Knowledge and use of asthma control measurement tools in the management of asthma: a survey of doctors working in family and internal medicine practice in Nigeria.

Objective: To investigate the knowledge and use of asthma control measurement (ACM) tools in the management of asthma among doctors working in family and internal medicine practice in Nigeria. Method: A questionnaire based on the global initiative on asthma (GINA) guideline was self-administered by 194 doctors. It contains 12 test items on knowledge of ACM tools and its application. The knowledge score was obtained by adding the correct answers and classified as good if the score ≥ 9, satisfactory if score was 6-8 and poor if < 6. Results: The overall doctors knowledge score of ACM tools was 4.49±2.14 (maximum of 12). Pulmonologists recorded the highest knowledge score of 10.75±1.85. The majority (69.6%) had poor knowledge score of ACM tools. Fifty (25.8%) assessed their patients’ level of asthma control and 34(17.5%) at every visit. Thirty-nine (20.1%) used ACM tools in their consultation, 29 (15.0%) of them used GINA defined control while 10 (5.2 %) used asthma control test (ACT). The use of the tools was associated with pulmonologists, having attended CME within six months and graduated within five years prior to the survey. Conclusion: The results highlight the poor knowledge and use of ACM tools and the need to address the knowledge gap.

Relationship between religiosity, religious coping and socio-demographic variables among out-patients with depression or diabetes mellitus in Enugu, Nigeria.

Background: Religion is a powerful coping strategy. Diabetes and depression are common conditions in our environment that induce psychological distress, thus requiring coping for better outcome. Studies indicate that increased religiosity is associated with better outcome in clinical and general populations. Therefore, studies of the distribution of religiosity and religious coping among these populations are essential to improve outcome. Objectives: To assess the association between religiosity, religious coping in depression and diabetes mellitus, and selected sociodemographic variables (age, gender and occupational status). Methods:Using simple random sampling we recruited 112 participants with diabetes and an equal number with depression consecutively, matching for gender. Religiosity was determined using religious orientation scale (revised), religious coping with brief religious coping scale and socio-demographic variables with a socio-demographic questionnaire. Results: Intrinsic religiosity was greater among older people with depression than among older people with diabetes(t=5.02,p<0.001); no significant difference among young people with depression and diabetes(t=1.47,p=0.15).Positive religious coping was greater among older people with depression than among older people with diabetes(t=2.31,p=0.02); no difference among young people with depression and diabetes(t=0.80,p=0.43). Females with depression had higher intrinsic religiosity scores than males with depression(t=3.85,p<0.001); no difference in intrinsic religiosity between females and males with diabetes(t=0.99,p=0.32).Positive religious coping was greater among participants with diabetes in the low occupational status(t=2.96,p<0.001) than those in the high occupational status. Conclusion: Religion is indeed a reliable coping method, most commonly used by the elderly and females with depression. Positive religious coping is more common among diabetic patients who are in the low occupational status.

Factors affecting vaccine handling and storage practices among immunization service providers in Ibadan, Oyo State, Nigeria.

Background: Improper handling has been identified as one of the major reasons for the decline in vaccine potency at the time of administration. Loss of potency becomes evident when immunised individuals contract the diseases the vaccines were meant to prevent. Objective: Assessing the factors associated with vaccine handling and storage practices. Methods: This was a cross-sectional study. Three-stage sampling was used to recruit 380 vaccine handlers from 273 health facilities from 11 Local Government areas in Ibadan. Data was analysed using SPSS version 16 Results: Seventy-three percent were aware of vaccine handling and storage guidelines with 68.4% having ever read such guidelines. Only 15.3% read a guideline less than 1 month prior to the study. About 65.0% had received training on vaccine management. Incorrect handling practices reported included storing injections with vaccines (13.7%) and maintaining vaccine temperature using ice blocks (7.6%). About 43.0% had good knowledge of vaccine management, while 66.1% had good vaccine management practices. Respondents who had good knowledge of vaccine handling and storage [OR=10.0, 95%CI (5.28 – 18.94), p < 0.001] and had received formal training on vaccine management [OR=5.3, 95%CI (2.50 – 11.14), p< 0.001] were more likely to have good vaccine handling and storage practices. Conclusion: Regular training is recommended to enhance vaccine handling and storage practices.

