Gregory E. Erhabor

Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital

OBJECTIVE The goal of this study was to explore specific psychiatric morbidity among chronic obstructive pulmonary disease (COPD) patients in Nigeria. METHOD The mental status of 30 COPD patients was compared with those of 30 uncomplicated hypertensive patients and 30 apparently healthy controls using the 30-item General Health Questionnaire (GHQ-30) and Present State Examination (PSE). The sociodemographic characteristics of the three groups were also compared. RESULTS The COPD population was significantly least educated and predominantly subsistent farmers. Thirty percent of the COPD population, 13.3% of the hypertensive patients and 3.3% of apparently healthy controls had psychiatric morbidity (P<.05). The COPD population, with psychiatric diagnoses consisted of 16.7% depressive episode, 10% generalized anxiety disorder and 3.3% delirium. This pattern is similar to data from industrialized countries. No sociodemographic factors were significantly associated with psychiatric morbidity. CONCLUSION Improving the psychiatric knowledge of the primary physician will result in better management of the COPD patient.

Prevalence of asthma symptoms among university students 15 to 35 years of age in obafemi awolowo university, Ile-Ife, osun state

Introduction. Asthma continues to cause increasing morbidity and mortality among young adults in the developing world. There is scarcity of data on the prevalence of asthma among young Nigerian adults. Methods. We studied the prevalence of asthma among students (15–35 years of age) of the Obafemi Awolowo University using a standardized questionnaire. One thousand self-administered questionnaires were distributed; 903 were retrieved and analyzed (469 males, 434 females). Symptoms indicative of asthma were cough, chest tightness at rest and on exposure to irritants, and the presence of nocturnal symptoms. Students with three or more symptoms or who had a diagnosis of asthma were considered probable asthmatics and those with one or two symptoms as suspected asthmatics. Students in any of these two categories were defined as symptomatic respondents. Results. The 12-month prevalence of wheeze, night waking with cough, and chest tightness in the morning was 9.0% (n = 81) 9.4% (n = 85) and 8.0% (n = 72), respectively. One hundred and twenty-seven respondents (14.1%) comprising 49 males (10.4%) and 78 females (17.9%) had probable asthma. The remaining symptomatic respondents consisting of 20 males (4.3%) and 16 females (3.9%) had suspected asthma. Of these, only 32.5% (53/163) had been previously diagnosed and 22.1% were on occasional inhaled bronchodilator treatment. Conclusion. These results indicate a relatively high prevalence of asthma among the students. A greater proportion of them had not been diagnosed and were not receiving proper treatment.

The association of anxiety with asthma among a sample of asthmatics in Ile-Ife Osun State Nigeria

Background. The association between asthma and anxiety has been a subject of various studies in developed countries, but there has been little work done in this area in developing countries. The goal of this study is to determine whether asthmatics are more anxious than orthopaedic patients and healthy individuals. Method. Fifty consecutive asthmatics were assessed. All completed a sociodemographic questionnaire, the General Health Questionnaire (GHQ—30) and the State Trait Anxiety Inventory (STAI—1 and 2). Healthy individuals (30) and orthopaedic patients (30) were also recruited as controls; they also completed the GHQ and the STAI—1 and 2. Results. No significant difference was found in the sociodemographic variables such as age, sex, occupation, and marital status. The asthmatics had a mean GHQ score of 4.2 (SD ± 4.6) while orthopaedic and healthy control groups scored 1.6 (SD ± 1.8) and 2 (SD ± 1.8), respectively. There was a significant difference in the mean score of the index population (Asthmatics) and the comparison groups (F = 7.09, DF = 2/107, P = 0.004). With GHQ, cutoff point of ≥ 5.34% of asthmatics scored above 5 while 10% and 13.3% of the orthopaedic patients and healthy controls each scored ≥ 5. A significant difference was obtained in the mean scores on the STAI—1 questionnaire (F = 4.6, DF = 2/107, P =.012) indicating state anxiety whereas there was no significant difference on the STAI—2 questionnaire (F = 1.2, DF = 2/107, P = 0.31). Conclusion. Although asthmatics have higher anxiety compared to controls, this is not an inherent problem or trait among them.

