Center In Nigeria Research Articles

Review of Echocardiographic reports of children undergoing noncardiac surgery in a tertiary health center in Nigeria

Background: The risk of cardiac anomalies, both acquired and congenital, is high in children undergoing noncardiac surgeries. These cardiac anomalies are associated with increased risk of perioperative complications. Objectives: This study, therefore, determined the common indications as well as the echocardiographic findings findings in children undergoing noncardiac surgery in Aminu Kano Teaching Hospital (AKTH), Kano. Materials and Methods: This is a retrospective descriptive study. The echocardiographic records of 25 children that underwent noncardiac surgery in AKTH over a 4 year period (from January 2015 to December 2018) were retrieved. The data obtained were analyzed using SPSS version 20 and the result was displayed using a frequency distribution table and bar chart. Results: There were 14 males and 11 females, with male to female ratio of 1.3:1. The ages of the patients range from 5 days to 8 years (median age of 8 months). The most common indication for echocardiography is orofacial cleft (cleft lip and/or palate), followed by adenotonsillar hypertrophy. The overall cardiac anomaly was found in 28% of the patients, with the highest anomaly being the atrial septal defect. Conclusion: The prevalence of cardiac anomaly was high in children with noncardiac surgical conditions.

Endoscopy for upper gastrointestinal bleeding in a tertiary hospital in Kaduna, North-West Nigeria: Experience and findings.

Upper gastrointestinal bleeding (UGIB) is a common medical emergency and upper gastrointestinal endoscopy (UGIE) makes diagnosis and treatment possible; performing this procedure within 24 h of bleeding is considered the standard of care for managing this condition. Access to upper endoscopy improves the prognosis of the disease. We present our experience and findings of performing UGIE in patients referred for UGIB to a new endoscopy unit in a tertiary center in North-West Nigeria. The age, gender, reasons for referral, interval between endoscopy, and last known episode of bleeding and endoscopic findings were obtained from endoscopy records. We performed UGIE in 204 patients for UGIB over a 7-year period: Mean age 45.5 years (range 10-88 years), 61.8% male, 54.8% <50 years. Most patients (81.3%) had endoscopy seven or more days after the last known episode of bleeding and none had endoscopy within 24 h. Esophageal and gastric varices were found in almost 30% of patients while peptic ulcer disease was found in 23%. Portal hypertensive gastropathy was found in 12.7% of patients all of whom also had esophageal or gastric varices. Gastric mucosal erosions (7.4%) and gastric malignancy (6.4%) were other notable findings. No significant abnormalities were detected in 11.8% of patients. Bleeding from esophageal/gastric varices and peptic ulcer disease were the most common finding in our patients. There was delay in performing endoscopy and improving access and training for endoscopy will go a long way in addressing some of the challenges we identified.

Global and Local Upsurge in Monkey pox Epidemic: Current Trends, Challenges and Future Prospects

