Heart failure in Nigeria: protocol for a systematic review and meta-analysis.

Background: Heart failure is now a significant contributor to the burden of non-communicable diseases in developing countries like Nigeria which is experiencing epidemiologic and demographic transition. The epidemiology of heart failure in this country is poorly characterized. The aim of the review is to determine the prevalence of heart failure, the associated risk factors, the aetiology, management, and outcomes of the condition in the country. Methods: Relevant databases such as PubMed /Medline, EMBASE, Web of Science, Google Scholar, African Index Medicus, and African journal online would be searched for articles published in English from January 2000 to December 2021. The analysis will include observational studies conducted among Nigerian adults aged 12 years and above. Article selection shall be conducted by pairs of independent reviewers. Data extraction shall be done by 2 independent reviewers. Results: The primary outcome would be the pooled prevalence of heart failure while the secondary outcomes would be to identify the risk factors and management of heart failure in Nigeria. Conclusion: This will be the first systematic review and meta-analysis of heart failure epidemiology in Nigeria which will hopefully identify gaps for future research and guidance for policy interventions.

Prevalence of Needle Stick and Sharps Injury and Hepatitis B Vaccination among Healthcare Workers in a South-East Nigerian Tertiary Hospital.

BACKGROUND: Daily, HCWs are exposed to needle stick and sharps injury (NSSI) and associated risk of life-threatening infections. AIM: A cross-sectional study was conducted to determine the prevalence of NSSI and HBV vaccination among 341 HCWs at NAUTH, Nnewi. METHODS: Data was collected using a self-administered. questionnaire and interview of key staff. RESULTS: The mean age of participants was 33.4±11.9 years while male: female ratio was 1:1.7. Prevalence of NSSI in the preceding 12 months was 25.5% with doctors (43.0% [34/79]), laboratory scientists (27.5%[14/51]) and nurses (21.8%[17/78]) leading (p=0.014). Noncompliance with standard precaution (SP) and non-display of relevant SP SOPs in prominent places were significantly associated with NSSI (p=0.001). Among those exposed to NSSI, only 33.7% (28/83) consulted a doctor, while 16.9%(14/83) took post-exposure prophylaxis. Two-third (68.8% [190/276]) of respondents correctly cited HBV/HCV as vaccine-preventable blood-borne healthcare-associated infection (HAI) while half (50.9% [161/316]) had received HBV vaccination. Profession (p=0.018), display of SOPs in prominent places (p=0.015), ability to cite HBV/HCV as vaccine-preventable blood-borne HAI (p=0.001), and compliance with SP (p<0.001) were significantly associated with HBV vaccination. Unit heads' responses implied lack of written policy on HBV vaccination, adequate training on NSSI prevention, and HBV vaccination support. CONCLUSION: Among HCWs, NSSI is high but under-reported while HBV vaccination rate is unimpressive. Profession, display of relevant SOPs, and compliance with SP positively affected both NSSI occurrence and HBV vaccination while knowledge about vaccine-preventable blood-borne HAI also influence HBV vaccination status. Written policies on HBV vaccination and NSSI prevention/ management, their communication and enforcement among HCWs, adequate training/retraining, display of SOPs in prominent places, and free HBV vaccination are recommended.

