact that most health workers at the primary health care level are females and a dilution effect may take place between females who are on the extreme sides of good and poor knowledge, with the larger number of females possibly contributing to the fact that more females will be at the 'negative' end of poor knowledge. more respondents who have a university degree and higher qualifications had good knowledge on disease prevention and this was statistically significant, (p<0.05), this should probably be expected, as they are likely to have more knowledge and experience during the course of their study than those who have diploma qualification. more doctors had good knowledge than others and this finding is similar to that of another study on lassa fever (17) and could be attributed to experience in their course of study and with higher training and exposure related to their qualification though this was not statistically significant. in this study, the overall attitude of the health workers towards disease prevention was favourable as 94.1% have positive attitude towards disease prevention, this is similar to other studies (18) and (19) which showed that a greater percentage of primary care workers had a positive attitude towards infectious disease prevention and another study on health promotion and prevention (20) but contrary to another nigerian study where many primary health care workers had negative attitude regarding the management of an infectious disease (10). the positive attitude of respondents in this study is higher compared to another study on infection prevention among healthcare workers where the overall attitude was poor (15). however, the study conducted in guinea on ebola virus disease reported low attitude compared to this study (21). workers attitudes are vital indicators to the willingness to learn and consequently improve themselves, thus the high level of positive attitude seen among health workers is commendable and shows the willingness of workers to further understand disease processes and prevention. although not statistically significant, younger respondents, those with higher education and in terms of profession, nurses made up the larger number of those with positive attitude when compared to their counterparts. this may be due to the enterprising nature of the young and their readiness to learn and those with higher qualifications have possibly being placed at an advantageous position in terms of an attitude than those who have diploma qualification by virtue of detailed academic processes they went through. more nurses/midwives had a positive attitude towards disease prevention than others including medical doctors. it is possible that some doctors who are more knowledgeable as shown in this study exercised a high degree of contentment with their level of knowledge and their attitudes towards res. j. health sci. vol 11(3), september 2023 229 kap of disease prevention among healthcare workers in phc tajudeen et al. disease prevention may be compromised because of their high level of knowledge, as they may feel that there is nothing new to learn about disease prevention. this study revealed that there was no gap between knowledge and practices which is in line with the study on tuberculosis (16) and another ethiopian study on infection prevention among health care workers (12). however, slightly more than one-sixth of the respondents who were involved in the preventive practice of regular exercise have poor knowledge of disease prevention. the overall good practices could be ascribed to the respondents' better knowledge reciprocated on their preventive practices. this study revealed that the majority of the respondents who had practised a healthy diet has significant good knowledge and a positive attitude towards the prevention of diseases p=0.004 and p=0.032 respectively. this could be attributed to the fact that the more one practices an act, the more knowledge acquired., respondents who rarely do medical check-up were found to have a greater proportion of poor knowledge on diseases prevention compared to those who do it sometimes and regularly. this could be attributed to the frequent check-up and therefore greater comprehension of diseases preventive practices. respondents who have done various screening/tests and check-up before such as males that had done prostate cancer and females that have done bse and cervical cancer screening were found to have good knowledge and a positive attitude towards disease prevention this might be due to awareness and health education. the majority of the respondents practices preventive measure including a thorough washing of vegetables, hand washing before and after eating and after using the toilet, abstinence from risky sexual behaviour, covering of nostril when sneezing or coughing and were found to have good knowledge and positive attitude towards disease prevention. the result of this study revealed that there is a significant positive association between attitude and preventive practice of diseases prevention, the better knowledge and favourable attitude could be attributed to their consistent preventive practices which may be due to their awareness of the associated health risks of poor practices and thereby having better knowledge on diseases prevention. however, more than three quarters of respondents who do not share personal things have positive attitude towards disease prevention and was statistically significant p=0.029. similarly, respondents who rarely go to work when sick was found to have more positive attitudes compared to others and also statistically significant p<0.001. a significant positive attitude was shown towards the preventive practices of alcohol consumption, as well as blood pressure check p=0.007 and p=0.129 respectively. although a good number of respondents had good knowledge and positive attitudes, the few workers who do not have cannot be said to be negligible because of the nature of work that health workers do, wrong information can be easily disseminated to the populace causing adverse effects. this thus emphasizes the reason why primary health care workers should have adequate diseases prevention knowledge coupled with a favourable attitude as well as practices. further studies may look at this research topic at state, geopolitical zone or on rural and urban comparison context. similarly, further study may assess this topic on communicable and noncommunicable context. conclusion this study revealed that the majority of the respondents had good knowledge of disease prevention. similarly, about nine out of ten of the respondents have positive attitude towards disease prevention. a number of factors were associated with knowledge on diseases prevention in this study including the level of education, there was no significant identifiable predictor of respondents' attitude towards disease prevention. this study also revealed that both the knowledge and attitude of the respondents were found to influence their practices towards disease prevention. when respondents' knowledge and attitude were related to their practices towards diseases prevention, most respondents who had good knowledge and positive attitudes also exhibited overall good practices. the findings of this study which although revealed a distinctively high level of k n o w l e d g e a n d p o s i t i v e a t t i t u d e a l s o demonstrated a significant relationship between knowledge and attitude of health workers towards their diseases preventive practices. training and retraining of primary health care workers especially those whose qualifications were below university degree on disease prevention and health promotion generally, sufficient training of new intakes among primary health care workers as well as periodic re-training after few years of practices, for instance at four to five years' intervals to enhance good knowledge and positive attitudes are recommended. res. j. health sci. vol 11(3), september 2023 230 kap of disease prevention among healthcare workers in phc tajudeen et al. res. j. health sci. vol 11(3), september 2023 231 acknowledgements: the authors of this study will like to appreciate mr olawale, department of nursing science at osun state university, and all others who have contributed in any way towards the success of this research. conflict of interest: none 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trinidad and tobago. int j community med public heal. 2017;4(june):2240–7. 16. alotaibi b, id yy, mushi a, maashi f, thomas a, mohamed g, et al. tuberculosis knowledge , attitude and practice among healthcare workers during the 2016 hajj. plos one. 2019;1–15. 17. tobin e, asogun d, isah e, ugege o, ebhodaghe p. assessment of knowledge and attitude towards lassa fever among primary care providers in an endemic suburban community of edo state?: implications for control. j med med sci. 2013;4(august):311–8. 18. alnoumas sr, enezi fai, isaeed mma, makboul g, el-shazly mk. knowledge , attitude and behavior of primary health care workers regarding health care-associated infections in kuwait . greener j med sci. 2012;2(4):92–8. 19. ekuma ae, oridota es. knowledge , attitude and tuberculosis infection control practice among healthcare workers in dots centres in lagos , nigeria. int j infect control. 2016;12(4):1–9. 20. raffy r l, harold l p. attitude about and practices of health promotion and prevention among primary care providers. sage journals. 2014;(12):11. 21. touré a, traoré fa, sako fb, delamou a, tonguino fs, sylla d, et al. knowledge , attitudes , and practices of health care workers on ebola virus disease in conakry , guinea?: a crosssectional study demographic characteristics. j public heal epidemiol. 2016;8(2): 12-6 kap of disease prevention among healthcare workers in phc tajudeen et al. table 1: frequency distribution of socio-demographic characteristics (n=204) variable frequency percentage age group [mean age 35.6 (8.9) years, minimum=20, maximum=59] 20-39 years (young adults) 121 59.3 40-59 years (middle-aged) 83 40.7 sex male 41 20.1 female 163 79.9 marital status currently married 133 65.2 not currently married 71 34.8 religion christianity 125 61.3 islam 79 38.7 ethnicity yoruba 195 95.6 non-yoruba 9 4.4 level of education diploma 121 59.3 university degree and higher 83 40.7 profession doctor 13 6.4 nurse/midwife 38 18.6 other health workers* 153 75.0 years of practice 1-5 years 91 44.6 6-10 years 46 22.5 11 years and above. 67 32.9 other health workers *chew (40.9%), cho (40.9%), health assistant (3.9%) pharmacist (10.3%), lab scientist/technician (5.4%), physiotherapists (0.5%) medical record (0.5%) kap of disease prevention among healthcare workers in phc tajudeen et al. res. j. health sci. vol 11(3), september 2023 232 table 2: knowledge and attitude of respondents on disease prevention related to their sociodemographic characteristics socio-demographic variables and their categories knowledge of diseases prevention (n=204) statistics attitude towards diseases prevention (n=204) statistics poor (%) n=20 good (%) n=184 negative (%) n=12 positive (%) n=192 sex male 1(2.4) 4(97.6) x2=2.191 p= 0.139 2 (4.9) 39 (95.1) x2< 0.001 p= 1.000 female 19(11.7) 114(88.3) 10 (6.1) 153 (93.9) marital status currently married 13 (9.8) 120 (90.2) x2< 0.001 p= 0.985 7 (5.3) 126 (94.7) x2= 0.041 p=0.840 not currently married 7 (9.9) 64 (90.1) 5 (7.0) 66 (93.0) age young adult 11(9.1) 110(90.9) x2=0.171 p=0.679 6 (5.0) 115 (95.0) x2= 0.140 p= 0.708 middle aged 9 (10.8) 74 (89.2) 6 (7.2) 77 (92.8) religion christianity 13 (10.4) 112(89.6) x2=0.130 p=0.719 6 (4.8) 119 (95.2) x2= 0.271 p= 0.602 islam 7(8.9) 72(91.1) 6 (7.6) 73 (92.4) ethnicity yoruba 18(9.2) 117(90.8) x2=0.501 p=0.479 11 (5.6) 184 (94.4) x2< 0.001 p= 1.000 non-yoruba 2(22.2) 7(77.8) 1 (11.1) 8 (88.9) level of education diploma 18 (14.9) 103(85.1) x2=8.652 p=0.003* 9 (7.4) 112 (92.6) x2= 0.701 p= 0.402 university degree and higher 2(2.4) 81(97.6) 3 (3.6) 80 (96.4) profession doctor 0(0.0) 13(100.0) x2=4.360 p=0.113# 1 (7.7) 12 (92.3) x2= 1.089# p= 0.580 midwife 2(5.3) 36(94.7) 1 (2.6) 37 (97.4) other health workers 18(11.8) 135(88.2) 10 (6.5) 143 (93.5) duration of practice 1-5 years 8 (8.8) 83(91.2) x2=0.665 p=0.717# 3 (3.3) 88 (96.7) x2= 2.153 p= 0.341 6-10 years 6 (13.0) 40 (87.0) 4 (8.7) 42 (91.3) 11 & above 6(9.0) 61(91.0) 5 (7.5) 62 (92.5) #= likelihood ratio * statistically significant kap of disease prevention among healthcare workers in phc tajudeen et al. res. j. health sci. vol 11(3), september 2023 233 table 3a: frequency distribution of respondents’ practices on disease prevention (n=204) variable sub-categories frequency percentage do you wash your hands before eating always 184 90.2 sometimes 18 8.8 rarely/not at all 2 1.0 hand washing after using the toilet always 184 90.2 sometimes 16 7.8 rarely/not at all 4 2.0 exercise at least thirty minutes at least five days a week. yes 144 70.6 no 60 29.4 eating of junks in the past 7 days none/rarely 47 23.0 sometimes/few times a week 117 57.4 once daily 40 19.6 taking of sugary drinks none/rarely 31 15.2 sometimes/few times a week 129 63.2 once daily 44 21.6 taking of fruit none/rarely 18 8.8 sometimes/few times a week 131 64.2 once daily 55 27.0 involvement in risky behaviour no 112 54.9 yes 92 45.1 thorough washing of vegetables when cooking at home yes 185 90.7 no 9 4.4 not sure 10 4.9 do you still take alcohol? yes 16 7.8 no 95 46.6 never taken 93 45.6 do you still smoke? yes 4 2.0 no 63 30.9 never taken 137 67.2 do you share personal things like combs, towel etc.? yes 55 27.0 no 149 73.0 do you cover your nostrils/mouth with tissue or handkerchief when sneezing or coughing? yes, always 161 78.9 sometimes 25 12.3 rarely 18 8.8 when you are sick, do you or your boss/superior usually insist that you come to work instead of staying at home? yes, always 35 17.2 sometimes 52 25.5 rarely 117 57.4 frequency of medical check-up regularly 71 34.8 sometimes 107 52.5 rarely 26 12.7 have ever had a hospital-acquired infection? yes 29 14.2 no 168 82.4 i don’t know 7 3.4 table 3b: frequency distribution of female respondents’ practices on disease prevention (n=163) breast cancer self-examination yes 117 71.8 no 46 28.2 cervical cancer screening using pap smear yes 40 24.5 no 123 75.5 table 3c: frequency distribution of male respondents’ practices on disease prevention (n=41) prostatic cancer screening using psa yes 13 31.7 no 28 68.3 kap of disease prevention among healthcare workers in phc tajudeen et al. res. j. health sci. vol 11(3), september 2023 234 table 4a: respondents’ preventive practices against the development of diseases related to their level of knowledge and attitude towards disease prevention. preventive practices against the development of diseases knowledge on disease prevention n= 204 statistics attitude towards diseases prevention (n=204) statistics poor (%) n=20 good (%) n=184 negativ e (%) n=12 positive (%) n=192 do you wash your hands before eating always 17 (9.2) 167 (90.8) x2= 1.290# p= 0.525 12(6.5) 172(93.5) x2=2.556# p=0.279 sometimes 3 (16.7) 15 (83.3) 0(0.0) 18(100.0) rarely/not at all 0 (0.0) 2 (100.0) 0(0.0) 2(100.0) exercise at least thirty minutes for at least five days in a week. yes 13 (9.0) 131 (91.0) x2= 0.334 p= 0.564 9(6.3) 135(93.8) x2<0.001 p= 0.985 no 7 (11.7) 53 (88.3) 3(5.0) 57(95.0) eating of junks in the past 7 days none/rarely 2 (4.3) 45 (95.7) x2=10.975# p= 0.004* 0(0.0) 47(100.0) x2=6.907# p=0.032* sometimes/f ew times a week 8 (6.8) 109 (93.2) 8(6.8) 109(93.2) once daily 10 (25.0) 30 (75.0) 4(10.0) 38(90.0) involvement in risky behaviour no 9 (8.0) 103 (92.0) x2= 0.878 p= 0.349 4(3.6) 108(96.4) x2=2.396 p= 0.122 yes 11 (12.0) 81 (88.0) 8(8.7) 84(91.3) do you still take alcohol? yes 2 (12.5) 14 (87.5) x2 = 0.335 p= 0.846 3(18.8) 13(81.3) x2= 9.883# p=0.007* no 10 (10.5) 85 (89.5) 8(8.4) 87(91.6) never taken 8 (8.6) 85 (91.4) 1(1.1) 92(98.9) had blood pressure check in the last one year yes 14 (9.0) 141(91.0) x2= 0.147 p= 0.701 5(3.2) 150(96.8) x2= 6.349 p= 0.012* no 6 (12.2) 43 (87.8) 7(14.3) 42(85.7) do you share personal things like combs, towel etc.? yes 5 (9.1) 50 (90.9) x2= 0.043 p= 0.835 7(12.7) 48(87.3) x2=4.792 p=0.029* no 15 (10.1) 134 (89.9) 5(3.4) 144(96.6) #: likelihood ratio * statistically significant. table 4b: male respondents’ preventive practice of prostate cancer screening against their knowledge and attitude towards disease prevention preventive practices against the development of diseases knowledge of disease prevention n= 204 statistics attitude towards diseases prevention (n=163) statistics poor (%) (n=20) good (%) (n=184) negative n=2 positive (n=39) prostatic cancer screening using psa (n=41) yes 0 (0.0) 13 (100.0) x2< 0.001 p= 1.000 2(15.4) 11(84.6) x2=1.820 p=0.177 no 1 (3.6) 27 (96.4) 0(0.0) 28(100.0) #: likelihood ratio * statistically significant kap of disease prevention among healthcare workers in phc tajudeen et al. res. j. health sci. vol 11(3), september 2023 235 table 4c: female respondents’ preventive practices of breast self-examination for breast cancer and cervical cancer screening against their knowledge and attitude towards disease prevention preventive practices against the development of diseases knowledge of disease prevention n= 204 statistics attitude towards diseases prevention (n=163) statistics poor (%) n=20 good (%) n=184 negative n=10 positive n=153 breast cancer selfexamination (n=163) yes 10 (8.5) 107 (91.5) x2=3.893 p= 0.048* 5(4.3) 112(95.7) x2=1.481 p= 0.224 no 9 (19.6) 37 (80.4) 5(10.9) 41(89.1) cervical cancer screening using pap smear (n=163) yes 2 (5.0) 38 (95.0) x2=1.505 p= 0.220 3(7.5) 37(92.5) x2=0.001 p=0.972 no 17 (13.8) 106 (86.2) 7(5.7) 116(94.3) #: likelihood ratio * statistically significant table 5: knowledge and attitude of respondents on disease prevention related to their disease preventive practice. categorized preventive practices against the development of diseases knowledge of disease prevention n= 204 statistics attitude towards diseases prevention (n=163) statistics poor (%) n=20 good (%) n=184 negative n=10 positive n=153 poor practice 5 (21.7) 18 (78.3) x2=2.077* p = 0.149 3 (13.0) 20 (87.0) x2=1.165* p = 0.281 good practice 17 (9.4) 164 (90.6) 9 (5.0) 172 (95.0) * continuity correction. table 6: binary logistic regression of the outcome variable “respondents' level of knowledge on diseases prevention” and selected l socio-demographic predictors predictor variable categories variable p-value odds ratio 95% confidence interval lower upper sex female (reference) 0.100 5.763 0.714 46.481 marital status not currently married (reference) 0.977 1.019 0.290 3.582 age middle aged (reference) 0.265 2.202 0.549 8.838 religion islam (reference) 0.614 0.765 0.270 2.167 ethnicity non-yoruba (reference) 0.167 4.058 0.556 29.640 level of education university degree and higher (reference) 0.024* 0.157 0.031 0.781 years of practice as health workers 11years and above (reference) 0.642 6-10 years 0. 776 0.772 0.129 4.611 1-5 years 0.381 0.525 0.124 2.217 kap of disease prevention among healthcare workers in phc tajudeen et al. res. j. health sci. vol 11(3), september 2023 236 table 7: binary logistic regression of the outcome variable “respondents' attitude towards diseases prevention” and selected socio-demographic predictors predictor variable categories variable p value odds ratio 95% confidence interval lower upper sex female (reference) 0.416 1.981 0.382 10.289 marital status not currently married (reference) 0.119 3.516 0.725 17.050 age middle aged (reference) 0.770 1.273 0.253 6.406 religion islam (reference) 0.437 1.629 0.475 5.586 ethnicity non-yoruba (reference) 0.247 4.173 0.372 46.794 level of education university degree and higher (reference) 0.458 0.569 0.128 2.522 profession other health workers (reference) 0.453 midwife/nurse 0.383 0.346 0.032 3.756 doctors 0.425 2.502 0.262 23.867 years of practice as health workers 11 and above (reference) 0.173 6-10 years 0.101 6.249 0.698 55.944 1-5 years 0.807 1.230 0.234 6.456 figure 2: knowledge and attitudes of the respondents towards disease prevention kap of disease prevention among healthcare workers in phc tajudeen et al. res. j. health sci. vol 11(3), september 2023 237 rjhs 11(3).cdr monkeypox related knowledge, attitudes and practices among students in a tertiary institution in southwest, nigeria: a crosssectional study 1 1 1 2 1 *oyebade, a.o. , oshineye, a.o. , olarinmoye, a.t. , kayode, o.o. , akinpelu, a.a. , 3 oladosu, m. abstract introduction: monkeypox caused by monkeypox virus, a member of the orthopoxvirus genus in the family poxviridae is usually a self-limited disease, however severe cases can occur with case fatality ratio of 3–6% being reported in recent times. this study is aimed at assessing monkeypox related knowledge, attitudes and practices among students in a tertiary institution in southwest, nigeria methodology: the study utilized a cross-sectional design and semi-structured questionnaire to collect data from 278 respondents from august to october 2022. results: in this study, only 37.8% of respondents had good monkeypox related knowledge, 87.8% had good monkeypox related attitude while 96% had good monkeypox related practices. there was association between good monkeypox related knowledge and university education level (p=0.002) with 100 level student having better knowledge. there was also association between good monkeypox related attitude and sex (p=0.012) with female respondents having better attitudes and there was association between monkeypox related practices and age (p=0.028) with respondents between the ages of 18-22 years having better practices. however, there was no association between monkeypox related knowledge, attitudes and practices and marital status, ethnicity and religion conclusion: our findings revealed the crucial need for public health education on monkeypox infection to improve knowledge in order to prevent and protect students from monkeypox infection. good monkeypox related attitudes and practices should be maintained and improved through measures for reduction of exposure to the virus and prompt detection and response keyword: monkeypox, knowledge, attitudes, practices, tertiary institution *corresponding author dr akin oyebade, email: akinoyebade@yahoo.com 1 department of public health, faculty of basic medical sciences, adeleke university, ede, nigeria 2 department of human nutrition and dietetics, osun state university, osogbo, nigeria 3 school of public health, university of illinois, chicago, united states received: december 30, 2022 accepted: april 17, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0003-0202-0315 original article research journal of health sciences res. j. health sci. vol 11(3), september 2023 205 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.3 connaissance, attitudes et pratiques concernant le monkeypox parmi les étudiants du sud-ouest du nigéria 1 1 1 2 1 *oyebade, a.o. , oshineye, a.o. , olarinmoye, a.t. , kayode, o.o. , akinpelu, a.a. , 3 oladosu, m. résumé introduction : le monkeypox causé par le virus monkeypox, un membre du genre orthopoxvirus de la famille des poxviridae, est généralement une maladie spontanément résolutive, mais des cas graves peuvent survenir avec un taux de létalité de 3 à 6% signalé ces derniers temps. cette étude vise à évaluer les connaissances, les attitudes et les pratiques liées au monkeypox chez les étudiants d'une institution tertiaire du sud-ouest du nigéria . méthode de l'étude : l'étude a utilisé une conception transversale et un questionnaire semi-structuré pour collecter des données auprès de 278 répondants d'août à octobre 2022. résultat de l'étude: dans cette étude, seuls 37,8 % des répondants avaient de bonnes connaissances sur le monkeypox , 87,8 % avaient une bonne attitude vis-à-vis du monkeypox tandis que 96 % avaient de bonnes pratiques liées au monkeypox . il y avait une association entre de bonnes connaissances liées au monkeypox et le niveau d'éducation universitaire (p = 0,002) avec un étudiant de niveau 100 ayant de meilleures connaissances. il y avait également une association entre une bonne attitude vis-à-vis du monkeypox et le sexe (p = 0,012) avec les répondantes ayant de meilleures attitudes et il y avait une association entre les pratiques liées au monkeypox et l'âge (p = 0,028) avec les répondants âgés de 18 à 22 ans ayant de meilleures pratiques. cependant, il n'y avait aucune association entre les connaissances, les attitudes et les pratiques liées au monkeypox et l'état matrimonial, l'origine ethnique et la religion. conclusion: nos résultats ont révélé le besoin crucial d'éducation en santé publique sur l'infection par le monkeypox pour améliorer les connaissances afin de prévenir et de protéger les étudiants contre l'infection par le monkeypox . de bonnes attitudes et pratiques liées au monkeypox doivent être maintenues et améliorées grâce à des mesures de réduction de l'exposition au virus et à une détection et une réponse rapides. mot-clé : monkeypox , connaissances, attitudes, pratiques, établissement tertiaire *corresponding author dr akin oyebade, email: akinoyebade@yahoo.com 1 department of public health, faculty of basic medical sciences, adeleke university, ede, nigeria 2 department of human nutrition and dietetics, osun state university, osogbo, nigeria 3 school of public health, university of illinois, chicago, united states received: december 30, 2022 accepted: april 17, 2023 published: september 30, 2023 orcid-no: https://orcid.org/0000-0003-0202-0315 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 206 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.3 introduction monkeypox is a rare zoonotic disease which is caused by a virus belonging to the family poxviridae and genus orthopoxvirus. the causative virus is divided into two clades: west african and congo basin clade. monkeypox is transmitted to humans through close contact with an infected person or animal, or with items contaminated with the virus. infection with monkeypox results in a smallpox-like disease in humans. clinical manifestation may be symptomatic or asymptomatic with incubation period of 5-21 days, usually 6-13 days. infection is usually mild-to-moderate in nature and clinical course comprises of the prodromal period and skin eruption period. natural host of monkeypox virus includes rope squirrels, tree squirrels, gambian pouched rats, dormice, non-human primates and other species (1). communities affected are known to be impoverished and generally have a background of high prevalence of parasitic infections, malnutrition and other significant heathcompromising conditions with no racial or gender preference (2). curtailing animal to human transmission and human to human transmission by ensuring standard precaution plays a very important role in prevention and control of monkey pox transmission (3). the use of airborne precaution is recommended for examination and admission of patient due to the risk of airborne transmission of the disease (4). history has it that small pox vaccination with vaccinia virus was approximately 85% protective against monkeypox (5). since 1970, human cases of monkeypox have been reported in west and central africa countries. nigeria has experienced a large outbreak since 2017, with more than 500 suspected cases and 200 confirmed cases and a case fatality ratio of approximately 3%. in may 2022, multiple cases of monkeypox were identified in several non-endemic countries. monkeypox is usually self-limiting but may be severe in children, pregnant women or persons with immune suppression resulting from other health conditions. the case fatality ratio of monkeypox has historically ranged from 0 to 11 % in the general population and higher among young children but recently case fatality ratio of around 3–6% has been reported (1). there is a need to conduct a study on the knowledge, attitudes and practice of monkeypox infection among the undergraduates, because undergraduate students can give a good insight on the subject matter in the population. results from this study will help to document the knowledge, attitudes and practices of monkeypox among undergraduates and by extension sensitize other undergraduates from other institutions nationwide. this study will also serve as a guide for policy development on prevention of monkeypox and the development of appropriate prevention and control programmes among the population, using health education as a tool for the desired change. materials and methods this study was carried out at adeleke university, ede, osun state, nigeria. osun state covers an area of approximately 14,875 square kilometre and lies between latitude 7° 30' 0? n and longitude 4° 30' 0? e. the capital city is osogbo and is bounded in the north by kwara state, in the east partly by ekiti state and partly by ondo state, in the south by ogun state, and in the west by oyo state. it lies within the tropical rain forest with abundance of resources and is blessed with presence of many rivers and streams which serves the water needs of the state (6). osun state has a projected 2016 population of 4,705,600 (7). adeleke university is located in an ambient and serene environment at loogun ogberin, ede north ede, osun state, nigeria. is a private faith-based learning institution located in a peaceful and friendly environment of about 520 acres of land in the historical town of ede, osun state, south-western part of nigeria. adeleke university comprises of six faculties, comprising of faculty of engineering (foe), faculty of basic medical sciences (fbms), faculty of sciences (fos), faculty of law (fol), faculty of arts (foa); and faculty of business and social sciences (fbss). it has an administrative (senate) building, residential buildings, university cafeteria and library we utilized the cross-sectional study design to assess monkeypox related knowledge, attitudes and practices among students of adeleke university. the study population comprised of undergraduate students. the inclusion criteria are: being a full-time undergraduate student of adeleke university, availability at the time of carrying out the study, giving full consent for participation in the study and being healthy and not diagnosed with any kind of diseases. the exclusion criteria are: being a post-graduate student, part-time student, fulltime undergraduate student on any form of medication, acutely ill or with known chronic res. j. health sci. vol 11(3), september 2023 207 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. diseases or unwilling to participate in the study. the sample size was determined using the formula for sample size determination for 2 2 known single proportion n = z p (1 p)/d , where n = minimum desired sample size, z = the standard normal deviate was set at 1.96 which corresponds to 5% level of significance (8). utilizing proportion of 48% reported in a similar study and precision of 6%, a minimum sample size of 260 was computed. however, to account for anticipated non-response a total sample size of 278 was utilized for the study (9). we utilized the purposive sampling method to select participants to cut across the six faculties, 23 departments and 100-500 levels of the undergraduate education. we designed a semi-structured self-administered questionnaire consisting of four sections used for data collection. the first section aimed at determining the socio-demographic characteristics of the respondents had 7 questions, the second section aimed to determine knowledge on monkeypox had 14 questions; the third section was aimed at detecting attitude towards monkey pox disease had 8 questions, while the fourth section aimed at capturing practices regarding prevention of monkeypox had 6 questions. the instrument was administered to respondents by the researchers. the range of scores for knowledge was 0-14 using yes, no and do not know questions. the range of scores for attitude was 5-40 using 5point likert scale questions while the range of score for practice was 0-6 using yes or no questions. knowledge was classified into low (07) and high (8-14), attitude was classified into low (8-25) and high (25-40) while practice was classified into low (0-3) and high 4-6) content validity of research instrument was determined through expert in the field of p u b l i c h e a l t h a s s e s s i n g t h e r e s e a r c h questionnaire. observations, corrections and suggestions made were used to revise the instrument before the final draft. the data collected was entered and analyzed using the ibm statistical package for social sciences (ibm spss) statistical software, version 26. descriptive statistics (means, s t a n d a r d d e v i a t i o n s , f r e q u e n c i e s a n d percentages) were computed for sociodemographic variables and the dependent variables. analysis of variance (anova) test was used to test hypothesis for difference in dependent variables among different sociodemographic groups to determine presence of statistical association. the level of significance was set at 5%. written informed consent was obtained from the respondents before commencement of the study. results there were 278 participants recruited into the study and there was 100% response rate. age range was 18-27 years with mean age of 19.7 years and a standard deviation of +5.01 years. majority (76.3%) of respondents were between 18-22 years, 14.7% were between 13-17 years while 9% were between 23-27 years. fifty-four (54%) percent of respondents are males while 46% are females. a bulk (96.4%) of respondents are single, 3.2% are married while 0.4% are separated. most (67.3%) respondents are yorubas, 27.7% are igbos, 4.7% are hausas while 0.4% are from other ethnic groups. a high proportion (80.6%) of respondents are christians, 18.7% are muslims while 0.7% are practicing traditional religion. a bulk (38.8%) are in 300 level, 28.4% are in 400 level, 25.2% are in 200 level, 4.7% are in 500 level while 2.9% are in 100 level (table i) monkeypox related knowledge score ranged from 0-14 with a mean score of 6.04 and standard deviation of +3.16, monkeypox related attitude score ranged from 17-36 with a mean score of 28.7 and standard deviation of +3.34 while monkeypox related practice score ranged from 0-6 with a mean score of 5.49 and standard deviation of +0.91 (table ii) a low proportion (37.8%) of respondents had high monkeypox related knowledge score while 62.2% had low monkeypox related knowledge score. a high proportion (54.3%) of respondents had high monkeypox related attitudes score while only 12.2% had low monkeypox related attitude score. majority (96%) of respondents had high monkeypox related practice score while only 4% had low monkeypox related practice score (table iii) respondents between the ages of 18-22 years had higher monkeypox related practice mean score compared to other age groups (p=0.028), however there was no association between age and monkeypox related knowledge (p=0.066) and monkeypox related attitude (p=0.249) f e m a l e r e s p o n d e n t s h a d h i g h e r monkeypox related attitude mean score compared to male respondents (p=0.012) but there was no association between sex and monkeypox related knowledge (p=0.363) and monkeypox related practice (p=0.103). respondents in 100 level had higher monkeypox related knowledge mean score compared to other respondents in levels 200-500 (p=0.002) res. j. health sci. vol 11(3), september 2023 208 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. however there was no association between university level and monkeypox related knowledge (p=0.270) and monkeypox related practice (p=0.743). there was no association between marital status and monkeypox related knowledge (p=0.727), monkeypox related attitude (p=0.111) and monkeypox related practice (p=0.229). there was also no association between religion and monkeypox related knowledge (p=0.317), monkeypox related attitude (p=0.091) and monkeypox related practice (p=0.532). there was equally no association between ethnicity and monkeypox related knowledge (p=0.808), monkeypox related attitude (p=0.693) and monkeypox related practice (p=0.380) (table v) discussion we observed that only 37.8% of respondents had high monkeypox related knowledge score. this means that a low proportion of students have good knowledge about monkeypox infection. this poor knowledge may be due to the fact that until the recent monkeypox outbreak of 2022, the last time cases of monkeypox were reported in nigeria was in the 1970s resulting in low level of awareness (10). this finding is similar to that of a study in nigeria in the general population with only 58.7% having good knowledge of monkeypox infection (11). in addition, a study saudi arabia among the general population reported only 48% of the respondents with high knowledge of monkeypox (9). a survey of the united state general public also found almost half the respondents (47%) feeling that their knowledge level about monkeypox is poor while a study in indonesia reported only 36.5% with good knowledge (12,13). also, a study in kurdistanregion of iraqi reported that participants had insufficient knowledge of monkeypox with a mean of 2.096 and standard deviation ±1.359 and a study at palembang indonesia reported that respondents' knowledge of monkeypox was not very good with only 34.7% knowing that monkeypox was not transmitted sexually (14,15). in addition, a study among physicians in saudi arabia reported 55% with good knowledge about human monkeypox, while a study in a malaysian dental school reported that 89.5% of preclinical students and 94.4% of clinical students were aware of the existence of monkeypox (16,17). we also observed 87.8% of respondents with high monkeypox related attitude score. this deduces that respondents have good attitude about monkeypox infection. the reason may be that people have fears that the recent monkeypox outbreak may mark the start of another pandemic like the covid-19 pandemic and therefore wants to avoid getting infected bringing about good attitudes towards prevention. in addition, a study in kurdistan-region of iraqi also reported participants positive attitude toward monkeypox viral disease with mean score of 4.031 and standard deviation ± 1 . 6 4 5 w h i l e a n o t h e r s t u d y a m o n g undergraduates of a malaysian dental school reported 95.2% preclinical and 96.8% clinical students demonstrating positive attitudes toward monkeypox (14,17). our study reported 96% of respondents with high monkeypox related practices score. this infers good monkeypox related practices among respondents. this is likely because majority of respondents have learnt about standard precaution prevention practices during the covid-19 era which is also applicable for prevention of monkeypox infection culminating in good prevention practices. this finding is analogous to that of a study in indonesia which observed 60% of respondents equipping themselves with personal protective equipment, 76% finding information about diagnosis and 77.3% willing to be vaccinated against monkeypox while a study among clinicians in ohio reported only about 40% who had received smallpox vaccination (15,18). this study revealed association between monkeypox related knowledge and university education level (p=0.002) with 100 level students having better knowledge. monkeypox related attitude was associated with sex (p=0.012), with female respondents having better attitudes. also, our study observed association between monkeypox related practices and age (p=0.028) with respondents between the ages of 18-22 years having better practices. we did not find any association between monkeypox related knowledge, attitudes and practices and marital status, religion and ethnicity. this finding is similar to observation in a study which reported that demographic factors were not associated with monkeypox knowledge, attitude and practice (18). however, another study reported association between monkeypox related knowledge and religion with p<0.001 and marital status with p-value<0.009 (14). a similar study reported association between monkeypox related knowledge and marital status with p<0.01(9). a limitation of this study is the use of purposive sampling method which means that generalization of the findings should be done with caution. res. j. health sci. vol 11(3), september 2023 209 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. conclusion we found that overall monkeypox related knowledge was poor while overall monkeypox related attitude and practices were good among students of adeleke university, ede in nigeria. better monkeypox related knowledge was associated with lower university education level. also, better monkeypox related attitude was associated with being female while better monkeypox related practices was associated with being young (18-22 years). we did not observe any association between monkeypox related knowledge, attitudes and practices and marital status, ethnicity and religion our findings revealed the crucial need for public health education on monkeypox infection to improve knowledge in order to prevent monkeypox infection among students and to empower them to protect themselves against monkeypox infection. good monkeypox related attitudes and practices should be maintained and improved through measures for reduction of exposure to the virus and prompt detection and response conflict of interest: authors declare no conflict of interest. a c k n o w l e d g m e n t s : t h e r e a r e n o acknowledgments references 1. world health organization. monkeypox. av a i l a b l e a t h t t p s : / / w w w. w h o . i n t / n e w s room/fact-sheets/detail/monkeypox. accessed december 5, 2022. 2. reynolds mg, mccollum am, nguete b, shongo lr. et al. improving the care and treatment of monkeypox patients in low-resource settings: applying evidence from contemporary biomedical and smallpox biodefense research. viruses. 2017; 9(12):380. 3. arita i, jezek z, khodakevich l, ruti k. human monkeypox: a newly emerged orthopoxvirus zoonosis in the tropical rain forests of africa. am j trop med hyg. 1985; 34(4):781-789. 4. hauser k, jamerson sl. eds. harrison's principle of internal medicine. 18th ed: mcgraw hill medical; 2012:1476-1478. infection control: hospital. 2015. available at https://www.cdc.gov / p o x v i r u s / m o n k e y p o x / c l i n i c i a n s / i n f e c t i o n control-hospital.html. accessed september 17, 2022. 5. fine pe, jezek z, grab b, dixon h. the transmission potential of monkeypox virus in human populations. int j epidemiol. 1988; 17(3): 643-650. 6. osun state government. geography. available at https://www.osunstate. gov.ng/about/geography/. accessed december 23, 2022. 7. nigeria bureau of statistics. population 20062016. available at https://nigerianstat.gov.ng /elibrary/read/474. accessed december 23, 2022 8. kish l. survey sampling. wiley.1965; isbn 9780471109495 9. alshahrani nz, alzahrani f, alarifi a.m. algethami, mr, alhumam mn, ayied, ha. et al assessment of knowledge of monkeypox viral infection among the general population in saudi arabia. pathogens 2022; 11:904 10. national centre for disease control and prevention, 2022. https://ncdc.gov.ng/diseases /factsheet/55 11. al-mustapha ai, ogundijo o.a, sikiru na, kolawole b, oyewo m, el-nadi h et al. a crosssectional survey of public knowledge of the monkeypox disease in nigeria. bmc public health (2023) 23:591, https://doi.org/ 10. 1186/s12889-023-15398-0 12. winters ms, malik aa, omer sb. attitudes of the us general public towards monkeypox. medrxiv; doi: https: //doi.org/10.1101 /2022.06.20.2227652 13. harapan h, setiawan am, yufika a, wahyuni s, asrizal s, febrivan s. et al. knowledge of human monkeypox viral infection among general practitioners: a cross-sectional study in indonesia. pathog glob health. 2020; 114(2):68-75. 14. ahmed sk, abdulqadirb so, omar rm, hussein s.h, m-amin hi, chandran d. et al. study of knowledge, attitude and anxiety in kurdistanregion of iraqi population during the monkeypox outbreak in 2022: an online cross-sectional study. d o i : 1 0 . 2 1 2 0 3 / r s . 3 . r s 1 9 6 1 9 3 4 / v 2 . p p r : ppr541524. 15. salim na, septadina is, permata m. harun h. knowledge, attitude and perception of anticipating 2022 global human monkeypox infection among internal medicine residents at palembang indonesia: an online survey. jurnal kedokteran dan kesehatan 2022; 9:253-262 16. alshahrani nz, algethami mr, alarifi am, alzahrani f, alshehri ea, alshehri am. et al. knowledge and attitude regarding monkeypox virus among physicians in saudi arabia: a crosssectional study. vaccines 2022; 10: 2099. https:// doi.org/10.3390/vaccines10122099 lin gs, 17. tan ww, chan dz, ooi k.s, hashim h. monkeypox awareness, knowledge, and attitude among undergraduate preclinical and clinical students at a malaysian dental school: an emerging outbreak during the covid-19 era. asian pac j. trop med 2022; 15(10):461 18. bates br, grijalva mj. knowledge, attitudes, and practices towards monkeypox during the 2022 outbreak: an online cross-sectional survey among clinicians in ohio, usa. j. infect public health, 15(12), 1459–1465 res. j. health sci. vol 11(3), september 2023 210 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. res. j. health sci. vol 11(3), september 2023 211 table i: frequency distribution of respondents by socio-demographic characteristics variable category frequency percent age group 13-17 years 41 14.7% 18-22 years 212 76.3% 23-27 years 25 9.0% total 278 100.0% gender male 150 54.0% female 128 46.0% total 278 100.0% marital status single 268 96.4% married 9 3.2% separated 1 0.4% ethnicity total 278 100.0% yoruba 187 67.3% hausa 13 4.7% igbo 77 27.7% others 1 0.4% religion total 278 100.0% christian 224 80.6% muslim 52 18.7% traditional 2 0.7% total 278 100.0% level of education 100 8 2.9% 200 70 25.2% 300 108 38.8% 400 79 28.4% 500 total 13 278 4.7% 100.0% table ii: descriptive statistics of respondent’s monkeypox related knowledge, attitude and practice score variable n possible scores actual score mean std. deviation knowledgescore 278 0-14 0-14 6.04 +3.16 attitudescore 278 5-40 17-36 28.70 +3.34 practicescore 278 0-6 0-6 5.49 +0.91 table iii: distribution of monkeypox related knowledge, attitude and practice score variable score frequency percent knowledge low (0-7) 173 62.2% high (8-14) 105 37.8% total 278 100.0% attitude low (8-24) 34 12.2% high (25-40) 244 87.8% total 278 100.0% practice low (0-3) 11 4.0% high (4-6) 267 96.0% total 278 100.0% monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. res. j. health sci. vol 11(3), september 2023 212 table iv: association between monkeypox related knowledge, attitude and practice and age, sex and university level (anova test) variable score category n mean f sig. age group knowledge score 13-17 years 41 5.37 2.745 0.066 18-22 years 212 6.28 23-27 years 25 5.08 total 278 6.04 attitude score 13-17 years 41 29.02 1.399 0.249 18-22 years 212 28.76 23-27 years 25 27.68 total 278 28.70 practice score 13-17 years 41 5.22 3.624 0.028 18-22 years 212 5.57 23-27 years 25 5.24 total 278 5.49 sex knowledge score male 150 5.88 0.829 0.363 female 128 6.23 total 278 6.04 attitude score male 150 28.24 6.350 0.012 female 128 29.24 total 278 28.70 practice score male 150 5.41 2.672 0.103 female 128 5.59 total 278 5.49 university level knowledge score 100 8 8.38 4.264 0.002 200 70 5.69 300 108 6.39 400 79 6.09 500 13 3.31 total 278 6.04 attitude score 100 8 29.75 1.301 0.270 200 70 29.36 300 108 28.55 400 79 28.25 500 13 28.54 total 278 28.70 practice score 100 8 5.25 0.490 0.743 200 70 5.44 300 108 5.49 400 79 5.51 500 13 5.77 total 278 5.49 table v: association between sociodemographic characteristics and monkey-pox related knowledge, attitude and practice (anova test) variable knowledge score p value attitude score p value practice score p value age 0.066 0.249 0.028 sex 0.363 0.012 0.103 marital status 0.727 0.111 0.229 religion 0.317 0.091 0.532 ethnicity 0.808 0.693 0.380 university level 0.002 0.270 0.743 monkeypox knowledge, attitudes and practices among students in southwest, nigeria oyebade et al. rjhs 11(1).cdr assessment of challenges inhibiting effective delivery of health care services among frontline professional health workers during covid 19 lock down in nigeria. 1,2 1 awolola, e. , maharaj, s. abstract background: coronavirus (covid-19) increased patient loads globally, having a negative impact on health services. social distancing is one strategy to prevent spreading covid-19 but creates challenges for health professionals. this study assessed the challenges of covid-19 for selected health professionals in nigeria. methodology: this is a cross-sectional survey of challenges inhibiting health care service provision during covid 19 lockdown. data collected with a pretested online self-administered questionnaire included age, gender, occupation, place of practice, physical distance practices, utilization of telemedicine, income and other concerns that may have inhibited their practices during the covid 19 lockdown. data were analyzed using a statistical package for social sciences (spss) version 26.0 with the level of significance set at p<0.05. chi square goodness of fit test was used to analyze the association between means and qualitative variables. results: response rate from 599 questionnaires was 481 (78%) with physiotherapists (n=108, 23%); nurses (n=106, 22%); doctors (n=86, 18%); laboratory technicians (n=87, 18%) and pharmacists (n=94, 19%); in public sector (n=318, 66%) and private practitioners (n=163, 34%). during the “lockdown” patients interacting with health professionals in private practice decreased except increases for laboratory technicians (11.91%) and pharmacists (68.35%). social distancing was feasible by pharmacists and laboratory technicians, but interactions by nurses, physiotherapists and doctors were compromised. telemedicine was used mostly by doctors (n=42, 48.8%), and physiotherapists (n=50, 46.3%). health professionals experienced mental stress 428 (89%); anxiety 176 (37%); feared infection 333 (69%) and 232 (48%) of transmitting to their families; 307 (64 %) had challenges with personal protective equipment. suggestions were: alternate accommodation or longer shifts with less working days 111 (37%); a hazard allowance 244 (51%) and counseling 238 (49%). conclusion: . private practitioners reported a loss of income with all health professionals indicating the "lockdown" and covid-19 compromised health delivery, health services, and individuals' health. health professionals suggested a hazard allowance, alternate accommodation, and dedicated counseling for health professionals during the pandemic. key words: covid 19, health care delivery, frontline workers, social distancing, telemedicine. *corresponding author: awolola, e email: 220068603@stu.ukzn.ac.za 1 department of physiotherapy, college of health sciences, university of kwazulu-natal, durban, south africa. 2 department of physiotherapy, lagos state university teaching hospital, ikeja, nigeria social distancing affected healthcare delivery, with some using telemedicine to access health services received: september 28, 2022 accepted: march 17, 2023 published: april 19, 2023 original article research journal of health sciences res. j. health sci. vol 11(1), march 2023 27 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.4 evaluation des défis qui entravent la prestation efficace des services de santé parmi les agents de santé professionnels de première ligne pendant le verrouillage de covid 19 au nigéria résumé contexte général de l'étude: le coronavirus (covid-19) a augmenté le nombre de patients dans le monde, ce qui a eu un impact négatif sur les services de santé. la distanciation sociale est une stratégie pour empêcher la propagation du covid-19, mais crée des défis pour les professionnels de la santé. cette étude a évalué les défis de covid-19 pour des professionnels de la santé sélectionnés au nigéria. méthode de l'étude: il s'agit d'une enquête transversale sur les défis qui entravent la prestation de services de santé pendant le confinement lié à la covid 19. les données recueillies à l'aide d'un questionnaire auto-administré en ligne prétesté comprenaient l'âge, le sexe, la profession, le lieu de pratique, les pratiques de distance physique, l'utilisation de la télémédecine, le revenu et d'autres préoccupations qui auraient pu entraver leurs pratiques pendant le confinement lié à la covid 19. les données ont été analysées à l'aide d'un progiciel statistique pour les sciences sociales (psss) version 26.0 avec le niveau de signification fixé à p<0, 05. le test d'ajustement du chi carré a été utilisé pour analyser l'association entre les moyennes et les variables qualitatives. résultats de l'etude: le taux de réponse de 599 questionnaires était de 481 (78 %) avec des physiothérapeutes (n = 108, 23 %) ; infirmières (n = 106, 22 %) ; médecins (n=86, 18 %) ; techniciens de laboratoire (n=87, 18%) et pharmaciens (n=94, 19%) ; dans le secteur public (n=318, 66%) et les praticiens privés (n=163, 34%). pendant le «confinement», les patients interagissant avec des professionnels de santé en pratique privée ont diminué sauf des augmentations pour les techniciens de laboratoire (11, 91%) et les pharmaciens (68,35%). la distanciation sociale était réalisable par les pharmaciens et les techniciens de laboratoire, mais les interactions des infirmières, des physiothérapeutes et des médecins étaient compromises. la télémédecine était principalement utilisée par les médecins (n = 42, 48,8 %) et les physiothérapeutes (n = 50, 46,3 %). les professionnels de la santé ont subi un stress mental 428 (89 %) ; anxiété 176 (37%); craignaient l'infection 333 (69%) et 232 (48%) de la transmettre à leur famille ; 307 (64 %) avaient des problèmes avec l'équipement de protection individuelle. les suggestions étaient les suivantes : logement alternatif ou quarts de travail plus longs avec moins de jours de travail 111 (37 %) ; une allocation de risque 244 (51 %) et des conseils 238 (49 %). conclusion: la prestation des soins de santé a été affectée par la distanciation sociale, certains utilisant la télémédecine. les praticiens privés ont signalé une perte de revenus, tous les professionnels de la santé indiquant que le « confinement » et la covid-19 ont compromis la prestation des soins de santé, les services de santé et la santé des individus. les professionnels de la santé ont suggéré une allocation de risque, un logement alternatif et des conseils dédiés aux professionnels de la santé pendant la pandémie. mots-clés : covid 19, prestation de soins de santé, travailleurs de première ligne, distanciation sociale, télémédecine *corresponding author: awolola, e email: 220068603@stu.ukzn.ac.za 1 department of physiotherapy, college of health sciences, university of kwazulu-natal, durban, south africa. 