Sexually Transmitted Infections among Patients Attending the General Practice Clinic; Wesley Guild Hospital; Ilesa; Nigeria

Sexually transmitted infections (STIs) are among the most common infectious diseases in the world today. There are few reliable statistics on the true prevalence of STIs in developing countries; especially in the general practice setting; hence the need to determine the prevalence in each locality. With the scourge and pandemicity of human immunodeficiency virus (HIV) and the fact that STIs are recognised as independent risk factors for its transmission; determining the risk profiles for STIs has become paramount. The aim of this study was to describe the pattern of STIs among patients attending a Nigerian general practice (GP) clinic. Methods: This was a descriptive; cross-sectional; hospital-based study. Consenting patients were recruited serially between February and April 2006 until the sample size of 415 was reached. Subjects' genital symptoms were considered according to the four common STI syndromes according to National AIDS/STD Control Programme guidelines. Results: The age range of the subjects was 15 to 95 years (mean 45.16 years; standard deviation 18.83 years; median 44 years). The median age at coitarche was 21 years while the median age at marriage was 25 years. The prevalence rates of current; past and lifetime STI were 18.8; 22.4 and 32 respectively. Only 28 (6.8) study subjects had laboratory evidence of STIs at the time of study. Previous sex with a commercial sex worker; previous history of STIs; premarital sex; first intercourse before or at 21 years of age and multiple sexual partners were significantly associated with STIs. Previous history of STIs was a strong predictor of current STI in this study while premarital sex and previous sex with a commercial sex worker were strong predictors of past STI. The frequency of HIV infection among subjects with STIs was more than double that of the control and a co-infection rate of 17.9was found. Conclusions: The findings of this study indicate a high prevalence of STIs in the study community in association with prevailing high sexual risk behaviours; hence the need for reliable control programmes targeting the latter

Prevalence of chronic kidney disease in a Nigerian family practice population

Background: Chronic kidney disease (CKD) is a global public health problem, with a greater burden and prohibitive cost of care particularly in developing countries. This study determined the prevalence of chronic kidney disease and identified its associated risk factors in patients attending the Family Practice Clinic, Wesley Guild Hospital, Ilesa, Nigeria. Method: Consecutive newly-registered patients who attended the Family Practice Clinic of Wesley Guild Hospital, Ilesa from August 2005 to January 2006 were recruited and studied. Relevant data were collected by using an interviewer-administered questionnaire, and determining the spot urinary ACR (albumin-creatinine ratio) of the subjects by using Microalbustix™ reagent strips and using their serum creatinine concentration. The glomerular filtration rate (GFR) of each subject was estimated using the Modification of Diet in Renal Disease (MDRD) formula. A repeat urine test was done three months after the initial screening to identify subjects with persistent microalbuminuria. Results: The age of the study subjects ranged from 20 to 74 years, with a mean age of 50.52 + 13.03 years. There were 68 males and 182 females in the sample population, showing a male to female ratio of 1:2.7. One hundred and thirteen of the 250 subjects (45.2%) were found to have pathologic albuminuria at the initial screening, while 31 (12.4%) had persistent albuminuria three months later. Also, 51 subjects (20.4%) had estimated low GFR at the initial screening and 26 (10.4%) had persistent low GFR three months later. Significant risk factors for CKD in the study subjects were increasing age, elevated blood pressure, history of diabetes mellitus (DM), habitual intake of analgesics and herbs, and an abnormal waist to hip ratio(p < 0.05). The association between persistent abnormal ACR and low GFR did not reach statistical significance (p = 0.053). Habitual analgesic intake (p = 0.002) and age group (p = 0.0027) were true predictors of CKD among the study subjects. Conclusions: The prevalence of CKD in the study population was high and its association with modifiable risk factors was demonstrated. Family physicians have a unique opportunity to identify and address these factors in their patients. Routine screening for CKD in family practice clinics is indicated to reduce the burden of renal disease in the population

The pattern of malaria infection in under-fives in Ile-Ife, Nigeria.

Over 90% of the burden of malaria occurs in sub-Saharan Africa. Children, especially under-fives, are the most vulnerable. In Nigeria, Africa's most populous nation, it accounts for 25 and 30% of infant and childhood deaths, respectively. One hundred and seventy-six children who fulfilled clinical and parasitological criteria for the diagnosis of malaria, 26.4% of all under-fives, who presented to the Seventh Day Adventist Hospital in Ile-Ife during the months of May to September 2005 were studied to identify the factors that were associated with severe malaria in the target population. The proportion of children with severe malaria in the study was 17%, while the case-fatality rate was 3.5%. Of the 17 variables examined, high malaria parasite density, non-use of mosquito-bite preventive measures and poverty remained independently and significantly associated with an increased risk for severe malaria. Progress in stemming the burden of malaria depends on accurate knowledge and understanding of the epidemiology and control of the disease in the affected populations.

Antimicrobial susceptibility of Helicobacter pylori isolates of dyspeptic Nigerian patients.

The resistance of Helicobacter pylori to antibiotic treatment is a growing global concern, but this has not been well studied in our environment. This study sought to determine: the susceptibility of the organism to common antimicrobial agents used in its eradication therapy. Twenty H. pylori isolates from dyspeptic patients were subjected to standard procedures for sensitivity testing and the determination of minimum inhibitory concentration against amoxycillin, ciprofloxacin, clarithromycin, erythromycin, metronidazole, rifampicin and tetracycline. The study showed marked in vitro multiple antimicrobial resistance to the commonly used eradication agents. All twenty isolates were however sensitive to ciprofloxacin. The findings of marked antimicrobial resistance may affect the effectiveness of currently recommended eradication regimes. In our environment, incorporating ciprofloxacin into the existing H. pylori antimicrobial therapy may improve the outcome of eradication.

