Prevlaence of chronic kidney disease markers in Kumbotso rural Northern Nigeria.

BACKGROUND: Data- on the epidemiology of Chronic Kidney Disease (CKD) from sub-SaharanAfrica are sparse. We investigated the prevalence of CKD and its early markers in Kumbotso, a rural community in northern Nigeria. METHODS: A total of 480 individuals were randomly selected from the general population using multistage stratified random sampling. Relevant- demographic and clinical data were obtained using a structured questionnaire. Biological samples (urine and blood) were drawn for relevant investigations. RESULTS: CKD (estimated glomerular filtration rate [eGFR <60 mls/min) was found in 117 participants (26%). Proteinuria was present in 106 persons (23.6%) and haematuria in 7 individuals (1.6%). The most common CKD stage was stage 1 (20%). CKD was associated with hypertension (P=0.002), diabetes (P=0.001), high cholesterol (P=0.030), smoking (P=0.015), increasing BMI (P=0.020), and increasing age (P=0.003). After adjusting for potential confounding with logistic regression modeling we found BMI, family history of hypertension, history of diabetes mellitus and family history of renal disease to be independent predictors of CKD. CONCLUSIONS: Early markers of CKD are common among rural inhabitants of northern Nigeria and this call for concerted efforts towards institution of preventive measures.

Impact of income on the profile of cardiovascular risk factors among hypertensives in a Nigerian tertiary health centre: a cross-sectional study.

BACKGROUND: In most developed countries, risk factors for cardiovascular diseases (CVD) are more prevalent in low socioeconomic classes. However, the pattern in developing countries appears to be different. This study sought to evaluate and compare risk factors for CVD as well as absolute CVD risk in hypertensive subjects grouped by income in Kano, Nigeria. METHODS: The study was cross-sectional in design and carried out in Aminu Kano Teaching Hospital, Kano, Nigeria. Seventy treatment-naïve hypertensives and an equal number of hypertensives on treatment were recruited by balloting from the outpatient clinics, and then regrouped into low- and high-income earners. These two groups were then compared in terms of their profile of CVD risk factors and absolute CVD risk. All the assessed CVD risk factors are recognised in standard guidelines for the management of persons with systemic hypertension. RESULTS: The low-income group comprised 45 patients (32.1%) while the remaining 95 (67.9%) had a high income. The most prevalent CVD risk factor was dyslipidaemia, found in 77.8 and 71.6% of low- and high-income earners, respectively (p = 0.437). The prevalence of proteinuria was significantly higher among low-income earners (42.2%) compared with high-income earners (15.8%) (p = 0.001). Mean serum creatinine was also higher among low-income earners but the difference did not reach statistical significance (p = 0.154). Very high CVD risk was found in 75.6 and 70.5% of low- and high income earners, respectively (p = 0.535). CONCLUSION: Dyslipidaemia and very high CVD risk were found in over 71% of the patients regardless of their level of income. Low-income earners had a higher prevalence of indices of renal damage. These findings pose a great challenge to the present and future management of all subjects, particularly those in the low-income group, given that in Nigeria, healthcare is largely paid for directly out of their pockets.

Impact of Income on the Profile of Cardiovascular Risk Factors among Hypertensives in a Nigerian Tertiary Health Centre: a Cross-Sectional Study : Cardiovascular Topics

Background: In most developed countries; risk factors for cardiovascular diseases (CVD) are more prevalent in low socioeconomic classes. However; the pattern in developing countries appears to be different. This study sought to evaluate and compare risk factors for CVD as well as absolute CVD risk in hypertensive subjects grouped by income in Kano; Nigeria. Methods: The study was cross-sectional in design and carried out in Aminu Kano Teaching Hospital; Kano; Nigeria. Seventy treatment-naIve hypertensives and an equal number of hypertensives on treatment were recruited by balloting from the outpatient clinics; and then regrouped into low- and high-income earners. These two groups were then compared in terms of their profile of CVD risk factors and absolute CVD risk. All the assessed CVD risk factors are recognised in standard guidelines for the management of persons with systemic hypertension. Results: The low-income group comprised 45 patients (32.1) while the remaining 95 (67.9) had a high income. The most prevalent CVD risk factor was dyslipidaemia; found in 77.8 and 71.6of low- and high-income earners; spectively (p = 0.437). The prevalence of proteinuria was significantly higher among low-income earners (42.2) compared with high-income earners (15.8) (p = 0.001). Mean serum creatinine was also higher among low-income earners but the difference did not reach statistical significance (p = 0.154). Very high CVD risk was found in 75.6 and 70.5of low- and high-income earners; respectively (p = 0.535). Conclusion: Dyslipidaemia and very high CVD risk were found in over 71of the patients regardless of their level of income. Low-income earners had a higher prevalence of indices of renal damage. These findings pose a great challenge to the present and future management of all subjects; particularly those in the low-income group; given that in Nigeria; healthcare is largely paid for directly out of their pockets

Cardiovascular risk factors in Nigerians with systemic hypertension.

