Serospositivity of Hepatitis B and C among Blood Donors in Private Laboratories in Lagos Nigeria

Background:. Difficulties in meeting demand of blood transfusion by government hospitals have dictated the need for patronizing laboratories by both government and private hospitals.Objective: The study was undertaken to ascertain the prevalence HBsAg and hepatitis C Virus of blood donors in private laboratories in Lagos Nigeria.Result: A total of 315 participants were used for this work 298 were male (94.6%) Seventeen (17) 5.4%were females.  4.8% tested positive for HBsAg. Male constitute 80% prevalence of the positive group. Analysis of gender related prevalence of HBsAg showed that prevalence was higher in females (17.3%) than males (4%).prevalence of 1.5%.was Hepatitis C (HVC Ab).positive participants are in the age range of 21-30.Conclusion:  The result revealed a decline in prevalence of viral hepatitis among voluntary blood donors in Lagos Nigeria. Key words: hepatitis B virus, hepatitis C virus, blood donor

Non-communicable airway disease and air pollution in three African Countries: Benin, Cameroon and The Gambia

Air pollution exposure can increase the risk of development and exacerbation of chronic airway disease (CAD). We set out to assess CAD patients in Benin, Cameroon and The Gambia and to compare their measured exposures to air pollution. We recruited patients with a diagnosis of CAD from four clinics in the three countries. We collected epidemiological, spirometric and home air pollution data. Of the 98 adults recruited, 56 were men; the mean age was 51.6 years (standard deviation ±17.5). Most (69%) patients resided in cities and ever smoking was highest in Cameroon (23.0%). Cough, wheeze and shortness of breath were reported across the countries. A diagnosis of asthma was present in 74.0%; 16.3% had chronic obstructive pulmonary disease and 4.1% had chronic bronchitis. Prevalence of airflow obstruction was respectively 77.1%, 54.0% and 64.0% in Benin, Cameroon, and Gambia. Across the sites, 18.0% reported >5 exacerbations. The median home particulate matter less than 2.5 μm in diameter (PM2.5) was respectively 13.0 μg/m3, 5.0 μg/m3 and 4.4 μg/m3. The median home carbon monoxide (CO) exposures were respectively 1.6 parts per million (ppm), 0.3 ppm and 0.4 ppm. Home PM2.5 differed significantly between the three countries (P < 0.001) while home CO did not. Based on these results, preventive programmes should focus on ensuring proper spirometric diagnosis, good disease control and reduction in air pollution exposure

Multi-site calibration and validation of SWAT with satellite-based evapotranspiration in a data-sparse catchment in southwestern Nigeria

The main objective of this study was to calibrate and validate the eco-hydrological model Soil and Water Assessment Tool (SWAT) with satellite-based actual evapotranspiration (AET) data from the Global Land Evaporation Amsterdam Model (GLEAM_v3.0a) and from the Moderate Resolution Imaging Spectroradiometer Global Evaporation (MOD16) for the Ogun River Basin (20&thinsp;292&thinsp;km2) located in southwestern Nigeria. Three potential evapotranspiration (PET) equations (Hargreaves, Priestley–Taylor and Penman–Monteith) were used for the SWAT simulation of AET. The reference simulations were the three AET variables simulated with SWAT before model calibration took place. The sequential uncertainty fitting technique (SUFI-2) was used for the SWAT model sensitivity analysis, calibration, validation and uncertainty analysis. The GLEAM_v3.0a and MOD16 products were subsequently used to calibrate the three SWAT-simulated AET variables, thereby obtaining six calibrations–validations at a monthly timescale. The model performance for the three SWAT model runs was evaluated for each of the 53 subbasins against the GLEAM_v3.0a and MOD16 products, which enabled the best model run with the highest-performing satellite-based AET product to be chosen. A verification of the simulated AET variable was carried out by (i) comparing the simulated AET of the calibrated model to GLEAM_v3.0b AET, which is a product that has different forcing data than the version of GLEAM used for the calibration, and (ii) assessing the long-term average annual and average monthly water balances at the outlet of the watershed. Overall, the SWAT model, composed of the Hargreaves PET equation and calibrated using the GLEAM_v3.0a data (GS1), performed well for the simulation of AET and provided a good level of confidence for using the SWAT model as a decision support tool. The 95&thinsp;% uncertainty of the SWAT-simulated variable bracketed most of the satellite-based AET data in each subbasin. A validation of the simulated soil moisture dynamics for GS1 was carried out using satellite-retrieved soil moisture data, which revealed good agreement. The SWAT model (GS1) also captured the seasonal variability of the water balance components at the outlet of the watershed. This study demonstrated the potential to use remotely sensed evapotranspiration data for hydrological model calibration and validation in a sparsely gauged large river basin with reasonable accuracy. The novelty of the study is the use of these freely available satellite-derived AET datasets to effectively calibrate and validate an eco-hydrological model for a data-scarce catchment.</p

Microbiological testing of adults hospitalised with community-acquired pneumonia: An international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p&lt;0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p&lt;0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

Prevalence and etiology of community-acquired pneumonia in immunocompromised patients

Background. The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods. We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results. At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non\u2013community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions. Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Clinical standards for the diagnosis and management of asthma in low- and middle-income countries

BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs). METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards. RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (&gt;6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (&gt;6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94–98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3–5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0–3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged &lt;5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6–11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12–18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged &gt;12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS. The following standards (14–18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual’s lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available. CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings

Air Pollution Exposure Among Adult Chronic Airway Disease Patients in the Gambia: A Pilot Case-control Study

