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

Correlation between Albuminuria and Ankle Brachial Index among Nigerians with Chronic Kidney Disease

Background: Peripheral arterial disease (PAD), the most common manifestation of atherosclerosis and chronic kidney disease (CKD), has been described as an independent risk factor for its development. The combination of CKD and PAD multiplies the risk of cardiovascular disease. Ankle-brachial pressure index (ABPI) is a good marker of atherosclerosis and is useful for the diagnosis of PAD. The study aimed to determine the prevalence, pattern and predictors of PAD in patients with CKD. Materials and Methods: This was a cross-sectional study of patients with CKD with age and gender-matched controls. Medical history relating to CKD and PAD was obtained using a pre-tested questionnaire. The ABPI was measured using handheld Doppler ultrasound equipment. Blood samples were drawn for serum creatinine and spot urine for Urinary Albumin Creatinine Ratio (UACR). Results: One hundred and thirty-two subjects participated in the study, 66 cases and 66 controls. The mean ages were 47.5±15.9 years in cases and 41.6±11.6 years in controls. The mean ABPI (0.9±0.2 vs 1.0±0.1, p-0.01), eGFR (62.8±28.2 vs 98±23.1ml/min/1.73m2 , p-0.01) were lower in the cases compared to the controls while UACR was higher in the cases (3.1±1.1 vs 1.2±0.1, p-0.01. The prevalence of PAD was 36 (54.5%) and 15 (22.7%) among cases and controls, respectively (p < 0.01) while low eGFR OR, 3.9 (1.86-10.41), elevated Systolic blood pressure (SBP) OR, 1.83 (1.40-5.78) and UACR (t-3.663, p-0.023) were associated with PAD in CKD. Conclusion: This study demonstrated that high prevalence of PAD among individuals with CKD while low eGFR, elevated SBP and microalbuminuria were clinical correlates of PAD in CKD

Significant Bacteriuria Among Asymptomatic Antenatal Clinic Attendees In Ibadan, Nigeria

Untreated asymptomatic bacteriuria can lead to urinary tract infection (UTI) in pregnancy with devastating maternal and neonatal effects such as prematurity and low birth weight, higher fetal mortality rates and significant maternal morbidity. We carried out a two year (April 2007 to March 2009) cross-sectional epidemiological study to determine the prevalence of significant bacteriuria among asymptomatic antenatal clinic attendees at two antenatal clinics (ANCs) in University College Hospital and Adeoyo Maternity Hospital, both in Ibadan, Nigeria

Effect of Hemodialysis on the Hearing Function of Patients with Chronic Renal Failure

Sensorineural hearing impairment (SHI) has been reported in chronic renal failure (CRF) patients with a prevalence of 20-40%. The aetiopathogenetic mechanisms reported included osmotic alteration resulting in loss of hair cells and in some, complications of haemodialysis have been hypothesized. We have in the past reported 2 cases of CRF patients who developed acute SHL following hemodialysis. This is a report of investigation of the effect of hemodialysis on the hearing function of CRF patients using pure tone audiometry findings. Thirty-three CRF patients were recruited for Pure Tone Audiometry (PTA) at admission and after three sessions of hemodialysis. The pure tone audiometry was done with a computer audiometer BA 20 Kamplex in the sound - proof (acoustic) booth in the ENT clinic. The duration of illness, dosage of diuretics and blood pressure were also noted. Similar age and sex-matched control were selected among volunteers who were otherwise clinically healthy. The data was processed using the Statistical Package for the Social Sciences (SPSS Inc, Chicago, Illinois, USA). Thirty-three CRF patients treated with haemodialysis and 28 healthy controls completed the study, 34 males and 27 females, age range was 16 - 72 years, mean of 45.30 (SD16.20) for subjects and 49.7 for controls. Hearing loss was found in 22/34 (67%) at recruitment and 27/34 (79%) after 3 sessions of hemodialysis. There was a significant difference between the mean pre- and post-hemodialysis PTA values, P =0.0008. There was also a significant correlation between post - hemodialysis hearing threshold and (i) duration of illness (P = 0.00340) and (ii) creatinine levels of the patients (P=0.035). In conclusion, there was a significant depression in the hearing threshold of patients with CRF following three sessions of hemodialysis. This could be caused by changes induced by hemodialysis or effects of the duration and severity of disease

Perceptions and opinions of Nigerians to the management and response to COVID-19 in Nigeria

Introduction: we present a qualitative analysis of opinions of the Nigerian public as to how successful healthcare strategies have been, in containing the COVID-19 outbreak. Methods: an online qualitative survey was conducted, consisting of 30 semi-structured questions. Results: four hundred and ninety-five (495) respondents participated, ranging in age from 18 to 59 years. Over 40% of all respondents were critical of public health information. Participants saw provision of social support measures (n = 83), lack of economic, financial and social support (n = 65), enforcement of restrictions on movement outside the home, availability of face-masks and social distancing (n = 53) and provision of COVID-19 testing (n = 48) as the major things that were handled poorly by the government and health authorities. Conclusion: we advocate coordinated forward planning for public safety until vaccines are widely available; while social distancing should continue. Policymakers need to be adaptable to changing conditions, given fluctuating case numbers and fatality rates

