Human immunodeficiency virus self-testing in adolescents living in Sub-Saharan Africa: An advocacy Serge Tonen-Wolyec, François-Xavier Mbopi-Kéou, Donato Koyalta, Mounir Filali, Salomon Batina-Agasa, Laurent Bélec Nigerian Medical Journal 2019 60(4):165-168 Acquired immune deficiency syndrome (AIDS) has become the leading cause of death among adolescents (aged 10–19) in sub-Saharan Africa. Less than 20% of African adolescents know their human immunodeficiency virus (HIV) status, whereas HIV testing remains the gateway to care. To end the AIDS epidemic by 2030 according to the Joint United Nations Programme on HIV/AIDS target, it is necessary to introduce scalable HIV testing strategies specific to different settings such as age groups, populations, and geographical areas. Demonstrated evidence on HIV self-testing (HIVST) in sub-Saharan Africa settings is reported, including data among adolescents. The All In initiative, which is the current international platform for the fight against HIV in adolescents is a good opportunity to address the challenge of HIV testing, including HIVST. Adapted strategies of HIVST such as (i) implementation of several listening and recreation centers for adolescents, (ii) door-to-door HIVST approach, and (iii) reducing the age of consent is urgently needed to promote HIV testing among adolescents living in Africa.

Evolution of bloodless surgery: A case for bloodless suprapubic prostatectomy Chukwudi Ogonnaya Okorie, Louis L Pisters Nigerian Medical Journal 2019 60(4):169-174 Allogeneic blood transfusion is commonly prescribed to patients undergoing suprapubic prostatectomy for benign prostatic hyperplasia as a treatment option to replace blood loss. Historically, suprapubic prostatectomy has been perceived as an extremely high hemorrhagic surgery, and this has led to the association of suprapubic prostatectomy with a high rate of allogeneic blood transfusion. However, the outcome of suprapubic prostatectomy has significantly improved over the years and has become less hemorrhagic in many hands – creating the opportunity to consistently avoid allogeneic blood transfusion. On the other hand, the efficacy of blood transfusion has come under more stringent scrutiny as many clinical studies have reported inconsistent effects of blood transfusion on patient outcome. In contemporary practice, a more conservative/bloodless approach in the perioperative management of anemia in surgical patients is strongly being advocated with convincing evidence that many surgical patients can be routinely and safely managed without allogeneic blood transfusion. There is no large-scale discussion on bloodless surgery in urology in the contemporary literature, especially in the area of suprapubic prostatectomy that has been historically associated with a high rate of blood transfusion. This review article will discuss the evolution of bloodless surgery including the ongoing controversies surrounding blood transfusion in general, and then the relatively small but ongoing penetration of bloodless surgical approach in the field of suprapubic prostatectomy. Furthermore, the authors' approach to bloodless suprapubic prostatectomy will be highlighted, and in doing so, it can be emphasized that suprapubic prostatectomy is no more as hemorrhagic as was historically perceived, but rather a routine bloodless suprapubic prostatectomy is now possible in many hands.

A study on childhood epilepsy among traders in Benin City Nigeria Peter Olusola Okunola, Damian Uchechukwu Nwaneri Nigerian Medical Journal 2019 60(4):175-180 Background: Epilepsy is a serious childhood disease associated with stigmatization in the community. Despite the deleterious effect of the disease on childhood brain growth and development, the disease is treatable. Objective: The aim of this study is to document the knowledge of childhood epilepsy by community members using traders (market women and men in a popular market in Benin City, Nigeria) as a case study. Methodology: This was a descriptive cross-sectional study carried out in April 2018. Data collection was by researcher-administered questionnaire. The respondents were traders (women and men) in Edaiken market Benin City Nigeria who were recruited consecutively during the period of the study. The analysis was performed using the Statistical Package for the Social Sciences version 21, and the level of statistical significance of variables was set at 95% confidence level and P < 0.05. Results: Of the 500 respondents, 47 (9.4%) males and 453 (90.6%) females; mean age (standard deviation) was 35.3 ± 9.4 years. Total knowledge score of childhood epilepsy in this study was 27.6%. Only 116 (23.2%) study participants gave correctly a description of epileptic fits in a child. Although majority 71.0% said that epilepsy has the medical cure, none was able to mention any known drugs for the treatment of epilepsy and 72.6% said that they would use traditional remedies. Conclusion: The overall observed knowledge score of childhood epilepsy was low. Although most respondents stated that epilepsy has medical cure, majority preferred the traditional options for treatment. These findings, therefore, highlighted the need to enlighten the public about childhood epilepsy and its medical treatment options.

