Labetalol versus Hydralazine in the Management of Severe Pre-Eclampsia at Tertiary Hospitals in a Low-Resource Setting: A Randomised Controlled Trial

Objective: Intravenous labetalol and hydralazine are both considered first-line medications for the management of acute-onset, severe hypertension in pregnant and postpartum women. The study compared the efficacy and safety profile of intravenous labetalol and hydralazine in the control hypertension in severe pre-eclampsia. Materials and Methods: One hundred patients who presented with severe pre-eclampsia were randomized into two study groups. The fifty patients in each arm of the study received either intravenous labetalol or intravenous hydralazine for the control of blood pressure. Results: The mean age of the labetalol subjects was 28.6 ± 5.47 years while that of their hydralazine counterparts was 29.12 ± 5.77 years. The majority of respondents in both groups were primigravidae (76% vs. 78%) (P = 0.813). The number of doses of drug needed to significantly lower the mean systolic blood pressure was slightly lower in the labetalol group (2 doses) compared to the hydralazine group (5 doses) (t = 0.803Y, P = 0.977). The incidence of headaches which were the commonest complaints was comparable in both groups 8% and 10% of respondents respectively (P > 0.05). Conclusion: Although both intravenous labetalol and hydralazine are useful in patients with severe pre-eclampsia, the response to labetalol was better with comparable side effects.

Awareness and Practice of Proper Health Seeking Behaviour and Determinant of Self-Medication among Physicians and Nurses in a Tertiary Hospital in Southwest Nigeria

Background: There is generally a lack of good health-seeking practices among health professionals due to a variety of factors, including the intensity of the medical practice itself. Doctors and nurses are perceived to have a good knowledge of ideal health-seeking behaviors and as such, it is important to determine the level of their awareness and estimate whether this knowledge is put into practice. This study, therefore, aimed to determine the level of awareness and practices of proper health-seeking behavior and to identify the factors responsible for self-medication among doctors and nurses in a tertiary hospital in Nigeria. Methodology: A cross-sectional descriptive study was conducted between April and may 2018 among 106 doctors and 164 nurses in a tertiary health facility in Ido-Ekiti, Ekiti State, Southwestern Nigeria. A simple random sampling technique by balloting was performed from the list of doctors and nurses in the hospital to select doctors and nurses that participated in the study. A pretested semi-structured self-administered questionnaire was designed and used to collect data. The data were entered into the computer software and analyzed using SPSS version 20. P ≤ 0.05 was taken as significant. Result: Out of 106 doctors and 164 nurses recruited, only 102 doctors and 143 nurses filled the questionnaire completely and returned for analysis. One hundred and four respondents (42.4%) fall within the ages of 31 - 40 years with a male to female ratio of 1:1.23. Awareness of proper health seeking behavior among both doctors and nurses was high among the two groups with no statistically significant difference between them. Twenty-nine (28.0%) doctors compared with thirty-four (23.8%) nurses go for a regular medical check-up with no statistically significant difference between the two groups (p = 0.411). Out of these, 5 (17.2%) doctors and 7 (23.8%) nurses visit at an interval of less than 6 month (p = 0.736). There is a statistically significant difference in the number of doctors (60.8%) compared with nurses (41.3%) that have consulted a doctor in the last one year (p = 0.003). More than half (51.6%) of this consultation among doctors was over the phone whereas 64.4% of such among nurses were via clinic appointment (p = 0.008). More doctors (90.2%) comply with their treatment prescription from physicians compared with nurses (77.6%) (p = 0.010). More nurses compared with doctors self-medicate when ill [Doctor 61.8% (63), Nurses 78.3% (112)] (p = 0.005) and had also self-medicated in the last one year [Doctor 34.3% (35), Nurses 42.7% (61)] (p = 0.187). Decreasing age, decreasing years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services are factors that significantly increased the likelihood of self-medication among doctors and nurses within the last one year. Conclusion: Awareness of proper health seeking behavior was high but this did not translate into proper health-seeking practices among doctors and nurses. There is apathy for regular medical check-up and self-medication was also high among this group of health workers. Decreasing age and years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services were factors were identified to significantly increase the likelihood of self-medication.

