Unaffordability of renal replacement therapy in Nigeria

AbstractWith the increase in epidemic proportions of diabetes worldwide, the number of patients who will require renal replacement therapy (RRT) will be a great challenge to the health infrastructures of developing countries such as Nigeria. Because those mostly affected are in the economically productive age group, a vicious circle is established whereby those who keep the economy going are the same people affected. Secondary and tertiary care of chronic kidney disease involving RRT would exact disproportionate toll on the income of patients in the developing world where patients pay out of pocket for their own care. Whilst there is an increase in the number of facilities offering RRT, there is no commensurate sustainability of care either by the patients themselves or even by the government. The level of unemployment is increasing. Kidney transplantation is out of reach in addition to the cost of post-transplant care, which includes hospitalization and immunosuppressive medications. Most of the end-stage kidney disease patients who enlisted in our dialysis program were unable to get or sustain adequate hemodialysis. The data also showed that more men were dialyzed at our facilities over the period under review and the age distribution has not changed much over the decade. From this dismal picture in the last decade emerges a series of questions as to why this is so and what must be done to increase access to RRT. Prudent fund management and cost containment, local manufacture of dialysis materials and nongovernmental sources of funding are means of driving down the cost of dialysis. In countries where drugs and equipment for health services are locally manufactured, such as India and other countries, the cost of health care is more affordable than in countries such as Nigeria where these are imported.在全世界，糖尿病的盛行率與日俱增，然而對於發展中國家如尼日利亞，基礎醫療架構並不足以應付患者對腎置換療法 (RRT) 的需求。本地民眾必須自費支付自身的醫療費用，但其收入水平遠不足以負擔慢性腎病二級與三級照護所需的 RRT。即使目前 RRT 設施已有所增加，但無論是患者或政府均難以維持治療的長期實施。此外，腎臟移植所需的資源在本地更是相當之有限。在被我們納入透析計劃的末期腎病 (ESKD) 患者間，大多數並未能接受足夠或持續的透析治療。過去十年間，在我們設施內接受透析的病人中，年齡分佈大致穩定，且男性佔較多數。目前，我們正研究如何能促進 RRT 普及實施的方案。透過謹慎的理財與成本控制、透析物料的本土生產、及非政府資金的運用，透析的相關費用可望得以降低。目前，發展中國家如尼日利亞的藥物與醫療器材大多仰賴進口，因此相關物資的本土生產是降低醫療成本的可行方案

Occurrence of antibiotic-resistant Staphylococcus aureus in some street-vended foods in Ogun State, Nigeria

Staff PublicationFood borne illnesses of microbial origin are a major international health problem associated with food safety and an important cause of death in developing countries. This study was carried out to investigate the occurrence of antibiotic-resistant Staphylococcus aureus in some street-vended foods in Ogun State, Southwerstern Nigeria. A total of 140 street-vended food samples which included 20 samples each of fish sausages, meat sausages, fried fish, fried meat, fried yam, moin-moin and jollof rice were purchased from vendors in three different communities (Sabo, Isale-Oko and Makun) in Sagamu, Ogun State, Nigeria. Demographic survey was carried out on the hygienic and safety attitudes cultivated by the vendors recruited for this study. Microbiological analyses were carried out on the food products to isolate typical S. aureus strains. The samples were serially diluted and dilution factors of up 10-6 were cultured on Mannitol salt agar medium employing the spread plate technique. The disc-diffusion method was employed to determine the antibiotic resistance patterns of the isolated S. aureus strains. Most vendors were aware of the heath risk associated with unhygienic practices. Percentage products contaminated ranged from 0%, as obtained from fried yam, to 40% obtained from fish sausages. Prevalence of S. aureus strains obtained from samples ranged from 0 (as in fried yam) to 5.20 + 1.2 cfu ml-1 (as obtained from jollof rice). The isolates were subjected to antibiotic susceptibility assay employing the disc diffusion technique. Results on the resistance patterns of the isolated S. aureus strains revealed that resistance was highest to gentamycin (45.8%) and lowest to cotrimoxazole (4.2%) and erythromycin (4.2%). In conclusion, street vended food samples are frequently contaminated with S. aureus and that these could serve as potential vehicle for the transmission of resistant strains of the pathogen. Increased resistance of S. aureus to certain broad spectrum antibiotics such as gentamicin and amoxicillin should stimulate the interest of researchers