CONTEXTE: Les travailleurs de la santé sont quotidiennement exposés aux blessures par piqûre d'aiguille et par objets tranchants (NSSI) et au risque associé. blessures par aiguilles et objets tranchants (NSSI) et au risque associé d'infections potentiellement mortelles. OBJECTIF: Une étude transversale a été menée pour déterminer la prévalence des blessures par aiguilles et objets tranchants et de la vaccination contre le VHB parmi 341 travailleurs de la santé à NAUTH, Nnewi. MÉTHODES: Les données ont été recueillies à l'aide d'un questionnaire autoadministré et d'un entretien avec un informateur clé. RÉSULTATS: L'âge moyen des participants était de 33,4±11,9 ans et le rapport hommes/femmes était de 1:1. le rapport hommes/femmes était de 1:1,7. La prévalence de l'INSS au cours des 12 mois précédents était de 25,5 %. mois précédents était de 25,5 %, avec des médecins (43,0 % [34/79]), des scientifiques de laboratoire (27,5 % [14/51]) et des professionnels de la santé. (27,5% [14/51]) et les infirmières (21,8% [17/78]) en tête (p=0,014). Le non-complaisance avec la précaution standard (SP) et le non-affichage des PONs pertinentes de la SP dans des endroits bien en vue étaient significativement associés à la NSSI (p=0.001). Parmi les personnes exposées aux MSSN, seuls 33,7 % (28/83) ont consulté un médecin, tandis que 16,9 % (28/83) ont consulté un médecin, tandis que 16,9% (14/83) ont pris une prophylaxie post-exposition. Deux tiers (68,8% [190/276]) des personnes interrogées ont correctement cité le VHB/VHC comme une infection transmissible par le sang et prévenue par un vaccin, tandis que la moitié (50,9% [161/316]) avait été vaccinée contre le VHB. La profession (p=0,018), l'affichage des SOPs dans des dans des endroits bien en vue (p=0,015), la capacité à citer le VHB/ VHC comme une IHA hématogène évitable par la vaccination (p=0,001) et la conformité à la PS (p<0,001) étaient significativement associés à la vaccination contre le VHB. Les réponses des chefs d'unité impliquaient l'absence de politique écrite sur la vaccination contre le VHB, de formation adéquate sur la prévention des INSS et de soutien à la vaccination contre le VHB. CONCLUSION: Parmi les travailleurs de la santé, l'INSS est élevée mais sous-déclarée tandis que le taux de vaccination contre le VHB n'est pas impressionnant. La profession, l'affichage de procédures opératoires normalisées (PON) pertinentes et la conformité à la PS ont eu un effet positif sur l'occurrence des INSS et la vaccination contre le VHB, tandis que les connaissances sur les infections hématogènes évitables par la vaccination influencent également le statut de la vaccination contre le VHB. Les politiques écrites sur la vaccination contre le VHB et la prévention et la gestion des INSS, leur communication et leur application parmi les établissements de soins de santé, une formation et un recyclage adéquats, l'affichage des procédures opérationnelles standard dans des endroits bien en vue, et la vaccination gratuite contre le VHB sont recommandées. MOTS CLÉS: Prévention, risques professionnels, personnel hospitalier, infections transmissibles par le sang, Nnewi.

A Comparison of Birth Weight for Gestational Age among Newborn Infants of HIV-Positive and Negative Mothers in a Southeast Nigerian Tertiary Hospital.

BACKGROUND: HIV infection in pregnant women is a known cause of low birth weight (LBW) and small for gestational age (SGA). This study compared the birth weight for gestational age (GA) of HIV exposed and non-exposed babies in Nnamdi Azikiwe University Teaching Hospital, (NAUTH) Nnewi, Nigeria. SUBJECTS AND METHODS: A retrospective comparative appraisal of birth weights for GA of babies born to HIV- positive and negative women, over a 7-year period (January 2009-December 2015), was conducted. Data were abstracted from PMTCT database, ANC and Labor ward registers of NAUTH. RESULTS: A total of 3459 babies (1782 males, 1677 females) were enrolled, out of which 1829 were HIV- exposed and 1630 were not. GA spanned from 26-42 weeks (mean 38.7 ± 2.2 weeks) and birth weights (BW) from 400-5300g (mean 3072.5 ± 630g). The mean BW of exposed babies was significantly lower than the unexposed babies (p=0.048). LBW occurred in 12.0% of exposed and 13.5% of non-exposed babies (p<0.001). Using either percentile or Z-score cut-offs, HIV-exposed babies had twice the proportion of SGA compared to their non-exposed counterparts. Using Z-score, maternal antiretroviral use for >5 years was significantly associated with the lowest proportion of SGA compared to shorter duration of use. CONCLUSION: Maternal HIV infection is associated with SGA. However, maternal ARV use in excess of 5 years is associated with better BW outcome. Targeted enhancement of maternal nutrition and strict adherence to ARV therapy prior to and during pregnancy will improve birth outcome.

