West African journal of medicine最新文献

Background: Sub-Saharan Africa faces a rising burden of non-communicable diseases, particularly among young adults. Structured self-management education is essential for managing chronic conditions, especially in low-income settings where a significant portion of the population with noncommunicable diseases resides.

Objective: To describe the effect of structured self-management education interventions on cardiometabolic disease outcomes in Sub-Saharan Africa.

Methods: A systematic review of controlled trials that assessed the effect of structured self-management education interventions on cardiometabolic outcomes such as HbA1c, blood pressure, and quality of life was conducted. We searched across PubMed, CINAHL, and Cochrane Library databases. Data retrieval, appraisal, and extraction were done with confidence and involved key study characteristics. The risk of bias was assessed using the Cochrane Risk-of-Bias tool. The review was registered on PROSPERO CRD42024539490.

Results: In total 1821 studies were identified. Of these, 19 studies involving 6344 participants from eight sub-Saharan countries were included. The review found that in six out of 14 studies, structured self-management education intervention significantly improved glycaemic control in patients with type 2 diabetes. However, evidence regarding blood pressure control was limited, with only five studies reporting relevant outcomes, two of which showed statistically significant improvements. Overall, 68% (n=13) of the studies had either high risk or some risk of bias.

Conclusions: The existing evidence on the effect of structured self-management education interventions on cardiometabolic disease outcomes in Sub-Saharan Africa is limited and checkered. Larger controlled trials are urgently needed to guide policy, and clinical practice and hopefully reverse the disturbing epidemiological trends in SubSaharan Africa.

Introduction/background: Children with sickle cell anaemia (SCA) experience recurrent vaso-occlusive crises and complications with possible impact on their health-related quality of life (HRQoL).

Objectives: This study determined HRQoL of 130 children aged 5-15 years with SCA and compared it to age- and sex-matched apparently healthy haemoglobin AA children in The Gambia. It also determined the impact of SCD severity, and sociodemographic and clinical data on HRQoL.

Methods: HRQoL was determined using the Pediatric Quality of Life Inventory. SCD severity was assessed with a validated clinico-laboratory scoring system.

Results: The mean age of the participants was 9.74 ± 2.81 years, with a male: female ratio of 1.1:1. Underweight (p = 0.019) and stunting (p = 0.045) were more prevalent among children with SCA. Majority, 83.1%, had mild SCD, while 13.1% had moderate SCD and 3.8% had severe SCD. The mean HRQoL scores were significantly lower in SCA than HbAA children in the physical, emotional, social, school and overall health domains, p <0.001. Seventy-five (57.7%) of SCA patients had poor HRQoL. SCD severity scores had significant inverse correlations with HRQoL scores in the emotional (r = - 0.2, p = 0.020) and school (r = -0.18, p = 0.039) domains. Significant pain >3 episodes in the preceding 12 months (OR=1.9; 95% CI = 1.392 - 2.201; p = 0.028); late diagnosis (OR = 1.8; 95% CI = 1.697-1.957; p = 0.012); and clinical stroke (OR = 69.3; 95% CI = 1.337-89.36; p = 0.037) were identified as significant independent predictors of poor overall HRQoL among children with SCA.

Conclusion: SCA has a negative impact on all domains of HRQoL. Frequent significant pain crises, late diagnosis and stroke were independent predictors of poor HRQoL in Gambian children with SCA.

Introduction: Thrombospondin-1 (TSP-1) is a key protein product of activated platelets which is significantly increased in sickle cell vaso-occlusive crisis (VOC) and other inflammatory conditions. This study aims to determine TSP-1 levels and their relationship with platelet indices and inflammation.

Objective: To evaluate TSP-1 levels in sickle cell anaemia (SCA) patients and assess their relationship with platelet indices and inflammation.

Methods: This hospital-based cross-sectional comparative study was conducted in North Western Nigeria from July to December 2022. The study included 120 participants: 80 adults with SCA (40 in VOC) and 40 in steady state (SS)), matched with 40 healthy controls (HbAA). TSP-1 levels were measured using ELISA and haematological parameters were obtained from an automated analyzer. Analysis of variance was used to compare groups and determinants of TSP-1 variability were analyzed using multiple logistic regression. Statistical significance was at p ≤0.05.

