Has Treatment Seeking Behaviour Changed in People Living with Epilepsy? Experience of People Living with Epilepsy Attending Adult Neurology Clinics in Enugu.

BACKGROUND: Over the years efforts has been made through public health education to change the knowledge, attitude and practice of epilepsy and seizures among the populace in Nigeria. One surrogate method of reviewing the impact of these educational interventions includes changes in treatment-seeking behavior of People Living With Epilepsy and the reasons for their choices of treatment. METHODS: This was a cross-sectional descriptive study. Data were collected from People Living With Epilepsy attending the medical outpatient clinics in two tertiary hospitals in Enugu, Enugu State southeast Nigeria. RESULTS: A total 276 people living with epilepsy were recruited with a mean age of 30.1 years and a median age of 25 years. After the onset of epilepsy, 76(27.5%) and 70(25.4%) visited general hospitals and teaching hospitals respectively, while prayer houses and traditional healing centers were first visited by 54(19.6%) and 40(14.5%) respectively. As a second choice of care 9(3.3%) and 13(4.7%) visited prayer houses and traditional healing centers. Only 42(15.2%) selected their treatment center because they were confident of getting a cure however, this was highest for those that visited traditional healing centers 11(27.5%). The age of onset of epilepsy positively correlated with selecting orthodox treatment at the choice of care, while occupational status negatively correlated with selecting orthodox care at the same period. CONCLUSIONS: Health care seeking behaviors among PLWE in Southeast Nigeria might have changed over the years as more people living with epilepsy were more likely to select orthodox treatment compared to non-orthodox means of treatment.

CONTEXTE: Au fil des ans, des efforts ont été déployés par le biais de l'éducation en santé publique pour changer les connaissances, les attitudes et les pratiques concernant l'épilepsie et les crises d'épilepsie parmi la population au Nigeria. Une méthode indirecte pour examiner l'impact de ces interventions éducatives comprend les changements dans le comportement de recherche de traitement des personnes vivant avec l'épilepsie et les raisons de leurs choix de traitement. MÉTHODES: Il s'agit d'une étude descriptive transversale. Les données ont été collectées auprès de personnes vivant avec l'épilepsie fréquentant les cliniques de consultations externes médicales dans deux hôpitaux tertiaires à Enugu, dans l'État d'Enugu, au sud-est du Nigeria. RÉSULTATS: Au total, 276 personnes vivant avec l'épilepsie ont été recrutées, avec un âge moyen de 30,1 ans et un âge médian de 25 ans. Après le début de l'épilepsie, 76 (27,5 %) et 70 (25,4 %) ont consulté respectivement des hôpitaux généraux et des hôpitaux universitaires, tandis que les lieux de prière et les centres de guérison traditionnelle ont été les premiers consultés par respectivement 54 (19,6 %) et 40 (14,5 %). Comme deuxième choix de soins, 9 (3,3 %) et 13 (4,7 %) ont consulté des lieux de prière et des centres de guérison traditionnelle. Seuls 42 (15,2 %) ont choisi leur centre de traitement parce qu'ils étaient confiants d'obtenir une guérison, cependant, ce taux était le plus élevé pour ceux qui ont consulté les centres de guérison traditionnelle (11 soit 27,5 %). L'âge de début de l'épilepsie était positivement corrélé avec la sélection d'un traitement orthodoxe comme choix de soins, tandis que le statut professionnel était négativement corrélé avec la sélection de soins orthodoxes au même moment. CONCLUSIONS: Les comportements de recherche de soins parmi les personnes vivant avec l'épilepsie dans le sud-est du Nigeria ont peut-être changé au fil des ans, car davantage de personnes vivant avec l'épilepsie étaient plus susceptibles de choisir un traitement orthodoxe par rapport aux moyens de traitement non orthodoxes. MOTS-CLÉS: Épilepsie, Comportement de recherche de soins, Guérisseurs traditionnels, Lieux de prière, Médecine orthodoxe, sud-est du Nigeria.

Effects of lead exposure on biomarkers of thyroid and renal function tests among panel beaters in Enugu Metropolis, Nigeria.