The influence of maternal anthropometric characteristics on the birth size of term singleton South-East Nigerian newborn infants.

OBJECTIVE: This study examined the usefulness of maternal anthropometry in predicting the birth size of term singleton newborn infants at NAUTH, Nnewi, Nigeria. MATERIALS AND METHODS: A cross-sectional study was conducted among 301 mother/newborn infant pairs. RESULTS: The mean birth weight was 3.27 ± 0.60 kg whereas the incidence of low birth weight and fetal macrosomia were 8.0% and 11.3%, respectively. The anthropometric indices varied in their ability to detect newborn babies who experienced abnormal intrauterine growth. The rate of subnormal intrauterine growth was 9.0%, 11.6%m and 18.6% using weight-for-gestational age (GA), ponderal index (PI), and mid-arm circumference (MAC)/occipito-frontal circumference (OFC) criteria, respectively. On the other hand, the rate of excessive intrauterine growth was 16.6% and 12.0% using weight-for-GA and PI criteria, respectively. Apart from maternal height, all the assessed maternal anthropometric parameters had a significant relationship with size at birth. Mothers of newborn infants who experienced subnormal intrauterine growth were more likely to have MAC < 25 cm, intrapartum weight < 65 kg, intrapartum BMI < 25 kg/m2, and rate of third trimester weight gain < 250 g/week. On the other hand, mothers of newborn infants who experienced excessive intrauterine growth were more likely to have MAC > 30 cm, intrapartum BMI ≥ 30 kg/m2, and rate of third trimester weight gain ≥ 500 g/week. Conclusion/Recommendation: Maternal anthropometry is a very useful tool in identifying mothers at risk of having newborn infants who experienced abnormal intrauterine growth. Therefore, its routine application is recommended to enable such mothers benefit from interventions targeted at ensuring optimal intrauterine growth and improved pregnancy outcomes.

Experiences from polio supplementary immunization activities in Anambra State, Nigeria.

BACKGROUND: Routine immunization coverage is low in some States in Nigeria and contributes to the transmission of wild poliovirus. Anambra State has been polio-free since 2004. However, the risk of importation of poliovirus from travelers and migrants is a public health concern due to the commercial nature of the State. This paper reported experiences and lessons from supplementary immunization activities (SIAs) conducted in the State that will be useful to other settings experiencing low uptake of routine immunization. MATERIALS AND METHODS: The SIAs were conducted simultaneously in the 21 local government areas (LGAs) in Anambra State during January, March, and November 2010. Data were entered and analyzed in Excel spreadsheet and findings were summarized as frequencies and proportions. RESULTS: A total of 1,187,866 children were vaccinated in January, 1,260,876 in March and 1,225,187 in November 2010. The State's cumulative coverage exceeded the target coverage of >90% in the three SIAs. All LGAs met the >90% target in January and March, but one LGA achieved 79% coverage in November. The proportion of zero-dose children decreased from 6% to 4.7%, and the vaccine wastage rate ranged from 6% to 6.6%. In that same year, the state did not achieve the target coverage of >80% for routine oral polio vaccine (OPV 3 ) immunization in any of the months and only 29% of the LGAs exceeded the routine OPV 3 target. CONCLUSION: The State achieved high polio vaccination coverage through the SIAs, but coverage through routine immunization was low. Adopting proper planning and supervision, financial and political support, community involvement, improved vaccine logistics, and other measures utilized during the SIAs could help to improve routine immunization.

