ADEMOLA EMMANUEL FAWIBE
@unilorin.edu.ng
Professor, Faculty of Clinical Sciences
university of ilorin
RESEARCH, TEACHING, or OTHER INTERESTS
Pulmonary and Respiratory Medicine, Internal Medicine
Scopus Publications
Scopus Publications
OB Ojuawo, OO Desalu, AO Aladesanmi, CM Opeyemi, AT Azeez, AE Fawibe, and AK Salami
Medknow
Background: Respiratory diseases constitute a significant cause of morbidity globally. There is limited information on the epidemiology of respiratory diseases in North Central Nigeria particularly with the changing trend in risk factors. Aim: This study aimed at evaluating the pattern and morbidity related to respiratory diseases among adult outpatients attending a chest clinic in a tertiary healthcare facility, especially with increasing environmental pollution and biomass exposure globally. Patients And Methods: This was a retrospective review of the case records of 338 newly referred patients seen in the chest clinic of the University of Ilorin Teaching Hospital (UITH) with respiratory illnesses over a 2-year period (January 2017–December 2018). Results: The mean age of the recruited patients was 47.6 ± 19.8 years with a male to female ratio of 1.1:1. Microbiologically confirmed tuberculosis (30.2%), chronic obstructive pulmonary disease (COPD) (24.3%), and bronchial asthma (17.8%) were the commonest conditions managed in the clinic. Overall, noncommunicable respiratory diseases (61.2%) constituted a larger proportion of cases when compared to infective respiratory conditions. Almost 90% of the patients were never smokers. Systemic hypertension (15.1%) and human immunodeficiency virus infection (3.6%) were the commonest comorbid illnesses. Conclusion: Although tuberculosis constituted the most observed single condition, noncommunicable respiratory diseases predominated cumulatively among the new cases seen in the chest clinic of UITH, Ilorin. This raises the need for significant attention in terms of prevention and management of noncommunicable respiratory diseases, which appear to be on the uprising.
Olufemi O Desalu, Olutobi B Ojuawo, Adeniyi Aladesanmi, Adekunle Adeoti, Christopher M Opeyemi, Taofeek Oloyede, Oluwafemi J Afolayan, and Ademola Fawibe
Informa UK Limited
Purpose The burdens of chronic cough are mostly reported from Western and Asian countries. We aimed to determine the etiology and clinical patterns of chronic cough (CC) in the chest clinic of a tertiary hospital in Nigeria. Patients and Methods This survey was a cross-sectional study of 218 patients. Chronic cough was defined as cough >8 weeks duration. The evaluation and diagnosis of patients was based on a diagnostic protocol developed from the international respiratory societies cough guidelines and a previous study. Results The median age of patients was 50 years (interquartile range 30–68). One etiology was identified in 96.3% of cases; dual etiologies in 2.3%, and 1.4% had an unexplained cough. The most frequent causes of cough were COPD (33.5%), PTB (27.1%), and asthma (21.1%) which included 3 cases of cough variants of asthma (CVA). Other causes were post-tuberculosis lung disease (bronchiectasis and fibrosis) in 6.9%, lung cancer in 4.7%, and interstitial lung disease (ILD) in 3.2%. Gastroesophageal-related cough (GERC) accounted for <1.0%. Before the age of 45, the chronic cough was more frequent in the females than in the males, and the commonest cause was asthma, whereas, beyond age ≥ 45, the occurrence in males surpasses that of the females, and the commonest cause was COPD. Eighty-six percent reported shortness of breath as the most associated symptom. Systemic hypertension (15.6%) was the most frequent comorbidity, followed by HIV infection (3.7%). Chest radiograph, sputum GeneXpert MTB/RIF for TB, spirometry, and detailed history and trial of treatment, were enough to identify the cause in 72% of cases. Conclusion The etiology and clinical patterns of chronic cough in this study are different from the western countries. When evaluating and managing chronic cough, clinicians in sub-Saharan Africa and TB endemic countries should consider these geographical variations in etiologies and clinical presentation.
