Substance Use and Treatment Outcome among People Living With HIV [PLWHIV] Accessing Care at CIDC 161 NAF Hospital, Makurdi, Nigeria: Implication for Intervention.

INTRODUCTION: Substance use is an increasing menace in Nigeria. It is common and even higher among PLWHIV compared to the general population. Substance use increases a person's chance of acquiring HIV due to increased risky behaviours. Gap exists on our understanding of why some clients fail on Antiretroviral Therapy (ART) adherence or appointment. Exploring psychoactive substance use among people living with HIV (PLWHIV) and their effect on treatment outcome may help in addressing these problems. METHODS: The study was at Military Hospital in Makurdi, Benue state, Nigeria. It involved 700 HIV positive clients >18 years selected using simple random sampling method. Analytical cross-sectional study using questionnaire (WHO ASSIST V3.1) was done. Chi-square test was used for association of characteristics of clients with substance use and treatment outcome (CD4 count and Viral load) at p < 0.05. Binary logistic regression was used to identify predictors. RESULTS: Prevalence of ever used and current use of any psychoactive substance were 539(77.0%) and 459(65.6%) respectively. Commonest used substances were alcohol 445(63.6%), Bitter cola/Kola nut 260(37.1%) and tobacco products 138(19.7%). Predictors of ever used substance were; Males (AOR 2.21; 95% CI 1.41-3.49), single (AOR 3.63; 95% CI 1.58-18.38), Christians (AOR 8.88; 95% CI 1.19-66.31), keeping to appointments (AOR 2.26; 95% CI 1.37-12.01). Ever used substance was predictor for CD4 count increase (AOR 1.45; 95% CI 1.22-1.83) and viral load suppression (AOR 0.40; 95% CI 0.12-0.75). CONCLUSION: There was a high prevalence of substance use. Ever used psychoactive substance were determinants for treatment outcome. There is need for new strategy and involvement of mental health professional in the care of PLWHIV to address this.

INTRODUCTION: La consommation de substances psychoactives est une menace croissante au Nigeria. Elle est courante et même plus élevée chez les PVVIH que dans la population générale. La consommation de substances psychoactives augmente le risque de contracter le VIH en raison de l'augmentation des comportements à risque. VIH en raison de l'augmentation des comportements à risque. Il existe des lacunes dans notre compréhension des raisons pour lesquelles certains clients n'adhèrent pas à la thérapie antirétrovirale (TAR) ou ne prennent pas de rendez-vous. L'étude de la consommation de substances psychoactives chez les personnes vivant avec le VIH (PVVIH) et de son effet sur le résultat du traitement peut aider à résoudre ces problèmes. MÉTHODES: L'étude a été menée à l'hôpital militaire de Makurdi, dans l'État de Benue, au Nigeria. Elle a porté sur 700 clients séropositifs de plus de 18 ans sélectionnés par une méthode d'échantillonnage aléatoire simple. Une étude transversale analytique a été réalisée à l'aide d'un questionnaire (WHO ASSIST V3.1). Le test du chi carré a été utilisé pour l'association des caractéristiques des clients avec la consommation de substances et les résultats du traitement (numération des CD4 et charge virale) à p < 0,05. Une régression logistique binaire a été utilisée pour identifier les prédicteurs. RÉSULTATS: La prévalence de l'utilisation antérieure et actuelle de toute substance psychoactive était de 539 (77,0%) et 459 (65,6%) respectivement. Les substances les plus fréquemment consommées étaient l'alcool (445, 63,6 %), le cola amer/la noix de kola (260, 37,1 %) et les produits du tabac (138, 19,7 %). Les facteurs prédictifs de la consommation de substances étaient les suivants : hommes (AOR 2,21; IC 95% 1,41-3,49), célibataires (AOR 3,63 ; IC 95% 1,58-18,38), chrétiens (AOR 8,88 ; IC 95% 1,19-66,31), respect des rendez-vous (AOR 2,26 ; IC 95% 1,37-12,01). Le fait d'avoir déjà consommé une substance était un facteur prédictif de l'augmentation du nombre de CD4 (AOR 1,45 ; IC 95 % 1,22-1,83) et de la suppression de la charge virale (AOR 0,40 ; IC 95 % 0,12-0,75). CONCLUSION: La prévalence de la consommation de substances psychoactives était élevée. Les substances psychoactives déjà consommées étaient déterminantes pour les résultats du traitement. Pour y remédier, il est nécessaire d'adopter une nouvelle stratégie et d'impliquer les professionnels de la santé mentale dans la prise en charge des PVVIH. Mots-clés: Substances psychoactives, PVVIH, résultats du traitement, Makurdi, Nigeria.

