Open Access Case Study

Gossypiboma: Twelve Years There-After

B. A. Ojo, E. O. Umobong, I.O. Ibrahim, J. C. Ezemamma, T. O. Fasoranti, B. M. Duduyemi, G. T. A. Jombo

International Journal of TROPICAL DISEASE & Health, Page 184-189
DOI: 10.9734/IJTDH/2013/2986

Gossypiboma is used to describe a retained cotton matrix surgical material in the body after an operation. Retained intra-abdominal surgical sponge is an uncommon surgical error. Among retained foreign bodies, a surgical gauze or sponge constitutes the most frequently encountered object because of its common usage, small size and amorphous structure. We report a case of a 32-year-old female patient who presented a left sided abdominal mass 12 years after an exploratory laparotomy. The policy of prevention coupled with use of several adjunct technologies which accounts for sponge use will help to reduce the incidence of gossypibomas.

Open Access Case Study

Gastroenteritis Outbreak in a Senior High School, Akwapim North District, Eastern Region-Ghana, 2012

Joseph K. L. Opare, Edwin Afari, Fred Wurapa, Chima Ohuabunwo, Samuel Sackey, George Kye-Duodu, Donne Ameme, Joseph Abankwa, Dorcas Kyeiwa Asante, Kofi Tornyeli, Praise Boamah, James Amankwah, Olivia Serwaa Opare

International Journal of TROPICAL DISEASE & Health, Page 210-216
DOI: 10.9734/IJTDH/2013/3684

Background: On the 28th of October, 12 students from a Senior-High-School (SHS) in the Akwapim North-District-Ghana, reported to the district hospital with abdominal cramps, diarrhea and vomiting. We investigated to identify the cause, the source of infection and to recommend control measures.
Methods: We conducted a descriptive investigation; with active case-search and a retrospective cohort-study. A case-patient was a student presenting with abdominal cramps, diarrhea and or vomiting from the 28th of October to the 2nd of November in the SHS. We interviewed students and reviewed medical records. Stool from case-patients and water samples were taken from known sources of drinking water and associated boreholes for laboratory diagnosis. We performed univariate analysis by person, place and time and assessed risk factors through relative risk 95% confidence level.
Results: Aeromonas-spp and Eschericia-coli were isolated from stool and water samples respectively. The overall attack rate was 8.0 (101/1254) /1000 with no fatalities. The index case, a 15 yr-old female student reported on october 28th and case-patients peaked (16/101) 24hours later. The mean age of case-patients was 17 years (±1.2) with females 77% (78/101) mostly affected. Eating waakye [RR=3.13(CI 2.35-4.17)], banku [(RR= 2.21(CI 1.33-3.69)], kenkey [RR=1.39 (CI 1.03- 1.87)] and drinking borehole water [( RR=7.60 (CI 6.26-9.25)] were associated with the gastroenteritis.
Conclusions: Drinking Eschericia coli-contaminated-bore hole water was the most likely cause of this point-source outbreak. Chlorination of the boreholes water coupled with education on food safety and personal hygiene were initiated based on our recommendations and these measures were temporally associated with containment of the outbreak.

Open Access Original Research Article

Pattern and Risk Factors for Musculoskeletal Complications of Sickle Cell Anaemia in South-East Nigeria: A Retrospective Study

Kenechi A. Madu, Agozie C. Ubesie, Anazoeze J. Madu, Augustine N. Duru

International Journal of TROPICAL DISEASE & Health, Page 175-183
DOI: 10.9734/IJTDH/2013/3838

