Heavy metal exposure and renal impairment: A systematic review of observational studies

Background: Environmental exposure to toxins has been strongly implicated in its multi-faceted etiology of chronic kidney disease, a serious public health problem affecting individuals, families, and communities. There is a need to synthesize available studies on the effect of heavy metal exposure on renal function, considering the rising global burden of kidney disease. The objective of this study is to determine the association between exposure to heavy metals and renal disease. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review. A comprehensive independent search, title, abstract, and full-text screening of available literature on Google Scholar, PubMed, and OAREScience was done between March 2021 and May 2021. The criteria for study inclusion were full-text articles published in English language in the last 20 years (2001-2020), and observational primary human studies reporting the association between heavy metal exposure and renal disease. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies. Results: A total of 552 studies were identified following the search from the different databases. A total of 13 studies were finally included in the review. Heavy metals implicated in the studies include cadmium, lead, mercury, and arsenic, with ten studies showing environmental exposure as the primary source. Ten (10) studies showed an association between heavy metal exposure and renal impairment (p<0.05) while only 3 studies reported no association. Conclusion: Environmental monitoring is needed to stem the tide of heavy metal exposure in view of the growing burden of chronic kidney disease.

Knowledge; Attitude; and Infection Control Practices of two Tertiary Hospitals in Port-Harcourt; Nigeria

Background: Surgical site infections (SSIs) are a significant cause of morbidity; emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSI in several health care institutions. This study assessed the effects of the implementation of the policy in a tertiary hospital in Port Harcourt; Nigeria. Materials and Methods: A cross-sectional; comparative study design was used for the study; with data collected using a structured questionnaire and guided observation of doctors and nurses involved in the management of patients that had caesarean sections in two comparable tertiary hospitals in Port Harcourt-the University of Port Harcourt Teaching Hospital (UPTH) and the Braithwaite Memorial Specialist Hospital (BMSH). Results: There were no statistically significant differences in the designations and length of practice of the respondents in both hospitals (P = 0.77). However; 63.64 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 and 69.69 respectively of the respondents in UPTH; compared with 22.86 (P = 0.00) and 0.00 (P = 0.02) in BMSH. The reasons given by the respondents in UPTH for nonadherence to the infection control policy include poor supervision (39.39) and lack of in-service training (21.21); while the respondents in BMSH gave reasons that include inadequate supply of consumables (34.29) and absence of a hospital's policy on infection control (22.88). Conclusion: The implementation of the infection control policy resulted in some improvements in certain infection control practices

How Effective is the 2012 Maternal; Newborn and Child Health Week (MNCHW) in River State?

Nigeria is one of the countries noted to have made insufficient progress towards the attainment of the health-related MDGs. Experience has however shown that a few cost-effective interventions that can be delivered in resource poor settings; through family/community-level action and schedulable population-oriented services; are able to rapidly attain these goals. This was the basis of the Maternal; Newborn and Child Health Week (MNCHW) in Nigeria; designed to achieve rapid population coverage of chosen interventions; within the one week period of the programme. This study assessed the effectiveness of the week held in Rivers State; in June 2012. of the LGAs; while iron and folate tablets were given to just 2.86Materials and Methods: The data for the assessment was collected through on-the- spot observations; three semi-structured questionnaires; and the final summaries of the week; provided by the State Ministry of Health. The questionnaires were administered in nine health centers; in three randomly selected LGAs. The first questionnaire was used to assess the extent of the social mobilization carried out for the week; the second was an exit interview of clients of the health facilities; and used to assess the success of the social mobilization campaign; while the third questionnaire was used to assess the availability of the intervention commodities; and the quality of care given to the clients.Results: The social mobilization campaign for the week was poorly funded and did not have much effect; as only 28.57 of the clients of the health facilities were aware of the week. Most of the commodities for the week; except the NPI vaccines and vitamin A; were not available in the required quantities. Long Lasting Insecticide-treated Nets (LLINs) and Sulphadoxine-Pyrimethamine (SP) were not available in 65.22 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; while iron and folate tablets were given to just 2.86 of the LGAs; while iron and folate tablets were given to just 2.86 of the targeted total. The coverage rate of the vaccines ranged from 1.29 recorded with the measles vaccine; to the 14.85; for the DPT vaccine. The coverage with vitamin A of 43.41; for the DPT vaccine. The coverage with vitamin A of 43.41 was the highest of all the interventions; while the 0.36 coverage for family planning commodities was the least.Conclusions: The MNCHW in Rivers State did not meet the stated objectives. Efforts should be made to leverage on the political will of the current government of the State for health programmes

