University of Ilorin Teaching Hospital

Background: Antibiotics are vital in the prevention and treatment of bacterial infections. However, prescribing practices often deviate from established guidelines with prolonged durations of surgical prophylaxis, redundant antibiotic combinations, and a significant reliance on broad-spectrum agents. This study seeks to determine the antibiotic prescribing practices in our teaching hospital. Methods This was a prospective, descriptive cross-sectional study of adult patients admitted into the ICU of the University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria. The study participants were critically ill patients between the ages of 6 months - 65 years who were admitted into the ICU. With the aid of a questionnaire, information such as age, sex, diagnosis, antibiotic prescription and regularity of administration, use of microbiological investigations and outcome of ICU care were extracted from the patients’ hospital files and recorded. Data from this study were summarized expressed as means, standard deviation, frequencies or proportions of the total. A p-value of less than 0.05 was considered statistically significant. Results A total of 128 ICU patients were enrolled into the study. One hundred and twenty four (96.88%) patients were prescribed antibiotics. Antibiotic prescription was for prophylactic reasons in 56 (45.16%) patients and therapeutic reasons in 68 (54.84%) patients. All antibiotic prescriptions were empirical. The most frequently prescribed antibiotic was ceftriaxone. The most frequently prescribed combination of antibiotics was Ceftriaxone/Metronidazole. There was no statistically significant difference in gender (0.7651) and age (p = 0.0775) between those who survived to ICU discharge and those who died. Prophylactic antibiotic prescription was associated with survival to ICU discharge compared to therapeutic prescription (p = 0.0018). Conclusion Ceftriaxone was the primary empirical ICU antibiotic therapy employed while metronidazole is strategically used for anaerobic coverage. Critical care physicians favoured empirical therapy to the detriment of targeted therapy in this study.

As a neurosurgeon practicing within the walls of a busy Nigerian tertiary hospital, I am witnessing a quiet but devastating shift in our nation’s epidemiological landscape. Where our wards were once dominated by trauma and infectious pathologies, we are now seeing an unprecedented surge in the incidence of brain tumors. This is no longer a peripheral concern; it is a burgeoning public health crisis that demands immediate attention from the global medical community and national stakeholders.

Approximately half of Nigerian women with non-metastatic breast cancer undergo surgery, yet psychosocial factors influencing mastectomy receipt are poorly understood. This study aimed to understand barriers, facilitators, and patient attitudes toward mastectomy for breast cancer in Nigeria. Using a prospective, convergent mixed-methods study design, we disseminated a structured questionnaire (N=225) and conducted in-depth interviews (N=18) among women with non-metastatic breast cancer recommended for mastectomy at 3 academic Nigerian institutions. Logistic regression identified factors associated with mastectomy within 1year of diagnosis; interviews were analyzed using the framework method. Qualitative and quantitative themes were triangulated using a joint display. Median age was 48years (IQR 40,57); median tumor size was 6.6cm (IQR 4.4,10.1). One hundred patients (44%) underwent mastectomy, 97 within 1 year of diagnosis. Nineteen percent (n=42/224) had not heard of breast cancer before diagnosis; 37% (n=82/223) had not heard of mastectomy. Interview participants expressed negative emotions toward mastectomy. Of those who did not receive surgery, the most common reasons were cost (n=41/125, 33%), loss to follow-up (n=20/125, 16%), traditional medicine (n=13/125, 10%), death (n=12/125, 9.6%), and disease progression (n=9/125, 7.2%). In multivariable analysis, awareness of mastectomy (OR 4.10, 95% CI 1.64,10.7, p-value=0.003) was significantly associated with surgery receipt within 1year. This study identified patient factors related to mastectomy receipt, including education and awareness, financial burden, fear of surgery, anticipated body image changes, and concern about adverse social impacts. Public health education about breast cancer surgery, pre-mastectomy counseling/peer-support, and financial may facilitate mastectomy receipt.

