Knowledge, attitude, willingness of HIV counseling and testing and factors associated with it, among long distant drivers in Enugu, Nigeria: an opportunity in reduction of HIV prevalence

Background: Long distance truck drivers (LDTDs) have been one of the key forces in the spread of HIV/AIDS across the African continent. Objective: We set out to assess the knowledge of HIV transmission route, preventive measures, attitude to HIV Counseling and Testing (HCT), willingness and factors associated with willingness to screen for HIV among long distance truck drivers in Enugu, Nigeria. Method: This was a cross-sectional study of 500 long distance truck drivers aged 19-65 years. They were interviewed with a semi-structured questionnaire on aspects of HCT. Data was analyzed using cross tabulations to examine associations and chi square test for various variables. Result: A good number of the respondents have wrong ideas of transmission route, ranging from 28.4% to 90.4%. Significantly high number of those with tertiary education will engage in incorrect preventive measures like using antibiotics after sex, and seeking protection from a traditional healer compared to those with no formal education ( \u3c7 2 = 3.2, p = 0.02; \u3c7 2 = 2.3, p = 0.01 respectively).. Those with tertiary education and those that were divorced showed a generally good attitude towards HCT and mostly agreed that HCT should be made compulsory compared to others (\u3c72 = 29.8, p< 0.001; \u3c72 = 10.1, p < 0.001 respectively). There was a significantly high willingness to screen among 302 (60.4%) of the participants. There was also significant association between marital status, educational level and willingness to screen ( \u3c72 = 174.4, p < 0.001; \u3c72 = 10.6, p < 0.001 respectively). Conclusion: A high number of LDTD had wrong knowledge of transmission route, better educational level did not affect incorrect knowledge of preventive measures, educational and marital statuses affected attitude to HCT, willingness to screen was high with marital status and educational level significantly associated with it. We recommend routine HCT at the work places of truck drivers to correct the anomalies discovered above

Prevalence of autonomic dysfunction among pre-dialysis chronic kidney disease patients in a tertiary hospital, South East Nigeria

Background: Autonomic dysfunction (AD) has been recognized as an important contributor to the poor outcome in chronic kidney disease (CKD) patients. Several studies have reported abnormalities in heart rate variability (HRV) among these patients. Objectives: To determine the prevalence of Autonomic Dysfunction (AD) in pre-dialysis Chronic Kidney Disease (CKD) patients in a tertiary hospital in South East Nigeria.Methods: A cross sectional study of eighty chronic kidney disease patients attending the renal unit out-patient in the University of Nigeria Teaching Hospital (UNTH) Enugu was carried out. Forty subjects, drawn randomly, who had no kidney disease served as control. Autonomic function was assessed with non – invasive cardiovascular tests including, measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing test, heart rate response to Vasalva manoeuvre and heart rate response to respiration. Results: With the battery of 5 tests used to assess AD, the frequency of autonomic dysfunction in pre-dialysis chronic kidney disease patients was 51.3% compared to 7.5% in the control group. Heart rate response to standing was the most sensitive test to detect AD in this group of subjects.  Conclusion: AD is a common problem among pre-dialysis CKD patients in Nigeria.  Keywords: Prevalence, autonomic dysfunction, pre-dialysis

High Prevalence and Low Awareness of Hypertension in a Market Population in Enugu, Nigeria

Background. A community-based study put the prevalence of hypertension in Nigeria at 32.8%. Market workers in Nigeria lead sedentary life style and often depend on salt-laden fast food while at work. Method. An unselected population of market workers were screened for hypertension and its risk factors by a pretested, structured questionnaire, clinical examination, and laboratory investigation. Hypertension was defined as BP ≥ 140 and/or ≥ 90 mmHg or being on drug therapy. Results. Forty-two percent of the screened population were hypertensive. Of this number, 70.6% did not know they were hypertensive before the screening. More males than females (P = .022) were hypertensive. Prevalence of hypertension increased with age from 5.4% in the age group <20 years to 80% in the age group ≥70 years. Conclusion. The prevalence of hypertension in market workers in this study was 42%, and the majority of them were unaware of their disease

Prevalence of autonomic dysfunction among pre-dialysis chronic kidney disease patients in a tertiary hospital, South East Nigeria