BACKGROUND: Hypertension is the commonest risk factor for cardiovascular disease, and it frequently coexists together with other risk factors, thereby increasing the absolute cardiovascular risk. This study is primarily aimed at assessing cardiovascular risk factors in patients with hypertension in comparison with controls. It is also aimed at assessing target organ damage and absolute cardiovascular risk among the hypertensives. STUDY DESIGN: The study was case-control in design, conducted at the General outpatient and Cardiology Clinics of Aminu Kano Teaching Hospital, Kano, Nigeria. Three groups of patients (treated hypertensives, untreated hypertensives and controls), each 70 in number, were matched for age and sex. Patients were selected by balloting, using simple random sampling method. RESULTS: The most prevalent cardiovascular risk factor was Increased Body Mass Index, which was significantly more prevalent among treated (70%) than untreated (45.7%) hypertensives and controls (44.3%). Left Ventricular Hypertrophy was the most prevalent Target Organ Damage, found in 54.3% of treated and 42.9% of untreated hypertensives, and 0% of controls. Very high cardiovascular risk was detected in 75.6% of treated and 68.5% of untreated hypertensives. CONCLUSION: Even before the commencement of treatment, hypertenisves had high prevalence of cardiovascular risk factors and evidence of target organ damage. These were more pronounced in treated hypertensives. The basis and prognosis are discussed.

Prevalence of serological markers of chronic hepatitis B virus infection in diabetics in the Lagos University Teaching Hospital, Lagos.

Hepatitis B virus (HBV) infection, a major world health problem, is hyper endemic in South-East Asia and sub-Saharan Africa including Nigeria. Being a major cause of morbidity and mortality, prophylaxis using the highly efficacious hepatitis B vaccine is recommended for those at risk. The prevalence of serological markers of chronic HBV infection was determined in a population of 100 outpatient diabetics and 80 non-diabetic controls at the Medical Outpatient Department of the Lagos University Teaching Hospital Idi-Araba between January and July 1992. Twenty diabetic patients [20%] and 14 controls [17.5%] had serological markers (HbsAg and antiHBc) indicating ongoing chronic HBV infection. The difference between diabetics and non-diabetic controls was not statistically significant (P>.05). None of the HbsAg and antiHBc positive diabetics [45%] and 8 control patients [57%] were HbeAg positive. The presence of serological markers was not related to the duration, type of diabetic treatment and degree of diabetic control. Our findings suggest that diabetics in Lagos appear not to be more predisposed to chronic HBV infection than the rest of the population, and therefore would require no special antiHBV prophylaxis.

Chronic duodenitis in Zaria, northern Nigeria.

Thirty-four consecutive patients presenting to the Endoscopy clinic of the Ahmadu Bello University Teaching Hospital, Zaria with symptoms of upper abdominal pain were investigated for chronic duodenitis by endoscopy and histology and for associated diseases. Twenty-two patients had histological evidence of chronic duodenitis. No clinical features separated these from those who had no duodenitis. Endoscopy was a good enough tool for diagnosis. Stool parasites were significantly commoner in those with histological duodenitis. Gastritis was also commoner in those with duodenitis. Ranitidine appeared superior to polycrol in relieving symptoms. Endoscopy is useful in the diagnosis of severe duodenitis. Specific ulcer healing drugs may be tried in treating symptoms associated with duodenitis, though their effectiveness is still open to further research.

Zinc status in chronic liver disease; studies in Nigerian patients.

Serum and urinary zinc were assessed in 53 patients with a variety of chronic liver diseases (CLD) and 59 healthy volunteers using atomic absorption spectrophotometry. Liver zinc was also assessed in 18 patients and 10 controls. All patients had significantly lower serum zinc (mean = 36.3 +/- 2.9 ug/dl) than controls (79.3 +/- 4.0 ug/dl) and higher urinary excretion (651.0 +/- 53 ug/24 hrs) than controls (316.0 +/- 26 ug/24 hrs). Mean liver zinc was also lower in cirrhotic patients (85.10 +/- 21.31 ug/g) than control values (112.40 +/- 31.72 ug/g) but patients with schistosomiasis had identical values with controls. Decreasing levels were noted from chronic hepatitis through cirrhosis to primary liver cancer and decompensated patients had lower levels than well-compensated disease. No difference was seen between alcoholic and non-alcoholic cirrhotics. This study indicates that hyperzincuria occurs in association with zinc deficiency in CLD, an abnormality which may be important in the genesis of some features of the disease.