Soil-transmitted helminths and associated risk factors among elementary school pupils in Dadin Kowa, Jos Abednego Samuel Dahal, Esther Onyimowo Francis, Joy Eguweye Francis, Francis Istifanus Wamtas Nigerian Medical Journal 2019 60(4):181-185 Background: Soil-transmitted helminths are intestinal parasites of humans transmitted through contaminated soil. They are considered neglected tropical diseases found mainly in areas with warm and moist climates where living condition and personal hygiene are poor. Aim: The aim of this study was to determine the prevalence of soil-transmitted helminths among primary school pupils in Kangang community of Dadin Kowa, Jos. Materials and Methods: This was a cross-sectional study of 136 elementary school pupils from three selected schools in Kangang community in Dadin Kowa of Jos South Local Government Area of Plateau State between April 2018 and June 2018. Stool samples were collected from all the consented participants in a sterile, universal sampling container prelabeled with the participant's identification number. The samples were analyzed within 2 h of collection using parasites concentration technique and microscopy. The results obtained were analyzed using SPSS version 21. Results: The prevalence of soil-transmitted helminthiasis among the study population was 42.6%. Ascaris lumbricoides (25.7%) was the most common parasites, followed by Trichuris trichiura (10.3%). Hookworm infection was observed in 5.1%, while strongyloidiasis caused 1.5% of STHs. The male participants had a prevalence of 55.2% compared to the females who had a prevalence rate of 44.8%. Based on the schools where the participants were recruited, STHs was more prevalence among participant from KS school with rate of 51.2% followed by EBI school (40.0%), while LP school had the least infection rate of 38.1%. Conclusion: This study revealed the prevalence of STHs among school pupils in Kangang community of Dadin kowa, Jos, as 42.6%. A. lumbricoides was the most common STHs in the area. Males were more infected than females. Age and type of toilet used by the participant were found to be significantly associated with STHs infection.

Management of epilepsies at the community cottage hospital level in a developing environment Emmanuel E Ekanem, Akinwunmi O Fajola, Rakiya Usman, Rebecca N Ogbimi, Gloria O Ikeagwu, Tamunoibim E Anidima, Michael N Etieh, Chidozie N Umejiego Nigerian Medical Journal 2019 60(4):186-189 Background: The epilepsy problem in much of Africa is characterized by stigmatization and neglect. This article describes the efforts at a cottage hospital level to ameliorate the epilepsy problem in a resource-limited environment. Methods: A seizure clinic was started in a cottage hospital after targeted health talks. The International League against Epilepsy (ILEA)/World Health Organization (WHO)/International Bureau for Epilepsy (IBE) manual was adopted for the training of staff and to guide management. Patients were followed up in the clinic and with the use of simple information communication technology. Results: Forty-five patients with ages ranging from 3 months to 42 years (who had lived with epilepsy for periods ranging from 3 weeks to 32 years) were registered over 12 months period. The most common seizure type was generalized tonic clonic (21 or 46.67%) followed by generalized clonic (8 or 17.78%). Ten (22.22%) had comorbidities mainly cerebral palsy (4 or 8.89%) and attention-deficit hyperactivity disorder (3 or 6.67%). Most (98.15%) were placed on carbamazepine. Twenty-three (51.11%) had complete control of seizures, 21 (46.67%) had reduced frequencies of attacks, and all 8 children who had dropped out of school resumed schooling. Conclusion: The epilepsy challenge in the developing world can be demystified and effectively managed at the cottage hospital level. Targeted health education, affordable management regimes, and committed follow-up are keys. A training manual based on the ILEA/WHO/IBE document should be developed for Africa.

