Pattern of Obesity Among Patients with Type 2 Diabetes at a Tertiary Healthcare Center in Northern Nigeria.

PURPOSE: Type 2 diabetes poses a major global health threat both in the developed and developing countries. Factors responsible for the soaring epidemic of T2DM in the developing countries include urbanization, ageing population, physical inactivity and increasing obesity rates. Our aim was to determine the pattern of obesity among patients with T2DM at the Aminu Kano Teaching Hospital (AKTH), Kano, Northwestern Nigeria. PATIENTS AND METHODS: We consecutively recruited 220 patients with type 2 diabetes attending the diabetes clinic of AKTH for the study. Patients with Type 1 diabetes, patients who could not stand or are wheelchair bound and pregnant women were excluded from the study. A pretested questionnaire was used to collect data on socio-demographic characteristics, treatment history for diabetes and history of hypertension from each participant. RESULTS: Of the 220 patients recruited for this study, 97(44.1%) were men, while 123(55.9%) were women. The prevalence of generalized obesity among the study participants was 27.4% (women -30.9% vs men- 22.7%, X2=4.76, p=0.190). Grades I. II and III obesity were found in 17.3%, 5.9% and 3.2% of the study participants, respectively. All the participants with grade III obesity were women. Central obesity defined by WC was detected in 111(50.5%) [20(20.6%) men and 91(73.9%) women, X2=1.93, p=0.001]. Obesity defined by WHR was recorded in 182(82.7%) participants [80(43.9%) men and 102(56.0%) women, X2= 1.97, 0.001]. Using a cut-off of ≥0.5, abnormal WhtR was detected in 179(81.4%) [72(40.2%) men and 107(59.8%) women, X2= 5.82, p=0.01], while using a cut-off of ≥0.6, abnormal WhtR was detected in 84(38.2%) participants [29 (34.5%) men and 55(65.5%) women, X2=6.38, p=0.09]. Hypertension was detected in 103(46.8%) participants, with a higher prevalence among women compared with men [46.3. % vs 47.4%, X2= 1.03 p=0.87]. CONCLUSION: The prevalence of obesity in our cohort of patients with type 2 diabetes was high. The predominant form of obesity was central obesity, which was most prevalent when indexed by WHR. The WhtR was as good as the WHR, but fared better than WC in detecting central obesity in our patients.

Sex disparities in outcomes among adults on long-term antiretroviral treatment in northern Nigeria.

BACKGROUND: There are conflicting reports of sex differences in HIV treatment outcomes in Africa. We investigated sex disparities in treatment outcomes for adults on first line antiretroviral treatment (ART) in Nigeria. METHODS: We compared clinical and immunologic responses to ART between HIV-infected men (n=205) and women (n=140) enrolled in an ART program between June 2004 and December 2007, with follow-up through June 2014. We employed Kaplan-Meier estimates to examine differences in time to immunologic failure and loss to follow-up (LTFU), and generalized estimating equations to assess changes in CD4+ count by sex. RESULTS: Men had lower baseline mean CD4+ count compared to women (327.6 cells/µL vs 413.4, respectively, p<0.01). Women had significantly higher rates of increase in CD4+ count than men, even after adjusting for confounders, p<0.0001. There was no significant difference in LTFU by sex: LTFU rate was 2.47/1000 person-months (95% CI 1.6-3.9) in the first five years for men vs 1.98/1000 person-months (95% CI (1.3-3.0) for women. There was no difference in time to LTFU by sex over the study period. CONCLUSIONS: Women achieved better long-term immune response to ART at baseline and during treatment, but had similar rates of long-term retention in care to men. Targeted efforts are needed to improve immune outcomes in men in our setting.

Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria.

HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART-). Symptomatic HAND was found among 40% of the HAART- individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (p = 0.0002). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04-1.44, p = 0.016]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART- patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease.

Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis.

Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp., P < 0.0001). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publication (P = 0.046). Factors found to be significant predictors of ACT adherence were years of education ≥ 7 {odds ratio (OR) (95% CI) = 1.63 (1.05-2.53)}, higher income {2.0 (1.35-2.98)}, fatty food {4.6 (2.49-8.50)}, exact number of pills dispensed {4.09 (1.60-10.7)}, and belief in traditional medication for malaria {0.09 (0.01-0.78)}. The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT.

Neurocognitive impairment in HIV-1-infected adults in Sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVE: To estimate the burden of HIV neurocognitive impairment (NCI) among adult patients on and off antiretroviral therapy (ART) in Sub-Saharan Africa. METHODS: Estimates were derived from a random effects meta-analysis of prospective studies reporting HIV status, utilization of ART, and the presence of NCI determined using the International HIV Dementia Scale. RESULTS: Sixteen studies with quality data from seven countries in Sub-Saharan Africa up to June 2012 were included. Among HIV patients, the frequency of NCI pre-ART was 42.37% (95% confidence interval (CI) 32.18-52.56%), and among those on ART for ≥6 months was 30.39% (95% CI 13.17-47.61%). Respective NCI estimates in studies from Uganda were 46.49% (95% CI 30.62-62.37%) and 28.50% (95% CI -1.31-58.30%). NCI was more common among patients with a concomitant psychiatric ailment. HIV-positive patients compared to HIV-negative controls were predisposed to NCI (odds ratio (OR) 6.49, 95% CI 1.68-25.08); the estimated unadjusted attributable risk of HIV infection leading to NCI was 85%. Meta-regression showed no associations between age, gender, CD4 cell counts, or years of education with NCI. Patients on ART were less likely to have NCI compared to HIV-infected pre-ART patients, with OR 0.36 (95% CI 0.19-0.69). In longitudinal studies with the same patients followed before and at ≥6 months after ART, the OR of NCI after ART compared to pre-ART was 0.23 (95% CI 0.14-0.37). The combined burden of NCI among pre-ART and on-ART patients in Sub-Saharan Africa was estimated at 8,121,910 (95% CI 5,772,140-10,471,680). No publication bias was observed, although residual confounding from differing environmental factors, stages of HIV infection, and viral clades might be a limitation. CONCLUSIONS: HIV strongly predisposes to NCI leading to a huge burden in Sub-Saharan Africa, and scale-up of ART can substantially reduce it.