Psychiatric morbidity among military personnel poses significant challenges to individual well-being, operational effectiveness, and force sustainability. Although combat exposure has been widely linked to adverse mental health outcomes in high-income countries, evidence from sub-Saharan Africa remains limited. In Nigeria, prolonged counter-insurgency and internal security operations expose Army personnel to diverse psychological stressors. Yet, little is known about how socio-demographic and occupational factors are differentially associated with psychiatric morbidity among combatant and non-combatant roles. A comparative cross-sectional study was conducted among 297 Nigerian Army personnel stationed at Sobi Cantonment, Ilorin, comprising 149 combatants and 148 non-combatants. Psychiatric morbidity was screened using the 12-item General Health Questionnaire (GHQ-12) and confirmed with the Mini International Neuropsychiatric Interview-Plus (M.I.N.I.-PLUS). Socio-demographic and occupational variables were collected using a structured pro forma. Data were analysed using descriptive statistics, chi-square tests, and multivariate logistic regression to identify factors independently associated with psychiatric morbidity within combatant and non-combatant groups, as well as in the combined sample. Overall prevalence of psychiatric morbidity was significantly higher among combatants (55.0%) compared to non-combatants (22.3%) (χ2 = 12.73, p < 0.01). The overall prevalence of psychiatric morbidity in the sample was 38.7%. In combatants, predictors included age < 30 years (AOR 2.14, 95% CI 1.12–4.08), unmarried status (AOR 1.96, 95% CI 1.04–3.71), living in barracks (AOR 2.27, 95% CI 1.18–4.36), and prior deployment (AOR 2.87, 95% CI 1.51–5.44). In non-combatants, lower educational attainment (secondary or less) predicted psychiatric morbidity (AOR 2.01, 95% CI 1.05–3.85). Across the entire sample, combatant role independently predicted psychiatric morbidity (AOR 3.21, 95% CI 1.85–5.58). Psychiatric morbidity is common among Nigerian Army personnel and is differentially associated with socio-demographic and occupational factors across combatant and non-combatant roles. Combat exposure, combined with younger age, limited social support, and barracks residence, appears to heighten vulnerability among combatants, while lower educational attainment may increase risk among non-combatants. These findings underscore the need for role-specific, culturally informed mental health screening, prevention, and intervention strategies within the Nigerian Army.

Dyslipidaemia is common in type 2 diabetes mellitus (T2DM) and contributes substantially to cardiovascular risk. Circulating proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates LDL receptor turnover, yet its relationship to the lipid phenotype in T2DM remains uncertain. To compare lipid fractions and PCSK9 concentrations between matched individuals with and without T2DM and to determine whether PCSK9 is independently associated with dyslipidaemia. A total of 100 age- and sex-matched pairs were enrolled. After excluding pairs with incomplete or compromised lipid or PCSK9 measurements, 92 pairs were retained for the primary analysis. Missingness was primarily due to inadequate sample volume and hemolyzed specimens. Fasting total cholesterol (TC), HDL-C, LDL-C, and triglycerides (TG) were measured in mmol/L, and serum PCSK9 was quantified in native assay units. Primary analyses used within-pair differences (paired t and Wilcoxon tests) and linear mixed-effects models (outcome ~ group + (1|pair_id)). Logistic regression evaluated associations of PCSK9 and diabetes status with dyslipidaemia, defined as LDL-C ≥ 3.37 mmol/L, HDL-C < 1.03 mmol/L, or TG ≥ 1.70 mmol/L. Multiple testing was controlled by the Benjamini-Hochberg false-discovery rate and Bonferroni correction. Compared with controls, participants with T2DM had significantly higher lipid fractions but similar PCSK9 concentrations. Mean paired differences (T2DM - Control [95% CI]) were: TC + 0.91 mmol/L (0.46 to 1.37), HDL-C + 1.11 mmol/L (0.90 to 1.32), LDL-C + 2.12 mmol/L (1.78 to 2.46), and TG + 0.59 mmol/L (0.50 to 0.68) (all p < 0.001); PCSK9 - 0.58 (-1.57 to 0.41, p = 0.25). In mixed-effects models, group effects remained significant for all lipid fractions but not for PCSK9. In logistic regression, PCSK9 was not associated with dyslipidaemia (OR 0.99, 95% CI 0.91-1.08, p = 0.81; AUC 0.51). Among matched adults with and without T2DM, serum PCSK9 showed no independent association with dyslipidaemia despite significant elevations in TC, LDL-C, HDL-C, and TG in the diabetic group. Interpretation is limited by the lack of HbA1c and lipid-modifying medication data and by single-time sampling. These findings suggest that PCSK9 alone may have limited utility for classifying dyslipidaemia in T2DM without adjustment for metabolic and therapeutic covariates. Not applicable.

