May Measurement Month 2021: an analysis of blood pressure screening results from Nigeria.

There is a need to constantly assess the awareness, treatment, and control of hypertension in Nigeria. This study determined the frequency of undiagnosed hypertension across the six geopolitical zones of Nigeria. We conducted an opportunistic screening of adults aged at least 18 years in the month of May 2021. Participants were recruited by trained volunteers using the May Measurement Month protocol. Blood pressure (BP) was measured using validated digital sphygmomanometers. We defined hypertension as systolic BP ≥ 140 and/or diastolic BP ≥ 90 mmHg and/or the use of BP-lowering medications. A total of 9361 participants (51.5% females) with a mean age of 40.7 ± 15.5 years were screened. Hypertension was present in 3192 (34.1%) of the participants. About half (1491, 46.7%) of the hypertensives were unaware of the diagnosis. Among the 3192 participants with hypertension, less than half (1540, 48.2%) were on antihypertensive medications, while only 36.4% of those on antihypertensive medications had their BP controlled (<140/90 mmHg). About one-third of Nigerians in this opportunistic screening had hypertension, with about half of them being unaware of their diagnosis while only about two out of every five on antihypertensive medications had controlled BP. Urgent health actions are needed in Nigeria to reduce the burden of hypertension and its complications.

The case for increased peritoneal dialysis utilization in low- and lower-middle-income countries.

Peritoneal dialysis (PD) has several advantages compared to haemodialysis (HD), but there is evidence showing underutilization globally, especially in low-income and lower-middle-income countries (LLMICs) where kidney replacement therapies (KRT) are often unavailable, inaccessible, and unaffordable. Only 11% of all dialysis patients worldwide use PD, more than 50% of whom live in China, the United States of America, Mexico, or Thailand. Various barriers to increased PD utilization have been reported worldwide including patient preference, low levels of education, and lower provider reimbursement. However, unique but surmountable barriers are applicable to LLMICs including the excessively high cost of providing PD (related to PD fluids in particular), excessive cost of treatment borne by patients (relative to HD), lack of adequate PD training opportunities for doctors and nurses, low workforce availability for kidney care, and challenges related to some PD outcomes (catheter-related infections, hospitalizations, mortality, etc.). This review discusses some known barriers to PD use in LLMICs and leverages data that show a global trend in reducing rates of PD-related infections, reducing rates of modality switches from HD, and improving patient survival in PD to discuss how PD use can be increased in LLMICs. We therefore, challenge the idea that low PD use in LLMICs is unavoidable due to these barriers and instead present opportunities to improve PD utilization in LLMICs.

May Measurement Month 2018: an analysis of blood pressure screening results from Nigeria.

Hypertension remains the dominant cardiovascular risk factor worldwide. May Measurement Month (MMM) is an annual global programme of the International Society of Hypertension aimed at screening for undetected hypertension in the general population. We report the outcome of MMM 2018 in Nigeria. An opportunistic screening of adults aged at least 18 years was conducted in the six geopolitical zones of Nigeria in the month of May, 2018. Screening for hypertension was done by trained volunteers with the use of validated digital and mercury sphygmomanometers following the MMM protocol. Hypertension was defined as blood pressure (BP) ≥140/90 mmHg or the use of BP-lowering medication. There were 6398 participants (53.0% female) with a mean (SD) age of 41.7 (15.0) years. Hypertension was present in 36.4% of the participants with 51.1% of the hypertensives aware of their status, 41.8% on medication, of whom 43.1% were controlled. Overall, only 18.0% of all hypertensive participants had their BP under control. The proportion with hypertension is high, and awareness, treatment, and control rates are low. Concerted efforts are needed to improve awareness and treatment of hypertension in Nigeria in order to reduce the high rate of complications associated with uncontrolled BP.

Spirometric evaluation of ventilatory function in adult male cigarette smokers in Sokoto metropolis.

