Heavy metal exposure and renal impairment: A systematic review of observational studies

Background: Environmental exposure to toxins has been strongly implicated in its multi-faceted etiology of chronic kidney disease, a serious public health problem affecting individuals, families, and communities. There is a need to synthesize available studies on the effect of heavy metal exposure on renal function, considering the rising global burden of kidney disease. The objective of this study is to determine the association between exposure to heavy metals and renal disease. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review. A comprehensive independent search, title, abstract, and full-text screening of available literature on Google Scholar, PubMed, and OAREScience was done between March 2021 and May 2021. The criteria for study inclusion were full-text articles published in English language in the last 20 years (2001-2020), and observational primary human studies reporting the association between heavy metal exposure and renal disease. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies. Results: A total of 552 studies were identified following the search from the different databases. A total of 13 studies were finally included in the review. Heavy metals implicated in the studies include cadmium, lead, mercury, and arsenic, with ten studies showing environmental exposure as the primary source. Ten (10) studies showed an association between heavy metal exposure and renal impairment (p<0.05) while only 3 studies reported no association. Conclusion: Environmental monitoring is needed to stem the tide of heavy metal exposure in view of the growing burden of chronic kidney disease.

Alcohol consumption among pregnant women attending the ante-natal clinic of a tertiary hospital in South-South Nigeria.

BACKGROUND: As efforts to reduce maternal and childhood mortality rates continue to yield results in Nigeria, it is time to put more emphases on the health of children. Alcohol consumption is one of the few modifiable risk factors for poor pregnancy outcome. This study assessed the consumption of alcohol among pregnant women attending the antenatal clinic of the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. MATERIALS AND METHODS: This study was carried out using a descriptive cross-sectional study design, with data collected using an interviewer-administered questionnaire. The questionnaire was used to collect information on the knowledge of the harmful effects of alcohol on the fetus, attitudes toward alcohol use by pregnant women, and alcohol use by the respondents. RESULTS: A total of 221 subjects were studied. The respondents had an average age of 29.5 ± 4.6 years, were mostly married (96.83%), Christians (94.57%), and had tertiary education (73.76%). Only, 51.58% of the respondents knew of the harmful effects of alcohol on the fetus; of whom, 62.29% were told by a health professional. More than half (59.28%) of the respondents had taken alcohol during the index pregnancy, about a third (39.40%) of whom drank alcohol on a regular basis, whereas 25.79% were binge drinkers. There were no statistically significant differences in the marital (P = 0.16) and educational status (P = 0.15) of the respondents who abstained from alcohol in the index pregnancy, compared with those who drank alcohol; although, statistically significant differences were observed in the age (P < 0.001), parity (P = 0.02) and religion (P < 0.001) of the respondents. CONCLUSION: The level of alcohol consumption among the pregnant women is high. Health education is, therefore, required to change the attitude of the public and the knowledge and behavior of the pregnant women.

Knowledge; Attitude; and Infection Control Practices of two Tertiary Hospitals in Port-Harcourt; Nigeria

Background: Surgical site infections (SSIs) are a significant cause of morbidity; emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSI in several health care institutions. This study assessed the effects of the implementation of the policy in a tertiary hospital in Port Harcourt; Nigeria. Materials and Methods: A cross-sectional; comparative study design was used for the study; with data collected using a structured questionnaire and guided observation of doctors and nurses involved in the management of patients that had caesarean sections in two comparable tertiary hospitals in Port Harcourt-the University of Port Harcourt Teaching Hospital (UPTH) and the Braithwaite Memorial Specialist Hospital (BMSH). Results: There were no statistically significant differences in the designations and length of practice of the respondents in both hospitals (P = 0.77). However; 63.64 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 and 69.69 respectively of the respondents in UPTH; compared with 22.86 (P = 0.00) and 0.00 (P = 0.02) in BMSH. The reasons given by the respondents in UPTH for nonadherence to the infection control policy include poor supervision (39.39) and lack of in-service training (21.21); while the respondents in BMSH gave reasons that include inadequate supply of consumables (34.29) and absence of a hospital's policy on infection control (22.88). Conclusion: The implementation of the infection control policy resulted in some improvements in certain infection control practices

Knowledge, attitude, and infection control practices of two tertiary hospitals in Port-Harcourt, Nigeria.