Importance: Multimorbidity, the coexistence of multiple long-term conditions, is a growing public health challenge in South Africa. Understanding the patterns of multimorbidity and their socioeconomic determinants is crucial for developing prevention and control solutions. Objective: To identify and characterize multimorbidity clusters and their socioeconomic determinants in the South African population using data from the Demographic and Health Survey (DHS). Design, Setting, and Participants: This cross-sectional study used data from the recent South Africa DHS, a nationally representative household survey. The study included 5,342 individuals aged 18 years and above who participated in the adult health module of the survey. Data were collected through interviews and biomarker measurements between June and November 2016. Main Outcome and Measures: The primary outcome was multimorbidity, defined as the presence of two or more chronic conditions. Twelve chronic conditions were considered: tuberculosis, hypertension, stroke, high blood cholesterol, anaemia, chronic bronchitis, diabetes, asthma, cancer, heart disease, HIV, and chronic pain. Socioeconomic determinants included wealth index, education level, occupation, health insurance, marital status, age, sex, ethnicity, and media access. Results: Of the 5,342 participants, 2,382 (44.6%) had multimorbidity. Four distinct multimorbidity clusters were identified: "Low Morbidity Group" (low prevalence of chronic conditions), "Cardiometabolic Cluster" (high prevalence of hypertension and diabetes), "Chronic Infectious Disease Cluster" (high prevalence of tuberculosis and HIV), and "Complex Chronic Disease Cluster" (high prevalence of multiple chronic conditions, including cancer, stroke, and heart attack). Multinomial logistic regression analysis revealed socioeconomic disparities in multimorbidity patterns, with lower levels of education, unemployment, and poverty associated with membership in the clusters characterized by a higher burden of chronic diseases. Conclusions and Relevance: This study identified four distinct multimorbidity clusters in the South African population, each characterized by unique patterns of chronic disease co-occurrence and socioeconomic determinants. The findings highlight the need for tailored interventions and policies that address the specific needs of each multimorbidity cluster while also tackling the underlying social and economic determinants of health.

Abstract Importance Multimorbidity, the coexistence of multiple chronic conditions, is a growing public health challenge, particularly in low- and middle-income countries like South Africa. Identifying individuals at high risk of multimorbidity is crucial for developing targeted interventions and allocating healthcare resources effectively. Objective To investigate the predictive performance of various machine learning models in identifying individuals at risk of multimorbidity in South Africa and to identify the most influential predictors of multimorbidity, considering both individual-level and contextual factors. Design, Setting, and Participants This cross-sectional study utilized data from the South Africa Demographic and Health Survey (SADHS) 2016, a nationally representative household survey. The study included 5,342 participants aged 18 years and older, of which 2,107 (33.9%) had multimorbidity, defined as the presence of two or more chronic conditions. Main Outcomes and Measures The primary outcome was the presence of multimorbidity. Machine learning models, including gradient boosting classifier, linear discriminant analysis, ada boost classifier, logistic regression, ridge classifier, catboost classifier, random forest classifier, light gradient boosting machine, extra trees classifier, naive bayes, quadratic discriminant analysis, extreme gradient boosting, k neighbors classifier, dummy classifier, decision tree classifier, svm - linear kernel, were developed and evaluated using a repeated train-test split approach. Model performance was assessed using accuracy, area under the receiver operating characteristic curve (AUC), recall, precision, F1 score, Cohen’s Kappa, and Matthews Correlation Coefficient (MCC). Shapley Additive Explanations (SHAP) were used to identify the most influential predictors of multimorbidity. Results The Gradient Boosting Classifier achieved the highest predictive performance, with an AUC of 0.7809, accuracy of 0.7478, and F1 score of 0.5798. Age, no medication use, sex, poor health perception, and community illiteracy rate were identified as the most influential predictors of multimorbidity. Individual-level factors had a more substantial impact on the likelihood of multimorbidity compared to community-level factors. However, higher community illiteracy rates and regional unemployment rates were associated with an increased likelihood of multimorbidity, highlighting the importance of contextual factors. The fairness and demographic bias assessment revealed that the Gradient Boosting Classifier maintained a high level of fairness across different regions, wealth index categories, age groups, and genders. Conclusion and Relevance Machine learning algorithms, particularly the Gradient Boosting Classifier, can accurately predict multimorbidity in the South African context. The findings emphasize the importance of considering both individual-level and contextual factors in understanding the determinants of multimorbidity.

