Outpatient burden of adult respiratory diseases in University of Ilorin Teaching Hospital, Nigeria.

Background: Respiratory diseases constitute a significant cause of morbidity globally. There is limited information on the epidemiology of respiratory diseases in North Central Nigeria particularly with the changing trend in risk factors. Aim: This study aimed at evaluating the pattern and morbidity related to respiratory diseases among adult outpatients attending a chest clinic in a tertiary healthcare facility, especially with increasing environmental pollution and biomass exposure globally. Patients And Methods: This was a retrospective review of the case records of 338 newly referred patients seen in the chest clinic of the University of Ilorin Teaching Hospital (UITH) with respiratory illnesses over a 2-year period (January 2017-December 2018). Results: The mean age of the recruited patients was 47.6 ± 19.8 years with a male to female ratio of 1.1:1. Microbiologically confirmed tuberculosis (30.2%), chronic obstructive pulmonary disease (COPD) (24.3%), and bronchial asthma (17.8%) were the commonest conditions managed in the clinic. Overall, noncommunicable respiratory diseases (61.2%) constituted a larger proportion of cases when compared to infective respiratory conditions. Almost 90% of the patients were never smokers. Systemic hypertension (15.1%) and human immunodeficiency virus infection (3.6%) were the commonest comorbid illnesses. Conclusion: Although tuberculosis constituted the most observed single condition, noncommunicable respiratory diseases predominated cumulatively among the new cases seen in the chest clinic of UITH, Ilorin. This raises the need for significant attention in terms of prevention and management of noncommunicable respiratory diseases, which appear to be on the uprising.

Assessment of Post-Treatment Health-Related Quality of Life among Patients with Pulmonary Tuberculosis in Ilorin, Nigeria.

BACKGROUND: A lot of attention has generally been given to the microbiology and treatment of pulmonary tuberculosis with relatively limited consideration on its impact on the physical, psychological and social domains of the individual especially after successful drug treatment. AIM AND OBJECTIVES: This study aimed at assessing the health-related quality of life (HRQoL) and related factors among individuals who had successfully completed treatment for pulmonary tuberculosis (PTB) in Ilorin. METHODS: This was a hospital based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. HRQoL assessment was conducted in 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding three years using the validated St. George's Respiratory Questionnaire (SGRQ). All subjects also had plain chest radiograph done for assessment of the presence and extent of lung parenchymal damage. RESULTS: The overall total median percentage HRQoL score was 18.5 (7.9-28.2) with the highest score in the activity component [33.7 (18.3-41.8)] and least scores in the impact component [10.0 (0.0-21.9)]. The independent predictors of impaired HRQoL were age > 40 years (p= 0.007), absence of formal education (p=0.004), mMRC score >1 (p= 0.002), PTB retreatment (p=<0.001) and radiographic scores >3 (p= <0.001). CONCLUSION: There is impaired HRQoL following treatment for PTB in Ilorin. Hence, there is a need to incorporate HRQOL assessment as an adjunct outcome measure after PTB treatment especially in those with the above identified risk factors.

Clinicopathological Pattern and Management of Primary Lung Cancer in Ilorin, Nigeria.

BACKGROUND: Lung cancer incidence and mortality rates have increased in some low and medium-resourced countries. OBJECTIVES: This study aimed to describe the clinicopathological pattern and management of lung cancer seen in our setting. METHODS: We reviewed cases of pulmonary neoplasm diagnosed and managed at the University of Ilorin teaching hospital over eight years. Cases with tissue diagnosis were enrolled in the study and relevant clinical data were collected from the medical record using a proforma. DESIGN: Hospital-based retrospective study. RESULTS: Out of the 71 cases of primary lung cancer reviewed, 44(62%) were males and the male to female ratio was 2:1. The mean age was 62±14 years and the occurrence was highest in aged 50-69 years. Thirty (42.3%) with histories of tobacco smoking were males. Adenocarcinoma accounted for 34(54.9%), 23(32.4%) were squamous cell carcinoma, 2(2.8%) were large cell carcinoma and 6(8.5%) were other histological variants. The majority (82.7%) presented at stage III-IV lung cancers, 56.3% had malignant pleural effusion and 74.6% received palliative care. Thirty-eight (53.3%) had chest tube drainage, 19(26.7%) underwent chemical pleurodesis and 22(31.0%) received Cisplatin-based systemic chemotherapy. One patient had curative surgery and none received radiotherapy. At 12 months, 4 (5.6%) were still alive, 14(19.7%) cases had medical records of their death and 53(74.7%) were lost to follow up. CONCLUSION: This study has highlighted the clinicopathological trend, high rate of mortality and late presentation of lung cancer in our setting. There is a need to increase the awareness of the warning signs and risk factors to ensure early detection and facilitate curative therapy.

