Iron Deficiency Anemia in Nigerians with Heart Failure (IDAN-HF): Therapeutic efficacy of iron replacement: An interventional study.

BACKGROUND: Recent evidence has reported significant improvement in clinical profile, quality of life, and prognosis of heart failure subjects with iron replacement. AIMS: This study aimed to determine the safety and outcome of parenteral iron replacement among heart failure subjects in Nigeria. METHOD: A randomized interventional study was done at the Cardiology Clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria. One hundred and forty subjects with heart failure were recruited. Iron deficiency and anemia were determined according to standardized criteria. Parenteral iron dextran was administered to a block randomized group of 30 of those identified with iron deficiency and compared with controls. The primary outcome was the six minutes' walk test (6 MWT) after 8 weeks while the Kansas City Cardiomyopathy Questionnaire (KCCQ) score was used to assess the quality of life as a secondary outcome. Statistical analysis was done with the SPSS 20.0. P value <0.05 was taken as statistically significant. RESULTS: Iron deficiency was present in 84 (60.0%) of all study participants. Iron dextran was fairly tolerated with mild to moderate adverse reactions reported in 7 (23.3%) subjects who had an iron infusion. Improvement in the 6 MWT distance (390.1 ± 92.6 vs. 156.9 ± 72.5 meters, P < 0.05) and the KCCQ score (84.5 ± 3.7 vs. 64.2 ± 12.5%, P < 0.05) among iron-deficient heart failure subjects who received iron dextran was significantly higher than those who did not receive the iron replacement. Functional classification according to the New York Heart Association (NYHA) profile and heart rate were also much improved after the iron replacement than those who did not receive it. CONCLUSION: Parenteral iron dextran therapy was fairly tolerated among heart failure subjects. Iron replacement is associated with improved quality of life, better temporal clinical profile, and functional classification among Nigerians with heart failure. Iron replacement therapy can be an additional therapeutic option in heart failure management among Africans to improve prognosis.

Demographic profile of mothers and their utilisation of maternal health-care services in Osun State, Nigeria.

BACKGROUND: The provision of prenatal care and the promotion of institutional childbirth have the potential to reduce maternal and neonatal morbidity and mortality. Despite this, high maternal and infant mortality is still being recorded in the developing countries and researchers still report low utilisation of maternal health care services in different communities in Nigeria. OBJECTIVE: This study examined the current level of utilisation of maternal health care in some rural and peri-urban communities of Olorunda Local Government Areas of Osun State in South Western Nigeria. METHODS: A cross-sectional descriptive study was carried out. Researchers conducted a house-to-house survey using a semi-structured questionnaire to interview adult women who are either pregnant or already had a child before. Information was collected on demographic characteristics and utilisation of maternal health care services. RESULTS: Most of the respondents (94.8%) delivered in health care facilities with the supervision of trained health personnel. The study showed a strong influence of mother's education and economic status of the family respectively (p<0.05) on the use of maternal health care services. CONCLUSION: This study revealed a higher level of utilisation of maternal health care services in the communities under study than earlier reported in Southwestern Nigeria. Continuous and sustained community education and mobilisation is essential so that women and their families learn about the need for special care during pregnancy and childbirth under trained health personnel.

Assessment of preventive oral health knowledge and practices among rural and urban mothers in Lagos state.

AIMS AND OBJECTIVES: To evaluate students' performance and its predictors in the preclinical examinations at the College of Health Sciences, Ladoke Akintola University of Technology Ogbomoso Nigeria. MATERIALS AND METHODS: A cross section of students' records admitted into medical programme in 1999/2000 sessions was studied. RESULTS: Younger students performed consistently better than the older ones in all the three subjects taken at the MBBS1. It was also noticed that the male students performed better, a statistically significant mean difference in score was observed in Biochemistry P>0.05. Students with better Ordinary level aggregate grade of (5-15) in the five core subjects at SSCE, consistently had better results in all the subjects taken at MBBS1 examination compared to their counter-part with aggregate SSCE grade of (16-30). Students that were admitted through JAMB performed better in all the three subjects than those that were admitted through pre-degree programme and the transferred students. However, the mean difference was statistically significant P<0.05 in Biochemistry only. CONCLUSION: Better performance at MBBS1 was found in younger age group, those with aggregate grade of (5-15) in SSCE and those admitted through JAMB. Ordinary level requirement irrespective of the mode of admission should not be compromised. Schools that admit students through pre-degree, transfer or direct entry will have to be more conscious of the quality of students they admit and also operate such system with utmost transparency and with a principle of promoting good academic standard.

