Co-occurrence of Modifiable Risk Factors for Cardiovascular Disease amongst Diabetic Patients in Lagos State, Nigeria.

BACKGROUND: Diabetes significantly increases the likelihood of developing cardiovascular disease (CVD). This risk can be reduced by addressing modifiable risk factors. The objectives of this study were to assess the modifiable risks for CVD amongst persons with diabetes and identify the factors associated with multiple risk factors. METHODS: This cross-sectional study was conducted amongst 357 diabetic patients attending a large tertiary hospital in Southwest Nigeria. Eligible patients were recruited consecutively on clinic days till the minimum sample size was reached. An interviewer-administered survey tool adapted from the World Health Organization STEPS was used to obtain information from study participants. The following risk factors were assessed: tobacco use, obesity, high blood pressure, physical activity, sedentary time and hours of sleep. Data were analysed using the STATA version 15.0 (Stata Corp.) statistical programme. RESULTS: The mean age of the participants was 61.7 ± 12.6 years, and they were mostly females (63.9%). Of the risk factors assessed, the most prevalent modifiable risk factors amongst the respondents were inadequate sleep - <8 h on average (91.6%), abdominal obesity (82.6%) and high blood pressure (72%). Others were inadequate physical activity (56%) and lifetime tobacco use (21%). Up to 40.3% of the diabetic persons had three or more co-existing CVD risk factors. Age, gender, work and marital status (P ≤ 0.01) were statistically associated with multiple CVD risk factors. Being male, unmarried and increasing age were predictors of multiple CVD risk factors amongst the diabetic patients. CONCLUSION: A significant proportion of the diabetic patients have multiple co-existing modifiable CVD risks. Abdominal obesity and poor sleep were the most prevalent. Older men who are unmarried were more likely to have multiple risks. Primary and secondary preventive measures to address CVD risks amongst diabetic patients are warranted and should target older unmarried men.

A continuous quality improvement strategy to strengthen screening practices and facilitate the routine use of intravenous iron for treating anaemia in pregnant and postpartum women in Nigeria: a study protocol.

BACKGROUND: Pregnancy-related anaemia is a public health challenge across Africa. Over 50% of pregnant women in Africa get diagnosed with this condition, and up to 75% of these are caused by iron deficiency. The condition is a significant contributor to the high maternal deaths across the continent and, in particular, Nigeria, which accounts for about 34% of global maternal deaths. Whereas oral iron is the mainstay treatment for pregnancy-related anaemia in Nigeria, this treatment is not very effective given the slow absorption of the medication, and its gastrointestinal adverse effects which lead to poor compliance by women. Intravenous iron is an alternative therapy which can rapidly replenish iron stores, but fears of anaphylactic reactions, as well as several misconceptions, have inhibited its routine use. Newer and safer intravenous iron formulations, such as ferric carboxymaltose, present an opportunity to overcome some concerns relating to adherence. Routine use of this formulation will, however, require addressing misconceptions and systemic barriers to adoption in the continuum of care of obstetric women from screening to treatment. This study aims to test the options to strengthen routine screening for anaemia during and immediately after pregnancy, as well as evaluate and improve conditions necessary to deliver ferric carboxymaltose to pregnant and postpartum women with moderate to severe anaemia. METHODS: This study will be conducted in a cluster of six health facilities in Lagos State, Nigeria. The study will employ continuous quality improvement through the Diagnose-Intervene-Verify-Adjust framework and Tanahashi's model for health system evaluation to identify and improve systemic bottlenecks to the adoption and implementation of the intervention. Participatory Action Research will be employed to engage health system actors, health services users, and other stakeholders to facilitate change. Evaluation will be guided by the consolidated framework for implementation research and the normalisation process theory. DISCUSSION: We expect the study to evolve transferable knowledge on barriers and facilitators to the routine use of intravenous iron that will inform scale-up across Nigeria, as well as the adoption of the intervention and strategies in other countries across Africa.

Cohort event monitoring for safety signal detection in adult individuals 18 years and above after immunisation with coronavirus disease 2019 vaccines in Nigeria.