Knowledge and Utilization of PMTCT Services among Women accessing Antenatal Care in Private Health Facilities in Abakaliki, Nigeria.

Prevention of mother-to-child transmission (PMTCT) of HIV programme provides antiretroviral treatment to HIV-positive pregnant women to reduce the likelihood of transmission to their infants. Despite concerted efforts to scale-up PMTCT services in Nigeria, coverage and uptake of the services by Antenatal Care (ANC) attendees is below the acceptable. Private health facilities provide ANC services to large number of women, but they are sparingly involved in PMTCT capacity enhancement interventions. This study assessed the knowledge and utilization of PMTCT services among women accessing antenatal care in Private Health facilities in Abakaliki, Ebonyi State. It was a descriptive cross-sectional study in ANC clinics of the health facilities. Data was collected using interviewer administered questionnaire and analysed with Statistical Package for Social Sciences (SPSS) version 22.0 and test of association was by Chi square at P<0.05 level of significance. Results showed mean age of the respondents was 27± 4.6 years. Majority of the respondents (83.4%) had good knowledge of PMTCT but only 68.4% accessed HIV Counselling and Testing (HCT) in the index pregnancy, with fear of stigmatization given as the major reason for not doing HCT. Only 54.5% of sero-positive attendees took anti-retroviral drugs (ARVs) during pregnancy though they all used ARVs during labour/ delivery. Utilization of PMTCT services of HIV wassignificantly associated with educational status and occupation. CONCLUSION: There was good knowledge of PMTCT but utilization of the services was suboptimal. Training and mentoring of health care workers in private facilities on HIV testing programmes is important to improve uptake of PMTCT services and allay fears of stigmatization among the pregnant women.

Le programme de prévention de la transmission mère-enfant (PTME) du VIH fournit un traitement antirétroviral aux femmes enceintes séropositives pour réduire la probabilité de transmission à leurs nourrissons. Malgré les efforts concertés pour étendre les services de PTME au Nigeria, la couverture et l'utilisation des services par les personnes participant aux soins prénatals (ANC) sont inférieures à l'acceptable. Les établissements de santé privés fournissent des services de soins prénatals à un grand nombre de femmes, mais ils sont peu impliqués dans les interventions de renforcement des capacités de PTME. Cette étude a évalué la connaissance et l'utilisation des services de PTME chez les femmes ayant accès aux soins prénatals dans les établissements de santé privés à Abakaliki, dans l'État d'Ebonyi. Il s'agissait d'une étude transversale descriptive dans les cliniques de soins prénatals des établissements de santé. Les données ont été recueillies à l'aide d'un questionnaire administré par l'intervieweur et analysées avec le logiciel Statistical Package for Social Sciences (SPSS) version 22.0 et le test d'association a été effectué par le Chi carré au niveau de signification P<0,05. Les résultats ont montré que l'âge moyen des répondants était de 27 ± 4,6 ans. La majorité des personnes interrogées (83,4%) avaient une bonne connaissance de la PTME, mais seulement 68,4% ont eu accès au HCT lors de la grossesse de référence, la peur de la stigmatisation étant citée comme la principale raison de ne pas pratiquer le HCT. Seulement 54,5% des participantes séropositives ont pris des médicaments antirétroviraux (ARV) pendant la grossesse, bien qu'elles aient toutes utilisé des ARV pendant le travail/l'accouchement. L'utilisation des services de PTME du VIH était significativement associée au niveau d'instruction et à la profession. CONCLUSION: Il y avait une bonne connaissance de la PTME mais l'utilisation des services était sous-optimale. La formation et l'encadrement des agents de santé dans les établissements privés sur les programmes de dépistage du VIH sont importants pour améliorer l'utilisation des services de PTME et dissiper les craintes de stigmatisation parmi les femmes enceintes. Mots clés: Médicaments antirétroviraux, séropositifs, transmission mère-enfant, femmes enceintes, hôpitaux privés.

