Prevalence and factors influencing cigarette smoking among young adults in a tertiary institution in Borno State, Nigeria

Objectives: Tobacco use, a preventable cause of morbidity and mortality, kills over 3.5 million people worldwide each year. Adverse effects of tobacco smoking on general health and longevity are well documented. WHO states that out of the 1.22 billion smokers, 1 billion live in developing and transitional economies. Epidemiological studies among different University students showed marked variation in the prevalence of smoking. The current study was aimed at finding the prevalence of smoking and factors influencing it among young adults in a tertiary institution in Borno State, northeast Nigeria and to find whether there is a change in the trend from previous studies. Factors influencing the onset of smoking habits among adolescents were investigated with peer-group/friends as the single most important contributory factor.Methods: A descriptive, cross-sectional survey of 400 undergraduate students of the University, carried out over six weeks using a structured, researcher-administered questionnaire.Result: Forty-eight percent of the respondents fall within the age group of 20-24 years and majority of them (76%) were male. The prevalence of those of them currently smoking was 11.5%. The major reason for initiating the smoking habit amongst the undergraduates was peer group influence observed in over 60% of respondents.Conclusion: The prevalence of current smokers among university students in Maiduguri is relatively low. Peer influence still plays an integral role in sustaining the habit and it can be targeted to further decrease the trend.Keywords: Cigarette, smoking, prevalence, tertiary, adult

Sputum smear positive tuberculosis among pulmonary tuberculosis patients at university of maiduguri teaching hospital: a retrospective study

The identification of sputum smear positive pulmonary tuberculosis cases is recommended by the World Health Organisation (WHO) as part of its directly observed therapy short course (DOTs) for effective global tuberculosis control. Earlier study performed in this centre (University of Maiduguri Teaching Hospital (UMTH) Maiduguri) showed a relatively small prevalence of sputum smear positivity among Pulmonary Tuberculosis (PTB) patients that is not close to the Millennium Development Goals (MDG). Objectives: To determine the prevalence of sputum smear positive tuberculosis and assess the progress so far, 5 years after the earlier study. Methods: This is a retrospective study, where the records of all patients treated for tuberculosis at UMTH between April 2008 and December 2008 were retrieved and analysed. Demographic data of PTB patients and their results of sputum smear, stained by Ziehl-Neelson technique were obtained. The effect of HIV seropositivity and of its treatment using HAART on sputum smear was assessed. Results: Four hundred and thirty nine patients with PTB aged 14 years and above consisting of 254(57.9%) males and 185(42.1%) females were used for this study. The 20-25 year age group had the highest sputum smear positive cases, while those within the 62-67 year age group had the lowest. One hundred and eight patients (41.4%) had sputum smear positive results while 153(58.6%) patients had negative smears. Nosignificant difference in sputum positivity between HIV negative and HIV positive patients. Conclusion: The higher rate of sputum smear positive pulmonary TB cases showed an increase in detection rate compared with an earlier finding, but is still some miles away from the set target (MDG goals)

Renal tuberculosis: an incidental finding in type II diabetes

Renal tuberculosis constitutes 14% to 41% of cases of extrapulmonary TB and with HIV pandemic; its prevalence is expected to increase. Case report: We report a case of a 51 year old diabetic/hypertensive female admitted via the A&E with complaints of vomiting and generalized malaise. She had hyponatraemia of 119mmol/l, creatinine 687µmol/L, and urea 28mmol/L. Her kidneys were normal sized and echogenic on ultrasound examination. She was treated for hyponatraemia with normal saline and discharged. She reported at the clinic 2 weeks later with complaints of fever, back pain and right sided neck swelling. Neck ultrasound revealed cystic mass in the lower part of the sternomastoid muscle, Xrays were normal, Urinary AFB done on four urine specimen collected over days was negative and Mantoux test was reactive. Spinal examination was unremarkable except for presence of tenderness at the T6 to T7 vertebrae. A diagnosis of extra pulmonary TB involving the cervical lymph nodes and spine was made and she was commenced on quadruple anti TB drugs which resulted in improvement of her renal function. Conclusion: The diagnosis of renal tuberculosis is usually difficult due to low yield of laboratory tests such as urine microscopy for AFB. High index of suspicion is often required in most patients

