Assessment of TB underreporting by level of reporting system in Lagos, Nigeria

BACKGROUND: Nigeria has an estimated TB prevalence of 219 per 100,000 population. In 2019, Nigeria diagnosed and notified 27% of the WHO-estimated cases of all forms of TB and contributed 11% of the missing TB cases globally.OBJECTIVE: To assess TB underreporting by type and level of health facility (HF), and associated factors in Lagos State, Nigeria.METHODOLOGY: Quantitative secondary data analysis of TB cases was conducted in 2015. χ2 test was used to assess the association between treatment initiation, TB underreporting, local government area (LGA) and HF characteristics.RESULTS: Overall, 2,064 persons with bacteriologically confirmed TB (15.5%) were not matched to patients in sampled TB registers. Treatment status was unknown for 86 cases (IQR 55–97) per LGA. LGAs with higher case-loads had higher proportions of cases with unknown TB status. Discrepant reporting of treated TB was also common (60% HFs). Primary-level TB treatment facilities and unengaged private facilities were less likely to notify.CONCLUSION: There was TB under-reporting across all types and levels of HFs and LGAs. There is a need to revise or strengthen the process of supervision and data quality assurance system at all levels

Association between Physical Inactivity and Metabolic Syndrome in South-West Nigeria

BACKGROUND

We assessed the prevalence of physical inactivity and its association with metabolic syndrome in a rural community and an urban community in South-west Nigeria.

METHODS

A cross-sectional descriptive study among healthy volunteers 18 years and above was conducted in urban (Ikeja) and rural (Ilara-Akaka) communities in Lagos and Ogun State, respectively, using a multi-stage sampling technique. Selfreported physical activity [measured in metabolic equivalent (MET)] was assessed using the World Health Organization Global Physical Activity Questionnaire. Metabolic syndrome was assessed using the definition recommended by the Joint Interim Statement of the International Diabetes Federation Task Force. Regression analysis of factors associated with physical inactivity was done using IBM Statistics version 26.

RESULTS

A total of 437 participants were recruited with a median age of 45 years (IQR 38,56). The prevalence of physical inactivity was 24.9%. There was a significant negative correlation between metabolic syndrome components and total MET except for high-density lipoprotein (HDL) cholesterol. Being a female (AOR 1.9 95% CI 1.0 - 3.5, p=0.040), living in an urban community (AOR 1.81 95% CI 1.1 - 2.9, p=0.014), and having metabolic syndrome (AOR 3.98 95% CI 2.2 - 6.7, p <0.001) were associated with physical inactivity. Having raised fasting plasma glucose, elevated blood pressure, increased waist circumference, and reduced HDL cholesterol were associated with physical inactivity.

CONCLUSION

There was an association between metabolic syndrome and its components with physical inactivity. In order to mitigate the effects of metabolic syndrome, public health actions that will promote physical activity, especially in urban communities, are urgently needed.

Length of Hospital Stay of COVID-19 Patients managed at the Lagos State Isolation Centres during the First Wave of the Pandemic

BACKGROUND

Lagos State has the highest number of COVID-19 cases in Nigeria. We assessed the factors predicting the length of hospital stay of COVID-19 patients admitted in 15 isolation centres across the state.

METHODS

We reviewed the electronic medical records of all COVID-19 patients admitted and discharged between February 27, 2020, and September 30, 2020. Logistic and linear regressions were used to assess factors predicting the length of hospital stay.

RESULTS

A total of 3153 records were reviewed, of which 2623 (83.2%) met the inclusion criteria. The mean age of patients admitted was 40.5 (Sd 14.8) years. The age range was four days-97 years. A total of 1258 (48.0%) were symptomatic, while 2056 (78.4%) and 567 (21.6%) presented with mild and severe disease, respectively. Cough (22.0%), fever (17.3%) and breathlessness (12.3%) were the most common symptoms at presentation. Generally, the median length of hospital stay was 11 (IQR 9, 14) days. A total of 1609 (61.3%) had a prolonged length of hospital stay. The odds for prolonged hospital stay was higher among elderly patients (AOR 12.1 95%CI 7.6-19.4, p<0.001), male (AOR 1.2 95%CI 1.0-1.4, p=0.031) and patients with severe disease (AOR 1.3 95% CI 1.0-1.7, p=0.042). Age, hypertension and shortness of breath made the most significant contribution to predicting the length of hospital stay (P<0.05).