CONTEXTE: L'incidence du cancer du poumon et les taux de mortalité ont augmenté dans certains pays à faibles et moyennes ressources. OBJECTIFS: Cette étude visait à décrire le modèle clinicopathologique et la prise en charge du cancer du poumon observé dans notre milieu. MÉTHODES: Nous avons passé en revue les cas de néoplasme pulmonaire diagnostiqués et pris en charge à l'hôpital universitaire de l'Université d'Ilorin pendant huit ans. Les cas avec diagnostic tissulaire ont été inclus dans l'étude et les données cliniques pertinentes ont été collectées à partir du dossier médical à l'aide d'un formulaire. CONCEPTION: étude rétrospective en milieu hospitalier. RÉSULTATS: Sur les 71 cas de cancer du poumon primitif examinés, 44 (62%) étaient des hommes et le ratio homme / femme était de 2:1. L'âge moyen était de 62 ± 14 ans et la fréquence était la plus élevée chez les 50 à 69 ans. Trente (42,3%) ayant des antécédents de tabagisme étaient des hommes. L'adénocarcinome représentait 34 (54,9%), 23 (32,4%) étaient des carcinomes épidermoïdes, 2 (2,8%) étaient des carcinomes à grandes cellules et 6 (8,5%) étaient d'autres variantes histologiques. La majorité (82,7%) des cancers du poumon de stade III-IV, 56,3% ont eu un épanchement pleural malin et 74,6% ont reçu des soins palliatifs. Trente-huit (53,3%) ont eu un drainage par sonde thoracique, 19 (26,7%) ont subi une pleurodèse chimique et 22 (31,0%) ont reçu une chimiothérapie systémique à base de cisplatine. Un patient a subi une chirurgie curative et aucun n'a reçu de radiothérapie. À 12 mois, 4 (5,6%) étaient encore en vie, 14 (19,7%) cas avaient un médical de leur décès et 53 (74,7%) étaient perdus de vue. CONCLUSION: Cette étude a mis en évidence la tendance clinicopathologique, le taux élevé de mortalité, et la présentation tardive du cancer du poumon dans notre milieu. Il est nécessaire d'accroître la sensibilisation aux signes avant-coureurs et aux facteurs de risque pour assurer une détection précoce et faciliter la thérapie curative. MOTS CLÉS: Clinico-pathologique, modèle, prise en charge, cancer du poumon, néoplasme, Nigéria.

Profile of patients with chronic obstructive pulmonary disease in Ilorin who were never-smokers.

BACKGROUND: The most recognized risk factor for chronic obstructive pulmonary disease (COPD) worldwide is cigarette smoking. However, recent surveys have revealed an increasing trend from nonsmoking causes especially from biomass exposure. This study, therefore, aimed to determine the proportion of patients and the clinical pattern of COPD among never-smokers in Ilorin. SUBJECTS AND METHODS: This is a retrospective study in which case records of patients with clinical diagnosis of COPD from January 2013 to December 2017 were reviewed. Data were collected with respect to their sociodemographic characteristics, clinical details, comorbid illnesses, and severity of the disease. RESULTS: A total of 135 case records of patients with COPD were reviewed, of which 66 had spirometric confirmation of the disease. In all, 38 (57.6%) of them were never-smokers with a male-to-female ratio of 1:1.1. The mean age of the subjects was 64.5 ± 11.7 years. Cough and exertional dyspnea were the most common symptoms (89.5% each), and systemic hypertension was the most common comorbid illness. Firewood exposure constituted the most common nonsmoking risk factor (47.4%), and the majority of the patients had mild COPD. When compared with ever-smokers, the mean post bronchodilator lung function parameters were found to be significantly better in never-smokers. CONCLUSION: Over half of COPD cases in Ilorin were never-smokers with firewood exposure as the main risk factor. This study has further highlighted the need for increased awareness of the hazards of biomass fuel exposure in our setting.

