Impact of post-tuberculosis lung disease on health-related quality of life in patients from two tertiary hospitals in Lagos, Nigeria.

BACKGROUND: Post-tuberculosis (TB) lung disease is a recognised cause of chronic respiratory disease, and its impact on health-related quality of life (HRQoL) has not been extensively described. OBJECTIVES: To describe the clinical profile, spirometry impairment and impact of post-TB lung disease on HRQoL among patients attending two tertiary hospitals in Lagos, Nigeria. METHODS: We conducted a cross-sectional study and obtained data through interviews, chart reviews and physical examination. We measured dyspnoea severity using the Medical Research Council (MRC) scale, HRQoL with the St George's respiratory questionnaire (SGRQ) and performed spirometry. Univariate regression was used to explore the associations between selected variables and HRQoL. RESULTS: A total of 59 participants were recruited and their median (interquartile range (IQR)) age was 45 (36 - 60) years. The most frequent symptom was cough (93.2%; n=55) and sputum production (91.5%; n=54). Less than two-thirds of the participants (62.4%; n=38) had received treatment for TB on more than one occasion, 50.8% (n=30) had moderate to very severe dyspnoea on the MRC scale and 88.7% (n=47/53) had abnormal spirometry with the mixed pattern predominating in 56.6% (n=30) of the participants. The mean (standard deviation (SD)) SGRQ component score for symptoms was 43.89 (18.66), followed by activity (42.50 (22.68)), impact (29.41 (17.82)) and total components (35.78 (17.25)). Dyspnoea, cough, sputum production and weight loss were associated with worsened HRQoL. CONCLUSION: Post-TB lung disease was characterised by a high symptom burden, severe spirometry impairment and poor HRQoL. There is a need for increased recognition and development of guidelines for diagnosis and treatment of post-TB lung disease and for further studies to explore preventive strategies.

Knowledge and practice assessment, and self reported barriers to guideline based asthma management among doctors in Nigeria.

BACKGROUND AND OBJECTIVE: Doctors' knowledge contributes to practice and quality of care rendered to patients. To assess the knowledge and practice assessment and self reported barriers to guideline-based management among doctors. SUBJECTS AND METHODS: This was a cross-sectional study among doctors from various part of the country attending a continuing medical education (CME) program in Lagos, Nigeria. We used a self-administered, pretested, semistructured, validated questionnaire based on the Global Initiative for Asthma (GINA) guideline. RESULTS: Of the 98 participants, 41 (42%) and 18 (18.4%) had good level of asthma knowledge and practice, respectively. There was no relationship between level of knowledge and practice and the level of knowledge was not associated with the practice (X2 = 6.56, P = 0.16). The most reported barriers to good guideline-based practice were the unavailability of diagnostic and treatment facilities (44.3%), poor medication adherence (25.7%), and high cost of asthma medications (18.6%). CONCLUSION: The level of asthma knowledge and practice, respectively, among doctors in Nigeria is low and there is no relationship between level of knowledge and practice. Unavailability of diagnostic and treatment facilities, poor medication adherence, and high cost of medications are important barriers to good practice. There is a need to improve asthma education among doctors in Nigeria. Addressing barriers to good practice is essential for the translation of knowledge into practice.

Tuberculosis infection prevention and control measures in DOTS centres in Lagos State, Nigeria.

Nigeria is a high tuberculosis (TB) burden country. However, there is limited evidence on implementation of tuberculous infection prevention and control (TBIC) practices in Nigeria. To assess TBIC practices, and barriers to their implementation, in TB-DOTS centres in Lagos State, Nigeria. A descriptive cross-sectional study was used to assess 112 TB-DOTS centres in primary and secondary health facilities in Lagos State using mixed methods. Quantitative data comprised a survey and measurement of the air exchange rate in a subsample of centres. The qualitative aspect comprised focus-group discussions to highlight health care workers' (HCWs') perceptions of TBIC guidelines and barriers to their implementation. The majority of the DOTS centres had a dedicated TBIC officer, while a fifth (21%) had documented TBIC plans. About 57% of DOTS centres had staff that had been trained on TBIC and 37% provided some form of personal respiratory protection (face masks/tissue papers) for staff or patients. The air exchange rate was adequate in 21% of centres. The HCWs' perception of being at risk of contracting TB was reported to affect the way they relate to TB patients. The key barrier to implementing TBIC was the design of DOTS centres. TBIC measures at study centres were inadequate. Institutional commitment, renovation of existing and appropriate design of new DOTS centres in the future to improve TBIC implementation is recommended. .

