Sexual practices and knowledge of sexually transmitted infections among hairdressers in Ibadan, Southwest Nigeria.

The environment in salons provides hairdressers the opportunity to discuss sexual exploits which may promote unhealthy sexual behaviour and increase the risk of sexually transmitted infections (STIs). The aim of the study was to determine sexual practices and knowledge and experience of STIs among hairdressers. The study was carried out in Ibadan, Southwest Nigeria. A total of 1700 hairdressers were selected by cluster sampling technique. Predictors of risky sexual behaviour, knowledge and experience of STIs were identified. Their mean age was 27.0 ± 8.1 years, 860 (50.6%) were single. Majority of them, 1453(85.5%) had ever had sex. The mean age at sexual debut was 15.9 years. Mean knowledge score of STIs was 14.0 out of 25. Only 158(9.3%) experienced symptoms of STIs in the last 12 months. Among singles, senior secondary education was a predictor of ever had sex (odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.53-3.13), good knowledge of STIs (OR: 2.04, 95% CI: 1.45-2.83) and experience of STIs in the last 12 months (OR: 2.20, 95% CI: 1.53-3.13). Hairdressers, especially singles, are a vulnerable group at risk of reproductive health morbidities. There is a need to focus reproductive health interventions on this occupational group.

Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy.

BACKGROUND: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients. OBJECTIVE: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH. MATERIALS AND METHODS: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test. RESULTS: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 ± 1.26 (normotensive control) to 7.62 ± 1.33 (hypertensive without LVH), 6.27 ± 0.99 (hypertensive with LVH) (P<0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 ± 79.1 to 411.6 ±8 2.3, 315.8 ± 75.6 respectively (P<0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P<0.003). CONCLUSION: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor.

The significance of mild renal dysfunction in chronic heart failure.

BACKGROUND: Heart failure is a major public health concern. Prediction models in heart failure have employed echo-cardiography and other advanced laboratory parameters in predicting the risk of mortality. However, most of the patients in the resource poor economies still do not have easy access to these advanced technology. OBJECTIVE: To determine the clinical and echocardiographic correlates of patients with chronic heart failure (CHF) in the presence or mild renal disease (MRD). METHODS: One hundred CHF patients were categorized based on their estimated glomerular filtration rates into either normal renal function or MRD. The clinical and echocardiographic variables of both groups were compared. RESULTS: There were 38 females and 62 males with an overall mean age of 54 years. A significantly greater proportion of patients with mild renal disease presented in New York Heart Association classes 3 and 4 (82.9% vs 27.1%). Patients with MRD had echocardiographic findings of a significantly larger left atrial dimension, lower ejection fraction and fractional shortening and shorter deceleration time. A significantly greater proportion of patients with mild renal disease also had moderate-severe mitral and tricuspid regurgitation and grades 2-3 diastolic dysfunction compared to patients without mild renal disease. Patients with MRD also exhibited a significantly greater degree of deterioration in the fractional shortening and ejection fraction compared to non-MRD patients. Multivariate regression analysis indicated that a low ejection fraction and a low fractional shortening were significantly associated with MRD. CONCLUSION: Identification of MRD in chronic heart failure patients using the estimated glomerular filtration rate is valuable in resource poor countries. The presence of MRD in CHF is associated with poor left ventricular function and increased deterioration of ventricular function.

Prediction of functional capacity during six-minute walk among patients with chronic heart failure.

BACKGROUND: Formulae for predicting functional capacity during 6-minute walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations. AIMS: The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 2 ) in Chronic Heart Failure Patients (CHF) during exercise. METHODS: Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated. RESULTS: The result showed that the distance covered was highly correlated with the VO2 (0.65, p< 0.01). The regression analysis revealed that a linear equation model developed was a good predictor of V0 2 for the group. CONCLUSION: The study concluded that in situation where sophisticated equipments are lacking, this equation might be useful during exercise supervision for patients with CHF. [VO2 (mlkg-1 min-1) = 0.0105 x distance (m) + 0.0238 age (yr) - 0.03085 weight (kg) + 5.598].

Reported occupational hazards and illnesses among hairdressers in Ibadan, Southwest Nigeria.