Olufemi O Desalu, Adekunle O Adeoti, Olutobi B Ojuawo, Adeniyi O Aladesanmi, Micheal S Oguntoye, Oluwafemi J Afolayan, Matthew O Bojuwoye, and Ademola E Fawibe
Informa UK Limited
Purpose Urbanization is associated with the risk of developing allergic conditions. Few studies have evaluated the urban–rural disparity of allergic diseases in sub-Saharan Africa. Objective To compare the epidemiology of adult asthma and allergies in urban and rural Nigeria. Subjects and Methods A population-based cross-sectional study was performed among 910 subjects in Kwara State, North Central Nigeria, comprising 635 urban and 275 rural adults who were randomly selected. We used standardized questionnaires for data collection. Results The age-adjusted prevalence of adults reporting a previous “asthma attack” or “currently taking asthma medication” within the preceding 12 months (ECRHS asthma definition) was 3.4% urban, 0.5% rural, current allergic rhinoconjunctivitis (26.2% urban, 22.2% rural), and current skin allergy (13.9% urban, 10.5% rural). The age-adjusted prevalence of “physician-diagnosed allergic conditions”: asthma (3.3% urban, 1.5% rural), allergic rhinoconjunctivitis (4.9% urban, 3.2% rural), and skin allergy (4.8% urban, 4.6% rural) were higher in urban areas than in rural areas. Urban areas recorded a higher age-adjusted 12 months prevalence of wheezing, night waking by breathlessness, night waking by chest tightness, asthma attack (p=0.042), and current use of asthma medication (p=0.031) than the rural areas. In the urban areas, 81% of those with asthma significantly had current allergic rhinoconjunctivitis, and 40.5% had current skin allergy, whereas in the rural areas, all subjects with asthma had current allergic rhinoconjunctivitis and 12.5% had current skin allergy (p=0.482). The most common trigger for asthma attack/respiratory symptoms among the urban household was exposure to environmental smoke (17.2%), and among the rural household, it was dust exposure (18.2%). Living in urban areas significantly increased the odds of having asthma [aOR: 5.6 (95% CI:1.6–19.6)] and allergic rhinoconjunctivitis [aOR: 1.7 (95% CI: 1.2–2.4)]. Conclusion This study shows that urban residents frequently reported more allergic and respiratory symptoms and were at risk of having asthma and allergic rhinitis compared to rural residents. The findings would assist the physicians in understanding the urban–rural differences in the occurrence of allergic conditions, symptom triggers, and comorbidity, which are relevant in patient’s clinical evaluation, treatment, and disease prevention.
A. Aladesanmi, O. Ojuawo, Olutosin Olukemi Aladesanmi, A. Fawibe, O. Desalu, A. Ojuawo, C. Opeyemi, M. Adio, Victoria Oluwaloniola and A. Salami
Introduction Latent Tuberculosis Infection (LTBI) screening is recommended for individuals with a known risk factor for progression to active disease especially in the setting of HIV infection. This will ensure early diagnosis and prompt treatment. The purpose of our study was to compare tuberculin skin test (TST) with Interferon Gamma Release Assay (IGRA) in the diagnosis of LTBI among patients with known HIV infection at University of Ilorin Teaching Hospital (UITH), Ilorin. Methods this was a hospital based cross-sectional study at the Highly Active Antiretroviral therapy (HAART) Clinic and medical wards of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 282 consenting patients with HIV infection were recruited. Sociodemographic and clinical information was obtained using a well-structured questionnaire. The screening for LTBI was done using Tuberculin skin test (TST) and Interferon Gamma release assay (IGRA). Results the prevalence of LTBI among HIV infected patients was 40.6% and 53.1% using TST and QFT-IT respectively, while the overall prevalence considering positivity to either of the test was 66%. There was mild agreement (κ: 0.218) between TST and QFT-IT in the diagnosis of LTBI among patients with HIV infection. The association between CD4 count and TST was not statistically significant (p value = 0.388) but there was strong association between CD4 cell count and QFT results (p = 0.001). Conclusion the prevalence of LTBI is quite high among patients with HIV infection in our locality. There is a need to encourage screening of at-risk individuals to forestall the morbidity and mortality associated with TB in this population.
Olutobi Babatope Ojuawo, Olufemi Olumuyiwa Desalu, Ademola Emmanuel Fawibe, Ayotade Boluwatife Ojuawo, Adeniyi Olatunji Aladesanmi, Christopher Muyiwa Opeyemi, Mosunmoluwa Obafemi Adio, Abdulraheem Olayemi Jimoh, Dele Ohinoyi Amadu, Abayomi Fadeyi,et al.
African Journals Online (AJOL)
Background: The optimal management of community acquired pneumonia (CAP) depends on the clinical and microbio- logical profile in the locality.
