Scholarly works in Community Medicine

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Use of seatbelts by vehicle occupants in University College Hospital, (U.C.H) Ibadan, Nigeria
(Association of Resident Doctors (ARD), University College Hospital (UCH), Ibadan, Nigeria., 2005) Sangowawa, A. O.; Ekanem, S. E. U.; Alagh, B. T.; Ebong, I. P.; Faseru, B.; Uchendu, O.; Adekunle, B. J.; Shaahu, V. H. S.; Fajola, A.; Ogbole, G. I.
Road traffic accidents are a major cause of death and disability worldwide. A number of mecha nisms have been put in place to reduce the ensu ing injuries, one of which is the use of seatbelts. This observational study was carried out to de termine seatbelt use by vehicle occupants in Uni versity College Hospital (U.C.H). Trained re search assistants observed drivers and other ve hicle occupants as they drove into the only fuel station within the hospital premises between 8.30a.m and 6.00 p.m. over a six-day period. Data on vehicle occupant characteristics, pres ence and use of installed seat belts was docu mented using a modified version of the FIA foun dation sample seatbelt wearing observation form. A total of 570 occupants in 402 vehicles were observed. There were 402 drivers and 117 and 50 front and rear seat occupants respectively. The only child observed was unrestrained and seated on an adults lap in the front. Seat belt use by the drivers, front and rear seat passengers were 76 (18.9%), 16 (13.7%) and 2 (4%) respectively. A higher proportion 29 (29.9%) of all female drivers compared with male drivers 47 (15.4%) were restrained (X2 = 9.152, p = 0.02). Overall seat belt use observed was 16.5% and driver use was only 18.9% in spite of the existence of a law mandating use of seatbelt by drivers. Better enforcement of the current law is necessary and it should be extended to cover other vehicle occupants. The hospital environment presents a good opportunity to edu cate the public on the importance of seatbelt use utilizing various health education methods.
Child seating position and retraint use in the Ibadan metropolis, South Western Nigeria
(University of South Africa (UNISA), 2006) Sangowawa, A.; Ekanem, S.; Alagh, B.; Ebong, I.; Faseru, B.; Uchendu, O.; Adekunle, B.; Shaahu, V.; Fajola, A.
Different measures, including placing children in the rear seats of vehicles and the use of age- appropriate restraints have been developed to reduce injuries among children during a motor vehicle crash. Many of these measures are not universally adhered to. This cross-sectional, observational study was accordingly conducted to describe child seating position and restraint use in the Ibadan Metropolis, south western Nigeria. Observations were made at selected primary school gates in 3 of the 5 Local Government Areas (LGAs) which make up the metropolis. Data on 796 children riding in 440 vehicles were collected. Driver restraint use was 48.0%. Restraint use among the children was 4.1%. Two hundred and twenty-three (28.0%) children between the ages 0-13 years were seated in the front, most, 86 (38.6%) of whom were aged 1-4 years. Just under a half (48.3%) of restrained drivers had at least one child seated in the front of the vehicle compared to 47.6% of unrestrained drivers. Children were more likely to be seated in the front when the rear seat was unoccupied. In addition, children were more likely to be restrained when riding in a vehicle with a restrained driver. There is an urgent need for multi-disciplinary action geared towards improving child passenger safety practices in the Ibadan metropolis. Legislation, health education and availing affordable child restraints will go a long way towards ensuring the safety of children in motor vehicles.
Noise levels and hearing impairment in an urban community in Ibadan, Southwest Nigeria
(Oxford University Press, 2008) Omokhodion, F. O.; Ekanem, S. U.; Uchendu, O. C.
Aim The study sought to measure the noise levels in an urban community and assess the hearing levels of persons working within the community. Subjects and methods Noise levels were measured in selected locations in Ibadan, southwest Nigeria, using a sound level meter CEL 269 (CEL Instruments UK Ltd.). Measurements were done between the hours of 08:00 and 15:00. Audiometric screening was done on 51 persons working within the community to determine the occurrence of hearing impairment. Results The noisiest locations were workshops using machines such as saw mills, 95–102 dBA; carpentry tools, 87–101 dBA; printing presses, 85–88 dBA; and grain mills, 88–105 dBA. Music shops also constituted a nuisance with noise levels of 89–99 dBA. Roadside noise levels on major road junctions were 86–90 dBA and 61–65 dBA on side streets. Noise levels in designated markets ranged from 65– 69 dBA and 61–81 dBA in street markets. Within residential areas, noise levels ranged from 39–41 dBA in low-density areas to 55–59 dBA in high-density areas. Audiometric screening showed that 28 participants (55%) had normal hearing. Mild and moderate hearing impairment was recorded among 17(33%) and 6 (11.7%) participants, respectively. Of the 23 who were hearing impaired, 10 had bilateral impairment. The prevalence of hearing impairment increased with age from 14% in the 2nd decade to 75% in the 5th decade. Conclusion Noise levels in several areas of the city exceed WHO guideline values and constitute a public health hazard to residents and street workers. There is a need for regulation and control of the social and economic activities that generate noise. This may reduce the occurrence of hearing impairment and other adverse health outcomes in the general population.