Amidst global relaxation of the Coronavirus Disease 2019 (COVID-19) intervention measures and celebration of the unprecedented grounds conquered in the fight against the pandemic, the monkeypox virus (MPXV) has emerged and remerged in many countries taking over major headlines around the globe at the present. Since 1 January and as of 22 June 2022, 50 nations and territories in five WHO Regions (Africa, America, Eastern Mediterranean, Europe, and Western Pacific) have reported 3413 laboratory-confirmed cases; along with one fatality. The Nigeria Centre for Disease Control (NCDC) received notice of a possible monkeypox epidemic in Bayelsa State on September 22, 2017. Thereafter, from Bayelsa to Rivers, Ekiti, Akwa Ibom, Lagos, Ogun and Cross River, the scourge of Monkeypox has continue to escalate five (5) years after the disease was first reported in Nigeria. An aggregate of 716 suspected cases have been recorded from 25 states nationwide between September 2017 and June 26, 2022. There have been 288 (40.2 percent) confirmed cases from 25 states out of the 716 suspected cases. So far, nine (9) deaths in total (CFR=3.1%) have been reported in 6 states between September 2017 and June 2022. At the moment, the following challenges are preventing the country from containing the virus effectively: 1) Low patient use of healthcare facilities because of stigma, cost, and low fatality rate; 2) Underreporting of cases due to inadequate access to healthcare facilities; 3) Low sample collection rate in reporting states; 4) Poor infectious disease laboratories support in remote areas; 5) Corruption and lack of political will by current administration to fight the virus; 6) Weak monkeypox monitoring, possibly related to a limited health workforce and the COVID 19 pandemic response; 7) A lack of international cooperation, unity, and coordination in the pursuit of establishing global health equity; and 8) Lack of access to authorized and safe treatment and vaccine among other things. Despite these challenges, a monkeypox-free Nigeria is possible. To this end, a safe and effective immunization of the public, as with smallpox, polio and yellow fever, is the key to the future. Until, a safe and effective vaccine becomes readily available, control and prevention lies largely on non-pharmaceutical intervention measures.

Perceived risk and protective behaviors related to COVID-19 among the Nigerian general population: An application of the extended parallel process model

Since the outbreak of the coronavirus disease 2019 (COVID-19), there have been heightened levels of fear worldwide. The steadily increasing number of COVID-19 cases in Nigeria as reported by the Nigerian center for Disease Control has led to different behavioral responses influenced by perceived threat and efficacy. This study aimed to understand the levels of perceived threat and efficacy to COVID-19 in Nigeria across various demographic groups using the Extended Parallel Process Model. This was a cross-sectional study conducted across all states in Nigeria, between May and June 2020. The majority of respondents were recruited via social media, with a smaller fraction interviewed face to face due to Government restrictions on movement in some states. Based on findings, respondents had high exposure to COVID-19 messages on social media (85%), followed by television (67%), radio (54%), and the Nigeria center for Disease Control short message services (52%). High exposure to COVID-19 messages across all media platforms was significantly associated with perceived severity, response efficacy, and self-efficacy (p< 0.01). Also, with an increase in age, there was a corresponding increase in the perceived susceptibility to COVID-19. As the level of education increased, respondents' perceived severity, susceptibility, self-efficacy, and response efficacy to COVID-19 increased. A chi-square test between demographic variables and intermediate outcome variables (danger or fear control process) showed a significant association with age, gender, highest educational level, and employment type. From the findings, the majority of respondents were less likely to practice the recommended protective behaviors as COVID-19 was not perceived as a threat. The proportion of the Nigerian population willing to take up recommended preventive behaviors were just 15%. Developing messages with an appropriate balance between threat and efficacy to target different audiences would likely encourage the adoption and practice of recommended COVID-19 preventive behaviors.

Descriptive Analysis of the COVID-19 Pandemic During the First and Second Waves in a North-Central State in Nigeria

Introduction: COVID-19 is a novel infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). This study was a descriptive analysis the epidemiology of COVID-19 during the first and second waves in Kwara State, North-Central Nigeria. Methods: This study investigated COVID-19 cases and deaths in Kwara State between 2nd April 2020 when Kwara State recorded her index case till the 15th of September 2020 (first wave), and between 16th September 2020 till 15th March 2021 (second wave). Case definitions of COVID-19 as obtained from the Nigeria Centre for Disease Control (NCDC) was used. Data were extracted from the case notes of patients and the Surveillance Outbreak Response Management System, and on-site activities engaged in by the field investigation team were duly captured. Results: Overall, 3015 confirmed cases of COVID-19 have been identified in Kwara State as of 15th March 2021. The median age was 38 years and ranged between 24 days to 97 years. Also, 1056 (35%) were aged 25 – 39 years, 1695 (56.2%) were males. The case fatality rate was less than 2%. A total of 1064 (35.3%) symptomatic COVID-19 cases had been identified as of the reference date, among whom 696 (65.4%) were mild, 308 (28.9%) were moderate, and 60 (5.6%) were severe/critical cases. Conclusion: COVID-19 remains a public health problem. A scale-up of COVID-19 surveillance activities should be conducted by the Ministry of Health through active case search and regular refresher training for volunteers. In addition, active community engagement should be prioritized by stakeholders in the national COVID-19 outbreak response.

