Obesity and obstructive sleep apnea risk among Nigerians.

BACKGROUND: The contribution of obesity to obstructive sleep apnea (OSA) is poorly described in Nigeria. We aimed to compare OSA risk between obese and nonobese adults in urban Nigeria. MATERIALS AND METHODS: An analytic cross-sectional study was conducted. Participants were interviewed using the World Health Organization Non-Communicable Disease questionnaire. OSA risk assessment was performed using the STOP-BANG questionnaire. A total score of ≥3 on the STOP-BANG questionnaire indicated OSA risk, whereas a score ≥5 indicated high OSA risk. Obesity was defined as body mass index (BMI) >30 kg/m2. Relationship between obesity and OSA was tested using chi-square and logistic regression models used to control for confounding factors. RESULTS: There were 744 respondents, with a mean age of 44 (standard deviation 10) years. A total of 206 [27.7%, 95% confidence interval (CI) 24.46-30.9] respondents were obese (BMI ≥30 kg/m2). A total of 307 (41.3%, 95% CI 37.7-44.9) respondents scored ≥3 on the STOP-BANG questionnaire, whereas 37 (4.9%, 95% CI 3.6-6.7) scored ≥5. More number of obese than nonobese [57.8% (119/206) versus 34.9% (188/538)] respondents met the criteria for OSA risk (P < 0.001). Similarly, more obese persons [10.3% (21/206)] met the criteria for high-risk OSA compared to the nonobese [3% (16/538)]; P < 0.001. In logistic regression models adjusted for cigarette smoking and alcohol consumption, the odds for OSA risk was 15.76 (95% CI 7.44-33.9) in persons with BMI >35 kg/m2 compared to those with a BMI range of 18.5-24.99. CONCLUSION: Obesity and OSA may be more prevalent in Nigeria than previously predicted. Obesity independently increased OSA risk in this population.

Evaluation of gene xpert for routine diagnosis of HIV-associated tuberculosis in Nigeria: A prospective cohort study.

BACKGROUND: Xpert MTB/Rif (Xpert) is described as a game changer in tuberculosis (TB) control. We evaluated the impact of Xpert on diagnosis, time to treatment, and treatment outcome among patients with HIV associated TB in Nigeria. METHODS: Adults with HIV being evaluated for pulmonary TB (PTB) were consecutively enrolled into the study cohort. At baseline, expectorated sputa were examined using Xpert and smear microscopy for Mycobacterium tuberculosis (MTB) and acid fast bacilli, respectively. Patients diagnosed with TB were followed-up until 6 months post TB diagnosis. TB was defined as sputum positive by smear microscopy, Xpert detection of MTB (bacteriologically confirmed case), or clinician diagnosed TB with initiation of full TB treatment (clinical diagnosis). Time to treatment was time from first clinic presentation for TB evaluation to initiation of TB treatment. We examined the proportion PTB patients with a positive Xpert result and compared time to TB treatment and outcome of TB treatment in patients based on sputum test results. RESULTS: A total of 310 adults with HIV were enrolled. The median CD4 cell count was 242 (interquartile range (IQR) 120-425) cells/mm3 and 88.1% were receiving antiretroviral therapy (ART). PTB was diagnosed in 76 (24.5%) patients, with 71 (93.4%) being bacteriologically confirmed. Among patients with PTB, 56 (73.7%) were Xpert positive. Median time to treatment was 5 (IQR 2-8) days and 12 (IQR 5-35) days in patient with and without Xpert positive results, respectively; p = 0.005. Overall 73.1% had symptom free survival at 6 months post PTB treatment initiation with no significant differences observed based on TB test method. 10 (14.9%) died within 6 months of TB treatment initiation. In analysis adjusted for age, sex, and mode of diagnosis (Xpert positive or negative), only ART use independently predicted mortality (AOR 0.10; 95% CI 0.01-0.93). CONCLUSION: The use of Xpert for routine care reduced time to PTB treatment, but did not improve survival in patients with HIV treated for susceptible PTB.

HIV Associated Chronic Obstructive Pulmonary Disease in Nigeria.

OBJECTIVE: To determine the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) among HIV-infected adults in Nigeria. DESIGN: Cross-sectional study. METHODS: HIV-infected adults aged ≥ 30 years with no acute ailments accessing care at the antiretroviral therapy clinic of Jos University Teaching Hospital were enrolled consecutively. Participants were interviewed to obtain pertinent demographic and clinical information, including exposure to risk factors for COPD. Post-bronchodilator spirometry was carried out. HIV related information was retrieved from the clinic medical records. COPD case-definition was based on the Global Initiative for Obstructive Lung Disease (GOLD) criteria using post-bronchodilator FEV1/FVC <0.7. COPD prevalence was also calculated using the lower limit of normal for FEV1/FVC criteria (LLN) from the European Respiratory Society normative equation. Factors associated with COPD were determined using logistic regression models. RESULTS: Study population comprised 356 HIV infected adults with mean age of 44.5 (standard deviation, 7.1) years and 59% were female. The mean time elapsed since HIV diagnosis was 7.0 (SD, 2.6) years and 97.5% of the respondents were on stable ART with virologic suppression present in 67.2%. Prevalence of COPD were 15.4% (95% confidence interval [CI] 11.7-19.2), 12.07% (95% CI 8.67-15.48), 22.19% (95% CI 18.16-26.83) using GOLD, ERS LLN and GLI LLN diagnostic criteria respectively. In multivariate analyses adjusting for gender, exposure to cigarette smoke or biomass, history of pulmonary tuberculosis, use of antiretroviral therapy, current CD4 T-cell count and HIV RNA, only age > 50 years was independently associated with COPD with OR 3.4; 95% CI 1.42-8.17 when compared to ages 30-40 years. CONCLUSION: HIV-associated COPD is common in our population of HIV patients.

Use of Electronic Health Records in sub-Saharan Africa: Progress and challenges.

BACKGROUND: The Electronic Health Record (EHR) is a key component of medical informatics that is increasingly being utilized in industrialized nations to improve healthcare. There is limited information on the use of EHR in sub-Saharan Africa. This paper reviews availability of EHRs in sub-Saharan Africa. METHODS: Searches were performed on PubMed and Google Scholar databases using the terms 'Electronic Health Records OR Electronic Medical Records OR e-Health and Africa'. References from identified publications were reviewed. Inclusion criterion was documented use of EHR in Africa. RESULTS: The search yielded 147 publications of which 21papers from 15 sub-Saharan African countries documented the use of EHR in Africa and were reviewed. About 91% reported use of Open Source healthcare software, with OpenMRS being the most widely used. Most reports were from HIV related health centers. Barriers to adoption of EHRs include high cost of procurement and maintenance, poor network infrastructure and lack of comfort among health workers with electronic medical records. CONCLUSION: There has been an increase in the use of EHRs in sub-Saharan Africa, largely driven by utilization by HIV treatment programs. Penetration is still however very low.