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Background: New evidences reveal significant association of cardiovascular risk factors to development of chronic kidney disease among children and adolescents but there is paucity of data from Africa. Objectives: We examined the association of cardiovascular risk factors to renal dysfunction among Nigerian pediatric subjects. Materials and method: This was a prospective, cross-sectional study of pediatrics aged 2 to 17 years. Blood pressure, body mass index, serum lipids and creatinine were determined. Their glomerular filtration rate was calculated using the revised Schwartz equation. Data was analyzed with SPSS 20. Test of association was by Chi square at P

Background: Inflammation is linked to the aetiopathogenesis of Metabolic syndrome (MetS). Objective: To assess the ability of high sensitivity C-Reactive Protein (hs-CRP), Tumour Necrosis Factor-alpha (TNFα) and Interleukin-6 (IL-6) to predict MetS. Methods: A case-control study involving 123 subjects with MetS (cases) and age-matched 123 subjects. without MetS (controls) was conducted. The levels of TNFα, IL-6, and hs-CRP between independent groups were compared. The Receiver Operative Characteristic Curve was used to assess the ability of inflammatory markers to discriminately identify MetS. Results: The mean age of the case and control groups was 49.9±0.9 years and 48.1±1.1 years (p = 0.274) respectively. The median levels of TNFα, IL-6 and hS-CRP were significantly higher among the cases than the control group in both genders (p 0.9 in both males and females. Conclusion: TNFα, IL-6, and hs-CRP identified MetS. There is a need for further studies to determine the inflammatory marker most predictive of MetS.

Background: Though industrial disputes are a global phenomenon, there is a rising concern of its frequent occurrence in Sub-Saharan Africa. Objective: To assess the effect of industrial actions embarked upon by the health workers during the year 2014 on Tuberculosis (TB) notification in Ogun State, Nigeria. Methods: A retrospective review of TB notification in 2013 and 2014 was conducted. Quarterly TB case notification, the proportions of Human Immunodeficiency Virus (HIV) test, Co-trimoxazole (CPT) uptake and Antiretroviral Therapy (ART) uptake in the years 2013 and 2014 were compared using the Epi-info software. Results: There was a decline in the proportion of TB cases reported by the public sector health services and an increase in the proportion of TB cases reported by the private health facilities during the period of industrial disputes in the public health sector (doctors and non-doctors) (p = 0.001). Compared to the year 2013, the proportion of presumptive TB cases tested for HIV declined significantly during the period of the strike actions by the non-doctors but not during the strike actions by doctors in 2014. There was no difference in the uptake of Co-trimoxazole (p = 0.456 and 0.511) and Anti-retroviral Therapy (p = 0.192 and 0.544) by TB/HIV co-infected patients during the strike actions by the doctors and the non-doctors respectively. Conclusion: This study demonstrated the importance of Public-Private–Mix for TB case finding efforts in the developing countries, where there are incessant strike actions by health workers in the public sector.

Background: Childhood tuberculosis (TB) account for about 6% of the global TB burden, but there is a paucity of data on childhood TB at the national and state level in many countries in Sub-Saharan Africa. Objective: To assess the childhood TB case notification rates and explore associated factors at the state level in Nigeria. Methods: A retrospective ecological study was carried out to determine the childhood TB case notification rates in the 36 states and the Federal Capital Territory (FCT) in Nigeria. TB data was retrieved from the National TB and Leprosy Control Programme (NTBLCP) 2014 Annual Report using a proforma. The association between TB case notification rate at the state level and the six selected explanatory variables (Human Development Index, Bacillus Calmette-Guerin [BCG] coverage, percentage underweight, HIV positivity rate, mean household size and population density) were carried out using negative binomial regression in R statistical software. Results: A total of 91, 353 TB patients were notified to the World Health Organization (WHO) in 2014 by the NTBLCP. Of these, 5463 (6%) were children aged 0-14 years. The childhood TB notification rate was 6.99/100,000 population. The highest childhood TB case notification rate was recorded in Nasarawa State followed by Lagos and Oyo States. There were significant associations between childhood TB case notification rate and HIV positivity rate, percentage underweight, household size, population density and BCG coverage. Conclusion: The study showed that childhood TB case notification rate in Nigeria was low. TB case notification rate was associated with high HIV rate, percentage underweight, household size, population density and BCG coverage. There is the urgent need to address the associated risk factors to effectively control childhood TB in Nigeria.

Optimal maternal caregiving is critical for children's healthy development, yet quality of maternal caregiving may be influenced by a negative birth experience. We examined whether the birth experience was associated with maternal caregiving attitudes and behavior throughout the first year. We conducted secondary analysis of the Avon Longitudinal Study of Parents and Children birth cohort on perinatal data. The birth experience was assessed using self-report data on level of support in labor. Maternal caregiving variables were self-report maternal attitudes at one and eight postnatal months, and observed maternal behavior at 12 postnatal months. Data were analyzed using multivariable logistic regression models adjusting for critical covariates at one (N = 4389), eight (N = 4580), and 12 (N = 842) postnatal months. Feeling supported in labor was associated with a report of "immediately falling in love" with one's baby after birth, surveyed at 1 month (adjusted OR 1.41 [95% CI 1.20-1.65]), and with more positive parenting scores at 8 months (adjusted OR 1.56 [95% CI 1.36-1.79]), but not with more positive observed maternal behavior at 12 months. Additional risk factors were identified. Our findings suggest that we may be able to modify the risk of poor postnatal maternal caregiving by supporting women in labor and facilitating a positive birth experience.

