Bamidele O. Adeniyi

Respiratory symptom, lung function and exhaled carbon monoxide among a sample of traffic workers in Lagos, Nigeria: A pilot survey

Background: Traffic-related air pollution (TRAP) is a major source of air pollution but the impact on health in Nigeria is not well described. Patients and Methods: A descriptive cross-sectional study of road traffic workers and university students in Lagos. Eligible, accessible and willing participants were included in the sample. Respiratory symptoms and anthropometry were obtained from all the participants using an adapted Medical Research Council (MRC) questionnaire and they all did a spirometry test and exhaled carbon monoxide (CO) test. Results: Fifty-nine individuals participated with complete data, including 47 traffic policemen and 12 students who acted as controls. The mean age (SD) was 35.1 (8.0) and 35.4 years (6.3) for the traffic workers and students, respectively. All the respondents were men. The mean (SD) duration of occupation as a traffic policeman was 4.4 (4.4) and a median of 4 years (range 1-25). There was no significant difference in the presentation of respiratory and non-respiratory symptoms between the two groups. Compared with the students, the traffic workers had higher age, height and sex adjusted forced expiratory volume in one second and forced vital capacity. Traffic policemen had significantly higher levels of exhaled CO than the students (1.18 vs 0.73 ppm, P < 0.006). Conclusion: There is a high prevalence of respiratory symptoms in both traffic policemen and non-traffic residents of Lagos metropolis, indicating widespread pollution.

Gaps in Capacity for Respiratory Care in Developing Countries. Nigeria as a Case Study

There are unmet needs for respiratory medical care in developing countries. We sought to evaluate the quality and capacity for respiratory care in low- and lower-middle-income countries, using Nigeria as a case study. We obtained details of the respiratory practice of consultants and senior residents (fellows) in respiratory medicine in Nigeria via a semistructured questionnaire administered to physician attendees at the 2013 National Congress of the Nigerian Thoracic Society. Out of 76 society-registered members, 48 attended the congress, 40 completed the questionnaire, and 35 provided complete data (73% adjusted response rate). Respondents provided information on the process and costs of respiratory medicine training and facility, equipment, and supply capacities at the institutions they represented. Approximately 83% reported working at a tertiary level (teaching) hospital; 91% reported capacity for sputum smear analysis for acid alcohol-fast bacilli, 37% for GeneXpert test cartridges, and 20% for BACTEC liquid sputum culture. Only 34% of respondents could perform full spirometry on patients, and none had the capacity for performing a methacholine challenge test or for measuring the diffusion capacity for carbon monoxide. We estimated the proportion of registered respiratory physicians to the national population at 1 per 2.3 million individuals. Thirteen states with an estimated combined population of 57.7 million offer no specialist respiratory services. Barriers to development of this capacity include the high cost of training. We conclude that substantial gaps exist in the capacity and quality of respiratory care in Nigeria, a pattern that probably mirrors most of sub-Saharan Africa and other countries of similar economic status. Health policy makers should address these gaps systematically.

Reduced Forced Vital Capacity in an African Population. Prevalence and Risk Factors