Predictors of students'performance in the pre-clinical MBBS programme in a Nigerian University.

AIMS AND OBJECTIVES: To evaluate students' performance and its predictors in the preclinical examinations at the College of Health Sciences, Ladoke Akintola University of Technology Ogbomoso, Nigeria. MATERIALS AND METHODS: A cross section of students' records admitted into medical programme in 1999/2000 sessions was studied. RESULTS: Younger students performed consistently better than the older ones in all the three subjects taken at the MBBS1. It was also noticed that the male students performed better, a statistically significant mean difference in score was observed in Biochemistry P<0.05. Students with better Ordinary level aggregate grade of (5-15) in the five core subjects at SSCE, consistently had better results in all the subjects taken at MBBS1 examination compared to their counter-part with aggregate SSCE grade of (16-30). Students that were admitted through JAMB performed better in all the three subjects than those that were admitted through pre-degree programme and the transferred students. However, the mean difference was statistically significant P<0.05 in Biochemistry only. CONCLUSION: Better performance at MBBS1 was found in younger age group, those with aggregate grade of (5-15) in SSCE and those admitted through JAMB ordinary level requirement irrespective of the mode of admission should not be compromised. Schools that admit students through pre-degree, transfer or direct entry will have to be more conscious of the quality of students they admit and also operate such system with utmost transparency and with also operate such system with utmost transparency and with a principle of promoting good academic standard.

Subjective assessment of childhood fever by mothers utilizing primary health care facilities in Osogbo, Osun State, Nigeria.

OBJECTIVE: To assess the accuracy of tactile examination by mothers as a method of fever determination in their children and thus determine the reliability of mothers' history about the presence or absence of fever in their children. METHODOLOGY: A descriptive cross-sectional study conducted in four health centers randomly selected in Osogbo metropolis. Three hundred mothers were studied, a semi-structured questionnaire was utilized. RESULTS: The study found the sensitivity and specificity of tactile examination for mothers as a means of detecting fever in their children to be 82.3% and 54.1% respectively. Mother's socio-demographic characteristics and the age of child did not affect mother's subjective assessment of childhood fever (p>0.05). CONCLUSION: Mothers are able to provide accurate information about the presence or absence of fever in their children by palpation without the use of a thermometer. Tactile examination was found to be adequate for mothers as a means of detecting fever in their children. Physicians should accept as reliable mothers' history of fever and give prompt management.

Refractive errors in Mercyland Specialist Hospital, Osogbo, Western Nigeria.

BACKGROUND: The study was conducted to determine the magnitude and pattern of refractive errors in order to provide facilities for its management. MATERIALS AND METHOD: A prospective study of 3601 eyes of 1824 consective patients was conducted. Information obtained included age, sex, occupation, visual acuity, type and degree of refractive error. The data was analysed using Statistical Package for Social Sciences 11.0 version) Computer Software. RESULTS: Refractive error was found in 1824(53.71%) patients. There were 832(45.61%) males and 992(54.39%) females with a mean age of 35.55. Myopia was the commonest (1412(39.21% eyes). Others include hypermetropia (840(23.33% eyes), astigmatism (785(21.80%) and 820 patients (1640 eyes) had presbyopia. Anisometropia was present in 791(44.51%) of 1777 patients that had bilateral refractive errors. Two thousand two hundred and fifty two eyes has spherical errors. Out of 2252 eyes with spherical errors, 1308 eyes (58.08%) had errors -0.50 to +0.50 dioptres, 567 eyes (25.18%) had errors less than -0.50 dioptres of whom 63 eyes (2.80%) had errors less than -5.00 dioptres while 377 eyes (16.74%) had errors greater than +0.50 dioptres of whom 81 eyes (3.60%) had errors greater than +2.00 dioptres. The highest error was 20.00 dioptres for myopia and 18.00 dioptres for hypermetropia. CONCLUSION: Refractive error is common in this environment. Adequate provision should be made for its correction bearing in mind the common types and degrees.