CONCLUSION

Age, gender, hypertension and breathlessness predicted the length of hospital stay. Proactive measures should be instituted in managing COVID-19 patients.

Ante-Natal Care Utilization and Comparison of Obstetric Performance of Pregnant Women Attending Tertiary and Secondary/Primary Health Facilities in South West Nigeria

BACKGROUND

The successful outcome of any pregnancy depends on a well formulated and implemented ANC, which to a larger extent also depends on its functional and operational continuum of care, that is affordable, accessible and of high quality during and after pregnancy and childbirth. Defective ANC, in terms of coverage and quality, has been shown to be associated with unfavourable pregnancy outcome.

OBJECTIVE

To determine the maternal and perinatal outcome(Obstetric performance) of booked and referred pregnant women who though, booked for ANC in lower health care facilities but were delivered at our facility.

METHODS

The is a retrospective and cross-sectional study conducted at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria from the 1st of January 2017 to 31st of December 2018.

RESULTS

The booked were significantly older than the unbooked (29.4±5.0 vs 28.5±5.5; P=0.001), while 47.6% and 35.3 % were nulliparous in the study and control groups respectively. Majority of the booked (69.3%) and the unbooked (59.3%) were aged 25-34 years. The mean Apgar scores at one minute were 7.0±2.0 and 4.7±3.1(P<0.001) for the booked and unbooked respectively while at five minutes they were 8.6±1.9 and 6.4±3.6 (P<0.001) for the booked and unbooked respectively and the differences were statistically significant at one and five minutes. The proportion of maternal deaths were higher among the unbooked than the booked (2.6% vs 0.4%; P<0.001), maternal morbidity ( 8.1% vs 2.5%; P<0.001) and fetal deaths (40.6% vs 6.3%; P<0.001) CONCLUSION: In all the indices and parameters compared between the two groups the unbooked patients (control) performed poorly and this is surprising despite the huge resources extended to secondary and primary health care delivery services in Nigeria.

Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding

Background

Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited.

Methods

We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral.

Results

CWs referred 4–22 % of presumptive TB clients tested, and 4–24 % of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables.

Conclusion

All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

TUBERCULOSIS CONTROL IN SECURITY CHALLENGED STATES OF NORTH-EAST NIGERIA. ARE THERE SIGNIFICANT IMPACT?

BACKGROUND

Nigeria in the past few years is faced with various security challenges in different parts of the country. The most severe in the last three years has been the crisis in northern Nigeria and specifically the north-eastern States, where three of the States have been under emergency rule for a year. Health care delivery system is usually one of the major casualties in a security challenged environment leading to unavailability or low utilization of services.The aim of this paper is to share the experience of TB services in states under emergency rule.

METHODOLOGY

A retrospective review of program data (reportable indicators for TB case finding,TB/HIV and treatment outcome for periods of eight years (2006-2013) comparing national data with north-east and the three states most affected by security challenges (Borno, Adamawa & Yobe).

RESULTS

A national positive trend on case notification for all forms of TB and smear positive, with a declined in 2011 but generally the case notification has remain low (59/100,000 in 2013 compared to estimated prevalence of 338/100,000). North east data is a negative trend for case notification and this is worse for 2 states (Borno and Yobe) while Adamawa shows and increase CNR from 2012 because of TB Reach active case, finding. Treatment success rate has a positive trend both national, north east states and in the 3 challenged states (TSR above 84%). TB/HIV indicators for north east are 81%, 75%, and 58% for HCT CPT and ART respectively, these figures has serious fluctuations within and among the three security challenged states with Borno most affected.

CONCLUSIONS

Insecurity can pose a challenge for TB control activities especially case finding, therefore the need for innovative approaches for case finding in areas of insecurity. Chronic infectious diseases like TB and HIV should be incorporated into emergency responses offered by organisations and agencies for internally displaced persons.

Ambulance services of lagos state, Nigeria: a six-year (2001-2006) audit

BACKGROUND

Emergency medical care is designed to overcome the factors most commonly implicated in preventable mortality, such as delays in seeking care, access to health facility, and the provision of adequate care at the facility. The developed world has recognized the importance of organized emergency medical services and has well established systems. The Lagos State Government established the first emergency medical system in Nigeria in 2001.

