African Journal of Medicine and Medical Sciences

The Metabolic syndrome and its components in individuals with autoimmune thyroid diseases attending an endocrine Clinic in Northern Nigeria

RA Nwaelugo — 2021-07-05

Background: Metabolic Syndrome (MS) and Autoimmune thyroid diseases (ATD) are characterized by common abnormalities - abdominal obesity, hyperglycemia, hypertension, and elevated triglyceride, and may compound the risk for atherosclerotic cardiovascular disease. The prevalence of MS in ATD, the association of these diseases, the specific common metabolic abnormalities and the influence of gender were investigated in this study.

Methods: This was a case control study where 230 individuals within the age range of 18 – 70 years, comprising of 130 participants with ATD {Hashimoto’s Thyroiditis (HT) (30); Graves’ disease (GD) (100)} attending endocrine clinics of two tertiary hospitals in North Western Nigeria, where conveniently enrolled together with age matched 100 apparently healthy individuals without MS, to serve as controls. Enzymatic methods were used for estimation of glucose and lipids while enzyme immunoassay methods were used for the thyroid hormones and antibodies. Data analysed were considered significant at p<0.05.

Results: ATD was significantly associated with MS (p<0.001). However, the influence of gender on this association was demonstrated in participants with GD only (p < 0.001). 30.8% (40) participants with ATD had MS. The prevalence of MS in participants with HT and GD were 33.3% (10) and 30% (30). Individual MS components; abdominal obesity (80% vs 53%), hypertension (36.7% vs 74%), dysglycemia (16.7% vs 16.0%), hypertriglyceridaemia (23.3% vs 14%) and reduced HDL-C (50% vs 51%) were observed in participants with HT and GD respectively.

Conclusion: The most frequent cluster of MS components in the participants with HT and GD was increased waist circumference (WC), reduced HDL-C and hypertension. Prevalence of MS and its components is high. Metabolic Syndrome is associated with ATD and influenced by gender.

Keywords: Atherosclerotic Cardiovascular Disease, Abdominal Obesity, Gender, Prevalence, Thyroid Diseases

Résumé
Contexte: Le syndrome métabolique (SEP) et les maladies thyroïdiennes auto-immunes (ATD) sont caractérisés par des anomalies communes - obésité abdominale, hyperglycémie, hypertension, et triglycéride élevé, et peuvent aggraver le risque de maladie cardio-vasculaire athérosclérostique. La prévalence de la SP dans la MALADIE, l’association de ces maladies, les anomalies métaboliques communes spécifiques et l’influence du genre ont été étudiées dans cette étude.

Méthodes: Il s’agissait d’une étude de cas où 230 personnes dans la gamme d’âge de 18 à 70 ans, comprenant de 130 participants avec ATD {Hashimoto’ Thyroïdite de s (HT) (30); Graves’ maladie (GD) (100)} fréquentant les cliniques endocriniennes de deux hôpitaux tertiaires dans le nord-ouest du Nigeria, où commodément inscrits avec l’âge correspondait à 100 personnes apparemment en bonne santé sans SP, pour servir de contrôles. Des méthodes enzymatiques ont été employées pour l’estimation du glucose et des lipides tandis que des méthodes d’immunoassay d’enzyme ont été employées pour les hormones thyroïdiennes et les anticorps. Les données analysées ont été jugées
significatives < 0,05 p. 2005.

Résultats: L’ATD a été significativement associé à la SP (p<0,001). Cependant, l’influence du genre sur cette association a été démontrée chez les participants avec GD seulement (p < 0,001). 30,8 % (40) participants atteints de DTS étaient atteints de SP. La prévalence de la SP chez les participants atteints d’HT et de DT était de 33,3 % (10) et de 30 % (30). Composantes individuelles de la SP; obésité abdominale (80 % vs 53 %), hypertension (36,7 % vs 74 %), dysglycémie (16,7 % vs 16,0 %), hypertriglycéridaemia (23,3 % vs 14 %) et réduction du HDL-C (50 % vs 51 %) ont été observés chez les participants ayant respectivement ht et GD.

Conclusion: Le groupe le plus fréquent de composants de SP chez les participants atteints d’HT et de DT a été l’augmentation de la circonférence de la taille (WC), la réduction du HDL-C et de l’hypertension. La prévalence de la SP et de ses composantes est élevée. Le syndrome métabolique est associé à l’ATD et influencé par le sexe.

Mots-clés: Maladies cardiovasculaires athéroclérotiques, Obésité abdominale, Sexe, Prévalence, Maladies thyroïdiennes

Correspondence: Rosemary A. Nwaelugo, Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria. Email: nwaelugorosemary@gmail.com

Depression and anxiety among patients with type 2 diabetes mellitus in Ibadan, Oyo State

HT Ilori — 2021-07-05

Background: The psychosocial burden of Diabetes Mellitus (DM) and its debilitating consequences could result in depression and anxiety. Several studies had been conducted on depression alone among diabetics in Nigeria. However, only few studies in addition to depression have explored the prevalence of anxiety and anxiety comorbidity with depression.

Aim: To determine the prevalence and factors associated with anxiety or depression among Type 2 DM patients.

Methods: This was a hospital based cross-sectional survey. Systematic random technique was used to select 273 Type 2DM patients aged 40 years and above attending a secondary health facility in Ibadan, Nigeria. Depression and anxiety were assessed by using Zung’s Self Depression Rating Scale and Beck Anxiety Inventory respectively. Data was analyzed using the Chi square test and multivariate logistic regression with a P value set at 0.05.

Results: The mean age of the respondents was 62.1 (+10.2) years and majority were female (85.3%). The prevalence of depression, anxiety and comorbidity of depression and anxiety were 27.5%, 16.5% and 4.4% respectively. Physical inactivity and uncontrolled blood glucose were found among 48.4% and 61.5% respondents respectively. Depression was significantly associated with physical inactivity [OR=0.58; 95% CI=0.34-0.93] and low-moderate social support [OR=1.85; 95% CI=1.08-3.17], while anxiety was significantly associated with religion. The predictors of depression and anxiety were low social support (OR=0.58; 95% CI=0.33-0.95 p=0.04) and Christianity (OR=2.25; 95% CI=1.10-4.61, P=0.03) respectively.

Conclusion: We recommend that clinicians should screen Type 2 DM patients for depression and anxiety, assess their level of social support, educate on the importance of physical activity and encourage physical activity.

Keyword: Depression, Anxiety, Type 2 Diabetes Mellitus, Comorbidity, Social support.

Résumé
Contexte: Le fardeau psychosocial du diabète sucré (DM) et ses conséquences débilitantes pourraient entraîner la dépression et l’anxiété. Plusieurs études ont été menées sur la dépression seule chez les diabétiques au Nigeria. Cependant, seulement peu d’études en plus de la dépression ont exploré la prévalence de l’anxiété et l’anxiété comorbidité avec la dépression.

Objectif: Déterminer la prévalence et les facteurs associés à l’anxiété ou à la dépression chez les patients atteints de DM de type 2.

Méthodes: Il s’agissait d’une enquête transversale en milieu hospitalier. Une technique aléatoire systématique a été utilisée pour sélectionner 273 patients de type 2DM âgés de 40 ans et plus fréquentant un établissement de santé secondaire à Ibadan, au Nigéria. La dépression et l’anxiété ont été évaluées en utilisant l’échelle d’évaluation de l’autodéfré dépression de Zung et l’inventaire de l’anxiété Beck respectivement. Les données ont été analysées à l’aide du test chi carré et de la régression logistique multivariée avec une valeur P fixée à 0,05.
Résultats: L’âge moyen des répondants était de 62,1 ans (+10,2 ans) et la majorité était une femme (85,3 %). La prévalence de la dépression, de l’anxiété et de la comorbidité de la dépression et de l’anxiété était de 27,5 %, 16,5 % et 4,4 % respectivement. L’inactivité physique et la glycémie incontrôlée ont été trouvées parmi 48,4 % et 61,5 % des répondants respectivement. La dépression était significativement associée à l’inactivité physique [OR=0,58; IC à 95 %=0,34-0,93] et à un soutien social faiblement modéré [OR=1,85; IC à 95 %=1,08-3,17], tandis que l’anxiété était significativement associée à la religion. Les prédicteurs de la dépression et de l’anxiété étaient un faible soutien social (OR=0,58; IC à 95 %=0,33-0,95 p=0,04) et christianisme (OR=2,25; IC à 95 %=1,10-4,61, P=0,03) respectivement.

Conclusion: Nous recommandons aux cliniciens de dépister la dépression et l’anxiété chez les patients de type 2, d’évaluer leur niveau de soutien social, d’éduquer sur l’importance de l’activité physique et d’encourager l’activité physique.

Mots-clés: Dépression, Anxiété, Diabète sucré de type 2, Comorbidité, Soutien social.

Correspondence: Prof. Olufunmilayo I. Fawole, Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Email address: fawoleo@ymail.com; Tel:08032180302

Chemical, biopharmaceutical and microbiological profiles of ciprofloxacin tablets in the Nigerian market

OE Adejumo — 2021-07-05

Background: The number of ciprofloxacin hydrochloride brands in the Nigerian market is continuously increasing; hence, there is need to establish their bioequivalence in the interest of public health. This study assessed the chemical, biopharmaceutical, and microbiological profile of thirty brands of ciprofloxacin (500 mg) tablets in Nigerian market.

Method: Quality parameters evaluated include weight uniformity, thickness and diameter, hardness, friability, disintegration, dissolution, identity, and antibacterial profile. Content of active ingredients was determined by a slightly modified and validated HPLC method.

Results: Results of thickness, diameter, and hardness tests of all the brands fell within acceptable limits. The percentage of brands within acceptable range for weight uniformity, friability, disintegration, dissolution, and active ingredient are 86.67, 96.67, 93.33, 26.67, and 93.33% respectively. About 87% of the tested generic version of ciprofloxacin demonstrated in-vitro antibacterial bioequivalence to the reference drug. The abysmal low dissolution rate of 26.67 % is a source of concern as it suggests a potential poor bioavailability of the active ingredient of these drugs.

Conclusion: The failure of a large portion of the tested brands may be due to deliberate counterfeiting, failure of current good manufacturing practices (cGMP) by manufacturers or poor handling by wholesalers/retailers. The study therefore recommends effective post marketing surveillance and enforcement of cGMP by the concerned regulatory agency in Nigeria.

Keywords: Bioequivalence, ciprofloxacin, quality, GMP, drug faking, and infectious diseases

Résumé
Contexte: Le nombre de marques de chlorhydrate de ciprofloxacine sur le marché nigérian ne cesse d’augmenter; par conséquent, il est nécessaire d’établir leur bioéquivalence dans l’intérêt de la santé publique. Cette étude a évalué le profil chimique, biopharmaceutique et microbiologique de trente marques de comprimés de ciprofloxacine (500 mg) sur le marché nigérian.

Méthode: Les paramètres de qualité évalués comprennent l’uniformité du poids, l’épaisseur et le diamètre, la dureté, la friabilité, la désintégration, la dissolution, l’identité et le profil antibactérien. La teneur en ingrédients actifs a été déterminée par une méthode HPLC légèrement modifiée et validée.

