Analgesia Self-Medication Practice and Pentazocine Dependency in Adult Sickle Cell Patients in Southeast Nigeria

Background: Painful crisis is a debilitating hallmark characteristic feature of sickle cell disease (SCD). Analgesia medication is the standard of care. Self‑medication is becoming a quick fix for pain resolution for persons living with SCD. The aim of this study was to evaluate analgesia self‑medication practice and pentazocine dependency among adult sickle cell patients. Methods: A descriptive cross‑sectional study was conducted among 111 adults with SCD attending sickle cell clinic at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla Enugu and Alex Ekwueme Federal University Teaching Hospital Abakiliki (AEFUTHA) Ebonyi. Data were analyzed using SPSS version 22. A P < 0.05 was considered statistically significant. Results: The proportion of adults SCD participants in the study was 45.4% from UNTH Enugu and 54.6% from AEFUTHA Ebonyi. The proportion of male and female who self‑medicated was 61.5% and 38.5%, respectively. The prevalence of analgesic self-medication was found to be 28.8%. Analgesics most and least frequently self‑administered were paracetamol 50.5% and morphine 0.9% most reported reason for self‑medication was “treatment delays in hospital” 73%. Dependency to pentazocine was 22.5%. Age was a significant predictor of self‑medication among adult SCD patients. Conclusion: This study shows high prevalence of self‑medication and dependency to pentazocine. There should be strict regulation on the use of pentazocine. Keywords: Analgesia, pentazocine dependency, self‑medication, sickle cell diseas

Dyslipidaemia in hypertension - are we treating enough?

Introduction: The coexistence of dyslipidaemia and hypertension results in enhanced atherosclerosis. Adequate treatment of dyslipidaemia in hypertensive patients is thus essential for reducing the burden of cardiovascular diseases.Objective: To determine the prevalence of dyslipidaemia among hypertensives and evaluate lipid treatment status of patients with dyslipidaemia in a tertiary hospital in Nigeria.Methods: This cross-sectional comparative study was done between May, 2015 and June, 2016 in a tertiary hospital in Nigeria. The serum lipid levels of adult patients with hypertension and controls without hypertension were determined. Lipid treatment status of patients with dyslipidaemia were also reviewed. Serum lipid levels were analyzed using spectrophotometric methods.Results: The study included 200 adult hypertensive patients and 100 control participants. The mean age (SD) was 56.3 (6.9) years and 54.9 (8.3) years with range 41-68 and 44-69 years for patients and controls respectively. Eighty-eight (44.0%) hypertensive patients and 23(23.5%) of the control group were found to have dyslipidaemia. Out of the 60(68.2%) patients with elevated LDL-C, 32(53.3%) had LDL-C >4.1mmol/L, out of which only 8(25%) were on antilipid medication.Conclusion: Over one-third of studied hypertensive patients had dyslipidaemia and only a quarter of those who needed antilipids were on the medication. Greater awareness is needed both in the medical and patient communities in order to effectively manage dyslipidaemic hypertension, and hence aid in ameliorating the burden of cardiovascular diseases

Opinion and use of contraceptives among medical students of the University of Nigeria, Enugu campus

Background: Non-use or poor usage of any form of contraception increases the chances of unwanted pregnancies, abortion and sexually transmitted infections (STIs), including HIV/AIDS occurring with attendant problems. The knowledge of, and the appropriate use of contraceptives will reduce the prevalence of unwanted pregnancies and unsafe induced abortion as well as limit incidence of STIs and associated complications.Objectives: Determination of the opinion and use of contraceptives; to examine the socio-demographics, knowledge and attitude towards contraception and contraceptive use among medical undergraduates in the University of Nigeria, Enugu campus.Methodology: A cross-sectional study. Stratified probability sampling technique was employed using the different medical classes as strata. Individuals were subsequently chosen at random until a statistically determined sample size was achieved. Statistical Package for Social Sciences (SPSS version 20) software was utilized for data analysis.Results: Our study found a statistically significant relationship between sex and contraceptive use. It was also statistically deduced that knowledge of possible contraceptives failure negatively impacts on opinion with regards to contraceptive use.Conclusion: Positive opinion towards contraceptives will go a long way to encourage proper and effective contraceptives use. This can be achieved by utilizing counseling by health workers.Keywords: Opinion, use, contraceptives, medical students

Five years retrospective cohort analysis of treatment outcomes of TB-HIV patients at a PEPFAR/DOTS Centre in South Eastern Nigeria.

Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment of patients. Objectives: The aim of this study was to assess treatment outcomes of a cohort of smear positive TB-HIV co-infected patients over a five-year study period. Methods: A retrospective cohort study of 600 smear-positive tuberculosis patients registered at the chest unit of the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2012 was done. The data was analyzed using SPSS Version 17. Results: One hundred and three (17.2%) of the patients were co-infected with TB/HIV, while 398 (66.3%) and 99 (16.5%) were HIV negative and unknown respectively. Among the co-infected patients, 45(43.7%) were cured as against 222(55.8%) in the TBHIV negatives (Z=4.53, p=0.000, 95%CI= 0.12-0.34). Respectively in the TB-HIV co-infected and TB-HIV negative patients, treatment completed were 21(20.4%) and 71(17.8%) (Z=9.15, p=0.000, 95%= 0.4035-0.60); defaulted 19(18.5%) vs 70 (17.6%) (Z=9.29, p=0.000, 95%CI=0.42-0.60), died 10(9.7%) vs. 6(1.5%) (Z=1.22, p=0.224, 95%CI= -0.0286-0.1086), and failures were 1(0.9%) vs. 7(1.8%) (Z=2.48, p=0.013, 95%CI=0.04-0.10). Treatment success rate was lower in TB-HIV co-infected patients, 64.1% compared to TB-HIV negative patients with 73.6%. Also those that defaulted among the TB-HIV co-infected patients (18.5%) were higher than 17.6% among TB-HIV negative patients, a difference of 0.9%. Conclusion: Findings demonstrate that HIV co-infection affects TB treatment outcomes adversely. Treatment adherence, timely and sustained access to antiretroviral therapy for TB/HIV co-infected patients are important

Opinion and use of contraceptives among medical students of the University of Nigeria, Enugu campus

Background: Non-use or poor usage of any form of contraception increases the chances of unwanted pregnancies, abortion and sexually transmitted infections (STIs), including HIV/AIDS occurring with attendant problems. The knowledge of, and the appropriate use of contraceptives will reduce the prevalence of unwanted pregnancies and unsafe induced abortion as well as limit incidence of STIs and associated complications. Objectives: Determination of the opinion and use of contraceptives; to examine the socio-demographics, knowledge and attitude towards contraception and contraceptive use among medical undergraduates in the University of Nigeria, Enugu campus. Methodology: A cross-sectional study. Stratified probability sampling technique was employed using the different medical classes as strata. Individuals were subsequently chosen at random until a statistically determined sample size was achieved. Statistical Package for Social Sciences (SPSS version 20) software was utilized for data analysis. Results: Our study found a statistically significant relationship between sex and contraceptive use. It was also statistically deduced that knowledge of possible contraceptives failure negatively impacts on opinion with regards to contraceptive use. Conclusion: Positive opinion towards contraceptives will go a long way to encourage proper and effective contraceptives use. This can be achieved by utilizing counseling by health workers

Determinants of psychosocial health‑related quality of life of adults with sickle cell disease in a Nigerian setting

Background: With improved understanding of disease mechanism in sickle cell disorder, many persons living with sickle cell disease (SCD) are surviving unto adulthood. There is a growing concern that SCD may impair the psychosocial health‑related quality of life (HRQoL), witha resultant lack of psychosocial stability and integration. The objective of this study was to assess the determinants of psychosocial quality of life (QoL) among adults with SCD. Materials and Methods: This was a cross‑sectional study of adults with SCD. A multidimensional self‑administered instrument, prevalidated for use in adults with chronic disease, was used. It consisted of 31 items that assessed physical function, physical and emotional role function, bodily pain, vitality, social function, mental health, and general health within 2 weeks prior to the time of survey. Questionnaires were administered to adults with sickle cell anemia who presented for their routine visit to the Sickle Cell Clinic at the Hematology Clinic in University of Nigeria Teaching Hospital, Ituku‑Ozalla Enugu, or during sickle cell support group meetings. Psychosocial HRQoL was the primary outcome measured. Sociodemographic features such as marital status, gender, educational qualification, and SCD were the primary independent variables of interest. Results: A total of I16 adults with SCD were participated in the study. After adjusting for marital status, gender, and educational qualification of adults with SCD, gender and marital status did not significantly affect psychosocial HRQoL (P = 0.619 and P = 0.146), respectively, while educational status significantly affected their HRQoL (P = 0.013). Conclusions: Adults with SCD have impaired psychosocial HRQoL. There is a need to upscale patient‑focused interventions to improve self‑esteem and overall QoL

