Benjamin A. Oyejola

Diabetic care in Nigeria: report of a self-audit

As part of a wider study aimed at establishing baseline data on standard of diabetic care to compare with subsequent reassessment after measures to improve outcomes have been introduced, the case notes of 118 Nigerians (42 males) with diabetes attending a teaching hospital-based diabetic clinic were reviewed to assess the quality of professional care in a year with reference to an international standard of diabetic care. Patient attendance at the clinic averaged about nine times annually and majority of them had been attending the facility for about 6 years. Fasting blood glucose (FBG) was tested four or more times in 92.4% of the patients. The corresponding figures for footcare were 1.7%; referrals for eye, dental, or cardiac examination were 12.7%, while lipid profile, serum creatinine, and urinary protein estimation were documented in 16.9% of the patients. In contrast, high-risk assessment or part of it was documented in all patients, and in 61.9%, high-risk intervention was recorded. The data suggest that the quality of diabetic care was less than optimal, and foot examination and referrals, etc. are specific areas for improvement.

Symptom Score for Allergic Rhinitis

Objectives To determine the prevalence of allergic rhinitis in our study population and the correlation between the Score for Allergic Rhinitis (SFAR) and nasal smear eosinophil count. Study Design Cross-sectional study. Setting Ear, nose, and throat clinic, University of Ilorin Teaching Hospital, Nigeria; a 450-bed tertiary health facility. Subjects Two hundred seventy-five consecutive, consenting patients who presented with nasal symptoms. Methods Information on the 8-parameter symptom score was collected using a semistructured questionnaire by interview. Nasal smear slides were air dried, fixed with 95% alcohol, stained using May-Grünwald-Giemsa stain, and examined under a light microscope. Results Of the 275 participants seen during the 1-year study, 116 (42.2%) were males. The mean ± SD age was 38.5 ± 16.3 (range, 14-75) years. Eighty-one (29.5%) were diagnosed with allergic rhinitis using a nasal smear eosinophil count. The most common symptom was excessive sneezing, involving 93% of patients with allergic rhinitis (P < .001). The prevalence of allergic rhinitis using SFAR was 31.6%. The SFAR cutoff was set at >8 (P < .001). The sensitivity and specificity for SFAR were 94.8% (confidence interval [CI], 90.5%-97.4%) and 95.1% (CI, 87.2%-98.4%), respectively. A high Spearman’s correlation (0.88) was obtained for SFAR when correlated with nasal smear eosinophil count. Conclusion The prevalence of allergic rhinitis using SFAR was 31.6%. The study shows that SFAR can be used as a simple, valid diagnostic tool in allergic rhinitis. This is important in rural settings where access to laboratory investigations might not be readily available.

Case Study: Environmental Noise Levels in Nigeria: A Report

Column Editor Lawrence Mazzuckelli

Health-Related Quality of Life and Its Contributory Factors in Allergic Rhinitis Patients in Nigeria

OBJECTIVES To determine the health-related quality of life (HRQoL) in allergic rhinitis patients as well as identify contributory factors to patients well-being. METHODS Cross-sectional study by multistage sampling. Four-month study duration (October 2013 to January 2014). The setting of the study was Kwara State, Nigeria, which has 16 local government areas with 3 senatorial districts, total land mass of 36,825km(2) with a population of 2,591,555. 132 consenting adults; 66 of them have allergic rhinitis (AR) using Score for Allergic Rhinitis (SFAR) instrument and 66 were age- and gender-matched controls (χ(2)=0, d.f.=1, P=1 and χ(2)=1.24, d.f.=2, P=0.54, respectively). Information on HRQoL was obtained using the 14-parameter mini-rhinoconjunctivitis quality of life questionnaire (mini-RQLQ). Socio-demographic variables possibly contributory to patients well-being were obtained. Kruskal-Wallis and Mann-Whitney U tests were used to compare means. RESULTS The overall Total Symptom Score (TSS) was 3.37±0.9, while male and female allergic patients and control TSS were 3.61±1.0; 3.16±0.8, and 0.98±0.2; 0.95±0.2, respectively. Effects of gender, marital status, senatorial districts, residential area and duration of symptoms had significant impact on the quality of life. The highest correlation with TSS and components of mini-RQOL questionnaire existed between nasal problems and other symptoms (r=0.866; 0.868). CONCLUSION AR had appreciable impact on HRQoL of the participants. Gender, number of dependents, marital status, senatorial districts, residential area and duration of symptoms were major identifiable contributory factors to the patients well-being.