Résultats: Les résultats des tests d’épaisseur, de diamètre et de dureté de toutes les marques se situaient dans des limites acceptables. Le pourcentage de marques dans la plage acceptable pour l’uniformité du poids, la friabilité, la désintégration, la dissolution et l’ingrédient actif est de 86,67, 96,67, 93,33, 26,67 et 93,33% respectivement. Environ 87% de la version générique testée de la ciprofloxacine a démontré une bioéquivalence antibactérienne in vitro avec le médicament de référence. Le faible taux de dissolution abyssal de 26,67% est une source de préoccupation car il suggère une mauvaise biodisponibilité potentielle de l’ingrédient actif de ces médicaments.

Conclusion: L’échec d’une grande partie des marques testées peut être dû à une contrefaçon délibérée, à un échec des bonnes pratiques de fabrication actuelles (cGMP) par les fabricants ou à une mauvaise manipulation par les grossistes / détaillants. L’étude recommande donc une surveillance post-commercialisation efficace et l’application des BPF par l’organisme de réglementation concerné au Nigéria.

Mots clés: Bioéquivalence, ciprofloxacine, qualité, BPF, contrefaçon de médicaments et maladies infectieuses

Correspondence: Dr. Olufunmilayo E. Adejumo, Department of Pharmaceutical and Medicinal Chemistry, Olabisi Onabanjo University, Sagamu, Nigeria. E-mail: funmilayo@yahoo.co.uk

Occurrence of cryptococcal antigenaemia among HIV- uninfected patients with stroke in Nigeria: a pilot case-control study

SA Fayemiwo — 2021-07-05

Background: Infections have been associated with stroke occasionally, but are not considered to be a direct cause. We aimed to compare the prevalence of cryptococcal antigenaemia in stroke patients compared to stroke-free controls.

Methods: Through the Stroke Investigative Research and Education Network (SIREN) project, adults (aged >18 years) with stroke confirmed by computed tomography (CT) scan or magnetic resonance imaging (MRI) (cases) and age-matched and gender-matched stroke-free controls were recruited from the communities in catchment areas of the cases. A simple random sampling was used to select blood samples of stroke patients and controls in a 1:1 ratio. Serum cryptococcal antigen (CrAg) tests were performed using CrAg Lateral Flow Assays (BIOSYNEXR Crypto PS).

Results: Of the 100 HIV-uninfected patients (50 cases and 50 controls), majority 70 (70%) were males with a median age of 57 (range: 33-86) years. Thirty-six (72%) cases and 23 (46%) controls were hypertensive (p<0.001), while 6 (12%) cases and 14 (28%) controls were diabetic (p=0.059). Overall, CrAg was positive in 16% (n=16) of the participants; 10 (20%) among cases and 6 (12%) among controls (Odds ratio: 1.83; 95% confidence interval: 0.61-5.5; p=0.275). Overall, 13 deaths occurred, all among cases; death rates were similar between CrAg positive (2/10, 20%) and CrAg negative (11/40, 27.5%) stroke patients (p=0.628). Diabetes mellitus had a trend towards predicting a positive CrAg among cases (Odds ratios, 1.52 (95% CI: 0.97-2.4); p=0.069).

Conclusions: Cryptococcal antigenaemia appears to be more common in stroke patients compared to controls. Adequately powered studies are required to explore this observation.

Keywords: Fungal infections, Cryptococcal antigenaemia, Stroke, Diabetes, Nigeria.

Résumé
Contexte: Des infections ont été associées à des accidents vasculaires cérébraux occasionnellement, mais ne sont pas considérées comme une cause directe. Nous visions à comparer la prévalence de l’antigénémie cryptococcique chez les patients victimes d’un AVC par rapport aux témoins sans AVC.

Méthodes: Dans le cadre du projet Stroke Investigative Research and Education Network (SIREN), des adultes (âgés de 18 ans ou plus) avec un AVC confirmé par tomodensitométrie (TDM) ou imagerie par résonance magnétique (IRM) (cas) et appariés selon l’âge et le sexe Des témoins sans AVC ont été recrutés dans les communautés des zones de desserte des cas. Un simple échantillonnage aléatoire a été utilisé pour sélectionner des échantillons sanguins de patients et de témoins d’AVC dans un rapport 1: 1. Des tests d’antigène cryptococcique sérique (CrAg) ont été réalisés à l’aide de tests CrAg à flux latéral (BIOSYNEXR Crypto PS).

Résultats: Sur les 100 patients non infectés par le VIH (50 cas et 50 témoins), la majorité 70 (70%) étaient des hommes avec un âge médian de 57 ans (intervalle: 33-86). Trente-six (72%) cas et 23 (46%) témoins étaient hypertendus (p <0,001), tandis que 6 (12%) cas et 14 (28%) témoins étaient diabétiques (p = 0,059). Dans l’ensemble, la CrAg était positive chez 16% (n = 16) des participants; 10 (20%) parmi les cas et 6 (12%) parmi les témoins (rapport de cotes: 1,83; intervalle de confiance à 95%: 0,61-5,5; p = 0,275). Dans l’ensemble, 13 décès sont survenus, tous parmi les cas; les taux de mortalité étaient similaires entre les patients ayant subi un AVC CrAg positif (2/10, 20%) et CrAg négatif (11/40, 27,5%) (p = 0,628). Le diabète sucré avait tendance à prédire un CrAg positif parmi les cas (odds ratios, 1,52 (IC à 95%: 0,97-2,4); p = 0,069).

Conclusions: L’antigénémie cryptococcique semble être plus fréquente chez les patients victimes d’un AVC que chez les témoins. Des études suffisamment puissantes sont nécessaires pour explorer cette observation.

Mots clés: Infections fongiques, antigénémie cryptococcique, accident vasculaire cérébral, diabète, Nigéria.

Correspondence: Dr. S. A. Fayemiwo, Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail address: dayteet@yahoo.co

Susceptibility pattern of clinical isolates of uropathogens from Southwest Nigeria to antibiotics and extracts of Dalbergia latifolia Roxb (Fabaceae)

PA Idowu — 2021-07-05

Methods: The susceptibility pattern of twenty clinical isolates of uropathogenic bacteria to standard antibiotics and extracts of Dalbergia latifolia was investigated using Agar Disc and Agar Well Diffusion methods, respectively. Minimum Inhibitory Concentrations (MICs) of the extracts were determined by Agar Dilution method on some of the uropathogens.

Results: All the test pathogens were resistant to Amoxicillin, Cotrimoxazole and Augmentin. The isolates had 25 % (4), 12.5% (2), 18.75% (3), 68.75% (11) susceptibility to Nitrofurantoin, Gentamicin, Nalidixic acid and Ofloxacin respectively while 87.5% showed resistant to Tetracycline. The E. coli and K. pneumoniae strains had the highest susceptibility to Ofloxacin while P. mirabilis 4 was susceptible to Ofloxacin. The uropathogenic S. aureus was highly resistant to the antibiotics, however S. aureus 3 and S. aureus 4 were susceptible to gentamicin while S. aureus 1 and S. aureus 5 were susceptible to chloramphenicol. Gentamicin and chloramphenicol were the most active on S. aureus. The extracts showed good activity on most of the uropathogens in which 81.81 % (18),
9.0% (2) and 63.63% (14) of the test pathogens were susceptible to the leaf, stem and root (successively) of D. latifolia. The MIC values of extracts on test organisms ranged from 0.063 to 2.0 mg/mL.

Conclusion: The results revealed varied patterns of susceptibility of the uropathogens to conventional antibiotics, necessitating rational use of antibiotic in routine treatment of UTI to prevent development of resistance. Further, activity of D. latifolia extracts on the uropathogens justified its folkloric use and underlined the potentials of the plant to furnish antimicrobial agents for the treatment of UTIs, including those resistant to conventional antibiotics.

Keywords: Uropathogens, antibiotics, resistance, Dalbergia latifolia extracts, MICs

Résumé
Contexte: La résistance des uropathogènes aux antibiotiques conventionnels augmente, créant ainsi le besoin de rechercher des agents antimicrobiens plus récents et efficaces pour traiter les infections des voies urinaires (IVU).

Résultats: Tous les pathogènes testés étaient résistants à l’amoxicilline, au cotrimoxazole et à l’augmentation. Les isolats présentaient respectivement une sensibilité de 25% (4), 12,5% (2), 18,75% (3), 68,75% (11) à la nitrofurantoïne, à la gentamicine, à l’acide nalidixique et à l’ofloxacine, tandis que 87,5% étaient résistants à la tétracycline. Les souches d’E. Coli et de K. pneumoniae étaient les plus sensibles à l’ofloxacine, tandis que P. mirabilis 4 était sensible à l’ofloxacine. Le S. aureus uropathogène était très résistant aux antibiotiques, cependant S. aureus 3 et S. aureus 4 étaient sensibles à la gentamicine tandis que S. aureus 1 et S. aureus 5 étaient sensibles au chloramphénicol. La gentamicine et le chloramphénicol étaient les plus actifs sur S. aureus. Les extraits ont montré une bonne activité sur la plupart des uropathogènes dans lesquels 81,81% (18), 9,0% (2) et 63,63% (14) des pathogènes testés étaient sensibles aux feuilles, aux tiges et aux racines (successivement) de D. latifolia. Les valeurs de CMI des extraits sur les organismes d’essai variaient de 0,063 à 2,0 mg / mL.

Background: Resistance of uropathogens to conventional antibiotics is increasing, thus creating the need to search for newer and effective antimicrobial agents to treat urinary tract infections (UTI). Methods: The susceptibility pattern of twenty clinical isolates of uropathogenic bacteria to standard antibiotics and extracts of Dalbergia latifolia was investigated using Agar Disc and Agar Well Diffusion methods, respectively. Minimum Inhibitory Concentrations (MICs) of the extracts were determined by Agar Dilution method on some of the uropathogens.

Results: All the test pathogens were resistant to Amoxicillin, Cotrimoxazole and Augmentin. The isolates had 25 % (4), 12.5% (2), 18.75% (3), 68.75% (11) susceptibility to Nitrofurantoin, Gentamicin, Nalidixic acid and Ofloxacin respectively while 87.5% showed resistant to Tetracycline. The E. coli and K. pneumoniae strains had the highest susceptibility to Ofloxacin while P. mirabilis 4 was susceptible to Ofloxacin. The uropathogenic S. aureus was highly resistant to the antibiotics, however S. aureus 3 and S. aureus 4 were susceptible to gentamicin while S. aureus 1 and S. aureus 5 were susceptible to chloramphenicol. Gentamicin and chloramphenicol were the most active on S. aureus. The extracts showed good activity on most of the uropathogens in which 81.81 % (18), 9.0% (2) and 63.63% (14) of the test pathogens were susceptible to the leaf, stem and root (successively) of D. latifolia. The MIC values of extracts on test organisms ranged from 0.063 to 2.0 mg/mL.

Keywords: Uropathogens, antibiotics, resistance, Dalbergia latifolia extracts, MICs

Méthodes: Le profil de sensibilité de vingt isolats cliniques de bactéries uropathogènes aux antibiotiques standard et aux extraits de Dalbergia latifolia a été étudié en utilisant les méthodes Agar Disc et Agar Well Diffusion, respectivement. Les concentrations minimales inhibitrices (CMI) des extraits ont été déterminées par la méthode de dilution d’agar sur certains des uropathogènes.
Résultats: Tous les pathogènes testés étaient résistants à l’amoxicilline, au cotrimoxazole et à l’augmentation. Les isolats présentaient respectivement une sensibilité de 25% (4), 12,5% (2), 18,75% (3), 68,75% (11) à la nitrofurantoïne, à la gentamicine, à l’acide nalidixique et à l’ofloxacine, tandis que 87,5% étaient résistants à la tétracycline. Les souches d’E. Coli et de K. pneumoniae étaient les plus sensibles à l’ofloxacine, tandis que P. mirabilis 4 était sensible à l’ofloxacine. Le S. aureus uropathogène était très résistant aux antibiotiques, cependant S. aureus 3 et S. aureus 4 étaient sensibles à la gentamicine tandis que S. aureus 1 et S. aureus 5 étaient sensibles au chloramphénicol. La gentamicine et le chloramphénicol étaient les plus actifs sur S. aureus. Les extraits ont montré une bonne activité sur la plupart des uropathogènes dans lesquels 81,81% (18), 9,0% (2) et 63,63% (14) des pathogènes testés étaient sensibles aux feuilles, aux tiges et aux racines (successivement) de D. latifolia. Les valeurs de CMI des extraits sur les organismes d’essai variaient de 0,063 à 2,0 mg / mL.