Blood pressure control and left ventricular hypertrophy in hypertensive Nigerians

Background : Hypertension is a disease characterized by end-organ complications, leading to high morbidity and mortality in many cases. People with untreated or uncontrolled hypertension often run the risk of developing complications directly associated with the disease. Left ventricular hypertrophy (LVH) has been shown to be a significant risk factor for adverse outcomes both in patients with hypertension and in the general population. We investigated the prevalence and pattern of LVH in a treated hypertensive population at the University College Hospital, Ibadan, Nigeria, using non-hypertensive subjects as control. Design and Setting : A prospective observational study performed at the University College Hospital, Ibadan, Nigeria. Methods : Patients had 6 visits, when at least one blood pressure measurement was recorded for each hypertensive subject and average calculated for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. The values obtained were used for stratification of the subjects into controlled and uncontrolled hypertension. Subjects also had echocardiograms to determine their left ventricular mass. Results : LVH was found in 14 (18.2%) of the normotensive group, 40 (20.8%) of the uncontrolled hypertensive group and 14 (24.1%) of the controlled hypertensive group when left ventricular mass (LVM) was indexed to body surface area (BSA). When LVM was indexed to height, left ventricular hypertrophy was found in none of the subjects of the normotensive group, while it was found present in 43 (22.4%) and 14 (24.1%) subjects of the uncontrolled and controlled hypertensive groups, respectively. Significant difference in the prevalence of LVH was detected only when LVM was indexed to height alone. Conclusion : Clinic blood pressure is an ineffective way of assessing BP control. Thus in apparently controlled hypertensive subjects, based on office blood pressure, cardiac structural changes do remain despite antihypertensive therapy. This population is still at risk of cardiovascular events.arri\ue8re-plan: l\u2019hypertension est une maladie caract\ue9ris\ue9e par l\u2019orgue de fi n complications menant \ue0 \ue9lev\ue9 de morbidit\ue9 et mortalit\ue9 dans de nombreux cas. Personnes avec l\u2019hypertension non trait\ue9e ou non contr\uf4l\ue9e souvent risquent de d\ue9velopper complications directement associ\ue9es \ue0 la maladie. Laiss\ue9 ventriculaire hypertrophie (LVH) a \ue9t\ue9 d\ue9montr\ue9 un facteur de risque signifi catif pour les effets n\ue9gatifs r\ue9sultats tant chez les patients atteints de l\u2019hypertension et de la population g\ue9n\ue9rale. Nous avons a enqu\ueat\ue9 sur la pr\ue9valence et le mod\ue8le de LVH dans un trait\ue9 hypertendues population au University College Hospital, \ue0 l\u2019aide Ibadan, Nigeria non-hypertendues des sujets comme contr\uf4le. conception et la confi guration: A \ue9ventuel \ue9tude d\u2019observation effectu\ue9e \ue0 la University College Hospital, Ibadan, Nigeria. m\ue9thodes: Patients avaient six visites o\uf9 au moins un sang mesure de pression a \ue9t\ue9 enregistr\ue9e pour chaque sujet hypertendues et moyenne calcul\ue9s s\ue9par\ue9ment pour SBP et DBP. Les valeurs obtenues ont \ue9t\ue9 utilis\ue9es pour stratifi cation des sujets dans l\u2019hypertension contr\uf4l\ue9e et incontr\uf4l\ue9e. Sujets ont \ue9galement echocardiograms pour d\ue9terminer leur masse ventriculaire gauche. r\ue9sultats: LVH a \ue9t\ue9 trouv\ue9 en 14(18.2%) de la groupe normotensive, 40(20.8%) de groupe de hypertendues non contr\uf4l\ue9es et 14(24.1%) de hypertendues contr\uf4l\ue9e groupe lorsque quitt\ue9 masse ventriculaire (LVM) a \ue9t\ue9 index\ue9e \ue0 corps surface (BSA). Lorsque LVM a \ue9t\ue9 index\ue9 \ue0 hauteur, laiss\ue9 ventriculaire hypertrophie a \ue9t\ue9 trouv\ue9 dans aucun du groupe normotensive, bien qu\u2019il a \ue9t\ue9 constat\ue9 pr\ue9sents dans les 43(22.4%) et 14(24.1%) de hypertendues non ma\ueetris\ue9e et contr\uf4l\ue9e groupes respectivement. \uc9tait de diff\ue9rence signifi cative dans la pr\ue9valence de la LVH d\ue9tect\ue9s uniquement lorsque LVM a \ue9t\ue9 index\ue9 \ue0 hauteur alone. conclusion: clinique art\ue9rielle est un moyen ineffi cace de mesurer le contr\uf4le de BP. Ainsi en sujet hypertendues apparemment contr\uf4l\ue9e bas\ue9e sur la pression art\ue9rielle de bureau, des changements structurels cardiaques restent malgr\ue9 th\ue9rapie antihypertensive. Cette population est toujours \ue0 risque de maladies cardiovasculaires \ue9v\ue9nements

