Co-occurrence of Modifiable Risk Factors for Cardiovascular Disease amongst Diabetic Patients in Lagos State, Nigeria.

BACKGROUND: Diabetes significantly increases the likelihood of developing cardiovascular disease (CVD). This risk can be reduced by addressing modifiable risk factors. The objectives of this study were to assess the modifiable risks for CVD amongst persons with diabetes and identify the factors associated with multiple risk factors. METHODS: This cross-sectional study was conducted amongst 357 diabetic patients attending a large tertiary hospital in Southwest Nigeria. Eligible patients were recruited consecutively on clinic days till the minimum sample size was reached. An interviewer-administered survey tool adapted from the World Health Organization STEPS was used to obtain information from study participants. The following risk factors were assessed: tobacco use, obesity, high blood pressure, physical activity, sedentary time and hours of sleep. Data were analysed using the STATA version 15.0 (Stata Corp.) statistical programme. RESULTS: The mean age of the participants was 61.7 ± 12.6 years, and they were mostly females (63.9%). Of the risk factors assessed, the most prevalent modifiable risk factors amongst the respondents were inadequate sleep - <8 h on average (91.6%), abdominal obesity (82.6%) and high blood pressure (72%). Others were inadequate physical activity (56%) and lifetime tobacco use (21%). Up to 40.3% of the diabetic persons had three or more co-existing CVD risk factors. Age, gender, work and marital status (P ≤ 0.01) were statistically associated with multiple CVD risk factors. Being male, unmarried and increasing age were predictors of multiple CVD risk factors amongst the diabetic patients. CONCLUSION: A significant proportion of the diabetic patients have multiple co-existing modifiable CVD risks. Abdominal obesity and poor sleep were the most prevalent. Older men who are unmarried were more likely to have multiple risks. Primary and secondary preventive measures to address CVD risks amongst diabetic patients are warranted and should target older unmarried men.

Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research.

BACKGROUND: A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort. METHODS: Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis. RESULTS: Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI. CONCLUSIONS: Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.

An evaluation of basic life support training among medical students in Southwest Nigeria: A web-based study.

Background: Basic Life Support (BLS) is considered a lifesaving measure and sound knowledge is expected among health professionals. Studies conducted among medical doctors and students in many developing countries show deficiencies in knowledge and practice of essential BLS skills. This study assessed the awareness, knowledge, perception, practice, accessibility and barriers to BLS training amongst medical students in South-Western Nigeria, exposing skill gaps and training challenges to inform appropriate solutions. Methods: This was a cross-sectional descriptive e-survey involving 2nd - 6th year medical students enrolled in 12 regional medical schools. Overall, 553 responses were received over a 3-month period from November 2020 to January 2021 and analyzed using IBM-SPSS 26. Results: Of the 553 respondents, 79.2% were aware of BLS however only 160 (29%) respondents had good knowledge of BLS principles. Increasing age, higher level of study, prior BLS training and being enrolled in College of Medicine, University of Lagos (CMUL) were significantly associated with a higher knowledge score (p<0.05). Majority (99.5%) considered BLS training necessary however, only 51.3% had prior training. Increased level of study correlated with prior BLS training (p<0.05) alongside higher BLS uptake by respondents from CMUL (26.7%) and College of Medicine, University of Ibadan (20.9%) compared to respondents from other schools (p<0.05). Only 35.4% had ever done Cardiopulmonary Resuscitation. Most respondents reported no confidence in performing BLS (67.1%) or in using an Automated External Defibrillator (85.7%). Unavailability of training opportunities in state (35%), town (42%) and cost (27%) were major barriers to BLS training identified. Conclusion: Despite a high level of awareness of BLS training, knowledge of BLS principles and its practice is poor among Nigerian medical students, reflecting a need to integrate stand-alone/structured BLS trainings into the medical curriculum to increase participation and accessibility by medical students.

A blended curriculum to improve student community health officers' competencies in newborn infection prevention and control.

