Assessment of the knowledge, practice, and barriers of physicians in Lagos about respiratory diseases preventable vaccines

Objectives: Immunizations are indicated in a wide range of clinical situations. There are gaps in the implementation of the acceptable recommended guidelines on adult immunization in Nigeria. This study aims to evaluate the perceptions, practices, and barriers of physicians in recommending adult vaccines. Materials and Methods: A descriptive cross-sectional study was conducted using an anonymous, self-administered survey to understand the perceptions, practice, and barriers to adult vaccine recommendations among adult physicians in Lagos. Results: Ninety-seven physicians completed the questionnaire with male-to-female ratio of 1:1.3. The mean age of the responders was 39.54 ± 6.2. The proportion with overall good knowledge was 40 (41.2%). The vaccines routinely recommended include: Pneumococcal conjugate vaccine 73 (81.1%), COVID-19 vaccine 70 (77.8%), and influenza vaccine 57 (63.3%), respectively. The common barriers for vaccine recommendation include: Unavailability 53 (54.6%), poor reminder systems, 43 (44.3%), inadequate insurance coverage 33 (34%), and vaccine shortage 31 (32%). There was a significant association between the knowledge of physicians and sociodemographics, including age (χ2 = 6.548, P = 0.038), duration of practice (χ2 = 7.761, P = 0.039), type of specialist training (χ2 = 3.860, P = 0.049), as well as specialty (χ2 = 11.282, P = 0.004). Conclusion: This study suggests that the knowledge of physicians regarding adult vaccinnations is below average. Most recommended adult respiratory disease preventable vaccines are pneumococcal conjugate, influenza, and COVID-19 vaccines. The major barriers to vaccination include availability and cost. The implication of this finding is the need to increase awareness about vaccine utilization as well as access among physicians in Lagos and Nigeria at large if the narrative must change

Evaluation of patients with suspected obstructive sleep apnea in a low-middle income country: Lagos experience

Obstructive sleep apnea (OSA) is a common chronic disorder that decreases the quality of life of patients. It is an underdiagnosed medical condition in Nigeria. This study aimed to describe the clinical presentations and validate the sleep apnea screening questionnaires with a home sleep study for the diagnosis of patients with suspected OSA seen in Lagos. This was a descriptive cross sectional study carried out on adult patients with suspicion of OSA referred to the Respiratory Clinic of Lagos State University Teaching Hospital. A proforma was used to obtain information and also data from home polysomnography was obtained for each patient. We selected 22 patients. The commonest presentations include snoring (20 or 90.9%), daytime somnolence (16 or 72.7%) and choking while sleeping (12 or 54.5%). The commonest comorbidities were hypertension (16 or 72.7%) and obesity (6 or 27.3%). The STOP-Bang  score identified more patients with a high clinical probability for OSA than the Epworth score (20 and 12 patients respectively). Polysomnography showed evidence of sleep apnea in most suspected patients with severity ranging from mild, to moderate to severe disease (3 or 13.6%, 3 or 13.6%, and 10 or 45.5% respectively). The use of combined Epworth and STOP-Bang questionnaires combination is great tool in identifying patients with suspected cases of OSA based on clinical presentations that will eventually benefit in a resource-limited environment like Lagos. There should be increased awareness of the use of this readily available and cheap questionnaire among physicians in Lagos for ease of OSAS diagnosis for many patients

Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers.

OBJECTIVES: This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates. DESIGN: One of the aims of our National Institute for Health Research global health research group 'Achieving Control of Asthma in Children in Africa' was to use qualitative thematic analysis of transcribed audio recordings from focus group discussions (FGDs) to describe barriers to achieving good asthma control. SETTING: Schools in Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda) and Harare (Zimbabwe). PARTICIPANTS: Children (n=136), 12-14 years with either asthma symptoms or a diagnosis and their caregivers participated in 39 FGDs. All were recruited using asthma control questions from the Global Asthma Network survey. RESULTS: There were four key themes identified: (1) Poor understanding, (2) difficulties experienced with being diagnosed, (3) challenges with caring for children experiencing an acute asthma episode and (4) suboptimal uptake and use of prescribed medicines. An inadequate understanding of environmental triggers, a hesitancy in using metred dose inhalers and a preference for oral and alternate medications were identified as barriers. In addition, limited access to healthcare with delays in diagnosis and an inability to cope with expected lifestyle changes was reported. Based on these findings, we recommend tailored education to promote access to and acceptance of metred dose inhalers, including advocating for access to a single therapeutic, preventative and treatment option. Furthermore, healthcare systems should have simpler diagnostic pathways and easier emergency access for asthma. CONCLUSIONS: In a continent with rapidly increasing levels of poorly controlled asthma, we identified multiple barriers to achieving good asthma control along the trajectory of care. Exploration of these barriers reveals several generalisable recommendations that should modify asthma care plans and potentially transform asthma care in Africa. TRIAL REGISTRATION NUMBER: 269211

Prevalence of diabetes mellitus in persons with tuberculosis in a tertiary health centre in Lagos, Nigeria

Context: In Nigeria, much has been reported on the unacceptably high disease burden of Tuberculosis (TB) and Diabetes Mellitus (DM) but not the possible co-existence of these diseases. Aim: This study was conducted to document the co-existence of DM and TB in persons with established TB. Settings and Design: This was a cross-sectional study conducted at a Tertiary hospital′s Directly Observed Therapy short course clinic in Lagos, South west, Nigeria. Materials and Methods: Three hundred and fifty one consecutive patients with TB who consented to the study participated after a written consent. Ethical approval was given by the Ethics committee of the institution. Clinical examination for documentation of anthropometric indices and biochemical evaluation for blood glucose levels were carried out. Results: The prevalence of DM among the patients with TB was 5.7%. About half of the diabetics were diagnosed (2.8%) at the screening. The mean age of the participants was 34.9 ± 13.21 years; the mean duration of symptoms of TB was 9.65 ± 9.49 months. Weight (kg) loss was the most predominant symptom occurring in 94% of the patients. There was no significant difference in the sputum positivity and duration of cough among patients with TB-DM and those with TB alone. Conclusion: Diabetes is an important co-morbid feature to be sought in patients with TB. This study re-echo the need to raise awareness on screening for DM in persons with TB

Factors influencing quality of life and predictors of low quality of life scores in patients on treatment for pulmonary tuberculosis: a cross sectional study.

There is paucity of information on the quality of life of patients with pulmonary tuberculosis in Nigeria. This study assessed the factors influencing their quality of life and the independent predictors of low quality of life scores. Two hundred and sixty consecutive patients with pulmonary tuberculosis seen at the Lagos University Teaching Hospital were evaluated for health related quality of life using the World Health Organization Quality of life instrument (WHOQoL-BREF). Sociodemographic characteristics of the patients were related to the various domains of quality of life and a multivariate logistic regression analysis was performed to identify the independent predictors of low quality of life scores in the patients. The mean age of the patients was 36.7±12 years. Sex, age and marital status of patients were found to influence quality of life scores. The independent predictors of low quality of life scores were low monthly income, duration of the illness, concomitant illnesses, unemployment, advancing age and male gender. Several socio demographic and economic factors influenced the quality of life of patients with tuberculosis and are predictive of poor scores. It is important to consider these factors when treating patients with tuberculosis to optimise outcome of care