Obianuju B. Ozoh

High-risk of obstructive sleep apnea and excessive daytime sleepiness among commercial intra-city drivers in Lagos metropolis

Background: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. Aim: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra-city commercial drivers. Setting and Design: A descriptive cross-sectional study in three major motor parks in Lagos metropolis. Materials and Methods: Demographic, anthropometric and historical data was obtained. The risk of OSA and EDS was assessed using the STOP BANG questionnaire and the Epworth Sleepiness Scale, respectively. Statistical Analysis: The relationship between the OSA risk, EDS risk and past road traffic accident (RTA) was explored using the Pearsons chi square. Independent determinants of OSA risk, EDS risk and past RTA, respectively, were assessed by multiple logistic regression models. Result: Five hundred male commercial drivers (mean age (years) ±SD = 42.36 ± 11.17 and mean BMI (kg/m2) ±SD = 25.68 ± 3.79) were recruited. OSA risk was high in 244 (48.8%) drivers and 72 (14.4%) had EDS. There was a positive relationship between OSA risk and the risk of EDS (Pearsons X2 = 28.2, P < 0.001). Sixty-one (12.2%) drivers had a past history of RTA but there was no significant relationship between a past RTA and either OSA risk (X2 = 2.05, P = 0.15) or EDS risk (X2 = 2.7, P = 0.1), respectively. Abdominal adiposity, regular alcohol use and EDS were independent determinants of OSA risk while the use of cannabis and OSA risk were independent determinants of EDS. No independent risk factor for past RTA was identified. Conclusion: A significant proportion of commercial drivers in Lagos metropolis are at high risk of OSA and EDS.

HIV associated chronic obstructive pulmonary disease in Nigeria.

OBJECTIVE To determine the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) among HIV-infected adults in Nigeria. DESIGN Cross-sectional study. METHODS HIV-infected adults aged ≥ 30 years with no acute ailments accessing care at the antiretroviral therapy clinic of Jos University Teaching Hospital were enrolled consecutively. Participants were interviewed to obtain pertinent demographic and clinical information, including exposure to risk factors for COPD. Post-bronchodilator spirometry was carried out. HIV related information was retrieved from the clinic medical records. COPD case-definition was based on the Global Initiative for Obstructive Lung Disease (GOLD) criteria using post-bronchodilator FEV1/FVC <0.7. COPD prevalence was also calculated using the lower limit of normal for FEV1/FVC criteria (LLN) from the European Respiratory Society normative equation. Factors associated with COPD were determined using logistic regression models. RESULTS Study population comprised 356 HIV infected adults with mean age of 44.5 (standard deviation, 7.1) years and 59% were female. The mean time elapsed since HIV diagnosis was 7.0 (SD, 2.6) years and 97.5% of the respondents were on stable ART with virologic suppression present in 67.2%. Prevalence of COPD were 15.4% (95% confidence interval [CI] 11.7-19.2), 12.07% (95% CI 8.67-15.48), 22.19% (95% CI 18.16-26.83) using GOLD, ERS LLN and GLI LLN diagnostic criteria respectively. In multivariate analyses adjusting for gender, exposure to cigarette smoke or biomass, history of pulmonary tuberculosis, use of antiretroviral therapy, current CD4 T-cell count and HIV RNA, only age > 50 years was independently associated with COPD with OR 3.4; 95% CI 1.42-8.17 when compared to ages 30-40 years. CONCLUSION HIV-associated COPD is common in our population of HIV patients.

Smoking habits, awareness of risks, and attitude towards tobacco control policies among medical students in Lagos, Nigeria

BACKGROUND This study aimed to assess the prevalence of cigarette smoking among medical students, and to determine their level of knowledge regarding risk associated with cigarette smoking and their attitude and behavior towards tobacco control strategies and policies. MATERIALS AND METHODS A stratified random sampling approach was used to select participants. A modified version of the the Global Health Professional Students Survey questionnaire was self-administered. Descriptive statistics were applied and comparisons were done using chi-square test. Multivariate logistic regression was used to obtain the significant determinants of smoking. A P < 0.05 was considered significant. RESULTS A total of 250 students participated in the study with a response rate of 89.2%. The mean age (years) was 21.4 ± 3. Rate of ever smoking and current smoking was 9.6 and 1.2%, respectively. Age > 21, having a smoking father, and use of alcohol were significantly associated with ever smoking. Knowledge of smoking as a risk for emphysema was 72.8%, coronary artery disease 82.8%, stroke 68.8%, and low birth weight 76.4%. There were 103 (41.2%) students aware of antidepressant usage in smoking cessation. One hundred and ninety-five (78%) offered smoking cessation advice if a smoker had no smoking-related disease and did not seek their opinion about smoking, 68.8% affirmed to having adequate knowledge on smoking cessation, and 56.8% had received formal training on smoking cessation techniques. The ban on cigarette smoking in enclosed public places was supported by 92.4%. CONCLUSIONS The prevalence of current cigarette smoking among medical students in Lagos is relatively low. Gaps exist in the level of knowledge of the students regarding risks of cigarette smoking, tobacco cessation strategies, and in their attitude and behavior towards offering tobacco cessation advice. There is need therefore to include formal training on tobacco control strategies at an early stage in the medical curriculum.

