Survivorship patterns of histopathological variants and molecular subtypes of breast cancer in a teaching hospital in Nigeria

Objective: To study the relationship of histopathological characteristics, molecular subtypes of breast cancer and survival in a low resource setting.Design: Tumours from prospectively ascertained patients newly diagnosed with breast cancer were analyzed. Formalin-fixed and paraffin-embedded sections were constructed into tissue micro-arrays and immunostained with five anti-bodies. Five molecular subtypes were determined.Settings: The study was conducted jointly in the Department of Pathology of University of Ilorin Teaching Hospital, Ilorin in Nigeria and at the University of Chicago in the United States.Subjects: The study included a total of 203 histologically confirmed breast cancer patients whose pathological specimens were processed in the Department of Pathology of University of Ilorin Teaching Hospital, Ilorin, Nigeria between January 2003 and December 2007.Results: Mean age at diagnosis was 49.2 (SO ±11.9) years. Median time from symptom onset to cancer diagnosis was six months. Median follow-up time was 8.3 months. Median tumour size at diagnosis was 6cm. The proportion of ER+, PR+, HER2+ tumours were 27%, 16% and 30%, respectively. The most common molecular subtype was basal-like (25.1%) followed by unclassified (24.0%), luminal A (20.5%), HER2+/ER( 19.3%) and luminal B (11.1 %). Luminal A and B had best prognosis while basal-like and unclassified had worst prognosis. ER+ patients had longer duration of symptoms to diagnosis (median 8 months) than ER- patients (5 months) but ER+ patients had smaller tumours (median 5cm) than ER-patients (6cm, p=0.02). Recurrence-free survival was best for stage 1 and worst for stage 4 tumours. About 32.6% of patients had locoregional and/or metastatic recurrence.Conclusions: In consecutive breast cancer cases in Nigeria, almost half of patients were triple negative. Luminal A and B subtypes had best prognosis while triple negative had worst prognosis. The delay in breast cancer diagnosis and higher proportion of late stage of breast cancer underscores need for prompt diagnosis and initiation of treatment, especially hormonal therapy for ER positive patients

Operations and roles of patent and proprietary medicine vendors in selected rural communities in Edu Local Government Area, Kwara State, north-central Nigeria

Background: Patent and Proprietary Medicine Vendors (PPMVs) are a ubiquitous feature of the informal health sector in many African countries including Nigeria. Little has been reported about the services they render. This study assessed the operations and role of PPMVs in selected rural communities of Edu LGA, Kwara State, NigeriaMethods: This explorative study used a mixed method approach of data collection. In-depth interviews were conducted among 25 purposively selected PPMVs in three out of the five operational zones in the LGA. Enumeration and mapping of PPMVs shops was done to determine the number and location of the PPMVs in all the five operational zones in the LGA.Results: PPMVs sell drugs with or without prescription and offer services like weight, blood pressure measurements. Products stocked align with the approved list of drugs, though some stock drugs outside the list. Their collaboration with the pharmacists is limited to drug purchasing. Collaboration with the formal health sector consists of training and patients’ referrals. Membership of National Association of Patent and Proprietary Medicine Dealers (NAPPMED) is a ‘sine qua non’ for business. Enumeration of PPMVs shops in the five zones revealed 136 shops with Lafiagi having the highest and the GPS coordinates mapped on Google Earth Map showed the location and spread of the PPMVsConclusion: PPMVs can potentially bridge the gap in healthcare delivery in the study area and by extension to the State. Organizing capacity building workshops for the PPMVs can help strengthen their quality of health service and collaboration with other stakeholders.Keywords: Patent medicine, Pharmacies, Proprietary medicine vendors, Rura

Knowledge of blood donation among adults in north-central Nigeria

Background: About half of the population in Nigeria is medically fit for blood donation but only four in one thousand are voluntary donors. The low level of blood donation has been attributed to poor knowledge, misconceptions, myths, bias, poverty, fear, malnutrition among the population. Therefore, this study assessed the knowledge of blood donation among adults in two selected North Central States of Nigeria.Methods: It was a descriptive cross-sectional study. A total of 3104 respondents comprising of adults between 18 and 60 years were involved in the study. A multistage sampling technique was used and the research tool was interviewer-administered questionnaire. The data generated were entered into the computer and subjected to appropriate statistical analysis using EPI INFO computer software package (version 3.5.3). Pearson Chi Square (χ2) was used to test statistical significance and p-value was set at < 0.05.Results: Majority of the respondents 2565 (82.5%) knew that blood donation save lives. More than three-quarters, 2468 (79.5%), knew where to go for voluntary blood donation. About one-third, (37.1%), demonstrated good knowledge of voluntary blood donation. Older respondents (>60 years) had poor knowledge of blood transfusion compared with younger age groups (p<0.001). Respondents’ occupation and educational status were significantly associated with knowledge of blood transfusion (p<0.001)Conclusion: Periodic awareness programme on voluntary blood donation in rural and urban areas across Nigeria is needed. In addition, sensitization of the informal sector on the significance of non-remunerated voluntary blood donation should be given priority.Keywords: Knowledge, Blood, Donation, North-Central, Nigeri

