Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study

INTRODUCTION

Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State.

MATERIALS AND METHODS

A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis.

RESULTS

There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM.

CONCLUSION

The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

Clinical and Epidemiological Characteristics of Hospitalized COVID-19 Patients in an Isolation Centre in South-West Nigeria

INTRODUCTION

The clinical presentation of coronavirus disease 2019 (COVID-19) can vary widely, and while the primary infection involves the respiratory system, other organs can also be affected. This study presents the clinical and epidemiological characteristics of hospitalized COVID-19 patients in a tertiary hospital in Ado Ekiti, South-West Nigeria.

MATERIALS AND METHODS

This is a retrospective study involving COVID-19 patients admitted to the isolation ward between August 2020 and January 2021. The data used for this study was obtained from the patient's medical record, which includes demographic characteristics, clinical presentation, baseline co-morbidities, and laboratory investigations.

RESULTS

The average age of the patients was 60.3 years, and more than two-thirds were male. The most common symptoms were fever, shortness of breath, cough, and tiredness. Comorbidities identified among the patients included diabetes mellitus, heart disease, obesity, and chronic kidney disease. The most common radiological findings were bilateral homogeneous patchy opacities and peripheral fluffy infiltrates. The overall mortality rate was 21.9%, with 13 deaths in patients with severe disease. Age and duration of admission were found to be significant predictors of death.

CONCLUSION

The results of this study provide valuable insights into the clinical presentation of COVID-19 in Nigeria and may guide future management strategies for similar infections.

Doctors' and Nurses' Knowledge and Perceived Barriers Regarding Acute Oxygen Therapy in a Tertiary Care Hospital in Nigeria

PURPOSE

Oxygen may cause serious consequences when administered wrongly. This study aimed to assess doctors' and nurses' knowledge of acute oxygen therapy and perceived delivery barriers.

PARTICIPANTS AND METHODS

We conducted a cross sectional study among 202 healthcare providers (134 doctors and 68 nurses) in a Nigerian hospital. The validated Acute Oxygen Therapy Questionnaire (AOTQ), which consisted of 21 knowledge assessment questions, was self administered by participants. Provider's knowledge was classified as good if the score was≥80% and poor if < 60%.

RESULTS

Overall, 26.7% (37.3% doctors and 5.9% nurses) had good knowledge of acute oxygen therapy (AOT), 35.9% were aware, and 19.3% used the AOT guidelines. The commonest source of knowledge on oxygen therapy was medical /nursing school (75.2%). The participants' mean knowledge score was 14.75 ± 2.83(possible score of 0-21). Doctors in postgraduate (PG) training obtained the highest score (15.96±2.48) among the participants (F=12.45, df=4, p<0.001). Most doctors (62%) and 23.5% of nurses considered oxygen as a drug. More doctors (52.2%) than nurses (14.7%) believed that a doctor's order was mandatory before oxygen administration, contrary to guidelines recommendations. Most nurses did not know that breathlessness does not always signify hypoxemia and that asymptomatic anemia was not an indication for oxygen. Concerning oxygen prescription, 39.7% of nurses and 64.2% of doctors knew that it should be prescribed to achieve a target saturation range rather than a fixed dose. In acute oxygen delivery in COPD, doctors and nurses exhibited poor knowledge of the appropriate device and flow rate. The reported barriers to oxygen delivery were: a shortage of oxygen supply, inadequate delivery devices, power outages and out of pocket costs.

CONCLUSION

A significant proportion of doctors and nurses had poor knowledge of acute oxygen therapy, poor awareness and infrequently used AOT guidelines, and reported pertinent delivery barriers that warrant educational and administrative interventions.

Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.

Targeting Apoptosis Signal-Regulating Kinase-1 (ASK-1) As a Biomarker of Monocrotaline-Induced Pulmonary Hypertension following Administration of Antiretroviral Medications in Rat Model

BACKGROUND

Apoptosis resistance is a recognized pathogenetic mechanism in pulmonary hypertension. However, the link between apoptosis signal-regulating kinase-1 (ASK-1) and pulmonary hypertension (PH) is unclear. This study was conducted to elucidate ASK-1 as a potential biomarker in PH. The study aimed to identify the role of ASK-1 in the mechanism of monocrotaline-induced PH in rats.

