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Abakaliki, Nigeria

Chigbu C.O.,University of Nigeria | Onyebuchi A.K.,Federal Teaching Hospital
International Journal of Gynecology and Obstetrics

Objective: To compare the treatment outcomes of women with high-grade squamous intraepithelial lesions (HSIL) who underwent immediate loop electrosurgical excision procedure (LEEP) and those who had directed biopsies prior to subsequent LEEP. Methods: Women who were referred for HSIL to 2 centers in southeast Nigeria were examined via colposcopy. Those with positive colposcopic findings were randomized to receive either immediate LEEP (see-and-treat group) or directed biopsies (3-step group). Women with directed biopsy-confirmed results underwent follow-up LEEP. Overtreatment rate, cost, default rate, and cytology-treatment interval were compared between the 2 groups. Results: In total, 314 women were included in the study. The overtreatment rate was similar between the groups. Treatment cost and cytology-treatment interval were significantly higher in the 3-step group (P = 0.0001). The default rate was significantly lower in the see-and-treat group (P = 0.0001). Most (219 [69.7%]) participants preferred the see-and-treat approach. Conclusion: Immediate see-and-treat LEEP for women with HSIL in southeast Nigeria is cheaper, less time-consuming, and associated with better patient compliance than the 3-step management procedure. Furthermore, it does not lead to significantly higher overtreatment. The immediate see-and-treat approach may be ideal for the management of women with HSIL in low-resource countries. © 2013 International Federation of Gynecology and Obstetrics. Source

Osakwe C.,World Health Organization | Otte W.M.,Community based Rehabilitation Effata | Otte W.M.,University Utrecht | Alo C.,Federal Teaching Hospital
Epilepsy Research

Epilepsy is a common neurological disorder in Nigeria. Many individuals are affected in rural areas, although prevalence data is not available. In this study we aimed to establish the prevalence of epilepsy in a rural community in south-east Nigeria, a community suspected for having a high number of people living with epilepsy. We compared this with the prevalence in a nearby semi-urban community in north-central Nigeria. In both communities we identified potential causes of epilepsy and obtained information on the social beliefs regarding epilepsy. We used door-to-door surveys and focus group discussions.The epilepsy prevalence in the rural community was 20.8/1000 [95% confidence interval (CI): 15.7-27.4]. The prevalence in the semi-rural community was lower, namely 4.7/1000 [CI: 3.2-6.9]. The difference in prevalence was highly significant (χ2-test, p<0.0001). In both communities most people with epilepsy were in the age range of 7-24 years. Causes that might be contributory to the prevalence of epilepsy in both communities included poor obstetric practices, frequent febrile convulsions, head trauma, meningitis and neurocysticercosis. In both communities we found stigma of people with epilepsy.In conclusion, the epilepsy prevalence in the semi-urban community is similar to that in industrialized countries. In contrast, the rural community has a much higher prevalence. This may require the establishment of specific community-based epilepsy control programs. Community interventions should focus on treatment of acute epilepsy and on stigma reduction. © 2013 Elsevier B.V. Source

Nigeria ranks fourth among 22 high tuberculosis (TB) burden countries. Although it reached 99% DOTS coverage in 2008, current case detection rate is 40%. Little is known about delays before the start of TB therapy and health-seeking behaviour of TB patients in rural resource-limited settings. We aimed to: 1) assess healthcare-seeking behaviour and delay in treatment of pulmonary TB patients, 2) identify the determinants of the delay in treatment of pulmonary TB. We conducted a cross-sectional study of adult new pulmonary TB patients notified to the National Tuberculosis Control Programme (NTP) by three rural (two mission/one public) hospitals. Data on health-seeking and delays were collected using a standardised questionnaire. We defined patient delay as the interval (weeks) between the onset of cough and the first visit to any health provider, and health system delay as the time interval (weeks) between patient's first attendance to any health provider, and the onset of treatment. Total delay is the sum of both delays. Multiple linear regression models using nine exposure variables were built to identify determinants of delays. Of 450 patients (median age 30 years) enrolled, most were males (55%), subsistent farmers (49%), rural residents (78%); and 39% had no formal education. About 84% of patients reported first consulting a non-NTP provider. For such patients, the first facilities visited after onset of symptoms were drug shops (79%), traditional healers (10%), and private hospitals (10%). The median total delay was 11 (IQR 9-16) weeks, patient delay 8 (IQR 8-12) and health system (HS) delay 3 (IQR 1-4) weeks. Factors associated with increased patient delay were older age (P <0.001) longer walking distance to a public facility (<0.001), and urban residence (P <0.001). Male gender (P = 0.001) and an initial visit to a non-NTP provider (P = 0.025) were independent determinants of prolonged HS delay. Those associated with longer total delay were older age (P <0.001), male gender (P = 0.045), and urban residence (P<0.001). Overall, TB treatment delays were high; and needs to be reduced in Nigeria. This may be achieved through improved access to care, further education of patients, engagement of informal care providers, and strengthening of existing public-private partnerships in TB control. Source

