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   Table of Contents - Current issue
Coverpage
September-December 2019
Volume 6 | Issue 3
Page Nos. 89-133

Online since Wednesday, November 27, 2019

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ORIGINAL ARTICLES  

Health and nutritional conditions of street children of Accra City Centers: An experiential study in Ghana p. 89
Frederick Vuvor, Peace Mensah
DOI:10.4103/jhrr.jhrr_34_19  
Aim: Children’s nutritional status offers valuable insights into the future of society’s well-being. Street children are quite vulnerable to poor health and malnutrition. The purpose of this study was to assess the health and nutritional status of street children in Accra, Ghana. Materials and Methods: A total of 300 children (210 males and 90 females) aged 10–17 years were recruited for the study. Anthropometric measurements included height, weight, mid-upper arm circumference, and triceps and calf skinfolds. Quality of diet and nutritional habits (number of meals per day and frequency of consuming particular foods) were studied using a 24-h dietary recall and food frequency questionnaires. Results: The mean age of the children was 14.8 years. Approximately 74.7% of them had at most primary education. The majority (65%) of the children lived on their own and the major economic activity engaged by them was hawking, and the average earnings per day were approximately US$1.00. The mean caloric intake of respondents was 1395 ± 483.63 kcal. Mean intake of vitamin A and iron among the children was 1054.63 ± 1222.84 retinol equivalent and 18.16 ± 10.28mg/day, respectively. Mean calcium intake was 424.57 ± 200.29mg/day. Children who were stunted formed 17.7% of respondents, 92.7% of them had normal range of body mass index (BMI), and 5.3% were underweight. Generally, BMI was higher in females compared to that in males. Conclusion: On the basis of findings, it could be concluded that street children were not adequately nourished and were highly susceptible to micronutrient deficiencies, stunting, and underweight. This calls for immediate action to put measures in place to combat this public health concern.
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Metabolic syndrome and its associated factors among apparently “healthy” adults residing in rural settlements in Dutse, Northwestern Nigeria: A community-based study p. 95
Salisu B Muazu, Rifkatu Mshelia, Hauwa Bako, Mohammad B Ahmad, Tasiu Mohammed, Innocent O Okpe, Adamu G Bakari
DOI:10.4103/jhrr.jhrr_37_19  
Background: Metabolic syndrome (MS) is a cluster of the most dangerous risk factors for heart attack, is associated with unhealthy lifestyle practices brought about by modernization of societies, and is thought to be uncommon in developing nations, especially in rural setting, hence we intend to document its prevalence and associated factors. Materials and Methods: A cross-sectional community-based study involved 362 apparently healthy consenting adults, aged 18–72 years (males, 197 and females, 165) who met the inclusion criteria. Structured questionnaire was used to generate data and physicals were carried out, including anthropometry using the World Health Organization Stepwise protocol. Fasting blood sample was taken for determination of serum lipid profiles and glucose. International Diabetes Federation ethnic-specific criteria for the diagnosis of MS were used. The Statistical Package for the Social Sciences (SPSS) (version 23) software was used for the analysis with P < 0.05. Results: The mean age was 30.2 (9.4) years. A prevalence of MS was found to be 8.8%. Female/male ratio was 15.1%:3.6%, P = 0.003, 40–49 years age group (37.5%) was the most common age group, and 19.8% of all subjects were overweight. The most common recurring components in the diagnosis of MS were reduced high-density lipoprotein cholesterol (HDL-C) (87.5%), raised fasting blood glucose (56.3%), and high systolic blood pressure (46.9%). Regression analysis revealed that being diabetic/hypertensive, family history of hypertension/diabetes mellitus, total cholesterol, and increasing age were found to be associated with MS. Conclusion: The prevalence of MS in this community was 8.8%, more common in females and 40–49 years age group, and was largely determined by the contribution of low levels of HDL-C but not hypertriglyceridemia. Independent predictors of MS were found to be family history of hypertension, raised total cholesterol, and increasing age.
