Prevalence of Kidney Dysfunction and Associated Risk Factors in a Southwestern City in Nigeria: A Cross-Sectional Study.

BACKGROUND: The burden of chronic kidney disease (CKD) is huge, especially in countries such as Nigeria where majority of patients succumb to the disease early due to inability to afford care. Early diagnosis through regular screening of at-risk population is pivotal to stemming the scourge of the disease. AIM: To determine the prevalence of kidney dysfunction and associated risk factors in a community screening program. METHODS: This cross-sectional study assessed kidney dysfunction and associated risk factors among adults in Ondo City, Nigeria. Information about socio-demographic characteristics and some risk factors for kidney dysfunction was sought. Blood pressure, weight and height were measured. Blood samples were collected for random blood glucose check and serum creatinine while urine sample was collected for urinalysis. Kidney dysfunction was defined by estimated glomerular filtration rate (eGFR) below 60mls/min/1.73m2. Prevalence of kidney dysfunction and associated factors were determined. P value<0.05 was taken as significant. RESULTS: There were 410 participants with a mean age of 58.96±13.78 years. Majority (75.1%) were female. One hundred and forty-seven (35.9%) participants had kidney dysfunction. Identified risk factors for kidney dysfunction were hypertension (72.7%), diabetes mellitus (18.0%), alcohol intake (13.2%), tobacco smoking (2%), analgesic use (82.7%), use of herbal preparations (81.7%), proteinuria (6.1%), overweight (27.8%), generalized obesity (28.5%), and central obesity (33.9%). Significant factors associated with kidney dysfunction were older age (p=<0.001), lower level of education (p=<0.001), and being hypertensive (p=0.019). On binary logistic regression, older age (AOR: 9.14; CI: 3.68-22.7; p=<0.001) was the only significant factor associated with kidney dysfunction. CONCLUSION: The prevalence of kidney dysfunction and that of associated risk factors were relatively high in the screened population. Regular assessment of kidney function should be done in those with higher risk of kidney dysfunction, especially older patients with hypertension.

CONTEXTE: Le fardeau de la maladie rénale chronique (MRC) est énorme, en particulier dans des pays tels que le Nigeria, où la majorité des patients succombent à la maladie tôt en raison de l'incapacité à se permettre des soins. Le diagnostic précoce par le dépistage régulier des populations à risque est crucial pour endiguer le fléau de la maladie. OBJECTIF: Déterminer la prévalence de la dysfonction rénale et des facteurs de risque associés dans le cadre d'un programme de dépistage communautaire. MÉTHODES: Cette étude transversale a évalué la dysfonction rénale et les facteurs de risque associés chez des adultes à Ondo City, au Nigéria. Des informations sur les caractéristiques sociodémographiques et certains facteurs de risque de dysfonction rénale ont été recueillies. La pression artérielle, le poids et la taille ont été mesurés. Un échantillon de sang a été prélevé pour vérifier la glycémie aléatoire et la créatinine sérique, tandis qu'un échantillon d'urine a été collecté pour une analyse d'urine. La dysfonction rénale a été définie par un taux de filtration glomérulaire estimé (TFGe) inférieur à 60 ml/min/1,73 m2. La prévalence de la dysfonction rénale et des facteurs associés a été déterminée. Une valeur de p<0,05 a été considérée comme significative. RÉSULTATS: Il y avait 410 participants avec un âge moyen de 58,96 ± 13,78 ans. La majorité (75,1 %) étaient des femmes. Cent quarante-sept (35,9 %) participants avaient une dysfonction rénale. Les facteurs de risque identifiés pour la dysfonction rénale étaient l'hypertension (72,7 %), le diabète sucré (18,0 %), la consommation d'alcool (13,2 %), le tabagisme (2 %), l'utilisation d'analgésiques (82,7 %), l'utilisation d'herbes médicinales (81,7 %), la protéinurie (6,1 %), le surpoids (27,8 %), l'obésité générale (28,5 %) et l'obésité centrale (33,9 %). Les facteurs significativement associés à la dysfonction rénale étaient l'âge plus avancé (p=<0,001), un niveau d'éducation plus bas (p=<0,001) et l'hypertension (p=0,019). Dans la régression logistique binaire, le seul facteur significatif associé à la dysfonction rénale était l'âge plus avancé (RA : 9,14 ; IC : 3,68-22,7 ; p=<0,001). CONCLUSION: La prévalence de la dysfonction rénale et des facteurs de risque associés était relativement élevée dans la population examinée. Une évaluation régulière de la fonction rénale devrait être réalisée chez ceux présentant un risque élevé de dysfonction rénale, en particulier chez les patients plus âgés souffrant d'hypertension. MOTS-CLÉS: Filtration glomérulaire réduite; Dysfonction rénale; Facteur de risque ; Dépistage communautaire.

First and Second Waves of Covid-19: A Comparative Study of the Clinical Presentation and Outcome among Hospitalized Patients in Lagos Nigeria.

OBJECTIVE: Nigeria experienced many waves of the COVID-19 pandemic. This study compared the clinical presentations and mortality among hospitalized patients during the first and second waves of the pandemic in Lagos State, Nigeria. METHODS: A retrospective cohort study was conducted. Deidentified medical records of laboratory-confirmed COVID-19 patients admitted into 15 isolation centers in Lagos, Nigeria between February 27, 2020, and September 30, 2020 (first wave) and October 1, 2020, and April 30, 2021 (second wave) were reviewed. IBM Statistics version 25 was used for data analysis. RESULTS: More patients were hospitalized during the first wave of the pandemic. The mean age of patients was higher during the second wave (54.5±15.8 years vs. 42.2±15.5 years, p <0.001). More patients admitted during the second wave had comorbidities (56.0% vs 28.6%, p <0.001), were symptomatic (90.8% vs 52.0%, p <0.001), had severe COVID-19 disease (58.9% vs 25%, p <0.001) and died (14.9% vs 6.4%, p<0.001) compared with the first wave. The odds of death increased with age and severity of COVID-19 disease during the first and second waves. CONCLUSION: A higher proportion of the patients admitted in Lagos, Nigeria during the second wave were older, had comorbidities, and had severe COVID-19 disease than the first wave. Despite the fewer hospitalized patients, there were more deaths during the second wave.

