Prevalence, severity, and correlates of erectile dysfunction among male adult patients of a primary care clinic in North-West Nigeria.

Background: Erectile dysfunction (ED) is a common sexual problem that profoundly affects intimate relationships. It is poorly studied in North-western Nigeria. Objectives: To assess the prevalence, severity and predictors of ED among adult males attending a primary care clinic in Northwest Nigeria. Methods: A cross-section of 392 males (aged ≥25 years) were randomly selected from attendees of a family medicine clinic in Kano, Nigeria. Information regarding their biodata, lifestyle factors, and clinical characteristics was obtained using a structured questionnaire. The International Index of Erectile Function Questionnaire (version 5) and Patient Health Questionnaire-2 assessed ED and depression, respectively. Results: The participants' mean age was 45±14.1 years (range: 26-86 years). Most participants were married (88.8%), had one sexual partner (71.7%), had tertiary education (44.4%) and were traders (49.7%). The prevalence of ED was 52.3% (205/392) [comprising mild (36.0%), mild-to-moderate (14.3%), moderate (1.5%) and severe (0.5%)]. Age, body mass index (BMI), marital status, number of sexual partners, monthly income, type of exercise, hypertension history, blood pressure reading, antihypertensive and peptic ulcer drug use were associated with ED (P<0.05). However, age (≥50years) (OR= 1.91, 95%CI [1.28-2.85], P=0.001) and overweight/obesity (OR =1.81, 95%CI [1.18-2.77], P=0.007) were the predictors of ED in this population. Conclusion: ED prevalence was high, although mainly of the mild form. Age (≥50years) and overweight/obesity predicted ED. Hence, the need for early screening, objective grading of ED, identification of modifiable risk factors (e.g., overweight/obesity) and commencing proper treatment and prevention in this setting.

Lifetime prevalence and knowledge of snakebite among graduates in Nigeria.

BACKGROUND: Given the lack of studies on snakebite envenoming knowledge in the general population, we examined the lifetime prevalence of snakebite and knowledge of snakebite and its prevention and first aid among recent Nigerian graduates in national service. METHODS: This questionnaire-based cross-sectional study involved 351 consenting national youth corps members at a rural orientation camp in Kano, Nigeria. RESULTS: Participants' mean age was 25.3±2.4 y. There were slightly more males (50.7%). Most attended universities (77.8%) and were mainly from the southwest (24.5%) and northeast (24.5%) geopolitical regions and the Yoruba tribe (24.7%). Their lifetime prevalence of snakebite was 4%. Their mean overall knowledge score was 6.8±3.1 out of 20. Only 0.9% had adequate knowledge. Gender (male; 7.2±3.1, t=2.83, p=0.0049), tribe (Yoruba; 7.5±2.9, F=2.968, p=0.0320), region (Southwest; 7.6±3.0, F=2.5289, p=0.0289) and nearly bitten by snake (7.8 ± 2.7, t=3.60, p=0.0004) were significantly associated with a higher mean knowledge score. CONCLUSIONS: Their lifetime prevalence of snakebites is significant, while knowledge of snakebite is very inadequate. However, the national service camp activities period provides an opportunity for educational intervention needed to raise their knowledge to optimal levels that will enable them serve as better snakebite prevention agents, as they will be working in rural communities where snakebite might be prevalent.

Case fatality rate and burden of snakebite envenoming in children - A systematic review and meta-analysis.

Snakebite is a major public health problem with an estimated global burden of 5 million people per annum. Data on snakebite envenoming in children are very limited and is unclear whether there is a significant difference in severity between adults and children. We therefore conducted a meta-analysis of observational studies on snakebite in children to obtain a more precise estimate of case fatality rate (CFR) as well as to explore the differences in outcome between children and adults. Studies from all over the world reported until the end of February 2023 were included. Analysis was conducted consistent with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria. Estimates were obtained from Random Effects Model (REM). Sub-analysis was conducted for studies from sub-Saharan Africa (SSA) to provide estimates for the continent. Adverse outcomes comprising composite endpoints (CE), defined as fatality and or complications, were compared between children and adults in sub-analysis of studies reporting on both groups. The annual burden and fatality of snakebite envenoming were derived based on lifetime prevalence of bite, meta-analysis estimates, and other data inputs. The pooled estimate of the CFR from 35 studies included worldwide was 1.98% [95%CI:1.38-2.58%] while the estimates from 6 studies within SSA was 2.43% (95%CI:0.67-4.20%). The odds of adverse outcomes were 2.52 times higher in children compared to adults. The estimated annual burden was 178,491 cases with 4346 deaths among children in SSA. These estimates compare favorably to those reported in the literature.