Aims: To determine the pattern and associated risk factors for musculoskeletal complications among sickle cell anaemia patients in South-east Nigeria.
Methodology: A retrospective review of prospectively collected data. The study was conducted at the Sickle Cell Clinic of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria between December 31st 2004 and January 1st 2013. We included 163 eligible sickle cell anaemia patients (105 males and 58 females; age range 6-53 years). Clinical, haematological (haemoglobin, white cell count, platelet) and radiological evaluation of these patients were done. Data analysis was by SPSS version 19. Chi-square and Fisher’s exact tests were used to test for significant association of the categorical variables while Mann Whitney U test was used to compare the mean ranks of the continuous variables and the dependent outcome.
Results: The three most common musculoskeletal complications seen among our patients population were leg ulcer (29.4%), avascular necrosis (17.8%) and osteomyelitis (12.9%). Complications were significantly more in older patients (P=0.04) and those with higher platelet counts (P=0.04). Haemoglobin level and platelet count were significantly higher in patients with avascular necrosis (P=0.01) and osteomyelitis respectively (P=0.01).
Conclusion: Musculoskeletal complications of SCA are not uncommon among our patients. Age and higher steady state haemoglobin were risk factors for developing complications. Further controlled studies are required to evaluate the steady state hematological parameters and risk of complications among SCA patients.

Open Access Original Research Article

Trend and Seasonality in Admission and Outcome of Low Birthweight Infants in Gwagwalada-Abuja, Nigeria

Richard Onalo, Kudirat E. Olateju

International Journal of TROPICAL DISEASE & Health, Page 190-198
DOI: 10.9734/IJTDH/2013/3416

Background: Low birthweight is an important contributor to neonatal morbidity and mortality. Various interventions have been instituted toward the reduction in the incidence of low birthweight deliveries and admissions. Knowledge of the current trend and seasonality in low birthweight admission is required in the control of the condition.
Objectives: To determine the trend and seasonality in admission and outcome of low birthweight deliveries.
Methods: Retrospective review of records of babies admitted into the Special Care Baby Unit of University of Abuja Teaching Hospital, with birthweights below 2500 grams over a 5-year period, from January 2006 through December, 2010, was undertaken and the data obtained were analyzed using Epi Info version 3.5.2 software. A p value of <0.05 was set as point of statistical significance.
Results: A total of 4358 babies were admitted into the Special Care Baby Unit during the study period, out of which 502 had low birthweight. Thus the unit’s prevalence of low birthweight is 11.5%. The proportion of infants admitted with low birthweight was fairly constant over the years but there was variation in monthly distribution. On the overall, survival rate steadily increased from 65.5% in 2006 to 76.0% in 2009 at an average rate of 2.6% per annum. Babies admitted during the wet/rainy season had higher mortality rate (27.6% versus 17.7%).
Conclusion: Low birthweight has continued to be one of the major reasons for admission of infants in the locale of study. Significant seasonal pattern in the outcome of infants with low birthweight exists. Reasons for seasonality in low birthweight admission and outcome are subjects of further studies.

Open Access Original Research Article

A New Superagglutination Test to Minimize False Negative and False Positive Results Common with Plate/Slide Agglutination Tests for the Diagnosis of Infectious Diseases

Hari Mohan Saxena, Paviter Kaur

International Journal of TROPICAL DISEASE & Health, Page 199-209
DOI: 10.9734/IJTDH/2013/3405

Agglutination is the clumping of antigenic particles by antibodies. Several diagnostic kits for infectious diseases of animals and humans, based on slide agglutination/plate agglutination tests like the Rose Bengal Plate Test (RBPT) for diagnosis of brucellosis are used worldwide. False negative and false positive results are commonly encountered in these conventional agglutination tests. Simple, cost effective modifications can help in circumventing these problems. The novel Superagglutination Test reported here is a modified slide / plate agglutination test. False negative results due to smaller clumps formed by low titer of antibodies in serum are minimized by the addition of biotinylated antiglobulin followed by Avidin which forms easily detectable larger clumps. Similarly, prior staining of serum antibodies with a dye helps in differentiating a specific agglutinate formed by both antigen and antibody, from a non-specific aggregate of antigen alone that leads to false positive results. Superagglutination is more sensitive than the current agglutination tests and agglutination based diagnostic kits. The modification steps are easy to perform and give a more accurate diagnosis without much increase in the cost of the test. The economic losses to livestock industry caused by the spread of infectious diseases like brucellosis due to false negative diagnosis and culling/slaughtering of productive animals due to false positive diagnosis can be avoided by employing the new test.

