Sleep quality and associated factors among patients with chronic kidney disease in Nigeria: a cross-sectional study.

OBJECTIVE: Poor sleep quality adversely affects the overall well-being and outcomes of patients with chronic kidney disease (CKD). However, it has not been well studied in Africans with CKD. We determined the prevalence of poor sleep quality and associated factors among patients with CKD. DESIGN: This was a cross-sectional study that involved patients with CKD . SETTINGS: The study was carried out in the outpatient clinic of nine hospitals in Nigeria. METHODS: Sleep quality, depressive and anxiety symptoms and quality of life (QoL) were assessed among 307 patients with CKD using Pittsburgh Sleep Quality Index Questionnaire, Hospital Anxiety Depression Scale Questionnaire and 12-item Short Form Health Survey Quality of Life Questionnaire, respectively. The prevalence of poor sleep quality and associated factors were determined. A p<0.05 was considered as statistically significant. RESULTS: The mean age of the study participants was 51.40±15.17 years. The male:female ratio was 1.5:1 One hundred and twenty-one (39.4%) of the patients were on maintenance haemodialysis (MHD). The prevalence of poor sleep quality, anxiety symptoms and depressive symptoms among the patients was 50.2%, 37.8% and 17.6%, respectively. The prevalence of poor sleep quality in the CKD stages 3, 4, 5 and 5D was 38.1%, 42.6%, 52.2% and 58.7%, respectively. The prevalence of poor sleep quality was significantly higher in MHD patients compared with predialysis CKD (59.5% vs 43.6%; p=0.008). Factors associated with poor sleep quality were CKD stage (p=0.035), anaemia (p=0.003), pruritus (p=0.045), anxiety symptoms (p≤0.001), depressive symptoms (p≤0.001) and reduced QoL (p≤0.001). On multivariate analysis, factors associated with poor sleep were anxiety (AOR 2.19; 95% CI 1.27 to 3.79; p=0.005), anaemia (AOR 5.49; 95% CI 1.43 to 21.00;p=0.013) and reduced physical component of QoL (AOR 4.11; 95% CI 1.61 to 10.47; p=0.003). CONCLUSION: Poor sleep quality is common among patients with CKD especially in the advanced stage. The significant factors associated with poor sleep quality were QoL, anaemia and anxiety symptoms. These factors should be adequately managed to improve the overall outcomes of patients with CKD.

Level of implementation of WHO COVID-19 document on rights, roles and responsibilities of health care workers in a tertiary hospital in Southwest Nigeria.

INTRODUCTION: in order to curb the increasing spread of COVID-19 amongst health care workers (HCWs), the World Health Organization (WHO) released the COVID-19 Rights, Roles and Responsibilities of Health workers (COVID-19 RRRHW) policy document aimed at protecting HCWs amidst the on-going pandemic. This study determined the level of implementation of the document in a tertiary hospital in Southwest Nigeria. METHODS: this was a cross-sectional descriptive study among HCWs in a tertiary hospital in South-western Nigeria that assessed the level of implementation of the WHO COVID-19 RRRHW document using a closed ended structured questionnaire. RESULTS: five hundred and thirty-five HCWs participated in the study comprising 165(30.8%) males and 370(69.2%) females. Majority (87.3%) of the HCWs were 40 years and below. One hundred and sixty-three (30.5%) of the HCWs had been involved in the care of COVID-19 patients; less than 60% of the respondents were aware of the presence of an official platform for dissemination of information on suspected or confirmed cases of COVID-19 and 435(81.3%) were aware of hospital training on Infection Prevention and Control (IPC); 191(35.7%) have had uninterrupted supplies of personal protective equipment(PPE) and IPC materials; 211(39.4%) were aware of mental and counselling services in the hospital while only 106(19.8%) knew how to access these services; 289(54%) have attended IPC training and 307(57.4%) are able to don and doff PPE. CONCLUSION: this study showed inadequate implementation of the WHO COVID-19 RRRHW document. There is urgent need for all stakeholders to familiarize with the document in order to ensure adequate protection of HCWs and minimize their risk of contracting COVID-19.