Relationship between anaemia, hypoalbuminaemia, and dietary lifestyle of the older adults attending a primary care clinic in Nigeria.

Objectives: To determine the prevalence and severity of anaemia and assess the relationship between dietary lifestyle, hypoalbuminaemia, and anaemia of older persons. Design: A cross-sectional hospital-based study. Setting: This study was conducted in the General Outpatient Clinic, the primary care unit of Aminu Kano Teaching Hospital in Kano, Nigeria. Participants: A total of 378 patients aged ≥ 60 years who presented to the General Out-patient Clinic. Main outcome measures: Prevalence and severity of anaemia, relationship between anaemia and hypoalbuminaemia, and dietary lifestyle of the participants. Results: A total of 348 respondents completed the study. The mean age of respondents was 67.83 ±7.53 years, with female (60.9%) predominance. The prevalence of anaemia and hypoalbuminaemia were 42.2% and 17.8%, respectively. Hypoalbuminaemia (ß=0.335, 95%CI=0.131-0.229, P<0.001), long duration of comorbidities (ß= -0.179, 95%CI= -0.165-0.047, P<0.001), one full meal/day (ß=0.130, 95%CI=0.224-1.879, P=0.013), and low monthly income (ß=0.122, 95%CI=0.179-1.543, P=0.026) were the predictors of anaemia among the older persons in this study. Conclusion: This study revealed a high prevalence of anaemia among older adults. The identified predictors, such as hypoalbuminaemia, long duration of comorbidities, reduced food intake and low monthly income, will be useful in developing guidelines and strategies for managing the condition in primary care settings and other similar sites. Funding: None declared.

Pre-clinical efficacy of African medicinal plants used in the treatment of snakebite envenoming: A systematic review.

The World Health Organization has listed Snakebite Envenoming (SBE) as a priority neglected tropical disease, with a worldwide annual snakebite affecting 5.4 million people and injuring 2.7 million lives. In many parts of rural areas of Africa and Asia, medicinal plants have been used as alternatives to conventional antisnake venom (ASV) due in part to inaccessibility to hospitals. Systemic reviews (SR) of laboratory-based preclinical studies play an essential role in drug discovery. We conducted an SR to evaluate the relationship between interventional medicinal plants and their observed effects on venom-induced experiments. This SR was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Modified collaborative approach to meta-analysis and review of animal data from experimental studies (CAMARADES) and SYRCLE's risk of bias tools were used to appraise the included studies. Data were searched online in Medline via PubMed, Embase via OVID, and Scopus. Studies reporting in vivo and in vitro pharmacological activities of African medicinal plants/extracts/constituents against venom-induced pathologies were identified and included for screening. Data from the included studies were extracted and synthesized. Ten studies reported statistically significant percentage protection (40-100%) of animals against venom-induced lethality compared with control groups that received no medicinal plant intervention. Sixteen studies reported significant effects (p ≤ 0.05) against venom-induced pathologies compared with the control group; these include hemolytic, histopathologic, necrotic, and anti-enzymatic effects. The plant family Fabaceae has the highest number of studies reporting its efficacy, followed by Annonaceae, Malvaceae, Combretaceae, Sterculiaceae, and Olacaceae. Some African medicinal plants are preclinically effective against venom-induced lethality, hematotoxicity, and cytotoxicity. The evidence was extracted from three in vitro studies, nine in vivo studies, and five studies that combined both in vivo and in vitro models. The effective plants belong to the Fabaceae family, followed by Malvaceae, and Annonaceae.

Climate change and primary health care in Sahelian Kano, Nigeria.

Climate change (CC) is a global phenomenon that impacts several aspects of human existence. The Sustainable Development Goal 13 implores stakeholders to take action to mitigate the effects of CC. However, its impact on health, particularly primary health care, has not been thoroughly studied. Here, we share anecdotal experiences of the impact of CC on health and primary care presentations in Kano, Northwest, Nigeria. We observed consistent clinical presentations logically associated with high temperatures and excessive flooding in certain months of the year. Presentations range from skin and water-borne diseases to malnutrition and stress-related disorders. Our experience in Kano, Nigeria could be a valuable exposition of the diversity of the impact of CC on primary health care presentation in Africa, considering geographical and cultural differences. It also exposes the paucity of data regarding the impact of CC on primary care activities in Africa.Contribution: In conclusion, CC has potential impacts on primary health care and practice. The full implications of CC on this vital level of care will require future research (quantitative and qualitative studies). This will help strategic intervention planning by stakeholders.

