Okoro Eo

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.

The effects of sulindac and diclofenac in essential hypertension controlled by treatment with a beta blocker and/or diuretic.

A placebo-controlled, double blind crossover study of the non-steroidal anti-inflammatory drugs (NSAIDs) sulindac and diclofenac was conducted in 16 patients with essential hypertension that was controlled by treatment with a beta blocker, a diuretic or co-administration of both. In 4 cases, another antihypertensive agent (prazosin or verapamil) was also co-administered. In every patient, plasma creatinine concentration was less than 0.14 mmol/l (normal range 0.07-0.12 mmol/l). Sulindac and diclofenac were each given for 7 weeks. Diclofenac caused a decrease of borderline significance in plasma aldosterone concentration. Neither NSAID altered the mean values for systolic or diastolic blood pressure, body weight, plasma electrolyte concentrations, urate clearance, creatinine clearance or plasma renin activity. However, rises in plasma creatinine concentration and falls in creatinine clearance occurred during NSAID therapy in three individual subjects. No significant differences were observed in this study between the effects on renal function or blood pressure of sulindac and diclofenac, both of which appear not to interfere with the antihypertensive actions of beta blockers and diuretics.

Case Study: Environmental Noise Levels in Nigeria: A Report

Column Editor Lawrence Mazzuckelli

Comparative and combined efficacy of doxazosin and enalapril in hypertensive patients

Twenty patients with essential hypertension were randomised to a 7-week period of dose titration with doxazosin, 1-8mg/day or enalapril, 5-20mg/day. In a further 7-week period the dosage level reached with the initial drug was halved, and titration with the second agent was carried out. Blood pressure responses at the end of each treatment period were assessed by clinic measurements made 24 hours post-dose. In the first treatment period, enalapril (mean dose 19mg/day) reduced serum free ACE activity by 40% and had a greater effect than doxazosin (mean dose 5.2mg/day) on clinic supine blood pressure (systolic and diastolic). In the second period, the addition of enalapril to doxazosin was associated with a significant fall in clinic standing blood pressure (systolic and diastolic), despite the doxazosin dose reduction and consequent decrease in median plasma doxazosin concentration (from 10.6 to 5.2ng/ml). Alternatively, when doxazosin was added to enalapril, free ACE activity remained 40% decreased despite enalapril dose reduction, and blood pressure was not further affected. Plasma renin activity was increased by enalapril. No changes were observed in plasma aldosterone or lipid concentrations with either drug. The combination of doxazosin and enalapril was well tolerated and lowered blood pressure overall. Judged by clinic measurements 24 hours post-dose, most of the antihypertensive effect was attributable to the enalapril component. However, ambulatory blood pressure monitoring 0-12 hours post-dose in a subset of patients suggested a contribution of doxazosin earlier in the dose interval.

Aspirin and Diabetes Care in Nigeria: Treatment or Exploitation?

Cardiovascular disorders have become leading drivers of untimely deaths almost everywhere. Such deaths are however declining globally due to effective interventions. Low dose aspirin contributes to this reduction when used appropriately through minimization of the risk of coronary heart disease and other occlusive atherosclerotic syndromes that can complicate type 2 diabetes/or hypertension. One local study published in 2004 indicated that aspirin was prescribed for 33% of patients with type 2 diabetes. Since then, aspirin prescription, as part of standard therapy for type 2 diabetes/or hypertension, has risen steadily with some studies reporting this to be 66%-88%; These figures more than double those reported in jurisdictions overseas where occlusive atherosclerotic disorders commonly complicate type 2 diabetes and/or hypertension. Even so, recent transnational data show that cardiovascular deaths linked to type 2 diabetes and or hypertension are not abating in sub-Saharan Africa as in many other regions. This can suggest that interventions in black Africa, if any, maybe less than effective in comparison to areas where health outcomes are improving. Significantly, type 2 diabetes and/or hypertension can behave differently in many black groups within Africa such that occlusive atherosclerotic disorders are less common health consequences even with rising cholesterol levels. In the case of Nigeria, the evidence of cardiovascular health benefits of aspirin, as extensively described in groups overseas, appears hard to find for local cohorts. Indeed what the available data strongly suggest is that effective control of blood pressure is a higher treatment priority for saving Nigerian lives than interventions aimed at retarding the atherosclerotic process. Given these observations, the question ought to be asked whether or not low dose aspirin in type 2 diabetes/hypertension therapies, as locally practiced, is the best way of optimizing limited resources in saving Nigerian lives. This paper examines the evidence.

Hazard of noise induced hearing loss (NIHL) among operators of music recording/retail centres in Nigeria

We studied the level of music loudness to which operators of music recording/retail centre were exposed in order to determine their risk of work-related hearing loss. A survey of consenting operators of music recording centres on six main streets selected by simple random sampling at different locations of the town was carried out using a structured questionnaire. The sound level of the music from the music player speakers in each centre was measured using a sound level meter (Testo 815) duly calibrated with a sound level meter calibrator (Testo 0554.0009). Results were analyzed by simple descriptive statistics. The study involved 79 mainly male young adults aged 27.7 ± 6.8 years (SD). The measured sound levels in the centres ranged from 86-104dBA; with a mean of 96 ± 2.5dBA(SD). Exposure to this music loudness was for an average of 9 hours daily for an employment period averaging about 5 years. Thirty percent of the study population reduced music loudness by turning down the volume; 6.3% sat at six or more metres from the speakers; 10% used ear plugs occasionally and 7.6% had hearing assessment at some stage prior to the present study. The level of noise exposure of this population of young males is in excess of the threshold associated with irreversible hearing loss, and protection measures were less than optimal.

Effective Treatment Matters: Revitalizing Pharmacovigilance

The thalidomide disaster remains a constant reminder that medical treatments can be hazardous. Since then, however, cross-border cooperation has fostered global awareness and galvanized actions. The result is better tools for detecting adverse drug reactions (ADRs) and assessing risk–benefit of medical treatments that guide therapeutic decisions. Unfortunately, despite these advances and widespread drug safety monitoring activities, treatment qualities of many conditions of public health importance remain problematic.

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.