Assessing desertification vulnerability and mitigation strategies in northern Nigeria: A comprehensive approach.

Desertification constitutes a grave threat to the environmental and socio-economic stability of desertification frontline states in Northern Nigeria. From 2003 to 2020, this research comprehensively analyzes desertification vulnerability, integrating parameters such as NDVI, LST, TVDI, MSAVI, and Albedo. Key factors contributing to land degradation are identified, along with the spatial patterns and trends of desertification over the two-decade period. The consequences are profound, with Northern Nigeria's ecosystem experiencing a steady decline in vegetation cover. Agriculture, vital to the region's economy, faces increased aridity and reduced arable land, jeopardizing food security. Diminishing water resources exacerbates scarcity issues, placing additional strain on communities. These environmental changes lead to severe socio-economic implications, including displacement, loss of livelihoods, and heightened vulnerability to climate-related risks. Urgent, comprehensive, and strategic interventions are imperative. Policy recommendations underscore revising and enforcing land use regulations, promoting sustainable agricultural practices, and establishing monitoring systems to guide decision-making. This research contributes practical strategies to enhance the resilience of desertification frontline states, safeguard livelihoods, and align with Nigeria's sustainable development objectives. Findings from the study indicate that only a tiny percentage (6.7 %) of the study area remains unaffected by desertification. Moreover, 13.3 % exhibit light vulnerability, 20 % demonstrate moderate exposure, and 60 % fall into the severe (26.7 %) and compelling (33.3 %) vulnerability categories. These statistics underscore the gravity of desertification in the study area, emphasizing the urgent need for effective mitigation measures to address its impact comprehensively.

Morbidity Pattern in the Medical Wards of a Nigerian Teaching Hospital During the COVID-19 Pandemic.

BACKGROUND: Morbidity patterns change due to emerging and re-emerging infections. Information obtained from alteration in patterns of morbidity is vital in structuring and providing safe health care services. OBJECTIVES: To determine disease patterns and highlight the prevalent disease entity in the medical wards at the University of Benin Teaching Hospital, Benin City, during the COVID-19 pandemic. METHODS: This was a retrospective study of 430 patient case records recruited between January 1st to 31st December 2020. The diagnosis was made during their hospital stay and classified using the International Classification of Disease Version 11. The demographics of the patients were also recorded in the data collection form. The data were analyzed descriptively. RESULTS: A total of 430 case records were evaluated during the study period, and the final diagnoses were noted. The commonest diagnostic classes were diseases of the nervous system (90, 20.9%), diseases of the respiratory system (78, 18.1%), diseases of the digestive system (67, 15.6%), and diseases of the circulatory system (61, 14.2%). The least prevalent was neoplasm (1, 0.2%), and the most prevalent disease entity was hypertension (48.5%). There was a statistical significance between age and the number of morbidities (Χ²=79.0, p=<0.01), but there was no statistical significance between the gender of the patient and the international classification of disease version 11 (Χ²=16.9, p=0.12). CONCLUSION: The study showed a higher trend in diseases of the nervous system during this period. Furthermore, this trend in morbidity appeared to be influenced by the number of morbidities, age, and gender.

CONTEXTE: Les schémas de morbidité changent en raison des infections émergentes et ré-émergentes. Les informations obtenues à partir de l'altération des schémas de morbidité sont essentielles pour structurer et fournir des services de santé sûrs. OBJECTIFS: Déterminer les schémas de maladies et mettre en évidence l'entité pathologique prévalente dans les services de médecine de l'Hôpital d'Enseignement de l'Université de Benin, à Benin-City, pendant la pandémie de COVID-19. MÉTHODES: Il s'agissait d'une étude rétrospective de 430 dossiers de patients recrutés entre le 1er janvier et le 31 décembre 2020. Le diagnostic a été établi pendant leur séjour à l'hôpital et classé selon la Classification Internationale des Maladies, 11ème version. Les données démographiques des patients ont également été enregistrées dans le formulaire de collecte de données. Les données ont été analysées de manière descriptive. RÉSULTATS: Un total de 430 dossiers de cas ont été évalués pendant la période d'étude, et les diagnostics finaux ont été notés. Les classes diagnostiques les plus courantes étaient les maladies du système nerveux (90, 20,9 %), les maladies du système respiratoire (78, 18,1 %), les maladies du système digestif (67, 15,6 %), et les maladies du système circulatoire (61, 14,2 %). La moins prévalente était le néoplasme (1, 0,2 %), et l'entité pathologique la plus prévalente était l'hypertension (48,5 %). Il y avait une signification statistique entre l'âge et le nombre de morbidités (Χ²=79,0, p=<0,01), mais il n'y avait pas de signification statistique entre le sexe du patient et la classification internationale des maladies version 11 (Χ²=16,9, p=0,12). CONCLUSION: L'étude a montré une tendance accrue dans les maladies du système nerveux au cours de cette période. De plus, cette tendance de la morbidité semblait être influencée par le nombre de morbidités, l'âge et le sexe. MOTS-CLÉS: Schéma de Morbidité, Hôpitaux d'Enseignement, COVID-19.

Risk factors and outcomes associated with pregnancy-related acute kidney injury in a high-risk cohort of women in Nigeria.

