West Africa Journal of Medicine

CASE REPORT: Radiographic Diagnosis of Anomalous Root Canal Morphology in Patients with Pulpal Diseases at a Tertiary Hospital in Nigeria: A Case Series

2025-06-12T09:32:08+00:00

Negotiation of the intricate pulp canal space may pose a challenge in endodontic treatment. Consequently, appropriate diagnosis and thorough knowledge of the pattern and distribution of root canal systems are imperative for a more predictable outcome in the treatment of pulp diseases. Accordingly, cone beam computed tomography (CBCT) is deemed appropriate as an adjunctive diagnostic tool in endodontics. This case series presents premolars and molars with anomalous root canal distribution that were further evaluated with the aid of CBCT.

ORIGINAL: Polysomnography in a Private Tertiary Hospital in Tanzania: Subjects' Characteristics and Sleep Disorders

2025-06-01T08:18:32+00:00

Background and objectives: Huge clinical and research gaps exist concerning the epidemiology, natural history, availability, and accessibility of care for sleep disorders in sub-Saharan Africa (SSA). This study aimed to profile the characteristics of patients referred for polysomnography and the frequencies of sleep disorders encountered at the new sleep laboratory in Dar es Salaam, Tanzania.

Materials and methods: This retrospective hospital-based descriptive observational study was conducted at the Aga Khan Hospital Dar es Salaam. Clinical and Polysomnographic parameters of the subjects referred for polysomnography between December 2019 and December 2022 were profiled.

Results: During the study period, 54 subjects underwent overnight polysomnography and multiple sleep latency tests (MSLT). The subjects' mean age ± standard deviation was 44.1 ± 15.2 years. Males accounted for 57.4% of all study participants. Twenty-nine (53.7%) subjects had OSA. Nineteen (35%) subjects had normal polysomnographic findings. Periodic limb movement of sleep was found in 2 subjects (3.7%). Sleep-related bruxism was found in one subject, while another subject met the MSLT criteria for the diagnosis of Narcolepsy. Male gender (odds ratio: 5.60; 95% confidence interval: 1.35-23.23; p = 0.018) and obesity (odds ratio: 6.13; 95% confidence interval: 1.48-25.47; p = 0.013) were found to be the two significant predictors.

Conclusion: Sleep-related breathing disorder was the predominant condition, and obesity was the major predictor. Periodic limb movement disorder and Narcolepsy were less encountered. Larger cohort and population-based studies are advocated.

ORIGINAL: Spectrum of Manifest Strabismus in A Tertiary Eye Care Hospital in Calabar, Nigeria: Demographics, Types and Co-morbidities

2025-06-01T08:39:20+00:00

Background: Strabismus is a potential cause of ocular morbidity.

Objective: The aim of this study was to determine the frequency, types of manifest strabismus and co-morbidities among patients attending a referral paediatric ophthalmology and strabismus clinic in Calabar, Nigeria.

Methods: A retrospective review of case-notes of patients attending the paediatric ophthalmology and strabismus clinic from January 1, 2017 to December 31, 2019 was done. Collected data was analyzed using chi square test (or Fisher's Exact Test) and multivariate binary regression. A p-value of <0.05 was considered statistically significant.

Results: Of the 4644 patients reviewed, 169 patients (3.6%) had strabismus during the study period but only 136 (80.4%) met the eligibility criteria for inclusion into this study. Most patients (89.0%) were aged below 16 years. Females (52.2%) were proportionately more. Sixty-three (46.3%) had one ocular comorbidity, 56(41.2%) had two while 16(11.8%) had three. The most common ocular comorbidity was amblyopia (31.6%), followed by hypermetropia (27.7%). Twenty-nine (21.3%) had systemic comorbidities. Sensory and infantile esotropia were the most common types; 35.3% and 32.4% respectively. Others included intermittent exotropia (16.2%) and sensory exotropia (6.6%). Primary strabismus was more common among those aged 16 years and above compared with those aged below 16 years (66.7% versus 57.0%), p=0.475. There were statistically significant relationships between strabismus and cataracts, retinoblastoma, hypermetropia, astigmatism among others. Amblyopia (AOR: 3.339; 95% CI: 1.100-10.131), hypermetropia (AOR: 10.615; 95% CI: 2.393-47.077), and myopia (AOR: 0.109; 95% CI: 0.016 to 0.732) were predictors of strabismus.

