West Africa Journal of Medicine

ORIGINAL: The Value of Targeted Screening for Glaucoma: The University of Ilorin Teaching Hospital Experience

2024-10-08T10:07:20+00:00

Background: Glaucoma is an irreversible silent and dangerous eye condition that leads to damage of the optic nerve head. This study aimed to determine the outcome of targeted glaucoma outreaches done in the University of Ilorin Teaching Hospital over three years with a view to early detection and timely institution of management.

Methods: The study is a retrospective review of 3 targeted hospital-based glaucoma screenings, World Sight Day of 2019 (140 participants), World Glaucoma Week of 2020 (176 participants), and World Glaucoma Week of 2022 (183 participants). The criteria for diagnosing glaucoma and glaucoma suspects were taken from the national study of prevalence and types of glaucoma from the Nigerian national blindness survey and International Society for Geographical and Epidemiological Ophthalmology criteria.

Results: The study population had a mean age of 45.54 years (SD 16.92) with individuals within the age group of 51-60 years comprising the majority of the participants (26.4%). Most participants had normal vision or mild visual impairment in the right eye (411, 86.1%) and left eye (405, 84.9%) while blindness was recorded in the right eye of 37 (7.7%) participants and left eye of 36 (7.5%). The prevalence of glaucoma cases and suspects among study participants was 29.4% and 42.5%, respectively. There was a statistically significant relationship between the diagnosis of glaucoma and older age, family history of glaucoma and elevated intraocular pressure.

Conclusion: This study showed that targeted screening for glaucoma is an invaluable tool for ensuring early detection of the disease.

ORIGINAL: Research Participation and Feedback: Perception of Adolescents and Young Adults Living with HIV in Lagos, Nigeria

2024-10-08T13:13:22+00:00

Background: Evidence-based research remains the cornerstone in changing the narrative of wholesome health among Adolescents and Young Adults Living with HIV (AYALHIV). However, little is known about the perceptions of AYALHIV in research participation and outcomes, in low- and middle-income countries, especially in sub-Saharan Africa. This study describes the perception of AYALHIV in research participation and outcome in Lagos, Nigeria.

Methods: The study population was drawn from a cohort of participants in a cross-sectional study at the Nigerian Institute of Medical Research. The survey questions were on perceptions of the importance of research participation, the frequency, understanding of participation in research, the interest in the outcome, the knowledge of the interpretation of the outcome and the willingness to participate in future studies. Data obtained was analyzed using SPSS version 26.0.

Results: The mean age of the AYALHIV was 15.7(±3.1) years, with a male-to-female ratio of (0.8:1), and 85.7% on antiretroviral drugs for at least five years. Seventy-two percent (46/63) have been involved in previous studies at least once, with only 27% (17/63) informed on the outcome of the research they have ever participated. Only 30% (19) of participants understood they were involved in research, with 92% interested in the study outcome. 87.3% (55) will request more information before participating in future research activities.

Conclusion: Educating AYALHIV on research participation is important in promoting concerted efforts by researchers towards improving engagement, patient-centred care, and research dissemination.

ORIGINAL: Assessment, Management and Quality of Care of Patients Presenting with Non-Traumatic Acute Chest Pain in the Emergency Room who had Acute Coronary Syndrome

2024-10-08T13:29:14+00:00

Background: Non-traumatic Acute Chest pain (NTACP) is a common presentation in the emergency services of many hospitals and a key presenting symptom of acute coronary syndrome (ACS). However, there is a dearth of data on the system of care of ACS patients in our facilities.

Objective: Our objective was to evaluate the process of care of patients presenting with NTACP at a Tertiary Hospital emergency department (ED) in sub-Saharan Africa, using quality indicators of a universal chain of survival to identify any care gaps in the diagnosis and management of those with life-threatening ACS.

Methods: This was a retrospective cross-sectional study of adult patients ≥18 years of age, seen between July 2020 and June 2023 at the ED of the University College Hospital (UCH), Ibadan, Nigeria. We used this information to determine the frequency of ACS amongst those presenting with NTACP. From this subset, we assessed the main domains of quality indicators of the universal chain of survival in ACS care. These were, early symptom recognition and call for help; emergency medical service (EMS) evaluation and treatment; ED evaluation and treatment; and reperfusion therapy.