Five years retrospective cohort analysis of treatment outcomes of TB-HIV patients at a PEPFAR/DOTS Centre in South Eastern Nigeria.

Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment of patients. Objectives: The aim of this study was to assess treatment outcomes of a cohort of smear positive TB-HIV co-infected patients over a five-year study period. Methods: A retrospective cohort study of 600 smear-positive tuberculosis patients registered at the chest unit of the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2012 was done. The data was analyzed using SPSS Version 17. Results: One hundred and three (17.2%) of the patients were co-infected with TB/HIV, while 398 (66.3%) and 99 (16.5%) were HIV negative and unknown respectively. Among the co-infected patients, 45(43.7%) were cured as against 222(55.8%) in the TBHIV negatives (Z=4.53, p=0.000, 95%CI= 0.12-0.34). Respectively in the TB-HIV co-infected and TB-HIV negative patients, treatment completed were 21(20.4%) and 71(17.8%) (Z=9.15, p=0.000, 95%= 0.4035-0.60); defaulted 19(18.5%) vs 70 (17.6%) (Z=9.29, p=0.000, 95%CI=0.42-0.60), died 10(9.7%) vs. 6(1.5%) (Z=1.22, p=0.224, 95%CI= -0.0286-0.1086), and failures were 1(0.9%) vs. 7(1.8%) (Z=2.48, p=0.013, 95%CI=0.04-0.10). Treatment success rate was lower in TB-HIV co-infected patients, 64.1% compared to TB-HIV negative patients with 73.6%. Also those that defaulted among the TB-HIV co-infected patients (18.5%) were higher than 17.6% among TB-HIV negative patients, a difference of 0.9%. Conclusion: Findings demonstrate that HIV co-infection affects TB treatment outcomes adversely. Treatment adherence, timely and sustained access to antiretroviral therapy for TB/HIV co-infected patients are important.

Population genomics diversity of Plasmodium falciparum in malaria patients attending Okelele Health Centre, Okelele, Ilorin, Kwara State, Nigeria.

Background: Plasmodium falciparum, the most dangerous malaria parasite species to humans remains an important public health concern in Okelele, a rural community in Ilorin, Kwara State, Nigeria. There is however little information about the genetic diversity of Plasmodium falciparum in Nigeria. Objective: To determine the population genomic diversity of Plasmodium falciparum in malaria patients attending Okelele Community Healthcare Centre, Okelele, Ilorin, Kwara State. Methods: In this study, 50 Plasmodium falciparum strains Merozoite Surface Protein 1, Merozoite Surface Protein 2 and Glutamate Rich Protein were analysed from Okelele Health Centre, Okelele, Ilorin, Nigeria. Genetic diversity of P. falciparum isolates were analysed from nested polymerase chain reactions (PCR) of the MSP-1 (K1, MAD 20 and RO33), MSP-2 (FC27 and 3D7) and Glutamate Rich Protein allelic families respectively. Results: Polyclonal infections were more in majority of the patients for MSP-1 allelic families while monoclonal infections were more for MSP-2 allelic families. Multiplicity of infection for MSP-1, MSP-2 and GLURP were 1.7, 1.8 and 2.05 respectively Conclusion: There is high genetic diversity in MSP – 2 and GLURP allelic families of Plasmodium falciparum isolates from Okelele Health Centre, Ilorin, Nigeria.

Stroke in patients with diabetes mellitus: a study from North Western Nigeria.

