What factors are associated with anaemia in pregnancy among Nigerian women? Evidence from a national survey.

Background: Anaemia in pregnancy remains a severe public health problem in sub-Saharan African countries including Nigeria. Objectives: To assess factors associated with anaemia in pregnancy among Nigerian women. Methods: A secondary analysis of the 2018 Nigeria demographic health survey was conducted to determine the predictors of anaemia among Nigerian pregnant women (N=1522). SAS 9.4 was used for the analysis. Results: The prevalence of anaemia in pregnancy was 61.1%. On multivariable logistic regression analysis, women in the North-central (AOR=2.52, CI=1.46-4.35) and South-south (AOR=2.21, CI=1.06-4.59) had increased odds of anaemia in pregnancy, compared to those in the Northwest. Women with no education (AOR=2.38, CI=1.28-4.44), primary education (AOR=3.06, CI=1.58-5.96) and secondary education (AOR=1.75, CI=1.04-2.94) had increased odds of anaemia in pregnancy compared to women with teriary education. Also, women not in marital union had increased odds of anaemia in pregnancy compared to women in a union (AOR=2.56, CI=1.15-5.72). Women in the second (AOR=2.42, CI=1.79-3.29) and third trimesters of pregnancy (AOR=2.83, CI=2.07-3.89) had increased odds of anaemia. Conclusion: These findings are important for the control of anemia among pregnant Nigerian women. Women in the Northcentral and Southsouth zones are particularly at risk for anaemia in pregnancy and should receive special attention during antenatal care.

Clinical and Sociodemographic Predictors of Mortality in End-Stage Renal Disease Inpatients in Rural Areas of the USA: Evidence From the Nationwide Inpatient Sample.

BACKGROUND: End-stage renal disease (ESRD) has been associated with an increase in all-cause mortality among patients. The accumulation of comorbidities appears to be a contributing factor. This study set out to identify the effect of comorbidity severity and other predictors of mortality among ESRD inpatients in rural America. METHODS: This is a cross-sectional study that used the 2016-2018 Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). The study included patients aged 18 years or older with ESRD hospitalized in rural hospitals in America. Independent variables used in the survey include age, gender, race, type of admission (elective versus nonelective), type of hospital control, expected primary payer, and severity of comorbidities. The dependent variable was death during hospitalization. All analyses were weighted. Univariate (frequencies), bivariate (Chi-square), and logistic regression analyses were done using the SAS Studio (SAS Institute Inc., Cary, NC, USA). RESULTS: There were 144,575 weighted ESRD hospitalizations, and 5% of the hospitalized patients died. In the bivariate analysis, significant variables include age group, race, type of hospital admission, expected primary payer, type of hospital control, and severity of comorbidities, and all had a significant P-value of <0.0001. On multivariable logistic regression analysis, middle-aged and elderly patients had 40% (adjusted odds ratio (AOR): 1.40, 95% confidence interval (CI): 1.20-1.62) and 201% (AOR: 3.01, 95% CI: 2.61-3.48) more odds of mortality while hospitalized, respectively, compared to the young. Compared to whites, blacks had 19% (AOR: 0.81, 95% CI: 0.77-0.86) reduced odds of mortality, Hispanics had 47% (AOR: 0.53, 95% CI: 0.46-0.61) reduced odds of mortality, Native Americans had 27% (AOR: 0.73, 95% CI: 0.63-0.84) reduced odds of mortality, and Asian or Pacific Islanders had 30% (AOR: 0.70, 95% CI: 0.54-0.90) reduced odds of mortality. ESRD patients on nonelective hospitalizations had 16% (AOR: 0.84, 95% CI: 0.79-0.90) reduced odds of mortality while hospitalized versus those on elective hospitalization. ESRD patients with severe comorbidities had 40% (AOR: 1.40, 95% CI: 1.26-1.54) more odds of mortality compared to those with mild comorbidities, and those with moderate comorbidities had 22% (AOR: 1.22, 95% CI: 1.10-1.36) compared to those with mild comorbidities. Compared to patients on Medicare, ESRD hospitalizations on Medicaid had 19% (AOR: 1.19, 95% CI: 1.06-1.32) higher odds of mortality, hospitalizations on private insurance had 26% (AOR: 1.26, 96% CI: 1.15-1.37) higher odds of mortality, self-pay patients had 99% (AOR: 1.99, 95% CI: 1.61-2.45) higher odds of mortality, and no charge patients had over 1400% (AOR: 15.61, 95% CI: 7.09-34.35) higher odds of mortality. The area under the curve (AUC) for the model was 62%. CONCLUSION: The severity of comorbidities and expected primary payer are the modifiable predictors identified to predict ESRD inpatient mortality. From this study, the findings suggest that strategies aimed at preventing the severity of comorbidities and ensuring universal health coverage might help reduce ESRD inpatient mortality in rural America.