Coronavirus infection and kidney disease: a review of current and emerging evidence.

In November 2009, an outbreak of a new strain of coronavirus (later named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first noticed in the city of Wuhan in China, rapidly spreading to assume pandemic proportions within a short period of time. The disease was subsequently designated as coronavirus disease-19 (COVID-19). The death toll has continued to rise with grave health and socio-economic implications for individuals, families and nations globally. Although the respiratory tract is primarily involved in this disease, kidney affectation is increasingly reported and has been shown to worsen the prognosis of the disease. Current evidence shows that kidney disease is not uncommon in patients with coronavirus infection especially in those with COVID-19 and may arise from a constellation of factors such as hypotension, sepsis, rhabdomyolysis, multi-organ failure, use of nephrotoxic medications as well as direct infection in some cases. Factors associated with acute kidney injury in coronavirus infected patients may include elderly age, male sex, presence of co-morbidities as well as pre-existing chronic kidney disease and end stage renal disease. Although, there is presently no effective treatment for COVID-19, there is room for conservative management, extracorporeal therapy and renal replacement therapy. The aim of this review was to integrate current and emerging evidences on renal disease resulting from COVID-19 and the previous epidemics of coronavirus infections including the Middle East Respiratory Syndrome (MERS) and the Severe Acute Respiratory Syndrome (SARS) caused by other strains of the virus.

Knowledge, attitude and practice towards COVID-19 among workers of a tertiary hospital in Bayelsa State, Nigeria.

INTRODUCTION: coronavirus disease (COVID-19) has since assumed pandemic dimensions with over 14million persons affected in 213 countries and territories worldwide as at mid-July 2020. The level of awareness and knowledge of the disease as well as the related attitude and practice amongst hospital workers could determine its extent of control. The aim of this study was to determine the knowledge, attitude and practices amongst hospital staff regarding COVID-19. METHODS: this cross-sectional study was conducted among staff of the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. A self-administered semi-structured questionnaire was adapted in assessing their knowledge, attitude and practice towards COVID-19. RESULTS: one hundred and twenty four respondents completed the study with a mean age of 30.9 ± 6.5 years. Up to 90% of them demonstrated good knowledge of COVID-19 with regard to preventive and control measures. Approximately 90% of them practiced good hand hygiene though a lesser proportion wore face masks (51.6%) and practiced crowd avoidance (58.1%). Medical doctors had a marginally higher practice score compared with "others" (p = 0,047). Up to 98(79.0%) of respondents were scared of self-infection and 99(79.8%) were not motivated to work due to inadequate facilities, equipment and resources in 50% of cases. Knowledge of COVID-19 was positively correlated with the practices of the participants (p = 0.023). CONCLUSION: the hospital staff lacked adequate motivation towards management of COVID-19 and were constrained for the fear of self- infection, inadequate equipment, resources and equipment despite possessing a good knowledge of the disease. There is need for concerted efforts by stakeholders in the health care industry to ensure hospital workers are adequately motivated and provided with the needed risk protection devices and resources during this pandemic.

Blood Pressure Changes among Patients Undergoing Hemodialysis in Yenagoa, Nigeria.