Prevalence of Overweight and Obesity in Maiduguri, North-Eastern Nigeria

BACKGROUND: The prevalence of obesity is on the increase worldwide including in many developing countries. There is no report on the magnitude of obesity among adults in Maiduguri, a major city in northeastern Nigeria.MATERIALS and METHODS: We selected a sample of 1650 men and women aged 15 years and above resident in Gwange ward in Maiduguri metropolitan council using a multistage sampling technique. Height, weight, waist (WC) and hip circumferences were measured. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Data were analyzed using SPSS version13. The ethics committee of the Universityof Maiduguri Teaching Hospital approved the study and consent was sought individually from the participants before being enlisted.RESULTS: The mean (SD) age of the respondents was 36.2 (14.4) years, with a range of 15 to 70 years. The mean (SD) ages of the males and  females were 34.9 (14.3) and 38.9 (14.0) years, respectively, (p<0.001). The overall crude prevalence rates of overweight and obesity were 27.1% and 17.1%, respectively. In men, 40.6% were either overweight or obese, while in women 51.9% were either overweight or obese. We observed thehighest prevalence rates of overweight and obesity in the middle age group. There were more obese females than males (14.05 vs. 4.3%) among both young and elderly (12.1% vs. 10.5%) subjects.CONCLUSION: The prevalence of overweight and obesity is high in Maiduguri metropolis particularly among women. Concerted efforts should be made to curb the menace of increasing rate of obesity in the metropolis through public enlightenment on the risks associated with obesity and the benefits of adopting a healthy lifestyle.KEY WORDS: Overweight, Obesity, Prevalence, Maiduguri

Predictive value of spot urine albumin-to-creatinine ratio for echocardiography-based left ventricular hypertrophy among newly diagnosed hypertensive patients

Objective: Studies have reported high prevalence of left ventricular hypertrophy (LVH) among patients with microalbuminuria. Both left ventricular hypertrophy and microalbuminuria (MA) are associated with increased risk of cardiovascular morbidity and mortality. The study aimed to determine the predictive value of spot urine albumin-to-creatinine ratio (ACR) for echocardiography-based LVH in newly diagnosed hypertensive patients.Methods: LVH was defined as left ventricular mass index (LVMI) of >115g/m2 in males and >95g/m2 in females. Microalbuminuria was defined as ACR >30 mg/g and diagnostic value of MA for LVH assessed using X2 2by2 table and the Receiver Operating Characteristics (ROC) curve plot.Results: Sixty six (48.5%) males and 70(51.5%) females with a mean age of 44.8(10.5 %) years were studied. Left ventricular hypertrophy was observed in 36.8% while 42.7% had MA. The prevalence of MA in those with LVH was 66%. Microalbuminuria showed a sensitivity of 64% and specificity of 70% for echocardiography (echo) detected LVH, while the positive predictive value (PPV) and negative predictive value (NPV) were 55% and 77% respectively. Diagnostic accuracy of MA for echo LVH was 68% with an odd ratio of 4.1. ROC curve plot revealed an area under the curve of 0.73 at ACR of 36mg/g, improving the sensitivity and NPV to 85.7% and 83.8% respectively.Conclusion: Microalbuminuria predicts LVH in treatment naïve Nigerian hypertensive patients. This can be used as a surrogate for LVH in outpatient settings, providing vital information for comprehensive management of patients.Keywords: Hypertension, microalbuminuria, albumin-to-creatinine ratio, left ventricular hypertroph

Sputum smear positivity among patients presenting to the dots clinic with chronic cough

