Co-occurrence of non-communicable disease risk factors among adolescents in Jos, Nigeria.

BACKGROUND: The co-occurrence and clustering of risk factors for non-communicable disease (NCD) is a global public health concern. AIM: This study aimed to assess the co-occurrence and clustering of risk factors for NCDs among in-school and out-of-school adolescents in Jos North Local Government Area, Plateau State, Nigeria. SETTING: Secondary schools and markets in Jos North Local Government Area. METHODS: A comparative cross-sectional study was conducted among 377 in-school and 377 out-of-school adolescents, aged 10-19 years of age. An interviewer-administered questionnaire was used to collect information on behavioural and physical risk factors for NCDs. Chi-square and Mann-Whitney U tests were used for comparisons at a 5% level of significance. Statistical analysis was carried out using Statistical Product and Service Solutions (SPSS) version 23.0. RESULTS: Of the 754 sampled adolescents, 386 (51.2%) were females and 368 (48.8%) were males. Adolescents aged 10-14 years made up 37.8% of the participants, 15 to 17 years of age accounted for 46.9% and 18-19 years 15.3%. Risk factors with the highest prevalence were a sedentary lifestyle (94.2%) and an unhealthy diet (92.4%). Majority (97.2%) had two or more risk factors while 1.9% of adolescents had no risk factor. More in-school adolescents (24.1%) had two risk factors compared to 14.1% of out-of-school adolescents (p 0.001); 14.1% of out-of-school adolescents had five or more risk factors compared to 2.9% of those in school (p 0.001). CONCLUSION: Co-occurrence and clustering of behavioural and physical risk factors was found among both in-school and out-of-school adolescents.Contribution: This study highlighted the burden of risk factors for NCDs among both in-school and out-of-school adolescents in the North-Central part of Nigeria. This is especially useful in developing targeted interventions to tackle these risk factors.

Preliminary Investigation into Plasmodium-like Piroplasms (Babesia/Theileria) among Cattle, Dogs and Humans in A Malaria-Endemic, Resource-Limited Sub-Saharan African City.

Babesia and Theileria are protozoan parasites belonging to the order piroplasmida, transmitted by hard ticks, and can cause diseases known as piroplasmosis. Human infections are usually asymptomatic, except in immuno-compromised persons who present malaria-like symptoms. Moreover, microscopically, the morphologies of Babesia and Theileria can resemble that of the malaria parasite, Plasmodium. In malaria-endemic areas with limited resources, these similarities can increase the possibility of misdiagnosing a patient as having malaria instead of piroplasmosis, which may further lead to inappropriate choice of disease management. This preliminary investigation aimed at detecting Babesia/Theileria in cattle, dogs and humans in some parts of Accra. Whole blood samples were taken from febrile cattle (n = 30) and dogs (n = 33), as well as humans diagnosed with malaria (n = 150). Blood samples of all study subjects were microscopically screened for possible presence of haemoparasites. Samples whose smears had features suggestive of possible piroplasmic infection were all given the label "suspected Babesia/Theileria-infected" samples. Nested polymerase chain reaction (PCR) was performed on extracted deoxyribonucelic acid (DNA) from all the "suspected" samples of cattle, dogs and humans, with primer sets that can detect 18S rRNA genes of Babesia/Theileria spp. In addition to this, amplification was performed on the "suspected" dog samples using the BcW-A/BcW-B primer set which detects the 18S rRNA genes of B. canis, while the BoF/BoR primer set which targets the rap-1 region of B. bovis and another primer set which detects the 18S rRNA genes of most bovine Babesia spp. (including B. divergens) were used on the suspected cattle samples. For the human samples, however, additional amplification was done on the extracted DNA using primers for the three other Babesia targeted (B. divergens, B. bovis and B. canis). Microscopy showed possible Babesia/Theileria infection suspected in all three groups of subjects in the following proportions: cattle (10/30; 33%), dogs (3/33; 9%) and humans (6/150; 4%). DNA from one-third of the "suspected" dog samples yielded amplification with Babesia canis primers. Moreover, a broad-detecting set of primers (that can amplify some Babesia and Theileria species) amplified DNA from nine (9/30; 30%) of the "suspected" cattle samples, but none from those of the humans. Although for this study conducted in the city, the Babesia/Theileria primers used did not amplify DNA from the six "suspected" human samples; the possibility of Babesia/Theileria infection in humans in other parts of the country cannot be overruled. There is therefore a need for further studies on possible emergence of human babesiosis/theileriosis in other parts of Ghana and sequencing for specific identification of any circulating strain.