2 department of physiotherapy, lagos state university teaching hospital, ikeja, nigeria 1,2 1 awolola, e. , maharaj, s. received: september 28, 2022 accepted: march 17, 2023 published: april 19, 2023 article original research journal of health sciences res. j. health sci. vol 11(1), march 2023 28 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i1.4 introduction the novel coronavirus, referred to as covid-19, created social, economic, and health crises globally, with the pandemic affecting people's activities and lives. the outbreak of covid-19 continues to have a dramatic impact throughout the world, and the incidence and prevalence increase rapidly daily, with current figures well over 17 million globally (1). the world health organization (who) declared covid-19 a public health emergency in january 2020 (2). this was followed by countries implementing r isks for spreading the virus and infection may also be highest at the beginning of an outbreak when healthcare professionals may not be familiar with or have adequate ppe. the rapid surge in demand for healthcare services resulted into an increase rates of burnout across medical specialties, according to wiederhold, cipresso (4), fred and scheid (5), liebenberg, coetzee (6), healthcare workers in primary healthcare environment were at greatest risk, including pharmacist and others at the frontline of heath care. the incidence, prevalence, and severity of covid 19 is now a major health crisis for health professionals, health delivery, and individuals worldwide (1). it has affected and continues to affect all nations, continents, races, and socioeconomic groups. the rapid increase in the number of covid -19 patients, especially those who presented clinically as critically ill, forced health professionals to perform in a unique environment with alternate and new patient management methods (1). apid responses of quarantining communities, closing schools, social and physical distancing, and isolation, all of which abruptly changed citizens' daily lives globally (3). the rapid adjustment had a concomitant effect on health professionals and health delivery because the rapid spread of this disease and the severity of symptoms pushed many countries to the limits of their health care systems. health professionals managing patients with covid-19 experienced a lack of personal protective equipment (ppe), the surge of critically ill patients requiring intensive care unit (icu) beds, and a shortage of ventilators (3). it is noted that the r while facing these challenges, health professionals performed to their full potential under extraordinary circumstances because patients expect health professionals to provide health care based on their specialist training (3). other challenges for health professionals coping with societal shifts and emotional stressors faced by patients while simultaneously facing a greater risk of exposure, extreme workloads, moral dilemmas, and a quickly evolving clinical environment differing from their usual practice (3). according to kannampallil, goss (7), in an american study, exposure although the covid-19 to covid-19 patients increased physician trainee stress and burnout compared to those not exposed to these patients. covid-19 is caused by the severe acute respiratory system coronavirus 2 (sars-cov-2) having a case fatality rate of 2-3%, with higher rates among patients with comorbidities and the elderly population (8). the disease can cause significant alveolar damage resulting in hypoxemic acute respiratory failure (arf), requiring the use of mechanical ventilation in most patients (9,10). pandemic in africa is several weeks behind europe and asia, the number of infections in africa is escalating daily (11-13). incidence varied between africa countries, which reflects in variations in air travel volume and differences in testing for covid-19 (14). although countries in africa are increasing their preparedness for covid-19, the who points to substantial response capacity limitations (14,15). many governments in africa require support from international donors due to lack of infrastructure and to protect "frontline" healthcare professionals from spreading the virus. mortality rates are high among healthcare professionals who become infected and are even higher in many parts of africa, given the limited number of critical intensive care unit beds (16). moreover, the large geographical distances between rural and urban areas pose practical difficulties in transferring health professionals from rural areas to secondaryor tertiary-level facilities in urban centers (17). although evidence of the impact of certain noncommunicable diseases, tuberculosis, and hiv on covid-19 is not yet available (17-19), many healthcare professionals in africa fall into the category of 'high-risk' groups for covid-19 (17). nigeria, with a population of 206,139,589, accounts for 2.6% of cases in africa and 0.02% of the global occurrence as of april 2nd, 2020 (2). nigeria has 36 states and a federal capital territory. the first case of covid-19 in nigeria was confirmed on february 27th, 2020 (20). the virus had an incidence in more than 50 percent of the states in nigeria, with lagos and abuja having the highest number of reported cases in nigeria (21). res. j. health sci. vol 11(1), march 2023 29 challenges of healthcare services during covid 19 lock down awolola and maharaj following the covid-19 pandemic, many countries implemented strict infection control measures and nationwide "lockdown." in nigeria, the government implemented the "lockdown" by restricting movement and placing a ban on social gatherings in all states. also, social distancing measures entailed physical distancing between a minimum of one and a half meters between individuals and restricting citizens and public transport to only emergency requirements. however, pandemics like covid19 have a vicious cycle because there is an increase in the demand for the services of health professionals in the aspects of palliative care (22). the expectation of effective and efficient health services is patients to get the best care by rapid response and new treatment methods when resources are over-stretched (23). however, the covid-19 pandemic has a detrimental effect on health services, health delivery, and individuals' overall health. "frontline" health professionals are usually those in first or direct contact with patients or the community, such as doctors, nurses, and community health workers. however, for this study, we identified "essential" health professionals as those who interact directly with patients in clinical and hospital settings daily, i.e doctors, nurses, and physiotherapists. additionally, these health professionals come into direct contact with patients infected with covid-19 who attend health facilities with intensive care units during the pandemic. therefore, these "essential" health professionals are required to play a role in identifying, containing, mitigating, and treating the symptoms of this disease. this includes i m p l e m e n t i n g m e t h o d s t o r e d u c e t h e transmission of covid-19, initiating early identification strategies, and dealing with infected patients appropriately. however, has forced health professionals to review their daily provision of health services, delivery, and the need to ensure patients' sustained care and welfare. therefore, this study was carried out with the primary aim of determining the challenges of covid-19 on selected health professionals during the "lockdown” especially with respect to social distancing and movement restrictions following covid-19 in nigeria and to offer ways to alleviate some of the challenges the current novel coronavirus has created panic among health professionals as they grapple with new experiences in the same way that other population groups do, thereby creating challenges for health delivery (23). the virus posed by this virus. materials and methods study design and participants this cross-sectional descriptive survey was conducted in may 2020. the "essential" health professionals selected were those usually in direct contact with patients, viz. doctors, nurses, physiotherapists, and those who may not necessarily be in direct contacts like pharmacists and laboratory technicians. healthcare professionals working in the private or public health sector and registered with their respective regulatory bodies gave consent to participate in the study. the medical rehabilitation and therapist board of nigeria (mrtb), association of medical laboratory scientists of nigeria (amlsn), national association of nigeria n u r s e s a n d m i d w i v e s ( n a n n m ) , pharmaceutical society of nigeria (psn), and nigeria medical association (nma) approved the use of their databases to send the survey link to their membership. the study sample was determined using the data from human resources for health (hrh) in africa, with an estimated 1.95 health workers per 1000 population for essential health care services in nigeria (24). using a population estimate of 206 million individuals in nigeria (25), approximately 401,700 health care workers are likely to be available for essential healthcare services in nigeria. the sample size of 599 was determined with a population of 401,700 health care workers, a confidence level of 95%, and a confidence interval of 4 using a survey system, an online sample size calculator (26). this study was approved by the biomedical research ethics committee of the university of kwazulu natal, durban, south a f r i c a , w i t h a p p r o v a l n u m b e r brec/00001883/2020. questionnaire development a structured self-administered online questionnaire was used to obtain data from the study respondents (mcleod 2018). since there were no available previous studies on this topic, the researchers used 'surveymonkey', an online software tool, to design a questionnaire based on the study's aims and literature review. this software tool provides customizable surveys and a suite of paid back-end programmes that include data analysis, sample selection, bias elimination, and data presentations. the researchers ensured validity and reliability of the questionnaire's content by consultation with health professionals res. j. health sci. vol 11(1), march 2023 30 challenges of healthcare services during covid 19 lock down awolola and maharaj and academics as prescribed by huijbregts (27). this was achieved by having the draft questionnaire reviewed by three social scientists followed by an online pilot survey to 10 health professionals from a hospital not used in the final study. after that, suggestions and changes were made with the final questionnaire having three sections with semi-structured openand closedended questions to evaluate participants' challenges and suggestions. these were presented as first and second sections having inquiries related to demographic data, professional identity, and sector of practice. the third section contained open questions to explore suggestions to improve health delivery during the pandemic qualitatively. procedure the dillman da (28) method was used, which required pre-notice information and a cover letter informing the health professionals about the web link and how to access the study. the pre-notification was used to avoid the risk of nonresponse and tell that the survey date's closure st was 31 may 2020. the survey software ensured respondents' anonymity, and they could only access the questionnaire if they responded "yes" to informed consent. only the researchers had access to the data, which was dated and stored in a folder on a computer with password protection under lock and key in the researcher's office. all paper-related data were shredded after being recorded with electronic data to be deleted after five years. data analysis q u e s t i o n n a i r e r e s p o n s e s w e r e downloaded from survey monkey as raw data to microsoft excel data. the quantitative data were evaluated using spss version 26.0 software, and "open-ended" comments analyzed using counts aggregated into themes. descriptive statistics with frequencies and percentages were used to summarize thes data obtained while a a chisquare goodness of fit test was used to show the effect of demographic status on challenges encountered while rendering vices during the lock down period. results from the 599 questionnaires distributed, the response rate was 78% (481 respondents. responses were from physiotherapists (n=108, 23%); nurses (n=106, 22%); doctors (n=86, 18%); laboratory technicians (n=87, 18%) and pharmacists (n=94, 19%). majority of the respondents' ages ranged 25 to 44 (n=335, 71%) with females constituting (n=272, 57%) (table 1). public hospital practitioners were (n=312, 66%) and private practice (n=163, 34%). the average time to complete the survey was 2 minutes 54 seconds. all health professionals' i n c o m e i n p r i v a t e p r a c t i c e d e c r e a s e d significantly compared to those in public hospitals (table 1). during the study period, patients interacting with doctors, nurses, and physiotherapists in private practice decreased, whereas laboratory technicians experienced an increase in their patient numbers by 12% and pharmacists by 68%. (table 2). sixty-eight percent of the pharmacists practiced social distancing with a practicability score of >5. it did not affect their patient interactions, whereas 24% of the physiotherapists recorded the least social distancing practicability score of < 5 (figure 1). telehealth was used the most by doctors (n=42, 49%) and physiotherapists (n=50, 46.3%), with laboratory technicians (n=9, 10%) using this facility the least. the open-ended questions were themed with the following summary (table 3). four hundred and twenty-eight (89%) of the participants experienced mental stress and a n x i e t y w i t h 9 9 n u r s e s ( 9 3 % ) ; 1 0 1 physiotherapists (94%); 69 doctors (80%) 76 laboratory technicians (87%); 83 pharmacists (88%). one hundred and seventy-six (37%) required psychological support as follows 48 nurses (45%); 64 physiotherapists (59%); 36 doctors (42%); 16 laboratory technicians (18%); 12 pharmacists (13%). fear of getting infected was indicated by 333 respondents (69%) which was -nurses 101(95%); physiotherapists 98 (91%); doctors 69 (80%); laboratory technicians 26 (30%) and pharmacists 39 (41%). two hundred and thirty two (48%) feared transmitting the coronavirus to their family members nurses 83 (78%) ; physiotherapists 69 (64%); doctors 33 (38%); laboratory technicians 19 (22%) and pharmacists 28 (30%). about two-thirds of the respondents 307 (64 %) indicated challenges with personal protection e q u i p m e n t w i t h n u r s e s 9 8 ( 9 2 % ) ; physiotherapists 83 (77%); doctors 69 (80%); laboratory technicians 38 (44%) and pharmacists 19 (20%). suggestions for improving health services during the covid-19 pandemic were alternate accommodation or longer shifts with fewer working days suggested by 111 (37%) as follows nurses 59 (56%); physiotherapists 36 (33%); doctors 16 (19%): allowance over and above their salaries (referred to as hazard/ challenges of healthcare services during covid 19 lock down awolola and maharaj res. j. health sci. vol 11(1), march 2023 31 res. j. health sci. vol 11(1), march 2023 32 danger) allowance was suggested by 244 (51%) with nurses 83 (78%); physiotherapists 69 (64%); doctors 38 (55%); laboratory technicians 16 (18%) and pharmacists 38 (40%) with 238 (49%) requesting dedicated counseling services during the pandemic by nurses 93 (88%); physiotherapists 56 (52%); doctors 38 (44%); l a b o r a t o r y t e c h n i c i a n s 2 2 ( 2 5 % ) a n d pharmacists 29 (31%). discussions this study presents a cross-sectional survey of health professionals' challenges during the "lockdown," particularly to social distancing and movement restrictions following covid-19 in nigeria. being an initial study, the researchers selected a sample of "essential" health professionals who interact in direct contact and those who may not necessarily interact in direct contact with patients. the rationale for selection was to determine if movement restrictions and social distancing during the "lockdown" affected patient interactions and health services. the reason governments globally introduced a "lockdown" and insisted that citizens stay at home was to ensure social distancing and minimize contact with each other as the coronavirus was transmitted by droplets from the host (29). social distancing is an effective nonmedical intervention to prevent the rapid spread of epidemics (30-33). other measures to stop transmission and slow the spread of the pandemic used by many countries were closing schools, prohibiting large gatherings, closure of nonessential stores, and limiting public transport (34,35). according to koren and peto (36) social distancing can be effective against epidemics but are potentially detrimental to the economy and services that rely on face-to-face communication or close physical proximity. health professionals requiring to interact in direct contact with patients when providing services will be affected, which will have a simultaneous effect on health delivery, health services, and individuals' overall health (36). effective and efficient health services expect that patients receive the best care by rapid response and new treatment methods, especially when resources are over-stretched (23). the data from this study shows that although social or physical distancing is simple to implement, ocial distancing it is affecting health professionals and health delivery because having social contacts between health professionals and their patients is an important component to administer the relevant modes of treatment; s between patients and administrative, cleaning staff, and health professionals may be challenging in busy, overcrowded primary health care clinics especially in third world countries with poor infrastructure (23). nursing elemedicine, also referred to as telehealth, is one such method of electronic communication used to study supported the use of telemedicine when denied direct access to their patients because it was used frequently by physiotherapists and doctors for patient and interprofessional engagement. the responses show that telemedicine was used frequently by physiotherapists in private hospitals as a tool to limit their physical contact with patients during physiotherapy sessions. in some instances, due to social distance they could not engage with patients. the 'readiness' of stakeholders to engage in telemedicine can be assessed on a variety of levels and should not be limited to stakeholders' willingness to engage but also their ability to engage through the availability of necessary technology and alignment with organizational strategic plans (alami, gagnon (37), theodors, hill (38). this study supports telemedicine as a beneficial way to engage with patients and individuals during a pandemic, especially if physical distancing and non-contact are enforced. telemedicine also allows national or international experts to give procedures are difficult to conduct when implementing social distancing due to nurses' frequent interactions with patients. the responses from health professionals in this study show that social distancing as a mitigating factor for coronavirus transmission negatively affects efficient and effective health delivery. this will ultimately have a concomitant negative effect on the health of patients and individuals. to overcome this mitigating factor, health professionals are using various strategies. t in nigeria, nurses have direct patient contact when carrying out routine patient management, e.g., drug administration, infusions, etc. the researchers postulate that, unlike physiotherapists and doctors, nursing procedures are difficult to conduct through telemedicine which is possibly why nurses in this study did not often engage in telemedicine as reflected by their low score for social distancing. further, it is suggested that exchange medical information from one location to another, especially in africa with a large rural population (37). the benefit of this exchange of information between health professionals is to exchange expert knowledge and information to improve the patient's health status. the health professionals in this challenges of healthcare services during covid 19 lock down awolola and maharaj advice from a distance and support newly qualified or inexperienced health professionals. this will reinforce health care and individuals' health as a means of virtual service delivery and mitigate the social distancing and direct contact that is not possible during a "lockdown". also, nigeria has a good telecommunication infrastructure as post-ebola outbreak, the authors of this study support t although this study was conducted during the pandemic's initial period, the number of patients marking consultation was reduced for most professionals, which could be due to three factors. the first being that during the "lockdown," transport to health professionals was minimized to emergency services only (20). even in these instances during consultations, patients were required to sanitize their hands, record the temperature, and record their symptoms. secondly, social distancing required a larger floor space requiring some patients to wait outside of the hospital, clinical sites or consultation rooms often exposed to the hot weather as noted by aldossary, martin-khan (39) which would have a negative impact on general healthcare services. thirdly some patients were either cautious or avoided attending surgeries, clinics and hospitals as they perceived these to be the epicenter for covid-19. therefore, during the "lockdown" patients may have been reluctant to access health services even though they may have required these services. this may possibly have been the reason for a decrease for physiotherapy services during the "lockdown". however this was in contrast to the study by downar j (41) who reported an increase in the number of patients requiring physiotherapy services during pandemics as a there was also a significant decrease in income for health professionals in private practice. the researchers are of the view that this may have been because private-sector health professionals in nigeria have their conditions of service and remuneration based on the basic conditions of employment act. this act prescribes the n i g e r i a n c o m m u n i c a t i o n s c o m m i s s i o n increased the number of telecommunication lines by over 45 million from 2014 to 2019. this enabled more nigerians access to mobile communications making telemedicine an important tool for engaging health professionals and patients. elemedicine, which holds promise as it rationalizes human resources and reduces patient contact and thus infection risks. triage system requiring palliative care for those denied critical care. that remuneration for health services is generally determined by patients, medical aid schemes and private hospital remuneration based solely as a function of patients and volume of work outputs. the public sector health professionals in contrast are remunerated on a monthly basis with a fixed salary irrespective of the number of patients or work outputs. the results from this study is supported by ekere and amah (2014) where they showed that the income of public health professionals was not affected because in most countries public sector health professionals have t h e i r c o n d i t i o n s o f e m p l o y m e n t a n d remuneration based on public-service policy set by the state. additionally, the income of physiotherapists in private practice, compared to other professionals in private practice was found to be much lower. this could have been as a result that only emergency services were allowed during the "lockdown" and some patients may not have regarded physiotherapy as an emergency requirement. alternatively, there was an increase in the number of patients receiving services from pharmacists and laboratory technicians as compared to other health professionals. the authors postulate that this increase in patients may be due to those requiring their chronic medication or medication for signs of infection or for those having symptoms of the virus requiring tests which increased the demand for the services of these professionals respectively. it is worth noting that the strain at work is compounded by the disruptions and uncertainties felt by members of the general population during a pandemic (42). securing the mental wellbeing of healthcare professionals who deliver health services for patients with covid-19 disease results in considerable mental stress, leading to high levels of anxiety and post-traumatic stress disorders, especially among nurses (43). currently, the impact of hiv/aids and tuberculosis has placed an additional burden on public health therapists within an over-burdened and under-resourced public health system with health professionals also experiencing an overwhelming fear for their health by getting infected or spreading the infection to their family members (44,45). while healthcare professionals accept an increased risk of infection as part of their chosen profession, they tend to have a considerable anxiety about talking about the virus to their children, families and friends, especially with the elderly or those with chronic medical conditions (46-47). female health professionals in particular have to juggle homeschooling, work overtime and do household challenges of healthcare services during covid 19 lock down awolola and maharaj res. j. health sci. vol 11(1), march 2023 33 tasks, which potentially can undermine their decision-making ability and quality of interaction with patients (48). these may have been compounding issues in this study as a predominantly large proportion of respondents were females mainly from the nursing and physiotherapy professions which is the common gender for these professionals in nigeria (49-50). psychological support is key, perhaps as was done with hiv/aids in the african continent where utilizing the large numbers of hiv counsellors or retired nurses to counsel health professionals had an ameliorating effect on health care professionals (51). given the competing priorities of health staff, formal structured interventions, however, may encounter obstacles, (52). informal mechanisms might be more successful, where counsellors or retired nurses visit healthcare workers to counsel them. also support through social media like the vula platform which when conducted in south africa relieved stress, this method could be extended to other countries (52). based on the above mental stressors and high risk imposed by covid-19, health professionals in this study suggested a hazard allowance or health insurance to "essential" health professionals during the pandemic. in this study a high percentage of nurses preferred alternative accommodation to avoid the risk of household transmission. this was successful in some countries where student residences or hotels that were empty were repurposed to serve as places where health professionals could rest and temporarily isolate themselves from their family (52). the authors also noted that this study showed support for an alternate way to mitigate home transmission is that health professionals increase hours of their shifts which will allow them more days off as compared to shorter shifts and returning home each night. considering the costs in setting up some of the suggestions listed above, investing in ppe, and staff resources may improve patient outcomes. respondents in this study also suggested that other mitigating factors for the spread of covid-19 such as basic hand hygiene and use of personal protective equipment (ppe) such as gloves, masks, gowns and goggles form the foundation of infection control which will enable health professionals to treat patients with communicable diseases while protecting themselves and others. conclusion majority of the health professionals who participated in this study were employed in the tertiary healthcare facility which managed almost a third of all patients treated during the pandemic. "essential" health professionals who are in close or direct contact with patients were the most affected by social distancing. restricted transportation by public transport and other social services may have affected health delivery contributing to ineffective health services during the "lockdown". health professionals employed in the private sector reported a significant decrease in their income during the pandemic. telemedicine can be beneficial during a pandemic, especially if non-contact is enforced as it is an ideal tool as a means of virtual health service delivery and mitigates the social distancing and direct contact that is not possible during a "lockdown." it will ensure an effective and efficient health service delivery and health of individuals in the absence of direct contact during the "lockdown" between health professionals and patients. the health professionals surveyed in this study suggested a hazard allowance, alternate accommodation and health insurance be provided to all "frontline" health professionals during the pandemic. health professionals suggested a monetary allowance over and above their salary, alternate accommodation and health insurance for to all "essential" health professionals during the pandemic. limitations of the study: the authors concede that the majority of the respondents were from the south-western part of nigeria and the result of the survey may not be generalized across all the regions of the country. the sample were selected "essential" health professionals and may not necessarily be the view of all health professionals in the region. finally, although the blinded technique was used to disseminate the questionnaires the acute nature of the covid-19 pandemic, complete closure of most health institutions and the inability to access the internet in some regions could have been an additional limitation to this study. availability of data and materials: the datasets used during the current study are available from the corresponding author on request. the findings from the study would be made available to participating researchers as required by law. conflict of interests: the authors declared that challenges of healthcare services during covid 19 lock down awolola and maharaj res. j. health sci. vol 11(1), march 2023 34 they have no competing interests. the views expressed in this study are strictly the views of the authors and not of the institution or any other group of people. references 1. w h o . w o r l d h e a l t h o r g a n i s a t i o n . 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selected professional cadre during and before movement restriction by federal government of nigeria. health services during restriction before restriction percentage difference remark physiotherapy 353 470 -31.06% reduction nursing 234 318 -26.40% reduction medical doctors 196 246 -20.30% reduction laboratoryservice 310 277 11.91% increase* pharmacy 234 139 68.35% increase* total 1327 1450 relationship between various health care practitioners and patients seen before and during the movement restrictions initiated by fgn. we evaluated the relationship between various health care practitioners and patient seen before and during movement restriction by comparing the total number of patients seen before and after movement restriction across all health care practices. laboratory and pharmaceutical healthcare services revealed an increase of 11.91% and 68.35% respectively during the pandemics while others showed a decrease in attendance. challenges of healthcare services during covid 19 lock down awolola and maharaj res. j. health sci. vol 11(1), march 2023 38 challenges of healthcare services during covid 19 lock down awolola and maharaj res. j. health sci. vol 11(1), march 2023 39 rjhs 11(3).cdr effect of psychoactive substance use on academic activities and performance among undergraduates of university of lagos 1 2 1 3 1 1 *osalusi, b.s. , koleowo, o. , ogunsemi, o.o. , ogunjimi, l. , afe, t.o. , ale, a. , 4 5 agboola, a.o.j. , deji-agboola, m.a. abstract background: the objective of this study was to assess the effect of psychoactive substance use on academic performance among university students of lagos undergraduates. methods: this is a descriptive cross-sectional study to assess psychoactive substance use and its relation to academic performance among undergraduate students of the university of lagos. a multi-stage sampling technique was used to select the participants. data was collected using a self-administered semistructured questionnaire adapted from who model core questionnaire self-administered format. data was collected and analyzed using the free-liscence software package epi-info, version 7.2.2.16. chi square and fisher's exact were used to test for any significant association between psychoactive substances use and academic performance of the respondents. level of significance (p) was set at 0.05. result. prevalence of psychoactive substance use was 28.6%. male and female respondents were270 (69.77%) and 117(30.23%) respectively, with age range between 14 and 30 and mean age of 20.51 (sd)(±2.91) year. alcohol was the most abused substance with 68.99%, this was followed by cigarette with 20.67% ever use prevalence. the mean age of first use of psychoactive substance was 16.31±3.89. using the grade point average system from the previous semester, majority of the respondents (87.08%) had gpa >2.50. both frequency of studying and mean cgpa was statistically better among non-life time users and non-current users of alcohol, tobacco and cannabis in the male group. however there was no statical significance among female group. using fischer exact test to assess the effect of age of fisrt substance use and mean cgpa. the age of first substance use was statistically significant for tobacco p = 0.007 conclusion. psychoactive substance use among students was common and negatively associated with students's academic performance especially among male gender. key words: psychoactive substance, academic performance, undergraduate students *corresponding author osalusi b.s, email: sanyabamidele@yahoo.com 1 department of medicine, obafemi awolowo college of health sciences, olabisi onabanjo university, remo campus, sagamu, nigeria. 2 department of medicine, college of medicine, university of lagos, nigeria 3 department of pharmacology and therapeutics, obafemi awolowo college of health sciences, olabisi onabanjo university, remo campus, sagamu, nigeria. 4 department of pathology, obafemi awolowo college medicine,olabisi onabanjo university, sagamu, nigeria. 5 department of microbiology, obafemi awolowo college medicine, olabisi onabanjo university, sagamu, nigeria. received: march 23, 2022 accepted: may 21, 2023 orcid-no: https://orcid.org/0009-0008-8188-6152 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.8 res. j. health sci. vol 11(3), september 2023 254 original article research journal of health sciences effet de la consommation de substances psychoactives sur les activités académiques et les performances des étudiants de premier cycle de l'université de lagos. 1 2 1 3 1 1 *osalusi, b.s. , koleowo, o. , ogunsemi, o.o. , ogunjimi, l. , afe, t.o. , ale, a. , 4 5 agboola, a.o.j. , deji-agboola, m.a. resume contexte: l'objectif de cette étude était d'évaluer l'effet de la consommation de substances psychoactives sur les résultats scolaires des étudiants universitaires de premier cycle de lagos. méthodes: il s'agit d'une étude transversale descriptive visant à évaluer la consommation de substances psychoactives et sa relation avec les résultats scolaires des étudiants de premier cycle de l'université de lagos. une technique d'échantillonnage à plusieurs degrés a été utilisée pour sélectionner les participants. les données ont été recueillies à l'aide d'un questionnaire semi-structuré auto-administré adapté du format auto-administré du questionnaire de base du modèle de l'oms. les données ont été recueillies et analysées à l'aide du progiciel libre epi-info, version 7.2.2.16. le chi carré et l'exact de fisher ont été utilisés pour tester toute association significative entre la consommation de substances psychoactives et les résultats scolaires des répondants. le niveau de signification (p) a été fixé à 0,05. résultat: la prévalence de la consommation de substances psychoactives était de 28,6 %. les répondants masculins et féminins étaient respectivement de 270 (69,77 %) et 117 (30,23 %), avec une tranche d'âge comprise entre 14 et 30 ans et un âge moyen de 20,51 (et) (± 2,91) ans. l'alcool était la substance la plus consommée avec 68,99 %, suivi de la cigarette avec 20,67 % de prévalence de consommation. l'âge moyen de la première consommation de substance psychoactive était de 16,31 ± 3,89 ans. en utilisant le système de moyenne pondérée cumulative du semestre précédent, la majorité des répondants (87,08%) avaient un gpa> 2,50. la fréquence des études et la mpc moyenne étaient statistiquement meilleures chez les consommateurs non permanents et les consommateurs non courants d'alcool, de tabac et de cannabis dans le groupe masculin. cependant, il n'y avait pas de signification statique parmi le groupe féminin. utilisation du test exact de fischer pour évaluer l'effet de l'âge de la première consommation de substances et l'acmg moyenne. l'âge de la première consommation de substances était statistiquement significatif pour le tabac p = 0,007 conclusion: la consommation de substances psychoactives chez les étudiants était courante et négativement associée aux résultats scolaires des étudiants, en particulier chez les hommes. mots-clés: substance psychoactive, rendement scolaire, étudiants de premier cycle *corresponding author osalusi b.s, email: sanyabamidele@yahoo.com 1 department of medicine, obafemi awolowo college of health sciences, olabisi onabanjo university, remo campus, sagamu, nigeria. 2 department of medicine, college of medicine, university of lagos, nigeria 3 department of pharmacology and therapeutics, obafemi awolowo college of health sciences, olabisi onabanjo university, remo campus, sagamu, nigeria. 4 department of pathology, obafemi awolowo college medicine,olabisi onabanjo university, sagamu, nigeria. 5 department of microbiology, obafemi awolowo college medicine, olabisi onabanjo university, sagamu, nigeria. received: march 23, 2022 accepted: may 21, 2023 orcid-no: https://orcid.org/0009-0008-8188-6152 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 255 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.8 introduction psycho active substance abuse is also defined by dsm-v as use of any drug, usually by self-administration, in a manner that deviates from approved social or medical patterns (1, 2). for different reasons, psycho active substance use has been practiced by students regardless of the negative consequences (3). the use of psycho active substances have become a major public health challenge, and this is associated with different factors like sex, age, peer pressure, family substance abuse, personal pleasure, and poor academic achievement (3, 4,5, 6). according to the national youth risk behavior survey, usa, negative association was seen between alcohol and other drug use and academic a c h i e v e m e n t a f t e r c o n t r o l l i n g f o r sociodemographic variables (7). another study conducted in usa school adolescents indicated that students who were engaged in different psycho active substance use practices were poor academic achievers (8). a study conducted at jimma university also showed that psycho active substance use was associated with poor academic achievement (9). despite some researchers suggesting that psycho active substance use is associated with poor academic performance, many students used variety of psycho active substances for the sake of good academic achievement (3, 10). as a study conducted in turkey indicates, psycho active substance use was practiced by significant proportion of university students; cigarette was smoked by 24.8% students regularly every day; alcohol was drunk occasionally by 37.8% of university students and by 8.1% of students regularly (11). in iran psycho active substance (alcohol, cigarette, and pipe was used by 22% male medical students and 8% female medical students at least once in their life (12). alcohol was consumed daily by 42% of osun state university students in nigeria and 34.1% of students consumed alcohol weekly. a research done in south africa showed the lifetime use of alcohol use was 38.7%, tobacco smoking 30%, and cannabis was 8.4% (13). different psycho active substances like alcohol, and tobacco have been consumed by significant proportions of university students in nigeria. since the proportion of student population in higher educational institutions is increasing, psycho active substance use and its association with academic performance is going to be an increased concern. as a good alert for universities and policymakers about the effect of psycho active substance use on academic performance; the result of this study will play a major role in conducting further interventional measures with evidence based actions. hence, the purpose of this study was to assess the relationship between psycho active substance use and its association with academic activities as well as academic performance among university students. materials and methods this is a descriptive cross-sectional study design to assess the effect of psycho active substance use on academic activities and academic performance of undergraduate students. the variables studied under this study were academic activities and academic performance which were the dependent variable and the main independent variable was students' psychoactive substance use. for the sake of this research, psycho active substance use was defined as using either tobacco products or alcoholic beverages or any combination of those substance. when the study participants used substances (alcohol, cocaine, cannabis heroine, sedatives, tranquilizers, or tobacco) even once in their life, it was defined as lifetime use. last year use of substance is when the study participants were using those substances in the last 12 months from the data collection time. current use when the participants using those substances in the last 30days from the data collection time. description of study site: the university of lagos was founded in 22nd october, 1962. it covers a total of 802 acres of land in akoka, north eastern part of yaba. it presently has two campuses in yaba (the main campus in akoka, and another campus at the former school of radiography) and surulere (college of medicine, university of lagos in idiaraba).university of lagos currently has twelve faculties, namely, arts, basic medical sciences, business administration, clinical sciences, dental sciences, education, engineering, environmental sciences, law, pharmacy, science, and social sciences. study design: this is a descriptive crosssectional study design seeking to assess psychoactive substance use and its relation to academic performance among undergraduate students of the university of lagos. study population: this study was carried out among undergraduate students in the university of lagos, akoka, lagos state. effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 256 inclusion criteria: only registered full-time undergraduates of the university of lagos. exclusion criteria ·undergraduate students from the college of medicine, university of lagos, idi-araba, lagos. ·first year students. ·undergraduates studying more than a 4year course. sample size determination: the sample size was calculated using the cochrane formula, which was developed to determine the sample size for a population greater than or equal to 10,000. 2 2 n = z pq/d where, n = minimum sample size z = confidence interval, set at 1.96 for 95% confidence level p = the estimate of expected prevalence of s u b s t a n c e a b u s e a m o n g s t u n i v e r s i t y undergraduates. this was 35.5% (0.355) as adapted from a similar study carried out amongst u n i v e r s i t y u n d e rg r a d u a t e s i n h a w a s s a university, hawassa ethiopia. q = 1.0 – p; 1.0 – 0.355 = 0.645 d = degree of accuracy required/acceptable margin of sampling error = 0.05 therefore; 2 2 n = [1.96 * 0.355 (0.645)] / 0.05 n = [3.8416 * 0.2290] / 0.0025 n = 351.89 therefore, the estimated minimum sample size as calculated above is 352. sampling technique: a multi-stage sampling technique was used to select the undergraduates who will participate in this study. stage 1: selection of faculties there are twelve faculties in the university of lagos which include; arts, basic medical sciences, business administration, clinical s c i e n c e s , d e n t a l s c i e n c e s , e d u c a t i o n , engineering, environmental sciences, law, pharmacy, science, and social sciences. but for the purpose of this study four faculties including; basic medical sciences, clinical sciences, dental sciences and pharmacy would be excluded from the selection process due to the exclusion criteria (exclusion of medical and paramedical students). this leaves 8 faculties that are situated in the main campus, akoka. 4 faculties of these eight were chosen by random sampling. stage 2: selection of departments simple random sampling (balloting) was used to select 4 departments each of the 4 faculties. f a c u l t y o f s c i e n c e – d e p a r t m e n t s o f mathematics, biochemistry, botany and microbiology. faculty of art – departments of english language, history and strategic studies, creative arts, philosophy. faculty of education – education economics, business education, physics education, chemistry education. faculty of social science – departments of departments of political science, psychology, economics, sociology. s t a g e 3 : s e l e c t i o n o f r e s p o n d e n t s (undergraduates) this stage involved selecting respondents (undergraduates) from each selected department from second year (200 level) to final year (400 level) by simple random method. sample size / no. of selected departments = 352 / 16 = 22. therefore, 22 questionnaires were administered to each slected departments across the aforementioned levels. an average of 6 questionnaires were then shared among undergraduates in each level. data collection tools: data was collected using a s e l f a d m i n i s t e r e d s e m i s t r u c t u r e d questionnaire adapted from who model core questionnaire self-administered format. academic performance of respondent was based on previous semester's cumulative grade point average (gpa) of the respondents. pretesting: the questionnaire was tested among 20 undergraduate students in yaba college of technology, yaba, lagos; a tertiary institution similar to the study area. the outcome from the pretesting was used to restructure the questionnaire to avoid incomprehensible or ambiguous questions and also to make the instructions understandable. data analysis: data was collected and analyzed electronically using the free-liscence software package epi-info, version 7.2.2.16. descriptive statistics were represented in frequency tables. chi square and fisher's exact were used to test for any significant association between psychoactive substances use and academic performance of the respondents. level of significance (p) was set at 0.05. effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 257 ethical consideration: ethical approval was obtained from the health research and ethics committee of lagos university teaching h o s p i t a l ( l u t h ) w i t h a s s i g n e d n o adm/dcst/hrec/app/562 results a total of 400 questionnaires were distributed, 387 were completed giving a response rate of 96.75%. questionnaires were excluded from analysis if they were incomplete, had inconsistent data, or were not returned. majority of the respondents 270 (69.77%) were male while 117(30.23%) were females. the age range of the respondents was between 1430 with mean age of 20.51 (sd) (±2.91) year. sources of income of the respondents were parents 249(64.34%), personal 118(30.49%) while (5.17%) had multiple sources of income. among the respondents 20 % had a monthly income of <25usd, while 38.50%, 20.41%, 20.93%, 20.16% had 25 – 50usd, 500 – 75usd and greater than 75usd respectively. when the respondent were asked of awareness of psychoactive substance use. most (80%) of the respondents had good knowledge about substance abuse while others (20%) had a poor knowledge about substance abuse substance use characteristics of the students the following substances were known to respondents as psycho active substances alcohol 307(79.33%), cocaine 322 (83.20%), cannabis 326 (84.24%), heroine 316(81.65%), cigarette 311(80.36%), amphetamines 198(51.16%), digoxin 168 (43.1), salbutamo1 65(42.64%), glue 209 (54.01%) and tramadol 207 (79.33%). most of the respondents (71.58%) have abused substance(s) at least once in their lifetime. while 54.26% respondents have abused substance(s) in the past year and 41.34% are current abusers of substance(s) (they have abused substances in the past 30 days). there is a statistically significant association between sex and lifetime (ever use) prevalence of substance abuse (p<0.05). more males (77.04%) had a positive lifetime (ever use) prevalence of substance abuse compared to the females (58.97%). there is no statistically significant association between lifetime (ever use) prevalence of substance abuse and age; ethnic group; religion (p>0.05). in our study alcohol was the most abused substance with 68.99% of the respondents having had alcohol at least once in their lifetime as well as 52.20% in the last 12 months while the current use of alcohol was 39.78%. this was followed by cigarette with 20.67% ever use prevalence, 11.11% 12-month prevalence, and 7.24% current (30-day) prevalence. the other prevalence of p s y c h o a c t i v e s u b s t a n c e s i n c l u d e c a n n a b i s / m a r i j u a n a ( 1 3 . 1 8 % e v e r u s e prevalence), sedatives (10.59% ever use p r e v a l e n c e ) , o p i a t e s ( 3 . 8 8 % e v e r u s e prevalence), amphetamines (3.36% ever use prevalence), tranquilizers (3.36% ever use prevalence), opium (2.33% ever use prevalence), cocaine (1.55% ever use prevalence) and heroine (1.03).the age range at first use of the various substances of abuse for majority of respondents fell between 15-19 years for most of the substances with a mean age of first use of psychoactive substance being 16.31±3.89. the ever use, past twelve month, and past month prevalence of substance use is displayed in table 2. academic activities most (65.89%) of the respondents attend classes every day. majority of the respondents also listen with rapt attention (69.77%); jot necessary notes in class (84.50%) and do their class assignments (77.26%). only about half of the respondents (55.30%) have a regular reading time. when participants were ask about satisfaction of their academic performance. more than half of the respondents (53.75%) are not satisfied with their academic performance, another 16.02% remain indifferent while only 30.23% were satisfied with their academic performance. using the grade point average (gpa) system from the previous semester, majority of the respondents (87.08%) had gpa >2.50. overall mean cgpa of the study population was 3.53 ±0.81 effect of substance use on academic activities and mean cgpa in this study we consider academic activities as frequency of study per week as well as duration of study per day. we divided frequency of studying into every day, once a week, two times in a week, three times in a week, four times in a week. in our study when we compare lifetime and current use of tobacco on frequency of study per week and mean cgpa among male respondents. both frequency of studying and mean cgpa was better among nonlife time users of tobacco (p < 0.001) as well as non-current user of tobacco (p < 0.001). we compared mean cgpa of lifetime and current tobacco user and frequency of study per week among female respondents. mean cgpa showed effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 258 no statistical significance. we equally compared lifetime and current use of alcohol and cannabis to frequency of study per week and mean cgpa among male respondents. both frequency of studying and mean cgpa was better among nonlife time users and non-current users of alcohol and cannabis in the male group statistically see table 3 and 4. however there was no statistical significance among female group see table 3 and 4. in this study we compare lifetime and current psycho active substance (tobacco, alcohol and cannabis) hours of study per day and mean cgpa among male respondents. both hours of studying and mean cgpa was better among non-life time and non-current psychoactive substance users among male gender see table 5 and 6 effect of age at first substance use and mean cgpa when we use fischer exact test to assess the effect of age of first substance use and mean cgpa. among the three drugs studied (cannabis, alcohol and tobacco) the age of first substance use was statistically significant for tobacco p = 0.007 (see table7) discussion the overall prevalence of psychoactive substance use among the university students was 28.6%. the most frequently consumed substance by the students was alcohol, followed by tobacco products, respectively. this finding was consistent with the study done in southern iran but lower than the study conducted in northern ethiopia (3.12). alcohol was consumed by 24.7% of the students and this was consistent with the study conducted in different higher education institutions in ethiopia; it was 21.6% among addis ababa university medical students, 20% in haramaya university students, and 21.7% in college students of southern ethiopia (16,17). similarly a research done in south africa showed the occurrence of alcohol use was 38.7%, tobacco smoking 30%, and cannabis was 8.4% (13). however, the finding in this study was lower than the study conducted among axum university students in which the alcohol consumption was 32.8% (18). in addition, the finding of this study was much more less than the study conducted in trinidad and tobago university students in which the six-month alcohol consumption was 70%, and turkey university students in which it was 37.9% (11,18, 19). this might be due to cultural and socioeconomic differences. the prevalence in our study was higher than those reported for undergraduate students of ahmadu bello university, nigeria (25.7%), (20 ), but lower than those reported for undergraduate students of university of benin in southern nigeria (46.6%) (21) and undergraduate medical students of the university of nigeria (56.0%).(22). this may be due to different sociocultural values of the different regions tobacco products were used by 5.7% of the students and it was consistent with other studies done among university students in ethiopia (23). however, the finding was lower as compared with the study done among haramaya university students which was 10.8% and italian university students in which current smoking was 24% (16,24).the use of substance is known for its significant association with mental distress and consequently this mental distress can affect the students' academic performance negatively (25,26,27). the most abused substances from previous studies in nigeria were tobacco and cannabis, and less frequently coffee and inhalants,(28) . in our study the academic performance and substance use has significance influence among the male gender. the study conducted at jimma university students indicated, substance use was associated with low academic performance (9). this may be due to the consequences of substance use towards social, economic, physical, and psychological aspects of the student. there may be conflict with parents or friends, health problems, financial hardships, and emotional disturbance because of substance use (29,30). male students who use psyhoactive substances had significantly high risk of poor academic performance (lower score of cumulative grade point average) as compared with non psyhoactive substances users. this is comparable to the findings of the previous studies of substance abuse by undergraduate students in nigeria wish revealed that male students showed more abuse than female ( 21, 22 28) smoking is known to be a getaway substance for other illicit drug uses, high risk drinking behavior, and high risk sexual behavior as well (6). those complex interactions with other risky behaviors make smoking the i m p o r t a n t p r e d i c t o r o f p o o r a c a d e m i c performance (6). our finding is similar to other reports that cgpa of the students who uses psychoactive substance at least weekly was less than those who were not using at all. even though most students perceived using psychoactive substance improves academic performance (31), it was associated with poor cgpa score as effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 259 indicated by this study. alcohol use usually tends to be more during ceremonial activity and most of the alcohol sessions are followed with smoking , which may interfere with students' academic activities negatively ( 32,33). drinking alcoholic beverages was also significantly and negatively associated with the academic performance. those who were drinking on a daily basis had scored significantly lower cgpa than those who never drank alcoholic beverages in the last 12 months. alcohol clouds judgment and can make the student be careless about academic and other success issues. this finding was consistent with the study done in united kingdom university students in which alcohol consumption was n e g a t i v e l y a s s o c i a t e d w i t h a c a d e m i c performance (34). in the study conducted elsewhere among adolescents, academic difficulties associated with alcohol consumption were reported (2).not only using substances was associated with academic performance, but also having an intimate friend who uses substance was associated (2). peer pressure is known to be an important predictor to shape adolescents behavior either in good or bad way. the cgpa of students who have intimate friend who uses substance was significantly lower as compared with those who did not have intimate friend who uses substance (3,23). previous studies in nigeria had observed that the academic performance of the students, class attendance, students' were affected by use of pychoactive drugs (20,21,22,28). student substance use is associated with different factors like sex, age, peer pressure, family substance abuse, personal pleasure, and poor academic achievement (3,5,6). according to the national youth risk behavior survey, usa, negative association was seen between alcohol and other drug use and academic achievement after controlling for sociodemographic variables (7). another study conducted in usa school adolescents indicated that students who were engaged in different substance use practices were poor academic achievers (8). a study conducted at jimma university also showed that substance use was associated with poor academic achievement (9). our study showed negative association between alcohol, cannabis and tobacco and academic achievement after controlling for gender variables. the use of these psychoactive substances could be being students of an urban university, have more money to spend on alcohol and cigarette wish is readily available in open markets. moreso in nigeria, there is no official alcohol cigarette control policy specifically targeting adolescents. despite some researchers suggesting that substance use is associated with poor academic performance, many students used variety of substances for the sake of good academic achievement (3,10). our study found significant association between academic activities, and mean cgpa as among the male gender undergraduates. conclusion and recommendations substance use was high among university under graduate students. life time prevalence and current prevalence of cigarette smoking, drinking alcohol as well smoking cannabis were significantly associated with poor cgpa score among male gender. the association of psychoactive substance use with poor academic performance especially among male gender requires the university authorities to have a good counselling programme to control the use of psychoactive substance. limitations of the study: this study was mainly about psychoactive substances such as tobacco alcohol and cannabis, effect of other psychoactive substances with academic achievement was not assessed. another limitation of the study is subjectivity of selfreporting of different academic activities and use of psychoactive substances conflicts of interest: all authors declare that they have no conflicts of interest. authors contribution: osalusi, koleowo and ogunsemi conceived the idea of the study. 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education and practice (2015):( 6): 305–315. 34. w. el ansari, c. stock, and c. mills. is alcohol consumption associated with poor academic a c h i e v e m e n t i n u n i v e r s i t y s t u d e n t s ? international journal of preventive medicine (2013);(4)1175–1188. effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 262 table 1: socio-demographics characteristics of the study population socio-demographic characteristics (n=387) frequency (n) percentage (%) age 16 – 20 21 – 24 >25 mean age = 20.51 standard deviation = 2.91 sex female male sources of income parents self/working other average monthly allowance/income < 10,000 usd 10,000 – 20,000usd 20,000 – 30,000usd > 30,000usd 241 118 28 117 270 249 118 20 79 149 81 78 62.27 30.49 7.24 30.23 69.77 64.34 30.49 5.17 20.41 38.50 20.93 20.16 table 2: prevalence / history of substance use variable (n=387) ever use n (%) 12-month use n (%) 30-day use n (%) cigarette/tobacco alcohol tranquillizers sedatives amphetamines cannabis/marijuana cocaine heroine opium opiates 80(20.67) 267(68.99) 13(3.36) 41(10.59) 13(3.36) 51(13.18) 6(1.55) 4(1.03) 9(2.33) 15(3.88) 43(11.11) 202(52.20) 6(1.55) 19(4.91) 11(2.84) 34(8.79) 4(1.03) 4(1.03) 5(1.29) 6(1.55) 28(7.24) 154(39.79) 4(1.03) 12(3.10) 7(1.81) 27(6.98) 3(0.78) 4(1.03) 3(0.78) 3(0.78) effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 263 table 3: association between lifetime psychoactive substance use and cgpa and study frequency frequency of studying in a week non-user tobacco user male mean gpa male mean gpa sd diff t p 3 times 44 3.53 14 3.47 0.71 4 6.37* <0.001 4 times 36 3.67 10 3.68 0.86 twice 63 3.68 15 3.64 0.77 once 28 2.88 9 3.11 0.96 everyday 43 3.37 8 3.31 0.74 non-user tobacco user female mean gpa female mean gpa sd diff t p 3 times 22 3.69 5 3.59 0.55 4 1.90* 0.115 4 times 18 3.36 4 3.69 0.94 twice 23 3.71 5 4.47 0.77 once 16 3.38 4 3.32 0.71 everyday 14 3.98 6 3.35 0.70 non-user alcohol user male mean gpa male mean gpa sd diff t p 3 times 17 3.46 41 3.54 0.71 4 6.37* <0.001 4 times 11 3.33 35 3.78 0.86 everyday 28 3.73 50 3.64 0.77 once 12 2.79 25 3.01 0.96 twice 18 3.53 33 3.27 0.74 non-user alcoholuser female mean gpa femal e mean gpa sd diff t p 3 times 6 3.53 21 3.71 0.55 4 1.90* 0.115 4 times 8 3.44 14 3.4 0.94 everyday 10 3.73 18 3.91 0.77 once 8 3.64 12 3.19 0.71 twice 2 3.96 18 3.77 0.70 non-user cannabis user male mean gpa male mean gpa sd diff t p 3 times 47 3.49 11 3.62 0.71 4 6.37* <0.001 4 times 38 3.74 8 3.33 0.86 everyday 69 3.67 9 3.64 0.77 once 33 3.03 4 2.21 0.96 twice 46 3.42 5 2.86 0.74 non-user cannabis user female mean gpa female mean gpa sd diff t p 3 times 25 3.69 2 3.35 0.55 4 1.90* 0.115 4 times 20 3.39 2 3.7 0.94 everyday 27 3.80 1 5 0.77 once 14 3.37 6 3.38 0.71 twice 17 3.82 3 3.63 0.70 effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 264 table 4: association between cuurent psychoactive substance use cgpa and study frequency frequency of studying in a week non-user tobbacco user female mean gpa female mean gpa sd diff t p 3 times 26 3.64 1 4.24 0.55 4 1.90* 0.115 4 times 21 3.43 1 3.2 0.94 everyday 26 3.76 2 4.9 0.77 once 20 3.37 0.71 twice 49 3.36 2 3.40 0.74 non-user tobbacco user male mean gpa male mean gpa sd diff t p 3 times 53 3.53 5 3.38 0.71 4 6.37* <0.001 4 times 39 3.72 7 3.39 0.86 everyday 74 3.66 4 3.90 0.77 once 34 2.89 3 3.53 0.96 twice 49 3.36 2 3.40 0.74 non-user alcohol user male mean gpa male mean gpa sd diff t p 3 times 32 3.65 26 3.35 0.71 4 6.37* <0.001 4 times 22 3.71 24 3.64 0.86 everyday 53 3.78 25 3.44 0.77 once 23 2.98 14 2.87 0.96 twice 35 3.40 16 3.29 0.74 non-user alcohol user female mean gpa female mean gpa sd diff t p 3 times 16 3.51 11 3.9 0.55 4 1.90* 0.115 4 times 14 3.29 8 3.63 0.94 everyday 20 3.79 8 3.97 0.77 once 13 3.38 7 3.36 0.71 twice 5 4.03 15 3.71 0.70 non-user user male mean gpa male mean gpa sd diff t p 3 times 49 3.46 9 3.81 0.71 4 6.37* <0.001 4 times 42 3.69 4 3.51 0.86 twice 71 3.67 7 3.70 0.77 once 37 2.94 0.96 everyday 49 3.37 2 3.08 0.74 non-user user female mean gpa female mean gpa sd diff t p 3 times 26 3.70 1 2.9 0.55 4 1.90* 0.115 4 times 21 3.43 1 3.2 0.94 twice 28 3.84 0.77 once 17 3.27 3 3.95 0.71 everyday 20 3.79 0.70 effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 265 table 5: mean cgpa hours of study and lifetime use of tobacco duration of studying time in a day non-user tobacco user male mean gpa male mean gpa sd diff t p >3 hours 74 3.67 22 3.71 0.66 4 6.75* <0.001 1 hour 26 3.06 4 2.86 0.93 2 hours 64 3.41 18 3.25 0.83 3 hours 39 3.66 8 3.91 0.75 < 1 hour 11 3.00 4 2.91 1.11 non-user tobacco user femal e mean gpa femal e mean gpa sd diff t p >3 hours 32 3.42 4 4.12 0.81 4 1.21* 0.350 1 hour 10 3.97 1 3.58 0.53 2 hours 24 3.74 11 3.64 0.72 3 hours 20 3.66 6 3.7 0.80 < 1 hour 7 3.45 2 3.05 0.65 non-user alcohol user male mean gpa male mean gpa sd diff t p >3 hours 28 3.54 68 3.74 0.66 4 6.75* <0.001 1 hour 11 3.03 19 3.03 0.93 2 hours 24 3.51 58 3.32 0.83 3 hours 15 3.91 32 3.60 0.75 < 1 hour 8 2.68 7 3.31 1.11 non-user alcohol user femal e mean gpa femal e mean gpa sd diff t p >3 hours 12 3.56 24 3.47 0.81 4 1.21* 0.350 1 hour 4 3.99 7 3.9 0.53 2 hours 8 3.85 27 3.67 0.72 3 hours 4 3.09 22 3.78 0.80 < 1 hour 6 3.54 3 3 0.65 non-user cnnnabis user male mean gpa male mean gpa sd diff t p >3 hours 83 3.69 13 3.60 0.66 4 6.75* <0.001 1 hour 27 3.08 3 2.62 0.93 2 hours 70 3.36 12 3.43 0.83 3 hours 41 3.75 6 3.39 0.75 < 1 hour 12 3.21 3 2.05 1.11 non-user cannabis user female mean gpa female mean gpa sd diff t p >3 hours 35 3.51 1 3.2 0.81 4 1.21* 0.350 1 hour 8 3.83 3 4.21 0.53 2 hours 32 3.72 3 3.62 0.72 3 hours 23 3.64 3 3.9 0.80 < 1 hour 5 3.66 4 2.98 0.65 effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 266 table 6: mean cgpa hours of study and current psychoactive use duration of studying time in a day non-user tobacco user female mean gpa female mean gpa sd diff t p >3 hours 33 3.45 3 4.08 0.81 4 1.21* 0.350 1 hour 11 3.93 0.53 2 hours 34 3.70 1 4.24 0.72 3 hours 23 3.66 3 3.74 0.80 < 1 hour 9 3.36 0.65 non-user tobacco user male mean gpa male mean gpa sd diff t p >3 hours 87 3.67 9 3.77 0.66 4 6.75* <0.001 1 hour 29 3.04 1 2.78 0.93 2 hours 76 3.39 6 3.20 0.83 3 hours 42 3.72 5 3.55 0.75 < 1 hour 15 2.97 1.11 non-user alcohol user male mean gpa male mean gpa sd diff t p >3 hours 57 3.74 39 3.59 0.66 4 6.75* <0.001 1 hour 19 3.03 11 3.04 0.93 2 hours 44 3.57 38 3.15 0.83 3 hours 34 3.74 13 3.61 0.75 < 1 hour 11 2.86 4 3.28 1.11 non-user alcohol user femal e mean gpa femal e mean gpa sd diff t p >3 hours 25 3.33 11 3.9 0.81 4 1.21* 0.350 1 hour 6 4.07 5 3.77 0.53 2 hours 17 3.77 18 3.66 0.72 3 hours 13 3.60 13 3.75 0.80 < 1 hour 7 3.38 2 3.3 0.65 non-user cannabis user female mean gpa female mean gpa sd diff t p >3 hours 35 3.51 1 3.2 0.81 4 1.21* 0.350 1 hour 9 3.87 2 4.19 0.53 2 hours 35 3.71 0.72 3 hours 25 3.70 1 2.9 0.80 < 1 hour 8 3.35 1 3.47 0.65 non-user cannabis user male mean gpa mal e mean gpa sd diff t p >3 hours 85 3.68 11 3.71 0.66 4 6.75* <0.001 1 hour 30 3.03 0.93 2 hours 75 3.35 7 3.64 0.83 3 hours 43 3.72 4 3.54 0.75 < 1 hour 15 2.97 1.11 effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 267 table 7: effect of age of first substance use and mean cgpa freq mean gpa sd diff t p age at first alcohol use <15 66 3.50 0.77 2 0.41* 0.666 >19 21 3.64 0.85 15-19 138 3.46 0.86 age at first tobacco use <15 17 3.51 0.88 2 2.81* 0.007 >19 7 3.29 0.70 15-19 46 3.82 0.56 age at first sedatives use <15 9 3.33 0.87 2 0.47* 0.631 >19 4 2.88 0.88 15-19 16 3.39 1.00 age at first cannabis use <15 3 3.89 0.31 2 0.82* 0.448 >19 5 3.28 1.23 15-19 37 3.32 0.71 table 8: mean and standard deviation of ages at first time of substance abuse substances of abuse mean ± standard deviation age range cigarette alcohol tranquillizers sedatives amphetamines cannabis/marijuan cocaine heroine opium opiates 16.11 ± 3.33 15.64 ± 3.64 17.10 ± 3.93 16.17 ± 3.44 18.44 ± 4.16 17.51 ± 2.03 15.50 ± 3.45 15.00 ± 5.20 17.57 ± 5.74 14.10 ± 3.98 (12.78 – 19.44) (12.00 – 19.28) (13.17 – 21.03) (12.73 – 19.61) (14.28 – 22.59) (15.48 – 19.54) (12.05 – 18.95) (9.80 – 20.20) (11.83 – 23.31) (10.12 – 18.08) effect of psychoactive substance use on academic activities among undergraduates osalusi et al. res. j. health sci. vol 11(3), september 2023 268 rjhs 11(3).cdr risk factors for chronic kidney disease among adults in a tertiary hospital community in north-central, nigeria. 