Delirium in Elderly Patients:Frequency and Precipitants in a Tertiary Hospital Setting.

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.

TOBACCO CESSATION SERVICES AND RELATED CHALLENGES AMONG DENTISTS IN SOUTHWEST NIGERIA.

INTRODUCTION: Oral health problems arising from tobacco use have been reported and some of these conditions can be prevented through Tobacco Cessation (TC). Dentists are well positioned to provide tobacco cessation services to patients. In Nigeria, little is documented on the provision of cessation services among dentists and the challenges. This study was conducted to assess the cessation practices of dentists and their related challenges in Southwest Nigeria. METHODS: A cross sectional study was carried out in all the tertiary healthcare facilities within the six states of the Southwest geopolitical zone. A total population survey involving dentists below the cadre of Consultant/Chief Dental Officers undergoing postgraduate training and/or providing services in the tertiary hospitals was conducted using a pretested semi structured self-administered questionnaire. This included questions on challenges experienced in the provision of TC services in their respective facilities. RESULTS: A total of 224 eligible dentists were approached to participate in this study with a response rate of 91.5%. Mean age and completed years of working experience were 33.8±5.2 and 6.1±4.4 respectively. In reporting challenges to implementing tobacco cessation services, 60% of respondents reported 'lack of perceived efficacy and training' as the major barriers. CONCLUSION: From this study, incorporation of tobacco cessation into the dental curriculum will increase the knowledge and competence of dentists. Provision of systems support to dentists willing to help patients quit smoking may be important in ensuring the health system is responsive to the tobacco control needs of patients in Southwest Nigeria.

Perceived effectiveness of graphic health warnings as a deterrent for smoking initiation among adolescents in selected schools in southwest Nigeria.

BACKGROUND: There has been a sustained increment in young people initiating smoking in low middle income countries like Nigeria. Health warnings on cigarette packages are a prominent source of health information and an effective means of communicating specific disease risks to adolescents and young adults alike. This study evaluated the perceived effectiveness of selected graphic warnings on smoking initiation amongst in-school adolescents. METHODS: This was a cross-sectional study conducted amongst secondary school students aged 13-17years in Igbo-Ora, Nigeria. A two-stage sampling technique with the school classes as the final sampling unit was used to select the students. An interviewer assisted questionnaire was used to obtain information on students demographic characteristics and their perception of graphic warnings using four images from the pictorial health warning galleries of the World Health Organization showing: 'cigarette smoking causes cancer of the airways, harms children, causes stroke and causes impotence respectively'. RESULTS: A total of 544 senior secondary students were included in this study with a male female ratio of 0.8:1. Of those interviewed, 40 (7.4 %) indicated that they had ever considered smoking, nine (1.7 %) responded that they had ever smoked and two students indicated that they were current smokers. With all the images, fear was the dominant emotion expressed by the respondents. This was expressed by 307 (56.4), 215 (39.5), 203 (37.3) and 228 (41.9 %) respondents to images 1, 2, 3, and 4 respectively. Furthermore, 76.7, 44.7, 58.5 and 62.1 % of respondents felt Images 1, 2, 3 and 4 respectively will to a large extent prevent people from initiating smoking. There was no association between perceived effectiveness and gender. However, those younger than 15 years rated images on cancer of the airway and impotence as probably effective to a larger extent than did those who were 15 years and older (p = 0.032). CONCLUSION: Introduction of graphic health warnings, especially with an imagery depicting cancer and impotence may influence non-smokers to remain abstinent. Therefore, this study provides a template for a future policy-relevant study on graphic health warning in Nigeria.

Apparent or Standardized Ileal Digestibility of Amino Acids of Diets Containing Different Protein Feedstuffs Fed at Two Crude Protein Levels for Growing Pigs.