The ACT and the ATAQ Are Useful Surrogates for Asthma Control in Resource-Poor Countries with Inadequate Spirometric Facilities

Objective. The objective of this study is to determine the utility of simple asthma control questionnaires in assessing the asthma control in our practice setting. Methods. The Asthma Control Test (ACT), Asthma Therapy Assessment Questionnaire (ATAQ), and mini Asthma Quality of Life Questionnaire (mini AQLQ) were administered to previously diagnosed asthma patients. Spirometry was performed to obtain the prebronchodilator forced expiratory volume in 1 second (FEV1). The relationship between test scores (ACT and ATAQ) and the FEV1 and mini AQLQ scores, respectively, was explored. Results. A total of 106 patients (mean age 41 ± 15.3 years, 61 (57.5%) females) participated in the study. The mean ACT score was 17 ± 5.3 and the mean ATAQ score was 1.46 ± 1.34. There was a significant positive correlation between the ACT score and FEV1% predicted indicating the improvement in asthma control when FEV1% predicted increases (Pearson’s correlation = 0.518, R2 = 0.268, p < .0001) and a negative correlation between the ATAQ score and FEV1% predicted also indicating the improvement in asthma control when FEV1% predicted increases (Pearson’s correlation = −0.516, R2 = 0.266, p < .0001). The ACT score was significantly and positively related to the mini AQLQ score signifying an improvement in quality of life with increasing ACT score (Pearson’s correlation = 0.691, R2 = 0.461, p < .0001).The ATAQ score was significantly and negatively related to the mini AQLQ score indicating an improvement in quality of life with decreasing ATAQ score (Pearson’s correlation = −0.654, R2 = 0.428, p ≤ .0001). The FEV1% predicted and the mini AQLQ score were the only significant determinants of both the ACT score and the ATAQ score. Conclusion. The ACT and ATAQ are the objective and reliable tools in determining asthma control due to their strong correlation with the FEV1 and the asthma-specific health-related quality of life. Use of either questionnaire routinely will identify more patients with poor asthma control even when spirometry services are not readily available.

An Assessment of the Knowledge and Attitudes of Graduating Medical Students in Lagos, Nigeria, Regarding Obstructive Sleep Apnea

RATIONALE Symptom scores show that a significant proportion of Nigerians are at high risk of developing obstructive sleep apnea; however, the diagnosis is rarely made in this country. The knowledge of medical students regarding sleep apnea may provide insight into their future ability to recognize patients with sleep apnea and can also inform student education on this disease. OBJECTIVES To assess the knowledge and attitudes of graduating medical students in Nigeria regarding obstructive sleep apnea using a standard validated questionnaire. METHODS This descriptive, cross-sectional survey study was performed at the College of Medicine of the University of Lagos, Nigeria. The Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) instrument was self-administered by the subjects. This validated questionnaire consists of 18 knowledge assessment questions and 5 attitude assessment questions. MEASUREMENTS AND MAIN RESULTS The response rate was 99%, and our final sample comprised 143 participants. The maximum achievable knowledge score was 18. Obtained scores ranged from 0 to 15; the mean ± SD score was 7.6 ± 3.2 (42.2%); and the median score was 8 (interquartile range, 6-10). Four participants (2.8%) had a score of 0, and 56 (39.2%) had a score corresponding to ≥50%. There was no significant difference in knowledge scores by sex or age. Regarding attitudes, over 80% considered obstructive sleep apnea an important disorder; 41% were confident in identifying patients with the condition; 16.1% were confident in managing the disease; and 16.8% expressed confidence in managing patients receiving continuous positive airway pressure therapy. The total attitude score ranged from 1 to 5 (mean, 2.9 ± 0.7). There was a significant correlation between the total attitude score and the total knowledge score (r = 0.22, P = 0.01) and the age of the participants (r = 0.18, P = 0.04). CONCLUSIONS The level of knowledge of obstructive sleep apnea among medical students at the Nigerian university in our study was not optimal. This study demonstrates a need to formally incorporate evaluation of sleep disorders into the undergraduate medical curriculum with the clear objective of enabling recognition of clinical features of common sleep disorders such as sleep apnea.

Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa

Introduction The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound, especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting. Methods The STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson χ2 test. Independent risk predictors for OSA were assessed in multivariate logistic regression analysis. Results A total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p). Conclusion A significant proportion of patients attending our tertiary care center are at high risk of OSA.