INTRODUCTION: Despite a decline in developed countries, pregnancy-related acute kidney injury (PRAKI) remains a significant contributor to maternal mortality and adverse fetal outcomes in resource-constrained settings. Little is known about the impact of pregnancy-related acute kidney injury in Nigeria. Therefore, this study aimed to assess the incidence and maternal-fetal outcomes associated with pregnancy-related acute kidney injury among a cohort of high-risk women in Nigeria. METHODS: This prospective multicenter study included women at high risk of acute kidney injury, who were more than 20 weeks pregnant or within 6 weeks postpartum and admitted to the Obstetrics and Gynecology units of two large public hospitals between September 1, 2019, and July 31, 2022. Acute kidney injury was defined and classified using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. RESULTS: A total of 433 women, with mean age (± standard deviation) of 28 ± 6 years, were included in the evaluation. Pregnancy-related acute kidney injury occurred in 113 women (26.1%; 95% confidence interval [CI]: 21.1%-30.2%). The leading cause was preeclampsia (n = 57; 50.1%); 19 women died (4.4%), with 17 deaths (15%) occurring in the PRAKI group. Increasing severity of pregnancy-related acute kidney injury was independently associated with maternal mortality: adjusted odds ratio (aOR) for KDIGO stage 2 = 4.40; 95% CI 0.66-29.34, p = 0.13, and KDIGO stage 3 aOR = 6.12; 95% CI 1.09-34.34, p = 0.04. The overall perinatal mortality was 15% (n = 65), with 28 deaths (24.8%) occurring in the PRAKI group. Pregnancy-related acute kidney injury was also associated with an increased risk of perinatal mortality, aOR = 2.23; 95 CI 1.17-4.23, p = 0.02. CONCLUSIONS: The incidence of pregnancy-related acute kidney injury was high, and significantly associated with maternal and perinatal mortality. The leading causes were hypertensive disorders of pregnancy.

An Evaluation of the Knowledge and Utilization of the Essential Medicines List among Health Professionals in Six Tertiary Institutions in Nigeria.

BACKGROUND: The introduction and operationalization of the Essential Medicines (EM) concept remains a major achievement of the WHO. This study assessed the current knowledge, utilization, and perception of the Essential Medicines programme in Nigeria. METHODS: This was a cross-sectional study conducted across six tertiary health institutions in Southern Nigeria from January to July 2018. A total of 750 semi-structured questionnaires were administered to doctors, pharmacists, and nurses. The information sought included the demographic characteristics of respondents, knowledge of definition of the essential medicines concept, date of launch at the national level, current edition, current use, the advantages and disadvantages of the EM List (EML). The data were analyzed qualitatively and presented descriptively as means (SD) and percentage frequencies. RESULTS: A total of 748 respondents (487 doctors, 208 nurses, and 53 pharmacists) participated in the study. Healthcare professionals' (HCP) knowledge of the EM concept and list was poor (15%), as determined by their ability to define or describe the concept of the EML, with less than 3% of respondents aware of the current edition of the EML in use in Nigeria. Less than 20% of all respondents used the EML during their internship, with nurses using it the least and only 8% using it during their first year of practice. Over 70% of respondents could not identify notable advantages of the EML and only 14.6% agreed that the program had been successful in Nigeria. CONCLUSION: The initial global momentum following the introduction of the EM program appears to have declined with the new generation of HCPs, likely due to lack of educational reinforcement. This negatively impacts the drug use scenario within our healthcare system.

CONTEXTE: L'introduction et l'opérationnalisation du concept de médicaments essentiels (ME) restent une réalisation majeure de l'OMS. Cette étude évalue la connaissance, l'utilisation et la perception actuelles du programme des médicaments essentiels au Nigeria. METHODES: Il s'agissait d'une étude transversale menée dans six établissements de santé tertiaires du sud du Nigéria de janvier à juillet 2018. Au total, 750 questionnaires semi-structurés ont été administrés aux médecins, pharmaciens et infirmiers. Les informations recherchées comprenaient les caractéristiques démographiques, la définition du concept de médicaments essentiels, la date de lancement au niveau national, l'édition actuelle, l'utilisation actuelle, les avantages et les inconvénients de la liste des ME (LME). Les données ont été analysées de manière qualitative et présentées de manière descriptive sous forme de moyenne (SD) et de pourcentage de fréquences. RESULTATS: Un total de 748 répondants (487 médecins, 208 infirmiers et 53 pharmaciens) ont participé à l'étude. Les connaissances des professionnels de santé (PSS) sur le concept et la liste des LME étaient faibles (15%), comme le montre leur capacité à définir, fournir ou décrire le concept de LME, avec moins de 3% des répondants connaissant l'édition actuelle de la LME utilisée au Nigeria. Moins de 20% de tous les répondants ont utilisé l'EML pendant leur stage, les infirmières étant celles qui l'ont le moins utilisé, avec seulement 8% l'utilisant pendant leur première année de pratique. Plus de 70% des répondants n'ont pas pu identifier d'avantages notables de l'EML, et seulement 14,6% étaient d'accord pour dire que le programme a été une réussite au Nigeria. CONCLUSION: L'élan initial qui a suivi l'introduction du programme d'EM semble avoir diminué avec la nouvelle génération de HCP, probablement en raison du manque de renforcement éducatif. Cela a un impact négatif sur le scénario d'utilisation des médicaments au sein de notre système de santé. Mots-clés: Médicaments essentiels; Médicaments essentiels; Professionnels de la santé; Connaissances, Attitudes, Pratiques (KAP); Organisation mondiale de la santé (OMS); Nigeria.

