African Journals Online
Nigerian Journal of Health and Biomedical Sciences

Volume 1, No. 2, July–December, 2002

Study on Extra-Cost Implications of Hospital Acquired
Infection in Paediatric Patients in a Tertiary Hospital in Lagos, Nigeria

Catherine N. F. Kesah*, Matthias Egri-Okwaji**, Tolu Odugbemi* and Edna Iroha**

*Department of Medical Microbiology and Parasitology,
College of Medicine, University of Lagos

**Department of Paediatrics,
Lagos University Teaching Hospital, Lagos, Nigeria.

*Correspondence:

M. T. C. Egri-Okwaji

Department of Paediatrics,
College of Medicine, University of Lagos,
P.M.B. 12003, Lagos, Nigeria
E-mail: [email protected] 

SUMMARY

Objectives: To assess excess duration of hospital stay, cost of laboratory tests and antibiotic therapy in consequence as well as deaths due to nosocomial infections (NI) in paediatric inpatients at the Lagos University Teaching Hospital, Nigeria.

Methods: Between 1994 and 1995, 4,981 admissions were prospectively studied for NI according to the CDC, NNIS criteria. A prospective cohort study of one-to-one matching of infected versus uninfected patients was used to estimate prolongation of hospital stay and added cost of management.

Results: There were 589 infected patients. Compared to the matched uninfected controls, the mean extra length of stay, in days, for patients with the indicated sites of infection was as follows: Blood-stream infection: 13.37, Surgical site infections: 11, Urinary tract infections: 9.92, Eye infections: 5.58; and other sites: 8.73.

Corresponding estimated average costs for the respective infection sites were each $119, $98, $88, $50 and $78. The total cost of laboratory tests in all infected patients was $7,785. The estimated total cost of antibiotic therapy was $15,515 in 310 infected patients versus $6,820 in 310 uninfected controls, difference $8,696 (P<0.00001). The Gross National product per capita in Nigeria during the study period was about $300 and the official exchange rate was N==22.50 to $1. Sixty-six infected patients (1.1%) died during hospitalization of whom most (0.8%) were related to a NI, particularly bloodstream infections.

Conclusion: Nosocomial infections constitute tremendous additional medical costs on health care service in children in Nigeria. In due cognizance, a review/prioritization of infection control measures and ensuring cost effective medical/laboratory facilities in hospitals will contain cost.

Key words: Nosocomial infections, cost, Paediatric patients.

Cost Evaluation of Commonly Prescribed

Antihypertensive Drugs and the Pattern of Prescription among Doctors in the Lagos University Teaching Hospital

S.O. OLAYEMI and A.F.B MABADEJE

Department of Pharmacology, College of Medicine, University of Lagos.

*Correspondence:

Dr. S. O. Olayemi,

Department of Pharmacology,
College of Medicine, University of Lagos,
P.m.b 12003, Idi-Araba, Lagos, Nigeria.

SUMMARY

Pharmacological anti-hypertensive prescriptions of 600 randomly selected mild to
moderate hypertensive patients were reviewed for 3 years in four Clinics of the Lagos
University Teaching Hospital namely Cardiology, Endocrine, Nephrology and Neurology
Clinics. Calcium channel blockers were the most frequently prescribed drugs (24.8%)
followed by Angiotensin converting enzyme inhibitors (12.5%). Others included combined Amiloride/Hydrochlorothiazide (Co-amilozide) (10.6%), Alpha methyl dopa (10%), Beta Blockers (8.5%), combination of Co-amilozide and Alpha methyl dopa (6.8%),
Co-amilozide,Calcium channel/Beta blockers (6.0%) etc. Brand name prescription was predominantly high in all the four Clinics (Cardiology – 87.4%, Endocrine - 86.8%, Nephrology 74.6% and Neurology 87.9%) as compared to low generic prescription. The overall Brand name prescription was (83.4%) compared with Generic of (16%). The monthly cost difference between Generic anti-hypertensive single drug treatment and Brand named single drug treatment was between N500.00 to N600.00. It was concluded that the prescribing of the new generation drugs i.e. Calcium channel blockers, ACE inhibitors with supposedly little or no metabolic side effects is a new trend which should be scientifically evaluated vis-à-vis cost effectiveness and adverse drug reaction. It was also concluded that generic prescription should be encouraged among prescribers to lessen the financial burden of patients because drugs marketed under generic names are usually cheaper than those with brand names.

Key words: Brand, Generic,Prescription, Antihypertensives,Cost.

