Open Access Case Study

Cholecystitis – Mode of First Presentation of Sickle Cell Anemia in an Adult Nigerian: A Case Report

Ugwu Ngozi Immaculata

International Journal of TROPICAL DISEASE & Health, Page 1-4
DOI: 10.9734/IJTDH/2016/28031

Background: This article aimed to sensitize the healthcare providers to the possibility of late and atypical presentation of sickle cell anemia (SCA).

Case Presentation: A 24 year old female university undergraduate presented to the Medical out-patient Department of our hospital with complaint of abdominal pain, vomiting, and yellowness of the eyes, all of 2 days prior to presentation. Abdominal pain was located at the right hypochondrial region, colicky in nature, not relieved nor aggravated by any known factor and does not radiate to any part of the body. There was associated vomiting, fever, weakness, and loss of appetite. Patient has been on apparent good health. No previous history of hospital admission(s), surgery nor blood transfusion. Physical examination showed an acutely ill-looking young girl in painful distress, febrile to touch, moderately pale, icteric, no pedal edema and no peripheral lymphadenopathy. Abdominal examination showed right hypochondrial tenderness, hepatomegaly and splenomegaly. A provisional diagnosis of hepatitis was made. However, in the course of investigations, there was no evidence of hepatitis rather cholelithiasis was reported by abdominal ultrasound scan. In the course of investigating for the cause of cholelithiasis, patient was diagnosed to have sickle cell anemia.. She subsequently had cholecystectomy done and is currently being followed up.

Conclusion: Patients with SCA usually present in infancy or early childhood with dactylitis, bone pain and/or symptomatic anemia which usually require frequent hospital admissions and blood transfusion especially in the absence of adequate care and follow up. This case is therefore to alert the health care providers to have high index of suspicion for late presentation in an atypical manner.

Open Access Case Study

Dengue Fever in Myasthenic Crisis

Alif Adlan Mohd Thabit, Wan Mohd Rasis Wan Ahmad Kamil, Mohd Ramadhan Mohd Din

International Journal of TROPICAL DISEASE & Health, Page 1-5
DOI: 10.9734/IJTDH/2016/28244

Aims: To investigate the possibility of a difference in late response towards intravenous immunoglobulin and its efficacy in myasthenic crisis when given during an acute dengue infection.

Presentation of Case: We report a 29-year old lady with myasthenia gravis diagnosed two years prior based on clinical presentation and positive anti-cholinesterase receptor antibody (AChR Ab) titre of > 20.98 nmol/L. Dengue infection was confirmed with positive SD® Dengue NS1 (Non Specific-1) antigen test. Muscle strength graded with the Medical Research Council (MRC) scale as well as hematological tests and arterial blood gases were done with chest X-rays to investigate for a concurrent chest infection. The patient was given IVIg) 0.4 g/kg/day for five days on the fifth day during the febrile phase of dengue fever after being ventilated in ICU for severe type 2 respiratory failure. 

Discussion: The patient showed neurological improvement only after twenty five days post-IVIg administration due to ventilator associated pneumonia and Stenotrophomonas maltophilia bacteraemia as post viral complications, as compared to five days during her previous uncomplicated myasthenic crisis. From a muscle power of 4/5 bilaterally of upper and lower limb extremities it had improved to 5/5 bilaterally together with improving hematological blood counts which coincides with the resolution of dengue and bacterial infections.

Conclusion: The delay in response towards IVIg in this myasthenic crisis is multifactorial – including the patient’s non-compliance to therapy, the dengue viraemia as well as the concomitant pneumonia which occurred during the later stage of the dengue infection. A future alternative option of plasma exchange should be looked into detail.

Open Access Original Research Article

Prevalence and Determinants of Antimalarial Self-medication in Southern Benin

V. Agueh, M. E. Badet, C. Sossa Jérôme, M. N. Paraiso, C. S. Azandjemè, C. Metonnou, Y. Ahanhanzo-Glèlè, A. Kpozehouen, G. E. Sopoh, L. Ouédraogo

International Journal of TROPICAL DISEASE & Health, Page 1-11
DOI: 10.9734/IJTDH/2016/27862

Aims: To determine the prevalence of antimalarial self-medication and identify its determinants in Comé, Southern Benin households.

Study Design: Cross-sectional community based study.

Place and Duration of Study: Benin southern setting, from April to July 2015.

Methodology: It was a cross-sectional study conducted from 1st to 14th July 2015 which involved 480 households randomly selected. Data on socioeconomic and demographic factors, the use of antimalarial drugs, health system and knowledge regarding malaria and dangers of self-medication were collected by questionnaire. Multivariate logistic regression was used to identify determinants of antimalarial self-medication in households.

