Prevalence of Hypertension and Associated Factors among Schoolteachers in Calabar, Nigeria: A Cross-Sectional Study.

BACKGROUND: Africa has the highest prevalence of hypertension at 46%. Schoolteachers are vulnerable to hypertension due to work-related and general risk factors. Identifying these factors is key to providing interventions. AIM: This study aimed to determine the prevalence of hypertension and associated factors among schoolteachers in Calabar, Nigeria. METHODS: This was a cross-sectional study of 427 randomly selected schoolteachers who were recruited through a multistage sampling technique. Questionnaires were self-administered, and blood pressure measurements were done. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 20. A binary logistic regression analysis was used to determine factors associated with hypertension at a 5% significance level. RESULTS: The mean age of the participants was 38 ± 9 years, and 65% of them were females. The prevalence of hypertension was 32%. The adjusted model showed that age and body mass index (BMI) were significantly associated with hypertension. The teachers in the 30-39 (adjusted odds ratio [aOR] = 2.63, 95% confidence interval [CI]: 0.93-7.43, P = 0.07), 40-49 (aOR = 6.27, 95% CI: 2.08-18.91, P < 0.01), and ≥50 (aOR = 7.95, 95% CI: 2.24-28.20, P < 0.01) year age categories had increased odds of being hypertensive than those in the 20-29-year-old age group. Those who were overweight (aOR = 2.63, 95% CI: 1.52-4.57, P < 0.01) or obese (aOR = 2.15, 95% CI: 1.21-3.85, P = 0.01) had two-fold increased odds of having hypertension compared with those who had normal weight. CONCLUSIONS: Increasing age and BMI are risk factors for hypertension in this study. Health interventions should focus on weight control, especially among older teachers.

Inflammatory Bowel Disease in Adults - Experience and Challenges in Gastroenterology Practices in Calabar, South-South Nigeria.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract that is reported to be rare in Africans. The objective of this study is to share the experience of our Gastroenterology practice in Calabar, Cross River State on IBD. METHODS: This is a ten-year review of the records of patients visiting the Gastroenterology clinic of the University of Calabar Teaching Hospital and two private gastroenterology clinics in Calabar Municipality. The diagnosis of IBD was made based on clinical, laboratory, endoscopic, and histological data obtained. RESULTS: Eight patients presented with features consistent with IBD. Six had ulcerative colitis while 2 had Crohn's disease. Seven patients had moderate disease with the main clinical features being recurrent mucoid bloody diarrhoea. All the patients had treatments with either sulphasalazine or mesalazine as well as azathioprine, steroids and antibiotics with variable response. One patient had strictures requiring a colostomy, while another developed colorectal cancer as complications of IBD. CONCLUSION: Although IBD is uncommon in Nigeria, a high index of suspicion is important, especially in patients presenting with the recurrent passage of mucoid bloody stools. Hence, the role of colonoscopy and histology are invaluable in establishing the diagnosis.

FONDEMENT: La maladie inflammatoire de l'intestin (MII) est un trouble inflammatoire chronique du tractus gastro-intestinal qui est rapporté comme étant rare chez les Africains. L'objectif de cette étude est de partager l'expérience de notre pratique en gastroentérologie à Calabar, dans l'État de Cross River, sur la MII. MÉTHODES: Il s'agit d'une revue de dix ans des dossiers des patients fréquentant la clinique de gastro-entérologie de l'Hôpital universitaire de Calabar et de deux cliniques privées de gastroentérologie dans la municipalité de Calabar. Le diagnostic de MII a été posé sur la base de données cliniques, biologiques, endoscopiques et histologiques obtenues. RÉSULTATS: Huit patients présentaient des caractéristiques compatibles avec la MII. Six présentaient une colite ulcéreuse tandis que 2 présentaient une maladie de Crohn. Sept patients avaient une maladie modérée avec comme principale caractéristique clinique des diarrhées muqueuses sanglantes récurrentes. Tous les patients ont été traités soit avec de la sulfasalazine soit avec de la mésalazine ainsi que de l'azathioprine, des stéroïdes et des antibiotiques avec une réponse variable. Un patient avait des sténoses nécessitant une colostomie, tandis qu'un autre développait un cancer colorectal comme complications de la MII. CONCLUSION: Bien que la MII soit rare au Nigeria, un indice de suspicion élevé est important, surtout chez les patients présentant un passage récurrent de selles muqueuses sanglantes. Ainsi, le rôle de la coloscopie et de l'histologie est inestimable pour établir le diagnostic. MOTS-CLÉS: Adultes, Maladie de Crohn, Maladie inflammatoire de l'intestin, Colite ulcéreuse.

