Some emerging issues in medical admission pattern in the tropics

Background: There is a changing pattern in terms of medical admissions worldwide with an alarming increase in the prevalence of noncommunicable diseases, especially in the tropics over the last decade. The aim of this study was to describe the pattern of medical admission and highlight emerging issues of noncommunicable diseases in a Nigerian University Teaching Hospital. Materials and Methods: A retrospective review of medical admission at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South Western Nigeria, over a 3 years period (January 2005 to December 2007). Data were retrieved from the medical records of all medical admission over the study period. Results: During the study period, 1786 patients were admitted into the medical wards. This consisted of 1089 males (61.0%) and 697 females (39.0%). Their ages ranged from 14 to 96 years with mean ages of 51 ± 16.89 years. Subjects ≥60 years of age accounted for 27.3% and 29.8% of total males and female admissions which were the largest age group. Noncommunicable diseases were responsible for 47.99% of total medical admissions. The indications for admission in order of frequency include cerebrovascular accidents 239 (13.4%), diabetes mellitus 194 (10.9%), tuberculosis 151 (8.5%), and chronic kidney disease 116 (6.5%). Hypertension was the underlying risk factor in majority of patients with CVD and CKD. Conclusion: Noncommunicable disease accounted for a significant number of admissions over 3 year duration. The elderly accounted for a major age group admitted for medical diseases. Therefore, preventive strategies against noncommunicable disease and effective geriatric care are advocated.Keywords: Cardiovascular disease, noncommunicable disease, tropicsNigerian Journal of Clinical Practice • Jan-Mar 2012 • Vol 15 • Issue

Electrocardiographic changes during oesophagogastroscopy

Background: Oesophagogastroduodenoscopy (EGD) should be very safe, but there are many potential hazards, although the rate of serious complications is small. There are so many complications that can arise during this procedure. Most of these complications involve the respiratory or cardiovascular systems, especially in sick or sedated patients. The aim of this study was to determine the various electrocardiographic changes that can occur at different stages of diagnostic EGD and to determine their severity.Materials and Methods: The study is a descriptive one which was carried out at the endoscopy unit of Ladoke Akintola University of Technology Teaching Hospital, (LAUTECH), Osogbo, Osun State. Consecutive patients who were referred for oesophagogastroduodenoscopy (EGD) over a 3-month period and who consented to take part in the study were recruited. The electrodes of a portable electrocardiographic (ECG) machine (model Cardiovit AT_1ECG Machine) were attached to the patients accordingly and remained fixed till the end of the procedure. ECG recordings were done at baseline, postpremedication, during intubation and 5 minutes postprocedure. The results of the study were analyzedusing simple descriptive statistical methods such as range, mean and standard deviation for continuous variables, and numbers and percentages for discreet variables.Results: Twenty-six (26) patients were studied, comprising 14 (53.8%) males and 12 (46.2%) females. The mean age of the patients was 47.19 ± 14.42 years. Three (11.5%) patients had tachycardia at the beginning of the procedure, while 13 (50%) patients developed tachycardia  postpremedication and during the procedure, whereas 17 (65.4%) patientshad tachycardia at the end of the procedure. Only one patient had bradycardia. Various ST-T wave abnormalities were observed at each stage of the procedure. Conduction abnormality was observed in 8 (30.8%), 9 (34.6%), 7 (26.9%) and 5 (19.2%) patients at rest, post-premedication, during the procedure and postprocedure respectively. Premature ventricular complexes (PVC) were observed in 4 (15.4%), 5 (19.2%), 4 (15.4%), and 4 (15.4%) patients at rest, postpremedication, during the procedure and post procedure respectively.Conclusion: This study has shown that, although ECG abnormalities do occur during EGD, these abnormalities are not severe enough to warrant specific interventions or discontinuation of the procedure.Key words: Changes, electrocardiography, oesophagogastroduodenoscop

Willingness To Seek Human Immunodeficiency Virus (HIV) Voluntary Counselling And Testing (VCT) Among Urban Residents in Osogbo, South-West Nigeria

