Comparative study of depression in hospitalized and stable heart failure patients in an urban Nigerian teaching hospital

OBJECTIVE: There are conflicting reports about the presence of depression in Black patients with heart failure (HF). We therefore evaluated the pattern of depression among hospitalized and stable HF patients in a homogenous Black population. METHOD: Patients hospitalized for new or decompensated HF were assessed. The Zung Self-Rating Depression Scale (SDS) questionnaire was administered to the subjects who were subsequently interviewed by a psychiatrist using the Hamilton Depression Rating Scale (HDRS). Stable HF patients at the outpatient clinic were used as controls. RESULTS: There were 123 hospitalized and 82 stable outpatients. Depression was present in 67% of hospitalized patients and 30.50% of the outpatients (P<.0001, using the SDS indexed scores). Stratifying the SDS indexed scores showed that 45.50%, 19.60% and 1.80% of the hospitalized patients compared with 26.80%, 3.70% and 0% of the outpatients had mild, moderate and severe depression (P=.007 and P=.001), respectively. The HDRS assessment showed that 63.40% of the hospitalized patients and 28.0% of the stable outpatients had significant depression (P<.0001). CONCLUSION: Depression affects two thirds of hospitalized urban Nigerian HF patients compared to one third of stable outpatients with HF. The prevalence of depression is similar to the prevalence among European and North American samples.     

Negative screening tests in classical galactosaemia caused by S135L homozygosity

Summary  Classical galactosaemia is relatively common in Ireland due to a high carrier rate of the Q188R GALT mutation. It is screened for using a bacterial inhibition assay (BIA) for free galactose. A Beutler assay on day one of life is performed only in high risk cases (infants of the Traveller community and relatives of known cases). A 16-month-old Irish-born boy of Nigerian origin was referred for investigation of developmental delay, and failure to thrive. He had oral aversion to solids and his diet consisted of cow’s milk and milk-based cereal mixes. He was found to have microcephaly, weight <2nd percentile, hepatomegaly and bilateral cataracts. Coagulation screen was normal and transaminases were slightly elevated. His original newborn screen was reviewed and confirmed to have been negative; urinary reducing substances on three separate occasions were negative. Beutler assay demonstrated “absent” red cell galactose-1-phosphate uridyltransferase (GALT) activity. GALT enzyme activity was <0.5 gsubs/h per gHb confirming classical galactosaemia. Gal-1-P was elevated at 1.88 μmol/gHb. Mutation analysis of the GALT gene revealed S135L homozygosity. S135L/S135L galactosaemia is associated with absent red cell GALT activity but with approximately 10% activity in other tissues such as the liver and intestines, probably explaining the negative screening tests and the somewhat milder phenotype associated with this genotype. The patient was commenced on galactose-restricted diet; on follow-up at 2 years of age, growth had normalized but there was global developmental delay. In conclusion, galactosaemia must be considered in children who present with poor growth, hepatomegaly, developmental delay and cataracts and GALT enzyme analysis should be a first line test in such cases. Non-enzymatic screening methods such as urinary reducing substances and BIA for free galactose are not reliable in S135L homozygous galactosaemia. Competing interests: None declared References to electronic databases: Classical galactosaemia: OMIM 230400.     

Improving knowledge and perception of HIV/AIDS among English language speaking children in rural areas through educational digital storytelling

Background/Objective:Previous research efforts have shown the need for improvement of knowledge and perception of HIV/AIDS among English Language speaking children in rural areas. Hence, the study at hand was designed to investigate the effect of using educational digital storytelling intervention to satisfy this need of English Language children in rural areas in Nigeria.Method:The study adopted a randomized control design involving a pretest, post-test, and follow-up measures. Eight-four children (n = 84) took part in the study. The HIV Knowledge Questionnaire (HIV-KQ-18) and the Perceived Risk of HIV Scale (PRHS) were used for data collection. Data were analyzed using t test statistics.Result:The educational digital storytelling intervention in appreciably improved knowledge and perception of English language children in rural areas who participated in the intervention concerning HIV/AIDS compared with their peers in the no-intervention control group. The improvement in knowledge and perception gained was also maintained throughout the follow-up evaluation period.Conclusion:The present study showed that the use of educational digital storytelling could improve knowledge and perception of HIV/AIDS among English Language speaking children in rural areas. Educational digital storytelling intervention effectively improved knowledge and perception of HIV/AIDS among children in rural areas. In return, we recommend that rural sociologists, counselors, language and communication experts, child educators, and other professionals involved in public health especially, as it concerns children be skilled in the use and application of educational digital storytelling intervention procedures to facilitate the move towards adopting the method in their professional practices.     

Maternal mid-arm circumference and other anthropometric measures of adiposity in relation to infant birth size among Zimbabwean women

BACKGROUND: To examine relationships between maternal anthropometric measures in Zimbabwean women and indices of infant birth size. METHODS: We conducted a cross-sectional study of pregnant women admitted for labor and delivery at the Harare Maternity Hospital from July 1998 to March 1999. The study population was comprised of 498 participants who delivered singleton infants. Anthropometric measures (height, weight, and mid-arm circumference) were taken during participants' postpartum hospital stay. Logistic regression and least-squares regression procedures were used to assess the association of maternal measures with infant size. RESULTS: Women in the highest weight quartile (>67 kg) were 58% less likely to have a low-birth-weight infant when compared to women in the lowest quartile (<57 kg) (OR = 0.42, 95% CI 0.19-0.90). Women in the highest body mass index quartile were 75% less likely to have a low-birth-weight infant compared to women in the lowest quartile (>27 versus <23 kg/m2: OR = 0.25, 95%CI 0.10-0.60). Similar trends were seen for risk of low birth weight in relation to mid-arm circumference. Maternal mid-arm circumference was most strongly related with the four infant size indices measured. Each unit increase in maternal mid-arm circumference resulted in a 36.1-g increase in infant birth weight (p<0.001). In general, women who were heavier at the time of delivery were less likely to have a low-birth-weight infant than women who were lighter. CONCLUSIONS: In areas where food security is a public health concern, as it is in most parts of the developing world, pregnant women may not be meeting their own nutritional needs and those of their fetus.     