Dynamics in Morbidity Markers and Cytological Observations Made in Urine of Schistosoma haematobium-Infected Children: Pre- and Post-Praziquantel Treatment in an Endemic Setting.

BACKGROUND: Schistosomiasis is a neglected tropical disease caused by helminths of the genus Schistosoma. Morbidity markers and cytological observations such as squamous metaplastic cells, inflammatory cells, and hyperkeratotic cells in the urine of S. haematobium-infected children may suggest disease severity. They may also help predict severe forms of clinical presentation, such as bladder cancer in later years, among infected ones who miss out on early detection and treatment. Insights into possible changes in the morbidity markers and cytological observations in the urine of these S. haematobium-infected children before and after treatment would be of high clinical importance. AIM: The aim of this study was to identify changes/dynamics in morbidity markers and cytological abnormalities in the urine deposits of S. haematobium-infected children, pre- and post-praziquantel treatment. METHODOLOGY: This was a longitudinal study involving baseline and follow-up sampling among basic school children living in schistosomiasis-endemic communities. Urine samples were collected from 520 children at baseline and examined for S. haematobium ova by microscopy, while urine chemistry analyses were used for the examination of morbidity markers. The cytological analyses involved cytopathological examination of the urine deposits. Children whose urine showed positivity for S. haematobium eggs were treated with a single oral dose of praziquantel (40 mg/kg), after which urine chemistry and cytological analyses were repeated weekly for comparison with baseline, until the eighth week. RESULTS: Morbidity markers such as hematuria, proteinuria, and leukocyturia were detected both at baseline and post-treatment among the infected children (30/520). Hematuria was the predominant parameter (90%, 27/30) detected at baseline, followed by proteinuria (53.3%, 16/30). Leukocyturia was the rarest parameter detected at baseline (13.3%, 4/30). However, almost all these parameters declined gradually post-treatment. Regarding cytological analyses, inflammatory cells were observed most (70.0%, 21/30) at baseline. For hyperkeratotic cells and squamous metaplastic cells, 46.7% and 26.7% were respectively observed at baseline, all of which gradually declined during the weekly follow-ups. Notably, squamous metaplastic cells persisted in all the participants from Week 1 through Week 3 post-treatment, but declined gradually thereafter. CONCLUSIONS: Morbidity markers and cytological observations in the children gradually decreased after treatment. Therefore, we continue to recommend routine cytological screening for urogenital schistosomiasis patients at hospitals in S. haematobium-endemic locations using both baseline and follow-up samples to detect these abnormalities early and monitor changes that may be occurring after treatment. Such changes may be useful in assessing treatment progress in infected persons.

Prevalence, socio-demographic and environmental determinants of asthma in 4621 Ghanaian adults: Evidence from Wave 2 of the World Health Organization's study on global AGEing and adult health.

BACKGROUND: A previous multi-site study involving lower- and middle-income countries demonstrated that asthma in older adults is associated with long-term exposure to particulate matter, male gender and smoking. However, variations may occur within individual countries, which are relevant to inform health promoting policies as populations live longer. The present study estimates asthma prevalence and examines the sociodemographic characteristics and environmental determinants associated with asthma in older adults in Ghana. METHODS: This study utilised data from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2. A final sample of 4621 individuals residing in 3970 households was used in analytical modelling. Factors associated with asthma were investigated using single level and multilevel binary logistic regression models. RESULTS: Asthma was reported by 102 (2.2%) respondents. Factors associated with asthma in the univariate model were: those aged 60-69 (OR = 5.22, 95% CI: 1.24, 21.95) and 70 or more (OR = 5.56, 95% CI: 1.33, 23.26) years, Ga-Adangbe dialect group (OR = 1.65, 95% CI: 1.01, 2.71), no religion (OR = 3.59, 95% CI: 1.77, 7.28), having moderate (OR = 1.76, 95% CI: 1.13, 2.75) and bad/very bad (OR = 2.75, 95% CI: 1.58, 4.80) health state, and severe/extreme difficulty with self-care (OR = 3.49, 95% CI: 1.23, 9.88) and non-flush toilet facility (OR = 0.62, 95% CI: 0.39, 0.99). Factors independently associated with asthma in the adjusted models were: those aged 60-69 (OR = 4.49, 95% CI: 1.03, 19.55) years, father with primary education or less (OR = 0.40, 95% CI: 0.17, 0.94), no religion (OR = 2.52, 95% CI: 1.18, 5.41), and households with non-flush toilet facility (OR = 0.58, 95% CI: 0.35, 0.96). Significant residual household-level variation in asthma was observed. Over 40% of variance in asthma episodes could be attributable to residual household-level variations. CONCLUSION: Individual as well as household factors were seen to influence the prevalence of asthma in this national survey. Clinical management of these patients in health facilities should consider household factors in addition to individual level factors.