Background: Clients with substance use disorders (SUDs) have a substantial risk of developing Type 2 diabetes mellitus (T2DM). The connection between SUD and DM stems from rapid cell damage, pancreatic beta-cell dysfunction, and glucose dysregulation due to increased oxidative stress and decreased antioxidant activity. This study aims to reduce the risk of T2DM among individuals undergoing SUD recovery treatments., Methods: This nurse-led diabetes prevention program, a 1-year-long, peer-based intervention, was implemented among clients at a federally funded, stand-alone drug addictions treatment center based on evidence that lifestyle modifications in dietary control, physical activity, and health behaviors can halt or delay the progression of Type 2 diabetes. Four trained peer educators delivered diabetes prevention interventions to a sample of individuals in drug addiction treatment in Nigeria. The nurse program leader provided weekly mentoring and guidance to the peer educators and collected, reviewed, and analyzed study participants' logs of weights and self-reported lifestyle modifications., Results: There were significant differences in participants' behaviors pre- and post-lifestyle interventions, except in dairy product intakes as well as cigarette and cannabis use., Conclusion: This diabetes prevention program is innovative and effective with this at-risk population. Interventions were delivered with minor financial resources., Implications for Nursing and Patient Care: SUD treatment must address physical and psychological health and consider the heightened risks of chronic illness in this population. Preventing somatic diseases, such as T2DM, is vital to long-term health and well-being., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: This study assessed the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness among people with drug-resistant tuberculosis., Methods: A descriptive cross-sectional study was conducted among 203 adults on treatment for drug-resistant tuberculosis for at least 8 weeks. Validated scales were used to assess experienced stigma, anxiety, depression, loneliness and social support. Partial correlations and hierarchical multiple regression were used to determine the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness. The interaction was visualised using slope analysis., Results: Anxiety, loneliness and depression were reported by 148 (72.9%), 114 (56.2%) and 128 (63.1%) of the 203 participants, respectively. Experienced stigma was positively associated with depression (B = 0.428, p < 0.001), anxiety (B = 0.374, p < 0.001) and loneliness (B = 0.285, p = 0.001). Social support was negatively associated with depression (B = -0.255, p < 0.001), anxiety (B = -0.406, p < 0.001) and loneliness (B = -0.270, p = 0.001). The impact of experienced stigma on depression was different at low (B = 0.567, SE = 0.115, p < 0.001) and high (B = 0.275, SE = 0.253, p = 0.024) groups of social support. Similarly, at low social support, the effect of experienced stigma on loneliness (B = 0.491, SE = 0.250, p < 0.001) and anxiety (B = 0.254, SE = 0.060, p = 0.044) was different compared to the effect of experienced stigma on loneliness (B = 0.275, SE = 0.253, p = 0.024) and anxiety (B = 0.127, SE = 0.094, p = 0.307) at high group of social support., Conclusion: In this study, social support reduced the effects of experienced stigma on anxiety, depression and loneliness suggesting that improving social support among people with drug-resistant tuberculosis is crucial in reducing the negative effects of stigma on anxiety, depression and loneliness., (© 2024 John Wiley & Sons Ltd.)

Background: The implementation of task sharing and shifting (TSTS) policy as a way of addressing the shortage of physicians and reducing the burden of hypertension in Africa birthed the idea of the African School of Hypertension (ASH). The ASH is saddled with the responsibility of training non-physician health workers across Africa continent in the management of uncomplicated hypertension., Aim: To get feedback from some faculty members and students who participated in the first ASH programme., Methods: This was a cross-sectional exploratory qualitative study conducted among eight students and eight faculty members. Feedback from the program was obtained by conducting in-depth interviews centred on description of course content; expectations and knowledge acquired from ASH; level of interaction between students and faculty members; challenges faced during the ASH; level of implementation of acquired training; and suggestions to improve subsequent ASH programs., Results: The course content of the ASH was described as simple, appropriate and adequate while interaction between students and faculty members were highly cordial and engaging. New knowledge about hypertension management was acquired by the students with different levels of implementation post-graduation. Some identified challenges with the ASH program were poor internet connectivity during lectures, non-uniformity of TSTS policies and hypertension management guidelines across Africa, technical problems with hypertension management app and low participation from other African countries apart from Nigeria. Some recommendations to improve ASH program were development of a uniform hypertension management guideline for Africans, wider publicity of the ASH, interpretation of lectures into French and Portuguese languages and improvement of internet connectivity., Conclusion: The ASH programme has largely achieved its objectives with the very encouraging feedback received from both faculty members and the students. Steps should be taken to address the identified challenges and implement the suggested recommendations in subsequent ASH program to sustain this success., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Dyslipidaemia contributes significantly to globalcoronary artery disease (CAD) and cardiovascular disease. Effective use of statins precludes adequate knowledge of its benefits. This study aimed to determine the gaps in the management of dyslipidaemia among physicians in Nigeria., Methods: This was a web-based survey of physicians across Nigeria regarding the management knowledge and practice of dyslipidaemia. Analysis was done by SPSS 23.0. P<0.05 was taken as statistically significant., Results: Three hundred and thirteen physicians across Nigeria consisting of 65.4% males responded to the survey. The majority, 57.5% were 25-40 years. While most of the participants (98.3%) believe that elevated LDL-C is an important cause of CAD, there were concerns about statins use and associated increased risk of muscle disorder (63.2%), hepatic disease (37.4%), hemorrhagic stroke (27.2%), cognitive impairment (12.6%) and new-onset diabetes mellitus (19.2%). Similarly, 41.9% of participants have concerns about hemorrhagic stroke while 32.2% also expressed concerns about lowering LDL-C and ischaemic stroke. More than a third (38.2%) indicated that >20% of their patients cannot use statins continuously due to adverse effects such as muscle symptoms, etc. The results obtained when asked about the target of LDLC in patients with or without a history of CAD and diabetes mellitus were as varied as 3-200 mg/dl., Conclusion: This study highlights there exist significant gaps in knowledge and practice of the management of dyslipidaemia among experts in Nigeria. Concerted efforts by relevant authorities and societies may be needed to enhance the knowledge and practice of the management of dyslipidaemia in reducing the CV risk among Nigerians., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2024 by West African Journal of Medicine.)