OBJECTIF: Le Nigeria a connu plusieurs vagues de la pandémie de la COVID-19. Cette étude a comparé les présentations cliniques et la mortalité chez les patients hospitalisés lors des première et deuxième vagues de la pandémie dans l'État de Lagos, Nigeria. MÉTHODES: Une étude de cohorte rétrospective a été réalisée. Les dossiers médicaux déidentifiés des patients atteints de la COVID-19 confirmée par laboratoire, admis dans 15 centres d'isolement à Lagos, Nigeria, entre le 27 février 2020 et le 30 septembre 2020 (première vague) et entre le 1er octobre 2020 et le 30 avril 2021 (deuxième vague), ont été examinés. IBM Statistics version 25 a été utilisé pour l'analyse des données. RÉSULTATS: Un plus grand nombre de patients ont été hospitalisés lors de la première vague de la pandémie. L'âge moyen des patients était plus élevé lors de la deuxième vague (54,5±15,8 ans vs. 42,2±15,5 ans, p <0,001). Un plus grand nombre de patients admis lors de la deuxième vague avaient des comorbidités (56,0% vs. 28,6%, p <0,001), étaient symptomatiques (90,8% vs. 52,0%, p <0,001), avaient une forme grave de la maladie à la COVID-19 (58,9% vs. 25%, p <0,001) et sont décédés (14,9% vs. 6,4%, p<0,001) par rapport à la première vague. Les chances de décès ont augmenté avec l'âge et la gravité de la maladie à la COVID-19 lors des première et deuxième vagues. CONCLUSION: Une proportion plus élevée des patients admis à Lagos, Nigeria, lors de la deuxième vague étaient plus âgés, avaient des comorbidités et présentaient une forme grave de la maladie à la COVID-19 par rapport à la première vague. Malgré un nombre moindre de patients hospitalisés, il y a eu plus de décès lors de la deuxième vague. MOTS-CLÉS: Présentation Clinique, Covid-19, Première Vague, Mortalité, Nigeria, Deuxième Vague.

Relationship between Kidney Dysfunction, Stroke Severity, and Outcomes in a Nigerian Tertiary Hospital: A Prospective Study.

BACKGROUND: Stroke is a common neurologic disease associated with fatal outcomes. Kidney dysfunction may be an important predictor of stroke severity and outcome. AIM: To determine the relationship between kidney dysfunction at admission and stroke severity and 30-day outcome. MATERIALS AND METHODS: This was a prospective study that involved 150 stroke patients. Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS). Renal dysfunction was assessed by the presence of albuminuria and or reduced glomerular filtration rate (GFR) at admission. Neurological outcome was assessed using mortality, modified Rankin Scale (mRS), and Glasgow Outcome Scale (GCS). RESULTS: The mean age of the study participants was 61.0 ± 13.2 years. Renal dysfunction was present in 66% of the participants while the case fatality rate of stroke was 26%. Poor neurological outcome at 30 days was found in 44.1% of survivors. Those with albuminuria had lower GCS (P = 0.041), lower GFR (P = 0.004), higher mRS score on day 14 (P = 0.041) and day 30 (P = 0.032), and higher NIHSS score (P = 0.034). Independent predictors of 30-day mortality were albuminuria (Adjusted Odd Ratio (AOR) 3.60, 95%CI: 1.07-12.17) and increasing NIHSS score (AOR = 1.15, 95%CI: 1.04-1.28). Lower GCS (P < 0.001), elevated white blood cells (P = 0.003), serum creatinine (P = 0.048), and NIHSS score (P < 0.001) were associated with poor neurological outcome. NIHSS score was the only significant predictor of neurologic outcome (AOR: 1.25; CI: 1.11-1.41; P ≤ 0.001). CONCLUSIONS: Kidney dysfunction was associated with stroke severity and mortality. However, it was not an independent predictor of neurological outcome.

Determinants of Interest in Nephrology Career Choice among Internal Medicine Junior Residents in Nigeria.

INTRODUCTION: There has been decreased interest in postgraduate nephrology training over the years. This trend could worsen the shortage of nephrologists and inability to meet the health needs of patients with kidney diseases if not urgently addressed. AIM: To determine interest in and determinants of nephrology career choice among junior internal medicine residents in Nigeria. METHODOLOGY: This was a cross-sectional study that enrolled 273 junior residents in internal medicine across Nigeria. A self-administered questionnaire that was adapted from two previous studies was used for data collection. RESULTS: The mean age of the respondents was 33.6±4.4 years with a male: female ratio of 1.8:1. This study showed that 16.8% and 21.6% of junior residents in internal medicine considered nephrology as their first and second choice area to specialize, respectively. Factors that ranked high as determinants of a decision to do nephrology were personal interest (94.3%), opportunities to perform renal procedures (93.3%), and exposure to nephrology training (85.7%). Factors that discouraged a choice of nephrology according to respondents were high mortality of renal patients (67.3%), poor outcomes of renal patients (70.2%), in ability to fund treatment by renal patients (66.1%), unsatisfactory life-work balance among nephrologists (60.7%), and late presentation of renal patients (59.0%). Others were high workload compared to available doctors (59.0%) and poor job satisfaction (55.4%). Factors that could stimulate more interest in nephrology according to respondents included creation of better working environment with adequate equipment for training (96.3%), provision of health insurance with adequate coverage for renal patients (97.4%), and increased government support for renal care services (99.3%). CONCLUSION: There is a need to promote and sustain interest of residents in nephrology by ensuring improved survival of patients through better access to renal care, ensuring an adequate and well motivated work force, provision of adequate facilities and health insurance services.

INTRODUCTION: L'intérêt pour la formation postuniversitaire en néphrologie a diminué au fil des ans. Cette tendance pourrait aggraver la pénurie de néphrologues et l'incapacité de répondre aux besoins de santé des patients atteints de maladies rénales si l'on n'y remédie pas de toute urgence. OBJECTIF: Déterminer l'intérêt et les déterminants du choix de carrière en néphrologie chez les jeunes résidents en médecine interne au Nigeria. MÉTHODOLOGIE: Il s'agit d'une étude transversale à laquelle ont participé 273 résidents juniors en médecine interne au Nigeria. Un questionnaire auto-administré, adapté de deux études précédentes, a été utilisé pour la collecte des données. RÉSULTATS: L'âge moyen des répondants était de 33,6±4,4 ans avec un ratio homme/femme de 1,8:1. Cette étude a montré que 16,8 % et 21,6 % des résidents juniors en médecine interne considéraient la néphrologie comme leur premier et deuxième choix de spécialisation, respectivement. Les facteurs les plus déterminants dans la décision de se spécialiser en néphrologie étaient l'intérêt personnel (94,3 %), la possibilité de pratiquer des interventions rénales (93,3 %) et l'exposition à la formation en néphrologie (85,7 %). Les facteurs qui découragent le choix de la néphrologie selon les répondants sont la mortalité élevée (67,3 %), les résultats médiocres (70,2 %), l'incapacité de financer le traitement (66,1 %), l'équilibre vie-travail insatisfaisant (60,7 %) et la présentation tardive des patients rénaux (59,0 %). D'autres facteurs sont la charge de travail élevée par rapport aux médecins disponibles (59,0 %) et la faible satisfaction au travail (55,4 %). Les facteurs qui pourraient susciter un plus grand intérêt pour la néphrologie, selon les répondants, sont la création d'un meilleur environnement de travail avec des équipements adéquats pour la formation (96,3%), la mise en place d'une assurance maladie avec une couverture adéquate pour les patients atteints de maladies rénales (97,4%), et un soutien accru dugouvernement pour les services de soins rénaux (99,3%). CONCLUSION: Il est nécessaire de promouvoir et de soutenir l'intérêt des résidents pour la néphrologie en assurant une meilleure survie des patients grâce à un meilleur accès aux soins rénaux, en assurant une main-d'œuvre adéquate et bien motivée, en fournissant des installations adéquates et des services d'assurance maladie. Mots clés: Néphrologie, Carrière, Intérêt, Résidents, Médecine interne.