Perception and practice of breastfeeding among HIV positive mothers receiving care for prevention of mother to child transmission in South-East, Nigeria

Abstract Background Although the risk of HIV transmission through breastfeeding is reduced considerably with the use of antiretroviral therapy, infant feeding by HIV positive mothers remains controversial. Weighing risks against benefits generates intense debate among policymakers, program managers and service providers in sub-Saharan Africa, considering that the major causes of infant death of malnutrition and infectious diseases, could be prevented if mothers breastfeed their babies. Whereas breastfeeding involves some risk of HIV transmission, not breastfeeding poses considerable risk to infant survival. This study investigated perceptions and practice of breastfeeding of HIV-exposed infants among HIV positive mothers. Methods A cross-sectional descriptive study was conducted in Enugu metropolis among HIV positive mothers receiving care for prevention of mother-to-child transmission of HIV from two public and two private hospitals. Interviewer-administered questionnaire survey was done with 550 participants as they exited the final point of service delivery. Descriptive statistics of perception and practice variables and cross tabulation of selected variables was performed. Results Most mothers knew that HIV could be transmitted through breast milk. The majority perceived any type of breastfeeding as beneficial to the infant: 230 (83.6%) in private facilities, and 188 (68.4%) public facilities. Over three-quarters of the mothers breastfed their infants and their reasons for breastfeeding included personal choice, cultural norms, fear of HIV status being disclosed and pressure from family members. A statistical significant association was found between; (i) practice of breastfeeding and marital status, (p < 0.01), and (ii) practice of breastfeeding and household income provider (p = 0.02). However, neither marital status (AOR 1.4; 95% CI 0.3, 6.8) nor being the household income provider (AOR 4.9; 95% CI 0.6, 12.9) is a significant predictor of breastfeeding of HIV-exposed infants. Conclusions Breastfeeding remains a common trend among HIV positive women and it is associated with economic independence of women and social support. Fear of stigma negatively affects practice of breastfeeding. Hence, HIV positive mothers need economic independence and the support of family members to practice recommended infant feeding options

Diagnosis of smear-negative tuberculosis in Nigeria: Do health care workers adhere to the national guidelines?

Objective: The study sought to assess the extent to which healthcare workers (HCWs) adhere to the National Tuberculosis Program (NTP) guidelines for the diagnosis of smear negative tuberculosis in Nigeria. Method: This was a cross-sectional retrospective desk analysis of case files of 280 smear negative pulmonary TB in six States in southern Nigeria. Results: About 93% of the 280 patients had their first set of sputum smear microscopy tests done, but only 3.6% had the second set of diagnostic tests as prescribed by the NTP guidelines. Only 45.7% (128/280) received broad spectrum antibiotics after their first smear microscopy. 98% had a chest X-ray done, while 93.6% (262/280) had HIV counseling and testing (HCT), out of which 45.0% were HIV positive. Overall, only 2 patients (0.7%) were diagnosed in strict compliance with the NTP guidelines. There was no significant difference in the pattern of diagnosis of smear negative TB cases and smear positive TB cases. Conclusion: The adherence of HCWs to the NTP guidelines for diagnosis of smear negative TB is apparently sub-optimal and needs improvement

Evaluation of Patient Satisfaction with Tuberculosis Services in Southern Nigeria

Objective Knowing tuberculosis (TB) patients’ satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients’ satisfaction with TB services in southern Nigeria. Materials and Methods A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction. Test of association was used to study the relation between patient satisfaction scores and patient and health facility characteristics, while multilinear regression analysis was used to identify predictors of patient satisfaction. Results Highest satisfaction was reported for adherence counseling and access to care. Patient characteristics were associated with overall satisfaction, registration, adherence counseling, access to care, amenities, and staff attitude, while health system factors were associated with staff attitude, amenities, and health education. Predictors of satisfaction with TB services included gender, educational status, if tested for HIV, distance, payment for TB services, and level and type of health-care facility. Conclusion Patient- and health system–related factors were found to influence patient satisfaction and, hence, should be taken into consideration in TB service programing