Trends of non-communicable diseases and public health concerns of the people of northeastern Nigeria amidst the Boko Haram insurgency

Background

The ongoing Boko Haram insurgency in northeastern Nigeria has depleted the country’s capability to deliver quality healthcare to her citizenry. The ailing health sector is overwhelmed with a rising incidence and prevalence of infectious and non-communicable diseases.

Aim

The aim of this paper was to determine the trend of kidney disease, end-stage renal disease (ESRD), anaemia, malnutrition and human immunodeficiency virus (HIV) in northeastern Nigeria.

Materials and methods

Data covering different periods between 1999 and 2017 were obtained from the University of Maiduguri Teaching Hospital (UMTH), Maiduguri in northeastern Nigeria. This hospital is the largest tertiary healthcare facility in the region. The data were demographic in nature, i.e. sex, age or simply the registered cases. A quadratic model of time-series analysis was used to create the various trends of the respective diseases with the aid of Minitab software (version 18.0). t-Tests and analysis of variance (ANOVA) were also performed, with a p-value of less than or equal to 0.05 being considered significant.

Results

About three out of every five patients treated for kidney disease were male, while three out of every five patients treated for HIV were female. Patients between the ages of 31 and 50 years were at the greatest risk of developing kidney disease. The mean distribution of disease incidence was the same for both sexes for kidney disease, anaemia, malnutrition and HIV. The mean distribution disease incidence was different between age groups for kidney disease but the same for anaemia. The incidence of anaemia and malnutrition reported was almost the same for both sexes. Children under the age of 10 years old were at the most risk of anaemia, with the distribution decreasing with increasing age. The trend analysis of the incidence of kidney disease, ESRD, anaemia and malnutrition showed that these ailments were on the increase, while the number of patients that were on antiretroviral therapy (ART) was on the decline in northeastern Nigeria.

Conclusion

These increasing trends are evidences of the effect of Boko Haram on the public health of the people of northeastern Nigeria and will continue to be a public health concern for the region and the country as a whole.

     

Nigerian folk medicine: practices and beliefs of the Ondo people

One hundred informants including full time/part time herbalists, old ladies, family heads and village heads were interviewed for the type of plants used in their homes for the treatment of some common diseases. Forty eight plant species were found to be used by Ondo people in folk medicine. Fourteen species were found to contain alkaloids and 34 plant species were found to have local actions. The plant parts used, their uses and biodynamic notes are given.     

Covid-19 pandemic: chronicle of responses and experiences of the infection prevention and control committee at a tertiary hospital in southwest Nigeria

Since the advent of 2019-Corona virus Disease (COVID-19) in Nigeria in February 2020, the number of confirmed cases has risen astronomically to over 61,307 cases within 8 months with more than 812 healthcare workers infected and some recorded deaths within their ranks.Infection prevention and control is a key component in ensuring safety of healthcare workers in the hospital as healthcare-associated infection is one of the most common complications of healthcare management. Unbridled transmission of infection can lead to shortage of healthcare personnel, reduced system efficiency, increased morbidity and mortality among patients and in some instances, total collapse of healthcare delivery services. The Infection Prevention and Control Committee is a recognised group by the Centre for Disease Control and Prevention with their core programmes including drawing up activities, procedures and policies designed to achieve above-stated objectives before, during and after any disease outbreak, especially emerging and re-emerging ones such as the 2019 Coronavirus Disease. In this report, we highlight the roles played by the Infection Prevention and Control Committee of the University of Medical Sciences Teaching Hospital to prevent the spread of COVID-19 within and outside the hospital community and the lessons learned to date.     

Challenges in the management of massive haemoptysis in a resource-scarce facility

Massive hemoptysis is a life-threatening condition requiring multidisciplinary management not often available in resource-deprived countries with a limited range of therapeutic options. Prognosis is poor when salvage surgery is offered during active bleeding.     

Modeling brain lentiviral infections during antiretroviral therapy in AIDS

Understanding HIV-1 replication and latency in different reservoirs is an ongoing challenge in the care of patients with HIV/AIDS. A mathematical model was created to describe and predict the viral dynamics of HIV-1 and SIV infection within the brain during effective combination antiretroviral therapy (cART). The mathematical model was formulated based on the biology of lentiviral infection of brain macrophages and used to describe the dynamics of transmission and progression of lentiviral infection in brain. Based on previous reports quantifying total viral DNA levels in brain from HIV-1 and SIV infections, estimates of integrated proviral DNA burden were made, which were used to calibrate the mathematical model predicting viral accrual in brain macrophages from primary infection. The annual rate at which susceptible brain macrophages become HIV-1 infected was estimated to be 2.90×10^?7–4.87×10^?6 per year for cART-treated HIV/AIDS patients without comorbid neurological disorders. The transmission rate for SIV infection among untreated macaques was estimated to be 5.30×10^?6–1.37×10^?5 per year. An improvement in cART effectiveness (1.6–48%) would suppress HIV-1 infection in patients without neurological disorders. Among patients with advanced disease, a substantial improvement in cART effectiveness (70%) would eradicate HIV-1 provirus from the brain within 3–32 (interquartile range 3–9) years in patients without neurological disorders, whereas 4–51 (interquartile range 4–16) years of efficacious cART would be required for HIV/AIDS patients with comorbid neurological disorders. HIV-1 and SIV provirus burdens in the brain increase over time. A moderately efficacious antiretroviral therapy regimen could eradicate HIV-1 infection in the brain that was dependent on brain macrophage lifespan and the presence of neurological comorbidity.     