METHODS

Forty adult male Sprague-Dawley rats (body weight: 200-250 g) were randomly divided into five groups (n=8 per group). The four treatment groups received a single intraperitoneal injection of monocrotaline (MCT) at a dose of 60 mg. kg-1 while the control group received an equivalent volume of intraperitoneal saline injection. Zidovudine (100mg. kg-1), ritonavir (30mg. kg-1), or combination of both drugs (zidovudine 100mg. kg-1 and ritonavir 30mg. kg-1) were administrated daily for the study period of 28 days to the rats in three of the four treatment groups with MCT for 28 days. On the twenty-eighth day of the study, rats were sacrificed, and organ harvested with the heart analyzed using RT-PCR for ASK-1. Antioxidant enzyme activities were determined using the colorimetric method.

RESULTS

Animal survival rate was one hundred percent in the treated and control groups while the untreated group recorded 62% survival rate. There was significantly lower mRNA gene expression of ASK-1 in the heart tissues of the treated rats with zidovudine (2.67 ± 0.09, p < 0.0001), ritonavir (2.57 ±0.11, p < 0.0001) and a combination of both (2.75 ± 0.06, p < 0.0001) when compared to rats in the untreated group. An overexpressed mRNA gene of ASK-1 in the untreated rats was observed (12.0 ± 0.90, p < 0.0001) when compared to the controls.

CONCLUSION

ASK-1 is a veritable biomarker for anti-apoptotic characteristics of PH. Our findings will spur new investigations on the role of ASK-1 in PH and the potential therapeutic benefits of antiretroviral medications in the prevention of PH.

CONTEXTE

La résistance à l’apoptose est une pathogénétique reconnue mécanisme dans l’hypertension pulmonaire. Cependant, le lien entrekinase-1 régulatrice du signal d’apoptose (ASK-1) et pulmonaire l’hypertension (HTP) n’est pas claire. La présente étude a été menée pour :élucider ASK-1 comme biomarqueur potentiel de l’HTP. L’étude visait à :identifier le rôle de l’ASK-1 dans le mécanisme induit par la monocrotalinePH chez le rat.

MÉTHODES

Quarante rats Sprague-Dawley mâles adultes (poids corporel:200 à 250 g) ont été divisés au hasard en cinq groupes (n = 8 par groupe).Les quatre groupes de traitement ont reçu une seule injection intrapéritonéalede monocrotaline (TCM) à une dose de 60 mg. kg–1 pendant que le témoina reçu un volume équivalent d’injection intrapéritonéale de solution saline.Zidovudine (100 mg kg–1), ritonavir (30 mg kg–1) ou combinaison deles deux médicaments (zidovudine 100 mg. Kg–1 et ritonavir 30 mg. kg–1) étaient administré quotidiennement pendant la période d’étude de 28 jours aux rats dans trois des quatre groupes de traitement avec MCT pendant 28 jours. Sur levingt-huitième jour de l’étude, des rats ont été sacrifiés et des organesrécolté avec le cœur analysé à l’aide de rt-PCR pour ASK-1. Les activités enzymatiques antioxydantes ont été déterminées à l’aide de la colorimétrieméthode.

RÉSULTATS

Le taux de survie des animaux était de cent pour cent dans les groupes traités et témoins tandis que le groupe non traité a enregistré 62 %taux de survie. L’expression des gènes de l’ARNm était significativement plus faible d’ASK-1 dans les tissus cardiaques des rats traités par la zidovudine (2.67 ± 0.09, p < 0.0001), ritonavir (2.57 ±0.11, p < 0.0001) et acombinaison des deux (2.75 ± 0.06, p < 0.0001) par rapport aux rats dans le groupe non traité. Un gène d’ARNm surexprimé d’ASK-1 dans les rats non traités ont été observés (12.0 ± 0.90, p < 0.0001) lorsque par rapport aux contrôles.

