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Background: Although an increasing access to ART in sub-Saharan Africa has made it possible for HIV/AIDS patients to live longer, clinicians managing such patients are faced with the challenge of drug-related metabolic complications. Methods: A cross -sectional study was carried out at the University of Calabar Teaching Hospital, Nigeria, on three groups of participants; namely HIV patients on ART, ART-naïve patients and HIV negative subjects (n =75). Demographic and anthropometric data were collected using a well-structured questionnaire while biochemical parameters were measured using colorimetric methods. Results: The highest prevalence of MS was associated with the HIV/AIDS patients on ART (i.e. 32.0 %, and 50.3% for NCEP-ATP III and IDF criteria respectively). Patients on ART had significant increases (p< 0.05) in waist to hip ratio, FPG, serum TG and LDL-c; and a significantly higher (p< 0.05) prevalence of hypertension, diabetes, low HDL-c and hypertriglyceridaemia compared to the ART-naïve patients. Low serum HDL-c was the most prevalent form of dyslipidaemia in allthree groups and the most prevalent component of MS in HIV patients. Conclusion: ART increases the risk of MS and CVD. HIV/AIDS patients on ART should be advised on lifestyle modifications and undertake regular assessment of their cardiovascular risk factors. Keywords: HIV/AIDS patients; antiretroviral therapy; ART-Naïve patients; Calabar Teaching Hospital; Calabar; Nigeria.

Background: Helminthic infections and diarrheal diseases have remained public health problem worldwide, especially in developing countries. Children below five years of age are at a higher risk. This study therefore aims to determine the prevalence, and intensity of intestinal helminths in children with and without the diarrheal disease. Materials and Methods: This was a cross-sectional analytical study of 130 children aged 6 to 59 months, carried out in the Children Emergency Room and the Diarrhea Treatment and Training Unit of the University of Calabar Teaching Hospital (U. C. T. H), Calabar, Nigeria. Those admitted with and without diarrhoea were consecutively recruited. Data were obtained by administration of questionnaires to parents/caregivers whose children met the inclusion criteria. Clinical examinations including anthropometric parameters (weight and length/height) were carried out on all the children recruited for the study while mid-upper arm circumference was done for children aged 12–59 months. Stool samples were collected from each child into a wide mouth universal, clean, dry, leak-proof, container, with the help of their parents/guardians. Microscopy was carried out on the stool samples collected within 1 h in the microbiology laboratory for the presence of ova, larva, or worm segment using direct microscopy with saline and iodine wet preparation and formol ether concentration. Ova were identified and quantified. The type of worm and intensity were recorded. Results: Out of the 130 children, 65 (50%) had diarrhea while the other 65 (50%) were without diarrhoea. The mean age of subjects with diarrhea was 16.86 ± 11.7 months and 17.60 ± 9.9 months for those without diarrhoea. There was no significant difference in sex distribution between the age groups (P = 0.86). The overall prevalence of intestinal helminthic infection in the study population was 1.5%. The prevalence of intestinal helminths in those with diarrhea and those without diarrhea was 3.1% and 0.0%, respectively, (P = 0.496). Only Ancylostoma duodenale (hookworm) was isolated in those with diarrhea and it was of light intensity. There was no significant difference in the method of disposal and source of water, comparing subjects having diarrhea and those not having diarrhea (P > 0.05). The proportions of subjects that usually played in the sand, go on footwear outside home, and go on footwear at home, were not significantly different comparing those having diarrhea and those not having diarrhea (P > 0.05). Conclusions: The prevalence rate of intestinal helminths in children with and without diarrhoea was low. There was general environmental cleanliness and personal hygiene in the study population which were likely responsible for the low helminthic infection thus emphasizing the need for maintenance of good hygiene, access to good water supply and periodic intake of anti-helminthic drugs in view of the public health importance of helminthic infection and diarrhoea.