Background: Chronic kidney disease (CKD) is commonly associated with psychosocial problems, especially depression, contributing to poor overall outcomes. Depression has not been given adequate priority in the management of CKD patients despite its significant adverse impact on all major outcomes. This systematic review and meta-analysis determined the pooled prevalence of clinical depression in the global CKD population and sub-populations., Methods: PubMed, African Journals Online (AJOL), and EMBASE were systematically searched to identify published articles with relevant data. The pooled prevalence of clinical depression in the global CKD population was determined using random effects meta-analytic techniques. The study protocol was registered with PROSPERO (CRD42022382708)., Results: Sixty-five articles were included in this review, comprising 80,932 individuals with CKD from 27 countries. The participants' mean age ranged from 11.0 to 76.3 years. Most (70.4%) of the studies had medium methodological quality. The overall pooled prevalence of depression was 26.5% (95% CI 23.1-30.1%). Studies using the Diagnostic Statistical Manual for Mental Diseases (DSM) and International Classification of Disease (ICD) returned a pooled prevalence of 25.5% and 39.6%, respectively, p = 0.03. There was a significant difference in the pooled prevalence across regions; p = 0.002.The prevalence of depression was higher among individuals on chronic hemodialysis compared to pre-dialysis patients (29.9% versus 18.5%; p = 0.01) and among those on hemodialysis compared to peritoneal dialysis (30.6% versus 20.4%; p = 0.04). There was no significant difference between adults and children (26.8% versus 15.9%, p = 0.21). There was an increasing temporal trend in depression prevalence, though this did not achieve statistical significance (p = 0.16)., Conclusion: Depression is common in patients with CKD. The findings of this study highlight the need for clinicians to make efforts to evaluate individuals with CKD for depression, especially those with advanced stages of the disease., (© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Background: Kidney transplantation is the best mode of kidney replacement therapy. However, the shortage of organ donations has been a major challenge globally. Relatives of patients with end-stage kidney disease (ESKD) are potential kidney donors. We explored their perspectives about kidney donation, kidney commercialisation, and barriers to kidney donation., Methods: In-depth interviews were conducted among 28 relatives of ESKD patients across the six geopolitical zones and Federal Capital Territory of Nigeria. The interview focused on potential sources of kidney donors, kidney commercialisation and barriers to kidney donation. ATLAS.ti version 9.0.22.0 was used for data analysis., Results: Mean age of the study participants was 41.57 ± 14.55 years; 54% were females, 60.7% were married, 93% had tertiary education and 75% were first degree relatives of ESKD patients. There were 7 themes and 28 subthemes generated in this study. The potential sources of kidney donors identified by the study participants included commercial, hospital, family and non-family member donors. While some opined that a family member is the best choice as a kidney donor, others preferred a commercial donor. The majority of those interviewed do not believe that it is wrong to purchase a kidney, and would be willing to do so. Identified factors that promote kidney commercialisation were unwillingness of a family member to donate, having the financial capacity to purchase a kidney, non-fitness of family members to donate. Identified barriers to kidney donation were age, poor health status, polygamy, perceived poor expertise of the medical team, perceived risk of the procedure, parental influence and religious beliefs., Conclusions: The majority of participants lacked correct information about kidney donation. Implementation of educational program policies and laws regulating and reinforcing ethical principles of kidney donation and transplantation should be ensured., (© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Introduction: Intradialytic hypertension (IDHTN) is a common but less frequently recognised complication of haemodialysis. However, it is associated with increased overall mortality in patients on haemodialysis. This systematic review and meta-analysis aimed to determine the prevalence of IDHTN and associated mortality risk in the global haemodialysis population., Method: A systematic search of PubMed and EMBASE was undertaken to identify articles with relevant data published between 1990 and 2023. The pooled prevalence of IDHTN in the global haemodialysis population was determined using the DerSimonian-Laird random-effects meta-analysis. The pooled hazards ratio for mortality in patients with IDHTN was also computed from the studies that reported mortality among haemodialysis patients with IDHTN. The study protocol was registered with PROSPERO (CRD42023388278)., Results: Thirty-two articles from 17 countries were included, with a pooled population of 127,080 hemodialysis patients (median age 55.1 years, 38.2% females). Most studies had medium methodological quality (53.1%, n = 17). The overall pooled prevalence of IDHTN was 26.6% [(95% CI 20.2-33.4%), n = 27 studies, I2 = 99.3%, p<0.001 for heterogeneity], with significant differences depending on the definition used. The pooled proportion of haemodialysis sessions with IDHTN was 19.9% [(95% 12.5-28.6%, n = 8 studies, I2 = 99.3%, p<0.001 for heterogeneity)] with significant differences across the different definition criteria. The p-value for the Begg test was 0.85. The median pre-dialysis blood pressure was not significantly associated with IDHTN. The pooled hazard ratio for mortality was 1.37 (95% CI 1.09-1.65), n = 5 studies, I2 = 13.7%, and p-value for heterogeneity = 0.33., Conclusion: The prevalence of IDHTN is high and varies widely according to the definition used. A consensus definition of IDHTN is needed to promote uniformity in research and management. The increased mortality risk forecasted by IDHTN highlights the need for optimal blood pressure control in patients on hemodialysis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Cutaneous morbidities are not uncommon in correctional centres and environmental cleanliness and sanitation practices influence their prevalence and pattern. Overcrowding and poor living conditions are common in correctional facilities and may increase the prevalence of skin diseases amongst inmates. This study aimed to determine the prevalence and pattern of dermatoses in a correctional centre in southern Nigeria., Materials and Methods: The study was an institutional-based cross-sectional descriptive study carried out during a health outreach to the facility involving inmates of a correctional centre in southern Nigeria. Using a purpose-designed questionnaire, sociodemographic data containing information on sex, age, prison status, and number of inmates per room was obtained from a total of 252 inmates who consented to the study. They were subsequently clinically examined for skin diseases. Dermatological tools like dermoscopes were used to boost diagnostic accuracy where expedient. All data collected were subsequently analysed using SPSS version 23.0., Results: The prevalence of cutaneous morbidities amongst the inmates was 224(88.9%). A total of 332 skin morbidities were observed in 224 prison inmates with a ratio of 1.5:1 per affected inmate. The common dermatoses encountered in our study were scabies 181(71.8%), bedbugs 38(15.1%), dermatophytosis 24(9.5%), pityriasis versicolor 20(7.9%), and pediculosis 18(7.1%) in a decreasing order of frequency., Conclusion: Cutaneous morbidities are common among prison inmates in southern Nigeria. Scabies was the most common dermatoses observed., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Background: Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance., Objective: We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received., Methods: A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior., Results: Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications., Conclusions: Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance., (©Ellen MH Mitchell, Olusola Adedeji Adejumo, Hussein Abdur-Razzaq, Chidubem Ogbudebe, Mustapha Gidado. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 25.04.2024.)