Conclusion: The prevalence of strabismus in this study revealed a higher burden than previously reported in Nigeria. Some comorbidities serve as predictors of strabismus, and their presence may aid timely case finding. Treatment of causes of secondary strabismus may reduce the burden of avoidable causes of strabismus and associated visual loss.

ORIGINAL: Evaluation of Biodentine® and Calcium Hydroxide in the Formation of Dentin Bridge in Deep Carious Lesions

2025-06-01T08:58:19+00:00

Background: Indirect pulp capping is the main treatment modality for reversible pulpitis.

Objective: To evaluate the efficacy of Biodentine® and Calcium hydroxide in the formation of dentin bridge.

Materials and methods: A double blinded, randomized clinical control trial involving 50 consenting subjects, aged 16 to 55 years with deep carious vital teeth. It was a comparative study with intervention comparing Biodentine® (test) and Calcium hydroxide (control). Subjects' teeth were assessed for normal response to pulp testing. Cavity preparation was done and the cavity was dressed with either Biodentine® or Calcium hydroxide (Ca(OH)2) then restored with Glass ionomer cement. A bitewing digital dental x-ray was taken at the end of the procedure to measure radiographically the dentin depth as base line using a digital meter. The subjects' teeth were examined radiographically at three, six and nine months. The probability level of p<0.05 was considered significant.

Results: There was a progressive increase in dentin formation at three months, six months and a significant increase at nine months: the subjects' teeth in the Biodentine® group recorded an increase in dentin depth of mean 0.67±0.07mm in the mesial aspect and mean 0.66±0.07mm in both the middle and distal aspects. The Ca(OH)2 group recorded an increase in dentin depth of mean 0.55±0.07mm in the mesial aspect, mean 0.52±0.07mm in the middle aspect and mean 0.55±0.07mm in the distal aspect at nine months. (p value 0.001).

Conclusion: Biodentine® and Ca(OH)2 have proven to be efficacious in dentin bridge formation. The Biodentine® group showed a statistically significant increase in mean dentin depth relative to that of Ca(OH)2 group following indirect pulp capping of deeply carious teeth.

ORIGINAL: Depression and Anxiety Disorders among Persons with Type 2 Diabetes Mellitus in a Tertiary Hospital in Zaria, Nigeria

2025-06-01T11:01:22+00:00

Background: Depression and anxiety disorders frequently co-occur with Type 2 Diabetes Mellitus, leading to poor glycaemic control and quality of life through complex biopsychosocial mechanisms. A dual diagnosis of chronic medical and mental health conditions reduces the probability of early recognition and intervention for either. This study was aimed at assessing the prevalence and correlates of depression and anxiety disorders among persons with Type 2 Diabetes Mellitus in a tertiary hospital in North-West Nigeria.

Methods: A hospital-based cross-sectional study was conducted among 370 adult respondents with Type 2 Diabetes Mellitus at the endocrinology clinic of Ahmadu Bello University Teaching Hospital using a systematic sampling technique to recruit participants. Data was collected using a sociodemographic questionnaire, the Mini International Neuropsychiatric Interview (MINI) to diagnose depression and anxiety, and the Morisky Medication Adherence Scale (MMAS-8) to assess medication adherence. Data were analysed with the SPSS Version 25.

Results: The prevalence of major depressive disorder was 46.5%. Of the 42.2% that had anxiety disorders, 46.7% had generalized anxiety disorder, 51.9% panic disorder, 30.1% agoraphobia, 31.4% had a coexisting depression and anxiety disorder. About 4 in 10 of the respondents reported medication non-adherence.

Conclusions: The study shows a high burden of depression and anxiety disorders among patients with Type 2 Diabetes Mellitus, associated with poor medication adherence and outcome. Physicians need to pay more attention to psychological distress associated with chronic medical conditions to improve treatment outcomes and quality of life.

ORIGINAL: Bacteriological Agents and Resistance Profiles in Neonatal Sepsis from a Poorly Regulated Antimicrobial Access Setting: Time for Action

2025-06-01T11:13:42+00:00

Background: Neonatal sepsis (NNS) is a known cause of morbidity and mortality especially in developing countries. The global resistance scourge may worsen the management outcomes of NNS. This study aims to determine the current profile of bacteriological agents of NNS, their resistance status and associated mortality in our setting.

