Preliminary Study on Open Labelled Randomized Controlled Trial of the Safety and Efficacy of Hydroxychloroquine and Chloroquine Phosphate for the Treatment of Persons Infected with 2019 Coronavirus Disease in Nigeria.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a causative agent of COVID-19 is a leading cause of ill-health and deaths worldwide. Currently, COVID-19 has no known widely approved therapeutics. Thus, the need for effective treatment. OBJECTIVES: We investigated the safety and efficacy of two (2) therapeutic agents; chloroquine phosphate (CQ), 2- hydroxychloroquine (HCQ) and a control (standard supportive therapy) among hospitalized adults with COVID-19. METHODS: The clinical trial was done in accordance to the World Health Organization master protocol for investigational therapeutics for COVID-19. Atotal of 40 participants with laboratory-confirmed positive COVID-19 were enrolled. Blood samples and oropharyngeal (OP) swabs were obtained on days 1,3,15 and 29 for safety and efficacy assessments. RESULTS: The baseline demographics showed that the median ages in years (range) were 45 (31-57) in CQ, 45 (36.5-60.5) in HCQ, 43 (39.5-67.0) and 44.5 (25.3-51.3) in the control (P<0.042).At randomization, seven (7) participants were asymptomatic, thirty-three (33) had mild symptoms, eight (8) had moderate symptoms while three (3) had severe symptoms. The average day of conversion to negative COVID-19 was 15.5 days for CQ, 16 days for HCQ and 18 days for the control(P=0.036). CONCLUSION: The safety assessment revealed no adverse effect of the drugs in COVID-19 patients after treatment. These findings proved that chloroquine and hydroxychloroquine are effective for the treatment of COVID-19 among hospitalized adults. It also confirmed that they are safe.

CONTEXTE: Le coronavirus du syndrome respiratoire aigu sévère 2 (SARS-CoV-2),agentcausaldelaCOVID-19, est l'unedes principales causes demaladie et de décès dans le monde. À l'heure actuelle, il n'existe aucun traitement largement approuvé pour la COVID-19. Ainsi, ilya un besoin de traitement efficace. OBJECTIFS: Nous avons étudié l'innocuité et l'efficacité de deux (2) agents thérapeutiques, le phosphate de chloroquine (CQ) et l'hydroxychloroquine (HCQ), ainsi qu'un groupe témoin (traitement de soutien standard) chez des adultes hospitalisés atteints de la COVID-19.MÉTHODES: L'essai clinique a été mené conformément au protocole maître de l'Organisation mondiale de la santé pour les thérapeutiques à l'étude de la COVID-19. Au total, 40 participants atteints de la COVID-19, confirmée en laboratoire, ont été in scrits. Des échantillons de sang et des prélèvements oropharyngés (PO) ont été effectuésauxjours1,3,15et29pourévaluerl'innocuitéetl'efficacité. RÉSULTATS: Les données démographiques initiales ont révélé que l'âge médian en années (plage) était de 45 (31-57) pour le groupe CQ, de 45 (36,5-60,5) pour le groupe HCQ, de 43 (39,5-67,0) et de 44,5 (25,3-51,3) pour le groupe témoin (P<0,042). À la randomisation, sept (7) participants étaient asymptomatiques, trente-trois (33) présentaient des symptômes bénins, huit(8) avaient des symptômes modérés, tandis que trois(3) avaient des symptômes graves. Le jour moyende conversionentest COVID-19 négatif était de 15,5 jours pour le groupe CQ, de 16 jours pour le groupe HCQ et de 18 jours pourle groupe témoin (P=0,036). CONCLUSION: L'évaluation de la sécurité n'a révélé aucun effet indésirable des médicaments chez les patients atteints de la COVID-19 après le traitement. Ces conclusions ont prouvé que la chloroquine et l'hydroxychloroquine sont efficaces pour le traitement de la COVID-19 chez les adultes hospitalisés. Cela a également confirmé qu' ilssont sûrs. Mots-clés: COVID-19, SARS-CoV-2, essai clinique, innocuité, efficacité, thérapeutiques.

Intimate Partner Violence and Risk Factors among Women during the COVID-19 Movement Restriction in Nigeria: An Online Survey.

BACKGROUND: The rapid spread of the SARS-CoV-2 infection in the absence of treatment or the presence of vaccines is forcing nations to respond with strong preventive measures ranging from mitigation, containment, and in extreme cases, quarantines. While these measures are a useful measure of infection control, they can lead to significant social, economic, and psychological consequences. This study sought to establish the prevalence and risk factors of intimate partner violence during the COVID-19 movement restriction in Nigeria among girls and women. METHODS: An online-based questionnaire survey using Google Forms was conducted over four weeks among girls and women aged 15 years and above. Data analysis was performed using SPSS version 20, and logistic regression was used to determine risk factors for IPV experience during the lockdown. RESULTS: Overall, 32.8% of respondents reported ever experiencing IPV, and 42.5% experienced IPV during the lockdown. Verbal (35.1%) and psychological (24.1%) violence were the commonest forms of violence in the study. There was considerable overlap between the various forms of IPV in the study. Age less than 35 years (aOR = 1.3; CI = 1.2 - 1.4), resident in the northeast region (aOR=1.6; CI=1.41.9), alcohol (aOR=1.3;CI=1.2-1.5) and substance (aOR = 1.5; CI = 1.3 - 1.8) use, average family monthly income < $100 (aOR = 1.4;CI=1.2 - 1.5), daily or weekly income (aOR = 2.7; CI = 2.5-3.1) had an increased association with IPV during the lockdown, residency in the southeast region had lower odds of experiencing IPV (aOR=.0.5; CI = 0.3-0.8). CONCLUSION: The reported lockdown prevalence of IPV was 42.8%, with verbal and psychological violence being the most prevalent form of IPV. Age less than 35 years, resident in northeast and southeast, use of alcohol or substances, average family monthly income < $100, and partner being a daily-weekly earner was associated with IPV experience. Policymakers in the future should consider the consequences, including IPV, before issuing such an order.