BACKGROUND: Surgical site infections (SSIs) are a significant cause of morbidity, emotional stress and financial cost to the affected patients and health care institutions, and infection control policy has been shown to reduce the burden of SSI in several health care institutions. This study assessed the effects of the implementation of the policy in a tertiary hospital in Port Harcourt, Nigeria. MATERIALS AND METHODS: A cross-sectional, comparative study design was used for the study, with data collected using a structured questionnaire and guided observation of doctors and nurses involved in the management of patients that had caesarean sections in two comparable tertiary hospitals in Port Harcourt-the University of Port Harcourt Teaching Hospital (UPTH) and the Braithwaite Memorial Specialist Hospital (BMSH). RESULTS: There were no statistically significant differences in the designations and length of practice of the respondents in both hospitals (P = 0.77). However, 63.64% of the respondents in UPTH were aware of the infection control committee, compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics, and for the removal of the hair at the incision site were observed by 57.58% and 69.69% respectively of the respondents in UPTH, compared with 22.86% (P = 0.00) and 0.00% (P = 0.02) in BMSH. The reasons given by the respondents in UPTH for nonadherence to the infection control policy include poor supervision (39.39%) and lack of in-service training (21.21%), while the respondents in BMSH gave reasons that include inadequate supply of consumables (34.29%) and absence of a hospital's policy on infection control (22.88%). CONCLUSION: The implementation of the infection control policy resulted in some improvements in certain infection control practices.

Nutrition intervention program and childhood malnutrition: a comparative study of two rural riverine communities in bayelsa state, Nigeria.

BACKGROUND: The prevalence of malnutrition is high in the Niger delta region of Nigeria, in spite of the region's oil wealth and nutrition intervention programs have been found to be effective in similar circumstance. AIM: This study is to assess the nutrition intervention program, implemented by UNICEF in some rural communities of Bayelsa State, one of the six States in the Niger delta region of Nigeria. SUBJECTS AND METHODS: The study was carried out in 2009 in Toruorua and Gbaranbiri, two rural riverine communities, in Baylesa State. Toruorua benefited from the nutrition intervention program of UNICEF between 1999 and 2008, while Gbaranbiri did not benefit. A comparative, cross-sectional study design was used, with the data collected using anthropometry and semi-structured questionnaire, administered on 105 respondents, chosen with the cluster sampling technique, popularized by UNICEF, from each of the study communities. Data were analyzed using EPI-INFO version 2002, Microsoft Excel software, and manually. Differences between the study communities were tested using the student's t-test for means, and Chi-square test for proportions. Significant values were set at P <0.05. RESULTS: A total of 210 questionnaires were administered and retrieved from both study communities, and the anthropometric measurements of equal number of under-five year children were also taken. There were no significant differences in the occupations of the respondents, and in the sizes of their households. The prevalence of wasting, under-weight and stunting were however found to be significantly higher in the reference community, as 20.0% (21/105) of the children were found to be wasted, compared to 5.0% (6/105) in the intervention community (P < 0.01); 17.1% (18/105) were found to be underweight, compared to 9.5% (10/105) in the exposed community (P = 0.01); while 24.8% (26/105) were stunted, compared to 10.5% (11/105) in the exposed community (P = 0.01). CONCLUSION: Nutrition intervention program delivered in a primary health care facility can positively change nutrition behavior and prevent childhood malnutrition.

The prevalence of hypertension and its modifiable risk factors among lecturers of a medical school in Port Harcourt, south-south Nigeria: implications for control effort.