Background: Advancements in the medical field have made organ transplantation an attractive treatment option for patients when indicated. Shortage of organs and commodification of organs are major challenges encountered in organ donation and transplantation. These could potentially breed unethical practices, if the process is not well regulated., Aim: The aim of this study was to assess the knowledge of healthcare workers (HCWs) on the legal provisions regulating organ donation and transplantation in Nigeria., Methodology: This cross-sectional study was conducted amongst physicians and nurses across Nigeria. Knowledge of legal provisions on organ donation and transplantation was assessed using a validated questionnaire that had 21 questions derived from the National Health Act. Each correctly answered question was given 1 point with a total obtainable score of 21 points. A score of ≥14 points was classified as good knowledge. P <0.05 was considered significant., Results: A total of 836 physicians and nurses with a mean age of 37.61 ± 9.78 years participated in the study. Females and physicians constituted 53.3% and 62.9% of the respondents, respectively. The mean knowledge score of the respondents was 9.70 ± 2.91 points. Eighty-three (9.9%) respondents had a good knowledge score. There was a significantly higher proportion of male HCWs (P < 0.037) and older HCWs (P = 0.017) with good knowledge of legal provisions. On logistic regression, age was the only factor found to be associated with good knowledge of legal provision (adjusted odds ratio: 3.92; confidence interval: 1.33-11.59; P = 0.01)., Conclusion: The overall knowledge of legal provisions on organ donation and transplant was very poor amongst HCWs in Nigeria. There is a need to educate them on these provisions to curb unethical practices., (Copyright © 2024 Copyright: © 2024 Nigerian Postgraduate Medical Journal.)

Introduction and Background: Individuals with substance use disorders (SUDs) are at an increased risk of developing comorbid medical conditions, including Type 2 diabetes. Although the diabetes prevention program (DPP) is efficacious and cost-effective, there is no published evidence to support its implementation in Nigeria or within SUD treatment settings. In this first known DPP within an SUD treatment program, we implemented a multiphased, nurse-led DPP at a small outpatient drug treatment center in Nigeria. The aim of this article was to describe only the processes utilized for the initial peer facilitator (PF) training (Phase 1)., Methods: In Phase 1, a diabetes prevention master trainer delivered a virtual DPP training to the facility's lead nurse, who return-demonstrated the DPP workshop skills and competencies over four 4-hour sessions. The lead nurse then independently delivered four 8-hour training sessions to a small number of client volunteers (n = 4) who subsequently delivered the DPP lifestyle interventions to their peers in the outpatient treatment program., Results: The client volunteers attended all PF workshop sessions and were observed to be proficient in all aspects of implementation. They indicated that the training objectives were easily achieved and expressed enthusiasm for delivering DPP content to their peers. The need to better contextualize the DPP curriculum specific to Nigerian food preferences was identified., Conclusion: The Phase 1 training process appears to be an appropriate and effective approach for preparing PFs to deliver health programs, like the DPP, in environments with limited resources for populations facing numerous challenges., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the editorial/article., (Copyright © 2024 International Nurses Society on Addictions.)