CONTEXTE: La propagation rapide de l'infection par le CoV-2 du SRAS en l'absence de traitement ou présence de vaccins oblige les nations à réagir par des mesures préventives fortes allant de l'atténuation à l'endiguement et, dans les cas extrêmes, à la mise en quarantaine. Bien que ces mesures soient utiles pour contrôler l'infection, elles peuvent avoir des conséquences sociales, économiques et psychologiques importantes. Cette étude visait à établir la prévalence et les facteurs de risque de la violence exercée par le partenaire intime au cours de la restriction de mouvement du COVID-19 au Nigeria, chez les filles et les femmes. MÉTHODES: Une enquête par questionnaire en ligne utilisant google form a été menée pendant quatre semaines auprès de filles et de femmes âgées de 15 ans et plus. L'analyse des données a été réalisée à l'aide de la version 20 de SPSS et une régression logistique a été utilisée pour déterminer les facteurs de risque de violence conjugale pendant la période de restriction. RÉSULTATS: Dans l'ensemble, 32,8 % des personnes interrogées ont déclaré avoir déjà subi des VPI, et 42,5 % ont subi des VPI pendant l'enfermement. La violence verbale (35,1 %) et la violence psychologique (24,1 %) étaient les formes de violence les plus courantes dans l'étude. Il y avait un chevauchement considérable entre les différentes formes de VPI dans l'étude. L'âge inférieur à 35 ans (aOR=1,3 ; CI= 1,2 - 1,4), la résidence dans la région nord-est (aOR=1,6; CI=1,4-1,9), la consommation d'alcool (aOR=1,3; CI=1,2 - 1,5) et de substances (aOR=1,5 ; CI = 1,3 - 1,8), le revenu mensuel moyen de la famille < 100 $ (aOR=1. 4 ; IC = 1,2 - 1,5), le revenu quotidien ou hebdomadaire (aOR = 2,7 ; IC = 2,5-3,1) était davantage associé à la VPI pendant le lockdown, la résidence dans la région du sud-est avait moins de chances d'être victime de VPI (aOR = 0,0,5 ; IC = 0,3-0,8). CONCLUSION: La prévalence de la VPI pendant le lockdown était de 42,8 %, la violence verbale et psychologique étant la forme de VPI la plus répandue. L'âge inférieur à 35 and, le fait de résider dans le nord-est et le sud-est, la consommation d'alcool ou de substances, le revenu mensuel moyen de la famille inférieur à 100 dollars et le fait que le partenaire gagne sa vie toutes les semaines étaient associés à l'expérience de la VPI. À l'avenir, les décideurs politiques devraient prendre en compte les conséquences, y compris la VPI, avant d'émettre un tel ordre. Mots-clés: Violence entre partenaires intimes, COVID-19, Lockdowns, Nigeria, Violence fondée sur le genre.

Abnormalities of Kidney Function in Acute Malarial and non-Malarial Infections.

INTRODUCTION: The tropical environment is endemic with malaria and non-malarial infections which are responsible for the high morbidity and mortality in these low- and middle-income countries. In particular, acute malarial infection can cause significant multi-organ dysfunction, including kidney involvement. Early detection of kidney dysfunction will help to improve the quality of care and reduce associated morbidity and mortality. This study aimed at identifying the spectrum of kidney dysfunction in patients with acute malaria and non-malarial infections. METHODS: This was a prospective observational study in which participants with acute malarial infection, acute non-malarial infection, and apparently healthy individuals were enrolled. For acute malarial infection, participants with thick blood smear parasite density of ≥1000 parasite/µl and falciparum species on thin smear were enrolled. Demographic, clinical, and laboratory parameters were measured. The renal abnormalities examined were urea, creatinine and eGFR, albuminuria, electrolytes, and presence of acute kidney injury (AKI). RESULTS: The following electrolyte abnormalities were observed in participants with acute falciparum infection: hyponatraemia (10.7%), hypernatraemia (4.0%), hypokalaemia (8.0%), and hyperkalaemia (13.3%). The mean serum urea in participants with acute malaria was 33.8±8.8mmol/l while participants with non-malarial febrile illnesses and healthy controls had 34.7±9.0mmol/l and 26.8±7.6mmol/l, respectively. The mean serum creatinine among participants with acute falciparum infection was 1.0±0.3mg/dl compared to those of participants with non-malarial infections and healthy controls which were 1.1±0.4mg/dl and 0.8±0.3mg/dl, respectively. The difference in the observed mean serum creatinine among the 3 groups was statistically significant (p=0.023). The mean urinary sodium among participants with non-malarial infection was highest at 23.03mmol/l. There was transient albuminuria in 6.7% of participants with acute malarial infection which resolved after recovery from the infection. CONCLUSION: A relatively high frequency of serum electrolyte abnormalities, albuminuria and urine microscopic abnormalities were observed among subjects with acute malaria compared to those without malaria infection.

