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Background: Diabetes significantly increases the likelihood of developing cardiovascular disease (CVD). This risk can be reduced by addressing modifiable risk factors. The objectives of this study were to assess the modifiable risks for CVD amongst persons with diabetes and identify the factors associated with multiple risk factors. Methods: This cross-sectional study was conducted amongst 357 diabetic patients attending a large tertiary hospital in Southwest Nigeria. Eligible patients were recruited consecutively on clinic days till the minimum sample size was reached. An interviewer-administered survey tool adapted from the World Health Organization STEPS was used to obtain information from study participants. The following risk factors were assessed: tobacco use, obesity, high blood pressure, physical activity, sedentary time and hours of sleep. Data were analysed using the STATA version 15.0 (Stata Corp.) statistical programme. Results: The mean age of the participants was 61.7 ± 12.6 years, and they were mostly females (63.9%). Of the risk factors assessed, the most prevalent modifiable risk factors amongst the respondents were inadequate sleep – <8 h on average (91.6%), abdominal obesity (82.6%) and high blood pressure (72%). Others were inadequate physical activity (56%) and lifetime tobacco use (21%). Up to 40.3% of the diabetic persons had three or more co-existing CVD risk factors. Age, gender, work and marital status (P ≤ 0.01) were statistically associated with multiple CVD risk factors. Being male, unmarried and increasing age were predictors of multiple CVD risk factors amongst the diabetic patients. Conclusion: A significant proportion of the diabetic patients have multiple co-existing modifiable CVD risks. Abdominal obesity and poor sleep were the most prevalent. Older men who are unmarried were more likely to have multiple risks. Primary and secondary preventive measures to address CVD risks amongst diabetic patients are warranted and should target older unmarried men. [ABSTRACT FROM AUTHOR]

Introduction: periodontitis is the sixth leading longterm complication of diabetes mellitus which can impair diabetic patients' metabolic control. Patients with both diabetes mellitus and periodontal disease present with the challenge of managing these two chronic diseases, each of which may impact the other. The aim of this study was to determine and compare the prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients attending a large tertiary hospital in Lagos, Nigeria. Methods: this was a cross-sectional comparative study involving 110 diabetics and 110 non-diabetic patients aged 40 years and above. They were recruited from the diabetes and general medical out-patient clinics respectively in a large tertiary hospital in Lagos using a systematic sampling method. Data was collected using an interviewer-administered questionnaire. In addition, blood tests for glycated haemoglobin and oral examination using a simplified periodontal examination were conducted. The prevalence and severity of periodontitis and oral hygiene practices were compared between both groups. Data were analyzed with IBM SPSS version 21 Software. Results: the prevalence of periodontitis was higher among the diabetics 100 (90.9%) compared to the non-diabetic patients 79 (71.8%), and this was statistically significant (p<0.001). Severity of periodontitis among both groups was also statistically high 54 (49.1%) vs. 35 (31.8%) p<0.001. Conclusion: the prevalence of periodontitis was higher and more severe among diabetics compared to non-diabetics. Oral hygiene practices in both groups are not statistically significant p>0.05. Oral health education programs targeted at diabetic patients should be carried out to prevent and control periodontitis. [ABSTRACT FROM AUTHOR]

Background: The Nigerian government implemented the National Tobacco Control Act (NTCA) in 2015, which prohibits tobacco advertising, promotion, and sponsorship (TAPS) exposure to children under 18 years of age. This study was conducted to assess the prevalence of attitudes and exposure to TAPS among in-school adolescents in Lagos State, Nigeria, 5 years after the implementation of the Act and to identify the factors associated with TAPS exposure among the adolescents. Materials and Methods: This cross-sectional study was conducted among 968 in-school adolescents selected through multistage random sampling. The data were collected using self-administered questionnaires adapted from the Global Youth Tobacco Survey. Results: Overall, 77% had been exposed to at least one form of TAPS in the past 30 days. The most frequently reported channel of exposure was through product placements, with 62% reporting exposure in films, TV, and videos. Up to 15.2% and 12.6% were exposed to TAPS through promotional activities and sponsorships, respectively. The majority (82.3%) had pro-tobacco attitudes, while about a third (33.1%) had pro-TAPS attitudes. Factors associated with TAPS exposure were having pro-TAPS attitudes (odds ratio [OR]: 3.5, 95% confidence interval [CI]: 2.3-5.3), being female (OR: 2, 95% CI: 1.4-2.7), and residing in a rural area (OR: 1.6, 95% CI: 1.2-2.3). Conclusion: Five years after implementing the NTCA, more than two-thirds of the adolescents reported exposure to TAPS, mainly through films, TV, and videos. This suggests that the NTCA is poorly enforced. Efforts to ensure the effective implementation of comprehensive TAPS bans are warranted. Gender-sensitive strategies that target adolescents' attitudes and school-level factors should be emphasized. [ABSTRACT FROM AUTHOR]