1 2 1 2 3 *mbah, i.o. , eseigbe, p. , david, o.s. , kabilis, e.d. , ihekaike, m.m. abstract background: the prevalence of chronic kidney disease (ckd) is on the increase globally with an attendant heavy disease burden and high morbidity and mortality from end-stage renal disease (esrd). data on the prevalence of risk factors for chronic kidney disease from sub-saharan africa are scanty, more so in the northern part of nigeria. there are several risk factors for ckd which include, obesity, hypertension, diabetes mellitus and some nephrotoxic agents. preventive strategy through early detection and treatment has been advocated for ckd especially in our own setting where majority of patients present late and cannot afford the cost of renal replacement therapy which again is not readily available. method: this study was conducted among the staff of bingham university teaching hospital (bhuth), jos, as part of a screening exercise during the world kidney day (wkd) program of 2021, to determine the prevalence of modifiable risk factors for ckd. adult subjects of 18 years and above, who consented to the study were mobilized after a sensitization talk. the parameters assessed were demographics, body mass index, blood pressures, proteinuria, fasting plasma glucose and plasma creatinine. glomerular filtration rate (gfr) was estimated using ckd-epi creatinine equation 2021. data were analyzed using spss version 25. the level of statistical significance was set at a p-value of < 0.05. results: 150 adult volunteers participated in the study. the mean age of the participants was 43.3±11.32 years (18-71 years), with 61.3% being females and 38.7% were males. the frequency of the risk factors of ckd observed were obesity in 45 (30.0%) of the participants and diabetes mellitus found in 44 (29.3%) of the participants, proteinuria and glycosuria were found in 49 (32.7%) and 9 (6.0%) of the participants respectively while a whopping 37 (24.7%) of the participants had haematuria. the number of participants found with estimated glomerular filtration rate (egfr) of <60ml/min/1.73m2 were 55 (36.7%). there was an independent association between older age (p = 0.010), being widowed/divorced (p = 0.041), and 2 having diabetes (p = 0.006) with an egfr <60ml/min/1.73m conclusion the prevalence of ckd risk factors in this study population was high. therefore, there is the need for adequate and continuous sensitization and routine screening in our various clinics for early detection and early management by lifestyle and risk factor modification to halt or reduce the growing burden of ckd with its attendant morbidity and mortality in nigeria. key words: risk factors, chronic kidney disease, glomerular filtration rate, world kidney day celebration *corresponding author dr. mbah, i.o. email: drikembah@yahoo.com. 1 department of internal medicine, college of medicine and allied sciences, bingham university /bingham university teaching hospital. jos. nigeria 2 dept. of family medicine, college of medicine and allied sciences, bingham university /bingham university teaching hospital. jos. nigeria 3 dept. of paediatrics, college of medicine and allied sciences, bingham university /bingham university teaching hospital. jos. nigeria received: march 8, 2022 accepted: april 12, 2023 published: september 30, 2023 original article research journal of health sciences res. j. health sci. vol 11(3), september 2023 269 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.9 facteurs de risque de maladie rénale chronique chez les adultes dans une communauté hospitalière tertiaire du centre-nord du nigéria 1 2 1 2 3 *mbah, i.o. , eseigbe, p. , david, o.s. , kabilis, e.d. , ihekaike, m.m. résumé contexte général de l'étude : la prévalence de l'insuffisance rénale chronique (irc) est en augmentation à l'échelle mondiale, avec un lourd fardeau de morbidité et une morbidité et mortalité élevées par insuffisance rénale terminale (irt). les données sur la prévalence des facteurs de risque de maladie rénale chronique en afrique subsaharienne sont rares, surtout dans la partie nord du nigéria. il existe plusieurs facteurs de risque d'irc , notamment l'obésité, l'hypertension, le diabète sucré et certains agents néphrologiques. une stratégie préventive par la détection et le traitement précoces a été préconisée pour l'irc, en particulier dans notre propre contexte où la majorité des patients se présentent tardivement et ne peuvent pas se permettre le coût d'une thérapie de remplacement rénal qui, encore une fois, n'est pas facilement disponible. méthode de l'étude : cette étude a été menée auprès du personnel du bingham university teaching hospital (bhuth), jos, dans le cadre d'un exercice de dépistage pendant le programme de la journée mondiale du rein (wkd) de 2021, afin de déterminer la prévalence des facteurs de risque modifiables pour l'irc. les sujets adultes de 18 ans et plus, qui ont consenti à l'étude ont été mobilisés après un entretien de sensibilisation. les paramètres évalués étaient la démographie, l'indice de masse corporelle, la tension artérielle, la protéinurie, la glycémie à jeun et la créatinine plasmatique. le débit de filtration glomérulaire (gfr) a été estimé à l'aide de l'équation de créatinine ckd-epi 2021. les données ont été analysées à l'aide de la version spss 25. le niveau de signification statistique a été fixé à une valeur p <0,05. résultat de l'étude: 150 volontaires adultes ont participé à l'étude. l'âge moyen des participants était de 43,3 ±11,32 ans (18-71 ans), 61,3 % étant des femmes et 38,7 % des hommes. la fréquence des facteurs de risque d'irc observés était l'obésité chez 45 (30,0%) des participants et le diabète sucré chez 44 (29,3%) des participants, la protéinurie et la glycosurie chez 49 (32,7%) et 9 (6,0%) des participants respectivement tandis que 37 (24,7 %) des participants souffraient d'hématurie . le nombre de participants trouvés avec un débit de filtration glomérulaire estimé (egfr ) de <60 ml/min/1,73 m2 était de 55 (36,7 %). il y avait une association indépendante entre l'âge avancé (p = 0,010), le fait d'être veuf/divorcé (p = 0,041) et le diabète (p = 0,006) avec 2 un dfge < 60 ml / min/1,73 m conclusion : la prévalence des facteurs de risque d'irc dans cette population d'étude était élevée. par conséquent, il est nécessaire d'assurer une sensibilisation adéquate et continue et un dépistage de routine dans nos différentes cliniques pour une détection précoce et une prise en charge précoce par modification du mode de vie et des facteurs de risque afin d'arrêter ou de réduire le fardeau croissant de l'irc avec sa morbidité et sa mortalité au nigéria. mots-clés: facteurs de risque, maladie rénale chronique, taux de filtration glomérulaire, célébration de la journée mondiale du rein. *corresponding author dr. mbah, i.o. email: drikembah@yahoo.com. 1 department of internal medicine, college of medicine and allied sciences, bingham university /bingham university teaching hospital. jos. nigeria 2 dept. of family medicine, college of medicine and allied sciences, bingham university /bingham university teaching hospital. jos. nigeria 3 dept. of paediatrics, college of medicine and allied sciences, bingham university /bingham university teaching hospital. jos. nigeria received: march 8, 2022 accepted: april 12, 2023 published: september 30, 2023 article original research journal of health sciences res. j. health sci. vol 11(3), september 2023 270 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.9 and in need of renal replacement therapy which is not readily available and not within reach of an average nigerian. as a result, therefore, regular screening to aid early detection of risk factors is paramount in the prevention of ckd and esrd. this need cannot be over-emphasized. the aim of this study was to determine the prevalence of risk factors for ckd among adults in a university community in the north central of nigeria, for early intervention. therefore, screening for chronic kidney disease in adults, especially diabetic patients may lead to early detection, evaluation, and treatment. this ultimately can prevent or retard the progression of ckd to eskd and better quality of life for patients [11]. the rate of diagnosis and public awareness of ckd remains low [12]. however, it has been shown that hypertensive and diabetic patients who are aware of their renal impairment are less likely to progress to eskd than those who are unaware of their renal status [13]. materials and methods this study was undertaken among the staff of bingham university teaching hospital (bhuth), jos, as part of a screening exercise during the world kidney day program of 2021, to determine the prevalence of modifiable risk factors for ckd. bingham university teaching hospital (bhuth), jos, like other university teaching hospitals in nigeria has an admix of clinical and non-clinical staff; and students. it is a tertiary care facility that provides several specialist services. this was a cross-sectional cohort study and convenient sampling method of adult volunteers in a university in the north central region of nigeria during the 2021 world kidney day exercise. subjects for the study were mobilized through bingham university and bingham university teaching hospital authorities. informed consent was obtained from each of the participants after a session of sensitization seminar on kidney health and chronic kidney disease, “the monster we ignore”. the study participants included doctors (house officers and residents) in internal medicine and family medicine, medical students, nurses, and laboratory scientists all of whom participated both in the screening and in data collection. inclusion criterion included all adult members of staff of 18 years and above who consented to the study while the exclusion criterion was those who did not give consent. demographic data were obtained through interviewer-administered questionnaires and introduction chronic kidney disease (ckd) is continually receiving public health attention due to its significantly increasing prevalence, the huge burden of human suffering, escalating costs of care, and high mortality from end-stage kidney disease (eskd) even in developed countries [1]. chronic kidney disease is defined as a progressive decline of kidney function shown by a glomerular filtration rate (gfr) of less than 2 60 ml/min per 1.73m as a standalone for three months. it can also be defined as the presence of markers of kidney damage, such as abnormal constituents of urine and/or blood, as well as radiological abnormalities of at least 3 months' duration, irrespective of the underlying cause [2]. criteria for defining ckd according to the kdigo 2012 is kidney damage or glomerular 2 filtration rate (gfr) <60ml/min/1.73m for 3 months or more irrespective of cause. kidney damage in many kidney diseases can be ascertained by the presence of albuminuria, defined as albumin-to-creatinine ratio >30mg/g in two of three spot urine specimens.[3] the common risk factors for ckd globally include exposure to heavy metals, excessive alcohol consumption, smoking, and the use of analgesic medications as well as advanced a g e , d i a b e t e s , h y p e r t e n s i o n , c h r o n i c glomerulonephritis, and polycystic kidney disease.[4] in nigeria, the commonest cause of ckd is hypertension, followed by chronic glomerulonephritis and diabetes mellitus. [5] chronic kidney disease (ckd) has become a major health concern globally, especially in developing countries with a marked burden in sub-saharan africa [6]. this concern is largely due to the rising prevalence of risk factors such as diabetes mellitus, hypertension, and nephrotoxic agents, the enormous cost implication of its treatment, its role in cardiovascular morbidity and mortality and the fact that the disease largely affects the economically productive younger age groups [6, 7]. several hospital-based studies in nigeria have put the prevalence of ckd between 1.6 12.4% [8] with a high prevalence of risk factors observed in various studies among different groups [5, 9]. the early stages of ckd (stages 13a) may go unnoticed; therefore, the burden of the disease at these early stages goes largely undetected and difficult to assess. the symptoms only begin to manifest when greater than fifty percent of renal functional mass has been lost [10]. most patients therefore present late to hospital, usually in the advanced diseased states res. j. health sci. vol 11(3), september 2023 271 risk factors ckd among adults in tertiary hospital community mbah et al. included age, sex, family and personal/family history of hypertension, diabetes and kidney disease. weight was measured with a standard measuring scale calibrated in kilograms with subjects standing erect, bare-foot, and without heavy clothing. height was measured with a stadiometer with subjects standing feet together without shoes or head gear. body mass index (bmi) was calculated as body weight in kilograms divided by the square of the height in 2 meters. obesity was defined as bmi≥ 30kg/m according to the who guidelines [14]. blood pressure was measured with a standard mercury sphygmomanometer on the patients' right arm in the seated position with feet on the floor after at least a five-minute rest. systolic and diastolic blood pressures were taken at korotkoff phases 1 and 5 respectively to the nearest 2 mmhg. the average of two blood pressure measurements taken five minutes apart was used. hypertension was defined as sbp ≥ 140mmhg and /or dbp ≥ 90mmhg [15]. for biochemical analysis, a sample of five millimeters (5mls) of venous blood was taken from each subject for assessment of serum creatinine. the samples were placed in lithium heparin bottles (gently mixed) and transported immediately to the chemical pathology laboratory. proteinuria and glycosuria were assessed in subjects' urine using combi-9 dipstick. proteinuria and glycosuria were defined as the presence of at least 1+ of protein and 1+ of glucose on dipstick respectively. random blood sugar was measured using the accucheck glucometer, and results were expressed in mmol/l. hyperglycaemia was defined as fasting blood sugar > 7.1mmol/l (>127.8mg/dl). the glomerular filtration rate was estimated using the ckd-epi creatinine equation 2021[16] with correction for body surface area (bsa). body surface area was calculated using the mosteller's formula in normal weight, overweight and obese adults because of its simplicity and suitability for laboratory and clinical work in adults [17]. their marital statuses were also grouped into married, single, and widowed/divorced. the participant's level of education was grouped into no formal education/primary, secondary, and tertiary. in addition, their occupation was grouped into attendants, administrators, traders (shop/canteen owners), medical doctors, nurses, and other health workers (comprising pharmacists, laboratory scientists, community health workers, and medical records officers) for the purpose of this analysis. the other independent variables that were regrouped included the participants' body mass index (bmi) and fasting blood glucose (fbg). the bmi (in kg/m2) was grouped into 18.5 to 24.9 (normal), 25.0 to 29.9 (overweight), and ≥ 30 (obese) [17]. the fbg (in mmol/l) was also grouped into three groups comprising of normal level (≤ 5.5), pre-diabetes (5.6 – 6.9), and ≥ 7.0 (diabetes) [18]. the data collected was analyzed using ibm spss version 25. the participants' ages were grouped into 3; those 18 to 39 years were referred to as young adults, 40 to 59 years were middle-aged, and 60 and above were termed elderly for the purpose of analyses. the dependent variable, estimated glomerular filtration rate (egfr), was classified into 2 categories of either a low (subnormal) value or a normal value using a cut-off value of 60.0 2 ml/min/1.73m . chi-square analysis was done and the level of statistical significance was set at a p-value of < 0.05. results 150 adults were screened at the bingham university teaching hospital, jos during the 2021 world kidney day program. the mean age of the participants was 43.3 ±11.32 years, with 61.3% being females. table 1 shows the distribution of the participants' sociodemographic characteristics. prevalence rate for abnormal egfr table 2 shows the distribution of the participants' clinical correlates. 30% of the participants were obese while 29.3% had abnormally high fbg levels. the number of p a r t i c i p a n t s f o u n d w i t h a l o w ( < 6 0 2 ml/min/1.73m ) estimated glomerular filtration rate (egfr) was 55 (36.7%) while those with normal values were 95 (63.3%). therefore, this study's prevalence rate for low egfr was 36.7%. association between the participants' sociodemographic variables/correlates and egfr a chi-square test for the association between the participants' egfr and their sociodemographic characteristics and correlates is shown in table 3. from the analysis, the participants' age, marital status, educational level, occupation, and fasting blood glucose (fbg) were significantly associated with their estimated glomerular filtration rates (egfr). the variables that were found to be significantly associated with egfr were subjected to a multivariate logistic analysis to res. j. health sci. vol 11(3), september 2023 272 risk factors ckd among adults in tertiary hospital community mbah et al. verify that they were significant predictors and not occurring by chance, as shown in table 4. following this analysis, age, marital status, and fbg remained significantly associated with egfr. distribution of identifiable risk factors for ckd of the study participants, thirty-two (21.3%) had a history of hypertension. those that had a positive family history of hypertension, diabetes, and sickle cell disease were 53 (35.3%), 26 (17.3%), and 7 (4.7%) respectively. the results of the urinalysis done for the participants showed that 49 (32.7%) had protein in their urine, 37 (24.7%) had blood, and 9 (6.0%) had glucose in their urine. 63 (42.0%) of the study participants were overweight while 45 (30.0%) were overtly obese. 44 (29.3%) of the participants had diabetes while 73 (48.7%) had prediabetes. discussion world kidney day is celebrated every year in the month of march globally just to raise global awareness of the importance of our kidneys to overall health, [19] thereby reducing the frequency of ckd and its attendant morbidity and mortality. sensitization talks to certain population groups especially vulnerable groups as well screening programs, as we did in this study usually characterize such events. the aim being to identify those at risk of developing chronic kidney disease and the possible obvious risk factors and possibly institute measures to halt or retard progression to chronic kidney disease and end stage kidney [20]. the risk factors of ckd screened for in this population included obesity, hypertension, pre-diabetes, diabetes mellitus, proteinuria, glycosuria, haematuria as well as egfr. the prevalence of hypertension observed in this study was 21.3%; this falls within the range of the overall prevalence of hypertension in nigeria reported to be between 8.046.4% [21]. ordinioha [22] reported a similar prevalence of 21.3% among lecturers in port harcourt. similarly, a report among civil servants in kano [ 2 3 ] s h o w e d a p r e v a l e n c e o f 2 9 . 8 % . hypertension remains among the top three causes of ckd in nigeria [24, 25] and is also a common cause of ckd in other parts of sub-saharan africa [10] and when uncontrolled, it is known to hasten the progress of ckd as well as increase cardiovascular complications. this relatively high prevalence of hypertension may be associated with increasing urbanization, and adoption of western lifestyle in this environment as well as the age range screened. most of the participants screened 51.3% were of middle age of 40-59 years. also, the stress of marital life with its attendant responsibilities may have also contributed as 76.7% were married while 6% were widowed. again, a good number of the participants were either overweight (42%) or obese (30.0%) in the population screened and this fact also may have been a contributory factor to a high prevalence of hypertension we recorded. according to the world health organisation (who), in 2014, more than 1.9 billion persons worldwide were overweight and of these greater than 600 million were obese [26]. sub-saharan africa is not exempt from the obesity epidemic and abubakari et al [12] in a review reported an obesity prevalence of 10% among west african adults. in this study, the prevalence of overweight and obesity was comparable to that earlier reported in a systematic review among adult nigerians [12]. this relatively high prevalence observed in our study may be due to an apparent upsurge in the consumption of fast foods with associated sedentary lifestyles as such may encourage the development of obesity. the commonest risk factors for ckd remain diabetes and hypertension [27, 28] and these conditions are known to be strongly associated with ckd. overt diabetes in this study was observed in 29.3% of the participants, which is way higher than what was observed in other studies [8,9]. in port harcourt, nigeria, the prevalence of diabetes was reported to be 6.8% among adults [27]. the prevalence of proteinuria in this study was 32.7%. a lower prevalence of 19.4% was reported among civil servants in kano [23], while a further lower prevalence of 5.6% was observed among civil servants in bayelsa [8]. this high prevalence observed in this study could be as a result of high prevalence of obesity as well as may be those who presented themselves are those who had some concerns about their health. proteinuria is an independent risk factor and an early indicator of kidney disease and its persistence is known to be associated with progression of kidney disease [30]. the 2 prevalence of ckd (egfr< 60mls/min/1.73m ) 36.7% in this cohort was quite high compared to recent reports in nigeria [8, 31, 32]. this is due to the relative older people in the study population since it was a convenient sampling method. secondly, the study is among a cohort of university population who may have one health issue or the other. it is also well known that the res. j. health sci. vol 11(3), september 2023 273 risk factors ckd among adults in tertiary hospital community mbah et al. res. j. health sci. vol 11(3), september 2023 274 egfr declines with increasing age. this study also showed a significant negative correlation between age, and egfr. conclusion from this study, 36.7% of the participants had a low egfr. the participant's age, marital status, occupation, educational level, and fbg were significantly associated with their egfr. however, following multivariate logistic analysis, being elderly, widowed/divorced, and having a high fbg were independently associated with having a low egfr. this further highlights the magnitude of ckd in our community and calls for the need to intensify awareness on identifiable risk factors for ckd a n d p r e v e n t i v e m e a s u r e s a g a i n s t t h e development of ckd. recommendations it is therefore firstly recommended that every adult attending all medical outpatient clinics should be screened for proteinuria, haematuria, and hyperglycemia, as well as documenting their serum creatinine level which should be used to calculate their gfrs. secondly, all patients with abnormal constituents of urine and blood with normal gfr and those with gfr <60ml/min/1.73m² with or without abnormal constituents of urine or blood should be on renal failure conservative management to curtail the rising prevalence of esrd. finally, all those overweight/obese with or without diabetes should start lifestyle modification to prevent or at least defer the development of ckd acknowledgement: i wish to appreciate almighty god for the grace and strength given us to accomplish this task. i will also not fail to acknowledge the help of the staff and management of bingham university teaching hospital, especially the chief medical director, prof stephen anzaku for providing for us an enabling environment to carry out this study and for the laboratory staff for running the samples sent to them. to my residents, especially drs momoh, daniel adoza and joy izang abi i appreciate your secretarial work in making sure all appropriate data were collected, properly documented and stored. conflict of interest: i hereby declare that there is no conflict of interest in this study. references 1. eckardt ku, kasiske bl. kidney disease: improving global outcomes. nat rev nephrol. 2009;5(11):650-657. 2. odubanjo mo, oluwasola ao, kadiri s. the epidemiology of end-stage renal disease in nigeria: the way forward. int urol nephrol. 2011;43(3):785-792. 3. inker la, astor bc, fox ch, isakova t, lash jp, peralta ca et al kdoqi us commentary on the 2012 kdigo clinical practice guideline for the evaluation and management of chronic kidney disease. am j kidney dis 2014. mag;63(5):71335 4. kazancioglu r, risk factors for chronic kidney disease: an update. kidney int. suppl(2011). 2013 dec;3(4) 368-371. 5. egbi og, okafor uh, miebodei ke, kasia be, kunle-olowu oe, unuigbe ei et al. prevalence and correlates of chronic kidney disease among civil 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babatunde s. type 2 diabetes in adult nigerians: a study of its prevalence and risk factors in port harcourt, nigeria. diabetes res clin pract. 2003 dec;62(3):177–185. 28. international working group on the diabetic foot; a v a i l a b l e f r o m http://www.idf.org/webdata/docs/background_if nfo_afr.pdf. 29. atkins rc. the epidemiology of chronic kidney disease. kidney int. 2005 apr;67(suppl 94):14–18. 30. abbak m, zoja c, remuzzi g. how does proteinuria cause progressive renal damage? jasn. 2006 nov;17(11):2974–2984. 31. ulasi ii, ijoma ck, onodugo od, arodiwe eb, ifebunandu na, okoye ju. towards prevention of chronic kidney disease in nigeria: a community-based study in southeast nigeria. kidney int suppl. 2013 may;3(2):195–201. 32. wachukwu cm, emem-chioma pc, wokoma fs, oko-jaja ri. prevalence of risk factors for chronic kidney disease among adults in a university community in southern nigeria. pan african medical journal. 2015; 21:120. risk factors ckd among adults in tertiary hospital community mbah et al. res. j. health sci. vol 11(3), september 2023 276 table 1: distribution of the participants’ socio-demographic characteristics (n = 150) characteristics frequency percentages (%) age group (years) 18 – 39 40 – 59 = 60 57 77 16 38.0 51.3 10.7 sex male female 58 92 38.7 61.3 marital status married single widow 115 26 9 76.7 17.3 6.0 level of education tertiary secondary primary 106 35 9 70.7 23.3 6.0 occupation attendants administrators /civil servants other health workers medical doctors nurses students traders 16 56 30 4 18 13 13 10.7 37.3 20.0 2.7 12.0 8.7 8.7 table 2: distribution of the participants’ clinical correlates (n = 150) variables frequency percentage (%) body mass index (bmi) normal overweight obese 42 63 45 28.0 42.0 30.0 fasting blood glucose (fbg) normal pre-diabetes diabetes 33 73 44 22.0 48.7 29.3 risk factors ckd among adults in tertiary hospital community mbah et al. res. j. health sci. vol 11(3), september 2023 277 table 3: association between the participant’s, risk factors and their egfr variables estimated glomerular filtration rate (egfr) low (%) normal (%) chisquare, ÷2 p-value age groups (years) 18 – 39 40 – 59 > 60 10 (6.7) 32 (21.3) 13 (8.7) 47 (31.3) 45 (30.0) 3 (2.0) 23.464 0.0001* sex male female 19 (12.7) 36 (24.0) 39 (26.0) 56 (37.3) 0.622 0.498 marital status married single widow/divorced 38 (25.3) 12 (8.1) 7 (4.7) 77 (51.3) 14 (9.3) 2 (1.3) 7.977 0.019* occupation attendants administrators other health workers medical doctors nurses students traders 8 (5.3) 13 (8.7) 15 (10.0) 0 (0.0) 10 (6.7) 4 (2.7) 5 (3.3) 8 (5.3) 43 (28.7) 15 (10.0) 4 (2.7) 8 (5.3) 9 (6.0) 8 (5.3) 13.180 0.040* educational level tertiary secondary primary/none 32 (21.3) 17 (11.4) 6 (4.0) 74 (49.3) 18 (12.0) 3 (2.0) 7.540 0.023* bmi normal overweight obese 19 (12.7) 24 (16.0) 12 (8.0) 23 (15.3) 39 (26.0) 33 (22.0) 3.322 0.190 fbg normal pre-diabetes diabetes 11 (7.3) 15 (10.0) 29 (19.3) 22 (14.7) 58 (38.7) 15 (10.0) 24.527 0.0001* bmi = body mass index, fbg = fasting blood glucose, * = significant p-value risk factors ckd among adults in tertiary hospital community mbah et al. res. j. health sci. vol 11(3), september 2023 278 table 4: logistic regression variables (post-hoc analysis) variables significant variables estimated glomerular filtration rate (egfr) p –value aor 95% ci age groups (years) 18 – 39 40 – 59 > 60 0.032 0.079 0.010* ref 0.314 0.079 0.086 – 1.145 0.009 – 0.535 marital status married single widow/divorced 0.089 0.466 0.041* ref 0.530 0.085 0.096 – 2.922 0.008 – 0.906 occupation attendants administrators other health workers medical doctors nurses students traders 0.175 0.645 0.897 0.135 0.999 0.108 0.369 ref 1.787 1.114 0.239 71816 0.185 0.367 1.151 – 21.12 0.217 – 5.718 0.036 – 1.568 0.0000001 0.024 – 1.451 0.041 – 3.277 educational level tertiary secondary primary/none 0.153 0.299 0.056 ref 0.538 0.064 0.167 – 1.731 0.004 – 1.071 fbg normal pre-diabetes diabetes 0.001 0.482 0.006* ref 1.515 0.173 0.476 – 4.819 0.049 – 0.609 aor = adjusted odds ratio, ci = confidence interval, * = significant p-value, fbg = fasting blood glucose. risk factors ckd among adults in tertiary hospital community mbah et al. rjhs 11(4).cdr rate of perceived exertion and cardiovascular response of community dwelling older adults to six-minute walk test osundiya o.c., *ajepe t.o., ileyemi b.a., jaiyeoba a.d. abstract objectives: this study was designed to determine the rate of perceived exertion, cardiovascular responses of community dwelling older adults to six minutes' walk (6mwt) and possible gender difference. methods: one hundred and three apparently healthy community dwelling older adults, aged 60 years and above participated in the study. rate of perceived exertion (rpe) and cardiovascular responses (blood pressure, peripheral capillary oxygen saturation (spo ) and pulse rate) were measured pre and post 2 6mwt. results: there was a significant increase (p = 0.01) in rpe among all participants after the 6mwt. there wasno significant difference (p>0.05) in all the cardiovascular parameters pre and post 6mwt but with a significant difference in spo between male and female participants.2 conclusion: among older adults, rate of perceived exertion after a 6mwt was sort of hard with possible influence on the systolic blood pressure following 6mwt. female participants showed higher oxygen saturation than males. key words: rate of perceived exertion, ageing, cardiovascular response, six-minutes walk test *corresponding author ajepe t.o. email: tigbari@unilag.edu.ng department of physiotherapy, college of medicine, university of lagos, nigeria. received: april 10, 2022 accepted: may 9, 2023 published: december 15, 2023 original article research journal of health sciences res. j. health sci. vol 11(4), december 2023 363 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.9 taux d'effort perçu et de réponse cardiovasculaire des personnes âgées vivant dans la communauté à un test de marche de six minutes osundiya o.c., *ajepe t.o., ileyemi b.a., jaiyeoba a.d. résumé objectif de l'étude : cette étude a été conçue pour déterminer le taux d'effort perçu, les réponses cardiovasculaires des personnes âgées vivant dans la communauté à six minutes de marche (6mwt) et la différence possible entre les sexes. méthode de l'étude : cent trois personnes âgées apparemment en bonne santé, âgées de 60 ans et plus, vivant dans la communauté, ont participé à l'étude. le taux d'effort perçu (tep) et les réponses cardiovasculaires (pression artérielle, saturation capillaire périphérique en oxygène (spo et pouls) ont 2) été mesurés avant et après 6mwt. résultat de l'étude : il y a eu une augmentation significative (p = 0,01) du rpe parmi tous les participants après le 6mwt. il n'y avait pas de différence significative (p>0,05) dans tous les paramètres cardiovasculaires avant et après 6mwt mais avec une différence significative de spo entre les 2 participants masculins et féminins. conclusion : chez les adultes plus âgés, le taux d'effort perçu après un 6mwt était assez difficile avec une influence possible sur la pression artérielle systolique après 6mwt. les participantes ont montré une saturation en oxygène plus élevée que les hommes. mots-clés : taux d'effort perçu, vieillissement, réponse cardiovasculaire, test de marche de six minutes *corresponding author ajepe t.o. email: tigbari@unilag.edu.ng department of physiotherapy, college of medicine, university of lagos, nigeria. received: april 10, 2022 accepted: may 9, 2023 published: december 15, 2023 article original research journal of health sciences res. j. health sci. vol 11(4), december 2023 364 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.9 increasing age has been established (4), making it i m p e r a t i v e t o e v a l u a t e t h e c h a n g e i n cardiovascular response of older adults to submaximal exercise (6mwt), necessary to carry out adl. hence, this study is aimed at evaluating the cardiovascular responses of community dwelling older adult to a 6mwt. materials and methods e t h i c a l c o n s i d e r a t i o n : p r i o r t o t h e commencement of this study, ethical approval was sought and obtained from the health research and ethics committee of the lagos university teaching hospital, idi-araba lagos, nigeria. permission was also sought from the community leaders/clergy at the sites of data collection. informed consent was also sought from the subject prior to the commencement of the study. all procedures were explained to the participants verbally and an information sheet which contained detailed information of what the study was all about was given to all participants. participants this cross-sectional analytical survey involved 103 apparently healthy community dwelling older adults (aged 60 to 91). they were recruited from churches and mosques in lagos state, nigeria. the study included older persons who were ambulant either independently or with an aid and a score of >18 on the mini mental state examination questionnaire (mmse). older adults with history of unstable angina, myocardial infarction, resting heart rate of greater than 120bpm, systolic blood pressure greater than180mmhg, diastolic blood pressure greater than 100mmhg and history of any form of cardiovascular disease were excluded from the study. procedure for data collection pretest assessment: participants that met the inclusion criteria and gave their consent were assessed for cognition using the mmse questionnaire. rate of perceived exertion was assessed using borg's rating scale of perceived exertion (16). this was followed by assessing the metabolic function (systolic and diastolic blood pressure were measure using an analogue sphygmomanometer and a stethoscope, the pulse rate and respiratory rate were assessed while oxygen saturation (spo ) was measured using a 2 pulse oximeter). following these baseline measurements, the participants were asked to perform the six-minute walk test. the six minutes' walk test: the six-minute walk introduction at a global level, especially in the developed world, the population of the people older than 65 years is growing at a faster rate compared to that of people below (1). the responsible factor is more connected with increase in life expectancy and decline in number of children being given birth to in a year (1). however, as people age, they experience changes or decline in health status which means that as age-related changes set in, the elderly become challenged health-wise and coping will become the only tool to move on with life (2). cardiovascular response which is the reaction by the body to a specific influence subject to individual factors such as advancing age, heredity, gender and level of physical fitness (3). studies have shown that advancing age is potentially the most contributor to the various causes of decline in the metabolic function (4). ageing results in a decrease of muscle power and exercise capacity (5). therefore, the elderly often functions at the limit of their capacity to perform the activities of daily living (adl) (6). in older people, physical activity is a key component of independent functioning and quality of life (qol) and it contributes to the prevention of diseases, disability, and falls (7,8). there are several modalities available for the objective evaluation of exercise capacity suchas six-minute walk test, stair climbing, shuttle-walk testand a cardiopulmonary exercise test (9,10). six-minute walk test (6mwt) is a sub maximal exercise test which measures the distance an individual covers in 6 minutes and it assesses the functional capacity of the individual. it has a high reliability in healthy older adults and since most activities of daily living are performed at submaximal levels of exertion, the 6mwt is more reflective of activities of daily living (adl) than the other forms of walk tests (11,12). the effort expended during these submaximal levels of exertion is objectively evaluated using the borg's scale, rating of perceived exertion (rpe). rating perceived exertion involves selfevaluation of physical effort which is drawn from perceptual, psychological and physiological factors (13). the bodily sensations, feedback, and the actual performance of a specific physical activity inform the expression of rpe (14). during aging process, blood flow to the brain reduces, which leads to decrease in cognitive and physical functions, hence, influencing rpe in older adults (15). a decline in cardiovascular function with res. j. health sci. vol 11(4), december 2023 365 perceived exertion and cardiovascular response to six-minutes walk test osundiya et al. test was performed indoors and outdoors when the weather condition was favourable enough, along a long, flat, straight, enclosed corridor with a hard surface that was seldom travelled. the walking course was 30 meters in length. a 100-ft hallway was, therefore, required. the length of the corridor was marked at every 3 meters. the turnaround point was marked with an orange traffic cone. the starting line, which marked the beginning and end of each 60-m lap, was marked on the floor using brightly coloured tape (17). the test was then carried out following the american thoracic society guideline for six-minutes walk test (12). posttest measurement: immediately after the six-minute walk test, participants were reassessed based only on the borg's scale of perceived exertion and all the cardiovascular responses measured at baseline (systolic and diastolic blood pressures, pulse rate, respiratory rate and spo ).2 statistical analysis data was analysed using statistical package for the social sciences (spss) windows version22.0. descriptive statistics of measures of central tendency (mean, median, and mode) and measure of variability (standard deviation) were used to summarize the data obtained. paired t-test was used to determine the changes in the rate of perceived exertion and cardiovascular responses before and after the six-minute walk test while independent t-test was used to compare the data of the male and female participants. spearman's rank correlation coefficient was used to determine the relationship between the rate of p e r c e i v e d e x e r t i o n s c o r e a n d a l l t h e cardiovascular responses assessed after the 6mwt. the level of significance for all the inferential statistics was p<0.05. results the participants include 76 (74%) females and 27 (26%) males. the mean age of female participants was 68.70 ± 7.24 year and mean age of male participants was 67.96 ± 7.25 years. using paired t-test, table 1 shows the comparison of rate of perceived exertion and cardiovascular response of the participants preand post-six minute walk test. it was observed that there was significant difference in the rpe pre and post 6mwt. spearman rank correlation test was used to determine the relationship between rate of perceived exertion and cardiovascular responses of the participants. there was significant positive relationship between rpe and sbp after 6mwt (r = 0.19, p = 0.04) (table 2).s independent t-test was used to compare the data of the male and female participants' pre and post 6mwt and it was observed that pre 6mwt, there was a significant difference in the pr while after 6mwt, a significant difference was observed in the oxygen consumption (spo ). 2 (table 3). discussion six-minutes walk test, a submaximal exercise, is a useful tool for the evaluation of the exercise capacity in older adults. understanding the immediate response to this level of exercise is of utmost importance to exercise prescription for older adults. as expected, it was observed in this study that there was a substantial increase in the rate of perceived exertion after the six-minute walk test but there was no significant increase in the cardiovascular response. shamay et al (18) while studying effect of walkway length, turning direction and distance covered during the six minute walk test among 25 ambulant stroke survivor (>50 years) observed a increase rpe post exercise. furthermore, this study showed that there was no significant difference in cardiovascular responses of participants before and after the sixminute walk test. this is not unexpected because with aging there is a reduced cardiac response to stress and exercise (19). even in diseases state, fonseca et al, (20) found no significant difference in cardiovascular parameters among elderly population with copd before and after two 6mwt with 30 mins rest in between. however, this disagrees with findings of chugh et al, (21) where a significant difference was found between the pre and post 6mwt heart rate among young smokers. there was a significantrelationship between rate of perceived exertion and systolic blood pressure after 6mwt. this implies that even-though there is a reduction in exercise response among the elderly, the increase in rate of perceived exertion could account for the observed marginal though not significant increase in systolic blood pressure, hence the weak relationship. among younger population, who do not experience a delay in response to exercise, there was an observed moderate to strong relationship between rate of perceived exertion and systolic blood pressure as reported by rodriguez et al (22). higher oxygen saturation rate was observed after the 6mwt among the female res. j. health sci. vol 11(4), december 2023 366 perceived exertion and cardiovascular response to six-minutes walk test osundiya et al. participants. this is inline with reported normative valueseven after considering age and body mass indices (23,24). this may be due to hormone-related differences. these hormones may have a direct or an indirect effect on the respiratory centers (25). progesterone hormone which has been shown to be higher in women throughout all phases of the menstrual cycle has been shown to stimulate breathing via central and peripheral chemoreceptors (26).furthermore, a possible indirect effect of sex on spo2 could be related to increase work of breathing (wob) as this has also been shown to be higher in women compared to men (23). conclusions based on the outcomes of this study it was concluded that among community dwelling older adults, rate of perceived exertion after a 6mwt was sort of hard with possible influence on the systolic blood pressure. also, female community dwelling older adults have more tendency for higher oxygen saturation than males following 6mwt. acknowledgment: the authors appreciate and acknowledge the participants in this study. conflicts of interest: authors declare no conflicts of interest and no external financial support. this study has not been submitted or published in any form in other journals. references 1. plank c, schneider s, eysholdt u. voiceand health-related quality of life in the elderly. j voice. 2011: 25(3):265-8. 2. birkeland, a and natvig, gk. coping with ageing and failing health: a qualitative study among elderly living alone. international journal of nursing practice. 2009: 15(4): 257-264. 3. world of sport science (2008). cardiovascular response. http;//www.faqs.org/sports science/jemo/cardiovascular response.html. accessed 23/08/2020. 4. watters jm, redmond ml, desai d. effects of age and body composition on the cardiovascular responses to elective colon resection. annals of surgery 1990: 212(2): 213–220. 5. marcell tj. review article: sarcopenia: causes, consequences and preventions”. journal of gerontology: medical science 2003: 58a (10): 911-916. 6. hortobagyi t, mizelle c, and beam s, devita p. 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(2018). sex differences in respiratory function. breathe (sheffield, england) 2018 14(2) 131–140. 24. ricart a, pages t, viscor g, leal c, ventura jl. sex-linked differences in pulse oxymetry. br j sports med 2008 42 (7): 620–1. 25. levental, s., picard, e., mimouni, f., joseph, l., samuel, t. y., bromiker, r., goldberg, s. sexlinked difference in blood oxygen saturation. the clinical respiratory journal 2018 12(5): 1900–1904. 26. schoene rb, robertson ht, pierson dj, peterson ap. respiratory drives and exercise in menstrual cycles of athletic and nonathletic women. j appl physiol 1981 50 (6): 1300–5. perceived exertion and cardiovascular response to six-minutes walk test osundiya et al. res. j. health sci. vol 11(4), december 2023 369 table 1: rate of perceived exertion and cardiovascular response of the participants preand post-sixminute walk test *level of significance letter < 0.05 key: sbp: systolic blood pressure dbp: diastolic blood pressure pr: pulse rate spo2: oxygen saturation rpe: rate of perceived exertion mmhg: millimeters of mercury t-test: paired t-test sd: standard deviation variable mean ±sd pre mean ±sd post t-value p-value sbp(mmhg) 137.93±18.29 138.45±18.57 -0.54 0.58 dbp(mmhg) 80.61±11.12 80.04±11.50 0.62 0.53 pr (bpm) 76.11±12.87 76.47±12.25 -0.65 0.51 spo2 (%) 96.90±4.76 97.76±1.63 -1.97 0.05 rpe 2.71±1.42 3.79±1.65 -10.73 0.01* table 2: relationship between rate of perceived exertion (rpe) and cardiovascular responses variable rs p-value pre 6mwt rpe vs. sbp 0.18 0.63 rpe vs. dbp -0.54 0.58 rpe vs. spo2 0.10 0.30 rpe vs. pr -0.32 0.75 post 6mwt rpe vs. sbp 0.19 0.04* rpe vs. dbp 0.00 1.00 rpe vs. spo2 0.03 0.76 rpe vs. pr 0.04 0.67 *level of significance letter < 0.05 key: sbp: systolic blood pressure dbp: diastolic blood pressure pr: pulse rate spo2: oxygen saturation rpe: rate of perceived exertion rs: spearman’s correlation coefficient table 3: comparison of perceived exertion rate of male and female participants *level of significance letter < 0.05 key: sbp: systolic blood pressure dbp: diastolic blood pressure pr: pulse rate spo2: oxygen saturation rpe: rate of perceived exertion mmhg: millimeters of mercury t-test: independent t-test sd: standard deviation variable mean ±sd male mean ±sd female t-value p-value pre 6mwt rpe 0.88±0.93 1.15±1.12 1.11 0.27 sbp(mmhg) 140.00 ± 19.44 137.19 ± 17.96 0.68 0.49 dbp(mmhg) 81.62 ± 10.55 80.25 ± 11.36 -0.55 0.58 pr (bpm) 71.51 ± 14.92 77.75 ± 11.74 2.20 0.03* spo2 (%) 96.44±6.87 97.06±3.79 0.58 0.56 post 6mwt rpe 1.62±1.17 2.09±1.51 1.43 0.15 sbp(mmhg) 139.40±18.13 138.11±18.83 -0.30 0.75 dbp(mmhg) 80.66±13.40 79.82±10.84 -0.32 0.74 pr (bpm) 73.51±12.95 77.52±11.90 1.46 0.14 spo2 (%) 97.22±2.51 97.96±1.13 2.04 0.04* perceived exertion and cardiovascular response to six-minutes walk test osundiya et al. rjhs 11(4).cdr comparison of ckd-epi, c-g and mdrd equations for estimating glomerular filtration rate in chronic kidney disease population in south-western nigeria. 1 2 1 1 1 1 *braimoh, r.w. , ediale, t.i. , mabayoje, m.o. , ale, o.k. , bello, b.t. , amira, c.o. abstract background: ethnic variabilities make reliability of formula equations for assessing glomerular filtration rate (gfr) doubtful in many populations. we compared cockroft-gault (cg), modification of diet in renal disease (mdrd), and chronic kidney diseases epidemiology collaboration (ckd-epi) equations in adult nigerian ckd subjects. methodology: we measured 24-hour-urinary creatinine clearance of 311 adult ckd patients and compared with the three estimated equations. bland-altman plots were used to assess agreement between estimated equations and measured creatinine clearance (mgfr). receiver-operating curve (roc) analysis was used to assess the diagnostic power of the equations. equation with accuracy within 30% of mgfr of ≥ 90% was considered acceptable for use. results: mean age was 41.9±12.7 years with 182(58.5%) females. the mean gfr using ckd-epi, 2 mdrd and cg equations were 69.5±33.9, 65.9±33.0 and 66.2±30.9 mls/min/1.73m respectively 2 (mgfr 68.3±31.1mls/min/1.73m ). the 3 equations showed positive correlation to mgfr (r=0.95) but ckd-epi had the least bias. conclusion: all three equations can be used but ckd-epi equation is preferable in nigerian ckd patients, especially with gfr> 60mls/min. keywords: ckd, black population. *corresponding author dr rotimi w. braimoh email:rotelbraimoh1234@gmail.com 1 department of medicine, college of medicine, university of lagos, lagos, nigeria. 2 total oil corporation, gbagada lagos, nigeria. mdrd, ckd-epi and cg equations, received: january 4, 2023 accepted: july 2, 2023 published: december 15, 2023 original article research journal of health sciences res. j. health sci. vol 11(4), december 2023 285 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.1 comparaison des équations cemrc, cg et mramr pour estimer le taux de filtration glomérulaire dans la population d'insuffisance rénale chronique dans le sud-ouest du nigéria 1 2 1 1 1 1 *braimoh, r.w. , ediale, t.i. , mabayoje, m.o. , ale, o.k. , bello, b.t. , amira, c.o. résumé contexte général de l'étude : les variabilités ethniques rendent douteuse la fiabilité des équations des formules d'évaluation du débit de filtration glomérulaire (dfg) dans de nombreuses populations. nous avons comparé les équations de cockroft-gault (cg), de la modification du régime alimentaire dans les maladies rénales (mramr) et de la collaboration sur l'épidémiologie des maladies rénales chroniques (cemrc) chez des sujets adultes nigérians atteints de cemrc méthode de l'étude: nous avons mesuré la clairance de la créatinine urinaire sur 24 heures de 311 patients adultes atteints d'irc et comparé avec les trois équations estimées. des tracés de bland-altman ont été utilisés pour évaluer la concordance entre les équations estimées et la clairance de la créatinine mesurée (dfgm). l'analyse de la courbe de fonctionnement du récepteur (roc) a été utilisée pour évaluer la puissance diagnostique des équations. une équation avec une précision dans les 30 % du dfgm ≥ 90 % a été considérée comme acceptable pour l'utilisation. résultat de l'étude : l'âge moyen était de 41,9 ± 12,7 ans avec 182 (58,5 %) femmes. le dfg moyen en utilisant les équations cemrc, mramr et cg était respectivement de 69,5 ± 33,9, 65,9 ± 33,0 et 66,2 ± 2 ( 2 30,9 ml/min/1,73 m mgfr 68,3 ± 31,1 ml/min/1,73 m ) . les 3 équations ont montré une corrélation positive avec le dfgm (r = 0,95) mais cemrc avait le moins de biais. conclusion : les trois équations peuvent être utilisées, mais l'équation cemrc est préférable chez les patients nigérians atteints d'irc, en particulier avec un dfg> 60 ml/min. mots-clés : emc, population noire. *corresponding author dr rotimi w. braimoh email:rotelbraimoh1234@gmail.com 1 department of medicine, college of medicine, university of lagos, lagos, nigeria. 2 total oil corporation, gbagada lagos, nigeria. received: january 4, 2023 accepted: july 2, 2023 published: december 15, 2023 mramr, cemrc et équations cg, article original research journal of health sciences res. j. health sci. vol 11(4), december 2023 286 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.1 require in-hospital treatment for acute conditions like sepsis, hypertensive or diabetic emergencies, acute stroke, and those who did not consent. the control subjects were consenting healthy adults, aged 18 years and above, from the community who had no history of kidney disease, acute conditions such as febrile illness, hypertensive or diabetic emergencies, or acute stroke. urine dipstick test was performed using accutest® uriscreen strips (jant pharma usa) to rule out kidney damage in them; and individuals with proteinuria of ≥ +1 were excluded from the control group. ethical approval was obtained from health research ethics committee of lagos u n i v e r s i t y t e a c h i n g h o s p i t a l (adm/dcst/hrec/app/1731) and written informed consent was obtained from all study participants. relevant clinical data were obtained with questionnaire. weight (in kilograms, to the nearest 0.1kg.) was measured using a weighing scale (secca 770 floor digital scale, hamburg germany) with each subject in light clothing and barefooted. height (in meters to the nearest 0.01metre) was measured using a stadiometer (secca 240 wall mounted, hamburg germany) with the patient barefooted. body mass index (bmi) was determined by dividing the weight (in kilograms) by the square of the height (in meters). body surface area (bsa) was calculated using 21 the mosteller formula . office blood pressure was measured (with subject sitting in a relaxed position) with mercury sphygmomanometer (accoson, england) using appropriate cuff size. twenty-four-hour urine samples were obtained in 5-litre containers after participants had been taught how to correctly obtain urine samples. ten milliliters (mls) of venous blood were collected via venipuncture between 7:00am and 8.00am in the morning of completion of 24-hour urine collection for serum creatinine, fasting glucose and serum albumin analysis. serum and urinary creatinine levels were analyzed by jaffe-kinetic method using randox kit (randox lab. usa) calibrated with an isotope dilution mass spectrometry traceable calibrator. fasting blood glucose analysis was done using roche hitachi 902 auto-analyzer (roche basel, switzerland). s e r u m a l b u m i n w a s a n a l y z e d w i t h a spectrophotometer using 2, 4-dinitrophenyl hydrazine reaction. the 24-hour urinary protein estimation was performed with robert riele 4040 photometer (robert riele gmbh & co. berlin, germany) using sulphosalicylic acid method. introduction chronic kidney disease (ckd) is a leading cause of mortality worldwide and is associated with reduced quality of life and high 1 cost of treatment . it's of major public health concern with prevalence tending towards 2,3 epidemic proportions . the mortality of endstage renal disease (esrd) is high in many 4,5 african countries . therefore, early treatment is of utmost importance, especially in resource6 constrained countries . the preferred index of kidney function is glomerular filtration rate (gfr) which is best measured by inulin 7 clearance . however, this is not clinically useful because of its cumbersome method. this led to 8,9 the development of alternative methods which, 10-13 unfortunately also have many drawbacks . in 1973, cockcroft and gault developed an equation for creatinine clearance (crcl) estimation as a point-of-care measurement of 14 kidney function . other equations were also 15-16 developed, all with limitations . this prompted the ckd-epi study group to develop an equation from a wide and varied population, including african-americans, diabetics, and 17 kidney transplant recipients . however, a major setback to this equation is the limited number of racial and ethnic minorities included in the 17 original study . the fact that this equation was developed based on the body surface area of a predominantly caucasian population limits its accuracy in many other racial and ethnic populations as body compositions differ among ethnic groups even within nations; causing 18-19 varying performance in different cohorts . this prompted us to compare the performance of the ckd-epi, cg, and mdrd equations in a cohort of ckd subjects in nigeria, a country with the largest black african population in the world. materials and methods this was a cross-sectional study of ckd patients attending the renal clinics of the lagos university teaching hospital and healthy controls recruited from the community. the sample size was determined by fisher's formula 20 for descriptive studies (with additional 10% attrition rate), to make a total of 311 each for ckd patients and control subjects. inclusion and exclusion criteria: ckd patients were selected by choosing every third ckd patient that met the inclusion criteria which are: a diagnosis of ckd (defined as gfr of ≤ 2 60mls/min/1.73m for at least 3 months) in stable condition, aged 18 years and above, who gave their consent. excluded were ckd patients who res. j. health sci. vol 11(4), december 2023 287 formula equations for kidney function in black africans braimoh et al. c a l c u l a t i o n s : c o c k c r o f t g a u l t ( 1 9 7 3 ) : gfr=[(140-age) (years) x weight (kg) / (72 x serum creatinine) x 0.85 (if female) (umol/l). mdrd equation(1999): gfr=175 x (serum cr -1.154 -0.203 in umol/l) x age x 1.212 if black x 0.742 if female. ckd-epi equation(2009): gfr=141 x á -1.209 age min(scr/k, 1) x max(scr/k, 1) x 0.993 x 1.018 if female -1.159 if black; where k= 0.7 for females, 0.9 for males; á= -0.329 for females, 0.411 for males. data collected were analyzed using a statistical package for social sciences version 22 software (ibm spss inc. usa). data on age, weight, height, bmi, sbp, dbp and biochemical parameters were expressed as means and standard deviations (sd). paired sample t-test was used to compare egfr formulae and measured gfr (mgfr). correlation between mgfr and the 3 equations (cg, mdrd and ckd-epi) was assessed using pearson's correlation coefficient. agreement between mgfr and the 3 equations was analyzed using bland-altman plots. receiver-operating curve (roc) analysis was used to assess the diagnostic power of the equations. p-value < 0.05 was considered statistically significant at 95% confidence interval. results the mean age of the ckd population was 41.9 ±12.7 years with 182(58.5%) females. 