 Objectives: To determine the clinical and microbiological profile of patients admitted with CAP in Ilorin, Nigeria.
 Methods: One hundred and two consenting consecutively selected patients with clinical and radiologic confirmation of CAP were recruited in 12 months. The socio-demographic, physical examination and laboratory/radiologic parameters were documented in a questionnaire. Microbiological evaluation of their sputum was done and blood samples were taken for complete blood count, culture, serum urea and serological evaluation for atypical bacteria and some viral pathogens.
 Results: CAP constituted 5.9% of the total medical admissions during the one-year study period. The mean age of the pa- tients was 49 ± 22 years with the largest frequency in those aged 65 years and above. The commonest symptoms were short- ness of breath (96.1%) and cough (94.1%), with a median duration of 3 days from symptom onset to admission. Systemic hypertension was the commonest comorbid illness (25/102; 24.5%). Klebsiella pneumoniae was the predominant pathogen iso- lated (20/102; 28.1%). The susceptible antibiotics were Imipenem, Ceftazidime and Ceftriaxone. Intra-hospital mortality was 17.6%. CURB – 65 score of ≥ 2 and the presence of complications of CAP were the independent predictors of mortality.
 Conclusion: CAP constitutes a significant disease burden in Ilorin, Nigeria. Typical bacteria accounted for over half of the pathogens isolated from the patients with gram negative agents predominating. This highlights a possible shift in the micro- biological profile which could guide empirical treatment.
 Keywords: Community acquired pneumonia; microbiological profile; Nigeria.
OlutobiBabatope Ojuawo, AdemolaEmmanuel Fawibe, OlufemiOlumuyiwa Desalu, AyotadeBoluwatife Ojuawo, AdeniyiOlatunji Aladesanmi, ChristopherMuyiwa Opeyemi, MosunmoluwaObafemi Adio, and AlakijaKazeem Salami
Medknow
Background: Pulmonary tuberculosis (PTB) contributes significantly to morbidity and mortality worldwide, and despite microbiological cure for the disease, many patients still demonstrate residual respiratory symptoms and spirometric abnormalities. Aim and Objectives: The study aimed at identifying the prevalence, pattern and factors associated with spirometric abnormalities in patients successfully treated for PTB in Ilorin, Nigeria. Materials and Methods: This was a hospital-based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. A total of 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding 3 years had assessment of residual pulmonary symptoms, spirometry and plain chest radiograph. Results: The prevalence of abnormal spirometry following treatment for PTB was 72.1% (confidence interval: 0.6682–0.7695), with restrictive pattern being the predominant abnormality (42.2%). Over half of the patients (56.5%) had at least one residual respiratory symptom. The significant predictors of abnormal spirometry were PTB retreatment (adjusted odds ratio [aOR] = 6.918; P = 0.012), increasing modified Medical Research Council dyspnoea scores (aOR = 7.935; P = 0.008) and increasing radiologic scores (aOR = 4.679; P ≤ 0.001) after treatment. Conclusion: There is significant residual lung function impairment in majority of the individuals successfully treated for PTB in Ilorin. This highlights the need for spirometric assessment and follow-up after treatment.
Davies Adeloye, Asa Auta, Ademola Fawibe, Muktar Gadanya, Nnenna Ezeigwe, Rex G. Mpazanje, Mary T. Dewan, Chiamaka Omoyele, Wondimagegnehu Alemu, Michael O. Harhay,et al.
Springer Science and Business Media LLC
Abstract Background National smoking cessation strategies in Nigeria are hindered by lack of up-to-date epidemiologic data. We aimed to estimate prevalence of tobacco smoking in Nigeria to guide relevant interventions. Methods We conducted systematic search of publicly available evidence from 1990 through 2018. A random-effects meta-analysis and meta-regression epidemiologic model were employed to determine prevalence and number of smokers in Nigeria in 1995 and 2015. Results Across 64 studies (n = 54,755), the pooled crude prevalence of current smokers in Nigeria was 10.4% (9.0–11.7) and 17.7% (15.2–20.2) for ever smokers. This was higher among men compared to women in both groups. There was considerable variation across geopolitical zones, ranging from 5.4% (North-west) to 32.1% (North-east) for current smokers, and 10.5% (South-east) to 43.6% (North-east) for ever smokers. Urban and rural dwellers had relatively similar rates of current smokers (10.7 and 9.1%), and ever smokers (18.1 and 17.0%). Estimated median age at initiation of smoking was 16.8 years (IQR: 13.5–18.0). From 1995 to 2015, we estimated an increase in number of current smokers from 8 to 11 million (or a decline from 13 to 10.6% of the population). The pooled mean cigarettes consumption per person per day was 10.1 (6.1–14.2), accounting for 110 million cigarettes per day and over 40 billion cigarettes consumed in Nigeria in 2015. Conclusions While the prevalence of smokers may be declining in Nigeria, one out of ten Nigerians still smokes daily. There is need for comprehensive measures and strict anti-tobacco laws targeting tobacco production and marketing.