Open Access Original Research Article

Complications of Male Infant Circumcision in a Semi-Urban Niger Delta Town

Paingha J. Alagoa, Isesoma Gbobo

International Journal of TROPICAL DISEASE & Health, Page 217-223
DOI: 10.9734/IJTDH/2013/3351

Aim: This study aims at documenting the prevalence and complications of male infant circumcision and compares the complication rates between various circumcisers.
Study Design: A prospective study.
Place and Duration of Study: 300 consecutive male infants attending the infant immunisation clinic of the Niger Delta University teaching hospital, Okolobiri over a 6 month period; between the October, 2011 and March, 2012.
Method: Relevant information was obtained from the patients who were then examined. Information obtained was recorded on a proforma.
Results: The ages of the infants were between 1 day and 336 days. The circumcision rate was 93.3%. The mean age at circumcision was 15.5± 17.0days. Nurses performed 47.1%, Traditional circumcisers 32.9% and Doctors 20.0% of all circumcisions. Educational status of mothers was a determinant of the Circumciser. None of the infants whose mothers had primary school education was circumcised by a Doctor, most (64.4%) of them were circumcised by a traditional circumciser. The general trend showed that the more educated the mothers of the infants, the more likely it was for their infants to be circumcised by Doctors and Nurses. The complication rate was 24.3%; most were mild. Infants circumcised by Nurses had the most complications (25.8%), followed by those circumcised by Doctors (25.0%) and least 21.7% in infants circumcised by Traditional circumcisers. There was however no significant difference in complication rates between infants circumcised by nurses as compared with Traditional circumcisers (p=.79); there was also no significant difference in complication rates between Doctors and Traditional circumcisers (p=.79).
Conclusion: The prevalence of infant circumcision is very high in our community. The complication rate is also high. There was however no significant difference in complication rates between circumcisers. Efforts must be made to properly train all persons involved in this procedure.

Open Access Original Research Article

Product of Free Radical Injury and Antioxidant Status of Newly Diagnosed HIV Sero-positive Pregnant Women Seen in Osogbo, Nigeria

Adeniran Samuel Atiba, Patric Temi Adegun, Daniel Adebode Adekanle, Babatunde Moses Duduyemi, Rasaq Akintunde Akindele

International Journal of TROPICAL DISEASE & Health, Page 224-232
DOI: 10.9734/IJTDH/2013/3884

Aim: The presence of HIV and pregnancy is a double insult on the health of mothers. Both of these have been associated with free radical injury. The aim was to determine levels of malondialdehyde and antioxidants of newly diagnosed HIV sero-positive pregnant women.
Place and Duration of the Study: This study was carried out in pregnancy booking clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. The study was carried out between June and December in 2011.
Methodology: Thirty nine HIV sero-positives pregnant, 58 HIV sero-negative pregnant and 56 HIV sero-negative non pregnant women were recruited into the study. Malondialdehyde, antioxidant enzymes (glutathione peroxidase and superoxide dismutase) and antioxidants vitamins (vitamins C and E) were analyzed accordingly from plasma and haemolysate prepared from subjects and controls.
Results: Highest and lowest plasma levels of malondialdehyde/µmol/l were found in HIV sero-positive pregnant women (5.93±0.57) and HIV sero-negative non pregnant women (0.95±0.62) respectively. Lowest levels of all the antioxidants were observed in HIV sero-positive pregnant women while highest level was found in HIV sero-negative non pregnant women. However, the differences were only statistically significant with Vitamin E and glutathione peroxidase when compared (p<0.05).
Conclusion: We conclude that Human immunodeficiency virus sero-positive pregnant women experience more free radical injury than those with HIV sero-negative pregnant women.