Background: Chronic Airway Diseases (CADs) are of public health importance in both the developed countries and Low-and-middle-income countries (LMICs). Air pollution has a role in the causation of CADs and the worsening of already established CADs. This study examines the extent to which adult CAD patients and age and sex-matched controls in The Gambia are exposed to fine particulate matter and carbon monoxide. Methodology: In a clinic-based pilot case-control study,50adult patients with diagnosis of asthma or COPD presenting at respiratory clinics in the Western Health region in The Gambia were consecutively recruited along with 50 age and sex-matched controls who presented for non-cardiorespiratory conditions. Baseline spirometry, clinical examination and chest x-ray were done alongside the questionnaire administration. Home and personal PM2.5, CO and Exhaled CO were subsequently measured. Results: The median (SD) age of cases was 51.5±26 years and controls 52.0±24.8 years. Most cases were urban dwellers, presented with wheeze, cough, shortness of breath and weight loss. Two-thirds (25/40) of the asthmatics had a poor asthma control test score, whilst 90% (9/10) of the COPD patients had CAT scores showing at least a medium impact on their lives. Three-quarters (21/50) of cases had ≥1exacerbation in the previous year. Passive smoking occurred in one-quarter of the cases. There is slightly more personal and home exposure to PM2.5 among controls (61.2μg/m3) than cases(51.8μg/m3). Controls had slightly more home CO exposure 71.2 μg/m3) compared to cases (65.2μg/m3). Cases have more personal CO exposure as the controls. Also, occupational dust exposure and exposure to burning refuse occurred among the cases. Conclusion: As compared with controls, Chronic airway disease patients in The Gambia, present with significantly advanced disease, are likely to have had at least one exacerbation in the last year, and are exposed to personal CO, second-hand smoke, occupational dust and burning refuse. There is need for concerted efforts among all stakeholders to reduce such exposure, thus preventing worsening of already established

Knowledge Attitude and Practice Regarding Obstructive Sleep Apnea among Medical Doctors in Southern Nigeria.

BACKGROUND Despite the high global burden of Obstructive Sleep Apnea (OSA), doctors' knowledge of OSA was reported to be generally poor. Data on knowledge, attitude and practice of doctors regarding OSA are scarce in Africa. The only Nigerian study providing data on this included few participants and did not assess practice. We assessed the knowledge, attitude and practice of doctors regarding OSA in southern Nigeria with the aim of finding gaps in knowledge and practice. METHODS We sent out online survey monkey self-administered structured questionnaires to the WhatsApp numbers or e-mails of 1917 eligible medical doctors. The questionnaires were used to collect data on demography of the medical doctors, their professional history and knowledge of OSA symptoms; general facts, risks factors, and treatment regarding OSA; and their attitude and practice in relation to OSA. RESULTS Data from five hundred and eighty one respondents (mean age, 39.8 ± 8.7) were analyzed. Overall mean knowledge score was 25.3±6.3 (68.6±17.2 percent). The mean knowledge score of Internists, Family Physicians, General practitioners and Surgeons were 28.2±5.0; 25.0±6.9; and 24.5±5.8 and 24.2±6.7 respectively. Only 47% and 51% of the respondents respectively affirmed that hypertension and diabetes mellitus were associated with increased risk of OSA; and 7.2% referred suspected OSA patients for polysomnography. CONCLUSION The level of knowledge of OSA among participating doctors was poor. Most of them had the right attitude to OSA but their practice and care of OSA patients was suboptimal. We suggest improvement in care through education and provision of diagnostic and treatment facilities

Longitudinal Ambient PM<inf>2.5</inf> Measurement at Fifteen Locations in Eight Sub-Saharan African Countries Using Low-Cost Sensors

Peer reviewed: TrueFunder: Medical Research Council Doctoral Training Program scholarshipFunder: Aldama FoundationFunder: NIHR Global Health Research Unit on Lung Health and TB in Africa at LSTM— “IMPALA”Funder: National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health researchAir pollution is a major global public health issue causing considerable morbidity and mortality. Measuring levels of air pollutants and facilitating access to the data has been identified as a pathway to raise awareness and initiate dialogue between relevant stakeholders. Low-and middle-income countries (LMICs) urgently need simple, low-cost approaches to generate such data, especially in settings with no or unreliable data. We established a network of easy-to-use low-cost air quality sensors (PurpleAir-II-SD) to monitor fine particulate matter (PM2.5) concentrations at 15 sites, in 11 cities across eight sub-Saharan Africa (sSA) countries between February 2020 and January 2021. Annual PM2.5 concentrations, seasonal and temporal variability were determined. Time trends were modelled using harmonic regression. Annual PM2.5 concentrations ranged between 10 and 116 µg/m3 across study sites, exceeding the current WHO annual mean guideline level of 5 µg/m3. The largest degree of seasonal variation was seen in Nigeria, where seven sites showed higher PM2.5 levels during the dry than during the wet season. Other countries with less pronounced dry/wet season variations were Benin (20 µg/m3 versus 5 µg/m3), Uganda (50 µg/m3 versus 45 µg/m3), Sukuta (Gambia) (20 µg/m3 versus 15 µg/m3) and Kenya (30 µg/m3 versus 25 µg/m3). Diurnal variation was observed across all sites, with two daily PM2.5 peaks at about 06:00 and 18:00 local time. We identified high levels of air pollution in the 11 African cities included in this study. This calls for effective control measures to protect the health of African urban populations. The PM2.5 peaks around ‘rush hour’ suggest traffic-related emissions should be a particular area for attention.</jats:p