INTRODUCTION: L'environnement tropical est endémique d'infections paludéennes et non paludéennes qui sont responsables d'une morbidité et d'une mortalité élevées dans ces pays à revenu faible et moyen. En particulier, l'infection palustre aiguë peut provoquer un dysfonctionnement significatif de plusieurs organes, y compris une atteinte rénale. La détection précoce du dysfonctionnement rénal permettra d'améliorer la qualité des soins et de réduire la morbidité et la mortalité associées. Cette étude visait à identifier le spectre du dysfonctionnement rénal chez les patients atteints d'une infection palustre aiguë ou d'une infection non palustre. MÉTHODES: Il s'agit d'une étude prospective d'observation à laquelle ont participé des personnes souffrant d'une infection palustre aiguë, d'une infection non palustre aiguë et des personnes apparemment en bonne santé. Pour l'infection palustre aiguë, les participants présentant une densité de parasites sur frottis sanguin épais de ≥1000 parasites/µl et des espèces de falciparum sur frottis mince ont été enrôlés. Les paramètres démographiques, cliniques et de laboratoire ont été mesurés. Les anomalies rénales examinées étaient l'urée, la créatinine et le DFGe, l'albuminurie, les électrolytes et la présence de lésions rénales aiguës (IRA). RÉSULTATS: Les anomalies électrolytiques suivantes ont été observées chez les participants atteints d'une infection aiguë à falciparum : hyponatrémie (10,7 %), hypernatrémie (4,0 %), hypokaliémie (8,0 %) et hyperkaliémie (13,3 %). L'urée sérique moyenne chez les participants atteints de paludisme aigu était de 33,8±8,8mmol/l alors que les participants atteints de maladies fébriles non palustres et les témoins sains avaient 34,7±9,0mmol/l et 26,8±7,6mmol/l, respectivement. La créatinine sérique moyenne chez les participants atteints d'une infection aiguë à falciparum était de 1,0±0,3mg/dl par rapport à celle des participants atteints d'infections non palustres et des témoins sains qui étaient de 1,1±0,4mg/dl et 0,8±0,3mg/dl, respectivement. La différence dans la créatinine sérique moyenne observée entre les 3 groupes était statistiquement significative (p=0.023). Le sodium urinaire moyen parmi les participants atteints d'une infection non palustre était le plus élevé à 23,03 mmol/l. Une albuminurie transitoire a été observée chez 6,7 % des participants atteints d'une infection palustre aiguë, qui s'est résorbée après la guérison de l'infection. CONCLUSION: Une fréquence relativement élevée d'anomalies des électrolytes sériques, d'albuminurie et d'anomalies microscopiques de l'urine a été observée chez les sujets atteints de paludisme aigu par rapport à ceux qui n'étaient pas infectés par le paludisme. Mots-clés: Anomalies de la fonction rénale, infection aiguë par le paludisme à falciparum, infections non palustres.

Comparative analysis of fibroblast growth Factor-23 as a correlate of cardiovascular disease among individuals with chronic kidney disease, hypertensives, and healthy controls.

Background: Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population. Aim: This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD. Patients and Methods: A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23. Results: The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively. Conclusion: Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events.

Impact of SARS-CoV-2 Pandemic on Antiretroviral Access at a Large Treatment Centre in Lagos, Nigeria.

INTRODUCTION: The SARS-CoV-2 pandemic has ravaged the world with significant implications on the socio-economic and health status of individuals. Several measures were put in place to curtail the pandemic especially movement restrictions. The effect of this pandemic and the restriction measures could further compound the health needs of PLWHA. This study thus described the trend in access to HIV/AIDS care services before and during the COVID-19 induced lockdown and the possible consequences on their treatment outcome. METHODS: A secondary analysis of client data was carried out at the HIV clinic of the Nigerian Institute of Medical Research. The sociodemographic and clinical data [type of ART, duration on ART, clinical services 3-months before and during the COVID-19 induced Lockdown] were extracted from the electronic medical records. Data obtained was analyzed using the SPSS version 22.0. RESULTS: The median age of PLWHA was 45 years (IQR: 39-51), with the predominant age group being 25-49 years (65.4%). The majority were females (68.7%), married (59.5%), had at least secondary education (82.8%), and employed (81.5%). The median duration on ART was 102 months (IQR: 67-138) with the majority on non-Protease Inhibitor based regimen (77.7%). In the 3 months before the lockdown, there was an increase in drug pick-up of approximately 25% over the booked appointment compared to a decline of 40% when the lockdown was enacted. CONCLUSION: The significant decline in drug pick-up during the SARS-CoV-2 pandemic raises the need for measures to ensure continued access to drugs and care among PLWHA.