Open Access Original Research Article

Seroprevalence of Cytomegalovirus among HIV-Infected Adult Patients on HAART

C. K. Ojide, E. I. Kalu, V. U. Nwadike, E. Ogbaini-Emovon, C. Omoti

International Journal of TROPICAL DISEASE & Health, Page 233-241
DOI: 10.9734/IJTDH/2013/4442

Background/Aims: Cytomegalovirus is one of the opportunistic infections associated with significantly high morbidity and mortality among patients living with HIV/AIDS. Clinical manifestation of CMV infection is worse among HIV patients not receiving highly active antiretroviral therapy (HAART) than those receiving HAART. This study is aimed at investigating the seroprevalence of CMV among HIV-infected adults on HAART.
Study Design: This is a cross sectional study.
Place and Duration of Study: HIV Outpatient Clinic of University of Benin Teaching Hospital between April and September, 2011.
Methodology: A total of 342 HIV infected adult patients on HAART attending the HIV Outpatients Clinic of the University of Benin Teaching Hospital between April and September 2011, were screened for CMV IgG and IgM using ELISA method. Clinical stage of HIV disease and CD4+ cell counts were also evaluated. Data was analyzed using SPSS version 17.
Results: Of the 342 patients studied 338 (98.8%) were sero-positive for CMV IgG antibodies while 24 (7.0%) demonstrated sero-positivity for CMV IgM antibodies. The seroprevalence of CMV IgM was significantly higher in patients in WHO clinical stages 3-4 (10.9%) than those in stages 1-2 (4.7%) (p = 0.04). There is no significant statistical difference in sereoprevalences of IgG and IgM with respect to sex, age, and CD4+ cell counts.
Conclusion: Clinical stage of HIV/AID is an important risk factor for reactivation or re-infection of CMV and may prompt early diagnosis and management of active CMV infection.

Open Access Original Research Article

Behavior Change Communications during Antenatal Visits Using Pictorial Cards Improves Institutional Delivery Rates: Evidence from Matlab, Bangladesh

A. Rahman, I. Anwar

International Journal of TROPICAL DISEASE & Health, Page 242-256
DOI: 10.9734/IJTDH/2013/2973

Aims: Behavior change communication (BCC) has been recommended in maternal health however, little is known about its effectiveness in improving knowledge and utilization of services. This paper presents findings from Matlab, a rural area of Bangladesh to inform policy about the effect of focused BCC on maternal knowledge and institutional delivery rates.
Study Design: Cohort Study.
Place and Duration of Study: The study took place in Matlab, Bangladesh from the period 2003 to 2006.
Method: The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) introduced pictorial cards in 1996 to monitor all pregnant women in Matlab service area and to provide BCC during routine antenatal visits on pregnancy danger signs, birth planning and maternal nutrition. Maternal knowledge was measured by asking about complications shown on the pictorial cards during 1st and 2nd (or successive) antenatal visits. The pictorial card data were linked with the birth file data and the socioeconomic survey data of the year 2005 of Matlab Health and Demographic Surveillance Systems (HDSS) for analysis.
Results: HDSS recorded 11,150 births during the study period but pictorial cards covered 10,657 women, and maternal knowledge data was available from 6,624 of these. Knowledge about all 5 danger signs increased from 8.9% to 34.2% between 1st and 2nd (or successive) antenatal visits (P <.001). Women with complete knowledge of all five pregnancy danger signs were 1.13 (Adjusted Odds: 1.13, 95% CI, 1.01-1.27) times more likely to have institutional deliveries than those without knowledge when the effect of socio-demographic co-variates were held constant.
Conclusion: Focused BCC using pictorial cards during antenatal visits improves knowledge regarding 5 pregnancy danger signs which has clear implications for improving institutional delivery rates. We recommend implementation research to demonstrate the effect of focused BCC in improving knowledge and practice to address high maternal mortality in resource-poor settings.