Assessment of the knowledge of teachers about asthma and the availability of facilities for asthma care in public secondary schools in Lagos, Nigeria.

BACKGROUND: Asthma is a common chronic illness affecting young people. Asthma management at schools may be influenced by teachers' knowledge of the condition and the availability of treatment facilities. OBJECTIVES: To assess the knowledge of secondary school teachers in Lagos, Nigeria, regarding asthma and to evaluate management options available at schools. METHODS: A descriptive cross-sectional study was conducted. Schools were selected by proportional sampling of the educational districts, followed by stratified single-stage cluster sampling. All consenting teachers in the 54 selected schools were recruited. A self-administered questionnaire was used for data collection. A composite score was calculated, with 32 as the maximum possible. Knowledge was regarded as poor if scores were <16, fair for scores between 16 and 21, and good if scores were ≥22. RESULTS: Results show that 475 (48.1%) of the respondents had poor knowledge, 414 (41.9%) had fair knowledge, and only 99 (10%) had good knowledge. Better knowledge about asthma was associated with personal experience (χ² =16.466; p=0.001) or history of a family member with the condition (χ² =6.412; p=0.04). Of the 54 schools surveyed, only 9 (16%) had a school clinic, while a school nurse was available at only 4 (7.41%) of the schools. None of the schools had access to a nebuliser in case of an asthma emergency. CONCLUSION: Teachers in secondary schools in Lagos have unsatisfactory knowledge about asthma and are not equipped to support affected students during an asthma episode.

Tuberculosis infection control measures in health care facilities offering tb services in Ikeja local government area, Lagos, South West, Nigeria.

BACKGROUND: Tuberculosis infection among health care workers is capable of worsening the existing health human resource problems of low--and middle-income countries. Tuberculosis infection control is often weakly implemented in these parts of the world therefore, understanding the reasons for poor implementation of tuberculosis infection control guidelines are important. This study was aimed at assessing tuberculosis infection control practices and barriers to its implementation in Ikeja, Nigeria. METHODS: A cross-sectional study in 20 tuberculosis care facilities (16 public and 4 private) in Ikeja, Lagos was conducted. The study included a facility survey to assess the availability of tuberculosis infection control guidelines, the adequacy of facilities to prevent transmission of tuberculosis and observations of practices to assess the implementation of tuberculosis infection control guidelines. Four focus group discussions were carried out to highlight HCWs' perceptions on tuberculosis infection control guidelines and barriers to its implementation. RESULTS: The observational study showed that none of the clinics had a tuberculosis infection control plan. No clinic was consistently screening patients for cough. Twelve facilities (60%) consistently provided masks to patients who were coughing. Ventilation in the waiting areas was assessed to be adequate in 60% of the clinics while four clinics (20%) possessed N-95 respirators. Findings from the focus group discussions showed weak managerial support, poor funding, under-staffing, lack of space and not wanting to be seen as stigmatizing against tuberculosis patients as barriers that hindered the implementation of TB infection control measures. CONCLUSION: Tuberculosis infection control measures were not adequately implemented in health facilities in Ikeja, Nigeria. A multi-pronged approach is required to address the identified barriers to the implementation of tuberculosis infection control guidelines.

Video-assisted thoracic surgery in a Nigerian teaching hospital: Experience and challenges.