Introduction: In Nigeria, immunisation with coronavirus disease 2019 (COVID-19) vaccines commenced in March 2021. COVISHIELD from AstraZeneca (AZ), a viral vector vaccine, was the brand administered in the first phase of vaccinations for pre-determined eligible adults 18 years and above. As more brands of COVID-19 vaccines have been introduced in Nigeria, identifying effective and safe vaccine brands is essential to pharmacovigilance and public health. The current study assessed the safety of the AZ-AZD1222 (ChAdOx1) COVID-19 vaccine in adults during the first phase of the vaccination exercise in Nigeria. Methodology: We conducted a descriptive analysis of safety data from selected vaccination sites across six states in Nigeria between June 2021 and September 2021. Respondents were monitored over 3 months for local and systemic reactions, as well as hospitalisation and mortality. Measures obtained from respondents include age, sex, pre-existing comorbidity, local and systemic reactions to vaccines, timing onset of reactions, hospitalisation and mortality. Bivariate and multivariable regression models were used to assess factors associated with vaccine reactogenicity. Results: A total of 1284 individuals were enrolled in the cohort study from the six selected states (Anambra, Borno, Edo, Katsina, Lagos and Plateau) representing the geopolitical zones of Nigeria. A total of 675 individuals or 52.6% of enrolees reported non-serious adverse effects, and only one individual or 0.08% reported a serious adverse event following immunisation in the first 7 days after vaccination. None of the enrolled participants reported adverse events requiring hospitalisation. The most common self-reported symptoms amongst vaccine recipients were tenderness at the injection site 20.9% and fever 20.3%. A majority of symptoms (55.5%) occurred on or before the 3rd day after vaccination. Multivariable logistic regression model showed that age 60 years or above (vs. 18-24 years) was significantly associated with a lower likelihood of a vaccine-related symptomatic reaction (adjusted odds ratio: 0.35; 95% confidence interval: 0.20-0.61). There was no reported mortality amongst all the enrolled and followed-up vaccine recipients. Conclusion: Our findings suggest that the safety profile of the AZ vaccine is acceptable, and the observed symptoms were mild and mostly within the first 3 days following vaccination. Vaccine recipients will benefit from counselling about potential transient reactions, and improving public awareness can potentially encourage the uptake of vaccines and reduce the spread of the COVID-19 pandemic.

Effects of a mHealth voice messaging intervention on antenatal care utilisation at primary care level in Lagos, Nigeria: a cluster randomised trial.

Background: Nigeria has one of the lowest antenatal care (ANC) utilization rates compared to other low- and middle-income nations. In order to ensure a positive pregnant experience, the World Health Organization recommends at least eight ANC visits during pregnancy. This study intends to examine the impact of a mobile phone-based voice message intervention on ANC use in Lagos, Nigeria. Methods: In this cluster-randomized experiment, primary healthcare centres were divided into five intervention and five control groups using multistage simple random sampling. The intervention consisted of a weekly voice message transmitted through mobile phone from the time of recruitment in the first trimester until two weeks postpartum. Attending at least eight ANC visits before birth was the primary outcome. STATA v17.0 was used to conduct descriptive and bivariate analyses as well as multivariate linear models to calculate crude risk ratios. Results: 458 women participated. All intervention group women (269 women, or 58.7% of the sample) received the text message. These ladies were mostly married, Christian, had several children, and had completed high school. Women who received the intervention were more likely to attend eight ANC visits. Conclusion: A voice message-based intervention can boost ANC utilization, according to the conclusion. This contributes to the existing body of information about the influence of mHealth treatments on maternal health outcomes and serves as a useful tool for ensuring that no woman is left behind.

Maternal and child health service readiness among primary health care facilities in Ekiti, Nigeria.