Observations on the Use of Low-Dose Hydrochlorothiazide in the Treatment of Hypertension in Diabetic Nigerians

Objective: The effects of low doses of hydrochlorothiazide (HCTZ) and amiloride in a fixed-combination formulation on blood pressure (BP), serum K+ and diabetic control were assessed in 11 adult Nigerians with hypertension and type 2 diabetes for 12 weeks. Methods: The study included concurrent exposure to 75 mg of aspirin daily by mouth and dietary advice not to add table salt to regular meals, initiated 4 weeks prior to HCTZ therapy. Results: The addition of 12.5 mg of HCTZ resulted in a significantly lower BP, which was evident within 4 weeks. There was no significant variation in serum K+, Na+, creatinine or body weight or the need to alter the dose of hypoglycaemic agents. An initial rise in fasting blood sugar (FBS) after 4 weeks of HCTZ therapy was evident but subsequent rises were not significantly different to the initial rise in FBS observed at week 4. Conclusions: These observations are preliminary and would need longer-term follow-up and treatment of a larger number of patients for confirmation, but they do have the potential to lead to a cheaper and safer therapeutic approach to effective control of BP in diabetic Nigerians with hypertension.

On the standard errors and other moments for ratios of biological measurements

A method of obtaining the standard error and some other moments for the ratios of biological measurements is given, with the conditions to be satisfied by the variables used to form such ratios. Some applications of the distributional properties of the ratios in the analysis of results from experiments are discussed

Blood pressure and body size preference in traditional communities of Ilorin metropolis, Nigeria

BackgroundOur previous work showed that many individuals with type 2 diabetes and in the background population may prefer larger body sizes. This prompted us to study the interaction between body size, body size perception and blood pressure. MethodsAnthropometric variables, body size perception and blood pressure were measured in adults of three Nigerian communities. The results were subjected to tests of correlation and regression to determine any association/functional relationship between predictor variables and blood pressure. ResultsParticipants with elevated blood pressure were older (52.75 vs. 39.58 years) and had a higher BMI (24.50 vs. 22.84), waist circumference (86.69 vs. 81.57) and hip circumference (95.23 vs. 92.49) compared with normotensives. There were significant (P<0.05) correlations between systolic blood pressure and age (0.401), weight (0.13), BMI (0.182), waist circumference (0.231), hip circumference (0.132), height (0.15), current body size perception (0.181), preferred body size (0.119) and preferred body size of the opposite gender (0.14). For normotensives, a 1 cm increment in waist circumference was associated with an increase in systolic blood pressure by 0.35 mmHg in those younger than 50 years of age. In older participants, an increase in BMI by 1 kg/m2 led to an increase in systolic blood pressure by 1.1 mmHg. Thirty-two per cent of the participants had hypertension. Less than 10% of the interindividual differences in blood pressure resulted from variations in body dimensions/or body size perception. Significantly, 66.5 versus 51.9% of hypertensive and normotensive individuals, respectively, desired a larger body size for self/spouse. ConclusionThe results indicated a dominant preference for larger body sizes, whereas body dimension predicted blood pressure only to a very limited degree.

A study of alley-cropping data from Northern Brazil : II. A comparison of methods to estimate sample size

Data from a Brazilian Inga/maize/bean alleycrop experiment are used to illustrate patterns of variation between and within crop rows and their possible effects in the determination of a sampling strategy. Three methods for the determination of sample sizes in agroforestry experiments are compared: the combined plant technique, the formula of Snedecor and Cochran and variance component estimation. Results show that variability in the edge rows was generally greater than variability in the inner rows and suggest three sampling strata – one for each of the two edge rows and the third for the inner rows. For all three sampling methods a sample size greater than ten plants per stratum per block gave little extra precision. Increasing the number of blocks improves precision and may permit a smaller sample size per row to achieve the same precision. The comparison of different methods of sample size determination shows that variance component estimation is the most flexible and efficient approach.