CONCLUSION

ASK-1 est un véritable biomarqueur antiapoptotique caractéristiques du pH. Nos conclusions donneront lieu à de nouvelles enquêtes sur le rôle de l’ASK-1 dans l’HTP et les avantages thérapeutiques potentiels demédicaments antirétroviraux dans la prévention de l’HTP.

Mots-clés

Hypertension pulmonaire, régulation du signal d’apoptosekinase 1 (ASK-1), zidovudine, ritonavir, VIH/SIDA.

Increased Risk of Migraine among Students with Asthma: Results of Headache and Asthma Study among University Students

BACKGROUND

Several studies in developed countries have investigated the relationship between migraine and asthma.

OBJECTIVE

To examine the relationship between asthma and migraine among university students in a low middle-income country.

METHODS

We conducted a cross-sectional study across three universities in the middle belt region of Nigeria. A self-administered questionnaire developed from the International Classification of Headache Disorders was used to screen for migraine. The European Community Respiratory Health Survey (ECRHS) survey tool screened for asthma and its related conditions. Migraine was diagnosed in subjects with recurrent, moderate to severe unilateral throbbing headaches associated with nausea, vomiting, or visual disturbances. Asthma was defined as reporting a previous asthma attack or currently taking asthma medication within the preceding 12 months.

RESULTS

The frequency of asthma was significantly higher among those with migraine than those without migraine (28.6% vs. 9.0%). Conversely, migraine was significantly prevalent in participants with asthma (7.1%vs. 1.9%). On multivariate analysis, there were significant associations between migraine and asthma [aOR = 2.56 (95% CI 1.15-5.77)]. Other factors associated with migraine were female gender [aOR = 2.22 (95% CI 1.06-4.65)] and family history of recurrent headache in firstdegree relatives [aOR = 4.03 (95% CI 1.15-5.77)].

CONCLUSION

Our study shows an increased frequency and risk of migraine in participants diagnosed with asthma and vice versa. These results support the bidirectional association between migraine and asthma. Physicians, therefore, should be aware of the possibility of migraine in patients with asthma who complain of headaches.

Preparedness and Perception on Virtual Learning during the COVID-19 Pandemic amongst Students of the Ekiti State University, Nigeria

BACKGROUND

The advent of COVID-19 pandemic affected education which necessitated rapid adjustments and reorganizations in the approach to learning. This study examined undergraduate students' perception on the pandemic and its effect on medical education.

METHODS AND MATERIALS

A cross-sectional online questionnaire-based survey of students in the College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria. A google form, free open-source software survey tool, was used to collect data on different domains like socio-demographic characteristics, preparedness and disposition to virtual learning in pandemic, risk perception, and knowledge on COVID-19.

RESULTS

A total of 568 participants took the survey with 311 (54.8%) females and a median age of 20 (IQR: 18-22) years. Four hundred and eighty-two (84.9%) of the students had regular access to the Internet, 57 (10%) have occasional access while 29 (5.1%) had no access. Three hundred and fifteen (56%) of the students agreed that their digital and online skills will be better after the pandemic. All the students were aware of the pandemic however, 441 (77.6%) students were aware of the pandemic through the social media, 79 (13.9%) through television and newspapers and 32(5.6%) through family and friends while only 4 (0.7%) became aware of the pandemic through healthcare workers. The median risk perception score for COVID-19 was 24 (IQR: 19-29).

CONCLUSION

The study participants were ill-disposed to virtual learning recommended during the pandemics and had a low-risk perception of COVID-19. Hence, there is an urgent need for continuous education on the benefits of virtual learning beyond the COVID-19 pandemics and the need to adopt proactive measures in anticipation of future outbreaks of other infectious diseases.

Urban-Rural Differences in the Epidemiology of Asthma and Allergies in Nigeria: A Population-Based Study

Purpose

Urbanization is associated with the risk of developing allergic conditions. Few studies have evaluated the urban-rural disparity of allergic diseases in sub-Saharan Africa.