Effects of COVID-19 on Neurosurgical Service: Perspective from a Tertiary Medical Center in Nigeria.

Background The outbreak of COVID-19 caused a significant impact on neurosurgical case volume in Nigeria due to the widespread recommendation to minimize elective procedures and redistribute healthcare resources to support COVID-19 patients. This study aims to analyze the effect of COVID-19 in one tertiary care Nigerian hospital on the demographic characteristics, diagnostic classes, and elective/non-elective procedure statuses. Methods A retrospective single-center chart review study was conducted to review all patients undergoing a neurosurgical procedure between March to June in 2019 and 2020. Descriptive data on patient age, gender, sex, diagnosis, surgical procedure, elective/non-elective surgery status, and month and year of admission were recorded. Diagnoses were categorized into one of seven types by author review. Pearson's Chi-Square and Fisher's Exact Tests were utilized to test for independence of the categorical variables to the year of patient admission, and a Welch two-sample t-test was used to test for a significant difference in mean age between the two cohorts. Results A total of 143 cases were reviewed. There was a 59.8% reduction in overall neurosurgical case volume with an 82% reduction in elective procedures (39 vs. 7, p = 0.017, 95% CI: 1.15 – 8.77) between 2019 and 2020. No significant differences were noted in patient cohorts when comparing demographic characteristics, diagnosis type, or month of admission between the two years. Conclusion There was a significant reduction in elective neurosurgical procedures during the early months of COVID-19 in Nigeria. Further studies should consider examining the effects of COVID-19 into 2021.

COVID-19 pandemic combating measures and competitiveness in tourism industry: moderating role of strategic dexterity

Purpose The purpose of this paper is to examine the effect of measures to combat Corona Virus Disease 2019 (COVID-19) pandemic on competitiveness in tourism in Nigeria taking strategic dexterity as the moderating variable. Design/methodology/approach Survey research design approach was used for the study. A total of 235 valid questionnaires gathered from the personnel of ten urban tourist centres in Nigeria were used to examine the goodness of model fit, measurement model and structural correlations between constructs. Partial least squares structural equation modelling approach (PLS-SEM) using Advanced Analysis for Composite (ADANCO 2.2.1) was used to evaluate the hypotheses. Findings This study finds that travel restriction, boarder closure and strategic dexterity were significant to competitiveness, among which border closures has generated the highest path coefficient. Moreover, the study finds a significant moderating role of strategic dexterity between travel restrictions, border closure and competitiveness. Future studies can reproduce the study by incorporating mediating variables covering the all-tourist centers in Nigeria. Research limitations/implications This study might be valuable for tourism-related stakeholders, researchers and policy makers as the result finds indicate strong effect of travel restrictions, border closure on competitiveness of urban tourism. Equally, the study provides new insight as the findings shows a significant moderating role of strategic dexterity between travel restrictions, border closure and competitiveness. Practical implications This study might be valuable for tourism-related stakeholders, researchers and policy makers as the result finds indicate strong effect of travel restrictions, border closure on competitiveness of urban tourism. The study provides new insight as the findings shows a significant moderating role of strategic dexterity between travel restrictions, border closure and competitiveness. Originality/value This study is among the few that analyses the effect of measures to combat COVID-19 pandemic on competitiveness in the urban tourism: strategic dexterity as the moderating variables. This study also contributes methodologically through the introduction of PLS-SEM approach.

Impact of COVID-19 on renal replacement therapy: perspective from a Nigerian renal transplant centre.

