Etiology of Chronic Kidney Disease in Nigeria and Management Challenges

The prevalence of chronic kidney disease (CKD) is increasing globally and is one of the noncommunicable diseases associated with increase mortality globally in the last two decades. The prevalence of CKD in Nigeria, it is 1.6% to 12.4%. Ninety percent of end-stage renal disease (ESRD) patients are said to die within 3 months of commencing dialysis. Indices are even worse in resource poor countries like Nigeria where prevention and adequate intervention are usually hampered by funds. In regions like Nigeria, it will be cheaper to prevent CKD than treating its complications. Hence, it is important to identify the common etiologies of CKD in Nigeria and prevent or promptly address them before causing irreversible damage to the kidneys. The most common cause of CKD in Nigeria includes hypertension, glomerulonephritis and diabetes mellitus. Many of these etiologies are preventable/treatable and should be looked for as a major way to reduce the incidence of CKD in Nigeria. Challenges identified in Nigeria, propagating CKD include westernization, inadequate manpower, late presentation, diagnostic challenge and poorly equipped facilities. Interventions like encouraging healthy lifestyle, making available essential drugs, training of health personnel, subsidized cost of treatment, legislation and policies to curb drug abuse. Therefore, resource-poor settings should focus on creating more awareness and making legislations and/or policies focused on these preventable causes of CKD as this is more realistic and effective in these settings.

Economic Impact of a Vaccine Preventable Disease: A Scoping Review on Tuberculosis

@#Using pulmonary tuberculosis (pTB) as an example of a vaccine-preventable disease (VPD), we aimed to gather evidence on the economic impact of treating a case or managing an outbreak of a VPD. A scoping review was conducted. Online databases (MEDLINE and Google Scholar) were used to collate published studies from the year 2015 to 2019 on the management cost of one case or an outbreak of pTB. Keywords used were cost, treatment, outbreak, pulmonary tuberculosis, tuberculosis, economic, economic evaluation. A total of 29 studies were analysed. The costs of pTB treatment for individual patient were higher in high-income countries compared to middle-income and low-income countries. A case of pTB can result in household catastrophic health expenditure; while an outbreak can overwhelm the health system’s capacity, and disrupts the economy of a country. Therefore, accessibility of vaccines especially in low-income countries must be ensured. Also, vaccine-hesitant individuals must reconsider their stance on vaccination.

Immunization coverage among under-five children living along a school student through child-to-child and child-to-parent information, education and communication strategy

Background: In spite of being a principal producer and exporter of vaccines and billions spent over decades, India is home to one-third of the world's under-five children (U5C) with no immunization. Objectives: The objective of this study was to find the outcome of child-to-child and child-to-parent Information, Education and Communication (IEC) strategy on the current percentage of immunization coverage (IC). Methods: A mixed design research with multilevel concurrent sampling was conducted in Pune. Based on school students' households, 44 clusters having U5C were divided randomly into 11 experimental/control groups each. IEC strategy to students was independent variable and IC among U5C was dependent variable. Data were collected from 1092 students and 2352 U5C parents over 6 years. Vaccination card and Bacillus Calmette–Guérin mark were considered as evidence to conclude on full, partial and no IC. Change in knowledge quotient (KQ) among students/parents and U5C IC before and after IEC strategy assessed. Results: Rural/urban age-appropriate full IC of U5C was 51% and 67% before and 88% and 85% in post-IEC, respectively. The mean KQ change score of 8–12/20 in students is likely to increase full IC by 37% and 18%, decrease partial coverage at 14% and 12%, and improve none coverage at 23% and 16%, from its existing level positively in experimental groups. Numerous factors discouraged parents to pursue their U5C immunization. Conclusions: Advocacy through school students can be an economically viable alternative marketing strategy for inadequate U5C IC than billions spent on treating vaccine-preventable diseases and impractical options.