Determinants of voluntary blood donation among adults in communities of north central region of Nigeria

Objective: The collection of blood from voluntary, non-remunerated blood donors is an important measure for ensuring the safety, quality, availability and accessibility of blood. The study assessed factors affecting voluntary blood donation in North-central zone, Nigeria.Methods: The study design was descriptive cross-sectional, data was collected using a pre-tested interviewer administered questionnaire from 3104 respondents using multistage sampling technique. Data was analyzed using EPI INFO computer software package (version 3.5.3). Level of significance was pre-determined at p-value < 0.05 at a confidence level of 95%.Results: Respondents with good knowledge of voluntary blood donation had better practice of voluntary blood donation. Younger age groups were 8 times more likely to donate blood voluntarily than older respondents. Yoruba ethnic groups are 1.5 times more likely to donate blood than other ethnic groups.Conclusion: For Nigeria and other developing countries at large to achieve 100% voluntary blood donation drive by year 2020, it is critical to change the blood donation culture from replacement to that of volunteerism through more effective communication and mobilization of donors. These efforts must be rendered more methodical and accomplished through a wider range of strategies.Keywords: Determinants, voluntary, blood, donation, Nigeri

Utilization of maternal health services and its determinants among mothers attending primary health care clinics in Kwara State, Nigeria

Objective: There is unacceptably high maternal mortality with about 800 women dying from pregnancy or delivery complications around the world daily. The study assessed the utilization of Maternal Health Services and its determinants among mothers attending primary health care clinics in Ilorin Metropolis, Kwara State, Nigeria.Methods: It was a descriptive cross-sectional study and data was collected through the use of a pre-tested semi-structured interviewer-administered questionnaire from 400 participants, using multistage sampling technique. The level of significance was pre-determined at p-value < 0.05 at a confidence level of 95%.Results: A total of 387 (96.8%) utilized at least one session of antenatal care (ANC) during their last pregnancy, 310 (77.6%) utilized health facilities for delivery while 48 (12%) delivered at home. Only about 68 (17%) utilized postnatal services. Women with secondary education were two times more likelyto deliver in health facility compared with those with no education (AOR=2.337,CI=1.178-4.637), whereby those who attended ANC more than four visit were two times more likely to deliver in health facility than those who attended less than that (AOR=2.398,CI=1.410-4.077).Conclusion: A higher education status and more than 4 ANC visits positively influenced utilization of health facility for delivery.Keywords: Utilization, Health Services, Mothers, Delivery, Primary Health Car

Traditional eye medication: A rural-urban comparison of use and association with glaucoma among adults in Ilorin-west Local Government Area, North-Central Nigeria

Background: Globally, the last two decades witnessed increase in the use of  Traditional Eye Medication (TEM); and its use worsens the prognosis of visual outcome. This study assessed and compared the use of TEM and its association with glaucoma among adults in selected rural and urban communities of Ilorin-west Local Government Area, North-Central Nigeria.Methodology: This was a comparative cross-sectional study. Respondents were selected using multi-stage sampling technique. Interviewer-administered structured questionnaire, and clinical report form were used to collect data. Data were analyzed using SPSS version 15. Level of statistical significance was set at p<0.05.Results: A higher proportion of the rural, 174 (38.7%) than the urban, 111 (24.7%) respondents knew about TEM (p<0.001). More of the rural, 83 (18.4%) than the urban, 78 (17.3%) respondents had ever used TEM (p=0.664). TEM known to the respondents in rural versus urban areas included camphor (47.1% vs 28.8%), personal urine (3.5% vs 2.7%) and salt-sugar solution (1.7% vs 14.4%) among others. There exists an association between the use of traditional eye medication and presence of glaucoma within rural (p=0.011) and urban (p<0.001) areas.Conclusion: The use of TEM among the respondents was associated with glaucoma. While the association between glaucoma and uptake of TEM may not be causal, it provides a window of thought for further researches. There is need to strengthen awareness on the dangers of using TEM in the communities. Regular  community-based eye screening involving measurement of intraocular pressure will be useful in early detection of glaucoma.Keywords: Traditional eye medication; Glaucoma; Rural-Urban; Nigeri

