Cardiovascular risk factors and kidney function among automobile mechanic and their association with serum heavy metals in Southwest Nigeria: A cross-sectional study.

INTRODUCTION: The burden of cardiovascular disease (CVD) is huge due to its associated morbidity, mortality and adverse socio-economic impact. Environmental pollution as a risk factor contributes significantly to the burden of CVD, especially in the low and middle income countries. One of the effective strategies to reduce CVD burden is to prevent or detect cardiovascular risk factors early in at-risk population. This study determined some cardiovascular risk factors, kidney function, and their association with heavy metals among automobile mechanics. METHOD: This was a cross-sectional study involving 162 automobile mechanics and 81 age and sex matched controls. Serum levels of lead, cadmium and some cardiovascular risks were assessed and compared in the two groups. Associations between serum lead, cadmium and some cardiovascular risks were determined using correlation analysis. P value of <0.05 was taken as significant. RESULTS: The mean ages of the automobile mechanics and controls were 47.27±9.99 years and 48.94±10.34 years, respectively. The prevalence of elevated serum cadmium was significantly higher in the automobile mechanics (25.9% vs 7.9%; p = <0.001). The significant cardiovascular risk factors in the automobile mechanics vs controls were elevated total cholesterol (32.1% vs 18.5%; p = 0.017), hyperuricemia (20.4% vs 1.2%; p = <0.001), elevated blood glucose (16.0% vs 4.9% p = 0.013); and alcohol use (55.1% vs 30.0%; p = 0.001). Among the automobile mechanics, there were significant positive correlations between serum cadmium, atherogenic index of plasma (AIP) (p = 0.024; r = 0.382) and triglyceride (p = 0.020; r = 0.391). Significant positive correlation was found between serum lead and neutrophil gelatinase associated lipocalin (NGAL) (p = <0.001; r = 0.329). There were significant positive correlation between serum cadmium level, AIP (p = 0.016; r = 0.373) and TG (p = 0.004; r = 0.439); between serum lead and NGAL in all the study participants (p = 0.005; r = 0.206). CONCLUSION: Automobile mechanics have notable exposure to heavy metals and a higher prevalence of some cardiovascular risk factors. Health education and sensitisation as well as policies that would regulate exposure of persons to heavy metals should be implemented in Nigeria.

Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study.

INTRODUCTION: Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. MATERIALS AND METHODS: This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS. RESULTS: A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria. CONCLUSION: This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.

Assessment of hypertension service availability in some primary health centres in Nigeria: a mixed-methods study.

OBJECTIVE: Strengthening primary health centre (PHC) systems is a potentially effective strategy to reduce the burden of non-communicable diseases in Nigeria, a low/middle-income country with limited resources. The aim of this study was to assess hypertension service availability in some PHCs in Nigeria and seek recommendations that could facilitate improved services from PHC workers. DESIGN: Explanatory sequential mixed-methods study. SETTINGS: PHCs in the six geopolitical zones and Federal Capital City of Nigeria. PARTICIPANTS: Eighteen PHC workers and 305 PHC facilities. METHOD: Hypertension service availability and readiness were assessed in PHCs across Nigeria using a pro forma adapted from the WHO Service Readiness and Assessment tool. Eighteen workers in the PHCs were subsequently interviewed for in-depth exploration of hypertension service availability and readiness. FINDINGS: Among the 305 health facilities assessed, 96 (31.5%) were in urban, 94 (30.8%) in semiurban and 115 (37.7%) in rural local government areas. Majority of the health facilities (43.0%) were manned by community extension workers. Only 1.6% and 19.7% of the health facilities had physicians and pharmacy technicians, respectively. About 22.3% of the providers had training in hypertension in the last 1 year. All the PHCs lacked adequate supply of essential antihypertensive medications. The identified deficiencies were less common in the urban PHCs compared with others. Qualitative analysis showed that the personnel, essential facilities and medicines required to provide hypertension services in the PHCs were inadequate. Suggested recommendations to successfully provide these services were provision of performance-based incentives; adequate staffing and training; supportive supervision of staff; provision of adequate equipment and essential medicines for hypertension management; provision of conducive environment for clients; and community engagement and participation. CONCLUSION: Majority of the PHCs are currently not adequately equipped to provide hypertension services. Addressing identified gaps and using suggestions provided will guarantee successful provision of effective services.

The burden of diabetic complications in subjects with type 2 diabetes attending the diabetes clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria - a cross-sectional study.

Introduction: the increasing prevalence of diabetes (DM) worldwide has resulted in an increase in the morbidity and mortality of DM. This burden is as a result of the development of the chronic complications associated with it. This study determined the burden of occurrence of microvascular and macrovascular complications of subjects with type 2 diabetes attending the out -patient clinic of a tertiary hospital in south west Nigeria. Methods: this cross-sectional study involved 400 consecutive subjects with type 2 diabetes. A study proforma was used to document the socio demographic data. While clinical assessment for anthropometric measurement, blood pressure was done. Laboratory measurement of blood glucose control and lipids were done. Assessment of the occurrence of microvascular and macrovascular complications were performed and documented. Results: four hundred type 2 DM participants made up of 190 males and 210 females with a mean age of 60.35±9.53 years, with a mean age of 60.35(SD 9.53) years for males and 60.81(SD10.29) years for females. Median duration of DM for all subjects was 6.00(IQR 3.00 - 11.00) years. Majority (45%) of the participants were overweight. The prevalence of hypertension was 78% and poor glycaemia using HBA1C was 75.5% and 59.8% had dyslipidaemia. The occurrence of microvascular complications (diabetic neuropathy - 82%, diabetic retinopathy - 46% and diabetic nephropathy - 44%) 69.3% while macrovascular complications (peripheral arterial disease - 42.5%, stroke - 4%, electrocardiographic changes if ischaemic heart disease -9.3% and left ventricular hypertrophy - 22%) in 49%. Regression analyses showed advancing age aOR (1.18 [95%CI 1.01 - 1.38]) and waist circumference (aOR 1.17 [95% CI 1.00 - 1.36]), as significant contributors to the presence of diabetes complications. Conclusion: the risk factors of both microvascular and macrovascular complications remain high in our clinic and this is linked to the high burden of diabetes mellitus and its long duration.

