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PubMedDate not supplied

Ventriculo peritoneal shunts in children. A ten year experience at the University of Nigeria Teaching Hospital, Enugu-Nigeria.

In a ten year period (1977--1986) one hundred and fifty children with hydrocephalus who received ventriculo-peritoneal shunt as their modality of treatment were followed up. Seventy-one per cent of these children were neonates and infants, the majority of them presenting within the first 3 months of onset of symptoms and signs. The major causes of hydrocephalus in these children were congenital malformations, meningitis, tumours and trauma. Pudenz shunt systems were favoured in the 1977--81 period, while 1982--86 period witnessed an upsurge of self devised catheters because of dwindling national economy. The latter were cheaper and more readily available. Apart from blockage of shunts which occurred more in self devised catheters, the performance of these catheters in terms of shunt infections and other complications were same in both self devised and conventional catheters. The main complications encountered were blockage and infection of the shunts, while rare complications included migration and extrusion of shunts to and from the peritoneal cavity, CSF ascites and recurrent abdominal cysts.

Child, Preschool↗
PubMed2004

Dermatology in Nigeria: evolution, establishment and current status.

The history of dermatology in Nigeria can be summarized by listing the "first events and people" who played major roles. The first dermatologist to work in Nigeria was George HV Clarke in the mid 1950s. He was based in Lagos. Organized training/teaching and research in dermatology was first established at the University of Ibadan in the western region of Nigeria, in collaboration with the Institute of Dermatology, London. The first set of dermatologists from the Institute on secondment who established dermatology as a discipline at the University of Ibadan were Roger RM Harman as lecturer and GC Wells as the Visitor/supervising consultant in 1962. The first indigenous dermatologist was Anezi Okoro. The first female dermatologist was Yetunde M Olumide. The first (and still the only) Department of Dermatology was at the Obafemi Awolowo University in Ile-ife in the western region of Nigeria, started by a German trained dermatologist: F. Soyinka, the junior brother of Nigeria's first (and only) Nobel Laureate. The first leprologist in Nigeria was George Stanley Browne, a medical missionary. He worked briefly as an associate lecturer (1963-65) under Professor Alexander Brown at the University of Ibadan. Most of the events in Nigeria's dermatology history as well as the greatest concentration of dermatologists in the country have been around the south-western part of the country: Lagos, Ibadan, and Ile-ife. The military coup and the political events that occurred thereafter had a great negative impact on the development/growth of dermatology in Nigeria. The documentation by Ryan as of 1990 indicates that many African countries still do not have a single trained dermatologist.

Academic Medical Centers↗
PubMed2001

A Cost-Effective Model for Increasing Access to Mental Health Care at the Primary Care Level in Nigeria.

BACKGROUND: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental health care services. The nation's Health Ministry has adopted mental health as the 9th component of Primary Health Care (PHC) but ten years later, very little has been done to put this policy into practice. Mental Health is part of the training curriculum of PHC workers, but this appears to be money down the drain. AIMS OF THE STUDY: To review the weaknesses and problems with existing mode of mental health training for PHC workers with a view to developing a cost-effective model for integration. METHODS: A review and analysis of current training methods and their impact on the provision of mental health services in PHC in a rural and an urban local government area in Nigeria were done. An analysis of tested approaches for integrating mental health into PHC was carried out and a cost-effective model for the Nigerian situation based on these approaches and the local circumstances was derived. RESULTS: Virtually no mental health services are being provided at the PHC levels in the two local government areas studied. Current training is not effective and virtually none of what was learnt appears to be used by PHC workers in the field. Two models for integrating mental health into PHC emerged from the literature. Enhancement, which refers to the training of PHC personnel to carry out mental health care independently is not effective on its own and needs to be accompanied by supervision of PHC staff. Linkage, which occurs when mental health professionals leave their hospital bases to provide mental health care in PHC settings, requires a large number of skilled staff who are unavailable in Nigeria. In view of past experiences in Nigeria and other countries, a mixed enhancement-linkage model for mental health in PHC appears to be the most cost-effective approach for these Nigerian communities. DISCUSSION: Nigeria is currently experiencing a 'double epidemic', and with high infant and maternal mortality rates, the burden of mental health problems is still invisible to policy makers. Meagre resources allocated to mental health need to be utilised maximally with cost-effective interventions. This mixed enhancement-linkage model draws on the strengths of both models, while taking into account their limitations. Concrete conclusions cannot be drawn until the model developed is fully tested. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: This model has the potential of making mental health services available, accessible and acceptable in these communities. This should reduce the burden of suffering for the mentally ill by providing treatment and restorative care, promoting mental health and preventing mental illness in the populace. IMPLICATIONS FOR HEALTH POLICY FORMULATION: The current mental health policy for Nigeria focuses on enhancement as the mode in which mental health can be successfully integrated into PHC and so far this has not been successful. Results emerging from this model can be presented to policy makers thereby supporting replication in other parts of the country. This could ultimately lead to a change in the mental health policy on training for mental health at the PHC level. IMPLICATIONS FOR FURTHER RESEARCH: Mental health services and mental health economics research are still at the stage of infancy in Nigeria. This study provides baseline information and should stimulate further research in these two vital areas.