Conclusion: Les résultats ont révélé des schémas variés de sensibilité des uropathogènes aux antibiotiques conventionnels, nécessitant l’utilisation rationnelle de l’antibiotique dans le traitement de routine des infections urinaires pour empêcher le développement d’une résistance. En outre, l’activité des extraits de D. latifolia sur les uropathogènes justifiait son utilisation folklorique et soulignait le potentiel de la plante à fournir des agents antimicrobiens pour le traitement des infections urinaires, y compris celles résistantes aux antibiotiques conventionnels.

Mots clés: Uropathogènes, antibiotiques, résistance, extraits de Dalbergia latifolia, CMI

Correspondence: Dr. P.A Idowu, Department of Pharmaceutical Microbiology, University of Ibadan, Ibadan, Nigeria. Email:igboyega@yahoo.com

Mitigation strategies in early phase of COVID-19 pandemic and recovery potential in Nigeria and United States

KO Ogunyemi — 2021-07-05

Background: In response to the ongoing coronavirus disease 2019 (COVID-19) pandemic, much uncertainty exists in low- and middle-income countries like Nigeria about the effects of different mitigation strategies on the trajectory and impact of the disease transmission given how high-income countries like the United States (US) with even better infrastructures have been impacted. Further uncertainty stems particularly from the significant challenges in a country’s health system, economy and food security prior to the emergence of the pandemic. The objective of this study was to compare the physical and psychosocial mitigation strategies during early phase of COVID-19 pandemic and recovery potential in Nigeria and US.

Methods: We performed a secondary data review of relevant studies and reports searched on PubMed, Google Scholar and Google databases. Data were analyzed using content analysis and grounded theory methods.

Results: We showed that the implementation of biomedical mitigation strategies during COVID-19 pandemic lockdown without physical and psychosocial mitigation strategies such as food supply and financial incentive puts Nigeria at risk of further crises while the US, though on the path of a long-term recovery, faced similar risk as well from protests despite availability of food and financial supports.

Conclusion: The lack of food supply and financial incentive during COVID-19 pandemic lockdown in Nigeria, and associated negative impact on recovery highlight the need for provision of social welfare packages for its citizens to mitigate the physical and psychosocial effects of the COVID-19 pandemic (e.g. violence). Evidence of protests in the US warrants intensified risk communication interventions.

Keywords: COVID-19, mitigation, community wellness, recovery.

Résumé
Contexte: En réponse à la pandémie de coronavirus en cours de 2019 (COVID-19), une grande incertitude existe dans les pays à revenu faible et intermédiaire comme le Nigéria quant aux effets des différentes stratégies d’atténuation sur la trajectoire et l’impact de la transmission de la maladie compte tenu de la des pays à revenu comme les États-Unis (États-Unis) dotés d’infrastructures encore meilleures ont été touchés. L’incertitude supplémentaire découle en particulier des défis importants du système de santé, de l’économie et de la sécurité alimentaire d’un pays avant l’émergence de la pandémie. L’objectif de cette étude était de comparer les stratégies d’atténuation physiques et psychosociales au cours de la phase précoce de la pandémie de COVID-19 et le potentiel de rétablissement au Nigéria et aux États-Unis.

Méthodes: Nous avons effectué un examen des données secondaires des études et des rapports pertinents recherchés dans les bases de données PubMed, Google Scholar et Google. Les données ont été analysées à l’aide d’une analyse de contenu et de méthodes théoriques fondées.

Résultats: Nous avons montré que la mise en œuvre de stratégies d’atténuation biomédicale pendant le verrouillage de la pandémie COVID-19 sans stratégies d’atténuation physique et psychosociale telles que l’approvisionnement alimentaire et les incitations financières met le Nigéria en danger de nouvelles crises tandis que les États-Unis, bien que sur la voie d’un long terme la reprise, a également fait face à un risque similaire à cause des manifestations malgré la disponibilité de la nourriture et des aides financières.

Conclusion: Le manque d’approvisionnement alimentaire et d’incitation financière pendant le verrouillage de la pandémie de COVID-19 au Nigéria, et l’impact négatif associé sur le rétablissement mettent en évidence la nécessité de fournir des programmes de protection sociale pour ses citoyens afin d’atténuer les effets physiques et psychosociaux de la pandémie de COVID-19 (ex. violence). Les preuves de manifestations aux États-Unis justifient une intensification des interventions de communication des risques.

Mots clés: COVID-19, atténuation, bien-être communautaire, rétablissement.

Introduction

The human existence has been threatened by pandemics such as plagues, small pox and the ongoing coronavirus disease 2019 (COVID-19) outbreak [1]. The COVID-19 outbreak was first reported in Wuhan, China on December 31, 2019. Prior to its emergence, some parts of the world were equally hit by other coronaviruses namely Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS) [2,3]. Following the World Health Organization (WHO)’s declaration of the outbreak as a pandemic on March 11, 2020, the number of cases and deaths worldwide has been on the increase, with different countries disproportionately affected [4]. As of April 8, 2020, a total of 1,353,361 COVID-19 cases including 79,235 deaths had been reported globally with the case-fatality rate being 5.8%, which is lower than 10% and 36% reported for SARS and MERS respectively [3,5]. Evidence so far indicates that COVID-19 virus infects humans of all ages but the risk of the disease severity is higher among elderly and people with pre-existing health conditions such as heart diseases and diabetes [4]. Globally, COVID-19 just like other pandemics has posed serious health, economic and socio-political challenges [6-9]. While this pandemic burden varies within and between regions, it is unclear why high-income countries with advanced technology and better health system like the US, had recorded higher cases of COVID19 infection and death while low- and middle-income countries (LMICs) like Nigeria with poorer infrastructures
had low figures [5,10-11]. Though, a study observed that Nigeria and other LMICs were at higher risk of impact, but this has been to the contrary, even though many factors could have contributed to this outcome [12]. Several biomedical mitigation strategies such as social distancing, hand hygiene and quarantine have been shown to be effective in curbing the spread of the infectious agents implicated in previous pandemics [3]. However, there is scarcity of data on physical and psychosocial mitigation strategies for pandemics. Hence, we attempted to primarily compare the physical and psychosocial mitigation strategies during early phase of COVID-19 pandemic and their implications on recovery or further crises outcomes in Nigeria and US.

Rationale for Nigeria and US Comparison

The rationale for this study was to gain insight into the mitigation strategies towards COVID-19 pandemic in LMICs like Nigeria, with weak health systems compared to advanced economies with better health systems to draw lessons for policy and practice implications. Hence, the US was randomly selected by balloting among the advanced economies including France, Germany, Canada, Italy, United Kingdom, Japan and Russia.

Relevance of study
Previous studies on this subject matter only focused on biomedical strategies to mitigating the spread of COVID19 virus and also the health impact of the pandemic [6, 13] and did not assess the physical and psychosocial factors that could potentially influence the further spread of COVID-19 virus and recovery potential from the pandemic. Conceptual clarification and frameworks

Community Wellness: is defined as “the optimal state of health of individuals and groups” according to WHO”. Hence, community wellness is said to be achieved when the health of individuals in a particular geographical location is optimal and they are also able to fulfill their roles in the society [14].

Food security: Based on World Food Summit definition, food security “is a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life” [15]. Food insecurity is “transitory” when there is a sudden drop in the ability to secure food due to unusual circumstances e.g. pandemic, variation in food prices etc. [16].

Health system
According to WHO consist of “all organizations, people and actions whose primary intent is to promote, restore or maintain health”. For a health system to achieve its goals, it has to carry out some basic functions which have been identified as “the six building blocks of a health system” namely health service delivery; health workforce; health information system; medical products, vaccines and technologies; health financing and leadership/governance [17].

Economic stability
Denotes a situation where a nation’s financial system manifests only a slight fluctuation in output growth and consist of inbuilt mechanism to maintain inflation rate at a low level. Output growth is usually measured among other indices by the gross domestic product (GDP) and employment [18].

Disaster recovery: is one of the phases of the disaster management cycle. Disaster recovery is “an opportunity for reflecting on the root causes of a disaster and recasting development priorities to reduce human vulnerability to natural hazards”. Inreduce human vulnerability to natural hazards”. In effect, the aim according to WHO is “re-establishing the economic, social and cultural life of the people affected and to rebuild damaged areas” [19]. Based on understanding from the “syndemic model of health” which describes how social and environmental factors interact synergistically with diseases to promote their transmission and unfavourable health outcomes,[20] the impact of theabove concepts on COVID-19 pandemic is shown in fig 1.(Check pdf file for diagram)
In addition, we used an adapted framework of Interagency Working Group on Behavioural Health and Pandemic Influenza as shown in fig 2 to describe the potential psychosocial consequences of a pandemic [21]. The concept described in this framework is consistent with the findings of studies specific to the past SARS outbreak and the ongoing COVID-19 pandemic [22-24].

Frameworks description
Fig 1 showed the biosocial complex of interactions with COVID-19 pandemic. At the biological level, COVID19 virus adversely interacts with comorbidities such as diabetes and hypertension within populations. This biological interaction is further influenced synergistically by social factors including the status of the health system, economic stability and food security which may result in either reduced transmission of COVID-19 virus and positive health, and psychosocial outcomes that facilitate recovery or increased disease progression and negative outcomes that favour further crises.
Fig 2 described the cause-effects associations due to COVID-19 pandemic and the mitigation strategies. The interplay of the triad; reactionary distress, mental disorders and personal behaviours, in individuals to a large extent determines the state of community wellness, which in this pandemic situation is perceived to be negative. However, other factors such as individual resilience, cultural norms, politics as well as religion may singly or collectively impact the state of community wellness, which in this pandemic situation is perceived to be negative. However, other factors such as individual resilience, cultural norms, politics as well as religion may singly or collectively impact the state of community wellness.

