Knowledge of Renal Nurses on Factors of Arteriovenous Fistula Failure in Hemodialysis Patients in Ikeja Lagos State

Arteriovenous fistula is a popular vascular access in patients for hemodialysis. However, it is threatened with high rate of failure. The failure of arteriovenous fistula results to high cost and wastage for the patient and the healthcare agency. This study assessed the knowledge of renal nurses on factors of arteriovenous fistula failure in hemodialysis patients in two dialysis centers in Lagos State, Nigeria.This study adopted a descriptive design using structured questionnaire for data collection.  The questionnaire was administered to 62 renal nurses with 60 copies retrieved representing 97% return rate. Data obtained were analyzed by descriptive and inferential statistics using Statistical Package for Social Sciences (SPSS) version 21.Results show that 60 (100%) of the nurses have adequate knowledge of arteriovenous fistula failure in hemodialysis patients. Findings show that 56(93.3%) of respondents use Rope Ladder Button Hole and Area Puncture needling techniques and 58(96.7%) perform the first cannulation of the AVF within 6 – 8 weeks after its creation. Tests of hypotheses reveal a significant relationship between nurses’ knowledge and arteriovenous fistula failure with (P=0.006 < 0.05), but there was no significant relationship between nurses’ needling technique and arteriovenous fistula failure with (P=0.086 > 0.05).The study recommends initial and regular training of new and experienced nurses to update their knowledge and skills in the use of AVF in hemodialysis patients. Additionally, management should encourage consistent coaching and supervision of nurses to validate their knowledge and skills in the management of hemodialysis patients to prevent arteriovenous fistula failure. Keywords: Nurses, Knowledge, Arteriovenous fistula failure, Hemodialysis, Needling technique, DOI: 10.7176/JHMN/81-08 Publication date:October 31st 202

Impact Assessment of Exclusive Breastfeeding Media Campaign Among Mothers in Selected Metropolitan Cities in South East Nigeria

This research is funded by Tertiary Education Trust Fund (TETFund) of the Federal Government of Nigeria through Abia State University, Uturu, Nigeria. Abstract Unarguably, the mass media by virtue of their information dissemination function play vital role in communication for health and sustainable development of the society. Health communication involves the study and use of communication strategies to inform and influence individuals and community decisions in enhancing healthy living. Therefore, the health sector, like any given sector of the society, shares a remarkable and unalienable relationship with the mass media, as evidenced through the radio, television, newspapers and magazines, among others, in communicating health policies, reporting activities in the health sector, embarking on health campaigns and in publicizing health programmes. The study is an impact assessment of exclusive breastfeeding media campaign among mothers in selected metropolitan cities in South East Nigeria to ascertain their disposition to exclusive breastfeeding media campaign messages amidst prevailing lack of interest among majority of mothers in upholding this auspicious agelong practice which invariably impacts on the wellbeing of the infant child, perhaps as a result of ignorance and lack of education, among other social factors. Qualitative and quantitative (mixed) research approaches were employed in this study. Findings reveal evident positive impact of exclusive breastfeeding media campaign messages on mother in South East Nigeria. However, antenatal channel rather than the traditional media channels remains the major source of information to mothers on exclusive breastfeeding practice in the region. The study, therefore, strongly affirms that much more is still required from the traditional media platforms especially in terms of enlivened programme design and committed publicity to rightly occupy their place in this campaign role considering the heterogeneous nature of the audience they serve, which predisposes them more advantageous to reach even prospective mothers (those not yet expecting babies) who may not have immediate need to come for antenatal to access such beneficial nutritional and health information. Key words: exclusive breastfeeding, health communication, media campaign, mothers, South East Nigeria, sustainable development DOI: 10.7176/RHSS/9-14-16 Publication date:July 31st 201

Environmental cadmium exposure: a possible factor in the pathogenesis of preeclampsia

Cadmium is a toxic metal, an environmental contaminant and a multi-organ poison which has been implicated in the derangement of a number of biological and molecular systems. Exposure to cadmium is a serious global health threat particularly in developing countries and pregnant women are at great risk, This is because they have increased gastrointestinal absorption and retention of cadmium and the tendency for increased risk of complications owing to its toxic effects. Preeclampsia is a pregnancy complication characterized by the development of onset of hypertension and significant proteinuria after 20 weeks of gestation or during labour and/or within 48 hours of delivery. This pregnancy-specific syndrome is a leading cause of maternal death particularly in developing countries. Several reports have provided evidence of remote association between preeclampsia and cadmium but the mechanism of the involment of this toxic metal in this disease is still surrounded with uncertainty. Some possible mechanistic pathways such as induction of oxidative stress, acting as an antimetabolite to zinc and deregulation of epigenetic mechanisms have been elucidated in this article may be interconnected, work synergistically or act independently. However, pertinent to understand them in a bid to possibly prevent the disease or forestall its devastating consequences. Environmental cadmium exposure may be considered a factor that merits further serious attention in the continuous search for the precise an etiology of preeclampsia particularly in developing countries that experience uncontrolled cadmium release into the environment

