Objectives: The Coronavirus disease 2019 (COVID-19) pandemic is currently ravaging the entire world. Doctors as well as other healthcare workers as front-liners in tackling this disease are at a higher risk of exposure to the virus and its potential consequences. The objectives of this study were to assess the knowledge of doctors on the mode of transmission of the virus, to assess their willingness and readiness to work at the COVID-19 treatment center, to identify factors that affect their willingness to work at the treatment center, and to assess their knowledge on infection prevention and control (IPC) practices. Materials and Methods: All medical doctors who attended the COVID-19 sensitization and preparedness meeting with the management of Federal Medical Centre, Owo, Ondo State Nigeria, were recruited into the study after an informed consent was obtained. Study period spanned from the beginning of April 2020 to middle of June 2020. A structured, pre-tested questionnaire was administered to collect relevant information. Results: A total of 112 doctors that were in attendance had the questionnaires administered to them; however, 106 (94.64%) questionnaires were returned. Out of these, 64.2% had correct knowledge of the mode of transmission of COVID-19. We observed that only 34.9% of doctors were willing to work in the treatment center while 1.9% were indifferent. The perceived lack of adequate training and insufficient personal protective equipment (PPE) for staff were major reasons why some doctors were not willing to work in these centers. Fifty percent of the participants got the correct meaning of donning and doffing and three quarters of them had good knowledge of IPC practice. Conclusion: We found in our study that a substantial number of doctors were unwilling to work in COVID-19 treatment areas due to a number of factors including perceived inadequate PPE and inadequate knowledge. The factors that would influence their willingness to work in COVID-19 treatment center were more training, provision of inducement or extra allowances and life insurance schemes. We recommend that in addition to putting emphasis on training, re-training, and providing appropriate equipment, special inducement allowance, and life insurance for healthcare workers might be helpful to encourage them to work in COVID-19 treatment centers.
Abstract Background : Tuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria. Methods: This was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary, and tertiary healthcare facilities in two TB high burden states. Data were collected using key informant interviews, a semi-structured instrument adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions. Results: The domain score for basic amenities in both states is 48.8%; 47.0% in Anambra and 50.8% in Oyo state with 95% confidence interval [-15.29, 7.56]. In Oyo, only half of the facilities (50%) have access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states is 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (p=0.56). The domain score for availability of staff and TB guidelines is 57.1% for both states with 95% confidence interval [-13.8, 14.4]. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states is 75%; this was higher in Oyo (76.5%) than Anambra state (73.6%) (p=0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing, and gaps with continuing education on TB management. Conclusions : The weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.
Abstract Objective To determine the treatment success rate among TB patients and associated factors in Anambra and Oyo, the two states with the largest burden of tuberculosis in Nigeria. Methods A health facility record review for 2016 was conducted in the two states (Anambra and Oyo). A checklist was used to extract relevant information from the records kept in each of the selected DOTS facilities to determine TB treatment success rates. Treatment success rate was defined as the proportion of new smear‐positive TB cases registered under DOTS in a given year that successfully completed treatment, whether with bacteriologic evidence of success (‘cured’) or without (‘treatment completed’). Treatment success rate was classified into good (≥85%) and poor (<85%) success rates using the 85% national target for TB treatment outcome. Data were analysed using descriptive statistics and chi‐square at P < 0.05. Results There were 1281 TB treatment enrollees in 2016 in Anambra and 3809 in Oyo (total = 4835). An overall treatment success rate of 75.8% was achieved (Anambra‐57.5%; Oyo‐82.0%). The percentage cure rates were 61.5% for Anambra and 85.2% for Oyo. Overall, only 28.6% of the facilities in both states (Anambra‐0.0%; Oyo‐60.0%) had a good treatment success rate. More facilities in Anambra (100.0%) than Oyo (40.0%) had a poor treatment success rate (p < 0.001), as did more private/FBO (100.0%) than public health facilities (60.0%) (p = 0.009). All tertiary facilities had a poor treatment success rate followed by 87.5% of secondary health facilities and 56.5% of primary healthcare facilities ( P = 0.035). Conclusion Treatment success and cure rates in Anambra state were below the 85.0% of the recommended target set by the WHO. Geographical location, and level/tier and type of facility were factors associated with this. Interventions are recommended to address these problems.
