Quantitative and qualitative assessment on individual perception and self-care practice of refractive error in a rural community in Enugu, South East Nigeria.

Background: Globally, uncorrected refractive errors have been identified as the most common cause of visual impairment and the second leading cause of treatable blindness. Aim: This study quantitatively and qualitatively assessed individual perception and self-care practice of refractive error (RE) in a rural community in Enugu State. Subjects and Methods: A descriptive, cross-sectional, population-based survey was done in Amorji community, Enugu State. A pretested, researcher-administered questionnaire was used to interview the respondents on knowledge of causes, features and treatment of RE, their self-care practices, and attitudes toward RE. Focus group discussions (FGDs) and in-depth interviews (IDIs) were also carried out to qualitatively assess these parameters. Data was analyzed using SPSS version 20. Results: A total of 522 adults, 307 (58.8%) males, and 215 (41.2%) females aged 43 ± 31.6 (range 18-83) years participated in the study. Of the participants, 235 (45.0%) had good knowledge of RE; 272 (52.1%) had positive attitude toward RE, while only 51 (9.8%) had good self-care practice. Educational status was significantly (p = 0.02) associated with participants' knowledge, attitude, and self-care practices. Good knowledge significantly (p = 0.001) influenced attitude and self-care practices among the participants. Results from FGDs and IDIs were in agreement with those obtained from the questionnaire-based part of the study. Conclusion: The participants from Amorji community had good knowledge of the features of RE but poor knowledge of its causes and treatment. They also exhibited positive attitude, but poor self-care practices toward refractive errors.

Factors associated with depression and anxiety among glaucoma patients in a tertiary hospital South-East Nigeria.

OBJECTIVE: To explore the factors associated with depression and anxiety among glaucoma patients. SUBJECTS AND METHODS: This was a cross-sectional study involving adult glaucoma patients, who attended the eye clinic of Enugu State University Teaching Hospital, Parklane, Enugu, from April to September 2018. In total, 182 glaucoma patients with no other significant ophthalmic or medical conditions were recruited. Information on their socio-demographic and clinical characteristics was obtained using a close-ended, interviewer-administered questionnaire. Detailed ophthalmic evaluation to characterize the glaucoma was done. Depression and anxiety were assessed using the hospital anxiety and depression scale. Data were analyzed using SPSS version 21. Bivariate analysis was done to identify factors associated with depression and anxiety. The level of significance was at P < 0.05. RESULTS: The participants were mainly females, 108 (59.3%), married, civil servants with tertiary education and mean age of 59.7 ± 13.3 SD years. Majority of them had advanced stage of primary open angle glaucoma. Eighty (44%) of the participants had anxiety, while 76 (41.8%) had depression. Severe/blind stage of glaucoma and reduced visual acuity were significantly associated with anxiety and depression; occupation (trading) and intraocular pressure of <21 mmHg also significantly associated with depression. CONCLUSION: The prevalence of anxiety and depression among glaucoma patients in Enugu was high. Severe/blind stage of glaucoma and reduced visual acuity were the most important factors that associated with both anxiety and depression. Incorporating a psychological health approach to glaucoma care especially in patients with severe glaucoma and reduced visual acuity may promote effective communication between clinicians and patients and treatment adherence.

Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary health facilities. POPULATION: Women admitted with complications during pregnancy, childbirth or puerperium. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria. MAIN OUTCOME MEASURES: Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO). RESULTS: Of 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe non-obstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO. CONCLUSION: Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications. FUNDING: The original research that generated the data for this secondary analysis and the publication of this secondary analysis were funded by the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). TWEETABLE ABSTRACT: Non-obstetric causes are important contributors to maternal deaths and life-threatening morbidities in Nigerian hospitals.

Relationship between corneal biomechanical properties among pregnant women in a tertiary hospital in Nigeria.

OBJECTIVE: In Nigeria, many pregnant women as well as health-care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them. MATERIALS AND METHODS: A prospective longitudinal study was used. One hundred and thirty-four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6-week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni's post hoc test. RESULTS: The women were aged 18-48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03). CONCLUSION: There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6-week postpartum.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

Effect of Hibiscus sabdariffaon blood pressure and electrolyte profile of mild to moderate hypertensive Nigerians: A comparative study with hydrochlorothiazide.

BACKGROUND: Hibiscus sabdariffa (HS) is widely consumed in Nigeria as a refreshing beverage and also as an antihypertensive agent. Since three decades ago when its antihypertensive activities were reported in several animal experiments, its consumption has greatly increased. AIM: The aim of this study is to investigate the effect of HS consumption on blood pressure (BP) and electrolytes of mild to moderate hypertensive Nigerians and compare it with that of hydrochlorothiazide (HCTZ), a diuretic widely used as first-line antihypertensive drug. SUBJECTS AND METHODS: Eighty newly diagnosed, but untreated mild to moderate hypertensive subjects attending Medical Out-Patients clinic of Enugu State University Teaching Hospital, Enugu, were recruited for the study. They were randomly divided into three groups: A, B and C. Those in Groups A were given placebo; those in Group B took HCTZ while those in Group C were given HS. Treatment lasted for 4 weeks. BP, serum, and urine electrolytes were measured at baseline, weekly during treatment and 1 week after withdrawal of treatment. RESULTS: At the end of treatment, both HCTZ and HS significantly (P<0.001) reduced systolic BP, diastolic BP, mean arterial pressure and serum Na+ compared to placebo. When compared to each other, HCTZ significantly (P<0.001) reduced serum Na+ and Cl- compared to HS and significantly (P<0.001) increased K+ and Cl- output in urine. After withdrawal of treatment, the fall in BP and serum Na+ in HS group were significant compared to HCTZ where they returned to baseline values. No side effect was reported during the study. CONCLUSION: HS was a more effective antihypertensive agent than HCTZ in mild to moderate hypertensive Nigerians and did not cause electrolyte imbalance. HS showed longer duration of action compared to HCTZ and reduction in serum Na+ may be another antihypertensive mechanism of action of HS.

