Akaninyene Otu

Prevalence of dysglycemia in Calabar: a cross-sectional observational study among residents of Calabar, Nigeria

Objective Population data on dysglycemia are scarce in West Africa. This study aimed to determine the pattern of dysglycemia in Calabar city in South East Nigeria. Design This was a cross-sectional observational study. Methods 1134 adults in Calabar were recruited. A multistage sampling method randomly selected 4 out of 22 wards, and 50 households from each ward. All adults within each household were recruited and an oral glucose tolerance test was performed. Dysglycemia was defined as any form of glucose intolerance, including: impaired fasting glucose (blood glucose level 110–125 mg/dL), impaired glucose tolerance (blood glucose level ≥140 mg/dL 2 h after consuming 75 g of glucose), or diabetes mellitus (DM), as defined by fasting glucose level ≥126 mg/dL, or a blood glucose level ≥200 mg/dL, 2 h after a 75 g glucose load. Results Mean values of fasting plasma glucose were 95 mg/dL (95% CI 92.1 to 97.5) for men and 96 mg/dL (95% CI 93.2 to 98.6) for women. The overall prevalence of dysglycemia was 24%. The prevalence of impaired fasting glucose was 9%, the prevalence of impaired glucose tolerance 20%, and the prevalence of undiagnosed DM 7%. All values were a few percentage points higher for men than women. Conclusions The prevalence of undiagnosed DM among residents of Calabar is similar to studies elsewhere in Nigeria but much higher than the previous national prevalence survey, with close to a quarter of the adults having dysglycemia and 7% having undiagnosed DM. This is a serious public health problem requiring a programme of mass education and case identification and management in all health facilities. Trial registration number CRS/MH/CR-HREC/020/Vol.8/43

Drug Resistance among Pulmonary Tuberculosis Patients in Calabar, Nigeria

Background. This study aimed to determine the pattern of drug susceptibility to first-line drugs among pulmonary TB patients in two hospitals in Calabar, Nigeria. Methods. This was a descriptive cross-sectional study carried out between February 2011 and April 2012. Sputum samples from consecutive TB patients in Calabar were subjected to culture on Lowenstein-Jensen (LJ) slopes followed by drug susceptibility testing (DST). The DST was performed on LJ medium by the proportion method. Results. Forty-two of the 100 Mycobacterium tuberculosis strains were found to be resistant to at least one drug. Resistance to only one drug (monoresistance) was found in 17 patients. No strains with monoresistance to rifampicin were found. Resistance to two drugs was found in 22 patients, while one patient was resistant to both three and four drugs. MDR TB was seen in 4% (4/100). The independent variables of HIV serology and sex were not significantly associated with resistance (P > 0.05). Conclusion. There was a high prevalence of anti-TB drug resistance in Calabar.

International Surviving Sepsis Campaign guidelines 2016: the perspective from low-income and middle-income countries

www.thelancet.com/infection Vol 17 September 2017 893 pro grammes re-affirms the power of a multidisciplinary approach. A winning team knows that teamwork is what makes the dream work; clinicians, infection prevention professionals, pharmacists, microbiologists, nurses, and an ever-expanding number of health-care professionals involved at the clinical interface form a whole that is greater than the sum of its parts. Only five of the 32 studies included in Baur and colleagues’ meta-analysis were from low-income or middle-income countries, where multidisciplinary teams are rarely found outside of central hospitals. In these settings, we need to re-examine our perception of what an antibiotic stewardship programme looks like. The success of pharmacist-led stewardship programmes highlights a model that builds stewardship teams around this key cadre of health professional. And what of stewardship programmes at the community level? We need to look to non-traditional stewards, such as community health workers and members of the public, in settings where health-care professionals are a scarce resource. Non-traditional stewards need to join us in a partnership that looks beyond what can be offered in high-resource settings. Decreasing antibiotic resistance while preserving the effectiveness of antibiotics is the dream and antibiotic stewardship is the team captain. Baur and colleagues have provided the ammunition to convey this important message to antibiotic stewardship naysayers, policy makers, and stakeholders. The results of Baur and colleagues’ meta-analysis are an important advocacy tool, and one that we should use in support of developing winning teams. If we get antibiotic stewardship right, the real winner will be the patient who avoids infection by a drug-resistant bacterium or C difficile, now and in the future, as we preserve antibiotics for the generations to come.