Background: Bronchial Asthma is a disease with increasing global significance.Its prevalence is projected to increase to 400 million by the year 2025 as compared to the present estimate of 300 million.Previously asthma was assessed mainly in terms of symptoms and measures of lung functions but more recently these indices have not been able to reflect the true state of the asthmatics.The focus is now shifting to an assessment and treatment approach based on control.Asthma Control Test (ACT) is a validated, simple and inexpensive instrument to assess control among patients with bronchial asthma.However, its relationship with lung function parameters is yet to be demonstrated among Nigerian asthmatic patients.Aim:The study aimed at assessing asthma control using ACT scores and to determine its relationship with lung function parameters among persons with asthma in a university respiratory clinic.Methodology: It was a cross-sectional study.The study included 65 patients with bronchial asthma who underwent routine check-ups in respiratory clinics at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ile-Ife, Nigeria between October 2009 and January 2011.The ACT was administered to assess for asthma control.Lung function test was done using the guidelines of American Thoracic Society (ATS).Results: The mean pre-bronchodilator FEV1 was 1.97 ± 0.87L, mean ACT score was 18.2+4.28,24 (37%) of the study subjects had well-controlled asthma.The ACT scores were weakly correlated with percentage of predicted Forced Expiratory Volume in 1 second, FEV1(r=0.220,p=<0.078) and Peak Expiratory Flow, PEF(r=0.168,p= 0.18).Conclusion: In this study, most of the patients had poor asthma control and lung function parameters correlated poorly with Asthma Control Test (ACT) scores.It is important that the ACT complements other physiological measures of assessing asthma control in our environment.
Background: Gene Xpert mycobacterium tuberculosis (MTB)/Rifampicin (RIF) was introduced for the detection of pulmonary tuberculosis (PTB) at the Federal Medical Centre, Owo, Ondo State, Nigeria in 2015. The study aimed to determine the effect of Gene Xpert MTB/RIF on diagnosis of PTB. Methods: We reviewed Gene Xpert register from January 2015 to January 2017. The agreement of Gene Xpert with acid-fast bacilli was determined using the sensitivity and positive predictive value of the Gene Xpert test. Association was assessed using chi-square test. Binary logistic regression was used to determine the predictors of positive Gene Xpert result. Results: A total of 1246 records were reviewed; the average age was 41 ± 19 years, and nearly half of the patients (48.6%) were female. While 264 (21.2%) were human immuno-deficiency virus (HIV) positive. Smear microscopy was positive in 118 (16.9%); 90 (13.6%) had tuberculosis (TB) detected on Gene Xpert. Those positive for smear microscopy and Gene Xpert were 21 (10.0%). The Gene Xpert detected 90 (8.3%) of the 653 with presumptive TB. The turnaround time for Gene Xpert was 24 hours. When compared to smear microscopy, Gene Xpert showed sensitivity of 45.7% (95% confidence interval [CI]: 31.7–60.1) and specificity of 98.2% (95% CI: 95.1–99.5) in all the cases and sensitivity of 50% (95% CI: 29.8–70.2) and specificity of 100% among HIV positives. Conclusion: Gene Xpert should be preferred to smear microscopy in evaluating HIV positive patients for TB. Nevertheless, clinicians can still rely on results from smear microscopy for clinical decision when Gene Xpert is not available.