Background: Stroke is one of the major causes of morbidity and mortality worldwide and apart from being exceedingly harmful in diabetics, stroke is a disabling disorder. The study was undertaken to describe the clinical characteristics, outcome pattern and predictors of mortality in a cohort of diabetic patients presenting with stroke in two tertiary health facilities in North Western Nigeria. Method: Out of all stroke patients seen from June 2007 to February 2011, persons with diabetes mellitus presenting with stroke in the emergency unit of the two tertiary hospitals in Kano were consecutively recruited for the study. Classification of stroke into hemorrhagic and infarctive subtypes was based on brain computerized tomography (CT), brain magnetic resonance imaging (MRI) and World Health Organization (WHO) criteria. Follow-up period was for thirty days. Result: Out of the five hundred and thirty six stroke patients seen during the study period, 85 (15.9%) patients, comprising 48 (56.5%) males, had diabetes. Thirty eight (44.7%) of the identified diabetics were previously undiagnosed. Sixty four (75.3%) had infarctive stroke. One-month case fatality rate was 30.6%. Factors associated with death included male sex, past history of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening GCS. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in the patients. Conclusion: In DM patients studied, infarctive stroke was more common, case fatality was 30.6%. Male gender, past history of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening Glasgow Coma Score (GCS) were associated with mortality. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in diabetic patients.

Semiparametric modeling of the spatial distribution of occupational accident risk in the casual labor market, Piracicaba, southeast Brazil

The objective of this study was to estimate the spatial distribution of work accident risk in the informal work market in the urban zone of an industrialized city in southeast Brazil and to examine concomitant effects of age, gender, and type of occupation after controlling for spatial risk variation. The basic methodology adopted was that of a population-based case-control study with particular interest focused on the spatial location of work. Cases were all casual workers in the city suffering work accidents during a one-year period; controls were selected from the source population of casual laborers by systematic random sampling of urban homes. The spatial distribution of work accidents was estimated via a semiparametric generalized additive model with a nonparametric bidimensional spline of the geographical coordinates of cases and controls as the nonlinear spatial component, and including age, gender, and occupation as linear predictive variables in the parametric component. We analyzed 1,918 cases and 2,245 controls between 1/11/2003 and 31/10/2004 in Piracicaba, Brazil. Areas of significantly high and low accident risk were identified in relation to mean risk in the study region (p < 0.01). Work accident risk for informal workers varied significantly in the study area. Significant age, gender, and occupational group effects on accident risk were identified after correcting for this spatial variation. A good understanding of high-risk groups and high-risk regions underpins the formulation of hypotheses concerning accident causality and the development of effective public accident prevention policies.

Select toxic metals status of pregnant women with history of pregnancy complications in Benin City, South-South Nigeria.

Toxic metals are part of the most important groups of environmental pollutants that can bind to vital cellular components and interfere with their functions via inhalation, foods, water etc. The serum levels of toxic metals (lead, mercury, cadmium and arsenic) in pregnant women with history of pregnancy complications, pregnant women without history of pregnancy complication and non-pregnant women in Benin City, South – South Nigeria was investigated in this paper, with total of 135 healthy women comprising of 45 pregnant women with history of previous pregnancy complications, 45 pregnant women without history of pregnancy complications and 45 non-pregnant women without history of pregnancy complications (controls). Some demographic characteristics and 4ml of blood samples were obtained from each subject for the analysis of lead, mercury, cadmium and arsenic by standard methods. Pregnant women with history of pregnancy complications recorded a highly significant increase in the toxic metal (lead) mean value of 25.81μg/dl as against 23.70μg/dl for pregnant women without history of pregnancy complications and 11.23μg/dl for non-pregnant (control) women without history of pregnancy complications as well as significant increases in the mean values of other toxic metals (mercury, cadmium and arsenic) compared with controls (p<0.001). The selected toxic metals (Pb, Hg, Cd and As) may be involved in the development of pregnancy complications among pregnant women in Benin City, South– South Nigeria. Lead in particular may pose threat to mothers and fetuses as its mean values in the two groups of pregnant women were well above normal.

