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BACKGROUND: Despite the huge burden of sickle cell disease (SCD) among Nigerian children, the burden and outcome of respiratory illnesses remain undocumented. Thus, we aimed to describe the spectrum and outcome of respiratory illnesses among SCD childrenand adolescentadmissions in ten Nigerian tertiary hospitals. METHOD: A retrospective review of the SCD admission records of children and adolescents with a confirmed diagnosis of respiratory illnesses from 2012 to 2021 in ten tertiary health facilities across five geopolitical zones in Nigeria was conducted. The data, collectedbetween March and June 2023, included the age, sex, diagnosis, complications, duration and outcome of hospitalization. RESULTS: Of the 72,333 paediatric admissions, 7,256 (10.0%) had SCD; the proportion of SCD from the total admission ranged from 2.1 to 16.3% in the facilities. Of the 7,256 children and adolescents with SCD, 1,213 (16.7%) had respiratory morbidities. Lower respiratory disease was the most common (70.0%) respiratory entity and the majority were pneumonia (40.1.0%), followed by acute chest syndrome (26.7%). Seventeen (1.4%) patients died; all had lower respiratory diseases [(acute chest syndrome ACS (11, 64.7%), pneumonia; 5, 29.4%, and asthma (1, 5.9%). Based on the proportion of deaths among overall SCD, the 17 death cases contributed 9.4% (95% CI 5.9 to 14.5). Factors associated with deaths included duration of hospitalization less than 72 hours and lower respiratory tract diseases. CONCLUSION: Sickle cell disease is a major contributor to hospitalization among Nigerian children and adolescents, with high respiratory morbidity and mortality. Pneumonia and acute chest syndrome were associated with mortality, andthe highest risk of death within the first 72 hours.
Subject(s)
Anemia, Sickle Cell , Tertiary Care Centers , Humans , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/epidemiology , Adolescent , Child , Nigeria/epidemiology , Male , Female , Retrospective Studies , Tertiary Care Centers/statistics & numerical data , Child, Preschool , Infant , Hospitalization/statistics & numerical data , Respiratory Tract Diseases/epidemiology , Acute Chest Syndrome/epidemiology , Cost of IllnessABSTRACT
BACKGROUND: Recent reports of artemisinin partial resistance from Rwanda and Uganda are worrisome and suggest a future policy change to adopt new anti-malarials. This is a case study on the evolution, adoption, and implementation of new anti-malarial treatment policies in Nigeria. The main objective is to provide perspectives to enhance the future uptake of new anti-malarials, with an emphasis on stakeholder engagement strategies. METHODS: This case study is based on an analysis of policy documents and stakeholders' perspectives drawn from an empirical study conducted in Nigeria, 2019-2020. A mixed methods approach was adopted, including historical accounts, review of programme and policy documents, and 33 qualitative in-depth interviews and 6 focus group discussions. RESULTS: Based on policy documents reviewed, the adoption of artemisinin-based combination therapy (ACT) in Nigeria was swift due to political will, funding and support from global developmental partners. However, the implementation of ACT was met with resistance from suppliers, distributors, prescribers, and end-users, attributed to market dynamics, costs and inadequate stakeholder engagement. Deployment of ACT in Nigeria witnessed increased developmental partner support, robust data generation, ACT case-management strengthening and evidence on anti-malarial use in severe malaria and antenatal care management. A framework for effective stakeholder engagement for the future adoption of new anti-malarial treatment strategies was proposed. The framework covers the pathway from generating evidence on drug efficacy, safety and uptake; to making treatment accessible and affordable to end-users. It addresses which stakeholders to engage with and the content of engagement strategies with key stakeholders at different levels of the transition process. CONCLUSION: Early and staged engagement of stakeholders from global bodies to community level end-users is critical to the successful adoption and uptake of new anti-malarial treatment policies. A framework for these engagements was proposed as a contribution to enhancing the uptake of future anti-malarial strategies.