Effectiveness of data collection and information transmission process for disease notification in Anambra State, Nigeria.

BACKGROUND: Disease surveillance and notification (DSN) has been shown to be weak in Nigeria, thus, its inability to promptly detect and control epidemics. OBJECTIVE: To examine the completeness and timeliness of data collection and information transmission process for DSN in the Anambra state. MATERIALS AND METHODS: The study was of cross-sectional design and employed the multistage sampling method to select 270 health workers who are involved in DSN in Anambra state. Data were collected by a mix method of interviewer administered questionnaire and observational checklist preceded by key informant interviews and desk review. RESULTS: One hundred (43.9%) health workers reported regular supply of Integrated Disease Surveillance and Response (IDSR) forms, 25% and 16.2% reported it was irregular and usually out of stock, respectively. Most facilities (81.5%) returned completed forms monthly. Secondary health facilities were less likely to submit completed forms, while majority of primary health facilities submitted theirs monthly ( X 2 = 4.42, P = 0.035). With respect to correctness of records, Health Management Information System records (55.6%) were the least correct, while out-patient register (88.9%) was the most correct. Only 10.0% of health facilities submitted completed forms 5 days after completion, 88.9% of them submitted completed IDSR002 forms within 2 days of completion, while the remainder was submitted 4 days later. CONCLUSION: The health workers were not operating the DSN system in the State to optimal functionality. Recommendations were therefore made for the periodic training-retraining of health personnel on DSN, improved funding, provision of logistics, improved supervision, and feedback of information.

Effectiveness of Data Collection and Information Transmission Process for Disease Notification in Anambra State; Nigeria

Background: Disease surveillance and notification (DSN) has been shown to be weak in Nigeria; thus; its inability to promptly detect and control epidemics.Objective: To examine the completeness and timeliness of data collection and information transmission process for DSN in the Anambra state.Materials and Methods: The study was of cross-sectional design and employed the multistage sampling method to select 270 health workers who are involved in DSN in Anambra state. Data were collected by a mix method of interviewer administered questionnaire and observational checklist preceded by key informant interviews and desk review.Results: One hundred (43.9) health workers reported regular supply of Integrated Disease Surveillance and Response (IDSR) forms; 25 and 16.2 reported it was irregular and usually out of stock; respectively. Most facilities (81.5) were the least correct; while out-patient register (88.9) was the most correct. Only 10.0 of health facilities submitted completed forms 5 days after completion; 88.9 of them submitted completed IDSR002 forms within 2 days of completion; while the remainder was submitted 4 days later.Conclusion: The health workers were not operating the DSN system in the State to optimal functionality. Recommendations were therefore made for the periodic training-retraining of health personnel on DSN; improved funding; provision of logistics; improved supervision; and feedback of information

The effect of age on knowledge of HIV/AIDS and risk related behaviours among army personnel.