Type 2 diabetes mellitus risk assessment among doctors in Ondo state.

Introduction: Diabetes Mellitus (DM) has become a disease of public health importance in Nigeria. Early identification of DM risk is important in the reduction of this disease burden. This study assessed ten-year risk of developing type 2 DM among some medical doctors in Ondo State. Methods: This was a cross-sectional study that assessed ten-year risk of developing type 2 DM among some doctors using the Finland Diabetic Risk Score form. Known diabetics were excluded from the study. Body mass index (BMI), waist circumference (WC), blood pressure and total DM risk score were determined for each participant. Results: One hundred and ninety-two doctors participated in the study with a male: female ratio of 1.3:1. Majority (92.2%) were below 55 years, 22 (11.5%) were obese, 32(16.7%) had central obesity, 46(24%) reported physical inactivity, 49(25.5%) had family history of DM, 141(73.4%) do not take fruits and vegetables regularly. Forty-three (22.4%) were found to have elevated blood pressure while 6(3.1%) had elevated blood glucose. Fifty-seven (29.7%) of the participants had increased ten-year DM risk. Significant predictors of increase DM risk were age ≥ 45 years (AOR:9.08; CI 3.13-26.33; p = <0.001); BMI ≥25kg/m2 (AOR:11.41; CI:4.14-31.45; p = <0.001); family history of DM (AOR:9.93; CI:3.25-30.39; p = <0.001); abdominal obesity (AOR:6.66; CI:2.08-21.29; p= < 0.001); and infrequent dietary intake of fruits and vegetable (AOR:3.11;CI:1.03:9.37: p = 0.04). Conclusion: There was increased 10-year DM risk in about 30% of the participants. Lifestyle modification such as physical activity and regular consumption of fruits and vegetables should be encouraged among doctors.

Perceptions of the COVID-19 vaccine and willingness to receive vaccination among health workers in Nigeria.

OBJECTIVE: The study aimed to examine health workers' perceptions of the coronavirus disease 2019 (COVID-19) vaccine in Nigeria and their willingness to receive the vaccine when it becomes available. METHODS: This multi-center cross-sectional study used non-probability convenience sampling to enroll 1,470 hospital workers aged 18 and above from 4 specialized hospitals. A structured and validated self-administered questionnaire was used for data collection. Data entry and analysis were conducted using IBM SPSS ver. 22.0. RESULTS: The mean age of respondents was 40±6 years. Only 53.5% of the health workers had positive perceptions of the COVID-19 vaccine, and only slightly more than half (55.5%) were willing to receive vaccination. Predictors of willingness to receive the COVID-19 vaccine included having a positive perception of the vaccine (adjusted odds ratio [AOR], 4.55; 95% confidence interval [CI], 3.50-5.69), perceiving a risk of contracting COVID-19 (AOR, 1.50; 95% CI, 1.25-3.98), having received tertiary education (AOR, 3.50; 95% CI, 1.40-6.86), and being a clinical health worker (AOR, 1.25; 95% CI, 1.01-1.68). CONCLUSION: Perceptions of the COVID-19 vaccine and willingness to receive the vaccine were sub-optimal among this group. Educational interventions to improve health workers' perceptions and attitudes toward the COVID-19 vaccine are needed.

Type 2 diabetes mellitus risk assessment among doctors in Ondo state

Introduction: Diabetes Mellitus (DM) has become a disease of public health importance in Nigeria. Early identification of DM risk is important in the reduction of this disease burden. This study assessed ten-year risk of developing type 2 DM among some medical doctors in Ondo State. Methods: This was a cross-sectional study that assessed ten-year risk of developing type 2 DM among some doctors using the Finland Diabetic Risk Score form. Known diabetics were excluded from the study. Body mass index (BMI), waist circumference (WC), blood pressure and total DM risk score were determined for each participant. Results: One hundred and ninety-two doctors participated in the study with a male: female ratio of 1.3:1. Majority (92.2%) were below 55 years, 22 (11.5%) were obese, 32(16.7%) had central obesity, 46(24%) reported physical inactivity, 49(25.5%) had family history of DM, 141(73.4%) do not take fruits and vegetables regularly. Forty-three (22.4%) were found to have elevated blood pressure while 6(3.1%) had elevated blood glucose. Fifty-seven (29.7%) of the participants had increased ten-year DM risk. Significant predictors of increase DM risk were age ≥ 45 years (AOR:9.08; CI 3.13-26.33; p = <0.001 ) ; BMI ≥25kg/m2 (AOR:11.41; CI:4.14-31.45; p = <0.001) ; family history of DM (AOR:9.93; CI:3.25-30.39; p = <0.001) ; abdominal obesity (AOR:6.66; CI:2.08-21.29; p= < 0.001); and infrequent dietary intake of fruits and vegetable(AOR:3.11;CI:1.03:9.37: p = 0.04) Conclusion: There was increased 10-year DM risk in about 30% of the participants. Lifestyle modification such as physical activity and regular consumption of fruits and vegetables should be encouraged among doctors.