Journal Article↗
PubMed2004

The epidemiology, diagnosis and treatment of subarachnoid haemorrhage in Nigeria: what do we know and what do we need to know?

Our goal was to review published literature on the epidemiology, diagnosis and treatment of subarachnoid haemorrhage (SAH) in Nigeria. With an estimated population of 126 million, roughly 6 million persons in Nigeria have or will develop an intracranial aneurysm in their lifetime. This study should highlight the areas requiring research and development, and facilitate future health care planning. A Medline and Embase literature review of reports on the management of SAH in Nigeria was conducted. The search terms were as follows: stroke, subarachnoid haemorrhage, intracerebral haemorrhage, brain, Nigeria, Nsukka, Ibadan, Lagos, Kaduna, Jos, Benin, Port Harcourt, Africa. All identified abstracts were reviewed for inclusion in the study. Only papers dealing with the study objectives were obtained for review of the bibliography and further analysis. Thirty articles have now been published about stroke in Nigerians. Fifteen of these either discussed SAH specifically or, in general, with other stroke subtypes (ischaemic stroke and intracerebral haematoma) or reviewed vascular intracranial anomalies such as aneurysms. The most detailed paper on this issue was published in 1970 and according to that report SAH is more common in males and prevalent in young people below the age of 40 years (68% of the patients reviewed). Worldwide improvements in medical and surgical management have not been reflected in the literature on SAH. Neurologists, stroke physicians and not neurosurgeons, treat patients with SAH in Nigeria. The results presented in this study reflect the current status of the medical and surgical management of SAH in Nigeria. Conclusive data relating to epidemiology, incidence, diagnosis, current treatment modalities and outcome of SAH in Nigeria have not been published. There is, therefore, a pressing need for further study in these areas and improvements in the management of patients with SAH.

Adult↗
PubMed1987

Background to the development of health services in Nigeria.

This paper concentrates on three main issues. First a brief overview of the nature of the politics, economy and health in Nigeria prior to colonialism. It is important to know, for instance, how medicine was organized prior to the advent of modern medicine. I think our understanding of pre-colonial Nigeria is important because it enables us a better grasp of the changes which were later introduced by imperialists. The second issue will be the imperial penetration of Nigeria by Britain. Imperialism took several forms ranging from the activities of Christian missionaries to the eventual colonial rule over the various kingdoms and empires which were in the region. The effects of the imperialist activities on the transformation of Nigerian society and particularly the introduction of the capitalist productive forces wil be discussed, with the view to examine changes in the organization of health and medicine. The last issue to be considered in this paper will be the role of imperialism in class formation in Nigeria. Emphasis will be first, on the social and economic condition of colonial physicians who came from England and then how they were related to the colonial state and colonial health policies. From this premise, we can examine the historically specific circumstances under which Nigerians were trained as physicians and how they (Nigerian physicians) got involved in the politics of nationalism. We will then discuss how the First and Second World War gave energy to Nigerian nationalist movements. The paper ends by stating that the Nigerian nationalists who had struggled and secured Nigeria's political independence eventually became Nigeria's ruling class which now controls the post-colonial state.

Health Services↗
PubMed1997

HIV/AIDS infection control enforcement: a comparison between Nigeria and the United States.

We examined differences in approaches to HIV-related infection control practices in two university teaching hospitals in the United States and Nigeria. Health care workers (n = 202 in Nigeria and 186 in the USA) responded to a previously validated measure of infection control practices. There were significant differences in the estimated probability of treating a person with HIV disease (higher in USA), and a greater probability of peer ridicule as a way of enforcing group norms on infection control in Nigeria. Peer enforcement of norms was significantly lower in the USA. In both countries, more precautions would be taken if it was known that the patient was HIV infected. Infection control practices were more likely to be followed in the USA compared with Nigeria if they were praised for this activity, if appropriate facilities (sharps containers, gloves, etc.) were nearby, and if they felt that infection control procedures were effective. These data point to the importance of normative social pressures in Nigeria and of knowing the patient is HIV infected in the USA and feeling that infection control procedures are effective ways of avoiding occupational HIV infection. The role of normative pressures and assumptions about HIV infection status as well as cues and availability of facilities for infection control appear to differ between these health care workers in Nigeria and the USA.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Influences of mother's work, childhood place of residence, and exposure to media on breast-feeding patterns: experience of Nigeria and Uganda.