Is the directly observed therapy short course (DOTS) an effective strategy for tuberculosis control in a developing country

Objective To investigate the effectiveness of the directly observed therapy short course (DOTS) strategy in tuberculosis control in developing countries.

A review of the national tuberculosis and leprosy control programme (ntblcp) of Nigeria: Challenges and prospects

This review evaluates the National Tuberculosis and Leprosy Control Programme (NTBLCP) of Nigeria to identify challenges and prospects for reducing the burden of tuberculosis (TB) in Nigeria. TB remains the leading cause of death due to an infectious agent globally. Nigeria has the tenth largest burden of TB cases in the world. Rates of TB morbidity and mortality in Nigeria are spiralling despite expressions of political will to control TB and a clearly articulated NTBLCP policy. This is in contradistinction to the global decline in incidence and mortality from TB recorded from 2004. Information for this review was gotten from NTBLCP annual reports and peer reviewed articles. Literature search was conducted using various databases. Through review and analysis, NTBLCP of Nigeria was found to have sub-optimal Directly Observed Treatment Short course (DOTS) population coverage with shortage of skilled TB health workers at Primary Health Care (PHC) level. There were shortfalls in TB laboratories and quality assurance services with weak integration of TB and Human Immunodeficiency Virus (HIV) services. Multidrug-resistant (MDR) TB care services were fledgling and funding for TB control was inadequate. Also identified were weak Advocacy, Communication and Social Mobilization (ACSM) and Public-Private-Mix (PPM). There was poor implementation of TB infection control strategies in health facilities. Prospects for TB control in Nigeria included the existence of a 20 year old TB control programme. Others were the presence of political commitment by the Nigerian government and willingness of development partners to assist. Some effective TB control strategies were also examined.

Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study

BackgroundThe Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa.MethodsWe conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease.ResultsOf 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P < 0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola.ConclusionsThe modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa.

Profile, Bacteriology, and Risk Factors for Foot Ulcers among Diabetics in a Tertiary Hospital in Calabar, Nigeria

Diabetic foot disease is a major medical, social, and economic problem. This retrospective study assessed the profile of diabetes mellitus patients with foot ulcers in the University of Calabar Teaching Hospital (UCTH), Nigeria. Admission records of all patients admitted unto the medical wards of UCTH over a 5 year period were analysed. The records of diabetic patients were retrieved. Data on patient characteristics and possible risk factors for diabetes mellitus foot ulcers was extracted. Of the 3,882 patients admitted, 297 (7%) were on account of complications of diabetes mellitus. Foot ulcers accounted for 63 (21.2%) of all diabetic admissions. The elderly constituted the majority of patients admitted with foot ulcers. The average duration of stay of diabetics with foot ulcers was 38.5 days. Diabetics admitted for other conditions had average duration of admission of 15.8 days. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. Most of the organisms identified from ulcer swab cultures were sensitive to quinolones and resistant to penicillins. These diabetic foot ulcers were significantly associated with peripheral sensory neuropathy, peripheral vascular disease, intermittent claudication, and walking barefoot. An effective diabetes foot programme is required to address these risk factors and reverse the current trend.

Coronary artery disease and the profile of cardiovascular risk factors in South South Nigeria: a clinical and autopsy study.

Introduction. Death from coronary artery disease (CAD) has been until recently considered rare in Nigeria. We present a report of a study of CAD with its predisposing cardiovascular (CVD) risk factors in South South Nigeria. Methods. We examined the autopsy reports of 747 coroner cases and 41 consecutive clinically diagnosed cases of ischemic heart disease seen in South South Nigeria. Results. CAD was diagnosed in 13 (1.6%) of 747 autopsies. They were predominantly males, urban residents, and of high social class with combination of CVD risk factors of hypertension, alcohol use, diabetes mellitus, cigarette smoking, poor physical activities, and obesity. The mean serum cholesterol of the clinical subjects was 4.7 ± 1.57 mmol/L and 5.07 ± 1.94 mmol/L for angina and myocardial infarction, respectively, which was higher than the mean total cholesterol for locality of 3.1 mmol/L. Conclusion. CAD and its risk factors are contributing to mortality and morbidity in South South Nigeria. These risk factors include hypertension, alcohol use, diabetes mellitus, cigarette smoking, poor physical activity, and obesity. Nigerians in this locality with CAD have raised serum lipids.