Bidirectional Screening for Tuberculosis, Diabetes Mellitus and other Comorbid Conditions in a Resource Constrained Setting: A Pilot Study in Lagos, Nigeria.

BACKGROUND: The epidemiological transition in developing countries is increasing the burden of non-communicable diseases such as diabetes. We aimed to determine the outcomes of bidirectional screening for TB and diabetes (DM) in resource constrained communities, Lagos, Nigeria. METHODS: A quasi-experimental study without control was conducted from March 1-31st, 2017 as part of the series of activities to mark the World TB Day. Community screening took place at multiple locations in multiple days. Participants were registered and screened for Tuberculosis (TB), Diabetes Mellitus (DM) and other comorbid conditions (viral hepatitis and HIV) during open medical outreaches carried out across six resource constrained communities in Lagos, Nigeria. Relevant data were collected and analyzed. Yield of TB among DM patients and vice-versa was analyzed. Associations between MTB detection among those with DM (versus those with no DM) and among those who were HIV positive (compared with those HIV negative) were determined at p ≤0.05. RESULTS: Some (24.7%) of the participants were between the ages 25-34 years. Majority were males (65.8%), Christians (55.7%), Married (73.7%), and 37.8% had secondary education. Many (41.0%) of the participants had 3-4 persons per household, and 1-2 persons per room (44.5%). 109(26%) of individuals screened were presumptive and 18(16.5%) of the 109 presumptive were MTB detected. Also, hyperglycemia (Fasting Blood Sugar, FBS >126 mg/dl or random blood sugar, RBS level >200mg/dl) was diagnosed in 31(5%) of the 620 patients screened. Overall, 1(3.2%) of the 32 patients with DM were diagnosed with TB while 1(5.5%) of the 18 patients with MTB detected were diagnosed with DM and no significant difference in TB or DM detection in either of the groups (p=1.000). The overall yield (in all participants) of HIV in this intervention was 1.27%, DM was 5.0% and HBsAg was 2.1%. CONCLUSION: This intervention showed that approximately one out of every twenty newly diagnosed TB patients in resource constrained communities had DM as a comorbid condition. This finding underlines the need to strengthen bidirectional screening for TB-DM in order to achieve additional gains in tuberculosis case findings in resource constrained and high TB burden countries.

CONTEXTE: La transition épidémiologique dans les pays en développement augmente le fardeau des maladies non transmissibles telles que le diabète. Nous avons cherché à déterminer les résultats du dépistage bidirectionnel de la tuberculose et du diabète (DM) dans les communautés à ressources limitées de Lagos, au Nigeria. MÉTHODES: Une étude quasi-expérimentale sans contrôle a été menée du 1er au 31 mars 2017 dans le cadre de la série d'activités marquant la Journée mondiale de la tuberculose. Le dépistage communautaire a eu lieu à plusieurs endroits en plusieurs jours. Les participants ont été enregistrés et dépistés pour la tuberculose (TB), le diabète sucré (DM) et d'autres conditions de comorbidité (hépatite virale et VIH) lors d'actions de proximité médicales ouvertes menées dans six communautés à ressources limitées de Lagos, au Nigeria. Les données pertinentes ont été collectées et analysées. Le rendement de la TB parmi les patients atteints de DM et vice-versa a été analysé. Les associations entre la détection de la tuberculose chez les personnes atteintes de DM (par rapport à celles qui n'en sont pas atteintes) et chez les personnes séropositives (par rapport aux personnes séronégatives) ont été déterminées à une p≤0.05. RÉSULTATS: Certains (24,7 %) des participants étaient âgés de 25 à 34 ans. La majorité était des hommes (65,8 %), chrétiens (55,7 %), mariés (73,7 %) et 37,8 % avaient une éducation secondaire. Beaucoup (41,0%) des participants avaient 3-4 personnes par foyer, et 1-2 personnes par chambre (44,5%). 109(26%) des individus dépistés étaient présomptifs et 18(16,5%) des 109 présomptifs ont été détectés par MTB. De plus, une hyperglycémie (glycémie à jeun, FBS >126 mg/dl ou glycémie aléatoire, RBS >200mg/dl) a été diagnostiquée chez 31(5%) des 620 patients dépistés. Dans l'ensemble, 1(3,2 %) des 32 patients atteints de DM ont reçu un diagnostic de tuberculose, tandis que 1(5,5 %) des 18 patients chez qui le bacille du charbon a été détecté ont reçu un diagnostic de DM. Il n'y a pas de différence significative dans la détection de la tuberculose ou du DM dans l'un ou l'autre des groupes (p=1,000). Le rendement global (chez tous les participants) du VIH dans cette intervention était de 1,27%, le DM était de 5,0% et l'HBsAg de 2,1%. CONCLUSION: Cette intervention a montré qu'environ un patient tuberculeux sur vingt nouvellement diagnostiqué dans des communautés aux ressources limitées avait un diabète comme comorbidité. Ce résultat souligne la nécessité de renforcer le dépistage bidirectionnel de la tuberculose et du diabète afin d'obtenir des gains supplémentaires dans la découverte de cas de tuberculose dans les pays à ressources limitées et à forte charge de tuberculose. Mots clés: Comorbidités, Diabète sucré, Dépistage bidirectionnel, Tuberculose.

Prevalence and Correlates of Suicidal Ideation among Medical Students in a Tertiary Institution in Southern Nigeria.