This study uses data from the Nigerian Demographic and Health Survey collected in 1990 and the Ugandan Demographic and Health Survey collected in 1995 to examine the implications of mother's work, childhood place of residence, and exposure to the media for breast-feeding patterns (exclusivity and intensity) in Nigeria and Uganda. Nigeria and Uganda present an interesting contrast because Nigeria is more modernized and economically developed than Uganda, thus providing a good indication of the influence of modernization on breast-feeding patterns. Mother's work status is defined by considering whether mothers earned cash from work and took their children to work, hence emphasizing the compatibility of work with child care. Work least compatible with child care had a negative effect on breast-feeding intensity in Nigeria. The negative effect of mother's work on exclusive breast-feeding (that is, if the mothers used formula or milk instead) observed for some working mothers in Nigeria and Uganda was partly confounded by urban residence, exposure to media, and other socioeconomic factors. Mother's work did not have a negative effect on breast-feeding intensity in Uganda. The relationship between mother's work, urban residence, media exposure, and breast-feeding practice seems to be stronger in Nigeria than Uganda.

Adolescent↗
PubMedDate not supplied

Breast cancer in Nigeria and Finland: epidemiological, clinical and histological comparison.

BACKGROUND: We compared the histology and patterns of occurrence of breast cancers in Nigeria (n = 297) and Finland (n = 285). PATIENTS AND METHODS: The histology of invasive ductal carcinoma (IDC) was re-evaluated using similar criteria. The clinical data were extracted from medical records. RESULTS: The mean age at presentation was 42.7 (12.2) years in Nigeria vs. 58.7 (12.5) years in Finland. In both populations there was an association between reproductive factors and the occurrence of breast cancer. In Nigeria, 53.2% of cases belonged to stages 3 and 4 (vs. 6.7% in Finland). In Finland there were higher frequencies of lobular, tubular and mucinous types than in Nigeria. The Nigerian material had more medullary type (2.7% vs. 0.7% in Finland), extensive necrosis, nuclear atypia and pleomorphism, with coexisting pleomorphic ductal carcinoma in situ. At 2 years after treatment, the survival figures for Nigeria and Finland were 72.8% and 96.4%, respectively. CONCLUSION: The histology of Nigerian and Finnish cancers clearly differ. Nigerian cancers appear more advanced with higher grade. The atypical in situ component is clearly more common in Nigeria. Part of the differences can be explained by diagnostic and treatment delays associated with misguided socio-cultural beliefs, poor health care access and impaired immunity.

Adolescent↗
PubMed1996

Maternal and perinatal health in Mali, Togo and Nigeria.

OBJECTIVE: The health care system in many developing countries is less efficient compared with that in the industrialized world. The aim of the present study was to investigate the differences of the efficiency of the health care in obstetrics in Nigeria, Mali and Togo. STUDY DESIGN: The data were collected in African district hospitals from Lomé/Togo (n = 1002), Bamako/Mali (n = 1462) and Kaduna/Nigeria (n = 1055) with a routinely applied questionnaire analyzed at the University Giessen and compared with the data from the Department of Obstetrics and Gynaecology Giessen (Germany) (referral hospital) (n = 1313) and the total data pool of the perinatal survey 1993 in Hesse (n = 58430). RESULTS: The medical history indicates important differences: the incidence of young mothers below 18 is highest in Mali (9.8%) compared with Nigeria (2.7%) and Togo (2.6%) (Hesse 0.6%). In general there is an increased rate of previous pregnancies of more than five: 13-28% (Hesse 2.1%). The rate of prenatal visits is also reduced: more than ten visits have 2% in Togo, 10.6% in Mali and 15.5% in Nigeria (Hesse 72%). Ultrasound examinations are very rare (1-12%) and tocolysis is nearly unknown. As a result the incidence of dead infants in the medical history is high: Mali 28%, Togo 18%, Nigeria 10.8% (Hesse 1.7%), as well as the rate of low birth weight infants. This is also reflected in the perinatal mortality which ranged from 115/1000 in Mali, 77/1000 in Togo and 68/1000 in Nigeria (Hesse 5.3/1000, Ob/Gyn Giessen 16.4/1000). CONCLUSION: The improvement of perinatal and maternal health in the developing world can only be achieved if family planning, prenatal care, selection of high risk pregnancies goes in parallel with a sound organization implemented and supported by the government.

Birth Weight↗
PubMed2001

Models of psychiatric nursing education in developing African countries: a comparative study of Botswana and Nigeria.

BACKGROUND: Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education (PMHNE) in two sub-Saharan African countries--Botswana and Nigeria. METHOD: Examination of the existing PMHNE programmes and responses to a self-reporting questionnaire administered to psychiatric nurse educators from Botswana and Nigeria provided the sources of data. FINDINGS: Findings from both countries revealed that participants used various terms to describe the same model for PMHNE programmes in the countries. Botswana adopted a more functional generalist basic diploma nursing education approach that encouraged an advanced postbasic diploma specialization and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital-based basic specialization with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Although community theme occurred in both countries' curricula, PMHNE in Botswana appeared to be more geared towards the community than in Nigeria. While PMHNE and nursing education generally is affiliated to the University with a clear pathway within the formal higher education system in Botswana, basic and postbasic nursing programmes are mostly run independent of the country's formal higher education system in Nigeria. CONCLUSION: A model that streamlined PMHNE within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of PMHNE in the two countries, and Africa in general, was the need to create a psychiatric-mental health nursing education programme and role that would be appropriate for people's mental health needs and the provision of quality nursing care.

Adult↗