Health-related quality of life in asthma measured by the World Health Organization brief questionnaire (WHO-BREF) and the effect of concomitant allergic rhinitis-A population-based study.

BACKGROUND AND OBJECTIVE: The impact of allergic rhinitis (AR), a common comorbidity in asthma, on global quality of life (QoL) using generic QoL questionnaires has not been extensively evaluated. METHODS: This was a cross-sectional population-based study among adults ≥18 years old. Generic QoL was measured using the World Health Organization (WHO) questionnaire (WHOQOL-BREF), and asthma control was assessed using the Asthma Control Test. Participants were categorized into four groups: Group 1 (No asthma, no AR), Group 2 (Asthma only), Group 3 (AR only) and Group 4 (Concomitant asthma and AR). The student t-test or the ANOVA was used for comparison between groups and based on the level of asthma control. Linear regression was used to assess the association between the level of asthma control and QoL scores, adjusted for age and sex. A p-value of less than 0.05 was considered significant for all associations. RESULTS: There were 9115 participants; 906 (9.9%) had asthma, and 1998 (21.9%) had AR. The lowest QoL scores were in the environment domain. Mean QoL scores were significantly lower in asthma compared to 'no asthma' and in AR compared to 'no AR'. Either asthma or rhinitis (Group 2 or 3) had significantly lower scores compared to no disease (Group 1) only in the environment domain, but the concomitant disease (Group 4) had lower scores across all categories and domains. Scores were significantly lower for uncontrolled asthma compared to controlled asthma and for 'concomitant asthma and AR' compared to 'asthma only'. Increasing age and uncontrolled asthma predicted worse health-related quality of life (HRQoL) consistently. CONCLUSION: Although asthma and AR negatively impact HRQoL independently, concomitant asthma and AR are worse. Uncontrolled asthma underpins poor QoL in asthma because QoL is not impaired in controlled disease. This underscores the need for recognition and treatment of AR in asthma and reinforces the benefits of achieving asthma control as a priority in asthma treatment.

The prevalence of asthma and allergic rhinitis in Nigeria: A nationwide survey among children, adolescents and adults.

PURPOSE: Asthma is an important cause of morbidity and mortality worldwide and information on the prevalence of asthma in Nigeria is inconsistent. Nationally representative data, important for health planning is unavailable. We aimed to determine the current prevalence of asthma and allergic rhinitis in Nigeria. MATERIALS AND METHODS: A cross-sectional population survey conducted between June 2017 and March 2018 across five cities representing five geo-political zones in Nigeria. Validated screening questionnaires were used to identify persons with asthma and allergic rhinitis respectively. Asthma was defined as physician diagnosed asthma, clinical asthma and by presence of wheeze in the last 12 months respectively. Socio-demographic information, tobacco smoking, sources of household cooking fuel were also obtained. RESULTS: A total of 20063 participants from 6024 households were screened. The prevalence (95% confidence interval) of physician diagnosed asthma, clinical asthma and wheeze was 2.5% (2.3-2.7%), 6.4% (6.0-6.64%) and 9.0% (8.6-9.4%) respectively. The prevalence of allergic rhinitis was 22.8% (22.2-23.4%). The prevalence of asthma and rhinitis increased with age (prevalence of clinical asthma: 3.1% (2.8-3.4%), 9.8% (9.1-10.5) and 10.7% (9.4%-12.0) among 6-17 years, 18-45 years and >45 years respectively). Prevalence also varied across different cities with the highest prevalence of clinical asthma occurring in Lagos (8.0%) and the lowest in Ilorin (1.1%). The frequency of allergic rhinitis among persons with clinical asthma was 74.7%. Presence of allergic rhinitis, family history of asthma, current smoking and being overweight were independent determinants of current asthma among adults. CONCLUSION: The prevalence of asthma and allergic rhinitis in Nigeria is high with variabilities across regions and age groups. The number of persons with clinical asthma in Nigeria (approximately 13 million) is likely to rank among the highest in Africa. This warrants prioritization by stakeholders and policy makers to actively implement risk reduction measures and increase investment in capacity building for the diagnosis and treatment of asthma and allergic rhinitis.

Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine.

BACKGROUND: Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). METHODS: From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. RESULTS: A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. CONCLUSIONS: Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.

Asthma management and control in Nigeria: the asthma insight and reality Nigeria (AIRNIG) study.

Background: The state of asthma management and asthma control at the population level in Nigeria is unknown. We aimed to determine the level of asthma control and asthma management practices in Nigeria. Methods: A cross-sectional population-based study of 405 participants with current asthma (physician-diagnosed with use of asthma medication or asthma symptoms in the preceding 12 months). We determined the level of asthma control, self-perception of asthma control, health-care use, missed work/school, and medication use. Results: Asthma was controlled in 6.2% of the participants. Night-time awakening and limitation in activity in the preceding 4 weeks were reported by 77.5% and 78.3%, respectively, 56.3% and 14.1% missed work/school and had emergency room visits, respectively, and 11.6% and 38.8% used inhaled corticosteroid and short-acting beta-2 agonist, respectively, in the preceding year. About a third (34.3%) had spirometry ever performed and 46.7% had training on inhaler technique. Nearly 90% with uncontrolled asthma had self-perception of asthma control between somewhat and completely controlled. Conclusion: The level of asthma control in Nigeria is poor with a high burden of asthma symptoms and limitation in activities. This calls for a broad-based approach for the improvement in asthma care that encompasses education and access to medications.

Impact of Operational Definitions on the Predictors and Prevalence of Asthma Estimates: Experience from a University Students' Survey and Implications for Interpretation of Disease Burden.

BACKGROUND: Inconsistent operational definitions during asthma surveillance can lead to inaccurate estimation of disease burden and formulation of health policy. This study aimed to evaluate the impact of different definitions on the prevalence estimates and predictors of asthma among university students in Ilorin, Nigeria. The secondary aim was to compare level of agreement of the different definitions. METHODS: This cross-sectional study was carried out from June to August 2015. The European Community Respiratory Health Survey (ECRHS) questionnaire was self-administered by 1485 students. Asthma diagnosis was based on five definitions used in previous studies in the country. These were ECRHS, International Study of Asthma, Allergies in Childhood (ISAAC), Probable, Modified ECRHS and Modified Probable asthma definitions. RESULTS: The prevalence rates varied from 10.4 to 24.1% depending on the definition. Prevalence obtained by using ECRHS definition significantly differed from estimates by other definitions (Z score ≥ 1.96 p<0.0001) except modified probable asthma. Identified predictors of asthma varied from five to six depending on the definition, and their strength also differed by definition. Regardless of the definition, reported nasal allergy, skin allergy, family history of nasal allergy, asthma and parental smoking were the predictors of asthma. The Kappa statistics demonstrated a fair to almost perfect association between the ECRHS and other asthma definitions (Kappa = 0.334-0.841, p < 0.001). CONCLUSION: The prevalence rates and predictors of asthma are affected by operational definitions. Researchers need to adopt a uniform definition for accurate estimation of disease burden, international comparison of result and formulation of prevention policy.

The effect of health insurance and health facility-upgrades on hospital deliveries in rural Nigeria: a controlled interrupted time-series study.