Results: The mean TSP-1 level was significantly higher in VOC patients (406.0 ± 164.6 ng/mL) compared to SS patients (312.4 ± 145.6 ng/mL) and HbAA controls (192.3 ± 121.2 ng/mL) (p < 0.001). In the SS group, TSP-1 negatively correlated with mean platelet volume (MPV; r = -0.38, p = 0.02) and platelet-large cell ratio (P-LCR; r = -0.36, p = 0.02). White blood cell count (WBC) was the only predictor of TSP-1 variability (β = 10.301, t = 3.843, p < 0.001).

Conclusion: Elevation of TSP-1 during VOC indicates its potential as a biomarker for crisis episodes. In SS patients, TSP-1 is associated with platelet indices, suggesting its role in platelet activation. WBC is a key predictor of TSP-1 variability, emphasizing the influence of inflammation.

Introduction: The National Health Management Information System (NHMIS) is vital for healthcare decision-making in Nigeria. However, effectiveness requires optimal information use including at the facility and local government level.

Objective: We assessed the use of information derived from the NHMIS and factors associated with information use at selected facilities and Local Government Areas (LGAs) in Oyo State.

Methods: A cross-sectional survey was conducted in 54 facilities and nine LGAs among healthcare workers responsible for data management and reporting selected by multistage techniques. The Performance of Routine Information System Management (PRISM) tool which assesses seven domains of information use was utilised. Information used was summarised as a mean score on a 0 - 100-point scale with 95% confidence limits. A linear regression was fitted to identify predictors of information use at α - 0.05.

Results: The use of information at the facility and LGA level were 42.2 ± 28.8 (95%CI 34.3 - 50.0) and 58.5 ± 39.8 (95%CI 28.0 -89.1) respectively. The positive predictors of use of information were the promotion of problem-solving skills β=0.776 (95%CI 0.031,1.522), the processes of checking data accuracy β=0.715 (95%CI 0.352,1.077), data collection β=1.080 (95% I 0.565,1.594), data transmission β=0.945 (95%CI 0.045, 1.846), data analysis β= 0.636 (95%CI 0.306, 0.966) and data display β=0.488 (95%CI 0.089,0.887).

Conclusion: Information use is modest at the facility and LGA level and depends on problem-solving, data collection, data analysis, and data display capacity which is often limited at these healthcare levels. AI tools that bridge these capacity gaps may improve NHMIS information use at the facility and LGA levels.

Summary/introduction: Acute Glomerulonephritis (AGN) is one of the most common childhood renal diseases in Nigeria. Acute Post-infectious glomerulonephritis (APIGN)-typified by post-streptococcal AGN (PSGN)-is the commonest, usually developing 1-6 weeks after an infectious episode. Rarely, AGN may occur concurrently with the inciting infectious process and may go unnoticed by clinicians. An example is pneumonia-associated AGN with isolated cases documented in Israel, the USA, and Europe but none to our knowledge from a Nigerian and perhaps the African population. This article reports a 17-year-old Nigerian male adolescent who developed AGN during an episode of complicated left lobar pneumonia.

Case report: A 17-year-old male adolescent presented with fever, left-sided chest pain, cough and progressive dyspnoea. There was no current or remote history of sore throat, skin rashes or urinary symptoms and past medical history was unremarkable. He is a paternal orphan and engages in subsistence farming with his mother. Examination revealed respiratory distress, pyrexia(38.9oC), BMI of 15Kg/M2(<-3SD, WHO, BMI-for-age/sex), stony-dull percussion notes over the left hemithorax, no oedema, and BP=100/60mmHg. Chest radiographs confirmed massive effusion with underlying left upper lobe consolidation. An immediate thoracostomy confirmed empyema thoracic, which initially did not grow pathogens. Initial management focused on empyema drainage and antibiotic coverage using intravenous amoxicillin-clavulanate but response was marginal. By the 5th day, he developed generalized oedema, oliguria, haematuria (+3), hypertension (140/90mmHg, >95thpercentile), congestive cardiac failure, and isolated C3 hypocomplementaemia (C3=60.3{80-160}mg/dL; C4=21.6{15-48}mg/dL). A repeat pleural fluid culture yielded Coliform species (not differentiated/identified because of resource constraints in our laboratory at this time) sensitive to ciprofloxacin but resisted amoxicillin clavulanate. He was subsequently treated with furosemide, amlodipine, and ciprofloxacin with complete resolution of the symptoms (except haematuria), and discharged on the 30 day. At 6-month follow-up, he remained normotensive with resolved haematuria; and normalized C3 complement (120{80-160}mg/dL).