Validation of age determination with historical events in Birnin Kebbi, Northwest Nigeria Folajimi Morenikeji Otubogun, Nasiru Sanni, Amina Lawal Bello Nigerian Medical Journal 2019 60(4):190-192 Context: Birth registration is not universal and remains elusive for some people living in developing countries, such as Nigeria; hence, age determination for healthcare and health-related research is often problematic. Aims: The aim is to validate the use of a historical events' scale as a tool for estimating the age of Nigerian adults residing in Birnin Kebbi, Northwest Nigeria. Settings and Design: A cross-sectional survey was conducted in Birnin Kebbi, a metropolitan capital city of Kebbi state, Northwest Nigeria, and included adults aged 18 years and older with a valid document indicating their year of birth. Subjects and Methods: Seven historical events comprising major national events were cross-referenced to the individual's personal history to estimate their ages, which were then compared to their documented ages. Statistical Analysis Used: Relationship of the documented and estimated ages was assessed with the Spearman's rank-order correlation and intraclass correlation coefficient (ICC) analyses. Results: A total of 288 subjects (63.2% males) with a mean documented age of 34.5 ± 11.3 (range 18–75) years were surveyed. The mean estimated age was 32.5 ± 11.18 years. Spearman's rank-order correlation analysis showed a statistically strong positive correlation between the actual and estimated ages (0.953, P < 0.001). The ICC between documented and estimated ages was 0.968 (95% confidence interval = 0.959–0.975). Conclusions: The use of this tool in Nigerian adults provides a reasonably accurate age estimation. Its use in populations and communities with inadequate birth registration may improve the quality of age-related health data in Nigerian adults.

Epidemiology and challenges of managing breast cancer in Keffi, North-Central Nigeria: A preliminary report Adeyinka A Adejumo, Olusola J Ajamu, Olusola O Akanbi, John C Onwukwe, Oluseyi A Adeosun, Paul O Omoregie, Aaron Amos, Yakubu Garba, Oyintobra F Koroye, Stephen E Garba Nigerian Medical Journal 2019 60(4):193-197 Background: Breast cancer is now the commonest female malignancy worldwide. The prognosis of such depends on the histopathological type, biological behavior, stage at presentation, availability of adequate oncological services. Aims and Objectives: The aim of this this study is to evaluate the statistics and challenges of breast cancer management in the study centre and compare with other centres. Materials and Methods: This is a prospective, descriptive study that spanned over a period of 4 years (January 2015-December 2018). The study was carried out in the General surgery division of the Surgery Department of the Federal Medical Centre, Keffi. Results: A total of 199 patients were recruited into this study out of which 196 (98.25%) were females and 3 (1.5%) were males. Their age ranged between 20-60 years. The commonest histopathological variant diagnosed is invasive ductal carcinoma (NOS). Early presentation was seen in 54 (<30%) while 145 (>70%) patients had late clinical presentation. Conclusion: Diagnosing and managing breast cancers successfully are mitigated my myriads of factors. Public awareness and provision of adequate care facilities will improve overall survival.

Factors associated with safe disposal practices of child's faeces in Nigeria: Evidence from 2013 Nigeria demographic and health survey Alhaji A Aliyu, Tukur Dahiru Nigerian Medical Journal 2019 60(4):198-204 Background: Stool disposal practices have been shown to be associated with childhood diarrhea. There exist variations in explanatory variables of safe child's faecal disposal practices depending on the context of the study. Thus, the need for this study to assess factors associated with safe disposal practices of children's faeces in Nigeria. Methods: This study utilized the 2013 Nigeria Demographic and Health Survey data. Child's faecal disposal practice was classified as safe and unsafe as defined by the World Health Organization/UNICEF Joint Monitoring Program. Binary and multivariate logistic regression models were used to identify factors associated with safe faecal disposal practices. The analysis was restricted to a weighted sample of 19, 288 youngest children in the households. Results: Overall, the prevalence of safe disposal of child's faeces was 59.4%. Safe child's faeces disposal was the highest among older women (64.4%), highly educated women and their husbands (67.1%) and (66.4%), respectively; among rich households (72.3%), Muslim (68.7%), urban areas (68.8%), and in North West zone (78.4%). In multivariate analysis, safe faecal disposal was significantly associated with the age of mother, maternal education level, wealth index, religion, source of water, and type of toilet facility. Marital status, geopolitical zone, having diarrhea in the past 2 weeks before the survey and sex of the child were not significant determinants of safe faecal disposal practice. Conclusion: Understanding the prevailing faecal disposal practices is a prerequisite to the formulation of effective intervention strategies. It is pertinent, therefore, that programs and interventions designed to improve safe child's faecal disposal practices need to take into consideration the factors identified in this study.