2 ckd subjects had mean bmi of 25.1±4.42kg/m and mean weight of 69.7±13.0kg. using the serum creatinine concentrations to calculate the egfrs, the mean ± sd egfrs did not differ s i g n i f i c a n t l y. t h e c k d e p i e q u a t i o n consistently overestimated gfr in this cohort by 2 2.2 ml/min/1.73m . table 1 shows the clinical and laboratory parameters of the study population while the comparative diagnostic performance of the estimating equations in ckd patients is shown in table 2. ckd-epi was more sensitive and had better positive predictive value than 2 mdrd in gfr above 90ml/min/1.73m ; more precise than cg and had its most bias in stage 1 and least bias in stage 3. within 15% of mgfr, there was significant difference between ckdepi and cg in stage 4 and 5 with cg being more accurate (p=0.003). mdrd equation had similar accuracy with ckd-epi equation at this level. within 30% of mgfr, ckd-epi and cg differed significantly in stage 5; with cg being more accurate (p=0.02). within 50% of mgfr, there was similar accuracy among the 3 equations across stage 1 to 5. hypertension was the commonest cause of ckd (figure1). all 3 equations showed a strong correlation to mgfr (r=0.96 p? 0.001) (figure 2) and had narrow limits of agreement (figure 3). overall, all three equations had good accuracy and minimal bias although ckd-epi had the least bias. figure 4 shows the receiver operating curves (roc) of the three equations in d e t e c t i n g t h o s e a b o v e o r b e l o w 6 0 2 ml/min/1.73m . the ckd-epi equation correctly classified 82% of the study population when compared with mgfr to the various ckd staging. of the remaining 18%, 8.0 % was underestimated and 10.0 % were over-estimated (cohen's k=0.77) but using mdrd and cg equations, 81% of ckd patients were classified correctly while 15.5% of the rest was underestimated gfr and 3.5% over-estimated (cohen's k=0.76). discussion the three equations performed well against mgfr. they had minimal bias and good accuracy. the ckd-epi was more sensitive in detecting patients with stage 1 and 2 ckd than those with stage 3 to 5 ckd, more specific in detecting stage 3 to 5 in the ckd population. the original ckd-epi study showed that the ckdepi equation has less bias than the mdrd equation, similar to our finding. unlike cg and mdrd equations, the ckd-epi equation had similar bias and precision in levels above and 2 below 60ml/min/1.73m but was more accurate in 2 gfr levels above 60 ml/min/1.73 . this suggests that the ckd-epi equation is acceptable for use to detect early stages of ckd among nigerians. 22 this is similar to the findings of steven et al as 23 well as eastwood and colleagues . from this study, ckd-epi equation over-estimated gfr in ckd subjects by 2.2 2 ml/min/11.73m but the ghanaian study which used a similar reference standard showed a more p r o n o u n c e d o v e r e s t i m a t i o n 2 23 (19ml/min/1.73m ). the reason for this is not clear but could be due to the lower bmi and weight of the ghanaian study population. within 15% of mgfr, ckd-epi equation was more accurate in stages 3-5 of ckd than mdrd, 24 similar to finding by michels et al and murata et 25 al but contrasted the findings of the original 17 ckd-epi validation study , in which the ckdepi showed better accuracy than mdrd mainly 2 in gfr > 60ml/min/1.73m . this disparity could be due to the larger population of the original ckd-epi study which increased its statistical power. in addition, the ckd-epi's african res. j. health sci. vol 11(4), december 2023 288 formula equations for kidney function in black africans braimoh et al. american population may not fully represent the ethnic black african population. overall, we found cg equation to be more accurate in established ckd patients than mdrd at lower gfrs (gfr below 60 2 ml/min/1.73m ) which is contrary to some studies when the two equations were compared against 26-28 the gold standard . however, most african studies are limited by sample size and nonavailability of gold standard reference materials for appropriate evaluation of these equations. till 29 date, van deventer's study is the only african study that used the gold standard marker to validate the performance of mdrd and ckdepi in a predominantly black population. in his 51 study, cg had an accuracy (within 30% of credta) of 58% compared to mdrd (52%). jafar 30 et al also documented superior accurate performance of cg to mdrd equation (65% versus 50%, respectively). however, michel's finding in a similar study comparing the 3 equations against the gold standard found that ckd-epi was significantly more accurate than 24 cg and more sensitive than the mdrd in ckd stages 1 and 2, which suggest that the ckd-epi can be used to detect early stages of ckd better than the mdrd equation. this is similar to the 26 finding of stevens et al. overall, ckd-epi may rightly classify patients better than the mdrd equation. this is 26 contrary to the findings of steven et al . this difference may be attributed to the relatively smaller sample size of our study compared to theirs. the strength of this study includes a 100% black african population and therefore little doubt about the racial factor. also, the method of serum creatinine assay was rate-blanked compensated jaffe method traceable to isotope dilution mass spectrophotometry, thus improving on variability error between laboratory methods. also, urban population was used where age is more accurately recorded. validation of ckd-epi has shown it is better than the mdrd in classifying higher stages of ckd patients. the limitations include the use of creatinine clearance as a standard to estimate gfr with formula equations; a relatively small sample size relative to that used in the mdrd and ckd-epi formulae and validation are major limitations. also, there was verification bias as the ckd population was selected from patients' records. finally, since gfr was measured only once, some individuals thought to be stable ckd may have been misclassified. however, our objective was not the prevalence of ckd but a comparison of egfr equations. conclusion the 3 estimating equations performed well against mgfr in our ethnic black population but ckd-epi was the least biased, most precise, and more accurate in staging ckd in gfr levels 2 >60 ml/min/1.73m in ckd patients and so is recommended for use in our ckd patients, especially in early stages. conflict of interest: the authors declare no conflict of interest. acknowledgement: nil authors' contribution: braimoh rw carried out the protocol design, literature search, data collection and analysis, and manuscript writing. ediale ti was involved in protocol design, literature review, data collection and analysis. mabayoje mo did the protocol design, literature search, data analysis and manuscript review. ale ok, bello bt and amira co was involved in data analysis. ale ok did the manuscript writing while bello bt and amira co did the manuscript review. references 1. zhang q, rothenbacher d. prevalence of chronic kidney disease in population-based studies: systematic review. bmc public health. 2008; 8: 117129. 2. levey as, andreoli sp, dubose t, provenzano r, collins aj. ckd: common, harmful, and treatable-world kidney day. 2007; am j kidney dis. 49:175-9. 3. hallan si, coresh j, astor bc. international comparison of the relationship of chronic kidney disease prevalence and end-stage renal risk. j am soc nephrol. 2006; 17 (8): 2275 2284. 4. fogazzi gb, attolou v, kadiri s, fenili d, priuli f. a nephrological program 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in black south africans by use of the modification of diet in renal disease and cockroft-gault equations. clin chem. 2008; 54: 1197-1202. 30. jafar th, schmid ch, levey as. serum creatinine as a marker of kidney function in south asians: a study of reduced grf in adult pakistanis. j am soc nephrol. 2005; 16: 14131419. res. j. health sci. vol 11(4), december 2023 290 formula equations for kidney function in black africans braimoh et al. res. j. health sci. vol 11(4), december 2023 291 table 1: clinical and laboratory characteristics of the study population variables all (n=622) ckd(n=311) control(n=311) p-value (ckd vs control) mean age(yrs) 41.9±12.7 42.0 ±12.7 41.8 ± 12.7 0.85 female n(%) 364(58.5) 182(58.5) 182(58.5) 0.94 male n(%) 258 (41.5) 129(41.5) 129(41.5) 0.94 mean weight (kg) 70.9 ± 12.9 69.7±13.0 72±12.7 0.03* mean height (m2) 1.67±0.09 1.67±0.09 1.68±0.08 0.14 mean bmi (kg/m2) 25.4±4.47 25.1±4.42 25.6±4.55 0.14 mean bsa(m2) 1.79±0.17 1.77±0.18 1.81±0.17 <0.001* mean sbp(mmhg) 122±22.0 129.9±25.5 114.2±14.5 <0.001* mean dbp(mmhg) 77.5±14.4 82.0±17.3 72.9±8.7 <0.001* mean plasma glucose(mg/dl) 83.8±24.9 87.8±30.7 79.9±16.6 <0.001* mean urine protein(mg/dl) 238.7±190.5 281±213 198±156 <0.001* mean serum creatinine(mg/dl) 1.4±1.7 1.98±2.2 0.83±0.14 <0.001* mean urine creatinine(mg/dl) 82.4±28.9 80.8±26.2 83.9±31.3 0.18 mean measured gfr(ml/min/1.73m2 89.3±33.0 68.3±31.1 110.2±18.3 0.001* mean estimated gfr(ml/min/1.73m2) cockcroft-gault 85.3±32.6 66.2±30.9 104.3±20.9 0.001* mdrd 87.4±35.7 65.9±33.0 108.7±23.5 0.001* ckd-epi 91.5±35.5 69.5±33.9 113.5±20.1 0.001* values are in mean± standard deviation. mdrd modification of diet in renal disease. ckd-epi chronic kidney disease epidemiological study group. *p<0.05. formula equations for kidney function in black africans braimoh et al. res. j. health sci. vol 11(4), december 2023 292 table 2. the comparative diagnostic performance of the estimated equations in ckd cohort gfr ckd-epi mdrd cg p-value pvalue ml/min/1.73m2 n ckd-epi vs mdrd ckd-epi vs cg bias =90 69 3.2 -1.3 -3.8 <0.001* <0.001* 60-89 136 2.4 -2.7 -2.3 <0.001* <0.001* 30-59 60 -0.7 -2.4 -1.2 0.32 0.39 15-29 23 -3.1 -3.4 -4.8 0.79 0.13 <15 23 -3.1 -2.8 -3.6 0.34 0.13 overall 1.2 -2.4 -2.1 <0.001* <001* sensitivity (%) =90 69 85.5 66.7 75.4 0.02* 0.2 60-90 136 81.6 87.5 83.1 0.24 0.87 30-59 60 73.0 81.7 88.3 0.36 0.06 15-29 23 82.6 78.3 95.7 0.99 0.34 <15 23 100 100 100 specificity (%) =90 69 93.8 99.2 97.9 0.21 0.44 60-89 136 87.4 83.4 86.9 0.45 0.95 30-59 60 96.0 94.0 92.4 0.93 0.65 15-29 23 93.6 98.3 99.7 0.95 0.74 <15 23 98.6 98.3 100 0.27 0.23 positive predictive value (%) =90 69 79.7 95.8 91.2 0.01* 0.09 60-89 136 83.5 80.4 83.1 0.61 0.94 30-59 60 81.5 76.6 73.6 0.66 0.41 15-29 23 82.6 78.3 95.7 0.99 0.34 <15 23 85.3 82.0 100 0.92 0.18 negative predictive value (%) =90 69 95.8 91.3 93.3 0.47 0.79 60-89 136 85.9 89.6 86.9 0.46 0.95 30-59 60 93.8 95.6 86.9 0.97 0.33 15-29 23 98.6 98.3 99.7 0.27 0.23 <15 23 100 100 100 precision =90 69 1.6 1.5 1.5 1.00 0.6 60-89 136 8.1 7.1 7.4 0.13 0.30 30-59 60 9.9 8.7 7.9 0.32 0.09 15-29 23 4.0 3.7 3.4 0.7 0.45 <15 23 1.1 1.0 1.1 0.66 1.00 overall 10.4 9.7 9.2 0.22 0.03* accuracy 15% =90 69 72.5 73.9 79.7 0.99 0.43 60-89 136 83.1 83.8 83.1 0.99 0.87 30-59 60 58.3 51.7 65.0 0.59 0.57 15-29 23 34.8 26.1 82.6 0.75 0.003* <15 23 8.7 13.0 82.6 0.99 0.001* overall 66.9 65.9 78.8 0.86 0.001* 30% =90 69 97.1 97.1 97.1 0.61 0.61 60-89 136 99.3 99.3 99.3 0.47 0.47 30-59 60 90.0 91.7 91.7 0.99 0.99 15-29 23 87.0 87.0 95.7 0.66 0.59 <15 23 52.2 78.3 100.0 0.12 <0.001* overall 92.6 94.9 97.1 0.3 0.02* 50% =90 69 100.0 98.6 100.0 0.97 60-89 136 100.0 100.0 100.0 30-59 60 96.7 100.0 100.0 0.78 0.78 15-29 23 100.0 100.0 100.0 <15 23 100.0 100.0 100.0 overall 99.4 99.7 100.0 0.97 0.53 bias is defined as mean difference between egfr and mgfr in mls/min/1.73m2. precision is the standard deviation (sd) of bias. accuracy is the percentage of egfr that falls within 30% of mgfr. * means p <0.05 for correlation between mgfr and egfr. formula equations for kidney function in black africans braimoh et al. res. j. health sci. vol 11(4), december 2023 293 figure 2: correlations of the egfr equations with creatinine clearance (mgfr) in the ckd population formula equations for kidney function in black africans braimoh et al. htn hypertension, cgn chronic glomerulonephritis, dm diabetes mellitus, scn sickle cell nephropathy, obs uro obstructive uropathy, hivan hiv associated nephropathy, adpkd autosomal dominant polycystic kidney disease, ras renal artery stenosis, lupus n lupus nephritis, solitary k solitary kidney. figure 1: etiology of ckd in the study population formula equations for kidney function in black africans braimoh et al. res. j. health sci. vol 11(4), december 2023 294 (a) mdrd (b) cg (c) ckd-epi figure 4: receiver operating curve for the 3 equations in the ckd population formula equations for kidney function in black africans braimoh et al. res. j. health sci. vol 11(4), december 2023 295 rjhs 11(4).cdr first laparoscopically-assisted vaginal hysterectomy in a tertiary health facility in abeokuta, nigeria: a case report 1 1 2 1 1 *jimoh o.s. , ogunfunmilayo t.a. , waheed s.a. , lemboye-bello r.t. , taiwo n.a. , 1 1 1 oladosu-aderolu a.o. , igbo a.m. , odunola a.a. abstract background: laparoscopic surgery as a form of minimal access operation has been performed for decades in the developed world, but is now gaining popularity in the developing countries including nigeria. the recent rise in minimal access surgery in low-resource settings may be attributed to increasing expertise, growing awareness among patients and relatively reducing cost. case report: although laparoscopically-assisted vaginal hysterectomy (lavh) has been documented from some centres in nigeria, we are reporting the first case of this highly-technical surgery in our centre. mrs. gj was admitted with second degree uterine prolapse and had lavh with a smooth post-operative recovery. she had reduced hospital stay as she was discharged on the first post-operative day and was satisfied with her choice of surgery as well as the outcome. there were no immediate or late post-operative complications. conclusion: the success of this procedure further emphasize the feasibility of minimal access surgery in resource-poor settings. keywords: laparoscopically-assisted vaginal hysterectomy, minimal access surgery, uterine prolapse *corresponding author jimoh, o.s. email: jsaheed81@gmail.com 1 department of obstetrics and gynaecology, federal medical centre, abeokuta, nigeria. 2 department of surgery, federal medical centre, abeokuta, nigeria. received: january 12, 2023 accepted: april 20, 2023 published: deceember 15, 2023 orcid-no: https://orcid.org/0000-0002-1016-8355 res. j. health sci. vol 11(4), december 2023 370 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.10 case report research journal of health sciences hystérectomie vaginale assistée par laparoscopie dans un établissement de santé tertiaire à abeokuta, nigéria : à propos d'un cas 1 1 2 1 1 *jimoh o.s. , ogunfunmilayo t.a. , waheed s.a. , lemboye-bello r.t. , taiwo n.a. , 1 1 1 oladosu-aderolu a.o. , igbo a.m. , odunola a.a. *corresponding author jimoh, o.s. email: jsaheed81@gmail.com 1 department of obstetrics and gynaecology, federal medical centre, abeokuta, nigeria. 2 department of surgery, federal medical centre, abeokuta, nigeria. received: january 12, 2023 accepted: april 20, 2023 published: deceember 15, 2023 résumé contexte général de l'étude: la chirurgie laparoscopique en tant que forme d'opération d'accès minimal est pratiquée depuis des décennies dans le monde développé, mais elle gagne maintenant en popularité dans les pays en développement, dont le nigéria. l'augmentation récente de la chirurgie à accès minimal dans les milieux à faibles ressources peut être attribuée à l'augmentation de l'expertise, à la sensibilisation croissante des patients et à la réduction relative des coûts. rapport de cas : bien que l'hystérectomie vaginale assistée par laparoscopie (hvl) ait été documentée dans certains centres au nigéria, nous rapportons le premier cas de cette chirurgie hautement technique dans notre centre. mme gj a été admise avec un prolapsus utérin au deuxième degré et a eu une hvl avec une récupération postopératoire en douceur. elle avait réduit son séjour à l'hôpital car elle était sortie le premier jour postopératoire et était satisfaite de son choix de chirurgie ainsi que du résultat. il n'y a pas eu de complications postopératoires immédiates ou tardives. conclusion : le succès de cette procédure souligne davantage la faisabilité d'une chirurgie à accès minimal dans les milieux à faibles ressources. mots-clés : hystérectomie vaginale assistée par laparoscopie, chirurgie à accès minimal, prolapsus utérin orcid-no: https://orcid.org/0000-0002-1016-8355 res. j. health sci. vol 11(4), december 2023 371 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.10 rapport de cas research journal of health sciences introduction hysterectomy is the second most frequently-performed major surgical procedure a m o n g r e p r o d u c t i v e a g e d w o m e n ( 1 ) . traditionally, hysterectomy is performed through the abdominal route and in the presence of significant uterine prolapse, vaginal approach has been the preferred option (2). laparoscopyassisted vaginal hysterectomy (lavh) has been widely reported to offer benefits such as shorter hospital stays, quicker recovery, lesser postoperative pain and lower complication rates when compared with abdominal hysterectomy hence is a viable option in patients scheduled for hysterectomy with uterine size less than 16 weeks (3). despite, the introduction of lavh as a surgical alternative to conventional vaginal hysterectomy, there are conflicting reports regarding the superiority of the former over the latter with both demonstrating comparable clinical outcomes from the available metaanalysis (4). case report m r s . g j w a s a 6 5 y e a r o l d grandmultiparous and post-menopausal woman who presented with history of protrusion of a mass through the vagina of three years duration. the mass was first noticed while she strained to pass stool and usually became prominent during exertive efforts such as micturition, defeacation and coughing. the mass was also prominent in the erect position and reduced on lying down. mrs. gj had associated pelvic pain, as well as urinary frequency, urgency and incontinence but there was no change in bowel activities. she had no history of chronic cough, constipation or abdominal swelling and there was no vaginal bleeding, discharge, ulcer or odour. she had no previous surgery or instrumental delivery despite six vaginal deliveries in the past. mrs. gj had no chronic medical condition, she was a widow and neither smoked cigarettes nor drank alcohol. there was no family history of similar condition. physical examination revealed an elderly woman, not pale, not jaundiced and afebrile (t 0 36.9 c). there was no pedal oedema and no significant peripheral lymphadenopathy. she weighed 59kg, her height was 1.67m and her -2 body mass index was thus 21.2kgm . the respiratory rate was 20 cycles/minute and breath sounds were vesicular. the pulse was 82 beats per minute, regular and of normal volume. the blood pressure was 120/70 mmhg, heart sounds were normal and no murmur was heard. the abdomen was full, soft, moved with respiration and there were no visible or palpable cough impulses at the hernial orifices. there was no area of tenderness, the liver, spleen as well as the kidneys were not enlarged and no palpable abdominal masses. perineal examination revealed a normal vulva with no demonstrable stress incontinence. a fleshy mass was at the level of the introitus, and on straining, it protruded slightly further out. the mass was identified to be the uterus as it was obvious the cervix was the leading point of the protusion. part of the uterus was still in the vagina. the cervix was healthy looking, no decubitus ulceration or bleeding. mrs. gj was put in sim's position, a cystocoele was observed in the anterior wall, it was reducible and no rectocele or enterocele demonstrated. a d i a g n o s i s o f s e c o n d d e g r e e uterovaginal prolapse with cystocele was made. the findings and probable aetiology were explained to her as well as the decision to perform a l a p a r o s c o p i c a l l y a s s i s t e d v a g i n a l hysterectomy, bilateral salpingo-oophorectomy and anterior colporrhaphy. she consented and was investigated on outpatient basis. all the investigations including electrocardiogram and papanicolaou's smear were normal. however, abdominal ultrasonography showed a 60 by 50mm right ovarian mass. mrs. gj eventually had surgery with intraoperative findings of normal vulva and vagina, second-degree uterine prolapse with cystocele, grossly normal cervix, atrophic uterus, slightly enlarged right ovary about 6 by 6cm with atrophic left ovary, healthy-looking fallopian tubes, clear post-operative urine and estimated blood loss was 300mls. the improvised uterine manipulator (vulsellum screwed to the spacksman cannula) was applied for mobilization of the uterus. the patient was then placed in lloyd-davies position under general anesthesia and pneumoperitoneum was created with carbon dioxide using the veress needle method following routine cleaning and draping a 5mm transverse stab wound was made through the upper border of the umbilicus. the anterior abdominal wall was digitally grasped and elevated on both sides of the umbilicus and the veress needle inserted through the skin incision down to the fascia into the peritoneal cavity. the veress needle, which was held like a dart, was pointing towards the sacral promontory 0 at an angle 45 . successful insertion was tested using the aspiration as well as “hanging drop” test. this is very necessary to prevent wrong insufflation of the gut and subcutaneous emphysema. the rubber tubing from carbon . res. j. health sci. vol 11(4), december 2023 372 a case report of lavh in low-resource setting jimoh et al. dioxide insufflator was then connected to the veress and pneumoperitoneum established while monitoring the pressure gauge during the insufflation at a preset pressure of 15 mmhg. the veress needle was subsequently removed and the umbilical incision enlarged to 1cm. the anterior abdominal wall was similarly digitally grasped and elevated on both sides of the umbilicus and 10mm trocar and cannula inserted through the incision with a twisting motion as far as the rectus sheath then angled towards the pelvis and a short quick stabbing motion was used to penetrate the rectus fascia with the peritoneum all at once. the trocar was then removed and proper placement 0 confirmed with the escape of gas. a “0 10mm” telescope was inserted and a panoramic viewing of the abdomen was done beginning with the entry point. two other 5mm secondary ports were created on both sides under direct vision of the telescope at points about 5cm inferior to the umbilicus on the midclavicular lines. the direct visualization of the abdominal entry is very important to prevent injuries to vital structures. bowel loops were retracted superiorly with the aid of a grasper and the uterus was mobilized to visualize the appendages as well as other pelvic structures (figure 1). following the elevation of the uterus, the round ligaments were dessicated and divided bilaterally using the harmonic scalpel. having recognized the course of the ureters, the infundibulopelvic ligaments were carefully identified, also dessicated and divided bilaterally. the anterior leaf of the broad ligament and uterovesical peritoneum were dissected and reflected carefully, then, the perineal approach to the surgery started with bladder emptying. the cervix was grasped with two vulsellum forceps, one to each lip. the sub epithelial tissues were infiltrated with about 10mls of (1:100,000) diluted adrenaline solution to define tissue planes and cause vasoconstriction. a circumferential incision was made on the cervix 2cm below margin of the bladder. the incision was extended vertically upward on the anterior vaginal wall up to the suburethral region. with blunt and sharp dissection, the vaginal skin was reflected off the cervix anteriorly, laterally and posteriorly (figure 2). under direct vision of the laparoscope, the bladder was dissected free of the cervix and pushed up until the utero-vesical pouch of peritoneum was seen. the direct visualization was to ensure proper dissection of the uterovesical peritoneum without any injury to the bladder. the posterior vaginal wall was also reflected off the cervix until the posterior layer of the peritoneum was exposed and opened with significant loss of carbon dioxide gas. the cardinal and uterosacral ligaments were identified clamped and transfixed with vicryl 1 suture and the pedicle held with artery forceps bilaterally. the peritoneum of the utero-vesical pouch was also opened. the uterine vessels were clamped, cut and ligated with vicryl 1suture bilaterally and the uterus with its appendages were delivered (figure 3). the uterosacral and cardinal ligament bundles were approximated by tying their stay sutures together and anchored to the lateral angles of the vagina. then, the vagina vault was closed with vicryl 0 sutures. the redundant anterior vaginal skin that was separated from the underlying bladder was removed and the prolapsed bladder wall supported by approximating the intervening pubocervical fascia with buttress sutures using vicryl 0 (kelly's plication). the anterior vaginal wall was then closed with vicryl 0 suture (figure 4). an in-dwelling foley's catheter was inserted in the bladder and the vagina was packed with gauze. pneumoperitoneum was re-created and the pelvis visualized (figure 5), irrigation and suction done after haemostasis was secured. the ports were removed under direct vision and the wounds were closed with vicryl sutures. postoperatively, she was placed on intravenous fluid, antibiotics and analgesics. subsequently, vaginal packs and urethral catheter were removed as she was discharged on the first postoperative day. mrs. gj had two follow-up visits and her general physical condition was satisfactory. histology showed features of postmenopausal uterus, cervix and left ovary with benign right ovarian cyst. discussion globally, hysterectomy ranked among the most frequently-performed gynaecological surgeries (5). it is a typical gynaecological procedure performed for varying indications using abdominal (56%), vaginal (19%), laparoscopic (20%), and robotic (5%) approaches (6). the first laparoscopic hysterectomy was performed by harry reich in pennsylvania, usa in 1989(7). developments in gynaecologic surgeries have led to more minimally invasive options for hysterectomy (6). minimal access procedures are typically preferable to more invasive procedures, where possible. generally, less invasive techniques are recommended for most benign lesion within the pelvis but the applicability and appropriateness of this innovation should be the determining factor (6). a 14-year review of gynaecological surgeries res. j. health sci. vol 11(4), december 2023 373 a case report of lavh in low-resource setting jimoh et al. performed at the obafemi awolowo university teaching hospital, ile-ife between 2005 and 2018 showed that vaginal hysterectomy accounted for 0.8% of gynaecological admissions with a rate of 2.3% of the major gynecological operations (8). the first laparoscopically-assisted vaginal hysterectomy performed in the south-eastern region of nigeria was reported by ikechebelu et al i n 2 0 0 9 ( 9 ) . s u c c e s s f u l l a p a r o s c o p i c hysterectomy requires good understanding of pelvic anatomy, proficiency in the safe use of energy sources, as well as laparoscopic suturing and knotting techniques (10). laparoscpicallyassisted vaginal hysterectomies offer an additional advantage of direct visualization of the abdominopelvic structures as well as performing some steps intra-abdominally before completion of the surgery through the vaginal route (11). although advancement in the field of gynaecological endoscopy has been relatively lagging in sub-saharan africa, total laparoscopic hysterectomy has been reported in ile-ife, southwe s t e r n n i g e r i a ( 1 0 ) . to t a l va g i n a l hysterectomy (tvh) and lavh are associated with reduced pain, shorter hospital stay as well as better cosmetic values when compared with total abdominal hysterectomy but limited operation field remains a major challenge in tvh while attendant cost of lavh is still a considerable drawback (12). our patient was discharged on the f i r s t p o s t o p e r a t i v e d a y w i t h o u t a n y complications. the main advantage of minimally invasive surgery (mis) is the absence of a large abdominal wound, which results in fewer woundrelated complications, less postoperative pain, and a shorter hospital stay(13). indications for lavh are not well-defined but factors such as uterine size, experience of surgeon, pelvic adhesions, adnexal pathology, previous surgeries and endometriosis would determine the success of the procedure (11,14). our patient had an atrophic uterus and qualified for the procedure as uterine size of less than 12-weeks was said to be appropriate for lavh (11). additionally, lavh is preferred to total vaginal hysterectomy in cases of planned concomitant salpingo-oophorectomy and possibility of abdomino-pelvic visualization as well as exploration as seen in mrs gj, a postmenopausal woman with enlarged right ovary(15)(16). conclusion the safety of laparoscopically-assisted vaginal hysterectomy is well-established (17). it is quite alarming that laproscopic procedures including lavh are not available, accessible and affordable in most centres in the developing countries despite all the established superiorities over the open surgeries (10). there is also an underwhelming level of expertise but this could improve if the government and relevant stakeholders could sponsor the training of more laparoendoscopic surgeons and subsidize these procedures to the level within the reach of the lower economic class. ethical consideration: written informed consent for publication was obtained from the patient whose management is being reported. conflicts of interest: the authors declare no conflicts of interest in the publication of this case report. financial supports and sponsorship: the authors did not receive any financial support for this publication. acknowledgement: we appreciate the management of federal medical centre, abeokuta as the surgical fee was greatly subsidized for our patient and full dedication as well as co-operation of the theatre support staff was also acknowledged. author’s contribution: the medical history taking of the patient were done by jimoh os, ogunfunmilayo ta, lemboye-bello rt. ogunfunmilayo ta, jimoh os, taiwo na, lemboye-bello rt did the pre-operative ward rounds/ reviews of the patient. the surgery was performed by jimoh os, waheed sa, ogunfunmilayo ta, oladosu-aderolu oa while the interpretation of surgical findings were done jimoh os, ogunfunmilayo ta, lemboye-bello rt, waheed sa. the post-operative reviews/ follow-up was conducted by jimoh os, taiwo na, igbo am, oladosu-aderolu oa, odunola aa. the case report writing was done by jimoh os, , oladosu-aderolu oa, igbo am, odunola aa, the editing was done by waheed sa, ogunfunmilayo ta, lemboye-bello rt, taiwo na and the proofreading before final submission was executed by jimoh os, igbo am. references 1. lepine la, hillis sd, marchbanks pa, et al. hysterectomy surveillance-united states, 19801993. mmwr: cdc surveill summ. 1997; 46(4):1-15. 2. p a r k a r r b , t h a g a n a n g , o t i e n o d . res. j. health sci. vol 11(4), december 2023 374 a case report of lavh in low-resource setting jimoh et al. laparoscopic assisted vaginal hysterectomy for benign uterine pathology: is it time to change? east afr med j. 2004;81(5):261-6 3. shin jw, lee hh, lee sp, park, cy. total laparoscopic hysterectomy and laparoscopyassisted vaginal hysterectomy. jsls. 2011; 15(2): 218–21. 4. guo y, tian x, wang l. laparoscopicallyassisted vaginal hysterectomy vs vaginal hysterectomy: meta analysis. j minim invasive gynecol. 2013;20(1):15-21 5. alkatout i, mettler l, peters g, et al. laparoscopic hysterectomy and prolapse: a multiprocedural concept. jsls. 2014;18(1):89101. 6. lee cy, tseng cj, chang ch, lee mc, ou yc, yang sf. effect of modified laparoscopic hysterectomy on pelvic floor function: a retrospective observational study. medicine. 2019;98(8):e14616. 7. reich h, decaprio jo, mcglynn fr. laparoscopic hysterectomy. j gynecol surg 1989;5(2):213-6. 8. igbodike ep, adepiti ca, ubom ae, et al. trends in vaginal hysterectomy in a nigerian teaching hospital: a 14-year review. trop j obstet gynaecol 2020;37(1):160-6 9. ikechebelu ji, mbamara su, ezike ha. laparoscopically assisted vaginal hysterectomy in southeast nigeria-case report. niger j med 2009;18(1):107-9 10. badejoko oo, ajenifuja ko, oluborode bo, adeyemi ab. total laparoscopic hysterectomy: a case report from ile-ife, nigeria. niger med j. 2012;53(4):254-6. 11. shiota m, kotani y, umemoto m, tobiume t, hoshiai h. indication for laparoscopicallya s s i s t e d v a g i n a l h y s t e r e c t o m y . jsls.2011;15(3):343-45 12. min bk, park js, ryu jh, et al. the comparison of laparoscopic assisted vaginal hysterectomy, total vaginal hysterectomy and total abdominal hysterectomy. obstet gynecol sci. 2006; 49(8):1754-63. 13. mustea a, holthaus b, elmeligy h, et al. comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy-surgical effects on safety and quality of life. gynecol surg. 2019; 16(1):1-5 14. mishra r.k. laparoscopic assisted vaginal h y s t e r e c t o m y . a v a i l a b l e @ https://www.laparoscopyhospital.com/laparosc opic_assisted_vaginal_hysterectomy.php. [accessed on 20-02-2023] 15. mothes ar, schlachetzki a, nicolaus k, et al. lavh superior to tvh when concomitant salpingo-oophorectomy is intended in prolapse hysterectomy: a comparative cohort study. arch gynecol obstet. 2018; 298: 1131-7 16. litwinska e, nowak m, kolasa-zwierzchowska d , e t a l . va g i n a l h y s t e r e c t o m y v s laparoscopically assisted vaginal hysterectomy i n w o m e n w i t h s y m p t o m a t i c u t e r i n e leiomyomas: a retrospective study. prz menopauzalny. 2014; 13(4): 242-6. 17. mothes ar, radosa mp, runnebaum ib. systematic assessment of surgical complications i n l a p a r o s c o p i c a l l y a s s i s t e d v a g i n a l hysterectomy for pelvic organ prolapse. eur j obstet gynecol reprod biol. 2015;194:228-32. res. j. health sci. vol 11(4), december 2023 375 a case report of lavh in low-resource setting jimoh et al. res. j. health sci. vol 11(4), december 2023 376 figure 1: laparoscopic view of the pelvis figure 3: uterus and appendages figure 5: inspection of the pelvis before irrigation and suction figure 4: anterior vaginal wall after colporraphy figure 2: dissection of the vaginal skin from the bladder a case report of lavh in low-resource setting jimoh et al. rjhs 11(4).cdr postnatal home visit: an effective strategy to a successful postnatal care 1 2 3 4 akinbowale, b.t. , ademuyiwa, o. , akinyele, a.a. , akinwale, o.d. abstract home visiting is a crucial aspect of postnatal care services as recommended by the who, but it appears to be the most neglected service. this is due to various challenges like a shortage of manpower, inadequately skilled or trained health care workers, the non-availability of assessment tools and resources, and a lack of community awareness of the importance of postnatal care. however, it's the responsibility of health care workers, especially the midwives, to carry out postnatal home care visits to ensure the well-being of both the mother and the neonates, as well as the assessment of the environment where the newborn will be nurtured. therefore, to ensure effective postnatal home care visits, there should be availability of adequate tools and resources for the services, training of health care personnel, allocation of experienced health care workers, and community awareness of the importance of postnatal home care visits. this review thus explained the concept of postnatal home care visits, the timing of visits, who should conduct postnatal home visits, what to look out for in mothers, babies, and environments. keywords: home visits, postnatal care, strategies, health care personnel *corresponding author akinbowale, b.t. email: busayoakinbowale2@gmail.com 1 department of nursing, babcock university, ilishan-remo, nigeria 2 department of nursing, lagos state university, lagos, nigeria 3 department of obstetrics and gyneacology, state hospital, ilesha, nigeria 4 department of nursing, osun state university teaching hospital, osogbo, nigeria received: february 24, 2023 accepted: june 17, 2023 published: december 15, 2023 review article research journal of health sciences research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v10i4.11 res. j. health sci. vol 11(4), december 2023 377 visite postnatale à domicile: une stratégie efficace pour une prise en charge postnatale réussie 1 2 3 4 akinbowale, b.t. , ademuyiwa, o. , akinyele, a.a. , akinwale, o.d. résumé les visites à domicile sont un aspect crucial des services de soins postnatals recommandés par l'oms, mais il semble que ce soit le service le plus négligé. cela est dû à divers défis comme une pénurie de maind'œuvre, des travailleurs de la santé insuffisamment qualifiés ou formés, la non-disponibilité d'outils et de ressources d'évaluation et un manque de sensibilisation de la communauté à l'importance des soins postnatals. cependant, il est de la responsabilité des travailleurs de la santé, en particulier des sagesfemmes, d'effectuer des visites de soins postnatals à domicile pour assurer le bien-être de la mère et des nouveau-nés, ainsi que l'évaluation de l'environnement où le nouveau-né sera nourri. par conséquent, pour assurer des visites de soins postnatals à domicile efficaces, il devrait y avoir la disponibilité d'outils et de ressources adéquats pour les services, la formation du personnel de santé, l'affectation de travailleurs de la santé expérimentés et la sensibilisation de la communauté à l'importance des visites de soins postnatals à domicile. cette revue a donc expliqué le concept des visites postnatales à domicile, le moment des visites, qui devrait effectuer les visites postnatales à domicile, ce qu'il faut surveiller chez les mères, les bébés et les environnements. mots-clés : visites à domicile, soins postnatals, stratégies, personnels soignants *corresponding author akinbowale, b.t. email: busayoakinbowale2@gmail.com 1 department of nursing, babcock university, ilishan-remo, nigeria 2 department of nursing, lagos state university, lagos, nigeria 3 department of obstetrics and gyneacology, state hospital, ilesha, nigeria 4 department of nursing, osun state university teaching hospital, osogbo, nigeria received: february 24, 2023 accepted: june 17, 2023 published: december 15, 2023 article aperçu research journal of health sciences research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v10i4.11 res. j. health sci. vol 11(4), december 2023 378 introduction post-natal care is the care given to women and their newborns after delivery within the first six weeks, which is also considered important as other natal care because complications could arise if both the baby and mother are not closely monitored (1). as part of the responsibilities of midwives, postnatal home visiting helps the healthcare professionals achieve the purpose of ensuring that mother and baby go through the normal changes of this phase without any danger or discomfort to the mother or the child (2, 3, 4). the world health organization (5) recommended that mothers and their newborns have at least four postnatal visits scheduled for the first day (first 24 hours), third day (48–72 hours), 7–14 days, and six weeks after birth. some of those recommendations include a full assessment of the baby, health talk on breastfeeding, thermal care, care of the cord, and harmful signs (6). h o w e v e r , d e s p i t e t h e s e recommendations, in 2016, it was estimated that about 2.6 million babies die annually within the first 28 days after birth (7, 8). evidence suggested that accessibility, knowledge of the health extension worker, and their availability are challenges faced in ensuring strategic home visits (9, 10, 11). therefore, the purpose of this review is to provide effective strategic postnatal home visiting based on the who guidelines on postnatal care for both mothers and babies so as to prevent the incidence of neonatal death and postnatal complications. timing for home visits based on who guidelines the first six (6) weeks postpartum are the most crucial and sensitive time for both mother and newborn, as they are prone to various health challenges (12, 13). home visiting during this period, especially the first 2-3 days following delivery, is important because about 7,000 neonates die every day, with about one-third occurring within the first few weeks of life (14). studies had shown that factors associated with neonatal mortality could be averted through postnatal inspections and examinations of both mothers and babies. more so, postnatal care (pnc) for the newborn and mother is as important as the birth experiences of the baby, and as such, it is an important opportunity to look out for danger signs such as jaundice, fever, lethargy, breastfeeding problems, and fast breathing, among others, during this period (5, 6). mothers can also be counseled on how to identify and deal with danger signs and the importance of exclusive breastfeeding in the first six months of life (15). who should conduct postnatal home visits? traditionally, postnatal care services should be done by skilled health personnel because they are trained to perform all the necessary care needed by both mother and baby. in many health care facilities, however, this is often not possible because of a shortage of skilled health workers, lack of passion, lack of transportation, or excessive workload that prevents them from making time for the visits. otherwise, the postnatal care home visits can be conducted by trained health assistants, community health extension workers, and other trained community health workers who are part of the healthcare delivery system. what are the things to look out for in mothers, babies, and the environment? during postnatal home care visits, there are certain things the health personnel have to look out for to ensure the wellbeing of the new mother and baby. for mothers postnatal home visits require regular evaluation and examination of vaginal bleeding, uterine tonus, fundal height measurement, and checking of heart rate during the first 24 hours after delivery (16). blood pressure should also be measured immediately after birth and 6 hours after delivery. after the first 24 hours, inquiries should be made to know the general wellbeing of the mother in the following areas: bowel function, healing of stitches if any, headache, fatigue, breast pain, lochia, and uterine tenderness (5, 6, 16). however, in areas prone to hiv, the mother should be tested to know her status, especially for those who missed it during the antenatal visit. screening for postpartum depression should be carried out, and she should be encouraged to eat healthy foods and continue with iron supplements and/or folic acid up to 6–12 weeks after delivery (17). additionally, the importance of rest should be emphasized, and mothers should be encouraged to do mild exercise that does not stress the body. also, information on contraceptive use and services should be provided, as well as information on breastfeeding. in other words, mothers should be counseled and provided with support for exclusive breastfeeding at each home visit (5). postnatal visit: an effective strategy to a successful postnatal care akinbowale et al. res. j. health sci. vol 11(4), december 2023 379 for newborn newborns should be assessed for danger signs such as fast breathing, jaundice, fever, no spontaneous movement, severe chest in-drawing, convulsions, abnormalities in the eye, etc. (18, 19). screening for neonatal hyperbilirubinemia and checking of the umbilical cord should be done, and regular cleaning of the cord (21, 22). assessment of the sleeping position of the baby (back to sleep) to prevent sudden infant death syndrome (sids) (23, 24) furthermore, the use of routine drugs for newborns should be discouraged except on rare occasions of complications. gentle body massage for the baby and exclusive breastfeeding for the first 6 months of life should be encouraged. health care personnel on visit should provide adequate knowledge on the importance of immunization for the newborn (25, 26). the environment the environment should be assessed for cleanliness and whether it is appropriate for a newborn, because babies are easily prone to infection. the families and those around the new mother should be encouraged to ensure proper hygiene around the baby. the room where the baby would be staying should be properly arranged, with just enough ventilation for a newborn (5, 6, 27). expected role of health care personnel on postnatal home visit the health personnel must be adequately prepared for what is needed for both the mother and the newborn (28). they should have sufficient knowledge of the care needed to be given to a new mother. it is the role of health care personnel to explain the immunization schedule to the mothers and encourage them not to miss any appointments. they should encourage the mother to get to the hospital if she notices anything unusual in her body or her baby and help the woman with different breastfeeding styles to ensure proper latching of the baby as well as a comfortable position for mother and baby. health care personnel should also discuss the best time to resume sex with her husband. most mothers may not feel comfortable discussing this in the hospital, but a home visit will afford them the opportunity to open up and ask for help. the health personnel should guide her on the best contraceptives to use in preventing unwanted pregnancy (29, 30). moreso, it is the responsibility of health care personnel to counsel the new mother on nutrition and advise her on what to eat. foods such as vegetables, meat, beans, a lot of water, and fruits should be encouraged. also, they are to inform the mothers about the best foods to eat to enhance lactation and breastfeeding (28, 29). additionally, healthcare providers are required to check for danger signs in both mother and baby, check for postpartum depression in the mother, and ensure she is adequately cared for by her family or people around her. finally, they are to encourage new mothers to enjoy the newborn period, which can be stressful, but once they do things they enjoy, it can be easy for them. emphasis must be laid on the importance of rest and sleep when the baby is sleeping (5, 6, 17, 29). challenges of a postnatal home visit postnatal care visits appear to be one of the components of maternal and child care services that is poorly utilized despite being a critical period for the survival of both mother and baby (10). research has shown that rates of provision, uptake, and quality of skilled postnatal care are generally lower than those of other maternal healthcare services (10, 11). more emphasis and resources tend to go to antenatal and intrapartum care (10, 11). this may be due to poor infrastructure, a shortage of skilled healthcare workers, poor access to services, and poor knowledge, among others. it was also reported that postnatal care visits had the lowest m e d i a n n a t i o n a l c o v e r a g e o f r e l e v a n t interventions among the various maternal and child health services (5, 6). solution to the challenges of postnatal home visits training the healthcare personnel: regular training of healthcare personnel is very important in ensuring the effective practice of postnatal home visits. (10) evidence has shown that most healthcare personnel do not know the importance of home visits during the postnatal period, and it would be helpful if the government could make enough resources and equipment available for these services (10). the provision of enough healthcare personnel would also go a long way in ensuring the effective and smooth running of postnatal care home visits, adequate coverage of postnatal homecare visits, and improved postnatal outcomes (29, 33, 35). availability of adequate postnatal care tools and resources at all levels of health facilities evidence suggests that 10–15% of postnatal mothers experience mental derailment and postnatal visit: an effective strategy to a successful postnatal care akinbowale et al. res. j. health sci. vol 11(4), december 2023 380 depressive symptoms, which are not discovered early due to inadequate physical examination by healthcare workers. however, if the right tools are available in healthcare facilities and accessible to health care workers to screen expectant and postpartum mothers, it will be easier to identify those that are prone to mental illness after delivery and also institute appropriate treatment on time (16). allocation of experienced healthcare workers or midwives for postnatal home care visits: most healthcare facilities only allocate one healthcare worker to care for mothers and neonates in postnatal wards. as a result, care is compromised, and there is no allocation for home visits after they are discharged from the health facility (5, 6). more so, the healthcare workers are overworked and exhausted at the end of the day. however, who recommends that standards of care for mothers and newborns should be provided in health facilities according to who guidelines, which should also extend to home visits shortly after discharge (5, 16). awareness in the community of the importance of postnatal home visits the health care personnel have a significant role to play in ensuring that the community members are aware of the importance of postnatal care home visits (30). this is very important, as most people in the community do not even know that they are entitled to postnatal care and visits after delivery. collaborating with community members may help individuals, families, and the community to embrace these activities as a form of health promotion and illness prevention after delivery (19, 30). conclusion home visit is an important aspect of postnatal care, and the who recommends that home visit for postnatal mothers and their babies be conducted in the first week after birth and continued until 6 weeks postpartum. these visits are crucial for assessing general wellbeing as well as identifying postnatal challenges and dealing with them early. however, to increase and encourage postnatal home care visits, it is important to increase community awareness of the importance of pnc and improve health facility roles in conducting postnatal home visits. it is therefore recommended that efforts be made to ensure that mothers and health care professionals are well trained on the benefits and importance of postnatal home visits, as documented by the who. conflict of interest: the authors declare no conflict of interest. acknowledgement: nil references 1. wudineh, kg., nigusie, aa., gesese, ss, et al. postnatal care service utilization and associated factors among women who gave birth in debretabour town, north west ethiopia: a communitybased cross-sectional study. bmc p r e g n a n c y c h i l d b i r t h 2 0 1 8 1 8 , 5 0 8 . https://doi.org/10.1186/s12884-018-2138-x 2. horowitz ja, murphy ca, gregory k, et al. nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression. journal of obstetric, gynecologic & neonatal nursing. 2013; 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16(10):e1002939. 36. sakala b. an evidence-based policy brief: improving the quality of postnatal care in mothers 48 hours after childbirth. malawi medical journal. 2019; 31(2):164-8. 37. nishimwe c, mchunu gg. exploring health provider's knowledge on the home-based maternal and neonatal health care package in rwanda. bmc pregnancy and childbirth. 2022; 22(1):1-2. 