O. Ojuawo, A. Aladesanmi, C. Opeyemi, O. Desalu, A. Fawibe and A. Salami
Background: The most recognized risk factor for chronic obstructive pulmonary disease (COPD) worldwide is cigarette smoking. However, recent surveys have revealed an increasing trend from nonsmoking causes especially from biomass exposure. This study, therefore, aimed to determine the proportion of patients and the clinical pattern of COPD among never-smokers in Ilorin. Subjects and Methods: This is a retrospective study in which case records of patients with clinical diagnosis of COPD from January 2013 to December 2017 were reviewed. Data were collected with respect to their sociodemographic characteristics, clinical details, comorbid illnesses, and severity of the disease. Results: A total of 135 case records of patients with COPD were reviewed, of which 66 had spirometric confirmation of the disease. In all, 38 (57.6%) of them were never-smokers with a male-to-female ratio of 1:1.1. The mean age of the subjects was 64.5 ± 11.7 years. Cough and exertional dyspnea were the most common symptoms (89.5% each), and systemic hypertension was the most common comorbid illness. Firewood exposure constituted the most common nonsmoking risk factor (47.4%), and the majority of the patients had mild COPD. When compared with ever-smokers, the mean post bronchodilator lung function parameters were found to be significantly better in never-smokers. Conclusion: Over half of COPD cases in Ilorin were never-smokers with firewood exposure as the main risk factor. This study has further highlighted the need for increased awareness of the hazards of biomass fuel exposure in our setting.
AdeseyeAbiodun Akintunde, Taofeek Oloyede, JamiuA Adeniran, MosesO Tanimowo, EmmanuelAdemola Fawibe, and AlakijaKazeem Salami
Medknow
Background: Local production of garri (cassava crisps) is associated with air pollution and consequently lung function abnormalities among garri processing workers. This study was aimed at describing lung function abnormalities among Nigerians engaged in cassava crisps (garri) processing. Methods: A total of 351 workers and 351 controls were recruited at garri factories in Ogbomoso, Nigeria by multistage random sampling technique. Lung functional abnormalities were defined according to standardised European Respiratory Society/American Thoracic Society guidelines. Data analysis was performed using the IBM SPSS statistics version 22.0. Results: The mean age of patients was similar to that of controls (41.7 ± 14.9 vs. 41.6 ± 14.7 yearsP = 0.960). Larger proportion (46.2%) of cassava crisps factory workers had abnormal ventilatory function parameters compared to 6.8% in controls (P < 0.001). The mean peak expiratory flow among garri factory workers was significantly lower than that of the controls; 268.25 ± 86.20 versus 349.04 ± 97.21 (L/min) (P < 0.001), likewise the mean forced vital capacity (FVC) (litres) and forced expiratory volume (FEV1) (litres) of garri factory workers and controls were significantly lower than those of the controls; 2.55 ± 1.07 versus 2.87 ± 0.79 (P < 0.001) and 2.00 ± 0.76 versus 2.41 ± 0.83 (P < 0.001) with FEV1/FVC ratio of 0.82 ± 0.16 versus 0.87 ± 0.06 (P < 0.001), respectively. The restrictive pattern of ventilatory functional abnormality was predominant among garri factory workers, 92 (26.2%). Sixty-two (17.7%) and 8 (2.3%) of garri factory workers had an obstructive and mixed pattern of ventilatory function abnormalities, respectively. Conclusion: Garri processing workers had significant ventilatory function impairment. Preventive strategies should be encouraged to reduce occupational hazards associated with garri processing in Nigeria.
J. K. Afolabi, A. Fadeyi, O. O. Desalu, I. A. Durotoye, A. E. Fawibe, M. A. N. Adeboye, H. O. Olawumi, A. S. Babatunde, S. K. Ernest, S. A. Aderibigbe,et al.