Helicobacter pylori infection in malnourished children in Lagos Oluwafunmilayo Funke Adeniyi, Iretiola Bamikeolu Fajolu, Edamisan Temiye, Christopher Imokhuede Esezobor, Cecilia Abimbola Mabogunje Nigerian Medical Journal 2019 60(4):205-210 Background/Aim: Helicobacter pylori infection is acquired in childhood, but there are conflicting reports on malnutrition and the infection. This study aimed to determine the prevalence of H. pylori infection among malnourished children and highlight the socioeconomic (SE) and clinical factors associated with the infection. Methodology: This was a descriptive cross-sectional study of 122 malnourished children and 120 healthy controls. Anthropometry was done for all the study participants, and the H. pylori status was determined with the use of monoclonal stool antigen test in all the participants. Logistic regression analysis was used to determine the factors that could predict the occurrence of the infection in the children. Results: Seventy percent (70.8%) of the malnourished children had moderate malnutrition, whereas 29.2% were severely malnourished. The prevalence of H. pylori in the malnourished children was 22.8% compared to 32.5% in the controls (P = 0.09). The infection was most prevalent in toddlers (60.7%). The SE class was significantly related to the infection (P = 0.01) and about a fifth (21.3%) of the malnourished children who belonged to the low SE class were H. pylori positive compared to 9.2% of the controls. About 64.3% of the malnourished children with H. pylori infection had fever and 25.8% had diarrhea. Multivariate analysis showed that stunting was significantly related to the infection (P = 0.02). Conclusion: H. pylori infection was prevalent among the toddlers and was significantly associated with stunting in this cohort of malnourished children. Screening of children for the infection is still advocated, and infected children should be referred for appropriate treatment and follow-up. The relationship between SE class and the infection still requires further research.

Investigating the comparative effects of six artemisinin-based combination therapies on Plasmodium-induced hepatorenal toxicity Innocent A Edagha, Arit J Ekpo, Edelungudi I Edagha, Joy V Bassey, Titus P Nyong, Anthony S Akpan, Rose F Obeten, Anthony S Okon, Blessing A Ating Nigerian Medical Journal 2019 60(4):211-218 Background: Too many artemisinin-based combination therapies (ACTs) are available, thus creating a dilemma on the most preferred for the treatment of malaria. Aim: We compared the effect of six ACTs in mitigating Plasmodium-induced hepatorenal toxicity in experimental malaria. Materials and Methods: Forty adult male Swiss mice allotted into eight groups: Group 1 (normal control [NC] uninfected and untreated), Group 2 (parasitized nontreated – [PNT]), and Groups 3–8 received Plasmodium berghei inoculum. After 72 h, the initial parasitemia was established. Groups 3–8 were administered oral therapeutic doses of artesunate-amodiaquine (AA), artesunate-mefloquine (AM), artesunate-sulfadoxine-pyrimethamine (ASP), artemisinin-piperaquine (AP), dihydroartemisinin-piperaquine (DP), and artemether-lumefantrine (AL) per kg bodyweight, respectively, as standard regimen, and final parasitemia determined. Animals were euthanized via chloroform inhalation and blood collected for hepatorenal analysis. Liver and kidney were dissected out for histology. Results: Parasitemia was significantly (P < 0.05) decreased in tests compared to PNT, except in ASP group. Liver enzymes were significantly (P < 0.05) increased in PNT compared to tests and NC. Hyperplastic cells and portal tract inflammation were prominent in ASP group, but mild to moderate in other treated groups. Urea-creatinine were significantly (P < 0.05) increased in PNT compared to treated groups. The Na+ and Cl− were significantly (P < 0.05) reduced in PNT, with significantly (P < 0.05) increased K+ compared to NC and treated groups. Glomerulonephritis and glomerulus splitting was observed in PNT, while moderate distortions were observed in treated groups. The AA and AM groups had good kidney histoarchitecture. Conclusion: Parasitemia decreased in all the treatment groups except in PNT and ASP groups which had severe hepatorenal distortions. Hepatorenal histoarchitecture were mildly distorted in the AA, AM and AL-administered groups with lower hepatorenal indices comparable to NC. The least elevated liver enzymes were in AA and AM. In decreasing order ASP > DP > AL > AP > AM > AA.