Objective

To compare the epidemiology of adult asthma and allergies in urban and rural Nigeria.

Subjects and Methods

A population-based cross-sectional study was performed among 910 subjects in Kwara State, North Central Nigeria, comprising 635 urban and 275 rural adults who were randomly selected. We used standardized questionnaires for data collection.

Results

The age-adjusted prevalence of adults reporting a previous "asthma attack" or "currently taking asthma medication" within the preceding 12 months (ECRHS asthma definition) was 3.4% urban, 0.5% rural, current allergic rhinoconjunctivitis (26.2% urban, 22.2% rural), and current skin allergy (13.9% urban, 10.5% rural). The age-adjusted prevalence of "physician-diagnosed allergic conditions": asthma (3.3% urban, 1.5% rural), allergic rhinoconjunctivitis (4.9% urban, 3.2% rural), and skin allergy (4.8% urban, 4.6% rural) were higher in urban areas than in rural areas. Urban areas recorded a higher age-adjusted 12 months prevalence of wheezing, night waking by breathlessness, night waking by chest tightness, asthma attack (p=0.042), and current use of asthma medication (p=0.031) than the rural areas. In the urban areas, 81% of those with asthma significantly had current allergic rhinoconjunctivitis, and 40.5% had current skin allergy, whereas in the rural areas, all subjects with asthma had current allergic rhinoconjunctivitis and 12.5% had current skin allergy (p=0.482). The most common trigger for asthma attack/respiratory symptoms among the urban household was exposure to environmental smoke (17.2%), and among the rural household, it was dust exposure (18.2%). Living in urban areas significantly increased the odds of having asthma [aOR: 5.6 (95% CI:1.6-19.6)] and allergic rhinoconjunctivitis [aOR: 1.7 (95% CI: 1.2-2.4)].

Conclusion

This study shows that urban residents frequently reported more allergic and respiratory symptoms and were at risk of having asthma and allergic rhinitis compared to rural residents. The findings would assist the physicians in understanding the urban-rural differences in the occurrence of allergic conditions, symptom triggers, and comorbidity, which are relevant in patient's clinical evaluation, treatment, and disease prevention.

Family physicians/GP and Internist opinions, familiarity and practice behaviour regarding clinical practice guidelines (CPGs) of common medical conditions in Nigeria

Background:

Few studies exist on physicians' opinions, attitudes, familiarity and practice behaviour regarding clinical practice guidelines in sub-Saharan Africa.

Objectives:

To determine the opinions, familiarity, and practice behaviour regarding clinical practice guidelines (CPGs) and factors associated with their use among internists and family physicians/GP in Nigeria.

Methods:

A semi-structured questionnaire regarding guidelines of five common medical conditions: hypertension, diabetes mellitus, tuberculosis, asthma and hepatitis B encountered in everyday medical practice were self-administered by 183 doctors across the country.

Results:

Over 90% of respondents believed that guidelines were evidence-based, improved management outcomes, and quality of care, nevertheless, 57.4% were against using them in litigations against doctors. The majority (>70%) of the respondents were familiar with the guidelines except that of hepatitis B. Overall, guidelines were used regularly by 45.9%, used in part by 23.5% and 30.6% never used it. Approximately 50% of physicians had immediate accessibility to them at the point of care. The proportions of respondents reporting a change in practice behaviour ranged from 37.7-57.9% depending on the guideline. The factors associated with guideline-related behaviour change were familiarity with its contents, postgraduate educational training, increased helpfulness score, and practiced >5 years.

Conclusions:

The present study shows that most physicians have favourable opinions and are familiar with these guidelines, however, the proportions reporting changes in their patient management because of the guidelines are not satisfactory. It is important to ensure guidelines accessibility and promotes factors that encourage their implementation in medical practice.