BACKGROUND: Cigarette smoking is a widespread social habit in Nigeria with extensive deleterious multisystemic effect. Ventilatory dysfunction is one of the cigarette smoking-related illnesses that affect the respiratory system. Spirometry is an investigative method that can be used for the early detection of ventilatory dysfunction even before the onset of the symptoms. SUBJECTS AND METHODS: A questionnaire adapted from the European Community Respiratory Health Survey was administered to collect demographic, clinical, and cigarette smoking data. Ventilatory function test was conducted using Clement Clarke (One Flow) Spirometer, version 1.3. The highest value of each ventilatory function index was chosen for analysis, and individual(s) with ventilatory dysfunction were subjected to post bronchodilator spirometry. RESULTS: For the purpose of this research, 150 participants who were currently cigarette smokers were enrolled, and 50 apparently healthy, age-matched individuals who were never smokers served as controls in the ratio of 3:1. Eighty percent of participants and 68% of controls were aged 40 years or below. The mean age of participants (34.27 ± 8.91 years) and the controls (35.08 ± 10.35 years) was not significantly different (P = 0.592). Similarly, there were no statistically significant differences between the mean anthropometric indices (weight: P = 0.663, height: P = 0.084, and body mass index: P = 0.099) of both participants and controls. The mean values of FEV1 (forced expiratory flow in one second) and FEV1/FVC (FVC=forced vital capacity) were lower in the participants compared to the controls, and this difference was statistically significant (P < 0.001). There was a weak negative correlation between pack-years of cigarette smoking and FEV1 (r = -0.237 and P = 0.004). Obstructive ventilatory defect was found among six study participants (4%) and two controls (4%). CONCLUSION: Cigarette smoking is associated with decline in ventilatory function test indices (FEV1 and FEV1/FVC) in adult males. Decline in FEV1 is directly related to pack-years of cigarette smoking.

Seroprevalence of SARS-CoV-2 in Niger State: Pilot Cross-Sectional Study.

Background: The COVID-19 pandemic caused by SARS-CoV-2 is causing ongoing human and socioeconomic losses. Objective: To know how far the virus has spread in Niger State, Nigeria, a pilot study was carried out to determine the SARS-CoV-2 seroprevalence, patterns, dynamics, and risk factors in the state. Methods: A cross-sectional study design and clustered, stratified random sampling strategy were used to select 185 test participants across the state. SARS-CoV-2 IgG and IgM rapid test kits (colloidal gold immunochromatography lateral flow system) were used to determine the presence or absence of antibodies to the virus in the blood of sampled participants across Niger State from June 26 to 30, 2020. The test kits were validated using the blood samples of some of the Nigeria Center for Disease Control-confirmed positive and negative COVID-19 cases in the state. SARS-CoV-2 IgG and IgM test results were entered into the Epi Info questionnaire administered simultaneously with each test. Epi Info was then used to calculate the arithmetic mean and percentage, odds ratio, χ2 statistic, and regression at a 95% CI of the data generated. Results: The seroprevalence of SARS-CoV-2 in Niger State was found to be 25.4% (47/185) and 2.2% (4/185) for the positive IgG and IgM results, respectively. Seroprevalence among age groups, genders, and occupations varied widely. The COVID-19 asymptomatic rate in the state was found to be 46.8% (22/47). The risk analyses showed that the chances of infection are almost the same for both urban and rural dwellers in the state. However, health care workers, those who experienced flulike symptoms, and those who had contact with a person who traveled out of Nigeria in the last 6 months (February to June 2020) were at double the risk of being infected with the virus. More than half (101/185, 54.6%) of the participants in this study did not practice social distancing at any time since the pandemic started. Participants' knowledge, attitudes, and practices regarding COVID-19 are also discussed. Conclusions: The observed Niger State SARS-CoV-2 seroprevalence and infection patterns meansuggest that the virus has widely spread, far more SARS-CoV-2 infections have occurred than the reported cases, and there is a high asymptomatic COVID-19 rate across the state.

Epidemiology of peritoneal dialysis outcomes.

Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

Family physicians/GP and Internist opinions, familiarity and practice behaviour regarding clinical practice guidelines (CPGs) of common medical conditions in Nigeria.

BACKGROUND: Few studies exist on physicians' opinions, attitudes, familiarity and practice behaviour regarding clinical practice guidelines in sub-Saharan Africa. OBJECTIVES: To determine the opinions, familiarity, and practice behaviour regarding clinical practice guidelines (CPGs) and factors associated with their use among internists and family physicians/GP in Nigeria. METHODS: A semi-structured questionnaire regarding guidelines of five common medical conditions: hypertension, diabetes mellitus, tuberculosis, asthma and hepatitis B encountered in everyday medical practice were self-administered by 183 doctors across the country. RESULTS: Over 90% of respondents believed that guidelines were evidence-based, improved management outcomes, and quality of care, nevertheless, 57.4% were against using them in litigations against doctors. The majority (>70%) of the respondents were familiar with the guidelines except that of hepatitis B. Overall, guidelines were used regularly by 45.9%, used in part by 23.5% and 30.6% never used it. Approximately 50% of physicians had immediate accessibility to them at the point of care. The proportions of respondents reporting a change in practice behaviour ranged from 37.7-57.9% depending on the guideline. The factors associated with guideline-related behaviour change were familiarity with its contents, postgraduate educational training, increased helpfulness score, and practiced >5 years. CONCLUSIONS: The present study shows that most physicians have favourable opinions and are familiar with these guidelines, however, the proportions reporting changes in their patient management because of the guidelines are not satisfactory. It is important to ensure guidelines accessibility and promotes factors that encourage their implementation in medical practice.