BACKGROUND:  The availability of adequate infrastructure, diagnostic medical equipment, medicines and commodities and well-trained medical personnel are essential for the effective delivery of health care services. AIM:  This study assessed maternal and child health (MCH) services' specific readiness by type and location of the health facility and compared the readiness between urban and rural primary health care (PHC) facilities in Ekiti State, Nigeria. SETTING:  The study was conducted amongst the heads (officers in charge) of PHC facilities in Ekiti State, Nigeria between August 2020 and October 2020. METHODS:  A descriptive cross-sectional study in which all PHC facilities were conducted and data were collected with the aid of the Service Availability and Readiness Assessment (SARA) tool using the KoboCollect app. Data were cleaned and coded on Microsoft Excel 2016 and exported to Stata SE 12 for analysis. The level of significance was set at p  0.05. RESULTS:  Overall, the MCH readiness score amongst PHC facilities was 47% (0.47 ± 0.18). About half (52%) of the facilities had necessary and relevant equipment. Health facilities located in urban areas had more medicines and commodities compared with those of rural areas (0.51 ± 0.16 vs 0.45 ± 0.17, p  0.05). Primary health care facilities in Ekiti North I had an overall higher service readiness score (0.63 ± 0.19) compared with other federal constituencies (p  0.001). CONCLUSION:  The overall MCH-specific service readiness in Ekiti State was relatively low. Strategies to address the identified gaps for a smooth journey towards the achievement of Universal Health Coverage (UHC) are recommended.

Mothers' knowledge, attitude and home management of diarrhoea among children under five years old in Lagos, Nigeria.

BACKGROUND:  Diarrhoea is a leading cause of death among children under five years old globally. It remains a major cause of morbidity and mortality among this age group in Nigeria. Using simple home management, mothers play important roles in the prevention and control of diarrhoea among these children. AIM:  This study aimed to assess mothers' knowledge, attitude and practice in the prevention and home management of diarrhoeal diseases among children under five years old in Lagos, Nigeria. SETTING:  This study was conducted within the communities of Kosofe local government area of Lagos State, Nigeria. METHODS:  A descriptive cross-sectional study design was conducted using a multistage sampling technique. Data were collected using a structured interviewer-administered questionnaire and analysed using EPI info version 7.2.1. Chi-square statistic was used to test the association between variable at the level of significance of 5%. RESULTS:  A total of 360 respondents participated in this study. The mean age of the respondents was 32.5 ± 5.5 years. About 59.2% of respondents had good knowledge, 59.2% of them had positive attitude, and 53.1% of them had good practice towards prevention and home management of diarrhoea. Age (p = 0.007), occupation (p = 0.008) and level of education (p = 0.001) were significantly associated with practice of home management of diarrhoea among children under five years old. CONCLUSION:  Educated, employed, and married mothers were more likely to have good prevention and home management practices towards diarrhoea in their children under five years old.

Feasibility and acceptability of early infant screening for sickle cell disease in Lagos, Nigeria-A pilot study.

In Nigeria, about 150000 babies are born annually with sickle cell disease (SCD), and this figure has been estimated to increase by 100% by the year 2050 without effective and sustainable control strategies. Despite the high prevalence, newborn screening for SCD which allows for early prophylactic treatment, education of parents/guardians and comprehensive management is not yet available. This study explored a strategy for screening in early infancy during the first and second immunization visits, determined the prevalence, feasibility and acceptability of early infant screening for SCD and the evaluation of the HemoTypeSC diagnostic test as compared to the high-performance liquid chromatography (HPLC) gold standard. A cross-sectional study was conducted in two selected primary health care centres in Somolu local government area (LGA) in Lagos, Nigeria. Two hundred and ninety-one mother-infant pairs who presented for the first or second immunization visit were consecutively enrolled in the study following written informed consent. The haemoglobin genotype of mother-infant pairs was determined using the HemoTypeSC rapid test kit. Confirmation of the infants' Hb genotype was done with HPLC. Data were analysed with SPSS version 22. Validity and Predictive value of HemotypeSC rapid screening test were also calculated. Infant screening for SCD was acceptable to 86% of mothers presenting to the immunization clinics. The prevalence of SCD among the infant cohort was 0.8%. The infants diagnosed with SCD were immediately enrolled in the paediatric SCD clinic for disease-specific care. The HemoTypeSC test had 100% sensitivity and specificity for sickle cell disease in early infancy compared to HPLC. This study affirms that it is feasible and acceptable for mothers to implement a SCD screening intervention program in early infancy in Lagos State. The study also demonstrates the utility of the HemotypeSC rapid testing for ease and reduced cost of screening infants for SCD.

