Clustering of cardiovascular risk factors in semi-urban communities in south-western Nigeria.

BACKGROUND: In addition to poor socio-economic indices and a high prevalence of infectious diseases, there have been various reports of a rising prevalence of cardiovascular diseases, with associated morbidity and mortality in developing countries. These factors co-exist, resulting in a synergy, with serious complications, difficult-to-treat conditions and fatal outcomes. Hence this study was conducted to determine the clustering of cardiovascular disease risk factors and its pattern in semi-urban communities in south-western Nigeria. METHODS: This was a cross sectional study over seven months in 11 semi-urban communities in south-western Nigeria. RESULTS: The total number of participants was 1 285 but only 1 083, with 785 (65%) females, completed the data. Participants were 18 years and older, and 51.2% were over 60 years. The mean age was 55.12 ± 19.85 years. There were 2.6% current cigarette smokers, 22% drank alcohol and 12.2% added salt at the table, while 2% had been told by their doctors they had diabetes, and 23.6% had hypertension. The atherogenic index of plasma was at a high-risk level of 11.1%. Elevated total cholesterol and low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol levels were seen in 5.7, 3.7 and 65.1%, respectively. Prevalence of hypertension was 44.9%, diabetes was 5.2%, obesity with body mass index (BMI) > 30 kg/m2 was 5.7%, and abdominal circumference was 25.7%. Prevalence of clusters of two, three, and four or more risk factors was 23.1, 15.5 and 8.4%, respectively. Increasing age 2.94 (95% CI: 1.30-6.67), BMI 1.18 (95% CI: 1.02-1.37), fasting plasma glucose level 1.03 (95% CI: 1.00-1.05), albuminuria 1.03 (95% CI: 1.00-1.05), systolic blood pressure 1.07 (95% CI: 1.04-1.10), diastolic blood pressure 1.06 (95% CI: 1.00-1.11) and female gender 2.94 (95% CI: 1.30-6.67) showed increased odds of clustering of two or more cardiovascular risk factors. CONCLUSION: Clustering of cardiovascular risk factors is prevalent in these communities. Patterns of clustering vary. This calls for aggressive and targeted public health interventions to prevent or reduce the burden of cardiovascular disease, as the consequences could be detrimental to the country.

Knowledge Regarding Organ Donation and Willingness to Donate among Health Workers in South-West Nigeria.

BACKGROUND: Organ transplantation program in developing countries is still significantly dwarfed. Health workers are undeniably important in the success of transplantation. OBJECTIVE: To assess the knowledge and attitude of health workers toward organ donation in South-West Nigeria with a view to explaining reasons for these shortcomings. METHODS: In a cross-sectional study conducted on 850 health care workers, self-administered questionnaires were used to obtain information from participants. RESULTS: Of 850 participants, 766 (90.1%) returned their completed questionnaires. The mean±SD age of participants was 36.7±9.2 years. Majority (93.3%) of participants had heard of organ donation; 82.5% had desirable knowledge. Only 29.5% and 39.4% would be willing to donate and counsel potential organ donors, respectively; 36.5% would consider signing organ donation cards. Only 19.4% believed that organ transplantation is often effective and 63.4% believed they were permitted by their religion to donate. Permission by religion (OR 3.5; 95% CI 2.3 to 5.3), good knowledge (OR 2.9; 95% CI 1.4 to 5.7), readiness to sign donation cards (OR 2.6; 95% CI 1.7 to 3.8), discuss organ donation (OR 2.7; 95%CI 8.0 to 63.8), and knowing somebody who had donated (OR 2.9) independently influenced willingness to donate organ. CONCLUSION: There is disparity in knowledge of organ donation and willingness to donate among health care workers. Efforts should be intensified to give comprehensive and appropriate education to health care workers about organ donation to bridge this gap.

Relationship between retinopathy and renal abnormalities in black hypertensive patients.