Methodology
Study design and procedure
We conducted a qualitative review of secondary data sources inclusive of journals, news items, WHO situation reports and data from public agencies. Using content analysis and grounded theories methodologies, we then performed a comparative analysis of the outcome variables in Nigeria and US. The outcome variables analyzed included biomedical containment/mitigation strategies, physical/psychosocial mitigation strategies on COVID19 pandemic and effects of mitigation strategies on recovery. Only journal articles in English language that contained relevant information were collected using Google scholar and PubMed databases while other data were searched on Google. Data search were conducted between April 5-23, 2020, and only one journal article that is specific to mitigation strategies on COVID-19 pandemic was found [13]. The article provided a review of community mitigation strategies in a pandemic (e.g. termination of mass events,
social distancing, travel restrictions, home quarantine, and clear communication of health information) that could be implemented by communities and countries to lessen the transmission of COVID-19 virus. Search words included “COVID-19”, “Coronavirus 2019”, “2019-nCov”, “COVID-19 and mitigation strategies”, “COVID-19 and recovery”, “food insecurity”, “health system”, “economic instability”, “disaster recovery”, “pandemic and health system”, “pandemic and food insecurity”, “pandemic and economic instability” with country (“Nigeria” or “US”). Only reputable local news sources (e.g. Guardian) and international news (e.g. BBC) that mitigation strategies on recovery. Only journal articles in English language that contained relevant information were collected using Google scholar and PubMed databases while other data were searched on Google. Data search were conducted between April 5-23, 2020, and only one journal article that is specific to mitigation strategies on COVID-19 pandemic was found [13]. The article provided a review of community mitigation strategies in a pandemic (e.g. termination of mass events, social distancing, travel restrictions, home quarantine, and clear communication of health information) that could be implemented by communities and countries to lessen the transmission of COVID-19 virus. Search
words included “COVID-19”, “Coronavirus 2019”, “2019-nCov”, “COVID-19 and mitigation strategies”, “COVID-19 and recovery”, “food insecurity”, “health system”, “economic instability”, “disaster recovery”, “pandemic and health system”, “pandemic and food insecurity”, “pandemic and economic instability” with country (“Nigeria” or “US”). Only reputable local news sources (e.g. Guardian) and international news (e.g. BBC) that were first provided in the Google search list were included for the review.

Study setting
Nigeria, according to United Nations (UN, 2019) has a population of 200,964,000 while the US has 329,065,000. The same source provided that the life expectancy at birth of a Nigerian is 54 years while that of US is 79 years. The percentage of population who are 65 years and above in Nigeria and US are 3% and 16% respectively [25]. The unemployment rate in Nigeria as at 2019 was 19.6%. The US unemployment rate was 3.5% within the same period prior to COVID-19 pandemic. As at March 2020, with the COVID-19 pandemic, the unemployment rate for Nigeria was unavailable but the projected rate was 33.5% for the year 2020. The US unemployment rate the same year was 4.4% as at first quarter [26-28]. As at April 8, 2020, the total number of COVID-19 cases in Nigeria was 276 with 6 deaths. In the US, it was 401,166 cases with 12,936 deaths [29-30]. The Nigeria Centre for Disease Control (NCDC) is the lead agency working in collaboration with other agencies such as Federal Ministry of Health, Office of the National Security Adviser among others to contain and mitigate the spread and effects of COVID-19 [31]. As for the US, the principal agency is the Centres for Disease Control (CDC), while the other agencies include but not limited to The Food and Drug Administration and National Institute of Health [32]. The biomedical mitigation strategies instituted by the NCDC and CDC include hand hygiene, face mask use, quarantine, social distancing, mass gathering ban, school closure and lockdown.

Results
Overview of Biomedical Containment and Mitigation Strategies
The implementation of containment strategies such as travel restriction was delayed in both Nigeria and US. This was evident in the time lag between the index imported case of COVID-19 (February 27, 2020 in Nigeria and January 21, 2020 in US) and the enforcement of travel restriction on high risk countries including China (March 21, 2020 in Nigeria and March 13, 2020 in US) which resulted in higher number of imported cases in both countries [33-39]. The banning of mass gatherings and schools closure mitigation strategies was implemented
late in Nigeria compared to the US. In Nigeria, this ban policy took effect on March 18, 2020 which was 1 week after COVID-19 was declared a pandemic while that of the US was same day of the declaration. The lockdown mitigation strategy was found to be implemented late in Nigeria compared to the US. The lockdown was effected on March 29, 2020 in Nigeria, about three weeks after the pandemic declaration while that of the US was on March 21, 2020, about 2 weeks post-pandemic declaration [40-41].

Physical and Psychosocial Mitigation Strategies: Food supply during the COVID-19 pandemic lockdown was found to be inconsistent in Nigeria while this does not appear to be so in the US [42-43]. Evidence showed that the financial incentive package in Nigeria had a less comprehensive allocation plan and lacked specificity of individual income compared to the US which had a robust plan and stated a sum of $2,000 per capita [45-46]. Data on the control of COVID-19 among the vulnerable populations (i.e. prisoners, refugees and internally displaced persons) in Nigeria and the US were unavailable at the time of this review.

Effects of Mitigation Strategies on Recovery
The effect of mitigation strategies on recovery was analyzed using a proposed framework in fig 3, which predicted the state of community wellness and the potential for recovery or further crises considering different scenarios of mitigation strategies. In this analysis, Nigeria and the US were found to be at risk of further crises rather than recovery from the COVID-19 pandemic.

Fig 3 showed the cause-effect associations of both a1-2 and b in multiple mitigation scenarios. With specific reference to scenario 1, it is apparent that both countries do not fit into short-term recovery. This is on account of lack of food supply, lack or inadequate financial incentive and possible presence of vulnerable populations’ infection in Nigeria, and the risk of vulnerable populations’ infection in the US despite food supply and financial incentive [42-46]. The goal of scenario 2 is long-term recovery, we observed that US was supposed to fit into this pathway but the expected compliance to lockdown was breached which may pose further danger while this is not applicable to Nigeria [42-46,48]. The primary outcome of scenario 3 is further crises, we projected that Nigeria fits into this pathway because of the peculiarities of physical and psychosocial mitigation strategies described above and the ongoing protest arising from poor social welfare while the US appears to be at risk as well because of its citizens’ protest for unclear motive [42-46,48-49].

Discussion
Biomedical containment and mitigation strategies to prevent or slow the progression and effects of pandemics are crucial for favourable outcomes such as recovery in a population. In this review, we found a delay in travel restriction after index imported cases in Nigeria and US. This delay could have been because COVID-19 had not been declared a pandemic at the time both countries had their index imported cases. Concerning mass gatherings ban, schools closure and lockdown during COVID-19 pandemic, we found that Nigeria implemented these policies late compared to the US. The difference in this implementation timelines could be attributed to the varying threshold definitions in terms of COVID-19 cases and deaths for such mitigation strategies in both countries. Additionally, this could be as a result of variance in socio-economic and political contexts in both countries. Regarding physical and psychosocial mitigation strategies, food supply during COVID-19 pandemic lockdown to mitigate potential transitoryood insecurity at household and national levels was found to be inadequate in Nigeria compared to the US. This difference could be due to the state of food security in both countries prior to the pandemic where Nigeria was found to be food insecure with 5-14.9% hunger index while the US has a reasonable level of food security with less than 2.5% hunger index [44]. About financial incentives to mitigate possible economic contractions due to the COVID-19 pandemic and the lockdown, we found that although both countries had financial incentive packages, Nigeria lacked a comprehensive and specific allocation plan compared to the US. This deficiency in the comprehensiveness of the financial incentives might be because
of the difference in economic stability status (i.e. in terms of per capita GDP) in both countries during the COVID-19 pandemic.

Our submission is corroborated with a data that showed that Nigeria had a 50% fall in per capita GDP ($2,407 to $1,181) compared to a 30% drop ($67,063 to $20,289) in the US [47]. One reason for the non-specificity of the financial incentive per individual in Nigeria might be attributed to the idea of government trying to avoid being held accountable on the disbursement of the budgeted funds. Despite lack of data on the control of COVID-19 among the vulnerable populations such as prisoners in Nigeria and US during the time of this review, we posit that given the increased risk of transmissibility of the disease due to overcrowding, poor
health facilities, epileptic water supply and sanitation challenges in their facilities, a decongestion policy is warranted in both countries. Concerning the effects of the identified mitigation strategies on recovery from COVID-19 pandemic, our assumption that both Nigeria and the US are at risk of further crises, especially Nigeria, calls for urgent evidence-based interventions to reverse this unfavourable outcome.

Limitations of study
Results in this study are subject to some limitations. First, because COVID-19 is an evolving area of study, there was dearth of journal articles particularly tailored to our study objectives which informed other data sources such as news items and other online resources that could have limited the precision of this study results. Second, there was potential for information bias especially from the news data due to its subjective nature and biases from the authors and/or publishers. Third, due to unavailability of data that modeled the effects of lockdown in association with food supply, financial incentive and vulnerable populations’ infection on the trajectory of disease transmission in pandemics, the assumptions in fig 3 were based on plausible reasoning. Fourth, the frameworks analyses but only showed associations and could not prove causality of factors. Fifth, the frameworks did not take into account other factors (e.g. individual resilience, cultural norms and politics) that may have influenced the state of community wellness in a pandemic situation as evident by the non-conformation of US to scenario 2 despite meeting all its requirements, hence creating the potential for a confounding bias. Nonetheless, our study still provided social insights for advancing the modeling methodologies for public health policy and practice
implications during pandemic situations.

Conclusion
The lack of food supply and financial incentive during COVID-19 pandemic lockdown in Nigeria, and associated negative impact on recovery highlight the need for provision of social welfare programs for its citizens to mitigate the physical and psychosocial effects of the COVID-19 pandemic such as violence. The evidence of mass gathering from protests in the US despite availability of social welfare programs warrants intensified risk communication by the public health and government leaders. Both Nigerian and the US governments should use evidence-informed approach to support vulnerable populations as well.

Correspondence: Dr. K.O. Ogunyemi, Department of Community Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria, Email: ogunyemik@babcock.edu.ngwere first provided in the Google search list were included for the review.

Effect of coronavirus disease lockdown on the physical and psychological attributes of Nigerian athletes

KI Oke — 2021-07-05

Background/ Objective: The aim of the study was to assess the effect of lockdown measures occasioned by COVID-19 pandemic on the physical and psychological characteristics of Nigerian athletes.
Methods: An online survey involving 578 elite athletes was utilized, using an electronic questionnaire which sought information on respondents’ socio-demographics, sports type, level of psychological distress, injury incidences management, and expectations or otherwise of financial support during the lockdown period. Data obtained were analyzed with descriptive and inferential statistics with SPSS version 21 with alpha set at <0.05.

Results: Results showed that the COVID-19 lockdown had a significant negative impact on respondents’ ratings of cardiovascular endurance, muscular strength, joint flexibility, speed, agility, coordination level and body weight. The Kessler Psychological Distress Scale showed that 44.1% of the respondents were likely to have been psychologically well, while 20.6% and 12.5% were likely to be having mild and moderate disorders respectively. 22.8% of the respondents were likely to be having severe disorder as a result of the lockdown restrictions. Results also showed no association between respondents’ age, gender, marital status, sports type and level of psychological distress. However, there were associations between the presence of injury and lack of access to its
management during the lockdown period, expectation of financial support or palliative from club during lockdown period and the level of psychological distress.

Conclusion: It was concluded that COVID-19 pandemic elicited reduction in physical attributes and varying levels of psychological distress among Nigerian athletes.

Keywords: Coronavirus disease, lockdown restrictions, Nigerian athletes, physical characteristics, psychological distress

Résumé
Contexte / Objectif: Le but de l’étude était d’évaluer l’effet des mesures de verrouillage occasionnées par la pandémie de Covid-19 sur les caractéristiques physiques et psychologiques des athlètes nigérians.

Méthodes: Une enquête en ligne portant sur 578 athlètes d’élite a été utilisée, à l’aide d’un questionnaire électronique qui cherchait des informations sur les caractéristiques sociodémographiques des répondants, le type de sport, le niveau de détresse psychologique, la gestion des incidences de blessures et les attentes ou non de soutien financier pendant la période de verrouillage. Les données obtenues ont été analysées avec des statistiques descriptives et inférentielles avec SPSS version 21 avec alpha fixé à d” 0,05.