Methods: Neonates numbering 480 presenting with clinical features of sepsis and /or risk for sepsis were consecutively recruited into the study and had their blood specimens collected at admission. Blood samples were logged into BacT/ALERT® and then inoculated onto blood, chocolate and MacConkey agar upon beeping. Inoculated agar plates were incubated aerobically at 35-37oC for 24-48 hours except the Chocolate agar incubated under an enriched CO2 atmosphere. Isolates were identified using standard microbiological techniques. Antibiotic susceptibility was performed by the modified Kirby-Bauer disc diffusion method and interpreted using CLSI recommendations. Multi-drug-resistant (MDR) bacterial strains were identified by resistance to at least one antimicrobial agent from three or more categories. Discharge and Deaths were the reported outcomes of treatment.

Results: The 480 neonates investigated M: F=1:0.8 and a mean age of 5.64 ± 7.28 days. The overall prevalence of microbiologically confirmed NNS was 24.6%. There is no significant difference (p=0.1395) in the NNS prevalence among males (22.0%) compared to females (28.3%). The highest prevalence of NNS (39.8%) was recorded at the gestational age of 32-36 weeks. NNS prevalence significantly (p=0.009) changed with increasing gestational age just as the prevalence of maternal chorioamnionitis history significantly (p=0.0006) increased with increasing gestational age. Gram-positive bacteria (56.2%) were the predominant isolates and S. aureus (47.9%) was the most frequent. Salmonella Typhi occurrence was 1.4%. A majority (54.8%) of the pathogens were MDR. The overall mortality rate in the study was 6.5% with significant (p=0.00001) higher deaths among microbiologically confirmed NNS (18.5%) compared to nonmicrobiologically confirmed NNS (2.5%).

Conclusion: The prevalence of 'microbiologically confirmed' NNS in this study is high and most identified pathogens were MDR. Salmonella Typhi was a rare agent of NNS seen in this study. Mortality recorded is high and the time for mitigating the emergence and spread of MDR such as regulated antimicrobial sale and use is now.

ORIGINAL: Evaluation of Patients' Satisfaction with Healthcare Services Provided at the National Health Insurance Authority Clinic of a Tertiary Hospital in South-West, Nigeria

2025-06-09T15:38:03+00:00

Background: Patient satisfaction is an essential indicator used for measuring the quality of health care delivered to a patient and contributes to strategies for the improvement of healthcare delivery. This study assessed patients' satisfaction with the quality of care at the National Health Insurance Authority (NHIA) clinic in a tertiary health facility.

Methods: The study was a descriptive cross-sectional design with 320 respondents who completed a semi-structured questionnaire. Satisfaction levels were scored on a five-point Likert scale. Frequencies for each satisfaction level (Poor, Fair, Good, Very Good, Excellent) were calculated, as well as mean scores and standard deviations (Mean ± SD). Bivariate analysis was done using Pearson's chi-square (p < 0.05) and multivariable logistic regression was performed to assess factors influencing patient satisfaction.

Results: Respondents generally expressed high satisfaction with the structures, medical record, laboratory, pharmacy, and account sections. The nursing section had slightly lower ratings, while the physician section showed varied satisfaction levels. Overall, 192 (60%) of respondents were very satisfied (overall satisfaction >75%) with the NHIA clinic's healthcare. A significant association (p < .05) was found between the likelihood of recommending the facility, perceptions of treatment outcomes, and overall patient satisfaction.

Conclusion: There was high satisfaction with the care received. More improvements can be made in areas such as cleanliness, availability of equipment or drugs, nurses' receptiveness and physicians' involvement of patients in decision-making to further enhance the overall satisfaction of patients at the clinic.

ORIGINAL: What Does it Cost to Provide Free Maternal and Child Health Services in Primary Health Centres? A Case Study of Imo State, Southeast Nigeria

2025-06-09T17:34:21+00:00

Background: This study estimated the cost of providing free maternal and child health (MCH) services at the primary health centre (PHC) level in southeast Nigeria. The costs of providing an essential benefit package of maternal and child health (MCH) services are unknown. Such information is required for optimal resource allocation decisions and for replicating similar programmes in different settings.

Methods: The full and unit costs of providing a thin benefit package of MCH services in all the 418 PHC centers in Imo State, southeast Nigeria were computed using an ingredient and activity costing approach from a provider perspective. Data on costs were collected both retrospectively and cross-sectionally. Data on service utilisation by mothers and children under five years were collected from the PHC attendance registers.