BACKGROUND: Video-assisted thoracic surgery (VATS) is well established. Its application in Nigeria has however been limited and not been reported. The aim of this study was to describe our institutional experience and challenges with VATS. MATERIALS AND METHODS: This was a retrospective cross-sectional study of all patients that underwent VATS in our institution between March 2008 and June 2013. Data were extracted from a prospectively maintained database. RESULTS: Two hundred and sixty-one patients were assessed as potential VATS cases. VATS was initiated in 26 patients, but completed in 25 patients (9.6%) as there was one case of conversion of a planned VATS bullectomy due to the failure of one lung ventilation. There were 12 males and 13 females. Mean age was 40.7 ± 13.9 years. The indication was interstitial lung disease in 9 patients (36%), malignant pleural effusion in 6 patients (24%), spontaneous pneumothorax in 5 patients (20%), indeterminate pulmonary nodule in 2 patients (8%), pleural endometriosis in 2 patients (8%) and bronchogenic cyst in one patient (4%). Procedures performed were lung biopsy in 13 patients (52%), pleural biopsy and pleurodesis in 6 patients (24%), bullectomy and pleurodesis in 5 patients (20%) and excision of bronchogenic cyst in one patient (4%). Mean hospital stay was 4 ± 0.7 days. There were no complications and no mortalities. CONCLUSION: VATS is being performed in our institution with successful outcomes. The use of VATS in Nigeria is encouraged. The relatively high cost of VATS is, however, a major limitation to more widespread use.

Screening for diabetes mellitus and human immunodefiency virus infection in persons with tuberculosis.

INTRODUCTION: Nigeria is a country saddled with a high tuberculosis (TB) and human immunodeficiency virus (HIV) burden but the possible combination of these communicable diseases with diabetes mellitus (DM) has been overlooked. We undertook to determine the burden of HIV and DM in persons with TB by documenting the prevalence rates of these disorders. METHODS: This is a cross-sectional Study that was conducted within 54TB/DOT centers in Lagos State. A total of 3,376 persons with TB who were on antiTB drugs were screened for HIV and DM using standardized tests. Statistical analysis was performed using Students t test and chi square. RESULTS: The frequency of occurrence of DM in TB and that of HIV in TB were comparable (4.8% Vs 3.5%). The Study subjects with DM were older, had higher waist circumference measurements and had higher proportions of hypertension compared to the subjects without DM. The combination of HIV and DM in TB was found in (0.3%). We also noted that DM in TB and HIV in TB occurred more frequently in the third and fourth decades of life. CONCLUSION: This study demonstrated the potential co existence of HIV, DM and Tuberculosis. It is therefore important that these two diseases are sought for in patients with TB considering the changing epidemiology of these diseases particularly in developing countries like Nigeria.

Body mass index and asthma severity in a population of Nigerian asthmatics.

BACKGROUND: Asthma and obesity have considerable impact on public health. There is increase prevalence of both conditions worldwide. This study was undertaken to determine the prevalence of obesity among asthma patients as well as determine the effect of body mass index (BMI) on asthma severity and pulmonary functions. METHODS: The study was conducted at the asthma clinic of the medical outpatient of Lagos State University Teaching Hospital, Ikeja. Ethical clearance was obtained from the hospital's research and ethics committee. Non probability sampling method was used with consecutive asthma patients diagnosed by the respiratory physicians according to NHLBI guideline recruited into the study. The weight, height and pulmonary function tests were carried out using standard methods. Acarefully designed interviewer administered questionnaire were used to collect information on the socio demographic characteristics of the patient, asthma symptoms, control use of rescue medications and emergency visits. RESULTS: One hundred and fifty eight (158) asthma patients participated in the study. There were 63 (39.9%) males and 95 (60.1%) females. The prevalence of obesity was 53.8%. The mean age of respondents was 46.48 +/- 17.16 years. Age, educational level and employment status were related to the body mass index while gender and duration of asthma were not. There was no difference in the severity of asthma and utilization of emergency services across the BMI categories. The obese asthmatics generally recorded lower lung function volumes compared with the non-obese asthmatic groups. CONCLUSION: Prevalence of obesity is high among the asthmatics studied. There is no difference in asthma severity across the BMI categories. Pulmonary functions are lower in obese asthmatics.

Willingness of Nigerians to donate a kidney.