BACKGROUND: Hypertension and other noncommunicable diseases are currently responsible for at least 20% of all deaths in Nigeria, and constitute up to 60% of the patients admitted into the medical wards of most tertiary hospitals in Nigeria. Yet, the treatment outcomes for the diseases have remained very poor, prompting calls for better patient education. It has however been established that the effectiveness of patient education is linked to the healthy habits of the doctor. This study was conducted to find out the prevalence of hypertension and its modifiable risk factors among the lecturers of the University of Port Harcourt Medical School. MATERIALS AND METHODS: A descriptive cross-sectional study design was used, with the data collected using a modified form of the WHO STEPS instrument that consists of a questionnaire component and the measurement of body mass index (BMI) and blood pressure. The questionnaire was used to collect information on the sociodemographic characteristics of the respondents, the use of tobacco, the consumption of alcohol, the type of diet, and the amount and types of physical activities undertaken. RESULTS: A total of 75 lecturers participated fully in the study, out of an eligible total of 109. They were mostly males (65.33%), married (88.33%), and had an average age of 46.06 ± 9.62 years. The prevalence of hypertension was 21.33%; out of which 12 (75.00%) were already aware of their status, and were on appropriate therapy. Only 13 (17.33%) of the lecturers were of normal weight, 45 (60.00%) were overweight, while 17 (22.67%) were obese. Only 2 (2.67%) currently smoke, while most (94.67%) drank less than three standard units of alcohol in a day, mainly in social occasions. CONCLUSION: The prevalence of hypertension among the lecturers in the medical school was lower than that in the general population, mainly due to their better health-seeking behavior and healthy lifestyle.

How Effective is the 2012 Maternal; Newborn and Child Health Week (MNCHW) in River State?

Nigeria is one of the countries noted to have made insufficient progress towards the attainment of the health-related MDGs. Experience has however shown that a few cost-effective interventions that can be delivered in resource poor settings; through family/community-level action and schedulable population-oriented services; are able to rapidly attain these goals. This was the basis of the Maternal; Newborn and Child Health Week (MNCHW) in Nigeria; designed to achieve rapid population coverage of chosen interventions; within the one week period of the programme. This study assessed the effectiveness of the week held in Rivers State; in June 2012. of the LGAs; while iron and folate tablets were given to just 2.86Materials and Methods: The data for the assessment was collected through on-the- spot observations; three semi-structured questionnaires; and the final summaries of the week; provided by the State Ministry of Health. The questionnaires were administered in nine health centers; in three randomly selected LGAs. The first questionnaire was used to assess the extent of the social mobilization carried out for the week; the second was an exit interview of clients of the health facilities; and used to assess the success of the social mobilization campaign; while the third questionnaire was used to assess the availability of the intervention commodities; and the quality of care given to the clients.Results: The social mobilization campaign for the week was poorly funded and did not have much effect; as only 28.57 of the clients of the health facilities were aware of the week. Most of the commodities for the week; except the NPI vaccines and vitamin A; were not available in the required quantities. Long Lasting Insecticide-treated Nets (LLINs) and Sulphadoxine-Pyrimethamine (SP) were not available in 65.22 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; while iron and folate tablets were given to just 2.86 of the LGAs; while iron and folate tablets were given to just 2.86 of the targeted total. The coverage rate of the vaccines ranged from 1.29 recorded with the measles vaccine; to the 14.85; for the DPT vaccine. The coverage with vitamin A of 43.41; for the DPT vaccine. The coverage with vitamin A of 43.41 was the highest of all the interventions; while the 0.36 coverage for family planning commodities was the least.Conclusions: The MNCHW in Rivers State did not meet the stated objectives. Efforts should be made to leverage on the political will of the current government of the State for health programmes

Energy saving bulbs: an emerging threat to public health, from. mercury contamination of the environment

Energy saving bulbs are promoted for their efficiency and capacity to reduce the emission of greenhouse gases; the acknowledged cause of global warming and climate change. They however contain varying quantity of mercury that can easily contaminate the environment. Mercury is a neuro-toxin; but damage has also been reported in the kidney; skin and the cardiovascular system. There is therefore an urgent need to emphasize the safe disposal of the energy-saving bulbs as their use increase in Nigeria. Recycling programme should be institutionalized; with the active participation of the manufacturers and importers of the bulbs; while education programme should be mounted on the handling and safe disposal of broken bulbs