Background: The burden of chronic kidney disease (CKD) is huge, especially in countries such as Nigeria where majority of patients succumb to the disease early due to inability to afford care. Early diagnosis through regular screening of at-risk population is pivotal to stemming the scourge of the disease., Aim: To determine the prevalence of kidney dysfunction and associated risk factors in a community screening program., Methods: This cross-sectional study assessed kidney dysfunction and associated risk factors among adults in Ondo City, Nigeria. Information about socio-demographic characteristics and some risk factors for kidney dysfunction was sought. Blood pressure, weight and height were measured. Blood samples were collected for random blood glucose check and serum creatinine while urine sample was collected for urinalysis. Kidney dysfunction was defined by estimated glomerular filtration rate (eGFR) below 60mls/min/1.73m2. Prevalence of kidney dysfunction and associated factors were determined. P value<0.05 was taken as significant., Results: There were 410 participants with a mean age of 58.96±13.78 years. Majority (75.1%) were female. One hundred and forty-seven (35.9%) participants had kidney dysfunction. Identified risk factors for kidney dysfunction were hypertension (72.7%), diabetes mellitus (18.0%), alcohol intake (13.2%), tobacco smoking (2%), analgesic use (82.7%), use of herbal preparations (81.7%), proteinuria (6.1%), overweight (27.8%), generalized obesity (28.5%), and central obesity (33.9%). Significant factors associated with kidney dysfunction were older age (p=<0.001), lower level of education (p=<0.001), and being hypertensive (p=0.019). On binary logistic regression, older age (AOR: 9.14; CI: 3.68-22.7; p=<0.001) was the only significant factor associated with kidney dysfunction., Conclusion: The prevalence of kidney dysfunction and that of associated risk factors were relatively high in the screened population. Regular assessment of kidney function should be done in those with higher risk of kidney dysfunction, especially older patients with hypertension., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Hypertension is a leading cause of mortality globally and one of the most common risk factors for cardiovascular disease. Diagnosis, awareness, and optimal treatment rates are suboptimal, especially in low- and middle-income countries, with attendant high health consequences and grave socioeconomic impact. There is an enormous gap between disease burden and physician-patient ratios that needs to be bridged. Task sharing and task shifting (TSTS) provide a viable temporary solution. However, sociocultural, demographic, and economic factors influence the effective uptake of such interventions. This review discusses the dynamics of TSTS in the African context looking at challenges, feasibility, and approach to adopt it in the management of hypertension in Africa., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Objective: Nigeria experienced many waves of the COVID-19 pandemic. This study compared the clinical presentations and mortality among hospitalized patients during the first and second waves of the pandemic in Lagos State, Nigeria., Methods: A retrospective cohort study was conducted. Deidentified medical records of laboratory-confirmed COVID-19 patients admitted into 15 isolation centers in Lagos, Nigeria between February 27, 2020, and September 30, 2020 (first wave) and October 1, 2020, and April 30, 2021 (second wave) were reviewed. IBM Statistics version 25 was used for data analysis., Results: More patients were hospitalized during the first wave of the pandemic. The mean age of patients was higher during the second wave (54.5±15.8 years vs. 42.2±15.5 years, p <0.001). More patients admitted during the second wave had comorbidities (56.0% vs 28.6%, p <0.001), were symptomatic (90.8% vs 52.0%, p <0.001), had severe COVID-19 disease (58.9% vs 25%, p <0.001) and died (14.9% vs 6.4%, p<0.001) compared with the first wave. The odds of death increased with age and severity of COVID-19 disease during the first and second waves., Conclusion: A higher proportion of the patients admitted in Lagos, Nigeria during the second wave were older, had comorbidities, and had severe COVID-19 disease than the first wave. Despite the fewer hospitalized patients, there were more deaths during the second wave., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2024 by West African Journal of Medicine.)

Purpose: Tuberculosis (TB) has far-reaching effects on the social, mental, and emotional well-being of patients and consequently, their health-related quality of life (HRQOL). Few studies in Nigeria have examined changes in quality of life over the course of treatment. changes in (PTB) and factors associated with HRQOL., Methods: A prospective cohort study was conducted with patients recruited from health facilities in Lagos State. The World Health Organization Quality of Life Instrument, Short-Form (WHOQOL-BREF) was used to assess HRQOL. A semi-structured questionnaire was also administered to elicit information on socio-demographic characteristics and the medical and social history of the respondents. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23. A repeated measures analysis of variance (ANOVA) test with polynomial contrasts was used to assess how domain scores varied over time. Multivariable analysis was conducted using generalized estimating equations (GEE) to assess change in HRQOL and its predictors., Results: Two hundred and ten patients, predominantly male [108 (63.3%)] were recruited. The mean age was 36.7 ± 12.3 years. The HRQOL was impaired in all four domains at baseline. However, HRQOL scores increased over the treatment period with the largest improvement being in the 'environment' domain, where mean scores increased from 45.27 ± 14.59 to 61.28 ± 15.86. The proportion of respondents that expressed satisfaction with their health increased from 13.5% at baseline to 55.7% at the end of treatment. Low socio-economic status, delay in presentation, and an HIV-positive status were found to be significantly associated with reduced HRQOL at baseline (p < 0.05). In the multivariable longitudinal analysis, patients who were employed had higher HRQOL scores while persistent symptoms and a delay in presentation (≥ 4 weeks) were negatively associated with change in HRQOL scores over the course of treatment., Conclusion: The HRQOL of respondents progressively improved over the six-month treatment period. However, change in HRQOL was influenced by a delay in presentation and persistence of symptoms. The study also highlights the need for increased recognition of patient-reported outcomes as an adjunct outcome measure., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Pregnancy-related acute kidney injury (PRAKI) is a common cause of AKI globally. The incidence and burden of PRAKI are still high in low and middle-income countries (LMICs) especially in Africa due to limited access to optimal obstetric care, late diagnosis, and referral. The study aimed to determine the incidence and aetiologies of PRAKI among women in the peripartum period in two government hospitals in Nigeria., Methodology: This was a prospective study where serum creatinine was measured among pregnant women presenting in labour at 0-hour, 6 hour, 12 hour, 24 hour, 48 hour and 7 days post-delivery. AKI was defined using the Kidney Disease Improving Global Outcome criteria. Binary logistic regression was used to determine predictors of PRAKI., Results: The mean age of the 162 pregnant women who completed the study was 30.05±1.28 years. The incidence of AKI use was 22.2%. The aetiologies of PRAKI were obstetric haemorrhage (66.7%), eclampsia (19.4%), and sepsis (13.9%). Seventeen (47.2%) patients had Stage 1 PRAKI, 12 (33.3%) had Stage 2 PRAKI, while seven (19.4%) had Stage 3 PRAKI. Factors significantly associated with PRAKI were parity (p=<0.001), caesarean section (p=<0.001), excess blood loss (p=<0.001), and prolonged duration of labour (p=0.002)., Conclusion: PRAKI occurred in 1 out 5 pregnant women in the peripartum period. Obstetric haemorrhage, sepsis, and eclampsia which are preventable or treatable are common major aetiologies of PRAKI. PRAKI is more associated with multi-parity, caesarean delivery, haemorrhage, and prolonged duration of labour. Optimal ante-natal care, health education, and prompt diagnosis and management of obstetric complications will reduce the incidence in Nigeria., (Copyright © 2023 Nigerian Medical Association.)