Rationale: Black Africans have reduced FVC compared with white persons, but the prevalence and determinants of reduced values are not well understood. Objectives: To evaluate the prevalence and factors leading to reduced FVC in a Nigerian population and to examine current theories regarding the determinants of this difference. Methods: We studied the ventilatory function of 883 adults aged 40 years or older participating in the Burden of Obstructive Lung Disease Study in Ile‐Ife, Nigeria. Respondents completed pre‐ and post‐bronchodilator spirometry test and provided information on their smoking history, respiratory symptoms, risk factors, and diagnoses, including anthropometric details. We used standard categories to define body mass index as either underweight, normal, overweight, or obese. We defined reduced FVC as a post‐bronchodilator FVC below the lower limit of normal using National Health and Nutrition Examination Survey (NHANES) equations, Global Lung Function Initiative 2012 equations, and local reference equations based on nonsmoking study participants without a respiratory diagnosis. We fit multivariate linear regression models to FVC as a continuous measure, adjusting for age, sex, height, and other confounders. Results: The prevalence of reduced FVC was 70.4% for men and 72.8% for women when using NHANES values for white Americans, 17.8% for men and 14.4% for women using NHANES equations for African Americans, and 15.5% for men and 20.5% for women using the Global Lung Function Initiative 2012 equations. Using the equations derived from nonsmoking respondents in the survey without a respiratory diagnosis, the prevalence of reduced FVC was less than 4% for both men and women. FVC was lower in participants who had less than 7 years of education (FVC, −96 ml; 95% confidence interval [CI], −172 to −19), were underweight (FVC, −269 ml; 95% CI, −464 to −73), were overweight (FVC, −132 ml; 95% CI, −219 to −46), and were obese (FVC, −222 ml; 95% CI, −332 to −112). Conclusions: There is a wide variation in the prevalence of reduced FVC based on the reference standard used. This variation is not satisfactorily explained by factors thought to affect FVC within individual populations. However, the prevalence strongly associates with both education level and body mass index in this population, regardless of the specific standard used.

Differences in serial lung function recorded on four data-logging meters.

Abstract Objective: Lung function measurements performed several times daily are useful for the diagnosis of occupational asthma. Patient fabrication of hand-recorded charts can limit confidence in the results; this is overcome using electronic meters that log time and measurement. We have compared individual and meter differences in FEV1 and PEF recorded by hand and from meter logs using expert subjects on four data-logging spirometers with different methods of measurement and different quality control software. Methods: Eight workers in a respiratory physiology department were asked to record FEV1 and PEF 2-hourly from waking for 7 days using four electronic meters (Easyone, Micro DL, Vitalograph Diary card 2110 and Piko-1) in random order. Subjects hand-recorded the best FEV1 and PEF from each session, this was compared with the logged data. Results: Discordant measurements from individuals were lower for FEV1 than PEF and differed from 4.4–19.1% for FEV1 (mean 9.4%, p < 0.0001) and 6–23.3% for PEF (mean 12.6, p < 0.0001). There were also significant differences between meters for both variables (p < 0.0001). The magnitude of the differences in PEF was highest for the Easyone (34l/min) and lowest for the Vitalograph Diary card 2110 (14l/min) and varied significantly between meters (mean 22l/min, p = 0.002). Conclusions: Differences between hand-recorded and logged measurements are unlikely to be due solely to patient fabrication and can be due to quality criteria or other unclear software requirements applied after the results are shown on the meter screen; they differ between meters. Whether the differences shown affect clinical outcome will require further investigation.

Knowledge of spacer device, peak flow meter and inhaler technique (MDIs) among health care providers: an evaluation of doctors and nurses.

Background Metered dose inhalers are cornerstone in effective management of bronchial asthma when correctly used. Most studies hitherto have focused on assessing patients knowledge of inhaler technique. We sought to assess the knowledge of inhaler technique, spacer device and peak flow meter among doctors and nurses in a tertiary healthcare institution in Nigeria. Method A cross sectional survey of nurses and doctors from emergency department, family and internal medicine; who were attending a continuous professional development lecture, was carried out. From a total of 100 questionnaires administered, we retrieved 87 of which 75 were completed, giving a response rate of 75%. It was a self-administered questionnaire. Data was analysed with SPSS version 21.0. Descriptive statistics were done. Association was examined using chi-square test. Result Mean age of respondent was 35.8 years ± 8.7, 47(62.7%) were < 40 years, 33(44%) were male, nurses were 30(40.0%). Only 28(37.3%) had ever used a peak flow meter. Only 4(14.3%) used peak flow meter frequently, while 12(26.7%) checked patients inhaler technique often. Only 9 out of the 75 (12%) participants all of who are doctors knew at least 3 essential steps of the techniques in using the metered dose inhaler correctly. None of the participants got all the steps for the use of pMDI totally correct. Conclusion Knowledge regarding the use of the metered dose inhaler and spacer device was poor. Health practitioners should have constant reminders in the form of continuous medical education to update their knowledge regarding correct inhaler technique. Funding self-funded.