INTRODUCTION: Medical students have an increased risk of suicidal ideation compared to similar age groups within the general population. Suicidal ideation is a significant predictor of suicidal attempt, therefore, identifying and addressing factors associated with suicidal ideation among medical students may potentially reduce their overall rates of suicide. AIM: To determine the prevalence and correlates of suicidal ideation among medical students in a Nigerian medical school. METHODOLOGY: This was a cross-sectional study that determined the prevalence and correlates of suicidal ideation among clinical students. Beck's suicidal ideation questionnaire, Beck's depression inventory and World Health Organisation Alcohol Smoking and Substance Involvement Screening Test (ASSIST) were used to assess for suicidal ideation, depression and lifetime substance use respectively. P value of <0.05 was taken as significant. METHODOLOGY: This was a cross-sectional study that determined the prevalence and correlates of suicidal ideation among clinical students. Beck's suicidal ideation questionnaire, Beck's depression inventory and World Health Organisation Alcohol Smoking and Substance Involvement Screening Test (ASSIST) were used to assess for suicidal ideation, depression and lifetime substance use respectively. P value of <0.05 was taken as significant. RESULTS: One hundred and twenty-one students participated in the study. Mean age of the participants was 21.78±3.54 years. The prevalence of suicidal ideation was 12.4%. Factors associated with suicidal ideation were intimate relationship problems (p=0.03); being managed for a chronic medical condition (p=0.02); higher depression scores (p<0.001); and having fewer maternal siblings (p=0.02). Forty-five (37.2%) students had a life time use of psychoactive substances which was mainly alcohol. CONCLUSION: Suicidal ideation was relatively high among the medical students. Medical schools should create programmes that will cater for the emotional and psychological wellbeing of their students to reduce their suicidal risk.

INTRODUCTION: Les étudiants en médecine ont un risque accru deles idées suicidaires par rapport à des groupes d'âge similaires au sein de l'population générale. Les idées suicidaires sont un prédicteur important de tentatives de suicide, par conséquent, identifier et traiter les facteurs associés à des idées suicidaires chez les étudiants en médecine peuvent réduire potentiellement leur taux global de suicide. OBJECTIF: Déterminer la prévalence et les corrélats des suicides idéation parmi les étudiants en médecine dans une école de médecine nigériane. MÉTHODOLOGIE: Il s'agissait d'une étude transversale qui déterminé la prévalence et les corrélats des idées suicidaires parmi les étudiants cliniciens. Le questionnaire d'idées suicidaires de Beck,L'inventaire de la dépression de Beck et l'Organisation mondiale de la santéTest de dépistage du tabagisme et de la toxicomanie(ASSIST) ont été utilisés pour évaluer les idées suicidaires, la dépression et la consommation de substances au cours de la vie, respectivement. La valeur P de <0,05 était considérés comme significatifs. RÉSULTATS: Cent vingt et un étudiants y ont participédans l'étude. L'âge moyen des participants était de 21,78 ±3,54 ans.La prévalence des idées suicidaires était de 12,4 %. Facteurs associés à des idées suicidaires étaient une relation intime problèmes (p = 0,03); être pris en charge pour un traitement médical chroniquecondition (p = 0,02); scores de dépression plus élevés (p<0,001); etavoir moins de frères et sœurs maternels (p = 0,02). Quarante-cinq (37,2 %)les élèves ont consommé toute leur vie des substances psychoactives qui était principalement de l'alcool. CONCLUSION: Les idées suicidaires étaient relativement élevées chez les étudiants en médecine. Les facultés de médecine devraient créer des programmes qui répondront aux besoins émotionnels et psychologiquesle bien-être de leurs élèves pour réduire leur risque suicidaire. Mots-clés: Idées suicidaires, étudiants en médecine, Nigéria.

Knowledge of the national health act among physicians in two tertiary hospitals in Southern Nigeria

Objective: Knowledge of provisions of the National Health Act among physicians and stakeholders is pivotal to its successful implementation. This study aimed to assess the knowledge of the National Health Act (NHA) among Physicians in two tertiary hospitals in Nigeria. Methods: This was a cross-sectional study conducted in two tertiary hospitals in Southern Nigeria. The consecutively recruited eligible respondents were assessed for knowledge of NHA using a 24-item self administered close-ended structured questionnaire. The total obtainable score was 26. Those with <13 points had poor knowledge, 13-21 points had good knowledge and >21 points had excellent knowledge. Data were analyzed using SPSS version 21 software. P-value of < 0.05 was taken as significant. Results: One hundred and ninety-five doctors with a male: female ratio of 1.9:1 participated in the study. The majority (91.8%) were ≤40 years and 129(66.2%) of the participants were ≤ 10 years post qualification. The frequency of correctly answered questions ranged between 7.7% - 89.2%. According to overall knowledge scores; 64.6% had poor knowledge; 35.4% had good knowledge and none had excellent scores. There was no statistically significant association between knowledge of NHA and gender, age, and number of years post qualification (p > 0.05). Conclusion: This study showed that only about a third of the participants had good knowledge of key provisions of the NHA. We strongly recommend that relevant sections of the Act should be incorporated into the medical curriculum both at the undergraduate and postgraduate levels.

Cardiovascular risk factors and renal impairment among young adults in a tertiary institution in Southwest Nigeria

Background: Specific research is sparse on renal dysfunction among homogenous group of young adults. This study estimated the prevalence of renal dysfunction among apparently healthy young adults and determine association (if any) between renal dysfunction and some cardiovascular risk factors. Methodology:Undergraduates (18-37 years) of a tertiary institution were studied on 2017 World Kidney Day. Their biodata, blood pressure, anthropometry, total cholesterol and estimated glomerular filtration rate were determined. Data was analyzed using SPSS version 20.0. Results:A total of 640 students were studied (M:F=1:3.8). Their mean age was 23.1±2.8 years. Thirty-three(5.2%) participants had renal dysfunction (eGFR < 60ml/min/1.73m2). The mean age of subjects with renaldysfunction (eGFR < 60ml/min/1.73m2) was significantly higher with an inverse association to renal function (p = 0.005). Two hundred and fifty-seven(40.2%) and 58 (9.1%) participants were pre-hypertensive and hypertensive respectively; overweight, abdominal obesity and hypercholesterolaemia were found among 12.2%, 14.2% and 8.1% of subjects respectively. The mean body mass index (p = 0.009) and serum total cholesterol (p = 0.003) were significantly higher among females. There was a higher prevalence of renal dysfunction among females even though this was not to the significant level (5.9 v 2.2%, p = 0.12). Conclusions:The prevalence of renal dysfunction among young adults is lower than current global estimates. The prevalence of cardiovascular risk factors for CKD were lower than that of older adults with no significant association to renal dysfunction. Increasing age was found to be significantly associated with reduced renal function.

Spatial Distribution of COVID-19 in Nigeria.