Prevalence, Awareness and Factors Associated with Glaucoma in a Rural Community of Ekiti State, South West Nigeria

Background: Glaucoma, a group of diseases that have optic neuropathy as a common end point, is the leading cause of irreversible blindness worldwide, accounting for 4.5 million blindness, which is about 12% of global blindness. This study aimed to assess the prevalence, awareness and risk factors associated with glaucoma in a rural community of Ekiti State. Methodology: This was a cross-sectional study conducted during a health outreach. All adults present during the outreach were enrolled into the study and screened for glaucoma and a semi-structured self-administered questionnaire was used for data collection. The validity of the questionnaire was tested at Ijero-Ekiti community before being used for this research. Data obtained was analysed using SPSS version 20 and p-value was predetermined at ≤ 0.05. Results: Majority of respondents were aged 60 years and above with a mean age of 55 ± 11.7. Majority (73%) were females and 41% had secondary education. Prevalence of glaucoma was 10.7%;36% of respondents had heard about glaucoma;and 43.2% of those that had heard were not aware that it can lead to blindness. Increasing age, level of education, procurement of glasses from friends/relatives/roadside, using eyes drop not prescribed, history of previous eyes injury and family history of glaucoma were factors identified as having significant relationship with glaucoma. Conclusion: Glaucoma is prevalent in the community (10.7%). However, level of awareness about the disease (36%) was low. Factors, such as age, level of education, procurement of glasses from quacks, use of eye drops not prescribed, previous injury to the eyes and family history of glaucoma, were shown to have significant relationship with glaucoma. There is need to increase community awareness on glaucoma as a major cause of blindness and the risk factors associated with it. Community screening for people above 40 years for glaucoma is also recommended.

Maternal Serum Lipids in Pre-Eclamptic and Normotensive Pregnant Women: A Case-Control Study

Background: Preeclampsia-eclampsia is a major contributor to maternal and fetal, morbidity and mortality especially in low to middle income countries. This hypertensive disorder of pregnancy remains a disease of theories due to its unclear etiology. We evaluated for possible associations between maternal serum lipids and preeclampsia. Methods: This was a prospective case-control study that recruited 60 consenting women diagnosed with preeclampsia (cases) and 60 normotensive healthy pregnant women (controls), matched for maternal age and gestational age over an 8-month period (18th June, 2014 to 18th February, 2015) at the Federal Teaching Hospital Ido-Ekiti, Nigeria. Cases and controls were recruited using the non-probability convenience sampling. Fasting venous blood samples were collected in both cases and controls and analyzed for serum total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL) and low density lipoproteins (LDL) using Randox standard enzymatic methods. Data obtained were analyzed using SPSS version 18 to compare and test for significance using Student t-test, Chi-square, and Pearson’s correlation as the appropriate. Tests of association were determined using logistic regression models. The difference was considered significant at P < 0.05. Findings: The mean serum levels of TC, HDL and LDL were significantly (p < 0.001) higher in the pre-eclamptics (6.6 ± 2.9 mmol/L, 2.1 ± 1.0 mmol/L and 3.6 ± 2.6 mmol/L) than in normotensive women (4.5 ± 1.3 mmol/L, 1.5 ± 0.9 mmol/L and 2.2 ± 1.2 mmol/L) respectively. Mean serum level of triglycerides was increased in the pre-eclamptics (2.0 ± 1.0 mmol/L) compared to the controls (1.8 ± 0.6 mmo/L) (p = 0.089). Serum TC, TG and LDL were similar in women with mild preeclampsia when compared with women with severe preeclampsia. Correlation between maternal systolic and diastolic blood pressures and the serum lipids was not significant. Adjusted multivariate logistic regression analysis revealed that total cholesterol (OR = 4.363, 95% CI = 1.410 - 13.506, p = 0.011) and high density lipoproteins (OR = 3.247, 95% CI = 1.086 - 9.709, p = 0.035) are significant independent risk factors for preeclampsia. Conclusion: Elevated maternal serum lipids are associated with preeclampsia, however, the widespread lack of uniformity in the patterns of dyslipidemias in pre-eclamptics, across different populations, may suggest that serum lipids will not be a reliable predictor or severity marker of preeclampsia.