BACKGROUND: Infections contribute significantly to neonatal mortality in Nigeria. Community health officers (CHOs) provide maternal, newborn and child health services at the primary health care level. However, newborn infection prevention and control (NB-IPC) is not included in their current training curriculum, which has little innovation in teaching methods. This study assessed the effectiveness of a blended curriculum on NB-IPC in improving the competencies of student CHOs. METHODS: This pre- and post-test study was conducted in the CHO training school of Lagos University Teaching Hospital (LUTH), which has 70 students enrolled. We developed and implemented a blended curriculum on NB-IPC using Kern's six-step framework. Twelve videos were recorded of content experts teaching various aspects of NB-IPC and were watched online or downloaded by students. Two interactive practical sessions were held in class. Pre- and post-course assessment of knowledge was with multiple choice questions, attitude with a Likert scale, and skills with an objective structured clinical examination (OSCE). Course satisfaction was also assessed with a validated scale. Paired t-test was used to determine mean differences at a significance level of 0.05. RESULTS: The mean knowledge score of students increased from 10.70 (95% confidence interval (CI): 10.15-11.24) pre-course out of a possible score of 20 to 13.25 (95%CI: 12.65-13.84) post-course (p < 0.001). Mean attitude score increased from 63.99 (95%CI: 62.41-65.56) out of a possible score of 70 to 65.17 (95%CI: 63.68-66.67) (p = 0.222). The mean OSCE score increased from 21.27 (95%CI: 20.20-22.34) out of a possible score of 58.5 to 34.73 (95%CI: 33.37-36.09) (p < 0.001). Mean post-course satisfaction score of students was 127.84 (95%CI: 124.97-130.89) out of a possible score of 147. CONCLUSION: The new curriculum on NB-IPC improved the competencies of student CHOs in LUTH and they were highly satisfied. The blended curriculum may be a feasible addition to learning in CHO schools across Nigeria.Key messageA blended curriculum on NB-IPC involving video teaching is effective in improving the competencies of student CHOs.

Depression and suicidal ideation among undergraduates in state tertiary institutions in Lagos Nigeria.

BACKGROUND: Depression is a common mental illness affecting majority of the world's population. However, evidence has shown that undergraduates are at an even higher risk compared to the general population, of developing depression due to the various challenges they face during that period. Suicide has been discovered to be the second leading cause of death among young people. Suicide ideation has been proven to be a predictor for not only suicide attempts but also completed suicides. Therefore, the aim of this study was to assess depression and suicidal ideation among undergraduates in the state tertiary institutions in Lagos, Nigeria. METHOD: This study was a descriptive, cross-sectional study carried out among undergraduates in two state tertiary institutions in Lagos, Nigeria using self-administered questionnaire. A total of 750 respondents were recruited using the multistage sampling technique. Data was analysed using SPSS version 27 and the level of significance was set at p -value < 0.05. RESULTS: The survey was conducted among undergraduates in the two state tertiary institutions in Lagos State: Lagos State University (48.3%) and Lagos State Polytechnic (51.7%). The mean age of the respondents was 21.5 (2.7) years. Majority of the respondents were females (54%), single (98.1%), Christians (70.3%), and the source of income of majority of the students was parents (72.8%). From the case vignette used in the questionnaire, 47.6% of the respondents were able to correctly identify depression. The prevalence of depression and suicidal ideation in this study was 22.5% and 21.6% respectively. Depression was statistically significantly associated with suicidal ideation (p < .001). Risk factors that were statistically significantly associated with depression and suicidal ideation were low self-esteem (p < .001), intake of recreational drugs (p < .001), alcohol dependence (p < .001), and positive history of bullying (p < .001). CONCLUSION AND RECOMMENDATIONS: The proportion of respondents with good knowledge of depression was not satisfactory. A strong relationship was found between depression and suicidal ideation indicating that people with depression are at a high risk of having suicidal ideation. Risk factors that were associated with depression and suicidal ideation were bullying, low self-esteem, intake of recreational drugs, alcohol dependence, poor academic performance, sexual assault and being hit by a partner. More works need to be done by the government and non-governmental organisations, school administration and parents to increase the awareness on the symptoms and manifestations of depression and reduce the burden created by some of the risk factors identified in this study to combat depression and suicidal ideation.

Electronic cigarettes use in COVID-19 era among students of a tertiary institution in Nigeria.