Objective: Poor sleep quality adversely affects the overall well-being and outcomes of patients with chronic kidney disease (CKD). However, it has not been well studied in Africans with CKD. We determined the prevalence of poor sleep quality and associated factors among patients with CKD., Design: This was a cross-sectional study that involved patients with CKD ., Settings: The study was carried out in the outpatient clinic of nine hospitals in Nigeria., Methods: Sleep quality, depressive and anxiety symptoms and quality of life (QoL) were assessed among 307 patients with CKD using Pittsburgh Sleep Quality Index Questionnaire, Hospital Anxiety Depression Scale Questionnaire and 12-item Short Form Health Survey Quality of Life Questionnaire, respectively. The prevalence of poor sleep quality and associated factors were determined. A p<0.05 was considered as statistically significant., Results: The mean age of the study participants was 51.40±15.17 years. The male:female ratio was 1.5:1 One hundred and twenty-one (39.4%) of the patients were on maintenance haemodialysis (MHD). The prevalence of poor sleep quality, anxiety symptoms and depressive symptoms among the patients was 50.2%, 37.8% and 17.6%, respectively. The prevalence of poor sleep quality in the CKD stages 3, 4, 5 and 5D was 38.1%, 42.6%, 52.2% and 58.7%, respectively. The prevalence of poor sleep quality was significantly higher in MHD patients compared with predialysis CKD (59.5% vs 43.6%; p=0.008). Factors associated with poor sleep quality were CKD stage (p=0.035), anaemia (p=0.003), pruritus (p=0.045), anxiety symptoms (p≤0.001), depressive symptoms (p≤0.001) and reduced QoL (p≤0.001). On multivariate analysis, factors associated with poor sleep were anxiety (AOR 2.19; 95% CI 1.27 to 3.79; p=0.005), anaemia (AOR 5.49; 95% CI 1.43 to 21.00;p=0.013) and reduced physical component of QoL (AOR 4.11; 95% CI 1.61 to 10.47; p=0.003)., Conclusion: Poor sleep quality is common among patients with CKD especially in the advanced stage. The significant factors associated with poor sleep quality were QoL, anaemia and anxiety symptoms. These factors should be adequately managed to improve the overall outcomes of patients with CKD., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Care cascades represent the proportion of people reaching milestones in care for a disease and are widely used to track progress towards global targets for HIV and other diseases. Despite recent progress in estimating care cascades for tuberculosis (TB) disease, they have not been routinely applied at national and subnational levels, representing a lost opportunity for public health impact. As researchers who have estimated TB care cascades in high-incidence countries (India, Madagascar, Nigeria, Peru, South Africa, and Zambia), we describe the utility of care cascades and identify measurement challenges, including the lack of population-based disease burden data and electronic data capture, the under-reporting of people with TB navigating fragmented and privatised health systems, the heterogeneity of TB tests, and the lack of post-treatment follow-up. We outline an agenda for rectifying these gaps and argue that improving care cascade measurement is crucial to enhancing people-centred care and achieving the End TB goals., Competing Interests: Declaration of interests MP serves on the Scientific Advisory Committee of the Foundation of Innovative New Diagnostics (FIND), a non-profit global alliance for diagnostics. MP is also an adviser to the Bill & Melinda Gates Foundation. He has no financial or industry conflicts. CU-G has received research support from the International Development Research Centre (Canada) and the Canadian Institutes of Health Research, the National Institutes of Health, FIND, and Abbott for projects unrelated to this work. CU-G has also received honoraria from Molbio for presentations unrelated to this work. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Stroke is a common neurologic disease associated with fatal outcomes. Kidney dysfunction may be an important predictor of stroke severity and outcome., Aim: To determine the relationship between kidney dysfunction at admission and stroke severity and 30-day outcome., Materials and Methods: This was a prospective study that involved 150 stroke patients. Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS). Renal dysfunction was assessed by the presence of albuminuria and or reduced glomerular filtration rate (GFR) at admission. Neurological outcome was assessed using mortality, modified Rankin Scale (mRS), and Glasgow Outcome Scale (GCS)., Results: The mean age of the study participants was 61.0 ± 13.2 years. Renal dysfunction was present in 66% of the participants while the case fatality rate of stroke was 26%. Poor neurological outcome at 30 days was found in 44.1% of survivors. Those with albuminuria had lower GCS (P = 0.041), lower GFR (P = 0.004), higher mRS score on day 14 (P = 0.041) and day 30 (P = 0.032), and higher NIHSS score (P = 0.034). Independent predictors of 30-day mortality were albuminuria (Adjusted Odd Ratio (AOR) 3.60, 95%CI: 1.07-12.17) and increasing NIHSS score (AOR = 1.15, 95%CI: 1.04-1.28). Lower GCS (P < 0.001), elevated white blood cells (P = 0.003), serum creatinine (P = 0.048), and NIHSS score (P < 0.001) were associated with poor neurological outcome. NIHSS score was the only significant predictor of neurologic outcome (AOR: 1.25; CI: 1.11-1.41; P ≤ 0.001)., Conclusions: Kidney dysfunction was associated with stroke severity and mortality. However, it was not an independent predictor of neurological outcome., (Copyright © 2023 Copyright: © 2023 Nigerian Journal of Clinical Practice.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Adejumo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Adejumo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: COVID-19 pandemic has resulted in disruptions in delivery of Tuberculosis services especially, in resource-limited settings. Provisional data by the WHO from 84 countries indicates that about 1.4 million fewer people received care for tuberculosis in 2020 than in 2019. This study assessed the effect of COVID-19 pandemic on tuberculosis case notification rates in Ogun state, Nigeria., Methods: A retrospective review of presumptive TB and diagnosed TB cases that were notified in 2019 and 2020. Analysis was done using Epi-info version 7.2.3.1. Level of statistical significance was p < 0.05., Results: A total of 3102 and 3326 confirmed cases were reported in 2019 and 2020 respectively with an increase of 7.2%. There was significant decline in total number of cases notified in Q2, 2020 compared to 2019 (p=0.001) with a significant increase in proportion of TB cases notified by private facilities from 11.65% in 2019 to 20.27% in 2020., Conclusion: Total TB cases notified in Ogun state increased during the covid-19 pandemic. There was significant decline in TB cases during the lockdown but an increase in proportion of TB cases notified by private facilities demonstrating that private facilities can withstand disruptions to TB case notifications due to the Covid-19 pandemic., (© 2023 Daniel OJ et al.)

