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.

Gut Microbiota Modulation as a Novel Therapeutic Strategy in Cardiometabolic Diseases.

The human gut harbors microbial ecology that is in a symbiotic relationship with its host and has a vital function in keeping host homeostasis. Inimical alterations in the composition of gut microbiota, known as gut dysbiosis, have been associated with cardiometabolic diseases. Studies have revealed the variation in gut microbiota composition in healthy individuals as compared to the composition of those with cardiometabolic diseases. Perturbation of host-microbial interaction attenuates physiological processes and may incite several cardiometabolic disease pathways. This imbalance contributes to cardiometabolic diseases via metabolism-independent and metabolite-dependent pathways. The aim of this review was to elucidate studies that have demonstrated the complex relationship between the intestinal microbiota as well as their metabolites and the development/progression of cardiometabolic diseases. Furthermore, we systematically itemized the potential therapeutic approaches for cardiometabolic diseases that target gut microbiota and/or their metabolites by following the pathophysiological pathways of disease development. These approaches include the use of diet, prebiotics, and probiotics. With the exposition of the link between gut microbiota and cardiometabolic diseases, the human gut microbiota therefore becomes a potential therapeutic target in the development of novel cardiometabolic agents.

Clinical and laboratory characteristics of COVID-19 among adult patients admitted to the isolation centre at Abubakar Tafawa Balewa Teaching Hospital Bauchi, Northeast Nigeria.

INTRODUCTION: as the epidemiological trend of COVID-19 infection continue to evolve with increasing prevalence and incidence globally, management of cases in low-resource health care settings require basic detailed clinical and laboratory characteristics. This study retrospectively described the clinical and laboratory characteristics of confirmed COVID-19 cases admitted into the isolation centre of ATBUTH, Bauchi. METHODS: clinical and laboratory data of 84 confirmed COVID-19 cases admitted into the isolation centre of ATBUTH, Bauchi according to NCDC guidelines were used. Diagnosis was based on nasal and nasopharyngeal swab positive result of reverse transcriptase-polymerase chain reaction (RT-PCR) result. Data extracted includes demographic, clinical presentations and laboratory characteristics. RESULTS: the 84 COVID-19 patients comprised of 72% (59) males and 28% (25) females with mean age of 41.0±10.5 years, majority of the patients were within age-group 21-40 years. Forty-one percent presented with mild to moderate symptoms, 3.6% (3) presented with severe symptoms while 58.3% (49) were asymptomatic with mean body temperature of 36.60C ± Sá. The common clinical manifestations were fever 23.4% (19) and cough 20.7% (17). About 29.3% of the patients had comorbidities, 17.1% (14) were hypertensive while 12.2% of the diabetic. Thirty percent (10) of the patients with DM required intensive care unit (ICU) admission with 10% mortality. Biochemical parameters were within normal range for all the patients. However, haematological parameters showed increased neutrophil (10, 43.5%) and lymphocyte count (19 (59.4%). CONCLUSION: the study findings revealed high number of asymptomatic cases, similarity in clinical manifestation and relatively normal laboratory characteristics. More experience with increase in number of patients may provide additional information. Interrupting community transmission will require early detection and contact trace of asymptomatic cases.

Prevalence of hepatitis C viral infection among injecting drug users in a Saudi Arabian hospital: A point cross sectional survey.

Hepatitis C Virus is an important cause of preventable morbidity and mortality among Injecting Drug Users worldwide. The aim of this study is to determine the prevalence and correlations of HCV infection among IDUs in Saudi Arabia. A point cross-sectional survey was conducted between May 2012 and Nov 2012 to determine hepatitis C viral antibodies serological status using venous blood among IDUs (N=300) accessing care at Al-Amal Hospital in the Kingdom of Saudi Arabia, as well as to determine clinical correlates of hepatitis C infection among the Injecting Drug Users. There was an overall HCV prevalence of 42.7% among IDUs studied. Low level primary education, single marital status, being unemployed and commencing Injecting Drugs beyond the age of 15 years have higher specific prevalence of HCV among IDUs population. There was statistically significant association between clinical assessments of the participants who were abusing drugs generally, dependent on drugs, specifically abusing cocaine, amphetamines, opioids, cannabinoids and alcohol with HCV antibodies seropositivity. There was no statistical significant relationship between drug induced sleep/sexual disorder and psychosis/delusion with HCV seropositivity. This study demonstrated a relatively high prevalence of HCV among IDUs in KSA. Targeted public health preventive strategies are necessary to halt the spread of HCV among IDUs in KSA. The resultant benefits of these will include reduction in morbidity and mortality as well as improved socioeconomic wellbeing of the IDU's population.

The population structure of clinical extra-intestinal Escherichia coli in a teaching hospital from Nigeria.

Limited information is available regarding the population structure of extra-intestinal pathogenic Escherichia coli (ExPEC) in Africa. Antimicrobial resistance profiles, sequence types (STs) and fimH types were determined on 60 clinical ExPEC from Nigeria using a 7-single nucleotide polymorphism quantitative PCR and sequencing of certain genes. Different ST131 clades were identified with a multiplex PCR. The isolates were mostly obtained from urines (58.3%). Not-susceptibility rates were as follows: trimethoprim-sulfamethoxazole (98%), cefotaxime (68%), gentamicin (55%), ciprofloxacin (62%) and piperacillin-tazobactam (2%). Dominant STs were associated with CTX-M-15 and included ST131-fimH30 (23%), ST457-fimH145 (20%), ST405-fimH27 (13%) and ST95-fimH41 (10%). We found the 7-SNP qPCR to be simple and cost-effective that can be utilized to tract different ExPEC clones on a global scale. This study provided insight into the population structure of ExPEC from Nigeria showing high prevalence of the rarely reported ST457 and the presence of multidrug resistant ST95.