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Abstract Background Spirometry is a cost-effective diagnostic tool for evaluation of lung function and for case-finding in a resource-limited setting. The acceptance of this test depends on the awareness of its indications and the ability to interpret the results. No studies have assessed the knowledge of spirometry among Nigerian doctors. The aim of this study was to evaluate the current knowledge, awareness and practice of spirometry among hospital-based Nigerian doctors. Methods We carried out a cross-sectional survey among 321 doctors working in Nigerian hospitals between March 2008 and June 2008. Information on knowledge, awareness, practice of and barriers to spirometry were obtained using a pre-tested, self-administered structured questionnaire and the data were then analysed. Results Of the 321 doctors that participated, 108 (33.6%) reported that they have good knowledge of spirometry. One hundred and ninety-five (60.7%) were aware of the importance of spirometry in aiding the diagnosis of respiratory diseases; 213(66.4%) were aware of the importance of spirometry in determining the severity of diseases. Medical school was the most common source of knowledge on spirometry (64.5%). Eighty-one (25.2%) doctors reported having a spirometer in their hospitals. Doctors having access to a spirometer used it more frequently for aiding the diagnosis of COPD (40.7% vs.27.5%) and for monitoring of asthma (18.5% vs.11.3%) than those without access to a spirometer. The doctors working in University Teaching Hospitals and Federal Medical Centres (FMC) (22.4% vs. 4.5%) and those having access to a spirometer (40.7 vs.11.3%) were very confident of interpreting spirometry results compared to those working in District and General Hospitals and without access to a spirometer. Irrespective of access to a spirometer or the type of hospital they were employed in, doctors reported that unavailability of a spirometer was the greatest barrier to its use (62.5%) followed by lack of awareness about its usefulness (17.2%). Conclusion The knowledge and practice of spirometry were poor among hospital-based Nigerian doctors because of unavailability of spirometers in most hospitals. These findings have implications for further evaluation, planning and management of patient care in respiratory disease. Spirometers should be made available in all hospitals, and the knowledge of spirometry should be improved among doctors.

The influence of composite CYP2B6*6/*18 genotype on trough plasma nevirapine levels, HIV RNA levels (virologic response) and CD4+ T lymphocyte and absolute lymphocyte counts (immunologic response) of HIV‐infected patients were evaluated. Patients with records of trough plasma nevirapine levels, CD4+ T lymphocyte, absolute lymphocyte and viral load counts at baseline and months 6 and 12 after initiation of nevirapine‐based antiretroviral therapy combinations were retrospectively analysed. Participants were from a cohort of 150 patients previously genotyped and with measured plasma nevirapine levels. Relationship between genotype and nevirapine levels, absolute lymphocyte and CD4+ T lymphocyte counts and viral load were explored. Composite CYP2B6*6/*18 genotype was significantly associated with trough plasma nevirapine levels (geometric mean [standard deviation]: 4482 ng/ml [1349] of normal metabolizers vs. 4632 ng/ml [1793] of intermediate metabolizers vs. 6229 ng/ml [2549] of poor metabolizers; P < 0.001), but not the plasma HIV RNA levels, absolute lymphocyte and CD4+ T lymphocyte counts. Overall, immunologic response showed improvement with approximately 61.3% and 70.4% of patients with CD4+ T lymphocyte count >350 cells/mm3 at months 6 and 12 therapy duration respectively compared to 23.1% at baseline. Composite CYP2B6*6/*18 genotype correlated with plasma nevirapine levels but not immunologic and virologic responses. [ABSTRACT FROM AUTHOR]