Nutritional Contents of Lunch Packs of Primary School Children in Nnewi; Nigeria

Background: Lunch packs play a significant role in the nutritional status and academic performance of school children. Available data show a high prevalence of malnutrition among school-age children. Aims: The aim of this study is to document the nutritional contents of lunch packs of primary school children in Nnewi; Anambra state; Nigeria. Subjects and Methods: A cross-sectional study was conducted among 1018 primary 1-6 pupils selected by stratified systematic random sampling from six primary schools; two each of private; - mission; - and government (public) - owned schools in Nnewi metropolis with the aid of the semi-structured questionnaire. Lunch packs of the pupils were examined. Results: Majority of the pupils (77.8[792/1018]) had lunch packs although about half of pupils in public schools had no lunch pack. Only 12.4 (98/792) and 19.2 (152/792) of pupils with lunch packs had balanced meals and fruits/vegetables in their lunch packs; respectively. The odds of not coming to school with packed lunch was about 13 and 12 times higher for mothers with no formal education or only primary education; respectively; compared with those with tertiary education. Type of school had a strong influence on possession and contents of lunch pack (?2 = 2.88; P 0.001; phi coefficient

Comparison of Dynabeads and Capcellia methods with FACScount for the estimation of CD4 T-lymphocyte levels in HIV/AIDS patients in Lagos, Nigeria.

OBJECTIVE: To compare the efficacy of the Capcellia assay and the Dynabeads technique against the FACScount technique in the estimation of CD4 T-lymphocytes within a Nigerian setting. DESIGN: Prospective study. SETTING: Urban area in Nigeria. SUBJECTS: Ninety seven subjects (51 HIV seronegative and 46 HIV seropositive adults) seen in the blood banks and two out patient clinics in Lagos within the study period. MAIN OUTCOME MEASURES: Dynadeads technique with a higher correlation coefficient is a feasible alternative to the FACScount method. RESULTS: There was an overall correlation coefficient of r = 0.75 for CD4 cell counts as determined by the Dynabeads technique in comparison with the FACScount method. Also, an overall correlation coefficient of r = 0.17 for CD4 cell counts as determined by the Capcellia technique against the FACScount method. CONCLUSION: Dynabeads technique is simple to carry out and cheaper in terms of demand for human expertise and infrastructural requirements than the FACScounts. Therefore, it was recommended for use in the laboratory for monitoring of ARV therapy in Nigeria and any other resource poor

Prevalence of human immunodeficiency virus (HIV) antibodies in tuberculosis patients in Lagos, Nigeria.

To establish the prevalence of HIV antibodies in patients with pulmonary tuberculosis, 536 new cases presenting with symptoms of bronchopulmonary disorders were randomly selected from the six referral chest clinics in Lagos and screened for tuberculosis and HIV infections. Sputum and serum samples were obtained from all the patients. The sputum samples were examined for acid-fast bacilli (AFB) by both microscopy and culture. The sera were screened for HIV-1 and HIV-2 antibodies by ELISA and confirmed by Western blot (WB). Of the 536 cases studied, 188 (35%) were positive for AFB while 13 (2.4%) were seropositive for HIV. Correlation between the AFB and HIV results revealed that 10 (5.3%) of the 188 AFB positives were also seropositive for HIV as compared to 3 (0.9%) in the 348 AFB negative cases. The difference in the HIV seroprevalence rates in the two groups was statistically significant (P < 0.001). The recorded higher frequency of HIV infections in the AFB positives strongly suggested some level of interaction between TB and HIV infections in Lagos. Infections with HIV-2 were more prevalent than HIV-1 in the patients with HIV and TB. No case of dual infection with HIV-1 and HIV-2 was recorded in this group of patients. However, in the 3 HIV-seropositive patients within the control group (non-tuberculosis patients), 2 (67%) were positive for both HIV-1 and HIV-2 while 1 (33%) was positive for HIV-2 only. Mycobacterium tuberculosis (70%), M. avium (20%) and M. kansasii (10%) were the mycobacteria strains isolated from the HIV/TB infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Human pulmonary nocardiosis.

The involvement of Nocardia species in human pulmonary infections was investigated. Pulmonary nocardiosis mimics pulmonary tuberculosis in both clinical symptoms and radiological characteristics. In third world countries where diagnosis is based solely on such findings, anti-tuberculosis regimens may indicate chronic tuberculosis when in fact pulmonary nocardiosis should have been treated. Differential diagnosis is recommended for efficient health care and cost-effective drug use.