SAGE Publications
Background: For the establishment and monitoring of the immune status, CD4 count is critical. Objectives: To determine the CD4 count range of apparently healthy Nigerians resident in Ilorin and compare with the national value. Methods: An automated blood analyzer was used to determine the full blood count and CD4 count. The percentage of CD4 count was derived by using other variables. Results: Of the 1205 participants, the reference CD4 count (percentage of CD4) range for adult was 400 to 1288 cells/mm3 (19%-48%) and for children was 582 to 3652 cells/mm3 (17%-50%). CD4 count and percentage of CD4 were significantly ( P = .001) higher in females than in males, and the CD4 count declined significantly with increasing age ( r = −.174, P ≤ .0001). The percentage of CD4 count shows less variation with age ( r = −.051, P = .076). Adult residents of Ilorin had significantly lower absolute mean CD4 count (808 ± 260) than that of the national reference values of 847.0 ± 307.0 cells/mm3 ( P = .001). Conclusion: We therefore advocate the use of CD4 count range derived in this study is lower than that of the national reference values.
Ademola Emmanuel Fawibe, Louis O. Odeigah, and Mohammed J. Saka
Springer Science and Business Media LLC
O. O. Desalu, A. E. Fawibe, E. O. Sanya, O. B. Ojuawo, A. O. Aladesanmi, and A. K. Salami
International Union Against Tuberculosis and Lung Disease
SETTING
Ilorin metropolis in the middle-belt region of Nigeria.
OBJECTIVES
To determine the awareness about warning signs and risk factors for lung cancer and the anticipated delay before seeking medical care in the middle-belt population of Nigeria.
DESIGN
This was a cross-sectional study performed among 1125 adults. Lung cancer awareness measure (Lung CAM) was administered face to face by trained interviewers.
RESULTS
The respondents' Lung CAM score was low for warning signs and risk factors for lung cancer. Apart from tobacco smoking (69.9%) and air pollution (56.4%), other risk factors were poorly recognised by respondents. Higher education and income and having a relative or friends who had previously had lung cancer were significantly associated with awareness about warning signs and risk factors. The majority (66.8%) would seek help before 2 weeks if they noticed a warning sign. Anticipated delay was associated with non-recognition of any warning sign (OR 3.09, 95%CI 2.26-4.22), lower education (OR 1.90, 95%CI 1.40-2.57), lower income (OR 1.86, 95%CI 1.26-2.75) and males (OR 1.50, 95%CI 1.15-1.97).
CONCLUSION
The awareness of lung cancer warning signs and risk factors are not satisfactory in Nigeria. There is a need to increase awareness about the condition to prevent delays in seeking medical help.
Olufemi Olumuyiwa Desalu, Cajetan Chigozie Onyedum, Adekunle Olatayo Adeoti, Obianuju Beatrice Ozoh, Joseph Olusesan Fadare, Fatai Kayode Salawu, Ali Danduram, Ademola Emanuel Fawibe, and Olufemi Olanisun Adewole
Pan African Medical Journal
Introduction The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception and treatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians and patients in Nigeria, with the goal of identifying barriers to optimal management. Methods To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians. Results Majority (66.7%) of the patients reported their asthma as moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to educational issues (31.4% vs.18.7%) and its contents: individual management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0%) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines. Conclusion This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria.
Olufemi Olumuyiwa Desalu, Cajetan C Onyedum, Adekunle O Adeoti, Laguhyel B Gundiri, Joseph O Fadare, Kehinde A Adekeye, Kelechi D Onyeri, and Ademola E Fawibe
Springer Science and Business Media LLC
Background: Few data exist on the understanding and adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in resource-limited settings, which are mostly in sub-Saharan Africa. Objectives: To assess physicians' understanding, adherence, and barriers to implementation of GOLD guidelines in Nigeria. Methods: A questionnaire based on the recommendations of the guidelines was self-administered by 156 physicians in departments of internal and family medicine in selected hospitals to assess physician understanding of the GOLD guidelines and barriers to its implementation. The medical records of patients with chronic obstructive pulmonary disease (COPD) were also reviewed to assess adherence to the guideline recommendations. Results: The performance score of all physicians was 22.37±0.39 (range 0–38). Pulmonologists had the highest score (37.00±0.00) while medical officers had the lowest score (19.93±4.98) (F=10.16, df=5, p<0.001). Forty one percent of physicians knew the spirometric criteria for diagnosing COPD and 26.9% could assess the severity. In clinical practice, 32% of patients had brief smoking counselling despite 70% being smokers, 24% had spirometry and 18% had assessment of severity. Almost 60% of patients were on oral aminophylline, 72% were on an inhaled long-acting β2-agonist and corticosteroid combination, 2% had pulmonary rehabilitation and no patients were vaccinated. Self-reported adherence to the COPD guidelines was 23.7%. Lack of familiarity (39.8%) was cited as the most common barrier to adherence to the guidelines. Conclusions: The understanding of GOLD guidelines is satisfactory among Nigerian doctors managing patients with COPD but the level of adherence is poor. Educational interventions are needed to improve the implementation of guideline-based management.