Assessment of body mass index and blood pressure among university students in, Enugu, South East, Nigeria.

BACKGROUND: Body Mass Index (BMI) has been described as a significant predictor of Blood Pressure (B.P) but few studies have demonstrated this association in our environment. The study aims to determine the pattern of relationship between BMI and blood pressure in our environment. METHODOLOGY: Two thousand and ninety six (2096) students in two Universities located in Enugu, South East Nigeria completed the study. The blood pressure, weight and height were measured. Body mass index was calculated as weight in Kilograms divided by height in meters square (kg/m2). RESULTS: More females than males were underweight (9.4% versus 4.7%). More males than females were overweight (8% versus 4%).Obesity occurred more in males than females (7% versus 0.9%). Blood pressure parameters increased significantly with BMI (p < 0.0001) with higher values in males than in females; (the mean systolic blood pressure 124.88 +/- 10.97 mmHg versus 114.93 +/- 6.82 mmHg, P < 0.0001; the mean diastolic blood pressure was 80.1 +/- 7.2 mmHg versus 73.36 +/- 6.82 mmHg, p = 0.035 and the mean arterial Pressure (MAP) 95.02 +/- 7.78 mmHg versus 87.2 +/- 9.58 mmHg, p < 0.0001). CONCLUSION: A significant relationship between BMI and Blood pressure was demonstrated among university students in South East Nigeria.

The effect of potassium bromate on some haematological parameters of Wistar rats.

Potassium bromate used widely in foods has been associated with various complications in humans. However there is paucity of literature on adverse effects on haematological parameters. Thus we decided to carry out an experimental study to determine the effects of potassium bromate on some blood indices using Wistar rats. Twenty (20) male Wistar rats aged 2-3 months obtained from the department of Veterinary Medicine, University of Nigeria Nsukka were acclimatized for two weeks. They were divided into five groups and fed with graded doses of potassium bromate solution for six weeks. One of the groups served as the control. Pre and post administration blood samples were collected and analyzed the same day using standard methods. The results revealed significant [P<0.05] decrease in the platelet count when compared with the controls. There were no statistically significant differences in the mean cell haemoglobin concentration, haematocrit, and total leukocyte counts between the test and control rats. Potassium bromate is injurious to health if consumed continuously and in high quantity. It has been shown to reduce platelet count in rats, and thus may cause thrombocytopenia in humans. It is therefore imperative to take adequate measures to eliminate the use of potassium bromate in the preparation of food products.

Blood pressure and heart rate changes during pregnancy in fructose-fed Sprague-Dawley rats.

Blood pressure and heart rate changes during pregnancy were investigated in fructose-fed (diabetic) Sprague-Dawley rats. A total of 48 pubertal female rats were used. The experimental rats were fed with 25% (w/w) fructose mixed with normal rat chow for minimum period of 3 weeks while the control rats were fed with the normal rat chow. They all had free access to drinking water. Systolic, diastolic and mean arterial blood pressures and the heart rates were measured in both non-pregnant and pregnant control rats and their diabetic counterparts. The results indicate that systolic blood pressures significantly increased progressively during pregnancy in fructose-fed rats as compared with the non-pregnant rats (P < 0.0001) while in the control rats, except for the 2nd trimester sub-group, which had a similar value with the non-pregnant sub-group, the systolic blood pressure (SBP) also, increased steadily. When the diabetic group is compared with the control group, the SBP (in the 2nd trimester sub-groups) was raised from 82.18 +/- 1.26 mmHg in control rats to 112.48 +/- 1.26 mmHg in the diabetic rats (P < 0.0001). Diastolic blood pressure (DBP) progressively increased significantly in the diabetic rats from 63.94 +/- 3.95 mmHg in the non-pregnant sub-group to 91.95 +/- 1.89 mmHg in the 3rd trimester sub-group of the pregnant rats (P < 0.0001). The DBP of the 2nd trimester sub-group of the diabetic rats was significantly raised from 61.88 +/- 4.20 mmHg in the control rats to 89.60 +/- 1.79 mmHg in the diabetic rats (P < 0.0001). In addition, the mean arterial blood pressure (MAP) was significantly raised in the 1st and 2nd trimester of the diabetic rats from 70.61 +/- 3.12 mmHg in the non-pregnant diabetic rats to 96.28 +/- 1.36 mmHg and 97.13 +/- 1.15 mmHg respectively, (P < 0.0001, P < 0.0001). There was a progressive increase in the heart rates, in both control and diabetic groups, from non-pregnant sub-groups to the 3 trimesters of pregnancy. The body weights of the 2 groups of rats increased significantly as pregnancy progressed. These results suggest that fructose-induced diabetes could cause the development of sustained hypertension during pregnancy via the insulin-resistance-hyperinsulinemia-link.

Plasma cholesterol, B-carotene and ascorbic acid changes in human malaria.

Serum cholesterol (Total and free) as well as B-carotene and vitamin C level concentrations during and after severe infection by Plasmodium falciparum were determined. The decrease in the concentrations of cholesterol and B-carotene during and after infection was not statistically significant (P > 0.01), while the decrease in vitamin C was statistically significant (P < 0.01) during and after infection.