Development, Implementation, and Process Evaluation of a Theory-Based Nutrition Education Programme for Adults Living With HIV in Abeokuta, Nigeria

Introduction: Healthy diets play a role in the management and care for adults living with HIV/AIDS (ALH). Appropriate nutrition education (NE) is necessary to equip ALH with relevant knowledge and skills for healthy eating. A needs assessment identified the need for a nutrition education programme (NEP) as part of the nutrition service for ALH in Abeokuta, Nigeria. The aim of this study was to design a theory-based NEP and to evaluate the implementation process among ALH attending selected federal and state hospitals in Abeokuta as out-patients.Materials and Methods: An exploratory descriptive needs assessment in the qualitative and quantitative domains was conducted among a convenient sample of ALH (N = 243) at the selected hospitals. The quantitative needs assessment identified needs for improvement in the primary outcome [quality of life (QoL)] and the secondary outcomes [quality of dietary intake, nutrition knowledge, attitudes, and practice (KAP), and anthropometric status]. Participants' perceptions of the NEP were obtained using an interviewer administered questionnaire among 70 ALH who attended the implementation of the NEP and process evaluation thereof at the intervention hospital.Results: The qualitative results identified a lack of knowledge on planning varied meals with limited resources. The identified needs, existing guidelines and literature were integrated with appropriate constructs of the Social Cognitive Theory (SCT) and the Health Belief Model (HBM) into the NEP. The NE manual, participant's work book, flipcharts, and the brochure were tailored to address the identified challenges.Discussion: The process evaluation showed that the NEP was implemented as planned and that the participants' perceptions were positive. The use of the NE manual, participant's work book, flipcharts, and brochure demonstrated the practicality of incorporating behavioral theories in NE for ALH

Partial Purification, Characterization and Application of Bacteriocin from Bacteria Isolated Parkia biglobosa Seeds

Staff PublicationBacteriocins are proteinaceous toxins produced by bacteria to inhibit the growth of similar or closely related bacterial strains. Fermented Parkia biglobosa seeds (African locust bean) were screened for bacteriocin-producing lactic acid bacteria (LAB) with the characterization of putative bacteriocins. Bacteriocin-producing lactic acid bacteria (LAB) were identified by 16s rDNA sequencing. Molecular sizes of the bacteriocins were determined using the tricine-sodium dodecyl sulphate-polyacrylamide gel electrophoresis (tricine-SDS–PAGE) and effects of enzymes, pH, detergents and temperature on bacteriocin activity investigated, using standard procedures. Bacteriocins production and activities were measured by spectrophotometric analysis. Statistical analysis was carried out using student t-test and Analyses of Variance. Bacteriocigenic LAB isolated were Lactobacillus plantarum Z1116, Enterococcus faecium AU02 and Leuconostoc lactis PKT0003. They inhibited the growth of both Gram-positive and Gram-negative bacteria. The sizes of bacteriocins Z1116, AU02 and PKT0003 were 3.2 kDa, 10 kDa and 10 kDa, respectively. The synergistic effects of characterized bacteriocins and rifampicin tested on organisms showed significant differences (P < 0.05), as compared with the effects of only one of the two. The antimicrobial activity of the three bacteriocins was deactivated after treatment of the cell-free supernatants with proteinase K, papain, pepsin and trypsin. Parkia biglobosa seeds are, therefore, rich in LAB bacteriocins which could be explored. The biosynthetic mechanisms of LAB bacteriocins could be employed in food safety and security, preservation, peptide design, infection control and pharmacotherapy. This should help in the control of undesirable bacteria and in designing more potent and selective antimicrobial peptides