Endemicity of vesical schistosomiasis in the Ebonyi Benue river valley,south eastern Nigeria

The investigation on the prevalence of patent and clinically severe infections with Schistosoma haematobium was carried out amongst inhabitants of Ebonyi Benue river valley, South Eastern Nigeria between August 2000 and June 2001. The inhabitants are predominantly farmers. Of the 3296 subjects examined from 15 randomly selected villages in the valley, 776 (23.5%) were excreting the eggs of S. haematobium in their urine. Infection rates varied between 18.9% and 30.6%. The severity of infection calculated by arithmetic mean egg counts (AMEC) and geometric mean egg counts (GMEC) varied significantly between the age groups and the villages (P < 0.05). The prevalence and severity of infection increased with age from 0 to 25 years and decreased thereafter. Symptoms associated with the disease include visible hematuria (63.1%), suprapubic pain (10.3%) and stranguary (9.9%). While 65 positive persons had more than one symptom, 64 of the positive persons had no noticeable symptoms. Visible hematuria showed moderate sensitivity and high specificity for the disease. Female genital schistosomiasis (FGS) of the lower reproductive tract was recorded in 19 females of child bearing age that complained of severe suprapubic pain. Eight snail species were recorded in the stagnant ponds and both Bulinus globosus and B. truncatus were infected with schistosome cercariae. The factors contributing to these observations and feasible control measures are discussed.     

The effects of different storage temperature conditions on the infectivity of Trypanosoma brucei in mice in Southeastern Nigeria

The effects of storing Trypanosoma brucei in different temperature conditions were studied using 55 adult female albino mice weighing between 18 and 33 g. The mice were divided into six groups. Groups 2–6 comprised ten mice each while group 1 comprised five mice and served as the control. Groups 2–6 were each further subdivided into two sub-groups of five mice each. Storage temperature conditions were room temperature (25–28 °C) (bench) and refrigeration temperature (4 °C). The onset of parasitaemia and packed cell volume were monitored. Groups 1–6 were infected intraperitoneally with 1.0?×?10⁶ trypanosomes at 0, 3, 6, 9, 12 and 24 h, respectively, following blood sample collection and storage. It was observed that the parasites in both temperature conditions were all active till the 9th hour of storage. However, the parasites stored at room temperature (bench) were sluggish and weak compared to the very active parasites in the group stored in the refrigerator by the 12th and 24th hours of storage. A pre-patent period of 4–8 days was recorded for all infected mice despite their storage condition. Surprisingly, the parasites in both storage conditions irrespective of time of infection produced patent infections. However, the pre-patent periods were highest for mice infected at both 12 and 24 h of storage. There were no significant differences (p?<?0.05) in the mean packed cell volume between groups infected with blood stored at either temperature prior to infection irrespective of the time of infection. We therefore conclude that trypanosomes in blood samples are infective for up to 24 h either at room temperature or at the refrigeration temperature (4 °C). Even so, for optimum infectivity, the infected blood should be used for infection within 9 h of collection.     

High dose vitamin D therapy for chronic pain in children and adolescents with sickle cell disease: results of a randomized double blind pilot study

We report results of a pilot study of high‐dose vitamin D in sickle cell disease (SCD). Subjects were given a 6‐week course of oral high‐dose cholecalciferol (4000–100 000 IU per week) or placebo and monitored prospectively for a period of six months. Vitamin D insufficiency and deficiency was present at baseline in 82·5% and 52·5% of subjects, respectively. Subjects who received high‐dose vitamin D achieved higher serum 25‐hydroxyvitamin D, experienced fewer pain days per week, and had higher physical activity quality‐of‐life scores. These findings suggest a potential benefit of vitamin D in reducing the number of pain days in SCD. Larger prospective studies with longer duration are needed to confirm these effects.     

Evaluation of the effect of an educational intervention on knowledge and adherence to HIV guidelines among frontline health workers in Alex-Ekwueme Federal University Teaching Hospital Abakaliki,Nigeria

BackgroundThe aim of this study was to appraise the implementation of the National HIV guidelines and determine the effect of an educational intervention on health worker knowledge and practice of the guidelines.MethodsA before and after study design without control was carried out using a self-administered questionnaire and key informant interviews. Data was also collected from client record cards. An educational intervention was carried out using pamphlets containing summarized information on the guideline. Data analysis was carried out using IBM-SPSS version 20.ResultResults showed that 54.5% of the respondents were males and 76% were medical doctors. Baseline knowledge level of respondents was high with 97% of respondents having good knowledge with a mean score of 3.9. This increased to 4.1 out of 5 post-intervention. All respondents had good practice of the guidelines before and after intervention with a mean score of 4.5 out of 5. Client records also showed good practice. Barriers to guideline implementation include: poor knowledge, inadequate training, guideline unavailability, poor functioning of the laboratory equipment, poor funding.ConclusionHIV guidelines are being implemented in the clinic to a large extent; however, trainings, funding and provision of the guideline in the clinics are recommended.