Cough is one of the cardinal features of Pulmonary Tuberculosis (PTB). However, even in communities with high prevalence of TB, lung diseases other than TB appear to account for this symptom. Objective: To estimate the prevalence of sputum smear positivity among patients with TB who presented with complaints of chronic cough to the Directly Observed Therapy Short Course (DOTS) clinic at the University of Maiduguri Teaching Hospital, North Eastern Nigeria. Methodology: A cross sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH) Borno state, Northeastern Nigeria between September 2014 and January 2017. All patients (new or previously treated) who presented to the DOTS clinic of the UMTH with complaints of chronic cough and had screening for pulmonary TB using sputum smear microscopy were reviewed. The minimum and the maximum ages were 1 year and 85 years, respectively, and the mean age was 36.0 (SD=14.0) years. The mean age did not differ among the male and female patients (i.e.37.3 ± 14.4 vs 34.1 ± 13.2, p=0.78). The overall prevalence of sputum smear positivity for TB was 26.5%. Although majority of patients who were sputum smear positive for TB fell within the age groups 30-39 and 20-29 thus accounting for 42.6% and 28.7% respectively, however, there was no significant association between age of those with chronic cough and sputum smear positivity TB (p=0.80). Among those who were sputum smear positive, 24.3% were new cases and 2.2% were previously treated. Conclusions: Data were entered into a computer database and analyzed with SPSS version 20.0 statistical software. Results: This study showed a high prevalence of sputum smear positivity among suspected TB patients with complaints of chronic cough This could be explained by the fact that the DOTS strategy has improved the case detection of PTB in this community. All patients with chronic cough should be evaluated for PTB

Hepatic transaminase and alkaline phosphatase enzyme levels in HIV/HBV co‑infected and HIV mono‑infected patients in Maiduguri, Nigeria

Background: Studies have shown that HIV‑HBV co‑infected patients have an increased risk of liver‑related morbidity and mortality compared to their HIV‑mono‑infected counterparts. Furthermore, it has been reported that HIV‑HBV co‑infected patients have a significantly high incidence of drug‑induced hepatotoxicity following commencement of HAART than HIV‑mono‑infected patients.Objectives: To compare the levels of aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALKPO4) enzyme levels between HAART naïve HIV‑HBV co‑infected patients and their HIV‑mono‑infected counterparts.Materials and Methods: A cross‑sectional descriptive study in which 142 newly diagnosed HIV/HBV co‑infected and HIV mono‑infected adults were investigated for alkaline aminotransferase, aspartate aminotransferase and alkaline phosphatase enzyme levels.Results: The study subjects comprised of 80 (56.3%) females and 62 (46.7%) males. The age range of the study population was 15‑65 years. The mean ages of male and female subjects were 45.5 ± 10.5 years and 39.1 ± 7.5 years respectively (P < 0.05). Sixty‑three (44.4%) study subjects were HIV/HBV co‑infected while 79 (55.6%) were HIV mono‑infected. The mean ALT enzyme level of HIV/HBV co‑infected subjects was significantly higher than that of HIV mono‑infected ones i.e., 42.12 IU/l vs. 27.86 IU/l, (P = 0.038). However, there was no statistically significant difference in the mean AST (30.14 IU/l vs. 29.09 IU/l, P = 0.893) and ALKPO4 (55.86 IU/l vs. 60.97 IU/l, P = 0.205) enzyme levels between HIV‑HBV co‑infected and HIV mono‑infected subjects albeit the two enzymes were moderately elevated in both categories of subjects.Conclusion: The significantly elevated ALT enzyme levels amongst HIV‑HBV co‑infected subjects suggest that HIV‑HBV co‑infected patients may have an increased risk of liver‑related morbidity and mortality than their HIV mono‑infected counterparts. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV‑positive patients is therefore recommended before commencement of HAART.Keywords: Alkaline phosphatase enzyme, hepatitis B virus surface antigen, hepatic transaminase enzymes, human immunodeficiency virusNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Prevalence of microalbuminuria in untreated Nigerian hypertensive patients