BACKGROUND: The first reported case of the novel coronavirus (COVID 19) in Nigeria was on the 27th of February 2020. Since then, the country has witnessed a steady increase in the number of patients confirmed with the disease. As of April 27th 2021, a total of 164,756 confirmed COVID-19 cases were notified making it the fifth-highest number of cases in the African region. This study aims to determine the spatial distribution of COVID-19 in Nigeria, identify clusters and determine factors associated with COVID-19. METHODS: The study used secondary data of COVID-19 cases notified in each of the 36 states and the Federal Capital Territory between 27th February and 9th June, 2020. The Global and Local Moran'sItest were used to identify significant spatial clusters. The negative binomial regression model was used to identify factors associated with COVID-19 and p d" 0.05 was regarded as statistically significant. RESULTS: The Local Moran I identified Lagos State as the significant cluster for COVID-19 in Nigeria at p<0.05. Higher GDP per capita and lower literacy rates were significantly associated with COVID-19 cases reported by the states while population density, BCG coverage and average temperature were not significantly associated. CONCLUSION: The study identified Lagos State as the hotspot for the COVID-19 pandemic in Nigeria. The states with lower literacy rate and higher GDP per capita reported a higher number of COVID-19 cases. Proactive measures are needed to control of the infection in Lagos state while improving the literacy about the disease transmission and control measures.

CONTEXTE: Le premier cas signalé du nouveau coronavirus (COVID 19) au Nigeria a eu lieu le 27 février 2020. Depuis lors, le pays a connu une augmentation constante du nombre de patients confirmés atteints de la maladie. Au 27 avril 2021, un total de 164 756 cas confirmés de COVID-19 ont été notifiés, ce qui en fait le cinquième plus grand nombre de cas dans la région africaine. Cette étude vise à déterminer la distribution spatiale du COVID-19 au Nigeria, à identifier les clusters et à déterminer les facteurs associés au COVID-19. MÉTHODES: L'étude a utilisé des données secondaires de cas de COVID-19 notifiés dans chacun des 36 États et le Territoire de la capitale fédérale entre le 27 février et le 9 juin 2020. Les tests Global et Local de Moran I ont été utilisés pour identifier des clusters spatiaux importants. Le modèle de régression binomiale négative a été utilisé pour identifier les facteurs associés au COVID-19 et p 0,05 a été considéré comme statistiquement significatif. RÉSULTATS: Le Moran local I a identifié l'État de Lagos comme le cluster significatif pour COVID-19 au Nigeria à p<0,05. Un PIB par habitant plus élevé et des taux d'alphabétisation plus faibles étaient significativement associés aux cas de COVID-19 signalés par les États, tandis que la densité de population, la couverture en BCG et la température moyenne n'étaient pas significativement associées. CONCLUSION: L'étude a identifié l'État de Lagos comme le point chaud de la pandémie de COVID-19 au Nigéria. Les États ayant un taux d'alphabétisation plus faible et un PIB par habitant plus élevé ont signalé un nombre plus élevé de cas de COVID-19. Des mesures proactives sont nécessaires pour contrôler l'infection dans l'État de Lagos tout en améliorant les connaissances sur la transmission de la maladie et les mesures de contrôle. Mots-clés: COVID-19, Nigeria, SARS-CoV-2, clusters spatiaux, épidémiologie spatiale, statistiques spatiales.

Pattern and Predictors of Cardiovascular Risks among Public Servants in a Southwestern State in Nigeria.

BACKGROUND: Cardiovascular disease is a major public health problem globally. The public service workers, who are facilitators of national development, are particularly vulnerable because the nature of their job predisposes them to unhealthy lifestyles. However, there is paucity of reference data on the profile of cardiovascular risks among public servants in Nigeria. Therefore, this study determined the pattern and predictors of cardiovascular risk among public servants in Southwest, Nigeria. METHODS: A total of 1,778 public servants were recruited from 47 Ministries, Departments and Agencies in Ondo State through multi-stage random sampling technique. The World Health Organization Stepwise instrument and Framingham Heart Study non-laboratory cardiovascular risk assessment tool were used to collect data. STATA version 14.2 was used for analysis and p-value of< 0.05 was taken as significant. RESULTS: The mean age of participants was 44.2±9.1 years. They were predominantly females (64.8%). The proportions of participants with moderate and high 10-year absolute cardiovascular risks were 18.3% and 5.6%, respectively. Significant factors associated with increased cardiovascular risk were age (p=<0.001), sex (p =<0.001), education (p =<0.001), income (p =<0.001), staff category (p =<0.001) and employment grade level (p=<0.001). The significant predictors of increased cardiovascular risk on multivariate analysis were age > 50years (AOR:1.25;CI:1.19-1.32;p=<0.001) and male sex (AOR:6.62; CI:3.76-11.65;p=<0.001). CONCLUSION: The prevalence of increased 10-year absolute cardiovascular risk among public servants in Ondo State was high. The significant predictors were age >50 years and male sex. Cardiovascular risk reduction strategies should be encouraged among public servants especially the older males.

CONTEXTE: Les maladies cardiovasculaires constituent un problème majeur de santé publique à l'échelle mondiale. Les travailleurs du service public, qui sont des facilitateurs du développement national, sont particulièrement vulnérables car la nature de leur travail les prédispose à des modes de vie malsains. Cependant, il existe peu de données de référence sur le profil des risques cardiovasculaires chez les fonctionnaires au Nigeria. Par conséquent, cette étude a déterminé le profil et les prédicteurs du risque cardiovasculaire chez les fonctionnaires du Sud-Ouest du Nigeria. MÉTHODES: Au total, 1 778 fonctionnaires ont été recrutés dans 47 ministères, départements et agences de l'État d'Ondo par le biais d'une technique d'échantillonnage aléatoire à plusieurs degrés. L'instrument Stepwise de l'Organisation mondiale de la santé et l'outil d'évaluation du risque cardiovasculaire non-laboratoire de la Framingham Heart Study ont été utilisés pour collecter les données. STATA version 14.2 a été utilisé pour l'analyse et une valeur p< 0,05 a été considérée comme significative. RÉSULTATS: L'âge moyen des participants était de 44,2±9,1 ans. Il s'agissait principalement de femmes (64,8 %). Les proportions de participants présentant un risque cardiovasculaire absolu à 10 ans modéré et élevé étaient de 18,3 % et 5,6 %, respectivement. Les facteurs significatifs associés à un risque cardiovasculaire accru étaient l'âge (p=<0,001), le sexe (p =<0,001), l'éducation (p =<0,001), le revenu (p =<0,001), la catégorie de personnel (p =<0,001) et le niveau d'emploi (p=<0,001). Les prédicteurs significatifs d'un risque cardiovasculaire accru dans l'analyse multivariée étaient l'âge > 50 ans (AOR:1,25;CI:1,19-1,32;p=<0,001) et le sexe masculin (AOR:6,62;CI:3,76-11,65;p=<0,001). CONCLUSION: La prévalence d'un risque cardiovasculaire absolu accru sur 10 ans chez les fonctionnaires de l'État d'Ondo était élevée. Les prédicteurs significatifs étaient l'âge >50 ans et le sexe masculin. Les stratégies de réduction du risque cardiovasculaire devraient être encouragées chez les fonctionnaires, en particulier chez les hommes âgés. Mots Clés: Maladies cardiovasculaires, facteurs de risque, évaluation du risque, service public, Nigeria.