38. allender j, rector c, rector c, warner k. community & public health nursing: promoting the public's health. lippincottwilliams & wilkins; 2013. postnatal visit: an effective strategy to a successful postnatal care akinbowale et al. res. j. health sci. vol 11(4), december 2023 383 rjhs 11(4).cdr congenital heart diseases: pattern of clinical presentations in children less than 2-years of age in a pediatric practice in southsouth nigeria 1 2 3 *osarenkhoe, o.j. . aiwuyo, o.h. , osaghae, d. abstract the increase in the prevalence of congenital heart disease remains a major contributing factor to childhood morbidity and mortality in africa. the study describes the clinical features of children with chd that presented to a general pediatric hospital, to improve on early recognition and management of the diseases. the prevalence of chd from the study was 2 per 100 (30 per 1577 or 1 in 52) i.e. (2/100 or 20/1000). a higher incidence in females (53.3%) with m: f = 1:1.14, the majority presented with difficulty / fast breathing (70%), cough(40%), other presenting symptoms are poor weight gain (26.7%), delayed milestones(13.3%). on examination, 60% had dyspnea, 56.7% had murmur. packed cell volume for acyanotic heart disease ranged 28-30%, and 50-61% for cyanotic heart disease. the majority had comorbid bronchopneumonia (46.6%), and heart failure (23.3%). echocardiographic findings revealed vsd in 26.7%, 20.0% had pda and tetralogy of fallot in 6.7%, transposition of great arteries in 3.3%, and dextrocardia in 3.3%. the outcome showed that 30% had no symptoms on follow-up, 23.3% were referred for surgery, 10% dropped from follow-up and 3.3% died. these findings which are comparable to the findings of other researchers showed that congenital heart disease has a place in childhood morbidity and mortality, therefore appropriate attention should be directed to improve on early recognition and management of the diseases. *corresponding author osarenkhoe, o.j. email: jefaghpublications@gmail.com 1 department of cardiology, igbinedion university teaching hospital, okada,, nigeria 2 department of medicine, brookdale medical center, brooklyn, new york, usa 3 department of pediatrics, modic medical centre, benin city, nigeria received: march 26, 2022 accepted: may 28, 2023 published: december 15, 2023 original article research journal of health sciences res. j. health sci. vol 11(4), december 2023 327 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.5 cardiopathies congénitales: modèle de présentations cliniques chez les enfants de moins de 2 ans dans une pratique pédiatrique du sud-sud du nigéria 1 2 3 *osarenkhoe, o.j. . aiwuyo, o.h. , osaghae, d. résumé objectif de l'étude : l'augmentation de la prévalence des cardiopathies congénitales demeure un facteur majeur contribuant à la morbidité et à la mortalité infantiles en afrique. méthode de l'étude : l'étude décrit les caractéristiques cliniques des enfants atteints de coronaropathie qui se sont présentés à un hôpital pédiatrique général, afin d'améliorer la reconnaissance précoce et la prise en charge des maladies. résultat de l'étude: la prévalence des coronaropathies de l'étude était de 2 pour 100 (30 pour 1577 ou 1 sur 52) c'est-à-dire (2/100 ou 20/1000). une incidence plus élevée chez les femmes (53,3 %) avec m : f = 1:1,14, la majorité présentait des difficultés/respiration rapide (70 %), de la toux (40 %), d'autres symptômes présentés sont une faible prise de poids (26,7 %), un retard jalon (13,3 %). a l'examen, 60% avaient une dyspnée, 56,7% un souffle. l'hématocrite pour les cardiopathies acyanotiques variait de 28 à 30 % et de 50 à 61 % pour les cardiopathies cyanotiques. la majorité avait une bronchopneumonie comorbide (46,6 %) et une insuffisance cardiaque (23,3 %). les résultats écho cardiographiques ont révélé un vsd chez 26,7 %, 20,0 % avaient un pda et une tétralogie de fallot chez 6,7 %, une transposition des grandes artères chez 3,3 % et une dextrocardie chez 3,3 %. le résultat a montré que 30% n'avaient aucun symptôme lors du suivi, 23,3% ont été référés pour une intervention chirurgicale, 10% ont abandonné le suivi et 3,3% sont décédés. conclusion : ces résultats, comparables à ceux d'autres chercheurs, ont montré que les cardiopathies congénitales ont une place dans la morbidité et la mortalité infantiles ; par conséquent, une attention appropriée doit être accordée à l'amélioration de la détection précoce et de la prise en charge des maladies. *corresponding author osarenkhoe, o.j. email: jefaghpublications@gmail.com 1 department of cardiology, igbinedion university teaching hospital, okada,, nigeria 2 department of medicine, brookdale medical center, brooklyn, new york, usa 3 department of pediatrics, modic medical centre, benin city, nigeria received: march 26, 2022 accepted: may 28, 2023 published: december 15, 2023 article original research journal of health sciences res. j. health sci. vol 11(4), december 2023 328 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.5 introduction congenital heart diseases are problems of heart structure and function resulting from developmental anomalies of the heart. it has an overall prevalence of 10 per 1000 live births [1]. congenital heart diseases (chd) are major contributors to childhood morbidity and mortality in africa because of late presentations and the shortage of skills and equipment for appropriate interventions [2]. the causes of chd are largely unknown for certain; however, many cases are multifactorial and result from combinations of genetic predisposition and asyet-to-be-determined environmental stimulus. thus, some of the heart lesions are related to known chromosomal abnormalities, in particular, trisomy 21, 13, and 18 and turner syndrome. in this regard, heart disease is found in more than 90% of patients with trisomy 18, 50% of patients with trisomy 21, and 40% of those with turner syndrome [1,3]. nonetheless, other etiological factors that are associated with chd include maternal rubella in the first trimester of pregnancy, and maternal ingestion of drugs such as anticonvulsants, steroids, anti-hypertensive and anti-neoplastic agents. [4] in addition, certain medical conditions in the mother are associated with a high incidence of congenital heart d e f e c t s i n c l u d i n g d i a b e t e s m e l l i t u s , p h e n y l k e t o n u r i a , a n d s y s t e m i c l u p u s erythematosus [4,5]. congenital heart diseases are divided into two groups, based on the presence or absence of cyanosis. examples of cyanotic congenital hd include tetralogy of fallot, truncus arteriosus, and transposition of great arteries. in contrast, illustrations of acyanotic heart diseases include ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, arterial septal defect, pulmonary stenosis and coarctation of the aorta [6]. chd shows a wide spectrum of clinical severity in infants; hence, approximately 2 – 3 per 1000 newborn infants are symptomatic in the first year of life. thus, it is possible to establish the diagnosis by 1 week of age in 40-50% of patients with chd and by 1 month in 50 – 60% of patients [3]. however, this early recognition of infants with chd is often not possible in our own setting because of either a heavy workload or lack of due diligence in the application of standard clinical methods in the assessment of infants and children generally. as a result, the diagnosis is often delayed or missed completely by attending practitioners in primary health care centers and general hospitals as well as specialist and private hospitals. consequently, these children only come to notice complications such as heart failure, recurrent pneumonia, and failure to thrive. this study, therefore, describes the clinical features of children with chd that presented to a general pediatric hospital, to improve on early recognition and management of the diseases. confirmed by chest x-ray and e c h o c a r d i o g r a p h y, r a d i o l o g i c a l a n d echocardiographic findings and outcome of chd in children presented to a general pediatric hospital to improve early recognition and management of the diseases. materials and methods study location. this study was carried out in modic medical centre situated within benin city in oredo local government area of edo state, nigeria. the centre is a private pediatric hospital receiving children with various diseases from benin city and its environs. study design, duration, and inclusion criteria t h e s t u d y w a s d e s c r i p t i v e , cross–sectional and was carried out between january 1, 2015 and december 31, 2017. it involved children aged ≤ 2 years that presented consecutively to the out-patient clinics or were admitted to the wards and newborn unit and d i a g n o s e d w i t h c h d b a s e d o n echocardiographic evidence of congenital heart lesion. children < 2 years with chd not confirmed by echocardiography and children > 2yrs of age with either congenital or acquired heart diseases were excluded from the study. consent: the purpose and nature of the study were explained to each parent and consent was obtained from them before the enrolment of the children. clinical assessment: the children that fulfilled the inclusion criteria were assessed on the presentation by standard clinical methods, including a detailed history and thorough physical examination with particular attention to cardiovascular and respiratory systems. investigations: full blood count, chest x-ray, and echocardiogram were ordered for each child with suggestive features of chd including abnormal facies, cyanosis, cardiac murmur, respiratory/cardiovascular symptoms, and poor growth. res. j. health sci. vol 11(4), december 2023 329 congenital heart disease: pattern of clinical presentation in children osarenkhoe et al. diagnosis: a diagnosis of chd was based on the presence of abnormal echocardiogram results provided by the pediatric cardiologist. treatment and follow up: the children with heart failure, pneumonia, sepsis or other comorbidities were hospitalized and treated with oxygen, diuretics, antibiotics and other appropriate measures as indicated. the children were either followed up in the clinic on a 2 to 4 – weekly basis or referred to pediatric cardiology or cardiothoracic units in teaching hospitals. laboratory, radiological and echocardiology tests were done periodically to ascertain the progress of the lesions. data collection and analysis the details for each child were recorded in a pro-forma include bio data, presenting complaints and antenatal history, findings at c l i n i c a l e x a m i n a t i o n , l a b o r a t o r y d a t a , radiological and echocardiogram findings and outcome. the data were analyzed by descriptive statistical methods. results pattern of congenital heart disease presentation at modic children's hospital, benin city from may 2015 to december 2017 (30 months) prevalence: a total of 5196 children aged ≤ 5 years were seen during the period of the study and 1577 (30.4 %) were aged ≤ 2 years and 30 (1.9%) were diagnosed with chd based on the study criteria, giving a prevalence of 2 per 100 (30 per 1577 or 1 in 52) i.e. (2/100 or 20/1000). yearly distribution: nine (9), 12 and 9 children were diagnosed with chd in 2015, 2016 and 2017 as shown in figure 1. gender and age distribution: the 30 cases of congenital heart disease comprise 14 (46.7%) boys and 16 (53.3%) girls (m: f = 1:1.14) and 21 (70%) were aged ≤ 6 months and 9 (30%) aged 7 to 24 months. the mean age of the children was 4.74 ± months (range: 0.1-23 months). the distribution of the children according to age and gender is shown in table 1, chd type match with age is shown in table 2 presenting complaints and history: the presenting complaints and frequencies were fever 7(23.3%), cough 12(40%); difficult/fast breathing 21(70%); noisy breathing 5(16.7%); easy fatigability 6(20.0%); poor weight gain/ failure to thrive 8(26.7%); delayed milestones 4(13.3%). clinical examination findings: the mean weight of the 30 children was 3.9kg ± 6.1 (range: 1.30 – 10) and for 21 ≤ 6months was 3.2kg ± 2 (range: 1.3 – 5.3) and 9 ≥ 7 months was 7.02kg ± 3 (range: 4.6 – 10). the mean weight for 27 children aged < 12 months was 1.78kg ± (range: 1.3 – 7.2) and for 3 children aged 13 – 24 months 9.63 kg ±0.37 (range: 8.9 – 10). the physical findings as shown in table 3 include pallor 3(10.0), pyrexia 7(23.3), cyanosis 5(16.7), finger/toe clubbing 1(3.3), oedema (1), tachycardia (8), tachypnoea (10), dyspnoea (18), murmur (17), crepitations (2) active precordium (5), dysmorphic features (7), cataract (1), hepatomegaly/ hepatosplenomegaly (11) laboratory data: hematocrit (pcv): mean pcv for the 30 children was 29.1% (range: 28 61); mean pcv for 25 children with acyanosis was 36% and mean for 5 with cyanosis was 56%. the distribution of pcv is shown in table 4. radiological findings: the radiological findings (table 6) include narrow cardiac pedicle with pulmonary oligaemia and boot shaped normal heart 1; bilateral pulmonary plethora with perihilar infiltrates and enlarged cardiac silhouette (3); bilateral pulmonary infiltrates with features of bronchopneumonia (2); pulmonary changes of intra cardiac shunt (1); pulmonary plethora with suspected intracardiac shunt (1); normal findings (2); bronchopneumonia with c a r d i o m e g a l y ( 1 ) ; h e a r t f a i l u r e w i t h cardiomegaly and intracardiac shunt (1); bilateral pulmonary consolidation with lobar involvement (1); cardiac failure with leftright shunt and bronchopneumonia (1); bronchopneumonia and boot shaped heart (1); dextrocardia with right to left shunt and bronchopneumonia (1); bronchopneumonia (1) e c h o c a r d i o g r a p h i c f i n d i n g s : t h e echocardiographic findings were ventricular septal defect 6(26.7), patent ductus arteriosus 6(20.0), tetralogy of fallot 2(6.7), transposition of great arteries 1(3.3), dextrocardia 1(3.3). the types and frequencies of echocardiographic findings are shown in table 7. discussion this study shows that the number of cases of congenital heart disease presenting to res. j. health sci. vol 11(4), december 2023 330 congenital heart disease: pattern of clinical presentation in children osarenkhoe et al. modic clinic has revealed a similar trend over the past 3 years. thus one can say, 2 out of every 100 children ≤ 2 years presenting to the clinic had congenital heart disease. the disease affected girls slightly more than boys in consonance with the findings of reports by freeman et al [7], and pinto and colleague [8] but contrary to the results of others amel-shahbaz et al [9] and begic et al [10]. the reason for the gender disparity is not clear but may be due to genetic rather than environmental factors. additionally, it was found that most of the cases of chd were seen in children aged ≤ 1year, though the majority of the affected children presented within the first 6-months of life in concurrence with the congenital nature of the condition. moreover, this early presentation of the children may be a reflection of the severity of the condition; thus leading to early manifestation of features of chd. thus the most frequent clinical features were cough, breathlessness and n o i s y b r e a t h i n g . t h e m o s t f r e q u e n t manifestations were difficult/fast/noisy breathing (70%); dyspnoea (60%); murmur (56.7%) these findings were often associated with fever and pulmonary rales. however, these findings were not surprising because they reflected the underlying cardiac lesions leading to shunting of blood from the left to the right sides of the heart. consequently, the shunting of blood leads to lung congestion that predisposes to the development of pneumonia and heart failure [11]. the presentation of finger clubbing was noted in the children with cyanotic chd because it is associated with chronic hypoxia. majority of the children had low weight for age and the finding was not surprising because growth failure is a manifestation of chronic hypoxia and chest infections [12]. it was also noteworthy that 23% of the children had dysmorphic features including microcephaly and cataract that perhaps indicate possibility of intrauterine infection such as rubella as cause of the chd. we also found that acyanotic chd was commoner than cyanotic chd accounting for 23/30 and 7/30 respectively. this finding concurs with results by other workers [1,2,5,6,8] significant findings include; 1. prevalence 30 (1.9%) out of 1577 or 1 in 52 or 2 per 100 or 20 / 1000 2. children < 5 years 5196 and 1577 (30.4%) were < 2 years 3. yearly distribution 9, 12, 9 4. fewer boys than girls 14/16; 1:1.14 5. most affected children ≤ 6 months (70%) than children ≥ 7 months (30%) 6. mean age of children 4.74months 7. most frequent presenting complaint – difficult/fast/noisy breathing – 21/30 (70%); dyspnea 18/30 (60%); murmur 17/30 (56.7%) 8. dysmorphic features 7/30 or 23.3%; 9. mean pcv – acyanotic chd 36%; cyanotic chd 56% 10. vsd, pda and tof were most frequently reported echocardiographic findings accounting for 8 (26.7%) 6 (20%), 2 (6.7%), 2 (6.7%) respectively. 11. symptoms disappeared in 15 (50%); 7 (23.3%) referred for surgery and 1(3.3%) death conclusion the african region has been quagmired with limitations in diagnosing and managing congenital heart disease, despite the increase in prevalence and risk factors of the disease. these findings, therefore, call for improvement in diagnosis and management in order to ameliorate the burden of childhood morbidity and mortality. conflict of interest: the authors declare no conflict of interest. acknowledgement: nil references 1. otaigbe be, tabansi pn. congenital heart disease in the niger delta region of nigeria: a four-year prospective echocardiographic analysis. cardiovasc j afr. 2014 novdec;25(6):265-8 2. tankeu at, bigna jjr, nansseu jrn, aminde ln, danwang c, temgoua mn, et al. prevalence and patterns of congenital heart diseases in africa: a systematic review and meta-analysis protocolbmj open 2017;7:e015633. 3. bernstein d. congenital heart disease. in: nelson textbook of pediatrics.behrman re, kleigman r m , j e n s o n h b ( e d s ) . 1 7 t h e d n , 2004:1501–1509. 4. jenkins kj, correa a, feinstein ja, botto l, britt ae, daniels sr, et al. noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the american heart association council on cardiovascular disease in the young: endorsed by the american academy of pediatrics. circulation. 2007;115(23):29953014. 5. abqari s, gupta a, shahab t, rabbani mu, ali sm, firdaus u. profile and risk factors for congenital heart defects: a study in a tertiary care hospital. ann pediatr cardiol. 2016 sepres. j. health sci. vol 11(4), december 2023 331 congenital heart disease: pattern of clinical presentation in children osarenkhoe et al. dec;9(3):216-21. 6. varma a, sharma v, damke s, meshram rj, kher a, vagha j. clinical presentation of cyanotic congenital heart diseases in the pediatric population. journal of datta meghe institute of medical sciences university. jan–mar 2020;15(1):7-11. 7. freeman sb, bean lh, allen eg, tinker sw, locke ae, druschel c, et al. ethnicity, sex, and the incidence of congenital heart defects: a report from the national down syndrome project. genet med. 2008;10:173–80. 8. pinto ff, nunes l, ferraz f, sampayo f. down's syndrome: different distribution of congenital heart diseases between the sexes. int j cardiol. 1990;27:175–8. 9. amel-shahbaz s, behjati-ardakani m, namayandeh sm, vafaeenasab m, andishmand a , m o g h i m i s , n e g a h d a r y m , sarebanhassanabadi m. the epidemiological aspects of congenital heart disease in central and southern district of iran. adv biomed res. 2014 nov 29;3:233. 10. begicæ h, tahirovicæ h, mesihovicæ-dinarevicæ s, ferkovicæ v, aticæ n, latifagicæ a. epidemiological and clinical aspects of congenital heart disease in children in tuzla canton, bosnia-herzegovina. eur j pediatr. 2003;162:191–3. 11. owayad af, campbell dm, wang ee. underlying causes of recurrent pneumonia in c h i l d r e n . a r c h p e d i a t r a d o l e s c m e d . 2000;154:190–194. 12. krieger i. growth failure and congenital heart disease. am j dis child 1970;120:497–502. res. j. health sci. vol 11(4), december 2023 332 congenital heart disease: pattern of clinical presentation in children osarenkhoe et al. res. j. health sci. vol 11(4), december 2023 333 table i. age and sex distribution of 30 children with congenital heart disease age months) males (%) females (%) total (%) < 1 4 (28.6) 2 (12.5) 6 (20) 1 <6 5 (35.7) 10 (62.5) 15 (50) 6 <12 4 (28.6) 2 (12.5) 6 (20) 12 – <18 1 (7.1) 1(6.25) 2 (6.7) 18-24 1 (6.25) 1 (3.3) total 14 (100) 16 (100) 30 (100) table 2: chd type match with age s/n age cyanotic (%) acyanotic (%) 1 0 – 1 mth 1(3.3) 9(30.0) 2 2 – 6 mths 2(6.7) 9(30.0) 3 7 – 12 mths 2(6.7) 4(13.3) 4 13 – 24 mths 1(3.3) 2(6.7) total 6(20.0) 24(80.0) figure 1: yearly distribution of 30 children with congenital heart disease (2015 2017) congenital heart disease: pattern of clinical presentation in children osarenkhoe et al. res. j. health sci. vol 11(4), december 2023 334 table 4: packed cell vol. (pcv) in 30 children with congenital heart disease s/n pcv acyanotic (%) cyanotic (%) total (%) 1 <30 4 (13.3) 0 (0.0) 4 (13.3) 2 31 – 35 4 (13.3) 0 (0.0) 4 (13.3) 3 36 – 40 3 (10.0) 0 (0.0) 3 (10.0) 4 41 – 45 0(0.0) 0 (0.0) 0 (0.0) 5 46 – 50 2 (6.7) 0(0.0) 2 (6.7) 6 > 50 0 (0.0) 5(16.7) 5(16.7) figure 2: presenting complaints and history findings of patients table 3: physical findings s/n findings frequency (%) 1 pallor 3 (10.0) 2 pyrexia 7 (23.3) 3 cyanosis 5 (16.7) 4 finger/toe clubbing 1 (3.3) 5 oedema 1 (3.3) 6 tachycardia 8 (26.7) 7 tachypnoea 10 (33.3) 8 dyspnoea 18 (60.0) 9 murmur 17 (56.7) 10 crepitations 2 (6.7) 11 active praecordium 5 (16.7) 12 dysmorphic features 7 (23.3) 13 cataract 1 (3.3) 14 hepatomegaly/ hepatosplenomegaly 11 (36.7) congenital heart disease: pattern of clinical presentation in children osarenkhoe et al. res. j. health sci. vol 11(4), december 2023 335 table 5: associated complications s/n complications frequency (%) 1 bronchopneumonia 14 (46.6) 2 heart failure 7 (23.3) 3 birth asphyxia 3 (9.9) 4 prematurity 3 (9.9) 5 feeding difficulty 2 (6.6) table 6: chest xray findings s/n frequency (%) 1 broncho pneumonic changes 7 (23.3) 2 cardiomegaly 4 (13.2) 3 normal heart size 3 (9.9) 4 dextrocadia 1 (3.3) 5 not reported 10 (36.6) congenital heart disease: pattern of clinical presentation in children osarenkhoe et al. table 7: echocardiographic diagnosis of chd (27pts) s/n types frequency (%) 1 ventricular septal defect, vsd 6 (26.7) 2 patent ductus arteriosus, pda 6 (20.0) 3 tetralogy of fallot, tof 2 (6.7) 4 atrial septal defect, asd 2 (6.7) 5 transposition of great arteries, tga 1 (3.3) 6 tricuspid atresia, ta 1 (3.3) 7 patent foramen ovale, pfo 1 (3.3) 8 atrioventricular septal defect, avsd 1 (3.3) 9 dextrocardia (vsd + pda + atrial situs solitus) 1 (3.3) 10 secundum type asd + vsd 1 (3.3) 11 secundum type asd + pda 1 (3.3) 12 perimembranous vso + bifid aorta 1 (3.3) 13 subaortic vsd + pfo 1 (3.3) 14 pda + pfo 1 (3.3) 15 pda + vsd + asd 1 (3.3) 16 ta + asd + vsd 1 (3.3) table 8: patient outcomes s/n category frequency (%) 1 no symptoms on follow up 15 (30.0) 2 referred for surgery 7 (23.3) 3 dropped off from follow up 3 (10.0) 4 died 1 (3.3) rjhs 11(4).cdr magnitude of limb loss attributable to diabetes mellitus in a tertiary institution in nigeria. 1 2 1 3 yusuf, a.o. , adedire, a. . ala, a.o. , olanrewaju, s. abstract background: diabetes mellitus (dm) and its complications, continues to pose enormous challenge to health and financial stability. diabetes has remained a source of national and global economic burden. it has been observed lately that incidence of diabetic foot ulcer (dfu); one of the complications of dm, is on the increase and it is contributing hugely to financial loss, morbidity and mortality among diabetic patients. this is taking a great toll on affected individuals in terms of cost of treatment, deformities sustained, number of working/productive days lost while on admission and its attendant economic implications, and ultimately mortalities recorded. the aim was to determine the magnitude of limb loss or lower extremity amputation attributable to dm over a period of 12 months in tertiary institution and to assess the clinical profile of the patients. method: this is a retrospective study of the records of all patients that were consecutively booked for lower limb amputation and operated upon in the last 12 months at uniosun teaching hospital, osogbo, south-western nigeria. out of these total, cases of dfu were extracted to form another study group and then studied in detail. results; a total of 38 patients had lower limb amputation from july 2021 to may 2022. twenty three of the total number of amputations had dfu with a huge proportion of 60.5%, followed by road traffic accident with 28.9% (n=11) of the 23 diabetic cases , females were 15 with m:f ratio of 1:1.9. mean age was 63±11.18 years. mean duration of dm was 8.06±5.64 years. 78.3% had no foot care education and doppler uss confirmed atherosclerosis in 100% of the patients. the commonest bacteria isolated was proteus 34.8%. length of hospital stay ranged between 6 weeks to 16 weeks. outcome of admission was largely successful with 95.7% discharged and 4.3% mortality. conclusion: dfu contributes markedly to morbidity and mortality. long duration of dm, presence of pad and dpn as well as advancement in age and wound infection with proteus bacterial are observed to be risk factors associated with gangrenous dfu. however, larger studies are needed to establish these factors as predictors of amputation in patient with dfu. outcome was majorly good as majority of the patients were discharged. keyword: diabetes, diabetic foot ulcer, amputation, lower limb loss, peripheral arterial disease. corresponding author: yusuf a.o. orcid id number: 0000-0001-9763-0479 e-mail address: kemibam2010@gmail.com 1 department of medicine, osun state university, osogbo/uniosun teaching hospital, osogbo, nigeria 2 department of surgery, , osun state university, osogbo/uniosun teaching hospital, osogbo, nigeria 3 dept. of community medicine, , osun state university, osogbo/uniosun teaching hospital, osogbo, nigeria received: august 14, 2022 accepted: july 1, 2023 published: december 15, 2023 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.6 res. j. health sci. vol 11(4), december 2023 336 original article research journal of health sciences ampleur de la perte d'un membre attribuable au diabète sucré dans une école tertiaire au nigéria 1 2 1 3 *yusuf, a.o. , adedire, a. . ala, a.o. , olanrewaju, s. résumé objectif de l'étude : dernièrement, l'incidence de l'ulcère du pied diabétique (upd) ; une complication du diabète sucré, a considérablement augmenté et contribue énormément à la morbidité et à la mortalité. l'objectif est de déterminer l'ampleur de l'amputation du membre inférieur (aami) attribuable au dm sur une période de 12 mois et d'évaluer le profil clinique des patients. méthode de l'étude: il s'agit d'une étude rétrospective des dossiers de tous les patients diabétiques qui ont subi une lla au cours des 12 derniers mois à l'hôpital universitaire uniosun d'osogbo. résultat de l'étude : trente-huit patients ont eu un lla de juillet 2021 à mai 2022. vingt-trois (60,5 %) des 38 cas opérés avaient un upd. les femmes étaient au nombre de 15 sur 23. l'âge moyen était de 63 ± 11,18 ans. la durée moyenne du diabète était de 8,06 ± 5,64 ans. l'athérosclérose était présente à 100 %. protée sp. était la bactérie la plus couramment isolée. la proportion totale de cas sortis était de 95,7 %. conclusion: l'upd contribue de manière marquée à la perte et à la déformation des membres dans notre société. mots-clés : diabète, ulcère du pied diabétique, amputation, perte du membre inférieur. *corresponding author yusuf a.o. e-mail address: kemibam2010@gmail.com 1 department of medicine, osun state university, osogbo/uniosun teaching hospital, osogbo, nigeria 2 department of surgery, , osun state university, osogbo/uniosun teaching hospital, osogbo, nigeria 3 dept. of community medicine, , osun state university, osogbo/uniosun teaching hospital, osogbo, nigeria received: august 14, 2022 accepted: july 1, 2023 published: december 15, 2023 orcid-no: https://orcid.org/0000-0001-9763-0479 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.6 res. j. health sci. vol 11(4), december 2023 337 article original research journal of health sciences introduction diabetes mellitus (dm), a metabolic disorder characterized by hyperglycaemia has remained a global health and economic challenge. the prevalence of dm is increasing exponentially in africa and globally. currently, staggering figures of about 537 million people are affected globally according to international diabetes federation (idf) report. (1) a metaanalysis done a few years ago put the prevalence in nigeria as 5.7% and extrapolation from this figure will translate to about 11.2 million nigerians suffering from this condition. (2) several complications are associated with improperly managed dm. common complications of diabetes mellitus include diabetic foot ulcer, blindness, and renal impairment among others. diabetic foot ulcer (dfu) is one of the complications of dm and usually results from a combination of macrovascular and microvascular damage. (3) diabetic foot ulcer contributes in no small measure to morbidity and mortality in developing countries like nigeria and sub-saharan africa (4). it constitutes a huge financial burden especially where hospital services and other related payments are made out-of-pocket. it also leads to financial losses from productive work days lost to a lengthy period of hospital admission. (5, 6, 7) it is a major contributor to limb deformity in form of joint deformity or amputation. (5, 6) it contributes to mortality which can be as high as 10% during admission and as much as 35-50% 3 years post-surgery. (7, 8) diabetic foot ulcer has been an age-long problem that imposes a heavy burden on individuals and health institutions with no respite in view going by the high rate of increase in the prevalence of dm especially in low/middleincome countries. (6) there is therefore an urgent need to evaluate the current magnitude of the contribution of dfu to limb loss in our environment in this post covid 19 pandemic period and to study the clinical events that are common to patients with gangrenous dfu. to this end, we sought to determine the proportion of diabetic foot ulcers that resulted in amputation during the study period and observe factors or clinical profiles common to the patients studied which can serve as a guide for preventive and therapeutic measures to limit morbidity and mortality in our environment, where novel intervention for dfu is beyond the reach of many individuals who cannot afford the standard dfu management. materials and method it was a descriptive/retrospective study of patients who had amputation done over 12 months between july 2021 and may 2022 at uniosun teaching hospital, osogbo, southwestern nigeria. it is a tertiary hospital that receives patients from secondary and private healthcare facilities in osun, oyo, ondo, ekiti, and kwara states. ethical approval was obtained from the research and ethics committee of osun state university. the main theatre operation record was used to determine the total number of amputations done during the study period. following this, the details of the dm-related cases were copied and the file numbers were used to retrieve folders from the hospital records department. all adult diabetic patients who had amputation done during the study period were enlisted for the study. a structured questionnaire was used to extract demographic, clinical and other relevant information from the patients' folders. peripheral arterial disease (pad) was taken to be present with subjective history suggestive of pad and doppler uss diagnosis. peripheral neuropathy was majorly based on subject's report in the history. cut-off value for hypertension was according today jnc 7 or use of antihypertensives. (9) abnormal random glucose was taken as ≥200mg/dl or 11.1 mmol/l. (10) data generated were processed using the statistical package for social sciences (ibm version 23. spss inc, chicago usa). frequencies were expressed as percentages. mean values were calculated for the variables measured. results a total of 23 patients had lower limb amputation secondary to dfu during the study period. this represented 60.5% of the total amputation carried out within 12 months. female preponderance was observed with a f:m ratio of 1.9:1. table 1. elderly patients (aged 65 years and above) formed the largest proportion, and the mean age was 63.13±11.18 years. tables 1 and 2. the mean duration of dm was 8.06±5.64 years. table 2. clinical information showed that some established risk factors for dfu namely peripheral arterial disease (pad) and diabetic peripheral neuropathy (dpn) were present in the cases studied. other contributing factors to dfu in the patients are displayed in table 3. laboratory investigations showed anaemia and poor glycaemic control. table 2. res. j. health sci. vol 11(4), december 2023 338 magnitude of limb loss attributable to diabetes mellitus in a tertiary institution yusuf et al. doppler uss confirmed atherosclerosis in 100% of the patients and the commonest bacteria isolated was proteus 34.8%, . the left lower limb was observed to be more commonly affected and wagner ulcer grade 4 was the most frequent. the outcome of admission was good with 95.7% discharged and 4.3% mortality. the length of hospital stay ranged between 6 weeks to 16 weeks. only 9 (39%) patients continued follow-up care after discharge. discussion limb loss following a non-healing diabetic foot ulcer is one of the most devastating experiences that patients can have. it comes with a lot of challenges among which are psychological trauma, job loss, restriction in freedom of movement and other forms of impairment in quality of life. (11) it is therefore worrisome that many more people would experience limb loss going by the rapidly rising prevalence of dm especially in low/middleincome countries of which nigeria is one. without intervention, this trend will continue to have a negative impact on our society ranging from restricted social interaction, strain on relationships, loss of independence, stress on caregiver, reduced economic power and so on. therefore, this is a topical health issue that needs urgent intervention to reduce this burden in our society. lower limb amputation secondary to dfu remains a major health challenge in developing countries like ours where health care services are paid for out of pocket. (12) the results from this study point to the fact that a lot has to be done to curb this menace in our society. a 3-year study carried out in lagos university teaching hospital, between 1998-2000 reported 26 (42.6%) cases of lower limb amputation secondary to dfu out of a total of 61 cases of lower limb amputation carried out during the study period. (6) according to our findings, 23 dfu cases resulting in lower limb amputation which is close to the total number seen over 3 years in the study mentioned abovewere seen within a year in our facility and were responsible for more than two-thirds of the total number of amputation carried out in a year. this further corroborates the rapid rise in the incidence of dfu complicated by limb loss among dm patients. (13) in our study, we observed that elderly patients were mostly affected. the mean age followed by staphylococus 14% and klebsiella 13% observed in our study is similar to that reported in some foreign studies but higher in a multicenter study conducted in nigeria. (14, 15, 16) it has been observed that wound healing tends to be slower in older people and advanced age increases the risk of peripheral arterial disease. (16, 17) unfortunately, most elderly people have little or no economic power and limited physical strength to cater for their health and so loss of a limb will further reduce quality of life and shorten life span. female preponderance was observed in our study and this appears to be in tandem with what is usually seen in the larger population of dm patients. however, it is contrary to what was observed in a multiethnic study in the tropics. (18, 19) from this study, none of the subjects seemed to have attended any health care facility where standard training and services for dm foot care offered by a podiatrist were available. it should be noted that podiatrists are very few and not available in many health facilities including referral hospitals in nigeria (12, 20). majority were also not compliant with medications and clinic attendance. local treatment with home remedies before presentation in the hospital could contribute to the outcome of dfu. (21) application of hot fermentation, incisions with non-sterile sharps, and the addition of potentially dangerous substances are some of the local practices that have been observed in practice. (21) long duration of dm was found in the patients and it has been documented that longstanding dm is a risk factor for pad. peripheral arterial disease was found to be present in all the subjects and it has been reported by authors to be an independent predictor of lower limb amputation in diabetic patients. (16, 18) physiologically, adequate blood supply through patent blood vessels is necessary for the supply of oxygen, nutrients, and growth factors to aid wound healing promptly, any vascular compromise will lead to delayed wound healing and ultimately tissue necrosis/gangrene. another risk factor for dfu is diabetic peripheral neuropathy and it was found to be present in the study population. it is a major risk factor for dfu but has not been proven to be a significant predictor of lower limb amputation in dm patients (16, 22). the left lower limb was this is expected as many patients cannot afford the cost of dm medications and other necessary care and this still stands as a major barrier to diabetes care in nigeria. (12, 21) res. j. health sci. vol 11(4), december 2023 339 magnitude of limb loss attributable to diabetes mellitus in a tertiary institution yusuf et al. more frequently involved accounting for about two-thirds of the patients studied. however in another study carried out right lower limb was found to be more affected. (23) wagner grades 4 and 5 were associated with limb amputation but grade 4 was commoner in our study. this is similar to a report by edo et al. (16, 24) pad, wagner grade 4 and wound infection have been reported as significant predictors of lower limb amputation in a recent study conducted among nigerians. (16) the mean pcv value suggested mild anaemia in the group studied. this could also potentiate existing hypoxia in the tissues at the extremities secondary to pad. (25) the glycaemic control of many of the patients was poor. this was also observed in previous studies (16, 24). though poor glycaemic control has not been found to independently predict amputation. (16) more than one-third had elevated blood pressure at presentation which may also be related to previously stated factors for poor glycaemic control. hypertension has also been found to be commoner among dm patients who had major limb amputation. (18) proteus mirabilis was majorly found in the cultured wound specimen. this is similar to a study reported by anyim et al in which proteus mirabilis was one of the major aerobes in dfu specimen of subjects though staphylococcus aureus was the most frequent aerobe (17.2%) cultured in that study which is close to 14% found in our study. (23) however, polymicrobial pattern is seen in many cases of dfu. (23) wound infection was found in more than 70% of patients with dfu in the same report. (23) in this study, below-knee amputation accounted for a larger percentage of the surgeries performed. the outcome was largely good as 95.7 % of the patients were discharged and 4.3% mortality was recorded. this percentage of mortality is lower compared to 10% mortality rate that has been documented in the literature. (7) management of these patients is successful, but it has been observed that some patients become depressed post-surgery and some others died within 3 years post-surgery (7, 8). this study revealed that only 39% continued with follow-up care with 61% having defaulted (21). this is quite worrisome and thus calls for another research in this area to find out the reasons for poor clinic attendance after having suffered some degree of setback from previous dfu. we think the challenges may be multiple ranging from financial limitation, abandonment, transportation issues, depression, and even death as previously observed in the literature. (7, 8, 21) conclusion in conclusion, diabetes foot ulcer has been found to be a major cause of lower limb loss especially among the elderly patients living with dm and contributing factors include peripheral arterial disease, peripheral neuropathy, poor drug compliance, wound infection, poor glycaemic control and anaemia. therefore increased advocacy, early diagnosis of dm and regular health education and examination of the feet should be encouraged. limitations of the study 1. small sample size. 2. the study is retrospective, hence limited information was available and quetionnaire for the research was filled with inferences drawn from the information documented in the patient's case files without room for further clarifications from the patients. 3. peripheral sensory neuropathy was not objectively assessed with a standard instrument such as biothesiometer or semmes-weinstein monofilament. conflict of interest: the authors declare that no conflicts of interest exist with regard to the publication of this paper. acknowledgements: i want to appreciate god for the success of this work. my appreciation goes to every member of the team for their immense contribution to this work. references 1. idf diabetes atlas tenth edition 2021. available at diabetesatlas.org > atlas > tenth edition 2. uloko ae, musa bm, ramalan ma, gezawa id, puepet fh, uloko at, et al. prevalence and risk factors for diabetes mellitus in nigeria: a systematic review and meta-analysis. diabetes ther. 2018;9(3):1307–16. 3. olamoyegun m, ibraheem w, iwuala s, audu m, k o l a w o l e b . b u r d e n a n d p a t t e r n o f microvascular complications in type 2 diabetes in a tertiary health institution in nigeria. afr health sci. 2015;15(4):1136–1141. 4. ekpebegh co, iwuala so, fasanmade oa, ogbera ao, igumbor e, ohwovoriole ae. diabetes foot ulceration in a nigerian hospital: in-hospital mortality in relation to the presenting demographic, clinical and laboratory features. int wound j. 2009;6(5):381–385. 5. jeffcoate wj, vileikyte l, boyko ej, armstrong dg, boulton ajm. current challenges and res. j. health sci. vol 11(4), december 2023 340 magnitude of limb loss attributable to diabetes mellitus in a tertiary institution yusuf et al. res. j. health sci. vol 11(4), december 2023 341 opportunities in the prevention and management of diabetic foot ulcers. diabetes care 2018; 41(4):645-652. 6. ogbera ao, fasanmade o, ohwovoriole ae, adediran o. an assessment of the disease burden of foot ulcers in patients with diabetes mellitus attending a teaching hospital in lagos, nigeria. int j low extrem wounds. 2006;(4):244-9. 7. karam j, shepard a, rubinfeld i. predictors of operative mortality following major lower extremity amputations using the national surgical quality improvement program public use data. j vasc surg. 2013;58(5):1276–824. 8. lavery la, hunt na, ndip a, lavery dc, van houtum w, boulton aj. impact of chronic kidney disease on survival after amputation in individuals with diabetes. diabetes care. 2010;33(11):2365–2369. 9. report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure. in hypertension 2003;289(19):2560-2571. 10. definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a who/idf consultation. geneva: world health organisation. 2006; 21. 11. desmond d, gallagher p. in: quality of life in people with lower limb amputation. handbook of disease burdens and quality of life measures. preedy vr, watson rr, editors. 2010. pp. 3785–3796. 12. fasanmade o. a, dagogo-jack s. diabetes care in nigeria. annals of global health 2015; 81(6):821–829. 13. zhang y, lazzarini pa, mcphail sm, van netten jj, armstrong dg, pacella re. global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. diabetes care. 2020;43(5):964-974. 14. yesil s, akinci b, yener s, bayraktar f, karabay o, havitcioglu h, et al. predictors of amputation in diabetics with foot ulcer: single center experience in a large turkish cohort. hormones (athens) 2009;8(4):286–295. 15. rathur hm, boulton aj. the diabetic foot. clin dermatol. 2007;25(1):109–120. 16. ugwu e, adeleye o, gezawa i, okpe i, enamino m, ezeani i. predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from medfun, a multi-center observational study. j foot ankle res. 2019 june 14;12:34. doi: 10.1186/s13047-019-0345-y. pmid: 31223342; pmcid: pmc6570910. 17. mcdermott mm, greenland p, liu k, guralnik jm, criqui mh, dolan nc, chan c, celic l, pearce wh, schneider jr, et al. leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. jama. 2001;286(13):1599–1606. 18. lo zj, surendra nk, saxena a, car j. clinical and economic burden of diabetic foot ulcers: a 5year longitudinal multi-ethnic cohort study from the tropics. int wound j. 2021;18(3):375-386. doi: 10.1111/iwj.13540. epub 2021 jan 26. pmid: 33497545; pmcid: pmc8244009. 19. zhang p, lu j, jing y, tang s, zhu by. global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. ann med. 2017;49(2):106-116. 20. chinenye s, young e (2011) state of diabetes care in nigeria: a review. the nigerian health journal. 2011;11(4):101-106. 21. okpe i, ugwu e, adeleye o, gezawa i, enamino m, et al. (2019) foot care education, healthseeking behaviour and disease outcome in patients with diabetic foot ulcer: results from the multi-centre evaluation of diabetic foot ulcer in nigeria study. int j foot ankle 3:038. doi.org/10.23937/2643-3885/1710038 22. clayton w, elasy ta. a review of the pathophysiology, classification, and treatment of foot ulcers in diabetic patients. clin diabetes. 2009;27(2):52–58. 23. anyim o, okafor c, young e, obumnemeanyim i, c n. pattern and microbiological characteristics of diabetic foot ulcers in a nigerian tertiary hospital. afri health sci. 2 0 1 9 ; 1 9 ( 1 ) . 1 6 1 7 1 6 2 7 . https://dx.doi.org/10.4314/ahs.v19i1.37 24. edo a, edo g, ezeani i. risk factors, ulcer grade and management outcome of diabetic foot ulcers in a tropical tertiary care hospital. niger med j. 2 0 1 3 ; 5 4 ( 1 ) : 5 9 – 6 3 . d o i : 1 0 . 4 1 0 3 / 0 3 0 0 1652.108900. 25. guo s, dipietro la. factors affecting wound healing. j dent res. 2010;89(3):219–229. doi: 10.1177/0022034509359125. magnitude of limb loss attributable to diabetes mellitus in a tertiary institution yusuf et al. table 1. demographic characteristics of study group variable frequency percentage age group n = 23 % 18-44 (young) 2 8.7 45-64 (middle aged) 9 39.1 =65 (elderly) 12 52.2 sex male 8 34.8 female 15 65.2 source of referral private 9 39.1 self 14 60.9 educational level no formal education 1 4.3 primary 7 30.4 secondary 6 26.1 tertiary 9 39.1 table 2. clinical and laboratory characteristics of study group mean ± sd minimum maximum age 63.13±11.18 37.00 80.00 dm duration 8.06±5.64 .30 20.00 duration of dm treatment 6.43±5.32 .00 18.00 rbs 11.79±4.89 6.50 29.60 pcv 30.26±3.60 22.00 36.00 key: dm diabetes mellitus, rbs random blood glucose, pcv packed cell volume res. j. health sci. vol 11(4), december 2023 342 magnitude of limb loss attributable to diabetes mellitus in a tertiary institution yusuf et al. table 3. clinical characteristics of study population clinical information frequency percentage foot care education received none 18 78.3 poor 5 21.7 peripheral neuropathy symptoms yes 23 100% no 0 0% pad symptoms yes 23 100% no 0 0% drug compliance yes 2 8.7 no 21 91.3 dietary compliance yes 21 91.3 no 2 8.7 prior foot ulcer yes 19 82.6 no 4 17.4 foot affected left 17 74 right 6 26 local intervention yes 15 65.2 no 8 34.8 ulcer grade 4 16 69.6 5 7 30.4 blood pressure status controlled 15 65.2 not controlled 8 34.8 random blood sugar normal 7 30.4 abnormal 16 69.6 key: pad: peripheral arterial disease res. j. health sci. vol 11(4), december 2023 343 magnitude of limb loss attributable to diabetes mellitus in a tertiary institution yusuf et al. rjhs 11(4).cdr covid-19 vaccination acceptability among type 2 diabetes mellitus patients in a tertiary hospital in southwest nigeria: a cross-sectional study 1 1 1 2 1 enikuomehin, a.c. , junaid, o.a. , *adejumo, o.a. , ogundele, o.a. , lawal, o.m. , 1 3 akinbodewa, a.a. , fakhraddeen, y.m. abstract background: the mortality from covid-19 is higher in diabetes mellitus (dm) patients compared to the general population, hence it is highly desirable that dm patients are vaccinated against covid-19 infection. the aim was to determine the willingness of type 2 dm patients to accept covid-19 vaccine and associated factors. methods: this was a cross-sectional descriptive study that involved dm patients. multivariable logistic regression was used to assess factors associated with willingness to be vaccinated. results: a total of 302 dm patients participated in the study. about 90% of the respondents perceived covid-19 to be a serious disease; however, 33.5% of the patients considered themselves to be at risk of contracting covid-19 despite having dm. about 70.0% of the dm patients were willing to receive the vaccine. factors associated with willingness to be vaccinated were perception of covid-19 as a severe disease (adjusted odds ratio (aor), 6.09; 95% ci, 4.9612.27), previous vaccination (aor, 1.58; 95% ci, 1.042.98), and higher education (aor, 2.36; 95% ci, 1.046.86). conclusion: about a third of the study participants were not willing to receive covid-19 vaccination. there is need to educate the at-risk population about the importance of covid-19 vaccination. keywords: covid-19, vaccine, acceptance, type 2 diabetes, nigeria *corresponding author adejumo, o.a. email: oluseyiadejumo2017@gmail.com 1 department of medicine, university of medical sciences, ondo, nigeria 2 department of community medicine, university of medical sciences, ondo state, nigeria 3 department of medicine, muhammad abdullahi wase teaching hospital, kano, nigeria a structured questionnaire was used for data collection. orcid-no: https://orcid.org/0000-0002-0111-2843 received: december 5, 2022 accepted: may 16, 2023 published: december 15, 2023 original article research journal of health sciences res. j. health sci. vol 11(4), december 2023 344 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.7 covid-19 acceptabilité de la vaccination chez les patients atteints de diabète sucré de type 2 dans un hôpital tertiaire du sud-ouest du nigéria : une étude transversale 1 1 1 2 1 enikuomehin, a.c. , junaid, o.a. , *adejumo, o.a. , ogundele, o.a. , lawal, o.m. , 1 3 akinbodewa, a.a. , fakhraddeen, y.m. résumé objectif de l'étude: la mortalité par covid19 est plus élevée chez les patients diabétiques par rapport à la population générale, il est donc hautement souhaitable que les patients dm soient vaccinés contre l'infection par covid-19. l'objectif est de déterminer la volonté des patients atteints de diabète de type 2 d'accepter le vaccin covid-19 et les facteurs associés. méthodes: il s'agissait d'une étude descriptive transversale qui impliquait des patients dm. une régression logistique multi variée a été utilisée pour évaluer les facteurs associés à la volonté de se faire vacciner. résultat de l'étude: au total, 302 patients atteints de diabète ont participé à l'étude. environ 90 % des répondants percevaient le covid-19 comme une maladie grave ; cependant, 33,5% des patients se considéraient comme à risque de contracter le covid-19 malgré le diabète. environ 70,0 % des patients atteints de diabète étaient disposés à recevoir le vaccin. les facteurs associés à la volonté de se faire vacciner étaient la perception du covid-19 comme une maladie grave (rapport de cotes ajusté (rca), 6,09 ; ic à 95 %, 4,96 à 12,27), une vaccination antérieure (rca, 1,58 ; ic à 95 %, 1,04 à 2,98) et l'enseignement supérieur (rca, 2,36 ; ic à 95 %, 1,04-6,86). conclusion : environ un tiers des participants à l'étude n'étaient pas disposés à recevoir le vaccin covid-19. il est nécessaire d'éduquer la population à risque sur l'importance de la vaccination contre la covid-19. mots-clés : covid-19, vaccin, acceptation, diabète de type 2, nigéria *corresponding author adejumo, o.a. email: oluseyiadejumo2017@gmail.com 1 department of medicine, university of medical sciences, ondo, nigeria 2 department of community medicine, university of medical sciences, ondo state, nigeria 3 department of medicine, muhammad abdullahi wase teaching hospital, kano, nigeria received: december 5, 2022 accepted: may 16, 2023 published: december 15, 2023 un questionnaire structuré a été utilisé pour la collecte des données. orcid-no: https://orcid.org/0000-0002-0111-2843 article original research journal of health sciences res. j. health sci. vol 11(4), december 2023 345 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.7 materials and methods this was a cross-sectional descriptive study carried out between april and june 2022 at the university of medical sciences teaching hospital complex, ondo state located in southwest nigeria. the minimum sample size for this study was calculated by using leslie kish formula for sample calculation in cross-sectional study (13). this was determined by using a prevalence of willingness of diabetic patients to accept covid-19 vaccine from a previous study carried out in saudi arabia (14) reported to be 36.2%; 95% confidence interval and a sample error of 5%. the minimum sample size following inclusion of an attrition rate of 10% is 390. inclusion criteria for this study were dm patient, willingness to give informed consent and age above 18 years. study participants that fulfilled inclusion criteria were consecutively recruited into the study from the medical outpatient clinic in the ondo and akure complexes of the hospital. data were collected through an interviewer-administered questionnaire which had 3 sections. the first section on sociodemographic characteristics of the participants such as age, gender, level of education, occupation, marital status, religion, ethnicity and monthly income. the second section assessed the risk of contracting covid-19 while the third section assessed the perception about covid 19 vaccine and willingness to accept the vaccine. perception about covid-19 was assessed using 5-point likert scale to capture the full range of opinions. ethical consideration ethical clearance was obtained from the ethics and research committee of the university of medical sciences, ondo. informed consents w e r e o b t a i n e d f r o m p a r t i c i p a n t s . a l l questionnaires were coded (without names) and confidentiality was ensured throughout the study data analysis data entry and analysis were made, using statistical package for the social sciences (spss) version 20.0 (spss inc., chicago, il, usa). socio-demographic variables were presented as frequency and percentages. the willingness to receive covid-19 vaccine was presented as bar graph. bivariate association between socio-demographic variables, other variables, and willingness to receive the covid19 vaccine were assessed using the chi-square test. multivariate logistic regression analysis was introduction the coronavirus disease (covid-19) outbreak started in wuhan, china in december 2019 (1). the virus was declared a pandemic by the world health organization (who) in march 2020 (2). since its onset, 632 million cases and 6.5 million deaths recorded globally as at 13th november, 2022 (1). protective measures along with efficacious vaccines form the best strategy to combat covid-19 infection as definitive treatment is still being investigated (3) . vaccination has been shown to decrease the spread and severity of covid-19 infection, as well as reduced the need for hospital and intensive care admission (4,5). there are different vaccines currently in use against covid-19 globally. in fact, as at march, 2022, 11,056,690, 967 doses of vaccines have been administered globally (1). therefore, sufficient vaccine coverage and a high acceptance rate will b e n e e d e d f o r s u c c e s s f u l c o v i d 1 9 immunization. however, the biggest challenge faced by most governments is vaccine acceptability. covid-19 acceptance by the public is affected by citizens' mistrust towards health authorities, governments, health professionals, and the misinformation about covid-19 on social media (6). who listed vaccine hesitancy as one of the ten major threats to health globally (7). generally, patients with diabetes mellitus are more prone to infectious diseases (8). also, these infections are more likely to be serious and are associated with fatal outcome in them (8). reports have shown that covid-19 infection is more severe in diabetic patients compared to the general population (9-12). diabetic patients with covid-19 are more likely to have respiratory failure, require intensive care admission, have long ventilator dependence and spend longer time on admission. the mortality from covid-19 is higher in diabetes mellitus (dm) patients compared to the general population (11,12). hence, it is highly desirable that diabetic patients are vaccinated against covid-19 infection in order to reduce their risk of contracting the disease and having devasting consequences from the infection. the aim of this study is to determine the willingness of type 2 dm patients to accept covid-19 vaccine and the factors that influence their decision. the findings from this study will provide useful information to address their concerns about covid-19 vaccines and this may eventually improve the vaccine uptake. res. j. health sci. vol 11(4), december 2023 346 covid-19 vaccination acceptability among type 2 diabetes mellitus patients enikuomehin et al. done to identify the predictors of respondents' willingness to accept covid-19 vaccine. using adjusted odds ratios (aors) and 95% confidence intervals (cis). the outcome variable for both the bivariate and multivariate analyses was willingness to accept covid-19 vaccine dichotomize into 'yes' or 'no' responses. the level of significance was set at p < 0.05. results a total of 302 diabetic mellitus (dm) patients participated in the study. the majority (65.9%) were 60 years and above, mostly male (68.9%) and married (67.9%). nearly half of the respondents had tertiary education (48.7), while more than half (5.3%) were self-employed and of yoruba extraction in southwest nigeria. [table1]. more than half (n=165; 54.6%) has systemic hypertension, while (n=80; 26.5%) had been vaccinated 2 years earlier. in all (n=270; 89.4%) of the respondents perceived covid-19 to be a serious disease; however, only 33.5% of the patients considered themselves to be at risk of contracting covid-19 despite being diabetic, while 25.3% agreed that visiting the hospital increases their risk of contracting the disease. regarding participants' acceptance of the covid-19 vaccine, 70.2% of the dm patients were willing to receive the vaccine. on bivariate analysis, to assess the factors associated with the willingness to be vaccinated, 76.3% of those who perceived covid-19 as a serious disease were willing to receive the vaccine compared to those that did not perceived it as a serious (p< 0.001). equally, 61.2% of those who had previous vaccination two years earlier were also willing to receive the vaccine (p< 0.041). [table 2]. the level of education, was also significantly associated with the willingness to receive the vaccine, 60% of those with secondary education and above showed willingness to receive the vaccine (p<0.006). however, age (p=0.367), marital status (p=0.292), religion (p=0.3570 and participants occupation (p=0.468) were not significantly associated with the willingness to receive covid-19 vaccine. [table 2]. on multivariate analysis for predictors of willingness to receive the vaccine, perceived seriousness of covid-19 infection, previous vaccination 2 years earlier and level of education were found to be predictors of willingness to receive vaccination. participants who perceived covid-19 to be a serious disease were six times more likely to receive the vaccination (adjusted odds ratio (aor), 6.09; 95% ci, 4.9612.27), in addition, those who had vaccination 2 years earlier were one and half times more likely to accept the vaccination (aor, 1.58; 95% ci, 1.042.98), and also, those having secondary education and above were also more likely to same. (aor, 2.36; 95% ci, 1.046.86). [table 3] discussion our study assessed the willingness to receive covid-19 vaccine among dm patients, a group of individuals at risk of developing severe covid-19 infection because of their underlying comorbid condition. in the study, majority (65.9%) of the 302 participants were older than 60 years with the least group being those between the ages of 20 and 39, a finding that reflects the increased prevalence of diabetes mellitus with age (15). the higher male prevalence reported in this study has been supported by a higher male preponderance of dm especially in previous studies and this has been attributed to a larger amount of visceral fat found in men compared to women(16,17) and the distinctiveness in lifestyle and behavioral pattern in both genders (18). higher male prevalence in the hospital may also be indicative of males more empowered to be in the hospital and participate in the study than female (19). level of education has had variable impact on the willingness to receive the covid 19 vaccination according to previous studies. this study found that 6 out of every 10 participants with secondary education and higher showed willingness to receive the vaccine. this finding is similar to report from a study conducted in ontario which found that those with less than tertiary education were more likely to be unwilling to receive covid-19 vaccine (20). in contrary, low level of education was reported has having a favorable effect on the willingness to receive covid-19 vaccine in a cross-sectional study among the southwestern ethiopian residents (21). majority (89.4%) of our respondents perceive covid-19 to be a serious infection; however, only about a third of the study population considered themselves at risk despite being diabetic. our study found that participants who perceived covid 19 to be a serious disease were six times more likely to receive the vaccinations. in addition, those who had been received other types of vaccine in the past were found to be one and a half times more likely to receive covid-19 vaccination. studies have shown increased susceptibility to severe covid 19 illness among diabetic patient (patients) (912,22). they have been found to be at a higher res. j. health sci. vol 11(4), december 2023 347 covid-19 vaccination acceptability among type 2 diabetes mellitus patients enikuomehin et al. risk of hospitalization and death(11,12). optimal glycemic control alone has not consistently shown favorable outcomes in hospitalized covid-19 infected diabetic patients (23), and covid-19 vaccines remain the most effective way to alleviate covid-19 related potential disaster in dm patients (24). previous report (24) has established that a perception of higher susceptibility to the infection and more dire consequences tend to favor higher covid 19 vaccine uptake among diabetic patients and also showed that concerns about safety and side effects portend a negative attitude towards the vaccine uptake (25). this is in keeping with our finding in which 76.3% of those who perceived covid-19 infection to be a serious disease were willing to take the vaccine compared to those who had no such viewpoint. perceived seriousness of the infection, previous vaccination 2 years earlier and level of education predicted the willingness to receive the covid 19 vaccination on multivariate analysis in this study. previous vaccination as a factor predicting willingness to vaccination in this study is similar to a study finding in which previous pneumonia vaccinated subjects were more willing to be vaccinated (26). although this study did not record any significant association between religion and covid 19 vaccine uptake, religious affiliations have been found to influence people's attitude towards the vaccine (27,28). conclusion individuals with underlying conditions like diabetes are likely to develop severe covid 19 infection. vaccination remains a potent weapon to fight the infection. perceived seriousness of the infection, level of education and previous vaccination predict the willingness to receive the covid 19 vaccine. there is need to educate diabetic patients on the safety and efficacy of covid 19 vaccine to improve vaccination rates in this group of patients. acknowledgement: we hereby acknowledged the support of residents, nurses and patients in the department of medicine for their support in this research. conflict of interest: no conflict of interest references 1. who situation report on covid-19. available from: https://www.who.int/ emergencies/ diseases/novel-coronavirus-2022/situationth reports accessed 26 april 2023 2. who director general's opening remarks at media briefing on covid-19 on march 11, 2020 a v a i l a b l e f r o m : https://www.who.int/dg/speeches/detail/whodirector-general-s-opening-remarks-at-themedia-briefing-on-covid-19---11-march-2020 3. h o w t o p r o t e c t y o u r s e l f a n d others.https://www.cdc.gov/coronavirus/2019ncov/prevent-getting-sick/prevention.html th 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ethiopia: a crosssectional study. patient prefer adherence. 2022;16:1177. doi:10.2147/ppa.s362264 22. aldossari kk, alharbi mb, alkahtani sm, alrowaily tz, alshaikhi am, twair aa. covid19 vaccine hesitancy among patients with diabetes in saudi arabia. diabetes metab syndr. 2 0 2 1 ; 1 5 ( 5 ) : 1 0 2 2 7 1 . doi:10.1016/j.dsx.2021.102271 23. cariou b, hadjadj s, wargny m, pichelin m, alsalameh a, allix i, et al. phenotypic characteristics and prognosis of inpatients with covid-19 and diabetes: the coronado study. d i a b e t o l o g i a . 