Omosivie Maduka

Palm oil and the heart: A review

Palm oil consumption and its effects on serum lipid levels and cardiovascular disease in humans is still a subject of debate. Advocacy groups with varying agenda fuel the controversy. This update intends to identify evidence-based evaluations of the influence of palm oil on serum lipid profile and cardiovascular disease. Furthermore, it suggests a direction for future research. The sources of information were based on a PubMed, Google Scholar, African Journal online and Medline search using key words including: palm oil, palmitic acid, saturated fatty acids and heart disease. Published animal and human experiments on the association of palm oil and its constituents on the serum lipid profile and cardiovascular disease were also explored for relevant information. These papers are reviewed and the available evidence is discussed. Most of the information in mainstream literature is targeted at consumers and food companies with a view to discourage the consumption of palm oil. The main argument against the use of palm oil as an edible oil is the fact that it contains palmitic acid, which is a saturated fatty acid and by extrapolation should give rise to elevated total cholesterol and low-density lipoprotein cholesterol levels. However, there are many scientific studies, both in animals and humans that clearly show that palm oil consumption does not give rise to elevated serum cholesterol levels and that palm oil is not atherogenic. Apart from palmitic acid, palm oil consists of oleic and linoleic acids which are monounsaturated and polyunsaturated respectively. Palm oil also consists of vitamins A and E, which are powerful antioxidants. Palm oil has been scientifically shown to protect the heart and blood vessels from plaques and ischemic injuries. Palm oil consumed as a dietary fat as a part of a healthy balanced diet does not have incremental risk for cardiovascular disease. Little or no additional benefit will be obtained by replacing it with other oils rich in mono or polyunsaturated fatty acids.

Stroke survivors in Nigeria: A door-to-door prevalence survey from the Niger Delta region

The burden of stroke has been projected to increase in low-and middle-income countries due to the ongoing epidemiological transition. However, community-based stroke prevalence studies are sparse in sub-Saharan Africa particularly in Nigeria. This study aimed to provide a comparative estimate of the prevalence of stroke survivors in the rural Niger Delta region. A three-phased door-to-door survey was conducted using WHO modified instruments. In the first-phase, 2028 adults (≥18years) participants randomly selected from two rural communities were screened by trained health research assistants for probable stroke. In the second phase, suspected cases were screened with stroke-specific tool. Positive cases were made to undergo complete neurological evaluation by two study neurologist in phase-three. Stroke diagnosis was based on clinical evaluation using WHO criteria. Overall, 27 (8 first-ever and 19 recurrent cases) stroke survivors with crude prevalence of 13.31/1000 (95% CI, 8.32-18.31) and a non-significant difference in prevalence between the two study communities were found, (P=0.393I). In addition, age-adjusted prevalence of stroke survivors was 14.6/1000 person, about 7-folds higher than previous estimates outside the Niger Delta region. The prevalence increases significantly with advancing in age, P<0·001. Among others, hypertension (92.59%) was the commonest risk factor and comorbidity found. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure, remains a public health priority.

The Burden of Hypertension in an Oil- and Gas-Polluted Environment: A Comparative Cross-Sectional Study

BACKGROUND Evidence of positive association between traffic-related air pollution and elevated blood pressure has been published widely. However, the risk of hypertension and prolonged exposure to crude oil pollution and gas flares remains unexplored. METHODS We recruited 2,028 residents (aged 18-80) in a cross-sectional survey of both oil/gas polluted and nonpolluted communities in the Niger Delta region of Nigeria. Prevalence and risk of hypertension, anthropometric indices, lifestyle and sociodemographic factors, and cardiovascular comorbidities were examined and compared between the 2 groups. Hypertension was defined as blood pressure ≥140/90mm Hg or on antihypertensive medication. Both univariate and multivariate logistic regression models were used to examine factors associated with hypertension. Model fits statistics were used to assess the parsimonious model and predictive power. RESULTS More than one-third of participants were hypertensive (37.4%). Half of the participants were from oil-polluted areas (51%). Only 15% of participants reported family history of hypertension. In the adjusted model, participants living in oil-polluted areas were almost 5 times as likely to have developed hypertension (adjusted odds ratio (aOR) = 4.85, 95% confidence interval (CI): 1.84-12.82) compared to participants in unpolluted areas. Age modifies the association between pollution status and risk of hypertension. For every 10 years increase in the age of the participants, the odds of developing hypertension increased by 108% (aOR = 2.08, 95% CI: 1.77-2.43). CONCLUSION The results suggested that exposure to oil/gas pollution may be associated with an increased risk of hypertension. Our findings need to be further investigated in longitudinal studies.

Awareness, acceptability, and use of female condoms among university students in Nigeria: implications for STI/HIV prevention.