Results: We assessed a total of 4,306 patients who presented to the ED during the study period. Of these, 225 patients presented with NTACP. The mean ± SD age of these patients was 45.9 ± 18.4 years, with most between the ages of 40-49 years (20.9%) and males (50.7%). More than 80% of the patients presented to ED 12 hours after the onset of chest pain. Only 4.0% presented via an ambulance service which offered no prehospital guideline-directed medical treatment, and 70.7% were non-referred patients. Only 37.3%, 57.8%, 12.4%, and 8.9% had ECG, chest x-ray, echocardiography, and cardiac enzyme evaluation, respectively, in the acute phase of care. There were 29 (12.9%) patients who had a diagnosis of ACS. Two (6.9%) had medical revascularization with thrombolytic agents, while 8 (27.6%) and 19 (65.5%) were referred for primary and secondary PCI respectively.

Conclusion: We found a high burden of late presentation and significant barriers to recommended guideline management of ACS patients, presenting with clinical features of NTACP in our hospital's ED.

ORIGINAL: A 7-Month Review of Clinical and Demographic Predictors of Childhood Mortality in a Tertiary Children Hospital in Freetown, Sierra Leone

2024-10-08T15:27:45+00:00

Background: Sierra Leone ranks among nations with unacceptably high infant and under-5 mortality rates. Understanding the clinical and demographic dynamics that underpin paediatric mortalities is not only essential but fundamental to the formulation and implementation of effective healthcare interventions that would enhance child survival.

Subjects and material: This was a 7-month review of all mortalities from May 24th 2021 to December 31st 2021 at Ola During Children's Hospital in Freetown, Sierra Leone. Information on biodata, presenting complaints, illness duration, diagnoses, treatment given inclusive of point-of-care investigations, and duration of hospital stay retrieved from all mortalities were entered into Excel spreadsheets and were analyzed using SPSS version 25.0 for IBM. Multivariable regression analysis was done to determine factors independently associated with mortalities within 24 hours of admission. All associations were considered significant if p < 0.05.

Results: There were 840 deaths out of 5920 children admitted during the period giving a mortality of 14.2% with a male-to-female ratio of 1:1. Three hundred and four (36.2%) of these deaths occurred in the neonatal age group while 63.8% occurred in the post neonatal age group. Perinatal asphyxia was the leading cause of neonatal deaths while acute respiratory infections and severe malaria were the leading causes of post neonatal deaths. The majority (64.8%) of the mortalities occurred within the first 24 hours of admission. In a multivariable regression, only transfusion status and use of respiratory support were independently associated with mortality within 24 hours of admission (P<0.05).

Conclusion: Paediatric mortality in Sierra Leone is high and is caused mainly by preventable morbidities such as perinatal asphyxia and infections. Most of the deaths occurred within 24 hours of admission. It is recommended that patients should be brought to the hospital early and preventive measures be instituted to address these causes.

ORIGINAL: Molecular Subtypes of Breast Cancer in a Tertiary Centre in Edo State: South-South Nigeria

2024-10-08T15:39:43+00:00

Background: Breast cancer constitutes a significant public health issue in most resource-constrained nations due to its high morbidity and mortality rates. There is a paucity of knowledge of the molecular subtypes of breast cancer in Nigeria primarily due to the lack of immunohistochemistry. This study aims to identify the molecular subtypes of histologically confirmed breast cancer cases at the University of Benin Teaching Hospital, Benin City, Nigeria, using ER, PR and HER2/neu as immunohistochemical biomarkers.

Materials and method: Breast cancer specimens received in the Histopathology department of the University of Benin Teaching Hospital between 2019 and 2021 were used for this study. Representative sections of paraffin-embedded blocks were recut for histological typing, tumour grading, and immunohistochemistry.

