Unmet needs in asthma treatment in a resource-limited setting: Findings from the survey of adult asthma patients and their physicians in Nigeria

Introduction: The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception andtreatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians andpatients in Nigeria, with the goal of identifying barriers to optimal management.Methods: To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians.Results: Majority (66.7%) of the patients reported their asthma as  moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to  educational issues (31.4% vs.18.7%) and its contents: individual  management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0 %) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side  effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines.Conclusion: This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria

Assessment of physicochemical qualities, heavy metal concentrations and bacterial pathogens in Shanomi Creek in the Niger Delta, Nigeria

The physicochemical and microbial qualities of Shanomi creeks in the Niger Delta of Nigeria were assessed between January and October 2011. The temperature across sampling stations ranged between 26 and 27.7‹C, while pH varied from 7.49 to 8.74. Turbidity ranged from 176.62-189.96 NTU and conductivity varied between 360.45 and 454.88 ƒÊS/cm. The concentrations of other physicochemical parameters were as follows: BOD (6.39-7.64 mg/L) COD (84.25-97.27 mg/L); ammonia (26.83-33.98 mg/L); nitrate (37.25-43.89 mg/L); nitrite (37.35-41.75 mg/L); and phosphate (28.83-37.85 mg/L). The relative dominance of metals in the water followed the sequence: Al > Zn > Cu > Fe > Mn > Cd > Pb > Hg > As. Feacal and total coliform densities ranged from 1.05 ~ 102 to 4.25 ~ 103 (cfu/mL) and 1.56 ~ 102 to 6.40 ~ 104 (cfu/mL) respectively. The study reveals that the water under study was heavily polluted and of serious threat to the aquatic biota and public health.Key words: Aquatic biota, contamination, pollution, public health, microbial indicators, toxic effects

Microanatomy and histomorphometry analysis of the effects of Moringa oleifera leaf extract on lead-induced kidney damage in adult wistar rats

This study evaluated the effects of lead exposure on the histoarchitecture of kidney, assessed the effects of lead on the levels of creatinine, urea and albumin in the plasma and determined the effects of M. oleifera leaf extract (MOLE) on the histoarchitecture of kidney in Wistar rats after lead-induced kidney damage. This was with a view to providing information on the ameliorative effects of M. oleifera leaf extract on lead-induced kidney damage. Thirty adult male Wistar rats weighing 120 - 180 g were used for this study. Kidney damage was experimentally induced by daily administration of lead acetate (50 mg/kg/day) for a period of 14 days. The test groups were treated with the M. oleifera leaf extract (100 mg/kg/day) for 14 days. At the end of treatment period, the rats were sacrificed and their kidneys were excised for histological and histomorphometric studies. Markers of renal function were biochemically determined in the plasma using enzyme calorimetric assay kit. Histomorphological examinations of the stained kidney sections revealed that 100 mg/kg of MOLE had no adverse effects on the kidney of group C rats as the morphology of kidney of the rats in this group were normal and comparable with that of groups A and B. However, deleterious effects such as distortion of Bowman’s capsule with diminished glomerular space, structural alteration of proximal and distal convoluted tubules were observed in the kidney of group D rats following lead-induced damage. Treatment with MOLE protected the kidneys of groups E and F rats from lead-induced damage as the renal morphology appeared normal. The results of biochemical analysis revealed a significant increase in the plasma level of urea (F=203.9, p = 0.0001), and creatinine (F= 7.42, p = 0.0002), in group D rats (56.79 ± 0.06 g/l, 2.91 ± 0.07 mg/dl), respectively compared with groups A (14.02±1.53 g/l, 2.33 ± 0.06 mg/dl), B (50.44±1.75 g/l, 2.54 ± 0.06 mg/dl), C (58.91±2.95 g/ l, 2.42 ± 0.11 mg/dl), E (12.18±1.45 g/l, 2.45 ± 0.08 mg/dl) and F (7.48±1.00 g/l, 2.39 ± 0.08 mg/dl) respectively. This is an indication of impaired renal function. Also, the results of the histomorphometry analysis showed a significant decrease in the number of glomeruli present in each photomicrograph and the diameter of the urinary space in group D respectively compared with groups A, B, C, E and F. This study showed that treatment with Moringa oleifera prevented the toxicity brought about by lead exposure and this is evidenced by an enhancement in the glomerular morphology and clearly seen renal tubules. In conclusion, our findings suggest that Moringa oleifera leaf extract had ameliorative and protective properties on lead-induced kidney injury.Keywords: Nephrotoxicity, lead acetate, renal, prophylactic

Assessment of the living conditions of rural based people living with HIV/AIDS with clinical presentations in Nigeria