Serum Vitamin E, Cholesterol and Triglyceride Levels of
Nigerian Women with Unexplained Infertility and Recurrent Miscarriage

O. S. OLADIMEJI*, O. A. MAGBAGBEOLA*, S. S. PETER*, T. A. ADEWOLE** and
I. A. AKINWANDE*

*Department of Biochemistry,
College of Medicine, University of Lagos,
P.M.B 12003, Lagos, Nigeria.

**National Institute of Medicine Research, Yaba, Lagos, Nigeria.

*Correspondence:

O. S. Oladimeji

Department of Biochemistry,
College of Medicine, University of Lagos,
P.M.B 12003, Lagos, Nigeria.

SUMMARY

This study was conducted to examine if there is a relationship between serum lipid and vitamin E levels and unexplained infertility and recurrent miscarriages. Eighty-two (82) healthy Nigerian Women volunteers were recruited for this study. The mean serum cholesterol and triglyceride were slightly higher in the women with unexplained infertility and recurrent miscarriage (177.50 ± 27.80 and 187.54 ± 20.92 mg/l00ml respectively) than the mean value in the fertile women (control) (155.13 ± 32.31 and 162.76 ± 24.70 mg/100ml) respectively. The difference between the sub group were however not statistically significant using the Student t- test. The serum triglycerides concentration in the primary infertility group was (188.88 ± 21.19mg/l00ml} while that of secondary infertility was (185.34 ± 23.77mg/l00ml) and that of recurrent miscarriage was 188.41 ± 17.81mg/l00ml. The difference between these sub groups were of no statistical significance. Mean serum vitamin E concentration in the fertile women (10.36 ± 3.52mg/ml) was found to be insignificantly higher than the observed values in the women with cases of unexplained infertility and recurrent miscarriage (8.97 ± 3.56mg/ml). It was concluded from this study that there is no relationship between recurrent miscarriages and unexplained infertility and the serum lipids and vitamin E levels.

KEY WORDS: Serum, Vitamin E, Cholesterol, Triglyceride, Infertility, Recurrent Miscarriage.

*Correspondence:

The College Medical Library
National Postgraduate Medical College of Nigeria, Ijanikin, Lagos.

SUMMARY

Key words: Residents, Perspectives, Activities, Programme.

Effect of Light and Darkness on Packed Cell Volume in the Rat

A. A. OSINUBI, F. I. DURU, C. C. NORONHA and A. O. OKANLAWON

Department of Anatomy,
College of Medicine, University of Lagos,
P.M.B 12003, Lagos, Nigeria.

*Correspondence:

A. O. Okanlawon

Department of Anatomy,
College of Medicine, University of Lagos,
P.M.B 12003, Lagos, Nigeria.

SUMMARY

The aim of the study is to identify and characterize the circadian oscillation of Packed Cell Volume (PCV) within a 24-hour time frame in adult Sprague-Dawley rats. 56 adult Sprague-Dawley rats consists of 28 male and 28 female rats were used. Male animals weighed 150-170g while the females weighed 130–140g. The animals were divided into two groups. The first group had tail-blood sampling commenced at 0600h while the second group had sampling commenced at 1800h. In each case, samples were assessed at 4 six-hourly intervals within a 24-hour time frame. PCV was determined using a standard laboratory method for haematocrit estimation. Results of the experiment did not show any sexual dimorphism between the peak and nadir of the circadian variation of PCV in male and female rats. A peak value was observed at 0600h and a nadir at 1200h in both sexes. The peak and nadir PCV values were significantly different (P < 0.05). We conclude that PCV exhibits rhythmic variations in Sprague-Dawley rats.

KEY WORDS: PCV, Circadian rhythm, Oscillation, Pineal gland, Melatonin.

Schistosoma Mansoni: Effect of Miracidial Dosage and

Aestivation on Cercarial Production and Survival Rate of Biomphalaria Pfeifferi

L. I. Badger and J. P. O. Oyerinde

Department of Medical Microbiology and Parasitology,
Lagos State University College of Medicine,
P.M.B 21266, Ikeja,
Lagos.

*Correspondence:

Dr. L. I. Badger

Lagos State University College of Medicine,
Ikeja.

SUMMARY

The effect of miracidial dosage and aestivation on cercarial production of Schistosoma mansoni and on the survival rate of Biomphalaria pfeifferi was studied. B. pfeifferi measuring between 7 and 8mm in diameter were grouped into four batches based on the number of miracidia they had been infected with. A number of freshly infected snails were aestivated with one , two, four and six miracidia. Results obtained showed that survival rate of B. pfeifferi aestivated with different miracidial dosage, differed significantly based on the number of miracidial dose. Cercariae produced post- aestivation did not increase as the number of infecting miracidia increased. Snails aestivated with one miracidium produced more cercariae than those aestivated with six miracidia post aestivation, while those aestivated with two and four miracidia emitted the most number of cercariae.