Results: A total of 330 cases were evaluated in this study. The average age was 49 years, with a M:F of 40.3:1. The most frequent histological type was invasive breast cancer (92.1%). Two hundred and forty-two (73.3%) cases were categorized as grade II tumours. The steroid hormone receptor positivity was 39.4%. Oestrogen and Progesterone receptor positivity were 39.4% and 22.1%, respectively. HER2/neu was positive in 16.4% of the cases. Triple-negative breast cancer (TNBC) was the most common molecular subtype, accounting for 49.4% of cases. Luminal A, Luminal B, and HER2/neu enriched subtypes were each found in 34.2%, 5.2%, and 11.2% of cases, respectively.

Conclusion: Triple-negative breast cancers predominated among the study population and were more common in high-grade tumours with unfavourable histological types and among women who were younger than their Caucasian counterparts.

ORIGINAL: Gaps in Management of Dyslipidaemia among Physicians in Nigeria: Report of a Web-Based Survey

2024-10-09T09:07:28+00:00

Background: Dyslipidaemia contributes significantly to globalcoronary artery disease (CAD) and cardiovascular disease. Effective use of statins precludes adequate knowledge of its benefits. This study aimed to determine the gaps in the management of dyslipidaemia among physicians in Nigeria.

Methods: This was a web-based survey of physicians across Nigeria regarding the management knowledge and practice of dyslipidaemia. Analysis was done by SPSS 23.0. P<0.05 was taken as statistically significant.

Results: Three hundred and thirteen physicians across Nigeria consisting of 65.4% males responded to the survey. The majority, 57.5% were 25-40 years. While most of the participants (98.3%) believe that elevated LDL-C is an important cause of CAD, there were concerns about statins use and associated increased risk of muscle disorder (63.2%), hepatic disease (37.4%), hemorrhagic stroke (27.2%), cognitive impairment (12.6%) and new-onset diabetes mellitus (19.2%). Similarly, 41.9% of participants have concerns about hemorrhagic stroke while 32.2% also expressed concerns about lowering LDL-C and ischaemic stroke. More than a third (38.2%) indicated that >20% of their patients cannot use statins continuously due to adverse effects such as muscle symptoms, etc. The results obtained when asked about the target of LDLC in patients with or without a history of CAD and diabetes mellitus were as varied as 3-200 mg/dl.

Conclusion: This study highlights there exist significant gaps in knowledge and practice of the management of dyslipidaemia among experts in Nigeria. Concerted efforts by relevant authorities and societies may be needed to enhance the knowledge and practice of the management of dyslipidaemia in reducing the CV risk among Nigerians.

ORIGINAL: Opinions of Dental Technologists in Nigeria on Quality of Work Authorization for Removable Dental Prosthesis

2024-10-09T09:32:41+00:00

Background: When fabricating a removable dental prosthesis, clear and sufficient communication between the dentist and dental laboratory technologist is crucial to ensure a successful outcome.

Objectives: To evaluate the quality of communication between dentists and dental laboratories via work authorizations for the fabrication of removable prosthesis across the six geographical zones in Nigeria.

Materials and methods: A cross-sectional descriptive study was conducted among dental technologists in Nigeria. A 22- item, online survey questionnaire was sent to all the participants through their respective states and the National Dental Technologist Association across the six geographical zones in the country. Data obtained were analyzed. Association between variables was carried out using the Chi-square test. Binary logistic regression was used to predict group membership.

Results: A total of 62 dental technologists participated in this study; the highest percentage of respondents, 29.1% was from South West. Only 21% of the respondents reported that they received work authorizations with adequate information to complete a denture setup most time. Also, 16.1% of the technologists received casts with adequate rest seats and guide planes prepared on the abutment teeth. Eighteen respondents (29%) stated that the authorization card does not contain all the required information. Fabrication of more than 7cast RPDs could be used to predict dental technologists who hold a positive view on the provision of quality work authorization by dentists. (P≤0.05).

ORIGINAL: Assessing the Quality of Life of Healthcare Professionals in High-Stress Units at a Tertiary Health Centre in South-eastern Nigeria

2024-10-09T09:42:01+00:00

Introduction: Work serves as a fundamental pillar of human life, shaping both individual livelihoods and societal engagements. The intricacies of the work environment play a pivotal role in determining the Quality of Life (QoL), with increasing emphasis on creating conducive workspaces that enhance employee satisfaction and productivity. Healthcare professionals, in particular, face various factors that contribute to occupational stress and such stressors can adversely affect their health and diminish their QoL.

