Physical and socioeconomic impact of asthma in Nigeria: Experience of patients attending three tertiary hospitals.

BACKGROUND: Understanding the impact of asthma is the key to optimal care. OBJECTIVE: To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria. METHODS: This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence). RESULTS: The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact. CONCLUSION: Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.

Hemodialysis among pregnancy related acute kidney injury patients: A single center experience in North-Western Nigeria.

Pregnancy related acute kidney injury (PRAKI) patients that underwent hemodialysis (HD) between May 2007 and April 2015 were studied with specific reference to clinical features, laboratory values, duration of pregnancy at the diagnosis of acute kidney injury and outcome. It involved 38 patients aged between 15 and 30 years. The main clinical features were fever, edema and oliguria. The leading etiological factors included ante/postpartum hemorrhage, septic abortion, and toxemia of pregnancy. The majority of cases occurred during the third trimester. PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. HD improved patient survival in our study.

Hemodialysis performance and outcomes among end stage renal disease patients from Sokoto, North-Western Nigeria.

The cost of managing end stage renal disease (ESRD) is prohibitive in Nigeria and the burden is solely borne by patients and their relatives. Despite increasing number of dialysis centers in urban areas, actual utilization of such facilities is very low. It is unclear if the outcomes of these patients have improved in recent times. We evaluated pattern of hemodialysis (HD) performance and outcome among ESRD patients. A 5-year prospective cross-sectional study of all ESRD patients on HD was undertaken. The final outcomes included duration on maintenance dialysis, death from inability to sustain dialysis, absconded, confirmed deaths within or outside health facility or referral for kidney transplant. A total of 540 (54%) of 976 cases of ESRD commenced HD, out of which 7 (1.3%) eventually had live-related kidney transplant in India. The male to female ratio was 2:1 with male and female mean ages of 43 ± 17 and 36 ± 16 years respectively. There was a progressive annual increase in the number of ESRD patients. The commonest underlying renal disorder was chronic glomerulonephritis. The mean HD session duration was 8.11 ± 5.4 hours, while the mean duration of stay on HD was 8.72 ± 1.0 weeks. In conclusion, ESRD is common and is being increasingly recognized. Financial constraint and late presentation are major contributory factors to poor outcomes despite the widespread availability of HD facilities. Therefore, effort should be geared towards aggressive strategies for early detection and treatment. Government commitment in terms of funding and/or subsidy for patient with ESRD is advocated.