Knowledge and Attitude of Physicians Towards the Cost of Commonly Prescribed Medicines: A Case Study in Three Nigerian Healthcare Facilities

OBJECTIVE

One of the core principles of rational prescribing is consideration of the cost of the medicines prescribed, especially in countries with high patient copayments and low incomes such as Nigeria. Little is known about Nigerian physicians' knowledge about the cost of commonly prescribed medicines. The principal objective of the study was to assess the knowledge of Nigerian physicians about the cost of commonly prescribed medicines.

METHODS

Descriptive cross-sectional survey conducted among physicians in 3 tertiary institutions in Nigeria. Apart from socio-demographic and other information, questions about the estimated costs of branded and generic versions of 11 commonly prescribed medications were included in the questionnaire.

RESULTS

One hundred and seventy-nine (179; 95.7%) respondents agreed that costs of medicines were important when writing prescriptions, although only 7 (3.7%) of them had any formal training in the economics of healthcare. The median percentages of respondents with accurate estimated costs for generic and originator brands were 6.2% and 12%, respectively. Respondents were more knowledgeable about the cost of medicines used for the treatment of infectious diseases (malaria, bacterial infections) than noncommunicable diseases (diabetes mellitus, hypertension, and dyslipidemia).

CONCLUSIONS

The knowledge of Nigerian physicians in the 3 participating hospitals about the costs of commonly prescribed medicines was poor. This is despite their awareness about the importance of costs of medicines when prescribing.

Physical and socioeconomic impact of asthma in Nigeria: Experience of patients attending three tertiary hospitals

Background

Understanding the impact of asthma is the key to optimal care.

Objective

To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria.

Methods

This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence).

Results

The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact.

Conclusion

Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.

Impact of Operational Definitions on the Predictors and Prevalence of Asthma Estimates: Experience from a University Students' Survey and Implications for Interpretation of Disease Burden

BACKGROUND

Inconsistent operational definitions during asthma surveillance can lead to inaccurate estimation of disease burden and formulation of health policy. This study aimed to evaluate the impact of different definitions on the prevalence estimates and predictors of asthma among university students in Ilorin, Nigeria. The secondary aim was to compare level of agreement of the different definitions.

METHODS

This cross-sectional study was carried out from June to August 2015. The European Community Respiratory Health Survey (ECRHS) questionnaire was self-administered by 1485 students. Asthma diagnosis was based on five definitions used in previous studies in the country. These were ECRHS, International Study of Asthma, Allergies in Childhood (ISAAC), Probable, Modified ECRHS and Modified Probable asthma definitions.

RESULTS

The prevalence rates varied from 10.4 to 24.1% depending on the definition. Prevalence obtained by using ECRHS definition significantly differed from estimates by other definitions (Z score ≥ 1.96 p<0.0001) except modified probable asthma. Identified predictors of asthma varied from five to six depending on the definition, and their strength also differed by definition. Regardless of the definition, reported nasal allergy, skin allergy, family history of nasal allergy, asthma and parental smoking were the predictors of asthma. The Kappa statistics demonstrated a fair to almost perfect association between the ECRHS and other asthma definitions (Kappa = 0.334-0.841, p < 0.001).

CONCLUSION

The prevalence rates and predictors of asthma are affected by operational definitions. Researchers need to adopt a uniform definition for accurate estimation of disease burden, international comparison of result and formulation of prevention policy.

Identifying patients at high risk for obstructive sleep apnoea syndrome in Nigeria: A multicentre observational study

Background

Obstructive sleep apnoea is associated with significant health consequences. A significant proportion of hospitalized patients at risk for obstructive sleep apnoea were never identified and referred for polysomnography for diagnosis. The objective of this study was to determine the factors associated with high risk for obstructive sleep apnoea and use it to identify patients at risk for the condition in tertiary hospitals in Nigeria.

Methods

This was a multicentre observational study of adult patients hospitalized in three selected hospitals from 15th January to 17th March 2015. Berlin questionnaire and Epworth sleepiness scale were used to assess for obstructive sleep apnoea risk and excessive daytime sleepiness respectively. Additional questions on traditional risk factors for obstructive sleep apnoea were also obtained.