Objective: This study sought to assess the quality of life of healthcare professionals in the Intensive Care Units (ICUs) and other stressful units in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi.

Methodology: A cross-sectional study was conducted involving 296 consenting participants after approval from the ethics and research committees at NAUTH, Nnewi. They were selected using a two-stage sampling approach. Data were collected with a structured self-administered questionnaire adopted from the World Health Organization Quality of Life scale (WHOQOL-BREF) and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The level of significance was set at P < 0.05.

Results: The results showed the mean overall quality of life score was 74.62 ± 14.0, the mean score for the physical domain (59.15 ± 12.49), the psychological domain (70.16 ± 13.46), the social domain (65.82 ± 18.19), and the environmental domain (53.90 ± 15.49). The majority 268 (90.5%), of the respondents had good quality of life. The profession (X2 =12.44, p<.05), years of work experience (X2 = 25.85, p<.05), and income level (X2 = 19.56, p<.05), show a statistically significant association with quality of life.

Conclusion: The result obtained from this study shows that the majority of the respondents report a good quality of life. Most respondents with poor quality of life were attributed to their profession, years of work experience and income.

ORIGINAL: Perception, Practice and Cost Burden of Medical Tourism Among Physicians in Public Tertiary Health Facilities in Oyo State, South-West, Nigeria

2024-10-09T09:54:28+00:00

Background: Physicians are key to the clinical decision-making of their clients. Their perception and practice of medical tourism could influence their clients' uptake of the same. This study assessed the perceptions about medical tourism among physicians practising in public tertiary health facilities in Oyo state. We then assessed its practice and cost burden among physicians who had ever engaged in medical tourism.

Methodology: This cross-sectional study conducted in 2019 involved 360 physicians working in two public tertiary health facilities in Oyo State, selected via a two-stage simple random sampling technique. Quantitative data was collected using a semi-structured pre-tested self-administered tool. Data collected was analysed using STATA 17.0 with statistical significance inferred at p<0.05.

Findings: The physicians' mean score on knowledge of medical tourism was 4.0±0.8 of 5 marks obtainable. Organ transplant was the most commonly known reason for engaging in medical tourism. Destination country hospital facilities and equipment ranked highest and cost considerations ranked least of perceived factors promoting it. Twenty-four (6.7%) of the physicians studied ever engaged in medical tourism, while 258 (71.7%) intend to if the need arose. The most popular destination country was India. The mean direct cost of engaging in medical tourism was $3,351±$4,357. The mean indirect cost was $2,389±$774, while the mean total cost was $5,739.6±$4,841.8. The majority of the 24 physicians (83.3%) who engaged in medical tourism suffered catastrophic health spending from it.

Conclusion: High burden of medical tourism on the physicians. Funds spent on medical tourism by them could be used to strengthen the delivery of health services, such as ensuring children are fully immunised.

ORIGINAL: Awareness of Primary Care Providers on Genital Schistosomiasis Infection in Northern Nigeria

2024-10-09T09:59:31+00:00

Background: Genital schistosomiasis (GS) is a debilitating neglected tropical disease caused by Schistosoma haematobium. Despite its significant impact on reproductive health, awareness and knowledge of GS among healthcare providers, especially in Sub-Saharan Africa, remain inadequate, leading to underdiagnosis and mistreatment.

Methods: This study conducted a cross-sectional online survey to assess the awareness and knowledge of GS among 139 primary healthcare providers in Northern Nigeria. A semi-structured self-administered questionnaire was utilized, covering various aspects of GS including its aetiopathogenesis, clinical features, complications, diagnosis, and prevention/treatment. Respondents were scored based on their answers, with an overall score of ≥35 considered indicative of good awareness.

Results: Most respondents were aged 31-50 years (41.0%), male (59.7%), married (84.9%), and working in the public sector (97.8%). Mean scores indicated varying levels of awareness across different aspects of GS, with higher awareness regarding aetiopathogenesis (13.99 ±3.275) and prevention/treatment (11.27±1.592). However, awareness of complications remained comparatively lower. Overall, 43.9% of respondents demonstrated good awareness of GS. Regional disparities in awareness were observed, with the North-western region exhibiting the highest awareness (52.6%) followed by the Northeast (40.6%) and Northcentral regions (36.0%).