Guías de Vacunación en Huéspedes Especiales / Guidelines for the Vaccination of Special Hosts

Los niños con alteración de su sistema inmunológico son más vulnerables ante las infecciones que el resto de la población. Una de las formas de protegerlos de infecciones graves es a través de la vacunación, deben ser correctamente evaluados al planear los esquemas a fin de establecer los riesgos vs. los beneficios que implican inmunizarlos. El rol del médico pediatra y del médico especialista trabajando en equipo es fundamental, para que puedan beneficiarse con vacunas y esquemas especiales que requieran por su patología de base. Una protección óptima de estos pacientes incluye además la adecuada inmunización de los convivientes y del equipo médico tratante. La inmunización de los huéspedes especiales es una situación clínica compleja que requiere un análisis exhaustivo personalizado en cada caso, debido a las diferentes características de estos pacientes con enfermedades crónicas y/o inmunosuprimidos, los diversos grupos y muchos tipos de terapias inmunosupresoras que se están desarrollando y utilizando en un número cada vez mayor. Es fundamental el trabajo en equipo del médico especialista y el pediatra de cabecera para lograr el mejor control de las enfermedades inmunoprevenibles en estos pacientes de tan alta complejidad

Children with weakened immune systems are more vulnerable to infections than the rest of the population. One of the ways to protect them against serious infections is vaccination; they must be correctly evaluated when planning schedules in order to define the risks versus the benefits involved by their immunization. The role of pediatricians and medical specialists working as a team is fundamental, so that patients can benefit from vaccines and special schedules that they may require due to their underlying pathologies. Optimal protection of these patients also includes the adequate immunization of household members and their treating medical teams. The immunization of special hosts is a complex clinical situation that requires an exhaustive personalized case-by-case analysis, due to the different characteristics of these patients who have chronic diseases and / or are immunosuppressed, the various groups and many types of immunosuppressive therapies that are being developed and increasingly used. The teamwork of specialists and family pediatricians is essential to achieve the best control of immuno-preventable diseases in these highly complex patients

Smoking control: challenges and achievements / Controle do tabagismo: desafios e conquistas

ABSTRACT Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

RESUMO O tabagismo é o fator de risco mais prevenível e controlável em saúde e, por isso, precisa ter a máxima atenção e ser muito mais enfocado por todos os profissionais da saúde. O tabaco é um produto de alta rentabilidade pela sua grande produção e pelo elevado número de consumidores. As políticas de controle e os recursos terapêuticos para o tabagismo avançaram muito nos últimos anos e têm mostrado resultados altamente satisfatórios, particularmente no Brasil. Entretanto, ainda resta um longo caminho a ser percorrido para que se possa considerar o tabagismo como uma doença controlada sob o ponto de vista da saúde pública. Já se observam modificações do comportamento da sociedade com relação ao tabagismo, mas ainda em escala muito lenta, de modo que os pneumologistas têm nesse setor um campo muito promissor para atuar junto a seus pacientes e a população em geral. É preciso atuar com maior ímpeto em prol das políticas de saúde e das normas de convívio social que contribuem diretamente para melhorar a saúde e a vida. Nesse aspecto, os pneumologistas podem ter um papel de maior destaque na medida em que se envolvam com o tratamento dos fumantes, a aplicação da lei antifumo e as políticas de saúde relacionadas às doenças respiratórias.

Chronic obstructive pulmonary disease: emergency care in acute exacerbation

Chronic obstructive pulmonary disease (COPD) is a preventable condition affecting more than 230 million people globally; and is expected to become the world's third largest cause of mortality by 2030. Despite this fact; it is thought to be widely underdiagnosed and underreported across the African continent. This presents a challenge to emergency medicine (EM) providers in the region; who are faced with treating large numbers of patients presenting with exacerbation of previously undiagnosed COPD. This is complicated by other factors; including lack of public awareness; high prevalence of other chronic respiratory illnesses; and difficulties in access to healthcare.The purpose of this paper is to outline the current state of research and international guidelines surrounding the management of acute exacerbation of COPD in the emergency centre. Strict adherence to international guidelines for management of acute exacerbation of COPD may be difficult for many African providers given factors affecting diagnosis; treatment; and access to care for many Africans suffering from COPD. Research looking into the role of the African EM practitioner in providing more cost-effective means of diagnosis and treatment of COPD is limited

Preventable Lifestyle Risk Factors for Non-Communicable Diseases in the Pakistan Adolescents Schools Study 1 (PASS-1) / 예방의학회지

OBJECTIVES: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. METHODS: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. RESULTS: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had > or =2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). CONCLUSIONS: Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.