Estimating morbidity due to stroke in Nigeria: a systematic review and meta-analysis

The response to stroke in Nigeria is impaired by inadequate epidemiologic information. We sought to collate available evidence and estimate the incidence of stroke and prevalence of stroke survivors in Nigeria. Using random effects meta-analysis, we pooled nationwide and regional incidence and prevalence of stroke from the estimates reported in each study. Eleven studies met our selection criteria. The pooled crude incidence of stroke in Nigeria was 26.0 (12.8-39.0) /100,000 person-years, with this higher among men at 34.1 (9.7-58.4) /100,000, compared to women at 21.2 (7.4-35.0) /100,000. The pooled crude prevalence of stroke survivors in Nigeria was 6.7 (5.8-7.7) /1000 population, with this also higher among men at 6.4 (5.1-7.6) /1000, compared to women at 4.4 (3.4-5.5) /1000. In the period 2000-2009, the incidence of stroke in Nigeria was 24.3 (95% CI: 11.9-36.8) per 100,000, with this increasing to 27.4 (95% CI: 2.2-52.7) per 100,000 from 2010 upwards. The prevalence of stroke survivors increased minimally from 6.0 (95% CI: 4.6-7.5) per 1000 to 7.5 (95% CI: 5.8-9.1) per 1000 over the same period. The prevalence of stroke survivors was highest in the South-south region at 13.4 (9.1-17.8) /100,000 and among rural dwellers at 10.8 (7.5-14.1) /100,000. Although study period does not appear to contribute substantially to variations in stroke morbidity in Nigeria, an increasing number of new cases compared to survivors may be due in part to limited door-door surveys, or possibly reflects an increasing mortality from stroke in the country. [Abstract copyright: Copyright © 2019 Elsevier B.V. All rights reserved.

Urinary calcium: a promising predictive biomarker for early recognition of environmental lead exposure in children

Background: In the continuous search for accessible, reliable and sensitive biomarkers for early detection of environmental lead exposure, authors determined the interaction between blood lead level (BLL), the conventional marker of lead exposure, and the indices of calcium and bone metabolism in children.Methods: This cross-sectional study involved 309 apparently healthy children from eight public primary schools in Ibadan, Nigeria who were classified as Elevated BLL (EBLL) and control based on standard cut-off for childhood BLL. BLL, serum Ca (tCa), phosphate, magnesium (Mg), 25-hydroxy-Vitamin D, alkaline phosphatase (ALP), urinary calcium (uCa) and urinary deoxypyridinoline (uDPD) were determined using AAS, HPLC and ELISA as appropriate. Bone-specific ALP (B-ALP) and ionized calcium (iCa) were calculated using standard formulae. Data analyses involved Student’s t-test, Pearson correlation and multivariate regression analysis. p0.05). BLL had significant positive correlation with uCa (r=0.176, p=0.002) (p0.05). BLL could be accounted for by uCa by applying the equation, BLL=0.329+0.324uCa.Conclusions: Urinary calcium could be a promising predictive biomarker for early recognition of significant environmental lead exposure in children

Current prevalence pattern of tobacco smoking in Nigeria: a systematic review and meta-analysis

Background National smoking cessation strategies in Nigeria are hindered by lack of up-to-date epidemiologic data. We aimed to estimate prevalence of tobacco smoking in Nigeria to guide relevant interventions. Methods We conducted systematic search of publicly available evidence from 1990 through 2018. A random-effects meta-analysis and meta-regression epidemiologic model were employed to determine prevalence and number of smokers in Nigeria in 1995 and 2015. Results Across 64 studies (n = 54,755), the pooled crude prevalence of current smokers in Nigeria was 10.4% (9.0–11.7) and 17.7% (15.2–20.2) for ever smokers. This was higher among men compared to women in both groups. There was considerable variation across geopolitical zones, ranging from 5.4% (North-west) to 32.1% (North-east) for current smokers, and 10.5% (South-east) to 43.6% (North-east) for ever smokers. Urban and rural dwellers had relatively similar rates of current smokers (10.7 and 9.1%), and ever smokers (18.1 and 17.0%). Estimated median age at initiation of smoking was 16.8 years (IQR: 13.5–18.0). From 1995 to 2015, we estimated an increase in number of current smokers from 8 to 11 million (or a decline from 13 to 10.6% of the population). The pooled mean cigarettes consumption per person per day was 10.1 (6.1–14.2), accounting for 110 million cigarettes per day and over 40 billion cigarettes consumed in Nigeria in 2015. Conclusions While the prevalence of smokers may be declining in Nigeria, one out of ten Nigerians still smokes daily. There is need for comprehensive measures and strict anti-tobacco laws targeting tobacco production and marketing