Background: Knowledge of mental disorders is poor in developing countries and often has a negative impact on the ways the public relate to persons with mentaldisorders. The present study seeks to explore changes in knowledge and attitude of student nurses to mental disorders following an educational program. Materials / Method: The study involved first and second-year students from two schools of basic nursing: the State School of Nursing, Calabar (intervention group) and the University of Calabar Teaching Hospital’s School of Nursing (control). A total of 191 students from both schools were assessed at different times (pre and post-intervention periods) using the modified World Psychiatric Association (WPA) questionnaire. The educational intervention was performed only on the students in the intervention group using the WPA semi-structured educational material. Results: The baseline results show that while a small proportion of the respondents (28.1% in the intervention group and 37.9% of control) attributed the cause of mental illness to witchcraft, majority had poor attitudes to mental disorders. One week post-intervention assessment shows some improvement in knowledgeof the respondents in the intervention group. This improvement was significant for those that endorsed witchcraft (P=0.01) and God’s punishment (P=0.01) as causes of mental disorders. This significant improvement was sustained at the one-month post-intervention assessment. Conclusion: The study shows that an educational program is capable of improving knowledge of aetiology of mental disorders and attitudes towards persons with such disorders.

BACKGROUND: Street sweeping is an increasing popular outdoor occupation in major cities of Nigeria. These workers are chronically exposed to diverse occupational and environmental sources of ocular hazards, that they may not be aware of. This may impair their adoption and compliance with the requisite safety practices. This study was aimed at assessing levels of awareness, knowledge, and practice of ocular safety among street sweepers in Calabar, Southern Nigeria. MATERIALS AND METHOD: The study was a cross sectional study among one hundred and fifteen (115) street sweepers in Calabar Urban Development Authority, Nigeria over a period of three months. A systematic random sampling method was used to select respondents eligible for the study and a pretested semi-structured interviewer administered questionnaire was used to obtain data. Data obtained was analysed using statistical package for social sciences version 20 (Armonk, NY:IBM Corp.). RESULTS: One hundred and fifteen (115) subjects were studied, with mean age of 41.8 ± 10.4 years, and female to male ratio of 1:0.03. Seventy percent had good knowledge of ocular health safety; while 68% were aware of the occupational hazards associated with the job. Less than a quarter (19%) of workers used personal protective devices (PPD). Only 1% of the total who used PPD wore protective goggles while at work. CONCLUSION: Good knowledge and a high level of awareness on ocular health safety was seen among street sweepers. However, there was poor utilization of personal protective devices especially protective goggles among the workers which will increase their risk to occupational hazards. RUNNING TITLE: Awareness and practice knowledge of ocular health safety

Background Globally, diabetes is a leading cause of impairment of quality of life. In the sub-Saharan African region, there is a need for studies that provide more valid assessment of effect of diabetes on quality of life (QoL). This study aimed at assessing quality of life among patients with diabetes attending a tertiary health service in Nigeria. Methods The study design was a case-control. Diabetic cases were randomly recruited from the University of Calabar Teaching Hospital, while non-diabetic controls were civil servants and retirees. The validated and pretested WHOQoL-BREF instrument was used to assess quality of life, with higher scores indicating higher quality of life. Results Three hundred and thirty subjects were studied, with mean ages of males and females of 55.2 ± 4.8 and 51.8 ± 6.3 years, respectively. The mean total QoL score was 75.77 ± 11.2, with no significant difference between males and females. Among male and female cases, the mean score of the physical health domain was significantly lower for cases compared with controls (p = 0.05). Male cases compared with controls had higher scores for the environment domain (p < 0.05). Older age and higher systemic blood pressure were associated with lower QoL scores for both sexes (p < 0.05). Unmarried status, obesity, and poor glycemic control (HbA1c > 7%) were associated with lower QoL scores (p < 0.05). Fasting blood sugar (FBS) level and lipid profile were not significantly correlated with QoL score in both sexes (p > 0.05). Conclusion Diabetes contributes to low quality of life among males and females, with significant differences in the affected domains. Diabetes care providers should identify affected domains during clinic consultation, in order to improve provision of more effective care.

BACKGROUND: Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility.AIM: This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures.METHODOLOGY: A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the “Woman Intervention Trial” was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition.RESULTS: There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission.CONCLUSION: Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.