Anthropometric Indices, Nutritional Status and Age at Menarche in Female Sickle Cell Anaemia Patients in Lagos

I. I. OLATUNJI-BELLO*, M. O. KEHINDE** and S. O. GBENEBITSE*

*Department of Physiology
College of Medicine of the University of Lagos
P. M. B. 12003, Lagos

**Department of Medicine
College of Medicine of the University of Lagos
P. M. B. 12003, Lagos

*Correspondence:

I. I. Olatunji-Bello,

SUMMARY

The nutritional status, anthropometric indices and the retrospective attainment of menarche were studied in homozygous sickle cell patients. The control subjects were 150 students in the College of Medicine of the University of Lagos whose genotype were AA. The homozygous sickle cell patients were 200 in number and they were outpatients of the Sickle Cell Clinic of the Lagos University Teaching Hospital (LUTH) Idiaraba. . Questionnaires were prepared and handed over to the students and patients to fill. Before this however, measurements of the mid upper arm circumference (MUAC) and the body mass index (BMI) were measured. The mean MUAC for the control subjects was 26.23 ± 0.58cm while that of the sickle cell group was 21.98 ± 0.27cm. This difference was statistically significant (P = 0.0001). The mean BMI was significantly lower in the sickle cell patients (19.6 ± 0.21) as compared with the control subjects, which was 21.56 ± 0.26 (P = 0.0001). The mean retrospective age of the control subjects at menarche was12.74 ± 0.14yr while that of the sickle cell patients was 15.71 ± 0.17yr. The difference is statistically significant (P = 0.0001). The results showed that in sickle cell disease, there was a 2.97-years delay in the attainment of menarche for the Nigerian female patients and also anthropometric indices of these were low even though the nutritional status was better than the control.

Key words: Sickle cell disease, adolescence, menarche, body weight, Nigeria

Sterilization and Disinfection Procedures by Dental Practitioners in Nigeria

C. O. ONYEASO*, O. O. da COSTA** and M. O. AROWOJOLU*

*Department of Preventive Dentistry,

**Department of Child Dental Health,

College of Medicine,University of Ibadan, Ibadan.

*Correspondence:

C. O. Onyeaso

Department of Preventive Dentistry,
College of Medicine, University of Ibadan, Ibadan.

SUMMARY

Objective: To assess the level of compliance with internationally recommended infection control/Centres for disease control (CDC) guidelines among Nigerian Dentists, and the perception of adequacy of such current sterilization and disinfection procedures as practised by them.

Design: A questionnaire-based survey.

Setting: Government-owned and private dental clinics in two major cities (Ibadan and Lagos) with high commercial activities as well as relatively high population of dentists in Nigeria.

Participants and Methods: 76 dentists working in these cities were asked to complete a 10-item questionnaire concerning cross-infection control procedures in dental clinics. For better effectiveness, the distribution of the questionnaire was by hand-delivery and not by mailing system.

Results: The average wound experienced by the respondents represent about 41 wounds per year. Blood was observed in the mouth a mean of 4 per week and 1.07 per week in impression with mean total number of patients per week as 24. Ninety-five percent of the dentists routinely used gloves, 87% used masks, 76% and 21% gowns and eye wear respectively. About 86% chair side assistants routinely used gloves, 59% used masks, 53% used gowns and 5% used protective eye wear. Laboratory assistants were reported to wear masks 28% of the time, gloves and gowns 22% of the time each and eye wear less than mask 7% of the time. The average practice had 19% children, 37% adolescent patients and 44% adults. At least one HBV patient was known and one HBV carrier suspected by 4% and 17% of the respondents respectively. At least one HIV/AIDS known and at least one suspected HIV/AIDS patients were reported by 3% and 18% respectively. One per cent, 11% and 14% reported not using any form of sterilization and disinfecting alginate impression. For HBV infection, 58% said prevention should be aimed at both saliva and blood. No respondent. Sixty-two per cent of the respondents felt their sterilization or disinfection procedures were adequate, 43% felt otherwise while 4% were not sure.

Conclusion: Nigerian dentists are handling the issue of sterilization and disinfection in a variety of manners though a reasonable percentage of them are conscientious and aware of the risk factors. There is, therefore, need for a more coordinated approach to the issue in the face of the HIV/AIDS pandemic and poor Nigerian economy.