Energy saving bulbs: an emerging threat to public health, from. mercury contamination of the environment

Energy saving bulbs are promoted for their efficiency and capacity to reduce the emission of greenhouse gases; the acknowledged cause of global warming and climate change. They however contain varying quantity of mercury that can easily contaminate the environment. Mercury is a neuro-toxin; but damage has also been reported in the kidney; skin and the cardiovascular system. There is therefore an urgent need to emphasize the safe disposal of the energy-saving bulbs as their use increase in Nigeria. Recycling programme should be institutionalized; with the active participation of the manufacturers and importers of the bulbs; while education programme should be mounted on the handling and safe disposal of broken bulbs

The Mortality of Serving African Presidents: A Lesson for the Health Profession and the Lay Public

Although Africa has the worst mortality data in the world; the picture painted by the high mortality rate of serving Africa leaders in the last five years suggests reasons and causes far beyond poor socio-economic conditions. This study examined the causes and age at death of serving African leaders; in the last five years; and draws out the lessons; for the health profession and the general public.Material and methods: An internet search of creditable websites was carried out to determine the number; causes and age at deaths of the leaders; within the study period of 2008 to 2012. The life expectancy rates of the bereaved countries were also considered.Results: A total of 13 presidential mortalities took place in the world during the study period; with 10 (76.92) involving serving African leaders. The leaders died at an average age of 66.9 +/- 7.22 years; an average of 12.1 years above the life expectancy rate of their respective countries; but less than the world average of 68 years. Most (80.00) of the leaders died from non-communicable diseases; 3 died from cardiovascular diseases; 3 died from cancer; while two were known diabetics. The remaining two leaders were killed in a violent change of government.Conclusion: The African leaders died mainly from non-communicable diseases; at an age that is below the world average. Public enlightenment campaigns and greater emphasis on patient-centered chronic care of non-communicable diseases are hereby recommended

Socio-Demographic Characteristics of Alcohol Abusers in a Rural Ijaw Community in Bayelsa State; South-South Nigeria

Background: Causal relationship has been established between alcohol and more than 60 types of disease and injury. Despite this, alcohol is still widely consumed in several communities in Nigeria, and sometimes considered a health tonic. This study described the pattern, prevalence, and factors associated with alcohol abuse in a typical Ijaw community, where alcohol is produced and consumed in large quantities. Materials and Methods: The study was carried out in Okoloba, a rural community in Bayelsa State, South-South Nigeria using an analytical cross-sectional study design. The data were collected from members of the community aged 16 to 65 years, using the Alcohol Use Disorders Identification Test questionnaire and clinical examination for hepatomegaly, tongue tremor, and hand tremor. Results: A total of 322 subjects, comprising 166 men and 156 women were studied. They had an average age of 41.4 ± 2.5 years, were mostly farmers (43.17%), married (66.15%), and had at most primary school education (62.42%). More than 90% of the subjects took alcohol in the preceding year, with more of them (43%) preferring the locally produced drinks. About 33% of the subjects had harmful drinking, while 12.73% had alcohol dependence problem. There is no significant age difference between the alcohol abusers and abstainers/social drinkers (P > 0.05), but alcohol abusers were significantly more likely to be males (P < 0.001), in polygamous marriages (P < 0.00001), had lower educational status (P < 0.0001), likely to be practitioners of the traditional religion (P < 0.0001), and more likely to be engaged in palm wine tapping. Conclusion: Alcohol is widely consumed in the community, but the prevalence of abuse was moderate, mainly due to cultural restrictions. Sales restrictions might be needed as the drinking habits of members of the community change with urbanization

Acute Health Effects of a Crude Oil Spill in a Rural Community in Bayelsa State; Nigeria

