West African journal of medicine最新文献

MOHOPA (Pattern of Morbidities, Mortality and Healthcare Financing of Hospitalised Medical Patients) Study aimed to determine the pattern of morbidities among patients admitted to the medical wards of 7 Teaching and Specialised Hospitals across Nigeria, the short-term outcomes of admissions and their determinants, challenges of managing the patients, and the pattern of healthcare financing for their care. The primary study outcomes were all-cause mortality (in-hospital and at 12 weeks post-discharge), duration of hospitalisation and rehospitalisation rate. 705 patients were recruited consecutively between May 2023 and March 2024, from Aminu Kano Teaching Hospital, University of Maiduguri Teaching Hospital, Federal Medical Centre Lokoja, University College Hospital, Ibadan, University of Nigeria, Ituku-Ozalla Campus, Enugu, Delta State University Teaching Hospital, Oghara, and University of Abuja Teaching Hospital. Each patient was followed up for 12 weeks or until his/her demise or referral to another facility. We hereby present the detailed study protocol. MOTS-CLÉS: Morbidités, Mortalités, Financement des Soins de Santé, Hospitalisation, MOHOPA.

Background: Chronic diseases contribute the highest to disease burden and deaths worldwide and require long-term access to health care. This study identified the payment methods and coping strategies for healthcare costs by patients with chronic diseases using public health facilities in Yenagoa, Bayelsa State, Nigeria.

Methods: Three hundred and thirty-nine (339) adult patients, being managed for chronic conditions (Hypertension, Diabetes mellitus, Tuberculosis & HIV), were randomly selected from three specialist hospitals that are the major providers of specialized care for patients with chronic diseases in the State. Data on sociodemographic characteristics, morbidity patterns, household financing and coping with health expenditure were collected. Chi-squared test was used to identify significant associations. A p-value 0.05 was considered significant.

Results: Majority were females 211(62%) and about a third were not working 113(33.3%). To pay for their chronic disease healthcare expenses, 268 (79.1%) paid out-of-pocket while 71 (20.9%) used social health insurance. Among the 120 (35.4%) patients who subscribed to a health insurance program, about 2 in 5 still paid out-of-pocket. Missing a clinic visit 145(42.8%) was the common coping strategy followed by patients having to forfeit necessities 113(33.3%) to cope with their healthcare costs. The type of chronic disease was statistically associated with payment methods adopted by patients (p<0.01).

Conclusions: Most patients with chronic diseases rely on out-of-pocket payments for healthcare expenditures including patients with health insurance coverage. This has necessitated households to adopt coping strategies, found to be economically distressing, to source funds for healthcare needs. Targeted programmes are needed for patients with chronic diseases to enhance financial risk protection.

Background: Acute dyspnoea (AD) is one of the most common presentations in the emergency room (ER). Its myriads of confusing differentials which include acute heart failure (AHF) has significant mortality and morbidity, and specific mode of treatment. The measurement of NT-proBNP among AD patients when AHF is being suspected will aid early diagnosis, treatment and improve outcomes.

Objective: To estimate the prevalence of AHF and usefulness of NT-proBNP among AD patients at the Ekiti State University Teaching Hospital's (EKSUTH) ER.

Method: This was a cross-sectional study. Persons aged 18 years or older with AD in the ER of the EKSUTH, Nigeria were recruited. The patients were sub-categorized into heart failure as a cause of AD (HFAD) and non-heart failure as a cause of AD (nHFAD). NT-proBNP was assayed alongside ECHO parameters for the participants.

Results: There were 143 cases and 72 matched controls. The mean age of patients was 56.96± 13.5yrs while that of the controls was 56.17± 14.5yrs (p=0.685). Seventy-seven patients (54%) had AHF while the remaining 46% were dyspnoea of non-cardiac origin. Pneumonia, COPD, asthma and PE accounted for 33.57%, 8.40%, 2.80% and 1.40% respectively. The median NT-proBNP level was higher (p<0.001) in the AD patients compared to controls; 592.0 vs 37.50 pg/mL. The median NT-proBNP level was higher in the HFAD group than those with nHFAD and the controls (2885.40 vs. 128.70 and 37.50 pg/mL, P<0.001). NT-proBNP levels inversely and moderately correlated with ejection fraction (EF) (ρ= 0.68, p<0.001). It directly and moderately correlated with HF severity using the NYHA functional classification (ρ=0.50, p=0.017). An age-independent NT-proBNP cut-point level of 305 pg/mL recorded 93.5%, 88.3%, 45.3% and 99.2% for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) respectively.