BACKGROUND: Hairdressers work in small scale enterprises with little or no health supervision in the workplace. OBJECTIVE: To identify workplace hazards and health problems of workers in this trade. METHODS: A cross sectional study was conducted in hairdressing salons in Ibadan, Southwest Nigeria. Questionnaires were administered to a total of 355 hairdressers by trained interviewers. Information on work conditions, workplace hazards, accidents and current illnesses was obtained. RESULTS: All respondents were females comprising 295 qualified hairdressers and 60 apprentices. They were aged 15-49 years, mean 29 +/- 6.9 years. With respect to work conditions, hairdressers complained of long working hours, poor earnings and prolonged standing. Occupational hazards identified included needles used for fixing hair attachments, 157 (44%), hair relaxing creams, 114 (32%), blades, 38 (11%), handling hot water, 16 (4%) and electrical equipment, 8 (2%). Types of accidents reported were needle pricks, cuts, accidents involving hot water and electric shock. Joint pains (21%) and low back pain (19%) were the most frequently reported illnesses among hairdressers. Hand dermatitis was reported by 5% of hairdressers. CONCLUSION: The hairdressers' work environment has predominantly mechanical and chemical hazards. Long working hours and poor earnings in a physically demanding job, as highlighted in this study are characteristic of small scale enterprises. The regulation of work conditions in this sector continues to pose a challenge to occupational health authorities in developing countries.

Prevalence of QTc prolongation in adult Nigerians with chronic heart failure.

BACKGROUND: The heart rate corrected QT interval (QTc) on the electrocardiogram (ECG) has been proposed as a risk factor for ventricular arrhythmias and death in apparently healthy populations, patients with myocardial infarction and diabetes mellitus. However, data on the significance of QTc prolongation in heart failure are scarce. OBJECTIVE: Our objective was to examine the prevalence of QTc prolongation in adult Nigerians with heart failure and its association with arrhythmias. METHODS: Ninety consecutive patients with heart failure were recruited along with 90 age-and sex-matched controls. All the subjects had a 12-lead ECG and a rhythm strip (lead II). The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using a 2D guided m-mode and Doppler echocardiogram respectively. RESULTS: The mean age of the patients was 51.9 (16) years compared with 50.3 (15.2) years for the control group, p = 0.47. Mean left ventricular ejection fraction was significantly lower in the patients than in the controls (38.9 (11)% versus 72.2 (8)%), p = 0.001. The mean QTc was significantly prolonged in the patients than in the controls (0.472 (0.036) versus 0.390(0.032) respectively), p = 0.001. The prevalence of QTc prolongation was 63% in the patients against 4.4% in the controls. There was a significant association between ventricular arrhythmias and QTc prolongation. CONCLUSION: The results of this study shows that there is a high prevalence of QTc prolongation in adult Nigerians with heart failure and this may be harbinger for ventricular arrhythmias and sudden death.

Prognostic significance of QT interval prolongation in adult Nigerians with chronic heart failure.

BACKGROUND AND OBJECTIVES: Prognostic survival studies for heart-rate corrected QT interval in patients with chronic heart failure are few; although these patients are known to have a high risk of sudden cardiac death. This study was aimed at determining the mortality risk associated with prolonged QTc in Nigerians with heart failure. MATERIALS AND METHOD: Ninety-six consecutive patients with heart failure were recruited with 90 age and sex-matched controls. All the subjects had a 12-lead electrocardiogram at a paper speed of 25 mm/sec and a rhythm strip (lead II) at 50 mm/sec. The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using 2D guided M-mode and Doppler echocardiogram respectively. They were followed-up for six months. RESULTS: Ninety-one patients and 90 controls completed the study. Five patients were lost to follow-up. The mean age (51.9 +/- 16 years) of the patients was similar to that of the controls (50.3 +/- 15) (P = 0.475). Twenty-eight (30.8%) patients died after 6 months of follow-up against none of the controls. The mean QTc was significantly longer in the non-survivors (0.494 +/- 0.027) than in the survivors (0.462 +/- 0.035) (P = 0.0001). The percentage mortality in patients with prolonged QTc against those with normal QTc was 41% and 14% respectively (P = 0.001). In the stepwise regression analysis, QTc was an independent predictor of mortality (R = 0.412, R2 = 0.17, P= 0.001). CONCLUSION: QTc prolongation is a predictor of mortality in CHF and may be an important adjunct in risk stratification of patients with heart failure.