Falls and outcomes amongst old people in rural dwellings
(Association of Resident Doctors (ARD), University College Hospital (UCH), Ibadan, Nigeria., 2009) Adebiyi, A. O.; Uchendu, O. C.; Ikotun, O. T.; Oluleye, O. W.; Olukotun, O. P.
Background: Falls are the leading cause of injury deaths among people 65 years and older. This study gives an insight into the prevalence of falls among older people and how they occur in a rural setting in Nigeria. Methods: A community based survey of 210 consenting old people aged 65 years and above selected using a multi-stage sampling technique was done. Study instrument was a semi-structured interviewer administered questionnaire and visual acuity was tested using Snellens chart. Results: Incidence of falls was 21.4%. Of those who had falls, 86.7% were walking while 11.1% were either sitting or running when it occurred. The nature of the fall was tripping in 44.4%, slipping in 35.6% and hitting an object in 17.8% of cases. Consequences of falls included pain 48.9%, bruises 22.2%, lacerations 13.3% and fractures 11.1%. Females had more falls than males; 23.8% vs 19.0%, p = 0.40. Major injuries resulting from falls also occurred more frequently amongst females than males; 30.7% vs. 15.0%, p = 0.3. History of diabetes and alcohol use increased the odds of falling (OR 4.1, 95% CI 1.0 – 16.0; OR 2.2, 95% CI 1.0 – 4.6 respectively). Being in a monogamous marriage and having normal sight were protective of having falls (OR 0.4, 95% CI 0.2 – 0.9; OR 0.4, 95% CI 0.2 – 0.9 respectively). Conclusion: Falls often occur from tripping and slipping while females are more likely to have major injuries. Risk factors for falls were alcohol use and diabetes while having normal sight and being monogamous were protective. Prevention should aim at a life course approach to addressing these intrinsic and extrinsic factors.
Perception and practice of child labour among parents of school-aged children in Ibadan, southwest Nigeria
(Blackwell Publishing Ltd, 2009) Omokhodion, F. O.; Uchendu, O. C.
Background The problem of child labour has lingered on in many countries because of the complex combination of social, cultural and economic factors involved. Parents play a critical role in child labour as it provides much needed extra income for the family. This study was carried out among parents of school-aged children in an urban, low-income community to determine the factors associated with child labour and attitudes to child labour in the community. Methods A cross-sectional study was carried out in an urban community in Ibadan, southwest Nigeria. Questionnaires were administered to parents of school-aged children. Results A total of 473 parents were interviewed. They were aged between 23 and 56 years, mean 37.9 years. Thirty-nine per cent of parents indicated that they thought their school-aged children should work. More women than men, those from polygamous homes and those with lower educational status held this view. Reasons given for wanting their children to work were to supplement family income, 45%, to gain experience, 35% and to help in family business, 10%. In all, 236 (50%) respondents reported that their school-aged children were working. Parental factors associated with practice of child labour were polygamous marriage, low educational status, unskilled or partly skilled occupation and large family size. Seventeen per cent of parents with working children were not satisfied with their children’s work conditions and complained of low earnings, long working hours, work on school days and unsafe work environment. Measures suggested to control child labour include addressing the issue of household poverty, public enlightenment about the ills of child labour and free education up to junior secondary level. Enforcement of child labour laws was the least mentioned. Conclusion We conclude that control of child labour should be a multifaceted approach involving poverty alleviation, family planning to reduce family size and free, compulsory education up to junior secondary level. Public enlightenment especially for mothers will be of additional benefit.
An observational study of seatbelt use among vehicle occupants in Nigeria
(BMJ Publishing Group Ltd, 2009) Sangosawa, A. O.; Alagh, B. T.; Ekanem, S. E. U.; Ebong, I. P.; Faseru, A.; Adekunle, B. J.; Uchendu, O. C.