Microbial quality of utility water at universities in Nigeria

Staff PublicationAims: Water is described as safe and wholesome when it is free from pathogenic microorganisms and chemical substances that are hazardous to human health. This study aimed to investigate the microbial quality of water used for drinking, cooking, bathing and other purposes at universities in Nigeria. Methodology and results: Water samples were collected from forty-four storage tanks across four selected universities. Total viable bacteria in the water samples were cultivated using the plate count agar. The isolation of total coliform and Escherichia coli were carried out on Harlequin™ E. coli/coliform agar (HA) medium, while media-faecal coliform was used for faecal coliform employing the membrane filtration technique. Physicochemical parameters such as alkalinity, pH, total alkalinity, total dissolved solid, total suspended solid, electrical conductivity, total hardness, fluoride and chloride ion concentrations, were evaluated in accordance with standard procedures. Data were compared statistically using MedCalc statistical software. Considering the heterotrophic bacterial counts, all water samples were unsatisfactory. For the total coliform counts, 50% of samples were satisfactory but suspicious, while remaining 50% were unsatisfactory. Faecal coliforms results showed that 50% of samples gave excellent quality, 25% showed satisfactory but suspicious quality, while 25% showed unsatisfactory result. There were no significant differences in the total viable, total coliform and E. coli counts of water sampled from universities A and D (p>0.05). The predominant bacterial species was Pseudomonas aeruginosa (23.17%), while the least encountered was Salmonella typhimurium (2.44%). All physicochemical parameters tested were within the acceptable limit. Conclusion, significance and impact of study: This study revealed that the water used by students of studied universities was contaminated with potential bacterial pathogens. However, all physicochemical parameters tested were within the permissible standard limits and satisfied the requirements for domestic utility

A nutrition education programme improves quality of life but not anthropometric status of adults living with HIV in Abeokuta, Nigeria

OBJECTIVE : The focus of interventions for adults living with HIV (ALH) in Nigeria has been mostly on prevention and provision of antiretroviral therapy (ART) with little consideration to nutrition-related matters. Therefore, the present study aimed to improve the quality of life (QoL) and anthropometric status of ALH in Abeokuta, Nigeria. DESIGN : A quasi-experimental design where 200 conveniently selected participants were stratified by gender and duration on ART. The intervention group (n 100) received the nutrition education programme (NEP) for 12 weeks. The control group received a brochure on nutrition guidelines for ALH. Socio-biographical information, QoL and anthropometric status were assessed using previously validated questionnaires and standard techniques at baseline, week 12 and week 24. Generalised least squares (GLS) regression analysis was used for group comparisons. Anthropometric status was summarised by gender. SETTING : Two tertiary hospitals in Abeokuta, Nigeria. PARTICIPANTS : ALH. RESULTS : TheNEP led to significant improvement in the physical functioning (week 12 and 24: P < 0·01), role limitation due to physical health (week 12: P = 0·01; week 24: P = 0·002) and pain (week 12: P = 0·01) constructs of the QoL of the intervention group compared with the control group. There was no significant difference (P = 0·07) between the mean weights of the two groups at baseline. CONCLUSIONS : There was a significant improvement at week 12 and week 24 in the QoL of the intervention participants. The results indicated that a tailored NEP could make a positive contribution to the management of ALH.The Department of Research and Innovation (DRI) of the University of Pretoria, Tertiary Education Trust Funds (TET Funds) and Red Cross International Lagos branch. The University of Johannesburg and National Research Foundation of South Africa is acknowledged for the postdoctoral fellowship support for first author (T.B.K.).https://www.cambridge.org/core/journals/public-health-nutrition2020-05-14am2019Human Nutritio