Estimating the prevalence of overweight and obesity in Nigeria in 2020: a systematic review and meta-analysis

Background Targeted public health response to obesity in Nigeria is relatively low due to limited epidemiologic understanding. We aimed to estimate nationwide and sub-national prevalence of overweight and obesity in the adult Nigerian population. Methods MEDLINE, EMBASE, Global Health, and Africa Journals Online were systematically searched for relevant epidemiologic studies in Nigeria published on or after 01 January 1990. We assessed quality of studies and conducted a random-effects meta-analysis on extracted crude prevalence rates. Using a meta-regression model, we estimated the number of overweight and obese persons in Nigeria in the year 2020. Results From 35 studies (n = 52,816), the pooled crude prevalence rates of overweight and obesity in Nigeria were 25.0% (95% confidence interval, CI: 20.4–29.6) and 14.3% (95% CI: 12.0–15.5), respectively. The prevalence in women was higher compared to men at 25.5% (95% CI: 17.1–34.0) versus 25.2% (95% CI: 18.0–32.4) for overweight, and 19.8% (95% CI: 3.9–25.6) versus 12.9% (95% CI: 9.1–16.7) for obesity, respectively. The pooled mean body mass index (BMI) and waist circumference were 25.6 kg/m2 and 86.5 cm, respectively. We estimated that there were 21 million and 12 million overweight and obese persons in the Nigerian population aged 15 years or more in 2020, accounting for an age-adjusted prevalence of 20.3% and 11.6%, respectively. The prevalence rates of overweight and obesity were consistently higher among urban dwellers (27.2% and 14.4%) compared to rural dwellers (16.4% and 12.1%). Conclusions Our findings suggest a high prevalence of overweight and obesity in Nigeria. This is marked in urban Nigeria and among women, which may in part be due to widespread sedentary lifestyles and a surge in processed food outlets, largely reflective of a trend across many African settings

Validation of a novel multivariate method of defining HIV-associated cognitive impairment

Background. The optimum method of defining cognitive impairment in virally suppressed people living with HIV is unknown. We evaluated the relationships between cognitive impairment, including using a novel multivariate method (NMM), patient– reported outcome measures (PROMs), and neuroimaging markers of brain structure across 3 cohorts. Methods. Differences in the prevalence of cognitive impairment, PROMs, and neuroimaging data from the COBRA, CHARTER, and POPPY cohorts (total n = 908) were determined between HIV-positive participants with and without cognitive impairment defined using the HIV-associated neurocognitive disorders (HAND), global deficit score (GDS), and NMM criteria. Results. The prevalence of cognitive impairment varied by up to 27% between methods used to define impairment (eg, 48% for HAND vs 21% for NMM in the CHARTER study). Associations between objective cognitive impairment and subjective cognitive complaints generally were weak. Physical and mental health summary scores (SF-36) were lowest for NMM-defined impairment (P < .05). There were no differences in brain volumes or cortical thickness between participants with and without cognitive impairment defined using the HAND and GDS measures. In contrast, those identified with cognitive impairment by the NMM had reduced mean cortical thickness in both hemispheres (P < .05), as well as smaller brain volumes (P < .01). The associations with measures of white matter microstructure and brain-predicted age generally were weaker. Conclusion. Different methods of defining cognitive impairment identify different people with varying symptomatology and measures of brain injury. Overall, NMM-defined impairment was associated with most neuroimaging abnormalities and poorer selfreported health status. This may be due to the statistical advantage of using a multivariate approac

STEM vs Fem: A Cognitive and Social Approach to Examining the Different Factors Potentially Keeping Black Women Out of STEM Fields

Black women are severely underrepresented in STEM fields (science, technology, engineering, and math) (Kelly, 1985, Smyth & Nosek, 2015). This paper offers a dual perspective (cognitive and social) on some potential causes of this underrepresentation. For the most part, existing research focuses on either the lack of racial diversity in STEM or the lack of gender diversity in STEM (Beede et al., 2011, NSF, 2015, Wang & Degol, 2017). However, there is a lack of substantial research introducing a new, intersectional understanding of the combination of both the racial and the gender disparity in STEM and the implications of such on Black women in those fields. The goal of this paper is to provide a better understanding of what current research tells us about the gender and racial discrepancy in STEM. It reviews literature that establishes a cognitive foundation, examines social factors that can explicitly affect Black women and their interest, entrance, and persistence in these fields and introduces ways to address and increase the lack of diversity in STEM. It is very important to continue building this body of research surrounding Black women in STEM, in order to shed light on the nuances of the racialized and gendered experiences, and factors that may lead to the lack of representation of Black women in these male-dominated domains. This can ultimately aid in the search for effective ways to increase Black female interest and representation in STEM fields