Objective: The use of seatbelts reduces the likelihood of death and severe injuries to crash-involved vehicle occupants by 45e60%. Several countries, including Nigeria, have laws mandating the use of seatbelts but compliance is not universal. This study was conducted to determine rates of use of seatbelts among vehicle occupants in Ibadan municipality. Design: An observational study was conducted. A selected petrol station in each of the five local government areas in Ibadan municipality was used as an observation site. Observations were documented by trained research staff between 08:30 and 18:00 hours over a 6-day period. Results: 5757 occupants in 2870 vehicles were observed. Approximately 90% of drivers were men. Driver seatbelts were installed in approximately 90% of vehicles. Overall seatbelt use was 18.7; 31.7% among drivers and 10.3% and 0.4% among front and rear-seated adults, respectively. Only one child (0.7%) was restrained. Significantly more female drivers 47.3% used their seatbelts compared with men, 30.3% (p<0.001). An adult passenger was more likely to be restrained when riding with a female driver (p=0.007) and when the driver was restrained (p=0.000). Conclusions: The study showed that seatbelt use among vehicle occupants was low. Further research into reasons for the non-use of restraints needs to be conducted so that these can be incorporated into programmes aimed at improving seatbelt use.
Clinical audit of antenatal service provision in Nigeria
(Taylor & Francis, 2011) Osungbade, K. O.; Shaahu, V. N.; Uchendu, O. C.
We audited records of 365 pregnant women whose mean age was 25.6 ± 5.6 years. Their mean gestational age at booking was 29.3 ± 2.7 weeks; their mean number of antenatal visits was 4.2 ± 2.3. Weight, blood pressure, and urine were checked on 97.3%, 95.1%, and 86.3% of the women respectively. Hemoglobin estimation was done on 19.2% of women; 34.8% received two doses of tetanus toxoid. Malaria prophylaxis and iron and folate supplements were provided to 263 (72.1%) and 293 (80.3%), respectively. Late booking was common, and antenatal service was inadequately equipped. Early booking and full implementation of preventive treatments are recommended. Support for detection of anaemia and immunization service is desirable.
Perianaesthetic complications associated With adenotonsillectomy at the University College hospital, Ibadan, Nigeria.
(Internet Scientific Publishers, 2012) Sanusi, A. A.; Akinwale, M. O.; Uchendu, O. C.; Lasis, A. O.
Adenoidectomy and tonsillectomy are common ear, nose and throat operations in children and are often accompanied by complications. This study assessed the perianaesthetic complications encountered among patients who had adenotonsillectomy in a tertiary hospital through May 2009 to April 2010.The study comprised of 49 subjects made up of 26 (53%) males and 23 (47%) females with a median age 36 (range=8 – 64) months and a median weight of 14kg (range = 5 –76kg). All the patients had general anaesthesia with endotracheal intubation. The procedures included tonsillectomy in 8 (16%) subjects, adenoidectomy in 18 (37%) and adenotonsillectomy in 23 (47%). Of the 49 patients, 24 (49%) had associated OSA, 2 (4%) had sickle cell disease, 1 (2%) patient had Down’s syndrome and 1 (2%) had hypertension. The estimated median blood loss was 50ml with a range of 20-200ml. The incidence of critical events and complications was 53.1%. Vomiting was the most common complication, occurring in 16% of the patients, followed by accidental tube dislodgement 14% and tube compression 10%. The use of plastic endotracheal tube was significantly associated with the occurrence of tube compression compared to the reinforced (non-kinkable) tube (Fisher’s exact=0.034), in addition, the presence of OSA is significantly associated with delayed post-operative recovery (Fisher’s exact = 0.05).We conclude that there is a high incidence of tube compression and dislodgement complicating adenotonsillectomy suggesting the need to modify the method of anchoring the endotracheal tube during the procedure.
Experiences of mistreatment among medical students in a University in South West Nigeria
(Nigerian Medical and Dental Consultants Association, 2012) Owoaje, E.T.; Uchendu, O. C.; Ige, O. K.
Objective: This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school. Materials and Methods: A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria. Results: Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression. Conclusion: Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed.
Evaluation of the Haemodynamic and Metabolic Effects of Local Anaesthetic Agent in Routine Dental Extractions
(Springer, 2013) Akinmoladun, V. I.; Okoje, V. N.; Akinosun, O. M.; Adisa, A. O.; Uchendu, O. C.
Introduction: The systemic effects of adrenaline adminisitered during dental local anesthesia have been the subject of many studies. The purpose of this study was to investigate the haemodynamic and metabolic effects attributable to adrenaline injected during local anesthesia in dental extraction patients. Methods Apparently medically fit patients were included and randomized into two groups. Participants had breakfast before coming in for tooth extraction. The weight, height, blood pressure and pulse rate were measured and blood sample taken before administration of local anaesthetic injections. Blood pressure, pulse and blood sample were again taken at 15 and 30 min. Results: While the adrenaline group showed a modest increase between pre- and post-drug administration states, the control group showed no difference in median systolic blood pressures. Both groups showed a slight increase in diastolic blood pressure observed between pre- and post drug administration states. Also both groups showed no significant difference in median pulse rate throughout. Although blood glucose values were widely dispersed in the pre-drug administration state in both groups, the control group showed no difference in median values throughout. However, a modest increase was observed in the adrenaline group between pre- and post-drug administration states, which persisted beyond 30 min. Conclusion: The patients treated with local anesthesia with adrenaline showed a response similar to that observed in the control group.