Background: Information about the burden of asthma during pregnancy in Africa is scarce. Objectives: To determine the prevalence of asthma and respiratory symptoms in pregnancy in Ilorin, Nigeria. Methods: This study uses the European Community Respiratory Health Survey (ECRHS) questionnaire and definitions to screen 870 pregnant women attending three hospitals for asthma. Results: The prevalence of possible asthma (i.e. awakened by shortness of breath, asthma attack(s) in the last 12 months, or currently taking asthma medication) was 2.1% (95% CI: 1.3–3.1%), physician-diagnosed asthma was 1.0% (95% CI: 0.5–1.7%), and current asthma (asthma attack in the last 12 months and currently taking asthma medication) was 0.7% (95% CI: 0.2–1.3%). The prevalence of respiratory symptoms ranged from 0.6% (95% CI: 0.1–1.1%) for wheezing without cold to 12.9% (95% CI: 10.7–15.2%) for nasal allergies. Less than 1% reported an asthma attack and using asthma medication in the last 12 months. None of the pregnant women smoked tobacco during pregnancy. Pregnant women with possible asthma experienced more respiratory symptoms and worsening symptoms than those without asthma (15.8% vs. 3.9%), and the most reported symptom was being awakened by shortness of breath. The majority (55.6%) with physician-diagnosed asthma had suffered an asthma attack in the current pregnancy with a median of two attacks. Conclusion: The prevalence of asthma and respiratory symptoms in pregnancy in this sample was low, but we observed an increase and worsening of respiratory symptoms during pregnancy in those with asthma. Hence, the priority of clinicians should be disease control to prevent feto-maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Copyright of Annals of African Medicine is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Microsporidiasis, which is of great concern for immunocompromised patients, is poorly studied in developing countries. Objectives: A study was carried out amongst HIV-positive hospital patients and HIVnegative hospital controls in Ilorin, Nigeria, between January 2009 and July 2010 to determine the prevalence and intensity of Microsporidium spores and the complications associated with their presence. Method: Stool samples from 750 HIV-positive patients and 375 HIV-negative patients were studied using the Chromotrope-2R staining technique. Determination of CD4+ count was performed on the Partec Cyflow SL-3 CD4/8 instrument. Intensity of spores was determined by counting the total number of the spores in a 10 µl stained smear of stool. Images were captured with Phenix Microimage Analysis Software and data obtained were analysed using the Statistical Package for the Social Sciences. Results: The prevalence of Microsporidium isolates amongst the HIV-positive hospital patients was significantly higher (42.4%) than amongst the HIV-negative controls (19.2%) (p < 0.05). The intensity of microsporidial spores amongst HIV-positive hospital patients was also significantly higher than amongst the controls (p < 0.05). However, the difference in the intensity of spores amongst HIV-positive patients who were on antiretroviral therapy (n = 411) and those who were not (n = 339) was not significant (p = 0.236). Microsporidiasis in HIV infection infection was common amongst patients with with low CD4+ counts, diarrhoea, body rashes and cough. Conclusion: Both the prevalence and intensity of Microsporidiasis are high amongst HIVpositive hospital patients; campaigns to promote awareness, prevention and control are required. Laboratory testing for microsporidia in HIV patients should be performed routinely so as to identify the organism for prompt medical attention. [ABSTRACT FROM AUTHOR]

Objectives. To determine the awareness of the warning signs, risk factors, and treatment of tuberculosis among urban Nigerians. Methods. This was a cross-sectional survey among 574 adults in Ilorin, Nigeria. Semistructured questionnaire was administered by trained interviewers to obtain information about awareness of tuberculosis warning signs, risk factors, and treatment. Results. Majority of the subjects (71.4%) were aware of at least one warning sign of tuberculosis. Cough (66.2%), weight loss (38.0%), and haemoptysis (30.7%) were the most identified warning signs. The predictors of awareness of warning sign were increasing age (r + 0.12), higher family income (r + 0.10), higher level of education (r + 0.10), and belonging to Christian faith (r + 0.11). Awareness of risk factors for tuberculosis was higher for tobacco smokers (77.0%) and history of contact with a case of TB (76.0%). Less than half were aware of HIV infection (49.8%), alcohol consumption (42.5%), chronic kidney disease (40.4%), extremes of ages (39.4%), cancers (36.9%), and diabetes mellitus (27.5%) as risk factors for TB. Tuberculosis was reported to be curable by 74.6% of the subjects and 67.9% knew that there are medications for treatment of tuberculosis, while 11.5% knew the duration of treatment. Conclusion. This study has revealed that the awareness of HIV and noncommunicable diseases as risk factors for TB is poor. This study has therefore demonstrated the need for health education programs that will emphasize recognition, identification, and modification of risk factor for TB. [ABSTRACT FROM AUTHOR]