Background: Occupational lead (Pb) exposure causes multisystem effects at high and sustained low doses. However, there are inconsistencies in the dose-response effects on the thyroid and kidneys. Aim: This study aimed to assess the effects of Pb exposure on the biomarkers of thyroid and renal functions among panel beaters in Enugu Metropolis, Nigeria. Subjects and Methods: This was a cross-sectional analytical study of 428-panel beaters selected using a multistage sampling technique. Blood lead (BPb), thyroid, and kidney biomarkers were analyzed using atomic absorption spectrometer at 238.3 nm wavelength, enzyme-linked immunosorbent assay, and automated chemistry analyzer, respectively. Analyses were performed using median, mean, Chi-square, correlation, and statistical significance. Results: The median BPb levels were 10.0 µg/dl among participants with about half, 211 (49.3%) having BPb within reference levels. Though the mean values of thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), and creatinine (Cr) were within the reference values, the majority of 275 (64.25%) of the participants had non-euthyroid statuses. Significant differences were found in TSH (P = 0.001), thyroid status (P = 0.0129), and estimated glomerular filtration rate (P = 0.00384) between those with BPb within reference level and those with elevated levels. Conclusion: Though the mean levels of thyroid hormones and Cr were within their respective reference intervals, there was a preponderance of non-euthyroid status among participants in the present study with the majority of the participants falling within CKD grades 2 and 3.

Sero-prevalence of Hepatitis B virus infection: A cross-sectional study of a large population of health care workers in Nigeria.

BACKGROUND: Hepatitis B virus (HBV) infection has been recognized globally as a major public health challenge necessitating a global call for increased awareness, patients' identification, and development of activities for prevention and control of the disease. Consequently, massive health education campaigns and screening exercises have been mounted globally to mark the World Hepatitis Day (WHD). AIMS: As part of WHD 2016 activities, we undertook a survey and screening of health care workers in order to raise awareness, identify patients and contribute to the Global Health Strategy goal of eliminating HBV infection by the year 2030. METHOD: This was a cross-sectional analytical study done at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria. Hospital workers voluntarily presented themselves to be screened using a rapid test kit and completing a semi-structured investigator-administered questionnaire. RESULTS: A total of 3123 participants were studied. The mean age of the participants was 39.4 ± 9.6 years. The seroprevalence of HBV infection was 2.3%. Most (97.0%) of the participants had previously heard about HBV infection and over two thirds (68.1%) could correctly identify risk factors and modes of transmission of HBV. Twenty-eight and a half percent of the participants knew their hepatitis B virus status prior to the study. CONCLUSION: The seroprevalence of HBV among healthcare workers in Enugu, Nigeria is relatively low compared to figures from other African countries. The healthcare workers have considerable knowledge of the disease. However, the observed knowledge gaps in awareness and screening need to be addressed.

Prevalence and distribution of hypertension in overweight and obese subjects in an urban community in Enugu, South East Nigeria. A post hoc analysis.

BACKGROUND: Most recent studies in Nigeria have documented high prevalence of hypertension, diabetes, and obesity. Several mechanisms may link hypertension and obesity hence the high prevalences of both disorders in Nigeria. There are however no studies on the prevalence of hypertension among the obese in urban settings. AIMS: The aim of this study was to describe the prevalence and pattern of hypertension in overweight/obese individuals in a community. METHODS: We conducted a post-hoc analysis on obese subjects 20 years and above from two urban settlements within Enugu metropolis. For database management and statistical analyses, we used the SPSS version 22. RESULTS: Data from a total of 301 individuals with obesity who met the selection criteria were re-analyzed. A total of 198 (65.8%) individuals were found to have hypertension most of whom were newly diagnosed 110 (55.6%). The prevalence of hypertension was 65.8% and increased with age and BMI. CONCLUSION: Individuals with overweight/obesity have very high rates of hypertension. The prevalence of hypertension also increased with and BMI. Thus, there is need for targeted health education in adults to address the burden of obesity and hypertension to reduce the burden of cardiovascular disease in the community.

Hepatitis B surface antigenemia in two rural communities in Enugu, Nigeria.

BACKGROUND: Hepatitis B virus infection is endemic in Nigeria, yet few data exist about the extent of infection in rural communities. OBJECTIVE: To determine seroprevalence of hepatitis B surface antigenemia in two rural communities in Nigeria. METHODS: A 330-person survey for seroprevalence of hepatitis B surface antigen (HBsAg) was carried out in two rural communities in Enugu State, Nigeria, in January, 2017. All study participants were screened for HBsAg using chromatographic immunoassay. Results: The mean age of participants was 57.2 ± 17.4 years, (range = 10-92 years) with 168 (50.9%) aged 60 years and above. The prevalence of HBsAg was found to be 2.1% with the 18-29 years age group having the highest prevalence. CONCLUSION: There is need to increase hepatitis B surveillance in rural communities to reduce transmission and institute early treatment.