Sir, The posterior mediastinum is a space within the thoracic cavity bounded by the posterior pericardium and extending posteriorly to the chest wall and laterally to the costovertebral sulci.[1] A majority of posterior mediastinal masses are neurogenic in origin[2] with schwannomas constituting 75% of benign nerve sheath tumors. We present the case of a large benign posterior mediastinal mass presenting with compressive symptoms in our hospital. A 45-year-old woman presented with a 4-month history of left-sided chest pain, progressively worsening dyspnea and complicated by hoarseness of voice and inability to sweat on the left side of her face. A preemployment plain chest radiograph done 20 years ago was said to have shown a small left-sided opacity, but by then, she was asymptomatic and nothing therapeutic was done. Examination showed a dyspneic woman with a respiratory rate of 36 cycles/min, left-sided ptosis, and miosis. She had tracheal deviation to the right, reduced expansion on the left side, and absent air entry in the left upper and middle lung zones. A chest radiograph revealed a large rounded radiopaque lesion extending across the whole of the upper and middle lung zones, displacing the trachea to the contralateral side. A chest computerized tomographic scan demonstrated that the mass extended from the apex of the left hemithorax to the level of the 7th rib with the erosion of the left first rib, displacement of the heart anteriorly, and compression of the left main bronchus [Figure 1]. Other investigations were all normal.Figure 1: Computed tomography scan showing compressed left main bronchusA diagnosis of large benign left posterior mediastinal tumor with compression of the left recurrent laryngeal nerve and a left Horner's syndrome was made. She had a left posterolateral thoracotomy which revealed a large, well-encapsulated, grayish-yellow, tumor occupying a large portion of the upper and middle left hemithorax. She had a capsulotomy and complete intracapsular excision of the tumor with a near total excision of the capsule, leaving behind the portion adherent to the suprapleural membrane and adventitia of the aortic arch. The tumor dimensions were 20 cm × 15 cm × 10 cm and weighed 2.7 Kg [Figure 2]. She was admitted to the Intensive Care Unit for monitoring for 2 days and was discharged home 8 days later after an uneventful postoperative period. The histology of the lesion turned out to be a benign schwannoma. The pre- and post-surgical chest radiographs are shown in Figure 3.Figure 2: TumorFigure 3: Comparison of pre- and post-operative chest radiographsPosterior mediastinal tumors in adults tend to be benign and asymptomatic and are usually only diagnosed as incidental findings on chest radiographs.[3] Neurogenic tumors are the most common type of posterior mediastinal tumors accounting for 75% of all posterior mediastinal tumors[4] and 20% of all mediastinal tumors. Of neurogenic tumors, 75–85%[5] of them are schwannomas. They typically arise from the base of spinal nerves or thoracic nerves but may also arise from paravertebral sympathetic, vagus, or phrenic nerves. Schwannomas are typically well encapsulated and show cystic degeneration. They are usually asymptomatic and are usually found incidentally,[2] when symptoms do appear in schwannomas; it is as a result of compression on other thoracic structures. These include dyspnea, dysphagia, stridor, superior vena cava syndrome, and features of Horner's syndrome.[6] This lack of early symptoms usually makes the patient present late, when the tumor would have grown to a sufficiently large size to cause compression of adjacent structures. This was typified by our patient who had an incidentally discovered mass 20 years earlier and only presented due to progressively increasing dyspnea, hoarseness of voice, and Horner's syndrome. Imaging modalities are the investigation of choice. A chest X-ray (posteroanterior and lateral views) would typically show a smoothly rounded or oval mass located in the paravertebral sulcus[7] which may be calcified or show erosion of bones in long-standing schwannomas. Overall, there is no pathognomonic feature on X-rays that would suggest a Schwannoma.[7] Computerized tomographic scans of the chest typically show a homogeneous soft-tissue mass with clear preservation of the fat planes. With contrast examination, these masses are typically heterogeneous due to cystic degeneration. The traditional approach to treating large posterior mediastinal tumors is complete excision via a posterolateral thoracotomy.[5] Video-assisted thoracoscopic surgery is ideal for small tumors and those not adherent to vital structures;[5] however, this would not have been appropriate for this patient due to the very large size. Surgical excision usually confers excellent survival and recurrence is uncommon.[5] Posterior mediastinal schwannomas should be considered in any patient with a mediastinal mass, especially one of long-standing duration. Surgical excision is usually warranted and confers cure. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Abstract Background : Tuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria. Methods: This was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary, and tertiary healthcare facilities in two TB high burden states. Data were collected using key informant interviews, a semi-structured instrument adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions. Results: The domain score for basic amenities in both states is 48.8%; 47.0% in Anambra and 50.8% in Oyo state with 95% confidence interval [-15.29, 7.56]. In Oyo, only half of the facilities (50%) have access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states is 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (p=0.56). The domain score for availability of staff and TB guidelines is 57.1% for both states with 95% confidence interval [-13.8, 14.4]. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states is 75%; this was higher in Oyo (76.5%) than Anambra state (73.6%) (p=0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing, and gaps with continuing education on TB management. Conclusions : The weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.