Background. According to the Global Initiative for Asthma (GINA) guidelines, the goal of asthma management is to achieve clinical control. Uncontrolled asthma places a significant social and economic burden on patients. Objective. The two aims of this study were to (1) assess the level of asthma control (according to the GINA definition of 'control') among adult patients attending two tertiary care centers in Nigeria and (2) to determine the predictors associated with uncontrolled asthma. Methods. This cross-sectional study was carried out from June 2009 to December 2010. The participants were all 18 years old or older with physician-diagnosed asthma. First, the participants completed an interviewer-administered questionnaire, which included items that collected their socio-demographic information and clinical data. Second, anthropometric indices were measured and spirometry was conducted to determine each participant's lung function. Finally, the researcher team members assessed each participant's inhaler device technique. The outcome measures were (1) uncontrolled asthma, (2) partly controlled asthma, and (3) controlled asthma. Results. One hundred and twenty-four asthma patients participated in the study. Of these, 69.3% had uncontrolled asthma, 22.6% had partly controlled asthma, and 8.1% had controlled asthma. Multivariate analysis showed that uncontrolled asthma was strongly associated with asthma severity based on clinical features, the incorrect use of an inhaler device, the use of oral corticosteroids, an abnormal pulmonary function test, the presence of comorbidity, and the lack of adherence to inhaled corticosteroids (ICSs). The results also revealed that increasing age and a lack of tertiary education were weakly associated with asthma control. In this study, gender, marriage, smoking status, occupation, socioeconomic status, income, and the duration of the asthma were not associated with asthma control. Conclusion. A significant proportion of the sampled patients had uncontrolled asthma. To reduce this number, health care providers must reinforce the education of each asthma patient and promote the regular assessment of asthma control at every clinic visit, identify those with poor control, and institute the appropriate therapy needed to achieve clinical control. [ABSTRACT FROM AUTHOR]

Copyright of Annals of African Medicine is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Spirometry is a noninvasive and cost-effective physiologic test that greatly complements other investigative procedures in evaluation of respiratory conditions. This study was aimed at auditing the spirometry performed at the University of Ilorin Teaching Hospital (UITH) Ilorin, Nigeria, and highlighting some of the challenges associated with the procedure. Methods: We reviewed and analyzed the record of spirometry performed at the cardiopulmonary unit of the hospital from June 2002 to December 2009. Results: A total of 119 patients had spirometry tests from 2002 to 2009 and their age ranged from 15 to 85 years with a mean of 47.6 ± 14.8 years. There were 69 (58%) males and the male:female ratio was 1.4:1. More than half (65%) of the tests were in patients <50 years old. The rate of spirometry performed annually increased from 12 (10.1%) in 2002 to 31 (26.1%) in year 2009. Evaluation of bronchial asthma was the most common indication for spirometry (43 patients; 36.1%). Majority of the requests (84 patients; 70.6%) were from adult respiratory physicians. The identified challenges were lack of awareness of the range of diseases that could be investigated by spirometry, lack of skills in interpreting the results, lack of time and delays in replacing exhausted consumables and faulty components of spirometer. Conclusion: Gradually, the trend of spirometry request is increasing in UITH; however, a wider acceptability could be achieved for this test by raising the level of awareness and improving the skills of all doctors on the usefulness and interpretation of spirometry. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to establish the risk factors of bronchial asthma in a Nigerian adult population. Materials and Methods: We conducted a cross-sectional study in Ilorin, Kwara State, Nigeria and selected 805 subjects from the study area by multi-stage cluster sampling. The European Community Respiratory Health Services (ECRHS) asthma-screening questionnaire was administered by trained assistants to collect demographic information, asthma symptoms in the preceding 12 months (Current asthma) and risk factors of asthma. The body weight (kg) and height (metre) were measured and the body mass index (BMI) was calculated. Odd ratio was calculated to determine the association between current asthma and risk factor of asthma. Results: Current asthma in this study was 12.8%. Family history of asthma was the strongest risk factor of asthma in this study (OR=5.32), followed by allergic rhinitis (OR=5.29), outdoor pollutants (OR=3.51), tobacco smoking (OR=3.47), and indoor pollutants (OR=3.32), as well as a family history of allergic diseases (OR=2.38) and obesity (OR=1.87). Age, sex, educational achievement, home and socioeconomic status were not strong determinants of asthma (p>0.05). The majority of these identified factors were environmental factors with the exception of family history of allergy and asthma. Conclusion: We identified family history of asthma, allergic rhinitis, outdoor pollutants and indoor pollutants, tobacco smoking and obesity as the risk factors of asthma. There is an urgent need to increase the awareness of the risk factors and promote preventive strategies to control the diseases. [ABSTRACT FROM AUTHOR]