INTRODUCTION: La pandémie de SRAS-CoV-2 a ravagé le monde avec des implications significatives sur l'état socio- économique et sanitaire. Plusieurs mesures ont été mises en place pour freiner la pandémie, en particulier la restriction des déplacements. L'effet de cette pandémie et les mesures de restriction pourraient encore aggraver les besoins de santé des PVVIH. Cette étude décrit ainsi la tendance des services de soins du VIH / SIDA avant et pendant le verrouillage induit par le COVID-19 et les conséquences possibles sur l'issue de leur traitement. MÉTHODES: Une étude transversale parmi les PVVIH fréquentant la clinique VIH de l'Institut nigérian de recherche médicale. Les données sociodémographiques et cliniques [type de TAR, durée de la TAR, services cliniques 3 mois avant et pendant le verrouillage induit par COVID-19] ont été extraites des dossiers médicaux électroniques. Les données obtenues ont été analysées à l'aide de la version 22.0 de SPSS. RÉSULTATS: L'âge médian des PVVIH était de 45 ans (IQR (39-51), le groupe d'âge prédominant étant 25-49 ans (65,4%). La majorité étaient des femmes (68,7%), mariées (59,5%), avaient au moins secondaire (82,8%) et employé (81,5%). La durée médiane des TAR était de 102 mois (IQR: 67-138), la majorité sous traitement sans inhibiteur de protéase (77,7%). Au cours des 3 mois précédant le verrouillage , il y a eu une augmentation de la cueillette de médicaments d'environ 25% par rapport au rendez-vous réservé, comparativement à une baisse de 40% lorsque le verrouillage a été décrété. CONCLUSION: La baisse significative de la collecte de médicaments pendant la pandémie de SRAS-CoV-2 fait ressortir la nécessité de prendre des mesures pour assurer un accès continu aux médicaments et aux soins parmi les PVVIH. Mots Clés: SRAS-CoV-2, antirétroviral, COVID-19, ramassage de médicaments, VIH, verrouillage.

Barriers and solutions to effective mentorship in health research and training institutions in Nigeria: Mentors, mentees, and organizational perspectives.

Aims and Background: Mentoring relationships and programs have become a subject of global interest and their relevance is high in the ever-evolving health system. In Nigeria, informal system of mentoring is largely practiced. To be able to institutionalize mentoring program, there is need to explore the various challenges of mentoring process and suggest potential approaches for effective mentor-mentee relationship in health research institutions in Nigeria. Subjects and Methods: The study was designed to explore the barriers and solutions to mentoring process from the perspectives of the mentor, mentee, and organization in health research and training institutions in Nigeria. A cross-sectional descriptive design was employed and the study was conducted among 21 health researchers drawn from 24 health research institutions across the 6 regions of Nigeria. The nominal group technique was adopted in the data collection process. Results: The most frequently reported mentor challenges were "lack of understanding of mentorship process" (84.2%) and "lack of capacity for mentoring" (78.9%), while those of mentee were "mentor preference" (73.7%) and "lack of freedom of expression" (47.4%). "Culture of selfishness/individualism" (84.2%) and "lack of formal relationship" (63.2%) were the most mentioned systemic challenges. Training on mentoring process and relationship was mentioned as the most frequent approach to overcoming challenges for the three perspectives. Conclusion: Significant mentorship challenges exist in the Nigerian health, academic and research institution. Systematic approaches to finding and implementing the appropriate solutions are needed to circumvent these bottlenecks.

Challenges of Accessing Care in Art Clinic during COVID-19 Lockdown in Lagos.

BACKGROUND: As the SARS-CoV-2 pandemic continues to ravage the world, its impact on the health systems and survival of people with chronic diseases especially People living with HIV [PLWH] could be undermined. It becomes relevant to assess the challenges PLWH face during this period to institute measures towards combating the negative effects of the pandemic. AIMS: This study aims to investigate the challenges faced by PLWH in accessing care during the lockdown period in Lagos, Nigeria. The study was a cross-sectional one involving PLWH aged 18 years and above who presented for care. An interviewer-administered questionnaire was used to obtain information on demographic characteristics, their knowledge about COVID-19 disease, and challenges experienced in accessing care during the COVID-19-induced lockdown. Ethical approval was obtained from the Institution Research Ethics Board (IRB) of NIMR. PATIENTS AND METHODS: Data generated from the survey was exported to Excel and analyzed using SPSS version 23.0. RESULTS: The mean age of PLWH who participated in the study was 42.2 (±12.2) years. The majority were female (74.3%), married (66.3%), employed (58.9%), and on less than $100 monthly income (80.5%). The commonest challenges experienced were psychological (78.5%), financial (68%) and food (40.7%). There were significant association among the income status, lack of food (OR: 2.5, CI: 1.4-4.5, P = 0.002), financial challenges (OR: 1.7, CI: 1.0-3.0, P = 0.048) and psychological challenges (OR; 1.8, CI: 1.0-3.5, P = 0.05). Ninety-five percent of participants believed SARS-COV-2 infection is a viral infection. CONCLUSIONS: PLWH faces a myriad of challenges that would have a significant impact on their overall well-being and the gains of HIV care.