Conclusion: The study underscores the urgent need for targeted educational interventions to enhance healthcare providers' knowledge of GS, particularly in regions with lower awareness levels. Improving awareness and knowledge among primary healthcare providers can facilitate early detection, appropriate management, and prevention strategies, thus alleviating the burden of GS on affected communities in Northern Nigeria and beyond.

ORIGINAL: Use of Prophylactic Parenteral Tranexamic Acid for Reduction of Blood Loss During and After Caesarean Section: A Double-Blind Randomized Controlled Study

2024-10-09T10:06:52+00:00

Background: Haemorrhage is a leading cause of maternal mortality. The prophylactic use of tranexamic acid during vaginal delivery or caesarean section has the potential to reduce blood loss and postpartum anaemia.

Objective: To determine the effectiveness and safety of tranexamic acid in reducing blood loss during and within twenty-four hours after a caesarean section.

Methods: This was a randomised controlled study of two hundred and eighty-four (284) pregnant women booked for caesarean section at the University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu, Nigeria. The women were randomised into two groups: the intervention group (n = 142) that received intraoperative tranexamic acid with routine post-delivery oxytocin injection and the control group (n =142) that received placebo with routine post-delivery oxytocin. Blood loss was assessed both intra and post-operatively using a standard technique.

Results: The mean intraoperative blood loss was significantly lower in the intervention group compared to the control group (435.9±34 vs. 918±258.7, P=0.036). Similarly, the postoperative blood loss within twenty-four hours of surgery was significantly less in the intervention compared to the control group (232.71±67.4 vs. 717±317.6, P=0.031). The incidences of postoperative anaemia and blood transfusion intra or postoperatively were also significantly less in the intervention group compared to the control group (33.2% vs. 48.6; RR = 0.623; 95% CI = 0.46-0.84; p = 0.002, and 6.3% vs 24.6%: RR = 0.257; 95%CI = 0.13-0.52; P= < 0.001, respectively). There were no differences in the incidences of maternal and neonatal complications.

Conclusion: The use of prophylactic parenteral tranexamic acid significantly reduces blood loss during and after caesarean section. It is therefore recommended in our obstetric practice as it has the potential to reduce the incidence of postpartum anaemia.

ORIGINAL: Analysis of the Factors Affecting the Male-Female Sex Ratio of Babies Born through Assisted Reproductive Technology

2024-10-10T09:14:07+00:00

Background: Until now, the sex ratio in a population is believed to be relatively stable with no male/female preponderance. There has been an increasing amount of evidence to suggest that assisted conception may significantly impact on sex ratio (SR). Several factors have been suggested to affect SR such as parental variables (paternal race, maternal age, and body mass index-(BMI), methods of fertilisation (in-vitro fertilisation/intracytoplasmic sperm injection), stage of embryo transfer (cleavage/blastocyst), type of IVF cycle (fresh/cryopreserved), medications used for controlled ovarian stimulation, poor sperm motility, and even culture media.

Objectives: This study aims to investigate the potential impact of the different ART procedures on sex ratio. It will also explore the relationship between paternal race, maternal age and body mass index BMI on sex ratio.

Methods: A retrospective cohort study from January 2017 to December 2023. Participants were women who had successful ART and delivery at Ninewells Assisted Conception Unit (NACU) Dundee and ART centre of Lagos University Teaching Hospital, Nigeria.

Results: Overall, 294 (66.2%) of the case records and 150 (33.8%) were evaluated from NACU and LUTH respectively. More male infants 244 (66.8%) were delivered following pregnancies conceived with blastocyst embryo stage transfer when compared with female infants which stood at 121 (33.2%). Concerning cleavage embryo stage transfer, 56 (70.9%) were in favour of female newborns while males accounted for 23 (29.1%).

Conclusion: The study revealed that there is an increase in the proportion of male babies born following certain assisted conception techniques such as blastocyst stage embryo transfer and IVF while more female babies were born when cleavage stage embryos were transferred or when ICSI was used as a method of fertilisation.