Objective: The present study aims to determine the association between clinical-demographic variables and length of stay of patients admitted into Federal Psychiatric Hospital, Calabar.Design: Retrospective review of case records.Methods: 280 case records of patients (discharged from September 1st, 2015 to August 31st, 2016) were assembled for review, out of which twelve cases were excluded for various reasons. Clinical and demographic data collected from the remaining 268 case records were subjected to univariate and multivariate analyses to determine variables associated with prolonged length of stay.Results: Mean length of stay was 56.2 ± 40.9 and the commonest clinical diagnosis was schizophrenia (45.9%). Although gender, age, marital status and clinical diagnoses tended to influence length of stay, gender (p =0.007) and clinical diagnosis of schizophrenia (p =0.044) were the only variables that significantly predicted prolonged length of stay.Conclusion: We found that gender and clinical diagnoses were important determinants of length of stay. If validated in future studies, these factors may help in accurate identification of cases at risk of prolonged hospitalization and act as guide to clinicians who may need to optimize intervention strategies early enough in managing such cases.Keywords: Psychiatric hospitalization, Length of stay, Prolonged hospitalization, Psychiatric patients, Calabar

Background: The advent of community-based care and de-institutionalization of persons with mental disorders have led to a progressive shift of care from formal health-care systems to informal care providers such as the family. This shift of care, from hospitals to the families, has led to a significant level of the burden on the family caregiver. This study aimed to identify factors which are associated with burden of care among caregivers of patients with bipolar affective disorder (BAD) seen at the Federal Psychiatric Hospital, Calabar. Materials and Methods: A simple random sampling technique of “yes or no” balloting was utilized to select 105 caregivers of bipolar patients seen at the outpatient clinic of the hospital. The selected caregivers (those who picked “yes”) were recruited along with their respective patients after obtaining their consent. They were assessed using a set of five questionnaires, of which three (Patient Health Questionnaire-9 [PHQ-9], Young Mania Rating Scale [YMRS] and Brief Psychiatric Rating Scale [BPRS]) were administered by the researchers on the patients whereas the remaining two (sociodemographic questionnaire and Family Burden Interview Schedule) were self-completed by the caregivers. Results: One hundred out of the 105 caregivers who were recruited completed the study procedure and returned properly filled questionnaires. The rates of objective and subjective burden on the caregivers were 79% and 74%, respectively. While the objective burden was associated with the patient's educational attainment and his/her scores on the YMRS and BPRS, the subjective burden was associated with the caregiver's monthly income and marital status, the patient's gender, number of suicide attempts, and scores on PHQ-9, YMRS, and BPRS. Of all the variables, the patients' scores on YMRS (P = 0.025) and PHQ-9 (P = 0.011) were the significant predictors of objective and subjective burden, respectively. Conclusion: This study identified the extent and factors associated with burden of care on caregivers of patients with BAD. Awareness of those factors might guide clinicians in instituting treatment strategies toward reducing the burden on caregivers.

Background: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are viral infections that are transmitted through transfusion of unscreened blood products, needlestick injuries, and unprotected sex. This was a study to determine the prevalence of Hepatitis B and HIV infection among pregnant women accessing antenatal care. Materials and Methods: Two ml of venous blood was also collected into ethylenediaminetetraacetic acid bottles for hepatitis B surface antigen (HBsAg) and HIV test using a rapid diagnostic test kit following the standard algorithm of performing diagnosis. Results: Of the 250 participants examined for the presence of HBV and HIV among pregnant women attending the antenatal clinic in Calabar, 14 (5.6%) and 3 (1.2%) were positive for HBsAg and HIV. Participants aged 26–30 years had the highest prevalence of HBsAg 8 (7.0%) and participants aged 31–35 had the highest prevalence of HIV 1 (3.2%). The seroprevalence of HBsAg and HIV infection among pregnant women attending antenatal clinics by occupation shows that students had the highest infection rate of 3 (9%) and 2 (6%) for HBsAg and HIV. Of the 250 participants enrolled, the level of HIV and HBV awareness was 178 (71.2%) and 242 (96.8%), respectively. Conclusions: The study has revealed that the prevalence of HBV and HIV is on the increase among pregnant women, with a prevalence of 5.6% and 1.2%, respectively. General precautions need to be strictly adhered to in the hospital and particularly in blood transfusion and handling of sharps objects.