The burden of cardiovascular disease imposed by hypertension is a result of target organ damage. Microalbuminuria (MA) is the first clinical expression of nephropathy and has become acardiovascular and/or renal disease prognostic indicator for hypertensive subjects. Objectives: To establish the prevalence of MA among newly diagnosed hypertensive patients using thesimple spot urine Albumin-Creatinine Ratio (ACR). Method: : One hundred and eighty six newly diagnosed hypertensive patients were enrolled for assessment of MA using spot urine ACR. Those with overt proteinuria, diabetes mellitus, overt kidney disease and other potential causes of albuminuria were excluded. Spot urine was obtained for measurement of albuminand creatinine. Anthropometric variables were measured and body mass index calculated. All patients had echocardiographic assessment. Statistical analysis was performed using SPSS version 11.0 software. Multiple regression analysis was used in determining predictors of MA. A p-value of ≤ 0.05 was considered significant. Results: Results of 136 patients comprising of 66(48.53%) males and 70(51.47%) females was considered. The overall prevalence of microalbuminuria was 42.65%. Males had a prevalence of 51.52% compared to 34.27% for the females (p=0.29). Weight, BMI, LVM, LVMI, UAE, and ACR were significantly higher in patients with MA, whereas those without MA had a significantly higher urinary creatinine. Multiple regression analysis identified DBP, MAP, LVM and LVMI as significant predictors of increased urinary albumin excretion Microalbuminuria showed significant positive correlation with LVM and LVMI. Conclusion: The prevalence of microalbuminuria is high among untreated Nigerian hypertensive patients. The spot urine ACR provides a simple, accurate and cost effective way of identifying this high risk group of hypertensive patients, allowing for more aggressive treatment to reduce cardiovascular outcomes

Mortality pattern among tuberculosis patients on treatment in Nigeria: A systematic review and meta-analysis

Background: Tuberculosis (TB) has continued to be associated with a substantial number of deaths, even in the era of effective antimicrobials. Nigeria is one of the countries with a high tuberculosis burden and has sub-optimal documentation of TB related deaths. Vital statistics/registration is not robust, and mortality surveys are rarely undertaken. In this study, we aimed to determine a precise estimate of TB related deaths on treatment and the trends in death rate while on TB treatment in Nigeria. Methods: We searched electronic databases for eligible studies from 1st January 2000 to 31st December 2017. We generated pooled death rate estimates using random-effects models and determined trends using meta-regression. Results: We identified 546 studies, of which 28 fulfilled the criteria for quantitative analysis. Overall, studies reported on 64,999 individuals. The pooled TB death rate during treatment was 6.6% (95% CI; 5.2-8.1%). There was a non-significant rise in TB related deaths on treatment of 0.2% per year (p-value = 0.454). Conclusion: We found a low TB related deaths on treatment, death rate and slight temporal rise over the study years. There is a need for continuous vital registration, including TB related death, and mortality survey among TB patients

Anthropometric correlates of insulin resistance: a study of healthy Nigerian adults in Maiduguri

Indices of obesity, especially abdominal adiposity have been shown to correlate positively with the components of the metabolic syndrome in several studies. Objectives: The aim of this study was to determine the correlation between anthropometric indices and insulin resistance in healthy subjects. Methods: A representative sample of 100 subjects aged 15 to 70 years was recruited for the study. Weight, height, waist circumference (WC) and hip circumference were measured, while body mass index (BMI) and waist-to-hip ratio (WHR) were calculated for each participant. Fasting blood samples were drawn for plasma glucose and plasma insulin concentrations, respectively. The values obtained were used to calculate insulin resistance using the Homeostasis Model Assessment Method for Insulin Resistance (HOMA-IR). Results: Insulin resistance (IR) was found in 25(25%) of the study subjects. There were significant andpositive correlations between waist circumference and HOMA-IR (r=+0.20, p<0.05), as well as between BMI and HOMA-IR(r=+0.19, p<0.05).Both anthropometric indices however, only predicted 4.1% and 3.9% of the variation in HOMA-IR, respectively. The correlation between WHR and HOMA-IR was positive but non-significant (r=+0.12, p>0.05). Conclusion: Waist circumference exhibited the strongest correlation with HOMA-IR, closely followed by BMI and WHR. We recommend that measurement of waist circumference should continue to be used as a screening tool for identifying individuals with insulin resistance in our setting