Chronic Airflow Obstruction in a Black African Population: Results of BOLD Study, Ile-Ife, Nigeria

Abstract Global estimates suggest that Chronic Obstructive Pulmonary Disease (COPD) is emerging as a leading cause of death in developing countries but there are few spirometry-based general population data on its prevalence and risk factors in sub-Saharan Africa. We used the Burden of Obstructive Lung Disease (BOLD) protocol to select a representative sample of adults aged 40 years and above in Ile-Ife, Nigeria. All the participants underwent spirometry and provided information on smoking history, biomass and occupational exposures as well as diagnosed respiratory diseases and symptoms. Chronic Airflow Obstruction (CAO) was defined as the ratio of post-bronchodilator (BD) one second Forced Expiratory Volume (FEV1) to Forced Vital Capacity (FVC) below the lower limit of normal (LLN) of the population distribution for FEV1/FVC. The overall prevalence of obstruction (post-BD FEV1/FVC < LLN) was 7.7% (2.7% above LLN) using Global Lung Function Initiative (GLI) equations. It was associated with few respiratory symptoms; 0.3% reported a previous doctor-diagnosed chronic bronchitis, emphysema or COPD. Independent predictors included a lack of education (OR 2·5, 95% CI: 1.0, 6.4) and a diagnosis of either TB (OR 23.4, 95% CI: 2.0, 278.6) or asthma (OR 35.4, 95%CI: 4.9, 255.8). There was no association with the use of firewood or coal for cooking or heating. The vast majority of this population (89%) are never smokers. We conclude that the prevalence of CAO is low in Ile-Ife, Nigeria and unrelated to biomass exposure. The key independent predictors are poor education, and previous diagnosis of tuberculosis or asthma.

Prevalence and predictors of obstructive sleep apnea syndrome in a sample of patients with type 2 Diabetes Mellitus in Nigeria.

Introduction: Obstructive sleep apnea (OSA) and Diabetes Mellitus (DM) are growing health challenges worldwide. However, the relation of OSA with type 2 diabetes is not well understood in developing countries. This study described the prevalence and predictors of OSA in type 2 DM patients using a screening questionnaire. Materials and Methods: Patients aged 40years and above with type 2 diabetes mellitus were recruited into the study consecutively from the outpatient clinics of a university hospital. They were all administered the Berlin questionnaire and the Epworth sleepiness scale (ESS) to assess the risk of OSA and the tendency to doze off, respectively. Anthropometric details like height, weight and body mass index (BMI) were measured and short-term glycaemic control was determined using fasting blood glucose. Results: A total of 117 patients with type 2 diabetes mellitus were recruited into the study. The mean (SD) age, height and BMI was 63 years (11), 160 cm (9) and 27.5 kg/ m2 (5.7), respectively. Twenty-seven percent of the respondents had a high risk for OSA and 22% had excessive daytime sleepiness denoted by ESS score above 10. In addition, the regression model showed that for every 1 cm increase in neck circumference, there is a 56% independent increase in the likelihood of high risk of OSA after adjusting for age, sex, BMI, waist, hip circumferences and blood glucose. Conclusion: Our study shows a substantial proportion of patients with type 2 diabetes may have OSA, the key predictor being neck circumference after controlling for obesity.

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.

Specific psychiatric morbidity among a sample of asthmatics in South Western Nigeria

Objective: This study was to identify specific psychiatric morbidity among asthma patients and to compare their rates to controls. Method: Hundred consecutive asthmatics were screened using the General Health Questionnaire (GHQ-30), and the Present State Examination (PSE). The same instruments were also administered to 75 healthy individuals, and 75 orthopaedic patients. Results: Patients with asthma had a higher occurrence of psychopathology. The specific psychiatric diagnoses among asthmatics were generalized anxiety disorder (23%), depressive disorder (11%), while 2% had panic disorder. Conclusion: Psychiatric morbidity is more common among asthmatics, than the general population and other patient group.

