Assessment of pattern of cigarette smoking and associated factors among male students in public secondary schools in Anambra State, Nigeria.

BACKGROUND: The WHO has estimated that there are about 1300 million smokers globally and about 75 of these are in the developing countries. It is also predicted that if the current pattern of smoking continues, by 2020, there will be 10 million tobacco-related deaths annually worldwide and seven million (70%) of these deaths will occur in the developing countries. The objective of the study was to assess the cigarette smoking pattern and associated factors among male students in public secondary schools in Anambra State. METHODS: The setting was public secondary schools in Anambra State. The study was in April 2008. It was a cross-sectional survey involving six schools, selected by multistage sampling technique. Eight hundred and fifty male students participated in the study. A semistructured self-administered questionnaire was used. Qualitative data were collected using focus group discussion (FGD). RESULTS: The mean age of respondents was 16 +/- 2.1 years. The ever-smoked and current smoking prevalence were 13.1% and 8.7% respectively. Mean age of commencement of cigarette smoking 13.7 +/- 2.6 years. Among smokers, 37.8% were dai smokers. Television (40.7%) and radio (33.3%) were the main sources of advertisement. Peer influence (34.2%) was the main reason for uptake of cigarette smoking. Major reason for not smoking among non-smokers was health concerns (57.9%). There were significant associations between smoking status and age of respondents (2 = 25.08; P = < 0.05), father's smoking status (2 = 158.77, P < 0.05), awareness of health hazards of smoking (2 = 5.13, P = 0.023) and advertisement on television (2 = 4.05, P = 0.044) and billboards (2 = 44.39, P < 0.05). CONCLUSION: Cigarette smoking prevalence among secondary school boys in Anambra State is high. Health education and strict implementation of anti-smoking policies of the federal government of Nigeria is recommended.

Intensive care unit admissions in Federal Medical Centre Umuahia south east Nigeria.

BACKGROUND: The Federal Medical Centre Umuahia (FMCU) is a tertiary referral centre in Abia state, southeast Nigeria serving a catchment area made of Abia state and environs. An intensive care unit (ICU) was established in the hospital in December 2009 to improve healthcare delivery to critically ill patients. OBJECTIVE: To determine the admission patterns and report the initial experience in the intensive care of patients in the FMCU. METHODS: This is a retrospective study ofthepatients admitted into the ICU of FMCU from December 2009 to March 2011. Data retrieved from the patients ICU records included demographics, indication for admission, length of stay in ICU, and outcome of stay The cost of ICU care was extracted from the financial records of the patient following discharge or demise. Data acquisition and analysis was performed using the statistical package for social sciences (SPSS) version 15. RESULTS: A total of 87 patients were studied consisting of 59 males and 28 females. The ages ranged from 2 days to 87 years with a mean age of 41 +/- 2.34 years. There were 11 patients within the pediatric age range (12.6%). Post-operative surgical patients (51) accounted for the majority of the admissions (58.6%). There were also 21 non-operated trauma cases (24.1%), 7 medical cases (8.1%), 8 obstetrics and gynecological cases (9.2%). Post-operative admissions were mainly emergencies--39 cases (76.5%) cases while 12 (23.5%) were elective. Most post-operative ICU admissions followed abdominal surgery -31 cases (58.8%) while neurological trauma accounted for most non-operated trauma 17cases (81%). The cost of stay per patient ranged from N2745.65 to N238123.4 ($82.23 to $1536.28) with an average cost per day of N19506.75 ($125.85). The cost per day for mortality cases was N28598, 74 ($184.51). The modal length of ICU stay was 2 days with a mean of 3.63 +/- 0.34 days and a range of one to sixteen days. About 68.4% of the patients spent = 3 days (38.3% of total ICU days), while 31.6% spent > 3 days (61.7% of total ICU days). Of the 87 patients, 57 (65.5%) were discharged from ICU to the wards, 28 (32.2%) died in ICU while 2 (2.3%) were referred to bigger centers. Twelve mortalities (42.8%) were among the emergency postoperative patients and 10 (35.8%) non-operated trauma patients (80% of which are neurological trauma). CONCLUSION: From our study, most ICU admissions and is comparable to other studies in Africa. The cost of stay is very high when compared with annual per capita income in Nigeria of $1190.

Pattern and Magnitude of Treatment Delay among TB Patients in Five States in Southern Nigeria

Prompt diagnosis and early treatment of Tuberculosis (TB) cases is an important strategy in TB prevention and control. Thus; passive case finding of TB suspects; sputum examination for diagnosis; and prompt treatment using Directly Observed Treatment Short Course (DOTS) are key elements in the national guideline for TB control programme. The aim of this study is to determine the time interval between diagnosis of smear-positive TB cases and the commencement of treatment in DOTS facilities in southern Nigeria. The study was carried out in 20 healthcare facilities supported by TB Control Assistance Program (TB-CAP) involved in TB management in southern Nigeria; which comprised tertiary; secondary; and primary healthcare facilities including public and private facilities. Data were collected through review of clients' and facility records covering July-September 2009. Data collected were sociodemographic characteristics; sputum-smear result; date of diagnosis; and date of commencement of treatment. Data were analyzed using SPSS version 15.0 software. Of the total 2;507 TB suspects examined for Acid-Fast Bacillus (AFB); 323 were diagnosed to be Sputum-Smear-Positive (SS+ve); However; 269 new smear positive cases were commenced on treatment within the period; thus 54 (17.0) of the new SS+ve cases defaulted initially. One hundred and two (38) of them commenced TB treatment within 3 days of smear examination for diagnosis; while 59 (22) commenced 4-6 days after diagnosis. The study revealed significant delay in commencement of TB treatment for most new smear positive TB cases in southern Nigeria and underlines the need to further explore factors responsible for delay in commencement of TB treatment following diagnosis