Results

Nine hundred and twenty-six patients were recruited into the study. Respondents' mean age was 44.3 years ± 15.2years, 486 (52.5%) were females and 556 (60.0%) had one or more medical co-morbidity and none of the patients had a previous diagnosis of obstructive sleep apnoea. Factors that were independently associated with high risk for obstructive sleep apnoea include systemic hypertension(aOR-10.33;95%: CI 6.42–16.61), obesity(aOR-7.87;95% CI: 4.33–14.29); excessive daytime sleepiness (aOR-3.77;95% CI :2.28–6.22), tobacco smoking (aOR-2.99;95% CI: 1.76–5.07), snoring in a first-degree relative (aOR-1.83;95% CI: 1.19–2.81); and the use of sedative (aOR-1.82;95% CI: 1.06–3.15).

Conclusions

This study shows that patients with systemic hypertension, obesity, excessive daytime sleepiness, history of smoking, snoring in a first-degree relative and use of sedatives are at high risk of obstructive sleep apnoea. None of the patients at high risk had a previous diagnosis of sleep apnoea by a physician, highlighting the diagnostic challenges of this condition. The results of this study will assist health care professionals in early identification of individuals at risk of obstructive sleep apnoea and subsequent referral for a sleep study.

Knowledge and use of asthma control measurement tools in the management of asthma: a survey of doctors working in family and internal medicine practice in Nigeria

OBJECTIVE

To investigate the knowledge and use of asthma control measurement (ACM) tools in the management of asthma among doctors working in family and internal medicine practice in Nigeria.

METHOD

A questionnaire based on the global initiative on asthma (GINA) guideline was self-administered by 194 doctors. It contains 12 test items on knowledge of ACM tools and its application. The knowledge score was obtained by adding the correct answers and classified as good if the score ≥ 9, satisfactory if score was 6-8 and poor if < 6.

RESULTS

The overall doctors knowledge score of ACM tools was 4.49±2.14 (maximum of 12). Pulmonologists recorded the highest knowledge score of 10.75±1.85. The majority (69.6%) had poor knowledge score of ACM tools. Fifty (25.8%) assessed their patients' level of asthma control and 34(17.5%) at every visit. Thirty-nine (20.1%) used ACM tools in their consultation, 29 (15.0%) of them used GINA defined control while 10 (5.2 %) used asthma control test (ACT). The use of the tools was associated with pulmonologists, having attended CME within six months and graduated within five years prior to the survey.

CONCLUSION

The results highlight the poor knowledge and use of ACM tools and the need to address the knowledge gap.

Tuberculosis, before and after Antiretroviral Therapy among HIV-Infected Children in Nigeria: What Are the Risk Factors?

INTRODUCTION

In Nigeria, there is a dearth of pediatric data on the risk factors associated with tuberculosis (TB), before and after antiretroviral therapy (ART).

METHODOLOGY

A retrospective observational cohort study, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. TB was noted among children less than 15 years of age at ART enrolment (prevalent TB-PrevTB), within 6 months (early incident tuberculosis-EITB) and after 6 months (late incident tuberculosis-LITB) of a 12-month follow-up on ART. Potential risk factors for PrevTB and incident TB were assessed using the multivariate logistic and Cox regression models respectively.