IntroductionCOVID-19 has had a huge impact on the health system and the world at large. Patients with kidney failure are a select group which have been affected significantly by the scourge of the disease. In the COVID-19 era, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation required modifications in many centres in order to maintain high quality care and reduce infection rates among this susceptible group of patients. The objectives were to describe some of the challenges experienced in one of the leading renal care centres in Nigeria during the height of the COVID-19 pandemic and analyse the impact of practice changes on select outcomes.Methodsa retrospective cross-sectional review of haemodialysis activities and kidney transplantation among chronic kidney disease patients was done over a 15-month period ranging from April, 2019 to June, 2021. Data was extracted from the electronic media record (EMR) and analysed using SPSS version 22.Resultsthere was an initial significant drop in the number of haemodialysis sessions and kidney transplant surgeries by 16.7% and 66% respectively in the first 2 months of COVID-19 in our centre following the national lockdown. The mean monthly kidney transplant rate was 9±3.29 before the COVID-19 and the national lockdown, this figure reduced to 3.0±0.1 during the lockdown. Activities however normalized at 6 months following the initial lockdowns have remarkable exceeded pre-COVID numbers as at early 2021.Conclusionafter the initial drop in numbers of patients for haemodialysis and renal transplantation, there was an increase in numbers in the following months. It was instructive to put several steps in place in order to continue to offer high level RRT in the COVID-19 pandemic. RRT can safely be practiced in the COVID-19 pandemic.

SECTORAL ANALYSIS OF CORONA VIRUS ATTACK IN NIGERIA: AN EMPIRICAL DIAGNOSIS AND SOME POLICY IMPLICATIONS

Recently the depth and extreme consequences of coronavirus in Nigeria have been alarming. In the last few months, the government has undertaken various steps by introducing certain policies that would help in reducing, if not eradicating the socio-economic implications of this novel virus outbreak in Nigeria. The study examines the implications of COVID 19 on the economic status of Nigeria using a daily time series data analysis for eighty-one days during the first heavy lockdown (27th February 2020 to 17th May 2020). The data used for the study were extracted from secondary sources: the NCDC reports, CBN reports, Nigeria Stock Exchange reports, Accuweather reports, and Bloomberg within the period of the study. The data was analyzed using the ordinary least square regression incorporating the correlation test. The study found that daily COVID 19 confirmed cases and daily FOREX rates have a negative and significant impact on daily oil price, a mirror of daily output growth whereas daily share index has a positive impact. Only the daily temperature report was insignificant but positive in the model. The study recommended that Nigerians should strongly adhere to the preventive guidelines as stipulated by the Nigeria Centre for Disease Control (NCDC) in line with World Health Organisation (WHO) recommendations.

Assessment and predictors of blood glucose levels in hypertensives attending a secondary health centre: relationship with physical activity and diet quality

The aim: this study aims to assess the prevalence of hyperglycaemia, the association between diet quality, physical exercise and blood glucose levels among hypertensives attending a secondary health centre in Nigeria. There is a paucity of data concerning these issues and the study would contribute positively to future management of the patients.&#x0D; Methods: the study was a cross-sectional study of 354 hypertensives that was conducted at the State Hospital, Oyo, Nigeria. The systematic sampling technique was used to recruit patients, and the data were analysed using SPSS software version 23. Linear regression was done to determine the predictors of hyperglycaemia, and logistic regression was done to determine the predictors of diet quality.&#x0D; Results: the mean age of the respondents was 52.60(SD±8.26) years. The prevalence of undiagnosed diabetes in this cohort was 19.60 %. The association of glycated haemoglobin (HbAic) with High Density Lipoprotein (HDL) was negative, weak in strength and statistically significant (p-value=0.034). For every 1 unit decrease in High Density Lipoprotein (HDL), there was a statistically significant increase in HbAic by about 0.383 units (95 % C.I equals -0.737 to -0.029, p-value=0.034). For every 1 unit increase in total Cholesterol, there was a significant increase in HbAic by about 0.158 units (95 % CI equals 0.007 to 0.308, p-value=0.04). Age group &lt;45 years were about 2 times less likely to have good diet quality than those of 55 years and above (OR=0.502; 95 % CI=0.270 – 0.932, p-value=0.029).&#x0D; Conclusions: the study has assisted to characterise this population of hypertensives in terms of serum glucose levels. The prevalence of hyperglycaemia was high among these hypertensives. The predictors of hyperglycaemia were HDL and Cholesterol. Also, the predictor of good diet quality was the age of the respondents