Results: The total cost was $27,710,009.00, whilst the unit costs for delivering combined MCH services in 418 PHCs were $37.2. However, for just child health services, the unit cost was $13.7 per child, whilst the unit cost of providing just maternal health services was $42.7 per pregnant woman. Personnel costs contributed 84.6% of the total cost.

Conclusion: The findings will guide the design and scale-up of a similar programme towards the achievement of universal health coverage of MCH services.

ORIGINAL: Relationship Between Pre- and Post-Orchidectomy Serum Dihydrotestosterone and Prostate Cancer Severity in a Cohort of Nigerian Patients

2025-06-12T07:41:40+00:00

Introduction: Prostate cancer (PCa) is the commonest urologic cancer worldwide and the leading cause of male cancer deaths in Nigeria. In Nigeria, orchidectomy remains the primary androgen deprivation therapy. Dihydrotestosterone (DHT) is the active prostatic androgen, but its relationship with PCa severity has not been extensively studied in Africa.

Objectives: This study assessed the relationship between serum levels of DHT (pre- and post-orchidectomy) and serum prostate specific antigen (PSA), as well as Gleason scores.

Methods: Patients undergoing orchidectomy for histologically confirmed prostate adenocarcinoma were studied. Serum PSA and DHT levels were assessed before orchidectomy, and 6 weeks afterwards. This was correlated with their Gleason scores. Data was analyzed using the IBM SPSS Statistics version 20. P < 0.05 was considered significant.

Results: Fifty-three patients completed the study. The mean age was 69.3 ± 6.9 years. Pre- and post-orchidectomy serum PSA ranged from 11.30 to 562.00 ng/ml and 0.01ng/mL to 245.00 ng/mL respectively. Pre- and post-orchidectomy DHT ranged from 6.91ng/mL to 4,996.38 ng/mL and 6.56 ng/mL to 2,575.03 ng/mL respectively. Up to 40% still had normal DHT post-orchidectomy. There was a positive but statistically insignificant correlation between pre-orchidectomy serum PSA and DHT (r = 0.089, p = 0.527). There was however a direct and significant relationship between pre-orchidectomy serum DHT and Gleason scores (p = 0.042).

Conclusion: This study showed a relationship between preorchidectomy serum DHT and Gleason scores. Assessing DHT in patients with high Gleason scores could influence hormonal manipulation.

REVIEW ARTICLE: Review of Childhood Mortality Pattern at the Paediatric Unit of a Teaching Hospital in Nigeria

2025-06-12T09:20:00+00:00

Background: The vital statistics in the third world countries are poor and have witnessed minimal improvement over the years with childhood mortality in Nigeria remaining one of the highest among the developing countries despite various child survival programmes. Child survival strategies can only be efficient if the major reasons for morbidity are known. The objective of this retrospective study was to review the patterns of childhood mortality at the emergency room of the Federal Teaching Hospital, Ido-Ekiti (FETHI).

Materials and methods: This study was conducted at the Children Emergency room of FETHI. Admission, discharge records and the case notes of the patients who died from September 2017 to October 2022 at the emergency units were retrospectively reviewed to extract the data on the age, sex, diagnosis, and duration of stay on admission before demise. A p-value of <0.05 was accepted as statistically significant.

Results: There was a total of 2503 admissions with a M: F ratio of 1.25:1. The mortality rate was 3.9%. Age at demise was independent of the sex of the patients with a p-value of 0.33. More deaths occurred within six to 72 hours on admission and 68% of deaths in the EPU were U-5. Sepsis and malaria were the leading causes of death.

Conclusions: The high incidence of mortality among under-5 largely from preventable causes of death stresses the need to strengthen the existing childhood preventive measures.