Olufemi O. Desalu, Ademola E. Fawibe, and Alakija K. Salami
Informa UK Limited
Background. According to the Global Initiative for Asthma (GINA) guidelines, the goal of asthma management is to achieve clinical control. Uncontrolled asthma places a significant social and economic burden on patients. Objective. The two aims of this study were to (1) assess the level of asthma control (according to the GINA definition of “control”) among adult patients attending two tertiary care centers in Nigeria and (2) to determine the predictors associated with uncontrolled asthma. Methods. This cross-sectional study was carried out from June 2009 to December 2010. The participants were all 18 years old or older with physician-diagnosed asthma. First, the participants completed an interviewer-administered questionnaire, which included items that collected their socio-demographic information and clinical data. Second, anthropometric indices were measured and spirometry was conducted to determine each participant’s lung function. Finally, the researcher team members assessed each participant’s inhaler device technique. The outcome measures were (1) uncontrolled asthma, (2) partly controlled asthma, and (3) controlled asthma. Results. One hundred and twenty-four asthma patients participated in the study. Of these, 69.3% had uncontrolled asthma, 22.6% had partly controlled asthma, and 8.1% had controlled asthma. Multivariate analysis showed that uncontrolled asthma was strongly associated with asthma severity based on clinical features, the incorrect use of an inhaler device, the use of oral corticosteroids, an abnormal pulmonary function test, the presence of comorbidity, and the lack of adherence to inhaled corticosteroids (ICSs). The results also revealed that increasing age and a lack of tertiary education were weakly associated with asthma control. In this study, gender, marriage, smoking status, occupation, socioeconomic status, income, and the duration of the asthma were not associated with asthma control. Conclusion. A significant proportion of the sampled patients had uncontrolled asthma. To reduce this number, health care providers must reinforce the education of each asthma patient and promote the regular assessment of asthma control at every clinic visit, identify those with poor control, and institute the appropriate therapy needed to achieve clinical control.
AdemolaE Fawibe, CajetanC Onyedum, OlumideM Sogaolu, AO Ajayi, and AJ Fasae
Medknow
BACKGROUND: A wide range of medications are now available for the treatment of asthma and selection of the optimal treatment combination of agents is essential. OBJECTIVES: This study was designed to evaluate a self-reported drug prescribing pattern for asthma among Nigerian doctors in general practice. METHODS: It was a cross-sectional survey conducted among general practitioners in six states of Nigeria. RESULTS: For acute severe asthma, 75.9% of the doctors prescribed intravenous methylxanthines, which was combined with oral or inhaled short-acting β2 agonists (SABA) by 56.3% of them. Systemic steroids were prescribed mainly via the intravenous route by 58.8% of them. Aberrant drugs such as antibiotics, antihistamines, and mucolytics were prescribed by 25.6% of them. For long-term, follow-up treatment of asthma, oral steroids, and oral SABA were commonly prescribed, while inhaled corticosteroids (ICS) and ICS/LABA (long acting beta agonists) were infrequently prescribed. Aberrant drugs such as analgesics, antimalaria, and antihistamines were prescribed by 22.8% of them. About 48% of the doctors had never attended any form of update training on asthma management, whereas, only 16.3% attended update training on asthma within the last year preceding this study. Awareness of international guidelines on asthma treatment was poor among them with only 16.4% being able to mention any correct guideline on asthma management. CONCLUSION: The poor anti-asthma prescribing behavior among these doctors is associated with a low level of participation at update training on asthma management and poor awareness of asthma guidelines. The Nigerian Medical Association and the Nigerian Thoracic Society should urgently address these problems.