BACKGROUND: Access to quality obstetric care is considered essential to reducing maternal and new-born mortality. We evaluated the effect of the introduction of a multifaceted voluntary health insurance programme on hospital deliveries in rural Nigeria. METHODS: We used an interrupted time-series design, including a control group. The intervention consisted of providing voluntary health insurance covering primary and secondary healthcare, including antenatal and obstetric care, combined with improving the quality of healthcare facilities. We compared changes in hospital deliveries from 1 May 2005 to 30 April 2013 between the programme area and control area in a difference-in-differences analysis with multiple time periods, adjusting for observed confounders. Data were collected through household surveys. Eligible households ( n = 1500) were selected from a stratified probability sample of enumeration areas. All deliveries during the 4-year baseline period ( n = 460) and 4-year follow-up period ( n = 380) were included. FINDINGS: Insurance coverage increased from 0% before the insurance was introduced to 70.2% in April 2013 in the programme area. In the control area insurance coverage remained 0% between May 2005 and April 2013. Although hospital deliveries followed a common stable trend over the 4 pre-programme years ( P = 0.89), the increase in hospital deliveries during the 4-year follow-up period in the programme area was 29.3 percentage points (95% CI: 16.1 to 42.6; P < 0.001) greater than the change in the control area (intention-to-treat impact), corresponding to a relative increase in hospital deliveries of 62%. Women who did not enroll in health insurance but who could make use of the upgraded care delivered significantly more often in a hospital during the follow-up period than women living in the control area ( P = 0.04). CONCLUSIONS: Voluntary health insurance combined with quality healthcare services is highly effective in increasing hospital deliveries in rural Nigeria, by improving access to healthcare for insured and uninsured women in the programme area.

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures.

OBJECTIVES: Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. METHODS: A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. RESULTS: The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. CONCLUSIONS: Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs-particularly women and the poor-forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower quality care, while their expenditures represent a higher share of their annual household consumption. This calls for targeted interventions that enhance health care accessibility and provide financial protection from the consequences of NCCDs, especially for vulnerable populations.

Tuberculosis, before and after Antiretroviral Therapy among HIV-Infected Children in Nigeria: What Are the Risk Factors?

INTRODUCTION: In Nigeria, there is a dearth of pediatric data on the risk factors associated with tuberculosis (TB), before and after antiretroviral therapy (ART). METHODOLOGY: A retrospective observational cohort study, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. TB was noted among children less than 15 years of age at ART enrolment (prevalent TB-PrevTB), within 6 months (early incident tuberculosis-EITB) and after 6 months (late incident tuberculosis-LITB) of a 12-month follow-up on ART. Potential risk factors for PrevTB and incident TB were assessed using the multivariate logistic and Cox regression models respectively. RESULTS: Among 368 HIV-1 infected children, PrevTB was diagnosed in 73 children (19.8%). Twenty-eight EITB cases were diagnosed among 278 children over 132 person-years (py) with an EITB rate of 21.2/100 py. Twelve LITB cases were seen among 224 children over 221.9 py with a LITB rate of 5.4/100 py. A significant reduction in the incidence rates of TB was found over time (75%, p˂ 0.001). Young age of children (12-35 months, aOR; 24, 95% CI; 4.1-146.6, p ˂ 0.001; 36-59 months, aOR;21, 95%CI;4.0-114.3, p ˂ 0.001); history of TB in children (aOR; 29, 95% CI; 7.3-119.4, P˂ 0.001); severe immunosuppression (aOR;38, 95% CI;12-123.2,p ˂ 0.001); oropharyngeal candidiasis (aOR;3.3, 95% CI; 1.4-8.0, p = 0.009) and sepsis (aOR; 3.2, 95% CI;1.0-9.6, p = 0.043) increased the risk of PrevTB. Urban residency was protective against EITB (aHR; 0.1, 95% CI; 0.0-0.4, p = 0.001). Virological failure (aHR; 4.7, 95% CI; 1.3-16.5, p ˂ 0.001) and sepsis (aHR; 26, 95% CI; 5.3-131.9, p ˂ 0.001) increased the risk of LITB. CONCLUSIONS: In our cohort of HIV-infected children, a significant reduction in cases of incident TB was seen following a 12-month use of ART. After ART initiation, TB screening should be optimized among children of rural residency, children with sepsis, and those with poor virological response to ART.

HIV-free survival according to the early infant-feeding practices; a retrospective study in an anti-retroviral therapy programme in Makurdi, Nigeria.