Résultats: Les résultats ont montré que le verrouillage du COVID-19 avait un impact négatif significatif sur les évaluations des répondants concernant l’endurance cardiovasculaire, la force musculaire, la flexibilité articulaire, la vitesse, l’agilité, le niveau de coordination et le poids corporel. L’échelle de détresse psychologique de Kessler a montré que 44,1% des répondants étaient susceptibles d’avoir été psychologiquement bien, tandis que 20,6% et 12,5% étaient susceptibles d’avoir des troubles légers et modérés respectivement. 22,8% des répondants étaient
susceptibles de souffrir de troubles graves en raison des restrictions de verrouillage. Les résultats n’ont également montré aucune association entre l’âge, le sexe, l’état matrimonial, le type de sport et le niveau de détresse psychologique des répondants. Cependant, il y avait des associations entre la présence d’une blessure et le manque d’accès à sa gestion pendant la période de verrouillage, l’attente d’un soutien financier ou palliatif du club pendant la période de verrouillage et le niveau de détresse psychologique.

Conclusion: Il a été conclu que la pandémie de COVID-19 a entraîné une réduction des attributs physiques et des niveaux variables de détresse psychologique chez les athlètes nigérians.Mots clés: maladie à coronavirus, restrictions de verrouillage, athlètes nigérians, caractéristiques physiques, détresse psychologique

Correspondence: O.O. Ogundiran, Department of Physiotherapy, Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, Ilesa, Nigeria. E-mail: femi_diran@yahoo.co

Treatment outcomes among adult drug sensitive pulmonary tuberculosis patients in a private tertiary hospital in Ogun State, Nigeria: a retrospective study

K Sodeinde — 2021-07-05

Department of Community Medicine1
, Babcock University Teaching Hospital,
Ilishan-Remo, and Department of Community Medicine and Primary Care2
,
Federal Medical Centre, Abeokuta, Ogun State, Nigeria
Abstract
Background: Tuberculosis (TB) remains a high burden disease particularly in developing countries. The periodic
appraisal of the outcome of treatment and associated determinants is of utmost value, as it serves as a litmus test
of the impact of the TB control programme in the facility and its catchment area. This study thus aimed to review
treatment outcomes and associated factors among drug sensitive pulmonary TB patients accessing care in a
private tertiary hospital in Ogun State, Nigeria.
Methods: A retrospective review of 171 drug sensitive pulmonary TB patients managed from January 2013 to
December 2020 at the TB (DOTS) clinic of Babcock University Teaching Hospital (BUTH) was done. The
socio-demographic, clinical, and laboratory data were extracted from the presumptive TB register. The analysis
was done using SPSS version 20. Relevant descriptive and inferential statistics were calculated with the level of
significance set at p< 0.05.
Results: The mean age of the drug sensitive pulmonary TB patients was 42.11±14.86 years. More than half
(51.5%) of them were females, while 48.5% were males. About two-fifth (38.6%) of the patients were classified
as completed treatment, 35.7% achieved cure, 7.0% were lost to follow up, 0.6% had treatment failure and
18.1% died. Overall, 75.4% of the patients had treatment success while 24.6% had unsuccessful treatment. Those
who were HIV negative had a statistically significantly better treatment outcome as compared to those who were
HIV positive (p=0.03). There was also a statistically significant association between usage of HAART and
treatment outcomes (p=0.002).
Conclusion: The findings on better TB treatment outcomes among HIV negative patients and HIV positive
patients on HAART highlight the need for HIV prevention strategies and sustainable provision of HAART
during the management of TB.
Keywords: BUTH, HAART, HIV, Ogun State, Treatment Outcome, TB.
Résumé
Contexte: La tuberculose (TB) reste une maladie à charge élevée, en particulier dans les pays en développement.
L’évaluation périodique des résultats du traitement et des déterminants associés est de la plus haute valeur, car
elle sert de test décisif de l’impact du programme de lutte antituberculeuse dans l’établissement et sa zone de
desserte. Cette étude visait donc à examiner les résultats du traitement et les facteurs associés chez les patients
atteints de tuberculose pulmonaire sensible aux médicaments accédant aux soins dans un hôpital tertiaire privé
de l’État d’Ogun, au Nigéria.
Méthodes: Une revue rétrospective de 171 patients atteints de tuberculose pulmonaire sensible aux médicaments
pris en charge de janvier 2013 à décembre 2020 à la clinique TB (DOTS) du Babcock University Teaching
Hospital (BUTH) a été réalisée. Les données sociodémographiques, cliniques et de laboratoire ont été extraites
du registre présomptif de la tuberculose. L’analyse a été effectuée à l’aide de la version 20 de SPSS. Les
statistiques descriptives et inférentielles pertinentes ont été calculées avec le niveau de signification fixé à p
<0,05.
Résultats: L’âge moyen des patients tuberculeux pulmonaires sensibles aux médicaments était de 42,11 ± 14,86 ans. Plus de la moitié
(51,5%) d’entre eux étaient des femmes, tandis que 48,5% étaient des hommes. Environ deux cinquièmes (38,6%) des patients ont été
classés comme traitement terminé, 35,7% ont guéri, 7,0% ont été perdus de vue, 0,6% ont échoué au traitement et 18,1% sont décédés.
Dans l’ensemble, 75,4% des patients ont eu un succès de traitement tandis que 24,6% ont eu un traitement infructueux. Ceux qui étaient
séronégatifs avaient des résultats de traitement statistiquement significativement meilleurs que ceux qui étaient séropositifs (p = 0,03). Il
y avait également une association statistiquement significative entre l’utilisation du HAART et les résultats du traitement (p = 0,002).Conclusion: Les résultats sur de meilleurs résultats du traitement de la tuberculose chez les patients séronégatifs
et les patients séropositifs sous HAART soulignent la nécessité de stratégies de prévention du VIH et de
fourniture durable de HAART pendant la prise en charge de la tuberculose.
Mots clés: BUTH, HAART, VIH, état d’Ogun, résultat du traitement, tuberculose.
Correspondence: Dr. K.O. Ogunyemi, Department of Community Medicine, Babcock University Teaching Hospital,
Ilishan-Remo, Ogun State, Nigeria. E-mail: ogunyemik@babcock.edu.n

Radiation doses to contralateral breast during unilateral breast external beam radiotherapy

BI Akinlade — 2021-07-05

Introduction: The cost benefit of external beam radiotherapy (EBRT) in the management of patients living with cancer, especially cancer of the breast cannot be over emphasized. It improves 5-year disease free survival, local tumour control and relieves associated pain. However, EBRT for unilateral breast cancer management could predispose contralateral breast (CB), that is outside the treatment volume (TV), to unavoidable scatter radiation doses. This is of great concern in radiation protection because of high radio-sensitivity of breast tissue.

Materials and Methods: Radiation dose to CB of 20 patients, who consented to participate and be managed with EBRT from Tele-Cobalt unit for primary breast cancer were considered. The dose to CB was measured with calibrated Thermoluminescent dosimeters (TLD) placed on CB at three different positions away from the TV.

Results: The scattered radiation dose (Gy) to CB measured at position 5cm (midline), 10cm (nipple) and 15cm away from the TV were 2.515 + 0.613; 1.548 + 0.578 and 0.780 ± 0.149 respectively. The average dose to CB was 1.601 + 0.40 Gy per session and this is 43% of the prescribed dose (3.75 Gy). This is a bit higher than result from similar study, where CB was covered with lead shield.

Conclusion: It was observed that the mean scattered radiation doses to three different portions of CB during EBRT varied according to the inverse squared principle, where the portion that is closest to TV got 67% of the prescribed dose followed by 41% and the farthest portion got 21%.

Keywords: Contralateral Breast, External Beam Radiotherapy, Breast Cancer, Scattered radiation doses.

Résumé
Contexte: Le rapport coût-bénéfice de la radiothérapie externe (EBRT) dans la prise en charge des patients atteints de cancer, en particulier le cancer du sein, ne peut être surestimé. Il améliore la survie sans maladie à 5 ans, le contrôle local des tumeurs et soulage la douleur associée. Cependant, l’EBRT pour la prise en charge unilatérale du cancer du sein peut prédisposer le sein controlatéral (BC), c’est-à-dire en dehors du volume de traitement (TV), à des doses de rayonnement diffus inévitables. Ceci est très préoccupant en radioprotection en raison de la radio-sensibilité élevée du tissu mammaire.

Matériel et méthodes: La dose de rayonnement à la C.-B. de 20 patientes, qui ont consenti à participer et à être prises en charge par EBRT de l’unité Tele-Cobalt pour le cancer du sein primaire a été prise en compte. La dose au CB a été mesurée avec des dosimètres thermoluminescents étalonnés (TLD) placés sur CB à trois positions différentes loin du téléviseur.

Résultats: La dose de rayonnement diffusé (Gy) au CB mesurée à la position 5 cm (ligne médiane), 10 cm (mamelon) et 15 cm du téléviseur était de 2,515 + 0,613; 1,548 + 0,578 et 0,780 ± 0,149 respectivement. La dose moyenne à CB était de 1,601 + 0,40 Gy par séance et cela correspond à 43% de la dose prescrite (3,75 Gy). C’est un peu plus élevé que le résultat d’une étude similaire, où le disjoncteur était recouvert d’un blindage en plomb.

Conclusion: Il a été observé que les doses moyennes de rayonnement diffusées sur trois parties différentes du CB pendant l’EBRT variaient selon le principe du carré inverse, où la partie la plus proche du VT recevait 67% de la dose prescrite suivie de 41% et la partie la plus éloignée. . obtenu 21%.

Mots clés: Sein controlatéral, radiothérapie externe, cancer du sein, doses de rayonnement diffusées.

Correspondence: Dr. Akinlade Bidemi I, Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria. Mobile: 08066659578; E-mail: bidy2012@yahoo.com, biakinlade@com.ui.edu.ng

Audit of anti-vascular endothelial growth factor medication use in Ekiti, Southwestern Nigeria