Background/Objective: Sub-Saharan Africa is home to two-thirds of all people living with HIV/AIDS. Nigeria has the third highest population of People Living with HIV/AIDS (PLWHAs). Voluntary counselling and testing (VCT) is rapidly becoming an important component of HIV/AIDS prevention and care strategy. The objective of this study was to assess the knowledge and perception of HIV/AIDS and the factors that may affect willingness to seek VCT among residents of an urban community in Nigeria. Methodology:  A cross-sectional descriptive study was conducted in Osogbo, Nigeria. Structured questionnaires were used to gather information from 332 residents. A multistage sampling technique was used for the selection of respondents. A total of 350 houses were selected from the 26 wards. Results: A high proportion (97.6%) of the respondents confirmed that they have heard of HIV/AIDS, 91.1% believed that AIDS is real. Knowledge of HIV/AIDS by the respondents was related to their level of educational attainment and their professions. Only 28.4% of the respondents are aware of VCT, but (66.9%) were willing to seek VCT services if the services are available; 66.7% confirmed that they would go ahead even if a fee is attached. However, 47.2% of those that think otherwise are scare of confidentiality, stigmatization and lack of fund. Willingness was also related to level of educational attainment, professionalism and age group. Conclusion: Programme managers should ensure that councillors have good knowledge on how to alleviate the fear of clients. Counselling should be the first step and if necessary test should follow.Journal of Community Medicine & Primary Health vol 23 (1-2) 201

Burden of obesity in essential hypertension: Pattern and prevalence

Obesity continues to be an epidemic worldwide. There also continues to be a relationship between obesity and hypertension both causal and consequentially. The study aims at determining the prevalence and pattern of overweight and obesity among our patients being managed for essential hypertension. The study was a cross sectional study. Consecutive patients diagnosed with essential hypertension were recruited from two university teaching hospitals in the SouthWest of Nigeria. Demographicdata such as age, gender, weight and height were obtained from patients at recruitment. Patients with congestive heart failure, secondary hypertension, chronic kidney disease, and other chronic diseases wereexcluded. Pregnant women were also excluded. Obesity was defined according toWHOclassification. Statistical analysis was done by the Statistical Package for Social Sciences version 11.0. One thousand one hundred and two (1102) consecutive hypertensive patients were recruited. Two hundred and eighty six (286) were dropped due to evidence of overt heart failure (98) and chronic kidney disease and others (188).There were (420) males (51.5%) and 396 females (48.5%), mean age 54.97 (±13.14) years. (Range 10-91). 7.6% (62) were underweight (36 males, 26 Females): 260 (31.9%) were overweight, consisting of 148 males and 112 females: 135 (16.5%) had mild obesity consisting of 48 males and 87 females: 43(5.3%) had moderate obesity with 15 males and 28 females while 30 (3.7%) had severe obesity (consisting of 22 females).About two thirds of the hypertensive patients seen in two teaching hospitals in the SouthWest of Nigeria in this study were either overweight or obese. Therefore lifestyle modification geared toward weightreduction should be emphasized in these patients

Prediction of functional capacity during six – minute walk among patients with chronic heart failure

Formulae for predicting functional capacity during 6-minue walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations. The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 ) in Chronic Heart Failure Patients (CHF) during exercise.Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated.The result showed that the distance covered was highly correlated with the VO2 (0.65, p< 0.01). The regression analysis revealed that a linear equation model developed was a good predictor ofV0 for the group.The study concluded that in situation where sophisticated equipments are lacking, this equation might be useful during exercise supervision for patients withCHF. [VO2 (ml kg-1 min-1) = 0.0105 x distance (m) + 0.0238 age (yr) - 0.03085 weight (kg) + 5.598]

Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients.Objective: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH.Materials and Methods: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test.Results: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 &#177; 1.26 (normotensive control) to 7.62 &#177; 1.33 (hypertensive without LVH), 6.27 &#177; 0.99 (hypertensive with LVH) (P&lt;0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 &#177; 79.1 to 411.6 &#177;8 2.3, 315.8 &#177; 75.6 respectively (P&lt;0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P&lt;0.003).Conclusion: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor

