Quality of acute asthma care in two tertiary hospitals in a state in South Western Nigeria: A report of clinical audit.

BACKGROUND: To audit the quality of acute asthma care in two tertiary hospitals in a state in the southwestern region of Nigeria and to compare the clinical practice against the recommendations of the Global Initiative for Asthma (GINA) guideline. PATIENTS AND METHODS: We carried out a retrospective analysis of 101 patients who presented with acute exacerbation of asthma to the hospital between November 2010 and October 2015. RESULTS: Majority of the cases were females (66.3%), <45 years of age (60.4%), and admitted in the wet season (64.4%). The median duration of hospital stay was 2 days (interquartile range; 1-3 days) and the mortality was 1.0%. At admission, 73 (72.3%) patients had their triggering factors documented and 33 (32.7%) had their severity assessed. Smoking status, medication adherence, serial oxygen saturation, and peak expiratory flow rate measurement were documented in less than half of the cases, respectively. Seventy-six (75.2%) patients had nebulized salbutamol, 89 (88.1%) had systemic corticosteroid, and 78 (77.2%) had within 1 h. On discharge, 68 (67.3%) patients were given follow-up appointment and 32 (31.7%) were reviewed within 30 days after discharge. Less than half were prescribed an inhaled corticosteroid (ICS), a self-management plan, or had their inhaler technique reviewed or controller medications adjusted. Overall, adherence to the GINA guideline was not satisfactory and was very poor among the medical officers. CONCLUSION: The quality of acute asthma care in our setting is not satisfactory, and there is a low level of compliance with most recommendations of asthma guidelines. This audit has implicated the need to address the non-performing areas and organizational issues to improve the quality of care.

A community survey of the pattern and determinants of household sources of energy for cooking in rural and urban south western, Nigeria.

INTRODUCTION: The use of solid fuels for cooking is associated with indoor pollution and lung diseases. The objective of the study was to determine the pattern and determinants of household sources of energy for cooking in rural and urban South Western, Nigeria. METHODS: We conducted a cross sectional study of households in urban (Ado-Ekiti) and rural (Ido-Ekiti) local council areas from April to July 2010. Female respondents in the households were interviewed by trained interviewers using a semi-structured questionnaire. RESULTS: A total of 670 households participated in the study. Majority of rural dwellers used single source of energy for cooking (55.6%) and urban dwellers used multiple source of energy (57.8%). Solid fuel use (SFU) was higher in rural (29.6%) than in urban areas (21.7%). Kerosene was the most common primary source of energy for cooking in both urban and rural areas (59.0% vs.66.6%) followed by gas (17.8%) and charcoal (6.6%) in the urban areas, and firewood (21.6%) and charcoal (7.1%) in the rural areas. The use of solid fuel was strongly associated with lack of ownership of dwellings and larger household size in urban areas, and lower level of education and lower level of wealth in the rural areas. Kerosene was associated with higher level of husband education and modern housing in urban areas and younger age and indoor cooking in rural areas. Gas was associated with high income and modern housing in the urban areas and high level of wealth in rural areas. Electricity was associated with high level of education, availability of electricity and old age in urban and rural areas respectively. CONCLUSION: The use of solid fuel is high in rural areas, there is a need to reduce poverty and improve the use of cleaner source of cooking energy particularly in rural areas and improve lung health.

Knowledge of and practices related to smoking cessation among physicians in Nigeria / Conhecimento e práticas para a cessação do tabagismo entre médicos nigerianos

OBJECTIVE: To evaluate the knowledge and practices of smoking cessation among physicians in Nigeria. METHODS: We conducted a cross-sectional survey in Lagos and three geopolitical zones of Nigeria. A self-administered structured questionnaire was used to obtain information on tobacco use and its health effects, as well as on the knowledge and practices of smoking cessation, from 436 physicians. RESULTS: Of the 436 physicians, 292 (67.0 percent) were aware of smoking cessation, but only 132 (30.3 percent) showed good knowledge on this topic. The prevalence of smoking among the physicians was 17.7 percent. In addition, 308 physicians (70.6 percent) reported that tobacco education in the medical school curriculum was inadequate. Of the 436 physicians, 372 (86.2 percent) asked their patients whether they smoked, and 172 (39.4 percent) asked their patients the reasons for using tobacco. As a means of smoking cessation intervention, 268 (61.5 percent) used brief advice/counseling (2-5 min), 12 (3.7 percent) prescribed antidepressants, 16 (2.8 percent) prescribed nicotine replacement therapy (NRT), and 76 (17.4 percent) arranged follow-up visits. When the physicians were questioned regarding the obstacles to smoking cessation interventions, 289 (66.3 percent) cited poor knowledge of the issue, 55 (12.6 percent) cited a lack of time, and 20 (4.6 percent) cited unavailability of NRT. CONCLUSIONS: The results of this study highlight the lack of knowledge among physicians in Nigeria in terms of smoking cessation, as well as their failure to apply appropriate practices. The results of this study can further the evaluation and formulation of guidelines on smoking cessation and smoking education programs for physicians. Our findings also underscore the need to offer smoking cessation programs in all treatment facilities.