Type 2 diabetes mellitus risk assessment among doctors in Ondo state

IntroductionDiabetes Mellitus (DM) has become a disease of public health importance in Nigeria. Early identification of DM risk is important in the reduction of this disease burden. This study assessed ten-year risk of developing type 2 DM among some medical doctors in Ondo State.MethodsThis was a cross-sectional study that assessed ten-year risk of developing type 2 DM among some doctors using the Finland Diabetic Risk Score form. Known diabetics were excluded from the study. Body mass index (BMI), waist circumference (WC), blood pressure and total DM risk score were determined for each participant.ResultsOne hundred and ninety-two doctors participated in the study with a male: female ratio of 1.3:1. Majority (92.2%) were below 55 years, 22 (11.5%) were obese, 32(16.7%) had central obesity, 46(24%) reported physical inactivity, 49(25.5%) had family history of DM, 141(73.4%) do not take fruits and vegetables regularly. Forty-three (22.4%) were found to have elevated blood pressure while 6(3.1%) had elevated blood glucose. Fifty-seven (29.7%) of the participants had increased ten-year DM risk. Significant predictors of increase DM risk were age ≥ 45 years (AOR:9.08; CI 3.13–26.33; p = <0.001); BMI ≥25kg/m² (AOR:11.41; CI:4.14–31.45; p = <0.001); family history of DM (AOR:9.93; CI:3.25–30.39; p = <0.001); abdominal obesity (AOR:6.66; CI:2.08–21.29; p= < 0.001); and infrequent dietary intake of fruits and vegetable (AOR:3.11;CI:1.03:9.37: p = 0.04)ConclusionThere was increased 10-year DM risk in about 30% of the participants. Lifestyle modification such as physical activity and regular consumption of fruits and vegetables should be encouraged among doctors.     

Acute generalized peritonitis in adult African patients: Assessment of severity using APACHE II score

Background: Generalized surgical acute abdomen is a significant cause of morbidity and mortality in the Nigerian environment. Severity assessment is useful in order to prioritize treatment and reduce morbidity and mortality. High severity scores are often faced with high morbidity and mortality; these patients, often require more intensive treatment than those with low severity scores. The purpose of this study was to assess the severity of generalized surgical acute abdomen in adult patients using the Acute Physiological and Chronic Ill Health Evaluation (APACHE II) score. Methods: All patients (184) aged 16 years and above, admitted and operated for generalized acute abdomen over a period of 6 years from January 1993 to December 1998 were prospectively studied. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Severity of illness was assessed using APACHE II parameters. Postoperative outcome and severity of illness were compared to determine the significance of severity of illness on postoperative outcome. Results: Thirty‐one patients (17%) died and 78 (42.4%) developed other postoperative complications. The APACHE II scores significantly correlated with the mortality and such other postoperative complications as residual intra‐abdominal abscess, abdominal sepsis, chest infection and faecal fistula (P < 0.05) and the duration of hospital stay (P < 0.05). The APACHE II scores ranged from 0 to 18, the mean score for survivors was 5.7, while it was 12.3 for those who did not survive. Only three (4%) patients who scored 0–5 died, six (9.4%) patients who scored 6–10, 15 (50%) patients who scored 11–15 and seven patients (87.5%) died who scored 16–20. Conclusion: The study showed that the severity of generalized peritonitis can be suitably assessed by APACHE II score in our environment and may serve as means of objective assessment of the quality of care. APACHE II score predicted mortality and morbidity in the patients studied. A further study is needed involving a larger number of patients to further validate our findings. We recommend to surgeons practicing in an environment similar to ours and to use the APACHE II scoring system in the assessment of patients with acute generalized peritonitis.      

Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death

Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial myxomas is rarely, if ever, associated with right atrial myxomas and may be secondary to cerebral infarction, cerebral hemorrhage and, more rarely subarachnoid hemorrhage. We review the case of a previously unknown, middle-aged Nigerian man who presented to hospital with severe headache and sudden loss of consciousness. A clinical diagnosis of hypertensive hemorrhagic cerebrovascular accident was made. The patient died suddenly a few hours after presentation. Post-mortem examination revealed a small intracerebral hemorrhage in the left superior temporal lobe as well as a large right atrial myxoma, a ventricular septal defect in the muscular septum, and right ventricular hypertrophy. The liver showed fatty change while the kidneys showed evidence of benign nephrosclerosis. Right atrial myxomas may, therefore, be remotely considered as a cause of intracranial hemorrhage, especially in the presence of predisposing cardiac anomalies such as a ventricular septal defect. Similarly, being a known cause of right heart failure, sudden death, and other constitutional derangements, it may contribute significantly to disease outcome. Hence, it should be given due consideration in the differential diagnosis of cerebrovascular accidents.     

Doctors as managers of healthcare resources in Nigeria: Evolving roles and current challenges

Over the years, medical practice in Nigeria has evolved in scope and practice, in terms of changing disease patterns, patients'' needs, and social expectations. In addition, there is a growing sentiment especially among the general public and some health workers that most doctors are bad managers. Besides drawing examples from some doctors in top management positions that have performed less creditably, critics also harp on the fact that more needs to be done to improve the training of doctors in health management. This article describes the role of doctors in this changing scene of practice and highlights the core areas where doctors'' managerial competencies are required to improve the quality of healthcare delivery. Areas such as health care financing, essential drugs and supplies management, and human resource management are emphasized. Resources to be managed and various skills needed to function effectively at the different levels of management are also discussed. To ensure that doctors are well-skilled in managerial competencies, the article concludes by suggesting a curriculum review at undergraduate and postgraduate levels of medical training to include newer but relevant courses on health management in addition to the existing ones, whereas also advocating that doctors be incentivized to go for professional training in health management and not only in the core clinical specialties.