2 0 2 0 ; 6 3 ( 8 ) : 1 5 0 0 1 5 1 5 . doi:10.1007/s00125-020-05180-x/tables/6 24. omar sm, khalil r, adam i, al-wutayd o. the concern of covid-19 vaccine safety is behind its low uptake among patients with diabetes mellitus in sudan. vaccines 2022, vol 10, page 5 2 7 . 2 0 2 2 ; 1 0 ( 4 ) : 5 2 7 . doi:10.3390/vaccines10040527 25. xu j, chen s, wang y, duan l, li j, shan y, et al. prevalence and determinants of covid-19 vaccination uptake were different between chinese diabetic inpatients with and without chronic complications: cross-sectional survey. v a c c i n e s . 2 0 2 2 ; 1 0 ( 7 ) : 9 9 4 . doi:10.3390/vaccines10070994 26. wu l, wang x, li r, huang z, guo x, liu j, yan h, sun x. willingness to receive a covid-19 vaccine and associated factors among older adults: a cross-sectional survey in shanghai, china. vaccines (basel). 2022 apr 21;10(5):654. 27. h a s s e n h d , we l d e m , m e n e b o m m . understanding determinants of covid-19 vaccine hesitancy; an emphasis on the role of religious affiliation and individual's reliance on traditional remedy. bmc public heal 2022 221. 2022;22(1):1-11. doi:10.1186/s12889-02213485-2 28. osuagwu ul, langsi r, ovenseri-ogbomo g, mashige kp, abu ek, envuladu ea et al. analysis of perception, reasons, and motivations for covid-19 vaccination in people with diabetes across sub-saharan africa: a mixedmethod approach. int j environ res public h e a l t h . 2 0 2 2 ; 1 9 ( 1 3 ) : 7 8 7 5 . doi:10.3390/ijerph19137875 covid-19 vaccination acceptability among type 2 diabetes mellitus patients enikuomehin et al. res. j. health sci. vol 11(4), december 2023 350 table 1. socio-demographic characteristic of the study participants. variable frequency n=302 percent (%) age (years) 20-39 8 2.6 40-59 95 31.5 60 and above 199 65.9 sex male 208 68.9 female 94 31.1 marital status single 12 4.0 married 205 67.9 divorced 5 1.7 widowed 80 26.5 education no formal education 27 8.9 primary 73 24.2 secondary 55 18.2 tertiary 147 48.7 religion christianity 288 95.4 islam 11 3.6 traditional religion 3 1.0 occupation government employed 70 23.2 self employed 167 55.3 unemployed 65 21.5 ethnicity yoruba 282 93.4 igbo 18 5.9 hausa 2 0.7 covid-19 vaccination acceptability among type 2 diabetes mellitus patients enikuomehin et al. res. j. health sci. vol 11(4), december 2023 351 table 2. factors associated with willingness to accept vaccination among dm patients willingness to accept vaccine n=302 variable yes n (%) no n (%) p-value perceived seriousness of covid19 yes 206(76.3) 64(23.7) p<0.001 no 6(18.8) 26(81.2) previous vaccination in the past ` yes 49(61.2) 31(38.8) p<0.041 no 163(73.4) 59(26.6) age 20-49 27(64.3) 15(35.7) p=0.367 =50 185(71.2) 75(28.8) sex male 148(71.2) 60(28.8) p=0.301 female 64(68.1) 30(31.9) marital status not married 72(74.2) 25(25.8) married 140(68.3) 65(31.7) p=0.292 level of education secondary education and below 60(60.0) 40(40.0) tertiary 152(75.2) 503(24.8) p=0.006 religion christianity 200(69.4) 88(30.6) islam 9(81.8) 2(18.2) p=0.357 traditional religion 3(100) 0(0.0) occupation employed 164(69.2) 73(30.8) unemployed 48(73.8) 17(26.2) p=0.468 covid-19 vaccination acceptability among type 2 diabetes mellitus patients enikuomehin et al. res. j. health sci. vol 11(4), december 2023 352 table 3: predictors of willingness to accept covid -19 vaccination among dm patients category of variables aor(95%ci) p-value perceived seriousness of covid-19 no (ref) 1 yes 6.09(4.96-12.27) <0.001 previous vaccination in the past = no (ref) =yes 1 1.58(1.04– 2.98) 0.002 marital status not married (ref) married 1 1.05(0.55 – 2.02) 0.866 sex female (ref) male 1 0.66(0.34 – 1.27) 0.213 educational level secondary and below (ref) tertiary 1 2.36(1.406.86) 0.018 occupation employed (ref) unemployed 1 0.84(0.41-1.74) 0.636 age (years) 20-49 (ref) =50 1 0.89 (0.35-1.80) 0.584 covid-19 vaccination acceptability among type 2 diabetes mellitus patients enikuomehin et al. rjhs 11(4).cdr prevalence of, disposition towards and factors associated with cohabitation among undergraduates in ladoke akintola university of technology, ogbomoso, nigeria 1 1 2 2 2 adeyera, o. , *omisore, a.g. , balogun, o.d. , akinwusi, m.d. , oyekanmi, o.d. , 1 1 abiodun, o.m. , adesina, k.a. abstract background: cohabitation is increasingly common in tertiary institutions and is associated with reproductive health and other related challenges. this study is designed to determine the prevalence, pattern, disposition and reasons for premarital cohabitation among students of a tertiary institution in south west nigeria methods: a descriptive cross-sectional study of 350 undergraduates selected from a university in oyo state using a multistage sampling technique. data was collected via a semi-structured self-administered questionnaire and analyzed using spss version 22.0 results: majority (90.0%) of the respondents were below 25 years and 70.0% were females. twenty seven (7.7%) were currently cohabiting while 70 (20.0%) had ever cohabitated. a third (32.0%) were favorably disposed towards cohabitation. more males, older respondents and those whose parents were not their source of income reported ever having cohabited. conclusion: cohabiting is practiced among university students and is socially acceptable to many. concerted efforts geared towards sensitization and awareness programs to educate students on the adverse consequences of cohabitation should be embarked upon by concerned stakeholders. keywords: cohabitation, disposition, prevalence, pattern, undergraduates, nigeria *corresponding author omisore, a.g. orcid id0002-3393-5721 email: akinlolu.omisore@uniosun.edu.ng 1 college of health science, osun state university, osogbo, nigeria 2 public health programme, college of health sciences, osun state university, osogbo, nigeria received: january 15, 2023 accepted: july 14, 2023 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v10i4.12 res. j. health sci. vol 11(4) 384 original article research journal of health sciences prévalence, disposition envers et facteurs associés à la cohabitation chez les étudiants de licence à l'université de technologie ladoke akintola, ogbomoso, nigéria 1 1 2 2 2 adeyera, o. , *omisore, a.g. , balogun, o.d. , akinwusi, m.d. , oyekanmi, o.d. , 1 1 abiodun, o.m. , adesina, k.a. résumé contexte général de l'étude: la cohabitation est de plus en plus courante dans les institutions tertiaires et elle est associée à la santé reproductive et à d'autres problèmes connexes. cette étude est conçue pour déterminer la prévalence, le modèle, la disposition et les raisons de la cohabitation avant le mariage chez les étudiants d'une institution tertiaire du sud-ouest du nigéria méthode de l'étude: une étude transversale descriptive de 350 étudiants de licence sélectionnés dans une université de l'état d'oyo à l'aide d'une technique d'échantillonnage à plusieurs degrés. les données ont été recueillies via un questionnaire auto-administré semi-structuré et analysées à l'aide de spss version 22.0 résultat de l'étude : la majorité (90,0 %) des répondants avait moins de 25 ans et 70,0 % étaient des femmes. vingt-sept (7,7 %) cohabitaient actuellement tandis que 70 (20,0 %) avaient déjà cohabité. un tiers (32,0 %) étaient favorables à la cohabitation. plus d'hommes, de répondants plus âgés et de ceux dont les parents n'étaient pas leur source de revenu ont déclaré avoir déjà cohabité. conclusion: la cohabitation est pratiquée parmi les étudiants universitaires et est socialement acceptable pour beaucoup. des efforts concertés axés sur des programmes de sensibilisation et de prise de conscience pour éduquer les étudiants sur les conséquences néfastes de la cohabitation devraient être entrepris par les parties prenantes concernées. mots-clés : cohabitation, prédominance, des dispositions, modèle, étudiants de premier cycle (licence), nigéria *corresponding author omisore, a.g. orcid id0002-3393-5721 email: akinlolu.omisore@uniosun.edu.ng 1 college of health science, osun state university, osogbo, nigeria 2 public health programme, college of health sciences, osun state university, osogbo, nigeria received: january 15, 2023 accepted: july 14, 2023 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v10i4.12 res. j. health sci. vol 11(4) 385 article original research journal of health sciences introduction living together of two people (a male and female) when they are not formally married is known as cohabitation. during cohabitation, marital intimacy and relationship are being assumed without the legality associated with marriage. a revolution in sexual values has seemingly eroded previously established human culture and values. what would have passed as vices or taboos hitherto have now been embraced in different parts of the world. cohabitation represents one of such increasingly acceptable values globally. although, this could be traced back to the western culture, it is now being accepted in the african culture (1,2,3). the act of cohabitation is now common among students of tertiary institutions in nigeria (2,3). it is also regarded as 'couples' life', 'campus marriage' and 'campus coupling' (1,2). in the past students were all accommodated within the institutions' halls of residence with different hostels for male and female. however, in recent years, the increasing population of students with little or no change in the available number of halls of residence has caused students to look for accommodation outside of the school premises (4). while insufficient accommodation is the case in some schools, others do not even provide any accommodation to students (1,2,4). they are therefore at liberty to reside outside the university premises. compared to on-campus residencies which have separate rooms/hostels for males and females, off-campus allows for mixed residence of both sexes which promotes or leads to cohabitation (1,4). thus, insufficient/lack of institutional residence has led to an increase in the rate of cohabitation. there are different reasons for cohabitation among students of tertiary institutions. some students who cohabit were found to regard cohabitation as a strategy that provides an opportunity to build quality and stable marital relationships (1,2,3). it is therefore not surprising that elements of marital relationships including sexual intimacy are present in these situations (5-7). other reasons given are accommodation issues, financial problems and testing of marriage compatibility (1,3,6). it has also been opined that moral decadence and eroding of morality among youths also fuels the high rate of cohabitation (1,3,6). premarital cohabitation has been reported to have health and social consequences for those who engage in it (2,7). it is associated with an increase in several risky behaviors like unprotected sex, drug use, clubbing, excessive alcohol intake, physical fight and delinquency (1,2,3). other sexually related consequences are sexually transmitted infections, abortions and unplanned pregnancy (2,7). asides these consequences, it has also been found to impact negatively on the academic performances of students in tertiary institutions (5). given the increasing prevalence of cohabitation and its consequences on the students and the society at large, its dynamics need to be examined in different populations to control it or minimize its adverse effects. of recent, there is increased demand for university education in nigeria with corresponding establishment of more private and public tertiary institutions (4). information is required for policy makers and regulatory bodies to ensure the establishment of academic environment that will guaranty healthy living and acceptable social interactions. this study, therefore, aimed to assess the prevalence, pattern, disposition and reasons for premarital cohabitation among students of a selected tertiary institution in south west nigeria. results from the study will provide insight into cohabitation which can guide interventions and policies formulations. materials and methods study area and site: ogbomoso is located in oyo state, southwestern nigeria. ladoke akintola university of technology (lautech) is a tertiary institution located in ogbomoso, with 0 0 geographical coordinate 8 8' 0” north, 4 16' 0” east. lautech is a public university with a student population of about 30,000 spread over seven faculties it was chosen because it is one of the institutions that do not have halls of residence/hostels for students. therefore, students of this institution dwell outside of the university premises. study design: the study was a descriptive crosssectional survey study population: the study was conducted among undergraduates of lautech. the year one students in the school were excluded from the study, while students in year two and above were surveyed. using leslie fischer's formula for sample size calculation in a population greater than 10,000 and prevalence rate of cohabitation of 23 % in a similar study (3), a minimum sample size of 273 was calculated. an estimated noncompletion rate of 30.0% was factored in, making a total of 360 respondents. however a total of 350 questionnaires were completed. the respondents cohabitation among undergraduates in lautech, ogbomoso adeyera et al. res. j. health sci. vol 11(4) 386 were randomly selected through multi-stage sampling technique. two faculties were selected using simple random sampling via balloting. in the two faculties, half of the departments were also selected using simple random sampling via balloting. using proportional allocation, the number of students to be selected from each department and level was determined. systematic random sampling was then used to select the respondents. questionnaires were administered in the lecture halls at the end of lectures. data collection: a semi-structured selfadministered questionnaire was used to elicit information from the respondents. the questionnaire elicited information on sociodemographic characteristics, practice and pattern of cohabitation and disposition towards cohabitation. the questionnaire was pre-tested among 35 undergraduates at osun state university, osogbo campus, which also has students living off-campus. all ambiguities were corrected following the pre-test. data analysis: data entry was done and analysed using ibm spss (statistical package for social sciences) version 22 software. descriptive analysis was done by making use of frequencies and percentages. inferential statistics was performed using chi-square test to find association between practice of cohabitation and socio-demographic characteristics of the respondents. significance level was set at 95%. ethical permission: ethical permission was obtained from health research ethics committee (hrec) of osun state university. permission from the heads of the selected departments was also sought and obtained. informed consent of the participant was obtained after explaining the purpose of the study. confidentiality as well as privacy were also ensured. results a total number of 360 students were selected to participate in the study but oonly 350 completed the questionnaire giving a response rate of 97.2% s o c i o d e m o g r a p h i c c h a r a c t e r i s t i c s o f respondents table 1 shows the socio-demographic characteristics of respondents: the majority, 315(90.0%) of the respondents were 24 years old and below and 234 (66.9%) were females. most, 298 (85.1%), of the respondents came from monogamous families and 300 (85.7%) lived with both parents (at home). the majority, 316 (90.2%) of the respondents stated that their parents were their main source of income while 207 (59.1%) stated that their average income was not enough to cater for their needs. disposition towards premarital cohabitation among students table 2 shows the disposition of the respondents towards premarital cohabitation among the respondents: a total of 198 (56.6%) of the respondents were against the act of cohabitation being banned among students. also 112 (32.0%) of the respondents said they would recommend cohabitation to students as long as they love each other while 142 (40.6%) said students should cohabit if one does not have enough money for accommodation. prevalence and pattern of cohabitation among respondents a total of 70 (20.0%) respondents have cohabited at one point in time or the other. out of the 70, 27 (38.6%) were cohabiting as at the time of data collection. furthermore, a total of 167 (47.7%) of all the respondents have friends who cohabit while 35 (10.0%) have relatives who cohabit. reasons for cohabitation the figure above shows the reasons for cohabitation among the 70 respondents who have ever cohabited. the commonest reason for cohabitation was found to be financial constraints (60.1%), followed by “to be closer to partner” (14.5%), and 13.1% cohabited “to improve relationship with partner” while only 6.5% cohabited for sexual gratification, and 2.9% cohabited because their partners insisted and another 2.9% because their friends were into it. association between socio-demographic characteristics and prevalence of cohabitation there was a statistically significant association between the independent variables age, gender, and source of income and the dependent variable “ever cohabiting”. a higher proportion (34.3%) of respondents who were 25 years old and above cohabited compared to 18.4% of those who were 24 years and below (p=0.026). also, a higher proportion of males (27.6%) reported cohabitation compared to their cohabitation among undergraduates in lautech, ogbomoso adeyera et al. res. j. health sci. vol 11(4) 387 female counterparts (16.2%) with p=0.012. in addition, a higher proportion of respondents whose parents were not their source of income (47.1%) reported cohabiting compared to those whose parents were their source of income cohabited (17.1%) (p<0.001). discussion this study examined the prevalence, pattern and disposition towards premarital cohabitation among undergraduates. three hundred and fifty respondents participated in the study and majority of the participants were youths below the age of 24 years. the prevalence of cohabitation in our study is 20.0%. however, the prevalence increased significantly from 18.4% among respondents who were below the age of 25 years to 34.3% among respondents who were 25 years and above. thus, older respondents were more involved in cohabitation compared to younger people. this may not be unexpected as the older ones are presumably more matured and experienced compared to younger people who may still be subject to the control of their parents. older adults were also more explicit and confident in talking about sexuality and relationship when compared to younger people (8). the higher reporting found among older respondents in this study could therefore be because they are usually more forthcoming and bolder to disclose engagement in relationships than younger people. older people also exercise more freedom and independence which are enabling factors for cohabitation thus, a significant level of under-reporting could have occurred among the younger respondents. though the prevalence of cohabitation in our study is similar to that reported from similar studies (2,3,6), the overall prevalence of cohabitation could be higher than as reported. out of the 70 students who had ever cohabited, only 27 of them were currently cohabiting at the time of the study. the durability of cohabitation has been found to be dependent on the purpose and the experience of the individual involved (7,8,9).in terms of total numbers, among the respondents who had ever cohabited in this study, 82.9% were young inexperienced individuals of less discretion and less decisive nature who are known to be ready victims of peer influence (10). peer influence related reasons in form of 'to be closer to partner', 'to improve relationship', for sexual relationship, 'friends are doing it' and 'partner insisted' are common reasons for cohabitation in our study. such 'couples' learn about the quality of their relationship during cohabitation and many decide to discontinue. it has been previously reported that a large number of premarital cohabitation relationships do not lead to marriage and they break up even while still in school while some who otherwise should not have married end up marrying through cohabitation. (7,9,10) this study found that a higher proportion of males (27.6%) compared to females (16.2%) reported ever cohabiting and the difference was statistically significant. reports differ from studies on association of cohabitation with regard to sex or gender. some studies have reported lack of association while others reported that there was an association (2,3,6,7). considering that the males who reported cohabitation are doing so with their female partners, the rate of cohabitation could arguably be the same in both genders. the higher reporting found among males in this study could therefore be because males are usually more forthcoming and bolder to disclose engagement in sexual relationships than females (8,11,12). financial constraint was the leading reason for cohabitation among the respondents. similar findings have been reported by other authors (1,2,3,6,). the enormous number of students and limited accommodation facilities make the available rooms/hostels expensive and out of reach of many students, hence the 'palliative measure' of resolving to either partner with or wholly lean on another individual to provide accommodation for them. furthermore, report of cohabitation among respondents whose parents were not their source of income is significantly higher compared to those whose parents were their source of income. lack of financial provision from parents encourages freedom from parental supervision with independence and less monitoring from parents or guardian (6,11). such students with financial difficulties have been found to readily resort to cohabitation for economic support to save on rent, food and other living expenses (1, 11). result from our study which revealed that 40% of the students were favorably disposed to cohabitation among students as a means to alleviate financial hardship further corroborates financial cause of cohabitation. one may wonder whether the issue actually goes beyond financial constraints, because ordinarily if it is just financial constraints, why shouldn't an individual find a partner of the same sex to partner with in paying for the needed accommodation rather than the opposite sex. this may imply that the cohabitation among undergraduates in lautech, ogbomoso adeyera et al. res. j. health sci. vol 11(4) 388 payment for accommodation by cohabiting partners may not necessarily be shared equally by both partners, perhaps, more often than not there is a principal financial partner to which the less financially capable partner is subject to. this may be the object of some future studies. however, a significant proportion of the respondents in our study practiced cohabitation for relationship motives. reasons like 'the need to be closer to partner', 'to improve relationship' and 'for sexual relationships' were reported. other studies have identified pleasure, companionship, love and sexual gratification as leading reasons for cohabitation (1,2,3,6). in such instances, young men are known to enjoy the gains of cohabitation in terms of sexual and domestic duties especially in nigeria and other african countries where there is cultural abhorrence to premarital sex but demonstrate a double standard blaming the female gender for sexual misdemeanors (8,11,12).thus, cohabitation tends to be more acceptable to the male gender and are confident and bold enough to report their involvement as suggested by our study. the fact that relationship and sexual driven factors were common reasons given for cohabitation shows that many youths of today have abandoned the rich african culture that forbids a boy and a girl from having sexual relationship until they are formally married. many commentators have opined that contemporary youths have abandoned valued african traditions for the inglorious culture of premarital sex. cohabitation is totally against the norms and values of the african society. conclusion c o h a b i t a t i o n i s c o m m o n a m o n g undergraduates in this study and perhaps in many tertiary institutions in the country. even students who do not engage in cohabitation have a positive disposition towards it and it is socially acceptable among them. cohabitation is found to be financial and relationship driven. therefore, there should be concerted efforts towards sensitization and dissemination of information to students on the adverse consequences of cohabitation on their health and academics. policies and interventions to lessen the financial obligation of students in the universities should also be put in place. such interventions should include establishment of affordable and well supervised residential halls by universities and scholarships for students from government and non-governmental bodies and individuals. conflict of interest: the authors declare no conflict of interest. acknowledgement: nil references 1. onayase a. cohabitattion among university students in oyo state, south wst nigeria. j edu learning. 2020; (9): 140-14 2. duyilemi an, tunde-awe bm, louis oa. cohabitation in nigeria tertiary institutions?: a case study of adekunle ajasin university , akungba-akoko , ondo state. int j soc sci humanit. 2018;3(1):27–37. 3. arisukwu oc. cohabitatio among university of ibadan undergraduate students. res humanities soc sci. 2013; 3(5): 1719 2222 4. egwunyenga ej. tending the ivory tower: rd swimming against the tide. 63 in the series of inaugural lectures of the the delta state univsity, abraka, nnigeria. 2018: 23 5. obikeze n, obi i, mmegbuanaeze nb. premarital cohabitation as predictor of academic engagement among undergraduates in public universities in anambra state , nigeria. j prof couns psychother res. 2019;1(1):87–99. 6. fareo do, moses kd. cohabitation among students of tertiary institutions in adamawa state , nigeria. int j sci educ. 2018;2(04):31–42. 7. ogunsola mo. premarital behaviour and length of courtship as determinant of marital stability among couples in oyo state, nigeria. unpublished m.ed project university of ibadan, ibadan.; 2004. 8. stewart ca, dennnis f, kathryn ip et al. 2014. sexuality talk duing adolescent health maintainance visits. jamm. 1682) 163-169 9. brien mj, lee ai, steven s. cohabitation , marriage and divorce in a model of match quality. int j econ ev 006 47((2):451-44 10. martin p, martin d, martin m. young adult premarital sexual activity, cohabitation and a t t i t u d e s a t t i t u d e s t o w a r d s m a r r i a g e . adolescence. 2001;36:601-609. 11. adeoye ao, ola o, aliu b. prevalence of premarital sex and factors influencing it among students in a private tertiary institution in nigeria. int psychol couns. 2012;4(1):6–9. 12. alo oa, akinde is. premarital sexual activities in urban society of southwest nigeria. ea journals. 2010;2(1):1–16 cohabitation among undergraduates in lautech, ogbomoso adeyera et al. res. j. health sci. vol 11(4) 389 figure 1: reasons for cohabitation cohabitation among undergraduates in lautech, ogbomoso adeyera et al. res. j. health sci. vol 11(4) 390 table 1: socio-demographic characteristics of respondents variables frequency percentage age 24 and below 315 90.0 25 and above 35 10.0 sex male 116 33.1 female 234 66.9 parental marital status married 332 94.9 separated 8 2.3 cohabiting 1 0.3 widowed 9 2.5 type of family monogamous 298 85.1 polygamous 52 14.9 who do you live with? (at home) mother only 32 9.1 father only 7 2.0 both parent 300 85.7 other 11 3.2 average monthly income enough to cater for need? yes 143 40.9 no 207 59.1 main source of income parent 316 90.2 guardian or other relatives 7 2.0 from business 21 6.0 spouse 1 0.3 dating or courtship partner 2 0.6 others 3 0.9 table 2: disposition towards premarital cohabitation among students (n=350) variable cohabitation against n (%) for n (%) cohabitation among students should be banned/outlawed 198(56.6) 152(43.4) i would recommend cohabiting to a student as long as they love each other 238(68.0) 112(32.0) students should cohabit if one does not have enough money for accommodation 208(59.4) 142(40.6) cohabitation among undergraduates in lautech, ogbomoso adeyera et al. res. j. health sci. vol 11(4) 391 table 3 : prevalence and pattern of cohabitation among respondents (n=350) variable frequency percentage ever cohabited yes 70 20.0 no 280 80.0 currently cohabiting (n=70) yes 27 38.6 no 43 61.4 length of cohabitation with current partner (n=27) 3 months and below 8 29.6 more than 3 months 19 70.4 length of cohabitation with last partner(n=43) 3 months and below 28 65.1 more than three months 15 34.9 have mates or friends who cohabit yes 167 47.7 no 183 52.3 have relatives or family member who cohabit yes 35 10.0 no 237 67.7 not sure 78 22.3 table 4: association between socio-demographic characteristics and prevalence of cohabitation (n=350) variable ever cohabited p-value age yes n (%) no n (%) 0.026* 24 and below 58(18.4) 257(81.6) 25 and above 12(34.3) 23(65.7) sex 0.012* male 32(27.6) 84(72.4) female 38(16.2) 196(83.8) type of family monogamous 59(19.8) 239(80.2) 0.822 polygamous 11(21.2) 41(78.8) parental marital status currently married 68(20.5) 264(79.5) 0.333 not currently married 2(11.1) 16(88.9) source of income parent 54(17.1) 262(82.9) =0.001* others 16(47.1) 18(52.9) *statistically significant at p<0.05 cohabitation among undergraduates in lautech, ogbomoso adeyera et al. res. j. health sci. vol 11(4) 392 rjhs 11(4).cdr common facts and fictions about hiv transmission, prevention and treatment among plwha attending a tertiary healthcare centre in north-western nigeria. 2 1 2 *amoko a. , macleod et. , dr koforade ay. abstracts objectives::the transmission, prevention, and treatment of the human immunodeficiency virus (hiv) are greatly influenced by human behavioral practices. this makes knowledge of some truths (facts) and lies (fictions) about the disease extremely important in its prevention and control. several studies on the assessment of knowledge about hiv infection have been undertaken among the general population, but only a few have involved people living with hiv/aids (plwha). this study was conducted to assess the level of knowledge and understanding on transmission, prevention, and treatment of hiv infection among plwha attending an adult anti-retroviral therapy (art) clinic at federal medical centre, birnin kebbi, north-western nigeria. method: the study was conducted as a hospital-based descriptive cross-sectional study using interviewer-administered questionnaires among 62 patients, selected by convenience sampling technique, attending adult art-clinic over a period of 8 weeks. the data was analyzed using spss-16. result: more than 70% of the respondents scored above 75% in the questions on modes of transmission of hiv infection. however, 73.4% of the respondents believed hiv infection was curable, and 40.6% believed there is commercially available vaccination against hiv infection. there were statistically significant associations between high mean scores (75% and above) in questions on modes of transmission and prevention of hiv, and being of hausa ethnicity (p-value=0.013), having a senior secondary or higher level of education (p-value=0.014) and being a resident in an urban setting (pvalue=0.003) conclusion: there is a fairly good basic knowledge about hiv transmission, prevention and treatment among the respondents; however, there is need for improvement in knowledge on certain lies/fictions regarding the disease. key words: facts, fictions, hiv, plwha, north-western nigeria *corresponding author amoko a. email: amokojt@yahoo.com. 1 department of global health and infectious diseases, university of edinburgh, edinburgh, scotland. 2 department of family medicine, university of ilorin teaching hospital, ilorin, kwara state, nigeria. received: january 9, 2022 accepted: march 22, 2023 published: december 15, 2023 orcid-no: https://orcid.org/0000-0002-5565-4314 original article research journal of health sciences res. j. health sci. vol 11(4), december 2023 317 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.4 faits et fictions courants sur la transmission, la prévention et le traitement du vih chez les pvvih fréquentant un centre de soins de santé tertiaires dans le nord-ouest du nigéria 2 1 2 *amoko a. , macleod et. , dr koforade ay. résumé objectif de l'étude: la transmission, la prévention et le traitement du virus de l'immunodéficience humaine (vih) sont fortement influencés par les pratiques comportementales humaines. cela rend la connaissance de certaines vérités (faits) et mensonges (fictions) sur la maladie extrêmement importante dans sa prévention et son contrôle. plusieurs études sur l'évaluation des connaissances sur l'infection à vih ont été entreprises dans la population générale, mais seules quelques-unes ont impliqué des personnes vivant avec le vih/sida (pvvih). cette étude a été menée pour évaluer le niveau de connaissances et de compréhension sur la transmission, la prévention et le traitement de l'infection à vih chez les pvvih fréquentant une clinique de thérapie antirétrovirale (art) pour adultes au centre médical fédéral de birnin kebbi, au nord-ouest du nigéria. méthode de l'étude : l'étude a été menée sous la forme d'une étude transversale descriptive en milieu hospitalier à l'aide de questionnaires administrés par un intervieweur auprès de 62 patients, sélectionnés par une technique d'échantillonnage de commodité, fréquentant une clinique de tar pour adultes sur une période de 8 semaines. les données ont été analysées à l'aide de spss-16. résultat de l'étude: plus de 70 % des répondants ont obtenu un score supérieur à 75 % aux questions sur les modes de transmission de l'infection à vih. cependant, 73,4 % des personnes interrogées pensaient que l'infection par le vih était guérissable et 40,6 % pensaient qu'il existe un vaccin contre l'infection par le vih disponible dans le commerce. il y avait des associations statistiquement significatives entre des scores moyens élevés (75 % et plus) aux questions sur les modes de transmission et de prévention du vih, et le fait d'être d'origine ethnique haoussa (valeur de p = 0,013), d'avoir un niveau d'études secondaire supérieur ou supérieur (p -value=0.014) et être résident en milieu urbain (p-value=0.003) conclusion : il existe une assez bonne connaissance de base sur la transmission, la prévention et le traitement du vih parmi les répondants; cependant, il est nécessaire d'améliorer les connaissances sur certains mensonges/fictions concernant la maladie. mots-clés: faits, fictions, vih, pvvih, nord-ouest du nigéria *corresponding author amoko a. email: amokojt@yahoo.com. 1 department of global health and infectious diseases, university of edinburgh, edinburgh, scotland. 2 department of family medicine, university of ilorin teaching hospital, ilorin, kwara state, nigeria. received: january 9, 2022 accepted: march 22, 2023 published: december 15, 2023 orcid-no: https://orcid.org/0000-0002-5565-4314 article original research journal of health sciences res. j. health sci. vol 11(4), december 2023 318 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.4 introduction hiv/aids remains one of the most serious public health problems in sub-saharan africa and the world as a whole. since the onset of the epidemics, more than 75 million people have been infected with the virus, and close to 32 million people have died from aids (1). as of 2018, an estimated 0.8% (0.6-0.9%) of adults aged 15-49 years worldwide were living with hiv infection (1). africa remains the most severely affected region in the world with 1 in every 25 adults (3.9%) living with hiv, and accounting for more than two-thirds of the people living with hiv in the world (1). in nigeria, in 2018, there were about 130,000 hiv newly infected individuals, and 1.9 million people were living with hiv/aids (2). in the same year, the hiv incidence per 1000 uninfected people in nigeria was 0.65; the prevalence among adults (15-49yrs old) was 1.5% and there were 53,000 aids-related deaths (2). transmission of hiv is highly related to some specific behavioral patterns, which make adequate knowledge about the disease imperative in its prevention (3,4). adequate knowledge about hiv infection can positively affect perceptions and attitudes towards the disease. though modification of certain behavioral practices among plwha is highly important in reducing the transmission of hiv/aids, studies on knowledge, attitude, and perception of hiv infection rarely include plwha. among the few studies found during the literature search for this work was a study done by gupta et al. (5) among plwha attending a tertiary health centre in north india. in this study, up to 87.3% of the participants believed hiv infection could be c o n t r a c t e d f r o m p u b l i c t o i l e t s , sneezing/coughing, hugging/kissing, shaking hands, and living in the same house with hiv infected persons (5). this study also showed that just 33% of the participants were aware that the disease could be transmitted through infected sharps, and up to 30.7% of the respondents believed that hiv infection could be transmitted by mosquitoes (5). a similar study conducted in puducherry, south india, among 200 hiv-positive subjects attending a tertiary care hospital and three nongovernmental organization centres, by mahalashmy et al.(6) in 2011 showed that 41% of the participants believed hiv could be transmitted through saliva, toilet seats, casual social contacts, and mosquito bites. this study also showed that urban residents, patients with educational status above class 10 (senior secondary school level of education and above), duration since diagnosis of more than one year, counseled subjects, and subjects who received care from the ngos were more likely to have a high knowledge score (6). considering these studies, it is obvious that there is a possibility that an individual with hiv infection may not have adequate knowledge about the disease. our study was set out to assess the knowledge about common facts (truths) and fictions (lies) that surround hiv transmission, prevention, and treatment among patients attending adult art-clinic at the federal medical centre (fmc), birnin kebbi, nigeria. materials and methods this study was conducted as a crosssectional study among adult (18 years and older) hiv positive patients attending an anti-retroviral (art) clinic at fmc, birnin-kebbi, northwestern nigeria. the study was conducted on clinic days (once weekly) over a period of 8 th th weeks (december 7 , 2019 to january 26 , 2020). the intention of the researchers was to recruit all patients who met the inclusion criteria and attended the clinic during the 8 weeks of the research using convenience sampling method. a total of 120 participants were anticipated to be recruited during the study duration, but just 64 participants were recruited due to low patients' turn-out during this period. all consenting adults of ages 18 years and older with hiv infections who were attending the art clinic at fmc, birnin kebbi, were considered as eligible for the study. patients that were less than 18 years of age; those that required emergency treatment, those that lacked adequate cognitive function to attend to the questionnaires; and those that did not grant their consent were excluded from the study. data were collected using an interviewer-administered semi-structured questionnaire that was adapted from a questionnaire used in a similar study by gupta et al in india (5). at the end of the study, the completed questionnaires were sorted and coded serially. collected data were analyzed using the statistical package for social sciences (spss) version 16.0. frequency tables were generated for relevant variables, and chi-square test was used to assess the degree of association between the mean scores and socio-demographic variables. a probability-value (p-value) of less than 0.05 was considered statistically significant, and the confidence interval was set at 95%. ethical principles guiding research of this nature were adhered to. clearance to conduct the study was obtained from the ethical review res. j. health sci. vol 11(4), december 2023 319 common facts and fictions about hiv transmission, prevention and treatment amoko et al. committee of fmc, birnin kebbi. participants were adequately informed about the study, and written consent was obtained from them. confidentiality with respect to the participants' information was thoroughly observed. results table1 shows the socio-demographic characteristics of the respondents. a total of 64 patients participated in the study and were analyzed. thirty-nine (60.9%) of the respondents were females, and 25(39.1%) were males, giving female to male ratio of 1.6:1. respondents' ages range from 18 to 60 years, with a mean age of 37.6 years (sd±9.4). more than 80% of the participants were between the ages of 20 and 50 years with the participants within the age group 3 0 3 9 y e a r s h a v i n g t h e h i g h e s t representation[25(39.1%)]. about 90% of the respondents were muslims, and the majority of the respondents were hausas (79.6%). close to 60% of the participants had at least a secondary level of education, and trading was the most common occupation practiced (34.4%). majority of the respondents were currently married (62.5%). thirty-five (56.3%) of the respondents were from urban settings. table 2 shows the sources of information on transmission, prevention and treatment of hiv/aids among the respondents. the major sources of information were radio (37.0%), family and friends (27.8%), and television (22.2%). only 1.6% of the participants identified healthcare personnel as their only source of information. table 3 shows the scores of the respondents in the questions on modes of transmission of hiv. all the respondents (100%) knew hiv could be transmitted through unprotected sexual intercourse and transfusion with infected blood and blood products. more than 95% (98.3%) of the participants knew hiv could be transmitted through injury from or use of contaminated needles; 93.8% knew it could be transmitted from mother to child during childbirth; and 90.6% knew it could be transmitted through breast feeding. however, up to 28.1% and 25.0% of the participants believe hiv can be transmitted through kissing and mosquito/insect bites, respectively. table 4 shows the scores of the respondents in questions on the prevention and treatment of hiv infection. more than 95% of the respondents knew hiv transmission could be prevented by abstinence from sexual intercourse, 84.4% knew it could be prevented by use of latex condom, and 81.2% knew it could be prevented by avoiding high risk behaviors such as excessive use of alcohol and/or recreational drugs. however, about 40% of the respondents thought there was commercially available vaccine to prevent hiv infection; 35.9% of the respondents thought that to prevent hiv transmission, all personal items should be separated from the items of infected persons, and 28.1% thought all physical contacts with infected persons should be avoided. forty-seven (73.4%) of the respondents believed hiv/aids was curable. sixty-three (98.4%) of the 64 respondents believed hiv/aids could be cured by prayers, even though 47(73.4%) of the respondents chose yes in the question on whether hiv infection was curable or not. out of the 64 total respondents, 43(67.2%) and 12 (18.8%) believed hiv/aids could be cured with orthodox medicine and traditional medicine (complementary and alternative medicine) respectively. table 5 shows the association between the mean scores in questions on prevention and modes of hiv transmission and the sociodemographic characteristics of the respondents; 75% of the respondents had mean scores of ≥ 75% (high mean score). significant associations were observed between high mean scores and the following socio-demographic characteristics: ethnicity, level of education, and social background. respondents of hausa ethnicity had a higher percentage of those with mean scores of ≥75% (82.4%) than those of non-hausa ethnicity (46.2%) (p=0.013). respondents that had a senior secondary level of education and above had a higher percentage of those with mean scores of ≥ 75% (87.9%) than those with a junior secondary level of education and below (61.3%) (p=0.014). respondents that came from urban settings had a higher percentage of those with mean scores of ≥ 75% (85.7%) than those from rural setting (62.1%) (p=0.030). discussion this study was conducted to assess the knowledge on the common facts (truths) and fictions (lies) that surround hiv transmission, prevention, and treatment among plwha attending adult art-clinic at fmc, birnin kebbi, northwestern nigeria. similar to other studies (7,5,8,9), radio (37.0%) and television (22.0%) were major sources of information for knowledge on hiv infection in this study. this shows the pivotal role that mass-media are capable of playing in providing health education about different kinds of health issues. it is, however, surprising that only 1 out of the 64 respondents (1.6%) indicated res. j. health sci. vol 11(4), december 2023 320 common facts and fictions about hiv transmission, prevention and treatment amoko et al. healthcare personnel as a source of information on hiv infection. this is contrary to findings in some similar studies, such as gupta's study in india, which indicated that 64.7% of the respondents identified healthcare personnel as source of information (5). ojieabu et al.(8) revealed in their study among pregnant women in south-western nigeria, that a relatively lower percentage of the participants indicated medical personnel (36.5%) as a source of information on hiv infection when compared to television (79.2%) and radio (about 60%). these findings may be an indication of the inadequate provision of health education on hiv/aids by healthcare personnel in nigeria. the knowledge of the respondents on ways hiv can be transmitted was very good, with 100% of the respondents knowing that hiv can be transmitted through unprotected sexual intercourse and transfusion with infected blood and blood products. over 90% of them knew hiv can be transmitted through contaminated needles and syringes, contaminated blades or razors, from an infected mother to a child during birth, and through breast feeding. a similar study by gupta in india also showed that high percentage of the respondents knew hiv could be transmitted through unprotected sexual intercourse (82.7%) and transfusion with infected blood (70.7%) (5). the proportions of respondents in gupta's study (5) who knew hiv could be transmitted from mother to child during birth and through breast feeding (38.7% and 22.7% respectively) were, however, well below the findings in our study (93.8% and 90.6% respectively). ojieabu's study among pregnant women also indicated a lower percentage of participants (51.4%) were aware of mother to child transmission of hiv (8). the higher percentage of respondents with knowledge on mother –to-child transmission of hiv in our study may be due to an increase in awareness of mother-to-child transmission of hiv that has come over time with the global campaigns on prevention of mother-to-child transmission of hiv. the performance of the respondents in questions on ways hiv is not usually transmitted was not too impressive, with up to 50% of the participants believing hiv can be transmitted through the sharing of personal items like clothes with the infected person. about 28% of the respondents also believed hiv could be transmitted through kissing, and 25% of them believed hiv could be transmitted through insect or mosquito bites. these findings were similar to those of gupta in india, who found in his study that the percentages of respondents who believed hiv could be transmitted through sharing of personal items, kissing, and mosquito bite were 26.7%, 21.3% and 30.7% respectively (5). mahalasmy et al. (6) in their study in south india found that up to 41% of plwha that participated in their study believed hiv could be transmitted through saliva, toilet seats, casual social touch and mosquito bite. it is surprising that such proportions of respondents could still be holding such misconceptions about hiv transmission. this may be due to significant number of the respondents having little or no formal education (48.4% of respondents had less than senior secondary level of education) which can possibly reduce their ability to access information on hiv infection. questions on facts about prevention of hiv transmission revealed that 95.3% of the respondents were aware that hiv could be prevented by abstinence from sexual intercourse, 84.4% were aware of prevention by the use of latex condoms during sexual intercourse, and 81.2% were aware that the risk of contracting hiv can be significantly reduced by avoiding certain high risk behaviors. durojaiye (7), in his study of the general population among tertiary education students in nigeria, also found that a high percentage of the respondents were aware that hiv transmission can be prevented by abstinence from casual sex (75.5%) and use of condom (80.8%). the study by gupta et al. (5) shows a high percentage of the respondents (70.7%) were aware that hiv transmission can be prevented by use of condom but only 16% of the participants favored complete abstinence as a preventive measure. having a high percentage of respondents aware of the fact that hiv transmission could be prevented by abstinence from sexual intercourse and the use of condoms in our study was good and not surprising, as campaigns on prevention of hiv transmission through the use of a (abstinence), b (be faithful), and c (condom) measures have been popular and in existence for some time. a multilevel analysis study done by uthman et al (10) in ilorin on individuals and contextual socio-economic determinants of knowledge of the abc approach to preventing sexual transmission of hiv in nigeria, showed that about 80% of the respondents were aware of at least one of the components of abc approach to preventing sexual transmission of hiv. in respect to the questions on fictions about prevention of hiv transmission, 28.1% of res. j. health sci. vol 11(4), december 2023 321 common facts and fictions about hiv transmission, prevention and treatment amoko et al. res. j. health sci. vol 11(4), december 2023 322 the respondents thought avoidance of all physical contacts was necessary for prevention of hiv transmission; 35.1% thought all personal items must be separated from the items of the infected persons; and 40.6% thought there was a commercially available vaccine to prevent hiv 5 transmission. gupta et al. also found a significant number of participants in their study, who believed avoidance of physical contacts (28.7%) and separating personal items (18.7%) would help prevent hiv transmission. it is surprising that such misconceptions still exist, particularly among plwha. concerning the treatment of hiv infection, 73.4% of the respondents believed the disease is curable at present; 98.7% believed it can be cured with prayer; 67.2% believed it could be cured with orthodox medicine; and 18.8% believed it can be cured with traditional medicine. up to 73.4% of the respondents believe hiv infection is curable at present, which is surprising. this may be due to high influence of religion in the country. an average nigerian, irrespective of their level of education, believes god can do all things through prayers. this can also be observed in the number of people who believed hiv could be cured with prayers; 98.4% of the respondents believed hiv/aids could be cured with prayer, despite the fact that 73.4% were those who indicated that hiv/aids was curable. a study by oluwabamide and umoh in 2010 on the assessment of the relevance of religion to healthcare delivery in nigeria in akwa ibom, south-south nigeria, revealed that nearly all the participants of the study expressed their total dependence on god for healing regardless of the nature of the illness (11). the number of respondents who believed hiv/aids could be cured with orthodox medicine at present was high (67.2%). 5 gupta et al. in their study also discovered that 31.3% of the respondents believed hiv/aids was curable with early treatment. this kind of information is important as it can be a reflection of the patients' expectations which can affect their compliance with treatment in future, especially when they are no longer symptomatic. it is therefore important to bridge this knowledge gap in managing a patient with hiv infection. it is, however; impressive that despite the claims by many traditional healers that they can cure hiv/aids, only 18.8% of the respondents in this study believed hiv could be cured with traditional medicine. statistically significant associations were found between higher mean scores in questions on modes of transmission and prevention of hiv infection and: 1) hausa ethnicity (p-value=0.013); 2) secondary or higher level of education (p-value=0.014); and 3) being from an urban setting (p-value= 0.003). a similar study done by mahalasmy et al. (6) in southindia in 2011, also showed that urban residents and patients with educational levels above class10 (senior secondary school and above) were more likely to have higher knowledge scores. mehmet's study among university students in xinjiang, china, showed that mean knowledge scores were significantly different by ethnicity, gender, subject major, and year of study in the university (12) the significant association between higher mean scores and hausa ethnicity may be due to the fact that the study was conducted in a place where hausa is the main local language, making access to information on hiv, especially through mass media, easy for the hausa ethnic group. the significantly positive association between higher mean scores, and senior secondary and higher levels of education, may be a result of higher literacy level among this group of respondents, which increases their chances of accessing information on hiv/aids. higher mean scores among respondents from urban settings may be a result of access to more information and communication media in urban areas. conclusion this study reveals a fairly good knowledge of the common facts, and a relatively poor knowledge of some common lies (fictions) about the transmission and prevention of hiv infection among plwha attending adult artclinic at fmc, birnin kebbi, north-western nigeria. there is therefore need to improve knowledge on some common lies (fictions) about hiv transmission, prevention, and treatment among this group of patients.. limitations of the study: the study was conducted among just 64 participants selected by c o n v e n i e n t s a m p l i n g t e c h n i q u e s u s i n g interviewer-administered questionnaires in only one tertiary health centre in north-west nigeria. all these factors are capable of affecting the strength of the findings and should be taken into consideration in generalizing the results. recommendations: we recommend adequate health education of hiv-infected patients, especially by healthcare workers, when attending common facts and fictions about hiv transmission, prevention and treatment amoko et al. to these patients. questions should be asked on transmission, prevention, and treatment of hiv infection each time we come in encounter with these patients in order to clarify issues. acknowledgement: we wish to acknowledge dr, kim picozzi, university of edinburgh, for her tremendous support during this work. conflict of interest: all financial obligations with regard to this study were borne by the researchers, and there was no involvement of any party that could result in a conflict of interest. reference 1. who. hiv: summary of the global hiv epidemic (2018). global health observatory (gho) data. who (2019). available at: https://www.who.int/gho/hiv/en/ accessed 03/09/2022. 2. unaids, 2019. nigeria: overview. available at: https://www.unaids.org/en/regionscountries/co untries/nigeria accessed 08/10/2022 3. bhosale sb, jadhav sl, singru sa, banerjee a. behavioral surveillance survey regarding hiv/aids among high school and junior college students. indian j dermatol venereol leprol 2010;76(1):33-37. 4. goswani s, chakrabory s, mukhopadhyay p. awareness of hiv/aids among pregnant women. indian j sex transm dis aids 2011; 32: 62-63. 5. gupta m, mahajan vk, chauahn ps, mehta ks, rawat r, shiny tr. knowledge, attitude and perception of disease among persons living with human immunodeficiency virus/ acquired immunodeficiency syndrome: a study from a tertiary care centre in north india. indian journal of sexually transmitted diseases and aids 2016; 37(2): 173-177. 6. mahalakshmy t, premarajan kc, abdoul h. correlates of human immunodeficiency virus (hiv)-related knowledge among hiv infected people. indian j dematol venereol leprol 2011; 77(1):37-41. 7. durojaiye oc. knowledge, attitudes and practice of hiv/aids: behavior change among tertiary education students in lagos state, nigeria. ann trop med public health 2011; 4: 18-24. 8. ojieabu wa, femi-oyewole mn, eze ui. hiv/aids knowledge, attitude and risk perception among pregnant women in a teaching hospital, southwestern, nigeria. journal of basic and clinical pharmacy 2011; 2(4): 185-198. 9. taraphdar p, ray tg, halda d, dargupta a, saha b. perceptions of people living with hiv/aids. india j med 2010; 64: 441-447 10. uthman oa, kayale ga, adekanmbi ut. individual and contextual socio-economic determinants of knowledge of abc approach of preventing the sexual transmission of hiv in nigeria: a multilevel analysis. sex health 2013; 10(6): 522-529 11. oluwabamidele a, umoh j. an assessment of the relevance of religion to health care delivery in nigeria: case of akwa ibom state. j social anthropol 2010; 2(1): 47-52. 