Medical students' knowledge about the management of chronic obstructive pulmonary disease in Nigeria

SETTING College of Medicine, University of Lagos, Nigeria. OBJECTIVE To determine the level of knowledge of medical students regarding the management of chronic obstructive pulmonary disease (COPD). DESIGN Descriptive cross-sectional survey using a structured questionnaire on risk factors for COPD and some of the diagnostic criteria recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and treatment options. RESULTS Among 139 questionnaires analysed, the mean total score (maximum 14) was 8.35 ± 2.75. Based on the opinion of pulmonologists in Nigeria who were considered an appropriate standard, 53 students (38.1%) had good (≥70%), 52 (37.4%) had fair (≥50 to <70%) and 28 (20.1%) had poor knowledge (≥30 to <50%) about COPD management; 76 (54.7%) students were familiar with the GOLD guidelines, and 111 (79.9%) knew that spirometry was the means of confirming a diagnosis of COPD. Most students (93.5%) recognised cigarette smoking as a risk factor for COPD; history of tuberculosis (20.1%) was least recognised as a risk factor for COPD. Thirty-nine (28.1%) students were aware that inhaled steroids and inhaled bronchodilators were the correct options for treatment of stable COPD. CONCLUSION Knowledge about COPD management among medical students in Nigeria is modest, and familiarity with the content of the GOLD guidelines is inadequate for optimal COPD management. More rigorous training would better equip medical students for COPD management in their careers as doctors.

Unmet needs in asthma treatment in a resource-limited setting: findings from the survey of adult asthma patients and their physicians in Nigeria

Introduction The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception and treatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians and patients in Nigeria, with the goal of identifying barriers to optimal management. Methods To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians. Results Majority (66.7%) of the patients reported their asthma as moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to educational issues (31.4% vs.18.7%) and its contents: individual management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0%) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines. Conclusion This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria.

Oral self-care practices, dental attendance and self-perceived oral health status among internal medicine residents in Nigeria

Background: Oral health is important for well-being and chronic disease prevention. Physician′s confidence and willingness to counsel patients on lifestyle practices is related to their personal behavior. Limited data exists regarding oral self-care practices among physicians in developing countries, as the majority seeks oral health advice and care from doctors rather than dentists. Aim: To determine the oral self-care practices, dental attendance, and self-perceived oral health status of internal medicine residents in Nigeria. Methods: A cross-sectional study was conducted among internal medicine resident doctors attending an update course using a self-administered structured questionnaire, which included oral care practices. Data were analyzed with SPSS version 21.0, P < 0.05 was significant. Results: The response rate was 82.0%. Data from 109 residents from the 6 geopolitical zones in Nigeria were analyzed. The mean age of the residents was 33.1 (4.0) years. 39.8% brushed twice a day, 20.2% used dental floss regularly, 10.1% used the roll technique for brushing and 30.3% of the doctors had never been to a dentist. However, 61.1% felt dental visits should be undertaken every 6 months and 57.8% strongly agreed/agreed that the state of their oral health was excellent. There was no difference in the oral hygiene practices by gender, designation or geopolitical zone of the residency program apart from dental flossing (female > male, P = 0.002). A higher proportion of junior compared to senior residents strongly agreed/agreed and strongly disagreed/disagreed that their oral health status was excellent (P = 0.026). Conclusion: The oral self-care practices of these doctors involved in managing patients with medical conditions linked to oral health is inadequate. There is a need for better education on oral self-care among physicians.

Cooking Fuels in Lagos, Nigeria: Factors Associated with Household Choice of Kerosene or Liquefied Petroleum Gas (LPG)

Cooking with dirty-burning fuels is associated with health risk from household air pollution. We assessed the prevalence of and factors associated with the use of cooking fuels, and attitudes and barriers towards use of liquefied petroleum gas (LPG). This was a cross-sectional, population-based survey conducted in 519 households in Lagos, Nigeria. We used a structured questionnaire to obtain information regarding choice of household cooking fuel and the attitudes towards the use of LPG. Kerosene was the most frequently used cooking fuel (n = 475, 91.5%; primary use n = 364, 70.1%) followed by charcoal (n = 159, 30.6%; primary use n = 88, 17%) and LPG (n = 86, 16.6%; primary use n = 63, 12.1%). Higher level of education, higher income and younger age were associated with LPG vs. kerosene use. Fuel expenditure on LPG was significantly lower than for kerosene (N (Naira) 2169.0 ± 1507.0 vs. N2581.6 ± 1407.5). Over 90% of non-LPG users were willing to switch to LPG but cited safety issues and high cost as potential barriers to switching. Our findings suggest that misinformation and beliefs regarding benefits, safety and cost of LPG are important barriers to LPG use. An educational intervention program could be a cost-effective approach to improve LPG adoption and should be formally addressed through a well-designed community-based intervention study.