Public-private partnership in hemodialysis in Nigeria: A comparative analysis of renal centers across three Northwestern states.

Background: Public-private partnership (PPP) in hemodialysis delivery in Nigeria is a new concept. We set out to compare the performance of Specialist Hospital Sokoto's (SHS) renal center operating with this model with four other neighboring government-operated dialysis centers. Materials and Methods: We reviewed the 6-year records (May 2011 to April 2017) of Dialysis Center of SHS, operated under a PPP and compared some performance indicators with four government-operated dialysis centers over the same period. Comparisons were made using Chi-square and corresponding P values were reported accordingly. P < 0.05 was considered significant. Results: A total of 1167 patients' data were studied. Of these, 252 (21.6%) patients with end-stage renal disease were dialyzed at SHS. The SHS dialysis center experienced 5 months of interruption in dialysis service. Only 38 (15.1%) patients sustained dialysis beyond 90 days and 105 (41.7%) patients had more than three sessions of hemodialysis. Only one patient was referred for kidney transplant from the dialysis center during the review period. SHS performed better than Federal Medical Center and Sir Yahaya Hospitals in terms of service availability, duration on hemodialysis, and greater number of hemodialysis sessions (χ2 = 29.06, df = 3, P < 0.001). Conclusion: PPP has improved the availability of dialysis service, mean duration on dialysis, and mean number of dialysis sessions but did not improve the kidney transplant referral rate at SHS. There is a need to encourage the current arrangement in the Hospital as well as other centers offering similar partnerships.

RésuméContexte: Le partenariat public-privé (PPP) dans la prestation d'hémodialyse au Nigéria est un nouveau concept. Nous avons entrepris de comparer les performances du centre rénal de l'hôpital spécialisé de Sokoto fonctionnant avec ce modèle avec quatre autres centres de dialyse gérés par le gouvernement voisin. Méthodes: Nous avons examiné les dossiers de six ans (mai 2011 à avril 2017) du centre de dialyse de l'hôpital spécialisé de Sokoto, exploité dans le cadre d'un partenariat public-privé et comparé certains indicateurs de performance avec quatre centres de dialyse gérés par le gouvernement au cours de la même période. Des comparaisons ont été faites en utilisant le chi carré et les valeurs p correspondantes ont été rapportées en conséquence. Une valeur p <0.05 était considérée comme significative. Résultats: Un total de 1167 données de patients a été étudié. Parmi ceux-ci, 252 (21.6%) patients atteints d'insuffisance rénale terminale ont été dialysés à l'hôpital spécialisé de Sokoto (SHS). Le centre de dialyse SHS a connu cinq mois d'interruption de service de dialyse. Seuls 38 (15.1%) patients ont subi une dialyse au-delà de 90 jours et 105 (41.7%) patients ont eu plus de trois séances d'hémodialyse. Un seul patient a été référé pour une transplantation rénale depuis le centre de dialyse pendant la période d'examen. L'hôpital spécialisé de Sokoto a obtenu de meilleurs résultats que le centre médical fédéral et les hôpitaux Sir Yahaya en termes de disponibilité des services, de durée d'hémodialyse et de plus grand nombre de séances d'hémodialyse (χ2 = 29.06, df = 3, p <0.001). Conclusion: PPP a amélioré la disponibilité du service de dialyse, la durée moyenne de la dialyse, le nombre moyen de séances de dialyse mais n'a pas amélioré le taux de référence pour une greffe de rein à l'hôpital spécialisé de Sokoto. Il est nécessaire d'encourager l'arrangement actuel à l'hôpital ainsi que dans d'autres centres offrant des partenariats similaires.

Trends in the epidemiology of childhood nephrotic syndrome in Africa: A systematic review.