Preclinical efficacy of African medicinal plants used in the treatment of snakebite envenoming: a systematic review protocol.

BACKGROUND: Snakebite envenoming (SBE) is a high-priority, neglected, tropical disease that affects millions of people in developing countries annually. The only available standard drug used for the treatment of SBE is antisnake venom (ASV) which consists of immunoglobulins that have been purified from the plasma of animals hyper-immunized against snake venoms. The use of plants as alternatives for treatment of poisonous bites particularly snakebites is important in remote areas where there might be limited, or no access to hospitals and storage facilities for antivenom. The pharmacological activity of some of the medicinal plants used traditionally in the treatment of SBE have also been scientifically validated. METHOD: A systematic review will be conducted according to the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies checklist for study quality in animal/in vivo studies. The tool will be modified and validated to assess in vitro models and studies that combine in vivo and in vitro studies. The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. English published articles on African medicinal plants used in the treatment of snakebite envenoming will be searched in Medline, Embase, and Scopus from 2000 to 2021. DISSEMINATION: The findings of the study will be communicated through publication in peer-reviewed journal and presentation at scientific conferences. Medicinal plants have been important sources for the development of many effective drugs currently available in orthodox medicine. Botanically derived medicines have played a major role in human societies throughout history. Plants components used in traditional medicine gained much attention by many toxinologists as a tool for designing potent antidotes against snake envenoming. Our systematic review will provide a synthesis of the literature on the efficacy of these medicinal plants. We will also appraise the prospects of African medicinal plants with pharmacologically demonstrated activity against snakebite and envenoming.

Prevalence and predictors of clinic appointment non-adherence among adults with poorly controlled hypertension in a primary care setting.

Objectives: To assess the prevalence and predictors of non-adherence to clinic appointments in adult patients with poorly controlled hypertension. Design: A descriptive cross-sectional study. Setting: A primary care setting (family medicine clinic) overseen by family physicians in Kano, Nigeria. Participants: Two hundred and thirty-four randomly selected patients, aged ≥ 18 years with a diagnosis of hypertension, who had been on treatment for ≥1 year and had a current blood pressure of ≥140/90 mmHg were included. Main outcome measures: Non-adherence to clinic appointment among participants. Results: Participants' mean age was 55±12.2 years (range: 23-85 years); they were predominantly females (163, 69.7%). Sixty (25.6%) participants were non-adherent to clinic-appointments. Being employed (OR [Odds ratio] =2.92, 95%CI [confident interval] =1.52-5.65, P=0.002), inability of participants or their children to pay the medical bills (OR=2.92,95%CI=1.42-6.00, P=0.004), and systolic blood pressure (SBP) of <160mmHg (OR=0.43, 95%CI=0.22-0.86, P=0.018) were predictors of clinic appointment non-adherence. Conclusions: The prevalence of non-adherence to clinic appointments was high. Being employed, patients or their children's inability to pay medical bills, and higher SBP were predictors of non-adherence to clinic appointments. Therefore, more studies are needed on effective interventions to reduce non-adherence to clinic appointments in this setting.

Knowledge assessment of anti-snake venom among healthcare practitioners in northern Nigeria.

