We studied pre-hospital practices of 72 consecutive snake bite victims at a hospital in north-central Nigeria. The primary outcome assessed was death or disability at hospital discharge. Victims were predominantly male farmers, and in 54 cases (75%) the snake was identified as a carpet viper (Echis ocellatus), with the remainder unidentified. Most subjects (58, 81%) attempted at least one first aid measure after the bite, including tourniquet application (53, 74%), application (15, 21%) or ingestion (10, 14%) of traditional concoctions, bite site incision (8, 11%), black stone application (4, 5.6%), and suction (3, 4.2%). The majority (44, 61%) presented late (after 4 hours). Most (53, 74%) had full recovery at hospital discharge. Three deaths (4.2%) and thirteen (18%) disabilities (mainly tissue necrosis) occurred. The use of any first aid was associated with a longer hospital stay than no use (4.6 ± 2.0 days versus 3.6 ± 2.7 days, respectively, P = 0.02). The antivenom requirement was greater in subjects who had used a tourniquet (P = 0.03) and in those who presented late (P = 0.02). Topical application (Odds Ratio 15, 95% CI 1.4-708) or ingestion of traditional concoctions (OR 20, 95% CI 1.4-963) were associated with increased risk of death or disability. Ingestion and application of concoctions were associated with a longer time interval before presentation, a higher cost of hospitalization, and an increased risk of wound infection.

Snakebite envenoming causes considerable morbidity and mortality in northern Nigeria. The clinician’s knowledge of snakebite impacts outcome. We assessed clinicians’ knowledge of snakebite envenoming to highlight knowledge and practice gaps for possible intervention to improve snakebite outcomes. This was a cross-sectional multicentre study of 374 doctors selected from the accident and emergency, internal medicine, family medicine/general outpatient, paediatrics and surgery departments of nine tertiary hospitals in northern Nigeria using a multistage sampling technique. A self-administered questionnaire was used to assess their sociodemographics, knowledge of common venomous snakes, snakebite first aid, snake antivenom treatment and prevention. The respondents’ mean age was 35.6±5.8 y. They were predominantly males (70.6%) from urban hospitals (71.9%), from the northwest region (35.3%), in family medicine/general outpatient departments (33.4%), of <10 years working experience (66.3%) and had previous experience in snakebite management (78.3%). Although their mean overall knowledge score was 70.2±12.6%, only 52.9% had an adequate overall knowledge score. Most had adequate knowledge of snakebite clinical features (62.3%), first aid (75.7%) and preventive measures (97.1%), but only 50.8% and 25.1% had adequate knowledge of snake species that caused most injuries/deaths and anti–snake venom treatment, respectively. Overall knowledge predictors were ≥10 y working experience (odd ratio [OR] 1.72 [95% confidence interval {CI} 1.07 to 2.76]), urban hospital setting (OR 0.58 [95% CI 0.35 to 0.96]), surgery department (OR 0.44 [95% CI 0.24 to 0.81]), northwest/north-central region (OR 2.36 [95% CI 1.46 to 3.82]) and previous experience in snakebite management (OR 2.55 [95% CI 1.49 to 4.36]). Overall knowledge was low. Improvements in overall knowledge may require clinicians’ exposure to snakebite management and training of accident and emergency clinicians in the region.

Snakebite envenoming (SBE) is a common neglected tropical disease in rural communities of Asia, Africa and Latin America. Among the several challenges besetting the control of SBE is inadequate access to high-quality care by snakebite victims, partly contributed by inadequate knowledge of SBE among healthcare professionals (HCPs). This narrative review examined the existing literature on the knowledge of snakebites among HCPs, the factors associated with their knowledge of snakebites and their training needs. Data on the knowledge of healthcare professionals regarding snakebites appeared scanty and were predominantly from studies done in Asia, Africa, and the Middle East. We found that the proportion of health workers with adequate knowledge of local medically important snakes could be as low as 20.2% in some settings in India, while as much as three-quarters of health workers still recommend tourniquets and Blackstone as first aid in some settings in India and Rwanda, respectively. In addition, the mean knowledge score of local snake-induced clinical syndromes could be as low as 46.2% in some settings in Ghana, while 52.7% of tertiary hospital doctors in northern Nigeria recommend antivenom in all snakebite cases. Similarly, 23% of Bhutan health workers have adequate overall knowledge of snakebite management. Furthermore, several sociodemographic characteristics of the HCPs (such as increasing age, years of experience, work setting, medical specialty, health profession and previous involvement in snakebite management) are associated with adequate snakebite knowledge. Moreover, most studies have consistently reported a lack of training on snakebites as a challenge. Therefore, the knowledge gaps identified could be incorporated into training programs and regional policies on SBE treatment protocols.