OBJETIVO: Avaliar o conhecimento e as práticas para a cessação do tabagismo entre médicos na Nigéria. MÉTODOS: Um inquérito transversal foi realizado na cidade de Lagos e em três zonas geopolíticas da Nigéria. Um questionário estruturado de autopreenchimento foi respondido por 436 médicos para a obtenção de informações a respeito do uso de tabaco e de seus efeitos na saúde, seu conhecimento e as práticas para cessação do tabagismo. RESULTADOS: Dos 436 médicos, 292 (67,0 por cento) estavam informados a respeito da cessação do tabagismo, mas somente 132 (30,3 por cento) demonstraram bons conhecimentos sobre esse assunto. A prevalência de tabagismo entre os médicos foi de 17,7 por cento. Além disso, 308 médicos (70,6 por cento) relataram que a educação sobre tabagismo nos currículos de medicina era inadequada. Dos 436 médicos, 372 (86,2 por cento) questionavam seus pacientes quanto ao tabagismo, e 172 (39,4 por cento) os questionavam quanto aos motivos para o fumo. Como forma de intervenção para a cessação do tabagismo, 268 (61,5 por cento) utilizavam breve aconselhamento (2-5 min), 12 (3,7 por cento) prescreviam antidepressivos, 16 (2,8 por cento) prescreviam terapia de reposição nicotínica (TRN), e 76 (17,4 por cento) agendavam consultas de acompanhamento. Quando os médicos eram questionados quanto aos obstáculos para as intervenções para a cessação do tabagismo, 289 (66,3 por cento) citaram pouco conhecimento do assunto, 55 (12,6 por cento) citaram a falta de tempo, e 20 (4,6 por cento) a indisponibilidade de TRN. CONCLUSÕES: Os resultados deste estudo destacam a falta de conhecimento dos médicos na Nigéria quanto à cessação do tabagismo, assim como a sua falha em aplicar práticas adequadas. Os resultados deste estudo podem auxiliar na avaliação e na formulação de diretrizes sobre cessação do tabagismo e de programas de educação em tabagismo para médicos. Nossos achados também destacam a necessidade da oferta de programas para cessação ...

Knowledge of and practices related to smoking cessation among physicians in Nigeria.

OBJECTIVE: To evaluate the knowledge and practices of smoking cessation among physicians in Nigeria. METHODS: We conducted a cross-sectional survey in Lagos and three geopolitical zones of Nigeria. A self-administered structured questionnaire was used to obtain information on tobacco use and its health effects, as well as on the knowledge and practices of smoking cessation, from 436 physicians. RESULTS: Of the 436 physicians, 292 (67.0%) were aware of smoking cessation, but only 132 (30.3%) showed good knowledge on this topic. The prevalence of smoking among the physicians was 17.7%. In addition, 308 physicians (70.6%) reported that tobacco education in the medical school curriculum was inadequate. Of the 436 physicians, 372 (86.2%) asked their patients whether they smoked, and 172 (39.4%) asked their patients the reasons for using tobacco. As a means of smoking cessation intervention, 268 (61.5%) used brief advice/counseling (2-5 min), 12 (3.7%) prescribed antidepressants, 16 (2.8%) prescribed nicotine replacement therapy (NRT), and 76 (17.4%) arranged follow-up visits. When the physicians were questioned regarding the obstacles to smoking cessation interventions, 289 (66.3%) cited poor knowledge of the issue, 55 (12.6%) cited a lack of time, and 20 (4.6%) cited unavailability of NRT. CONCLUSIONS: The results of this study highlight the lack of knowledge among physicians in Nigeria in terms of smoking cessation, as well as their failure to apply appropriate practices. The results of this study can further the evaluation and formulation of guidelines on smoking cessation and smoking education programs for physicians. Our findings also underscore the need to offer smoking cessation programs in all treatment facilities.