Prescription Patterns and Patient Care Practices in Two Tertiary Hospitals in South-South Nigeria.

BACKGROUND: Inappropriate use of medicines still characterize all levels of healthcare, with important public health implications. Available evidence indicate that irrational use of medicines can lead to poor therapeutic outcomes, adverse drug reactions, and thus increase morbidity and mortality rates. This study assessed the prescription pattern, patient and health care facility indicators in two tertiary health facilities in Nigeria. METHODS: A cross-sectional survey of 1800 prescriptions and 600 patients' encounters was conducted at the General Outpatient Departments of the University of Benin and Delta State University Teaching Hospitals using the WHO drug use indicators. Data from 12-month prescription sheets as well as patient interviews were entered into standard indicator forms and analyzed according to WHO guidelines. RESULTS: Overall, the average number of drugs per encounter was 2.8 ± 1.6. The percentage of generic prescription was 49.6%, while percentage of encounters with antibiotics, antimalarial and injections were 27.4%, 23.2% and 12.4% respectively. Prescription of medicines listed in the Essential Medicines List was 66.6%, even though no copy was available at the consulting rooms. Average consulting and dispensing time were 15.3 minutes and 136 seconds respectively. Percentage of medicines actually dispensed was 86.2% while 98.7% of medicines were adequately labelled. CONCLUSION: Gaps still exist in the rational use of medicines in Nigeria. There needs to be sustained interventional schemes with capacity for monitoring and evaluation to detect inappropriate drug use patterns and prevent the undesirable consequences of irrational use of medicines.

CONTEXTE: L'utilisation inappropriée des médicaments caractérise encore tous les niveaux de soins de santé, avec d'importantes implications pour la santé publique. Les preuves disponibles indiquent que l'utilisation irrationnelle des médicaments peut entraîner de mauvais résultats thérapeutiques, des réactions indésirables aux médicaments et donc augmenter les taux de morbidité et de mortalité. Cette étude a évalué les modèles de prescription, les patients et les indicateurs des établissements de soins de santé dans deux établissements de santé tertiaires au Nigeria. MÉTHODOLOGIE: Une enquête transversale portant sur 1800 ordonnances et 600 rencontres avec des patients a été menée dans les départements ambulatoires généraux de l'Université du Bénin et des hôpitaux universitaires de l'État du Delta à l'aide des indicateurs de consommation de médicaments de l'OMS. Les données des feuilles d'ordonnance de 12 mois ainsi que des entretiens avec les patients ont été saisies dans des formulaires d'indicateurs standard et analysées conformément aux directives de l'OMS. RÉSULTATS: Dans l'ensemble, le nombre moyen de drogues par rencontre était de 2,8 ± 1,6. Le pourcentage de médicaments génériques prescrits était de 49,6 %, tandis que le pourcentage de consultations avec des antibiotiques, des antipaludéens et des injections était de 27,4 %, 23,2 % et 12,4 % respectivement. La prescription des médicaments figurant sur la liste des médicaments essentiels était de 66,6%, même si aucune copie n'était disponible dans les salles de consultation. Le temps moyen de consultation et de distribution était de 15,3 minutes et 136 secondes respectivement. Le pourcentage de médicaments effectivement délivrés était de 86,2 %, tandis que 98,7% des médicaments étaient correctement étiquetés. CONCLUSION: Des lacunes subsistent dans l'utilisation rationnelle des médicaments au Nigéria. Il faut des programmes d'intervention durables dotés d'une capacité de suivi et d'évaluation pour détecter les modes de consommation inappropriés de drogues et prévenir les conséquences indésirables d'une utilisation irrationnelle des médicaments. Mots clés: Médicaments essentiels, Utilisation rationnelle des médicaments, Modèle de prescription, Hôpitaux tertiaires, Sud-Sud du Nigéria.

Association between Abnormal Serum Lipid Levels in Early Pregnancy and Development of Preeclampsia.

BACKGROUND: Accurate early biomarkers of oxidative stress, placenta perfusion and vascular resistance and endothelial platelet interaction for prediction of preeclampsia have not been shown to be beneficial for routine clinical use. The study of association between abnormal lipid levels in early pregnancy and preeclampsia is thus necessary in a bid to reduce the progression and severity of complications of preeclampsia. OBJECTIVE: To determine the association between abnormal lipid levels in early pregnancy and the development of preeclampsia. MATERIALS AND METHODS: A prospective longitudinal study involving 184 pregnant women with singleton pregnancy who met the inclusion criteria and recruited from the antenatal clinic at gestational age of < 20weeks. Their fasting blood samples were collected for the measurement serum lipid profile. They were monitored until delivery for the development of preeclampsia. The mean values of serum lipid profile were analyzed for association with pre-eclampsia using the statistical package for social sciences (SPSS) version 21.0 and P value of < 0.05 was considered statistically significant. RESULTS: Out of 184 participants, 3 had spontaneous miscarriage and were excluded while 5 were lost to follow up. This left a total of 176 participants who completed the study, 11 of which developed preeclampsia. There was a statistically significant increase in the levels of total cholesterol (TC) and low-density lipoprotein (LDL) in the preeclamptic group. The mean serum lipid levels were 4.8 mmol/L for total cholesterol, 1.87 mmol/L for total triglycerides, 1.3 mmol/L for high-density lipoprotein and 2.67 mmol/L for low-density lipoprotein. Age and parity also showed a causal association with development of preeclampsia. CONCLUSION: There was an association between elevated serum total cholesterol and low-density lipoprotein with development of preeclampsia later in pregnancy.