Process modeling and simulation of Gmelina arborea (GmW) and Mansonia altissima (MaW) wood drying.

This study simulate the process modeling of drying characteristics of Gmelina arborea (GmW) and Mansonia altissima (MaW) wood under the influence of various process variables such as drying time, drying temperature, and airflow velocity. GmW and MaW moisture desorption isotherms, kinetics, and thermodynamics were also studied. Five (5) thin-layer and desorption isotherm drying models were used to model the moisture ratio and water activity data from the process. According to the anatomical analysis, the GmW sample has an average lumen size of 147.44 m, indicating a high moisture content. The results showed that the Guggenheim, Anderson, and de Boer (GAB) model with the lowest sum of squared error value (0.046) demonstrated the best-fit to the experimental desorption data for GmW samples and the Henderson-P model for MaW samples, while the Demir et al. model emerged as the best kinetics model fit for describing the moisture desorption isotherm and thin-layer drying kinetics. GmW effective diffusivity (Deff) values ranged from 3.671 × 10-8 to 5.378 × 10-8 m2/s and MaW effective diffusivity (Deff) values ranged from 2.923 × 10-8 to 4.678 × 10-8 m2/s. GmW and MaW activation energies were 252.702 kJ/mol and 313.604 kJ/mol, respectively. The thermodynamic studies revealed that the heat and mass transfer coefficients varied linearly with temperature, as the change in enthalpy (ΔH) and change in entropy (ΔS) decreased while the Gibbs free energy (ΔG) increased. The results obtained from this study demonstrated that the proposed drying process modeling and simulation approach could be successfully applied to investigate the wood drying phenomena. The information can be used to reduce the drying costs and improve the wood quality.

Managerial competencies-A survey of healthcare managers in a tertiary hospital in Calabar, South-South Nigeria.

BACKGROUND: Tertiary hospitals are specialized institutions that provide managed care for patients. It has been shown that the productivity of any organization/institution is as good as the performance of its managers. AIM: This study assessed the management knowledge of Healthcare Managers in a tertiary hospital in Calabar, Nigeria. METHODOLOGY: This was a descriptive cross-sectional study that employed a structured questionnaire (adapted from the Health Leadership Alliance competency directory). Data were analyzed using SPSS version 20. RESULTS: A total of 266 managers were included in this studywith a M: F ratio of 1.3:1. The knowledge rating of role of non-clinical professionals, regulatory agency standards, preparation of business communication, change process management and policy formulation and analysis varied significantly among the three levels of management (p < 0.05). Less than 50% of operational and middle managers rated themselves as experts in all the competency domains while majority (80%) of strategic managers rated themselves as more than proficient in most of the competency items. CONCLUSION: There is inadequate managerial knowledge at all levels of management in a typical tertiary hospital in Nigeria with the potential to impact negatively on quality healthcare delivery.

Implementation of multi-criteria decision method for selection of suitable material for development of horizontal wind turbine blade for sustainable energy generation.

