Challenges of Case Management of COVID-19 in University of Uyo Teaching Hospital: A One-Year Experience

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020­May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2(0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.

Predictors of Delayed Enrolment for Care among People Living with HIV in a Tertiary Hospital in South Eastern Nigeria.

Aim: This study aimed to identify predictors of delayed enrolment to HIV care in Calabar, Nigeria. Study Design: This was a cross sectional observational study. Place and Duration: This study was carried out in a tertiary level hospital in Calabar, Nigeria between February 1st, 2013 and June 30th, 2013. Methodology: We recruited 500 consecutive HIV-infected persons presenting to care for the first time following HIV diagnosis using a validated, semi-structured and pretested questionnaire. The outcome variable of interest was delayed enrolment for HIV care (>12 months after HIV diagnosis). The independent variables included age, sex, marital status, occupation, income, level of education and exposure to risky behaviour. Others were sexual orientation, duration between HIV testing and presentation for care, residential conditions, lack of spousal HIV status disclosure, distance of residence from nearest HIV care centre and being in a long-standing steady partnership. Results: A total of 45 (9.0%) of the participants enrolled for HIV care within twelve months of HIV diagnosis while 455 (91.0%) enrolled for care after 12 months of diagnosis. The average CD4+ count of those who enrolled early was 248cells/μl which was much lower than the average CD4+ count of those who delayed enrolment (310cells/μl). The average distance of participants who enrolled early for care was lower (296km) than those who delayed enrolment (346km). The covariates significantly associated with delayed enrolment on bivariate analysis were sex, occupation, alcohol use and CD4+ count. Three out of the four covariates retained their significance following multivariate logistic regression and they were CD4+ count, male sex and farming. Conclusion: A significant proportion of clients diagnosed with HIV infection delay in enrolling for care in Calabar. The predictors of delayed enrolment are CD4+ count, male sex and farming. A multifaceted approach of advocacy and social mobilization, poverty alleviation strategies and provision of effective health insurance for all is required.

Chronic Obstructive Pulmonary Disease (COPD): A Review of the Clinical Management

Chronic Obstructive Pulmonary disease (COPD) is one of the most common chronic respiratory diseases which contribute significantly to the burden of non-communicable diseases(NCDs). With the increasing prevalence of COPD in developing countries a good knowledge of the diagnosis and adequate management are important tools for both primary care and specialist physicians to ensure appropriate treatment.Methods: Review of the available literature on the subject was done through Medline and Google search utilizing the following keywords COPD; epidemiology; pathogenesis and management.Result: Spirometry is an important tool in the diagnosis and staging of COPD. Various treatment targets aimed at improving breathing and the quality of life in patients are available.Conclusion: New therapies that have the potential to improve disease outcome are urgently needed

An Overview of Chronic Obstructive Pulmonary Disease (COPD): Epidemiology and Pathogenesis

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic respiratory diseases which contribute significantly to the burden of non-communicable diseases. With the increasing prevalence of COPD in developing countries a good knowledge of disease burden and process is essential.Methods: Review of the available literature on the subject was done through Medline and Google search utilising the following keywords COPD; epidemiology; pathogenesis and management.Result: COPD which is increasing in prevalence has varied pathogenetic mechanisms which are influenced by both intrinsic and extrinsic environmental promoters.Conclusion: The prevalence of COPD is increasing especially in developing countries. The pathogenesis is multifactorial and current understanding provides insights that are expected to improve on treatment and outcome

Community-Based Survey of Unwanted Pregnancy in Southwestern Nigeria

Unwanted pregnancy; and consequently unsafe abortion; remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately; there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views; perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3;743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life; 26.6 of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7 . Short birth intervals (21.1 ); high cost of raising children (20.1 ); interruption of education (20.1 ) and being unmarried (17.3 ) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3 ) were aware of some form of contraception but ever-use rate was only 36.6 while current use rate was 23.4 . Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage; as increased usage will reduce unwanted pregnancy and induced abortion