CONTEXTE: Les biomarqueurs précoces précis du stress oxydatif, de la perfusion et de la résistance vasculaire du placenta et de l'interaction endothéliale-plaquettaire pour la prédiction de la prééclampsie ne se sont pas révélés avantageux pour l'utilisation clinique courante. L'étude de l'association entre les taux anormaux de lipides en début de grossesse et la prééclampsie est donc nécessaire pour réduire la progression et la gravité des complications de la prééclampsie. OBJECTIF: Déterminer l'association entre des taux de lipides anormaux en début de grossesse et le développement de la pré- éclampsie. MATÉRIEL ET MÉTHODES: Une étude longitudinale prospective impliquant 184 femmes enceintes avec une grossesse unique qui répondaient aux critères d'inclusion et qui ont été recrutées à la clinique prénatale à l'âge gestationnel de < 20 semaines. Des échantillons de sang à jeun ont été prélevés pour mesurer le profil lipidique sérique. Elles ont été suivies jusqu'à l'accouchement pour le développement de la pré-éclampsie. Les valeurs moyennes du profil lipidique sérique ont été analysées pour leur association avec la pré-éclampsie à l'aide du progiciel statistique pour les sciences sociales (SPSS) version 21.0 et une valeur P de < 0,05 a été considérée comme statistiquement significative. RÉSULTATS: Sur les 184 participantes, 3 ont fait une fausse couche spontanée et ont été exclues, tandis que 5 ont été perdues de vue. Il restait donc un total de 176 participantes qui ont terminé l'étude, dont 11 ont développé une prééclampsie. On a constaté une augmentation statistiquement significative des taux de cholestérol total (CT) et de lipoprotéines de basse densité (LDL) dans le groupe prééclamptique. Les taux moyens de lipides sériques étaient de 4,8 mmol/L pour le cholestérol total, 1,87 mmol/L pour les triglycérides totaux, 1,3 mmol/L pour les lipoprotéines de haute densité et 2,67 mmol/L pour les lipoprotéines de basse densité. L'âge et la parité ont également montré une association causale avec le développement de la prééclampsie. CONCLUSION: Il y avait une association entre un taux élevé de cholestérol total sérique et de lipoprotéines de basse densité et le développement de la prééclampsie plus tard dans la grossesse. Mots clés: Association, Prééclampsie, Cholestérol sérique, Lipoprotéines de basse densité, Lipoprotéines de haute densité, Triglycérides, Lipides sériques.

Barriers and solutions to effective mentorship in health research and training institutions in Nigeria: Mentors, mentees, and organizational perspectives.

Aims and Background: Mentoring relationships and programs have become a subject of global interest and their relevance is high in the ever-evolving health system. In Nigeria, informal system of mentoring is largely practiced. To be able to institutionalize mentoring program, there is need to explore the various challenges of mentoring process and suggest potential approaches for effective mentor-mentee relationship in health research institutions in Nigeria. Subjects and Methods: The study was designed to explore the barriers and solutions to mentoring process from the perspectives of the mentor, mentee, and organization in health research and training institutions in Nigeria. A cross-sectional descriptive design was employed and the study was conducted among 21 health researchers drawn from 24 health research institutions across the 6 regions of Nigeria. The nominal group technique was adopted in the data collection process. Results: The most frequently reported mentor challenges were "lack of understanding of mentorship process" (84.2%) and "lack of capacity for mentoring" (78.9%), while those of mentee were "mentor preference" (73.7%) and "lack of freedom of expression" (47.4%). "Culture of selfishness/individualism" (84.2%) and "lack of formal relationship" (63.2%) were the most mentioned systemic challenges. Training on mentoring process and relationship was mentioned as the most frequent approach to overcoming challenges for the three perspectives. Conclusion: Significant mentorship challenges exist in the Nigerian health, academic and research institution. Systematic approaches to finding and implementing the appropriate solutions are needed to circumvent these bottlenecks.