Factors affecting interest in respiratory medicine as a subspecialty of choice: survey of internal medicine residents in Nigeria.

AIMS AND OBJECTIVES: The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine. RESULTS: Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice. CONCLUSION: The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.

Prevalence of cough among adults in an urban community in Nigeria.

BACKGROUND: Cough is the commonest symptom for which patients seek medical attention and may be a warning sign of an impending disease. OBJECTIVE: To determine the prevalence of cough among adults in an urban community in Nigeria. METHODS: We conducted a cross sectional study among subjects aged >18 years from May 2009 to October 2009 in Ilorin, Nigeria. A semi-structured questionnaire was used to collect the data. The American College of Chest Physicians (ACCP) and the European Respiratory Society (ERS) cough guidelines were used to define acute, sub acute and chronic cough. RESULTS: A total of 472 subjects participated in this study, 238(50.4%) were men and 234(49.6%) were women. Ninety-seven (20.6%) had cough in the preceeding 12 months. Thirty-one (6.6%) had cough at the time of interview, of which 17(3.6%) were productive. The prevalence of acute cough was 3.8%, sub acute 1.7% and chronic cough was 1.1%. All types of cough were common in those aged <45 years, unskilled workers, low educational attainment, while chronic cough was common in the women. The risk of coughing increased with tobacco smoking and the number of sticks smoked per day. Majority of subjects with acute cough [16(88.9%)], sub acute cough [8(100%)] and chronic cough [3(60 %)], were yet to consult a doctor. CONCLUSION: Our study revealed a low prevalence of cough among adults in this urban community in Nigeria. It is imperative to enlighten the community on the importance of seeking early treatment for cough, which may be a warning sign of life threatening lung disease.

Profile and outcome of unilateral tuberculous lung destruction in Ilorin, Nigeria.

BACKGROUND: Unilateral tuberculous lung destruction is a serious chronically disabling and often fatal complication of pulmonary tuberculosis. A few previous studies have dealt with some aspects of this entity among Nigerians with pulmonary tuberculosis but these studies may not truly reflect its current trends. OBJECTIVE: To describe the presenting profiles and outcome of unilateral tuberculous lung destruction among patients with pulmonary tuberculosis. METHODS: The study was a chart review of the medical records of adult patients with pulmonary tuberculosis complicated by unilateral lung destruction seen between January 1999- December 2008. Data extracted included demographic, and outcome of treatment. The clinical features, sputum results and illustrative cases are presented. RESULTS: Unilateral lung destruction complicated 74(1.3%) of 5,926 pulmonary tuberculosis cases seen over the review period. Most cases occurred in males [45(60.8%)] and they were predominantly [51(68.9%)] below 40 years of age. Most of them [52(70.2%)] presented after six months of symptoms. Forty-seven (63.5%) of them had had previous exposure to antituberculosis drugs. The left lung was affected in 49 (66.2%) patients. Only 25 (33.8%) of them were cured while the adjusted mortality rate was 25.5%. Male gender, presence of dyspnoea on mild exertion and right ventricular failure were significantly associated with increased mortality. CONCLUSION: Unilateral tuberculous lung destruction has unacceptably high mortality rate which can be prevented by patient presenting early to the hospital, prompt diagnosis and strict adherence to the standard treatment.

Utilisation of spirometry among hospitalised patients with clinical findings of COPD in a tertiary hospital in Nigeria.

AIMS AND OBJECTIVE: The aim of this study was to determine the rate of spirometry utilisation among hospitalised patients with clinical findings of chronic obstructive pulmonary disease (COPD) in a tertiary hospital in Nigeria. PATIENTS AND METHODS: A case record review of hospitalised patients with clinical findings of COPD from January 2002 to June 2009 from the record of the cardiopulmonary unit of the University of Ilorin Teaching Hospital Ilorin, Nigeria was carried out. Age and sex, hospital stay, admitting physician, and outcome of admission were obtained. RESULTS: A total of 228 patients were hospitalised with clinical findings of COPD, 185 (81. 1%) were males and 43(18.9 %) were females. The rate of utilisation of spirometry in hospitalised patients (228) with clinical findings of COPD was 8.3%. More than half of those that had spirometry were aged ≥ 65 years. Majority (16; 84.2%) of those that underwent spirometry were under the care of the pulmonologist (p

Prevalence and characteristics of cigarette smokers among undergraduates of the University of Ilorin, Nigeria.