Evaluation of Cervical Cancer Screening Program at a Rural Community of South Africa

Objective: Cervical cancer is a leading cause of deaths among women worldwide. But the condition is preventable through regular screening of women those are 'at risk' for abnormal changes in the cervix and treating them who have positive results. Although screening facilities are available in South Africa; the incidence and mortality from cervical cancer remains very high and many women present health facilities with late stage diseases. Purpose of the study is to determine the baseline information on knowledge and practices on risk factors for cervical cancer and Pap smear and to design an intervention to improve Pap smear uptake. Methods: A cross-sectional population based descriptive study was undertaken at a rural community of South Africa targeting women 30 years and over. The assessment was performed by means of a questionnaire survey. Outcome measures were percentage of women with the knowledge on risk factors for cervical cancer and use of Pap smear test and had undertaken Pap smear test. Binary logistic regression analysis was carried out to identify possible predictors of Pap smear test undertaken. A total of 611 women (random samples) were recruited from the selected households. Results: The mean age of the sample was 43 years and 54of them had no education. Only 6knew all and 65knew any one of the risk factors of cervical cancer whereas less than half (49) of them knew that Pap smear is used for prevention of cervical cancer. Only 43respondents received information on Pap smear from health care workers. Among all the respondents only 18(95CI; 15-21) had ever done Pap smear test. Conclusions: This study showed low uptake of Pap smear test and low level of knowledge on prevention of cervical cancer and risk factors thus warrants urgent extensive health education program for this rural communities

Economic evaluation of seizures associated with solitary cysticercus granuloma.

BACKGROUND: Patients with solitary cysticercus granuloma (SCG) develop acute symptomatic seizures because of the inflammatory response of the brain and the seizures are self-limiting. Thus seizure disorder associated with SCG provides a good model to study the total cost of illness (COI). MATERIALS AND METHODS: COI of new-onset seizures associated with SCG was studied in 59 consecutive patients registered at the epilepsy clinic. Direct treatment-related costs and indirect costs, man-days lost and wages lost were evaluated. The relative cost was calculated as the percentage of per capita gross national product (GNP) at current prices for the year 1997-1998. RESULTS: The total COI, for treating seizure disorder associated with SCG per the period of CT resolution of the lesion per patient was INR 7273.7 (US$ 174.66, I$ 943.16) and he/she would be spending 50.9% of per capita GNP The direct cost per patient was INR 5916 (US$ 137.14, 41.4% of per capita GNP). If the patient had received only AEDs for the period of resolution of CT lesion, the cost would be INR 5702.48 (US$132.2, 40% of per capita GNP). The extra expenditure on albendazole and steroid was INR 213.72 (US$ 4.95), 3.6% of the total direct cost and 20.7% of the medication cost. Indirect cost (average wage loss) per patient was INR 1312.7 (US$ 30.42) and it accounted for 9% of per capita GNP. The one-time expenditure at present costs (adjusted for inflation) to the nation to treat all the prevalence cases is to the tune of INR 1.184 billion (US$ 2.605) and 0.0037% of GNP. CONCLUSIONS: This study suggests that seizure disorder associated with SCG, a potentially preventable disorder, is a good model to study the total COI. The one-time expenditure at present costs to the nation to treat all the prevalence cases of seizure disorder associated with SCG is to the tune of INR 1.184 billion (US$ 2.605 million) and 0.0037% of GNP.