Monitoring Aspergillus flavus genotypes in a multi-genotype aflatoxin biocontrol product with quantitative pyrosequencing

Open Access Journal; Published online: 15 Nov 2019Aflatoxins pose significant food security and public health risks, decrease productivity and profitability of animal industries, and hamper trade. To minimize aflatoxin contamination in several crops, a biocontrol technology based on atoxigenic strains of Aspergillus flavus is commercially used in the United States and some African countries. Significant efforts are underway to popularize the use of biocontrol in Africa by various means including incentives. The purpose of this study was to develop quantitative pyrosequencing assays for rapid, simultaneous quantification of proportions of four A. flavus biocontrol genotypes within complex populations of A. flavus associated with maize crops in Nigeria to facilitate payment of farmer incentives for Aflasafe (a biocontrol product) use. Protocols were developed to confirm use of Aflasafe by small scale farmers in Nigeria. Nested PCR amplifications followed by sequence by synthesis pyrosequencing assays were required to quantify frequencies of the active ingredients and, in so doing, confirm successful use of biocontrol by participating farmers. The entire verification process could be completed in 3–4 days proving a savings over other monitoring methods in both time and costs and providing data in a time frame that could work with the commercial agriculture scheme. Quantitative pyrosequencing assays represent a reliable tool for rapid detection, quantification, and monitoring of multiple A. flavus genotypes within complex fungal communities, satisfying the requirements of the regulatory community and crop end-users that wish to determine which purchased crops were treated with the biocontrol product. Techniques developed in the current study can be modified for monitoring other crop-associated fungi

PREDICTIVE FACTORS OF MEDICATION ADHERENCE AMONG HYPERTENSIVE AND DIABETICS PATIENTS IN A NORTH CENTRAL STATE OF NIGERIA

Introduction: Hypertension and diabetes are the two most common non-communicable diseases seen in outpatient clinics in Sub-Saharan Africa. Promoting medication adherence is a major clinical hurdle to be crossed in reducing the premature morbidity and mortality associated with these diseases. This study explored factors that predict medication adherence among hypertensive and diabetic patients in Ilorin, Nigeria. Methods: This cross-sectional study was carried out among hypertensive and diabetic patients in outpatient clinics of a teaching hospital in Ilorin, Nigeria. Data was collected from 1,203 patients using a validated Morisky 8-item medication adherence questionnaire. Multivariate ordinal logistic regression was used to model the medication adherence explanatory factors with SPSS version 22. Result: Less than half (43.3%) of the patients were highly adherent to their medication. The relative proportion for high adherence was 42.7%, 35.6% and 49.2% for hypertension, diabetes and both diseases respectively. The odds of medication adherence improving from either low to medium level or from medium to high level was explained by; age, symptoms count, absence of disease complication and absence of drug side effect among the patients. Blood pressure, gender and disease duration did not explain medication adherence among hypertensive and diabetic patients. Conclusion: It is concluded that the discomfort experienced due to the disease condition and the medication regimen are important explanatory factors for patient’s medication adherence in the study setting. This study recommends strategies to reduce multiple drug combinations and promote medication adherence counselling and education among patients

PATTERN AND EXPLANATORY FACTORS FOR MEDICATION ADHERENCE AMONG PATIENTS WITH HYPERTENSION, DIABETES MELLITUS AND THEIR COMORBIDITY IN A NORTH CENTRAL STATE OF NIGERIA

Introduction: Hypertension and diabetes are the two most common non-communicable diseases seen in outpatient clinics in Sub-Saharan Africa. Promoting medication adherence is a major clinical hurdle to be crossed in reducing the premature morbidity and mortality associated with these diseases. This study explored factors that predict medication adherence among hypertensive and diabetic patients in Ilorin, Nigeria. Methods: This cross-sectional study was carried out among hypertensive and diabetic patients in outpatient clinics of a teaching hospital in Ilorin, Nigeria. Data was collected from 1,203 patients using a validated Morisky 8-item medication adherence questionnaire. Multivariate ordinal logistic regression was used to model the medication adherence explanatory factors with SPSS version 22. Result: Less than half (43.3%) of the patients were highly adherent to their medication. The relative proportion for high adherence was 42.7%, 35.6% and 49.2% for hypertension, diabetes and both diseases respectively. The odds of medication adherence improving from either low to medium level or from medium to high level was explained by; age, symptoms count, absence of disease complication and absence of drug side effect among the patients. Blood pressure, gender and disease duration did not explain medication adherence among hypertensive and diabetic patients. Conclusion: It is concluded that the discomfort experienced due to the disease condition and the medication regimen are important explanatory factors for patient’s medication adherence in the study setting. This study recommends strategies to reduce multiple drug combinations and promote medication adherence counselling and education among patients