IA Ajayi — 2021-07-05

Department of Ophthalmology, Ekiti State University Teaching Hospital,
Ado-Ekiti, Nigeria.
Abstract
Background: The use of anti-vascular endothelial growth factor (anti-VEGF) agents has increased in recent years.
This is because of the increasing detection of vitreo-retinal disorders associated with vascular abnormalities. The
indications vary from one location to another. Visual outcome following treatment with these agents also vary
with disease severity and promptness of intervention.
Methodology: A prospective observational study was carried out on all patients with retinal disorders who had
intravitreal injection between November 2013 and November 2019. Data on demographic characteristics,
presenting visual acuity, diagnosis, type of anti-VEGF agent used, post-treatment visual acuity and complications
were retrieved and entered into Statistical Package for Social Sciences (SPSS) version 25 and analysed for
frequency and proportions.
Results: Seven hundred and thirty two patients with retinal pathologies were seen during the study period. A total
of 251 intravitreal anti-VEGF agent injections were administered to 95 patients during the period under review.
The mean age of the patients was 64.3 ±12.7 years. The number of injections per eye varied from 2 to 6 with an
average of 2.6 per eye. Bevacizumab was the more commonly utilized anti-VEGF medication as it was used for
231(92%) injections. Wet age-related maculopathy was the commonest indication for intravitreal anti-VEGF
agent in 61(24.3%) followed by diabetic macula edema in 55(21.9%) and retinal vein occlusion with macular
edema in 54(21.5%) injections. Visual improvement was observed in 69 (72.6%) patients.
Conclusion: Anti-VEGF therapy was useful in the management of patients with retinal disorders. The need for
multiple injections and the attendant cost still constitutes a major challenge in the use of these medications.
Keywords: Intravitreal, Retina, Bevacizumab, Ranibizumab, Retina disorders, Antivascular endothelial growth
factor agents.
Résumé
Contexte: L’utilisation d’agents anti-facteur de croissance endothélial vasculaire (anti-VEGF) a augmenté ces
dernières années. Ceci est dû à la détection croissante des troubles vitréo-rétiniens associés auxanomalies. Les
indications varient d’un endroit à l’autre. Le résultat visuel après le traitement avec ces agents varie également en
fonction de la gravité de la maladie et de la rapidité de l’intervention.
Méthodologie: Une étude observationnelle prospective a été menée sur tous les patients atteints de rétine
troubles ayant subi une injection intravitréenne entre novembre 2013 et novembre 2019. Données sur les
caractéristiques démographiques, présentant l’acuité visuelle, le diagnostic, le type de agent anti-VEGF utilisé,
l’acuité visuelle post-traitement et les complications ont été récupérées et entré dans le progiciel statistique pour
les sciences sociales (SPSS) version 25 et analysé pour fréquence et proportions.
Résultats: Sept cent trente-deux patients atteints de pathologies rétiniennes ont été vus au cours de la période
d’étude. Au total, 251 injections d’agent anti-VEGF intravitréen ont été administrées à 95 patients au cours de la
période sous revue. L’âge moyen des patients était de 64,3 ± 12,7 ans. Le nombre d’injections par œil variait de 2
à 6 avec une moyenne de 2,6 par œil. Le bévacizumab était le médicament anti-VEGF le plus couramment utilisé
car il était utilisé pour 231 injections (92%). La maculopathie humide liée à l’âge était l’indication la plus
courante de l’anti-VEGF intravitréen chez 61 (24,3%), suivie de l’œdème diabétique de la macula dans 55
(21,9%) et de l’occlusion veineuse rétinienne avec œdème maculaire dans 54 (21,5%) injections. Une
amélioration visuelle a été observée chez 69 patients (72,6%).
Conclusion: La thérapie anti-VEGF a été utile dans la prise en charge des patients atteints de troubles rétiniens. La
nécessité de multiples injections et le coût associé constituent toujours un défi majeur dans l’utilisation de ces
médicaments.
Mots clés: Intravitréen, Rétine, Bévacizumab, Ranibizumab, Troubles de la rétine, Agents de facteur de
croissance endothélial anti-vasculaire.
Correspondence: Dr. I.A. Ajayi, Department of Ophthalmology, Ekiti State University Teaching Hospital, Ado-Ekiti,
Nigeria. E-mail:iyiseye2005@gmail.com

Effects of zoledronic acid on metastatic bone pain in cancer of the prostate: A randomised controlled trial

MO Akinwale — 2021-07-05

Background: Advanced cancer of the prostate often causes pain that can be severe requiring palliation with analgesics. Zoledronic acid, a third-generation bisphosphonate, has not been primarily used as an adjunct to treat pain in patients with metastatic bone secondary to advanced prostate cancer in Nigeria. The study investigated the effects of 3 doses of Zoledronic acid, at 4-weekly intervals, in addition to the analgesic regimen of oral morphine, diclofenac, paracetamol and amitriptyline, on bone pain in patients with metastatic prostate cancer .

Methods: A prospective randomized open-labelled trial in which forty patients with moderate to severe bone pain due to metastatic prostate cancer were recruited after institutional ethics approval. Patients were assigned to two groups: The Control (C) group received liquid oral morphine, diclofenac, paracetamol and amitriptyline. Zoledronic acid (ZG) group received 3 doses of Zoledronic acid at 4-weekly intervals in addition to liquid morphine, diclofenac, paracetamol and amitriptyline. Severity of pain and quality of life (QoL) were measured at baseline and weekly for 12 weeks. Data were analysed using means, range, standard deviations and proportions while independent t-test was used to compare the variables between the two groups.

Results: Demographic variables, baseline pain scores and quality of life between the 2 groups were similar. Therewas a statistically significant improvement in pain score in the Zoledronic acid group (1.38±0.53 vs 2.13±0.94) post-intervention, (p = 0.004).

Conclusion: The administration of three doses of Zoledronic acid at 4-weekly intervals significantly improved bone pain score during the 12-weeks follow up in patients with advanced prostate cancer.

Keywords: Zoledronic acid, Bone pain, Prostate cancer.

Résumé
Contexte: Le cancer avancé de la prostate provoque souvent des douleurs qui peuvent être sévères nécessitant des soins palliatifs avec des analgésiques. L’acide zolédronique, un bisphosphonate de troisième génération, n’a pas été principalement utilisé comme adjuvant pour traiter la douleur chez les patients présentant des métastases osseuses secondaires à un cancer avancé de la prostate au Nigéria. L’étude a examiné les effets de 3 doses d’acide zolédronique, à des intervalles de 4 semaines, en plus du régime analgésique de morphine orale, de diclofénac, de paracétamol et d’amitriptyline, sur la douleur osseuse chez les patients atteints d’un cancer métastatique de la prostate.

Méthodes: Un essai prospectif randomisé ouvert dans lequel quarante patients souffrant de douleurs osseuses modérées à sévères dues à un cancer métastatique de la prostate ont été recrutés après approbation éthique de l’établissement. Les patients ont été répartis en deux groupes: Le groupe témoin (C) a reçu de la morphine orale liquide, du diclofénac, du paracétamol et de l’amitriptyline. Le groupe acide zolédronique (ZG) a reçu 3 doses d’acide zolédronique à intervalles de 4 semaines en plus de la morphine liquide, du diclofénac, du paracétamol et de l’amitriptyline. La sévérité de la douleur et la qualité de vie (QdV) ont été mesurées au départ et chaque semaine pendant 12 semaines. Les données ont été analysées à l’aide des moyennes, de la plage, des écarts-types et des proportions, tandis qu’un test t indépendant a été utilisé pour comparer les variables entre les deux groupes.

Résultats: Les variables démographiques, les scores de douleur de base et la qualité de vie entre les 2 groupes étaient similaires. Il y avait une amélioration statistiquement significative du score de douleur dans le groupe acide zolédronique (1,38 ± 0,53 vs 2,13 ± 0,94) après l’intervention, (p = 0,004).

Conclusion: L’administration de trois doses d’acide zolédronique à des intervalles de 4 semaines a significativement amélioré le score de douleur osseuse au cours des 12 semaines de suivi chez les patients atteints d’un cancer de la prostate avancé.

Mots clés: Acide zolédronique, douleur osseuse, cancer de la prostate.

Correspondence: Dr. M.O . Akinwale, Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan. Nigeria E-mail: akinsmko@yahoo.com, moakinwale@com.ui.edu.ng

The effect of socio-demographic factors and past denture experience on complete denture satisfaction and utilization

IM Ogbonmwan — 2021-07-05

Background: The success of rehabilitation of completely edentulous patients with complete denture depends on the satisfaction and utilization of the complete denture after treatment. This outcome is influenced by various factors.

Objective: To determine the effect of socio- demographic factors and past denture experience on complete denture satisfaction and utilization among patients.

Method: Fifty-two completely edentulous patients who presented at the prosthodontics unit of the Dental Center, Obafemi Awolowo University Teaching Hospitals Complex, Île Ife were recruited for the study having met the inclusion and exclusion criteria. The data taken were the socio- demographic profile such as age, gender, biological age and educational level. Past denture experience was also recorded. The complete dentures were fabricated using the procedure described by the British Society of Prosthetic Dentistry. All dentures met the Functional Assessment of Denture Criteria before delivery. Patient were recalled after 3 months to assess satisfaction and utilization.

Result: A total of fifty-two patients comprising of 19 males (36.5%) and 33 females (63.5%) were recruited for the study. Age, gender, educational level and past denture experience did not affect denture satisfaction and utilization. However, biological age affected denture satisfaction but did not affect utilization of the denture.

Conclusion: Complete denture satisfaction was affected by biological age despite ensuring good quality of dentures fabricated using the Functional Assessment of Denture Criteria to assess complete denture.

Keywords: Complete denture, complete denture satisfaction, complete denture utilization.

Résumé
Contexte: Le succès de la rééducation des patients complètement édentés avec une prothèse complète dépend de la satisfaction et de l’utilisation de la prothèse complète après le traitement. Ce résultat est influencé par divers facteurs.

Objectif: Déterminer l’effet des facteurs sociodémographiques et de l’expérience antérieure de la prothèse sur la satisfaction et l’utilisation complètes de la prothèse chez les patients.

Méthode: Cinquante-deux patients complètement édentés qui se sont présentés à l’unité de prosthodontie du Centre dentaire, Complexe des Hôpitaux Universitaires Obafemi Awolowo, Île Ife ont été recrutés pour l’étude ayant satisfait aux critères d’inclusion et d’exclusion. Les données recueillies étaient le profil sociodémographique tel que l’âge, le sexe, l’âge biologique et le niveau d’éducation. L’expérience antérieure de la prothèse dentaire a également été enregistrée. Les prothèses complètes ont été fabriquées selon la procédure décrite par la British Society of Prosthetic Dentistry. Toutes les prothèses ont satisfait aux critères d’évaluation fonctionnelle des prothèses avant la livraison. Les patients ont été rappelés après 3 mois pour évaluer leur satisfaction et leur utilisation.

Résultat: Un total de cinquante-deux patients comprenant 19 hommes (36,5%) et 33 femmes (63,5%) ont été recrutés pour l’étude. L’âge, le sexe, le niveau d’éducation et l’expérience antérieure de la prothèse n’ont pas affecté la satisfaction et l’utilisation de la prothèse. Cependant, l’âge biologique affectait la satisfaction de la prothèse, mais n’affectait pas l’utilisation de la prothèse.

Conclusion: La satisfaction totale de la prothèse dentaire a été affectée par l’âge biologique malgré la bonne qualité des prothèses fabriquées en utilisant les critères d’évaluation fonctionnelle des prothèses pour évaluer la prothèse complète.

Mots clés: Prothèse complète, satisfaction totale de la prothèse, utilisation complète de la prothèse.