The rapid scale-up of antiretroviral therapy (ART) is associated with the challenges of ensuring that HIV care delivered to clients is of the highest quality. This study was designed to evaluate the pretreatment and 12 month follow-up monitoring of clinical and laboratory profiles of HIV-infected patients at the adult HIV clinic of the University of Ilorin Teaching Hospital, in Nigeria. It was a retrospective analysis of records of 440 adult patients who were on follow-up visits for 1 or more years. Two hundred two (45.9%) were male and 238 (54.1%) were female. Weight was documented at baseline in 314 (71.4%) and at month 12 of follow-up in 258 (58.6%). Baseline World Health Organization (WHO) clinical stage was documented in 269 (61.1%). Baseline CD4 count, full blood count (FBC), creatinine (Cr), liver function tests (LFT), fasting blood sugar (FBS), and fasting serum lipids (FSL) were documented in 243 (55.6%), 260 (59.1%), 143 (32.5%), 136 (30.9%), 268 (60.9%), and 161 (36.6%), respectively. At 12th month of follow-up visit, the CD4 count, FBC, Cr, LFT, FBS, and FSL were documented in 121 (27.5%), 94 (21.4%), 59 (13.4%), 77 (17.5%), 179 (40.7%), and 95 (21.6%), respectively. This report shows that the pretreatment and the 12th-month follow-up monitoring of HIV-infected adult patients in our center was less than optimal. We recommend periodic self-assessment by care providers to monitor compliance with standards. [ABSTRACT FROM PUBLISHER]

Background: Drug-resistant tuberculosis (TB) is a significant public health problem. Greater than 90% of rifampicin (RIF)-resistant isolates were also isoniazid resistant, and hence, rifampicin resistance (RR) is frequently used as a surrogate for multidrug-resistant TB., Setting: This study was conducted at Infectious Disease Hospital Kano in North-Western Nigeria., Objectives: The aim of this study was to determine the prevalence of RR among patients previously treated for pulmonary TB (PTB)., Materials and Methods: A total of 120 patients previously treated for PTB with current clinical features of PTB were recruited into this study. Relevant clinical information were obtained using a questionnaire. The sputum was collected and analyzed by the Gene Xpert MTB/RIF ® machine to detect RR tuberculosis infection and blood screened for HIV infection., Results: The mean (±standard deviation) age of the participants was 35.9 ± 14.3 years and they comprised 73 (60.8%) males and 47 (39.2%) females. HIV-seropositive rate was 11.7% among the participants. Of the 120 participants, PTB was detected in 35 (29.2%) of the participants by Gene Xpert MTB/RIF and 29 of them were cases of relapse. Five patients (4.2%) had RR tuberculosis and 80% of them were below the age of 45 years., Conclusion: The prevalence of RR is not high among previously treated PTB patients in this study when compared with other previous studies. This finding is a window for evaluating the efficacy of current interventions in the region and evidence for the consolidation of existing control policies., Competing Interests: There are no conflicts of interest.