In May 2000; there was a breach in the crude oil pipeline belonging to a major oil company in Etiama Nembe; in Bayelsa State; Nigeria. This study is to investigate if the residents in the affected community suffered an increase in self reported symptoms that might be attributable to exposure to the spilled crude oil. : A retrospective cohort study; with a comparison control group was carried out; using an interviewer - administered questionnaire and focus group discussions as the study tools. Exposure status was assigned on the basis of geographical location. The questionnaire was administered to male respondents in both the exposed and unexposed communities; while the focus group discussions were held only with adult women in the exposed community.:Atotal of 420 questionnaires were administered and retrieved from both study groups. There were no significant differences in the age; cigarette smoking or the history of chemical allergy between the exposed and the unexposed groups; though the respondents in the exposed communities were significantly better educated (p-value 0.005). There were significant differences in the period prevalence for diarrhea (OR

Experiences and Attitudes of Young Men towards Abortion in a Semi-Urban Community in Rivers State; Nigeria

Background: Most of the studies on abortion focused on the roles and responsibility of women; with very little attention given to the role played by men. Aim: To assess the experiences and attitudes of young men towards abortion in Mgbede Egbema; a semi-urban community in Rivers State; south-south Nigeria. Methods: A descriptive cross-sectional study design was employed; using a structured questionnaire and focus group discussion as study methods. The questionnaire was administered to all the registered male members of the community's youth association; while the focus group discussion was held with members of the youth association's vigilante committee; to gain more insight into the responses contained in the answered questionnaires. Results: A total of 181 questionnaires were administered and retrieved. The average age of the respondents was 23.1 years; and they were mostly single (77.9); with secondary school education (65.8); and combined Christianity with traditional religion (71.3). Almost all (93.4) had a girl friend; but the responsibility of preventing unwanted pregnancy rested almost entirely on the girl (75.7); and in the event of an unwanted pregnancy; 85.1of the respondents would recourse to abortion. Most of the respondents (74.6) would advice their sister to procure an abortion in the event of an out-of-wedlock pregnancy; but only 20.0of them would like to be actively involved in the process of procuring the abortion. All the respondents knew that abortion was illegal in Nigeria; but 47.5thought that the offence did not include the woman; while 29.8thought the offence was committed by the abortion provider alone. Most (64.6) of the respondents felt abortion should not be freely available; but 90.6of them would want the offenders to be prosecuted only in the event of serious complications; or death. Conclusion: There is a broad support for abortion among the respondents; but fears still exists that liberalization might lead to increase demand for the procedure. A review of the nation's abortion law is therefore recommended

Mandatory HIV Testing and Uptake of Ante-Natal Services in a Primary Health Care Centre in South-South Nigeria

Background: The Nigeria's national policy on HIV/AIDS did not allow for mandatory HIV testing. But several health institutions in Nigeria insist on an HIV test before certain services are given. Fears have been expressed that such mandatory HIV testing might lead to poorer uptake of associated services. Aim: To assess the impact of mandatory HIV testing on the uptake of ante-natal services in a primary health centre located in Obrikom - a semi-urban community in south-south Nigeria. Method: A cross-sectional study was carried out; using the ante-natal records of the primary health centre. The HIV testing procedure of the health centre was clearly established using in-depth interview of staff; and exit interview of women attending the ante-natal clinic. A four-year (October; 2002 to September; 2006) review of the ante-natal records of the health center was then carried out to coincide with the period; two years before; and two years after the introduction of Mandatory HIV testing in the health centre. Results: The health centre had a total of 281 new antenatal registrations during the study period; out of which; only 75 (26.69) were registered two years after the introduction of the policy. This is a significant reduction (p-value 0.001); when compared to the number that registered before the introduction of the policy. There is also a significant decrease in the number of antenatal visits (p-value 0.05); the number of visits decreased from a total of 840 visits; and an average quarterly visits of 105 (s.d 19.94) before the implementation of the policy; to 394 visits and an average quarterly visits of 44.75 (s.d 15.1). Conclusion: Mandatory HIV testing can lead to a significant decrease in the uptake of associated health care services. Efforts should be made to discourage it

Ethical scrutiny of HIV testing in the ante-natal clinic of a secondary health care facility in Rivers State; Nigeria