BACKGROUND: Electronic cigarette (e-cigarette) use is becoming popular among undergraduate students in Nigeria with a tendency for escalation because of the coronavirus disease 2019 (COVID-19) pandemic. AIM: The aim of this study was to assess electronic cigarette use in COVID-19 era among undergraduate students of a tertiary institution in Lagos state, Southwestern Nigeria. SETTING: A tertiary institution in Southwestern Nigeria. METHODS: The study design was a descriptive cross-sectional study with a pretested, structured, close- and open-ended self-administered questionnaire used for collection of data on knowledge, attitude and use of e-cigarettes. RESULTS: Data from 183 respondents were analysed. The mean age of respondents was 24.8 ± 3.38 years, most (63%) of whom were males. The prevalence of ever-use of e-cigarettes was 15.3% of which 60.7% reported increased use of e-cigarettes since the COVID-19 pandemic. Age, education, tribe and religion (p 0.001) were significantly associated with higher odds of use of e-cigarettes. CONCLUSION: This study found an increase in the quantity of e-cigarettes used and online purchase of the same by respondents since the COVID-19 pandemic. Paying attention to the rate of use and having control measures in place for online purchase of e-cigarettes by youths in Nigeria may be necessary in the years to come.Contribution: This study addresses a gap in the availability of knowledge of use of e-cigarettes among a growing population of youths in Nigeria.

Development and Comparison of Three Data Models for Predicting Diabetes Mellitus Using Risk Factors in a Nigerian Population.

OBJECTIVE: This study developed and compared the performance of three widely used predictive models-logistic regression (LR), artificial neural network (ANN), and decision tree (DT)-to predict diabetes mellitus using the socio-demographic, lifestyle, and physical attributes of a population of Nigerians. METHODS: We developed three predictive models using 10 input variables. Data preprocessing steps included the removal of missing values and outliers, min-max normalization, and feature extraction using principal component analysis. Data training and validation were accomplished using 10-fold cross-validation. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUROC) were used as performance evaluation metrics. Analysis and model development were performed in R version 3.6.1. RESULTS: The mean age of the participants was 50.52 ± 16.14 years. The classification accuracy, sensitivity, specificity, PPV, and NPV for LR were, respectively, 81.31%, 84.32%, 77.24%, 72.75%, and 82.49%. Those for ANN were 98.64%, 98.37%, 99.00%, 98.61%, and 98.83%, and those for DT were 99.05%, 99.76%, 98.08%, 98.77%, and 99.82%, respectively. The best-performing and poorest-performing classifiers were DT and LR, with 99.05% and 81.31% accuracy, respectively. Similarly, the DT algorithm achieved the best AUC value (0.992) compared to ANN (0.976) and LR (0.892). CONCLUSIONS: Our study demonstrated that DT, LR, and ANN models can be used effectively for the prediction of diabetes mellitus in the Nigerian population based on certain risk factors. An overall comparative analysis of the models showed that the DT model performed better than LR and ANN.

Internalization of stigma among parents of children with autism spectrum disorder in Nigeria: a mixed method study.

BACKGROUND: Autism Spectrum disorder (ASD) has uniquely stigmatizing aspects because children with ASD have no physical markers of their condition. Parents are usually blamed and judgment from others is often internalized (felt stigma). AIM: This study was conducted to determine knowledge about ASD, negative experiences (enacted stigma), internalization of stigma (felt or self stigma) and its correlates among parents of children with ASD in Lagos, Nigeria. METHODS: This was a cross-sectional study of 230 parents in Lagos, Nigeria employing mixed-method data collection methods. Quantitative data were collected using a structured interviewer-administered questionnaire and analyzed with Epi- Info™ version 7.0 statistical package. Data were summarized with proportions, mean and standard deviation. Chi square and Spearman's correlation tests were done, and the level of significance was pre-determined at 5% (p < 0.05). In-depth interviews were also conducted among six parents to further explore the topic. The interviews were analyzed narratively. RESULTS: The proportion of mothers and fathers were 175 (76.1%) and 55 (23.9%) respectively. The mean age of respondents was 42 ± 8.5 years. Overall knowledge of ASD was very poor as only 3(1.3%) had good knowledge. Overall, 122(53%) usually had negative experience of parenting a child with ASD (enacted stigma), mothers (17.1%) more than fathers (9.1%). Majority 192(83.5%) internalized stigma. There was a low-moderate correlation between 'enacted' stigma and 'internalized' stigma (ρ- 0.400, p < 0.001). From in-depth interviews, many parents revealed that their child's condition had negative effects on the family. Many also recounted negative experience of stigma. CONCLUSION: Overall, parents of children with ASD had poor knowledge of the condition. Majority internalized stigma and this increases with negative treatment from others. Parents should be properly educated about ASD. Community-based education to increase awareness about ASD in addition to encouraging people to show empathy and reduce stigmatizing behaviour towards parents of children with ASD are recommended.