BACKGROUND: Complications of hypertension are particularly common in people of African descent but previous reports had suggested rarity of hypertensive retinopathy in black Africans. We evaluated retinal changes among Nigerian hypertensive patients and determined their relationship with renal function. METHODS: Consecutive Hypertensive patients who were ≥18 years were selected for the study. Socio-demographic characteristics, anthropometric parameters and blood pressure were measured. All patients had ophthalmoscopic examination and retinal changes were graded according to Keith-Wegener's classification. Blood samples were taken for blood urea nitrogen, lipids and C-reactive protein; and urine was collected for creatinine and microalbuminuria. Serum creatinine was determined using modified Jaffe method and estimated glomerular filtration (eGFR) was calculated using MDRD equation: 186 × (Creatinine/88.4)-1.154 × (Age)-0.203 × (0.742 if female) × (1.210 if black). RESULTS: Of the 240 patients studied, 187 (78 %) had one form of retinopathy or the other. While 85 (35.4 %) patients had grade 1 retinopathy, 87 (36.3 %) had grade 2, 13 (5.4 %) had grade 3 and 2 (0.83 %) had grade 4 respectively. Comparison of patients with and without retinopathy showed that, the former were older (p = 0.001) and had longer duration of hypertension (p = 0.001). Similarly, hypertensive patients with retinopathy had higher total cholesterol and low density lipoprotein cholesterol (p = 0.017, p = 0.041 respectively). However, eGFR was lower in individuals with retinopathy (46.2 ml/min/1.73) than those with normal retinal (55.9 ml/min/1.73) findings, p = 0.019. Multi-variable adjusted odds ratios showed increased probability of retinopathy with age (odds ratio-1.08, p = 0.001) and body mass index (odds ratio-1.20, p = 0.013). CONCLUSIONS: Hypertensive retinopathy is a common clinical finding among hypertensive Nigerians and may occur pari passu with renal damage as consequences of long standing hypertension.

Methicillin resistant Staphylococcus aureus: awareness, knowledge and disposition to screening among healthcare workers in critical care units of a Nigerian hospital.

BACKGROUND: Awareness level about methicillin resistant Staphylococcus aureus (MRSA) is high in the western world but the status in developing countries is not well defined. OBJECTIVE: To assess MRSA awareness level, knowledge and disposition to screening among critical healthcare givers (HCGs) in Nigeria. METHODS: A self-administered questionnaire was used to assess the level of awareness and knowledge of HCGs in critical care units of the University of Ilorin Teaching Hospital, Ilorin, Nigeria on MRSA and their willingness to submit to screening. RESULTS: Only 103 (52.0%) of the 198 participants were aware of MRSA but all were favourably disposed to screening for the organism. Awareness was through hospital rounds 65(63.1%) and journals/ textbooks 35(34.0%), and Many, 120 (60.6%) considered MRSA as a threat in the hospital, while only 27 (13.6%) thought otherwise and 51(25.8%) were indifferent. Most HCGs, 124 (87.9%) reported that there were no MRSA control measures in their respective duty post. The age, cadre of work, and number of years in the hospital's critical care units correlated positively with awareness level. CONCLUSION: Methicillin resistant Staphylococcus aureus awareness level among the HCGs in our hospital is just a little above 50.0% with substantial proportion of them not realizing the medical implication of the organism. However, majority are well disposed to MRSA screening. Inadequate publicity is a major contributor to poor knowledge and awareness. There is need for educational intervention and sensitization programs on MRSA and other infection control techniques for HCGs in developing nations especially Nigeria.

Descriptive analysis of blood pressure control among treated hypertensive patients in a tertiary hospital in Nigeria.

BACKGROUND: Blood pressure (BP) is poorly controlled in sub-Saharan Africa and this is due to poor utilization of antihypertensive drugs among other factors. Evaluation BP control will provide basis for recommendation for appropriate therapeutic measures for achieving target BP. AIM: To determine the pattern of BP control as a measure of impact of antihypertensive usage among treated hypertensive patients in University of Ilorin Teaching Hospital in Nigeria. METHODOLOGY: This is a descriptive-analytical study of 605 treated adult hypertensive patients who have been attending our specialist clinics for at least one year. Definition of blood pressure control was according to the World Health Organization criteria. RESULTS: The results showed that the mean age was 58.48 +/- 11.65 with 211 (34.9%) males (M:F =1:1.87). Median duration of follow up was 4(1-27) years. 152 (25%) were diabetic, 381 (63%) were taking antiplatelet aspirin and 213 (35.2%) had cardiovascular events. There was a significant difference between the first visit BP (initial BP) and last BP observed during the study (SBP[initial])=154 +/- 28mmHg, SBP(last)=133 +/- 21 mmHg (p<0.01); DBP[initial]=95 +/- 17mmHg, DBP[last]=80 +/- 12mmHg (p<0.001)).The pattern of BP control was: SBP+DBP controlled 322(53.3%); SBP+DBP uncontrolled 149 (24.6%); SBP controlled/DBP uncontrolled 39 (6.4%); DBP controlled/SBP uncontrolled 95 (15.7%).The control rate among the diabetic subgroup was 23.7%. CONCLUSION: BP control rate among treated hypertensive patients in our institution is significantly higher than reports from similar patient populations in similar healthcare centres in Nigeria and sub-Saharan Africa which reflects an improved and appropriate usage of antihypertensive drugs recently observed in our institution. The rate of control among diabetics is still very poor.

