Study of antimicrobial prescribing at a secondary health facility in a semi-urban community in Bayelsa State, south-south Nigeria

Background: Monitoring antimicrobial prescribing helps generate data to inform local policies on antimicrobial use and guides estimations for their stocking.Objectives: To assess utilization of antimicrobial agents, diagnosis and management of infections as well as associated drug therapy problems (DTPs) at a secondary health facility in Bayelsa State.Materials and Methods: In a retrospective study, case notes belonging to 1,278 patients who attended clinics at the study center from January 1st to December 31st, 2016 and who were prescribed at least an antimicrobial agent each for the treatment of infection were evaluated. Of these, 320 were retained for study having met completeness of prescription items. Data obtained were expressed in simple percentages while average values were presented in mean ± standard deviation (SD).Results: Two hundred and ninety-seven (92.8%) of the retained case notes were actually diagnosed with infections. In all, 24.8% of the 467 cases of infections treated were confirmed with requisite laboratory tests with 43.5, 19.9, and 13.1% of all being malaria, typhoid fever, and respiratory tract infections, respectively amongst others. Antibacterial (46.6%), antimalarial (35.5%), and anthelmintic (9.6%) agents were the most prescribed antimicrobial drugs. Respective average numbers of infections treated and antimicrobials prescribed per encounter were 1.47 ± 0.71 and 2.19 ± 0.97, and each prescription contained an average of 0.89 ± 0.86 DTP.Conclusion: Most of the antimicrobial prescribing were done without requisite diagnostic tests and each of the prescriptions contained at least a DTP necessitating a need for the education of the prescribers on rational use of antimicrobials.Keywords: Antimicrobial agents, communicable diseases, Niger Delta Are

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Medication management of hypertension and diabetes mellitus at two referral health institutions in Bayelsa State, Nigeria: a prospective study

Despite the call for timely diagnosis and management of hypertension (HTN) and diabetes mellitus (DM), recent developments in outcomes of their medication management in concerned patients remain largely unimpressive. This study is aimed at assessing the impact of pharmacist-led health educational intervention on outcomes of medication management as well as drug utilization among hypertensive and/or diabetic patients attending clinics at the Federal Medical Center and Niger Delta University Teaching Hospital in Bayelsa State, Nigeria. Following ethical approval, 430 hypertensive and/or diabetic patients were recruited and studied prospectively. Their blood pressure (BP), fasting plasma glucose (FPG), and drug utilization pattern (DUP) were first assessed after which patient- and healthcare professional- (comprising Physicians, Pharmacists, and Nurses) focused health-educational intervention was done. Subsequently, they were followed up for a period of 10 months. The parameters (including BP, FPG, DUP, and prevalence of resistant HTN) for those patients (n = 307) not lost to follow-up were determined and compared with their pre-intervention data. Data generated were analyzed using descriptive statistics, Student t-test, Fisher’s Exact and Chi-square tests. A 2-tailed p-value < 0.05 was considered significant. In this study, 66.1, 26.1, and 7.8% of the cohort had HTN alone, comorbid HTN and diabetes, and diabetes alone, respectively. Proportion of hypertensive patients with controlled BP increased from 31.5% before intervention to 51.2% after intervention (p < 0.0001) while the prevalence of resistant HTN reduced from 34.6% to 27.9% correspondingly. There was no significant difference in the proportion of diabetic patients with controlled FPG before and after intervention (p > 0.05). Diuretics (37.8% vs. 31.4%), calcium channel blockers (23.9% vs. 22.0%), and angiotensin converting enzyme inhibitors (16.4% vs. 16.4%) were the most prescribed antihypertensive drugs both pre- and postintervention, respectively. The most prescribed antidiabetic agents were the biguanides (52.6% vs 54.1%) and sulphonylureas (36.8% vs 37.3%), before and after intervention, respectively. The health educational intervention adopted in the study improved outcomes of medication therapy among the hypertensive patients but not in the diabetics. Diuretics and the biguanide (metformin) were the most prescribed drugs for HTN and diabetics, respectively.Keywords: Blood pressure, hyperglycemia, health-educational intervention, Niger Delt

Acute phase proteins and immunoglobulin classes in newly diagnosed Nigerian schizophrenic patients and those on anti psychotic drug treatment

Background: No single organic cause has been found for schizophrenia and its management has been difficult. More so, there are few data on the immune parameters of Nigerian schizophrenic patients on drug treatment and those that are not on treatment.Methodology: This study determines the levels of immunoglobulinclasses (IgG, IgA, and IgM) and acute phase proteins (caeruloplasmin, haptoglobin, transferrin and alpha 2- macroglobulin) in schizophrenic patients that are on drug treatment and those that are not on drug treatment compared with the controls.Results: The mean level of IgG was significantly reduced in newlydiagnosed drug free schizophrenic patients compared with controls(p=0.00) or with those on treatment (p=0.00). The mean level oftransferrin was significantly reduced in newly diagnosed drug freeschizophrenic patients compared with controls (p=0.00) or with thoseon treatment (p=0.00).Conclusion: This study suggests the use of IgG and transferrin asindicators of drug compliance/efficacy in schizophrenic and inassessing the severity of schizophrenia.Keywords: Schizophrenia, transferrin, anti-psychotic drugs, Nigeria and immunoglobulin