Perspectives on the current state of Nigeria's emergency care system among participants of an emergency medicine symposium: a qualitative appraisal.

INTRODUCTION: Emergency care systems provide timely and relevant care to the acutely ill and injured. Published commentaries have characterised deficiencies in the Nigerian emergency care system and offered potential solutions but have not included the perspectives of the Nigerian public. A more inclusive approach that includes feedback from the public may help improve the Nigerian emergency care system through better understanding of the needs, values and expectations of the community. METHODS: Participants of an emergency medicine symposium participated in focus group discussions that were randomly divided into small groups led by two trained facilitators. These facilitators asked open-ended, semistructured questions to lead discussions in the English language. Participant responses were audio-recorded and transcribed verbatim into transcripts. Two independent investigators employed conventional content analysis to code the transcripts until thematic saturation was achieved. RESULTS: Three descriptive themes emerged characterising the current state of Nigeria's emergency care system as it relates to prehospital care delivery, hospital care delivery and health system governance: rudimentary, vulnerable and disconnected. At the prehospital level, concepts revolved around emergency recognition and response, ambulance and frontline providers, and cultural norms. At the hospital level, concepts centred around the health workforce, clinical competency, hospital capacity and the burden of financial hardship. At the health system level, concepts concentrated on healthcare access and healthcare financing. Opportunities for emergency care system improvement at each component level were identified and explored. CONCLUSIONS: The participants in this study identified shortcomings and opportunities to improve prehospital care, hospital care and health system governance. The results of this study may help healthcare professionals, policy makers and community leaders identify gaps in the emergency care system and offer solutions in harmony with the needs, values and expectations of the community. If successful, these community-informed interventions may serve as a model to improve emergency care systems throughout Africa.

Comparison of respiratory and skin disorders between residents living close to and far from Solous landfill site in Lagos State, Nigeria.

BACKGROUND: Solid waste dump sites have proven to have potentially high risk to human health as it serves as a source of air, soil and underground water pollution. AIM: This study aimed to assess and compare the knowledge, respiratory disorders and skin disorders between residents living close to and far from landfill sites in Lagos State, Nigeria. SETTING: Igando (a community within 5 km close to) and Badagry (a community beyond 5 km from) Solous Landfill sites in Lagos state, Nigeria. METHODS: A comparative cross-sectional study amongst 103 respondents recruited from each of the two study sites by multistage sampling method was carried out. Data were collected using pretested, structured, interviewer-administered questionnaire, and analysed using Microsoft Excel 2007, EPI Info 7 and WinPepi statistical software packages. Student t-test, Fisher's exact and Chi-square tests were carried out. The p ≤ 0.05 was considered statistically significant. RESULTS: The mean age of Igando and Badagry respondents was 34.18 ± 10.21 years and 32.62 ± 9.84 years, respectively. The two communities differed significantly (p 0.0001) with respect to distance of workplace from landfill site and duration of stay in the residential location. The mean knowledge score of respondents on respiratory and skin disorders associated with solid waste dump site close to landfill sites (82.53 ± 20.60) was statistically significantly higher than those of respondents far from landfill sites (71.84 ± 20.57) (p = 0.0003). Respiratory and skin disorders experiences of respondents close to landfill sites were statistically significantly (p 0.0001) higher than those of residents far from landfill sites with respect to wheezing, frequent sneezing, unpleasant odour, fever and skin rashes. CONCLUSION: Respiratory and skin disorders experienced by respondents close to landfill sites are higher than those of residents far from landfill sites. Landfill sites should not be located close to human settlements.

Results from the implementation of the World Health Organization Basic Emergency Care Course in Lagos, Nigeria.