Background: HIV testing has been shown to be a crucial gateway to treatment; prevention; and support services; hence the urgent need to swiftly scale-up testing in a wide range of clinical encounters; as a means of controlling the pandemic. Fears have however been expressed that such swift scale-ups might result in unethical practices; espe- cially in developing countries without strong civil institutions and legal protection. Aim: To carry out an ethical scrutiny of HIV testing; in a secondary health care facility; in an urban community in south-south Nigeria. Methods: The study was carried out in March 2006; in Omoku General Hospital; a secondary health care facility; with the full comple- ment of staff and facilities. In-depth interviews were held with the relevant staff of the hospital; to ascertain the HIV testing procedure in the ante-natal clinic of the hospital. These were corroborated with exit interviews of women attending the clinic. Results: The HIV testing procedure showed several ethical breaches. The women that attended the ante-natal clinic had mandatory HIV test; were inadequately counselled; and tested without proper linkage with prevention; care and treatment facilities. Conclusion: Most of the ethical breaches stemmed from poor funding; and improper linkage with other services. Funding of HIV testing programmes must go beyond the provision of test kits

Clandestine Abortion in Port Harcourt: Users' Profile and Motivation

Background: Most of the information on abortion in Nigeria are based on information from women hospitalized for abortion complications. However a lot of abortions; especially those carried out by medical doctors do not cause enough complications to register in hospital statistics. This study is to explore the profile of women that obtain these relatively safe abortions; and to ascertain their reasons for opting for an abortion. Methods: A cross sectional study was carried out in five clinics located in various parts of Port Harcourt; Nigeria; known to provide abortion services. Data on all the women that sought abortion in the clinics between January and March 2007 were collected by the attending doctors. Results: A total of 793 women sought abortion in the clinics within the three months study period; a daily average of 1.76. The clients had an average age of 23.73 years (s.d 7.3); and a large proportion were not yet married (72.01); had no children (67.97); were still in school or learning a trade (66.08); and were having their first termination of pregnancy (68.22). Clients that identified themselves as widowed; divorced or separated made up 17.78of the total. The commonest reasons cited for the decision to terminate the pregnancy were that the women were not yet married (63.43); and that they were still students or learning a trade (60.15). Few women gave contraceptive failure (3.91) or the fact that they did not want any more children (3.66) as a reason for the abortion. Conclusions: Abortion on demand is still very common in Nigeria in spite of legal restrictions. Amending the abortion laws would assist in resolving this paradox

Food insecurity, malnutrition and crude oil spillage in a rural community in Bayelsa State; South-South Nigeria

BACKGROUND:Oil is the main stay of Nigeria's economy, but most residents in the oil producing communities still depend entirely on the environment for their sustenance; and so likely to have a problem of food security in the event of a deleterious impact on the environment. This study is to examine the effect of a major crude oil spillage on household food security and the nutritional status of under-five children in the affected communities. This oil spillage occurred in May 2000, in Etiama Nembe, a rural communityin Bayelsa State, south-south Nigeria.METHOD:The study was carried out six months after the spill, using cross-sectional, external control group study design, with a semi-structured questionnaire and anthropometry as the study tools. The study participants were chosen using a two-stage cluster sampling technique. The questionnaire assessing food insecurity was administered on an adult woman in each of the chosen households, while the anthropometric measurements were taken for every under-five year child in the household.RESULTS:A total of 592 questionnaires were administered and retrieved in both study communities, while anthropometric measurements of 956 under-five year children were taken There were no significant differences in the age and occupations of the respondents, and in the sizes of their households; although, the respondents in the exposed communities were significantly better educated (p-value < 0.001). There were significant differences in the study groups, in household food security (p-value < 0.000001), and in the prevalence of under-five children with underweight (p-value <0.0001), and wasting (p-value <0.01).CONCLUSIONS:Crude oil spillage can increase household food insecurity and childhood malnutrition in the affected communities. Efforts should always be made to provide food aid to affected communities, irrespective of the cause of the spillage

The Effect of Insectide-Treated Bed Net on Malarial Parasitaemia and Haemoglobin Level of Under-Five Children in a Semi-Urban Community in South-South Nigeria