Prevalence and control of hypertension in a Niger Delta semi urban community, Nigeria

Background: Hypertension is a public health problem worldwide, but the prevalence in Amassoma, Southern Ijaw Local Government Area is not known. Objective: To investigate the prevalence of hypertension in the locality and the extent of control in diagnosed cases. Methods: It is a prospective study involving interviewing. Four hundred adults aged 20 years and above selected through stratified random sampling across the various compounds called "AMA"; a unit of settlement comprising extended families of common ancestors. A self-developed, validated and pretested interviewer-administered questionnaire on demographics, predisposing factors, and medication history was used. In addition, measurement of respondents´ blood pressure, weight and height was carried out. The Body Mass Index calculated and the data were appropriately analysed. Results: The response rate of questionnaire distribution was 100.0% being interviewer administered alongside weight, height and blood pressure measurement. Majority of respondents were female. Almost half of respondents (46.5%) had their BMI above normal, 15.3% (61) of which falls within the obese region (>30.0kg/m2). The mean (SD) systolic blood pressure among males was 133.3 (3.2) mmHg and that of females was 127.4 (3.0) while the mean (SD) diastolic blood pressures were 86.2 (1.7) and 83.9 (2.4) for males and females respectively. Crude prevalence rate of hypertension in the community was 15.0% (60) out of which 13.8 % (55) were previously diagnosed. The hypertension was that of Stage I in 11.5% (46) and Stage II in 3.5% (14). Hypertension prevalence was slightly higher in males (18.8%) than that of the females (12.5%) (p= 0.0889), Relative Risk (RR)=1.500 [95%CI 0.9422:2.388]. The prevalence rate among 40 years and above was 41.6% (42/101) who also constituted 70.0% (42/60) of participants with hypertension in the survey and 10.5% (42/400) of the total. Of the previously diagnosed cases of hypertension, only 31% (17/55) were taking their drugs during the survey and only 12.7% (07/55) had regular adherence to medication and adequate BP control was achieved in 7.3% (04/55). Majority of the patients on drugs (21.8%) (12/55) were either taking methydopa as monotherapy or in combination with amiloride and hydrochlorothiazide. Other drugs being taken by patients include lisinopril, propranolol, amlodipine, atenolol, nifedipine and low dose aspirin. Conclusion: The prevalence of hypertension in the semi urban community is 15.0% with a prehypertension in another 23.5%. There was poor control of blood pressure among previously hypertensive patients.Antecedentes: La hipertensión es un problema de salud pública mundial, pero la prevalencia en Amassoma, Región del gobierno local de Southern Ijaw, es desconocida. Objetivo: Investigar la prevalencia de hipertensión en la localidad y el grado de control de los casos diagnosticados. Métodos: Estudio prospectivo que incluyó una entrevista. Se seleccionó a 400 adultos de 20 años o más mediante un muestreo aleatorio estratificado en los varios sectores llamados "AMA"; la unidad familiar comprendía las familias con los antepasados comunes. Se utilizó un cuestionario auto-desarrollado, validado y pre-testeado administrado por encuestador sobre demografía, factores predisponentes y medicación. Además, se realizó una medición de presión arterial, peso y altura de los respondedores. Se calculó el índice de masa corporal y se analizaron los datos pertinentemente. Resultados: La tasa de respuesta de la distribución del cuestionario fue del 100%, siendo el entrevistador quien midió peso, altura y presión arterial. La mayoría de los respondentes eran mujeres. Casi la mitad de los respondentes (46,5%) tenían un IMC por encima de lo normal, 15,3% (61) de ellos estaban en la zona de obesidad (>30,0 kg/m2). La media (DE) de la presión arterial sistólica entre hombres era de 133,3 (3,2) mmHg y en mujeres de 127,4 (3,0), mientras que la media (DE) de la presión arterial diastólica fue de 86,2 (1,7) y de 83,9 (2,4) para hombres y mujeres, respectivamente. La tasa de prevalencia cruda de hipertensión en la comunidad fue del 15,0% (60) de los que el 13,8% (55) habían sido previamente diagnosticados. La hipertensión era de estadio I en el 11,5% (46) y de estadio II en el 3,5% (14). La prevalencia de hipertensión fue ligeramente mayor en hombres (18,8%) que en mujeres (12,5%) (p=0,0889; riesgo relativo (RR)=1,500 [IC95%= 0,9422:2,388]. La tasa de prevalencia entre los de 40 años o más fue del 41,6% (42/101) que también constituían el 70,0% (42/60) de los participantes con hipertensión en el estudio y el 10,5% (42/100) del total. De los casos previamente diagnosticados de hipertensión, sólo el 31% (17/55) estaban tomando medicamentos regularmente durante la encuesta y sólo el 12,7% cumplían regularmente la medicación y se alcanzó el control adecuado de la presión arterial en el 7,3% (4/55). La mayoría de los pacientes medicados (21,8%) (12/55) estaban o con metildopa en monoterapia o en combinación de amiloride and hydrochlorothiazide. Otros medicamentos utilizados incluían lisinopriolo, propranolol, amlodipina, atenolol, nifedipina y bajas dosis de aspirina. Conclusión: La prevalencia de hipertensión en el área semi-urbana es del 15,0% con una prehipertensión en otro 23,5%. Había in pobre control de la presión arterial entre los pacientes previamente diagnosticados