Application of Pharmacoeconomics in "Treating Preventable Diseases" / 中国药房

OBJECTIVE:To discuss the application of pharmacoeconomics in "Treating Preventable Diseases" in traditional Chinese medicine. METHODS:Based on the brief introduction of pharmacoeconomics and the theory of "Treating Preventable Diseases",and taking preventing cerebral infarction by using drugs for invigorating blood circulation and eliminating stasis as example to analyze the feasibility and significance of pharmacoeconomics in the study of "Treating Preventable Diseases". RESULTS & CONCLUSIONS:The application of pharmacoeconomics in evaluating the theory of "Treating Preventable Diseases" will establish an objective evaluation system of Traditional Chinese Medicine and guide the rational use of drugs in clinic.

The experience of professor WANG Li-zhong using the method of lipi / 中华中医药杂志

In this article,the professor WANG Li-zhong’s experiences was described,which use the Lipi method to treat the cold,cough,dazzling dizziness,insomnia,stomach pain.Professor WANG Li-zhong Consider that the normal spleen and stomach’s ying and wei are harmonious,and there is no phlegm producted.When the functions of five zang viscera are coordinate,the vital qi is sufficiently and the pathogenic qi can’t injury to the body.Lipi method incarnates the professor WANG Li-zhong’s views to the dieases,its unique to treatment in clinic,and the academic thoughts of treating preventable diseases in Chinese medcine.

Prescribing drugs for patients with liver disease.

BACKGROUND: Adverse reactions to prescribed drugs are a common cause of morbidity in patients receiving medical care. Pre-existing or underlying liver dysfunction is one of the commonest factors that enhance the risk of such adverse events in medical practice. Most textbooks of medicine contain no guidelines on special precautions to be taken in prescribing to a patient with pre-existing liver disease. METHODS: To provide a ready reckoner for modifying drug dosage in liver diseases, a literature search was carried out. All papers related to human studies were reviewed and relevant material extracted for preparing the guidelines. RESULTS: Most adverse drug reactions in the presence of liver disease are related to altered pharmacokinetics, pharmacodynamics and susceptibility to drugs. The influence of hepatic disease on various drugs is highly variable. However, many such adverse events are predictable and preventable. Ideally, drug dosage should be modified with the help of serum drug concentrations, which unfortunately, are not available in most Indian hospitals. Hence, some broad guidelines are presented to assist the treating physician to be aware of the risk of adverse drug reactions and modify drug dosage empirically to avoid such events. CONCLUSION: The altered metabolism of pharmacological agents in patients with liver disease may induce several undesirable effects. A large number of adverse drug reactions can be prevented by modifying drug prescribing habits for patients who have pre-existing liver disease.

Acute respiratory infection management at community level an experience and a proposal

This paper highlights the aspect that by involving masses creating awareness, advocating simple measures of family welfare of detecting ARI, and other infectious and preventable diseases, providing training for First-Aid domestic management of these diseases and teaching pirnciples of referral for diseases beyond the competency of VCDHWS, health can be restored through community's own action. Diseases can be prevented by acquiring and practising health education Information, by the community through participatory research in primary health care projects. Now Doctors are not paid only for treating the patients but helping the community to restore and maintain its health. This plan was put to test with cooperation of NGO'S PVHNA at a micro scale. Results were evaluated and progress was found satisfactory. Keeping the national interest dearest to their hearts, if each one of the paediatricians and community medicine physicians from all Medical Colleges of Pakistan, after joint thorough planning, accept the responsibility of training 30 VCDHWS each month in various demarcated localities. Then within next 5 years not only ARI will be managed at community level, but overall health and hygiene standard will be improved besides they will have an opportunity to test their own health management knowledge and capability of running PHC programmes. No doubt that the four local medical teaching institutions of Karachi have know-how, man-power and will to serve. They are running their own health management programme for over a decade. But have not succeeded in changing overall health status of Karachiites. Most probably some of the institutions are egoistic, others lack spirit of initiation for cooperation or perhaps they have never thought of it due to administrative bottlenecks. An irony of fate is that those who are responsible for giving sense of direction to the community through field training of the students and volunteers seem deficient in having collective sense of direction themselves, which is a dire need of this country and time