West African journal of medicine最新文献

Background: Hyperglycemia in pregnancy (HIP) comes with both maternal and fetal complications; universal and selective screening have been used by various guidelines for its diagnosis. An appraisal of FIGO's recommended universal screening is essential for domestication in low-resource settings.

Objective: To compare universal and selective screening methods for the determination of hyperglycemia in pregnancy (HIP), including gestational diabetes mellitus (GDM) and diabetes in pregnancy (DIP) in a low-resource setting.

Methods: A cross-sectional study of pregnant women in Enugu, southeast Nigeria. The eligible women in each group were consecutively recruited between 24-28 weeks gestational age and their fasting blood sugar (FBS) and 2 hours post prandial (2HPP) glucose levels were tested. Included were all consenting pregnant women between 24-28 weeks gestational age while excluded were those beyond 28 weeks and know diabetics already on treatment. The first group (universal group) was universally screened while in the second group (selective group) only participants with risk factors for HIP were screened. All data were analysed using statistical package for social sciences version 24 at 95% confidence level.

Results: The overall prevalence of HIP, GDM and DIP were 7.1% (36/508), 5.6% (28/508) and 1.4% (7/508), respectively. There was no significant difference in the prevalence of HIP, GDM and DIP between the two groups (P > 0.05). However, 42.9% of cases of GDM and 66.7% of cases of DIP recorded in the universal group were from participants without any risk factor for HIP.

Conclusion: The detection of HIP, GDM and DIP is similar using the two screening methods. However, about half of the cases of HIP would be missed with selective screening. Obstetricians are therefore encouraged to adopt the universal screening method as selective screening is associated with missed diagnosis of HIP.

Background: Spirometry provides useful information on lung diseases. The spirometry patterns of patients with lung disease and respiratory symptoms have not been completely identified. This study sought to determine the spirometry patterns of patients presenting with respiratory symptoms and the relationship between the spirometry patterns and the respiratory symptoms.

Methods: This was a cross-sectional descriptive study involving 285 patients at a specialist respiratory laboratory in Enugu, Nigeria. Sociodemographic data, risk factors and respiratory symptoms were collected and spirometry conducted. Spirometry patterns were determined and the relationship between spirometry patterns and respiratory symptoms were determined using ANOVA and Chi-square. p<0.05 was taken as statistically significant.

Results: Two hundred and eighty-five subjects were studied. Their mean age was 48.4 ±21.7 years. Male patients were 117 and females 168. The most frequent symptom was cough (58.6%) followed by chest tightness (46.3%), central chest pain (46.0%), and difficulty breathing during physical activity (41.4%). Nine (3.2%) had asthma, whereas chronic obstructive pulmonary disease (COPD) was found in 14(4.9%), asthma-COPD overlap (ACO) 16(5.6%), normal pattern 144(50.53%), and preserved ratio impaired spirometry (PRISm) 63(22.11%). There was statistically significant difference (F = 3.002, p = 0.031) in the mean Forced Expiratory Time (FET) values between the groups. Abnormal ventilatory function, predominantly the obstructive pattern, was significant in patients with cough and sputum production (p=0.001), noisy breathing (p<0.001), and difficulty in breathing out (p=0.012). COPD was poorly diagnosed without spirometry, 2 (14.29%).

Conclusion: Obstructive spirometry pattern were common in patients with respiratory symptoms in this study.

Background: COPD comorbidities have a significant impact on prognosis. There is underdiagnosis of comorbidities in sub-Saharan Africa. The study aimed to assess the prevalence and spectrum of comorbidities in stable COPD patients, and compare the pattern of comorbidities in COPD caused by biomass smoke (B-COPD) with tobacco smoking (T-COPD) in a Nigerian hospital's chest clinic.

Methods: This was a cross-sectional clinico-laboratory study. Standardized instruments and questionnaire administration followed by spirometry and laboratory blood tests were used to obtain relevant clinical information and identify comorbidities, and 94 (31.3%) of them were assessed retrospectively.

Results: All 75 patients had multiple comorbidities; 8(10.7%) had two comorbidities, and 67 (89.3 %) had ≥ 3 comorbidities. The mean comorbidity count was 4.2 in males and 3.8 in females (p=0.130). The prevalence of haematologic, neurologic, cardiovascular, psychological, musculoskeletal, and infectious conditions were 86.7%, 76.0%, 61.3%, 49.7%, 34.7%, and 33.3%, respectively. The leading comorbidities were anaemia (65; 86.7%), impaired sleep quality (57; 76%) and systemic hypertension (42; 56%). None of the subjects had polycythemia. One-third (25; 33.3%) had osteoarthritis, 23(30.7%) had anxiety, 26(34.7%) had dyslipidemia, and 13(17%) had depression. 10(13.3%) were underweight, and 9(10.7%) had pulmonary TB. Less than 10% had obesity, HIV infection and renal impairment. Anaemia was more prevalent in male patients compared to female patients (97.7% vs. 71.9%), whereas osteoarthritis was more prevalent in female patients compared to male patients (53.1% vs 18.6%). Systemic hypertension, anxiety, and HIV were significantly more frequent in COPD caused by tobacco (T-COPD) than in COPD caused by biomass smoke (B-COPD). Osteoarthritis was more common in B-COPD than in T-COPD.

