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

The role of cervical mediastinoscopy in Nigerian thoracic surgical practice

Introduction: Cervical mediastinoscopy is the gold standard for obtaining histological diagnosis of mediastinal pathology. It has been used for the staging of lung cancer as well as to determine the cause of Isolated Mediastinal Lymphadenopathy. There is very limited evidence in the literature of its use in Nigeria to assess mediastinal pathology. The aim of this study was to describe our institutional experience with cervical mediastinoscopy. Methods: This study was a retrospective analysis of 40 patients that underwent cervical mediastinoscopy in our institution between March 2007 and February 2013. Results: The indication for Cervical Mediastinoscopy was Isolated Mediastinal Lymphadenopathy in 24 patients (60%) and lung cancer staging in 16 patient (40%). The mean age of the patients was 52.7 + 15.1 years. There were 21 females (52.5%) and 19 males (47.5%). The most commonly biopsied lymph nodes were level 4 in 35 patients (87.5%) and level 7 in 21 patients (52.5%). Malignant diagnosis was made in 16 (66.7%) patients with Isolated Mediastinal Lymphadenopathy and in 13 (81.3%) patients staged for lung cancer. Hospital stay was less than 24 hours in all patients and there were no complications. Conclusion: Cervical Mediastinoscopy is available in Nigeria and has been performed in our institution with high diagnostic yield and no complications. Its increased use, along with the development of other mediastinal biopsy techniques is advocated to increase tissue biopsy of mediastinal pathology, especially for lung cancer and isolated mediastinal lymphadenopathy.Pan African Medical Journal 2016; 2

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

Screening for diabetes mellitus and humanimmunodefiency virus infection in personswith tuberculosis

Introduction. Nigeria is a country saddled with a high tubercu- losis (TB) and human immunodeficiency virus (HIV) burden but the possible combination of these communicable diseases with diabetes mellitus (DM) has been overlooked. We undertook to determine the burden of HIV and DM in persons with TB by docu- menting the prevalence rates of these disorders. Methods. This is a cross-sectional Study that was conducted within 54TB/DOT centers in Lagos State. A total of 3,376 persons with TB who were on antiTB drugs were screened for HIV and DM using standardized tests. Statistical analysis was performed using Students t test and chi square. Results. The frequency of occurrence of DM in TB and that of HIV in TB were comparable (4.8% Vs 3.5%). The Study subjects with DM were older, had higher waist circumference measure- ments and had higher proportions of hypertension compared to the subjects without DM. The combination of HIV and DM in TB was found in (0.3%). We also noted that DM in TB and HIV in TB occurred more frequently in the third and fourth decades of life. Conclusion. This study demonstrated the potential co existence of HIV, DM and Tuberculosis. It is therefore important that these two diseases are sought for in patients with TB considering the changing epidemiology of these diseases particularly in develop- ing countries like Nigeria

Prevalence and factors associated with hypertension among rural community dwellers in a local government area, South West Nigeria

Background: Many African countries including Nigeria are said to be at various stages of an epidemiological transition from communicable to non-communicable diseases (NCD). Objective: This study determined the current pattern and correlates of hypertension among adults in some rural communities in South West Nigeria. Methods: It was a descriptive cross-sectional study of 1012 individuals across 16 rural communities. The respondents\u2019 blood pressure, weight, height and waist circumference were measured. Bivariate and multivariate analyses were done. Results: Among the participants, 461 (45.6%) had hypertension out of whom 217 (47.1%) and 244 (52.9%) had stage 1 and stage 2 hypertension respectively. The systolic, diastolic and mean arterial blood pressures increased with age. The significant predictors of hypertension were; increasing age (p<0.001), higher waist circumference (p = 0.01) and overweight / obesity (p = 0.03). While systolic blood pressure (SBP) had the strongest correlation with age, waist circumference (WC) was the strongest correlate of diastolic blood pressure (DBP). Conclusion: Despite being a rural population, there was a high prevalence of hypertension in the study area

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

Knowledge of diabetes mellitus in tuberculosis amongst healthcare workers in Nigeria

Background: There is a World Diabetes Foundation funded research on detection of diabetes mellitus (DM) in tuberculosis (TB) which is currently being carried out in 56 TB centers in Lagos State Nigeria and against this background, we decided to evaluate the knowledge of DM and (TB) amongst the health workers from these facilities. Materials and Methods: We employed the use of self-administered questionnaires comprising questions to determine participant′s knowledge on risk factors, clinical presentation and complications of DM, diagnosis, management of DM, and presentation and management of TB. We documented and also compared responses that differed in a statistically significant manner amongst the various cadres of health worker and the three tiers of healthcare facilities. Results: A total of 263 health care workers responded, out of which medical doctors constituted 72 (27.4%) while nurses and other categories of health care workers constituted 191 (72.6%). All the respondents knew that TB is a communicable disease and a large majority- 86% knew that DM is a chronic disorder that as of now has no cure. One hundred and eighty one (71%) respondents gave a correct response of a fasting plasma glucose level of 9mmol/L, which is in the range for diagnosis of DM. About a third-90-of the health workers, however, stated that DM may be diagnosed solely on clinical symptoms of DM. However, 104 (46%) of the Study participants stated that urine may be employed for objectively diagnosing DM. All respondents had hitherto not had patients with TB who had been routinely screened for DM. There was insufficient knowledge on the non-pharmacological management with over half of the respondents, irrespective ofstatus, maintained that all persons diagnosed with DM should be made to lose weight and carbohydrate should make up less than 30% of the component of their meals. Conclusion: There remains largely inadequate knowledge on diagnosing and non-pharmacological management of DM among the health workers in our TB facilities

Cooking Fuels in Lagos, Nigeria: Factors Associated with Household Choice of Kerosene or Liquefied Petroleum Gas (LPG).

Cooking with dirty-burning fuels is associated with health risk from household air pollution. We assessed the prevalence of and factors associated with the use of cooking fuels, and attitudes and barriers towards use of liquefied petroleum gas (LPG). This was a cross-sectional, population-based survey conducted in 519 households in Lagos, Nigeria. We used a structured questionnaire to obtain information regarding choice of household cooking fuel and the attitudes towards the use of LPG. Kerosene was the most frequently used cooking fuel ( = 475, 91.5%; primary use = 364, 70.1%) followed by charcoal ( = 159, 30.6%; primary use = 88, 17%) and LPG ( = 86, 16.6%; primary use = 63, 12.1%). Higher level of education, higher income and younger age were associated with LPG vs. kerosene use. Fuel expenditure on LPG was significantly lower than for kerosene ( N (Naira) 2169.0 ± 1507.0 vs. N 2581.6 ± 1407.5). Over 90% of non-LPG users were willing to switch to LPG but cited safety issues and high cost as potential barriers to switching. Our findings suggest that misinformation and beliefs regarding benefits, safety and cost of LPG are important barriers to LPG use. An educational intervention program could be a cost-effective approach to improve LPG adoption and should be formally addressed through a well-designed community-based intervention study

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