Tuberculosis treatment outcomes in State Hospital, Osogbo, southwestern Nigeria: a four year review.

BACKGROUND: A retrospective review of all cases of tuberculosis (TB) enrolled in the directly observed treatment-short course chemotherapy (DOT-SCC) between June 2000 and June 2004 at a General Hospital in Southwestern Nigeria was undertaken. The aim is to determine treatment outcomes and ascertain the effectiveness of the programme for TB control. METHODOLOGY: Case registers of all TB patients enrolled were reviewed and data obtained analyzed by statistical methods. RESULTS: A total of 879 TB patients (467 males, 412 females; M: F ratio 1.13:1) aged 1 to 80 years (mean age 33.0 +/- 14.0 years) were enrolled. The disease was pulmonary in 98.4% and extrapulmonary in 1.6%. Seven hundred and thirty four (83.6%) patients complied with the DOTS-SCC regimen, 127 (14.4%) defaulted while 18 (2%) transferred out. The overall treatment success rate was 76.3% while 3.8% had treatment failures. Outcome was not significantly affected by types of TB lesion (P = 0.1103), patient category (P = 0.4968), age (P = 0.7198), gender (P = 0.1726) or smear positivity (P = 0.5497). CONCLUSION: Although the currently advocated DOT-SCC regimen achieved a high success rate in this locality, it fell below the 85% recommended target. There is need to step up health education campaign on compliance with therapy and aggressively follow up defaulters to forestall the emergence of multidrug resistant M. tuberculosis.

Kidney function and clinical correlates in newly diagnosed hypertensives attending a university teaching hospital in southwest Nigeria.

Summary Hypertension is associated with development of cardiovascular and kidney complications. Low awareness of hypertension leads to late presentation and development of complications. Studies have also shown that chronic kidney disease is often undiagnosed and patients present late. In view of the aforementioned, the prevalence and clinical correlates of decreased kidney function in newly diagnosed hypertensives were assessed. The study was carried out at LAUTECH Teaching Hospital, Osogbo, Nigeria. One hundred and forty three patients satisfied the inclusion criteria. Hypertension was defined by SBP > or = 140 and/or DBP > or = 90 mm Hg. Kidney function was assessed by glomerular filtration rate (GFR) using Modification of Diet in Renal Disease (MDRD) formula. Patients with GFR < 60 mL/min were defined as having decreased kidney function. Determinants of decreased kidney function were assessed. Thirty three patients (23.1%) have decreased kidney function. On univariate analysis, age, educational status, BMI, SBP and DBP were significantly associated with decreased kidney function. After logistic regression, age and BMI were significantly associated with decreased kidney function. Decreased kidney function was present in 23.1% of the study population. These patients stand a higher risk of faster progression of kidney disease and cardiovascular complications. This finding underscores the need to improve the awareness of hypertension in the population.

Sociodemographic characteristics and health risk behaviours among students of a tertiary institution in south western Nigeria.