Upper gastrointestinal endoscopy in Zaria, northern Nigeria.

The indications for and findings in 431 consecutive patients who had upper gastrointestinal endoscopy in Zaria from June 1978 to August 1982 are reviewed. The major indications were dyspepsia (78.1%), upper gastro-intestinal bleeding (12.1%) and portal hypertension (4.2%). Other indications were persistent vomiting, dysphagia and abdominal masses. The mean age of the patients was 32 years. The male: female ratio (3:1) was not different from that in the hospital population. There were no abnormal findings in 32.7%. 26.6% had duodenal ulcers. Duodenitis was noted in 24.8%, oesophageal varices in 6.3%, gastritis in 6.3% and hiatus hernia in 4.6%. In those who presented with upper-gastrointestinal haemorrhage, oesophageal varices (34.6%) and peptic ulcer (17.3%) were the commonest findings. Complication seen commonly were soreness in the throat and thrombophlebitis at the site of valium injection. One death was recorded from the procedure over the period.

A field trial of a single intramuscular injection of long-acting chloramphenicol in the treatment of meningococcal meningitis.

During an epidemic of meningococcal meningitis 86 patients with symptoms and signs of meningitis were treated with a single intramuscular injection of a long-acting oily preparation of chloramphenicol (Tifomycine). Treatment was given by auxiliary medical staff who worked in four separate village dispensaries under the supervision of the local medical officer. The clinical response to treatment was satisfactory; 79 of 86 patients (92%) recovered fully with few residual disabilities. There were five deaths (5.8%) but a definite diagnosis of meningococcal meningitis was established in only one of these patients. Treatment was changed because of a poor clinical response in two further patients. Diagnosis was eventually proved in 45 patients (52%). The response to treatment of patients in this group was similar to that observed in the remaining 41 patients. The results of this preliminary study show that a single dose injection of a long-acting chloramphenicol is of value in the management of epidemics of meningococcal meningitis in rural areas because patients can be treated locally and early in their village dispensaries, thereby minimizing the need to transport them to urban hospitals which are often distant and congested.

Control of meningococcal infection in the African meningitis belt by selective vaccination.

During an outbreak of group-A meningococcal meningitis, information was collected on the distribution of cases of this infection in an area in northern Nigeria. More than 1 case was recorded in all but 3 of 23 affected villages. Members of 9 villages, with a population of about 10 000, in which there had been 2 cases of meningococcal disease were vaccinated with 50 microgram of group-A and group-C meningococcal polysaccharide vaccine. There were subsequently 10 cases of meningococcal disease in these villages but only 2 of these patients had been vaccinated. In contrast there were 38 cases of meningococcal disease in 7 control villages with a similar population. Until we have more information on the duration of immunity after meningococcal vaccination, selective vaccination may be a more cost-effective means of controlling meningococcal disease in the African meningitis belt than routine mass immunisation.

Single injection treatment of meningococcal meningitis. 1. Long-acting penicillin.

A single injection of a long-acting preparation of penicillin (Triplopen) was compared with a five-day course of crystalline and procaine penicillin in the treatment of meningococcal meningitis. The clinical response of patients treated with Triplopen was very similar to that of patients treated with crystalline penicillin and much more convenient to administer. However, four patients treated with Triplopen had a positive CSF culture 48 or 72 hours after their injection. One injection of Triplopen cannot, therefore, be recommended as an entirely safe form of treatment for meningococcal meningitis unless patients can be carefully followed.

Single injection treatment of meningococcal meningitis. 2. Long-acting chloramphenicol.

A single injection of a long-acting oily preparation of chloramphenicol (Tifomycine) was compared with a five-day course of crystalline and procaine penicillin in the treatment of 131 adult patients with meningococcal meningitis. The clinical response to treatment was similar in the two groups of patients. Serial lumbar punctures showed a parallel fall in CSF cell count, protein and lactate and all posttreatment cultures were sterile. Single injection chloramphenicol treatment was cheaper and much easier to administer than penicillin. Long-acting chloramphenicol is thus an effective form of treatment for meningococcal meningitis and is likely to prove of particular value in the management of epidemics in areas with limited medical resources.