Correspondence: Dr I.M. Ogbonmwan, Department of Restorative Dentistry, Faculty of Dentistry, College of Health Sciences, Obafemi Awolowo University, Ile- Ife. E-mail: mikeigx79@gmail.com

Oral hygiene practice among general outpatients in a tertiary hospital in North Central Nigeria

JO Ajayi — 2021-07-05

Department of Dental and Maxillofacial Surgery University of Abuja
Teaching Hospital, Gwagwalada, Abuja, Nigeria.
Abstract
Aim: To assess oral hygiene practices in patients attending the General Outpatient Department (GOPD) of the
University of Abuja Teaching Hospital, Gwagwalada, Abuja.
Materials and Methods: This was a cross sectional study of patients attending the GOPD of University of Abuja
Teaching Hospital, Gwagwalada, Abuja, Nigeria. A semi structured pretested questionnaire was administered to
416 consecutively recruited adult patients that consented to participate in the study. Data collected were analyzed
using SPSS version 23.
Results: The age ranged from 18 to 60 years with the mean age being 33.22 years (SD = 10.11). About 55% of the
participants were females while 45.4% were males. Most (98.6%) of the respondents used toothbrush to clean
their teeth and 62.0% brush their teeth twice a day. Only very few (1.7%) used dental floss to clean the interdental
area while most respondents (92.1%) used toothpicks.. Half of the respondents brush for over 3 minutes.
Irrespective of age groups or gender, most of our respondents (64.2%) preferred soft brush while and 28.1%
preferred hard toothbrush. Just a little above half of our respondents (52.2%) preferred using tooth brush with big
head while 40.1% preferred brushes with small head. While a very good number (at least 93.9%) replace their
toothbrushes within 6 months. only one hundred and forty (33.7%) of our respondents had ever visited dentist
while fifty-five (13.2%) did so within the past 12 months.
Conclusion: The oral hygiene practice among our study population was fairly good but need to be reinforced
through various oral health education programs and outreaches with more emphasis on the use of dental floss and
importance of regular visit to the dentist.
Key words: Oral hygiene practice, tooth brushing, dental floss, dental visits
Résumé
Objectif: Évaluer les pratiques d’hygiène bucco-dentaire chez les patients fréquentant le département général de
consultations externes (GOPD) de l’hôpital universitaire de l’Université d’Abuja, Gwagwalada, Abuja.
Matériel et méthodes: Il s’agissait d’une étude transversale de patients fréquentant le GOPD de l’hôpital
universitaire de l’Université d’Abuja, Gwagwalada, Abuja, Nigéria. Un questionnaire pré-testé semi-structuré a
été administré à 416 patients adultes recrutés consécutivement qui ont consenti à participer à l’étude. Les données
collectées ont été analysées à l’aide de la version 23 de SPSS.
Résultats: L’âge variait de 18 à 60 ans, l’âge moyen étant de 33,22 ans (ET = 10,11). Environ 55% des
participants étaient des femmes tandis que 45,4% étaient des hommes. La plupart (98,6%) des répondants
utilisaient une brosse à dents pour se nettoyer les dents et 62,0% se brossaient les dents deux fois par jour. Seuls
très peu (1,7%) utilisaient du fil dentaire pour nettoyer la zone interdentaire tandis que la plupart des répondants
(92,1%) utilisaient des cure-dents. La moitié des répondants se brossent les dents pendant plus de 3 minutes.
Quels que soient les groupes d’âge ou le sexe, la plupart de nos répondants (64,2%) préféraient une brosse douce
tandis que 28,1% préféraient une brosse à dents dure. Un peu plus de la moitié de nos répondants (52,2%)
préféraient utiliser une brosse à dents à grosse tête tandis que 40,1% préféraient des brosses à petite tête. Alors
qu’un très bon nombre (au moins 93,9%) remplacent leurs brosses à dents dans les 6 mois. seulement cent
quarante (33,7%) de nos répondants avaient déjà consulté un dentiste alors que cinquante-cinq (13,2%) l’ont fait
au cours des 12 derniers mois.
Conclusion: La pratique de l’hygiène bucco-dentaire au sein de notre population d’étude était assez bonne, mais
doit être renforcée par divers programmes d’éducation en santé bucco-dentaire et des activités de sensibilisation
mettant davantage l’accent sur l’utilisation de la soie dentaire et l’importance d’une visite régulière chez le
dentiste.
Mots clés: Pratique d’hygiène bucco-dentaire, brossage des dents, soie dentaire, visites dentaires
Correspondence: Dr. J.O. Ajayi, Department of Dental and Maxillofacial Surgery, University of Abuja Teaching Hospital,
Gwagwalada, Abuja. E mail: drjoajayi@yahoo.com

Cognitive factors and preventive practices relating to hepatitis B infection among in-school adolescents in Ogun State, Nigeria

CO Agbede — 2021-07-05

Background: Hepatitis B virus infection is endemic in Nigeria and constitutes a public health concern. In-School adolescents in Ogun State indulge in practices which have potentials for putting them at risk of HBV infection. However, their cognitive factors and preventive practices relating to Hepatitis B infections among them are yet to be fully explored systematically.

Methods: A descriptive cross-sectional survey was conducted among 300 students recruited through the multistage sampling process. The respondents were drawn from junior and senior arms in four public secondary schools in Ogun State. A pre-tested self-administered questionnaire was used to facilitate data collection. Descriptive statistics were used to analyze the data on socio-demographic characteristics, as well as data on Hepatitis B related knowledge and prevention practices. Pearson correlation coefficient was used to determine the relationship between Hepatitis B knowledge and prevention practices.

Results: The participants’ mean knowledge score was 16.4±4.4, and 79.3% (238) had fair knowledge of HBV infection, while 94.7% (284) had in appropriate HBV preventive practices. Only 6.7% (20.1) had been vaccinated against HBV. No significant relationship was found between knowledge of HBV and adoption of prevention practices among the participants (r=0.06; p=0.30).

Conclusion: The fair knowledge of the infection implies that there are some gaps in the participants’ knowledge relating to Hepatitis B infection. An appreciable proportion of the respondents were vulnerable to HBV due to poor uptake of the HBV vaccine and involvement in practices that can put them at risk of the infection. Educational interventions and advocacy are needed to address these concerns.
Keyword: In-school Adolescents, Hepatitis B infection Cognitive factors, Preventive practices.

Résumé
Contexte: L’infection par le virus de l’hépatite B est endémique au Nigéria et constitue un problème de santé publique. Les adolescents scolarisés de l’État d’Ogun se livrent à des pratiques susceptibles de les exposer à un risque d’infection par le VHB. Cependant, leurs facteurs cognitifs et leurs pratiques préventives liées aux infections par l’hépatite B parmi eux doivent encore être complètement explorés de manière systématique.

Méthodes: Une enquête transversale descriptive a été menée auprès de 300 étudiants recrutés dans le cadre du processus d’échantillonnage à plusieurs degrés. Les personnes interrogées provenaient des classes juniors et seniors de quatre écoles secondaires publiques de l’État d’Ogun. Un questionnaire auto-administré pré-testé a été utilisé pour faciliter la collecte de données. Des statistiques descriptives ont été utilisées pour analyser les données sur les caractéristiques sociodémographiques, ainsi que les données sur les connaissances et les pratiques de prévention liées à
l’hépatite B. Le coefficient de corrélation de Pearson a été utilisé pour déterminer la relation entre les connaissances sur l’hépatite B et les pratiques de prévention.

Résultats: Le score de connaissance moyen des participants était de 16,4 ± 4,4 et 79,3% (238) avaient une bonne connaissance de l’infection par le VHB, tandis que 94,7% (284) avaient des pratiques préventives appropriées contre le VHB. Seulement 6,7% (20,1) avaient été vaccinés contre le VHB. Aucune relation significative n’a été trouvée entre la connaissance du VHB et l’adoption de pratiques de prévention chez les participants (r = 0,06; p = 0,30).

Conclusion: la bonne connaissance de l’infection implique qu’il existe des lacunes dans les connaissances des participants concernant l’hépatite B. Une proportion appréciable des répondants étaient vulnérables au VHB en raison de la faible utilisation du vaccin contre le VHB et de leur implication dans des pratiques qui peuvent les exposer à un risque d’infection. Des interventions éducatives et un plaidoyer sont nécessaires pour répondre à ces préoccupations.

Mot clés: Adolescents scolarisés, hépatite B, facteurs cognitifs, pratiques préventives.

Correspondence: Olaoye T, Department of Public Health, Babcock University, Ilishan-Remo, Ogun State Nigeria. Email: olaoyet@babcock.edu.ng

Disparities in COVID-19 death rates between sub-Saharan Africa and the Western world: a Pathologist’s perspective

CA Okolo — 2021-07-05

The COVID 19 infection was first reported in Wuhan China in December 2019. It has become a global pandemic affecting almost all countries of the world. The virus is an enveloped RNA virus which is a member of the Coronaviridae family with 4 major structural proteins: spike surface glycoprotein, small envelope protein, matrix protein and nucleocapsid protein. The spread of the virus appears more rapid across Europe and the western world with more profound manifestations and increased death rates compared with sub-Saharan Africa. The reasons for these disparities are not clearly understood. A few factors have been suggested to be contributory to the disparities. These include obvious factors such as inadequate testing and reporting of cases in SSA. Other suggested factors including lower life expectancy in SSA, increased maternal mortality reducing many cases of congenital abnormalities, enhanced immunity in SSA due to repeated exposure to infectious agents, mutations with differing severity of infections and effect of the tropical weather on the pandemic.These suggested factors should generate research questions for further investigation as the pandemic rages on.

Keywords: COVID 19, pandemic, coronaviridae, manifestation.

Résumé
L’infection au COVID 19 a été signalée pour la première fois à Wuhan en Chine en décembre 2019. Elle est devenue une pandémie mondiale affectant presque tous les pays du monde. Le virus est un virus à ARN enveloppé qui appartient à la famille des Coronaviridae avec 4 protéines structurales majeures: la glycoprotéine de surface du pic, la protéine de la petite enveloppe, la protéine de la matrice et la protéine de la nucléocapside. La propagation du virus semble plus rapide à travers l’Europe et le monde occidental avec des manifestations plus profondes et des taux de mortalité accrus par rapport à l’Afrique subsaharienne. Les raisons de ces disparités ne sont pas clairement comprises. Il a été suggéré que quelques facteurs contribuent aux disparités. Ceux-ci incluent des facteurs évidents tels que des tests et des rapports inadéquats des cas en ASS. D’autres facteurs suggérés, notamment une espérance de vie plus faible en ASS, une mortalité maternelle accrue réduisant de nombreux cas d’anomalies congénitales, une immunité renforcée en ASS en raison d’une exposition répétée à des agents infectieux, des mutations avec une gravité différente des infections et l’effet du climat tropical sur la pandémie. Ces facteurs suggérés devraient générer des questions de recherche à approfondir alors que la pandémie fait rage.

Mots-clés: Covid 19, pandémie, manifestation de coronavividae

Correspondence: Dr. C.A. Okolo, Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Email: clemabuokolo@yahoo.com

Expanding access to assisted reproductive technology in a developing country: getting more for less.

GO Obajimi — 2021-07-05

Background: Infertility is a universal health burden with profound consequences in low/middle-income countries (LMIC). The global prevalence of infertility is between 8-12 % with values as high as 32 % in Central and Southern Africa, often referred to as the “infertility belt” [1]. In Nigeria, a prevalence rate of between 20-30% has been estimated due to the high prevalence of sexually transmitted infections [2]. The consequences of involuntary childlessness in a low/middle-income country can be devastating, leading to economic deprivation and impoverishing medical costs [3]. There is a high premium placed on childbearing in developing countries due to the socio-cultural beliefs and practices, yet there exists a high disparity between urban and rural dwellers with respect to accessing health care [4].

Challenge(s): There is an unmet need for assisted conception in sub-Saharan Africa as published data suggest less than 1.5% of the African population have access to assisted conception services [3]. This is further compounded by the high tubal factor infertility requiring in-vitro fertilization. Assisted conception requires significant investment in manpower and infrastructure, the cost of which is borne by the patients seeking care. Invariably, assisted conception is strenuous, time consuming, expensive, and often inaccessible to the financially vulnerable. Out-of- pocket payment for services is a major limiting factor in developing countries as insurance coverage and government support are lacking. In the absence of financial protection, out-of-pocket payments can ultimately lead to household poverty [5].

Opportunities: Expanding access to Assisted Reproductive Technology in developing countries will alleviate the impact of infertility which has been declared an issue of Public Health importance by the World Health Organization [6]. Embracing low-cost treatment protocols and partnerships via the hub-and-spoke organization design with relevant stakeholders may be the panacea in developing countries, as resources are far from equitable.