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An evaluation of the errors occurring in pathology and microbiology laboratories of a tertiary care teaching hospital and their root cause analyses p. 102
Asitava Deb Roy, Dipmala Das
DOI:10.4103/jhrr.jhrr_38_19  
Background: Clinical laboratory testing is an important part of health-care services. Medical laboratories play a pivotal role in the health-care system and the decision-making of clinical doctors about their patients. In the era of consumer protection, everyone is aware of and tries to ensure quality health-care services to all. However, medical errors may sometimes cause undesirable consequences to patients. Therefore, it is important to know the types of errors occurring in laboratories in order to formulate strategies to prevent these. Although literature reporting errors in biochemistry laboratory is available, the literature pertaining to pathology and microbiology laboratories is very limited. Aims: This was a cross-sectional study done in pathology and microbiology laboratories of a tertiary care teaching hospital. Our study aimed to find different errors in these departments and also perform root cause analyses of these errors. Materials and Methods: The study was conducted for a period of 3 months. All the requisition forms, specimens, entered reports, and certified reports were scrutinized, and any error observed as per predefined categories was recorded. Errors that were noticed by laboratory personnel, laboratory doctors, clinicians, and nurses in the wards were included in this study. Each error was documented, and root cause analysis of the same was also done. Data were compiled on Microsoft excel worksheets (Microsoft Office Excel 2007, Redwoods, WA, USA) analyzed with GraphPad Prism 5 (GraphPad Software Inc., CA, USA). Chi-square test was applied to compare categorical data. Results: Among a total of 21,746 tests, a number of errors recorded were 304 (1.4%). The most common errors observed were preanalytical (64.5%), followed by postanalytical (18.1%) and analytical (17.4%). Conclusion: An error detection program must be in place, and it has to be acknowledged in order to ensure patients’ safety. Adequate measures must be adopted to reduce errors in laboratory.
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Screening for obesity and undiscovered glucose intolerance among employees of a tertiary health center in northeast Nigeria p. 107
Yakubu Lawal, Sanusi Muhammad, Umar F Dahuwa, Ibrahim Bichi, Hayatu Ahmed
DOI:10.4103/jhrr.jhrr_44_19  
Background: The prevalence of type 2 diabetes is increasing worldwide, and according to the International Diabetes Federation, one in every two i.e. 212 million people with diabetes is undiagnosed. This screening exercise was carried out during the World Diabetes Day celebration in line with global efforts toward early detection of persons with glucose intolerance. Aim: The aim of this study was to determine the prevalence of obesity and undiscovered glucose intolerance among the hospital employees and to assess the relationship among blood glucose level, some obesity indices, and blood pressure. No such study was ever carried out in this hospital and it afforded the employees the opportunity to get enlightened about the menace of obesity and diabetes. Materials and Methods: The screening exercise was approved by the hospital management after due ethical consideration. Consent was obtained from each participant and then some anthropometric indices and 2-h postprandial plasma glucose level were measured. Data were entered into Microsoft Excel, and then analyzed using IBM Statistical Package for the Social Sciences (SPSS) software, version 23. Results: The prevalence of obesity by body mass index, waist circumference, and waist-height ratio criteria was 17.4%, 33.7%, and 55.8%, respectively, and was more common among females. The prevalence of previously undiagnosed glucose intolerance was 12.7% (impaired glucose tolerance [IGT], 11.5% and diabetes mellitus, 1.2%) and the proportion among females and males was 12.5% and 11.9%, respectively. Conclusion: Though the prevalence of undiscovered diabetes was low, the prevalence of obesity and IGT was high, suggesting a population in transition from low prevalence to high prevalence of diabetes. In addition, obesity and glucose intolerance were more common among female compared to those among male participants.