Smoking prevalence and attitudes regarding its control among health professional students in South-Western Nigeria.

Background: Tobacco use is one of the leading preventable causes of morbidity and mortality globally; about 70% of smokers see physicians each year. Health care professionals have a very unique role in motivating people to quit smoking. Aim: The aims of this study were to document the smoking prevalence and attitudes regarding its control among these set of students who will be tomorrows health care providers. Subjects and Methods: A cross-sectional survey was conducted in two medical schools in South-Western Nigeria with their accompanied nursing and pharmacy students. All students in the selected schools were eligible to participate and students participation was voluntary. The Global Health Professional Students Survey core questionnaire was used to collect data on smoking prevalence and attitudes regarding its control. The data were summarized using percentages and confidence interval (CI) was calculated using standard error of mean. Pearsons Chi-square and fishers exact were employed to test the significance. Results: Life-time prevalence of cigarette smoking was 17.9% (121/675) with (95% confidence interval [CI] 15-20.8). Only 5.04% (34/675) with (95% CI 3.7-7.1) of the respondents were currently smoking. Ever smokers were significantly less likely than non-smokers to indicate that tobacco sales to adolescents should be banned (P < 0.01). Fewer smokers than non-smokers agreed that there should be a complete ban on advertising of tobacco products (P < 0.001). 93.3% of them said that they were taught about danger of smoking but only 48.6% ever heard of using anti-depressant in tobacco cessation program. Conclusions: Smoking prevalence among health professional students in South-West Nigeria is relatively low; however, majority believed that health-care providers serve as role models for their patients and the public.

Influence of self-reported socio-economic status on lung function of adult Nigerians

OBJECTIVES Low socio-economic status is known to be associated with reduced lung function in childhood and early adulthood, and an increased risk of cardiovascular disease in older adults. The lung function of people in developing nations is known to be lower than that of their counterparts in developed nations. This study assessed whether childhood socio-economic status is related to lung function in adults in Nigeria. DESIGN Cross-sectional study. SETTING Ife central local government, Ile-Ife, Nigeria. PARTICIPANTS One thousand nine hundred and thirty healthy adults aged 40 to 80 years took part in the study. Forced vital capacity (FVC) and forced expiratory volume in 1second (FEV(1)) were measured with a spirometer, and peak expiratory flow (PEF) was measured with a mechanical peak expiratory flow meter. The socio-economic status questionnaire gave equal importance to education, occupation and family income. Based on the score, the subjects were classified as lower, middle or higher status. MAIN OUTCOME MEASURES Spirometry, assessment of peak flow meter and questionnaire to assess socio-economic status. RESULTS The results showed a difference between the group with the highest socio-economic status and the other two groups [mean (standard deviation) FVC: high 3.63l (0.33), middle 3.57l (0.41), low 3.38l (0.35)]. The mean difference between the high and middle socio-economic groups was 0.07l [95% confidence interval (CI) 0.02 to 0.11]. A similar difference existed for FEV(1): high 3.16l (0.28), middle 3.06l (0.31), low 2.94l (0.34). The mean difference between the high and middle socio-economic groups was 0.11l (95% CI 0.07 to 0.15). Values for PEF were: high 404.30l/second (35.98), medium 390.56l/second (41.53), low 376.03l/second (45.81). The mean difference between the high and medium socio-economic groups was 13.74l/second (95% CI 8.42 to 19.06). There was a weak but significant association between socio-economic status and FVC (r=0.28), FEV(1) (r=0.26) and PEF (r=0.25). CONCLUSION Self-reported low socio-economic status is associated with lower lung function among adult Nigerians. This may increase their risk for respiratory and cardiovascular disease.

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.