Introduction: Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, especially those with advanced stage. It worsens frailty, sarcopenia and debility in CKD patients. Despite the importance of PEW, it is not routinely assessed during management of CKD patients in Nigeria. The prevalence of PEW and its associated factors were determined in pre-dialysis CKD patients., Methods: This was a cross-sectional study that involved 250 pre-dialysis CKD patients and 125 age- and sex- matched healthy controls. Body mass index (BMI), subjective global assessment (SGA) scores and serum albumin levels were used in PEW assessment. The factors associated with PEW were identified. P-value of < 0.05 was taken as significant., Results: The mean age of CKD and control group were 52.3±16.0 years and 50.5±16.0 years, respectively. The prevalence of low BMI, hypoalbuminaemia and malnutrition defined by SGA in pre-dialysis CKD patients were 42.4%, 62.0% and 74.8%, respectively. The overall prevalence of PEW among the pre-dialysis CKD patients was 33.3%. On multiple logistic regression, the factors associated with PEW in CKD were being middle aged (adjusted odds ratio: 12.50; confidence interval: 3.42-45.00; p <0.001), depression (adjusted odds ratio: 2.34; confidence interval: 1.02-5.40; p = 0.046) and CKD stage 5 (adjusted odds ratio: 12.83; confidence interval: 3.53-46.60; p <0.001)., Conclusion: PEW is common in pre-dialysis CKD patients and it was associated with middle age, depression and advanced CKD. Early intervention aimed at addressing depression in early stages of CKD may prevent PEW and improve overall outcome in CKD patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Osunbor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: There has been improvement in the overall outcomes of people living with human immunodeficiency virus (PLWHIV) following the advent and use of highly active antiretroviral therapy (HAART). However, there is an increased risk of nephrotoxicity from using HAART in PLWHIV as their life expectancy improves. This study assessed and compared renal dysfunction among PLWHIV on tenofovir-based and non-tenofovir-based HAART., Methodology: This comparative cross-sectional study determined and compared glomerular and tubular dysfunction among PLWHIV on tenofovir-based and non-tenofovir-based HAART. Urine beta2-microglobulin, fractional excretion of bicarbonate, uric acid, and Phosphate were used to assess proximal tubular function. The modification of diet in renal disease (MDRD) formula was used to estimate the glomerular filtration rate (eGFR)., Result: There were 120 participants with a mean age of 42.2 ±9.2 years. Sixty participants were on tenofovir-based HAART, and 60 were on non-tenofovir-based HAART. The overall prevalence of proximal renal tubular dysfunction among PLWHIV on HAART was 9.1%. The proximal renal tubular dysfunction prevalence was higher in the tenofovir-based group (15.0%vs3.3% P= 0.01). The mean urine β 2 MG level was higher in the tenofovir-based HAART group (0.21±0.15ug/ml vs 0.14±0.12ug/ml; P= 0.01). The mean eGFR was lower in the tenofovir-based HAART group (86.99±18.51mls/min/1.73m 2 vs 99.59±34.48mls/min/1.73m 2 ; P=0.01)., Conclusion: Tenofovir-based HAART was associated with a significant decrease in GFR and proximal renal tubular dysfunction compared to non-tenofovir-based HAART. Those on tenofovir should be regularly monitored with markers of tubular dysfunction., (Copyright © 2023 Nigerian Medical Association.)