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Pediatric Laryngeal Papillomatosis: Experiences at an Indian Teaching Hospital p. 114
Santosh K Swain, Ishwar C Behera, Loknath Sahoo
DOI:10.4103/jhrr.jhrr_45_19  
Background and Aims: Laryngeal papillomatosis is an uncommon disease in pediatric age caused by the human papilloma virus, which presents as warty, exophytic growths in the larynx. Children having laryngeal papillomatosis frequently present with dysphonia. It can lead to severe airway obstruction and voice change. The aim of this study was to assess the detailed clinical presentations, treatment options, and outcome of the laryngeal papillomatosis in pediatric patients. Materials and Methods: This was a prospective study carried out among pediatric age group (n = 21) and among those who underwent surgical treatment with different modalities such as coblation, microdebrider, and laser on diagnosed cases of laryngeal papillomatosis during December 2015 to March 2019. Clinical presentations and detailed patient profile including maternal aspects were documented. Details of previous surgeries conducted on the child’s larynx were also recorded. Results: Dysphonia is the most common clinical presentation. Of 21 children, 12 were boys and 9 were girls. The mean age was 11.52 years. No child with a history of immunodeficiency or exposure to smoking was reported. Of 21 children, 9 had a history of previous surgeries for laryngeal papillomatosis. There were five primiparous mothers in this study and they are considered as as risk factors. One child underwent tracheostomy due to compromised airway by laryngeal papillomatosis. Coblation and microdebrider are common and effective techniques performed among children with laryngeal papillomatosis. Conclusion: Coblation and microdebrider were found to be safe and cost-effective than laser and coblation. Only maternal risk factor in this study was primiparous mother. Children with laryngeal papillomatosis were associated with multiple surgeries in the past due to recurrence and aggressive nature of the disease. Very young children and patients with tracheostomy needed strict follow-up in case of severe diseases.
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A retrospective observational study to compare the safety of fondaparinux versus enoxaparin among patients who underwent hemiarthroplasty p. 122
Sangeetha Gopinath, Anoop S Pillai
DOI:10.4103/jhrr.jhrr_50_19  
Background: Major orthopedic surgeries carry a high risk of venous thromboembolism. Enoxaparin has been in use for this indication for a long time. Fondaparinux, a relatively new anticoagulant, has also shown favorable results. Till date, there are limited studies comparing the safety of fondaparinux with enoxaparin in Indian patients undergoing major orthopedic surgery. Aim: The aim of this study was to compare the safety of fondaparinux with enoxaparin in the real-life setting. Materials and Methods: Patients who underwent hemiarthroplasty between January 2016 and December 2017, and who were administered fondaparinux or enoxaparin were retrospectively analyzed using patient case files, discharge database, and blood bank database. The safety was assessed based on the requirement of blood transfusion, need for reexploration, wound complications, any occurrence of bleeding, and death from all causes. Pearson’s chi-square test was used using the Statistical Package for the Social Sciences (SPSS) software (IBM, India), version 16. Results: The safety profile of fondaparinux was comparable with enoxaparin with regard to occurrence of bleeding, transfusion requirements, wound complications, and need for reexploration. A higher proportion of patients on fondaparinux had to be given blood transfusion, though this difference was not statistically significant (P = 0.120). Conclusion: In patients who underwent hemiarthroplasty, safety of fondaparinux was comparable to enoxaparin in actual clinical experience.
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REVIEW ARTICLE Top

Health financing mechanisms and extension of health coverage to the poor and vulnerable groups: What options are available in the Nigerian context? p. 126
Godpower C Michael, Ibrahim Aliyu, Bukar A Grema
DOI:10.4103/jhrr.jhrr_43_19  
Background: Prepayment health-care financing mechanisms are recommended for achieving universal health coverage (UHC) as it prevents catastrophic health-care expenditure and poverty. This preference is due to the inadequacies of the out-of-pocket model in many low- and middle-income countries such as Nigeria. However, it took Nigeria several decades to operationalize the national health insurance scheme in 2005. This review aimed at highlighting various health-care financing options and their suitability for providing health care to all (including the poor and vulnerable groups). Materials and Methods: Data for this review were obtained from searching Google Scholar, MEDLINE (via PubMed), and African Journal Online, using relevant terms (in English language) that addressed health-care financing options and their suitability for UHC (including the poor and vulnerable groups) and were published between January 2007 and May 2019. Studies published in other languages were excluded for lack of resources to translate them. Results: Out-of-pocket, general taxation, private, community-based, and social health insurance, and innovative financing were found to have differing attributes. The social health insurance adopted by low- and middle-income countries such as Nigeria appears promising but not without challenges. Conclusion: A mixed model of social health insurance and general taxation is a prospect in extending health coverage to all citizens including the poor and vulnerable groups. Information on health financing options offers stakeholders the opportunity to understand the attributes of these options, an essential in the choice of a suitable mechanism that can deliver UHC.
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