Health and Wellbeing amidst a Prolonged Pandemic: Implications for Physicians and Patients.

Health is wealth, so goes the popular maxim. The 46th West African College of Physicians Annual General and Scientific Meeting focuses on Health and Wellbeing Amidst a Prolonged Pandemic. Health and wellbeing are closely related components critical to healthy living and cannot be considered independent of each other. While health is a state of total wellbeing; wellbeing is intricately linked with happiness and satisfaction in life. The COVID- 19 pandemic has significantly impacted the health and well-being of nations all over the world. In the wake of the pandemic came the COVID-19 recession which brought a crash in the global economy, reduction in productivity, rise in unemployment, massive layoffs, collapse of businesses and manufacturing industries, disruptions in transportation and much more. These harsh economic realities have placed a huge strain on global mental health resulting in physical, mental and social disorders. The workload of the average physician and other health care workers increased tremendously resulting in burnout and psychological stress with a consequent increase in the incidence of psychological disorders including anxiety, depression, suicide and suicidal ideation amongst others. The lack of preparedness for the pandemic and the inequality in strength of healthcare systems across the world prolonged the pandemic and its adverse consequences on health and wellbeing of the populace. Promotion of health and well-being of health care professionals and the populace at large is essential for the growth of any economy and is an essential consideration for stakeholders involved in disease prevention and health promotion.

La santé est une richesse, dit la maxime populaire. La 46e réunion générale annuelle et scientifique du Collège des médecins d'Afrique de l'Ouest a pour thème la santé et le bien-être dans un contexte de pandémie prolongée. La santé et le bien-être sont des éléments étroitement liés et essentiels à une vie saine et ne peuvent être considérés comme indépendants l'un de l'autre. Alors que la santé est un état de bien-être total, le bien-être est intimement lié au bonheur et à la satisfaction dans la vie. La pandémie de COVID- 19 a eu un impact considérable sur la santé et le bien-être des nations du monde entier. Dans le sillage de la pandémie, la récession du COVID-19 a entraîné un effondrement de l'économie mondiale, une réduction de la productivité, une hausse du chômage, des licenciements massifs, l'effondrement des entreprises et des industries manufacturières, des perturbations dans les transports, etc. Ces dures réalités économiques ont exercé une pression énorme sur la santé mentale mondiale, entraînant des troubles physiques, mentaux et sociaux. La charge de travail du médecin moyen et des autres travailleurs de la santé a considérablement augmenté, entraînant un épuisement professionnel et un stress psychologique, avec pour conséquence une augmentation de l'incidence des troubles psychologiques, dont l'anxiété, la dépression, le suicide et les idées suicidaires, entre autres. Le manque de préparation à la pandémie et l'inégalité des systèmes de santé dans le monde ont prolongé la pandémie et ses conséquences négatives sur la santé et le bien-être de la population. La promotion de la santé et du bien-être des professionnels de la santé et de la population en général est essentielle à la croissance de toute économie et constitue une considération essentielle pour les acteurs impliqués dans la prévention des maladies et la promotion de la santé. Mots clés: Santé, Bien-être, Pandémie de COVID-19, Santé mentale, Prevention des maladies.

Community Advocacy and Capacity Building of Community Health Workers on Rheumatic Heart Disease in Osun State, Nigeria.

Rheumatic heart disease (RHD) is one of the leading causes of cardiovascular diseases in the world. The study aimed to assess awareness and capacity building on the diagnosis and prevention of RHD among Community Health Workers (CHWs) Nigeria. It was an interventional study, where 300 CHWs from public Primary Health Care (PHC) facilities were selected pre-assessed on the diagnosis and prevention of RHD before their training on RHD. Also, a post-test evaluation was done to reassess the CHWs awareness on RHD. Data were analyzed and RHD knowledge was scored and graded. Results showed, at pre-test evaluation, that 49% of the CHWs had good knowledge, 49.7% had fair knowledge while 4.1% had poor knowledge on the diagnosis and prevention of RHD, while post-test evaluation revealed that 100% of the CHWs had good knowledge. Awareness of the CHWs about the diagnosis and prevention of RHD was fair in the pre-test and improved after the training with all the CHWs having good knowledge. This showed the training was impactful. Intermittent assessment of the awareness and simultaneous training of the CHWs on RHD may be scaled up into a significant and effective measure in the armamentarium of community prevention of the disease.