Conclusion: AHF is the major cause of AD in ER. In AHF patients, NT-proBNP correlated inversely well with EF and NYHA functional classification, and has high sensitivity and NPV.

Background: Good quality sleep is critical to human functioning as decline in sleep quality has been linked with health issues. One of the factors that has been identified with decline in sleep quality is increasing age, making older persons at risk of significant deleterious consequences on their physical, social, and mental spheres of well-being when they have poor sleep quality.

Objectives: This study aimed at determining the predictors of sleep quality among older persons aged 60 years and above attending the outpatient clinics of a tertiary hospital in Uyo, South-South Nigeria with a view to suggesting appropriate recommendations for health improvement of participants and clinical practice, where necessary.

Methodology and methods: This was a cross-sectional study involving two hundred and fourteen (214) respondents. Those who met the inclusion criteria were interviewed with the aid of a semi- structured questionnaire containing items on socio-demographic characteristics, clinical data, and items from the Pittsburgh sleep quality index. Data was analysed using Epi info® version 3.5.1.

Results: Of the 214 respondents recruited, the prevalence of good sleep quality was 63.1% with a higher rate of poor sleep quality observed in males (57%). Factors affecting sleep quality after bivariate analysis in this study were age group (70-74 years), polygamous family type, significant stress, sleep problems, chronic medical illness, routine medication, high blood pressure, overweight and obesity. However, when multiple logistic regression was done on these factors, family type, sleep problems, and chronic medical illness were still statistically significant.

Conclusions: More than one-third of the older persons had poor quality of sleep in this study, and the predictors of sleep quality were family type (polygamous), sleep problems, and chronic medical illness. Therefore, there is need for a careful routine assessment of sleep among older persons and this should include comprehensive sleep history as well as evaluation and treatment of various co-morbidities in order to improve sleep quality among them.

Background: Globally, glomerulonephritis with its diverse clinical manifestations and histologic attributes still maintains a dominant position among the myriads of aetiological culprits associated with the pathophysiologic course of chronic kidney disease. This study distinctively correlated the graded and scored histologic features observed in the glomerulus and tubulo-interstitium with clinical and biochemical features.

Methods: A hospital-based cross-sectional study of 70 adult patients who presented consecutively with features of glomerulonephritis was carried out. Renal biopsies were undertaken after renal function assessment. Light microscopy and immunoperoxidase staining utilising IgA, IgM, IgG and C3 antibodies were carried out on the biopsied renal tissues. The degree of glomerular, tubular, interstitial and vascular affectation were graded and scored. Total activity and chronicity indices were collated and their association/correlation with clinical parameters assessed.

Results: Male gender predominated (67.2%) with an overall mean age of 28.4 ±10.3 years. Statistically significant correlations were found between interstitial oedema with serum creatinine (r=0.35, p=0.003) and GFR (r=-0.38, p=0.004); interstitial infiltrate with serum creatinine (r=0.52, p<0.0002) and GFR (r=-0.70, p=0.002); total activity index with serum creatinine (r=0.60, p=0.0001) and GFR (r= -0.48, p = 0.004). Statistically significant correlations were also seen between total chronicity indices with serum creatinine (r=0.62, p=0.001) and GFR (r= -0.58, p<0.001).

Conclusion: Both activity and chronicity indices significantly influenced renal function. The higher they are, the lower the GFR and vice versa. These further buttress the need for aggressive management protocol for GN patients with higher indices to slow down renal function decline.

Background: Biomarkers are crucial for assessing the severity of heart failure (HF) and monitoring its treatment. Cardiac troponin I (cTnI) has traditionally been used as a marker for myocardial injury but its role in non-ischemic heart failure (NIHF) remains unclear.

Objectives: This study was aimed at determining the relationship between cTnI and left ventricular function and geometry in NIHF patients.

Methods: This was a cross-sectional comparative study that recruited 60 NIHF patients and 60 controls from the cardiology unit in a tertiary hospital. All participants had cTnI assay and transthoracic echocardiography done to assess left ventricular function and geometry. Data was analysed using Statistical Package for Social Sciences (SPSS) version 23. The level of statistical significance was fixed at p value < 0.05.

Results: The mean age of patients with NIHF was 50.0±12.6 years versus 50.3±12.0 years for controls (p=0.456). The mean serum cTnI level was 358.52±56.60ng/L in NIHF patients versus 218.54±36.01ng/L in the controls (p <0.001). Serum cTnI had a moderate negative correlation with ejection fraction (EF) in NIHF patients (R= -0.70, R2 = 0.492); and a positive correlation with left ventricular mass index (LVMI) (R= 0.12, R2 = 0.015). Mean cTnI levels increased with worsening grade of diastolic dysfunction in NIHF patients. Higher levels of serum cTnI was associated with worse New York Heart Association (NYHA) class of HF (p <0.001).