BACKGROUND: HIV/AIDS has been described as the fourth largest cause of death globally and leading cause of death in Africa∙HIV/AIDS has been a devastating inferno for nearly 30 years, and has particularly impacted countries in sub-Saharan Africa∙In most African countries, it has been reported that the HIV infection amongst the military has been shown to be about 2 to 5 times higher than their civilian counterparts. OBJECTIVE: To address the knowledge level of HIV/AIDS and risk-related behaviours in military personnel, a well-described high risk groups for HIV/AIDS. METHODS: A cross-sectional study among army personnel in 82 Division Nigerian Army Headquarters Enugu, which has a population of about 1777. A random sampling in all the departments of 82 Division Nigerian Army Headquarters was done using the ballot method to select the respondents. Approval for the study was obtained from the General Officer in Command (GOC) of the 82 Division Nigerian Army Headquarters Enugu. RESULTS: There were no significant differences between the risk related behavior variables when comparisons were made between those under 30 years, and those 30 years and above. Furthermore, more respondents under 30 years (48.0%) did not seek medical treatment when infected with another STI before having sex again as against 45% of those above 30 years. Most of the respondents (9.1%) under the age of 30 years believed that HIV/AIDS could be contracted through mosquito bites as against 2.8% of those above 30 years. CONCLUSION: The knowledge level of HIV/AIDS among the army personnel was high, though misconceptions about transmission modes like getting HIV through the bites of mosquitoes and casual body contacts were noted, especially among those under 30 years of age.

Some behavioural risk factors for intestinal helminthiasis in nursery and primary school children in Enugu, south eastern Nigeria.

UNLABELLED: The objective of this study was to determine some common behavioural risk factors for intestinal helminthiasis in nursery and primary school children in Enugu. DESIGN: A cross-sectional survey on 460 children attending nursery and primary schools in Enugu was carried out in 2003 with a view to determine some behavioural risk factors for intestinal helminthiasis. SETTING: This study was carried out in the research laboratory of the Federal Ministry of Health, National Arbovirus and Vector Research Centre, Enugu. METHOD: Intestinal helminthiasis was diagnosed using the kato-katz method in analysing fresh stool samples collected from nursery and primary school children in Enugu. These fresh stool samples were collected into appropriately labeled clean containers. Questionnaires were administered by the researchers to obtain data from the children and their parents or guardians as regards some behavioural risk factors for intestinal helminthiasis. RESULTS: The results from this study showed that the prevalence of intestinal helminthiasis was significantly affected by various behavioural risk factors. The rate of helminthic infection varied significantly with hand washing habits after defeacation (chi2 = 75.77; df= 2; p = 0.001) and with different habits of washing fruits before eating (chi2 = 52.79; df=2; p = 0.001) among the pupils. Also, the rate ofhelminthic infection varied significantly with the source of drinking water (chi2 = 55.12; df = 3; p = 0.01), water boiling habits (chi2 = 40.89; df = 2; p = 0.001), use of footwear after school hours (chi2 = 30.72; df = 2; p = 0.001). Sites utilized for defeacation by the pupils (chi2 = 80.25; df=3; p = 0.001) also significantly influenced the rate ofhelminthic infection. CONCLUSION: Various behavioural factors which significantly affect the rate of helminthic infection abound in children living in Enugu. The government should give attention to the control of these behavioural risk factors. A lot of health education will be needed to curb the poor personal hygienic habits which are obvious risk factors for intestinal helminthiasis.

The effects of health education on knowledge and attitudes to emergency contraception by female students of a tertiary educational institution in Enugu, South East Nigeria.

This was an intervention study to assess the effects of health education on the knowledge and attitudes to emergency contraception (EC) by female students of University of Nigeria in southeast Nigeria. A structured questionnaire was used to collect data from 337 female students of a tertiary educational institution (150 in the study group and 187 from the control group) who were selected by multistage sampling. Subsequently, health education was conducted only among students in the study institution. Three months after this intervention, its effects were assessed through a survey using the same structured questionnaire employed in the baseline survey. Unlike the pre-intervention results, knowledge of EC was significantly higher among the study group than the controls. Attitudes to EC were also more favourable at the post- intervention survey among the study group. Health education can effectively improve knowledge and attitudes to EC among female students of tertiary institutions and this should be encouraged.