La cardiopathie rhumatismale est l'une des principales causes de maladies cardiovasculaires dans le monde. L'étude visait à évaluer la sensibilisation et le renforcement des capacités sur le diagnostic et la prévention de la cardiopathie rhumatismale chez les agents de santé communautaire (ASC). au Nigeria. Il s'agissait d'une étude interventionnelle, dans le cadre de laquelle 300 ASC des établissements publics de soins de santé primaires (PHC) ont été sélectionnés et pré-évalués sur le diagnostic et la prévention des RHD avant leur formation sur les RHD.. De plus, une évaluation post-test a été réalisée pour réévaluer la connaissance des ASC sur la RHD. Les données ont été analysées et les connaissances sur la RHD ont été notées et évaluées. Les résultats ont montré, lors de l'évaluation du pré-test, que 49% des ASC avaient une bonne connaissance, 49,7 % une connaissance moyenne et 4,1 % une mauvaise connaissance du diagnostic et de la prévention de RHD, tandis que l'évaluation du post-test a révélé que 100% des ASC avaient de bonnes connaissances. La connaissance des ASC sur le diagnostic et la prévention de la RHD était moyenne dans le pré-test et s'est améliorée après la formation, tous les ASC ayant de bonnes connaissances. Cela montre que la formation a eu un impact. L' évaluation intermittente de la sensibilisation et la formation simultanée des ASC sur la RHD peut devenir une mesure significative et efficace dans l'arsenal de prévention communautaire de la maladie. Mots-clés: Cardiopathie rhumatismale, Agents de santé communautaire, service de santé, prévention.

Assessment of Risk Factors for Metabolic Syndrome in Adolescents with Obesity in Ile-Ife, South West Nigeria.

BACKGROUND: Metabolic syndrome (MS) is the occurrence of risk factors which increase the risk for cardiovascular diseases and type 2 diabetes mellitus. These risks factors include abdominal obesity, hypertension, increased triglycerides (TG), elevated blood glucose, and reduced high-density lipoprotein cholesterol (HDL- C). MS is now increasingly reported among children and adolescents. OBJECTIVES: To assess risk factors for MS in adolescents with and without obesity. METHODS: One hundred and twenty-five adolescents with obesity and an equal number of age- and sex- matched adolescents without obesity from secondary schools in Ile- Ife were studied. Weight, height, waist circumference, body mass index (BMI), and blood pressure (BP) were determined. Seven mls of venous blood from each participant (collected after a 12 hour overnight fast) were processed and analysed for total plasma cholesterol, triglycerides, HDL-C and fasting plasma glucose (FPG). Low density lipoprotein - cholesterol (LDL-C) was determined using Friedewald formula. Data was analysed using independent samples t-test, Chi-square test, Fisher's exact test and Pearson's correlation analysis. P- value was set at ˂ 0.05. RESULTS: Adolescents with obesity had elevated systolic (122.03 ± 13.93 mmHg vs 109.82 ± 12.07 mmHg; t= 7.40, p= 0.001) and diastolic blood pressures (76.06 ± 10.22 mmHg vs 66.78 ± 9.18 mmHg; t= 7.55, p= 0.001) compared with non- obese adolescents. Significant differences in mean HDL-C (0.97 ±0.28mmol/L vs 1.11 ± 0.38mmol/L; t= -3.40, p= 0.001) and FPG (4.30 ± 0.78mmol/Lvs 3.95 ± 0.83mmol/L; t= 3.45, p = 0.001) in adolescents with and without obesity were observed. MS was present in 18 adolescents with obesity (predominantly males) and absent in adolescents without obesity. CONCLUSION: Older male adolescents with obesity are at increased risk of MS. Low HDL- C, elevated BP and abdominal obesity were the most frequently identified risk factors.

Aortic Valve Regurgitation following Transthoracic Open Surgical Ligation of Patent Ductus Arteriosus.

BACKGROUND: Transthoracic open surgical ligation (TTOSL) of patent ductus arteriosus (PDA) remains the most readily available and affordable treatment option in resource-poor countries such as Nigeria. OBJECTIVES: To determine the incidence and outcome of aortic valve regurgitation (AR) following TTOSL of PDA. METHODS: Retrospective audit of consecutive patients who underwent TTOSL of PDA over a 4½-year period (January 2015 to June 2019) at the OAUTHC, Ile-Ife, Nigeria. Hospital records including echocardiograms (pre-operative, immediate post-operative and follow-up performed a day after TTOSL, at 1, 3 and 12 months) were reviewed for presence and severity of AR. RESULTS: Twenty-six patients (11 males and 15 females) aged 3 months 24 years (Mean = 3.16 years) had TTOS PDA ligation. Only 3 (11.5%) patients had AR pre-operatively; 2 graded moderate AR and 1 graded mild. Twenty (76.9 %) patients had immediate post-operative AR; 4 (20.0%) of which were moderate and the others (80.0%) were mild. Eighteen (69.2%) patients still had AR post-operative day 1; 16 were mild and the rest 2 which were moderate were the same patients that had AR pre-operatively. At 3 months follow-up, 6 of 20 patients (30.0%) had AR; all were mild. Only 2 of 18 (11.1%) followed up for 12 months had AR. They both had had moderate AR pre-operatively which were now graded as mild. There was no mortality. CONCLUSION: Aortic regurgitation is common after TTOSL of PDA. However, in most instances, it is mild and transient.