The current use of the artemisinin-based combination therapies in adult patients at a tertiary hospital, South-South Nigeria

Objective:The antimalarial preferences, tolerability, and cost of the Artemisinin-based combination therapies (ACTs) among adult patients and caregivers are largely understudied despite being the recommendedtreatment for Plasmodium falciparum.We, therefore, evaluated antimalarial preferences, tolerability, and cost of the ACTs among adult patients attending the University of Benin Teaching Hospital, Nigeria. Methods:This was a cross-sectional study conducted among adult patients and their caregivers atthe University of Benin Teaching Hospital, Nigeria,using a semi-structured questionnaire. Their preferred antimalarial medication, previous use of antimalarial monotherapies, current ACT use; cost considerations, and adverse effects profile were sought.Result:Six hundred respondents were recruited with a mean age of 41.4±16.3years and M/F ratio of 1.4. The majority (88.0%), reported that they had between 1-5 episodes of malaria fever in a year. Only 28.2% received doctors' prescriptions while 85.8% purchased their antimalarial medications from a pharmacy. Sixty percent of the respondents used at least one ACT; mainly Artemether-Lumefantrine (AL) 312(52.0%). Only 9.3% reported previous adverse effects with the ACTs with 4.0% of respondents discontinuing their medications. The mean (SD) cost of purchasing ACTs was 1,516.47±760.3 (3.65 USD) Naira.Conclusion: This study showed adult patients' preference for the ACTs, especially Artemether-Lumefantrine despite some inclination towards antimalarial monotherapies and parenteral route. There was also a high rate of use of malaria presumptive treatment, but only a few reported adverse effects. There is a need to make ACTs affordable because the cost is still presently high for most Nigerians.

Artemisinin-based antimalarial combination therapy amongst healthcare professionals in a tertiary facility in south-south Nigeria: preferences, tolerability, and cost considerations

Background: Nigeria adopted the Artemisinin-Based Combination Therapy (ACT) as the mainstay of treating uncomplicated malaria in February 2005. However, the individual preferences for the use of these medicines by health care professionals (HCP) as distinct from their observed prescribing practices is largely unknown. This study determined the preferences, tolerability and cost of the ACTs among HCP in Benin-City. Methods: This descriptive cross-sectional study was conducted in the University of Benin Teaching Hospital, Benin-City, Nigeria. Consenting HCPs were recruited consecutively for the study. Semi structured questionnaires were administered to doctors, nurses and pharmacists in the hospital. Information obtained included demographics, treatment of malaria in the previous year, antimalarial medication preferences and tolerability as well as cost of ACT. Results: A total of 556 HCPs, 295 doctors (54.1%), nurses 200 (36.0%), pharmacists 61(11.0%) completed the questionnaire. In the previous year, 224 (75.9%) doctors, 153 (79.1%) nurses, and 48 (70.5%) pharmacists had treatment for malaria and self-medication was highest among doctors (228,77.3%). Artemether-Lumenfantrine was the most preferred antimalarial used, 294 (52.8%); however, 1.6% used chloroquine sulphate and ACTs were perceived to be ineffective by 25.4%. Adverse effects were experienced by 167 (29.1%) resulting in 50 (9.0%) discontinuing their medication. Between 500 and 1500 Naira (~US$1-4) was expended on ACT by 66.3% of the staff, while 21.4% were concerned about the high cost of medications. Conclusion: This study highlights the use and preferences, self-medication practices, perceived lack of effectiveness and high cost of ACTs from a HCP perspective. There is an urgent need to address these concerns in view of adverse consequences as well as the likely possibility of its the impact on prescribing practices.

Toxicological effect of Artemisinin-Based Combination Therapies plus Paracetamol in malaria patients.

BACKGROUND: Following the paucity of safety reports in the use of Artemisinin-Based Combination Therapies (ACTs) plus paracetamol, the study assessed safety potential of artemether-lumefantrine (ALP), artesunate-amodiaquine (AAP), artesunate-mefloquine (AMP), artesunate-sulphadoxine-pyrimethamine (ASPP) and dihydroartemisinin-piperaquine (DHPP) combination with paracetamol in malaria patients. METHODS: ACTs and paracetamol were administered concomitantly in conventional doses/regimen to randomly selected patients. Blood samples were collected from the ante-cubital vein before and after completion of therapies. Toxicity markers such as weights, glucose, lipids, renal electrolytes, liver enzymes and haematological indices were assessed using standard protocols. RESULTS: The total numbers of participants were 57 patients. Male to female ratio was 1:1.1. Mean body weight and ages were 59.19 ± 1.39 kg and 42.86 ± 1.32 years respectively. The mean temperatures prior to and after therapy were 37.49 ± 1.02 °C and 37.50 ± 0.17 °C respectively. Mean parasitaemia before the commencement of therapy was 6282 ± 21.01 parasites/µl. Out of thirty-seven toxicological indices evaluated, twenty-four were significantly altered by ACTs plus paracetamol (P < 0.05). Increased serum toxicity markers due to the drug combinations were glucose (AAP, AMP), urea (ALP, ASPP), bicarbonate ion (ALP, AAP, AMP, ASPP), chloride ion (ALP, AAP, AMP), creatinine (ALP, AAP, AMP, ASPP), alkaline phosphatase (ALP, AAP), aspartate aminotransferase and alanine aminotransferase (ALP, AAP, AMP, ASPP, DHPP), total protein (AMP, DHPP) and albumin (AMP, DHPP). Decreased serum toxicity markers due to the drugs were glucose (ALP, ASPP, DHPP), urea (AMP), bicarbonate ion (DHPP), chloride ion (ASPP, DHPP), creatinine (DHPP), alkaline phosphatase (AMP, ASPP, DHPP), total protein (ALP, AAP, and ASPP) and albumin (ALP, AAP, ASPP). Altered haematological indices were white blood cells, red blood cells, mean cell haemoglobin and platelets. CONCLUSION: Since ACTs plus paracetamol altered human system, discrete selection is essential in managing uncomplicated malaria most especially in patients with co-morbid conditions.