Mathematical model of measles transmission dynamics using real data from Nigeria

Measles is a highly contagious and life-threatening disease caused by a virus called morbillivirus, despite the availability of a safe and cost-effective vaccine, it remains a leading cause of death, especially in children. Measles spreads easily from person to person via infected people's coughs and sneezes. It can also be transmitted through direct contact with the mouth or contaminated surfaces. To have a better knowledge of measles epidemiology in Nigeria, we develop a deterministic mathematical model to study the transmission dynamics of the disease in the population. The boundary of the model solution is performed, both equilibrium points are calculated, and the basic reproduction number is determined. We have proved that when , the disease-free equilibrium point is both locally and globally stable. When , the endemic equilibrium point exists and is stable if it satisfies Routh–Hurwitz criteria. We demonstrate the model's effectiveness by using a real-life application of the disease spread in Nigeria. We fit the proposed model using available data from Nigeria Center for Disease Control (NCDC) from January to December 2020 to obtain the best fit, this help us to determine the accuracy of the proposed model's representation to the real-world data. We investigate the impact of vaccination rate and hospitalization of infected individuals on the dynamics of measles in the population. The result shows that the combined control strategies reduce the peak of infection faster than the single control strategy.

The Nigerian Military Public Health Response to COVID-19: A 14-Month Appraisal.

The COVID-19 pandemic has caused significant morbidity and mortality since its emergence in December 2019. In Nigeria, the government inaugurated the Presidential Task Force on COVID-19 to coordinate resources while the Nigeria Centre for Disease Control led the public health response. The Nigeria Ministry of Defence Health Implementation Programme (MODHIP), in partnership with the US Army Medical Research Directorate - Africa/Nigeria, responded immediately to the pandemic by establishing a public health emergency operations center to coordinate the military response in support of national efforts. MODHIP has 5 functional units and 6 pillars that coordinate testing, surveillance, case management, risk communication, logistics, research, and infection prevention and control. It developed an incident action plan and each pillar had its own terms of reference to guide specific response activities while preventing duplication of efforts within the military and the Nigeria Centre for Disease Control. In addition, awareness and sensitization sessions were conducted on preventive practices for COVID-19 and infrastructure was provided for hand hygiene and screening at all military facilities. Military laboratories were configured for SARS-CoV-2 testing while selected military health facilities were equipped and designated as COVID-19 treatment centers. Research proposals aimed at better understanding the disease and controlling it were also developed. The traditional combat role of the military was redirected to complement this public health emergency response. In this article, we highlight gaps, opportunities, and lessons to improve military participation in public health emergency response in the future. More funding and multisectoral collaboration with civilian institutions are key to strengthening military public health emergency preparedness and response capabilities.