Challenges of accessing care in art clinic during COVID-19 lockdown in Lagos

Background: As the SARS-CoV-2 pandemic continues to ravage the world, its impact on the health systems and survival of people with chronic diseases especially People living with HIV [PLWH] could be undermined. It becomes relevant to assess the challenges PLWH face during this period to institute measures towards combating the negative effects of the pandemic. Aims: This study aims to investigate the challenges faced by PLWH in accessing care during the lockdown period in Lagos, Nigeria. The study was a cross-sectional one involving PLWH aged 18 years and above who presented for care. An interviewer-administered questionnaire was used to obtain information on demographic characteristics, their knowledge about COVID-19 disease, and challenges experienced in accessing care during the COVID-19-induced lockdown. Ethical approval was obtained from the Institution Research Ethics Board (IRB) of NIMR. Patients and Methods: Data generated from the survey was exported to Excel and analyzed using SPSS version 23.0. Results: The mean age of PLWH who participated in the study was 42.2 (±12.2) years. The majority were female (74.3%), married (66.3%), employed (58.9%), and on less than $100 monthly income (80.5%). The commonest challenges experienced were psychological (78.5%), financial (68%) and food (40.7%). There were significant association among the income status, lack of food (OR: 2.5, CI: 1.4-4.5, P = 0.002), financial challenges (OR: 1.7, CI: 1.0­3.0, P = 0.048) and psychological challenges (OR; 1.8, CI: 1.0-3.5, P = 0.05). Ninety­five percent of participants believed SARS-COV-2 infection is a viral infection. Conclusions: PLWH faces a myriad of challenges that would have a significant impact on their overall well-being and the gains of HIV care.

Determinants of Antimicrobial Use for Covid-19 Related Symptoms among Nigerians.

BACKGROUND: Antimicrobial use plays a key role in development and spread of antimicrobial resistance. Following the global coronavirus disease 2019 (COVID-19) pandemic and the report of the first confirmed case in Nigeria, several states embarked on either a full or partial lockdown as a measure to prevent or curtail the spread of the virus with its attendant challenges. This survey was designed to provide a snapshot of public antimicrobial use and common perception related to antimicrobial use for COVID-19 related symptoms among Nigerian populace. METHODS: We developed and tested a 29-question electronic questionnaire with Google forms asking respondents about their antimicrobial use and perceptions regarding appropriate antimicrobial use for real or perceived symptoms during the outbreak period. Respondents aged 18 years and above were recruited through crowd sourcing and they received the link to the survey tool through emails and social media including WhatsApp, Twitter, Facebook, LinkedIn, and Instagram. All data analysis was performed using SPSS version 26.0. RESULTS: A total of 410 responses were received from the six geopolitical zones in Nigeria comprising 200 (48.8%) females and 210 (51.2%) males. Majority (62.9%) of the respondents had taken antimicrobials in the 3 months period preceding the survey, while less than half (46.8%) received prescription for it. Previous intake of antimicrobial for similar illness was a predictor of antimicrobial intake (OR: 0.55, 95%CI: 0.30-1.01). The most consumed antimicrobial was antimalarial drugs, specifically Artemisinin-based combination therapy (43.4%), followed by antibiotics [Ciprofloxacin (20.2%)]. CONCLUSION: There was high levels of antimicrobial use for COVID-19 related symptoms by the Nigerian public. This is likely to escalate the already high prevalence of antimicrobial use previously reported and may further fuel the emergence of antimicrobial resistance.

CONTEXTE: L'utilisation d'antimicrobiens joue un rôle clé dans le développement et la propagation de la résistance aux antimicrobiens. À la suite de la pandémie mondiale de coronavirus 2019 (COVID-19) et du rapport du premier cas confirmé au Nigéria, plusieurs États se sont engagés dans un verrouillage complet ou partiel en tant que mesure pour prévenir ou freiner la propagation du virus avec ses défis associés. Cette enquête a été conçue pour fournir un aperçu de l'utilisation publique des antimicrobiens et de la perception commune liée à l'utilisation des antimicrobiens pour les symptômes liés au COVID-19 parmi la population nigériane. MÉTHODES: Nous avons développé et testé un questionnaire électronique de 29 questions avec des formulaires Google interrogeant les répondants sur leur utilisation d'antimicrobiens et leurs perceptions concernant l'utilisation appropriée d'antimicrobiens pour les symptômes réels ou perçus pendant la période d'épidémie. Les répondants âgés de 18 ans et plus ont été recrutés via le crowdsourcing et ils ont reçu le lien vers l'outil d'enquête via des e-mails et des médias sociaux, notamment WhatsApp, Twitter, Facebook, LinkedIn et Instagram. Toutes les analyses de données ont été effectuées à l'aide de la version 26.0 de SPSS. RÉSULTATS: Un total de 410 réponses ont été reçues des six zones géopolitiques du Nigéria comprenant 200 (48,8%) femmes et 210 (51,2%) hommes. La majorité (62,9%) des répondants avaient pris des antimicrobiens au cours des 3 mois précédant l'enquête, tandis que moins de la moitié (46,8%) en avaient reçu une prescription. La prise antérieure d'antimicrobiens pour une maladie similaire était un prédicteur de l'ingestion d'antimicrobiens (OR: 0,55, IC à 95%: 0,30-1,01). L'antimicrobien le plus consommé était les antipaludiques, en particulier les associations thérapeutiques à base d'artémisinine (43,4%), suivis des antibiotiques [Ciprofloxacine (20,2%)]. CONCLUSION: Il y avait des niveaux élevés d'utilisation d'antimicrobiens pour les symptômes liés au COVID-19 par le public nigérian. Cela est susceptible d'augmenter la prévalence déjà élevée de l'utilisation d'antimicrobiens rapportée précédemment et peut encore alimenter l'émergence de la résistance aux antimicrobiens.