BACKGROUND: Kidney transplantation is a popular modality of RRT in the developed world. OBJECTIVE: To assess the willingness of the general population of Nigerians across the country to donate a kidney METHODS: This is a multiregional, cross sectional, questionnaire based study. One thousand Three hundred respondents participated in the study. This study was carried out in four major Towns and cities across Nigeria between January 2009 and December 2010. The locations are Birnin Kebbi in the north, Ilorin in the middle belt, Iddo Ekiti in the south and Lagos, the economic capital of Nigeria. The respondents were randomly selected within the four localities. Those below the age of 16 or above the age of 65 years were excluded from the study RESULTS: There were 727 (55.9%) males. The mean age (S.D) of respondents was 39.5 (10.7) years. The largest population of participants, 494 (38.3%) were non health workers and 692 (53.2%) of them were Muslims. Eight hundred and fifty eight (66%) of the participants were willing to donate a kidney. Twenty five percent (25% were not willing and 115 (8.9%) were not sure. Majority of those who were unwilling to donate a kidney, 325 (99.4%) will not change their minds even if they were to be given incentives CONCLUSION: Nigerians are willing to donate a kidney irrespective of geographical location, religion or gender and many are willing to do so altruistically.

Five-year Audit of Spirometry at the Lasuth; Ikeja; South-West Nigeria

Spirometry is a non-invasive tool of importance in respiratory medicine. There is an enormous burden ofpulmonary disease worldwide, including in Nigeria.This retrospective study was done to determine the utilisation of spirometry services in the Lagos StateUniversity Teaching Hospital (LASUTH). It determined the sources of referral, indications, and pattern of pulmonary abnormalities.This is a retrospective study. An audit was done on the data collected at the Pulmonary Function Laboratory of the LASUTH between September 2006 and October 2011. Spirometry was done using the Gold Standard Vitalograph spirometer. The demographic characteristics of the patients who had spirometry as well as FEV1, (forced expiratory volume in 1 second)FVC (forced vital capacity), and their predicted values were noted.A total of 849 patients had spirometry done over the 5-year period. Slightly more than half were male patients. The mean age of the patient was 50±19 years. There was a steady increase in the number of spirometry tests performed from 2006 reaching a peak in 2009. Thereafter, a sharp decline was seen in 2010 with a steady rise in the first 10 months of 2011.The most common indication for spirometry was in the evaluation and assessment of asthma in 487 patients (57%). Most of the referrals for spirometry were from the medical department of the hospital representing 532 (63%) patients; 202 (24%) of the request were from the general out-patient department by family physicians, while 115 (13%) came from the surgical department. The outcome of the ventilatory abnormalities showed that 372 (44%) had normal ventilatory indices, 206 (24%) had obstructive patterns,169 (20%) had mixed type, while restrictive patterns were seen in 102 (12%).We concluded that although spirometry is frequently used in our clinical practice, this can be improved upon

Understanding medication and use of drug delivery device by asthmatic in Lagos.

BACKGROUND: There are several internationally accepted guidelines for the management of asthma. OBJECTIVE: To examine the utilization of these guidelines in the management of asthmatics as well as the use of inhaler devices among the asthmatics presenting for specialist assessment and treatment in Lagos, Nigeria. METHODS: One hundred and six consecutive patients with physician-diagnosed asthma referred on account of poor control for specialist review participated in the study between April 2006 and March 2007. The setting was the Chest Clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos. The patients aged between 13 and 64 years were interviewed about asthma control using previous hospitalization, frequency of night-time symptoms, and frequency of attendance at The Emergency Unit. Their knowledge of medications was assessed. Inhaler techniques were directly observed. RESULTS: Fifty two (49.1%) had previous hospitalization for asthma. Fifty (47.2%) had weekly nighttime symptoms. Forty-eight (45.3%) had exacerbations requiring treatment at the emergency room in the week preceeding the interview. The metered dose inhaler was the commonest drug delivery device, in use by 72 (67.9%) of the patients. Thirty-two (30.2%) used diskus. Only 10 (10.6%) used nebulisers at any point. The inhaler technique was rated as good by thirty-four (47.2%) out of the seventy-two respondents and poor by thirty-eight (52.8%). Only thirty-four satisfactorily performed all steps. One hundred respondents (943%) skipped their medications. Majority of the asthmatics did not receive any health education about their condition. Possession of peak flow meter and use were low among the patients with only 22 (20.8%) having one. CONCLUSION: Asthma control is poor among the patients in Lagos, Nigeria. Poor knowledge of disease, medication use and inhaler techniques contribute significantly to this problem.