Competitive Adsorption of Congo red in Single and Binary Systems Using a Low-cost Adsorbent.

BACKGROUND: Sawdust from Parkia biglobosa was prepared as an adsorbent for the adsorption of dye from aqueous solution. OBJECTIVES: The ability of sawdust to adsorb Congo red in a single dye system and binary dye system was examined. METHODS: Effects of several variables (pH, contact time, initial dye concentration and adsorbent dose) were investigated and optimum conditions were established. The equilibrium data were subjected to kinetic and isotherm models. RESULTS: Equilibrium time was observed at 600 mins while the optimum dose was 0.2 g and there was an increase in adsorption at low pH. The equilibrium data fitted the Freundlich isotherm model in both systems (coefficient correlation (R2) > 0.9). Harkin-Jura was the worst-fitted (R2 < 0.8). The qm in the single system (21.65) was lower than in BDS (27.17; 34.01). The values of 1/n show the heterogeneity on the surface of sawdust which reduced in the BDS. The increase in qm in the binary system showed that the presence of another dye (Reactive black 5) had a synergistic effect on the adsorption of Congo red. The kinetics of the process followed the pseudo-second-order model both in the single system and one of the binary systems. The dynamics of the process showed that the single system was non-spontaneous at low temperatures, endothermic and increased randomness on the surface of the adsorbent, while in the binary system, the process was exothermic and had little affinity for the adsorbent. CONCLUSIONS: Sawdust from Parkia biglobosa is a potential adsorbent for removing Congo red dye from aqueous solution in single and binary systems. COMPETING INTERESTS: The authors declare no competing financial interests.

Impact of an Educational Intervention on Adverse Drug Reaction reporting in Tertiary Hospitals in South-South Nigeria.

BACKGROUND: Nigeria is yet to achieve the internationally recommended number of Adverse Drug Reactions (ADRs) reports. OBJECTIVE: This study evaluated the impact of an educational lecture followed by repeated text messages via the Short Messaging System (SMS) on ADR reporting. METHODS: Six teaching hospitals in the South-South zone of Nigeria were randomized in 1:1 ratio into intervention and non-intervention hospitals. The intervention hospitals received an educational lecture followed by monthly SMS reinforcements over 12 months. The number and quality of ADR reports from the local pharmacovigilance centers of each teaching hospital over the 12 months before and after the intervention were described. RESULTS: A total of 4912 healthcare professionals were working in the 6 hospitals at the time of the study (3099 in the intervention and 1813 in the control) and the educational intervention was conducted between January and March 2016. In the intervention hospitals, the number of ADR reports increased from 57 in the pre-intervention period (from January 1st 2015) to 75 in the post- intervention period. However, the proportion of serious ADRs decreased slightly from 26(45.6%) to 33(44%). Post-intervention, the report of suspected drug details in the ADR report form also improved. CONCLUSION: There was a trend to increased absolute number and quality of reports following educational intervention and SMS reminders.

CONTEXTE: Le Nigéria n'a pas encore atteint le nombre recommandé au niveau international de rapports sur les effets indésirables des médicaments (EIM). OBJECTIF: Cette étude a évalué l'impact d'une conférence éducative suivie par les messages texte répétés via le système de messagerie courte (SMS) sur les rapports d'ADR. MÉTHODES: Six hôpitaux universitaires de la zone Sud-Sud du Nigeria ont été randomisés dans un rapport 1:1 en hôpitaux d'intervention et de non-intervention. Les hôpitaux d'intervention ont reçu une conférence pédagogique suivie de renforcements SMS mensuels sur 12 mois. Le nombre et la qualité des rapports d'EIM des centres locaux de pharmacovigilance de chaque hôpital universitaire au cours des 12 mois avant et après l'intervention ont été décrits. RÉSULTATS: Au total, 4912 professionnels de santé travaillaient dans les 6 hôpitaux au moment de l'étude (3099 dans l'intervention et 1813 dans le contrôle) et l'intervention éducative a été menée entre janvier et mars 2016. Dans les hôpitaux d'intervention, le nombre des notifications d'EIM sont passés de 57 dans la période pré-intervention (à partir du 1er janvier 2015) à 75 dans la période post-intervention. Cependant, la proportion d'effets indésirables graves a légèrement diminué, passant de 26 (45,6 %) à 33 (44 %). Après l'intervention, le rapport des détails sur les médicaments suspects dans le formulaire de rapport d'EIM s'est également amélioré. CONCLUSION: Il y avait une tendance à l'augmentation du nombre absolu et de la qualité des rapports après une intervention éducative et des rappels par SMS. MOTS CLÉS: Effet indésirable médicamenteux, Intervention éducative, Professionnels de santé, Rappels SMS, Hôpitaux universitaires, Nigéria.

Evaluating Postgraduate Surgical Education Experience, Professional Satisfaction and Personal Well-Being: A Cross-Sectional Survey of Trainees in A Low-Middle Income Country in Sub-Saharan Africa.