Prevalence and Clinical Characteristics of Coronavirus Disease 2019 Seen at a Testing Centre in Lagos Nigeria.

BACKGROUND: The SARS-CoV-2 infection continues to ravage the global community since it was declared a pandemic. The socio-demographic and clinical characteristics defining the disease are mainly from Europe and Asia. The disease symptomatology is similar to the prevalent diseases in our environment, this could result in the delay in prompt identification and appropriate management of suspected cases toward combating community transmission. This study evaluates the prevalence, socio-demographic and clinical characteristics of positive cases of COVID -19. METHODS: This was a retrospective cohort study. Data on the socio-demographic, clinical characteristics and the results of the SARS-CoV-2 test of participants at the Nigerian Institute of Medical Research [NIMR] Modified Drive-through Centre for COVID-19 test sample collection over two months [24th February 2020- 27th April 2020] were retrieved from the electronic medical records (EMR). Data obtained were analyzed using SPSS version 22.0. RESULTS: A total number of 481 clients were evaluated in this review. The prevalence of SARS-CoV-2 infection in the population was 14.6%. The mean age of the positive cases was 42.2 [±15.9] years. The common symptoms reported by the positive cases were fever (40.0%), cough (32.9%), sore throat (17.1%) and running nose (15.7%). Fever depicted statistical significance with positive cases with the majority being of mild to moderate clinical severity. CONCLUSION: The prevalence of SARS-CoV-2 infection among this cohort was 14.6% with a male preponderance. Fever and sore throat were the variables that predicted SARS CoV-2 infection among our cohort.

Prevalence and determinants of depression among patients with hypertension: A cross-sectional comparison study in Ghana and Nigeria.

BACKGROUND: Despite evidence linking depression to poor blood pressure (BP) control and increased hypertension-related morbidity and mortality, there is paucity of data about depression among patients with hypertension in sub-Saharan Africa. We assessed factors associated with depression among patients with hypertension in Ghana and Nigeria. SUBJECTS AND METHODS: Patients with hypertension were recruited from four hospitals: In Ghana, Korle Bu Teaching Hospital (n = 120), and in Nigeria, the University of Port Harcourt Teaching Hospital, the Lagos State General Hospital, and the University College Hospital Ibadan (n = 237). Demographic, socioeconomic, psychosocial, and clinical factors which predicted depression among the study cohort were assessed by logistic regression. Depression and beliefs about medications were assessed with the Patient Health Questionnaire (PHQ-9) and the Beliefs about Medication Questionnaire, respectively. Depression was regarded as PHQ-9 score >4. RESULTS: The mean ages of the Ghanaian and Nigerian cohort were 57.0 ± 13.7 years (58.3% female) and 56.4 ± 12.9 years (57.0% female), respectively. Prevalence of depression was 41.7% and 26.6% among the Ghanaian and Nigerian cohorts, respectively. Significant predictors of depression in the Nigerian cohort were age in years [OR 0.97 (0.95-0.99)], concern about medications [OR 1.15 (1.03-1.30)], and poor BP control [OR 2.06 (1.09-3.88)]. Young age was the only independent predictor of depression in the Nigerian cohort. In the Ghanaian cohort, none of the factors significantly predicted depression. CONCLUSION: Prevalence of depression is high among patients with hypertension in Ghana and Nigeria. Screening and treatment of depression among patients with hypertension in Ghana and Nigeria may have important implications for improving outcomes.

Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study.

BACKGROUND: Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS: Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m . RESULTS: A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001. CONCLUSION: This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.

Salivary Electrolytes, Total Protein and Immunoglobulin A in Patients with Chronic Kidney Disease: A Case Control Study.

The objectives of this study were to compare levels salivary electrolytes, total protein and immunoglobulin A(IgA) in patients with chronic kidney disease (CKD) and healthy individuals; and to determine the relationship between thesalivary and blood levels of these factors between the two groups. Ninety-eight participants consisting of 48 patients withCKD and 50 healthy individuals (age and gender matched) were included. Whole saliva and blood samples were collectedand analyzed for concentrations of electrolytes (K+, Na+, Ca2+, Cl-, and HCO32-), total protein and IgA. Data were analyzedusing Independent-Samples t-test and Pearson correlation test. Concentrations of salivary K+, Ca2+, Cl-, and total proteinwere higher; while concentrations of salivary Na+, HCO32- were lower in patients with CKD compared with healthyindividuals. There was no difference in the salivary IgA levels in patients with CKD compared with healthy individuals.Salivary calcium level showed linear correlation with the plasma calcium level while salivary chloride level showed negativecorrelation with plasma chloride level among patients with CKD. These findings indicate that saliva and plasma from patientswith CKD are characterized by higher potassium, chloride, and lower sodium concentrations than their levels in healthyindividuals; thus, suggesting a possible increased adrenal-cortical activity in patients with CKD.

ASSESSMENT OF MEASURES OF ADIPOSITY THAT CORRELATE WITH BLOOD PRESSURE AMONG HYPERTENSIVE AFRICANS.