OBJECTIVE

This was to review the activities of the Lagos State Emergency Ambulance Services (LASAMBUS) within the stated period with the hope that our findings can be used to audit the system and make recommendations for further improvement.

SUBJECTS, MATERIALS AND METHODS

We reviewed the records of the State Ministry of Health for the data on the activities of LASAMBUS from 2001-2006. The number and types of emergencies that were seen and managed with the associated morbidity and mortality were reviewed. The constraints that were encountered by the LASAMBUS staff were also studied. The data that was obtained was entered into a proforma designed for the study. Analysis of the data was done using the Microsoft Excel software.

RESULTS

A total of 32,774 cases comprising 21,977(67.1%) males,10,797(32.9%) females and a male to female (M:F) ratio of 2.04:1, were seen during the study period. Trauma was responsible for 29,500 (90%) of the cases. No mortality was recorded during the transfer of the cases. The records of mortality for the LASAMBUS-transferred cases were not available.

CONCLUSION/RECOMMENDATIONS

Trauma cases formed the majority of the cases that were seen with road traffic accident constituting a large proportion of these. Health education focusing on improving driving etiquette of Drivers and injury prevention should intensified. More equipped emergency centres should be established to reduce victims transit and injuryintervention time. Record keeping and documentations should be improved for better assessment of the activities.

Clinical ethics in African countries and emerging nurse's role in Nigeria

Emerging trends in nursing have broadened the traditional scope of nursing practice with growing demands for ethical considerations in clinical judgments. Nurses are experiencing more ethical dilemmas in areas such as end of life issues, organ donation and transplantation, and truth telling among others. It is expected that these challenges will continue to increase and even become more complex. Despite this, the academic and professional preparation of nurses in Africa to cope with these issues is doubtful. The myriad of peculiar socioeconomic and political problems in many African societies present potential threat to the adoption of ethical standards in health care practice. Many health care workers including nurses attach little importance to consumer rights in making informed decisions in issues related to clinical care and research participation. The alleged participation of nurses in the inhuman treatment of the children recruited during the Pfizer's clinical trial of Trovan for cerebrospinal meningitis in northern Nigeria exemplifies this. Such conducts could reduce patients' worth as persons, and at the same time an indictment of nurses' moral sanctity. This paper reviews the current ethical challenges facing professional nurses in Nigeria. The concept and critical relevance of clinical ethics in giving adequate information to patients, relatives and other health workers upon which ethically sound informed decision making is done in clinical situations were highlighted.

Theatre personnel's perception of operating room resource allocation

Operating rooms (OR) in hospitals represent big investments and must be utilized efficiently. Inaccurate scheduling of OR resources often results in delays of surgery or cancellations of procedures. These are costly to the patient, surgical team and hospital. Existing literatures in the OR management lack consensus on the method of evaluating management decisions from the perspectives of personnel or those affected by management decision-making processes. Eight key informant interviews were conducted. Also, 50 Operating Theatre Personnel (OTP), i.e., Surgeons, OR Nurses, Anaesthetists, and Executive Officers in the Nigeria's premier University Teaching Hospital were asked to complete a survey questionnaire concerning operating theatre resource allocation in the hospital. Five close-ended and 10 open-ended questions were used. (For example, how are the decisions to allocate OR resources in this hospital made?) Thematic analysis and descriptive statistics were done. The theoretical framework, accountability for reasonableness was applied. Forty-eight percent of the participants were ignorant of the framework guiding OR resource allocation. 54% of the respondents admitted the current mechanism for publicizing management decisions on OR resource allocation is ineffective. Another 50% of the respondents knew little about the mode of appealing against unfavourable allocation decisions. Participants' open ended responses revealed that hospital executives and a few consultant surgeons control the allocation of OR resources, with little recourse to OR personnel's concerns. If operating theatre stake holders are excluded in the planning, allocation and evaluation of OR resources, the efficiency required in surgical services would never be realized irrespective of the dexterity of the surgical team.