The rapid scale-up of antiretroviral therapy (ART) is associated with the challenges of ensuring that HIV care delivered to clients is of the highest quality. This study was designed to evaluate the pretreatment and 12 month follow-up monitoring of clinical and laboratory profiles of HIV-infected patients at the adult HIV clinic of the University of Ilorin Teaching Hospital, in Nigeria. It was a retrospective analysis of records of 440 adult patients who were on follow-up visits for 1 or more years. Two hundred two (45.9%) were male and 238 (54.1%) were female. Weight was documented at baseline in 314 (71.4%) and at month 12 of follow-up in 258 (58.6%). Baseline World Health Organization (WHO) clinical stage was documented in 269 (61.1%). Baseline CD4 count, full blood count (FBC), creatinine (Cr), liver function tests (LFT), fasting blood sugar (FBS), and fasting serum lipids (FSL) were documented in 243 (55.6%), 260 (59.1%), 143 (32.5%), 136 (30.9%), 268 (60.9%), and 161 (36.6%), respectively. At 12th month of follow-up visit, the CD4 count, FBC, Cr, LFT, FBS, and FSL were documented in 121 (27.5%), 94 (21.4%), 59 (13.4%), 77 (17.5%), 179 (40.7%), and 95 (21.6%), respectively. This report shows that the pretreatment and the 12th-month follow-up monitoring of HIV-infected adult patients in our center was less than optimal. We recommend periodic self-assessment by care providers to monitor compliance with standards.

Background: Spirometry is a cost-effective diagnostic tool for evaluation of lung function and for case-finding in a resource-limited setting. The acceptance of this test depends on the awareness of its indications and the ability to interpret the results. No studies have assessed the knowledge of spirometry among Nigerian doctors. The aim of this study was to evaluate the current knowledge, awareness and practice of spirometry among hospital-based Nigerian doctors., Methods: We carried out a cross-sectional survey among 321 doctors working in Nigerian hospitals between March 2008 and June 2008. Information on knowledge, awareness, practice of and barriers to spirometry were obtained using a pre-tested, self-administered structured questionnaire and the data were then analysed., Results: Of the 321 doctors that participated, 108 (33.6%) reported that they have good knowledge of spirometry. One hundred and ninety-five (60.7%) were aware of the importance of spirometry in aiding the diagnosis of respiratory diseases; 213(66.4%) were aware of the importance of spirometry in determining the severity of diseases. Medical school was the most common source of knowledge on spirometry (64.5%). Eighty-one (25.2%) doctors reported having a spirometer in their hospitals. Doctors having access to a spirometer used it more frequently for aiding the diagnosis of COPD (40.7% vs.27.5%) and for monitoring of asthma (18.5% vs.11.3%) than those without access to a spirometer. The doctors working in University Teaching Hospitals and Federal Medical Centres (FMC) (22.4% vs. 4.5%) and those having access to a spirometer (40.7 vs.11.3%) were very confident of interpreting spirometry results compared to those working in District and General Hospitals and without access to a spirometer. Irrespective of access to a spirometer or the type of hospital they were employed in, doctors reported that unavailability of a spirometer was the greatest barrier to its use (62.5%) followed by lack of awareness about its usefulness (17.2%)., Conclusion: The knowledge and practice of spirometry were poor among hospital-based Nigerian doctors because of unavailability of spirometers in most hospitals. These findings have implications for further evaluation, planning and management of patient care in respiratory disease. Spirometers should be made available in all hospitals, and the knowledge of spirometry should be improved among doctors.