BACKGROUND: Smoking control is urgently needed to prevent the epidemic of tobacco-related diseases and deaths in developing countries. This requires data on smoking, especially among vulnerable groups like students. We have surveyed cigarette smoking among undergraduates of the University of Ilorin, in the North Central region of Nigeria. MATERIALS AND METHODS: This was a questionnaire-based survey among undergraduates of the University of Ilorin. A total of 1800 students were selected by multistage random sampling. RESULTS: A total of 1754 students (234 medical and 1520 non-medical students) completed the questionnaires. They were 1148 (65.5%) males and 606 (34.5%) females with a mean age of 21.6 ± 3.1 years. The prevalence rate of current smoking was 5.7% (males 7.7%, females 2.0%) and of ever smoking was 17.1% (males 22.9%, females 6.2%). Smoking was more common in non-medical students. Eighty-three (83.8%) of the smokers had already started smoking by their eighteenth birthday. Fifty-one (51.5%) of them smoked ≤ 5 sticks of cigarettes daily. Most of them were influenced into smoking by peer pressure and commercial advertisements. Sixty-seven (67.6%) of them believed that smoking could never have a negative impact on their health status and quality of life and just 39 (39.4%) smokers were willing to quit. CONCLUSIONS: Despite the low prevalence rate of smoking in the studied population, a majority of them were not willing to quit because of a low perception of the negative effects of smoking on their health and quality of life. Comprehensive antismoking campaigns were urgently needed to control cigarette smoking among University undergraduates in Nigeria.

The pattern and outcome of adult tetanus at a sub-urban tertiary hospital in Nigeria.

Though tetanus is a major cause of preventable morbidity and mortality in Nigeria, there is a paucity of data on the pattern and outcome of the disease among the sub-urban and rural populations. This retrospective study of adult tetanus at a suburban tertiary hospital in Nigeria reports a high case fatality rate of 57.1% in 35 patients with a mean age of 33.0+/-14.8 years. Severity of disease (p=0.02), presence of complications (p=0.001) and length of hospital stay (p<0.001) were significantly associated with fatality. Preventive measures for control of tetanus should be extended to the inaccessible suburban and rural areas of Nigeria.

Sickle cell chronic lung disease among young adult Nigerians.

BACKGROUND: Sickle cell chronic lung disease (SCLD) is often underappreciated by health care providers because its exact prevalence and methods of diagnosis have not been well studied. OBJECTIVE: To describe the pattern of SCLD among young adult Nigerians with sickle cell anaemia (SCA).its exact prevalence and methods of diagnosis have not been well studied. OBJECTIVE: To describe the pattern of SCLD among young adult Nigerians with sickle cell anaemia (SCA). METHODS: Ninety (43 males and 47 females) patients with SCA who were selected by balloting and 90 (54 males and 36 females) healthy subjects with normal adult haemoglobin were studied. Their ventilatory function test (spirometry and peak expiratory flow rates), radiological and electocardiographic parameters were obtained and analyzed for SCLD. RESULTS: Seventeen (18.9%) of the patients had SCLD. Majority (94.1%) of them were in stage1 disease, 5.9% in stage two, and none in the more advanced stages3 and 4. The number of patients with SCLD increased with increasing age. SCLD was associated with more than five previous hospital admissions: 82.4%, (OR of 10.02; CI:4.51 to 22.22) and presence of symptoms suggesting previous acute chest syndrome: dyspnoea in 58.8% (OR of 33.33, CI 7.39 to 150.30); chest pain in 94.1%, (OR of 81.33, CI 9.83 to 672.85); and cough in 47.1%, (OR of 64.00, CI 7.15 to 572.60). CONCLUSION: SCLD may not be a rare event in Nigeria. Therefore efforts should be made to diagnose it in the early asymptomatic stage so as to offer effective intervention therapy to halt progression to the more disabling advanced stages.

Managing acute chest syndrome of sickle cell disease in an African setting.