INTRODUCTION: Anti-snake venom (ASV) is the standard therapy for the management of snakebite envenoming (SBE). Therefore, the knowledge of ASV among healthcare practitioners (HCPs) is essential for achieving optimal clinical outcomes in snakebite management. This study aimed to assess knowledge of ASV among the HCPs in northern Nigeria. METHODS: We conducted a cross-sectional study involving eligible HCPs from different healthcare settings in northern Nigeria. The participants were recruited into the study using a combination of online (via Google Form) and face-to-face paper-based survey methods. The ASV knowledge of the respondents was measured using a validated anti-snake venom knowledge assessment tool (AKAT). Inadequate overall knowledge of ASV was defined as scores of 0-69.9%, and 70-100% were considered adequate overall knowledge scores. The predictors of ASV knowledge were determined using multiple logistic regression. RESULTS: Three hundred and thirty-one (331) eligible HCPs were included in the study analysis (310 from online and 21 from paper-based survey). Overall, an estimated 12.7% of the participants had adequate knowledge of ASV. Adequate ASV knowledge was higher among physicians compared with other HCPs (21.7%; χ2 = 8.1; p = 0.04). Those without previous training on ASV (adjusted odds ratio [aOR], 0.37; 95% confidence interval [CI], 0.18-0.73; p = 0.004) and who have not previously administered/dispensed ASV (aOR, 0.31; 95% CI, 0.15-0.63; p < 0.001) were less likely to have adequate knowledge of ASV. CONCLUSION: The knowledge of ASV among healthcare practitioners in northern Nigeria is grossly inadequate. Experience with administering or dispensing ASV predicts ASV knowledge. Therefore, appropriate interventions are needed to improve ASV knowledge, particularly among the HCPs, for optimal healthcare outcomes.

Knowledge assessment of snake antivenom among healthcare practitioners involving educational intervention in northern Nigeria: a study protocol.

INTRODUCTION: Snakebite envenoming (SBE) is an important occupational and public health hazard especially in sub-Saharan Africa. For optimum management of SBE, adequate knowledge of Snake antivenom (SAV) is very critical among the healthcare practioners in this region. Information related to the knowledge of SAV use in the management of SBE, as well as SAV logistics is scarce among the Health Care Professionals (HCPs) in Nigeria, particularly in the northern region. We therefore aimed to develop, validate and utilize a tool to assess the SAV knowlegde among HCPs in northern Nigeria. We also sought to implement and evaluate an intervention that could improve the SAV knowledge among the HCPs. METHODS: The proposed study will be conducted in three phases: Phase I will involve the development of the item-pool to be included in the tool, followed by a face, content validity and construct validity. The tool reliability, readability and difficulty index will be determined. Phase II will involve the utilization of the tool to assess baseline SAV knowledge among the HCPs followed by an educational intervention. Multiple Linear Regression analysis will be used to determine the factors associated with SAV knowledge among the HCPs. Lastly, Phase III which will be a repeat of Phase II to assess and evaluate the knowledge after the intervention. DISCUSSION: The study design and findings may guide future implementation and streamline the intervention of improving SAV knowledge in HCPs training and practice. LAY SUMMARY: Knowledge assessment and educational intervention of snake antivenom among healthcare practitioners in northern Nigeria: a study protocol Snakebite envenoming (SBE) is an important occupational and public health hazard especially in sub-Saharan Africa. For optimum management of SBE, adequate knowledge of snake antivenom (SAV) is very critical among the healthcare practitioners. The baseline knowledge SAV dosage, mode of administration, availability, and logistics is very relevant among healthcare professionals, particularly those that are directly involved in its logistics. It is paramount that SAV is handled and used appropriately. The efforts and advocacy for the availability for more SAV will be in vain if not handled appropriately before they are used. This study protocol aims to develop a tool, to assess SAV knowledge and effects of educational interventions among healthcare professionals (HCPs) in northern Nigeria. This protocol suggests conducting studies in three phases: (a) Development and validation of SAV knowledge assessment tool, (b) Baseline assessment of SAV knowledge assessment tool among HCPs, and (c) Development, implementation and evaluation of an educational intervention to improve SAV knowledge among HCPs in northern Nigeria.

Development and validation of antisnake venom knowledge assessment tool (AKAT) for healthcare practitioners.