Background: In Sub-Saharan Africa (SSA), the prevalence of hypertension is increasing due to many factors like rapid population growth, globalization, stress, and urbanization. We aimed to characterize the perceptions of cardiovascular disease (CVD) risk among individuals with hypertension living in Nigeria and identify barriers and facilitators to optimal hypertension management. Methods: This cross-sectional survey study was conducted at a large teaching hospital in Lagos, Nigeria. We used a convenient sample of males and females, aged 18 or older, with a diagnosis of hypertension who presented for outpatient visits in the cardiology, nephrology, or family medicine clinics between November 1 and 30, 2020. A semiquantitative approach was utilized with a survey consisting of closed and open-ended questionnaires focused on patient knowledge, perceptions of CVD risk, and barriers and facilitators of behavioral modifications to reduce CVD risk. Results: There were 256 subjects, and 62% were female. The mean age was 58.3 years (standard deviation (SD) = 12.6). The mean duration of the hypertension diagnosis was 10.1 years. Most participants were quite knowledgeable about hypertension; however, we observed some knowledge gaps, including a belief that too much "worrying or overthinking" was a major cause of hypertension and that an absence of symptoms indicated that hypertension was under control. Barriers to hypertension management include age, discomfort or pain, and lack of time as barriers to exercise. Tasteless meals and having to cook for multiple household members were barriers to decreasing salt intake. Cost and difficulty obtaining medications were barriers to medication adherence. Primary facilitators were family support or encouragement and incorporating lifestyle modifications into daily routines. Conclusion: We identified knowledge gaps about hypertension and CVD among our study population. These gaps enable opportunities to develop targeted interventions by healthcare providers, healthcare systems, and local governments. Our findings also help in the promotion of community-based interventions that address barriers to hypertension control and promote community and family involvement in hypertension management in these settings. [ABSTRACT FROM AUTHOR]

Introduction: Nigeria is among six countries responsible for the majority of tuberculosis (TB) cases in the world. The Nigerian government has emphasized community-based case finding to increase detection of TB. This process requires efforts to improve knowledge, attitudes and practices (KAP) of TB, particularly in the poorest of communities. This study presents data from a KAP survey administered in two underserved Nigerian communities. Methods: a structured survey was administered by trained interviewers among adult residents in two slum communities in Lagos, Nigeria. Participants were selected through multistage random sampling. KAP scores were computed and the predictors of higher scores were assessed. Results: a total of 504 respondents were surveyed. The mean KAP scores were relatively low: 9.8 ± 7.1 for knowledge (out of a maximum 34), 5.3 ± 3.4 for attitude (maximum = 10), and 5.2 ± 1.5 for practice (maximum = 7). The predictors of good knowledge were increasing age, post secondary education and professional occupation. The predictors of positive attitude were post secondary education and good TB knowledge. Good knowledge was a predictor of good practice. Conclusion: our findings underscore the need to improve the education about TB in underserved communities. Improving KAP scores will ultimately lead to higher rates of TB detection and treatment. [ABSTRACT FROM AUTHOR]

Background: Patient medical records are an objective tool for the systematic identification and treatment of tobacco users. The aim of this study was to assess brief intervention tobacco cessation activities documented by physicians in some select tertiary hospitals in Nigeria.Methods: We conducted a cross-sectional descriptive study using information obtained from 1588 randomly selected patient records in six teaching hospitals participating in a study to capacitate physicians to deliver brief advice. Trained data collectors collected data using a uniform checklist prior to the training of the physicians in these hospitals.Results: Of the audited health records, 33.1% of patients had documentation of physicians' inquiry of their tobacco use mostly during out-patient clinics (37%) and by a resident doctor/medical officer (42.9%). Among identified tobacco users, it was documented that 12.9% were offered some form of tobacco cessation advice; readiness to quit was recorded in 2.6%; assistance with quitting was documented for 1.5% of tobacco users, while only 0.8% showed documentation of patient follow-up. Males and patients admitted to the hospital were 1.86 times and 2.14 times respectively more likely to have records of physicians' inquiry of their tobacco use. Patients who had tobacco-related morbidities and the unemployed were also more likely to have records of inquiry of their tobacco use.Conclusions: There was poor documentation of tobacco use by physicians in these hospitals and many opportunities for brief intervention activities were missed. Efforts to educate the physicians on the importance of documenting tobacco use in clinical notes are recommended.Implications: This study provides empirical evidence showing that there is poor documentation of tobacco use inquiry and brief intervention among physicians in tertiary hospitals in Nigeria. Records showing implementation of the 5A's were abysmally low and opportunities for brief intervention may have been missed. In line with the World Health Organization recommendations of Article 14 of the Framework Convention on Tobacco Control, efforts to promote brief intervention among physicians in tertiary hospitals in Nigeria should include an emphasis on appropriate documentation of tobacco control interventions in patient clinical notes. [ABSTRACT FROM AUTHOR]