Abstract Background: Most university students in Nigeria are sexually active and engage in high risk sexual behaviors. The aim of this study was to assess the acceptability and use of female condoms in the context of HIV prevention in order to provide basic information that can stimulate female condom programming to promote sexually transmitted infection and HIV prevention among youths in tertiary institutions. Materials and methods: A descriptive, cross-sectional study was carried out among 810 undergraduate students of the University of Port Harcourt from October to November 2011, using a stratified sampling method and self-administered questionnaires. Results: Most of the students, 589 (72.7%) were sexually active; 352 (59.7%) reported having just one sexual partner, while 237 (40.3%) had multiple partners. The mean number of sexual partners in the past six months was 2.2±0. Consistent condom use was reported among 388 (79.2%) students, 102 (20.8%) reported occasional usage, while 99 (16.8%) did not use condoms at all. Only 384 (65.2%) of the students had ever been screened for HIV. Although 723 (89.3%) were aware of female condoms, only 64(8.9%) had ever used one due to unavailability, high cost, and difficulty with its insertion. Nevertheless, 389 (53.8%) of the students expressed willingness to use them if offered, while 502 (69.4%) would recommend it to friends/peers. Conclusion: This study highlights significant challenges in the use of female condoms among university students. These include unavailability, high cost, and difficulty with insertion. Therefore, deliberate efforts using social marketing strategies, appropriate youth-friendly publicity, and peer education must be exerted to provide affordable female condoms and promote usage; such efforts should target vulnerable youths in Nigerian tertiary institutions.

Ethical challenges of containing Ebola: the Nigerian experience

Responding effectively to an outbreak of disease often requires routine processes to be set aside in favour of unconventional approaches. Consequently, an emergency response situation usually generates ethical dilemmas. The emergence of the Ebola virus in the densely populated cities of Lagos and Port Harcourt in Nigeria brought bleak warnings of a rapidly expanding epidemic. However, these fears never materialised largely due to the swift reaction of emergency response and incident management organisations, and the WHO has now declared Nigeria free of Ebola. However, numerous ethical issues arose in relation to the response to the outbreak. This paper discusses some of these ethical challenges and the vital lessons learned. Ethical challenges relating to confidentiality, the dignity of persons, non-maleficence, stigma and the ethical obligations of health workers are examined. Interventions implemented to ensure that confidentiality and the dignity of persons improved and stigma was reduced, included community meetings, knowledge communication and the training of media personnel in the ethical reporting of Ebola issues. In addition, training in infection prevention and control helped to allay the fears of health workers. A potential disaster was also averted when the use of an experimental medicine was reconsidered. Other countries currently battling the epidemic can learn a lot from the Nigerian experience.

Effective risk communication and contact tracing for Ebola virus disease prevention and control – Experiences from Port Harcourt, Nigeria

O. Maduka , S. Maleghemi , W. Komakech , I. Nwaduito , P. Green , A. Ikpe , D. Ywoga , N. Onyekwere c,e a Department of Preventive and Social Medicine, University of Port Harcourt, Nigeria b World Health Organization, Nigeria c Rivers State Ministry of Health, Nigeria d Rivers State Primary Health Care Management Board, Nigeria e Rivers State Ebola Emergency Operations Centre, Nigeria f Lagos State Ministry of Health, Nigeria

Partnering with broadcast and print media for risk communication: EVD control in Rivers State, Nigeria

In August 2014, the World Health Organization (WHO)1 declared the outbreak of Ebola Virus Disease (EVD) to be a public health emergency of international concern. Disease outbreaks are unique events in public health. They are typically sudden, frequently unpredictable and fraught with setbacks and surprises. Therefore, there is need, under most circumstances, for an emergency response.2 Outbreaks are eminently newsworthy. The public has a right to be informed and the media are key partners in the communication triangle with health officials.The role of the media is critically important, particularly at the start of an outbreak, to create an informed public who are equipped to protect themselves and others. Community media, particularly radio stations, often play a critical role in reaching rural residents.2,3 The media may also exert pressure on those in authority to act rapidly and positively. The EVD outbreak in Port Harcourt, Nigeria, brought to the fore the important role of the media in imparting positive and negative influences on the population.The Nigerian outbreak was first reported in Lagos in July 2014 and later spread to Port Harcourt, Rivers State on 20 August 2014. The outbreak in Nigeria is the first of its kind in the country, and its occurrence in two of its densely populated urban cities posed peculiar challenges to containment.4 A total of 19 confirmed cases, one probable case and eight deaths were recorded in Nigeria. Rivers State contributed four cases (one probable and three confirmed) and two deaths. In addition, contact tracing teams identified and followed up 530 contacts in Port Harcourt.Port Harcourt is home to 11 radio stations, five television stations with local and national coverage and several more cable/satellite television stations. A rapid community survey conducted by the Ebola Emergency Operations Centre (EOC) found that the majority of the population got their information about Ebola primarily from radio and television, with newspaper and social media platforms also being significant sources. The media took centre stage in the Lagos and Port Harcourt outbreaks. Early media reports evoked panic and irrational behaviour among the population; for instance, the media were awash with rumours of drinking concentrated salt water for the prevention of Ebola. In addition, on some occasions during the early stages of the outbreak, the media released confidential information about names and locations of some cases and contacts. These actions negatively impacted on surveillance efforts as it created distrust.The Rivers State Ebola EOC was set up in Port Harcourt with the purpose of mobilising resources for a rapid and coordinated response to the outbreak: the Communication and Social Mobilisation unit was part of this structure. Its objective was to use risk communication strategies to foster the adoption of practices that would facilitate the breaking of the chain of transmission of the virus. The unit quickly took advantage of the key role the media could play in achieving this objective.It went on to build partnerships with broadcast and print media agencies and supported them to relay balanced and accurate information to the public. This is in line with the key principles identified by the WHO5 to govern outbreak communications: announcing early, transparency, listening and planning. Two stakeholder meetings of the Rivers State EOC and top media executives were held within the first two weeks of the response. The result was commitments secured for continuous media public education programmes at state and local government area (LGA) levels. Trainings on ethical reporting of EVD issues, EVD prevention and control and appropriate EVD messaging were held for media correspondents. Following these meetings and trainings, health professionals working in the EOCs were granted daily slots for recorded and live interviews on various radio and television stations at no cost. …

