Prevalence of dysglycemia in Calabar: a cross-sectional observational study among residents of Calabar, Nigeria.

OBJECTIVE: Population data on dysglycemia are scarce in West Africa. This study aimed to determine the pattern of dysglycemia in Calabar city in South East Nigeria. DESIGN: This was a cross-sectional observational study. METHODS: 1134 adults in Calabar were recruited. A multistage sampling method randomly selected 4 out of 22 wards, and 50 households from each ward. All adults within each household were recruited and an oral glucose tolerance test was performed. Dysglycemia was defined as any form of glucose intolerance, including: impaired fasting glucose (blood glucose level 110-125 mg/dL), impaired glucose tolerance (blood glucose level ≥140 mg/dL 2 h after consuming 75 g of glucose), or diabetes mellitus (DM), as defined by fasting glucose level ≥126 mg/dL, or a blood glucose level ≥200 mg/dL, 2 h after a 75 g glucose load. RESULTS: Mean values of fasting plasma glucose were 95 mg/dL (95% CI 92.1 to 97.5) for men and 96 mg/dL (95% CI 93.2 to 98.6) for women. The overall prevalence of dysglycemia was 24%. The prevalence of impaired fasting glucose was 9%, the prevalence of impaired glucose tolerance 20%, and the prevalence of undiagnosed DM 7%. All values were a few percentage points higher for men than women. CONCLUSIONS: The prevalence of undiagnosed DM among residents of Calabar is similar to studies elsewhere in Nigeria but much higher than the previous national prevalence survey, with close to a quarter of the adults having dysglycemia and 7% having undiagnosed DM. This is a serious public health problem requiring a programme of mass education and case identification and management in all health facilities. TRIAL REGISTRATION NUMBER: CRS/MH/CR-HREC/020/Vol.8/43.

Diverse blood exposures associated with incident HIV infection in Calabar, Nigeria.

Few types of blood exposures have been assessed in relation to incident HIV infection in sub-Saharan Africa, despite evidence that penile-vaginal sex cannot account for the epidemic in the region. To investigate correlates of incident HIV infection in Calabar, Nigeria, we surveyed clients at voluntary HIV counselling and testing centres. Participating clients who tested multiple times were generally similar to those testing only once in terms of demographic characteristics, sexual and blood exposures and HIV prevalence. Blood exposures were common. Serial testers had a 10% annual incidence of HIV infection. Seroconverters and seronegative serial testers were similar on most demographic characteristics and sexual exposures. However, seroconverters were more likely than seronegatives to report blood exposures during the test interval, both for most specific exposures as well as summary measures of blood exposures. In particular, seroconverters were substantially more likely to report one of a set of blood exposures that cannot be explained as a consequence of unprotected vaginal sex or of health care for symptoms of HIV infection (adjusted odds ratio = 6.6, 95% confidence interval = 1.2-38). The study design we used is an inexpensive approach for describing the local epidemiology of HIV transmission and can also serve as the foundation for more definitive investigations that employ contact tracing and sequencing of HIV DNA.

Perception of ischaemic heart disease, knowledge of and attitude to reduction of its risk factors.

OBJECTIVES: To assess the perception of ischaemic heart disease (heart attack) as a cause of mortality and determine the current knowledge of its risk factors as well as the level of adoption of preventive strategies among Nigerians working in a tertiary institution. DESIGN: Cross-sectional study. SETTING: University of Calabar, Calabar, Nigeria. SUBJECTS: Five hundred randomly selected University workers both senior and junior staff. MAIN OUTCOME MEASURES: Assessment of the awareness of ischaemic heart disease as a cause of morbidity and mortality, knowledge of risk factors and degree of adoption of lifestyle modification strategies. RESULTS: Only 136 (27.7%) of respondents considered ischaemic heart disease (heart attack) as the leading cause of death in their environment while 201 (40.2%) thought it was hypertension. Smoking was readily identified by 70.6% as a risk factor, excessive alcohol use by 52.8% and 41.6% of respondents identified obesity. Sedentary life-style and oral contraceptive use were least identified with only 16.6% and 6.4% of respondents respectively identifying them. This knowledge was significantly influenced by the educational status and cadre of the subjects. The senior staff who were also better educated demonstrated more knowledge. Two point two percent of respondents were smokers and smoked ten sticks of cigarettes or less per day. All expressed willingness to stop. One hundred and fifty eight admitted taking alcohol, most taking less than ten units a week and of these, only 64 were willing to quit. Fifty three point four percent (29.2% of senior and 24.2% of junior undertook some exercise while only 45.6% checked their body weights regularly. Only 25% of all the respondents visited the hospital or clinic for routine medical check-up. No statistically significant difference was found between the senior/better educated and the junior/less educated members of staff in the adoption of these life style modification measures. Sixty four point four percent got medical information from doctors and other health workers. CONCLUSION: Level of awareness of ishaemic heart disease as a leading cause of death is poor even in an academic environment. Knowledge of risk factors is also poor and is influenced by the level of educational attainment. Life style modification strategies are still not widely accepted irrespective of educational status. A concerted public health response is advocated to improve the present level of knowledge and establish behavioural changes.

Prevalence and pattern of abnormal glucose tolerance in adult Nigerians with primary hypertension.