Self-perceived Burden on Caregivers, Anxiety and Depression among Chronic Kidney Disease Patients in Southern Nigeria.

Introduction: Psychosocial problems are common in chronic kidney disease (CKD) patients and are associated with poor overall outcomes; however, their evaluation has not received the deserved attention. This study assessed self-perceived burden on caregivers, psychosocial wellbeing, anxiety and depression among CKD patients, and the impact on their quality of life (QoL) in two hospitals in Nigeria. Methods: This was a cross-sectional study. Self-perceived burden on caregivers, QoL, anxiety, and depression of the patients, were assessed using the Cousineau questionnaire, modified SF-12 questionnaire, Hospital Anxiety and Depression Scale, respectively. Results: There were 141 participants in the study comprising 50 haemodialysis (HD) patients, 41 pre-dialysis CKD patients and 50 controls. The male: female ratio for CKD patients and controls were 1.1 and 1.4 respectively. Prevalence of depressive and anxiety symptoms in the CKD patients were 46.2% and 33.0% respectively. The QoL score was significantly higher in the control group compared to the CKD patients (p= <0.001) and significantly lower in the HD patients compared to the pre-dialysis CKD patients (p= <0.001). Self-perceived burden score was significantly higher in the HD group compared to the pre-dialysis CKD group (p = < 0.001) There was a negative correlation between QoL score and self-perceived burden, hospital anxiety score and hospital depression score (p =<0.001). Conclusion: Psychological disorders and self-perceived burdens are highly prevalent among CKD patients. They have negative impact on their QoL, hence regular evaluation and management of these disorders should be incorporated into the care of CKD patients.

Introduction: Les problèmes psychosociaux sont commun chez les patients atteints d'insuffisance rénale chronique (MRC) et associés à de mauvais résultats globaux, mais leur évaluation n'a pas reçu l'attention méritée. Cette étude a évalué le fardeau autoperçu par les patients sur les soignants, le bien-être psychosocial des patients atteints d'IRC et l'impact sur leur qualité de vie (QoL) dans deux hôpitaux en Nigéria. Méthodes: Il s'agissait d'une étude transversale qui évaluait lefardeau auto-perçu des patients sur les soignants, la qualité de vie, l'anxiété et la dépression à l'aide du questionnaire Cousineau, du questionnaire SF-12 modifié et de l'échelle d'anxiété et de dépression hospitalière respectivement chez les patients atteints d'IRC et les témoins. Résultats: Il y avait 141 participants à l'étude comprenant 50 patients hémodialysés d'entretien (HD), 41 patients atteints d'IRC en pré-dialyse et 50 témoins. Le rapport homme: femme pour les patients atteints d'IRC et le groupe témoin était respectivement de 1,1 et 1,4. La prévalence des symptômes dépressifs et anxieux chez les patients atteints d'IRC était de 46,2% et 33,0% respectivement. Le score de qualité de vie était significativement plus élevé dans le groupe témoin par rapport aux patients atteints d'IRC (p = <0,001). Le score de qualité de vie était significativement plus faible chez les patients HD par rapport aux patients atteints d'IRC en pré- dialyse (p <0,001). Le score d'autoévaluation du fardeau était significativement plus élevé dans le groupe HD que dans le groupe avant la dialyse CKD (p = <0,001) Il y avait une corrélation négative significative entre la qualité de vie et l'auto-perception du fardeau, le score d'anxiété hospitalière et le score de dépression hospitalière (p = < 0,001). Conclusion: Les maux psychologiques sont très répandus chez les patients atteints d'IRC et ont un impact négatif sur leur qualité de vie. Une évaluation et une prise en charge régulières de ces maux doivent être intégrées dans la prise en charge des patients atteints d'IRC. Mots clés: anxiété, dépression, qualité de vie, fardeau pour les soignants, maladie rénale chroniq.

Awareness and Knowledge of Patients' Bill of Right among Physicians and Patients in a Tertiary Hospital in Southwest Nigeria.

BACKGROUND: Patients' Bill of Right (PBoR) was launched in Nigeria in 2018 with the aim of improving health service delivery to Nigerians. However, knowledge of PBoR among physicians and patients is pivotal to achieving its laudable objective. AIM: This study assessed the awareness and knowledge of PBoR and associated factors among physicians and their patients at the University of Medical Sciences Teaching Hospital in Ondo State, Southwest Nigeria. METHODS: This was a cross-sectional study that assessed awareness and knowledge of PBoR among physicians and patients using questionnaire. Maximum score obtainable was 16 and those with less than 8 were considered as having poor knowledge, 8-12 as good knowledge and 13-16 as excellent knowledge. P value of <0.05 was taken as significant. RESULTS: Four hundred and fifty-three respondents made up 199 physicians and 254 patients participated in the study. There were 227(50.1%) males and 226(49.9%) females. Amongst the participants, 212(46.8%) were aware of existence of PBoR and 108(23.8%) claimed to be aware of its contents. Physicians and patients with good to excellent knowledge were 60.6% and 21.3 % respectively. The physicians had significantly better knowledge of PBoR compared to patients (p= <0.001). Factors associated with good to excellent knowledge of PBoR were male gender (p= 0.004), higher educational level (p= <0.001), being physician (p= <0.001) and younger age (p= <0.001). CONCLUSION: Overall level of knowledge of PBoR was unsatisfactory especially among the patients. There is an urgent need for government to adequately educate and sensitize the public on PBoR in order to ensure qualitative health services delivery.

Metabolic Syndrome and Atherosclerotic Cardiovascular Risk in a Population Of Market Women in a Semi-Urban Town, South-West Nigeria.