Knowledge and Factors Affecting Perceived Practice of Foot Care among Patients with Diabetes Mellitus in a Federal Medical Centre in Nigeria

Diabetic foot is one of the most dreaded complications of diabetes due to the disability it presents and the repercussions on the quality of life of individuals suffering from it. This study assessed the knowledge and factors affecting the perceived practice of foot care among patient with diabetes mellitus in Federal Medical Center, Owo, Ondo State. A cross sectional design was adopted. Purposive sampling technique was used to select 150 respondents. Data was collected using a self-administered questionnaire. Data collected were analyzed using descriptive and inferential statistics with the aid of SPSS version 23. Results were presented using frequency tables and charts. Result from this study showed that 40% of the respondents had good knowledge on foot care, while 15.3% had poor knowledge on foot care. Also, 70.7% of the respondents had high level of foot care practice, while 29.3% had low level of foot care practice. Also, the study showed that the following factors affected the practice of foot care among diabetic patients: Financial weakness (65.3%); improper hospital management (82%), time frame for cleaning (52%), inadequate knowledge of foot care (66.7%), failure to get appropriate footwear (62.7%), and religious’ belief (60.7%). The study showed a significant relationship between the level of education and knowledge on foot care (X2=20.32, df =4, P=0.03), also, there was a significant relationship between knowledge and practice of foot care among respondents (X2=23.12, df=6, P=0.04). The study concluded that the level of education of the patients has a significant impact on their understanding of diabetic foot and the level of knowledge also influenced their good practice of diabetic foot.

LASSA Fever: A 1400% Fold Increase in Infection Rate among Health Care Workers in Nigeria-a Cause for Concern and a Comparative Analysis of NCDC 2021 and 2022 Situation Reports

Background: Lassa fever is an acute viral haemorrhagic illness {fever} caused by Lassa virus, which is hosted by rodents in the Mastomys natalensis species. It is found in abundance in West, East, and Central Africa. Lassa fever is caused by an arenavirus, which is a single-stranded, bisegmented RNA virus that is enclosed. Lassa fever was originally documented in 1969 in the Borno State town of Lassa in Nigeria, when two missionary nurses died of the sickness. Unfortunately, despite the fact that the first case was recorded 53 years ago, hundreds of thousands of cases are reported each year without proper epidemic preparedness and prevention strategies.&#x0D; Objectives: The study's goal is to characterize the different percentage increases in the various Lassa fever report indicators as reported by the Nigeria Centre for Disease Control (NCDC), with the goal of giving a comparative analysis of the Lassa fever report in 2021 and 2022 using the 7th week epidemiological report of 2021 and 2022.&#x0D; Methods: Data and information for this article was obtained in Nigeria Centre for Disease Control (NCDC) 7th week epidemiological situation report of 2022.&#x0D; Results: A comparison of the Lassa fever situation report for week 7 epidemiology report for 2021 and 2022 revealed a 1400 percent rise in the infection rate in health care workers in 2022 compared to the previous year, 2021. Other report indicators (suspected/confirmed cases, state and local government involvement, etc.) increased by more than 100 percent in the 2022 report compared to the 2021 report.&#x0D; Conclusion: This comparative analysis has revealed the lack of an epidemic preparation strategy for such an annual epidemic, which is eye-opening for all health care workers, administrators, and governments. As a result, establishing an emergency preparation strategy and implementing several prevention strategies (deratization, health-care training, community sensitization etc) that can lead to a reduction in the number of cases and deaths each year is critical.

Clinical and haematological determinants of outcome among children with cerebral malaria in a tertiary centre in Nigeria