Antisnake venom (ASV) is the only specific and standard treatment for snakebite envenoming worldwide. The knowledge of antivenom dosage, mode of administration, availability, and logistics is essential to the healthcare practitioners (HCPs) in the management of snakebites. It is vital for the HCPs involved in the handling of ASVs to have its basic knowledge. The ASV contains proteins and can, therefore, easily get denatured if not handled appropriately, leading to poor therapeutic outcome. It is also essential for clinicians to be aware of the tendency of ASV to cause a severe life-threatening hypersensitivity reaction. There is currently no validated tool for assessing the knowledge of ASV among HCPs. Therefore, we developed and validated a tool for evaluating the HCPs knowledge of ASV. The items included in the tool were first generated from a comprehensive literature review. Face validity were conducted by presenting the drafted tool to ten experts on the subject matter. A validation study was conducted among doctors, pharmacists, nurses, pharmacy technicians, and the general public. The objectives of the study were to test the tool for content validity using the content validity index (CVI), construct validity using contrast group approach, difficulty index, readability, and reliability test using the test-retest method. We developed and validated a final tool containing thirty-three items. The tool was valid for face validity and had a scale-level (average) content validity (S-CVI/Ave) of 0.91. The ASV knowledge of pharmacists was higher than that of doctors, pharmacy technicians, nurses, and the general public (p < 0.001), thus, valid for construct validity. The readability of the tool using the Simple Measure of Gobbledygook (SMOG) was determined to be grade level 7. The test-retest analysis showed no significant difference between the mean knowledge scores measured at four weeks interval (p = 0.916), implying excellent reliability. The AKAT has demonstrated good psychometrical properties that would enable its application among a wide range of healthcare practitioners.

Knowledge of venomous snakes, snakebite first aid, treatment, and prevention among clinicians in northern Nigeria: a cross-sectional multicentre study.

Background: Snakebite envenoming causes considerable morbidity and mortality in northern Nigeria. The clinician's knowledge of snakebite impacts outcome. We assessed clinicians' knowledge of snakebite envenoming to highlight knowledge and practice gaps for possible intervention to improve snakebite outcomes. Methods: This was a cross-sectional multicentre study of 374 doctors selected from the accident and emergency, internal medicine, family medicine/general outpatient, paediatrics and surgery departments of nine tertiary hospitals in northern Nigeria using a multistage sampling technique. A self-administered questionnaire was used to assess their sociodemographics, knowledge of common venomous snakes, snakebite first aid, snake antivenom treatment and prevention. Results: The respondents' mean age was 35.6±5.8 y. They were predominantly males (70.6%) from urban hospitals (71.9%), from the northwest region (35.3%), in family medicine/general outpatient departments (33.4%), of <10 years working experience (66.3%) and had previous experience in snakebite management (78.3%). Although their mean overall knowledge score was 70.2±12.6%, only 52.9% had an adequate overall knowledge score. Most had adequate knowledge of snakebite clinical features (62.3%), first aid (75.7%) and preventive measures (97.1%), but only 50.8% and 25.1% had adequate knowledge of snake species that caused most injuries/deaths and anti-snake venom treatment, respectively. Overall knowledge predictors were ≥10 y working experience (odd ratio [OR] 1.72 [95% confidence interval {CI} 1.07 to 2.76]), urban hospital setting (OR 0.58 [95% CI 0.35 to 0.96]), surgery department (OR 0.44 [95% CI 0.24 to 0.81]), northwest/north-central region (OR 2.36 [95% CI 1.46 to 3.82]) and previous experience in snakebite management (OR 2.55 [95% CI 1.49 to 4.36]). Conclusions: Overall knowledge was low. Improvements in overall knowledge may require clinicians' exposure to snakebite management and training of accident and emergency clinicians in the region.

The effect of pre-hospital care for venomous snake bite on outcome in Nigeria.

We studied pre-hospital practices of 72 consecutive snake bite victims at a hospital in north-central Nigeria. The primary outcome assessed was death or disability at hospital discharge. Victims were predominantly male farmers, and in 54 cases (75%) the snake was identified as a carpet viper (Echis ocellatus), with the remainder unidentified. Most subjects (58, 81%) attempted at least one first aid measure after the bite, including tourniquet application (53, 74%), application (15, 21%) or ingestion (10, 14%) of traditional concoctions, bite site incision (8, 11%), black stone application (4, 5.6%), and suction (3, 4.2%). The majority (44, 61%) presented late (after 4 hours). Most (53, 74%) had full recovery at hospital discharge. Three deaths (4.2%) and thirteen (18%) disabilities (mainly tissue necrosis) occurred. The use of any first aid was associated with a longer hospital stay than no use (4.6 ± 2.0 days versus 3.6 ± 2.7 days, respectively, P = 0.02). The antivenom requirement was greater in subjects who had used a tourniquet (P = 0.03) and in those who presented late (P = 0.02). Topical application (Odds Ratio 15, 95% CI 1.4-708) or ingestion of traditional concoctions (OR 20, 95% CI 1.4-963) were associated with increased risk of death or disability. Ingestion and application of concoctions were associated with a longer time interval before presentation, a higher cost of hospitalization, and an increased risk of wound infection.