Background: Childhood nephrotic syndrome, if left untreated, leads to progressive kidney disease or death. We quantified the prevalence of steroid-sensitive nephrotic syndrome, steroid-resistant nephrotic syndrome, and histological types as the epidemiology of nephrotic syndrome in Africa remains unknown, yet impacts outcomes. Methods: We searched MEDLINE, Embase, African Journals Online, and WHO Global Health Library for articles in any language reporting on childhood nephrotic syndrome in Africa from January 1, 1946 to July 1, 2020. Primary outcomes included steroid response, biopsy defined minimal change disease, and focal segmental glomerulosclerosis (FSGS) by both pooled and individual proportions across regions and overall. Findings: There were 81 papers from 17 countries included. Majority of 8131 children were steroid-sensitive (64% [95% CI: 63-66%]) and the remaining were steroid-resistant (34% [95% CI: 33-35%]). Of children biopsied, pathological findings were 38% [95% CI: 36-40%] minimal change, 24% [95% CI: 22-25%] FSGS, and 38% [95% CI: 36-40%] secondary causes of nephrotic syndrome. Interpretation: Few African countries reported on the prevalence of childhood nephrotic syndrome. Steroid-sensitive disease is more common than steroid-resistant disease although prevalence of steroid-resistant nephrotic syndrome is higher than reported globally. Pathology findings suggest minimal change and secondary causes are common. Scarcity of data in Africa prevents appropriate healthcare resource allocation to diagnose and treat this treatable childhood kidney disease to prevent poor health outcomes. Funding: Funding was provided by the Canadian Institute for Health Research (CIHR) and the National Institute of Health (NIH) for the H3 Africa Kidney Disease Research Network. This research was undertaken, in part, from the Canada Research Chairs program.

International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Africa.

Despite positive economic forecasts, stable democracies, and reduced regional conflicts since the turn of the century, Africa continues to be afflicted by poverty, poor infrastructure, and a massive burden of communicable diseases such as HIV, malaria, tuberculosis, and diarrheal illnesses. With the rising prevalence of chronic kidney disease and kidney failure worldwide, these factors continue to hinder the ability to provide kidney care for millions of people on the continent. The International Society of Nephrology Global Kidney Health Atlas project was established to assess the global burden of kidney disease and measure global capacity for kidney replacement therapy (dialysis and kidney transplantation). The aim of this second iteration of the International Society of Nephrology Global Kidney Health Atlas was to evaluate the availability, accessibility, affordability, and quality of kidney care worldwide. We identified several gaps regarding kidney care in Africa, chief of which are (i) severe workforce limitations, especially in terms of the number of nephrologists; (ii) low government funding for kidney care; (iii) limited availability, accessibility, reporting, and quality of provided kidney replacement therapy; and (iv) weak national strategies and advocacy for kidney disease. We also identified that within Africa, the availability and accessibility to kidney replacement therapy vary significantly, with North African countries faring far better than sub-Sahara African countries. The evidence suggests an urgent need to increase the workforce and government funding for kidney care, collect adequate information on the burden of kidney disease from African countries, and develop and implement strategies to enhance disease prevention and control across the continent.

Awareness and attitude to deceased kidney donation among health-care workers in Sokoto, Nigeria.

BACKGROUND: Access to renal replacement therapy by the increasing population of patients with end-stage kidney disease across Sub-Saharan Africa, including Nigeria, has become a major public health challenge. Although deceased kidney donation constitutes a viable source, its uptake by patients is contingent on its acceptance by health-care workers. OBJECTIVES: The aim of this study is to assess the awareness and attitude to deceased kidney donation among health-care workers in Sokoto, Nigeria. MATERIALS AND METHODS:: A cross-sectional study was conducted among 470 staff of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria (attending a 1-week seminar), selected by universal sampling. Data were collected with a set of pretested, self-administered, and semi-structured questionnaire. RESULTS: The mean age of the respondents was 34.1 ± 7.8 years, and most of them (77.7%) were aged <40 years. Majority of respondents were males (60.6%), married (76.5%), and Moslems (73.5%). While almost all the respondents (98.1%) were aware of deceased kidney donation, only about half (51.9%) were willing to accept deceased kidney donation. Furthermore, 43.4% were willing to give consent to donate deceased relative's kidney, and 26.1% were willing to carry an organ donation card. Predictors of willingness to accept deceased kidney donation were male sex, being a medical doctor or laboratory scientist and being a Moslem (Odds ratio >2, P < 0.05). The major disincentives reported were fear that it may not work (42%) and fear of disease transmission (37.0%). CONCLUSION: Periodic education of health-care workers on effectiveness and safety of deceased kidney donation is crucial to promoting its acceptance among them.