Health Risks Associated with Oil Pollution in the Niger Delta, Nigeria.

BACKGROUND: Although there is considerable public concern about the environmental impacts of oil pollution in the Niger Delta of Nigeria, actual evidence on the pathological and psychological effects in the health of local communities is minimally known. We sought to associate the perspective measures of exposure to oil pollution with health outcomes (inventory of health symptoms and functional capacity limitations) and determine how emotional reactions to environmental risks moderate these health outcomes. METHOD: The study was conducted with 600 participants selected from five local government areas in Akwa Ibom State where oil pollution is rampant. A structured questionnaire was used to collect the data on the respondents' exposure to oil pollution, self-rated health and disease symptoms, perception of risk of exposure and emotional reactions to local oil pollution. RESULTS: Most of the participants lived in areas with visible oil pollution and/or near gas flaring facilities and regularly suffered direct exposure to oil in their environment. High level of emotional distress was a part of everyone's life for the study population. Risk perception in the study area was mediated, to a large extent, by dreaded hazards (catastrophic fears of pipeline explosions and oil spill fire), visual cues (gas flares and smoke stacks) and chemosensory cues (off-flavor in drinking water). The exposure metrics were found to be significant predictors of the health effects and influencing factors (emotional reactions). Multi-levels models suggest that at the individual level, the demographic variables and direct contact with oil pollution were important mediators of functional capacity limitation. At the community level, emotional distress from fear of the sources of exposure was an important mediator of the health symptoms. CONCLUSIONS: This study documents high levels of disease symptoms and environmental distress (worry, annoyance and intolerance) associated with oil pollution in the Niger Delta areas of Nigeria. It highlights the need for some intervention to ameliorate the psychological distress associated with living under such environmental adversity.

Factors associated with alcohol consumption: a survey of women childbearing at a national referral hospital in Accra, Ghana.

A hospital based cross-sectional study was conducted to identify the factors associated with alcohol consumption in Ghanaian women of childbearing age. The sample consisted of 394 women of reproductive age, of which 234 were pregnant. Systematic random sampling was used to select respondents from the clinics of the Department of Obstetrics and Gynecology outpatient at the Korle Bu Teaching Hospital in Accra, Ghana. Data were collected using structured questionnaires and analyzed using SPSS for Windows version 17.0. In the three months preceding the survey, 37.6% imbibed alcoholic drinks, while 24.4% had ever imbibed an alcoholic herbal brew. Non-Islamic religion, not being in marital union, consuming an alcoholic herbal brew and considering alcohol was beneficial to health were strong predictors of alcohol consumption. We conclude that the prevalence of alcohol consumption is high among this cohort of Ghanaian women. Women should be screened for alcohol consumption and informed about the dangers of heavy alcohol consumption during pregnancy.

Birth and emergency planning: a cross sectional survey of postnatal women at Korle Bu Teaching Hospital, Accra, Ghana.

Birth and emergency planning encourages early decision making, helps overcome barriers to skilled maternity care and reduces preventable maternal and newborn deaths. A facility based postnatal survey of 483 childbearing women in Accra, Ghana determined birth and emergency planning steps, awareness of obstetric danger signs, reported maternal and newborn complications and birth outcome based on length of hospital stay. Supervised antenatal care and delivery were nearly universal. Overall, 62% had a birth plan, 74% had adequate knowledge of danger signs, while 64% and 37% reported maternal and newborn complications respectively. Accompaniment by a birth companion and saving money were considered the most useful planning steps. Knowledge of danger signs was associated with birth and emergency planning, and birth and emergency planning was associated with reported birth outcome. Birth and emergency planning as a critical component of antenatal care can influence birth outcomes and should be extended to all pregnant women.

Awareness, use and main source of information on preventive health examinations: a survey of childbearing women in Uyo, Nigeria.

The study determined awareness, use and the main source of information about preventive health examinations among 387 childbearing women attending three health facilities in Uyo, Nigeria. Respondents were consenting women aged 15-49 years who had a live birth in the two months preceding the survey. Respondents were interviewed using structured questionnaires during child welfare clinic visits at each facility. Awareness about pap smears and breast self examination was 14.2% and 35.3% respectively. Testing rates were highest for blood pressure checks, HIV and blood sugar and lowest for Pap smears and mammograms. Health workers were the main informants on preventive tests. Awareness and secondary education enhanced women's uptake of screening services across levels of health care. Secondary education as a minimum and intensified awareness creation about preventive health examinations through media, school based programs, durbars and public health campaigns are vital to the health and well being of women and children.