Caregiver experiences with the introduction of pentavalent vaccines in two centers in Port Harcourt, South-South Nigeria.

Background: The Nigerian government, with support from the Global Alliance for Vaccine Initiative (GAVI) in 2012, began a three year phased roll out of the pentaval ent vaccine as a replacement for DPT in the routine immunization schedule. Aim: To assess client experiences with the use of pentavalent vaccines in two center s in Port Harcourt, Nigeria. Methods: A cross - sectional study was carried out in January 2013. C aregiver - baby pairs who had index child six weeks to two years, who had received at least one dose of the pentavalent vaccine and had at least one other living child who took DPT, were interviewed using a semi - structured questionnaire. Chi squared test of significance was done with p - value set at 0.05. Results: One hundred and eleven (111) caregivers were int erviewed. Their mean age was 31± 4.6 years, whi le mean age for babies was 16± 8.6 weeks. Although 71 caregivers (76.3%) had received

Barriers to HIV Treatment Adherence: Findings from a Treatment Center in South-South, Nigeria.

Aims: Non-adherence to treatment represents a significant challenge to anti-retroviral treatment goals. This study aimed to identify and explore perceived barriers to adherence in non-adherent HIV patients attending the University of Port Harcourt Teaching Hospital. Study Design: This was a descriptive, cross-sectional study of HAART experienced patients who had less than 95% adherence to their HAART medication. Place and Duration of Study: The study was carried out between May and June 2011 at the Antiretroviral treatment center of the University of Port Harcourt Teaching Hospital in the Southern part of Nigeria Original Research Article International Journal of TROPICAL DISEASE & Health, 4(12): 1233-1244, 2015 1234 Methodology: Data collection was via quantitative and qualitative methods. A structured interviewer administered questionnaire adapted from the Adult Antiretroviral Clinical Trials Group (AACTG) study was used to identify barriers to adherence. In addition, four focus group discussions (FGDs) were held with 27 purposively selected participants. Quantitative data was analyzed with SPSS version 18, while the FGDs were analyzed using thematic content analysis. Results: Ninety-six (96) patients, 39 (40.6%) males and 57 (59.4%) females with median age of 35.5 years participated in the study. Identified barriers to adherence included; being away from home during medication times 41 (42.7%), being busy with other things 35 (36.5%), forgetfulness 33 (34.4%), running out of pills 25 (26%), difficulty taking pills at specified times 25 (26.0%), the need to avoid side effects 16 (16.7%), and lack of a social support system 15 (15.6%). Barriers identified by the FGDs were fear of taking HIV drugs in front of others, sharing drugs with infected spouse, alcohol use, financial challenges, poor understanding about the effects of the drugs, forgetfulness, long clinic hours and poor attitude of health workers. Conclusion: Adherence counseling, use of reminder systems and treatment supporters are useful Public Health interventions for improving adherence and should be integrated into service delivery at this and other centers. In addition, better organization of the clinic, increasing staff strength and training will go a long way to address these barriers. Decentralization of HIV treatment centers to secondary and primary health facilities needs consideration.

Factors associated with severe stigma among patients living with HIV/AIDS in Port Harcourt

Mater ia l and methods : This was a hospital-based cross sectional study involving PLWHA attending anti-retroviral clinic of the University of Port Harcourt Teaching Hospital (UPTH) in Port Harcourt. Data on sociodemographic characteristics and stigma were obtained from 302 participants selected by systematic random sampling. Bivariate and multivariate analyses were performed to explore factors associated with severe stigma among PLWHA.