Background: Imperfect control measures like insecticide-treated bed net that merely reduces transmission; appear unlikely to have any significant effect on malarial morbidity in an area of intense perennial malaria transmission. Also; some field studies have indicated that the efficacy achieved might be due to the high coverage rate achieved during the trial that produced a mass killing of mosquitoes in the communities. Aim : To assess the impact of the use of the insecticide-treated bed net in a programme situation; on malarial parasitaemia; haemoglobin levels and spleen sizes in under-five children; in an area of intense perennial malaria transmission in South-South Nigeria. Methods: The study was carried out over a six-month period in two communities in the Ogba/ Egbema/ Ndoni Local Government Area of Rivers State; South-South Nigeria. A non-randomized control group pre-intervention-post-intervention study design was used. Fifty five children under five years systematically chosen from buyers of the nets sold by a social marketing project were used as the intervention group. Fifty eight children were recruited as controls; from a neighbouring community about ten kilometers away; and matched for age and socio-economic status of their parents with those in the intervention group. Results: The baseline data of the study groups were broadly the same (p 0.1). However; in the post-intervention study; there was a 0.75g/dl (p0.05) difference in the haemoglobin level of the children; with a concomitant difference of 24.05 (p-value 0.05) in the proportion with moderate anaemia (8g/dl). There was also a 2.03cm (p-value 0.001) difference in spleen size; and a 34.42 (p-value 0.05) difference in the prevalence of splenomegaly. The 21.35 difference in the proportion with parasitaemia between the two groups was also found to be significant (p-value 0.05). Conclusion : The study shows that insecticide-treated bed net can be an effective tool for malaria control in an area of intense perennial malaria transmission

The effect of insecticide-treated bed net on malarial parasitaemia and haemoglobin level of under-five children in a semi-urban community in south-south Nigeria

Background: Imperfect control measures like insecticide-treated bed net that merely reduces transmission; appear unlikely to have any significant effect on malarial morbidity in an area of intense perennial malaria transmission. Also; some field studies have indicated that the efficacy achieved might be due to the high coverage rate achieved during the trial that produced a mass killing of mosquitoes in the communities.Aim: To assess the impact of the use of the insecticide-treated bed net in a programme situation; on malarial parasitaemia; haemoglobin levels and spleen sizes in under-five children; in an area of intense perennial malaria transmission in South-South Nigeria.Methods: The study was carried out over a six-month period in two communities in the Ogba/ Egbema/ Ndoni Local Government Area of Rivers State; South-South Nigeria. A non-randomized control group pre-intervention-post-intervention study design was used. Fifty five children under five years systematically chosen from buyers of the nets sold by a social marketing project were used as the intervention group. Fifty eight children were recruited as controls; from a neighbouring community about ten kilometers away; and matched for age and socio-economic status of their parents with those in the intervention group.Results: The baseline data of the study groups were broadly the same (p 0.1). However; in the post-intervention study; there was a 0.75g/dl (p0.05) difference in the haemoglobin level of the children; with a concomitant difference of 24.05(p-value 0.05) in the proportion with moderate anaemia (8g/dl). There was also a 2.03cm (p-value 0.001) difference in spleen size; and a 34.42(p-value 0.05) difference in the prevalence of splenomegaly. The 21.35difference in the proportion with parasitaemia between the two groups was also found to be significant (p-value 0.05). Conclusions: The study shows that insecticide-treated bed net can be an effective tool for malaria control in an area of intense perennial malaria transmission

Social Marketing of Insecticide-Treated Bed Net for Malaria Control : an Experience in a Semi-urban Community in South-South Nigeria

Background: The effectiveness of the insecticide- treated bed net in reducing the morbidity and mortality associated with malaria has been proved at all levels of malaria transmission. Several models on how to achieve massive coverage have been suggested; but social marketing of the nets is highly favoured for its sustainability.Aim: To report the experience of a small- scale social marketing project for insecticide-treated bed net in a semi-urban community in south-south Nigeria.Methods: The social marketing project was established in 2003 in Egbema; a semi-urban community in Rivers State; with a population of 47;000. A descriptive cross-sectional study design was used for the study; with the sales records of the project and a structured; interviewer-administered questionnaire as study tools. The sales records were analysed to assess the performance of the project; while the questionnaire was used to collect data on the socio-economic characteristics of buyers of the net.Results: In six months; the project achieved an uptake rate of 1.10 ITN per month; per 1000 population; and a 6.5 coverage of the target population. Most; 208 (67); of the paid up sales were achieved at the well-child clinic and the antenatal clinic of the health facilities that serve the community. Buyers in the two lower socio- economic quartiles bought only about one third of the nets. Members of the community were predominantly farmers/fishermen; but only 19 (10) of the buyers of the nets identified themselves as such.Conclusion: The study shows that the use of social marketing for promoting the use of ITN for malaria control is slow in a poor community