AE Fawibe, OF Olaosebikan, PO Oluboyo, KJ Joseph, AK Salami, and OO Desalu
Medknow
BACKGROUND
Despite the benefits of regular follow-up in the long-term care of asthma, no previous study has reported on it among asthma patients in Nigeria.
OBJECTIVE
This survey was designed to evaluate GP-reported follow-up visits among asthma patients in North Central Nigeria.
METHODS
It was a cross-sectional survey conducted among GPs in three North Central states of Nigeria.
RESULTS
Overall, 48.3% of the GPs reported that their patients usually come for follow-up visits. About 63.6%, 40.0%, and 55.3% of the GPs in Kwara, Kogi, and Niger states, respectively, reported that their patients came for follow-up visits in the month prior to this study. Less than two-third of GPs in both private (55.1%) and public (56.8%) hospitals reportedly attended to patients on follow-up visits. About 46.5%, 37.5%, and 52.0% of the GPs who attended to patients <1 week, 1-2 weeks and >2 weeks prior to the study reported that their patients came for follow-up visits. There was significant difference (P = 0.04) in the reported follow-up visits by GPs who attended to ≥10 asthma patients compared to others. None of the nine GPs who reportedly treated ≥ 10 patients in the preceding month of the study attended to any patient on follow-up visits.
CONCLUSION
The GP-reported rates of follow-up visits in patients that are accessing asthma care from GPs practicing in the North Central part of Nigeria are low. Further studies to identify barriers to follow-up visits and how to correct them are therefore recommended.
AE Fawibe and AO Shittu
Medknow
BACKGROUND
Smoking control is urgently needed to prevent the epidemic of tobacco-related diseases and deaths in developing countries. This requires data on smoking, especially among vulnerable groups like students. We have surveyed cigarette smoking among undergraduates of the University of Ilorin, in the North Central region of Nigeria.
MATERIALS AND METHODS
This was a questionnaire-based survey among undergraduates of the University of Ilorin. A total of 1800 students were selected by multistage random sampling.
RESULTS
A total of 1754 students (234 medical and 1520 non-medical students) completed the questionnaires. They were 1148 (65.5%) males and 606 (34.5%) females with a mean age of 21.6 ± 3.1 years. The prevalence rate of current smoking was 5.7% (males 7.7%, females 2.0%) and of ever smoking was 17.1% (males 22.9%, females 6.2%). Smoking was more common in non-medical students. Eighty-three (83.8%) of the smokers had already started smoking by their eighteenth birthday. Fifty-one (51.5%) of them smoked ≤ 5 sticks of cigarettes daily. Most of them were influenced into smoking by peer pressure and commercial advertisements. Sixty-seven (67.6%) of them believed that smoking could never have a negative impact on their health status and quality of life and just 39 (39.4%) smokers were willing to quit.
CONCLUSIONS
Despite the low prevalence rate of smoking in the studied population, a majority of them were not willing to quit because of a low perception of the negative effects of smoking on their health and quality of life. Comprehensive antismoking campaigns were urgently needed to control cigarette smoking among University undergraduates in Nigeria.
OlufemiO Desalu, CajetanC Onyedum, OlufemiO Adewole, AdemolaE Fawibe, and AlakijaK Salami
Medknow
BACKGROUND
Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities.
MATERIALS AND METHODS
We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure, awareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult.
RESULTS
Of the 585 nonsmoking adults that completed the study, 38.8% had regular exposure to SHS; mostly, in public places (24.4%). More men were exposed at public places when compared with women (27.0% vs. 19.5%). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95% confidence interval (CI), 3.08-9.42]; and in men, it was lack of home smoking restriction (PR ratio-6.35; 95% CI, 4.51-8.93). Among men, SHS exposure at any location was associated with lack of secondary school education, residing in slum apartment (house with many households), living with a smoking family member (non-spouse), lack of home smoking restriction, and alcohol intake. Among women, SHS exposure at any location was associated with having a smoking spouse, residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r = +0.45; P = <0.01), lack of secondary school education (r = -0.10; P = 0.04), residing in slum apartment (r = -0.12; P = 0.03) and being a widow/widower (r = +0.24; P < 0.01). Only 17.4% of the employees reported availability of outdoor smoking area at their workplaces.
CONCLUSION
Our results show that prevalence of SHS exposure was the highest in public places. These findings underscore the need for enactment of comprehensive smoke-free legislation and implementation of educational strategies to reduce SHS exposure in homes.