BACKGROUND: Education at the postgraduate level is important in grooming competent specialists in different fields of surgical care. This study aimed to evaluate the training experience, professional satisfaction, and personal well-being of postgraduate surgical residents in northern Nigeria. SUBJECTS, MATERIALS AND METHODS: It was a cross-sectional survey of 157 medical doctors enrolled for a minimum of 6 months in surgical residency training in tertiary hospitals in the northern zone of the country. All participants filled a pre-tested questionnaire and their responses were analyzed using Statistical Package for the Social Sciences version 20. RESULTS: The respondents had a mean age of 34.4 ± 4.8 years. Thirty-two (20.5%) agreed that there was a balance between their training needs and rotation for clinical services. There was a marked disparity between the median time allocated for non-ward-based training activities (4.0 hours each per week) and the average time allocated for research activities (1.0 hours per week). Although 89 (57.4%) and 82 (53.3%) reported fair satisfaction in their professional role and private life respectively, a larger proportion expressed poor satisfaction with their participation in recreational (107 [68.6%]) and social activities (90 [58.4%]). One hundred and seventeen (74.5%) stated that a high level of stress was associated with their training. CONCLUSIONS: The surgical residents experienced relatively more training on patient management than on research work. Although their educational experience was associated with a high level of stress in majority of them, most of the trainees expressed fair satisfaction with activities in their professional role and private life.

Kinetic and thermodynamic studies of fenton oxidative decolorization of methylene blue.

The need for light intensity has made dye degradation very costly for industry. In this work, Fenton reagent was used for the efficient degradation of an aqueous solution of dye without the need for a light source. The influences of the pH of the media, the initial concentrations of Fe2+, H2O2, and methylene blue (MB) dye; in addition to temperature on the oxidation of MB dye were studied. The optimum amounts of the Fenton reagent were 4mM of Fe2+ and 70mM of H2O2 at 20 mg/L of dye. The optimum ratio of 0.05 of Fe2+/H2O2 was found to give the best result for the decolorization of dye. The Fenton process was effective at pH 3 with a maximum dye decolorization efficiency of 98.8% within 30 min of reaction, corresponding to a COD removal of 85%. The decolorization process was thermodynamically feasible, spontaneous, and endothermic. The activation energy (Ea) was 33.6 kJ/mol suggesting that the degradation reaction proceeded with a low energy barrier.

Efficacy of Single Fixed Dose of Radioiodine (I 131) Therapy in Patients Treated for Hyperthyroidism at Nuclear Medicine Department of Groote Schuur Hospital(GSH).

BACKGROUND: Failure of radioactive iodine therapy (RAI) in patients with hyperthyroidism is not uncommon. A Second dose is usually needed if the first one failed. The purpose of this audit was to determine the efficacy of RAI in patients with hyperthyroidism at Groote Schuur Hospital (GSH). METHODS: This was a retrospective study. A single observer reviewed the records of all patients who received I131 therapy for hyperthyroidism between 23rd April, 2010 and 23rd November, 2017 in conjunction with their pre- and post-treatment thyroid function tests. Results of their thyroid ultrasound were retrieved and documented. The images of their Tc99m sodium per-technetate thyroid scans were also retrieved and reprocessed. Cure was determined by three consecutive thyroid function tests by euthyroid or hypothyroid status 6 months after therapy. RESULTS: Of the 353 patients with complete records, 310 (88%) of our patients were females and 43 (12%) were male patients. Majority (200 patients) of the patients were older than 45 years of age, 148 patients were between 15 to 45 years and 5 patients were 5 years and below. 314 patients (89%) achieved cure at some stage after receiving one dose of RAI; 239(76%) achieved cure < 6 months of therapy and 75(24%) patients after 6 months. Patients who failed to achieve cure following the first RAI therapy appeared to be younger (median(interquartile range) age 39(16), p=0.03), had severe hyperthyroidism as demonstrated by higher pre-treatment FT4 (median(interquartile range) 27 pmol/L(30.6), p= 0.05) and high pertechnetate uptake (median(interquartile range) uptake 9.9%(14), p= 0.002) on thyroid scintigraphy. CONCLUSION: Our audit showed cure rate was 68% at 6 month and 89% at a year. A second dose was indicated in 32% of patients. Patients presenting with severe thyrotoxicity are likely to require more than one RAI therapy. Further researches are suggested to find out if pre-treatment with antithyroid drugs would influence efficacy of RAI in patients with severe thyrotoxicity and would a one year follow up after radioiodine therapy be considered before second RAI.

Association between maternal lipid profile and gestational diabetes mellitus

Background: Dyslipidemia is the third component of metabolic syndrome and is a wellknown cardiovascular risk factor. However, the association of dyslipidemia with gestational diabetes mellitus is still a subject of ongoing research in Nigerian obstetric populations.Objective: To determine the relationship between second trimester maternal fasting plasma lipid constituents and gestational diabetes mellitus.Methods: This was a prospective nested case control study that enrolled 288 pregnant women out of which 36 women with GDM (cases) where matched with 72 without GDM (controls) following results of oral glucosetolerance testing and plasma fasting lipid profiles done between 24 28 weeks. The patients were followed up until delivery to document maternal and fetal outcomes. Data was analyzed using Statistical Package for Social Sciences (SPSS). Categorical variables were presented in percentages while continuous variables were expressed as means (±Standard Deviation). Student ttest and Chisquare test or Fishers exact test were used for comparing variables between the two groups. A value of <0.05 at 95%confidence interval was considered statistically significant.Results: The overall mean plasma lipid levels for the four lipid constituents in the study population were 187.9mg/dL, 163.5mg/dl, 49.1mg/dL and 108.1mg/dL for TC, TG, HDLc and LDc respectively. The mean plasma triglyceride was significantly higher in cases compared to the controls: 187.0±67.7mg/dL vs. 151.7±66.4mg/dL, (p = 0.01). Abnormaltriglyceride was significantly associated with GDM (AOR:4.8, 95% CI (1.6-14.4), (p= 0.005).Conclusion:Maternal dyslipidemia (abnormal triglyceride) was shown to be significantly associated with GDM in this study and it appeared to be causally related