Conclusion: Children with pneumonia who develop features of impaired renal function should be investigated for AGN. This report highlights this rare and unusual association as a possibility in our setting; and also brought up the difficulties with diagnostic procedures in resource constrained settings like ours, especially in light of widespread antimicrobial resistance and rational antibiotics use.

Background: Parental use of online search engines to get information on diagnosis and treatment options of their children's illnesses, a common practice in developed countries, is creeping into our society, especially in the face of chronic and life-threatening illnesses. Health-related information on the internet is largely unregulated and disease-specific information accessed online may be hard to understand and assimilate by parents making it needful to crosscheck such information with the child's healthcare provider.

Objectives: This study was undertaken to ascertain the proportion of parents of children with neurological disorders browsing the internet for medical information and factors associated with this behaviour.

Methods: This cross-sectional study was carried out in the paediatric neurology clinic of the Rivers State University Teaching Hospital, consecutively recruiting 106 child-parent pairs attending the clinic. A questionnaire was used to collect information on biodata and their use of the internet to assess information on their children's diseases. Data was analysed with SPSS 23, with statistical significance set at P value < 0.05.

Result: The mean ages of the children, mothers, and fathers were 5.5±4.6 years, 37.2±6.9 years, and 44.6±6.9 years respectively. Most mothers (63.2%) and fathers (61.3%) attained tertiary education and were of middle socioeconomic class. Of the 54(50.9%) parents who had browsed the internet, 49(90.7%) used Google, 5 (92.6%), used their phones, but only 11(20.4%) discussed information obtained with a physician. Fifteen (27.8%) parents browsed the internet to conveniently obtain medical information while 50.8% were satisfied with their online search. Tertiary education among parents and middle socioeconomic status was significantly associated with browsing the internet.

Conclusion: A good proportion of enlightened parents are browsing the internet for medical information but few are verifying this information with physicians, which may have untoward consequences in the future such as the adoption of non-scientific harmful practices.

Background: Rates of drug use in Nigeria are one of the highest globally, with the use of opioids associated with increased morbidity and mortality more so with injecting drug users (IDU). MAT) can reduce the harmful effects of opioid use but usage in the country is low despite a country-specific guideline in place. A notable barrier to MAT uptake is professionals' knowledge and attitudes. This study aimed to evidence the opinions of Substance use professionals (SUPs) in Nigeria regarding MAT.

Objective: To ascertain the opinions of SUPs in Nigeria regarding MAT prescriptions for opioid dependence.

Methods: An online Google form was developed by the researchers to assess knowledge and attitudes towards MAT. This form was circulated among SUPs across the six geopolitical zones and the Federal capital territory in Nigeria.

Results: Three hundred and twenty-nine professionals completed the questionnaire. Most were medical doctors (53.8%) and worked in the public sector (89%). Average work experience was 11 years and respondents estimated that nearly 1 in 10 OUD patients they cared for were IDU. A majority (85.7%) endorsed the need for MAT in Nigeria, though had no previous experience (65.3%), training (74.2%), or knowledge of existing guidelines (68.7%). Over half (55%) endorsed a preference for the availability of buprenorphine and methadone. Most endorsed positive attitudes towards MAT prescriptions.

Conclusion: Substance use professionals endorsed positive attitudes towards MAT for OUDs and its rollout in Nigeria. Awareness of published guidelines and training are unmet needs arising from this study.

Background: Developmental delays in children are often missed during routine medical visits, leading to long-term consequences if undetected. The Children's Emergency Room (CHER) offers a unique opportunity for early screening, serving as a frequent contact point for families. This study aimed to assess the developmental profiles of children presenting to CHER at NAUTH, Nnewi, Anambra State, Nigeria, emphasizing the need for early intervention.