Work conditions and health problems of female traders in Ibadan, Nigeria.

This descriptive cross-sectional survey was conducted among all the female traders in Sango market, Ibadan in, April 2003. The aim of the study was to identify the common health problems of women traders in Sango and their work conditions. The most commonly reported health problems were muscular and joint pains by 105 (37.4%), 95 (33.8%) had symptoms suggestive of malaria and 66 (23.5%) had chronic low back pain. The prevalence of muscular and joint pain was highest among respondents aged > 60yrs (p=0.023), and among those who spent eight to ten hours per day in the market (p=0.200). On examination 56 (19.9%) were hypertensive, 88 (31.3%) and 97 (16.7%) were overweight and obese respectively. The prevalence of hypertension was associated with increasing age and obesity (p=0.000). The common health problems among these female traders were muscular and joint pain, symptoms suggestive of malaria, chronic low back pain and hypertension. It is recommended that appropriate health interventions be instituted to address these problems.

Right ventricular systolic function in hypertensive heart failure.

BACKGROUND: Heart failure (HF) is a major cause of cardiovascular admissions and hypertensive heart failure (HHF) is the most common cause of HF admissions in sub-Saharan Africa, Nigeria inclusive. Right ventricular (RV) dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters. METHODOLOGY: One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls. All study participants gave written informed consent, and had a full physical examination, blood investigations, 12-lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults. This included tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI), and RV systolic excursion velocity by tissue Doppler (S'). RESULTS: RV systolic dysfunction was found in 53% of subjects with HHF by TAPSE, 56% by RV MPI, and 48% by tissue Doppler systolic excursion S'. RV systolic dysfunction increased with reducing left ventricular ejection fraction (LVEF) in subjects with HHF. CONCLUSION: A high proportion of subjects with HHF were found to have RV systolic functional abnormalities using TAPSE, RV MPI, and RV S'. Prevalence of RV systolic dysfunction increased with reducing LVEF.

Echocardiographic Assessment of Cardiac Changes During Normal Pregnancy Among Nigerians.

BACKGROUND: Pregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women. MATERIALS AND METHODS: Echocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of <0.05 was considered significant. RESULTS: The mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19-44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e' velocity at the septal margin but a progressive increase in a' velocity were also observed (P < 0.05). CONCLUSION: Cardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

Regression of left ventricular hypertrophy in patients with hypertension.

Left ventricular hypertrophy is an ominous prognostic factor for all the cardiovascular complications of hypertension. Treatment has undoubtedly improved the outlook, particularly in patients with congestive cardiac failure. It has recently been shown that the hypertrophy process itself can be regressed by control of hypertension. The principal factor of importance in this regression process is the fall in blood pressure. Although experimental studies suggest that the renin-angiotensin-aldosterone (RAA) system and the sympathetic nervous system (SNS) both play a role in regression, clinical studies in this regard are suggestive but not conclusive. Left ventricular function appears well preserved with the control of blood pressure and parallel reduction in pressure and left ventricular mass is likely to have no adverse effect on myocardial perfusion. The implications of regression of hypertrophy and the patient's long term prognosis have not yet been determined.

Sustained beneficial effects of enalapril in Africans with congestive heart failure.

A single blind, placebo controlled, dose-ranging 3 month study of the effects of enalapril on cardiovascular parameters, clinical status and self-paced exercise capacity was undertaken in 12 Nigerians with chronic heart failure. Enalapril exerted only a modest reduction in blood pressure and heart rate but significantly improved functional capacity (P less than 0.01), and prolonged self-paced exercise time (P less than 0.05) compared to the placebo baseline. The pressure rate product and the double product corrected for exercise time, an index of myocardial oxygen demand, exhibited a significant and sustained reduction on enalapril treatment (P less than 0.01). Concentration of sodium in the serum was significantly increased (P less than 0.05) but concentrations of potassium and creatinine were unaltered. These results demonstrate the sustained efficacy of enalapril in black Africans with heart failure and indicate no important racial difference in the response to inhibition of angiotensin converting enzyme in congestive heart failure.