The status of tuberculosis infection control measures in health care facilities rendering joint TB/HIV services in "German Leprosy and Tuberculosis Relief Association" supported states in Nigeria.

OBJECTIVE: To assess the status of tuberculosis (TB) infection control practice in health care facilities implementing joint TB/HIV activities. MATERIALS AND METHODS: A descriptive survey triangulating self-administered questionnaire (facility survey to Infection Control Officer, individual health worker to general health workers), review of facility case notes and participant observation techniques was carried out. Twelve health facilities from southern Nigeria were assessed. RESULTS: (1) Administrative and work practice control measure: Only 1 (8.3%) facility had a documented TB Infection control policy; 2 (16.7%) facilities had Infection Control Committee; 5 (41.7%) facilities had Infection Control Officer; 2 (16.7%) asked questions at the health records about cough; 1 (8.3%) facility had health workers intermittently checking for patients with cough in the waiting hall; and 2 (16.7%) facilities had Infection Control Officers who have attended some training on infection control. No facility had Information, Education and Communication (IEC) materials reminding patients and health workers of the possibility of TB transmission in the health care setting. While 86.4% of TB patients were screened for HIV, only 54.7% of HIV patients were tested for TB. (2) Environmental control measures: All the waiting halls were well ventilated. Though 66.7% of the consulting rooms were well ventilated, 25% of them were over crowded; 58.3% of the facilities managed sputum smear positive TB patients in the same ward with HIV-positive and other vulnerable patients; no facility had air cleaners. CONCLUSION: Implementation of the different aspects of the administrative control and work practice component of TB infection control measure range from 8.3% to 41.7% of the facilities. Urgent measures should be taken to reverse this trend in the face of TB burden due to HIV.

Diagnostic approach of childhood pulmonary tuberculosis in endemic areas of Southeast Nigeria.

UNLABELLED: There is the need to ascertain the diagnostic approach on which medical doctors based their diagnosis of childhood pulmonary tuberculosis especially in tuberculosis endemic areas. AIM OF THE STUDY: To determine the diagnostic approach used by medical doctors in the diagnosis of childhood pulmonary tuberculosis. METHODOLOGY: A cross sectional study, using structured questionnaires to collect data from medical doctors whose daily routine include seeing sick children was carried out. RESULTS: The common diagnostic approach or criteria were ranked by medical doctors in descending order of importance as follows; clinical features elicited from patients' history was ranked-1 by 56.4% (or 23 of 218); bacteriological investigation to isolate Mycobacterium Tuberculosis was ranked-2 by 22.5% or 49 of 218; radiological investigation to demonstrate typical changes consistent with active pulmonary tuberculosis was ranked-3 by 25.2% or 55 of 218; therapeutic trial with standard anti tuberculosis drugs was ranked-4 by 52.3% or 114 of 218; immunological investigation using tuberculin skin testing was ranked-5 by 30.3% or 66 of 218; and residual ranking of histological investigation using tissue biopsy was ranked-6 by 15.6% or 34 of 218. Therapeutic trial with standard anti tuberculosis drugs was consistently ranked as 4th by most groups of clinicians. CONCLUSIONS: Most clinicians from different subgroups studied followed a fairly similar order in the diagnosis of childhood pulmonary tuberculosis with a high premium placed on clinical features, bacteriologic, radiologic and therapeutic trial with anti tuberculosis drugs. The specialist in paediatric medicine relied more on clinical features and therapeutic trials for their diagnosis of childhood pulmonary tuberculosis.

Congenital diaphragmatic hernia: neonatal outcomes following referral to a paediatric surgical centre.

Congenital diaphragmatic hernia (CDH) is a rare malformation observed in approximately 1 in 3000 live births. Estimates of postnatal survival range from 50 to 70% despite advances in neonatal care. Antenatal diagnosis is associated with termination of pregnancy in 25-50% pregnancy internationally which may not be reflective of the Irish population. We aimed to evaluate the mortality of infants with CDH who survived to admission in a tertiary referral paediatric hospital between 1996 and 2007. The Hospital In-Patient Enquiry system was used to determine the number of neonatal referrals for CDH to OLHSC between 1996 and 2007. Mortality, sex distribution, length of patient stay and the number of cases per year were examined. 141 neonates with CDH were over 12 years with approximately 12 referrals per annum of which 82 (58%) were male and 59 (42%) female. The average length of stay in the hospital was 33 (range 0-364) days. Overall 71% of the patients survived to discharge. In the first epoch (1996-2001) survival was 63% compared with 78% in the later epoch (2002-7). The overall survival for neonates with CDH presenting to OLCHC during the 12 year-period was 71% although this improved to 78% in recent epoch. Further study of associated congenital anomalies, number of terminations of pregnancy, complexity of the diaphragmatic defect and degree of pulmonary hypertension are required to compare this population with other international centres.