BACKGROUND: Studies differ on which anthropometric measure of adiposity shows good correlation with cardiovascular diseases. In this study, we evaluated the effects of common epidemiological measures of adiposity as a correlate of elevated blood pressure in an African population. METHODOLOGY: The study was carried out between June 2009 and December 2011 at the medical out-patient department of a tertiary healthcare center in Nigeria. Correlation analysis was used to assess the relationship between blood pressure and body mass index (BMI), waist to height ratio (WHtR), and waist circumference (WC). RESULTS: A total of 1,416 Hypertensives comprising 1090 (77%) adult females recruited over two and half years. Women were significantly older (49.2±8.1 vs. 48.0±10.0 years, p=0.039) and shorter (1.6±6.3 vs 1.7±6.8 meters, p<0.0001) when compared with men. Blood pressure parameters were comparable between women and men. Approximately 1 out of 5 participants had good blood pressure control with no gender difference. Anthropometric measurements showed that 446(32%) were overweight, 404(29%) obese and 40(3%) were morbidly obese. Compared with their male counterparts, females were significantly more likely to be obese (P<0.0001). Similarly, 51.6% of the subjects had abdominal obesity, with female preponderance (P<0.0001). Likewise, a greater proportion of women had substantially higher measured waist circumference risk. Compared with other measures of adiposity, body mass index correlated best with diastolic blood pressure in both gender (P< 0.05). CONCLUSION: This study adds to the evidence that obesity is a major cardiovascular risk factor. BMI, as a measure of adiposity, was found to correlate best with blood pressure. These findings support other observations in other populations that BMI rather than waist to height ratio (WHtR), and waist circumference (WC) is a better correlate of hypertension.

The knowledge, awareness, and acceptability of renal transplantation among patients with end-stage renal disease in Ibadan, Nigeria.

Renal transplantation is well established in the USA, Europe, India, and South Africa. However, it is still in its infancy in Nigeria. The objective of our study is to determine the knowledge, awareness, and acceptability of renal transplant among patients with end-stage renal disease (ESRD) and the factors which are responsible for the low level of transplantation in Ibadan, Nigeria. A 15-item pilot-tested questionnaire was administered to willing patients with ESRD seen at the medical outpatient clinic of the University Teaching Hospital, from January to December 2011. There was 81% participation rate of the respondents. Exactly 90.1% had formal education and 44% earned <50,000 naira per month. Seventy-nine percent of respondents was aware of renal transplantation, 70.4% would recommend it to others, and 66.7% accepted renal transplantation; 77.8% would maintain a close relationship with their donors. About 61.7% considered it very expensive, while 33.3% did not know the cost for transplantation. Of the reason for the low level of kidney transplantation in Nigeria, 39.5% had no idea and in 27.2% of the respondents, the fear of death by potential donors may be responsible. Eleven percent of responded that recipients had no money for kidney transplantation and another 11% thought the potential donors would like to be paid for donating their kidneys. Most of the respondents with ESRD were knowledgeable, aware of, and accepted renal transplantation as the next step to treat chronic renal failure. However, majority of these patients could not afford the cost for renal transplantation.

Ethical and legal issues in renal transplantation in Nigeria.

With the increasing number of patients being offered kidney transplantation by many centers in the developing world, it is not unexpected that there would be attendant ethical and legal issues even when the selection process for transplantation seems medically justified. Because of the inadequate infrastructure for hemodialysis and peritoneal dialysis, coupled with the challenges of logistics for maintenance dialysis, transplantation would seem to be the best option for patients with end-stage renal failure, even in developed economies where these can easily be tackled. The main issues here revolve around incentives for donors, organ trade and trafficking and the economics of eliminating the waiting list and the criminal activities of organ trans-plantation. In the developing world, with the current level of corruption and poverty, there is a need to redouble efforts to monitor transplant activities. Professional bodies should take the lead in this regard. Furthermore, there is a need for governments to engage in public consultation and community awareness concerning organ donation in living and deceased persons.

Effects of aerobic exercise and drug therapy on blood pressure and antihypertensive drugs: a randomized controlled trial.

BACKGROUND: Although aerobic exercise has been shown to lower blood pressure (BP) in human beings, its additive BP-reducing effect on antihypertensive drug therapy seems to have been investigated in only laboratory animals. OBJECTIVES: This study investigated the effects of aerobic dance combined with antihypertensive drugs on BP and number of antihypertensive drugs in individuals with hypertension. METHODS: This open label randomised-controlled trial involved new-diagnosed male and female individuals with mild-to-moderate essential hypertension after at least four weeks of treatment. They were randomly assigned to drug therapy (Normoretic: Hydrochlorothiazide + amiloride hydrochloride, and Amlodipine) (control: n=33) and aerobic dance combined with drug therapy (exercise: n=30) groups. Intervention in each group lasted 12 weeks. BP was measured at baseline and during and pos-intervention. Number of antihypertensive drugs was recorded post-intervention. RESULTS: There were significant reductions in SBP at some periods of the intervention in the exercise group (p=0.000 to 0.002) and control group (p=0.001 to 0.002), and significant difference in DBP at some periods of the intervention in exercise group (p=0.000 to 0.003) and control group (p=0.000 to 0.001). SBP (p=0.066) and DBP (p=0.100) did not differ between the two groups post-12-week intervention. The BP control rates were similar between the exercises (56.7%) and control (35.5%) groups (p=0.075). Similarly, between-group difference in the number of drugs was not significant (p=0.511). CONCLUSION: This preliminary report demonstrates the tendency of aerobic dance to enhance BP control in individuals on two antihypertensive drugs without BP control.