An account of the Ebola virus disease outbreak in Nigeria: implications and lessons learnt

BackgroundThe 2014 Ebola virus disease (EVD) outbreak remains unprecedented both in the number of cases, deaths and geographic scope. The first case of EVD was confirmed in Lagos Nigeria on 23 July 2014 and spread to involve 19 laboratory-confirmed EVD cases. The EVD cases were not limited to Lagos State as Rivers State recorded 2 confirmed cases of EVD with 1 out of the 2 dying. Swift implementation of public health measures were sufficient to forestall a country -wide spread of this dreaded disease. This exploratory formative research describes the events of the Nigeria Ebola crisis in 2014.MethodsThis research was implemented through key informant in-depth interviews involving 15 stakeholders in the EVD outbreak in Nigeria by a team of two or three interviewers. Most of the interviews were conducted face-to-face at the various offices of the respondents and others were via the telephone. The interviews which lasted an hour on average were conducted in English, digitally recorded and notes were also taken.ResultsThis study elucidated the public health response to the Ebola outbreak led by Lagos State Government in conjunction with the Federal Ministry of Health. The principal strategy was an incident management approach which saw them identify and successfully follow up 894 contacts. The infected EVD cases were quarantined and treated. The Nigerian private sector and international organizations made significant contributions to the control efforts. Public health enlightenment programmes using multimodal communication strategies were rapidly deployed. Water and sanitary facilities were provided in many public schools in Lagos.ConclusionsThe 2014 Ebola outbreak in Nigeria was effectively controlled using the incident management approach with massive support provided by the private sector and international community. Eight of the confirmed cases of EVD in Nigeria eventually died (case fatality rate of 42.1%) and twelve were nursed back to good health. On October 20 2014 Nigeria was declared fee of EVD by the World Health Organization. The Nigerian EVD experience provides valuable insights to guide reforms of African health systems in preparation for future infectious diseases outbreaks.

Intensive patient education improves glycaemic control in diabetes compared to conventional education: A randomised controlled trial in a Nigerian tertiary care hospital

Background Diabetes is now a global epidemic, but most cases are now in low- and middle-income countries. Diabetes self-management education (DSME) is key to enabling patients to manage their chronic condition and can reduce the occurrence of costly and devastating complications. However, there is limited evidence on the effectiveness of different DSME programmes in resource limited settings. Methods We conducted an unblinded, parallel-group, individually-randomised controlled trial at the University of Calabar Teaching Hospital (Nigeria) to evaluate whether an intensive and systematic DSME programme, using structured guidelines, improved glycaemic control compared to the existing ad hoc patient education (clinical practice was unchanged). Eligible patients (≥18 years, HbA1c > 8.5% and physically able to participate) were randomly allocated by permuted block randomisation to participate for six months in either an intensive or conventional education group. The primary outcome was HbA1c (%) at six-months. Results We randomised 59 participants to each group and obtained six-month HbA1c outcomes from 53 and 51 participants in the intensive and conventional education groups, respectively. Intensive group participants had a mean six-month HbA1c (%) of 8.4 (95% CI: 8 to 8.9), while participants in the conventional education group had a mean six-month HbA1c (%) of 10.2 (95% CI: 9.8 to 10.7). The difference was statistically (P < 0.0001) and clinically significant, with intensive group participants having HbA1c outcomes on average -1.8 (95% CI: -2.4 to -1.2) percentage points lower than conventional group participants. Results were robust to adjustment for a range of covariates and multiple imputation of missing outcome data. Conclusions This study demonstrates the effectiveness of a structured, guideline-based DSME intervention in a LMIC setting versus a pragmatic comparator. The intervention is potentially replicable at other levels of the Nigerian healthcare system and in other LMICs, where nurses/diabetes educators can run the programme. Trial Registration Pan African Clinical Trial Registry PACTR20130200047835