Evaluation of Sexual Maturity among Adolescent Male Sickle Cell Anaemia Patients: the Usefulness of Testicular Volume Estimation

Use of Tanner stages i.e. Sexual Maturity Rating; (SMR); in evaluation of sexual maturity has gained widespread acceptance. Tanner staging assesses pubic hair growth and increase in genital sizes; the latter of which is best reflected by the increase in testicular size. Testicular volume increases is thought to be the most sensitive clinical indication of onset and progress of puberty. It has been argued that the initial stage of sexual development may be missed if testicular volume is not assessed. We explored usefulness of testicular volume estimation for assessing sexual maturity among adolescent male sickle cell anaemia (SCA) patients. Methods: We conducted a cross-sectional case-control study evaluating sexual maturation of male patients with sickle cell anaemia and those with HbAA genotype. Tanner staging and testicular volume assessment were both used as models for evaluating stages of sexual maturation among SCA patients and their normal counterparts matched for age and socioeconomic status. Results: SCA patients demonstrated delay in onset and completion of sexual maturation. Testicular volumes (TV) of subjects were smaller than those of controls but when related to stages of sexual maturity; there was no statistically significant difference between both groups. The correlation coefficients between various stages of sexual maturity and TV suggest strong associations. Conclusion: Testicular volume increase is shown as a reasonably good predictor of onset and progression of sexual maturity in both SCA subjects and their healthy controls

Basal insulin resistance and secretion in Nigerians with type 2 diabetes mellitus.

AIM: The objective of this study was to estimate basal insulin resistance (IR) and insulin secretion (IS) in Nigerians with type 2 diabetes mellitus (T2DM). METHODS: The homeostasis model assessment (HOMA) method was used to estimate basal IR and IS in 146 Nigerians with T2DM and in 33 controls at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Correlations and multiple regression analysis between Box-Cox-transformed IR and log-transformed IS and anthropometric indices were carried out. RESULTS: IR and reduced IS were present, respectively, in 139 (95.5%) and 109 (74.7%) of the diabetic subjects and in 25 (75.8%) and 4 (12.1%) of the controls. In the diabetic subjects, age at diagnosis, duration of diabetes, waist circumference (WC), and body mass index (BMI) correlated significantly with IR (r = -0.2399, P = 0.0035; r = 0.1993, P = 0.0166; r = 0.2267, P = 0.0059; r = 0.2082, P = 0.0120; respectively), whereas duration of diabetes, WC, and BMI correlated significantly with IS (r = -0.2166, P = 0.0091; r = 0.3062, P = 0.0002; r = 0.2746, P = 0.0008; respectively). Age at diagnosis, WC, and duration of diabetes were significant predictors of IR (beta = -0.0161, P < 0.001; beta = 0.0121, P = 0.002; beta = 0.0138, P = 0.042; respectively), whereas duration of diabetes and WC significantly predicted IS (beta = -0.0159, P = 0.025; beta = 0.0155, P < 0.001). CONCLUSIONS: This study shows that both IR and reduced IS are major features of T2DM in Nigerians and that WC consistently correlated and predicted IR. WC measurement is simple and ideal in resource-poor settings for the detection of IR and abdominal obesity. The apparent rarity of coronary heart disease (CHD) in black Africans with T2DM despite a high prevalence of IR warrants further investigation.

Management of primary congenital glaucoma by trabeculectomy in Nigeria.

AIM: To review the management of congenital glaucoma, bearing in mind the limited facilities available in developing countries. METHODS: The medical records of children aged < or = 3 years with primary congenital glaucoma seen at two teaching hospitals and one private eye hospital in Enugu, Nigeria over a 5-year period were reviewed retrospectively. All the children underwent trabeculectomy without use of anti-metabolites. RESULTS: Fifty-seven eyes of 32 patients (5 unilateral, 26 bilateral) were reviewed. Pre-operatively, 63.2% of the eyes had a corneal diameter of 12-15 mm. After surgery, the number with corneal haziness decreased from 25 (43.8%) to 15 (26.4%) (p=0.05). The mean (SD) pre-operative intra-ocular pressure (IOP) was 28.3 (7.5) mmHg and the mean post-operative IOP was 17 (5.6) mmHg (p=0.001). CONCLUSIONS: When facilities for other treatment modalities are not available, primary trabeculectomy without the use of anti-metabolites can be employed to manage primary congenital glaucoma.

Cardiac risk indices of staff of Federal University Of Technology Owerri, Imo State, Nigeria.