The identification of early risk factors among undergraduate students that impact on health, both mental and physical is a primary focus of this survey. This is more so since people suffering from an illness may not be currently engaging in any health risk behaviours but might have engaged in such behaviours before they developed the illness condition. Therefore the identification of health risk behaviours among this group of people would permit a better understanding of localized patterns of health risk behaviours as well as help to target intervention activities towards this particular group of people.The study is based upon data obtained from a cross-sectional survey of students in a tertiary institution in South Western Nigeria. Participants voluntarily and anonymously completed a baseline semistructured questionnaire which elicited information on demographic information, sexual behaviours and substance use among others. Of the 368 respondents, majority 225 (60.9%) are in the age group of 20-24 years. A total of 152 (41.3%) are either currently or have previously indulged in heavy drinking of alcohol and a statistically significant association (p<0.05) was found between the use of alcohol and having multiple sexual partners and use of commercial sex workers. Ninety-four (25.5%) and 52 (14.1%) are currently smoking or have smoked cigarette and marijuana before respectively; while 56 (15.2%) are currently using or have before used narcotic drugs. The relationship between hard drug use and non use of condom was statistically significant (p<0.05). Ninety-two (25.0%) have more than one sexual partners at the same given period; the male respondents indulged more in having multiple partners than the female and the result was statistically significant (p<0.05). As many as 155 (47.8%) of the 324 (88.0% of the respondents) sexually active respondents had never used condom during sexual intercourse. Also 88 (27.1%) of this group of the respondents have had sexual relationship with commercial sex workers (CSW) at one time or the other. Condom use was low among the sexually active respondents. Only 29.3% of the respondents always use condom when having any sexual relationship. This study has shown that students in this survey indulge in health risk behaviours such as "unsafe sexual practices", alcohol, cigarette smoking and other substance use. The males are more involved in having multiplicity of sexual partners than their female counterpart. The study also revealed a significant association between the use of alcohol and in having multiple sexual partners. Comprehensive health education and intervention programs are needed to influence positive behavioural change among this group of students and this will require working in partnership with schools authorities and other local community groups.

Anisometropia in a tropical hospital.

BACKGROUND: This was to determine the prevalence and distribution of anisometropia and to study the difference in refraction between the eyes of patients with anisometropia and look for evidence of laterality, if any. STUDY DESIGN: A prospective study of 1819 consecutive new patients seen in our clinic with no other pathology except refractive error between November 1998 and December 2002 were included in the study. Information obtained included age, sex, visual acuity, type and degree of anisometropic error. Non-parametric statistical methods were used for analysis. RESULTS: Of 1819 patients seen, 815 (44.81%) had anisometropia. There were 389 males and 426 females with a male to female ratio of 1.00 to 1.1 and a mean age of 35.15 (standard deviation 17.38). Of the 815 patients, 476 (58.40%) had spherical anisometropia and 339 (41.60%) had cylindrical anisometropia. Myopic anisometropia (253 (31.04%) was the most common. Of the spherical anisometropic errors excluding the mixed types, majority (245 (57.65%) had a difference of 0.25 dioptres and 28 (6.59%) had a difference of 2.00 dioptres and above. The highest difference of 8 dioptres was found in only one patient. The mean error degrees were higher on the left in both myopia and hypermetropia. CONCLUSION: Anisometropia is quite common in this environment. There is a tendency for the left to be higher contrary to previous findings. In order to allow for data comparison between countries and give room for the occasional high difference between eyes, it may be better to use both eyes in data analysis contrary to previous impression.

Plasma selenium concentration and glutathione peroxidase activity in HIV-1/AIDS infected patients: a correlation with the disease progression.

AIMS AND OBJECTIVES: To find a correlation, if any, between the concentration of plasma selenium and erythrocyte activity in HIV-infected patients with the progression of the disease. MATERIALS AND METHODS: Plasma selenium concentration and erythrocyte glutathione peroxidase (GSH-Px) activity were measured in 62 HIV-1 seropositive patients before commencing antiretroviral drug. Thirty (30) age-matched and apparently healthy HIV-1/11 seronegative subjects were recruited as control subjects. HIV-1 seropositive patients were classified according to the Centre for Disease Control and Prevention (CDC) Criteria. RESULTS: The mean plasma selenium concentrations of 0.53+/-0.06_mol/L and 0.71+/-0.10_mol/L were significantly reduced (P<0.001) in HIV- 1 patients with CD4+ count of <200 lym/mm3 and that of 200-499 lym/mm3 respectively when compared with the controls which is 1.01+/-0.10_mol/L. The mean erythrocyte GSH-Px activity of 15.1+/-2.4 U/g Hb and 20.7+/-3.7U/g Hb of HIV-1 seropositive patients with CD4+ count of <200 lym/mm3 and 200-499 lym/mm3 respectively were significantly reduced (P<0.001) compared with 31.5+/-4.5 U/g Hb for the control. Our results clearly show that there is reduced scavenging antioxidant i.e Selenium and GSH-Px which will lead to oxidative stress in the HIV-1 patients when compared with controls, and decrease significantly with the progression of disease, i.e. AIDS

Knowledge, attitudes and practices of the educated and non-educated women to cancer of the breast in semi-urban and rural areas of SouthWest, Nigeria.