The current study determined the apparent or standardized ileal digestibility of amino acids (AID or SID of AA) in growing pigs fed diets containing three protein feedstuffs with different fiber characteristics at two dietary crude protein (CP) levels. Twenty boars (Yorkshire×Landrace) with average initial body weight of 35 (±2.6) kg were fitted with a simple T-cannula at the distal ileum. These pigs were offered six diets containing soybean meal (SBM), canola meal (CM) or corn distillers dried grains with solubles (corn-DDGS) that were either adequate (19%) or marginal (15%) in CP using a triplicated 6×2 Youden Square Design. Except for Met, Trp, Cys, and Pro, AID of AA was greater (p<0.05) in the SBM diet compared with the CM diet. Apparent ileal digestibility for Gly and Asp was greater (p<0.05) in the SBM diet compared with the corn-DDGS diet. The AID of Ile, Leu, Phe, Val, Ala, Tyr, and Asp was greater (p<0.05) in the corn-DDGS diet compared with the CM diet. Standardized ileal digestibility of AA was greater (p<0.05) in the SBM diet compared with the CM diet for all AA except Trp and Pro. The SID of Ile, Leu, Val, Ala, Tyr, and Asp was greater (p<0.05) in the corn-DDGS diet compared with the CM diet. It was concluded that protein feedstuff affects ileal AA digestibility and is closely related to dietary fiber characteristics, and a 4-percentage unit reduction in dietary CP had no effect on ileal AA digestibility in growing pigs.

Metabolizable energy content of wheat distillers' dried grains with solubles supplemented with or without a mixture of carbohydrases and protease for broilers and turkeys.

In this study, 2 experiments were conducted to determine the AME and AMEn of wheat distillers' dried grains with solubles (DDGS) without or with supplementation of an enzyme mixture containing xylanase, amylase, and protease (XAP) in broilers and turkeys. One hundred twenty-six male Ross 308 broilers (Experiment 1) or 126 male BUT 10 turkeys (Experiment 2) were offered a nutrient-adequate diet from d 1 to 14. On d 14, birds in each experiment were allocated to 6 treatments consisting of 3 levels of wheat-DDGS (0, 300, or 600 g/kg) and 2 levels of XAP (0 or 250 mg/kg diet) in a randomized complete block design. The AME or AMEn content of wheat-DDGS was determined from the slope of regression of wheat-DDGS-associated energy intake (kilocalories) against wheat-DDGS intake (kilograms). In Experiment 1, wheat-DDGS inclusion in the diets linearly decreased (P<0.05) DM retention, AME, and AMEn, irrespective of XAP supplementation. The AME of wheat-DDGS without or with XAP for broilers was 3,587 or 3,700 kcal/kg DM, respectively, and AMEn was 3,356 and 3,459 kcal/kg DM for wheat-DDGS without and with XAP, respectively. In Experiment 2, wheat-DDGS inclusion in the diet linearly decreased (P<0.05) DM retention irrespective of XAP supplementation. Diet AME and AMEn linearly decreased (P<0.05) as the level of wheat-DDGS increased in the diets without added XAP, whereas there was no effect of increasing wheat-DDGS level on dietary AME or AMEn in the XAP-supplemented diets. The AME of wheat-DDGS without and with supplemental XAP for turkeys were 3,355 and 3,558 kcal/kg DM, respectively, and AMEn was 3,109 and 3,294 kcal/kg DM, respectively, for wheat-DDGS without and with XAP. Supplemental XAP increased (P>0.05) the AME and AMEn of wheat-DDGS for broilers and turkeys by up to 6%. It was concluded that wheat-DDGS is a valuable source of AME for broilers and turkeys.

Sexual risk behaviours and HIV knowledge of migrant farm workers in a rural community in Nigeria.

Migration has been associated with a higher risk of STI/HIV but few studies have assessed the sexual risk behaviour of migrant farm workers in Nigeria. An exploratory survey was conducted to assess the knowledge of HIV/AIDS and sexual risk behaviours of migrant farmers in Saki West Local Government Area, Oyo State, Nigeria. Questionnaires were used to obtain information on socio-demographic and occupational characteristics, knowledge of HIV/AIDS, sexual behaviours and history of STI symptoms. Overall 518 respondents were interviewed, slightly over half were aware of HIV/AIDS; awareness was significantly lower among the females, those aged 15-24 years and those with no formal education. Majority (80.7%) were sexually experienced, the mean age at sexual debut was 19.4 +/- 5.2 years and 18.4 +/- 4.2 years for males and females respectively. Sexual intercourse with multiple sexual partners in the past year was reported by 24.6% (males, 35.7%, versus females, 10.4%, p < 0.05). Recent sexual intercourse with a casual partner was reported by 9.1% (12.8% males versus 4.4% females). Only 18.2% used a condom during the last casual sexual contact. Level of awareness of HIV is unacceptably low and sexual risk behaviours are prevalent among these workers. Appropriate sexual health and HIV prevention interventions should be instituted.