Conclusion: The study shows that most COPD patients had multimorbidity, and anaemia, impaired sleep quality and systemic hypertension were the leading comorbidities. Systemic hypertension is commoner in tobacco-related COPD. This study highlights the need for healthcare providers to be aware of these differences in comorbidity patterns compared to those in developed nations when caring for COPD patients. WAJM 2025; 42 (8): 642-651.

Background: Higher Education Institutions are expected to lead the paradigm shift in waste management by adopting strategies that will contribute to sustainable development in their operations. The impact of these innovations will expectedly diffuse to their surrounding communities. Waste composition studies in HEIs enables the identification of campus-specific opportunities for waste reduction and recycling. The aim of this study was to assess the quantity, composition of solid waste generated by the staff and students of the Lagos University Teaching Hospital and College of Medicine, University of Lagos (LUTH/CMUL) compound.

Methods: The study was a descriptive cross-sectional study conducted in the LUTH/CMUL compound. Solid waste generated from the commercial, academic and research; administrative and residential areas were quantified and characterized during the study. Solid waste generated in the four activity areas collected were sorted, classified and weighed using a weighing balance.

Results: An estimated 14.775 tonnes of waste is generated daily from the compound with a waste generation rate of 0.29/kg/capita/day. Plastic and polythene bags made up majority (31.1%) of the total solid waste generated in the compound followed by organic waste (23%). In the commercial area, organic waste (57.21%) formed majority of the waste, plastics formed the majority (22.95%) of the waste in the residential areas and paper waste was mostly generated in the administrative area (41.22%) and, the academic and research areas (36.10%).

Conclusion: The quantity and composition of the solid waste generated are affected by the activities ongoing in the different categorized areas. A solid waste management scheme hinged on a zero waste policy should be designed by the LUTH and CMUL authorities. This scheme should tackle reduction of waste at source, efficient waste collection from generation points, waste recovery, recycling and composting, proper training of stakeholders and provision of incentives.

Background: Hypertension is a major chronic comorbidity among people living with HIV (PLHIV), and it remains a significant risk factor for cardiovascular disease in this group. The study identified risk factors for hypertension among PLHIV and assessed their cardiovascular risk.

Methods: A cross-sectional study of 284 adults attending the Special Treatment Clinic, National Hospital Abuja (June-August 2021) collected hypertension risk-factor data using an interviewer-administered questionnaire. Analysis was conducted with EPI Info 7.1, and logistic regression identified factors associated with hypertension at a significance level of p < 0.05.

Result: Two hundred and eighty-four (284) patients met the inclusion criteria and were recruited. The mean ±SD age of the respondents was 43.2±8.8 years, with a range of 20 to 67 years. The prevalence of hypertension among HIV sero-positive patients was 19.7%. After logistic regression, the independent determinants of hypertension were age group 45-54 years (OR 0.9, CI 0.8-1.0, P=0.007), female gender (OR 3.4, CI 1.3-8.5, P 0.009), secondary level of education (OR 2.9, CI 1.5-5.6, P 0.002), physical inactivity (OR 0.4, CI 0.2-0.9, P 0.033), and CD4 count >500 cells/mm³ (OR 0.4, CI 0.2-0.8, P 0.013).

Conclusion: Hypertension is common among PLHIV. Older age, female gender, secondary level of education, physical inactivity, and CD4 count >500cells/mm³ were significantly associated with hypertension. Most participants had a low cardiovascular risk. Incorporating routine hypertension screening and risk factor assessment into HIV care is crucial to lessen the burden of this condition in this population.

Background and objectives: This study aimed to assess the knowledge and perception of Nigerian paediatricians regarding paediatric sleep disorders and their management. It also assessed the state of their current practice with screening, evaluating and treating sleep disorders in children and the perceived barriers and facilitators to the provision of quality care for sleep disorders for Nigerian children.

Methods: This descriptive cross-sectional study was conducted among 153 Paediatricians who practice in Nigeria and attended the Annual Scientific Meeting of the Paediatrics Association of Nigeria (PAN) held in January 2023 at Akure, Ondo state, Nigeria. We utilized a pilot-tested, semi-structured questionnaire adapted from the Paediatrics sleep survey questionnaire. Data was analysed with the IBM SPSS software, version 20.

Results: The 153 respondents were from the six geopolitical zones in Nigeria. More than two-thirds (66.7%) had a poor knowledge score (<6). The majority of the respondents rated their confidence in diagnosing sleep disorders as fair (63.4%), while 22.2% rated it as poor. Almost all (98.7%) reported the lack of sleep laboratory in their centre of practice. Also, about two-thirds (68.0%) had no paediatric sleep clinic. The main barriers to the management of paediatric sleep disorders were lack of training (119; 77.3%) and lack of sleep laboratory (102; 66.7%). Having a sleep laboratory in the centre of practice was significantly associated with the knowledge of the paediatricians (p = 0.044).

Conclusion: There is a need for interventions to improve the knowledge of Nigerian paediatricians on sleep medicine and the provision of Paediatric sleep laboratory facilities in Nigeria.