Knowledge, attitude and preventive practices of sexually transmitted infections among unmarried youths in an urban community in Lagos State, Nigeria.

BACKGROUND: Sexually transmitted infections (STIs) are of public health importance as over 1 million STIs are acquired daily worldwide. One-third of the new cases of curable STIs affect younger persons aged less than 25 years. Sexually transmitted infections can lead to severe complications beyond the immediate impact of infections as such. AIM: This study assessed knowledge of, attitude towards and preventive practices of STI among young unmarried persons in Surulere local government area (LGA) of Lagos State, Nigeria. SETTING: The study was conducted among young unmarried persons in Surulere LGA, Lagos State, Nigeria, between June and November 2018. METHODS: A descriptive cross-sectional study was conducted among 450 young unmarried persons selected using a multistage sampling technique. An interviewer-administered questionnaire was used to obtain data. Analysis was carried out with Epi-Info 7.2.2.2 software. Chi-square was used to test for associations. Level of significance was at p ≤ 0.05. RESULTS: The mean age was 19.9 + 2.5 years. Majority of the respondents (84.7%) had heard of STIs. About two-third (65.6%) had good knowledge, while majority (98.6%) had good attitude towards the prevention of STIs, but less than half (34.0%) had good preventive practices. Knowledge of STI was statistically significantly associated with age, level of education, attitude and preventive practices of the respondents. CONCLUSION: Most of the respondents were aware and had good attitude towards prevention of STI, but gaps exist in knowledge and preventive practices. Hence, targeted education to improve the knowledge and preventive practices against STI among young unmarried persons is recommended.

Knowledge, attitude and uptake of human papillomavirus vaccination among female undergraduates in Lagos State, Nigeria.

BACKGROUND AND AIMS: Human papillomavirus (HPV) is a known cause of cervical cancer which is the second-most common cancer among women worldwide. HPV vaccination is a primary prevention to reduce the occurrence of cervical cancer. This study assessed knowledge, attitude and uptake of HPV vaccine among female undergraduates in Lagos State Polytechnic (LASPOTECH). METHODS: A descriptive cross-sectional survey was conducted among 400 female undergraduates of LASPOTECH in August 2018. Participants were selected using a multi-stage sampling technique and data was collected with a pretested, self-administered, semi-structured questionnaire. Univariate and bivariate analyses were conducted using IBM SPSS version 20. Statistically significant level was set at P ≤ 0.05. RESULTS: Mean age of respondents was 21.3 ± 2 years. Only 11 (3%) of the respondents had good knowledge of HPV and the vaccine. However, majority of the respondents 356 (92.7%) had positive attitude towards uptake of HPV vaccine. Only 10 (2.6%) of the respondents had received a single dose of HPV vaccine. Age, level of study and number of sexual partners of the respondents were statistically significantly associated with knowledge and attitude towards the HPV vaccine (P ≤ 0.05). The most common reason stated by the respondents for none uptake of HPV vaccine was lack of information. CONCLUSION: Knowledge and uptake of HPV vaccination among the respondents were poor. However, majority had positive attitude towards uptake of the vaccine. It is recommended that information on HPV and the vaccine should be made available to increase the knowledge and the uptake among female undergraduates in Lagos State.

Hand hygiene practices in the context of Ebola virus disease: A cross-sectional survey of Lagos residents.

BACKGROUND: The Ebola virus disease outbreak that ravaged parts of West Africa has been described as the most severe acute public health emergency seen in modern times. Hand washing was promoted among other measures for infection prevention. OBJECTIVE: This study assessed the awareness of Ebola virus disease and hand-washing practices among Lagos residents, southwest Nigeria. METHODS: A descriptive cross-sectional study was used. A total of 1982 respondents aged 18 ⩾ years were selected using a multi stage sampling technique. An interviewer-administered, pre-tested questionnaire was used for data collection between August and November 2015. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 22, with level of significance set at 0.05. RESULTS: Almost all (97.3%) respondents were aware of Ebola virus disease, with over half of respondents having heard about it from television. A majority of 1890 (95.4%) respondents were aware of the importance of hand washing in disease prevention. Similarly, high proportions of respondents were aware they should wash their hands after an outing, toilet use, touching pets, before and after meals, while 1628 (82.1%) of respondents knew to wash their hands after a hand shake. However, less than half of respondents (38.8%) always washed their hands after handshakes. DISCUSSION: A majority of respondents surveyed were aware of Ebola virus disease and hand washing, but the practice of hand washing, which is key in prevention of infection, lagged behind the knowledge of the respondents.