BACKGROUND: In Nigeria, reports of the outcomes of prevention of mother to child transmission of HIV (PMTCT) interventions had been limited to the MTCT rates of HIV, with no information on HIV-free survival (HFS) in the HIV-exposed infants over time. METHODS: A retrospective study between June 2008 and December 2011 at the Federal Medical Centre, Makurdi, Nigeria comparing HFS rates at 3 and 18 months according to the infant feeding pattern at the 6th week of life. HFS was assessed by Kaplan-Meier analysis and association of maternal and infant variables and risk of HIV acquisition or death was tested in a Cox regression analysis. RESULTS: 801 HIV uninfected infants at 6 weeks of life were studied in accordance with their reported cumulative feeding pattern. This includes 196 infants on exclusive breast feeding (EBF); 544 on exclusive breast milk substitute (EBMS) feeding and 61 on mixed feeding (MF). The overall HFS was 94.4% at 3 months and this declined significantly to 87.1% at the 18 months of age (p-value=0.000). The infants on MF had the lowest HFS rates of 75.7% at 3 months and 69.8% at 18 months. The HFS rate for infants on EBF was 97.4% at 3 months and 92.5% at 18 month whilst infants on EBMS had HFS of 99.1% at 3 months and 86.2% at 18 months. A higher and significant drop off in HFS at the two time points occurred between infants on EBMS (12.9%) compared to infants on EBF (4.9%), p-value of 0.002, but not between infants on MF (5.9%) and EBMS, p-value of 0.114 and those on MF and EBF, p-value of 0.758. In Cox regression multivariate analyses; MF, gestational age of ˂37 weeks, and a high pre-delivery maternal viral load were consistently associated with HIV infection or death at 3 months and 18 months (p˂.05). CONCLUSION: For a better HFS in our setting; MF must be avoided, efforts to deliver babies at term in mothers with reduced viral load are advocated and EBF must be promoted as the safest and the most feasible mode of infant-feeding.

Malaria Parasitaemia among Blood Donors in Ilorin, Nigeria.

BACKGROUND: The prevalence of malaria parasitaemia among blood donors in Ilorin has not been documented. In this study, we determined the prevalence of malaria parasitaemia among blood donors in Ilorin, as well as, the sociodemographic and other factors associated with it. METHOD: This was a hospital-based cross sectional study involving 308 consenting blood donors. The sociodemographic characteristics of participants as well as blood donation history were obtained using structured questionnaires specifically designed for this purpose. Giemsastained thick and thin blood films to identify malaria parasites were performed using standard method. ABO blood grouping and haemoglobin electrophoresis tests were also done using standard methods. RESULTS: The prevalence of malaria parasitaemia among blood donors in Ilorin was 27.3%. The parasite species found were more of Plasmodium falciparum(85.7%) than Plasmodium malariae(14.3%) . There was no age or sex difference in malaria parasitaemia. (p-value of 0.8 and 0.32 respectively). A greater proportion of blood group O individuals had malaria parasitaemia than groups A and B but this difference was not significant (p-value = 0.13). There was also no significant difference among haemoglobin genotypes. CONCLUSION: The prevalence of malaria parasites among blood donors in Ilorin is considerably high and lack of routine screening of blood puts recipients at risk. We recommend that routine screening for malaria parasites be commenced in our blood banks. Treatment of donor blood with riboflavin and UV light to inactivate malaria parasites and other infectious pathogens before they are transfused to patients may also be considered in our blood banks.

The relationship between obesity and peripheral arterial disease in adult Nigerian diabetics.

AIMS AND OBJECTIVES: The aim was to identify any relationship between obesity and peripheral arterial disease (PAD) in diabetic subjects. SUBJECTS AND METHODS: Male and female diabetic subjects aged 50-89 years. Body mass index (BMI) was used to estimate total body weight and the waist-to- hip ratio (WHR) as well as waist circumference (WC) were used for abdominal fat distribution estimation. Peripheral arterial disease was defined by an ankle brachial index <0.9. RESULTS: Peripheral arterial disease (PAD) was observed in 52.5% of the subjects. BMI, WHR and WC did not correlate with PAD. CONCLUSION: None of the parameters (i.e BMI, WHR and WC) used to assess the relationship between obesity and PAD was found to correlate with PAD.