Cardiovascular risk factors and kidney function among automobile mechanic and their association with serum heavy metals in Southwest Nigeria: A cross-sectional study

INTRODUCTION

The burden of cardiovascular disease (CVD) is huge due to its associated morbidity, mortality and adverse socio-economic impact. Environmental pollution as a risk factor contributes significantly to the burden of CVD, especially in the low and middle income countries. One of the effective strategies to reduce CVD burden is to prevent or detect cardiovascular risk factors early in at-risk population. This study determined some cardiovascular risk factors, kidney function, and their association with heavy metals among automobile mechanics.

METHOD

This was a cross-sectional study involving 162 automobile mechanics and 81 age and sex matched controls. Serum levels of lead, cadmium and some cardiovascular risks were assessed and compared in the two groups. Associations between serum lead, cadmium and some cardiovascular risks were determined using correlation analysis. P value of <0.05 was taken as significant.

RESULTS

The mean ages of the automobile mechanics and controls were 47.27±9.99 years and 48.94±10.34 years, respectively. The prevalence of elevated serum cadmium was significantly higher in the automobile mechanics (25.9% vs 7.9%; p = <0.001). The significant cardiovascular risk factors in the automobile mechanics vs controls were elevated total cholesterol (32.1% vs 18.5%; p = 0.017), hyperuricemia (20.4% vs 1.2%; p = <0.001), elevated blood glucose (16.0% vs 4.9% p = 0.013); and alcohol use (55.1% vs 30.0%; p = 0.001). Among the automobile mechanics, there were significant positive correlations between serum cadmium, atherogenic index of plasma (AIP) (p = 0.024; r = 0.382) and triglyceride (p = 0.020; r = 0.391). Significant positive correlation was found between serum lead and neutrophil gelatinase associated lipocalin (NGAL) (p = <0.001; r = 0.329). There were significant positive correlation between serum cadmium level, AIP (p = 0.016; r = 0.373) and TG (p = 0.004; r = 0.439); between serum lead and NGAL in all the study participants (p = 0.005; r = 0.206).

CONCLUSION

Automobile mechanics have notable exposure to heavy metals and a higher prevalence of some cardiovascular risk factors. Health education and sensitisation as well as policies that would regulate exposure of persons to heavy metals should be implemented in Nigeria.

Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study

INTRODUCTION

Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS.

MATERIALS AND METHODS

This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS.

RESULTS

A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria.

CONCLUSION

This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.

Prevalence and distribution of primary glomerular diseases in Africa: a systematic review and meta-analysis of observational studies

Glomerulonephritis (GN) is a predominant cause of kidney failure in Africa. The prevalence of primary GNs varies widely across Africa depending on the relative proportion of secondary GNs and genetic predispositions. We assessed the overall and sub-regional prevalence of primary GN and its histologic subtypes in Africa. We searched PubMed, EMBASE and African Journals Online for studies of biopsy-proven primary GNs across all age groups in Africa published between 2010 and 2022. Data for primary GNs [minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), mesangioproliferative GN (MesPGN), membranoproliferative GN (MPGN), post-infectious GN (PIGN), IgA Nephropathy (IgAN), and crescentic GN (CresGN)] were extracted. Pooled prevalence was determined using the random effects model. Seventeen eligible articles (n = 6,494 individuals) from 8 African countries met the inclusion criteria. The overall pooled prevalence of FSGS, MCD, MN, MPGN, MesPGN, PIGN, IgAN and CresGN was 26.10%, 22.40%, 8.40%, 6.40%, 6.40%, 2.60%, 2.60%, 1.40%, respectively. Only 4 studies (23.5%) used light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM) for diagnosis. There were significant differences in the distribution of histologic subtypes in the paediatric compared to the adult population and across geographic sub-regions, with West Africa having a higher prevalence of FSGS. Overall, the dominance of FSGS across most regions and age groups has implications for disease diagnosis and ongoing care. Research efforts to understand the impact of this trend on kidney disease outcomes and efforts to improve kidney biopsy practice as a means of early disease detection are needed in Africa.

Determinants of Interest in Nephrology Career Choice among Internal Medicine Junior Residents in Nigeria

INTRODUCTION

There has been decreased interest in postgraduate nephrology training over the years. This trend could worsen the shortage of nephrologists and inability to meet the health needs of patients with kidney diseases if not urgently addressed.

AIM

To determine interest in and determinants of nephrology career choice among junior internal medicine residents in Nigeria.

METHODOLOGY

This was a cross-sectional study that enrolled 273 junior residents in internal medicine across Nigeria. A self-administered questionnaire that was adapted from two previous studies was used for data collection.

RESULTS

The mean age of the respondents was 33.6±4.4 years with a male: female ratio of 1.8:1. This study showed that 16.8% and 21.6% of junior residents in internal medicine considered nephrology as their first and second choice area to specialize, respectively. Factors that ranked high as determinants of a decision to do nephrology were personal interest (94.3%), opportunities to perform renal procedures (93.3%), and exposure to nephrology training (85.7%). Factors that discouraged a choice of nephrology according to respondents were high mortality of renal patients (67.3%), poor outcomes of renal patients (70.2%), in ability to fund treatment by renal patients (66.1%), unsatisfactory life-work balance among nephrologists (60.7%), and late presentation of renal patients (59.0%). Others were high workload compared to available doctors (59.0%) and poor job satisfaction (55.4%). Factors that could stimulate more interest in nephrology according to respondents included creation of better working environment with adequate equipment for training (96.3%), provision of health insurance with adequate coverage for renal patients (97.4%), and increased government support for renal care services (99.3%).

CONCLUSION

There is a need to promote and sustain interest of residents in nephrology by ensuring improved survival of patients through better access to renal care, ensuring an adequate and well motivated work force, provision of adequate facilities and health insurance services.

Towards prevention of hypertension in Nigeria: a study of prehypertension and its associations among apparently healthy adults in Umuahia, South-East Nigeria

BACKGROUND

The prevalence of hypertension is on the increase in Nigeria. Prehypertension is considered a precursor of hypertension and a predictor of excessive cardiovascular risk. Identifying individuals with prehypertension and initiating effective measures will aid in reducing the incidence and prevalence of hypertension in our environment. The aim of this study was to quantify the magnitude of prehypertension and determine its associations among adults in a representative semi-urban Nigerian population.

METHODS

A cross-sectional study which was carried out in a semi-urban setting in Southeast Nigeria. Blood pressure (BP) was measured using the standard methods. A cardiovascular risk factor screening based on physical characteristics, individual medical, and family history of participants was done.

RESULTS

There were a total of 389 participants comprising 223 (57.3%) males and 116 (42.7%) females; male:female ratio been 1.9:1. The prevalence of prehypertension and hypertension were 45.5% and 37.8%, respectively. Males were significantly more likely to have prehypertension than females (61% vs. 39% respectively; OR = 1.32, P = 0.03). There was a weak positive significant correlation between age and both systolic (r = 0.16, P < 0.01) and diastolic (r = 0.12, P = 0.02) blood pressures. Up to 72.6% of individuals with prehypertension have abnormal body mass index (BMI). While up to 8.5% of the participants had a family history of cardiovascular disease, 20.3%, and 17.3% had a history of significant intake of alcohol and smoking, respectively.

CONCLUSIONS

The prevalence of prehypertension in the community was high. It was associated with increasing age, male gender, and increasing BMI. Interventions at this stage may aid in stemming the rising prevalence of hypertension in our environment.