Predictors of autonomic dysfunction among predialysis chronic kidney disease patients in Nigeria.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem with increasing incidence and mortality in Africa. Autonomic dysfunction (AD) has been implicated as a major contributor to the disease morbidity and mortality, but little is known about the predictors of this dysfunction in African populations. Understanding the predictors of this condition is necessary for early detection and management of CKDs. Objectives: This study was designed to determine the predictors of AD in CKD patients in Nigeria. MATERIALS AND METHODS: It was a cross-sectional study of CKD patients at University of Nigeria Teaching Hospital, Enugu, Nigeria. The CKD patients with AD were compared with those without AD and a normal control group. Autonomic function was assessed through noninvasive cardiovascular tests: measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing, HRR to Valsalva maneuvre, and HRR to respiration. Data on symptoms of CKD and AD were obtained using a validated questionnaire. RESULTS: The mean age of the CKD patients was 41.3 ± 1.5 (range: 21-69) years. Early hospital presentation is associated with significantly less risk of the development of AD (P < 0.001). Dizziness, nocturnal diarrhea, and impotence are the major markers/predictors of AD in CKD patients (P < 0.05). CONCLUSION: AD is common among predialysis CKD patients in Nigeria, and best predicted by the presence of postural dizziness, nocturnal diarrhea, and impotence in men. Physicians should, therefore, be on the lookout for these features for prompt and adequate management of cases.

Seizure disorder among chronic kidney disease patients in Enugu, South East Nigeria.

BACKGROUND: Seizures are the commonest neurological condition presenting in Africa. The pattern of non- epileptic seizures in systemic diseases including chronic kidney disease is unknown in South East Nigeria. OBJECTIVES: This study examined the pattern of seizures in chronic kidney disease patients in Enugu, South East Nigeria. METHODS: This was a retrospective study of chronic kidney disease patients who presented to the University of Nigeria Teaching Hospital Enugu (UNTH) from January 2007 December 2008. Data from subjects who satisfied the inclusion criteria were reviewed and analysed using Statistical Package for the Social Sciences version 13.5. Ethical clearance was obtained from the UNTH Ethics Committee. RESULTS: There were 145 patients, 95 males and 50 females. Mean age was 35 years. Only 5 patients (3,4%) had seizures (mostly generalized tonic-clonic) associated with severe hypertension. None had hypocalcaemia. Three patients (60%) received dialysis with benefit while 2 patients (40%) died before dialysis could be done. CONCLUSION: Seizures are infrequent in chronic kidney disease patients in Enugu; are commoner in males and those with severe disease. Dialysis improved survival in those with seizures. Larger multicentre studies are needed to further elucidate the spectrum of Nigeria.

Low-dose lisinopril in normotensive men with idiopathic oligospermia and infertility: a 5-year randomized, controlled, crossover pilot study.

The outcomes of drug treatment for male infertility remain conjectural, with controversial study results. Our pilot study employed a randomized, placebo-controlled, crossover methodology with intention-to-treat analysis. Thirty-three men with idiopathic oligospermia were randomized to start either daily oral lisinopril 2.5 mg (n = 17) or daily oral placebo (n = 16). Lisinopril was found to cause a normalization of seminal parameters in 53.6% of the participants. Although the mean ejaculate volume was unchanged (P ≥ 0.093), the total sperm cell count and the percentage of motile sperm cells increased (P ≤ 0.03 and P < 0.001, respectively), whereas the percentage of sperm cells with abnormal morphology decreased (P ≤ 0.04). The pregnancy rate was 48.5%, and there was no serious adverse drug event. It is concluded, albeit cautiously, that prolonged treatment with 2.5 mg/day of oral lisinopril may be well tolerated in normotensive men with idiopathic oligospermia, may improve sperm quantity and quality, and may enhance fertility in approximately half of those treated.

Pattern and presentation of epilepsy in Nigerian Africans: a study of trends in the southeast.

One-quarter of the 40 million individuals estimated to have epilepsy in the developing world live in Africa. Data on epilepsy in Nigeria are scanty. The disease is associated with significant socioeconomic effects. This study reviewed the pattern of presentation of epilepsy in Enugu, southeast Nigeria. A retrospective study was performed of adult epilepsy patients who presented to the medical clinic at the University of Nigeria Teaching Hospital, Enugu, from January 2002 to December 2006. Case records were reviewed and data were extracted using a pro forma and analysed. A total of 207 patients were studied (113 males and 94 females). Most affected were those aged 15-34 years. Approximately 22% had childhood seizures and approximately 88% had generalised convulsive seizures. Electroencephalography was not performed in 85% of cases. Alcohol use and head injury were seizure risks in 12% and 20% of patients, respectively. More than 25% reported socioeconomic effects, including stigmatisation and job loss. Monotherapy was used in 89% of patients, with 71% having good control. Epilepsy is a considerable source of stigma and misery for sufferers in Nigeria. There is a need for greater public health education as well as training and re-training of specialists in its management.