Human immune responses to vaccines in the first year of life: biological, socio-economic and ethical issues - a viewpoint.

Human newborns are vulnerable to infectious diseases that account for majority of the morbidity and mortality, particularly in first year of life. Vaccines have become the most effective public health intervention strategy to curtail the prevalence of these infectious diseases. Although vaccines against a number of diseases exist, there are no vaccines against many other diseases that commonly affect children. The adequate assessment of immune responses to vaccines is an important step in the development of vaccines. However, a number of biological and "non-medical" socio-economic and ethical factors could influence either the administration and/or evaluation of vaccines in infants. Recognition and understanding of these determinants are crucial in planning interventions and for logical interpretations of results.

Roles of family dynamics on adherence to highly active antiretroviral therapy among people living with HIV/AIDS at a tertiary hospital in Osogbo, south-west Nigeria.

BACKGROUND: Adherence to highly active antiretroviral therapy (HAART) has been proven to be the only effective treatment for HIV/AIDS worldwide. Good adherence to HAART might require good family support. OBJECTIVE: To determine the family dynamics and social support of people living with HIV/AIDS (PLWHA) and its roles on HAART adherence at an ARV treatment clinic in Osogbo, Nigeria. METHOD: Descriptive cross-sectional study. Consenting PLWHA on HAART were interviewed using pre-tested semistructured questionnaire incorporating Perceived Social Support- Family Scale and Family APGAR. HAART adherence was measured using patient self report. RESULTS: A total of 379 PLWHA were interviewed. Their mean age was 40.8 (SD=9.9) years. Most (60.7%) were females. More than half (55.7%) were currently married and the majority (72.1%) had secondary education and were Yoruba (86.3%). Most respondents (95.5%) were adherent to HAART. Over 90% were satisfied with support received from their family while 82.3% were treated like other family members. Most attributed their HAART adherence to the care and support received from their family. CONCLUSION: Most PLWHA had good social support and were adherent to HAART.

Construct validation of an instrument to measure patient satisfaction with pharmacy services in Nigerian hospitals.

BACKGROUND: Patient satisfaction is a multidimensional construct that reflects the type and quality of service provided by healthcare providers, how well it is delivered, and the extent to which the expectations and needs of patients are met. As a performance measure, patient satisfaction has been defined as the personal evaluation of health care services and providers. OBJECTIVE: To develop a patient satisfaction scale, that could be used to assess the quality of pharmacy services provided in Nigerian hospitals and to determine the construct validity of the scale with a view to identifying the factors that may be considered relevant to the target users. METHODS: The questionnaire was a 35-item inventory titled "Patient Satisfaction Survey (PSS)". This study was carried out in three university teaching hospitals located in Southwestern Nigeria. The patient satisfaction survey instrument (PSS) was administered on 506 clinic outpatients who patronised the hospital pharmacies. Participation in the study was voluntary with appropriate informed consent. Ethical approval was obtained for this study from the Medical and Ethics Committee of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC). RESULTS: Patients with post secondary education were in the majority with a frequency of 224 (44.3%) subjects. This was followed by a frequency of 116 (22.9%) for those with secondary education. Eighty-seven (17.2%) of those included in the main study had primary education 64 (12.7%) did not receive any formal education. Fifteen (3%) out of the 506 sampled did not indicate their level of education. CONCLUSION: This study developed a scale to measure patient satisfaction with pharmaceutical services in selected Nigerian university teaching hospitals. The final 25 item scale presents significant and stable coefficients of correlation and yielded six derived dimensions of patient satisfaction.

Researching the vulnerables: issues of consent and ethical approval.

Imagine you are a biomedical scientist attempting to cross a busy, beggar-crowded road in Lagos. You suddenly notice that the loud horns of the speeding cars, trucks and trailers draw no visible physiologic response from any of the beggars including their children and babies, unlike the rest of the crowd. Consequently, certain questions such as the following begin to engage your mind: Is this phenomenon a kind of habituation? If so, is its onset the same for the blind ones amongst them? Have these beggars acquired a neural system absent from "normal" people? If so, just how long does it take for such a system to be established? At the very height of this creative outburst, you however realize that the informed consent and ethical approval you would need for this particular research differs from the type you have previously encountered in your career.... Although the above scenario suggests that new and difficult ethical questions may confront scientists while pursuing their curiosity, our research ethics guidelines do not currently address this issue. This paper explores some of the ethical challenges involved in carrying out basic research on vulnerable subjects such as beggars. It highlights how the notions of autonomy and informed consent in this context become vague, thus, liable to exploitation. Ultimately, the paper offers a useful framework in relation to developing a research ethics committee charged with the moral mandate of overseeing the integrity of research involving this vulnerable population in particular and basic biomedical research in general.

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