The material selection process for producing a horizontal axis wind turbine blade for sustainable energy generation is a vital issue when using Nigeria as a case study. Due to the challenge faced with the low wind speed variations. However, this paper focuses on implementing MCDM for the material selection process for a suitable material for developing a horizontal wind turbine blade. This paper used a quantitative research approach using AHP and TOPSIS multi-criteria decision method. The study put into consideration the environmental conditions for the material selection process when designing the questionnaire. The authors extracted the data used for the selection process from the 130 research questionnaire distributed to materials engineers and renewable energy professionals. This research considered four alternatives that is, aluminum alloy, stainless steel, glass fiber, and mild steel to determine the best material for the wind turbine blade. Also, the model has four criteria and eight sub-criteria used for developing the pair-wise matrix and the performance score used for the ranking process of the alternatives. The result shows that a consistency index of 0.056 and a consistency ratio of 0.062 gotten via the AHP method is workable for material selection practice. 78%, 43%, 67%, and 25% are the performance scores for the four alternatives via the TOPSIS techniques. In conclusion, aluminum alloy is the best material, followed by glass fibre. Therefore, the decision-makers recommended aluminum alloy; hence, manufacturers should apply aluminum alloy to develop the wind turbine blade for sustainable energy generation.

Public Awareness of Hepatitis B Virus Infection in Cross River State, Nigeria: A Population-Based Survey.

BACKGROUND: Hepatitis B Virus (HBV) infection is a public health problem that is endemic in Nigeria. Cross River State, a tourist state, located in the coastal area of Nigeria has a relatively high prevalence rate. Insufficient knowledge and negative attitudes are barriers to effective control of infectious diseases. OBJECTIVES: To determine the Knowledge, Attitude and Practice (KAP) of HBV amongst residents of Cross River State, Nigeria. METHODS: This was a cross sectional descriptive study. A total of 1,620 healthy adults from the three senatorial districts in Cross River State participated in the study from March to September, 2015. KAP towards HBV was assessed using a structured pre-tested questionnaire. Categorical variables were described as frequencies and continuous variables as median and interquartile range. In the inferential analysis, Kruskal-Wallis test was used to determine the relationship between socio-demographic variables and median KAP scores. A p value < 0.05 was considered significant. All analyses were performed using Stata 12 statistical package. RESULTS: A total of 1,465 respondents completed the questionnaire correctly giving a response rate of 91%. The M: F ratio was 1:1.8. The median age was 38 years. Majority (61%) was married and 32% had formal education up to the tertiary level. Only 45% knew that HBV causes hepatitis. Knowledge of routes of transmission was >50% for blood transfusion, sexual contact and sharps but < 48% for vertical transmission. Median and interquartile range of knowledge scores for the south, central and northern senatorial districts were 8 (2-14), 13 (5-17) and 14 (6-18) which varied significantly with age (p =0.027). The overall attitude and practice towards persons living with HBV was poor. There was good correlation between KAP scores (p<0.05). CONCLUSION: Knowledge of hepatitis B is low among adults in Cross River State. This correlates with poor attitude and practice towards HBV. There is need to utilize health education strategies to improve awareness among the populace, if Nigeria is to meet the global target of elimination of viral hepatitis by 2030.

Knowledge of hepatitis B virus infection among traders.

INTRODUCTION: Hepatitis B virus (HBV) is a public health problem in Nigeria, with 13% of its general population having evidence of a previous or current infection. Lack of awareness of HBV, its risk factors, and its consequences are recognized as major deterrents to adopting positive preventive behavior including immunization among HBV high-risk groups. OBJECTIVE: The objective of this study is to evaluate the knowledge, attitude, and practice (KAP) of HBV infection among traders. MATERIALS AND METHODS: A structured KAP questionnaire on HBV infection was administered to traders as part of the activities to mark the World Hepatitis Day in 2014. A score was created for the correct answer to 20 questions. RESULTS: A total of 335 traders were interviewed for this study. The mean age was 33.08 ± 13.8 years and the median age was 29 years. There were 165 males and 170 females. Majority of the traders had secondary education (57.1%) and were of the Ibibio and Igbo tribes. Only 10.4% had HBV vaccination. Only 44.2% of the traders reported having any knowledge of HBV. The most common source for the knowledge was television/radio (25%) and hospitals (22%). The median (interquartile range) of the overall KAP score was low (11, 5-16). The score was least in persons aged 35 years and above, but the difference was not statistically significant (P = 0.33). CONCLUSION: The knowledge of HBV is low among traders in Calabar metropolis. There is need to intensify educational campaigns for the general public.