BACKGROUND: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. METHOD: Oral glucose tolerance test was performed on 124 adult Nigerians (64 hypertensives, 60 normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. RESULTS: The hypertensive (32 males, 32 females) and normotensive (30 males, 30 females) had mean ages of 47.6 +/- 10.1 years and 44.2 +/- 7.6 years. The mean body mass index and waist circumference of hypertensives and normotensives were 30.2 +/- 80 kg/m, 100.8 +/- 17.2 cm and 28.5 kg/m, 88.5 +/- 14.1 cm. The mean plasma glucose in mmols/l, during oral glucose tolerance test of hypertensives and normotensives, at 0 hr, 1 hr and 2 hrs were, 4.79 +/- 0.99, 6.94 +/- 1.5, 5.96 +/- 1.82 and 4.42 +/- 0.90, 6.25 +/- 1.02, 5.05+ +/- 1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2 hours p < 0.001. 62.5% of hypertensives responded normally to glucose load. 32.8% had impaired glucose tolerance. All controls responded normally. 6.25% of hypertensives had impaired fasting glucose. 4.6% of hypertensives had diabetes. No control had diabetes. The hypertensives with abnormal glucose tolerance had higher body mass index and waist circumference, than hypertensives with normal glucose tolerance, and controls. CONCLUSION: Mean venous plasma glucose levels are higher in hypertensive adult Nigerians, than their normotensive counterparts. Impaired glucose tolerance is more prevalent than impaired fasting glucose and diabetes mellitus.

CD4 count levels and pattern of respiratory complications in HIV seropositive patients in Calabar, Nigeria.

A prospective observational study was carried out to describe the pattern of pulmonary complications in hospitalized patients with Human Immune-deficiency Virus (HIV) infection at the University of Calabar Teaching Hospital, Calabar between January 2005 to December 2006. One hundred and twenty-four patients which consists 60 males and 64 females, aged between 20-60 who met the inclusion criteria formed the subjects for the study. The mean age of the subjects was 34.60 +/-1.2 years. A structured questionnaire was used to obtain the demographic data, clinical information and CD4 lymphocyte count. Radiological analysis of chest was done with the chest X-ray of each subject. Chronic productive cough topped the list of respiratory symptoms (89%) followed by chest pain (74%) and dyspnea (62 %). Lung consolidation was the commonest respiratory sign as seen in 44 % of the cases. Hilar lymphadenopathy was seen in (35 %), Pleural effusion (32%), lung fibrosis (21%) and finger clubbing (15%). The clinical and radiological pattern of most patients with chronic cough was highly suggestive of mycobacterial infection such as tuberculosis, although only 40% of cases had positive acid fast bacilli. The mean CD4 lymphocyte count level was 174.8 +/- 5.4 cells/microlitre and this may be responsible for the respiratory findings as opportunistic lung infections are said to be commoner at CD4 count levels below 200 cells/microlitre. However, four patients had mediasternal masses which may suggest neoplasms. Concerted efforts and continuous evaluation of these patients are needed to determine the spectrum of respiratory illnesses among HIV positive patients in Calabar.

Prevalence and Pattern of Abnormal Glucose Tolerance in Adult Nigerians with Primary Hypertension

Background: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty. This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. Method: Oral glucose tolerance test was performed on 124 adult Nigerians (64hypertensives; 60normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. Results: The hypertensive(32 males;32females) and normotensive (30males; 30females) had mean ages of 47.6+/-10.1years and 44.2+/-7.6years.The mean body mass index and waist circumference of hypertensives and normotensives were 30.2+/-80kg/m;100.8+/-17.2cm and28.5kg/m;88.5+/-14.1cm. The mean plasma glucose in mmols/l; during oral glucose tolerance test of hypertensives and normotensives; at 0hr; 1hr and 2hrs were;4.79+/-0.99;6.94+/-1.5;5.96+/-1.82 and4.42+/-0.90;6.25+/-1.02;5.05++/-1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2hours p

Prevalence and Pattern of Abnormal Glucose Tolerance in Adult Nigerians with Primary Hypertension

Background: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty. This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. Method: Oral glucose tolerance test was performed on 124 adult Nigerians (64hypertensives; 60normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. Results: The hypertensive(32 males;32females) and normotensive (30males; 30females) had mean ages of 47.6+/-10.1years and 44.2+/-7.6years.The mean body mass index and waist circumference of hypertensives and normotensives were 30.2+/-80kg/m;100.8+/-17.2cm and28.5kg/m;88.5+/-14.1cm. The mean plasma glucose in mmols/l; during oral glucose tolerance test of hypertensives and normotensives; at 0hr; 1hr and 2hrs were;4.79+/-0.99;6.94+/-1.5;5.96+/-1.82 and4.42+/-0.90;6.25+/-1.02;5.05++/-1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2hours p

Traditional healers' practices and the spread of HIV/AIDS in south eastern Nigeria.

A 3-year (1997-1999) prospective study was carried out to evaluate the possible role of traditional healers (THs) in the spread of HIV/AIDS in south eastern Nigeria. Their patients' knowledge of HIV infection was also ascertained during the review period. Four contiguous states in south eastern Nigeria with high prevalent rates of HIV infection were chosen for the survey. Sixty-nine patients ofTHs were randomly selected and contacted from the patients' list of five selected THs in each state. Thus, a total of 20 THs and 69 patients formed subjects of the study. The study involved a face-to-face interview of the subjects by trained health personnel in each state using a prepared structured questionnaire. The questionnaire elicited information on their biodata, past/present medical history, social/family history, nature and mode of treatment received or administered, and their knowledge of HIV infection, where applicable. The results showed that there was a serious HIV/AIDS related risk inherent in the practices of Nigerian THs patronized by over 60% of the population. This was suggested by the continuous usage of unsterilized instruments and cross contamination with patients' blood and body fluid in their practices. It was further revealed that, the patients' HIV/AIDS related knowledge was poor (30%). Basic education on HIV/AIDS must be given to all groups in Nigeria including THs, their patients and general public. The World Health Organization and other agencies involved in the fight against HIV infection should focus on the safety of THs' practices as a possible mode of transmission of HIV infection in Africa. Unless this aspect is taken seriously along with other preventive strategies already adopted, the epidemic of the disease condition may continue to spread in Africa.