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., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

Background: The epidemiological transition in developing countries is increasing the burden of non-communicable diseases such as diabetes. We aimed to determine the outcomes of bidirectional screening for TB and diabetes (DM) in resource constrained communities, Lagos, Nigeria., Methods: A quasi-experimental study without control was conducted from March 1-31st, 2017 as part of the series of activities to mark the World TB Day. Community screening took place at multiple locations in multiple days. Participants were registered and screened for Tuberculosis (TB), Diabetes Mellitus (DM) and other comorbid conditions (viral hepatitis and HIV) during open medical outreaches carried out across six resource constrained communities in Lagos, Nigeria. Relevant data were collected and analyzed. Yield of TB among DM patients and vice-versa was analyzed. Associations between MTB detection among those with DM (versus those with no DM) and among those who were HIV positive (compared with those HIV negative) were determined at p ≤0.05., Results: Some (24.7%) of the participants were between the ages 25-34 years. Majority were males (65.8%), Christians (55.7%), Married (73.7%), and 37.8% had secondary education. Many (41.0%) of the participants had 3-4 persons per household, and 1-2 persons per room (44.5%). 109(26%) of individuals screened were presumptive and 18(16.5%) of the 109 presumptive were MTB detected. Also, hyperglycemia (Fasting Blood Sugar, FBS >126 mg/dl or random blood sugar, RBS level >200mg/dl) was diagnosed in 31(5%) of the 620 patients screened. Overall, 1(3.2%) of the 32 patients with DM were diagnosed with TB while 1(5.5%) of the 18 patients with MTB detected were diagnosed with DM and no significant difference in TB or DM detection in either of the groups (p=1.000). The overall yield (in all participants) of HIV in this intervention was 1.27%, DM was 5.0% and HBsAg was 2.1%., Conclusion: This intervention showed that approximately one out of every twenty newly diagnosed TB patients in resource constrained communities had DM as a comorbid condition. This finding underlines the need to strengthen bidirectional screening for TB-DM in order to achieve additional gains in tuberculosis case findings in resource constrained and high TB burden countries., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Background: Assessing associated factors of pretreatment attrition and treatment delays among rifampicin-resistant tuberculosis (RR-TB) patients could serve as a valuable tool to control and prevent its community spread. We assessed the factors associated with pretreatment attrition and treatment initiation delays among RR-TB patients in Lagos, Nigeria., Methods: A retrospective cohort study was conducted involving secondary program data of RR-TB patients diagnosed using the Xpert MTB/RIF assay and initiated on treatment between 1 January 2015 and 31 December 2017 in Lagos. Factors associated with pretreatment attrition and treatment initiation delay were determined using logistic regression., Results: Of the 606 RR-TB patients diagnosed during the review period, 135 (22.3%) had pretreatment attrition. Previously treated TB patients had a 2.4-fold greater chance of having pretreatment attrition than new RR-TB patients (adjusted odds ratio 2.4 [95% confidence interval 1.2-5.0]). The median time to treatment initiation was 29 d (interquartile range [IQR] 18-49). It was longer for new RR-TB patients (49 d [IQR 36-59]) than previously treated TB patients (28 d [IQR 17-44]). A total of 47% had long treatment delays. Being newly diagnosed with RR-TB was associated with long treatment delays., Conclusions: The pretreatment attrition rate and proportion of RR-TB patients with treatment delays were high. Pragmatic approaches to address the high pretreatment attrition and treatment delays in Lagos, Nigeria, are urgently needed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Treatment success rate is an important indicator to measure the performance of the National Tuberculosis Program (NTP). There are concerns about the quality of outcome data from private facilities engaged by NTP. Adherence of private providers of tuberculosis care to NTP guideline while assigning treatment outcomes to patients is rarely investigated. We aimed to determine whether Lagos private for-profit (PFP) and private not-for-profit (PNFP) facilities adhere to domestic TB guideline while assigning treatment outcome and the availability of periodic sputum acid-fast bacilli (AFB) results., Method: A retrospective review of facility treatment register and treatment cards of TB patients managed between January and December 2016 across 10 private directly observed treatment short-course (DOTS) facilities involved in the public-private mix (PPM) in Lagos, Nigeria. The study took place between January and June 2019., Results: Of the 1,566 patients, majority (60.7%) were male, >30 years (50.2%), HIV-negative (88.4%), and attended PNFP (78.5%). The reported treatment success rate (TSR) was 84.2% while the actual TSR was 53.8%. In total, 91.1, 77.6, and 70.3% of patients had sputum acid-fast bacilli (AFB) at 2/3, month 5, and month 6, respectively, while 68.6% had all the three sputum AFB in the register. Healthcare workers (HCWs) were adherent in assigning treatment outcome for 65.6% of TB patients while 34.4% of patients were assigned incorrect treatment outcomes. Most variations between reported and actual treatment outcomes were found with cured (17%) and completed (13.4%). Successful and unsuccessful outcomes were overreported by 30.4% and 4.1%, respectively. DOTS providers in private facilities with available TB guideline (OR 8.33, CI 3.56-19.49, p < 0.0001) and PNFP facility (OR 4.42, CI 1.91-10.3, p = 0.001) were more likely to adhere to National TB Guideline while assigning TB treatment outcome., Conclusion: Frontline TB providers in Lagos private hospitals struggled with assigning correct treatment outcome for TB patients based on NTBLCP guideline. Increased access to all the periodic follow-up AFB tests for TB patients on treatment and availability of National TB Guideline for referencing could potentially improve the adherence of private TB service providers while assigning TB treatment outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Adepoju, Adejumo, Adepoju, Adeniyi, Etuk, Nzekwe, Inegbeboh, Adelekan and Oladimeji.)