BACKGROUND: Metabolic Syndrome (MS) is a non-communicable disease of global significance. The presence of MS denotes increased risk of cardiovascular disease. The global prevalence of MS is on the increase because of lifestyle changes like consumption of high calorie, low fibre foods coupled with reduced physical activity OBJECTIVES: To determine the prevalence of MS and its components and to estimate atherosclerotic cardiovascular disease (ASCVD) risk in a population of market women. METHODS: A cross-sectional, observational study among female traders in a market in South-western Nigeria. MS was determined using the harmonized NCEP-ATPIII and IDF criteria. The ASCVD risk estimator by the American College of Cardiologists and American Heart Association was used to assess ASCVD risk. RESULTS: One hundred and sixty-nine female traders aged 23 to 80 years with a mean age of 52.8±13.2 years were involved in the study. Overweight and obesity were seen in 61 (36.5%) and 57 (34.1%) participants respectively. Prevalence of MS was 34.9% and the most frequent components of MS were hypertension (62.1%), low HDL-cholesterol (53.8%) and elevated serum triglycerides (18.3%). MS was associated with increasing age (p= 0.010) and BMI (p= 0.009). Significant 10-year ASCVD risk was found in 63 (52.1%) out of 121 participants eligible for ASCVD risk estimation. Significant 10-year ASCVD risk was found in 33(67%) out of 59 participants with MS. CONCLUSION: This study demonstrated significant risk for cardiovascular disease in a population of market women. A more active lifestyle, appropriate diet and treatment of hypertension, diabetes and dyslipidaemia should be encouraged.

A Multicentre Study of Awareness and Practice of Vaccination Against Infectious Diseases Among Haemo-Dialysis Subjects in Nigeria.

BACKGROUND: Numerous studies indicate that immunization against vaccine-preventable infectious diseases lowers mortality among Chronic Kidney Disease/dialysis patients and improve their quality of life. However, their knowledge and practice of this appears to be poor in Nigeria and parts of Africa. OBJECTIVES: We set out to determine subjects' awareness of vaccination against preventable infectious diseases and its impact on their participation in vaccination programs. METHODS: A prospective, cross-sectional study. Data was collated using questionnaires, laboratory results and dialysis entries and analyzed using IBM SPSS Statistics19. RESULTS: One hundred and twenty-four participants (mean age, 48.26±14.45 years) undergoing maintenance haemodialysis were studied. Sixty-two subjects (50.4%), 15.3% and 16.9% had heard of Hepatitis B Virus, S. pneumoniae and H. influenza virus respectively. Thirty-four (54.6%) of the participants first heard of these infections from sources other than healthcare personnel. Of the three common infections, study participants only received formal counselling on Hepatitis B Virus (HBV) infection. Majority had never heard of S. pneumoniae or H. influenzae. Seven (5.7%) had completed their HBV immunisation schedule only. Better educated participants were more aware of necessary vaccination against Hepatitis B Virus (p=0.000) S. pneumoniae (p=0.005) and H. influenza virus (p = 0.003). A significantly higher proportion of participants who received health-personnel driven formal education commenced vaccination against Hepatitis B virus (p=0.000). CONCLUSION: Awareness and practice of vaccination against infectious diseases by haemodialysis patients was found to be poor. Defective system and practice of information dissemination by healthcare workers was remarkably contributory.

Study of association between sickle cell trait and renal dysfunction among young adults in South-west Nigeria.

BACKGROUND: Although sickle cell disease has become a recognized etiology of chronic kidney disease (CKD), the sickle cell trait (SCT) variant was until recently believed to be a benign carrier state with little or no effect on the health of affected individuals. However, recent studies now appear to suggest an association between SCT and CKD. OBJECTIVE: The objective of the study is to determine the association between SCT (hemoglobin AS) and renal dysfunction among young Nigerian adults. METHODOLOGY: This was a cross-sectional, descriptive study among apparently healthy undergraduates of Adeyemi College of Education, Ondo, southwest Nigeria. Their hemoglobin genotypes were determined using standard alkaline electrophoresis; their blood pressure, anthropometry, serum total cholesterol (TC), creatinine, and estimated glomerular filtration rate (eGFR) were determined. Data analyzed using Statistical Package for Social Sciences (SPSS) 20 were significant at P < 0.05. RESULTS: Six hundred and two subjects with HbAS (SCT, n = 465) and HbAA (non-SCT, n = 137) were studied. Their age range was 18-30 years with male-to-female ratio 1:3.8. There was no difference in the prevalence of renal dysfunction between SCT and non-SCT subjects (5.1% vs. 5.2%, P = 0.591). There was no increased risk of CKD among subjects with SCT (PR, 0.99 at 95% CI [0.417-2.348]). CONCLUSION: SCT was not associated with increased risk of renal dysfunction among young adults in Nigeria. Further studies are needed to clarify the controversy, especially in Nigeria, with a relatively higher prevalence of SCT.

The birth experience and subsequent maternal caregiving attitudes and behavior: a birth cohort study.

Optimal maternal caregiving is critical for children's healthy development, yet quality of maternal caregiving may be influenced by a negative birth experience. We examined whether the birth experience was associated with maternal caregiving attitudes and behavior throughout the first year. We conducted secondary analysis of the Avon Longitudinal Study of Parents and Children birth cohort on perinatal data. The birth experience was assessed using self-report data on level of support in labor. Maternal caregiving variables were self-report maternal attitudes at one and eight postnatal months, and observed maternal behavior at 12 postnatal months. Data were analyzed using multivariable logistic regression models adjusting for critical covariates at one (N = 4389), eight (N = 4580), and 12 (N = 842) postnatal months. Feeling supported in labor was associated with a report of "immediately falling in love" with one's baby after birth, surveyed at 1 month (adjusted OR 1.41 [95% CI 1.20-1.65]), and with more positive parenting scores at 8 months (adjusted OR 1.56 [95% CI 1.36-1.79]), but not with more positive observed maternal behavior at 12 months. Additional risk factors were identified. Our findings suggest that we may be able to modify the risk of poor postnatal maternal caregiving by supporting women in labor and facilitating a positive birth experience.

Pregnancy-related acute kidney injury: Etiologies and short-term outcomes in a tertiary hospital in Southwest Nigeria.

Although the incidence of pregnancy-related acute kidney injury (PRAKI) is declining in developing countries, it still remains a major cause of maternal and fetal morbidity and mortality. The aim of this study was to determine the etiologies, short-term outcomes, and their predictors in patients with PRAKI managed in a tertiary health facility in Southwest Nigeria over a four-year period. This was a four-year retrospective review of clinical records of patients managed for PRAKI in University of Medical Sciences Teaching Hospital, Ondo State, Nigeria. Thirty-two women with a mean age of 31.09 ± 7.50 years had PRAKI during the period reviewed. Twenty-four (75%) patients were multiparous and PRAKI was most common in the postpartum period (56.3%). Twenty-three patients (71.9%) were in RIFLE Stage 3, 24 (75%) received blood transfusion, 5 (15.6%) required intensive care unit (ICU) care, 24 (75%) needed dialysis while 19 (59.4%) had hemodialysis. The common causes of PRAKI were obstetric hemorrhage in 16 (50%), sepsis in seven (21.9%), and eclampsia in six (18.8%). Maternal and fetal mortality were 34.4% and 50% respectively. Seventeen (53.1%) had full renal recovery and only one (3.1%) became dialysis dependent. Significant factors that were associated with maternal mortality were admission to ICU (P = 0.01), hypotension (P = 0.02), and impaired consciousness (P <0.001) PRAKI is still relatively common and significantly contributes to maternal and perinatal mortality in Nigeria. Obstetric hemorrhage which is the most common cause of PRAKI is preventable and treatable. There is a need for physicians to effectively prevent and manage obstetric hemorrhage.