EDITORIAL: Stress-Related Quality of Life Among Healthcare Professionals, and the Urgent Need for Systemic Reforms Towards Bridging Gaps in Healthcare Delivery

2024-10-08T09:29:30+00:00

As we release this latest edition of the WAJM, we are reminded of the vital role medical research plays in advancing the quality of healthcare delivery in our region. Despite the many challenges that persist, including the economic pressures and resource limitations faced by many institutions and individuals, the commitment of our medical community remains steadfast. This edition is a testament to that dedication, featuring a diverse collection of articles from distinguished researchers across various medical and surgical specialities.

In these times of uncertainty, it is heartening to see how our contributors continue to spotlight and provide solutions to healthcare challenges specific to the West African context. Each article represents not just a significant contribution to the field, but also the resilience and passion of those who work tirelessly behind the scenes. To the authors, reviewers, and all stakeholders—your work matters. It is through your collective efforts that this journal can continue to serve as a platform for scholarly discourse and medical advancement in our region.

Healthcare professionals are the backbone of any health system, but the physical and emotional demands associated with their work can negatively impact their personal well-being and quality of life.^1-3 This remains a critical issue, particularly in recent years. The demands of the profession are unparalleled, with healthcare workers facing a unique combination of emotional, physical, and mental stressors daily. From long working hours to emotionally draining situations, the stress can significantly impact their well-being. While the work of saving lives is noble, it is important to address the toll it takes on those who provide care.

One of the primary contributors to stress in healthcare is the heavy workload and long hours. This leads to physical exhaustion, which, when compounded with the emotional intensity of the job, can severely impair a healthcare worker's ability to provide quality care. Consistently working under such conditions results in burnout, which is increasingly common in the healthcare profession. The emotional strain of working in healthcare cannot be overemphasized. Healthcare workers frequently witness trauma, suffering, and death. Whether they are dealing with patients in pain or comforting distressed families, the emotional burden can be overwhelming. In addition, many healthcare workers become emotionally invested in their patients, and when outcomes are unfavourable, it can take a significant toll on their mental well-being. This repeated exposure to suffering often leads to compassion fatigue, a form of burnout specific to caregivers, where they become desensitized to the pain and needs of their patients.^1-3

A further stressor among healthcare workers is the lack of resources especially in under-developed settings like ours. In times of crisis, such as during the COVID-19 pandemic, these issues are magnified. The COVID-19 pandemic served as a stark reminder of how healthcare providers face extraordinary stress. They worked on the frontlines during the pandemic, dealing with overwhelming patient loads, rapidly changing treatment protocols, and fears of infection. Many experienced a heightened sense of isolation, as they were unable to see their loved ones for fear of spreading the virus. This prolonged exposure to stress and trauma led to increased rates of depression, anxiety, and even post-traumatic stress disorder (PTSD) among healthcare workers.^4,5

Achieving a healthy work-life balance is often difficult for healthcare professionals. Long hours leave little time for personal life or self-care, which can result in feelings of isolation and frustration. Furthermore, organizational issues such as poor management and unclear communication can compound stress. When healthcare workers feel unsupported or unable to make decisions affecting patient care, their job satisfaction declines.^1,2

Every health worker is exposed to this phenomenon but those working in high-stress environments such as Intensive Care Units (ICUs), Accident & Emergency wards, and Special Care Baby Units face extraordinary physical and emotional demands. A recent study featured in this edition examined the quality of life (QoL) among these professionals, providing vital insights into how stress, profession, and work environment affect their well-being. Among the respondents in a tertiary teaching hospital, Ezemenahi et al reported that the lowest quality of life scores were found in the environmental domain, highlighting dissatisfaction with work conditions such as safety, financial resources, and opportunities for professional development. A crucial finding of the study is that healthcare workers' quality of life was significantly associated with their profession, years of work experience, and income. The professionals earning lower wages were more likely to report dissatisfaction with their physical and environmental health.

This study emphasizes that healthcare professionals in high-stress units had challenges related to work conditions and environmental factors. The findings point to a critical need for policy interventions that improve the work environment, promote mental health, and provide adequate financial compensation. To enhance the QoL of healthcare workers, particularly in high-stress units, health institutions must invest in stress management programs, mental health support, and better work-life balance initiatives.