Clinical Risk Factors Associated with Ambulatory Outcome in Acute Ischemic Stroke Patient Smokers Treated with Thrombolytic Therapy.

BACKGROUND: Patients who have suffered an acute ischemic stroke (AIS) and are smokers may have a better outcome following thrombolytic therapy when compared with non-smokers. While this finding is controversial, data on baseline clinical risk factors to predict treatment efficacy of thrombolytic therapy using ambulatory status in patients who suffered AIS and are smokers is not common. METHODS: Between 2010 and 2016, retrospective data on patients who have suffered an AIS and received recombinant tissue plasminogen activator (rtPA) were obtained from Greenville health system registry. Assessment of clinical risk factors and the likelihood of an improvement in post-stroke ambulation among smokers and non-smokers was carried out using multivariate logistic regression. RESULTS: Of 1001 patients, 70.8% were smokers and 29.2% non-smokers. Among the smokers and non-smokers, 74.6% and 84.6% improvement in ambulation respectively at discharge. The odds of improved ambulation decrease among smokers as age group increases compared to those below 50 [(60-69 years, aOR, 0.30, 95% C.I, 0.108-0.850, p < 0.05), (70-79 years aOR, 0.27, 95% C.I, 0.096-0.734, p < 0.05), (80+ years aOR, 0.16, 95% C.I, 0.057-0.430, P < 0.01). Patients with National Institute of Health Stroke Scale Score (NIHSS) score > 7 (reference <7) were 91% less likely to have improved ambulation among smokers and non-smokers (aOR, 0.09, 95% C.I, 0.055-0.155, P = 0.01), and (aOR, 0.08, 95% C.I, 0.027-0.214, P = 0.01) respectively. Atrial fibrillation was an independent predictor of decreased improvement in ambulation only among smokers (aOR, 0.58, 95% C.I, 0.356-0.928 P < 0.05). CONCLUSION: Our findings suggest that elderly smokers with atrial fibrillation would benefit more from aggressive management of atrial fibrillation than non-smokers.

The COVID-19 pandemic and orthodontic practice in Nigeria.

OBJECTIVES: This study was aimed at assessing the knowledge and awareness of orthodontists and orthodontic residents in Nigeria about the COVID-19 pandemic and the appropriate infection control measures required to mitigate its spread in orthodontic practice. MATERIALS AND METHODS: It was a cross-sectional descriptive study of orthodontists and orthodontic residents. Ethical approval for the study was obtained from the Institutional Review Board. Data collection was via an online questionnaire designed using Google forms and these were sent to the phone numbers of study participants. Data analysis was done using Statistical Package for Social Sciences version 20. RESULTS: A total of 73 respondents with a mean age of 43.41 ± 9.21 years participated in the study. About 90% of the respondents had a very good knowledge of COVID-19, including its etiology, modes of transmission, signs, and symptoms. However, very few respondents were aware of the less common symptoms such as skin rash (16.4%) and red eyes (26%). Over 80% of the respondents knew the appropriate measures to take to prevent the spread of the virus in the dental clinic, in addition to the appropriate personal protective equipment (PPE) to use. CONCLUSION: The respondents had a very good knowledge of the basic epidemiology of COVID-19 and the means of prevention of its transmission in the dental clinic. However, there was limited knowledge of the less common symptoms of the infection. In addition, majority of the respondents had a very good idea of the appropriate PPE to be used.