Conclusion: A paradigm shifts by government towards prioritizing infertility management against the background of a delicate balance between overpopulation and paucity of resources will provide succor to the financially vulnerable and often forgotten infertile couples.

Keywords: Access, Assisted Reproductive Technology, Developing Country.

Résumé
Contexte: L’infertilité est un fardeau de santé universel avec des conséquences profondes dans les pays à revenu faible ou intermédiaire (PRFI). La prévalence mondiale de l’infertilité se situe entre 8 et 12% avec des valeurs aussi élevées que 32% en Afrique centrale et australe, souvent appelée «ceinture d’infertilité» [1]. Au Nigéria, un taux de prévalence compris entre 20 et 30% a été estimé en raison de la forte prévalence des infections sexuellement transmissibles [2]. Les conséquences de l’absence d’enfant involontaire dans un pays à revenu faible ou intermédiaire peuvent être dévastatrices, entraînant une privation économique et une diminution des frais médicaux [3]. Les croyances et pratiques socioculturelles accordent une grande importance à la procréation dans les pays en développement, mais il existe une forte disparité entre les citadins et les ruraux en ce qui concerne l’accès aux soins de santé [4].

Défi (s): Il existe un besoin non satisfait de procréation assistée en Afrique subsaharienne car les données publiées suggèrent que moins de 1,5% de la population africaine a accès à des services de procréation assistée [3]. Ceci est encore aggravé par l’infertilité tubaire élevée nécessitant une fécondation in vitro. La conception assistée nécessite un investissement important en main-d’œuvre et en infrastructure, dont le coût est supporté par les patients qui recherchent des soins. Invariablement, la conception assistée est ardue, longue, coûteuse et souvent inaccessible aux personnes financièrement vulnérables. Le paiement direct des services est un facteur limitant majeur dans les pays en développement, car la couverture d’assurance et le soutien gouvernemental font défaut. En l’absence de protection financière, les paiements directs peuvent en fin de compte conduire à la pauvreté des ménages [5].Opportunités: L’élargissement de l’accès aux technologies de procréation assistée dans les pays en développement atténuera l’impact de l’infertilité, qui a été déclarée problème de santé publique par l’Organisation mondiale de la santé [6]. Adopter des protocoles de traitement à faible coût et des partenariats via la conception d’organisation en étoile avec les parties prenantes concernées peut être la panacée dans les pays en développement, car les ressources sont loin d’être équitables.

Conclusion: Un changement de paradigme du gouvernement vers la priorité à la gestion de l’infertilité dans le contexte d’un équilibre délicat entre la surpopulation et la rareté des ressources apportera une aide aux couples infertiles financièrement vulnérables et souvent oubliés.

Mots clés: Accès, technologie de procréation assistée, pays en développement.

Correspondence: Dr G.O. Obajimi, Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: gbolahanobajimi@gmail.com

Multiple compound odontoma with maxillary canine impaction: combined orthodontic and surgical management

OO Jaiyeoba — 2021-07-05

Department of Child Oral Health, College of Medicine,
University of Ibadan, Ibadan, Nigeria
Abstract
A case of bilaterally impacted maxillary permanent canines with associated left maxillary compound odontoma
with cortical bone swelling obstructing the path of eruption of the left permanent maxillary canine and retention
of primary canine on the right maxillary anterior segment. Management was by extraction of the right maxillary
primary canine, surgical excision of the compound odontoma on the left maxillary anterior segment and surgical
exposure of both maxillary permanent canines with subsequent orthodontic traction in order to move the impacted
canines to their normal anatomic positions.
Keywords: Odontoma, impacted maxillary canine, orthodontic traction
Résumé
Un cas de canines permanentes maxillaires impactées bilatéralement avec odontome composé maxillaire gauche
associé avec gonflement de l’os cortical obstruant le chemin d’éruption de la canine maxillaire permanente
gauche et rétention de la canine primaire sur le segment antérieur maxillaire droit. La prise en charge était par
extraction de la canine primaire maxillaire droite, excision chirurgicale de l’odontome composé sur le segment
antérieur maxillaire gauche et exposition chirurgicale des deux canines permanentes maxillaires avec traction
orthodontique ultérieure afin de déplacer les canines incluses dans leurs positions anatomiques normales.
Mots clés: Odontome, canine maxillaire incluse, traction orthodontique
Correspondence: Dr. O.T. Temisanren, Department of Child Oral Health, College of Medicine, University of Ibadan,
Ibadan, Nigeria. oyetemisanren@yahoo.com

Thyroid hormone in Immunoglobulin Density (IgGp), and postpartum haemorrhage: two case reports

K Amadi — 2021-07-05

Background: The human foetus receives a passive immunization by selective passage across the placenta of maternal gamma immunoglobulin (IgG) by attaching to the constant fraction of neonatal receptor (FcRn) which is a specific IgG transporter. Two of the patients assayed hypothyroid had postpartum haemorrhage (PPH), incidentally also had very low mean thyroid hormone level which should normally increase in pregnancy.

Rationale/Aim: A probable relationship of immunoglobulin density (IgGp) of mothers, their thyroid hormone levels and postpartum haemorrhage was evaluated for possible clinical intervention.

Methodology: Twenty pregnant women were presented at our antenatal clinics and qualified for the inclusion criteria consented freely to participate in the investigation. Ex-vivo placental models of different thyroid states, as well as maternal blood from the antecubital vein and umblical cord blood (mixed blood) were taken within five minutes postpartum. The trafficking of IgG was investigated by immunohistochemical staining and pulsechased at 370C at neutral pH. Maternal thyroid hormone levels were also evaluated.

Results: The IgG in two hypothyroid cases with post partum haemorrhage was significantly (P<0.001) deficient in the sera and (P<0.01) in the other hypothyroids that had no PPH when compared with euthyroid mothers.

Conclusion: The thyroid hormone level of the mother suggests to be an obvious natural determinant of the passive immunization of the neonate and possible occurrence of post partum haemorrhage.

Keywords: Immunoglobulin density, Post-partum haemorrhage, thyroid hormones, hypothyroidism, immunization.

Résumé
Contexte : Le fœtus humain reçoit une vaccination passive par passage sélectif à travers le placenta de l’immunoglobuline gamma maternelle (IgG) en s’attachant à la fraction constante du récepteur néonatal (FcRn) qui est un transporteur IgG spécifique. Deux des patients hypothyroïdiens assayed ont eu l’hémorragie puerpérale (PPH), incidemment ont également eu le niveau moyen très bas d’hormone thyroïdienne qui devrait normalement augmenter dans la grossesse.

Justification / But : Une relation probable de densité d’immunoglobuline (IgGp) des mères, de leurs niveaux d’hormone thyroïdienne et de l’hémorragie puerpérale a été évaluée pour l’intervention clinique possible.
Méthodologie : Vingt femmes enceintes ont été présentées dans nos cliniques prénatales et qualifiées pour les critères d’inclusion qui ont consenti librement à participer à l’enquête. Des modèles placentéraux ex vivo de différents états thyroïdiens, ainsi que le sang maternel de la veine antecubitale et du sang de cordon ombilical (sang mélangé) ont été pris dans les cinq minutes du post-partum. Le trafic d’IgG a été étudié par coloration immunohistochimique et chassé à 370C au pH neutre. Des niveaux maternels d’hormone thyroïdienne ont été également évalués.

Résultats : L’IgG dans deux cas hypothyroïdiens avec l’hémorragie post-partum était significativement (P<0.001) déficient dans le sera et (P<0.01) dans les autres hypothyroïdes qui n’ont eu aucun PPH par rapport aux mères euthyroïdes.

Conclusion : Le niveau d’hormone thyroïdienne de la mère suggère d’être un déterminant normal évident de la vaccination passive du nouveau-né et de l’occurrence possible de l’hémorragie post-partum.

Mots-clés: Densité d’immunoglobuline, hémorragie post-partum, hormones thyroïdiennes, hypothyroïdie, immunisation.

Correspondence: Dr. K Amadi, Department of Human Physiology, College of Medical Sciences, University of Jos, Nigeria. Email: parkers2004amam@yahoo.com

Implementation science to the rescue for solving health challenges from microbes and non-communicable diseases

Prof. A Ogunniyi — 2021-07-05

Man faces health challenges caused by microbes and environmental factors including overindulgence in certain habits and neglect of health promoting activities. Research directs purposeful response against these factors andproffers solutions for overcoming the various challenges. The diet in this issue of the journal comprises a balance of papers on communicable and non-communicable research. Three of the papers provide information on the enigmatic Corona virus which has taken the world by storm for close to 18 months. The virus has continued to mutate resulting in more transmissible forms and perhaps more deadly infections worldwide. The recent mutation is the Delta variant B.1.617.2 which originated from India and was preceded by the Gamma, Alpha, Beta and Epsilon variants that affected various countries/continents. It is intriguing that the apocalyptic prediction for sub-Saharan Africa (SSA) has not happened and researchers continue to wonder why. Okolo reviewed the status of SARS-COV-2 infection in SSA and proffered 8 reasons why the pandemic has not been as severe as predicted. Israel and colleagues noted that COVID-19-lockdown resulted in the reduction of physical attributes of athletes and also caused psychological distress while Ogunyemi and others emphasized the need for the provision of welfare packages for mitigating against the effects of the pandemic as was done in some high-income countries.

Adejumo and colleagues’ paper on quality check of ciprofloxacin brands available in the Nigerian market with regards to physico-chemical properties and efficacy is of interest. They noted an abysmally low dissolution rate of about 25% which could potentially cause low bioavailability. It is important for the regulatory arms of government to extend such a quality control study to other medications and maintain a tight control on pharmaceutical standards. Idowu reported on the spectrum of susceptibility of uropathogens to various antibiotics in use and showed that the extracts of Dalbergia latifolia (Fabaceae) has potential for managing individuals with urinary tract infections. A retrospective analysis of data on tuberculosis treatment in Ogun State of Nigeria by Sodeinde and colleagues noted a treatment success of 75.4% especially in individuals who were HIV-negative. Fayemiwo and others reported cryptococcal antigenaemia in 16% of stroke cases and this incidental finding was more likely among diabetic individuals. Poor vaccine uptake was blamed for increased predisposition to hepatitis B virus infection among in-school adolescents, and this would not surprise anyone knowledgeable about public health. There should be a policy on improved vaccination coverage for overcoming various communicable diseases where available.

With regards to non-communicable diseases, readers will find the review on the state of affairs with assisted reproductive technology in Nigeria by Obajimi and others worth reading. The finding that depression could be a co-morbid condition in over a quarter of patients with Type 2 diabetes mellitus should also stimulate further research, more so the link with physical inactivity as was reported in another study involving a secondary health facility in Ibadan. Nwaelugo and colleagues observed that autoimmune thyroid diseases could be linked with metabolic syndrome and this should arouse curiosity and lead to further mechanistic studies. Akinlade presented data that the radiation doses to the contralateral breast during unilateral breast external beam radiotherapy ranged between 21% and 67% depending on the distance from the source which could be important in determining collateral damage. Akinwale and colleagues showed that the administration of zolendronic acid was efficacious in reducing metastatic bone pain in cancer of the prostate. An innovative therapy using anti-vascular endothelial growth factor agents for managing vitreo-retinal disorders associated with vascular anomalies was reported by Ajayi and others.

Our readers will find the eighteen articles in this issue very interesting. The appropriate next step should be implementation of the results of these elegant studies. We advocate collaboration between basic, clinical and public health scientists for improvement in quality and depth of research findings for better health outcomes overall.

A. Ogunniyi
Editor-in-Chief