12. mehmet n, shamsuddin k, tohti a, maimati r. knowledge, attitude and practice regarding hiv/aids among university students in xinjiang. global journal of health sciences 2010;2(2):51-60. res. j. health sci. vol 11(4), december 2023 323 common facts and fictions about hiv transmission, prevention and treatment amoko et al. res. j. health sci. vol 11(4), december 2023 324 table1: socio-demographic characteristics of the respondents. n=64 variable frequency (%) age group (years) <20 20-29 30-39 40-49 50-59 60&above 1(1.6) 10(15.6) 25(39.1) 19(29.7) 8(12.5) 1(1.6) gender female male 39(60.9) 25(39.1) religion islam christianity traditional 58(90.6) 5(7.8) 1(1.6) ethnicity hausa fulani zuru igbo others (minorities) 51(79.6) 2(3.1) 2(3.1) 2(3.1) 7(10.9) level of education none arabic (basic) only primary level junior secondary school level senior secondary school level tertiary level 1 (1.6) 20(31.2) 6(9.4) 4(6.3) 20(31.2) 13(20.3) nationality nigerian non-nigerian 64(100) 0(0) marital status single currently married separated/divorced widow/widower 11(17.2) 40(62.5) 4(6.2) 9(14.1) occupation trading civil service house-wife farming artisan professional schooling unemployed 26(34.4) 12(18.8) 12(18.8) 5(7.8) 5(7.8) 1(1.6) 1(1.6) 6(9.4) social background rural urban 29(49.5) 35(56.7) n= total number of respondent. %= percentage of the variable. ci= confidence interval common facts and fictions about hiv transmission, prevention and treatment amoko et al. res. j. health sci. vol 11(4), december 2023 325 table2: sources of information. n=54 source frequency (%) radio 20(37.0%) television 12 (22.2%) family and friend 15(27.8%) healthcare personnel 1(1.9%) other sources 1(1.9%) multiple sources 5(9.2%) n= total number of respondents. table3: knowledge of respondent on modes of transmission of hiv infection. n=64 question hiv can be transmitted by: yes (%) no (%) don’t know/ can’t remember unprotected sexual intercourse 64(100.0) 0(0.0) 0(0.0) using contaminated needles and syringes 63(98.4) 0(0.0) 1(1.6) transfusion with infected blood and blood products 64(100.0) 0(0.0) 0(0.0) from infected mother to the child during delivery 60(93.8) 2(3.1) 2(3.1) from infected mother to the child through breast feeding 58(90.6) 3(4.7) 3(4.7) by sharing personal items like cloths with the infected person* 32(50) 29(45.3) 3(4.7) by kissing infected person* 18(28.1) 40(62.5) 6(9.4) by holding/shaking hands with the infected person* 2(3.1) 59(92.2) 3(4.7) by living together in the same house with the infected person* 3(4.7) 60(93.7) 1(1.6) by using public toilet* 5(7.6) 53(82.8) 6(9.4) by inhaling droplets from coughing or sneezing of the infected person* 3(4.7) 57(89.1) 4(6.2) through insect or mosquito bite* 16(25.0) 45(70.3) 3(4.7) through contaminated blade/razor 62(96.9) 2(3.1) 0(0.0) n=total number of the respondents. %= percentage of the affected variable *= ways hiv is not transmitted table 4: knowledge and perception of respondents on prevention and cure of hiv infection. n=64 question transmission of hiv can be prevented yes (%) no (%) don’t know/ can’t remember (%) by complete abstinence from sexual intercourse 61(95.3) 3(4.7%) 0(0) by using latex condom during sexual intercourse 54(84.4%) 8(12.5) 2(3.1) by avoiding all physical contacts with infected person* 18(28.1) 44(68.8) 2(3.1) by separating all personal items from the items of the infected person* 23(35.9) 39(60.9) 6(9.4) by avoiding smoking, excessive use of alcohol , use of recreational drugs and other high risk behavior 52(81.2) 6(9.4) 6(9.4) by use of commercially available vaccines* 26(40.6) 26(40.6) 12(18.8) concerning the cure of hiv infection hiv infection is curable 47(73.4) 8(12.5) 9(14.1) hiv infection can be cured with prayers 63(98.4) 1(1.6) 0(0) hiv infection can be cured with orthodox medicines 43(67.2) 11(17.2) 10(15.6) hiv infection can be cured with traditional medicine (cam) 12(18.8) 29(45.3) 23(35.9) n=total number of the respondents. %= percentage of the affected variable; *= fictions about prevention of hiv transmission common facts and fictions about hiv transmission, prevention and treatment amoko et al. res. j. health sci. vol 11(4), december 2023 326 table5: association between the mean scores in questions on prevention and modes of transmission of hiv and socio-demographic characteristics of the respondents. n=64 variable mean scores total n=64 x(%) x2 df p-value <75% of total score n1= 16 x1(%) =75% of total score n2=48 x2(%) age group <20years 20-29 years 30-39 years 40-49 years 50-59 years =60 years 0(0.0) 4(40.0) 5(20.0) 6(31.6) 1(12.5) 0(0.0) 1(100) 6(60.0) 20(80.0) 13(68.4) 7(87.5) 1(100) 1(100) 10(100) 25(100) 19(100) 8(100) 1(100) 3.409 *0.706 gender female male 8(20.5) 8(32.0) 31(79.5) 17(68.0) 39(100) 25(100) 1.072 1 0.300 marital status currently married single separated/divorced widow/widower 10(25.0) 2(18.2) 2(50.0) 2(22.2) 30(75.0) 9(81.8) 2(50.0) 7(71.8) 40(100) 11(100) 4(100) 9(100) 1.761 *0.684 ethnicity hausa non-hausa 9(17.6) 7(53.8) 42(82.4) 6(46.2) 51(100) 13(100) 7.240 1 0.013 educational status jss & below, none sss and above 12(38.7) 4(12.1) 19(61.3) 29(87.9) 31(100) 33(100) 6.027 1 0.014 occupation trading civil service farming housewife artisan professional schooling unemployed 6(27.3) 3(25.0) 1(20.0) 4(33.3) 1(20.0) 0(0.0) 0(0.0) 1(16.7) 16(72.7) 9(75.0) 4(80.0) 8(66.7) 4(80.0) 1(100.) 1(100) 5(83.3) 22(100) 12(100) 5(100) 12(100) 5(100) 1(100) 1(100) 6(100) 1.927 *0.995 religion christianity islam others 2(40.0) 14(24.1) 0(0.0) 3(60.0) 44(75.9) 1(100) 5(100) 58(100) 1(100) 1.305 *0.695 social background rural urban 11(37.9) 5(14.3) 18(62.1) 30(85.7) 29(100) 35(100) 4.729 1 0.030 n=total of respondents; n1=total number of respondents with mean score <75% of the total score; n2=total number of respondents with mean score =75% of the total; x1=number of respondents with mean scor <75% of total score affected by the variable; x2=number of respondents with mean score =75% of total score affected by the variable; x2=chi square value/fisher’s exact test value; df=degree of freedom. * fisher’s exact test was used. common facts and fictions about hiv transmission, prevention and treatment amoko et al. rjhs 11(4).cdr leadership competencies of primary healthcare managers: a cross-sectional quantitative study of high, medium and low performing district councils in tanzania 1,2 3 4 *kingu, u.a. , ismail, j.i. , kibusi, s.m. abstract objectives: this research article examined the leadership competency of primary healthcare facility managers in the selected high, medium and low performing district councils in tanzania. methods: the study was conducted in the selected high, medium and low performing district councils in tanzania. this research used cross sectional quantitative research design. a complete enumeration sampling strategy was employed to inquire data from 102 primary healthcare facility managers. similarly, the statistical package for social sciences (spss version 25) was used to analyse the data. ethically, the permission was granted by the university of dodoma. findings: results revealed that, (72.55%), (66.45%) and (80.39%) of primary healthcare manager were competent and (27.45%), (33.55%), and (19.61%) were less than competent in leading people and teams, leading organisation, and leader quality respectively. conclusions: the study concludes that primary healthcare managers exhibited competent and less than competent levels of leadership competency in all investigated constructs. keywords: leadership competency, primary healthcare managers, lowand middle-income countries. *corresponding author kingu, u.a. email: ukendekingu@yahoo.com 1 department of business administration and management, university of dodoma 2 department of business management, mbeya university of science and technology, mbeya, tanzania 3 4 orcid-no: https://orcid.org/0000-0002-4908-3666 , tanzania department of business administration and management, university of dodoma, tanzania department of public health, university of dodoma, tanzania received: october 11, 2022 accepted: march 22, 2023 published: deceember 15, 2023 original article research journal of health sciences res. j. health sci. vol 11(4), december 2023 307 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.3 compétences de leadership des gestionnaires de soins de santé primaires : une étude quantitative transversale des conseils de district à rendement élevé, moyen et faible en tanzanie 1,2 3 4 *kingu, u.a. , ismail, j.i. , kibusi, s.m. résumé objectif de l'étude : cet article de recherche a examiné les compétences de leadership des gestionnaires d'établissements de soins de santé primaires dans les conseils de district sélectionnés à rendement élevé, moyen et faible en tanzanie. méthode de l'étude : l'étude a été menée dans les conseils de district sélectionnés à rendement élevé, moyen et faible en tanzanie. cette recherche a utilisé une conception de recherche quantitative transversale. une stratégie d'échantillonnage par dénombrement complet a été utilisée pour interroger les données de 102 gestionnaires d'établissements de soins de santé primaires. de même, le package statistique pour les sciences sociales (spss version 25) a été utilisé pour analyser les données. sur le plan éthique, l'autorisation a été accordée par l'université de dodoma. résultat de l'étude: les résultats ont révélé que (72,55 %), (66,45 %) et (80,39 %) des gestionnaires de soins de santé primaires étaient compétents et (27,45 %), (33,55 %) et (19,61 %) étaient moins que compétents pour diriger des personnes et respectivement les équipes, l'organisation dirigeante et la qualité du leader. conclusion: l'étude conclut que les gestionnaires de soins de santé primaires ont fait preuve de niveaux de compétence en leadership compétents et moins que compétents dans tous les concepts étudiés. mots-clés : compétence de leadership, gestionnaires de soins de santé primaires, pays à revenu faible ou intermédiaire. *corresponding author kingu, u.a. email: ukendekingu@yahoo.com 1 department of business administration and management, university of dodoma 2 department of business management, mbeya university of science and technology, mbeya, tanzania 3 4 received: october 11, 2022 accepted: march 22, 2023 published: deceember 15, 2023 orcid-no: https://orcid.org/0000-0002-4908-3666 , tanzania department of business administration and management, university of dodoma, tanzania department of public health, university of dodoma, tanzania article original research journal of health sciences res. j. health sci. vol 11(4), december 2023 308 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.3 introduction assessing the leadership competency of primary healthcare managers in the context of lowand middle-income countries (lmics) is very important (1,11). this is because, its assessment will contribute knowledge and empirical evidence in understanding the leadership competency of primary healthcare managers. similarly, its understood will enable identification of current leadership knowledge and skills, and contributing to support individual and organizational leadership improvement and development (1,2,32). additionally, the support of leadership competency development deemed necessary. since leadership abilities inspire individual and organizational excellence, develop a common vision, and successfully manage change to achieve an organization's strategic goals (3,34). moreover, the ability to lead is also very crucial for the efficient and effective management of hospitals (4,6,7). despite the important need to understand leadership competency among health service managers, limited knowledge and empirical evidence exist in the context of lmics (5,11). the study conducted in south africa found that front line nursing managers at the unit level encountered difficulties in resolving conflict between individuals and generally in the unit (8). similarly, the study by (9) revealed several crucial leadership abilities that need to be developed, according to the quantitative, crosssectional study from four private hospitals in kwazulu-natal, south africa, which examined the efficacy of nurse leaders across the nine leadership dimensions. also, majority of respondents (66.4%) gave doctor-managers worse strategic orientation scores than the median in comparison to the public hospital, a greater percentage of respondents from private hospitals gave their doctor-managers ratings that were higher than the median for the transformation domain's accomplishment oriented and innovation thinking subcomponents. similarly, more respondents from public hospitals said that their doctor-managers performed better than the median figure for information seeking (10). the study by (11) conducted in the eastern region of ghana, investigated the leadership competencies of front-line nursing a cross-sectional, multicenter comparison analysis was conducted in jos metropolis to ascertain and compare perceived leadership competencies of doctor-managers working with public and private hospitals. results reported that, . managers. the study used quantitative crosssectional design. the findings revealed the moderate level of leadership competencies among front-line nursing managers in ghana. on one hand, the study further revealed a high knowledge and ability to apply delegation, higher decision-making skills, and high knowledge and ability to apply conflict resolution at the unit. on the other hand, the lowest score of leadership competency was knowledge of research process and ability to apply the research process. previous scholarly works revealed limited evidence on the leadership competency of health managers (12,13). furthermore, other scholars reported that leadership capabilities are limitedly investigated in most lmics (14). moreover, a study by (15) revealed the limited empirical research on leadership competency related issues at the primary healthcare level in developing countries this has resulted to a considerable knowledge gaps on the leadership competency of health managers in the lmics that substantiate the need to be investigated (14,16). thus, a reliable information is necessary to unveil the evidence on the leadership competency among primary healthcare facility managers in the lmics including tanzania (16,17). that have shown a knowledge gaps that needs to be contributed to. on one hand, if this study will not be conducted there will be a continuing limited knowledge and empirical evidence on the leadership competency among primary healthcare managers in the lmics. on the other hand, the limited knowledge and empirical evidence on the leadership competency of primary healthcare managers leads to limit the understanding of policy makers, stakeholders, health managers and researchers, on whether primary healthcare faciality managers know their leadership roles and have the required capacity. consequently, leads to hinder and limit the efforts to improve leadership competency of the primary healthcare facility managers. with that respect, this research article aimed at contributing to the empirical evidence and knowledge on the leadership competency of primary healthcare facility managers in the lmics including tanzania. materials and methods study settings the study conducted in the three district councils, that were purposively selected based on their category of low, medium, and high performance of health facilities in tanzania (18). . res. j. health sci. vol 11(4), december 2023 309 leadership competencies of primary healthcare managers kingu et al. research design the study used a cross-sectional quantitative descriptive research design. in the cross sectional is whereby the measurable data on the leadership ability of primary healthcare managers were gathered at the same time. also, the statistical evidence indicating the current status as being experienced in a perfectly typical and unchanging natural environment of the variables of interest in the current study was examined in the descriptive phase (19). the descriptive study design was used to reveal precisely what a certain group's characteristics are (20). measuring leadership competency in the current study, management competency assessment project (mcap) framework was adapted to measure leadership competency of primary healthcare facility managers. in the mcap framework, the leading people and organisation domain with the following constructs were assessed. the leading people and teams (abilities to inform and educate influential decision makers, encourage ideas and identify opportunities and empower others to achieve goals indicators). also, leading organization (developing and implementing a shared vision, managing with the broader organisational context as well as engage effectively in organizational decision-making i n d i c a t o r s ) . m o r e o v e r, l e a d e r q u a l i t y (encompasses aspects of flexibility to leadership style with respect to the situation, perseverance to achieve goals, establishing and maintaining personal and professional support network as well as being able to remain calm under pressure) (21). the mcap framework questionnaire with a seven-point likert scale ranging from 1not competent, 2-basic or novice, 3-advanced beginner, and 4-competent with occasional guidance. likewise, 5-competent with no guidance, 6-proficient, and 7-superior expertise. thereafter, the scores from 1 to 4 were considered as less than fully competent meaning primary healthcare facility managers needed assistance in performing their leadership duties and responsibilities. similarly, the scores from 5 to 7 were considered as fully competent, meaning that primary healthcare facility managers do not need assistances in performing their leadership duties and responsibilities (21). pilot study the pilot study was carried out using the questionnaire prior to the start of the actual data collection process. the pre-test of the questionnaire on style and approach was made possible by the pilot research (22,23). pre-testing also provides an opportunity to evaluate if the research tools can gather valid and trustworthy data that is consistent with the study's purpose. prior testing of the questionnaire was conducted at ten primary healthcare facilities. utilizing (1%–10%) of the sample size that deemed sufficient (24). similarly, a range of (5% to 10%) of the sample size was also recommended (25). sampling and data collection the total of 102 public primary healthcare facilities were chosen using the complete enumeration sampling approach from the selected low, medium and high performing district councils. it enlisted the study's participants by contacting managers of public primary healthcare facilities. the data was collected between september and december 2020. survey was conducted to collect quantitative primary data to realize pre-stated objective and responding to research questions. in the survey questionnaires was administered to the primary healthcare facility managers of the public primary healthcare facilities. the survey intended to collect quantitative data related to the leadership competency of primary healthcare facility managers. in order to characterize and investigate relevant variables and constructs, the survey research method was an effective and valid strategy . data analysis the statistical package for socio sciences (spss) version 25 was used to descriptively analyze the quantitative data. the results on the leadership competency of the primary healthcare facility managers were presented using descriptive statistics, including means and standard deviations. ethical consideration the university of dodoma, which is authorized to provide staff and students authorization to conduct research on behalf of the tanzanian government and the tanzania commission for science and technology, gave ethical consent. the selected low, medium and high performing district councils gave their approval for the study in their respective administrative councils after receiving the clearance. the primary healthcare facility managers were asked verbally for their consent. respondents were advised that participation in the study was voluntary and that they might leave (26) res. j. health sci. vol 11(4), december 2023 310 leadership competencies of primary healthcare managers kingu et al. at any time without facing any repercussions. additionally, they received guarantees that all material would be kept confidential and that the study would maintain their identities (27). results and discussion l e a d e r s h i p c o m p e t e n c y o f p r i m a r y healthcare facility managers the leadership competency of the primary healthcare facility managers' ability in leading people and teams, leading organization, and leader quality were analysed. leading people and teams with respect to leading people and teams, primary healthcare facility managers were assessed in their abilities to inform and educate influential decision makers, encourage ideas and identify opportunities and empower others to achieve goals (table 1). findings indicated the least mean competency score of 5.0 was noted in informing and educating influential decision makers as well as leading, developing and evaluating performance to build an effective team. on the other hand, the highest mean competency score of 5.1 was found for all other indicators. also, the overall mean competency of 5.2 was noted in leading people and teams construct (table 1). this establishes that, in all indicators related to leading people and teams primary healthcare facility managers scored slightly above the average mean competency. overall, the results establish that, (27.45%) of the primary healthcare facility managers are less than fully competent, implies that, they needed assistance in performing their duties and responsibilities related to leading people and teams. the rest (72.55%) of the primary healthcare facility managers considered to be fully competent, and that they did not need any form of assistance in performing their duties and responsibilities related to the indicators within leading people and teams construct (table 1). related findings were observed among both the head nurses and directors working in finland with specialized primary healthcare organizations and social care sector of nursing whose mean competency score of leadership competencies was quite good at 2.11 (28). on the other hand, conflicting findings show that those who were educated primarily as clinical experts and healthcare managers frequently lack core competencies of leaders (29). similarly, managers in a study by miller et al., were also found to have low competencies for teambuilding, (30). an explanation of this could be that, the managerial skills between two groups differ according to the characteristics of the respondents (31). similarly, the line managers' awareness of the manager's capacity to build future plans with the team (40%). also, the manager's capacity to forge a unifying goal to unify the team and enable them to work cohesively to deliver (55%), and other skills were among the lowest reported nurse manager competencies. likewise, the line manager is always seeking for ways to recognize and honor excellent performance (46%). additionally, the capability of the line manager to give long-term coaching and mentoring (46%). moreover, the ability of the line manager to identify high potential team members and concentrate development efforts on them (45%) (9). leading organization leading organization aspects of health managers' competency include developing and implementing a shared vision, managing with the broader organisational context as well as engage effectively in organizational decision making (table 2). the study findings indicate that, the least mean competency score of 5.1 was found in managing with reference to the broader organizational context. furthermore, the highest mean competency score of 5.2 was noted in engaging effectively in organizational decision making. the overall mean score competency was 5.1 in leading the organization (table 2). similarly, the findings of the matching nature was witnessed among hospital managers in the south africa, working in the public and private sectors who perceived themselves as relatively more competent in their ability to lead with a mean competency score of 4.02 (33). also, in iran, the mean score of management competency in leadership in general hospitals was found to be good at 3.49 (34). likewise, in south africa, the clinic nursing managers working in gauteng (an urban province) and free state (a mixed urban–rural province) overall rated themselves high on leadership and management with a mean score competency of 8.67 (35). equally, clinic nursing managers rated themselves high in planning and priority setting (8.6) (36). on a similar move, a group of private and public hospital managers in south africa perceived themselves relatively more competent in their ability to plan (4.14) (33). overall, this establishes that, (33.33%) of the primary healthcare facility managers considered themselves less than fully competent, meaning that, (33.33%) of primary healthcare facility managers needed assistance in res. j. health sci. vol 11(4), december 2023 311 leadership competencies of primary healthcare managers kingu et al. performing their managerial duties and responsibilities related to leading organization. the rest, (66.67%) of the primary healthcare facility managers were considered as fully competent, in that they did not need any form of assistance in performing their duties and responsibilities related to the indicators within leading organization construct (table 2). also, m a n a g e r s c o n s i d e r e d t h e m s e l v e s m o r e competent in the dimensions of leadership and strategic management (37). additionally, the greatest reported nurse manager competency scores (73%) were found to be in motivating a shared purpose (9). leader quality the leader quality encompasses aspects of flexibility to leadership style with respect to the situation, perseverance to achieve goals, establishing and maintaining personal and professional support network as well as being able to remain calm under pressure (table 3). the study findings indicate the highest mean competency score of 5.5 in adapting leadership style to suit the situation (table 3). this implies that, primary healthcare facility managers were more capable in adapting leadership style to suit the situation. the results indicate further that, the majority (38.24%) of the primary healthcare facility managers rated themselves at the proficient level of managerial competency in the area of leader quality. this communicate that (38.18%) of the primary healthcare facility m a n a g e r s a l w a y s a p p l i e d c o m p e t e n c y appropriately in their role and with extensive experience in performing their duties and responsibilities related to the indicators within leader quality construct (table 3). overall, this establish that, (19.6%) of the primary healthcare facility managers were considered less than fully competent, meaning that, primary healthcare facility managers needed assistance in performing their managerial duties and responsibilities related to leader quality. the rest, (80.4%) of the primary healthcare facility managers were considered to be fully competent, in that they did not need any form of assistance in performing their duties and responsibilities related to the indicators within leader quality construct (table 3). this proves that, in the pool of primary healthcare facility managers, more than three quarter of them were capable in demonstrating competency in their managerial duties and responsibilities related to leader quality without any assistance. this higher rating in leadership could also be explained by the reflection that, some key issues in the leadership were taught in their formal clinical classes. conclusion overall, the study establishes that, (27.45%) and (72.55%) of the primary healthcare facility managers considered themselves as less than fully competent and full competent respectively related to the indicators within leading people and teams. similarly, (33.33%) and (66.67%) of the primary healthcare facility managers are less than full competent and full competent respectively in the indicators within leading organization construct. moreover, (19.6%) and (80.4%) of the primary healthcare facility managers were considered less than fully competent and fully competent respectively in performing their duties and responsibilities related to the indicators within leader quality construct. recommendations there is a need to improve leadership competency of primary healthcare facility managers, in the areas of leading people and teams, leading organization and the leader quality. the emphasis should be more prominence in leading organization that revealed to have a large proportion of primary healthcare facility managers perceived to be less than competent. also, based the evidence that training is a tool to strengthen key managerial competencies backs up the recommendations . similarly, training leadership is crucial due to the need for learning and renewal brought on by ongoing organizational changes . similarly, the capability of health service management to deal with complex as well as dynamic nature of health system has empirically evidenced to be improved potentially by formal training and education, continuous professional development, on the job coaching, mentoring, role modelling work-based as well as experiential learning . conflict of interest: the authors declare no conflict of interest. acknowledgement: the research acknowledges the financial support from mbeya university of science and technology. author’s contribution: kingu ua, ismail ji and kibusi sm carried out the proposal development, data collection, data analysis, manuscript preparation res. j. health sci. vol 11(4), december 2023 312 leadership competencies of primary healthcare managers kingu et al. res. j. health sci. vol 11(4), december 2023 313 references 1. alison d. t, scott, v & gilson l. enabling relational leadership in primary healthcare s e t t i n g s : l e s s o n s f r o m t h e d i a l h s collaboration. health policy and planning. 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(2017);38(4):576-587. 40. briggs, d. s, smyth, a & anderson, ja. in search of capable health managers: what is distinctive about health management and why does it matter? asia pacific journal of health m a n a g e m e n t 2 0 1 2 ; 7 ( 2 ) : 7 1 7 8 . links/552c553b0cf21acb0920c78b leadership competencies of primary healthcare managers kingu et al. table 1: summary of statistics for leading people and teams indicators statement not competent basic/ novice adv beginner comp, guidance comp, no guidance proficient super expert m (sd) informs and educates decision makers 0 (0.00) 7 (6.86) 10 (9.80) 25 (24.51) 12 (11.76) 26 (25.49) 22 (21.57) 5.0 (1.5) leads and evaluates performance 0 (0.00) 2 (1.96) 10 (9.80) 27 (26.47) 19 (18.63) 28 (27.45) 16 (15.69) 5.1 (1.3) empowers others to achieve goals 0 (0.00) 4 (3.92) 12 (11.76) 17 (16.67) 20 (19.61) 30 (29.41) 19 (18.63) 5.1 (1.4) identifies opportunities 0 (0.00) 2 (1.96) 13 (12.75) 18 (17.65) 24 (23.53) 33 (32.35) 12 (11.76) 5.1 (1.3) leading people and teams 0 (0.00) 2 (1.96) 8 (7.84) 18 (17.65) 26 (25.49) 35 (34.31) 13 (12.75) 5.2 (1.2) table 2: summary of statistics for leading organization indicators statement not competent basic/ novice adv beginner comp, guidance comp, no guidace proficient super expert m (sd) develops and implements vision 0 (0.00) 3 (2.94) 7 (6.68) 25 (24.51) 16 (15.69) 35 (34.31) 16 (15.69) 5.2 (1.3) manages with the broader org. context 0 (0.00) 3 (2.94) 11 (10.78) 21 (20.59) 19 (18.63) 35 (34.31) 13 (12.75) 5.1 (1.3) engages in org. decisionmaking 0 (0.00) 4 (3.92) 5 (4.9) 26 (25.49) 16 (15.69) 33 (32.35) 18 (17.65) 5.2 (1.3) overall leading 0 (0.00) 1 (0.98) 9 (8.82) 24 (23.53) 22 (21.57) 33 (32.35) 13 (12.75) 5.1 (1.2) leadership competencies of primary healthcare managers kingu et al. res. j. health sci. vol 11(4), december 2023 315 table 3: summary of statistics for leader quality indicators statement not competent basic/ novice adv beginner comp, guidance comp, no guidace proficient super expert m (sd) adapts leadership style to suit the situation 0 (0.00) 6 (5.88) 5 (4.90) 10 (9.80) 18 (17.65) 36 (35.29) 27 (26.47) 5.5 (1.4) establishes and maintains network 0 (0.00) 4 (3.92) 5 (4.90) 18 (17.65) 21 (20.59) 38 (37.25) 16 (15.69) 5.3 (1.3) perseveres to achieve goals 1 (0.98) 5 (4.90) 5 (4.90) 12 (11.76) 25 (24.51) 36 (35.29) 18 (17.65) 5.3 (1.4) demonstrates confidence and commitment 0 (0.00) 1 (0.98) 13 (12.75) 14 (13.73) 18 (17.65) 38 (37.25) 18 (17.65) 5.3 (1.3) remains calm under pressure 0 (0.00) 6 (5.88) 8 (7.84) 14 (13.73) 13 (13.73) 38 (37.25) 23 (22.55) 5.4 (1.5) overall 0 (0.00) 2 (1.96) 6 (5.88) 12 (11.76) 31 (30.39) 39 (38.24) 12 (11.76) 5.3 (1.1) leadership competencies of primary healthcare managers kingu et al. res. j. health sci. vol 11(4), december 2023 316 rjhs 11(4).cdr biologic quality of households' drinking-water in an urban local government area of oyo state, southwest, nigeria. 1 2 3 4 3 5 *israel o.k. , olotu a.a. , idowu a. , ojewuyi a.r. , odusan m.o. , adeniji o.a. abstract background: inadequate access to water, sanitation, and hygiene (wash) facilities is a global public health issue with several associated illnesses, particularly in developing countries like nigeria. it is imperative to understand the availabilities of these facilities, to provide baseline data for policy design and implementation. this study assessed access to wash facilities. it also examined the factors associated with drinking-water contamination by coliform organisms in households within ogbomoso north local government area, oyo-state, nigeria. methods: cross-sectional design was employed and a two-stage cluster-sampling method was used to recruit eligible respondents from 100 households. interviewer-administer, semi-structured questionnaire was used to collect data. chi-square test and binary logistic regression were used for inferential statistics. results: mean age of respondents was 40.5±16.7years, 81.0% of the households practiced open defecation, and 78.9% of those with toilet facilities used pit latrines. the most common water source was borehole (71.6%); available within 5 minutes walking distance to residence of 68.0% of study participants. sixty-three percent of the households had high drinking water coliform counts. high drinking-water coliform counts were influenced by the presence or absence of toilets facilities (or=4.61, ci=1.22-1.68), types of toilets (or=2.63, ci=3.22-5.34), and water sources (or=0.12, ci=0.47-0.68). conclusion: access to good quality water and basic sanitation facilities is sub-optimal in the study setting despite being an urban community. authors advocate for more vibrant and intentional government efforts at ensuring equitable access to wash facilities in the nigerian communities. this is to fast-track the nation's journey towards the actualization of the sustainable development goal (sdg)-6. keywords: coliform organism, water quality, households, hygiene, nigeria. *corresponding author israel o.k. email address: okisrael@lautech.edu.ng 1 department of community medicine, college of health sciences, ladoke akintola university of technology, ogbomoso, nigeria 2 department of medical microbiology, bowen university teaching hospital, ogbomoso, nigeria 3 department of community medicine, bowen university teaching hospital, ogbomoso, nigeria 4 department of medical microbiology and parasitology, college of health sciences, osun state university, osogbo, nigeria 5 department of medical microbiology and parasitology, college of health sciences, ladoke akintola university of technology, ogbomoso, nigeria , 2023 orcid-no: https://orcid.org/0000-0001-8839-8217 received: april 16, 2022 accepted: may 29, 2023 ` published: december 15 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.8 res. j. health sci. vol 11(4), december 2023 353 original article research journal of health sciences qualité biologique de l'eau potable des ménages dans une zone de gouvernement local urbain de l'état d'oyo, au sud-ouest du nigéria. 1 2 3 4 3 5 *israel o.k. , olotu a.a. , idowu a. , ojewuyi a.r. , odusan m.o. , adeniji o.a. résumé contexte général de l'étude : l'accès insuffisant aux installations d'eau, d'assainissement et d'hygiène (eah) est un problème mondial de santé publique avec plusieurs maladies associées, en particulier dans les pays en développement comme le nigéria. il est impératif de comprendre les disponibilités de ces installations, afin de fournir des données de référence pour la conception et la mise en œuvre des politiques. cette étude a évalué l'accès aux installations eah. il a également examiné les facteurs associés à la contamination de l'eau potable par des organismes coliformes dans les ménages de la zone de gouvernement local d'ogbomoso north, dans l'état d'oyo, au nigéria. méthode de l'étude : une conception transversale a été utilisée et une méthode d'échantillonnage en grappes à deux degrés a été utilisée pour recruter des répondants éligibles dans 100 ménages. l'intervieweur-administré, un questionnaire semi-structuré a été utilisé pour recueillir les données. le test du chi carré et la régression logistique binaire ont été utilisés pour les statistiques inférentielles. résultat de l'étude : l'âge moyen des répondants était de 40,5 ± 16,7 ans, 81,0 % des ménages pratiquaient la défécation à l'air libre et78, 9 % de ceux qui disposaient de toilettes utilisaient des latrines à fosse. la source d'eau la plus courante était le forage (71,6 %) ; disponible à moins de 5 minutes à pied de la résidence de 68,0 % des participants à l'étude. soixante-trois pour cent des ménages avaient un nombre élevé de coliformes dans l'eau potable. le nombre élevé de coliformes dans l'eau potable était influencé par la présence ou l'absence de toilettes (or = 4,61, ic = 1,22-1,68), les types de toilettes (or = 2,63, ic = 3,22-5,34) et les sources d'eau (or = 0,12, ic=0,47-0,68). conclusion : l'accès à une eau de bonne qualité et à des installations sanitaires de base est sous-optimal dans le cadre de l'étude, bien qu'il s'agisse d'une communauté urbaine. les auteurs plaident pour des efforts gouvernementaux plus dynamiques et intentionnels pour assurer un accès équitable aux installations wash dans les communautés nigérianes. il s'agit d'accélérer le parcours de la nation vers l'actualisation de l'objectif de développement durable (odd)-6. mots-clés : organisme coliforme, qualité de l'eau, ménages, hygiène, nigéria *corresponding author israel o.k. email address: okisrael@lautech.edu.ng 1 department of community medicine, college of health sciences, ladoke akintola university of technology, ogbomoso, nigeria 2 department of medical microbiology, bowen university teaching hospital, ogbomoso, nigeria 3 department of community medicine, bowen university teaching hospital, ogbomoso, nigeria 4 department of medical microbiology and parasitology, college of health sciences, osun state university, osogbo, nigeria 5 department of medical microbiology and parasitology, college of health sciences, ladoke akintola university of technology, ogbomoso, nigeria received: april 16, 2022 accepted: may 29, 2023 ` published: december 15, 2023 orcid-no: https://orcid.org/0000-0001-8839-8217 article original research journal of health sciences res. j. health sci. vol 11(4), december 2023 354 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.8 introduction inadequate access to good quality water and sanitation facilities is a global public health issue. according to the world health organization (who), about 740 million people worldwide do not have access to improved water sources while nothing less than 173 million people still obtain their domestic water from untreated surface waters (1). meanwhile, access to potable water and basic sanitation is now a fundamental human right issue. as such, nigeria was a signatory to the 2010 united nations general assembly declaration of the right to water (2,3). this pact was supposed to enable all nigerians to have access to potable water for personal and domestic uses. according to who, only about 19% of the people in nigeria have access to safe and clean drinking water, even though 70% of the nigerian population have access to basic water supply (4). there are several implications of lack of access to good quality water in any community. it has been estimated that 88% of diarrhoea related deaths globally is as a result of unsafe drinking water supply, inadequate sanitation and hygiene (5). also, improved water supply has been demonstrated to have the potential of reducing diarrhoea incidence by 6-25% (3). diarrhoea accounted for 8 percent of all deaths among under-five children worldwide in 2016 (6,7). this shows that about 1,300 young children die daily and about 480,000 of them die annually of diarrhoea disease (7). yearly, nigeria suffers from the immense socio-economic impacts of outbreaks of diseases such as cholera and typhoid fever which are both water-related diseases. according to united nations children's funds (unicef), not less than 70,000 under-five children are lost to diarrhoea disease annually (8). the 2018 national demographic and health survey (ndhs) report for nigeria reported that 13% of under-five children had diarrhoea episodes within two weeks preceding the survey. majority of these needless childhood deaths were associated with poor quality of water in most communities (9). thus, the united nations' sustainable development goal (sdg) 6 calls for universal access to safe and affordable drinking water, sanitation, and hygiene (wash), also to end open defecation. water quality assessment surveys often involve evaluating its physical, chemical, and biological characteristics. however, our study assessed the biological characteristics of household drinking water by estimating coliform counts in the water. the who has stated that getting water from improved sources does not entirely guarantee that the water cannot be contaminated at one point or another. thus, assessing the quality of drinking water is an important step in preventing many infections and other diseases in the human population. the presence and concentration of coliforms organisms in domestic waters have been used as a very good indicator of faecal water-contamination (10). the coliform group of organisms is composed of strains of the four genera of the intestinal group: escherichia, enterobacter, klebsiella, and citrobacter of which escherichia and enterobacter cells are the most predominant in human intestine (10). coliform count is the test of water contamination in which the number of colonies of coliform bacteria (e. coli) per 100ml of water are counted (11). ideally, drinking water should not contain any coliform organism/100ml of water tested (12). however, coliform count of 1-2 coliform/100ml of water may be acceptable in developing countries; 3-10 coliform/100ml is doubtful while ≥11coliform/100ml indicates heavy faecal pollution of the water (12). out of all the coliform organisms, the presence of e. coli in drinking water has been used as the most reliable yardstick of measuring the occurrence of recent faecal contamination of drinking water and a breakdown of the water treatment process since the organism is almost exclusively of faecal origin (13). the presence of e coli also indicates the possible presence of many other faeco-orally transmitted diseases in the water. most previous studies had focused on determining water-qualities from water sources such as rivers and streams, the current study aimed at assessing water quality at the point-ofuse (households). the study aimed at providing base-line information on quality and adequacy of drinking-water in ogbomoso town. this information can help governments and policy makers in the field of environmental health to intensify efforts at combatting several waterrelated diseases by providing potable drinkingwater to every household in nigeria. materials and methods the study was conducted in selected communities within ogbomoso north local government area (lga). the lga has a projected population of 284,200 as at 2022 by the national bureau of statistics (nbs) (14). the predominant religions of the inhabitants of the lga are christianity, islam, and traditional religions. the main occupation of people in the res. j. health sci. vol 11(4), december 2023 355 water quality in an urban community of oyo state, nigeria idowu et al. lga include farming and trading but civil servants constitute a large percentage of the people. while some households in the lga are irregularly supplied with pipe-borne water from the oyo state water corporation, most people access to water through other means such as well water, bore-holes, rainwater, and surface water from streams and springs. this was a descriptive cross-sectional study among heads of household or their partners who were at least 18 years of age and had consistently resided in the selected communities for a minimum of three months. leslie kish 2 2 formula (n = z (pq)/d ) was used to estimate the á minimum sample size for the study. where; n = minimum sample size required in population greater than 10,000, z = standard normal deviate á of 1.96 at 95% confidence level, d = desired level of precision (margin of error) = 5%, p = proportion of water sample with e-coli from previous study = 95% (15) and q=1-p. a minimum sample size of 100 was estimated for the study after adjusting for non-response. the study employed cluster sampling method in recruiting study participants. line listing of all the 10 electoral wards within ogbomoso north lga was first made; each of the wards constituted a cluster, thus a sampling frame of 10 wards was drawn. two wards (isale alasa and isale ora wards) were selected using simple random sampling method (balloting) from the sampling frame made. all the households in the two chosen electoral wards with eligible respondents were visited for the survey. in houses with more than one eligible respondent, one of such respondents was chosen using simple random sampling method (balloting). the study made use of a semi-structured, i n t e r v i e w e ra d m i n i s t e r e d q u e s t i o n n a i r e developed by reviewing previous studies on our topic. the questionnaire collected information on the socio-demographic characteristics of the respondents, their most common sources of drinking water, and household's sanitation facilities. the questionnaire was interpreted into yoruba language for respondents who were more comfortable answering in their local language and back translation into english language was done to preserve the original meaning of the questions asked. data were collected over a period of one month (november 2022) by ten nursing students of bowen university teaching hospital (buth), ogbomoso. they were trained on questionnaire administration and household water collection procedures by public health experts in the department of community medicine, buth, over a period of three days. the training involved practical sessions and demonstrations. the questionnaire was pretested at low-cost estate area of ogbomoso south lga which was not part of those selected for the main study. the exercise helped us to identify some ambiguous questions. such questions were either re-phrased or removed completely in line with our study objectives. laboratory procedures for drinking water coliform count: the multiple fermentation tube technique t h e m u l t i p l e f e r m e n t a t i o n t u b e technique (16) was used in the analysis of the water sample collected from each household included in this study to determine the most probable number (mpn) index of coliform bacteria present per 100ml of the sample. about 75mls of drinking water was collected from individual homes into sterile bottles and separate analysis was conducted on 15 portions for each of the test samples: 5 portions of 10mls, 5 portions of 1mls, and 5 portions of 0.1mls each. each portion was added into 10mls each of single-strength macconkey broth in test tubes with inverted durham tubes. the sample-medium solution was mixed gently and incubated for 48 hours at 37°c aerobic condition for total coliforms. the test tubes which showed turbidity, gas production, and colour change indicating acid production was regarded as positive. the mpn index and 95% p e r c e n t c o n f i d e n c e l i m i t s f o r v a r i o u s combinations of positive results provided for testing drinking were used to interpret the result (13). results were expressed as most probable number (mpn) index of coliforms per 100 ml of drinking water. the same process was followed for all the samples and asepsis was maintained at all steps. the main outcome variable was high coliform count. this was defined as presence of at least 11 coliform organism/100mls of household water (16). each questionnaire was field edited daily before entering the data into statistical product and service solutions (spss, version 23) for analysis. data presentation was carried out using tables and charts, mean and standard deviation were used as summary statistics for continuous variables while chi-square test was used to compare categorical variables. a stepwise binary regression model was built at the multivariate level. variables imputed into the model were chosen based on whether they were statistically res. j. health sci. 356vol 11(3) water quality in an urban community of oyo state, nigeria idowu et al. significant at the bivariate level. confidence intervals and p-values were obtained to identify significant predictors of at least 11 coliform organisms per 100ml of water. approval to conduct the study was obtained from the ethical review committee of buth, ogbomoso. moreover, permission to conduct the study was obtained from leaders of the communities chosen for the study. respondents were assured of the confidentiality of the information obtained from them during the study; this was done by ensuring that their names were not collected during the interview. also, information collected from respondents was entered into a computer that was only accessible to the researchers. study participation was entirely voluntary, written consents were obtained from each participant before they were allowed to take part in the study. there was no discrimination in the selection of respondents. results the mean age of our respondents was 40.5±16.9years while more than half (52.0%) of them were 20-39 years of age. eighty percent of the respondents were females, 86.0% of them were married and 64.0% were christians by religion. respondents with primary education constituted the highest proportion (36.0%) while 41.0% of them were traders (table 1). more than three-quarter (78.0%) of the households visited had at least four inhabitants, 81.0% of the households had no toilet facilities while 78.9% of those with toilet facilities used pit latrines. the most consistent water source in the study population was borehole; reported by 71.6% of the households visited, only 1.7% of them had access to piped borne water (figure 1). sixty-one percent of the households did not have a satisfactory safe water supply all year round; 68.0% of the households had potable water available within 5 minutes walking distance to their residential homes but 18.0% of them walk for about 30 minutes to access good quality water. almost all (96.0%) of the respondent do not employ any domestic water treatment method before drinking. only 37.0% of the households had 0-2 coliform counts per 100ml of water; 31.0% had 10-100 coliform organisms per 100ml of water while 17.0% of them had more than 100 coliform counts per 100ml of water (table 2). in table 3, households without toilet facilities had 5 times increased odds of having water coliform counts of at least 11/100ml of water when compared to those with toilets (or=4.61, ci=1.22-1.68). households using pit latrines to dispose of faecal matters were 3 times more likely to have coliform counts of 11 or more per 100ml of water than those with improved sanitation facilities (or=2.63, ci=3.22-5.34). similarly, households with boreholes as their most stable water sources were 12 times less likely to have high coliform counts of at least 11/100ml of water when compared with those with other water sources (or=0.12, ci=0.470.68) discussion our study assessed the adequacy of wash facilities and examined the biological characteristics of households' drinking water by analysing water coliform counts in the selected clusters within ogbomoso town. the study revealed that 81.0% of the households visited had no toilet facilities (were practising open defecation) while 78.9% of those with toilet facilities utilized pit latrines in disposing faecal matters. several studies had revealed poor levels of sanitary facilities in nigeria. the main report of the 2016/2017 multiple indicator cluster survey revealed that only 35.9% of nigerian households used improved sanitation while just 58.1% of women used safe disposal systems for child's faeces (17). also, in 2018, alphonsus et al., showed that 71.7% of households in edo state nigeria used pit latrines while 28.3% had no form of toilets (18). similarly, a study in bayelsa state published in early 2019 by raimi et al., revealed that 33.8% of the survey participants used open defecation (19). yet, empirical pieces of evidence have linked poor household's sanitation systems to the occurrence of different water-borne diseases due to increased risks of water contamination from such faecal disposal systems (20). the most consistent water source in our study population was borehole; this was reported by 71.6% of the households visited (mainly through the purchase of water from nearby borehole owners but not by individual ownerships). only 1.7% of our study participants had access to piped-borne water (this is in spite of the availability of municipal water treatment plants in the community). meanwhile, 68.0% of the households stated that they had potable water available within 5-kilometer walking distance to their residential homes but 18.0% of them had to walk for about 30 minutes to access good quality water, this contradicts the specification according to the world health organization (who) that the water source has to be within 1,000 metres (1km) of the home and collection time should not res. j. health sci. vol 11(4), december 2023 357 water quality in an urban community of oyo state, nigeria idowu et al. exceed 30 minutes (21). almost all (96.0) of the respondent do not employ any domestic water treatment method before drinking. our findings are in agreement with findings from the 2016-2017 nigerian mics in which 64.1% of households had access to improved water sources and only 2.3% of them practiced domestic water treatment before drinking (17). worst still, unicef revealed that only 26.5% of nigerian households have access to improved water sources and sanitation facilities (8). thus, the authors advocate for improved government efforts at providing good quality water to nigerians. strong associations existed between households' water and sanitation status and the presence of faecal coliform organisms in the drinking water of participants in the current study. households without toilet facilities had 5 times increased odds of having high water coliform counts when compared to those with toilet facilities. households using pit latrines to dispose of faecal matters were 3 times more likely to have high drinking-water coliform counts than those with improved toilet facilities. however, households with borehole as their most stable water sources were 12 times less likely to have high drinking-water coliform counts when compared with those with other water sources. these findings are in consonance with reports from similar studies (22,23). thus, the environmental unit of ogbomoso north lga should be more alert in discharging their responsibilities. abatement notices should be issued to houses without basic sanitation facilities as enshrined in the nigerian public health laws. considering the main findings of the current study, achieving sdg 3 by 2030 remains an uphill task in nigeria as poor access to improved wash facilities continues to pose a serious threat to the health of nigerians. to solve this critical problem, the authors advocate that the nigerian government needs to increase budgetary allocation to the provision of wash facilities/services. there is an urgent need to enforce the existing law against open defecation in nigeria as most of our respondents engaged in such practice. also, there is dire need for the construction of public toilets in most communities of nigeria since many households in rural /peri-urban communities lack this sanitary facility. the existing monthly sanitation exercise needs urgent review for service improvement. oyo state government needs as a matter of urgency to revamp and expand the capacity of the oyo state water corporation to provide good quality and sustained water supply to the populace. study limitation: due to the paucity of funds, this study was conducted among residents of two electoral wards in ogbomoso north lga. it may be difficult to generalise the findings from this survey on the entire nigerian communities. however, the external validity of the study may have been improved due to the robust sampling technique used by the authors. conclusion water supply and sanitation facilities were sub-optimal in the study population. many houses had evidences of high drinking-water coliform contamination. there is a need for review and/or design as well as implementation of cost-effective and equitablse wash policies in nigeria in order to achieve the 2030 target of sdg 6. conflict of interest: the authors declare that there is no conflict of interest in conducting this research. a c k n o w l e d g e m e n t : a u t h o r s w i s h t o acknowledge the community leaders and the good people of alasa and isale ora community of ogbomoso north lga where the study was conducted. we also appreciate all the school of nursing students of buth, ogbomoso, who assisted in data collection. funding. the study was 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widowed 13 13.0 separated 1 1.0 religion christianity 64 64.0 islam 33 33.0 traditional 3 3.0 level of education no formal education 31 31.0 primary 36 36.0 secondary 7 7.0 tertiary 26 26.0 occupational type civil servant 4 4.0 self employed 29 29.0 artisan 19 19.0 unemployed 5 5.0 trader 41 41.0 others 2 2.0 water quality in an urban community of oyo state, nigeria idowu et al. res. j. health sci. vol 11(4), december 2023 361 table 2: respondents’ household characteristics (n= 100) variable frequency percent (%) number of persons per household 2-3 22 22.0 =4 78 78.0 have a toilet in the house yes 19 19.0 no 81 81.0 type of toilet n=19 pit latrine 15 78.9 vip latrine 1 5.3 water closet 3 15.8 others 0 0.0 satisfactory water supplies all year round yes 61 61.0 no 39 39.0 average walking distance to the source of potable water i have quality water source in my house 11 11.0 within 5minutes 68 68.0 within 30minutes 18 18.0 =30 minutes 3 3.0 treats water before drinking yes 4 4.0 no 96 96.0 water storage method nil 2 2.0 mud-pot 24 24.0 plastic containers 72 72.0 fridge/freezer 2 2.0 water dispenser 0 0.0 others 0 0.0 household water coliform count/100ml <2 37 37.0 3-9 15 15.0 10-100 31 31.0 >100 17 17.0 water quality in an urban community of oyo state, nigeria idowu et al. res. j. health sci. vol 11(4), december 2023 362 table 3: determinants of levels of faecal coliform counts in households’ drinking water variable water coliform count x2 p-value odds ratio 95% ci 0-10/100ml n=52 n(%) =11/100ml n=48 n(%) number of persons per household 0.073 0.787 1.14 0.44 – 2.94 2-3 12 (54.5) 10 (45.5) =4 40 (51.3) 38 (48.7) have a toilet in the house 0.920 0.002* 4.61 1.22 – 1.68 yes 15 (79.0) 4 (21.0) no 37 (45.7) 44 (54.3) type of toilet 0.608 0.001* 2.63 3.22 – 5.34 pit latrine 7 (46.7) 8 (53.3) others 3 (75.0) 1 (25.0) satisfactory water supplies all year round 0.087 0.768 0.89 0.39 – 1.98 yes 31 (50.80 30 (49.2) no 21 (53.8) 18 (46.2) average walking distance to the source of potable water 0.670 0.413 0.58 0.16 – 2.14 i have quality water source in my house 7 (63.6) 4 (36.4) within a distance 45 (50.6) 44 (49.4) treats water before drinking 1.217 0.270 0.29 0.03 – 2.93 yes 1 (25.0) 3 (75.0) no 51 (53.1) 45 (46.9) sources of drinking water 0.062 0.000* 0.12 0.47 – 0.68 borehole 40 (91.0) 4 (9.0) others 11 (19.6) 45 (80.1) *statistically significant figure 1: sources of households’ drinking water water quality in an urban community of oyo state, nigeria idowu et al. rjhs 11(4).cdr determinants of cervical cancer screening uptake among female staff in a multicampus university in south-western nigeria 1 1 2 2 1 *farinloye, e.o. , abiodun, o.m. , omisore, b. , olowookere, s.a. , fafowora, r.o. , 1 1 1 omobuwa, o. , adeyemo, m.o.a. , tajudeen, w.a. abstract backgroundcervical cancer remains a leading cause of morbidity and mortality among women in developing countries despite the availability of screening tests that could detect pre-cancerous conditions. the aim was to assess the respondents' level of knowledge and attitude towards cervical cancer screening as well as to identify factors predictive of screening uptake. methodologya cross-sectional survey of 150 female staff of osun state university, south western nigeria selected across campuses by multi-stage sampling. data was collected with the aid of semistructured questionnaire and analysed using descriptive and inferential statistics. resultsthe mean age for the respondents was 34.7 (±8.32) years. majority (80%) of the respondents were aware of cancer of the cervix but only 40% had good knowledge of the disease. about 77.5% of the respondents had a good attitude towards its screening. only 21 (%) had ever done cervical cancer screening. factors associated with cervical cancer screening uptake include age, income, level of education, staff category, respondents' belief on general availability of cervical screening, attitude, having known a person with cervical cancer, having had information through counseling on cervical cancer as well as respondents' knowledge of cervical cancer. the latter two are predictive of screening uptake. respondents with good knowledge were about four times likely to have had cervical cancer screening compared with respondents with poor knowledge. conclusionmajority of the respondents had poor knowledge of cervical cancer but good attitude towards its screening. identifiable determinants of cervical cancer screening uptake were knowledgebased, thus continuous enlightenment of women of all age-groups becomes imperative. key wordsattitude, cervical cancer, determinants, knowledge, pap smear, screening uptake *corresponding author farinloye e.o. email: emmanuel.farinloye@uniosun.edu.ng 1 college of health sciences, osun state university, osogbo (main campus), osun state, nigeria. 