RESULTS

Among 368 HIV-1 infected children, PrevTB was diagnosed in 73 children (19.8%). Twenty-eight EITB cases were diagnosed among 278 children over 132 person-years (py) with an EITB rate of 21.2/100 py. Twelve LITB cases were seen among 224 children over 221.9 py with a LITB rate of 5.4/100 py. A significant reduction in the incidence rates of TB was found over time (75%, p˂ 0.001). Young age of children (12-35 months, aOR; 24, 95% CI; 4.1-146.6, p ˂ 0.001; 36-59 months, aOR;21, 95%CI;4.0-114.3, p ˂ 0.001); history of TB in children (aOR; 29, 95% CI; 7.3-119.4, P˂ 0.001); severe immunosuppression (aOR;38, 95% CI;12-123.2,p ˂ 0.001); oropharyngeal candidiasis (aOR;3.3, 95% CI; 1.4-8.0, p = 0.009) and sepsis (aOR; 3.2, 95% CI;1.0-9.6, p = 0.043) increased the risk of PrevTB. Urban residency was protective against EITB (aHR; 0.1, 95% CI; 0.0-0.4, p = 0.001). Virological failure (aHR; 4.7, 95% CI; 1.3-16.5, p ˂ 0.001) and sepsis (aHR; 26, 95% CI; 5.3-131.9, p ˂ 0.001) increased the risk of LITB.

CONCLUSIONS

In our cohort of HIV-infected children, a significant reduction in cases of incident TB was seen following a 12-month use of ART. After ART initiation, TB screening should be optimized among children of rural residency, children with sepsis, and those with poor virological response to ART.

The prescribing of generic medicines in Nigeria: knowledge, perceptions and attitudes of physicians

Generic medicines have the same efficacy and safety as originators at lower prices; however, there are concerns with their utilization in Nigeria. Objective was to evaluate physicians' understanding and perception of generics. A questionnaire was administered among physicians working in tertiary healthcare facilities in four geo-political regions of Nigeria. Questionnaire response was 74.3% (191/257) among mainly males (85.9%). The mean knowledge score regarding generics was 5.3 (maximum of 9) with 36.6%, 36.1% and 27.2% having poor, average and good knowledge respectively. Cross-tabulation showed statistical significance (p = 0.047) with the duration of practice but not with position, subspecialty or sex. The majority of respondents did not believe that generic medicines are of lower quality than branded medicines. Therapeutic failure was a major concern in 82.7%, potentially discouraging the prescribing of generics, and a majority (63.9%) did not support generic substitution by pharmacists. Knowledge gaps were identified especially with the perception of generics, which need to be addressed.

Factors affecting interest in respiratory medicine as a subspecialty of choice: survey of internal medicine residents in Nigeria

AIMS AND OBJECTIVES

The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria.

SUBJECTS, MATERIALS AND METHODS

This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine.

RESULTS

Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice.

CONCLUSION

The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.

Guideline-based COPD management in a resource-limited setting - physicians' understanding, adherence and barriers: a cross-sectional survey of internal and family medicine hospital-based physicians in Nigeria

Background:

Few data exist on the understanding and adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in resource-limited settings, which are mostly in sub-Saharan Africa.

Objectives:

To assess physicians' understanding, adherence, and barriers to implementation of GOLD guidelines in Nigeria.

Methods:

A questionnaire based on the recommendations of the guidelines was self-administered by 156 physicians in departments of internal and family medicine in selected hospitals to assess physician understanding of the GOLD guidelines and barriers to its implementation. The medical records of patients with chronic obstructive pulmonary disease (COPD) were also reviewed to assess adherence to the guideline recommendations.

Results:

The performance score of all physicians was 22.37±0.39 (range 0–38). Pulmonologists had the highest score (37.00±0.00) while medical officers had the lowest score (19.93±4.98) (F=10.16, df=5, p<0.001). Forty one percent of physicians knew the spirometric criteria for diagnosing COPD and 26.9% could assess the severity. In clinical practice, 32% of patients had brief smoking counselling despite 70% being smokers, 24% had spirometry and 18% had assessment of severity. Almost 60% of patients were on oral aminophylline, 72% were on an inhaled long-acting β₂-agonist and corticosteroid combination, 2% had pulmonary rehabilitation and no patients were vaccinated. Self-reported adherence to the COPD guidelines was 23.7%. Lack of familiarity (39.8%) was cited as the most common barrier to adherence to the guidelines.

Conclusions:

The understanding of GOLD guidelines is satisfactory among Nigerian doctors managing patients with COPD but the level of adherence is poor. Educational interventions are needed to improve the implementation of guideline-based management.