Subject(s)
Antimalarials , Artemisinins , Malaria , Pregnancy , Female , Humans , Antimalarials/therapeutic use , Nigeria , Stakeholder Participation , Malaria/drug therapy , Malaria/prevention & control , Artemisinins/therapeutic useABSTRACT
Background and Purpose: Exposure to heavy metals (HMs) in indoor dusts is a serious public concern that is linked to a myriad of deleterious health outcomes. The objectives of this study are to estimate the contamination levels of HMs in indoor dusts of different residential areas in Ilorin, Nigeria; identify HMs sources in different residential areas; and evaluate human health risks of HMs in selected residential areas. Methods: Indoor dust sampling was conducted in ten randomly selected from low, medium and high population density residential areas of Ilorin, Nigeria. Ten HMs concentration levels, their health risk implication and the associated potential ecological risks were evaluated. Results: The mean concentration levels measured for Fe, Pb, Zn, As, Co, Cr, Cu, Cd, Mn and Ni were 38.99, 5.74, 3.99, 0.08, 2.82, 2.13, 0.47, 0.60, 6.45 and 1.09 mg/kg, respectively. Positive Matrix Factorization (PMF) model was applied to ascertain sources of HMs in sampled indoor dust. Percentage contribution from oil-based cooking (29.82%) and transportation (29.77%) represented the highest source to HM concentrations among the six factors identified. The results of the various pollution indices employed showed that Pb, Zn, As, Co, Cr, Cu, Mn and Ni contributed moderately to HMs concentration levels in the sampled dusts. Cd had highest potential ecological risk factor E r i of between 160 and 320. The average values of Enrichment Factors (EFs) obtained aside from Fe used as the reference metal, ranged between 8.46 (As) and 2521.61(Cd). Health risk assessment results revealed that children are the most susceptible to the risks associated with HMs bound indoor dust than the adults. The percentage risk contributions of Hazard Quotient via ingestion route (HQing) in Hazard Index (HI) for non-cancer risk of indoor HMs were 93.17% and 69.87% in children and adults, respectively. Likewise, the percentage cancer risks contribution through ingestion pathway (CRing) were higher than cancer risks through inhalation and dermal pathways (CRinh and CRdermal), accounting for 99.84% and 97.04% of lifetime cancer risk in children and adults, respectively. The contamination level of Cd recorded is of great concern and signifies very strong contribution from anthropogenic sources. Conclusion: This study has further revealed the levels of HMs in typical African residential settings that could be used by relevant stakeholders and policy makers in developing lasting control measures. Supplementary Information: The online version contains supplementary material available at 10.1007/s40201-021-00778-8.
ABSTRACT
Polycyclic aromatic hydrocarbons (PAHs) have attracted significant attention in recent times on account of their reasonably high environmental burden and extreme toxicity. Samples of indoor dusts were obtained daily over a period of 2 weeks from 10 residences located within low, medium, and high density residential areas of Ilorin City. The concentration levels, potential sources, and cancer health risks of sixteen polycyclic aromatic hydrocarbons (PAHs) were investigated using gas chromatography/mass spectrometry. PAHs total concentrations varied from 3.95 ± 0.19 to 8.70 ± 0.43 µg/g with arithmetic mean of 6.09 ± 0.46 µg/g. Fluoranthene was the most dominant PAHs congener. High molecular weight (HMW) PAHs (4-6 rings) were the most prevalent PAHs and were responsible for 79.29% of total PAHs in sampled residences. Chrysene (Chry) was the most abundant compound among the 7 carcinogenic PAHs (CPAHs). Moreover, diagnostic ratios and positive matrix factorization (PMF) employed to apportion PAHs suggested that indoor dusts originated from indoor activities and infiltrating outdoor air pollutants. Diagnostic ratios revealed that PAHs are from mixed sources which include coal/wood combustion, non-traffic and traffic emissions, petroleum, petrogenic (gasoline), and petroleum combustion. Similarly, positive matrix factorization (PMF) model suggested five sources (factors) were responsible for PAHs in indoor dusts comprised of petroleum combustion and traffic emissions (60.05%), wood and biomass combustion emissions (20.84%), smoke from cooking, incense burning and tobacco (4.17%), gasoline combustion from non-traffic sources (13.89%), and emissions from coal burning and electronic devices (1.05%). The incremental lifetime carcinogenic risks (ILCR) of PAHs in adults and children estimated by applying benzo(a)pyrene (BaP) equivalent were within the satisfactory risk limits in Ilorin. Indoor PAHs emissions in Ilorin residences could be monitored and controlled by using data provided in this study.