Background: Preventing tobacco use is a key aspect of health promotion during adolescence. We assessed prevalence and impact of school-based tobacco prevention programs in 43 countries. Methods: We performed a secondary analysis of national data of students aged 13-15 years (Global Youth Tobacco Surveys) from 43 countries during 2005-2011. National surveys of the corresponding school personnel (Global School Personnel Surveys) were performed in each country during the same year as the student surveys. Data on status of enforcement of national smoke-free school policies were obtained from the 2008 and 2009 WHO MPOWER reports. Logistic regression was used to measure ecologic-level associations between school-based tobacco prevention programs and tobacco-related knowledge and behaviour among students (P < 0.05). Results: The proportion of students who were taught in class about the dangers of tobacco use during the school year ranged from 31.4% (Georgia) to 83.4% (Papua New Guinea). For every 10% increase (country level) in the proportion of teachers who reported having a tobacco prevention curriculum in their school, the odds of students reporting exposure to education in class about the dangers of tobacco increased by 6.0% (AOR = 1.06; 95% CI: 1.04-1.08). However, didactic education in class about the dangers of tobacco use was not independently associated with student current cigarette smoking behavior. Conversely, the likelihood of being a current smoker was significantly lower among students in countries with moderate/strongly enforced national smoke-free school policies compared with those in countries with poorly enforced/no national smoke-free school policies (AOR = 0.59; 95% CI: 0.45-0.76). Conclusions: Comprehensive tobacco prevention programs that include well-enforced smoke-free school policies may help reduce youth smoking. [ABSTRACT FROM AUTHOR]

Background: There are no safe levels of exposure to second hand smoke and smoke-free policies are effective in reducing the burden of tobacco-related diseases and death. Pharmacists, as a unique group of health professionals, might be able to play a role in the promotion of smoke-free policies. Objective: To determine the tobacco-related knowledge of community pharmacists and assess their support for smoke-free policies in Lagos state, Nigeria. Methods: A cross-sectional descriptive study design using both quantitative and qualitative methods was employed. Two hundred and twelve randomly selected community pharmacists were surveyed using a pre-tested selfadministered questionnaire. In addition, one focus group discussion was conducted with ten members of the Lagos state branch of the Association of Community Pharmacists of Nigeria. Results: The quantitative survey revealed that the majority (72.1%) of the respondents were aged between 20 and 40 years, predominantly male (60.8%), Yoruba (50.2%) or Igbo (40.3%) ethnicity and had been practicing pharmacy for ten years or less (72.2%). A majority (90.1%) of respondents were aware that tobacco is harmful to health. Slightly less (75.8%) were aware that second hand smoke is harmful to health. Among the listed diseases, pharmacists responded that lung (84.4%) and esophageal (68.9%) cancers were the most common diseases associated with tobacco use. Less than half of those surveyed associated tobacco use with heart disease (46.9%), chronic obstructive pulmonary disease (27.8%), bladder cancer (47.2%), peripheral vascular disease (35.8%) and sudden death (31.1%). Only 51.9% had heard of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). A little over half of the respondents (53.8%) were aware of any law in Nigeria controlling tobacco use. The majority of respondents supported a ban on smoking in homes (83.5%), in public places (79.2%), and in restaurants, nightclubs and bars (73.6%). For every additional client attended to daily, knowledge scores increased by 0.022 points. Current smokers were 1.3 times less likely to support smoke-free policies compared with non-smokers. The findings emanating from the focus group discussion *Edward Oluwatobi POLUYI. Department of Community Health and Primary Care, College of Medicine, University of Lagos. Idi-Araba, Lagos State (Nigeria). eddiepolz@yahoo.com Oluwakemi Ololade ODUKOYA. Department of Community Health and Primary Care, College of Medicine, University of Lagos. Idi-Araba, Lagos State (Nigeria). drolukemiodukoya@yahoo.com Bolajoko AINA. Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos. Idi-Araba, Lagos State (Nigeria). bolajokoaina@yahoo.com Babalola FASERU. Department of Preventive Medicine and Public Health, and Department of Family Medicine, University of Kansas Medical Center. Kansas City, KS (United States). bfaseru@kumc.edu reinforced the fact that the pharmacists were in support of smoke-free policies particularly in homes and public places. It also demonstrated that most of them were aware of the health risks associated with tobacco use and second hand smoke however some misconceptions seemed to exist. Conclusion: The pharmacists surveyed expressed support of smoke-free policies and most of them were aware of the health risks associated with tobacco use. However, awareness of WHO FCTC and country-level tobacco legislation was low. Current smokers were less likely to support smoke-free policies. Community pharmacists should therefore be considered worth engaging for the promotion of smoke-free policies. Efforts should also be made to educate pharmacists about country level smoke-free laws. [ABSTRACT FROM AUTHOR]

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