Despite the fact that acute chest syndrome contributes immensely to morbidity and mortality in patients with sickle cell anaemia, its exact aetiopathogenesis is very complex and not yet well understood. Therefore, a high index of suspicion is needed in its diagnosis, and appropriate treatment should be commenced as soon as possible to prevent lethal complications of this condition, especially in Nigeria where appropriate diagnostic and therapeutic facilities may not be readily available. This is very important, as it may even develop on hospital admission. There is a need to further investigate preventive measures such as the use of hydroxyurea and the newly introduced Nicosan, especially in those people with recurrent disease, in order to reduce both short- and long-term complications of this syndrome among sickle cell patients in Nigeria.

Normal CD4 Count Range among Healthy Nigerian Population in Ilorin.

BACKGROUND: For the establishment and monitoring of the immune status, CD4 count is critical. OBJECTIVES: To determine the CD4 count range of apparently healthy Nigerians resident in Ilorin and compare with the national value. METHODS: An automated blood analyzer was used to determine the full blood count and CD4 count. The percentage of CD4 count was derived by using other variables. RESULTS: Of the 1205 participants, the reference CD4 count (percentage of CD4) range for adult was 400 to 1288 cells/mm3 (19%-48%) and for children was 582 to 3652 cells/mm3 (17%-50%). CD4 count and percentage of CD4 were significantly ( P = .001) higher in females than in males, and the CD4 count declined significantly with increasing age ( r = -.174, P ≤ .0001). The percentage of CD4 count shows less variation with age ( r = -.051, P = .076). Adult residents of Ilorin had significantly lower absolute mean CD4 count (808 ± 260) than that of the national reference values of 847.0 ± 307.0 cells/mm3 ( P = .001). CONCLUSION: We therefore advocate the use of CD4 count range derived in this study is lower than that of the national reference values.

Lung cancer awareness and anticipated delay before seeking medical help in the middle-belt population of Nigeria.

SETTING: Ilorin metropolis in the middle-belt region of Nigeria. OBJECTIVES: To determine the awareness about warning signs and risk factors for lung cancer and the anticipated delay before seeking medical care in the middle-belt population of Nigeria. DESIGN: This was a cross-sectional study performed among 1125 adults. Lung cancer awareness measure (Lung CAM) was administered face to face by trained interviewers. RESULTS: The respondents' Lung CAM score was low for warning signs and risk factors for lung cancer. Apart from tobacco smoking (69.9%) and air pollution (56.4%), other risk factors were poorly recognised by respondents. Higher education and income and having a relative or friends who had previously had lung cancer were significantly associated with awareness about warning signs and risk factors. The majority (66.8%) would seek help before 2 weeks if they noticed a warning sign. Anticipated delay was associated with non-recognition of any warning sign (OR 3.09, 95%CI 2.26-4.22), lower education (OR 1.90, 95%CI 1.40-2.57), lower income (OR 1.86, 95%CI 1.26-2.75) and males (OR 1.50, 95%CI 1.15-1.97). CONCLUSION: The awareness of lung cancer warning signs and risk factors are not satisfactory in Nigeria. There is a need to increase awareness about the condition to prevent delays in seeking medical help.

General practitioner reported follow-up visits among asthma patients in North Central Nigeria.

BACKGROUND: Despite the benefits of regular follow-up in the long-term care of asthma, no previous study has reported on it among asthma patients in Nigeria. OBJECTIVE: This survey was designed to evaluate GP-reported follow-up visits among asthma patients in North Central Nigeria. METHODS: It was a cross-sectional survey conducted among GPs in three North Central states of Nigeria. RESULTS: Overall, 48.3% of the GPs reported that their patients usually come for follow-up visits. About 63.6%, 40.0%, and 55.3% of the GPs in Kwara, Kogi, and Niger states, respectively, reported that their patients came for follow-up visits in the month prior to this study. Less than two-third of GPs in both private (55.1%) and public (56.8%) hospitals reportedly attended to patients on follow-up visits. About 46.5%, 37.5%, and 52.0% of the GPs who attended to patients <1 week, 1-2 weeks and >2 weeks prior to the study reported that their patients came for follow-up visits. There was significant difference (P = 0.04) in the reported follow-up visits by GPs who attended to ≥10 asthma patients compared to others. None of the nine GPs who reportedly treated ≥ 10 patients in the preceding month of the study attended to any patient on follow-up visits. CONCLUSION: The GP-reported rates of follow-up visits in patients that are accessing asthma care from GPs practicing in the North Central part of Nigeria are low. Further studies to identify barriers to follow-up visits and how to correct them are therefore recommended.