By addressing these factors, not only can the well-being of healthcare workers improve, but the quality of care they provide will also be positively impacted—ultimately benefiting both patients and the healthcare system. The study is a vital contribution to the ongoing conversation about improving healthcare systems in Nigeria and the broader West African region. It must be reiterated that health workers must learn to take personal measures towards improving their work-life balance. These include being intentional about taking breaks, and vacations and setting boundaries between work and personal life.

This edition also features an article by Akhigbe and colleagues which reported the findings from a retrospective review of clinical and demographic predictors of childhood mortality at a hospital in Freetown, Sierra Leone. Childhood mortality remains a grave concern globally, particularly in resource-limited regions like sub-Saharan Africa. Notably, about two-thirds of the recorded deaths in the review occurred within the first 24 hours of admission. This underscores the importance of prompt health-seeking behaviour among the populace and also the need for timely and effective intervention in preventing paediatric deaths, particularly among neonates and children presenting with severe illnesses.

The leading causes of neonatal mortality were perinatal asphyxia, neonatal sepsis, and complications related to prematurity—conditions that are largely preventable with adequate prenatal care and timely interventions. For children beyond the neonatal period, the study identified acute respiratory infections and severe malaria as the primary killers. These findings are not new; they echo patterns seen across sub-Saharan Africa where infectious diseases and preventable conditions continue to claim young lives at unacceptable rates. There is an urgent need to strengthen the referral system and improve access to primary healthcare as well as improve the capacity of frontline healthcare workers at primary and secondary levels.

As highlighted in another study by Oladapo et al, the assessment, management, and quality of care of patients presenting with acute coronary syndrome (ACS) is another critical area requiring urgent improvement. The findings revealed significant gaps in the timely diagnosis and treatment of ACS. Acute coronary syndrome remains a leading cause of morbidity and mortality globally, with sub-Saharan Africa seeing a rising incidence of the condition. One of the major challenges identified in the study is the lack of prehospital care and the poor utilization of emergency medical services (EMS). Only 4% of the patients arrived via ambulance, and none received appropriate prehospital treatment for ACS during transportation. This points to a serious deficiency in the EMS system, which currently focuses on trauma care rather than medical emergencies like ACS. There were also gaps in diagnostic protocols. The absence of prompt and comprehensive diagnostic evaluations delays treatment and worsens patient outcomes. Another significant barrier to effective ACS management is the lack of readily available revascularization options. The reliance on distant, out-of-pocket services exacerbates delays in life-saving interventions, as many patients cannot afford the high costs associated with these procedures. The findings from this study align with those from other sub-Saharan African countries, where healthcare systems are often ill-equipped to manage ACS efficiently. Delays in presentation, diagnosis, and treatment, coupled with inadequate EMS services and financial barriers to care, contribute to the region's high ACS mortality rates. Hospitals must adopt triage-based protocols that ensure rapid identification and management of ACS, reducing the time to definitive treatment. Implementing point-of-care diagnostics like highly sensitive cardiac troponin assays can further streamline the process and improve outcomes.

These and many other articles in this edition underscore the need to bridge identified gaps in healthcare delivery through systemic reforms and massive investment in the availability and quality of healthcare personnel and infrastructure across the primary, secondary and tertiary levels of care in the region. As we reflect on these crucial issues, I want to encourage all authors and readers to continue their invaluable contributions. Despite the financial and logistical challenges that our region faces, we are determined to keep this journal a vibrant hub of medical knowledge, collaboration, and innovation. I encourage all of you to stay connected with us, share your research, and engage with the content to foster a stronger, more resilient healthcare community. Together, we will continue to advance medical science and healthcare delivery in West Africa, ensuring that our collective work leads to tangible improvements in patient care and outcomes.