Methods: In this cross-sectional, mixed-methods study, children aged 0-5.5 years presenting to CHER over one month were screened using the Ages and Stages Questionnaire (ASQ-3). Data analysis was conducted using STATA 16.0, and children with identified developmental delays were referred to the Developmental and Behavioural Paediatrics (DBP) clinic. Interviews with healthcare providers and caregivers explored the feasibility of implementing routine screening in CHER.

Results: Out of 34 children screened, 55.9% (19/34) displayed developmental delays, with problem-solving and fine motor skills being the most affected (29.4% each). Global developmental delay was identified in 32.4% (11/34). Female children had significantly higher communication delays than males (29.4% vs. 0%, p=0.044). Sixty percent of healthcare providers believed screening would be feasible with additional training and resources.

Conclusion: The high prevalence of developmental delays, particularly in girls' communication skills, highlights the need for early detection. With adequate training and resources, integrating developmental screening into CHER could significantly enhance early intervention efforts and address the unmet needs of children in resource-limited settings.

Background: Psychoactive substance use among adolescents presents a significant global challenge, contributing notably to morbidity and mortality. Adolescence is a critical developmental phase that is marked by various psycho-social hurdles, yet local data on predictors of substance use remains scarce. This study aims to illuminate these issues within Gombe State, providing essential data for evidence-based interventions.

Methodology: A cross-sectional study was conducted between March and August 2018, employing a multistage sampling technique to recruit a random sample of 368 adolescents from 12 secondary schools in Gombe Local Government Area. Participants completed the WHO Alcohol, Smoking and Substance Involvement Screening Test for the Young (ASSIST-Y) alongside a sociodemographic questionnaire. Adolescents taking prescribed psychoactive medication were excluded. Ethical clearance and informed consent were obtained prior to data collection.

Results: Of the 368 participants analyzed, 245 (66.6%) were males giving a male-to-female ratio of 1.9:1. The mean age was 15.6 ± 1.2 years. The lifetime prevalence of psychoactive substance use was 17.4% with 7.6% reporting current use (within the past three months). Tobacco was the commonest substance abused 38/368(10.1%) followed by opioids 26/368(7.1%). Significant associations were observed for lifetime substance use among males, those aged 15-17 years, students in public schools, and adolescents with family or peer substance use (p <0.05). The study identified Familymember substance use: (OR = 4.7, 95% CI 1.93 - 11.54) and Peer substance use: (OR = 5.6, 95% CI 2.08 - 15.11) as predictors of current substance use.

Conclusion: The study highlights the prevalence of psychoactive substance use among adolescents in Gombe, with significant predictors linked to familial influence, and peer associations. Further research is required for effective prevention.

Introduction/background: Assessing cardiovascular disease (CVD) risk is necessary in preventive cardiology. Studies have imputed CVD risk factors in algorithms to predict ASCVD. These various scores were derived from risk equations acquired from other populations. In our research, we found that abdominal height measured with our locally conceptualized appliance the Abdominometer predicted ASCVD better than established anthropometric indices.

Objectives: We, therefore, decided to build it into a risk equation and come up with a new algorithm that will not require data generated from invasive procedures.

Methods: We secondarily analysed our data and generated an algorithm utilizing 10 risk factors: one of which was our new anthropometric index of abdominal height (AH). Using the CIMT as a standard with a cut of value of ≥0.078 cm for high atherosclerotic risk we compared our new tool with the Framingham Risk Score (FRS).

Results: With our new algorithm, 24/221 (10.9%) were at high risk with 109 and 88 at low and intermediate risks respectively. Using the FRS, 218/221 were at low risk; only 3 being in the intermediate and high risk. Both risk algorithms correlated significantly with CIMT-determined risk but the correlation coefficient was more for the new (0.448) than the FRS (0.300).

Conclusions: We found that with sub-clinical atherosclerosis indexed by carotid intima-media thickness as standard, our new Jos App as well as the Framingham Risk score correlated positively and significantly. However, interestingly the level of correlation was higher with our new risk estimation App. We have input this into smart devices for pilot clinical studies.