Summary Background There are various reports of higher mortality rates occurring after admissions over the weekend and during after-hours. This study aimed to determine if there was a difference in mortality rates occurring during the weekend and after-hours among cardiovascular admissions in a tertiary hospital in Nigeria. Methods A review of cardiovascular admissions (including stroke) was carried out at the University of Calabar Teaching Hospital in Nigeria from January 2010 to December 2013. All admissions to the medical wards from the emergency department and medical out-patient department clinics during the study period were included. Results A total of 339 patients were studied and stroke was the commonest type of cardiovascular disease (CVD) admitted (187; 55.2%). Hypertension was the commonest cause of heart failure (70; 48.6%). Presentation to hospital during after-hours and length of stay of more than 14 days were significant predictors of death (OR: 3.37; 0.22). Conclusion An increase in CVD mortality rates occurred during after-hours, most likely a consequence of uneven staffing patterns and poor access to equipment. Healthcare providers in Nigeria need to consider remedies to this with a view to reducing excess mortality rates.

Background: Chronic lymphocytic leukemia (CLL) is a heterogeneous group of monoclonal forms of lymphoproliferative disorder, which is usually common among older adults. There is an increasing trend in the number of patients presenting with the disease. Aim: This study aims to determine the epidemiology pattern of CLL in Cross River state. Methodology: A retrospective study with 10-years data (2010–2019) obtained from the register of the Department of Haematology and Blood Transfusion, University of Calabar Teaching Hospital, Calabar. The data collected include the date of presentation, the age, gender, location of residence, and occupations of the patients. Results: A total of 47 cases were seen during the 10-year period, with a male: female ratio of 1:1. The mean age at presentation was 59 years. The majority of the patients were in their fifth and sixth decades of life. Most patients (44.68%) practice farming as their profession. Conclusion: The study has reawaken our consciousness on the increasing trend on the epidemiological burden of CLL in our environment and will help to enhance further investigation into the relationship between the rising trend and available possible risk factors in our environment.

Background: Contraception is known to contribute to a reduction in maternal mortality rates directly. Jadelle implant is a long-lasting, reversible contraceptive that is safe, highly effective, and convenient. Objectives: The objectives of this study were to determine the sociodemographic profile, side effects, and reasons for discontinuation among users of Jadelle in the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Methodology: This was a 5-year retrospective study carried out at UCTH, Calabar, Nigeria. Case files of women who accepted and inserted Jadelle implant between January 1, 2013, and December 31, 2017, were retrieved, and data were extracted for the study. Descriptive and analytical statistics of the data using mean and standard deviation were done, and results were presented in frequency and percentage tables. Results: A total of 270 women accepted and inserted Jadelle implant during the period under review with a mean age of 33.0 ± 6.2. Majority of the clients were Christians 98.1%, and 85.9% had at least secondary school education. About half (49.6%) of these women had a desire for future fertility, whereas 49.7% have had four or more children. Sixty-one percent (61.5%) of the clients had previously used a form of contraception. Menstrual irregularities were the most commonly reported side effect (55.0%) as well as the most common reason for removal and discontinuation of the implant (43.3%). Conclusion: Jadelle is a highly effective, safe, and reversible method of contraception. The most commonly reported side effect was menstrual irregularities, which was also the most common reason for discontinuation in the UCTH, Calabar, Nigeria.

BACKGROUND: Â X-ray and sonomammography constitute a significant option in the early detection and management of breast diseases in the developed world. Unfortunately these modalities became available in Nigeria, only in the past few decades.AIM: The aim of this audit is therefore to document the imaging findings, in the past three years in a developing facility in Nigeria relating them with the demograghic features.METHODS: We prospectively studied the x-ray and sonomammography in all patients, presenting over a three year period, for breast evaluation with the hope of discerning the epidemiologic pattern of breast lesions in this environment.RESULTS: One hundred and forty-five females and four males. Median was 38 years (IQR=30-48). The commonest reason for evaluation was screening. Patients that were below 38 years showed no significant difference in frequency and type of lesion compared with patients over 38 years. The commonest breast pattern was fatty replaced. The upper outer quadrant was the commonest site.CONCLUSION: Patients presenting for breast evaluation in Calabar do so for screening mainly. Patients below 38 are nearly equally affected by malignant breast disease as their older counterparts. The commonest breast pattern was fatty replaced. Digital mammography should be available in all tertiary institutions.