Contexte: L'accès à la thérapie de remplacement rénal par l'augmentation de la population de patients atteints d'insuffisance rénale terminale à travers l'Afrique subsaharienne, y compris le Nigéria, est devenu un défi de santé publique majeur. Bien que le don de rein décédé constitue une source viable, son acceptation par les patients dépend de son acceptation par les travailleurs de la santé. Objectifs: Évaluer la sensibilisation et l'attitude envers le don de rein décédé chez les professionnels de la santé à Sokoto, au Nigeria. Méthodes: Une étude transversale a été menée auprès de 470 membres du personnel de l'hôpital universitaire d'UsmanuDanfodiyo, Sokoto, au Nigeria (participation à un séminaire d'une semaine) sélectionnés par échantillonnage universel. Les données ont été recueillies avec un ensemble de questionnaires pré-testés, auto-administrés et semi-structurés.Résultats: L'âge moyen des répondants était de 34,1 + 7,8 ans, et la plupart d'entre eux (77,7%) avaient moins de 40 ans. La majorité des répondants étaient des hommes (60,6%), mariés (76,5%) et musulmans (73,5%). Alors que presque tous les répondants (98,1%) étaient au courant du don de rein décédé, seulement environ la moitié (51,9%) étaient disposés à accepter un don de rein décédé. De plus, 43,4% étaient prêts à consentir à donner le rein d'un parent décédé et 26,1% étaient disposés à porter une carte de don d'organes. Les prédicteurs de la volonté d'accepter un don de rein décédé étaient le sexe masculin, étant un médecin ou un scientifique de laboratoire et étant musulman (Odds ratio> 2, p <0,05). Les principaux facteurs de dissuasion signalés étaient la crainte que cela ne fonctionne pas (42,0%) et la peur de la transmission de la maladie (37,0%). Conclusion: L'éducation périodique des travailleurs de la santé sur l'efficacité et la sécurité du don de rein décédé est cruciale pour promouvoir son acceptation parmi eux. Mots-clés: attitude, don de rein décédé, Sensibilisation, travailleurs de la santé.

Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease.

To determine the correlation of renal ultrasonic parameters and degree of kidney function among chronic kidney disease patients seen at the Nephrology unit of the University of Ilorin Teaching Hospital (UITH) Ilorin, we studied 322 patients. The results were analyzed with specific reference to socio-demography and correlating renal length and volume with estimated glomerular filtration rate. The male to female ratio was 2:1, with an age range from 20 to 80 years and mean age of 45.06 (±13.0) years. The serum creatinine levels ranged from 201 to 1205 µmol/L, with a mean of 388 ± 168 µmol/L, while the estimated glomerular filtration rate (eGFR) ranged from 3.77 to 44.32 mL/min, with a mean of 18.2 ± 7.19 mL/min. The right and left renal lengths ranged from 6.9 to 13.0 cm, with a mean of 9.11 ± 1.06, and 6.5-13.4 cm, with a mean of 9.23 ± 1.07 cm, respectively. The mean volumes of the right and left kidneys were 98.6 ± 41.9 cm 3 and 105 ± 46.2 cm 3 , respectively. The Pearson correlation of the right and left kidneys length to eGFR were -0.197 and -0.137 respectively, while that of the right and left kidney volume to eGFR were -0.122 and -0.043, respectively. Our study showed that there is a positive correlation between ultrasonic renal measurements and degree of kidney function.

Prevalence of non-communicable diseases and its awareness among inhabitants of Sokoto metropolis: outcome of a screening program for hypertension, obesity, diabetes mellitus and overt proteinuria.

INTRODUCTION: Developing countries confront double jeopardy of prevalent infectious disease and increasing Non-Communicable Diseases (NCD) with imminent projected epidemic proportions. Nigeria has witnessed tremendous socio-economic changes and rural to urban migration culminating in emergence of NCD. The impact of these diseases on the lives of people is enormous when measured in terms of outcomes. We initiated a screening program among inhabitants of Sokoto metropolis in an attempt to unravel the prevalence and pattern of NCD. METHODS: This is a descriptive cross sectional study involving 535 participants who were randomlyselected during World Kidney Day Screening in Sokoto. Health promotion talk was organized for the participants before commencing the screening. We took anthropometric measurements and calculated body mass index (BMI) and waist/hip ratio for all individuals. We also checked blood pressure and blood glucose levels and performed urinalysis for all participants. RESULTS: There were 535 participants including 332 males and 203 females with a mean age of 37 ± 17 years. Overweight, obesity and morbid obesity were found in 12.3%, 6.7% and 0.9% of participants respectively. About 11% had waist/hip ratio greater than 1. The prevalence of pre-hypertension and hypertension was 8.5% and 30.2% respectively. Elevated random blood glucose levels were found in 6% of participants while 17.9% had at least 1+ of proteinuria in urinalysis. CONCLUSION: Non-communicable diseases are common in our environment and the level of awareness is low. Regular health education and screening programs are necessary in order to reduce the menace.