Prevalence of hepatitis B, hepatitis C and human immunodeficiency viruses, and evaluation of risk factors for transmission: Report of a population screening in Nigeria.

BACKGROUND: Hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV are common blood-borne infections unevenly distributed across regions in Nigeria. Few population-based prevalence studies have been done in Nigeria. OBJECTIVE: To determine the prevalence of HBV, HCV and HIV and risk factors for infection with these viruses in a Nigerian population. METHODS: Hepatitis B surface antigen, anti-HCV and HIV were assayed in 1 498 healthy adult participants. A structured questionnaire was used to assess risk factors for viral acquisition. Bivariate analysis was used to compare differences in sociodemographic characteristics. Significant risk factors were identified by stepwise logistic regression. A p-value <0.05 was considered significant. RESULTS: The prevalences of HBV, HCV and HIV were 8.8%, 10.0% and 12.9%, respectively, with urban/rural disparity. HBV/HCV positivity was higher among males than females. The reverse was true for HIV. Age was significantly associated with being HBV-, HCV- or HIV-positive. Communal use of a toothbrush was significantly associated with HBV positivity in the final model (odds ratio 2.46, 95% confidence interval 1.45 - 4.18). CONCLUSIONS: The prevalence of HBV, HCV and HIV infection is high in Nigeria, with urban/rural disparity. HCV may be more of a public health concern than HBV in some communities. Population-based studies are required to provide vital data to inform optimal national control strategies.

Characteristics of inflammatory bowel disease in three tertiary health centers in southern Nigeria.

BACKGROUND: Inflammatory bowel disease (IBD) refers to two chronic inflammatory disorders of the gastrointestinal tract which is generally believed to be rare in most African countries. The objectives of the current study were to present the experience of three tertiary gastroenterology centers in southern part of Nigeria on IBD, highlighting the age distribution of the patients seen, management and the impact on the quality of their life in university-based community-type practices in Nigeria. METHODS: This was a retrospective review of charts of inflammatory bowel disease seen between January 2007 and June 2010 at three teaching hospitals in Southern Nigeria. Diagnosis of IBD was made from clinical manifestations, colonoscopic and histopathological findings. RESULTS: During the study period, 12 patients presented with clinical features consistent with inflammatory bowel disease. There were 8 (66.7%) males and 4 (33.3%) females and had ages ranged from 18 years to 80 years with a median of 26.5 years. Eight (66.7%) patients had ulcerative colitis while 4(33.3%) had Crohn's disease. Ten (83.3%) patients had severe disease with main clinical features being recurrent diarrhoea and passage of mucoid bloody stools. All the patients had treatments with sulphasalazine or mesalazine, steroids and antibiotics with good responses. One patient died following the occurrence of toxic megacolon. CONCLUSION: Although IBD is uncommon in Nigeria, high index of suspicion is necessary by attending physicians managing patients with recurrent passage of mucoid bloody stools. Prompt gastroenterological referral and judicious use of colonoscopy and biopsy will assist in making the diagnosis.

Prevalence of hepatitis B surface antigen seropositivity among HIV-infected and non-infected individuals in Nnewi, Nigeria.

BACKGROUND: Co-infection of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) is common as both viruses share common routes of transmission. HIV significantly affects the natural history of HBV, hence the need to determine the prevalence of co-infection. MATERIALS AND METHODS: This was a retrospective study between 2005 and 2009, in which is a total of 2018 subjects who reported at our University Teaching Hospital blood bank and human immunodeficiency virus clinic were studied. Hepatitis B surface antigen (HBsAg) was tested for using a one step lateral flow rapid chromatographic immunoassay (Acumen labs and diagnostic centre, Bangalore, India) and HIV 1/2 was tested using two kits, Determine (made by Abbot, Japan for Inverness Medical, Japan). RESULTS: A total of 2018 subjects were studied out of which 1176 were HIV positive (964 males and 212 females) and 842 (334 males and 508 females) were negative. The prevalence of HBsAg positivity in the study population was 5.9%. It was 6.3% and 5.6% in the HIV-infected and un-infected population, respectively. Although the prevalence was higher in those who are HIV infected, the difference was not statistically significant (P=0.52). Males who were HIV positive were found to be more likely to have co-infection than females (8.7% vs. 4.2%, P=0.02, OR=1.917). CONCLUSION: This study showed that in south-eastern Nigeria, infection with HBV is relatively common in both HIV-infected and un-infected individuals. Routine screening for HBV should be done for all HIV positive individuals.