Health-Related Quality of Life (HRQOL) of Hypertensive and Diabetic Patients in Two Tertiary Health Institutions in Niger Delta Region, Nigeria

Background: With the ever increasing prevalence of hypertension and diabetes mellitus in Nigeria, a major issue in their care is the improvement of patients' HRQoL.Objectives: To assess the HRQoL of hypertensive and diabetic patients attending cardiology and endocrinology clinics of two tertiary health institutions in Bayelsa State, Niger Delta region, Nigeria.Methods: Short form-12v2® Health Survey questionnaire was administered to randomly selected 600 hypertensive and/or diabetic patients attending the cardiology and/or endocrinology clinics of the facilities (from May to December, 2013) to evaluate their HRQoL. The instrument assessed majorly the physical and mental component summaries (PCS and MCS) scores relative to the general population norm (50±10). Data generated were appropriately analyzed and presented using descriptive statistics.Results: Patients' response rate was 82.0% with males constituting 57.5% of the respondents. Most (54.9%) of the respondents were hypertensive, while 129(26.2%) were diabetic with 18.9% of the cohort being both hypertensive and diabetic. The average PCS and MCS scores were 45.05±7.46 and 52.25±9.12 respectively. Physical Functioning (PF, 46.05±9.49), Role-Physical (RP, 44.31±7.99), Bodily Pain (BP, 47.37±9.32), and General Health (GH, 45.72±10.26) that constitute the PCS were all below the general population norm (50±10). However, Vitality (VT, 57.10±9.56) and Mental Health (MH, 53.83±9.04) scales in the MCS were both above the general population norm. An appreciable proportion of the subjects (15.0%) were at risk of screening positive for depression. Overall HRQoL (48.31±10.33) was below the expected norm.Conclusion: The HRQoL of patients studied is relatively poor and a reasonable proportion may be at risk of developing depression. This suggested suboptimal outcome of therapy and the need for improved adherence to therapy and overall patient management.Keywords: Bayelsa State; diabetes; hypertension; quality of life; Niger Delta

Efficiency of cassava steep liquor for bioremediation of diesel oil-contaminated tropical agricultural soil

Soil artificially contaminated with diesel oil, treated with cassava steep liquor (CSL) and designated EXPS. Similar polluted soil without CSL amendment (CSSl) and uncontaminated soil (CSS2) served as controls. There were dramatic changes in the physic-chemistry of systems EXPS and CSSl with utilization of the inorganic nutrients to near-depletion in the former than the latter. In contrast, the properties of CSS2 remained relatively stable throughout the investigated period. Similarly, the population densities of microflora in the polluted soils showed an initial decrease between days 0 and 5 before assuming an increasing trend with percent hydrocarbon-utilizers ranging significantly (P < 0.05) from 0.56 to 6.6, 0.1 to 2.46 and 0.56 to 0.26, respectively for EXPS, CSSl, and CSS2. In EXPS, the residual oil decreased from 98,045 to 1,102.3 mg/kg soil at day 35 representing about 98.88% degradation. The corresponding value for CSSl was 98,106.1 to 52,110 mg/kg soil, amounting to 46.88% oil disappearance. The GC finger prints of alkane fractions of the recovered oil reduced significantly by day 15 for EXPS with near-similar results of CSSl. However, by day 35, there was complete disappearance of all peaks including the pristane and phytane molecules in the former whereas in CSS1, there were no observable changes. The germination and growth profiles of maize seed plants as evidence of recovery of oil-impacted soils were poor in CSS1 (10%) with pronounced abnormal morphology when compared with the data obtained for EXPS (74%) and CSS2 (80%). These results suggest that CSL could be an indispensable tool in bioremediation of environments contaminated with hydrocarbons. The technology of application is simple, rapid and cost-effective and may be appropriate for use in developing countries to ameliorate the problems of petroleum pollutio