Concurrent alpha 1 adrenergic blockade and angiotensin converting enzyme inhibition in the treatment of congestive heart failure.

We tested the hypothesis that concurrent inhibition of the renin angiotensin system by enalapril (5 mg) and the sympathetic nervous system by alpha 1 adrenergic blockade (prazosin 1 mg) will be superior to enalapril alone in 17 patients with heart failure on standard therapy, in a single blind, placebo-controlled, randomized parallel group study for 4 weeks. Enalapril alone induced a significant increase in exercise time from 499 +/- 412 s to 707 +/- 608 s (P < 0.05, ANOVA), but the increase induced by the enalapril + prazosin combination was significantly greater (P < 0.025, MANOVA) from 214 +/- 271 to 1007 +/- 784 s as was the increase in creatinine clearance (P < 0.05).

Spectrum of treadmill exercise responses in Africans with normotension, essential hypertension and hypertensive heart failure.

Hypertension is an important and common risk factor for cardiovascular morbidity and mortality in Africans. In Africans, hypertension carries a more dismal prognosis for target organ damage. We therefore studied the influence of blood pressure on treadmill exercise performance in normotensives, hypertensives and patients with hypertensive heart failure, matched for age and sex. The spectrum of response was a progressive diminution of the systolic rise in blood pressure during exercise, exercise-induced tachycardia, exercise time, and maximal oxygen intake. There was an increase in functional aerobic impairment with a rank order from normotensives to WHO I hypertensives, then WHO II, with a non-linear extreme rise with the onset of heart failure. The results indicate that impaired exercise performance in African hypertensives occurs with the onset of ventricular hypertrophy, and that this is accentuated by the neuroendocrine response in congestive heart failure.

Correlation among radiologic, echocardiographic indices and self paced-exercise capacity in heart failure.

We investigated the relationships between the cardiothoracic ratio, M-mode echocardiographic indices and symptom-limited, self-paced exercise tolerance in 8 Nigerian patients with chronic stable congestive heart failure. Left ventricular diastolic dimension was inversely related to exercise duration; thus: log exercise time (sec) = 6.142-0.057x (r2 = 0.83, P less than 0.05), but was directly correlated to an index of myocardial oxygen demand, the ratio of the pressure rate product (PRP) to the exercise time; thus: log PRP/exercise time = 0.073x-3.04 (r2 = 0.87, P less than 0.05). These preliminary findings need extensive confirmatory evidence.

An audit of emergency echocardiography in a district general hospital.

Eighty patients (43 M, 37 F), aged 23-89 years who were referred for emergency echocardiography over a 12-month period were prospectively studied in order to determine the reasons for emergency echocardiography and the influence of its results on patient management. The most frequent emergency request was to clarify whether the basis for cardiomegaly in a haemodynamically unstable patient was pericardial effusion or left ventricular dilatation. Other reasons for requests were for assessment for source of systemic emboli, acute complications of myocardial infarction, endocarditis, valve dysfunction and cardiac trauma. As a consequence of the emergency echocardiography, management was immediately influenced in 19 patients. This study has provided information on the specific settings in which emergency echocardiography can be justified.

Influence of parental socioeconomic status on casual blood pressures of Nigerian school children.

The purpose of this study was to determine the effect of parental socioeconomic status on blood pressures of Nigerian school children. The weight, height, blood pressure and heart rate of 807 school children in Ile-Ife, Nigeria were measured. The subjects' ages ranged between 8 and 20 years. The subjects were classified into three (lower, middle and upper) groups based on the socioeconomic status of their parents. The findings revealed that parental socioeconomic status has no effect on the systolic and diastolic pressure, heart rate, rate pressure product and pulse pressure of Nigerian children. We found the 95th centile blood pressure to be 133/92 mm Hg. If the 95th centile is considered the diagnostic criteria for hypertension, then Nigerian children with sustained blood pressure in excess of 133/92 mm Hg should be investigated.