2 department of family medicine, oauthc, ile-ife, nigeria received: june 6, 2023 accepted: july 16, 2023 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v10i4.13 res. j. health sci. vol 11(4) 393 original article research journal of health sciences déterminants du recours au dépistage du cancer du col de l'utérus chez le personnel féminin d'une université multicampus du sudouest du nigéria abstrait contexte général de l'étude : le cancer du col de l'utérus demeure l'une des principales causes de morbidité et de mortalité chez les femmes dans les pays en développement malgré la disponibilité de tests de dépistage qui pourraient détecter des affections précancéreuses. évaluer le niveau de connaissances et l'attitude des répondants à l'égard du dépistage du cancer du col de l'utérus ainsi que d'identifier les facteurs prédictifs du recours au dépistage. méthode de l'étude : une enquête transversale auprès de 150 membres du personnel féminin de l'université d'état d'osun, au sud-ouest du nigéria, sélectionnées sur les campus par échantillonnage à plusieurs degrés. les données ont été recueillies à l'aide d'un questionnaire semi-structuré et analysées à l'aide de statistiques descriptives et inférentielles. résultat de l'étude : l'âge moyen des répondants était de 34,7 (±8,32) ans. la majorité (80%) des répondants était au courant du cancer du col de l'utérus mais seulement 40% avaient une bonne connaissance de la maladie. environ 77,5% des répondants avaient une bonne attitude envers son dépistage. seulement 21 (%) avaient déjà effectué un dépistage du cancer du col de l'utérus. les facteurs associés au recours au dépistage du cancer du col de l'utérus comprennent l'âge, le revenu, le niveau d'éducation, la catégorie de personnel, la croyance des répondants quant à la disponibilité générale du dépistage du col de l'utérus, l'attitude, le fait d'avoir connu une personne atteinte d'un cancer du col de l'utérus, d'avoir eu des informations par le biais de conseils sur le cancer du col de l'utérus ainsi que connaissances des répondants sur le cancer du col de l'utérus. les deux derniers sont prédictifs du recours au dépistage. les répondants ayant de bonnes connaissances étaient environ quatre fois susceptibles d'avoir subi un dépistage du cancer du col de l'utérus par rapport aux répondants ayant de faibles connaissances. conclusion : la majorité des répondants avaient une mauvaise connaissance du cancer du col de l'utérus mais une bonne attitude envers son dépistage. les déterminants identifiables du recours au dépistage du cancer du col de l'utérus étaient fondés sur les connaissances, de sorte qu'il devient impératif d'éclairer en permanence les femmes de tous les groupes d'âge. mots-clés : attitude, cancer du col de l'utérus, déterminants, connaissances, frottis de pap, participation au dépistage 1 1 2 2 1 *farinloye, e.o. , abiodun, o.m. , omisore, b. , olowookere, s.a. , fafowora, r.o. , 1 1 1 omobuwa, o. , adeyemo, m.o.a. , tajudeen, w.a. *corresponding author farinloye e.o. email: emmanuel.farinloye@uniosun.edu.ng 1 college of health sciences, osun state university, osogbo (main campus), osun state, nigeria. 2 department of family medicine, oauthc, ile-ife, nigeria received: june 6, 2023 accepted: july 16, 2023 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v10i4.13 article original research journal of health sciences res. j. health sci. vol 11(4) 394 introduction cervical cancer is among the leading cancers that affect women globally (1). it is the leading cause of cancer related deaths in the developing world.(1) the challenge of cervical cancer is further worsened by a concomitant presence of hiv infection in many women in the sub-saharan african region which accounted for about 75% of the over 20 million women diagnosed with hiv infection globally in 2020.(2) women infected with hiv have increased susceptibility to human papilloma virus (hpv) infection which is known to cause cervical cancer.(3)the burden faced by lowand middle-income countries is significantly greater than developed countries. the incidence and mortality rate from cervical cancer have been reduced greatly in developed countries consequent upon the advent of cervical screening and vaccination.(4,5) approximately 570,000 cases of cervical cancer and over 300,000 deaths from the disease occurred in 2018.(1) most of the patients that die from the disease are from the developing countries where poverty, ignorance, unhealthy lifestyle and reduced funding of the health sector among others have immensely contributed to a higher prevalence of cervical cancer.(6) apart from these factors, patients seek medical help at advanced stages when metastases would have occurred thereby reducing the chances of cure and patients' survival (7). early detection and treatment of the precursor or preinvasive lesions has been found to prevent cervical cancer and reduce morbidity and mortality (7,8). human papilloma virus (hpv) infection causes neoplastic changes in the cervical epithelium which can be detected early with screening techniques (7). routine screening with a pap smear is recommended for all women from 18 years of age or earlier if sexually active till age 60.(9) this has not been the case in developing countries due to inadequate and poor uptake of screening services (9,10). non availability or poor uptake of screening facilities is responsible for higher morbidity and mortality from cervical cancer in developing world (5). studies show low level of uptake of cervical cancer screening services among african women (9). marital status, knowledge, perceived barriers and having a regular health care provider were identified as those factors that determine its uptake.(11) according to who, the choice of having the screening done is hampered by lack of knowledge about the disease and risk factors, beliefs about the disease, poor access to preventive services, affordability of the service and current health service system (5,8). in nigeria, over 40 million women are said to be at risk of developing cervical cancer (12). no national policy on cervical cancer screening exists in the country. good knowledge of the disease and a positive attitude towards screening is needed for women to access the largely opportunistic screening services currently being offered (13). although a number of studies have looked at the determinants of screening uptake (11,14,15). it is imperative that current evidence on knowledge, attitude and practice of cervical cancer screening as well as their determinants be obtained so as to know whether there is progress in this part of the world. this study was carried out to determine the knowledge of cervical cancer together with the determinants of the uptake of cervical cancer screening among female staff in a multi-campus university with six campuses spread across different geo-political regions in osun state. it was designed to offer an insight into the perspectives of women located across urban, semi-urban and rural settings with regards to the acceptability, availability and accessibility of cervical cancer screening services. this study therefore aimed to identify the determinants of the uptake of cervical cancer screening among women working in a multicampus university with campuses located in varying geo-political environments. materials and methods the study was carried out at osun state university in osun state, south-western nigeria. according to the national population and housing census projections, osun state was estimated to have about 4.1million people in 2022. osun state university has six campuses spread across six rural and urban towns in the state with the main campus situated in osogbo, the state capital. the institution has over 1000 workers out of which about a third are women. the study is a descriptive cross-sectional study focused on factors responsible for the uptake of cervical cancer screening among the respondents. the sample size was estimated using the leslie formula. a sample size of 138 was gotten which was approximated to 150. a multistage sampling technique taking into c o g n i z a n c e t h e c a m p u s e s , c o l l e g e s , faculties/departments as well as administrative units was employed to recruit participants into the study. through, this sampling technique, participants were selected from 16 departments and six administrative units or directorates from cervical screening uptake among female staff in a multicampus university farinloye et al. res. j. health sci. vol 11(4) 395 eight faculties in five colleges across four campuses. two of the four campuses were located in an urban and a rural area respectively while the other two were located in semi-urban areas. research instruments were semistructured self-administered questionnaires. the questionnaires were pretested in one of the other two campuses which were not selected for the study. study variables included sociodemographic data, knowledge about cancer of the cervix and attitude towards the screening, as well as factors associated with cervical screening uptake. there were nine knowledge and eleven attitude questions, and anyone who scored up to 50% and above of the total mark was assigned as having good knowledge or positive attitude, while those who scored less were classified as having poor knowledge or negative attitude. ethical clearance was obtained from the college of health sciences ethical review committee, osun state university; also permissions were obtained from the heads of the selected campuses and the selected respondents who took part in the study. an informed consent was duly obtained from each participant. the spss software version 20 was used for data entry and analysis after sorting out the questionnaires. relevant frequency distribution tables were generated. the chi-square test was used to demonstrate relationships between categorical variables. logistic regression models were used to identify possible predictors of cervical screening uptake while level of statistical significance was set at p-values less than 0.05. results table 1 shows the socio-demographic characteristics of respondents. the majority of the respondents were in the age group 30-39 years (47.4%), from the osogbo/main campus of the university (58.0%), married (69.3%), christians (79.3%), non-teaching staff (83.3%) and had tertiary educational status of having had a first or master's degree (67.4%) as shown in table 1. out of the 150 respondents, only 120 (80%) have ever heard of cancer of the cervix and are the ones whose data were further analysed in this study. the sources of information about cancer of the cervix were radio/tv (48.0%); health workers (34.0%); friends (28.7%); internet/social media (26.0%); newspapers (18.7%) and religious organizations (8.7%). a total of 37 (30.8%) respondents correctly identified the causative agent of cancer of the cervix as a virus. also, 52 (43.3%) were aware of pap smear as a screening method while 39 (32.5%) respondents correctly identified pap smear to be a “swab test. only 40% of respondents had good knowledge of cancer of the cervix with 60% having poor knowledge. however, 77.5% of the respondents showed a positive attitude towards cervical cancer screening while only 22.5% showed a negative attitude as shown in figure 1. in table 2, respondents' knowledge and attitude on cervical cancer/ screening were related with selected socio-demographic and other characteristics. age was the only variable that showed statistical significance with knowledge. among the respondents in the agegroup 20-29 and 40-49 years, 57.1% and 50% had good knowledge respectively while for those in the age groups 30-39 and above 50, 28.3% and 12.5% had good knowledge respectively. with regards to attitude, having had information through counselling on cancer of the cervix showed statistical significance with a positive attitude towards cervical cancer screening as 90.0% of respondents who had information had a positive attitude compared to 65% of those who did not. staff category also showed statistical significance with attitude towards cervical cancer screening as all respondents who were teaching staff had a positive attitude towards cervical cancer screening compared to 72.2% of the nonteaching staff. in table 3, respondents' belief and practice of cervical cancer screening is explored. most, (80.8%) of all respondents either were not sure or clearly said that cancer screening centres were not available. similarly, 79.2% of all respondents said screening centres were not a c c e s s i b l e . h o w e v e r, w i t h r e g a r d s t o affordability and socio-cultural acceptability of cervical cancer screening, 67.5% and 59.2% of respondents affirmed that the screening was affordable and socio-culturally acceptable to them respectively. with regards to practice of cervical cancer screening using pap smear, only 21 (17.5%) of the respondents had ever done the screening, and of this, 17 had at least one screening in the last three years. only four respondents had done the test twice while the others had it once. in terms of absolute figures, there were more respondents in the urban areas who answered affirmatively to both sets of questions than those in the semi-urban and/or rural areas, however this was not statistically significant. the factors that were associated with ever having had cervical screening using pap cervical screening uptake among female staff in a multicampus university farinloye et al. res. j. health sci. vol 11(4) 396 smear are shown in table 4. respondents aged 40-49 (41.7%), those having above the mean income (34.2%), high level of education (21.2%), knowing a person with cancer of the cervix (40.7%), having had counseling on cancer of the cervix (31.7%), good knowledge of the disease (27.1%) and positive attitude (21.5%) towards cervical cancer screening have been screened for cervical cancerg compared to their counterparts. also, more teaching/ academic staff (39.4%) had done pap smear screening test compared to nonteaching staff (12.4%). similarly, more respondents with the belief that cervical screening are generally available (30.4%) had practice screening compared to those who did not have the belief (19.0%) or those who were not sure (5.9%). the factors that were associated with cervical screening uptake were further subjected to logistic regression in table 5 to identify possible predictors/determinants of screening uptake. table 5 shows that knowing a person having cancer of the cervix, having information through counseling about cancer of the cervix and having good knowledge are the predictors of screening uptake among the respondents. among those yet to do cervical cancer screening, some of the reasons proffered are shown in figure 2. availability (37.4%), counting the test as unnecessary (20.2%) and accessibility (16.2%) are the leading reasons for not taking up the screening. discussion this study on the predictors of the uptake of cervical cancer screening shows that respondents' level of knowledge and access to information through counselling about the disease are the factors that determine screening uptake among the study population. various studies on cancer of the cervix have reported similar findings (4,16). thus, efforts to increase the uptake of screening for cancer of the cervix must be targeted at improving access to information through counselling to enhance knowledge about the disease. although majority of the women were aware of cancer of the cervix, the overall level of knowledge is low. radio and television were the commonest source of information to the respondents. previous studies have shown the relevance of mass media in informing, educating, and communicating important health issues to the general public including the rural areas (14,17). unfortunately, mass media hardly give comprehensive information that can result in good knowledge of health issues among the populace. however, our study shows that good knowledge of the disease is significantly associated with prior counselling (18). thus, programmes on mass media should focus more on comprehensive counselling of women and the general populace about the disease and its screening. also, our study shows that very few respondents were aware of cancer of the cervix through religious bodies despite all women interviewed being religiously inclined. idowu et al. in a community study on cervical screening uptake among women reported similar finding. religious leaders are important route through which necessary information can reach both their adherents and the general populace through preaching either in their religious houses or through the mass media (14). although, most respondents believe that pap smear is affordable and acceptable to them, the non-availability of screening centres is a major limiting factor to access the screening. raising awareness without access to screening facility could delay diagnosis and worsen prognosis. it is therefore not surprising that only few respondents have ever had cervical cancer screening. this finding is however not limited to our study as various studies in this setting have reported poor uptake of pap smear due to limited access (14,16,19). t h i s s t u d y p r o v i d e s i m p o r t a n t information that will guide policy but is limited by its cross-sectional study design and selfreported nature with information bias such as recall bias. efforts made to reduce recall bias include asking questions to double check responses. conclusion i n c o n c l u s i o n , m a j o r i t y o f t h e respondents had poor knowledge on cervical cancer but good attitude towards its screening. identifiable determinants of cervical cancer screening uptake were all knowledge-based, thus continuous enlightenment of women of all agegroups becomes imperative. also, more screening centres should be made available and religious leaders targeted in order to reach more women in the community. conflict of interest: the authors declare no conflict of interest. cervical screening uptake among female staff in a multicampus university farinloye et al. res. j. health sci. vol 11(4) 397 acknowledgement: nil references 1. arbyn m, weiderpass e, bruni l, de sanjosé s, saraiya m, ferlay j, et al. estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. lancet glob heal [internet]. 2020 feb 1 [cited 2023 may 26];8(2):e191–203. a v a i l a b l e from:ttp://www.thelancet.com/article/s2214109 x19304826/fulltext 2. castle pe, einstein mh, sahasrabuddhe v v. cervical cancer prevention and control in women living with human immunodeficiency virus. ca cancer j clin. 2021;71(6):505–26. 3. world health organization. who releases new estimates of the global burden of cervical cancer associated with hiv [internet]. who webpage. 2022 [cited 2023 may 26]. p. e. available from: https://www.who.int/news/item/16-11-2020who-releases-new-estimates-of-the-globalburden-of-cervical-cancer-associated-with-hiv 4. peirson l, fitzpatrick-lewis d, ciliska d, warren r. screening for cervical cancer: a systematic review and meta-analysis. syst rev. 2013;2(1). 5. yu fq, murugiah mk, khan ah, mehmood t. meta-synthesis exploring barriers to health seeking behaviour among malaysian breast cancer patients. asian pacific j cancer prev. 2015;16(1):145–52. 6. hull1 r, mbele m, makhafola t, hicks c, wang sm, reis rm, et al. cervical cancer in low and middle-income countries. oncol lett [internet]. 2020 sep 1 [cited 2023 may 26];20(3):2058. available from: /pmc/articles/pmc7400218/ 7. priya s, ashok kumar m. a review on cervical cancer and current preventive measures. res j pharm technol. 2019 nov 1;12(11):5641–5. 8. world health organization. cervical cancer [internet]. who webpage. 2022 [cited 2023 may 2 6 ] . p . e 0 7 . a v a i l a b l e f r o m : h t t p s : / / w w w. w h o . i n t / n e w s r o o m / f a c t sheets/detail/cervical-cancer 9. abd el all hs, refaat a, dandash k. prevalence of cervical neoplastic lesions and human papilloma virus infection in egypt: national cervical cancer screening project. infect agent cancer. 2007;2(1):1–14. 10. sankaranarayanan r, budukh am, rajkumar r. effective screening programmes for cervical cancer in lowand middle-income developing c o u n t r i e s . b u l l wo r l d h e a l t h o r g a n . 2001;79(10):954–62. 11. nwabichie cc, manaf ra, ismail sb. factors affecting uptake of cervical cancer screening among african women in klang valley, malaysia. asian pacific j cancer prev. 2018;19(3):825–31. 12. rimande-joel r, ekenedo go. knowledge, belief and practice of cervical cancer screening and prevention among women of taraba, northeast nigeria. asian pacific j cancer prev. 2019;20(11):3291–8. 13. bansal ab, pakhare ap, kapoor n, mehrotra r, kokane am. knowledge, attitude, and practices related to cervical cancer among adult women: a hospital-based cross-sectional study. j nat sci biol med. 2015;6(2):324–8. 14. idowu a, olowookere sa, fagbemi at, ogunlaja oa. determinants of cervical cancer screening uptake among women in ilorin, north central nigeria: a community-based study. j cancer epidemiol [internet]. 2016;2016(1):1–8. a v a i l a b l e f r o m : https://www.scirp.org/(s(vtj3fa45qm1ean45vvff cz55))/reference/referencespapers.aspx?refere nceid=1402515 15. sutton s, rutherford c. sociodemographic and attitudinal correlates of cervical screening uptake in a national sample of women in britain. soc sci med. 2005;61(11):2460–5. 16. ugwu eo, obi sn, ezechukwu pc, okafor ii, ugwu ao. acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in enugu, southeast nigeria. niger j clin pract. 2013;16(2):249–52. 17. olowookere sa, abioye-kuteyi ea, adepoju ok, esan ot, adeolu tm, adeoye tk, et al. knowledge, attitude, and practice of health workers in a tertiary hospital in ile-ife, nigeria, towards ebola viral disease. j trop med. 2015;2015(10):1–6. 18. gupta a, sinha ak. health coverage in mass media: a content analysis. j commun. 2010 jul;1(1):19–25. 19. hyacinth hi, adekeye oa, ibeh jn, osoba t. cervical cancer and pap smear awareness and utilization of pap smear test among federal civil servants in north central nigeria. plos one. 2012;7(10):1–8. cervical screening uptake among female staff in a multicampus university farinloye et al. res. j. health sci. vol 11(4) 398 table 1: socio-demographic characteristics of the total respondents (n= 150) variable frequency n=150 percentage age group (mean age 34.7 yrs, sd= 8.32) minimum= 20, maximum=59 20-29 years 41 27.3 30-39 years 71 47.4 40-49 years 29 19.3 50 years & above 9 6.0 campus location osogbo (urban) 87 58.0 okuku (semi-urban) 26 17.3 ikire(semi-urban) 19 12.7 ejigbo (rural) 18 12.0 marital status single 43 28.7 married 104 69.3 widow 3 2.0 religion islam 29 19.3 christianity 119 79.3 traditional 2 1.3 highest level of education attained primary education 5 3.3 secondary education 5 3.3 post-secondary education (pse), 23 15.3 (first or masters’ degree) 101 67.4 phd equivalent or higher 16 10.7 staff position/ category academic staff 25 16.7 non-academic staff 125 83.3 income*** mean and below 47 31.3 above the mean for the group 40 26.7 respondent didn’t give any figure 63 42.0 *** only 87 out of 150 respondents gave income figures cervical screening uptake among female staff in a multicampus university farinloye et al. res. j. health sci. vol 11(4) 399 figure 1: knowledge and attitude categories of respondents on cancer of the cervix and its screening (n= 120) table 2: respondents’ knowledge and attitude on cervical cancer/screening related with selected socio-demographic and other characteristics. variable sub variables test of knowledge (n= 120) ÷2 (p value) attitude (n= 120) ÷2 (p value) poor (%) n=72 good (%) n=48 (%) negative n=27 (%) positive n=93 age-group 20-29 15(42.9) 20(57.1) 10.829(0.013) 11(31.4) 24(68.6) 2.498#, (0.476) 30-39 38 (71.7) 15 (28.3) 10(18.9) 43(81.1) 40-49 12(50.0) 12(50.0) 5(20.8) 19(79.2) 50 above 7 (87.5) 1(12.5) 1(12.5) 7(87.5) marital status single 21 (60.0) 14 (40.0) 0.000, (1.000) 11(31.4) 24(68.6) 2.259, (0.133) ever married. 51 (60.0) 34(40.0) 16(18.8) 69(81.2) education low 11(52.4) 10(47.6) 0.616, (0.433) 2(9.5) 19(90.5) 1.639*, (0.201) high 61(61.6) 38(38.4) 25(25.3) 74(74.7) having known a person with ca cervix yes 13(48.1) 14(51.9) 2.039, (0.153) 3(11.1) 24(88.9) 2.591, (0.107) no 59(63.4) 34(36.6) 24(25.8) 69(74.2) having had counselling on ca cervix yes 41(68.3) 19(31.7) 3.472 (0.062) 6(10.0) 54(90.0) 10.753, (0.001) no 31(51.7) 29(48.3) 21(35.0) 39(65.0) staff position/ category teaching 11(47.8) 12(52.2) 1.757, (0.185) 0(0.0) 23(100.0 ) 8.261, (0.004) non teaching 61(62.9) 36(37.1) 27(27.8) 70(72.2) #likelihood ratio used *continuity correction applied. cervical screening uptake among female staff in a multicampus university farinloye et al. res. j. health sci. vol 11(4) 400 table 3: respondents’ beliefs and practice of cervical cancer screening variable sub variables total respondents campus location frequency (%) n=120 urban (%) semiurban (%) rural (%) belief availability of cervical cancer screening centres yes 23 (19.2) 14 (60.9) 6(26.1) 3(23.1) no/ not sure 97 (80.8) 56 (57.7) 31(32.0) 10(10.3) accessibility to cervical cancer screening centres yes 25 (20.8) 14(56.0) 5(20.0) 6(24.0) no/ not sure 95 (79.2) 56(58.9) 32(33.7) 7(7.4) affordability of cervical cancer screening (pap smear) @n3,000 per test yes 81 (67.5) 49(60.5) 24(29.6) 8(9.9) no/ not sure 39 (32.5) 21(53.8) 13(33.3) 5(12.9) socio-cultural acceptability of pap smear (cervical cancer screening) yes 71 (59.2) 46(64.8) 16(22.5) 9(12.7) no/ not sure 49 (40.8) 24(49.0) 21(42.8) 4(8.2) practice has ever done pap smear screening before yes 21 (17.5) 10(47.6) 8(31.8) 3(14.3) no 99 (82.5) 60(60.6) 29(29.3) 10(10.1) has done pap smear screening at least once in the last three years yes 17 (14.2) 9(52.9) 6(35.3) 2(11.8) no 103 (85.8) 61(59.2) 31(30.1) 11(10.7) number of times respondent had ever had pap smear screening done once 17 (14.2) 8(47.1) 6(35.3) 3(17.6) twice 4 (3.3) 2(50.0) 2(50.0) 0(0.0) not yet 99 (82.5) 60(60.6) 29(29.3) 10(10.1) table 4: factors associated with cervical screening uptake among respondents factor/ variable sub variables cervical screening uptake ÷2 (p value) yes (%) n=21 no (%) n=99 age 20-29 4 (11.4) 31 (88.6) 11.698#(0.008) 30-39 5 (9.4) 48 (90.6) 40-49 10 (41.7) 14 (58.3) 50 and above 2 (25.0) 6 (75.0) income [n= 75] *** mean and below 3 (8.1) 34 (91.9) 6.135*(0.013) above the mean 13 (34.2) 25 (65.8) education low 0 (0.0) 21 (100.0) 4.030* (0.045) high 21 (21.2) 78 (78.8) having known a person with ca cervix yes 11 (40.7) 16 (59.3) 13.034 (<0.001) no 10 (10.8) 83 (89.2) having had counselling on ca cervix yes 19 (31.7) 41 (68.3) 16.681 (<0.001) no 2 (3.3) 58 (96.7) staff position/ category teaching 9 (39.1) 14 (60.9) 9.221(0.002) non-teaching 12 (12.4) 85 (87.8) respondents’ knowledge poor 8 (11.1) 64 (88.9) 5.089 (0.024) good 13 (27.1) 35 (72.9) respondents’ attitude negative 1 (3.7) 26 (96.3) 5.913# (0.015) positive 20 (21.5) 73 (78.5) respondents’ belief on general availability of cervical screening yes 7 (30.4) 16 (69.6) 6.463# (0.039) no 12 (19.0) 51 (81.0) not sure 2 (5.9) 32 (94.1) ***only 75 out of 120 respondents gave income figures. #likelihood ratio used *continuity correction applied. cervical screening uptake among female staff in a multicampus university farinloye et al. res. j. health sci. vol 11(4) 401 table 5: binary logistic regression of the outcome variable “ever had pap smear screening” and its possible predictors. predictor variable categories of variable p value odd’s ratio 95% confidence interval lower upper 40-49 0.381 0.400 0.052 3.105 income above mean (reference) 0.813 1.251 0.197 7.946 educational status high educational status (reference) 0.999 0.237 0.141 9.549 staff category non-teaching (reference) 0.421 0.540 0.120 2.423 having known a person with ca cervix yes (reference) 0.030 0.267 0.081 0.883 having had counselling on ca cervix yes (reference) 0.002 0.066 0.012 0.362 respondents’ knowledge poor 0.026 4.322 1.188 15.727 respondents’ attitude negative 0.542 2.010 0.214 18.913 respondents’ belief on general availability of cervical screening yes 0.308 0.385 0.061 2.411 figure 2: respondents’ reasons for not having done cervical cancer screening (n=99). cervical screening uptake among female staff in a multicampus university farinloye et al. res. j. health sci. vol 11(4) 402 rjhs 11(4).cdr kidney dysfunction and mortality risk in hospitalized covid-19 patients: a large covid-19 centre experience 1 1 2 2 mamven h.m. , kwaghe g.v. , habib g.z. , galadima s.u. abstract objective: kidney dysfunction is common in patients infected with the coronavirus (covid-19). the study's objective was to determine the relationship between glomerular filtration rate and mortality in covid-19 patients. methods: this is a retrospective cohort study of patients admitted into the covid-19 isolation center from march 2020 through december 2021. the serum creatinine at admission was used to estimate the glomerular filtration rate (egfr) using the ckd equation method. the patients were categorized into 2 groups based on the egfr (≥ or < 60ml/minute). the outcome was in-hospital mortality. kaplan meier survival plots and cox proportional modelling were employed in the data analysis. results: a total of 623 patients were analysed. the mean age was 53.4±15.3 years, and 58.6% were male. an egfr of < 60 ml/min was observed in 196 (31%) patients. a significantly higher number of deaths occurred among patients with egfr <60ml/min (32% vs 10.5% (p<0.001). after adjusting for age, sex, disease severity, haemoglobin, icu admission, and dialysis, the patients with reduced egfr of (<60ml/min) were twice more likely to die than patients with egfr ≥ 60mls/min (ahr 1.95, 95% ci 1.263.04, p = 0.003). conclusion: egfr of < 60mls/min is associated with an increased risk of mortality in covid-19 patients. this stresses the need for better recognition of renal dysfunction as a high-risk for mortality in covid-19 infections. keywordscovid-19, egfr, mortality *corresponding author mamven h.m. email: manmakm@yahoo.com 1 department of medicine, college of health sciences, university of abuja, nigeria 2 department of medicine, university of abuja teaching hospital, gwagwalada abuja nigeria received: may 22, 2023 accepted: july 2, 2023 orcid-no: https://orcid.org/0000-0003-3229-6689 original article research journal of health sciences res. j. health sci. vol 11(4) 296 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.2 dysfonctionnement rénal et risque de mortalité chez les patients hospitalisés covid-19: une grande expérience de centre covid-19 1 1 2 2 mamven h.m. , kwaghe g.v. , habib g.z. , galadima s.u. résumé objectif de l'étude: le dysfonctionnement rénal est fréquent chez les patients infectés par le coronavirus (covid-19). l'objectif de l'étude était de déterminer la relation entre le taux de filtration glomérulaire et la mortalité chez les patients covid-19. méthode de l'étude : il s'agit d'une étude de cohorte rétrospective de patients admis dans le centre d'isolement covid-19 de mars 2020 à décembre 2021. la créatinine sérique à l'admission a été utilisée pour estimer le taux de filtration glomérulaire (egfr) à l'aide de la méthode ckd epi. les patients ont été classés en 2 groupes en fonction du dfge ( ≥ ou < 60 ml/minute). le critère de jugement était la mortalité hospitalière. des diagrammes de survie de kaplan meier et une modélisation proportionnelle de cox ont été utilisés dans l'analyse des données. résultat de l'étude: au total, 623 patients ont été analysés. l'âge moyen était de 53,4 ± 15,3 ans et 58,6 % étaient des hommes. un dfge < 60 ml/min a été observé chez 196 (31 %) patients. un nombre significativement plus élevé de décès est survenu chez les patients avec un dfge<60 ml/min (32 % contre 10,5 % (p< 0,00 1). après ajustement en fonction de l'âge, du sexe , de la gravité de la maladie , de l'hémoglobine, de l'admission en usi et de la dialyse, les patients avec un dfge réduit de ( <60 ml/min ) étaient deux fois plus susceptibles de mourir que les patients avec un dfge ≥ 60 ml/min ( a hr 1,9 5 , ic à 95 % 1,2 63,0 4 , p = 0,00 3 ). conclusion : un dfge < 60 ml/min est associé à un risque accru de mortalité chez les patients covid-19. cela souligne la nécessité d'une meilleure reconnaissance de la dysfonction rénale en tant que risque élevé de mortalité dans le covid-19 infections. titre du fonctionnement courant : taux de filtration glomérulaire estimé et risque de mortalité. mots-clés covid-19, egfr, mortalité *corresponding author mamven, h.m. email: manmakm@yahoo.com 1 department of medicine, college of health sciences, university of abuja, nigeria 2 department of medicine, university of abuja teaching hospital, gwagwalada abuja nigeria received: may 22, 2023 accepted: july 2, 2023 orcid-no: https://orcid.org/0000-0003-3229-6689 article original research journal of health sciences res. j. health sci. vol 11(4) 297 research journal of health sciences subscribed to terms and conditions of open access publication. articles are distributed under the terms of creative commons licence (cc by-nc-nd 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i4.2 introduction coronavirus disease (covid-19) is a novel disease caused by the severe acute respiratory syndrome coronavirus 2 (sarscov-2) that is responsible for the global pandemic recently (1). though respiratory involvement is the major presentation, other organ involvement is common, especially in severe cases. (2) the kidneys are one of the most c o m m o n l y a f f e c t e d o r g a n s . k i d n e y abnormalities have been reported globally by several authors (3-6). the spectrum of renal involvement described in covid-19, includes urinary abnormalities and changes in kidney function (reflected by decreased glomerular filtration rate (gfr) which might be present in up to 75%-80% of cases.(6) acute kidney injury (aki) at one end of the spectrum is a common complication and may be due to several causes s u c h a s s e p s i s , h y p o t e n s i o n , o r glomerulonephritis (7-9). proteinuria and haematuria with or without the loss of kidney function are also common abnormalities encountered in these patients (7-10). several mechanisms for kidney damage have been proposed such as acute tubular injury from systemic hemodynamic changes, tissue inflammation, and local immune cell infiltration with endothelial injury and microvascular thrombi and possibly viral invasion in the kidneys. an impaired type i interferon response has also been reported in patients with severe covid-19 (11). kidney dysfunction in covid19 patients is associated with increased mortality (5,10,12). other significant independent predictors of mortality reported are older age, the presence of comorbidities such as diabetes mellitus, hypertension, and proteinuria (12-14). during the early part of the covid-19 pandemic, not much attention was paid to testing for kidney abnormalities routinely during hospitalization in many centres in nigeria, unless there were obvious signs of kidney involvement, which might have been noticed too late. our centre is a major referral centre that is well equipped to manage systemic complications such as kidney failure and has good laboratory support to run samples with a quick turnaround time of results. this significantly contributed to our success in managing covid-19 infection. few large studies have been conducted on kidney function and mortality outcomes in covid-19 patients in nigeria. the purpose of our study was to investigate the impact of egfr (kidney function) on in-hospital mortality in hospitalized patients with covid-19. we hypothesize that an estimated glomerular filtration rate (egfr) of 2 less than 60mls/min/1.73m at admission is significantly associated with mortality among patients with covid-19. the finding of this study will increase clinicians' awareness of kidney dysfunction in our hospitalized patients with covid-19. materials and methods setting and design the study was conducted at a major referral hospital in the north central region of the country. the hospital is a treatment centre for moderate to severe cases of covid-19 in the federal capital territory (fct) in nigeria. the design was a retrospective cohort study involving all adult patients aged?18 years and above with at least one respiratory sample positive for sars-cov-2 by polymerase chain reaction (pcr), admitted to the isolation and st treatment centre between the 21 of march 2020 and december 2021. we excluded patients with no measurements of creatinine at admission. sample size determination for obtaining the minimum sample size, assuming that 18.4% of covid-19 patients with egfr > 60mls/min will die during the study,(14) and a prevalence of reduced egfr in covid-19 patients of 30% (14), with a power of 90% and alpha of 0.05, we would like our study to have adequate power to detect a relative risk of 2.0. a minimum sample size of 294 with n1=89 and n2=205 was required. data sources the data were extracted from the patient medical records by a trained research assistant. variables and definitions the primary exposure of interest was the egfr. using the creatinine obtained at admission, age and sex it was calculated using the ckd-epi creatinine formula (15). other exposures were age, sex, clinical features on admission such as oxygen saturation (sp02%), blood pressure, severity of covid-19 disease, elixhauser comorbidity index score (cis), t r e a t m e n t r e c e i v e d s u c h a s o x y g e n supplementation, renal replacement therapy use, use of medications and intensive care unit requirement. laboratory data was full blood count, serum urea, creatinine, potassium, sodium, and bicarbonate obtained during admission. for the purpose of this study, patients were categorised into two groups according to res. j. health sci. vol 11(4) 298 kidney function abnormality and risk of mortality mamven et al. their egfr. group one was made up of patients with egfr ≥?60ml/min/1.73 while group two w a s m a d e u p o f t h o s e w i t h e g f r 2 <60ml/min/1.73 m which (was termed low egfr).(15) the severity of respiratory covid-19, cases was obtained from the patient's records and were categorized as mild, moderate, and severe. the comorbidity index score (cis) was according to elixhauser comorbidities and van wolverine scoring .(16,17) the neutrophillymphocyte ratio (nlr) at hospital admission was calculated as the ratio of neutrophils to lymphocytes and both were obtained from the blood sample collected. the outcome was in-hospital mortality and the time from admission to death. in-hospital mortality was all-cause deaths within 30 days of being admitted to the hospital. the time to event was the time from hospital admission to events w h i c h w a s a l l c a u s e d e a t h . c e n s o r e d observations were those who had not yet had the event. patients were censored on the day of discharge or 30 days from the day of admission if st still alive and on 31 december 2021, the final date of follow-up for this study. statistical analysis the normality of variables was assessed using visual inspection of histograms and confirmed by the shapiro–wilk test. any variable with more than 10% missing was not used. patient characteristics were described for the overall cohort according to the two groups of egfr. categorical variables were summarized as proportions and percentages and continuous variables were expressed as the mean and standard deviation (sd) or median with interquartile range (iqr) for skewed measures. we compared characteristics between the egfr groups using chi-square or fisher exact tests for categorical variables. two samples independent t-test or wilcoxon rank-sum (mann-whitney u) test for skewed data was used to compare continuous variables between the two groups. we explored the relationship between e g f r a n d 3 0 d a y m o r t a l i t y u s i n g a kaplan–meier survival curve with the log-rank test. univariable and multivariable cox proportional hazards regression models were estimated, to further explore the relationship between egfr and in-hospital death while adjusting for any confounders. results were reported as hazard ratios (hr) with a 95% confidence interval. the proportional hazard assumption was tested using graphical means. given the multiplicity of variables, we p e r f o r m e d v a r i a b l e s e l e c t i o n f o r t h e multivariable model building and used a stepwise selection of variables to select variables for the model. other variables of known clinical relevance were added. potential confounding variables were age, sex, comorbidities index, disease severity, haemoglobin concentration, and icu admission. all tests were two-sided and the statistical significance was p <0.05 for all analyses. data were collected and managed using excel and statistical analyses were performed using stata software (16.1 statacorp llc, college station, tx). ethical statement the study was approved by the health research ethics committee of the institution w i t h t h e n u m b e r : uath/hrec/pr/2022/003/006 on 21/03/2022 and was conducted in accordance with the national hrec code and with the helsinki declaration of 1975, as revised in 2000. a waiver of informed consent for patients was obtained as this was a review of the data collected. strict confidentiality of data was maintained. results out of the 750 patients hospitalised with covid-19 during the period, 623 formed the primary sample for analysis. 196 (31%) had egfr of < 60ml/min. characteristics of the primary sample are demonstrated in table 1. a significant proportion of the lower egfr group of < 60 ml/min was older and had a higher proportion of patients with diabetes, hypertension, anaemia, severe covid19, sepsis, and higher median cis than those with egfr ≥ 60 ml/min. patients with egfr < 60 ml/min also had lower levels of median oxygen saturation, lower mean haemoglobin, and lower bicarbonate levels. they also had higher mean wbc, and nlr. the treatment most frequently used was antibiotics (64.4%), dexamethasone (60.4%), and clexane (56.8%). the group with the lower egfr was less frequently treated with antivirals (lopinavir/ritonavir) (6.6% vs 30.4%) and were more frequently treated with antibiotics (85% vs 54.9%), dexamethasone (79.5% vs 52%) and oxygen supplementation (55.6% vs 32.0%). a higher proportion of deaths occurred among patients with lower egfr than in the higher egfr group. (32 % vs 10.5%; p<0.001) (table 1) figure 1 displays the kaplan-meier survival curves in the two egfr groups. res. j. health sci. vol 11(4) 299 kidney function abnormality and risk of mortality mamven et al. mortality was significantly higher in patients 2 with egfr < 60mls/min/1.73m (global log-rank test p < 0.001). there were no violations of the c o x p r o p o r t i o n a l h a z a r d s a s s u m p t i o n s graphically. tables 2a and b demonstrate the distribution according to survival status in the patients. a significantly higher proportion of patients with covid-19 who died were older. those who died had more severe covid-19 than mild disease, and higher median cis than survivors. table 2b shows the treatment of the patients. a significantly higher proportion of patients who were admitted into icu died compared to those who were not. more of those treated with antibiotics (25.3 vs 3.7%), clexane (24 vs 9%) and with corticosteroids (25vs 7%) died compared to those who were not. a significantly higher proportion of patients who had dialysis did not survive compared to those who did not have (table 2). the cox proportional analysis is displayed in table 3, the unadjusted hazard ratio for egfr <60 ml/min on mortality was 3.3, while the adjusted hazard was 1.95 (95% ci, 1.26-3.04). the confounders, were age, sex, disease severity, haemoglobin, icu admission, and dialysis. (table 3). the cox proportional hazards assumption after adjusting for confounders was met on graphical analysis. discussion in this study, we looked at the kidney function using the egfr observed during admission and associated it with mortality in patients afflicted with covid-19. we observed that 31% of our patients had an egfr of < 60 2 ml/min/1.73 m . this is consistent with several other authors globally that kidney dysfunction 2 (low egfr of <60 ml/min/1.73m ) is not uncommon in confirmed cases of covid-19 infection.(14, 18, 19) uribarri, mirijello and cei reported similar values of about 30%,27.3% and 30% respectively in their patients.(14, 18, 19) on the other hand cheng reported lower prevalences of elevated serum creatinine, blood urea nitrogen 2 and egfr under 60 ml/min/1.73m of 14.4, 13.1 and 13.1%, respectively .(10) in ssa and specifically reporting on aki as the dysfunction, ibrahim et al. reported aki occurring in 14.6% of their patients while dolaamas reported higher in 32.6% .(20, 21) a report from a hospital-based registry in ghana showed that 10% of patients admitted with covid-19 had underlying ckd with aki in nearly half of the cases.(22) this wide variation in prevalence of the kidney abnormalities is most likely due to heterogeneity in cohorts studied, from variations in definitions and components of kidney dysfunction to methods employed in diagnosis and reporting. while the studies reported on several renal abnormalities, our study reported low egfr as the sole dysfunction. kidney disease in covid-19 is associated with an enhanced risk of deterioration and mortality. in this study, we observed 32% mortality in our patients with kidney dysfunction and 10.5% in those with egfr >60mls/min. the hazard of mortality in our patients wth dysfunction was 1.9, 95% ci: 1.26-3.04, p = 0.003 after adjusting for age, sex, disease severity, haemoglobin levels, icu admission, and dialysis as confounders. similarly, several other investigators worldwide reported high risk of mortality in their covid-19 cohorts with renal dysfunction. in africa, dolaama reported death in 55.8% of their patients with kidney dysfunction and the factors associated with death were, kdigo stage (p = 0.049), and invasive ventilation (p < 0.001). (21) in ghana, in-hospital mortality of 43.5% was reported among those with ckd in an unpublished hospital-based report of covid-19 patients admitted at the komfo anokye teaching hospital as of february 2021.(22) in italy, cei, et al., showed that an egfr value of <60 ml/min/1.73 m2 (or 2.6,95% ci:1.7-4.8, p = 0.003); as well as age >?73 years (or 4.3, 95% ci: 2–9, p?<?0.001), lymphocyte count below 460?u/l (or 3, 95% ci 1.4–6.4, p?=?0.004) and platelet count below 177,000 (or 2.2, 95% ci 1.2–4.2, p?=?0.017) were significantly associated with in-hospital mortality (19), also in italy mirijello demonstrated a risk of 1.64 for low egfr (ahr 1.64, 95% ci 1.02–2.63, p = 0.040).(18) in china cheng et al., reported 16% of their patients died in-hospital and had a significantly higher risk for in-hospital death with an elevated creatinine (ahr:2.10, 95% ci: 1.36-3.26) (10). pei et al. reported mortality in 11.2% of their patients with kidney involvement compared with (1.2%) of patients, without (7). chan et al., reported higher mortality of 50% among their patients with aki versus 8% among those without aki (aor, 9.2; 95%ci: 7.5 to 11.3) (4). a meta-analysis by robbins-juarez et al. reported higher mortality of 52% of patients with severe covid-19 infection with aki and a pooled odds ratio of 15.27; 95% ci 4.82-48.36) .(23) contrary to the above studies, bravi et al., reported that egfr was not res. j. health sci. vol 11(4) 300 kidney function abnormality and risk of mortality mamven et al. res. j. health sci. vol 11(4) 301 an independent predictor of poor outcomes including death, however, their population was composed of younger patients with a higher prevalence of normal egfr and fewer comorbidities (24). there is no doubt that mortality risk is increased in covid-19 patients with kidney dysfunction. reasons for the high mortality rate observed in our cohort are proffered. mortality occurred more in the older patients as they tend to have higher prevalence of kidney diseases, more comorbidities and so poorer prognoses. the higher mortality observed in older patients with comorbidities may be related to a reduction in their renal functional reserve, an impaired capacity of their kidney to increase gfr in response to stress, and reduced functioning nephron mass (25). chronic kidney disease alone, or with other comorbidities such as diabetes mellitus, hypertension and obesity may be present in some of our patients and is linked to increased mortality in patients with covid19.(10) there was a higher occurrence of these comorbidities in our patients with egfr < 60mls/min/1.73m2. our findings show that sex, severity of covid-19, egfr <60mls/min, wbc count, and use of antibiotics were significantly associated with mortality in the relationship. (table 3) this study has some limitations even as it represents a real-life setting in a tertiary health centre in the tropics. it was a retrospective design with some missing data. only those with creatinine values taken at admission were included in the study. there was no baseline information on kidney function (serum creatinine) in some patients and almost all of the patients had creatinine done only on admission and once so we could not differentiate between aki or if pre-existing ckd was the case. during the early phase of the covid-19 pandemic, available resources were focused more on covid-19 infection, so kidney function was assessed only in patients who had symptoms, signs, and known risk factors of kidney disease. this may have led to an underestimation of kidney dysfunction or distorted associations between covid-19 infection and kidney outcomes. we did not include urine analysis because it was not done for most of the patients. complicating the reliability of the diagnosis. nonetheless, this study was performed in a tertiary-level hospital and a dedicated referral center for covid-19 especially for severe infections in the federal capital territory and beyond, therefore, the result can be generalisable locally. conclusion in conclusion, kidney dysfunction in our hospitalized patients with covid-19 was high. patients with egfr, < 60mls/min/1.73m2 were 2 times more likely to die than those with egfr ≥ 2 60mls/min/1.73m . findings from our study underscore the importance of looking out for kidney abnormalities in covid-19 patients. even though the infection and the pandemic seem to have subsided, it is still pertinent for clinicians and hospitals in nigeria to be ready and prepared for future occurrences or epidemics of covid19.(26, 27) clinicians should be aware of kidney diseases in covid-19 infections and monitor closely patients who are at risk of kidney involvement this may reduce mortality in these patients. acknowledgments: we want to acknowledge and thank all the research assistants who supported and helped collate data for this study. source(s) of support: no funding was obtained for this study conflict of interest: the authors declare no conflict of interest. acknowledgement: nil author's contribution: mm and vk developed the concepts, the definition of intellectual content and manuscripts preparation while both the design of the study and the statistical analysis of the acquired data was done by mm. the literature search was carried out by mm, zh and ug. vk, zh and ug did the data acquisition. the manuscript editing and review was done by mm, vk, zh and ug. references 1. cucinotta d, vanelli m. who declares covid19 a pandemic. acta biomed. 2020;91(1):15760. 2. huang c, wang y, li x, ren l, zhao j, hu y, et al. clinical features of patients infected with 2019 novel coronavirus in wuhan, china. lancet (london, england). 2020;395(10223):497-506. 3. guan wj, ni zy, hu y, liang wh, ou cq, he jx, et al. clinical 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afr med j. 2020;35(suppl 2):101. kidney function abnormality and risk of mortality mamven et al. res. j. health sci. vol 11(4) 303 table 1: clinico-demographic, laboratory and treatment profiles of covid-19 patients during hospitalization parameters all patients egfr =60mls/min egfr<60mls/min total number (%) 623 427(68.5%) 196(31.4%) mean egfr mls/min 76.7±39.0 98.5± 22.6 29.1±20.0 mean age(years) 53.4±15.3 50.9±15.5) 58.9±13.4 sex male (%) 386(61.9) 271(63.4) 115 (58.6) female 237(38) 156(36.5) 81 (41.3) mean temp 0c 36.6±0.6 36.48±0.5 36.7± 0.8 temp >37.20c (%) 62(9.9) 27(6.3) 35(18) mean spo2. 93.1±9.7 94.5± 7.9 90.1±12.3 map 100.9±14.7 101.4± 14.6 99.8± 14.9 severity of covid mild 196(32.0) 177(42.2) 19 (9.8) moderate 169(27.6) 104(24.8) 65 (33.7) severe 247(40.3) 138(32.9) 109 (56.5) diabetes (%) 197(31.7) 121(28.40) 76 (38.8) hypertension (%) 322(51.6) 194(45.4) 128 (65.3) sepsis (%) 25 (4.0) 12 (2.8) 13 (6.6) median cis 0(0,3) 0(0,0) 0(0,5) laboratory mean wbc 10.4± 6.5 9.4±5.9 12.4±7.4 median nlr ratio 2.3 (1.3,4.3) 2.06(1.2,3.8) 2.95(1.8,5.5) mean hemoglobin, g/l 12.4±2.7 12.9±2.3 11.43±3.04 mean hgb = 10(%) 497(84) 359(88.9 ) 138 (73.8) mean hgb <10 94(15.9) 45(11.1) 49 (26.20) median urea mmol/l 5.8±(4.1,9.8) 4.8 (3.7,6.5) 14.7(8.4,23.2) med creatinine umol/l 82(64, 117) 69(52, 82) 208.5(125.5,450.5) mean sodium mmol/l 138.5± 3.9 138.7± 3.3 138.1± 4.9 mean potassium mmol/ 4.0± 0.5 4.0± 0.5 4.1±0.6 mean hco3 22.8±3.3 23.2± 2.8 21.8±3.9 treatments (%) antibiotics 395(64.4) 229(54.9) 166(84.7) diuretics 24(3.9) 9(2.2) 15 (7.7) hydroxychloroquine 118(18.9) 92 (21.6) 26 (13.3) lopinavir-ritonavir 143(22.9) 130(30.4) 13 (6.6) remdesevir 151(24.3) 94(22.1) 57 (29.1) dexamethasone 376(60.7) 220(52.0) 156 (79.6) clexane 354(56.8) 207(48.5) 147 (75) zinc 443(71.2) 323(75.8) 120 (61.2) oxygen supplementation 246(39.5) 137(32.1) 109 (55.6) dialysis 23(3.7) 0(0) 23/196(11.7) icu admission 25(4) 7 (1.64) 18 (9.18) died 108 (17.4) 45(10.5) 63 (32.1) median los 9(6,13) 9(7,13) 9(4,13) abbreviations: egfr estimated glomerular filtration rate, map mean arterial pressure, spo2 oxygen saturation, cis comorbidity index score, hgb haemoglobin, icu intensive care unit, wbc white blood cells, nlr neutrophil lymphocyte ratio, hco3 bicarbonate, los length of stay, *mannwhitney u kidney function abnormality and risk of mortality mamven et al. res. j. health sci. vol 11(4) 304 number at risk time(hr s) 0 100 200 300 400 500 600 700 egfr=6 0 427 379 246 119 47 22 10 6 egfr<6 0 191 141 99 49 16 8 2 2 figure 1: kaplan-meier curve for patient survival after hospital admission for covid-19 infection according to egfr. the median survival time was not defined because less than half of the patients have experienced an event by day 30. kidney function abnormality and risk of mortality mamven et al. res. j. health sci. vol 11(4) 305 table 2a: distribution according to survival status in patients with covid-19 parameters numbers survivors non survivors p-value (%) n=515 (82.7%) n=108 (17.3%) egfr = 60mls/min(%) 427 382(89.5) 45 (10.5) <0.001 egfr <60mls/min 196 133(67.9) 63(32.1) age: <60 years 392(63) 339(86.5) 53(13.5) <0.001 = 60 years 231(37) 176(76.2) 55(23.8) sex male (%) 386(62.0) 326(84.5) 60(15.5) 0.132 females 237(38.0) 189(79.7) 48(20.3) mean temperature0c 36.6±0.6 36.5± 0.6 36.7± 0.8 0.002 temperature = 37.2 62(10.0) 47(75.8) 15(24.2) 0.133 temperature <37.2 561(90) 468(83.4) 93(16.5) mean spo2 93.1±9.7) 94.7±7.4 85.9±14.8 <0.001 map 100.9±14.7 100.8±14.1 101.2±17.4 0.808 severity of covid (%) mild 196(31.5) 191(97.1) 5(2.5) <0.001 moderate 168(27.0) 149(88.7) 19(11.3) severe 248(39.8) 164(66.1) 84(33.9) diabetes:yes (%) 197(31.7) 152(77.2) 45(22.8) 0.011 no 425 363(85.4) 62(14.6) hypertension (%) 322(51.7) 251(77.9) 71(22.1) 0.001 no 301 264(87.7) 37 (12.29) sepsis (%) 25(4.01) 17 8(32) 0.048 no 598 498(83.3) 100(16.7) median cis 0(0,3) 0(0,3) 0(0,5) 0.006* laboratory mean wbc count, 10.4±6.5 9.6±6.1 14.2±7.2 <0.001 median nlr 2.3 (1.3,4.3) 2.1(1.2,3.6) 3.9 (2.3,7.6) <0.001* median urea mmol/l 5.8 ±(4.1,9.8) 5.5(3.9,8.6) 9(5.0,17.9) <0.001* median creatinine umol/l 82(64,117) 77(62.3,108) 110(82, 352.5) <0.001* mean hemoglobin g/l 12.4± 2.7 12.53± 2.6 11.91± 2.9 0.032 hgb = 10 (%) 497(84.1) 418(84.1) 79(15.9) 0.024 hgb <10 (%) 94(15.1) 70(74.47) 24(25.5) mean sodium, mmol/l 138.5± 3.9 138.6± 3.6 138.1± 4.9 0.245 mean potassium, mmol/l 4.05±0.6 4.03±0.5 4.16± 0.7 0.034 mean hco3 22.8±3.3 22.9±3.2 22.3±3.7 0.149 abbreviations: egfr estimated glomerular filtration rate, map mean arterial pressure, spo2 oxygen saturation, cis comorbidity index score, hgb haemoglobin, icu intensive care unit, wbc white blood cells, nlr neutrophil-lymphocyte ratio, hco3 bicarbonate, los length of stay, *mann-whitney u kidney function abnormality and risk of mortality mamven et al. res. j. health sci. vol 11(4) 306 table 2b: treatment profile according to survival status in patients with covid-19 parameters numbers survivors non survivors p-value n=515 (82.7%) n=108 (17.3%) treatments (%) antibiotics 395(64.4) 295(74.7) 100(25.3) <0.001 no 218 210(96.3) 8(3.7) diuretics 24(3.9) 17(71 ) 7(29) 0.127 no 591 490(83) 101(17) hydroxychloroquine 118(19) 105 (88.9) 13(11.9) 0.044 no 505 410(91.2) 95(18.8) lopinavirritonavir 143(23) 136(95.1 ) 7(4.9) <0.001 no 480 379(79) 101(21.04) remdesevir 151 120 (79.5) 31(20.5) 0.242 no 470 393(83.62) 77(16.38) dexamethasone 376(61) 284(75.5) 92(24.5) <0.001 no 243 227(93.4) 16 (6.6) clexane 354 270 (76.3) 84(23.7) <0.001 no 269 245 (91.0) 24 (9.0) zinc 443(71.2) 384 (86.7) 59 (13.3) <0.001 no 179 130 (72.6) 49 (27.4) o2 supplementation 246(39.5) 166 (67.5) 80(32.5) <0.001 no 349(92.6) 28(7.4) dialysis 23(3.7) 16(69.5) 7(30.4) <0.001 no 499(83.2) 101(16.8) icu admission 25(4.0) 12(48) 13(52) <0.001 no 598 503(84.11) 951(5.89) median los 9(6,13) 10 (7,13) 3(1.5,6) <0.001 abbreviations: egfr estimated glomerular filtration rate, map mean arterial pressure, spo2 oxygen saturation, cis comorbidity index score, hgb haemoglobin, icu intensive care unit, wbc white blood cells, nlr neutrophil-lymphocyte ratio, hco3 bicarbonate, los length of stay, *mann-whitney u table 3: cox proportional analysis of the relationship between egfr and mortality in covid-19 patients. univariate analysis multivariable analysis covariate crude-hr 95% ci p-value adj-hr 95% ci p-value egfr =60ml/min ref ref egfr<60mls/min 3.3 2.24-4.86 <0.001 1.95 1.26-3.04 0.003 age <60 years ref ref age = 60 years 1.76 1.20-2.57 0.004 1.15 0.76-1.72 0.500 sex male% 0.69 0.47-1.02 0.063 0.61 0.39-0.92 0.019 severity of disease mild ref ref moderate 4.83 1.81-12.96 0.002 1.84 0.65-5.25 0.253 severe 15.17 6.15-37.45 <0.001 4.73 1.79-12.55 0.002 sepsis 1.95 0.94-4.01 0.071 1.11 0.52-2.38 0.786 hgb =12g/l ref hgb 10-11.9 1.04 0.62-1.76 0.873 0.62 0.36-1.07 0.088 hgb <10 1.64 1.012.64 0.043 0.85 0.50-1.45 0.557 wbc 1.06 1.04-1.08 <0.001 1.04 1.01-1.06 0.001 cis 1.07 1.02-1.12 0.009 1.03 0.98-1.09 0.180 temperature >37.2 1.35 0.77-2.37 0.296 0.83 0.45-1.51 0.543 icu admission 3.79 2.08-6.92 <0.001 1.25 0.64-2.43 0.515 antibiotics 7.16 3.48-14.72 <0.001 3.46 1.52-7.88 0.003 dialysis 1.87 0.87-4.03 0.111 0.74 0.31-1.78 0.497 abbreviations: egfr estimated glomerular filtration rate, cis comorbidity index score, hgb haemoglobin, icu intensive care unit, wbc white blood cells. kidney function abnormality and risk of mortality mamven et al.