Eze J.N.,Ebonyi State University | Emeka-Irem E.N.,Federal Teaching Hospital | Edegbe F.O.,Ebonyi State University
Clinical Medicine Insights: Oncology

Cervical cancer is still a major contributor to cancer-related mortality amongst women living in poor, rural communities of developing countries. The objective of this study is to establish the clinical presentation of cervical cancer and the management challenges encountered in Abakaliki, southeast Nigeria, with a view to finding intervention strategies. This study is a retrospective descriptive assessment of cases of clinically diagnosed cervical cancer managed at a state teaching hospital over six years. Of 76 cases managed, 61 (80.3%) cases notes were available for study. The mean age and parity of patients were 53.8 years and 6.8 years, respectively. The majority (75.4%) were illiterate. All had been married, but 42.6% were widowed. The main occupations were farming or petty trading. One patient (1.6%) had had a single Pap smear in her life. The major presenting complaints were abnormal vaginal bleeding (86.9%), offensive vaginal discharge (41.0%), and weight loss. Twenty patients (32.8%) were lost to follow-up prior to staging. Of the remaining 41 patients, 16 (39.0%) had stage III disease and 17.1% stage IV. Fifteen patients (24.6%) with late stage disease accepted referral, and were referred for radiotherapy. Those who declined were discharged home on request, though 4 (9.8%) died in the hospital. There was no feedback from referred patients confirming that they went and benefitted from the referral. The presentation followed known trends. Illiteracy, poverty, early marriages, high parity, widowhood, non-use of screening methods, late presentation, non-acceptance of referral, and lack of communication after referral were some of the major challenges encountered. These underscore the needs for health education and awareness creation, women educational and economic empowerment, legislation against early marriages and in protection of widows, and creation of a well-staffed and well-equipped dedicated gynecologic oncology unit to forestall further referral. © the author(s), publisher and licensee Libertas Academica Ltd. Source

Schultz T.,Ruhr University Bochum | Ezeanosike E.,Federal Teaching Hospital | Dick H.B.,Ruhr University Bochum
Journal of Refractive Surgery

PURPOSE: To report femtosecond laser-assisted cataract surgery in pediatric Marfan syndrome. METHODS: Case report. RESULTS: A 10-year-old boy with ectopia lentis due to Marfan syndrome underwent femtosecond laser-assisted cataract surgery (Catalys Precision Laser System; OptiMedica, Sunnyvale, CA) under general anesthesia. Anterior capsulotomy was performed on the decentered lens. Routine irrigation/aspiration devices were used for lens and cortex removal. Centration of the capsular bag was achieved using a Cionni scleral fi xation ring. A foldable intraocular lens was implanted. A free-positioned and precise sized capsulotomy was cut by the femtosecond laser. No intraoperative or postoperative complications were observed within the 10 weeks of follow-up. CONCLUSIONS: The use of a femtosecond laser has potential to perform a circular, well-centered capsulotomy for subsequent capsular tension ring and intraocular lens implantation without decentration in patients with Marfan syndrome. Copyright © SLACK Incorporated. Source

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