Daily versus twice daily dose of ferrous sulphate supplementation in pregnant women: A randomized clinical trial.

BACKGROUND: The International Nutritional Anaemia Consultative Group has recommended a twice daily dose of 65 mg elemental iron supplementation in pregnant women living in areas where anaemia is prevalent contrary to the World Health Organization (WHO) universal recommendation of a daily dose of 60 mg. Whether twice or daily dose schedules proffer a better outcome is a subject of on-going research. OBJECTIVE: To compare the effectiveness of the once versus twice daily doses of ferrous sulphate in the prevention of iron deficiency anaemia in pregnancy. METHODS: There are about one hundred and eighty two (182) pregnant women at gestational ages of 14-24 weeks with haemoglobin (Hb) levels ≥10 g/dl but ≤14.5 g/dl were recruited during the antenatal booking clinic. They were randomized into receiving either once daily dose (65 mg of elemental iron) or twice daily dose (130 mg of elemental iron) of ferrous sulphate. Pre and post- supplementation haemoglobin, serum iron and ferritin levels were assessed at recruitment and at 37 weeks gestation respectively. RESULTS: Eighty-four (84) and 80 women respectively in the once and twice daily dose groups were analysed. The serum haemoglobin was significantly lower (P = 0.002) among those on once daily than those on twice daily supplementation. The side effects were however, significantly higher in the twice daily group (P = 0.005, P = 0.043 and P = 0.004 respectively). There were no differences between the serum ferritin levels pre and post supplementation in both groups just as they were no reported significant differences in both birth weight of neonates (P = 0.936) and average gestational age at delivery (P = 0.469) between the two groups. CONCLUSION: Once daily (65 mg elemental iron) ferrous sulphate is as effective as twice daily (130 mg elemental iron) dose regimen in prevention of Anaemia in pregnancy in a developing economy like Nigeria. Once daily dose possesses fewer side effects and guarantees better compliance in this study.

Cohort event monitoring of patients treated for uncomplicated malaria with artemisinin-based combination therapies in selected hospitals and community pharmacies in Nigeria.

AIMS AND OBJECTIVES: The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population. PATIENTS AND METHODS: This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur. RESULTS: A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9-<15 years), P = 0.000. CONCLUSIONS: Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.

In vitro sensitivity of Plasmodium falciparum clinical isolates to 4-aminoquinolines in Northeast Nigeria.

Background: Widespread dr ug-resistant Plasmodium falciparum strains have challenged the pivotal role played by 4-aminoquinolines, including chloroquine (CQ), which has been delisted for the treatment of malaria in most parts of the world. This study assessed the in vitro sensitivity of P. falciparum clinical isolates (PfCIs) to amodiaquine (AQ) and CQ in Northeast Nigeria. Materials and methods: PfCIs were collected from subjects with uncomplicated P. falciparum malaria in Azare, Bauchi State and Maiduguri, Borno State following an informed consent. The in vitro sensitivity was assessed by micro-test (MarkIII) method and the IC50 of AQ and CQ was determined using HN-NonLin Version VI.1 software. The reference standard cut-off values for in vitro AQ and CQ resistance of 80 and 160 nmol/l, respectively, were used. Isolates that were inhibited by lower AQ and CQ concentrations were referred to as sensitive. Results: Valid in vitro assay r esults were obtained for 88.9% (80/90) of the PfCIs; Azare had 93.3% (28/30) and Maiduguri had 86.7% (52/60) [χ2 = 0.35; df = 1; p = 0.486]. The geometric mean (GM) IC50 of AQ and CQ were 24.2 nmol/l (95% CI, 10.5 - 49.6 nmol/l) and 39.5 nmol/l (95% CI, 34.5 - 49.6 nmol/l), respectively. The AQ (p = 0.922) and CQ (p = 0.085) GM IC50 were similar between Azare and Maiduguri PfCIs. Only one isolate showed in vitro resistance to AQ giving a sensitivity of 98.8% (79/80) while 17 PfCIs showed in vitro resistance to CQ giving a sensitivity of 78.8% (63/80). The CQ sensitivity was similar between Azare (67.9%; 19/28) and Maiduguri (84.6%; 44/52) PfCIs (χ2 = 3.05; df = 1; p = 0.081). Conclusions: The findings may suggest that the AQ in vitro sensitivity remains high and the isolates in Northeast Nigeria may appear more sensitive to CQ than isolates from other parts. These findings may affect malaria treatment and control policy in Nigeria.