Renal status of multiple myeloma patients in ibadan, Nigeria.

INTRODUCTION: The spectrum of clinical manifestation in multiple myeloma (MM) ranges from asymptomatic disease to severely debilitative state. Unexplained renal disease is an indication for the investigation of patients for MM. This study is a retrospective analysis of the renal profile of patients with multiple myeloma in relation to management strategy in our institution. METHODS: Medical records of 64 patients with multiple myeloma seen between 2000 and 2008 were retrospectively reviewed at an 850-bed tertiary hospital in South-Western Nigeria. The Mahn-Whitney test was used to compare laboratory features between patient with renal failure and those without renal failure. Subjects with serum creatinine ≥2mg/dL were regarded to have renal failure. Overall survival was calculated from diagnosis to death or lost to follow-up. RESULTS: A total of forty three patients were eligible. The renal status was categorized into three according to serum creatinine level; those with normal serum creatinine level (0.5-1.5mg/dl) were 26 (60.5%), serum creatinine level (>1.6-1.9mg/dl), and creatinine level ≥2mg/ dl were 3(7%) and 14(32.5%) respectively. Hyperuricaemia was observed in 6(42.9%) of MM patients with renal failure compared with 7(26.9%) of patient without renal failure (p<0.05). Twenty-one percent of those with renal failure had hypercalceamia. Thirty-six percent of the renal failure patients had haemodialysis. The average survival for all patients with renal failure was 18 months after diagnosis. CONCLUSION: The outcome in patients with renal failure remained poor with early mortality despite supportive management. Hyperuricaemia and dehydration, given the hot climate might have worked in concert with other factors to worsen the renal status in these patients.

Co-occurrence of diabetes and hypertension: pattern and factors associated with order of diagnosis among nigerians.

BACKGROUND: There is a high frequency of co-occurrence of diabetes and hypertension all over the world. Such association results in higher rate of cardiovascular complications. It is however not clear whether the order of occurrence distinguishes two different groups of patients and the implications of this on morbidity and mortality. The main objective of this study is to determine if there are any clinical and metabolic differences between those first diagnosed with diabetes (hypertensive diabetics) compared to those first diagnosed with hypertension (diabetic hypertensives). METHODOLOGY: A total of 124 patients with co-existent diabetes and hypertension were consecutively recruited into the study. Demographic and clinical history was captured on a semi-structured questionnaire, followed by measurement of anthropometry and blood pressure. Records of fasting plasma glucose, urinalysis and electrolytes, urea and creatinine were obtained from the case records. RESULTS: There were 83 (66.9%) females and 41 (33.1%) males with mean age of 61.1 (SD 11.1) years. Sixty or 49.6% was hypertensive diabetics while 52 or 43% was diabetic hypertensive. The rest had simultaneous diagnosis of diabetes and hypertension. The diabetic hypertensive subjects significantly had higher BMI (p= 0.04) while the hypertensive diabetics group had higher hip/waist ratio (p = 0.01). The diabetic hypertensive group had higher waist circumference statistically significant only in women (p = 0.04). Also significantly more people (21 or 42%; p = 0.04) in the diabetic hypertensive group used table salt often. A logistic regression performed showed that only use of table salt was independently associated with order of diagnosis of diabetes or hypertension. CONCLUSION: There could be significant differences in some clinical characteristics of hypertensive diabetics and diabetic hypertensives, and use of table salt may be an important risk factor contributing to coexistence of both conditions.

Blood Pressure Control and Left Ventricular Hypertrophy in Hypertensive Nigerians

Background : Hypertension is a disease characterized by end-organ complications; leading to high morbidity and mortality in many cases. People with untreated or uncontrolled hypertension often run the risk of developing complications directly associated with the disease. Left ventricular hypertrophy (LVH) has been shown to be a significant risk factor for adverse outcomes both in patients with hypertension and in the general population. We investigated the prevalence and pattern of LVH in a treated hypertensive population at the University College Hospital; Ibadan; Nigeria; using non-hypertensive subjects as control. Design and Setting : A prospective observational study performed at the University College Hospital; Ibadan; Nigeria. Methods : Patients had 6 visits; when at least one blood pressure measurement was recorded for each hypertensive subject and average calculated for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. The values obtained were used for stratification of the subjects into controlled and uncontrolled hypertension. Subjects also had echocardiograms to determine their left ventricular mass. Results : LVH was found in 14 (18.2) of the normotensive group; 40 (20.8) of the uncontrolled hypertensive group and 14 (24.1) of the controlled hypertensive group when left ventricular mass (LVM) was indexed to body surface area (BSA). When LVM was indexed to height; left ventricular hypertrophy was found in none of the subjects of the normotensive group; while it was found present in 43 (22.4) and 14 (24.1) subjects of the uncontrolled and controlled hypertensive groups; respectively. Significant difference in the prevalence of LVH was detected only when LVM was indexed to height alone. Conclusion : Clinic blood pressure is an ineffective way of assessing BP control. Thus in apparently controlled hypertensive subjects; based on office blood pressure; cardiac structural changes do remain despite antihypertensive therapy. This population is still at risk of cardiovascular events