Evaluating the health risk of metals (Zn, Cr, Cd, Ni, Pb) in staple foods from Lagos and Ogun States, Southwestern Nigeria.

The study evaluated the health risk of metals in commonly consumed staple foods from Lagos and Ogun states, southwestern Nigeria. One hundred and thirty-three food samples were collected and analyzed for Zn, Cr, Cd, Ni, and Pb using atomic absorption spectrophotometric method. Data collected were analyzed for simple descriptive and inferential statistics using SPSS for Windows. The health risk of metals in staple foods was assessed for average daily dose (ADD), hazard quotient (HQ), hazard index (HI), and cancer risk (CR). Results showed the highest concentrations of Zn (18.99 ± 13.62 mg kg-1) and Ni (0.21 ± 0.10 mg kg-1) in beans, while the highest amount of Cr (2.04 ± 1.44 mg kg-1) was obtained in rice. Cd concentrations in staple foodstuffs ranged from < 0.01 to 0.30 mg kg-1, while Pb was below the detection limit. The average levels of Zn in beans and maize were higher than the recommended dietary allowance (9.5 mg kg-1) of the Institute of Medicine. The mean concentrations of Cr and Cd (except for rice) in staple food samples were also higher than the permissible standards. The health risk data revealed HQ value greater than 1.0 for Cr in the food samples, indicating non-carcinogenic adverse health effects. The HI value greater than 1.0 in staple foods established cumulative adverse effects of metals. The carcinogenic evaluation of Cr (in all the food samples) and Ni (in beans) showed CR values greater than the acceptable limit of 1.0 × 10-4, thereby demonstrating possible development of cancer through consumption of the staple foodstuffs.

Bioremediation of industrially contaminated soil using compost and plant technology.

Compost technology can be utilized for bioremediation of contaminated soil using the active microorganisms present in the matrix of contaminants. This study examined bioremediation of industrially polluted soil using the compost and plant technology. Soil samples were collected at the vicinity of three industrial locations in Ogun State and a goldmine site in Iperindo, Osun State in March, 2014. The compost used was made from cow dung, water hyacinth and sawdust for a period of twelve weeks. The matured compost was mixed with contaminated soil samples in a five-ratio pot experimental design. The compost and contaminated soil samples were analyzed using the standard procedures for pH, electrical conductivity (EC), organic carbon (OC), total nitrogen (TN), phosphorus, exchangeable cations (Na, K, Ca and Mg) and heavy metals (Fe, Mn, Cu, Zn and Cr). Kenaf (Hibiscus cannabinus) seeds were also planted for co-remediation of metals. The growth parameters of Kenaf plants were observed weekly for a period of one month. Results showed that during the one-month remediation experiment, treatments with 'compost-only' removed 49 ± 8% Mn, 32 ± 7% Fe, 29 ± 11% Zn, 27 ± 6% Cu and 11 ± 5% Cr from the contaminated soil. On the other hand, treatments with 'compost+plant' remediated 71 ± 8% Mn, 63 ± 3% Fe, 59 ± 11% Zn, 40 ± 6% Cu and 5 ± 4% Cr. Enrichment factor (EF) of metals in the compost was low while that of Cu (EF=7.3) and Zn (EF=8.6) were high in the contaminated soils. Bioaccumulation factor (BF) revealed low metal uptake by Kenaf plant. The growth parameters of Kenaf plant showed steady increments from week 1 to week 4 of planting.

FEMALE GENITAL MUTILATION: ARE WE WINNING?

BACKGROUND: For more than 25 years, efforts have been geared towards curtailing the practice of female genital mutilation (FGM) in countries like Nigeria. This study was designed to see if all these efforts have made any impact in reducing the prevalence of FGM appreciably in the south-West of Nigeria. OBJECTIVE: To determine the prevalence of female genital mutilation and profiling the trends of FGM affected patients. DESIGN: A prospective study based on direct observation of the external genitalia by health-care workers . SUBJECTS: Five hundred and sixty five females less than 15 years of age. SETTING: The children emergency and gynaecological wards of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st of January to December 31s 2007. RESULTS: Forty one point nine percent of the patients examined had female genital mutilation, 93.2% of these had the procedure before attaining the age of one year. Type 2 FGM predominated (58.22%). The procedure was performed predominantly (64.6%) by traditional birth attendants. The decision to have the procedure done was influenced in 78% of cases by mothers and grandmothers. In 35.4% of cases, there were immediate and short term complications. Demands of tradition predominated (59.1%) as the most important reason for the practice of female genital mutilation. CONCLUSION: The practice of FGM appears to be still highly prevalent and resistant to change probably due to deep rooted socio-cultural factors. Strategies such as public education campaigns highlighting its negative impact on health and disregard for human rights should be evolved.