OBJECTIVES: That women with cancer of the breast seek medical help late is a common occurrence in developing countries. We decided to see if education and environment play any role in this and in cancer screening. A semi-structured questionnaire was drawn to inquire about knowledge, attitude (beliefs) and practices of women to breast cancer and available cancer screening methods in their environment- particularly Self and Clinical Breast Examination. PATIENTS AND METHODS: The questionnaires, prepared in English and vernacular, were given to women and women relations seen in the surgical clinics and wards of Ladoke Akintola University Teaching Hospital, Osogbo and some primary health centers, for various ailments. Traders in market places and rural communities were included. RESULTS: Analysis was by SPSS, chi-square, percentage frequency and tested at probability level of 0.05. Eight hundred and thirty two respondents were collected. Six hundred and twenty five (72.2%) were from Semi-urban while 207(27.8%) were from the rural regions. The age range was between 15 and 72 years with a mean age of 30.89+/-11.58. The educational level showed that 304(36.4%) had tertiary education. Six hundred and four (72.6%) have previous knowledge of cancer of the breast, 149(17.4%) offered possible aetiological reasons, and 341(41.1%) have some knowledge of associated symptoms. Available screening methods of Self and Clinical breast examination was practised by 393(47.2%) of the respondents. One hundred and fifty five (32.3%) would give consent to mastectomy while as many as 619(74.4%) have deep fear of the disease. CONCLUSION: Despite a relatively high literate level in the study group, knowledge of aetiological causes of breast cancer, including risk factors is abysmally low; so is knowledge and attitude to symptoms. Because of this poor/inadequate knowledge, as well as available screening methods, efforts should be made to upgrade the knowledge of our women through Information, Education and Communication (I.E.C) on cancer of the Breast and the consequences of late presentation.

Cervico-vaginal foetal fibronectin: a predictor of cervical response at pre-induction cervical ripening.

CONTEXT: Not all pregnant women with an "unripe" cervix can be successfully ripened by the cervical ripening agents; therefore tests with predictive information are justified. OBJECTIVES: To examine the effect of the presence of foetal fibronectin (FFN) in the cervico-vaginal secretions on pre-induction cervical ripening with either intravaginal Misoprostol or transcervical Foley catheter. METHODOLOGY: Twenty (20) patients managed at a tertiary health institution in South-western Nigeria between March and May 2003 were randomised for cervical ripening by either intravaginal Misoprostol or Transcervical Foley catheters. Cervico-vaginal secretions were assessed for presence of FFN with Foetal Fibronectin Enzyme Immunoassay Kit (Adeza Corp.) prior to commencement of cervical ripening. MAIN OUTCOME MEASURES: FFN status, Pre-ripening and Pre-induction modified Bishop scores and duration of cervical ripening. RESULTS: Ten of the fifteen patients with positive membrane immunoassay for FFN achieved ripened cervix (modified Bishop score > or = 6) within 6 - 12 hours of exposure to the agents of cervical ripening. In the FFN negative group, only 2 of the five patients achieved ripe cervix within the >12 - 18 hours period, the rest being in the >18 - 24 hours period. CONCLUSION: Foetal fibronectin test may offer useful predictive information prior to institution of processes of cervical ripening in patients with unfavourable cervices.

Sociodemographic characteristics of anaemic gravidae at booking: a preliminary study at Llesha, Western Nigeria.

BACKGROUND: Anaemia in pregnancy is a significant cause of direct and indirect morbidity and mortality to both the pregnant mother and her fetus. The prevalence however remains undetermined in many parts of Africa. The study aims at determining the prevalence of anaemia and sociodemographic characteristics of anaemic pregnant women in a Nigerian tertiary obstetric care centre. METHODS: A cross-sectional study involving all pregnant women that registered for ante-natal care between 1st January 2001 and 30th of June 2001 in Wesley Guild Hospital Unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-lfe. RESULTS: Prevalence of anaemia among the pregnant women during the period of study was 62.2%. Two percent of the women had severe anaemia. Parity and gestational age at booking significantly influenced the prevalence of anaemia. CONCLUSION: Prevalence of anaemia among pregnant women in developing world is still unacceptably high, and it calls for improvement in standard of living for our pregnant women.