There are unmet needs for respiratory medical care in developing countries. We sought to evaluate the quality and capacity for respiratory care in low- and lower-middle-income countries, using Nigeria as a case study. We obtained details of the respiratory practice of consultants and senior residents (fellows) in respiratory medicine in Nigeria via a semistructured questionnaire administered to physician attendees at the 2013 National Congress of the Nigerian Thoracic Society. Out of 76 society-registered members, 48 attended the congress, 40 completed the questionnaire, and 35 provided complete data (73% adjusted response rate). Respondents provided information on the process and costs of respiratory medicine training and facility, equipment, and supply capacities at the institutions they represented. Approximately 83% reported working at a tertiary level (teaching) hospital; 91% reported capacity for sputum smear analysis for acid alcohol-fast bacilli, 37% for GeneXpert test cartridges, and 20% for BACTEC liquid sputum culture. Only 34% of respondents could perform full spirometry on patients, and none had the capacity for performing a methacholine challenge test or for measuring the diffusion capacity for carbon monoxide. We estimated the proportion of registered respiratory physicians to the national population at 1 per 2.3 million individuals. Thirteen states with an estimated combined population of 57.7 million offer no specialist respiratory services. Barriers to development of this capacity include the high cost of training. We conclude that substantial gaps exist in the capacity and quality of respiratory care in Nigeria, a pattern that probably mirrors most of sub-Saharan Africa and other countries of similar economic status. Health policy makers should address these gaps systematically.
Biomass is a common domestic fuel in sub Saharan Africa but its association with respiratory symptoms, lung function and quality of life among adults is less understood. Using the Burden of Obstructive Lung Diseases (BOLD) study protocol, we assessed the relation of biomass exposure to respiratory symptoms, quality of life and lung function Methods: We sampled a representative population of adults aged 40 years and above. All the respondents had spirometry testing and completed standardized questionnaires including the five-level modified Medical Research Council (mMRC) dyspnoea scale. We defined biomass exposed as those who reported using wood or coal for domestic cooking/heating ever for at least 6 months duration AND current user. We assessed quality of life using the short form 12 questionnaire. We fitted regression models to estimate the effect of biomass. on outcome variables Results: In total, 1145 (63% female) were sampled - 795 biomass exposed and 350 non-biomass exposed. The mean (SD) age of participants was 56.7 (13.1) years. Biomass exposed participants were less likely to be overweight or obese, had less education and were no more likely to be smokers compared with non-biomass exposed respondents. Biomass exposed women were more likely to have cough; 2.89 (95% CI: 1.25-6.72) compared with men. No difference in the occurrence of wheeze, sputum or dyspnoea (mMRC>2) was observed. Women had lower SF-12 physical functioning score -1.73 (95% CI: -3.17 - -0.29) compared with men but there were no differences in their lung function parameters. Conclusion: Use of biomass as domestic fuel is associated with cough and lower quality of life.
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