KEY WORDS: Survey; Sterilization; Disinfection; Infection control; Dentists.

K. A. Ogbeche*, Y. O. Ogunbiyi* and F. I. O. Duru**

*Department of Pharmaceutical Chemistry,
School of Pharmacy, College of Medicine,
University of Lagos, Nigeria.

**Department of Anatomy,

College of Medicine of the University of Lagos, Lagos.

*Correspondence:

Department of Pharmaceutical Chemistry,
School of Pharmacy,
College of Medicine,
University of Lagos, Nigeria.

SUMMARY

The fertility activities of the fruit of Kigelia africana Lam. Benth. Family Bignoniaceae, a medicinal plant used in south eastern Nigeria by local traditional healers for treatment of fertility abnormalities especially in male and female adults has been carried out. The research revealed that male rats treated with the methanol extract of the fruit showed greater sperm motility 95.14 ± 1.35, when compared to that of male rats treated with testosterone and the untreated control rats which had 89.34 ± 1.45 and 82.81 ± 2.51 respectively. The result also showed that 77.8% of mated pro-estrus female rats were pregnant after a four day circle. There was also a 66.7% pregnancy rate in females mated with testosterone induced male rats and 44.4% for the control, showing that the methanol extract had greater fertility effects on male rats.

Key words: Kigelia africana, fertility, spermatozoa, methanol extract and pregnancy.

Comparison of the Metabolic Effects of Ethanolic Extract of Ancistrophyllum Secundiflorum and Menstrogen in the

Pregnant Dutch-White Rabbit

*O. S. Odesanmi*, A. O. Dawodu**, G. M. Osituga*** and O. A. Magbagbeola*

*Department of Biochemistry, College of Medicine, Unilag. Idi-Araba.

**Yaba College of Technology, Yaba, Lagos.

***Department of Biochemistry, Lagos State University, Ojo.

*Correspondence:

O. S. Odesanmi

Department of Biochemistry,
College of Medicine,
University of Lagos, Idi-Araba, Lagos, Nigeria.

SUMMARY

Objective: To compare the effects of mid-gestational oral administration of ethanolic extract of Ancistrophyllum secundiflorum (EAS), a herbal contraceptive and pharmacological dose of menstrogen (orthodox contraceptive) on metabolic parameters in pregnant rabbits.

Methods: Extract of Ancistrophyllum secondiflorum (EAS) was obtained by soxhlet extraction of dried, powdered, stem bark samples under reflux with 85% ethanol and concentration by rotatory evaporation under vacuum.

Plant Extract (EAS) (dose – 75mg/kg body wt) and menstrogen (10mg/kg body wt) were administered orally by stomach tubes, for 7 days to separate groups, of 5 pregnant rabbits per group at mid-gestation – from Day 15-21. The control group received no drug. Test and control rabbits were sacrificed after an 18-hour fast before the end of gestation. Blood serum samples were collected from test and control rabbits and analyzed for albumin, total proteins, triglycerides, cholesterol, HDL cholesterol and LDL cholesterol levels by standard methods.

Results indicated a lowering of fasting serum triglycerides and a significant elevation of blood
serum albumin, total protein and serum cholesterol levels in rabbit fed EAS compared to both menstrogen and control groups.

Conclusion: Results suggest that ethanolic extract of ancistrophyllum secundiflorum is abortifacient and hypercholestrolaemic.

Key words: Herbal Contraceptives, Metabolic Effects.

Basal Metabolic Rate in Healthy Young Adults in Lagos

I.I. OLATUNJI-BELLO* and ODEWALE O. A.

*Correspondence:

I. I. Olatunji-Bello,

SUMMARY

The study was carried out in order to provide local reference values of basal metabolic rate (BMR) by determining the BMR of healthy young adult males in Lagos and that of their female counterparts. A total of 80 students from the College of Medicine of the University of Lagos were studied. There were forty (40) males and forty (40) females. All the subjects fasted for at least 12 hours before determining the Basal Metabolic Rate (BMR) from the rate of oxygen consumption by the subjects. Results obtained from the study showed that males had significantly higher BMR mean value of 52.36 ± 4.13 Kcal/hr as compared to the mean value of the females which was 36.28 ± 2.96Kcal/hr (P < 0.002). We conclude by presenting reference values of BMR young adults in Lagos: The young adult male has a BMR of 52.36 ± 4.13 Kcal/hr while that of this female counterpart is 36.28 ± 2.96Kcal/hr.

Key words: Basal metabolic rate, Oxygen consumption, Nigeria, Energy expenditure.