Medication adherence and patient satisfaction among hypertensive patients attending outpatient clinic in Lagos University Teaching Hospital, Nigeria.

BACKGROUND OF THE STUDY: Low adherence is an essential element responsible for impaired effectiveness and efficiency in the pharmacological treatment of hypertension. Patient satisfaction is an important measure of healthcare quality and is a crucial determinant of patients' perspective on behavioural intention. AIMS: This study determined the association between medication adherence and treatment satisfaction among hypertensive patients attending hypertension outpatient clinic in Lagos University Teaching Hospital (LUTH), Nigeria. MATERIALS AND METHODS: Setting - The study setting was LUTH; a descriptive cross-sectional study was conducted. Study design - Hypertensive patients were consecutively recruited from the outpatient clinic. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale and treatment satisfaction was assessed using the 14-item Treatment Satisfaction Questionnaire for Medication. STATISTICAL ANALYSIS: Univariate and linear regression analyses were conducted using STATA software version 14.1 (StataCorp LP, College Station, TX, USA). Statistical significance was set at P ≤ 0.05. RESULTS: A total of 500 respondents with a mean age of 58.9 ± 13.3 years participated in the study. Overall, majority (446 [89.2%]) of the respondents in this study had 'moderate' adherence to antihypertensive medication. However, only five (1.0%) respondents reported 'high' adherence. Mean scores were highest in the moderate adherence category for all satisfaction domains and overall domain. Treatment satisfaction was associated with medication adherence, and was statistically significant (P = 0.000). CONCLUSION: One in every hundred patients had high adherence to hypertensive medication in this study, and there was a positive association between treatment satisfaction and medication adherence. Continuous patient-specific and tailored adherence education and counselling for hypertensive patients is recommended.

Malaria in pregnancy: A community-based study on the knowledge, perception, and prevention among Nigerian women.

BACKGROUND: Malaria accounts for approximately 1 million deaths annually and about 300,000 deaths in Nigeria alone. Pregnant women and their unborn babies are particularly vulnerable to the adverse consequences of malaria. This study assessed the knowledge, perception, and preventive practices for malaria in pregnancy (MiP) among women in Lagos, Nigeria. MATERIALS AND METHODS: A cross-sectional, descriptive study design was adopted. A total of 422 respondents were selected using multistage sampling technique. Data were collected using a structured, interviewer-administered questionnaire in the first quarter of 2016. Analysis was done with Epi Info™ 7 software with level of significance set at P < 0.05. RESULTS: All respondents were aware of MiP, and almost all the respondents (96.2%) were aware that malaria is caused by infected mosquito bite. Majority (89.3%) of the respondents registered for antenatal care in their last pregnancy, but 56.6% did so in the second trimester. A little over half (55.5%) had good knowledge of MiP. There was poor knowledge of the complications of MiP in mothers, with 27% unaware of any complications. Majority (51.6%) of them did not know the complications of malaria in the fetus. Better educated respondents had statistically significant better knowledge of MiP (P = 0.001). Only two-fifths of the respondents (39.8%) agreed that MiP can lead to death of the fetus. Most (41.9%) used insecticide spray and coils in the prevention of MiP, whereas only 36.9% used intermittent preventive treatment. Only 24.1% used insecticide-treated nets and almost 20% used no form of prevention. CONCLUSION: Respondents' knowledge, perception, and preventive practices for MiP were not satisfactory. Public health education on MiP should be intensified at the community level in order to improve knowledge and prevention and also to correct misconceptions.