Non-communicable diseases are the major health burden in the industrialized countries and are increasing rapidly in the developing countries owing to demographic transitions and changing lifestyles among the people. Cardiovascular diseases (CVD) are increasingly becoming a great cause of morbidity and mortality. A total of 100 senior and 141 junior staff in Federal University of Technology, Owerri (FUTO), Imo State, Nigeria was randomly selected for a study on cardiac risk factors. A questionnaire was used to record cardiac risk indices like age, heredity, body mass index (BMI), tobacco smoking, exercise, serum cholesterol estimation, systolic blood pressure and sex. There was no significant difference between the senior and junior staff in sex distribution (P = 0.71), family history of CVD (P = 0.34), smoking habit (P = 0.85) and serum cholesterol (P = 0.89). Senior staff had significantly higher values in age distribution (P < 0.001), presence of systolic hypertension (P<0.001) and overweight (P < 0.001). Senior staff workers, were however, significantly less involved in moderate exercise than junior staff (P < 0.001). The senior staff had a significantly higher total score in CVD risk scoring than junior staff (chi2 = 7.25; P = 0.01). In conclusion, the risk of CVD among staff of FUTO is high especially among the senior staff. Health education campaign targeted at improving life style is strongly recommended.

Teachers' attitude is not an impediment to adolescent sexuality education in Enugu, Nigeria.

Studies have shown that adolescents in Nigeria have poor knowledge of reproductive health issues and that there was a need to provide them with correct broad-based information on reproductive health as part of a nationally-approved school curriculum. However, the non-application of the curriculum on sexuality education in many secondary schools in Nigeria has been blamed on a negative attitude of teachers. This study was undertaken to determine the attitude of secondary school teachers in Enugu, South-eastern Nigeria, to adolescent sexuality education and to determine whether this depends on their socio-demographic characteristics. A cross-sectional study of the attitude of teachers to adolescent sexuality education was done. A total of 249 teachers were studied. Their mean age was 38.7 years +/- 8.08 SD. Two hundred and ten teachers (84%) were females. Two hundred and twenty-four teachers (90%) were married and 168 (67.5%) were of Roman Catholic faith. The awareness of reproductive health activities was high. There was a high proportion of respondents who approved of sexuality education for adolescents (77.5%) and an equally high proportion who believed that it was important (89%). One hundred and ninety-eight (79%) of the respondents were willing to teach sexuality education. The attitude to sexuality education was independent of religion, sex or marital status (p>0.05). It was concluded that secondary school teachers in Enugu urban were willing to offer sexuality education to adolescents under their care irrespective of their religion, sex or marital status. It is, therefore, recommended that teachers in Enugu be given the necessary special training in the teaching of sexuality education now and that sexuality education be officially incorporated into the school curriculum in Enugu, preferably as part of moral studies.

Spectrum of paediatric malignancies in eastern Nigeria (1989-1998).

A 10-year retrospective survey of childhood malignancies in eastern Nigeria was carried out based on data from the University of Nigeria Teaching Hospital Cancer Registry. The aim was to discover the current pattern of paediatric malignancies in the study area. A total of 313 children aged less than 15 years, diagnosed with cancer by means of histological or cytological examination during the study period (January 1989-December 1998) were analyzed. The male-to-female ratio was 1.6:1. The lymphomas constituted the highest prevalence (38.3%) with Burkitt's lymphoma being the commonest (65.8%) of all the lymphomas. These were followed by sarcomas (14.7%), nephroblastoma (14.4%), retinoblastoma (12.1%) and leukaemias (8.6%). The less common ones were teratomas (2.9%) and neuroblastoma (1.9%). Comparison of two clinicopathological studies of childhood cancer in Enugu between 1976-1980 and 1989-1998 showed an increase in the relative frequencies of sarcomas, retinoblastoma, leukaemias and a decline in the frequencies of Burkitt's lymphoma, nephroblastoma, teratomas and neuroblastoma. Further epidemiological studies are necessary in order to determine whether these changes actually reflect the distribution of childhood cancer in the general population and also to elicit the possible mechanisms of carcinogenesis.