Results: The prevalence of antimalarial self-medication in households was 69.77% [CI95: (65.64; 73.89)]. The use of antimalarial drug from illicit market was reported in 83.75%. In 28.73% of cases, the main anti-malarial drug used in self-medication was artemisinin-based combination. Determinants of antimalarial self-medication were level of economic status: quintiles poor (1 and 2) versus the richest quintile: OR = 6.50 [95%IC (3.43 – 10.68)]; quintiles less poor (3 et 4) versus the richest quintile: OR = 3,05 [95%IC (1,49 – 6,25)]; knowledge of the dangers of antimalarial self-medication, knowledge versus ignorance, OR = 0.26 [95%IC (0.14 – 0.48)], knowledge of dangers associated with street drugs: knowledge versus ignorance; OR =0,40 [95% (0,19 – 0,86)], knowledge of consequences of poorly treated malaria, knowledge versus ignorance: OR = 0,36 [95%IC (0,16 – 0,8)].

Conclusion: The results point out the high prevalence of antimalarial self-medication in households in Comé, Southern Benin. Strengthening knowledge on consequences of antimalarial self-medication, street drugs consumption and poorly treated malaria is needed to avert antimalarial self-medication practices in Comé in Southern Benin.

Open Access Original Research Article

National Health Insurance Scheme and Universal Health Coverage among Formal Sector Employees in Ilorin, Nigeria: Has Any Progress Been Made?

David A. Adewole, Oladimeji A. Bolarinwa, Magbagbeola D. Dairo

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2016/27777

Aims: Nigeria implemented a prepayment scheme for health over a decade ago with the aim of achieving universal health coverage. Though the formal sector employees in the federal civil service are the focus, universal health coverage has not been achieved among them. This study aimed to assess the awareness and annual coverage rate of the scheme among employees in the formal sector in Ilorin, Nigeria.

Study Design: A cross-sectional survey.

Place and Duration of Study: Ilorin, Kwara state Nigeria. July and August, 2015.

Methodology: Study was carried out among 507 formal sector employees in Ilorin metropolis. The respondents were chosen using stratified random sampling in 2 stages among employees in the federal, state and local government establishments. Data was collected with the aid of a semi-structured, interviewer-administered questionnaire. Analysis was carried out using SPSS statistical package version 17. Chi-square test was used to establish associations while logistic regression analysis was used for estimation of predictors of awareness about the coverage and enrolments in the scheme. Level of statistical significance was set at p value of <0.05.

Results: Awareness about the scheme was higher than it was in a previous study (85.4% vs 78.9%). Population coverage was better than it was in the previous study (89.8% vs 63.3%). Predictors of awareness of the scheme include working in federal (OR = 7.75, CI = 1.749-10.152, P = 0.001) and state governments establishments (OR = 2.544, CI = 1.212-5.340, P = 0.014).

Conclusion: The present annual population coverage rate of the scheme is too slow. There is a need for stakeholders to address this finding as a challenge and strategize modalities for enrolling those who are currently not under the scheme.

Open Access Original Research Article

Human Onchocerciasis among Children and Teenagers in Rural Nigerian Farm Settlement

Okoro Onyekwere Joseph, Okoye Chris Ikem, Nnamonu Emmanuel Ikechukwu, Onyishi Grace Chinyere, Ani Ogonna Christiana, Martins Paul Emenike

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2016/22294

This study investigated the prevalence of onchocerciasis among children and teenagers (1-15 years of age) in Adani - Enugu state, Nigeria. Rapid Assessment Method (RAM) was used during the study. Among 210 subjects examined, 66 (31.4%) were shown to be positive. Occurrence of the symptoms showed that onchocerca skin disease had 21.4%, onchocercoma, 8.6% and leopard skin, 1.4% respectively. Age was shown to be a major determinant for onchocerciasis prevalence, as 13-15 years age group had the highest percentage of occurrence (41.0%) while the 1-3 years age bracket had the least occurrence (16.7%). This demonstrates the cumulative nature of the disease which occurs with advance in age. There was no significant difference between the male (45.5%) and female (35.3%) infections (P>0.05). The frequency of Onchocerca Skin Deisease (OSD) studied revealed that acute papular onchodermatitis (APOD) appeared most among the children (71.7%) while depigmentation (DPM) had the least occurrence (4.4%). Nodules location and leopard skin were also investigated among the subjects. However, none of the candidates showed sign of visual impairment or blindness.