The Mortality of Serving African Presidents: A Lesson for the Health Profession and the Lay Public

Although Africa has the worst mortality data in the world; the picture painted by the high mortality rate of serving Africa leaders in the last five years suggests reasons and causes far beyond poor socio-economic conditions. This study examined the causes and age at death of serving African leaders; in the last five years; and draws out the lessons; for the health profession and the general public.Material and methods: An internet search of creditable websites was carried out to determine the number; causes and age at deaths of the leaders; within the study period of 2008 to 2012. The life expectancy rates of the bereaved countries were also considered.Results: A total of 13 presidential mortalities took place in the world during the study period; with 10 (76.92) involving serving African leaders. The leaders died at an average age of 66.9 +/- 7.22 years; an average of 12.1 years above the life expectancy rate of their respective countries; but less than the world average of 68 years. Most (80.00) of the leaders died from non-communicable diseases; 3 died from cardiovascular diseases; 3 died from cancer; while two were known diabetics. The remaining two leaders were killed in a violent change of government.Conclusion: The African leaders died mainly from non-communicable diseases; at an age that is below the world average. Public enlightenment campaigns and greater emphasis on patient-centered chronic care of non-communicable diseases are hereby recommended

A Survey of the Community Water Supply of some rural Riverine Communities in the Niger Delta region, Nigeria: Health implications and literature search for suitable interventions.

BACKGROUND: Water is a fundamental human need. This is the basis for target 10, goal 7 of the Millennium Development Goals which sets to reduce the proportion of people without access to safe water by half by 2015. This study assessed the access to safe water supply in 22 riverine communities in the Niger delta region of Nigeria. MATERIALS AND METHOD: The study was carried out using a descriptive cross-sectional study design, with the data collected using a structured interviewer-administered questionnaire, field observations and focused group discussions. The questionnaire was administered to female heads of household, and used to collect information on the main source of drinking water, the time it took for the round trip to the main water sources, and methods used for the treatment of water of suspicious quality. An inventory of all the community water facilities in the communities was also taken, and information collected on the functionality of the facilities, and how they were constructed, operated and maintained. A sample of the water from each of the facilities was also collected in a sterile container for microbiological analysis. RESULTS: A total of 456 questionnaires were administered and retrieved. The most common source of drinking water was surface water (37.9%), and most (61.2%) of the water drawers spent less than 15 minutes to complete the round trip to the water sources. There were an average of 17 community water supply facilities, but only 23.8% of the facilities were functional during the study. Most of the functional facilities were being managed by community members. More than two third (67.9%) of the samples tested were found to contain significant numbers of Escherichia coli. CONCLUSION: The communities had easy access to water supply, but most of the facilities were either contaminated or nonfunctional. The management of the facilities by members of the communities, and the promotion of point-of-use purification systems are hereby advocated.

Socio-Demographic Characteristics of Alcohol Abusers in a Rural Ijaw Community in Bayelsa State; South-South Nigeria

Background: Causal relationship has been established between alcohol and more than 60 types of disease and injury. Despite this, alcohol is still widely consumed in several communities in Nigeria, and sometimes considered a health tonic. This study described the pattern, prevalence, and factors associated with alcohol abuse in a typical Ijaw community, where alcohol is produced and consumed in large quantities. Materials and Methods: The study was carried out in Okoloba, a rural community in Bayelsa State, South-South Nigeria using an analytical cross-sectional study design. The data were collected from members of the community aged 16 to 65 years, using the Alcohol Use Disorders Identification Test questionnaire and clinical examination for hepatomegaly, tongue tremor, and hand tremor. Results: A total of 322 subjects, comprising 166 men and 156 women were studied. They had an average age of 41.4 ± 2.5 years, were mostly farmers (43.17%), married (66.15%), and had at most primary school education (62.42%). More than 90% of the subjects took alcohol in the preceding year, with more of them (43%) preferring the locally produced drinks. About 33% of the subjects had harmful drinking, while 12.73% had alcohol dependence problem. There is no significant age difference between the alcohol abusers and abstainers/social drinkers (P > 0.05), but alcohol abusers were significantly more likely to be males (P < 0.001), in polygamous marriages (P < 0.00001), had lower educational status (P < 0.0001), likely to be practitioners of the traditional religion (P < 0.0001), and more likely to be engaged in palm wine tapping. Conclusion: Alcohol is widely consumed in the community, but the prevalence of abuse was moderate, mainly due to cultural restrictions. Sales restrictions might be needed as the drinking habits of members of the community change with urbanization