Total antioxidant status and lipid peroxidation in HIV-1 infected patients in a rural area of south western Nigeria.

Total serum antioxidant status (TAS) and lipid peroxidation were evaluated in 62 HIV-1 seropositive patients before the commencement of antiretroviral drug therapy. Twenty-four (24) age-marched and apparently healthy HIV-1 seronegative subjects were recruited as control subjects. HIV-1 seropositive patients were classified according to the Centre for Disease Control and Prevention (CDC) Criteria. The mean serum malondialdehyde (MDA) concentrations of 5.58 +/- 0.99nmol/ml and 4.24 +/- 0.80nmol/ml were significantly elevated in HIV-1 infected patients with CD4+ count of <200 lym/mm3 and that of 200-499 lym/mm3 respectively when compared with the control which is 3.37 +/- 0.56nmol/ ml (P<0.001). Whereas when compared with control, the serum MDA concentration of 3.45 +/- 0.48nmol/ml in HIV-1 patients with CD4+ count of >500 lym/mm3 was not significant (P>0.05). In the intra groups comparison serum concentration of MDA were significantly elevated when compared with each other (P<0.001). The mean serum total antioxidant status (TAS) of 1.30 +/- 0.11mmol/L, 1.12 +/- 0.24 mmol/L and 0.95 +/- 0.17mmol/L of HIV- 1 seropositive patients with CD4+ count of >500 lym/mm3, 200-499 lym/mm3 and <200 lym/mm3 respectively were significantly reduced compared with 1.69 +/- 0.23mmol/L for the control group (P<0.001). Similarly in the intra groups comparison, serum concentration of TAS were significantly reduced when compared with each other (P<0.001). The weight of 54.81 +/- 5.13 Kg for HIV-I seropositive patients with CD4+ count of <200 lym/mm3 was significantly reduced when compared with 69.17 +/- 4.38Kg for the control (P<0.05). Our results clearly show that severe oxidative stress occurs in the serum of seropositive patients in comparison with controls, and increases significantly with the progression of disease, i.e. AIDS > symptomatics > asymptomatics > controls. The inclusion of antioxidants in the therapeutic approach in managing HIV- 1 seropositive patients will prevent the additional damage that free radicals could do to such patients.

Knowledge, attitudes to HIV/AIDS and sexual behaviour of students in a tertiary institution in south-western Nigeria.

OBJECTIVE: To determine the knowledge, attitude and sexual behaviour of students in a tertiary institution in south western Nigeria with regard to HIV/AIDS. METHODS: Descriptive cross-sectional survey conducted between January and March 2005. Information was collected from 368 students of a tertiary institution in Ede, Osun State, Nigeria. Participants were selected by a multi-stage sampling method and data obtained using a semi-structured pre-tested questionnaire. RESULTS: Most (89.4%) respondents were aware of the existence of HIV/AIDS, and knew the aetiology, routes of transmission, signs and symptoms, and preventive measures against the disease. While a little over half (59.8%) of the respondents revealed that they could hug people with HIV/AIDS, one out of four (27.2%) stated that these persons should be isolated from the community. Less than a quarter (22.3%) of the respondents believed that they were vulnerable to HIV/AIDS. More than half (58.2%) had ever had sex; the mean age at their first sexual exposure (for all respondents) was 16.7 +/- 4.4 years. Almost half (48.2%) of the 191 currently sexually active respondents had multiple sexual partners. Of the sexually active respondents, 75.9% claimed to have ever used condoms; among these, male respondents were more likely to have ever used condoms than their female counterparts (p < 0.05). CONCLUSION: The study revealed a gap in the knowledge of HIV/AIDS and an inappropriate sexual behaviour among respondents. Meaningful strategies, such as an innovative and culturally sensitive adolescent sexual and reproductive health programme that focuses on modification of sexual behaviour should be adopted to allow young people to prevent transmission of the HIV/AIDS virus.