The clinical and pathological features of hepatocellular carcinoma in Nnewi, Nigeria.

BACKGROUND: Hepatocellular carcinoma (HCC) remains the commonest malignancy of the liver. In spite of the recent advances in treatment, prognosis is still abysmal especially in developing countries. This article aims to review the clinical and pathological features of HCC in a tertiary hospital at Nnewi. METHOD: This was a cross-sectional study. Patients with HCC seen at the Medical Out-patient Department or admitted into the Medical wards of the Nnamdi Azikiwe University Teaching Hospital Nnewi were recruited. The study lasted from June 2007 to May, 2008. Subjects were clinically evaluated and blood samples collected for HBsAg, anti-HCV and HBeAg assays. RESULTS: The prevalence of HCC was 2.4%. Of the 60 patients studied, 38 were males and 22 were females with a male to female ratio of 2:1. Their ages ranged from 19-86 years with a mean age of 50.62 +/- 17.54. The mean duration of symptoms before presentation was 16 weeks and the mean duration from onset of symptoms to death is 20 weeks. Common presenting symptoms were painful right hypochondrial mass, abdominal swelling, weight loss, early satiety and fatigue while coagulopathy, ascites and hepatic encephalopathy were the most common complications. Multiple lesions affecting both lobes of the liver was seen in 48 patients on ultrasound, 36.6% were positive for HBsAg of which 41% were HBeAg positive. HCV antibodies were present in 8.3% of the patients. Well differentiated HCC of the pseudo-glandular variety was the most common histological type. CONCLUSION: HCC affects middle aged Nigerians. Though well differentiated, it presents late with clinical features of advanced disease leading to death within six months. It is more often associated with chronic HBV than HCV infection.

Patent medicine vendors, community pharmacists and STI management in Abuja, Nigeria.

BACKGROUND: Increasingly, literature indicates that Patent Medicine Vendors (PMVs) and Community Pharmacists (CPs) provide sexual reproductive health services and products to their young patrons. OBJECTIVES: This study explored the validity of literature claims, principally from CPs and PMVs perspective in Abuja, Nigeria. METHODS: Participants were recruited with convenience sampling based on their willingness to participate in the study and our judgement of their professional competence. They were administered a semi-structured questionnaire, which was modelled after McCracken's long interview. We empirically assessed the validity of CPs and PMVs opinions with an exit interview of seven consenting patrons. Interviews were audio taped, transcribed verbatim and subjected to iterative thematic analysis. RESULTS: Participants' accounts and our observations indicate that PMVs and CPs serve young people's sexual reproductive healthcare needs in Abuja. CPs and PMVs provide young people with a seamless and non-judgemental access to contraceptives, sexual health advice and post-sexual risk exposure care. CONCLUSION: The study corroborates literature claims that CPs and PMVs provide sexual reproductive health advice, services and products to young people. However, participants contend that the current pharmacy practice laws in Nigeria constrain the scope and quality of services that young unmarried people require. Because it is unlikely that Nigeria will reinvigorate her primary healthcare system soon, we call for the formal co-option of CPs and PMVs into the sexual reproductive health management system to standardize and improve services.

Early virologic response to pegylated interferon in chronic hepatitis B infection.

BACKGROUND: Early virologic response to pegylated interferon in the treatment of chronic hepatitis B infection is not frequently reported. METHOD: The case notes of the patients was retrieved and relevant data extracted, literature review was done using Medline. RESULT: A report of a case of early virologic response in a 62 year old man with chronic hepatitis B infection, receiving pegylated interferon is presented with a review of the relevant literature. He had HBV DNA level assessed by PCR and histology of liver biopsy specimen. CONCLUSION: Clinicians should be on the lookout for early virologic response to pegylated interferon and the eventual outcome of such early response.