Acute health effects of a crude oil spill in a rural community in Bayelsa State, Nigeria.

BACKGROUND: In May 2000, there was a breach in the crude oil pipeline belonging to a major oil company in Etiama Nembe, in Bayelsa State, Nigeria. This study is to investigate if the residents in the affected community suffered an increase in self reported symptoms that might be attributable to exposure to the spilled crude oil. METHOD: A retrospective cohort study, with a comparison control group was carried out, using an interviewer--administered questionnaire and focus group discussions as the study tools. Exposure status was assigned on the basis of geographical location. The questionnaire was administered to male respondents in both the exposed and unexposed communities; while the focus group discussions were held only with adult women in the exposed community. RESULTS: A total of 420 questionnaires were administered and retrieved from both study groups. There were no significant differences in the age, cigarette smoking or the history of chemical allergy between the exposed and the unexposed groups; though the respondents in the exposed communities were significantly better educated (p-value < 0.005). There were significant differences in the period prevalence for diarrhea (OR = 4.6, p-value < 0.0001), sore eyes (OR = 10.93, p-value < 0.0001), itchy skin (OR = 13.48, p-value < 0.00001) and occupational injuries (OR = 5.29, p-value < 0.0005). These increases were further elaborated by the discussants in the focus group discussions. CONCLUSIONS: Exposure to the mists and fumes generated by a crude oil spill some acute health effects, albeit mild and transient. This increase in the disease burden of the exposed communities should be recognized and given adequate attention by all the stakeholders.

Acute Health Effects of a Crude Oil Spill in a Rural Community in Bayelsa State; Nigeria

In May 2000; there was a breach in the crude oil pipeline belonging to a major oil company in Etiama Nembe; in Bayelsa State; Nigeria. This study is to investigate if the residents in the affected community suffered an increase in self reported symptoms that might be attributable to exposure to the spilled crude oil. : A retrospective cohort study; with a comparison control group was carried out; using an interviewer - administered questionnaire and focus group discussions as the study tools. Exposure status was assigned on the basis of geographical location. The questionnaire was administered to male respondents in both the exposed and unexposed communities; while the focus group discussions were held only with adult women in the exposed community.:Atotal of 420 questionnaires were administered and retrieved from both study groups. There were no significant differences in the age; cigarette smoking or the history of chemical allergy between the exposed and the unexposed groups; though the respondents in the exposed communities were significantly better educated (p-value 0.005). There were significant differences in the period prevalence for diarrhea (OR

Experiences and Attitudes of Young Men towards Abortion in a Semi-Urban Community in Rivers State; Nigeria