Objective: To describe the living conditions of rural based people living with HIV/ AIDS (PLWHA) and their clinical presentationsDesign: Descriptive cross-sectional studySetting: University College Hospital, IbadanSubjects: PLWHA on anti-retroviral therapyResults: One hundred and fifty PLWHA participated. The mean age of the respondents was 28.7±8.9 years. Majority of the respondents visited had advanced disease (97%), were poor (75%) and presented with opportunistic infections such as oral candidiasis (92%), chronic diarrhoea (70%) and pulmonary tuberculosis (46%). Majority were treated for malaria (72%) and anaemia (61%). All respondents lived in homes predisposed to these opportunistic infections. They drink unsafe water and had poor disposal of their domestic wastes.Conclusion: PLWHA visited lived in homes that predispose them to various opportunistic infections. Improved living conditions and economic empowerment will improve the health conditions of PLWHA

HIV treatment is associated with a twofold higher probability of raised triglycerides: pooled analyses in 21 023 individuals in sub-Saharan Africa

Background Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations. Methods Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models. Findings Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies. Interpretation Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SS

Characterisation of heart failure with normal ejection fraction in a tertiary hospital in Nigeria

<p>Abstract</p> <p>Background</p> <p>The study aimed to determine the frequency and characteristics of heart failure with normal EF in a native African population with heart failure.</p> <p>Methods</p> <p>It was a hospital cohort study. Subjects were 177 consecutive individuals with heart failure and ninety apparently normal control subjects. All the subjects underwent transthoracic echocardiography. The group with heart failure was further subdivided into heart failure with normal EF (EF ≥ 50) (HFNEF) and heart failure with low EF(EF <50)(HFLEF).</p> <p>Results</p> <p>The subjects with heart failure have a mean age of 52.3 ± 16.64 years vs 52.1 ± 11.84 years in the control subjects; p = 0.914. Other baseline characteristics except blood pressure parameters and height were comparable between the group with heart failure and the control subjects. The frequency of HFNEF was 39.5%. Compared with the HFLEF group, the HFNEF group have a smaller left ventricular diameter (in diastole and systole): (5.2 ± 1.22 cm vs 6.2 ± 1.39 cm; p < 0.0001 and 3.6 ± 1.24 cm vs 5.4 ± 1.35 cm;p < 0.0001) respectively, a higher relative wall thickness and deceleration time of the early mitral inflow velocity: (0.4 ± 0.12 vs 0.3 ± 0.14 p < 0.0001 and 149.6 ± 72.35 vs 110.9 ± 63.40 p = 0.001) respectively.</p> <p>The two groups with heart failure differed significantly from the control subjects in virtually all echocardiographic measurements except aortic root diameter, LV posterior wall thickness(HFLEF), and late mitral inflow velocity(HFNEF). HFNEF accounted for 70(39.5%) of cases of heart failure in this study.</p> <p>Hypertension is the underlying cardiovascular disease in 134(75.7%) of the combined heart failure population, 58 (82.9%) of the subjects with HFNEF group and 76(71%) of the HFLEF group. Females accounted for 44 (62.9%) of the subjects with HFNEF against 42(39.3%) in the HFLEF group (p = 0.002).</p> <p>Conclusion</p> <p>The frequency of heart failure with normal EF in this native African cohort with heart failure is comparable with the frequency in other populations. These groups of patients are more likely female, hypertensive with concentric pattern of left ventricular hypertrophy.</p

Secondhand smoke exposure among non smoking adults in two Nigerian cities

Background: Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities. Materials and Methods: We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure, awareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult. Results: Of the 585 nonsmoking adults that completed the study, 38.8% had regular exposure to SHS; mostly, in public places (24.4%). More men were exposed at public places when compared with women (27.0% vs. 19.5%). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95% confidence interval (CI), 3.08-9.42]; and in men, it was lack of home smoking restriction (PR ratio-6.35; 95% CI, 4.51-8.93). Among men, SHS exposure at any location was associated with lack of secondary school education, residing in slum apartment (house with many households), living with a smoking family member (non-spouse), lack of home smoking restriction, and alcohol intake. Among women, SHS exposure at any location was associated with having a smoking spouse, residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r= +0.45; P

Human Papilloma Virus Vaccination for Control of Cervical Cancer: A Challenge for Developing Countries

Primary HPV prevention may be the key to reducing incidence and burden of cervical cancer particularly in resource-poor countries. Vaccination programmes are already established in several developed regions, but several grey areas stand in the path of similar success in developing countries. This review sought to identify challenges of HPV vaccination in developing countries and discuss vaccine use, pitfalls and controversies; areas requiring collaborative efforts were identified. A Pub Med search was done; key words included Human papilloma virus, HPV vaccine and sub-Saharan Africa. Other resources included locally-published articles and additional internet resources. The potential benefit of mass HPV vaccination appears enormous. However, the challenges of competing health demands, poverty, ignorance, religion, culture, weak health system, establishment of an effective intersectoralcollaboration and underfunding must be overcome to make maximal vaccine uptake a reality. Education and effective communication is crucial in achieving successful immunization programmes (Afr J Reprod Health 2011; 15[1]: 25-30)