Factors influencing the choice of health care providing facility among workers in a local government secretariat in south western Nigeria
(Association of Resident Doctors (ARD), University College Hospital (UCH), Ibadan, Nigeria., 2013) Uchendu, O. C.; Ilesanmi, O. S.; Olumide, A. E.
Background: There is increasing interest in the choice of health care providing facility in Nigeria. Objectives: This study aimed to assess the factors influencing choice and satisfaction with health service providers among local government staff. Methods: A cross sectional survey of all 312 workers in a Local Government Secretariat in South West Nigeria was done. Chi Square and logistic regression analysis was done. Results: The mean age was 38.6 ± 7.5 years, 55% were females and 71.7% had tertiary education. The median monthly family income of the respondents was N 28, 000 (N3,000 – N500,000), with 24.4% earning a monthly income of N21, 000 to N30, 000. Many (72.3%) utilized public health facilities attributing the choice to the low cost of services. Respondents who are satisfied with their usual care providing facilities are 12.2 times more likely to have used public facilities than private facilities (95%, CI 3.431 – 43.114). Respondents who described the quality with ease of getting care/short waiting times as being good are 3.9 times more likely to have private facilities as their chosen health care providing facility (95%, CI 1.755 – 8.742). Cost/payment for service is 2.9 times more likely to predict the use of public health facility as the usual health care provider. Conclusion: Private facilities though costlier do not appear to be providing better services than public facilities. To increase access to health care the cost of services and the waiting time are important factors to address.
Evaluation of the effectiveness of computed tomography in the diagnosis of orbital tumours in ibadan, southwest Nigeria
(West african College of Surgeons, 2013) Akinmoladun, J. A.; Adeyinka, A. O.; Uchendu, O.; Akinmoladun, V. I.
Background: The orbit is a bony cavity within the skull that is composed of many structures which may undergo neoplastic transformation. Failure to diagnose the tumour and determine its extent may lead to high morbidity and mortality. The aim of this study was to evaluate the role of computed tomography in the diagnosis of orbital tumours in our centre. Materials and methods: Computed Tomography images acquired from a multi-sliced CT machine, tissue diagnoses obtained from histopathology reports and patients' clinical records were reviewed. The data were analyzed and presented using frequency tables, percentages and charts as appropriate. Results: Sixty six patients made up of 34 (51.6%) males and 32 (48.4%) females were studied. The ages ranged between 1 and 80 years with a mean of 35 years. Majority (50%) of the patients were in their 4th – 6th decades of life. While secondary orbital tumours were seen in 42 (63.6%) patients, primary tumours occurred in 23 (34.8%) cases. Metastatic deposit was seen in 1 (1.6%) patient. Bone was the most commonly affected orbital tissue. The CT diagnoses of benign and malignant tumours were accurate when compared with histopathological diagnoses in 80.6% and 96.7 % of the cases respectively. Conclusion: Computed Tomography is useful in characterizing the nature, precise location of a lesion within the orbit and to demonstrate the extension of the orbital lesion into contiguous structures. This study showed that Computed tomography is also a useful imaging technique in the diagnosis of orbital tumours with high concordance rate when compared with histological diagnoses.
Differences in the malariometric indices of asymptomatic carriers in three communities in Ibadan, Nigeria
(Hindawi Publishing Corporation, 2014) Amodu, O. K.; Olumide, A. O.; Uchendu, O. C.; Amodu, F. A.; Omotade, O. O.
This study was conducted to determine the malariometric indices of children in three different settings in Ibadan,Nigeria. Children were recruited from an urban slum (Oloomi) and a periurban (Sasa) and a rural community (Igbanda) in Ibadan. Children aged between 2 and 10 years were randomly selected from primary schools in the urban and periurban areas. In the rural community, children were recruited fromthe centre of the village. A total of 670 (55.0%) out of 1218 children recruited were positive formalaria parasitaemia.The urban population had the highest proportion of children with malaria parasitaemia. Splenomegaly was present in 31.5%, hepatomegaly in 41.5%, hepatosplenomegaly in 27.5%, and anaemia in 25.2% of the children.The parasite density was not significantly different among children in the three communities. Children in the rural community had the highest mean PCV of 34.2% and the lowest rates of splenomegaly (6.1%), hepatomegaly (7.6%), and hepatosplenomegaly (4.6%).The spleen rates, liver rates, and presence of hepatosplenomegaly and anaemia were similar in the urban and periurban communities.The malariometric indices among the asymptomatic carriers were high, especially in the urban slum. This stresses the need for intensified efforts at controlling the disease in the study area.