Background: Most of the studies on abortion focused on the roles and responsibility of women; with very little attention given to the role played by men. Aim: To assess the experiences and attitudes of young men towards abortion in Mgbede Egbema; a semi-urban community in Rivers State; south-south Nigeria. Methods: A descriptive cross-sectional study design was employed; using a structured questionnaire and focus group discussion as study methods. The questionnaire was administered to all the registered male members of the community's youth association; while the focus group discussion was held with members of the youth association's vigilante committee; to gain more insight into the responses contained in the answered questionnaires. Results: A total of 181 questionnaires were administered and retrieved. The average age of the respondents was 23.1 years; and they were mostly single (77.9); with secondary school education (65.8); and combined Christianity with traditional religion (71.3). Almost all (93.4) had a girl friend; but the responsibility of preventing unwanted pregnancy rested almost entirely on the girl (75.7); and in the event of an unwanted pregnancy; 85.1of the respondents would recourse to abortion. Most of the respondents (74.6) would advice their sister to procure an abortion in the event of an out-of-wedlock pregnancy; but only 20.0of them would like to be actively involved in the process of procuring the abortion. All the respondents knew that abortion was illegal in Nigeria; but 47.5thought that the offence did not include the woman; while 29.8thought the offence was committed by the abortion provider alone. Most (64.6) of the respondents felt abortion should not be freely available; but 90.6of them would want the offenders to be prosecuted only in the event of serious complications; or death. Conclusion: There is a broad support for abortion among the respondents; but fears still exists that liberalization might lead to increase demand for the procedure. A review of the nation's abortion law is therefore recommended

Food insecurity, malnutrition and crude oil spillage in a rural community in Bayelsa State, south-south Nigeria.

BACKGROUND: Oil is the main stay of Nigeria's economy, but most residents in the oil producing communities still depend entirely on the environment for their sustenance; and so likely to have a problem of food security in the event of a deleterious impact on the environment. This study is to examine the effect of a major crude oil spillage on household food security and the nutritional status of under-five children in the affected communities. This oil spillage occurred in May 2000, in Etiama Nembe, a rural communityin Bayelsa State, south-south Nigeria. METHOD: The study was carried out six months after the spill, using cross-sectional, external control group study design, with a semi-structured questionnaire and anthropometry as the study tools. The study participants were chosen using a two-stage cluster sampling technique. The questionnaire assessing food insecurity was administered on an adult woman in each of the chosen households, while the anthropometric measurements were taken for every under-five year child in the household. RESULTS: A total of 592 questionnaires were administered and retrieved in both study communities, while anthropometric measurements of 956 under-five year children were taken. There were no significant differences in the age and occupations of the respondents, and in the sizes of their households; although, the respondents in the exposed communities were significantly better educated (p-value < 0.001). There were significant differences in the study groups, in household food security (p-value < 0.000001), and in the prevalence of under-five children with underweight (p-value <0.0001), and wasting (p-value <0.01). CONCLUSIONS: Crude oil spillage can increase household food insecurity and childhood malnutrition in the affected communities. Efforts should always be made to provide food aid to affected communities, irrespective of the cause of the spillage.

Clandestine abortion in Port Harcourt: providers' motivations and experiences.

BACKGROUND: Abortion is illegal in Nigeria. It is a crime to perform or obtain an abortion except to save a woman's life. In spite of this, several medical practitioners working in profit-oriented private clinics still provide abortion services on demand and on a fee for service basis. This study is to find out the motivations and experiences of these practitioners. METHODS: The study was carried out in 15 clinics in Port Harcourt that were known to provide abortion services, using a descriptive, cross-sectional study design. Data were collected using a semi-structured, self-administered questionnaire, followed a few days later by in-depth interview to further explore responses in the questionnaire. RESULTS: A total of 34 doctors, 29 males and 5 females that routinely provide abortion services in the clinics were interviewed. Most of them (79.42%) were below the age of 40 years, married (76.47%), non-specialist doctors (55.88%), and had practiced for less than fifteen years (88.24%). All the owners/Medical Directors of the clinics were actively engaged in providing abortion services, and most of the clinics (86.67%) had less than ten in-patient beds. All the providers were Christians, but most (85.29%) provided abortion services mainly for the financial benefit. Expertise for the abortion procedures were acquired in private clinics, but most of the providers (61.76%) restricted themselves to terminating pregnancies in which they felt were firmly within their level of competence. All the respondents used manual vacuum aspiration for the termination of pregnancies less than 12 weeks and charge an average of five thousand naira (N5,000.00) for an 8-week pregnancy CONCLUSIONS: Most abortion providers in Nigeria are lured by the large market and the huge fees collected for the services. Abortion should be formally legalized in Nigeria to at least force down the service charge, and hence make safe abortion accessible to women of low socio-economic class.