Serum albumin levels and intraethnic variations in susceptibility to a seasonal ataxia in Nigerians.

A seasonal ataxic syndrome occurs annually, predominantly among the Ijeshas of Western Nigeria, characterized by intention tremors, cerebellar ataxia, nystagmus, and varying levels of impaired consciousness. There are evidences for intraethnic variations in susceptibility to the ataxic syndrome among the Ijeshas. The reasons for such intraethnic variations in susceptibility are unclear. To test the notion that the protein nutritional status of individuals may presage susceptibility to disease, we have undertaken a controlled study of serum albumin levels as an index of protein nutriture in patients presenting with the disease. Our study shows that the mean serum albumin level in susceptible individuals on admission was significantly lower than at discharge (Mann-Whitney test: P = .0019), was significantly lower than in controls (P = .0004), and was in no single case higher than 34 g/L (laboratory reference value 35 to 50 g/L). These results imply that the protein nutriture of individuals predicts susceptibility to the seasonal ataxia.

A three year clinical review of the impact of angiotensin converting enzyme inhibitors on the intra hospital mortality of congestive heart failure in Nigerians.

Angiotensin converting enzymes inhibitors are now regarded as the cornerstone of congestive heart failure therapy owing to established reduction in mortality and the symptomatic amelioration following their use. Although the response to converting enzyme inhibitor therapy may be influenced by race, we have reported a trend to reduce intra hospital mortality, the correction of hyponatremia and shortened hospitalization in Nigerians treated with converting enzyme inhibitors. We have now conducted an extended retrospective study, to evaluate the trends in the use of enalapril or captopril and its impact on prognosis in Nigerian patients with heart failure alone, admitted between January 1992 to December 1994. The proportion of heart failure treated with (captopril or enalapril) increased from 37pc in 1992, to 50pc in 1993, to 65pc in 1994. The demographic variables and cause of heart disease were similar in patients treated with converting enzyme inhibitors (n = 55) and those treated conventionally (n = 36). The cumulative mortality among converting enzyme inhibitors treated patients, was (8/55, 14pc) compared to patients not treated (17/36, 48pc) x2 = 12.4; p < 0.0001. There was no sex predilection in mortality (M = 25pc, F = 28pc, mean 27pc). However, initial serum Na+,125mmol was significantly (x2 = 11.1; p < 0.001) more common in the dead patients, 25pc compared to the survivors discharged home 7.5pc. The median hospital stay was 17 days in captopril treated survivors (range two to 44 days) and 19 days (range four to 67 days) in conventionally treated patients. Thus converting enzyme inhibitor therapy may reduce intra hospital mortality in Black Africans hospitalized for congestive heart failure and shorten hospital stay, despite the epidemiologically low plasma renin in Blacks. Hyponatremia may be a poor prognostic index in heart failure in our patients, and its reversal by converting enzyme inhibitors may reflect neurohormonal inhibitor. Earlier and more wide spread use of angiotensin converting enzyme inhibitors in Nigerian and Black Africans with chronic heart failure is now clearly indicated.

Cardiovascular responses to exercise in essential hypertension.

Cardiovascular responses to treadmill exercise were studied using the Bruce protocol in 40 patients with essential hypertension (20 males; 20 females) and 36 normotensive controls (20 males; 16 females) with similar age, level of habitual physical activity, smoking and alcohol habits. Maximal heart rate (MHR) was significantly lower in hypertensives than normotensives but there was no significant difference when treated were compared with untreated male hypertensives. Rest -maximal change in heart rate (delta HR) was lower in hypertensives than normotensives (males P less than 0.02). The blood pressure (BP) response was significantly higher in hypertensives than normotensives and in untreated than treated hypertensive males. The delta SBP was not significantly different in hypertensives and normotensives. The mean PRP max was significantly higher in male hypertensives than normotensives, lower in treated vs untreated male hypertensives; similar in treated hypertensives and normotensives and also in female hypertensives (mainly a treated group) compared with controls. The cardiovascular responses to exercise in the hypertensive population studied were significantly different from normotensives. The benefit of treatment of hypertensives is further emphasized by the reduction in blood pressure response to exercise and the reduced myocardial oxygen consumption during maximal exercise.