Conclusion: Elevated serum cTnI level was associated with worsening clinical and echocardiographic indices of left ventricular function in NIHF patients suggesting that it is an important surrogate marker for worsening HF.

Background: Early identification of risk factors in pregnancy is essential to improving maternal and neonatal outcomes. High-risk pregnancies, characterized by maternal or fetal factors that increase the likelihood of complications, contribute significantly to maternal mortality, particularly in low- and middle-income countries (LMICs). This study examines the influence of antepartum risk stratification on labour interventions and outcomes among women in Lagos, Nigeria.

Methods: This retrospective cohort study included 507 women admitted to the labour ward at Lagos State University Teaching Hospital (LASUTH) from May 2019 to April 2022. Participants were classified as low-risk or high-risk based on antenatal clinical profiles, including sociodemographic, obstetric, and medical factors. Outcomes were assessed based on labour interventions (induction, augmentation, mode of delivery) and neonatal outcomes (APGAR scores, NICU admissions). Data was analyzed using descriptive statistics, chi-square tests, and logistic regression to identify factors associated with high-risk classification and outcomes.

Results: High-risk pregnancies constituted 17.6% of the cohort and were associated with younger maternal age, nulliparity, and higher antenatal care utilization. High-risk women had significantly higher rates of induction (14.6% vs. 1.2%), oxytocin augmentation (27% vs. 5.3%), and emergency cesarean delivery (39.3% vs. 23.4%). Neonates of high-risk pregnancies had lower APGAR scores and higher NICU admissions (25.8% vs. 3.8%, p < 0.001). Increased ANC attendance was significantly associated with high-risk classification.

Conclusion: High-risk pregnancies are associated with increased maternal and neonatal complications, highlighting the importance of early risk stratification and adherence to WHO guidelines for adequate antenatal care. Strengthening ANC services and timely interventions can improve outcomes in LMICs.

Introduction: Kidney transplantation is the optimal treatment for improving survival and quality of life for patients with end-stage kidney disease. There was no kidney transplant surgery and acute transplant care services in Southeast Nigeria until 2017 when our institution commenced kidney transplant surgery and acute transplant care. This study aims to share our first eight year experience including graft and patient outcome.

Objectives: To obtain the transplant rate, short and long term complications and the graft and patient survival over an eight year period in a tertiary hospital in Southeast Nigeria.

Method: A retrospective review of the transplant register for patients referred to the kidney transplant unit over an eight year period from January 2017 to January 2025.

Result: Complete data for ninety-three patients were analyzed. Out of these, twelve were transplanted giving a transplantion rate of 13%. Financial constraint is the leading reason (40%) for failure to get a kidney transplant done. Hypertension, hyperkalemia, anemia and urinary tract infection were the leading acute complications encountered while cytomegalovirus infection, recurrence of native disease, chronic graft loss and death were the major long term complications. The three-month, one-year, three-year and five-year patient survival in our program were 100%, 90%, 80% and 80% respectively while the graft survival were 90%, 90%, 70% and 60% respectively.

Conclusion: The transplant conversion rate is low and a review of atient selection criteria will improve access kidney transplant. Acute complications were treatable in most cases. The patient and graft outcomes appear similar with other centres in Nigeria.

Introduction: As the incidence of colorectal cancer increases in Nigeria, more patients will get colostomies. Previous studies of patients with colostomies in other African countries have reported significant decreases in quality of life. Understanding the experiences of Nigerian patients is crucial for designing interventions that ensure patients can maintain a high quality of life after colostomy. This study aims to explore the impact of colostomy on the quality of life of Nigerian patients.

Methods: Between August and December 2022, 16 in-depth interviews were conducted with patients who had undergone a colostomy for at least six months. Patients were identified through an institutional database of colorectal cancer patients at Obafemi Awolowo University Teaching Hospital in Southwest Nigeria.

Results: Patients overwhelmingly reported life-altering challenges related to their colostomy. Some of the most commonly reported challenges included social isolation, financial constraints, sexual dissatisfaction, and altered self-image. Patients also reported that they did not understand until after surgery what it would be like to live with a colostomy.

Conclusion: As the number of cancer patients with colostomies increases in Nigeria, it is important to address the social and financial barriers that patients face after having a colostomy.