Background: Many cl inicaland haematological changes occur as a result of severe malaria, of which cerebral malaria (CM) is a common entity. These changes affect virtually all organs and systems of the body. We identify various clinical and haematological determinants of outcome in CM so as to institute proactive management of such children. Methods: All children who met World Health Organization (WHO) diagnostic criteria for CM over 8 month-period were prospectively studied. The presenting symptoms and its duration, detailed physical examination and laboratory parameters were obtained. Logistic regression was employed to determine the prognostic significance of various clinical and laboratory parameters. Outcome indicators were full recovery, alive with neurological sequelae or death of the children.Results: Of the 892 children admitted into the Children Emergency Unit (CEU) over the study period, 50 (5.6%) had CM with M: F ratio of 1:1 and age range of 6 months to 12 years. Sixty percent were aged less than 5 years. The defining symptoms were fever (100%), coma (100%) and convulsion (98%). Forty-one (82%) patients survived, while nine (18%) died. Of the 41 survivors, 30 (73.2%) recovered fully, while 11 (26.8%) had neurological deficits at discharge.Identified clinical and laboratory predictors of mortality and neurological sequelae in CM included Blantyre coma score of 0-2(p = 0.018) prolonged coma recovery time &gt; 26 hours (p =0.026), abnormal breathing pattern (p = 0.0124), absent corneal reflex (p = 0.012), absent pupillary reflex (p = 0.012), depressed tendon reflex (p = 0.028), hyperreflexia (p =0.014), retinal haemorrhage (p =0.001), duration of admission (p=0.000), hyper parasitaemia (p=0.001), hypoglycemia (p= 0.014) and leucocytosis (p = 0.008). Independent determinants of immediate post-recovery neurological deficits and death were hyper-parasitaemia (OR = 8.657, p = 0.017.) and leucocytosis (OR = 1.090; p = 0.035Conclusion: CM is a potentially reversible encephalopathy associated with high mortality and sequelae. Affected children with the above listed clinical / haematological parameters especially hyperparasitemia and leucocytosis should be given proactive management to improve the outcome.

Disengagement From HIV Care and Failure of Second-Line Therapy in Nigeria: A Retrospective Cohort Study, 2005-2017.

Understanding the correlates of disengagement from HIV care and treatment failure during second-line antiretroviral therapy (ART) could inform interventions to improve clinical outcomes among people living with HIV (PLHIV). We conducted a retrospective cohort study of PLHIV aged >15 years who started second-line ART at a tertiary center in Nigeria between 2005 and 2017. Participants were considered to have disengaged from care if they had not returned within a year after each clinic visit. Cox proportional hazard models were used to investigate factors associated with: (1) viral failure (HIV-1 RNA >1000 copies/mL), (2) immunologic failure (CD4 count decrease or <100 cells/mm3), and (3) severe weight loss (>10% of bodyweight), after >6 months of second-line ART. Among 1031 participants, 33% (341) disengaged from care during a median follow-up of 6.9 years (interquartile range 3.7-8.5). Of these, 26% (89/341) subsequently reentered care. Disengagement was associated with male gender, age <30 years, lower education level, and low CD4 count at second-line ART initiation. Among participants with endpoint assessments available, 20% (112/565) experienced viral failure, 32% (257/809) experienced immunologic failure, and 23% (190/831) experienced weight loss. A lower risk of viral failure was associated with professional occupations compared with elementary: adjusted hazard ratio 0.17 (95% confidence interval 0.04 to 0.70). Adverse outcomes were common during second-line ART. However, reengagement is possible and resources should be allocated to focus on retaining PLHIV in care and providing services to trace and reengage those who have disengaged from care.

Prereferral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda

IntroductionChildren who receive prereferral rectal artesunate (RAS) require urgent referral to a health facility where appropriate treatment for severe malaria can be provided. However, the rapid improvement of a child’s...