Background: The presence of breast lump(s) is one of the most common reasons for hospital visits by women especially those of reproductive age. Despite the heightened anxiety associated with the discovery of breast lump often erroneously thought to be breast cancer, majority of these lumps are usually found to be benign histologically. The aim of this study is to determine the prevalence of benign breast diseases in Calabar , Nigeria and to profile their histologic patterns. Method: A descriptive retrospective review over a period of 5 years (January 2012 – December 2017) of laboratory request forms and histopathology records of all patients whose specimens were received in the Department of Histopathology, University of Calabar Teaching Hospital, Calabar, Nigeria were analysed for clinical findings, histopathology reports and demographic data like age, sex etc. Results: Of the 380 reports retrieved 8(2.1%) were male and 372(97.9%) were females. The mean age of the patients was 25.4 ± 9.9 years with majority of the patients in the 2 and 3 decade of life. Gynaecomastia (62.5%) was the commonest benign breast lesion found in males. Fibroadenoma (59.3%) was most frequently found among the females followed by fibrocystic disease and fibrocystic changes (16.4%). Atypical ductal hyperplasia (0.8%) was less commonly found. Conclusion: Benign breast diseases are common amongst young female patients within the 2 and 3 decades of life in Calabar, Nigeria with fibroadenoma being the commonest histologic type. Keywords: Breast, Benign, Histopathology, Calabar

BACKGROUND: The mental health status of medical students has been proven to be poor compared to their peers in other disciplines and has led to grave personal and professional consequences. This subject has however remained largely unexplored in our medical school.AIM: The study was therefore conducted to assess the prevalence of mental health of medical students in the University of Calabar, Cross river state, Nigeria.METHODOLOGY: A descriptive cross-sectional survey of 451 randomly selected medical students from the pre-clinical and clinical levels of study in the University of Calabar. A self administered questionnaire including the GHQ12 was used to elicit information from the respondents. A score of ≥ 3 suggested poor mental while a score < 3 represented good mental health. Data were summarized using proportions, and c2 test was used to explore associations between categorical variables. Level of significance was set at p < 0.05.RESULTS: The mean age of the respondents was 23.4 ± 4.3 years, 63.8% were males, 34.8% were from the preclinical and 65.2% from clinical levels of study. Based on the GHQ categorisation, 39.2% had a poor mental health status, compared to 60.8% with good mental health status. The factors significantly associated with poor mental health, were recent experience of mistreatment by trainers or colleagues, perceived inadequate monthly allowance and perception that medical training is stressful (p < 0.05). CONCLUSION: With more than a third of undergraduate medical trainees with traits of poor mental health, provision of accessible mental health services/counselling is strongly recommended early in their training.

The pains and challenges of pregnancy and delivery are made worse when the resultant neonate dies. Fortunately, many of these neonatal deaths can be prevented if autopsies are routinely conducted to ascertain the immediate and remote causes of death toward subsequent prevention. Unfortunately, there is paucity of studies on neonatal autopsy rates (NARs) in many developing countries, with few reports indicating unacceptably low rates. This study was therefore aimed at assessing the trend in neonatal deaths and autopsy rates in Calabar, Nigeria. Trend analysis of retrospective data obtained from medical records of neonatal deaths and deliveries was conducted. Neonatal mortality rate (NMR) and NAR were obtained for each of the years within 2004-2013. Ethical approval was obtained from the ethical committee of University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. In the 10-year study period, there were 22,916 deliveries with a male:female ratio of 1:0.95. There were 1136 neonatal deaths, yielding a total NMR of 49.6 per 1000 live births (ranging from 26.7 in 2011 to 93.7 in 2004). Bimodal peak in NMR was found at 2008 and 2012. Eighty six neonatal autopsies were conducted within the study period yielding a mean autopsy rate of 7.57%, ranging from 0% in 2008 to 25.0% in 2013. This study found unacceptably high NMR and low NAR in the study setting. There was, however, gradual decrease in mortality and increase in autopsy rates through the study period. It is essential to redouble the efforts at improving public health education and awareness on the relevance of autopsy toward improved health service delivery. Similar studies are recommended in other similar and dissimilar settings.