The effect of pH and chemical preservatives on the growth of bacterial isolates from some Nigerian packaged fruit juices.

Bacterial pathogens were isolated from some Nigerian packaged fruit juices. The isolates were characterized and identified as Bacillus licheniformis, Aeromonas hydrophila, Bacillus circulans, Proteus morganii, Pseudomonas cepacia, Bacillus alvei and Pseudomonas chlororaphis. The antibiotic susceptibility profile of the seven isolates was determined and it was discovered that 65% of the microorganisms isolated were resistance to the antibiotic used while 35% were sensitive. The effect of pH, benzoic acid and sodium chloride concentration on the growth rate of isolates was investigated. It was found that as the pH of the growth medium increased from 3 to 9, the rate of growth of most isolates also increased except for Pseudomonas cepacia, which had optimum growth at neutral pH 7. As the concentration of sodium chloride increased from 2 to 5%, the rate of growth of all the seven isolates decreased. It was also noted that as concentration of benzoic acid increased from 250 to 1000 mg L(-1) Bacillus licheniformis decreased from 1.330 to 0.167 nm, Aeromonas hydrophila decreased from 1.208 to 0.164 nm Bacillus circulans decreases from 1.158 to 0.299 nm, Proteus morganii decreases from 1.377 to 0.141 nm etc. The higher the concentration of Benzoic acid the lower the rate of growth of the isolates.

Bias: a review of current understanding.

The results of many research findings have come under scrutiny in recent years due to the introduction of systematic errors at one stage or the other of the research. Over the years, literature has been rife about the issue of bias with many authors describing unique types of bias. More often, researchers have often been left in the dark about the basic concept of this important phenomenon. Using a method of cross referencing, exploded tree search, consultation of textbooks of epidemiology and conference proceedings, this article examines the basic concept of bias and the current understanding of bias as present in various literature. A simple classification of biases into conceptualization, selection and information biases is proposed. A distinction is made of confounding as describing an association that is true but potentially misleading and bias which on the other hand creates an association that is not true. The article further goes on to describe the different types of biases applicable to different study designs before concluding on the need for researchers to pay attention to the issue of bias so as to make their studies useful to readers.

Sexual risk behaviours and HIV knowledge of migrant farm workers in a rural community in Nigeria

Migration has been associated with a higher risk of STI/HIV but few studies have assessed the sexual risk behaviour of migrant farm workers in Nigeria. An exploratory survey was conducted to assess the knowledge of HIV/AIDS and sexual risk behaviours of migrant farmers in Saki West Local Government Area, Oyo State, Nigeria. Questionnaires were used to obtain information on socio-demographic and occupational characteristics, knowledge of HIV/AIDS, sexual behaviours and history of STI symptoms. Overall 518 respondents were interviewed, slightly over half were aware of HIV/AIDS; awareness was significantly lower among the females, those aged 15-24 years and those with no formal education. Majority (80.7%) were sexually experienced, the mean age at sexual debut was 19.4 +/- 5.2 years and 18.4 +/- 4.2 years for males and females respectively. Sexual intercourse with multiple sexual partners in the past year was reported by 24.6% (males, 35.7%, versus females, 10.4%, p < 0.05). Recent sexual intercourse with a casual partner was reported by 9.1% (12.8% males versus 4.4% females). Only 18.2% used a condom during the last casual sexual contact. Level of awareness of HIV is unacceptably low and sexual risk behaviours are prevalent among these workers. Appropriate sexual health and HIV prevention interventions should be instituted

Condom use amongst out of school youths in a local government area in Nigeria.

BACKGROUND: Reported low condom use amongst out of school requires studying the context in which condom use occurs. METHODS: A cross sectional study of 350 out-of-school youth aged 15-24 years in a local government area of Nigeria was enrolled using cluster sampling. RESULTS: Those who had ever had sexual intercourse were 74.9%. Of these, 56.5% used no protection while 29.0% used condoms. Up to 78.6% have had sex within the preceding 12 months with 38.9% condom use. The commonest reason for non-condom use was that it reduces sexual enjoyment. Those who believed a single unprotected sexual exposure may result in HIV infection reported more condom use than those who believed otherwise (42% vs 27.2%, P<0.05). Those who had prior discussion with their partners on HIV/AIDS reported more condom use compared to those who had not (50% vs 25%, P<0.05). Also, those who had sexual intercourse occurring as a spontaneous event reported less condom use compared to those who have previously discussed about the possibility of having sex (68.0% vs 51.8%, P<0.05). CONCLUSION: Condom use is likely to occur within relationships where opportunity exists for discussion on sexual matters. Thus, further studies are needed on communication and condom use within sexual partnerships.

