Etiology of Chronic Kidney Disease in Nigeria and Management Challenges

The prevalence of chronic kidney disease (CKD) is increasing globally and is one of the noncommunicable diseases associated with increase mortality globally in the last two decades. The prevalence of CKD in Nigeria, it is 1.6% to 12.4%. Ninety percent of end-stage renal disease (ESRD) patients are said to die within 3 months of commencing dialysis. Indices are even worse in resource poor countries like Nigeria where prevention and adequate intervention are usually hampered by funds. In regions like Nigeria, it will be cheaper to prevent CKD than treating its complications. Hence, it is important to identify the common etiologies of CKD in Nigeria and prevent or promptly address them before causing irreversible damage to the kidneys. The most common cause of CKD in Nigeria includes hypertension, glomerulonephritis and diabetes mellitus. Many of these etiologies are preventable/treatable and should be looked for as a major way to reduce the incidence of CKD in Nigeria. Challenges identified in Nigeria, propagating CKD include westernization, inadequate manpower, late presentation, diagnostic challenge and poorly equipped facilities. Interventions like encouraging healthy lifestyle, making available essential drugs, training of health personnel, subsidized cost of treatment, legislation and policies to curb drug abuse. Therefore, resource-poor settings should focus on creating more awareness and making legislations and/or policies focused on these preventable causes of CKD as this is more realistic and effective in these settings

Clinical features, predictive factors and outcome of hyperglycaemic emergencies in a developing country

<p>Abstract</p> <p>Background</p> <p>Hyperglycaemic emergencies are common acute complications of diabetes mellitus (DM) but unfortunately, there is a dearth of published data on this entity from Nigeria. This study attempts to describe the clinical and laboratory scenario associated with this complication of DM.</p> <p>Methods</p> <p>This study was carried out in DM patients who presented to an urban hospital in Nigeria with hyperglycaemic emergencies (HEs). The information extracted included biodata, laboratory data and hospitalization outcome. Outcome measures included mortality rates, case fatality rates and predictive factors for HEs mortality. Statistical tests used are <it>χ</it>², Student's t test and logistic regression.</p> <p>Results</p> <p>A total of 111 subjects with HEs were recruited for the study. Diabetes ketoacidosis (DKA) and hyperosomolar hyperglycaemic state (HHS) accounted for 94 (85%) and 17 (15%) respectively of the HEs. The mean age (SD) of the subjects was 53.9 (14.4) years and their ages ranged from 22 to 86 years. DKA occurred in all subjects with type 1 DM and 73 (81%) of subjects with type 2 DM. The presence of HSS was noted in 17 (19%) of the subjects with type 2 DM.</p> <p>Hypokalaemia (HK) was documented in 41 (37%) of the study subjects. Elevated urea levels and hyponatraemia were noted more in subjects with DKA than in those subjects with HHS (57.5%,19% vs 53%,18%). The mortality rate for HEs in this report is 20% and the case fatality rates for DKA and HHS are 18% and 35% respectively.</p> <p>The predictive factors for HEs mortality include, sepsis, foot ulceration, previously undetected DM, hypokalaemia and being elderly.</p> <p>Conclusion</p> <p>HHS carry a higher case fatality rate than DKA and the predictive factors for hyperglycaemic emergencies' mortality in the Nigerian with DM include foot ulcers, hypokalaemia and being elderly.</p

Yoruba ontology: Perception of the physical body of the dead and its implications for cadaveric organ transplantation in south-west Nigeria.: Yoruba death ontology: implications for organ transplantation

Introduction: The perception of death differs by region, culture, religion, and ethnic group in Nigeria. These differences can affect the consent rate for cadaveric transplantation. Understanding the Yoruba concept of death and approaching families for consent in a culturally sensitive manner may increase family consent to deceased donor organ harvesting. This literature review explores the Yoruba concept of death and organ transplantation.Methods: Three research questions were formulated and a search strategy was drafted by creating a SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) logic search grid. Relevant databases were then examined using the search terms, concepts and keywords so generated. The findings of publications retrieved on Yoruba beliefs regarding death were entered into a summary table based on the themes identified in them. These themes served as the basis for the interpretation synthesis.Results: Fifteen of the eighty-five studies identified initially were deemed contextually relevant to the researchquestions and used in the analysis. These sources revealed that death in the Yoruba belief system signifies the dematerialization of the soul and its transformation from earthly existence into a spiritual one. Consequently, the physical body of the deceased is perceived as becoming dust and of little relevance to the afterlife.Conclusion: In the Yoruba worldview, the state of the physical body after death has no relevance to afterlife and reincarnation. However, transplant teams must consider the circumstances of death when asking for consent. When death is viewed positively, success is more likely