Physical and socioeconomic impact of asthma in Nigeria: Experience of patients attending three tertiary hospitals.

BACKGROUND: Understanding the impact of asthma is the key to optimal care. OBJECTIVE: To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria. METHODS: This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence). RESULTS: The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact. CONCLUSION: Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.

Hemodialysis performance and outcomes among end stage renal disease patients from Sokoto, North-Western Nigeria.

The cost of managing end stage renal disease (ESRD) is prohibitive in Nigeria and the burden is solely borne by patients and their relatives. Despite increasing number of dialysis centers in urban areas, actual utilization of such facilities is very low. It is unclear if the outcomes of these patients have improved in recent times. We evaluated pattern of hemodialysis (HD) performance and outcome among ESRD patients. A 5-year prospective cross-sectional study of all ESRD patients on HD was undertaken. The final outcomes included duration on maintenance dialysis, death from inability to sustain dialysis, absconded, confirmed deaths within or outside health facility or referral for kidney transplant. A total of 540 (54%) of 976 cases of ESRD commenced HD, out of which 7 (1.3%) eventually had live-related kidney transplant in India. The male to female ratio was 2:1 with male and female mean ages of 43 ± 17 and 36 ± 16 years respectively. There was a progressive annual increase in the number of ESRD patients. The commonest underlying renal disorder was chronic glomerulonephritis. The mean HD session duration was 8.11 ± 5.4 hours, while the mean duration of stay on HD was 8.72 ± 1.0 weeks. In conclusion, ESRD is common and is being increasingly recognized. Financial constraint and late presentation are major contributory factors to poor outcomes despite the widespread availability of HD facilities. Therefore, effort should be geared towards aggressive strategies for early detection and treatment. Government commitment in terms of funding and/or subsidy for patient with ESRD is advocated.

Metabolic dysfunctions in non-antiretroviral treated HIV/AIDS patients.

BACKGROUND: AIDS related metabolic and morphologic disorders have been attributed to protease inhibitor based antiretroviral therapy. HIV/AIDS is however a multi-systemic disease with potential for alteration of metabolic and endocrine functions. OBJECTIVE: To determine if metabolic disorders occur in non-antiretroviral treated HIV/AIDS patients. METHODS: Case control study of prospectively recruited 48 HIV seropositive patients, and randomly selected age and sex-matched controls. Main outcome measures included plasma lipid concentrations and intravenous glucose tolerance measured using glucose assimilation coefficient, K. A K-value less than 1.2 constituted an impaired glucose tolerance. RESULTS: Compared to the controls, HIV/AIDS patients had significantly lower glucose assimilation coefficient (1.5 +/- 0.5 versus 2.7 +/- 0.9; p < 0.001); higher proportion of individuals with impaired glucose tolerance (35.4% versus 7.5%; P = 0.01); and higher plasma triglyceride concentration (166.5 +/-20.7 mg/dL versus 148.9 +/- 13.5 mg/dL; p = 0.04). The proportion of patients with hypertriglyceridaemia was also significantly higher among patients than controls (56.3% versus 17.5%; p = 0.04). CONCLUSIONS: Metabolic dysfunctions occur in HIV/AIDS independent of antiretroviral therapy. Routine monitor of plasma lipids and glucose is therefore advocated in HIV/AIDS patients.

An audit of snake bite injuries seen at the Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria.

BACKGROUND AND OBJECTIVES: Snakebite is an important but often overlooked medical problem worldwide. This work is an audit of snakebite injuries in Sokoto, North West Nigeria using hospital-based data. METHODOLOGY: A retrospective analysis of the records of all adult patients with snakebite managed at Usmanu Danfodiyo University Teaching Hospital Sokoto, North West Nigeria from January 2000 to December 2004 was carried out. Information retrieved included demographic and clinical data. RESULTS: Seventy three patients made up of 55 males (75.3%) and 18 females (24.7%) were involved. Male to female ratio was 3:1. Snakebite constituted 1.7 per 1000 hospital admissions and 12.7 per 1000 medical admissions. 82.2% of the patients were between 15 and 40 years of age. 89% of the bites were between the months of March and October. 54.8% of the patients were bitten in the home environment while 39.7% were bitten in the bush. The lower limbs were the most common sites of bite (58.9%). Most( 63%) of the bites occurred during the daytime. 50.7% of the patients showed signs of envenomation while 64.4% received antivenom. Majority of the patients survived and 2.7% of the patients died. The outcome was unknown in 26.0% of patients. CONCLUSION: Snakebite constitutes an important cause of hospital admission and occurs mainly during the rainy season which coincides with the period of intense farming activities in the study population. The build up commences during the period of intense heat. Envenomation status of patients need to be accurately determined to avoid excessive use of antivenoms with the attendant risk to patients.

Experiences in management of Pott's paraplegia and paraparesis in medical wards of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

BACKGROUND: Pott's disease refers to spinal tuberculosis, which commonly leads to a gradual onset of neurological deficit that are difficult to diagnose at the early stage. METHOD: The study was a combination of retrospective and prospective study. Information was obtained using a predesigned protocol. Diagnosis was based on clinical features and plain spinal x-ray. Anti-tuberculous therapy was instituted in all patients for a minimum of 18 months. Monitoring of neurological status was done weekly. RESULTS: There were 92 patients made up of 71 males (77.2%) and 21 females (22.8%) with a male: female ratios of 3.4:1. 53.3% were paraplegic while 46.7% were paraparetic. The age group 31-40 years was the most affected. 43.5% of the patients were farmers who formed the majority. Back pain, weight loss, paraplegia and paraparesis in that order were the common clinical features. 25% of the patients recovered full use of their lower limbs at the end of the study. Thoracic spine and lumbar spine were equally involved (41.5% respectively) while thoraco-lumbar spine was involved in 15.1% of patients. Cervical spine was only involved in 1.9% of the patients. CONCLUSION: Effective management of spinal tuberculosis should be a teamwork involving the physician, orthopedic surgeon, neurosurgeon as well as the radiologist. The rural populace needs to be educated to prevent late complications and ensure better prognosis.