Prevalence of hypertension in the rural adult population of Osun State, southwestern Nigeria

EO Asekun-Olarinmoye,1 PO Akinwusi,2 WO Adebimpe,1 MA Isawumi,3 MB Hassan,3 OA Olowe,4 OB Makanjuola,4 CO Alebiosu,2 TA Adewole51Department of Community Medicine, 2Department of Medicine, 3Department of Surgery, 4Department of Microbiology, 5Department of Chemical Pathology, College of Health Sciences, Osun State University, Osogbo, Osun State, NigeriaBackground: The purpose of this study was to determine the prevalence of hypertension in two rural communities of Osun State, Nigeria.Methods: A consenting adult population of the Alajue and Obokun rural communities in southwestern Nigeria that presented for the screening exercise participated in this community-based cross-sectional descriptive study. Two hundred and fifty-nine respondents aged older than 18 years completed a standardized, pretested, structured questionnaire as part of activities celebrating World Kidney Day and World Glaucoma Day in 2011. Anthropometric data and blood pressure were recorded, and the data were analyzed using the Statistical Package for Social Sciences version 17.Results: The mean age of the respondents was 49.7 &plusmn; 1.6 years, 100 (38.6%) were males, 84 (32.4%) were farmers, and 111 (42.9%) were traders. The prevalence of hypertension was 13.16% (present in 34 respondents). Seventeen (6.6%) had isolated systolic hypertension, while 11 (4.2%) had isolated diastolic hypertension. Two hundred and thirty-six (91.1%) undertook daily exercise lasting at least 30 minutes and 48 (18.5%) had ever taken antihypertensive drugs on a regular basis. Four respondents (1.6%) claimed a family history of hypertension. The average body mass index (BMI) among respondents was 23.4 &plusmn; 4.9 kg/m2, 51 (19.6%) had a BMI of 25.0&ndash;29.9, and 30 (11.5%) had a BMI &ge; 30. A significant association existed between age older than 40 years and having hypertension (P < 0.05), while no relationship existed between age and BMI or between gender and hypertension (P > 0.05). Rates of older age and high BMI were significantly higher among hypertensives than among normotensives. Respondents with BMI < 25 had at least a three times greater likelihood of developing hypertension than those with BMI < 25 (odds ratio 2.9, 95% confidence interval 0.007&ndash;0.056, P = 0.011).Conclusion: The prevalence of hypertension is high in this study population and we recommend scaling up primary prevention efforts to reduce this in Nigerian communities.Keywords: prevalence, hypertension, anthropometry, body mass index, rural communit

Communicable disease-related sudden death in the 21st century in Nigeria

Patience Olayinka Akinwusi,1,2 Akinwumi Oluwole Komolafe,3 Olanrewaju Olayinka Olayemi,2 Adeleye Abiodun Adeomi4 1Department of Medicine, College of Health Sciences, Osun State University, Osogbo, Osun State, Nigeria; 2Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria; 3Department of Morbid Anatomy, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria; 4Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria Background: Some cases of sudden death (SD) have been attributed to communicable diseases (CD) in middle- and low-income countries of the world even in this 21st century. CDs produce clinical symptoms and signs over several days before culminating in death. They are also amenable to treatment with antimicrobials if affected persons present early. We sought to find out the incidence of CD-related SD at the Ladoke Akintola University of Technology Teaching Hospital (Osogbo, Osun State, Nigeria) &ndash; a tertiary health facility in southwest Nigeria &ndash; and the prevailing associated factors. Methods: We conducted a retrospective study of CD-related SD in adult patients aged 18 years and older that occurred from January 2003 to December 2011. The Statistical Package for the Social Sciences version 16 was used for analysis of the generated data. Percentages and frequencies were calculated. Results: There were 17 (39.6%) CD-related SDs out of the 48 cases of SD studied. CD-related SD also accounted for 2.4% of all adult medical admissions. The mean age of the patients was 37.6 &plusmn; 11.6 years, age range of 25&ndash;62 years, mode of 25 years, and median 34 years. The male-to-female ratio was 1.8:1. Typhoid sepsis was responsible for SD in 47.1% of patients, pulmonary tuberculosis in 17.7% of patients, and lobar pneumonia in 17.7% of patients. The most affected age group was the 20&ndash;29-year-old group (41.2%), while the unskilled occupational group was the most affected occupational group with 35.3% of them having SD. Most of the patients with acute bacterial infection died of multiple organ failure. Conclusion: There is an urgent need to step up public health strategies to curtail infections in this environment, encourage better use of the existing health facilities by the people, and the government should strive hard to make health a top priority. Keywords: infections, septic shock, typhoid sepsis, pulmonary tuberculosis, HIV/AIDS, public healt