Background: Autonomic dysfunction (AD) has been recognized as an important contributor to the poor outcome in chronic kidney disease (CKD) patients. Several studies have reported abnormalities in heart rate variability (HRV) among these patients. Objectives: To determine the prevalence of Autonomic Dysfunction (AD) in pre-dialysis Chronic Kidney Disease (CKD) patients in a tertiary hospital in South East Nigeria. Methods: A cross sectional study of eighty chronic kidney disease patients attending the renal unit out-patient in the University of Nigeria Teaching Hospital (UNTH) Enugu was carried out. Forty subjects, drawn randomly, who had no kidney disease served as control. Autonomic function was assessed with non \u2013 invasive cardiovascular tests including, measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing test, heart rate response to Vasalva manoeuvre and heart rate response to respiration. Results: With the battery of 5 tests used to assess AD, the frequency of autonomic dysfunction in pre-dialysis chronic kidney disease patients was 51.3% compared to 7.5% in the control group. Heart rate response to standing was the most sensitive test to detect AD in this group of subjects. Conclusion: AD is a common problem among pre-dialysis CKD patients in Nigeria

Prevalence of CKD-MBD in pre-dialysis patients using biochemical markers in Enugu, South-East Nigeria

Background: As kidney function declines, there is a progressive deterioration in mineral homeostasis with disruption of normal serum and tissue concentration of phosphorus and calcium, and changes in circulating levels of hormones-parathyroid hormone (PTH), calcitriol (1,25(OH)2 D), and Fibroblast growth factor-23 (FGF-23). Objective: This study was aimed at determining the prevalence of markers of CKD-MBD in pre-dialysis patients. Methods: We evaluated consecutively 168 subjects made up of 85 CKD patients and 83 healthy controls, who were attending the renal clinics and medical outpatient of University of Nigeria Teaching Hospital, Enugu. GFR was estimated and serum calcium, phosphorus, alkaline phosphatase, PTH, and 25(OH) D levels assayed. Results: The prevalence of various mineral bone disease abnormalities were 70% hyper-phosphatemia, 85% hyper-parathyroidism, and 100% low levels of 25 (OH) D among the patients. Estimated GFR correlated negatively with both serum phosphorus, and PTH. Age of the patients ranged from18-76 years with a male to female ratio of 1.7:1. Chronic Glomerulonephritis (CGN), hypertension and diabetes mellitus caused CKD in 75% of the patients. There was no significant decrease in serum calcium levels of patients compared to controls. The patients did not have pathologically raised alkaline phosphatase, although their mean level was significantly higher than that of the control group. Conclusion: Low 25 (OH) D levels (insufficiency/deficiency), hyperparathyroidism, and hyper-phosphatemia were the obvious markers of CKD-MBD in our pre-dialysis patients. These should be evaluated at presentation in these patients

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Background. A community-based study put the prevalence of hypertension in Nigeria at 32.8%. Market workers in Nigeria lead sedentary life style and often depend on salt-laden fast food while at work. Method. An unselected population of market workers were screened for hypertension and its risk factors by a pretested, structured questionnaire, clinical examination, and laboratory investigation. Hypertension was defined as BP ≥ 140 and/or ≥ 90 mmHg or being on drug therapy. Results. Forty-two percent of the screened population were hypertensive. Of this number, 70.6% did not know they were hypertensive before the screening. More males than females (P = .022) were hypertensive. Prevalence of hypertension increased with age from 5.4% in the age group &lt;20 years to 80% in the age group ≥70 years. Conclusion. The prevalence of hypertension in market workers in this study was 42%, and the majority of them were unaware of their disease

Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges

Sub-Saharan Africa (SSA), occupying about 80% of the African continent is a heterogeneous region with estimated population of 1.1 billion people in 47 countries. Most belong to the low resource countries (LRCs). The high prevalence of end-organ diseases of kidney, liver, lung and heart makes provision of organ donation and transplantation necessary. Although kidney and heart transplantations were performed in South Africa in the 1960s, transplant activity in SSA lags behind the developed world. Peculiar challenges militating against successful development of transplant programmes include high cost of treatment, low GDP of most countries, inadequate infrastructural and institutional support, absence of subsidy, poor knowledge of the disease condition, poor accessibility to health-care facilities, religious and trado-cultural practices. Many people in the region patronize alternative healthcare as first choice. Opportunities that if harnessed may alter the unfavorable landscape are: implementation of the 2007 WHO Regional Consultation recommendations for establishment of national legal framework and self-sufficient organ donation/transplantation in each country and adoption of their 2020 proposed actions for organ/transplantation for member states, national registries with sharing of data with GODT, prevention of transplant commercialization and tourism. Additionally, adapting some aspects of proven successful models in LRCs will improve transplantation programmes in SSA