Urinary Schistosomiasis and malaria remain endemic in rural Nigerian communities, contributing significantly to the burden of anaemia among children. Despite control efforts, persistent co-infection and their impact on child health require localized investigation to inform effective interventions. This study investigates the prevalence of urinary schistosomiasis, malaria, their co-infection, and the relationship with anaemia among children aged 5–15 years in Dogo Community, Moro Local Government Area, Kwara State. One hundred children (47 males, 53 females) were randomly selected and screened. Urinary schistosomiasis was diagnosed via urine filtration microscopy detecting Schistosoma haematobium eggs, while malaria was identified through Giemsa-stained thin and thick blood smears targeting Plasmodium falciparum. Haemoglobin concentration was measured to assess anaemia status. Results reveal that 25% of participants tested positive for malaria, with females constituting 68%. Urinary schistosomiasis prevalence was 22%, predominantly among males (68.2%). Co-infection was detected in 5% of children, all males, who exhibited anaemia defined by haemoglobin levels below 11 g/dL. Notably, 37% of uninfected children maintained normal haemoglobin values, whereas the remainder had subnormal levels. Chi-square revealed a significant association between infection status and anaemia at 5% level of significance. These findings indicate that urinary schistosomiasis and malaria are significant contributors to anaemia and remain significant public health problems in the study area, with distinct gender disparities. The burden of co-infection and its link to anaemia underscore the urgent need for integrated control measures through mass drug administration, health education, and improved sanitation, to reduce the prevalence and impact of these diseases.

Background: Death is a common occurrence in nursing practice, and nurses are expected to provide professional and sensitive care to families, which can be psychologically demanding. However, there is a paucity of studies describing the experiences of nurses dealing with pediatric end-of-life (EOL) care and death.Purpose: This study explored nurses’ lived experiences following EOL care among pediatric nurses working in two selected hospitals in Nigeria.Methods: A hermeneutic qualitative design was adopted to describe and interpret participants’ experiences. Twenty-one nurses were purposively selected from pediatric wards. Data were collected through semi-structured, in-depth interviews and analyzed using ATLAS.ti with thematic analysis.Results: Five themes emerged: (1) EOL care training during nursing education, (2) experiences of EOL care as a practicing nurse, (3) perceived contributing factors to child death, (4) nurses’ roles in supporting families after child loss, and (5) coping strategies for managing grief after pediatric patient death. The findings revealed that nurses are affected by the death of a child regardless of years of experience. Limited knowledge of EOL care negatively influenced their coping abilities. Nurses considered open grieving unprofessional, with the primary coping strategy being increased commitment to work.Conclusion: The study concluded that years of work experience do not significantly influence nurses’ lived experiences of pediatric patient death. Limited knowledge of EOL care strongly shapes their perspectives on death, dying, and grieving. Grieving is perceived as unprofessional, while dedication to work serves as the preferred coping mechanism. Mandatory training on EOL nursing care and the provision of institutional guidelines are recommended.