Knowledge and Practice of Cervical Cancer Screening amongst Nurses in Ahmadu Bello University Teaching Hospital Zaria

Cervical cancer is both preventable and curable, yet morbidity and mortality from the disease remain high especially in developing countries. Request for cervical cancer screening by Pap smear and cytology or any other screening methods have been found to be exceedingly low even among health workers. This study was conducted to examine the knowledge, attitude and practice of cervical screening among female nurses in Ahmadu Bello University Teaching Hospital Zaria, with a view to identifying defining variables of attitude and practice of cervical screening. Data was collected from a convenience sample of 117 nurses through a self-administered questionnaire. Those who were not aware of cervical cancer screening (n=3) were excluded. A descriptive analysis of the data collected from 114 of the nurses who were aware of the screening revealed that awareness and knowledge of the cervical cancer screening was very high but they exhibited indifference and negative attitude, and low personal screening practices. Several reasons were put forward for this low level of practice among which were fears of test being positive and non consent from husbands. This finding among nurses being agents of such health education calls for concern. It is therefore recommended that concerted efforts should be made to dispel the fears of outcome of test and to incorporate husbands into future health education of married female nurses. This will increase the number of nurses who will go for voluntary cervical cancer screening. Keywords: Cervical cancer screening, Pap smear, Cancer prevention, Knowledge, Practic

Seroprevalence of hepatitis C virus antibodies amongst blood donors in Ahmadu Bello University Teaching Hospital (ABUTH) Kaduna

Background: Hepatitis C virus (HCV) is one of the most common transfusion transmissible infections hence the introduction of routine screening for its antibodies in blood donors in most blood banks. Methods: This was a retrospective study in which the blood donor screening register for all intending donors were reviewed and analyzed. Results: There were 4,731 potential donors with age range 20-41years. Eighty six (1.8%) were sero-positive to HCV antibodies with a decreasing incidence over the period under review. The highest incidence was recorded the age group 31-40 years. Aim: To determine the sero-prevalence of HCV among blood donors in ABUTH Kaduna. Conclusion: HCV infection is not uncommon in our environment hence the need to emphasize it’s routine screening among all potential donors.

Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to$24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and$195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential

Erythropoietic response to anaemia of dialysis naïve patients with chronic kidney disease in Zaria, north west Nigeria

Introduction: Chronic kidney disease (CKD) is a global health problem with an increasing prevalence worldwide. Anemia is one of its consistent and severe hematological complications although its mechanism is not fully elucidated. The primary defect could manifest as serum erythropoietin (sEPO) deficiency or EPO resistance. We set out to determine the erythropoietic response to anemia of patients with CKD and its relationship with their iron status in a cross‑sectional descriptive study of 91 patients in various stages of CKD.Materials and Methods: Soluble transferrin receptor (sTfR), sEpo, and serum ferritin levels were determined using ELISA method (Diagnostic Automation Inc and WKEA med supplies corp.). Data generated were analyzed using Epi Info version 3.5.3 and level of statistical significance was set at ≤0.05.Results: Participants comprised of 50 females (54.9%) and 41 (45.1%) males with an overall mean age of 47 ± 15 years. The major causes of CKD were hypertension (HTN) (50.54%), diabetes mellitus (DM) (6.59%), and HTN + DM (19.78%). The mean hemoglobin (Hb) concentration of the participants was 10.97 ± 2.28 g/dl; the red cell indices were within normal ranges except for Red cell distribution width‑Coefficient of variation (%) which was elevated (16.29%). The mean serum ferritin, sTfR, and sEpo were 70.58 ± 46.44 ng/ml (interquartile range [IQR] 82.00), 22.9 ± 49.7 ng/ml (IQR 15.00), and 12.49 ± 33.47 IU/L (IQR 6.00), respectively, with a high variance. Serum ferritin and sTfR are consistentlylow across the stages of CKD (range between 54.54 ng/ml and 88.64 ng/ml), but sEPO for stage 3 and 4 showed a 2‑fold increase when compared to normal level at Hb 10.97 g/dl (29.54 IU/L and 38.83 IU/L, respectively). Correlation between sTfR and sEpo (r2 = 0.96, P = 0.001), while between sEpo and serum ferritin (r2 = 0.02, P = 0.185), and between Hb and stage of CKD undulating (r2 = 0.41, P = 0.001).Conclusion: In contrast to some existing literature, this study has demonstrated that EPO resistance and iron deficiency contributes to anemia in CKD and serumferritin can be used to assess the iron level of dialysis naïve CKD patients at every stage of the disease.Keywords: Chronic kidney disease, erythropoietin, serum erythropoietin, serum ferritin, serum transferrin recepto

Protein C and antithrombin levels in patients with sickle cell anemia in Ahmadu Bello University Teaching Hospital Zaria

Background: Alterations in the components of hemostasis, namely platelet function, the procoagulant, anticoagulant, and the fibrinolytic systems, are observed in sickle cell anemia (SCA) and are in favor of a procoagulant phenotype. Therefore, study of protein C and antithrombin (AT) levels in patients with SCA in steady state may be used in the treatment and/or prevention of SCA-related thrombotic complications. We studied the changes of these naturally occurring anticoagulants in patients with SCA attending the sickle cell clinic in Ahmadu Bello University Teaching Hospital, Zaria.Methods: We conducted a case–control study involving 50 SCA (HbSS) patients in the steady state as cases and 25 healthy volunteers with normal hemoglobin (HbAA) as controls. Protein C and AT levels were estimated by semi-automation using Diagnostica Stago hematology coagulation analyzer. Frequencies, proportions, and independent t test were performed using SPSS version 20.Results: The mean ages of both the patients and controls were 23.80 ± 7.46 and 24.28 ± 3.48 years, respectively, and study participants comprised 40 (53.0%) women between the ages of 15–50 years and 15–34 years (P = 0.76). The mean values of protein C and AT levels in patients with SCA in the steady state and the control group were 60.26 ± 20.58% versus 81.30 ± 19.74%, 95% CI 11.13–30.96, and 42.11 ± 5.01% versus 61.88 ± 11.27%, 95% CI 16.03–23.51 with P values (P < 0.001), respectively.Conclusions: This study showed that there was a significant decrease in the levels of protein C and AT between the SCA patients in the steady state and the controls. We recommend baseline investigations of these naturally occurring anticoagulants in patients with SCA, especially in those with frequent vaso-occlusive crises. This will give us an insight into the additional pathophysiologic mechanism in SCA-related thrombotic complications for better patient management and outcome.Keywords: Antithrombin, hemostasis, protein C, sickle cell anemia, steady state