Effect of Cocoa ( Theobroma cacao ) Plantation Types on the Distribution of Anuran Communities in Ore, Ondo State, Nigeria

Anuran species diversity and abundance were evaluated in different farming status of cocoa plantation in Ore, Ondo State, Nigeria. Applying the combination of visual encounter survey (VES) and acoustical survey (AES), the different farms surveyed were categorized as; 1) pure cocoa farms with pesticides applied (PCWP); 2) pure cocoa farms without pesticides application; 3) intercropped cocoa farms with pesticides applied (ICWP); and 4) intercropped cocoa farms without pesticides application (ICNP). The surrounding primary/secondary forest (PSFV) was sampled applying the transect method. A mean total of 690±2.6 anurans belonging to 28 species, 14 genera and 9 families were recorded during the study. Out of these, 10, 19, 17, 22 and 26 species were recorded respectively from PCWP, PCNP, ICWP, ICNP and PSFV. The anuran species richness was significantly different between the different cocoa plantation status and the forest sites (F4, 10 = 20.55, P< 0.01). The highest mean number of individuals (190±9.5) was observed at ICNP followed by PSFV (183±5.7), while the least was at PCWP (77±8.0). There was also significant difference (F4, 10 = 150.48, P< 0.01) between the abundance of anuran species at the various sites. Diversity indices (Shannon and Margalef) showed that the forest sites had the greatest (3.204 and 4.799) respectively while the pesticide using pure cocoa farms had the least (1.853 and 2.072). Generally, the result of the study clearly indicated that pesticide use cocoa farms were significantly lower compared to other sites. Farmers are encouraged to engage in intercropping (polyculture) especially with food and economic crops in a biodiversity friendly manner which could have similar characteristics of a natural ecosystem, thereby enhancing the biological diversity of agro-ecosystems.

Geological Characterisation of Depleted Oil and Gas Reservoirs for Carbon Sequestration Potentials in a Field in the Niger Delta, Nigeria

The injectivity, containment and storage capacity of sandstone reservoirs in a field in the Coastal Swamp depobelt of the onshore eastern Niger Delta were evaluated using wireline logs and seismic data to assess their potentials for carbon dioxide storage and geosequestration. The reservoir formation consists of multilayered alternating beds of sandstone and shale cap rocks. Active seismicity and fracturing intensity are low and growth faults provide the reservoir sealing mechanisms. Three reservoirs were delineated at depths between 3319 m and 3539 m which will keep injected CO2 in a supercritical state. The reservoir depth of at least 800 m, porosity and permeability of more than 10 percent and 20 mD, and a caprock thickness of at least 10 m, in addition to geothermal gradients of 13.46 to 33.66 ºC /km are the ideal conditions for the efficacy of storage. Comparison of the derived reservoir and seal properties such as porosity, permeability, thickness and depth with the minimum recommended site selection criteria shows that the reservoirs are potential candidates for carbon geosequestration with a total theoretical storage capacity of 147MM tons.

Organic Matter Removal from Piggery Wastewater in Waste Stabilisation Pond in Nigeria

Four (4) wastewater quality variables: chemical oxygen demand (COD), total solid (TS), total dissolved solid (TDS), and total suspended solid (TSS) were determined. Analysed samples comprises of raw influent and effluents entering and leaving the stabilisation ponds. Significant reduction in variables were obtained, maximum and minimum values obtained for COD were 917mg/l (anaerobic pond), and 13mg/l (maturation pond). For TS, TDS and TSS, maximum and minimum values obtained were 14,420mg/l, 9,180mg/l, 5,240mg/l and 3,398mg/l, 3,120mg/l, 278mg/l respectively. Removal efficiencies recorded for parameters in final effluent (maturation pond) were 98.55% (COD), 76.44% (TS), 66.01% (TDS), and 94.69% (TSS) respectively.