Open Access Original Research Article

Environmental Influences in Normal Weight Women with History of Recurrent Pregnancy Loss

O. B. Aborisade, M. A. Charles-Davies, M. A. Okunlola

International Journal of TROPICAL DISEASE & Health, Page 257-266
DOI: 10.9734/IJTDH/2013/1268

Aim: The study investigated the possible relationship of luteal phase progesterone, toxic heavy metals and nutrients in normal-weight women with history of recurrent pregnancy loss for adequate management.
Study Design: Cross sectional study.
Place and Duration of Study: The Obstetrics and Gynaecology Clinic, University College Hospital, Ibadan, Olabisi Onabanjo University Teaching Hospital, Shagamu and State Hospital, Ijebu-Ode; the University of Ibadan and environs between April and September, 2009.
Methodology: 90 apparently healthy women with normal weight aged 18-45years with regular and ovulatory cycles of 26-30 days were enrolled. They were 60 women with history of recurrent pregnancy loss (cases) age-matched with 30 women without history of recurrent pregnancy loss (controls). Demographic and anthropometric measurements were done by standard methods. Progesterone was determined by enzyme immunoassay (Immunometrics UK Ltd). Total cholesterol, triglyceride and high density lipoprotein were performed by enzymatic methods (Randox laboratories, USA) while low density lipoprotein was calculated using Friedwald’s formula. Zinc, selenium, chromium, manganese, iron, magnesium, copper, lead, and cadmium were estimated by atomic absorption spectrophotometry while Vitamin E was measured by high performance liquid chromatography. Statistical analysis was done using SPSS version 16.0.
Results: Results showed significantly higher levels of triglycerides, cadmium and lead, and significantly lower levels of progesterone, iron, copper, magnesium, chromium, selenium and vitamin E in cases compared with controls (p<0.013).
Conclusion: Oxidative stress mechanisms in normal-weight women with history of recurrent pregnancy loss were implicated. Healthcare policies should focus on pollution reduction and increase awareness on healthy diet for optimal periconceptional micronutrient requirements.

Open Access Original Research Article

Barriers to Contraceptive Use among Married Young Adults in Nigeria: A Qualitative Study

A. Ankomah, J. Anyanti, S. Adebayo, A. Giwa

International Journal of TROPICAL DISEASE & Health, Page 267-282
DOI: 10.9734/IJTDH/2013/4573

Aims: Nigeria’s contraceptive prevalence is one of the lowest in sub-Saharan Africa. The majority of married women in Nigeria is not currently using contraceptives and has no intention of doing so in the near future. This study was aimed at exploring the key cultural and societal perceptions, beliefs and practices that impede the uptake of contraceptives among young married Nigerians.
Study Design: Focus group discussions (FGDs); qualitative.
Place and Duration of Study: The study took place in thirteen locations across Nigeria’s six geo-political zones between July 2010 and September 2010.
Methodology: This is a qualitative study based on 30 focus group discussions held across 13 states in Nigeria’s six geo-political zones. Thirteen cities and towns were purposively selected to reflect the main ethnic and geographical variations in Nigeria. Focus groups were stratified, after initial screening, into four main groups: males, females currently using contraceptives, females not currently using contraception but with no unmet need; and females with unmet need. Local ‘mobilizers’ were enlisted to help in the recruitment. Trained FGD moderators and note takers used a semi-structured FGD guide to hold discussions in English or local languages.
Results: Compared with women, men have poorer knowledge of family planning. Women currently using family planning do so for two main reasons. The first is for economic reasons at the family level and the second is for health reasons. The greatest impediment to women’s contraceptive use is lack of support from husbands and other significant others as well as the absence of inter-spousal communication. Real and perceived fear of side effects is a major barrier. Rumours, myths and misinformation about contraceptives often have a strong negative impact on use.
Conclusion: The study confirms that even among young couples, inter-spousal communication is poor and contraceptive use in Nigeria is unlikely to improve without addressing men’s apparent lack of interest and involvement in family planning.