Background: Sleep is a necessity; it is nourishing, refreshing and healing. The nursing profession is associated with busy and difficult work schedules, especially the running of shifts which has been associated with cardiovascular and metabolic complications. There is a dearth of local data on sleep disorders, especially among nurses. In this study, we evaluated the quality of sleep and the tendency of daytime sleepiness among nurses. Subjects and Methods: This study was cross-sectional in nature involving 100 nurses working with Federal Medical Centre Birnin Kebbi, Kebbi State; the study was carried out between October 2016 and February 2017. The Pittsburg Sleep Quality Index was used to determine poor sleepers; while the Epworth Sleepiness Scale (ESS) was adopted to determine the presence of tendency of daytime sleepiness; 0–7 was considered normal, 8–9 represented average tendency of daytime sleepiness, 10–15 represented excessive daytime sleepiness, while 16–24 represented daytime sleepiness requiring medical intervention. P < 0.05 was set as statistically significant. Results: There were 23 (23%) males and 77 (77%) females, with a male-to-female ratio of 0.3:1. The age range was 18–50 years, with a mean age of 31.4 ± 8.6 years. The ESS score ranged from 0.0–17.0, with a mean score of 7.3 ± 3.5; while the Pittsburg score ranged between 1 and 15, with a mean score of 5.7 ± 2.7, and 61% of the nurses had a poor sleep quality. There was unlikely tendency of excessive sleepiness across all the age groups, though this was not statistically significant (χ² = 7.258, P = 0.283), and poor sleep quality was most prevalent among the 25–40-year-old group but this observation was also not statistically significant (χ² = 2.259, df = 2, P = 0.334). Conclusion: Poor sleep quality is a problem among nurses, though less tendency to daytime sleepiness was observed in this report.

Background: Snakebite envenoming is a neglected tropical disease that accounts for preventable morbidity and mortality, especially in resource-limited settings. ?This review aimed at examining the snake and human behaviors that facilitate snake-human encounters and highlighting the primary preventive measures for snakebite and the resultant envenoming. Materials and Methods: Google Scholar, Medline?(via PubMed), and African Journal Online were searched from January 1959 to April 2019 for peer-reviewed studies addressing primary prevention of snakebite. We extended our search to grey literature from conference proceedings, documents from organizations, book chapters, and thesis. Results: We found few studies in medical literature on community knowledge of the intrinsic characteristics of snakes (e.g., its unique venom apparatus for nutrition, defense and competition, and its habitat and activities); however, there is appreciable amount of studies on human activities associated with snakebite envenoming. Deservedly, more studies appear to focus on snakebite management?(secondary and tertiary prevention) with inadequate emphasis on primary prevention of snakebite?(which may be the only intervention in some resource-limited settings). Conclusion: Synergy of efforts toward improving community knowledge of human behaviors associated with snakebite and snake behaviors may generate appropriate environmental and behavioral responses to curtail human-snake encounters. Hence, intensive promotion of primary prevention may be a useful approach toward reducing snakebite burden in resource-limited settings.

Background Depression is a common psychological disorder in women with infertility, which causes significant morbidity and mortality. Little attention is currently given to depression by health care providers who manage infertility, and there is a scarcity of studies on depression among women with infertility in northern Nigeria. Objective This study aimed at assessing the association between family functionality, sociodemographic factors, and depression severity in women with infertility attending a gynecology clinic in northwest Nigeria. Methods This was a cross-sectional study involving 415 females systematically selected from women with infertility attending a gynecology clinic in a Nigerian hospital. They were interviewed using Beck's Depression Inventory and Family APGAR (Adaptability, Partnership, Growth, Affection, Resolve) questionnaires over 12 weeks. Data regarding participants' sociodemographic and infertility characteristics were also collected. The association between categorical variables was assessed using the chi-square or Fisher's exact test. The determinants of depression severity were assessed using logistic regression analysis. A p-value of < 0.05 was considered significant. Results The mean age of respondents was 30.9 ± 6.6 years; the prevalence of depression was 44.6% (32.5% were of mild severity). Most families (73.5%) were highly functional. Association between family functionality and depression severity was not statistically significant (chi-square =5.143, p = 0.259). Respondents' religion (chi-square = 10.813, p = 0.029), education (chi-square = 36.835, p = 0.001), and monthly income (chi-square = 9.261, p = 0.010) were associated with depression severity. Being a Muslim (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.8–5.6, p = 0.001) and having formal education (OR = 10.2, 95% CI = 4.7–16.5, p = 0.001) were determinants of depression severity. Conclusion The prevalence of depression was high among the respondents. Although no association was found between family functionality and depression severity, respondents who are Muslims or had formal education were at increased risk of depression. Therefore, a high index of suspicion for depression and holistic care is required to manage women with infertility.