Victor Aniedi Umoh

Drug Resistance among Pulmonary Tuberculosis Patients in Calabar, Nigeria

Background. This study aimed to determine the pattern of drug susceptibility to first-line drugs among pulmonary TB patients in two hospitals in Calabar, Nigeria. Methods. This was a descriptive cross-sectional study carried out between February 2011 and April 2012. Sputum samples from consecutive TB patients in Calabar were subjected to culture on Lowenstein-Jensen (LJ) slopes followed by drug susceptibility testing (DST). The DST was performed on LJ medium by the proportion method. Results. Forty-two of the 100 Mycobacterium tuberculosis strains were found to be resistant to at least one drug. Resistance to only one drug (monoresistance) was found in 17 patients. No strains with monoresistance to rifampicin were found. Resistance to two drugs was found in 22 patients, while one patient was resistant to both three and four drugs. MDR TB was seen in 4% (4/100). The independent variables of HIV serology and sex were not significantly associated with resistance (P > 0.05). Conclusion. There was a high prevalence of anti-TB drug resistance in Calabar.

The relationship between lung function and indoor air pollution among rural women in the Niger Delta region of Nigeria

Background: Burning of biomass is widely used by the rural poor for energy generation. Long term exposure to biomass smoke is believed to affect lung function and cause respiratory symptoms. Materials and Methods: Women with long term occupational exposure to burning firewood were recruited from a rural fishing community in Nigeria. A questionnaire was used to obtain information on symptoms of chronic bronchitis and spirometery was performed to measure lung function. Data obtained from the subjects was compared with that from healthy controls. Results: Six hundred and eighty six women were recruited for this study made up of 342 subjects and 346 controls. Sixty eight (19.9%) of the subjects had chronic bronchitis compared with eight (2.3%) of the controls (χ2 = 54.0, P < 0.001). The subjects had lower values for the lung function as well as the percentage predicted values (P < 0.05). Fish smoking and chronic bronchitis were significantly associated with predicted lung volumes. Conclusion: Chronic exposure to biomass smoke is associated with chronic bronchitis and reduced lung functions in women engaged in fish smoking.

Profile, Bacteriology, and Risk Factors for Foot Ulcers among Diabetics in a Tertiary Hospital in Calabar, Nigeria

Diabetic foot disease is a major medical, social, and economic problem. This retrospective study assessed the profile of diabetes mellitus patients with foot ulcers in the University of Calabar Teaching Hospital (UCTH), Nigeria. Admission records of all patients admitted unto the medical wards of UCTH over a 5 year period were analysed. The records of diabetic patients were retrieved. Data on patient characteristics and possible risk factors for diabetes mellitus foot ulcers was extracted. Of the 3,882 patients admitted, 297 (7%) were on account of complications of diabetes mellitus. Foot ulcers accounted for 63 (21.2%) of all diabetic admissions. The elderly constituted the majority of patients admitted with foot ulcers. The average duration of stay of diabetics with foot ulcers was 38.5 days. Diabetics admitted for other conditions had average duration of admission of 15.8 days. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. Most of the organisms identified from ulcer swab cultures were sensitive to quinolones and resistant to penicillins. These diabetic foot ulcers were significantly associated with peripheral sensory neuropathy, peripheral vascular disease, intermittent claudication, and walking barefoot. An effective diabetes foot programme is required to address these risk factors and reverse the current trend.

Prevalence and clinical predictors of drug-resistant tuberculosis in three clinical settings in Calabar, Nigeria

Drug‐resistant tuberculosis (TB) poses a serious challenge to global control of TB. This multicentre study was to identify risk factors for drug resistance to the first line anti‐TB drugs among TB patients presenting for care in three health facilities in Calabar, Nigeria.

The Pattern of Respiratory Disease Morbidity and Mortality in a Tertiary Hospital in Southern-Eastern Nigeria

Background. Respiratory complaints are commonly encountered in medicine and respiratory diseases place a high burden on healthcare infrastructure. Healthcare planning should be based on adequate information: this study will help us to analyze the pattern of respiratory disease admissions in the medical wards in a developing country. Methods. The medical records of patients admitted into the medical wards over a 5-year period were retrieved and reviewed. Information obtained included demography, diagnosis, comorbid conditions, and risk factors for respiratory disease. Results. Three thousand four hundred and ninety patients were admitted into the medical wards with 325 (9.3%) of them diagnosed with a respiratory condition. There were 121 females and 204 males. The average age of the patients was 40.7 ± 14.7 years. Only 7% of the patients smoked cigarette. The commonest respiratory conditions were tuberculosis (66.8%) and pneumonia (24.9%). The commonest comorbidity was HIV infection (39.7%). Tuberculosis/HIV coinfection rate was 50.7%. HIV infection was the single most important predictor of an adverse outcome (OR 5.1, 95% CI 2.05–12.7, P < 0.001). Conclusion. Infective conditions make up a large percentage of respiratory diseases in low income countries with HIV infection constituting a significant risk factor for a poor disease outcome.

Asthma control among patients in Uyo South-Eastern Nigeria

Background: The prevalence of asthma is increasing in the developing world. Asthma, management guidelines have been instituted to provide recommendations for the optimal control of asthma. This study evaluated the current level of asthma control as reported by the patients, which may be a reflection of adherence to guidelines. Materials and Methods: Asthma patients referred to a respiratory diseases clinic were recruited for the study. The asthma control test (ACT) was administered on the patients and data were also obtained for medication use and disease monitoring. A total ACT score of Results: Out of 78 patients, 70 completed the survey (89.7%). The average age of patients was 46 ± 18 years (mean ± standard deviation). The average ACT score was 14.4 ± 4.8 82.9% of patients had poor control. 57.1% of patients who perceived their asthma to be well or totally controlled were objectively assessed to be poorly controlled. More than half of the patients used short acting β2 agonist alone and only 20% used inhaled corticosteroids for maintenance therapy. Thirty eight patients made unscheduled emergency room visits in the past 12 months and 68.8% could not use their inhaler devises well. Emergency room visits (odds ratio [OR] 9.5) and poor inhaler technique (OR 18.9) was independent predictors of poor asthma control. Conclusion: The current level of asthma control among patients in Uyo is below guideline recommendations. Management of patients did not appear to follow guideline recommendations and patients tend to over-estimate their disease control.

Psychological Distress in Women with Chronic Bronchitis in a Fishing Community in the Niger Delta Region of Nigeria

Background. Biomass smoke exposure is a known risk factor for chronic bronchitis. Psychiatric comorbidities may have significant impact on the quality of life of patients with chronic bronchitis. Methods. Women who engage in fish preservation by drying over burning firewood in a fishing community were recruited for this survey. The British medical research questionnaire was used to determine chronic bronchitis, and psychological distress was determined using the hospital anxiety and depression scale. Results. A total of 342 women were recruited for this study and 63 of them had chronic bronchitis. 96 women had features suggestive of psychological distress: 57 (16.6%) women with anxiety, 51 (14.9%) women with depression and 12 women (3.5%) had combined features. Psychological distress was more common among women with chronic bronchitis. Anxiety was significantly associated with chronic bronchitis and the level of biomass exposure while depression was significantly associated with chronic bronchitis, level of exposure, and a history of sleeping in the fish smoking room. Conclusion. Anxiety and depression show significant association with chronic bronchitis among women with biomass smoke exposure with the level of exposure having an aggravating effect on the relationship.