Background: Kidney transplantation in Nigeria has witnessed remarkable advancements. Availability of suitable and willing living donors is one of the major factors leading to its success. The aim of this study was to identify and analyze the reasons for exclusion of potential living kidney donors in a transplant program at a tertiary hospital in Southeast Nigeria. This is important in order to improve donor screening, maximize the living donor pool and ensure donor safety.

Methods: This was a retrospective study of kidney transplant register and medical records at the transplant clinic of Federal Medical Center Umuahia, Southeast Nigeria. Relevant clinical data of potential living kidney donors who presented for pre-donation evaluation over a period of 8 years were collated in excel sheet and analyzed using SPSS version 23.0. Tables, charts and graphs were used to illustrate some data.

Results: Pre-donation evaluation records of sixty four potential living donors were retrieved. Median age was 23 (IQR=19-39) years There were 62 males and 2 females with M:F ratio of 31:1. Majority were unskilled workers (83%) and unrelated to prospective recipients (61%). Among those related to the patients (39%), there were more second-degree relatives (22%) than first degree relatives (17%). Out of the 64 potential kidney donors, 13 (20%) eventually donated while 51(80%) did not. Factors that prevented eventual kidney donation included immunological incompatibility (32.8%), albuminuria (11%), hypertension (9%), financial motivation (9%), nephrolithiasis (4.7%), donor withdrawal from donation process (4.7%), Hepatitis B infection (3%), prediabetes (3%) and abnormal cardiac function (1.5%).

Conclusion: The potential living donors evaluated were mostly young males that were unrelated to their potential recipients. Immunologic incompatibility was the leading cause of failure to donate a kidney; mainly from donor-recipient significant HLA mismatches.

Background and objectives: This study investigates the prevalence of the symptoms and risk factors of Digital Eye Syndrome (DES) among tertiary institution students in the post-COVID era.

Methods: This is a cross-sectional observational study conducted in a tertiary institution. Participants included students who use digital screens for academic and recreational activities. Inclusion criteria involved students with at least ten minutes of daily screen time. A structured questionnaire was used to assess screen time, symptoms, and ergonomic practices. Data collection included self-reported symptoms of DES and potential risk factors such as screen duration, posture, and lighting conditions. The primary outcomes were the prevalence of DES symptoms, including eye strain, headaches, dryness, and blurred vision, as well as associated ergonomic and behavioral risk factors.

Results: A significant proportion of students reported experiencing symptoms of DES as follows: approximately half of the respondents (49.8%) reported experiencing irritation or a gritty feeling in the eye(s), 26.5% reported a burning sensation in their eyes, eye fatigue (57.6%), sensitivity to bright light (68.7%), and a dry feeling in the eye (25.4%). Additionally, symptoms like blurring of vision (37.1%), itching (41.3%), and tearing (35.8%) were also prevalent among respondents. Statistical analysis (Chi-square test) revealed associations between prolonged screen time (8-11 hours screen time, p = 0.040) which is statistically significant; poor ergonomic practices are not statistically significant (p = 0.444 for lying down, placing the screen below the eye level, p = 0.560) and increased symptom severity.

Conclusions: Symptoms of Digital Eye Syndrome are still prevalent among tertiary institution students in the post-COVID era, exacerbated by prolonged screen use and poor ergonomics. Implementing preventive strategies, such as regular breaks and optimized lighting, may mitigate symptoms. Further studies are recommended to explore the long-term ocular effects of digital devices.

Background: The human immunodeficiency virus (HIV) screening protocol for high and low risk for HIV transmission exposed infants needs appraisal.

Objective: To audit the cost effectiveness of the early HIV infant diagnosis protocol, by the 2020 (recent) and 2016 (previous) Nigerian guidelines screening protocol.

Methods: All babies delivered by HIV infected mothers over 4years at the Wesley Guild Hospital, Ilesa were studied. Their HIV status, risk category and age at early infant diagnosis were analyzed.

Results: Seventy-two infants and their mother were studied. Thirteen (18.1%) of the total 72 studied were HIV infected. All HIV infections were in the 21 high risk category compared to none in the 51 low risk category (P <0.01). Fifty (98.0%) low risk infants had HIV DNA Polymerase chain reaction (PCR) testing between 6 -8 weeks compared to one (4.5%) high risk between 6-8weeks. (P <0.01). The 21 (95.5%) high risk infants had their first PCR screening between 3 and 14 months. Rapid screening was conducted at 18months for all the 67 infants that survived till this age. The calculated screening cost by the current protocol is thrice as expensive, but equally sensitive for diagnosis as the year 2016 National screening protocol, for low-risk category infants. More than 95% of infants were well immunized and stopped breast feeding at 12 months.

Conclusion: The year 2016 HIV screening protocol is cost effective and should be adopted for screening infants at low risk of HIV acquisition. Significantly higher rates of infection occur in the high-risk category at unknown times, thus necessitating very early screening. Rescheduling of the 9th month rapid screening to coincide with MMR vaccination at 15months is advised to allow for cessation of HIV exposure following breast feeding termination at 12 months.