Subject(s)
Polycyclic Aromatic Hydrocarbons , Adult , Child , Dust/analysis , Environmental Monitoring , Humans , Nigeria , Polycyclic Aromatic Hydrocarbons/analysis , Population Density , Risk AssessmentABSTRACT
BACKGROUND: Hypertension and diabetes are the two most important modifiable risk factors for cardiovascular disease (CVD) among Nigerian population. Because of the lifelong nature of the two diseases and the attendant long treatment regimen required, assessing the health-related quality of life (HRQoL) is an important outcome of these diseases. OBJECTIVE: This study assessed the pattern and predictive factors of HRQoL among patients with hypertension, diabetes and concomitant hypertension and diabetes using the 36-item short-form version 2. PATIENTS AND METHODS: A cross-sectional study of 1203 patients attending the outpatient clinics of the University of Ilorin Teaching Hospital, Ilorin; the patients were sampled using systematic random sampling methods. Patients were divided into those with hypertension, diabetes and both diseases. The predictors of physical and mental component summaries of HRQoL were analysed using Norm-based Scoring. The level of significance was set at P < 0.05 and 95% confidence interval. RESULTS: The patients with both diseases have lowest physical HRQoL (45.6), while the diabetic patients have the worst mental HRQoL (39.5). Negative predictors of physical HRQoL across the three groups were: drug regimen (hypertension P < 0.001, diabetes P < 0.001, both P = 0.005), CVD complication (hypertension P < 0.001, diabetes P = 0.025) and accompanying persons (P < 0.001). The positive predictors of physical HRQoL across the three groups were medication adherence (hypertension P < 0.001, diabetes P < 0.001 and both P = 0.002). Similarly, medication adherence was the positive predictor for mental HRQoL across the three groups of patients (hypertension P < 0.001, diabetes P = 0.001 and both P < 0.001). CONCLUSION: This study provided evidence to show that HRQoL across the three categories of patients in Ilorin, Nigeria, is suboptimal. Drug regimen, medication adherence and support from accompanying persons were important predictive factors of HRQoL.
Subject(s)
Diabetes Complications , Hypertension/complications , Quality of Life , Cross-Sectional Studies , Diabetes Mellitus , Humans , NigeriaABSTRACT
INTRODUCTION: Malaria has proven to be the most horrendous and intractable amongst the health problems confronting countries in the sub-Saharan Africa. This study aims to determine the ownership and utilisation of long lasting insecticide treated nets following free distribution campaign in a state in South West Nigeria. METHODS: Multi-stage sampling technique was used to recruit 2560 households spread across the 16 LGAs of the state. Interviewer administered standardized questionnaire was used for the survey. Data analysis was done using Stata 10 software. RESULTS: Sixty eight point six percent (68.6%) of the households had at least one under-five child living in the household while 32.6% had at least one pregnant woman living in the household. A total of 2440 (95.3%) households received LLIN during the campaign. Overall, the utilization rate for all respondents was 58.5%. Despite the fact that 2440 households received LLINs during the campaign, only 84.3% of them were seen to have hung theirs during the survey. CONCLUSION: Coverage and ownership of LLINs increased significantly following the free distribution campaign. There was a discrepancy between net possession and net use with rate of use lower than possession. Post distribution educational campaign should be incorporated into future distribution campaigns to help increase net utilisation.
Subject(s)
Insecticide-Treated Bednets/statistics & numerical data , Malaria/prevention & control , Mosquito Control/methods , Ownership/statistics & numerical data , Child, Preschool , Cross-Sectional Studies , Family Characteristics , Female , Humans , Insecticide-Treated Bednets/supply & distribution , Malaria/epidemiology , Nigeria/epidemiology , Pregnancy , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Lack of access to information and knowledge about mother and child health was identified as a major contributor to poor maternal and child health in Nigeria. The Partnership for Maternal, Newborn and Child Health (PMNCH) has recognized mapping the knowledge management of Maternal Newborn and Child Health (MNCH) as one of the major strategies to be deployed in improving the health of these vulnerable groups. The main aim of this study is to map the knowledge management resources of Maternal, Newborn and Child Health (MNCH) in rural and urban settings of Ilorin West LGA of Kwara state Nigeria. METHODS: It is a descriptive cross-sectional study with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map responses. The p-value of less than 0.05 was considered significant at 95% confidence level. RESULTS: The study showed that traditional leader was responsible for more than half of the traditional way of obtaining information by rural (66.7%) and urban (56.2%) respondents while documentation accounts for the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers. Traditional leaders (32.2%) and elders (46.7%) were the main people responsible for dissemination of knowledge in rural areas whereas elders (35.9%) and Parents (19.9%) were the main people responsible in urban areas. CONCLUSION: It was concluded that traditional and family institutions are important in the knowledge management of MNCH in both rural and urban settings of Nigeria.