Poverty and fever vulnerability in Nigeria: a multilevel analysis

<p>Abstract</p> <p>Background</p> <p>Malaria remains a major public health problem in Sub Saharan Africa, where widespread poverty also contribute to the burden of the disease. This study was designed to investigate the relationship between the prevalence of childhood fever and socioeconomic factors including poverty in Nigeria, and to examine these effects at the regional levels.</p> <p>Methods</p> <p>Determinants of fever in the last two weeks among children under five years were examined from the 25004 children records extracted from the Nigeria Demographic and Health Survey 2008 data set. A two-level random effects logistic model was fitted. </p> <p>Results</p> <p>About 16% of children reported having fever in the two weeks preceding the survey. The prevalence of fever was highest among children from the poorest households (17%), compared to 15.8% among the middle households and lowest among the wealthiest (13%) (p<0.0001). Of the 3,110 respondents who had bed nets in their households, 506(16.3%) children had fever, while 2,604(83.7%) did not. (p=0.082). In a multilevel model adjusting for demographic variables, fever was associated with rural place of residence (OR=1.27, p<0.0001, 95% CI: 1.16, 1.41), sex of child: female (OR=0.92, p=0.022, 95% CI: 0.859, 0.988) and all age categories (>6months), whereas the effect of wealth no longer reached statistical significance.</p> <p>Conclusion</p> <p>While, overall bednet possession was low, less fever was reported in households that possessed bednets. Malaria control strategies and interventions should be designed that will target the poor and make an impact on poverty. The mechanism through which wealth may affect malaria occurrence needs further investigation. </p

Seroprevalence of SARS-CoV-2 in four states of Nigeria in October 2020: A population-based household survey

The observed epidemiology of SARS-CoV-2 in sub-Saharan Africa has varied greatly from that in Europe and the United States, with much lower reported incidence. Population-based studies are needed to estimate true cumulative incidence of SARS-CoV-2 to inform public health interventions. This study estimated SARS-CoV-2 seroprevalence in four selected states in Nigeria in October 2020. We implemented a two-stage cluster sample household survey in four Nigerian states (Enugu, Gombe, Lagos, and Nasarawa) to estimate age-stratified prevalence of SARS-CoV-2 antibodies. All individuals in sampled households were eligible for interview, blood draw, and nasal/oropharyngeal swab collection. We additionally tested participants for current/recent malaria infection. Seroprevalence estimates were calculated accounting for the complex survey design. Across all four states, 10,629 (96·5%) of 11,015 interviewed individuals provided blood samples. The seroprevalence of SARS-CoV-2 antibodies was 25·2% (95% CI 21·8–28·6) in Enugu State, 9·3% (95% CI 7·0–11·5) in Gombe State, 23·3% (95% CI 20·5–26·4) in Lagos State, and 18·0% (95% CI 14·4–21·6) in Nasarawa State. Prevalence of current/recent malaria infection ranged from 2·8% in Lagos to 45·8% in Gombe and was not significantly related to SARS-CoV-2 seroprevalence. The prevalence of active SARS-CoV-2 infection in the four states during the survey period was 0·2% (95% CI 0·1–0·4). Approximately eight months after the first reported COVID-19 case in Nigeria, seroprevalence indicated infection levels 194 times higher than the 24,198 officially reported COVID-19 cases across the four states; however, most of the population remained susceptible to COVID-19 in October 2020

Adrenergic Alpha-1 Pathway Is Associated with Hypertension among Nigerians in a Pathway-focused Analysis

The pathway-focused association approach offers a hypothesis driven alternative to the agnostic genome-wide association study. Here we apply the pathway-focused approach to an association study of hypertension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in 1614 Nigerians with genome-wide data.Testing of 28 pathways with biological relevance to hypertension, selected a priori, containing a total of 101 unique genes and 4,349 unique single-nucleotide polymorphisms (SNPs) showed an association for the adrenergic alpha 1 (ADRA1) receptor pathway with hypertension (p<0.0009) and diastolic blood pressure (p<0.0007). Within the ADRA1 pathway, the genes PNMT (hypertension P(gene)<0.004, DBP P(gene)<0.004, and SBP P(gene)<0.009, and ADRA1B (hypertension P(gene)<0.005, DBP P(gene)<0.02, and SBP P(gene)<0.02) displayed the strongest associations. Neither ADRA1B nor PNMT could be the sole mediator of the observed pathway association as the ADRA1 pathway remained significant after removing ADRA1B, and other pathways involving PNMT did not reach pathway significance.We conclude that multiple variants in several genes in the ADRA1 pathway led to associations with hypertension and DBP. SNPs in ADRA1B and PNMT have not previously been linked to hypertension in a genome-wide association study, but both genes have shown associations with hypertension through linkage or model organism studies. The identification of moderately significant (10(-2)>p>10(-5)) SNPs offers a novel method for detecting the "missing heritability" of hypertension. These findings warrant further studies in similar and other populations to assess the generalizability of our results, and illustrate the potential of the pathway-focused approach to investigate genetic variation in hypertension