Approaches in handling ethical challenges of cancer treatment and research in Nigeria

The diagnosis of cancer can devastate the physical, emotional, and socio-economic life of an individual. Caring for most cancer patients presents serious ethical challenges to physicians and other health workers. Inclusion of cancer patients in research could be no less challenging. These ethical problems become significantly magnified in the context of patients who have cancer in a low resource environment characterized by high illiteracy rate, poverty and poor health care infrastructure. Some of the ethical problems include: palliative care and end of life issues, particularly since most patients present in advanced stages, withholding or withdrawal of life support, global equity and justice in drug availability, drug pricing, cancer research and breaking bad news. Adherence to ethical guidelines in conducting cancer research would go a long way in reducing harms and unethical conducts. Similarly, the relevance of clinical and research ethics committees in resolving complex ethical issues in clinical practice has been suggested. However, where these are in place, the need for recourse to philosophical approach, especially virtue ethics in analyzing and resolving ethical concerns in clinical practice cannot be overemphasized. This paper highlights the burden of cancer in Nigeria and the ethical challenges of clinical management of cancer patients, using a case study. The role of clinical ethics and health research ethics committees as well as the justification for virtue ethics above principlism in handling ethical issues in cancer management and research in Nigeria were highlighted.

Constraints in nurses' use of HIV protective barriers in the care of PLWHA in the University College Hospital, Ibadan, Nigeria

This survey examines the constraints limiting nurses' use of protective barriers in the care of people living with HIV/AIDS in Ibadan, Nigeria. 270 females and 5 male nurses working in UCH were purposively selected. A self-developed questionnaire was used during data collection. Data was analyzed using descriptive statistics and chi square. Results about nurses' use of protective devices (eg gloves) showed that 206 (94.2%) use PB always, 15 (5.5%) frequently use PB and 1 (0.4%) occasionally use PB. Chi-square test shows significant differences between constraints in the use of PB in the care of PLWHA and adherence to HIV/AIDS universal precautions (chi2 = 15.22, 1df, P < 0.05). It was concluded that nurses in the selected setting were faced with constraints in the use of PB and as such were inadequately protected from blood-borne diseases especially when caring for PLWHA.

Evaluation of the effect of cognitive therapy on perioperative anxiety and depression among Nigerian surgical patients

STUDY OBJECTIVE

Surgical paients have been known to benefit immensely from psychological interventions. This study set out to assess the pre and postoperative anxiety levels and depression and the effect of cognitive therapy among Nigerian surgical patients. The effects of gender and educational status on perioperative anxiety and depression were also evaluated.

STUDY DESIGN

The study utilized a controlled outcome design to evaluate the efficacy of self-instructional training (SIT) and rational emotive therapy (RET) in surgical patients. Preoperative anxiety and depression scores were used as co-variants.

PATIENTS

Thirty-three (33) elective surgical patients were sampled randomly, divided into 3 groups of eleven (11) patients each. Eight (8) subjects underwent gynaecological procedures while the remaining 25 subjects had general surgical procedures. The mean age was 32.72 +/- 15.83 years (range = 17-16 years.)

MEASUREMENTS

The major instruments used in the study were the State Anxiety Subscale of the Speilberger State Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Inventory.

MAIN RESULTS

SIT had the potential to reduce anxiety level among subjects postoperatively (t = 2.06; df = 10; p < 0.05). The use of RET reduced depression among surgical patients (t = 1.23; df = 10; p < 0.05).

CONCLUSIONS

It was concluded that surgical patients manifest varying degrees of anxiety preoperatively and postoperatively. Patient's pre and postoperative anxiety and depression can be reduced by the introduction of SIT and RET.

Diabetic care in Nigeria: report of a self-audit

As part of a wider study aimed at establishing baseline data on standard of diabetic care to compare with subsequent reassessment after measures to improve outcomes have been introduced, the case notes of 118 Nigerians (42 males) with diabetes attending a teaching hospital-based diabetic clinic were reviewed to assess the quality of professional care in a year with reference to an international standard of diabetic care. Patient attendance at the clinic averaged about nine times annually and majority of them had been attending the facility for about 6 years. Fasting blood glucose (FBG) was tested four or more times in 92.4% of the patients. The corresponding figures for footcare were 1.7%; referrals for eye, dental, or cardiac examination were 12.7%, while lipid profile, serum creatinine, and urinary protein estimation were documented in 16.9% of the patients. In contrast, high-risk assessment or part of it was documented in all patients, and in 61.9%, high-risk intervention was recorded. The data suggest that the quality of diabetic care was less than optimal, and foot examination and referrals, etc. are specific areas for improvement.