Socio-demographic characteristics of street children in rural communities undergoing urbanization.

BACKGROUND: The concept of the street child in rural communities has received little attention. This study describes the sociodemographic characteristics of the street children found in a group of rural communities. METHOD: This descriptive study is nested in a cross sectional analytical study of street children in a group of rural communities undergoing urbanization. A cluster sample of street children as defined by the United Nations was taken in the seven chosen political wards. RESULTS: Majority of the street children (88.9%) were within the age group 15-17 years with more males (58.3%) than females (41.7%). Up to 64.7% had attained secondary level education while only 3.9% had no formal education. A high percentage, (61.4%) were still attending school and 15.8% had no work. Of those who work on the streets, being an apprentice (16.4%), petty trading (15.0%), part-time driving (9.5%) and car washing (5.0%) were the commonest types of work. Of those still schooling, 41.6% had no form of part-time work on the streets. None of the street children lived on the street with 65% still living with parents. However, 75% had been involved in the street life for 1-2 years with a median time of 2 years. More than 30% of their parents work outside town. CONCLUSION: The street child in rural communities differs from the urban perception which often has to do with those living rough and existing outside the family framework. More studies would be needed on the driving factors for street life in rural communities undergoing urbanization.

Falls and outcomes amongst old people in rural dwellings.

BACKGROUND: Falls are the leading cause of injury deaths among people 65 years and older. This study gives an insight into the prevalence of falls among older people and how they occur in a rural setting in Nigeria. METHODS: A community based survey of 210 consenting old people aged 65 years and above selected using a multi-stage sampling technique was done. Study instrument was a semi-structured interviewer administered questionnaire and visual acuity was tested using Snellens chart. RESULTS: Incidence of falls was 21.4%. Of those who had falls, 86.7% were walking while 11.1% were either sitting or running when it occurred. The nature of the fall was tripping in 44.4%, slipping in 35.6% and hitting an object in 17.8% of cases. Consequences of falls included pain 48.9%, bruises 22.2%, lacerations 13.3% and fractures 11.1%. Females had more falls than males; 23.8% vs 19.0%, p = 0.40. Major injuries resulting from falls also occurred more frequently amongst females than males; 30.7% vs. 15.0%, p = 0.3. History of diabetes and alcohol use increased the odds of falling (OR 4.1, 95% CI 1.0 - 16.0; OR 2.2, 95% CI 1.0 - 4.6 respectively). Being in a monogamous marriage and having normal sight were protective of having falls (OR 0.4, 95% CI 0.2 - 0.9; OR 0.4, 95% CI 0.2 - 0.9 respectively). CONCLUSION: Falls often occur from tripping and slipping while females are more likely to have major injuries. Risk factors for falls were alcohol use and diabetes while having normal sight and being monogamous were protective. Prevention should aim at a life course approach to addressing these intrinsic and extrinsic factors.

Condom use amongst out of school youths in a local government area in Nigeria

Background: Reported low condom use amongst out of school requires studying the context in which condom use occurs. Methods: A cross sectional study of 350 out-of-school youth aged 15-24 years in a local government area of Nigeria was enrolled using cluster sampling. Results: Those who had ever had sexual intercourse were 74.9. Of these; 56.5used no protection while 29.0used condoms. Up to 78.6have had sex within the preceding 12 months with 38.9condom use. The commonest reason for non-condom use was that it reduces sexual enjoyment. Those who believed a single unprotected sexual exposure may result in HIV infection reported more condom use than those who believed otherwise (42vs 27.2; P0.05). Those who had prior discussion with their partners on HIV/AIDS reported more condom use compared to those who had not (50vs 25; P0.05). Also; those who had sexual intercourse occurring as a spontaneous event reported less condom use compared to those who have previously discussed about the possibility of having sex (68.0vs 51.8; P0.05). Conclusion: Condom use is likely to occur within relationships where opportunity exists for discussion on sexual matters. Thus; further studies are needed on communication and condom use within sexual partnerships