Physicochemical properties of water quality of Imeh, Edegelem and Chokocho communities located along Otamiri-oche River in Etche Ethnic Nationality of Rivers State, Nigeria

Some physiochemical properties of water quality of Otamiri-oche River which runs through Imeh, Edegelem and Chokocho Communities in Etche ethnic nationality of Rivers State, Nigeria were investigated. Samples were collected in triplicate from the three different locations along the river in both rainy and dry seasons. Each sampling points is located 500m away from the successive one, and the samples were taken from the open river at the zone extending beyond the shoreline. Samples were stored in ice packs and immediately taken to the laboratory to investigate some selected physico-chemical characteristics. Also, bacteriological study was carried out on the samples. The laboratory results of the selected physico-chemical parameters when compared with the world health organization (WHO) standard showed that all the selected physico-chemical parameters were within the world health organization (WHO) permissible in both rainy and dry season except pH. For rainy season, the pH values were 5.00±0.00, 5.40 ±0.40, and 5.40± 0.30 for Imeh, Edegelem and Chokocho respectively. For the dry season, the pH values were 5.83± 0.01, 5.56±0.01, 5.90±0.01 for Imeh, Edegelem and Chokocho respectively. Also magnesium hardness exceeded the World Health Organization (WHO) permissible limit in rainy season only. The results of bacteriological study showed that all the sampling locations contained high numbers of coliform bacteria in both rainy and dry seasons. The number of coliform bacteria during rainy season was 25.00±0.00, 25.00±0.00, and 35.00±0.00 for Imeh, Edegelem and Chokocho respectively. Those of dry season were 93.00±3.55, 56.66±4.49, and 35.60±4.17 for Imeh, Edegelem and Chokocho respectively. The difference between the rainy and dry season was tested statistically using the t-test. The results of the statistical analyses showed a significant difference (p<0.05) between the rainy and dry seasons.

Impact of Hypoxia on the Community Structure of Benthic Macroinvertebrates of Lagos Lagoon, Nigeria

Study of the Lagos lagoon was conducted for two years to investigate the impact of hypoxia on the benthic macroinvertebrates. Water and benthic samples were collected monthly along the study stretch and analysed in a standard laboratory. Temporal variation in water physico-chemistry was largely controlled by rainfall pattern while the spatial variation was influenced by proximity to the Harbour as well as the pollution sources and types. A total of 3,159 individuals comprising three phyla, five classes, nineteen families and twenty three species were recorded. Iddo I, Iddo II, Ogudu and Agboyi study stations recorded very low individuals, but relatively high number of polychaetes. Benthic macro- invertebrate community was dominated by the molluscs. Margalef’s index of species richness ranged from 0.79 to 2.57 while Shannon-Wiener index ranged from 0.40 to 2.19. Species evenness index ranged from 0.29 to 0.80. There was generally low biodiversity indicating the stressed nature of the study area.

Ambient Air Quality Monitoring in Metropolitan City of Lagos, Nigeria

Twenty one sampling locations were assessed for carbon monoxide (CO), carbondioxide (CO2), oxygen (O2), sulphur dioxide (SO2), nitrogen dioxide (NO2), nitrogen oxide (NO), suspended particulate matter (SPM) and noise level using air pollutants measurement methods approved by ASTM for each specific parameter. All equipments and meters were all properly pre-calibrated before each usage for quality assurance. Findings of the study showed that measured levels of noise (61.4 - 101.4 dBA), NO (0.0 - 3.0 ppm), NO2 (0.0 - 3.0 ppm), CO (1.0 – 42.0 ppm) and SPM (0.14 – 4.82 ppm) in all sampling areas were quite high and above regulatory limits however there was no significant difference except in SPM (at all the sampling points), and noise, NO2 and NO (only in major traffic intersection). Air quality index (AQI) indicates that the ambient air can be described as poor for SPM, varied from good to very poor for CO, while NO and NO2 are very good except at major traffic intersection where they were both poor and very poor (D-E). The results suggest that strict and appropriate vehicle emission management, industrial air pollution control coupled with close burning management of wastes should be considered in the study area to reduce the risks associated with these pollutants.