Retinoblastoma in a Referral Center in Nigeria

Abstract Background: Improvement in survival from retinoblastoma (RB) improved to about 98% in developed countries because of early presentation and prompt intervention at designated RB care center, whereas in low-resourced countries, late presentations and poor survival are not unusual. This study reviews the changing pattern of presentations over a 7-year period when various efforts were deployed to improve early presentation and intervention in a low-resourced setting. Materials and methods: Data were extracted from RB clerk sheets that were used for documentation of clinical records of patients with RB managed at a single tertiary referral center for RB in Nigeria between 2013 and 2019. The data were analyzed for changing trend of clinical presentation and lag time. Ethical approval was obtained from the institution. Results: Two hundred and twenty-two eyes of 148 children were reviewed. There were 79 males and 69 (46.6%) females, and male to female ratio was 1.14:1. There were 74 (50%) unilateral, 72 (48.6%) bilateral, and 2 (1.4%) trilateral cases. Discussion: Overall, 66 (44.6%) and 82 (55.4%), patients had shown symptoms by 6 months and 1 year, respectively, whereas only 39 (25.7%) had presented by 1 year. Early disease stage presenting as leukocoria increased from 22.2% to 85.7%, whereas late presentation as proptosis declined from 55.5% to 10.7% between 2013 and 2019. Some cases were identified during vision screening performed by community health workers during routine immunization at primary healthcare clinics. At presentation, 188 (84.7%) RB eyes were intraocular, 32 (14.4%) orbital, and 2 (0.9%) had systemic spread. The median of the lag-time (delay) between when symptom was noticed to presentation reduced gradually each year by 1 month, from a median of 9 months in 2013 to 4 months in 2018. Conclusions: In Nigeria, early presentation as leukocoria increased, whereas late presentation as proptosis and lag time in RB reduced significantly from year 2013 to 2019 which was supported by deliberate efforts to educate the public and institute training across all levels of health care. In low-resourced country like ours, achieving early presentation of RB cases would increase the survival of affected children.

Pattern of specific comorbidities and the association with overweight and obesity in adults attending a tertiary hospital in Rivers State, Nigeria

Aims: Overweight and obesity constitute a major risk to the development of chronic non communicable diseases such as hypertension, diabetes mellitus, dyslipidaemias, osteoarthritis which in turn impact on the individual, the family and the community. This study explored specific comorbidities associated with overweight and obesity among adults attending the Family Medicine Clinic of a tertiary health centre in Nigeria. Methods: This was a descriptive hospital-based study. A combination of structured questionnaires, physical examination and laboratory analysis were used to generate appropriate data. The information was analysed using Statistical Package for Social Sciences (SPSS) version 22. Chi square (x2) and Fisher’s exact test were used to investigate the association between variables and the level of significance was set at p&lt;0.05. Results: The mean age of the subjects was 44.9±13.8years. Females constituted the majority (64.4%) with a female to male ratio of 1.8:1. While 55 persons (28.4%) were normal weight, 63 (32.5%) were overweight, 36 (18.5%) had class 1, 27 (13.9%) had class 2 obesity and 8 (4.1%) were morbidly obese. The prevalence of overweight/obesity was 69.1%. There was a significant relationship between overweight/obesity with previous diagnosis of hypertension and osteoarthritis but not with a previous diagnosis of DM. There was no statistically significant relationship between overweight/obesity and elevated BP, abnormal gait and blood glucose; however, the relationship with total cholesterol was significant. Conclusion: This study highlights a high prevalence of overweight/obesity and the association with specific comorbidities in the Nigeria.

Mathematical model of the spread of COVID-19 in Plateau State, Nigeria

In this research, a mathematical model consisting of non-pharmaceutical control measures is formulated. The developed model helps to examine the transmission of COVID-19 infection in Plateau State, Nigeria, using face masks c_{f} and social distancing c_{d} as control measures. Data used for the simulation of the developed model were obtained from Nigeria Centre for Disease Control which was fitted to the system of ordinary differential equations using nonlinear least squares method. Results at baseline values c_{f} = 0.1 and c_{d} = 0.2 of control measures indicate 2.3 estimation as basic reproduction number which suggests that COVID-19 in Plateau State tends towards endemic state. However, above about 40% in the use of face masks in the population and corresponding above 50% adherence to social distancing could as well bring down the basic reproduction number to a value below 1 necessary for disease eradication. The results at baseline values further indicate that the peak of the COVID-19 had been reached in less than 250 days from the first detection date after about 476,455 undetected asymptomatic individuals, 92,168 undetected symptomatic individuals and 83,801 detected quarantined individuals have been fully infectious. Therefore, the policymakers in Plateau State have the possibility of eradicating the disease with further strict non-pharmaceutical control measures provided that the present conditions of analysis remain fairly the same.