INTRODUCTION: Hemodialysis (HD) is a common modality of renal replacement therapy in Nigeria. Despite its usefulness, it may have complications such as intra-dialytic hypotension (IDH) and intra-dialytic hypertension (IDHTN), both of which may impact negatively on the patient. The aim of the study was to examine blood pressure (BP) changes during HD, to determine the frequency of IDH and IDHTN in patients undergoing HD, and to possibly identify associated factors. MATERIALS AND METHODS: The study design was a retrospective review of records of patients who had HD in the Rainbow Dialysis Center, a foremost private dialysis center in Bayelsa State. The records of all adults who had HD in the center from June 2014 to June 2018 were reviewed. Data retrieved include sociodemographics, type and cause of renal disease, and clinical and laboratory parameters such as BPs, packed cell volume, urea, and creatinine. STATISTICAL ANALYSIS USED: Data were analyzed with SPSS version 20.0. Data were presented in tabular forms. Variables were expressed as mean with standard deviation, frequencies, and percentages. The means were compared using Student's t-test or analysis of variance where appropriate. Chi-square test was used to compare proportions. Statistical significance was set at P < 0.05. RESULTS: One hundred and thirty-six cases were recruited for the study. IDH and IDHTN were found in 16.9% and 16.2% of the patients, respectively. There was no significant difference between the mean predialysis and postdialysis systolic, diastolic, mean arterial BP, or pulse pressure (P > 0.05). Older age was positively and significantly associated with IDHTN (P = 0.047). CONCLUSIONS: IDH and IDHTN were prevalent among the patients studied, with the latter being slightly more likely to occur with advancing age. There is a need for adequate BP monitoring and management during HD.

Prevalence and determinants of cognitive impairment in patients with chronic kidney disease: a cross-sectional study in Benin City, Nigeria.

BACKGROUND: Chronic kidney disease (CKD) has become a public health concern and may be complicated by cognitive impairment (CI) contributing significantly to morbidity and poor prognosis. This hospital-based study aimed at determining the prevalence and the determinants of CI among CKD patients in Nigeria. MATERIALS AND METHODS: A total of 190 CKD patients and a 100 healthy control subjects completed this cross-sectional study. Sociodemographic data and history of common clinical features of CKD were obtained with the use of interviewer administered semi-structured questionnaires. The six-item cognitive impairment test was used for assessment of cognitive function of patients and controls. RESULTS: The prevalence of CI in Stages 3, 4, and 5 CKD patients were 24.0%, 41.6%, and 46.2%, respectively with overall prevalence of 35.3% while only 6.0% of controls had CI (P = 0.03). The most potent determinants of CI were low hematocrit (odds ratio [OR] =3.50), low serum bicarbonate levels (OR = 2.20), and high serum urea (OR = 2.11). CONCLUSION: CKD is associated with significant CI in Nigerian patients especially with progressive deterioration in renal function. There is a need for regular evaluation of CKD patients for cognitive deficits.

Prevalence of hypertension and its correlates among employees of a tertiary hospital in Yenagoa, Nigeria.

BACKGROUND: Hypertension (HTN) is a common medical problem with increasing prevalence and dire consequences. Considering the relative proximity of hospital workers to health care delivery, one may expect a better control of HTN and associated risk factors in this population. The objective of the current study was to determine the prevalence of HTN and risk factors among hospital employees in a Nigerian tertiary hospital. MATERIALS AND METHODS: All employees of the Federal Medical Center, Yenagoa (Bayelsa State, Nigeria) were invited for a HTN screening exercise on the world kidney day on March 14, 2013. A total of 231 participants completed this cross-sectional study. Data was obtained with a pre-tested interviewer-administered structured questionnaire while blood pressure was taken with an Accoson sphygmomanometer. Anthropometry was done using standardized protocols. Urine and blood were analyzed for glucose. HTN was defined as blood pressure >140/90 or prior diagnosis or use of antihypertensives. Data was entered, stored and analyzed with Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20. RESULTS: The crude and age-adjusted prevalence of HTN among the hospital employee was 21.3% and 23.8% respectively. Age, marital status, educational level, body mass index, waist circumference (WC) and waist hip ratio showed significant association with HTN in the univariate analysis. However, in multivariate regression analysis, only older age and abnormal WC predicted HTN. CONCLUSION: The prevalence of HTN among the hospital employees compared with reports in other population and was predicted by advancing age and abnormal WC. The study underscores the need for introduction of HTN screening programs among hospital employees especially staff that are older with truncal obesity.