Hospital-based incidence of maternal heart failure during pregnancy in Nigeria

Patience Olayinka Akinwusi,1,2 Adetunji Oladeni Adeniji,3 Oluseyi Olaboyede Atanda,3 Adebayo Duyile Adekunle3 1Department of Medicine, College of Health Sciences, Osun State University, 2Department of Medicine, 3Department of Obstetrics and Gynecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria Purpose: To determine the incidence of heart failure during pregnancy and incriminated cardiac lesions, as well as maternal and fetal outcomes in Ladoke Akintola University of Technology Teaching Hospital (LTH), Osogbo, Southwest Nigeria. Methods: This study was a retrospective, descriptive review of all cases of heart failure during pregnancy based on data retrieved from the medical records of LTH over a 7-year period from January 2004 to December 2010. Analysis of these data was carried out using SPSS 17. Ethical clearance was obtained from the Ethical Committee of LTH. Results: A total of 4523 patients delivered babies over the 7-year period, ten (2.2/1000) of which had cardiac decompensation. All patients were not registered at LTH for antenatal care (unbooked), with 70% of them aged 18&ndash;24 years. Fifty percent were primigravidae and the majority of them presented with symptoms in the second and third trimester. There were two cases of maternal deaths recorded and three cases of fetal/perinatal mortality. Only one case of congenital heart disease (pulmonary stenosis) and no cases of rheumatic heart disease were found. Conclusion: The data suggests that heart failure during pregnancy is uncommon in Southwest Nigeria. However, it occurs more often in young, unbooked primigravid women. Efforts should be aimed at encouraging early booking for antenatal care and a full cardiovascular evaluation to prevent associated maternal and fetal/perinatal morbidity and mortality. Keywords: heart failure, pregnancy, cardiac disease, fetal outcome, maternal outcom

Awareness, knowledge and perception of chronic kidney disease in a rural community of South‑West Nigeria

Background: Awareness and education on kidney disease impact on its effective management and will reduce the significant economic and public health burden. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behavior. We conducted a cross‑sectional descriptive study to assess the level of awareness, knowledge and conventional risk factors of CKD in the community to strategize on preventive modalities using the information gathered from this population.Methods: We used a pretested structured questionnaire to draw information on sociodemography, knowledge and risk factors of CKD from 563 residents aged &gt;18 years.Results: A total of 454 residents completed this study, mainly farmers, with a mean age of 45.8 ± 19.0 years and male: female ratio of 0.8:1. Only 33.7% had heard of kidney disease with 59.3% from the media and 35.3% from health workers; the level of knowledge of CKD was good in 27.1%. The majority (67.0%) do not know the correct location of the kidneys. Only 10.6% could mention at least one function of the kidneys with only 24.5% agreeing that NSAIDs can cause kidney disease. A laboratory test for kidney function was known by 4.4%; 45.9% and 47.8% believe that CKD can be cured by spiritual means and herbal concoctions respectively. Only 11.1% agreed that CKD can be hereditary. Abdominal obesity and cigarette smoking were seen in 14.6% and 16.6% respectively. Hypertension was seen in 26.5% while 17.8% actually knew they were hypertensive. Diabetes mellitus was found in 3.4%. None of the patients with CKD who had diabetes or hypertension was aware of kidney disease.Conclusion: There are a misconception and low level of awareness and knowledge of CKD, including those with risk factors, in the community. Efforts should be made to create awareness and educate people on CKD and prevention of its risk factors.Key words: Awareness, chronic kidney disease, knowledge, perceptio