Assessment of dietary knowledge, practices and control in type 2 diabetes in a Nigerian teaching hospital.

BACKGROUND: In spite of the importance of diet in the management of diabetes mellitus (DM), diabetics are often unaware of its place in ensuring good glycaemic control. Consequently, compliance and adherence with dietary advice remain poor among diabetics. The standard of practice of dietary therapy for DM among physicians is also low. The aim of this study therefore was to assess the dietary knowledge, practices and control of type 2 DM in Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria. METHOD: All 33 type 2 diabetes patients that attended the hospital over a three month period were studied to assess knowledge of DM, dietary practice and control. Percentage perceived, correct and accurate knowledge as well as practice were used for comparative analysis. RESULTS: All 33 subjects had truncal obesity and needed to lose weight. This was moderately severe in 60% of subjects. About 52% received dietary advice. The latter had a significantly higher mean dietary knowledge score than those without dietary advice. Significantly higher mean knowledge scores seemed to be associated with better dietary practices and better glycaemic control. Overall, dietary practices improved significantly following diagnosis and counselling. A significant proportion of subjects increased their use of food with low glycaemic index (legumes 48.5%, cereals 90.9%) following diagnosis. CONCLUSION: The findings further emphasize the importance of structured dietary advice and dietary control in Type 2 diabetes. In settings where dieticians are scarce, physicians managing diabetic patients must be skilled in the dietary management of the condition and show commitment to it.

Body build and blood pressure in a rural Nigerian community.

Five hundred and fifty randomly selected healthy non-pregnant females and males aged 15 years and above were studied to determine the variation of blood pressure with body build and sex. Of the 550 respondents, 265 (48.2%) and 285 (51.8%) were males and females respectively while 60.2% were youths. Body build rose steadily with increasing age groups until middle age. In the males, it levelled up at the 6th decade of life while in the female this levelling up was at the 4th decade. Systolic and diastolic blood pressures rose with body build (p < 0.05). Body build was higher in those respondents with elevated blood pressure than in normotensives (p < 0.05). This community survey has demonstrated a similar pattern of variation of body build with blood pressure observed in European and American populations in a rural West African population.

The role of traditional birth attendants in Atakumosa, Nigeria.

All 26 traditional birth attendants (TBAs) and their 109 clients in 15 settlements in Atakumosa West Local Government Area (LGA) in Nigeria were interviewed to assess TBA training, practices and utilisation. The study showed that more than 80% of TBAs were older women with more than four children, practiced single-handedly and held other occupations. About 54% of those studied had no designated room for deliveries; twenty-one (80.8%) did not consider any pregnant woman to be at high risk; three (11.5%) perform intravaginal examinations during labour and only a few recognise complications; twelve (46.2%) never refer patients. Despite these deficiencies, TBAs continue to practise in appreciable numbers and their services continue to be on demand in the communities under study. Nearly all of the clients interviewed had started to use TBAs by the age of 25 and 50% had used TBAs for all of their deliveries. Most TBAs provide antenatal care and 77% had a case load of less than five clients per month. Ninety-six per cent of the clients had not been referred by the TBA before. Although 61% of clients felt TBAs in a future pregnancy and 49% would recommend TBA care to other women. Low socio-economic status, illiteracy, poor awareness of modern maternal health (MCH) facilities, personalized care, strong family influence and easy access to TBA services were strong factors promoting traditional midwifery in the LGA. If adequately trained, equipped, supported and supervised, TBAs can contribute towards safe motherhood in Nigeria and in other developing countries.

Menstrual knowledge and practices amongst secondary school girls in Ile Ife, Nigeria.

The menstrual knowledge and practices of 352 randomly selected healthy Nigerian schoolgirls were studied. 187 (53.1%) had attained menarche. 40% of subjects were deficient in knowledge about menstruation. Although menstrual knowledge was higher in post-menarcheal girls, 10% of these were totally ignorant about menses and 84% were not psychologically prepared for the first menses. Girls' menstrual knowledge was positively associated with parental education. The major source of menstrual information was the family. Although more than half of the girls menstruated regularly, 66.3%, used insanitary materials as menstrual absorbent. The mean duration of menstrual flow was 4.32 +/- 1.15 days (mean +/- SD) with a range of 3-7 days in 95.2% of the study population. There is an acute need for education and psychological preparation of girls for menstruation well ahead of menarche.

The influence of socioeconomic and nutritional status on menarche in Nigerian school girls.

A study of 352 randomly selected secondary school girls in an urban population in Southern Western Nigeria revealed a mean menarcheal age of 13.94 +/- 1.31 years and that 76.8% of girls attained menarche between ages 13 and 15 years. Age-matched pre- and post-menarcheal girls did not differ significantly in biophysical measurements, however, nutritional status was strongly and positively associated with attainment of menarche. School girls from the upper socio-economic class reached menarche 11 months earlier than the lower socio-economic counterparts. A significant finding of this study is that the declaration rate in age at menarche was slowest in girls from high socio-economic households. This deceleration was not influenced by body mass suggesting that socio-economic factors play a unique role in the secular trend widely reported in menarcheal age.