Co-existing autosomal dominant polycystic kidney disease and nephrotic syndrome in a Nigerian patient with lupus nephritis.

A little over 30 cases on co-existing nephrotic syndrome and autosomal dominant polycystic kidney disease (ADPKD) have been reported from different regions of the world since 1957. We present a case report on co-existence of nephrotic syndrome (secondary to lupus nephritis) with ADPKD in a 24-year-old woman from Nigeria. She was positive for anti-double stranded DNA. Renal histology showed International Society of Nephrology/Renal Pathology Society Class II lupus nephritis. The co-existence of nephrotic syndrome and ADPKD may have been overlooked in Africa in the past. There is a need to screen for nephrotic syndrome in patients with ADPKD among clinicians in the African setting.

Caregivers and Healthcare Workers' Willingness to Donate Kidney in Three Tertiary Institutions in Southern Nigeria.

BACKGROUND: Kidney transplantation (KT) is now the preferred renal replacement therapy in suitable patients with end-stage renal disease but organ availability is a major limiting factor. AIMS: To evaluate the willingness of caregivers (CGs) and healthcare workers (HWs) to donate a kidney and possible motivating factors in our setting. METHODS: This cross-sectional study was done at Mother and Child Hospital, Kidney Care Centre Ondo and Babcock University Teaching Hospital, all in Southern Nigeria. Participants' willingness to donate a kidney was assessed using Likert and Visual Analogue Scales (VAS). The data were analyzed using SPSS version 20.0. Student t test was used to compare weighted mean scores. Multivariate analysis done; P < .05 was taken as significant. RESULTS: A total of 563 CGs and HWs took part in the study. Sixty percent of them were aware of kidney donation (KD) but only 43.7% had a favorable attitude towards it, and these were predominantly HWs (63.4% vs 33.1%, P < .001). A quarter of the participants were adequately willing to donate a kidney; HWs were significantly more willing than CGs (45.4% vs 15.8%, P < .001). On VAS, the mean willingness score of HWs was higher than that of CGs (t = 7.13, P < .001). Factors strongly influencing the willingness of CGs to donate include their educational level (P = .028, OR = 4.86, 95% CI: 1.19-19.91) social class (P = .012, OR = 6.17 95% CI: 1.5-24.8) and having a relative with kidney disease (P = .019; OR = 3.07 95% CI: 1.25-12.00). Willingness correlated with awareness of KD among CGs (r = 0.534, P < .001). CONCLUSION: There is a low level of willingness alongside negative attitudes toward kidney donation among our participants.

HIV-TB co-infection in children: associated factors and access to HIV services in Lagos, Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children. METHODS: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013. RESULTS: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1-4 years and 186 (58.1%) 5-14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05). CONCLUSION: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.

Contexte : Le virus de l'immunodéficience humaine (VIH) et la tuberculose (TB) sont les causes majeures de décès dû à une maladie infectieuse dans le monde. L'Organisation Mondiale de la Santé estime que la prévalence du VIH parmi les enfants atteints de TB dans des pays à prévalence modérée à élevée va de 10% à 60%. Cette étude a eu pour but de déterminer l'accès aux services VIH pour les enfants coinfectés par TB-VIH.Méthodes : Une revue rétrospective des données d'enfants ayant eu un diagnostic de TB dans l'état de Lagos au Nigeria entre le 1e janvier 2012 et le 31 décembre 2013.Résultats : Un total de 1199 enfants âgés de 0 à 14 ans ont eu un diagnostic de TB. Parmi eux, 1095 (91,3%) ont eu un test VIH, dont 320 (29,2%) ont été positifs. Le ratio garçon/fille de coinfection TB-VIH a été de 1:0,9. Sur les 320 enfants coinfectés TB-VIH, 57 (17,8%), 86 (26,9%) et 186 (58,1%) respectivement avaient <1 an, 1­4 ans et 5­14 ans. Sur les 320 enfants coinfectés TB-VIH, 186 (58,1%) ont débuté le cotrimoxazole (CPT) tandis que 151 (47,2%) étaient sous traitement antirétroviral (ART). La mise sous ART n'a pas été significativement plus élevée dans les structures où les services TB-VIH se trouvaient au même endroit (P > 0,05).Conclusion : La mise sous CPT et ART a été faible. Il est nécessaire d'intensifier les efforts d'amélioration de l'accès aux services VIH à Lagos, Nigeria.

Marco de referencia: La infección por el virus de la inmunodeficiencia humana (VIH) y la tuberculosis (TB) son las principales causas de muerte por enfermedad infecciosa en todo el mundo. La Organización Mundial de la Salud considera que la prevalencia de infección por el VIH en los niños con TB de los países con prevalencia moderada o alta oscila entre 10% y 60%. El presente estudio tuvo por objeto determinar el acceso de los niños coinfectados por el VIH y la TB a los servicios relacionados con el VIH.Método: Se llevó a cabo un examen retrospectivo de los datos sobre los niños con diagnóstico de TB en el estado de Lagos en Nigeria del 1° de enero del 2012 al 31 de diciembre del 2013.Resultados: Se estableció el diagnóstico de TB en 1199 niños de 0 a 14 años de edad, de los cuales 1095 contaban con una prueba diagnóstica del VIH (91,3%) y 320 habían obtenido un resultado positivo (29,2%). La proporción entre el sexo masculino y femenino fue 1:0,9 en los niños coinfectados. De los 320 casos de coinfección, 57 eran menores de un año de edad (17,8%), 86 tenían entre 1 y 4 años (26,9%) y 186 entre 5 y 14 años de edad (58,1%). De los 320 niños coinfectados, se inició tratamiento preventivo con cotrimoxazol (CPT) en 186 (58,1%) y 15 niños comenzaron el tratamiento antirretrovírico (ART) (47,2%). La aceptación del ART no fue significativamente más alta en los establecimientos donde los servicios contra la TB y el VIH compartían la ubicación (P > 0,05).Conclusión: La aceptación del CPT y el ART fue baja. Es preciso intensificar las iniciativas tendentes a mejorar el acceso a los servicios relacionados con el VIH de Lagos, en Nigeria.