REFERENCES

Onigbogi CB, Banerjee S. Prevalence of psychosocial stress and its risk factors among health-care workers in Nigeria: A systematic review and meta-analysis. Niger Med J. 2019;60(5):238-244.
Amole BB, Adebiyi SO, Dakare O. Multi-criteria decision analysis of occupational stress among healthcare professionals in Nigeria. Prog Health Sci. 2018;8(1):109-121.
Al-Ruzzieh MA, Ayaad O. Work stress, coping strategies, and health-related quality of life among nurses at an international specialized cancer center. Asian Pac J Cancer Prev. 2021;22(9):2995-3004.
Babore A, Lombardi L, Viceconti ML, Pignataro S, Marino V, Crudele M, Candelori C, Bramanti SM, Trumello C. Psychological effects of the COVID-2019 pandemic: Perceived stress and coping strategies among healthcare professionals. Psychiatry Res. 2020;293:113366. doi: 10.1016/j.psychres.2020.113366.
Couarraze S, Delamarre L, Marhar F, Quach B, Jiao J, Avilés Dorlhiac R, et al. The major worldwide stress of healthcare professionals during the first wave of the COVID-19 pandemic - the international COVISTRESS survey. PLoS ONE. 2021;16(10):e0257840. doi: 10.1371/journal.pone.0257840.

CASE REPORT: Biventricular Hypertrophic Cardiomyopathy in a 26-year-old Nigerian Woman with Noonan Syndrome

2024-10-10T11:04:13+00:00

Background: Cardiac disorders are found in about half of cases of Noonan syndrome (NS). The most common congenital heart diseases in this syndrome include pulmonary valvular stenosis obstructive or nonobstructive hypertrophic cardiomyopathy (17%). Biventricular hypertrophic cardiomyopathy (HCM) is very rare in this condition.

Objective: The objective is to report a case of biventricular hypertrophic cardiomyopathy in a 26-year-old Nigerian female with the phenotype.

Methods: This is a descriptive case report.

Results: The patient presented with dyspnoea on exertion which started at the age of 7 years and has progressively worsened. There was associated precordial chest pain and palpitation. Clinical examination revealed a young woman, who is small for her age. She had some dysmorphic features such as a webbed neck, lowset ears, low posterior hairline, crowded teeth, high arched palate, a small and asymmetric chin and a high carrying angle at the elbows. The pulses were synchronous and there was no radio-radial or radiofemoral delay and her blood pressures were within normal limits. Cardiac auscultation was unremarkable. The 12-lead ECG showed biventricular hypertrophy with a strain pattern. The echocardiogram showed features in keeping with biventricular hypertrophic cardiomyopathy.

Conclusion: Biventricular HCM is relatively uncommon in Noonan syndrome. Patients with typical dysmorphia should have a full cardiac evaluation to look for these anomalies.

CASE REPORT: Intramural Pregnancy: An Intriguing Diagnosis in a Resource Constraint Practice

2024-10-10T11:36:27+00:00

A 30-year-old G4P1+2(1 alive) woman with a history of cervical incompetence initially presented at a gestational age (GA) of 10 weeks and 6 days with lower abdominal pain and was managed conservatively as a case of threatened miscarriage. She re-presented two weeks later and was admitted on account of lower abdominal pain and spotting per vagina of 4hrs duration. An obstetric ultrasound revealed an intrauterine pregnancy invading the posterior myometrium with thinning of the uterine wall and hemoperitoneum. She subsequently had an exploratory laparotomy, evacuation of the hemoperitoneum, separation of the fetus from the myometrium, and repair with no. 2 vicryl suture. The patient recovered satisfactorily and had two units of whole blood transfused. She was managed with analgesics, hematinics and broad-spectrum antibiotics. She was discharged on the 4th post-operative day to be followed up at the gynaecological clinic.

CASE REPORT: Cerebral Echinococcosis Mimicking a Brain Tumour in Rural Southwest Nigeria

2024-10-10T12:23:46+00:00

Echinococcosis is a zoonosis caused by tapeworms of the genus Echinococcus. Cerebral echinococcosis (CE) poses a significant public health challenge due to its neglected status. It is endemic in Central Asia, Africa and parts of South America, with prevalence estimated to be 1.18-3 per 100,000 population in Iran. We report the case of a 45-year-old male who presented with seizure disorders and was evaluated and treated for a neoplasm, with complete excision of the lesion. Pathologic examination revealed the characteristic echinococcal (hydatid) cyst. The patient recovered fully. As CE is a great imitator of several other conditions in endemic areas, a high index of suspicion must be maintained in endemic countries.