Cardiovascular autonomic reflex function in sickle cell anaemia patients.

AIMS AND OBJECTIVES: Cardiovascular autonomic dysfunction (CAD) has been documented as part of neurological complications in sickle cell anaemia (SCA). There is little information on CAD from sub-Saharan Africa with 25-40% prevalence rate of sickle cell trait. This study therefore assessed cardiovascular autonomic reflex function in a group of Nigerians with SCA. SUBJECTS AND METHODS: Forty SCA and 44 controls (Hemoglobin AA) were studied. They were assessed using 6 non-invasive cardiovascular autonomic reflex (CAR) tests. Parasympathetic functions were assessed with heart rate variability (HRV) to deep breathing, Valsalva maneuver and lying-to-standing test while sympathetic blood pressure regulation was assessed by systolic and diastolic blood pressure responses to lying-to-standing position and isotonic handgrip test. RESULTS: Mean haemoglobin (Hb) concentration of SCA patients and controls were 8.4 +/- 2.4 g/dl and 13.1 +/- 0.9 g/dl, respectively. Baseline heart rate was significantly faster in the SCA patients (84 +/- 12 beats/minute) than in controls (76 +/- 11 beats/minute) [P < 0.05]. Eleven SCA compared to 2 controls had abnormal responses to deep breathing test (P = 0.003); 15 SCA and 6 controls had impaired Valsalva ratio (P = 0.01); 8 SCA and 4 controls had abnormal responses lying-to-standing test (P = 0.2). Although, more SCA patients compared to controls had abnormal responses to sympathetic mediated blood pressure tests the difference was insignificant (P > 0.05). Overall 21 (53%) SCA patients compared to 4 control subjects (9%) fulfilled the criteria for cardiovascular autonomic neuropathy (presence of e"3 CAR tests) with p < 0.05. CONCLUSION: CAN occur in Nigerians with SCA with relative preservation of the sympathetic blood pressure reflex control compared to parasympathetic heart rate regulation. Increase baseline heart rate associated with SCA in the presence of chronic anaemia could result in myocardial hypertrophy and dilatation. This is likely to be predispose sicklers to hypoxia-related arrhythmia.

Antihypertensive drug utilization and conformity to guidelines in a sub-Saharan African hypertensive population.

BACKGROUND: Despite availability and usage of wide array of antihypertensive drugs, blood pressure has remained poorly controlled in most health care settings particularly in Africa. The cost of these drugs among other factors strongly determines the prescription and usage pattern which ultimately affects control of blood pressure particularly in sub-Saharan Africa. The aim of this study was to describe the current utilization pattern of antihypertensive drugs in a tertiary hospital in Nigeria in line with the regional and international guidelines for hypertension management and to compare with similar studies in other parts of the country to generate the national outlook. METHODS: This is a cross sectional study of 805 adult hypertensive patients who were on treatment at the Medical Out-Patient Department of University of Ilorin Teaching Hospital in Nigeria, a country with the most populous black hypertensive patients. Data were collated from the patients' records and evaluated according to drug classifications. RESULTS: 787 patients out of the 805 evaluated were eventually included in the analysis. Mean age was 57.88 + or - 12.59 years with 490 (62.3%) females. Frequency of use of classes of antihypertensive was: diuretics (D, 84%), calcium channel blockers (CCB, 66%), angiotensin converting enzyme inhibitors (ACEI, 65%), a-methyldopa (ALD, 26%), beta-blockers (BB, 11.9%) and angiotensin receptor blockers (3.8%). Proportions of number of drugs usage per patient were: 0 (2.2%), 1 (9.1%), 2 (37.1%), 3 (35.8%), 4 (15.6%), and 5 (0.1%). The most commonly used combinations of drugs were ACEI + CCB + D (21.6%), followed by CCB + D (14.5%), ACE + D (11.4%) and ACEI + D + ALD (9.8%). Other recent studies in Nigeria revealed diuretics and multiple agents as the prevalent prescription pattern. CONCLUSION: Antihypertensive utilization in Ilorin, Nigeria like some parts of the country conforms to the guidelines for the management of hypertension in blacks with majority of patients on diuretics particularly in combination with other agents. Angiotensin converting enzyme inhibitors are increasingly being used whereas beta-blockers and angiotensin receptor antagonists are still less utilized.