Negative screening tests in classical galactosaemia caused by S135L homozygosity.

Classical galactosaemia is relatively common in Ireland due to a high carrier rate of the Q188R GALT mutation. It is screened for using a bacterial inhibition assay (BIA) for free galactose. A Beutler assay on day one of life is performed only in high risk cases (infants of the Traveller community and relatives of known cases). A 16-month-old Irish-born boy of Nigerian origin was referred for investigation of developmental delay, and failure to thrive. He had oral aversion to solids and his diet consisted of cow's milk and milk-based cereal mixes. He was found to have microcephaly, weight <2nd percentile, hepatomegaly and bilateral cataracts. Coagulation screen was normal and transaminases were slightly elevated. His original newborn screen was reviewed and confirmed to have been negative; urinary reducing substances on three separate occasions were negative. Beutler assay demonstrated "absent" red cell galactose-1-phosphate uridyltransferase (GALT) activity. GALT enzyme activity was <0.5 gsubs/h per gHb confirming classical galactosaemia. Gal-1-P was elevated at 1.88 micromol/gHb. Mutation analysis of the GALT gene revealed S135L homozygosity. S135L/S135L galactosaemia is associated with absent red cell GALT activity but with approximately 10% activity in other tissues such as the liver and intestines, probably explaining the negative screening tests and the somewhat milder phenotype associated with this genotype. The patient was commenced on galactose-restricted diet; on follow-up at 2 years of age, growth had normalized but there was global developmental delay. In conclusion, galactosaemia must be considered in children who present with poor growth, hepatomegaly, developmental delay and cataracts and GALT enzyme analysis should be a first line test in such cases. Non-enzymatic screening methods such as urinary reducing substances and BIA for free galactose are not reliable in S135L homozygous galactosaemia.

Where do tuberculosis patients go for treatment before reporting to DOTS clinics in southern Nigeria?

Health-seeking patterns of persons with tuberculosis (TB) before reporting at the Directly Observed Treatment Short-course (DOTS) clinic for diagnosis and treatment were analysed. A total of 221 persons registered in the DOTS programme in 12 randomly selected rural and urban Local Government Areas in southern Nigeria were interviewed using a semi-structured questionnaire. Perceived causes of TB influenced first choice of treatment. Patients re-evaluated initial choices and shop for alternatives in persistent TB. Chemists were the first port of call for most patients. Those with unscientific causative theories of tuberculosis such as witchcraft engaged more in multiple health-seeking than those who indicated bacterial infection (P < 0.0001). The respondents had a median diagnostic-delay of 90 days. Delay in commencement of DOTS treatment was attributable to ignorance among patients and poor attitude of health workers. In conclusion, delay exists between recognition of symptoms and initiation of treatment in DOTS clinics partly because of ignorance among patients. Health workers' attitude to patients reporting at health clinics also discouraged the use of DOTS facilities. Consequently, it is recommended to address such delay through social mobilization of communities and through engaging Chemists in TB service delivery in this area.

Proximate composition and selected functional properties of fermented and unfermented African oil bean (Pentaclethra macrophylla) seed flour.

Flour samples were prepared from fermented and unfermented African oil bean (Pentaclethra macrophylla) seeds (AOBS). The flour samples were evaluated for proximate composition and certain functional properties. The influence of defatting on these properties was also determined. Fermentation significantly increased (p < 0.05) the protein and decreased the crude fiber, ash, fat and carbohydrate contents of the AOBS flours. The nitrogen solubility of both fermented and unfermented flours was pH dependent with minimum and maximum solubility at pH 4.0 and pH 8.0, respectively, and with increased nitrogen solubility in the fermented sample. The fermented and unfermented flour samples had least gelation concentrations of 14 and 16% (w/v), respectively. The water absorption capacity and foam capacities of the fermented flour were 36 and 34%, respectively, over the unfermented seed flour. On the other hand, fermentation decreased the fat absorption capacity, emulsion activity and emulsion and foam stabilities. Fermentation decreased (p < 0.05) the bulk density of AOBS flour by 15%. Defatting improved all the functional properties evaluated except emulsion activity. These results indicate potential food uses of fermented and unfermented AOBS flour samples as protein supplements in diets and as functional ingredients in formulated foods.

The tuberculosis emergency in Africa: opportunities and strategies for action.

Tuberculosis rates are increasing dramatically in many regions of the world due to poverty, rapid population growth, ineffective Tb programmes and the HIV pandemic. Innovative approaches of treatment supervision are required to increase cure rates and hence reduce transmission. National tuberculosis programmes need to be strengthened, co-ordinated with AIDS programmes and supported by national advocacy groups.