Background: The emergency care of time-sensitive injuries and illnesses is increasingly recognized as an essential component of effective health care systems. However, many low- and middle-income countries (LMICs) lack healthcare providers formally trained in the care of emergency conditions. The Disease Control Priorities 3 project estimates that effective emergency care systems could avert up to half of all premature deaths in LMICs. Nigeria, a lower-middle income country of nearly 200 million people in Sub-Saharan Africa, could save approximately 100,000 lives per year with an effective emergency care system. The World Health Organization developed the Basic Emergency Care (BEC) course to train frontline healthcare workers in the management of emergency conditions in low resource settings. In this study we describe our work implementing the BEC course Nigeria. Methods: This study was designed as a mixed methods research analysis comparing pre- and post- course examination results and surveys to evaluate participant knowledge acquisition and levels of confidence with management of various emergency conditions. Thirty-two participants were involved in the course which took place over four days at the Lagos University Teaching hospital. Quantitative data was analyzed using Stata 14.2 (College Station, TX). Paired data sets were analyzed using McNemar's chi-squared. Unpaired data sets were analyzed using a Wilcoxon signed-rank test. Results: Post-course test scores showed significant improvement (p-value <0.001) as compared to pre-course. The average pre-course test score was 73% and average post-course score was 86.5%. Pre- and post-course questionnaires demonstrated significantly increased confidence in managing emergency conditions and agreement with course objectives. Conclusions: The WHO Basic Emergency Care (BEC) course successfully increased the knowledge and confidence of frontline emergency care providers in Nigeria. The course was well received by participants. Future study should focus on BEC course scalability and long-term knowledge retention.

Knowledge, attitudes and preventive practices for human Papilloma virus infection among female sex workers in Lagos metropolis.

INTRODUCTION: risky and hard-to-reach populations like female sex workers (FSW) face a huge burden with sexually transmitted infections (STIs) among which is human Papilloma virus (HPV) infection. This study was conducted to evaluate the knowledge, attitudes and preventive practices for HPV infection among FSW in Lagos, Nigeria. METHODS: a descriptive cross-sectional study was carried out among 403 respondents. The sampling units were FSW in brothels in two urban communities of Lagos. A multistage sampling technique was used for selection of respondents. Pre-tested, validated questionnaire was used for data collection. Responses to knowledge, attitude and practice questions were scored graded as poor (<50%) and good (≥50%). Bivariate analysis were carried out using Chi-square, Fisher exact test and student t-test. Logistic regression model was used for multivariate analysis. P-value < 0.05 was considered statistically significant. RESULTS: the mean age of the respondents was 32.97 ± 8.43. Majority of the respondents were within the age range of 18-34 years (51.61%), christians (51.12%), single (42.93%) and had secondary education (52.61%). Among the respondents 51.61% had good knowledge, 97.27% had good attitude and 62.28% had good preventive practice. FSW belonging to the age group 35-51 or 52-68 years, were more likely to have a good knowledge compared to those between 18-34 years. FSW with no formal education or living with a relative are less likely to have a good knowledge, compared to those having primary education or living alone. FSW with traditional or other religious beliefs are less likely to have good preventive practices against HPV compared to christian religious belief. Having tertiary education or married makes a FSW less likely, while being widowed makes her more likely to have good preventive practice. FSW living with friends are more likely to be exposed to good preventive practices compared to those living alone. CONCLUSION: there is a need for regular health education program on HPV for FSW in order to increase their awareness and encourage best preventive practices against HPV.

Knowledge, attitude and compliance towards travel vaccines among Nigerian travellers at an international airport.

BACKGROUND: The risk of contracting a travel-related disease does not only depend on the destination of travel and length of the trip, but also on the traveller's own health status. Travel vaccines avert the increase of communicable disease. Awareness of traveller's behaviours and their attitudes concerning infectious diseases can inform policy aimed at protecting the individual travellers, their contacts and the communities into which they travel. AIM: This study on travel vaccine was aimed to determine the level of knowledge, attitude and compliance to travel vaccines. SETTING: This study was conducted among Nigerian travellers at Murtala Mohammed International Airport, Ikeja, Nigeria. METHODS: It was a cross-sectional descriptive study using systematic sampling technique, with the aid of interviewer-administered questionnaire to select 198 respondents for the study. The statistical software EPI-Info 7 was used for data analysis. RESULTS: The mean age of respondents was 35.34 + 9.91 years and majority (58.1%) of the respondents were men. Majority (54.0%) were married and (43.4%) had tertiary education. About 35.9% were travelling to other African countries, 9.6% to Middle Eastern countries, 16.2% to Europe, 13.6% to North America and 7.6% to Australia. Their main purpose of travel was for employment or working (22.2%), business activities (20.7%), touring (16.2%) and visiting families and relatives (15.7%). About a half (41.4%) had good knowledge of travel vaccines, majority (83.8%) had positive attitude and majority (66.2%) had been vaccinated for yellow fever before travel. CONCLUSION: Significant associations exist between tribe, religion, education and knowledge of travel vaccines.