EDITORIAL: Addressing Psychological Well-Being in Chronic Disease Management

2025-05-29T16:40:11+00:00

Addressing Psychological Well-Being in Chronic Disease Management

We are thrilled to present another rich collection of articles that explore critical health concerns spanning diverse disciplines, reflecting the dynamic and multifaceted nature of healthcare challenges in Africa. The topics underscore the pressing need to bridge gaps in healthcare delivery, emphasizing the importance of context-specific approaches tailored to the unique socio-cultural and economic realities in our clime. A recurring theme is the necessity of targeted interventions to address urgent health challenges, ranging from infectious diseases and chronic conditions to mental health and preventive care. I will like to highlight a few, including the study by Fadeyi et al. at the University of Ilorin Teaching Hospital which reported a high prevalence of microbiologically confirmed neonatal sepsis. More than half of the identified pathogens were multidrug resistant, mainly caused by Staphylococcus aureus, emphasizing the urgent necessity for antimicrobial stewardship and caregiver education. Adebayo et al. in Tanzania found obstructive sleep apnoea to be prevalent in tertiary hospital patients, linked to obesity and male gender, and advocated the need for improved diagnostics and public awareness. In another study, Babalola et al. highlighted the significant association between pre-orchidectomy dihydrotestosterone levels and Gleason scores among patients with prostate cancer while the work by Adaje et al. serves as a poignant reminder of the significant efforts still required to reduce the high mortality rate among children under the age of five, primarily due to preventable causes.

Chronic diseases such as diabetes, cardiovascular diseases, cancer, and autoimmune disorders significantly impact not only physical health but also psychological well-being. An increasing body of research emphasizes the necessity of addressing psychological factors in chronic disease management, as these aspects influence disease progression, treatment adherence, and overall quality of life.^1,2 Living with a chronic illness often leads to psychological distress, including anxiety, depression, and reduced self-esteem. This exacerbates the burden of disease by reducing functional status and complicating disease management.¹

It has been shown that depression is a significant predictor of poor outcomes in chronic conditions, such as increased hospitalizations, non-adherence to medication, and higher mortality rates.³ Conversely, positive psychological states, including resilience and optimism, are linked to better health outcomes. For example, the role of optimism in fostering adaptive coping mechanisms and enhancing recovery in cardiac patients has been demonstrated.^4,5 Therefore, addressing psychological health can improve not only mental well-being but also physical health outcomes.

The importance of assessing the psychological health status of patients with Type 2 Diabetes Mellitus (T2DM) was the focus of the study by Mohammed et al. The findings showed a significant mental health burden among individuals with T2DM, with 46.5% experiencing major depressive disorder and 42.2% suffering from anxiety disorders. These co-morbidities correlated with poor glycaemic control, increased complications, and reduced medication adherence. The research emphasizes the need for integrating mental health care into diabetes management, recommending routine mental health screenings and early intervention to enhance glycaemic control and treatment adherence. There is also the need for policymakers to prioritize mental health resources within diabetes care programs, invest in healthcare worker training, and support public awareness campaigns. This approach is also relevant to the care of other chronic health conditions.^1–3 Healthcare providers must be trained to recognize psychological distress in such patients, and to offer appropriate care, including mental health referrals where necessary. The biopsychosocial model advocates for a comprehensive approach to chronic disease management, incorporating biological, psychological, and social dimensions. Studies support the efficacy of this approach in improving patient outcomes, patients with chronic illnesses who participated in cognitive-behavioural therapy (CBT) experienced significant improvements in emotional well-being and self-management behaviours.^6,7

Despite the evidence, psychological care is often overlooked in chronic disease management. Barriers include stigma associated with mental health, limited access to mental health services, and a lack of interdisciplinary collaboration. Addressing these challenges requires policy changes, increased funding for integrated care models, and training for healthcare providers to recognize and address psychological distress.⁸ It has also been suggested that digital mental health tools can be developed and deployed to address treatment gaps in resource-limited settings. In some other clinical context, digital tools have been shown to improve health literacy and coping mechanisms among patients.^9,10 In addition, more research is needed in our climes that focus on the development and implementation of integrated care models that prioritize psychological well-being alongside physical health.

We extend our sincere appreciation to our reviewers, authors, and readers whose dedication and collaboration continue to shape the success of this journal. The journal remains committed to serving as a dynamic forum for sharing knowledge and innovation among healthcare professionals, researchers, and policymakers worldwide. Publishing with us not only ensures your work reaches a broad and diverse audience but also amplifies its impact on healthcare advancement in the region and beyond. Let us jointly uphold and elevate the journal’s standing as a vibrant platform for disseminating medical knowledge, research and education. We eagerly look forward to your contributions, which will undoubtedly enrich future editions and inspire progress in global healthcare.

Prof G.E Erhabor

Editor-in-Chief

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